Eradication of cervical canal colonization associated with prophylactic cervical cerclage: the look further study.

OBJECTIVES: The perioperative management of the cervical cerclage procedure is not unified. In general population controlling microbiome cervical status does not affect obstetric outcomes, but it might be beneficial in patients with cervical insufficiency. The aim of our study was to present the obstetric, neonatal and pediatric outcomes of patients undergoing the cervical cerclage placement procedure in our obstetric department using a regimen of care that includes control of the microbiological status of the cervix and elimination of the pathogens detected. MATERIAL AND METHODS: Thirty-five patients undergoing cervical cerclage in the 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, were included in the study. The procedure was performed only after receiving a negative culture from the cervical canal. RESULTS: Thirty-one (88.6%) patients delivered after the 34th and twenty-eight (80.0%) after the 37th week of gestation. The colonization of the genital tract was present in 31% of patients prior to the procedure, in 42% of patients - during the subsequent pregnancy course and in 48% of patients - before delivery. A total of 85% of patients who had miscarriage or delivered prematurely had abnormal cervical cultures. In patients with normal cervical cultures, and 91.7% of women delivered at term. No abnormalities in children's development were found. CONCLUSIONS: Controlling microbiological status of the cervical canal results in better or similar outcomes to those reported by other authors in terms of obstetric and neonatal outcomes. Active eradication of the reproductive tract colonization potentially increases the effectiveness of the cervical cerclage placement.

Gestational weight gain and glycemic control in GDM patients with positive genital culture.

OBJECTIVE: Gestational diabetes mellitus (GDM) is related to many complications of pregnancy. The aim of the study was the assessment of cervical colonization in GDM patients and its correlation with inappropriate glycaemic control and gestational weight gain (GWG). MATERIALS AND METHODS: The study included 483 women with GDM in a singleton pregnancy who delivered at term. Cervical smears samples were collected >35th week of gestation and cultured for aerobic and aerobic bacteria, and fungi. The patients were divided into two groups on the basis of cervical culture test results: women with negative and positive cervical culture results. Gestational weight gain was estimated in both groups as inadequate, adequate or excessive based on pre-gestational body mass index (BMI) according to the Institute of Medicine (IOM) guidelines. GWG and need of insulin therapy were used as an indicator of complying with dietary recommendations. RESULTS: Patients with positive cervical culture results more frequently had pre-pregnancy BMI >35kg/m2 (4.9% vs 9.5%, p = 0.0508) than patients who had negative cervical culture results. One third (32.1%) of patients had one, and 9.3% had at least two microorganisms in their genital tracts. The most frequent bacteria species isolated was Streptococcus agalactiae (20.1%). Fungi were present in 14.1% of the cervical cultures. Patients with GDM with inadequate GWG more often had genital tract's colonization with Enterococcus spp. (6.83% vs. 1.19% vs. 1.83%, in group with inadequate GWG vs. adequate GWG vs. excessive GWG respectively p = 0.007). CONCLUSION: Insulin therapy in GDM patients was not correlated with the presence of microorganisms in genital tracts. Inadequate GWG in GDM may be linked to genital tract colonization with Enteroccocus spp. Genital colonization during pregnancy among patients with GDM is more often among patients' with pre-pregnancy BMI >35 kg/m2.

Risk factors for unsuccessful vaginal birth after caesarean at full dilatation.

OBJECTIVES: The purpose of this study was to determine the risk factors for caesarean sections in the second stage of labour after a previous caesarean section among women who underwent trial of labour (TOL). MATERIAL AND METHODS: From a total of 639 women who experienced one caesarean section, 456 women were qualified for TOL. From this group, 105 women were subjected to a caesarean section in the first stage of labour and another 351 women reached the second stage of labour. From the latter group, 309 women delivered naturally and 42 were subjected to a caesarean section. RESULTS: Risk factors for the necessity of performing a caesarean section in the second stage of labour after a previous caesarean section was the weight gain during pregnancy (OR = 1.07), the height of fundus uteri (OR = 1.25) before delivery, and the estimated foetal weight (OR = 1.01), a past delivery of a child with a birth weight exceeding 4.000 g (OR = 2.14), the presence of pre-gestational diabetes (OR = 15.4) and gestational diabetes (OR = 2.22), necessity of applying a delivery induction (OR = 2.52), stimulation of uterine activity during delivery (OR = 2.43) and application of epidural analgesia (OR = 4.04). A factor reducing the risk of a caesarean section in the second stage was a vaginal delivery in a woman's history (OR = 0.21). CONCLUSIONS: Women should be encouraged to deliver naturally after a previous caesarean section, especially when their history includes a vaginal delivery and if there is no need for labour induction.

