[Transvaginal sonography in prediction of preterm delivery in patients presenting with signs and symptoms of preterm labor]. / Zastosowanie ultrasonografii przezpochwowej w predykcji porodów przedwczesnych w grupie ciezarnych z zagrazajacym porodem przedwczesnym.

OBJECTIVE: The purpose of the study was to assess the clinical value of transvaginal sonography in the group of women presenting with preterm contractions and cervical changes. MATERIAL AND METHODS: We prospectively evaluated 82 patients between 23-34 weeks of gestation presenting in our department with signs and symptoms of preterm labor, intact membranes and cervical dilatation < 3 cm. In all cases transvaginal sonography was performed. The following parameters were assessed: functional canal length, funneling, cervical diameter and the length of the vaginal portion of the cervix. The primary outcome was delivery < or = 28 days from examination. RESULTS: The rate of preterm delivery (< 37 weeks) was 25.6% (21/82) and 17.1% (14/82) of the patients delivered < or = 28 days from the examination. Among the analyzed parameters, the significant difference between patients delivered < or = 28 and > 28 days from examination, was noticed only for the functional canal length (21.6 mm vs 30.1 mm; p < 0.001). The analysis of ROC curves showed that functional canal length had the highest diagnostic capability. Two important thresholds were found--20 mm and 31 mm. For predicting delivery < or = 28 days the functional canal length < or = 20 mm had sensitivity of 57.1%, specificity of 92.6%, PPV of 61.5% and NPV of 91.3%. The cutoff value of 31 mm had sensitivity of 100%, specificity of 47.1%, PPV of 28% and NPV of 100%. In multiple logistic regression analysis only FCL < or = 20 mm (OR 8.18; p = 0.027) was independently associated with PTD. CONCLUSIONS: 1. The shortening of the functional canal length (< or = 20 mm) is predictive of impending preterm delivery and the functional canal length > 31 mm is the indicator of the absence of labor. 2. Cervical sonography can be a valuable adjunct to the clinical assessment of patients with signs and symptoms of preterm labor.

[Serial amniocentesis in TTTS]. / Seryjne amnioredukcje w przypadkach TTTS.

AIM OF THE STUDY: The aim of our study was to estimate the efficacy of serial amniocentesis in cases of acute polyhydramnion in TTTS. We analyzed the time and the route of delivery, as well as the status of newborns. MATERIAL AND METHODS: The study group consisted of 13 twins with confirmed hydramnios. In each case thorough examination allowed to make the diagnosis of TTTS. After the examination patients were prepared for amnioreduction. During the procedure the excess of amniotic fluid was removed through the punction needle. RESULTS: The therapy of TTTS was based mainly on serial amniocentesis. In 2 cases, due to an extremely high amniotic volume, the therapy was started with placing the catheter to provide continuous amniotic drainage. The volume of AF removed during the single amniocentesis varied between 700-3000 ml and depended on AFI and the gestational age. In one case maternal treatment with indomethacin was introduced beside amniocentesis and in 3 pregnancies the Digoxin therapy was implemented together with amniocentesis. In all cases the deliveries were preterm. The mean donor weight was 730 +/- 290 g and the mean recipient weight was 1145 +/- 435 g (the difference was approximately 37%). In 7 cases we observed an intrauterine demise of one fetus. The 5th min Apgar score was 1 pt (median). When the analysis was performed after exclusion of stillborns, the median Apgar score for donors and recipients was 4 and 2 pt respectively. CONCLUSIONS: 1. Acute TTTS is a rare pathology occurring in monochorionic twin gestations. 2. The concomitant pathologies include: acute hydramnios, preterm labor and delivery, intrauterine growth restriction, cardiac failure. 3. Serial amniocentesis are effective in significant prolongation of gestation (the mean interval between diagnosis and delivery 24 days). 4. The improvement of perinatal outcomes in twin gestations complicated by TTTS can be achieved by the combination of serial amniocentesis and the laser ablation of anastomoses.

