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Objective: Twin pregnancies are associated with higher neonatal mortality and morbidity. Growth discordance and monochorionicity are among the factors that worsen the course of pregnancy. The study aimed to assess neonatal conditions and mortality in relation to growth type and chorionicity., Materials and Methods: Data from 820 pregnant women with twin pregnancies and their 1640 newborns were analyzed. The Apgar score and umbilical artery blood pH, as well as the rate of complications, were compared between dichorionic diamniotic (DCDA) and monochorionic diamniotic (MCDA) twins with symmetric and discordant growth. The Student's t-test and the Pearson chi-square test were used for comparisons., Results: There were 576 (70.2%) DCDA pregnancies, including 421 (73.1%) with symmetric growth and 155 (26.9%) with discordant growth, and 244 (29.8%) MCDA pregnancies, including 110 (45.1%) with symmetric growth and 134 (54.9%) with discordant growth. A significantly greater percentage of twins with discordant growth occurred in women older than 34 years than in those that were younger. An Apgar score of ≤7 was significantly more common among MCDA discordant twins, while an arterial umbilical blood pH of <7.2 was more common among MCDA twins with symmetric growth. Early neonatal deaths (n = 29; 1.8%), respiratory disorders, and a birth weight of <1500 g were significantly more common in MCDA twins than in DCDA twins., Conclusion: MCDA twins with growth discordance are burdened with a higher risk of neonatal morbidity and mortality than symmetric DCDA twins. Chorionicity and growth discordancy are important determinants of the outcome of twin pregnancy., (Copyright © 2019. Published by Elsevier B.V.)

The aim of the study was to assess the self-reported cervical cancer screening rate among patients with inflammatory bowel diseases (IBD) and patient attitude towards human papilloma virus (HPV) vaccination. A self-designed survey was conducted in hospitalized IBD patients. The survey comprised demographic data, questions regarding cervical smear test frequency and vaccinations recommended for an IBD patient. Randomly, patients completed the survey with a physician present to determine question comprehension. In order to provide test-retest reliability a group of 10 patients completed it twice. Survey data from 150 IBD patients (mean age: 36 years, SD ± 13; mean IBD duration: 10 years, SD ± 6.5) were analyzed. Fifteen percent of the patients reported irregular cervical testing and 15% do not remember when having had a previous cervical testing performed. Only 69% of the patients undergo testing regularly; 30% annually, 32% every 2-3 years; 7% every 5 years. The mean age of patients tested regularly was 22 years, vs. 32 years tested irregularly (p < .001). Only 10% of women claimed that HPV vaccine is recommended for an IBD patient. There is a low adherence to the recommendations regarding cervical cancer screening and prophylaxis. Better multi-disciplinary cooperation between patients and physicians is required to improve patient education and outcomes.

Background: Interleukin 18 (IL-18) is a glycoprotein produced by macrophages. IL-18 influences different populations of T lymphocytes and NK cells and stimulates the production of INF-gamma by these cells. IL-18 induces both Th1 and Th2 response. That is why IL-18 is a unique cytokine., Objectives: The aim of work was to examine the concentration of interleukin 18 in amniotic fluid in the 2nd and the 3rd trimesters of physiological pregnancies., Material and Methods: 74 pregnant women were qualified to take part in the studies. The amniotic fluid samples by amniocentesis were taken from the patients. Two groups were distinguished among the examined patients: group I - 45 pregnant women qualified for genetic amniocentesis between the 15th and 19th week of pregnancy. All findings of the cytogenetic tests were normal. Group II: 29 pregnant women in their 3rd trimester were qualified for diagnostic amniocentesis in order to determine the biological maturity of the fetuses. The concentration of IL-18 was marked with the immunoenzymatic method ELISA with the use of the kit produced by the MBL company. Method sensitivity was < 12.5 pg/mL., Results: In the 2nd trimester of pregnancy the average concentration of IL-18 in the amniotic fluid was 454.69 pg/mL and in the 3rd trimester was 71.73 pg/mL. The obtained data proved that the average concentration of IL-18 in the 2nd trimester was significantly higher than in the 3rd trimester. The obtained differences in the findings were statistically significant (p < 0.05)., Conclusions: The presence and high levels of IL-18 in the amniotic fluid in the 2nd trimester of pregnancy indicate an early process of initiation of immunological mechanisms by the fetus. An average concentration of IL-18 in the amniotic fluid was significantly higher in the 2nd trimester of pregnancy than in the 3rd trimester, which may indicate the influential role of IL-18 on the development of the immune response in the fetus in this period of gestation.

