[Congenital pneumonia in fetuses and newborns ad inflammatory lesions in the placenta]. / Wrodzone zapalenia pluc plodów i noworodków a zapalenia poplodów.

The authors compared the degree of congenital pneumonia in stillborn and neonates died in first two days of life with inflammation lesions of placenta. The coexistence of those two processes and its significant correlation was found, especially among preterm LBW neonates. This finding supports the hypothesis about infection as a probable cause not only of preterm deliveries but infection of fetuses and neonates as well. Analysis of some cases revealed also that general infection of mother could cause transplacental infection of foetuses.

[Oxidative stress in pregnancies complicated by gestational hypertension (GH), effect of oxidized serum lipoproteins (O-LDL)--the role of antio-LDL antibodies]. / Nasilenie stresu oksydacyjnego w ciazach powiklanych nadcisnieniem ciazowym. Efekt dzialania utlenowanych lipoprotein osocza (O-LDL)--rola przeciwcial anty O-LDL.

OBJECTIVE: To explain correlations between metabolism of serous oxidized lipoproteins, their influence on placental function in pregnancies complicated by GH and intrauterine asphyxia. MATERIALS AND METHODS: The group of 233 pregnant women characterised by gestational age between 32-40 weeks were divided into two sub-groups: the study group of 105 women with GH and the control group of 128 healthy pregnant women. In all the subjects doppler flows in umbilical and middle brain artery as well as the serum levels of anti o-LDL antibodies (oLAB) were measured. RESULTS: In the study group mean PI values in middle brain artery equal 1.62 +/- 0.41 while in the control group 0.91 +/- 0.16 (p < 0.01), with oLAB values 1133 +/- 24 for the study group and 619 +/- 15 for the controls. Having analysed vascular flows in umbilical artery, mean PI values of 1.41 +/- 0.36 for the study group and 0.63 +/- 0.12 for the control group were obtained, (p < 0.01). The levels of oLAB in these groups were as follows: 1019 +/- 18 for the study group and 600 +/- 12 for the controls. CONCLUSIONS: 1. In pregnancies complicated by GH an intensified oxidative stress was observed as determined by increased levels of anti o-LDL antibodies (oLAB). 2. Pulsatility indices in umbilical and middle brain artery exhibited enhanced values in pregnancies complicated by GH.

[Transvaginal sonography in prediction of preterm delivery in patients presenting with signs and symptoms of preterm labor]. / Zastosowanie ultrasonografii przezpochwowej w predykcji porodów przedwczesnych w grupie ciezarnych z zagrazajacym porodem przedwczesnym.

OBJECTIVE: The purpose of the study was to assess the clinical value of transvaginal sonography in the group of women presenting with preterm contractions and cervical changes. MATERIAL AND METHODS: We prospectively evaluated 82 patients between 23-34 weeks of gestation presenting in our department with signs and symptoms of preterm labor, intact membranes and cervical dilatation < 3 cm. In all cases transvaginal sonography was performed. The following parameters were assessed: functional canal length, funneling, cervical diameter and the length of the vaginal portion of the cervix. The primary outcome was delivery < or = 28 days from examination. RESULTS: The rate of preterm delivery (< 37 weeks) was 25.6% (21/82) and 17.1% (14/82) of the patients delivered < or = 28 days from the examination. Among the analyzed parameters, the significant difference between patients delivered < or = 28 and > 28 days from examination, was noticed only for the functional canal length (21.6 mm vs 30.1 mm; p < 0.001). The analysis of ROC curves showed that functional canal length had the highest diagnostic capability. Two important thresholds were found--20 mm and 31 mm. For predicting delivery < or = 28 days the functional canal length < or = 20 mm had sensitivity of 57.1%, specificity of 92.6%, PPV of 61.5% and NPV of 91.3%. The cutoff value of 31 mm had sensitivity of 100%, specificity of 47.1%, PPV of 28% and NPV of 100%. In multiple logistic regression analysis only FCL < or = 20 mm (OR 8.18; p = 0.027) was independently associated with PTD. CONCLUSIONS: 1. The shortening of the functional canal length (< or = 20 mm) is predictive of impending preterm delivery and the functional canal length > 31 mm is the indicator of the absence of labor. 2. Cervical sonography can be a valuable adjunct to the clinical assessment of patients with signs and symptoms of preterm labor.

