Intrapartum cardiotocography and fetal pulse oximetry in assessing fetal hypoxia.

OBJECTIVES: A retrospective analysis of short-term variability (STV), a cardiotocography (CTG) parameter, in relation to fetal blood saturation values (FSpO(2)) obtained by fetal pulse oximetry. METHODS: The study included 26 healthy pregnant women monitored continuously during delivery with both cardiotocography and fetal pulse oximetry. RESULTS: Lower FSpO(2) values were observed in the group showing STV levels 6.0 ms (34.4+/-2.9% vs. 43+/-7.2%; P<0.001). A positive correlation was found between STV levels

[The relationship between the levels of proinflammatory cytokines, and AFI value in pregnancies complicated by premature rupture of membranes]. / Zwiazek stezenia cytokin prozapalnych we krwi ciezarnych z przedwczesnym peknieciem pecherza plodowego z indeksem plynu owodniowego.

OBJECTIVE: The aim of the study was to test the relationship between maternal serum proinflammatory cytokines level and AFI (amniotic fluid index) in pregnancies complicated by premature rupture of membranes (PROM). MATERIALS AND METHODS: The maternal serum levels of IL-6, IL-1 beta and TNF-alfa were assessed in patients with PROM between 24-34 weeks of gestation (n = 45) by means of commercially available ELISA assays. The patients were divided in two groups according to AFI values: < 50 (n = 25) mm and < or = 50 mm (n = 20). Cytokine concentrations were compared between groups. RESULTS: The median concentrations of proinflammatory cytokines in maternal serum were: IL-6--5.74 pg/ml (range 3.24-3111 pg/ml), IL-1 beta--0.76 pg/ml (range 0.001-3.16 pg/ml), TNF-alfa--1332.46 pg/ml (range 2.13-1969.68 pg/ml). Compared to patients with AFI values > or = 50 mm, the group of patients with AFI < 50 mm had significantly higher concentration of IL-6 (6.61 pg/ml vs. 4.66 pg/ml; p = 0.002). No significant differences in IL-1 beta and TNF-alfa levels have been found between groups. The significant correlation have been observed between maternal serum level of IL-6 and AFI values (R = -0.47, p = 0.003), but not of IL-1 beta and TNF-alfa. CONCLUSION: The assessment of AFI values in pregnancies complicated by premature rupture of membranes seems to be the valuable method of early diagnosis in cases of intrauterine infection.

[The usefulness of the intrapartum fetal pulse oximetry in anticipating the neonatal outcome]. / Zastosowanie sródporodowej pulsoksymetrii plodowej w przewidywaniu stanu urodzeniowego noworodka.

OBJECTIVE: The aim of the study was to evaluate the usefulness of the intrapartum fetal pulse oximetry in anticipating the neonatal outcome. MATERIALS AND METHODS: The saturation of the fetal blood (SpO2) was measured during labor with non-invasive pulse oximeter designed for fetal application. The average, minimum and maximum SpO2 were evaluated separately for the first and the second stage of labor. The average SpO2 of the fetus was compared to neonatal condition assessed by umbilical vein pH, pO2 and pCO2 and according to Apgar score. RESULTS: Twenty patients have been monitored with fetal pulse oximetry. All those patients had normal vaginal delivery. During the first stage of labor, the average fetal SpO2 was 51.94 +/- 8.03%, the minimum SpO2 was 38.35 +/- 9.15%, and the maximum SpO2 was 63.35 +/- 7.75%; in the second stage of labor average fetal SpO2 was 43.82 +/- 7.16%, minimum SpO2 was 34.35 +/- 7.79% and the maximum SpO2 was 50.94 +/- 8.37%. A significant decrease in fetal average and maximum SpO2 occurred from stage I to stage II of labor (average SpO2: 51.94 +/- 8.03% vs. 43.82 +/- 7.16%, p = 0.0002; maximum SpO2: 63.35 +/- 7.75% vs. 50.94 +/- 8.37%, p < 0.00001). The significant correlation between the average SpO2 during the first stage of labor and umbilical vein pH (R = 0.60, p = 0.02) and pO2 (R = 0.54, p = 0.04) was found. No relationship between fetal SpO2 in the first and second stage of labor and Apgar score was observed. CONCLUSIONS: 1. The second stage of labor results in significant decrease in fetal SpO2. 2. The fetal SpO2 > 30% in the first and second stage of labor is related to good neonatal outcome. 3. The fetal SpO2 assessment in first stage of labor seems to be important in newborn's acidosis and hypoxemia predicting.

[Maternal serum cytokine levels in pregnancies complicated by PROM]. / Stezenia wybranych cytokin w surowicy ciezarnych z przedwczesnym peknieciem pecherza plodowego.

OBJECTIVE: The aim of the study was to evaluate the maternal serum cytokines levels in pregnancies complicated by premature rupture of membranes (PROM). MATERIALS AND METHODS: Maternal serum of IL-1 beta, IL-4, IL-6, IL-8 and TNF-alfa levels were assessed in patients with PROM between 24-34 weeks of pregnancy (n = 45). Control group consisted of healthy pregnant women (n = 41) at 24-34 weeks of gestation. Serum cytokines concentrations were measured by commercial available enzyme-linked immunosorbent assays. C-reactive protein level and WBC were estimated in both groups. RESULTS: Compared to healthy pregnant, the group of patients with PROM had significantly higher serum levels of IL-1 beta (0.76 pg/ml vs 0.41 pg/ml, p = 0.022), TNF-alfa (1332.46 pg/ml vs 58.01 pg/ml, p < 0.00001) and IL-8 (15.79 pg/ml vs 0 pg/ml, p < 0.00001). CRP concentration and WBC were also significantly higher in serum of pregnant women with PROM then in healthy ones (CRP: 10 mg/l vs 0 mg/l, p = 0.043; WBC: 13,188 +/- 3625/mm3 vs 9132 +/- 1913/mm3, p < 0.00001). No significant differences in IL-6 and IL-4 levels were found between groups. CONCLUSION: Differences in serum maternal levels of cytokines between patients with premature ruptures of membranes and healthy pregnant women suggest that reasons and/or consequences of PROM results in changes in immunological system.

