HLHS – wrodzona wada serca na materiale Kliniki Patologii Ciąży w latach 2001-2007

Abstract Background: HLHS (hypoplastic left heart syndrome) is a serious congenital heart defect. In neonates with congenital heart disease HLHS accounts for nearly 25% of neonatal deaths. The etiology of HLHS is unknown. At present we expect to have those cases diagnosed in the second trimester of pregnancy. Aim: The main aim was to find the rate and outcome of the congenital heart defect – left heart hypoplasia (HLHS). Material and methods: All cases of this heart defect found in the High Risk Pregnancy Clinic in 2001-2007 were presented. Twice the congenital malformation was diagnosed after delivery and once during pregnancy - in the second trimester. All babies were delivered between 38 and 39 weeks of pregnancy, one by the spontaneous normal delivery, one by elective caesarean section and one by emergency caesarean section because of fetal distress during the delivery. All of the newborns were transported to the Pediatric Cardio surgery Unit of M.U. and operated in first weeks after delivery. Results: In two cases the operation was complicated and children died due to the cardiac arrest. One of the babies died before surgical correction. Two of the women, whose babies died after the operation gave birth to healthy newborns with no cardiac abnormalities. Conclusion: The HLHS is the most serious heart congenital malformation diagnosed often after the delivery because of lack of sufficient diagnostic system in healthy women. The prognosis for the children is bad, but the chance of giving birth to healthy children in the future is good.Streszczenie Wstęp: HLHS (Zespół niedorozwoju lewego serca) należy do ciężkich zespołów wrodzonych wad serca. Wśród noworodków urodzonych z różnymi wadami, 25% zgonów dotyczy dzieci z ta anomalia. Etiologia zespołu HLHS jest ciągle nieznana. Obecnie spodziewamy się rozpoznania tej wady już w II trymestrze ciąży. Cel: Głównym celem pracy była ocena częstości występowania zespołu HLHS oraz dalszych losów osób z tą wadą. Materiał i metody: Wszystkie przypadki z rozpoznaniem tej anomalii w Klinice Patologii Ciąży z lat 2001-2007 zostały zaprezentowane. Dwukrotnie wada została rozpoznana podczas ciąży, a w jednym przypadku pourodzeniowo. Wszystkie noworodki były urodzone o czasie- między 38 a 39 tygodniem ciąży, jeden drogami natury a dwa drogą cięcia cesarskiego – jeden cięciem elektywnym a kolejny z powodu zagrożenia wewnątrzmacicznego podczas porodu. Wszystkie noworodki po porodzie przenoszone były do Kliniki Kardiochirurgii Uniwersytetu Medycznego w Łodzi, a następnie – przygotowywane do operacji w pierwszym tygodniu życia. Wyniki: W dwóch przypadkach wystąpiły komplikacje pooperacyjne na kolejnych etapach złożonych operacji i dzieci zmarły na skutek nagiego zatrzymania krążenia. Jeden noworodek zmarł przed wykonaniem korekty operacyjnej. Dwie kobiety, których dzieci zmarły w trakcie kolejnych etapów korekcji chirurgicznej w 2007 roku urodziły zdrowe donoszone noworodki. Wnioski: HLHS jest poważna anomalią budowy serca, która często rozpoznawana jest dopiero po urodzeniu ze względu na niedostatecznie skuteczną diagnostykę ultrasonograficzną w grupie zdrowych ciężarnych. Rokowanie dla dzieci jest poważne, chociaż szansa na urodzenie zdrowego dziecka w kolejnej ciąży jest duża

Dylematy diagnostyczne i terapeutyczne u ciężarnej z zatorowością płucną

Hypercoagulable state during pregnancy and puerperium is associated with an increased risk of venous thromboembolic disease. Pulmonary embolism (PE) is the leading cause of maternal death in the developed world. Clinical assessment of PE may be difficult due to nonspecific signs and symptoms, especially in pregnant women. Diagnostic procedures using ionizing radiation may be harmful for the fetus while aggressive anticoagulation may expose the mother to bleeding complications The aim of this paper was to present a case of a 27-year-old pregnant woman with high-risk PE.Stan nadkrzepliwości w okresie ciąży i połogu zwiększa ryzyko wystąpienia żylnej choroby zakrzepowo – zatorowej (ŻChZZ). Jedna z jej postaci - zatorowość płucna (ZP) należy do najczęstszych przyczyn zgonów ciężarnych i położnic w krajach rozwiniętych stanowiąc duży problem diagnostyczno-terapeutyczny. Trudności może sprawiać samo rozpoznanie ZP, ze względu na nieswoistość objawów bądź ich brak, badania diagnostyczne narażają płód na promieniowanie jonizujące, a stosowane leczenie grozi ciężarnej powikłaniami krwotocznymi. Poniżej przedstawiliśmy opis przypadku – ciężarnej pacjentki z zatorowością płucną wysokiego ryzyka zgonu

Analysis of the indications for the caesarean section deliver for very low birthweight neonates (

Abstract Despite better care pregnant women receive nowadays, preterm birth and prematurity remain to be the reason of many complications and high mortality of neonates. Objective: The goal was to analyze the indications for cesarean sections delivery for very low birthweight

Concentration of selected biochemical parameters in blood of pregnant women infected by HPV 16 and 18

