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Amnion is a membrane surrounding the embryo/fetus which determine growth factors and interleukins with angiogenic, immunogenic, and anti-inflammatory properties. The aim of the present study was to investigate the effects of conditioned culture medium from 24-h cultures of human amnion (hAM CCM) on migration and proliferation of human umbilical vein endothelial primary cells (HUVECs), freshly isolated bone marrow mononuclear cells (BM MNCs), and Jurkat leukemia cell line. Amnion membrane was freshly isolated from healthy placenta and its fragments cultured in vitro to produce hAM CCM. Members of the IGFBP protein family made up one third of all assayed proteins present in the hAM medium. The hAM CCM did not affect the proliferation rate of HUVECs or MNCs, but we observed more intensive migration of those cells, and lower expression of CD31 surface antigen on HUVECs as compared to control cultures. In contrast, Jurkat cells did not respond to hAM CCM treatment by proliferation or mobility change. The conditioned medium from 24-h cultures of human amnion is easy to obtain and is a convenient source of various growth and other factors that may be useful in practical medicine.

The aim of the study was to develop an optimal educational model for contraceptive counseling, to analyze conditions influencing choice of hormonal contraception, to study patients' opinions on present, planned and proposed contraceptive methods and to link these data with socioeconomic and demographic conditions.One thousand eight hundred fifty women (mean age 26.8 +/- 5.9 yrs) willing to use hormonal contraception were presented with essential information on combined hormonal contraception and asked to fill the anonymous questionnaire investigating factors influencing contraceptive choice and patients' opinion on alternative forms of birth regulation. The study was conducted in selected 185 centers in Poland and was a part of a larger survey (CHOICE) conducted on 11 216 women in Europe and Israel.Majority of the studied women were in stable relationship (85,5%), had higher or incomplete higher education (54.8%) and permanent job (54%). The purpose of the visit was to start/change contraception (64.2%), a routine gynecologic check-up (36.7%) or the need for a prescription for the continued contraceptive medication (18.7%). The most commonly used contraceptive methods were oral contraceptive pills (OCP 38.7%) and condom (24.9%). Majority of women highly valued contraceptive counseling and more than 90% were eager to get familiarized with information leaflets. Before the counseling majority of subjects stated that were convinced to use OCP (52.7%; major advantages named: easy to use, favorable bleeding profile, amelioration of menstrual discomfort, comfortable, discrete) and contraceptive patch (22%; major advantages named: applied once a week, comfortable, simple, low risk for noncompliance, favorable bleeding profile). After the counseling there was an increase in proportion of women interested in contraceptive hormonal ring (by 19%; major advantages named: applied once a month, comfortable, very low risk for noncompliance, high efficacy and positive recommendation from a physician). In 58 women no hormonal contraception was recommended, predominantly due to medical contraindications.Appropriate patient counseling on all forms of combined hormonal contraception, with special attention paid to benefits and safety issues, suited to women's expectations and education is fundamental for the selection of an optimal birth control method.

Nomegestrol acetate (NOMAC) combined with E2 (Zoely) is a monophasic oral contraceptive (OC) which safety and efficacy was confirmed in a number of level I evidence clinical trials. Zoely is highly effective OC, especially in overweight and obese patients, with good cycle control, safe and well tolerated. NOMAC/E2 combination causes no or minimal weight gain and is characterized by minimal influence on bone mineral density or blood pressure and presence of acne. Moreover lipids profile, carbohydrates metabolism, haemostasis and endocrine glands functioning were not affected. High tolerance and acceptance of NOMAC/E2 combination by women, low adverse event profile, fast recovery of ovarian activity and ovulation is a reasonable treatment tool in everyday practice.

Prenatal aortic valvuloplasty is performed only in few perinatal centers in the world. Critical aortic stenosis which can lead to hypoplastic left heart syndrome or severe fetal heart failure with nonimmune hydrops is an indication for this procedure. Prenatal intervention can change the natural course of the disease. Authors present the first successful fetal balloon aortic valvuloplasty in Poland. It was performed in a 29-week fetus with critical aortic stenosis, severe impairment of left ventricular function, heart failure and fetal hydrops. After successful intervention, without any complications, left ventricular function and fetal condition improved gradually Effective fetal intervention was possible after few months of preparation and building a team of specialists. This is the first successful fetal cardiac intervention in Poland, which opens the way to the new era of fetal cardiology and hopefully will lead to improve results in children with this critical heart defect.

