Search

Objective: The aim of this study was to assess the amoxicillin concentration in maternal serum, cord blood, amniotic fluid and the placenta, 2 h following vaginal administration and the factors influencing the drug level.Methods: Twenty-eight full-term pregnant women who qualified for elective cesarean delivery were included in the study. Vaginal suppositories containing 250 mg of amoxicillin were administered 2 h prior to the operation. Amoxicillin levels were determined using the diffusion microbial assay.Results: The amoxicillin level in amniotic fluid was significantly higher in comparison to that of maternal serum, cord blood or the placenta. Maternal age positively and gestational weight gain negatively correlated with the amoxicillin concentration in maternal serum. The maternal serum hemoglobin level and red blood cell count were positively correlated with amoxicillin concentration in the amniotic fluid. Neonatal birth weight was positively correlated with maternal serum and cord blood amoxicillin levels. Hypertensive women had significantly higher amoxicillin concentrations in amniotic fluid, and women with thrombocytopenia presented significantly higher cord blood amoxicillin concentrations.Conclusions: Amoxicillin presented poor concentration in maternal-fetal compartments after vaginal administration, but the factors influencing the drug level in different compartments require further investigation. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess the relationship between the body mass index (BMI) of the firstborn offspring at age 12 and maternal lipid levels at term and at 6 months postpartum. Design and Methods: The study included children born in the 2nd Department of Obstetrics and Gynecology of the Medical University of Warsaw between 1 November 1991 and 31 May 1993. The end point was BMI in the upper quartile - considered high BMI of the firstborn offspring at age 12. Results: The risk of high BMI in the offspring at age 12 significantly increased with an increase in the LDL-C level at term (OR = 2.41 per SD increase, 95% CI: 1.01-5.80; p < 0.049), a decrease in the HDL-C% at term (OR = 0.35 per SD increase, 95% CI: 0.14-0.84; p < 0.019) and a decrease in the HDL-C level at 6 months postpartum (OR = 0.25 per SD increase, 95% CI: 0.08-0.82; p < 0.022), regardless of maternal weight status before pregnancy and at 6 months postpartum, gestational weight gain, the offspring's gender and birth weight. Conclusion: LDL and HDL cholesterol levels at term are markers of maternal adaptation to a first pregnancy and predict the future growth of firstborn offspring. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare the effects of two betamethasone dosage regimens on selected parameters in mothers and on the status of the preterm newborn. Methods: The analysis included 121 patients who gave birth by gestational week 35 and within 7 days after the completion of a full course of steroid treatment (24 mg). The study group consisted of 45 patients receiving six 4-mg doses of betamethasone every 8 h. The control group consisted of 76 patients receiving two 12-mg doses of betamethasone separated by 24 h. Results: After treatment, a significant increase in the leukocyte count was observed in the control group. Significant reductions in the erythrocyte counts, hemoglobin levels and hematocrit after treatment were also found in the control group. The post-natal status of newborns did not differ significantly between groups. The betamethasone dosage regimen used did not affect the incidence of moderate and severe respiratory disorders, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), retinopathy (ROP), infection, hyperbilirubinemia or anemia in neonates. Mild respiratory disorders were slightly more common in the study group. Conclusion: A reduction in the single steroid dose administered to patients at risk of premature birth may reduce maternal side-effects. [ABSTRACT FROM AUTHOR]

