Trophoblasts and soluble adhesion molecules in peripheral blood of women with pregnancy-induced hypertension.

PROBLEM: The current hypothesis on the pathogenesis of pregnancy-induced hypertension (PIH) considers it as an endothelial disorder that is first local but with the potential of becoming general. The aim of the work was to investigate the relation of the number of trophoblast cells in maternal peripheral blood against the serum levels of soluble vascular and intercellular cell adhesion molecule (sVCAM-1 and sICAM-1) in PIH. METHOD OF STUDY: Women with PIH were at 28th to 40th week of gestation. Control group were normotensive (NT) pregnant women at 28th to 41st week of gestation. Flow cytometry was used to assess the relative number of the trophoblasts in the peripheral blood. Trophoblasts were labeled with monoclonal anti-human trophoblast protein antibody MCA 277. The presence of sVCAM-1 and sICAM-1 was determined using the enzyme-linked immunosorbent assay method. RESULTS: Women with PIH had significantly higher trophoblasts number than NT women (median 19.0, range 5.0-57.0/400 microL versus median 7.0, range 0.0-18.0/400 microL; P = 0.000011) as well as plasma level of sVCAM-1 when compared with NT women (median 730.0, range 325.0-1525.0 ng/mL versus median 493, range 310-1075 ng/mL; P = 0.02). ICAM-1 level in the PIH group was slightly elevated (median 280.0, range 174.0-524.0 ng/mL) when compared with NT women (median 260.0, range 190.0-464.0 ng/mL, P = 0.322). Eight of 21 women with PIH had proteinuria but no correlation was found between this symptom and the laboratory findings. CONCLUSION: The increased number of trophoblast cells in maternal peripheral blood and higher levels of sVCAM-1 correlate with the presence of PIH. The differences of sVCAM levels were significantly higher than those observed for sICAM. The results indicate an association between circulating trophoblasts and vascular endothelium activation, during PIH.

[Application of 2% clindamycin cream in the treatment of bacterial vaginosis and valuation of methylcellulose gel containing the complex of Chitosan F and PVP k-90 with lactic acid as carrier for intravaginally adhbited medicines in the cases of pregnancies with the symptoms of preterm delivery]. / Zastosowanie 2% kremu z klindamycyna w leczeniu bakteryjnej waginozy oraz ocena zelu z metylocelulozy, zawierajacego kompleks Chitiozanu F i PVP K-90 z kwasem mlekowym, jako nosnika dla leków stosowanych dopochwowo w przypadkach ciezarnych z objawami porodu przedwczesnego zagrazajacego.

OBJECTIVES: There are many reports informing about the connection between BV and the increased risk of preterm delivery. The reason of self-concession and reversion of BV after having executed an efficient treatment has not yet been properly explained. DESIGN: The aim of this work was the clinical valuation of the 2% Clindamycin cream in the treatment of BV and of the methylcellulose gel containing the complex of Chitosan F and PVP K-90 with lactic acid as a carrier for intravaginally adhbited medicines in the cases of pregnancies with the symptoms of a preterm delivery. MATERIAL AND METHODS: The research comprised 145 pregnant between 24-34 week of pregnancy, hospitalised because of the symptoms of a preterm menace delivery. In the case of the detection of BV, a 10-day therapy using intravaginal cream containing 2% Clindamycin was executed. In the cases not qualified as BV, the methylcellulose gel containing the complex of Chitosan F and PVP K-90 with lactic acid has been intravaginally adhibited for 10 days. CONCLUSIONS: 1. Application of 2% Clindamycin cream is an efficient method of the treatment of bacterial vaginosis. 2. Methylcellulose gel containing lactic acid combined with the complex of Chitosan F and PVP K-90 allows a persistent maintenance of the correct pH of vagina. 3. Methylcellulose gel, because of its physico-chemical properties similar to physiological mucus, is a universal carrier for intravaginally adhibited medicines.

[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.

[Semen analysis results and air pollution in the group of men from infertile couples in the Lower Silesia in 1977-2000]. / Analiza wplywu zanieczyszczen powietrza na obraz nasienia mezczyzn z nieplodnych par w Regionie Dolnoslaskim w latach 1977-2000.

