Placental pathology in a pregnant woman with severe COVID-19 and successful ECMO treatment: a case report.

BACKGROUND: Infection with SARS-CoV-2 during pregnancy can lead to a severe condition in the patient, which is challenging for obstetricians and anaesthesiologists. Upon severe COVID-19 and a lack of improvement after multidrug therapy and mechanical ventilation, extracorporeal membrane oxygenation (ECMO) is introduced as the last option. Such treatment is critical in women with very preterm pregnancy when each additional day of the intrauterine stay is vital for the survival of the newborn. CASE PRESENTATION: We report a case of a 38-year-old woman at 27 weeks of gestation treated with multidrug therapy and ECMO. The woman was admitted to the intensive care unit (ICU) with increasing fever, cough and dyspnoea. The course of the pregnancy was uncomplicated. She was otherwise healthy. At admission, she presented with severe dyspnoea, with oxygen saturation (SpO2) of 95% on passive oxygenation, heart rate of 145/min, and blood pressure of 145/90. After confirmation of SARS-CoV-2 infection, she received steroids, remdesivir and convalescent plasma therapy. The foetus was in good condition. No signs of an intrauterine infection were visible. Due to tachypnea of 40/min and SpO2 of 90%, the woman was intubated and mechanically ventilated. Due to circulatory failure, the prothrombotic activity of the coagulation system, further saturation worsening, and poor control of sedation, she was qualified for veno-venous ECMO. An elective caesarean section was performed at 29 weeks on ECMO treatment in the ICU. A preterm female newborn was delivered with an Apgar score of 7 and a birth weight of 1440 g. The newborn had no laboratory or clinical evidence of COVID-19. The placenta showed the following pathological changes: large subchorionic haematoma, maternal vascular malperfusion, marginal cord insertion, and chorangioma. CONCLUSIONS: This case presents the successful use of ECMO in a pregnant woman with acute respiratory distress syndrome in the course of severe COVID-19. Further research is required to explain the aetiology of placental disorders (e.g., maternal vascular malperfusion lesions or thrombotic influence of COVID-19). ECMO treatment in pregnant women remains challenging; thus, it should be used with caution. Long-term assessment may help to evaluate the safety of the ECMO procedure in pregnant women.

The analgesic efficiency of transversus abdominis plane (TAP) block after caesarean delivery.

OBJECTIVES: The ultrasound-guided transversus abdominis plane (TAP) block is a supporting method of pain relief after different types of surgical and gynecological procedures. The aim of the present study was to evaluate the analgesic effects of the TAP-block in patients undergoing caesarean section. MATERIAL AND METHODS: 88 women undergoing elective caesarean section under spinal anaesthesia were prospectively randomized into two groups. In the first group, an ultrasound-guided bilateral TAP block was performed using 40 mL 0.25% bupivacaine, while the second group was treated without a regional nerve block. Both groups received a standard analgesia protocol with intravenous paracetamol administered every 6 hours and intravenous tramadol on-demand, delivered using the Patient Controlled Analgesia (PCA) method. Pain intensity was assessed according to the visual analogue scale (VAS) directly after the TAP block and at 3, 6 and 12 hours postoperatively. Any patient complaints and side-effects during the postoperative period were recorded. RESULTS: The TAP block resulted in a significant reduction of pain intensity using the visual analogue scale after 3, 6 and 12 hours (p < 0.05) and a significant decrease in tramadol administration (p < 0.05) during the first 12 hours postoperatively. No significant differences in the heart rate and blood pressure were noted between groups (p > 0.05). There were no complications related to the TAP block. CONCLUSIONS: The TAP block is a safe and effective adjunctive method of pain relief after caesarean delivery.

Sonographic evaluation of surgical repair of uterine cesarean scar defects.

