[Treatment of twin to twin transfusion syndrome - comparison of two therapeutic methods - amnioreduction and lasertherapy]. / Leczenie zespolu przetoczenia miqdzy plodami /TTTS/ - porównanie dwóch terapeutycznych metod - amnioredukcji i laseroterapii.

BACKGROUND: Twin to twin transfusion syndrome occurs in 15% of monochorionic twin pregnancies. Untreated, TTTS has been reported to have a mortality of nearly 100%. Two main therapies include serial amnioreduction and fetoscopic laser coagulation for the vascular anastomoses. OBJECTIVES: The aim of the project was to investigate the optimal diagnostic and therapeutic procedure in pregnancies complicated by TTTS. Additionally the study was supposed to compare non-invasive and invasive methods of treatment and to show antenatal and postnatal follow - up to 4 months of age. METHODS: 42 pregnant women with twin-to-twin transfusion syndrome were assigned to laser therapy using diode laser and 33 pregnant women underwent only several amnioreductions. Selected parameters characterizing the pregnancy were compared in both groups. RESULTS: In the amnioreduction group, the perinatal survival rate seven days after the delivery was 31.8%. The survival rate of at least one twin was 39.4%. As compared to the amnioreduction group, in the laser group the survival rate of at least one twin was observed in 31 cases (31/42) and it was equal to 74%. Neurological complications in the amninoreduction group were observed in 19% (4/21) of cases, in the laser group and in 5% (2/40) of neonates at 4 months of age. CONCLUSIONS: Currently the preferred and only method that addresses the cause of the disease is the endoscopic laser coagulation of anastomoses. Comparison of the two treatments shows better outcomes with higher survival rates and minor neurological defects in cases treated with laser coagulation.

[The use of steroids in the treatment of HELLP syndrome--case report]. / Zastosowanie sterydoterapii w leczeniu zespolu HELLP--opis przypadku, przeglad pismiennictwa.

The HELLP syndrome is a variant of severe preeclampsia. Its leading symptoms are: hemolysis, increased liver enzymes and low platelet count. The treatment of the HELLP syndrome remains controversial as there are no standards of proven efficacy. The article presents a case of a 27- year-old patient, G1P0, 30 wk of gestation, reporting no fetus movements for several hours, who was admitted to The Materno-Fetal Medicine Department, Polish Mother's Memorial Hospital in Lódz, with symptoms of the onset of the HELLP syndrome. The authors present the course of the therapy based on steroids administration, with reference to the most up-to-date literature.

[Massive fetomaternal hemorrhage--case report]. / Masywne przetoczenie plodowo-matczyne--opis przypadku.

Massive fetomaternal hemorrhage is defined as a loss of more than 30-50ml of fetal blood, transferred into maternal circulation. It can lead to severe anemization of the fetus and its consequences such as fetal hydrops or stillbirth. We present a case in which the diagnosis was based on the decresased fetal movement and pathological cardiotocography record. The Kleihauer-Betke test revealed a high percentage of fetal cells and allowed to state a proper diagnosis. An immediate cesarean section was performed and the lab tests confirmed severe anemization of the newborn.

[Prenatal ultrasound findings in complete trisomy 9]. / Regularna trisomia 9 chromosomu--opis przypadku, przeglad pismiennictwa.

This case report describes a 40-year-old woman, primigravida. On 13,3 weeks of gestation we diagnosed an abnormal flow pattern in the umbilical artery and abnormal hyperechogenic structure in fetal abdomen. In next sonographic examination on 16 weeks of gestation we diagnosed ventriculomegaly and ahydramnion. We also observed spina bifida, hyperechogenic kidneys, abnormal flow pattern in the umbilical vein and pulmonary valve insufficiency. We performed genetic amniocentesis. We observed complete trisomy in cytogenetic examinations. The woman opted for an elective TOP according to the Polish Abortion Act on 20 weeks of gestation.

[Occurrence of plasmic and platelet prothrombotic polymorphisms in women in childbirth]. / Wystepowanie osoczowych i plytkowych polimorfizmów prozakrzepowych u poloznic.

