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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.

Altered function of maternal platelets has been evidenced in intrauterine growth restriction (IUGR) but intraplatelet burden of trace elements, factors known to affect platelet activity, remains unknown in IUGR pregnancy. This study assessed the intraplatelet status of Ca, Cu, Mg, Na, K, P, Zn and their ratios (Ca/P, Ca/Mg, Na/K, Cu/Zn) in IUGR pregnancy (n = 35), uncomplicated pregnancy (n = 25) and in non-pregnant females (n = 25). The IUGR group was characterized by the lowest content of Ca, Mg and Zn, and Ca/P ratio (1.0), and the highest Ca/Mg and Cu/Zn ratios. The studied parameters in non-pregnant women and in uncomplicated pregnancy were comparable except P content and Ca/Mg ratio which were significantly lower in the former group. No differences in Na and K contents, and Na/K ratio between studied groups were found. This study reports that maternal intraplatelet status of selected minerals may be altered in IUGR.

Altered function of platelets can lead to cardiovascular complications in numerous disorders. Various studies aimed to investigate mechanisms triggering platelets activation cascade show a significant role of reactive oxygen species (ROS) in this matter. Moreover, ROS are known causal factor of oxidative stress that can result in DNA, lipid and protein damage. This review aims to comprehensively present the variety of methods that are potentially useful in assessment of platelets redox balance, such as intracellular concentration of particular ROS, activity of antioxidant enzymes, reduced/oxidized glutathione ratio, level of lipid peroxidation, Cu/Zn ratio, and molecular oxygen consumption. They may help to establish the platelet-related etiological factors in different disorders and to evaluate the antiplatelet therapies. The advantages and limitations of these methods are also discussed. The present paper highlights that clinicians may benefit from implementation of such tools and further encourages developing interdisciplinary evidence-based practice.

The objective of this study was to compare oxidative stress indices in 24 patients (mean &plusmn, SD age 71 &plusmn, 13 years) undergoing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR). Serum total antioxidant capacity (TAC), copper/zinc ratio (Cu/Zn), activity of lactate dehydrogenase (LDH), and thiobarbituric acid reactive substances (TBARS) were assessed at four different time-points: pre-procedure, immediately post-procedure, and one day and two days after the procedure. All oxidative stress parameters were comparable in both groups pre-procedure. TAC decreased significantly when assessed immediately after procedures in both groups (p &lt, 0.001), however, the magnitude of the reduction was more pronounced after SAVR (88% decrease from baseline: 1.8 &plusmn, 0.1 vs. 0.2 &plusmn, 0.03 mM) compared to TAVR procedures (53% decrease from baseline: 1.9 &plusmn, 0.1 vs. 1.0 &plusmn, 0.1 mM, p &lt, 0.001). TAC returned to baseline two days after TAVR in all patients, but was still reduced by 55% two days after SAVR. In concordance, TBARS levels and Cu/Zn ratio increased significantly with maximum levels immediately after procedures in both groups (p &lt, 0.001), but the magnitude of the increase was significantly higher in SAVR compared to TAVR (TBARS: 3.93 &plusmn, 0.61 &micro, M vs. 1.25 &plusmn, 0.30 &micro, M, p = 0.015, Cu/Zn ratio: 2.33 &plusmn, 0.11 vs. 1.80 &plusmn, 0.12, 0.001). Two days after the procedure, TBARS levels and the Cu/Zn ratio returned to baseline after TAVR, with no full recovery after SAVR. TAVR is associated with a lesser redox imbalance and faster recovery of antioxidant capacity compared to SAVR.

