Genotyping of STR and DIP-STR Markers in Plasma Cell-Free DNA for Simple and Rapid Noninvasive Prenatal Diagnosis of Zygosity of Twin Pregnancies.

Due to the high rate of complications, special medical care must be provided especially for monozygotic twin pregnancies, which are characterized as having 2.5 times higher mortality of fetuses. In recent years, examination of cell-free DNA (cfDNA) circulating in maternal plasma has become a useful noninvasive method of prenatal diagnosis. However, fetal DNA constitutes only 3-20% of plasma cfDNA during pregnancy. Short tandem repeats (STRs) are routinely used in forensic examination of DNA mixtures and are able to identify 5% minority components. Haplotypes of deletion/insertion polymorphisms and STRs (DIP-STRs) are able to detect even 0.1% minority components of DNA mixtures. Thus, STRs and DIP-STRs seem to be a perfect tool for detection of fetal alleles in DNA isolated from maternal plasma. Here, we present a novel noninvasive prenatal diagnosis technique of determination of pregnancy zygosity based on examination of feto-maternal microchimerism of plasma cfDNA with the use of STRs and DIP-STRs. Our preliminary results based on 22 STR loci showed 67% sensitivity, 100% specificity and 82% accuracy for prenatal detection of twin dizygosity. The corresponding values for seven DIP-STRs were 13%, 100% and 54%, respectively. Owing to assay performance, low DNA input requirements, low costs (below 10 USD per patient) and simplicity of analysis, genotyping of STR/DIP-STR markers in maternal plasma cfDNA may become a useful supplementary test for noninvasive prenatal diagnosis of twin zygosity in cases when chorionicity and zygosity cannot be reliably determined by ultrasound examination and prognostic value may be provided by a DNA test determining pregnancy zygosity.

Limb body wall complex - the history of the entity and presentation of our series of cases.

We present an analysis of two first historically documented limb body wall complex (LBWC) cases and our own contemporary perinatal autopsy series of this rare complex. So far it was supposed that the first case of this complex was reported in 1685 by Paul Portal. Studying the Joachim Oelhaf's autopsy report from 1613 with attached engraving showing the neonate with multiple birth defects led our research team to a conclusion that it was genuinely the first description of LBWC in the medical literature so far. We compared the Oelhaf's case from 1613 and the Portal's autopsy report from 1685 with our series of LBWC cases dissected in the Medical University of Gdansk between 1999 and 2011. Reviewing 1100 autopsy reports performed we encountered 9 cases of this unique complex. The analysis was supported by the literature review.

Socio-demographic and psychological determinants of exclusive breastfeeding after six months postpartum - a Polish case-cohort study.

OBJECTIVES: The purpose of this study was to explore the socio-demographic and psychological factors connected with exclusive breastfeeding after 6 months postpartum. MATERIAL AND METHODS: A total of 251 women filled in questionnaires in the first week postpartum, then again after 3 and 6 months. The questionnaires included socio-demographic and medical questions, as well as psychological tools: the NEO-FFI Personality Inventory, the Berlin Social Support Scales (BSSS), and the Edinburgh Postnatal Depression Scale (EPDS). Further detailed questions concerning breastfeeding were relevant to this study. RESULTS: The rate of exclusive breastfeeding after 6 months was 39.68%. It was found that exclusive breastfeeding was most strongly connected with attending prenatal classes (ORa = 2.84, CI 1.18-6.87, p = 0.01), formula supplementation after 3 months (ORa = 0.01, CI 0.002-0.08, p < 0.001) and the mother's subjective satisfaction with feeding the infant after 3 months (ORa = 1.44, CI 1.01-2.06, p = 0.04). No other psychological (as far as personality, social support or risk of postpar-tum depression are concerned), demographic or medical factors were significant. Only factors pertaining to breastfeeding were significant. CONCLUSIONS: The prevalence of exclusive breastfeeding in Poland is unsatisfactory. Women should have easy access to prenatal classes with the most up-to-date knowledge on lactation and be advised against supplementing with formula, whenever possible. This could lead to higher satisfaction with breastfeeding.

Medical and psychosocial determinants of risk of postpartum depression: a cross-sectional study.

