Reakcja śródbłonka naczyniowego na hiperglikemię i/lub nadciśnienie tętnicze w późnej ciąży jest zróżnicowana w zależności od przewlekłego lub indukowanego ciążą charakteru zaburzeń

Objectives: We investigated how maternal endothelial function is affected by pregestational (Type 1) diabetes mellitus (PGDM) or gestational diabetes mellitus (GDM) and/or chronic hypertension (chHT) or gestational hypertension (PIH). Methods: We conducted a prospective, observational study involving 78 participants with GDM, PGDM and/or hypertension (PIH-16, GDM + PIH-14, PGDM + chHT-8, PGDM-20, GDM-20) in the third trimester of a singleton viable pregnancy. Twenty healthy women with uncomplicated pregnancies matched for gestational age served as controls. We analysed maternal data, disease history and serum concentrations of E-selectin and Vascular cell adhesion molecule 1 (sVCAM-1). Results: Only the maternal serum concentration of sVCAM-1 differed significantly among the subgroups (p< 0.0001), with the highest levels evident in women with PIH or GDM + PIH and the lowest in women with PGDM alone or PGDM + chHT. Conclusions: Pregestational or pregnancy associated disorders, although sharing similar clinical symptoms, have a different impact on endothelial function in pregnant women.Wstęp: Śródbłonek naczyniowy jest uważany obecnie za narząd docelowy w rozwoju powikłań towarzyszących cukrzycy, jak również nadciśnieniu tętniczemu. Celem badania była analiza wpływu cukrzycy ciążowej lub przedciążowej typu 1(GDM, PGDM) oraz nadciśnienia tętniczego przewlekłego lub indukowanego ciążą (chHT, PIH) na markery funkcji śródbłonka naczyniowego. Materiał i metoda: Prospektywne badanie obserwacyjne na grupie 78 ciężarnych w III trymestrze pojedynczej ciąży (PIH-16, GDM+PIH-14, PGDM+chHT-8, PGDM-20, GDM-20). Grupę kontrolną stanowiło 20 zdrowych ciężarnych w pojedynczej, niepowikłanej ciąży dobranych pod względem wieku ciążowego. W grupie badanej analizowano dane antropometryczne i biochemiczne oraz stężenia rozpuszczalnych frakcji E-Selektyny (sE-Sel) i VCAM-1 (sVCAM-1) w surowicy krwi. Wyniki: Wykazano znamienną różnicę w stężeniach sVCAM-1 między analizowanymi podgrupami (p < 0,0001) przy czym najwyższe stężenia zaobserwowano w podgrupach PIH oraz GDM+PIH, a najniższe stężenia w podgrupach z PGDM z lub bez chHT. Wnioski: W ciążach powikłanych hiperglikemią i/lub nadciśnieniem tętniczym zróżnicowany wpływ chorób matczynych na śródbłonek naczyniowy ciężarnej zależy od przewlekłego lub indukowanego ciążą charakteru zaburzeń

Application of medical simulation in the education of medical students in the area of gynecology and obstetrics

The education of new generations of doctors faces major challenges. The education system should ensure access to modernand effective educational techniques. Medical simulation is a method that is developing very dynamically. Currently, everymedical university in Poland has access to the facilities of a Medical Simulation Centre. Many types of simulations can beused. The variety of techniques is considerable. Starting from simple trainers, through advanced patient simulators to hybridsimulation or virtual reality. Thanks to their use, it is possible to teach basic medical procedures in a safe way, withoutcompromising the patient’s intimacy. An additional advantage is the possibility to train in an interdisciplinary team. Theaim of this work was to present the possibility of using medical simulation as a method of effective and interesting teachingof medical students in the field of gynaecology and obstetrics. The authors described different techniques and levels ofsimulation sophistication. The basic tasks of the teacher were also described. The paper may be an interesting complementto the knowledge of education for each physician involved in the work with students

Application of medical simulation in the education of medical students in the area of gynecology and obstetrics

The education of new generations of doctors faces major challenges. The education system should ensure access to modern and effective educational techniques. Medical simulation is a method that is developing very dynamically. Currently, every medical university in Poland has access to the facilities of a Medical Simulation Centre. Many types of simulations can be used. The variety of techniques is considerable. Starting from simple trainers, through advanced patient simulators to hybrid simulation or virtual reality. Thanks to their use, it is possible to teach basic medical procedures in a safe way, without compromising the patient’s intimacy. An additional advantage is the possibility to train in an interdisciplinary team. The aim of this work was to present the possibility of using medical simulation as a method of effective and interesting teaching of medical students in the field of gynaecology and obstetrics. The authors described different techniques and levels of simulation sophistication. The basic tasks of the teacher were also described. The paper may be an interesting complement to the knowledge of education for each physician involved in the work with students

Zapalenie wyrostka robaczkowego u ciężarnej chorującej na cukrzycę typu 1 – opis przypadku

