Skin changes during pregnancy. Is that an important issue for pregnant women?

Objectives: The aim of the study was to investigate the prevalence of self-reported skin complaints during pregnancy, applied treatment and the impact on well-being of pregnant women. Material and methods: We asked 1935 women that were maximum 4 years after labor to fill in our questionnaire. The questionnaire included questions concerning the course of pregnancy, observed skin lesions, applied treatment and influence on the quality of life. Results: Skin changes during pregnancy were reported by 1447 patients (74.78%). The prevalence of self-reported skin complaints were as follows: stretch marks (77.4%), acne (21.6%) and recurrent herpes labialis (11.6%). In 43.67% (n = 632) of women who reported dermatological problems during pregnancy the disease caused significant deterioration in their well-being. Only 168 patients (11.61%) received dermatological treatment from their obstetricians. Dermatological con­sultation required 217 patients (14.99%). For 133 of treated women (25.68%) the recommended treatment was expensive. However, in the majority of patients (379; 73.15%) who received treatment the skin changes resolved after therapy. Skin symptoms resolved significantly faster in the treated group (3.5 ± 4.3 week vs 5.8 ± 6.2 week; p < 0.001). Conclusions: Self-reported skin complaints seem to be a relevant problem during pregnancy. Proper skin care as well as appropriate treatment applied by obstetricians and/or dermatologists may help women to recover

Pregnancy and the eye. Changes in morphology of the cornea and the anterior chamber of the eye in pregnant woman

Objectives: The main goal of the study was to determine whether uncomplicated pregnancy and natural labor exert influence on the cornea and the anterior chamber of the eye. Material and methods: The study included 114 eyes of 57 women in age of 21–35 years old. Only patients in the physiological pregnancy and giving natural birth were recruited into study. Prospective observative examination was performed. Patients were diagnosed twice: in 36 HBD and 6 weeks after labor. Using the Scheimpflug camera (Pentacam system) the following parameters were assessed: central corneal thickness (CCT), keratometric parameters: flat (K1) and steep (K2), astigmatism value and axis, anterior chamber depth (ACD), anterior chamber volume (ACV) and anterior chamber angle (ACA). The statistical analysis was carried out in the StatSoft Statistica 13 program. Results: CCT value is greater in the third trimester than in 6th week after the labour. ACD and ACA values are higher in 36 HBD than in the post-partum period but the difference is not statistically important (p > 0.05). K1, K2, cylindrical refraction error, axis of cylindrical refraction error do not change. Conclusions: Authors claim that it is the result from an increase in water retention in the corneal stroma as a response to hormonal changes. The plasticity of the anterior chamber seen before delivery can be a natural adaptive mechanism of the female body, which counteracts the excessive increase in intraocular pressure in the second stage of delivery

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

Changes in the parameters of the anterior segment of the eye in pregnant women — literature review

The physiology of pregnancy is a curious issue for specialists from different branches of medicine and science. In this systematic review, the attention was focused on changes in eyes during pregnancy and confinement. To summarise and systematize actual knowledge in eyes’ changes during pregnancy, publications from years 2011–2017 were analysed. Stud­ies about parameters of corneal endothelial cells, corneal biomechanical parameters, keratometric variables, intraocular pressure and biometry of the anterior chamber were compared. The conducted studies demonstrated the unambiguous character of changes only in case of intraocular pressure, which decreased during the II and III trimesters of pregnancy. Inconsistent study methods and low number of examined patients did not enable to draw explicit conclusions in context of other parameters of the anterior segment of the eye in pregnant women. It is indicated to perform further studies on a representative and homogeneous group of female patients

Successful complex management of a congenital diaphragmatic hernia – a case report

Abstract Congenital diaphragmatic hernia is a very serious congenital defect associated with high mortality rate. The syndrome is characterized by migration of abdominal viscera to thoracic cavity, a variable degree of pulmonary hypoplasia associated with pulmonary hypertension caused by alteration of pulmonary vessels diameter, increased muscularisation of pulmonary arteries and decreased compliance of the lungs resulting in increased afterload of the right ventricle, decreased cardiac output and impaired oxygenation. We describe a case of congenital diaphragmatic hernia with migration of the stomach, the small and the large bowels and the left hepatic lobe into the left pleural space, diagnosed by ultrasound in utero at 24 weeks of gestation. The child was initially placed on high-frequency oscillation and nitric oxide and required vigorous inotropic support. The defect was repaired after stabilization of the cardiac output and gas exchange. The patient made successful recovery

