Accuracy of Pretreatment Ultrasonography Assessment of Intra-Abdominal Spread in Epithelial Ovarian Cancer: A Prospective Study.

The aim of this study was to test the accuracy of ultrasonography performed by gynecological oncologists for the preoperative assessment of epithelial ovarian cancer (EOC) spread in the pelvis and abdominal cavity. A prospective, observational cohort study was performed at a single tertiary cancer care unit. Patients with suspected EOC were recruited and underwent comprehensive transvaginal and abdominal ultrasonography performed by a gynecological oncologist. Sixteen intra-abdominal localizations and parameters were assessed using ultrasonography and compared with surgical-pathological status (reference standard). Sensitivity, specificity, positive and negative predictive values, and overall accuracy were calculated. Differences were analyzed using Fisher's exact and chi-square tests. Ultimately, we included 132 patients (median age 62 years), of whom 67% were in stage IIIC-IVB and 72% had serous cancer. Overall prediction accuracies for the involvement of the omentum, small bowel mesentery root, and frozen pelvis, and detecting ascites were >90%. Detecting the involvement of the pelvis peritoneum, liver and spleen hilum, and rectosigmoid colon, and predictions of disease stage and residual disease had overall accuracies of 80-90%. The lowest accuracy was for involvement of the abdominal peritoneum (69%) and diaphragm peritoneum (right 71%; left 75%) and surgical complexity prediction (77%). Stratification of results by presence or absence of ascites revealed significantly higher specificity of ultrasonography (clinically meaningful) for assessments of the abdominal/pelvic peritoneum, spleen hilum, and rectum wall, if there were ascites. A gynecological oncologist, experienced in surgery and sonology, performing comprehensive ultrasonography on patients with EOC can accurately detect intraperitoneal lesions and recognize critical disease manifestations and predict stage, surgical complexity, and residual disease, which allow accurate qualification of patients for primary debulking surgery or neoadjuvant chemotherapy.

Family delivery from the standpoint of fathers--can stereotypes of participant or non-participant father be fully justified?

OBJECTIVES: Family delivery is an important aspect of modern obstetrics. The aim of this study was to estimate the phenomenon of family delivery from the standpoint of participating and non-participating fathers. STUDY DESIGN: Two types of questionnaires were used in the study. Five hundred and five men were divided into two groups: (A) delivery participants and (B) delivery non-participants. RESULTS: The participants were significantly younger than non-participants. Better educated men dominated in group (A), whereas men with trade education were the majority in group (B). Low birth classes attendance among women in group (B) was noticed. All men in group (B) knew about the possibility of taking part in the delivery. Almost 100% of participants declared their satisfaction with family delivery. For non-participants, wife and media were the main source of knowledge, while for participants it was the medical staff and labor schools. CONCLUSIONS: Family labor is commonly accepted by both partners and is generally connected with positive emotions. This phenomenon is generally approved by couples with higher economical status. Family labor resignation, common among pairs with lower economical status, is caused generally by fear and lack of proper knowledge. Health care providers, through labor schools and outpatients visits, should concentrate on getting to couples, whose attitude towards family labor is negative. Educational programs and popular press articles should be prepared more thoroughly, focusing on the whole population of potential fathers.

[Is grand multiparity an obstetrical risk factor?]. / Czy wielokrotne wielorództwo jest polozniczym czynnikiem ryzyka?

OBJECTIVES: The aim of the study was to analyze the course of labor of grand multiparas (4 deliveries and more) in comparison to multiparas (2 or 3 deliveries). MATERIALS AND METHODS: A group of 400 grand multiparas were included in the study and compared with a group of 393 multiparas. All the deliveries took place in the City Hospital in Puck in the years 1998-2002. The age of parturients, duration of pregnancy, pregnancy accompanying pathologies, course and way of delivery, indications for cesarean section, complications of labor and newborns' condition were taken into account and analyzed statistically. RESULTS: It occurred that grand multiparas were significantly more often countryside dwellers, experienced preterm deliveries, gained less weight during pregnancy and amniorrhexis took place in a more advanced 1st stage of labor. Perineal ruptures and episiotomies were significantly less frequent in the study group. Moreover, grand multiparas preferred traditional form of labor, more rarely deciding on water labor, despite its common access. There were no differences as to the duration of labor stages, accompanying pathologies, the use of oxytocin, postpartum curettage and newborns' condition. CONCLUSIONS: Grand multiparity seems not to be an independent risk factor of obstetrical complications and should not be considered dangerous in centers with well organized modern perinatal care.

[Attitude of pregnant women towards labour--study of forms of preparation and preferences]. / Postawy ciezarnych wobec porodu--analiza form przygotowania i preferencji.

OBJECTIVE: The aim of this study was to assess the knowledge of alternative delivery techniques among pregnant women and their preferences concerning the course of labour. MATERIAL AND METHODS: 275 woman hospitalizated in obstetric wards in Puck and Ist Clinic in Warsaw were questionnaired in the period of July 2003 - February 2004. The mean age of women was 26 +/- 4.9. 55.7% of them were nulliparous, 44.3% multiparous. T-Student test was used for statistical analysis. RESULTS: The majority of questionnaired women knew alternative positions during delivery and possible analgetic techniques. 25.1% of women attended labour school. 81.2% wanted to give birth in the hospital, 10% at home and 8.8% in the delivery room. 51.1% preferred waterbirth and 22.5% obstetric chair--most of them came from the big cities, were better educated and attended labour school. Almost half of all women are in favour of epidural anaesthesia of delivery. Caesarean section on request was supported by 13.8%. For 67.4% the presence of intimates during labour was important. CONCLUSIONS: Labour school has a significant influence on women's knowledge and their preferences. Waterbirth and other modern delivery techniques are very popular among better educated women from big cities, while those with lower education from small cities and villages prefer "classic" labour. Therefore promotion of modern delivery methods and active participation in labour should be concentrated on these groups of women. Nowadays obstetric departments should ensure not only safety of giving birth but also complete personal comfort for pregnant women.