Maternal reproductive history and the risk of isolated congenital malformations.

We examined the relationship between maternal reproductive history and the newborn's risk of isolated congenital malformations in a large case-control cohort from the Polish Registry of Congenital Malformations. Congenital malformations were classified into four categories: isolated congenital heart defects (n=1673), isolated cleft palate (n=255), cleft lip with or without cleft palate (n=448) and renal agenesis (n=103). The case groups were compared with a shared group of 2068 controls recruited in the same time period and geographic area. Multivariable logistic regression was used to assess the risk associated with maternal gravidity and of previous miscarriages after accounting for maternal age and other potential risk factors. In unadjusted analyses, maternal gravidity was significantly associated with increased risk of all four classes of congenital malformations. After adjustment, a significant association persisted for congenital heart defects [odds ratio (OR)=1.22, [95% confidence interval (CI) 1.09, 1.36], P=0.0007] and cleft lip with or without cleft palate (OR=1.21, [95% CI 1.09, 1.36], P=0.0005). A similar trend existed for isolated cleft palate (OR=1.18, [95% CI 1.02, 1.37], P=0.03). There was no appreciable increase in the risk of congenital malformations associated with a maternal history of miscarriages, but a trend for a protective effect on the occurrence of cleft lip with or without cleft palate was observed (OR=0.72, [95% CI 0.52, 0.99], P=0.045). Based on our data, maternal gravidity represents a significant risk factor for congenital heart defects and cleft lip with or without cleft palate in the newborn infant. Our data do not support an increase in risk because of past history of miscarriages.

[Management and outcome of pregnancy in women with hypothyroidism--case report]. / Ciaza i poród u kobiety z wrodzona niedoczynnoscia tarczycy--opis przypadku.

We analysed the influence of congenital hypothyroidism, diagnosed in the third year of life, on the outcome of pregnancy. We observed the physiological progress of pregnancy and normal development of the foetus. We delivered newborn by caesarean section. We did not observe any disadvantageous influence of congenital hypothyroidism in the mother on newborn status. We analysed the pharmacological substitution and its influence on pregnancy outcome.

[Management and outcome of preterm labor in department of obstetrics and pathology of pregnancy school of medicine in Lublin]. / Metody rozwiazania porodów przedwczesnyciw materiale Kliniki Poloznictwa i Patologii Ciazy AM w Lublinie.

OBJECTIVES: We present data of three years experience of management and outcome of preterm labour. MATERIALS AND METHODS: The study comprised 335 pregnant women with preterm labour. We analyzed the pharmacological therapy and way of labour. There were two groups of patients: I group--180 patients who had cesarean delivery, II group--155 patients who had vaginal delivery. RESULTS: It has been found 7.54% more cesarean delivery than vaginal delivery of preterm labour.

[Management in premature rupture of the membranes (PROM) at term--own experiences]. / Postepowanie w przedwczesnym peknieciu blon plodowych w terminie porodu-doswiadczenia wlasne.

UNLABELLED: In our study the management and outcomes in 211 women with premature rupture of the membranes at term was analyzed. According to the time elapsed since PROM to delivery the study group was divided into four groups: within 6 h, within 6-12 h, within 12-24 h and over 24 h after PROM. The analysis was focused on the maternal age, obstetric history, induction of labor, mode of delivery, duration of interval between PROM and active labor, use of maternal antibiotics, newborns evaluation in Apgar score and the neonatal infections. CONCLUSIONS: 1. In our study PROM at term occurred more frequently in primigravidae than in multigravidae. 2. The relationship between duration of time from the membranes rupture to delivery and frequency of labor induction, use of maternal antibiotics and neonatal infections was observed. 3. The higher percentage of cesarean sections in patients with interval from PROM to delivery less than 6 and over 24 hours was found.

[Peculiarities of multiple pregnancy: epidemiology]. / Osobliwosci ciazy mnogiej: epidemiologia.