BACKGROUND: The aim of the study was to assess the clinical outcomes of surgical repair of uterine cesarean scar defects with sonography (US). METHODS: Seven nonpregnant women with history of cesarean section and a large uterine scar defect were enrolled. The surgical repair was performed by minilaparotomy. The US assessment of the uterine scar was performed using a standardized approach at baseline, then at a first visit 2-3 days following the surgical intervention (V1) and at a follow-up visit 3 months later (V2). Residual myometrial thickness (RMT), width, and depth of the scar defect were measured. RESULTS: The mean RMT increased significantly from 1.9 mm at baseline to 8.8 mm at V1 and 8.0 mm at V2. No intraoperative complications were observed. Postmenstrual spotting and abdominal pain reported preoperatively resolved after the operation. CONCLUSIONS: A surgical repair procedure for an incompletely healed uterine cesarean scar is effective in increasing RMT thickness, decreasing the depth of the scar, and reducing symptoms related to the cesarean section scar defect. Further studies on post-repair pregnancy outcomes are required to evaluate whether the procedure affects the rate of cesarean scar pregnancy, morbidly adherent placenta, and/or uterine scar dehiscence and rupture. The repair of a cesarean scar defect is recommended only for symptomatic women. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:455-460, 2017.

Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section.

OBJECTIVES: A growing number of studies suggest that the incomplete healing of the CS scar in the uterus increase the risk of uterine dehiscence or rupture during subsequent pregnancies. Thus, the factors that affect wound healing should be evaluated. We aimed to determine whether the morphology of the CS scar in non-pregnant women after one elective CS was affected by the site of the uterine incision, uterine flexion, maternal age, and fetal birth weight. MATERIAL AND METHODS: 208 non-pregnant women were invited for participation in the study, but only 101 of them met inclusion criteria. Standardized scar parameters (residual myometrial thickness (RMT), depth (D) and width (W) of the hypoechoic niche) were measured using ultrasonography at least 6 weeks after the CS. RESULTS: Scar defect was detected in 26 of 101 subjects. Women without scar defect had significantly higher RMT values (1.87 vs. 0.87), lower newborn birth weight (3127 g vs. 3295 g), and higher scar location above the internal cervical os (62% vs. 16%), than those with scar defect. Maternal age was significantly correlated with D value (R = 0.40). Uterine retroflexion was significantly correlated with a larger D value (R = 0.63) and a larger D/RMT ratio (R = 0.24). CONCLUSIONS: In low-risk women who have undergone one elective CS, several risk factors are associated with development of the scar defect, but only scar location can be modified during surgery. Future research is needed to determine whether a relatively higher incision location in the uterus can ensure optimal healing of the CS scar.

Values of T/QRS ratio in pregnancies complicated by intrauterine growth restriction.

AIMS: To evaluate values of T/QRS ratio in normal pregnancies and those complicated by intrauterine growth restriction (IUGR) using non-invasive method with transabdominal electrodes. Assessment of fetal well-being in IUGR pregnancies. METHODS: Fetal electrocardiograms were recorded and analyzed by KOMPOREL software from ITAM (Zabrze, Poland) and T/QRS ratios were automatically calculated. Doppler velocimetry of the middle cerebral artery and umbilical artery was carried out. The study group consisted of IUGR pregnancies with normal cerebroplacental ratios (CPRs) (n=110), IUGR pregnancies with decreased CPRs (n=29), and healthy controls (n=549). Analyses were performed between the study groups and by gestational age. T/QRS ratio variables and CPRs were calculated. Analysis of variance and linear regression were performed. RESULTS: Maximum values, maximum minimal value differences, and standard deviations of T/QRS ratio were significantly different between the IUGR group with reduced CPRs and normal CPRs (P=0.0009, P=0.0000, P=0.0034, respectively) as well as between the IUGR group with reduced CPRs and healthy controls (P=0.0000, P=0.0001, P=0.0009, respectively). Mean maximum values in the IUGR group with reduced CPRs exceeded normal values. CONCLUSIONS: T/QRS ratio may be useful in assessing fetal well-being in IUGR pregnancies; however, future studies are needed to determine typical ranges of T/QRS ratio in pregnancies complicated by IUGR.

