Causes and frequency of tocophobia - own experiences.

OBJECTIVES: The phenomenon of tocophobia (pathological fear of labor) has not been fully explored. Currently, there are no diagnostic criteria that would enable its detection or make it recognizable as a disease entity. The aim of study was to determine the degree of anxiety/tocophobia as well as to learn about and analyze the causes of this phenomenon in Polish pregnant women. MATERIAL AND METHODS: The prospective study included 120 pregnant women in the third trimester of gestation from February to May 2016. The study was performed with the use of a standardized and revised version of the Labor Anxi-ety Questionnaire (KLP II) designed by Putynski and Paciorek (1997) as well as a proprietary interview questionnaire and structured data documentation form. RESULTS: In 6.7% of the subjects, the level of labor anxiety was very high (> 18 in KLP II). It was the highest in women over 30 years of age (Pearson's chi squared test = 0.00422; p < 0.05). It has been shown that successive childbirths have an im-pact on the degree of anxiety (p = 0.04217).The highest level of anxiety was noted in primiparous women. In 85% of the subjects, anxiety was caused by fear of labor pain. 56.7% of the tested women did not use any professional help in the preparation for childbirth and motherhood. CONCLUSIONS: Primiparas and women over 30 years of age experience very high levels of fear significantly more frequently. The lack of proper preparation for childbirth determines the occurrence of tocophobia. Ante-natal classes and prenatal education based on standards of obstetric care should be promoted in order to reduce or eliminate fear of natural labor.

Paternal engagement during childbirth depending on the manner of their preparation.

OBJECTIVES: The analysis of the forms of paternal activity depending on the manner of their preparation, including stages of labor. MATERIAL AND METHODS: A prospective survey-based study involved 250 fathers who participated in their child's birth. The fathers included in the study were present during all stages of family-assisted natural labor. The study was conducted one day after childbirth with the use of a survey prepared by the authors. Statistical calculations were conducted using the Statistica PL software. The frequency of individual qualitative features (non-measurable) was assessed by means of a non-parametric χ² (chi-squared) test. The statistical significance level was p < 0.05. RESULTS: A half of the fathers included in the study (52.4%) participated in childbirth with no prior preparation. The dominant form of preparation involved self-education from books, magazines and the Internet (24%). 23.6% of fathers participated in ante-natal classes. The study demonstrated that fathers prepared for childbirth in ante-natal classes more often engaged in the supportive role, provided nursing care and carried out instrumental monitoring during each stage of childbirth. CONCLUSIONS: The fathers prepared for childbirth in ante-natal classes more often engage in the supportive role, provide nursing care and carry out instrumental control during each stage of childbirth. Ante-natal classes should be promoted as an optimal form of preparation for active participation in childbirth. Moreover, other forms of paternal ante-natal education as well as continued education in a delivery room should be developed.

The preferences of parturient women and the participation of the child's father during birth.

BACKGROUND: The participation of the father in the birth manifests itself in action, that depends on the attitude towards family-assisted birth and the preferences of the parturient woman. AIM: Evaluation of expectations of parturient women in the aspect of the active participation of the father, that would enable the use of the most commonly reported preferences in the clinical praxis and the establishment of factors influencing the presented preferences. METHODS: 250 married couples who participated in natural childbirth were subjected to prospective survey. Couples after physiological delivery with the participation of father in all stages of childbirth were qualified. The surveys were conducted in the first day after the childbirth. The survey tool was an author-developed survey questionnaire in two versions: (A) for the mother and (B) for the child's father who participated in the birth. The statistical calculations were performed with use of the Statistica PL software. The frequency of occurrence of respective quality (non-measurable) features was evaluated with χ² (chi-square) nonparametric test. The level of statistical significance adopted for tests was p<0.05. RESULTS: The preferences of parturient women, regardless of their age, education, duration of marriage, number of family-assisted births and the form of preparation mostly concerned the adaptation of a supportive role by the fathers, on every stage of the birth. During the second stage of birth 74.4% of parturient women expected the father to cut the umbilical cord. After the birth the majority of mothers (76%) preferred the presence of the father in post-delivery period. CONCLUSIONS: The pre-birth education of couples of parents should include the expectations of the parturient woman, regarding the forms of father's activity during a family-assisted birth. High expectations of parturient women regarding the emotional support indicate the need for educating future fathers, as there is large demand for such element of mid-delivery care.

The model of active participation of the father in childbirth, based on the preferences of the parturient women.

