Leczenie zachowawcze ciąży ektopowej

Ciąża ektopowa stanowi jedną z najczęstszych przyczyn śmiertelności matek w I trymestrze ciąży. Jest definiowanajako stan, w którym pęcherzyk ciążowy implantuje się poza jamą macicy i stanowi 1–2% wszystkich ciąż. Charakterystyczne objawy w postaci opóźnionego krwawienia miesięcznego, nieprawidłowych krwawień z narządówpłciowych i bólu brzucha rzadko występują jednocześnie, zwłaszcza na wczesnych etapach ciąży.Znajomość czynników ryzyka oraz wykorzystanie ultrasonografii i seryjnych oznaczeń stężeń gonadotropiny kosmówkowej pozwalają na ustalenie rozpoznania, zanim pojawią się niepokojące symptomy, a tym samym w części przypadków uniknąć leczenia operacyjnego.Leczenie zachowawcze ciąży ektopowej polegające na zastosowaniu metotreksatu wymaga starannej kwalifikacjipacjentek, niemniej jednak wiąże się z krótszym czasem hospitalizacji i znaczną redukcją kosztów leczenia. Celempracy było przedstawienie aktualnego piśmiennictwa w aspekcie skuteczności zachowawczego leczenia ciążyektopowej i odpowiedniej kwalifikacji pacjentek do terapii

The course of pregnancy and delivery and the state of the newborns after genetic amniocentesis

Objectives: The risk of fetal loss after amniocentesis is 0,2-1%. The aim of the study was to compare the course of pregnancy and delivery and the state of the newborn in patients after genetic amniocentesis and in the control group. Material and methods: 783 patients who underwent amniocentesis at the Department of Obstetrics of Medical University of Gdansk in 1996-2003 and 221 women who did not undergo amniocentesis. Results: Fetal loss occurred in 8 pregnancies (3,8%) after amniocentesis and in 12 (5,4%) p=0,37 in the control group. There was no significant statistical difference between the amniocentesis group and the control group comparing complications during pregnancy such as gestational diabetes mellitus, pregnancy induced hypertension, urinary tract infections. Cesarean section was more often performed in the amniocentesis group than in the control group, statistical difference p=0,003. Most often (28,09%) there was an elective cesarean section because of advanced maternal age without any obstetrician cause. The frequency of pneumonia, respiratory infections and congenital malformations in the first weeks of life was more frequent in the amniocetesis group. Conclusions: Invasive prenatal diagnosis has no influence of the frequency of complications during pregnancy and delivery

The course of pregnancy and delivery in women after genetic amniocentesis before and after 35 years of age

Objectives: The demand for genetic amniocentesis in case of young pregnant women has significantly increased due to various new indications. Moreover, nowadays a growing number of women aged ≥35, who required genetic amniocentesis, get pregnant. The aim of the following study has been to compare the course of the pregnancy, the delivery and the condition of the newborn in two groups of patients: 18-34 years old and ≥35 years old. Material and methods: 783 women underwent the procedure of amniocentesis at the Department of Obstetrics of Medical University of Gdansk in 1996-2003. A group of 540 women, who answered the questionnaire about the course of the pregnancy and the delivery after the procedure, has been isolated. Results: Fetal loss occurred in 2 cases (1.6%) in the group of the younger women and in 8 cases (0.8%) in the group of ≥35 year-olds (p=0.84). There was no statistically significant difference between younger and older patients when comparing complications after the procedure in the first three weeks following amniocentesis: spotting, bleeding, leakage of amniotic fluid. Frequency of late complications such as gestational diabetes mellitus, pregnancy induced hypertension and urinary tract infections were comparable in both age groups women. Cesarean section has been more frequently performed in case of the older women than in the group of younger patients, with statistical difference p=0.003. In most cases (33.9%) it has been an elective cesarean section, performed due to advanced maternal age rather than any obstetric cause. Frequency of pneumonia and the number of respiratory infections in the newborns have been comparable in both groups. Conclusions: Prenatal invasive diagnosis has no influence on frequency of complications during pregnancy and delivery in the group of women less than 35 years old and more than 35 years old

Early or late amniocentesis – which method is safer?

