Search

OBJECTIVE: Fetal hypoxia and preterm delivery are reported to be strongly associated with brain damage and neurodevelopmental delay. Doppler signs of fetal brain sparing have been described during chronic hypoxia, but whether they are related to brain damage is unknown. The aim of this study was to evaluate if markers of tissue injury, i.e., tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) are related to signs of increased perinatal vascular impedance and/or fetal brain sparing in high-risk pregnancies. STUDY DESIGN: TNF-alpha and IL-6 levels were evaluated in maternal blood serum of 67 high-risk pregnancies. Serum samples were taken at the time of umbilical, middle cerebral artery and uterine artery Doppler velocimetry examination. The values for TNF-a and IL-6 were correlated with reference median values obtained with gestational age in the form of a Z-score. RESULTS: TNF-alpha levels showed values within the normal range in only four cases. IL-6 values were found normal in 14 cases. The Z-score for mean middle cerebral artery pulsatility index (PI) showed a significant correlation to TNF-alpha and IL-6 levels, P < 0.0001 and P < 0.003, respectively. This might suggest a strong correlation between signs of fetal brain sparing and increased maternal serum TNF-alpha and IL-6 levels. Abnormal uterine artery PI and the presence of a 'notch' were also highly significantly related to TNF-alpha and IL-6 levels, which were nearly two-fold higher compared to normal uterine artery blood flow and the absence of a 'notch'. Abnormal cerebro/placental ratios showed significant correlations to TNF-alpha and IL-6 levels. CONCLUSION: The present results suggest a strong correlation between levels of TNF-alpha and IL-6 not only for signs of fetal brain sparing, but also for uteroplacental blood flow. This finding supports the role of tissue injury in cases of fetal brain sparing, but whether this is a reflection of brain damage or secondary to placental pathology needs further evaluation. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to determine a healthy fetal growth pattern of twins from a Polish population based on an outcome-dependent growth curve., Methods: The fetal growth data of live-born twin pregnancies between 25th and 40th week gestation in the period of 1 January 2005 to 31 March 2018 from the database of a tertiary care women's hospital in Western Poland was used to calculate birth weight percentiles. The growth curves of singletons from the same database were used as comparison. Because this study aimed for an outcome-dependent approach for the calculation of fetal growth curves, all babies born that may have high risk of unfavorable outcome were excluded. After application of all exclusion criteria, 1317 records referring to 2634 children were included in our analysis. Growth curves of singletons from the same database were used as reference for this study., Results: A linear relationship between 10th, 50th, and 90th percentiles and gestational age were found for twins but not for singletons suggesting the different mechanisms of intrauterine growth between singleton and twin pregnancies. Week-to-week weight gain equal to or higher than 150 g in twins also predict a favorable outcome in absence of other pathologies., Conclusion: The calculated outcome-dependent fetal growth curves for twins in this study may help in the accurate diagnosis of small or large twin fetuses for their gestational age in this Western Poland population.

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.

Introduction: The etiology and pathogenesis of pregnancy-related hypertensive disorders is complex and multifactorial. The aim of our study is the investigation of the differences in the autoantibodies against angiotensin II type 1 receptor (AT1-AA) titers among pregnant patients with chronic hypertension, gestational hypertension, and preeclampsia compared to the healthy pregnant women. Patients and methods: We created three study groups (preeclampsia [ n  = 16], chronic hypertension [ n  = 13], gestational hypertension [ n  = 17]) and the control group consisting of 17 healthy pregnant women. Every compared group was matched for mother's age, parity, prepregnancy BMI, and gestational age at time of recruitment into study. The autoantibodies titer were assessed using commercially available ELISA kit. Results: We found a statistically higher AT1-AA titer in the group of patients with gestational hypertension (GH) and preeclampsia (PE) compared to healthy normotensive pregnant women (median 9.6 versus 7.8 ng/ml, p  = .01 and 10.9 ng/ml versus 7.8 ng/ml, p  = .02, respectively). There was no correlation between blood pressure values and AT1-AA titer in any group. We found no correlation in group with preeclampsia between urinary protein excretion and AT1-AA titer ( p  = .23, R = 0.32). Conclusions: We assume that pregnancy-related hypertensive disorders might be autoimmune diseases and AT1-AA contribute to the pathophysiology of the disease. Our study may have some therapeutic implications and shows the necessity of new research into the mechanisms involved in the production of AT1-AA. Such investigations might enable to inhibit the formation of these autoantibodies or elaborate another method for AT1-AA removal.

Objectives: Endocan plays a role in the development of vascular tissue in health and disease and is an indicator of endothelial cells activation and angiogenesis. Therefore, this study aimed to investigate the relationship between maternal endocan serum level and intrauterine growth restriction (IUGR) as well as ultrasound Doppler flow measurements indicating placental insufficiency., Methods: This study included a group of women with IUGR (n = 37) and a group of healthy pregnant women (controls, n = 37). The endocan serum concentrations were assessed using commercially available enzyme-linked immunosorbent assay kit. Every woman underwent an ultrasound examination with Doppler flow measurements of the uterine arteries, umbilical vessels, and fetal middle cerebral artery. We used the cerebroplacental ratio (CPR) to determine placental insufficiency., Results: We found significant differences in median (interquartile) endocan serum level (pg/mL) between study and control groups (464 [374-532] vs 339 [189-496], respectively; P < .001). The endocan serum level correlated neither with umbilical cord blood gases nor with Apgar score. Ultrasound Doppler findings revealed significant differences in middle cerebral artery pulsatility index (PI), umbilical artery PI, CPR, as well as mean uterine arteries PI between IUGR group and controls. In the study group, we found significant correlations between the serum endocan and CPR ( R = 0.56, P < .001) as well as between serum endocan and mean uterine arteries PI ( R = 0.46, P = .006)., Conclusion: Endocan is likely involved in the pathogenesis of IUGR in pregnant women and possibly is a useful marker of endothelial dysfunction in these cases.

