[Selected polymorphisms of Renin-Angiotensin System in the pathology of hypertensive disorders of pregnancy]. / Wybrane polimorfizmy genów ukladu renina-angiotensyna w patogenezie nadcisnienia w przebiegu ciazy.

Pregnancy induced hypertension and pre-eclampsia, defined as hypertension and proteinuria after 20 weeks of pregnancy with no history of such symptoms, are a great challenge in the field of perinatology They are a serious threat to the mother and the child. Regardless of numerous studies on the subject, the pathogenesis of pregnancy-induced hypertension and pre-eclampsia is still unknown, although a crucial role of genetic factors combined with environmental factors has been confirmed. New theory based on genetic analysis of Renin-Angiotensin System and its impact on blood pressure in pregnant women, has been subject to much debate recently Numerous genes have been studied but angiotensinogen remains to be the best known. Little is known about angiotensin receptor type 1 and 2. This paper presents the knowledge about selected genes of RAS and their impact on pregnancy

Leptin and interferon-gamma as possible predictors of cesarean section among women with hypertensive disorders of pregnancy.

BACKGROUND: This study was designed to evaluate maternal levels of leptin and interferon-gamma (IFN-gamma) in pregnancy complicated with hypertension and to assess the role of cytokines in predicting the risk of cesarean section. MATERIAL/METHODS: This was a cohort study with a prospective follow-up. After proportional sampling procedure, the study included the follow-up of 40 women with hypertensive disorders of pregnancy (pregnancy-induced hypertension [PIH] or preeclampsia [PE]) and 40 uncomplicated pregnancies. Women were followed from the time of admission to the delivery. Levels of leptin and interferon-gamma were measured in serum samples from all women. A p-value <0.05 was considered as significant. RESULTS: Significant increase in IFN-gamma and leptin concentration in women with pre-eclampsia was observed. We found a significant 1.4-fold increase in the risk of birth by cesarean section associated with the increase of the IFN-gamma concentration by 0.1 pg/ml and almost 3-fold increase in the risk associated with the increase of the leptin concentration. CONCLUSIONS: IFN-γ and leptin might be risk markers of cesarean section in hypertension disorders of pregnancy, but further studies supporting this evidence are needed.

Usefulness of marking alkaline phosphatase and C-reactive protein in monitoring the risk of preterm delivery.

BACKGROUND: The purpose of this paper is to compare the effectiveness of use of alkaline phosphatase (ALP) and C-reactive protein (CRP) levels in marking and monitoring the risk of preterm delivery due to infection. MATERIAL/METHODS: The study involved 83 patients assigned to groups: Group I (n=43) consisted of patients hospitalized for symptoms of preterm delivery, and Group II (control group n=40) consisted of patients controlled or hospitalized delivering on time without complications, whose pregnancy had a physiological course. All patients had a single marking of ALP and CRP levels in serum performed. RESULTS: CRP levels were within the range 7 mg/l to 94 mg/l in the study group, and 4.83 mg/l to 90 mg/l in the control group. The level of ALP in the study group ranged from 139 u/l to 368 u/l and from 218 u/l to 321 u/l in the control group. In more than half of women (72.1%) from study group, CRP level exceeded 7 mg/l; in the control group, the CRP level exceeded 7 mg/l in 35% of cases. Significantly higher levels of CRP (above 20 mg/l) and ALP (above 300 u/l) were found in the 18 patients from the study group compared to the control group. CONCLUSIONS: Although an increase in the level of ALP in serum cannot be an absolute and sole marker of the risk of preterm delivery, it can be used in conjunction with a significantly elevated CRP level.

[Management of thyroid diseases during pregnancy]. / Postepowanie w chorobach tarczycy u kobiet w ciazy.

