The concentrations of bile acids and erythropoietin in pregnant women with intrahepatic cholestasis and the state of the fetus and newborn.

UNLABELLED: Intrahepatic cholestasis of pregnancy (ICP) is not a common complication of pregnancy, but may be a threat to fetal condition. The elevated level of bile acids defines ICP and determines its severity. Indicators of hepatocyte damage during ICP are elevated ALT and AST. The fetal condition in the ICP depends on the degree of liver damage. The most common complication is preterm delivery, but the risk of fetal death is currently around 3.5%. Erythropoietin is a peptide hormone produced mostly in the kidneys and liver due to tissue hypoxia. EPO concentration in the blood serum of pregnant women increases, because of its production in the placenta. Reducing the blood flow through the fetal-placental unit is the cause of fetal complications associated with ICP. The reason for blood flow the decrease is elevated TBA concentration. The hypothesis of the study assumed that in the course of ICP, elevated bile acids reduce blood flow through the fetal-placental unit, which causes placental hypoxia, and which can lead to the increased secretion of EPO in the placenta. THE AIM: of this study was to find a correlation between high levels of bile acids and concentration of erythropoietin in the serum of women with ICP without anemia and renal dysfunction and to evaluate the course and outcome of pregnancy in women with ICP. MATERIAL AND METHODS: 73 pregnant women from the Department of Obstetrics and Gynaecology, Institute of Mother and Child in Warsaw, were included in the study. 33 pregnant women with ICP were included in group I. Group II (control) consisted of 40 women with pregnancy without ICP. The inclusion criteria for the study in group I were as follows: TBA≥11 µmol/l; elevated liver enzymes: ALT>41 U/l and/ or AST>40 U/l; and the presence of pruritus (current or history). The exclusion criteria included: anemia (HGB<11 g/dl); viral hepatitis A, B, C; other abnormalities of the liver and of the biliary tract; alcohol and drug addiction; HIV infection; diseases of skin with itching and rash; acute and chronic kidney disease; bone disease; acute and chronic bleeding in pregnancy and preeclampsia. Laboratory analysis of the parameters of liver function, kidney function and blood counts was performed on the same day as the TBA and EPO concentration. The intensity of pruritus in patients with ICP was determined on the basis of a special 5-degree scale, proposed by the author. the conditions of fetuses were monitored during laboratory tests of the pregnant women and delivery with cardiotocography and ultrasound. Analysis of the newborns was based on the following data: gestational age at delivery, birth weight, 1-minute and 5-minute Apgar scores, blood gas parameters in the umbilical artery. The statistical analysis of clinical and laboratory parameters was performed using Statistica 5.5 PL package. The results were analyzed in order to find significant differences between them. RESULTS: In the group of pregnant women with ICP mean gestational age at delivery was 35.97±1.86 weeks, in the control group 38.1±1.46 weeks (p<0.05). The percentage of preterm births (<37 weeks) in group I was 45.5%, in group II 15% (p<0.05). At the time of delivery in group I fetal hypoxia symptoms were observed in 9.8% of fetuses vs 17.4% in group II (p=ns.). In the group of women with ICP 36.6% of newborns had low birth weight (less than 2500 g), including 2.4% of extremely low birth weight (<1000 g). In group II, the percentage of infants with low birth weight was 10.9% (p<0.05). The average 1-minute and 5-minute Apgar scores were lower in group I compared to group II (p<0.05). The average TBA concentration was 22.82±14.78 µmol/L in group I vs 2.43±2.04 µmol/L in group II (p<0.05). The obtained data show that the intensity of pruritus was not directly related to the concentration of bile acids. The activity of liver enzymes in the group of women with ICP was significantly increased compared to controls. There were no cases of jaundice among the women examined. Among coagulation parameters in group I, significantly elevated concentration of fibrinogen (p<0,05) was found. Differences in the values of selected markers of renal function (urea, creatinine) and hematological parameters were not statistically significant. Erythropoietin concentrations in both groups were similar. In group I the mean value was 17.35±8.86 mU/ml and in the control group 18.12±9.48 mU/ml (p>0.05). CONCLUSIONS: In the group of pregnant women with ICP there was no correlation between the concentration of bile acids and erythropoietin. Preterm delivery and worse neonatal outcome were more common in the ICP group, which indicates that perinatal care should be improved and further studies are needed.