Background: The ductus venosus (DV) is an intrahepatic end-part of the umbilical vein. Inappropriate first trimester DV Doppler blood flow patterns correspond to a higher risk of chromosomal abnormalities., Objectives: The aim of the study was to assess the usefulness of ductus venosus Doppler flow in a first trimester screening for aneuploidies., Material and Methods: A prospective study included 1526 singleton pregnancies with increased risk of chromosomal abnormalities who underwent prenatal first trimester screening between the years 2006-2009. All ultrasound scans were performed by experienced sonographers and included an assessment of fetal growth, nuchal translucency (NT), nasal bone assessment (NB) and ductus venosus (DV) blood flow. Reversed a-wave (atrial diastole) in the ductus venosus flow pattern was recognized as abnormal. In addition to DV blood flow, the levels of pregnancy-associated plasma protein-A (PAPP-A) and free β - human chorionic gonadotropin (β-hCG) in maternal serum were measured. The risk of chromosomal abnormalities was calculated using the Fetal Medicine Foundation software. The following risk levels were assumed: high risk results - 1:100 or lower, intermediate risk 1:100 - 1:1000, and low risk above 1:1000. In 523 pregnancies, patients underwent amniocentesis and karyotyping., Results: The authors diagnosed 46 cases with chromosomal abnormalities (using amniocentesis and karyotyping). 29 patients had spontaneous miscarriage, in 21 cases they reported fetuses with congenital malformations (mostly heart defects). Abnormal DV blood flow was recognized in 113 pregnant women (7.4%). The majority of cases affected by abnormal DV blood flow were classified as intermediate and high disorder risk groups - 100 (6.5%). The comparison between a combined test with and without DV assessment revealed that the addition of DV flow pattern results increased sensitivity from 84% to 92% in screening for aneuploidies. The false-positive ratio was between 0.4% and 2.4%., Conclusions: Ductus venosus Doppler blood flow examination is useful in the first trimester prenatal diagnostic since it increases the sensitivity of the combined test in the assessment of risk for chromosomal abnormalities. The authors recommend assessing DV blood flow during the first trimester screening in all pregnancies, irrespectively of the chromosomal abnormalities background risk. This procedure in clinical practice seems to be favorable and less complicated.

Objectives: The study aimed at determining whether there exists a correlation between the cervical cohesion parameters assessed in the elastography and the length of the cervix., Material and Methods: Assessment of cervical cohesion parameters with the use of real-time sonoelastography was performed on 59 patients between 28 and 39 weeks of gestation., Results: The analysis showed that there exists a statistically significant (p=0.033) correlation between the cervical length and the elasticity of the front cervical labium (strain ratio A). Correlation coefficient (r) stood at (-) 0.28., Conclusions: 1. There exists a negative correlation between the condition on the front cervical labium in elastographic imaging and the length of the cervical canal in USG imaging. 2. Elastography of the uterine cervix may be helpful in assessing the risk of premature labour or cervical insufficiency. 3. There is a need to perform a study on a larger group of patients in order to determine whether elastography may find its place among routine obstetric diagnostic methods.