The management of thyroid disorders during pregnancy is one of the most frequently disputed problems in modern endocrinology. It is widely known that thyroid dysfunction may result in subfertility, and, if inadequately treated during pregnancy, may cause obstetrical complications and influence fetal development. The 2007 Endocrine Society Practice Guideline endorsed with the participation of the Latino America Thyroid Association, the American Thyroid Association, the Asia and Oceania Thyroid Association and the European Thyroid Association, greatly contributed towards uniformity of the management of thyroid disorders during pregnancy and postpartum. Despite the tremendous progress in knowledge on the mutual influence of pregnancy and thyroid in health and disease, there are still important areas of uncertainty. There have been at least a few important studies published in the last 3 years, which influenced the thyroidal care of the expecting mother. It should also be remembered that guidelines may not always be universally applied in all populations with different ethnical, socio-economical, nutritional (including iodine intake) background or exposed to different iodine prophylaxis models. The Task Force for development of guidelines for thyroid dysfunction management in pregnant women was established in 2008. The expert group has recognized the following tasks: development of the coherent model of the management of thyroid dysfunction in pregnant women, identification of the group of women at risk of thyroid dysfunction, who may require endocrine care in the preconception period, during pregnancy and postpartum - that is in other words, the development of Polish recommendations for targeted thyroid disorder case finding during pregnancy, and the development of Polish trimester-specific reference values of thyroid hormones. Comprehensive Polish guidelines developed by the Task Force are to systematize the management of the thyroid disorders in pregnant women in Poland.

Aspirin resistance may be associated with adverse pregnancy outcomes.

OBJECTIVE: Verify that resistance to aspirin may have an impact on pregnancy and neonatal outcome. METHODS: We enrolled 43 pregnant women, aged 30.7 ± 4.0 years regularly taking 75 mg of aspirin daily and 32 (aged 30.8 ± 4 years) pregnant women not receiving aspirin who served as control group. Laboratory tests were performed at 18 to 22 weeks of gestation, 28 to 32 weeks of gestation and 16 to 32 weeks after delivery. Resistance to aspirin was defined as urinary 11-dehydrothromboxane B2 (u11-dTXB2) concentrations in the highest quartile and additionally, as the resistance index (RI) calculated for each woman, defined as the difference between u11-dTXB2 concentration of each woman treated with aspirin and the median value at the same time point measured in the control group. RESULTS: Women taking aspirin in the highest quartile of u11-dTXB2 delivered prematurely (35.8±3.4 vs 38.1±1.7 weeks, p=0.02). Delivery of small for gestational age (SGA) newborns (p=0.003) as well as fetal distress (p=0.014) and preeclampsia (p=0.003) occured more frequently in aspirin-resistant women. Resistance to aspirin based on the RI value was also associated with higher prevalence of preeclampsia (p=0.02) and SGA newborns delivery (p=0.01). The two groups resistant to ASA designed on the basis of both (RI and u11-dTXB2 urine levels) methods compared with ASA sensitive group differed in frequency of SLE prevalence. CONCLUSION: Aspirin resistance may be associated with increased risk of adverse pregnancy outcomes including preeclampsia, premature delivery and delivery of SGA newborns.

Beneficial influence of postmenopausal estrogen therapy on serum adhesion molecules is independent of the route and dose of administration.

OBJECTIVE: In current literature, the immune-inflammatory theory of atherosclerosis is widely discussed. The role of how adhesion molecules contribute to the development of atheromatic plaques is especially underlined. MATERIAL AND METHODS: 120 females in menopausal age were included in the study between 2004 and 2009. All the women were of menopausal age (51±3 years), from southern Poland, with FSH levels above 30 mIU/ml, and complaining of menopausal symptoms that disturbed normal daily activity. The study was conducted over a 6 month period. Three groups of 40 randomized patients were selected. The control group consisted of 40 volunteers, who were also from southern Poland, in good health, without menopausal symptoms, or menstrual periods in the last 6 months. Control subjects were match according to age and weight, with FSH levels above 25 mIU/ml and normal TSH and prolactin values. All patients, in the treatment and control groups were seronegative for Chlamydia pneumonia throughout the duration of the study. RESULTS: After 6 months, hormonal therapy was found to significantly reduce levels of sICAM-1 and sVCAM-1 in all treated groups compared to the control group and the results were statistically significant. Alternatively, in the latter group, we observed increased levels of the investigated adhesion molecules (group I: 37.5 µg/24h transdermal estradiol + dydrogesteron; group II 50 µg/24h transdermal estradiol + medroxyprogesteron; group III 1mg of oral estradiol + noretisteron sICAM-1 and control group; using paired Wilcoxon test). CONCLUSION: All of the investigated estrogen therapy schemas have a favorable impact on the blood levels of sICAM-1 and sVCAM-1 in postmenopausal women without cardiovascular risk factors, reducing their concentration.