OBJECTIVE: The aim of this study was to investigate the degree of risk of maternal postpartum depression during the second month of puerperium. METHOD: In total, 387 postnatal women filled out a questionnaire concerning their health and social status, as well as the following tests: the Edinburgh Postnatal Depression Scale (EPDS), the Patient Health Questionnaire-9 (PHQ-9), the Neo Five-Factor Inventory (NEO-FFI) Personality Inventory and the Berlin Social Support Scales. After 4-8 weeks, patients responded to another questionnaire with the EPDS and the PHQ-9. RESULTS: In total, 48 patients (12.40%) were found to be at risk of postpartum depression between the fourth and eighth weeks after delivery. Premenstrual syndrome [adjusted odds ratio (ORa)=2.93, confidence interval (CI) 1.30-6.63] and EPDS>12 points during the first week after the delivery (ORa=3.74, CI 1.59-9.04) increased the risk of postnatal depression. A similar role is played by a high result in neuroticism scale of the NEO-FFI (ORa=1.50, CI 1.17-1.92) and a positive family history of any psychiatric disorder (ORa=1.03, CI 1.01-1.06). CONCLUSION: A history of premenstrual syndrome and a higher risk of affective disorder soon after a childbirth are associated with greater chances of depressive symptoms in the second month postpartum. This is also the case if a patient is neurotic and has a relative with a history of any psychiatric disorder. Such women should have their mental status carefully evaluated.

Early vesico-amniotic shunting - does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

OBJECTIVES: The aim of the study was to assess the outcome of vesico-amniotic shunting performed before 16 weeks of pregnancy in fetuses with severe megacystis diagnosed in the first trimester of pregnancy. MATERIAL AND METHODS: Between January 2008 and October 2012 severe megacystis with the bladder length > 15 mm was diagnosed in 17 fetuses. The procedure of early vesico-amniotic shunting (VAS) was offered to 8 patients with presumably isolated LUTO. The procedure of VAS was performed in 6 fetuses. Before the intervention one or two procedures of vesicocentesis and urine analysis were performed. RESULTS: In all treated cases shunts provided urinary tract decompression. All babies were born prematurely, 2 of them died due to premaurity, 3 of them survived and have normal renal function at the age of 5-6 years. In 4/5 children accompanying malformations were later diagnosed, in 1 born prematurely neonate necropsy was not performed. CONCLUSIONS: Our results suggest that early vesico-amniotic shunting in fetal LUTO is feasible and may potentially prevent not only pulmonary hypoplasia but also renal insufficiency. However, the rationale of the procedure needs further investigation due to a high risk of long-term morbidity and co-existing malformations in children Before offering the therapy detailed counseling of the parents about the possible pros and cons of the therapy is necessary.

Relationship, social support, and personality as psychosocial determinants of the risk for postpartum blues.

OBJECTIVES: The purpose of the study was to identify factors increasing or decreasing the risk for postpartum blues. MATERIAL AND METHODS: A total of 101 women in their first week postpartum were included in the study. The Edinburgh Postnatal Depression Scale, questions concerning their medical and social status, and psychological tests (the Personality Inventory NEO-FFI, The Mieczyslaw Plopa and Jan Rostowski Marriage Questionnaire, and the Berlin Social Support Scales) were used. RESULTS: The probability of postpartum blues was detected in 16.8% of the respondents. The risk decreased with higher satisfaction with intimacy (OR = 0.81), partner similarity (OR = 0.78), and the overall satisfaction with the relationship (OR = 0.94), while higher disappointment elevated that risk (OR = 1.12). As far as social support is concerned, further inde-pendent factors included perceived available social support (OR = 0.31), perceived instrumental social support (OR = 0.24), need for support (OR = 2.74), and protective buffering support (OR = 3.41). High level of neuroticism as well as fear of childbirth increased the risk for postpartum blues (OR = 2.17 and OR = 1.30, respectively). High level of extraversion and better quality of sleep constituted protective factors (OR = 0.74 and OR = 0.60, respectively). CONCLUSIONS: Maternal disappointment with marriage/relationship, neuroticism and introversion, poor quality of sleep, fear of childbirth, and seeking social support are among the factors signaling the need for careful observation for signs of possible postpartum mood disorders both, during hospitalization and the follow-up visits.

Personality type, social support and other correlates of risk for affective disorders in early puerperium.

