Fetal macrosomia--an obstetrician's nightmare?

OBJECTIVES

Fetal macrosomia is defined as a fetus that is of large size for gestational age, i.e. equal to or greater than the 90th percentile of weight. There is some evidence of increased perinatal mortality and morbidity rates in cases of macrosomia.

DESIGN

This is a retrospective study of patients with term pregnancy. We analyzed the deliveries of 508 infants born with birth weight ≥ 4 200 grams and considered them as a study group. The deliveries of newborns with birth weight less than 4 000 g constituted the control group (330 cases). Maternal and neonatal medical records were retrospectively reviewed for clinical data.

SETTING

The study was conducted in Second Department of Obstetrics and Gynecology Warsaw Medical University from January 2004 to December 2007.

RESULTS

Maternal age, parity, BMI and pregnancy weight gain were positively related to fetal macrosomia. Prolonged first stage of labor, cesarean section rate and increased blood loss were observed more frequent in macrososmia. There were no differences between both groups according to Apgar score and neonatal birth trauma. Macrosomia was observed more frequent in male fetuses. Our data showed that careful qualification to way of delivery let us achieve the same good outcome in macrosomia.

CONCLUSIONS

Older obese multiparas are at increased risk of having macrosomic baby. The increased incidence of cesarean section in these women is due to cephalo-pelvic disproportion or obstructed labor. Macrosomia is more often in male fetuses.

System for objective assessment of fetal activity

Fetal activity is an important indicator of fetal well-being. It is proposed to assess this activity using the pulsed wave Doppler method to collect fetal activity data and dedicated software for on-line processing. The system, addressed to 3rd trimester pregnancies, provides information on presence of pseudobreathing, the heart rate trace, the fetal movement trace, the movement velocity spectrogram, histograms of the velocity and acceleration of both the body movements and pseudobreathing, parameters of these histograms (mean values, standard deviations, shape descriptors), and cumulative counts of the velocity histograms. These parameters form the feature vector of the fetal activity. The system was validated by simultaneous echographic and cardiotocographic recordings and during oxytocin challenge tests. Feature vectors obtained from 1h recordings in 61 pregnancies were submitted to multivariate analysis of variance. Activity patterns of physiological cases and "borderline pathologies" were discriminated using reduced feature vectors, containing cumulative counts of velocity histograms.

[Cardiotocography in fetal heart arrhythmia--analysis of cases]

Cardiotocography (CTG) is routinely used in obstetric units to monitor fetal well-being during pregnancy and labor Nevertheless the use of CTG is limited in cases of fetal arrhythmia, because it truncates the FHR if faster than 210 bpm and slower than 50 bpm. In fetal arrhythmias, with the heart rate between 50 bpm and 210 bpm, CTG may be nonconclusive, difficult to interpret and should not be taken into consideration when making the decision to end the pregnancy especially when it is premature. Until now the usefulness of CTG in the fetal arrhythmia has not been sufficiently described. The following study evaluates typical cases of fetal arrhythmia diagnosed by fetal echocardiography with corresponding cardiotocography and reviews the decision that had been made in each case.

The first case report of sulfonylurea use in a woman with permanent neonatal diabetes mellitus due to KCNJ11 mutation during a high-risk pregnancy

