[Non-closure of the visceral peritoneum during abdominal gynecological surgery]. / Nie zamykanie otrzewnej trzewnej po brzusznych zabiegach ginekologicznych.

OBJECTIVES AND STUDY DESIGN: The analysis of influence of closure and nonclosure of the visceral peritoneum during abdominal gynecological surgery was done. MATERIALS AND METHODS: A postoperative course and late consequences (occurrence of adhesions) in the 427 patients were studied. There were two groups of patients: I group--203 patients who had visceral peritoneum closed, II group--224 patients who had visceral peritoneum non closed. RESULTS: There were not significant differences in postoperative course in both groups. In the group where the visceral peritoneum was not closed occurrence of the adhesions was significantly decreased, when compared the group where the visceral peritoneum was closed. CONCLUSIONS: 1. Nonclosure of the visceral peritoneum doesn't increase the incidence of early postoperative complications. 2. Nonclosure of the visceral peritoneum during abdominal gynecological surgery decreased the incidence of adhesions. 3. Nonclosure of the visceral peritoneum prevents dislocation and ligation of the ureter.

[Application of 2% clindamycin cream in the treatment of bacterial vaginosis and valuation of methylcellulose gel containing the complex of Chitosan F and PVP k-90 with lactic acid as carrier for intravaginally adhbited medicines in the cases of pregnancies with the symptoms of preterm delivery]. / Zastosowanie 2% kremu z klindamycyna w leczeniu bakteryjnej waginozy oraz ocena zelu z metylocelulozy, zawierajacego kompleks Chitiozanu F i PVP K-90 z kwasem mlekowym, jako nosnika dla leków stosowanych dopochwowo w przypadkach ciezarnych z objawami porodu przedwczesnego zagrazajacego.

OBJECTIVES: There are many reports informing about the connection between BV and the increased risk of preterm delivery. The reason of self-concession and reversion of BV after having executed an efficient treatment has not yet been properly explained. DESIGN: The aim of this work was the clinical valuation of the 2% Clindamycin cream in the treatment of BV and of the methylcellulose gel containing the complex of Chitosan F and PVP K-90 with lactic acid as a carrier for intravaginally adhbited medicines in the cases of pregnancies with the symptoms of a preterm delivery. MATERIAL AND METHODS: The research comprised 145 pregnant between 24-34 week of pregnancy, hospitalised because of the symptoms of a preterm menace delivery. In the case of the detection of BV, a 10-day therapy using intravaginal cream containing 2% Clindamycin was executed. In the cases not qualified as BV, the methylcellulose gel containing the complex of Chitosan F and PVP K-90 with lactic acid has been intravaginally adhibited for 10 days. CONCLUSIONS: 1. Application of 2% Clindamycin cream is an efficient method of the treatment of bacterial vaginosis. 2. Methylcellulose gel containing lactic acid combined with the complex of Chitosan F and PVP K-90 allows a persistent maintenance of the correct pH of vagina. 3. Methylcellulose gel, because of its physico-chemical properties similar to physiological mucus, is a universal carrier for intravaginally adhibited medicines.

Effects of exposure to tobacco smoke in pregnancies complicted by oligohydramnios and premature rupture of the membranes. II. Activity of brush border enzymes in human amniotic fluid.

The aim of the present study was to assess the activity of membrane enzymes: alanine aminopeptidase (AAP), gamma-glutamyltransferase (GGT) and trehalase in amniotic fluid of women who smoke cigarettes during pregnancy complicated by idiopathic oligohydramnios or premature rupture of the membranes (PROM). The enzyme activity was measured between 22 and 31 (group A) and between 32 and 39 (group B) weeks of gestation. In the women of group A with idiopathic oligohydramnios, AAP activity was five times higher than in PROM women. AAP activity was declining with the progression of gestation, and in the B group women with oligohydramnios, it was over eight times lower than in group A. A threefold increase in GGT activity was found in women of group A with oligohydramnios as compared to women of group A with PROM. No statistically significant differences in trehalase activity were found in amniotic fluid of women with oligohydramnios and PROM, AAP, GGT and trehalase activity in women with idiopathic oligohydramnios correlated with the cadmium ion concentration, and AAP and GGT activity with the lead ion concentration in amniotic fluid which confirms toxical properties of these heavy metals present in cigarette smoke. It has already been confirmed that measurements of the brush border enzyme activity in amniotic fluid are very useful in prenatal diagnosis and detection of the placenta disorders.

