Obstetric outcomes of pre-induction of labor with a 200 µg misoprostol vaginal insert.

OBJECTIVES: Labor induction is indicated in 20% to 40% of pregnancies. Over half of pregnancies qualified for the induction of labor require stimulation of the cervix to ripen. The drug used increasingly more often in pre-induction is the PGE-1 pros-taglandin analog - misoprostol 200 µg. MATERIAL AND METHODS: The study includes a total of 100 patients qualified for labor pre-induction with Misodel® (miso-prostol 200 µg vaginal insert). The study group comprises two subgroups: primigravidas and multiparas. Assessments included: indications for labor pre-induction, time from Misodel application to delivery, caesarean section rate and indica-tions, duration of first and second stage of labor, rate of vaginal deliveries, need for oxytocin or fenoterol administration side effects and newborn condition. RESULTS: The most common indication for labor induction was gestational diabetes and pregnancy past term. The average time to vaginal delivery was 14 h 45 min, time to the onset of active phase of labor - 11 h 45 min, time to membranes' rupture - 15 h, time to vaginal delivery - 14 h 18 min. The times of multiparas were significantly shorter. The rate of vaginal deliveries within 12 hours amounted to 42.42%, while within 24 hours it reached 83.33%. The overall caesarean section rate was 33%. The most common indication for caesarean section was the risk of intrauterine hypoxia. Tachysystole and hyperstimulation was observed in 4% of cases, while abnormalities in the cardiotocographic tracing in 43%. CONCLUSIONS: Misodel is an effective method for labor pre-induction, without affecting the caesarean section rate and has no adverse effect on the newborn condition.

[Evaluation of carbetocin and oxytocin efficacy in prevention of postpartum hemorrhage in women after cesarean section]. / Ocena skutecznosci karbetocyny i oksytocyny w profilaktyce krwawien poporodowych u kobiet po cieciu cesarskim.

INTRODUCTION: Postpartum hemorrhage (PPH) constitutes the main cause of delivery-related maternal mortality worldwide. Identification of the risk factors, as well as knowledge about preventive measures and adequate management, allow to limit blood loss. Oxytocin, carbetocin, methylergometrine, dinoprostone, suiprostone, and misoprostol are commonly used drugs in prevention of PPH. OBJECTIVES: The aim of the study was to evaluate the efficacy of carbetocin and oxytocin in prevention of PPH after cesarean section. MATERIAL AND METHODS: The study included 130 female patients after C-section who received 1 00 pg of carbetocin i.v. as a preventive agent after the surgery The control group consisted of 60 women who received 10 units of oxytocin i.v. In the study the risk factors for PPH were determined, and hemoglobin and hematocrit values before and 12 hours after birth, as well as blood loss and the need to use other prevyentfive and operational methods were evaluated. Results were compared between the groups. Statistical analysis was performed with the use of Statistica for hemoglobin and hematocrit values. The p-value of < or = 0.05 was considered as statistically significant. RESULTS: Risk factors for PPH occurred in almost 100% of the women with carbetocin and in 90% of the women with oxytocin. The decrease in hemoglobin and hematocrit levels was not statistically significant, although a greater drop was detected in the group with oxytocin (hemoglobin - 1.24 vs. 1.17 g%, hematocrit - 3.26 vs. 2.93%). The decrease in hematological values was not statistically significant between both groups. In the group with'carbetocin, there was no need for additional pharmacological therapy or operative procedures. No adverse events in either of the groups were observed. CONCLUSIONS: (1.) Carbetocin effectively prevents PPH after C-section. (2.) Carbetocin seems to have high efficiency in PPH prevention in pregnant women classified to the PPH risk group. (3.) Efficacy of Carbetocin in PPH prevention is higher than oxytocin.

