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Objectives: Growth disorders are frequent in diabetic pregnancies. However, they are difficult to predict and capture early during pregnancy. These newborns are at risk of obesity, diabetes, and cardiovascular disease. While developing, fetal growth abnormalities are typically progressive. Therefore, capturing the earliest moment when they emerge is essential to guide subsequent obstetric management. Material and methods: We aimed to analyze fetal ultrasound growth trajectories in type 1 diabetics. Moreover, we aimed to establish time points when first ultrasound manifestations of fetal growth abnormalities appear and to identify factors that affect fetal growth in women with diabetes. We collected clinical and ultrasound data from 200 patients with PGDM managed in the third-referential centre for diabetes in pregnancy. During every visit, patients underwent an ultrasound examination according to a standard protocol giving 1072 ultrasound scan’s records. Every ultrasound consisted of fetal weight estimation, according to the Hadlock 3 formula. Retrospectively patients were divided into three groups depending on neonatal weight. In the group of 200 patients, 60 (30%) delivered LGA and 9 (4.5%) SGA newborns. Results: Fetal growth trajectories show different patterns among fetuses with growth abnormalities in women with type 1 diabetes. The moment, when fetal growth curves diverge, seems to take place in the second trimester, just after the 23rd week of gestation. Conclusions: It suggests that fetal growth abnormalities in type 1 diabetes may have its roots much earlier than expected. In the first trimester, there were differences in LDL-cholesterol, total cholesterol, triglyceride levels and in insulin requirements between AGA, SGA and LGA subgroups.

The aim of the Guideline is to unify the diagnostic-therapeutic management of multiple-gestation pregnancies complicated by fetal growth restriction in at least one fetus.

Objectives: The aim of the study was to characterize nutritional behavior in pregnancy. Material and methods: The survey study included 250 pregnant women. The survey concerned dietary behavior reffered to the type of diet, the number of meals per day, snacking between meals, consumption of meat, fish, dairy products, bread, fruits and vegetables. Results: 88.8% of the respondents were not on a special diet. The most of the women ate more than three times a day. The women usually ate fruits and vegetables, yogurt and sweets as snacks between meals. The majority of respondents consumed meat and sliced meats twice or once a day with the preference of poultry. Only 17.6% of them ate fish with the recommended frequency and as much as 21.2% chose not-recommended species. Almost 29.6% of patients consumed 3 to 4 servings of milk or milk products a day and 16.8% of them excluded milk. Half of the respondents declared eating wheat bread and 24% of them chose wheat roll during pregnancy. Despite the large number of women who consumed wheat baking, a considerable amount of women chose wholemeal bread and wholemeal rolls. Nutritional behaviors were correlated with on education level and weight gain during pregnancy. Conclusions: The frequency of meals was adequate for the most of pregnant women as well as recommended consumption of meat with poultry preference. However, the inappropriate nutrition was also observed in a low consumption of fish and dairy products, a high consumption of wheat breadstuff and sweets, as well as in a small intake of milk. Education level and weight gain during pregnancy were associated with nutritional behaviors.

Uterine arteriovenous malformations are uncommon but potentially life-threatening conditions. They can be congenital or acquired and should be suspected in cases of severe or persistent uterine bleeding. In recent years, there has been an in-creasing number of reports of acquired vascular lesions of the uterus following pregnancy, abortion, caesarean delivery and curettage. This paper presents the review of the literature considered epidemiology, pathophysiology, diagnostic methods and treatment options. Unexplained uterine bleeding should be always an indication for colour Doppler ultrasonography and the presence of arteriovenous malformation should be always excluded.

Objectives: The aim of the study was to compare effects of addition of two methods of ductus venosus (DV) flow assessment: qualitative — the assessment of shape of the A-wave (positive or negative), and quantitative — based on the pulsatility index for veins (DVPI) to the basic screening for trisomy 21 at 11 to 13 + 6 weeks of pregnancy. Material and methods: The ultrasound examination was performed in 8230 fetuses in singleton pregnancies at 11– –13 + 6 wks, as a part of a routine screening for chromosomal defects. In DV A-wave was assessed and DVPI was calculated. After the scan blood sample was taken for first trimester biochemistry (BC). Risk for chromosomal defects was calculated and high-risk patients were offered an invasive test for karyotyping. Results: Basic screening with following combination of markers: MA, NT and BC provided lowest detection rate (DR) 87.50% for FPR = 6.94%. After adding qualitative DV A-wave assessment DR increased to 88.75% for FPR = 5.65%. The best DR = 93.75% for FPR = 5.55% was achieved when quantitative DVPI was added. The application of the Receiver Operating Curves curve confirmed validity of the addition of DV flow assessment to the screening model. The highest diagnostic power of the test was achieved when DVPI was added, with the ROC AUC of 0.974. Conclusions: The assessment of DV flow performed at 11–13 + 6 weeks increases DR for trisomy 21 and reduces FPR. The screening model based on the quantitative DV flow analysis (DVPI) gives better results compared to the qualitative flow assessment.

Objectives: The aim of the study was to determine if, and to what extent, structural and functional changes of the secundines influence biometric parameters of neonates from dichorionic twin pregnancies. Material and methods: The study included neonates from dichorionic, diamniotic twin pregnancies, along with their secundines. Based on histopathological examination of the secundines, the mass and dimensions of the placenta, length and condition of the umbilical cord, chorionicity, focal lesions, and microscopic placental abnormalities were determined for 445 pairs of twins. Morphological development of examined twins was characterized on the basis of their six somatic traits, while birth status of the newborns was assessed based on their Apgar scores. Statistical analysis included Student t-tests, Snedecor’s F-tests, post-hoc tests, non-parametric chi-squared Pearson’s tests, and determination of Spearman coefficients of rank correlation. Results: The lowest values of analyzed somatic traits were observed in twins who had placentas with velamentous or marginal cord insertion. Inflammatory lesions in the placenta and placental abruption turned out to have the greatest impact of all analyzed abnormalities of the secundines. Inflammatory lesions in the placenta were associated with lower values of biometric parameters and a greater likelihood of preterm birth. Neonates with a history of placental abruption were characterized by significantly lower birth weight and smaller chest circumference. Conclusions: Morphological changes in the secundines have a limited impact on biometric parameters of neonates from dichorionic twin pregnancies. In turn, functional changes exert a significant effect and more often contribute to impaired fetal development.

