[Right ventricular hypertrophic cardiomyopathy in the fetus --may it be caused by chronic oral tocolysis with fenoterol?]. / Kardiomiopatia przerostowa prawej komory u plodu--czy przewlekla doustna tokoliza fenoterolem moze byc jej przyczyna?

The use of fenoterol in the treatment of preterm labor is associated with the risk of many complications in the mother and the fetus. We present a case of a multipara treated with oral fenoterol due to threatening preterm labor 14 weeks. At 35 weeks of gestation the fetus was diagnosed with hypertrophic cardiomyopathy with severe impairment of the right ventricle. The only factor that might have caused such a state of the fetal circulatory system was fenoterol, used from 21 weeks of gestation. After the withdrawal of the fenoterol the fetal right ventricular function improved gradually. However fetal cardiac hypertrophy persisted until the birth at 39 weeks of gestation. Concentric hypertrophy of the right ventricular wall and interventricular septum were confirmed in the newborn.

[Quantitative assessment of the right and the left ventricular function using pulsed Doppler myocardial performance index in normal fetuses at 18 to 40 weeks of gestation]. / Ilosciowa ocena funkcji-prawej i lewei komory metoda Dopplera pulsacyjnego z uzyclem wskaznika sprawnosci miesnia serca u zdrowych plodów miedzy 18 a 40 tygodniem ciazy.

OBJECTIVE: To establish the values of the pulsed Doppler myocardial performance index (MPI, Tei index) for the left and the right ventricle in normal fetuses at 18 to 40 weeks gestation. MATERIAL AND METHODS: Echocardiography exams were performed in 140 normal fetuses at 18 to 40 weeks gestation at the tertiary centre for fetal cardiology MPI was calculated in pulsed Doppler using formula: (a-b)/b. The time a was measured from a closure click to the subsequent opening click of the mitral/tricuspid valve and time b from opening to the closure clicks of the aortic/pulmonary valve. RESULTS: The mean MPI for the LV was 0.47 +/- 0.07 and for RV 0.48 +/- 0.1. There was no difference between the Tei index LV and the Tei index RV (p = 0.41). We observed a linear correlation between the Tei index LV and the Tei index RV (p = 0.008; r = 0.22). Fetal heart rate and gestational age had no effect on the MPI for both ventricles. CONCLUSIONS: The assessed normal values of Tei index for the left and the right ventricles in fetuses may be used in comparison of myocardial performance in various clinical settings.

[Cardiotocography in fetal heart arrhythmia--analysis of cases]. / Zapisy kardiotokograficzne u plodów z zaburzeniami rytmu serca--analiza przypadków.

Cardiotocography (CTG) is routinely used in obstetric units to monitor fetal well-being during pregnancy and labor Nevertheless the use of CTG is limited in cases of fetal arrhythmia, because it truncates the FHR if faster than 210 bpm and slower than 50 bpm. In fetal arrhythmias, with the heart rate between 50 bpm and 210 bpm, CTG may be nonconclusive, difficult to interpret and should not be taken into consideration when making the decision to end the pregnancy especially when it is premature. Until now the usefulness of CTG in the fetal arrhythmia has not been sufficiently described. The following study evaluates typical cases of fetal arrhythmia diagnosed by fetal echocardiography with corresponding cardiotocography and reviews the decision that had been made in each case.

[Fetal tachyarrhythmia--current state of knowledge]. / Tachyarytmie u plodów--aktualny stan wiedzy.

Fetal tachyarrhythmia occurs in approximately 10% of all fetal arrhythmias. The majority of fetal tachyarrhythmias occur due to atrioventricular reentrant type of supraventricular tachycardia. A fetal tachycardic heart is at risk of developing low cardiac output, hydrops and ultimately fetal death or significant neurological morbidity. Reliable diagnosis of fetal tachyarrhythmia is possible by echocardiography and is crucial for a managed therapeutic approach. The goals of therapy for fetal tachyarrhythmias are to restore sinus rhythm, resolve heart failure and postpone delivery before term. A review of fetal tachyarrhythmias has been reported in our work.

[Successful outcome of a pregnancy with an extremely low fetal heart rate (34 bpm) due to isolated complete heart block--case report]. / Pomyslne zakonczenie ciazy u plodu ze skrajnie wolna czynnoscia komór (34/min.) w przebiegu izolowanego calkowitego bloku przedsionkowo-komorowego--opis przypadku.

