Microplastics and additives in patients with preterm birth: The first evidence of their presence in both human amniotic fluid and placenta

Considering the well documented, almost ubiquitous nature of microplastics in different environments, the exposure of pregnant women to microplastics may pose risks to the unborn children. The study focused on investigating the presence of microplastics in amniotic fluid and placenta, and brings the first evidence of the simultaneous presence of microplastics and additives in both human amniotic fluid and placentas. In total, 20 samples of amniotic fluid and placenta from 10 patients were analyzed for the presence of microplastics and plastic additives by Fourier transform infrared spectroscopy - attenuated total reflectance (FTIR-ATR) after alkaline digestion with KOH. In 9 out of 10 patients, microplastics or additives were found in amniotic fluid, placenta, or both. Specifically, 44 particles of microplastics and polymer additives were identified in all samples. Chlorinated Polyethylene (CPE) and Calcium zinc PVC Stabilizer with particle sizes between 10 and 50 μm prevailed. Although all women involved in this study, who provided placenta and amniotic fluid samples, experienced physiological, singleton pregnancies complicated with preterm prelabour rupture of membranes (PPROM), it is too early to draw any conclusions and more research is needed.

Acute appendicitis in pregnancy - do we treat correctly, or do we delay unnecessarily?

OBJECTIVES

Acute appendicitis is the most common non-gynaecological indication for surgical intervention during pregnancy. The aim of this study was to compare perioperative and postoperative results of surgical treatment of acute appendicitis in the early and late stage of pregnancy.

MATERIAL AND METHODS

This is a retrospective study focused on the evaluation of perioperative and postoperative results of appendectomy in pregnancy. The study included all pregnant patients who underwent laparoscopic or open appendectomy at the University Hospital Ostrava during the observed 10-year period (January 2012-December 2021). The patients were divided into two subgroups according to the stage of pregnancy in relation to the expected viability of the foetus (the viability limit was defined as the 23rd week of pregnancy).

RESULTS

In the monitored 10-year period, a total of 25 pregnant patients underwent appendectomy. Comparing the two subgroups of patients, there were no statistically significant differences in any of the admission parameters. Laparoscopy was performed in 100% of the patients in the lower stage of pregnancy (< 23 g.w.) and in 61% of the subgroup of patients with more advanced pregnancy (> 23 g.w.); this difference was statistically significant (p = 0.039). Differences in subgroups regarding duration of surgery, risk of revision and 30-day postoperative morbidity were not statistically significant. In the subgroup of patients < 23 g.w., uncomplicated forms of appendicitis predominated (66%), whereas in the subgroup > 23 g.w., complicated forms predominated (69%); this difference was statistically significant (p = 0.026). When comparing the two subgroups of patients, there was a statistically significant difference in the length of hospitalization (p = 0.006). The mortality rate of the group was zero.

CONCLUSIONS

The results of the study confirm the fact that advanced pregnancy may be related to complicated forms of appendicitis. Therefore, early appendectomy is still the method of choice. In accordance with the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) recommendations, laparoscopic approach is preferred in pregnant patients, even in advanced pregnancy.

Is there a difference between acute appendicitis in pregnant and non-pregnant women?

OBJECTIVE

Acute appendicitis is the most common indication for surgical intervention during pregnancy for non-gynaecological or non-obstetric causes. The aim of this study was to compare perioperative and postoperative outcomes of acute appendectomies in pregnant and non-pregnant patients of childbearing age.

METHODS

A retrospective clinical study focused on the comparison of perioperative and postoperative outcomes of acute appendectomy in pregnant and non-pregnant patients of reproductive age between January 2012 and December 2021 at the University Hospital in Ostrava.

RESULTS

A number of 308 patients underwent acute appendectomy, 25 pregnant and 283 non-pregnant. There were no statistically significant differences in age, ASA (American Society of Anesthesiologists) classification, duration of complaints, baseline C-reactive protein values, sensitivity or specificity of sonography. A statistically significant difference was found in the leukocyte count between subgroups (P = 0.014) and in the number of laparoscopic procedures performed between the two subgroups (P < 0.001; 98.9% non-pregnant vs. 80.0% pregnant). There was also a statistically significant difference in the length of hospital stay, with the pregnant subgroup having a longer hospital stay (P = 0.014) and a statistically significant difference in the rate of postoperative complications between the defined subgroups (P = 0.039). Serious complications were described predominantly in the subgroup of pregnant patients, where they reached 12% compared to non-pregnant patients, where they were 2.8%. The mortality rate of the cohort was zero.

CONCLUSION

The results of the study support the fact that pregnancy may be associated with complicated forms of acute appendicitis. Accurate and early diagnosis not only prevents the development of complicated forms of appendicitis but also reduces the number of negative appendectomies in pregnancy.

