[Diagnostic and therapeutic dilemmas in pregnant woman with pulmonary embolism]. / Dylematy diagnostyczne i terapeutyczne u cizarnej z zatorowoscia plucna.

Hypercoagulable state during pregnancy and puerperium is associated with an increased risk of venous thromboembolic disease. Pulmonary embolism (PE) is the leading cause of maternal death in the developed world. Clinical assessment of PE may be difficult due to nonspecific signs and symptoms, especially in pregnant women. Diagnostic procedures using ionizing radiation may be harmful for the fetus while aggressive anticoagulation may expose the mother to bleeding complications The aim of this paper was to present a case of a 27-year-old pregnant woman with high-risk PE.

[Pregnancy and delivery in a patient with non-Hodgkin lymphoma--a case report]. / CiAza i poród u pacjentki z chloniakiem nieziarniczym--opis przypadku.

INTRODUCTION: Neoplasmatic diseases during pregnancy are relatively rare, with the incidence of approximately 1/1000 pregnancies. The symptoms of neoplasmatic processes are unspecific and often mirror physiological changes during pregnancy Chemotherapy is the main therapeutic management of non-Hodgkin lymphomas. The strategy of the treatment and its influence on the course of pregnancy remain controversial. AIM: The aim of this study was to present the case of a pregnant woman with non-Hodgkin lymphoma. CASE REPORT: We described the case of a 27-year-old pregnant nullipara with anemia, breathlessness, cough and general weakness with diagnosed diffused large B-cell lymphoma. During pregnancy the patient received six cycles of CHOP chemotherapy without any serious complications. On 37 week of gestation the caesarean section was performed. CONCLUSIONS: Coexisting non-Hodgkin lymphomas and pregnancy are seldom the case and the treatment requires complex chemotherapy.

[Analysis of delivery types in women after previous cesarean section]. / Analiza sposobu zakonczenia ciazy u kobiet po przebytym cieciu cesarskim.

OBJECTIVE: The study was undertaken to analyze the course of pregnancy and delivery in women after previous cesarean section. MATERIAL AND METHODS: The study group consisted of 1272 pregnant women after one cesarean section, who delivered at the 1st Department of Gynecology and Obstetrics, Medical University of Lodz between 1st January 2007 and 31st December 2010. RESULTS: Among patients after previous cesarean section, the most numerous group constituted women whose pregnancy was resolved with an elective repeat cesarean section, without the attempt to deliver vaginally - 58,96% whereas the remaining 41,04% of the women were qualified to make an attempt at vaginal delivery 48,28% of them succeeded to gave birth vaginally and 51,72% underwent repeat cesarean section. CONCLUSIONS: Proper qualification of patients after previous caesarean section for a natural vaginal birth allows a successful vaginal delivery. A critical analysis of the indications for surgical delivery needs to be performed in order to lower the rate of cesarean sections.

[Intrauterine contraceptive device in an appendix--a case report]. / Wkladka wewnatrzmaciczna w wyrostku robaczkowym--opis przypadku.

The application of an intrauterine contraceptive device can perforate the uterus and migrate to adjacent organs such as the bladder or small bowel. The main symptoms are painful insertion of the intrauterine contraceptive device and missing IUD strings. The diagnosis of perforation and transuterine migration of the IUD is made on the basis of an ultrasound examination and an abdominal X-ray. The proper management is such case is immediate removal of the IUD. The aim of this paper was to present a case of a 34-year-old woman with a copper IUD found during a caesarean section.

[Analysis of the indications for the caesarean section delivery for very low birthweight neonates (< 1500 g) delivered in I department gynecology and obstetrics, Medical University in Lodz in 2006-2010]. / Analiza wskazan do porodu droga ciecia cesarskiego noworodków ze skrainie niska masa urodzeniowa (< 1500 g) urodzonych w latach 2006-2010 w I Katedrze Ginekologii i Poloznictwa UM W Lodzi.