[Comparison of vaginal misoprostol and oxytocin for labor induction in post-term pregnancy]. / Porównanie skutecznosci misoprostolu i oksytocyny w prowokacji porodu w przypadku ciazy przenoszonej.

OBJECTIVES: To compare labour induction intervals between vaginal misoprostol and intravenous oxytocin as well as side effects of induction in post term pregnancies with intact membranes. METHODS: One hundred women were retrospectively selected to two groups treated with vaginal misoprostol 50 micrograms every 12 hours as needed to maximum 150 micrograms and treated with intravenous oxytocin. The primary outcome measure was time from induction to vaginal delivery. Statistical analysis was performed by t-Student test. RESULTS: Maternal age, parity, gestation were similar. There was a statistically important difference in labour induction intervals between the two groups. The mean time +/- SD to vaginal delivery in misoprostol group was 20.6 +/- 15.2 hours compared with 11.23 +/- 7.4 hours with oxytocin (p = 0.0396). Induction of labour failed in 12% and 32% in misoprostol and oxytocin treated group. Pethidine consumption in oxytocin treated group was higher (41 mg vs 89 mg, p = 0.04). Episodes of vomiting were more frequent in misoprostol treated group (22% vs 6%). There were no episodes of uterine hyperstimulation in both groups. CONCLUSIONS: Oxytocin stimulation resulted in a shorter induction to delivery interval. In misoprostol group induction failed in only 12% whereas in oxytocin group in 32%. There were no serious side effects in both groups. In misoprostol treated group patients required less analgetics then in oxytocin treated group.

Effects of exposure to tobacco smoke in pregnancies complicated by oligohydramnios and premature rupture of the membranes. I. Concentration of Cd and Pb in blood and Zn, Cu, Cd and Pb in amniotic fluid.

To assess the exposure to tobacco smoke in pregnant women with oligohydramnios, idiopathic or caused by premature rupture of the membranes (PROM), cotinine concentrations were measured, using enzyme-like immunosorbent assay (ELISA). In women with idiopathic oligohydramnios (22-31 weeks of gestation), serum cotinine concentration was 1010 +/- 445 micrograms/L which provides evidence that women of this group were heavy smokers. In these women, significantly higher Cd concentrations in blood and amniotic fluid were found as compared to other pregnant women. A positive correlation between Cd concentrations in blood and amniotic fluid was observed (PROM r = 0.784; p < 0.001; idiopathic oligohydramnios r = 0.7118; p < 0.02). In oligohydramnios cases of both types, Cd concentration in amniotic fluid was over two times and Pb concentration ten times lower than blood concentrations of these metals, whereas amniotic fluid Zn concentration was two times lower than that found earlier in women with normal pregnancy. In the group of women with idiopathic oligohydramnios who were mostly exposed to tobacco smoke, a considerably larger number of still births and new-borns with CNS disorders than in PROM cases, were observed. Zn deficiency at increased exposure to Cd and Pb could play a significant role in etiology of these abnormalities. A positive correlation was found between Zn and Cu concentrations (r = 0.862; p < 0.05) in PROM cases which indicates regular transport of trace metals to the fetal ovum. The condition of infants born to this group of women was much better, and prematurity was the only complication of pregnancy.

[Evaluation of the neonatal status from pregnancies complicated by PROM or oligohydramnios in smoking women]. / Ocena stanu noworodków z ciaz powiklanych przedwczesnym odplywaniem plynu owodniowego lub malowodziem u kobiet palacych papierosy.

