[24-hour Holter measurement of blood pressure in pregnant women and effectiveness of the treatment]. / Ocena przydatnosci 24-godzinnego monitorowania cisnmienia tetniczego u ciezarnych metoda Holtera, dla poprawy efektów leczenia nadcisnienia tetniczego.

OBJECTIVES: Hypertension remains a very serious obstetric problem and a severe pregnancy complication. Hypertension in pregnancy influences the intrauterine fetal growth. Proper monitoring of antihypertensive therapy effects enables us to make suitable modifications of the treatment. The aim of the study was to evaluate the benefits of 24-hour Holter arterial pressure monitoring method in hypertensive pregnant women. MATERIAL AND METHODS: Pregnant women hospitalized and treated for hypertension in the Department of Pathology of Pregnancy of Medical University of Lódz were investigated in the study. Two groups were compared, namely: the control group--pregnant hypertensive women with blood pressure controlled 4 times a day and a study group with 24-hr blood pressure control. RESULTS: In the study group examined by 24-hr arterial pressure monitoring, measured, values of blood pressure during the treatment was significantly higher. This observation shows the necessity to increase doses of antihypertensive agents. CONCLUSION: 24-hr arterial pressure monitoring allows us to administer a more precise dosage of antihypertensive drugs than several arterial blood pressure measurements per day.

[The Lesniowski-Crohn disease and pregnancy--case report]. / Przebieg ciazy w chorobie Lesniowskiego-Crohna--opis przypadku.

Lesniowski-Crohn disease is an inflammatory process, involving all layers of the intestine, mesentery and regional lymph nodes. During the development of the disease, a thickening of the intestine wall, stricture of its lumen and adhesions have been observed. The aim of the study was to present the case of a 27-year-old pregnant woman with Crohn's disease, a very rare complication of gestation.

HLHS--congenital heart defect in High Risk Pregnancy Unit in 2001-2007.

BACKGROUND: HLHS (hypoplastic left heart syndrome) is a serious congenital heart defect. In neonates with congenital heart disease HLHS accounts for nearly 25% of neonatal deaths. The etiology of HLHS is unknown. At present we expect to have those cases diagnosed in the second trimester of pregnancy. AIM: The main aim was to find the rate and outcome of the congenital heart defect--left heart hypoplasia (HLHS). MATERIAL AND METHODS: All cases of this heart defect found in the High Risk Pregnancy Clinic in 2001-2007 were presented. Twice the congenital malformation was diagnosed after delivery and once during pregnancy--in the second trimester. All babies were delivered between 38 and 39 weeks of pregnancy, one by the spontaneous normal delivery, one by elective caesarean section and one by emergency caesarean section because of fetal distress during the delivery. All of the newborns were transported to the Pediatric Cardio surgery Unit of M.U. and operated in first weeks after delivery. RESULTS: In two cases the operation was complicated and children died due to the cardiac arrest. One of the babies died before surgical correction. Two of the women, whose babies died after the operation gave birth to healthy newborns with no cardiac abnormalities. CONCLUSION: The HLHS is the most serious heart congenital malformation diagnosed often after the delivery because of lack of sufficient diagnostic system in healthy women. The prognosis for the children is bad, but the chance of giving birth to healthy children in the future is good.

[Influence of parity on the body mass of neonates]. / Wplyw dzietnosci matki na mase urodzeniowa noworodka.

OBJECTIVES: The purpose of the study was to determine whether there exists a positive correlation between the mother's parity and the child's weight on delivery. MATERIALS AND METHODS: A retrospective study has been conducted on a selected group of 86 multiriparas with three deliveries. Only in term babies of healthy mothers were taken into consideration. Data derived from cases has been analyzed by means of Microsoft Excel and Statistica 6.0 software. RESULTS: In 65.1% of the cases, the birth weight of the second neonate exceeded the weight of the first one. The rate diminishes to 51.2% when we compare the third child with the second. In 2.3% of the records no changes have been observed. The abovementioned criteria enabled us to form three groups out of the initial cohort and perform further analysis. CONCLUSIONS: Significant correlation between birth weight of the first and second newborn has been found. No such correlation was found in the case of the second compared to the third delivery.

[The effects of operative SUI treatment established using Burch colposuspension and IVS tape and evaluated through various urogynecologic tests]. / Efekty leczenia operacyjnego wysilkowego mietrzymania moczu (wnm) za pomoca kolpopsuspensji sposobem Burcha oraz tasmy IVS oceniane przy uzyciu róznych badan uroginekologicznych.