Sulfonylureas (SUs) were proven to be more effective than insulin in most Kir6.2 permanent neonatal diabetes mellitus (PNDM) patients. We report SU use during pregnancy in PNDM. A woman with the R201H Kir6.2 mutation became pregnant at the age of 37. The patient had been on glipizide 30 mg for 3 yr; her glycosylated hemoglobin level was 5.8%. She was diagnosed with chronic diabetes complications and a congenital defect of the urogenitary tract-a bicornuate uterus with septum. Because the effect of SU on fetal development is uncertain, she was switched to insulin after the pregnancy diagnosis; however, the subsequent glycemic control was unsatisfactory, with episodes of hyper- and hypoglycemia. Thus, in the second trimester, the patient was transferred to SU (glibenclamide, 40 mg), which resulted in stabilization of glycemic control; glycosylated hemoglobin in the third trimester was 5.8%. Prenatal genetic testing excluded the Kir6.2 R201H mutation in the fetus. A preterm cesarean delivery was carried out in the 35th week. The Apgar score of the newborn boy (weight, 3010 g; 75th percentile) was 8 at 1 min. He presented with hypoglycemia, transient tachypnea of the newborn, and hyperbilirubinemia. The recovery was uneventful. No birth defects were recorded. His development at the ninth month of life was normal. In summary, we show a high-risk pregnancy in long-term PNDM that despite perinatal complications ended with the birth of a healthy child. SUs, which seem to constitute an alternative to insulin during pregnancy in Kir6.2-related PNDM, were used during the conception period and most of the second and third trimesters.

[Extrauterine mislocated IUD]

Intrauterine contraceptive device (IUD) is a safe and effective method of contraception, widely used all over the world. The most common IUD complications include heavy bleeding, painful cramps, expulsion, complete or partial uterine perforation, infertility caused by pelvic inflammatory disease (PID), and an increased risk for septic and spontaneous abortion in cases of pregnancy with an IUD in situ. A potentially serious complication is the perforation of the uterus, with reported incidence of 0.5-1/1000 insertions. After perforation, devices have been found in various locations in the pelvis and abdomen. Between 2000 and 2008 there were five cases with mislocated intrauterine devices in our clinic. All patients were operated by laparoscopy and there was one conversion into laparotomy. Three patients were breast-feeding at the time. An average time between insertion and recognizing expulsion was 19.2 months. Missing strings during gynaecologic examination are the first sign of an expulsion. Transvaginal sonography combined with abdominal X-ray, is necessary to reach a definitive diagnosis. Laparoscopic treatment may be appropriate in most cases. IUD is a safe and effective method of contraceptive but its insertion may be connected with serious complications.

Successful perinatal outcome in an early onset intrahepatic cholestasis of pregnancy with extremely high serum hepatic function tests

We report a case of a 21-year-old pregnant woman with an early onset of intrahepatic cholestasis of pregnancy with very high aminotransferases activity and bilirubin concentration. Viral and autoimmune hepatitis, and other possible causes of liver function impairment were excluded. Treatment with ursodeoxycholic acid improved biochemical markers. The patient delivered a healthy female neonate by caesarean section. Neonatal and postoperative courses were uneventful.

Automatic detection of ultrasonic Doppler signal episodes resulting from fetal breathing movements

A method for automatic detection of fetal breathing movements has been proposed, based on the time-frequency structure of the corresponding continuous wave ultrasonic Doppler signals. The method uses spectral analysis of the envelope of the directional Doppler signal and cross-correlation analysis of both directional envelopes. Detection rule comprises the following criteria: presence of the peak in the envelope spectrum and of the adequate signal level in the frequency range corresponding to the fetal breathing rhythm, the peak value and the position limits of the peak of the cross-correlation coefficient of the both directional envelopes. The effect of the criteria setting on the rule performance and the tradeoff between the specificity and sensitivity was investigated. The rule is most sensitive to the threshold value of the cross-correlation coefficient of the envelopes. The limits of the position of this peak are crucial for the distinction between the breathing episodes and hiccups. The optimal settings of the criteria, resulting in average sensitivity and specificity exceeding, respectively, 0.70 and 0.80, are proposed.

[The possibility of evaluation of the myocardial performance index in fetuses at 11,0 to 13,6 week of gestation]

OBJECTIVES

To assess myocardial performance index (Tei index) for left and right ventricle in fetuses at 11.0 to 13.6 week of gestation.

MATERIAL AND METHODS

Flow velocity waveforms of mitral, tricuspid, aortic and pulmonary valves were obtained. The Tei index for the left ventricle (Tei LV) was calculated in 55, and for the right ventricle (Tei RV) in 27 fetuses.

