Pregnancy and Delivery in Women with Uterine Malformations.

BACKGROUND: Uterine defects are the most common malformations of the female reproductive system. They can lead to many obstetric complications, e.g. preterm delivery, intrauterine growth restriction, oligohydramnios and operational delivery. OBJECTIVES: Our aim was to analyze the impact of different types of uterine defects on pregnancy outcomes. MATERIAL AND METHODS: The study involved 94 pregnant women with different types of uterine defects hospitalized at the Department of Fetal--Maternal Medicine and Gynecology, RIPMMH in Lódz, between 1994 and 2012. The patients were divided into 5 groups on the basis of diagnosed defects: arcuate (n=6), bicornuate (n=50), duplex (n=29), septate (n=5) and unicornuate uterus (n=4). In order to avoid correlated data in statistical analysis, our research did not consider the total number of pregnancies and births but the number of patients. The first pregnancy of each patient, if completed after 22-week gestation, was studied and analyzed. RESULTS: Preterm delivery was the most common complication in pregnancy (55 women, 58.5%). The caesarean section was performed in 73 (78%) women. IUGR was diagnosed in 16% of cases. Placental abruption occurred in 13 (14%) and cervical insufficiency in 10 cases (11%), respectively. Prenatal diagnostic showed abnormalities in 12 fetuses (13%). The Apgar score from 0 to 4 points was assigned to 9 newborns (9.6%), 5-7 to 20 children (21.3%) and 8-10 points to 75 cases (69.1%). Normal birth weight (>2500 g) was determined in 51 newborns (54.3%). CONCLUSIONS: Women with uterine defects are subject to an increased risk of complications in pregnancy and delivery, including premature births, low birth weights, births by cesarean section.

Cross-cultural adaptation and translation of a quality of life tool for new mothers: a methodological and experiential account from six countries.

AIM: To examine the challenges and solutions encountered in the translation and cross-cultural adaptation of an English language quality of life tool in India, China, Iran, Portugal, Brazil, and Poland. BACKGROUND: Those embarking on research involving translation and cross-cultural adaptation must address certain practical and conceptual issues. These include instrument choice, linguistic factors, and cultural or philosophical differences, which may render an instrument inappropriate, even when expertly translated. Publication bias arises when studies encountering difficulties do not admit to these, or are not published at all. As an educative guide to the potential pitfalls involved in the cross-cultural adaptation process, this article reports the conceptual, linguistic, and methodological experiences of researchers in six countries, who translated and adapted the Mother-Generated Index, a quality of life tool originally developed in English. DATA SOURCES: Principal investigator experience from six stand-alone studies (two published) ranging from postgraduate research to citywide surveys. DISCUSSION/IMPLICATIONS FOR NURSING: This analysis of a series of stand-alone cross-cultural studies provides lessons about how conceptual issues, such as the uniqueness of perceived quality of life and the experience of new motherhood, can be addressed. This original international approach highlights practical lessons relating to instrument choice, and the resources available to researchers with different levels of experience. Although researchers may be confident of effective translation, conceptual and practical difficulties may be more problematic. CONCLUSION: Instrument choice is crucial. Researchers must negotiate adequate resources for cross-cultural research, including time, translation facilities, and expert advice about conceptual issues.

[Relation between occupation and health related quality of life of pregnant women]. / Zaleznosc miedzy wykonywana praca a jakoscia zycia zwiazana ze zdrowiem kobiet ciezarnych.

BACKGROUND: The aim of this study was to find out the relationship between occupation and health-related quality of life. MATERIAL AND METHODS: The study included 504 pregnant women. Two questionnaires, SF-36v2 and EQ-5D, were used to estimate health-related quality of life. The information on socio-economic status were gathered by performing the third survey. RESULTS: The study evidenced that the health-related quality of life of working women was significantly better than that of those who were on sick leave or unemployed. In the study group, white collar workers had significantly more childbirths in the past than blue collar workers (p = 0.0055). The mean age ofprimiparas employed as white collar workers was 28 while the mean age of blue-collar primiparas was 26, and the difference was significant (p = 0.0000). CONCLUSIONS: The occupation is important not only because it decides about the economic status, but it also influences the health-related quality of life of pregnant women.

[Evaluation of antenatal quality of life of hospitalized women with the use of Mother-Generated Index--pilot study]. / Ocena jakosci zycia kobiet hospitalizowanych w ciazy z wykorzystaniem Mother-Generated Index--badania pilotazowe.

