Birth Weight < 3rd Percentile Prediction Using Additional Biochemical Markers-The Uric Acid Level and Angiogenesis Markers (sFlt-1, PlGF)-An Exploratory Study

(1) Aim: Ultrasound is the gold standard for assessing fetal growth disorders. The relationship between high sFlt-1/PlGF scores and LBW (low birth weight) was described. In this study, we attempted to assess whether uric acid could be used as a secondary marker in estimating the pregnancy risk associated with LBW. (2) Material and methods: 665 pregnant women with a suspected or confirmed form of placental insufficiency were enrolled. In each of the patients, sFlt-1 and PlGF and uric acid levels were determined. Patients were divided into two groups according to birth weight below and above the third percentile for the given gestational age with the criteria of the neonatal definition of FGR (fetal growth restriction). (3) Results: A significant negative correlation between neonatal birth weight and the uric acid level across the entire study group was observed. We found a significant negative correlation between neonatal birth weight and the uric acid level with birth weights < 3rd percentile. (4) Conclusions: There is a significant link between the uric acid concentration and LBW in the group with placental insufficiency. Uric acid can improve the prediction of LBW. An algorithm for LBW prognosis that makes use of biophysical (ultrasound) and biochemical (uric acid level, angiogenesis markers) parameters yields better results than using these parameters separately from each other.

Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: Results of a web-based multinational cross-sectional study

OBJECTIVE

To assess risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic using Mind-COVID, a prospective cross-sectional study that compares outcomes in middle-income economies and high-income economies.

METHODS

A total of 7102 pregnant women from 12 high-income economies and nine middle-income economies were included. The web-based survey used two standardized instruments, General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9).

RESULT

Pregnant women in high-income economies reported higher PHQ-9 (0.18 standard deviation [SD], P < 0.001) and GAD-7 (0.08 SD, P = 0.005) scores than those living in middle-income economies. Multivariate regression analysis showed that increasing PHQ-9 and GAD-7 scales were associated with mental health problems during pregnancy and the need for psychiatric treatment before pregnancy. PHQ-9 was associated with a feeling of burden related to restrictions in social distancing, and access to leisure activities. GAD-7 scores were associated with a pregnancy-related complication, fear of adverse outcomes in children related to COVID-19, and feeling of burden related to finances.

CONCLUSIONS

According to this study, the imposed public health measures and hospital restrictions have left pregnant women more vulnerable during these difficult times. Adequate partner and family support during pregnancy and childbirth can be one of the most important protective factors against anxiety and depression, regardless of national economic status.

Evaluation of the Risk of Birth Defects Related to the Use of Assisted Reproductive Technology: An Updated Systematic Review

Fertility problems constitute a serious medical, social, and demographic problem. With this review, we aim to critically appraise and evaluate the existing literature surrounding the risk of birth defects in offspring conceived using techniques based on assisted reproductive technology (ART). Based on searches of the literature in PubMed and ScienceDirect, we obtained a total of 2,003,275 works related to the topic. Ultimately, 11 original papers published in the last 10 years qualified for inclusion in the study. Based on five studies included in this analysis, it was shown that ART significantly increases the risk of congenital malformations in associated newborns. Due to the specifics of given studies, as well as potential confounding risk factors, this influence cannot be ignored. Therefore, considering the information contained in the articles included in this systematic review, it was determined that the risk of birth defects is not directly related to the use of ART itself but also depends on the age of partners, causes of infertility, comorbidities, and the number of fetuses during a pregnancy, as well as many other factors not covered in the literature. It is thus necessary to impress upon infertile couples who wish to have offspring that the use of ART is not risk-free but that the benefits outweigh the risks. Further education in this field, as well as social understanding, is also required.

First-Trimester Fetal Hepatic Artery Examination for Adverse Outcome Prediction

Objective: To assess whether there are differences in first-trimester fetal hepatic artery flows depending on pregnancy outcomes. Methods: The prospective study conducted in 2012–2020 included 1841 fetuses from singleton pregnancies assessed during the routine first-trimester ultrasound examination (between 11- and 14-weeks’ gestation). Also, each fetus was examined to determine their hepatic artery flows by measuring the artery’s pulsatility index (HA-PI) and peak systolic velocity (HA-PSV). Results: The fetuses that were classified as belonging to the adverse pregnancy outcome group (those with karyotype abnormalities and congenital heart defects) were characterized by a significantly lower HA-PI and higher HA-PSV compared to normal outcome fetuses. Conclusion: Hepatic artery flow assessment proved to be a very useful tool in predicting adverse pregnancy outcomes, in particular karyotype abnormalities and congenital heart defects.

Amniocentesis in Twin Pregnancies: Risk Factors of Fetal Loss

This study aims to determine if second trimester amniocentesis in twin pregnancies provides a significant independent contribution in the prediction of miscarriage or fetal loss at any stage of pregnancy. This was a retrospective cohort study of women with twin gestations booked for routine prenatal care in four fetal medicine units in Poland in the years 2010-2020. The study population included: (1) twin pregnancies that underwent amniocentesis at 16-20 weeks' gestation; (2) twin pregnancies that did not require any further testing and were followed-up routinely. Univariable and multivariable regression analysis was used to define which maternal and pregnancy characteristics provided a significant independent contribution in the prediction of miscarriage and fetal loss at any stage of pregnancy. In the study period, 2645 twin pregnancies were eligible for analysis. There were 144 cases of miscarriage defined as fetal loss of one or both twins before 24 weeks and 40 cases of intrauterine death of one or both twins after 24 weeks. A total number of 162 twin pregnancies underwent amniocentesis at 16-20 weeks' gestation. The rate of miscarriage before 24 weeks and the rate of fetal loss at any stage of pregnancy in the group that underwent amniocentesis was 10.49% and 13.58%, respectively, compared to 5.11% and 6.52% that did not undergo amniocentesis. Multivariable regression analysis showed that factors providing a significant independent contribution in the prediction of miscarriage and fetal loss at any stage of pregnancy were monochorionicity (MC), large intertwin discordance in crown-rump length (CRL), low Pregnancy Related Plasma Protein (PAPP-A) MoM and nuchal translucency (NT) above 95th centile. Amniocentesis in twin pregnancies does not provide a significant contribution in the prediction of miscarriage or fetal loss at any stage of pregnancy.

Implementation of the Publicly Funded Prenatal Screening Programme in Poland during the COVID-19 Pandemic: A Cross-Sectional Study

The COVID-19 pandemic in 2020 affected the entire healthcare system in Poland, causing medical personnel to be relocated to other duties and limiting patients’ contacts with healthcare professionals. A large part of the planned diagnostics and treatment was delayed due to lack of equipment and personnel. Against this background, we analysed the implementation of the publicly funded prenatal screening programme (PSP) in Poland compared to the previous year. This is a cross-sectional study. We used nationwide datasets on the implementation of the prenatal testing programme over the period 2019−2020, datasets from the Statistics Poland on birth and the data on the development of the COVID-19 epidemic in Poland. In the year 2020, we observed a 12.41% decrease in woman enrolled to the programme compared to 2019. However, the decrease concerned only women under 35 years of age. With respect to the number of deliveries in the calendar year, the number of patients enrolled in the programme decreased by 3% (31% vs. 34%, p < 0.001). We also observed an increase in estriol measurements per the number of patients included in the programme, and a reduction in the number of PAPP-A tests in the first trimester, which proves an increased share of the triple test in the prenatal diagnosis of chromosomal aberrations. With respect to the number of deliveries, the number of amniocentesis procedures performed under PSP decreased by 0.19% (1.8% vs. 1.99%, p < 0.0001). In 2020, compared to the previous year, the number of patients included in the prenatal testing programme in Poland decreased. In terms of the number of births in Poland, the number of integrated screening tests also decreased, at the expense of increasing the percentage of triple tests. There were also significant reductions in the number of invasive diagnostic tests.