RESULTS

The value of Tei LV ranged from 0.28 to 0.59, mean 0.41 +/- 0.08, and for Tei RV from 0.23 to 0.56, mean 0.37 +/- 0.11. There was no statistically important correlation either between Tei index and both ventricles or gestational age and fetal heart rate. The possibility to measure Tei index increased with the progress of the pregnancy. There remains a significant correlation between Tei LV and Tei RV values.

CONCLUSIONS

Tei index may be useful for the assessment of fetal myocardial performance in the first trimester of pregnancy. Tei index is independent of gestational age and fetal heart rate. It is easier to measure the Tei index for the left ventricle than for the right one.

Uteroplacental circulation in early pregnancy complicated by threatened abortion supplemented with vaginal micronized progesterone or oral dydrogesterone

OBJECTIVE

To compare the influence of vaginal micronized progesterone and oral dydrogesterone supplementation on uteroplacental circulation in early pregnancy that is complicated by threatened abortion.

DESIGN

Randomized, parallel group, double-blind, double dummy-controlled study.

SETTING

Tertiary care university hospital.

PATIENT(S)

Fifty-three patients with threatened abortion and a living embryo.

INTERVENTION(S)

Three hundred milligrams of micronized vaginal progesterone or 30 mg of oral dydrogesterone daily supplementation for 6 weeks, serial transvaginal Doppler ultrasound measurement of pulsatility index, resistance index, and systolic/diastolic ratio of the spiral arteries, the uterine arteries, and the intrachorionic area.

MAIN OUTCOME MEASURE(S)

Uteroplacental blood flow.

RESULT(S)

The study demonstrated that vaginal progesterone administration, but not oral dydrogesterone treatment, results in the decrease in the spiral artery pulsatility and resistance index and systolic/diastolic ratio. Insignificant decrease in pulsatility index and resistance index of the uterine artery was observed at >9 weeks and was not associated with treatment regimen. Dydrogesterone treatment was only accompanied by the decrease in the uterine artery systolic/diastolic ratio.

CONCLUSION(S)

Vaginal progesterone and oral dydrogesterone supplementation have a different influence on the uteroplacental circulation in early pregnancy that is complicated by threatened abortion.

[Epidural analgesia and the course of delivery in term primiparas]

OBJECTIVES

Epidural analgesia provides the most effective pain control during labor. Of great concern is its influence on the course of delivery and perinatal complications.

DESIGN

The aim of the study was to assess the effect of epidural analgesia on the course of delivery and perinatal outcome.

MATERIALS AND METHODS

609 deliveries among 1334 (323 women with epidural analgesia (53%) and 548 without epidural analgesia (47%)) met the following criteria: primipara, singleton, live pregnancy, > =37 weeks' gestation, cephalic presentation of a fetus, lack of contraindication for vaginal delivery. The incidence of instrumental deliveries and fetal distress, duration of the first, second and third stage of labor, perinatal outcome, perinatal complications and perinatal blood loss and were analyzed.

RESULTS

The incidence of fetal distress during second stage of labor was significantly higher in the epidural group (12.69 vs. 6.99%, P=0.02). The incidence of fetal distress during first stage of labor did not differ in both groups (10.53% vs. 8.74%, NS). Cesarean sections rate was similar in epidural and non-epidural group (17.7 vs. 18.2%, NS). Among vaginal deliveries duration of the first and second stage of labor was longer in epidural group (6.5+/-2.4 vs. 5.4+/-2.5 godz., P=0,000003 and 47.3+/-34.8 vs. 29.1+/-25.8 min., P=0.000003) and this was independent of period of time between onset of first stage of labor and epidural analgesia. Oxitocin use was significantly more frequent in the epidural group (20.6 vs. 10.3%, P<0.004). There were no statistically significant differences in the rates of instrumental vaginal deliveries, 1 and 5-minute Apgar scores, length of third stage of labor and perinatal blood loss in patients with and without epidural analgesia. Perinatal outcome did not depend on previous use of epidural analgesia or mode of analgesia for the operation in cesarean section subgroup.

