Fernando Maia Peixoto-Filho

Background/Objectives: Deep endometriosis is a chronic inflammatory disease that significantly affects fertility. The objective was to evaluate the magnitude of the effect of minimally invasive nerve-sparing complete excision of endometriosis on natural conception rate in women with documented infertility. Methods: This pre-planned interdisciplinary retrospective observational study included 45 patients who wished to conceive naturally (spontaneous pregnancy) and were followed for 12 months after surgery. Results: The spontaneous conception rate was 33.3% (95% CI: 20.0–46.7) and the mean time to conception was 6.7 months. Age, body mass index, and history of infertility showed no significant differences between the success and failure spontaneous pregnancy groups, but annual income was positively associated with reproductive success (p = 0.022). None of the procedures needed to be converted to open surgery, required colostomy/ileostomy, blood transfusion or abdominal drains. No cases of urinary retention were observed across different levels of nerve preservation. In addition, the absence of serious surgical complications (Clavien–Dindo III/IV) supports the safety of this intervention for infertile patients. Conclusions: The absence of serious surgical complications in this cohort supports the concept that minimally invasive nerve-sparing complete excision of endometriosis is a safe intervention when performed by an experienced team. The results underscore the importance of exploring socioeconomic-related factors through an individualized assessment of patients who wish to conceive naturally after minimally invasive nerve-sparing surgery. Future studies focusing on personalized management of endometriosis should attempt to identify socioeconomic-related covariates that influence natural conception.

SUMMARY OBJECTIVE: The aim of this study was to compare the performance of different fetal growth reference standards—Hadlock, INTERGROWTH-21st, and World Health Organization—in pregnancies complicated by systemic lupus erythematosus. METHODS: This retrospective cohort study was conducted at a tertiary referral center and included singleton pregnancies delivered at ≥22 weeks of gestation. Pregnant women were classified into two groups: those with systemic lupus erythematosus, defined by ≥4 American College of Rheumatology criteria, and controls without autoimmune disease. Estimated fetal weight obtained from routine obstetric ultrasonography was converted into gestational age-specific percentiles using the Hadlock, INTERGROWTH-21st, and World Health Organization reference standards. Correlations between ultrasound-based fetal weight percentiles and birth weight percentiles were assessed using Spearman's rank correlation coefficient. RESULTS: Of 225 initially identified pregnancies, 179 fetuses were included in the final analysis, comprising 124 from women with systemic lupus erythematosus (69.3%) and 55 from controls (30.7%). Data distribution was non-normal. Across all growth standards, fetuses from women with systemic lupus erythematosus demonstrated lower mean weight percentiles than those from controls. Mean percentiles for controls versus the systemic lupus erythematosus group were 47.1% versus 38.4% using Hadlock, 63.3% versus 55.2% using INTERGROWTH-21st, and 51.7% versus 42.6% using World Health Organization. No statistically significant differences were observed among the three reference standards; however, INTERGROWTH-21st consistently yielded higher percentile values in both groups. CONCLUSION: Although fetal weight classification varied according to the growth standard used, pregnancies complicated by systemic lupus erythematosus consistently exhibited lower fetal weight percentiles. Awareness of systematic differences among commonly used growth references is essential, as these may influence the detection of fetal growth restriction.

Fetus in fetu (FIF) is a rare congenital anomaly in which a malformed parasitic twin is enclosed within its host, usually in the retroperitoneum. Oral presentation is extremely rare, with few cases described. Differentiation from teratomas, particularly epignathus, is challenging but crucial for prognosis and management. An 18-year-old gravida 3, para 2 was referred at 26 weeks for suspected epignathus. Ultrasound showed a large oropharyngeal mass, polyhydramnios, omphalocele, diaphragmatic hernia, and cardiac anomalies. Fetal demise occurred at 32 weeks. Postmortem examination revealed a second head-like mass with skin, cranial bones, facial features, and cerebral tissue. Histopathology confirmed highly organized fetiform mass consistent with FIF despite absence of vertebral axis. This is a rare case of oral FIF entirely comprising a second head and associated with major host anomalies. Awareness of this entity is essential for accurate diagnosis and perinatal planning when airway compromise is anticipated.

Objective: This study sought to analyze the profile of fetuses, newborns and pregnant women with alloimmunization (anti-RhD) referred to and treated over the twenty years since the launch of the Rio de Janeiro State. Methods: An observational, retrospective, descriptive study was conducted, with data obtained by analyzing the medical records of 481 mothers and […] Abstract Objective: This study sought to analyze the profile of fetuses, newborns and pregnant women with alloimmunization (anti-RhD) referred to and treated over the twenty years since the launch of the Rio de Janeiro State. Methods: An observational, retrospective, descriptive study was conducted, with data obtained by analyzing the medical records of 481 mothers and […]

Congenital cystic adenomatoid malformation (CCAM) is a rare fetal lung anomaly characterized by benign multicystic masses that can lead to severe complications, such as pulmonary hypoplasia, fetal hydrops, and neonatal death. This literature review examines current knowledge on antenatal therapies for CCAM, focusing on pharmacological, procedural, and surgical interventions. Betamethasone, the first-line pharmacological treatment, has shown efficacy in reducing lesion size and resolving hydrops, particularly in microcystic CCAM. Procedural options, such as thoracoamniotic shunting, are effective for macrocystic lesions but carry risks including preterm labor and thoracic deformities. Open fetal surgery remains a last-resort intervention for severe cases, while emerging techniques, like percutaneous laser ablation and sclerotherapy, offer promising minimally invasive alternatives. A proposed treatment algorithm emphasizes individualized care based on lesion type, gestational age, and the presence of complications. The authors searched the US National Library of Medicine Database, Google Scholar, and PubMed Central to gather information on antenatal therapies for CCAM. This review emphasizes that, despite significant advancements, considerable challenges persist, underscoring the need for prospective studies to refine therapeutic protocols and assess long-term outcomes.

