Ciąża bliźniacza jako czynnik ryzyka wystąpienia krwawienia do komór bocznych mózgu u noworodków

Objectives: The aim of this study was to find the perinatal risk factors of intravenricular hemorrhage in twin neonates. Material and methods: A retrospective analysis of 203 twin pregnancies and deliveries between 2003 and 2009 was performed. Then data according birth state and neonatal complications in 406 twins were analyzed. Twin outcome was compared with the outcome of 105 singletons born at the same time and at the same gestational age as twins. Results: Intraventricular hemorrhage was diagnosed in 116/406 (29%) of twins. IVH was found two times more often in the analyzed group than in singletons born at the same gestational age (29% vs. 18%, p = 0,03). In 96% I and II grade hemorrhage was diagnosed and in 4% III and IV grade hemorrhage in the Papille scale was found. Conclusions: 1) Intraventricular hemorrhage is found more often in twins than in singleton neonates born at the same gestational age. 2) IVH in twins correlate with preterm birth and low birth weight. IVH occur more often in twins with birth weight discordance and with too small maternal weight gain.Cel pracy: Celem pracy było wykrycie czynników ryzyka i powikłań ciąży bliźniaczej, które mogą być przyczyną wystąpienia krwawień około i domózgowych u bliźniąt. Materiał i metody: Retrospektywnie przeanalizowano dane dotyczące 203 ciąż bliźniaczych i porodów z lat 2003 - 2009. Następnie przeanalizowano informacje dotyczące stanu okołoporodowego i powikłań noworodkowych u 406 bliźniąt z tych ciąż. Wyniki bliźniąt porównano z wynikami 105 noworodków z ciąż pojedynczych, urodzonych w tym samym czasie i w tym samym wieku ciążowym co bliźnięta z grupy badanej. Wyniki: Krwawienia do komór bocznych mózgu stwierdzono u 116/406 (29%) bliźniąt. W badanej grupie IVH stwierdzano dwa razy częściej u bliźniąt niż u noworodków z ciąż pojedynczych urodzonych w tym samym wieku ciążowym (29% vs. 18%, p = 0,03). W 96% zdiagnozowano wylewy I i II stopnia w skali Papille’a i w 4% przypadkach III i IV stopnia. Wnioski: 1) Krwawienia do komór bocznych mózgu występują częściej u bliźniąt niż u noworodków z ciąż pojedynczych urodzonych w tym samym wieku ciążowym. 2) IVH u bliźniąt korelują z porodem przedwczesnym i niską masą urodzeniową. Występują częściej u noworodków z ciąż powikłanych rozbieżnym wzrastaniem płodów i zbyt małym przyrostem masy ciała ciężarnej

Subchorionic hematoma as a risk factor of pregnancy and delivery in women with threatening abortion

Summary Objectives: The aim was to present pregnancy complications and outcome in the group of women with subchorionic hematoma (SCH) diagnosed in the first or second trimester of pregnancy. Methods: A retrospective study was performed to compare the perinatal outcome of 41 patients with SCH (study group) with 59 women treated of threatening abortion (control group). Age, obstetric history, the course of pregnancy and obstetric outcomes were analyzed. Results: More SCH patients lost the pregnancy before 22 weeks gestation when Compared to the control group (39.02% vs. 15.3%). The mean age of women in both groups was similar, but a previous loss of pregnancy was more often observed in SCH group (24.4% vs. 9.4%). The majority of SCH women were multiparas (63.25% vs. 43,75%). The frequency of perinatal complications such as premature delivery, intrauterine growth retardation (IUGR) or premature rupture of membranes (PROM), was similar in both groups, but pregnancy-induced hypertension (PIH) was observed more often in SCH group (p=0,008). The percentage of caesarean sections, the average condition of the newborns in Apgar score and weight were similar in both groups. There were no differences either in the frequency of meconium stained fluid or the presence of late decelerations in delivery CTG pattern. The patients with SCH delivered female fetuses more frequently; 81.25 % of those who delivered vaginally had incomplete placenta. Conclusions: 1. SCH is more frequent in multiparas, especially if previous pregnancy loss was reported. 2. About 40% of pregnancies with SCH are lost before 22 weeks gestation; bleeding is a bad prognostic factor. 3. SCH diagnosed at the beginning of pregnancy is a risk factor of PIH in the third trimester. 4. SCH diagnosed in early pregnancy does not influence the method of delivery and does not increase the risk of adverse pregnancy outcome