The T/QRS ratio values in pregnancies complicated by threatened preterm labour treated with intravenous infusions of fenoterol.

AIMS: To evaluate values of foetal T/QRS ratios in pregnancies complicated by threatened preterm labour treated with intravenous infusions of fenoterol using non-invasive methods with transabdominal electrodes. MATERIALS AND METHODS: The study group consisted of 451 Caucasian women (63 preterm pregnancies and 327 healthy controls) whose pregnancies ranged from 28 to 37 gestational weeks. Foetal electrocardiograms were recorded and T/QRS ratios were calculated by KOMPOREL software (ITAM, Zabrze, Poland). The first recording was performed 30 min after the start of fenoterol infusion and the second 2 days after finishing tocolysis. T/QRS ratio variables were calculated. One-way analysis of variance was carried out. RESULTS: Significantly higher mean values of the T/QRS ratio were observed in pregnancies during tocolytic treatment in comparison to controls and pregnancies after tocolysis (P=0.0158 and P=0.0071, respectively). The T/QRS ratio values fall again shortly after finishing intravenous tocolysis. CONCLUSIONS: The T/QRS ratio is one of the methods used for non-invasive foetal distress assessment that can be used in antepartum foetal monitoring in complicated pregnancies. Raised values of the T/QRS ratio in the foetus during tocolysis with fenoterol and next its fall to values observed in physiological pregnancies may indicate transient worsening of fetal well-being, however, additional research is required.

Prediction of uterine dehiscence using ultrasonographic parameters of cesarean section scar in the nonpregnant uterus: a prospective observational study.

BACKGROUND: Every year 1.5 million cesarean section procedures are performed worldwide. As many women decide to get pregnant again, the population of pregnant women with a history of cesarean section is growing rapidly. For these women prediction of cesarean section scar performance is still a serious clinical problem. METHODS: Starting in 2005, the study included 308 nonpregnant women with a history of low transverse cesarean section. The following ultrasonographic parameters of the cesarean section scar in the nonpregnant uterus were assessed: the residual myometrial thickness (RMT) and the width (W) and the depth (D) of the triangular hypoechoic scar niche. During 8 years of follow-up, 41 of these women were referred to our department for delivery. In all cases, a repeat cesarean section was performed and the lower uterine segment was assessed. Two independent statistical methods namely the logit model and Decision Tree analysis were used to determine the relation between the appearance of the cesarean section scar in the nonpregnat state and the performance of the scar in the next pregnancy. RESULTS: The logit model revealed that the D/RMT ratio showed significant correlation with cesarean section scar dehiscence (P-value of 0.007). Specifically, a D/RMT ratio value greater than 1.3035 indicated that the likelihood of dehiscence was greater than 50%. The Decision Tree analysis revealed that a diagnosis of dehiscence versus non-dehiscence could be based solely on one criterion, a D/RMT ratio of at least 0.785. The sensitivity of this method was 71%, and the specificity was 94%. CONCLUSIONS: Assessment of the cesarean section scar in the nonpregant uterus can be used to predict the occurrence of scar dehiscence in the next pregnancy.

Values of T/QRS ratios measured during normal and post-term pregnancies.