Comparison of HPV Testing and Colposcopy in Detecting Cervical Dysplasia in Patients With Cytological Abnormalities.

AIM: The aim of the study was to compare the diagnostic value of HPV testing and colposcopy in patients with abnormal cytology results. PATIENTS AND METHODS: A total of 186 women with cytological abnormalities were included in the study. The patients underwent colposcopy examinations and DNA HPV testing of cervical smear with genotyping. RESULTS: The HPV test was demonstrated to be more sensitive (79.4%) than specific (60.2%) and was more sensitive than colposcopy for detecting CIN changes (79.4% vs. 73.7%). Combined tests achieved a high sensitivity (90.9%) and negative predictive value (96.1%) in detecting patients with CIN2+ and demonstrated the highest positive predictive value (77.3%) for detecting CIN1+. Colposcopy had a very good specificity (83.5%) and positive predictive value (71.2%) in finding CIN1+ cases. CONCLUSION: HPV tests showed a higher sensitivity than colposcopy, but colposcopy results presented higher specificity. Combining HPV testing and colposcopy proved to be the most efficient method for detecting CIN lesions.

Pregnant surgeon - assessment of potential harm to the woman and her unborn child.

Although most countries developed regulations concerning pregnant women at work, they are not strictly adjusted forevery profession. In the European countries directives prevent pregnant women from working during night shifts, but apartfrom a vague paragraph about avoiding hazardous agents, there are no guidelines specific for pregnant surgeons. The aimof the study was to analyse the risks and consequences of working in the operating theatre during pregnancy. An in-depthanalysis of available literature, laws and regulations concerning health and safety of pregnant surgeons was performed. Notonly they are surgeons exposed to radiation and infectious agents like any other physicians, but they also face the risk ofstrenuous physical activity affecting their pregnancy. The unpredictability of this occupation, prolonged hours and stressassociated with work can all affect the future mother and her child. The available research on potential risks for pregnantwomen performing surgical activities named such consequences as premature birth, miscarriage, foetal growth retardation,hypertensive disorders and infertility. There are no unanimous guidelines for pregnant surgeons on how long and to whichextent they should work. The key is to maintain a balance between limiting the likelihood of pregnancy complications andrespecting women's voluntary wish to continue professional development.

Influence of Glycemic Control on Coagulation and Lipid Metabolism in Pregnancies Complicated by Pregestational and Gestational Diabetes Mellitus.

Hypercoagulability and altered lipid metabolism, which are observed in normal pregnancy, can be enhanced in diabetes mellitus. The aim of the study was to evaluate the influence of glycemic control on coagulation and lipid metabolism in women with pregestational (PGDM) and gestational (GDM) diabetes treated with insulin. There were 50 patients with PGDM and 101 patients with GDM enrolled into the study. Serum lipid and coagulation parameters were assessed at 18-22, 25-28, and 31-34 weeks of pregnancy and were compared within the diabetic groups with reference to the effectiveness of glycemia control. We found that poor glycemic control was associated with shortened activated partial thromboplastin time (APTT) and increased activity of antithrombin III (ATIII) in both diabetic groups and with a higher plasminogen activator inhibitor (PAI-1) content level in the GDM group. Poorly controlled PGDM was associated with higher levels of total cholesterol and high-density cholesterol (HDL) in the second trimester and triglycerides in the third trimester. In patients with poorly controlled GDM, a higher concentration of HDL was observed in third trimester, whereas a higher triglyceride level was found in both second and third trimesters. Positive correlations between total cholesterol and APTT and between triglyceride and APTT and ATIII were found in the poorly controlled PGDM group. We conclude that poor glycemic control of diabetic pregnancy impacts both lipid metabolism and the blood coagulation system.

Evaluation of an Integrated Cell Culture-based and PCR Assay for Diagnosis of Genital Herpes in Women.