Background/aims: Recent evidence suggests that impaired cytotrophoblast proliferation and migration are major factors responsible for the development of hypertension in pregnancy. Studies report that von Willebrand factor (vWf) is a specific endothelial damage plasma marker. The aim of this study was to evaluate the relationship between vWf maternal plasma concentration and maternal and fetal Doppler flow measurements in pregnancies complicated by hypertension. It may provide additional insight into the pathophysiology of pregnancy-related hypertension and show the potential method for disease prevention and therapy., Methods: We created 3 study groups: pregnant women with chronic hypertension (n = 10), gestational hypertension (n = 18), preeclampsia (n = 21), and control (22 healthy pregnant women). Every woman underwent ultrasound Doppler flow measurements performed simultaneously with venous blood collection. The vWf plasma concentrations were assessed using the commercially available enzyme-linked immunosorbent assay kit., Results: The preeclampsia group had significantly higher vWf plasma concentrations in those patients with ultrasonographic features of placental insufficiency than in those without these characteristics (638 ± 208 vs. 377 ± 74 ng/mL; p < 0.017)., Conclusion: Our results may confirm the arrangement and severity of endothelial damage in preeclamptic patients and may have identified those patients with a significantly higher risk of developing cardiovascular disease., (© 2018 S. Karger AG, Basel.)

Patients suffering from Turner syndrome (TS) demonstrate characteristic clinical features, with a short stature and gonadal dysgenesis causing infertility in most patients. Spontaneous pregnancies in women with TS are quite rare and pregnancy outcomes involving an increased risk of miscarriage and stillbirths are observed. In this case report, we present a 28 years old pregnant woman with the diagnosis of TS. Due to hypergonadotrophic hypogonadism, she was proposed an in vitro fertilization (IVF) program with an oocyte donor from unrelated anonymous women. After the second transfer, implantation occurred. In the 24th week of gestation, gestational diabetes class 1 was diagnosed. In the 31st week of gestation, polyhydramnios was diagnosed, although other parameters were reassuring. Considering the polyhydramnios, along with the diagnosis of Turner syndrome in the mother, we decided to perform an elective cesarean section. Subsequently, a healthy term male was born. For most women with the diagnosis of TS, the only way to become pregnant is through oocyte donation. The aim of this work was to characterize the course of pregnancy in TS patient and review literature addressing this issue.

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.

In prenatal life the fetus can be exposed to more incentires which affect the mother. In case of both active and passive smoking by pregnant women many pernicious substances contained in tobacco smoke can influence the foetus. The components of tobacco smoke can contribute to various antenatal complications. The aim of present work was to assess if the data given by the patient in anonymous questionnaire go along with the real exposure to components of smoke assessed on the basis of concentration of nicotine metabolite- cotinine in mother's serum and next to assess the risk of development of gestational hypertension and hypotrophy. The biological material was extracted with means of liquid-liquid technique and next we performed laboratory determinations with means of liquid chro- matography with sectrophotometric detection, in which norephedrine is used as inner sample. The study was carried out on 106 women in perinatal period who give birth from single, full term pregnancy. On the basis of questionnaire data considering the concentration of cotinine, the patients were divided into three groups: I group--active smokers (n = 27), II group--passive smokers (n = 32), III group--not exposed to tobacco smoke (n = 41). The average concentration of cotinine in blood serum in the first group was 129.6 ng/ml, second group--5.1 ng/ ml, but in all patients from the control group the concentration of cotinine was below the detection level. Gestational hypertension was diagnosed in 17 women (16%) and hypotrophy of the foetus was diagnosed in 15 patients (14%). Tobacco smoking didn't influence the development of gestational hypertension and hypotrophy showered it is more often observed in women exposed to components of tobacco smoke during pregnancy.

The aim of the study was to evaluate the influence of active and passive maternal tobacco smoking on the parameters of blood flow in the uterine arteries in the third trimester. of pregnancy. The study was performed among 96 pregnant women in a single full-term pregnancy in the third trimester of pregnancy. A questionnaire assessing the status of the concentration of nicotine and nicotine metaboliteotinine in the serum of pregnant. The plasma was extracted technique of liquid-liquid, and then performed laboratory assays using high performance liquid chromatography with spectrophotometric detection using norepinephrine as an internal standard. Based on the concentration of cotinine and interview patients were assigned to three groups: Group 1--patients smoking cigarettes during the entire pregnancy (23), group 2--patients exposed to environmental tobacco smoking (30) and a control group 3--nonsmokers and patients unexposed to passive smoking (43). In the third trimester of pregnancy blood flow in the uterine arteries was performed using "B-mode" technique with function of spectral Doppler. We analized the pulsatility index and resistance index in both uterine arteries, the presence of the indent diastolic "notch" and the scale of the uterine arteries. There were no statistically significant differences with regards to pulsatility index and index of resistance in blood flow in the uterine arteries in different groups of patients. The presence of the indent diastolic "notch" was significantly more frequent among active smokers, compared to women passively exposed to tobacco smoke and non-smoking women (39.1% vs. 20% vs. 4.6%; p = 0.012). The values in the scale of uterine arteries showed no significant difference between groups. Both active and passive smoking had no significant effect on the blood flow in uterine artery in pregnant women in the third trimester of pregnancy.