OBJECTIVES: The aim of the study was analysis of neonatal status from pregnancies complicated oligohydramnios and from pregnancies complicated premature rupture of the membranes (PROM). MATERIALS AND METHODS: Authors analyzed 15 newborns from pregnancies with oligohydramnios diagnosed and 15- from pregnancies complicated PROM. Mothers of these newborns smoked cigarettes or were exposed to tobacco smoke. The features taken into consideration was prematurity, hypotrophy, malformations, birth weight, Apgar scale gained by newborns in first minutes after delivery. RESULTS AND CONCLUSIONS: The higher perinatal mortality, more frequent occurrence of hypotrophy and malformations were shown in newborns from pregnancies complicated oligohydramnios. The most frequent developmental anomaly was defect of nervosal system. Status of newborns from PROM pregnancies was getting better in according to lengthening duration of gestation. It wasn't stated in case of pregnancies with oligohydramnios complications.

[Activity of N-b-D-acetylglucosaminidase molecular forms in amniotic fluid of tobacco smoking pregnant women with oligohydramnios or premature rupture of the membrane complications]. / Aktywnosc molekularnych form N-acetylo-beta-D-glukozaminidazy w plynie owodniowym kobiet palacych papierosy podczas ciazy powiklanej malowodziem lub przedwczesnym odplywaniem plynu owodniowego.

OBJECTIVES: Morphological lesions in placenta and changed metal distribution through placenta, which were observed in pregnancy exposed to tobacco smoke, could cause alternations in lysosomal enzymes secretion to amniotic fluid. DESIGN: Assessment of total activity and molecular forms of N-beta-D-acetylglucosaminidase in amniotic fluid in pregnancy with oligohydramnios or PROM. MATERIALS AND METHODS: The materials for studies were amniotic fluids collected from pregnancy with oligohydramnios and from pregnancy with PROM. Determination of N-beta-D-acetylglucosaminidase activity was performed with use of sodium salt of 3-crezolosulfthaleinyl-N-beta-D-acetylglucosamide as a substrate (test Boehringer, Niemcy). Creatinine was determined by kinetic method (test of Analco-GBG firm). Protein was determine by Bredford method. NAG-B was assessed after previous thermal NAG-A inactivation in 56 degrees C, for 2 hours and the difference between activity of total form and termostabile form of NAG were assessed. The microsomal and cytosol fractions were separated by ultracentrifugation. RESULTS AND CONCLUSIONS: The statistically significant growth of NAG activity in amniotic fluid in pregnant with oligohydramnios was observed. The cytosol form took over 90% of whole activity. The activity of NAG microsomal fraction was lower in amniotic fluid in women with PROM diagnosis. The positive coleration between NAG-A activity and the Pb level was observed in this group of women as well. In the second group of women with oligohydramnios, the positive coleration between NAG and Cd level, NAG-A and level, NAG-B and Pb level were demonstrated. Obtained results show on damage of placental and foetal membranes cell structure. It could be caused by metal ions cumulation and releasing of molecular N-beta-D-acetylglucosaminase form to amniotic fluid.

[Frequency cesarean section in pregnant women with uterine myoma]. / Ciaza w macicy miesniakowatej a ilosc wykonywanych ciec cesarskich.

We were investigated in the connection of the frequency of cesarean sections at pregnant women with uterus myomatous and physiological pregnancies. 189 pregnant patients with myomas have been analyzed retrospectively 72 women with physiological pregnancies belong to the controlled group. Our results didn't confirm the higher risk of cesarean sections in analyzed group.

[Fibronectin level in amniotic fluid as an index of unavoidable labor]. / Stezenie fibronektyny w plynie owodniowym jako wykladnik nieuchronnego porodu.

