Paternal engagement during childbirth depending on the manner of their preparation.

OBJECTIVES: The analysis of the forms of paternal activity depending on the manner of their preparation, including stages of labor. MATERIAL AND METHODS: A prospective survey-based study involved 250 fathers who participated in their child's birth. The fathers included in the study were present during all stages of family-assisted natural labor. The study was conducted one day after childbirth with the use of a survey prepared by the authors. Statistical calculations were conducted using the Statistica PL software. The frequency of individual qualitative features (non-measurable) was assessed by means of a non-parametric χ² (chi-squared) test. The statistical significance level was p < 0.05. RESULTS: A half of the fathers included in the study (52.4%) participated in childbirth with no prior preparation. The dominant form of preparation involved self-education from books, magazines and the Internet (24%). 23.6% of fathers participated in ante-natal classes. The study demonstrated that fathers prepared for childbirth in ante-natal classes more often engaged in the supportive role, provided nursing care and carried out instrumental monitoring during each stage of childbirth. CONCLUSIONS: The fathers prepared for childbirth in ante-natal classes more often engage in the supportive role, provide nursing care and carry out instrumental control during each stage of childbirth. Ante-natal classes should be promoted as an optimal form of preparation for active participation in childbirth. Moreover, other forms of paternal ante-natal education as well as continued education in a delivery room should be developed.

[Jak obnizyc umieralnosc kobiet z powodu krwotoków poporodowych?].

Postpartum hemorrhage (PPH) is still a common obstetrical complication and is believed to be the leading cause of peripartum maternal mortality in Poland. PPH prevention is though the main aim of contemporary obstetrics. It might be obtained by careful screening for high risk of PPH gravidas and active management of the third stage of labor. Postpartum hemorrhage requires aggressive measures, accurate diagnosis and precise management. The knowledge of algorithms of PPH management is essential and required for all physicians working in the Delivery Room.

Physical efficiency and activity energy expenditure in term pregnancy females measured during cardiopulmonary exercise tests with a supine cycle ergometer.

OBJECTIVES: To evaluate physical efficiency and activity energy expenditure (AEE) in term pregnancy females during cardiopulmonary exercise tests with a supine cycle ergometer. MATERIAL AND METHODS: The study comprised 22 healthy full-term pregnancy women with uncomplicated pregnancies hospitalized in the Department of Gynecology and Obstetrics, Specialist Teaching Hospital in Tychy, Poland. All subjects underwent cardiopulmonary exercise tests (CPET) on a supine cycle ergometer. The 12-min, three-stage, progressive, symptom-limited submaximal test protocol (up to 80% HRmax) was used. Pulsometry was used to record HR on a beat-to-beat analysis and to calculate AEE. Respiratory responses were measured by ergospirometer and a computer system on a breath-by-breath basis at rest, during exercise and at restitution. RESULTS: In the studied population, VO2max was established at the level of 2.19 ± 0.33 L/min in ergospirometry and 2.04 ± 025 L/min in pulsometry. Physical efficiency calculated for sub-maximal exercise by use of the Davis equation was 30.52 ± 0.12%. AEE, based on VO2 in various phases of the CPET, was 0.47, 0.71 and 0.88 L/min for phases 25, 50 and 75 W. Based on ergospirometer readouts, AEE was 10.60, 16.11 and 20.94 kJ/min for phases 25, 50 and 75 W. Overall mean AEE (determined by pulsometry) was 10.59 kJ/min. CPET testing did not have any negative effect upon the health or life of the neonates involved in the study. CONCLUSIONS: Submaximal CPET up to 80% HRmax with a supine cycle ergometer is a safe and precise method for assessing work efficiency in term pregnancy women.

The preferences of parturient women and the participation of the child's father during birth.

