The role of lymphocytes in fetal development and recurrent pregnancy loss

Fetal survival and development is supported by the maternal immune system. Questions regarding those mechanisms have risen from development of transplantation medicine and observation of graft rejection. Initial theories of anatomic division, fetal immune immaturity and maternal immune system inertia were found incorrect. Rejection of fetal “semi-allograft” by maternal immune system could result in pregnancy loss. Two pregnancy losses of any etiology are considered recurrent and effort should be made to name the probable cause. Immune causes of pregnancy loss are probably multifactorial, thus difficult to research and implement findings in clinical practice. Although a full understating of pregnancy loss is not established, new therapies are being developed. This review summarizes the role of lymphocytes in pregnancy develop- ment, presents data from studies on recurrent pregnancy loss patients, evidence of new therapies and ESHRE guidelines regarding immunologic investigations.

Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: Results of a web-based multinational cross-sectional study.

Objective To assess risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic using Mind-COVID, a prospective cross-sectional study that compares outcomes in middle-income economies and high-income economies. Methods A total of 7102 pregnant women from 12 high-income economies and nine middle-income economies were included. The web-based survey used two standardized instruments, General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire–9 (PHQ-9). Result Pregnant women in high-income economies reported higher PHQ-9 (0.18 standard deviation [SD], P < 0.001) and GAD-7 (0.08 SD, P = 0.005) scores than those living in middle-income economies. Multivariate regression analysis showed that increasing PHQ-9 and GAD-7 scales were associated with mental health problems during pregnancy and the need for psychiatric treatment before pregnancy. PHQ-9 was associated with a feeling of burden related to restrictions in social distancing, and access to leisure activities. GAD-7 scores were associated with a pregnancy-related complication, fear of adverse outcomes in children related to COVID-19, and feeling of burden related to finances. Conclusions According to this study, the imposed public health measures and hospital restrictions have left pregnant women more vulnerable during these difficult times. Adequate partner and family support during pregnancy and childbirth can be one of the most important protective factors against anxiety and depression, regardless of national economic status.pre-print2752 K

Zaburzenia metabolizmu homocysteiny w stanie przedrzucawkowym

Summary Preeclampsia is one of the main causes of maternal and fetal mortality. We lack a reliable test that would identify the „at risk” group of pregnant women, thus allowing us to implement a specific prevention, management and treatment program. Recently, a number of theories regarding the pathophysiology of preeclampsia has been published. The role of vascular pathology as a result of an increase in homocysteine level is often mentioned. The aim of this paper is to review the current literature related to the pathology of preeclampsia and to evaluate the usefulness of assessment of homocysteine level and homocysteine metabolism disorders as a potential predictor of preeclamsia. Hiperhomocysteinemia is a known risk factor of cardiovascular diseases and hypertension. Different sources report a similar correlation between an increase in homocysteine level and the incidence of preeclampsia. As far as the topic of homocysteine in pregnancy is concerned, numerous questions and problems remain unanswered and unsolved. Although there exists a relationship between an increased values of homocysteine and the incidence of preeclampsia, there is not enough information about what group of patients should be included in the screening test to increase the rate of diagnosis and prevention of the most dangerous sequele.Streszczenie Stan przedrzucawkowy jest jedną z głównych przyczyn zgonów matek oraz umieralności okołoporodowej noworodków. Brakuje wiarygodnego testu pozwalającego zidentyfikować grupę ryzyka wśród ciężarnych celem wdrożenia adekwatnego postępowania, zapobiegania i leczenia. Na przestrzeni ostatnich lat pojawiło się w literaturze szereg teorii co do patomechanizmów doprowadzających do wystąpienia rzucawki. Podnosi się istotną rolę patologii naczyń łożyska, której przyczyną jest wzrost poziomu homocysteiny. Celem pracy jest przegląd literatury patologii stanu przedrzucawkowego pod katem oceny przydatności badania poziomu homocysteiny oraz zaburzeń jego metabolizmu jako potencjalnego predyktora wystąpienia stanu przedrzucawkowego. Hiperhomocysteinemia jest znanym czynnikiem ryzyka chorób układu krwionośnego i nadciśnienia. Liczne źródła podają podobną korelację między narastającym poziomem homocysteiny a występowaniem stanu przedrzucawkowego. Zagadnienie homocysteiny w ciąży nastręcza wiele pytań. Nie ma wiążących rekomendacji co do zasad postępowania. Wiele aspektów tego zagadnienia nadal pozostaje nie rozwiązanych. Chociaż wykazano związek między podwyższonymi wartościami homocysteiny a występowaniem stanu przedrzucawkowego to nie wiadomo jakimi badaniami objąć jaką grupę pacjentek aby istotnie wpłynąć na zwiększoną wykrywalność i zapobieganie występowania tych najpoważniejszych powikłań

