OBJECTIVE:The aim of the present study was to compare the placental weight and birth weight/placental weight ratio for intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins.METHODS:This was a retrospective analysis of placentas from twin pregnancies. Placental weight and the birth weight/placental weight ratio were compared in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins. The association between cord insertion type and placental lesions in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins was also investigated.RESULTS:A total of 105 monochorionic (intrauterine growth restriction=40; non-intrauterine growth restriction=65) and 219 dichorionic (intrauterine growth restriction=57; non-intrauterine growth restriction=162) placentas were analyzed. A significantly lower placental weight was observed in intrauterine growth-restricted monochorionic (p=0.022) and dichorionic (p<0.001) twins compared to non-intrauterine growth-restricted twins. There was no difference in the birth weight/placental weight ratio between the intrauterine growth restriction and non-intrauterine growth restriction groups for either monochorionic (p=0.36) or dichorionic (p=0.68) twins. Placental weight and the birth weight/placental weight ratio were not associated with cord insertion type or with placental lesions.CONCLUSION:Low placental weight, and consequently reduced functional mass, appears to be involved in fetal growth restriction in monochorionic and dichorionic twins. The mechanism by which low placental weight influences the birth weight/placental weight ratio in intrauterine growth-restricted monochorionic and dichorionic twins needs to be determined in larger prospective studies.

OBJECTIVES:To describe the perinatal outcomes of type II and III selective fetal growth restriction (sFGR) in monochorionic-diamniotic (MCDA) twin pregnancies treated with expectant management or laser ablation of placental vessels (LAPV).METHODS:Retrospective analysis of cases of sFGR that received expectant management (type II, n=6; type III, n=22) or LAPV (type II, n=30; type III, n=9). The main outcomes were gestational age at delivery and survival rate.RESULTS:The smaller fetus presented an absent/reversed “a” wave in the ductus venosus (arAWDV) in all LAPV cases, while none of the expectant management cases presented arAWDV. The median gestational age at delivery was within the 32nd week for expectant management (type II and III) and for type II LAPV, and the 30th week for type III LAPV. The rate of at least one twin alive at hospital discharge was 83.3% and 90.9% for expectant management type II and III, respectively, and 90% and 77.8% for LAPV type II and III, respectively.CONCLUSION:LAPV in type II and III sFGR twins with arAWDV in the smaller fetus seems to yield outcomes similar to those of less severe cases that received expectant management.

CONTEXT AND OBJECTIVE: Anesthesiologist-patient relationships are established preoperatively and intraoperatively. These are opportunities for providing correct information about anesthesia/anesthesiologists, thereby improving outcomes. The aim here was to evaluate patients' perceptions about anesthesiologists before anesthesia and to identify whether the anesthetic care would change such perceptions. DESIGN AND SETTING: Prospective cross-sectional study using data obtained in [2007][2008], at a tertiary university hospital. METHODS: 518 patients aged 16 years or over were interviewed before and after anesthesia exposure. A questionnaire was used to determine patient characteristics and perceptions of anesthesia/anesthesiologists. RESULTS:The patients were 16-89 years of age and 59.8% had attended elementary school. 79.1% said that anesthesiologists were specialized physicians. Anesthesiologists' roles were associated with loss of consciousness (35.5% pre-anesthesia; 43.5% post-anesthesia), pain relief (29.7% pre-anesthesia, 31.7% post-anesthesia), vital sign monitoring (17.6% pre-anesthesia, 35% post-anesthesia; P < 0.05); and drug administration (10.8% pre-anesthesia, 43.9% post-anesthesia; P < 0.05). The level of confidence in the physician was rated high (82.2% and 89.8% pre-and post-anesthesia, respectively; P < 0.05) or intermediate (5.8% and 6.6% pre-and post-anesthesia, respectively; P < 0.05). The care provided by anesthesiologists was classified as: elucidating (52.8%), encouraging (52.6%), neutral (10.2%) and careless (0.8%). CONCLUSION: Patients' perceptions of anesthesiologists' roles were fairly good, but improvements in this relationship still need to be pursued, to achieve better outcomes. Anesthetic care was important in providing information, confidence and reassurance among patients, regarding their perceptions. Anesthesiologists should not miss opportunities to provide excellent professional care for patients, thereby improving anesthesia outcomes and their image. responderam que o anestesiologista é um médico especializado. O papel do anestesiologista foi associado à perda de consciência (35,5% pré-anestesia, 43,5% pós-anestesia), alívio de dor (29,7% pré-anestesia, 31,7% pós-anestesia), monitorização dos sinais vitais (17,6% pré-anestesia, 35% pós-anestesia; P < 0,05), e administração de medicamentos (10,8% pré-anestesia, 43,9% pós-anestesia; P < 0,05). O nível de confiança no médico foi considerado alto (82,2% e 89,8% no pré e pós-anestesia, respectivamente, P < 0,05) ou intermediário (5,8% e 6,6% no pré e pós-anestesia, respectivamente, P < 0,05). A assistência prestada pelo anestesiologista foi classificada como: elucidativa (52,8%), encorajadora (52,6%), indiferente (10,2%) e displicente (0,8%). CONCLUSÃO: A percepção sobre o papel do anestesiologista foi satisfatória, mas as melhorias nessa relação ainda são necessárias para se conseguirem melhores resultados. O atendimento anestésico foi importante para a informação, confiança e segurança do paciente sobre essa percepção. O an...

