Publications by authors named "Andrzej Torbe"

54 Publications

Pregnancy and childbirth during the coronavirus pandemic - current stage of knowledge.

Pol Merkur Lekarski 2020 Dec;48(288):459-463

Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Poland.

SARS-CoV-2 (Severe Respiratory Syndrome Coronavirus-2), is a new strain of β-coronavirus. At the time of the current pandemic, pregnant women fear of infection by this pathogen and related consequences both for themselves and for their children. Adaptive changes occurring in the body of a pregnant woman can increase her susceptibility to infections, especially when it concerns the cardiopulmonary system. Clinical data relating to infection by this pathogen, referred to as Coronavirus Disease 2019 (COVID-19) in pregnant women are still limited. Most of the cases in which these data are available apply to the third trimester of pregnancy. This article provides an overview of a current knowledge and recommendations regarding the management of SARS-CoV-2 infection during pregnancy and its impact on the pregnancy outcome.
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December 2020

The temporal link between prenatal steroid therapy and labor.

Pol Merkur Lekarski 2020 Dec;48(288):394-398

Pomeranian Medical University of Szczecin, Poland: Department of Gynecology and Obstetrics.

Prematurity has been one of the greatest challenges faced by perinatal medicine for many years. The recommended therapy for women with threatened preterm labor at 24 to 34 weeks' gestation is a single course of glucocorticoids. The greatest benefits have been proven when labor occurs at least 24 hours, but no later than 7 days after steroid administration. Applied treatment is not without influence on neonates' development.

Aim: The aim of this study is to analyze the time between the administration of a course of glucocorticoids to patients with threatened preterm labor between 24 and 34 weeks of gestation and labor.

Materials And Methods: 459 deliveries by patients between 24 and 34 weeks' gestation who had received betamethasone (two 12 mg doses) or dexamethasone (four 6 mg doses) were analyzed. Their indications for glucocorticoid therapy were divided into four categories: the signs of threatened preterm labor, premature rupture of membranes, iatrogenic prematurity and cervical incompetence. The neonates (n=530) were divided into two main groups: group 1 of those born within the first 7 days (n1=127) and group 2 of those born more than 7 days (n2=403) after the glucocorticoids therapy. Statistical analysis was performed using the Statistica 13.3 software with calculations performed using the Mann- Whitney U and χ2 tests, assuming the level of statistical significance of <0.05 (p<0.05).

Results: The neonates born within the first 7 days after the glucocorticoid therapy accounted for 23.96% (127 children). The average time of delay between the course of glucocorticoids and labor was 33 days, with the longest interval being 116 days. The most common indications for glucocorticoids were iatrogenic causes in group 1 (35.40%) and the signs of threatened preterm labor (67.63%) in group 2.

Conclusions: The percentage of births at the recommended time after steroidotherapy (not later than 7 days) was lower than expected. The prenatal steroid therapy qualification methods, should be reanalyzed, especially when signs of preterm labor are observed.
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December 2020

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

Ginekol Pol 2020;91(11):693-699

Department Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Poland.

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.
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http://dx.doi.org/10.5603/GP.2020.0117DOI Listing
January 2020

The crown-rump length measurement - ISUOG criteria and clinical practice.

Ginekol Pol 2020;91(11):674-678

Clinical Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Poland.

Objectives: Significance of the crown-rump length (CRL) measurement criteria in the assessments of gestational age and actual precision in daily clinical practice.

Material And Methods: We recruited 806 pregnant women with singleton pregnancy and history of regular menstrual periods.We analysed retrospectively CRL measurements obtained during routine first trimester scan performed between 11 + 0 and 13 + 6 weeks gestation. Gestational age was calculated using both the last menstrual period (LMP) and the CRL. The images of the CRL measurements were assessed by the expert. The visual analysis of the images in terms of meeting the five criteria recommended by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) was performed. Statistical analysis were used to assess how the above-mentioned criteria influenced calculation of the gestational age.

Results: The study showed 323 out of 806 of the CRL measurements (40.1%) were qualified by a specialist as accurate, 279 (34.6%) as inaccurate, and 204 (25.3%) as inaccurate, but not changing the duration of a pregnancy. With the application in the assessment of the five criteria of the ISOUG 217 (26.9%), the following results of qualification were obtained: accurate - fulfilled ≥ 4, inaccurate 341 (42.3%) - fulfilled ≤ 2, whereas inaccurate, but not changing the duration of a pregnancy 248 (30.8%) - 3 criteria fulfilled. We found that only the neutralof the fetus demonstrated a significant corellation with the assessment of the duration of a gestation.

