Effective administration of recombinant tissue plasminogen activator (rt-PA) during resuscitation of a post partum patient with massive pulmonary embolism.

Severe pulmonary embolism with cardiac arrest occurred half an hour after the 5th spontaneous delivery in a 34-year-old multipara. Standard resuscitation for 30 minutes remained ineffective. Only after Actilyse rt-PA infusion the patient's state improved. She regained consciousness on the third day. After 32 days of hospital treatment the patient was discharged in a generally good condition. Today, 5 years after the described event her state of health is very good.

[Normal pregnancy after laser salpingostomy, blighted ovum, and right tubal pregnancy treated with methotrexate]. / Ciaza prawidlowa po laserosalpingostomii, pustym pecherzyku ciazowym i ciazy prawego jajowodu leczonej metotreksatem (MTX).

The 8-years lasting primary infertility in 28 years old woman was caused by bilateral hydrosalpinx, anovulation and husband's oligozoospermia. CO2 laser salpingostomy, treatment of the husband and ovulation induction with clomiphene citrate were successful. The consecutive pregnancies were achieved: 1. blighted ovum, 2. right tubal pregnancy cured with (MTX), 3. normal pregnancy.

[The influence of the proper preparation of the female patients with missed labor syndrome on the diminishing of the complications after its termination]. / Wplyw wlasciwego przygotowania pacjentek z zespolem ciazy obumarlej na zminimalizowanie powiklan po jej rozwiazaniu.

During the period of 6 and half years the cases of 175 patients with missed labour were analysed in Gynaecology--Obstetric Ward of the City Hospital in Tarnów. Laboratory and clinical being--well of a pregnant woman with missed labour syndrome does not exclude the possibility of complications among the patients who have not been prepared. The introduced method made it possible to eliminate such complications as deaths, hemorrhages, clotting disturbances and infections. The period of hospitalization has become evidently shorter.

[Actively continued twin pregnancy with intrauterine death of one fetus]. / Aktywnie podtrzymywana ciaza blizniacza z obumarlym wewnatrzmacicznie jednym plodem.

A case of twin pregnancy with intrauterine death of one fetus in the 28 th week of pregnancy been described. The pregnancy was actively continued. The following procedure was introduced: 1. Tocolysis, 2. Drugs accelerating lung maturation of the alive fetus, 3. Antinfectious and anticoagulopathy prophylaxis, 4. Special care of the mother and the alive fetus. In the 30 th week of pregnancy spontaneus labor occurred "per via naturales". The macerated dead fetus and the alive premature newborn were born. The baby was charged home in good condition in the 45 th day after delivery.

[A case of cervical pregnancy diagnosed by laparotomy and photographically documented]. / Przypadek ciazy szyjkowej rozpoznany podczas laparotomii i udokumentowany fotograficznie.

A case deals with 33 years old primipara in the last stage of the first trimenom of pregnancy. To dispel the doubts connected with development of pregnancy and ultrasound assessments the explorative laparotomy was undertaken. The cervical pregnancy was stated. The curettage and tamponing of the cervical canal failed. The procedure was completed with hysterectomy without adnexa. The advantage of early laparotomy consisted in getting a clear view of the situation and giving the maximum of safety to the patient when the attempts to save the uterus were being carried out. The early laparotomy made it possible to take some unique photographs of the uterus "in situ" with cervical pregnancy.

[The repeated ignoring of prenatal care by a pregnant woman after kidney transplantation]. / Powtórne zignorowanie opieki przedporodowej przez ciezarna z przeszczepiona nerka.

A multipara after kidney transplantation who had for the second time completely neglected prenatal care was admitted to a delivery room at the end of the first stage of labour. She delivered a daughter, weight 2900 g, Apgar 9 points. Mother's puerperium was without complications. The transient oliguria occurred in the baby on the second day. The problems connected with pregnancy after kidney transplantation were discussed.

[Intrauterine growth retardation (IUGR) vs small for gestational age fetus (SGA). Diagnostic aspects]. / Hypotrofia plodu (IUGR), a genetycznie male dziecko (SGA). Aspekt diagnostyczny.

Fetal growth deficiency and low birthweight requires an accurate assessment and may be divided into two groups: 1. Intrauterine growth retardation (IUGR) which is strongly associated with a fetal structural malformation, infections (TORCH) and utreoplacental dysfunction considered to be the most common cause. 2. Genetically, constitutionally small baby (SGA) classified as a well-nourished, healthy and short baby. Taking into account clinical data, medical history, health state of a patient, serial ultrasound growth scan, Doppler ultrasound, cardiotocography and enzymatic monitoring may proved to be useful to differentiate between these two problems.

