Fetal kidney measurement - additional biometric parameter for accurate gestational age assessment.

OBJECTIVES: Ultrasound examination - recommended in the prenatal period - allows for an assessment of fetal anatomy and well-being and for monitoring its growth trend. Determining gestational age is important in monitoring the developing fetus. Research is increasingly being conducted in search of further biometric components that may improve ultrasound techniques in terms of predicting the gestational age. It should be noted that a fairly large number of publications focus on the accessibility of fetal kidneys to diagnostic imaging during routine ultrasound examination. The reported study was an attempt to answer the question whether fetal kidney dimensions correlated with gestational age. The obtained results are presented as fetal kidney normograms for particular weeks of gestation. MATERIAL AND METHODS: The study covered by dissertation was conducted among patients hospitalized at the Provincial Specialist Hospital in Zgierz, Department of Gynecology, Obstetrics and Endoscopic Therapy, in the period from 1st April 2019 to 30th November 2019. The study group included patients in a single pregnancy. The control group was not included in the study. The ultrasound examinations, which are the basis of the study, were carried out using the PHILIPS Affiniti 70 ultrasound device, with a frequency of 3.5 MHz transabdominal transducer. All data were subjected to statistical analysis using the Statistica 13.1 program. CONCLUSIONS: Kidney dimensions strongly correlated with gestational age. Fetal kidney growth was a linear process in normal pregnancy. Fetal kidney measurements can provide additional biometric parameters for accurate gestational age assessment.

Different modes of delivery and hormonal stress response.

OBJECTIVES: The aim of the study was to determine how the type of delivery affects the stress response cycle and the level of cortisol, progesterone and corticoliberin. MATERIAL AND METHODS: The study was conducted among 26 pregnant women admitted to the Gynecology and Obstetrics Ward due to an approaching delivery date or the onset of labor. The participants were aged between 20 and 41 years, with a mean age of approximately 30 years. After delivery, blood was drawn in parallel from the maternal antecubital vein, the umbilical cord vein and the umbilical cord artery. The levels of stress hormones were assessed by ELISA. The results were subjected to statistical analyses, and correlation coefficients were calculated for individual variable pairs. The analysis also examined the participation of pregnant woman in antenatal education. RESULTS: A high correlation was observed between cortisol and progesterone levels in venous and arterial cord blood and physiological delivery. The mean cortisol level was 247.37 ng/mL in venous cord blood and 233.59 ng/mL in arterial blood and the respective mean progesterone levels were 331.81 ng/mL and 342.36 ng/mL. The highest cortisol concentration was determined in the primiparas umbilical cord blood (236.182 ng/mL in the vein, 230.541 ng/mL in the artery). Correlation between cortisol level in venous and arterial cord blood and prenatal education was also noted (venous cord blood: r = -0.5477; F = 10.2833; p = 0.0038; cord arterial blood: r = -0, 4436; F = 5.8789; p = 0.0232). CONCLUSIONS: The results obtained emphasize the importance of the hypothalamic-pituitary-adrenal (HPA) axis as one of the potential mechanisms actively involved in childbirth. The determined levels of cortisol and progesterone in the maternal and umbilical cord blood varied significantly depending on the type of delivery, with higher concentrations being observed in the case of natural delivery. In addition, the highest levels of cortisol were determined in primiparas; however, lowered umbilical cord blood cortisol levels were observed in pregnant women who had participated in antenatal education, regardless of the number of deliveries.

[Evaluation of erythromycin concentration in the umbilical artery serum]. / Ocena stezenia erytromycyny w surowicy krwi z tetnicy pepowinowej.