This study describes the ultrasound diagnostic process and management in a patient with a unique, rare form of fibroids, i.e. the atypical variant. According to the WHO definition, an atypical uterine myoma cannot be histologically unambiguously diagnosed as benign or malignant. Atypical leiomyomas are characterized by moderate or high quantity of pleomorphic atypical tumor cells, with a small number of mitotic divisions and lack of coagulative necrosis in the tumor. They have a low rate of extrauterine, intraabdominal recurrence, with a negligible risk for distant metastases. Due to the fact the atypical variant of leiomyomas is very rare, it presents a significant diagnostic challenge for obstetricians. The most reliable diagnosis can be made only on the basis of the histopathological examination. In this paper, we present a case of a patient in whom an echo with the diameter of 92 mm and a heterogeneous echogenicity with visible anechoic fields were discovered in the uterine fundus. HD color Doppler demonstrated high vascularization within the tumor, peripherally as well as centrally. The peripheral and central vascularization was rated at 4/4 points on a scale by Exacoustos. The tumor in the uterus met the criteria of high probability of malignancy i.e. 8 points on the vascular scale (power Doppler scale ≥ 7 pts.), solid tumor and a size over 8 cm. Blood flow velocity and vascular resistance in the tumor vessels were evaluated (PSV - 5.76 cm/s, ED - 3.16 cm/s, RI - 0.45 S / D - 1.82). Blood flow in the tumor presented low resistance. Hysterectomy without oophorectomy, with an intraoperative histopathological examination, was performed, and a fibroid was confirmed. The tumor was soft, yellow, with small and medium level of dispersed atypia in microscopic examination. There was no necrosis or mitotic figures. The histopathological image confirmed the atypical leiomyoma of low risk of recurrence. Atypical fibroids are rare in gynecological oncology and they do not have the characteristic clinical course. Furthermore, they do not show the typical characteristics during imaging studies, including ultrasound screening, Sometimes, due to the sonographic image, they should be differentiated from sarcomas. Also, it is necessary to exclude malignancy because of their ambiguous histological characteristics.

This paper presents the diagnostic algorithm in twin pregnancy. The most important sonographic parameters in the assessment of twins have been discussed. Moreover, the most significant complications of twin pregnancy, as well as diagnostic possibilities and management, have been also presented and defined.

Introduction: Venous insufficiency in pregnancy is associated witch an increased risk of complications. Objectives: The aim of the study was to analyse the venous system changes of the lower limbs during pregnancy and puerperium with or without venous insufficiency. Material and methods: The research was carried out on pregnant women divided into two groups according to the presence or lack of venous insufficiency. The venous system was examined four times: between 11-14th, 18-22nd, 28-32nd gestational week and at the 6th week of puerperium. The doppler examination included the measurement of the blood flow velocity in selected deep veins of the lower limbs: common femoral vein, the superficial femoral vein and the popliteal vein. Consecutively, the changes in the blood flow velocity during pregnancy and puerperium were compared between groups and finally to the results obtained in the 1st trimester. Results: The analysis of the blood flow showed that the blood flow velocity was statistically lower in the group with venous insufficiency. Velocity changes in time showed, in majority of cases, a substantial reduction in the blood flow velocity in the third trimester in both groups. This blood flow velocity increases during the puerperium and does not differ from those observed in the first trimester. Thus, the tendency of changes in the blood flow velocity were similar in character in both groups. Conclusions: The pregnancy related changes in venous system of lower extremities showed the reduction of blood flow velocity with advancing gestational age and were more evident in pregnancy complicated by venous insufficiency.

The aim of the study was to present a case of Smith-Lemli-Opitz syndrome (SLOS) in a fetus of a 33-year-old patient. At 31 weeks of gestation, the following fetal malformations were detected on an ultrasound: atrioventricular septal defect (AVSD), aortic coarctation, shortening of the lower limbs, narrow forehead, hyperthelorism, micrognathia, anteverted nares, ambiguous genitalia, and signs of intrauterine growth restriction. The baby died 11 days after birth. Further genetic screening of the parents revealed the 7-DHCR enzyme mutation in both of them. Although the prenatal diagnosis of SLOS presents a challenge due to the fact that little is known about its prenatal phenotype but it may be vital while attempting to treat the fetus in utero.

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.

