The first trimester aneuploidy biochemical markers in IVF/ICSI patients have no additional benefit compared to spontaneous conceptions in the prediction of pregnancy complications.

OBJECTIVES: The aim of this study was to determine if the levels of biochemical aneuploidy markers in in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) pregnancies differ from those in spontaneous pregnancies and to verify if biochemical markers could predict pregnancy outcome in IVF/ICSI gestations. METHODS: This was a prospective observational study performed in a group of 551 patients who underwent a combined first trimester prenatal screening (ultrasound scan and serum markers). All patients were divided into two groups according to the mode of conception: IVF/ICSI pregnancies (study group) and spontaneous conceptions (control group). The concentrations of first trimester biochemical markers were presented as multiples of median (MoM) and were compared between the study and control groups. Analysed pregnancy complications included: preterm delivery (PTD), small for gestational age (SGA), gestational hypertension (GH), preeclampsia (PE) and gestational diabetes (GDM). RESULTS: The analysis was performed on 183 IVF/ICSI and 368 spontaneously conceived gestations, with complete data regarding obstetric outcome. There were no significant differences in the concentrations of biochemical markers between the analysed groups. Pregnancy-associated plasma protein-A (PAPP-A) levels were lower in hypertensive than in normotensive patients, although the difference was not significant. Twenty-three patients had GDM (12.5%), 16 had GH or PE (8.7%), SGA was diagnosed in 18 (9.8%) and 25 delivered preterm (13.6%). CONCLUSIONS: The trend for lower PAPP-A MoM was visible in all affected patients, although the results did not reach statistical significance. The first trimester biochemical markers in assisted reproduction technique (ART) pregnancies do not seem to have additional effect on predicting the risk of pregnancy complications.

Gd-EOB-DTPA-Enhanced MR Imaging of the Liver: The Effect on T2 Relaxation Times and Apparent Diffusion Coefficient (ADC).

BACKGROUND: To investigate the effect of gadoxetic acid disodium (Gd-EOB-DTPA) on T2 relaxation times and apparent diffusion coefficient (ADC) values of the liver and focal liver lesions on a 1.5-T system. MATERIAL/METHODS: Magnetic resonance (MR) studies of 50 patients with 35 liver lesions were retrospectively analyzed. All examinations were performed at 1.5T and included T2-weighted turbo spin-echo (TSE) and diffusion-weighted (DW) images acquired before and after intravenous administration of Gd-EOB-DTPA. To assess the effect of this hepatobiliary contrast agent on T2-weighted TSE images and DW images T2 relaxation times and ADC values of the liver and FLLs were calculated and compared pre- and post-injection. RESULTS: The mean T2 relaxation times of the liver and focal hepatic lesions were lower on enhanced than on unenhanced T2-weighted TSE images (decrease of 2.7% and 3.6% respectively), although these differences were not statistically significant. The mean ADC values of the liver showed statistically significant decrease (of 4.6%) on contrast-enhanced DW images, compared to unenhanced images (P>0.05). The mean ADC value of liver lesions was lower on enhanced than on unenhanced DW images, but this difference (of 2.9%) did not reach statistical significance. CONCLUSIONS: The mean T2 relaxation times of the liver and focal liver lesions as well as the mean ADC values of liver lesions were not significantly different before and after administration of Gd-EOB-DTPA. Therefore, acquisition of T2-weighted and DW images between the dynamic contrast-enhanced examination and hepatobiliary phase is feasible and time-saving.

Reference values for placental growth factor (PlGF) concentration and uterine artery doppler pulsatility index (PI) at 11-13(+6) weeks of gestation in the Polish population.

