Difficulties in prenatal diagnosis of tumour in the fetal sacrococcygeal area.

Prenatal ultrasound at the 20th week of gestation revealed a 3-cm tumour in the sacrococcygeal area. Initially, a sacrococcygeal teratoma was suspected on the basis of fetal ultrasonography, which revealed normal heart anatomy and an increasing tumour mass. The diagnosis was then changed to fetus in fetu or teratoma. Prenatal magnetic resonance imaging at the 34th week of pregnancy confirmed the ultrasound diagnosis. No other anomalies were found. Elective caesarean section was performed at term. The care team included a paediatric surgeon, obstetricians, neonatologists, midwives, and an anesthesiologist. A female newborn was delivered in good condition. The tumour was resected in the operating room and mature teratoma was established by histopathological evaluation. Surprisingly, agenesis of the right forearm was revealed which had not been detected prenatally, despite many examinations (both in our hospital and earlier at a primary care obstetrician office).

The impact of excessive maternal weight on the nutritional status of the fetus - the role of leptin.

INTRODUCTION: Assessment of leptin concentration in the blood of pregnant women (leptin concentration - Lc) and in their newborns, according to their nutritional status. MATERIAL AND METHODS: Pregnant women (n = 42) were divided into normal body mass (NBM) and excessive body mass (EBM) groups. Neonates were divided into AGA (eutrophic) and LGA (macrosomic) groups. Leptin concentraction was studied in 4 subgroups: NBM/AGA, NBM/LGA, EBM/AGA, EBM/LGA. RESULTS: Mothers: A significant correlation was found between maternal Lc and body mass index (BMI) (r = 0.75, p < 0.001). Maternal Lc was 3 times higher than neonatal Lc (p < 0.00001). The NBM mothers showed lower Lc compared to EBM mothers (p = 0.000018). Leptin concentration values in NBM/LGA and NBM/AGA mothers were similar (p = 0.6775). Newborns: Correlations were found between Lc and ponderal index (PI) (r = 0.67, p < 0.001), weight (r = 0.43, p = 0.004) and placental weight (r = 0.56, p < 0.001). Girls presented higher Lc than boys (p = 0.0338). In LGA groups, newborns born to EBM mothers presented higher Lc than those born to NBM mothers (p = 0.0013). In both AGA groups, Lc was similar (AGA/EBM vs. AGA/NBM p = 0.1619). The highest Lc and the largest placentas were found in the group of LGA newborns born to EBM mothers. CONCLUSIONS: Leptin concentration positively correlates with BMI in pregnant women, with PI and female sex in newborns as well as with placental weight. The nutritional status of fetuses does not affect the Lc of their non-obese mothers. The LGA neonates born to EBM women demonstrate higher Lc than LGA neonates born to NBM mothers, whereas Lc of AGA neonates is similar regardless of the nutritional status of their mothers.

Finding NEMO in preeclampsia.