Conclusions: a) the accurate audit of the CRL measurements is recommended; b) neutral position of the fetus is the most important criterion out of 5.
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http://dx.doi.org/10.5603/GP.a2020.0098DOI Listing
January 2020

Reference Values of D-Dimers and Fibrinogen in the Course of Physiological Pregnancy: the Potential Impact of Selected Risk Factors-A Pilot Study.

Biomed Res Int 2020 24;2020:3192350. Epub 2020 May 24.

Department of Laboratory Diagnostics, Pomeranian Medical University, Szczecin, Poland.

Pregnancy predisposes to thrombotic hemostasis, reflected in the laboratory as, e.g., increased levels of D-Dimers and fibrinogen, but in physiological pregnancy, the risk of venous thrombosis does not increase. Risk may increase if gestational diabetes mellitus (GDM) or nicotinism coexists. Study aims were to determine reference values for D-Dimers and fibrinogen concentrations in each trimester of pregnancy, corrected for GDM and nicotinism. . The study involved 71 pregnant women aged 25-44 y. Venous blood was collected three times: in the first (11-14 weeks), second (20-22 weeks), and third (30-31 weeks) trimesters. D-Dimer concentrations were determined by an enzyme-linked fluorescence assay, fibrinogen concentrations by a coagulation method according to Clauss. . Significant increases in D-Dimers and fibrinogen concentrations were observed, increasing with successive trimesters ( ANOVA < 0.0001). Furthermore, a positive correlation between D-Dimers and fibrinogen was detected in the second trimester of pregnancy ( = 0.475; < 0.0001). In addition, a significantly higher fibrinogen concentration was found in women with GDM compared to without GDM ( = 0.0449). Reference ranges for D-Dimers were established, in trimester order, as follows: 167-721 ng/mL, 298-1653 ng/mL, and 483-2256 ng/mL. After adjusting for risk factors, significantly higher D-Dimer values (mainly second and third trimesters) were obtained: 165-638 ng/mL, 282-3474 ng/mL, and 483-4486 ng/mL, respectively. Reference ranges for fibrinogen were, in trimester order, 2.60-6.56 g/L, 3.40-8.53 g/L, and 3.63-9.14 g/L and, after adjustment for risk factors, 3.34-6.73 g/L, 3.40-8.84 g/L, and 3.12-9.91 g/L. . We conclude that the increase in D-Dimers and fibrinogen levels in women with physiological pregnancy was compounded by gestational diabetes (GDM) and nicotinism. Therefore, D-Dimers and fibrinogen pregnancy reference values require correction for these risk factors.
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http://dx.doi.org/10.1155/2020/3192350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273490PMC
March 2021

Cesarean scar pregnancy - case resports and literature review.

Pol Merkur Lekarski 2020 Jun;48(285):179-183

Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Poland.

The current increase in the percentage of cesarean sections is accompanied by a significant growth in the incidence of cesarean scar pregnancies (CSP) located in the lower uterine segment, while the advancements in diagnostic ultrasound techniques have led to an increased number of CSP diagnoses. A misdiagnosed cesarean scar pregnancy, or one that is diagnosed too late, is a threat to the pregnant patient's life, and predisposes her to such complications as hemorrhage or uterine rupture, which often necessitate hysterectomy and therefore result in irreversible fertility loss. In this paper 4 cases of ectopic pregnancies located within the cesarean scar in women hospitalized at the university clinical center, within a short span of merely three months in 2018, are presented. The purpose of this paper is to indicate to doctors and gynecology and obstetric societies that there is a very urgent need for drawing up guidelines for CSP management. To this effect, information about individual cases should be gathered and analyzed thoroughly, latest reports followed, and knowledge skills and experience shared in order to be able to work out a procedure that is both effective and as safe as possible.
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June 2020

COVID-19 and pregnancy - where are we now? A review.

J Perinat Med 2020 Jun;48(5):428-434

Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72 Av, 70-111 Szczecin, Poland.