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.

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 (/ll/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.

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.

Adrenal diseases in pregnant women are diagnosed relatively rarely. The main cause of hypercortisolemia during pregnancy is Cushing's syndrome related to adrenal adenoma. It is important to diagnose Cushing's syndrome in pregnant women because it can lead to significant maternal and foetal complications and morbidity. However, due to physiological endocrine changes and symptoms in pregnant women the diagnosis of this disorder can be a challenge. One current case describes a 38-year-old pregnant woman with hypertension, oedema and an adrenal tumour. At the beginning, Conn syndrome was suspected, but after careful analysis Cushing's syndrome (with an adenoma of the right adrenal gland) was diagnosed. After delivery and 5 weeks of pharmacological treatment the patient underwent right side adrenalectomy by laparoscopy.

Chorioangioma (chorionic angioma) is the most common non-malignant placental tumor Taking into account its morphological structure, it can have significant influence on fetal condition and pregnancy depending on its size. In the presented case a substantial placental tumor was diagnosed and complications typical for chorioangioma, such as fetal hemodynamic disorders, polyhydramnios, gestational diabetes and premature labor were observed. The applied treatment led to normalization of the fetal and maternal condition and to prolongation of the pregnancy

There are many theories regarding the ultimate cause of pre-eclampsia, and nowadays it is thought that the mechanism of pathogenesis is most likely multifactorial. The pathophysiology probably involves both fetal or placental and maternal factors. The most likely relevant factors in the pathogenesis are the abnormal development of the placenta, systemic endothelial dysfunction or cell activation, and an imbalance between pro-angiogenic and anti-angiogenic proteins with a predominance of anti-angiogenic factors. In women with pre-eclampsia, placental tissue overproduces two main anti-angiogenic proteins which enter into the maternal circulation: soluble Fms- such as tyrosine kinase 1 (sFlt1 or sVEGFR1) and soluble endoglin (sEng). Moreover, these patients have low circulating blood levels of two pro-angiogenic peptides: placental growth factor (PlGF) and vascular endothelial growth factor (VEGF). Adequate levels of CECs (circulating endothelial cells), EPCs (endothelial progenitor cells) and microparticles most likely play an important part in the development and regulation of vascularization in pregnancy but the exact role of these cells and micropatticles in the pathogenesis of pre-eclampsia is unknown. Some imbalances in these levels are associated with endothelial insufficiency.

Unlabelled: 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 (PI) 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.

Unlabelled: Pregnant women are exposed to benzodiazepines for therapeutic purposes during gestation. The goal of this study was to evaluate prenatal exposure to benzodiazepines. Time of exposure during course of pregnancy is a significant aspect of fetal exposure to drugs. Benzodiazepine concentration assay in hair of mothers and newborns exposed prenatally to these drugs was performed in the studies. Development, validation and evaluation of benzodiazepine determination method in mothers and their newborns enables assessment of health risks for the child and implementation of adequate therapeutic procedures. We used A LC-ESI-MS/MS method that allowed determination of diazepam (the main benzodiazepine used by pregnant women was diazepam) and its metabolites (nordazepam, oxazepam) in hair of mothers and newborns. LOQ 10 pg/mg of hair was used in the study., Results: concentration of nordazepam was higher than parent drug (diazepam) and higher in newborns' hair when compared to mothers'. The mean concentrations of diazepam in mothers' hair were 31.6±36.0 and 34.1±42.4 pg/mg in the second and third trimester of pregnancy respectively. The mean concentration of diazepam in newborns' hair was higher and reached levels of 53.3±36.5 pg/mg. The mean concentration of nordazepam in the mothers' hair corresponding to the second and third trimester was 52.9±48.1 and 89.9±122.8 pg/mg, respectively. Nordazepam in the newborns' hair was detected at the mean level of 108.1±144.2 pg/mg. It was concluded that diazepam and nordazepam are permanently incorporated into the hair structure. Presence of diazepam and its metabolites in newborn's hair confirms that these benzodiazepines permeate placental barrier. Segmental analysis of mothers' hair enabled the assessment of drug administration time. Diazepam and its metabolites determined in hair of newborns may serve as biomarkers of prenatal exposure to these drugs. The performed LC-MS/MS analysis was accurate enough to determine even low concentrations of benzodiazepines, at the level of few pg/mg of hair. Levels of diazepam detected in hair of newborns were higher than levels determined in mothers. This may confirm the fact, that fetus's ability to metabolize diazepam is scarce. Nordazepam was found in higher concentrations in hair of newborns than in hair of mothers, which may suggest that it is cumulated in child's organism. Other metabolites of diazepam--oxazepam and temazepam--were detected in very few cases, in low concentrations.

