Ultrassonografia modo-b e elastografia da estrutura uteroplacentária durante o período gestacional e pós-parto de cadelas
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Data
2019-12-05
Autores
Simões, Ana Paula Rodrigues [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Os objetivos deste estudo foram avaliar e caracterizar a estrutura uteroplacentária durante o período gestacional e pós-parto, em cadelas submetidas a cesariana ou parto normal por meio da ultrassonografia modo-B e elastografia “Acoustic Radiation Force Impulse” (ARFI). Foram utilizadas 12 cadelas braquicefálicas, com peso entre 10 a 15 quilos e 2 a 5 anos. Após revisão do histórico clínico, realização de exames prévios e verificada a higidez, as gestantes foram submetidas aos exames ultrassonográfico convencional e elastografia da estrutura uteroplacentária, com a utilização do aparelho ultrassonográfico ACUSON S2000™/SIEMENS® equipado com transdutor linear de 9,0 MHz. A avaliação da estrutura placentária (materna, fetal e materno-fetal) foi realizada diariamente a partir do dia 15 de gestação ao parto; do dia 56 de gestação à parturição as avaliações foram realizadas a cada 12 horas. O estudo da involução uterina (miométrio e endométrio) iniciou imediatamente após o parto, sendo diário e até o dia 10 do puerpério. Foram verificados biometria (mm); velocidade da onda de cisalhamento (SWV m/s) e rigidez tecidual através dos softwares VTTQ™ (Virtual Touch™ Tissue Quantification) e VTIQ™ (Virtual Touch™ Tissue Imaging Quantification). Os resultados das variáveis foram comparados pela análise de variância (ANOVA). A significância estatística foi estabelecida em 95% (P < 0,05). A espessura placentária materno-fetal aumentou até o dia 63 de gestação (P < 0,0001; R² = 0,91), a espessura materna aumentou até o dia 40 de gestação (P = 0,0340; R² = 0,54) e a espessura fetal até o dia 50 de gestação (P < 0,0001; R² = 0,83). A velocidade da onda de cisalhamento (SWV) da área dorsal (P < 0,0010) foi maior que a lateral, que por sua vez foi maior (P = 0,020) que a área ventral. A SWV da área dorsal, determinada pelo VTTQ ™, diminuiu do dia 21 ao dia 35 e aumentou no dia 56 da gestação (P = 0,0291; R² = 0,4021); A SWV lateral diminuiu do dia 24 ao dia 45 e aumentou até o momento do parto (P < 0,001; R² = 0,6055). A SWV da área dorsal, conforme determinada pelo VTTIQ ™, diminuiu do dia 21 ao dia 43 e depois aumentou no dia 60 da gestação (P = 0,0016; R² = 0,5075); e a SWV da área ventral aumentou do dia 21 ao dia 23 e diminuiu até o momento do parto (P < 0,001; R² = 0,8055). O diâmetro uterino foi maior (P = 0,012) no pós-parto dos animais submetidos à cesariana (15,26 ± 4,73 mm) comparado ao parto normal (12,53 ± 2,64 mm) durante os primeiros sete dias pós-parto. A espessura uterina evoluiu gradualmente nos dois grupos (P < 0,0001), o miométrio durante os primeiros nove dias (P = 0,005) e o endométrio durante os primeiros seis dias (P = 0,003). As SWV´s miometriais e endometriais foram semelhantes entre os tipos de parto (P = 0,7846 e 0,8273) e apresentaram aumento gradual (P = 0,411; 0,0043, respectivamente), durante os primeiros 10 dias pós-parto. As avaliações foram factíveis e não causaram alterações na viabilidade materna, fetal ou neonatal, com resultados promissores e correspondência com o desenvolvimento gestacional normal, constituindo o primeiro estudo a empregar a ARFI na avaliação da estrutura uteroplacentária em cadelas, fornecendo bases para estudos que envolvam processos patológicos em outras espécies.