OBJECTIVES: The objectives of this study included: (1) evaluation of the Polish version of Mother Generated-Index (MGI) as a tool for measuring antenatal Health Related Quality of Life (HRQL) of hospitalized women; (2) identification of factors influencing antenatal quality of life of hospitalized women; (3) assessment of correlations between MGI and SF-36v2, and between MGI and EQ-5D. MATERIAL AND METHODS: MGI is a three-step questionnaire. Respondents were asked to name important areas of life that had been affected by their pregnancy (step 1) and then to assess, on the scale from 0 to 10, their positive or negative value (step 2). In Step 3, the women ranked the importance of the areas by allocating a total of 20 'spending points' among them. The sub-index MGI1 is defined as the mean of the Step 2 scores, the sub-index MGI2 is defined as the weighted mean of Step 2 scores with weights given in Step 3. Using SF-36v2, EQ-5D, MGI questionnaires and socioeconomic survey we studied the HRQL of 99 pregnant women hospitalized in ICZMP in Lódz. RESULTS: Sub-index MGI1 was included between 1.83 and 10 with mean 5.86 (SD 1.71). Sub-index MGI2 was between 0 and 10, with mean 6.70 (SD 2.34). Sub-indexes of MGI were significantly (p < 0.05) positively correlated with EQ-5D and with sub-indexes of SF-36v2. The correlations are weak or moderate (between 0.2 and 0.4). The mean of the score given in the second part of MGI was 8.58 (SD 1.13) for positive comments, 2.63 (SD 1.22) for negative comments, and 5.02 (SD 1.55) for neutral comments. Differences between positive, negative and neutral comments were statistically significant (ANOVA, p = 0.00). Among factors which influence antenatal quality of life, the respondents named relationship with partner and family attitudes towards pregnancy delivery and baby work and personal finances. CONCLUSIONS: (1) MGI should be treated as an additional tool for HRQL measurement, since it reflects the differences between expectations towards pregnancy and reality Multicultural factors can influence MGI. (2) MGI allows to identify factors which influence the antenatal quality of life, taking into account their importance. (3) There are statistically significant positive correlations between sub-indexes of MGI and sub-indexes of SF-36v2, and between sub-indexes of MGI and EQ-5D.

[Knowledge of toxoplasmosis among pregnant women, midwifes, medical students and obstetricians]. / Ocena stanu wiedzy dotyczacej toksoplazmozy wsród ciezarnych, poloznych, studentów medycyny i lekarzy polozników.

BACKGROUND: Knowledge of toxoplasmosis has been assessed among obstetricians, medical students, midwifes and pregnant women. The aims of the study were as follows: 1) evaluation of intra- and inter-group variation in correct answers to the questions included in the questionnaire used as a study tool; 2) evaluation of inter-group variation in answers to specialist and non-specialist questions; and 3) intra-group evaluation of self-assessed difficulty in completing the questionnaire. MATERIALS AND METHODS: In the prospective study, 310 participants were included: 109 pregnant women, 116 midwifes 85 physicians (including 69 specialists in OB/GYN) and 16 medical students. The anonymous questionnaire consisted of 26 questions, with four answers proposed for each question of which one was correct. RESULTS: There was no difference between correct answers among midwifes, physicians and medical students (p = 0.20), but the difference was found between the group of physicians and medical students and pregnant women as well as between midwifes and pregnant women (p < 0.001). Physicians, medical students and midwifes gave best answers to the non-specialist questions (p < 0.001), and midwifes obtained higher scores than pregnant women (p < 0.001). The mean percentage of correct answers to the specialist questions was among pregnant women (29%) showing a high level of randomness. The best answers to the non-specialist questions were found for physicians and midwifes (p = 0.93). However, there was a difference between the group of physicians and medical students and pregnant women and between midwifes and pregnant women in self-assessment of difficulty in completing the questionnaire (p < 0.001). CONCLUSIONS: Pregnant women assessed their knowledge of toxoplasmosis as least adequate, whereas midwifes, as most adequate. Pregnant women's knowledge about toxoplasmosis is poor. The group of physicians and medical students yielded evidently better score than pregnant women. There is a need for the improvement among prenatal care providers in both patient education and self-education.

[Mother Generated-Index--a new indicator of antenatal and postnatal quality of life]. / Mother Generated-Index--nowy miernik oceny jakosci zycia kobiet w ciazy i po porodzie.