This is a case report of a successful pregnancy outcome in a 36-year-old primigravida with an enormous leiomyoma. Potential pregnancy complications and pain treatment during pregnancy are discussed in the following work.

Pregnancy is a risk factor for both pulmonary embolism (PE), and an incorrect diagnostic assessment in cases of suspected PE with potentially dangerous consequences for the mother and foetus. The major concern is ionising radiation utilized by diagnostic tests and its potential negative effect on foetal safety. This paper presents diagnostic difficulties encountered in a 31-year-old patient at 20 weeks of gestation who was admitted to hospital with non-specific chest pain and suspected PE as a complication of right lower limb venous thrombosis. The case study reminds of chest ultrasound as a useful tool in the diagnosis of PE. The official clinical practice guidelines do not recommend the use of chest ultrasound for diagnosing of PE due to lack of a sufficient number of published studies. This case report may encourage further, prospective studies in the hope to define whether and when chest ultrasound might find its place in the diagnostic strategy of PE, especially in pregnant women.

Renal angiomyolipoma is a rare benign tumour composed of adipose tissue, blood vessels and smooth muscles. However it can locally grow to a great size and its numerous blood vessels may cause major bleeding requiring immediate intervention.At 20th week of pregnancy a previously healthy 26-year old pregnant woman with an episode of sudden and severe pain in the left flank followed by fainting was diagnosed with a bleeding tumour of the left kidney. The diagnosis was based on ultrasonography and magnetic resonance imaging (MRI). Diagnostic angiography was followed by selective embolization of the tumour blood vessels. At 38th week of pregnancy elective caesarean section was performed and after the puerperium the tumour was resected.Embolization of renal angiomyolipoma bleeding vessels during pregnancy can be an effective therapeutic approach protecting against further bleeding and haemorrhagic shock thereby obviating the need to perform urgent surgery and allowing the woman to carry her pregnancy to term safely in outpatient setting.

Recent epidemiologic studies indicate that use of combined oral contraception is associated with a increase in the incidence of cardiovascular disease (venous thromboembolism, pulmonary embolism, myocardial infarction and stroke). The risk of cardiovascular disease is strongly related to estrogen dose, progestogen type and other factors for example thrombogenic mutations and cigarette smoking among female over age 35. The progestogen only contraception is safe alternative to combined hormonal contraception. Progestogen only pill (POP) has different levels of action (local and/or central) which may vary from one drug to another. As for the cardiovascular disease risk, progestogens are not considered to be risk factors. Desogestrel containing POP is advised in the following cases: bad tolerance of exogenous oestrogens; in order to counteract an endogenous hyperoestrogenosis; medical, metabolic or cardiovascular contraindications to estroprogestogen contraception. Lastly, POP should be used as a prime contraception in some particular situations (breast feeding, endometriosis, adenomyosis, cigarette smoking, contraception for older women). These recommendations present the actual system of care in that population of women in Poland.

The number of HIV-infected women is increasing worldwide. A similar phenomenon has also been observed in Poland, where women constitute 30% of the HIV-infected population. Every year in Poland there are 70-100 infants born by HIV-infected mothers. Since the beginning of the epidemic, 147 HIV-infected children have been registered. The key issue in the prevention of mother-to-child transmission of HIV (PMTCT) is to identify the infection in pregnant women who report to hospitals for delivery and in breastfeeding mothers. In the majority of EU countries, the percentage of pregnant women diagnosed for HIV is over 60%, with some countries (England, Holland, France) where the percentage amounts to as much as 98%. In Poland the proportion is not greater than 10%. Almost all perinatal HIV infections in Poland occured due to the lack of timely diagnosis of the infection in a pregnant woman and the resultant failure to apply known and effective prevention measures. These recommendations present the actual system of care in that population of women in Poland.

