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2. Brazilian network for gestational trophoblastic disease study group consensus on management of gestational trophoblastic disease

Author

Braga, A., Souza, P. O., Dos Santos Esteves, A. P. V., Padrón, L., Uberti, E., Viggiano, M., Sun, S. Y., Izildinha Maestá, Elias, K. M., Horowitz, N., Berkowitz, R., Grillo, B., Botogoski, S. R., Madi, J. M., Cardoso, R. B., Costa, F. R. P., Filho, A. C., Filho, H. Z. B., Osanan, G. C., Gomes, D. A. Y., Lin, L. H., Pitorri, A., Silveira, E., Andrade, J. M., Sousa, C. B., Fernandes, K. G., Rezende-Filho, J., Junior, J. A., Cardoso, F. F. O., Asmar, F. T. C., Pesce, R. R. P., Moraes, V., Obeica, B., Mora, P., Gonçalves, V. C., Itaborahy, R. M. R., Resende, S. S., Dos Santos Júnior, J. A., Costa, A., Melo, E., Paiva, C. S. M., Silva, M. C., Melo, M. C. L., Martins, M. G., Menezes, M. P. N., Costa, O. L. N., Amorim, M. M. R., E Silva, J. M. M., Moraes, F. R. R., Brum, I. R., Macedo Lins, C. D., Da Luz, M. G. Q., Da Silva, N. C., Silva, R. C. A. F., Leal, E. A. S., Fluminense Federal University, Irmandade da Santa Casa de Misericordia Hospital, Goias Federal University, Sao Paulo Federal University, Universidade Estadual Paulista (UNESP), Harvard Medical School, Clinics Hospital of Parana Federal University, General Hospital of Caxias do Sul University, Carmela Dutra Maternity, Santa Casa Misericordia de Vitoria, Clinics Hospital of Espirito Santo Federal University, Clinics Hospital of Minas Gerais Federal University, Universidade Estadual de Campinas (UNICAMP), Universidade de São Paulo (USP), Maternity School of Dr Mario de Moraes Altenfelder Silva (Vila Nova Cachoeirinha), Guilherme Alvaro Hospital of Lusiada University Center, University Hospital of Jundiai Medical Faculty, Rio de Janeiro Federal University, Regional Hospital of Asa Norte Trophoblastic Disease Center, Julio Muller University Hospital of Mato Grosso Federal University Cuiaba, Regional Hospital of Mato Grosso do Sul. Campo Grande, University Hospital of Piaui Federal University, Pernambuco Institute of Maternal Child Health, Clinics Hospital of Pernambuco Federal University, Lauro Wanderley University Hospital of Paraiba Federal University, University Hospital of Alagoas Federal University, Januario Cicco Maternity School of Rio Grande do Norte University, Marly Sarney State Maternity, University Hospital of Sergipe Federal University, Climerio de Oliveira Maternity of Bahia Federal University, University Hospital of Campina Grande Federal University, Assis Chateaubriand Maternity School of Ceara Federal University, Dona Regina Maternity, Getulio Vargas University Hospital, Roraima General Hospital, Santa Casa de Misericordia do Para Foundation, Mae Luiza Women’s Hospital, Ary Pinheiro Hospital of Base, and Clinics Hospital of Acre

Subjects
Gestational trophoblastic disease, Rare cancers, Hydatidiform mole, Brazil
Abstract