Echogenic foci in fetal heart from a pediatric cardiologists point of view

OBJECTIVES

To evaluate the occurrence and the significance of echogenic foci in the fetal heart and to assess the prognosis of the fetus and child.

SETTING

Department of Pediatrics and Prenatal Cardiology, Department of Pediatrics, University Hospital, Faculty of Medicine, Ostrava.

DESIGN

Original article.

METHODS

A retrospective study was conducted between 2008-2017. Fetal echocardiography was performed in the second trimester of pregnancy in the study population. The identification of echogenic heart foci, and their follow up during and after the pregnancy were performed by a pediatric cardiologist.

RESULTS

In the monitored period, a total of 27,633 fetuses were examined. Isolated cardiac hyperechogenic foci were detected in 3% (829/27,633) of the fetuses. The foci was found in 93%, 5%, and 2% in the left ventricle, mainly in valvular apparatus of the mitral valve, in the both ventricles, and in the right ventricle, respectively. In 1% (11/829) of the fetuses with cardiac echogenic foci, the others concomitant pathologies (tricuspid regurgitation, extrasystoles, renal pathology) were found. No genetic abnormalities were detected in the fetuses with cardiac hyperechogenic foci.

CONCLUSION

The echogenic focus in fetal heart is a relatively common, mostly insignificant finding, with any serious consequences for the fetus and the child.

[Development of prenatal diagnostics of congenital heart defects, profit of standardized scanning planes]

OBJECTIVE

To audit the development and success rate of prenatal detection of congenital heart defects (CHDs), and to evaluate the effectiveness of diagnostics performed in standardized scanning planes.

SETTING

Department of Pediatrics, University Hospital Ostrava.

DESIGN

Retrospective study.

METHODS

Ultrasound examination of fetal heart (fetal echocardiography) was performed in the second trimester pregnancy. The observed region was the Moravian-Silesian region; the assessment was performed in the retrospective study performed between 2000- 2016. The knowledge of all significant heart defects in the region, processing of data from genetic reporting, further examination of all prenatal pathologies by a pediatric cardiologist, presence of a pediatric cardiologist at all autopsies, with a precise description of the defect, birth of a pathological new-born at a specialized centre. Analysis of detected CHDs was performed in relation to the ultrasound scans used.

RESULTS

During the monitored 17-year period, a total of 748 (3.8 cases per 1,000 foetuses) of prenatally identified and postnatally significant CHDs were observed in the total population of 198,300 foetuses. There were 53% (393/748) CHDs detected prenatally and 47% (355/748) of cases were not prenatally recognized. The effectiveness of CHD screening has improved progressively, from the initial 10% up to the current 74%. The best results were obtained using the basic four-chamber (4CH) scan; the results in practice gradually decreased, from the basic 4CH projection to the aortic arch.

CONCLUSION

The effectiveness of prenatal detection of congenital heart defects gradually improves, namely in cases of hypoplasia and significant ventricular anomalies, with up to 100% prenatally detected cases in the past three years. The level of detection statistically decreases, from the four-chamber projection to out-flow tracts, great arteries and the aortic arch. Congenital heart defect is generally well detectable prenatally, and is usually observed as an isolated anomaly. The most important factors include a precise diagnosis, overall examination of the pregnancy and correct counselling provided for the affected family.

[Ultrasound diagnosis of fetal inflammatory response syndrome in women with preterm premature rupture of membrane]

OBJECTIVE

The aim of this review is to analyze the existing possibilities of using ultrasound in the diagnosis of the fetal inflammatory response.

DESIGN

Review.

SETTINGS

Gynekologicko-porodnická klinika, Fakultní nemocnice Ostrava.

METHODS

Preterm delivery is defined as a delivery before completed 37 weeks of gestation. Approximately one-thirdof these cases is associated with preterm premature rupture of membranes. About forty percent of preterm premature rupture of membranes is complicated by the fetal inflammatory response syndrome, which is associated with the development of severe perinatal morbidity. Recent prenatal diagnosis of the fetal inflammatory response syndrome is based on the invasive methods (amniocentesis, cordocentesis), which are limited by several risk factors accompanying these procedures and technical difficulties. Therefore, there is an effort to replace them by non-invasive approach. The development of ultrasound, as a diagnostic method through the last decade, and knowledge of pathophysiological and morphological changes in fetal organs associated with the fetal inflammatory response may lead to more specific diagnosis in the future and improvement of neonatal outcome.

CONCLUSION

Early identification of fetuses affected by FIRS in pregnancies with PPROM is necessary for right management of these pregnancy pathology. At this moment, ultrasonography examination of fetal lineal vein and fetal echocardiography, seems to be suitable for diagnosing FIRS.