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This manual has been prepared by the Expert Team of the Polish Menopause and Andropause Society for physicians representing various medical specialties who see patients with menopausal symptoms in their daily practice. In order to make the manual as practical as possible, the current state of knowledge on menopausal hormone therapy (MHT) is presented in the form of questions and answers. They address issues which are essential for initiating and managing MHT based on the most up-to-date treatment algorithms and, at the same time, in line with the old maxim “primum non nocere”.

This article presents the technical aspects of the Polish fetal cardiac interventions (FCI) program, including preparation of the team and modifications in the technique of the procedure that aim to increase its safety for the mother and the fetus. Over 9 years, 128 FCI in 113 fetuses have been performed: 94 balloon aortic valvuloplasties (fBAV), 14 balloon atrioseptoplasties (fBAS) with stent (BAS+), 5 balloon atrioseptoplasties without stent placement (BAS&minus, ), and 15 fetal pulmonary valvuloplasties (fBPS). The technical success rate ranged from 80% (BAS&minus, ) to 89% (fBAV), while the procedure-related death rate (defined as death within 72 hours following the procedure) ranged from 7% (fBAV and fBPV) to 20% (BAS). There were 98 live births after all FCI (3 pregnancies continue). Median gestational age at delivery was 39 weeks in our center and 38 weeks in other centers.

Short cervical length (SCL) should be defined as cervical length (CL) less than 25 mm between 18 and 22 weeks of gestation. This definition of SCL is fully applicable for singleton pregnancies but is not entirely correct for twin pregnancies. So far there are no explicit guidelines on the treatment of twin pregnancy with SCL. The use of progesterone in the treatment of SCL and preterm birth (PTB) prophylaxis is one of the interventions recommended by the Polish Ministry of Health for cervical shortening in singleton pregnancies. In twin pregnancies attention should be paid to the potential benefits of using vaginal progesterone in reduction of neonatal mortality and incidence of neonatal complications in a group of patients with twin pregnancies and CL less than 25 mm or below the 10th percentile for the gestational age, measured between 18 and 22 weeks of gestation. It is still difficult to identify the benefits of using pessaries in the prevention of PTB in twin pregnancies. The usage of pessaries appears to be beneficial only in selected subpopulations of patients with asymptomatic CL less than 25 mm or 10th percentile for gestational age. The use of cervical cerclage in PTB prevention in twin pregnancies is limited to cases where the external cervical dilation is >1 cm and

Source at https://doi.org/10.5114/aoms.2016.63600. Licensed CC BY-NC-ND 4.0. Introduction: Pregnant women negative for human platelet antigen 1a (HPA-1a) are at risk of alloimmunization with fetal HPA-1a antigen inherited from the father, and their offspring may develop fetal and neonatal alloimmune thrombocytopenia (FNAIT). The aim of this study was to analyze the frequency of HPA-1a alloimmunization in pregnant Polish women, the feasibility of using maternal platelets for intrauterine transfusions in women subjected to diagnostic fetal blood sampling (FBS) and to discuss potential consequences of alloimmunization. Material and methods: Fifteen thousand two hundred and four pregnant women were typed for HPA-1a; HPA-1a negative were screened for anti-HPA-1a. Alloimmunized women received specialist perinatology care; some of them were subjected to FBS, followed by transfusion of HPA-1a negative platelet concentrates (PC) prepared from maternal blood. Results: Three hundred seventy-three (2.5%) women were HPA-1a negative, and 32 (8.6%) tested positively for anti-HPA-1a. Antibodies were detected in 22 women during pregnancy. Diagnostic FBS followed by PC transfusion was performed in 14 woman, who were platelet donors for their 16 unborn babies. Blood donations were tolerated well by the patients, and also intrauterine platelet transfusions were uneventful. Pharmacotherapy with intravenous immunoglobulins was implemented in 11/22 patients. Conclusions: HPA-1a negative women (ca. 2.5% of all pregnant patients) are at risk of alloimmunization with HPA-1a antigen and developing FNAIT. Alloimmunized women can be donors of platelets for their offspring providing removal of antibodies from PC. Owing to potential complications, special care should be taken if an alloimmunized woman was qualified as a blood or stem cell recipient.