DESIGN: Plasmic pro-thrombotic factors as well as pro-thrombotic platelet glycoprotein mutations have been shown to play an important role in the mechanism of the thrombo-embolic disease. However, there is no published study evaluating the role of above mentioned genetic factors in the thrombo-embolic episodes in women in childbirth. OBJECTIVE: The aim of the study was to evaluate the role of selected genetic factors in appearance of thrombo-embolic complications in the women in childbirth, and to determine if there is the coexistence of selected platelet glycoprotein polymorphisms and factor V Leiden mutations. MATERIAL AND METHODS: 71 cases of women in child birth with thrombo-embolic disease were analyzed. Selected demographic characteristics, and genetic pro-thrombotic factors like factor V Leiden mutation, and pro-thrombotic platelet glycoprotein GP Ia, and GP IIIa polymorphisms were examined. RESULTS: Amongst pro-thrombotic platelet glycoprotein polymorphisms moderately pro-thrombotic heterozygous A1/A2, and heterozygous C/T were most prevalent. The least common were strongly pro-thrombotic homozygous A2/A2, and T/T. Analysis of the factor V Leiden mutation revealed statistically significant difference in the presence of allele A, which determines the prothrombotic tendencies in its carrier. CONCLUSIONS: Our study shows that factor V Leiden mutation, and investigated platelet GP Ia, and GP IIIa polymorphisms frequently coexist. Moreover, presence of factor V Leiden mutation is a risk factor for thrombo-embolic disease in the women in childbirth.

[Umbilical cord entanglement in monoamniotic twin preganacy--case presentation and literature review]. / Powiklania pepowinowe w ciazy blizniaczej jednoowodniowej--omówienie przypadków i przeglad pismiennictwa.

Monoamniotic twins are at most increased risk of perinatal complications with perinatal mortality of 28-60 % reported in literature. The most specific complication to monoamniotic twins is entanglement and (or) knotting of the cords leading to intrauterine death of both (more often) or one twin. In first presented case 1, 23-year-old primigravida in 33wks of twin monoamniotic gestation was reffered to our Institute due to intrauterine death of one co-twin caused by umbilical cord entanglement. In second case, 26-year-old multigravida in monoamniotic twin gestation was admitted to our institution. A serious umbilical cord entanglement was observed and a presence of true knot of umbilical cord was suspected. Presented cases indicate that establishing a chorionicity and amniocity in twin pregnancy is an essential part of ultrasound examination. The diagnosis of cord entanglement in monoamniotic twin pregnancy enables a forecasting of possible complications. According to the established diagnosis future protocols of perinatal management could be proposed. Due to possible complications counseling and management of monoamniotic twins should be performed in tertiary medical centers.

[Unconjugated serum estriol in the prediction of preterm delivery]. / Zastosowanie oznaczen estriolu w surowicy ciezarnych w diagnostyce porodów przedwczesnych.

OBJECTIVE: The objective was to analyze the serum estriol levels among patients with sings and symptoms of preterm labor and/or preterm rupture of membranes. STUDY DESIGN: A prospective study included pregnant women with sings and symptoms of preterm labor. The main end point of the study was the delivery <28 days from testing. RESULTS: 196 patients were included. 116 patients were included in group I (idiopathic preterm labor), 37 patients in group II (PROM) and the control group (group III) consisted of 43 patients. The incidence of preterm delivery was 31% in group I; in the PROM group all the patients delivered preterm. The mean serum estriol levels in all groups were compared regarding delivery <28 days from testing. In group I patients that delivered <28 days had statistically higher serum level of E3 (14.5 ng/ml vs. 11.1 ng/ml, p = 0.03); in group II the mean E3 serum level did not differ significantly (12.5 ng/ml, p = 0.168). The detailed analysis revealed that significant difference was observed in patients tested after completed 30 wk of gestation (15.4 ng/ml vs 12,8 ng/ml, p = 0.043), but not in patients <30 wk of gestation (9,5 ng/ml vs. 10.0 ng/ml, p = 0.842). CONCLUSIONS: The serum level of E3 seems to have prognostic value in the diagnosis of preterm delivery among symptomatic patients after 30 week of gestation.

