Pregnancy After Kidney Transplantation With Maternal and Pediatric Outcomes: A Single-Center Experience.

Outcomes of pregnancies after kidney transplantation were evaluated. Thirty-one pregnancies in 26 women were noted. The mean maternal age at pregnancy was 31 ± 5 years (range, 23-44 years). The interval between transplantation and conception was 54 ± 51 months (range, 7-213 months). The mean serum creatinine concentration before conception was 1.28 ± 0.4 mg/dL (range, 0.8-2.45 mg/dL), and mean estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration) was 62 ± 18 mL/min/1.73 m2 (range, 27-106 mL/min/1.73 m2). There were no maternal deaths. There was 1 case of suspected acute rejection after delivery. There was 1 case of graft loss during pregnancy. Maternal complications included edema (6/26), hypertension (7/26), increase of (2/26) or appearance of proteinuria (5/26), and preeclampsia (4/26). Mean creatinine increase during pregnancy was 0.02 mg/dL. Mean creatinine 1 year after pregnancy was 1.54 mg/dL (±0.8 mg/dL). There were 19 cesarean sections. Fetal outcomes included 25 live births, 4 abortions, and 2 stillbirths. Out of 25 live births, 22 children were considered healthy, 2 children had congenital defects, and there were 2 deaths at neonatal age. Mean pregnancy age was 35 ± 4 weeks (range, 24-40 weeks). The rate of premature deliveries was 15 of 25. Mean neonate birth weight was 2363 ± 1029 grams (range, 490-4100 grams). The rate of babies small for gestational age was 19%. During follow-up (range, 0.5-30 years) 5 of 26 patients lost grafts (between 3 and 15 years after pregnancy); most (20) of the children previously considered healthy had good long-term development. Our results confirm that risk of pregnancy in kidney transplant recipients can be accepted, and children considered healthy at delivery develop well.

Intra- and inter-observer variability of evaluation of uterine cervix elastography images during pregnancy.

OBJECTIVES: To evaluate reproducibility and repeatability of the assessment of elastography images of the uterine cervix using an Elastography Index. MATERIAL AND METHODS: Elastography images of the uterine cervix were obtained. Numeric scale called Elastography Index, previously published by the authors, was used to describe parts of the cervix. A total of 282 images were evaluated twice by an experienced and twice by an inexperienced operator RESULTS: Reproducibility and repeatability of the evaluation of internal and external os and cervical canal were over 90%. Inter-assay coefficient of variation was 1.84%, 6.76% and 7.27% respectively and 5.84% for anterior and 16.74% for posterior wall. Analysis of the second evaluation only of both operators revealed no significant difference for posterior wall as well (F-test; p = 0.09). CONCLUSION: Authors proved satisfactory reproducibility and repeatability of subjective assessment of elastography images of uterine cervix during pregnancy with the use of Elastography Index in the hands of experienced and inexperienced observer

Comparison of fetal myocardial contractility before and after laser photocoagulation of communicating vessels in twin-to-twin transfusion syndrome.

OBJECTIVES: To evaluate changes in myocardial contractility that occur after selective laser photocoagulation of communicating vessels (SLPCV) in fetuses from pregnancies complicated with twin-to-twin transfusion syndrome (TTTS). METHODS: The study included 51 pregnant women between 16 and 26 weeks of gestation who underwent SLPCV due to TTTS. Ultrasonography was performed before SLPCV and on postoperative day 1, 3(4) and 7. Fetal heart contractility in both fetuses was evaluated by determining the shortening fractions of the left and right ventricles (FS LV and FS RV), and the myocardial performance index (Tei-Index). RESULTS: There was a significant increase in postoperative FS LV and FS RV in recipients (from 35.7% to 44%, P = 0.037 and from 27.6% to 32.9%, P = 0.021, respectively). Pre-operative Tei-Index values for both the left (0.55) and right ventricle (0.6) were above normal. The mean postoperative Tei-Index for the left ventricle decreased significantly to 0.49 (P = 0.011), while no significant change was observed in the right ventricle (0.57). No significant differences between pre- and postoperative FS and Tei-Index values were noted in the donors. CONCLUSIONS: SLPCV is reflected by a significantly increased myocardial contractility in recipients.

Results of laser therapy in twin-to-twin transfusion syndrome: our experience.

OBJECTIVE: The authors of this paper present the results of laser treatment in twin-to-twin transfusion syndrome. METHODS: Laser photocoagulation of communicating vessels was performed on 91 patients from April 2005 to June 2010, at the Medical University of Gdansk (Poland). Results of treatment were analyzed. RESULTS: The following results were achieved: at least one survival at delivery in 71 patients (83.5%), two survivors in 49 women (57.6%), and an overall survival rate of 70.6%. After the inclusion of neonatal deaths, at least one survival was reported in 65 women (76.5%) - 30 with two survivors (44.7%) and 27 with one survivor (31.8%). The incidence of preterm rupture of membranes (4 cases - 4.3%), dual intrauterine fetal demise (7 cases - 7.4%) and miscarriage or delivery (8 cases - 8.5%) during the first week after surgery were the main reasons of pregnancy loss in the analyzed group. The frequency of cerebral palsy diagnosed after 6 months was 7%. CONCLUSIONS: Despite a lower incidence of dual neonatal survivals than in other series, the results of the first years of experience with laser treatment of twin-twin transfusion syndrome are encouraging, and prompt us to improve our surgical skills to achieve better outcomes.