Diagnosis of genital herpes requires a combination of clinical presentation and laboratory studies. Laboratory diagnostics allow us to clearly establish the etiology (HSV-1 or HSV-2) in order to determine the course of infection and prognosis. Decisive factors in the selection of the appropriate test are: diagnostic goals, patient population, specimen type, and implementation of conditions for the specific method. In total, 187 samples collected during a routine gynecological examination from 120 women were examined for the presence of HSV-1 and HSV-2 in the genital area. Two methods were used to test swabs: cell culture isolation and PCR. HSV-1 was the dominant type of virus in both study groups. The cytopathic effect was observed in 67 (35.8%) cultures with clinical material. HSV-1 and HSV-2 DNA were detected by PCR in 73 (39.0%) cell cultures infected with clinical samples. We did not observe typical, virus related cytopathic changes in 13.7% DNA HSV positive cell cultures, but on the other hand we did not detect viral DNA in 6% of positive cell cultures. High values of the parameters, defining the usefulness of diagnostic tests (sensitivity, specificity, and predictive values) in both groups, are determined by previous viral replication in cell culture.

Gestational diabetes mellitus (GDM) - do the number of fulfilled diagnostic criteria predict the perinatal outcome?

OBJECTIVES: The aim of the study was to check whether the number of fulfilled diagnostic criteria of gestational diabetes mellitus (GDM) had any association with patients' characteristics and pregnancy outcomes. MATERIAL AND METHODS: A total of 756 women with single pregnancies and GDM who gave birth at the 2nd Department of Obstetrics and Gynecology of the Medical University of Warsaw between 01.2013-12.2016 were included in a retrospective analysis. Patients were divided into 2 groups: A - 499 patients diagnosed with GDM on the basis of one diagnostic criterion, B - 257 patients diagnosed with GDM on the basis of more than one diagnostic criterion. RESULTS: Patients from group A had lower pre-pregnancy BMI than those from group B (median 24.9 kg/m2 vs. 26.5 kg/m2, p=0.0003). Women from group A were less frequently treated with insulin than women from group B (19.1% vs. 32.7%; p=0.00002). Group A had lower median OGTT levels than group B (85.9 mg/dL vs. 94.1 mg/dL, p=0,0001; 160.2 mg/dL vs. 197.6 mg/dL, p=0.0001; 144.8 mg/dL vs. 167.0 mg/dL,p=0.0001; respectively). Moreover, in group B the average week of labor was earlier than in group A (mean 38,1 and 38,5 weeks of gestation, p=0,0006). CONCLUSIONS: Patients who fulfilled more than one diagnostic criterion for GDM may have worse pregnancy outcome. We think that a number of fulfilled diagnostic criteria for GDM may be an important risk factor for insulin therapy during pregnancy and earlier gestational age at delivery.

Evaluation of the amoxicillin concentrations in amniotic fluid, placenta, umbilical cord blood and maternal serum two hours after oral administration.

OBJECTIVES: Amoxicillin is a broad-spectrum beta-lactam antibiotic. Due to its low toxicity, it is commonly used in obstetrics. The objective of this study was to assess amoxicillin concentrations in amniotic fluid, umbilical blood, placenta and maternal serum two hours following oral administration among pregnant women at term and to assess obstetric and non-obstetric factors that might affect amoxicillin's penetration of these tissues. MATERIALS AND METHODS: A total of 30 full-term pregnant women who qualified for elective Caesarean delivery were included in the study. Amoxicillin at a dose of 500 mg was administered prior to surgery. Amoxicillin levels were determined by diffusion microbial assay. RESULTS: The maternal serum, placental, umbilical blood and amniotic fluid levels of amoxicillin two hours after oral administration were 2.18±1.30 µg/g, 1.00±0.71 µg/g, 1.00±0.73 µg/g, and 0.67±0.59 µg/g, respectively (Table 2). Maternal serum levels of amoxicillin were significantly higher compared to other tissues (p<0.05). CONCLUSION: If the target tissues for the use of antibiotic drugs in pregnant patients are the fetus and/or the placenta, the drug should be administered in a higher-than-standard dose than that used to treat infections in non-pregnant patients. Considering that there is a maximum absorbable dose following oral administration, intravenous administration should be considered to prevent failure of antibiotic treatment. A higher dose of amoxicillin should be considered in obese mothers.