Epilepsy is one of the most common neurological diseases in the world. One of the most difficult clinical problems associated with the disease is to treat pregnant women because the use of antiepileptic drugs increase the risk of birth defects in the fetus. The second most common use in pregnant women is an antiepileptic drug valproic acid. Its use is associated with an increased risk of serious birth defects such as neural tube defects, heart defects, cleft palate, urinary tract defects, limb defects, specific syndromes that cause dysmorfizm face or abnormalities of the reproductive organs and developmental disorders affecting cognitive and behavioral functions. To minimize the risk to the fetus can be through the use of contraception and planning for pregnancy, taking valproic acid monotherapy, at a dose of less than 1000 mg/day in 2-3 divided doses, folic acid supplementation, close monitoring during pregnancy and full cooperation with doctors: a gynecologist and neurologist. The aim of this study was to measure the concentrations of valproic acid in maternal serum and cord serum and a reference to the results of the newborn. The concentrations of valproic acid in the serum was performed using high performance liquid chromatography method with fluorometric detection. Valproic acid concentration in the blood serum of patients housed or slightly exceed the therapeutic concentration. In all samples of umbilical cord blood serum were detected, no drug found to have birth defects. Born children should remain under control in order to detect possible birth defects that cannot be detected immediately after birth.

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.

Aim: 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 trimester, Material and Methods: the 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., 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., Conclusions: 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.

Objective: 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 pregnancy, Material and Methods: The 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 trimester, Results: In 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 insufficiency, Conclusion: Pregnancy 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.

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.

Congenital high airway obstruction syndrome (CHAOS) is a very rare fetal malformation caused by obstruction of fetal airway because of laryngeal or tracheal atresia, subglottic stenosis, laryngeal cyst or laryngeal web. The prenatal diagnosis is inferred from secondary changes such as enlarged, hyperechogenic lungs, ascites and/or hydrops, flattened or everted diaphragms, dilated distal airways and mediastinal compression. There are only few cases of long-term survival described in literature. We present the case of fetus with such secondary changes diagnosed during routine ultrasound evaluation in 20 weeks' gestation. There were no other abnormalities and the kariotype was normal. In 26 weeks' gestation fetal hydrops appeared and subsequent polyhydramnios occurred in 28 weeks' gestation. The patient was planned for EXIT procedure during labor in experienced in CHAOS cases center. In 29 weeks' gestation the premature rupture of membranes and regular uterine contractions occurred and we've performed cesarean section. A multidisciplinary team of neonatologists, laryngologists and pediatric surgeons made their efforts to save the newborn, but there was complete laryngeal atresia and tracheal agenesia and immediate tracheostomy was impossible. The most important about CHAOS are early diagnosis, detailed fetal assessment and an adequate postnatal intervention for establishing fetal airways.

Objective: Preeclampsia (PE) is a hypertensive complication of the pregnancy. In our study we investigated the expression, localization, and signaling pathways of PK1 and PKR1 in third-trimester human placenta and myometrium and assessed the correlation between the PK1 and PKR1 expression and signaling and the incidence of the PE., Materials & Methods: We designed two study groups: pregnant PE patients and healthy, pregnant women. After collection, tissue was placed in RNAlater for RNA extraction, fixed in 4% neutral buffered formalin, and wax embedded for immunohistochemistry or placed in RPMI and transported to the laboratory for in vitro culture. We have collected and processed placental and myometrial biopsies from 40 patients - 19 were PE patients., Results: Only the PK1 mRNA expression comparison between PE and CTRL in placenta showed statistically significant difference (p=0.004). There was statistically significant difference in cell signaling in myometrium controls in 30 minutes after ligand. The rise in pERK/tERK ratio is clearly visible in time intervals 20 and 30 minutes in controls, although with no statistical significance. There was no difference in PK1 and PKR1 localization in the placenta and myometrium in the groups., Conclusions: The number of PKR1 is not reduced in PE. The reduced PK1 mRNA expression is not than dependent on PKR1 mRNA expression. The data shows that ST produces much more PK1 in healthy pregnant women than those suffering from PE. We can conclude that in PE the production of PK1 is impaired and so are the endocrine functions of the ST.

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.

Objective: We sought to establish references ranges and to test the hypothesis that biochemical tissue-specific markers for the heart in umbilical cord blood of newborns with cardiac defects and intrauterine growth restriction (IUGR) are abnormal., Study Design: A prospective study was conducted. Serum samples of the umbilical vein (n = 280) and artery (n = 156) from 599 healthy newborns at 37(+0)-42(+0) weeks of gestation were collected. Total creatine kinase (CK), CK-MB heart type (CK-MB), cardiac troponin T (cTnT), myoglobin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and S100 were measured. Reference ranges for each marker were constructed. Concentrations of tissue-specific markers from umbilical cord blood of neonates with cardiac defects (n = 10) and IUGR (n = 41) were plotted against the established reference ranges., Results: Reference ranges for each studied marker were established for both umbilical artery and vein. In fetuses with cardiac defects, both NT-proBNP (4/6 [66%] in the artery, 7/10 [70%] in the vein) and cTnT (2/10 [20%] in the vein) were increased. In fetuses with IUGR in the vein, NT-proBNP (10/41 [24%]) and cTnT (5/41 [12%]) were increased, whereas S100 (9/41 [21%]) was decreased., Conclusion: In a subset of neonates with cardiac defects or growth restriction, irrespective of the pH at birth, tissue-specific injury markers for the heart in umbilical cord blood are abnormal.

