Pregnancy Weight Gain as a Predictor of Fetal Wellbeing in Liver Transplant Recipients.

BACKGROUND Gestational weight gain (GWG) is an important index influencing perinatal outcomes. Inappropriate weight gain during pregnancy is strongly associated with multiple pregnancy complications. In pregnant liver transplant recipients whose risk of adverse pregnancy outcomes is already high, this aspect may be even more significant. The present study analyzed the gestational weight gain in female liver transplant recipients and its effect on neonatal complications. MATERIAL AND METHODS A cohort study of retrospective data was performed in the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw. There were 23 patients who fulfilled all inclusion criteria. The gestational weight gain was analyzed in the context of pre-pregnancy BMI, immunosuppression, and perinatal outcomes. RESULTS The preterm delivery rate was 39.13% and GWG increased according to the duration of pregnancy. The model adjusted to week of delivery revealed no association between weight gain and the length of pregnancy (p=0.82). GWG in liver transplant recipients did not affect hypotrophy incidence, adverse perinatal outcomes, or caesarian delivery rate. A positive correlation between GWG and neonatal birth weight was observed (p=0.06). One patient, with coexisting PIH, had a stillbirth at 23 weeks. In all other cases, the 5-min Apgar score was 10 points. CONCLUSIONS Current obstetrical recommendations do not consider patients with chronic diseases undergoing immunosuppressive treatment. Proper counselling and preparing liver transplant recipients for pregnancy, especially optimizing maternal pre-pregnancy BMI, may be an important element in improving perinatal outcomes by lowering the risk of maternal complications. GWG itself is not relevant as a predictor of term gestation, but it might be important in achieving eutrophic fetus growth.

The efficacy of misoprostol in the first trimester miscarriage treatment - an individual patients' data analysis.

INTRODUCTION: The study aimed to detect factors predicting a successful pharmacological induction of first-trimester miscarriage. MATERIAL AND METHODS: A prospective, cohort research was conducted at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, between years 2011-2015. 642 women diagnosed with first trimester miscarriage qualified for pharmacological induction with misoprostol were included in the study. Each patient underwent repeatable doses of 800mcg misoprostol vaginally. The endpoint was complete excretion of all tissues, with no need to perform surgical curettage. Type of miscarriage, gravidity, parity, number of doses, time of drug administration and side effects were analysed as possible factors influencing the results. The statistical analysis was performed with STATISTICA 10.0 software. RESULTS: The percentage of successful miscarriage induction was 83.6%. Two main factors corresponded with successful pharmacological treatment in regression analysis: number of administered doses (adjusted OR 1.64; 95% CI 1.18-2.29) and week of gestation (aOR 1.22; 95%CI 1.03-1.44). The success of the pharmacological induction of miscarriage was significantly decreased if the woman had a history of caesarean section (aOR 0.34; 95% CI 0.2-0.57). 2.2% of patients experienced benign side effects of the therapy. CONCLUSIONS: Pharmacological induction is an effective and safe treatment method of first trimester abortion in the majority of cases. The knowledge of factors influencing the efficacy of misoprostol may help clinicians in proper counselling and individualisation of therapy.

Labor in pregnancies with small for gestational age suspected fetuses.

BACKGROUND: Fetal growth restriction (FGR) is an unclearly defined condition described as a fetal weight which is too low in relation to gestational age. It is recognized in 10-15% of singleton pregnancies and can lead to severe complications, including stillbirth. To reduce the adverse fetal and neonatal outcomes, many medical interventions are being introduced by obstetricians. These, like all medical procedures, may induce further complications, such as preterm labor and its consequences. OBJECTIVES: The aim of this study was to assess in terms of perinatal and neonatal outcomes such management procedures as expectant monitoring, induction or elective cesarean section (ECS) in pregnancies where the fetus is suspected of being small for gestational age (SGA). There was also the goal of determining the specificity of ultrasound examination in the recognition of SGA. MATERIAL AND METHODS: The single-center retrospective study was carried out among 146 patients who were prenatally suspected of having SGA pregnancies and who delivered in our hospital. Small for gestational age was defined as estimated fetal weight (EFW) in the 10th percentile or below. The output cohort was divided into 2 subgroups: group A - with antenatally confirmed hypotrophy, and group B - without antenatally confirmed hypotrophy. RESULTS: Out of 146 newborns suspected of being SGA, 65 had a birth weight in the 10th percentile or below, and the estimated positive predictive value of ultrasound examination amounted to 44.5%. Underweight mothers correlated with 5 times higher rates of SGA overdiagnosis. Serious neonatal complications, such as neonatal deaths, respiratory or cardiovascular dysfunctions, and admission to the neonatal intensive care unit (NICU), occurred significantly more often in confirmed SGA cases (46% vs 19% in group B, with a p-value of 0.0066, 0.0253, 0.0027, and 0.0253, respectively). The highest rate of ECS concerned patients from group A (44.6% vs 30.9% in unconfirmed samples; p = 0.04), while expectant management was more often associated with neonatal death and admission to the NICU than with elective procedures (18.2% vs 7.4% and 36.4% vs 27.8%, respectively). CONCLUSIONS: Customized charts used during ultrasound examination, which evaluate additional parameters such as body mass index (BMI), may decrease the overdiagnosis of SGA.

Is there a rationale for aggressive breast cancer liver metastases resections in Polish female patients? Analysis of overall survival following hepatic resection at a single centre in Poland.

INTRODUCTION: Breast cancer (BC) makes up nearly 26% of malignant tumours worldwide and is the leading cause of cancer-related deaths in European women. With approximately 18,000 new cases of BC diagnosed in Polish women annually, breast cancer liver metastasis (BCLM) is respectively an increasing issue. Recent data found in literature indicates improved survival following liver resection with systemic therapy. OBJECTIVE: The aim of study was to evaluate surgical treatment in patients with isolated BCLM. MATERIALS AND METHOD: During 2009-2013, a retrospective study was undertaken and 30 cases analysed. From nearly 2,000 liver resections performed, 11 female patients at the mean age of 59.18 years with BCLM were qualified for surgery. RESULTS: The median time between primary and secondary treatment was 3.5 years (1-7). One patient (9.1%) presented an extrahepatic lesion - bone metastasis. The left lobe, right lobe and both lobes of the liver were affected, respectively, in 3 (27.3%), 4 (36.4%) and 4 (36.4%) patients. 5 patients (45.5%) presented single hepatic lesion, in contrast to the maximum number of lesions which equalled 6 in the right lobe. Average hospitalisation period was 13.27 days and discharge on the 11.3 postoperative day. One-year survival was 72.7% (8 patients); therefore, three-year survival was 36.4% (4 patients). CONCLUSIONS: Oncological centres should assess BCLM patients more openly and qualify them for hepatic resection along with adjuvant systemic treatment in order to improve overall survival. This, however, needs to be studied in a multicentre randomized trial.