Abnormal implantation of placenta previa is life-threatening condition. The purpose of this study was to evaluate the impact of the conservative management of pregnancies with such complication on maternal morbidity rate and the chance for uterine preservation (fertility).Eleven patients with abnormal implantation of placenta previa were analyzed prospectively. This complication was diagnosed antenatally by two-dimensional ultrasound and color flow Doppler. The following outcomes were analyzed: need for blood transfusion, admission and duration of stay in intensive care unit, infections, coagulopathies, time between cesarean section and delivery of placenta, hysterectomy and preservation of uterus.Among the 20 085 women who had a singleton gestation, 11 (0.054%) were identified with placenta previa with abnormal placentation. In five patients (group A), hysterectomy was performed because of hemorrhage or placenta ablation. In six patients (group B), conservative management succeeded and placenta were preserved. In group A, placenta were delivered earlier (2 d-8 weeks) in comparison with group B (6-15 weeks). Estimated blood loss during the delayed delivery of placenta was higher in the group with hysterectomy (respectively, 450-1600 and 300-500 ml).Conservative management of placenta previa with abnormal implantation decreases the risk of severe hemorrhage at the time of delivery and can preserve fertility.

Aim: The study evaluated the applicability of Doppler ultrasonography in predicting the course of pregnancy and neonatal outcome in dichorionic pregnancy complicated by growth discordance. Methods: Doppler examination of the umbilical artery (UA) and middle cerebral artery (MCA) was performed in 106 twins. Abnormal values of the UA pulsatility index (PI) were considered to be above the 95th percentile and below 5th percentile for the MCA PI for gestational week. The difference of UA PI ≥0.5 in twin pairs was considered abnormal. Doppler results were compared with selected parameters that characterize the course of pregnancy and fetal outcome. Results: Abnormal UA PI as well as the intertwine PI difference of 0.5 and more correlated significantly with lower gestational age at delivery, intertwine growth discordance of 35% or more, lower birth weight, and abnormal fetal outcome. The abnormal cerebro-umbilical (C/U) ratio correlated statistically with lower birth weight, abnormal fetal outcome, and an increased risk of premature delivery. There were no statistically significant differences in the majority of parameters that characterize the neonatal outcome between the groups with normal and abnormal MCA PI. Conclusion: The intertwine UA PI difference ≥0.5 had the highest predictive value in the assessment of adverse fetal outcome and risk for small for gestational age (SGA). Relatively poor sensitivity was noted with regard to the abnormal values of UA PI and C/U ratio. The worse correlation was found in case of MCA PI.

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 contains a joint position of the Polish Gynecological Society and Polish Human Genetics Society on the cell-free fetal DNA testing in prenatal diagnosis. We present situations where the cell-free fetal DNA testing should be applied and cases in which performing of the test is not useful. We indicate what diagnostic steps should be performed before the test and how the test results should be interpreted and followed.

