Congenital diaphragmatic hernia: pathogenesis, prenatal diagnosis and management — literature review

Congenital diaphragmatic hernia (CDH) is a developmental discontinuity of the diaphragm. It allows abdominal viscera to herniate into the chest and leads to lung hypoplasia. Congenital diaphragmatic hernia is one of the most severe birth defects, with extremely high neonatal mortality. This paper presents a review of the available literature on prenatal diagnosis, management and treatment options for CDH. In selected cases, a prenatal procedure to improve neonatal survival is possible. The authors of this manuscript believe their work might contribute to a better understanding of congenital diaphragmatic hernia and patient selection for the FETO (fetal endoscopic tracheal occlusion) surgery or expectant management

How to identify pregnant women at risk of pre-eclampsia? — a review of the current literature

Pre-eclampsia remains a major cause of poor perinatal outcome worldwide. As administering acetylsalicylic acid in a high risk population reduces the risk of PE, it is essential to identify women at risk of PE. Several algorithms for PE risk assessment have been developed. They include maternal factors combined with uterine artery pulsatility index, mean arterial pressure, serum pregnancy-associated plasma protein-A, placental growth factor, and serum soluble fms-like tyrosine kinase-1. Beside PE prophylaxis with acetylsalicylic acid, a proper management of women considered at a high risk of PE is essential. The sFlt-1:PlGF ratio between 20 and 34 + 6 weeks may be used to predict a short-term absence of PE or to predict the risk of PE diagnosis within 4 weeks and a significant shortening of the duration of pregnancy associated with it. The sFlt-1:PlGF ratio may be helpful in deciding about hospitalization or choosing the optimal time for corticosteroid administration in women at risk of PE. It may also help to reduce overall healthcare costs

Diaphragmatic hernia as an early ultrasound manifestation of Apert syndrome

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Assessment of the usefulness of pipelle biopsy in gynecological diagnostics

Objectives: The aim of this study is to assess the effectiveness of pipelle in sampling diagnostic material from the uterine cavity and determining clinical factors, which may affect its effectiveness. Material and methods: The retrospective analysis included 312 patients who underwent pipelle biopsy because of various indications. Evaluated factors which may affect the effectiveness of this method were: types of indications for the procedure, age, BMI, anteflexion or retroflexion of the uterus, presence of uterine fibroids, miscarriages, natural deliveries, deliveries in general. Results: In 259 (83.01%) cases sampled material allowed for a histopathological diagnosis. In 53 (16.99%) of the women we failed to sample tissue material from the uterine cavity. Indications for the procedure, BMI, age and menopausal status were factors of potential impact on the diagnostic effectiveness (p < 0.05). The diagnostic value of pipelle was found to be the lowest in women with overweight and obesity (BMI > 28), post-menopausal women, women over 55 years of age and where biopsy was performed for indications other than abnormal uterine bleeding. On the other hand, pipelle shows clearly the highest effectiveness in sampling diagnostic material from the uterine cavity in young women (< 45 years of age), menstruating women, women with normal body weight or underweight (BMI < 23) and abnormal uterine bleeding. Conclusions: Choosing a pipelle as an endometrial biopsy method should consider the indications, BMI, age and menopausal status. Omission of these factors can increase non-diagnostic outcomes resulting in necessity of repeated biopsies, the risk of complications and increases the costs of health care system

Three-dimensional neurosonography — a novel field in fetal medicine

Neurosonography is a promising technique for prenatal diagnosis, combining features of ultrasound imaging with fetal neurology. The brain is a three-dimensional structure, therefore observing brain structure in the three basic planes (sagittal, coronal and axial) is mandatory. The anterior fontanelle and sagittal suture may serve as acoustic ultrasound windows in the transvaginal brain scan, allowing to obtain high-resolution neuroimages of the intracranial structures. Furthermore, three-dimensional (3D) ultrasound combined with the transvaginal brain approach provides detailed and sophisticated neuroimages. Three orthogonal planes of the brain, tomographic ultrasound imaging (TUI) and other off-line approaches (e.g. volume contrast imaging (VCI) or HDlive silhouette imaging) may be obtained from a single 3D dataset. 3D Doppler ultrasound enables visualization of the intracerebral vascularity, allowing to obtain more precise information on cerebral perfusion. Various abnormal brain conditions, including ventriculomegaly, agenesis of the corpus callosum, posterior fossa abnormalities and others, can be well-demonstrated. Due to high rates of the associated anomalies and uncertain prognosis, any suspicion of CNS abnormalities shall imply detailed ultrasonographic evaluation of the fetal anatomy to exclude the associated anomalies. Despite a growing number of neuroimaging modalities, prenatal counselling remains a challenge as prediction of brain functionality and the neurological prognosis often remain uncertain. New investigations on the relations between various migration disorders and gene mutations, as well as recent clinical research on the relations between neuroimaging detection of local migration disorders using sophisticated imaging technologies and the postnatal neurological prognosis will contribute to the development of maternal-fetal medicine as well as pediatric neurology