Endometriosis is a prevalent gynecological condition, affecting around 10% of reproductive-age women. Inflammatory processes associated with endometriosis may contribute to endothelial dysfunction. Increased skin accumulation of advanced glycation end-products (AGEs), reflecting arterial stiffness, potentially links endometriosis with elevated risk of cardiovascular events. We hypothesized that patients with endometriosis have impaired endothelial function as well as increased arterial stiffness and AGE skin accumulation, compared to healthy controls. We compared endothelial function, arterial stiffness, and levels of AGEs in patients suffering from endometriosis and in healthy controls. The study included 45 women aged 20 to 40: 21 patients with endometriosis and 24 healthy controls, matched in terms of age, BMI, and blood pressure values. Endo-PAT 2000 device was used for non-invasive assessment of (i) endothelial function, expressed as Reactive Hyperemia Index (RHI), and (ii) arterial stiffness, expressed as Augmentation Index (AI) and Augmentation Index at 75 heart beats/min (AI@75). Endothelial dysfunction was defined as an RHI value ≤ 1.67. AGE Reader device was used for non-invasive evaluation of skin AGE level accumulation. Patients with endometriosis had lower mean RHI values (1.69 ± 0.54 vs. 2.02 ± 0.48, p = 0.037) and a higher prevalence of endothelial dysfunction, (52.4% vs. 20.8%, p = 0.027) compared to healthy controls. Skin AGE level was higher in patients with endometriosis, compared to controls (2.00 ± 0.57 vs. 1.70 ± 0.24, p = 0.013). There were no significant differences in AI and AI@75 between the two groups. Patients with endometriosis have impaired endothelial function and higher AGE skin accumulation, which are well-established preclinical manifestations of increased cardiovascular risk. There is a great need for comprehensive cardiovascular risk assessments in women with endometriosis to prevent the development of potential atherosclerotic-based complications. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) is a frequent pregnancy complication, affecting the maternal and neonatal health. The new diagnostic strategy for GDM, proposed by the International Association of Diabetes and Pregnancy Study Groups in 2010 and World Health Organization in 2013, raised hope to reduce perinatal complications. The purpose of the study was to compare risk factors influencing maternal and foetal outcomes in a group of pregnant women diagnosed with GDM, and in a group of pregnant women without GDM, regardless of the adopted diagnostic criteria. Also, the aim of the study was to evaluate the impact of risk factors on perinatal results and the "cost" of reducing adverse pregnancy outcomes in patients with GDM.Methods: It was a retrospective study based on the analysis of births given after 37 weeks of pregnancy at the 2nd Department of Obstetrics and Gynaecology, Warsaw Medical University during the years 2013 to 2015. All pregnant women had a 75 g OGTT between the 24th and 28th weeks of pregnancy. The study compared risk factors for perinatal complications in 285 GDM patients and in 202 randomly selected women without GDM. The impact of selected risk factors on perinatal outcomes was analysed.Results: Both the diagnosis of GDM and maternal BMI prior to pregnancy, significantly modified the risk of excessive and insufficient weight gain during pregnancy. The parameters significantly influencing the risk of the composite adverse maternal outcome were the maternal abdominal circumference [OR: 1.08 (1.04; 1.11)] and multiparity, which reduced the risk by almost half [OR: 0.47 (0.30; 0.75)]. The maternal abdominal circumference before the delivery was a strong factor correlating with the occurrence of perinatal complications in both the mother and the foetus in the entire cohort. A circumference over 100 cm increased the risk of at least one maternal complication (increased blood loss, soft tissue injury, pre-eclampsia) by almost 40% (OR 1.38, p < 0.001).Conclusions: No differences were found in maternal and foetal outcomes in GDM and non-GDM women except gestational weight gain below Institute of Medicine recommendations. The only "cost" of reducing adverse pregnancy outcomes in GDM patients seems to be lowering gestational weight gain, the future impact of which on GDM pregnant population should be assessed. The maternal abdominal circumference measured before delivery not the severity of carbohydrate intolerance, remained the main predictor for significant perinatal complications. [ABSTRACT FROM AUTHOR]