Background: Little is known about the behavior of interleukin 15 (IL-15) and 18 (IL-18) in the amniotic fluid in the second trimester of gestations complicated by chromosomal defects in the fetus. Likewise, it has not yet been established whether a fetus with chromosome abnormalities creates its immunity mechanisms in the same way as a fetus with a normal karyotype., Objectives: The aim of this work was to assess the concentration of IL-15 and IL-18 in the amniotic fluid in the second trimester of gestation in fetuses with normal karyotypes and with chromosome abnormalities., Material and Methods: The material consisted of 51 samples of amniotic fluid obtained from genetic amniocenteses carried out between the 15th and the 19th weeks of gestation. On the basis of cytogenetic screening, two groups were singled out: Group I--45 fetuses with normal karyotypes, and Group II--6 fetuses with abnormal karyotypes. The concentrations of IL-15 and IL-18 in the amniotic fluid were assessed with ready-made assays and analyzed, and the results from both groups were compared., Results: The differences between the IL-15 levels in the amniotic fluid from Groups I and II proved to be statistically insignificant (p = 0.054). However, the average IL-18 levels in the amniotic fluid of the fetuses with normal karyotypes were significantly higher than in the amniotic fluid of the fetuses with chromosome abnormalities (p = 0.032)., Conclusions: Some defense mechanisms in the second trimester of gestation in fetuses with chromosome abnormalities may develop in a different way than in fetuses with normal karyotypes.

Background: Cytokines play an essential role in the regulation of immunological responses. Interleukin 15 (IL-15) is a glycoprotein secreted primarily by macrophages and monocytes. IL-15 plays a key role in the immunological response of the cellular type., Objectives: The objective of this study was to evaluate changes in the concentration of interleukin 15 in amniotic fluid in the second and the third trimesters ofa normal pregnancy., Material and Methods: The study included 74 pregnant women who were subjected to a diagnostic amniocentesis in order to extract amniotic fluid samples. The patients were divided into two groups: group I - 45 pregnant women in the 2nd trimester, subjected to genetic amniocentesis during the 15th through 19th weeks. The results of the cytogenetic tests were found to be normal in all the fetuses. Group II: 29 pregnant women in their 3rd trimester, were subjected to amniocentesis in order to determine the biological maturity of the fetuses. The concentration of IL-15 was marked with the ELISA method using a kit made by the R&D company. Method sensitivity was > 2 pg/ml., Results: The average concentration of IL-15 in the amniotic fluid of 2nd trimester pregnancies was 6.54 pg/ ml, whereas in the 3rd trimester it rose to 18.62 pg/ml. Discrepancies were found to be statistically significant (p < 0.05)., Conclusions: The presence of IL-15 in the amniotic fluid in the second trimester of gestation indicates an early activation of the fetus's defensive mechanisms. An average concentration of IL-15 in the amniotic fluid is significantly higher in the third trimester of pregnancy than in the second trimester, which can mean about the development of the immune response in the fetus.

Triploidy is one of the most common chromosomal numerical aberrations, resulting usually from one out off two main mechanisms: aberrant segregation of chromosomes during meiosis or from the fertilization of one egg by two sperms. Triploidy usually causes prenatal death. In present paper the methods of non-invasive and invasive prenatal diagnosis of triploidy are described. We also report the case of triploid fetus, diagnosed by ultrasound visualisation followed by amniocenthesis and cytogenetic analysis.

Triploidy is one of the most common chromosomal numerical aberrations, resulting usually from one out off two main mechanisms: aberrant segregation of chromosomes during meiosis or from the fertilization of one egg by two sperms. In present paper the methods of non-invasive and invasive prenatal diagnosis of triploidy in I and II trimester are described. We also report the case of triploid fetus, diagnosed by ultrasound visualisation followed by amniocenthesis and cytogenetic analysis.

A leukaemic reaction is an increase of leukocytes count in peripheral blood between 20-50 G/l with significant percentage of immature white blood cells: metamyeloblasts, myelocytes and even myeloblasts in blood smear. The leukaemic reactions during cancers and many infections diseases, especially in the pregnancy, by their clinical symptoms and laboratory changes can imitate acute and chronic leukaemias. In this article we introduce a pregnant woman with the leukaemic reaction with leucocyte count 51 G/l and a presence of immature white blood cells with myeloblasts in peripheral blood smear. This leukaemic reaction was caused by inflammatory process in the myoma uteri and the urinary tract.