Isolated complete congenital heart block (CHB) in the majority of cases is associated with the presence of autoantibodies to SSA (Ro) and SSB (La) antigens in the maternal serum. The prognosis is less favorable in fetuses with a ventricular rate < 55bpm. We have reported a case of a fetus with an isolated non-autoimmune CHB with an extremely low ventricular rate (34bpm) in which the outcome was favorable. In the neonate the non-compaction of the myocardium was diagnosed.

[Estimation of the atrioventricular time interval by pulse Doppler in the normal fetal heart]. / Ocena czasu przewodzenia przedsionkowo-komorowego metoda Dopplera pulsacyjnego u zdrowych plodów.

OBJECTIVES: To assess normative values of the fetal atrioventricular (AV) time interval by pulse-wave Doppler methods on 5-chamber view. MATERIAL AND METHODS: Fetal echocardiography exams were performed using Acuson Sequoia 512 in 140 singleton fetuses at 18 to 40 weeks of gestation with sinus rhythm and normal cardiac and extracardiac anatomy. Pulsed Doppler derived AV intervals were measured from left ventricular inflow/outflow view using transabdominal convex 3.5-6 MHz probe. RESULTS: The values of AV time interval ranged from 100 to 150 ms (mean 123 +/- 11.2). The AV interval was negatively correlated with the heart rhythm (p<0.001). Fetal heart rate decreased as gestation progressed (p<0.001). Thus, the AV intervals increased with the age of gestation (p=0.007). However, in the same subgroup of the fetal heart rate there was no relation between AV intervals and gestational age. Therefore, the AV intervals showed only the heart rate dependence. The 95th percentiles of AV intervals according to FHR ranged from 135 to 148 ms. CONCLUSIONS: 1. The AV interval duration was negatively correlated with the heart rhythm. 2. Measurement of AV time interval is easy to perform and has a good reproducibility. It may be used for the fetal heart block screening in anti-Ro and anti-La positive pregnancies. 3. Normative values established in the study may help obstetricians in assessing fetal abnormalities of the AV conduction.

[The possibility of cardiovascular system evaluation in fetuses at 11.0 to 13.6 weeks of gestation in a reference perinatal cardiology centre]. / Mozliwosc oceny plodowego ukladu krazenia pomiedzy 11.0 a 13.6 tygodniem ciazy w referencyjnym osrodku kardiologii perinatalnej.

OBJECTIVE: To assess the possibility of foetal circulatory system evaluation between 11+0 to 13+6 weeks of gestation in a reference perinatal cardiology centre. MATERIAL AND METHODS: A prospective study was conducted between January 2004 and June 2008 in patients admitted to the reference perinatal cardiology centre for a foetal echocardiographic examination. 1170 foetuses were examined: 31 in 2004, 167 in 2005, 310 in 2006, 406 in 2007 and 262 in the first half of 2008. All foetuses had early echocardiography performed during 11-13+6 weeks of gestation, following the Foetal Medicine Foundation guidelines. The examination included: position and size of the heart, 4-chamber view and outflow tracts evaluation. The flow through ductus venosus, atrio-ventricular and arterial valves were assessed with colour and pulsed Doppler. 982 patients with confirmed normal heart anatomy in the second trimester were further analysed. RESULTS: Mean maternal age was 30 years. 237 (20%) patients were >35 years old. Mean CRL (crown rump length) was 65 mm. 4-chamber view was obtained in 933 foetuses (95%) and outflow tracts in 813 (83%) cases. Diagnostic flow through the tricuspid valve was detected in 894 (91%) foetuses. CONCLUSIONS: Early foetal echocardiography is available in a reference perinatal cardiology centre since 11th week of gestation, in most cases with transabdominal probe. Possibility of the foetal heart anatomy evaluation increases with gestational age. Only patients from the high risk group (i.e. previous child with a major cardiac defect, diabetes mellitus, monochorionic pregnancy) and foetuses with increased NT should be examined. In every case, a control echocardiographic examination in the second trimester must be performed.

[Evaluation of the embryonic and foetal heart rate at 6(+0) to 11(+6) weeks of gestation]. / Ocena rytmu serca zarodka i plodu miedzy 6(+0) a 11(+6) tygodniem ciazy.