The role of individual blood flow parameters through ductus venosus in the first and second trimesters of pregnancy in predicting the condition of the fetus and newborn

OBJECTIVES

To predict fetal and neonatal outcome during pregnancy based on detailed analysis of ductus venosus blood flow velocities in first and second-trimester fetuses.

MATERIAL AND METHODS

A retrospective analysis was made in 680 patients with single pregnancies in years 2015 and 2016. The following ductus venosus blood flow velocities in first and second-trimester were analyzed: S-wave velocity, D-wave velocity, a-wave velocity, Tmax velocity, PIV. Results were divided into sub-groups with reduced value, normal value and increased value and compared with fetal and neonatal condition.

RESULTS

The relationship between the increased PIV value in the first trimester of pregnancy and an increased risk of chromosomal aberrations was observed, whereas the increased DV PI value in the second trimester of pregnancy with reduced A -wave were associated with a higher incidence of FGR. No correlation between the remaining DV blood flow velocities in the first and second trimester of pregnancy and the more frequent occurrence of fetal and neonatal complications has been confirmed.

CONCLUSIONS

The increased DV PIV is a good prognostic tool for the detection of chromosomal aberrations in first trimester of pregnancy. In the second trimester, the increased DV PIV and the reduced A- wave velocity correlate with the fetal growth restriction. Ductus venosus seems to be an indirect indicator of intrauterine hypoxia with moderate prognostic value for adverse obstetric outcomes.

"The Killer Placenta" - a threat to the lives of young women giving birth by cesarean section

OBJECTIVES

It is necessary to create a universal algorithm for the management of placenta accreta spectrum in order to minimize morbidity and mortality in young patients giving birth by caesarean section.

MATERIAL AND METHODS

This was a retrospective study of seven women before the age of 30 selected out of larger group of 40 pregnant patients. The patients were hospitalized in the Clinical Department of Perinatology, Gynecology and Obstetrics in Ruda Śląska, which is a 3rd level reference department. The inclusion criterion was the suspicion of placent accreta spectrum, based on clinical condition, ultrasound examination and magnetic resonance imaging.

RESULTS

A patient with a diagnosed placenta accreta spectrum should be provided with a highly specialized 3rd level referential center by an experienced multidisciplinary team of specialists. There should be free access to the blood bank, adult intensive care unit and neonatal intensive care unit. According to the results of this study, the recommended time of cesarean section is 34 + 0 - 36 + 6 weeks of pregnancy. Hysterectomy after the cesarean section is a method of choice for a placenta increta or percreta. It is the most difficult surgery in obstetrics, with a high risk of intraoperative complications. Damage to the urinary system is the most common complication of perinatal hysterectomy. Preoperative placement of ureteral catheters reduces the risk of intraoperative damage.

CONCLUSIONS

It is necessary to plan individual procedure for women who has low-lying or previa placenta, and who has history of prior cesarean section - in this group the risk of placenta accreta spectrum is higher.

The Polish Society of Gynecologists and Obstetricians Guideline for the diagnostic assessment and management of multiple-gestation pregnancy complicated by fetal growth restriction

The aim of the Guideline is to unify the diagnostic-therapeutic management of multiple-gestation pregnancies complicated by fetal growth restriction in at least one fetus.

Prediction of preterm birth using PAMG-1 test: a single centre experience - preliminary report

OBJECTIVES

Placental alpha microglobulin-1 (PAMG-1) is a novel biomarker detected in cervicovaginal discharge in patients threatened with preterm birth (PTB). This study aimed to show a single centre experience of assessment of imminent spontaneous PTB risk in patients with symptoms suggesting preterm labour (PTL).

MATERIAL AND METHODS

The study group consisted of 46 women with singleton pregnancies between 24 + 0/7 and 33 + 6/7 weeks of gestation who presented with symptoms of threatened PTL, with cervical dilatation of < 3 cm, cervical length (CL) of < 30 mm and clinically intact fetal membranes. CL was measured via transvaginal ultrasound and the PAMG-1 test was performed in all of the objectives.

RESULTS

Sensitivity (SN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of prediction of PTB within seven days for CL were 100%, 11.11%, 5.88% and 100%, respectively. The PAMG-1 test SN, SP, PPV and NPV of the same endpoint were 50%, 80.56%, 12.5% and 96.67%, respectively.

CONCLUSIONS

PAMG-1 is a more accurate predictor of PTB when compared to CL. Routine use of both mentioned tests could allow identification of low-risk patients and reduction of rate of unnecessary hospitalizations and treatments.

Evaluation of indications for amniocentesis in cases of normal fetal ultrasound results

OBJECTIVES

The objective of this study was to analyze indications for amniocentesis in cases of patients with normal fetal ultrasound results between 11+0 and 13+6 weeks of gestation.

MATERIAL AND METHODS

The results of first-trimester screening tests performed between 2014 and 2018 on 6,863 patients of the Prenatal Testing Outpatient Clinic at the Clinical Department of Obstetrics and Gynecology, Pomeranian Medical University, Szczecin, Poland, were analyzed. The inclusion criteria were a singleton pregnancy and normal results of fetal ultrasound between 11+0- and 13+6-weeks' gestation. Depending on the calculated risk of fetal trisomy 21, the patients were divided into three groups (group A = RS > 1:300, group B = RS 1:300 - 1:999, group C = RS ≤ 1:1000). Subsequently, values such as PAPP-A and fβ-hCG protein levels and maternal age were analyzed for each of the groups.

RESULTS

The patients, 6,310 (91.94%) met the inclusion criteria. A high risk of fetal trisomy 21 was identified for 514 women (8.15%). Group B had 733 (11.62%) and group C 5,063 (80.23%) patients. In group A, an fβ-hCG level of ≥ 2.000 MoM was shown for 50.97% of the women. A PAPP-A level ranging from 0.001 to 0.499 MoM was observed for 38.72% of group A patients. The mean maternal age in groups A, B and C was 36.45, 36.08 and 31.64 years, respectively.

CONCLUSIONS

In the first-trimester, patients with normal ultrasound results obtained during prenatal screening tests, the main cause of an increased risk of trisomy 21 was elevated PAPP-A and fβ-hCG concentrations. According to this paper's authors, in these cases extension of diagnosis to include other gestational complications, e.g. preeclampsia, should be considered.

Quantitative and qualitative Ductus Venosus blood flow evaluation in the screening for Trisomy 18 and 13 - suitability study

OBJECTIVES

The objective of the paper is the suitability assessment of screening for Trisomy 18 and 13 on the basis of nuchal translucency (NT) measurement, Fetal Heart Rate (FHR), double test, quantitative [Ductus Venosus (DV) Pulsatility Index for Veins (PIV)] and qualitative (the A-wave assessment) blood flow evaluation in the DV.

MATERIAL AND METHODS

The study was performed in 7296 singleton pregnancies. In each fetus NT, FHR, DV-PIV were examined. Double test from maternal blood was examined. These ultrasound and biochemical factors were in combined screening investigated. Additional doppler ultrasound markers such as abnormal a-wave in Ductus Venosus and Pusatility Index for Veins of Ductus Venosus were and their impact on Trisomies 18 and 13 screening were examined.