Serum S100B Protein Concentrations in SGA/FGR newborns

Objectives: Fetal growth restriction is associated with chronic fetal hypoxia, poor perinatal outcome and increased perinatal mortality. There are no reliable methods to detect cell damage in the central nervous system (CNS) in these patients. The findings of increased an acidic calcium-binding protein (S100B) concentration in biological fluids of infants after brain injury have supported the use of S100B as a biochemical marker of CNS damage. The purpose of the study was to assess blood S100B concentrations in small for gestational age (SGA) and appropriate for gestational age (AGA) newborns and to evaluate the usefulness of S100B for early detection of hypoxia. Material and methods: The investigation was carried out between November 2011 and April 2014. Serum S100B protein level was assessed in cord blood collected from newborns after birth. Medical records of mothers of neonates studied were reviewed for pregnancy induced hypertension (PIH), preeclampsia, maternal smoking during pregnancy and abnormalities in umbilical artery (UA) Doppler ultrasound examination. Results: The study was carried out in 88 SGA neonates and 80 AGA neonates. The median value of S100B protein concentration in the SGA study group was significantly higher than in AGA controls (p < 0.001). Cord blood serum S100B concentration in SGA neonates with prenatal normal UA Doppler ultrasound findings (n = 32) did not differ from that SGA neonates with abnormal prenatal UA Doppler findings (n = 25) (p = 0.74), but was significantly higher than in AGA newborns (p < 0.001). Conclusions: Elevated S100B protein levels in cord blood collected from SGA newborns may be helpful in detecting infants at higher risk of postnatal neurologic disturbances at an early stage

Low Content of Cyclosporine A and Its Metabolites in the Colostrum of Post-Transplant Mothers

The rate of post-transplant mothers who breastfeed while on immunosuppression is progressively increasing. Data on breastfeeding while on cyclosporine-based regimens are limited. Therefore, we assessed the amount of cyclosporine and its metabolites that might be ingested by a breastfed infant by measuring the concentration of cyclosporine and its metabolites in the colostrum of seven post-transplant mothers. The mean concentration of cyclosporine in the colostrum was 22.40 ± 9.43 mcg/L, and the estimated mean daily dose of the drug was 1049.22 ± 397.41 ng/kg/24 h. Only three metabolites (AM1, DHCsA, and THCsA) had mean colostrum amounts comparable to or higher than cyclosporine itself, with the daily doses being 468.51 ± 80.37, 2757.79 ± 1926.11, and 1044.76 ± 948.56 ng/kg/24 h, respectively. Our results indicate a low transfer of cyclosporine and its metabolites into the colostrum in the first two days postpartum and confirm the emerging change to the policy on breastfeeding among post-transplant mothers. A full assessment of the safety of immunosuppressant exposure via breastmilk will require further studies with long-term follow-ups of breastfed children

Does pregnancy influence eye parameters? Assessment of choroidal thickness using EDI-OCT before and after labour depending on the way of delivery method

Objectives: The aim of this study is to assess the choroidal thickness (CT) with use of EDI-OCT in patients before and afterdelivery depending on the mode of delivery.Material and methods: The study involved 146 eyes of 73 patients aged 20-34 years, after natural labour (66 eyes) andC-section (80 eyes). Main inclusion criteria: Informed consent to participate in the study, age 18–35 years, single pregnancy,spherical refraction error –4.00 to +4.00 D, no eye pathologies, no surgery and ophthalmic procedures-including refractivesurgery, childbirth after 36 weeks of pregnancy, BCVA = 1.0. Patients were examined twice: in 36 WG and on 6th week afterthe birth. All examinations were carried out between 8:00 am and 10:00 am in order to avoid daily cycle fluctuations. CTmeasurements were made manually by two independent researchers at: subfoveal and 500 μm, 1000 μm, 1500 μm, 3000 μmtemporally and nasally. The student’s t-test was made.Results: In C-section group CT differences before and after delivery were statistically significant in 7/9 of the analysedareas. Mean subfoveal choroidal thickness was 370.86 μm vs 388.71 μm in 36 WG and in 6th week postpartum respectively(p = 0.0003). In women after natural labour, differences were statistically significant in 3/9 of the analysed areas. Mean subfovealchoroidal thickness was 303.27 μm vs 308,34 μm in 36 WG and in 6th week postpartum respectively (p = 0.4800).Conclusions: The thickness of the choroid was lower in women in 36 WG in comparison to 6th week after birth. Changesin the thickness of the choroid are particularly noticeable in women after caesarean section

Ciężka choroba hemolityczna noworodka w wyniku późnej i nierozpoznanej immunizacji – opis przypadku