The new acute respiratory disease severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is highly contagious. It has caused many deaths, despite a relatively low general case fatality rate (CFR). The most common early manifestations of infection are fever, cough, fatigue and myalgia. The diagnosis is based on the exposure history, clinical manifestation, laboratory test results, chest computed tomography (CT) findings and a positive reverse transcription-polymerase chain reaction (RT-PCR) result for coronavirus disease 2019 (COVID-19). The effect of SARS-CoV-2 on pregnancy is not already clear. There is no evidence that pregnant women are more susceptible than the general population. In the third trimester, COVID-19 can cause premature rupture of membranes, premature labour and fetal distress. There are no data on complications of SARS-CoV-2 infection before the third trimester. COVID-19 infection is an indication for delivery if necessary to improve maternal oxygenation. Decision on delivery mode should be individualised. Vertical transmission of coronavirus from the pregnant woman to the fetus has not been proven. As the virus is absent in breast milk, the experts encourage breastfeeding for neonatal acquisition of protective antibodies.
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http://dx.doi.org/10.1515/jpm-2020-0132DOI Listing
June 2020

The Jehovah's Witness obstetric patient - a literature review.

Anaesthesiol Intensive Ther 2019 ;51(5):390-403

Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Poland.

The patient's right to refuse blood transfusion must be honoured in case of its clear expression. Some special pharmacologic and/or surgical procedures can be useful in a Jehovah Witness (JW) parturient. In case of excess blood loss the maintenance of peripheral tissue oxygenation is crucial. Only a few hospitals have equipment for blood salvage, and alternative oxygen carriers have potentially lethal side effects. Findings suggest that obstetric facilities should develop special algo-rithms of management in the case of the JW obstetric patient, with written declaration of which elements of blood are not acceptable for the patient, early diagnosis and intensive treatment of anaemia in pregnancy, administration of antifibrinolytic agents before surgery, use of electric surgical tools to restore haemostasis, early detection and aggressive treatment of excessive blood loss and, last but not least, close cooperation between obstetricians and anaesthesiologists, including sharing the information about the patient's refusal of blood transfusion.
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http://dx.doi.org/10.5114/ait.2019.90991DOI Listing
September 2020

The sFlt-1/PlGF ratio values within the <38, 38-85 and >85 brackets as compared to perinatal outcomes.

J Perinat Med 2019 Sep;47(7):732-740

Department of Gynecology and Obstetrics, Pomeranian Medical University, Szczecin, Poland.

Background Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are used as markers of preeclampsia. The aim of this paper was to assess the correlations between the sFlt-1/PlGF ratio values within the <38, 38-85 and >85 brackets and perinatal outcomes in pregnancies that require determination of these markers. Methods A total of 927 pregnant patients between 18 and 41 weeks' gestation suspected of or confirmed with any form of placental insufficiency (preeclampsia, intrauterine growth restriction [IUGR], gestational hypertension, HELLP syndrome, placental abruption) were included in the study. In each of the patients, the sFlt-1/PlGF ratio was calculated. Patients were divided into three groups according to the sFlt-1/PlGF ratio brackets of <38, 38-85 and >85. Results Significantly worse perinatal outcomes were found in the sFlt-1/PlGF >85 group, primarily with lower cord blood pH, neonatal birth weight and shorter duration of gestation. Statistically significant correlations between the values of these markers and the abovementioned perinatal effects were found. Conclusion An sFlt-1/PlGF ratio value of >85 suggests that either preeclampsia or one of the other placental insufficiency forms may occur, which is associated with lower cord blood pH, newborn weight and earlier delivery. Determining the disordered angiogenesis markers and calculating the sFlt-1/PlGF ratio in pregnancies complicated by placental insufficiency may lead to better diagnosis, therapeutic decisions and better perinatal outcomes.
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http://dx.doi.org/10.1515/jpm-2019-0019DOI Listing
September 2019

The role of disordered angiogenesis tissue markers (sflt-1, Plgf) in present day diagnosis of preeclampsia.

Ginekol Pol 2019 ;90(3):173-176

Clinical Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Poland.