OBJECTIVES: The aim of the study was to investigate the effectiveness of erythromycin in preventing intrauterine infection caused by group B streptococcus (GBS). MATERIAL AND METHODS: The study included 20 pregnant women with GBS-positive screening or whose laboratory screening was not available, who delivered between April 17, 2013 and July 22, 2013. The women were given 600 mg of erythromycin intravenously After delivery blood was drawn in parallel from maternal antecubital vein and umbilical cord artery Serum erythromycin concentrations were evaluated using enzyme-linked immunosorbent assay (ELISA) kit. Statistical analysis for measurable and non-measurable characteristics were performed, correlation coefficients for each pair of variables were calculated in order to investigate the sought dependence. RESULTS: Mean placental transfer of erythromycin was 2.04%. There was a high correlation between umbilical artery serum and maternal serum erythromycin concentration. Selected variables of mothers in the control group had no effect on serum erythromycin concentration in the umbilical artery CONCLUSIONS: Transplacental transfer of erythromycin is limited (2.04%). Intravenous application of erythromycin at a dose of 600 mg does not allow to achieve the value of MIC50 and MIC90 for erythromycin against strains S. agalactiae in umbilical artery serum, what suggests a compromised efficacy in the treatment of intrauterine fetal infections. At the same time, the placenta seems to be an effective barrier reducing fetal exposure when this macrolide is used to treat maternal infections.

The placental transfer of erythromycin in human pregnancies with group B streptococcal infection.

OBJECTIVES: The aim of this study was to investigate the effectiveness of erythromycin in preventing fetal and intrauterine group B streptococcal (GBS) infections. The study evaluated the penetration of erythromycin through the placenta, by comparing umbilical vein and maternal serum erythromycin concentrations. MATERIAL AND METHODS: The study subjects were 42 pregnant women, with GBS-positive screening or whose laboratory screening was not available, who delivered between 17th April 2013 and 22nd July 2013. The women were given 600 mg of erythromycin intravenously. After delivery blood was drawn from the mother's antecubital vein and umbilical cord vein. Serum erythromycin concentrations were evaluated using enzyme-linked immunosorbent assay (ELISA) kit. The percentage and correlation between umbilical vein and maternal serum erythromycin concentration were calculated. Based on regression function parameters selected factors: maternal age, maternal body weight, gestational age at delivery related to the umbilical vein serum erythromycin concentration, were investigated. Results: A total of 42 umbilical vein-maternal serum pairs were included in the analysis. The mean umbilical vein-maternal serum erythromycin concentration percentage was 2.64 ± 1.55%. There was a moderate correlation between umbilical vein serum and maternal serum erythromycin concentration. Pregnancy complications and selected variables of mothers in control group had no effect on the serum erythromycin concentration in the umbilical vein. CONCLUSIONS: Intravenous application of erythromycin at a dose of 600 mg, allowed to achieve therapeutic concentration in maternal serum. However, when it comes to placental transfer of erythromycin, the lack of therapeutic concentration in umbilical vein serum was observed. The limited transplacental transfer of erythromycin, which was approximately 2.6%, suggests compromised efficacy in the treatment of intrauterine fetal infections. On the other hand, the placenta seems to produce an effective barrier reducing the fetal exposure when erythromycin is used exclusively to treat maternal infections.

[Assessment of fetal fibronectin concentration in identifying patients at risk for preterm delivery]. / Przydatnosc oznaczen poziomów fibronektyny plodowej w przewidywaniu porodu przedwczesnego.

DESIGN: Identifying patients at risk for preterm delivery continues to be difficult. OBJECTIVES: This study aimed at evaluating fetal fibronectin concentrations in cervical secretions measured by an enzyme-linked immunosorbent assay, as a tool for of premature delivery screening in patients with preterm uterine contractions. MATERIALS AND METHODS: Symptomatic 115 women, admitted to Department of Perinatology (RIPMMH) between 24 weeks 0 days and 34 weeks 6 days, with intact amniotic membranes, single pregnancy, cervical dilatation <3 cm and with no cerclage were included. Samples of the cervical secretion were taken every week until the delivery or to hospital discharge. RESULTS: The enzyme-linked immunosorbent assays revealed sensitivity of 73.7% and specificity of 90.9%. CONCLUSIONS: This test was found to be a good tool for the prediction of premature delivery.

[Antibiotic administration in preterm delivery]. / Profilaktyczna antybiotykoterapia w porodach przedwczesnych.

