Evolution of the indications for genetic amniocentesis after the introduction of the Prenatal Screening Program by the National Health Insurance in Poland

Objective: In 2008, the Prenatal Screening Program was introduced by the National Health Insurance in the Pomeranian region of Poland. As of then, biochemical and ultrasound screening was offered to women eligible for amniocentesis according to the earlier policy. The aim of the study was to investigate the evolution of the indications for amniocentesis after the introduction of the Program. Material and Methods: In total, 2579 women referred for amniocentesis to the Department of Obstetrics, Medical University of Gdansk, were included in the study. They were divided into two groups: 1705 women referred between 1996 and 2007 (group A) and 874 women referred between 2008 and 2010 (group B). Indications for amniocentesis were compared between the groups. Results: A significant difference in the indications for amniocentesis was found between the groups (Kruskal-Wallis test;

Intra- and inter-observer variability of evaluation of uterine cervix elastography images during pregnancy

Objectives: To evaluate reproducibility and repeatability of the assessment of elastography images of the uterine cervix using an Elastography Index. Material and methods: Elastography images of the uterine cervix were obtained. Numeric scale called Elastography Index, previously published by the authors, was used to describe parts of the cervix. A total of 282 images were evaluated twice by an experienced and twice by an inexperienced operator. Results: Reproducibility and repeatability of the evaluation of internal and external os and cervical canal were over 90%. Inter-assay coefficient of variation was 1.84%, 6.76% and 7.27% respectively, and 5.84% for anterior and 16.74% for posterior wall. Analysis of the second evaluation only of both operators revealed no significant difference for posterior wall as well (F-test; p=0.09). Conclusion: Authors proved satisfactory reproducibility and repeatability of subjective assessment of elastography images of uterine cervix during pregnancy with the use of Elastography Index in the hands of experienced and inexperienced observer

Solitary fibrous tumor of the retroperitoneum in pregnancy: case report

Abstract Solitary fibrous tumor (SFT) is a rare, usually benign tumor. Most cases occur on the pleura, being less frequent at other serosal sites. We present a case of a large retroperitoneal tumor with no accompanying clinical symptoms, which was detected due to apparent abdominal asymmetry in a 24-year-old woman at 16 weeks of gestation. The MRI scan taken at 20 weeks demonstrated a retroperitoneal mass measuring 25 cm in length. The tumor was surgically removed at 24 weeks of gestation. The final diagnosis was established on the basis of the anatomopathological examination supplemented by immunohistochemical phenotyping

Comparison of fetal myocardial contractility before and after laser photocoagulation of communicating vessels in twin-to-twin transfusion syndrome

Objectives: To evaluate changes in myocardial contractility that occur after selective laser photocoagulation of communicating vessels (SLPCV) in fetuses from pregnancies complicated with twin-to-twin transfusion syndrome (TTTS). Methods: The study included 51 pregnant women between 16 and 26 weeks of gestation who underwent SLPCV due to TTTS. Ultrasonography was performed before SLPCV and on postoperative day 1, 3(4) and 7. Fetal heart contractility in both fetuses was evaluated by determining the shortening fractions of the left and right ventricles (FS LV and FS RV), and the myocardial performance index (Tei-Index). Results: There was a significant increase in postoperative FS LV and FS RV in recipients (from 35.7% to 44%, P=0.037 and from 27.6% to 32.9%, P=0.021, respectively). Pre-operative Tei-Index values for both the left (0.55) and right ventricle (0.6) were above normal. The mean postoperative Tei-Index for the left ventricle decreased significantly to 0.49 (P=0.011), while no significant change was observed in the right ventricle (0.57). No significant differences between pre- and postoperative FS and Tei-Index values were noted in the donors. Conclusions: SLPCV is reflected by a significantly increased myocardial contractility in recipients

Personality type, social support and other correlates of risk for affective disorders in early puerperium

Objectives: The purpose of this study was to assess the prevalence of risk for postpartum mood disorders in mothers during the early postnatal period and to search for coexisting conditions. Material and methods: We studied 546 women in the first week after delivery. The subjects filled out a questionnaire concerning their health, social and demographic status, the Edinburgh Postnatal Depression Scale, the Patient Health Questionnaire, the NEO-FFI Personality Inventory and the Berlin Social Support Scales. Results: Probable mood disorders affected 15.85% of these patients. The risk increased with a current cesarean section (ORa = 2.54), a higher level of neuroticism (ORa = 1.65), greater fear of childbirth (ORa = 1.18), a lower level of extraversion (ORa = 0.77) and greater need for social support (ORa = 2.68). Conclusions: High level of neuroticism and introversion, as well as higher fear of delivery and the need of social support are among factors increasing the probability of mood disturbances in early postpartum period. A cesarean section might elevate the risk similarly. The mental health of such patients should be carefully examined

