Multiple multiparity is a negative prognostic factor for endometrial cancer in Poland.

BACKGROUND: Nulliparity is one of the most important reproductive risk factors for endometrial cancer. It is still discussed whether multiparity implies a more favorable course of the disease and higher overall survival rates. The aim of the study was to analyze the effect of parity on the overall survival of endometrial cancer patients in Poland. MATERIAL AND METHOD: A retrospective analysis of parity on survival rates was performed in 810 women treated surgically for endometrial cancer in a single referential center of gynecological oncology. RESULTS: Higher parity was shown to be associated with significantly lower survival rates (p=0.03). Parity turned out to be an independent prognostic factor of survival (HR 1.9). Multiple multiparous women were older at the time of surgery, more often presented with deep myometrial infiltration and with involvement of the cervical stroma and had higher clinical stages of the cancer (only according to FIGO 1988 classification). The group of multiple multiparous women was characterized by significantly lower recurrence rates. Multiple multiparous women significantly more often presented with lower educational level, more often were diagnosed with comorbidities and a history of other malignancies, while breast cancer and colon cancer were of lesser evidence in multiple multiparous endometrial cancer patients. CONCLUSION: Multiparity turns out to be an unfavorable prognostic factor of survival in Polish women. Unfavorable prognosis in endometrial cancer patients in this group is associated with interactions between risk factors and negative prognostic factors, i.e. the conditions of tumor growth, rather than with the nulliparity itself.

[DNA profiling as a method of zygosity determination in multiple pregnancy]. / Profilowanie DNA jako metoda okreslania zygotycznosci w ciazy wieloraczej.

The aim of the report was to present a method of zygosity determination in multiple pregnancy. The study wascarried out on same-sex neonates born as a result of spontaneous quadruplet pregnancy. Zygosity was determinedby DNA profiling. The pregnancy was confirmed to be polyzygotic. DNA profiling may be used as a method ofzygosity determination in multiple pregnancy.

Pregnancy and Delivery in Patients with Mastocytosis Treated at the Polish Center of the European Competence Network on Mastocytosis (ECNM).

OBJECTIVE: To present current guidelines regarding treatment of mastocytosis in pregnancy on the example of observed patients. DESIGN: Case control national study. SETTING: Polish Center of the European Competence Network on Mastocytosis (ECNM). POPULATION OR SAMPLE: 23 singleton spontaneous pregnancies in 17 women diagnosed with mastocytosis in years 1999-2014, before becoming pregnant. METHODS: Prospective analysis outcomes of pregnancies and deliveries. MAIN OUTCOME MEASURES: Survey developed in cooperation with the Spanish Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Red Espanola de Mastocitosis (REMA), Spain. RESULTS: All 23 pregnancies resulted from natural conception. Obstetrical complications recorded in the first trimester included spontaneous miscarriage (5 pregnancies). Four patients delivered preterm, including one delivery due to preeclampsia at 26 weeks which resulted with neonate death due to extreme prematurity. Five women delivered via cesarean: four due to obstetrical indications and one due to mastocytosis, during which no anesthesia related complications were recorded. Of patients delivering vaginally, two received extradural anesthesia, three required oxytocin infusion due to uterine hypotonia. No labor complications were recorded. In one woman with pregnancy-induced hypertension, early puerperium was complicated by the presence of persistent arterial hypertension. One neonate was born with the signs of cutaneous mastocytosis. Another neonate was diagnosed with Patau syndrome. Four women were treated for mastocytosis prior to conception and continued therapy after becoming pregnant. One patient was put on medications in the first trimester due to worsening of her symptoms. Pregnancy exerted only a slight effect on the intensity and frequency of mastocytosis-related symptoms observed. Worsening of the disease-related symptoms was documented in only four patients (23%). None of the patients showed the signs of anaphylaxis, either before becoming pregnant, or during pregnancy and puerperium. CONCLUSIONS: There is no contraindication to pregnancy when mastocystosis-related pathologies are under appropriate medical control.

[Analysis of pregnancy, labor and neonatal course in babies with prenatally-diagnosed complete atrioventricular heart block]. / Analiza przebiegu ciazy, porodu i losów noworodków z prenatalnie diagnozowanym calkowitym blokiem przedsionkowo--komorowym.