In this paper different views regarding the diagnosis and management of uterine myomas during pregnancy, delivery and puerperium are presented. A review was done of the complications which may develop during pregnancy depending on the sizes of the myomas and their localization in relation to the placenta. Indications for operative management of uterine myomas, given by various authors are presented. Controversies connected with enucleation of uterine myomas in pregnancy are described. Indications, contraindications as well as possible complications regarding enucleation of uterine myomas in pregnancy which appear in the bibliography are presented. An analysis was done of the possible dangers which threaten women with uterine myomas during puerperium. On the basis of our own experience, the authors are of the opinion that only abiding by the indications for enucleation of uterine myomas in pregnancy and during caesarean sections, can bring about good results. Management of women who have uterine myomas must be cautious and devoid of routine.

In this paper a case of a young pregnant woman with a uterine tumour of 9 cm in size, which was diagnosed as leiomyoma is presented. The patient was delivered at 33 weeks through caesarean section, during which abdominal viscera were found to be normal. Due to the size of the tumour, as well as its localisation--in the uterine wall in the vicinity of the big uterine vessels--an operation to excise it was postponed until after the puerperium period was over. After a few weeks the patient developed intensive abdominal pains. A computer tomography scan was done in which apart from swelling of the retroperitoneal lymph nodes, metastatic type changes in the lungs were also observed. Suspicion of a malignant uterine tumour was confirmed during operation, however due to the extensive progress of the disease a radical operation was not possible. In the histopathological examination stromal sarcoma was revealed. In spite of attempts at using chemotherapy and hormonotherapy no positive effect was achieved. Rapid development of the sarcoma led to the death of the patient after 4 months.

Objectives: To compare labour induction intervals between vaginal misoprostol and intravenous oxytocin as well as side effects of induction in post term pregnancies with intact membranes., Methods: One hundred women were retrospectively selected to two groups treated with vaginal misoprostol 50 micrograms every 12 hours as needed to maximum 150 micrograms and treated with intravenous oxytocin. The primary outcome measure was time from induction to vaginal delivery. Statistical analysis was performed by t-Student test., Results: Maternal age, parity, gestation were similar. There was a statistically important difference in labour induction intervals between the two groups. The mean time +/- SD to vaginal delivery in misoprostol group was 20.6 +/- 15.2 hours compared with 11.23 +/- 7.4 hours with oxytocin (p = 0.0396). Induction of labour failed in 12% and 32% in misoprostol and oxytocin treated group. Pethidine consumption in oxytocin treated group was higher (41 mg vs 89 mg, p = 0.04). Episodes of vomiting were more frequent in misoprostol treated group (22% vs 6%). There were no episodes of uterine hyperstimulation in both groups., Conclusions: Oxytocin stimulation resulted in a shorter induction to delivery interval. In misoprostol group induction failed in only 12% whereas in oxytocin group in 32%. There were no serious side effects in both groups. In misoprostol treated group patients required less analgetics then in oxytocin treated group.

Objectives: Sialic acid is a negatively charged monosaccharide attached to non-reducing end of N- and O-linked carbohydrate chains of glycoconjugates. The claimed biological functions of sialic acid include its participation in cell to cell recognition and interaction as well as affecting the function of receptors by providing binding sites for ligand. Increased sialic acid concentration have been observed in several diseases e.g. malignancies, diabetes, inflammatory disorders, rheumatoid arthritis and alcoholism., Design: The aim of the present work was to determine if the amount of sialic acid attached to glycoconjugates of amniotic fluid changes during pregnancy., Materials and Methods: The sialic acid content in 47 samples of amniotic fluid derived from pregnant women with gestational age between 13 and 42 was studied by sialic acid specific lectins immunosorbent assay. The patient samples were divided into seven groups., Results: Time dependent changes in the degree of sialylation of glycoconjugates in amniotic fluid during pregnancy, particularly in advanced pregnancy were observed. Moreover, the highest sialic acid content on glycoconjugates in pregnancies complicated by premature rupture of membranes and is prolonged pregnancy were also detected., Conclusions: Sialic acid content determination in amniotic fluid could be a potentially useful marker of inflammation process of amniochorion during pregnancy.

