Pre-eclampsia affects the immunophenotype of neonates.

OBJECTIVE: We tried to estimate whether immunological changes are present in neonates born to mothers who had been suffering from pre-eclampsia. STUDY DESIGN: Eighteen neonates born to mothers with severe pre-eclampsia (between 35 and 40 weeks of gestation) and 20 full-term healthy newborns (between 38 and 40 weeks of gestation) were included in the study. The lymphocytes were isolated from umbilical cord blood. The specific lymphocyte antigens were determined using direct staining with monoclonal antibodies and analysed by flow-cytometry. RESULTS: We observed that neonates born to pre-eclamptic mothers had decreased percentage of T CD 3(+), CD 4(+) and T CD 8(+)28(+) (cytotoxic) lymphocytes and increased percentage CD 3(-)16/56(+) cells and CD 8(+)28(-) (suppressor) lymphocytes in comparison with newborns of healthy women. Furthermore, we found decreased CD 4: CD 8 lymphocyte ratio in the study group in comparison with the control group. We also observed that the percentage of CD 19(+)5(+), CD 4(+)8(+), CD 19(+)40(+) and CD 3(+)40L(+) lymphocytes did not differ in both studied groups. The percentage of CD 4(+)45RO(+), CD 8(+)45RO(+) memory cells was higher in neonates born to pre-eclamptic mothers when compared to controls. Moreover, the expression of CD 25 molecule was higher on T CD 8(+) and B CD 19(+) lymphocytes of neonates of pre-eclamptic mothers. CONCLUSION: The alterations in the immunological parameters of neonates born to pre-eclamptic mothers can be associated with the maternal disease.

CD1c(+) immature myeloid dendritic cells are predominant in cord blood of healthy neonates.

It has been suggested lately that some types of antigen presenting cells-myeloid dendritic (DC-1) cells can differentiate the immune response towards Th1 type immunity, whereas lymphoid cells (DC-2) can stimulate Th2 type immunity. It has been observed that neonates are deficient in Th1 response. The purpose of our study was to estimate the proportions of immature myeloid (CD1c(+)) and lymphoid (BDCA-2(+), BDCA-4(+)) dendritic cells and the CD1c(+):BDCA-2(+) cell ratio in cord blood of healthy neonates in comparison with dendritic cells of healthy adults. Thirty healthy neonates born from normal pregnancies and 30 healthy adults were included in the study. The dendritic cells were isolated from cord and peripheral blood, stained with anti-CD1c, anti-BDCA-2, anti-BDCA-4, anti-CD123 and anti-CD19 monoclonal antibodies and estimated using flow cytometry. The percentage of CD1c(+) dendritic cells in cord blood of healthy newborns did not differ significantly when compared to those in peripheral blood of healthy adults. The percentages of cord blood BDCA-2(+) and BDCA-4(+) dendritic cells of neonates were significantly lower when compared to lymphoid dendritic cells in peripheral blood of adults. The CD1c(+):BDCA-2(+) ratio was significantly higher in cord blood of neonates in comparison with CD1c(+):BDCA-2(+) ratio in adult's blood. Myeloid and lymphoid dendritic cells may be involved in the immune regulation during fetal development. Immature myeloid dendritic cells are predominant in cord blood of healthy neonates. Immature lymphoid dendritic cells are not the major population of dendritic cells in cord blood.

The expression and concentrations of Fas/APO-1 (CD95) antigen in patients with severe pre-eclampsia.

PROBLEM: Apoptosis has been proposed as a mechanism for maintaining homeostasis in the immune system. Activated lymphocytes are removed by a Fas/FasL-mediated programmed cell death process called activation induced cell death (AICD). The aim of the study was to investigate surface Fas antigen (APO-1, CD95) expression on T lymphocytes and NK cells and also soluble Fas antigen concentrations in pre-eclamptic patients and healthy pregnant women. MATERIALS AND METHODS: Sixteen pre-eclamptic patients and 18 healthy pregnant women were studied. Peripheral blood lymphocytes were isolated, labeled by direct staining with anti-CD95 monoclonal antibodies and analyzed using the flow cytometric method. Furthermore, the concentrations of soluble CD95 molecule in serum of patients with severe pre-eclampsia and women with uncomplicated pregnancy were measured using ELISA method. RESULTS: We found that Fas antigen expression and fluorescence intensity on T CD8+ lymphocytes were higher in patients with severe pre-eclampsia in comparison with healthy pregnant women (P<0.05). Furthermore, the concentrations of soluble CD95 molecule were higher in the group of pre-eclamptic patients when compared to controls (P<0.001). CONCLUSIONS: These findings suggest that T CD8+ lymphocytes in patients with severe pre-eclampsia can be activated. Moreover, higher concentrations of soluble CD95 antigen can suggest altered possibilities to undergo Fas/FasL-mediated activation induced cell death process of lymphocytes in severe pre-eclampsia.