RESULTS

Two groups of patients were compared - with chromosomal normal and chromosomal abnormalities - Trisomy 18 and 13. Detection Rate of Trisomies 18 and 13 at the risk cutoff 1/300 using combined screening was 90.2% and FPR was 6%. Detection Rates of examined chromosomal abnormalities using contingent screening were: 92.1% using DV abnormal a-wave and 94.84% using DV-PIV. FPR's for booths parameters 5.8% and 5.4% respectively.

CONCLUSIONS

Quantitative analysis of the flow - assessment of DV-PIV in the first trimester significantly influences the improvement of screening values focusing on Trisomy 18 and 13 detection.

Nasal bone in screening for Trisomy 18 and 13 at 11-13 + 6 weeks of gestation - own experiences

OBJECTIVES

The objective of the paper is the suitability assessment of screening for Trisomy 18 and 13 on the basis of NT measurement, FHR, double test and assessment of Nasal Bone.

MATERIAL AND METHODS

The study was performed in 6,661 singleton pregnancies. In each fetus NT, FHR, DV-PIV were examined. Double test from maternal blood was examined. These ultrasound and biochemical factors were in combined screening investigated. Additional ultrasound marker - Nasal Bone was and its impact on Trisomies 18 and 13 screening was examined.

RESULTS

Two groups of patients were compared - with chromosomal normal and chromosomal abnormalities - Trisomy 18 and 13. Detection Rate of Trisomies 18 and 13 at the risk cutoff 1/300 using combined screening was 84.1% and FPR was 7.1%. Detection Rates of examined chromosomal abnormalities using screening with additional marker - NB was 93.2% and False Positive Rate - 5.6%.

CONCLUSIONS

It should be noted that the qualitative analysis of the assessment of NB in the first trimester significantly influences the improvement of screening values focusing on Trisomy 18 and 13 detection. In summary, our research indicates a more effective type of Trisomy 13 and 18 screening using NT, double test, maternal age, CRL and FHR as well as nasal bone presence and absence.

Nasal bone in screening for T21 at 11-13 + 6 weeks of gestation - a multicenter study

OBJECTIVES

Trisomy 21 is one of the most common chromosomal defects diagnosed prenatally. Screening for Down syndrome is based on maternal age, measurement of crown-rump length, nuchal translucency and fetal heart rate, together with free β-hCG and PAPP-A at 11 to 13 + 6 weeks. Introduction of additional ultrasound marker of trisomy 21 (evaluation of the nasal bone) may result in increased DR and decreased invasive diagnostic testing rates (FPR).

MATERIAL AND METHODS

Ultrasound scan with NB evaluation was performed in 5814 fetuses during routine screening for chromosomal defects at 11 to 13 + 6 weeks of gestation. DR and FPR coefficients were calculated for 4 levels of risk as cut-off points for screening model 1, based on MA, NT, and first trimester biochemistry, as well as for screening model 2, based on MA, NT, first trimester biochemistry and NB.

RESULTS

There were 5708 normal cases, 71 cases of trisomy 21 and 35 cases of other chromosomal defects. NB was absent in 46 (64.8%) cases and present in 25 (35.3%) cases of trisomy 21, comparing to present NB in 5463 (95.7%) and absent in 245 (4.3%) of normal cases.

CONCLUSIONS

First-semester screening with additional NB assessment significantly increases the detection rate for trisomy 21 and decreases the rate of false-positive results. Adding NB evaluation at the risk level of 1:50 causes only a small increase in detection rate. Invasive procedures should be performed in that group regardless NB assessment.

Influence of first trimester biochemistry methodology on detection rate in screening for trisomy 21

OBJECTIVES

The purpose of the study was to compare detection rates (DR) of FMF-certified and non-certified biochemical tests (BC) in trisomy 21 screening at 11-13 + 6 weeks.

MATERIAL AND METHODS

In 2267 singleton pregnancies FMF-certified doctors measured crown to rump length (CRL) and nuchal translucency (NT). Serum samples were tested for free β-hCG and the PAPP-A using 2 analysers (Delfia - Perkin Elmer and Immulite 2000 - DPC), the results were expressed in MoM values and used for computer calculation of the risk for trisomy 21. The cut-off value for the high trisomy 21 risk was 1:300.

RESULTS

Comparison of free β-hCG MoMs by DPC and Delfia demonstrated statistically significant differences in normal, and trisomy 21 fetuses respectively. Similarly, statistically significant differences were noted for PAPP-A MoMs. The above differences in MoMs resulted in altered sensitivity in screening for aneuploidy. The application of the FMF-certified method ensures a markedly higher DR = 74%, compared to non-certified tests (64%), both at 5% FPR. The ROC analysis was performed in order to assess the efficacy of both tests. Results of trisomy 21 BC + NT risk scales using the Delfia and DPC methods are highly significant (p < 0.0001), which means that their discrimination ability is > 90%. The difference between results obtained using the Delfia and DPC methods is AUC = 0.0150 and is statistically significant (Z = 2.4728, p = 0.0134).

CONCLUSIONS

The use of FMF-certified first trimester biochemistry analysers improves DR for trisomy 21. The use of non-certified analysers causes reduction of DR and an increase of invasive procedure rate.

Does prior knowledge of maternal age affect judgment of operators measuring nuchal translucency?

OBJECTIVES

To test the hypothesis that, in real life standard clinical practice, knowledge of maternal age (MA) by operators measuring nuchal translucency (NT) for screening of aneuploidy may influence their judgment, resulting in a tendency to over-measurement in older women.

MATERIAL AND METHODS

We retrospectively analyzed the correlation between MA and NT MoMs in data from a group of operators from several clinical practices, with different levels of experience.

RESULTS

We assessed 66,918 measurements by 41 operators. There was no association between NT and MA in all the measurements analyzed together In 3 experienced operators (N > 1900), there was a significant association between the variables, although all were negative and its effect size was very small (0.004, 0.006 and 0.01). However one of the less experienced operators (N = 47) had a statistically significant (p = 0.0002) and strong (R2 = 0.2634) association. We tested the hypothesis that this bias could occur in less experienced operators but time/experience would correct it. We did the same analyses for each set of 50 tests, sorted by date, for each operator up to the 7th set. No significant progression was identified in association with increase in experience.

CONCLUSIONS

Our data does not support the hypothesis that operators might be biased towards over-measuring NT in older women.

[Agenesis of the ductus venosus--an irrelevant anomaly or a severe clinical problem?]

BACKGROUND

Ductus venosus is the fetal blood vessel connecting the abdominal portion of the umbilical vein with the inferior vena cava. Numerous studies have confirmed the important role of this vessel in fetal circulation. There are, however cases when finding the ductus venosus during an ultrasound examination is impossible.

OBJECTIVE

The objective of the study was to assess the fate of fetuses with known ductus venosus agenesis and its severity in fetal life.

MATERIAL AND METHODS

17 fetuses from singleton pregnancies with agenesis of the ductus venosus were observed and followed up.

RESULTS

A total of 3 intrauterine deaths, preceded by fetal hydrops and signs of heart failure, were observed in the study group. One newborn required cardiac care after birth. In the majority of cases with ductus venosus agenesis, where no accompanying developmental anomalies were found, prognosis for the fetus and the newborn was good.

CONCLUSIONS

Cases of ductus venosus agenesis should be directed to and followed up in referral centers, where adequate diagnostic and therapeutic procedures can be undertaken.

[Frontomaxillary facial angle measurement at 11+0 to 13+6 weeks' gestation. Application in every day prenatal diagnosis of trisomy 21]

OBJECTIVE

The aim of the study was to evaluate the effectiveness of prenatal screening for trisomy 21 with the use of the FMF angle measurement, depending on the disease risk group.