AIM: To evaluate values and variability of T/QRS ratios between 28 and 42 weeks' gestation in term and post-term pregnancies using non-invasive methods with electrodes placed over the maternal abdomen. METHODS: Fetal electrocardiograms were recorded from 657 women with singleton pregnancies. Recorded signals were analyzed by KOMPOREL software from ITAM (Zabrze, Poland) and the T/QRS ratios were automatically calculated. The analyses were performed in subgroups according to gestational age. The T/QRS ratio variables were calculated; one-way analysis of variance (ANOVA test) and linear regression were carried out. RESULTS: The T/QRS ratio was successfully measured in 95.4% (n=627) of patients during 30 min recordings. Values of T/QRS ratio variables changed during pregnancy. The mean T/QRS ratio ranged between 0.134 in the 41st gestational week and 0.178 in the 35th gestational week. Mean minimal and maximum values of the T/QRS ratio ranged between 0.02 and 0.29 [x=0.09; standard deviation (SD)=0.05] and 0.08 and 0.5 (x=0.27; SD=0.1), respectively. The highest values occurred in pre-term and post-term pregnancies. CONCLUSIONS: Measurement of the T/QRS ratio is one of the techniques used for non-invasive fetal distress assessment that can be used in antepartum fetal monitoring. Values of T/QRS ratio variables changed during pregnancy from higher in pre-term pregnancies, lower in the peripartum period and rose again in post-term pregnancies. The study provides more insight into the values of T/QRS ratios during pregnancy; however, additional research is required.

Sonoelastography of the uterine cervix as a new diagnostic tool of cervical assessment in pregnant women - preliminary report.

OBJECTIVES: The study aimed at determining whether there exists a correlation between the cervical cohesion parameters assessed in the elastography and the length of the cervix. MATERIAL AND METHODS: Assessment of cervical cohesion parameters with the use of real-time sonoelastography was performed on 59 patients between 28 and 39 weeks of gestation. RESULTS: The analysis showed that there exists a statistically significant (p=0.033) correlation between the cervical length and the elasticity of the front cervical labium (strain ratio A). Correlation coefficient (r) stood at (-) 0.28. CONCLUSIONS: 1. There exists a negative correlation between the condition on the front cervical labium in elastographic imaging and the length of the cervical canal in USG imaging. 2. Elastography of the uterine cervix may be helpful in assessing the risk of premature labour or cervical insufficiency. 3. There is a need to perform a study on a larger group of patients in order to determine whether elastography may find its place among routine obstetric diagnostic methods.

Polish Adaption of Pregnancy-Related Anxiety Questionnaire - Revised 2 (PRAQ-R2). / Polska adaptacja Pregnancy-Related Anxiety Questionnaire ­ Revised 2 (PRAQ-R2).

AIM: To create a Polish adaption of the Pregnancy-Related Anxiety Questionnaire - Revised 2 (PRAQ-R2), which is widely used abroad. METHODS: PRAQ-R2 was translated into Polish by independent bilingual speakers. Fortyeight pregnant women completed our survey containing the Polish version of PRAQ-R2, Hospital Anxiety and Depression Scale - Modified (HADS-M), and a short sociodemographic questionnaire. After a week, they were asked to complete the PRAQ-R2 questionnaire again. Parametric statistics were used to assess psychometric properties. RESULTS: Our study has shown a good test-retest correlation of 0.70. Participants completed the survey twice (in t1 and after one week - in t2). Cronbach's alpha was calculated as 0.847 at t1 and 0.895 at t2. There was a moderate correlation between PRAQ-R2 at both time points and the HADS-M scale and its subscales. CONCLUSIONS: Our Polish adaption of PRAQ-R2 has shown good validity and reliability. It has good internal consistency. Moderate correlation with HADS-M proves that pregnancyrelated anxiety (PrA) is a distinctive disorder from generalized anxiety disorder and depressive disorder. Given the great frequency and the burden of PrA, we believe that PRAQ-R2 should be routinely used among physicians working with pregnant patients.

Comparative analysis of placental vasculature and placental volume in normal and IUGR pregnancies with the use of three-dimensional Power Doppler.