The epidemiology of multiple pregnancy is complex and depends on various factors including age, race, genetic and environmental factors, season of conception and, more recently, iatrogenic factors. In recent years, twinning rate increased dramatically especially in countries where ovulation induction and assisted reproductive technologies are widely used. Multiple pregnancies are most frequent in Nigeria where majority of them are dizygotic. The lowest frequency of twinning is observed in Japan where almost 70% of multiples are monozygotic. This paper discusses genetic, environmental and sociocultural factors which are related to the "epidemic" of multiples.

[Peculiarities of multiple pregnancy: embryology]. / Osobliwosci ciazy mnogiej: embriologia.

Multiple pregnancies are not physiologic in humans and the understanding of the pathogenesis of this phenomenon is not fully established. Embriology of multiple pregnancy has been extensively investigated and this paper presents the phases of embrional development of monozygotic and dizygotic twins.

[Peculiarities of multiple pregnancy: diagnosis]. / Osobliwosci ciazy mnogiej: diagnostyka.

Before ultrasound was aggressively introduced into everyday obstetrical practice, diagnosis, prophylaxis and active pre- and perinatal management were at best inadequate, but more often nonexistent. Twin pregnancies were complicated by high perinatal morbidity and mortality. The use of classical radiography was limited due to proven teratogenic and carcinogenic properties. Introduction of ultrasound dramatically changed the obstetrician's approach to twin pregnancy management. This paper discusses in detail the recent advances in ultrasound diagnosis of twin pregnancy.

[Peculiarities of multiple pregnancy: complications]. / Osobliwosci ciazy mnogiej: powiklania.

Multiple pregnancies are considered high risk. This qualification is associated with the multitude of conditions which are known to complicated these pregnancies. Early diagnosis of these complications is the fundamental element of clinical managements. In numerous cases therapeutic protocols are widely known and in many others intensive monitoring and appropriate management may save the fetus from early and late complications. This paper will discuss the most common prenatal and perinatal complications associated with multiple pregnancies as well as the most widely accepted therapeutic protocols.

[Analysis of twin pregnancies in material from the Department of Obstetrics and Pathology of Pregnancy in Lublin from 1991-1998]. / Analiza ciaz blizniaczych w materiale Kliniki Poloznictwa i Patologii Ciazy AM w Lublinie w latach 1991-1998.

The course of multiple pregnancies and multiple fetus labor were analyzed in 111 women delivered in the Department of Obstetrics, School of Medicine in Lublin in the years 1991-1998. It has been found that the most frequent patients were those aged 25-29 coming from the cities and after the infertility treatment. The aim of this research was to characterize twin pregnant patients, and present the outcome of multiple pregnancy. The studies were performed on 67 women from the cities and 44 women from the villages. It is significant that almost 55% pregnant women underwent the cesarean section and their average birth weight was 2490 g. These results indicate that multiple pregnancy is in high risk pregnancy.

[Amniotic band syndrome: a case study]. / Zespól tasm owodniowych--opis przypadku.

This study present a case of a female newborn, gestational age (GA)--27 weeks, birth weight--1020 g (50 percentile), body length--38 cm, head circumference--26 cm, chest circumference--24 cm. The newborn came from the first pregnancy, the amniotic fluid leak was observed for 7 days before delivery resolved by cesarean section. The following consequences of the amniotic band syndrome were observed in the newborn: congenital amputation of lower left limb, congenital amputation of 2nd, 3rd, 4th, 5th fingers in the upper right limb, congenital constricting ring of 1 finger in the upper right limb, congenital amputation of 1st toe in the lower right limb, syndactylism of fingers of upper and lower limbs. The above malformations will be presented and supported by photographic, ultrasound and radiographic documentation.

[Multiple malformations syndrome: a case report]. / Zespól wad wrodzonych--opis przypadku.

We described a case with multiple congenital malformations diagnosed at 35 weeks of pregnancy by ultrasound examinations.

Serum level of endothelin-1 and -2 in pregnancies complicated by EPH gestosis.