During uterus contractions detaching of amino-chorionic layer from uterus wall occurs and released fibronectin penetrates into amniotic fluid. The aim of this study was to estimate in a quantity mode the presence of fibronectin in amniotic fluid and to find the dependence between the fibronectin level in amniotic fluid and the period of time from collecting the sample to the labor. We wanted also to find the dependence between fibronectin level in amniotic fluid and duration of pregnancy, preterm rupture of amniotic membranes, patients' age, parity and number of deliveries. We analysed 86 pregnant women where we estimated the fibronectin level in specimens of amniotic fluid. During carrying out the experiment we noted that fibronectin is present in amniotic fluid and can be identified in a quantity mode. We have proved dependence between fibronectin level in amniotic fluid and the period of time from collecting the sample, up to the delivery. Fibronectin level in amniotic fluid in pregnancies uncomplicated with premature delivery was on the average 350 mg/ml. Increase of fibronectin in amniotic fluid above 700 mg/ml points at detaching of amino-chorionic layer and the occurrence of unavoidable preterm labor at the time no longer than 24 hours. Fibronectin level in amniotic fluid doesn't depend of pregnancy duration, preterm rupture of amniotic membranes.

[Levels of Cd, Pb in blood and Zn, Cu, Cd, Pb in amniotic fluid of tobacco smoking women during pregnancy complicated oligohydramnios or premature rupture of membranes]. / Poziom metali Cd i Pb we krwi oraz Zn, Cu, Cd i Pb w wodach plodowych kobiet palacych papierosy podczas ciazy powiklanej malowodziem lub przedwczesnym odplywaniem wód plodowych.

OBJECTIVES: The ingredients of tobacco smoke have the impact on uterine blood vessels. They caused vascular insufficiency of placenta during development of gestation and changes in placental tissue and fetal membranes. It manifest changeable metal permeability and others symptoms. DESIGN: Assessment of metal contents in blood and amniotic fluid in pregnancies with oligohydramnios and PROM. MATERIALS AND METHODS: The materials for studies were blood and amniotic fluid of 30 pregnancies. All of them had made amino-punction between 20 and 38 week of pregnancy before procedure of amniotic fluid supplementation. 15 patients had diagnosed oligohydramnios and the next 15 women had diagnosed premature rupture of membranes. Metals were determined by method of electrothermal atomical absorbic spectrophotometry (ET-ASA). RESULTS AND CONCLUSIONS: Twice lower concentration of Zn and Cd and ten times lower concentration of Pb in amniotic fluids in examined women than women in normal pregnancy were observed. The women, with oligohydramnios in earlier period of gestation, smoked many more cigarettes and cotinine++ and Cd. were much higher. Both these facts had relevance with each other certainly. The stillborns were many more in this group. The different distribution of Cd, Pb, Zn in pregnant women with PROM and oligohydramnios, comparing with women in normal pregnancy was demonstrated. It is probable to be effect of placental tissue and fetal membranes disfunction.

[Nonclosure of the visceral peritoneum during Cesarean sections]. / Nie zamykanie otrzewnej trzewnej po cieciach cesarskich.

OBJECTIVES AND STUDY DESIGN: The analysis of the influence of the closure or nonclosure of the visceral peritoneum during cesarean sections on the course of puerperium and late consequences. MATERIALS AND METHODS: There were 577 patients at whom cesarean section was performed. They were divided into two groups: in the first group (270 patients) during the cesarean sections visceral peritoneum was closed whereas, in the second group (307 patients) visceral peritoneum was not closed. Postoperative course and conditions of the organs in situ at the time of the following operations was considered. RESULTS: There were no differences in regard to postoperative course between two groups. In the group where visceral peritoneum was closed adhesions and upward dislocation of the bladder was observed whereas in the group where visceral peritoneum was not closed these abnormalities were not observed. CONCLUSIONS: 1. Nonclosure of the visceral peritoneum during cesarean sections is safe procedure. 2. Nonclosure of the visceral peritoneum during cesarean sections reduced frequency of the postoperative adhesions. 3. Nonclosure of the visceral peritoneum prevent upward dislocation of the urinary bladder.

[Analysis of effectiveness for treating endometriosis with a Synarel (acetate naphareline) preparation]. / Analiza skutecznosci leczenia endometriozy preparatem Synarel (octan nafareliny).