The P-glycoprotein (P-gp) plays an important role in carcinogen distribution and is connected with cell differentiation and apoptotic processes leading to carcinogenesis. Interindividual differences in P-gp activity could modulate susceptibility to cancer development. The MDR1 gene, coding for P-gp, is highly polymorphic and some mutations modulate P-gp activity. Recently, association between the MDR1 C3435T polymorphism and the cancer susceptibility was shown. We have hypothesized that MDR1 polymorphism could influence endometrial cancer susceptibility. We have matched 198 women with endometrial cancer and 198 controls. An additional group of 488 healthy volunteers was investigated. The MDR1 C3435T polymorphism was tested by LightCycler assay. The distribution of MDR1 3435 genotypes was significantly different between cases and controls (P = 0.006). Genotypes containing at least one 3435T allele were statistically significant more frequent in the endometrial cancer group (86.8% vs 75.2%, OR 2.18, P = 0.004). Our observation suggests that MDR1 C3435T polymorphism is correlated with endometrial cancer susceptibility.

Determination of xenobiotics in hair has become common in evaluation of exposure to drugs. It can be used to assess the drug intake among adults and exposure to these substances in prenatal period. The aim of this study was the nicotine determination in hair of newborns' whose mothers were smoking during pregnancy. Also the relationship between concentration of cotinine--the main metabolite of nicotine in the urine of mothers and nicotine concentration in their infants' hair has been evaluated. The group of 15 women who had been smoking during pregnancy and 10 non-smoking and not exposed to ETS women and their newborns were the subject of the study. The cotinine levels in maternal urine samples was measured by the high performance liquid chromatography (HPLC) with a spectrometric detection, with the use of norephedryne as an internal standard, after a prior extraction with the use of liquid-liquid technique. Nicotine assess in infants' hair was carried out by means of gas chromatography coupled with mass spectrometry, with the use of ketamine as an interior standard, after the prior extraction with the use of liquid-liquid technique. The mean cotinine concentration in the group of smoking women amounted to 1132.5+/-1236.3 ng/mg creatinine and the level of nicotine in hair of children amounted to 1.9+/-3.2 ng/mg of hair. In the group of non-smoking women the urine cotinine test showed that two patients were exposed to the tobacco smoke. Nicotine in their children's hair was below the detection limit. The demonstrated correlation between the nicotine concentration in infants' hair and the cotinine levels in mothers' urine shows that the source of fetal exposure to tobacco smoke constituents is smoking during pregnancy. The applied gas chromatography method/mass spectrometry method allows to evaluate the level of nicotine in hair of the newborns, whose mothers were smoking during pregnancy, however it seems that in the case of exposure to ETS a more sensitive method, such as gas or liquid chromatography coupled with tandem mass spectrometry has to be applied.

To assess the exposure to tobacco smoke constituents, the biomarkers are used. In most studies conducted among active smokers, the cotinine is usually utilised as such a biomarker. The aim of this study was to estimate an application of determining two nicotine metabolites, cotinine and trans-3'-hydroxycotinine (3-HC) in order to assess cigarette smoking among pregnant women. There were 25 patients (15 smokers, 10 non-smokers) admitted to Delivery Ward in Gynecology and Obstetrics Clinical Hospital of the University of Medical Sciences in Poznan. The free and total form of cotinine and trans-3'-hydroxycotinine in urine were determined by the means of high performance liquid chromatography with spectrometry detection. The results of this studies indicated that in urine both cotinine and trans-3'-hydroxycotinine are conjugated with glucoronide acid in the high degree. The linear correlation between free and conjugated form of cotinine and whole cotinine concentration indicates the possibility of application of all three of them as biomarkers of tobacco smoke exposure. The high conjugation of trans-3'-hydroxycotinine with glucuronic acid (over 80 %), and high correlation between glucuronide and total trans-3'-hydroxycotinine concentration proves necessity of having the urine samples hydrolysed or determining the 3'-hydroxycotinine glucoronide, when application of 3-HC as a biomarker of tobacco smoke exposure is concerned. Our studies confirm other authors' observations that division of 3'-hydroxycotinine and cotinine concentrations might be used as a predictor of differences in cotinine metabolite ratio (polimorphism). The studies shown that using analytical equipment, nowadays available in the most laboratories (HPLC), it is possible to determined two biomarkers which are very useful and give various information, no matter whether they are conjugated with glucuronic acid, or not.

