Plasma fibronectin in pregnancy complicated by diabetes mellitus and preeclampsia

Abstract Objectives: The aim of this study was to evaluate concentration of plasma fibronectin (FN) in course of pregnancy complicated by preeclampsia accompannied by diabetes mellitus and to assess whether the concentration of FN depends on the state of carbohydrate metabolism . Material and methods: The study was carried out in 2 groups: group K – consisting of 35 healthy pregnant women without complications, and group G – consisting of 12 pregnant women, 4 with gestational diabetes mellitus and 8 with pregestational diabetes mellitus, who developed preeclampsia, in course of reaserch, after 37th week of pregnancy. Concentration of FN and Fm – in order to the state of carbohydrate metabolism – was marked in the following: before 33rd week of pregnancy, between 33rd and 37th week of pregnancy and after 37th week of pregnancy. Results: No correlation between concentration of FN and duration of pregnancy in group K was found. Average concentration of FN in the subsequent periods of the pregnancy in group K were simillar and have not shown vital, statistical differences. In group G crucial statistical increase in FN concentration along with increase of pregnancy duration was found (r=0,3860,

Umbilical cord plasma endothelin 1 and cyclic guanosine concentrations monophosphate at delivery in pregnancy complicated by diabetes mellitus

Abstract Objectives: The aim of the study was to assess the relationship between maternal and umbilical cord plasma concentrations of endothelin 1 (ET-1) and cyclic guanosine monophosphate (cGMP) in women with diabetes mellitus (DM). Material and methods: The study was performed on 19 neonates of women with pregestational DM, 23 neonates of women with gestational diabetes (GDM), and 18 neonates of healthy, uncomplicated pregnancies. Results: We found that umbilical and maternal ET-1 and cGMP concentrations in pregestational DM or GDM women were not changed in comparison with the controls. In women without DM, positive correlations between maternal (r=0.64;

Morphological estimation of incomplete uterine scar rupture (dehiscence) in post- cesarean deliveries. Immunohistochemical studies

Objectives: No studies were found that analysed the properties of the caesarean scar, therefore the new study analysedthe myometrial immunohistochemical expression of elastin, collagen type VI, alpha smooth muscle actin, smooth musclemyosin heavy chain, and endothelial cell marker CD31.The aim of the study was to determine the risk of uterine rupture in future pregnancies.Material and methods: A total of 89 women of Caucasian ethnicity were eligible: 20 healthy pregnant women, who underwentrepeat caesarean section complicated by incomplete uterine scar rupture before labour, and 69 healthy pregnantwomen, who underwent repeat caesarean section without subsequent uterine scar rupture as the control group. In all cases,uterine tissue sample from the scarred region was collected during the caesarean section operation.Results: The lack of observed significant changes of elastin, collagen type VI, alpha smooth muscle actin, smooth musclemyosin heavy chain and endothelial cell marker CD31 concentrations in ruptured and unruptured uteri indicates that thesecomponents cannot be found to be a marker of risk of uterine rupture in future pregnancies.Conclusions: It could be suggested that the examined components do not contribute to the mechanism of maintainingintegrity and are not responsible for the biomechanical properties of the uterine scar

Terapia wewnątrzmaciczna płodu z obrzękiem nieimmunologicznym oraz masywnym wysiękiem opłucnowym – analiza przypadku klinicznego

Hydrops fetalis (fetal hydrops) is a serious fetal condition defined as abnormal accumulation of fluid in two or more extravascular compartments, including ascites, pleural effusion, pericardial effusion, and skin edema. Edema is classified as immune or non-immune. Today, more than 90% of fetal edema has non-immune cause. This paper presents a case of a pregnant woman who was admitted to the Obstetrics and Gynecology Department because of fetal hydrops with massive pleural effusion and polyhydramnios at 34 weeks gestation. The intrauterine therapy consisted of two treatments. During the first surgery amnioreduction, evacuation of fluid from the pleural cavity of the fetus, and shunts to both pleural cavities were performed. During the second surgery amnioreduction, cordocentesis with albumin administration and pleural shunt were performed. Intrauterine therapy led to a reduction of swelling of the fetus from 7mm up to 1-2 mm and the total evacuation of fluid from the pleural cavity and the fetal lung expansion. We also present the condition of the neonate after birth and after 12 months of life.Obrzęk płodu jest to patologia polegająca na kumulacji płynu w dwóch lub więcej przestrzeniach zewnątrznaczyniowych płodu w postaci wodobrzusza, wysięku opłucnowego, wysięku osierdziowego oraz obrzęku tkanki podskórnej. Obrzęk jest klasyfikowany jako immunologiczny lub nieimmunologiczny. Obecnie ponad 90% przypadków obrzęku płodu ma podłoże nieimmunologiczne. Celem pracy jest przedstawienie pacjentki skierowanej do leczenia w ośrodku o trzecim stopniu referencyjności z powodu cech uogólnionego obrzęku płodu z masywnym wysiękiem opłucnowym wraz z wielowodziem. Opisywana przez nas ciężarna została przyjęta do ośrodka w 34 tygodniu ciąży. Na terapię wewnątrzmaciczną u pacjentki składały się dwa zabiegi. Podczas pierwszego zabiegu wykonano amnioredukcję, ewakuowano płyn z jam opłucnowych płodu, a następnie do obu jam założono shunty obarczające. Podczas drugiego zabiegu wykonano amnioredukcję, kordocentezę z podaniem roztworu albumin oraz ponownie założono shunt do jamy opłucnowej. Terapia wewnątrzmaciczna doprowadziła do redukcji obrzęku płodu z 7mm do 1-2 mm oraz do całkowitej ewakuacji płynu z jam opłucnowych i rozprężenia się płuc płodu. Przedstawiamy również stan noworodka po urodzeniu oraz w wieku 12 miesięcy

