Wpływ znieczulenia zewnątrzoponowego na przebieg i rodzaj porodu oraz stan urodzeniowy noworodków – badanie retrospektywne

Objectives: to evaluate the impact of epidural analgesia (EA) on labor, delivery and neonatal status. Material and methods: retrospective, observational, cohort study comprising 5593 pregnant women who met the inclusion criteria (singleton pregnancy, cephalic presentation, 37-42 weeks of gestation). Out of them, 2496 had EA and 3097 constituted the control group. Main outcome measures: incidence of labor complications and operative deliveries in women who received EA, neonatal status assessed by Apgar score in 1- and 5-minute, and cord pH values. Results: Labor complications were more frequently observed in the epidural group, with an almost 1.5-fold higher incidence in nulliparous (16.32% vs. 11.29%) and 1.4-fold in multiparous women (9.86% vs. 7.08%). Stepwise logistic regression confirmed that EA is a significant risk factor for labor complications in nulliparous women (OR 1.27, 95% CI 1.03-1.58) and for forceps delivery in multiparous women (5.20, 95% CI 3.31-8.17). Also, EA is an important risk factor for both, low cord arterial pHCel: Ocena wpływu znieczulenia zewnątrzoponowego (ZO) na przebieg porodu oraz stan urodzeniowy noworodków. Materiał i metody: Retrospektywnej analizie poddano 5593 pacjentek spełniających kryteria włączenia do grupy badanej: ciąża pojedyncza, położenie płodu podłużne główkowe, wiek ciążowy ≥37tyg oraz brak stwierdzanych prenatalnie i postnatalnie anomalii rozwojowych. W tej grupie u 2496 ciężarnych zastosowano znieczulenie zewnątrzoponowe porodu, natomiast 3097 stanowiło grupę kontrolną. Oceniane parametry: Częstość występowania powikłań porodowych oraz porodów operacyjnych w grupie pacjentek rodzących w ZO, stan urodzeniowy noworodków oceniony na podstawie skali Apgar (w 1 i 5 minucie) oraz pH krwi pępowinowej. Wyniki: W analizie regresji wieloczynnikowej wykazano, że znieczulenie zewnątrzoponowe jest niezależnym czynnikiem ryzyka powikłań porodowych tylko w grupie pierworódek (IS 1,27, 95% CI 1,03-1,58), natomiast w grupie wieloródek wpływa na zwiększenie odsetka porodów kleszczowych (5,20, 95% CI 3,31-8,17). ZO jest również istotnym czynnikiem ryzyka wystąpienia niskiego pH

Selected trace elements concentrations in pregnancy and their possible role — literature review

The aim of this study was to review the role of selected trace elements in pregnancy and fetal development. Citations related to the role of iron (Fe), zinc (Zn), manganese (Mn), copper (Cu) and selenium (Se) during pregnancy were searched in PubMed, Medline, Web of Science, using keywords and MeSH terms. Inadequate supply of trace elements can cause abnormalities of fetal development and predispose a child to disorders later on in life. Trace elements are the key elements of complex enzymes responsible for the modulation of the antioxidant defense system of the organism. It has been suggested that there is a correlation between reduced levels of trace elements essential for antioxidant function in the body of pregnant women, and an increased risk of developing preeclampsia. Trace elements are components of numerous regulatory enzymes and hormones essential to the division and differentiation of fetal cells and their further development. Mineral deficiencies in pregnant women can cause birth defects of the central nervous system, and growth disorders. Future research should be directed to explain the interaction between trace elements, and establish the optimum levels of macro and micronutrients supplementation, as well as determine the reference values for trace elements in the maternal serum, umbilical cord blood and amniotic fluid

The course of pregnancy and delivery in a patient with malaria

Malaria is one of the most common lethal parasitic diseases. Infection is transmitted when an infected female mosquito bites a human introducing the sporozoites into human blood. The article presents the course of pregnancy and delivery in a patient complicated by Plasmodium infection. The patient had repetitive several trips to Tanzania over a short time period before she developed the condition. She had been taking antimalarial medication (proguanil-atovaquone) in a prophylactic dose during and after her first travel to Tanzania. Following her first return to Poland she experienced infection-related symptoms

Nasilone wymioty jako nowy objaw rozwijającej się choroby Addisona we wczesnej ciąży

