Personalized embryo transfer (pET) guided by endometrial receptivity (ER) assessment - a possibility to increase effectiveness of IVF procedures. Review of available methods.

The continuous development of assisted reproductive techniques (ART) implies the search for solutions that could increase the effectiveness ofavailable methods. In the context of in vitro fertilization (IVF), a significant proportion of failures are due to unsuccessful embryo transfers. At this stage the most important issue is proper dialogue between implanting embryo and the maternal endometrium. Therefore, it seems justified to assess endometrial receptivity (ER), defined as the tissue's ability to accept an embryo to attach and invade into the mucosa. Window of implantation (WOI), is a certain period in which implantation of the properly developed embryo is possible. The cause of endometrial receptivity disorders is believed to be the disturbed expression of cytokines and endometrial surface proteins, the presence of which has been proven in commonly diagnosed diseases such as endometriosis or chronic endometritis. Despite many years of research on endometrial receptivity, the area of ​​diagnostic methods enabling clinical monitoring of ER still remains undeveloped. The aim of this study is to review the utility of selected markers and the available methods of ER assessment, ranging from noninvasive ultrasound, through endometrial fluid analysis, to genomic studies based on endometrial biopsy, in order to increase the effectiveness of IVF. Such an approach could potentially be a significant step towards personalizing medical procedures especially in patients diagnosed with repeated implantation failure (RIF).

Transabdominal and transvaginal ultrasound assessment of cervical length - can transvaginal approach be avoided?

OBJECTIVES: This study aimed to compare transabdominal (TA) and transvaginal (TV) ultrasound assessment of cervical length during pregnancy and to establish cervical length above which transvaginal measurement is not necessary. MATERIAL AND METHODS: Cervical length was measured using TA and TV method in the first (11 + 0-13 + 6 weeks), the second (20 + 0-21 + 6 weeks) and the third trimester (28 + 0-31 + 6 weeks) in 250 women with singleton pregnancy and low risk for preterm birth. RESULTS: If the cervical length measured in the second trimester of pregnancy with transabdominal approach is ≥ 28.5 mm and ≥ 30.5 mm in the third trimester, it can be assumed with 100% sensitivity the cervical length measured with transvaginal method will be > 25 mm. Transabdominal cervical length measurement in the second and third trimester allows 89% and 65% of patients, respectively, to avoid transvaginal scan. CONCLUSIONS: Second and third trimester screening by transabdominal cervical length measurements in a group of pregnant women with low risk for preterm birth is useful to determine which patients require transvaginal measurement.

The Polish Society of Gynecologists and Obstetricians Guideline for the diagnostic assessment and management of multiple-gestation pregnancy complicated by fetal growth restriction.

The aim of the Guideline is to unify the diagnostic-therapeutic management of multiple-gestation pregnancies complicated by fetal growth restriction in at least one fetus.

Assessment of the Thyroid Functions among Female Flight Attendants.

INTRODUCTION: Epidemiological observations indicate that stewardesses are exposed to reproductive and endocrine system disturbances. The aim of the study was to assess of thyroid function disturbances as well as to identify factors affecting the thyroid function among stewardesses working both within one time zone and on long-distance flights. MATERIAL AND METHODS: The cross-sectional study covered 103 women aged 23-46. The study group (I) was divided into two subgroups: group Ia comprising stewardesses flying within one flight zone and group Ib stewardesses working on long-distance flights. The control group (II) were women of reproductive age who sought medical assistance due to marital infertility in whom the male factor was found to be responsible for problems with conception in the course of the diagnostic process. The assessment included: age, BMI, menstrual cycle regularity, length of work, frequency of flying, thyroid stimulating hormone (TSH) concentration, level of free thyroxine (fT4), antibodies to thyroglobulin (aTG) and to thyroperoxidase (aTPO), prolactin concentration, sex hormone binding globulin (SHGB) concentration, total cholesterol, and low density lipoprotein (LDL) fraction. Descriptive methods and inferential statistics methods were used to compile the data. RESULTS: The difference between the concentrations of TSH in the study group (2.59 mcIU/mL) and the control group (1.52 mcIU/mL) was statistically significant (p < 0.01). An elevated titer of thyroid antibodies (aTPO and/or aTG) was revealed in 46.3% of stewardesses and in 15.1% of patients from the control group (p < 0.001). Groups Ia and Ib in individual concentrations were not statistically significant. The frequency of occurrence of an elevated titer of thyroid antibodies depended on the length of work in the study group (p > 0.05). No statistically significant difference was found in patients spending up to 60 h a month flying and in patients spending more than 60 h flying, the percentage of the occurrence of thyroid antibodies was 50% and 43.5, respectively. CONCLUSIONS: The occurrence in stewardesses of a higher TSH concentration than in the control group can signify that stewardesses are burdened with a higher risk of the development of hypothyroidism in the future. The character of the work of stewardesses (frequency of flying as well as length of work) does not affect the immunological profile of the thyroid.

