Endometriosis resembling endometrial cancer in a postmenopausal patient.

Endometriosis occurs in 2-4% of postmenopausal women. There have been a few reports of endometriosis in women in whom neither history nor diagnostic imaging indicated the presence of this disease, either at reproductive age or after menopause. A case is described of an 84-year-old patient with extensive deep pelvic endometriosis imitating advanced neoplastic process.

Pregnancy and delivery in women with esophageal varices due to hepatic vein thrombosis.

AIM: Retrospective analysis of the course of pregnancy, labor and mode of anesthesia in women with portal hypertension and esophageal varices induced by portal vein thrombosis. MATERIAL: From 2000 to 2012 seven pregnant were admitted. None had liver transplantation (Ltx), the varicose have been in the 1st stage. Each of them has been consulted by the obstetrician, transplant surgeon and anesthetist. The patient condition during pregnancy, labor and postpartum period was analyzed. RESULTS: Pregnancy in five cases proceeded physiologically. In one threatening miscarriage was diagnosed and treated with gestagens, two patients had tocolytic. One required variceal banding twice. In three thrombocytopenia worsened, with platelet count <70 g/L (up to 59 g/L). They received platelet transfusion before delivery. In one case, significant hipoproteinemia (4.7 g/L) occurred. In a case, GDM G1 and oligohydramnios were found. All women delivered at term (37-40 Hbd). In all general anesthesia with the use of remifentanil was done. There were no fluctuations in MAP and HR. Incision to delivery time was 2.5 min. Time from opioid administration to birth was <4 min. All children were born in good condition, weight 10-90 percentile. Regional anesthesia is contraindicated in patients with thrombocytopenia. In patients with esophageal varices sudden increase in heart rate and blood pressure can cause hemorrhage. CONCLUSION: Patients with portal hypertension can deliver at term. It is a high-risk pregnancy. In this group it is desirable to shorten the second stage of labor or complete it by c-section under general anesthesia with remifentanyl which allows getting desired analgesia without complications in the newborn. Surveillance of pregnant with portal hypertension must include monitoring of liver function and coagulation disorders.

[Analysis of the postnatal condition and mortality of neonates with extremely low birth weight]. / Analiza umieralnosci poporodowej, stanu pourodzeniowego oraz przyczyny zgonów noworodków z ekstremalnie niska urodzeniowa masa ciala.

OBJECTIVE: The aim of this study was to analyze the postnatal condition and mortality of neonates with extremely low birth weight. MATERIALS AND METHODS: The study group consisted of 35 neonates delivered in the 1st Dept of Ob/Gyn. Medical University of Warsaw in the period of 1996-2000. The group was divided into two classes depending on the birth weight. There were newborns weighted 500-750 g in the first class and 751-1000 g in the second one. Newborns condition in the 1st minute of life was assessed with Apgar score. The rate of mortality up to the 7th day of life as well as the causes of deaths was analyzed. CONCLUSIONS: Postnatal mortality rate of premature newborns extremely low birth weight is still very high, especially in case of newborns below 750 g. Respiratory distress syndrome and intracranial hemorrhage are the most common causes of demise of those newborns.

[Preterm deliveries of extremely low birth babies--analysis of the course of pregnancy, labour and neonatal outcome]. / Porody przedwczesne noworodków ze skrajnie niska masa urodzeniowa ciala--analiza przebiegu ciazy, porodu oraz stanu pourodzeniowego noworodka.

OBJECTIVE: Preterm delivery of baby with extremely low birth weight (ELBW) is an important problem in contemporary perinatology and a major reason of perinatal mortality. A great development of neonatal intensive care that has occurred over the last few years has resulted in the decrease of perinatal mortality rate. The aim of the study is to analyse the course of pregnancy, labour and neonatal outcome in the group of patients who delivered ELBW children. MATERIALS AND METHODS: In 1st Obstetric and Gynaecology Department Clinic of Medical University of Warsaw, 6982 deliveries were conducted from 1996 to 2000. Among them there were 589 preterm ones. As a result 44 women delivered ELBW children. These 44 deliveries were divided into three groups according to the reasons: Idiopathic preterm contractility-24 patients PROM with intrauterine infection or threatening infection-14 Induction of delivery because of lethal foetal defects and direct foetal distress-6. RESULTS: The most common reasons for deliveries of ELBW children were hypertension and ascending infections. CONCLUSIONS: A great number of mothers who delivered ELBW children had low socioeconomic status. In most cases pregnancy was unplanned and body mass index of the mothers was below 19. Almost all these newborns were severely depressed and delivery was often complicated. It is important to conduct labour in a careful way to avoid tissue injuries.

[Analysis of pregnancy and delivery ways in nulliparous women over 30 years old]. / Analiza przebiegu ciazy i sposobu ukonczenia porodu u pierworódek powyzej 30. roku zycia.

Courses of pregnancy and ways of delivery of 274 nulliparous women aged over 30, who delivered between 1992 and 1998 were analyzed. Control group consisted of 274 nulliparous women aged 22-27, who delivered in the same period. Among the women delivering over 30, premature labours, medical disorders during pregnancy and deliveries by cesarean sections were noticeable more frequent.

[Ways of delivery after cesarean section]. / Sposób ukonczenia ciazy i porodu po przebytym cieciu cesarskim.

OBJECTIVE: To analyse deliveries after a previous cesarean section. STUDY DESIGN: The way of birth of 262 patients between 1993-1995 in the Ist Department of Obstetrics and Gynaecology of Warsaw University Hospital was analysed. Material was divided into two groups: an elective cesarean section operation was performed on 117 women, while 145 women underwent a trial of labour. RESULTS: The most common indications for an elective cesarean section were fetal distress and maternal diseases. A trial of vaginal delivery was successful in 55.2%. The repeated operation was performed on 44.8% of women. The most frequent indication for a cesarean section during a trial of labour was failure to progress. CONCLUSIONS: Women after a previous cesarean section, who underwent a trial of labour delivered vaginally in 55.2%-30.5% of all the patients in the analysed material. The indications for the repeated operation were the same as for the first one in 27% of the cases.