Relationship, social support, and personality as psychosocial determinants of the risk for postpartum blues

Objectives: The purpose of the study was to identify factors increasing or decreasing the risk for postpartum blues. Material and methods: A total of 101 women in their first week postpartum were included in the study. The Edinburgh Postnatal Depression Scale, questions concerning their medical and social status, and psychological tests (the Personality Inventory NEO-FFI, The Mieczysław Plopa and Jan Rostowski Marriage Questionnaire, and the Berlin Social Support Scales) were used. Results: The probability of postpartum blues was detected in 16.8% of the respondents. The risk decreased with higher satisfaction with intimacy (OR = 0.81), partner similarity (OR = 0.78), and the overall satisfaction with the relationship (OR = 0.94), while higher disappointment elevated that risk (OR = 1.12). As far as social support is concerned, further inde­pendent factors included perceived available social support (OR = 0.31), perceived instrumental social support (OR = 0.24), need for support (OR = 2.74), and protective buffering support (OR = 3.41). High level of neuroticism as well as fear of childbirth increased the risk for postpartum blues (OR = 2.17 and OR = 1.30, respectively). High level of extraversion and better quality of sleep constituted protective factors (OR = 0.74 and OR = 0.60, respectively). Conclusions: Maternal disappointment with marriage/relationship, neuroticism and introversion, poor quality of sleep, fear of childbirth, and seeking social support are among the factors signaling the need for careful observation for signs of possible postpartum mood disorders both, during hospitalization and the follow-up visits

Socio-demographic and psychological determinants of exclusive breastfeeding after six months postpartum — a Polish case-cohort study

Objectives: The purpose of this study was to explore the socio-demographic and psychological factors connected with exclusive breastfeeding after 6 months postpartum. Material and methods: A total of 251 women filled in questionnaires in the first week postpartum, then again after 3 and 6 months. The questionnaires included socio-demographic and medical questions, as well as psychological tools: the NEO-FFI Personality Inventory, the Berlin Social Support Scales (BSSS), and the Edinburgh Postnatal Depression Scale (EPDS). Further detailed questions concerning breastfeeding were relevant to this study. Results: The rate of exclusive breastfeeding after 6 months was 39.68%. It was found that exclusive breastfeeding was most strongly connected with attending prenatal classes (ORa = 2.84, CI 1.18–6.87, p = 0.01), formula supplementation after 3 months (ORa = 0.01, CI 0.002-0.08, p < 0.001) and the mother’s subjective satisfaction with feeding the infant after 3 months (ORa = 1.44, CI 1.01–2.06, p = 0.04). No other psychological (as far as personality, social support or risk of postpar­tum depression are concerned), demographic or medical factors were significant. Only factors pertaining to breastfeeding were significant. Conclusions: The prevalence of exclusive breastfeeding in Poland is unsatisfactory. Women should have easy access to prenatal classes with the most up-to-date knowledge on lactation and be advised against supplementing with formula, whenever possible. This could lead to higher satisfaction with breastfeeding

Wpływ ondansetronu na parametry hemodynamiczne matki podczas znieczulenia podpajęczynówkowego do cięcia cesarskiego – badanie randomizowane, przeprowadzone metodą podwójnie ślepej próby