[Clinical study of perinatal hysterectomy between 2000-2011 in the clinic of obstetrics, gynecological diseases and oncological gynecology in Bydgoszcz]. / Analiza kliniczna okoloporodowego wyciecia macicy w latach 2000-2011 w Klinice Poloznictwa, Chorób Kobiecych i Ginekologii Onkologicznej w Bydgoszczy.

INTRODUCTION: Perinatal hysterectomy (PH) is usually a life-saving procedure, which is performed after all conservative treatment options fail. The PH frequency rate ranges from 0.04 to 0.23%. The most frequent indications for this procedure include: abnormal placental implantation, placenta previa, uterine rupture and uterine atony OBJECTIVE: Clinical study of perinatal hysterectomy cases taking into consideration the frequency indications, complications and risk factors related to this procedure. MATERIALS AND METHODS: The study included 16 women who underwent perinatal hysterectomy at the Department and Clinic of Obstetrics and Gynecological Diseases between 2000-2011. The following data were collected from medical records: course of pregnancy labor and puerperium. The profile of the study group was conducted in terms of: maternal age, parity gestation length, history of caesarean sections and gynecological operations. The following factors were studied: the termination of pregnancy, indications for caesarean section, hysterectomy-related complications and indications, neonatal birth weight and Apgar score. The statistical analysis was performed using Statistica 9.1 by StatSoft. Data are expressed as the arithmetic mean and standard deviation (SD). RESULTS: Sixteen perinatal hysterectomy procedures were performed, accounting for 0.066% of the overall number of labors. Average maternal age and pregnancy length were 31.6 years [SD+/-6.3] and 36.1 weeks of gestation [SD+/-3.4], respectively PH was more frequently performed among multiparous women (81.25%) and after caesarean sections (87.5%). Fetal asphyxia was the most frequent indication for caesarean section (35.7%). Fourteen percent of all indications accounted for the lack of consent from a pregnant woman to make an attempt at spontaneous vaginal delivery after previous c-section. Fifty percent of the women from the study group had a previous caesarean section, whereas 25% had more than one prior c-section. Between 2009-2011, as compared to previous years, the highest percentage of hysterectomies (80%) was reported in pregnant women after a previous caesarean section. The most frequent indication for hysterectomy included abnormal placental implantation (43.75%) diagnosed more often in patients with a history of caesarean section (57%). Among PH complications, a hemorrhagic shock was reported in 37.4% and bladder injury in 18.7% of the women. Every patient required a transfusion of erythrocyte concentrate, 4.7 units [SD+/-3.5] on average. Twenty-five percent of the neonates were born in poor condition with an Apgar score of 1-3. In case of all women, the therapy required cooperation of different specialists including obstetricians, anesthesiologists, urologists, surgeons and general practitioners. CONCLUSIONS: 1. Current and previous caesarean section constitutes a risk factor for perinatal hysterectomy 2. Placental pathology is the most frequent indication for perinatal hysterectomy 3. The growing number of caesarean sections should encourage obstetricians to conduct a more careful analysis of indications.

[Evaluation of the efficacy and safety of Foley catheter pre-induction of labor]. / Ocena skutecznosci i bezpieczenstwa preindukcji porodu cewnikiem Foley'a.