New criteria for gestational diabetes mellitus - do they impact the outcome?

OBJECTIVE: The aim of the study was to compare the perinatal outcome of pregnancies in mothers who were diagnosed with gestational diabetes mellitus (GDM) with previous versus current Polish Gynecological Society (PTG) criteria. METHODS: 475 patients were divided into three groups. In group A, the patients only met the previous PTG criteria for a GDM diagnosis, i.e., those with a blood glucose level of 140-152 mg/dl 2 hours after administration, a fasting glucose level <92 mg/dl, and a blood glucose level <180 mg/dl 1 hour after administration. Group B included patients complying with both the previous and current PTG criteria for a GDM diagnosis. Group C included patients who only met the current PTG criteria for a GDM diagnosis, i.e., those with a fasting blood glucose level of 92-99 mg/dl, a blood glucose level <180 mg/dl 1 hour and <140 mg/dl 2 hours after administration, respectively. RESULTS: Women from group C were characterized by the highest fasting glycaemia in the first trimester of pregnancy (93.0 mg/dL vs. 88.0 mg/dL vs. 83.5 mg/dL, p=0.012) and during the OGTT (p=0.001). Gestational diabetes was diagnosed significantly earlier in patients from group C (23 vs. 26 vs. 26 weeks, p=0.005). The patients from group A significantly less frequently required insulin therapy for proper glycemic control (p=0.035). Women from group A were characterized by lower pre-pregnancy BMI (p=0.001). CONCLUSIONS: Current PTG criteria for diagnosing GDM according to the IADPSG allow for identification of women who often require insulin therapy to achieve proper glycemic control.

Emergency peripartum hysterectomy - a challenge or an obstetrical defeat?

OBJECTIVES: Peripartum hysterectomy remains an obstetric nightmare. Most obstetricians consider it a defeat. The aim of our study was to assess the prevalence, indications, procedures and complications of emergency peripartum hysterectomy (EPH) in the 2nd Department of Obstetrics & Gynecology, Medical University of Warsaw during a 7 year period (2007-2013). METHODS: A retrospective evaluation of 21,144 deliveries was performed. We analyzed all cases of EPH, including the maternal characteristics, obstetrical history, course of pregnancy and delivery, type of surgery and complications. RESULTS: Nineteen peripartum hysterectomies were performed between January 1, 2007 and October 30, 2013 (0.9/1000), including 16 EPH (0.76/1000). The rate of EPH was between 0.66 and 1.0 per 1000 deliveries. The majority of the patients were multiparous (79.0%), and EPH was performed after at least one cesarean section (75.0%). Fifteen women had a singleton pregnancy and one woman had a triplet pregnancy. The mean gestational age was 34.2 weeks. The delivery mode was cesarean section in 93.8% of the cases. The most common reason for peripartum hemorrhage and the indication for EPH was abnormal placentation (75.0%). All patients underwent a total hysterectomy, including 43.8% during the same operation and 50.0% during a reoperation. There was no maternal death. The serious maternal complication rates were relatively low in our study and included one case of cardiac arrest that required cardiopulmonary resuscitation and one case of sepsis with pulmonary embolism. CONCLUSIONS: EPH is typically performed as a result of massive hemorrhage associated with abnormal placentation, and it should be treated as a challenging, life-saving procedure.

Evaluation of the amoxicillin concentrations in amniotic fluid, placenta, umbilical cord blood and maternal serum two hours after intravenous administration.

