Intrapartum prophylaxis against Group B Streptococcus infection – own experience

Summary Introduction: Group B Streptococcus (GBS) infection is a leading cause of neonatal complications. Objectives: The aim of the following work was to assess the efficacy of the intrapartum antibiotic prophylaxis (IAP) of the GBS infection, together with the diagnostic and therapeutic management of the newborn, based on the type and frequency of neonatal complications in the children of GBS carriers. Material and methods: 2212 patients, who gave birth at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, between January 2007 and March 2008, were included in the study. In accordance with current recommendations, all patients were screened for GBS colonization and carriers were qualified for IAP. In the end, the study group consisted of 250 GBS-positive parturients and their children (253). Retrospective analysis of the chosen variables and statistical analysis were performed. Results: GBS colonization rate in the studied population reached 11.4%. 199 parturients were qualified for IAP (79.56% of 250 women). Optimal chemoprophylaxis was administered in 87.9% of GBS carriers. Intrauterine infection was diagnosed in 13.04% of 253 newborns. In 2 cases (0.8%) GBS was the etiological factor of the infection. The neonatal infection rate was significantly lower among children of GBS-positive mothers who received IAP in comparison to those not qualified for prophylaxis (11.05% vs. 21.56%; p=0.036). The rate of intrauterine infection was also lower among newborns of mothers who had received prophylaxis with ampicillin in comparison to macrolides administration (8.2% vs. 37.5%; p=0.001). Conclusions: Optimal intrapartum antibiotic prophylaxis of GBS infection in carriers does not eliminate GBSrelated neonatal complications. Intrapartum penicillin administration seems to be more efficient than macrolides administration in GBS infection prophylaxis

Assessment of efficacy and safety of medical treatment of non-viable first trimester pregnancy

Objectives: The aim of our study was to assess the efficacy and safety of medical treatment of non-viable first trimester pregnancy. Material and methods: We analyzed 50 cases of women diagnosed with non-viable first trimester pregnancy: missed abortion (79.6%) or anembryonic pregnancy (20.4%), who were admitted and treated at the First Clinic of Obstetrics and Gynecology, Medical University of Warsaw, between June 2011 and February 2012. The diagnosis was made after two ultrasound examinations, performed at least one week apart. None of the patients manifested symptoms of imminent miscarriage. All women received medical treatment - misoprostol administered vaginally or, in cases of excessive bleeding in the course of the procedure, sublingually - according to our own scheme. The patients were informed that any moment they could decide to discontinue medical treatment and ask for surgery. Initially, 4 tablets containing misoprostol (800 mcg) were administered vaginally. A control ultrasound examination was performed 6 hours later. If expulsion of the gestational sac was completed, the patient was discharged. If the gestational sac was still present in the uterus, an additional dose of misoprostol was administered: 4 tablets vaginally or, if excessive bleeding occurred, 3 tablets (600 mcg) sublingually. Another ultrasound examination was performed after 6 hours from the second dose and the patient was discharged if the expulsion of the gestational sac was completed. If the procedure failed, it was repeated in the same manner the next day. D&C was performed in cases of excessive bleeding, failure of medical treatment after 48 hours, patient decision to discontinue medical treatment or suspected incomplete abortion after menstrual bleeding. For women who completed the medical treatment, control visits were scheduled 14 days after hospital discharge and after menstrual bleeding, if incomplete abortion was suspected. Results: D&C was performed in 12% of patients because of failure of medical treatment after 48 hours, excessive bleeding or incomplete abortion after menstrual bleeding. Additional 6% of women decided to discontinue medical treatment and demanded D&C before completing 48 hours of treatment. The mean dose of misoprostol administered until the expulsion of the gestational sac was 1.404 g (7.02 tablets). In 60% of cases the expulsion was completed before 12 hours from the beginning of the procedure. In multiparae, the time until expulsion did not exceed 6 hours more frequently than in nulliparae (50 vs. 24.14%,

Intrauterine growth restriction in pregnant women after kidney transplantation as a marker of preeclampsia