INTRODUCTION: Labor induction is being increasingly used (15-30% of pregnancies). The most common indications include late pregnancy preeclampsia, intrauterine fetal growth retardation (IUGR), hypertension. Preinduction by speeding up the ripening of the cervix increases the chances of successful induction. There are mechanical and pharmacological methods of pre-induction: the Foley catheter hygroscopic dilators, prostaglandin gel, misoprostol. There are various schemes of labor pre-induction and the differences relate primarily to duration of catheter time, amniotomy or the start of the oxytocin. Numerous studies on pre-induction and induction of labor aimed to compare the efficacy of these different methods. The effectiveness of the Foley catheter is usually assessed by comparing cervical maturity (Bishop score) and ripening of the cervix, evaluated in centimeters, before and after removing the cathetec time to labor since pre-induction and the number of births. In order to select the appropriate method, its safety for the mother and the fetus/newborn needs to be assessed. According to most authors, the use of a Foley catheter does not cause over-stimulation of the uterus, does not increase the risk of rupture or intrauterine infection, and does not adversely affect the fetus and newborn. AIM OF THE STUDY: To assess the efficacy and safety of labor pre-induction using a Foley catheter MATERIAL AND METHODS: The study included 109 women hospitalized between 03.01.2011 and 11.30.2011, who underwent labor pre-induction with a Foley catheter The inclusion criteria were: one fetal pregnancy longitudinal cephalic fetal position, completed 36 weeks of pregnancy fetal bladder preserved, Bishop score < 5 points. The exclusion criteria were: placenta previa, uterine infection, unexplained bleeding, abnormal fetal heart rate, and other reasons preventing vaginal delivery such as fetal weight above 4500 g. Vaginal swabs for the presence of Streptococcus agalactiae (GBS) were obtained from each patient. In case of a positive result perinatal antibiotic prophylaxis was administered before insertion of the catheter The study group was divided into two subgroups according to parity: primiparous and multiparous. Indications for induction, method of pregnancy termination, the pregnancy and its complications were evaluated. The condition of the newborns was evaluated using the Apgar score, cord blood pH and infant birth weight. We analyzed cervical ripeness (Bishop score) before the insertion and after the removal of the catheter and serum C-reactive protein (CRP) before and 20 hours after insertion. CRP was not studied in pregnant women diagnosed with GBS colonization. The results were compared between the subgroups. An increase in the Bishop score to> 5 and delivery within 12 hours since the planned removal of the catheter regardless of the method of pregnancy and the use of oxytocin, was considered as successful induction of labor RESULTS: Catheter pre-induction was performed in 109 pregnant women, what amounted to 7.87% all of deliveries in our department during the analyzed period. Mean patient age was 29.3 +/- 5.35 years, mean duration of pregnancy 40 weeks of gestation (+/- 1 week 5 days), and primiparas constituted 66.06% of all cases. The most common indication for labor induction was post-term pregnancy (55.05%), hypertension and preeclampsia (16.51%). The following complications were observed in the study group after insertion of the catheter: 8 (7.34%) cases of premature rupture of the membranes (PROM), but none of them occurred in the process of inserting the catheter 11 (10.09%) women had the catheter removed (patients request) due to pain and the feeling of discomfort before the scheduled time, 2 (1.84%) cases of bleeding (in the first case the cesarean section was performed and the baby was born in a good overall condition, in the second case the bleeding subsided spontaneously). There was a statistically significant increase in the Bishop score for the entire study group and in the two subgroups. Mean increase in the Bishop score was 2.68 +/- 1.39 points for the entire cohort (p < 0.005). The rate of successful pre-induction resulting in a delivery was 69.4%, with vaginal births accounting for 66.67% of all cases. Also, 30.66% of the pregnant women did not require the use of oxytocin. The most common indication for cesarean section was threatening intrauterine fetal asphyxia. Higher efficiency of pre-induction was found in the multiparous group. The observed increase in CRP (p < 0.005) was within the normal range for pregnant women (< 12 mg/I). None of the patients showed any clinical signs of infection. Mean birth weight of the infants was 3392 +/- 644.72 g, mean Apgar score was 9.5 +/- 0.80 and mean cord blood pH was 7.3 +/- 0.08. CONCLUSIONS: The Foley catheter is an effective method of inducing cervical maturation. The Foley catheter is safe method of labor induction for the mother fetus and newborn.

[Alcohol--woman, pregnancy and a newborn child]. / Alkohol--kobieta, ciaza, noworodek.