Made available in DSpace on 2022-04-30T09:10:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-01 OBJECTIVE: To present the Brazilian Network for Gestational Trophoblastic Disease Study Group consensus on management of gestational trophoblastic disease (GTD). STUDY DESIGN: The modified Delphi technique was used in this study to obtain a consensus among Brazilian specialists on the treatment of GTD. For the 64 statements listed, each participant was asked to assign a Likert scale value according to their agreement. The RAND/UCLA method was used to define the level of consensus among the specialists. RESULTS: The response rate of the potential study participants after the 2 rounds was 40/47 (85%). Of the 64 statements presented, there was an agreement on 54/64 (84%). The situations of disagreement were as follows: 1/12 (8%) statements in the section on diagnosis of GTD, 5/10 (50%) statements in the section on treatment of hydatidiform mole (HM), 2/16 (12.5%) statements in the section on diagnosis of gestational trophoblastic neoplasia (GTN), 1/14 (7%) statements in the section on treatment and followup of GTN, and 1/5 (20%) statements in the section on appropriate time to allow pregnancy after HM and GTN. CONCLUSION: This guideline will serve to standardize the conduct among the Brazilian GTD reference centers as well as to guide the new specialized services that may arise and eventually to physicians who may need to treat cases of GTD. Rio de Janeiro Trophoblastic Disease Center Fluminense Federal University Porto Alegre Trophoblastic Disease Center Mario Totta Maternity Ward Irmandade da Santa Casa de Misericordia Hospital Goiania Trophoblastic Disease Center Clinics Hospital of Faculty of Medicine Goias Federal University Sao Paulo Trophoblastic Disease Center Sao Paulo Hospital Paulista School of Medicine Sao Paulo Federal University Botucatu Trophoblastic Disease Center Clinics Hospital of Botucatu Medical School Sao Paulo State University New England Trophoblastic Disease Center Department of Obstetrics and Gynecology Division of Gynecologic Oncology Brigham and Women’s Hospital Dana Farber Cancer Institute/Harvard Cancer Center Harvard Medical School Clinics Hospital of Parana Federal University General Hospital of Caxias do Sul University Carmela Dutra Maternity Santa Casa Misericordia de Vitoria Clinics Hospital of Espirito Santo Federal University Clinics Hospital of Minas Gerais Federal University Campinas University Clinics Hospital of Sao Paulo University Maternity School of Dr Mario de Moraes Altenfelder Silva (Vila Nova Cachoeirinha) Guilherme Alvaro Hospital of Lusiada University Center University Hospital of Jundiai Medical Faculty Rio de Janeiro Federal University Fluminense Federal University Regional Hospital of Asa Norte Trophoblastic Disease Center, Distrito Federal Julio Muller University Hospital of Mato Grosso Federal University Cuiaba Regional Hospital of Mato Grosso do Sul. Campo Grande University Hospital of Piaui Federal University Pernambuco Institute of Maternal Child Health Clinics Hospital of Pernambuco Federal University Lauro Wanderley University Hospital of Paraiba Federal University University Hospital of Alagoas Federal University Januario Cicco Maternity School of Rio Grande do Norte University Marly Sarney State Maternity University Hospital of Sergipe Federal University Climerio de Oliveira Maternity of Bahia Federal University University Hospital of Campina Grande Federal University Assis Chateaubriand Maternity School of Ceara Federal University Dona Regina Maternity Getulio Vargas University Hospital Roraima General Hospital Santa Casa de Misericordia do Para Foundation Mae Luiza Women’s Hospital Ary Pinheiro Hospital of Base Clinics Hospital of Acre Botucatu Trophoblastic Disease Center Clinics Hospital of Botucatu Medical School Sao Paulo State University

3. Centralized coordination of decentralized assistance for patients with gestational trophoblastic disease in Brazil: A viable strategy for developing countries