Verification of the results of questionnaire studies of exposure to tobacco smoke require determination of the biomarkers in body fluids. For performing such measurements the fast and simple method is needed. The aim of this study was to estimate usefulness of enzyme-linked immunosorbent assay (ELISA) in routine cotinine determination in urine of active smokers and compare it with reference high performance liquid chromatography method (HPLC). In the study participated 15 non smoking and 15 smoking women. In the urine of tese women cotinine concentration of cotinine was measured by the means of HPLC and ELISA methods. The ELISA method, used in quantity measurement of cotinine in urine, is of great accuracy, sensitivity and specificity which were proved by comparison with high performance liquid chromatography (HPLC) reference method. Number of false positive and false negative results obtained by ELISA method did not exceed 10%. A high correlation coefficient, r=0.9056, between results of determining cotinine in urine by means of ELISA and HPLC methods, confirmed the utility of ELISA method to estimate the tobacco smoke exposure. The differences in cotinine concentration values obtained by ELISA and HPLC methods did not depend on cotinine concentrations in the urine samples. Although numerous advantages of ELISA method used to detect and determine cotinine, it should be taken into consideration that results might be overestimated and cross-reactivity with other xenobiotics present in urine must be concern.

Three-dimensional (3-D) ultrasound imaging has improved evaluation of organ circulation and might contribute new information on maternal and fetal blood supply. Flow index (FI) of 3-D color images has been proposed as a measure of perfusion. The aim of this study was to evaluate whether the 3-D FI is a parameter of volume flow and flow velocity in a human vessel and in a flow phantom. A 1-cm-long strip of the uterine artery was recorded in 3-D power Doppler (3D-PD) mode in a cross-sectional study of 170 normal singleton pregnancies between 26 and 42 weeks' gestation. A fixed ultrasound system installation was used during the examination. The VOCAL software integrated in the ultrasound unit calculated vessel volume and FI. Reproducibility of the measurements was tested. The method was also tested on a commercially available flow phantom. Reproducibility measurements gave satisfactory results, both in terms of inter- and intraobserver variation. Unexpectedly, in normal pregnancy, the uterine artery FI decreased slightly with gestation. Uterine artery vessel volume increased, however, with gestational age. A poor correlation was found between the FI and both flow velocity and volume flow in the flow phantom. In conclusion, 3D-PD imaging can give impressive anatomical pictures of organ vascular tree. However, the new FI is poorly related to flow velocity or volume of flow.

The purpose of the study was to measure the concentration of lead and cadmium in urine of women who smoked, were exposed to environmental tobacco smoke (ETS) and were unexposed during pregnancy. The correlations between exposition to tobacco smoke and socioeconomic factors, course of pregnancy and health status of newborns were estimated. The subjects of the study were 231 pregnant women. Information about exposition to tobacco smoke, socioeconomic state, course of pregnancy and health status of newborns was collected from self-created questionnaire. The estimation of tobacco smoke exposition of the women was based on the questionnaire data and their urine cotinine concentration. The urine concentration of lead and cadmium was measured by atomic absorption spectrometry with graphite furnace. The mean urine lead concentration of women who smoked, were exposed to ETS and unexposed to tobacco smoke during pregnancy were respectively: 38.2 +/- 59.1; 36.2 +/- 50.1; 32.7 +/- 53.5 ng/ mg of creatinine, and mean cadmium concentration were respectively: 1.9 +/- 1.6; 1.1 +/- 1.2; 1.3 +/- 1.5 ng/mg of creatinine. The correlation between the urine concentration of cadmium and cotinine was statistically significant. Increased frequency of tobacco smoking was in the group of the women aged less than 25 years, that finished primary or vocational school, had monthly income less tan 500 zł/family member, and have smoking partners. In the group of women who smoked during pregnancy the childbirth was statistically more often by caesarian and supported delivery. The newborns of mothers who smoked and were exposed to ETS had birth weight respectively 348.5 g and 281.1 g smaller than newborns of unexposed mothers. The length of newborns of smoking and ETS exposed mothers were respectively 2.8 cm and 0.7 cm shorter then newborns of unexposed mothers.

In Poland, tobacco smoking by women in a procreational age as well as the pregnant women is a common phenomenon. The aim of the conducted research was to assess the usefulness of cotinine markers in different biological materials--mother and newborn's urine, cord blood se. rum, placenta--as a biomarker of tobacco smoking by delivering women, and dependence between these biomarkers and the newborn's health state. 218 pregnant women (117 smokers and 101 non-smokers), who were checked in at the Perinatology and Gynecology Clinic of the University of Medical Sciences in Poznan, took part in the first stage of the research (period between the twelfth and sixteenth week of pregnancy) carried out between years 2004-2006. In the second stage, 201 pairs of women (89 smokers and 112 non-smokers) and their newborns were checked after the women came to hospital to deliver. The research that was conducted showed that both cotinine in the urine of delivering women and in the urine of newborns as well as in the cord blood serum may be used as a biomarker of exposure of a foetus to tobacco smoke. For practical reasons, it must be assumed that the delivering women urine should be the material from choice. The research did not indicate the usefulness of the determination of cotinine in the placenta, in order to assess the exposure of the foetus to the components of tobacco smoke. On the other hand, again it confirmed the influence of tobacco smoking on the newborn's birth parameters, a correlation between the birth weight, body length and cotinine concentration in the urine of a mother makes it possible to predict the lowering of the antropometric parameters of the newborn as a result of tobacco smoking by pregnant women.

