P701 Usefulness of echocardiography in diagnosis and monitoring in patient with pulmonary embolism during pregnancy, a case report

Pulmonary embolism is one of the leading causes of maternal mortality despite a low incidence of during pregnancy. We present 32-year-old woman, in the 35 week of first pregnancy, admitted to the Intensive Care Unit with dyspnea, tachycardia, cyanosis. Echocardiography confirmed the presence of embolic material in the main trunk of pulmonary artery, spreading to the right pulmonary artery. D-dimer and troponin T level were elevated, BNP remained within the normal range. The risk in PESI scale was assumed as intermediate high. LMWH therapy was initiated, the patient was constantly monitored. Venous thrombotic disease in lower extremities was excluded by ultrasonography. The treatment was carried out under obstetric supervision. The clinical state gradually improved, the patient was hemodynamically stable. Serial echocardiographic testing, revealed gradual regression of changes in the pulmonary trunk. Normalization of troponins and lowering of BNP levels were observed. The pregnancy was terminated in 39 week, by cesarean section (obstetric indications). The LMWH was continued few days after delivery, as the patient started lactation. She decided to terminate lactation in a first week after delivery so the therapy was switched into rivaroxaban for at least 3 months. Echocardiography after 3 month confirmed lack of changes in pulmonary trunk, the risk of pulmonary hypertension was low. Echocardiography can be a method of choice for confirming and monitoring pulmonary embolism during pregnancy, in a situation of high or intermediate clinical risk and good visualization of changes in pulmonary arteries

Abstract P701 Figure. Embolism of pulmonary trunk and RPA

[Electroconization of uterine cervix efficacious method in cervical cancer prophylaxis: analysis of 2555 cases]

The authors tried to assess considerably of the cervical electroconisation in the cervical cancer prophylaxis. The 2555 women with cervical erosions were treated by electroconisation. The electroconisations were performed when cytological and colposcopical examinations were unsuspected and conservative treatment in these cases has failed. Histopathological studies after conisation's samples demonstrated in 97% cases paraphysiological cervical changes. In 3% treated women cervical intraepithelial neoplasia was diagnosed. In one case cervical carcinoma was diagnosed in postoperative material. In this study 97% efficiacy of cervical electroconisation was demonstrated. Authors suggest that cervical electroconisation is recommended method in the treatment of cervical paraphysiological changes and plays important role in cervical cancer prophylaxis.

[Colposcopy images of cervix in women with Gardnerella vaginalis infection]

Among micro-organisms infecting vagina whose dominant genus is GV anaerobic bacteria are often present. There are reports that GV infections of vagina and uterine cervix, apart from their well-known negative role in obstetrics practice can play a role in carcinogenic processes of uterine cervix. The aim of the study was to assess characteristic colposcopy images of cervix in women with Gardnerella vaginalis infection. The research was carried out on 1180 women hospitalised in the period of 14 months. Many observations lead to conclusions that pathognomic clinic feature of Gardnerella vaginalis infection of uterine cervix is visible in colposcope presence of clean, translucent mucus in external cervical os and opaque vaginal contents in the rear vaginal vault. High hydrogen ion concentration in vaginal contents (pH 6.0 and over) correlates with positive "fishy odour test" of this contents. Gardnerella vaginalis infection of vagina and uterine cervix concerns women with existing erosion-type changes of uterine cervix. Visible in colposcopic test restless and "spotted" images visible after Schiller test are pathognomic colposcopic features of Gardnerella vaginalis infection.

[Estimation of cytological smears in women with Gardnerella vaginalis infections of vagina and uterine cervix]

Among micro-organisms infecting vagina whose dominant genus is Gardnerella vaginalis anaerobic bacteria are often present. Well-known damaging tissues and cells features of anaerobic bacteria are taken under consideration as factors which are conductive to generating pathological changes in cervical epithelium. The aim of this study was evaluation of cytological smears (Pap smear, Gram stain and H + E stain) in women with Gardnerella vaginalis infections of vagina and uterine cervix. The research was carried out on 1180 women hospitalised in the prior of fourteen months in Obstetrics-Gynaecological Department of the Municipal Hospital in Kielce. It was proved that characteristic microscopic feature of vagina and uterine cervix Gardnerella vaginalis infection is the absence of lactic acid bacillus, Lactobacillus vaginalis in vaginal contents and a presence of a small number of polynuclear neutrophil leucocytes. Marker cells (clue cells) are easily recognised in microscopic image in vaginal smears stained by Gram's method as well as Papanicolaou method. High sensitivity and specificity of these markers suggest usefulness of cytological smears in diagnosing Gardnerella vaginalis infections.

[A case of cervix neck pregnancy--report on conservative treatment]

Authors presented successful conservative treatment early diagnosed cervical pregnancy. After this procedure abdominal hysterectomy was not necessary.

[Cancer and pathologic hyperplasia of endometrial mucosa. Clinical study]

The authors carried out a tentative evaluation of the factors regarded as increasing the proneness to endometrial cancer development. Particular attention was paid to pathological hyperplasia of the endometrium. The studied material consisted of 592 women (76 with endometrial cancer and 516 with endometrial hyperplasia). The incidence of pathological hyperplasia of the endometrium was six times higher than that of endometrial cancer. Endometrial cancer was found mainly in postmenopausal women. Apart from pathological hyperplasia of the endometrium, among other factors characterizing women developing endometrial cancer, hypertension should be mentioned in the first place. In the postoperative material obtained from women operated on for endometrial cancer (76 cases) and pathological endometrial hyperplasia (244 cases) the character of pathological changes in removed ovaries in 2/3 of the cases pointed to hyperplastic non-malignant lesions. In 1/3 of the women either no pathological changes or only fibrosis and ovarian tissue atrophy were found in the ovaries.

[Chlamydia trachomatis infections of the cervix and postoperative course]

In the paper authors consider the problem if Chlamydia trachomatis infection of urogenital tract exerts an influence on postoperative course in women who were operated in the gynaecology department. 186 women have been examined in this study. Using the criteria for selective screening for Chlamydia trachomatis infection proposed by Handsfield, 29 women with higher risk for chlamydial infection were seperated. The personal details have been obtained by standardized questionnaire. Using the immunoenzymatic test "Chlamydiazyme" the incidence of Chlamydia trachomatis infection of the cervical canal was studied in 29 women from groups of higher risk for this infection. No Chlamydia trachomatis antigens were found in this group. These results don't answer the question if Chlamydia trachomatis infection of urogenital tract exerts an influence on postoperative course in women who were operated in gynaecology department, because it is to small trial.