According to the World Health Organization, alcohol is the third most dangerous factor following smoking of tobacco and hypertension of risks impacting health of the population. 50 % of men and 10 % of women suffer from diseases caused by alcohol drinking. Chronic consumption of alcohol damages the nervous system, causes adverse changes in the circulatory system and intestine, increases the risk of cancers. Comparing the impact of alcohol on the health of women and men, in case of women, even similar levels of consumption cause stronger action. Alcohol is the cause of endocrine diseases and among others- reduces fertility. It is the risk factor of premature deliveries, abortions, and placenta- associated pathologies. Disorders of children with prenatal exposure to alcohol are described as fetal alcohol syndrome, alcohol related neurodevelopmental disorders and alcohol related birth defects. It is recommended to impose a total ban on alcohol consumption by pregnant women. Moreover one should emphasize that the minimum safe dose of alcohol for the foetus cannot be specified. In order to resolve alcohol drinking problems a cooperation of representatives of many professions such as: doctors, psychologists, educators and employees of care facilities is necessary. It is also obligatory to obtain support and assistance from the nearest surroundings of the patient.

[The phenomenon of alcoholism in Poland as a legal issue]. / Zjawisko alkoholizmu w Polsce jako zagadnienie prawne.

Alcoholism is a problem of a social value. About 140 million people worldwide suffer from alcoholism. Research has demonstrated adverse effects of alcohol. In the scientific project were confirmed: increased risk of cancer, liver disease, abnormal course of pregnancy and development of fetus. Among alcoholics are frequent phenomena of criminal behavior, accidents and trauma. The Polish Constitution granted the right to health citizens. The consequence of the above mentioned constitutional guarantee is the duty of the state that consists in caring for the functioning of a society free from addictions and alcohol problems. The basic legal act in this field is the Act on Upbringing in Sobriety and Counteracting Alcoholism. The state policy in the fight against alcoholism is implemented at various levels of both government and local government. The established National Agency for Solving Alcohol Problems drafts a National Programme for Prevention and Solving Alcohol Problems every year. Also important are public awareness campaigns conducted to raise awareness about the negative effects of alcohol.

[Retrospective analysis of ocular disorders and frequency of cesarean sections for ocular indications in 2000-2008--our own experience]. / Retrospektywna analiza patolog i narz du wzroku i czestosci ciec cesarskich ze wskazan okulistycznych w latach 2000-2008 w materiale wlasnym.

UNLABELLED: 1. Evaluation of frequency of cesarean sections for ocular indications. 2. Analysis of ophthalmological disorders as indications for cesarean section. MATERIAL AND METHODS: 4895 cesarean sections were performed (100 due to ocular indications) in the Department of Obstetrics, Female Pathology and Oncological Gynecology between 2000 and 2008. Medical documentation was analyzed. RESULTS: Among 4895 patients undergoing cesarean sections, 100 (2.04%) presented a written certification from an ophthalmologist suggesting this way of delivery. The frequency of c-sections due to ocular indications continued to increase between 2000-2005 and has been in decline since 2006. The most common ophthalmological disorders included myopia (57%), retinopathy (20%), glaucoma (5%), imminent retinal detachment (4%) and past retinal detachment (3%). In 45% of patients an eye pathology was the only reason for a cesarean section. CONCLUSION: 1. The frequency of cesarean sections due to ocular reasons in our material was 0.7%- 3.44%, average 2.04%. 2. Since 2006 the number of ocular indications for cesarean section has been decreasing. Nevertheless, it remains to be twice as high as in 2000. 3. The most common eye disorders leading to cesarean section were myopia and retinopathy 4. In almost half of the patients the decision to conduct a cesarean section was based solely on ophthalmological indications.

[Prevalence of tobacco smoking among medical staff at Department of Obstetrics and Gynecology Collegium Medicum in Bydgoszcz]. / Rozpowszechnienie palenia tytoniu wsród pracowników Kliniki Poloznictwa i Chorób Kobiecych Collegium Medicum w Bydgoszczy.