DESIGN: Although an association between subclinical intrauterine infection and preterm birth is well established, there is conflicting evidence regarding the benefits of antibiotic administration in women in preterm labor. OBJECTIVES: We attempted to determine the effect of antibioticotherapy in mothers on congenital neonatal infection. MATERIALS AND METHODS: The study group consisted of 1049 pregnant women with imminent preterm labor hospitalized in Clinics of The Research Institute Polish Mother's Memorial Hospital. RESULTS: 244 women delivered preterm and no significant difference in neonatal outcomes could be detected in two groups with intact membranes and preterm premature rupture of membranes. CONCLUSIONS: The results of this study do not support the routine use of antibiotic administration in women with preterm labor.

[Perinatal outcomes and duration of preterm premature rupture of membranes]. / Odplywanie wód plodowych a stan urodzeniowy noworodka.

DESIGN: 30% preterm deliveries are the consequence of preterm premature rupture of membranes. The available data suggests lack of benefit of conservative management of preterm premature rupture of membranes. OBJECTIVE: Our objective was to compare perinatal outcomes in regard to the duration of rupture of membranes and gestational ages. MATERIALS AND METHODS: 435 newborns delivered below 28 weeks of pregnancy, 28-32 weeks of pregnancy and above 32 weeks of pregnancy were studied. RESULTS: There was no significant difference in the group of newborns delivered before 33 weeks of gestation. CONCLUSION: The duration of rupture of membranes had significant on perinatal outcomes among neonates born after 33 weeks of gestation.

[Maternal serum concentration of corticotropin releasing hormone (CRF) as a marker of preterm labor]. / Ocena stezenia poziomu hormonu uwalniajacego kortykotropine (CRF) jako markera zagrazajacego porodu przedwczesnego.

UNLABELLED: There is still an urgent need for obstetricians to develop new, noninvasive, accurate methods of diagnosing preterm labor. The purpose of this study was to evaluation of maternal serum corticotropin-releasing factor concentrations and its concentration with onset of labor. The analysis was undertaken of women hospitalized in Research Institute Polish Mother's Memorial Hospital-Clinical of Perinatology (2001-2002) year with pregnancy between 16 to 35 weeks. All pregnancies were singleton gestation free of medical complications but with threatened labor. Maternal peripheral blood samples were obtained from antecubital vein during the first day of hospitalization. The control group consisted of 77 pregnant who delivered term infants whose growth was appropriate for gestational age. The study group consisted of pregnant women who gave preterm delivery. The serum CRF concentrations were measured using EIA method. Maternal serum CRF concentration in control group was 7.28 +/- 1.92 ng/ml. The material was obtained in 26.2 +/- 4.5 week of gestation. CRF concentration in studied group was 6.37 +/- 1.86 ng/ml +/- and the serum was obtained in 24.3 +/- 4.9 ng/ml weeks of gestation. The results were paradoxically significantly higher in control group. CONCLUSIONS: Our results were not in agreement with the findings of other investigators.

[Is the mother's bacterial vaginosis with PROM a significant factor for intrauterine infection of the fetus in preterm labor before 32 weeks of gestation]. / Czy bacterial vaginosis u matek z PROM jest znaczacym czynnikiem ryzyka zakazenia wewnatrzmacicznego u noworodków z porodów przedwczesnych ponizej 32 tygodni.