An independent correlation was found between skin thickness and bone density, suggesting that these events occur simultaneously. Skin signs may represent a non-invasive method of stratifying risk in these patients, helping identify cases requiring early treatment.

An individual patient meta-analysis does not support that the optimal timing of delivery for twin pregnancies should be changed by the presence of growth disorders alone.

Purpose To compare lung ultrasound (US) and computed tomography (CT) in the assessment of pregnant women with COVID‐19. Methods Prospective study comprising 39 pregnant inpatients with COVID‐19 who underwent pulmonary assessment with CT and US with a maximum span of 48 h between the exams. The thorax was divided into 12 regions and assessed in terms of the following: the presence of B‐lines (>2), coalescent B‐lines, consolidation on US; presence of interlobular thickening, ground glass, consolidation on CT. The two methods were scored by adding up the scores from each thoracic region. Results A significant correlation was found between the scores obtained by the two methods (rICC = 0.946; p < 0.001). They were moderately in agreement concerning the frequency of altered pulmonary regions (weighted kappa = 0.551). In US, a score over 15, coalescent B‐lines, and consolidation were predictors of the need for oxygen, whereas the predictors in CT were a lung score over 16 and consolidation. The two methods, US ( p < 0.001; AUC = 0.915) and CT ( p < 0.001; AUC = 0.938), were fairly accurate in predicting the need for oxygen. Conclusion In pregnant women, lung US and chest CT are of similar accuracy in assessing lungs affected by COVID‐19 and can predict the need for oxygen.

Objective To investigate the clinical and sonographic parameters associated with adverse fetal outcomes in patients with congenital parvovirus B19 infection managed by intrauterine transfusion. Methods This was a single-center retrospective study conducted from January 2005 to December 2016 that assessed patients with singleton pregnancies with fetal parvovirus infection confirmed by a polymerase chain reaction of the amniotic fluid or fetal blood samples who underwent at least one intrauterine transfusion. The maternal characteristics, sonographic findings and parameters related to intrauterine transfusion were compared between the two groups (recovery/non-recovery), who were categorized based on fetal response after in-utero transfusions. Progression to fetal death or delivery without fetal recovery after the transfusions was considered nonrecovery and categorized as an adverse outcome. Results The final analysis included ten singleton pregnancies: seven of which were categorized into the recovery group and three of which into the non-recovery group. The baseline characteristics were similar between the groups. All fetuses were hydropic at the time of diagnosis. No significant differences related to sonographic or intrauterine transfusion parameters were identified between the groups; however, the nonrecovery group tended to have an increased number of sonographic markers and lower fetal hemoglobin and platelet levels before the transfusion. Conclusion We were unable to firmly establish the clinical or sonographic parameters associated with adverse fetal outcomes in patients with parvovirus infection managed with intrauterine transfusions; however, edema, placental thickening and oligohydramnios may indicate greater fetal compromise and, subsequently, adverse outcomes. However, further studies are necessary, mainly due to the small number of cases analyzed in the present study.

Objective: The objective of this study was to compare the frequency and percentage of fetal hemoglobin (HbF%) by flow cytometry of (1) first-trimester asymptomatic patients with intrauterine hematoma (IUH), (2) first-trimester pregnant patients with vaginal bleeding (VB), and (3) first-trimester asymptomatic pregnant women without hematoma. Methods: Prospective study involving pregnant women in the first trimester of pregnancy. Patients with ultrasound findings of asymptomatic hematoma and with VB were paired with asymptomatic pregnant women of same gestational age without hematoma (control group [CG]). Maternal blood HbF% was evaluated by flow cytometry. The groups were compared in terms of circulating fetal hemoglobin and HbF%. Results: Sixty-six patients were selected, 22 with hematoma, 17 with bleeding, and 27 in the CG. Fetal hemoglobin was detected in 15 patients with hematoma (68.2%) and 13 with bleeding (76.5%) and in 20 of the control (74.1%) (p = 0.830). The mean HbF% of each group was 0.054, 0.012, and 0.042 for hematoma, bleeding, and control, respectively, and differences were not significant (p = 0.141). There was a moderate negative correlation between the volume of hematoma and HbF% (rSpearman = −0.527; p = 0.012). Conclusions: The fetal-maternal hemorrhage expressed by Hbf% in first-trimester pregnancies did not seem to differ between patients with and without ultrasound findings of IUH.