[Evaluation of the efficacy and safety of Foley catheter pre-induction of labor]. / Ocena skutecznosci i bezpieczenstwa preindukcji porodu cewnikiem Foley'a.

INTRODUCTION: Labor induction is being increasingly used (15-30% of pregnancies). The most common indications include late pregnancy preeclampsia, intrauterine fetal growth retardation (IUGR), hypertension. Preinduction by speeding up the ripening of the cervix increases the chances of successful induction. There are mechanical and pharmacological methods of pre-induction: the Foley catheter hygroscopic dilators, prostaglandin gel, misoprostol. There are various schemes of labor pre-induction and the differences relate primarily to duration of catheter time, amniotomy or the start of the oxytocin. Numerous studies on pre-induction and induction of labor aimed to compare the efficacy of these different methods. The effectiveness of the Foley catheter is usually assessed by comparing cervical maturity (Bishop score) and ripening of the cervix, evaluated in centimeters, before and after removing the cathetec time to labor since pre-induction and the number of births. In order to select the appropriate method, its safety for the mother and the fetus/newborn needs to be assessed. According to most authors, the use of a Foley catheter does not cause over-stimulation of the uterus, does not increase the risk of rupture or intrauterine infection, and does not adversely affect the fetus and newborn. AIM OF THE STUDY: To assess the efficacy and safety of labor pre-induction using a Foley catheter MATERIAL AND METHODS: The study included 109 women hospitalized between 03.01.2011 and 11.30.2011, who underwent labor pre-induction with a Foley catheter The inclusion criteria were: one fetal pregnancy longitudinal cephalic fetal position, completed 36 weeks of pregnancy fetal bladder preserved, Bishop score < 5 points. The exclusion criteria were: placenta previa, uterine infection, unexplained bleeding, abnormal fetal heart rate, and other reasons preventing vaginal delivery such as fetal weight above 4500 g. Vaginal swabs for the presence of Streptococcus agalactiae (GBS) were obtained from each patient. In case of a positive result perinatal antibiotic prophylaxis was administered before insertion of the catheter The study group was divided into two subgroups according to parity: primiparous and multiparous. Indications for induction, method of pregnancy termination, the pregnancy and its complications were evaluated. The condition of the newborns was evaluated using the Apgar score, cord blood pH and infant birth weight. We analyzed cervical ripeness (Bishop score) before the insertion and after the removal of the catheter and serum C-reactive protein (CRP) before and 20 hours after insertion. CRP was not studied in pregnant women diagnosed with GBS colonization. The results were compared between the subgroups. An increase in the Bishop score to> 5 and delivery within 12 hours since the planned removal of the catheter regardless of the method of pregnancy and the use of oxytocin, was considered as successful induction of labor RESULTS: Catheter pre-induction was performed in 109 pregnant women, what amounted to 7.87% all of deliveries in our department during the analyzed period. Mean patient age was 29.3 +/- 5.35 years, mean duration of pregnancy 40 weeks of gestation (+/- 1 week 5 days), and primiparas constituted 66.06% of all cases. The most common indication for labor induction was post-term pregnancy (55.05%), hypertension and preeclampsia (16.51%). The following complications were observed in the study group after insertion of the catheter: 8 (7.34%) cases of premature rupture of the membranes (PROM), but none of them occurred in the process of inserting the catheter 11 (10.09%) women had the catheter removed (patients request) due to pain and the feeling of discomfort before the scheduled time, 2 (1.84%) cases of bleeding (in the first case the cesarean section was performed and the baby was born in a good overall condition, in the second case the bleeding subsided spontaneously). There was a statistically significant increase in the Bishop score for the entire study group and in the two subgroups. Mean increase in the Bishop score was 2.68 +/- 1.39 points for the entire cohort (p < 0.005). The rate of successful pre-induction resulting in a delivery was 69.4%, with vaginal births accounting for 66.67% of all cases. Also, 30.66% of the pregnant women did not require the use of oxytocin. The most common indication for cesarean section was threatening intrauterine fetal asphyxia. Higher efficiency of pre-induction was found in the multiparous group. The observed increase in CRP (p < 0.005) was within the normal range for pregnant women (< 12 mg/I). None of the patients showed any clinical signs of infection. Mean birth weight of the infants was 3392 +/- 644.72 g, mean Apgar score was 9.5 +/- 0.80 and mean cord blood pH was 7.3 +/- 0.08. CONCLUSIONS: The Foley catheter is an effective method of inducing cervical maturation. The Foley catheter is safe method of labor induction for the mother fetus and newborn.

[HIV infection in women in childbearing age]. / Zakazenie HIV u kobiet w wieku rozrodczym.