[Pregnancy in nullipara after conservative excision of uterine cellular leiomyoma and supplementary GnRH analog therapy]. / Ciaza u nieródki po konserwatywnej operacji miesniaka bogatokomórkowego macicy i po uzupelniajacej terapii analogiem GnRH.

The conservatively excised 7 cm in diameter uterine myoma in 34 year old nullipara was proved cellular one. Successively the patient received 6 doses every 4 weeks GnRH analogue (Zoladex a 3.6 mg s.c.). Four months after suppression therapy, the woman conceived. She delivered by caesarean section in 39 week of pregnancy weight 2800 g, Apgar 7 score.

[Prevention of deep vein thrombosis (DVT) with the low molecular weight heparin (LMWH) and epidural/spinal anesthesia. The efficacy viewpoint]. / Profilaktyka zylnej choroby zakrzepowo-zatorowej (ZChZZ) niskoczasteczkowa heparyna (LMWH), a znieczulenie zewnatrzoponowe i podpajeczynówkowe. Aspekt skutecznosci.

OBJECTIVES: To compare the frequency of DVT and PE (pulmonary embolism) events in patients who had undergone gynecological operations under epidural/spinal anaesthesia without LMWH prophylaxis with patients receiving LMWH prophylaxis. DESIGN: Retrospective, hospital record based study. MATERIALS AND METHODS: The majority of patients had undergone vaginal operations. 441 consecutive, unselected patients without LMWH prophylaxis vs. 463 ones treated with LMWH. The patients were given Fraxiparine a 7,500 ICU s.c. 2 h before operation. The same doses were repeated every 24 h during 5-7 days or to the regaining by the patient sufficient physical activity. DVT diagnosis was based on the clinical signs and ultrasound techniques. PE was stated on clinical symptoms, ECG chest x-ray characteristics and gasometric data. RESULTS: Among the patients without LMWH prophylaxis 2 cases of PE occurred (0.45%), one of these was fatal. 1 case of proximal DVT (0.23%) and 3 distal DVT complications (0.68%) were stated. In the LMWH group 1 proximal DVT (0.22%) and 2 distal DVT (0.43%) developed. CONCLUSIONS: Perioperative LMWH prevention proved to be efficient. The clinically expressed incidence of DVT expressively diminished: 8 cases-(1.66%) vs. 3 cases-(0.53%). The pulmonary embolism was avoided.

[Pregnancy and delivery in a pregnant woman with polycystic kidneys complicated by hypertension]. / Ciaza i poród u cienzarnej z wielotorbielowatym zwyrodnieniem nerek powiklanym nadcisnieniem.

The authors described the case of 21 years old hypertonic primipara with polycystic kidneys od hereditary origin. This disease was diagnosed in our ward by means of ultrasonographic examination. The pregnancy induced severe hypertension with preeclamptic symptoms in the 20th week. The intensive procedure resulted in blood pressure normalisation. The ultrasonographic examination of the feats kidneys "in utero" and after delivery didn't show the presence of cysts. The pregnancy was ended by caesarean section in the 37th week and a son of 2700 g with Apgar score 9 was delivered.

[Intra-uterine fetal death syndrome--not only a gynecologic problem]. / Ciaza obumarla--problem nie tylko ginekologiczny.

Intra-uterine fetal death may seriously affect maternal health and implies considerable risk of maternal death, especially when clotting and septic disorders arise. Management od IUFD should include removal of the triggering mechanism for DIC, antiinfectious prophylaxis and consider prompt evacuation of uterus. Low-dose heparin therapy is safe and offers sufficient protection against coagulopathy associated with IUFD. Treatment with low-dose aspirin, steroids or substitutive ACTH therapy is useful for patients with a poor obstetrical outcome. Etiopathology of IUFD, complications, methods terminating of the pregnancies has also been presented.

[Sarcoidosis in the scar after a perineal surgery]. / Sarkoidoza w bliznie po operacji plastycznej krocza.

An infiltration in the perineal scar occurred in a 34 years old patient six months after colpomyoperineoplasty. This infiltration which turned out to be a focus of sarcoidosis. The patient was treated pharmacologically. The lung and local symptoms regressed.

[Spinal analgesia and perioperative low molecular weight heparin (LMWH) prophylaxis of thrombosis. Safety aspect]. / Znieczulenie zewnatrzoponowe i podpajeczynówkowe a okolooperacyjna profilaktyka przeciwzakrzepowa niskoczasteczkowa heparyna. Aspekt bezpieczenstwa.