OBJECTIVES: To evaluate the relation among the concentration of selected air pollution and seminal parameters, examined from 1977 to 2000. DESIGN: Semen analysis and air pollution results were retrospectively evaluated. MATERIALS AND METHODS: We have analysed semiograms from 1363 men from infertile couples inhabiting Lower Silesia. Seminal volume, sperm concentration, percentage of pathologic sperms were measured in all men. Estimation of mean seminal volume, total sperm number, sperm motility, and percentage of pathologic sperms per year was performed. Average values for NO2, CO, SO2 and dust concentrations during the study were taken from official sources. RESULTS AND CONCLUSIONS: We showed the statistically significant increase in the percentage of pathological sperms (R2 = 0.9, p < 0.05), the slight increase in the semen volume(R2 = 0.4, p < 0.05). The total sperm count in the semen samples revealed a slight increase (R2 = 0.25, p < 0.05). The sperm concentrations and the percentage of motile sperms remained relatively stable and relatively constant. Statistically important decrease in NO2 (R2 = 0.85, p < 0.05), SO2 (R2 = 0.96, p < 0.05) and dust concentration (R2 = 0.89, p < 0.05) and no change in CO concentration was revealed. There is no correlation among concentrations of dust, NO2, SO2, CO and the increase in percentage of pathologic sperms.

[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.

[The usefulness of hysteroscopy and hysterosalpingography in diagnosis of tubal infertility]. / Przydatnosc badania histeroskopowego i histerosalpingograficznego w diagnostyce nieplodnosci jajowodowej.

OBJECTIVES: To estimate the usefulness of hysteroscopy (HSC) and hysterosalpingography (HSG) examination on a retrospective study. DESIGN: Canulisation and morphology of ovarian tube detected during HSG and reactivity of uterine tubal ostia observed in HSC were compared. MATERIAL AND METHODS: The results of HSG and HSC examination performed on 125 young infertile women whom the tubal uterine factor of infertility was suspected were analyzed 250 ovarian tubes, after previous selection were taken into consideration. The analysis had a retrospective character. RESULTS: The analyzed group of women were divided into 3 group which differed from each other in reactivate of uterine ostia of the ovarian tubes. The first group first with correct reactivity of tubal ostia was the largest. The authors observed canulisation, which was the best in the first group and morphologic changes in the internal structure of the ovarian tubes. The highest percentage of these changes were observed in group three with unreactive uterine ostia. CONCLUSIONS: The HSG and HSC examination are supplementary examinations. The use of both methods together increases their diagnostic value and gives a more correct estimation of tubal status.

PIH is associated with an increase of trophoblasts circulating in maternal blood.

One of the reason of PIH problems may be due to exposition to placental trophoblast. The objective of the work was to evaluate the number of trophoblast cells deported into maternal peripheral blood of patients with PIH (pregnancy induced hypertension) as compared to normal pregnancy. Trophoblasts have been detected, by cytofluorimetry, in peripheral maternal venous blood of hypertensive woman (15 cases) and normotensive pregnancy (16 cases). Women with PIH had statistically significant (p < 0.005) higher trophoblasts number than that found in normotensive pregnant women without PIH (16 cases). Our results indicate that the increased trophoblasts deportation into peripheral blood could be a marker of the maternal syndrome of PIH.

Increased maternal plasma levels of soluble vascular cell adhesion molecule-1 (VCAM-1) in pregnancy induced hypertension (PIH).

One of the reason of PIH problems may be due to the presence of increased circulating levels of cell adhesion molecules, markers of endothelial damage and leukocyte activation. The objective was to evaluate the plasma levels of soluble vascular cell adhesion molecule in maternal peripheral blood of patients with PIH (pregnancy induced hypertension) and compared to those of normal healthy women with uncomplicated pregnancy. Maternal plasma samples were prepared from peripheral venous blood collected from 10 patients with PIH and 10 matched normotensive patients with uncomplicated pregnancies. Samples were assayed for soluble VCAM-1 by specific enzyme-linked immunosorbent assay (ELISA). Women with PIH had significantly higher plasma level of soluble VCAM-1 as compared with healthy pregnant women without PIH (653.50 vs. 456.39 ng/mL, respectively, p < 0.005). Our results on the increased plasma levels of soluble VCAM-1 in patients with PIH provide evidence for endothelial activation of PIH. It suggest that increased plasma level of soluble VCAM-1 could be an early marker of the maternal syndrome of PIH.

[Analysis of bacterial flora in the uterine cervix in women during preterm labor]. / Analiza flory bakteryjnej szyjki macicy kobiet, u których wystapil poród przedwczesny.

The aim of this study was to estimate type and frequency the bacterial flora of uterine cervix of female in case of preterm labor. There were analyzed 153 uterine cervix swabs of women before 37 weeks of pregnancy. It has been shown that the main etiologic factors of infestations were Escherichia coli and Staphylococcus epidermidis. Positive results of bacterial investigation has been occurred more frequently in multiparas with precocious ammonirrhea.