We examined the endothelin (ET)-1 and -2 concentration in peripheral blood serum of 27 pregnant patients with EPH gestosis who underwent cesarean section between the 32nd and 38th week of gestation (group Gc). The control group consisted of 26 healthy pregnant women who underwent cesarean section due to fetal malpositions (group Kc). ET concentration in umbilical venous blood serum in 22 cases of EPH gestosis (group Gp) and 20 cases from the control group (Kp) was measured after delivery. ET concentration was determined with use of a radioimmunoassay method after extraction with column chromatography. The mean ET concentration was 41.55 pg/ml in group Gc and was significantly higher than in group Kc-6.77 pg/ml. The mean ET concentration in umbilical blood serum in group Gp was 50.59 pg/ml and was significantly higher than in Gc and Kp groups-where ET concentration was 17.11 pg/ml. These studies indicate that the high level of ET may play an important role in pathogenesis of EPH gestosis as well as having influence on uteroplacental and umbilicoplacental circulation.

[Metabolism of triglycerides of the placenta during extraorganic circulation]. / Einige Aspekte des Metabolismus von Triglyzeriden der Plazenta im ausserorganischen Kreislauf.

An attempt has been made to evaluate the behaviour of triglycerides in the perfusional liquid of the human placenta under the influence of orciprenaline in the quantity of 40 micrograms/min and papaverine in quantity of 320 micrograms/min. In own experiments the authors discovered that these drugs which are given in the above mentioned doses increase the tension of the anaerobic metabolism of the placenta which is expressed by the quotient of lactate/pyruvate. The examinations were made on 30 placentas which were perfused extracorporally. In the control group of the placentas isotonic saline was administered. Concentration of triglycerides in the perfusion fluid was determined 30, 60, 90, 120 minute after beginning the experiment. Increase in the concentration of triglycerides after administration of orciprenaline was found and a constant decrease after the application of papaverine. Based on examinations of the metabolism of glucose in an identical experimental model and observations made by other authors a hypothesis was put forward that the increased synthesis of triglycerides is a reflection of the increasing tension of the anaerobic metabolism of the placenta. This process may constitute a compensatory mechanism of the metabolic activity of the placenta in the conditions of the limited accessibility of oxygen. The synthesis of triglycerides in ischemic tissue can perform two basic functions: 1. it assures constant regeneration of NADP, 2. it eliminates the endproducts of glycolyse transforming the pyruvate through the acetylo-CoA into the fatty acid and triglycerides. The increase of synthesis of triglycerides serves as replacement of oxygen and makes it possible to maintain the hexose-monophosphate shunt activity and Embden-Mayerhof pathway.(ABSTRACT TRUNCATED AT 250 WORDS)

[Energetic metabolism of the placenta and vascular blood flow as criteria for the choice of drugs in risk pregnancy--results of our investigations]. / Der energetische Metabolismus der Plazenta und der Gefässdurchfluss als Kriterien für die Wahl der Arzneimittel bei der Risikoschwangerschaft--Ergebnisse eigener Untersuchungen.

Object of this paper was to estimate the vascular resistances of the placenta and the lactate/pyruvate-quotient influenced by 8 and 40 mu/min orciprenaline and 320 micrograms/min papaverine. 38 placentas were tested in extraorganic circulation. The content of lactic acid and pyruvic acid was determined in the perfusion solution flowing out of the umbilical vein. Pressure was registered with cymograph. Infusion of 8 micrograms/min orciprenaline diminishes the lactate/pyruvate-quotient and the vascular resistances. 40 micrograms/min orciprenaline causes spasm of placental vessels in the terminal phase of examination. In this group the processes of oxygenation were limited by the oxygen content in the perfusion solution. Papaverine turned the metabolism of the placenta to an anaerob way and the antispasmodic effect was shortlasting.--Therefore the drug effect results out of a metabolic and a spasmolytic component. In risk pregnancy there has to be considered in addition to the spasmolytic the metabolic effects, too.