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Master's Dissertation
DOI
Document
Author
Full name
Gilmar de Souza Osmundo Junior
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Brizot, Maria de Lourdes (President)
Bunduki, Victor
Francisco, Rossana Pulcineli Vieira
Paiato, Lilian Cristine Rolo
Title in Portuguese
Gastrosquise fetal: associação de trabalho de parto espontâneo com resultados perinatais adversos em fetos de termo e pré-termo
Keywords in Portuguese
Doenças e anormalidades congênitas hereditárias e neonatais
Gastrosquise
Gravidez
Início do trabalho de parto
Parto obstétrico
Trabalho de parto prematuro
Abstract in Portuguese
OBJETIVOS: O presente estudo objetiva investigar a associação entre resultados neonatais e trabalho de parto espontâneo de termo e pré-termo em gestações com gastrosquise fetal. O objetivo secundário é analisar a associação entre marcadores ultrassonográficos e a ocorrência de trabalho de parto espontâneo em gestações de gastrosquise fetal. MÉTODOS: Análise retrospectiva de 207 gestantes portadoras de fetos com gastrosquise isolada entre 2005 a 2017. As pacientes foram seguidas por meio de protocolo préestabelecido envolvendo ultrassonografias seriadas com avaliação rotineira do Perfil Biofísico Fetal, além de avaliação dos diâmetros das alças intestinais intra- e extra-abdominais. Os dados referentes a trabalho de parto, via de parto e resultados perinatais foram revisados. Os desfechos neonatais avaliados foram gastrosquise complexa, fechamento cirúrgico da gastrosquise com silo, síndrome do intestino curto, tempo de ventilação mecânica, tempo de nutrição parenteral e enterocolite necrotizante. RESULTADOS: A ocorrência de trabalho de parto prematuro espontâneo associou-se a gastrosquise complexa (30,7% vs. 6,8%, p = 0,002) e síndrome do intestino curto (13,2% vs. nenhum caso, p = 0,013) quando comparada aos partos prematuros indicados fora de trabalho de parto. O trabalho de parto espontâneo associou-se ainda a maiores tempos de ventilação mecânica em casos de termo e pré-termo. Não foram observadas associações entre parâmetros ultrassonográficos e trabalho de parto espontâneo. CONCLUSÕES: O trabalho de parto espontâneo em gestações com gastrosquise fetal associa-se a desfechos neonatais adversos, principalmente nos casos pré-termo
Title in English
Fetal gastroschisis: association of spontaneous labor onset with adverse perinatal outcomes in term and pre-term pregnancies
Keywords in English
Congenital hereditary and neonatal diseases and abnormalities
Gastroschisis
Labor onset
Obstetric delivery
Pregnancy
Preterm labor
Abstract in English
OBJECTIVES: The present study aims to investigate the association of spontaneous labor onset with neonatal outcomes in pregnancies with fetal gastroschisis. The secondary goal was to evaluate the association between ultrasound markers and labor onset in pregnancies with fetal gastroschisis. METHODS: A retrospective analysis was performed for 207 pregnancies with fetal gastroschisis followed at the Fetal Medicine Division of the University of São Paulo between 2005 and 2017. Patients were followed according to a strict protocol involving ultrasound scans and routine evaluations of fetal biophysical profile parameters and intra- and extra-abdominal bowel diameters. Labor, delivery and neonatal records were reviewed. The neonatal outcomes were complex gastroschisis, staged surgical closure of the abdominal defect, short bowel syndrome, time on mechanical ventilation, time to full enteral feeding and necrotizing enterocolitis. RESULTS: Spontaneous labor onset was associated with complex gastroschisis (30.7% vs. 6.8%, p = 0.002) and short bowel syndrome (13.2% vs. none, p = 0.013) in cases with spontaneous preterm delivery compared to the indicated preterm deliveries. Spontaneous labor onset was associated with a longer time on mechanical ventilation for term and preterm newborns. Associations were not observed between ultrasound markers and spontaneous labor onset. CONCLUSION: Spontaneous labor onset in pregnancies with fetal gastroschisis was associated with adverse neonatal outcomes particularly in those born at preterm gestation
 
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Publishing Date
2019-11-18
 
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