Compara la asociación entre el apoyo de la pareja y la depresión en gestantes del tercer trimestre de embarazo que acuden al Instituto Nacional Materno Perinatal en los meses de junio y julio del 2017. Estudio observacional, analítico de casos y controles, prospectivo y transversal, en el que se cuenta con dos grupos: 45 gestantes con depresión (grupo caso) y 45 gestantes sin depresión (grupo control), que cumplen con los criterios de selección. Se usa la estadística inferencial mediante la prueba de ji cuadrado de Pearson (X2), el cual se considera significativo cuando el valor de p es menor a 0.05. Los resultados revelan que las gestantes tienen grado de instrucción secundaria (con depresión: 57.8% y sin depresión: 64.4%), ocupación ama de casa (con depresión: 57.8% y sin depresión: 62.2%), estado civil conviviente (con depresión: 62.2% y sin depresión: 60%) y religión católica (con depresión: 71.1% y sin depresión: 82.2%). De acuerdo a las dimensiones, se encuentra asociación entre el apoyo emocional (p=0.000), el apoyo instrumental (p=0.001), el apoyo informacional (p=0.000) y el apoyo valorativo (p=0.000) con la presencia de depresión en las gestantes. A nivel general, la falta de apoyo por parte de la pareja se asocia significativamente con la presencia de depresión en las gestantes (p=0.000), aumentando 7 veces el riesgo de presentarla (OR:7.61). Concluye que existe asociación significativa entre el apoyo de la pareja y la depresión en gestantes del tercer trimestre de embarazo que acuden al Instituto Nacional Materno Perinatal en los meses de junio y julio del 2017 (p=0.000). / Tesis

Publicación a texto completo no autorizada por el autor / Determina la relación entre la anemia materna durante tercer trimestre de embarazo y los resultados neonatales en gestantes atendidas en el Centro Obstétrico del Hospital Sergio E. Bernales durante el año 2016. Estudio observacional, correlacional, retrospectivo y transversal. Participaron 84 gestantes con anemia durante el tercer trimestre. Los resultados revelan que durante el tercer trimestre del embarazo el 56% de las gestantes presentó anemia moderada, 42.9% anemia leve y el 1.2% anemia severa. Asimismo, se encuentra diferencias estadísticamente significativas entre el grado de anemia de las gestantes y el peso del recién nacido (p=0.000), y la edad gestacional por Capurro de sus recién nacidos (p=0.002). No se observa diferencias estadísticamente significativa entre el grado de anemia de las gestantes con la talla del recién nacido (p=0.39), el Apgar al minuto de sus recién nacidos (p=0.841). / Tesis

Les complications de la grossesse associées à la dysfonction placentaire affectent plus de 10% des femmes enceintes. Il a été proposé que l'activité physique puisse modifier le développement et la fonction du placenta. Nous avons évalué l'association entre la fréquence d'activités physiques (AP) au début de la grossesse et le volume, la perfusion ainsi que certains indices biochimiques de la fonction placentaire chez 94 nullipares. Le volume et la circulation placentaire maternelle ainsi que les niveaux de P1GF et PAPP-A sériques ont été comparés pour des niveaux de fréquence d'AP différents. Nous avons observé une association négative entre la fréquence d'AP et le facteur de croissance placentaire P1GF (p=0.003) et une tendance inversée avec le volume placentaire. Nos résultats suggèrent que la pratique d'AP au début de la grossesse pourrait affecter défavorablement la fonction et le volume placentaire.