Safety and success rate of vaginal birth after two cesarean sections: retrospective cohort study

Objectives: Cesarean section is a lifesaving procedure with short and long-term consequences. Growing rates of cesarean sections worldwide arise problems for subsequent birth. The aim of this study was to compare safety of vaginal birth after two cesarean sections with repeat third cesarean section to help healthcare providers and patients make well informed decisions about mode of subsequent delivery.  Material and methods: This was a retrospective cohort study conducted in a tertiary reference hospital. Database of all deliveries (2010–2017) after two previous cesarean sections was created from electronic and paper medical records. Preterm deliveries, abnormal karyotype and neonates with congenital anomalies were excluded from the study. The final analysis included 412 cases for maternal outcome analysis and 406 cases for neonatal outcome analysis.  Results: Trial of labor after two cesareans in comparison to repeat cesarean section increases the risk of hemorrhage (OR: 10.84) and unfavorable composite maternal outcome (OR: 2.58). Failed trial of labor increases this risk of hemorrhage (OR: 15.27) and unfavorable composite maternal outcome (OR: 4.59) even further. There were no significant differences in neonatal outcomes. 22 out of 35 trials of labor ended in successful delivery giving a success rate of 62.85%. 5 of 7 labor inductions ended in repeat cesarean section giving 28.6% success rate. There were no maternal deaths and emergency hysterectomies. Conclusions: Trial of labor, especially failed trial of labor, is associated with an increased risk of perinatal complications

Post-menopausal vulvovaginal atrophy — an overview of the current treatment options

Sex hormone deficiency in post-menopausal women causes changes in the lower urinary tract. Vulvovaginal atrophy is a pathology resulting from those changes. VVA has a negative effect on the quality of life therefore prompting a search for new therapeutic options. The aim of this article is to summarize the current treatment modalities, both hormonal and non-hormonal for post-menopausal vaginal atrophy. Topical oestrogen therapy remains the “golden standard”. Alternatives, although promising, require well-designed control studies

Growth charts and prediction of abnormal growth — what is known, what is not known and what is misunderstood

Objectives: Assessment of fetal growth has an important effect on perinatal morbidity and mortality. To understand what tool to choose best for a given population a basic knowledge of how growth charts are developed and used has to be acquired. For this reason, this literature review was performed. Material and methods: An extensive literature review aimed at identifying articles related to the development of growth assessment in both spectrums of abnormal fetal growth — large and small. The analyzed articles were chosen and presented to show both the historical aspects of growth assessment, current trends and future considerations. Results: Identification of both large and small fetuses and neonates is equally crucial. Definitions and methodology vary worldwide and there is an ongoing discussion on the best tool to choose for a given population. An important part of the debate is how to differentiate between the physiologically small fetus and the truly growth restricted fetus who is at risk of perinatal complication. Similarly, the diagnosis of a large fetus is important in prevention of perinatal complications and surgical deliveries. Many clinical settings still lack growth standards. Conclusions: Birthweight for gestational age charts are biased for weight in preterm birth. Prediction and management of outcome cannot be based solely on fetal size. Small is not the only problem, we have to think large as well. A common misunderstanding in clinical practice is not using uniform charts in defining growth

Ocena wiedzy i świadomości dotyczącej czynników ryzyka i profilaktyki raka szyjki macicy kobiet świadczących usługi seksualne w Polsce