UNLABELLED: Despite better care pregnant women receive nowadays, preterm birth and prematurity remain to be the reason of many complications and high mortality of neonates. OBJECTIVE: The goal was to analyze the indications for cesarean sections delivery for very low birthweight (<1500 g) newborns delivered in the I Department Gynecology and Obstetrics, Medical University in Lodz. MATERIAL: The data from 560 preterm caesarean sections were analyzed. Detailed analysis referring to 120 cesarean sections resulting in deliveries of very low birthweight neonates was performed. Maternal age, parity neonatal weight and gestational age were assessed. The authors also assessed the number of cesarean sections performed for extremely low birthweight newborns, in particularly years and the rate of the indications in the groups of gestational age. RESULTS: The greatest number of the cesarean sections was done between 26-35 years of age of the patients (68,4%) in 28-32 weeks of gestation (53,3%). The rate of cesarean section performed for very low birthweight neonates was 2,3% of preterm caesarean sections. Fetal growth restriction (IUGR) and the symptoms of intrauterine hypoxia were the indications for cesarean sections in 33,4%, multiple pregnancy in 17,5%, abnormal fetal presentation in 15,8%, intrauterine infection in 13,3% and placental abruption in 11,7% of cases. The rate of the other indications was 11,7% of cases. CONCLUSIONS: In our material the most frequent indication for the cesarean section for very low birthweight neonates was fetal growth restriction with the symptoms of intrauterine hypoxia.

[Body mass changes during pregnancy and concentration of insulin and neuropeptide Y in women with regard to the BMI]. / Zmiany masy ciala podczas ciazy oraz stezenie insuliny 1 neuropeptydu Y u kobiet ciezarnych w zaleznosci od BMI.

INTRODUCTION: Obesity poses a serious problem to human population as it increases the risk of diabetes, hypertension, metabolic syndrome. In pregnancy obesity increases the frequency of its complications. AIM: The main aim of the study was to estimate the increase of body mass and insulin and neuropeptide Y concentrations in pregnant women. MATERIAL AND METHODS: The changes of body mass and BMI in women before pregnancy and before delivery and the concentrations of insulin and neuropeptide Y in blood were estimated. RESULTS: The increase of body mass and BMI during the pregnancy period was higher in the group with high body mass and I stage obesity and increase of insulin concentration depended on increase of the body mass. Higher concentration of NPY was found in the group of women with normal body mass and obese if compared to stages II and III of obesity No correlation between insulin increase and concentration of NPY was found. CONCLUSIONS: In most pregnant women body mass gain is excessive and leads to obesity of different stages. Insulin concentration increases as BMI increases. Neuropeptide Y concentration in the obese women group was lower than in the normal weight group.

[Physiotherapy in obstetrics]. / Fizjoterapia w poloznictwie.

Physical activity during pregnancy, active preparation for the delivery and rehabilitation after delivery are factors that can influence the quality of life of a woman at those stages of life. Treatment and prevention of leg edemas decreases the risk of hospitalization. Kinezytherapy helps pregnant women to prevent obesity and stay in good physical condition. Physiological changes in skeleton and muscle system may be the reason of pain during pregnancy and physiotherapy may effectively prevent it. Preparation for the delivery by physical activity, kinezytheraphy and respiratory exercises increase awareness and help a pregnant woman to participated more actively in the act of the delivery.

[The role of physiotherapy in selected gynecological disorders]. / Znaczenie zabiegów z zakresu fizjoterapii w wybranych schorzeniach ginekologicznych.

Physical training is a method supporting pharmacological and surgical treatment by shortening the time of recovery and effectiveness of the entire treatment. Many kinds of such methods, despite their availability remain unpopular and unused. The aim of the following study was to present possibilities of aiding the processes of curing by means of new physical methods. Guidelines for the treatment of adnexitis and rehabilitation after operative treatment were presented.

[Concentration of selected biochemical parameters in blood of pregnant women infected by HPV 16 and 18]. / Ocena stezenia wybranych parametrów biochemicznych w surowicy kobiet ciezarnych z zakazeniem HPV 16 i 18.