BACKGROUND: The model of family-assisted birth is an element of obstetric care that met with large interest, with the development of perinatology in numerous countries. The modern father is expected to more actively participate both during pregnancy and birth, and also in the childcare. AIM: The comparative analysis of the parturient Polish women and the forms of activity of the fathers participating in family-assisted births in order to know which forms of father's activity correlate with the expectations of women in labor and define the range of tasks for the father (model of action for family-assisted birth) that would correspond to the preferences of parturient women. METHODS: 250 parturient women and 250 fathers who participated in the delivery were included in the survey. Couples after physiological delivery with the participation of father in all stages of childbirth were qualified. The surveys were conducted in the first day after the childbirth. The survey tool was an author-developed survey questionnaire in two versions: (A) for the mother and (B) for the child's father who participated in the birth. The statistical calculations were performed with use of the Statistical PL software. The frequency of occurrence of respective quality (non-measurable) features was evaluated with χ² (chi-square) nonparametric test. The level of statistical significance adopted for tests was p<0.05. RESULTS: The largest coherence between the form of father's activity and the expectations of the parturient woman was found in case of psychical support in every stage of the delivery. Another form of activity of fathers, that in 85% of cases was concurrent with the expectations of women in labor was the act of cutting the umbilical cord and the participation of father in the child measurements and tests (78.5% coherence) and the need of stay of father with the woman and the newborn in the post-delivery period (70% coherence). CONCLUSIONS: Obstetric care should take the preferences, connected with family-assisted birth, of both parents into account. The model of active participation of father in family-assisted birth forms a practical guideline for fathers willing to actively participate in the childbirth.

Sudden loss of vision due to breast cancer metastasis to the eyeball.

Intraocular choroidal metastasis is a very rare cause of blindness. Carcinoma of breast is the most common primary malignancy the accounts for choroidal metastasis in females. Other primary neoplasms which can uncommonly metastasize to the choroid are gastrointestinal tract, thyroid, pancreas, prostate and testis. Metastatic neoplasm to the eye outnumbers the primary tumors such as retinoblastoma and malignant melanoma. We present a case of sudden loss of vision due to breast cancer metastasis to the eyeball. The interval between the diagnosis of the primary tumor and the choroidal metastasis was 4 years.

Streptococcus group B serotype distribution in anovaginal isolates of women in term pregnancy.

BACKGROUND: To evaluate Streptococcus group B (GBS) serotype distribution in anovaginal isolates of women in term pregnancy and to assess the correlation of the distribution with socio-epidemiological variables and neonatal outcomes. DESIGN: An observational study. SETTINGS: Department of Gynecology and Obstetrics, Specialist Teaching Hospital in Tychy, Poland. POPULATION: 80 women between 37 and 40 gestation weeks with preserved fetal membranes and who had not been treated with antibiotics for at least two weeks before the study. MATERIAL AND METHODS: The specimens from the vagina and the rectum of pregnant women were collected. GBS colonization tests were conducted in compliance with Centers for Disease Control and Prevention recommendations. Serotyping of the isolates was performed using the Essum GBS Serotyping Kit (Umea, Sweden) according to manufacturer's instruction. Mein outcome measures. GBS serotype distribution in the population of Polish women in term pregnancy. RESULTS: In the studied group of 80 pregnant women GBS colonization rate was 28.7%. Four GBS serotypes were observed (Ia, V, III and II). Serotype Ia was the most predominant - 43.47%. For GBS Ia, V and III serotypes, no significant difference in the prevalence of diabetes mellitus and neonatal outcomes was observed. Only in one case early-onset sepsis was diagnosed in the neonate and serotype Ia was determined. CONCLUSIONS: 1) From among four identified GBS serotypes in the population of Polish pregnant women, serotype Ia was the most dominant. 2) For GBS serotypes, no significant difference in the prevalence of diabetes mellitus and neonatal outcomes was observed. 3) Active immunization aimed for preventing GBS colonization in mothers should include not only serotypes V, II and III but also Ia in order to be an effective and safe in preventing life threatening neonatal infections.

Sexual dysfunction and distress--development of a Polish version of the female sexual distress scale-revised.

INTRODUCTION: The concept of sexually related personal distress, central to the diagnosis of all female sexual dysfunction (FSD), is currently a subject of scientific debate. Several psychometric instruments have been used to measure sexually related personal distress in women, including the Female Sexual Distress Scale (FSDS) and its revised version (FSDS-R). AIM: To develop a Polish version of the FSDS-R (PL-FSDS-R). METHODS: In total, 210 women aged 18-55 years were included in the study. Seventy-five were diagnosed with hypoactive sexual desire disorder (HSDD), 31 were diagnosed with another FSD, and 104 were control. All subjects completed the PL-FSDS-R at baseline (day 0), day 7, and day 28. Internal consistencies were evaluated by Cronbach's α. Intraclass correlation coefficient was used to assess test-retest reliability. Discriminant validity was assessed by comparing mean scores of the FSD and control groups in a between-groups analysis of variance. Receiver operating characteristic (ROC) analysis was performed to determine optimal cutoff values of the PL-FSDS-R. MAIN OUTCOME MEASURES: To measure the validity and reliability of the PL-FSDS-R and to determine optimal cutoff values. RESULTS: Mean total PL-FSDS-R score was statistically higher in women with HSDD and other FSD compared to healthy individuals, showing the test had discriminant validity. The frequency of sexual intercourse and quality of relationship with sexual partner but not other sexual behaviors were statistically correlated with the PL-FSDS-R score. ROC analysis confirmed these findings. All domains of the PL-FSDS-R demonstrated satisfactory internal consistencies, with a Cronbach's α-value of >0.70 for the entire sample. Test-retest coefficients were between 0.86-0.92, with the best reliability for a 7-day recall period. CONCLUSIONS: The PL-FSDS-R is a reliable questionnaire with good psychometric and discriminative validity, and can be used to measure sexually related personal distress in Polish women with FSD with a cutoff score of ≥13.