We present a case report of a 22-year-old pregnant patient with type 1 diabetes mellitus diagnosed with an appendicitis at 21st week of gestation, who underwent laparotomy and appendectomy. In later pregnancy, she required treatment for recurrent urinary tract infections and nephrolithiasis. Despite having several risk factors for an unfavorable perinatal outcome, she had caesarean section performed at term and delivered a healthy, full-term newborn. In this patient, we also discuss clinical conundrum of pregnancy complicated with several conditions that may manifest with acute abdominal symptoms and perioperative care for a pregnant woman with type 1 diabetes..Przedstawiono opis przypadku 22-letniej pierworódki chorującej na cukrzycę typu 1, z ropnym zapaleniem wyrostka robaczkowego w 21. tygodniu ciąży, wymagającym pilnego leczenia operacyjnego. Dalszy przebieg ciąży był powikłany nawracającym infekcjami układu moczowego i kamicy nerkowej. Mimo licznych czynników ryzyka niekorzystnego wyniku położniczego (stan po przebyciu appendektomii, długotrwała cukrzyca, nawracająca kamica nerkowa), ciążę zakończono w terminie, cięciem cesarskim, porodem zdrowego, donoszonego noworodka. Na przykładzie omawianej sytuacji klinicznej przedstawiamy trudności diagnostyczne charakterystyczne dla ciąży powikłanej licznymi stanami mogącymi imitować objawy tzw. „ostrego brzucha” oraz specyfikę postępowania okołooperacyjnego w warunkach zagrożenia dekompensacją cukrzycy typu 1 u ciężarnej

An observational study of the risk of neonatal macrosomia, and early gestational diabetes associated with selected candidate genes for type 2 diabetes mellitus polymorphisms in women with gestational diabetes mellitus

Objectives: 1) to analyse the prevalence of selected candidate genes for type 2 diabetes mellitus polymorphisms (IRS1 G972R; ENPP1 K121Q; ADRB3 W64R) among women with gestational diabetes; and 2) to investigate any association between variants of these genes and risk of neonatal macrosomia.Material and methods: We conducted a prospective observational study of a group of women (N = 140) in singleton pregnancies who delivered at term. Characteristics of the study group at enrolment: age: 32.0 ± 4.9 years; GA: 26.6 ± 7.5 weeks; HbA1c: 5.6 ± 0.6%; fasting blood glucose: 102.3 ± 16.3 mg/dL; insulin treatment (G2DM): 65.7%; chronic hypertension: 11.4%; gestational hypertension: 17.9%; preeclampsia: 1.4%; birth weight: 3590 ± 540 g; birth weight ≥ 4000 g (macrosomia): 18.6%; caesarean section: 44.3%; and female newborns: 57.1%.Results: The maternal metabolic characteristics at the time of booking did not differ between polymorphisms. Macrosomia was insignificantly more frequent in females (22.5%) than in males (13.3%) (p = 0.193). Only maternal height and body weight at the time of booking significantly predicted birth weight (R = 0.27, p = 0.007; R = 0.25, p = 0.005, respectively). IRS1 G972R GR and ENPP1 K121Q KQ polymorphisms were associated with an insignificantly increased risk for macrosomia. Carriers of the heterozygotic variant of the IRS 1 gene were significantly more likely to be diagnosed with GDM/DiP in the first trimester: OR 5.2, 95% CI: 1.4; 19.2; p = 0.014.Conclusions: 1) having similar metabolic characteristics, carriers of specific variants of T2DM candidate genes might be at increased risk of delivery of macrosomic newborns; 2) any association between genetic variants and macrosomia in this population might be gender-specific; and 3) allelic variation in the IRS1 gene is associated with early GDM/DiP

Ciąża u pacjentki z cukrzycą powikłaną niedoczynnością tarczycy, chorobą wieńcową oraz zespołem nerczycowym – opis przypadku

We present a case of pregnancy in 28-years old nulliparous woman with an over 20-years long history of diabetes, hypothyroidism, diabetic nephropathy with nephrotic syndrome, retinopathy and coronary artery disease treated with PCA prior the pregnancy (class H diabetes, according to White classification).W pracy przedstawiono przypadek 28 letniej ciężarnej, chorującej na cukrzycę od ponad 20 lat, leczoną także z powodu niedoczynności tarczycy, nefropatii cukrzycowej z zespołem nerczycowym, która przed ciążą przebyła ostry zespół wieńcowy, leczony za pomocą PCA (cukrzyca kl. H wg White)

Chorionic thickness and PlGF concentrations as early predictors of small-for-gestational age birth weight in a low risk population