HIV infected women compromise about half of all people living with HIV worldwide. Since HIV is frequently sexually transmitted it follows that women who are seropositive are likely to acquire other sexually transmitted diseases. The gynecologic infections led enhance HIV replication and increased transmission of virus. The presence of STD in known to increase of both acquiring and transmitting HIV. The risk of MTCT can be reduced to below 1% by interventions that include antiretroviral prophylaxis given to women during pregnancy and labour and to the infant in the first weeks of life.

[Neo-angiogenesis in immunohistochemical techniques as a prognostic factor in endometrial carcinoma]. / Immunohistochemiczna ocena neoangiogenezy jako elementu rokowniczego w raku endometrium.

OBJECTIVE: Angiogenesis in malignant tumors is a prognostic factor associated with tumor growth and metastasis. The aim of the research was: determination of the angiodensity rate in two immunohistochemical techniques, estimation of the value of the examined parameter at different stages of clinical progression and histological differentiation of endometrial carcinoma, and analysis of the obtained values as prognostic factors in the disease process. MATERIALS AND METHODS: The examination covered 86 women treated surgically for endometrial carcinoma. The preliminary histological evaluation was followed by immunohistochemical methods. The microvessels within the invasive cancer were highlighted by means of immuno-cytochemical staining to detect CD-31 and CD-105 antigen. The average value of angiodesity was estimated by means of a computer image analyser. RESULTS: The group of patients at the preinvasive stage of the disease manifested significantly statistically lower values of angiodensity. It was detected that the histological differentiation of carcinoma does not influence intensification of angiogenesis. Higher values of this parameter have an adverse influence on the survival rate. CONCLUSION: The evaluation of the angiodensity coefficient can be a helpful prognostic parameter in endometrial carcinoma.

[Microvessel density index as a prognostic factor in a low histological differentiation stage of endometrial carcinoma]. / Przydatnosc oznaczania gestosci naczyniowej jako czynnika rokowniczego w rakach trzonu macicy o niskim stopniu zróznicowania.

OBJECTIVE: Angiogenesis in malignant tumors is a prognostic factor associated with tumor growth and metastasis. Studies of angiogenesis in breast, prostate and lung cancer showed that neovascularisation correlates with likelihood of metastasis and recurrence. Our study was to evaluate microvessel density as a prognostic factor in endometrial cancer. METHODS: Between 1995-1999, 58 women were treated for endometrial carcinoma. The primary treatment consisted of total abdominal hysterectomy, bilateral salpingoophorectomy and pelvic lymphadenectomy. The microscopic examination of paraffin blocks showed the areas of the deepest myometrial invasion. The microvessels within the invasive cancer were highlighted by means of immuno-cytochemical staining to detect CD-31 antigen. RESULTS: Microvessel count was related to likelihood of recurrence. We found statistically significant differences between patients who died after operation and patients with nonrecurrence process. All patients were in the same stage and grade of endometrial carcinoma. CONCLUSION: Microvessel density index seems to be an important factor for planing postoperation treatment in endometrial carcinoma.

[Evaluation of selected risk factors in patients operated for uterine body carcinoma]. / Ocena wybranych czynników rokowniczych u kobiet operowanych z powodu raka trzonu macicy.

OBJECTIVES: Uterus body carcinoma ranks among to the most common malignant neoplasms. It is of special interest what kind of factor influences on the survival span of treated patients. DESIGN: Evaluation of selected risk factors such as: age, obesity, clinical stage, type and histologic differentiation and proliferation depths on the 5-year survival span. MATERIALS AND METHODS: /Due to our research we analyzed 280 endometrium samples of patients with the diagnosis of endometrial cancer, who*.../ Analysis was made on the group of 280 endometrium carcinoma patients, who were operated in the Department of Obstetrics and Women Diseases, University School of Medicine in Bydgoszcz in 1982-2000 period, 221 of the total number of patients (78.8%) were in the cancer stage I, while 33 (11.9%) in stage II, followed by 26 (9.3%) in stage III. RESULTS: The highest percentage of 5-year survival time was observed in the group of patients under age of 50. In patients with the clinical stage I and proliferation depths under 1/2 of myometrum the percentage of 5-year survival time was 91%. Adenocarcinoma was the most common type of cancer and also with the best prognosis (81% of 5-year survival). Neither histologic differentiation G1 nor G2 have an influence on the survival time of operated patients. CONCLUSIONS: 1. The proliferation depths, histologic type of the endometrial carcinoma and clinical stage are the major prognostic factors for the uterus body carcinoma. 2. Endometrial carcinoma in the group of patients under age of 50 is connected with the higher percentage of five-year survival time.