Development and validation of the Polish version of the Female Sexual Function Index in the Polish population of females.

INTRODUCTION: Unlike male sexual function, which is relatively easy to assess, female sexual function is still a diagnostic challenge. Although numerous new measurements for female sexual dysfunction (FSD) have recently been developed, the Female Sexual Function Index (FSFI) remains the gold standard for screening. It has been validated in more than 30 countries. The FSFI has been used in several studies conducted in Poland, but it has never been standardized for Polish women. AIM: The aim of this study was to develop a Polish version of the FSFI (PL-FSFI). MATERIALS AND METHODS: In total, 189 women aged 18-55 years were included in the study. Eighty-five were diagnosed with FSD as per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV-TR) criteria; 104 women did not have FSD. All subjects completed the PL-FSFI at baseline (day 0), day 7, and day 28. MAIN OUTCOME MEASURES: Test-retest reliability was determined by Pearson's product-moment correlations. Reliability was tested using Cronbach's α coefficient. Construct validity was evaluated by principal component analysis using varimax rotation and factor analysis. Discriminant validity was assessed with between-groups analysis of variance. RESULTS: All domains of the PL-FSFI demonstrated satisfactory internal consistencies, with Cronbach's α value of >0.70 for the entire sample. The test-retest reliability demonstrated good-to-excellent agreement between the assessment points. Based on principal component analysis, a 5-factor model was established that explained 83.62% of the total variance. Domain intercorrelations of the PL-FSFI ranged from 0.37-0.77. The optimal PL-FSFI cutoff score was 27.50, with 87.1% sensitivity and 83.1% specificity. CONCLUSION: The PL-FSFI is a reliable questionnaire with good psychometric and discriminative validity. Therefore, it can be used as a tool for preliminary screening for FSD among Polish women.

Assessing the Risk of Depression Tendency in Pregnancy and Puerperium during COVID-19 Pandemic in Poland.

The aim of the study was to assess the risk and severity of depression tendency in pregnant and postpartum women and to determine the relative risk for selected psychosocial and obstetric variables. The study included 317 women in the perinatal period. The severity of depressive disorders was assessed using standard self-report scales: EPDS (Edinburgh Postnatal Depression Scale), BDI-II (Depression Inventory-Second Edition), and HADS (Hospital Anxiety and Depression Scale). High rates of depression tendency in women in the third trimester of pregnancy were reported in 48.05% of pregnant women (≥10 EPDS scores), 49.36% (≥12 BDI II scores), and 41.55% (≥8 HADS-D scores). In contrast, in women in the first week after delivery, respectively: 33.74%; 28.83%; 22.08%. In the EPDS assessment, 11.69% of pregnant women and 17.79% of postpartum women confirmed the presence of self-injurious thoughts. A woman's diagnosis of depressive disorder before pregnancy increases the risk of postpartum depression tendency 3.35 times according to the EPDS, 3.51 times according to the BDI-II, and 4.89 times according to the HADS-D. Depressive disorders were significantly more common in pregnant women compared to women in the first week of postpartum. Systematic screening can identify risk factors for prenatal and postpartum depression.

Clinical value of real time 3D sonohysterography and 2D sonohysterography in comparison to hysteroscopy with subsequent histopathological examination in perimenopausal women with abnormal uterine bleeding.

OBJECTIVE: In many publications the transvaginal ultrasound is regarded as the first step to diagnose the cause of uterine bleeding in perimenopausal women. In order to improve the sensitivity and specificity of the conventional ultrasound physiological saline solution was administered to the uterine cavity and after expansion of its walls the interior uterine cavity was examined. And this procedure is called 2D sonohysterography (SIS 2D). By the ultrasound scanners which enable to get 3D real time image a spatial evaluation of the uterine cavity is possible. Clinical value of the real time 3D sonohysterography and 2D sonohysterography compared to hysteroscopy with histopathological examination in perimenopausal women. MATERIAL AND METHODS: The study concerned a group of 97 perimenopausal women with abnormal uterine bleeding. In all of them after a standard transvaginal ultrasonography a catheter was inserted into the uterine cavity. After expansion of the uterine walls by administering about 10 ml of 0,9% saline solution the uterine cavity was examined by conventional sonohysterography. Then a 3D imaging mode was activated and the uterine interior was examined by real time 3D ultrasonography. The ultrasound results were verified by hysteroscopy, the endometrial lesions were removed and underwent a histopathological examination. RESULTS: In two cases the SIS examination was impossible because of uterine cervix atresion. In the rest of examined group the SIS 2D sensitivity and specificity came up to 72 and 96% respectively. In the group of SIS 3D the sensitivity and specificity reached 83 and 99% respectively. CONCLUSIONS: Adding SIS 3D, a minimally invasive method, to conventional sonohysterography improves the precision of diagnosis of endometrial pathology, allows to get three-dimensional image of the uterine cavity and enables examination of endometrial lesions. The diagnostic precision of this procedure is similar to the results achieved by hysteroscopy.