Badanie przesiewowe wśród kobiet w ciąży w kierunku zakażenia wirusem cytomegalii (CMV) — zalecenia w Polsce i w wybranych krajach świata (opracowanie wstępne do badania występowania powikłań neurologicznych u dzieci zakażonych CMV)

Cytomegalovirus (CMV) is the most common cause of congenital infections worldwide, yet it remains an underestimated public health problem. There are no international standards for the prevention of vertical transmission of the infection, and the management of pregnant women as well as fetuses with symptoms of infection. The analysis was conducted between December and February 2022. The detailed criteria of inclusion in the analysis included: a separate study group, consisting only of pregnant women regardless of their stage, and statistical analysis of obtained data with particular emphasis on the result of antibodies against CMV antigens in IgG and IgM class. The introduction of universal screening is still controversial. In most countries, routine determination of IgG and IgM antibodies to CMV antigens is not recommended among pregnant women, but these tests are often offered to them independently of nationally approved screening programmes. (JNNN 2022;11(2):83–94).Wirus cytomegalii (CMV) jest najczęstszą przyczyną zakażeń wrodzonych na świecie, a mimo to wciąż pozostaje niedocenionym problemem zdrowia publicznego. Brak jest międzynarodowych standardów zapobiegania wertykalnej transmisji zakażenia, postępowania w stosunku do kobiet ciężarnych, jak i płodu z objawami infekcji. Analizę przeprowadzono od grudnia do lutego 2022 r. Szczegółowe kryteria włączenia do analizy obejmowały: wyodrębnioną grupę badawczą, składającą się tylko i wyłącznie z kobiet w ciąży niezależnie od jej etapu, analizę statystyczną uzyskanych danych ze szczególnym uwzględnieniem wyniku przeciwciał przeciwko antygenom wirusa CMV w klasie IgG oraz IgM. Wprowadzenie powszechnych badań przesiewowych wciąż jest kwestią sporną. W większości krajów nie zaleca się wśród kobiet w ciąży rutynowego oznaczania przeciwciał przeciwko antygenom wirusa CMV w klasie IgG oraz IgM, jednak badania te są im często proponowane niezależnie od programów skriningowych zatwierdzonych na szczeblu krajowym. (PNN 2022;11(2):83–94)

Fetal ovarian cysts – 420 cases from literature – metaanalysis 1984-2005

Despite an improvement in prenatal ultrasonographic diagnosis, the management of fetal ovarian cysts remains controversial. 420 fetuses with ovarian cyst from Medline data base have been analyzed. In 209 cases (50%), the cysts regressed spontaneously and in 145 cases (35%) cysts were complicated by torsion and intracystic hemorrhage. Surgical treatment was performed in 174 cases (41%) of neonates. Cysts 50mm in 93% resulted in complications (n=14). After the diagnosis of fetal ovarian cysts 50mm cysts, needle aspiration was an option in selected cases (n=28). Spontaneous regression cysts >50mm after needle aspiration was observed in 89% (n=25) of the cases. Prenatal aspiration of ovarian cysts appears effective and safe, however, in the course of the last twenty years it has been performed relatively rarely

Badanie echokardiograficzne płodu przed i po zabiegu aspiracji torbieli jajnika

Abstract The main criteria for establishing fetal ovarian cysts prognosis are their diameter and echogenicity. The choice of management in case of fetal ovarian cyst remains controversial. In the following article we have reported a case of a fetal ovarian cyst with detailed fetal echocardiography before and after prenatal aspiration. The fetus at 35 weeks of gestation presented with an ovarian cyst of 70mm in diameter and normal heart anatomy and size. However, detailed fetal echocardiography revealed functional abnormalities such as: monophasic inflow pattern of tricuspid valve, holosystolic tricuspid regurgitation and pericardial effusion. Two days after prenatal aspiration of the cyst, the functional abnormalities in fetal echocardiography receded. After prenatal aspiration we observed a residual cyst of 15mm in maximal diameter. The delivery was spontaneous at 36th week of pregnancy and the infant was discharged from Neonatology Dept on the sixth day of postnatal life. The cyst regressed spontaneously in the course of the next two months. This is the first report when detailed fetal echocardiography revealed hemodynamic improvement after prenatal aspiration of a fetal ovarian cyst which may mean that huge fetal ovarian cysts might complicate fetal heart function.Streszczenie W rokowaniu u płodów z torbielą jajnika brany jest pod uwagę rozmiar zmiany i jej echogeniczność. Jednak wybór postępowania w przypadku torbieli jajnika jest wciąż kontrowersyjny. Przedstawiliśmy przypadek płodu z torbielą jajnika poddaną prenatalnej aspiracji, u którego przed i po zabiegu wykonano badanie echokardiograficzne. W 35 tygodniu ciąży stwierdzono u płodu torbiel jajnika o średnicy 70mm, natomiast budowa i wielkość serca były prawidłowe. W badaniu echokardiograficznym stwierdzono zaburzenia czynnościowe pod postacią: monofazowego napływu przez zastawkę trójdzielną, niedomykalności zastawki trójdzielnej i wysięku w osierdziu. Dwa dni po prenatalnej aspiracji torbieli zmiany czynnościowe ustąpiły. W wykonanym dwa dni po zabiegu badaniu ultrasonograficznym opisano torbiel o średnicy 15mm. Pacjentka urodziła w 36 tygodniu ciąży, noworodka wypisano do domu w 6 dobie po porodzie. W ciągu następnych dwóch miesięcy torbiel uległa całkowitej regresji. Opisaliśmy po raz pierwszy przypadek, w którym w badaniach echokardiograficznych zarejestrowano poprawę stanu hemodynamicznego po prenatalnej aspiracji torbieli jajnika u płodu co może świadczyć o wpływie obecności dużej torbieli jajnika u płodu na funkcję jego serca