We analysed 86 pregnant women where we estimated the fibronectin level in specimens of amniotic fluid. During carrying out the experiment we noted that fibronectin is present in amniotic fluid and can be identified in a quantity mode. We have proved dependence between fibronectin level in amniotic fluid and the period of time from collecting the sample, up to the delivery. Fibronectin level in amniotic fluid doesn't depend on pregnancy duration, preterm rupture of amniotic membranes.

Objective: The aim of this study was to assess the usefulness of the assessment of cervical length and and measurement of fetal fibronectin level in cervical secretion of pregnant women in prophylaxis of premature deliveries., Material and Methods: 78 pregnant women hospitalized in Department of Fertility and Obstetrics, University School of Medicine Wrocław. They were divided into III groups: Group I-13 pregnant women who had premature delivery and the time between examination and delivery was no longer than 24 hours. Group II-20 women who had premature delivery, and the time between examination and delivery was longer than 24 hours. Group III-pregnant who delivered at term (control group). Between the 25th and the 34th week of pregnancy presence of fetal fibronectin in cervical secretion and ultrasonographic assessment of cervical length were done., Results: Significantly higher percentage of women with presence of fibronectin in cervical secretion and significantly shorter length of cervical length was stated in 13 pregnant women who delivered prematurely, between the 28th and 35th week of pregnancy comparing with other groups. In group II pregnant women delivered between the 28th and 35th week of pregnancy, and the time between examination and delivery was from 3 days to 4 weeks. In this group in 75% examined women fibronectin was present in cervical secretion. Significant was that cervical length in 14 of this group of women (70%) was no longer than 20 mm and in the rest was between 20-30 mm, moreover in no cases was longer than 30 mm. In group III only in 7% women presence of fibronectin in cervical secretion was stated and only in two cases (4%) cervical length was shorter than 20 mm, both of them delivered in 38th week of pregnancy., Conclusions: 1. Examination of fetal fibronectin in cervical secretion allows precisely estimate the risk of premature delivery. 2. Cervical length shorter then 20 mm collerates with the presence of fetal fibronectin in cervical secretion and with increased risk of premature delivery.

Objectives: Estimation of the long term prophylactic or therapeutic application of low molecular weight heparin (LMWH) on the platelets count, and incidence bleedings during pregnancy, delivery and puerperium in the women with varices of lower extremities and past thrombophlebitis of lower extremities., Material and Methods: 5212 pregnant, women in labour and in puerperium divided into 4 groups.; 142 women with varices and thrombophlebitis of lower extremities (group I); 10 with past thrombophlebitis of lower extremities (group II); 15 with thrombophlebitis in current pregnancy; 5045 without vascular complications (group IV--control). In group I during pregnancy compression therapy was applied (stockings) and low molecular weight heparins (LMWH) in course of puerperium. In group II during the 1st trimester of pregnancy and in labour the same heparin doses were administered, while the doses were increased in the 2nd and 3rd trimester. In group III, when thrombophlebitis was stated non-steroid anti-inflammatory drugs and LMWH were administered. In all cases treated with heparin both number of platelets and incidents of bleedings from genitourinary tract were observed. Presence of embolic complications was also noted., Results: No cases of decrease platelets number or bleedings from genitourinary tract were observed in group I-III during administering of LMWH. In women in group II where prophylactic with LMWH was applied no incidences of recurrent thrombophlebitis during pregnancy and puerperium were observed. In group I-III all newborns were born in good condition and no complications were observed. Average blood loss during both labour and cesarean section, among women in group I-III was not significantly different comparing with control group. No incidences of pulmonary artery embolism or decrease number of platelets were observed., Conclusions: 1. The long term prophylactic or therapeutical administration of LMWH in the women with varices of lower extremities or thrombophlebitis has no influence on the platelets count and incidence of bleedings from genitourinary tract during pregnancy or increase of blood loss during labour and puerperium. 2. In the women with past thrombophlebitis of the lower extremities after application of LMWH during pregnancy there were no recurrence observed.