OBJECTIVES: To evaluate the differences in placental vascular indices and placental volume between normal and IUGR pregnancies. METHODS: A prospective study was conducted on a group of 100 normal and 20 IUGR pregnancies between 22 and 42 weeks of gestation. For the purpose of evaluation of placental volume and placental vascular indices, we applied 3D Power Doppler and VOCAL technique. Only patients with entirely visualized placenta were included in the study. RESULTS: A comparative analysis of vascularization index (VI), vascularization flow index (VFI), flow index (FI), and placental volume (PV) revealed statistically significant differences between normal and IUGR pregnancies. In normal pregnancies, the volume of the placenta was on average 92.42 cm(3) larger than in pregnancies complicated by IUGR. Receiver operating characteristic (ROC) curves were used to evaluate the clinical usefulness of placental vascular indices and placental volume for discriminating IUGR and normal pregnancies. It was concluded that the VI, VFI, PV, FI parameters are the best discriminants, with the cut-off values of 5.30, 2.30, 199, and 36.0, respectively. CONCLUSIONS: The quantitative assessment of placental vasculature and placental volume by means of 3D Power Doppler and VOCAL technique is an adjunctive modality for differentiation between normal and IUGR pregnancies. Our findings further suggest that the vascularization index (VI) and vascularization flow index (VFI) are the best parameters with the most favorable discriminating potential for proper identification of IUGR pregnancies.

The Application of Artificial Intelligence-Assisted Colposcopy in a Tertiary Care Hospital within a Cervical Pathology Diagnostic Unit.

The rising global incidence of cervical cancer is estimated to have affected more than 600,000 women, and nearly 350,000 women are predicted to have died from the disease in 2020 alone. Novel advances in cancer prevention, screening, diagnosis and treatment have all but reduced the burden of cervical cancer in developed nations. Unfortunately, cervical cancer is still the number one gynecological cancer globally. A limiting factor in managing cervical cancer globally is access to healthcare systems and trained medical personnel. Any methodology or procedure that may simplify or assist cervical cancer screening is desirable. Herein, we assess the use of artificial intelligence (AI)-assisted colposcopy in a tertiary hospital cervical diagnostic pathology unit. The study group consisted of 48 women (mean age 34) who were referred to the clinic for a routine colposcopy by their gynecologist. Cervical images were taken by an EVA-Visualcheck TM colposcope and run through an AI algorithm that gave real-time binary results of the cervical images as being either normal or abnormal. The primary endpoint of the study assessed the AI algorithm's ability to correctly identify histopathology results of CIN2+ as being abnormal. A secondary endpoint was a comparison between the AI algorithm and the clinical assessment results. Overall, we saw lower sensitivity of AI (66.7%; 12/18) compared with the clinical assessment (100%; 18/18), and histopathology results as the gold standard. The positive predictive value (PPV) was comparable between AI (42.9%; 12/28) and the clinical assessment (41.8%; 18/43). The specificity, however, was higher in the AI algorithm (46.7%; 14/30) compared to the clinical assessment (16.7%; 5/30). Comparing the congruence between the AI algorithm and histopathology results showed agreement 54.2% of the time and disagreement 45.8% of the time. A trained colposcopist was in agreement 47.9% and disagreement 52.1% of the time. Assessing these results, there is currently no added benefit of using the AI algorithm as a tool of speeding up diagnosis. However, given the steady improvements in the AI field, we believe that AI-assisted colposcopy may be of use in the future.

SARS-CoV-2 Infection and Pregnancy: Maternal and Neonatal Outcomes and Placental Pathology Correlations.