[The pregnancy and delivery course in patients with reproductive tract anomalies]. / Przebieg ciazy i porodu u pacjentek z wadami rozwojowymi narzadu rodnego.

OBJECTIVES: The goal of our study was to analyse the course of pregnancy and delivery in women with reproductive tract anomalies. MATERIAL AND METHODS: We retrospectively analyzed the pregnancy and delivery course of 16 patients with previously diagnosed reproductive tract anomalies. The control group constisted of 200 healthy pregnant women. All patients were hospitalized in our department between January 1st 2001 and 31st May 2005. RESULTS: In the study group preterm delivery and abnornal fetal lie were more common. The incidence of cesarean sections (81%) was also statistically higher in the study group. CONCLUSIONS: The course of pregnancy and delivery in women with previous diagnosis of specific reproductive tract anomalies is more likely complicated by several obstetrical pathologies. The pregnant women with this a diagnosis should be considered as a group of high risk pregnancy and perinatal intensive care procedures should be carried out.

[Cervical ectopic pregnancy--a case report]. / Ciaza szyjkowa--opis przypadku.

Authors present a case of a viable cervical pregnancy in a 31 year old woman. Conservative management with intramuscular methotrexate and local injection of KCl was applied. We describe the ultrasound and biochemical findings in this case and discuss those reported in the literature along with the available treatment options.

[Pregnancy and delivery after bariatric surgery]. / Przebieg ciazy i porodu u pacjentek po chirurgii bariatrycznej.

The obesity in Europe is established for 15-20% of population. About 20% of women in reproductive age have accrued body weight. Obesity in this group leads to increased obstetrical risk. Preconceptional normalization of body mass is crucial. Bariatric surgery is one of the most effective methods of obesity treatment with Roux en Y gastric by pass (RYGB) as the one of its kind. In this report we present tree cases of pregnancy and delivery after RYGB.

Polymorphism of the glycoprotein Ia and IIIa in the group of women in childbirth does not correlate with an increased risk of developing thrombosis.

OBJECTIVE: The aim of the study was to evaluate the prevalence of the GP Ia and GP IIIa polymorphisms in the group of women in labor, and to assess the risk of thrombosis associated with their occurrence. DESIGN AND SETTINGS: 245 women in labor hospitalized between 1.01.2001 and 31.12.2003 r. were enrolled in the study. Patients were qualified for the study if detailed physical exam and past medical history excluded existence of known risk factors predisposing to thrombosis. Study group was composed of 72 women in childbirth, which at some point during current pregnancy or in early labor were diagnosed with thrombosis, and control group included 173 women in labor randomly picked from the group of patients with uncomplicated pregnancies. Polymorphic regions of platelets glycoprotein were detected using genotyping methods based on polymerase chain reactions (PCR). RESULTS: 1.72% of patients were found to have thrombosis. The thrombosis was located in the venous system in 97.2% of cases. Arteries were affected in two patients (2.7%). Prevalence of individual platelets glycoprotein mutations did not differ between controls and study group. In both groups platelets glycoprotein polymorphisms moderately pro-thrombotic A1/A2 and C/T dominated, and the least numerous were strongly pro-thrombotic A2/A2 and T/T. CONCLUSIONS: Our results did not show the causative relationship between the existence of platelets GP IIIa/GP Ia mutations and venous system thrombosis in the women in labor. Probably presence of pro-thrombotic mutations of platelets glycoprotein in this group of patients does not represent the increased risk of thrombosis.

Pregnancy complicated by Myasthenia gravis - twelve years experience.