Does pregnancy influence eye parameters? Assessment of choroidal thickness using EDI-OCT before and after labour depending on the way of delivery method.

OBJECTIVES: The aim of this study is to assess the choroidal thickness (CT) with use of EDI-OCT in patients before and after delivery depending on the mode of delivery. MATERIAL AND METHODS: The study involved 146 eyes of 73 patients aged 20-34 years, after natural labour (66 eyes) and C-section (80 eyes). Main inclusion criteria: Informed consent to participate in the study, age 18-35 years, single pregnancy, spherical refraction error -4.00 to +4.00 D, no eye pathologies, no surgery and ophthalmic procedures-including refractive surgery, childbirth after 36 weeks of pregnancy, BCVA = 1.0. Patients were examined twice: in 36 WG and on 6th week after the birth. All examinations were carried out between 8:00 am and 10:00 am in order to avoid daily cycle fluctuations. CT measurements were made manually by two independent researchers at: subfoveal and 500 µm, 1000 µm, 1500 µm, 3000 µm temporally and nasally. The student's t-test was made. RESULTS: In C-section group CT differences before and after delivery were statistically significant in 7/9 of the analysed areas. Mean subfoveal choroidal thickness was 370.86 µm vs 388.71 µm in 36 WG and in 6th week postpartum respectively (p = 0.0003). In women after natural labour, differences were statistically significant in 3/9 of the analysed areas. Mean subfoveal choroidal thickness was 303.27 µm vs 308,34 µm in 36 WG and in 6th week postpartum respectively (p = 0.4800). CONCLUSIONS: The thickness of the choroid was lower in women in 36 WG in comparison to 6th week after birth. Changes in the thickness of the choroid are particularly noticeable in women after caesarean section.

Epidemiology, prevention and management of early postpartum hemorrhage - a systematic review.

Early Postpartum Hemorrhage (EPH) is one of the leading causes of postpartum mortality. It is defined as blood loss of at least 500 mL after vaginal or 1000 mL following cesarean delivery within 24 hours postpartum. The following paper includes literature review aimed to estimate the incidence and predictors of early postpartum hemorrhage (EPH). Available prevention and treatment methods were also assessed. The inclusion criteria for the study were met by 52 studies. The exact frequency of EPH in different populations varies from 1.2% to 12.5%. Maternal, pregnancy-associated, laborcorrelated and sociodemographic risk factors seem to be important predictors of EPH. In these cases appropriate prophylaxis should be considered. However, EPH may occur without previous risk factors. The main reason for EPH is uterine atony which contributes to up to 80% of cases of postpartum hemorrhage (PPH). Other common reasons for PPH include genital tract injuries, placenta accreta or coagulopathies. Interestingly, the majority of uterotonics seem to have a similar effect. However, carbetocin seems to be the most effective in certain situations. Appropriate diagnosis of EPH is the most important issue. The treatment should be causative. The first-line treatment should include uterotonics. Surgical interventions, if required, should be performed without delay, although preoperative uterine tamponade should be considered due to its high effectiveness. Medical staff training in medical simulation centers is an important factor that improves the outcomes of EPH treatment. It provides adaptation to hospital protocols, team work improvement, self-confidence building, more accurate blood loss evaluation and reduced perception of stress. The implementation of systematic trainings provides better outcomes in the future.

