Navegando por Palavras-chave "cesarean section"
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- ItemAcesso aberto (Open Access)Anestesia para tratamento intraparto extraútero (EXIT) em fetos com diagnóstico pré-natal de malformações cervical e oral: relato de casos(Sociedade Brasileira de Anestesiologia, 2012-06-01) Helfer, Daniel Corrêa [UNIFESP]; Clivatti, Jefferson [UNIFESP]; Yamashita, Américo Massafuni [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND AND OBJECTIVES: Fetus prenatally diagnosed with neck tumors, or with any other disease that obstructs the airways, should not be treated conventionally, as the assistant physician has to face two challenges right after the infant's delivery: the limited time to establish the access to the potentially difficult airways and the lack of anesthesia of the neonate in case of instrumentation of the airways. The ex utero intrapartum treatment, i.e., the EXIT procedure consists of maintaining the fetoplacental circulation during the cesarean section, until the airways of the fetus be secured. CASE REPORTS: Female patient, 37 years old, G3P2, 38 weeks pregnant, having polyhydramnios and fetus diagnosed with large cervical masses by prenatal ultrasound. A cesarean section was performed using the EXIT procedure to enable safe access to the infant's airways. After hysterotomy, the fetus was intubated by direct laryngoscopy. The neonate was immediately transferred to another operating room, where cervical tumor resection of the neck tumor and tracheostomy were successfully performed. Female patient, 27 years old, G3P1A1, 32 weeks pregnant, whose fetus was prenatally diagnosed with a large oral tumor. As the tumor obstructed the fetus' airways, a tracheostomy was performed when the fetus underwent EXIT procedure. It was then possible to use direct laryngoscopy for neonate intubation. The fetus underwent tumor resection and was sent to the Neonatal Intensive Care Unit. CONCLUSIONS: Reports describe the successful use of general anesthesia with isoflurane for cesarean delivery followed by the EXIT procedure in fetus diagnosed with tumors obstructing the airways.
- ItemSomente MetadadadosCorrelation between urethral sphincter activity and Valsalva leak point pressure at different bladder distentions: Revisiting the urethral pressure profile(Lippincott Williams & Wilkins, 2005-10-01) Almeida, F. G.; Bruschini, H.; Srougi, M.; Universidade Federal de São Paulo (UNIFESP)Purpose: We determined the correlation between Valsalva leak point pressure (LPP) and the urethral pressure profile (UPP) in urodynamically selected patients with stress urinary incontinence (SUI) as well as the interference of bladder volume on this correlation.Materials and Methods: A total of 450 consecutive women with SUI were clinically evaluated and underwent urodynamic study. Inclusion criteria were urodynamically demonstrable SUI with normal bladder compliance, sensitivity and capacity. Severe pelvic prolapse, detrusor overactivity and a pattern suggestive of obstruction were excluded. Urodynamic study was performed using a 7Fr 4 channel membrane catheter. LPP was determined at mid bladder capacity and UPP was determined at 50 ml, between 200 and 250 ml, and at bladder capacity.Results: A total of 200 women fulfilled the selection criteria, of whom 30, 114 and 56 had a LPP of 60 or less, between 60 and 120, and greater than 120 cm H2O, respectively. Except for age and the number of pads the 3 groups were well matched in clinical and bladder urodynamic parameters. A progressive correlation of LPP with maximum urethral closure pressure was found when UPP was performed at 50 ml (r = 0.305, p < 0.0001), at 250 ml (r = 0.483, p < 0.0001) and at maximum bladder filling (r = 0.561, p < 0.0001). Urethral functional length did not show a correlation with LPP at a bladder distention of 50 ml (r = 0. 117, p = 0. 100) or 200 ml (r = 0. 167, p = 0.019) but there was a minor correlation at bladder capacity (r = 0.234, p = 0.002).Conclusions: There is a significant correlation between maximum urethral closure pressure and LPP. Patients with a LPP of 60 cm H2O or less have a shorter urethral functional length and lower sphincter activity. Patients with SUI have a more remarkable correlation between UPP and Valsalva LPP when UPP is determined after filling the bladder to more than 200 ml.
- ItemAcesso aberto (Open Access)Local management with methotrexate of cesarean scar ectopic pregnancy with live embryo guided by transvaginal ultrasound: A case report(Assoc Medica Brasileira, 2016) Leite, Juliana de Freitas [UNIFESP]; Fraietta, Renato [UNIFESP]; Elito Junior, Julio [UNIFESP]Cesarean scar ectopic pregnancy is a rare type of ectopic pregnancy with high morbidity and mortality. Use of conservative conducts, including medical management with methotrexate, has avoided mutilating surgeries such as hysterectomy and spared the fertility of women. We report the case of a 30-year old patient with a cesarean scar ectopic pregnancy, with a live embryo, who was treated locally with transvaginal ultrasound-guided injection of methotrexate, complemented with various doses of systemic methotrexate.