OBJECTIVES: The aims of this study were to evaluate amoxicillin concentrations in amniotic fluid, placenta, umbilical cord blood and maternal blood two hours after intravenous administration to assess obstetric and non-obstetric factors that could have influences on the penetration of the antibiotic into the examined tissues and to analyze the sensitivity to amoxicillin of the most common pathogens isolated from the genital tract. METHODS: A total of 35 full-term pregnant women who qualified for elective Caesarean delivery were included in the study. Amoxicillin at a dose of 1000 mg was administered prior to surgery. Amoxicillin levels were determined by diffusion microbial assay. RESULTS: The drug concentration was highest in umbilical cord blood compared with amniotic fluid, maternal blood and placenta (4.20±1.06 µg/g versus 3.96±0.79 µg/g, 3.22±0.64 µg/g and 2.81±0.64 µg/g, respectively). Obstetric and non-obstetric factors had no influence on the amoxicillin concentration. The most common bacteria isolated from the genital tracts of pregnant women (Streptococcus agalactiae, Enterococcus faecalis, Escherichia coli) were sensitive to amoxicillin. The MIC for the sensitive strain of Streptococcus agalactiae was seen in the majority of tissues of all of the patients; however, the MICs for E. faecalis and E. coli were not observed in any compartment. CONCLUSIONS: Amoxicillin proved to have good penetration into the fetal tissues and placenta after intravenous administration. The most common bacteria isolated from the genital tracts of pregnant women were sensitive to amoxicillin. Pregnancy complications were not found to have an influence on the amoxicillin concentrations in the examined tissues.

Concentration of amoxicillin in maternal serum, cord blood, amniotic fluid and the placenta after vaginal administration.

OBJECTIVE: The aim of this study was to assess the amoxicillin concentration in maternal serum, cord blood, amniotic fluid and the placenta, 2 h following vaginal administration and the factors influencing the drug level. METHODS: Twenty-eight full-term pregnant women who qualified for elective cesarean delivery were included in the study. Vaginal suppositories containing 250 mg of amoxicillin were administered 2 h prior to the operation. Amoxicillin levels were determined using the diffusion microbial assay. RESULTS: The amoxicillin level in amniotic fluid was significantly higher in comparison to that of maternal serum, cord blood or the placenta. Maternal age positively and gestational weight gain negatively correlated with the amoxicillin concentration in maternal serum. The maternal serum hemoglobin level and red blood cell count were positively correlated with amoxicillin concentration in the amniotic fluid. Neonatal birth weight was positively correlated with maternal serum and cord blood amoxicillin levels. Hypertensive women had significantly higher amoxicillin concentrations in amniotic fluid, and women with thrombocytopenia presented significantly higher cord blood amoxicillin concentrations. CONCLUSIONS: Amoxicillin presented poor concentration in maternal-fetal compartments after vaginal administration, but the factors influencing the drug level in different compartments require further investigation.

BMI of the firstborn offspring at age 12 reflects maternal LDL and HDL cholesterol levels at term pregnancy and postpartum.

OBJECTIVE: The aim of this study was to assess the relationship between the body mass index (BMI) of the firstborn offspring at age 12 and maternal lipid levels at term and at 6 months postpartum. DESIGN AND METHODS: The study included children born in the 2nd Department of Obstetrics and Gynecology of the Medical University of Warsaw between 1 November 1991 and 31 May 1993. The end point was BMI in the upper quartile - considered high BMI of the firstborn offspring at age 12. RESULTS: The risk of high BMI in the offspring at age 12 significantly increased with an increase in the LDL-C level at term (OR = 2.41 per SD increase, 95% CI: 1.01-5.80; p < 0.049), a decrease in the HDL-C% at term (OR = 0.35 per SD increase, 95% CI: 0.14-0.84; p < 0.019) and a decrease in the HDL-C level at 6 months postpartum (OR = 0.25 per SD increase, 95% CI: 0.08-0.82; p < 0.022), regardless of maternal weight status before pregnancy and at 6 months postpartum, gestational weight gain, the offspring's gender and birth weight. CONCLUSION: LDL and HDL cholesterol levels at term are markers of maternal adaptation to a first pregnancy and predict the future growth of firstborn offspring.

Shoulder dystocia in diabetic and non-diabetic pregnancies.