Résumé : L’aggravation de certaines caractéristiques cliniques des femmes enceintes (âge, poids) et l’augmentation de la prévalence du diabète gestationnel (DG) poussent à dépister le DG le plus tôt possible pour éviter chez la mère et le fœtus les complications à court et à long terme. Le dépistage du DG est recommandé à 24-28 semaines de grossesse, et le plus souvent un test de tolérance à 50g de glucose (TTG) est réalisé. Pour les femmes qui ont des facteurs de risque, ce test doit être effectué plus précocement, habituellement pendant le premier trimestre de la grossesse. Cette dernière recommandation est peu suivie, d’autant qu’il n’y a pas de consensus international sur le dépistage du DG pendant le premier trimestre de la grossesse. Objectifs. 1) Définir au premier trimestre de la grossesse la valeur de la glycémie du TTG qui prédit le diagnostic de DG à 24-28 semaines avec une sensibilité et une spécificité optimales à l’aide d’une courbe ROC. 2) Déterminer si la glycémie du TTG au premier trimestre est un facteur prédictif indépendant du DG. Méthodes. Étude prospective de cohorte. Les facteurs d'inclusion étaient : âge ≥ 18 ans et âge gestationnel entre 6 et 13 semaines après la dernière menstruation. Les TTG ont été effectués à la première visite prénatale. Une deuxième visite était programmée à 24-28 semaines pour faire une hyperglycémie provoquée par voie orale (HGPO) et donc un éventuel diagnostic de DG. Les critères utilisés pour ce diagnostic étaient ceux de l’Association américaine du diabète. Résultats. Les TTG ont été faits à 9,1±2,0 semaines et les HGPO à 26.5±1.1semaines chez 1180 femmes (28,2±4,4 ans, IMC : 25,2±5,5 kg/m[indice supérieur 2]). Un DG a été diagnostiqué chez 100 (8,4%) participantes. La valeur de glycémie du TTG à 5,6 mmol/L a prédit le DG avec une sensibilité de 84,1% et une spécificité de 62,3%, tandis que la valeur prédictive positive était de 0,121 et la valeur prédictive négative de 0,985. Cette valeur de 5,6 était indépendamment associée au DG (OR=2,806, IC 95%: 1,98 à 3,97, p <0,001). Comparé à d'autres facteurs de risque, le TTG était le plus puissant prédicteur indépendant du DG (OR=1,767, IC 95%: 1,52 à 2,05, p <0,001). Conclusions. Au premier trimestre, la valeur glycémie de 5.6 mmol/L du TTG prédit avec une bonne sensibilité et spécificité l’apparition d’un DG à 24-28 semaines. La glycémie du TTG au premier trimestre est le plus puissant prédicteur indépendant de DG. / Abstract : The changes in clinical characteristics of pregnant women and an increase in the prevalence of gestational diabetes mellitus (GDM) warrant the importance of screening as early as possible in order to possibly prevent short and long-term complications in both the mother and fetus. GDM screening is recommended at 24-28 weeks of pregnancy, using a 50g glucose challenge test (GCT) although women with multiple risk factors are expected to be assessed “early” in pregnancy, a recommendation poorly followed. Most importantly, there is no universal agreement currently in place for GDM screening, particularly during the first trimester of pregnancy. Objectives. 1) To define the cut-off value of GCT during the first trimester in order to predict GDM diagnosed at 24-28 weeks of gestation with optimal sensitivity and specificity using ROC curve. 2) To determine if GCT during the first trimester of pregnancy is an independent predictor of GDM diagnosed at 24-28 weeks gestation. Methods. This is a prospective cohort study. Women were recruited at their first prenatal visit. Inclusion factors were: age ≥ 18 years and gestational age between 6 and 13 weeks from their last menstrual period. GCT were performed at the first prenatal visit. The second visit was scheduled at 24-28 weeks for the diagnostic 75g oral glucose tolerance test (OGTT). GDM diagnosis was made in accordance with the American Diabetes Association guidelines. A variety of statistical analysis including multivariate logistic regression models and ROC curve were used to address the aims of the study. Results. Participants (n=1180, age: 28.2±4.4 years, BMI: 25.2±5.5 kg/m[superscript 2]) underwent GCT at 9.1±2.0 weeks and OGTT at 26.5±1.1 weeks of gestation. GDM was diagnosed in 100 (8.4%) women. The cut-off value of 5.6 mmol/L predicted GDM with 84.1% (75.4-92.7) sensitivity, 62.3% (59.5-65.1) specificity, while the positive predictive value was 0.121 (0.091-0.150) and the negative predictive value was 0.985 (0.975-0.994). This 5.6 value was independently associated with GDM (OR=2.806, 95% CI: 1.98-3.97, p<0.001). Compared to other risk factors, GCT was the strongest independent predictor of GDM (OR=1.767, 95% CI: 1.52-2.05, p<0.001). Conclusions. The cut-off value of 5.6 mmol/L has the optimal sensitivity and specificity for the GCT during the first trimester to predict GDM at 24-28 weeks of gestation according to ADA guidelines. GCT during the first trimester is the strongest independent predictor of GDM at 24-28 weeks of gestation.