BACKGROUND: The participation of the father in the birth manifests itself in action, that depends on the attitude towards family-assisted birth and the preferences of the parturient woman. AIM: Evaluation of expectations of parturient women in the aspect of the active participation of the father, that would enable the use of the most commonly reported preferences in the clinical praxis and the establishment of factors influencing the presented preferences. METHODS: 250 married couples who participated in natural childbirth were subjected to prospective survey. Couples after physiological delivery with the participation of father in all stages of childbirth were qualified. The surveys were conducted in the first day after the childbirth. The survey tool was an author-developed survey questionnaire in two versions: (A) for the mother and (B) for the child's father who participated in the birth. The statistical calculations were performed with use of the Statistica PL software. The frequency of occurrence of respective quality (non-measurable) features was evaluated with χ² (chi-square) nonparametric test. The level of statistical significance adopted for tests was p<0.05. RESULTS: The preferences of parturient women, regardless of their age, education, duration of marriage, number of family-assisted births and the form of preparation mostly concerned the adaptation of a supportive role by the fathers, on every stage of the birth. During the second stage of birth 74.4% of parturient women expected the father to cut the umbilical cord. After the birth the majority of mothers (76%) preferred the presence of the father in post-delivery period. CONCLUSIONS: The pre-birth education of couples of parents should include the expectations of the parturient woman, regarding the forms of father's activity during a family-assisted birth. High expectations of parturient women regarding the emotional support indicate the need for educating future fathers, as there is large demand for such element of mid-delivery care.

The model of active participation of the father in childbirth, based on the preferences of the parturient women.

BACKGROUND: The model of family-assisted birth is an element of obstetric care that met with large interest, with the development of perinatology in numerous countries. The modern father is expected to more actively participate both during pregnancy and birth, and also in the childcare. AIM: The comparative analysis of the parturient Polish women and the forms of activity of the fathers participating in family-assisted births in order to know which forms of father's activity correlate with the expectations of women in labor and define the range of tasks for the father (model of action for family-assisted birth) that would correspond to the preferences of parturient women. METHODS: 250 parturient women and 250 fathers who participated in the delivery were included in the survey. Couples after physiological delivery with the participation of father in all stages of childbirth were qualified. The surveys were conducted in the first day after the childbirth. The survey tool was an author-developed survey questionnaire in two versions: (A) for the mother and (B) for the child's father who participated in the birth. The statistical calculations were performed with use of the Statistical PL software. The frequency of occurrence of respective quality (non-measurable) features was evaluated with χ² (chi-square) nonparametric test. The level of statistical significance adopted for tests was p<0.05. RESULTS: The largest coherence between the form of father's activity and the expectations of the parturient woman was found in case of psychical support in every stage of the delivery. Another form of activity of fathers, that in 85% of cases was concurrent with the expectations of women in labor was the act of cutting the umbilical cord and the participation of father in the child measurements and tests (78.5% coherence) and the need of stay of father with the woman and the newborn in the post-delivery period (70% coherence). CONCLUSIONS: Obstetric care should take the preferences, connected with family-assisted birth, of both parents into account. The model of active participation of father in family-assisted birth forms a practical guideline for fathers willing to actively participate in the childbirth.

Streptococcus group B serotype distribution in anovaginal isolates of women in term pregnancy.

BACKGROUND: To evaluate Streptococcus group B (GBS) serotype distribution in anovaginal isolates of women in term pregnancy and to assess the correlation of the distribution with socio-epidemiological variables and neonatal outcomes. DESIGN: An observational study. SETTINGS: Department of Gynecology and Obstetrics, Specialist Teaching Hospital in Tychy, Poland. POPULATION: 80 women between 37 and 40 gestation weeks with preserved fetal membranes and who had not been treated with antibiotics for at least two weeks before the study. MATERIAL AND METHODS: The specimens from the vagina and the rectum of pregnant women were collected. GBS colonization tests were conducted in compliance with Centers for Disease Control and Prevention recommendations. Serotyping of the isolates was performed using the Essum GBS Serotyping Kit (Umea, Sweden) according to manufacturer's instruction. Mein outcome measures. GBS serotype distribution in the population of Polish women in term pregnancy. RESULTS: In the studied group of 80 pregnant women GBS colonization rate was 28.7%. Four GBS serotypes were observed (Ia, V, III and II). Serotype Ia was the most predominant - 43.47%. For GBS Ia, V and III serotypes, no significant difference in the prevalence of diabetes mellitus and neonatal outcomes was observed. Only in one case early-onset sepsis was diagnosed in the neonate and serotype Ia was determined. CONCLUSIONS: 1) From among four identified GBS serotypes in the population of Polish pregnant women, serotype Ia was the most dominant. 2) For GBS serotypes, no significant difference in the prevalence of diabetes mellitus and neonatal outcomes was observed. 3) Active immunization aimed for preventing GBS colonization in mothers should include not only serotypes V, II and III but also Ia in order to be an effective and safe in preventing life threatening neonatal infections.