INTRODUCTION: Complete heart block (third-degree atrioventricular block) is a defect of the conduction system of the heart, in which the impulse generated in the sinoatrial node does not propagate to the ventricles, and thus the latter contract independently of the atria. A third-degree atrioventricular block can be either congenital or acquired. In 60-70% of the cases, the congenital heart block results from destruction of the conduction system of the fetal heart by anti-Ro/SSA and anti-La/SSB antibodies present in maternal serum. The antibodies are synthesized in the course of autoimmune maternal conditions, most often systemic lupus erythematosus or rarer rheumatoid arthritis, dermatomyositis or Sjögren's syndrome. The complete block can occur as an isolated defect or be associated with structural anomalies of the fetal heart. MATERIAL AND METHODS: A total of five patients whose fetuses were diagnosed with the third-degree atrioventricular block have been hospitalized at the Department of Obstetrics, Medical University of Gdansk between 2012 and 2014. RESULTS: We present the data of the five patients, hospitalized at the Department of Obstetrics, Medical University of Gdansk, whose fetuses were diagnosed prenatally with the complete heart block. The cases differ in terms of etiology clinical outcome, and postnatal treatment. All data are presented in Table I. CONCLUSIONS: We emphasize the role of appropriate pregnancy management and careful monitoring of the fetal condition. From obstetrical perspective, it is important to monitor the condition of fetuses with the third-degree atrioventricular block ultrasonographically and echocardiographically; in turn, cardiotocography is less useful in this setting. Therefore, a non-reactive cardiotocographic tracing should not constitute an indication for a preterm delivery. An affected fetus should be delivered in a tertiary center for perinatal care that cooperates with a pediatric cardiology center. An efficient program for cardologic prenatal care and close cooperation between obstetricians, neonatologists, pediatric cardiologists, and cardiac surgeons constitute the key to a successful outcome.

Influence of place of residence on indications for genetic amniocentesis in the Pomeranian region of Poland before and after introduction of the Prenatal Screening Program in 2008.

BACKGROUND: The aim of the study was to analyze differences in the indications for amniocentesis in patients living in urban and rural areas before and after introduction of the Prenatal Screening Program by Polish National Health Insurance agency in the Pomeranian region in 2008. MATERIAL AND METHODS: Indications for 2578 amniocenteses performed in the Department of Obstetrics of the Medical University of Gdansk between 1996 and 2010 were recorded. RESULTS: Advanced maternal age accounted for 69% of women in urban areas and 61% of women in rural areas being referred for amniocentesis (p<0.001). There was also a significant difference between locations in chromosomal abnormality in previous pregnancy, accounting for 4% of referrals for amniocentesis in urban areas compared with 7% of referrals in rural areas. In urban areas, advanced maternal age accounted for 73% of referrals between 1996-2007 compared with 60% of referrals for amniocentesis between 2008 and 2010 (p=0.004), and in rural areas it was 66% and 54%, respectively (p<0.001). Abnormal result of biochemical screening surprisingly accounted for 13% of referrals for amniocenteses between 1996-2007 in urban areas compared with 28% after 2008 (p<0.001). In rural areas this indication accounted for 12% referrals before 2008 and for 28% from 2008 onward (p<0.001). CONCLUSIONS: The results of the study suggest that in both urban and rural areas there was a significant decrease in advanced maternal age as a reason for referral for amniocentesis, but a significant increase in abnormal results of biochemical screening as an indication for amniocentesis after 2008.

Evolution of the indications for genetic amniocentesis after the introduction of the prenatal screening program by the national health insurance in Poland.