OBJECTIVES: The aim of the study was to determine placental growth factor (PIGF) concentration and uterine artery (UtA) Doppler pulsatility index (PI) at 11-13(+6) weeks of gestation in the Polish population. MATERIAL AND METHODS: A prospective study was performed in pregnant women who underwent routine ultrasound scan at 11-13(+6) weeks of gestation. All participants completed a questionnaire about their medical history demographics and current pregnancy. Mean arterial pressure (MAP) was calculated. Gestational age was confirmed by CRL and mean UtA PI was calculated. Blood samples were taken to measure beta HCG, PAPP-A and P/GF concentrations. RESULTS: Out of the 577 analyzed participants, 60 (10.4%) were found to have abnormal placentation disorders (20 -hypertensive disorders and 40-IUGR). The patients were subdivided into two groups, depending on pregnancy outcome: unaffected (n = 517) and affected (n = 60). The study did not confirm the anticipated correlation between maternal BMI and PIGF, but the concentration of PIGF was significantly increased in smokers. UtA PI values were not statistically significantly different depending on maternal age, BMI, method of conception, smoking or parity The study confirms that both, UtA PI and PIGF concentrations are CRL-dependent. Median MoM values for PIGF and UtA PI were obtained for each set of CRL measurements. Median PIGF MoM was decreased in pregnancies complicated by hypertensive disorders and IUGR as compared to the unaffected group. CONCLUSIONS: The established reference ranges for UtA PI and PIGF at 11-13(+6) weeks of gestation may be of clinical value in predicting placenta-associated diseases in early stages of pregnancy in the Polish population.

Doppler ultrasound-based evaluation of hemodynamic changes in the ophthalmic artery and central retinal artery in patients with type 1 diabetes mellitus without retinopathy and with mild non-proliferative retinopathy.

Aim: Determination of blood flow parameters in the ophthalmic artery and central retinal artery using Doppler ultrasound in patients with type 1 diabetes mellitus without fundus signs of diabetic retinopathy and with mild non-proliferative retinopathy. Material and methods: To eliminate the impact of other systemic factors on vascular flow, the study enrolled a total of 80 patients with type 1 diabetes mellitus, aged between 18 and 45 years. The study participants did not have any diabetic complications or other systemic or ocular comorbidities. The control group comprised 81 healthy individuals within a similar age range. Color Doppler ultrasound examinations of the ophthalmic artery and central retinal artery were performed to evaluate selected blood flow parameters including peak systolic velocity, end-diastolic velocity, and resistance index. Results: Patients with type 1 diabetes mellitus exhibited statistically significant decrease in both systolic and end-diastolic velocities in the central retinal artery, accompanied by an elevation in resistance index, compared to the control group. The study revealed differences in blood flow parameters between the patients without fundus changes and those exhibiting mild non-proliferative retinopathy. Specifically, patients with retinopathy showed a significant decrease in both systolic velocity and end-diastolic velocity in the central retinal artery. No differences were observed for the same parameters in the ophthalmic artery. When analyzing the patients' blood flow parameters in relation to the degree of diabetes control, as determined by glycated hemoglobin levels, a statistically significant reduction in systolic velocity was identified in both the ophthalmic and central retinal arteries in the group with poorly controlled diabetes. Conclusions: Examination of the orbital vessels using Doppler ultrasound in patients with type 1 diabetes mellitus holds promise as an effective method for early detection of vascular abnormalities.

Iatrogenic and spontaneous late preterm twins--which are at higher risk of neonatal complications?

