Antonio Moron
Universidade Federal de São Paulo (UNIFESP), Obstetrícia, Faculty Member
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O crescimento e desenvolvimento fetal representa processo complexo, dependente da interacao de inumeros fatores. Dentre estes destaca-se a transferencia de oxigenio e nutrientes do compartimento materno para o fetal. Este fenomeno esta na... more
O crescimento e desenvolvimento fetal representa processo complexo, dependente da interacao de inumeros fatores. Dentre estes destaca-se a transferencia de oxigenio e nutrientes do compartimento materno para o fetal. Este fenomeno esta na dependencia de ajustes continuos na circulacao utero-placentaria durante a gravidez. A avaliacao clinica da hemodinamica fetal e materna tornou-se possivel nos ultimos anos com o desenvolvimento da tecnologia Doppler. Este metodo nao-invasivo realiza esta avaliacao tanto de maneira qualitativa como quantitativa, e para tanto a literatura apresenta inumeros parametros de normalidade. Este trabalho discute a importância dos estudos do plerfluxometricos na avaliacao do crescimento e do desenvolvimento fetal, particularmente nos casos de crescimento fetal retardado, anomalias fetais e nas intercorrencias clinicas maternas associadas, como hipertensao arterial, diabetes melito e incompatibilidade sanguinea ao fator Rh. Paralelamente, sao apresentados o...
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Research Interests: Inga and Vitrification
The aim of this study was to evaluate feasibility of fetal lateral ventricle (LV) volumetry in fetuses with ventriculomegaly and to compare measurements performed by 3D sonographic method virtual organ computer-aided analysis (VOCAL) with... more
The aim of this study was to evaluate feasibility of fetal lateral ventricle (LV) volumetry in fetuses with ventriculomegaly and to compare measurements performed by 3D sonographic method virtual organ computer-aided analysis (VOCAL) with those obtained by magnetic resonance imaging (MRI). This cross-sectional study evaluated 30 fetuses with atrial width (AW) between 10 and 30 mm, from 20 to 36 gestational weeks. Fifty-nine ventricles were measured by two observers. Sonographic volumetric measurements using VOCAL 30° were performed with an ACCUVIX XQ machine (Medison, Korea) and MRI assessments with a Sonata system using ARGUS software (Siemens, Germany). Agreement between both techniques was assessed by intraclass correlation coefficient (ICC) calculation, and proportionate Bland-Altman plots were constructed. A high degree of reliability was observed between VOCAL and MRI measurements (ICC 0.928, 95%CI [0.876;0.958]). Bland-Altman plots confirmed the high correlation (mean of differences: 1.62 cm(3) and standard deviation: ± 8.41 cm(3)). Three-dimensional volumetry of fetal LVs by VOCAL method has good agreement with fetal MRI in fetuses with ventriculomegaly and may be used as an additional tool in patient counseling and prognosis prediction.
Research Interests: Magnetic Resonance Imaging, Nuclear medicine, Ultrasound, Adolescent, Medicine, and 14 moreHydrocephalus, Pregnancy, Humans, Female, Male, Intraclass Correlation Coefficient, Vocal, Adult, Prognosis, Fetus, Gestational Age, Fetal MRI, Cross Sectional Studies, and Paediatrics and reproductive medicine
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Objectives: The aim was evaluated the preliminary results of an implementation of assessment of risk in a tertiary center hospital in Brazil. Methods: This was a prospective study of 1.555 singleton pregnancies with a live fetus at 10–14... more
Objectives: The aim was evaluated the preliminary results of an implementation of assessment of risk in a tertiary center hospital in Brazil. Methods: This was a prospective study of 1.555 singleton pregnancies with a live fetus at 10–14 weeks of gestation attending for routine antenatal care in a tertiary hospital in Brazil. Fetal crown–rump length (CRL) and NT thickness were measured and the risks for trisomy 21 were calculated by a combination of maternal age and fetal NT according to the software provided by The Fetal Medicine Foundation. Results: The maternal age ranged from 13 to 48 years (median, 30 years, SD +7.6) whereas 15.5% were younger than 20 years (144/931), 32.0% and 7.4% older than 35 years (506/1555) and 40 years old. The body mass index was greater than 30 kg/m2 in 10% of these pregnant women and 61% from 18.5–24.9 kg/m2. Nulliparous and primiparous were found in 48.9% and 29.8% respectively. The distribution of NT measurements revealed that 64.5% and 11.6% of the population had measurements above the 50th and 95th percentile for gestational age with no difference among the six members of the group. The estimated risk was greater than 1 : 300 and 1 : 100 in 57 patients (3.7%) and in 16 patients (1.0%) respectively. Based on the distribution of maternal age, it was expected 2.6 cases of trisomy 21 and approximately the same number of other chromosomal defects. In this population, the invasive procedure was performed in 100 pregnant women and there were three cases of autosomal trisomies, one of trisomy of sex chromosomes, one case of Turner syndrome and two cases of structural chromosomal alterations. Of this population, 85.7% (6/7) had NT > 95th percentile for gestational age and 42.8% (4/7) were younger than 35 years old. Conclusions: The discriminative capacity of nuchal translucency measurement makes it a useful tool in screening for chromosomal abnormalities.
