Perinatal outcome in women with inflammatory bowel disease.

INTRODUCTION: Inflammatory bowel disease (IBD) is a lifelong, chronic inflammatory condition of the gastrointestinal tract. IBD morbidity rate in Europe has been steadily growing for the last six decades. Women with IBD are often diagnosed during the childbearing years, which makes the influence of the disease on pregnancy and birth outcomes an important clinical issue. OBJECTIVES: The aim of the study was to estimate the influence of the IBD process among pregnant women on maternal, fetal and neonatal parameters. MATERIAL AND METHODS: A retrospective analysis of data on patients suffering from IBD, diagnosed before pregnancy who were admitted to the Department of Perinatology and Gynecology Polish Mother's Memorial Hospital Research Institute for delivery between 2009-2013, was conducted. IBD was diagnosed in 10 cases. The control group consisted of 10 healthy pregnant women near delivery RESULTS: IBD activity status at conception in women receiving continuous mesalazine treatment does not correlate with gestational age, birth weight, Apgar score or maternal platelet count at delivery in comparison to controls. IBD patients under mesalazine management had lower: i) maternal body mass index and platelet count, ii) neonatal birth weight and Apgar score as compared to controls. However, no impact of IBD on the frequency of congenital anomalies was noted. CONCLUSIONS: To the best of our knowledge, this has been the first study conducted among pregnant women with IBD in Poland. The analysis demonstrates that pharmacological treatment has a deteriorating influence on maternal weight gain in pregnancy as well as production and activity of platelets. Moreover, it diminishes fetal growth and worsens short-term neonatal condition. Further studies with larger sample size are necessary but the rarity of this complication limits the possibility of research therapeutic perspectives.

Maternal and fetal parameters including umbilical artery PI and fibrinogen/CRP ratio as predictive factors of perinatal outcome in women with HELLP syndrome.

INTRODUCTION: HELLP syndrome appears in approximately 0.2-1% of all pregnancies and is associated with in- creased maternal and fetal mortality and morbidity. It is diagnosed in cases when all three of the following criteria are present: (1) microangiopathic hemolytic anemia with abnormal blood smear low serum haptoglobin and elevated LDH levels; (2) elevated ASPATand ALAT (levels of both enzymes more than twice the upper limit of normal values), or bilirubin more than 1.2 mg/dl; 3) platelet count below 150x1009 L(-1). The etiopathogenesis of HELLP syndrome is associated with abnormal placentation in the first trimester production of cellular active substances, and pathological response of the maternal organism. Objectives: The aim of the study was to establish maternal and fetal characteristics and perinatal outcome in HELLP syndrome. The examination protocol included comparison of maternal blood parameters, umbilical artery pulsatility index (UmbA PI) in relation to short-term neonatal outcomes. MATERIAL AND METHODS: Retrospective data analysis of patients hospitalized at the Perinatology and Gynecology Department, Polish Mother's Memorial Hospital Research Institute between 2009-2013, due to HELLP syndrome was conducted. RESULTS: None of the investigated maternal or fetal parameters correlated with the neonatal outcome. CONCLUSIONS: Our study demonstrated that maternal parameters do not influence the perinatal outcome in women with HELLP syndrome. Moreover UmbA PI and fibrinogen/CRP ratio do not correspond to neonatal parameters, either Thus, none of the examined features can be used as a prognostic factor of the neonatal outcome. Further studies with large sample size are necessary but the rarity of this complication limits the possibility of research.