OBJECTIVE: To establish the normal range of embryonic heart rate (EHR) and foetal heart rate (FHR) at 6(+0) to 11(+6) weeks of gestation, to evaluate the risk of pregnancy loss depending on EHR and FHR values and to establish if checking of FHR with the use of M-mode method is possible in different levels obstetric departments. MATERIAL AND METHODS: Transvaginal or transabdominal ultrasound using M-mode in 255 singleton pregnancies. Maternal age varied between 16 and 44 years (mean 29 +/- 5 years). There were 67% primigravidas. Gestational week was established on the basis of CRL measurements. Demographic factors, obstetrical history and follow-up were collected. Data was statistically reviewed. RESULTS: FHR varied between 47 and 192 bpm (mean 154 +/- 26 bpm). At 6 weeks, mean EHR was 116 +/- 21 bpm, then slowly increased, reaching mean 172 +/- 9 bpm at 10 weeks. At 11 weeks the mean FHR achieved the level of 165 +/- 7 bpm. The difference was statistically significant. The r-correlation ratio between FHR and the gestational week was 0.58. In case of 7 embryos (2.75%) at 6.1 to 8.1 weeks of gestation slow FHR was noted (< 100 bpm). The scan performed 7-10 days later revealed miscarriages in all cases. CONCLUSIONS: EHR and FHR in the first trimester depends on gestational week. It increases since 6 to 9 weeks and decreases after 10 weeks. The highest values of FHR are observed between 9 and 10 weeks of gestation. The risk of early pregnancy loss increases significantly in case of detecting slow FHR. FHR can be checked by M-mode methods using any kind of ultrasound machine.

[The possibility of evaluation of the myocardial performance index in fetuses at 11,0 to 13,6 week of gestation]. / Moiliwosci oceny skurczowo-rozkurczowej funkcji miesnia sercowego u plodów miedzy 11,0 a 13,6 tygodniem ciazy.

OBJECTIVES: To assess myocardial performance index (Tei index) for left and right ventricle in fetuses at 11.0 to 13.6 week of gestation. MATERIAL AND METHODS: Flow velocity waveforms of mitral, tricuspid, aortic and pulmonary valves were obtained. The Tei index for the left ventricle (Tei LV) was calculated in 55, and for the right ventricle (Tei RV) in 27 fetuses. RESULTS: The value of Tei LV ranged from 0.28 to 0.59, mean 0.41 +/- 0.08, and for Tei RV from 0.23 to 0.56, mean 0.37 +/- 0.11. There was no statistically important correlation either between Tei index and both ventricles or gestational age and fetal heart rate. The possibility to measure Tei index increased with the progress of the pregnancy. There remains a significant correlation between Tei LV and Tei RV values. CONCLUSIONS: Tei index may be useful for the assessment of fetal myocardial performance in the first trimester of pregnancy. Tei index is independent of gestational age and fetal heart rate. It is easier to measure the Tei index for the left ventricle than for the right one.

[Genetic amniocentesis in the II Department of Obstetrics and Gynecology of the Medical University of Warsaw]. / Ocena wyników amniopunkcji genetycznych w materiale II Kliniki Poloznictwa i Ginekologii AM w Warszawie.

OBJECTIVE: Characteristic of patients, indications, outcomes and complications of genetic amniocentesis. MATERIAL AND METHODS: Retrospective analysis of 420 women who underwent genetics amniocentesis from January 1999 to 2001. It was done by ultrasound-guided insertion of a 22-gauge needle from 12 to 19 week's gestation. From 9 ml to 24 ml of amniotic fluid were removed for cytogenic analysis. RESULTS: The mean maternal age was 37.6 +/- 4 years. The mean gestational age of amniocentesis was 14.2 +/- 1.2 weeks. 416 (99%) women were in singleton pregnancy, 3 (0.7%) in twin pregnancy and one (0.2%) in triplet pregnancy. The most common indication for amniocentesis was maternal age over 35 years (366 cases - 87%). Chromosomal abnormalities were identified in 23 cases (5.5%). Any neural tube defects were observed. In 6 (1.4%) cases the cell culture of amniotic fluid was unsuccessful and procedure was repeated. 2 (0.4%) women lost pregnancy during 7 days after procedure. 4 patients (0.9%) had amniotic fluid leakage, of which no ended in fetal loss. 1 (0.2%) had pain in hypogastrium after amniocentesis, all delivered at term. CONCLUSIONS: The pregnancy loss rate in women who underwent genetics amniocentesis was 0.4%. The most common indication for genetic amniocentesis was maternal age over 35 years. Chromosomal abnormalities were detected in 5.4% of the fetuses.

[Evaluation of fetal heart anatomy at the end of the first trimester and the beginning of the mid-trimester]. / Ocena anatomii serca plodu na przelomie pierwszego i drugiego trymestru ciazy--doniesienie wstepne.