Glycemic control and pregnancy outcomes in women with type 2 diabetes from Poland. The impact of pregnancy planning and a comparison with type 1 diabetes subjects.

The number of pregnancies complicated by type 2 diabetes mellitus (T2DM) is growing; however, their clinical characteristics remain incomplete. We aimed to assess clinical characteristics, glycemic control, and selected pregnancy outcomes in pregestational T2DM from Poland and to compare them with those of T1DM. We analyzed 415 consecutive singleton pregnancies; among them, there were 70 women with T2DM and 345 with T1DM. As compared to T1DM patients, women with T2DM were older (mean age 33.1 years vs. 27.8, respectively), heavier before pregnancy (mean BMI 30.8 kg/m² vs. 23.9), and had a shorter duration of diabetes (mean 3.3 years vs. 11.4); ( P<0.0001 for all comparisons). The gestational age at the first visit was higher in T2DM (mean 11.4 weeks vs. 8.6; P=0.0004). Nevertheless, they had better glycemic control in the first trimester (mean HbA1c 6.2% vs. 7.0; P=0.003); in subsequent months, the differences in HbA1c were no longer significant. T2DM women gained less weight during pregnancy (mean 9.9 kgs vs. 14.1; P<0.0001). The proportion of miscarriages (10.0 vs. 7.3%; P=0.32), preterm deliveries (12.7 vs. 17.8%; P=0.32), combined infant deaths, and congenital malformations were similar in both groups (9.5 vs. 8.8%; P=0.4) as was the frequency of caesarean sections (58.7 vs. 64.1%; P=0.30). Macrosomic babies were more than twice less frequent in T2DM and the difference reached borderline significance (7.9 vs. 17.5%, P=0.07). Pregnancy planning in T2DM had a significant impact on HbA1c in the first trimester (5.7 vs. 6.4% in the planning vs. the not planning group, P=0.02); the difference was not significant in the second and third trimester. T2DM women had better glycemic control in the first trimester than T1DM subjects and gained less weight during pregnancy. This could have been the reason for the slightly lower number of macrosomic babies but did not affect other outcomes. In T2DM, pregnancy planning had a beneficial glycemic effect in the first trimester.

Glycemic control and selected pregnancy outcomes in type 1 diabetes women on continuous subcutaneous insulin infusion and multiple daily injections: the significance of pregnancy planning.

BACKGROUND: Two regimens are used to achieve excellent glycemic control during pregnancy in type 1 diabetes mellitus (T1DM): continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI). We assessed their efficacy and safety and the effect of pregnancy planning. METHODS: We examined 269 pregnant T1DM women: 157 treated with MDI (MDI group), 42 with CSII (CSII group), and 70 who switched from MDI to CSII in the first trimester (MDI/CSII group). There were 116 women who planned pregnancy: 58 in the MDI group, 38 in the CSII group, and 20 in the MDI/CSII group. The estimated differences in glycemic control and maternal and fetal outcomes were adjusted for baseline characteristics. RESULTS: Mean glycated A1c (HbA1c) in the first trimester in the whole group was 6.9%, and the women differed depending on whether they planned pregnancy or not (P < 0.0001). A multiple regression model showed an average difference of about 0.9% in favor of pregnancy planning, with no interaction between the planning and treatments. In the second trimester, HbA1c decreased to a mean value of 5.8%, with improvement of HbA1c across all treatments: by 1.5% in not-planning and 0.9% in planning women. Despite greater improvement, not-planning women still had a higher HbA1c (by 0.3%, P = 0.05). In the third trimester, there was no further significant changes; nevertheless, women who planned pregnancy still had a lower HbA1c (by 0.5%, P = 0.02). There were 14 malformations, stillbirths, and perinatal infant deaths in the not-planning versus five in the planning group (P = 0.07). Patients in the CSII group had a 2 kg greater weight gain compared to the MDI group (15.0 kg vs. 13.0 kg; P = 0.005). CONCLUSIONS: In pregnancy with T1DM, both MDI and CSII can provide excellent glycemic control. Pregnancy planning has a beneficial effect on glycemic control, independent from the therapy model. CSII seems to predispose to a larger weight gain in mothers.