[Doppler evaluation as a predictor of asphyxia in fetuses with intrauterine growth retardation (IUGR)]. / Dopplerowskie cechy centralizacji krazenia we wczesnej ocenie niedotlenienia u plodów z wewnatrzmacicznym zahamowaniem wzrostu (IUGR).

Many papers showed that the pulsatility index of the fetal middle cerebral artery decreases during gestation. We observed equalization of the PI in MCA and PI in UMB in the perinatal period (after 38 weeks of gestation). We observed the increase the diastolic cerebral flow through the brain in cases of hypoxia. We interpreted that situation as a vasomotor response to fetal hypoxia (for example in IUGR). This phenomenon, is called in the literature as brain sparing effect. The aim of our study was estimation of application Doppler technique in diagnosis of changes in circulatory system in pregnancies complicated by intrauterine growth restriction (IUGR). We included 66 fetuses with IUGR and sonographic signs of the brain sparing effects, without any congenital malformation, oedema and genetic abnormalities to the study group. We included 1730 foetuses from normal, physiological pregnancies to the control group. In all cases time of gestation were calculated from Naegele's rule and were confirmed in sonographic examination before 16 weeks of gestation. SGA fetuses were defined on the basis of ultrasonographic measurements of BPD, HC, AC, FL and weight below 10th percentile of our reference curve. Sonographic examination were performed on Acuson 128 XP/10 with transducers (2.5 MHz-5 MHz). We performed Doppler examinations in MCA and UMB. Redistribution (brain sparing effect) was diagnosed when CPR (cerebroplacental ratio) was less than 1. We analysed the way and time of delivery and neoanatal follow up. Obtained in advance of researches results made possible expression of following conclusions: 1. Use of Doppler techniques in pregnancies complicated by IUGR makes possible diagnosis of hypoxia that helps in settlement of continuing or ending of pregnancy. 2. Changes in Doppler flows in foetus resoluteness outdistance irregular other values of biophysical methods of foetus monitoring.

[Laparoscopic or laparotomic surgery in the treatment of ovarian benign teratomas?]. / Chirurgia laparoskopowa czy tradycyjna w leczeniu potworniaków dojrzalych jajników?

The operation treatment of ovarian dermoid cysts by laparoscopy (examined group) and by laparotomy (control group) was compared. The mean size of teratomas measured by USG was similar: in the examined group 59 +/- 20 mm, in the control group 62 +/- 27 mm. There was no significant difference in the operation time: laparoscopy 65 +/- 27 min. (range 35-105 min.) and laparotomy 66 +/- 27 min. (range 40-120 min.). The antibiotic therapy both intra-operation and after operation was applied twice more frequent for laparotomy operated patients. The number of patients with post-operative fever was much higher in the control group (laparotomy: 7 patients--26.9%) than in examined group (laparoscopy: only 1 patient--3.9%). The hospitalization after operation was longer in the control group (mean: 6.8 +/- 3.7 days) than in examined group (mean: 3.1 +/- 2.8 days). Laparoscopic surgery is valuable operating method for selected teratomas in comparison with classical surgery.

[The evaluation of blood flow in uterine arteries in girls with polycystic ovary syndrome by transvaginal color Doppler ultrasonography]. / Ocena przeplywu krwi w tetnicach macicznych u dziewczat z zespolem policystycznych jajników przy wykorzystaniu ultrasonografii przezpochwowej z "kolorowym" Dopplerem.