Objectives and Study Design: The analysis of influence of closure and nonclosure of the visceral peritoneum during abdominal gynecological surgery was done., Materials and Methods: A postoperative course and late consequences (occurrence of adhesions) in the 427 patients were studied. There were two groups of patients: I group--203 patients who had visceral peritoneum closed, II group--224 patients who had visceral peritoneum non closed., Results: There were not significant differences in postoperative course in both groups. In the group where the visceral peritoneum was not closed occurrence of the adhesions was significantly decreased, when compared the group where the visceral peritoneum was closed., Conclusions: 1. Nonclosure of the visceral peritoneum doesn't increase the incidence of early postoperative complications. 2. Nonclosure of the visceral peritoneum during abdominal gynecological surgery decreased the incidence of adhesions. 3. Nonclosure of the visceral peritoneum prevents dislocation and ligation of the ureter.

Objectives and Study Design: The analysis of the influence of the closure or nonclosure of the visceral peritoneum during cesarean sections on the course of puerperium and late consequences., Materials and Methods: There were 577 patients at whom cesarean section was performed. They were divided into two groups: in the first group (270 patients) during the cesarean sections visceral peritoneum was closed whereas, in the second group (307 patients) visceral peritoneum was not closed. Postoperative course and conditions of the organs in situ at the time of the following operations was considered., Results: There were no differences in regard to postoperative course between two groups. In the group where visceral peritoneum was closed adhesions and upward dislocation of the bladder was observed whereas in the group where visceral peritoneum was not closed these abnormalities were not observed., Conclusions: 1. Nonclosure of the visceral peritoneum during cesarean sections is safe procedure. 2. Nonclosure of the visceral peritoneum during cesarean sections reduced frequency of the postoperative adhesions. 3. Nonclosure of the visceral peritoneum prevent upward dislocation of the urinary bladder.

Objectives: Assessment of the effectiveness of using low molecular weight heparin in the prophylaxis of venous thrombo-embolic diseases in pregnant women, parturients and puerperants., Material and Methods: 14,106 female patients were retrospectively analysed in the period between 1990-1999. The patients were divided into 4 groups: I--142 pregnant patients with crural varices, II--10 pregnant patients who had suffered from deep venous thrombosis, III--5 patients with implanted artificial cardiac valves, IV--13,949 patients without any risk factors. In the patients in groups I-III low molecular weight heparin was used prophylactically., Results: In the studied groups no cases of pulmonary embolism were observed. Superficial venous thrombosis occurred in 10 women (3 in group I and 7 in group IV). Deep venous thrombosis occurred in 5 patients (2 in group I and 3 in group IV). In patients who received low molecular weight heparin over a long period of time, no excessive bleeding during delivery was observed. Other complications in the form of osteoporosis and thrombocytopenia were also not observed., Conclusions: 1. Administering of low molecular weight heparin during pregnancy, labour and puerperium has no influence on the increase of maternal et fetal complications. 2. Administering of low molecular weight heparin in pregnant women, in labour and in puerperium with increase risk of thrombo-embolic disease allows to avoid pulmonary arteries embolism. 3. Pregnant women and women in puerperium with increased risk of venous thrombo-embolic disease should be under control of experienced obstetrician in cooperation with vascular surgeon and hematologist.