OBJECTIVES: Numerous diagnostic instruments have been used in modern urogynecology; alas, sufficient comparative analysis between most of them has not been carried out in world literature. DESIGN: The aim of the study was to compare the results of selected urogynecology tests, used to analyze the effectiveness of SUI treatment, using Burch colposuspension and IVS tape. MATERIAL: The study was conducted among 76 patients selected for operative treatment of SUI II and III degree, using of Burch colposuspension (I group, n=47) and IVS tape, Tyco (II group, n=29). METHODS: The following investigations: urogynecologic anamnesis and examination with cough test, miction diary, pad test, urodynamic exam and UDI-6 questionnaire, have been used to evaluate SUI symptoms before and half a year after the operation. RESULTS: The percentage of the cured, depending on the adopted urogynecology investigation, oscillated in group I between 56.8% to 91.5%, and 56.5% to 86.2% in group II. The best results were obtained in anamnesis and cough test. CONCLUSIONS: 1. The analyzed methods of urogynecology tests correlate with anamnesis as far as SUI symptoms after operative treatment are concerned. 2. There are relevant differences between several tests, in case of the estimation of SUI cure rate after colposuspension, as well as when using IVS tape.

[The influence of SUI operative treatment with use of IVS tape on quality of life]. / Wplyw operacyjnego leczenia wysilkowego nietrzymania moczu (wnm) za pomoca tasmy IVS na jakosc zycia pacjentek.

OBJECTIVES: Real influence of urinary incontinence symptoms and adopted modes of treatment on patient's quality of life is not known. DESIGN: Assessment of influence of operative SUI treatment with the use of IVS tape on patient's quality of life. MATERIAL AND METHODS: Prospective study was conducted among 57 patients with SUI symptoms II and III degree (type III according to Blavais), who were classified to apply IVS tape. Diagnostic investigations were completed by questionnaires: IIQ-7 and UDI-6, which were filled by patients. In analysis there were included results obtained before the operation and 6 months after procedure. RESULTS: We recognized women as cured: based on physicians anamnesis--80.7% of patients, according to UDI-6 --71.93%. Half year after operation relevant improvement of quality of life, evaluated by IIQ-7 questionnaire, showed 89.47%. Improvement of quality of life correlated with lack of SUI symptoms in anamnesis (r = 0.631; p < 0.001) and in UDI-6 questionnaire (r = 0.597; p < 0.001). CONCLUSIONS: (1) Operation with the use of IVS tape is effective according to improvement of quality of life in majority of patients treated due to SUI. (2) Efficacy of operative treatment in domain with SUI symptoms correlates with influence of procedure on quality of life. (3) Assessment of SUI operative treatment should include analysis of SUI symptoms and their influence on quality of life, achieved upon standardized questionnaires filled by patients.

[The analysis of the uterine cervix biocenosis in pregnant women]. / Analiza biocenozy kanalu szyjki macicy u ciezarnych.

OBJECTIVES: Infections of the vagina and the uterine cervix are some of the most frequently diagnosed and treated complications during pregnancy. AIMS: The aim of the study was to carry out biocenosis of the uterine cervix among pregnant women and the assessment of the resistance of the previously isolated types of bacteria to antibiotics. MATERIAL AND METHODS: The study was done in a group of 244 pregnant women, aged from 17 to 43, hospitalized and treated for various reasons in the Department of Pathology of Pregnancy at Medical University in Lódz. The biocenosis of the uterine cervix and the results of microbiological bacterial culture have been analyzed and the sensitivity of bacterial flora on the applied antibiotics has been assessed. RESULTS: Enterococcus faecalis, Escherichia coli and Staphylococcus epidermidis were the most frequent bacteria found in the smear from the uterine cervix. Negative culture was obtained in 2% of the pregnant women. The most frequently observed resistance to antibiotics manifested itself in case of amoxicillin, ampicillin, penicillin, erythromycin, clarithromycin and azithromycin. The bacteria showed least resistance to cephalosporins and fluoroquinolones. Staphylococcus epidermidis showed the highest resistance to antibiotics in general. CONCLUSIONS: In cases of bacterial vaginal infections, with unknown sensitivity to bacteria, treatment the use of cephalosporins is highly recommended.

[Successful termination of pregnancy complicated by fetal ascites--case report and review of the literature]. / Pomyslne zakonczenie ciazy powiklanej wodobrzuszem plodu--opis przypadku i przeglad pismiennictwa.

This is a case of 25-year-old woman, primigravida, admitted to our department in 27th week of pregnancy complicated by fetal ascites revealed by ultrasound examination. The patient underwent diagnostic amniopunction and viral examinations in 20th week of pregnancy. The results from these studies were normal. This pregnant woman was qualified for fetal abdomen puncture, fluid evacuation and shunt applying between fetal abdomen and amniotic sac. Further outcome of pregnancy was uncomplicated. A live female child was born by caesarean section in 38th week of gestation. The shunt was removed after delivery. The woman and the baby were discharged in a good general condition.