CONCLUSION

Epidural labor analgesia is associated with slower progress of labor but has no adverse effect on perinatal outcome and perinatal complications.

Alpha-hydroxybutyrate dehydrogenase activity in intrahepatic cholestasis of pregnancy

OBJECTIVES

Intrahepatic cholestasis of pregnancy (ICP) is associated with increased perinatal mortality and morbidity. Alpha-hydroxybutyrate dehydrogenase (alpha-HBDH) is an enzyme that originates in the cytoplasm of hepatocytes and can be detected in the serum. The aim of this study was to determine the characteristics of alpha-HBDH activity in ICP.

METHODS

The study included 100 women in their third trimester of pregnancy, 58 of whom had ICP (the study group) and 42 were healthy (the control group); another group, 26 nonpregnant women, was also analyzed to follow changes in alpha-HBDH activity during pregnancy. The concentrations or activity of fractionated bilirubin; bile acids; total alkaline phosphatase; alanine and aspartate aminotransferases; total high-density and low-density lipoprotein cholesterol; triglycerides; total protein; and alpha-HBDH were assessed.

RESULTS

The activity of serum alpha-HBDH is increased during the third trimester of pregnancies complicated by ICP, and it correlates positively with total and direct bilirubin concentration and total alkaline phosphatase activity.

CONCLUSIONS

Alpha-hydroxybutyrate dehydrogenase serum activity seems to be another biochemical parameter useful in the assessment of ICP severity.

[Pulsed Doppler measurements of flow velocities in the intracranial and abdominal arteries of newborns of diabetic mothers]

OBJECTIVE

To define the character of haemodynamic changes and brain-sparing phenomena in newborns of diabetic mothers.

METHODS

On the basis of blood indices flow in the middle cerebral artery (MCA), anterior cerebral artery (ACA), right renal artery (RRA) and the superior mesenteric artery (SMA) the character of haemodynamic change and the brain-sparing phenomena in 53 newborns of diabetic mothers was analyzed. As a control group we chose 29 healthy newborns delivered at term. Doppler examinations were performed with ATL 3500 machine (Philips) using 7.5 MHz transducer and pulsed and colour Doppler. Pulsatility (PI) and resistance (RI) indices were calculated and analyzed.

RESULTS

In the MCA and ACA both indices (PI and RI) were lower than in abdominal arteries. We have found higher values of PI and RI in MCA than in ACA in both studied groups. In comparison to full-term newborns born from normal pregnancies, values of PI and RI in ACA were higher in IDM (infants of diabetic mothers) group (p<0.01).

CONCLUSIONS

In IDM similarly to neonates from physiological pregnancies we can observe physiological phenomenon of brain-sparing effect. In the IDM group postnatal haemodynamic disturbances are limited to the brain circulation only. In IDM in spite of absence of signs of hypoxia, some brain-sacrifice effect was observed. Haemodynamic disturbances were not observed in renal and mesenteric circulation.

[Course of pregnancy and delivery in patients with pregestational diabetes mellitus]

INTRODUCTION

Pregnancy in a woman with pregestational diabetes mellitus (PGDM) is associated with increased risk of complications in both the mother and the fetus. A close surveillance is strongly recommended in these pregnancies.

OBJECTIVES

The aim of the study was to assess perinatal outcome in pregnancies complicated by PGDM.

STUDY DESIGN

The study covered 127 pregnancies with PGDM. Apart from perinatal outcome the patient's age, past obstetric history, the duration of perinatal diabetic care and the course of pregnancy were taken into consideration. Diabetes mellitus was classified according to White.

