Recommendations of the Polish Society of Gynecologists and Obstetricians regarding caesarean sections

In recent years, the worldwide percentage of deliveries by caesarean section has increased. However, this has only improved obstetric outcomes in low-income countries [1, 2]. Unfortunately, in Poland and other high-income countries, the rate of caesarean section, which is greater than 20%, is no longer associated with decreases in the perinatal mortality of mothers and their offspring. Currently in Poland, 43.85% of births are by caesarean section [3]. The increased number of caesarean sections may be associated with the development of perinatal medicine, and of diagnostics in particular, which can have an impact on the frequency of detecting foetal abnormalities. The results of randomised multicentre study carried out across various populations in the last two decades have indicated there is a greater risk to a child during vaginal delivery in cases of breech presentation [4]. Also, among women with one prior caesarean, planned elective caesarean section compared with planned vaginal birth was associated with a lower risk of fetal and infant death or serious infant outcome [5]. As a consequently, some national associations of obstetricians and gynecologists recommended the classification of pregnant women with these abnormalities for elective caesarean section. Epidemiological data from various populations indicate, however, that the main indications for caesarean section are still labour arrest and intrapartum fetal hypoxia [6, 7]

Fetal growth trajectory in type 1 pregestational diabetes (PGDM) — an ultrasound study

Objectives: Growth disorders are frequent in diabetic pregnancies. However, they are difficult to predict and capture earlyduring pregnancy. These newborns are at risk of obesity, diabetes, and cardiovascular disease. While developing, fetalgrowth abnormalities are typically progressive. Therefore, capturing the earliest moment when they emerge is essentialto guide subsequent obstetric management.Material and methods: We aimed to analyze fetal ultrasound growth trajectories in type 1 diabetics. Moreover, we aimedto establish time points when first ultrasound manifestations of fetal growth abnormalities appear and to identify factorsthat affect fetal growth in women with diabetes.We collected clinical and ultrasound data from 200 patients with PGDM managed in the third-referential centre for diabetesin pregnancy. During every visit, patients underwent an ultrasound examination according to a standard protocol giving1072 ultrasound scan’s records. Every ultrasound consisted of fetal weight estimation, according to the Hadlock 3 formula.Retrospectively patients were divided into three groups depending on neonatal weight. In the group of 200 patients,60 (30%) delivered LGA and 9 (4.5%) SGA newborns.Results: Fetal growth trajectories show different patterns among fetuses with growth abnormalities in women withtype 1 diabetes. The moment, when fetal growth curves diverge, seems to take place in the second trimester, just afterthe 23rd week of gestation.Conclusions: It suggests that fetal growth abnormalities in type 1 diabetes may have its roots much earlier than expected.In the first trimester, there were differences in LDL-cholesterol, total cholesterol, triglyceride levels and in insulin requirementsbetween AGA, SGA and LGA subgroups

Fetal pulmonary and cerebral artery Doppler velocumetry in normal and high risk pregnancy.

Studies on fetal lung/brain circulation by means of power Doppler technique have suggested a marked reduction in lung perfusion in high-risk pregnancies as a sign of circulation redistribution. The ratio between lung/brain perfusion might therefore give a new method to predict fetal circulation centralization

Fetal pulmonary and cerebral artery Doppler velocimetry in normal and high risk pregnancy

Studies on fetal lung/brain circulation by means of power Doppler technique have suggested a marked reduction in lung perfusion in high-risk pregnancies as a sign of circulation redistribution. The ratio between lung/brain perfusion might therefore give a new method to predict fetal circulation centralization. Objective: The aim of the present study was to obtain fetal lung and cerebral artery ratio in normal and high-risk pregnancies. Study design: Doppler samples from proximal right pulmonary artery blood velocities and middle cerebral artery (MCA) were recorded cross-sectionally in 228 normal singleton pregnancies at gestational age 22 to 40 weeks. MCA / right pulmonary artery pulsatility index (PO ratio was calculated. Doppler samples from proximal right pulmonary artery and MCA were also recorded in 89 high-risk singleton pregnancies and the results related to perinatal outcome. Results: In the normal controls, right pulmonary artery PI remained stable until 30 weeks of gestation with slight increase thereafter until term. The MCA to right pulmonary artery PI ratio increased between 22 and 28 weeks of gestation with the rapid fall towards term. In the high-risk pregnancies group, right pulmonary artery PI showed no significant correlation to perinatal outcome, but signs of brain-sparing in the MCA were correlated to all adverse outcome parameters. Conclusion: Velocimetry of the middle cerebral artery is better than velocimetry of right pulmonary artery in predicting adverse outcome of pregnancy The brain/lung PI ratio does not improve the prediction of adverse outcome of pregnancy

Blood velocity in the fetal vein of Galen and the outcome of high-risk pregnancy

BACKGROUND: Pulsation in the flow velocity waveform in the umbilical vein is related to perinatal mortality but the flow velocity waveform in the fetal vein of Galen is normally even and without fluctuation. OBJECTIVES: To establish whether blood flow velocity pulsations in the vein of Galen in high-risk pregnancies are related to outcome. STUDY DESIGN: The vein of Galen was located by colour Doppler ultrasound in 102 pregnancies complicated by severe pregnancy-induced hypertension. The blood velocity waveform was recorded by pulsed Doppler within 2 days of delivery and the presence pulsations related to pregnancy outcome, including emergency operative intervention and neonatal distress. Umbilical artery and vein and uterine artery blood flow velocity waveform were also recorded at the same time. The clinicians managing the women were unaware of the venous flow results. RESULTS: Pulsation were present in the vein of Galen in 68 cases and in the umbilical vein in 21. Both were significantly related to adverse outcome. Pulsations in the vein of Galen were seen in all seven perinatal deaths. CONCLUSIONS: Since umbilical venous pulsation are a late sign of fetal compromise, and pulsations in the vein of Galen seem to appear earlier, thus being an intermediate sign of fetal compromise that might be of great value for fetal surveillance