Alex Sandro Rolland Souza

Objective: To review the literature on palliative care protocols and models of care for pregnant women and their fetuses with life-limiting conditions. Methods: A narrative literature review was conducted in the PubMed/MEDLINE and Virtual Health Library (VHL)—BIREME/SciELO/LILACS, using the descriptors “palliative care” and “prenatal care”. Studies of all designs published between February 2015 and May 2025 were considered for inclusion. Articles in languages other than Portuguese, English, and Spanish, duplicates, and those that did not discuss care protocols or experiences in perinatal palliative care for life-limiting fetal conditions starting from prenatal care were excluded. Articles were selected through title, abstract, and full-text screening. Results: Twenty-one studies focused on prenatal care were selected, presenting protocols and experiences of care in palliative fetal medicine. Most addressed the diagnosis of life-limiting fetal malformations, prenatal care, birth and delivery plan, perinatal grief and the puerperium. Across the included studies, a recurring emphasis on individualized, patient and family-centered approaches was identified, reflecting core principles of personalized medicine. Tailoring communication, care planning, and bereavement support to the specific clinical, genetic, cultural, and psychosocial profile of each dyad emerged as a structural characteristic of effective perinatal palliative care models. Conclusions: There is a scarcity of specific palliative care protocols for pregnancy, indicating a need to expand studies. The reviewed literature can contribute to the creation and adaptation of palliative care protocols and models for pregnant women and their fetuses with life-limiting conditions, may support more consistent care planning, improved communication, and better alignment with parental values.

Objective: This study aimed to describe gestational age-specific biometric and estimated fetal weight (EFW) patterns derived from a multicenter cohort of fetuses with gastroschisis and to evaluate the agreement between prenatal EFW and birth weight. Methods: This retrospective study included singleton pregnancies with a prenatal diagnosis of gastroschisis and at least two ultrasound evaluations between 20 and 37 weeks. Data were collected from four Brazilian tertiary centers between 2010 and 2024. Biometric parameters (biparietal diameter, head circumference [HC], abdominal circumference, and femur length) and EFW were recorded. EFW was calculated using Hadlock IV and Siemer formulas. Polynomial regression models were applied to generate gestational age-specific curves for HC, femur length (FL), and EFW. Agreement between prenatal EFW and birth weight (in cases assessed within 14 days of delivery) was analyzed using Bland–Altman plots and the concordance correlation coefficient (CCC). Results: A total of 116 pregnancies and 355 ultrasound tests were included. Polynomial models showed a strong association between gestational age and EFW (R² = 0.837 for Siemer; R² = 0.728 for Hadlock), HC (R² = 0.849), and FL (R² = 0.877). The 50th percentile curves for gastroschisis were consistently lower than those from standard growth charts. In the birthweight concordance analysis (n = 46), the Siemer formula showed low agreement (CCC = 0.55), while the Hadlock formula showed even lower concordance (CCC = 0.44), with both formulas underestimating actual birth weight. Conclusions: Fetuses with gastroschisis have distinct growth patterns not captured by standard references. Tailored growth curves and careful interpretation of EFW are essential to improve prenatal assessment in this population.

Objectives: To determine the prevalence and factors associated with malnutrition in older adults with cancer upon admission for outpatient treatment. Methods: This cross-sectional study was conducted with older adults with cancer admitted to an oncogeriatrics outpatient clinic from 2015 to 2020 in the Northeast of Brazil. Sociodemographic data, lifestyle, and clinical variables were collected. Nutritional status was assessed using the Mini Nutritional Assessment short-form (MNA-SF) and classified as normal nutritional status (12 to 14 points), at risk of malnutrition (8 to 11 points), or malnourished (0 to 7 points). The multivariate Poisson regression was used to verify the association between the independent variables and malnutrition. Results: A total of 1954 patients were included. Of these, 14.9% were at risk of malnutrition, and 31.5% were malnourished. The risk factors for malnutrition were female gender (prevalence ratio [PR] = 1.28; 95% confidence interval [CI] = 1.03–1.59), upper gastrointestinal tumor (PR = 2.39; 95%CI = 1.66–3.45), colon, rectum, anus, and anal canal tumors (PR = 2.54; 95%CI = 1.77–3.64), lung tumor (PR = 2.35; 95%CI = 1.37–4.02), metastasis (PR = 1.37; 95%CI = 1.11–1.70), history of falls (PR = 1.27; 95%CI = 1.01–1.61), sedentary lifestyle (PR = 1.46; 95%CI = 1.11–1.93), and risk of depression (PR = 1.42; 95%CI = 1.16–1.73). Conclusion: The prevalence of nutritional risk and malnutrition was relatively high in older adults with cancer at the beginning of outpatient treatment. These findings underscore the need for routine malnutrition screening at admission in oncology outpatient settings to ensure early identification and management. The associated factors were easily identifiable within standard clinical evaluations, supporting the feasibility of systematic screening.

Objective: This study aimed to characterize tricuspid valve sound signals in healthy fetuses during the first trimester of pregnancy using Doppler ultrasound and computational analysis. Methods: A cohort of pregnant women at 11–14 weeks of normal-risk gestation was assessed at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) between December 2019 and May […] Abstract Objective: This study aimed to characterize tricuspid valve sound signals in healthy fetuses during the first trimester of pregnancy using Doppler ultrasound and computational analysis. Methods: A cohort of pregnant women at 11–14 weeks of normal-risk gestation was assessed at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) between December 2019 and May […]

A infecção pelos vírus linfotrópicos de células T humanas (HTLV-1 e HTLV-2) permanece historicamente negligenciada no Brasil, apesar de o país figurar entre aqueles com maior número absoluto de pessoas infectadas no mundo. Em 2025, o Ministério da Saúde publicou a Nota Técnica Conjunta nº 6/2025, com o objetivo de orientar a atenção à gestante, à parturiente e ao recém-nascido em contextos de infecção por HTLV, respondendo a uma demanda legítima por padronização de condutas no âmbito do Sistema Único de Saúde (SUS).¹