Background: Cytomegalovirus (CMV) infection represents a major issue worldwide, since it constitutes the most common viral congenital infection, with a prevalence of 0.58% and 1–5% in developed and developing countries, respectively. According to recent studies, prenatal treatment significantly decreases the risk of vertical CMV transmission, and early intervention may even prevent the termination of pregnancy. This study aimed to investigate the level of awareness of CMV among pregnant patients through a semi-systematic review. Methods: We included all of the original articles investigating knowledge and awareness about CMV infection among pregnant women. Our research included the PubMed database. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, the Covidence system automatically guided us to screen the titles and/or abstracts, and then full-texts, followed by data extraction from the eligible studies. Results: We screened 764 studies altogether, with 13 studies included in this analysis. Knowledge about the existence of CMV infection risk varied between the articles, ranging from 11.4% in a study performed in Ireland to 60% reported in a study on the French population. Studies analyzing the impact of educational interventions on patients' knowledge about preventive measures reported significant improvement compared to their level of awareness before the intervention. Conclusions: Patients' awareness and knowledge about CMV seemed to be generally low or very low during the last decade before the development of effective secondary prevention methods. Educational interventions seem to be effective, and therefore their wide use could be of potential benefit. In the era of available secondary prevention of vertical transmission, it is crucial to concentrate the efforts of different stakeholders to increase the awareness of cCMV among pregnant women. [ABSTRACT FROM AUTHOR]

We aimed to determine the volume of the thyroid gland in full-term neonates born to hypothyroid mothers as compared with full-term infants born to healthy mothers and to investigate the association between levothyroxine doses and the thyroid volume of neonates. This is single center prospective observational study of 245 full-term neonates (96 from hypothyroid and 149 from healthy mothers). Ultrasound examination in both longitudinal and transverse projections was used to calculate the thyroid volume applying the ellipsoid formula. Median (interquartile range) thyroid volume of newborns from hypothyroid mothers was significantly smaller compared to the control group with regard to the total thyroid volume and the left lobe (p < 0.05). We found no statistically significant difference for the right lobe (p > 0.05) and inverse correlation between the thyroid volume and levothyroxine doses taken by mothers. Results of the present study indicate that maternal thyroid hormone levels may interfere with the fetal hypothalamic-pituitary axis. [ABSTRACT FROM AUTHOR]

Introduction. Methodological assumptions as well as the initial stage of the execution of the project entitled “Breast-POL” — the use of sensory perception of blind and visually impaired masseurs for the purpose of breast cancer screening by palpation were presented. Materials and methods. A list of incentives to conduct this methodologically adequate study includes: 1. Encouraging and widely disseminated German reports (these reports, however, were of high generality and they did not provide the adequate methodology); 2. Theoretical data on the hypercompensation of other senses than vision in the blind; 3. Preliminary information on the involvement of the blind in breast cancer screening by palpation in developing countries. Results. Compared to people with normal vision, a statistically significant higher sensitivity (63.0 vs 47.5%) and lower specificity (89.6 vs 93.7%) in the detection of pathological lesions, using a phantom, was reported in the blind. Conclusion. Our study confirms that the detection of pathological breast lesions by the blind is highly effective, however, the ability to exclude such lesions was not of clinical significance. [ABSTRACT FROM AUTHOR]

Vulvar intraepithelial lesions are a heterogenic group of diseases, which can be easily misdiagnosed. The case of a 61-year-old woman with a history of genital intraepithelial lesions and infection with HPV is presented. Her main complaint was vulvar pruitus. Vulvoscopy revealed the presence of two skin lesions: the first one had the morphology of lichen sclerosus, and the second of a Bowenoid lesion. The biopsy of the first lesion revealed vulvar intraepithelial neoplasia, whereas cells of squamous vulvar cancer were identified in the secon lesion. After staging, the patient was advised to undergo hemivulvectomy and lymphadenectomy. The coexistence of morphologically diverse vulvar skin lesions may cause difficulties with diagnosis and the selection of an adequate treatment. Long-term follow-up and regular examination are essential for diagnosis of vulvar malignancies in the early stage. [ABSTRACT FROM AUTHOR]

Background: Mirror syndrome (MS) is a pregnancy-related condition characterized by fetal, placental and maternal edema. Methods: We report a case of MS with severe postpartum presentation following stillbirth, shoulder dystocia, McRoberts maneuver, anterior shoulder disimpaction and manual posterior shoulder delivery together with serum soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio results. Results: A 33-year-old patient G3P0A2 at 34 weeks gestation was referred with fetal Ebstein anomaly and fetal hydrops. At 36 weeks of gestation, examination revealed fetal demise with placental hydrops. Delivery of a stillborn child was complicated by shoulder dystocia. Twelve hours postpartum patient developed massive edema and acute kidney injury. Five days postpartum serum creatinine level (CrL) peaked and the sFlt-1/PlGF ratio was elevated. Twelve days after delivery CrL normalized and edema resolved. Conclusions: Shoulder dystocia may increase the severity of postpartum MS. The sFlt-1/PlGF ratio may be useful for MS management. [ABSTRACT FROM AUTHOR]