The aim of the work was estimation of effectiveness of Synarel preparation in the treatment of pelvic pain syndrom caused by endometriosis, and assessment of remission of endometriosal focuses, situated in the small pelvis. Examination were performed on 10 cases which were divided into two groups. First of them the group of 6 patients with the intensive premenstrual pain complaints. The second group involved 4 patients with the little subjective pain ailments, which were treated for sterility. The patients were qualified for the 6-months Synarel treatment in according to the grade of intensification of endometriosis. The studies proved that Synare therapy was well-tolerate and effective in the treatment of intermediate and low-advanced cases of endometriosis with pelvic pain complaints.

[Changes in morphological picture of the semen in the group of men from infertile couples in the Lower Silesia in 1977-1993]. / Zmiany w morfologicznym obrazie nasienia mezczyzn z bezdzietnych par malzenskich, mieszkanców regionu dolnoslaskiego, w latach 1977-1993.

OBJECTIVES: To reveal the trends of the particular semen parameters changes during the 17 years period. DESIGN: Semen analysis results were retrospectively evaluated. MATERIALS AND METHODS: We have analysed semiograms from 618 men from infertile couples in 1977-1993. Regression analysis of the results from years of observation was performed. RESULTS AND CONCLUSIONS: We showed the statistically important increase in the percentage of pathological sperms (R2 = 0.89, p < 0.0001), the slight increase in the semen volume (R2 = 0.30, p < 0.02). The total sperm count in the semen samples revealed a slight increase (R2 = 0.33, p < 0.02). The sperm concentrations and the percentage of the motile sperms remained relatively stable and relatively constant.

[Insulin-like growth factor binding protein 1 (IGFBP-1) in vaginal secretion as a marker of premature rupture of amniotic membranes]. / Insulino podobny bialkowy czynnik wzrostu-1 (IGFBP-1) w tresci pochwowej jako marker przedwczesnego odplywania wód plodowych (PROM).

Diagnosis of premature rupture of amniotic membranes in premature pregnancy allows to estimate dangers which threaten foetus and pregnant woman and helps to put into practice the most accurate therapeutics procedures. The aim of this study was to prove the clinical usefulness of test detecting insulin-like growth factor binding protein-1 in vaginal secretion for diagnose of premature rupture of amniotic membranes and compare the sensiviteness and specificity the above test with Gram stained vaginal smears. We examined group of 50 pregnant women between 25 and 42 week of pregnancy treated in Department of Fertility and Obstetrics Medical University of Wroclaw. Pregnant women were divided into 3 groups. In each of them both tests were performed to diagnose premature rupture of amniotic membranes. Achieved scores shows that Amni Check is specific and sensitive test detecting even insignificant premature rupture of amniotic membranes and has higher sensitivity comparing with common method used until now for detection of premature rupture of amniotic membranes based on Gramm stained vaginal secretion.

[The use of Gynipral (hexoprenaline) in suppression of uterus contractions]. / Zastosowanie gynipralu (hexoprenaliny) w hamowaniu czynnosci skurczowej macicy.

OBJECTIVE: The aim of of this study was to estimate the effectiveness and tolerance of Gynipral (hexoprenaline)-beta-2 sympathomimetic used as oral and intravenous tocolytic. MATERIAL AND METHODS: We analysed 110 pregnant women admitted to the hospital with premature uterus contractions between 17 and 37 week of pregnancy. Pregnant women were divided into two groups. Group I--86 patients with regular uterus contractions. In this group Gynipral was administered to suppress uterus contractions. Group two consisted of 24 patients without regular uterus contractions. In this group women were treated with Gynipral to keep pregnant uterus in maximum relaxation in such cases as IUGR, oligohydramnion, after Strassman procedure before pregnancy or cerclage procedure in current pregnancy. Group I was treated with intravenous Gynipral infusion and after suppression of uterus contractions the way of administration was changed into oral. Group II from the beginning was treated with oral tocolysis with Gynipral. Pregnant women were continually under CTG control and all ailments such as tachycardia, flapping tremor and anxiety were analysed and noted. RESULTS: Gynipral has effectively suppressed premature uterus contractions in 80 cases in group I (93%) and in 24 cases in group II (100%). In 106 cases (96%) patients have not presented any side effects. CONCLUSIONS: Gynipral is an effective tocolytic successfully used in premature labor treatment. Gynipral has a good tolerance administered both intravenously and orally as well and in most cases there was no need to add antiarrhythmic drugs to reduce side effects.

