[Non-closure of the visceral peritoneum during abdominal gynecological surgery]. / Nie zamykanie otrzewnej trzewnej po brzusznych zabiegach ginekologicznych.

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

[Ultrasonographic assessment of cervical length and measurement of fetal fibronectin level in cervical secretion of pregnant women in prophylaxis of premature deliveries]. / Ultrasonograficzna ocena dlugosci szyjki macicy oraz oznaczenia fibronektyny plodowej w wydzielinie szyjkowej w profilaktyce porodów przedwczesnych.

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

[The importance of fibronectin in amniotic fluid in anticipation of premature labor]. / Znaczenie fibronektyny w plynie owodniowym w przewidywaniu porodu przedwczesnego.

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

[The course of pregnancy, delivery and puerperium in women with varices and thrombophlebitis of lower extremities, after application of low molecular weight heparins]. / Przebieg ciazy, porodu i pologu u kobiet z zylakami lub zakrzepowym zapaleniem zyl konczyn dolnych, u których stosowano heparyny drobnoczasteczkowe.

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

[Comparison of vaginal misoprostol and oxytocin for labor induction in post-term pregnancy]. / Porównanie skutecznosci misoprostolu i oksytocyny w prowokacji porodu w przypadku ciazy przenoszonej.

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

[Sialic acid of glycoconjugates in amniotic fluid]. / Zawartosc kwasu sjalowego glikokoniugatów plynu owodniowego ciezarnych kobiet.

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

[Assessment of the effectiveness of using low molecular weight heparin in the prophylaxis of venous thrombo-embolic diseases in obstetrics]. / Ocena skutecznosci podawania drobnoczasteczkowych heparyn w profilaktyce zylnej choroby zakrzepowo--zatorowej w poloznictwie.

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

[The influence of computer supervision of deliveries on the medical procedures during labor and neonatal post-delivery status]. / Wplyw komputerowego nadzoru porodu na sposób postepowania medycznego w czasie porodu oraz stan pourodzeniowy noworodków.

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

[The use of oxytocin and prostaglandin in pregnancies after cesarean delivery or uterine surgery]. / Zastosowanie oksytocyny i prostaglandyn u ciezarnych po przebytych cieciach cesarskich oraz operacjach w obrebie trzonu macicy.

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

[Useful of cerebral placental ratio in pregnancies complicated by intrauterine growth retardation and it correlation with perinatal outcome]. / Ocena wspólczynników mózgowo-lozyskowych w ciazach powiklanych wewnatrzmacicznym zahamowaniem wzrostu plodu i ich korelacja ze stanem pourodzeniowym noworodków.

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

[Nonclosure of the visceral peritoneum during Cesarean sections]. / Nie zamykanie otrzewnej trzewnej po cieciach cesarskich.

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

[Results of surgical treatment of urinary stress incontinence women]. / Ocena wyników leczenia operacyjnego kobiet z wysilkowym nietrzymaniem moczu.

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

[Amniocentesis and amniotic infusion: benefits and risks]. / Amniopunkcja, a ciagla amnioinfuzja; korzysci i ryzyko.

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

[Evaluation of the usefulness and reference values for the amniotic fluid index in normal pregnancy between 30 and 42 weeks of gestation]. / Ocena przydatnosci i podanie wartosci indeksu plynu owodniowego w ciazy niepowiklanej miedzy 30 a 42 tygodniem ciazy.

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

[Ultrasonographic evaluation of fetal weight in normal, single fetus pregnancies in the population of Wroclaw]. / Ultrasonograficzna ocena masy plodów z ciaz jednoplodowych o przebiegu prawidlowym w populacji Wroclawskiej.

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

[Ultrasonographic evaluation of growth in twin pregnancies in the population of Wroclaw. I]. / Ultrasonograficzna ocena wielkosci plodów blizniaczych w populacji Wroclawskiej. CZ. I.

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

[Ultrasonic evaluation of fetal growth of twins in the Wroclaw population. II. Proposed percentile curves of ultrasonographic parameters]. / Ultrasonograficzna ocena wielkosci plodów blizniaczych w populacji Wroclawskiej. Cz. II. Propozycje percentylowych siatek parametrów ultrasonograficznych.

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

[Pregnancy and labor in the patient with arteriovenous congenital fistula]. / Ciaza i poród u ciezarnej z wrodzona przetokowatoscia tetniczo-zylna.

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

Results of treatment of imminent premature labour with the preparation Salbupart-POLFA.

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