Uterine arteriovenous malformations are uncommon but potentially life-threatening condition. They can be congenital or acquired and should be suspected in cases of severe or persistent uterine bleeding. In recent years, there has been an increasing number of reports of acquired vascular lesions of the uterus following pregnancy, abortion, caesarean delivery and curettage. This paper presents the case of unexplained vaginal bleeding with subsequent suspicion and diagnosis of uterine arteriovenous malformation. Unexplained uterine bleeding should be always an indication for colour Doppler ultrasonography and the presence of AVM should be always excluded.

Studies on fetal lung/brain circulation by means of power Doppler technique have suggested a marked reduction in lung perfusion in high-risk pregnancies as a sign of circulation redistribution. The ratio between lung/brain perfusion might therefore give a new method to predict fetal circulation centralization. Objective: The aim of the present study was to obtain fetal lung and cerebral artery ratio in normal and high-risk pregnancies. Study design: Doppler samples from proximal right pulmonary artery blood velocities and middle cerebral artery (MCA) were recorded cross-sectionally in 228 normal singleton pregnancies at gestational age 22 to 40 weeks. MCA / right pulmonary artery pulsatility index (PO ratio was calculated. Doppler samples from proximal right pulmonary artery and MCA were also recorded in 89 high-risk singleton pregnancies and the results related to perinatal outcome. Results: In the normal controls, right pulmonary artery PI remained stable until 30 weeks of gestation with slight increase thereafter until term. The MCA to right pulmonary artery PI ratio increased between 22 and 28 weeks of gestation with the rapid fall towards term. In the high-risk pregnancies group, right pulmonary artery PI showed no significant correlation to perinatal outcome, but signs of brain-sparing in the MCA were correlated to all adverse outcome parameters. Conclusion: Velocimetry of the middle cerebral artery is better than velocimetry of right pulmonary artery in predicting adverse outcome of pregnancy The brain/lung PI ratio does not improve the prediction of adverse outcome of pregnancy. (Less)

Objectives: The aim of the study was to analyze the perinatal outcome of twin gestations and estimate the influence of chorionicity on the outcome in a large cohort of twin pregnancies in Poland. Material and methods: A retrospective analysis of 465 twin deliveries in 6 Polish centers in 2012 was conducted. Baseline characteristics, the course of pregnancy and labor, as well as the neonatal outcome were analyzed in the study group and according to chorionicity. Results: A total of 356 twin pregnancies were dichorionic (DC group) (76.6%), and 109 were monochorionic (MC group) (23.4%). There were no differences in the occurrence of pregnancy complications according to chorionicity, except for IUGR of at least one fetus (MC 43.1% vs. DC 34.6%; p = 0.003). 66.5% of the women delivered preterm, significantly more in the MC group (78% vs. 62.9%; p = 0.004). Cesarean delivery was performed in 432 patients (92.9%). Mean neonatal birthweight was statistically lower in the MC group (2074 g vs. 2370 g; p < 0.001). Perinatal mortality of at least one twin was 4.3% (2.8% in the DC group vs. 9.2% in the MC group; p = 0.004). Neonatal complications, including NICU admission, respiratory disorders, and infections requiring antibiotic therapy, were significantly more often observed among the MC twins. Conclusions: The overall perinatal outcome in the presented subpopulation of Polish twins and its dependence on cho­rionicity is similar to the reports in the literature. Nevertheless, the rates of preterm and cesarean deliveries remain higher. It seems that proper counselling of pregnant women and education of obstetricians may result in reduction of these rates.

Congenital heart defects are among the most common birth defects and represent a major challenge in prenatal diagnosis and therapy of a newborn.

This paper describe the case of pulmonary thromboembolism (PTE) in pregnancy diagnosed by angio CT The clinical diagnosis of PTE in normal population is difficult. In pregnancy is even more complicated, because physiologic changes of pregnancy can mimic signs and symptoms of PTE. Our patient presented dyspnoea, breathing effort and cyanosis of the mouth at admission. In the check-up there was a distinct murmur just under the heart and tachycardia 115 bpm. The Doppler examination of the venous vessels of the lower extremities was normal. Echocardiography revealed features of right ventricular failure. Due to increased level of D-dimers and echocardiographic features of right-ventricular overload, the suspicion of pneumonic embolism was made. Therefore, in order to verify the initial diagnosis the decision of pulmonary CT angiography was made with the radiological protection of the fetus. This study revealed pulmonary embolism in the form of numerous defects in the contrast fillings of the pulmonary arteries. CT pulmonary angiography is the first imaging test of choice in general population who is suspected to have PTE. However there is no consensus what should be preferred during pregnancy. In this paper the diagnostic concepts and an evidence-based guidelines were discussed in case of PTE in pregnancy as well as its side effects including teratogenicity and oncogenicity. In each case, the risks and benefits must be compared before a decision is taken. In case of thrombosis symptoms in the lower extremities, ultrasound should be taken as the next step, otherwise chest X-ray must be performed. In patients with normal chest X-ray the next step should be scintigraphy but if chest X-ray is abnormal, angio CT is preferred.

