[The role of a family delivery in the modern obstetrics]. / Rola porodu rodzinnego we wspólczesnym poloznictwie.

UNLABELLED: The aim of the study were the comparison of a course of delivery and the baby's condition between family delivery and traditional mode of labour, and the analysis of factors influencing the choice for a particular delivery option. MATERIAL AND METHODS: retrospective analysis of the medical records of healthy pregnant women at term hospitalised in 2001-2003 in the Department of Perinatology and Gynecology, Zabrze, Poland. Patients were divided into two groups depending on a delivery mode basis: group I (n = 520) were those attended by a family member, group II involved patients who were not (n = 1480). RESULTS: In the analysed period of time the rate of family deliveries has risen from 14% only in 2001 till 26% in 2002 and 36% in 2003. Younger patients, particularly occupationally active primigravidae with at least secondary education were more likely to choose the family delivery. This group of patients revealed two times lower rate of caesarean section or abnormal foetal heart rate. At the same time longer the first and the second stage of labour were noted. Duration of the III stage did not differ. CONCLUSIONS: Support by a family member during delivery could significantly elongate time spent in the delivery room as well as decrease the number of invasive procedures during and after the delivery.

[Risk assessment for preterm delivery in pregnant women with active periodontitis]. / Próba oceny ryzyka porodu przedwczesnego u ciezarnych z aktywnym zapaleniem tkanek przyzebia.

INTRODUCTION: Premature labor has been regarded as a highly problematic clinical event not only due to its relation with perinatal mortality but also in the light of the remote results of the prematurity. Therefore many ongoing studies concentrate on evaluation of potentially avoidable risk factors of premature labor. Relatively few studies have suggested chronic periodontitis as such a determinant. OBJECTIVES: Prospective evaluation of periodontium changes in the course of otherwise normal pregnancy. Assessment of potential influence of periodontium pathology, and its severity, on the obstetrical complications. The authors have made literature search on the relation of active periodontitis and premature labor. MATERIALS AND METHODS: Study involved 120 randomized gravidae attending electively dental clinic for a routine control. INCLUSION CRITERIA: single pregnancy, no preterm delivery in a history, mother's age 18 to 35 years, gestational age 10 to 20 weeks based on a last menstrual period date--confirmed on ultrasound. Every patient underwent dental examination twice--at the inclusion date and 48 hours after delivery. Patients were divided into three groups. Group I (n = 25)--healthy patients. Group II (n = 61)--patients with mild or moderate periodontitis. Group III (n = 39) patients with a severe periodontitis. Progression of lesions was recognized if the post-delivery dental assessment revealed increase of the pockets depth higher than 2mm and in at least 4 places compared with the initial findings. RESULT: In the course of otherwise normal pregnancy women with signs of inflammation within periodontium revealed progression of this pathology proportional to its severity in early pregnancy. This increase was associated with 4-fold higher rate of preterm deliveries in Group II and 12-fold in Group III compared with healthy patients. CONCLUSION: Active and severe periodontitis should be regarded as independent and highly influential risk factor of the preterm delivery.

[Why do we observe a high concentration of CA125 in mother's serum during pregnancy?]. / Dlaczego obserwuje sie podwyzszone stezenia antygenu CA125 w surowicy krwi ciezarnych?

INTRODUCTION: CA125 was evaluated in a group of 100 pregnant women in the first trimester, at term and during puerperium to find out its main source at those stages. OBJECTIVES: Findings were analysed against history and symptoms of an imminent abortion in the first trimester. In patients with a history of vaginal spotting or bleeding regardless of the time of their duration, serum levels of CA125 were significantly higher in those who miscarried later. No such relation was noticed in those presenting with other symptoms only (e.g. abdominal pain) where CA125 titres did not depend on the outcome of the present pregnancy. MATERIAL AND METHODS: CA125 was evaluated in a group of 100 pregnant women at term to find out its main source in pregnancy. CA125 levels was evaluated with Roche Cobas Core CA125 II EIA. RESULTS: In every study group patients with a history of previous miscarriages revealed significantly higher levels of serum CA125 regardless of a number of previous abortions. Mean value of CA125 in a 3rd stage of labour was significantly higher than in a 2nd day of puerperium, when it dropped to the levels similar to that of nonpregnant women. These values were significantly higher in women admitted to the hospital in the early pregnancy on an imminent abortion basis. In patients who had caesarean section CA125 levels were significantly lower in respective period of delivery and puerperium. CONCLUSIONS: Maternal serum CA125 levels did not depend on other maternal, placental nor foetal factors evaluated in the study.