The role and regulation of secretion of erythropoietin in pregnancy.

Although erythropoietin plays a significant role in human metabolism, relatively little attention has been devoted in scientific literature to its role and mechanisms regulating its secretion in pregnancy. The authors of this article discussed the following issues: - construction, biological role and regulation of erythropoietin secretion, - its extra-hematologic effect, - erythropoietin concentration in normal and complicated pregnancy, - erythropoietin secretion in placenta, including its effect on placental function, - the role of erythropoietin in evaluation of fetal well-being. What seems to be a particularly promising trend in further studies is popularizing the measurement of EPO concentration in cord blood or amniotic fluid as fetal hypoxia marker.

C-reactive protein as the indicator of severity in ovarian hyperstimulation syndrome.

BACKGROUND: To establish correlations between laboratory findings and clinical symptoms of moderate and severe ovarian hyperstimulation syndrome (OHSS). DESIGN: A retrospective study. SETTING: Department of obstetrics and gynecology, public clinical hospital. PATIENTS: Nineteen women admitted to the public hospital with a diagnosis of OHSS. The procedure of controlled ovarian stimulation (COH) was performed in the private assisted reproductive technology centre. METHODS: Blood samples were collected, ultrasound examination of ovaries, abdominal circumference measurement were performed, intravenous crystalloids, plasma expanders such colloids and albumin were given. Correlations between mean laboratory results (haematocrit, c-reactive protein (CRP), white blood count, serum protein, serum albumin), ovarian size in ultrasound examination, abdominal circumference, and amount of albumin and hydroxyethyl starch transfused to the patient were assessed. RESULTS: Significant correlation was observed between CRP concentration and abdominal circumference measured when the patient was admitted to the department, between CRP concentration and ovarian size measured during ultrasound examination at admission and between CRP concentration and body weight. CONCLUSIONS: CRP can be a potential candidate to an indicator of OHSS severity.

[Chlamydia trachomatis infection in sexually active teenagers]. / Zakazenie Chlamydia trachomatis u aktywnych seksualnie nastolatek.

BACKGROUND: The prevalence of Chlamydia trachomatis infections among Polish teenagers remains unknown. Sexually active teenagers are exposed at sexually transmitted infections, including Chlamydia trachomatis (CT). Most infections are asymptomatic and, therefore, untreated. Early detection and treatment of cervical chlamydial infections may prevent pelvic inflammatory diseases and prevent later infertility. AIM: to determine the prevalance and risk factors of Chlamydia trachomatis infections among sexually active female teenager. MATERIALS AND METHODS: 243 sexually active girls, 16-19 year-olds, attending the outpatient clinic were enrolled in this study between 2005-2007. The participants filled in a questionnaire containing such information as age, purpose of visit, level of education, age at the first intercourse, number of sexual partners, number of current partners (in the past 3 months), contraceptive methods, use of condoms, past history of STD and obstetric history at the first visit. Pelvic examination was performed to check the following: vaginal discharge, presence of abnormalites of the cervix (ectopy, erythema, tenderness of uterine and adnexal) and to take a Pap smear and a cervical swab for Chlamydia trachomatis. Cervical swabs for Chlamydia trachomatis were tested by polymerase chain reaction (PCR). RESULTS: The prevalence of CT genital infection in the studied group was 2,9%. Adolescent females infected by CT less frequently admitted to the use of condom and more often did not use any contraception at all, in comparison with the girls without CT genital infections (29% and 57% vs. 37% and 19%). There were statistically significant differences in the results of the abnormal Pap smears (ASCUS, LGSIL) between the two groups.

[PI index value in fetal ductus venosus blood flow at 11-14 weeks in normal course of pregnancy]. / Wartosci wskaznika pulsacji (PI) w przewodzie zylnym plodu pomiedzy 11-14 tygodniem ciazy w przebiegu ciazy fizjologicznej.