The aim of this study was to evaluate the effect of hormone replacement therapy (HRT) on exercise tolerance and ischemia during treadmill exercise test.Prospective, cohort study.Fifty-six postmenopausal women with proven coronary artery disease (CAD) were enrolled into the study (31 were assigned to HRT and 25 were matched as a control group). Clinically both groups were comparable. All patients underwent treadmill exercise test at the beginning and after 12 months of follow up.After 12-months of follow-up exercise tolerance increased significantly and similarly in both groups: duration time (sec): HRT 347 +/- 142 to 401 +/- 113; control 328 +/- 112 to 368 +/- 120; workload (MET): 6.6 +/- 2.1 to 6.8 +/- 2.0 and 6.1 +/- 1.9 to 6.8 +/- 1.7; time to onset of ischemia (sec): 256 +/- 116 to 293 +/- 120 and 238 +/- 87 to 299 +/- 133. Number of leads with ST changes and total sum (mm) of ST depression in all leads did not change significantly. All above parameters were comparable at baseline and after 12 months follow-up between both groups.Short term, combined, transdermal HRT does not improve exercise tolerance nor coronary ischemia during exercise test in women with CAD.

Objectives: Epidemiology of the carpal tunnel syndrome (CTS) during pregnancy remains to be fully elucidated. The purpose of the following study is to determine occurrence of that complication in a population of pregnant women. So far, the literature in Polish lacks information that might enable adequate diagnosis and proper therapy. Material and methods: The study included 301 women who delivered at term (between 37 and 41 weeks of pregnancy) at the Gynecological and Obstetrical University Hospital in Poznan. An original questionnaire about CTS symptoms was prepared for the purpose of the study. The tool included questions about general health, current and previous pregnancies, CTS symptoms, as well as the Boston Carpal Tunnel Questionnaire (BCTQ), modified for the purpose of the study. The original BCTQ includes questions about symptoms frequency during the last 2 weeks, while in our modified BCTQ we asked about symptoms during the whole pregnancy. The respondents filled in the questionnaire with the help of a physician. A part of the research group underwent Phalen sign evaluation. Results: Ninety-eight patients (32.6%) reported occurrence of at least one CTS symptom during pregnancy and 22 patients (22.4%) had similar symptoms in previous pregnancies. Only 3 patients had received any form of therapy. The number of patients with CTS symptoms who reported extremities edema was significantly higher than in the group without CTS symptoms (26.3% vs. 6.1%; p

to analyze the changes in the width of selected veins in the lower limbs during pregnancy and puerperium, with or without venous insufficiency (VI) diagnosed at the first trimesterthe group of 100 pregnant was divided into two subgroups with or without VI. The examination was performed, namely between 11-14th, 18-22nd, 28-32nd weeks of gestation and in 6th week of the puerperium. The sonographic examination included the measurement of the transverse diameter (TD) of the common femoral vein (CFV), the superficial femoral vein (SFV) and the popliteal vein (PV). The changes in the vessel width during pregnancy and puerperium were compared in both groups. Moreover the changes of analyzed ultrasound parameters between the two groups in the 4 analyzed time periods were compared to the first trimester results.there was a statistically significant increase in the TD of CFV with the highest values in the third trimester and significantly higher in the puerperium compared to the first visit. TD in all analyzed stages of pregnancy in the group with VI was significantly higher SFV and PV were not statistically different between the groups in any of the analyzed periods. Average TD of these vessels was higher in the third trimester decreasing gradually during the postpartum period.The average TD was highest in the third trimester decreasing during the postpartum period. In VI group a full return of TD to the values observed in the first trimester was not observed in the puerperium.

The venous system alters its function in pregnancy--the changes are both functional and structural. It becomes particularly vulnerable to the development of venous thrombosis and related complications. These adverse factors acting on the veins in pregnancy include: an increase in circulating blood volume, expansion of the uterus, weight gain, reduced physical activity hormonal changes. The changes in the plasma have a significant impact on the venous system. In pregnancy an increased level of fibrinogen and coagulation factors VII, VIII, IX and X, and von Willenbrand factor can be observed. Smooth muscle relaxation and relaxation of collagen fibers are caused by progesterone and estrogen, and it may result in the development of varicose veins, venous thrombosis and venous insufficiency The relationships between the hormones and the muscle pump efficiency has not been proven as yet. Estrogens cause an increase in the synthesis of coagulation proteins and it may result in the high risk of venous thrombosis and its consequences. Progesterone inhibits smooth muscle contraction, while estrogens cause relaxation and loosening of the bonds between the collagen fibers. The increase in the level of progesterone is of particular importance. It has a relaxing effect on the muscle, resulting in disorders of the vein shrinkage, affecting the increase of their capacity and valvular insufficiency, and valvular edges are not in contact with each other due to the vasodilatation. Estrogens have a similar effect, and additionally it may also cause an impairment in the collagen fibers connection and synthesis. This can result in the formation of telanglectasia without venous hypertension. Estrogens may also affect the synthesis of prostaglandins and nitric oxide. Estradiol inhibits vascular smooth muscle cell proliferation and stimulates cell migration and secretion of matrix proteins, as well as regeneration of the damaged vessels. Estrogen inhibits the production of cytokines, adhesion molecules, and reduce platelet response, i.e. the aggregation and adhesion in the presence of monocytes. Estradiol increases the production, activity and bioavailability of nitric oxide, a molecule with a strong vasodilating effect. Additionally adverse affects may appear due to short intervals between pregnancies, genetics, presence of venous thrombosis or venous insufficiency in the superficial and deep system in anamnesis. Caesarean section is also a risk factor for venous thrombosis. Family factors are associated with inheritance of the formation of varicose changes and venous insufficiency in both ways, dominant and recessive, and also sex-related. Among other factors affecting the development of venous insufficiency during pregnancy the following can be distinguished: type of work (standing, sitting, in forced positions and vibration), interval between pregnancies (determining the possibility of regeneration of physiological regeneration of the system). In case of women who were pregnant more than once, the risk of developing varicose veins and other venous insufficiency is doubled.

