Strategies for overcoming oncological treatment-related ovarian dysfunction - literature review.

In the majority of developed countries, it is observed that the time for maternity is being postponed to over the 30th and even 40th year of life. A significant number of cancers are diagnosed during reproductive age, often before the first pregnancy. A fertility preservation is an important issue in oncological treatment, where there is a need for balancing between radicality and the preservation of function of reproductive organs. The authors discuss the problem of ovarian dysfunction after oncological treatment and present the possible strategies for saving the reproductive function of ovaries, including both invasive and pharmacological approaches.

Serum nitric oxide metabolites as a predictive factor of premature delivery.

UNLABELLED: In spite of medical progress in evolving diagnostic methods and clinical treatment premature delivery still remains the main problem in obstetric and perinatology. Nitric oxide (NO) is one of the factors which can be important in physiological mechanisms of placental angiogenesis and regulation of vascular tone and could be useful in predicting the risk of premature labor. AIM: The aim of this study was to establish the relation between NO concentration in serum and uterine activity before 37 weeks of gestation in pregnancy with premature delivery. Correlations between serum level of NO and hemoglobin, C- reactive protein (CRP) and total leukocyte count (TLC) were also studied. MATERIALS AND METHODS: The examined group included 47 primigravidas between 23 and 37 weeks of gestation with diagnosis of premature delivery and 26 gestational age-matched women with uncomplicated pregnancy. Serum NO concentration was determined by colorimetric method using a commercially available kit. In this assay total nitrite (nitrites + nitrates) - was analyzed as indicator of NO production. RESULTS: As compared to the control group, the maternal serum concentrations of NO in each group of women with premature delivery were lower and these differences were statistically significant (p<0.05). The lowest concentration of NO was observed in the group of patients with spontaneous uterine activity and without premature rupture of membranes (PROM) in comparison to other groups with imminent premature delivery and to the control group. The levels of hemoglobin and CRP were within the physiological range and correlated positively with the concentrations NO (r=0.635, p=0.015; r=0.484, p=0.035 respectively) in all women included in the study. CONCLUSIONS: The decreased level of NO in patients with preterm labor was not connected with subclinical infections but it may be associated with initiation of uterine contraction before 37 weeks of gestation.

The Impact of Coexisting Gestational Diabetes Mellitus on the Course of Preeclampsia.

A strict correlation between gestational diabetes mellitus (GDM) and preeclampsia (PE) has been shown in previous studies. This case-control observational study evaluates the influence of concomitant GDM on the severity of PE. Ninety-nine patients were included: thirty-eight with PE without GDM (group 1), fourteen with PE and concomitant GDM (group 2), and forty-seven with uncomplicated pregnancies (group 3). Adverse maternal/fetal and neonatal outcomes were registered. Patients underwent blood sample analysis of serum PlGF, sFlt-1, creatinine levels, and platelet count (PLT). The incidence of preterm birth, FGR, HELLP syndrome, and NICU admission was significantly higher in group 1 in comparison to groups 2 and 3, whereas RDS was diagnosed most often in group 2 in comparison to groups 1 and 3. All studied biochemical parameters differed between the control group and both PE groups; however, there were no differences between patients with PE with and without GDM. The presented study indicates that the coexistence of GDM may mitigate the course of PE. The lack of differences between patients with PE with and without GDM in serum levels of studied biomarkers may also confirm its usefulness in the diagnosis and management of PE in patients with coexisting GDM.

[25 years of work: The Interdisciplinary Team for Fetal Malformation at the Institute of Mother and Child in Warsaw - from counselling to clinical ethics].

Perinatology is a dynamically developing field of medicine. The progress of technology in recent decades has made it possible to recognize birth defects very early, including those which are lethal or genetically determined. In many clinical situations, it is no longer possible to work alone to reach a definitive diagnosis, plan treatment or predict the clinical course of the affected fetus/newborn. There is a need for teamwork, which ensures the proper, early care starting in the fetal period, not only in the delivery room or NICU. This paper discusses the ethical foundations of creating interdisciplinary teams, taking as an example the Interdisciplinary Team for Fetal Malformation at the Institute of Mother and Child in Warsaw, which has been active for 25 years, and presents how it works in practice. On the basis of the clinical cases that are examined, practical guidelines were formulated for both the work of medical teams and the way parents are informed about the clinical situation of their child and about sharing the care after the birth of the child. A document was also proposed with information on prenatal diagnosis, decisions made by the interdisciplinary team regarding the mother and child, as well as the conclusions resulting from discussions with parents.