OBJECTIVE To present the preliminary outcomes of fetal urethroplasty using a coronary angioplasty balloon catheter in lower urinary tract obstruction (LUTO). METHODS We included 10 consecutive male fetuses diagnosed with LUTO caused by presumed isolated posterior urethral valves (PUVs), who underwent urethroplasty with a balloon catheter in our center between 2015 and 2018. During urethroplasty, the fetal urethra was dilated using a balloon catheter (diameter, 0.014 inches; balloon size, 2 × 9 mm) inserted under ultrasonographic guidance via an 18-gauge needle introduced into the fetal bladder. RESULTS Mean gestational age at the time of urethroplasty was 17.8 (range, 16.5-20.4) weeks. All fetuses survived the procedure without any complications and there was no case of preterm prelabor rupture of the membranes. The procedure was successful in 5/10 (50%) fetuses, while in the other five (50%), we were unable to insert the balloon catheter into the urethra. In the five successfully treated cases, mean gestational age at delivery was 38 (range, 36-40) weeks and presence of PUVs was confirmed after birth. All five neonates micturated spontaneously and presented with normal urine output after birth. During the follow-up period, the parameters of kidney function were within normal limits in two neonates, whereas signs of impaired renal function were seen in another two. The other was diagnosed with renal insufficiency and required kidney transplant with bladder sparing at 2 years of age. CONCLUSIONS Urethroplasty with a balloon catheter is a new prenatal treatment option for fetuses with PUVs. By restoring fetal micturition, the procedure can preserve normal urinary bladder and kidney function. Although data on its efficacy and potential to differentiate the etiology of LUTO are sparse, a significant advantage of this method is its safety for the fetus and the mother. Even if the neonates develop renal insufficiency, they may be eligible for kidney transplant with connection to their own bladder, without the need for urostomy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Introduction: Foetal hypothyroidism negatively impacts somatic and neurological child development and can be the cause of serious obstetric and perinatal complications. We present a rare case of a large foetal dyshormonogenetic goitre, causing foetal neck hyperexten­sion, oesophageal compression, and cardiac high-output failure. Material and methods: A foetal goitre complicated by cardiomegaly and polyhydramnios was diagnosed at 23 weeks of gestation (WG) on a routine ultrasonographic (US) assessment in a healthy nullipara. Foetal blood sampling was performed and a severe foetal hypothyroid­ism was diagnosed. Treatment was undertaken with an intra-amniotic followed by combined intra-amniotic and intravenous injections of L-thyroxine (L–T4). A total of 11 doses of L–T4 were administered between 24–37 WG to the foetus. Results: A complete regression of foetal goitre, cardiomegaly, and polyhydramnios was observed. At 38 WG the patient delivered vagi­nally a male infant with mild hypothyroidism and no signs of goitre or cardiomegaly on postnatal US. Neurological development of the one year old baby is normal. Conclusions: The effective diminishing of serum TSH concentration and goitre size was reached after combined intra-amniotic and in­travenous L–T4 injections were given. L–T4 requirement in the foetus is equal to or above 15 μg/kg daily and should be given in weekly intervals due to its rapid metabolism by the foetus and by placental type 3 deiodinase. Intra-amniotic L–T4 administration may be inef­fective when a large goitre indisposes amniotic fluid swallowing by the foetus, so then the combined L–T4 injections into the umbilical vein and intra-amniotically in experienced hands seems to be a reasonable and effective option.

Polycystic ovary syndrome (PCOS) diagnosis and therapy still arouse a lot of controversy. Each year brings new information, so, having collected the experience of three scientific societies, we present contemporary recommendations concerning PCOS diagnostics and treat-ment. In adult female diagnosis, we still use the Rotterdam criteria, which is two out of three of the follwing characteristics: a) ovulation abnormality, b) clinical or biochemical hyperandrogenism, and c) polycystic ovaries. In the case of teenagers, diagnostic criteria are as follows: menstruation disturbances two years after menarche and clinical or biochemical hyperandrogenism. The presence of polycysti-cally abnormal ovaries is not necessary. The consensus paper presents the threats resulting from imperfect diagnostic methods applied in PCOS (hyperandrogenism diagnostics, ultrasound examination of ovaries). Suggested therapy includes personalised schemes according to the dominant PCOS phenotype, i.e. metabolic, hyperandrogenic, or reproductive ones.

Polycystic ovary syndrome (PCOS) diagnosis and therapy still arouse a lot of controversy. Each year brings new information, so, having collected the experience of three scientific societies, we present contemporary recommendations concerning PCOS diagnostics and treat-ment. In adult female diagnosis, we still use the Rotterdam criteria, which is two out of three of the follwing characteristics: a) ovulation abnormality, b) clinical or biochemical hyperandrogenism, and c) polycystic ovaries. In the case of teenagers, diagnostic criteria are as follows: menstruation disturbances two years after menarche and clinical or biochemical hyperandrogenism. The presence of polycysti-cally abnormal ovaries is not necessary. The consensus paper presents the threats resulting from imperfect diagnostic methods applied in PCOS (hyperandrogenism diagnostics, ultrasound examination of ovaries). Suggested therapy includes personalised schemes according to the dominant PCOS phenotype, i.e. metabolic, hyperandrogenic, or reproductive ones.