The development of steroid-releasing vaginal rings over the past three decades is reviewed to illustrate the role of this device as an effective hormonal contraceptive for women. NuvaRing is a combined contraceptive vaginal ring that releases constant low doses of ethinylestradiol and etonogestrel. The soft flexible combined ring is inserted in the vagina for three weeks and removed for seven days to allow withdrawal bleeding with no serious side-effects. Maximum levels of EE and ENG with NuvaRing were 30% and 40%, respectively, of those seen with the COC. Because ENG bioavailability was higher following vaginal administration, the systemic progestogen exposures were comparable with the oral contraceptives. NuvaRing has been shown to be safe and effective, with high levels of user compliance, acceptance and patient satisfaction.

To compare efficacy and tolerability of drotaverine 80 mg and ibuprofen 400 mg in patients with primary dysmenorrhoea.Nine-month, multicenter (11 study centers in Poland), randomised, double-blind, phase III study, conducted in two parallel group, included 345 women between the ages of 18 and 35, suffering from primary dysmenorrhoea with presence of moderate to severe pain in each of the last 3 cycles. Patients had regular menstrual cycles and used an adequate barrier contraception method with a negative pregnancy test before randomization. Patients were given 80 mg drotaverine or 400 mg ibuprofen and asked to assess the pain intensity rated on a 4 point categorical scale (0--none, 1--mild, 2--moderate, 3--severe) at baseline and 0.5, 1, 2, 3, 4, 5 and 6 hours after the first intake and evaluate the efficacy (excellent, good, fair, poor) at the end of the treatment period. They were also asked to asses the tolerance of the medication (excellent, good, fair, poor).The weighted sum of pain intensity differences over the 6-hour observation period (SPID-6) was calculated. The pain intensity before the first intake was comparable in the two groups. At the time-points, the decrease of pain was always greater in the ibuprofen 400 mg group, than in the drotaverine 80 mg group and was maximum at the 4th hour in the drotaverine 80 mg group (-1.2+/-1.18) and at the 3rd hour in the ibuprofen 400 mg group (-1.7+/-0.99). 41.8% patients treated with drotaverine and 68.6% patients treated with ibuprofen assessed drug efficacy as excellent or good. Although the patients' global assessment of tolerability was significantly better (p=0.02) with ibuprofen 400 mg (excellent or good: 86.8%), than with drotaverine 80 mg (excellent or good: 78.4%), no relevant difference between the both groups was observed for frequency, nature intensity and causality of the reported adverse events.After analizing the data statistically and clinically, significant differences in favour of ibuprofen 400 mg were evidenced for efficacy criteria. Ibuprofen was more efficient and the effect was faster, than drotaverine in relieving pain in dysmenorrhoea. Both drugs were well tolerated. The reported adverse events were typical drug reactions or expected events in patients suffering from dysmenorrhoea.

Numerous commonly used medical contraception methods have been presented in this article. For obvious reasons, most of them are described only in general. The importance of selecting a method individually for every patient, taking into account her request, efficacy and safety of the method, was particularly emphasized.

The aim of our study was to determine the risk of aneuploidy and associated malformations in fetuses with holoprosencephaly. We have also analyzed the gestational age during the first examination.We have studied ultrasound reports of fetuses with holoprosencephaly.We analyzed 33 cases, diagnosed in the course of the last eight years in our center. All fetuses underwent a detailed ultrasound survey and, in most cases, antenatal karyotyping. In all cases the type of holoprosencephaly was assessed.In analyzed fetuses alobar holoprosencephaly was diagnosed in 24, semilobar in 7 and lobar holoprosencephaly in 2 cases. Associated anomalies were detected in 28 (mostly face defects) and chromosomal abnormalities in 12 cases. The median gestational age at the first examination was 25 weeks. No more than 14 examinations had been performed before 24 week.Our findings suggest that in case of fetuses with holoprosencephaly, a detailed ultrasound survey and karyotyping are essential to be performed in all cases. For that reason, patients with fetuses with holoprosencephaly should be diagnosed as early as possible in the referral center.