[Changes to the periodontium in postmenopausal women]. / Wplyw zmian okresu menopauzy na stan tkanek przyzebia.

Few up to date studies on the influence of hormonal replacement therapy (HRT) on periodontium has been conducted on small groups of patients and the conclusions made may require further investigation on a larger population. It has been widely accepted that decreased estrogen levels in postmenopausal women are associated with a gradual loss of a bone density and increased risk of a dental loss. Much less stress is put however on the fact that the same phenomenon, especially suboptimal levels of estradiol, may deteriorate periodontal tissue condition. The authors made a literature search on the influence of HRT on periodontium.

[Etiology of intrauterine growth retardation. Part I: placental-fetal interrelationship disorder]. / Etiologia wewnatrzmacicznego opóznionego wzrastania plodu. Czesc I--Czynniki zwiazane z zaburzeniami jednostki plodowo-lozyskowej.

Intrauterine growth retardation (IUGR) increases a risk of perinatal complications and may carry a negative influence on a later baby's mental and physical development. Poorer function revealed by many vital organs seems to be the effect of their lower mass and their relative immaturity. In the first part of a paper the authors discuss two groups of factors thought to be responsible for IUGR. The first one has been related to the fetal status-genetic anomalies, other primary developmental defects and different growth patterns.

[Etiology of intrauterine growth retardation. Part II: maternal disorders]. / Etiologia wewnatrzmacicznego opóznionego wzrastania plodu. Czesc II--Czynniki pochodzenia matczynego.

The second part of discussion incorporates maternal conditions influencing the risk of intrauterine growth retardation. Special attention was paid to the systemic abnormalities, and those pregnancy related, known for their links with affected placenta-uterine barrier or otherwise related to abnormal fetal growth. Both social and environmental groups of factors potentially influencing prenatal development have been discussed.

[Doppler measurements of blood flow velocity and waveforms in fetal venous circulation]. / Zastosowanie ultrasonografii dopplerowskiej w badaniach zylnej czesci ukladu naczyniowego plodu.

Ultrasonic velocimetry of the fetal circulation became a very useful method in assessment of fetal well-being, especially in high risk pregnancies. There are many papers concerning on distribution and regulation of blood flow in umbilical artery, middle cerebral artery, and much less dealing with flow velocity waveforms in inferior vena cava and ductus venosus and their clinical significance. Fetal compromise is associated with significant alterations in the fetal arterial and venous circulation. Changes in venous Doppler waveforms develop due to increased afterload and perhaps myocardial failure in deterioration after arterial redistribution is established. Doppler investigation of the fetal venous circulation may play an important role in monitoring the redistribution and may help to determine the optimal time for delivery.

[The role of early diagnosis of gestational diabetes mellitus]. / Rola wczesnej diagnostyki cukrzycy ciezarnych.

The study aimed to assess fetal outcome in gestational diabetic women and necessity of making screening test in these cases. 94 consecutive women with gestational diabetes mellitus (GDM) made up a study group. All women had been taken care of Perinatology and Gynecology Department of Silesian Medical Academy in period 2002-2003. The study group patients were divided into subgroups. The first group (n = 32) young women, in the second group (n = 62) patients over 30 years old. The following parameters were analyzed: obesity, hypertension, glucosuria, family history of diabetes mellitus, past obstetric history (pregnancy complications, abortions, dead infants and infants over 4000 g). Early glucose tolerance screening during first clinic visit could prevent some diabetes-related complications in GDM among women with risk factors.