A roadmap for a comprehensive control of cervical cancer in Poland: integration of available solutions into current practice in primary and secondary prevention.

In Poland, cervical cancer incidence and mortality still remain considerably higher than in Western European countries or North America. Recent data indicate decreasing trends in women younger than 60 years and stable trends in older women. In this article, we identified obstacles in primary and secondary prevention of cervical cancer in Poland. We analysed local legislation, management structure and organization of cervical cancer prevention in Poland and reviewed solutions available and implemented in other European countries. The main weaknesses include: (i) very low coverage of organized screening; concurrent unregistered opportunistic screening with unknown coverage and high test consumption (ii) suboptimal quality assurance in organized screening and no external quality assurance in opportunistic screening (iii) very low coverage of human papillomavirus vaccination that is not centrally reimbursed (iv) absence of pilot evaluation of (a) interventions that may improve population coverage and (b) performance of new preventive strategies. The proposed solutions are multifaceted and involve: (i) legislative and organizational regulation of cervical cancer screening aimed at comprehensive registration of procedures, data access and quality assurance (ii) pilot testing and implementation of new ways to increase coverage of cervical cancer screening, in particular among older women (iii) pilot evaluation with possible introduction of human papillomavirus-based screening and (iv) inclusion of human papillomavirus vaccination into the reimbursed national immunization program.

Screening for trisomy 21 based on maternal age, nuchal translucency measurement, first trimester biochemistry and quantitative and qualitative assessment of the flow in the DV - the assessment of efficacy.

OBJECTIVES: The aim of the study was to compare effects of addition of two methods of ductus venosus (DV) flow assessment: qualitative - the assessment of shape of the A-wave (positive or negative), and quantitative - based on the pulsatility index for veins (DVPI) to the basic screening for trisomy 21 at 11 to 13 + 6 weeks of pregnancy. MATERIAL AND METHODS: The ultrasound examination was performed in 8230 fetuses in singleton pregnancies at 11- -13 + 6 wks, as a part of a routine screening for chromosomal defects. In DV A-wave was assessed and DVPI was calculated. After the scan blood sample was taken for first trimester biochemistry (BC). Risk for chromosomal defects was calculated and high-risk patients were offered an invasive test for karyotyping. RESULTS: Basic screening with following combination of markers: MA, NT and BC provided lowest detection rate (DR) 87.50% for FPR = 6.94%. After adding qualitative DV A-wave assessment DR increased to 88.75% for FPR = 5.65%. The best DR = 93.75% for FPR = 5.55% was achieved when quantitative DVPI was added. The application of the Receiver Operating Curves curve confirmed validity of the addition of DV flow assessment to the screening model. The highest diagnostic power of the test was achieved when DVPI was added, with the ROC AUC of 0.974. CONCLUSIONS: The assessment of DV flow performed at 11-13 + 6 weeks increases DR for trisomy 21 and reduces FPR. The screening model based on the quantitative DV flow analysis (DVPI) gives better results compared to the qualitative flow assessment.

Assessment of the usefulness of pipelle biopsy in gynecological diagnostics.