Published version. Source at http://doi.org/10.1007/s00005-015-0371-9. Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is a relatively rare condition (1/1000–1/2000) that was granted orphan status by the European Medicines Agency in 2011. Clinical consequences of FNAIT, however, may be severe. A thrombocytopenic fetus or new-born is at risk of intracranial hemorrhage that may result in lifelong disability or death. Preventing such bleeding is thus vital and requires a solution. Anti-HPA1a antibodies are the most frequent cause of FNAIT in Caucasians. Its pathogenesis is similar to hemolytic disease of the newborn (HDN) due to anti-RhD antibodies, but is characterized by platelet destruction and is more often observed in the first pregnancy. In 75 % of these women, alloimmunization by HPA-1a antigens, however, occurs at delivery, which enables development of antibody-mediated immune suppression to prevent maternal immunization. As for HDN, the recurrence rate of FNAIT is high. For advancing diagnostic efforts and treatment, it is thereby crucial to understand the pathogenesis of FNAIT, including cellular immunity involvement. This review presents the current knowledge on FNAIT. Also described is a program for HPA-1a screening in identifying HPA-1a negative pregnant women at risk of immunization. This program is now performed at the Institute of Hematology and Transfusion Medicine in cooperation with the Department of Obstetrics and Gynecology of the Medical Centre of Postgraduate Education in Warsaw as well as the UiT The Arctic University of Norway.

Ultrasonography has been extensively used in obstetrics and gynecology since 1980's. It found application in pediatric gynecology, procreation period, post-menopause, pregnancy monitoring and after delivery. Although the first reports on the use of ultrasonography in assessing delivery mechanism were published in 1990's, yet to date labor progress is evaluated by means of physical examination in most delivery units. Intrapartum sonography is not routinely performed despite the fact that numerous studies documented high error rates of conventional obstetrical examination. Even an experienced physician makes a mistake in every third case of the fetal head descent and fontanelle position assessment. Nowadays, obstetrician's role is not to strain for vaginal delivery at all costs, but to provide the patient in labor and her newborn with maximal safety. To achieve this objective, an obstetrician should distinguish between women who will deliver spontaneously and whose who require Cesarean section. Proper decision should be made on the basis of objective and valid evaluation of obstetric setting, which cannot be achieved solely with physical examination. Intrapartum sonography was shown to be far more accurate than digital examination. Moreover, it is not technically demanding, provides high reproducibility and neither increases the rate of ascending infection or causes discomfort to the patient. Current research suggests that if used routinely, intrapartum sonography can increase the safety of labor and reduce cesarean section rate.Diagnostyka ultrasonograficzna jest powszechnie stosowana w położnictwie i ginekologii od lat 80. ubiegłego wieku. Badania ultrasonograficzne wykonuje się w ginekologii dziecięcej, w okresie prokreacyjnym, po menopauzie, w monitorowaniu przebiegu ciąży i po porodzie. Pierwsze doniesienia o wykorzystaniu ultrasonografii do oceny mechanizmu porodowego pojawiły się w latach 90., jednak do dziś w większości ośrodków postęp porodu oceniany jest wyłącznie w badaniu klinicznym. Nie wykonuje się śródporodowego badania ultrasonograficznego, mimo że w wielu pracach wykazano, że tradycyjne badanie położnicze cechuje się wysokim odsetkiem błędów. Nawet doświadczony lekarz, oceniając zaawansowanie głowy w kanale rodnym i lokalizację ciemiączek, myli się w tym badaniu przeciętnie w co trzecim przypadku. Obecnie rola położnika nie polega na dążeniu za wszelką cenę do ukończenia porodu drogami natury, lecz na zapewnieniu maksymalnego bezpieczeństwa rodzącej i jej dziecku. Aby je zapewnić, położnik powinien określić, które pacjentki mają szansę urodzić drogami natury, a u których lepszym rozwiązaniem będzie wykonanie cięcia cesarskiego. Właściwa decyzja może zostać podjęta jedynie na podstawie obiektywnej i prawidłowej oceny sytuacji położniczej, co nie jest możliwe jedynie na podstawie samego badania klinicznego. Wykazano, że badanie ultrasonograficzne w czasie porodu jest znacznie bardziej wiarygodne niż badanie palpacyjne. Ponadto jest proste technicznie, powtarzalne, nie zwiększa ryzyka infekcji wstępującej i nie powoduje dyskomfortu dla pacjentki. Dotychczasowe wnioski wynikające z prac naukowych oceniających zastosowanie ultrasonografii w trakcie porodu są bardzo optymistyczne i wskazują, że jej wprowadzenie może wpłynąć na zwiększenie bezpieczeństwa porodu, a nawet na zmniejszenie odsetka cięć cesarskich.