Author

Braga, A., Burlá, M., Freitas, F., Uberti, E., Viggiano, M., Sue Sun, Maestá, I., Elias, K. M., Berkowitz, R. S., Goldstein, D. P., Grillo, B., Madi, J. M., Costa, F. R. P., Filho, A. C., Filho, H. Z. B., Osanan, G. C., Gomes, D. A. Y., Lin, L. H., Pitorri, A., Silveira, E., Andrade, J., Fernandes, K. G., Rezendefilho, J., Amim Junior, J., Moraes, V., Gonçalves, V. C., Itaborahy, R. M. R., Resende, S. S., Dos Santos Júnior, J. A., Costa, A., Paiva, C. S. M., Silva, M. C., Melo, M. C. L., Martins, M. G., Nogueira Menezes, M. P., Costa, O. L. N., Amorim, M. M. R., E Silva, J. M. M., Deus, J., Lins, C. D. M., Brum, I. R., Da Luz, M. G. Q., Da Silva, N. C., Ferreira Silva, R. C. A., Leal, E. A. S., Fluminense Federal University, Irmandade da Santa Casa de Misericórdia Hospital, Goiás Federal University, São Paulo Federal University, Universidade Estadual Paulista (UNESP), Trophoblastic Tumor Registry, Brigham and Women’s Hospital Dana Farber Cancer Institute/Harvard Cancer Center Harvard Medical School, Clinics Hospital of Paraná Federal University, General Hospital of Caxias do Sul University, Carmela Dutra Maternity, Santa Casa Misericórdia de Vitoria, Clinics Hospital of Espírito Santo Federal University, Clinics Hospital of Minas Gerais Federal University, Universidade Estadual de Campinas (UNICAMP), Universidade de São Paulo (USP), Maternity School of Dr. Mário de Moraes Alten-felder Silva (Vila Nova Cachoeirinha), Guilherme Alvaro Hospital of Lusiada University Center, University Hospital of Jundiai Medical Faculty, Rio de Janeiro Federal University, Regional Hospital of Asa Norte Trophoblastic Disease Center, Júlio Müller University Hospital of Mato Grosso Federal University Cuiabá, Regional Hospital of Mato Grosso do Sul, University Hospital of Piaui Federal University, Instituto de Medicina Integral Professor Fernando Figueira, Lauro Wanderley University Hospital of Paraíba Federal University, University Hospital of Alagoas Federal University, Januário Cicco Maternity School of Rio Grande do Norte University, Maranhão Federal University, University Hospital of Sergipe Federal University, Climério de Oliveira Maternity of Bahia Federal University, University Hospital of Campina Grande Federal University, Assis Chateaubriand Maternity School of Ceará Federal University, Dona Regina Maternity, Roraima General Hospital, Getúlio Vargas University Hospital, Santa Casa de Misericórdia do Pará Foundation, Mãe Luiza Women’s Hospital, Ary Pinheiro Hospital of Base, and Clinics Hospital of Acre

Subjects
Gestational trophoblastic disease, Chemotherapy, Hydatidiform mole, Brazil, Gestational trophoblastic neoplasia, Molar pregnancy
Abstract