The objectives of this study were to evaluate and characterize the uteroplacental structure during gestational and postpartum periods in bitches using B-mode ultrasound and Acoustic Radiation Force Impulse (ARFI). Twelve brachycephalic bitches, weighing between 10 - 15 kg and 2 - 5 years, were used. After revision of clinical history, general examination and verified the healthiness, pregnants underwent to conventional ultrasonographic and elastography examinations of uteroplacental structure, using ACUSON S2000 ™ ultrasound / SIEMENS® equipped with a 9.0 MHz linear transducer. The evaluation of the placental structure (maternal, foetal and maternal-foetal) was performed daily from the day 15 of gestation to delivery; from the day 56 of gestation to the parturition evaluations were performed every 12 hours. The study of uterine involution (myometrium and endometrium) started immediately after delivery, being daily until the day 10 of puerperium. Was verified biometry (mm); shear wave velocity (SWV m / s) and tissue stiffness through softwares VTTQ ™ (Virtual Touch ™ Tissue Quantification) and VTTIQ™ (Virtual Touch ™ Tissue Imaging Quantification). The results of the variables were compared by analysis of variance (ANOVA). Statistical significance was set at 95% (P < 0.05). Maternal-fetal placental thickness increased to day 63 (P < 0.0001; R² = 0.91); maternal placental thickness increased until day 40 (P = 0.0340; R² = 0.54); and fetal placental thickness increased to day 50 (P < 0.0001; R² = 0.83) of gestation. Shear wave velocity (SWV) of the dorsal (P < 0.0010) was greater than lateral, which in turn was greater (P = 0.020) than the ventral area. The SWV of the dorsal area as determined using VTTQ, decreased from day 21 to 35 and increased to day 56 of gestation (P = 0.0291; R² = 0.4021); lateral SWV decreased from day 24 to 45 and increased until the time of parturition (P < 0.001; R² = 0.6055). The SWV of the dorsal area, as determined using VTTIQ, decreased from day 21 to 43 and then increased to day 60 of gestation (P = 0.0016; R² = 0.5075); and ventral area SWV increased from day 21 to 23 and decreased until the time of parturition (P < 0.001; R² = 0.8055). Uterine diameter was higher (P = 0.012) in the post-partum period of the animals animals submitted to c-section (15.26 ± 4.73 mm) than in normal birth (12.53 ± 2.64 mm) during the first 7 days post-partum. Uterine thickness gradually involuted in both groups (P < 0.0001), the myometrium during the first 9 days (P = 0.005) and the endometrium during the first 6 days (P = 0.003). The myometrial and endometrial SWVs were similar between types of delivery (P = 0.7846 and 0.8273) and presented a gradual increase (P = 0.411; 0.0043, respectively), during the first 10 day post-partum. The evaluations were feasible and did not cause changes in maternal, foetal or neonatal viability, with promising results and correspondence with normal gestational development, being the first study to use ARFI to evaluate the uteroplacental structure in bitches, providing bases for studies involving pathological processes in other species.
The objectives of this study were to evaluate and characterize the uteroplacental structure during gestational and postpartum periods in bitches using B-mode ultrasound and Acoustic Radiation Force Impulse (ARFI). Twelve brachycephalic bitches, weighing between 10 - 15 kg and 2 - 5 years, were used. After revision of clinical history, general examination and verified the healthiness, pregnants underwent to conventional ultrasonographic and elastography examinations of uteroplacental structure, using ACUSON S2000 ™ ultrasound / SIEMENS® equipped with a 9.0 MHz linear transducer. The evaluation of the placental structure (maternal, foetal and maternal-foetal) was performed daily from the day 15 of gestation to delivery; from the day 56 of gestation to the parturition evaluations were performed every 12 hours. The study of uterine involution (myometrium and endometrium) started immediately after delivery, being daily until the day 10 of puerperium. Was verified biometry (mm); shear wave velocity (SWV m / s) and tissue stiffness through softwares VTTQ ™ (Virtual Touch ™ Tissue Quantification) and VTTIQ™ (Virtual Touch ™ Tissue Imaging Quantification). The results of the variables were compared by analysis of variance (ANOVA). Statistical significance was set at 95% (P < 0.05). Maternal-fetal placental thickness increased to day 63 (P < 0.0001; R² = 0.91); maternal placental thickness increased until day 40 (P = 0.0340; R² = 0.54); and fetal placental thickness increased to day 50 (P < 0.0001; R² = 0.83) of gestation. Shear wave velocity (SWV) of the dorsal (P < 0.0010) was greater than lateral, which in turn was greater (P = 0.020) than the ventral area. The SWV of the dorsal area as determined using VTTQ, decreased from day 21 to 35 and increased to day 56 of gestation (P = 0.0291; R² = 0.4021); lateral SWV decreased from day 24 to 45 and increased until the time of parturition (P < 0.001; R² = 0.6055). The SWV of the dorsal area, as determined using VTTIQ, decreased from day 21 to 43 and then increased to day 60 of gestation (P = 0.0016; R² = 0.5075); and ventral area SWV increased from day 21 to 23 and decreased until the time of parturition (P < 0.001; R² = 0.8055). Uterine diameter was higher (P = 0.012) in the post-partum period of the animals animals submitted to c-section (15.26 ± 4.73 mm) than in normal birth (12.53 ± 2.64 mm) during the first 7 days post-partum. Uterine thickness gradually involuted in both groups (P < 0.0001), the myometrium during the first 9 days (P = 0.005) and the endometrium during the first 6 days (P = 0.003). The myometrial and endometrial SWVs were similar between types of delivery (P = 0.7846 and 0.8273) and presented a gradual increase (P = 0.411; 0.0043, respectively), during the first 10 day post-partum. The evaluations were feasible and did not cause changes in maternal, foetal or neonatal viability, with promising results and correspondence with normal gestational development, being the first study to use ARFI to evaluate the uteroplacental structure in bitches, providing bases for studies involving pathological processes in other species.
Descrição
Palavras-chave
Biometria, Canino, Elastografia, Gestação, Puerpério, Uteroplacentária, Biometry, Canine, Elastography, Gestation, Puerperium, Uteroplacental