OBJECTIVES: The aim of this study is to assess the effectiveness of pipelle in sampling diagnostic material from the uterine cavity and determining clinical factors, which may affect its effectiveness. MATERIAL AND METHODS: The retrospective analysis included 312 patients who underwent pipelle biopsy because of various indications. Evaluated factors which may affect the effectiveness of this method were: types of indications for the procedure, age, BMI, anteflexion or retroflexion of the uterus, presence of uterine fibroids, miscarriages, natural deliveries, deliveries in general. RESULTS: In 259 (83.01%) cases sampled material allowed for a histopathological diagnosis. In 53 (16.99%) of the women we failed to sample tissue material from the uterine cavity. Indications for the procedure, BMI, age and menopausal status were factors of potential impact on the diagnostic effectiveness (p < 0.05). The diagnostic value of pipelle was found to be the lowest in women with overweight and obesity (BMI > 28), post-menopausal women, women over 55 years of age and where biopsy was performed for indications other than abnormal uterine bleeding. On the other hand, pipelle shows clearly the highest effectiveness in sampling diagnostic material from the uterine cavity in young women (< 45 years of age), menstruating women, women with normal body weight or underweight (BMI < 23) and abnormal uterine bleeding. CONCLUSIONS: Choosing a pipelle as an endometrial biopsy method should consider the indications, BMI, age and menopausal status. Omission of these factors can increase non-diagnostic outcomes resulting in necessity of repeated biopsies, the risk of complications and increases the costs of health care system.

Placental examination with dye injections in post-delivery chorionicity assessment in dichorionic triplet pregnancy.

The incidence of spontaneous triplet pregnancy is approximately 1 in 7000 deliveries. Due to the fact that every presentation of a triplet and higher order pregnancy is associated with high rate of morbidity and preterm delivery, chorionicity and amnionicity remain significant predictive factors which determine specific management throughout the pregnancy. Ultrasound chorionicity assessment in triplet pregnancies is more complex than in twins, and in many cases it remains unknown. We present a case report of a 24-year-old primipara in a spontaneous dichorionic triplet pregnancy, qualified for a cesarean section at 33 weeks of gestation, with subsequent placental examination with dye injections and post-delivery chorionicity assessment.

Quality of life assessment in women after cervicosacropexy with polypropylene mesh for pelvic organ prolapse: a preliminary study.

AIM OF THE STUDY: Aim of the study was to assess the changes in the subjective perception of quality of life in patients who underwent abdominal cervicosacropexy for pelvic organ prolapse. MATERIAL AND METHODS: Forty patients with diagnosed pelvic organ prolapse (Pelvic Organ Prolapse - Quantification [POPQ] stage IV or IIIC) underwent abdominal supracervical hysterectomy and cervicosacropexy. The questionnaire concerning the quality of life was filled in before and 6 months after the surgery. RESULTS: In all patients, an accurate prolapse correction was achieved. In 42% of patients, stress urinary incontinence (SUI) was diagnosed prior to surgery, while after the surgery in 38.24% (p > 0.05). In 50% of women, symptoms of overactive bladder (OAB) occurred pre-surgery. These symptoms were reported by 17.65% of patients postoperatively (p < 0.05). Urinary retention was observed in 32.36% before and in 2.5% after the surgery (p < 0.05). The average score of the quality of sexual life was 5.75 (SD 2.52, 95% CI: 4.41-7.1) before and increased to 7.93 (SD 1.77, 95% CI: 6.9-8.95) after the procedure (p < 0.05). The mean score of the overall quality of life in relation to POP before and after the procedure was 2.77 (SD 2.39, 95% CI: 1.87-8.64) and 9.03 (SD 1.08, 95% CI: 8.66-9.43), respectively (p < 0.001). CONCLUSIONS: These results show a highly significant improvement of the quality of life in patients who underwent abdominal cervicosacropexy for POP. The change in quality of their sexual life, reduced OAB and urinary retention rates, as well as improvement of the esthetic self-perception may have contributed to this positive effect.

Evaluation of sonographic assessment of the progress of labor.