Local anesthetics are able to inhibit inflammatory phenomena. The influence of bupivacaine broadly applied in obstetrical anesthesia on the reactive oxygen species (ROS) production is a matter of controversy. The study was aimed at elucidation of the influence of racemic bupivacaine on the opsonized zymosan (OZ) stimulated-peripheral blood chemiluminescence (CL) in laboring women, reflecting the reactive oxygen species (ROS) production associated with phagocytosis.Blood samples drawn from 8 healthy parturients in active spontaneous labor and from 5 healthy non-pregnant controls were incubated with the 0.3, 30, and 3000 microM bupivacaine concentrations and then luminol-dependent OZ-stimulated whole blood CL was assessed.Bupivacaine depressed CL; however the inhibitory effect was significant only at the highest, clinically irrelevant concentration (3000 microM), in parturients being comparable to that observed in non-pregnant women.Bupivacaine at clinically relevant concentrations does not influence ROS production accompanying phagocytosis in peripheral blood of laboring women. The effect is comparable in parturients and non-pregnant controls.

A case of an umbilical cord collision diagnosed in the first trimester of a monochorionic monoamniotic twin pregnancy is presented. An intensive surveillance included ultrasound monitoring with color and spectral Doppler and fetal echocardiography. The first signs of fetal distress were observed at 31 weeks of gestation. The brain sparing effect as well as a periodic appearance of the "notch" in the wave forms obtained from the umbilical artery from the collision region were observed. In the first ultrasound scan there were no abnormalities in twin I. In contrast, in twin II a vascular resistance in the umbilical artery was at the upper limit for the gestational age. Five days later, decreased vascular resistance in the middle cerebral artery, which fluctuated at the lower limit, was noticed in twin II. After the next four days, PI in the middle cerebral artery decreased below the lower limit and tricuspid regurgitation appeared. In twin I the vascular resistance in the umbilical artery increased and remained at the upper limit of the reference ranges. Cardiotocographic records did not reveal signs of fetal distress. After a week the signs of brain sparing effect were visible in both fetuses. However, twin II showed features of umbilical cord clamping in the form of abnormal blood flow waveforms in the umbilical artery ("notch"). Therefore, despite the absence of signs of fetal distress in CTG in monochorionic monoamniotic twins with growth discordance of 20% and exponents of periodical clamping of the umbilical cord in twin II at 34 weeks, the decision to perform a caesarean section was made. The patient gave birth to two daughters (twin I: weight 1780g, Ap 10, pH 7.39, 7.40, BE -3.0, -2.6, and twin II: weight 1860g, Ap 10, pH 7.29, 7.35, BE -1.4, -2.4). During the delivery the umbilical cords collision was found at the region close to the body of twins. This case presents the possibility of using ultrasound and Doppler in the early diagnosis, monitoring and surveillance of pregnancies complicated by umbilical cords collision in monochorionic monoamniotic twins from the first trimester. Application of these methods allowed a safe monitoring of the fetuses and the identification of the onset of the cords collision. This in turn allowed the achievement of fetal maturity at 34 weeks, when both the risk of death and neonatal morbidity are significantly minimized. The use of Doppler blood flow velocimetry allowed the diagnosis of umbilical cords tightening before there were any signs of cardiac dysfunction in the CTG. This enabled to determine the most favorable, earlier time for delivery. The paper presents diagnostic management and surveillance in monochorionic monoamniotic pregnancy complicated by umbilical cord collision since the early pregnancy.

Selective intrauterine growth restriction (sIUGR) is a major complication of monochorionic pregnancies, with potentially high risk of intrauterine fetal death or neurological dysfunction in both fetuses. Diagnostic ultrasound has contributed to the understanding of the pathophysiology of sIUGR and allowed to propose a classification. That, in turn, allows to interpret a wide clinical variety of sIUGR and, depending on the type, to propose a specific clinical management. The introduction of diagnosis based on Doppler studies enables the correct diagnosis of the disorders, fetal monitoring, to determine the prognosis and optimal strategies, and to propose the best therapeutic intervention.

The paper presents a case of coexistence of the aortic coarctation with TTTS. This rare coincidence and hemodynamic disturbances resulting from hypovolemia interfere with the hemodynamic picture of the structural cardiac defect. Prenatal diagnosis is based on the assessment of the size of both ventricles. If the defect is present, the left ventricle is usually smaller than the right one. Coarctation may be also suspected in case there is disparity between large vessels in the mediastinum. Comparison of the width of the aorta, and ductus arteriosus, especially if the rate is 2:1 in favor of the latter may suggest such defect. Furthermore, the finding of continuous flow through the aortic isthmus increases the likelihood of the defect 16-fold. The presence of "coarctation shelf" in color Doppler may suggest the existence of the cardiac defect that will require an intervention. In the present study the aortic coarctation was diagnosed in the recipient, who presented marked features of hypervolemia in venous Doppler studies, and in echocardiographic assessment of the right heart. The paper presents signs of hemodynamic disturbances in Doppler studies and changes of Doppler blood flow parameters observed during therapy (i.e., amnioreduction, fetoscopy). Diagnosis of coarctation may be hindered by the presence of the right heart volume overload, hypertrophy of the heart muscle as a result of associated hemodynamic disturbances in twin-to-twin transfusion syndrome. The impact of therapeutic interventions such as amnioreduction and fetoscopy the on cardiovascular hemodynamic parameters of both fetuses is also discussed. Also, a wide ductus arteriosus may make it difficult to diagnose this defect in utero. The paper presents diagnostic and therapeutic management in a case of TITS complicated by an aortic coarctation in the recipient.