Ebstein’s malformation in the fetus with cardiomegaly. To treat or to observe? – a case report

Abstract Ebstein’s malformation is a rare congenital cardiac defect characterized by an abnormal formation and /or displacement of the leaflets of the tricuspid valve. Prognosis for a neonate is poor in case of cardiomegaly, due to coexistence of lung hypoplasia. This paper presents a case of a fetus with Ebstein’s malformation with massive cardiomegaly (HA/CA = 0.62) in a 27-year-old patient in her first pregnancy. The cardiac defect was diagnosed in the 22nd week of pregnancy. Due to the fact that the patient decided to continue her pregnancy, and taking into consideration single reports of transplacental Digoxin therapy, an attempt to apply Digoxin therapy was made. The mother and the fetus were monitored in two centers, in Rzeszów and in Łódź. In the course of a 12-week transplacental therapy, 8 fetal echocardiography examinations were performed and the following parameters improved: HA/CA (0.62-0.5), CVPS (5/10-7/10) SF RA (0%-11%), SF RV (18%-28%). There was also a conversion of the oxygen test from negative to positive, which seems to document that prevention of the lung hypoplasia was achieved. The neonate died on the 8th day of postnatal life before a cardiac surgery attempt

Markers of oxidative stress in pregnancies complicated by pregnancy induced hypertension and intrahepatic cholestasis

Abstract Objective: The aim of the study was to investigate levels of superoxide dismutase (CuZnSOD-1), catalase (CAT), glutathione peroxidase (GPx) and malonodialdehyde (MDA) in groups of pregnant women with pregnancy induced hypertension (PIH), hypertension recognized before pregnancy (HA) or intrahepatic cholestasis. Material and methods: 33 women with PIH, 6 with HA and 12 with cholestasis were compared with 33 healthy pregnant women. Levels of enzymes were assessed in blood samples. Methods of delivery and obstetric results were presented. Results: SOD and GPx levels did not differ significantly in any of the investigated groups. A tendency for lower mean levels of CAT in the group of PIH women, and a higher level of MDA in the group of women with HA has been noted. The mean CAT level was significantly lower in PIH and HA patients delivered instantaneously due to the risk of eclampsia. All mean levels of enzymes in the group of women with cholestasis were similar to the ones in the group of healthy women. Patients with PIH and HA gave birth more often by cesarean section, but the overall condition of the newborns was satisfactory. Conclusions: There is no substantial evidence that the level of oxidative enzymes in a blood sample can be an indicator of oxidative stress in pregnant women with PIH, HA or cholestasis. Although CAT levels were lower in PIH and HA women who had cesarean section due to the risk of eclampsia, there was no correlation between these enzyme levels and the clinical outcome of patients or the condition of the newborns

Znaczenie badania echokardiograficznego w przepuklinie pępowinowej (Pp) u 83 płodów w materiale Zakładu Diagnostyki i Profilaktyki Wad Wrodzonych ICZMP i Uniwersytetu Medycznego w Łodzi w latach 1999-2006

Material and Methods: It was a retrospective analysis of fetal echocardiography results (analysis of congenital heart defect (CHD) and functional abnormalities in normal heart anatomy) in 83 fetuses diagnosed and treated in the same institution. Results: In our group of fetuses, the most common structural defect, in addition to omphalocele, proved to be CHD. In the group of omphalocele, normal heart anatomy and functional abnormalities (tricuspid regurgitation, myocardial hypertrophy, arrhythmias) , the hospital stay was longer comparing to the group of omphalocele, normal heart anatomy and normal heart study (t – test p=0,005). CHD was a bad prognostic factor and most fetuses/newborns did not survive (Chi-square 0,0005, Fisher test 0,000032). In the group of omphalocele and normal heart anatomy based on fetal echocardiography, the survival rate was 70%. The omphalocele and CHD survivors (n=3) had been only those, who did not require a cardiac surgery in first month of postnatal life. Conlusion: Echocardiography exam of fetus with omphalocele and CHD and functional abnormalities has diagnostic and prognostic value.Streszczenie Cel pracy: Ocena przydatności badania echokardiograficznego u płodów z przepukliną pępowinową (Pp), zarówno w odniesieniu do oceny budowy serca płodu jak i zmian czynnościowych w układzie krążenia, przy prawidłowej budowie serca płodu. Materiał i metody: Analizie retrospektywnej poddano wyniki badań echokardiograficznych 83 płodów z przepukliną pępowinową z materiału Zakładu Diagnostyki i Profilaktyki Wad Wrodzonych Instytutu Centrum Zdrowia Matki Polki i Uniwersytetu Medycznego w Łodzi. Wyniki: Przepuklina pępowinowa najczęściej współistniała z wadą serca, stanowiącą zły czynnik prognostyczny (test Chi-kwadrat 0,0005, test Fishera 0,000032). Przeżyły tylko te dzieci, które w okresie noworodkowym nie wymagały operacji kardiochirurgicznej. W grupie płodów z Pp i prawidłową budową serca, ale z anomaliami czynnościowymi stwierdzano istotnie dłuższy czas leczenia szpitalnego po porodzie, w stosunku do grupy noworodków bez zmian czynnościowych w prenatalnym badaniu echokardiograficznym (t-test p=0,005). W grupie płodów z Pp i prawidłową budową serca potwierdzoną w badaniu echokardiograficznym, odsetek przeżyć wyniósł 70%. Wnioski: Badanie echokardiograficzne u płodów z Pp ma znaczenie diagnostyczne i rokownicze przy stwierdzeniu wady serca (złe rokowanie) oraz zaburzeń czynnościowych serca (dłuższy pobyt noworodka po operacji w szpitalu)

