Ultrasonographic pattern of spontaneous resolving fetal ovarian cyst: a case report

Fetal ovarian cyst is diagnosed at the rate of one per 2,500 live births and its behaviour in utero may range from spontaneous resolution with no further consequences to torsion, necrosis, and to the necessity of surgical treatment in the postnatal stage. Ovarian cyst torsion in a fetus results in the loss of its reproductive function in adult life. The authors present a case of spontaneous resolving fetal ovarian cyst. The lesion was diagnosed during an ultrasound scan in 30th week of pregnancy. An ultrasound scan performed two weeks later revealed symptoms of cyst torsion; the lesion was 5.7 cm in diameter, heterogeneous, and had a normoechogenic inside. A subsequent ultrasound exam showed a lesion with a diameter of 2.16 cm. An ultrasound exam of the newborn's abdominal cavity performed on the second day showed that the cyst was six mm in diameter. However, the cyst did not show on an ultrasound scan made on the fourth day.

[The importance of fibronectin in amniotic fluid in anticipation of premature labor]

We analysed 86 pregnant women where we estimated the fibronectin level in specimens of amniotic fluid. During carrying out the experiment we noted that fibronectin is present in amniotic fluid and can be identified in a quantity mode. We have proved dependence between fibronectin level in amniotic fluid and the period of time from collecting the sample, up to the delivery. Fibronectin level in amniotic fluid doesn't depend on pregnancy duration, preterm rupture of amniotic membranes.

[Ultrasonographic assessment of cervical length and measurement of fetal fibronectin level in cervical secretion of pregnant women in prophylaxis of premature deliveries]

OBJECTIVE

The aim of this study was to assess the usefulness of the assessment of cervical length and and measurement of fetal fibronectin level in cervical secretion of pregnant women in prophylaxis of premature deliveries.

MATERIAL AND METHODS

78 pregnant women hospitalized in Department of Fertility and Obstetrics, University School of Medicine Wrocław. They were divided into III groups: Group I-13 pregnant women who had premature delivery and the time between examination and delivery was no longer than 24 hours. Group II-20 women who had premature delivery, and the time between examination and delivery was longer than 24 hours. Group III-pregnant who delivered at term (control group). Between the 25th and the 34th week of pregnancy presence of fetal fibronectin in cervical secretion and ultrasonographic assessment of cervical length were done.

RESULTS

Significantly higher percentage of women with presence of fibronectin in cervical secretion and significantly shorter length of cervical length was stated in 13 pregnant women who delivered prematurely, between the 28th and 35th week of pregnancy comparing with other groups. In group II pregnant women delivered between the 28th and 35th week of pregnancy, and the time between examination and delivery was from 3 days to 4 weeks. In this group in 75% examined women fibronectin was present in cervical secretion. Significant was that cervical length in 14 of this group of women (70%) was no longer than 20 mm and in the rest was between 20-30 mm, moreover in no cases was longer than 30 mm. In group III only in 7% women presence of fibronectin in cervical secretion was stated and only in two cases (4%) cervical length was shorter than 20 mm, both of them delivered in 38th week of pregnancy.

CONCLUSIONS

1. Examination of fetal fibronectin in cervical secretion allows precisely estimate the risk of premature delivery. 2. Cervical length shorter then 20 mm collerates with the presence of fetal fibronectin in cervical secretion and with increased risk of premature delivery.

[The course of pregnancy, delivery and puerperium in women with varices and thrombophlebitis of lower extremities, after application of low molecular weight heparins]

OBJECTIVES

Estimation of the long term prophylactic or therapeutic application of low molecular weight heparin (LMWH) on the platelets count, and incidence bleedings during pregnancy, delivery and puerperium in the women with varices of lower extremities and past thrombophlebitis of lower extremities.

MATERIAL AND METHODS

5212 pregnant, women in labour and in puerperium divided into 4 groups.; 142 women with varices and thrombophlebitis of lower extremities (group I); 10 with past thrombophlebitis of lower extremities (group II); 15 with thrombophlebitis in current pregnancy; 5045 without vascular complications (group IV--control). In group I during pregnancy compression therapy was applied (stockings) and low molecular weight heparins (LMWH) in course of puerperium. In group II during the 1st trimester of pregnancy and in labour the same heparin doses were administered, while the doses were increased in the 2nd and 3rd trimester. In group III, when thrombophlebitis was stated non-steroid anti-inflammatory drugs and LMWH were administered. In all cases treated with heparin both number of platelets and incidents of bleedings from genitourinary tract were observed. Presence of embolic complications was also noted.

RESULTS

No cases of decrease platelets number or bleedings from genitourinary tract were observed in group I-III during administering of LMWH. In women in group II where prophylactic with LMWH was applied no incidences of recurrent thrombophlebitis during pregnancy and puerperium were observed. In group I-III all newborns were born in good condition and no complications were observed. Average blood loss during both labour and cesarean section, among women in group I-III was not significantly different comparing with control group. No incidences of pulmonary artery embolism or decrease number of platelets were observed.