[Prevention of iron deficiency anemia--influence on the course of pregnancy, delivery and the infant's status]. / Wplyw profilaktyki niedokrwistosci z niedoboru zelaza na przebieg ciazy, porodu oraz stan pourodzeniowy noworodka.

BACKGROUND: Iron deficiency is probably the most common nutritional disturbance in the world. At the highest risk, irrespective of economical status, are women at the reproductive age--especially those who are pregnant. Retrospective analysis of a course of gestation, delivery and the infant's status depending on mothers' iron supplementation during pregnancy. Medical notes of healthy 860 pregnant women hospitalized at term in the Clinic of Perinatology and Gynaecology, Zabrze, Poland were analyzed. Patients were divided into two categories: Group I (n = 610) were those having iron subjunction and Group II (n = 250) those who did not. Mean gestational age at the delivery was significantly lower in those without the prophylaxis. These patients had significantly higher rate of preterm deliveries and caesarean sections. Macroscopic abnormalities of the afterbirth were commoner in this group as were bleeding during III labour stage and indications for postpartum curettage. insignificantly lower mean birth weight and 1st/5th minute Apgar scores had children born to women without supplementation. Routine iron supplementation in women with initially normal haemoglobin levels seems to be a safe strategy for preventing perinatal complications.

[Influence of the prevention of maternal periodontitis on the risk of preterm delivery]. / Wplyw profilaktyki aktywnego zapalenia tkanek przyzebia na ryzyko wystapienia porodu przedwczesnego.

The premature labour has been regarded as a highly problematic clinical event not only due to its relation with perinatal mortality but also in the light of the remote results of the prematurity. Evaluation of the influence of active periodontitis on a preterm delivery risk. Retrospective assessment of the preterm delivery risk in a group of pregnant women with clinically confirmed periodontitis and healthy otherwise was performed. Further risk assessment was stratified on a basis whether prophylactic measures against this dental pathology were introduced (n = 30 of women were treated). The control group consisted of 30 pregnant and healthy women. Patients with active periodontitis and having a prophylactic treatment had a 4-fold increase of a preterm delivery risk compared to those without this dental pathology. The risk was 12 times higher in the group with advanced changes and no treatment. According to the results, periodontitis should be regarded as a systemic disorder capable of affecting a pregnancy so prevention procedures should be introduced as soon as the problem is recognized. Such a procedure involving dental assessment in described population could significantly decrease the number of preterm deliveries.

[Value of selected biophysical surveillance methods in prediction and prophylaxis of complications associated with adverse pregnancy outcome in intrauterine growth restriction]. / Analiza wartosci parametrów wybranych testów biofizycznych w przewidywaniu i profilaktyce problemów zdrowotnych zwiazanych ze zlym stanem pourodzeniowym noworodków w ciazach powiklanych wewnatrzmacicznym opóznionym wzrastaniem.

Intrauterine growth restriction is associated with higher rate of complications occurring during pregnancy and in labour, increased morbidity and mortality rate in neonatal period, impaired psychosomatic development in childhood and increased susceptibility for particular diseases in adulthood. For improvement of perinatal outcome it is essential to establish objective criteria based on biophysical surveillance methods for prediction and prophylaxis of adverse outcome in IUGR pregnancies. The aim of the study was to compare selected biophysical surveillance methods in prediction and prophylaxis of complications associated with adverse pregnancy outcome in intrauterine growth restriction. There were statistically significant differences in CTG, BPS, AFI, and pulsatile index values in umbilical artery and MCA between IUGR and normal fetuses. The best predictor of adverse pregnancy outcome in IUGR fetuses was PI value in umbilical artery.

[Serum levels of CA-125 antigen during the first trimester of pregnancy complications and the risk of miscarriage]. / Ocena stezenia antygenu CA125 w surowicy krwi ciezarnych w i trymestrze ciazy powiklanej zagrazajacym poronieniem.