OBJECTIVES: Shoulder dystocia remains an obstetric emergency. Maternal diabetes is considered to be one of the major risk factors for shoulder dystocia. The aim of this study was to analyze antepartum and peripartum risk factors and complications of shoulder dystocia in diabetic and non-diabetic women. DESIGN: We performed a retrospective analysis of 48 shoulder dystocia cases out of 28,485 vaginal deliveries of singleton, live-born infants over a 13 year period: 13 cases were diagnosed in diabetic women and 35 cases in non-diabetic women. SETTING: The study was conducted in the 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland, from January 2000 to December 2012. RESULTS: Compared to non-diabetic women, diabetic patients had significantly higher pre-pregnancy body weight (83.4±23.8 kg vs. 62.5±10.9 kg, p=0.002), higher pre-pregnancy BMI (30.2±6.8 kg/m2 vs. 22.9±4.3 kg/m2, p=0.0003), and lower gestational weight gain (11.4±6.2 kg vs. 16.0±4.7 kg, p=0.01). Diabetic women with shoulder dystocia were more likely to deliver before completion of the 38th week of gestation (30.8% vs. 5.7%, p=0.02) and had a higher incidence of 1st and 2nd stage perineal tears compared with the non-diabetic group (23.1% vs. 0%, p=0.02). There were two cases of symphysis pubis dehiscence in non-diabetic women. Children of diabetic mothers had a significantly higher birth weight (4,425.4±561.6 g vs. 4,006.9±452.8 g, p=0.03). Children of diabetic mothers with dystocia were at significantly higher risk of peripartum injuries (92.3% vs. 45.7%). A significant difference was observed in the percentage of brachial plexus palsy (61.5% vs. 17.1%). Children of diabetic women experiencing shoulder dystocia were more frequently affected by Erb's brachial plexus palsy and respiratory disturbances. These children had an increased likelihood of birth weights above the 90th percentile (not necessarily reaching 4,000 g) compared to children born to non-diabetic mothers. CONCLUSIONS: Shoulder dystocia in women with diabetes mellitus during pregnancy was associated with earlier gestational age of labor, and these women were more frequently overweight. The newborns of diabetic mothers after shoulder dystocia appeared to be at an increased risk for perinatal morbidity compared to the newborns of non-diabetic mothers experiencing this complication.

[Laboratory diagnosis of genital herpes--direct immunofluorescence method]. / Laboratoryjne rozpoznanie opryszczki narzadów plciowych--metoda immunofluorescencji bezposredniej.

OBJECTIVES: Aim of the study was to determine clinical usefulness of direct immunofluorescence method in the laboratory diagnosis of genital herpes in women. MATERIAL AND METHODS: Overall 187 anogenital swabs were collected from 120 women. Using a dacron-tipped applicator 83 swabs were collected from women suspected of genital herpes and 104 from patients with no signs of genital infection. All samples were tested using cell culture (Vero cell line) and then direct immunofluorescence method (DIF) for the identification of antigens of herpes simplex viruses: HSV-1 and HSV-2. RESULTS: Characteristic cytopathic effect (CPE), indicative of alphaherpesvirus infection, was observed in 43.4% of cultures with clinical specimens collected from women with suspected genital herpes and in 29.8% of cultures of clinical specimens taken from patients with no clinical symptoms of genital herpes. Herpes simplex viruses were determined in 73 samples by direct immunofluorescence method after amplification of the virus in cell culture. The DIF test confirmed the diagnosis based on the microscopic CPE observation in 85%. In 15% of samples (taken from pregnant women without clinical signs of infection) we reported positive immunofluorescence in the absence of CPE. The frequency of antigen detection was statistically significantly higher in samples that were positive by culture study (chi-square test with Yates's correction, p < 0.01). This method proved to be highly sensitive (97%) in women with clinically suspected infection. High negative predictive value (99%) proves the clinical utility of the DIF in these group of patients. In asymptomatic infections, viral antigens were detected most frequently in the swabs from the cervical canal, and in cases of suspected genital herpes in swabs taken from the vestibule of the vagina and the vulva. However, there was no statistically significant difference in the frequency of detection of Herpes Simplex Virus antigens in specimens from different parts of the genital tract in both groups of women (chi-square test, p > 0.05). In our study HHV-1 was the main causative agent of genital herpes. CONCLUSIONS: The growing worldwide prevalence of genital herpes, challenges with the clinical diagnosis, and availability of effective antiviral therapy are the main reasons for a growing interest in rapid, proper laboratory diagnosis of infected patients. Optimal testing diagnostic algorithm depends on patient population, clinical circumstances and availability. Our results indicated that combination of laboratory tests may help to establish the diagnosis if genital herpes is suspected but there are no typical signs.

Dosage regimen of antenatal steroids prior to preterm delivery and effects on maternal and neonatal outcomes.