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obtain the values of EV: XI VOCAL method. Using a sequential section, the contour of each gestational embryo was drawn manually in the fifteen different rotation planes to obtain the 3D volume measurement. To evaluate the relation between... more
obtain the values of EV: XI VOCAL method. Using a sequential section, the contour of each gestational embryo was drawn manually in the fifteen different rotation planes to obtain the 3D volume measurement. To evaluate the relation between EV and gestational age (GA), Person’s correlation coefficient (r) was used. The paired Student’s t-test (P) and ANOVA were used to compare the methods. Results: The study showed there was correlation between EV and GA (r = 0.83 for VOCAL 30 degrees, r = 0.83 for XI VOCAL and r = 0.80 for multiplanar). There was a strong correlation between EV measured by the XI VOCAL e multiplanar methods (RICC = 0,941) and XI VOCAL and VOCAL methods (RICC = 0,965). There weren’t difference statistics between EV measured by the VOCAL, XI VOCAL and the multiplanar by the paired Student’s t-test, but ANOVA showed differences between all methods (p < 0.001). Conclusion: We have demonstrated a strong correlation with the age gestational and embryo volume measurements obtained using the XI VOCAL, VOCAL and multiplanar methods in first trimester gestational. The methods were concordant, but there were differences statistics.
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A avaliacao ultra-sonografica das caracteristicas do colo uterino tem sido introduzida na obstetricia moderna e pode fornecer a mais reprodutiva e acurada avaliacao das transformacoes cervicais relacionadas com o mecanismo de parto. A... more
A avaliacao ultra-sonografica das caracteristicas do colo uterino tem sido introduzida na obstetricia moderna e pode fornecer a mais reprodutiva e acurada avaliacao das transformacoes cervicais relacionadas com o mecanismo de parto. A medida do comprimento cervical e a deteccao da formacao do funil sao marcadores sonograficos utilizados na avaliacao do colo durante a gravidez; entretanto, a associacao isolada destes dois criterios nao e medida exclusiva para rastreamento do risco para trabalho de parto prematuro. Para resolver este problema, especula-se a analise de outro marcador morfologico que possa refletir o processo de maturacao cervical. Durante exame da cervice das gestantes utilizando ultra-sonografia transvaginal, foi possivel identificar a area glandular cervical ao redor do canal endocervical e parece que o desaparecimento desta reflete processo de maturacao cervical. Mesmo com bons resultados relatados na literatura sao necessarios estudos mais amplos e multicentricos sobre a relacao entre desaparecimento sobre a area glandular cervical e inicio do trabalho de parto
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Results: The gestation at delivery was later by 3.5 days for the GDM group (P = 0.0005) with no difference in birth weights. The one perinatal mortality was a fetus terminated at 20+6 weeks for trisomy 13. There were fewer caesarean... more
Results: The gestation at delivery was later by 3.5 days for the GDM group (P = 0.0005) with no difference in birth weights. The one perinatal mortality was a fetus terminated at 20+6 weeks for trisomy 13. There were fewer caesarean deliveries in those women with diet controlled GDM than in women taking insulin (34% vs. 48% P = 0.005), fewer instrumental deliveries (9 vs. 22 P = 0.028) and fewer admissions to SCN (1 vs. 16 P < 0.001). There were no differences in birth weight, shoulder dystocia, admissions to NICU or 5 minute Apgar scores ≤ 7. The majority of women in both groups delivered without needing induction of labour (70% and 56%). Conclusions: Our approach in the management of diabetes in pregnancy was associated with good outcomes for a cohort of 390 women managed in our unit over a 2-year period. The majority of women in both groups delivered before the need for induction of labour.