Prenatal ultrasonographic diagnosis of congenital epulis – two case reports and literature review

Abstract The following work presents prenatal ultrasonographic examination of two rare fetal cases of epulis, among 13 792 fetuses referred to our unit due to suspected fetal anomalies by obstetricians (estimated prevalence 1/7000 among fetuses with different anomalies). Sonographic differential diagnosis, value of fetal nasal amniotic fluid flow assessment by color Doppler and the probability of EXIT procedure have been described

Diaphragmatic hernia in Reference Hospital ICZMP – diagnostic problems and outcome

Objectives: The aim of the study was to analyze US/ECHO examinations in fetuses with diaphragmatic hernia (DH) diagnosed and treated in our institution from 1994-2006, and their follow-up. Material and methods: Retrospective analysis of the data base from Department for Diagnoses & Prevention of Fetal Malformations, Research Institute of the Polish Mother’s Memorial Hospital: 14 481 fetal echo/ultrasound examinations in 10 077 fetuses have been analyzed to retrieve 115 fetuses with DH. Results: The mean gestational age at the targeted US/ECHO examination was 30 wks. There were 8 terminations of pregnancies (at mean 21 wks), 6 intrauterine demises, 60 neonatal deaths after delivery (in 1-3rd day of postnatal life), 8 deaths after surgery, 19 neonates were discharged home and in 14 cases the follow-up could not be monitored. The most common anomalies accompanying DH have been central nervous system anomalies (20%), polyhydramnion (16%) and cong heart defects (10%). In this subgroup, there was 100% mortality. Isolated DH has been diagnosed in every third case. In this subgroup, 27 neonates had undergone surgery and the survival rate was 70%, however since 2004 there was not a single death on record. Conclusions: Late gestational age of US/ECHO examinations in our tertiary center suggests that DH has been relatively difficult to detect during ultrasound screening. DH and the other structural malformations have been a lethal disease in our series in 100%. Isolated DH was much less frequent and was present in every third case (29%), and in this group the survival rate was 70%, regardless of the way of the delivery (CS or Vaginal)

Incidence of and mortality from breast cancer among women in Poland in the years 2001-2010

Introduction : Breast cancer is the most common malignant tumour among women. About 15,000 new cases of breast cancer are diagnosed and more than 5,000 women die in Poland every year. The aim of this study was to analyse the incidence and mortality rate of breast cancer among women in Poland in the years 2001-2010. Material and methods: Analysed data concerning the incidence of and mortality from cancer among women were obtained from the National Cancer Registry. Results : The number of new cases reported in 2010 exceeded that reported in 2001 by 3,666. The mortality from breast cancer among women increased by 15.1% by 2009, to subsequently drop by 0.3% in 2010. The standardized incidence rate increased by 7.4 and the standardized mortality rate fell by 1.3 in 2001-2010. Conclusions : In the years 2001-2010 the incidence of breast cancer in women in Poland rose by 30.3%, with an increase of 7.4 in the incidence rate. The highest rise in the incidence and mortality of women due to breast cancer in Poland is reported in the Lodz voivodeship. In the years 2001-2009 the number of women’s deaths due to breast cancer increased slightly, while the mortality rate dropped