OBJECTIVE: To evaluate fetal heart anatomy in the late first and in the early second trimester. MATERIALS AND METHODS: The study included 75 fetuses between 11 and 19 weeks' gestation. Exams were performed using transabdominal or transvaginal probes. RESULTS: The proportion of cases successfully visualized to all cases in particular week of pregnancy was following: 11 week--0/1 (0%), 12--1/1 (100%), 13 week--1/1 (100%), 14--18/23 (79%), 15--6/9 (67%), 16--23/27 (86%), 17--4/5 (80%), 18--6/6 (100%), 19--2/2 (100%). In 11 weeks' gestation two ventricles and two atrias could be imaged. Anatomy was seen from 12 weeks' gestation with transvaginal and from 13 weeks' gestation with transabdominal transducers. Two tricuspid regurgitations were detected. The interventricular septum was the most difficult structure to visualize in all cases. The grey scale alone was not sufficient for accurate examination of the heart and it was necessary to use colour Doppler to confirm normal forward flow to both ventricles and to identify outflow tracts. CONCLUSIONS: 1. Successful visualization of the heart in early pregnancy is possible from 12 weeks' gestation with transvaginal and from 13 weeks' gestation with transabdominal probe. 2. Fetal echocardiography between first and second trimester should lead to better understanding of fetal hemodynamics in normal and abnormal fetuses and help to introduce new therapeutic treatment in some cases.

[Sexuality in pregnant women]. / Seksualizm kobiet w ciazy.

The aim of the study was to evaluate the effects of pregnancy on women's sexuality. The studies were conducted using questionnaires to interview 120 women from 35 weeks' of gestation or just after the delivery. There were no medical contraindications for sexual intercourse in pregnancy in this group. More than half of respondents reported a decrease in libido during gestation. A reduction in coital frequency, oral intercourse, gratification of coitus, caress of breasts or genitals and erotic dreams occurred during pregnancy. Lateral position was mainly used during coitus in pregnancy. Most of women didn't discuss the problems of sexual activity in pregnancy with their obstetricians.

[Effectiveness of cervical cerclage and pessary in the treatment of isthmo-cervical insufficiency]. / Ocena porównawcza skutecznosci szwu szyjkowego i pessarium w leczeniu niewydolnosci ciesniowo-szyjkowej w ciazy.

The aim of this study was comparison of gestation, labour, puerperium and condition of newborns in women with cervical incompetence treated with cerclage or pessary. The interval from treatment to delivery was longer in women with pessary. In women who had cervical cerclage tocolysis was applied more frequently. Among patients with pessary kolpitis was found more often. Gestational age at delivery, the way of a labour, condition of newborns and complications during puerperium didn't differ significantly between both groups.

[Sex during pregnancy and risk of premature labour]. / Wspólzycie plciowe podczas ciazy a ryzyko porodu przedwczesnego.

Sexual life in pregnancy may be connected with preterm delivery. This fact, which is observed in clinical practice, is not confirmed by, references. There are no modern, well conducted trials about the risk of premature labour as a result of sexual activity. The concentration of fetal fibronectin is false, when the examination is performed before 24 hours from the last sexual intercourse.

[Genetic amniocentesis--characteristic of patients, indications, outcomes, complications]. / Amniopunkcja genetyczna--charakterystyka pacjentek, wskazania, wyniki, powiklania.

The indications, outcomes and complications of genetic amniocentesis in a group of 358 women were undeped. The most frequent indication for amniocentesis was maternal age over 35 years. Chromosomal abnormalities were identified in 21 cases (5.8%)--most of them were chromosomal inversions. There were no neural tube defects. In 6 (1.6%) cases the cell culture of amniotic fluid was unsuccessful. The level of alpha-fetoprotein was lower in fetuses with chromosomal abnormalities. 2 (0.5%) patients lost pregnancy after procedure, 4 (1.1%) had amniotic fluid leakage and 1 (0.2%) had pain in hypogastrium after amniocentesis.

[Curettage immediately after delivery]. / Instrumentalna kontrola jamy macicy bezposrednio po porodzie.

The purpose of the study was to compare indications for curettage directly after delivery with histologic findings. Only in 51% there was a histologic confirmation of placental or membrane tissue. Residences indications of the suspected retained placenta were wrong in 70% cases. The curetting of 75% of the patients experiencing post partum bleeding revealed no fragments of placental or membrane tissue.