Fetal Growth Velocity-A Breakthrough in Intrauterine Growth Assessment?

The pursuit of assessing fetal well-being in obstetrical practice remains a central tenet, propelling ongoing endeavors to explore innovative markers and diagnostic methodologies aimed at prognosing potential perinatal adversities. Deviations from standard patterns of intrauterine growth, whether exhibiting excessive or insufficient trajectories, stand as pivotal indices hinting at underlying pathophysiological processes or heightened concurrent medical conditions. Initiatives like the Delphi consensus and the INTERGROWTH-21st project strive to refine diagnostic criteria and establish international standards for fetal growth assessment. This article aims to present the current knowledge regarding the assessment of abnormal growth, including novel methods such as growth velocity. Integrating fetal growth velocity assessment into perinatal care protocols holds promise in enhancing diagnostic precision. Growth velocity, involving changes in fetal size over a given period, offers insights into distinguishing between constitutional and pathological growth abnormalities. Various methodologies and models have been proposed to evaluate growth velocity, with notable advancements in understanding fetal growth patterns across different trimesters. It is believed that accelerated and reduced growth velocity may be a sensible parameter in the detection of fetal growth restriction (FGR), small-for-gestational-age (SGA) fetuses, large-for-gestational-age (LGA) fetuses and macrosomic fetuses as well as appropriate-for-gestational age (AGA) fetuses that encounter problems with growth continuation. Recent studies found that changes in growth velocity reflect the risk of adverse perinatal outcomes (APOs). Future directions in fetal health research aim to elucidate the long-term consequences of abnormal fetal growth velocity on neurodevelopmental outcomes, highlighting the critical role of early assessment and intervention.

Does Exposure to Ambient Air Pollution Affect Gestational Age and Newborn Weight?-A Systematic Review.

Current evidence suggests that airborne pollutants have a detrimental effect on fetal growth through the emergence of small for gestational age (SGA) or term low birth weight (TLBW). The study's objective was to critically evaluate the available literature on the association between environmental pollution and the incidence of SGA or TLBW occurrence. A comprehensive literature search was conducted across Pubmed/MEDLINE, Web of Science, Cochrane Library, EMBASE, and Google Scholar using predefined inclusion and exclusion criteria. The methodology adhered to the PRISMA guidelines. The systematic review protocol was registered in PROSPERO with ID number: CRD42022329624. As a result, 69 selected papers described the influence of environmental pollutants on SGA and TLBW occurrence with an Odds Ratios (ORs) of 1.138 for particulate matter ≤ 10 µm (PM10), 1.338 for particulate matter ≤ 2.5 µm (PM2.5), 1.173 for ozone (O3), 1.287 for sulfur dioxide (SO2), and 1.226 for carbon monoxide (CO). All eight studies analyzed validated that exposure to volatile organic compounds (VOCs) is a risk factor for SGA or TLBW. Pregnant women in the high-risk group of SGA occurrence, i.e., those living in urban areas or close to sources of pollution, are at an increased risk of complications. Understanding the exact exposure time of pregnant women could help improve prenatal care and timely intervention for fetuses with SGA. Nevertheless, the pervasive air pollution underscored in our findings suggests a pressing need for adaptive measures in everyday life to mitigate worldwide environmental pollution.

Diagnostic and Therapeutic Challenges of Oligosymptomatic Vesicovaginal Fistula in the Complex Case of Endometriosis.

Endometriosis is a complex condition causing surgical challenges, sometimes leading to urogynecological complications, the diagnosis and treatment of which are not always obvious. We present a case of a 46-year-old woman with a history of severe endometriosis and adenomyosis who developed an oligosymptomatic vesicovaginal fistula (VVF) as a complication of surgery. The patient's medical history included multiple surgeries for endometriosis, a cesarean section, and a laparoscopic hysterectomy. After the excision of the full-thickness infiltration of the urinary bladder, she experienced postoperative bowel obstruction treated by laparotomy. Subsequent urinary complications of bladder healing were eventually recognized as oligosymptomatic VVF. Symptoms of VVFs may vary, making a diagnosis challenging, especially when the lesion is narrow. Imaging techniques such as cystoscopy and cystography are helpful for diagnosis. The treatment options for VVFs range from surgical repair to conservative methods, like bladder catheterization, hormonal therapy, and platelet-rich plasma (PRP) injections, depending on the lesions' size and location. In this case, the patient's VVF was treated with PRP injections, a low-invasive method in urogynecology. PRP, known for its pleiotropic role, is increasingly used in medicine, including gynecology. The patient's fistula closed after 6 weeks from the PRP session, highlighting the potential of this conservative treatment modality.