[Elastography in the examination of the uterine cervix before labor induction]. / Zastosowanie elastografii w ocenie szyjki macicy przed indukcja porodu.

OBJECTIVE: The authors of the following work have attempted to assess the usefulness of elastography in the uterine cervix examination before induction of labor MATERIAL AND METHODS: Sixteen pregnant women, hospitalized at the Department of Obstetrics and prepared for labor induction due to post-term pregnancy or diabetes, were examined. Differences in stiffness of anterior and posterior cervical wall was assessed by means of elastography. The results were compared to Bishop Score and correlation with reaction to Oxytocin infusion was calculated. RESULTS: There was no statistically significant correlation between cervical consistence assessed by vaginal examination and by elastography. Correlation between the Bishop Score and cervical consistence assessed manually was not statistically significant. Authors found strong correlation between elastography results and success of labor induction. CONCLUSIONS: Cervical assessment by means of elastography predicts the results of labor induction with Oxytocin better than vaginal examination.

[Presentation of our own results of twin-to-twin laser therapy]. / Wyniki wlasne fetoskopowego leczenia zespolu przetoczenia pomiedzy plodami w ciazach wieloplodowych.

OBJECTIVE: To present our own results of selective laser photocoagulation of communicating vessels in twin-to-twin transfusion syndrome. MATERIAL AND METHODS: From April 2005 till January 2008 in the Department of Obstetrics in Gdansk, 37 selective laser photocoagulation of communicating vessels were performed on 38 patients with twin-to-twin transfusion syndrome. Surgery--delivery interval and data about neonates were collected and analyzed. At least one survival, two survivals and overall survival rate were calculated. RESULTS: At least one baby survived in 84% of patients, two babies--in 62% women. Overall survival rate was 73%. CONCLUSIONS: Results of the treatment were similar to other centers and fully encourage laser surgery instead of earlier used amnioreductions wherever it is possible.

Surgical management of twin reversed arterial perfusion sequence.

OBJECTIVE: The purpose of this study was to review our experience in the management of twin reversed arterial perfusion sequence to derive management recommendations. STUDY DESIGN: All patients with twin reversed arterial perfusion sequence who were seen for consultation between 1993 and 2004 were studied. Criteria for umbilical cord occlusion included abdominal circumference of the twin reversed arterial perfusion fetus that was more than or equal to the pump twin, polyhydramnios (maximum vertical pocket > or = 8 cm), abnormal Doppler studies or hydrops of the pump twin, or monoamniotic twins. Various surgical and access techniques for umbilical cord occlusion were used as they were developed. RESULTS: Seventy-four patients with twin reversed arterial perfusion sequence were studied. Sixty-five patients were considered surgical candidates, of which 51 patients underwent umbilical cord occlusion attempt. The overall perinatal survival for surgical candidates who had umbilical cord occlusion was 65% (33/51 patients) versus 42.9% (6/14 patients) for the surgical candidates who did not undergo umbilical cord occlusion (P = .1). However, perinatal outcomes in surgical patients were significantly better than expectantly treated surgical candidates if the dividing membrane was not disrupted purposely (22/28 patients; 78.5%; P = .02). Surgery within the sac of the twin reversed arterial perfusion fetus was feasible in 23.5% of patients and was associated with no incidence of premature rupture of membranes, with 83% perinatal survival, and with a significantly greater gestational age at delivery (36 weeks). There were no significant differences in perinatal outcome relative to the specific surgical technique that was used. CONCLUSION: Surgical management of twin reversed arterial perfusion sequence is indicated in high-risk patients. The surgical approach and the surgical technique should be tailored to the specific clinical presentation, preferably by performing the surgery within the sac of the twin reversed arterial perfusion sequence fetus and avoiding disruption of the dividing membrane.

[Repeated torsion of the normal adnexa in a premenarchal girl]. / Wielokrotnie powtarzajacy sie skret prawidlowych przydatków u dziecka.

Recurrent normal adnexal torsion is rare. The clinical presentation is poor and nonspecific. Authors present 11-years old girl with repeated torsion of the normal adnexa. At the first laparotomy salpingo-oophorectomy was performed. Next two incidences were treated conservatively by ovary detorsion in laparoscopy. After second laparoscopy the girl was referred to the Adolescent Gynecology Outpatient Clinic. Preventive oophoroplexy was performed. After half of a year observation the girl reported no complaints and no abnormalities in physical examinations were found. Oophoroplexy in the cases of repeated normal adnexal torsion is a very useful method of prevention of recurrence.