[The relationship of maternal serum levels of Il-6 and TNF-alpha with fertility and parity of women with pregnancies complicated by PROM]. / Zwiazek stezenia IL-6 i TNF-alfa z liczba ciaz i porodów u pacjentek z przedwczesnym peknieciem pecherza plodowego.

OBJECTIVE: The aim of the study was to assess the relationship of maternal serum IL-6 and TNF-alfa levels with fertility and parity of women with pregnancies complicated by premature rupture of membranes (PROM). MATERIALS AND METHODS: The maternal serum of IL-6 and TNF-alfa levels were evaluated in patients with PROM between 24-34 weeks of pregnancy (the study group, n = 45). The control group consisted of healthy pregnancy (n = 41) at 24-34 weeks of gestation. Serum cytokines concentrations were measured by commercial available enzyme-linked immunosorbent assays. C-reactive protein level and WBC were estimated in both groups. RESULTS: The positive correlation between maternal serum TNF-alfa and fertility (R = 0.322, p = 0.042), and parity (R = 0.339, p = 0.032) in patients in the study group was found. No relationship of evaluated cytokines, CRP, WBC with fertility and parity was found in healthy pregnancy women. Compared to primigravidas, multiparas with PROM had significantly higher serum levels of TNF-alfa (1571.41 pg/ml vs 854.54 pg/ml, p = 0.014); serum IL-6 levels was significantly higher in patients with fourth delivery or more compared to patients with third delivery and less (32.32 pg/ml vs 5.52, p = 0.039). CRP concentration and WBC were comparable in those groups. CONCLUSION: 1. Women with at least one pregnancy in the past are at higher risk of premature rupture of membranes in following pregnancies. 2. Every suspicion of intrauterine infection or presence of potential risk factors such as bacterial vaginosis, cervicitis, kolpitis or urinary tract infection should be carefully evaluated in this group of patients.

[The influence of antenatal TRH and glucocorticoids therapy for survival rate of extremely low birth infant]. / Wplyw podawania TRH i glikokortykosteroidów na przezywalnosc wczesniaków ze skrajnie mala urodzeniowa masa ciala.

Respiratory distress syndrome (RDS) as a consequence of lung immaturity remains a major cause of perinatal morbidity and mortality. TRH used with glucocorticoids shows synergistic influence on surfactant synthesis and morphological lung maturation in preterm born infants. The purpose of this study was to examine the influence of antenatal TRH + glucocorticoids treatment on survival rate of extremely low birth infants (less than 1000 g). We evaluated 94 premature neonates born between 1993 and 1997 at the Department of Obstetrics and Perinatology of University School of Medicine in Lublin. Better survival rate of extremely low birth infants was observed in the TRH + steroids group then in only steroids one. The ratio of RDS was similar in both groups. Further investigations to determine the safety and efficacy of antenatal TRH therapy are needed.

[Complications of multiple pregnancy in the 2nd and 3rd trimesters]. / Powiklania ciazy wieloplodowej w II i III trymestrze.

Multiple pregnancy contributes to higher maternal and fetal risks than a single one. Complications typical only for multiple pregnancy such as PROM with preterm delivery, intrauterine death or IUGR of one of twins can occur during 2nd and 3rd trimester. Treatment in such situations is usually difficult and often controversial because of simultaneous presence of an alive and/or healthy fetus and possible risk for mother. The paper presents such situations and possible ways of treatment.

[The value of doppler velocimetry of umbilical and middle cerebral arteries in pregnancy complicated by diabetes mellitus]. / Znaczenie badan dopplerowskich w tetnicy pepowinowej i tetnicy srodkowej mózgu plodu w ciazy powiklanej cukrzyca.

Fifty-three diabetic pregnant treated in Dpt of Obstetrics and Perinatology in Lublin were investigated. The paper presents correlations between metabolic parameters in diabetic patients and Doppler welocimetry in umbilical and middle cerebral arteries and also analyses way of delivery and outcomes. Correlations between fetal Doppler parameters and metabolic status of mothers have been found. We estimate that Doppler velocimetry hasn't prognostic value in predicting of fetal distress.

[Level of EGF in cord blood and biological maturity of the newborn]. / Poziom EGF we krwi pepowinowej a dojrzalosc biologiczna noworodka.

The concentration of epidermal growth factor-EGF has been measured in umbilical vein serum among preterm and term newborns by means of specific RIA assay. The mean EGF concentration among term newborns was found to be higher than in preterm (0.236 +/- 0.094 vs 0.167 +/- 0.087 pg/ml; p < 0.05). We did not observed any correlation between EGF concentrations and the occurrence of respiratory distress syndrome in preterm babies. The role of EGF in human parturition has been discussed.

[The concentration of n-terminal propeptide of type III procollagen in umbilical cord serum--biochemical marker of newborn maturity]. / Stezenie N-koncowego propeptydu prokolagenu typu III w surowicy krwi z pepowiny--biochemiczny marker dojrzalosci noworodka.

The concentration of N-terminal propeptide of type III procollagen (PIIINP) in umbilical cord serum was estimated in preterm and term newborns. The mean concentration of PIIINP was significantly higher in preterm infants, despite their lower body mass. This indicates higher rate of collagen biosynthesis in early gestation. The highest PIIINP were found among the most immature infants, which suggest the usefulness of PIIINP as an biochemical marker of newborn maturity.