Made available in DSpace on 2022-05-02T14:14:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-06-01 OBJECTIVE: To report on the Brazilian Association of Gestational Trophoblastic Disease’s (GTD) formation of a network of regional care at specialized centers for women with GTD. STUDY DESIGN: We developed a questionnaire composed of 15 questions, which was sent by email to the 38 Brazilian GTD Reference Center (BGTDRC) Directors who are members of the Brazilian Association of GTD, in order to characterize the professionals involved in the care of patients with GTD and the type of assistance provided. RESULTS: The Directors of the BGTDRCs are usually specialists in Gynecology and Obstetrics (97%), with a median experience of a decade in treating women with GTD. The BGTDRCs are linked to university hospitals in 75% of centers and provide completely free medical care in 87%. However, 52% of centers do not perform chemotherapy in their reference center, and patients are referred elsewhere for chemotherapy. Despite some difficulties, the rate of patients lost to follow-up before human chorionic gonadotropin remission is 9%, and the GTD mortality rate is 0.9%. CONCLUSION: Due to large regional disparities, the BGTDRCs are not uniformly organized. However, under the coordination of the Brazilian Association of GTD there is now strong communication and collaboration among reference centers, which has significantly advanced both patient care and research into the management of these diseases. Rio de Janeiro Trophoblastic Disease Center Maternity School of Rio de Janeiro Federal University and Antonio Pedro University Hospital Fluminense Federal University Porto Alegre Trophoblastic Disease Center Mario Totta Maternity Ward Irmandade da Santa Casa de Misericórdia Hospital Goiania Trophoblastic Disease Center Clinics Hospital of Faculty of Medicine Goiás Federal University São Paulo Trophoblastic Disease Center São Paulo Hospital Paulista School of Medicine São Paulo Federal University Botucatu Trophoblastic Disease Center Clinics Hospital of Botucatu Medical School São Paulo State University New England Trophoblastic Disease Center Trophoblastic Tumor Registry Division of Gynecologic Oncology Department of Obstetrics and Gynecology Brigham and Women’s Hospital Dana Farber Cancer Institute/Harvard Cancer Center Harvard Medical School Clinics Hospital of Paraná Federal University General Hospital of Caxias do Sul University Carmela Dutra Maternity Santa Casa Misericórdia de Vitoria Clinics Hospital of Espírito Santo Federal University Clinics Hospital of Minas Gerais Federal University Campinas University Clinics Hospital of São Paulo University Maternity School of Dr. Mário de Moraes Alten-felder Silva (Vila Nova Cachoeirinha) Guilherme Alvaro Hospital of Lusiada University Center University Hospital of Jundiai Medical Faculty Rio de Janeiro Federal University Fluminense Federal University Regional Hospital of Asa Norte Trophoblastic Disease Center, Distrito Federal Júlio Müller University Hospital of Mato Grosso Federal University Cuiabá Regional Hospital of Mato Grosso do Sul University Hospital of Piaui Federal University Instituto de Medicina Integral Professor Fernando Figueira Lauro Wanderley University Hospital of Paraíba Federal University University Hospital of Alagoas Federal University Januário Cicco Maternity School of Rio Grande do Norte University Maternal Child Unity of University Hospital Maranhão Federal University University Hospital of Sergipe Federal University Climério de Oliveira Maternity of Bahia Federal University University Hospital of Campina Grande Federal University Assis Chateaubriand Maternity School of Ceará Federal University Dona Regina Maternity Roraima General Hospital Getúlio Vargas University Hospital Santa Casa de Misericórdia do Pará Foundation Mãe Luiza Women’s Hospital Ary Pinheiro Hospital of Base Clinics Hospital of Acre Botucatu Trophoblastic Disease Center Clinics Hospital of Botucatu Medical School São Paulo State University

4. Avaliar a correlação entre a concentração da hemoglobina e a medida ecográfica do diâmetro biventricular externo em fetos anêmicos de gestantes isoimunizadas

Author

Rodrigues Rosangela Lopes Miranda, Pereira Alamanda Kfoury, Taveira Marcos Roberto, Melo Isabela Gomes de, Osanan Gabriel Costa, and Cabral Antônio Carlos Vieira

Subjects
ecocardiografia, anemia fetal, hemoglobina, isoimunização gestacional, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

OBJETIVO: Verificar se existe correlação significativa entre a medida ecográfica do diâmetro biventricular externo e a concentração sérica da hemoglobina fetal pré-transfusional e se essa medida ecográfica poderá vir a ser utilizada como marcador não invasivo da anemia fetal. MÉTODOS: Estudo transversal prospectivo, no qual foram selecionadas 65 cordocenteses realizadas em 36 fetos anêmicos de mães portadoras de isoimunização pelo fator Rh. Obteve-se a medida do diâmetro biventricular externo (DBVE), por meio do modo M, utilizando-se aparelho de ultra-som convencional. Anterior à transfusão foi obtida amostra de 0,5ml de sangue fetal, para dosagem da hemoglobina, sendo a medida imediatamente realizada através de espectrofotometria, no equipamento Hemocue®. Como análise estatística foi utilizada a regressão dos mínimos quadrados, aceitando-se p

Published
2005

5. Causes and investigation of stillbirths in Brazil: A multicentre cross-sectional study in 10 referral maternity hospitals.