BACKGROUND: The mechanism of preeclampsia and its way of inheritance are still a mystery. Biochemical and immunochemical studies reveal a substantial increase in tumor necrosis factor alpha, interleukin-1 beta, and interleukin-6 concentrations in the blood of women with preeclampsia. The level of these factors is regulated by nuclear facxtor-kappa B, whose activation in a classical pathway requires inhibitory kappa B kinase gamma (known as NEMO or IKBKG). Moreover, NEMO can schedule between cytoplasma and the nucleus. In the nucleus, IKBKG interacts with other proteins, and thus, it is implicated in the regulation of different gene expressions, which are related to cell cycle progression, proliferation, differentiation, and apoptosis. OBJECTIVE: This is the first study investigating the association between the level of NEMO gene expression and the presence of preeclampsia. We tested the hypothesis that the simultaneous increase in NEMO gene expression both in the mother and her fetus may be responsible for the preeclampsia development. Moreover, the relationships between clinical risk factors of preeclampsia and the levels of NEMO gene expression in blood, umbilical cord blood, and placentas were investigated. STUDY DESIGN: A total of 91 women (43 preeclamptic women and 48 controls) and their children were examined. Real-time reverse transcription-polymerase chain reaction was used to assess the amount total NEMO messenger ribonucleic acid (mRNA) content and the mRNA level of each NEMO transcript from exons 1A, 1B, and 1C in maternal blood, umbilical cord blood, and placentas. Univariate analyses and correlation tests were performed to examine the association between NEMO gene expression and preeclampsia. RESULTS: Newborn weight and height, maternal platelet number, and gestational age (week of delivery) were lower in the group of women with preeclampsia than controls. NEMO gene expression level was found to be almost 7 times higher in the group of women with preeclampsia than healthy controls. The correlation analysis found that a simultaneous increase in the expression level of total NEMO mRNA in maternal blood and the mRNA for total NEMO (Rs = 0.311, P < .05), transcripts 1A (Rs = 0.463, P < .01), 1B (Rs = 0.454, P < .01), and 1C (Rs = 0.563, P < .001) in fetal blood was observed in preeclamptic pregnancies. In addition, the mRNA levels for total NEMO and transcripts 1A, 1B, and 1C were lower in placentas derived from pregnancies complicated by preeclampsia. CONCLUSION: Simultaneous increase of NEMO gene expression in maternal and fetal blood seems to be relevant for preeclampsia development. The results of our study also suggest that a decreased NEMO gene expression level in preeclamptic placentas may be the main reason for their intensified apoptosis.

Endometrial and cervical cancer: incidence and mortality among women in the Lodz region.

INTRODUCTION: By the early 21(st) century the most common cancer of female genitals in Poland was cervical cancer. Now endometrial cancer ranks first. The aim of this study was to analyse the incidence and mortality of endometrial and cervical cancer among women in the Lodz region. MATERIAL AND METHODS: Data on the incidence and mortality of endometrial and cervical cancer among inhabitants of the Lodz region were obtained from the National Cancer Registry and Bulletin of Cancer Cases in the Lodz region. The analysis covered ten consecutive years beginning in 2001. RESULTS: The number of new cases reported in 2010 exceeded that observed in 2001 by 181. The standardized incidence rate of endometrial cancer increased by 6.3, while the standardized incidence rate of cervical cancer decreased by 1.4. CONCLUSIONS: In the years 2001-2010, the incidence of endometrial cancer increased by 88.3% and that of cervical cancer decreased by 6.5% among inhabitants of the Lodz region. In the years 2001-2010, mortality of endometrial cancer increased by 24.5% and that of cervical cancer decreased by 12.6%. In 2010, the highest crude incidence rates in the Lodz region of both endometrial and cervical cancer at 39.1 were recorded in the district town of Piotrków.

[Twin pregnancy as the risk factor for neonatal intraventricular hemorrhage]. / Ciaza blizniacza jako czynnik ryzyka wystapienia krwawienia do komór bocznych mózgu u noworodków.

OBJECTIVES: The aim of this study was to find the perinatal risk factors of intravenricular hemorrhage in twin neonates. MATERIAL AND METHODS: A retrospective analysis of 203 twin pregnancies and deliveries between 2003 and 2009 was performed. Then data according birth state and neonatal complications in 406 twins were analyzed. Twin outcome was compared with the outcome of 105 singletons born at the same time and at the same gestational age as twins. RESULTS: Intraventricular hemorrhage was diagnosed in 116/406 (29%) of twins. IVH was found two times more often in the analyzed group than in singletons born at the same gestational age (29% vs. 18%, p = 0,03). In 96% I and II grade hemorrhage was diagnosed and in 4% III and IV grade hemorrhage in the Papille scale was found. CONCLUSIONS: 1) Intraventricular hemorrhage is found more often in twins than in singleton neonates born at the same gestational age. 2) IVH in twins correlate with preterm birth and low birth weight. IVH occur more often in twins with birth weight discordance and with too small maternal weight gain.