Objectives: Whether or not to perform early or late amniocentesis remains questionable due to higher fetal loss and the rate of talipes equinovarus after early amniocentesis. Material and methods: We have compared the course of pregnancy, delivery and the condition of the newborns in patients after early and late amniocentesis in the group of women who had undergone amniocentesis in the Department of Obstetrics of Medical University of Gdansk between the years 1996-2003. Results: Early amniocentesis was performed in 302 patients (55,9%), late amniocentesis in 302 patients (44,1%). Fetal loss occurred in 8 pregnancies (2,6%) after early amniocentesis and in 2 cases (0,8%) after late amniocentesis (P=0,10). There was no statistically significant difference between early and late amniocentesis, comparing complications following the procedure in the first 3 weeks after amniocentesis: lower abdominal pain, spotting, bleeding, leakage of amniotic fluid. Mean duration of pregnancy in patients after early amniocentesis was 38,5}3,9 and 38,4}3,3 weeks in late amniocentesis group. There was no statistically significant difference between these groups in the type of delivery and premature delivery rate. Frequency of pneumonia and the respiratory infections in newborns were comparable in two groups (6,8% vs 4,8%). There was only one case of talipes equnovarus in a fetus after late amniocentesis and one case of congenital dysplasia of the hip in a fetus after late amniocentesis, too. There were not any such defects in a group after early amniocentesis. Conclusions: The type of amniocentesis - early or late - has not got any influence on the frequency of complicartions after amniocentesis

Case report: lipoprotein apheresis reduces the risk of cardiovascular events and prolongs pregnancy in a woman with severely elevated lipoprotein(a), cardiovascular disease, and a high risk of preeclampsia

BackgroundPreeclampsia is a common and serious pregnancy-induced disease, with potential severe maternal and fetal complications. Recently, an increased lipoprotein (a) (Lp[a]) concentration, an important factor in cardiovascular diseases (CVDs) pathogenesis, has been identified as a sensitive and specific marker of preeclampsia severity. Although lipoprotein apheresis (LA) is currently used in patients with hyperlipoproteinemia(a) and CVD, real-life data on its efficacy among pregnant women with an increased risk of preeclampsia are limited.Case presentationWe present the case of a pregnant woman with severely elevated Lp(a), two previous episodes of the acute coronary syndrome and multivessel coronary disease treated with long-term LA before pregnancy, and a high risk of preeclampsia (as assessed using combined test screening). An increased pulsatility index and early diastolic notch were observed on Doppler interrogation at 18 weeks’ gestation. Biweekly LA therapy was re-initiated at 21 weeks’ gestation. The LA safely removed 70% of the serum Lp(a) concentration and reduced low-density lipoprotein-cholesterol (LDL-C) levels by 60%. We also observed an improvement in her urine protein/creatinine ratio, a reduction in the pulsatility index, and a notch on Doppler interrogation. The pregnancy lasted until week 36, when severe preeclampsia prompted an emergency cesarean delivery.ConclusionPregnancy in women with elevated Lp(a), CVD, and a high risk of preeclampsia can present challenges in clinical management. Our case report indicates the benefits of LA in preventing atherosclerotic CVD progression during pregnancy, its potential influence on uteroplacental circulation, and prolongation of pregnancy for the best possible intrauterine fetus development. LA may be considered as a treatment option during pregnancy in such conditions. In addition, in pregnant women with CVD, we suggest screening using a combined test and measurement of Lp(a) as a marker of preeclampsia severity

Multiple multiparity is a negative prognostic factor for endometrial cancer in Poland