RESULTS

37.8% of patients were diagnosed PGDM B class, 38.6%--C class, 15.7%--D class, 1.6%--F class and 6.3%--RF class. Less than half of women (45.5%) remained under medical care since the first trimester. The arterial hypertension was the most common complication of pregnancy and occurred in over 18% of studied pregnancies. The incidence of preterm delivery was 41.7%. Cesarean section was performed in 55.9% of patients. 16.6% of the neonates had a birth weight below 2500 g. 4 neonates were stillborn (2.4%) and the next 3 ones (2.4%) died within the first month following the delivery. Congenital heart defects were found in 8.7% of offsprings.

CONCLUSIONS

Despite the progress in perinatal care pregestational diabetes mellitus is still associated with increased risk of maternal and fetal mortality and morbidity.

[Genetic amniocentesis in the II Department of Obstetrics and Gynecology of the Medical University of Warsaw]

OBJECTIVE

Characteristic of patients, indications, outcomes and complications of genetic amniocentesis.

MATERIAL AND METHODS

Retrospective analysis of 420 women who underwent genetics amniocentesis from January 1999 to 2001. It was done by ultrasound-guided insertion of a 22-gauge needle from 12 to 19 week's gestation. From 9 ml to 24 ml of amniotic fluid were removed for cytogenic analysis.

RESULTS

The mean maternal age was 37.6 +/- 4 years. The mean gestational age of amniocentesis was 14.2 +/- 1.2 weeks. 416 (99%) women were in singleton pregnancy, 3 (0.7%) in twin pregnancy and one (0.2%) in triplet pregnancy. The most common indication for amniocentesis was maternal age over 35 years (366 cases - 87%). Chromosomal abnormalities were identified in 23 cases (5.5%). Any neural tube defects were observed. In 6 (1.4%) cases the cell culture of amniotic fluid was unsuccessful and procedure was repeated. 2 (0.4%) women lost pregnancy during 7 days after procedure. 4 patients (0.9%) had amniotic fluid leakage, of which no ended in fetal loss. 1 (0.2%) had pain in hypogastrium after amniocentesis, all delivered at term.

CONCLUSIONS

The pregnancy loss rate in women who underwent genetics amniocentesis was 0.4%. The most common indication for genetic amniocentesis was maternal age over 35 years. Chromosomal abnormalities were detected in 5.4% of the fetuses.

[Newborn of a mother with HELLP syndrome]

HELLP syndrome is a serious complication of pregnancy with characteristic appearances between 22 to 26 weeks of gestation. Clinical classification in three groups, is based on platelet count. Early diagnosis and appropriate management allow women to achieve a mortality rate below 1%. Neonatal complications are strongly associated with a newborn's immaturity and class of HELLP syndrome. In both presented cases despite identical maternal treatment (steroids because of I st class of HELLP syndrome) neonatal clinical courses were different due to the differences in gestational age. However, appropriate prenatal and neonatal care in tertiary centers was successful.

Renal function and lipid metabolism in pregnant renal transplant recipients

OBJECTIVE

To estimate renal function and lipid metabolism in pregnant renal transplant recipients.

STUDY DESIGN

The study covered 64 women during the third trimester of pregnancy including 33 renal transplant recipients (the study group) and 31 healthy women (the control group). Serum concentrations of uric acid, urea, creatinine, electrolytes, total protein, albumin, acid-base balance and blood cell count were examined to assess renal function. Moreover, the levels of the following lipid metabolism parameters were estimated: (1) total lipids (TL), (2) total LDL fraction (TLDL), (3) total cholesterol (TCh), (4) free cholesterol (fCh), (5) free/total cholesterol (fCh/TCh) ratio, (6) phospholipids (PhL), (7) total cholesterol/phospholipids (fCh/PhL) ratio, (8) triglycerides (TG), (9) HDL-cholesterol (HDL-Ch), (10) LDL-cholesterol (LDL-Ch) and (11) LDL-Ch/HDL-Ch ratio. 'The effect of immunosuppressants (cyclosporine, prednisone and azathioprine) on serum lipid levels was estimated in the study group. The mean maternal age, gestational age and BMI did not differ in both groups.