The course of pregnancy and delivery in a patient with malaria

Malaria is one of the most common lethal parasitic diseases. Infection is transmitted when an infected female mosquito bites a human introducing the sporozoites into human blood. The article presents the course of pregnancy and delivery in a patient complicated by Plasmodium infection. The patient had repetitive several trips to Tanzania over a short time period before she developed the condition. She had been taking antimalarial medication (proguanil-atovaquone) in a prophylactic dose during and after her first travel to Tanzania. Following her first return to Poland she experienced infection-related symptoms

Recommendations for Prenatal Echocardiography: A Report from International Prenatal Cardiology Collaboration Group.

AbstractInternational Prenatal Cardiology Collaboration Group (IPCCG) links specialists from prenatal cardiology all over the world. In this recommendation we would like to focus on the fetal/prenatal echocardiography official report. So far many recommendations focused mainly on technical aspects of the fetal heart examination

Maternal hyperoxygenation test in prediction of fetal lung hypoplasia – preliminary report

Summary Objectives: The aim of our study was to present the detailed execution and interpretation of the hyperoxygenation test in the fetus. Material and methods: This was a retrospective investigation of fetuses examined in The Department for Diagnosis and Prophylaxis of Congenital Malformations (Polish Mother’s Memorial Hospital Institute and Medical University in Lodz) between January 2006 and December 2009, in whom in addition to the routine echocardiographic examination the hyperoxygenation test was performed. Indications for such an extended evaluation were suspected fetal malformations and pulmonary hypoplasia. Changes in the fetal pulmonary circulation before and after maternal exposure to hyperoxygenated air together with the newborn follow-up were analyzed. Results: Clinical outcome was available for 42 of 52 cases: 16 patients died (including 11 cases with negative hyperoxygenation test), whereas 24 patients were discharged home (including 17 cases with positive hyperoxygenation test). The probability of survival for fetuses with the positive test was significantly higher than for fetuses with the negative one (p=0.016, Fischer’s exact test). Conclusions: Based on changes evoked in the fetal pulmonary circulation, the hyperoxygenation test seems helpful in predicting impaired fetal lung development Functional assessment of the fetal pulmonary circulation may be useful in predicting fetal lung hypoplasia and respiratory failure in the neonate

Assessment of the usefulness of ultrasound screening in fetal ovarian cysts

Abstract Objectives: The aim of the study was to assess the usefulness of ultrasound in management and prognosis in fetal ovarian cysts. Material and methods: The study included 38 fetuses with cyst in abdominal cavity, who, between 1995 and 2006, underwent an ultrasound examination in our unit at the Polish Mother’s Memorial Hospital in Lodz , The Department for Diagnosis and Prevention of Birth Defects. Results: In all 38 fetuses with cyst in abdominal cavity we have diagnosed 27 (74%) cases of ovarian cyst. In 14 (74%) fetuses cysts regressed spontaneously, including all cysts ≤40mm (n=7). In 3 cases with cysts >40mm needle aspiration has been successfully performed, without any further complications. Surgical neonatal treatment has been performed in 5 cases in prenatal cysts >40mm without prenatal aspiration. In 3 cases cysts >40mm regressed spontaneously. Ovarian cysts in 22 (81%) cases were an isolated malformation; in 5 (19%) cases other malformations were present. Conclusions: 1. Fetal ovarian cysts ≤40mm required only ultrasound assessment and, in majority of cases, revealed the tendency to spontaneous regression. 2. Cysts >40mm in maximal diameter have signaled complications more often and required surgical procedure after birth. 3. In utero, aspiration of fetal ovarian cyst >40mm may lead to cyst regression, making the surgery after birth unnecessary

Fetal echocardiography in fetal ovarian cysts

Abstract Objectives: The aim of the study was to evaluate the outcome of fetuses with ovarian cysts in relation to fetal echocardiography. Material and methods: In the Department for Diagnosis and Prophylaxis of Birth Defects at the Polish Mother's Memorial Hospital in Lodz fetal echocardiography was performed in 21 fetuses with ovarian cysts between the years 1995-2006. Outcomes: In 18 out of 21 (86%) fetuses we have found normal heart anatomy (NHA) and in 3 fetuses congenital heart defect (CHD). In 7 out of 18 (39%) fetuses with NHA there were functional anomalies, including 5 fetuses with hypertrophy. Four neonates with hypertrophy required surgical procedures after the delivery. Prenatal hypertrophy was not observed in case of only one neonate which was operated after the delivery. Conclusions: 1. Fetal echocardiography studies were very often abnormal in fetus with ovarian cysts (mainly as functional anomalies). 2. Functional anomalies detected in fetal echocardiography more often resulted in surgical procedures after the birth, whereas normal heart study was more often connected with spontaneous regression of ovarian cyst (p=0,0265)