This paper presents a case of a pregnant woman with a history of two cesarean sections. The patient was admitted to the hospital because of vaginal bleeding. The ultrasound revealed a placenta covering the internal os. The placenta was characterized by heterogeneous echogenicity with visible irregular hypoechogenic areas and blurred border between the placenta and the cervix. Rich vascularity was observed on the border of the placenta, urethra and the urinary bladder. Cystoscopy showed severe congestion around the urethra. On the back wall of the bladder a slightly increased vascularity was seen, which did not allow to confirm or exclude placental ingrowth in the urinary bladder. At 38 weeks, the patient was scheduled for an elective cesarean section. A classic perpendicular incision and leaving the placenta in the uterine cavity were proposed. After opening the abdomen, a strong vascularization in the region of lower part of the uterus and the urinary bladder was seen. Uterine incision in the fundus and the posterior wall was performed. A female fetus (weight: 2950g, Apgar: 10,10) was born. Then, the umbilical cord was ligated with non-absorbable suture and inserted back into the uterus. However, due to the presence of abundant and persistent vaginal bleeding during the next few minutes, conversion to obstetric hysterectomy was required. During relaparotomy fragments of the placenta appeared on the right side after sliding the urinary bladder. The bladder and the left ureter were damaged during surgery. The urinary bladder was sewn after removal of the uterus. Next, the urologist anastomosed end-to-end the left ureter on the pigtail catheter In the third hour of operation, cardiac arrest was caused by ventricular fibrillation. Immediate resuscitation with defibrillation allowed to restore normal function of the cardiovascular system. Total blood loss during the operation was 3000-4000 ml. During surgery 10 units of packed RBCs, 7 units of fresh frozen plasma, and 4 units of cryoprecipitate were transfused. The patient received antibiotics and anticoagulation therapy. Polyuria was diagnosed in the following days of puerperium, accompanied by electrolyte disturbances in serum and urine. The patient was treated with vasopressin and the electrolyte disturbances were corrected. On day 10 postpartum, the urinary catheter was removed, and clear significant improvement and stabilization of renal function and patient health were obtained. The patient was discharged from the hospital on day 19 of the puerperium. In summary it is clear that the steadily increasing rate of cesarean deliveries may result in the future in an increased number of abnormal placentation cases. Abnormal placentation is one of the most important risk factors of severe obstetric complications, including perinatal massive hemorrhage, which can lead to abnormal organ perfusion with cardiac arrest. Therefore, prenatal diagnosis and identification of abnormal placentation are vital in order to plan adequately the date, place, and mode of delivery as well as to ensure the availability of highly qualified specialists in the field of obstetrics and anesthesia, and organize sufficient amount of blood products and blood substitutes.

Vasa previa is a rare condition in which unsupported by the placenta, umbilical cord blood vessels runs within the placental membranes between internal os of the cervix and presenting part of the fetus. We report an antenatal diagnostic procedure and management of a patient with low-lying placenta and velamentous cord insertion near to the internal os with two large fetal blood vessels coursing between the internal cervical os and fetal presenting part. An elective cesarean section was performed at 36 weeks gestation.

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.

Aim: To evaluate the relation between retrograde diastolic blood flow in the aortic isthmus and adverse perinatal outcome in fetuses with IUGR. Materials and Methods: The study included 33 fetuses with IUGR defined as the estimated fetal weight and abdominal circumference under the 10th percentile for a given gestational age. The Doppler examination of the blood flow in the aortic isthmus, umbilical artery, umbilical vein, middle cerebral artery, uterine arteries and ductus venosus was performed regularly. The study population was further divided into two subgroups, depending on the aortic isthmus blood flow direction, i.e. with and without retrograde isthmic diastolic flow. Furthermore, the relation between Doppler blood flow parameters and determinants of the perinatal outcome was analyzed. The perinatal outcome was reported as adverse if any of the following occurred: umbilical cord blood pH < 7,2; 5-minute Apgar score < 7; respiratory distress syndrome, intraventricular hemorrhage (III/IV grade); necrotizing enterocolitis; sepsis; intrauterine or neonatal death. Results: There was no statistically significant difference in the incidence of adverse perinatal outcome between the antegrade and retrograde isthmic blood flow groups. Moreover, the study showed no statistically significant relationship between the retrograde blood flow in the aortic isthmus and the prevalence of abnormal flow in the analyzed vessels. Conclusion: Retrograde diastolic blood flow in the aortic isthmus presents a low sensitivity and low predictive value in predicting the adverse perinatal outcome in pregnancies complicated with IUGR.