UNLABELLED: Asymptomatic HPV infection in pregnant women may be connected with changes of pro-inflammatory cytokines and proteolytic enzymes which may condition the persistence of infection during pregnancy. AIM: The main aim of the study was to evaluate the concentration of interleukin-1, TNF-alpha and alpha-1 antitrypsin in pregnant women infected by oncogenic types HPV. MATERIALS AND METHOD: The study was conducted in 2008-2009 at the Department of Obstetrics and Gynecology Medical University Lodz, on pregnant women in the third trimester of pregnancy The study group consisted on 19 pregnant women HPV-16, -18 infected. The control group consisted on 34 pregnant women at the same gestational age, HPV-negative. The concentration of interleukin-1, TNF-alpha and alpha-1 antitripsin was estimated in blood. RESULTS: The results of concentration interleukin-1, TNF-alpha and alpha-1 antitrypsin were similar in both groups of pregnant women. CONCLUSIONS: High risk HPV infection has no influence on the concentration of pro- inflammatory cytokines. In HPV infection during pregnancy the anti proteolytic defense did not decrease.

[Course of pregnancy and delivery in a patient with ovarian cancer after conservative surgical treatment--case report]. / Przebieg ciazy i porodu u pacientki po leczeniu oszczedzajacym z powodu raka jajnika--opis przypadku.

Ovarian cancer is most often recognized in women at a menopausal age. It rarely appears in young women, however it can coexists with pregnancy or even precede their reproductive activity. Therefore, the exists a risk that the advancement of the illness or the course of treatment will prevent them from having children. The aim of the study is to describe and present the case of a 30-year-old patient treated conservatively for the cancer of the ovary, the course of pregnancy and the way of delivery.

[The course of pregnancy and perinatal period in overweight or obese pregnant women with regard to the condition of the newborn--own experience]. / Wplyw nadwagi lub otylosci u ciezarnych na przebieg ciazy i okresu okoloporodowego z uwzglednieniem stanu urodzeniowego noworodka w oparciu o material kliniczny.

OBJECTIVES: The aim of the study was to estimate whether obesity and overweight influence the course of a pregnancy and labor and to assess the condition of a newborn. MATERIAL AND METHODS: 92 cases of pregnant women with singleton pregnancy were analyzed and assessed. The patients were divided into three groups according to their body mass index. Women with BMI between 18.5 and 24.9 comprised the first group (controls), those with BMI from 25.0 to 29.9--the second group (overweight but not obese) and those with BMI of 30 and above--the third one (obese). RESULTS: Average weight gain in the course of a pregnancy was significantly lower in the obese group whereas average blood pressure in obese women was significantly higher than in the control group. Gestational complications, such as hypertension and gestational edemas were more common in the third group. Birth weight and neonatal outcome were similar in all groups. CONCLUSIONS: 1. There is a higher risk of complications in pregnancy in overweight and obese women. 2. Obesity of women may worsen the outcome of the neonate.

[Obstetric hysterectomy in a patient with uterine myoma of uterus duplex--case report]. / Histerektomia poloznicza u pacjentki z miesniakiem macicy podwójnej--opis przypadku.

A case of a 43-year-old multipara in 36th week of pregnancy with a duplicate uterus and uterine myoma with 15 centimeters diameter has been presented in the article. The aim of the study was to present her obstetric history, course of pregnancy and delivery mode.

[The assessment of leptin concentration and Vascular Endothelial Growth Factor (VEGF) in relation to the body mass index since 20th week of pregnancy]. / Ocena stezenia leptyny oraz sródblonkowo- naczyniowego czynnika wzrostu od 20 tygodnia ciazy, w zaleznosci od wskaznika masy ciala.

UNLABELLED: High body mass index and obesity in pregnancy signify an increased obstetrical risk. Obesity before pregnancy qualifies a patient into the group that demands more attention from the obstetrician. Leptin and VEGF are among numerous factors that influence the pregnancy course and outcome. MATERIAL AND METHOD: The study was conducted in a group of pregnant women from 20-24 weeks of gestation in High Risk Pregnancy Clinic, Medical University Lodz, between 2005-2007. The study group consisted of 30 pregnant women with BMI > or =30 and the control group consisted of 25 pregnant women at the same gestational age and BMI < or =25. Concentrations of leptin and VEGF were measured in venous blood every 4 weeks. RESULTS: More body mass gain during pregnancy was observed in the group of women with BMI > or =30 when compared to the group of BMI < or =25. Mean value of leptin was higher in the group of obese women. No difference was found in leptin concentration measured every 4 weeks. The correlation between leptin concentration and BMI was found in the group of obese women. The concentration of VEGF was higher in controls than in the group of obese women. The mean concentration of VEGF measured every 4 weeks in both groups was similar. The highest values of VEGF were found in 20-24 and 30-34 weeks of pregnancy in women with normal BMI. CONCLUSIONS: 1. The synthesis of leptin depends on body mass, not the duration of pregnancy. 2. Obesity in pregnancy is connected with decreased VEGF synthesis.