CONCLUSIONS

1. The long term prophylactic or therapeutical administration of LMWH in the women with varices of lower extremities or thrombophlebitis has no influence on the platelets count and incidence of bleedings from genitourinary tract during pregnancy or increase of blood loss during labour and puerperium. 2. In the women with past thrombophlebitis of the lower extremities after application of LMWH during pregnancy there were no recurrence observed.

[Comparison of vaginal misoprostol and oxytocin for labor induction in post-term pregnancy]

OBJECTIVES

To compare labour induction intervals between vaginal misoprostol and intravenous oxytocin as well as side effects of induction in post term pregnancies with intact membranes.

METHODS

One hundred women were retrospectively selected to two groups treated with vaginal misoprostol 50 micrograms every 12 hours as needed to maximum 150 micrograms and treated with intravenous oxytocin. The primary outcome measure was time from induction to vaginal delivery. Statistical analysis was performed by t-Student test.

RESULTS

Maternal age, parity, gestation were similar. There was a statistically important difference in labour induction intervals between the two groups. The mean time +/- SD to vaginal delivery in misoprostol group was 20.6 +/- 15.2 hours compared with 11.23 +/- 7.4 hours with oxytocin (p = 0.0396). Induction of labour failed in 12% and 32% in misoprostol and oxytocin treated group. Pethidine consumption in oxytocin treated group was higher (41 mg vs 89 mg, p = 0.04). Episodes of vomiting were more frequent in misoprostol treated group (22% vs 6%). There were no episodes of uterine hyperstimulation in both groups.

CONCLUSIONS

Oxytocin stimulation resulted in a shorter induction to delivery interval. In misoprostol group induction failed in only 12% whereas in oxytocin group in 32%. There were no serious side effects in both groups. In misoprostol treated group patients required less analgetics then in oxytocin treated group.

[Non-closure of the visceral peritoneum during abdominal gynecological surgery]

OBJECTIVES AND STUDY DESIGN

The analysis of influence of closure and nonclosure of the visceral peritoneum during abdominal gynecological surgery was done.

MATERIALS AND METHODS

A postoperative course and late consequences (occurrence of adhesions) in the 427 patients were studied. There were two groups of patients: I group--203 patients who had visceral peritoneum closed, II group--224 patients who had visceral peritoneum non closed.

RESULTS

There were not significant differences in postoperative course in both groups. In the group where the visceral peritoneum was not closed occurrence of the adhesions was significantly decreased, when compared the group where the visceral peritoneum was closed.

CONCLUSIONS

1. Nonclosure of the visceral peritoneum doesn't increase the incidence of early postoperative complications. 2. Nonclosure of the visceral peritoneum during abdominal gynecological surgery decreased the incidence of adhesions. 3. Nonclosure of the visceral peritoneum prevents dislocation and ligation of the ureter.

[Assessment of the effectiveness of using low molecular weight heparin in the prophylaxis of venous thrombo-embolic diseases in obstetrics]

OBJECTIVES

Assessment of the effectiveness of using low molecular weight heparin in the prophylaxis of venous thrombo-embolic diseases in pregnant women, parturients and puerperants.

MATERIAL AND METHODS

14,106 female patients were retrospectively analysed in the period between 1990-1999. The patients were divided into 4 groups: I--142 pregnant patients with crural varices, II--10 pregnant patients who had suffered from deep venous thrombosis, III--5 patients with implanted artificial cardiac valves, IV--13,949 patients without any risk factors. In the patients in groups I-III low molecular weight heparin was used prophylactically.

RESULTS

In the studied groups no cases of pulmonary embolism were observed. Superficial venous thrombosis occurred in 10 women (3 in group I and 7 in group IV). Deep venous thrombosis occurred in 5 patients (2 in group I and 3 in group IV). In patients who received low molecular weight heparin over a long period of time, no excessive bleeding during delivery was observed. Other complications in the form of osteoporosis and thrombocytopenia were also not observed.

CONCLUSIONS

1. Administering of low molecular weight heparin during pregnancy, labour and puerperium has no influence on the increase of maternal et fetal complications. 2. Administering of low molecular weight heparin in pregnant women, in labour and in puerperium with increase risk of thrombo-embolic disease allows to avoid pulmonary arteries embolism. 3. Pregnant women and women in puerperium with increased risk of venous thrombo-embolic disease should be under control of experienced obstetrician in cooperation with vascular surgeon and hematologist.