OBJECTIVE: Development of ultrasound diagnostic with Doppler examination allows early and and more precise assessement of fetal anatomy and well-being. DESIGN: Evaluation of blood flow parameters in fetal ductus venosus between 11 and 14 weeks of pregnancy was performed. MATERIAL AND METHODS: Fetal anatomy, nuchal translucency, nasal bone and ductus venosus blood flow has been studied with transabdominal probe in 225 consecutive fetuses according to Fetal Medicine Foundation recommendations. RESULTS: From total number of 225 cases finally ten women were excluded from analysis due to absent or reversed A-wave in DV blood flow. In remaining 215 cases mean value of PI was 0,94 (range 0,53-1,88), mean value of Vmax (S-wave) was 42,48cm/s (range 18,7-102,9cm/sek), and mean value of Vmin (A-wave)--11,91cm/s (range 1,13- 37,32 cm/sek). CONCLUSIONS: PI index value slightly decreased with increasing CRL. There was no differences in mean blood flow velocity with CRL for S-wave. A decrease in mean blood flow velocity with CRL was noted for A-wave.

[Prenatal diagnosis of Crouzon syndrome--actual diagnostic possibilities]. / Prenatalne rozpoznanie zespolu Crouzona-- wspólczesne mozliwosci diagnostyczne.

Crouzon syndrome is a cranio-facial dysostosis with autosomal dominant transmission and a birth prevalence of 16.5 per million newborns. Up till now there is no publications in polish medical journals about ultrasonic diagnosis of Crouzon syndrome or of any other craniostenosis. The development of ultrasonography, three-dimensional ultrasonography and in the last years also MRI, allows earlier detection and diagnosis of fetal malformation and enables precise evaluation of his anatomy. The aim of the study is presentatoin Crouzon syndrom diagnosed prenatally by ultrasonography and confirmed moleculary by DNA analysis. We would like to stress the diagnostic problems and the difficult decisions that we encountered.

[Acid-base balance and umbilical blood gases in neonates born at term in North-Eastern region of Poland]. / Ocena równowagi kwasowo-zasadowej i gazów krwi pepowinowej zylnej i tetniczej noworodków urodzonych o czasie w pólnocno-wschodnim regionie polski.

INTRODUCTION: acidosis observed in infants in the neonatal period can be the cause of many disturbances in adaptation to extra uterine life. In the literature various values of acid-base balance and umbilical blood gases parameters are quoted as borderline between normal and pathological. AIM: of study was to determine the parameters of acid-base balance and umbilical venous and arterial blood gases in newborn infants from North-Eastern Poland, significant for the evaluation of the condition of the neonate population from this region. MATERIAL AND METHODS: three groups of newborns were selected for the study. Group I consisted of 492 neonates, born at term, by spontaneous vaginal birth, from single pregnancies, without detectable developmental malformations, without traits of hypotrophy or macrosomy, with normal record of foetal cardiac activity during pregnancy and delivery. Apgar score at 5 min. was >7. Group II consisted of 121 infants born by Caesarean section due to maternal indications. Group III, (75 neonates) was selected from infants born at term by vaginal birth, with Apgar score

Chlamydia trachomatis infection in pregnant women hospitalised in the Institute of Mother and Child in Warsaw, Poland.

UNLABELLED: Chlamydia trachomatis infection is the most common sexually transmitted disease. It concerns both epidemiologists and clinicians as it is often asymptomatic and can cause permanent sequelae. Chlamydia trachomatis infection in women causes nongonococcal cervicitis, endometritis, urethritis, inflammation of the Bartholin's gland, acute and chronic pelvic inflammatory disease, Fitz-Hugh-Curtis syndrome and can lead to Fallopian tube obstruction, infertility and ectopic pregnancy. During pregnancy it can cause chorioamnionitis, premature rupture of membranes, premature delivery, intrauterine growth restriction, low birth weight. post partum endometritis and also infection in the newborn. AIM: To assess the prevalence and to describe risk factors (behavioural and clinical) of genital infection caused by Chlamydia trachomatis in the population of pregnant women attending the Obstetrics Clinic at the Institute of Mother and Child and to study the impact of this infections of pregnancy outcome. METHODS: We have tested 80 pregnant women attending the clinic of obstetrics and gynaecology of the Mother and Child Institute in Warsaw: The presence of C. trachomatis in cervical swabs was assessed using the Polymerase Chain reaction (PCR). RESULTS: We found two cases of C. trachomatis infection, which represents 2.5% of the tested population. CONCLUSIONS: controversial data on the prevalence of C. trachomatis in pregnant women and its influence on pregnancy duration justify further investigations despite the observed law prevalence in this study. This will allow to determine the role and usefulness of routine screening for C. trachomatis in pregnant women in Poland.