[24-hour Holter measurement of blood pressure in pregnant women and effectiveness of the treatment]. / Ocena przydatnosci 24-godzinnego monitorowania cisnmienia tetniczego u ciezarnych metoda Holtera, dla poprawy efektów leczenia nadcisnienia tetniczego.

OBJECTIVES: Hypertension remains a very serious obstetric problem and a severe pregnancy complication. Hypertension in pregnancy influences the intrauterine fetal growth. Proper monitoring of antihypertensive therapy effects enables us to make suitable modifications of the treatment. The aim of the study was to evaluate the benefits of 24-hour Holter arterial pressure monitoring method in hypertensive pregnant women. MATERIAL AND METHODS: Pregnant women hospitalized and treated for hypertension in the Department of Pathology of Pregnancy of Medical University of Lódz were investigated in the study. Two groups were compared, namely: the control group--pregnant hypertensive women with blood pressure controlled 4 times a day and a study group with 24-hr blood pressure control. RESULTS: In the study group examined by 24-hr arterial pressure monitoring, measured, values of blood pressure during the treatment was significantly higher. This observation shows the necessity to increase doses of antihypertensive agents. CONCLUSION: 24-hr arterial pressure monitoring allows us to administer a more precise dosage of antihypertensive drugs than several arterial blood pressure measurements per day.

HLHS--congenital heart defect in High Risk Pregnancy Unit in 2001-2007.

BACKGROUND: HLHS (hypoplastic left heart syndrome) is a serious congenital heart defect. In neonates with congenital heart disease HLHS accounts for nearly 25% of neonatal deaths. The etiology of HLHS is unknown. At present we expect to have those cases diagnosed in the second trimester of pregnancy. AIM: The main aim was to find the rate and outcome of the congenital heart defect--left heart hypoplasia (HLHS). MATERIAL AND METHODS: All cases of this heart defect found in the High Risk Pregnancy Clinic in 2001-2007 were presented. Twice the congenital malformation was diagnosed after delivery and once during pregnancy--in the second trimester. All babies were delivered between 38 and 39 weeks of pregnancy, one by the spontaneous normal delivery, one by elective caesarean section and one by emergency caesarean section because of fetal distress during the delivery. All of the newborns were transported to the Pediatric Cardio surgery Unit of M.U. and operated in first weeks after delivery. RESULTS: In two cases the operation was complicated and children died due to the cardiac arrest. One of the babies died before surgical correction. Two of the women, whose babies died after the operation gave birth to healthy newborns with no cardiac abnormalities. CONCLUSION: The HLHS is the most serious heart congenital malformation diagnosed often after the delivery because of lack of sufficient diagnostic system in healthy women. The prognosis for the children is bad, but the chance of giving birth to healthy children in the future is good.

[Influence of parity on the body mass of neonates]. / Wplyw dzietnosci matki na mase urodzeniowa noworodka.

OBJECTIVES: The purpose of the study was to determine whether there exists a positive correlation between the mother's parity and the child's weight on delivery. MATERIALS AND METHODS: A retrospective study has been conducted on a selected group of 86 multiriparas with three deliveries. Only in term babies of healthy mothers were taken into consideration. Data derived from cases has been analyzed by means of Microsoft Excel and Statistica 6.0 software. RESULTS: In 65.1% of the cases, the birth weight of the second neonate exceeded the weight of the first one. The rate diminishes to 51.2% when we compare the third child with the second. In 2.3% of the records no changes have been observed. The abovementioned criteria enabled us to form three groups out of the initial cohort and perform further analysis. CONCLUSIONS: Significant correlation between birth weight of the first and second newborn has been found. No such correlation was found in the case of the second compared to the third delivery.

[The analysis of the uterine cervix biocenosis in pregnant women]. / Analiza biocenozy kanalu szyjki macicy u ciezarnych.