The aim of this study was to estimate the prevalence of factor V Leiden and prothrombin gene G20210A mutation among women with pregnancy loss in Poland.we analyzed a group of 396 women (mean age of 30.4 (+/- 4.6) years), who experienced at least one pregnancy loss. Patients were recruited from 6 academic centers (Poznań, Białystok, Lublin, Wrocław Bydgoszcz, Gdańsk), and were divided into the following groups: 122 patients with 3 episodes of early recurrent pregnancy loss (group 1), 87 patients with late pregnancy loss (group 2) and 46 patients with intrauterine pregnancy loss (group 3). Patients who did not fulfill the above inclusion criteria were divided into additional groups. 50 healthy women (mean age of 29.2 (+/- 4.5) years), having at least one child, constituted the control group. Factor V Leiden mutation and prothrombin G20210A gene mutation were examined in all 396 women with pregnancy loss and 50 controls. For molecular analysis peripheral blood was tested. Genome DNA isolation from lymphocyte was performed with commercial assay QIAampDNA Blood Mini Kit.Among 396 women with unexplained loss of at least one pregnancy 36 (9.1%) were carriers of inherited thrombophilia. Factor V Leiden mutation was present in 29 women (73%), prothrombin gene mutation G20210A in 6 (1.5%) and in 1 (0.3%) patient both mutations were detected. No coagulation defects were found in the control group. Factor V Leiden mutations was the most common disorder (21.7%) in patients with intrauterine demise and was significantly higher than in the group of women with early recurrent and late losses, p0.011 and p0,006 respectively The frequency of G20210 A prothrombin gene mutation did not differ substantially between the examined groups; the highest number (2.6%) was found in women with early and late pregnancy losses, and the lowest number (0.8%) was seen in women with early recurrent miscarriages.Factor V Leiden screening should be performed, regardless of negative history of thrombosis, in patients who experienced intrauterine fetal demise or recurrent early miscarriages.

Intrauterine growth restriction (IUGR) is defined as fetal growth below the expected genetic potential. The paper presents the principles of fetal surveillance in pregnancy complicated by IUGR in accordance with the guidelines of the Fetal Medicine Foundation (FMF). Fetal surveillance includes integrated monitoring by analyzing Doppler blood flow in selected vessels, fetal heart rate, biophysical profile and amniotic fluid volume. The aim of the integrated fetal monitoring is to prolong the pregnancy to minimize the consequences of prematurity and prevent a potentially lethal damage. The paper presents the symptoms preceding the intrauterine demise and proposes methods of determining the date of delivery according to the guidelines of FMF.

To analyze risk factors for venous insufficiency and the appearance of clinical symptoms during pregnancy and childbirth in the group of pregnant women without (nvi) and with symptoms of venous insufficiency (vi) of the lower limbs that was present during the first visit in the first trimester of pregnancyThe study included 103 pregnant women consulted at the Clinic of Vascular Disease "Calisia" in Kalisz in the years 2006-2008. Venous system was assessed in CEAP clinical classification. Patients were divided into two groups depending on the presence or absence of symptoms of venous insufficiency of the lower limbs during the first examination, which took place in the first trimester of pregnancy. Pregnant women with symptoms of vi qualified for the test group (B), whereas patients without signs of vi constituted the control group (K). The observed changes in each group in the second, third trimester and postpartum were compered to the first trimesterIn the control group, clinical symptoms such as telangiectasis, varicose changes, and edema increased with advancing gestational age, with the greatest intensity in the third trimester. Similar intensification of symptoms was observed in the group B. The incidence of some of the observed clinical symptoms decreased at 6 weeks postpartum, whereas some of them remained unchanged. In the group K statistically significant differences were found between the incidence of symptoms in the II and III trimesters compared to the first trimester. There were no statistically significant differences between puerperium and the first trimester. No statistical significance was found in the group B. In the puerperium a gradual reduction of clinical symptoms was observed. In the group K the greatest changes were observed in the prevalence of edema and pain. Similar changes were observed in women with venous insufficiencyPregnancy predisposes to chronic venous insufficiency. Edema of the lower limbs is not an authoritative exponent of the severity of venous insufficiency during pregnancy due to the emergence of different pathogenesis of these changes during pregnancy. The six-week postpartum period is not sufficient to normalize the functional state of the venous system in terms of changes occurring during pregnancy.

To determine the resistance index (RI) and pulsatility (PI) in the umbilical artery (UA) in prediction of abnormal fetal heart rate during labor and poor fetal outcome in term pregnancy.The study included 148 patients at term in uncomplicated pregnancy Daily evaluation of blood flow in the UA was performed and PI and RI were calculated. The last value before delivery was taken for the analysis. In turn predictive value of Doppler parameters has been determined in the prediction of abnormal FHR during labor and abnormal newborn condition. Evaluation included fetal CTG parameters and newborn status based on the V.Apgar scale and acid-base equilibrium in the umbilical cord blood. Then selected parameters, characterizing pregnancy and the newborn status, with abnormal Doppler results were compared. The prognostic value of Doppler indices was assessed for selected parameters determining the course of pregnancy and abnormal fetal heart rate.A poor predictive value of UA PI and RI in the prediction of abnormal fetal heart rate during labor and poor fetal outcome was found. The RI in the UA presented the highest predictive value.RI in the UA shows higher predictive value than PI in the detection of abnormal fetal outcome and abnormal fetal heart rate in uncomplicated pregnancy at term. However, PI as well as RI in the UA have a low predictive value for the analyzed parameters.

The aim of the study was the analysis of antiphospholipid syndrome frequency in Polish women with pregnancy loss.We analyzed 352 women with average age of 31.4 (+/- 4.3) who experienced one or more pregnancy losses. Patients from 5 University centers: Poznań, Białystok, Lublin, Wrocław and Bydgoszcz were divided into 3 groups. In the 1st group there were 150 women with recurrent early pregnancy losses before 10 weeks gestation, in the 2nd group we included 160 women with late pregnancy losses, in the 3rd group we analyzed 42 women with labor complicated by preeclampsia or placental insufficiency within or before 34 gestational week. All 352 women were screened for the presence of anticardiolipin antibodies (aCL), anti beta2glikoprotein I (abeta2GPI) and lupus anticoagulant (LA). The first two antibodies were investigated with ELISA test and the last one with APPT based test. Only the second positive result qualified patients as antiphospholipid antibody (aPL) positive. Antibodies against cardiolipin and beta2glicoprotein I were analyzed in three classes--IgA, IgG and IgM--where the laboratory criteria of positivity were titers above 40 unitsU/ml or above 99 centile.13 patients (3.69%) in the screened population of 352 women met the criteria of the antiphospholipid syndrome. The frequency of APS in women with early and late pregnancy losses were 1.33% and 6.25%, respectively. The most common antibody found was lupus anticoagulant (LA). In 3 women with late pregnancy loss all three antibodies were found. In women with premature deliveries complicated with preeclampsia and/or placental insufficiency the frequency of APS was 2.58%.1. Screening of antiphospholipid syndrome should be routinely performed in women with late pregnancy loss 2. We can conclude that APS is rarely found in women with pregnancy loss before 10 gestational week.