Objetivo: Calcular os valores preditivos da ultrassonografia de primeiro trimestre gestacional para a detecção da artéria umbilical única. Avaliar a relação dos marcadores ultrassonográficos de cromossomopatias do primeiro trimestre (translucência nucal, osso nasal e ducto venoso), além da idade gestacional do exame, CCN, sexo fetal, medida da bexiga fetal, alterações de morfologia e IMC da gestante, com a acurácia do diagnóstico no primeiro trimestre. Métodos: Estudo longitudinal prospectivo envolvendo 1.564 gestantes, que foram submetidas à ultrassonografia com avaliação do cordão umbilical entre 11 e 13 semanas e 6 dias, no período de novembro de 2007 a setembro de 2009. Posteriormente, realizaram a avaliação do cordão umbilical em ultrassonografia realizada no segundo ou terceiro trimestres. Foi verificada a concordância do diagnóstico de AUU no primeiro trimestre com o diagnóstico no segundo trimestre, calculando-se o coeficiente Kappa. Os testes qui-quadrado e exato de Fisher foram utilizados para verificar a existência de associação entre a acurácia da ultrassonografia de primeiro trimestre e as variáveis da ultrassonografia e da gestante (translucência nucal, osso nasal, ducto venoso, idade gestacional do exame, CCN, sexo fetal, medida da bexiga fetal, alterações de morfologia e IMC da gestante). Resultados: A concordância dos diagnósticos de AUU no primeiro e segundo trimestres foi moderada (Kappa = 0,609), sendo que a sensibilidade da ultrassonografia de primeiro trimestre em relação à ultrassonografia de segundo trimestre foi de 76%, a especificidade foi de 99%, o valor preditivo positivo foi de 51,6% e o valor preditivo negativo foi de 99,6%. A acurácia foi de 98,7%. Dentre as variáveis analisadas, que poderiam ter influenciado na acurácia da ultrassonografia de primeiro trimestre na detecção de AUU, a única que se mostrou estatisticamente significante foi o sexo fetal. Conclusão: A sensibilidade da ultrassonografia de primeiro trimestre na detecção da AUU é de 76%, o que é menor do que a observada no segundo ou terceiro trimestres. / Objective: To calculate the predictive values of first gestational trimester ultrasonography for detection of single umbilical artery. Assess the relation of ultrasound markers of chromosomal disease in the first trimester (nuchal translucency, nasal bone and ductus venosus) in addition to gestational age at exam, CRL, fetal gender, measurement of fetal bladder, morphological alterations and BMI of a pregnant woman, with accuracy of diagnosis in the first trimester. Methods: A prospective longitudinal study was conducted from November 2007 to September 2009 encompassing 1564 pregnant women submitted to ultrasound imaging for umbilical cord assessment between the 11 and 13 weeks and six days. Later they underwent evaluation of the umbilical cord by ultrasound performed in the second or third trimesters. Consistency of SUA diagnosis in the first trimester was verified with that of the second trimester by calculating the Kaplan coefficient. The Chi-square and Fisher\'s exact tests were used to verify if there was an association between accuracy of ultrasonography of the first trimester and the variables of ultrasonography and those of the pregnant woman (nuchal translucency, nasal bone, ductus venosus, gestational age at exam, CRL, fetal gender, measurement of fetal bladder and morphological alterations as well as pregnant woman\'s BMI). Results: SUA diagnoses in the first and second trimester disclosed moderate consistency (Kaplan=0.609) while sensitivity of first trimester ultrasound in relation to that of the second trimester was of 76% and specificity was of 99%, positive predictive value was of 51.6% and negative predictive value was of 99.6%. Accuracy was of 98.7%. Among the analyzed variables, fetal gender was the only one with a statistical significance that might bear influence on first trimester ultrasound accuracy for detection of SUA. Conclusion: Sensitivity of the first trimester ultrasound for detection of SUA is of 76%, that is to say, lower than that observed in the second or third trimesters