Doppler velocimetry of the materno-fetal circulation in preterm delivered pregnancies complicated with hypertension.

BACKGROUND: Hypertension is one of the most frequent complications of pregnancy. Due to high risk of morbidity and mortality in both mothers and children, it is necessary to continuously monitor the pregnancy, principally with biophysical methods. Particularly, doppler velocimetry of the materno-fetal circulation proves useful. THE AIM of the study was to assess the usefulness of doppler test in monitoring the condition of the foetus in preterm delivered pregnancy complicated with hypertension. MATERIAL AND METHODS: The retrospective analysis comprised the data of 116 women who delivered prematurely at the Clinics of the Department of Gynaecology and Obstetrics at the Collegium Medicum of the Jagiellonian University in the years 2006-2007, resulting in creation of Group I involving 38 pregnant women with preeclampsia, and Group II of 36 women whose pregnancy was complicated with gestational hypertension. Control group was formed of 42 women with correct arterial blood pressure. When describing the groups, the differences in the birth weight and Apgar score were indicated. RESULTS: A significant statistical difference was found in the area of pulsation rate in the umbilical artery and cerebro-placental ratio (CPR). In the case of preterm delivery complicated with arterial pressure disorders, the foetus is characterised with worse organic perfusion and slower somatic growth than if no concomitant hypertension is present. Hypertension forms an additional risk factor in the course of preterm delivery, and doppler velocimetry is a good method for monitoring the condition of the foetus, as it allows for detection of irregularities and for implementation of relevant treatment to improve the newborn's condition at birth.

RCAS1 decidual immunoreactivity during stillbirth: immune cell presence and activity.

PROBLEM: Alterations in RCAS1 (a receptor-binding cancer antigen expressed on SiSo cells) expression in the placenta and decidua may be related to the regulation of the process of maternal immune tolerance against fetal antigens. Moreover, it has been demonstrated that the occurrence of the spontaneous beginning of stillbirth is related to a decrease in the placental expression of RCAS1. There are no data currently available on the immune processes in decidua during stillbirth. The aim of this study was to evaluate the RCAS1 immunoreactivity level in decidua and to identify the cytotoxic immune cells present during labor, induced after intrauterine fetal death either with a combination of oxytocin (OT) and prostaglandins or with OT alone; a further objective was to assess the potential impact of these molecular alterations on the effectiveness of stillbirth induction. METHODS: The immunoreactivity of RCAS1, CD3, CD56, CD69, and CD25 was assessed by immunohistochemistry in 31 decidual samples derived from patients in whom the stillbirth occurred before the onset of labor. RESULTS: The RCAS1 immunoreactivity level was higher in a statistically significant manner in decidual tissue samples derived from patients in whom OT alone proved insufficient to induce labor after the diagnosis of intrauterine fetal death but required additionally the use of prostaglandins when compared with samples from women in whom stillbirth was induced successfully with OT alone. However, we did not observe any differences either in CD56 and CD3 positive cell presence or in CD25 and CD69 antigen immunoreactivity in the respective decidua of these two groups of patients. CONCLUSION: The level of RCAS1 in decidua seems to influence the effectiveness of stillbirth induction.

The influence of antibiotic treatment on tocolysis in threatened advanced pregnancy.

OBJECTIVE: The aim of this study was to determine: a) to what extent application of antibiotics enhances efficiency of tocolysis; b) whether the duration of antibiotic treatment influences its efficacy; c) what criterion is decisive for efficacy of tocolysis assisted by antibiotic therapy. MATERIALS AND METHODS: 223 successive women with unifetal pregnancies, aged 17 to 42 (average age 27.3), admitted to the Department of Gynecology and Obstetrics of the JU Medical College in the period from January 1, 1999 to September 9, 2001, were enrolled in the study. Using clinical methods such as: assessment of contractile activity of the uterus, of uterine cervix and membranes, presence of bleeding and other clinical symptoms, these women were diagnosed with imminent preterm labour. CONCLUSIONS: Antibiotic treatment enhances the efficacy of tocolysis, influencing the time of prolonging pregnancy in imminent preterm delivery. This synergistic effect is clinically crucial as in this way significantly larger number of children will be born at term and also a number of premature neonates who survive may be increased.