OBJECTIVE: In 2008, the Prenatal Screening Program was introduced by the National Health Insurance in the Pomeranian region of Poland. As of then, biochemical and ultrasound screening was offered to women eligible for amniocentesis according to the earlier policy. The aim of the study was to investigate the evolution of the indications for amniocentesis after the introduction of the Program. MATERIAL AND METHODS: In total, 2579 women referred for amniocentesis to the Department of Obstetrics, Medical University of Gdansk, were included in the study They were divided into two groups: 1705 women referred between 1996 and 2007 (group A) and 874 women referred between 2008 and 2010 (group B). Indications for amniocentesis were compared between the groups. RESULTS: A significant difference in the indications for amniocentesis was found between the groups (Kruskal-Wallis test; p < 0.001). Maternal age, fetal malformation in the previous pregnancy and anxiety were less frequent in group B (p < 0.0001, p = 0.0008 and p = 0.0156, respectively). In contrast, a higher frequency of positive biochemical screening and abnormal ultrasound results as indications for amniocentesis was found in group B (p < 0.0001 and p = 0.0008, respectively). CONCLUSIONS: The introduction of the Prenatal Screening Program by the National Health Insurance shifted the proportion of indications for amniocentesis from maternal age to positive results in biochemical and ultrasound screenings, and increased the number of invasive testing. Further observation of the trend and its influence on the detection rate is imperative to confirm that the proposed Program is adequate and does not require adjustments.

Prenatal diagnosis of an atrioventricular canal in a foetus with deletion of chromosome 8 (pter-->p21).

Congenital heart malformations, detected during a pregnancy, are associated in 20-48% of cases with a chromosomal aberration. In the following study we have reported the deletion of chromosome 8 (pter-->p21), diagnosed prenatally at 22 weeks of gestation, because of a visible defect in the upper part of the interventricular septum and a partial defect of the atrial septum. The atria and the ventricles were joined with a common central valve. The cordocentesis was performed and karyotype: 46, XX ish del(8)(wcp8x2) was detected. Because of the persistent bradycardia of the foetus, indicating a danger of intrauterine asphyxia of the foetus, as well as features of premature placental detachment, the caesarean section was performed at 27 weeks of gestation. The patient gave birth to a daughter weighing 960 g. The child died in the 4th hour of her life. On the basis of the present observation it is safe to say that when an AV-canal defect is diagnosed prenatally, special attention must be paid to the detection of chromosomal abnormalities and amniocentesis or cordocentesis should be performed to assess the state of affairs.

[The course of pregnancy and delivery in women after genetic amniocentesis before and after 35 years of age]. / Analiza przebiegu ciazy i porodu po amniopunkcji genetycznej w grupie ciezarnych przed i po 35 roku zycia.

OBJECTIVES: The demand for genetic amniocentesis in case of young pregnant women has significantly increased due to various new indications. Moreover, nowadays a growing number of women aged > or =35, who required genetic amniocentesis, get pregnant The aim of the following study has been to compare the course of the pregnancy, the delivery and the condition of the newborn in two groups of patients: 18-34 years old and > or =35 years old. MATERIAL AND METHODS: 783 women underwent the procedure of amniocentesis at the Department of Obstetrics of Medical University of Gdansk in 1996-2003. A group of 540 women, who answered the questionnaire about the course of the pregnancy and the delivery after the procedure, has been isolated. RESULTS: Fetal loss occurred in 2 cases (1.6%) in the group of the younger women and in 8 cases (0.8%) in the group of > or =35 year-olds (p=0.84). There was no statistically significant difference between younger and older patients when comparing complications after the procedure in the first three weeks following amniocentesis: spotting, bleeding, leakage of amniotic fluid. Frequency of late complications such as gestational diabetes mellitus, pregnancy induced hypertension and urinary tract infections were comparable in both age groups women. Cesarean section has been more frequently performed in case of the older women than in the group of younger patients, with statistical difference p=0.003. In most cases (33.9%) it has been an elective cesarean section, performed due to advanced maternal age rather than any obstetric cause. Frequency of pneumonia and the number of respiratory infections in the newborns have been comparable in both groups. CONCLUSIONS: Prenatal invasive diagnosis has no influence on frequency of complications during pregnancy and delivery in the group of women less than 35 years old and more than 35 years old.

[Early or late amniocentesis--which method is safer?]. / Amniopunkcja wczesna czy pózna--która metoda jest bardziej bezpieczna?