MATERIAL AND METHODS

The study included 2,026 single pregnancy fetuses, examined in years 2009-2011. The crown-rump length, nuchal translucency and frontomaxillary facial angle were measured for each of the fetuses according to the Fetal Medicine Foundation guidelines. All ultrasound exams were performed using trans-abdominal probes paired with Voluson 730 Expert and Expert E8 systems. All physicians conducting the exams were FMF-certified professionals. Maternal age at the time of the study was also reported. In 1621 pregnant women serum concentration of PAPP-A was determined using Delfia Express system (Perkin Elmer). Astraia software was used to assess fetal risk of trisomy 21. The final analysis included 791 fetuses which were followed up for the occurrence of trisomy 21. Data were analyzed using PQStat package ver 1.4.2.324. Highly significant likelihood was set at p < 0.01 and significant likelihood at p < 0.05.

RESULTS

Average maternal age was 31.42 years (median: 32 in a range from 27 to 45). Average FMF angle was 76.24 degrees (median: 75 degrees in a range from 69 to 04). Average CRL measurements was 63.70 mm (median: 64.10 mm in a range from 45 to 84). Average NT measurement was 1.91 mm (median: 1.6 mm in a range from 0.50 to 9.3). There was no significant (p > 0.05) correlation between maternal age and FMF. Highly significant (p < 0.01) negative correlation between the CRL and the FMF angle was found. There were 41 fetuses with trisomy 21 (Down syndrome) in the study group. In the normal karyotype group, the FMF angle was highly significantly lower (p < 0.0001) than in the trisomy 21 group. 95th percentile of the each of four separated CRL ranges was calculated. Detection rate and false positive rate for each of four different risk levels were estimated. They were used as cutoff points for two models of first trimester screening compared: Model 1, including maternal age, NT measurement and PAPP-A test, and Model 2, including maternal age, NT measurement, PAPP-A test and Frontomaxillary facial angle measurement.

CONCLUSIONS

1. Detection rate (DR) of the Down syndrome increases after the introduction of FMF angle measurement as an additional component of screening including maternal age, NT measurement and PAPP-A test. 2. Introduction of the FMF angle as an independent marker for fetal trisomy 21 risk requires further research on large populations.

Reference values for variables of fetal cardiocirculatory dynamics at 11-14 weeks of gestation

OBJECTIVE

Despite the increasing popularity of first-trimester fetal echocardiography, the evaluation of fetal heart function during this period remains challenging. The parameters of normal cardiac function at 11-14 weeks' gestation are not well defined and appropriate reference values have not yet been established. The purpose of this study was to evaluate the fetal cardiocirculatory dynamics during routine first-trimester screening and establish cross-sectional reference ranges for 11-14 weeks' gestation.

METHODS

Fetal echocardiography was performed on 202 women with singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation. Global cardiac function was evaluated using the heart : chest area ratio and Tei index of the left (LV) and right (RV) ventricles. The proportion of isovolumic contraction (ICT%) and ejection (ET%) times of the cardiac cycle, and the outflow velocities described the systolic function. Diastolic function was evaluated by the proportion of relaxation (IRT%) and filling (FT%) times, the ratio of the blood velocity through the atrioventricular valves during early filling (E) and atrial contraction (A) phases of the cardiac cycle, and ductus venosus pulsatility index for veins (DV-PIV). All participants had additional fetal echocardiography in the second trimester and neonatal clinical examination after birth to confirm normality.

RESULTS

The mean heart : chest area ratio (0.203 +/- 0.04) and the Tei indices of both ventricles did not vary significantly during weeks 11-14, but the mean Tei index of the LV (0.375 +/- 0.092) was significantly higher than that of the RV (0.332 +/- 0.079) (P = 0.001). The fetal heart rate (FHR) decreased with increasing crown-rump length (CRL) (P < 0.00001). The LV-ICT% did not vary significantly (P = 0.27), LV-IRT% (P = 0.03) and LV-ET% decreased (P = 0.01), whereas the LV-FT% increased (P = 0.02) with CRL. The RV-ET% (P = 0.84) and RV-FT% (P = 0.60) remained relatively stable. The LV-ET% was lower than the RV-ET% (P = 0.0001). The LV (P = 0.004) and RV (P < 0.00001) outflow velocities and E : A ratios of both ventricles (P < 0.0001) increased with advancing gestation. The E-velocity of the LV (P = 0.003) and RV (P = 0.002) increased significantly but the increase in A-velocity was not significant. The outflow velocity (P = 0.008) and E-velocity (P = 0.005) of the RV were higher than that of the LV but the A-velocities were similar (P = 0.066). The mean DV-PIV was 0.97 +/- 0.23 and did not change significantly (P = 0.95) during weeks 11-14. The FHR and DV-PIV did not correlate with the Tei index of either ventricle.

CONCLUSION

We have established reference ranges for the noninvasive evaluation of fetal cardiocirculatory dynamics at 11-14 weeks' gestation.

Doppler study of the embryonic heart in normal pregnant women

OBJECTIVE

To describe normal fetal cardiac and hemodynamic development in normal early first trimester pregnancies.

MATERIALS AND METHODS

Eighty-eight women with singleton, uncomplicated pregnancies were prospectively studied with transvaginal ultrasound, pulsed and color Doppler. Heart diameter, heart rate, and inflow and outflow waveforms with valve signals were documented. The proportion of the cardiac cycle of isovolumetric relaxation time (IRT%) and isovolumetric contraction time (ICT%) as well as Tei index were calculated.

RESULTS

Ninety-one percent of studies were successful. Heart diameter and the fetal heart rate showed a positive correlation with increasing gestational age: R = 0.80 (p < 0.000001), R = 0.76 (p < 0.000001), respectively. Mean heart diameter at 6 weeks was 1.28 +/- 0.26 mm and mean fetal heart rate was 117 +/- 6 bpm compared to 3.88 +/- 0.54 mm and 171 +/- 6 bpm at 10 weeks. The inflow waveform was monophasic (atrial contraction) in all cases from 6 to 9 weeks. Eight pregnancies (9%) miscarried between 6 and 12 weeks of gestation and the heart exams were characterized by increased IRT% compared with the survivors. In survivors, IRT% decreased between 7 and 8 weeks, from 32.9 +/- 10.7% to 20.8 +/- 5.7% (p < 0.0001). ICT% decreased from 18.6 +/- 4.4% of the cardiac cycle at 8 weeks to 12.6 +/- 4.4% at 9 weeks (p < 0.0008) (after heart development period).

CONCLUSIONS

Doppler examination of the fetal cardiac function is possible after 5 weeks of gestation. After 8 weeks of gestation, the fetal heart is morphologically mature but has not yet achieved effective myocardial compliance. The embryonic human heart is dependent on the atrial contraction for ventricular filling throughout the period of cardiac development. Non-survivors manifest myocardial dysfunction.

[Prenatally reported fetal ovarian cysts--treatment and prognosis]

We present 6 case reports of ovarian cysts, diagnosed in the prenatal and postnatal period, as well as treatment. There was no need for invasive prenatal therapy in any of the reported fetuses. Most of the cysts disappeared spontaneously (in one case uncomplicated cyst rupture in fetus have been observed), only in one case laparoscopy was performed after birth.