OBJECTIVES: The purpose of this study was to assess the prevalence of risk for postpartum mood disorders in mothers during the early postnatal period and to search for coexisting conditions. MATERIAL AND METHODS: We studied 546 women in the first week after delivery. The subjects filled out a questionnaire concerning their health, social and demographic status, the Edinburgh Postnatal Depression Scale, the Patient Health Questionnaire, the NEO-FFI Personality Inventory and the Berlin Social Support Scales. RESULTS: Probable mood disorders affected 15.85% of these patients. The risk increased with a current cesarean section (ORa = 2.54), a higher level of neuroticism (ORa = 1.65), greater fear of childbirth (ORa = 1.18), a lower level of extraversion (ORa = 0.77) and greater need for social support (ORa = 2.68). CONCLUSIONS: High level of neuroticism and introversion, as well as higher fear of delivery and the need of social support are among factors increasing the probability of mood disturbances in early postpartum period. A cesarean section might elevate the risk similarly. The mental health of such patients should be carefully examined.

[Estimation of fetal middle cerebral artery peak systolic velocity at 18-39 weeks of gestation in Polish population]. / Ocena wartosci maksymalnej predkosci skurczowej w tetnicy srodkowej mózgu plodu miedzy 18. a 39. tygodniem ciazy w polskiej populacji.

OBJECTIVES: The aim of this paper was to establish normal values of fetal middle cerebral artery peak systolic velocity (MCA-PSV) between 18-39 weeks' gestation in the Polish population and to compare the results with values published by other authors, for different populations seeking the discrepancies between them. MATERIAL AND METHODS: 280 healthy pregnant women from the Polish population underwent ultrasound examination. The cross-sectional data were obtained based on the measurements of fetal middle cerebral artery peak systolic velocity A chart of normal MCA-PSV values as a function of the gestational age was constructed. RESULTS: Normal ranges for MCA-PSV in the Polish population were established. The results were compared with values published by other authors, for different populations. CONCLUSIONS: The use of MCA-PSV measurements has proven itself to be a reliable method in diagnosis of fetal anemia. Differences in normal values of MCA-PSV in the Polish population compared with other nations have been observed.

Influence of place of residence on indications for genetic amniocentesis in the Pomeranian region of Poland before and after introduction of the Prenatal Screening Program in 2008.

BACKGROUND: The aim of the study was to analyze differences in the indications for amniocentesis in patients living in urban and rural areas before and after introduction of the Prenatal Screening Program by Polish National Health Insurance agency in the Pomeranian region in 2008. MATERIAL AND METHODS: Indications for 2578 amniocenteses performed in the Department of Obstetrics of the Medical University of Gdansk between 1996 and 2010 were recorded. RESULTS: Advanced maternal age accounted for 69% of women in urban areas and 61% of women in rural areas being referred for amniocentesis (p<0.001). There was also a significant difference between locations in chromosomal abnormality in previous pregnancy, accounting for 4% of referrals for amniocentesis in urban areas compared with 7% of referrals in rural areas. In urban areas, advanced maternal age accounted for 73% of referrals between 1996-2007 compared with 60% of referrals for amniocentesis between 2008 and 2010 (p=0.004), and in rural areas it was 66% and 54%, respectively (p<0.001). Abnormal result of biochemical screening surprisingly accounted for 13% of referrals for amniocenteses between 1996-2007 in urban areas compared with 28% after 2008 (p<0.001). In rural areas this indication accounted for 12% referrals before 2008 and for 28% from 2008 onward (p<0.001). CONCLUSIONS: The results of the study suggest that in both urban and rural areas there was a significant decrease in advanced maternal age as a reason for referral for amniocentesis, but a significant increase in abnormal results of biochemical screening as an indication for amniocentesis after 2008.

Intra- and inter-observer variability of evaluation of uterine cervix elastography images during pregnancy.