Abstract A 32-year old Caucasian was admitted at 14 weeks of gestation with hypotension and weight loss. Family members noted that she appeared “tired” prior to pregnancy. Past medical history included primary hypothyroidism treated with thyroxine (100μg/day). She had a healthy daughter aged 2.5 years who had been born small for gestational age. At about 8 weeks of gestation she started to vomit several times a day. She was treated with antiemetics and intravenous fluids. Following discharge she remained nauseated, weak and lightheaded and lost about 8 kg of weight. After readmission she appeared ill and dehydrated, BMI 16.6 kg/m2, BP 90/60 mmHg supine, 70/50mmHg upright (with faint-like sensation), normal heart sounds, chest clinically clear, abdomen soft and not tender. Investigations revealed severe hyponatraemia (sodium 112mmol/L), normal potassium level 4.3mmol/L, normal renal function, TSH 1.31μIU/mL (reference range (RR): 0.27-4.2), freeT4 1.99ng/dL (RR: 0.93-1.7), freeT3 3.29pg/mL (RR: 2.57-4.43), anti-TPO antibodies 467IU/mL (RR:Streszczenie 32 letnia kobieta rasy kaukaskiej została skierowana do szpitala z powodu hipotensji i utraty masy ciała. Jej członkowie rodziny zwracali uwagę na fakt, że w okresie poprzedzającym ciążę często zgłaszała uczucie zmęczenia i znużenia. W przeszłości rozpoznano u niej pierwotną niedoczynność tarczycy i była leczona tyroksyną (100μg/dobę). Pierwsza ciąża została zakończona urodzeniem noworodka z rozpoznaną hipoptrofią, którego dalszy rozwój przebiegał prawidłowo. W obecnej ciąży od ósmego tygodnia ciąży rozpoczęły się nasilone wymioty. U ciężarnej zastosowano leki przeciwwymiotne oraz dożylną suplementację płynową. Pomimo zastosowanego leczenia nadal obserwowano uporczywe wymioty, osłabienie i znaczną utratę masy ciała (około 8 kilogramów). Po ponownej hospitalizacji stwierdzono nasilenie objawów chorobowych, znaczne osłabienie i odwodnienie, BMI 16,6kg/m2, ciśnienie krwi tętnicze 90/60mmHg w pozycji leżącej, 70/50mmHg w pozycji stojącej z następową hipotonią ortostatyczną. W badaniu fizykalnym tony serca czyste, akcja serca miarowa, szmer pęcherzykowy prawidłowy, brzuch miękki, niebolesny. W badaniach laboratoryjnych stwierdzono hiponatremię (sód 112mmol/L), potas 4,3mmol/L, prawidłowe wykładniki funkcji nerek, TSH 1,31μIU/mL (wartości referencyjne (WR): 0,27-4,2), fT4 1,99ng/dL (WR: 0,93-1,7), fT3 3,29pg/mL (WR: 2,57-4,43), przeciwciała anty-TPO 467IU/mL (WR

Successful treatment of fetal bilateral primary chylothorax – report of the two cases

Primary fetal chylothorax is an uncommon complication, associated with high perinatal morbidity and mortality. In our report, we describe two cases of fetal bilateral primary chylothorax successfully treated with pleuro-amniotic In both cases, ultrasound scans showed bilateral, hypoechoic fluid in the pleural space without any associated structural malformations and features of infection and aneuploidy. Laboratory analysis of pleural fluids revealed 79% and 92% of lymphocytes, respectively, confirming chylothorax in both fetuses. In the first case, pleuro-amniotic shunts were successfully inserted at 31 weeks and 6 days of gestation. Ultrasound scan after two weeks showed expansion of the left lung and lack of fluid in both pleural cavities. At 39 weeks of gestation, a 2660 g baby boy was delivered by cesarean section (Apgar score: 9). The child did not require surgical intervention and was discharged home on day 16 of life. In the second case, the insertion of shunts (at 24 weeks and 6 days of gestation) also significantly reduced the amount of the fluid in the pleural cavities, but one shunt had to be surgically removed after birth. At 30 weeks and 2 days of gestation, a cesarean section was performed due to maternal cholestasis. A female weighing 1400 g was delivered (Apgar score: 7). The chest X-ray revealed only a small amount of fluid in the left pleural cavity. The infant was discharged on postnatal day 26, in good condition and with body weight of 2150g. Pleuro-amniotic shunt insertion is a method of choice in the treatment of confirmed primary fetal chylothorax

Stress and Anxiety Levels in Pregnant and Post-Partum Women during the COVID-19 Pandemic

The aim of this study was to analyze stress and anxiety levels experienced by pregnant and post-partum women during the COVID-19 pandemic, as well as to indicate the social and medical factors that could contribute to stress and anxiety. A total of 210 patients were enrolled in the study. Two well-established test-tools were applied: State-Trait Anxiety Inventory (STAI) and Perceived Stress Scale (PSS-10). The study revealed that the levels of stress and anxiety experienced by the surveyed patients were moderate to high. We demonstrated that women with mental treatment history, those in the first trimester of pregnancy and the ones that are single or in an informal relationship tend to experience higher levels of psychological distress and anxiety. Such factors as age, education, parity, eventful obstetric history, comorbidities, and the number of hospital stays proved to be statistically insignificant in the analysis. Our findings could be used to identify patients at greater risk of experiencing adverse mental effects and to provide them with adequate psychological support. Further multi-center studies are warranted in order to draw final conclusions