We have recently developed and published a noninvasive determination of fetal RhD status by examination of cell-free DNA in maternal plasma. The predictive value of the procedure of fetal testing, already published by us, was 99,6%.To assess the necessity of RhD fetal testing in immunized Rh(-) mothers with Rh(+) partners.Rh(-) mothers with anti-D antibodies, their partners and children.Molecular: RHD gene examination by real-time polymerase chain reaction; analysis of control genes present in the father but not in the mother. Serological: titre of anti-D antibodies, Rh phenotypes.Among 53 Rh(+) partners of immunized Rh(-) pregnant women, 56,6% were homozygous and 43,6%--heterozygous. The latter ones might have had either Rh(+) or Rh(-) children; in fact, in 52,2% of fetuses the D gene was not detected. Among fetuses of homozygous fathers (based on their phenotypes) 2 fetuses, to our surprise, occured to be Rh(-); however the subsequent genotyping showed that both fathers were heterozygous. The titres of anti-D in both groups of mothers with Rh(-) and Rh(+) fetuses were very similar.The examination of fetal D gene by noninvasive method should be performed in each alloimmunised Rh(-) mother if her partner is Rh(+). The prediction of RhD fetal status based on the fathers phenotype can be misleading, thus may result in unnecessary invasive method.

Our objectives were to determine the kind and localisation of the spina bifida and if open neural tube defects are associated with other anomalies and ventriculomegaly.We retrospectively studied ultrasound reports of the fetuses with open neural tube defects.We analyzed 178 cases diagnosed during the last seven years in our center. All fetuses underwent a detailed ultrasonographic survey. We also analyzed gestational age at the first examination.Associated anomalies were detected in 78 cases, in 100 cases spina bifida was the only anomaly. Lumbo-sacral and sacral localisation was presented in 88% of spina bifida not related with other anomalies and in 50% of cases with associated anomalies. In 94.4% of cases the malformation was myelomeningocoele. Ventriculomegaly was present in 89.1%. The median gestational age at the first examination was 26 weeks. Before 24 week only 34.3% of examinations was done.In fetuses with spina bifida detailed ultrasonographic survey should be performed. Measurement of the lateral ventricules should be done in each examination. Furthermore patient with fetus with spina bifida should be diagnosed as early as possible in the referral center.

The study was designed to evaluate the effectiveness of cervical cancer prophylactics by identification of the time of last cervical cytological examination as well as by recognition of frequency of repeated cervical cytological examinations and reimbursement for the examination costs in representative sample of Polish women aged 45-54.The study was conducted with the use of a standardized questionnaire in April 2004 in Polish nation-wide representative sample of 1083 women selected by random-route method. The study was adjusted for the following controllable variables: age, place of residence and its number of inhabitants, province.For the last 3 years cytological examination of cervical smear has been performed in 58% of women regardless of their age and education including 32% for the last year. Between 3 and 10 years ago the examination had been performed in 16% of women. As many as 14% of respondents admitted that they had never had this examination. 5% declared having the examination more than 10 years ago, 4% could not remember having this examination at all and the remaining women either were not aware of this examination or did not answer this question. Cervical cytological examinations repeated regularly every 12-18 months were declared by 30% of women. Regular cervical cytological examinations were performed significantly more often among women using hormonal replacement therapy (54%) and those living in big cities (44%). These examinations were free of charge for 823 of women.Considerable proportion (42%) of women aged 45-54 years have not had cervical cytology performed for the last 3 years. More than a half of them (23%) do not care about their health and are not aware how important this examination is. As few as 30% of women have regular cytologic examinations. These are more often women interested in hormonal replacement therapy and big city dwellers.