Objectives: The aim of the study was estimation of the influence of computer supervision of delivery on the way of medical management during partus., Materials and Methods: Authors analyzed 10,983 labours which took place in years 1990-1999 in University Clinic of Reproduction and Obstetrics of Medical Academy in Wrocław. Cases of labours without computer monitoring was the first analyzed group, and the cases of computer monitoring deliveries was the second group. In both groups, the count of cesarean sections performed because of first symptoms of fetal asphyxia, and Apgar score gained by newborns, were taken into consideration., Results and Conclusions: The frequency of cesarean sections and neonatal Apgar score gained by newborns were compared in two characterized group in order to evaluation the influence of computer monitoring deliveries on the neonatal status. No impact of computer supervision on the way of delivery procedures, quality of work and neonatals state was observed.

Objectives: Evaluation of risks involved with the use of oxytocin and prostaglandin in pregnancies after caesarean delivery or uterine surgery., Materials and Methods: This study involved 267 pregnant women who underwent caesarean delivery or gynaecological surgery within the uterus (myomectomy or Strassmann corrective surgery). Oxytocin and prostaglandin was used to induce uterine contraction in these women. We analysed their delivery methods and the frequency of complications like uterine rupture and rupture of past caesarean scar., Results: Uterine rupture occurred in one women had history of caesarean delivery (0.5%), and rupture past history of caesarean scar occurred in eight women (3.5%) who previously underwent caesarean delivery. Complications were not found in women with past history of myomectomy or Strassmann Corrective surgery. We did not observe an increase in complications among women who received prostaglandin compared to those who received oxytocin., Conclusions: 1. Cardiotocographic monitor during labour reduces the risk of uterine rupture and rupture of past caesarean scar in pregnant women with past history of caesarean delivery or other uterine surgeries. 2. The use of prostaglandin in comparison to oxytocin does not increase complications in women with past history of uterine surgery. 3. The choice of delivery method in pregnant women with past history of uterine should be individualised.

Objective: The aim of this study was to asses usefulness of cerebro-placental ratio in the estimation of the intrauterine fetal well being in pregnancies complicated by intrauterine growth retardation and prediction of perinatal outcome., Material and Methods: We investigated 22 pregnant women between 28th and 40th week of pregnancy with IUGR detected by ultrasound examination. 19 pregnant women between 28th and 41st week of pregnancy was control group. We measured parameters blood flow in umbilical arteries and in middle cerebral arteries in both groups. We calculated cerebro placental ratios(CPR, CPP). We divided pregnant women with IUGR int 2 groups depending on correct (CPR, CPP > 1.08) or incorrect (CPR, CPP < 1.08). In both groups we analyzed perinatal outcome., Results: In group pregnancies complicated with IUGR cerebro-placental ratios (CPR and CPP) were statistically significant lower than in control group. (for CPR p < 0.015 and for CPP p < 0.033). Sensitivity of cerebro placental ratio in screening small gestational age fetuses was 59% and specificity 89%. Sensitivity of cerebro placental ratio in predicting adverse perinatal outcome was 85% and specificity was 82%., Conclusions: Statistically significant decrease of cerebro-placental ratios is observed in pregnancies complicated wit IUGR. Cerebro placental ratio is very useful tool for prediction of adverse perinatal outcome.

Objectives: Analysis of early and late effects of surgical treatment at women suffering from the urinary stress incontinence., Materials and Methods: There were examined 52 patients treated surgically with urinary stress incontinence, and treated with perineoplasty (group I), treated with Marshall-Marchetti-Krantz procedure (group II), or both types of operations at the same time (group III). Early results of treatment were estimated at the 8th-10th day after surgical procedure, and late after two-eight years considering clinical and ultrasound examinations, and individual feelings of the patient., Results: A very good therapeutical effect of surgical treatment was obtained at 75% of patients, but the late one at 42% of patients. The early effect was the best within the group II (88%), whereas the late one within the group I, the worst results were obtained within the group III. The period between the procedure and repeated disorder was the longest within the group I. At women operated before menopause there were noted very good effects at 61% of them, but at those patients operated after menopause--at 38%, whereas the late repeated disorder often concerned the women operated before than after menopause (adequately 65 and 35%)., Conclusion: The treatment of the urinary stress incontinence employing perineoplasty compared with Marshall-Marchetti-Krantz procedure proved slighter risk of recurrence, slighter intensity and longer period without disorders. The application of both perineoplasty and Marshall-Marchetti-Krantz procedures simultaneously are more ineffective than of those procedures applied individually. Early effects of surgical treatment of urinary stress incontinence are better at patients operated before menopause, however more stable effect was noted at women operated after menopause.