OBJECTIVES: Whether or not to perform early or late amniocentesis remains questionable due to higher fetal loss and the rate of talipes equinovarus after early amniocentesis. MATERIAL AND METHODS: We have compared the course of pregnancy, delivery and the condition of the newborns in patients after early and late amniocentesis in the group of women who had undergone amniocentesis in the Department of Obstetrics of Medical University of Gdansk between the years 1996-2003. RESULTS: Early amniocentesis was performed in 302 patients (55.9%), late amniocentesis in 302 patients (44.1%). Fetal loss occurred in 8 pregnancies (2.6%) after early amniocentesis and in 2 cases (0.8%) after late amniocentesis (P = 0.10). There was no statistically significant difference between early and late amniocentesis, comparing complications following the procedure in the first 3 weeks after amniocentesis: lower abdominal pain, spotting, bleeding, leakage of amniotic fluid. Mean duration of pregnancy in patients after early amniocentesis was 38.5 +/- 3.9 and 38.4 +/- 3.3 weeks in late amniocentesis group. There was no statistically significant difference between these groups in the type of delivery and premature delivery rate. Frequency of pneumonia and the respiratory infections in newborns were comparable in two groups (6.8% vs. 4.8%). There was only one case of talipes equnovarus in a fetus after late amniocentesis and one case of congenital dysplasia of the hip in a fetus after late amniocentesis, too. There were not any such defects in a group after early amniocentesis. CONCLUSIONS: The type of amniocentesis--early or late--has not got any influence on the frequency of complicattions after amniocentesis.

[The course of pregnancy and delivery and the state of the newborns after genetic amniocentesis]. / Przebieg ciaz i porodów oraz ocena stanu zdrowia noworodków po amniopunkcji genetycznej.

OBJECTIVES: The risk of fetal loss after amniocentesis is 0.2-1%. The aim of the study was to compare the course of pregnancy and delivery and the state of the newborn in patients after genetic amniocentesis and in the control group. MATERIAL AND METHODS: 783 patients who underwent amniocentesis at the Department of Obstetrics of Medical University of Gdansk in 1996-2003 and 221 women who did not undergo amniocentesis. RESULTS: Fetal loss occurred in 8 pregnancies (3.8%) after amniocentesis and in 12 (5.4%) p=0.37 in the control group. There was no significant statistical difference between the amniocentesis group and the control group comparing complications during pregnancy such as gestational diabetes mellitus, pregnancy induced hypertension, urinary tract infections. Cesarean section was more often performed in the amniocentesis group than in the control group, statistical difference p=0.003. Most often (28.09%) there was an elective cesarean section because of advanced maternal age without any obstetrician cause. The frequency of pneumonia, respiratory infections and congenital malformations in the first weeks of life was more frequent in the amniocetesis group. CONCLUSIONS: Invasive prenatal diagnosis has no influence of the frequency of complications during pregnancy and delivery.

[The use of pelvic packing for intraoperative hemorrhage during pelvic exenteration--case reports]. / Zastosowanie materialu opatrunkowego w celu opanowania krwawienia sródoperacyjnego w trakcie zabiegu wytrzewienia miedniczego--opis przypadków.

This is a report of two cases of haemorrhage after pelvic exenteration in patients with vulvar cancer and cervical cancer treated by temporary pelvic packing at the Department of Gynaecology of the Medical University in Gdansk. The packing was successful and the sponges were removed after 24 and 48 hours. There were no major postoperative complications in both cases and one wound dehiscence. Both patients recovered after surgery. In cases with severe intraoperative haemorrhage, intraabdominal packing can be effective mode of treatment, especially in bleeding which originates from the sacral venous plexus.

Major complications following exenteration in cases of pelvic malignancy: a 10-year experience.

AIM: To analyze the major complications after exenteration of gynecological and rectal malignancies. METHODS: Twenty-two patients with gynecological malignancy and 6 with rectal malignancy underwent pelvic exenteration (PE) between 1996 and 2005. PE was performed for primary malignancy in 71.4% of cases (vulvar cancer in 13, cancer rectal in 5, cervical cancer in 1 and Bartholin's gland cancer in 1 cases respectively and recurrent malignancy in 28.6% of cases (cervical cancer in 5, ovarian cancer in 1, uterine sarcoma in 1 and rectal cancer in 1 cases respectively). Posterior PE, total PE and anterior PE were most often performed. RESULTS: Major complications in the operative field involving the urinary tract infection or the wound dehiscence occurred in 12 patients (42.9%). Early complications included massive bleeding from the sacral plexus, adult respiratory distress syndrome (ARDS), thrombophlebitis, acute renal failure, urinary bladder dysfunction, ureter damage, re-operation and pulmonary embolus. Urinary incontinence was observed in 2 women as a late complication. In 1 patient a nephrostomy was performed in 1 patient due to extensive hydronephrosis and 1 patient had complications connected with the gastrointestinal tract. The mortality rate was 7%, of which inter-operative mortality accounted for 3.5%. Major complications often occurred in advanced primary vulvar cancer affecting those with recurrent malignancies. CONCLUSION: PE is more beneficial to patients with primary vulvar and rectal cancer than to those with recurrent cancer. Knowledge of the inherent complications and morbidity of PE is essential.