Perinatal factors affecting the gut microbiota — are they preventable?

Intestinal microbiota affects many aspects of physiological processes. The type of microbiota in the early stages of life isa critical element conditioning the development of the immune response and food tolerance. Disturbed colonization ofthe digestive tract resulting from the amount or diversity of bacteria colonies stimulates an inflammatory response thatis associated in later life with inflammatory and autoimmune diseases. One of the elements disturbing normal colonizationin the perinatal period is the operative way of delivery by caesarean section and the administration of antibiotics,used as a prophylactic measure as well as for therapeutic reasons. Based on the current state of knowledge, there is a lotof evidence demonstrating the long-term adverse effects of these modifying agents for gut microbiota, which should bekept to a minimum as far as possible

Wyniki przesiewowych badań prenatalnych w materiale 2285 ciąż z rejonu Pomorza Zachodniego diagnozowanych w latach 2005-2006

Summary In the following paper we have presented the results of non-invasive and invasive prenatal diagnostic tests performed on 2285 pregnant women from the Western-Pomeranian Region between 2005 and 2006. Material and methods: Retrospective analysis of screening tests on 2285 pregnant women. Medical history, including age, weight, familial data pedigrees up to third degree relatives, accompanying diseases, gestational complications in the family, type, dosage and period of any drugs intake, was obtained. Sonographic screening and evaluation of maternal serum PAPP-A and betaHCG levels. Results: Screening tests identified 4.5% high-risk pregnancies in this group. 69% of the patients consented to invasive diagnosis. As a result, genetic anomalies were detected in 43.7% of cases. Significant differences in betaHCG levels correlated with oral gestagens intake and place of residence (coastal areas). Conclusion: Broad use of certified non-invasive methods of prenatal screening allow substansial reduction of invasive procedures with high levels of positive prediction. Medical drugs intake as well as place of inhabitation may influence on free betaHCG levels.Streszczenie Cel pracy: Celem pracy było przeanalizowanie wyników nieinwazyjnych i inwazyjnych badań prenatalnych przeprowadzonych w regionie zachodniopomorskim w latach 2005-2006. Materiał i metody: Analiza retrospektywna 2285 ciąż. Wywiad z uwzględnieniem 3 pokoleniowego rodowodu, badania ultrasonograficzne I trymestru wraz z testem podwójnym. Amniopunkcje ze standardową oceną kariotypu. Wyniki: Drogą badań przesiewowych wyłoniono 4,5% ciąż podwyższonego ryzyka, z których 69% poddało się amniopunkcji. Pozwoliło to na potwierdzenie w wysokim odsetku (43,7%) nieprawidłowości genetycznych. W badanej grupie ciężarnych zaobserwowano istotne zmiany w parametrach biochemicznych betaHCG zależne od przyjmowanych leków (gestageny) oraz od miejsca zamieszkania (okolice nadmorskie). Wnioski: Powszechne zastosowanie certyfikowanych nieiwazyjnych badań prenatalnych pozwala na ograniczenie liczby przeprowadzanych amniopunkcji przy utrzymaniu wysokiego wskaźnika predykcji. Doustne przyjmowanie niektórych leków oraz miejsce zamieszkania pacjentki może wpływać na poziomy wolnej podjednostki betaHCG