OBJECTIVE: To evaluate the practical application of intrapartum sonographic assessment of the progress of labor. MATERIAL AND METHODS: Eighty three full-term pregnant women who delivered at the Obstetrics and Gynecology Department were enrolled into this study. Transperineal ultrasonographic examinations were conducted with a convex transducer at the onset of active labor, yielding mid-sagittal and coronal images. Three parameters were measured: 1) the angle between the long axis of the symphysis pubis and the line joining its lowest margin to the contour of the fetal head (angle of progression); 2) the distance between the presenting point and the line perpendicular to the symphysis pubis and passing through its lowest margin; 3) the fetal head-perineum distance. The relationship between measurement results and the period from examination to delivery was also analyzed. RESULTS: There were 73 vaginal deliveries and 10 women underwent a cesarean section due to failure to progress. The two groups (vaginal vs. cesarean delivery) differed significantly in terms of the angle of progression (131 vs. 110 degrees, respectively p<0.01) and the distance between the presenting point and the infrapubic line (34 vs. 20 mm, respectively p<0.01). The inter-group difference in fetal head-peritoneum distances (53 and 61 mm, respectively) was noticeable but non-significant (p>0.05). The study also demonstrated a relationship between all three of the measured values and the time to second labor phase completion. CONCLUSIONS: Ultrasonography may be useful in assessing the progress of labor as well as in predicting or early diagnosis of abnormal fetal head descent.

[Fetal hepatic artery flow assessment in prenatal diagnostics--a review of the literature]. / Ocena przeplywów w tetnicy watrobowej plodu w diagnostyce prenatalnej. Przeglad literatury.

Standards of screening tests for the most frequent fetal chromosomal defects in modern non-invasive prenatal diagnostics provide sensitivity of about 93-96%, with the false positive rate of 2.5%. During the first trimester scan, routinely performed between 11 and 13+6 week of pregnancy the calculation of the risk for chromosomal aberrations is based on maternal age (MA), nuchal translucency (NT), levels of free beta human chorionic gonadotropin (free beta-hCG), pregnancy associated plasma protein A (PAPP-A) in maternal blood, as well as the parameters from extended ultrasound examination like evaluation of the nasal bone (NB), blood flow in ductus venosus (DV), visualization of the tricuspid valve with potential regurgitation (TR) or measurement of the frontomaxillary facial angle (FMFA). The 100% detection rate remains unachievable at present, despite constantly improving guidelines for specialists, quality of imaging, and advancement in ultrasound technology Therefore, several studies have been undertaken to establish the group of 'additional markers' of chromosomal defects which, when combined with basic markers of routine screening tests, might increase the detection rate and approach it to 100%. Results of recent studies imply that evaluation of blood flow in fetal hepatic artery performed during the first trimester scan may become a new additional marker for chromosomal defects.

Advantages and disadvantages of over-the-counter availability of emergency contraception.

OBJECTIVES: To compare usage patterns, accessibility and knowledge about over-the counter (OTC) emergency contraception (EC) in comparison to prescription-only EC. DESIGN AND SETTING: Self-designed, paper-based validated questionnaires containing 26 questions were distributed among students and high school pupils in Poland (PL) - 1000 questionnaires and in Lithuania (LT) - 650. In Lithuania EC is available OTC, whereas in Poland EC is a prescription-only drug. Statistical analysis was performed using SAS software with p<0.05 considered significant. RESULTS: 74.01% of Poles and 70.89% of Lithuanians reported a history of sexual activity. About one third of the respondents in both countries used EC at least once in a lifetime (PL: 29.01%, LT: 32.2%; p>0.05). The main reason for EC usage in both countries was a broken condom (PL: 60.63%, LT: 57.66 %; p>0.05). In case of emergency more than half of the questioned women in both countries would use EC pill. The knowledge about EC was significantly lower in Poland (PL median - 8 out of 16; LT - 10 out of 16 true/false statements; p<0.01). CONCLUSIONS: Over-the-counter availability of EC does not cause repetitive or increased usage. Moreover, an easier access to EC improves patients' knowledge about the drug.

Assessment of the occurrence of menstrual disorders in female flight attendants - preliminary report and literature review.