Microvessel density assessment in benign and malignant endometrial changes

Tumor angiogenesis is believed to be a prognostic indicator associated with tumor growth and metastasis. Microvessel density (MVD) assessment with common endothelial markers such as CD34 has been found to influence prognosis among endometrial carcinoma patients. The CD105/endoglin antibody has been reported to preferentially bind to proliferated endothelial cells in tissues participating in angiogenesis. The aim of this study was to evaluate the quantification of angiogenesis by assessing MVD in endometrial lesions when comparing the performance of anti-CD34 and anti-CD105 in women with benign and malignant endometrial changes. The study included 58 women (37 postmenopausal) with normal, hyperplastic and malignant endometrium in which preoperative transvaginal sonography was performed. Histological results of the removed endometrium were correlated with MVD assessed in "hot areas" where high densities of microvessels were detected within tumoral tissue. Endometrial cancer was confirmed in 37 women (3 premenopausal). Benign hyperplasia (14 cases), secretory or proliferative endometrium (5 cases) or endometrial atrophy (2 cases) was found in the remaining women. Malignant changes were mostly noted as FIGO stage I and II (28 cases) and had a low (1 or 2) histological grade (29 cases). Median MVD's assessed with CD105 and CD34 were 10.4 and 32.3, respectively. Median MVD assessed with CD34 was almost twice higher in women with endometrial cancer than in women with benign endometrium (CD34 MVD = 41.8 vs. 27.6, p=0.004). In cases of CD105 MVD significant differences between women with benign and malignant endometrial changes were also found (CD105 MVD = 11.8, vs. 6.4; p=0.00007). The menopausal status, but not the clinical stage or histological grading was significantly correlated with both CD34 MVD (p=0.02) and CD105 MVD (p=0.0003). A significant correlation was also found between CD34 and CD105 measured MVD (p=0.000001). In conclusion, transition from endometrial hyperplasia to endometrial cancer appears to be accompanied by microvessel density changes. MVD assessed with both CD34 and CD105 antibodies could be used as a potential prognostic factor in women with endometrial cancer. Our study showed that endoglin, by staining the proliferating microvessels could be more specific and sensitive marker for tumor neoangiogenesis than the more commonly used marker, CD34.

Microvessel density and CpG island methylation of the THBS2 gene in malignant ovarian tumors

We aimed to investigate the role of thrombospondin-2 (THBS2) related angiogenic activity in malignant ovarian tumors and to determine if aberrant methylation associated inactivation is involved in down-regulating THBS2 expression in ovarian cancer. The methylation status of the THBS2 promoter region and microvessel density (MVD) was studied in 70 malignant ovarian tumors and in 15 control ovarian samples. A methylation specific PCR (MSP) method was used to distinguish methylated from unmethylated DNA in the promoter regions of the THBS2 gene. MVD was assessed with anti-CD34 antibodies and the results were compared between tumors with average (AVD) and high (HVD) microvessel density. Alterations in the expression of trombospondin-2 were more often seen in early (FIGO stage I and II ) than in late stage tumors (66% vs. 30%, p=0.01). Age, menopausal status, the histological type and tumor grade did not correlate with thrombospondin-2 expression, however, silencing of THBS2 gene was more often seen in higher rather than in lower grade (50% vs. 28%) cancers and in nonserous rather than in serous (43% vs. 32%) tumors. In 81% of THBS2 mRNA-negative tumors, ahypermethylated promoter region of THBS2 was found (p=0.00003). An unmethylated product of the MSP reaction was more often detected in high grade tumors (93% vs. 76%, p=0.04). The incidence of THBS2 hypermethylation was not related to the tumor histological type, but unmethylated THBS2 was more often found in serous rather than in nonserous tumor (96% vs. 74%, p=0.01). The median MVD in malignant the tumor samples was 21,7 (range: 7.6-55.2). In the group with HVD, 54% were THBS2 mRNAnegative, conversely, in the group with AVD tumors only 26% of the cases had undetectable THSB2 mRNA. A significant correlation between microvessel density and the expression of trombospondin-2 (p=0.009) was found. In the samples with HVD, 51% had hypermethylated THBS2, however methylation pattern had no significant influence on microvessel density. In conclusion, hypermethylation might be responsible for altered expression of thrombospondin-2 in ovarian cancer. The THSB2 methylation pattern had no significant influence on microvessel density.

Doppler study of the peripheral flows in early gestation

The aim of this study was to determine the first trimester human peripheral arterial and venous blood flow between 5 - 10 weeks of gestation. Two hundred twenty four women with singleton, uncomplicated pregnancies were prospectively studied with transvaginal ultrasound. Ductus venosus, umbilical artery waveforms and pulsatility indexes (PI) were assessed as well as the waveform of the umbilical vein and the mean velocity (V(mean)) of the umbilical artery flow. The heart rate was also obtained and analyzed. The fetal heart rate showed a positive correlation with increasing gestational age R=0.76 (p<0.000001). Recordings from the umbilical artery, umbilical vein and ductus venosus were obtained starting from 7 weeks of gestation. The signal from the ductus venosus presented always as antegrade flow during atrial contractions. The pulsatility index (PI) of DV as well as PI of the umbilical artery remained unchanged during the study (statistically non-significant). The umbilical artery, using Doppler tracing was investigated and an absent diastolic flow was documented in every case. Umbilical artery V(mean) increased from 3.8 + 0.32 cm/s to 9.0 + 0.21 cm/s from 7 to 10 weeks of gestation (p< 0.005). Recordings from the umbilical vein showed the pulsation during atrial contractions. Ductus venosus blood velocity and waveform patterns did not change significantly during the study period. Pulsation in the umbilical vein is a typical Doppler finding at the embryonic time. Placental volume blood flow increased significantly with no change in the placental vascular impedance.

Laparoscopic treatment of uterine myomas in women of reproductive age

OBJECTIVES

To analyze the indications, safety and feasibility of laparoscopic myomectomies performed during the last 10 years.

MATERIAL AND METHODS

The studied material consisted of 187 typically performed laparoscopies, mostly due to uterine myomas. All the patients underwent an ultrasound examination at the time of admission and those with the maximum of 3 tumors, where the largest tumors were less than 10cm in diameter, were qualified for endoscopic surgery.

RESULTS

Out of 187 women, 39 patients had laparoscopy performed twice, with a 3-4 months interval for GnRH analogues treatment. Among 164 operative laparoscopies myomas were enucleated in 132 of the women (80.5%). In the case of 18 patients (9.6%) there was a need for laparoconversion resulting from the difficulties with enucleation, adhesions, and the size or localization of the tumor. There were also 62 cases of diagnostic laparoscopy, where myomas were either too large or too small to be enucleated. On analyzing the number and size of the tumors it occurred that a single myoma was the most frequent finding, while more than half of all the enucleated uterine tumors found during diagnostic and operative endoscopies were up to 2cm in diameter.

CONCLUSIONS

Laparoscopic myomectomy is a safe and reliable surgical alternative for women suffering from symptomatic myomas and is a method of choice in young patients of reproductive age. Beside skillful surgical techniques, a proper qualification for the operation is essential for the desired outcome.

[Genital warts associated with HPV infection during II and III trimester of pregnancy--a case report and analysis of treatment options]

More than 30 HPV types can infect the genital tract. Viral infection can be present in clinical, subclinical or latent form. A visible genital form of HPV infection are genital warts, which are commonly caused by HPV types 6 and 11, and appear on the vulva, cervix, vagina, urethra and anus. Oncogenic HPV types 16, 18, 31, 33 and 35 are also found in genital warts and are associated with vulval (VII), cervical (CIN) and anal (AIN) intraepithelial neoplasia. The general prevalence of HPV infection in the form of visible genital warts estimates to about 1% of sexually active adults. Approximately 15% of the infected group / of all adults have a subclinical or latent infection and at least 80% had been infected with one or more genital HPV types at some point in their lives. The highest rate of frequency of infections occurs in the group of adults, aged from 18 to 28. Over the last twenty years figures have shown a constant growth of the infection rate, which also includes pregnant women. Genital warts can proliferate during pregnancy due to altered immunity and increased blood supply. Cryotherapy, electrocautery, laser therapy, surgery or trichloroacetic acid may be used to remove the warts. In the paper a case report on genital warts associated with HPV infection during II and III trimester of pregnancy and analysis of treatment options has been presented.