[Usefulness of ultrasonographic measurement for fetal sacrum length in assessment of gestational age in physiologic pregnancy]. / Przydatnosc ultrasonograficznego pomiaru dlugosci kosci krzyzowej plodu w ocenie czasu trwania ciazy fizjologicznej.

Assessment of gestational age is one of the most important aims of ultrasonography in obstetrics. As pregnancy progresses, influences of factors which makes the growth of the fetuses different, cumulates. It has been revealed that the earlier in pregnancy ultrasound examination was performed, the better precision in the assessment of gestational age was obtained. The best precision is encountered when Crown-rump length is measured between 7-9 weeks of gestation. Until the end of the half of pregnancy, biparietal measurement allows for better assessment of gestational age than the date of the last menstrual period. As pregnancy progresses the variability of the measurements increases, reaching 7 week variation at term. The aim of this study is the assessment of fetal sacral length ultrasonographic measurements in the calculation of gestational age. The investigated group consists of 453 pregnant women between 16-41 weeks of physiological gestation.

[Usefulness of amniotic fluid index determination in monitoring the effectiveness of amniotic infusion in pregnancy complicated by oligohydramnios]. / Ocena przydatnosci oznaczania Indeksu Plynu Owodniowego w monitorowaniu skutecznosci amnioinfuzji w ciazach powiklanych malowodziem.

In our research we intended to evaluate the usefulness of AFI measurements in the monitoring of the effectiveness of the amnioinfusions in the cases of pregnancy complicated by premature rupture of membranes (PROM), or in the selected cases idiopathic oligohydramnios, in pregnancies between 26-36 weeks of gestation.

Delayed interval delivery in a quintuplet pregnancy.

We present a case report of delayed delivery of a quintuplet pregnancy. The pregnancy resulted from intrauterine insemination following hormonal treatment. This case may represent the first report of quintuplets delivered using the technique of delayed interval delivery. Three separate spontaneous labours and one Caesarean section for two fetuses took place between the 24th and 32nd weeks of pregnancy. The delay between the first and the last delivery was 61 days. Only a boy, born fourth, survived.

Effect of exogenous tumor necrosis factor alpha, interleukin 6 and interferons on vesicular stomatitis virus replication in human placenta and amniotic membrane organ cultures.

Effects of exogenous cytokines on replication of vesicular stomatitis virus (VSV) in amniotic membrane and placental organ cultures (OC) were studied. We compared the effects observed in OC and established human carcinoma cell lines: A549 and HEp-2. Recombinant human tumor necrosis factor alpha (rHuTNF-alpha), added to amniotic membrane, villous, or decidual OC at concentrations of 30 to 3000 U/ml, potentiated VSV replication by 10-1000 fold. Addition of 5 to 10000 U/ml of recombinant human interleukin 6 (rHuIL-6) to OC from 5 placentas was without effect on VSV growth, except one culture in which enhanced VSV replication has been observed. rHuTNF-alpha was found to have no effect on VSV growth in HEp-2 and A549 cell cultures. In contrast, the placental OC were sensitive to antiviral activity of natural interferons (IFNs): alpha, beta and recombinant IFN-gamma, although A549 cells were 5 to 10 fold more responsive to the cytokines.

[Evaluation of the usefulness and reference values for the amniotic fluid index in normal pregnancy between 30 and 42 weeks of gestation]. / Ocena przydatnosci i podanie wartosci indeksu plynu owodniowego w ciazy niepowiklanej miedzy 30 a 42 tygodniem ciazy.

The four-quadrant sum of amniotic fluid pockets (amniotic fluid index) was studied prospectively in 130 normal pregnancies from 30 to 42 weeks. Statistical investigation were used to establish the mean, 95% confidence intervals and standard deviations for the AFI at each week of gestation. The AFI value decreased since 30 week, especially between 33 and 34 week and after 41 week. The AFI value < or = 5 represents oligohydramnios, the AFI value > or = 20 constitutes polyhydramnios.