OBJECTIVE: The aim of the presented study was to determine the incidence of menstrual disorders and to evaluate the influence of the work period and the frequency of flying on the occurrence of these disorders in flight attendants flying within one time zone. METHODS: The questionnaire-based survey covered 43 flight attendants which remained within one time zone. The statistical analysis was made by Statistica 10.0 (StatSoft Inc., USA). RESULTS: The study population of flight attendants revealed the occurrence of irregular menstrual cycles in 21%. Irregular menstruations were found to occur more frequently in women with length of work period exceeding 5 years and in women covering more than 14 routes a week though the differences were not statistically significant (p>0.05). Statistically significant correlation was found between years of work and incidence of thyroid diseases and cervical erosions. Only flight attendants working longer than 5 were found to be treated for thyroid diseases. Also in these women cervical erosions developed more frequently than in women with a shorter period of work (55.00% and 21.74%, respectively). Sleep disturbances in the form of insomnia were reported in 19 cases (44%). The study revealed that women with sleep disturbances complain on dysmenorrhea significantly more frequently (p=0.03). CONCLUSIONS: The specificity of the work of flight attendants contributes to a higher incidence of menstrual disorders, sleep disturbances and cervical erosions. These disorders seem to be largely related to the shift work.

The comparison of microlaparoscopy and laparoscopy in pelvic region assessment in infertile women.

OBJECTIVES: To compare the efficacy of microlaparoscopy and laparoscopy in the assessment of pelvic region in infertile women. MATERIALS AND METHODS: 47 patients (aged 24-35) had microlaparoscopy and subsequent laparoscopy performed in order to diagnose the cause of infertility. Pelvic region assessment was performed in both procedures and the results were afterwards compared in regard to duration of the operations and findings reported by independent surgeons. The data was statistically analyzed using Statistica for Windows 5.1. RESULTS: There were no major differences in the assessment of the pelvic region and found abnormalities in the analyzed postoperative protocols. All the diagnosed abnormalities were described similarly by both surgeons; the differences referred only to subjectively evaluated sizes of findings. The assessment of the pelvic region during microlaparoscopy was fully satisfactory in all cases, none required earlier than scheduled conversion to laparoscopy. The duration of endoscopic procedures was calculated from the moment of trocars insertion into the peritoneal cavity. The average duration time of microlaparoscopic evaluation was 6'20"+/-45", while in laparoscopy - 3'40"+/-32" (p<0.0001). CONCLUSIONS: Microlaparoscopy and laparoscopy are of similar efficacy in the assessment of small pelvis organs and in detecting pathological changes. Both procedures differ significantly only in regard to the duration.

Ultrasonographic assessment of fetal nuchal translucency (NT) at 11th and 14th week of gestation--Polish multicentre study.

UNLABELLED: THE AIMS OF THE STUDY WERE: To evaluate range and median values of NT in a large, unselected Polish population; to determine the value of the 95th percentile and the median values for NT for given weeks of late 1st trimester pregnancy and to determine the level of chromosomal aberration risk corresponding to the values of the 95th percentile in the examined groups; to examine the possible correlation between CRL, NT width as well as the mother's age with the risk of the most frequent chromosomal aberrations. MATERIAL & METHODS: We have retrospective analyzed 7,866 pregnant women. All fetuses of this women had NT measurement performed, as well as CRL and assessed of the most frequent chromosomal abnormalities. The group of pregnant women was divided into 2 subgroups: until and above 35 years old. All population group was divided into 3 subgroups depending on gestational age (11, 12 and above 13th weeks of gestation). RESULTS: The median of NT in all population group was 1.5 mm and 95th percentile was 2.4 mm, whilst in group with low risk median of NT and 95th percentile were the same and in group with high risk of chromosomal abnormalities respectively 1.5 mm and 2.5 mm. There were strong correlations between maternal age and the risk of most frequent chromosomal abnormalities from NT. CONCLUSIONS: The obtained results of median values and the 95th percentiles of NT in the examined group and the age groups under 35 and 35 plus are similar to these quoted by FMF. The risk levels of trisomy of 21st chromosome were similar to the reference values used by FMF. With gestational age, NT value increases in a non-linear way, therefore it is incorrect to use the term "a normal value" for NT, therefore, only the risk level calculated with the dedicated software using NT and CRL measurements with maternal age should be stated.