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Premature ossification and closure of the cranial sutures results in the abnormal shape and size of the skull. This can cause compression on cranial nerves and increased pressure on growing brain. In most cases, only one suture is... more
Premature ossification and closure of the cranial sutures results in the abnormal shape and size of the skull. This can cause compression on cranial nerves and increased pressure on growing brain. In most cases, only one suture is affected and the condition is isolated and sporadic. However, in a minority of cases, closure of multiple sutures is possible and associated anomalies are present. The most frequent craniosynostosis is due to closure of the sagittal suture, which is responsible for about half of the cases, resulting in an elongated head (scaphocephaly). The second most frequent type is due to closure of the coronal suture that results in a very flat, recessed forehead (brachycephaly). We report a rare case of craniosynostosis in the sagittal and bilateral lambdoid sutures. Ultrasound examinations were performed in the ACCUVIX XQ (Medison, Seoul, Korea). Antenatal sonographic finding was normal except occipital calcification. Fetus occipital area was calcified and protrudent. Fetal brain MRI was checked and it was not detected any pathology finding. Cesarean section was performed at 37 weeks gestation. 2990g, male was born. He had abnormal scalp shape and small head. Craniosynostosis with sagittal and both lambdoid sutures and small cranial volume was detected in brain 3 dimensional CT. But brain MRI was not any evidence of brain anomaly. So we report our experience with a brief review of literature.
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Page 1. 263 Rev Imagem 2005;27(4):263 268 Fendas fetais labiais e palatinas detectadas pela ultra-sonografia tridimensional / Araujo Júnior E et al. Atualização Fendas fetais labiais e palatinas detectadas pela ultra-sonografia... more
Page 1. 263 Rev Imagem 2005;27(4):263 268 Fendas fetais labiais e palatinas detectadas pela ultra-sonografia tridimensional / Araujo Júnior E et al. Atualização Fendas fetais labiais e palatinas detectadas pela ultra-sonografia tridimensional ...
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To evaluate the first 100 cases of in utero myelomeningocoele (MMC) repair and urological outcomes in a prospective analysis aiming to define possible improvement in bladder function.
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ABSTRACT Doutor -- Escola Paulista de Medicina, Sao Paulo, 1994.
Research Interests: Medicine and Gynecology
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PURPOSE In utero myelomeningocele (MMC) closure is a valid alternative to postnatal repair with unclear benefits to bladder function. We compared the bladder status in patients that underwent fetal MMC surgery and postnatal repair.... more
PURPOSE In utero myelomeningocele (MMC) closure is a valid alternative to postnatal repair with unclear benefits to bladder function. We compared the bladder status in patients that underwent fetal MMC surgery and postnatal repair. MATERIALS AND METHODS We retrospectively reviewed our database: Group 1 consisted of in utero surgery and group 2 consisted of postnatal repair. Group 3 was a subgroup of 2, including patients presenting initially with age below 12 months. We recorded medical history, radiological investigation renal ultrasonography, voiding cystourethrography (VCUG), urodynamic evaluation (UE) and clinical outcome of the bladder pattern after treatment. RESULTS We identified 88 patients in Group 1, 86 in Group 2, and 38 patients in Group 3. The incidence of UTI was higher in the postnatal period (45% versus 20%). Hydronephrosis occurred in 20.7%, 22.6%, and 28.9% in Groups 1, 2 and 3, respectively. VUR was diagnosed in 15% in all groups. Urodynamic data showed a higher prevalence of detrusor overactivity in Group 1, no difference in others urodynamic parameters. The high-risk bladder pattern at initial evaluation occurred in 56%, 50%, and 46% of groups 1, 2 and 3, respectively. There was a trend to decrease the percentages of the high risk bladder pattern and to increase the normal pattern after the treatment in all groups. CONCLUSION In utero repair did not improve urological parameters when compared to patients operated in the postnatal period.