OBJECTIVES: To evaluate data regarding neonatal mortality and short term morbidity among iatrogenic late preterm (ILP) and spontaneous late preterm (SLP) twin births, and to estimate whether medical interventions - induction of labor in this particular context, are associated with better or poorer outcomes. MATERIAL AND METHODS: Retrospective analysis of 110 late preterm dichorionic twin pregnancies was performed basing on medical charts data. All twins were delivered in years 2005-2011 at the 1st Department of Obstetrics and Gynecology Medical University of Warsaw Late preterm twins, defined as those delivered between 34 + 0-36+ 6 weeks of gestation, were divided into spontaneous and iatrogenic preterm births. The primary outcomes of the study were various neonatal adverse events, including one of the following per pregnancy: admission to Neonatal Intensive Care Unit (NICU), respiratory disorders (RD) and pneumonia, intraventricular hemorrhage (IVH), sepsis, NEC and jaundice requiring phototherapy Mann-Whitney U-test and chi-squared test were used and logistic regression performed to calculate odds ratio, with p value < 0.05 considered significant. RESULTS: There were 69 (62.7%) spontaneous and 41 (37.3%) iatrogenic late preterm twins. There were no differences in maternal characteristics, mode of delivery and newborns' Apgar scores. The mean birth weight did not differ significantly between the groups. There was one case of perinatal death of one twin in ILP group. Preeclampsia (31.7%) and IUGR (17%) were the most frequent indications for labor induction in ILR Women in the ILP group were administered steroid treatment for lung maturation more frequently than SLP group due to pregnancy complications (73.17% vs. 30.44%; p < 0.0001). Nevertheless, ILP twins were at higher risk of respiratory disorders (41.46% vs. 15.94%; p = 0.003--significant either with or without pneumonia) and NICU admission (31.71% vs. 14.49%; p = 0.032) than SLP twins. The only two independent factors influencing the occurrence of poor neonatal outcome were gestational age in weeks (OR 0.57; 95% Cl 0.34-0.94) and preeclampsia (OR 5.01; 95% CI 1.51-16.67). In the additional analysis of gestational age odds ratio, only the delivery at 34 weeks of gestation increased the incidence of adverse neonatal outcome almost five times (OR 4.94, 95% Cl: 1.64-14.88). The rate of cesarean delivery in the SLP was 81.61%, while in the ILP it reached 90.23% (p = 0.17). CONCLUSIONS: Late prematurity in twin pregnancies is associated with higher risk of neonatal morbidity than in term twins. Iatrogenic late preterm birth increases the risk of NICU admission and respiratory disorders in neonates in comparison to spontaneous late preterm birth. Despite the fact that respiratory complications are generally mild and mostly temporary there is a need for careful evaluation of indications for delivery in that particular group.

Characterization of focal liver lesions using quantitative techniques: comparison of apparent diffusion coefficient values and T2 relaxation times.

OBJECTIVES: To compare the efficacy of two quantitative methods for discrimination between benign and malignant focal liver lesions (FLLs): apparent diffusion coefficient (ADC) values and T2 relaxation times. METHODS: Seventy-three patients with 215 confirmed FLLs (115 benign, 100 malignant) underwent 1.5-T MRI with respiratory-triggered single-shot SE DWI (b = 50, 400, 800) and dual-echo T2TSE (TR = 3,000 ms; TE1 = 84 ms; TE2 = 228 ms). ADC values and T2 relaxation times of FLLs were calculated. Sensitivity, specificity and accuracy of both techniques in diagnosing malignancy were assessed. RESULTS: The mean ADC value of malignant tumours (1.07 × 10(-3) mm(2)/s) was significantly lower (P < 0.05) than that of benign lesions (1.86 × 10(-3) mm(2)/s ); however, with the use of the optimal cut-off value of 1.25 × 10(-3) mm(2)/s, 20 false positive (FP) and 20 false negative (FN) diagnoses of malignancy were noted, generating 79 % sensitivity, 82.6 % specificity and 80.9 % accuracy. The mean T2 relaxation time of malignant tumours (64.4 ms) was significantly lower (P < 0.05) than that of benign lesions (476.1 ms). At the threshold of 107 ms 22 FP and 1 FN diagnoses were noted; the sensitivity was 99 %, specificity 80.9 % and accuracy 89.3 %. CONCLUSIONS: Quantitative analysis of T2 relaxation times yielded significantly higher sensitivity and accuracy in diagnosing malignant liver tumour than ADC values. KEY POINTS: • Diffusion-weighted magnetic resonance imaging is increasingly used for liver lesions. • But ADC values demonstrated only moderate accuracy for differentiation of liver lesions. • T2 relaxation times yielded higher accuracy in diagnosing malignant liver tumours. • Both ADC and T2 values overlapped between focal nodular hyperplasia and malignant lesions. • Nevertheless T2 liver mapping could be valuable for evaluating focal liver lesions.