Blood myeloid and lymphoid dendritic cells are stable during the menstrual cycle but deficient during mid-gestation.

The aim of this study was to estimate the populations of peripheral blood myeloid and lymphoid dendritic cells (CD1c(+), BDCA-2(+), BDCA-4(+)) and the CD1c(+):BDCA-2(+) ratio in phases of the ovarian cycle and in normal pregnant patients. 18 non-pregnant women and 17 normal pregnant women were included. Dendritic cells were isolated from peripheral blood, stained with monoclonal antibodies (mAbs) against blood dendritic cell antigens (anti-BDCA-1, BDCA-2, BDCA-4) and estimated using flow cytometry. CD1c(+), BDCA-2(+) and BDCA-4(+) dendritic cells were present in the follicular and luteal phases of the ovarian cycle and in all trimesters of normal pregnancy. The percentages of CD1c(+) dendritic cells did not differ between the follicular and luteal phases of the ovarian cycle. The percentage of BDCA-2(+) dendritic cells was lower in the luteal phase of the ovarian cycle compared with the follicular phase, but the differences were not statistically significant. The CD1c(+):BDCA-2(+) cell ratio was significantly lower in the luteal phase compared with the follicular phase of the ovarian cycle. The numbers of dendritic cells were significantly lower in the second trimester when compared with the first and third trimesters of normal pregnancy. Furthermore, in the second trimester, the CD1c(+):BDCA-2(+) ratio was higher than in the other trimesters of normal pregnancy. All populations of dendritic cells and the CD1c(+):BDCA-2(+) ratio did not differ in the first and third trimesters of physiological pregnancy. Our results suggest that myeloid and lymphoid dendritic cells are not affected by steroid hormones during the menstrual cycle. The deficiency of peripheral blood dendritic cells observed during the second trimester of normal pregnancy can be associated with their migration to the uterus during the second physiological invasion by cytotrophoblast.

T helper 1- and T helper 2-type cytokine imbalance in pregnant women with pre-eclampsia.

OBJECTIVES: The purpose of our study was to investigate T helper 1/T helper 2 balance in pregnant women with pre-eclampsia. STUDY DESIGN: 18 patients with pre-eclampsia and 20 healthy pregnant women were included in the study. Peripheral blood mononuclear cells (PBMC) were stimulated with phytohaemagglutinin (PHA) for 48 h. Cytokine: interleukin-2 (11-2), interferon-gamma (IFN-gamma) and interleukin-10 (I1-10) concentrations in culture supernatants were determined using the ELISA method. Statistical analysis was performed using a standard non-parametric Mann-Whitney U-test. RESULTS: We found that in pre-eclamptic patients PHA-stimulated 11-2 and IFN-y production was significantly higher (P<0.001) and I1-10 production significantly lower (P<0.005) in comparison with the control group. CONCLUSION: These results could suggest that there is Th1/Th2 imbalance in pre-eclamptic patients with predominant Th1-type immunity.

The concentrations of osteocalcin and degradation products of type I collagen in pregnant women with pre-eclampsia.

OBJECTIVES: To investigate the concentrations of osteocalcin and collagen type I C-terminal telopeptides in pregnant women with pre-eclampsia. STUDY DESIGN: 26 patients with severe pre-eclampsia and 24 healthy pregnant women were included in the study. Serum concentrations of osteocalcin and C-telopeptides--degradation products of type I collagen were determined using the ELISA method. Statistical analysis was performed using Mann-Whitney U-test. RESULTS: In pre-eclamptic patients, the concentrations of osteocalcin and degradation products of collagen type I were significantly higher (P<0.005) when compared to healthy pregnant women. CONCLUSION: These results could suggest that there are alterations in bone metabolism in pregnant women with pre-eclampsia.

Evaluation of placental angiotensin type 1 receptors in women with hypertension during pregnancy.