The aim of the study was to analyze types and methods of intrauterine fetal cardiac interventions performed between June 2011 and December 2013, and to assess the perinatal management of the neonates.The program was developed after analysis of the available literature, practical individual training in Linz, Austria, and simulation of the procedure in a dissecting-room. The rules for anesthesia in pregnant women and their fetuses were developed. The interventions were performed in fetuses with critical cardiac defects, in the operating room, under ultrasonographic control. The protocol was approved by the Local Bioethics Committee at the Centre of Postgraduate Medical Education.We included fetuses with critical aortic stenosis (n=29), critical pulmonary stenosis (n=2), and closed or extremely restricted foramen ovale (n=7). Between June 2011 and December 2013, the team comprised of JD, MD and AK conducted 42 interventions in 35 fetuses, including 32 balloon aortic valvuloplasties (in 29 fetuses), 2 pulmonary valvuloplasties, 4 balloon atrial septostomies and 4 atrial septal stent placement. Three fetuses required both, aortic valvuloplasty and fenestration of the atrial septum.Out of the 42 procedures, 41 (97%) were technically successful. We recorded 3 cases of fetal demise associated with the intervention. We modulated the protocol of anesthesia given to pregnant women, switching from general to local anesthesia with intravenous sedation. We always provided additional fetal anesthesia with fentanyl and atracurium via the umbilical vein.Based on our 2.5-year experience, it seems safe to conclude that all types of fetal cardiac interventions may be successfully conducted at Polish centers. The procedures are safe for the pregnant women and improve fetal status. Most of the neonates treated prenatally were referred in good general condition to a tertiary pediatric cardiology and cardiac surgery center

Objectives: The aim of the study was to assess the outcome of vesico-amniotic shunting performed before 16 weeks of pregnancy in fetuses with severe megacystis diagnosed in the first trimester of pregnancy. Material and methods: Between January 2008 and October 2012 severe megacystis with the bladder length > 15 mm was diagnosed in 17 fetuses. The procedure of early vesico-amniotic shunting (VAS) was offered to 8 patients with presumably isolated LUTO. The procedure of VAS was performed in 6 fetuses. Before the intervention one or two procedures of vesicocentesis and urine analysis were performed. Results: In all treated cases shunts provided urinary tract decompression. All babies were born prematurely, 2 of them died due to premaurity, 3 of them survived and have normal renal function at the age of 5–6 years. In 4/5 children accompanying malformations were later diagnosed, in 1 born prematurely neonate necropsy was not performed. Conclusions: Our results suggest that early vesico-amniotic shunting in fetal LUTO is feasible and may potentially prevent not only pulmonary hypoplasia but also renal insufficiency. However, the rationale of the procedure needs further investigation due to a high risk of long-term morbidity and co-existing malformations in children Before offering the therapy detailed counseling of the parents about the possible pros and cons of the therapy is necessary.

Foetal hypothyroidism negatively impacts somatic and neurological child development and can be the cause of serious obstetric and perinatal complications. We present a rare case of a large foetal dyshormonogenetic goitre, causing foetal neck hyperexten-sion, oesophageal compression, and cardiac high-output failure.A foetal goitre complicated by cardiomegaly and polyhydramnios was diagnosed at 23 weeks of gestation (WG) on a routine ultrasonographic (US) assessment in a healthy nullipara. Foetal blood sampling was performed and a severe foetal hypothyroid-ism was diagnosed. Treatment was undertaken with an intra-amniotic followed by combined intra-amniotic and intravenous injections of L-thyroxine (L-T4). A total of 11 doses of L-T4 were administered between 24-37 WG to the foetus.A complete regression of foetal goitre, cardiomegaly, and polyhydramnios was observed. At 38 WG the patient delivered vagi-nally a male infant with mild hypothyroidism and no signs of goitre or cardiomegaly on postnatal US. Neurological development of the one year old baby is normal.The effective diminishing of serum TSH concentration and goitre size was reached after combined intra-amniotic and in-travenous L-T4 injections were given. L-T4 requirement in the foetus is equal to or above 15 μg/kg daily and should be given in weekly intervals due to its rapid metabolism by the foetus and by placental type 3 deiodinase. Intra-amniotic L-T4 administration may be inef-fective when a large goitre indisposes amniotic fluid swallowing by the foetus, so then the combined L-T4 injections into the umbilical vein and intra-amniotically in experienced hands seems to be a reasonable and effective option.