OBJECTIVES: To evaluate reproducibility and repeatability of the assessment of elastography images of the uterine cervix using an Elastography Index. MATERIAL AND METHODS: Elastography images of the uterine cervix were obtained. Numeric scale called Elastography Index, previously published by the authors, was used to describe parts of the cervix. A total of 282 images were evaluated twice by an experienced and twice by an inexperienced operator RESULTS: Reproducibility and repeatability of the evaluation of internal and external os and cervical canal were over 90%. Inter-assay coefficient of variation was 1.84%, 6.76% and 7.27% respectively and 5.84% for anterior and 16.74% for posterior wall. Analysis of the second evaluation only of both operators revealed no significant difference for posterior wall as well (F-test; p = 0.09). CONCLUSION: Authors proved satisfactory reproducibility and repeatability of subjective assessment of elastography images of uterine cervix during pregnancy with the use of Elastography Index in the hands of experienced and inexperienced observer

Comparison of fetal myocardial contractility before and after laser photocoagulation of communicating vessels in twin-to-twin transfusion syndrome.

OBJECTIVES: To evaluate changes in myocardial contractility that occur after selective laser photocoagulation of communicating vessels (SLPCV) in fetuses from pregnancies complicated with twin-to-twin transfusion syndrome (TTTS). METHODS: The study included 51 pregnant women between 16 and 26 weeks of gestation who underwent SLPCV due to TTTS. Ultrasonography was performed before SLPCV and on postoperative day 1, 3(4) and 7. Fetal heart contractility in both fetuses was evaluated by determining the shortening fractions of the left and right ventricles (FS LV and FS RV), and the myocardial performance index (Tei-Index). RESULTS: There was a significant increase in postoperative FS LV and FS RV in recipients (from 35.7% to 44%, P = 0.037 and from 27.6% to 32.9%, P = 0.021, respectively). Pre-operative Tei-Index values for both the left (0.55) and right ventricle (0.6) were above normal. The mean postoperative Tei-Index for the left ventricle decreased significantly to 0.49 (P = 0.011), while no significant change was observed in the right ventricle (0.57). No significant differences between pre- and postoperative FS and Tei-Index values were noted in the donors. CONCLUSIONS: SLPCV is reflected by a significantly increased myocardial contractility in recipients.

Prognostic value of elastography in predicting premature delivery.

OBJECTIVES: The aim of the study was to assess changes in the consistency of the uterine cervix and correlate the obtained results with the risk of premature delivery and time from examination to delivery MATERIAL AND METHODS: Elastographic images of the cervix in a group of 44 patients, admitted to the hospital due to uterine contractions before 37 weeks of gestation, were recorded and analyzed. Elastograms were assessed with the use of Elastography Index (El), a five-step (0-4) color scale, which visualizes tissue hardness by encoding numerical values in specific colors (0-violet/the hardest tissue; 4-red/the softest tissue). Correlation between El for different parts of the uterine cervix was evaluated and analyzed in relation to preterm delivery and time from examination to delivery. RESULTS: Twenty-one patients delivered before term and 23 at term. A strong correlation for El of the internal os and time from examination to delivery (Pearson test, p<0.001), and risk of preterm birth (Mann-Whitney-Wilcoxon test, p<0.001), was noted. We also found a strong correlation between cervical canal length and risk of preterm delivery (Anova test, p=0.001), and time from examination to delivery (Pearson test, p=0.006). CONCLUSIONS: Elastography may offer a chance for an objective assessment of elasticity of the uterine cervix and may become an alternative to vaginal examination and Bishop score. Proper selection of patients with high or low risk of preterm delivery may facilitate good management decisions and, consequently decrease the percentage of immature deliveries, unnecessary medical procedures, and hospitalization.

How important are elements in polycystic ovary syndrome? Should they be supplemented? A systematic review.

Polycystic ovary syndrome (PCOS) is a multifactorial disorder with unknown etiology. The purpose of this systematic review is to analyze the available clinical trials on elemental supplementation in terms of improving biochemical parameters in women with PCOS. Electronic databases were searched from their inception until February 2023. Randomized controlled trials (RCTs) of PCOS during therapy with elemental supplementation alone or in combination with other elements were analyzed. Recommendations regarding supplementation with elements are not clear. There are many factors to consider, with the primary factor being the type of element and the possibility of supplementation and a balanced diet. Another aspect to consider is the presence of comorbidities, which may increase the demand for and absorption of elements. A final factor to be considered is the determination of the body's need for specific elements. Some elements may require supplementation (e.g., magnesium, selenium, iodine, calcium), while others (e.g., iron, copper, potassium, zinc, manganese, chromium) are in sufficient amounts in a proper diet, and some should be limited (e.g., sodium, phosphorus). It is necessary to determine the optimal dose of each element in order to improve the biochemical parameters of PCOS as much as possible, while at the same time avoiding the negative effects of excessive consumption.