[Evaluation of the correlation between IL-1ß, IL-8, IFN-γ cytokine concentration in cervico-vaginal fluid and the risk of preterm delivery]. / Ocena korelacji miedzy stezeniem cytokin IL-1ß, IL-8, IFN-ß w wydzielinie szyjkowo-pochwowej, a ryzykiem wystapienia porodu przedwczesnego.

OBJECTIVES: The aim of the study was to evaluate IL-1ß, II-8, IFN-γ cytokine concentrations in cervico-vaginal fluid in patients with threatening preterm delivery. MATERIAL AND METHODS: The study group included 84 patients between 27 and 34 weeks of pregnancy admitted with symptoms of threatened preterm delivery. The cervico-vaginal fluid was taken from each patient qualified for the study and IL-1ß, II-8, IFN-γ concentration was analyzed by enzyme-linked immunosorbent assay (ELISA). The following factors were analyzed: maternal age and parity gestational age at admission for the examination and at delivery, sex of the newborn, Apgar evaluation at 1 and 5 minutes of life, umbilical blood pH, history of miscarriage or preterm delivery pre-pregnancy body mass index, and smoking. Their influence on the concentration of biochemical markers tested in patients at risk of preterm delivery was investigated. RESULTS: In the study group, patients who delivered preterm had significantly higher concentrations of IL-1ß and II-8 as compared to patients who delivered at term. Patients who delivered preterm more often had a history of a miscarriage and their newborns had lower birth weight, lower Apgar score, and lower pH of the umbilical blood. CONCLUSION: As far as factors significantly influencing cytokine concentrations are concerned, the level of IL-1ß and II-8 concentration is an independent predictor of preterm delivery in patients with threatened preterm labor. In the study group, the IFN-γ concentration did not significantly diversify patients who delivered preterm and at term.

Incidence of and mortality from breast cancer among women in Poland in the years 2001-2010.

INTRODUCTION: Breast cancer is the most common malignant tumour among women. About 15,000 new cases of breast cancer are diagnosed and more than 5,000 women die in Poland every year. The aim of this study was to analyse the incidence and mortality rate of breast cancer among women in Poland in the years 2001-2010. MATERIAL AND METHODS: Analysed data concerning the incidence of and mortality from cancer among women were obtained from the National Cancer Registry. RESULTS: The number of new cases reported in 2010 exceeded that reported in 2001 by 3,666. The mortality from breast cancer among women increased by 15.1% by 2009, to subsequently drop by 0.3% in 2010. The standardized incidence rate increased by 7.4 and the standardized mortality rate fell by 1.3 in 2001-2010. CONCLUSIONS: In the years 2001-2010 the incidence of breast cancer in women in Poland rose by 30.3%, with an increase of 7.4 in the incidence rate. The highest rise in the incidence and mortality of women due to breast cancer in Poland is reported in the Lodz voivodeship. In the years 2001-2009 the number of women's deaths due to breast cancer increased slightly, while the mortality rate dropped.

Prenatally evolving ectopia cordis with successful surgical treatment.

Ectopia cordis (EC) is a rare malformation due to failure of maturation of the midline mesodermal components of the chest and abdomen. It can be defined as a complete or partial displacement of the heart outside the thoracic cavity. It comprises 0.1% of congenital heart diseases. Common cardiac anomalies associated with EC are ventricular septal defect, atrial septal defect, and tetralogy of Fallot. EC and additional anomalies usually lead to intrauterine death. The possibility and efficacy of surgery in a surviving neonate depends on the degree of EC, coexisting congenital heart defects and extracardiac malformations. We present a case of prenatally diagnosed isolated EC diagnosed in the first half of pregnancy. After counseling, the patient decided to continue her pregnancy which ended with a newborn baby discharged from the hospital after cardiac surgery performed just after elective cesarean section.

[Prenatal ultrasonographic diagnosis of congenital epulis--two case reports and literature review]. / Prenatalna diagnostyka guzów jamy ustnej--opis dwóch przypadków oraz przeglad pismiennictwa.