Cel: Nierództwo jest jednym z najważniejszych czynników ryzyka rozwoju raka błony śluzowej trzonu macicy. Wciąż trwają rozważania, czy wielorództwo implikuje bardziej korzystny przebieg choroby i wyższe współczynniki całkowitego przeżycia chorych. Celem pracy jest ocena wpływu rodności na całkowite przeżycie kobiet w Polsce z rakiem błony śluzowej trzonu macicy. Materiał i metody: Retrospektywna analiza wpływu rodności na współczynniki przeżycia została przeprowadzona u 810 kobiet leczonych operacyjnie z powodu raka błony śluzowej trzonu macicy w ośrodku referencyjnym ginekologii onkologicznej. Wyniki: Wykazano, że wyższa rodność jest związana z istotnie niższym współczynnikiem całkowitego przeżycia chorych (p=0.03). Rodność okazała się być niezależnym czynnikiem przeżycia chorych (HR 1.9). Wielokrotne wieloródki były starsze w chwili zabiegu operacyjnego, stwierdzano u nich częściej głębokie naciekanie mięśniówki macicy i częściej naciek podścieliska szyjki macicy oraz wyższe stopnie zaawansowania nowotworu (wyłącznie w klasyfikacji FIGO z 1988 roku). Grupa wielokrotnych wieloródek charakteryzowała się znacząco niższym współczynnikiem nawrotów choroby. Kobiety te statystycznie częściej cechowało posiadanie niższego wykształcenia, częściej również stwierdzano u nich obecność chorób towarzyszących w tym również występowanie innych nowotworów złośliwych. W grupie tej jednakże rzadziej występowały nowotwór piersi i jelita grubego niż u pozostałych kobiet. Wnioski: Wielorództwo okazuje się być niekorzystnym czynnikiem prognostycznym przeżycia u Polek. Niekorzystne rokowanie w raku błony śluzowej trzonu macicy w tej grupie jest mniej związane z nierództwem a zdecydowanie bardziej związane z interakcją niekorzystnych czynników ryzyka i negatywnych czynników prognostycznych, które tworzą sprzyjające okoliczności i środowisko dla wzrostu nowotworu.  Background: Nulliparity is one of the most important reproductive risk factors for endometrial cancer. It is still discussed whether multiparity implies a more favorable course of the disease and higher overall survival rates. The aim of the study was to analyze the effect of parity on the overall survival of endometrial cancer patients in Poland. Material and method: A retrospective analysis of parity on survival rates was performed in 810 women treated surgically for endometrial cancer in a single referential center of gynecological oncology. Results: Higher parity was shown to be associated with significantly lower survival rates (p=0.03). Parity turned out to be an independent prognostic factor of survival (HR 1.9). Multiple multiparous women were older at the time of surgery, more often presented with deep myometrial infiltration and with involvement of the cervical stroma and had higher clinical stages of the cancer (only according to FIGO 1988 classification). The group of multiple multiparous women was characterized by significantly lower recurrence rates. Multiple multiparous women significantly more often presented with lower educational level, more often were diagnosed with comorbidities and a history of other malignancies, while breast cancer and colon cancer were of lesser evidence in multiple multiparous endometrial cancer patients. Conclusion: Multiparity turns out to be an unfavorable prognostic factor of survival in Polish women. Unfavorable prognosis in endometrial cancer patients in this group is associated with interactions between risk factors and negative prognostic factors, i.e. the conditions of tumor growth, rather than with the nulliparity itself.

THE SPATIAL DIMENSION OF NEIGHBOURHOOD LIVEABILITY. A COMBINED PERSPECTIVE OF LOCAL CUSTOMERS AND SERVICES PROVIDERS

Neighbourhood liveability is a concept reflecting the perceived living conditions in a housingarea. Liveability depends, on the one hand, on the relationship between the demand and the supply on thelocal services market, and – on the other hand – on the spatial structure of the neighbourhood. In this paper,we combine those two aspects by asking the question: What physical forms are the most effective in providing quality of life and satisfying the everyday needs of citizens? We present the results of a social survey and mapping analysis conducted in 5 neighbourhoods in Poland representing big cities, medium-sized towns and suburbs. Each case study included opinions of both customers and services providers. The results show that there are particular spatial structures (streets, squares, passages) positively evaluated by each of the two groups, determining the neighbourhood liveability.Żywotność osiedla (neighbourhood liveability) to pojęcie określające warunki życia w obszarach mieszkaniowych. Żywotność zależy z jednej strony od relacji między popytem i podażą na lokalnym rynku usług, a z drugiej od struktury przestrzennej osiedla. W prezentowanym artykule łączymy te dwa aspekty zadając pytanie o to, jakie formy przestrzenne są najbardziej efektywne w zapewnianiu jakości życia i zaspokajaniu potrzeb mieszkańców. Przedstawiamy tu badania społeczne i analizy przestrzenne przeprowadzone w 5 osiedlach reprezentujących różne konteksty osadnicze w Polsce. Każdy przypadek uwzględniał opinie klientów i usługodawców. Wyniki badań pozwalają na wskazanie elementów struktury funkcjonalno-przestrzennej (ulic, placów, pasaży, skwerów etc.) ocenianych pozytywnie przez obie grupy, a tym samym sprzyjających żywotności wybranych osiedli