An 89-year-old woman was reffered to our Clinic with vulvar cancer. She also suffered from obesity [with body mass index (BMI) 35 kg/m2], persistent hypertension, diabetes mellitus type 2 treated with oral medications. In 2015 she underwent a surgery due to endometrial carcinoma. Total abdominal hysterectomy with bilateral salphingoophorectomy, omentectomy and pelvical node dissection was performed (histopathology revealed adenocarcinoma serosum G2; FIGO stage Ib). In January 2016 after vulvar ulceration biopsy plano-epithelial squamous vulvar cancer was diagnosed. She was referred to surgery. She has undergone an operation in October 2016. She was admitted to gynaecological unit at our institution. Physical examination revealed mutilated vulva with excised labia major, labia minor, and narrowing of vaginal orifice. The right side shown tumor 2.5 cm in diameter, with slough area and no deep infiltration and satellital nodule on the left labia majora 1cm in diameter. The cervix, vaginal wall, rectum and anus appeared normal. There were no enlarged lymph nodes at the inguinal area.

A 34-year-old multiparous woman presented with anti-Rh-D antibodies (1: 512) and fetal hydrops at the 21(st) week of gestation. Ultrasound revealed massive fetal skin edema, ascites, hepatomegaly, placentomegaly, and anhydramnios. No fetal movements were observed. Fetal heart was enlarged, with reportedly decreased contractibility. The Doppler parameters were abnormal: the peak systolic velocity in median cerebral artery (MCA PSV) was increased (84 cm/s, 3 MoM), and absent end diastolic flow (AEDF) was reported in the umbilical artery. Ultrasound examination indicated severe fetal anemia and heart failure. Umbilical vein puncture was performed and the fetal blood count was determined (RBC 0.01 × 10(6)/µl, Ht 0.1%, PLT 67 × 10(3)/µl, WBC 2.1 × 10(3)/µl, indeterminable hemoglobin level). Packed red blood cells (0 Rh-, 30 ml) were immediately transfused to the fetus. Altogether, seven intrauterine transfusions were performed. Fetal hydrops disappeared gradually during the next few weeks. The male neonate (1860 g, 45 cm, Apgar score 3-4) was delivered after the last transfusion at 34(th) week of gestation due of intrauterine asphyxia. The infant was discharged after 21 days, in good condition, on breastfeeding. There was one 10 mm focus of periventricular leukomalacia in the brain, diagnosed based on trans-fontanel ultrasound, without any signs of damage to other organs. At the age of 5 years, the child is healthy, with no abnormalities in his neurodevelopmental parameters.

Objective To establish fetal thyroid nomograms based on gestational age and biparietal diameter and to compare obtained results with previously published data. Study design A cross-sectional study of 241 healthy pregnant women at 14–38 week of gestation was undertaken. Exclusion criteria were: known maternal thyroid or systemic disease, unknown date of last menstrual period, multiple pregnancy and fetal malformations. Fetal thyroid diameter (FTD), circumference (FTC) and area (FTA) were measured by two-dimensional ultrasonography and plotted against gestational age (GA) and biparietal diameter (BPD). Results FTD, FTC and FTA increased logarithmically to GA and BPD. Fetal thyroid measurements as a function of GA were expressed by logarithmic formulas: ln(FTD) = 3.6025–23.0315/GA, ln(FTC) = 4.6227–22.8003/GA, ln(FTA) = 6.6303–45.0831/GA. The following logarithmic formulas were obtained for fetal thyroid measurements according to BPD: ln(FTD) = 3.4068–45.4271/BPD, ln(FTC) = 4.4271–44.8359/BPD, ln(FTA) = 6.2390–88.4408/BPD. There were highly significant correlations between thyroid measurements and GA or BPD: r = 0.87–0.90, p Conclusions We have established age-dependent and age-independent nomograms of fetal thyroid. These nomograms will enable prenatal diagnosis in fetuses at risk of thyroid disorders.

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

The group of experts representing the Polish Cardiologic Society, the Polish Gynecological Society and the Polish Menopause and Andropause Society has issued this Joint Position Statement based on the review of available literature on the effect of postmenopausal hormone replacement therapy on the cardiovascular system. The results of older clinical and epidemiological studies are confronted with the most recently published data. The importance of type, doses and delivery route of hormones is discussed with respect to the cardiovascular safety of HRT.