Wound Microbiota and Its Impact on Wound Healing.

Wound healing is a complex process influenced by age, systemic conditions, and local factors. The wound microbiota's crucial role in this process is gaining recognition. This concise review outlines wound microbiota impacts on healing, emphasizing distinct phases like hemostasis, inflammation, and cell proliferation. Inflammatory responses, orchestrated by growth factors and cytokines, recruit neutrophils and monocytes to eliminate pathogens and debris. Notably, microbiota alterations relate to changes in wound healing dynamics. Commensal bacteria influence immune responses, keratinocyte growth, and blood vessel development. For instance, Staphylococcus epidermidis aids keratinocyte progression, while Staphylococcus aureus colonization impedes healing. Other bacteria like Group A Streptococcus spp. And Pseudomonas affect wound healing as well. Clinical applications of microbiota-based wound care are promising, with probiotics and specific bacteria like Acinetobacter baumannii aiding tissue repair through molecule secretion. Understanding microbiota influence on wound healing offers therapeutic avenues. Tailored approaches, including probiotics, prebiotics, and antibiotics, can manipulate the microbiota to enhance immune modulation, tissue repair, and inflammation control. Despite progress, critical questions linger. Determining the ideal microbiota composition for optimal wound healing, elucidating precise influence mechanisms, devising effective manipulation strategies, and comprehending the intricate interplay between the microbiota, host, and other factors require further exploration.

Evidence of Placental Aging in Late SGA, Fetal Growth Restriction and Stillbirth-A Systematic Review.

During pregnancy, the placenta undergoes a natural aging process, which is considered normal. However, it has been hypothesized that an abnormally accelerated and premature aging of the placenta may contribute to placenta-related health issues. Placental senescence has been linked to several obstetric complications, including abnormal fetal growth, preeclampsia, preterm birth, and stillbirth, with stillbirth being the most challenging. A systematic search was conducted on Pubmed, Embase, and Scopus databases. Twenty-two full-text articles were identified for the final synthesis. Of these, 15 presented original research and 7 presented narrative reviews. There is a paucity of evidence in the literature on the role of placental aging in late small for gestational age (SGA), fetal growth restriction (FGR), and stillbirth. For future research, guidelines for both planning and reporting research must be implemented. The inclusion criteria should include clear differentiation between early and late SGA and FGR. As for stillbirths, only those with no other known cause of stillbirth should be included in the studies. This means excluding stillbirths due to congenital defects, infections, placental abruption, and maternal conditions affecting feto-maternal hemodynamics.

Atypical Preeclampsia before 20 Weeks of Gestation-A Systematic Review.

This systematic review was conducted to gather evidence of preeclampsia occurring before the 20th week of gestation, additionally considering the role of PLGF and sFlt-1 in the development of the disease. In the three cases of preeclampsia before the 20th week of gestation presented in the authors' material, all pregnancies ended up with IUFD, and the SFlt-1/PLGF ratios were significantly elevated in all women. Eligible publications were identified with searches in the PubMed, Embase, Scopus, and Web of Science databases. No date or language restrictions were made. All original peer-reviewed scientific reports were included. A total of 30 publications were included in the final report, including case reports and case series. No other publication types regarding this issue were identified. In the literature, 34 cases of preeclampsia with onset occurring before the 20th week of gestation were identified, for a final total of 37 cases. Live births were reported in 5 cases (10.52%), and there were 9 intrauterine fetal demises (24.32%), and 23 terminations of pregnancy (62.16%). Preeclampsia before the 20th week of gestation is rare but can occur. We collected all available evidence regarding this phenomenon, with 37 cases reported worldwide. We call for large-scale cohort or register-based studies to establish revised definitions or develop new ones regarding the currently unrecognized very early onset preeclampsia.

Case report of ovarian torsion mimicking ovarian cancer as an uncommon late complication of laparoscopic supracervical hysterectomy.

Laparoscopic supracervical hysterectomy (LSH) is an example of a partial hysterectomy, performed due to benign gynaecological complaints. Better endoscopic instruments and operational techniques have led to a great reduction in the number of abdominal hysterectomies. It is believed that LSH is a safe and minimally invasive hysterectomy technique. The Cochrane Database meta-analysis proves the benefits of minimally invasive surgery compared with abdominal gynaecological surgery, including decreased pain, surgical-site infections and hospital stay, quicker return to activity, and fewer postoperative adhesions. According to recent publications, the overall complication rate of all hysterectomy methods is about 1-4.5%. Adnexal torsion is a correlated complication. About 3-5% of patients undergoing emergency surgery due to pelvic pain are diagnosed with this condition. It may be the cause of acute abdomen and correlated symptoms such as vomiting, nausea, or severe pain. To the best of our knowledge a case of asymptomatic, delayed ovarian torsion mimicking ovarian tumour has not been reported so far. In the presented case, torsion successfully imitated neoplastic process as both ROMA score and IOTA 'simple rules' indicated a malignancy with high degree of probability. This case demonstrates that, if ovarian tumour is detected in the postoperative period, a torsion of ovarian pedicle should be taken into consideration as it may mimic malignant neoplasm.