Preeclampsia and conditions associated with impaired placental perfusion develop in almost 10% of all pregnancies. Patho- logic angiogenesis is one of the processes observed in preeclampsia. sFlt-1, PlGF and the sFlt-1/PlGF ratio are new and promising angiogenesis-related biomarkers. Our paper describes the present status of, and clinical practice opportunities for, these factors. According to present data, sFlt-1, PlGF and the sFlt-1/PlGF ratio are very useful tools in assessing placental angiogenesis abnormalities associated with preeclampsia and can be use in clinical practice.
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http://dx.doi.org/10.5603/GP.2019.0030DOI Listing
February 2020

sFlt-1/PlGF and Doppler ultrasound parameters in SGA pregnancies with confirmed neonatal birth weight below 10th percentile.

Pregnancy Hypertens 2018 Oct 17;14:79-85. Epub 2018 Aug 17.

Department of Obstetrics and Gynecology, Pomeranian Medical University, Szczecin, Poland.

We explored whether there was a relationship between the sFlt-1/PlGF ratio in early-late and late-onset SGA patients and whether it is associated with neonatal birth weight.

Material/methods: 110 patients who were diagnosed with a fetal weight below the 10th percentile for gestational age and who at the same time delivered neonates with a birth weight below the 10th percentile for gestational age. For each of the patients sFlt-1, PlGF and the sFlt-1/PlGF ratio were studied and uterine artery (UtA) and umbilical artery (UA) Doppler were performed.

Results: sFlt-1/PlGF ratios and neonatal birth weight which showed significant negative correlation across the entire population studied (R = -0.46, p < 0.001). In late-onset SGA patients this negative correlation was observed, as well (R = -0.54, p < 0.001) In the group of patients with pregnancies older than 34 weeks and an sFlt-1/PlGF ratio ≥38, we observed a significantly lower neonatal birth weight when compared to the same gestational age group with an sFlt-1/PlGF ratio <38 (2045 g vs 2405 g, p < 0.001).

Conclusion: Late-onset SGA syndromes are characterized by lower sFlt-1/PlGF ratios, which indicates a lower degree of placental function impairment. The sFlt-1/PlGF ratio can be a predictor of more significant growth disorders and a lower neonatal birth weight. The sFlt-1/PlGF ratio can be helpful in distinguishing between disordered angiogenesis-dependent and other causes of late-onset SGA cases.
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http://dx.doi.org/10.1016/j.preghy.2018.08.448DOI Listing
October 2018

Novel View on Umbilical Cord Blood and Maternal Peripheral Blood-an Evidence for an Increase in the Number of Circulating Stem Cells on Both Sides of the Fetal-Maternal Circulation Barrier.

Stem Cell Rev Rep 2017 Dec;13(6):774-780

Stem Cell Institute at James Graham Brown Cancer Center, University of Louisville, 500 S. Floyd Street, Rm. 107, Louisville, KY, 40202, USA.

Umbilical cord blood (UCB) is a rich source of stem cells, including hematopoietic stem cells (HSCs), mesenchymal stem cells (MSCs), endothelial progenitors cells (EPCs), and very small embryonic-like stem cells (VSELs). These cells most likely are mobilized into UCB in response to hypoxia and delivery stress. We have hypothesized that they may play a role in repairing certain tissue/organ injuries that occur in the newborn child after delivery. Here we asked whether delivery also mobilizes stem cells into maternal blood, as the mother also experiences hypoxia and several types of internal tissue injuries, particularly in the reproductive tract. We observed that the number of HSCs, MSCs, EPCs, and VSELs increases in maternal blood at 24 h after physiological delivery (n = 17). Based on this observation, we propose that delivery stress is associated with an increase in the number of circulating stem cells, not only on the fetal side but also on the maternal side of the fetal-maternal circulatory barrier.
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http://dx.doi.org/10.1007/s12015-017-9763-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5730629PMC
December 2017

Do the physiological aging of the placenta and the changes in angiogenesis marker sFlt-1 and PlGF concentrations predispose patients to late-onset preeclampsia?

J Matern Fetal Neonatal Med 2019 Jan 29;32(1):11-20. Epub 2017 Aug 29.

a Department of Obstetrics and Gynecology , Pomeranian University of Medicine , Szczecin , Poland.

Objective: Aging of the placenta is associated with natural processes that impair its functions. The processes are related to both oxidative stress exacerbation and the occurrence of higher concentrations of disordered angiogenesis markers. Both these types of processes are known to play roles in the development of preeclampsia. We attempted to show that natural ageing of the placenta can be one of the cofactors contributing to the development of late-onset preeclampsia.