- ItemSomente MetadadadosProactive management of extreme prematurity: disagreement between obstetricians and neonatologists(Nature Publishing Group, 2012-12-01) Guinsburg, Ruth [UNIFESP]; Branco de Almeida, M. F. [UNIFESP]; Santos Rodrigues Sadeck, L. dos; Marba, S. T. M.; Suppo de Souza Rugolo, L. M.; Luz, J. H.; Andrade Lopes, J. M. de; Martinez, F. E.; Procianoy, R. S.; Brazilian Network Neonatal Res; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Universidade Estadual de Campinas (UNICAMP); Pontificia Univ Catolica Rio Grande do Sul; Fundaco Oswaldo Cruz; Univ Fed Rio Grande do SulObjective: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death.Study Design: Prospective cohort of 484 infants with 23(0/7) to 26(6/7) weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of >= 1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life.Result: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/neonatal clinical conditions.Conclusion: in infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day. Journal of Perinatology (2012) 32, 913-919; doi:10.1038/jp.2012.28; published online 29 March 2012
- ItemAcesso aberto (Open Access)Qualidade da informação sobre cesariana disponível na internet(Universidade Federal de São Paulo (UNIFESP), 2014-08-31) Fioretti, Beatriz Trentini dos Santos [UNIFESP]; Torloni, Maria Regina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: Examine the quality and completeness of information on caesarean section (CS) in Webpages used by laypersons in Portuguese. Methods: This was across-sectional analytical study. The term ?caesarean delivery? and 25 synonyms were entered into the 5 most popular search engines in Brazil (google.com.br; bing.br.com; google.com; br.ask.com e br.search.yahoo.com) using the browser Google Chrome. The first 3 pages of hits were downloaded and assessed for possible inclusion. Freely available Web pages written in Portuguese in a language accessible for lay persons and which presented at least two paragraphs with information on CS were analyzed by two independent investigators using the Discern instrument to assess quality and a content checklist to assess completeness of information on CS. Results: 3900 Webpages were retrieved and 176 fulfilled the selection criteria. The overall average Discern score was 43.6 (+ 8.9 SD), of a maximum score of 75. Overall, 30% of the pages were of very poor or poor quality (total score < 39) and 47% were of regular quality (total score 39-50). Most pages scored low especially in questions related to reliability of the information presented. The most frequently covered topics were indications for CS (80% of Páginas Web), which did not reflect clinical practice, short-term maternal risks (80%) and potential benefits of CS (56%), including maternal and doctor convenience. Less than half of the Páginas Web mentioned perinatal risks and less than one third mentioned longterm maternal risks associated with CS such as uterine rupture (17%) or placenta praevia/accreta (12%) in future pregnancies. Conclusions: The quality and completeness of Web-based resources in Portuguese about CS were poor to regular. Pending improvement of these resources, Brazilian obstetricians should warn their patients about these facts and encourage them to discuss what they have read on the net about CS.
- ItemSomente MetadadadosResuscitative procedures at birth in late preterm infants(Nature Publishing Group, 2007-12-01) Almeida, Maria Fernanda Branco de [UNIFESP]; Guinsburg, Ruth [UNIFESP]; Costa, J. O. da; Anchieta, L. M.; Freire, L. M. S.; Campos, D.; Universidade Federal de São Paulo (UNIFESP); Med Sch Barbacena; Universidade Federal de Minas Gerais (UFMG); Universidade de Brasília (UnB)Objective: Evaluate the need for resuscitative procedures at birth, in late prematures.Study Design: This prospective cohort study enrolled all liveborn infants from 1 to 30 September 2003, with 34 to 41 weeks of gestation without congenital anomalies, born in 35 public hospitals of 20 Brazilian state capitals. Logistic regression analyzed variables associated with the need for bag and mask ventilation.Result: of the 10 774 infants studied, 1054 were late preterms and 485 required resuscitative measures. of the 1054, 338 ( 32%) received only free-flow oxygen, 143 ( 14%) were bag and mask ventilated, 27 ( 3%) were intubated and 10/27 received chest compressions and/or medications. Bag and mask ventilation in late preterms was associated with twin gestation, maternal hypertension, nonvertex presentation, cesarean delivery and lower gestational age.Conclusion: Improving control of maternal hypertension, prolonging gestation for 1 to 2 weeks and restricting operative deliveries could decrease the need of resuscitation of late preterms at birth.