Association of Maternal and Fetal Single-Nucleotide Polymorphisms in Metalloproteinase (MMP1, MMP2, MMP3, and MMP9) Genes with Preeclampsia

Background. Metalloproteinases (MMPs) play a pivotal role during the process of trophoblast invasion and placentation. The appearance of five functional single-nucleotide polymorphisms (SNP) in the genes of the metalloproteinases most commonly implicated in the implantation process may influence the development of preeclampsia. Methods. Blood samples were collected from 86 mothers and 86 children after preeclampsia and 85 mothers and 85 children with uncomplicated pregnancies. The distribution of genotypes for −1607 1G/2G MMP1, −735 C/T MMP2, −1306 C/T MMP2, −1171 5A/6A MMP3, and −1562C/T MMP9 polymorphisms was determined by RFLP-PCR. Results. The occurrence of 1G/1G MMP1 or 5A/5A MMP3 genotype in the mother or 1G/1G MMP1 or 5A/6A MMP3 genotype in the child is associated with preeclampsia development. Moreover, simultaneous maternal and fetal 1G/1G homozygosity increases the risk of preeclampsia development 2.39-fold and the set of maternal 5A/5A and fetal 5A/6A MMP3 genotypes by over 4.5 times. No association between the carriage of studied MMP2 or MMP9 polymorphisms and the predisposition to preeclampsia was found. Conclusion. The maternal 1G/1G MMP1 and 5A/5A MMP3 and fetal 1G/1G MMP1 and 5A/6A MMP3 gene polymorphisms may be strong genetic markers of preeclampsia, occurring either individually or together

Biotope and biocenosis of cryoconite hole ecosystems on Ecology Glacier in the maritime Antarctic

Abstract: Despite recent great interest in glacier ecosystems in the continental Antarctic, little is known about their maritime counterparts. Our study presents descriptive data on cryoconite sediments and cryoconite holes on Ecology Glacier (King George Island) to accomplish three main objectives: (a) to identify main eukaryotic (algae, invertebrates) and prokaryotic (cyanobacteria) components of microbial communities; (b) to provide a “baseline” of community composition, organic matter and artificial contamination; and (c) identify key abiotic factors that might be important in community assembly. Cryoconite holes were sampled along an altitudinal gradient of Ecology Glacier in January, mid Austral Summer 2017. Cryoconite holes located in lower altitude were deeper than those located in the middle and the highest altitude. Seventeen species of algae and cyanobacteria with biomass of 0.79 to 5.37 µg/cm3 have been found in sediments. Dominant species were cyanobacterial Pseudanabaena frigida and Bacillariophyceae Microcostaus sp. Biomass of Bacillariophyceae was significantly higher than that of Chlorophyta and Cyanobacteria. We found three species of rotifers (two potentially new to science) and for the first time a glacier dwelling Acari (suspension feeder, Nanorchestes nivalis). Organic matter content ranged from 5.4% to 7.6%. Investigated artificial radionuclides included 137Cs, 238Pu, 239+240Pu and 241Am. 210Pb seems to be related to organic matter content. Overall, cryoconite holes on Ecology Glacier present unique habitats that serve as biodiversity hotspots of psychrophiles, source of organic matter, matrices for radioactivity tracking and model for observing changes in supraglacial ecosystems in Maritime Antarctic

Przestępczość - resocjalizacja - profilaktyka. Współczesne aspekty

Z wprowadzenia: "Zagadnienia współczesnej przestępczości (a zwłaszcza dostrzegalnych zmian w jej rozmiarach i coraz bardziej zróżnicowanym obrazie), społecznej reakcji na to zjawisko i związanych z nim prób instytucjonalnie zorganizowanej interwencji profilaktyczno-resocjalizacyjnej znajdują się w orbicie zainteresowań przedstawicieli różnych dyscyplin naukowych. Specjaliści zwracają uwagę na kilka istotnych aspektów przestępczości. Jednym z nich są coraz bardziej odczuwane trudności w trafnym diagnozowaniu mechanizmów prowadzących do naruszania standardów prawnych, ponieważ wyjaśnianie przyczyn przestępczości jedynie w oparciu o ugruntowane w nauce teorie kryminologiczne wydaje się zabiegiem niewystarczającym."(...

Impact of Prenatal and Postnatal Diagnosis on Parents: Psychosocial and Economic Aspects Related to Congenital Heart Defects in Children

Congenital heart defects (CHD) are defects detected both prenatally and after birth. They are the most common congenital defects. Despite advances in diagnosis and treatment, CHD remain an important cause of morbidity and mortality in newborns, which has a great impact on economic aspects. It is crucial to provide a holistic approach to the care of children with CHD, including regular cardiac check-ups, appropriate drug treatment, surgical or cardiac interventions as needed, rehabilitation, psychological support, and education for patients and their families. Parents experience a variety of psychological problems. This article summarizes the influence of CHD in the psychological and economic areas