Objective: The purpose of this study was to evaluate the agreement between and reproducibility of specific two-dimensional (2D) and three-dimensional (3D) ultrasound methods in assessing cervical volume in pregnant women in their second trimester. Materials and Methods: This was a prospective cross-sectional study of 48 asymptomatic pregnant women at 20–24 weeks of gestation. All cervical volumes were determined by transvaginal ultrasound, with a 2D method employing a geometric formula {π * [(anteroposterior diameter + transverse diameter) * ¼] * length}, where π = 3.14, and a 3D method employing a virtual organ computer-aided analysis. Intraobserver and interobserver reliability was analyzed by calculating the intraclass correlation coefficient (ICC). Results: The mean maternal age and timing of the ultrasound examination were 26 ± 6 years and 21 ± 1 weeks of gestation, respectively. The mean cervical volumes measured by the 2D and 3D ultrasound methods were 27.71 ± 9.27 cm3 and 35.21 ± 8.85 cm3, respectively. Cervical length and volume showed a positive correlation with both methods–r = 0.77 (p < 0.001) and r = 0.70 (p < 0.001), respectively. Intraobserver reliability was excellent for both methods, with ICCs of 0.92 and 0.93 for the 2D and 3D methods, respectively. Interobserver reliability was good (ICC: 0.81) for the 3D method, whereas it was poor (ICC: 0.37) for the 2D method. Reproducibility of the transverse diameter measurement was low, with an intraobserver ICC of 0.41 and an interobserver ICC of 0.48. Conclusion: Cervical volume measurements obtained with 2D and 3D ultrasound methods seem to show satisfactory agreement and good intraobserver reliability. In our study sample, the 2D ultrasound method showed low interobserver reliability, whereas the 3D ultrasound method was more reliable, with good intraobserver and interobserver reliability.

Objective: To study the effect of antenatal corticosteroid administration on fetal hemodynamics using longitudinal analysis of Doppler waveforms in the umbilical artery (UA) and middle cerebral artery (MCA). Materials and Methods: This was a retrospective study that included 30 fetuses at risk for preterm birth. Twenty-eight pregnant women were treated with betamethasone for fetal lung maturation. Doppler examinations of the UA and MCA were performed once before and three or eight times after corticosteroid administration. We used a Bayesian hierarchical linear model. Reference ranges were constructed, and associations between variables (gestational age and pre-eclampsia) were tested. Results: The mean maternal age, gestational age at betamethasone administration, and gestational age at delivery were 32.6 ± 5.89 years, 30.2 ± 2.59 weeks, and 32.9 ± 3.42 weeks, respectively. On UA Doppler, there was a significant decrease in the pulsatility index (PI) after corticosteroid administration, with a mean of 0.1147 (credibility interval: 0.03687-0.191) in three observations and a median of 0.1437 (credibility interval: 0.02509-0.2627) in eight observations. However, there was no significant change in the Doppler MCA PI, regardless of gestational age and the presence or absence of pre-eclampsia. Conclusion: Although antenatal corticosteroid administration induced a significant decrease in the Doppler UA PI, we observed no change in the cerebral vasculature.

During pregnancy, the various changes women undergo can affect their health status. Manual therapies are important aids because they do not use medication. This study aimed to evaluate the influence of osteopathic manipulative treatment on the intensity of lumbar and pelvic pain and changes in quality of life. This prospective study included women over 18 years old and between 27 and 41 weeks pregnant, and excluded women with fetal malformations, multiple fetuses, premature rupture of membranes, and in labor. Forty-six pregnant women were selected and divided into two groups of ≤3 and ≥4 visits. Statistically significant improvements were observed in the intensity of maximum low back pain (7.54 ± 1.47 vs. 3.815 ± 1.73, p ≤ 0.01) and minimum low back pain (5.67 ± 2.03 vs. 3.111 ± 1.67, p ≤ 0.01), maximum pelvic pain (6.54 ± 2.22 vs. 2.77 ± 1.64, p = 0.01), and minimum pelvic pain (5.615 ± 2.21 vs. 2.615 ± 1.66, p = 0.01). Both groups achieved improvements in quality of life indices, with the improvements achieved by the ≥4-visits group being statistically significant. Osteopathic treatment was effective in reducing the intensity of lumbar and pelvic pain and in improving the quality of life of pregnant women in the third trimester.

Pallister − Hall syndrome is a rare malformation that involves the presence of a suprasellar hamartoma and associated malformations. Prenatal diagnosis is also rare, and few cases have been reported using magnetic resonance imaging (MRI). A 35-year-old G5P2A2 woman at the 35th week of gestation was referred to our service. Fetal MRI showed an isointense image in the suprasellar region, pushing the brainstem up and backward, and compressing the vermis and cerebellum on T2-weighted images. On T1-weighted images, the hypointense signal of the tumor was similar to that of the brain parenchyma. Ultrasound images showed a suprasellar mass, which was more echogenic than the normal cerebral parenchyma, posteriorly pushing the brain stem, with involvement of the vermis of the tumor and compression of the posterior fossa. Three-dimensional reconstruction using MRI scan data showed a space view of the tumor and its relationships with the other brain tissues allowing better understanding by parents and multidisciplinary team.