Evolution of the indications for genetic amniocentesis after the introduction of the prenatal screening program by the national health insurance in Poland.

OBJECTIVE: In 2008, the Prenatal Screening Program was introduced by the National Health Insurance in the Pomeranian region of Poland. As of then, biochemical and ultrasound screening was offered to women eligible for amniocentesis according to the earlier policy. The aim of the study was to investigate the evolution of the indications for amniocentesis after the introduction of the Program. MATERIAL AND METHODS: In total, 2579 women referred for amniocentesis to the Department of Obstetrics, Medical University of Gdansk, were included in the study They were divided into two groups: 1705 women referred between 1996 and 2007 (group A) and 874 women referred between 2008 and 2010 (group B). Indications for amniocentesis were compared between the groups. RESULTS: A significant difference in the indications for amniocentesis was found between the groups (Kruskal-Wallis test; p < 0.001). Maternal age, fetal malformation in the previous pregnancy and anxiety were less frequent in group B (p < 0.0001, p = 0.0008 and p = 0.0156, respectively). In contrast, a higher frequency of positive biochemical screening and abnormal ultrasound results as indications for amniocentesis was found in group B (p < 0.0001 and p = 0.0008, respectively). CONCLUSIONS: The introduction of the Prenatal Screening Program by the National Health Insurance shifted the proportion of indications for amniocentesis from maternal age to positive results in biochemical and ultrasound screenings, and increased the number of invasive testing. Further observation of the trend and its influence on the detection rate is imperative to confirm that the proposed Program is adequate and does not require adjustments.

Influence of Entonox (mixture of 50% nitrous oxide and 50% oxygen) on physiological labor and neonatal outcome in own material.

OBJECTIVES: The aim of the study was to compare maternal and neonatal outcome of delivery with inhaled anesthesia to delivery without pain control. MATERIAL AND METHODS: Authors performed retrospective analysis of 260 term deliveries. In the study group (130 women) a mixture of nitrous oxide and oxygen was used. The control group included 130 patients who used no pain relief during delivery. RESULTS: In nulliparas the pain assessment in 11-points scale was similar in both groups, but the labor was longer (350 ± 152 vs 228 ± 113 minutes; p < 0.001 for the first stage and 46 ± 37 vs 18 ± 18 minutes; p < 0.001 for the second stage), episiotomy incidence was higher (81.4% vs 41.9%; p < 0.001) and perineal laceration lower (2.3% vs 25.7%; p < 0.001) in the study group. In multiparas the pain assessment was lower in the study group (5 vs 7 points; p = 0.006), oxytocin was administered more frequently (45.5% vs 21.4%, p = 0.011), but labor duration was the same in both groups. Episiotomy was more frequent (61.4% vs 37.5%, p = 0.02), but there was no difference in perineal laceration. Apgar score was the same in the study and control group. CONCLUSIONS: We found that Entonox prolongs labor significantly and increases frequency of episiotomy in primiparas with no clear analgesic effect. Offering Entonox to the patients giving birth for the first time is thus questionable. In multiparas it has a good analgesic effect but increases probability of episiotomy with no significant influence on perineal tear, what seems not very high cost of decreased pain related to delivery.

Pregnancy-associated gastric cancer.

Gastric cancer is a very uncommon diagnosis in pregnancy (app. 1/1000 pregnant women), which has a significant impact on the health and life of mother and fetus and can impede the diagnostic and therapeutic process. Oncological vigilance, not underestimating the symptoms, and decisions made ahead of time could increase the chances of survival. Authors are describing the case of pregnancy-associated gastric cancer, diagnosed on the basis of the histopathological result from samples taken during a laparotomy with cesarean section performed due to a suspected gastrointestinal perforation in the 3rd trimester of pregnancy.

Guidelines of the Polish Society of Gynecologists and Obstetricians, the Polish Society for Vaccinology, and the Polish Society for Family Medicine on vaccinating women with reproductive plans and pregnant or breastfeeding women.