[Fetal fibronectin as a predictor of preterm delivery in patients with preterm contractions and cervical changes]. / Fibronektyna plodowa jako marker porodu przedwczesnego w grupie ciezarnych z przedwczesna czynnoscia skurczowa i zmianami szyjki macicy.

OBJECTIVE: The purpose of the study was to assess the clinical value of fetal fibronectin assay in the group of women presenting with preterm contractions and cervical changes. STUDY DESIGN: We prospectively evaluated 82 patients between 23-34 weeks of gestation presenting with signs and symptoms of preterm labor, intact membranes and cervical dilatation < 3 cm. In all cases cervico-vaginal samples were collected and assayed for the presence of fetal fibronectin. The primary outcome was delivery < or = 28 days from examination. RESULTS: The rate of preterm delivery (< 37 weeks) was 25.6% (21/82) and 17.1% (14/82) of the patients delivered < or = 28 days from the examination. The mean Bishop score was significantly higher in patients delivered < 28 days (5.9 +/- 1.2 vs 4.7 +/- 1.4; p = 0.004). Positive result of fFN (> 0.05 mg/ml) was found in 71.4% of patients that were delivered < or = 28 days and in 7.4% delivered > 28 days (p < 0.001). For predicting delivery < or = 28 days the positive fFN testing had sensitivity of 71.4%, specificity of 92.7%, PPV of 66.7% and NPV of 94%. The cutoff value for Bishop's score > or = 5 had sensitivity of 85.7% and specificity of 48.5%. Performing fFN testing only in patients with Bishop score > or = 5 resulted in the sensitivity of 71.4%, specificity of 95.6%, PPV of 76.9% and NPV of 94.2%. CONCLUSIONS: Fetal fibronectin is a very good predictor of imminent preterm delivery. It needs further research whether performing of the fFN assay can be limited only to the patients with the estimated Bishop's score > or = 5.

[Serial amniocentesis in TTTS]. / Seryjne amnioredukcje w przypadkach TTTS.

AIM OF THE STUDY: The aim of our study was to estimate the efficacy of serial amniocentesis in cases of acute polyhydramnion in TTTS. We analyzed the time and the route of delivery, as well as the status of newborns. MATERIAL AND METHODS: The study group consisted of 13 twins with confirmed hydramnios. In each case thorough examination allowed to make the diagnosis of TTTS. After the examination patients were prepared for amnioreduction. During the procedure the excess of amniotic fluid was removed through the punction needle. RESULTS: The therapy of TTTS was based mainly on serial amniocentesis. In 2 cases, due to an extremely high amniotic volume, the therapy was started with placing the catheter to provide continuous amniotic drainage. The volume of AF removed during the single amniocentesis varied between 700-3000 ml and depended on AFI and the gestational age. In one case maternal treatment with indomethacin was introduced beside amniocentesis and in 3 pregnancies the Digoxin therapy was implemented together with amniocentesis. In all cases the deliveries were preterm. The mean donor weight was 730 +/- 290 g and the mean recipient weight was 1145 +/- 435 g (the difference was approximately 37%). In 7 cases we observed an intrauterine demise of one fetus. The 5th min Apgar score was 1 pt (median). When the analysis was performed after exclusion of stillborns, the median Apgar score for donors and recipients was 4 and 2 pt respectively. CONCLUSIONS: 1. Acute TTTS is a rare pathology occurring in monochorionic twin gestations. 2. The concomitant pathologies include: acute hydramnios, preterm labor and delivery, intrauterine growth restriction, cardiac failure. 3. Serial amniocentesis are effective in significant prolongation of gestation (the mean interval between diagnosis and delivery 24 days). 4. The improvement of perinatal outcomes in twin gestations complicated by TTTS can be achieved by the combination of serial amniocentesis and the laser ablation of anastomoses.

[Doppler evaluation as a predictor of asphyxia in fetuses with intrauterine growth retardation (IUGR)]. / Dopplerowskie cechy centralizacji krazenia we wczesnej ocenie niedotlenienia u plodów z wewnatrzmacicznym zahamowaniem wzrostu (IUGR).