We report a case of a hemolytic disease in a newborn from the first pregnancy due to anti-D antibodies. The maternal blood group was A Rhesus negative. She had an antibody screening test twice during the pregnancy (in the second trimester) and it was negative. The pregnancy was uneventful, without any invasive procedures and bleeding. The infant was born at 39 weeks of gestation in good overall condition. After the delivery, the blood group of the neonate was indicated – A Rhesus positive, BOC positive. Anti-D antibodies were detected in maternal blood. Neonatal blood tests revealed severe anemia (hemoglobin level: 6.0 g/dl, hematocrit: 22.2%, erythrocytes: 2.01 T/L). During the first day of neonatal life, the newborn received two transfusions of red blood cells. Bilirubin level and rate of rise were not recommendation enough for exchange transfusion. The newborn was treated with continuous phototherapy since the delivery. The perinatal period was complicated with intrauterine infection and respiratory failure. Hematopoietic vitamins and iron supplementation was initiated in the second week of neonatal life due to persistent anemia. The child remained under medical care of a hematologic clinic and received human recombinant erythropoietin treatment.Opisano przypadek konfliktu serologicznego w zakresie czynnika Rh u noworodka z ciąży pierwszej. Grupa krwi matki była dwukrotnie oznaczana w czasie ciąży (2 trymestr): A Rh (-) ujemny, nie stwierdzono przeciwciał. Ciąża przebiegała prawidłowo, nie wykonywano zabiegów inwazyjnych, nie obserwowano krwawienia w czasie ciąży. Noworodek urodzony w 39 tygodniu ciąży, w stanie ogólnym dobrym. Po porodzie oznaczono grupę krwi dziecka z pępowiny: A Rh (+) dodatni, BTA(+) dodatni. U matki wykryto p-ciała anty-D. W badaniach laboratoryjnych u dziecka znaczna niedokrwistość (Hemoglobina: 6,0 g/dl, Hematokryt: 22,2%, Erytrocyty: 2,01 T/L). W pierwszej dobie dwukrotnie przetaczano koncentrat krwinek czerwonych. Poziomy bilirubiny i tempo narastania bez wskazań do transfuzji wymiennej. Od urodzenia stosowano fototerapię ciągłą. Okres okołoporodowy był powikłany infekcją wewnątrzmaciczną oraz niewydolnością oddechową. W drugim tygodniu życia ze względu na utrzymującą się niedokrwistość włączono witaminy krwiotwórcze oraz suplementację żelazem. Dziecko było pod opieką Poradni Hematologicznej, otrzymywało erytropoetynę

Interstitial laser coagulation in Twin Reversed Arterial Perfusion sequence

Twin Reversed Arterial Perfusion (TRAP) sequence complicates about 1% of all monochorionic twin pregnancies and about 1 to 35000 of all pregnancies. It involves an acardiac twin whose structural defects are incompatible with life, and an otherwise normal ‘‘pump” co-twin. As the blood flow in the acardiac twin is reversed, it keeps on growing owing to the oxygenated blood from the co-twin. Here we report a case of monochorionic, diamniotic twin pregnancy after ICSI-ET complicated with TRAP sequence, diagnosed at 11 weeks of pregnancy. The unusual finding in this case was the residual heart in the so called acardiac twin. Gradually, the normal twin developed signs of hemodynamic compromise. Reversed a-wave in ductus venosus was observed. The acardiac twin showed subcutaneous oedema. On 24 November, 2011 a successful interstitial ultrasound-guided laser coagulation was performed at 16 weeks of gestation. 17G needle and 0.6 mm laser fibre were used. The needle was introduced into the pelvic region of the acardiac twin through the abdominal wall. A series of laser bursts lasting 5-10 seconds were fired, until cessationof blood flow in the pelvic vessels and umbilical cord of the acardiac twin was confirmed using colour Doppler. Thecourse of the intervention was uneventful. Routine steroid therapy was administered at 27 weeks of gestation.At 32 weeks the patient was hospitalized and oral antibiotics were administered due to premature rupture of the membranes and suspicion of intrauterine growth retardation of the pump twin. The patient delivered spontaneously at completed 33 weeks of pregnancy (weight 1805g, Apgar 10). After the delivery, a stage 2 intraventricular hemorrhage and jaundice were observed in the neonate. Phototherapy was administered and the mother and the child were eventually discharged from the hospital, both in good general condition. Since then, two more successful interstitial laser coagulations in TRAP sequence were performed in our institution. The essence of the treatment of TRAP sequence is cessation of the blood flow from the pump to the acardiac twin. Fetoscopic cord ligature or coagulation, and laser or radiofreqency ablations of the acardiac twin vessels, are the possible methods of intervention. The interstitial laser coagulation of the acardiac twin is less invasive than fetoscopic umbilical cord coagulation, as the outer diameter of the 17G needle is much smaller. A meticulous comparison of these methods would require a randomised study, but at 16 weeks of MCDA twin pregnancy, interstitial laser coagulation seems to be the method of choice. The outcome of the procedure and possible treatment options in case of TRAP, together with the review of literature, are presented in the article