There is accumulating evidence on the perinatal aspects of COVID-19, but available data are still insufficient. The reports on perinatal aspects of COVID-19 have been published on a small group of patients. Vertical transmission has been noted. The SARS-CoV-2 genome can be detected in umbilical cord blood and at-term placenta, and the infants demonstrate elevated SARS-CoV-2-specific IgG and IgM antibody levels. In this work, the analysis of clinical characteristics of RT-PCR SARS-CoV-2-positive pregnant women and their infants, along with the placental pathology correlation results, including villous trophoblast immunoexpression status for SARS-CoV-2 antibody, is presented. RT-PCR SARS-CoV-2 amniotic fluid testing was performed. Neonatal surveillance of infection status comprised RT-PCR testing of a nasopharyngeal swab and the measuring of levels of anti-SARS-CoV-2 in blood serum. In the initial study group were 161 pregnant women with positive test results. From that group, women who delivered during the hospital stay were selected for further analysis. Clinical data, laboratory results, placental histomorphology results, and neonatal outcomes were compared in women with immunohistochemistry (IHC)-con SARS-CoV-2-positive and IHC SARS-CoV-2-negative placentas (26 cases). A positive placental immunoprofile was noted in 8% of cases (n = 2), whereas 92% of cases were negative (n = 24). Women with placental infection proven by IHC had significantly different pathological findings from those without. One infected neonate was noted (n = 1; 4%). Infection was confirmed in perinatal autopsy, as there was the intrauterine fetal demise. The potential course of the infection with the risk of vertical transmission and implications for fetal-neonatal condition is critical for proper clinical management, which will involve comprehensive, multidisciplinary perinatal care for SARS-CoV-2-positive patients.

The assessment of selected parameters of bioelectric and mechanical activity of the uterus during pharmacologic treatment of threatening preterm delivery.

OBJECTIVES: To analyze and compare the bioelectric and mechanical activity of the uterus in pregnant women with threatening preterm delivery treated with tocolysis. Additionally, auxiliary parameters of the bioelectric signal, as registered by electrohysterography and characteristic only for this method, were measured and analyzed. MATERIAL AND METHODS: Forty-five women with pregnancies from 24 to 36 weeks of gestation with typical clinical symptoms of threatening preterm delivery were given tocolytic therapy. Registration and analysis of bioelectric activity with electrohysterography was performed simultaneously with registration and analysis of mechanical activity with tocography. RESULTS: After administration of tocolytic treatment, the presence of bioelectric activity was accompanied by the lack of or minimal occurrence of mechanical activity. All parameters of contraction recorded by electrohysterography had significantly greater values than those recorded by tocography. CONCLUSIONS: Measurement of bioelectric activity is more sensitive than measurement of mechanical activity of the uterus. Elevated bioelectric activity of the uterine muscle was observed despite the use of tocolysis, a lack of symptoms of threatening preterm delivery, as well as a lack of contraction in tocography. The presence of bioelectric activity may precede the occurrence of mechanical activity of the uterus, but further research is required on larger groups of patients.

Prenatal and Postnatal Manifestations of Congenital Chloride Diarrhea Due to a Heterozygote Variant of the SLC26A3 Gene: A Case Report.

Congenital chloride diarrhea (CCD) is caused by a recessive mutation in the SLC26A3 gene and characterized mainly by watery diarrhea, hypochloremia and metabolic alkalosis. Various different mutations in SLC26A3 are responsible for the disease. In the prenatal period, the symptoms of CCD may include polyhydramnios, preterm labor and abdominal distension. The main feature of CCD is chloride-rich diarrhea, which leads to excessive loss of fluid and salt immediately after birth and is followed by weight loss and dehydration. Hyponatremia and hypochloremia are soon accompanied by hypokalemia and metabolic alkalosis. Untreated CCD is fatal even in the first weeks of life. Diagnosis is made by high fecal chloride concentrations in patients with serum electrolytes corrected by salt substitution and confirmed using genetic testing of peripheral blood samples. Here, we detail prenatal and postnatal manifestations of a preterm infant, born via Caesarian section, who was suspected to suffer intrauterine bowel obstruction. Upper median laparotomy was performed and no intestinal abnormalities found. The course of the neonatal period was complicated by severe diarrhea with hypochloremia, hyponatremia and metabolic alkalosis. Based on the patient's clinical picture and stool examination, a diagnosis of CCD was established. Mutation of the SLC26A3 gene was confirmed using genetic testing.

The clinical evaluation of internal iliac arteries balloon occlusion for placenta accreta spectrum.