Patients, Materials And Methods: 159 pregnant patients were divided into four groups: Two of preeclampsia patients and two of patients with physiological pregnancies, depending on the gestational age. For each group, disordered angiogenesis markers sFlt-1 and PlGF before and after 34 weeks of gestation and in particular stages of gestation were analyzed.

Results: Lower PlGF and sFlt-1/PlGF ratio values were found in cases of late-onset preeclampsia. In physiological pregnancies, sFlt-1 values were observed to increase and PlGF values to decrease with gestational age. An association was shown to exist between disordered angiogenesis markers and gestational age both in preeclampsia and physiological pregnancies.

Conclusions: (1) Analyses of disordered angiogenesis markers in early- and late-onset preeclampsia patients and patients with physiological pregnancies allow for a suggestion that natural "ageing of the placenta" and placental hypoperfusion lesions exacerbating with the advancing gestational age are some of the causes of late-onset preeclampsia. (2) Cases of early-onset preeclampsia are associated with more severe changes of disordered angiogenesis marker concentrations, which may be indicative of a more considerable impairment of placental perfusion in such patients. (3) In the course of the physiological pregnancy, there is a gradual increase in sFlt-1 and decrease in PlGF, which implies an elevated angiogenesis disorder that progresses with the gestational age.
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http://dx.doi.org/10.1080/14767058.2017.1369517DOI Listing
January 2019

[Outline of the history of caesarean section – from ancient times to the end of 17th Century].

Przegl Lek 2017;74(1):48-50

Problems with the childbirth accompanied the human civilization since its beginning. From the ancient times, physicians and other people specializing in healing, tried to help women in this special moment of life. At the base of this exceptional meaning of childbirth for humans lies the fact, that if something is going wrong there are two victims - mother and the child. As a result, many times there had been very dramatic attempts of help in this the most difficult journey which in his life every man is undergoing. In this paper a comprehensive review of literature about the history of caesarean section from ancient times to the end of 17th century was done.
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June 2018

Maternal endothelial damage as a disorder shared by early preeclampsia, late preeclampsia and intrauterine growth restriction.

J Perinat Med 2017 Oct;45(7):793-802

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Introduction: Preeclampsia (PE) and intrauterine growth restriction (IUGR) are separate disease entities that have frequently been reported as sharing the same pathogenesis. In both of them, angiogenesis disorders and generalized endothelial damage with an accompanying inflammation are the dominant symptoms. In this study, we attempted to prove that both these processes demonstrate the same profile in early PE, late PE and IUGR patients, while the only difference is in the degree of exacerbation of the lesions.

Patients, Materials And Methods: In 167 patients divided into four groups, three of those with early PE, late PE and IUGR and one control group, fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), high sensitive c-reactive protein (hsCRP) and fibronectin were determined. The behavior of these parameters in each of the groups was studied, and correlations between them were sought for.

Results: Higher concentrations of sFlt-1, hsCRP and fibronectin and a lower concentration of PlGF were found in the study groups compared to the control group. Significant correlations were observed between the factors concerned.

Conclusions: The higher values of disordered angiogenesis markers, endothelial damage markers and inflammatory markers both in the PE and the intrauterine growth restriction (IUGR) groups suggest the existence of shared disorders in the development of these pathologies. The correlations between disordered angiogenesis markers and endothelial damage markers argue in favor of a mutual relationship between these two processes in the development of pathologies evolving as secondary to placental ischemia. The results obtained confirm that the lesion profiles are the same in both PE and IUGR patients, which can be utilized in developing common diagnostic criteria.
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http://dx.doi.org/10.1515/jpm-2016-0178DOI Listing
October 2017

Using Doppler ultrasound of the uterine and umbilical arteries and disordered angiogenesis markers (sFlt-1/PlGF) in unified monitoring of ischemic placental syndrome patients.

Hypertens Pregnancy 2016 Nov 17;35(4):490-498. Epub 2016 Jun 17.

a Department of Gynecology and Obstetrics , Pomeranian Medical University , Szczecin , Poland.

Objective: The shared pathogenesis of placental ischemia entitles us to create a single treatment model. We attempted to develop a unified method for monitoring ischemic placental syndrome patients using Doppler ultrasound of the uterine and umbilical arteries and disordered angiogenesis markers sFlt-1 and PlGF.