Objetivo: Calcular os valores preditivos da ultrassonografia de primeiro trimestre gestacional para a detecção da artéria umbilical única. Avaliar a relação dos marcadores ultrassonográficos de cromossomopatias do primeiro trimestre (translucência nucal, osso nasal e ducto venoso), além da idade gestacional do exame, CCN, sexo fetal, medida da bexiga fetal, alterações de morfologia e IMC da gestante, com a acurácia do diagnóstico no primeiro trimestre. Métodos: Estudo longitudinal prospectivo envolvendo 1.564 gestantes, que foram submetidas à ultrassonografia com avaliação do cordão umbilical entre 11 e 13 semanas e 6 dias, no período de novembro de 2007 a setembro de 2009. Posteriormente, realizaram a avaliação do cordão umbilical em ultrassonografia realizada no segundo ou terceiro trimestres. Foi verificada a concordância do diagnóstico de AUU no primeiro trimestre com o diagnóstico no segundo trimestre, calculando-se o coeficiente Kappa. Os testes qui-quadrado e exato de Fisher foram utilizados para verificar a existência de associação entre a acurácia da ultrassonografia de primeiro trimestre e as variáveis da ultrassonografia e da gestante (translucência nucal, osso nasal, ducto venoso, idade gestacional do exame, CCN, sexo fetal, medida da bexiga fetal, alterações de morfologia e IMC da gestante). Resultados: A concordância dos diagnósticos de AUU no primeiro e segundo trimestres foi moderada (Kappa = 0,609), sendo que a sensibilidade da ultrassonografia de primeiro trimestre em relação à ultrassonografia de segundo trimestre foi de 76%, a especificidade foi de 99%, o valor preditivo positivo foi de 51,6% e o valor preditivo negativo foi de 99,6%. A acurácia foi de 98,7%. Dentre as variáveis analisadas, que poderiam ter influenciado na acurácia da ultrassonografia de primeiro trimestre na detecção de AUU, a única que se mostrou estatisticamente significante foi o sexo fetal. Conclusão: A sensibilidade da ultrassonografia de primeiro trimestre na detecção da AUU é de 76%, o que é menor do que a observada no segundo ou terceiro trimestres. / Objective: To calculate the predictive values of first gestational trimester ultrasonography for detection of single umbilical artery. Assess the relation of ultrasound markers of chromosomal disease in the first trimester (nuchal translucency, nasal bone and ductus venosus) in addition to gestational age at exam, CRL, fetal gender, measurement of fetal bladder, morphological alterations and BMI of a pregnant woman, with accuracy of diagnosis in the first trimester. Methods: A prospective longitudinal study was conducted from November 2007 to September 2009 encompassing 1564 pregnant women submitted to ultrasound imaging for umbilical cord assessment between the 11 and 13 weeks and six days. Later they underwent evaluation of the umbilical cord by ultrasound performed in the second or third trimesters. Consistency of SUA diagnosis in the first trimester was verified with that of the second trimester by calculating the Kaplan coefficient. The Chi-square and Fisher\'s exact tests were used to verify if there was an association between accuracy of ultrasonography of the first trimester and the variables of ultrasonography and those of the pregnant woman (nuchal translucency, nasal bone, ductus venosus, gestational age at exam, CRL, fetal gender, measurement of fetal bladder and morphological alterations as well as