OBJECTIVE: The objective of this study was to compare the effects of two betamethasone dosage regimens on selected parameters in mothers and on the status of the preterm newborn. METHODS: The analysis included 121 patients who gave birth by gestational week 35 and within 7 days after the completion of a full course of steroid treatment (24 mg). The study group consisted of 45 patients receiving six 4-mg doses of betamethasone every 8 h. The control group consisted of 76 patients receiving two 12-mg doses of betamethasone separated by 24 h. RESULTS: After treatment, a significant increase in the leukocyte count was observed in the control group. Significant reductions in the erythrocyte counts, hemoglobin levels and hematocrit after treatment were also found in the control group. The post-natal status of newborns did not differ significantly between groups. The betamethasone dosage regimen used did not affect the incidence of moderate and severe respiratory disorders, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), retinopathy (ROP), infection, hyperbilirubinemia or anemia in neonates. Mild respiratory disorders were slightly more common in the study group. CONCLUSION: A reduction in the single steroid dose administered to patients at risk of premature birth may reduce maternal side-effects.

Fetal macrosomia--an obstetrician's nightmare?

OBJECTIVES: Fetal macrosomia is defined as a fetus that is of large size for gestational age, i.e. equal to or greater than the 90th percentile of weight. There is some evidence of increased perinatal mortality and morbidity rates in cases of macrosomia. DESIGN: This is a retrospective study of patients with term pregnancy. We analyzed the deliveries of 508 infants born with birth weight ≥ 4 200 grams and considered them as a study group. The deliveries of newborns with birth weight less than 4 000 g constituted the control group (330 cases). Maternal and neonatal medical records were retrospectively reviewed for clinical data. SETTING: The study was conducted in Second Department of Obstetrics and Gynecology Warsaw Medical University from January 2004 to December 2007. RESULTS: Maternal age, parity, BMI and pregnancy weight gain were positively related to fetal macrosomia. Prolonged first stage of labor, cesarean section rate and increased blood loss were observed more frequent in macrososmia. There were no differences between both groups according to Apgar score and neonatal birth trauma. Macrosomia was observed more frequent in male fetuses. Our data showed that careful qualification to way of delivery let us achieve the same good outcome in macrosomia. CONCLUSIONS: Older obese multiparas are at increased risk of having macrosomic baby. The increased incidence of cesarean section in these women is due to cephalo-pelvic disproportion or obstructed labor. Macrosomia is more often in male fetuses.

[Nutrition habits in pregnant women]. / Nawyki zywieniowe kobiet ciezarnych.

INTRODUCTION: Proper diet during pregnancy is one of the conditions of correct fetal development and maintenance of good health of pregnant women. Increased demand for energy and nutritial substances is connected with growth of mother's tissue mass and also with growth of fetals mass and afterbirth. During pregnancy, quality composition of ailment is not only important, but also the quantity and regularity in taking meals. AIM: The aim of this study was to investigate nutrician status of pregnant women hospitalized in Department of Obstetrics and Gynaecology Collegium Medicum of The Jagiellonian University. METHODS: There were 96 women, hospitilized for complications during pregnancy, from 1.11.2002 to 28.02 2003, in Department of Obstetrics and Gynaecology Collegium Medicum of The Jagiellonian University, asked for filling up the questionnaire about their diet during pregnancy. RESULTS: Medium age of patients was 28.3 years. 47% of women were multiparas. Average body mass before pregnancy was 60 kg and BMI (Body Mass Index) was 21.95. 46% examined women had highschool education. In 96 of questioned women 50% took informations about proper diet during pregnancy from the pass, only 12.5% from the obstetricians. None of the questioned women defined their nutritian condition as bad or mild, for 72% it was good and for 28% very good. Most of them (69%) applied common diet without modifications, only 6% of women had good digestive diet. Alcohol was consumed occasionally by 22% of women, rest of them did not consume it at all. Majority of women, 90.5% did't smoke cigarettes, 6.5% smoked occasionally and 3% up to 10 cigarettes per day. CONCLUSIONS: 1. Obtained data suggests that nutrition habits don't change significantly during pregnancy. 2. Pregnant women are not enough informed about healthy diet during pregnancy by doctors which leads to irregularity in taking meals. 3. General nutritial status of pregnant women could be considered satisfactory in the most of cases.