Smoking increases the risk of cancer, cardiovascular and respiratory diseases. It has been proven, that cigarette smoking has adverse effects on pregnancy and children health. The particularly important role in efforts to reduce cigarette smoking accounts for representatives of health care. The aim of this study was to analyze the prevalence of smoking among employees of the Clinic. An anonymous questionnaire about smoking cigarettes was prepared. This study involved 135 people. Smokers accounted for 29% of respondents. The highest percentage of smokers was among the lower staff--42%, the lowest among physicians--15%. Nurses and midwives represented the highest average of cigarettes smoked per day--15, in contrast to physicians--11.70% questionned smoked a cigarette in stressful situations. Ban on smoking in the hospital wasn't respected by 31% of smokers. Among non-smokers 62% do not tolerate smoking in their environment. The prevalence of smoking among health staff is still a common phenomenon. It is important to implement educational programs for the staff of healthcare facilities in order to raise the awareness on smoking hazards. It is necessary to effectively enforce the ban on smoking in hospitals by both the hospital mastership and nonsmoking staff and patients.

[History of cigarette smoking. The effect of tobacco smoking on women's health]. / Nikotynizm--rys historyczny. Uzaleznienie od nikotyny a zdrowie kobiety.

History of cigarette smoking started on XV century, when Columb imported tobacco to Europe. Popular using of tobacco we are indebted Jaen Nicot Villeman, the name of nicotine originate from his surname. Tobacco first was exploited like a drug, however now it is a very harmful stimulant. Cigarette smoking is still an actual problem and increased risk of many diseases. Very toxic components of smoke get inside all the organs and upsetting their activities and proper running of the life processes. It is common knowledge that smoking badly influences women's health. Nicotine makes the negative influence on function of ovaries metabolism of hormones and state of osseous tissue. Maternal smoking during pregnancy is associated with obstetrical and pediatrician complication with fetus, newborn and child. The aim of the article is to summarize the role of tobacco smoking on women's health.

[Smoking amongst women arriving at an outpatient clinic in hospital. Nicotine addiction versus disorders in the menstrual cycle]. / Palenie papierosów wsród kobiet zglaszajacych sie do Przyklinicznej Poradni dla Kobiet. Nikotynizm a zaburzenia cyklu miesiaczkowego.

It is common knowledge that smoking badly influences women's health. Nicotine addiction does not only increase the risk of cancerous diseases, blood circulation and coronary system disorders as well as osteoporosis, but also it can cause disorders of the menstrual cycle, infertility and earlier menopause. One hundred and seven patients took part in the research and attended the women's clinic (Clinic "K"). On the basis of the questionnaire, some data was assessed: demographic data, frequency and type of menstrual cycle disorders, fertility and age of menopause occurrence. A group of smoking women (36.05%) was distinguished and non-smoking women (63.95%). A higher percentage of menstrual cycle disorders was noticed in a group of smoking women (p < 0.05). The most frequent symptoms were painful period, painful breasts and premenstrual tension. No significantly statistical difference was stated in frequency of menstrual cycle depending on the amount of smoked cigarettes and addiction duration. The main decisive factor of giving up smoking is the awareness of the harmfulness of nicotine addiction.

[Maternal smoking: effect on neonatal's health]. / Zjawisko nikotynizmu wsród ciezarnych. Palenie papierosów w ciazy a stan noworodka.

The influence of maternal smoking on the higher miscarriage rate, premature births and premature detachment of the placenta was proved in numerous so far undertaken medical researches. Apart from that smoking has an influence on fetal developmental retardation, low birth weight as well as the baby's abnormal development. The investigated population comprised of 100 healthy women that gave birth to their children after the 37th week of pregnancy and their newborns. The pregnant women's morphology parameters, the newborns' health (after the third minute of life according to the Apgar's scale) and the birth weight were assessed. The results achieved were analysed taking into consideration the problem of maternal smoking. The lower Apgar's notes as well as lower birth weight of the newborns whose mothers used to smoke during pregnancy were observed. The fact of being pregnant is the most significant argument for women to give up or diminish the habit of smoking.