pregnant woman\'s BMI). Results: SUA diagnoses in the first and second trimester disclosed moderate consistency (Kaplan=0.609) while sensitivity of first trimester ultrasound in relation to that of the second trimester was of 76% and specificity was of 99%, positive predictive value was of 51.6% and negative predictive value was of 99.6%. Accuracy was of 98.7%. Among the analyzed variables, fetal gender was the only one with a statistical significance that might bear influence on first trimester ultrasound accuracy for detection of SUA. Conclusion: Sensitivity of the first trimester ultrasound for detection of SUA is of 76%, that is to say, lower than that observed in the second or third trimesters

Les élèves français doivent légalement entrer à l'école élémentaire au mois de septembre de l'année civile où ils atteignent l'âge de six ans. Cela implique que, dans une même classe, il puisse exister une différence d'âge de 12 mois entre les élèves nés en début et en fin d'année. L'analyse de l'effet de ces différences d'âge d'entrée à l'école élémentaire sur le devenir scolaire des élèves constitue l'objectif principal de cette recherche. En s'appuyant sur deux échantillons de 10000 et 2000 écoliers, suivis longitudinalement à partir du cours préparatoire, cette recherche montre d'une part, que l'effet de l'âge d'entrée à l'école est un élément important dans l'explication des différences interindividuelles de réussite scolaire. D'autre part, elle souligne le pouvoir prédictif et discriminant de l'évaluation des habiletés d'autorégulation dans la classe. Enfin, l'examen des liens entre ces deux facteurs et les performances scolaires, par le biais de médiations simples, multiples et modérées, montre que les habiletés d'autorégulation évaluées dans le contexte de la classe constituent un médiateur significatif de l'effet de l'âge sur le devenir des élèves. De plus, les résultats suggèrent que, pour les élèves les plus jeunes, des interventions portées sur ces habiletés d'autorégulation pourraient réduire les inégalités scolaires liées à l'effet de l'âge et s'avérer d'autant plus bénéfiques que les élèves sont en difficulté en début de scolarité.

THESIS SUMMARY:BACKGROUND: Abnormal ductus venosus flow at 11-13 weeks has been associated to fetal chromosomal abnormalities and cardiac defects.The hypothesis of the studies is that flow through the ductus venosus can be assessed routinely at 11-13 weeks of gestation and that abnormal flow at this scan can help identify fetal chromosomal and structural defects as well as adverse pregnancy outcome.STUDIES:In the first study, ten sonographers received practical training in accurate assessment of the ductus venosus and performed 300 examinations each. The sonographers required an average of 80 examinations before they could successfully examine the ductus venosus flow. In the second study ductus venosus flow was assessed immediately before chorion villous sampling (CVS) in fetuses with nuchal translucency (NT) thickness of 3.5 mm or more. A fetal echocardiography was performed in euploid fetuses at 11-13 weeks and/or 18-22 weeks. Reverse or absent flow during atrial contraction was observed in 68.8% of the fetuses with cardiac defects and in 22.9% with no cardiac defects. In the third study screening by the combined test was performed in singleton pregnancies, including 19,614 with euploid fetuses, 122 with trisomy 21, 36 with trisomy 18, 20 with trisomy 13 and 8 with Turner syndrome. We examined the performance of two screening strategies: firstly, assessment of the a-wave in all patients and secondly, first-stage screening using the combined test in all patients followed by second-stage assessment of the a-wave only in those with an intermediate risk of 1 in 51 to 1 in 