RESULTS

Pregnant renal transplant recipients presented mild renal insufficiency during the third trimester resulting in the increase in serum level of uric acid (P<0.001), urea (P<0.001), creatinine (P<0.001), and Cl- (P<0.001). Proteinuria (1.19+/-1.9 g/24 h) leading to hypoproteinemia (P<0.001) and hypoalbuminemia (P<0.05) confirmed renal function impairment in the study group. Additionally, the diagnosis of renal insufficiency was supported by mild acidosis reflected by a drop in pH (P<0.001). standard HCO3- (P<0.001) and base excess (P<0.001). The women with renal grafts presented vital lipid metabolism disturbances illustrated by the elevated levels of: (1) TL by 72% (P<0.001), (2) TLDL by 21% (P<0.001), (3) TCh by 16% (P<0.001), (4) fCh by 34% (P<0.001), (5) fCh/TCh ratio by 21% (P<0.001), (6) PhL by 28% (P<0.001), (7) TG by 53% (P<0.001), (8) LDL-Ch by 13% (P<0.05) and (9) LDL-Ch/HDL-Ch ratio by 23% (P<0.001). No difference in HDL-Ch level between the two groups was found. Hyperlipidemia in pregnant kidney recipients was associated with immunosuppressive treatment and depended on cyclosporine treatment regimen. Treatment with azathioprine and prednisone was associated with elevated serum levels of examined lipids.

CONCLUSION

Serum lipid abnormalities are significantly influenced by the administered dosages of immunosuppressants.

Extremely elevated activity of serum alkaline phosphatase in gestational diabetes: a case report

We report a case of a 25-year-old pregnant woman with gestational diabetes and increased activity (25-fold) of placental isozyme of alkaline phosphatase. Abdominal ultrasonographic scan revealed no hepatobiliary disease. After delivery, the alkaline phosphatase level decreased but did not return to the reference range. Similar abnormalities were found in the patient's first-degree relatives, which included a mother and a sister.

[Pregnancy and delivery course in patients with gestational diabetes mellitus]

OBJECTIVES

The aim of the study was to assess mother and fetal outcome in gestational diabetic women.

MATERIALS AND METHODS

The study covered 689 patients with gestational diabetes mellitus. All women had been taken care of II Department of Obstetrics and Gynecology Warsaw Medical University in 1997-2001 years. The following parameters were analyzed: the patients ages, past obstetric experience, gestational age of GDM diagnosis, pregnancy complications, delivery course and neonatal outcomes.

RESULTS

Among study group 11.9% patients required insulin to maintain blood glucose concentration in normal range. GDM was mostly (44.1%) diagnosed between 29 and 34 weeks of pregnancy. At the recommended gestational age of screening tests--24-28 weeks--there were detected only 33.4% GDM. The most frequent pregnancy complication was imminent preterm delivery (16.7%). Delivery at term occurred of 89.1% of cases. Percentage of preterm deliveries was 10.9%. Spontaneous vaginal deliveries were the most frequent (72.5%). 23.2% women were delivered by Cesarean section. The most frequent indication of surgical labor were the symptoms of intrauterine fetal asphyxia (35.6%) and cephalo-pelvic disproportion (26.3%). Most of the newborn (83.3%) had normal birth weight between 2500 g and 4000 g. Among infants the most frequent complications were: hyperbilirubinemia (17.3%) and hypoglicemia (15.6%). Intranatal death occurred in 0.1% of cases, whereas neonatal death--0.4%. Congenital defects were found in 4.3% of all offspring. The most frequent congenital malformation was heart defect--1.3% of newborns (almost half of all congenital defects)

CONCLUSIONS

Early diagnosis of gestational diabetes mellitus and specialists obstetric surveillance prevent of pregnancy complications and perinatal mortality, morbidity.