Many papers showed that the pulsatility index of the fetal middle cerebral artery decreases during gestation. We observed equalization of the PI in MCA and PI in UMB in the perinatal period (after 38 weeks of gestation). We observed the increase the diastolic cerebral flow through the brain in cases of hypoxia. We interpreted that situation as a vasomotor response to fetal hypoxia (for example in IUGR). This phenomenon, is called in the literature as brain sparing effect. The aim of our study was estimation of application Doppler technique in diagnosis of changes in circulatory system in pregnancies complicated by intrauterine growth restriction (IUGR). We included 66 fetuses with IUGR and sonographic signs of the brain sparing effects, without any congenital malformation, oedema and genetic abnormalities to the study group. We included 1730 foetuses from normal, physiological pregnancies to the control group. In all cases time of gestation were calculated from Naegele's rule and were confirmed in sonographic examination before 16 weeks of gestation. SGA fetuses were defined on the basis of ultrasonographic measurements of BPD, HC, AC, FL and weight below 10th percentile of our reference curve. Sonographic examination were performed on Acuson 128 XP/10 with transducers (2.5 MHz-5 MHz). We performed Doppler examinations in MCA and UMB. Redistribution (brain sparing effect) was diagnosed when CPR (cerebroplacental ratio) was less than 1. We analysed the way and time of delivery and neoanatal follow up. Obtained in advance of researches results made possible expression of following conclusions: 1. Use of Doppler techniques in pregnancies complicated by IUGR makes possible diagnosis of hypoxia that helps in settlement of continuing or ending of pregnancy. 2. Changes in Doppler flows in foetus resoluteness outdistance irregular other values of biophysical methods of foetus monitoring.

[Administration of natural anthocyanins derived from chokeberry retardation of idiopathic and preeclamptic origin. Influence on metabolism of plasma oxidized lipoproteins: the role of autoantibodies to oxidized low density lipoproteins]. / Zastosowanie naturalnych antocyjanów pochodzacych z soku aronii czarnoowocowej (aronia melanocarpa) w leczeniu idiopatycznego oraz powiklanego preeclampsja wewnatrzmacicznego zahamowania wzrostu plodu. Wplyw na metabolizm utlenowanych lipoprotein osocza--rola prezeciwcial anty-o-LDL (olab).

PURPOSE: To determinate the influence of anthocyanins from chokeberry on the generation of autoantibodies to oxidized low density lipoproteins (oLAB) in pregnancies complicated by intrauterine growth retardation (IUGR). MATERIAL AND METHODS: Study group consisted of 105 pregnant women (on the turn of II trimester according to LMP) with IUGR (sonographic examination results below 5th percentile for real gestational age) who were randomly divided into 2 groups: in 50 anthocyanins were administered, 55 women were on placebo; control group--60 healthy pregnant women. We examined the level of oxidative stress measured by serum concentration of autoantibodies to oxidized low density lipoproteins (oLAB). RESULTS: In the anthocyanin group oLAB titres decreased from 1104 +/- 41 mU/ml before treatment to 752 +/- 36 mU/ml (1st month) and 726 +/- 35 mU/ml (2nd month), p < 0.01. In the placebo group oLAB titres were of slightly increasing trend--1089 +/- 37 mU/ml before treatment, 1092 +/- 42 mU/ml (1st month) and 1115 +/- 43 mU/ml (2nd month), p > 0.05; oLAB tires in the control group: 601 +/- 49 mU/ml before treatment, 606 +/- 45 mU/ml (1st month) and 614 +/- 43 mU/ml (2nd month), p > 0.05. CONCLUSIONS: Our results indicate that natural antioxidants (anthocyanins) can be useful in controlling of oxidative stress during pregnancies complicated by IUGR.

[Substance abuse and pregnancy: narcotics--selected problems]. / Uzywki a ciaza: narkotyki--wybrane zagadnienia.

The increasing substance abuse causes serious medical problems in many countries. The perinatal effects of these substances are of obstetricians' interest. The frequency of drug usage during pregnancy ranges from 0.4% to 27% depending on the population. In Poland there is no data concerning drug usage. The aim of this review is to show the risk which results from drug usage during pregnancy, especially cocaine, heroine and marijuana.

[Substance abuse and pregnancy: alcohol]. / Uzywki a ciaza: alkohol.

Alcohol is one of the most widespread substances being abused. In recent years the usage of alcohol has increased in most societies. Its abuse concerns also pregnant women. In this article the problem of alcohol consumption during pregnancy is taken up.