Objectives: SGA is associated with higher incidence of postnatal complications, including suboptimal neurodevelopment and increased cardiovascular risk. Screening for SGA, carried out at 11–13 (+ 6d) gestational weeks enables to reduce or completely eliminate the above mentioned complications. The aim of this study was to assess the correlation between chorionic thickness, concentration of PIGF protein and foetal birth weight in a single low-risk pregnancy. Material and methods: The study included 76 patients at 11–13 (+ 6d) gestational weeks, monitored throughout preg­nancy. Ultrasound examinations identified the location and thickness of the chorion by measuring it in its central part at its widest point in a sagittal section. Additionally, at each visit venous blood was collected to determine the level of PlGF, PAPP-A, and BhCG. Results: A significant positive correlation (r = 0.37) was found between the foetal weight and chorionic thickness. This correlation was affected by the location of the chorion and a significant negative correlation was observed between the level of PLGF, FHR, weight and length of the newborn. Maternal early-pregnancy BMI did not affect neonatal weight and body length, FHR, chorionic thickness, and the levels of PlGF, PAPP-A, and BhCG. Conclusions: The preliminary analysis indicates an association between chorionic thickness assessed during ultrasound at 11–13 (+ 6d) gestational weeks, PIGF levels assayed at the same time and birth weight. Increasing chorion thickness was accompanied by increasing foetal birth weight. PlGF level showed an inversely proportional effect on the foetal weight. This correlation was significant for the posterior location of the chorion

Współczesne metody wczesnej diagnostyki stanu przedrzucawkowego i nadciśnienia indukowanego ciążą

Preeclampsia remains to be a serious perinatal complication and early screening for this disease to identify the high risk population before the first symptoms develop constitutes a considerable clinical challenge. Modern methods of screening for preeclampsia and pregnancy-induced hypertension include patients history, biochemical serum markers and foetal DNA and RNA in maternal serum. They aid the process of developing an optimal protocol to initiate treatment in early pregnancy and to reduce the rate of complications. Our review presents an overview of the novel methods and techniques used for early screening for preeclampsia and pregnancy-induced hypertension. Most of the research focuses on 11-13 weeks of gestation due to the fact that the first prenatal examination is performed at that time. The most important information seems to be: weight, mass, mean blood pressure, history of pregnancy-induced hypertension or preeclampsia at previous pregnancies as well as the ethnic origin. During an ultrasound scan, pulsatility index of the uterine arteries is measured. Blood samples are obtained during the last part of the examination. At the moment only a few markers seem to be strong predictors of hypertensive disorders during pregnancy: pregnancy-associated plasma protein-A (PAPP-A), placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1). Also, fetal DNA and RNA in maternal plasma are helpful in the prediction of preeclampsia as they are markers of the trophoblast apoptosis. Researchers aim at identifying the population at high risk of pregnancy-induced hypertension and preeclampsia in order to offer appropriate antenatal care to these women. At the moment many drugs and diet supplements are investigated to reduce the prevalence of hypertensive disorders in pregnancy. These medications are usually administrated in early gestation (up to 16 week of gestation) before the first clinical symptoms present. Low doses of aspirin were found to decrease the risk of preeclampsia in high-risk groups. Moreover, according to some recent research, also essential Ω-3 fatty acids reduce the incidence of preeclampsia. None of the other investigated diet supplements or antioxidants were proven to successfully reduce incidents of hypertensive disorders. So far, there is available evidence on the lack of any effect for vitamins C,D or E. Further studies are necessary to define clinical useful markers of gestational hypertension.Stan przedrzucawkowy jest poważnym powikłaniem położniczym. Wyselekcjonowanie pacjentek wysokiego ryzyka wystąpienia zaburzeń nadciśnieniowych we wczesnej ciąży, przed pojawieniem się pierwszych objawów klinicznych, stanowi wyzwanie dla współczesnego położnictwa. Współcześni badacze analizują przeszłość położniczą ciężarnych, wyniki badania przedmiotowego, stężenie markerów biochemicznych w krwi a nawet obecność płodowego DNA i RNA w surowicy matki. Znalezienie markera stanu przedrzucawkowego pozwoli na wdrożenie wczesnego leczenia i zmniejszenie częstości występowania zaburzeń regulacji ciśnienia tętniczego krwi u ciężarnych. Niniejszy artykuł przedstawia przegląd najnowszych metod wczesnej diagnostyki stanu przedrzucawkowego

The influence of metabolic parameters on fetal development weight in women with type 1 diabetes and homozygotic variant in -2548 G/A of leptin gene and its 668 A/G receptor polymorphism

Introduction: Leptin, as many other hormones and metabolic factors, may play a role in fetal development in pregnancy complicated by type 1 diabetes. Different genetic variants in leptin gene and leptin gene receptor may have influence on leptin synthesis in the course of pregnancy and metabolic state of the mother. Aim: To assess the possible influence of metabolic factors on fetal weight in type 1 diabetic subjects with homozygotic variants in leptin gene (-2548 G/A) and leptin gene receptor (668 G/A). Methods: 30 diabetic and homozygotic subjects (out of 100 diabetic subjects) were qualified to the study. Genotyping was performed by PCR-RFLP. The following factors were assessed: glycemia, leptin concentration, glycated hemoglobin, lipid profile (total cholesterol, LDL, HDL, triglycerides), maternal body weight. Multiple regression models were developed and ROC curves were used in the analysis. Results: Mean fetal weight in the analyzed group was 3600g. The following parameters were found to have influence on fetal weight: I trimester leptin (R2-0.80741288,