[The case of spleen's tumor and trombocytopenia in pregnant women]. / Przypadek krwiaka sledziony i maloplytkowosci u ciezarnej--opis przypadku.

The women with spleen's tumor and trombocytopenia was diagnosed and observed during pregnancy, labour and puerperium. The lowest level of thrombocytes (50 K/microl) was detected in 32nd week of pregnancy. Termination of the pregnancy by cesarean section was performed because of a big risk for the mother and child (tumor's crack, haemorrhage, infection). The same time the splenectomy was conducted. The results were successful.

[Twin pregnancy with single fetal death due to triploidy--a case report]. / Ciaza blizniacza z obumarlym wewnatrzmacicznie plodem z triploidia.

The incidence of multiple pregnancies is associated with the increased risk in maternal and fetal complications. Intrauterine death of one twin in the second trimester is a rare obstetric complication. Authors report a case of a twin pregnancy with triploidy of one fetus and no chromosomal anomaly of the other twin in a dichorionic diamniotic twin pregnancy. Amniocentesis at 16th weeks disclosed triploidy of this fetus who died afterwards at 20th week of gestation. The pregnancy was continued with special care of the mother and the alive fetus. The second twin was successfully delivered by cesarean section in the 41st week of pregnancy due to the intrauterine fetal distress.

[The role of pelvic exenteration for the treatment of vulvar cancer]. / Wytrzewienie miednicy mniejszej w leczeniu zaawansowanego raka sromu.

OBJECTIVES: The pelvic exenteration is a method of treatment in cases of recurrence or locally advanced gynecological tumors without distance metastases. The total pelvic exenteration has been used as salvage therapy especially for advanced gynecological malignancy. DESIGN: The aim of study was to analyse the group of women who underwent pelvic exenteration. MATERIAL AND METHODS: A series of 13 patients who underwent pelvic exenteration for advanced vulvar cancer at the Department of Gynecology, Medical University of Gdansk Poland between 1996-2003 was retrospectively reviewed. RESULTS: The more often performed exenteration in patients with vulvar cancer was posterior pelvic exenteration in 11 cases, total pelvic exenteration in 2 cases. The mean age at diagnosis was 56 years. The estimated blood transfusion due to operation ranged from 300 ml to 3580 ml with a mean of 1200 ml. The operating time ranged from 4 hours to 7 hours 30 minutes with a mean of 6 hours and 5 minutes. Patients stayed in hospital from 14 to 54 days after operation with a mean 33 days. The overall complication rate after pelvic exenteration was 61.5% with 8 of the 13 patients. Three times it was infection, six times wound dehiscence, in 1 case it was: ARDS, thrombophlebitis, ureter damage. There was no late complication. CONCLUSION: Pelvic exenteration offers the last chance for some women with gynecological malignancy.

[Maternal cardiac arrhythmias in pregnancy]. / Analiza przebiegu ciazy i porodu u pacjentek z zaburzeniami rytmu serca.

OBJECTIVES: Perinatal care of women with cardiac arrhythmias is very important for every obstetrician. Maternal heart disease complicates 0.2 to 4% of pregnancies. DESIGN: The purpose of this study was to analyze the course of pregnancy, delivery and postpartum period pregnant women with cardiac arrhythmias MATERIALS AND METHODS: We analyzed 14 pregnant women with cardiac arrhythmias. hospitalized in the Department of Obstetrics of Medical University of Gdansk, 1998-2003. Time of delivery, weight and length of neonates in patients with cardiac arrhythmias was presented. RESULTS: Delivery and postpartum period were uncomplicated in all the patients and no stimulation was used. In two women with congenital complete atrio-ventricular block dicavital heart stimulator was applied. All patients and infants were discharged from hospital in good condition. CONCLUSION: We found no cardiological complications during pregnancy in patients with cardiac arrhythmias.