OBJECTIVES: To evaluate the balloon occlusion of the internal iliac arteries during a caesarean section in the group of patients with placenta accreta spectrum. MATERIAL AND METHODS: We analysed 29 pregnant women with placenta accreta spectrum. The study group consisted of 15 patients, who underwent a caesarean delivery with temporary bilateral internal iliac artery occlusion. In the control group, we examined 14 women who had a standard caesarean delivery without any radiologic procedure. We compared pre- and post-operative haemoglobin level, necessity of blood transfusion, intraoperative blood loss, intensive care requirement, complications, duration of surgery, anaesthesia and hospital stay. RESULTS: The history and obstetric outcomes were similar in both groups. The study group required fewer blood transfusions than the control group (p = 0.0176). We administered less packed red blood cells and fresh frozen plasma. Complications were more frequent in the control group (p = 0.0014). Complications related to occlusion of the internal iliac arteries did not occur. The intensive care unit transfer was more frequent in the control group (p = 0.0329). The duration of surgery and hospital stay did not differ between groups. The anaesthesia time was longer in a study group, which related to the radiologic procedure. CONCLUSIONS: Caesarean delivery for placenta accreta spectrum with bilateral balloon occlusion of the internal iliac arteries requires fewer transfusions. It contributes to a decrease in the complication rate and maternal morbidity.

Perinatalna opieka paliatywna realizowana w oddziale polozniczym i neonatologicznym we wspólpracy z hospicjum dla dzieci - doswiadczenia wlasne.