The introduction of the amnioinfusion technic in the treatment of chosen complications of pregnancy, requires an easy access to the amniotic cavity. Catheterisation of the amniotic cavity requires the skilled technic, and is not associated with the rise of the obstetrics complications.

The four-quadrant sum of amniotic fluid pockets (amniotic fluid index) was studied prospectively in 130 normal pregnancies from 30 to 42 weeks. Statistical investigation were used to establish the mean, 95% confidence intervals and standard deviations for the AFI at each week of gestation. The AFI value decreased since 30 week, especially between 33 and 34 week and after 41 week. The AFI value < or = 5 represents oligohydramnios, the AFI value > or = 20 constitutes polyhydramnios.

The paper presents a case of uncomplicated pregnancy in 26-years old primipara suffering from congenital arteriovenous fistula. The clinical picture of disease was manifested by presence of vaso-dilatations in lower and upper limbs and in the vulva, because of which the pregnancy was terminated by cesarean section. Puerperal and postoperative outcome was uncomplicated. In the puerperal period heparin and large-spectrum antibiotic therapy was administered. No cardiovascular or thromboembolic complications were observed. Authors are of opinion, that in face of menace, the pregnancy and labour in the women presenting arterio-vascular fistula have to be considered as situation of high obstetrical risk.

Authors analyzed and evaluated biparietal head dimension (BPD), transversal chest dimension (THD) and femur length (FL) measured in the fetuses from 28 to 40th week in bigeminal pregnancies on the material of Wrocław population. Obtained results were presented as percentile curves of each parameter in succeeding weeks of pregnancy. In the face of findings in the 1st part of work (statistically lower parameters BPD and THD in twins in confrontation with fetuses in single fetus pregnancies and lack of correlations between FL dimensions), authors are of opinion that, for accurate evaluation of twins growth in examined population, in the period from 28 to 40 weeks of pregnancy, the application of ultrasonographical parameters net-work of BPD and THD parameters in necessary. Moreover, the authors are considering that the presented percentile BPD and THD curves may make a graphic image of twins intrauterine growth in the evaluated population.

Authors have ultrasonographically evaluated and analysed appropriate parameters determining fetal growth in bigeminal pregnancies in the population of Wrocław. The following parameters were taking in consideration: biparietal head dimension (BPD), transversal chest dimension (THD) and thigh bone length (FL). After the comparative analysis of the average BPD, THD, and FL values in fetuses from 28-40th single fetus and bigeminal pregnancies authors revealed, that BPD and TDH values were significantly smaller in twins that single fetuses. No correlation was found in FL values in both groups. In the aim to obtain more accurate evaluation of intrauterine growth in twins. Authors proposed an application of special ultrasonographic BPD and THD parameters net-works, different from those applicable for primiparous pregnancies.

The aim of this paper was the analysis of the clinical usefulness of the nomogram presented by Hansmann for the fetal weight prediction in normal, single fetus pregnancies of Wrocław population. The authors proved, that in the group of 36 pregnant women the least difference between fetal weight evaluated before birth and the birth weight of newborn was noted in the group of babies with birth weight 2000-4000 g. In the group with birth weight below 2000 g and over 4000 g respectively, the twice to octuple evaluation error is expected.

The preparation Salbupart POLFA was used in 40 pregnant women in the treatment of imminent premature labour. The tocolytic effect of the drug was confirmed, especially in pregnancy over 32 weeks. The observed side effects, mainly in the cardiovascular system, did not require drug withdrawal, but tended towards the necessity of using symptom-alleviating drugs such as Isoptin.