Sudden loss of vision due to breast cancer metastasis to the eyeball.

Intraocular choroidal metastasis is a very rare cause of blindness. Carcinoma of breast is the most common primary malignancy the accounts for choroidal metastasis in females. Other primary neoplasms which can uncommonly metastasize to the choroid are gastrointestinal tract, thyroid, pancreas, prostate and testis. Metastatic neoplasm to the eye outnumbers the primary tumors such as retinoblastoma and malignant melanoma. We present a case of sudden loss of vision due to breast cancer metastasis to the eyeball. The interval between the diagnosis of the primary tumor and the choroidal metastasis was 4 years.

Sexual dysfunction and distress--development of a Polish version of the female sexual distress scale-revised.

INTRODUCTION: The concept of sexually related personal distress, central to the diagnosis of all female sexual dysfunction (FSD), is currently a subject of scientific debate. Several psychometric instruments have been used to measure sexually related personal distress in women, including the Female Sexual Distress Scale (FSDS) and its revised version (FSDS-R). AIM: To develop a Polish version of the FSDS-R (PL-FSDS-R). METHODS: In total, 210 women aged 18-55 years were included in the study. Seventy-five were diagnosed with hypoactive sexual desire disorder (HSDD), 31 were diagnosed with another FSD, and 104 were control. All subjects completed the PL-FSDS-R at baseline (day 0), day 7, and day 28. Internal consistencies were evaluated by Cronbach's α. Intraclass correlation coefficient was used to assess test-retest reliability. Discriminant validity was assessed by comparing mean scores of the FSD and control groups in a between-groups analysis of variance. Receiver operating characteristic (ROC) analysis was performed to determine optimal cutoff values of the PL-FSDS-R. MAIN OUTCOME MEASURES: To measure the validity and reliability of the PL-FSDS-R and to determine optimal cutoff values. RESULTS: Mean total PL-FSDS-R score was statistically higher in women with HSDD and other FSD compared to healthy individuals, showing the test had discriminant validity. The frequency of sexual intercourse and quality of relationship with sexual partner but not other sexual behaviors were statistically correlated with the PL-FSDS-R score. ROC analysis confirmed these findings. All domains of the PL-FSDS-R demonstrated satisfactory internal consistencies, with a Cronbach's α-value of >0.70 for the entire sample. Test-retest coefficients were between 0.86-0.92, with the best reliability for a 7-day recall period. CONCLUSIONS: The PL-FSDS-R is a reliable questionnaire with good psychometric and discriminative validity, and can be used to measure sexually related personal distress in Polish women with FSD with a cutoff score of ≥13.

Development and validation of the Polish version of the Female Sexual Function Index in the Polish population of females.

INTRODUCTION: Unlike male sexual function, which is relatively easy to assess, female sexual function is still a diagnostic challenge. Although numerous new measurements for female sexual dysfunction (FSD) have recently been developed, the Female Sexual Function Index (FSFI) remains the gold standard for screening. It has been validated in more than 30 countries. The FSFI has been used in several studies conducted in Poland, but it has never been standardized for Polish women. AIM: The aim of this study was to develop a Polish version of the FSFI (PL-FSFI). MATERIALS AND METHODS: In total, 189 women aged 18-55 years were included in the study. Eighty-five were diagnosed with FSD as per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV-TR) criteria; 104 women did not have FSD. All subjects completed the PL-FSFI at baseline (day 0), day 7, and day 28. MAIN OUTCOME MEASURES: Test-retest reliability was determined by Pearson's product-moment correlations. Reliability was tested using Cronbach's α coefficient. Construct validity was evaluated by principal component analysis using varimax rotation and factor analysis. Discriminant validity was assessed with between-groups analysis of variance. RESULTS: All domains of the PL-FSFI demonstrated satisfactory internal consistencies, with Cronbach's α value of >0.70 for the entire sample. The test-retest reliability demonstrated good-to-excellent agreement between the assessment points. Based on principal component analysis, a 5-factor model was established that explained 83.62% of the total variance. Domain intercorrelations of the PL-FSFI ranged from 0.37-0.77. The optimal PL-FSFI cutoff score was 27.50, with 87.1% sensitivity and 83.1% specificity. CONCLUSION: The PL-FSFI is a reliable questionnaire with good psychometric and discriminative validity. Therefore, it can be used as a tool for preliminary screening for FSD among Polish women.