The following Guidelines present the most up-to-date treatment and management recommendations, which may be modified and altered after detailed analysis of a specific clinical situation, which in turn might lead to future modifications and updates.

Intrauterine deaths - an unsolved problem in Polish perinatology.

OBJECTIVES: The Polish criteria for "intrauterine death" include fetal demise after 22 weeks of gestation, weighing > 500 g and body length at least 25 cm, when the gestational age is unknown. The rate of fetal death in Poland in 2015 is 3:10,000. In 2020, 1,231 stillbirths were registered. MATERIAL AND METHODS: An analysis using 142,662 births in the period between 2015-2020 in 11 living in Poland. The first subgroup was admitted as patients > 22 to the beginning of the 30th week of pregnancy (n = 229), and the second from the 30th week of pregnancy inclusively (n = 179). In the case of women from both subgroups, there was a risk of preterm delivery close to hospitalization. RESULTS: It was found that stillbirth in 41% of women in the first pregnancy. For the patient, stillbirth was also the first in his life. The average stillbirth weight was 1487 g, the average body length was 40 cm. Among fetuses up to 30 weeks, male fetuses are born more often, in subgroup II, the sex of the child was usually female. Most fetal deaths occur in mothers < 15 and > 45 years of age. CONCLUSIONS: According to the Polish results of the origin of full-term fetuses > 30 weeks of gestation for death in the concomitant antenatal, such as placental-umbilical and fetal hypoxia, acute intrapartum effects rarely, and moreover < 30 Hbd fetal growth restriction (FGR), occurring placental-umbilical, acute intrapartum often.

Long-term follow-up for organic dysfunction in breech - presenting children.

BACKGROUND: The authors performed a long term outcome analysis of minimal brain damage in children delivered in breech presentation, and related the results to the mode of delivery (vaginal or by cesarean section). MATERIAL/METHODS: In the Department of Obstetrics at the Medical University of Gdansk (Poland), 917 breech deliveries took place between 1981 and 1990. Excluding stillbirths and multiple pregnancies, 874 deliveries were analyzed. We received positive responses from 232 mothers, who provided us with considerable information about the children's further development and problems that had arisen during their school years. All the respondents were contacted by telephone, and 83 of them agreed to visit our Department with their children to undergo a psychological examination - the following tests were performed: 1) the Bender-Kopitz Test (BKT), and 2) the Benton Visual Retention Test (BVRT). RESULTS: The mode of delivery for all groups and subgroups had no influence on the incidence of organic brain disorders in later childhood, assessed by the Benton Visual Retention test and by the Bender-Kopitz test. CONCLUSIONS: Vaginal breech deliveries are safe in both primiparous and multiparous mothers.

Loss of E-Cadherin Staining Continuity in the Trophoblastic Basal Membrane Correlates with Increased Resistance in Uterine Arteries and Proteinuria in Patients with Pregnancy-Induced Hypertension.

Pregnancy-induced hypertension (PIH), especially when complicated with pre-eclampsia (PE), could be a life-threatening complication of pregnancy. Pre-eclampsia is one of the leading causes of perinatal morbidity and mortality in women. Pre-eclampsia is mainly characterized by hypertension and kidney damage with proteinuria. Abnormal placentation and altered structure of the placental barrier are believed to participate in the pathogenesis of pregnancy-induced hypertension, leading to PE. In the current study, we aimed to analyze the immunohistochemical expression pattern of E-cadherin and p120, two markers of epithelial-mesenchymal transition, in placental samples derived from a group of 55 patients with pregnancy-induced hypertension, including pre-eclampsia and 37 healthy pregnant controls. The results were correlated with the presence of an obtained early uterine artery flow notching during diastole on Doppler ultrasound. We observed a higher frequency of discontinuous E-cadherin staining in the basement membrane of syncytiotrophoblast in patients with PIH/PE compared to controls (p < 0.001, Fisher's exact test). Moreover, the loss of continuity of E-cadherin expression correlated with the presence of a bilateral early diastolic notch on Doppler ultrasound (p < 0.001, Fisher's exact test) and the presence of proteinuria (p = 0.013, Fisher's exact test). These findings suggest that E-cadherin contributes to the integrity of the placental barrier, and its loss could be an immunohistochemical marker of PE.