OBJECTIVES: Infections of the vagina and the uterine cervix are some of the most frequently diagnosed and treated complications during pregnancy. AIMS: The aim of the study was to carry out biocenosis of the uterine cervix among pregnant women and the assessment of the resistance of the previously isolated types of bacteria to antibiotics. MATERIAL AND METHODS: The study was done in a group of 244 pregnant women, aged from 17 to 43, hospitalized and treated for various reasons in the Department of Pathology of Pregnancy at Medical University in Lódz. The biocenosis of the uterine cervix and the results of microbiological bacterial culture have been analyzed and the sensitivity of bacterial flora on the applied antibiotics has been assessed. RESULTS: Enterococcus faecalis, Escherichia coli and Staphylococcus epidermidis were the most frequent bacteria found in the smear from the uterine cervix. Negative culture was obtained in 2% of the pregnant women. The most frequently observed resistance to antibiotics manifested itself in case of amoxicillin, ampicillin, penicillin, erythromycin, clarithromycin and azithromycin. The bacteria showed least resistance to cephalosporins and fluoroquinolones. Staphylococcus epidermidis showed the highest resistance to antibiotics in general. CONCLUSIONS: In cases of bacterial vaginal infections, with unknown sensitivity to bacteria, treatment the use of cephalosporins is highly recommended.

[Pregnancy in primigravida complicated by premature rupture of membranes in 15th week of pregnancy with successful delivery outcome of the mature newborn--case report and review of the literature]. / Ciaza u pierwiastki powiklana przedwczesnym peknieciem pecherza plodowego w 15 tygodniu ciazy zakonczona porodem donoszonego noworodka--opis przypadku i przeglad pismiennictwa.

Premature rupture of membranes and amniotic fluid leakage is a very serious complication of pregnancy. In most cases it causes the premature contractile activity of uterine muscle and premature labour. It is a very rare situation when after premature rupture of membranes at less than 20 weeks of gestation it is possible to carry pregnancy to term with a successful delivery outcome of healthy mature infant. In the study we analysed the course of pregnancy in 28 years old primigravida with PROM from 15th week of pregnancy with a successful delivery outcome of mature newborn in 37th week of gestation. Our analysis revealed that in certain cases of premature rupture of membranes it is possible to successfully prolong the duration of pregnancy till the foetus matures. It seems necessary to improve the management which allows to prolongate the duration of pregnancy in premature rupture of membranes.

[Successful termination of pregnancy complicated by fetal ascites--case report and review of the literature]. / Pomyslne zakonczenie ciazy powiklanej wodobrzuszem plodu--opis przypadku i przeglad pismiennictwa.

This is a case of 25-year-old woman, primigravida, admitted to our department in 27th week of pregnancy complicated by fetal ascites revealed by ultrasound examination. The patient underwent diagnostic amniopunction and viral examinations in 20th week of pregnancy. The results from these studies were normal. This pregnant woman was qualified for fetal abdomen puncture, fluid evacuation and shunt applying between fetal abdomen and amniotic sac. Further outcome of pregnancy was uncomplicated. A live female child was born by caesarean section in 38th week of gestation. The shunt was removed after delivery. The woman and the baby were discharged in a good general condition.

[The mode of anaesthesia for caesarean section in the opinion of pregnant and delivering women]. / Znieczulenie do ciecia cesarskiego--preferencje ciezarnych i rodzacych.

OBJECTIVES: Conduction anaesthesia is regarded as a very safe method for the mother and for a newborn. This kind of anaesthesia reduces the risk of gastric contents aspiration and does not cause the respiratory depression. However in every case it is essential to take into consideration the woman's opinion, for whom delivering of the child is the particularly important event. DESIGN: The aim of the study was the evaluation the presence and the intensification grade of side effects of the anaesthesia to the caesarean section and establishing, which kind of anaesthesia to this operation: general or conduction is assessed as the best method for the delivering women. RESULTS: In study group among 76 women after cesarean section were 49 (64.5%) after epidural anaesthesia, 22 women (28.9%)--after spinal anaesthesia, and 5 patients (6.6%) were operated in general anaesthesia. The most common side effects after anaesthesia for cesarean section were: weakness and backache. After POP the headache was much more often symptom. CONCLUSIONS: Most of pregnant women preferred epidural anaesthesia during delivering of the child by caesarean section.