OBJECTIVE: The aim of this study was to examine and compare the localization and immunoreactivity of the angiotensin type-1 receptor (AT1R) in human placental tissue in patients with pregnancy complicated by pre-eclampsia with and without intrauterine growth restriction (IUGR). METHODS: Immunohistochemistry was used to examine the localization of the AT1R in human placental tissue. Semiquantitative immunohistochemical H-score values for each placental cell type were calculated. RESULTS: Elevated H-score index values for decidual cells, syncytiotrophoblast and cytotrophoblast in pre-eclamptic patients were found to be higher in comparison with values in the control group. Decreased H-score index values for syncytiotrophoblast and cytotrophoblast were found in patients with pregnancy complicated by IUGR in the course of pre-eclampsia. CONCLUSIONS: The results obtained in this study point out the significant role of the AT1R and suggest that normal AT1R activity is of fundamental significance for the normal course of pregnancy and proper fetal growth.

Intrapartum cardiotocography and fetal pulse oximetry in assessing fetal hypoxia.

OBJECTIVES: A retrospective analysis of short-term variability (STV), a cardiotocography (CTG) parameter, in relation to fetal blood saturation values (FSpO(2)) obtained by fetal pulse oximetry. METHODS: The study included 26 healthy pregnant women monitored continuously during delivery with both cardiotocography and fetal pulse oximetry. RESULTS: Lower FSpO(2) values were observed in the group showing STV levels 6.0 ms (34.4+/-2.9% vs. 43+/-7.2%; P<0.001). A positive correlation was found between STV levels

Nitric oxide for treatment of threatened preterm labor.

OBJECTIVE: The aim of our study was the assessment of effectiveness of nitroglycerin as a donor of nitric oxide, administered in the form of transdermal therapeutic system, applied in the treatment of threatening preterm labor. PATIENTS AND METHODS: The study was carried out on 30 pregnant patients with the symptoms of threatening preterm labor between 27th and 34th week of gestation. The patients were given nitroglycerin in the form of transdermal system releasing 5 mg of nitroglycerin in 24 h. RESULTS: In our study the decrease in contractility and relaxation of uterus was observed in all obstetric patients. No changes in the fetal pulse rate and cardiotocographic tracing in the course of treatment and after completing treatment were observed. CONCLUSION: Nitroglycerin in the form of transdermal therapeutic system releasing nitric oxide may be an effective and safe tocolytic drug, however, further investigation needs to be performed.

[Immunological aspects of preeclampsia]. / Immunologiczne aspekty nadcisnienia w ciazy.

Pre-eclampsia is a common obstetric syndrome affecting about 7-10% of pregnant women. Symptoms of this syndrome: hypertension and impaired renal function appear during the second or third trimester of pregnancy. Despite intensive efforts to find mechanisms and markers induced pre-eclampsia, no specific etiological factor has been identified until now. It is known that pre-eclampsia is a placental disorder developing in two stages. The first lies in the poor placentation with acute atheroma. It seems that abnormal cell adhesion molecule (integrin) expression can contribute to inappropriate invasion of trophoblasts. Furthermore, T helper 1 type cytokines which are present in decidua of patients with pre-eclampsia can alter the trophoblast invasion. Lower expression level of HLA-G molecule in pre-eclamptic placenta can influence on the profile of cytokines which are produced in pre-eclampsia. The second stage of the disease development comprises the consequences of placental ischemia. It has been suggested that TNF-alpha is produced by ischemic placenta and causes endothelial activation. It seems that some types of pre-eclampsia can be autoimmune origin, with the autoantibodies directed against phospholipids, laminin and endothelium. The events leading to pre-eclampsia are not known, but it seems that abnormal activation of the immune system may play a role in the etiology of this disorder.

[Pregnancy after four recurrent pregnancy losses: a case report]. / Ciaza po czterech poronieniach nawykowych w przebiegu astmy oskrzelowej--opis przypadku.

The patient M.S, 24 years old has been admitted to the Department of Obstetrics and Perinatology of University School of Medicine in Lublin with diagnosis: V pregnancy, bronchial asthma. History taken from the patient revealed four recurrent pregnancy losses. The patient has taken prednisone in the dose 10 mg per day for several weeks. After performing immunological phenotyping of lymphocytes we have found some alterations in the patient's immune status: increased T CD4:TCD8 ratio, increased percentage of B CD19+ and B CD19+5+ lymphocytes, increased percentage of Natural Killer cells CD3(-)16/56+, deficiency of T CD8+ suppressor lymphocytes and increased expression of CD25 and HLA-DR antigens on T CD4+ lymphocytes. According to the obtained results we have increased prednisone dose to 20 mg per day. After forty days of prednisone therapy in the dose mentioned above patient's immunological status has evolution favorably: T CD4:TCD8 ratio decreased, percentage of B CD19+ and B CD19+5+ lymphocytes decreased, percentage of Natural Killer cells CD3(-)16/56+ decreased, the expression of CD25 and HLA-DR antigens on T CD4+ lymphocytes decreased. Due to the PROM (premature rupture of membranes), and obstetric anamnesis the patient was qualified for caesarean section (21st of September 1998). Male baby was born in good general condition (weight 1180 g, Apgar score 8 pts.). The baby was discharged from Prematurity Department 10th of November 1998 in good general status (weight 2180 g). The child was observed for one year after being discharged from the ward, psycho-physical development is normal.