C-reactive protein as a predictor of threatening preterm delivery.

OBJECTIVES: Preterm deliveries represent still one of the most important problems in contemporary obstetrics. They are associated with prematurity and higher rate of perinatal mortality and morbidity. During the last few years, the role of C-reactive protein (CRP) in prediction of threatening preterm delivery was emphasized. CRP is produced mainly inside the liver as a response to acute and chronic inflammatory processes. AIM: The aim of this study was to assess relations between C-reactive protein, oxytocinase, izooxytocinase and vaginal culture in prediction of preterm delivery. METHODS: This study was performed in the years 2000-2004 in the Department of Septic Obstetrics and Gynecology of Collegium Medicum of the Jagiellonian University. Some 389 patients hospitalized because of threatening preterm delivery or preterm delivery in tractu were enrolled into the trial. CONCLUSION: C-reactive protein is a useful marker of threatening preterm delivery, overtaking the results of vaginal culture. CAP1 and CAP2 are effective biochemical markers in pregnancy monitoring.

[Gynecological endoscopy--laparoscopy]. / Endoskopia ginekologiczna--laparoskopia.

The development of operative laparoscopy in gynecology and obstetrics has greatly increased in the past decade. The Authors attempt to show the most important applications of the laparoscopic procedures in the diagnostics and therapy of gynecological diseases.

Influence of the operative treatment of leiomyomas on lipid profile.

OBJECTIVE: The aim of this study was to asses the influence of operative treatment of leiomyomas on lipid profile. The study was conducted from April 1, 2000, through April 30, 2002 in The Department of Septic Gynecology and Obstetrics at Collegium Medicum of the Jagiellonian University. METHODOLOGY: Most hysterectomies are performed because of leiomyomas, which are the most common benign tumors of the female reproductive organ. Pathogenesis and evolution of uterine leiomyomas are not well understood. Treatment of leiomyomas is divided into operative and inoperative. Operative methods include generally laparoscopic myomectomy, conservative myomectomy and hysterectomy. 130 women with diagnosed leiomyomas were analyzed in four groups. CONCLUSION: Regardless of the type of performed surgery, decrease in cholesterol, HDL and LDL are observed 10 days after operation, with return to preoperative values at 6 months after surgical procedure. The highest level of cholesterol and LDL (6 moths from surgery) is observed in patients who underwent hysterectomy with bilateral oophorectomy.

[Severe infectious complications after an excessively long use of intrauterine device]. / Ciezkie powiklania infekcyjne po wieloletnim noszeniu wkladki antykoncepcyjnej.

Intrauterine device (IUD) is a widely used method of contraception in the world. The aim of our study was to examine infectious cases due to a prolonged use of IUD. We present four patients who had carried IUD for about seventeen years. On admission, all cases were presenting symptoms of acute adnexitis. On further examination, we diagnosed tubo-ovarian abscess in two patients. In our article, we carefully describe all cases and focus attention on side effects of abnormally extended period of using IUD. We conclude that the only proper way of informing patients how to use IUD and good gynecological care while using IUD may protect against severe infectious complications of the genital tract.

[Nutrition habits in pregnant women]. / Nawyki zywieniowe kobiet ciezarnych.