The paper presents current views and recommendations for pregnancy complicated by TTTS. The symptoms that should attract our attention during the first-trimester ultrasound, i.e. CRL asymmetry NT > 95th percentile, or 20% or more of the NT difference between the fetuses, absent or reversed A wave in DV, and TV regurgitation, are discussed and presented. Similarly symptoms that should attract our attention in the second trimester such as amniotic fluid volume imbalance, asymmetry in the size of the urinary bladders, abdominal circumferences discordance, inter-twin membrane folding, membranous attachment of the donor's umbilical cord, different placental echogenicity and abnormal Doppler measurements, are listed. The paper presents the principle of monitoring based on ultrasound examination, including Doppler studies. The necessity and usefulness of echocardiography is underlined. It is also stressed that the frequency of monitoring depends on the severity of hemodynamic changes and the check-up rate varies from once a week to daily monitoring in extreme cases. This paper presents a variety of therapeutic options, including conservative management, septostomy amnioreduction, laser and selective fetoreduction. Taking into account the level of disease severity stages I and V can be managed conservatively. Fetoscopic laser coagulation of anastomoses, which can be used almost in all stages of TTTS (I-IV), remains to be the treatment of choice. However the current level of evidence does not yet allow us to determine whether laser coagulation increases or reduces the risk of neurodevelopmental delay and mental retardation in children, as compared to other types of therapy. Amnioreduction may be recommended in cases when laser therapy is unavailable or as first-line therapy before transporting the patient to the intrauterine therapy center.

Monochorionic twin pregnancy is associated with an increased perinatal morbidity and mortality Placental anastomoses are typical for monochorionic pregnancies and may play a role in the development of severe complications such as twin-twin transfusion syndrome (TTTS) and recently discovered twin anemia-polycythemia sequence (TAPS). Both TTTS and TAPS are the chronic form of feto-fetal transfusion. There is a typical oligohydramnios/polyhydramnios sequence in the TTTS syndrome, whereas TAPS is characterized by large inter-twin hemoglobin difference in the absence of amniotic fluid discordances. The paper presents a case of TAPS at 20 weeks of gestation in a 35-year-old primigravida with monochorionic, diamniotic pregnancy TAPS was the cause of Intrauterine fetal death of one of the twins. In the absence of signs of fetal distress an expectant management was considered. An elective cesarean section was performed at 35 weeks of gestation due to decelerations in CTG. This paper presents a clinical case, as well as diagnostic criteria, classification, perinatal management and outcome in TAPS. The review of the literature is also included, focusing on the diagnostic differences between TAPS and TTTS, two distinct variants of feto-fetal transfusion. This case presents a twin anemia-polycythemia sequence, a rare and heterogeneous disease with a wide range of outcome. TAPS may remain undetected during pregnancy and result in the delivery of two healthy neonates with large inter-twin hemoglobin discordance. Unfortunately TAPS may also lead to intrauterine fetal demise of one or both twins, particularly in cases when it is undetected and untreated.

Venous insufficiency can be defined as a fixed venous outflow disturbance of the limbs. It is caused by the malfunction of the venous system, that may or may not be associated with venous valvular insufficiency and may involve the superficial or deep venous system of the lower limbs, or both. The CEAP scale includes clinical, etiologic, anatomic and pathophysiologic aspects and has been used in the assessment of venous insufficiency Clinical classification comprises of 7 groups. It takes into account the appearance of the skin of the lower limbs, presence of edema, teleangiectasis and varicose ulcers. CLINICAL GRADING: Group C0 - no visible changes in the clinical examination; Group C1 - telangiectasis, reticular veins, redness of the skin around the ankles; Group C2 - varicose veins, Group C3 - the presence of edema without skin changes; Group C4 - lesions dependent of venous diseases (discoloration, blemishes, lipodermatosclerosis); C5 Group - skin changes described above with signs of healed venous ulcers; Group C6 - skin lesions such as in groups C1 to C4 plus active venous ulcers. ETIOLOGICAL CLASSIFICATION INCLUDES: Ec - congenital defects of the venous system, Ep - primary pathological changes of the venous system, without identification of their causes; Es - secondary causes of venous insufficiency of known etiology (post-thrombotic, post-traumatic, etc.). There are many methods of assessing the venous system. One of the most accurate methods is an ascending phlebography which is especially useful in determining detailed anatomy of the venous system, venous patency and identification of perforans veins. The second method may be a descending phlebography useful in determining the venous reflux and morphology of venous valves. Another radiological method is varicography in which the injection of the contrast medium directly into the veins is performed. It is especially useful in the ,,mapping" of venous connections. Trans-uterine phlebography when contrast medium is injected into the bottom of the uterus and its flow is observed, is a very rare test. A similar method is used in a selective phlebography of the ovarian vein and internal iliac vein. This examination is performed when there is a suspicion of connections between varicose veins of the inferior extremities and the pelvis, in case of the occluded iliac and femoral veins. However these tests are highly invasive, causing a lot of discomfort and are connected with numerous complications, particularly the development of venous thromboembolism. An invasive study but not exposing to the emission of ionizing radiation, is a measurement of the marching pressure (known also as ambulatory venous pressure - AVP). Ultrasound Doppler is the "gold standard" in the diagnosis of venous system. Color Doppler technique is irreplaceable due to its non-invasiveness, availability constantly improving of the ultrasound machines and is the method of choice in pregnancy Unfortunately clinical correlation of Doppler ultrasound and thrombosis is bad. Invasive methods, which include various types of phlebographies, have been reserved only for cases of very high diagnostic doubt.