[Maternal serum cytokine levels in pregnancies complicated by PROM]. / Stezenia wybranych cytokin w surowicy ciezarnych z przedwczesnym peknieciem pecherza plodowego.

OBJECTIVE: The aim of the study was to evaluate the maternal serum cytokines levels in pregnancies complicated by premature rupture of membranes (PROM). MATERIALS AND METHODS: Maternal serum of IL-1 beta, IL-4, IL-6, IL-8 and TNF-alfa levels were assessed in patients with PROM between 24-34 weeks of pregnancy (n = 45). Control group consisted of healthy pregnant women (n = 41) at 24-34 weeks of gestation. Serum cytokines concentrations were measured by commercial available enzyme-linked immunosorbent assays. C-reactive protein level and WBC were estimated in both groups. RESULTS: Compared to healthy pregnant, the group of patients with PROM had significantly higher serum levels of IL-1 beta (0.76 pg/ml vs 0.41 pg/ml, p = 0.022), TNF-alfa (1332.46 pg/ml vs 58.01 pg/ml, p < 0.00001) and IL-8 (15.79 pg/ml vs 0 pg/ml, p < 0.00001). CRP concentration and WBC were also significantly higher in serum of pregnant women with PROM then in healthy ones (CRP: 10 mg/l vs 0 mg/l, p = 0.043; WBC: 13,188 +/- 3625/mm3 vs 9132 +/- 1913/mm3, p < 0.00001). No significant differences in IL-6 and IL-4 levels were found between groups. CONCLUSION: Differences in serum maternal levels of cytokines between patients with premature ruptures of membranes and healthy pregnant women suggest that reasons and/or consequences of PROM results in changes in immunological system.

[The relationship of maternal serum levels of Il-6 and TNF-alpha with fertility and parity of women with pregnancies complicated by PROM]. / Zwiazek stezenia IL-6 i TNF-alfa z liczba ciaz i porodów u pacjentek z przedwczesnym peknieciem pecherza plodowego.

OBJECTIVE: The aim of the study was to assess the relationship of maternal serum IL-6 and TNF-alfa levels with fertility and parity of women with pregnancies complicated by premature rupture of membranes (PROM). MATERIALS AND METHODS: The maternal serum of IL-6 and TNF-alfa levels were evaluated in patients with PROM between 24-34 weeks of pregnancy (the study group, n = 45). The control group consisted of healthy pregnancy (n = 41) at 24-34 weeks of gestation. Serum cytokines concentrations were measured by commercial available enzyme-linked immunosorbent assays. C-reactive protein level and WBC were estimated in both groups. RESULTS: The positive correlation between maternal serum TNF-alfa and fertility (R = 0.322, p = 0.042), and parity (R = 0.339, p = 0.032) in patients in the study group was found. No relationship of evaluated cytokines, CRP, WBC with fertility and parity was found in healthy pregnancy women. Compared to primigravidas, multiparas with PROM had significantly higher serum levels of TNF-alfa (1571.41 pg/ml vs 854.54 pg/ml, p = 0.014); serum IL-6 levels was significantly higher in patients with fourth delivery or more compared to patients with third delivery and less (32.32 pg/ml vs 5.52, p = 0.039). CRP concentration and WBC were comparable in those groups. CONCLUSION: 1. Women with at least one pregnancy in the past are at higher risk of premature rupture of membranes in following pregnancies. 2. Every suspicion of intrauterine infection or presence of potential risk factors such as bacterial vaginosis, cervicitis, kolpitis or urinary tract infection should be carefully evaluated in this group of patients.

[The relationship between the levels of proinflammatory cytokines, and AFI value in pregnancies complicated by premature rupture of membranes]. / Zwiazek stezenia cytokin prozapalnych we krwi ciezarnych z przedwczesnym peknieciem pecherza plodowego z indeksem plynu owodniowego.