Background: This paper presents an analysis of 25 patient cases in which recombinant factor VIIa was used in the management of postpartum hemorrhage, including severe and/or life-threatening bleeds. Anecdotal experiences in the empirical use of this agent are described and dosing regimens, effects on bleeding, and safety data are presented., Methods: Data were extracted from the international, internet-based, voluntary registry, haemostasis.com. Search results were manually cross-checked against monthly summary reports and cases of confirmed postpartum hemorrhage were analyzed by the authors. Case providers were contacted individually to approve the use of their cases, supply any missing data, and validate the data already held., Results: Of 43 reported gynecological admissions for hemorrhage, 13 were excluded as they did not relate to childbirth, and 5 due to insufficient data. The remaining 25 records, all associated with postpartum hemorrhage, were submitted by 14 doctors from 5 countries. Following administration of recombinant factor VIIa, bleeding stopped in 18 cases (72%), markedly decreased in 2 (8%), and decreased in 4 (16%). Bleeding increased following recombinant factor VIIa administration in only 1 patient (4%). Requirements for replacement blood products and crystalloids/colloids were also greatly curtailed. A full recovery was achieved by most patients (22/25, 88%) with few complications, even when recombinant factor VIIa was administered as salvage therapy. There were no thrombotic complications associated with recombinant factor VIIa administration., Conclusions: This review provides the largest aggregate of cases in which recombinant factor VIIa has been used to control obstetrical bleeding. A review of these cases suggests that this agent may be a useful and safe adjunctive therapy in the management of postpartum hemorrhage.

An essential problem related to tobacco smoking is exposure of children in the foetal period and early childhood to toxic compounds. The aim of this paper was to assess the exposure of pregnant women and their newborns to polycyclic aromatic hydrocarbons as a consequence of tobacco smoking. The exposure to tobacco smoke was determined through surveys and cotinine measurement in the urine of pregnant women and newborns, and the exposure to polycyclic aromatic hydrocarbons has been determined by measure of 1-hydroxypyrene in the same biological material. The cotinine concentration in the urine of smoking women and their newborns was respectively 416.0 +/- 319.9 ng/mg of creatinine and 46.5 +/- 37.2 ng/mg of creatinine. In case of non-smoking as well as non-exposed patients and their newborns, the concentration of cotinine was 0. The correlation between the concentration of cotinine in the urine of smoking women and their newborns was shown. The mean concentration of 1-hydroxypyrene in the urine of smoking patients was 0.65 +/- 0.45 ng/mg of creatinine, whereas in the urine of newborns, it was 0.46 +/- 0.41 ng/mg of creatinine. The concentration of 1-hydroxypyrene in the urine of smokers was increased together with the increase of cotinine, and the correlation factor was 0.5128. Such dependence was not indicated for concentrations of these compounds in the urine of newborns of these women. Within the group of non-smoking women, the concentration of 1-hydroxypyene urine of women was 0.25 +/- 0.29 ng/mg of creatinine, whereas among children 0.20 +/- 0.23 ng/mg of creatinine. In both examined group (smoking and non-smoking women) there is a dependence between the concentration of 1-hydroxypyrene in the urine of women and their newborns. The research concerning the assessment of exposure of pregnant women and their newborns to polycyclic aromatic hydrocarbons was conducted, and at the same time it was proven, that the placenta does not constitute a barrier for these compounds, which may freely get into the fetus. Probably for the first time a relatively large group of patients took part in this research. The directly proportional dependence between the concentrations of 1-HP in a mother and a newborn and significantly lower concentrations of this biomarker among the persons who are not exposed to tobacco smoke, indicate that the pro-health behaviours of the future mother (no tobacco smoking) significantly lowers the exposure of foetus to the carcinogenic compounds.

Three-dimensional (3-D) ultrasound (US) has greatly improved evaluation of organ circulation. The aim of this study was to explore the possible use of this new technique in normal and high-risk pregnancies. Fetal brain, lung and placenta 3-D power Doppler signal intensity were recorded in 115 normal singleton pregnancies (24 to 42 weeks gestation) and in 67 high-risk pregnancies. Mean image pixel signal intensity was calculated for each organ and a brain-lung ratio. In normal pregnancy, placental and lung signal intensity increased until 33, with a rapid decrease after 38, weeks of gestation. Fetal cerebral signal intensity increased with gestational age. Placental and fetal lung signal intensity was significantly lower in high-risk pregnancies than in the control group, with increased fetal brain and brain-lung ratios. The present results suggest a reduction of placental perfusion after 38 weeks of gestation in normal pregnancy, with redistribution of fetal circulation. Lung signal intensity increased abruptly at 32 weeks of gestation, which might reflect lung maturity. The new method showed signs of centralization of fetal circulation at the end of gestation. The results might suggest a possible clinical use for fetal surveillance in high-risk pregnancies.

Objective: To ascertain the frequency of polymorphic variants of the gene coding for angiotensin II type 1 receptor (AT1) and its correlation with umbilical artery (UA) blood flow velocity in a group of women with preeclampsia (PE)., Study Design: AT1 polymorphism, pulsatility index (PI) in UA, and perinatal outcome in 47 women with PE and in 113 healthy pregnant women were investigated. Investigation of AT1 receptor genotypes was performed by PCR/RFLP assays. PI value has been measured by Doppler velocimetry technique., Results: The overrepresentation of CC homozygotic genotype in PE group (6.4% vs. 2.7%) and the overrepresentation of mutated C allele in the PE group were observed (28.7% vs. 23.0%). Analyzing PI index we observed statistically significant differences between PE and control groups. Comparing PI values in PE group between genotypes: AA vs. AC + CC statistically significant differences (p < 0.05) have been observed., Conclusions: Observed overrepresentation of mutated C allele of the AT1 gene was correlated with increased blood flow in umbilical artery in women with preeclampsia. Doppler velocimetry might be a useful tool for indication in the high-risk group with overrepresentation of C alleles.