Comparison of tubal patency assessment during microlaparoscopy and laparoscopy, and its compatibility with previous histerosalpingography results.

OBJECTIVES: The aim of the study was to compare tubal patency assessment during microlaparoscopy and laparoscopy and its compatibility with previously performed histerosalpingography (HSG). MATERIAL & METHODS: Endoscopic evaluation of tubal patency was performed on 135 women, aged 30-39 (microlaparoscopy in 65 cases, laparoscopy in 70). In the group of 42 patients qualified for endoscopy, histerosalpingography was carried out in the past. The duration of tubal patency assessment was counted from the moment of the salpingograph placement, with trocars already introduced into the peritoneal cavity. RESULTS: The mean duration of tubal patency evaluation during laparoscopy was 5'45"+/-39 and during microlaparoscopy - 7'30"+/-49". The results of the examination were afterwards compared with the results of previously performed HSG. Their sensitivity, specificity, compatibility and positive and negative predictive values were calculated. The sensitivity and specificity of microlaparoscopy in tubal patency assessment were 81% and 100%, respectively; its positive predictive value -100% and negative -96%. As to laparoscopy, the values were established at 90%, 100%, 100% and 98.4%, respectively. CONCLUSIONS: Tubal patency assessment during microlaparoscopy and laparoscopy is characterized by similar sensitivity and specificity. Although the mean duration of microlaparoscopy is significantly longer, the difference in time is of no practical implication.

Family delivery from the standpoint of fathers--can stereotypes of participant or non-participant father be fully justified?

OBJECTIVES: Family delivery is an important aspect of modern obstetrics. The aim of this study was to estimate the phenomenon of family delivery from the standpoint of participating and non-participating fathers. STUDY DESIGN: Two types of questionnaires were used in the study. Five hundred and five men were divided into two groups: (A) delivery participants and (B) delivery non-participants. RESULTS: The participants were significantly younger than non-participants. Better educated men dominated in group (A), whereas men with trade education were the majority in group (B). Low birth classes attendance among women in group (B) was noticed. All men in group (B) knew about the possibility of taking part in the delivery. Almost 100% of participants declared their satisfaction with family delivery. For non-participants, wife and media were the main source of knowledge, while for participants it was the medical staff and labor schools. CONCLUSIONS: Family labor is commonly accepted by both partners and is generally connected with positive emotions. This phenomenon is generally approved by couples with higher economical status. Family labor resignation, common among pairs with lower economical status, is caused generally by fear and lack of proper knowledge. Health care providers, through labor schools and outpatients visits, should concentrate on getting to couples, whose attitude towards family labor is negative. Educational programs and popular press articles should be prepared more thoroughly, focusing on the whole population of potential fathers.

[Assessment of fetal circulation in the late first trimester--preliminary study]. / Ocena ukladu krazenia plodu w póznym pierwszym trymestrze--doniesienie wstepne.

OBJECTIVES: to confirm that fetal echocardiography is indeed possible in late first trimester and that it improves the standard of the so-called "genetic" ultrasound scan. MATERIAL AND METHODS: Early echocardiography was performed in 75 fetuses from high and low risk pregnancies. All fetuses underwent echocardiography examination in 18-22 weeks of gestation and established follow up. RESULTS: The most suitable method of visualization seems to be transabdominal examination, between 13.0-13.6 weeks of gestation, an transvaginal one, between 12.0-12.6 weeks of gestation, with 90% effectiveness. In researched group of 75 fetuses (with established follow up) there were four heart defects (5.3%). Three of them were diagnosed before 14th week of gestation. One case (tetralogy of Fallot) was overlooked. There were two false positive diagnosis verified at 20th week of gestation. CONCLUSIONS: Early echocardiography, especially between 12.0-13.6 weeks of gestation, is a possible and valuable method of diagnosis. Reference evaluation should be performed between 18 and 22 weeks of gestation. In cases with suspected anomalies karyotyping is recommended. Congenital heart disease diagnosed at late first trimester should be treated as the next potential marker of genetic disorder.