[Oral combined hormonal contraception containing nomegestrol acetate and 17beta-oestradiol--the statement of Polish Gynecological Society Experts Group]. / Stanowisko Ekspertów Polskiego Towarzystwa Ginekologicznego. Doustna zlozona antykoncepcja hormonalna oparta na octanie nomegestrolu i 17beta-estradiolu.

Nomegestrol acetate (NOMAC) combined with E2 (Zoely) is a monophasic oral contraceptive (OC) which safety and efficacy was confirmed in a number of level I evidence clinical trials. Zoely is highly effective OC, especially in overweight and obese patients, with good cycle control, safe and well tolerated. NOMAC/E2 combination causes no or minimal weight gain and is characterized by minimal influence on bone mineral density or blood pressure and presence of acne. Moreover lipids profile, carbohydrates metabolism, haemostasis and endocrine glands functioning were not affected. High tolerance and acceptance of NOMAC/E2 combination by women, low adverse event profile, fast recovery of ovarian activity and ovulation is a reasonable treatment tool in everyday practice.

Adiponectin to leptin index as a marker of endometrial cancer in postmenopausal women with abnormal vaginal bleeding: an observational study.

OBJECTIVES: To evaluate the correlation between endometrial cancer and adiponectin plasma concentration, leptin plasma concentration as well as adiponectin to leptin index in the population of postmenopausal women with abnormal vaginal bleeding. DESIGN: An observational study SETTINg: Department of Gynecology and Obstetrics, Specialist Teaching Hospital in Tychy, Poland. Population. 99 women between 47 and 88 years old, in postmenopausal state. METHODS: The cases (54 women) were females hospitalized due to postmenopausal vaginal bleeding in whom dilation and curettage (D&C) was performed and endometrial intraepithelial neoplasia (EIN) was diagnosed in anathomopathology. Hysterectomy was then performed in all cases and the endometrial cancer diagnosis was confirmed. The controls (45 women) consists of females with no postmenopausal uterine bleeding in whom endometrial thickness in transvaginal ultrasound was greater than 5 mm. D&C was than performed and no endometrial neoplasia was detected in any of the subjects. Adiponectin and leptin plasma concentration was measured in both groups. Mein outcome measures. The area under the curve, sensitivity, specificity and cutoffs for adiponectin, leptin and adiponectin to leptin index. RESULTS: Adiponectin, leptin and adiponectin to leptin index were statistically correlated with the risk of endometrial cancer. At the suggested cutoffs, corresponding to the highest accuracy (minimal false-negative and false-positive results), adiponectin to leptin index resulted in the highest sensitivity and specificity compared to adiponectin and leptin alone. CONCLUSIONS: Adiponectin to leptin index due to the highest sensitivity and specificity may be used as a marker of endometrial cancer in postmenopausal women with abnormal vaginal bleeding.

[The statement of Polish Society's Experts Group concerning diagnostics and methods of endometriosis treatment]. / Stanowisko Zespolu Ekspertów Polskiego Towarzystwa Ginekologicznego dotyczace diagnostyki i metod leczenia endometriozy.

Endometriosis is defined by endometrial glands and stroma outside of the endometrial cavity Three types of endometriosis have been described: peritoneal endometriosis, ovarian endometriosis and deep infiltrating endometriosis. Endometriosis afflicts 6-15% of women population. It occurs mainly in the group of women in reproductive age, but also in the group of minors and approximately 3% of women after menopause. Within the group of women suffering from infertility the frequency of endometriosis increased to 35-50% of cases. Endometriosis is associated with pain symptoms which can bear the character of pain occurring periodically and altering into constant pain, dysmenorrhea, dyspareunia, dysuria and dyschezia. The correlation between the stage of endometriosis and intensity of pain symptoms not always has to be proportionate. Laparoscopy can be perceived as a standard procedure in endometriosis diagnostics as it allows simultaneous treatment. Profound interview as well as visual diagnostics (USG, MRI) should precede laparoscopy Treatment of endometriosis can be divided into pharmacological and surgical treatment, which can be invasive or non-invasive. The type of treatment depends on patient's age and her procreation plans, occurring ailments and endometriosis type. Important role is played by adjuvant treatment such as appropriate diet and lifestyle. Treatment of advanced endometriosis should be conducted in reference centres that are appointed with adequate equipment and have the possibility of interdisciplinary treatment. Presented standards can digest and outline the order of proceedings both in diagnostics and endometriosis treatment. The research group believes that the above compilation will facilitate undertaking appropriate decision in diagnosis and treatment of the disease, which will subsequently contribute to therapeutic success.