Author

Brasileiro M, Metelus S, Griggio TB, Vieira MC, Dias MAB, Leite DF, da Cunha Filho EV, Schreiner L, Ramos JGL, Haddad SM, Osanan G, Mayrink J, de Jesús GR, Fernandes KG, Pasupathy D, Cecatti JG, and Souza RT

Abstract

Objective: Understanding the local characteristics and statistics related to stillbirths may be the first step in a series of strategies associated with a reduction in stillbirth ratio. The aim of this study was to estimate the fetal mortality ratio and evaluate the investigation processes related to the causes of death, comparing the investigation according to the specific cause of death., Methods: A cross-sectional study was retrospectively conducted in 10 tertiary obstetric care centers. Medical records of women with stillbirth managed between January 1, 2009 and December 31, 2018 were analyzed and classified, according to sociodemographic characteristics, and gestational and childbirth data, culminating in stillbirth. The stillbirth ratio and its causes were presented in proportions for the study period and individually for each health facility., Results: Cases of 3390 stillbirths were analyzed. The stillbirth ratio varied from 10.74/1000 live births (LBs) in 2009 to 9.31/1000 in 2018. "Intrauterine hypoxia and asphyxia" (ICD-10 P20) and "unspecific causes of death" (ICD-10 P95) represented 40.8% of the causes of death. Investigation for TORCHS and diabetes occurred in 90.8% and 61.4% of deaths, respectively. Placental and necroscopic tests were performed in 36.6% of the cases., Conclusion: The adoption of a rational and standardized investigation of stillbirth remains an unmet need; the use of additional tests and examinations are lacking, especially when unspecific causes are attributed., (© 2024 International Federation of Gynecology and Obstetrics.)

Published
2024
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7. Management practices for placenta accreta spectrum patients: a Latin American hospital survey.

Author

Nieto-Calvache AJ, Palacios-Jaraquemada JM, Hidalgo A, Vergara-Galliadi LM, Cortés Charry R, Aguilera Daga LR, Verástegui Goyzueta R, Osanan G, Fernandez J, Corrales F, Mereci W, Yuen-Chon V, Guevara E, Zúñiga LA, Girón, Turcios FE, Muñoz H, Perez AM, Meade P, Basanta N, and Pineda JP

Subjects
Pregnancy, Humans, Female, Latin America epidemiology, Cross-Sectional Studies, Retrospective Studies, Hospitals, Placenta, Placenta Accreta epidemiology, Placenta Accreta therapy
Abstract

Introduction: Placenta accreta spectrum (PAS) causes severe morbidity and can result in maternal death. It must be managed in specialized centers with interdisciplinary groups, but few publications have described the usual management within a specific geographic region. We intend to describe the usual approach for PAS in reference centers in Latin America., Methodology: This was an observational, multicenter, cross-sectional study conducted in Latin American PAS reference centers. A standardized survey was implemented and applied to obstetric service coordinators and leaders of interdisciplinary groups with experience in PAS between September and November 2020., Results: One hundred fifty-four hospitals were included. Most of them (64.3%) handle approximately one case of PAS every two months, and almost all centers (89.6%) believe that their performance could be improved., Conclusions: Most of the reference centers for PAS in Latin America attend to a small number of cases each year, and almost all of these hospitals identify opportunities to improve the management or approach for PAS in women.

Published
2022
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8. Expert Recommendations on Monkeypox (MPX) in Pregnancy, Postpartum and Lactating Women.

Author

Mattar R, Neto ARB, Luz AG, Hatanaka A, Zaconeta A, Guazzelli CAF, Traina E, Baptista FS, Osanan G, Duarte G, Ramos JGL, Oppermann ML, Francisco RPV, Cardoso SMLQ, Quintana SM, Sun SY, and Borges VTM

Subjects
Humans, Female, Pregnancy, Lactation, Postpartum Period, Mpox (monkeypox)
Abstract

Competing Interests: The authors have no conflict of interests to declare.