The following work presents prenatal ultrasonographic examination of two rare fetal cases of epulis, among 13 792 fetuses referred to our unit due to suspected fetal anomalies by obstetricians (estimated prevalence 1/7000 among fetuses with different anomalies). Sonographic differential diagnosis, value of fetal nasal amniotic fluid flow assessment by color Doppler and the probability of EXIT procedure have been described.

[Ebstein's malformation in the fetus with cardiomegaly. To treat or to observe?--a case report]. / Zespól Ebsteina z kardiomegalia plodu. Leczyc czy obserwowac?--opis przypadku.

Ebstein's malformation is a rare congenital cardiac defect characterized by an abnormal formation and/or displacement of the leaflets of the tricuspid valve. Prognosis for a neonate is poor in case of cardiomegaly due to coexistence of lung hypoplasia. This paper presents a case of a fetus with Ebstein's malformation with massive cardiomegaly (HA/CA = 0.62) in a 27-year-old patient in her first pregnancy. The cardiac defect was diagnosed in the 22nd week of pregnancy. Due to the fact that the patient decided to continue her pregnancy, and taking into consideration single reports of transplacental Digoxin therapy an attempt to apply Digoxin therapy was made. The mother and the fetus were monitored in two centers, in Rzeszów and in Lódz. In the course of a 12-week transplacental therapy, 8 fetal echocardiography examinations were performed and the following parameters improved: HA/CA (0.62-0.5), CVPS (5/10-7/10) SF RA (0%-11%), SF RV (18%-28%). There was also a conversion of the oxygen test from negative to positive, which seems to document that prevention of the lung hypoplasia was achieved. The neonate died on the 8th day of postnatal life before a cardiac surgery attempt.

[Subchorionic hematoma as a risk factor of pregnancy and delivery in women with threatening abortion]. / Krwiak podkosmówkowy jako czynnik ryzyka clizy i porodu kobiet z zagrazajacym poronieniem.

OBJECTIVES: The aim was to present pregnancy complications and outcome in the group of women with subchorionic hematoma (SCH) diagnosed in the first or second trimester of pregnancy METHODS: A retrospective study was performed to compare the perinatal outcome of 41 patients with SCH (study group) with 59 women treated of threatening abortion (control group). Age, obstetric history the course of pregnancy and obstetric outcomes were analyzed. RESULTS: More SCH patients lost the pregnancy before 22 weeks gestation when Compared to the control group (39.02% vs. 15.3%). The mean age of women in both groups was similar, but a previous loss of pregnancy was more often observed in SCH group (24.4% vs. 9.4%). The majority of SCH women were multiparas (63.25% vs. 43.75%). The frequency of perinatal complications such as premature delivery, intrauterine growth retardation (IUGR) or premature rupture of membranes (PROM), was similar in both groups, but pregnancy-induced hypertension (PIH) was observed more often in SCH group (p = 0.008). The percentage of caesarean sections, the average condition of the newborns in Apgar score and weight were similar in both groups. There were no differences either in the frequency of meconium stained fluid or the presence of late decelerations in delivery CTG pattern. The patients with SCH delivered female fetuses more frequently; 81.25% of those who delivered vaginally had incomplete placenta. CONCLUSIONS: 1. SCH is more frequent in multiparas, especially if previous pregnancy loss was reported. 2. About 40% of pregnancies with SCH are lost before 22 weeks gestation; bleeding is a bad prognostic factor 3. SCH diagnosed at the beginning of pregnancy is a risk factor of PIH in the third trimester. 4. SCH diagnosed in early pregnancy does not influence the method of delivery and does not increase the risk of adverse pregnancy outcome.

[Fetal echocardiography in 83 fetuses with omphalocele from Dept. for Diagnoses and Prevention of Fetal Malformations, Research Institute Polish Mother's Memorial Hospital, and Medical University of Lodz, (1999-2006)]. / Znaczenie badania echokardiograficznego w przepuklinie pepowinowej (Pp) u 83 plodów w materiale Zakladu Diagnostyki i Profilaktyki Wad Wrodzonych ICZMP i Uniwersytetu Medycznego w Lodzi w latach 1999-2006.