Material And Methods: 182 pregnant women suffering from the ischemic placental syndrome were divided into four groups depending on the severity of their lesions revealed in the Doppler ultrasound examination and weeks of pregnancy. We analyzed the behavior of clinical and biochemical parameters in these groups and the correlations between the ultrasound examination and the disordered angiogenesis markers.

Results: In the group of patients demonstrating more severe Doppler ultrasound lesions, the clinical and biochemical parameters were significantly more expressed, whereas unfavorable obstetric events occurred either earlier or more frequently. Lesions revealed in Doppler occur more commonly in groups before 34th week of pregnancy. Disordered angiogenesis markers are significantly correlated with ultrasound examination results.

Conclusions: A unified method for monitoring the ischemic placental syndrome based on pathogenetic, biophysical (Doppler ultrasound), and biochemical (sFlt-1/PlGF) parameters is feasible and constitutes a valuable supplement to the existing standards, while the high correlations between Doppler ultrasound examinations and both sFlt-1 and PlGF point to a shared pathogenesis of the lesions. Intensity of Doppler changes is connected with time of testing and pregnancy duration.
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http://dx.doi.org/10.1080/10641955.2016.1186688DOI Listing
November 2016

A Common Profile of Disordered Angiogenic Factor Production and the Exacerbation of Inflammation in Early Preeclampsia, Late Preeclampsia, and Intrauterine Growth Restriction.

PLoS One 2016 19;11(10):e0165060. Epub 2016 Oct 19.

Department of Gynecology and Obstetrics, Pomeranian Medical University, Szczecin, Poland.

Preeclampsia and intrauterine growth restriction are two separate disease entities that, according to numerous reports, share the same pathogenesis. In both, angiogenesis disorders and generalized inflammation are the dominant symptoms. In this study, we hypothesized that both diseases demonstrate the same profile in early preeclampsia, late preeclampsia, and intrauterine growth restriction patients, with the only difference being the degree of exacerbation of lesions. One hundred sixty-seven patients were enrolled in the study and divided into four groups: early preeclampsia, late preeclampsia, and intrauterine growth restriction groups, and one control group. Concentrations of the angiogenesis and inflammatory markers soluble fms-like tyrosine kinase receptor 1, placental growth factor, high-sensitivity C-reactive protein, and interleukin-6 were determined, and the behavior of these markers and correlations among them were studied. Higher concentrations of soluble fms-like tyrosine kinase receptor 1, high-sensitivity C-reactive protein, and interleukin-6 and a lower concentration of placental growth factor were observed in the study groups compared with the control group. No differences in concentrations of the studied markers were found among the study groups but significant correlations were observed. The higher values for the angiogenesis and inflammatory markers both in preeclampsia patients and patients with intrauterine growth restriction of placental origin compared with the control group suggest the existence of the same underlying disorders in the development of these pathologies. The observed mutual correlations for disordered angiogenesis and inflammatory markers are suggestive of a mutual relationship between these processes in the development of pathologies evolving secondary to placental ischemia. The same lesion profile was observed for both preeclampsia and 'placental' intrauterine growth restriction patients, which could be used in developing common diagnostic criteria for pregnant patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0165060PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070778PMC
June 2017

Diagnostic Potential of Evaluation of SDF-1α and sRAGE Levels in Threatened Premature Labor.

Biomed Res Int 2016 31;2016:2719460. Epub 2016 Jul 31.

Department of Obstetrics and Gynecology, Pomeranian Medical University, Ulica Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland.

Preterm birth remains the most prevalent cause of neonatal morbidity. This study aimed to evaluate the diagnostic value of SDF-1α, resistin, secretory RAGE (sRAGE), and endogenous secretory RAGE (esRAGE) in preterm labor. A total of 211 pregnant women participated in the study. Group A contained 72 women between 22 and 36 weeks of gestation, with premature labor, who finally had preterm birth. Group B contained 66 women in labor between 37 and 41 weeks of gestation. Women in group A had lower SDF-1α and sRAGE levels than those in group B. Moreover, in group A, SDF-1α and sRAGE levels were correlated with the latency period from the occurrence of premature labor symptoms until delivery. Sensitivity and specificity of studied parameters for prediction of preterm birth were 95% and 40% for SDF-1α and 51.3% and 93.5% for sRAGE, respectively. The prognostic value of plasma SDF-1α and sRAGE levels was comparable with that of cervical length ultrasound measurement and serum C-reactive protein levels. We conclude that SDF-1α and sRAGE appear to play a major role in the diagnosis of preterm birth and its evaluation could be convenient and useful for predicting preterm birth.
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http://dx.doi.org/10.1155/2016/2719460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4983339PMC
February 2017

The Determination of Procalcitonin Concentration in Early-Onset Neonatal Infection.