[Evaluation of fetal heart anatomy at the end of the first trimester and the beginning of the mid-trimester]

OBJECTIVE

To evaluate fetal heart anatomy in the late first and in the early second trimester.

MATERIALS AND METHODS

The study included 75 fetuses between 11 and 19 weeks' gestation. Exams were performed using transabdominal or transvaginal probes.

RESULTS

The proportion of cases successfully visualized to all cases in particular week of pregnancy was following: 11 week--0/1 (0%), 12--1/1 (100%), 13 week--1/1 (100%), 14--18/23 (79%), 15--6/9 (67%), 16--23/27 (86%), 17--4/5 (80%), 18--6/6 (100%), 19--2/2 (100%). In 11 weeks' gestation two ventricles and two atrias could be imaged. Anatomy was seen from 12 weeks' gestation with transvaginal and from 13 weeks' gestation with transabdominal transducers. Two tricuspid regurgitations were detected. The interventricular septum was the most difficult structure to visualize in all cases. The grey scale alone was not sufficient for accurate examination of the heart and it was necessary to use colour Doppler to confirm normal forward flow to both ventricles and to identify outflow tracts.

CONCLUSIONS

1. Successful visualization of the heart in early pregnancy is possible from 12 weeks' gestation with transvaginal and from 13 weeks' gestation with transabdominal probe. 2. Fetal echocardiography between first and second trimester should lead to better understanding of fetal hemodynamics in normal and abnormal fetuses and help to introduce new therapeutic treatment in some cases.

[Analysis of complications of the tension-free vaginal tape procedure for surgical treatment of female stress urinary incontinence]

OBJECTIVE

The most common types of urinary incontinence in women are stress, urge and mixed incontinence. Stress urinary incontinence may be caused by an urethral hypermobility and internal sphincter deficiency (ISD). There are over 100 different surgical procedure for the treatment of female stress incontinence. Tension-free vaginal tape (TVT) is a new anti-incontinence surgical technique which was first described by Ulmsten in 1996. The aim of the study was to evaluate the complications of tension-free vaginal tape (TVT) for the surgical treatment of female stress incontinence.

METHODS

The study group was consisted of 162 women, aged 32-84. All patients had a basic evaluation that included a history, frequency/volume chart, questionnaire of micturition (self-made), physical examination, stress test, Bonney test, urinalysis and bacterial culture of urine. Women with mixed urinary incontinence and who underwent surgical treatment of SUI in the past had been done urodynamic investigation. The operation was carried out under epidural, subarachnoid and general anesthesia. The TVT procedure was performed as described by Ulmsten. The follow-up was done after 1 day, 1 and 3 and 6 months since the operation.

RESULTS

Among complications related to the procedure were 11 cases of cystotomy, 5 cases of urinary retention requiring four days catheterization, 3 cases of bleeding from the vagina, 14 cases of detrusor instability de novo. In 4 cases occurred postoperative obstinate pain. In 4 cases occurred recurrent urinary tract infection. None complication required invasive treatment. No evidence of defect healing or rejection of the tape was found.

CONCLUSIONS

We conclude that the TVT procedure is safe method of the surgical treatment of urinary stress incontinence associated with a low complications.

[Assessment of pregnancy and labour outcome and the condition of the newborn in primiparous women aged 35 and older]

OBJECTIVE

To assess the effect of maternally advanced age on pregnancy and labour outcome.

MATERIAL AND METHODS

Pregnancies of 95 primiparous women aged 35 or older were compared with pregnancies of 130 women aged 20-30 with respect to pregnancy complications and labour outcome.

RESULTS

Women aged 35 or older had cesarean section three times as often as women in the 20-30 year group old. Advanced maternal age compared with younger age was associated with a significantly higher rate of diabetes, hypertensive disorder, thrombocytopenia and intrauterine growth retardation.

CONCLUSIONS

Primiparous women aged 35 or older are at an increased risk of complications in pregnancy and are at a higher risk of cesarean section compared with younger women.