1,000 after the first-stage. Reversed a-wave was observed in 3.2% of the euploid fetuses and in 66.4%, 58.3%, 55.0% and 75.0% of fetuses with trisomies 21, 18 and 13 and Turner syndrome, respectively. Inclusion of ductus venosus flow in all pregnancies would detect 96%, 92%, 100% and 100% of trisomies 21, 18 and 13 and Turner syndrome, respectively, at a false positive rate of 3%. The same detection rates were achieved with the two-stage strategy at a false positive rate of 2.6%.In the fourth study the patients were subdivided into five groups: normal outcome (n=10,120), miscarriage or fetal death (n=185), abnormal karyotype (n=95), major cardiac (n=20) or non-cardiac defect (n=70). The prevalence of reversed a-wave was significantly higher in the groups with miscarriage or fetal death (10.8%), abnormal karyotype (62.1%) and fetal cardiac defect (25.0%) but not non-cardiac defect (4.3%) than in the normal outcome group (3.7%). The fifth study was a prospective study in 516 dichorionic and 179 monochorionic twin pregnancies. The prevalence of reversed a-wave in the fetal ductus venosus was compared between monochorionic and dichorionic pregnancies and between those with and without pregnancy complications. The prevalence of reversed a-wave in at least one of the fetuses was significantly higher in monochorionic than in dichorionic pregnancies (18.4% vs. 8.3%, p<0.001) and in pregnancies complicated by miscarriage (28.6%, p=0.005), fetal aneuploidy (70.0%, p<0.001) and twin-to-twin-transfusion syndrome (TTTS) (38.5%, p<0.001) compared to the pregnancies with two healthy live births (7.7%). Pregnancy outcome was normal in 76.7% dichorionic and in 42.4% monochorionic twins with reversed a-wave in at least one of the fetuses.CONCLUSIONS: After an extensive supervised training, ductus venosus flow assessment can be incorporated into the first trimester scan, where it improves the performance of screening for chromosomal defects and cardiac defects, and it helps to identify the fetuses with a higher risk of death. Similarly, in twin pregnancies ductus venosus assessment identifies the pregnancies with a higher risk of having a fetus with an aneuploidy, those with a higher risk of miscarriage, and those that will subsequently develop TTTS.KEY WORDS: Ductus venosus, First trimester, Chromosomal abnormality, Cardiac effect, Adverse outcome, Twin pregnancy

Objetivo: Determinar os valores dopplervelocimétricos normais do fluxo através da valva tricúspide em gestações únicas, entre 11 e 13 semanas e seis dias. Examinar a reprodutibilidade dos parâmetros avaliados e sua correlação com variáveis clínicas maternas e obstétricas. Métodos: Estudo prospectivo envolvendo 166 gestações únicas, com desfecho normal, examinadas entre 11 e 13 semanas e seis dias, no período de fevereiro de 2006 a agosto de 2008. Foram aferidas as velocidades máximas das ondas E e A, duração do ciclo cardíaco completo e sua fase diastólica e calculadas as relações onda E/onda A e diástole/ciclo. Os valores normais foram descritos pelas respectivas médias e desvio-padrão. Para análise da reprodutibilidade desses parâmetros foi calculado o coeficiente de correlação intra-classes em 12 casos examinados por dois examinadores. Regressão linear simples e multivariada foram empregadas para examinar a correlação dos parâmetros dopplervelocimétricos entre si e com a idade gestacional, a medida da translucência nucal e variáveis maternas. Resultados: Neste intervalo gestacional, os valores normais encontrados foram: onda E, 25 (± 4,6) cm/s; onda A, 42,9 (± 5,9) cm/s; relação E/A, 0,58 (± 0,07); ciclo cardíaco, 390 (± 21,1) ms; diástole, 147 (± 18) ms; relação diástole/ciclo, 0,38 (± 0,04). Entre as variáveis dopplervelocimétricas, foi observada correlação