Published
2022
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9. Lack of experience is a main cause of maternal death in placenta accreta spectrum patients.

Author

Nieto-Calvache AJ, Palacios-Jaraquemada JM, Osanan G, Cortes-Charry R, Aryananda RA, Bangal VB, Slaoui A, Abbas AM, Akaba GO, Joshua ZN, Vergara Galliadi LM, Nieto-Calvache AS, Sanín-Blair JE, and Burgos-Luna JM

Subjects
Adult, Africa epidemiology, Asia epidemiology, Central America epidemiology, Female, Gestational Age, Humans, Pregnancy, Retrospective Studies, South America epidemiology, Delivery, Obstetric standards, Placenta Accreta mortality
Abstract

Introduction: Placenta accreta spectrum (PAS) is a serious condition with a mortality as high as 7%. However, the factors associated with this type of death have not been adequately described, with an almost complete lack of publications analyzing the determining factors of death in this disease. The aim of our work is to describe the causes of death related to PAS and to analyze the associated diagnosis and treatment problems., Material and Methods: This is an inter-continental, multicenter, descriptive, retrospective study in low- and middle-income countries. Maternal deaths related to PAS between January 2015 and December 2020 were included. Crucial points in the management of PAS, including prenatal diagnosis and details of the surgical treatment and postoperative management, were evaluated., Results: Eighty-two maternal deaths in 16 low- and middle-income countries, on three continents, were included. Almost all maternal deaths (81 cases, 98.8%) were preventable, with inexperience among surgeons being identified as the most relevant problem in the process that led to death among 87% (67 women) of the cases who had contact with health services. The main cause of death associated with PAS was hemorrhage (69 cases, 84.1%), and failures in the process leading to the diagnosis were detected among 64.6% of cases. Although the majority of cases received medical attention and 50 (60.9%) were treated at referral centers for severe obstetric disease, problems were identified during treatment in all cases., Conclusions: Lack of experience and inadequate surgical technique are the most frequent problems associated with maternal deaths in PAS. Continuous training of interdisciplinary teams is critical to modify this tendency., (© 2021 Nordic Federation of Societies of Obstetrics and Gynecology.)

Published
2021
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10. Antenatal ultrasonographic anteroposterior renal pelvis diameter measurement: is it a reliable way of defining fetal hydronephrosis?

Author

Pereira AK, Reis ZS, Bouzada MC, de Oliveira EA, Osanan G, and Cabral AC

Abstract

Purpose. It was to quantify the intraobserver and interobserver variability of the sonographic measurements of renal pelvis and classify hydronephrosis severity. Methods. Two ultrasonographers evaluated 17 fetuses from 23 to 39 weeks of gestation. Renal pelvis APD were taken in 50 renal units. For intraobserver error, one of them performed three sequential measurements. The mean and standard deviation from the absolute and percentage differences between measurements were calculated. Bland-Altman plots were used to visually assess the relationship between the precision of repeated measurements. Hydronephrosis was classified as mild (5.0 to 9.9 mm), moderate (10.0 to 14.9 mm), or severe (≥15.0 mm). Interrater agreement were obtained using the Kappa index. Results. Absolute intraobserver variation in APD measurements was 5.2 ± 3.5%. Interobserver variation of ultrasonographers was 9.3 ± 9.7%. Neither intraobserver or interobserver error increased with increasing APD size. The overall percentage of agreement with the antenatal hydronephrosis diagnosis was 64%. Cohen's Kappa to hydronephrosis severity was 0.51 (95% CI, 0.33 to 0.69). Conclusion. Inter and intraobserver APD measurement errors were low in these group, but the agreement to hydronephrosis diagnosis and classification was fair. We suggest that standard and serial APD measurement can better define and evaluate fetal hydronephrosis.

Published
2011
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