INTRODUCTION The aim of the study was to determine the usefulness of Doppler velocimetry, based on cerebroplacental ratio (C/U) evaluation, in predicting intrapartum fetal heart rate abnormalities and adverse neonatal outcome in uncomplicated pregnancies at 40 weeks and beyond. MATERIAL AND METHODS One hundred and forty-eight women in uncomplicated pregnancies, between 40 and 42 completed weeks, were divided into control and study groups: with the absence (n = 79) and with the presence of a fetal brain-sparing effect (n = 69), respectively. Pulsatility and resistance indices in the middle cerebral, the umbilical artery and the C/U ratio were evaluated daily by Doppler ultrasonography. C/U < 1.1 was reported as suggestive of a brain-sparing effect. Abnormal flow indices were analyzed and compared to adverse pregnancy and neonatal outcome determinants. RESULTS In the abnormal C/U group the abnormal CTG records were significantly more frequently observed (62.3%) than in normal C/U group (19.0%) (p = 0.0001). The comparison of selected Doppler indices revealed that C/U showed the highest sensitivity in prediction of both the intrapartum abnormal FHR (74.1%) and the adverse neonatal outcome (87.8%). CONCLUSIONS The C/U index shows the highest sensitivity in prediction of FHR abnormalities and adverse neonatal outcome in uncomplicated pregnancies at 40 weeks and beyond. The C/U index is useful in clinical practice in antenatal monitoring of these women in order to select those at high risk of intra- and postpartum complications.

The incidence of multiple pregnancies has increased dramatically over the last few years in developed countries, largely attributed to delayed childbearing and the increasing use of assisted reproduction technologies and ovulation inducing hormones. Relatively few countries have population-based statistics covering birth statistics. Of those that do, the numbers of quintuplet pregnancies rose sharply in the nineties while, at the same time, their delivery rates decreased greatly because of the use of fetal reduction. Fetal reduction is not possible or legal in some countries, Poland being one of them, and therefore obstetricians are faced with the challenges of quintuplet deliveries. Conservative treatment and management is difficult, and outcomes often vary greatly. Despite this, expert care provided at tertiary care centers can positively influence outcomes. The objective of this article is to present different care options and their consequences in two illustrative cases, as well as to establish a set of obstetric care and management goals that would allow prolongation of the gestation time. Quintuplet pregnancy is rare but poses relevant clinical problems to both the obstetrician and the neonatologist. It should be managed with close cooperation between all concerned. Due to the extreme and invariable risk of premature delivery associated with quintuplet pregnancies, we recommend early diagnosis, adequate prenatal care at one tertiary medical center, routine hospitalization and bed rest, repeated ante partum ultrasound surveillance with tests of fetal well-being, tocolytic therapy at first signs of the risk of premature labor, and specialized neonatology care after delivery.