OBJECTIVE: The aim of the study was to evaluate the effect of Myasthenia gravis (MG) on the course of pregnancy, labor and delivery, and the condition of neonate. DESIGN AND SETTINGS: Retrospective chart review of pregnant patients with MG hospitalized in tertiary care center over 12 year period was performed. Course of MG before and during pregnancy, mode of delivery, and condition of the newborn were analyzed. RESULTS: There was 42 913 deliveries in the Polish Mother's Research Institute in Lodz during analyzed period. Thirteen patients with MG were identified, giving the incidence of 3/10 000 live births. Mean age of the patients was 28 years, range 18 - 36 years. Average time since diagnosis was 9 years. Eleven women with MG delivered at term (one twin pregnancy), and two babies were born prematurely. In seven patients pregnancy was ended via normal spontaneous vaginal delivery (NSVD), one was forceps extraction, four patients had elective Cesarean Section (CS), and two had emergency CS. Indications for CS were purely obstetrical. Spontaneous vaginal deliveries were speedy. None of the patients had exacerbation of MG during current pregnancy. Mean birth weight of the newborns was 3014,3 g, range 1730 g to 3700 g. Mean Apgar score was 8,7 at 1 minute and 8,9 at 5 minutes. Only one neonate (second twin) developed Transient Neonatal Myasthenia Gravis (TNMG). CONCLUSIONS: Myasthenia gravis did not have significant effect on the course of pregnancy or mode of delivery. In the twin pregnancies it is possible that only one twin will present with the symptoms of TNMG.

[Pregnancy and childbirth course after IVF-ET patients admitted to KMMP ICZMP on Lodz between 1996-2002]. / Przebieg ciazy i porodu po IVF-ET u pacjentek hospitalizowanych w Klinice Medycyny Matczyno--Plodowej ICZMP w Lodzi w latach 1991-2002.

THE AIM: The evaluation of pregnancy course and the birth body weight of the infants from the women, which got pregnant as a result of IVF-ET procedures. MATERIALS AND METHODS: 72 female patients admitted to KMMP ICZMP in Lódz between January 1996 and December 2002 were put to the analysis (group I). The control group consisted of 400 random chosen female patients admitted to the Clinic during the examined period (group II). The course of the pregnancy, childbirth and the birth body weight of infants in both groups since 23rd week of the pregnancy were analysed. Mean age of the female patients in group I amounted 32 years (22-42), and in the group II 26 years (17-37). For the purposes of statistic analyse the test chi 2 was used. RESULTS: In group I the patients presented significantly elder population then in the group II. The multiple pregnancies in the group I presented 32% and they occurred significantly more often then in the group II (2%). In the group I significantly statistically more often the cholestase (6.9%), the imminent premature childbirth (36%), the premature amniorrhoea (20.8%), the premature childbirth (22%), the isthmo--cervicalis insufficiency (6.9%) and the inhibition of the intrauterine foetus growth (11%) were affirmed. Statistically significantly more often the childbirth was ended with Caesarean section in the group I (47.2%) then in group II (17.8%). The infants with birth body weight less than 2500 g statistically significantly more often were born from group I (36.4%) then from group II (8.6%). CONCLUSION: 1. The pregnancy and childbirth course after IVF-ET is burden with bigger risk of obstetric pathology occurrence. 2. The pregnant women after IVF-ET are more often giving birth to the infants with low birth body weight.

[Central nervous system tumors in pregnancy]. / Guzy osrodkowego ukladu nerwowego w ciazy.

Central nervous system tumour in pregnancy constitutes a serious complication. Considering frequent difficulties in diagnostics and therapy, the aim of the study was to present our experience in management with pregnant women with brain and spinal cord tumours. Between 1988-2000, in The Research Institute Polish Mother's Memorial Hospital in Lodzi, 4 pregnant women had been diagnosed with brain and spinal cord tumours. The incidence of tumours complicating pregnancy was 1/11460. Two patients diagnosed at 29 weeks' gestation, underwent craniotomy and tumour resection during pregnancy. Two other women with central nervous system tumours diagnosed at 39 weeks' gestation, were operated in the postpartum period. The analysis of the postoperative period, gestation and/or postpartum period in all women and well-being of their new-borns confirm undertaken medical decisions.