MATERIAL AND METHODS: It was a retrospective analysis of fetal echocardiography results (analysis of congenital heart defect (CHD) and functional abnormalities in normal heart anatomy) in 83 fetuses diagnosed and treated in the same institution. RESULTS: In our group of fetuses, the most common structural defect, in addition to omphalocele, proved to be CHD. In the group of omphalocele, normal heart anatomy and functional abnormalities (tricuspid regurgitation, myocardial hypertrophy, arrhythmias), the hospital stay was longer comparing to the group of omphalocele, normal heart anatomy and normal heart study (t-test p = 0.005). CHD was a bad prognostic factor and most fetuses/newborns did not survive (Chi-square 0.0005, Fisher test 0.000032). In the group of omphalocele and normal heart anatomy based on fetal echocardiography, the survival rate was 70%. The omphalocele and CHD survivors (n=3) had been only those who did not require a cardiac surgery in first month of postnatal life. CONCLUSION: Echocardiography exam of fetus with omphalocele and CHD and functional abnormalities has diagnostic and prognostic value.

[Diaphragmatic hernia in reference hospital ICZMP--diagnostic problems and outcome]. / Problemy diagnostyczne i losy plodów z przepuklina przeponowa w osrodku referencyjnym ICZMP w latach 1994-2006.

OBJECTIVES: The aim of the study was to analyze US/ECHO examinations in fetuses with diaphragmatic hernia (DH) diagnosed and treated in our institution from 1994-2006, and their follow-up. MATERIAL AND METHODS: Retrospective analysis of the data base from Department for Diagnoses & Prevention of Fetal Malformations, Research Institute of the Polish Mother's Memorial Hospital: 14,481 fetal echo/ultrasound examinations in 10,077 fetuses have been analyzed to retrieve 115 fetuses with DH. RESULTS: The mean gestational age at the targeted US/ECHO examination was 30 wks. There were 8 terminations of pregnancies (at mean 21 wks), 6 intrauterine demises, 60 neonatal deaths after delivery (in 1-3rd day of postnatal life), 8 deaths after surgery, 19 neonates were discharged home and in 14 cases the follow-up could not be monitored. The most common anomalies accompanying DH have been central nervous system anomalies (20%), polyhydramnion (16%) and cong heart defects (10%). In this subgroup, there was 100% mortality. Isolated DH has been diagnosed in every third case. In this subgroup, 27 neonates had undergone surgery and the survival rate was 70%, however since 2004 there was not a single death on record. CONCLUSIONS: Late gestational age of US/ECHO examinations in our tertiary center suggests that DH has been relatively difficult to detect during ultrasound screening. DH and the other structural malformations have been a lethal disease in our series in 100%. Isolated DH was much less frequent and was present in every third case (29%), and in this group the survival rate was 70%, regardless of the way of the delivery (CS or Vaginal).

[Markers of oxidative stress in pregnancies complicated by pregnancy induced hypertension and intrahepatic cholestasis]. / Niektóre wykladniki stresu oksydacyjnego w ciazy powiklanej nadcisnieniem tetniczym i cholestaza.

OBJECTIVE: The aim of the study was to investigate levels of superoxide dismutase (CuZnSOD-1), catalase (CAT), glutathione peroxidase (GPx) and malonodialdehyde (MDA) in groups of pregnant women with pregnancy induced hypertension (PIH), hypertension recognized before pregnancy (HA) or intrahepatic cholestasis. MATERIAL AND METHODS: 33 women with PIH, 6 with HA and 12 with cholestasis were compared with 33 healthy pregnant women. Levels of enzymes were assessed in blood samples. Methods of delivery and obstetric results were presented. RESULTS: SOD and GPx levels did not differ significantly in any of the investigated groups. A tendency for lower mean levels of CAT in the group of PIH women, and a higher level of MDA in the group of women with HA has been noted. The mean CAT level was significantly lower in PIH and HA patients delivered instantaneously due to the risk of eclampsia. All mean levels of enzymes in the group of women with cholestasis were similar to the ones in the group of healthy women. Patients with PIH and HA gave birth more often by cesarean section, but the overall condition of the newborns was satisfactory. CONCLUSIONS: There is no substantial evidence that the level of oxidative enzymes in a blood sample can be an indicator of oxidative stress in pregnant women with PIH, HA or cholestasis. Although CAT levels were lower in PIH and HA women who had cesarean section due to the risk of eclampsia, there was no correlation between these enzyme levels and the clinical outcome of patients or the condition of the newborns.