Effectiveness of laparoscopic surgeries in treating infertility related to endometriosis.

INTRODUCTION: Endometriosis is defined as an illness caused by the presence of foci of endometrial tissue outside the uterine cavity. The illness is found in 5-10% of women at reproductive age. In the group of those suffering from endometriosis, the percentage of infertile women amounts to 50%. At higher stages of endometriosis clinical advancement, the suggested treatment is the application of assisted reproductive technology. OBJECTIVE: The aim of the study was assessment of the effectiveness of laparoscopy in treating infertility related to endometriosis among women treated in our clinic in 2009-2012. MATERIALS AND METHOD: The clinic is a medical centre focused on advanced minimally invasive surgical treatment, especially laparoscopic surgeries in diseases of the uterus - with a focus on laparoscopic surgeries for patients with endometriosis of the recto-vaginal area. 53 female patients treated for infertility who underwent a laparoscopic surgical procedure to remove the foci of endometriosis in 2009-2012, were analysed retrospectively. After the surgical procedure, the patients were observed over a period of 12 months, during which the frequency of pregnancies (including natural and assisted pregnancies) was assessed in relation to the stage of endometriosis advancement (rAFS). RESULTS: In 17 out of 53 (32%) patients who underwent the surgical procedure a clinical pregnancy was diagnosed. 11 out of 53 (20.75%) women became pregnant spontaneously, 6 out of 53 (11.32%) patients became pregnant as a result of assisted reproductive technology (ART) (5 IVF and 1 IUI). The average time from the date of surgical procedure to spontaneous pregnancy amounted to 6 months. CONCLUSIONS: Laparoscopy is a vital therapeutic method. Operative laparoscopy is an efficient method for treating infertility related to endometriosis, and the procedure seems to be the most effective particularly at stage III rAFS. The period for expectant management after a surgical procedure should last 6 months.

Changes in ambient temperature and oxygenation during the proestrus do not affect duration, regularity and repeatability of the estrus cycle in female rats.

There are a lot of factors affecting the release of hormones from the anterior part of pituitary gland and their interactions with other parts of the endocrine, nervous and immune systems. The special significance of the proestrus phase of the estrous cycle of the rat, during which LH and FSH levels increase, followed by ovulation is known. The short length of the estrous cycle and the well recognized sequence of vaginal lavage cytology make it useful for investigating the influence of a stressful environment on the reproductive function. Short duration and mild changes in environmental conditions is considered as a factor analogous to psychological stress. The study was undertaken to determine the effects of a short duration change in the ambient temperature and oxygenation (30 minutes) on the proestrus phase of reproductive cycle and on the repeatability and regularity of phases of the reproductive cycle of Wistar strain rats. The animals were kept under standard conditions and had food and water available ad libitum. The climatic chamber with automatically adjustable and monitored internal parameters (temperature, oxygenation, humidity) was used to develop stress conditions. An estimation of the vaginal lavage using the microscope was done to determine the estrous cycle. The animals were divided into 6 groups. On the day of experiment: the control group (CG) stayed in the climatic chamber for 30 minutes (ambient temperature 21 degrees C, normoxia - 21% O(2)), the five test groups (TG - I - V) remained in the climatic chamber for 30 minutes, in the established environmental conditions (I - 21 degrees C, 10% O(2); II - 10 degrees C, 21% O(2); III - 10 degrees C, 10% O(2); IV - 35 degrees C, 21% O(2); V - 35 degrees C, 10% O(2)). During the following days after the experiment, a microscopic estimation of vaginal lavage was collected over again. There were no changes of duration and sequence of the present estrous cycle and repeatability of the next cycles. Our results indicate that short duration change in the ambient conditions do not cause a disturbance in the hypothalamo - pituitary - gonadal axis, although it can activate adaptation mechanisms of the organism.

The utilization of the climatic chamber to evaluate the influence of ambient conditions on endocrine, nervous and immune systems of rats.