Both Low and High PAPP-A Concentrations in the First Trimester of Pregnancy Are Associated with Increased Risk of Delivery before 32 Weeks in Twin Gestation.

In twin gestation, the relationship between pregnancy associated plasma protein (PAPP-A) and perinatal outcome is unclear. The aim of the study was to determine if low and high concentrations of PAPP-A in the first trimester are related to perinatal outcome in twins. A retrospective study was conducted. Medical data of women in twin pregnancies who delivered between 2013 and 2018 were analyzed. PAPP-A concentrations were measured between 10 + 0 and 13 + 6 weeks. The associations between low (<10th percentile) and high (>90th percentile) values of PAPP-A and pregnancy complications were analyzed. A total of 304 patients were included. PAPP-A <10th percentile was associated with a high risk of preterm delivery (OR 6.14; 95% CI 2.1-18), delivery <34 weeks (OR 2.39; 95% CI 1.1-5.1) or <32 weeks (OR3.06; 95% CI 1.4-6.8). Significant relations between PAPP-A >90th percentile and delivery <34 weeks (OR4.09; 95% CI 1.8-9.1) or <32 weeks (OR 2.83; 95% CI 1.2-6.6) were found. PAPP-A >90th percentile was related to high risk of intrauterine fetal demise (OR 10; 95% CI 2.4-42.5). Both low and high PAPP-A concentrations seem to be related to pregnancy outcome. Further research is needed to investigate evaluation of risk of pregnancy complications according to PAPP-A concentrations as a continuous variable.

KARDIONET: telecardiology based on GRID technology.

The telecardiological system Kardionet is being developed to support interventional cardiology. The main aim of the system is to collect specific and systemized patient data from the distant medical centers and to organize it in the best possible way to diagnose quickly and choose the medical treatment. It is the distributed GRID type system operating in shortest achievable time. Computational GRID solutions together with distributed archive data GRID support creation, implementation and operations of software using considerable computational power. Kardionet system devoted to cardiology purposes includes specially developed data bases for the multimodal data and metadata, including information on a patient and his/her medical examination results. As Kardionet uses modern technology and methods we expect it could have a considerable impact on telemedicine development in Poland. The presented telecardiological system can provide a number of important gains for the national health care system if it is implemented nationwide.

Observational study of associations between gestational weight gain and perinatal outcomes in dichorionic twin pregnancies.

OBJECTIVE: To evaluate relationships between gestational weight gain (GWG) and adverse events during pregnancy among patients of normal weight with twin pregnancies. METHODS: The present observational study included patients with dichorionic twin pregnancies with a pre-gravid body mass index of 18.5-24.99 kg/m2 who underwent delivery at no earlier than 22 weeks of pregnancy between January 1, 2007, and June 30, 2016, at the Medical University of Warsaw, Warsaw, Poland. The GWG ratio was categorized as low (<0.45 kg/wk), adequate (0.45-0.66 kg/wk), or high (>0.66 kg/wk), and pregnancy outcomes were compared between the GWG ratio groups. Associations between GWG ratio and pregnancy outcomes were estimated using generalized additive models. RESULTS: There were 201 patients included in the study. No differences in rates of preterm delivery, very preterm delivery (VPTD), small for gestational age fetus, pre-eclampsia, gestational diabetes, preterm premature rupture of membranes, or intrauterine fetal demise were observed between the patient groups. Linear relationships with GWG ratio were recorded for VPTD (P=0.019) and spontaneous VPTD (P=0.003); non-linear relationships with GWG ratio were recorded for pre-eclampsia (P=0.023) and perinatal mortality (P=0.015). A GWG ratio of 0.55-0.56 kg/wk appeared optimal in terms of twin pregnancy outcomes. CONCLUSION: The incidence of VPTD, pre-eclampsia, and perinatal mortality during dichorionic twin pregnancy were associated with GWG ratio.