OBJECTIVE: Bacterial vaginosis of pregnant woman is an important factor of appearance of the PROM in result of intrauterine infections on every stage of pregnancy. Frequency exist of intrauterine infection evaluate from 1 to 10% pregnancies. Clinical chorio-amnionitis complicates 1-5% of term pregnancies, but nearly 25% of preterm deliveries and really increase morbidity and mortality of newborns and they are also a reason of mothers morbidity. A condition of recognition the intrauterine infections is ascertainment of infection factor risk of mother and appearance of clinic symptoms of newborns. The aim of this work was a valuation of dependence between bacterial flora taken from cervics uteri of pregnant woman with PROM who gave birth with preterm below 32 weeks and a presence of clinic and laboratory symptoms of infections and the presence of bacterial flora in blood culture of the newborns. MATERIAL AND METHODS: 37 pregnant women at the age from 20 to 43 hospitalized in Department Perinatology ICZMP between 1999-2001 because of PROM and a threat of preterm labor at the fetal age from 24 to 32 weeks were taken by an analysis. The average time of amniotic liquid outflowing before the labor was 11.1 days +/- 8.63, average length persistence of pregnancy was 27.6 hbd +/- 1.85, average born mass was 1029 g +/- 187.5. Laboratory factors and clinics symptoms chorionamnionitis, bacteriology cultures of swabs from cervics uteri and information of the labor of pregnant women were analyzed. Diagnostics of newborns contained: making of blood cultures and skin, nose, throat, urine cultures, estimation WBC and level CRP, estimation of lungs X-ray. RESULTS: In result of bacteriology cultures from cervics uteri of mothers gained bacteria of frequent occurrence: Staphylococcus epiderm.--27%, E. coli--19%, Streptococcus gr. B--10.8%, Enterococcus foecalis--8.1%. In result of bacteriology cultures of newborns blood gained bacteria of frequent occurrence: Staphylococcus epiderm.--13.5%, Staphylococcus haemolitycus--10.8%, Klebsiella pneumoniae--10.8%, Pseudomonas aeruginosa--8.1%. In 97.3% cases at newborns appeared inborn infections in a shape of pneumonia confirmed by X-ray. Confirmation of intrauterine infection in histopathology examination of the placenta in a shape of chorionamnionitis was shown in 25 cases, in other words in 67.5%. Positive results of pathogenic bacteriology flora cultures taken from cervics uteri was in 50% pregnant woman, however in 43% of newborns bacteriology cultures of the blood were positive. In none of the analyzed preterm labor cases with PROM bacterial flora from positive cultures taken from cervics uteri of mothers did not correlate with bacterial flora found in blood cultures of newborns. CONCLUSIONS: On a base of analyzed values PROM of mothers with bacterial vaginosis is the important factor risk of the evolution of intrauterine infections of newborns, besides did not ascertain the dependence between the values of bacteriology cultures taken from cervics uteri of mothers and the values of bacteriology cultures of the newborns blood with clinic symptoms of intrauterine infection.

Anti-phlogistic and immunocompetent effects of acupuncture treatment in women suffering from chronic pelvic inflammatory diseases.

Thirty-nine women of reproductive age suffering from chronic pelvic inflammatory disease (PID) for at least two years, previously treated pharmacologically with no effect, were enrolled in a four-week therapeutic protocol consisting of 12 acupuncture treatments performed with the frequency of three per week. In each female patient at baseline and after the study, pain score and the following parameters in blood serum were evaluated: concentration of immunoglobulin M (IgM), albumins, alpha1-globulins, alpha2-globulins and gamma-globulins, erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count. During the study, we obtained a significant drop in ESR and IgM levels together with a rise in gamma-globulin concentrations. A significant decrease (from 4.89 +/- 0.82 to 0.63 +/- 1.05) in pain score was obtained. The other parameters remained unchanged. These results suggest that acupuncture treatment of PID exhibits a clear anti-inflammatory and immunocompetent effect.

Laser acupuncture and low-calorie diet during visceral obesity therapy after menopause.

BACKGROUND: To compare the efficiency of low-calorie diet and low-calorie diet applied together with laser acupuncture in the therapy of visceral obesity in postmenopausal women. METHODS: The study population consisted of 74 postmenopausal females with visceral obesity who were divided into two groups according to an employed 6-month slimming procedure. In the first group (n = 36) a low-calorie diet was applied, while women in the second group (n = 38) were on the same kind of diet, having additionally one cycle of laser acupuncture procedure at the same time. At baseline and at the end of the study, body weight, body mass index and waist-to-hip ratio were determined in all women. RESULTS: After 6 trial months both groups exhibited a statistically significant drop in body weight, body mass index and waist-to-hip ratio. The mean reduction of body weight, body mass index and waist-to-hip ratio was significantly higher in the second group of women (laser acupuncture plus low-calorie diet). CONCLUSIONS: (1) Our results testify that the combination of a low-calorie diet and laser acupuncture is characterized by a higher efficacy than a low-calorie diet alone in lowering body weight, body mass index and waist-to-hip-ratio. (2) Laser acupuncture is an additional useful healing method in the therapy of visceral postmenopausal obesity.