For many gynecological surgery patients belonging to deep vein thrombosis (DVT) high-risk group the analgesia of choice is regional spinal analgesia. Perioperatively LMWH--Fraxiparine was administered to 426 gynecological surgery patients and to 113 caesarean section patients. The first dose 7500 ICU s.c. was administered 2 hours before operation and consecutive ones every 24 hours for 5 to 7 days. The drug didn't cause any anaesthesia complications like enhanced bleeding after lumbar punction. It was emphasised in the discussion that in choosing this kind of prophylaxis certain conditions should be fulfilled in order to avoid spinal hematoma.

[Spontaneous uterus eversion in a primipara after delivery repositioned manually under fenoterol premedication]. / Samoistne wynicowanie macicy u pierwiastki po porodzie odprowadzone recznie w premedykacji fenoterolem.

The complete, spontaneous uterus eversion in 23 years old primipara in the third stage of normal labour is described. After detachement of placenta the uterus was repositioned manually. To make the procedure easier the drip infusion of fenoterol was applied.

[Appendiceal abscess in the third gestational trimester of pregnancy, complications pre and postoperatively]. / Zapalenie wyrostka robaczkowego w trzecim trymestrze ciazy, powiklania przed i pooperacyjne.

Delayed surgical intervention connected with misdiagnosis of preterm labour and urinary tract infection caused in gravida 3 in 34th gestational week appendiceal abscess, septic shock, stillbirth by cesarean section, necessity of hysterectomy, recidivism of multi peritoneal and pleural abscesses. Although the patient was rescued the retrospective pro memoria considerations of our procedure are regarded.

[Early diagnosis as a condition for conservative treatment of tubal pregnancy with methotrexate]. / Wczesna diagnostyka jako warunek zachowawczego leczenia ciazy jajowodowej przy uzyciu metotrexatu.

27 women with diagnosed unruptured tubal pregnancy were treated using methotrexate given intravenous. Three patients failed medical therapy and required surgical treatment for tubal rupture. The method was effective in 88,89% of cases. 17 women (63%) were given only one dose of methotrexate, ten others required 2-4 doses. Using the diagnostic algorithm (endovaginal sonography, serial B-hCG determinations and uterine curettage) the presence of an ectopic pregnancy was confirmed. The early and relatively easy to follow diagnosis allowing an increase in the proportion of patients who could undergo the alternative of methotrexate therapy and avoidance of laparotomy. The side effects of therapy were mild and transient. Because rupture of ectopic pregnancy can occur despite low and declining B-hCG levels, efficient monitoring was performed.

[Preparation for delivery in patients with missed labor considering low-dose heparin and prostaglandins]. / Przygotowanie do rozwiazania pacjentek z zespolem obumarlej ciazy z uwzglednieniem niskoczasteczkowej heparyny i prostaglandyn.

No complications were reported in the group of 71 missed labour patients who were previously administrated Fraxiparin, antibiotic, Metronidazole and prostaglandins as delivery preparation. The following complications were reported in the control group of 72 patients: blood loss 500-600 ml without coagulopathy-2 (2.8%), shock caused by coagulopathy-2 (2.8%), outcome-1 (1.4%), pelvic inflammatory disease (PID)-2 (2,8%). After delivery hematocrit value, red blood cells count, platelets count and fibrinogen value were significantly lower, activated partial thromboplastic time (APTT) and prothrombin time (PT) were significantly longer in control patients in comparison with the group who were given prophylaxis.

[A happy ending in the case of a careless pregnant woman after kidney transplantation]. / Szczesliwe zakonczenie ciazy u beztroskiej ciezarnej po przeszczepie nerki.

A successful delivery of a woman after kidney transplantation who had completely neglected prenatal care is described. PGE2 anal suppository was successfully administered during the delivery to make the cervix more susceptible. Problems connected with pregnancy after kidney transplant are discussed. Psychological consultation should be included in perinatal care.

[Pregnancy and labor in a pregnant woman with nephrocalcinosis complicated by renal failure]. / Ciaza i poród u ciezarnej z nefrokalcynoza powiklana niewydolnoscia nerek.

The paper presents a case of woman with nephrocalcinosis confirmed 10 years ago. During her third pregnancy a renal failure occurred with increasing urinary retention in the right kidney. Conservative treatment was applied without dialysis, despite of renal biochemical parameters, which balanced on the edge of the indication for this procedure. The pregnancy was managed by the 32-nd week and then cesarean section was performed because of increasing levels of creatinine and urea in the serum and enlargement of hydronephrosis. After the delivery a recovery of renal function was observed. Patient was discharged in good general condition on 9-th day after cesarean section and baby after 52 days of hospitalization in neonatal department when she has reached weight of 3000 g.