The adaptation of an organism to a change in environmental conditions is a complex and in some aspects a poorly understood physiological process. The activating influence of stress on the sympathetic nervous system, the hypothalamic - pituitary - adrenal axis and the suppression of TSH, LH, FSH release is well known. The interplay of communication between the endocrine and immune systems plays an essential role in modulating the response to stress related mediators. The basis of many contradictory and incoherent results of experiments is due to the various methodologies of creating changes in environmental conditions, the way of collecting blood samples which influence stress mediators, the case of assessing the influence of many factors on reproductive functions and the performance of experiments without synchronization with the reproductive cycle. The review will focus on the presentation of simple and repeatable methods of development of an adaptation stress to changed environmental conditions (temperature, oxygenation, humidity) and the technique of blood collection during hour-long estimation of interactions between the endocrine, nervous and immune systems. We would like to place emphasis on appropriate ways of performing experiments on female rats, with regards to the choice of a suitable phase of the reproductive cycle. Also on ways of anaesthesia and microsurgical techniques of vein catheterisation for repeated blood sampling. The performance of all phases of the experiment allow us to estimate only the influence of environmental conditions and eliminate interfering factors during the process of preparing animal for the experiment.

The influence of short-time period of an adaptation to decreased ambient temperature on interleukin-6 and corticosterone levels in female Wistar strain rats in the proestrous phase of the reproductive cycle.

To date, there has been little research examining whether short-time changes of external environmental conditions exert any effects on immune responses. The activation of metabolic changes, release of hormones responsive for immunomodulation and the action of interleukins play an important role in interaction with hormones of an anterior pituitary gland in the proestrous phase of the reproductive cycle. The aim of our study was to determine the effects of a short-time change of ambient temperature (30 minutes) on interleukin-6 (IL-6) and corticosterone plasma concentration of female rats in the proestrous phase of the reproductive cycle. The climatic chamber with automatically adjustable and monitored internal environmental parameters (temperature, oxygenation, humidity) was used during the experiment. The estimation of the vaginal lavage using a microscope was done to determine the estrous cycle. On the day of the experiment, animals were divided into 2 groups: the control group (ambient temperature 21 degrees C +/- 1 degrees C; normoxia 21% O2) and the test group (ambient temperature 10 degrees C +/- 1 degrees C; normoxia 21% O2) stayed in the climatic chamber for 30 minutes. The blood samples were collected before the experiment and after 30, 60, 90, 150 and 210 minutes from the beginning of the experiment. The concentrations of IL-6 and corticosterone were measured in blood plasma samples using ELISA method. There was a significant elevation of IL-6 levels after staying in 10 degrees C during the first 150 minutes from the beginning of the experiment, with the highest value occurring after 60 minutes (426.6 pg/ml; SE - 146.1) with comparison to the value at first sampling (108.5 pg/ml; SE - 29.5; p<0.05) and with comparison to the control group at the same time from the beginning of the experiment (87.6 pg/ml; SE - 2.3; p<0.05). The changed level of corticosterone in the test group in comparison to control group was observed but the differences were insignificant. Our observations confirm the proposition, that even short-time changes of ambient conditions can activate adaptation mechanisms in the organism, which in part, is the activation of the immune system.

[Androgen deficiency in women]. / Hipoandrogenizm u kobiet.

Androgens are defined as the steroids having a binding affinity of the androgen receptor. In the reproduction age a daily production of testosterone is equally divided between the ovaries and adrenal and local tissue conversion of androstenedione and DHEA. After menopause the 80% of testosterone is produced in ovaries, but majority of precursors for peripheral conversion is adrenal origin. Androgen receptors are present throughout in the body; over 200 cellular actions of androgens have been described. Androgenic action is determined by quantitative level of the androgen present in the circulation, its degree of binding to proteins, the degree of interconversion to other androgens and estrogens, and the biological potency and androgen receptor binding affinity of the androgen. The most common clinical symptoms of androgen deficiency are the reduction of sex motivation, sex fantasy, sex enjoyment, sex arousal, vaginal vasocongestion, but also reduction of pubic hair, bone mass, muscle mass, worsening of quality of life (mood, affect, energy), more frequent vasomotors symptoms, insomnia, depression, headache. All these signs and symptoms can be multifactorial. Most common conditions associated with hypoandrogenism in women are hypothalamic-pituitary abnormalities, lack or insufficiency of ovaries, adrenal insufficiency, glucocorticoid therapy, exogenous estrogen administration. Besides the clinical picture the free testosterone measuring is important for diagnosis. The method of choice of this measure is equilibrium dialysis assay. Despite of clinical importance of androgen insufficiency in women, none of methods of androgen substitution is approved by FDA.