Human papillomavirus (HPV) is one of the most important carcinogens in humans. Vaccines against HPV are now considered the first anti-cancer vaccinations. Since 2007, in many developed countries, there have been recommendations present for preventive vaccines against HPV. At present, the degree of implementation of these recommendations depends on a number of country-specific factors such as the health care system organization or the ways of funding. HPV vaccines are primarily to prevent the development of cervical cancer and other genital cancers. Therefore, only their long-term effectiveness can be measured, when a correspondingly large cohort of vaccinated teenagers reaches the age of the greatest incidence of these cancers. However, great care should be taken in assessing the results of vaccinations due to the possibility of misinterpretation and possible erroneous data. Undoubtedly, teenagers are the target population of HPV vaccines. However, vaccinating young sexually active women is also justified from an individual point of view. A 9-valent vaccine has been registered in the USA and in Europe – including Poland – as one of the three preventive vaccines. It is recommended to vaccinate women between 13 and 26 and men between 13 and 21, previously unvaccinated. It is also recommended to vaccinate men aged 26 years or less who have sexual relations with other men and people with reduced immunity, including HIV-positive people who have not been vaccinated previously.

Introduction: Pregnant women require about 250 μg of iodine daily. Hypothyroid women treated with L-thyroxine do not utilise iodine, and metabolism of L-thyroxine tablets is an additional source of iodine for their foetuses. The aim of the study was to evaluate the influence of iodine supplementation in hypothyroid pregnant women treated with L-thyroxine on neonate TSH concentration and maternal thyroid parameters. Material and methods: Ninety-two pregnant women with primary hypothyroidism on adequate thyroid hormone replacement were voluntarily divided into two groups: “thyroxine” (n = 38) treated with L-thyroxine only, and “thyroxine + iodine” (n = 54) treated additionally with 150 μg/day of iodine since 10th gestational week. Primary outcomes were the maternal thyroid function tests (TSH, fT4, fT3) and neonatal TSH concentrations at the 3–4th day of life. Urinary iodine concentration was measured at first and third trimester to compare iodine status in both groups. Results: Iodine supplementation significantly increased median urinary ioduria in the third trimester (from 95.15 μg/L to 151.50 μg/L), but did not prevent the decrease of maternal fT4 and fT3 concentrations in the second and third trimester. Median neonate TSH concentration in both groups was within normal range, but was 33% higher in the “thyroxine + iodine” than in the “thyroxine” group (1.91 mU/L vs. 1.34 mU/L). Moreover, 8.77% of newborns in the “thyroxine + iodine” group had TSH g 5 mIU/L. Conclusions: We did not find evidence for a positive influence of iodine supplementation on thyroid function of either hypothyroid pregnant women sufficiently treated with L-thyroxine or their neonates. (Endokrynol Pol 2016; 67 (4): 367–374)

Aforesaid recommendations for the management of T.gondii infection, elaborated by the group of experts, are intended for physicians of various specialties in order to standardize and facilitate diagnostic and therapeutic management. Early diagnosis of congenital toxoplasmosis, both symptomatic and asymptomatic, in neonatal period, initiation of adequate treatment and long-term, multispecialist monitoring, including multi-organ rehabilitation of children may prevent or reduce the complications of congenital toxoplasmosis. Health education, whose role is often underestimated, should be targeted mainly on girls and women at reproductive age as to prevent from infection during pregnancy.

Fetal/Neonatal Alloimmune Thrombocytopenia (FNAIT) is caused by destruction of fetal blood platelets due to maternal antibodies. This condition, which most commonly results from incompatibility between the mother and the fetus for the Human Platelet Antigen-1a (HPA-1a), may lead to intracranial hemorrhage, damage of the central nervous system (CNS) and even death of the fetus or the newborn. It can be the cause of strokes in term newborns. FNAIT is usually attributed to the presence of anti-HPA-1a antibodies. Its incidence rate is estimated at approximately 1/1000- 2000 live births. In the absence of a screening program, it is usually diagnosed after birth of a child with symptoms of thrombocytopenia or CNS hemorrhage. Monitoring of antibody production and thrombocytopenia treatment to effectively minimize the risk of stroke are therefore launched only at the next pregnancy. Testing indications are broader to include fetal ultrasound for symptoms of stroke to the CNS, ventricular enlargement or hydrocephalus, and obstetric failure. Diagnostic process is also recommended prior to the planned cordocentesis, in vitro fertilization and in sisters of mothers with children with FNAIT history. HPA-1a testing remains the best method for diagnosing pregnancies at risk. The detection frequency for FNAIT in Poland remains low Therefore, the Institute of Hematology and Transfusion Medicine (IHTM ) will have performed such HPA-1a antigen testing in 30000 Polish women within the framework of the PREVFNAIT program by March 2016. HPA-1a negative women (2% of the population) are a risk group for production of anti- HPA-1a antibodies responsible for FNAIT therefore all of them will be monitored for the presence and activity of anti-HPA-1a antibodies. Such testing will be performed free of charge for the women. The scientific goals related to the grant include 1) estimation of FNAIT prevalence in Poland and 2) search for biomarkers to predict the risk of the antibody production and severity of fetal thrombocytopenia.