Pregnancy complicated by HCL is an extremlely rare event: only 5 report of HCL in pregnancy have been previously described. A 36-year-old women was diagnosed of HCL presented in 14 week of her 5th pregnancy. Therapy was initiated in 18 wk of gestation with IFN-alpha at dose 6 x 106 U subcutaneous 3 times per week and prednisone 20 mg/d. IFN-alpha administration was well tolerated. After IFN-alpha therapy partial remission was achieved. The course of the pregnancy was normal. At week 39 of gestation a cesarean cection was performed and the patient delivered a healthy male infant weighing 3460 g with Apgar score of 10. The placenta was of normal size, no infiltration of hairy cell was founded. Post-partum course was uncomplicated. The patient elected to not breast feed her infant. 3 weeks after delivery patient had a 5-days course of 2CDA

This is a case of a patient, who had peripheral blood progenitor cells transplantation as treatment for aplastic anaemia and changed her blood group phenotype from Rh plus to Rh minus. When she became pregnant, she produced very early anti-Rh-D antibodies. These antibodies were directed against erythrocytes of the foetus who inherited Rh-D antigen after his mother (father was Rh minus). During this pregnancy we observed a mild example of Rh-disease, which required fetal blood testing, without the necessity of intrauterine blood transfusion. We can assume, that the immunization with Rh-D antigen had taken place before pregnancy, probably during the blood group conversion after the transplantation. We think, that blood progenitor cells transplantation, different in groups of blood may exemplify a new source of immunization and development of serological conflict in pregnancy. In cases of pregnancies, in which the child's mother or father is after grafting of blood progenitor cells, when analyzing the blood group of the foetus we should know the blood groups of parents before transplantation.

We describe the case of a woman, who changed her blood group phenotype from Rh plus to Rh minus, as an effect of peripheral blood progenitor cells allotransplantation, and produced anti-Rh-D antibodies at an early stage of her first pregnancy. These antibodies were directed against blood red cells of the fetus, who inherited Rh-D antigen after his mother. During the pregnancy came to a light figure of a Rh disease. Because of the clinical appearance of this disease we assume, that the primary immunization had place before the pregnancy and was complication of the RhD mismatched transplantation. We think, that allotransplantation of hemopoietic cells provides a new, but essential source of immunization of women, who become pregnant after completion of the treatment. It may concern to Rh antigens, but probably also other, less known antigens.

Our objectives were to determine the risk of aneuploidy and anatomic anomalies in fetuses with different kinds of abdominal wall defects.We retrospectively studied ultrasound reports of the fetuses with abdominal wall defects.We analyzed 108 cases diagnosed during the last five years in our center. All fetuses underwent a detailed ultrasonographic survey and in majority of cases (78.8%) antenatal karyotyping was performed. We also analyzed gestational age at the first examination.35 cases presented gastroschisis, 60 omphalocele, 7 ectopia cordis and 6 limb-body wall complex. Associated anomalies were detected in 48.1% of all cases. It was 22.9% in gastroschisis group, 58.3% in omphalocele group, 42.9% in ectopia cordis group and in all fetuses with limb-body wall complex. Chromosomal abnormalities were present in 13% of all cases; in 2.9% of gastroschisis group, 20% of omphalocele group, 16.7% of limb-body wall complex group and none of the fetuses with ectopia cordis. The median gestational age at the first examination was 24 weeks.In fetuses with abdominal wall defects detailed ultrasonographic survey and in majority of cases prenatal karyotyping should be done. Furthermore patients with fetus with such a defect should be diagnosed as early as possible in the referral center.

Our objective was to determine if ventriculomegaly not related to the open neural tube defects is associated with other anomalies and aneuploidy. What we should do after such diagnosis. We also analyzed gestational age at the first examination.We retrospectively studied ultrasound reports of the fetuses with this type of ventriculomegaly.We analyzed 71 cases diagnosed between September 1997 and March 2002. Ventriculomegaly was a assumed to be present when atrial width was equal or greater than 10 mm. Antenatal karyotyping was performed in all fetuses.21 cases were concomitant with other CNS malformations, in 50 cases ventriculomegaly was the only one brain anomaly. The incidence of chromosomal abnormalities was 8.5% and it was strongly related to the presence of multisystem malformations. The median gestational age at diagnosis was 27.6 weeks.Our results suggest that in fetuses with ventriculomegaly not related to the open neural tube defects a detailed ultrasonographic survey and karyotyping should be done. Furthermore, every pregnant woman should undergo ultrasound screening before the 24th gestational week.