Chlamydia trachomatis infection in sexually active adolescents and young women.

BACKGROUND: The prevalence of Chlamydia trachomatis infections among Polish teenagers is unknown. Sexually active adolescents are at a greater risk for sexually transmitted infections, including Chlamydia trachomatis (ChT). Most inflections are asymptomatic and therefore untreated. Early detection and treatment of cervical chlamydial infections can prevent pelvic inflammatory disease and has a strong protective effect against infertility. AIM: To determine the prevalence and risk factors of Chlamydia trachomatis infections among sexually active female adolescents attending the outpatient gynaecological clinic of the Institute of Mother and Child in Warsaw. MATERIALS AND METHODS: 249 sexually active girls, 16-19 years old, attending the outpatient clinic of the Institute of Mother and Child in Warsaw were enrolled in this study from December 2002 to May 2004, The participants filled out a questionnaire containing informations on age, purpose of the visit, level of education, age of the first intercourse, number of lifetime sexual partners, number of current partners (in the last 3 months), number of sexual partners in the past (patients' partner), contraceptive methods, use of condoms at the first and the last intercourse, past history of STD and obstetric history at first visit. Pelvic examination was done for the following reasons: checking vaginal discharge, presence of abnormalities of the cervix such as ectopy, erythroplakia and uterine tenderness and taking a Pap smear and a cervical swab for Chlamydia trachomatis detection. Cervical swabs for Chlamydia trachomatis were tested by Polymerase Chain Reaction (PCR). RESULTS: The prevalence of ChT genital infection in the studied group was 3.2%. Adolescent females infected by ChT less frequently reported the use of condom and more often did not use any contraception in comparison with the girls without ChT genital infections (42.8% and 42.8% vs. 49% and 12.8%), The existence of other STDs was more frequently noted in adolescents with Chlamydial infection in comparison to healthy girls (14.2% vs. 8.3%). There were no statistically significant differences in results of the Pap smears and the incidence of cervical ectopy between the two groups.

[Preterm delivery by cesarean section in patient with polycythemia vera]. / Przedwczesne ukonczenie ciazy cieciem cesarskim u pacjentki z czerwienica prawdziwa.

Polycythemia vera is a myeloproliferative disease most commonly diagnosed in male 60-70 years old patients. It is associated with a higher risk of thrombosis and bleeding. It is very rarely diagnosed in young patients, and thus only few cases of pregnant women have been reported in the literature. These reports show that polycythemia vera may have a detrimental effect on outcome of the pregnancy (PIH, spontaneous miscarriages, preterm delivery, and stillbirth). We report a 33-year-old woman with polycythemia vera who underwent caesarean delivery in 34 weeks gestation. This case demonstrates fully successful result of our intensive perinatal care.

[Twin pregnancies and their outcome at the Department of Obstetrics and Gynecology, Institute of Mother and Child in Warsaw, in the period of 1993-2000]. / Przebieg ciazy i porodu w przypadkach ciaz mnogich w materiale Kliniki poloznictwa i Ginekologii Instytutu Matki i Dziecka w latach 1993-2000.

OBJECTIVE: The aim of this study was to analyse the course of twin pregnancies delivered at the Department of Obstetrics and Gynaecology, Institute of Mother and Child in Warsaw, from 1993 to 2000. MATERIALS AND METHODS: The medical documentation of women with twin pregnancy was looked into. Such parameters as mode of conception, maternal age and parity were taken into account. The data concerning the duration of pregnancy, mode of delivery, birth weight and condition of newly born infants were retrospectively reviewed. RESULTS: There a total of 232 (1.46%) twin pregnancies out of 15,869 births. A gradual increase in absolute number of twin deliveries and a relative increase of multiple pregnancies due to the use of assisted reproduction techniques was observed. The tendency to end twin pregnancies by caesarean section was detected. Although the perinatal care improved over the years, a small decrease of mean gestational age at delivery was observed. No significant difference in neonatal outcome in relation to the mode of delivery in researched material was noticed. CONCLUSIONS: The number of twin pregnancies due to the use of assisted reproduction techniques is on the increase. A percentage of women delivering for the first time has risen among women with twin pregnancy. Twin pregnancies are often ended by caesarean section and the frequency of caesarean sections has increased over time.