IL16 and IL18 gene polymorphisms in women with gestational diabetes

Objectives: Gestational diabetes mellitus is a carbohydrate intolerance that occurs during pregnancy. Various inflammatory mediators are considered to be risk factors leading to GDM development. Among them are pro-inflammatory cytokines, such as IL16 and IL18. The aim of this study was to examine the association between IL16 and IL18 polymorphisms and GDM. Material and methods: This study included 204 pregnant women with GDM and 207 pregnant women with normal glucose tolerance (NGT). All samples were genotyped in duplicate using allelic discrimination assays with TaqMan® probes. Results: We observed that there was a decreased frequency of IL16 rs4778889 CC genotype carriers among women with GDM (CC vs. CT + TT: OR = 0.14; 95% CI = 0.02–1.15; p = 0.034). However, there was no significant difference in the distri­bution of alleles (C vs. T: OR = 0.81; 95% CI = 0.54–1.21; p = 0.30). There was a decreased frequency of the IL18 rs187238 G allele among GDM women (G vs. C: OR = 0.71; 95% CI = 0.53–0.96; p = 0.027). We also observed a decreased frequency of the IL18 rs1946518 T allele among women with GDM; however, this difference had only borderline statistical significance. We observed an association between IL18 rs187238, rs1946518 and BMI in pregnant women. Conclusions: The results of this study suggest that IL18 rs187238 and rs1946518 polymorphisms may be associated with an increased risk of GDM as well as with BMI in pregnant women

Intrapartum PCR assay is a fast and efficient screening method for Group B Streptococcus detection in pregnancy

Objectives: The aim of the study is to verify the usefulness of a real-time polymerase chain reaction versus the culture forante- and intrapartum group B Streptococcus maternal colonization (GBS) and prevalence of discordance during the periodbetween an antepartum screening and delivery.Material and methods: The study involved 106 pregnant women aged 18 to 39 years. Rectovaginal samples were collectedaccording to CDC guidelines at 35–37 weeks of gestation as well as in the first stage of labour, during physical examinationand were analyzed using two independent diagnostic methods: microbiological culture with standard culture andpolymerase chain reaction with real-time assay.Results: The discordance between antenatal and intrapartum GBS prevalence has been demonstrated as well as differencesassociated with diagnostic strategies, culture and PCR.Conclusions: Intrapartum detection of GBS colonization using culture or Real-Time PCR assay as well, regardless of antenatalscreening test for GBS, is very useful in identifying women who require implementation or withdrawal from prophylacticintrapartum antibiotic therapy. Real-Time PCR is a quick efficient method for GBS screening in pregnant women, whichcan be even applied during labor due to its short time of analyzing and high sensitivity and specificity. The above fact mayindicate the need to perform the GBS test in the intrapartum period in all pregnant GBS negative women using PCR assayas a more adequate diagnostic method as the procedure could reduce the risk of a neonatal GBS infection subsequentlyto a prophylactic antibiotic therapy in women with an intrapartum positive GBS

Krwotok poporodowy – przyczyny, profilaktyka, farmakoterapia

Krwotok poporodowy stanowi jedną z głównych przyczyn umieralności kobiet po porodzie. Najczęstszym powo- dem jego wystąpienia jest atonia macicy, resztki łożyskowe w jamie macicy, uraz tkanek narządu rodnego lub zaburzenia układu krzepnięcia. Jedną z podstawowych zasad skutecznego leczenia krwotoku jest wczesne roz- poznanie z określeniem jego przyczyny oraz wdrożenie intensywnego leczenia. Poza zabiegowym postępowaniem przyczynowym, leczenie farmakologiczne stanowi nadal istotny element terapii krwotoku, zwłaszcza w przebiegu atonii macicy. W pracy przedstawiono aktualną wiedzę dotyczącą przyczyn, czynników ryzyka, a także sposobów farmakologicznego leczenia krwotoków poporodowych, z uwzględnieniem aktualnie obowiązujących rekomendacji.

The possible role of corticosterone in regulating sodium and potassium concentrations in human milk

Objectives: The aim of the study was to find the presence of corticosterone as a regular human milk constituent. We have evaluated the correlation of concentrations between the analyzed hormone and sodium and potassium in breast milk and serum. Material and methods: Hand expressing breast milk samples and median cubital vein blood samples had been taken from 69 healthy, lactating women in early puerperium period (between the 3rd and 10th day) twice, before and after breastfeeding. Corticosterone concentrations in human plasma and breast milk were determined by radioimmunoassayed method. Direct assays were performed before and after breastfeeding, twice. The serum and milk sodium and potassium concentrations were estimated by Flame Emission analyzer CIBA-Corning 480, equipped with an automatic diluter. Results: Corticosterone was found in all milk samples, which is an original observation, and its concentration in milk was a few times lower than in serum. Its concentration values in human serum when were not higher than 3 nmol/L (n  = 108) positively correlated with its concentrations in milk, and those exceeding 3 nmol/L (n  = 30) have demonstrated a negative correlation. An original finding has shown a positive correlation between concentrations of corticosterone in human serum and of potassium in human milk (r  = 0.018, p < 0.03). An attempt was also made to determine the presence of aldosterone in breast milk, but the radioimmunoassay did not reveal its presence. Conclusions: The results confirm a relation between potassium concentration in milk and serum corticosterone concentration delivered to mammal gland with blood