OBJECTIVE: The aim of the study was to test the relationship between maternal serum proinflammatory cytokines level and AFI (amniotic fluid index) in pregnancies complicated by premature rupture of membranes (PROM). MATERIALS AND METHODS: The maternal serum levels of IL-6, IL-1 beta and TNF-alfa were assessed in patients with PROM between 24-34 weeks of gestation (n = 45) by means of commercially available ELISA assays. The patients were divided in two groups according to AFI values: < 50 (n = 25) mm and < or = 50 mm (n = 20). Cytokine concentrations were compared between groups. RESULTS: The median concentrations of proinflammatory cytokines in maternal serum were: IL-6--5.74 pg/ml (range 3.24-3111 pg/ml), IL-1 beta--0.76 pg/ml (range 0.001-3.16 pg/ml), TNF-alfa--1332.46 pg/ml (range 2.13-1969.68 pg/ml). Compared to patients with AFI values > or = 50 mm, the group of patients with AFI < 50 mm had significantly higher concentration of IL-6 (6.61 pg/ml vs. 4.66 pg/ml; p = 0.002). No significant differences in IL-1 beta and TNF-alfa levels have been found between groups. The significant correlation have been observed between maternal serum level of IL-6 and AFI values (R = -0.47, p = 0.003), but not of IL-1 beta and TNF-alfa. CONCLUSION: The assessment of AFI values in pregnancies complicated by premature rupture of membranes seems to be the valuable method of early diagnosis in cases of intrauterine infection.

[Evaluation of the platelet angiotensin receptor in pregnancy complicated by preeclampsia]. / Ocena receptorów angiotensynowych na plytkach krwi u kobiet z ciaza powiklana stanem przedrzucawkowym.

UNLABELLED: Preeclampsia is a major complication during human pregnancy. It results from a breakdown in the balance between the vasoconstrictor and vasodilator substances. Angiotensin II is a potent vasoconstrictor, which participates in the regulation of blood pressure and may be involved in the control of vascular tone. OBJECTIVE: The purpose of this study was to determine the platelet angiotensin II receptor number and angiotensin II level in pregnancies complicated by preeclampsia. Preeclampsia was defined according to American College of Obstetricians and Gynecologists (ACOG) classification. PATIENTS AND METHODS: Ligand binding techniques were used for the examination of platelet angiotensin II binding sites in the third trimester pregnant women. The study was carried out in 13 patients with singleton pregnancy complicated by preeclampsia. A control group consisted of 17 healthy normotensive patients with singleton uncomplicated pregnancy and normal laboratory tests. All studied patients were nonsmokers. RESULTS AND CONCLUSIONS: There were no statistically significant differences in patient profiles between groups including gravidity, parity, maternal age, gestational age and height. Maternal weight, BMI and systolic, diastolic blood pressure and mean arterial blood pressure (MAP) were higher in the study group in comparison with the control group. Our study revealed elevated platelet angiotensin II receptor number and decreased maternal angiotensin II level in singleton pregnancies complicated by preeclampsia. There were no correlations between platelet angiotensin II receptor number and plasma angiotensin II level in the studied subjects. Our results are in accord with other published data and point out to the significant role of renin-angiotensin-aldosterone system and angiotensin II receptors in the pathogenesis of preeclampsia.

[The influence of infertility treatment and assisted reproduction techniques on multiple pregnancy rates]. / Wplyw leczenia nieplodnosci i technik wspomaganego rozrodu na czestosc wystepowania ciaz wieloplodowych.

It has to be remembered that pregnancies resulting from assisted reproductive technologies are more complicated that spontaneous pregnancies. There are higher rates of spontaneous abortions, ectopic, and multiple pregnancies. This work summarizes the latest year's experiences from the best world's clinics with multifetal pregnancy incidence in assisted reproductive technologies programs.

[Twin pregnancy and preeclampsia]. / Ciaza blizniacza i stan przedrzucawkowy.