significativa entre o ciclo cardíaco e diástole (r=0,53; p<0,0001), diástole e onda A (r=-0,15; p=0,05), ondas E e A (r=0,77; p<0,0001), onda E e relação D/C (r=0,16; p=0,04), onda A e relação diástole/ciclo (r=-0,17; p=0,03). Todas as variáveis, exceto a velocidade da onda A, correlacionaram-se positivamente com a idade gestacional. Não foi observada correlação significativa das variáveis com a medida da translucência nucal, e, na comparação com as variáveis maternas, apenas a onda E e a idade materna apresentaram correlação significativa (r=-0,18, p=0,04). Os coeficientes de correlação intra-classes para a avaliação interobservador e intra-observador (examinadores um e dois) foram: onda E = 0,53 (0,53 e 0,64); onda A = 0,45 (0,46 e 0,49); ciclo cardíaco = 0,70 (0,79 e 0,84) e diástole = 0,63 (0,85 e 0,82). Conclusão: O presente estudo estabeleceu os valores normais dos parâmetros dopplervelocimétricos do fluxo através da valva tricúspide e demonstrou que tais parâmetros, com exceção da onda A, correlacionaram-se de forma positiva com a idade gestacional, e apresentaram reprodutibilidade boa/moderada. / Objective: To establish the measurements of normal tricuspid valve flow velocities at 11 to 13 weeks and 6 days to determine E-wave, A-wave, E/A ratio, cardiac cycle length, diastole length, diastole/cardiac cycle ratio, and their relationship with gestational age, nuchal translucency thickness, the characteristics of the study population, and to assess the reproducibility of flow measurements. Methods: Between February, 2006, and August, 2008, a total of 166 women with a singleton normal pregnancy between 11 and 13 + 6 weeks of gestation consented to participate in the study. Analysis of the waveforms consisted of calculation of peak velocity (cm/s) of the E-wave and A-wave, E-wave/A-wave ratio, cardiac cycle length (ms), diastole length (ms) and diastole/cardiac cycle ratio. To evaluate the intraobserver and interobserver agreement, a subgroup of 12 patients, chosen randomly, was examined twice by each examiner. For descriptive analysis of the results were calculated average and standard deviation. Simple and multivariate linear regression was used to establish the correlation between dopplervelocimetry among parameters and with gestational age, nuchal translucency thickness and the characteristics of the study population. Results: The average (± standard deviation) for transtricuspid flow-velocities waveforms parameters were: E-wave 25 (± 4.6) cm/s; A-wave 42.9 (± 5.9) cm/s; E/A ratio 0.58 (± 0.07); cardiac cycle length 390 (± 21.1) ms; diastole length 147 (± 18) ms; diastole/cardiac cycle length 0,38 (± 0.04). A statistically significant linear increase relative to gestational age was established for all parameters, except A-wave. Nuchal translucency thickness was not correlated with any parameter. A statistically significant negative regression coefficient was established for E-wave to maternal age (r=-0,18, p=0,04). A statistically significant relationship was established between: cardiac cycle length and diastole length (r=0.53; p<0.0001); diastole length and A-wave velocity (r=-0.15; p=0.05); E-wave and A-wave velocities (r=0.77; p<0.0001); E-wave velocity and D/C ratio (r=0.16; p=0.04); A-wave velocity and D/C ratio (r=-0.17; p=0.03). The intraclass correlation coeficients of interobserver and intraobsever evaluations (examiners 1 and 2) were: Ewave = 0.53 (0.53 and 0.64); A-wave = 0.45 (0.46 and 0.49); cardiac cycle = 0.70 (0.79 and 0.84) and diastole= 0.63 (0.85 and 0.82). Conclusions: These data determine normal parameters for tricuspid valve dopplervelocimetry and shows that these parameters, except A-wave, have positive correlation with gestational age, and good/moderate reproducibility.