Factors influencing the severity of pain during hysterosalpingography.

OBJECTIVE: To analyze factors influencing the severity of pain during hysterosalpingography (HSG). METHODS: A prospective randomized study was performed among women with ongoing infertility undergoing HSG at a center in Poland between March and September 2013. The patients were assigned by random draw to receive 0.1g ketoprofen or 2.5g metamizole intravenously. Patients and physicians performing HSG were masked to assignment, but the healthcare workers who administered analgesics were not. Pain was assessed by a visual analogue scale (VAS) during and after the HSG procedure. RESULTS: A total of 80 women were assigned to ketoprofen and 89 were assigned to metamizole. There were no significant differences in VAS scores with regard to the administered analgesic, patient age, duration of infertility, medical history (previous delivery, abdominal surgery), or type of infertility. However, women who went on to have abnormal HSG results had higher VAS scores at time of contrast instillation and 30minutes after the procedure than did those who had confirmed bilateral patency of the tubes (P≤0.03 for both). CONCLUSION: An abnormal HSG result seems to be the main factor influencing the sensation of pain perceived by patients during the procedure.

Adjunctive Pessary Therapy after Emergency Cervical Cerclage for Cervical Insufficiency with Protruding Fetal Membranes in the Second Trimester of Pregnancy: A Novel Modification of Treatment.

AIM: To evaluate the effectiveness of adjunctive pessary therapy after emergency cervical cerclage (ECC) in improving perinatal outcome in cervical insufficiency with fetal membranes protruding into the vagina. MATERIAL AND METHODS: A retrospective analysis of patients treated at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, between 2008 and 2013. The study group consisted of 15 women treated with ECC and a pessary and the control group consisted of 17 patients treated with cerclage only. RESULTS: The mean gestational age at delivery was significantly higher in the study group (34.7 versus 29.7 weeks, p = 0.03). The period between cerclage insertion and delivery was significantly longer in the study group (82.9 versus 52.1 days, p = 0.045). The mean neonatal birthweight and neonatal "discharge alive" ratio were higher in the study group, although not statistically significant (2550 g versus 1883 g, p = 0.14, and 93.3% versus 70.5%, p = 0.18, resp.). NICU hospitalization rates were comparable (33.3% versus 35.3%, p = 0.9). CONCLUSIONS: Adjunctive pessary therapy allows delaying delivery in women treated with ECC due to cervical insufficiency with protruding fetal membranes. It also seems to improve neonatal outcome, although the differences are not statistically significant. Further prospective study is required to prove these findings.

Non-contrast-enhanced whole-body magnetic resonance imaging in the general population: the incidence of abnormal findings in patients 50 years old and younger compared to older subjects.