[Obstetric outcome and behavior of women after transabdominal isthmocervical cerclage]. / Wyniki poloznicze i ocena zachowania kobiet po zalozonym szwie okreznym ciesni macicy z dojscia przezbrzusznego.

OBJECTIVES: The aim of this study was to evaluate the course of the life in women with preconception transabdominal cervicoisthmic cerclage. MATERIALS AND METHODS: The studied material consisted of 9 women with cervical incompetence treated with transabdominal cervicoisthmic cerclage in period 2001-2005 in II Department of Gynaecology and Obstetrics of Medical University in Lódz. We paid special attention to mental condition. RESULTS: In analysed group 7 women got pregnant. Actually 6 of them have children and 1 is in 32 weeks pregnant. CONCLUSIONS: 1. Women after repetitive abortion or premature delivery because of serious defect of cervical isthmus are likely to suffer from depression. 2. Management with transabdominal cervicoisthmic cerclage makes carrying pregnancy up to term possible. 3. Prophylactic transabdominal cervicoisthmic cerclage left after childbirth seriously improves feeling of this women. 4. Women with transabdominal cervicoisthmic cerclage left after birth don't complain about dysurical symptoms.

[Occurrence of plasmic and platelet prothrombotic polymorphisms in women in childbirth]. / Wystepowanie osoczowych i plytkowych polimorfizmów prozakrzepowych u poloznic.

DESIGN: Plasmic pro-thrombotic factors as well as pro-thrombotic platelet glycoprotein mutations have been shown to play an important role in the mechanism of the thrombo-embolic disease. However, there is no published study evaluating the role of above mentioned genetic factors in the thrombo-embolic episodes in women in childbirth. OBJECTIVE: The aim of the study was to evaluate the role of selected genetic factors in appearance of thrombo-embolic complications in the women in childbirth, and to determine if there is the coexistence of selected platelet glycoprotein polymorphisms and factor V Leiden mutations. MATERIAL AND METHODS: 71 cases of women in child birth with thrombo-embolic disease were analyzed. Selected demographic characteristics, and genetic pro-thrombotic factors like factor V Leiden mutation, and pro-thrombotic platelet glycoprotein GP Ia, and GP IIIa polymorphisms were examined. RESULTS: Amongst pro-thrombotic platelet glycoprotein polymorphisms moderately pro-thrombotic heterozygous A1/A2, and heterozygous C/T were most prevalent. The least common were strongly pro-thrombotic homozygous A2/A2, and T/T. Analysis of the factor V Leiden mutation revealed statistically significant difference in the presence of allele A, which determines the prothrombotic tendencies in its carrier. CONCLUSIONS: Our study shows that factor V Leiden mutation, and investigated platelet GP Ia, and GP IIIa polymorphisms frequently coexist. Moreover, presence of factor V Leiden mutation is a risk factor for thrombo-embolic disease in the women in childbirth.

[Obstetrical results in women who underwent intrauterine invasive procedures during the pregnancy]. / Wyniki polznicze kobiet, u których stosowano podczas ci zy inwazyjne wewnatrzmaciczne procedury medyczne.