WSTĘP: W roku 2015 rak szyjki macicy był w Polsce siódmym najczęstszym nowotworem u kobiet, ze śmiertelnością na poziomie 1585. Kobiety świadczące usługi seksualne wydają się jedną z grup najbardziej narażonych na czynniki ryzyka tego schorzenia (infekcje HPV, duża liczba partnerów seksualnych, wczesny wiek inicjacji seksualnej, przewlekłe infekcje pochwy, palenie papierosów, doustna antykoncepcja). Ze względu na charakter ich pracy, niejasną sytuację prawną oraz chęć utrzymania anonimowości wiedza medyczna na temat tej grupy jest niewielka. Celem pracy była ocena wiedzy i świadomości kobiet świadczących usługi seksualne w Polsce dotyczącej czynników ryzyka i profilaktyki raka szyjki macicy. MATERIAŁ I METODY: Dane uzyskano za pomocą anonimowej, autorskiej ankiety internetowej, zawierającej 25 pytań. Zebrano 129 formularzy z obszaru całej Polski. WYNIKI: W niniejszym badaniu 25% respondentek zadeklarowało wczesny wiek inicjacji seksualnej (&gt; 16. roku życia), 41% stosuje doustną antykoncepcję. Najlepiej identyfikowanym czynnikiem ryzyka raka szyjki macicy był wirus HPV (78% respondentek) oraz wczesna inicjacja seksualna (21%). Spośród badanych kobiet 92% było świadomych faktu, że wczesne wykrycie raka szyjki macicy daje duże szanse na wyleczenie choroby, 88% badanych poprawnie wskazało cytologię jako badanie przesiewowe, a 89% badanych poddaje się badaniu cytologicznemu przynajmniej raz na 3 lata. Większość kobiet (70%) nie informuje lekarza o fakcie świadczenia usług seksualnych. WNIOSKI: Zebrane dane potwierdzają, że kobiety świadczące usługi seksualne są grupą szczególnie narażoną na analizowane czynniki ryzyka. Ankietowane kobiety często chodzą do ginekologa, a większość z nich poprawnie identyfikuje badanie przesiewowe. Największa świadomość w zakresie czynników ryzyka dotyczy infekcji HPV, przewlekłych zakażeń pochwy oraz dużej liczby partnerów seksualnych, natomiast mniej poznane są: palenie papierosów, doustna antykoncepcja hormonalna oraz wczesna inicjacja seksualna

Is there respectful maternity care in Poland? Women’s views about care during labor and birth.

Background: Abuse against women in labor starts with subtle forms of discrimination that can turn into overt violence. Therefore it is crucial to work towards prevention and elimination of disrespect and ill-treatment in medical facility perinatal care in which staff allows such abuse. The aim of the study was to analyze the experiences of women related to perinatal care. Special emphasis was put on experiences that had traits indicating disrespectful and offensive care during childbirth in medical facilities providing perinatal care. Methods: This was a cross-sectional survey. A questionnaire was prepared for respondents who gave birth in medical facilities. Information about the study was posted on the website of a non-governmental foundation dealing with projects aimed at improving perinatal care. The respondents gave online consent for processing the submitted data. 8378 questionnaires were submitted. The study was carried out between February 06 and March 20, 2018. The results were analyzed using the Chi-square independence test. The analysis was carried out at the significance level of 0.05 in Excel, R and SPSS. Results: During their hospital stay, 81% of women in the study experienced violence or abuse from medical staff on at least one occasion. The most common abuse was having medical procedures without prior consent. Inappropriate comments made by staff related to their own or a woman’s situation were reported in 25% of situations, whilst 20% of women experienced nonchalant treatment. In the study 19.3% of women reported that the staff did not properly care for their intimacy and 1.7% of the respondents said that the worst treatment was related to feeling anonymous in the hospital. Conclusions: The study shows that during Polish perinatal care women experience disrespectful and abusive care. Most abuse and disrespect involved violation of the right to privacy, the right to information, the right to equal treatment, and the right to freedom from violence. The low awareness of abuses and complaints reported in the study may result from women’s ignorance about relevant laws related to human rights

Epidural analgesia: effect on labor duration and delivery mode — a single-center cohort study

Objectives: Parturients in labor experiencing severe pain may develop several complications, which could be avoided using various forms of labor analgesia. Researchers hold divergent opinions about the effect of epidural analgesia (EA) on labor duration and delivery mode. This paper aims to establish if EA affects the duration of the 1st and the 2nd phase of labor and the percentage of emergency Cesarean sections (CS) and instrumental delivery. Material and methods: The patients in this cohort study were recruited at St. Sophia’s Specialist Hospital in Warsaw, between 1/1/2020 and 6/1/2020. We used following inclusion criteria: patients aged 18–40 with singleton pregnancies and cephalic presentation of the fetus who gave live birth at a gestational age of 37–42 weeks to neonates with birthweight 2500–4250 g and received EA at the cervical dilation between three and six centimeters. The control group didn’t receive anesthesia. We excluded planned CS and vaginal births after CS. Data analysis was performed for all parturients and separately for multiparas and nulliparas. Results Out of 2550 deliveries, we included 1052 patients — 443 participants with EA and 609 in the control group. Patients with epidural analgesia experienced longer labor 415 vs 255 min (p &lt; 0.01), longer 1st and 2nd stage (p &lt; 0.01). They had a lower risk of emergency CS (OR = 0.56) (p &lt; 0.01) but were more likely to have instrumental delivery. Conclusions: EA prolongs the first and the second stage of labor yet doesn’t affect neonatal outcomes. Moreover, the risk of emergency CS in nulliparas with EA is three times lower