PURPOSE: To assess and compare the incidence of abnormal findings detected during non-contrast-enhanced whole-body magnetic resonance imaging (WB-MRI) in the general population in two age groups: (1) 50 years old and younger; and (2) over 50 years old. MATERIALS AND METHODS: The analysis included 666 non-contrast-enhanced WB-MRIs performed on a 1.5-T scanner between December 2009 and June 2013 in a private hospital in 451 patients 50 years old and younger and 215 patients over 50 years old. The following images were obtained: T2-STIR (whole body-coronal plane), T2-STIR (whole spine-sagittal), T2-TSE with fat-saturation (neck and trunk-axial), T2-FLAIR (head-axial), 3D T1-GRE (thorax-coronal, axial), T2-TSE (abdomen-axial), chemical shift (abdomen-axial). Detected abnormalities were classified as: insignificant (type I), potentially significant, requiring medical attention (type II), significant, requiring treatment (type III). RESULTS: There were 3375 incidental findings depicted in 659 (98.9%) subjects: 2997 type I lesions (88.8%), 363 type II lesions (10.8%) and 15 type III lesions (0.4%), including malignant or possibly malignant lesions in seven subjects. The most differences in the prevalence of abnormalities on WB-MRI between patients 50 years old and younger and over 50 years old concerned: brain infarction (22.2%, 45.0% respectively), thyroid cysts/nodules (8.7%, 18.8%), pulmonary nodules (5.0%, 16.2%), significant degenerative disease of the spine (23.3%, 44.5%), extra-spinal degenerative disease (22.4%, 61.1%), hepatic steatosis (15.8%, 24.9%), liver cysts/hemangiomas (24%, 34.5%), renal cysts (16.9%, 40.6%), prostate enlargement (5.1% of males, 34.2% of males), uterine fibroids (16.3% of females, 37.9% of females). CONCLUSIONS: Incidental findings were detected in almost all of the subjects. WB-MRI demonstrated that the prevalence of the vast majority of abnormalities increases with age.

Autonomous adrenocorticotropin reaction to stress stimuli in human fetus.

The aim of the study was to determine whether human fetuses show ACTH response to stress stimuli, to define the gestational age from which these reactions may be present and to analyze the relationship between hormone concentrations and their changes, both in fetuses and in pregnant women. The study included 81 intrauterine transfusions carried out in 19 pregnant women. 52 procedures were performed directly into the umbilical vein, which is not innervated, so neutral for the fetus (the PCI group) and 29 transfusions into the intrahepatic vein -which puncture is stressful for the fetus (the IHV group). ACTH and cortisol concentrations in fetal and maternal plasma obtained during the procedures were assayed. The initial mean plasma ACTH concentration in the PCI group equaled 18.94pg/mL, but in the IHV group it was significantly higher and amounted 75.17pg/mL (p<0.001). There was no significant change in the hormone concentration during the transfusion both in the IHV group (95.8pg/mL, p>0.05) and in the PCI group (22.36pg/mL, p>0.05). The observed hormonal response in the IHV group proves the existence of fetal pituitary reaction to stress. The initial fetal ACTH concentration in the IHV group correlated with the number of transfusions performed on a single fetus (R=0.41; p=0.04). No correlation with parity, gestational weeks or the volume of transfused packed red blood cells was found. There was also no correlation between fetal and maternal ACTH concentrations in any group. Presented data suggest that the human fetus shows autonomous ACTH reaction to stress stimulation.

Vaginal progesterone after tocolytic therapy in threatened preterm labor.

OBJECTIVE: The aim of this study was retrospective evaluation of progesterone efficacy in pregnant patients with preterm uterine contractions. MATERIAL: 190 women hospitalized at 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, in 2007-2010, with symptoms of threatened preterm labor were enrolled in the study. 94 women were treated with tocolytics and steroids (control group), while 96 women received additionally 200 mg of progesterone vaginally until delivery or 34th weeks of gestation (progesterone group). RESULTS: The mean gestational age at admission was 27 weeks in progesterone group and 28 weeks in control group. Cervical length was similar in both groups. There were no significant differences in week of delivery between groups, but the progesterone group had significant increase in prolongation of pregnancy (7.6 versus 6.3 weeks, p = 0.039). Vaginal progesterone was associated with reduction of delivery before 34 weeks (9.8% versus 35.3%; p = 0.002) and neonatal birth weight <1500 g (3.2% versus 20.6%; p = 0.011) only in patients presenting with uterine contractions after 27 weeks. CONCLUSION: The administration of vaginal progesterone after tocolysis in threatened preterm labor is associated with prolongation of pregnancy. The reduction of deliveries before 34 weeks was observed in patients presenting with contractions after 27 weeks gestation.