Objective: verification of a hypothesis assuming that 5-HT3 receptor blockade by intravenous administration of ondansetron reduces the incidence of hypotension and bradycardia in patients undergoing spinal anaesthesia for Caesarean section. Material and methods: The study design was approved by the Bioethics Committee and included 72 patients undergoing elective Caesarean section, randomly assigned to ondansetron group (group O) or placebo group (group P). Finally, group O encompassed 35 patients administered ondansetron 8 mg i.v. dissolved in 10ml 0.9% NaCl whereas group P consisted of 34 patients receiving 0.9% NaCl 10 mg. Systolic and diastolic pressures were measured every 2 minutes since the onset of anaesthesia. Heart rate (HR) was monitored continuously. The criterion of hypotension requiring ephedrine was a decrease in systolic pressure by 20% compared to its baseline value or a decrease in systolic pressure below 90 mm Hg. The criterion of bradycardia was a decrease in HR below 60/min. Results: Hypotension was observed in 14 group O patients (39%) and in 15 group P patients (44%); the difference was not statistically significant. Bradycardia was noted in 1 group O patient (3%) and in 2 group P patients (6%); the difference was not statistically significant. Conclusion: A hypothesis assuming a reduction in pressure following subarachnoid anaesthesia for Caesarean section after the administration of 8 mg of ondansetron was not confirmed.Cel pracy: weryfikacja hipotezy zakładającej, że blokada receptorów 5-HT3 poprzez dożylne podanie ondansetronu redukuje częstość występowania hipotensji i bradykardii u pacjentek znieczulanych podpajęczynówkowo do cięcia cesarskiego. Materiał i metodyka: Plan badań uzyskał zgodę komisji bioetycznej. Do badania zakwalifikowano 72 pacjentki poddawane planowemu cięciu cesarskiemu, losowo przydzielając je do grupy ondansetronu (grupa O) lub grupy placebo (grupa P). Ostatecznie grupa O liczyła 36 pacjentek, którym przed znieczuleniem podano dożylnie 8 mg ondansetronu rozcieńczonego w 10 ml 0,9% NaCl, grupa P liczyła 34 pacjentki, które otrzymały 10 ml 0,9% NaCl. Pomiaru skurczowego i rozkurczowego ciśnienia tętniczego krwi dokonywano co 2 minuty od momentu znieczulenia. Częstość akcji serca (HR) monitorowana była w sposób ciągły. Za kryterium hipotensji wymagającej podania efedryny przyjęto spadek ciśnienia skurczowego o 20% w porównaniu z ciśnieniem wyjściowym lub spadek ciśnienia skurczowego poniżej 90 mm Hg. Za kryterium bradykardii przyjęto spadek akcji serca poniżej 60/min. Wyniki: Hipotensję zanotowano u 14 pacjentek w grupie O (39%) i u 15 pacjentek w grupie P (44%) co nie stanowiło statystycznie istotnej różnicy. Bradykardię zanotowano u 1 pacjentki w grupie O (3%) i u 2 pacjentek w grupie P (6%) co nie stanowiło statystycznie istotnej różnicy. Wnioski: Nie potwierdzono przyjętej hipotezy zakładającej redukcję spadku ciśnienia po znieczuleniu podpajęczynówkowym do cięcia cesarskiego po podaniu 8 mg Ondansetronu

Potential of DNA zygosity tests for non-invasive evaluation of risk of complications in twin pregnancies

Objectives: To evaluate and compare the potential of DNA analysis and ultrasound examination for diagnosis of high-risk and low-risk twin pregnancies. Material and methods: Chorionicity of 42 twin pregnancies was determined by routine high-resolution sonographic examination between 10 and 14 weeks of gestation. Zygosity was analysed in umbilical cord blood samples collected immediately after the birth by genotyping of 22 autosomal short tandem repeats used in human identity testing. Results: Routine ultrasound imaging in the first trimester of twin gestations revealed 21 low-risk dichorionic (50%) and 21 high-risk monochorionic pregnancies (50%). DNA typing of umbilical cord blood showed 23 twin pairs with different genotypes (low-risk dizygotic pregnancies, 55%) and 19 twin pairs with identical genotypes (high-risk monozygotic pregnancies, 45%). We found four pregnancies (10%), which were diagnosed sonographically as monochorionic diamniotic, but were identified as dizygotic in postnatal DNA testing. They constituted 19% of all high-risk monochorionic pregnancies detected by ultrasound imaging. Conclusions: Our results indicate high potential of prenatal DNA testing of zygosity in identification of low-risk and high-risk twin gestations requiring different prenatal care, especially in cases when chorionicity and zygosity cannot be reliably determined by ultrasound examination and as a supplementary test able to detect gestations misdiagnosed as monochorionic, resulting from fusions of dizygotic placentas. In such cases, dizygosity detected prenatally eliminates the need for frequent prenatal visits typical for monochorionic pregnancies. If chorionicity cannot be unequivocally determined and a prenatal DNA test detects monozygotic twins, a more pessimistic variant of monochorionic pregnancy should always be assumed