Background: In the light of a growing interest in breast augmentation with implant devices, physicians should be aware of medium and long-term complications after such procedures. Moreover, an increased risk of breast cancer with higher mortality in the group of implant recipients is observed, which requires an implementation of accurate screening. Summary: A special approach must be considered when managing a patient with breast implants due to the possibility to encounter unexpected difficulties during the diagnostic process. Certain complications of breast augmentation require urgent diagnosis followed by adequate treatment, often including surgical management. On the other hand, a patient may report worrying symptoms which mimic those related to breast implants. Plastic surgery patients should be counseled on multiple health aspects prior to the surgery, with emphasis on the oncological risk. Regular breast check-ups are necessary among women with breast implants since proper exposition of breast tissue may be problematic. Key messages: Proper oncological vigilance is needed as adequate imaging of augmented breasts might be compromised. A decreased survival of breast cancer patients with breast implants compared with non-augmented women is observed. A holistic approach towards the patient with breast implants helps to mitigate the risk of overlooking important symptoms. Wstęp: W związku z coraz większym zainteresowaniem zabiegami powiększania piersi personel medyczny powinien posiadać wiedzę na temat możliwości wystąpienia komplikacji po tego typu operacjach. Ze względu na obserwowaną większą śmiertelność związaną z rakiem piersi wśród pacjentek z implantami piersi jest to grupa wymagająca szczególnej uwagi podczas badań przesiewowych. Rozwinięcie: Badania przesiewowe w kierunku raka piersi powinny być odpowiednio dostosowane do pacjentek z implantami z uwagi na możliwe trudności w wyborze metody obrazowania piersi. Dodatkowe utrudnienia w procesie diagnostycznym mogą wynikać z niektórych komplikacji zabiegu powiększania piersi. Kluczową rolę odgrywają edukacja pacjentek na temat konieczności wykonywania regularnych badań obrazowych oraz samobadania piersi, jak również informowanie przed samą operacją o możliwych odległych skutkach zabiegu, z ryzykiem onkologicznym włącznie. Podsumowanie: Odpowiednia czujność onkologiczna u pacjentek z implantami piersi jest konieczna ze względu na możliwe utrudnienia w obrazowaniu i konieczność dostosowania postępowania diagnostycznego. [ABSTRACT FROM AUTHOR]

Introduction. Hyperthermia during the first trimester increases the risk of miscarriage and birth defects. A variety of activities predisposing to hyperthermia during pregnancy such as attending sauna, hot tubs or solarium may lead to irreversible abnormalities of the developing fetus. Aim. The aim of the study was to assess women's knowledge on the risks of maternal hyperthermia during each trimester of pregnancy. Material and methods. It was a cross-sectional study conducted by means of an anonymous questionnaire. The study group included 302 women aged 17-65 who were admitted to a tertiary referral hospital. The questionnaire was designed on the basis of the Committee Opinion formulated by the American College of Obstetricians and Gynecologists and was consisted of two sections: demographic data and respondents' opinions on activities associated with hyperthermia in pregnancy. Statistical analysis was conducted to estimate the association of age, level of education and obstetrical status. Results. The lowest percentage of given proper answers was observed in case of questions about early pregnancy. There was no association between respondents' level of education and choice of correct answers. Current pregnancy was associated with higher awareness of contraindicated using of hot tubs and steam rooms. Conclusions. Patients' education concerning hyperthermia in pregnancy should focus on information about high risk of birth defects caused by overheating in the early pregnancy and a variety of activities linked with temperature elevation. [ABSTRACT FROM AUTHOR]