[Pregnancy in primigravida complicated by premature rupture of membranes in 15th week of pregnancy with successful delivery outcome of the mature newborn--case report and review of the literature]. / Ciaza u pierwiastki powiklana przedwczesnym peknieciem pecherza plodowego w 15 tygodniu ciazy zakonczona porodem donoszonego noworodka--opis przypadku i przeglad pismiennictwa.

Premature rupture of membranes and amniotic fluid leakage is a very serious complication of pregnancy. In most cases it causes the premature contractile activity of uterine muscle and premature labour. It is a very rare situation when after premature rupture of membranes at less than 20 weeks of gestation it is possible to carry pregnancy to term with a successful delivery outcome of healthy mature infant. In the study we analysed the course of pregnancy in 28 years old primigravida with PROM from 15th week of pregnancy with a successful delivery outcome of mature newborn in 37th week of gestation. Our analysis revealed that in certain cases of premature rupture of membranes it is possible to successfully prolong the duration of pregnancy till the foetus matures. It seems necessary to improve the management which allows to prolongate the duration of pregnancy in premature rupture of membranes.

[The mode of anaesthesia for caesarean section in the opinion of pregnant and delivering women]. / Znieczulenie do ciecia cesarskiego--preferencje ciezarnych i rodzacych.

OBJECTIVES: Conduction anaesthesia is regarded as a very safe method for the mother and for a newborn. This kind of anaesthesia reduces the risk of gastric contents aspiration and does not cause the respiratory depression. However in every case it is essential to take into consideration the woman's opinion, for whom delivering of the child is the particularly important event. DESIGN: The aim of the study was the evaluation the presence and the intensification grade of side effects of the anaesthesia to the caesarean section and establishing, which kind of anaesthesia to this operation: general or conduction is assessed as the best method for the delivering women. RESULTS: In study group among 76 women after cesarean section were 49 (64.5%) after epidural anaesthesia, 22 women (28.9%)--after spinal anaesthesia, and 5 patients (6.6%) were operated in general anaesthesia. The most common side effects after anaesthesia for cesarean section were: weakness and backache. After POP the headache was much more often symptom. CONCLUSIONS: Most of pregnant women preferred epidural anaesthesia during delivering of the child by caesarean section.

[Arterial hypertension in pregnant women]. / Nadcisnienie tetnicze u kobiet ciezarnych.

In the paper we described the criteria of diagnostics and divisions of hypertension in pregnant women. We noticed the possible etiology, symptoms and complications of the disease both for fetus and mother. We described the treatment of hypertension during pregnancy as well.

[Leiomyomas in pregnancy]. / Miesniaki u kobiet ciezarnych.

OBJECTIVES: The problem of leiomyomas founded in pregnancy is reported. DESIGN: Diagnostic methods, indications and contraindications for the myomectomy and surgical technique are presented. MATERIALS AND METHODS: In years 1991-2000--185 pregnant women with leiomyomas diagnosed during pregnancy or caesarean section were treated. RESULTS: There were indications for the myomectomy during pregnancy in the group of 26 women, in next 55 women leiomyomas were diagnosed in the course of pregnancy but myomectomy was performed during caesarean section. In the other group of 104 pregnant women leiomyomas were found and enucleated first during caesarean section made on the other indications. CONCLUSIONS: It was observed that myomectomy during caesarean section and also in the course of pregnancy is a safe procedure when the indications and surgical technique are correctly made.

[Ultrasound assessment of uterine myomas in pregnancy]. / Ultrasonograficzna ocena miesniaków macicy w ciazy.

OBJECTIVE: Visualisation of myomas in pregnancy and evaluation of their dimension, localisation and echogenic structure are essential to establish the proper diagnosis and further therapeutic management. DESIGN: Our goal was to define a diagnostic value of ultrasound examinations for uterine myomas assessment during pregnancy. MATERIALS AND METHODS: The study group included 53 women with uterine myomas which were visualised in ultrasound examination before pregnancy or during first and second trimester. RESULTS: During third trimester the presence of uterine myomas were observed in 40 cases what is 75.5% of all examined women. The difference of 6.1 mm in the mean values of measured diameters was obtained in comparison of ultrasound examination and intraoperative evaluation (7.6% of mean value diameter). It was found a statistically significant correlation between ultrasonic and intraoperative myomas diameters evaluation (p < 0.01). CONCLUSIONS: 1. The accuracy of ultrasonic measurements completes the knowledge about presence and size of uterine myomas what is of great importance to establish proper diagnosis and mode of delivery. 2. Difficulties in ultrasound visualisation of myomas situated on the posterior uterine wall were noticed during third trimester. Limited role of ultrasound examination was observed in assessment of uterine myomas during third trimester.