To determine the resistance index (RI) and pulsatility (PI) in the middle cerebral artery (MCA) in prediction of abnormal fetal heart rate during labor and poor fetal outcome in term pregnancy.The study included 148 patients at term in uncomplicated pregnancy Daily evaluation of blood flow in the MCA was performed and PI and RI were calculated. The last value before delivery was taken for the analysis. The predictive value of Doppler parameters has been determined in turn to predict abnormal FHR during labor and abnormal newborn condition. Evaluation included fetal CTG parameters and newborn status based on the V Apgar scale and acid-base equilibrium in the umbilical cord blood. Then selected parameters, characterizing pregnancy and the newborn status, were compared with abnormal Doppler results. The prognostic value of Doppler indices was assessed for selected parameters determining the course of pregnancy and abnormal fetal heart rate.Poor predictive value of UA PI and RI in the prediction of abnormal fetal heart rate during labor and poor fetal outcome was found. The RI in the UA presented the highest predictive value.PI in the MCA shows higher predictive value than RI in the detection of abnormal fetal outcome and abnormal fetal heart rate in uncomplicated pregnancy at term. However PI indices, particularly RI in the middle cerebral artery have low predictive value for the analyzed parameters.

The paper presents a case of placental tumor causing hemodynamic changes. Doppler studies and fetal echocardiography allowed the diagnosis of hyperkinetic circulation in the course of fetal anemia. Cordocentesis has been performed and confirmed fetal anemia. The treatment used, intrauterine blood transfusion, allowed the compensation of hemodynamic and hematological disorders. Paper presents a detailed diagnostic and therapeutic procedures in the event chorangioma in pregnancy.

Placenta percreta is potentially a life-threatening condition. Pelvic organ invasion of the placenta carries high mortality and morbidity to the mother and fetus. We present a 33 year old gravida 3, para 2-0-0 female with placenta previa, percreta with bladder invasion. Placental invasion caused a giant vesicouterine fistula. The pregnant woman was managed conservatively until 33 weeks gestation, at which time she underwent a classical cesarean section. Postoperatively the patient was treated with methotrexate. Immediately postpartum the placenta was left in situ and successfully removed transvaginally after 11 weeks postpartum.

The role of CYP1A1, CYP1B1 and CYP3A4 polymorphism in pathogenesis of breast cancer has not been fully elucidated. From three CYP1A1 polymorphisms *2A (3801TC), *2C (2455AG), and *2B variant, which harbors both polymorphisms, the *2A variant is potentially carcinogenic in African Americans and the Taiwanese, but not in Caucasians, and the CYP1B1*2 (355GT) and CYP1B1*3 (4326CG) variants might increase breast cancer risk. Although no association of any CYP3A4 polymorphisms and breast cancer has been documented, the CYP3A4*1B (392AG) variant, correlates with earlier menarche and endometrial cancer secondary to tamoxifen therapy.The present study was designed to investigate the frequency of CYP1A1, CYP1B1 and CYP3A4 polymorphisms in a sample of breast cancer patients from the Polish population and to correlate the results with the clinical and laboratory findings.The frequencies of CYP1A1*2A; CYP1A1*2C; CYP1B1*3; CYP3A4*1B CYP3A4*2 polymorphisms were determined in 71 patients aged 36-87, with primary breast cancer and 100 healthy individuals. Genomic DNA was extracted from the tumor and individual gene fragments were PCR-amplified. The polymorphisms were determined by RFLP and were correlated with the patients' TNM stage, grade, estrogen and progesterone receptor status as well as the level of c-erbB-2 protein.CYP1A1 polymorphisms were more frequent in younger patients and in the patients with high level of c-erbB-2 protein. No correlation between these polymorphisms and the cancer stage or grade, as well as the receptor status was demonstrated.CYP1A1 polymorphisms probably predispose to an earlier onset of breast cancer and might be associated with higher c-erbB-2 protein level, but further studies on a much larger group are required to substantiate our findings.

Neuraxial methods provide the most effective labor pain relief. This study aimed at assessing anxiety level in parturients requesting epidural analgesia (EA).Forty five women in spontaneous, active labor were enrolled, both primiparas (n=36) and multiparas (n=9). Anxiety was assessed by means of Spielberger State and Trait Anxiety Inventory (STAI) before administration of EA, and pain was measured by visual-analog scale (VAS) before and after analgesia.In all the studied parturients state anxiety was strikingly higher than the trait (53.9 +/- 11.8 vs. 39.3 +/- 8.4; P0.0001); the difference appeared insignificant in multiparas only. State anxiety was comparable independently of parity, labor outcome and systemic opioid administration. No association between anxiety level and labor pain intensity preceding analgesia, the duration of labor stages and demographic parameters could be found. However, a negative correlation between state anxiety and pain intensity reported after EA administration was noted (R = -0.315, p = 0.040), and, in cases of physiological labor, a negative association between state anxiety and the neonate Apgar score at the 1st minute after birth could be observed (R = -0.337, p = 0.047, Spearman rank test).In parturients requesting EA, state anxiety level is increased and not connected with the trait. Furthermore, in these women, anxiety appears not to be associated with labor pain but may influence the analgesic effect of the blockade. Anxiety does not determine labor duration and outcome; however, it may be connected with the well-being of the neonate immediately after birth.

