Pregnancy and delivery in women with esophageal varices due to hepatic vein thrombosis.

AIM: Retrospective analysis of the course of pregnancy, labor and mode of anesthesia in women with portal hypertension and esophageal varices induced by portal vein thrombosis. MATERIAL: From 2000 to 2012 seven pregnant were admitted. None had liver transplantation (Ltx), the varicose have been in the 1st stage. Each of them has been consulted by the obstetrician, transplant surgeon and anesthetist. The patient condition during pregnancy, labor and postpartum period was analyzed. RESULTS: Pregnancy in five cases proceeded physiologically. In one threatening miscarriage was diagnosed and treated with gestagens, two patients had tocolytic. One required variceal banding twice. In three thrombocytopenia worsened, with platelet count <70 g/L (up to 59 g/L). They received platelet transfusion before delivery. In one case, significant hipoproteinemia (4.7 g/L) occurred. In a case, GDM G1 and oligohydramnios were found. All women delivered at term (37-40 Hbd). In all general anesthesia with the use of remifentanil was done. There were no fluctuations in MAP and HR. Incision to delivery time was 2.5 min. Time from opioid administration to birth was <4 min. All children were born in good condition, weight 10-90 percentile. Regional anesthesia is contraindicated in patients with thrombocytopenia. In patients with esophageal varices sudden increase in heart rate and blood pressure can cause hemorrhage. CONCLUSION: Patients with portal hypertension can deliver at term. It is a high-risk pregnancy. In this group it is desirable to shorten the second stage of labor or complete it by c-section under general anesthesia with remifentanyl which allows getting desired analgesia without complications in the newborn. Surveillance of pregnant with portal hypertension must include monitoring of liver function and coagulation disorders.

[Relationship between the iron status of the pregnant woman and her body size and body composition before and during pregnancy]. / Zaleznosc pomiedzy stopniem wysycenia zelazem organizmu kobiety ciezarnej a jej budowa i skladem ciala przed i w trakcie ciazy.

For the analysis the relationship of the iron status of 86 pregnant women and size and composition body factors before and during pregnancy were made anthropometric, hematological and iron status indices. There were significant relations between pregestational body weight, height, body mass index and body weight, body composition in pregnancy and the values of iron status indicators in blood throughout gestation.

[Estimation of iron reserves in the body of pregnant women]. / Oszacowanie zapasów zelaza w organizmie kobiet ciezarnych.

The iron reserves were assessed using Cook's formulas in 86 women in following trimesters of pregnancy and in the course of labour. The range of obtained iron reserves' levels was wide and amounted from -570 mg to 874 mg. The iron reserves' levels differed statistically in the groups of women with normal iron amount, with hypoferraemia and with sideropenic anaemia diagnosed on the basis of haematologic and iron indexes. Iron reserves insufficient for the maintenance of iron positive balance in organism were found in about 30% of examined gravidae.

[Estimation of iron status in women in the course of gestation and delivery]. / Oszacowanie stanu zelaza w organizmie ciezarnych.

The triple examinations have taken in the course of gestation on 86 pregnant women living in Lódz. The determinations of HGB, HCT, RBC, MCV, MCH, MCHC, RDW, SF, TIBC, SI, TS, ST, and EP in the venous blood were made between 8-14 hbt, 22-24 hbt, 32-35 hbt and at the first phase of the delivery. Among the examined women it was state the decrease of the value of hematological and iron indexes during the testified to the depletion of the reserved, transport and functional iron store in the organism of the pregnant women. The multiple criteria models were applied to diagnose the prevalence of different stages of iron deficiency with or without anemia in our pregnant women. For women in all trimesters of pregnancy the prevalence of iron deficiency and iron deficiency anemia was 38% in first and 54% in second half of pregnancy.

[Effectiveness of peritoneal dialysis using dialysis fluid of modernized composition]. / Wydajnosc dializy otrzewnowej prowadzonej plynem dializacyjnym o zmodernizowanym skladzie.

In six patients with terminal renal failure the effectiveness was assessed of intermittent peritoneal dialyses (IPD) using the dialysing fluid of modernised composition. On the basis of the obtained results the values were calculated of the total sodium (TMTNa) and potassium (TMTK) elimination glomerular filtration rate, and the sodium elimination index. The values were calculated of the dialysing clearance of urea, creatinine, potassium, and inorganic phosphorus. The correlations were analysed between the dialysing clearance of studied substances and the body area of patients, the duration of dialysis, and glomerular filtration rate. The results were compared with the effectiveness of peritoneal dialysis carried out with the dialysing fluids of formerly used electrolyte composition.

Kinetics of continuous ambulatory peritoneal dialysis (CAPD) with four exchanges per day.

Fourteen patients who had no signs of peritonitis were studied during CAPD. Different exchange time schedules were used alternating exchanges with 1.5% and 2.6% glucose solutions. Usually longer exchanges followed shorter ones and vice versa. Total exchange time varied from 2--10 hours. Maximal ultrafiltration volumes were observed after 3 hours with 1.5% and 5 hours wit 2.6% glucose solutions. For small molecular weight solutes (urea, creatinine, sodium, potassium, and phosphate) dialyzate to plasma concentration ratios tended to be lower with 2.6% glucose solutions during the shorter exchanges. Equilibrium between plasma and dialyzate was attained for all these solutes by 10 hours total exchange time. The concentration ratios for inulin were similar with both types of solution, and did not achieve equilibrium by 10 hours. Protein concentrations and losses were higher with 2.6% glucose solution. Total protein and immunoglobulin losses per 24 hours were markedly lower than those reported for intermittent peritoneal dialysis. White blood cell counts increased slightly up to 5 hours and then remained constant up to 10 hours. Mononuclear cell counts were consistently higher than those of granulocytes. The efficiency of dialysis was not markedly influenced by uneven distribution of total exchange time. If 1.5% and 2.6% glucose solutions were used for particular time schedules, slightly higher dialysis efficiency could be obtained by using hyperosmolar solutions for the longer exchanges. Ultrafiltration volumes, protein and immunoglobulin losses, cell counts in dialyzate, and clearance of inulin varied among individual patients. Protein losses correlated positively with serum protein concentration and the body surface area of the patient. Clearances of insulin also correlated with body surface area but ultrafiltration volumes did not.