[Heart defects and other anomalies in fetuses conceived by assisted reproduction techniques]

AIM

The aim of the work was to evaluate the frequency of occurrence of structural, chromosome defects and developmental disorders in fetuses conceived with the help of different assisted reproduction techniques.

MATERIAL AND METHODS

The research group consisted of 30 patients, aged from 25 to 37, subjected to various techniques of assisted reproduction from 2003 to 2006, who reported for consultation in the referral centre. 13 (43%) of the patients underwent the IVF procedure, 12 (40%) the ICSI procedure, 5 patients underwent interuterine insemination. Ultrasonographic examination with the evaluation of the fetal heart was conducted on average in the 22nd week of gestation.

RESULTS

Multiple pregnancies constituted 14 (47%) of the examined pregnancies. In total, fetal anomalies were diagnosed in 3 fetuses (6%). Cardiovascular anomalies occurred in 2 fetuses (atrioventricular septal defect--AVSD and ventricular septal defect--VSD), each with diagnosed trisomy of chromosome pairs 21 and 18 respectively. In one case an anomaly within the urinary system was diagnosed.

CONCLUSIONS

Multiple pregnancies constituted nearly half of the researched group. Structural defects were diagnosed in 3 (6%) fetuses, which slightly exceeds population risk. A higher anomaly percentage occurred in fetuses from twin pregnancies and in the group after ICSI. In the study the risk is related to the selected group of patient undergoing fetal echocardiography exam. To estimate the risk in the ART group precisely, all pregnancies conceived with implementation of ART should be examined. Multi-centre studies are our future goal.

[Assessment of fetal circulation in the late first trimester--preliminary study]

OBJECTIVES

to confirm that fetal echocardiography is indeed possible in late first trimester and that it improves the standard of the so-called "genetic" ultrasound scan.

MATERIAL AND METHODS

Early echocardiography was performed in 75 fetuses from high and low risk pregnancies. All fetuses underwent echocardiography examination in 18-22 weeks of gestation and established follow up.

RESULTS

The most suitable method of visualization seems to be transabdominal examination, between 13.0-13.6 weeks of gestation, an transvaginal one, between 12.0-12.6 weeks of gestation, with 90% effectiveness. In researched group of 75 fetuses (with established follow up) there were four heart defects (5.3%). Three of them were diagnosed before 14th week of gestation. One case (tetralogy of Fallot) was overlooked. There were two false positive diagnosis verified at 20th week of gestation.

CONCLUSIONS

Early echocardiography, especially between 12.0-13.6 weeks of gestation, is a possible and valuable method of diagnosis. Reference evaluation should be performed between 18 and 22 weeks of gestation. In cases with suspected anomalies karyotyping is recommended. Congenital heart disease diagnosed at late first trimester should be treated as the next potential marker of genetic disorder.

Blood flow in ductus venosus in early uncomplicated pregnancy

The ductus venosus is the very important part of fetal venous circulation. It plays a central role in return of venous blood from the placenta. This unique shunt carries well-oxygenated blood from the umbilical vein through the inferior atrial inlet on its way across the foramen ovale. Using Doppler ultrasound, it is possible to assess the blood flow in fetal vessels including ductus venosus. It is observed, in animal and human studies, that the typical waveform for blood flow in ductus venosus in early pregnancy can be different depending on numerous conditions e.g. fetal karyotype. This study is performed to assess the physiologic parameters of blood flow in ductus venosus in uncomplicated early pregnancy.

MATERIAL AND METHODS

404 women were examined between 11+0 and 13+6 weeks (+ days) of gestation by ultrasound. Fetal crown-rump length (CRL) was measured to assess the gestational age. The assessment of risk of fetal abnormalities was based on nuchal translucency (NT) measurement. The ductus venosus blood flow with color and spectral Doppler was obtained in all patients. The following features were assessed: pulsatility index (PI), and direction of flow (positive/negative) during atrial contraction (wave A). All cases were followed up to 22 weeks of gestation when the control scan was performed.

RESULTS AND CONCLUSIONS

30 cases were excluded from the uncomplicated group due to: high risk of fetal abnormalities, fetal loss, confirmed fetal abnormalities and utero-placental pathology. 374 women were considered as uncomplicated pregnancy. In both uncomplicated and complicated groups the mean values for pulsatility index (PI) were established. The mean PI value in uncomplicated pregnancies was: 0.91 (SD +/- 0.32). No significant differences between groups were noticed. In 370 cases of uncomplicated pregnancy the A wave direction was positive but in 1.1% of cases the reverse flow in atrial contraction was observed.

[Evaluation of pregnancy-associated plasma protein A (PAPP-A) and free beta subunit of human chorionic gonadotropin (beta hCG) levels and sonographic assesement of fetal nuchal translucency (NT) in singleton pregnancies between 11 and 14 weeks of gestation--Polish multi-centre research]

Evaluation of pregnancy-associated plasma protein A (PAPP-A) and free beta subunit of human chorionic gonadotropin (beta hCG) levels and sonographic assessment of fetal nuchal translucency (NT) in singleton pregnancies between 11 and 14 weeks of gestation--Poland's multi-centers research.

OBJECTIVES

Pregnancy-associated plasma protein A has been reported to be low in Down syndrome affected pregnancies during the first trimester of pregnancy. Enlarged nuchal translucency (NT) is observed in about 80% of fetuses affected with chromosomal abnormalities and congenital heart defects (CHD).

MATERIAL AND METHODS

The aim of this study were to determine value and the medians of free beta-human chorionic gonadotropin (beta-hCG) and pregnancy associated plasma protein-A (PAPP-A) and nuchal translucency thickness in the first trimester in a prospective study of a non-selected Polish population.

RESULTS

All examinations have been performed according to the Fetal Medicine Foundation (FMF) rules. We have included 800 women between 11 weeks 0 days and 13 weeks 6 days gestation into a biochemical examination. Women booked into the clinic were offered screening, using a combination of maternal serum free beta-hCG and pregnancy-associated plasma protein-A (PAPP-A) and fetal nuchal translucency thickness. The maternal serum were measured using the Kryptor analyzer (Brahms Diagnostica). All pregnant women have been divided into 2 groups younger than (first group) and older than (second group) 35 years of age.

CONCLUSIONS

Nomogrames for free beta-hCG and PAPP-A levels in physiological pregnancy between 11(+0) and 13(6) weeks were determined in the examined population. A positive correlation between PAPP-A and CRL levels, as well as a weak negative correlation between free beta-hCG and CRL, were demonstrated.

Ultrasonographic assessment of fetal nuchal translucency (NT) at 11th and 14th week of gestation--Polish multicentre study

THE AIMS OF THE STUDY WERE: To evaluate range and median values of NT in a large, unselected Polish population; to determine the value of the 95th percentile and the median values for NT for given weeks of late 1st trimester pregnancy and to determine the level of chromosomal aberration risk corresponding to the values of the 95th percentile in the examined groups; to examine the possible correlation between CRL, NT width as well as the mother's age with the risk of the most frequent chromosomal aberrations.

MATERIAL & METHODS

We have retrospective analyzed 7,866 pregnant women. All fetuses of this women had NT measurement performed, as well as CRL and assessed of the most frequent chromosomal abnormalities. The group of pregnant women was divided into 2 subgroups: until and above 35 years old. All population group was divided into 3 subgroups depending on gestational age (11, 12 and above 13th weeks of gestation).