OBJECTIVES: The objective of this study was 1. description of an antenatal and postnatal quality of life measure, namely Mother Generated-Index (MGI), and its applications in the scientific studies. 2. critical analysis of MGI survey. 3. suggestion of further studies on MGI survey. FINDINGS: The MGI is a three-step questionnaire. Women were asked to specify the important areas of their life that had been affected by their pregnancy (Step 1). Having specified up to eight such areas, the women scored each of them from 0 to 10 (Step 2). The women allocated 20 'spending points' between areas, with more points given to those aspects that their felt were more important (Step 3). The sub-index MGI 1 is defined as the mean of the Step 2 scores, and the subindex MGI 2 is defined as the weighted mean of Step 2 scores with weights given in Step 3. MGI was used in several studies to evaluate postnatal and antenatal quality-of-life. It was used to study HRQL of different populations, namely women in Scotland and in India, and it was used together with number of psychometric tools for measuring HRQL (generic and specific), such as EPDS, SF-12, PNMI, MAMA, GHQ-30, SF-36v2, EQ-SD. KEY CONCLUSIONS: 1. Three step questionnaire MGI was used in several studies on postnatal and antenatal quality-of-life. The authors are planning further study on antenatal HRQL with MGI 2. MGI should be still treated as a methodological experiment. It is not clear what mean MGI scores, how surveying, description of query, multi-culture and socio-economical factors can affect the results. However, MGI can be easily translated to Polish, since it does not require linguistic validation, which is important because of lack of Polish versions of postnatal and antenatal HRQL tools. 3. Further studies on MGI are needed. In particular, test-retest study should be perform to verify reliability of MGI.

[Determinants of smoking cessation during pregnancy]. / Czynniki determinujace zaprzestanie palenia tytoniu przez kobiety ciezarne.

The numerous researches confirmed that cigarette smoking during pregnancy negatively affects unborn fetus. A survey of 330 pregnant women hospitalized in ICZMP in Lódz was performed; 257 women agreed to participate in the study. Smoking prevalence was 9.2% and 73% women quit successfully smoking while pregnant or near to pregnancy. Smoking cessation is higher among older, wealthier and better educated women. According to the Mental Health factor of SF36v2 health related quality of life (HRQL) survey, women who quit smoking successfully have better psychological well-being, than that who smoked during pregnancy.

[Occurrence of fungal infections in pregnant women and non-pregnant women with diabetes and without diabetes]. / Czestosc wystepowania zarazen grzybami u kobiet ciezarnych i nieciezarnych z cukrzyca i bez cukrzycy.

UNLABELLED: Diabetes and pregnancy are thought to be independent factors increasing the risk of fungal infections. OBJECTIVES: The aim of the study was to evaluate the occurrence of fungal infection of the vagina, rectum and oral cavity in pregnant and non-pregnant women with and without diabetes. MATERIAL AND METHODS: 627 women were included in the study, among them healthy non-pregnant women (HN), healthy pregnant women (HP), pregnant women with diabetes (PD) and non-pregnant women with diabetes (ND). In total, 1881 samples obtained from the vagina, rectum and oral cavity were tested. For species identification API 20 C i API C AUX tests were used. RESULTS: Fungi in at least one locus were detected in 62.4% of all women, among them in 69.8% of HN, 58.5% of HP, 62.5% of PD and 62.7% of ND. Strains were isolated from vaginal samples of HP (16%) less often than in HN (27%) (95% CI 0.29-0.85; OR = 0.5); in ND (31%) and PD (25%) there were no differences in the occurrence of fungi in the vagina (95% CI 0.37-1.38; OR = 0.71). Similar rates of prevalence of fungi in rectum were found in HN (30%) and HP (23%) (95% CI 0.43-1.16; OR = 0.7) as well as in ND (27%) and PD (24%) (95% CI 0.41-1.64; OR = 0.82). Strains have been isolated from oral cavity of 57% of HN and 54% of HP (95% CI 0.58-1.42; OR = 0.9) as well as from 55% ND and 59% of PD (95% CI 0.65-2.21; OR = 1.2). CONCLUSIONS: Lower prevalence of fungi in the vagina of HP, in comparison to HN, suggests a protective effect of pregnancy on the risk of vaginal mycosis. Pregnancy and diabetes independently have no influence on the prevalence of fungi in oral cavity and rectum.