[HELLP syndrome: problems in diagnosis and treatment illustrated on the basis of the fully symptomatic case]. / Zespól HELLP, problem diagnostyczno-leczniczy omówiony w oparciu o przypadek wlasny.

HELLP syndrome is a serious complication of Pregnancy-Induced Hypertension (PIH) which is very dangerous for the mother and her foetus. The prognosis depends on early diagnosis and correct treatment. The etiopathogenesis of the syndrome is still investigated but remains unclear. Taking as an example the precisely monitored, fully symptomatic case of the HELLP syndrome, we present review of modern opinions on pathogenesis, recognition and treatment.

[Changes in morphological picture of the semen in the group of men from infertile couples in the Lower Silesia in 1977-1993]. / Zmiany w morfologicznym obrazie nasienia mezczyzn z bezdzietnych par malzenskich, mieszkanców regionu dolnoslaskiego, w latach 1977-1993.

OBJECTIVES: To reveal the trends of the particular semen parameters changes during the 17 years period. DESIGN: Semen analysis results were retrospectively evaluated. MATERIALS AND METHODS: We have analysed semiograms from 618 men from infertile couples in 1977-1993. Regression analysis of the results from years of observation was performed. RESULTS AND CONCLUSIONS: We showed the statistically important increase in the percentage of pathological sperms (R2 = 0.89, p < 0.0001), the slight increase in the semen volume (R2 = 0.30, p < 0.02). The total sperm count in the semen samples revealed a slight increase (R2 = 0.33, p < 0.02). The sperm concentrations and the percentage of the motile sperms remained relatively stable and relatively constant.

[The evaluation of concentration myeloperoxidase and interleukin-8 in blood serum of pregnant women with or without pregnancy induced hypertension]. / Ocena stezen mieloperoksydazy i interleukiny-8 w surowicy krwi ciezarnych z nadcisnieniem indukowanym ciaza oraz w ciazach fizjologicznych.

In the serum of woman during the pregnancy with and without PIH the activity of interleukin-8 and myeloperoxydase was measured. 40 pregnant woman with PIH and 16 normal pregnant woman were included in the study. We have not found significative difference between examined populations.

[Usefulness of ultrasonographic measurement for fetal sacrum length in assessment of gestational age in physiologic pregnancy]. / Przydatnosc ultrasonograficznego pomiaru dlugosci kosci krzyzowej plodu w ocenie czasu trwania ciazy fizjologicznej.

Assessment of gestational age is one of the most important aims of ultrasonography in obstetrics. As pregnancy progresses, influences of factors which makes the growth of the fetuses different, cumulates. It has been revealed that the earlier in pregnancy ultrasound examination was performed, the better precision in the assessment of gestational age was obtained. The best precision is encountered when Crown-rump length is measured between 7-9 weeks of gestation. Until the end of the half of pregnancy, biparietal measurement allows for better assessment of gestational age than the date of the last menstrual period. As pregnancy progresses the variability of the measurements increases, reaching 7 week variation at term. The aim of this study is the assessment of fetal sacral length ultrasonographic measurements in the calculation of gestational age. The investigated group consists of 453 pregnant women between 16-41 weeks of physiological gestation.

[Usefulness of amniotic fluid index determination in monitoring the effectiveness of amniotic infusion in pregnancy complicated by oligohydramnios]. / Ocena przydatnosci oznaczania Indeksu Plynu Owodniowego w monitorowaniu skutecznosci amnioinfuzji w ciazach powiklanych malowodziem.

In our research we intended to evaluate the usefulness of AFI measurements in the monitoring of the effectiveness of the amnioinfusions in the cases of pregnancy complicated by premature rupture of membranes (PROM), or in the selected cases idiopathic oligohydramnios, in pregnancies between 26-36 weeks of gestation.

[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.

Delayed interval delivery in a quintuplet pregnancy.

We present a case report of delayed delivery of a quintuplet pregnancy. The pregnancy resulted from intrauterine insemination following hormonal treatment. This case may represent the first report of quintuplets delivered using the technique of delayed interval delivery. Three separate spontaneous labours and one Caesarean section for two fetuses took place between the 24th and 32nd weeks of pregnancy. The delay between the first and the last delivery was 61 days. Only a boy, born fourth, survived.

[Endolymphatic stromal myosis corporis in a 50-year-old woman]. / Sródlimfatyczna mioza podscieliskowa trzonu macicy u 50-letniej kobiety.

The authors present a rarely-observed case of endolymphatic stromal miosis (ESM) in a fifty-year old female patient. ESM is a low malignancy stromal endometrial tumor that is usually treated by surgery.

[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.