Summary Asymptomatic HPV infection in pregnant women may be connected with changes of pro-inflammatory cytokines and proteolytic enzymes which may condition the persistence of infection during pregnancy. Aim: The main aim of the study was to evaluate the concentration of interleukin-1, TNF-α and α-1 antitrypsin in pregnant women infected by oncogenic types HPV. Materials and method: The study was conducted in 2008-2009 at the Department of Obstetrics and Gynecology, Medical University Lodz, on pregnant women in the third trimester of pregnancy. The study group consisted on 19 pregnant women HPV-16, -18 infected. The control group consisted on 34 pregnant women at the same gestational age, HPV-negative. The concentration of interleukin-1, TNF-α and α-1 antitripsin was estimated in blood. Results: The results of concentration interleukin-1, TNF-α and α-1 antitrypsin were similar in both groups of pregnant women. Conclusions: High risk HPV infection has no influence on the concentration of pro- inflammatory cytokines. In HPV infection during pregnancy the anti proteolytic defense did not decrease

The course of pregnancy and perinatal period in overweight or obese pregnant women with regard to the condition of the newborn – own experience

Summary Objectives: The aim of the study was to estimate whether obesity and overweight influence the course of a pregnancy and labor and to assess the condition of a newborn. Material and Methods: 92 cases of pregnant women with singleton pregnancy were analyzed and assessed. The patients were divided into three groups according to their body mass index. Women with BMI between 18.5 and 24.9 comprised the first group (controls), those with BMI from 25.0 to 29.9 – the second group (overweight but not obese) and those with BMI of 30 and above – the third one (obese). Results: Average weight gain in the course of a pregnancy was significantly lower in the obese group whereas average blood pressure in obese women was significantly higher than in the control group. Gestational complications, such as hypertension and gestational edemas were more common in the third group. Birth weight and neonatal outcome were similar in all groups. Conclusions: 1. There is a higher risk of complications in pregnancy in overweight and obese women. 2. Obesity of women may worsen the outcome of the neonate

The analysis of the uterine cervix biocenosis in pregnant women

Objectives: Infections of the vagina and the uterine cervix are some of the most frequently diagnosed and treated complications during pregnancy. Aims: The aim of the study was to carry out biocenosis of the uterine cervix among pregnant women and the assessment of the resistance of the previously isolated types of bacteria to antibiotics. Material and methods: The study was done in a group of 244 pregnant women, aged from 17 to 43, hospitalized and treated for various reasons in the Department of Pathology of Pregnancy at Medical University in ，ode. The biocenosis of the uterine cervix and the results of microbiological bacterial culture have been analyzed and the sensitivity of bacterial flora on the applied antibiotics has been assessed. Results: Enterococcus faecalis, Escherichia coli and Staphylococcus epidermidis were the most frequent bacteria found in the smear from the uterine cervix. Negative culture was obtained in 2 % of the pregnant women. The most frequently observed resistance to antibiotics manifested itself in case of amoxicillin, ampicillin, penicillin, erythromycin, clarithromycin and azithromycin. The bacteria showed least resistance to cephalosporins and fluoroquinolones. Staphylococcus epidermidis showed the highest resistance to antibiotics in general. Conclusions: In cases of bacterial vaginal infections, with unknown sensitivity to bacteria, treatment the use of cephalosporins is highly recommended

Physiotherapy in obstetrics

Abstract Physical activity during pregnancy, active preparation for the delivery and rehabilitation after delivery are factors that can influence the quality of life of a woman at those stages of life. Treatment and prevention of leg edemas decreases the risk of hospitalization. Kinezytherapy helps pregnant women to prevent obesity and stay in good physical condition. Physiological changes in skeleton and muscle system may be the reason of pain during pregnancy and physiotherapy may effectively prevent it. Preparation for the delivery by physical activity, kinezytheraphy and respiratory exercises increase awareness and help a pregnant woman to participated more actively in the act of the delivery

Course of pregnancy and delivery in a patient with ovarian cancer after conservative surgical treatment – case report

Ovarian cancer is most often recognized in women at a menopausal age. It rarely appears in young women, however it can coexists with pregnancy or even precede their reproductive activity. Therefore, the exists a risk that the advancement of the illness or the course of treatment will prevent them from having children. The aim of the study is to describe and present the case of a 30-year-old patient treated conservatively for the cancer of the ovary, the course of pregnancy and the way of delivery

24-hour Holter measurement of blood pressure in pregnant women and effectiveness of the treatment

Objectives: Hypertension remains a very serious obstetric problem and a severe pregnancy complication. Hypertension in pregnancy influences the intrauterine fetal growth. Proper monitoring of antihypertensive therapy effects enables us to make suitable modifications of the treatment. The aim of the study was to evaluate the benefits of 24-hour Holter arterial pressure monitoring method in hypertensive pregnant women. Material and methods: Pregnant women hospitalized and treated for hypertension in the Department of Pathology of Pregnancy of Medical University o

Intrauterine contraceptive device in an appendix – a case report

The application of an intrauterine contraceptive device can perforate the uterus and migrate to adjacent organs such as the bladder or small bowel. The main symptoms are painful insertion of the intrauterine contraceptive device and missing IUD strings. The diagnosis of perforation and transuterine migration of the IUD is made on the basis of an ultrasound examination and an abdominal X-ray. The proper management is such case is immediate removal of the IUD. The aim of this paper was to present a case of a 34-year-old woman with a copper IUD found during a caesarean section