[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.

[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.