INTRODUCTION: Wady letalne prowadza do wewnatrzmacicznego zgonu plodu lub dziecka bezposrednio po urodzeniu lub we wczesnym okresie niemowlecym, bez wzgledu na zastosowane leczenie. W przypadku wad letalnych nie ma mozliwosci skutecznej pomocy dziecku, mimo postepu mi zeadsytcoysnoyw ania najnowoczesniejszej aparatury lub terapii. Rodzice, którzy decyduja sie na urodzenie dziecka z wada letalna moga byc objeci perinatalna opieka hospicyjna, która ma charakter kompleksowy. Polega ona na wsparciu ciezarnej w okresie przygotowania do porodu, w czasie porodu i po porodzie oraz na wsparciu jej rodziny oraz obejmuje udzielenie rodzicom pelnej informacji o chorobie ich dziecka. Opieka nad dzieckiem po urodzeniu jest nastawiona na ochrone przed uporczywa terapia i zapewnienie dziecku opieki paliatywnej. CEL: Wykazanie znaczenia perinatalnej opieki paliatywnej dla kobiet w ciazy, u których wyniki badan prenatalnych wskazywaly na ciezkie zaburzenie rozwojowe u plodu o potencjalnie letalnym rokowaniu oraz przedstawienie schematu postepowania wedlug modelu wewnatrzszpitalnego hospicjum perinatalnego. MATERIAL I METODY: Analiza retrospektywna objeto dokumentacje 67 pacjentek skierowanych do Programu RAZEM we Wroclawiu w latach 2014-2018 z powodu nieprawidlowych wyników badan prenatalnych (ultrasonograficznych lub/i genetycznych), które wskazywaly na ciezkie zaburzenie rozwojowe u plodu o potencjalnie letalnym rokowaniu. Dokonanoanalizy danych socjodemograficznych, danych klinicznych rozpoznania choroby u plodu, przebiegu ciazy i porodu, trybu postepowania w okresie prenatalnym, podczas porodu i po urodzeniu sie dziecka. WYNIKI: Do Programu zostalo skierowanych 67 kobiet w wieku 20-43 lat (srednio 31,2), które zglaszaly sie w okresie od 15 do 39 tygodnia ciazy (srednio w 25. tygodniu ciazy). Do opieki paliatywnej zakwalifikowano 57 kobiet, czyli 85% skierowanych do programu. Opieke paliatywna kontynuowano u 51 pacjentek, poniewaz 6 kobiet w trakcie procesu diagnostycznego zdecydowalo sie na zakonczenie ciazy (10,5%). Najczestszymi zaburzeniami u plodów byly aberracje chromosomowe, wady OUN i wady nerek. W 95% przypadków doszlo do obumarcia wewnatrzmacicznego plodu lub smierci noworodka. WNIOSKI: Perinatalna opieka paliatywna jest niezbedna forma opieki dla kobiet w ciazy, u których wyniki badan prenatalnych wskazuja na ciezkie zaburzenie rozwojowe u plodu o potencjalnie letalnym rokowaniu. Model wewnatrzszpitalny hospicjum perinatalnego jest korzystna forma opieki, zapewnia jej spójnosc i dobra komunikacje w zespole, co wplywa na dobra jakosc opieki. INTRODUCTION: Lethal defects lead to the intrauterine death of the fetus or the passing away of the child immediately after birth or in early infancy, regardless of the treatment used. In the case of lethal defects, it is not possible to effectively help the child, despite using the most modern equipment or medicines in the treatment or the progress made by medicine. Parents, who decide to continue the pregnancy, although the fetus has a lethal defect that cannot be cured, may be covered by perinatal hospice care, which is comprehensive and consists in supporting the pregnant woman during the prenatal time, during delivery and after delivery and support of her family, giving full information to the parents about their child's illness. Childcare after birth is focused on protecting the infant from persistent therapy and providing him with appropriate conditions. AIM: To demonstrate the role of perinatal palliative care for pregnant women in whom the results of prenatal tests pointed to a severe developmental disorder in the fetus with a potentially lethal prognosis, and to present a pattern of behavior for their hospitalization in the perinatal hospice. MATERIALS AND METHODS: The retrospective analysis included documentation of 67 patients referred to the RAZEM (TOGETHER) Program in Wroclaw in 2014-2018 due to abnormal results of (ultrasound and / or genetic) prenatal tests, which indicated a serious developmental disorder in the fetus with potentially lethal prognosis. Analysis was conducted of sociodemographic data, clinical data on fetal diagnosis, pregnancy and delivery, the procedure for prenatal delivery and postnatal birth. RESULTS: 67 women aged 20-43 years (mean 31.2) were referred to the RAZEM Program. Out of these, 57 women were enrolled for palliative care, which accounted for 85% of those referred to the program. Palliative care was continued in 51 patients, because 6 women decided to terminate their pregnancy during the diagnostic process (10.5%). The most common abnormalities in the fetuses were chromosomal aberrations, CNS defects and kidney defects. In 95% of the cases, intrauterine fetal death or neonatal death occurred. CONCLUSIONS: Perinatal palliative care is an indispensable form of care for pregnant women in whom the results of prenatal tests indicate a serious developmental disorder in the fetus with potentially lethal prognosis. The in-hospital model of a perinatal hospice is a beneficial form of care, as it ensures consistency and good communication in the team, which favourably affects its quality.

Polish Society of Gynecologists and Obstetricians recommendations on supplementation during pregnancy.

Polish Society of Gynecologists and Obstetricians recommendations on supplementation during pregnancy.

Placental mesenchymal dysplasia and hepatic cyst.

Placental mesenchymal dysplasia (PMD) is a rare benign vascular anomaly of the placenta. It can be misdiagnosed as a molar pregnancy resulting in unnecessary termination of pregnancy. A 30-year-old woman was referred to our hospital at 18 gestational weeks due to suspicion of molar pregnancy. The ultrasound showed a bulky placenta with multiple cysts. Oligohydramnion and fetal hypoechogenic cystic area without doppler flow were diagnosed at 23 weeks. The baby was operated on after delivery, and an 80 mm multifocal cyst originating from the right lobe of the liver was removed. The placenta demonstrated swelling stem villi with enlarged vessels and increased interstitial cells without trophoblast proliferation. PMD and fetal hepatic cyst can coexist; however, the relationship between those conditions remains to be elucidated. PMD is associated with adverse pregnancy outcomes but also with a good prognosis.