[Fibronectin level in amniotic fluid as an index of unavoidable labor]

During uterus contractions detaching of amino-chorionic layer from uterus wall occurs and released fibronectin penetrates into amniotic fluid. The aim of this study was to estimate in a quantity mode the presence of fibronectin in amniotic fluid and to find the dependence between the fibronectin level in amniotic fluid and the period of time from collecting the sample to the labor. We wanted also to find the dependence between fibronectin level in amniotic fluid and duration of pregnancy, preterm rupture of amniotic membranes, patients' age, parity and number of deliveries. We analysed 86 pregnant women where we estimated the fibronectin level in specimens of amniotic fluid. During carrying out the experiment we noted that fibronectin is present in amniotic fluid and can be identified in a quantity mode. We have proved dependence between fibronectin level in amniotic fluid and the period of time from collecting the sample, up to the delivery. Fibronectin level in amniotic fluid in pregnancies uncomplicated with premature delivery was on the average 350 mg/ml. Increase of fibronectin in amniotic fluid above 700 mg/ml points at detaching of amino-chorionic layer and the occurrence of unavoidable preterm labor at the time no longer than 24 hours. Fibronectin level in amniotic fluid doesn't depend of pregnancy duration, preterm rupture of amniotic membranes.

[The influence of computer supervision of deliveries on the medical procedures during labor and neonatal post-delivery status]

OBJECTIVES

The aim of the study was estimation of the influence of computer supervision of delivery on the way of medical management during partus.

MATERIALS AND METHODS

Authors analyzed 10,983 labours which took place in years 1990-1999 in University Clinic of Reproduction and Obstetrics of Medical Academy in Wrocław. Cases of labours without computer monitoring was the first analyzed group, and the cases of computer monitoring deliveries was the second group. In both groups, the count of cesarean sections performed because of first symptoms of fetal asphyxia, and Apgar score gained by newborns, were taken into consideration.

RESULTS AND CONCLUSIONS

The frequency of cesarean sections and neonatal Apgar score gained by newborns were compared in two characterized group in order to evaluation the influence of computer monitoring deliveries on the neonatal status. No impact of computer supervision on the way of delivery procedures, quality of work and neonatals state was observed.

[The use of oxytocin and prostaglandin in pregnancies after cesarean delivery or uterine surgery]

OBJECTIVES

Evaluation of risks involved with the use of oxytocin and prostaglandin in pregnancies after caesarean delivery or uterine surgery.

MATERIALS AND METHODS

This study involved 267 pregnant women who underwent caesarean delivery or gynaecological surgery within the uterus (myomectomy or Strassmann corrective surgery). Oxytocin and prostaglandin was used to induce uterine contraction in these women. We analysed their delivery methods and the frequency of complications like uterine rupture and rupture of past caesarean scar.

RESULTS

Uterine rupture occurred in one women had history of caesarean delivery (0.5%), and rupture past history of caesarean scar occurred in eight women (3.5%) who previously underwent caesarean delivery. Complications were not found in women with past history of myomectomy or Strassmann Corrective surgery. We did not observe an increase in complications among women who received prostaglandin compared to those who received oxytocin.

CONCLUSIONS

1. Cardiotocographic monitor during labour reduces the risk of uterine rupture and rupture of past caesarean scar in pregnant women with past history of caesarean delivery or other uterine surgeries. 2. The use of prostaglandin in comparison to oxytocin does not increase complications in women with past history of uterine surgery. 3. The choice of delivery method in pregnant women with past history of uterine should be individualised.

[Results of surgical treatment of urinary stress incontinence women]

OBJECTIVES

Analysis of early and late effects of surgical treatment at women suffering from the urinary stress incontinence.

MATERIALS AND METHODS

There were examined 52 patients treated surgically with urinary stress incontinence, and treated with perineoplasty (group I), treated with Marshall-Marchetti-Krantz procedure (group II), or both types of operations at the same time (group III). Early results of treatment were estimated at the 8th-10th day after surgical procedure, and late after two-eight years considering clinical and ultrasound examinations, and individual feelings of the patient.

RESULTS

A very good therapeutical effect of surgical treatment was obtained at 75% of patients, but the late one at 42% of patients. The early effect was the best within the group II (88%), whereas the late one within the group I, the worst results were obtained within the group III. The period between the procedure and repeated disorder was the longest within the group I. At women operated before menopause there were noted very good effects at 61% of them, but at those patients operated after menopause--at 38%, whereas the late repeated disorder often concerned the women operated before than after menopause (adequately 65 and 35%).

CONCLUSION

The treatment of the urinary stress incontinence employing perineoplasty compared with Marshall-Marchetti-Krantz procedure proved slighter risk of recurrence, slighter intensity and longer period without disorders. The application of both perineoplasty and Marshall-Marchetti-Krantz procedures simultaneously are more ineffective than of those procedures applied individually. Early effects of surgical treatment of urinary stress incontinence are better at patients operated before menopause, however more stable effect was noted at women operated after menopause.