Objective: To estimate the usefulness of Doppler angiography in differential diagnosis of benign and malignant breast tumors., Setting: District special hospital, 1997-2000., Patients: 195 women with breast lesions detected by mammography or palpation in the out-patient clinic; 120 (average age 40 years) had benign lesions, and 75 (average age 54 years), malignant tumors, all confirmed by histopathology. There were 125 healthy controls, both pre- and postmenopausal., Methods: Areas of tumor in vivo and healthy breast tissue were scanned using the Doppler angiography option of an Acuson 128XP sonograph, with a 7-MHz transducer. The signals were recorded on videotape and transferred with a QuickCapture frame grabber board for PC analysis by HLImage 97 software (256 gray scale). Signal strength was given per 1 cm2. This result was taken as semi-quantitative perfusion of the tissue section., Results: In malignant breast lesions perfusion was significantly greater than in benign ones. Furthermore, perfusion of malignant lesions was not dependent on the phase of the menstrual cycle (1st vs. 2nd phase). The maximum sensitivity and specificity were 72% and 72.5%, respectively, based on ROC curves., Conclusions: This computerized Doppler angiography system is useful for differentiating between benign and malignant breast lesions in combination with other findings. It would also be useful for surveillance of apparently benign lesions. A limitation is the complicated computer analysis.

According epidemiological study tobacco smoking is popular addiction around the world. It was estimated, that one third of world population smoking tobacco. The statistical data from 2002 show that in Poland 42% of men and 22% of women smoke tobacco on a daily basis. As many as 60% of non-smokers are exposed to environmental tobacco smoke (ETS). The aim of the study was verification the answer on a standardised survey questionnaire (related to tobacco smoking) by laboratory method--determination of cotinine in urine. In the study participated 244 delivering women. In the tested group 23.8% of surveyed declared smoking during their pregnancy and around 28% of non-smoking women were exposed to passive inhalation of tobacco smoke. More than 15% of women, which declared non smoking has concentration of cotinine higher than 50 ng/mg creatinine (mean 227.3 ng/mg creatinine) what indicated active smoking of cigarettes. From these results we can conclude that as much as 35.6% of women smoking tobacco during pregnancy and is higher than suggested the questionnaire examination.

Despite of significant progress in the area of perinatal care, there have been numerous perinatal complications still existing. The health status of mother and newborn is affected by many factors, namely: socio-economical; medical prior to pregnancy and medical through the pregnancy; dietary customs, substance use, including tobacco smoking; health service quality; and risk factors that may occur through fertilization. The active and passive exposure to tobacco smoke in utero have been linked to numerous gestation and delivery complications, including low birth weight, preterm delivery and low Apgar score. In this survey, the awareness of health consequences of active and passive smoking in the population of pregnant women and access to the information of this consequence was assessed. Among of women smoking through their pregnancies, the only 19.7% got the information from their doctors about harmful effect of active and passive smoking, and 16.5% of respondents declared self-awareness on health effects of exposure to the tobacco smoke.

Among other toxic compounds, tobacco smoke contains also heavy metals, for example lead. Lead can cross the placenta barrier and have negative influences on fetus development. In the study compared urine lead concentration of pregnancy women exposed to tobacco smoke (active smokers and exposed to environmental tobacco smoke--ETS) with unexposed. There was find that mean urine lead concentrations in groups of pregnant women exposed and unexposed to tobacco smoke was no different (F2,189=0.2 p>0.8). However it was found that in urine of women exposed to tobacco smoke the concentration of lead increase with increase the concentration of cotinine (r2=0.14, t106=4.2, p<<0.0001).

Unlabelled: Anxiety constitutes one of the most important psychological factors influencing body reaction to surgical injury; in gynecological patients anxiety ratings appear especially high. Cigarette smoking belongs to essential risk factors in the perioperative period and may result in increased levels of anxiety. A pilot study has been carried out with the aim of evaluating the impact of smoking habit on the perioperative anxiety level and postoperative pain in women undergoing gynecological surgical procedures. In 9 smokers and 10 non-smokers, anxiety was assessed by means of the State Anxiety Score of the Spielberger State-Trait Anxiety Inventory (STAI) and the visual analog scale (VAS), preoperatively and on the second day after surgery. Additionally, intraoperative and postoperative opioid analgesic uses were analyzed and on the second day after surgery patients rated their recall of postoperative pain with the use of the VAS. Postoperative State anxiety was lower than that reported preoperatively only in non-smokers (median: 53.0-40.0, p=0.02, Wilcoxon p=0.02). Smoking did not significantly influence intra- and postoperative opioid analgesic requirements and postoperative pain., Conclusions: This study suggests that in female smokers subjected to gynaecological surgery cigarette smoking may contribute to altered anxiety kinetics in the perioperative period.