[Analysis of labour and perinatal complications in case of foetus weight over 4000 g]. / Analiza przebiegu porodów oraz powiklan okoloporodowych u noworodków z masa urodzeniowa przekraczajaca 4000 g.

UNLABELLED: The fetal macrosomia occurs in 3-15% pregnancies. It is recognized when foetus weight exceeds 4000 g in any period of pregnancy. Macrosomia can also be determined in case of foetus weight over 90 percentyl for the appropriate pregnancy period. The most detrimental foetal complications of macrosomia are: shoulder dystocia with Erb's brachial palsy, facial nerve palsy, clavicular and humeral bone fracture. The attempts in order to eliminate these complications lead to increase in the number of caesarean sections and labour inductions. Clinical examination and assessment of risk factors as well as ultrasonographic examination cannot exclude or confirm the possibility of macrosomia with sufficient specificity and sensitivity. On the other hand it is well known that delivery of macrosomic foetus is not always associated with perinatal complications. The aim of the study was to assess the risk of perinatal complication in foetuses with large birth weight. MATERIAL AND METHODS: In case-control study the data from medical records of 652 newborns with birth weight over 4000 g were analysed. Only single born at term foetuses in cephalic presentation were included into the analysis. RESULTS: The Erb's brachial palsy, clavicular bone fracture, shoulder dystocia and convulsions in newborn were significantly associated with excessive fetal weight. Shoulder dystocia, clavicular bone fracture and brachial palsy were more frequent in group of newborns with birth weight over 4500 g. The frequency of brachial dystocia and its complications (clavicular bone fracture and Erb's brachial palsy) were significantly connected with the use of VE. CONCLUSIONS: Significant increase in the frequency of perinatal complications in foetuses with birth weight over 4500 g indicates the necessity of considering caesarean section as a favourable mode of delivery.

[Accuracy of weight prediction of full term newborns in ultrasonography]. / Wartosc badania ultrasonograficznego w ocenie masy plodu donoszonego.

OBJECTIVES: The estimation of prognostic value of ultrasonography in fetal weight assessment. DESIGN: Assessment of practical value of ultrasonography in full term newborns. MATERIAL AND METHODS: We have retrospectively analyzed the outcomes of 611 ultrasonographic studies. It was divided into three groups: K, B, BD in relation to weight of newborns. According to that K group involved 302 newborns weighing between 2500-4000 g, B group 262 of newborns weighing more than 4000 g, BD group (47 cases) with weight exceeding 4500 g. Expected fetal weight were determined by using Shepard's algorithm. The single factor variance analysis with multiple coparison test was applied for assessment of mean errors of predicting fetal weight. RESULTS: The highest absolute value of error of expected weught of newborns occured in the group of the newborns wieghing more than 4500g in comparison with its real weight stated just after delivery (p<0,05). The underestimation of fetal weight appeared with incresing newborn weight (beta, 1 BD groups). The overestimation of fetal weight was found in the group of the newborns between 2500-4000 g (p<0,05). CONCLUSIONS: The prognostic value of Shepard algorithm in predicting fetal weight is the most accurate for fetuses weighing between 2500-4000 g. The result of our study indicates U/S was the most useless for the newborns over 4500 g. Obstetricans should take into account other factors affecting fetal growth (maternal, paternal, environmental), especially with suspicion of fetal weight over 4500 g.

[Postoperative verification of cervical intraepithelial neoplasia grade]. / Pooperacyjna ocena zaawansowania procesu sródnablonkowej neoplazji szyjki macicy.

UNLABELLED: Colposcopically directed punch biopsy and endocervical curettage is considered to be a "gold standard" in diagnosing premalignant lesions of the uterine cervix. However, in daily routine practice the CIN grade, assessed on the basis of colposcopically directed punch biopsy, sometimes differs from postoperative histopathological evaluation. Such a situation can influence the methods and outcomes of further treatment of women with premalignant lesions of the uterine cervix. OBJECTIVE: The comparison of histopathological diagnoses of punch biopsies to postoperative findings. MATERIAL AND METHODS: The accuracy of punch biopsies findings was evaluated in 104 women treated in the Gynecology Ward of the District Hospital in Kielce in the years 1996-2000. Women with cytological diagnosis of LGSIL and HGSIL were included to the study. Histopathological findings of colposcopically directed punch biopsies and endocervical curettage were compared to definitive diagnoses of postoperative material obtained by conization or hysterectomy. RESULTS: Discrepancies between the diagnosis of CIN grade, evaluated by colposcopically directed punch biopsies, and postoperative findings were detected in 37 cases (35.5%). Lower grade of CIN evaluated in biopsy was found in 23 cases (22.1%). Discrepancies in this group were found most often when colposcopy was unable to examine the entire lesion and positive endocervical specimen was obtained by curettage. In 12 (11.5%) cases when preoperative diagnosis showed CIN an early invasion was detected in postoperative material. CONCLUSIONS: Significant discrepancies were found between pre- and post-operative evaluation of CIN grade. Therefore in each case of LGSIL diagnosed in punch biopsy HGSIL should be ruled out. Expectant management of LGSIL lesions and ablative treatment of CIN should be performed only in centers with highly qualified medical staff experienced in colposcopy and cytology. It seems to be advisable to discriminate a group threatened with fast progression into CIN III or cancer among women with LGSIL (e.g. typing of high risk HPV, aneuploidy).