OBJECTIVE: The aim of this study was retrospective analysis of the results of pregnancies among women who had intrauterine invasive procedures (IIP)--amnioinfusion, amnioreduction, cordocentesis and shunts, based on the materials from Polish Mother's Memorial Hospital Research Institute in 2000-2003. MATERIAL AND METHODS: 320 women performed IIP: amnioinfusions due to the oligohydramnion (frequently connected with congenital fetal abnormalities) or premature rupture of membranes. Amnioreduction due to the polihydramnion (also in a twin pregnancy with TTTS syndrome). Implantation of shunts in fetal abnormalities--hydrocephalus, megabladder, CALM. Cordocentesis--diagnostic or therapeutic in a fetal immunisatio anty-Rh factor and fetal arrhythmias. RESULTS: The total percentage of pregnancy failure after IIP was 53.2%. The best results were in the groups with hydrocephalus and immunisatio anty Rh factor, the worst in the group of patients with severe oligohydramnion due to the congenital abnormalities of fetuses' kidney. The most frequent early complications after IIP were premature rupture of membranes (12.2%), fetal hypoxia (13.7%) and premature constrictions of uterus (8.4%). 21.3% of patients delivered in less than 5 days after IIP ( delivery or abortion) due to the early complications or after resolving the obstetrical situation, e.g. the genetic reason of fetal abnormalities or lethal abnormalities. More complications were connected with amnioinfusion than with amnioreduction. Cordocentesis seemed not to be connected with more often appearing of fetal hypoxia. CONCLUSION: (1) IIP are connected with a big percentage of pregnancy failure, but it is more a result of fetal serious disease than a intrauterine procedure. (2) Performing an amnioinfusion or cordocentesis in severe oligohydramnion gives a quick diagnosis of fetal potential abnormalities and makes it possible to outlook the fetal prognosis. (3) Patients should be as early as possible qualificated to IIP to avoid complications caused by the primary fetal disease. (4) Patients for IIP should be carefully selected and prepared. They need very strict observation for a fetal well-being and monitoring the infective factors after the procedure.

[Antibiotic administration in preterm delivery]. / Profilaktyczna antybiotykoterapia w porodach przedwczesnych.

DESIGN: Although an association between subclinical intrauterine infection and preterm birth is well established, there is conflicting evidence regarding the benefits of antibiotic administration in women in preterm labor. OBJECTIVES: We attempted to determine the effect of antibioticotherapy in mothers on congenital neonatal infection. MATERIALS AND METHODS: The study group consisted of 1049 pregnant women with imminent preterm labor hospitalized in Clinics of The Research Institute Polish Mother's Memorial Hospital. RESULTS: 244 women delivered preterm and no significant difference in neonatal outcomes could be detected in two groups with intact membranes and preterm premature rupture of membranes. CONCLUSIONS: The results of this study do not support the routine use of antibiotic administration in women with preterm labor.

Changes in the cardiovascular system during pregnancy in women with secondary atrial septal defect.

BACKGROUND: The secundum atrial septal defect (ASD II) is, after bicuspid aortic valve, the second most frequent congenital heart disease. In the majority of females with ASD II the course of pregnancy is uncomplicated, however, pregnancy-related cardiovascular changes may affect hemodynamic parameters of the defect. AIM: To assess cardiovascular changes in pregnant females with ASD II. METHODS: The study group consisted of 54 pregnant females with ASD II and 30 control healthy pregnant women. NYHA class, standard ECG, 24-hour ambulatory ECG monitoring and echocardiography were analysed in the second and third trimester of pregnancy as well as during puerperium. RESULTS AND CONCLUSIONS: (1) Due to the relatively small sample of population studied and limitations of the usage of NYHA classification in pregnant women, the relationship between ASD II and the development of heart failure during pregnancy could not be definitely proved. (2) An increase in the right ventricular and right atrial enlargement was significantly greater in pregnant women with ASD II compared with healthy pregnant females. Also indirect parameters of the right ventricular strain (paradoxical systolic movement of the interventricular septum or tricuspid regurgitation) were more frequent in patients with ASD II rather than in controls. These alterations were accompanied by a significant decrease in the mean value of the Qp/Qs index which may suggest pregnancy-related favourable changes in the hemodynamic consequences of the defect - a decrease in the left-to-right shunt. (3) Paroxysmal supraventricular tachycardia was the most frequent cardiac arrhythmia in pregnant women with ASD II.