[Polish guidelines for the prevention and treatment of venous thromboembolism. 2012 update]. / Polskie wytyczne profilaktyki i leczenia zylnej choroby zakrzepowo-zatorowej. Aktualizacja 2012.

The overall objective of the Polish guidelines for the prevention and treatment of venous thromboembolism is to increase patient benefit and safety by appropriate prevention and treatment of deep vein thrombosis and pulmonary embolism as well as proper management of the complications associated with antithrombotic and thrombolytic therapy. These guidelines apply to adult trauma, cancer, surgical, and medical patients as well as those at increased risk of venous thromboembolism. Specific recommendations have been formulated for pregnant women, patients requiring surgery while receiving long-term oral anticoagulant treatment, and patients undergoing regional anesthesia and/or analgesia. We chose to update the existing Polish guidelines with the use of the most recent high-quality international guidelines that we identified and adjusted the final product to Polish cultural and organizational setting. We based our recommendations primarily on the 9th edition of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines on Antithrombotic Therapy and Prevention of Thrombosis, the European Society of Cardiology Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism, the 3rd edition of the American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines on Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy, the ACOG practice bulletin on thromboembolism in pregnancy (Number 123), and Guidance from the Scientific and Standardisation Committee of the International Society on Thrombosis and Haemostasis on the Duration of Anticoagulant Therapy after a First Episode of Unprovoked Pulmonary Embolus or Deep Vein Thrombosis, as well as two other Polish practice guidelines on the prophylaxis and treatment of venous thromboembolism and the management of patients treated with oral direct inhibitors of factor X or factor II. To make recommendations regarding specific management issues that had not been addressed in other guidelines, or whenever the panel members felt they needed additional information to reach the decision, we also consulted the authors of guidelines developed by other professional societies and organizations as well as additional sources of evidence. For each adapted recommendation, we explicitly assessed its relevance and applicability in the context of the healthcare system in Poland. When necessary, we explicitly stated the rationale for modification of the previously published recommendations and judgements about the values and preferences we assumed. The information regarding reimbursement of drugs mentioned in the recommendations was added in chapters 6-9 and 13 and approved by the National Health Fund. The final version of the practice guidelines was officially approved by the scientific societies and institutions listed at the beginning of the document.  

[Clinical practice guidelines of the Team of Experts of the Polish Gynecological Society: management of the intrahepatic cholestasis of pregnancy]. / Rekomendacje Zespolu Ekspertów Polskiego Towarzystwa Ginekologicznego dotyczace postepowania w wewnatrzwatrobowej cholestazie ciezarnych.