RESULTS

The median of NT in all population group was 1.5 mm and 95th percentile was 2.4 mm, whilst in group with low risk median of NT and 95th percentile were the same and in group with high risk of chromosomal abnormalities respectively 1.5 mm and 2.5 mm. There were strong correlations between maternal age and the risk of most frequent chromosomal abnormalities from NT.

CONCLUSIONS

The obtained results of median values and the 95th percentiles of NT in the examined group and the age groups under 35 and 35 plus are similar to these quoted by FMF. The risk levels of trisomy of 21st chromosome were similar to the reference values used by FMF. With gestational age, NT value increases in a non-linear way, therefore it is incorrect to use the term "a normal value" for NT, therefore, only the risk level calculated with the dedicated software using NT and CRL measurements with maternal age should be stated.

Basal and postprandial gut peptides affecting food intake in lean and obese pregnant women

Maternal obesity has been reported as a risk factor for various maternal and fetal complications. The aim of the present study was to examine the patterns of basal and postprandial plasma concentrations of certain gut hormones affecting food intake such as acylated ghrelin, peptide YY(3-36) (PYY(3-36)), cholecystokinin (CCK), insulin and glucose in pregnant women with varying body mass gain during physiological pregnancy. The study included 34 women with singleton pregnancies in the 2(nd) trimester of gestation. The examined pregnant women were divided into 4 groups; I. control pregnancy (CP) with weight gain below 0.5 kg/week; II. overweight low weight gain <1 kg/week (OLWG), III. overweight high weight gain >1 kg/week (OHWG); morbidly obese pregnant with weight gain >1.5 kg/week (MOP). The basal acylated-ghrelin levels in MOP subjects were significantly higher than those in CP and no usual suppression of acylated ghrelin after the meal observed in CP as well as in OLWG and OHWG was found in MOP women. Basal PYY(3-36) plasma levels were similar in CP, OLWG and OHWG but in MOP was significantly reduced and no significant increase in hormone level, typically observed in CP, was detected after a meal in overweight or obese women studied. The fasting CCK and C-reactive protein (CRP) levels in MOP subjects were significantly higher than those in CP and other overweight women. In conclusion, we found that pregnant women with overweight and obesity exhibit significant changes in fasting and postprandial gut hormones affecting food intake such as acylated ghrelin, PYY(3-36) and CCK as well as in CRP and these changes might contribute, at least in part, the development of obesity in pregnancy.

[Spontaneus ductal closure in a fetus postnatally diagnosed as Adams-Olivier syndrome]

In utero isolated ductal closure is uncommon and can lead to congestive heart failure, fetal hydrops and death if not recognized. A case report of premature spontaneus ductal closure in the third trimester of pregnancy in a fetus postnatally diagnosed as Adams-Olivier Syndrome is presented. On ultrasound examination an intrauterine growth restriction, defects of bones of hands and feet as well as ventriculomegaly were found. No nonsteroid drug treatment during pregnancy was applied. Fetal echocardiography was performed following an abnormal four-chamber view. Premature ductal closure was diagnosed. Fetal echocardiogram showed absent flow in the ductus arteriosus, dilated right ventricle with decreased function, and moderate tricuspid and pulmonary valve insufficiency with no signs of fetal hydrops. An elective cesarean section was performed. All abnormalities observed on former echocardiogram exam withdrew within 3 months of infant's life. The infant stays in the tertiary care centre due to the extracardiac malformations.

[PI index value in fetal ductus venosus blood flow at 11-14 weeks in normal course of pregnancy]

OBJECTIVE

Development of ultrasound diagnostic with Doppler examination allows early and and more precise assessement of fetal anatomy and well-being.

DESIGN

Evaluation of blood flow parameters in fetal ductus venosus between 11 and 14 weeks of pregnancy was performed.

MATERIAL AND METHODS

Fetal anatomy, nuchal translucency, nasal bone and ductus venosus blood flow has been studied with transabdominal probe in 225 consecutive fetuses according to Fetal Medicine Foundation recommendations.

RESULTS

From total number of 225 cases finally ten women were excluded from analysis due to absent or reversed A-wave in DV blood flow. In remaining 215 cases mean value of PI was 0,94 (range 0,53-1,88), mean value of Vmax (S-wave) was 42,48cm/s (range 18,7-102,9cm/sek), and mean value of Vmin (A-wave)--11,91cm/s (range 1,13- 37,32 cm/sek).

CONCLUSIONS

PI index value slightly decreased with increasing CRL. There was no differences in mean blood flow velocity with CRL for S-wave. A decrease in mean blood flow velocity with CRL was noted for A-wave.

[Risk of fetal cytomegaly virus infection depending on number of CMV genome in mother's blood and amniotic fluid]

The cytomegalovirus infection is most common causes of intrauterine infection of the fetus. Using of serologic diagnostic methods the kind of infection is unknown. The aim of the study was assessment of the risk of CMV infection depending of genome account in mother's blood and I amniotic fluid. The study was performed in choosen pregnancies, in which we expected cytomegalovirus infection using serological criteria. In prenatal diagnostic CMV infection using QPCR, the best material is amniotic fluid. Mother's blood assessment of CMV genome count does not make growth diagnostic possibility of the assesement of transmission the infection from mother to fetus.

[Actual treatment options of twin-to-twin transfusion syndrome]

Twin-to-twin transfusion syndrome -TTTS is observed in 10-15% of monochorionic twin pregnancies. The pathogenesis of the syndrome is still unknown, and the mortality reaches 80-90% if not treated. There are two invasive treatment options of TTTS: Fetoscopic laser coagulation of the placental anastomoses and serial amniodrainages. Endoscopic laser coagulation of anastomoses is a more effective first-line treatment than serial amnioreduction for severe TTTS. The rate of major neurologic complications is higher in amnioreduction group, than in Fetoscopic group.

[Doppler assessment of the fetal asphyxia in pregnancies complicated by gestational hypertension and intrauterine growth retardation]

OBJECTIVES

Gestational hypertension is associated with a high morbidity for both mother and fetus. Doppler ultrasound has allowed the fetal circulation to be examined. Now it is possible to monitor the response of the fetal circulation to hypoxia.

DESIGN

The aim of this study was to determine flow patterns in fetal circulation from pregnancies complicated by gestational hypertension and intrauterine growth restriction.

MATERIALS AND METHODS

The investigation included 23 fetuses with signs of the gestational hypertension and intrauterine growth restriction. We evaluated cerebral-placental ratio (CPR) and pulsation index (PI) in the middle cerebral artery (MCA) and the umbilical artery (UA). We also evaluated flows in umbilical vein.

RESULTS

We observed abnormal flow pattern in all cases of analyzing fetuses. The most common abnormal flow was vein pulsation (48%).

CONCLUSIONS

All analyzing fetuses shown signs of the hypoxia. Present of the umbilical vein pulsation or decompensate of the brain sparing effect is closely related o increased perinatal mortality.

[Assessment of blood flow in the middle cerebral artery and the umbilical artery in fetuses with umbilical venous pulsations]

OBJECTIVES

Umbilical venous pulsation is an important sign of hemodynamic compromise, especially during fetal heart failure and asphyxia.

DESIGN

The aim of this study was to determine of the blow flow in the middle cerebral artery and the umbilical artery in fetuses with umbilical venous pulsations.