Obstetrical hysterectomy still remains life saving operation. The aim of study was to determinate the frequency, indications and complications after the operation in the hospital in Zielona Góra, Poland.A retrospective review based on hospital data of 36 patients undergoing obstetrical hysterectomy over the period of 11 years was undertaken.The incidence of obstetrical hysterectomy during 1990-2001 et the Department of Obstetrics and Gynaecology in the district hospital in Zielona Góra was 1: 593 deliveries. Post partum hysterectomy occurred in 0.021% of normal deliveries and 1.03% of cesarean sections. The most common indications were placenta increta and placenta accreta /61.1%/, followed by uterine atony /13.8%/ and rupture of the uterus /11.1%. The most frequent complications were shock and lesion of the urinary bladder/both 5.6%/. The maternal mortality was 2.8%.1. The most common indications for the obstetrical hysterectomy are: placenta's pathologies; uterine atony and rupture of the uterus. 2. Obstetrical hysterectomy is connected with high risk of complications and maternal mortality.

In the present study fetal right coronary artery blood flow velocimetry was assessed.The prognostic value of the fetal right coronary artery blood flow velocimetry was evaluated in relationship with parameters of newborn's condition after birth.The study was performed in 102 cases of pregnancies complicated by pregnancy induced hypertension. Blood flow velocimetry was visualized from fetal right coronary artery and correlated with perinatal outcome parameters.Fetal coronary blood flow velocimetry was visualized only in 11 cases. Coronary blood flow velocimetry visualisation correlated with each parameter of after-birth evaluation. The method has the highest specificity (97.7%) and positive prognostic value (85%) concerning evaluation of newborn's condition.Fetal right coronary artery blood flow velocimetry visualisation is a late sign of chronic fetal hypoxia. This seems to be a factor which causes maximal coronary vessels dilatation and allows oxygenation of fetal heart muscle.

Blood velocity in the fetal vein of Galen and straight sinus is normally even and without fluctuation. Transverse sinus blood velocity pattern shows a characteristic triphasic shape. The aim of this study was to establish whether blood flow velocity pulsations in the Galen vein, straight sinus and transverse sinus velocimetry in high-risk pregnancies are related to an adverse outcome.The Galen vein, straight sinus and transverse sinus were located by color Doppler ultrasound in 110 pregnancies complicated by pregnancy-induced hypertension and intra-uterine growth retardation with blood velocity recorded by pulsed Doppler. The incidences of blood velocity pulsations in Galen vein and straight sinus as well as peak systolic velocity, lowest diastolic velocity and resistance index (RI) from transverse sinus were correlated to pregnancy outcome, including emergency operative intervention and/or neonatal distress. Umbilical artery and venous and uterine and middle cerebral artery blood velocity was also recorded at the same time.Pulsating blood velocity in the Galen vein and transverse sinus was found in 40 and 10 cases, respectively. Signs of brain sparing in the middle cerebral artery were seen in 23 fetuses. Abnormal values for RI, peak systolic velocity and lowest diastolic velocity from transverse sinus were found in 20.6 and 18 cases, respectively. Galen vein pulsations were highly significantly related to adverse outcome of pregnancy and significantly more frequent in the present study than in the umbilical vein. Parameters studied in straight sinus and transverse sinus showed poor correlation with outcome of pregnancy.Venous pulsations in the Galen vein are significantly correlated to adverse outcome of high-risk pregnancy. Straight sinus and transverse sinus velocimetry was not associated with perinatal outcome and might not be useful in predicting fetal distress.

A report of 33 years old female with Wernicke's encephalopathy is presented. The disease was secondary to hyperemesis gravidarum, started from the 6th week of pregnancy. Neurological symptoms as nystagmus, headache, vertigo, disturbance of consciousness and ataxia are described, as well as difficulties in finding out the right diagnosis. We present the therapy with vitamin B1. The subsequent course of the pregnancy was uncomplicated and resulted in a birth--by caesarean section of a healthy male infant, weighted 2790 grams. However, four months later after the delivery, the patient is not yet completely recovered and still demands thiamine supplementation.

The case of a 25 year-old pregnant woman with a history of miscarriage (8 week) and a triple intrauterine fetal death (35, 25, 21 week) was reported.Personal and family history did not revealed any abnormalities. In the 25th week of gestation routine ultrasonographic examination showed abnormal pulsation indexes in the umbilical artery, as well as the right and left uterine artery. Also extremely high vascular resistance was confirmed in both uterine arteries (notch). The routine laboratory tests were normal. Because of high risks of stillbirth and preliminary pregnancy termination the screening tests for thrombophilia were performed. The presence of a heterozygous form of factor V Leiden mutation and C677T polymorphism of a methylenetetrahydrofolate reductase gene were confirmed. The low doses of LMWH (nadroparine) subcutaneously and aspirin (150 mg per day, orally) were administered until pregnancy termination. In the 35th week of gestation the pregnancy was terminated by cesarean section due to fetus intrauterine asphyxia (boy 1180 g, Apgar 1 min-6, Agar 5 min 9 points). Three months' follow-up after delivery did not revealed any complication in the mother or in the child.Successful pregnancy outcome in the woman with thrombophilia and multiple miscarriages confirms the necessity for both prophylactic anticoagulant treatment and detailed laboratory testing.

Contribution to prepare present paper were extremely unsatisfied result of perinatal mortality rate in Wielkopolska, the region in which for many years efficiently works three-level perinatal care system and exists high class III level center. The main reasons of such situation Authors suspect in incorrect full filling of rapport forms prepared by maternal hospitals in Poland and in interpretation coming only just from 70% Polish hospitals performing care over mother and newborn. We suggest also, that estimation of perinatal mortality should take place after elimination of number of deaths due to developmental, lethal defects and malformations, classified in accordance with ICD-10 code.