Women surviving breast cancer in the postmenopausal period suffer from hormonal alternations with adverse effect on mental status and functioning of a number of organs and systems. Two thirds of these women had menopause before the diagnosis of breast cancer. In the remaining one-third ovarian failure is natural or induced by chemotherapy. Doctors cautiously approach the use of estrogen therapy in this group of patients. Their fears are not unsupported bearing in mind known epidemiological data exist linking breast cancer with the use of hormonal therapy. The purpose of this review is to evaluate current data on hormonal use and breast cancer risk.

Wstep: Wyniki badan z ostatnich lat dokumentują wiele korzyści wynikających z dzialania witaminy D na organizm czlowieka na wszystkichetapach jego zycia. Wiekszośc badan epidemiologicznych sugeruje, ze niedobor witaminy D jest powszechny wśrod mieszkancow EuropyŚrodkowej. Naturalną konsekwencją tej sytuacji jest koniecznośc ciąglego uświadamiania spoleczenstwu oraz środowisku medycznemu,jaką role odgrywa witamina D w rozwoju i funkcjonowaniu organizmu ludzkiego. Metody: Na podstawie przeglądu danych literaturowych Polski Zespol Wielodyscyplinarny opracowal tezy dotyczące zasad suplementacjiwitaminą D, ktore przeslano do czlonkow Komitetu Naukowego konferencji „Witamina D — minimum, maksimum, optimum”,19–20 Październik, 2012, Warszawa. W trakcie powyzszej konferencji z udzialem 550 delegatow oraz Ekspertow roznych dziedzin medycynyomowiono i przedyskutowano propozycje wytycznych suplementacji witaminą D populacji Europy Środkowej. Wyniki: W efekcie przeprowadzonych dyskusji Zespol Ekspertow opracowal wytyczne suplementacji witaminą D dla wszystkich grupwiekowych populacji Europy Środkowej. Określono rowniez kryteria diagnostyczne charakteryzujące stan zaopatrzenia organizmu w witamine D: deficyt witaminy D ustalono jako stezenie 25(OH)D < 20 ng/mL (< 50 nmol/L)], suboptymalne zaopatrzenie jako stezenie25(OH)D wynoszące 20–30 ng/mL (50–75 nmol/L), a stezenie 30–50 ng/mL (75–125 nmol/L) uznano za docelowe dla zapewnienia efektuplejotropowego witaminy D. Wnioski: Poprawa obecnego stanu zaopatrzenia witaminy D w grupach dzieci, mlodziezy, osob aktywnych zawodowo i seniorowpowinna zostac wlączona do priorytetow polityki zdrowotnej spoleczenstw Europy Środkowej.

The polycystic ovary syndrome (PCOS) is one of the most frequent endocrinopathies in women. Its incidence is assessed at 6–8% of the female population in the reproductive age. It is characterised by oligomenorrhea (Oligo), hyperandrogenism (HA), and the presence of polycystic ovaries (PCOs). Carbohydrate and lipid metabolism is being disturbed in many women with PCOS. The pathogenesis of PCOS is still unexplained. Following the main criteria of diagnosis (Rotterdam Consensus 2003), Dewailly, Welt and Pehlivanov divided the patients with PCOS into 4 phenotype groups: A, B, C, and D. In our studies of 93 patients with PCOS, we found (1) the most frequent appearance (60,2%) of the phenotype A [Oligo + HA + PCO]; (2) an increased androstenedione concentration in a group with HA (A, B, C); (3) an increased HOMA-β and insulin concentration after 30 min an oral 75 g glucose tolerance test (OGTT) in a group of obese women with BMI>30 kg/m2; (4) high levels of total testosterone, total cholesterol, and LDL cholesterol concentrations in a group A with classic phenotype of PCOS: Oligo + HA + PCO—increasing the risk of development of cardiovascular diseases, type 2 diabetes, or metabolic syndrome. The average androstenedione concentrations could be a good diagnostic and prognostic parameter.