O objetivo desse estudo foi determinar os valores do volume do líquido amniótico e do embrião, pela ultra-sonografia bidimensional e tridimensional em gestantes normais da 8ª a 11ª semana de gestação. Realizamos estudo prospectivo longitudinal em 25 fetos normais. Os critérios de inclusão foram gestações únicas, avaliação clínica e laboratorial normal e os de exclusão, gestantes portadoras de patologias maternas e/ou próprias da gestação, como também as usuárias de fumo, álcool ou drogas. Todas as pacientes assinaram o termo de consentimento esclarecido pós-informado. Os exames foram realizados por dois observadores que utilizaram aparelho ultra-songráfico modelo SA-9900 (MEDISON), transdutor endovaginal volumétrico, banda larga, de 5- 6,5 MHz, com 120 0 de campo visual. Cada gestante foi avaliadana 8ª, 9ª, 10ª e 11ª semana de gestação. O estudo bidimensional consistiu da determinação das medidas volumétricas por cálculo matemático baseado na forma do elipsóide, averiguando-se o volume do saco amniótico total e do embrião. No estudo tridimensional o volume do líquido amniótico foi feito pela técnica VOCAL. Em ambos o volume do líquido amniótico foi obtido da subtração da medida do volume do saco amniótico pela medida volumétrica do embrião. Os dados foram analisados pela análise de variância (ANOVA), correlação e análise de regressão. Em todas as análises foi utilizado como nível de significância p< 0,05. O volume do líquido amniótico (V LA ) pela ultra-sonografia bidimensional aumentou de 5,45 cm3 para 39,52 cm 3 da 8ª para a 11ª semana (ANOVA - p< 0,05). A correlação entre a idade gestacional e o volume do líquido amniótico foi forte e positiva (p< 0,001,r 2 = 88,3%). No estudo tridimensional o volume do líquido amniótico aumentou de 5,75 cm 3 para 42,96 cm 3 da 8ª para a 11 semana (ANOVA - p< 0,05). A correlação entre a idade gestacional e o volume do líquido amniótico foi forte e positiva (p< 0,001,r 2 = 98,1%). Concluindo, o volume do líquido amniótico e do embrião aumenta progressivamente da 8ª para a 11ª semana de gestação tanto na avaliação bidimensional como natridimensional. A estimativa do volume do líquido amniótico na ultra-sonografia tridimensional é menor que a bidimensional na 9ª e 10ª semana gestacional e maior na 11ª semana de gestação. O volume do embrião é maior pela técnica tridimensional do que pela bidimensional em todas as semanas gestacionais avaliadas. / The objective of this study was to determine amniotic fluid and embryo volumes by two-dimensional and three-dimensional ultrasonography in normal pregnant women from the 8th to the 11th week of gestation. We made a prospective longitudinal study on 25 normal fetuses. Inclusion criteria were singleton fetuses and normal clinical and laboratoryevaluation, and exclusion criteria were pregnant women withmaternal diseases and/or diseases typical of pregnancy, smokers, and alcohol or drug users. All patients signed an informed consent form. The tests were performed by two observers using an ultrasonography apparatus model SA-9900 (MEDISON), a volumetric endovaginal transducer, a 5-6.5 Hz broad band and 120 o of visual field. Each pregnant woman was evaluated in the8 th ,9 th , 10 th and 11 th week of gestation. The two-dimensional study consisted of the determination of volumetric measurements by a mathematical calculation based on the ellipsoid shape, with determination of total amniotic sac volume and embryo volume. In the three-dimensional study the amniotic fluid volume was determined by the VOCAL technique. In both methods, the amniotic fluid volume was obtained by subtracting the volumetric measurement of the embryo from the measurement of the amniotic sac volume. Data were analyzed statistically by analysis of variance (ANOVA), by correlation and by regression analysis, with the level of significance set at p< 0.05 in all analyses. The amniotic fluid volume (V AF ) determined by two-dimensional ultrasonography increased from 5.45 to 39.52 cm 3 from the8 th to the 11 th week (ANOVA - p< 0.05). There was a strongpositive correlation between gestational age andVAF (p< 0.001,r 2 = 88.3%). In the three-dimensional study,VAF increased from 5.75 to 42.96 cm 3 from the8 th to the 11 th week (ANOVA - p< 0.05). The correlation between gestational age andVAF was strong and positive (p< 0.001,r 2 = 98.1%). In conclusion, the volume of the amniotic fluid and of the embryo increased progressively from the 8th to the 11th week of gestation both when evaluated by two-dimensional and three-dimensional ultrasonography. The estimate ofVAF obtained by three-dimensional ultrasonography was lower than that obtained by two-dimensional ultrasonography in the 9th and 10th week of gestation and higher in the 11th week of gestation. The embryo volume obtained by the three-dimensional technique was larger than that obtained by the two-dimensional technique in all gestational weeks evaluated.