"The Killer Placenta" - a threat to the lives of young women giving birth by cesarean section.

OBJECTIVES: It is necessary to create a universal algorithm for the management of placenta accreta spectrum in order to minimize morbidity and mortality in young patients giving birth by caesarean section. MATERIAL AND METHODS: This was a retrospective study of seven women before the age of 30 selected out of larger group of 40 pregnant patients. The patients were hospitalized in the Clinical Department of Perinatology, Gynecology and Obstetrics in Ruda Slaska, which is a 3rd level reference department. The inclusion criterion was the suspicion of placent accreta spectrum, based on clinical condition, ultrasound examination and magnetic resonance imaging. RESULTS: A patient with a diagnosed placenta accreta spectrum should be provided with a highly specialized 3rd level referential center by an experienced multidisciplinary team of specialists. There should be free access to the blood bank, adult intensive care unit and neonatal intensive care unit. According to the results of this study, the recommended time of cesarean section is 34 + 0 - 36 + 6 weeks of pregnancy. Hysterectomy after the cesarean section is a method of choice for a placenta increta or percreta. It is the most difficult surgery in obstetrics, with a high risk of intraoperative complications. Damage to the urinary system is the most common complication of perinatal hysterectomy. Preoperative placement of ureteral catheters reduces the risk of intraoperative damage. CONCLUSIONS: It is necessary to plan individual procedure for women who has low-lying or previa placenta, and who has history of prior cesarean section - in this group the risk of placenta accreta spectrum is higher.

Prediction of preterm birth using PAMG-1 test: a single centre experience - preliminary report.

OBJECTIVES: Placental alpha microglobulin-1 (PAMG-1) is a novel biomarker detected in cervicovaginal discharge in patients threatened with preterm birth (PTB). This study aimed to show a single centre experience of assessment of imminent spontaneous PTB risk in patients with symptoms suggesting preterm labour (PTL). MATERIAL AND METHODS: The study group consisted of 46 women with singleton pregnancies between 24 + 0/7 and 33 + 6/7 weeks of gestation who presented with symptoms of threatened PTL, with cervical dilatation of < 3 cm, cervical length (CL) of < 30 mm and clinically intact fetal membranes. CL was measured via transvaginal ultrasound and the PAMG-1 test was performed in all of the objectives. RESULTS: Sensitivity (SN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of prediction of PTB within seven days for CL were 100%, 11.11%, 5.88% and 100%, respectively. The PAMG-1 test SN, SP, PPV and NPV of the same endpoint were 50%, 80.56%, 12.5% and 96.67%, respectively. CONCLUSIONS: PAMG-1 is a more accurate predictor of PTB when compared to CL. Routine use of both mentioned tests could allow identification of low-risk patients and reduction of rate of unnecessary hospitalizations and treatments.

Factors associated with fear of childbirth among Polish pregnant women.

The purpose of our study was to elucidate the association between obstetric and psychological factors and fear of childbirth (FOC) during the third trimester of pregnancy and to identify women at risk of severe FOC in Poland. An additional goal of the study was to verify the Polish version of the Wijma Delivery Expectancy Questionnaire (W-DEQ) and to establish its psychometric characteristics. Cross-sectional study with a total of 359 women recruited during routine visits to an antenatal clinic in Poland during the third trimester (≥ 27 weeks gestation). The survey included obstetric details (parity, obstetric history and preferred mode of delivery), and standardized psychological measures: the W-DEQ (fear of childbirth) and the EPDS (depressive symptoms). We demonstrated the satisfactory psychometric properties of the Polish version of the W-DEQ. Our findings confirm the one-factor structure found by the authors of the original version of the scale. A greater FOC was reported by women with unplanned pregnancies, women whose preferred mode of delivery was a cesarean section, and women who had previously undergone psychiatric treatment. The risk factors for severe FOC were depression, unplanned pregnancy or parity, and disagreement with the birth plan proposed by the obstetrician. The W-DEQ is a widely used, valid instrument for the assessment of FOC in pregnant women and can be used in Poland. Findings support the key role of obstetric and psychological variables in predicting fear of childbirth.

Vaginal delivery or caesarean section - Severity of early symptoms of postpartum depression and assessment of pain in Polish women in the early puerperium.

OBJECTIVES: The primary objective of this study is to examine the differences between women following vaginal delivery and caesarean section (elective or emergency) in terms of early symptoms of postpartum depression, and to evaluate pain during labour and in the early puerperium. An additional goal was to determine if pain evaluation is associated with depressive symptoms. MATERIALS AND METHODS: A cross-sectional study was conducted among 224 women in the early puerperium recruited from a public hospital in Poland, who were divided into three groups by method of delivery: caesarean section - elective and emergency, and a vaginal delivery. The measurement tools used in the research were the Edinburgh Postnatal Depression Scale (EPDS) and a Numerical Rating Scale (NRS). A Pearson correlation analysis, a Student's t-test, a Mann-Whitney U test for independent groups and nonparametric multivariate analyses of variance (Kruskal-Wallis test) were carried out. RESULTS: The number of early symptoms of postpartum depression and the level of pain experienced vary depending on type of delivery. Following a caesarean section, women have more early symptoms of depression (MCS = 7.40; SDCS= 5.18 vs MVD= 5.98; SDVD = 4.19; p = 0.03) (especially an emergency CS: Mean rankEm-CS=141.41 vs Mean rankEl-CS = 100.94 vs Mean rankVD = 100.93; p < 0.01) and more pain on discharge (Mean rankCC=126.51 vs Mean rankVD = 84.11; p < 0.01) (especially after Em-CS: Mean rankEm-CS =130.38 vs Mean rankEl-CS=123.62 vs Mean rankVD = 84.11; p < 0.01), compared to women following a vaginal delivery. Pain in a time of discharge from hospital was found to be associated with increased frequency of EPSD but only in El-CS group (r = 0.24; p = 0.02). CONCLUSIONS: Caesarean section (especially emergency CS) is a risk factor for postpartum depression, and the level of pain experienced is a marker of its potential severity. Evaluation of factors associated with postpartum pain and depressive symptoms can help midwives to counsel women better about their delivery alternatives and can promote improved management of women undergoing both types of delivery experiences.