Methods: Among 3554 amniocentesis 1170 RPF-tests with normal results capable of detecting aneuploidy for chromosomes 13, 18, 21 and the number of X, Y chromosomes were included in the study. For this group we calculated the rate of fetal structural abnormalities. To characterize patients with an elevated risk we compared anamnestic factors (age, mode of conception, history of miscarriages, results of first trimester screening, fetal gender) and different structural sonographic abnormalities. Results: In 1170 normal RPF-tests we detected no aneuploidy but 30 structural abnormalities (2.56%). 8 abnormalities (0.68%) appeared as chromosomal variants, 12 (1.02%) as balanced translocations and 10 (0.85%) as unbalanced translocations. Most relevant predictive anamnestic factors for structural cytogenetic abnormality are women

The patient was a 29-year multiparous woman, hospitalised in the 25 week of pregnancy because of fetal hydrops (ascites, polyhydramnios, placentomegaly) and cardiomegaly. The results of the physical and laboratory examinations of the mother were initially normal. MCA PSV in the fetus was 1.9 MoM. Diagnostic cordocentesis revealed profound fetal anemia with high erytroblastosis, thrombocytopenia and fetal PVB19 viremia (2.27 × 108 IU/ml). We transfused to the fetal umbilical vein 35 ml of packed red cells and 0.5 g IVIG. After the transfusion the MCA PSV normalised. In the fourth day after the transfusion the patient reported dyspnoea, oedema of lower extremities and rash on the palmar side of her hands. There was fluid in both pleural cavities. The fluid balance was positive (plus 9 kg in one week), the blood pressure was normal all the time, but the condition of the mother was deteriorating rapidly. The blood parameters showed surprisingly progressive hemodilution and the patient was gradually developing anemia and thrombocytopenia, with elevation of aminotransferases. In the next few days we observed dyspnoea at rest, continuous liver pain and enlargement and massive generalised oedema. The patient was given high doses of diuretics (i.v. furosemide up to 60 mg a day), antibiotics, steroids, IVIG (0.5 g/day) and FFP. After about one week of treatment the condition of the fetus and the mother started to improve and the oedema in both patients gradually disappeared. In the 30 week of pregnancy the patient left the hospital. There was PROM and premature delivery in the 31 week of pregnancy. She delivered a child 1750/45 g with minor ascites, but no important medical problems.

Fetal stem cells have several therapeutical advantages when compared to their adult counterparts. Cell populations residing in “waste” tissues (cord blood, umbilical cord and placenta) may be collected without any medical or ethical contraindications concerning mother or newborn baby. Cord blood hematopoietic stem cells are routinely used for clinical transplantations, and the methods for their collection, isolation and freezing are now well standardized. We have tested the efficiency of cell separator (Sepax, Biosafe) in volume reduction of cord blood units, and in washing-out DMSO after cell thawing. Results of the volume-reduction procedure revealed that the average MNC recovery rate was 91±5%, cell viability was ≥90%, and CD34+ cell recovery rate was 92±4%. Volume reduction process eliminated 88±4.5% of red cells. In vitro clonogenic potential of cells isolated with Sepax did not differ from this of cells isolated according to the standard HES sedimentation protocol. Protocol of Sepax-based washing of thawed cells resulted of 9±4% cell loss and 10±6% decrease in cell viability, when compared to thawed non-processed cells. We conclude, that Sepax separator may be used both for cord blood volume reduction, and DMSO elimination from thawed samples. The other cord blood stem cell population, identified by us (J Cell Sci 2002, 115:2131–2138), was plastic-adherent, nonhematopoietic stem cell differentiating at least into neuropoietic progeny. Attempted optimisation of cell isolation/culture methods did not allow for successful isolation of these cells from more than approximately 20% cord blood samples - we postulate, that this cell population, when detected in mature newborn blood, is rather a remnant of cells circulating in earlier stages of fetus development. The population of cells residing in Wharton jelly of umbilical cord (CD34−, CD45−, CD29+, CD44+, CD51+, CD105+, SH-2+, SH-3+, plastic-adherent) is capable, according to published data, to differentiate into several tissues, resembling the adult mesenchymal stem cells. We were able to isolate these cells from 85% of cord collections, and to expand them for 5–10 passages in in vitro cultures in IMDM + 10% FCS media without growth factors added. We have also developed the protocol, allowing for storage of frozen umbilical cord tissue without preliminary cell isolation and expansion, allowing for labor-economical and cost-economical banking of large numbers of umbilical cord cell samples. Conclusions: Sepax application for cord blood volume reduction, or DMSO elimination from thawed cell samples, is an improvement in cord blood bank routine protocols. The low frequency of non-hematopoietic plastic-adherent stem cells in cord blood samples, collected during mature deliveries, is rather a biological phenomenon than the inadequacy of laboratory techniques, and may reduce the utility of these cells for clinical purposes. Stem cells from Wharton’s jelly of umbilical cords, if confirmed their “stemness”, can be an easy to obtain cell source for tissue engineering. Our technique of freezing-storage of the umbilical cord tissue may be useful for low-cost, time-saving banking of large numbers of fetal stem cells.