INTRODUCTION: Preeclampsia is a pregnancy-specific disorder of humans which rates among one of the major cases of maternal and fetal morbidity and mortality. Etiology of preeclampsia is still largely unraveled and treatment is syndrome specific. OBJECTIVE: Evaluation of the incidence of preeclampsia in twin pregnancies and comparison of selected clinical characteristics among preeclamptic and non-preeclamptic twin pregnancy patients. METHODS: Retrospective analysis of 194 normotensive and 25 preeclamptic patients with twin pregnancies admitted to the Lublin State Hospital Nr 4 between January 1st 1992 and December 31st 1997. Patients were matched for gravidity, parity, maternal age and selected biochemical parameters. RESULTS: Preeclampsia occurred two times more frequently in nulliparous women (68% vs 32%). Gravidas with preeclampsia had significantly higher serum uric acid levels than their non-preeclamptic counterparts (6.7 +/- 0.3 vs 4.3 +/- 0.1; p < 0.001). Hypertension, proteinuria and edema coexisted concomitantly in 52% of preeclamptic patients. CONCLUSIONS: 1. Preeclampsia complicates one tenth of twin pregnancies. 2. In preeclamptic women nulliparas were two times more frequent. 3. In preeclamptic women is significantly higher level of uric acid.

[Complications of multiple pregnancy in the 2nd and 3rd trimesters]. / Powiklania ciazy wieloplodowej w II i III trymestrze.

Multiple pregnancy contributes to higher maternal and fetal risks than a single one. Complications typical only for multiple pregnancy such as PROM with preterm delivery, intrauterine death or IUGR of one of twins can occur during 2nd and 3rd trimester. Treatment in such situations is usually difficult and often controversial because of simultaneous presence of an alive and/or healthy fetus and possible risk for mother. The paper presents such situations and possible ways of treatment.

[Using of Misoprostol for preinduction and induction of labor in term pregnancy]. / Zastosowanie misoprostolu w preindukcji i indukcji porodu w terminie.

UNLABELLED: Labour induction is frequently indicated in women with an unfavourable cervix. Oxytocin and prostaglandins are the most common drugs used for labour induction. Induction of labour with prostaglandins offers the advantage of promoting both cervical ripening and myometrial contractility. The purpose of the study was to evaluate the safety and efficacy intravaginal administration prostaglandin E1 methyl analogue, misoprostol in cervical ripening and induction of labour in term pregnancy and in women with unfavourable cervix (Bishop score < = 4). The approval for this study was given by the Board of Medical Ethics, University Medical School of Lublin in Poland. MATERIALS AND METHODS: 64 women with indication for termination of pregnancy received either misoprostol (Cytotec-Searle) vaginally (group M, n = 30) or intravenous drip infusion of oxytocin(group Ox, n = 34). We evaluated profile of the studied women (gravidity, weight, height, maternal age, gestational age), effectiveness and safety of the misoprostol and need for oxytocin administration in group M, start of induction-to-active labour interval (contractions), start of induction-to-vaginal delivery interval, hyperstimulation syndrome, delivery within 24 hours of drug application and caesarean section rate. Before starting labour induction a Bishop score was obtained. Statistical analysis was performed. Baseline and outcome variables were tested with student's t-test and c2 analysis. We needed p < 0.05 for statistical significance. RESULTS: There were no differences in the patient profiles (gravidity, weight, height, maternal age, gestational age) between groups except the score of cervical ripening. The Bishop score before induction was lower in group M. The interval between the initiation of induction to active labour was shorter in the misoprostol group (334.23 +/- 126.35 versus 610.00 +/- 352.14 minutes). The mean time between the initiation of induction to delivery was shorter in group M (707.69 +/- 341.15 +/- versus 1025.77 +/- 369.16 minutes). These differences were statistically significant. 28 (93.33%) patients in the misoprostol group delivered within 24 hours compared with 24 (70.59%) women in the oxytocin group. 8 patients in the misoprostol group and 8 patient in the oxytocin group had caesarean section. Labor induction was successful in 30 (100%) women in the misoprostol group compared with 24 (70.59%) patients in the group Ox. CONCLUSIONS: Intravaginal misoprostol is an effective, easy to use and cheap drug for the induction of labour, especially for cervical ripening in women with unfavourable cervix (Bishop score < = 4).

[Amniocentesis and mother's bladder overfilling in operative treatment of advanced cervical incompetence]. / Amniopunkcja i wypelnienie pecherza moczowego ciezarnej w operacyjnym leczeniu zaawansowanej niewydolnosci szyjki macicy.

We describe two cases treated for cervical incompetence with prolapsed fetal membranes with emergency cerclage. Two methods of membranes reducing were used: transabdominal amniocentesis and bladder overfilling. We recommend these procedures in patients with advanced cervical incompetence when the membrane reduction by Trendelenburg position or pharmacological tocolysis were ineffective.