MATERIALS AND METHODS

The investigation included 18 fetuses with signs of the intrauterine growth restriction and umbilical venous pulsations after 28th weeks of gestation. We evaluated cerebral-placental ratio (CPR) and pulsation index (PI) in the middle cerebral artery (MCA) and the umbilical artery (UA).

RESULTS

We observed brain sparring effect in all cases of analyzing fetuses. There were 77,8% of abnormal flow pattern in umbilical artery. 13 fetuses had a single pulsation pattern in umbilical vein and another 5 had double pulsation pattern.

CONCLUSIONS

The coexistence of umbilical vein pulsation and abnormal flow pattern in umbilical artery is closely related to increased perinatal mortality.

[Prenatal diagnosis of Beckwith-Wiedemann syndrome in third trimester]

AIM OF THE STUDY

The aim of the study was to analyze prenatally recognized cases of Beckwith-Wiedemann syndrome (BWS) and further follow-up. We report the most common features which can help in prenatal diagnosing of that condition.

MATERIAL AND METHODS

3 fetuses diagnosed with BWS, referred for echocardiographic evaluation had been examined in referral centre from 2003-2005.

RESULTS

Mean gestational age at the diagnosis was 31 week. During ultrasound evaluation characteristic features were recognized: macrosomy, macroglossia, nephromegaly in all cases, polyhydramnion was associated in 2 cases. No congenital heart defect and any functional changes were found during ECHO. In one case prenatal karyotyping was performed and revealed normal karyotype. Postnatal karyotyping in remain two cases was normal in one and abnormal in second case (Moz 46XX (13/46XX-18, +MAR5).

CONCLUSIONS

1. Prenatal diagnosis of Beckwith-Wiedemann syndrome can be obtained based on characteristic ultrasound features in the third trimester. 2. Most common features of BWS diagnosed in prenatal ultrasound included: macrosomy, macroglossia, visceromegaly and polyhydramnios. 3. In utero diagnosis is important for further mode and time of delivery planning, also neonates' clinical condition directly after delivery and long-term postnatal prognosis. 4. Karyotyping is recommened in all cases of BWS.

[Diagnostic difficulties of Toxoplasma gondii infection in pregnant women. Is it possible to explain doubts by polymerase chain reaction?]

OBJECTIVES

Toxoplasma gondii infection during pregnancy is still a difficult problem in the contemporary perinatology. Difficulties met during interpretation of serological tests carried out in pregnant patients to detect Toxoplasmosis implies more and more frequent use of the Polymerase Chain Reaction (PCR).

DESIGN

To evaluate the dependence between serological tests and quantity of the Toxoplasma gondii genomes in mothers' blood and amniotic fluid or neonatal blood, the quantitative PCR (q-PCR) method was applied.

MATERIALS AND METHODS

The analysis was performed in 81 pregnant women. Maternal blood, amniotic fluid and newborns' umbilical blood samples were evaluated for the presence of Toxoplasma gondii DNA. IgG and IgM Toxoplasma gondii antibodies were evaluated by the ELISA method.

RESULTS

High seroprevalence (51.9%) of the Toxoplasma gondii was confirmed. Toxoplasma gondii genetic material in blood and/or amniotic fluid was found in 33 patients. It was stated that quantity of the protozoa and anti-IgM presence in mothers' blood are the factors influencing significantly the Toxoplasma gondii manifestation in amniotic fluid.

CONCLUSION

High suitability of PCR in diagnosis of Toxoplasmosis during pregnancy and vertical transmission was confirmed.

[Prenatal diagnostics of Toxoplasma gondii invasion by quantitative method of PCR-TaqMann]

Routine serological diagnosis of toxoplasmosis provides high sensitivity, but not high specificity. The high sensivity combined with high specifity offered by PCR-TaqMann as well as the degree of infection led us to investigate the presence and levels of T. gondii DNA in amniotic fluid, maternal and neonatal blood in cases of pregnancy where infection with this agent was suspected. Samples of amniotic fluid and blood were taken from pregnant women. Postnatal blood samples were also taken from their infants. Presence and levels of toxoplasma DNA was investigated using PCR-TaqMann. PCR products were detected by electrophoresis on polyacrylamide gel. The PCR-TaqMann test is highly sensitive, specific and useful method allowing detection of the parasite genome and assessement of its level.

[Detection of Toxoplasma gondii DNA by PCR in mother's blood, amniotic fluid and child's blood in selected cases of pathological pregnancy]

Prenatal screening of Toxoplasma gondii infection is controversial. The diagnosis is based on serological tests detecting IgM and IgG antibodies against T. gondii, but interpretation of these tests results is often confusing. It is commonly made retrospectively when serological screening indicates a possibility of recent infection. Most women have antibodies against T. gondii and serial testing is required only in monitoring of pregnancies where initial screening is negative. The introduction of Polymerase Chain Reaction (PCR) assay for detection of Toxoplasma gondii DNA in selected cases of pathologic pregnancies has permitted a more accurate and faster diagnosis of congenital toxoplasmosis infections.

[Usefulness of quantitative assessment of Toxoplasma gondii genome using PCR-TaqMan in amniotic fluid, maternal and neonatal blood in selected complications in pregnancy]

Routine serological diagnosis of Toxoplasmosis provides high sensitivity, but not high specificity. The high sensitivity combined with high specificity offered by PCR-TaqMan as well as the degree of infection led us to investigate the presence and levels of Toxoplasma gondii genome in amniotic fluid, maternal and neonatal blood in cases of pregnancy where infection with this agent was suspected.

MATERIALS AND METHODS

Samples of amniotic fluid and blood were taken from 28 women between the 16th and 40th week of gestational age. Postnatal blood samples were also taken from their infants. Included in the study group were women with IUGR, PROM, preterm delivery imminent, Toxoplasmosis in previous pregnancies, raised IgG or IgM anti-Toxoplasma antibody titers and with amniotic fluid disturbances (oligohydramnios and polyhydramnios). Presence and levels of Toxoplasma genome was investigated using PCR-TaqMan. PCR products were detected by electrophoresis on polyacrylamide gel.

RESULTS

Toxoplasma gondii genome was detected in blood from 13 women, 3 newborns and in amniotic fluid from one other women. Toxoplasma genome was detected in blood from one newborn, but was not detected in sample from its mother.

CONCLUSIONS

The PCR-TaqMan test is highly sensitive and specific method allowing detection of the parasite genome and assessment of its level. Limitations of this method are its relatively high cost and poor access to ABI PRISM 7700 (TaqMan) sequence detector. The PCR TaqMan is useful in cases, where serological tests for the presence of infections are ambiguous.

[Predictive usefulness of lipoproteins a -Lp (a) in cases of preeclampsia]

The causes of Pregnancy Induced Hypertension are still under study. A genetic cause has been suggested as well as raised activity of the blood lipid system, which is however determined genetically. One element of the lipid system is lipoprotein a, which may have a key role in prediction of preeclampsia. The aim of our study was to determine lipoprotein (a) concentration in women with preeclampsia and in healthy pregnancies, and to assess the usefulness of lipoprotein (a) concentration as prognostic factor of eclampsia. Sera from 19 women with preeclampsia and from 19 with healthy pregnancies were tested. Our results show that determination of lipoprotein (a) levels in preeclampsia may be significant as predictive factor of eclampsia.

Production of PEG-modified bovine hemoglobin: economics and feasibility

Bovine hemoglobin has many advantages as a blood substitute: a) it's ready availability; b) it's low cost; c) it's oxygen carrying capacity; and d) the ease with which it can be modified with polyethylene glycol (PEG) to improve its pharmacokinetic profile. This study investigates the potential of PEG-modified bovine hemoglobin as a cost-effective blood substitute.