Objectives: Delayed motherhood is associated with an increasing number of comorbidities such as glomerulonephritis, systemic lupus erythematosus, and diabetic nephropathy. Women after renal transplant belong to the group of patients who require a highly individualized approach to treatment and diagnosis. The aim of the study was to validate the commonly used diagnostic criteria for preeclampsia which seem to be irrelevant in patients with chronic renal insufficiency.Material and methods: The course of pregnancy and delivery were retrospectively analyzed in 48 renal transplant patients. Two patients were excluded. Group I included 23 patients with eutrophic neonates, while Group II consisted of 23 patients with fetal hypotrophy (birth weight of < 10th percentile).Results: The duration of pregnancy was 34.5 and 35 weeks in Groups I and II, respectively. Mean birth weight in Groups I and II was 2608.64 g and 2046.30 g, respectively (p = 0.002). Mean weight percentile in Groups I and II was 36.57 and 2.91, respectively (p < 0.000). Proteinuria in the first half of pregnancy occurred in 16 and 14 patients from Groups I and II, respectively, and increased in the second half of pregnancy in 6 and 6 patients from Groups I and II, respectively. Patients from Group II were more prone to urinary tract infections (0.43 vs. 0.79; p = 0.02).Conclusions: Current diagnostic criteria for preeclampsia are insufficient in case of pregnant women after kidney transplant. General criteria should be applied with special care in women with chronic kidney disease or in patients with systemic lupus erythematosus. As a predictive factor of neonatal morbidity, intrauterine growth restriction seems to be more valuable than typical markers of kidney function

Depression, anxiety, insomnia and interleukins in the early postpartum period

BackgroundSome new mothers have been shown to suffer from anxiety and depression associated with insomnia during the postpartum period. Our study assessed the impact of demographic, psychopathological, and biochemical factors on the incidence of depression in women during the early postpartum period.MethodsA total of 119 women were evaluated at 24–48 h postpartum with the following psychometric scales: Hamilton Depression Rating Scale (HDRS), Edinburgh Postnatal Depression Scale (EPDS), Hamilton Anxiety Rating Scale (HARS) and Athens Insomnia Scale (AIS). In addition, blood was drawn to assay interleukin 6 (IL-6) and interleukin 10 (IL-10).ResultsThe factors that had the greatest impact on the risk of postpartum depression detected with the HDRS were high HARS scores and evidence of insomnia in the AIS. There were no significant differences in IL-6 or IL-10 levels in women with and without depression (based on either HDRS or EPDS scores) and insomnia (based on AIS) after childbirth. Considering demographic factors, divorced and single women were shown to be at higher risk of postpartum depression (based on EPDS scores).LimitationsSmall sample size and short observation span.ConclusionThis study highlights the relationship between postpartum depression and both anxiety and insomnia and emphasises the importance to assess symptoms of anxiety and sleep quality as part of screening in women at risk of postpartum depression

Activity of Proteolytic Enzymes and Level of Cystatin C in the Peripartum Period

Objectives. The aim of the study was to evaluate the activity of cathepsin B, collagenases, trypsin, and plasmin and concentration of cystatin C in serum of healthy pregnant women in peripartum period. Study Design. The study group included 45 women in uncomplicated pregnancies. Blood samples were collected in four time points. Enzyme activity was measured by spectrofluorometric method. The level of cystatin C was measured using immunonephelometric method. Results. Mean activity of cathepsin B and the level of serum cystatin C were significantly higher in the study group. Collagenase activity was significantly lower in the study group than the control group. No differences in collagenase, plasmin, and trypsin activity on each day of the peripartum period were found. Conclusion. High activity of cathepsin B and increased level of cystatin C are typical for women in late pregnancy. Those levels significantly decrease after delivery which can be associated with potential role of those markers in placental separation. The insignificant changes of cystatin C level in the peripartum period seem to exclude the possibility of using cystatin C as a marker for renal insufficiency in the peripartum period but additional research is necessary to investigate the matter further

Human Papillomavirus (HPV) DNA Detection Using Self-Sampling Devices in Women Undergoing Long Term Immunosuppressive Therapy

Immunosuppression is a risk factor of persistent human papillomavirus (HPV) infections, which might lead to development of (pre)malignant lesions of the cervix and lower anogenital tract. Results of HPV DNA testing using cervicovaginal self-samples are comparable to those that are clinician-obtained and therefore might be used in cervical screening. The aim of this study was to assess the prevalence of high-risk HPV (hrHPV) infections, their risk factors and the genotypes distribution among women undergoing immunosuppressive therapy. Women undergoing immunosuppressive therapy for at least three months due to solid organ transplantation or autoimmune disorders were asked to self-collect samples for HPV testing using cervicovaginal brushes and complete questionnaires regarding cervical cancer risk factors. HPV DNA detection and genotyping were performed using Genotyping kit HPV GP version 2. hrHPV was detected in 26/90 (28.9%) specimens. Genotyping revealed a broad range of hrHPV, with type 16 being the most common genotype (11/26). The components of bivalent/quadrivalent or nonavalent vaccines cover all genotypes present in 4.4% and 17.8% women, respectively, and occur as a co-infection with other types in 12.2% and 23.3% of women, respectively. The only feature significantly associated with being hrHPV-positive was having at least two lifetime sexual partners. The high prevalence of hrHPV infections among immunosuppressed women emphasizes the need for regular cervical cancer screening with HPV DNA testing, which might be performed on self-collected specimen