OBJECTIVE: The aim of this study was to evaluate of blood flow in uterine arteries in girls with PCOS and to determine whether uterine blood flow variations are associated with endocrine findings typical of PCOS. METHODS: Seventy two girls with clinical, endocrinologic and ultrasonographic features of PCOS (mean age 18.8 +/- 1.3 years) were examined. The control subject consisted of twenty girls with regular, ovulation cycles. None of these girls had received hormonal treatment for at least 6 months before the study. Pelvic ultrasound examination was made in each patient with Acuson 128 XP/10 with the 4/5/7 MHz transvaginal transducer. Examination was performed in early follicular phase. Blood flow was made in each patient in the ascending branches of uterine arteries. Index values pulsatility index (PI) and resistance index (RI) were used for the purpose of better comparison of the data. Associations between values of PI and RI and hormones (testosterone, luteinizing hormone) were examined. RESULTS: No significant differences between PI and RI of the left and right uterine artery was observed. PI in PCOS girls was mean 3.19 +/- 0.52 ranged from 2.1 to 4.3, in control girls PI was mean 2.33 +/- 0.36 ranged from 1.6 to 3.1. The PI was positively correlated (r = 0.435, p < 0.01) with testosterone and PI was positively correlated (r = 0.450, p < 0.001) with LH. The RI in PCOS patients was mean 0.87 +/- 0.04 ranged from 0.74 to 0.93, in control girls 0.72-0.87, mean 0.80 +/- 0.04. The RI was positively correlated (r = 0.466, p < 0.001) with testosterone and RI was positively correlated (r = 0.492, p < 0.001) with LH. CONCLUSIONS: The elevated uterine artery resistance was observed in girls with PCOS.

Fetal bladder catheterization in severe obstructive uropathy before the 24th week of pregnancy.

OBJECTIVE: Fetal obstructive uropathy is simple to diagnose before the 24th week of life. Drainage of the pathologically enlarged fetal bladder avoids development of hydronephrosis and destruction of kidneys and, obviously, prevents development of secondary oligohydramnios and pulmonary hypoplasia. The aim of our study was to evaluate the usefulness of a fetal bladder shunt in cases of obstructive uropathy before the 24th week of gestation. METHODS: From January 1997 we diagnosed 6 cases of fetal obstructive uropathy before the 24th week of gestation. In all cases oligohydramnios or ahydramnios was also observed. After evaluation of the renal function on the basis of fetal urine samples, we shunted 5 fetuses. After routine preparation of the operative field, a special puncture needle was inserted through the abdominal wall of mother and fetus into the fetal bladder. Through the needle a fetal bladder catheter was inserted between the fetal bladder and the amniotic sac. After shunt placement, fetal urine fills the amniotic sac and the fetal bladder is decompressed. After the procedure, the patients were hospitalized and serial sonographic examinations were performed to evaluate shunt function. Bladder size, presence and size of hydronephrosis, and volume of amniotic fluid were evaluated. RESULTS: The Rocket Medical catheters have an excellent 'shape memory'. All but 1 newborns had a good perinatal outcome. Mean Apgar score was 8 at 1 min, weight at delivery was between 1,700 and 3,100 g. No pulmonary hypoplasia was observed. All deliveries were after the 33rd week of gestation (range 33-38 weeks). The minimum drainage time was 11 weeks, maximum 18 weeks. In 2 cases premature delivery occurred because of premature rupture of the membranes. One newborn died of respiratory distress syndrome. CONCLUSIONS: Early bladder drainage (before the 24th week of gestation) enables delivery of newborns with a good perinatal outcome, without pulmonary hypoplasia. This method of therapy limits renal damage and allows time for normal development of the fetal lungs.

[Evaluation of the value of clinical doppler sonography and sonographic contrast media for assessment of tubal patency]. / Ocena wartosci klinicznej sonografii dopplerowskiej i sonograficznego srodka kontrastowego w badaniu droznosci jajowodów.

The tubal factor still remains one the most often reason of female infertility. The applying of colour Doppler sonography and up-to-date constant medium (Echovist-Schering) make possible the comparison of clinical value between colour Doppler imaging and others presently used diagnostic methods. The aim of this study was the comparison of results obtained by means of hysterosalpingography, laparoscopy and hysterosalpingosonography (HSSG) directly observing tubal flow as an estimation of tubal patency.

[Treatment of infertility in marriage using a method of transcervical gamete introduction into the fallopian tube under control of USG]. / Leczenie nieplodnosci malzenskiej metoda przezszyjkowego gamet do jajowodu pod kontrola USG.

GIFT under USG control (USGIFT) was performed in 18 females between may and december of 1992. The ovulation was stimulated by gonadotropin and Clomid. In result we obtained four pregnancies--three normal uterine pregnancies and one ectopic pregnancy. One of these pregnant women gave birth to a child in February 1993.