Between 1993 and 2000, 7529 patients underwent cesarean section (24.3% of 31,798 delivering women) at University Hospital in Poznań. There were 52 cases of simultaneous adnexal surgery among them because of ovarian tumors (1 case/144 abdominal deliveries; 1 case/612 pregnancies). In 43 cases tumor was accidentally diagnosed at time of operative delivery (1/174 abdominal deliveries). The average age of all delivering women was 27 +/- 7 yrs, among abdominally delivering 28 +/- 7 yrs. The respective value for patients with ovarian tumor was significantly higher--30 +/- 7 yrs. The mean diameter of the tumor was 4.8 +/- 4.7 cm, but the largest 30 cm. In 9 cases adnexectomy was performed, remaining patients were treated conservatively. Benign cyst teratoma was diagnosed in 26.9%, cystis simplex in 21.2%, fibroma in 15.4%, endometriosis and luteal cyst every in 9.6%. There were two cases of malignant tumors, both diagnosed earlier: dysgerminoma and adenocarcinoma.1. incidence of ovarian tumors of pregnant women was previously probably underestimated, 2. the risk of malignant ovarian tumor is relatively low.

Perinatal bleeding may lead to a fatal outcome in about 10% of cases. We present a case of a 29 year old woman in childbirth, in whom a preparation of recombinant activated factor VII (rFVIIa, NovoSeven, Novo Nordisk A/S, Bagsvaerd, Denmark) was used with success to control intraoperative bleeding during haemorrhagic shock after caesarean section and obstetrical hysterectomy, in the course of the patient's third abdominal cavity revision for continuing blood loss. Administration of the preparation enabled for quick intraoperative control of haemorrhage, which allowed safe and clear identification and elimination of the cause of bleeding. No significant clotting abnormalities were noted at postoperative monitoring of the coagulation system. rFVIIa seems to be an effective alternative treatment of life-threatening haemorrhages in obstetrics, allowing for quick arrest of bleeding, and thus safe control of intraoperative local hemostasis.

Abnormal spectra of blood flow are observed in many fetal vessels in pregnancy complicated by intrauterine growth restriction. Redistribution of blood flow to the most important organs causes a diminished perfusion of the others. The disturbances of lung perfusion in utero are related to abnormal growth and development of the fetal lung. The aim of this study was to describe blood flow velocity waveforms in fetal pulmonary veins in normally grown and growth restricted fetuses above 30 weeks of gestation. Doppler studies were performed in 53 normally grown and 39 growth restricted fetuses. The subjects of analysis were: peak systolic (VS), peak diastolic (VD), end-diastolic (VA), and pulsatility index for veins (PIV). Analysis was performed for two gestational intervals: 31-36, 37-41 wks. The pulmonary venous flow in growth retarded fetuses demonstrates the similar pattern to that observed in normally grown fetuses above 30 weeks of gestation. There were no statistically significant differences between normally grown and growth restricted fetuses in all analyzed indices in both gestational intervals.

The paper presents a review of literature concerning the use of Doppler technique in the evaluation of pulmonary blood flow. Especially, it is important to monitor the development of lung in suspicion of lung hypoplasia that closely correlates with abnormal development of pulmonary vessels. In the literature there are single reports pointing on its usefulness in the detection of lethal lung hypoplasia. It has been suggested that this technique may provide valuable information of the development of vascular bed in lung. Recent data concerning Doppler blood flow velocimetry in hypoplastic lung stimulate to further studies suggesting their significant value in the diagnosis and distinguishing the lethal form of pulmonary hypoplasia.

It has been studied the relation between fetal breathing activity and labor among 216 patients in uncomplicated pregnancies at term. It has been also described the value of fetal breathing movements in the evaluation of fetal well-being. Among patients where fetal breathing movements were absent 81.9% women delivered within 3 days since ultrasonographic examination. And among patients with visible fetal breathing activity only 25.0% delivered within this period. The analysis of newborn condition based on Apgar score in pregnant women with or without fetal breathing movements showed no significant statistical differences. The absence of fetal breathing movements has no prognostic value concerning the evaluation of fetal well-being in antepartum period. The cessation of fetal breathing activity facilitates to prognose the time of labor in mature pregnancies.

At patients threatened with premature childbirth the influence of glicocorticoids on short and tong-term fetal heart rate variability and the occurrence of respiratory arrhythmia was evaluated. It has been ascertained statistical significant lowering of the incidence of fetal respiratory arrhythmia and short-term variability. Described changes had a temporary character and surrendered of normalization in the course 72 of hours after last use of glicocorticoids. The influence of glicocorticoids on select biochemical and biophysical parameters of state pregnant women was also studied. One specified occurrence of incidental symptoms in road drove of therapy. Pregnant women in road of treatment glicocorticoids have also observed a temporary weakness of feeling of fetal movements.

Authors described a case of twin-to-twin transfusion syndrome that did not comply with a classic definition of syndrome. It has been presented possibilities of ultrasound screening regarding to Doppler blood flow velocimetry. It has been also shown the usefulness of these methods in the monitoring and assessment of fetal status. This is an example of Doppler blood flow velocimetry applying that yields information concerning fetal condition. This method seems to be very useful in these situations when fetal heart rate monitoring is difficult or even inapplicable.

The use of vesicoamniotic shunt in the case of obstructive uropathy was described. On the base of ultrasound screening it has been diagnosed urethral obstruction. This abnormality of urinary tract was found in male fetus. It has been diagnosed the posterior urethral valve. Qualification to intrauterine therapy was based on normal parameters of renal function. Under ultrasound guidance the vesicoamniotic shunt was installed. The normal drenage was observed within 6 weeks, until it was dislocated. In 36th week of gestation the cesarean section was performed. The indications were signs of urethral obstruction. The boy was born in whom posterior urethral valves were recognized. He was born in good condition without any biochemical features of renal damage as well as signs of hypoplastic lung.