Correlation between indication for amniocentesis and the time of its performing.

OBJECTIVES: Prenatal diagnosis of fetal disorders is a very wide range of noninvasive and invasive methods. We use ultrasound examination and biochemical tests as screening tools in the low risk pregnancies. In a high risk pregnancy we perform invasive procedures to obtain definitive diagnosis. Amniocentesis is carried out in the first or in the early second trimester of pregnancy to determine: fetal karyotype, monogenic disorders, metabolic errors, the level of alpha-fetoprotein and acetylocholinesterase. DESIGN: The aim of our study was to determine the impact of the indication to amniocentesis on the time of performing the procedure. MATERIALS AND METHODS: We have analysed all the 721 amniocenteses carried out in the Department of Obstetrics in Gdansk in 1996-2002. Amniocenteses were performed due to: advanced maternal age in 553 cases, fetal malformation in current pregnancy in 39 cases, inherited disease in previous pregnancies in 80 cases, maternal balanced translocation in 6 cases, psychological reasons in 15 cases, inherited diseases in the family in 8 cases and serious obstetric history in 9 cases, abnormal results of triple test in 11 cases. The T-Student test was used for statistical analysis with the significance level p=0.05. RESULTS: The amniocentesis was performed in the 15th (from the 12th to the 26th) week of gestation. Amniocentesis performed because of: advanced maternal age in the 15th (from the 12th to the 25th); foetal malformation in current pregnancy in the 16th (from the 12th to the 26th); inherited disease in previous pregnancies in the 14th (from the 12th to the 18th); maternal balanced translocation in the 13th (from the 13th to the 14th); psychological reasons in the 15th (from the 13th to the 18th); inherited diseases in the family in the 15th (from the 13th to the 22nd); serious obstetric history in the 16th (from the 15th to the 17th); abnormal results of triple test in the 16th (from the 14th to the 19th). There is a statistical difference between time of performing amniocentesis because of advanced maternal age, fetal malformation in current pregnancy, maternal balanced translocation and other indications. CONCLUSION: In pregnancies with serious obstetric history--balanced translocation, inherited disease in previous pregnancies--women decided to perform amniocentesis earlier than in cases when advanced maternal age was the only indication for this procedure.

[The risk of complications of diagnostic and therapeutic cordocentesis]. / Ryzyko wystapienia powiklan po kordocentezie diagnostycznej lub terapeutycznej.

OBJECTIVES: Cordocentesis is one of the wide range of invasive diagnostic and therapeutic procedures used during pregnancy. Most common indications for is are suspicion of chromosomal abnormalities, Rh-immunisation or assessment of fetal renal function. Authors report the frequency of complications of this procedure as high as 1.5-5% with pregnancy loss rate up to 3%. DESIGN: The aim of our study was to determine the frequency of complications after cordocentesis. MATERIAL AND METHODS: We analyzed 145 pregnancies, during which 199 cordocentesis were performed. 124 of them were qualified as diagnostic with obtaining fetal blood (during 4 of them furosemidum was administered to the fetus), 22 diagnostic with furosemidum administration only and 53 therapeutic with blood transfusion (52) or pentaglobin administration (1). RESULTS: Complications of the cordocentesis were diagnosed in three cases--it was 1.5% of all of the procedures. Fetal bradycardia was reported in our material--in two cases it was isolated complication, in one case it appeared with retroplacental haematoma. In all three cases cesarean section was performed and alive babies were born. Data about the end of the pregnancy were obtained from 69 patients (47.5%). CONCLUSIONS: Cordocentesis in many case allows to establish proper diagnosis, make up decisions about treatment or termination of pregnancy and introduce management according to the needs and decisions of the patient. Complications are not very frequent and only in 1.5% were the reason of immediate caesarean section. Cordocentesis is safe and very useful tool of diagnosis in management of high risk pregnancies.