[Prevalence of group B streptococcal colonization in pregnant women and their newborns based on the results of examination of patients in the Obstetric and Gynecology Department of the National Research Institute of Mother and Child--a pilot study]. / Czestosc wystepowania kolonizacji paciorkowcami beta hemolizujacymi grupy B kobiet ciezarnych i noworodkow--okreslona na podstawie badan przeprowadzonych u pacjentek Polikliniki i Kliniki Poloznictwa i Ginekologii Instytutu Matki i Dziecka--badanie pilotazowe.

UNLABELLED: Group B streptococcus is a main cause of perinatal infections and neonatal sepsis. In Poland there is no epidemiological data of the prevalence group B streptococcal colonization in pregnant women and the risk for their newborns. OBJECTIVES: The aim of the study is to define the prevalence of streptococcal B colonization in pregnant women and their newborns. MATERIALS AND METHODS: The pregnant women and their newborns from Obstetric and Gynecology Department of National Research Institute of Mother and Child were included to our study during 2001 and 2002 years. Cervical, vaginal and perianal swab were obtained. Women with positive cultures were treated with antibiotic during labor. The external swabs of their neonate were obtained. RESULTS: 1678 pregnant women took part in our study. The GBS (streptococcus agalactiae) colonization was found in 331 women. The prevalence of pregnant women group B streptococcal colonization in the study is 19.7%. 70 of 203 neonates form mothers with positive results of our screening, had the GBS colonization confirmed. The prevalence of confirmed streptococcal colonization in neonates was 34.5%. One newborn developed early onset neonatal sepsis, during the study period. CONCLUSIONS: The prevalence of pregnant women group B streptococcal colonization about 20%. For the prevention of newborns intrapartum infections a major thing is the prevalence of the transmission risk to newborns from mothers with a GBS colonization and the appropriate intrapartum management.

[Determination of beta-hexosaminidase and gamma-glutamyltranspeptidase activities in urine of pregnant women to monitor alcohol consumption]. / Oznaczanie aktywnosci beta-heksozoaminidazy oraz gamma-glutamylotranspeptydazy w moczu jako markerów spozycia alkoholu przez kobiety ciezarne - doniesienie wstepne.

BACKGROUND: Drinking of alcohol by pregnant women provokes many fetal development disorders, first of all the function of central nervous system and can lead to Fetal Alcohol Syndrome - FAS. AIM: Aims of investigation were to determine beta - hexosaminidase (HEX) and gamma - glutamyltranspeptidase (GGT) activity in the urine to monitoring consumption of alcohol by pregnant women in first trimester and to assess the effect of ethyl alcohol on fetus development. MATERIAL AND METHODS: 22 pregnant women, who did not declare consumption of ethanol containing drinks. The level of creatinine, GGT and HEX in urine was analysed. RESULTS: Preliminary results of our study indicate that determination of GGT and HEX activities could be useful in monitoring of alcohol consumption during pregnancy.

[The prevalence of Toxoplasma gondii infection among 2016 pregnant women and their children in the Institute of Mother and Child in Warsaw]. / Czestosc wystepowania zarazen pierwotniakiem Toxoplasma gondii u 2016 kobiet ciezarnych oraz ich dzieci urodzonych w Instytucie Matki i Dziecka w Warszawie.

During the year 2000 a screening was performed to estimate the frequency of Toxoplasma gondii infections in 2016 pregnant women and their children in the Department of Gynaecology and Obstetrics and in the Outpatient Clinic of the Institute of Mother and Child in Warsaw. The study was based on identifying IgG and IgM specific antibodies. All tests were done in the Department of Immunology. Women with serologically diagnosed primary infection were offered further follow up, antibiotic therapy and care during delivery in the Institute of Mother and Child. Children born by infected mothers were examined serologically and observed in terms of congenital abnormality. There were 1294 (64.19%) seronegative; 722 (35.81%) were infected before pregnancy (the presence of IgG antibodies). Five women with previous seronegative results (0.29%) were diagnosed as having primary infection during pregnancy. Congenital infection, confirmed serologically, was recognized in 3 newborn infants.