Intrahepatic Cholestasis of Pregnancy (ICP) constitutes the most common, reversible liver disease closely connected with pregnancy and spontaneously resolving in puerperium. ICP usually reoccurs in consecutive pregnancies (45-90%), often in a more intensified form. Many compounds (hormones, cytokines, medicines, endotoxins) can impair transport in the hepatocyte, disturb the intracellular transport and increase the permeability of the intercellular connections. As a result, the elements of bile may appear in the peripheral blood. Gestational cholestasis constitutes a classic example of intrahepatic cholestasis. The etiology of ICP is multifactorial with hormonal, genetic and environmental factors participating in the process. The diagnosis is based on the presence of pruritus, elevated values of bile acids in the blood serum and of aminotransferases (aspartic, aminopropionic and gamma-glutamylotranspeptydase (AspAt, AlAt, GGTP)), as well as spontaneous remission in the second or third week after childbirth, of lack of other illnesses causing pruritus and icterus. Clinical and biochemical symptoms of ICP include: pruritus without skin rash (usually after 30 weeks of gestation), mild icterus, steatorrhea etc. Abnormalities in the laboratory tests of the LFT (liver function tests) encompass: an increase in the serum concentration of fatty acids (BA) which can be the first and only laboratory abnormality. Concentrations surpassing 10 micromol/l are considered to be abnormal. Concentration of BA higher than 40 micromol/l allows to recognize a case of severe ICP, connected with the risk of premature delivery presence of the meconium liquor, surgical means of delivery and low APGAR score of the newborn (< 7 pt). In about 80% of pregnant women with ICP, the BA concentration ranges between 10-40 micromol/l, but perinatal results are comparable with uncomplicated pregnancies. Some authors are of the opinion that abnormal AlAt value is the most sensitive test, other authors consider the abnormal values of alkaline phosphatase and bilirubin to be the most pathognomonic factors. Other abnormal tests include: higher activity of alpha-hydroxybutyric dehydrogenase correlated with an increase of the alkaline phosphatase and bilirubin; mild metabolic acidosis; dyslipidemia with elevated concentrations of the total lipids, total cholesterol and free LDL cholesterol and apolipoprotein; abnormal glucose tolerance test. ICP constitutes a medical problem that carries a considerable risk for the fetus, resulting from an increased flow of bile acids to the fetal blood circulation (elevated level in the amniotic fluid, in the umbilical blood serum and meconium). The risk of adverse effects for the fetus correlates with the rise of BA concentration in maternal blood serum. Cholestasis increases the risk of premature labor, presence of meconium in the amniotic fluid, fetal bradycardia, intrauterine asphyxia and stillbirth, particularly when the concentration of serum bile acids on an empty stomach is above 40 micromol/l. However, maternal clinical signs and symptoms do not correlate with the fetal outcome. Aspiration of bile acids or their accumulation in the fetal blood circulation are responsible for the increased frequency of RDS appearing in ICP. The aim of the obstetric management of ICP is to reduce maternal symptoms and biochemical disorders and to minimize the risk of premature delivery fetal distress and sudden death. ICP management should include: bed regime, light, low-fat diet, no stress, upper abdomen ultrasound examination, LFT tests and thrombotic tests once a week, monitoring of the fetal well-being with the available biophysical methods, pharmacotherapy and therapeutic termination of pregnancy in case of serious illness and/or the fetal distress. Ursodeoxycholic acid (UDCA) is the basis of the pharmacological treatment of pregnant women and currently constitutes the most promising treatment option of ICP. UDCA is administered orally in the dosage of 10-16 mg/kg/24, what in practice means 250-300 mg/2-3 times a day.

[Management of thyroid diseases during pregnancy]. / Postepowanie w chorobach tarczycy u kobiet w ciazy.

The management of thyroid disorders during pregnancy is one of the most frequently disputed problems in modern endocrinology. It is widely known that thyroid dysfunction may result in subfertility, and, if inadequately treated during pregnancy, may cause obstetrical complications and influence fetal development. The 2007 Endocrine Society Practice Guideline endorsed with the participation of the Latino America Thyroid Association, the American Thyroid Association, the Asia and Oceania Thyroid Association and the European Thyroid Association, greatly contributed towards uniformity of the management of thyroid disorders during pregnancy and postpartum. Despite the tremendous progress in knowledge on the mutual influence of pregnancy and thyroid in health and disease, there are still important areas of uncertainty. There have been at least a few important studies published in the last 3 years, which influenced the thyroidal care of the expecting mother. It should also be remembered that guidelines may not always be universally applied in all populations with different ethnical, socio-economical, nutritional (including iodine intake) background or exposed to different iodine prophylaxis models. The Task Force for development of guidelines for thyroid dysfunction management in pregnant women was established in 2008. The expert group has recognized the following tasks: development of the coherent model of the management of thyroid dysfunction in pregnant women, identification of the group of women at risk of thyroid dysfunction, who may require endocrine care in the preconception period, during pregnancy and postpartum - that is in other words, the development of Polish recommendations for targeted thyroid disorder case finding during pregnancy, and the development of Polish trimester-specific reference values of thyroid hormones. Comprehensive Polish guidelines developed by the Task Force are to systematize the management of the thyroid disorders in pregnant women in Poland.