Ocena przydatności ultrasonografii do oceny przebiegu porodu

Objective: To evaluate the practical application of intrapartum sonographic assessment of the progress of labor. Material and methods: Eighty three full-term pregnant women who delivered at the Obstetrics and Gynecology Department were enrolled into this study. Transperineal ultrasonographic examinations were conducted with a convex transducer at the onset of active labor, yielding mid-sagittal and coronal images. Three parameters were measured: 1) the angle between the long axis of the symphysis pubis and the line joining its lowest margin to the contour of the fetal head (angle of progression); 2) the distance between the presenting point and the line perpendicular to the symphysis pubis and passing through its lowest margin; 3) the fetal head-perineum distance. The relationship between measurement results and the period from examination to delivery was also analyzed. Results: There were 73 vaginal deliveries and 10 women underwent a cesarean section due to failure to progress. The two groups (vaginal vs. cesarean delivery) differed significantly in terms of the angle of progression (131 vs. 110 degrees, respectively, pCel pracy: Ocena przydatności zastosowania ultrasonografii śródporodowej do oceny postępu porodu. Materiał, metody: Do badania losowo włączono 83 pacjentki w ciąży donoszonej, które rodziły w I Klinice Położnictwa i Ginekologii. Przy pomocy sondy convex wykonywano badanie ultrasonograficzne przez wargi sromowe na początku II okresu porodu, uzyskując przekroje w płaszczyźnie strzałkowej oraz czołowej. Obliczano 3 parametry: 1) kąt między spojeniem łonowym, a linią styczną do główki płodu, przechodzącą przez dolny brzeg spojenia łonowego (tzw. kąt progresji) 2) odległość między punktem prowadzącym, a linią prostopadłą do spojenia łonowego, przechodzącą przez jego dolny brzeg, 3) odległość między główką płodu, a skórą sromu rodzącej. Przeanalizowano także związek pomiędzy uzyskanymi wynikami, a czasem jaki upłynął między badaniem USG i urodzeniem dziecka. Wyniki: Drogami i siłami natury urodziły 73 pacjentki (88 %). Z powodu braku postępu porodu w II okresie, cięcie cesarskie wykonano u 10 rodzących (12 %). Wykazano istotne różnice pomiędzy tymi grupami (poród fizjologiczny oraz poród operacyjny) w wartościach kąta progresji (odpowiednio 131 i 110 stopni,

Metody oceny postępu porodu we współczesnym położnictwie

Assessment of progress in labor is one of the foremost problems in obstetrics. Obstructed labor increases danger to maternal and fetal life and health, and may be caused by birth canal pathologies, as well as inefficient uterine contractions or failure of cervical dilation. Such obstructions require the use of vacuum extraction, forceps, or a Caesarean section. Operative delivery should be performed only when specifically indicated. Conversely, postponing an operative delivery when the procedure is necessary is detrimental to the neonatal outcome. Therefore, it is advisable to make the decision on the basis of objective, measurable parameters. Methods of evaluating the risk of labor disorders have evolved over the years. Currently, ultrasonography is used for fetal biometric measurements and weight estimation. It helps to evaluate the risk of labor disorders. This method, however, is limited by a relatively large measurement error. At present, vaginal examination is still the primary method of evaluating labor progress, although the technique is known to be operator-dependent and poorly reproducible. Recent publications suggest that intrapartum translabial ultrasonography is more accurate and allows for an objective assessment of labor progress. Recent studies have evaluated fetal head engagement based on the following parameters: angle between the pubic symphysis and fetal head, distance between the presenting point and the interspinous line and fetal head direction in the birth canal. Each of the described parameters allowed for an objective assessment of head engagement but no advantage of any particular parameter has been revealed so far.Poród jest procesem dynamicznym, a zahamowanie jego postępu stanowi ryzyko dla życia i zdrowia rodzącej oraz płodu. Nieprawidłowości anatomiczne kanału rodnego i niewspółmierność główkowo-miednicowa, mogą zaburzyć mechanizm porodowy, podobnie jak niewykształcenie się prawidłowej czynności skurczowej lub brak rozwierania szyjki macicy. Jeśli wystąpią zaburzenia w przebiegu porodu, konieczne jest zastosowanie próżniociągu, kleszczy lub wykonanie cięcia cesarskiego. Brak postępu porodu jest jednym z najczęstszych wskazań do wykonania cięcia cesarskiego. Decyzji o wykonaniu cięcia cesarskiego nie należy podejmować pochopnie. Z drugiej strony, odwlekanie decyzji wtedy, kiedy jest to konieczne, pogarsza rokowanie dla dziecka. Dlatego idealna byłaby sytuacja, gdyby postęp porodu dało się ocenić w oparciu o obiektywne, dające się zmierzyć parametry. Sposoby oceny ryzyka zaburzeń mechanizmu porodowego ewoluowały na przestrzeni lat. Rozwój technik obrazowych w XX wieku spowodował, że zainteresowano się ich wykorzystaniem w diagnostyce niewspółmierności porodowej. Obecnie wykonuje się przedporodowe USG z oceną biometrii płodu i jego masy. Pozwala to oszacować ryzyko wystąpienia nieprawidłowości w przebiegu porodu, aczkolwiek ta metoda jest obarczona stosunkowo dużym błędem pomiaru. Badanie wewnętrzne rodzącej wciąż pozostaje podstawową metodą oceny porodu. Jednak, ze względu na subiektywizm, jest ona również obarczona pewnym błędem. W ostatnich latach ukazały się publikacje sugerujące, że w obiektywnej ocenie postępu porodu pomocne może być śródporodowe USG. Oceniano zaawansowanie główki w kanale rodnym na podstawie analizy: kąta zawartego między spojeniem łonowym a główką płodu, odległości punktu prowadzącego od linii międzykolcowej oraz kierunku osi główki w kanale rodnym. Każdy z opisanych parametrów pozwalał na obiektywną ocenę zaawansowania główki ale nie wykazano jednoznacznie przewagi żadnego z nich

Is fetus able to feel pain?

Abstract On the basis of fetal hormonal and hemodynamic responses to pain related stimuli, neuroanatomy and observations of preterm babies, it was concluded that human fetus is able to feel pain after 24 weeks gestation. However, it is possible that the fetus may feel pain even before that time. With the development of intrauterine diagnostic and therapeutic procedures, it is crucial to provide fetuses undergoing painful procedures not only with anesthesia but also analgesia. The article presents fetal pain research history and its implications for medicine