INTRODUCTION: Proper diet during pregnancy is one of the conditions of correct fetal development and maintenance of good health of pregnant women. Increased demand for energy and nutritial substances is connected with growth of mother's tissue mass and also with growth of fetals mass and afterbirth. During pregnancy, quality composition of ailment is not only important, but also the quantity and regularity in taking meals. AIM: The aim of this study was to investigate nutrician status of pregnant women hospitalized in Department of Obstetrics and Gynaecology Collegium Medicum of The Jagiellonian University. METHODS: There were 96 women, hospitilized for complications during pregnancy, from 1.11.2002 to 28.02 2003, in Department of Obstetrics and Gynaecology Collegium Medicum of The Jagiellonian University, asked for filling up the questionnaire about their diet during pregnancy. RESULTS: Medium age of patients was 28.3 years. 47% of women were multiparas. Average body mass before pregnancy was 60 kg and BMI (Body Mass Index) was 21.95. 46% examined women had highschool education. In 96 of questioned women 50% took informations about proper diet during pregnancy from the pass, only 12.5% from the obstetricians. None of the questioned women defined their nutritian condition as bad or mild, for 72% it was good and for 28% very good. Most of them (69%) applied common diet without modifications, only 6% of women had good digestive diet. Alcohol was consumed occasionally by 22% of women, rest of them did not consume it at all. Majority of women, 90.5% did't smoke cigarettes, 6.5% smoked occasionally and 3% up to 10 cigarettes per day. CONCLUSIONS: 1. Obtained data suggests that nutrition habits don't change significantly during pregnancy. 2. Pregnant women are not enough informed about healthy diet during pregnancy by doctors which leads to irregularity in taking meals. 3. General nutritial status of pregnant women could be considered satisfactory in the most of cases.

[Assessment of prenatal care in pregnant women]. / Ocena opieki przedporodowej kobiet ciezarnych.

INTRODUCTION: The aim of Prenatal care of pregnant woman is to asses her general condition and as soon as possible all eventual complications associated with pregnancy. Only diagnoses of pathological states in early stages may allow to use prophylaxis and to treat it. OBJECTIVE: The purpose of this study is to asses prenatal care of pregnant women who delivered in Department of Obstetrics and Gynaecology Collegium Medicum of The Jagiellonian University. MATERIAL/METHODS: On the basis of questionnaire we analyzed 100 pregnant women, the average age was 27.6, and different socioeconomic status who delivered neonates in Department of Obstetrics and Gynaecology Collegium Medicum of The Jagiellonian University in 2002 year. RESULTS: Majority of patients were in the age range between 25 and 28 with middle education. 95.5% women underwent first obstetrical visit during first 3 months of the gestational age. The average number of obstetrical visits during pregnancy was 11. 69% women had one obstetrical visit per month. The average duration of visit was more than 20 minutes. 99% women underwent examinations for pregnancy induced hypertension, gestational diabetes mellitus and anemia. Ultrasound examination was performed in 99% women. In majority of cases women were not enough informed about birthing school, possibilities of administration of anesthesia during labour, family delivery and sexual intercourses during pregnancy. CONCLUSION: 1. This study suggests that pregnant women benefit from appropriate medical care during pregnancy. 2. Correctly performed screening for pregnancy induced hypertension, gestational diabetes mellitus and anemia allow to prevent pathology. 3. Pregnant women are not enough informed about possibilities of administration of anesthesia during labour, family delivery, birthing school and sexual intercourses during pregnancy.

[Relationship between cervical infections and premature rupture of membranes]. / Flora bakteryjna szyjki macicy a przedwczesne pekniecie pecherza plodowego.

Preterm delivery is still one of the most important problems of the modern obstetrics. In our country frequency of preterm delivery is 7.2-8.4% of all deliveries. Although preterm birth is the leading cause of perinatal morbidity and mortality, the diagnosis and appropriate treatment of preterm labor remains an unresolved clinical problem. A growing body of evidence supports the view that preterm labor is a syndrome with multiple causes and the urogenital infections play a very important role in the pathogenesis of preterm birth. The study analyses relationship between results of microbiological examination of cervical smear and preterm rupture of membranes.

[Conjoined twins (Monstra duplicia)]. / Zespolone bliznieta (Monstra duplicia).

The Authors present a delivery of conjoined twins--thoracopagus, of an 18 years old primigravida. A pregnant woman was admitted to delivery room with full cervical dilation. She underwent ultrasonography examination which showed bigeminal pregnancy--two fetus in breech presentation with the suspicion of conjoined twins. Ultrasonography measurements of fetus corresponded to gestational age of 23 weeks. The heart rate of the first fetus was about 40 per minute, the heart rate of the second fetus was undetectable. She underwent delivery through manual extraction of the fetuses. Both fetuses were female, without any signs of life. The result of the autopsy was: Hemithoracogastropagus holoacardius immaturus.