BACKGROUND: The ultrasound, serum beta-HCG and progesterone titres are widely used to assess the risk of miscarriage at the early stages of pregnancy. Though very useful, they are not considered as satisfactorily accurate predictors of imminent abortion during the first three months of pregnancy. AIM OF STUDY: Prospective evaluation of clinical usefulness of serum CA125 from 4-12th week of pregnancy in a group of women with symptoms of imminent abortion. MATERIAL AND METHODS: A study group were 250 consecutive women with symptoms of imminent abortion. Inclusion criteria were: abdominal pain, spotting, ultrasound picture of the embryo in the uterus, monovular pregnancy, normal ultrasound picture of ovaries, gestational age ranging from 4-12 weeks (assessed on a last menstrual period basis with ultrasound corroboration). 55 women with physiological course of pregnancy made up a control group. CA125 levels was evaluated with Roche Cobas Core CA125 II EIA. RESULTS: In patients with symptoms of imminent abortion, serum CA125 titration in 4 to 12 weeks' gestation seems to be valuable only in woman with vaginal spotting or bleeding.

[Serum CA125 variability--new aspects of clinical usefulness]. / Zachowanie sie stezenia antygenu CA125--nowe aspekty przydatnosci klinicznej.

Serum levels of CA125 turned out to be a valuable parameter not only as a marker of ovarian carcinoma but also in other fields of obstetrics and gynaecology. Up to date most of the studies dealing with the subject remain experimental and their clinical usefulness is not widely acknowledged. Accessible and relatively cheap tests measuring the serum level of this antigen together with its proven clinical value might contribute to a more frequent and much wider use than it takes place contemporarily.

Clinical value of a single serum CA-125 level in women with symptoms of imminent abortion during the first trimester of pregnancy.

OBJECTIVE: To assess the clinical value of a single serum CA-125 level in women presenting with symptoms of imminent abortion from 5 to 12 weeks' gestation. STUDY DESIGN: Two hundred women with symptoms of imminent abortion from 5 to 12 weeks' gestation were allocated to 3 subgroups: group I (n = 50), abdominal pain only; group II (n = 80), abdominal pain and vaginal bleeding of less than 3 days' duration; and group III (n = 70), abdominal pain and vaginal bleeding of > or = 3 days' duration. The control group (n = 55) was women undergoing a normal pregnancy of comparable gestational age. In all patients, CA-125 and beta-human chorionic gonadotropin (beta-hCG) levels were determined with commercially available enzymatic immunoassay tests. RESULTS: A significant increase in serum CA-125 levels was observed in patients with vaginal bleeding (groups II and III) in comparison with the control group. In contrast to CA-125, serum beta-hCG levels were significantly lower in patients who went on to miscarry. Receiver operating characteristic curve analysis revealed that all women with symptoms of imminent abortion who have a CA-125 level of > or = 43.1 U/mL should be considered as having a greater risk of miscarriage. Patients with bleeding of > or = 3 days should have a threshold value of 66.5 U/mL applied as a risk determinant. CONCLUSION: A single serum CA-125 level determination is valuable in women with imminent abortion presenting with abdominal pain, vaginal bleeding or both.

[Level of CA 125 antigen in serum of first trimester normal and miscarried pregnancy]. / Stezenie antygenu CA 125 w surowicy krwi ciezarnych w i trymestrze ciazy prawidlowej I powiklanej zagrazajacym poronieniem.

The ultrasound and titres of serum beta-HCG and progesterone are widely used to assess the risk of miscarriage at early stages of pregnancy. Although very useful, they are not considered as satisfactorily sensitive tests during the first three months of pregnancy. Therefore, their value is limited. Evaluation of serum levels of CA 125 antigen has been considered as useful in diagnosis and monitoring of some ovarian carcinomas. But there are some studies suggesting its predictive value when estimating the risk of miscarriage at early stages of pregnancy. The authors prove that women with threatening abortion revealed higher values of serum CA 125 antigen than those in control groups. The patients who had presented the highest values of the antigen later miscarried.