Clin Pediatr (Phila) 2017 Apr 20;56(4):333-340. Epub 2016 Jul 20.

1 Pomeranian Medical University, Szczecin, Poland.

The aim of this study was to assess the clinical usefulness of blood procalcitonin (PCT) levels for the diagnosis and therapeutic monitoring of early-onset neonatal sepsis (EONS). PCT as well as C-reactive protein (CRP) levels and white blood cell (WBC) count were measured in venous blood from 57 infected and 72 uninfected neonates. Differences between groups for PCT, CRP, and WBC levels were significant. The threshold value on the receiver operating characteristic curve in the prediction of EONS was 5.33 ng/mL for PCT, 9.3 mg/L for CRP, and 14.9 × 10/L for WBC. There was no effect of antibiotic administered to the mother on PCT, CRP, and WBC levels in neonatal blood sampled before treatment of EONS. Evidently reduced PCT levels are observed after 2 days of treatment. The authors conclude that prenatal antibiotic therapy does not reduce the value of PCT levels in blood for the diagnosis of EONS.
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http://dx.doi.org/10.1177/0009922816656622DOI Listing
April 2017

[Physical activity recommended in the early postpartum period].

Pomeranian J Life Sci 2016;62(3):53-6

Despite the growing emphasis on the need for pregnant women to keep an appropriate level of physical activity, less attention is devoted to the aspects associated with physical activity after childbirth. Physical activity is indicated in the postpartum period, and properly targeted and practiced exercises promote faster regression of the changes in body caused by childbearing. However, the possibilities to undertake physical activity at this time, especially at the first days of puerperium, are very limited. This paper presents the principles of undertaking physical activity in the early puerperium period. Exercises aimed at preventing the effects of immobilization, especially venous thrombosis, and the rules of early mobilization in the postpartum period are described. Special attention is paid to transverse abdominal muscle training, and to the correct activation of pelvic floor muscles.
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May 2018

Ischemic placental syndrome--prediction and new disease monitoring.

J Matern Fetal Neonatal Med 2016 7;29(12):2033-9. Epub 2015 Oct 7.

c Department of Laboratory Diagnostics , Pomeranian University of Medicine , Szczecin , Poland.

The last decade has seen an improved understanding of the cause of the development of pathologies such as gestational hypertension, preeclampsia, intrauterine growth restriction, intrauterine fetal death or placental abruption. Nowadays, we know that most conditions within this group share the same pathogenesis, the cause of which is placental ischemia. The following review is an attempt to propose a new method for prediction, diagnosis and--above all--appropriate monitoring of pregnant women and fetuses developing the ischemic placental syndrome with the use of tests that are new but yet widely available in clinical diagnosis. They are closely related to the condition's pathogenesis, therefore their elevated levels may predate clinical symptoms, and--most importantly--they correlate with syndrome aggravation and the occurrence of complications. Perhaps, the new look will allow us to improve perinatal results by reducing mortality and severe complications in pregnant women and fetal deaths resulting from sudden intrauterine fetal death or placental abruption.
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http://dx.doi.org/10.3109/14767058.2015.1072165DOI Listing
January 2017

Soluble and Endogenous Secretory Receptors for Advanced Glycation End Products in Threatened Preterm Labor and Preterm Premature Rupture of Fetal Membranes.

Biomed Res Int 2015 27;2015:568042. Epub 2015 Aug 27.

Department of Obstetrics and Gynecology, Pomeranian Medical University, 70-204 Szczecin, Poland.

The aim of the study was to compare sRAGE and esRAGE plasma levels in pregnant women with (A) threatened premature labor (n = 41), (B) preterm premature rupture of membranes (n = 49), and (C) preterm rupture of membranes at term (n = 48). The relationship between these and classic intrauterine infection markers and the latent time from symptoms up to delivery depending on RAGE's concentration were investigated. In groups A and B, a positive correlation was found between plasma sRAGE and latent time (r = 0,422; p = 0,001; r = 0,413, p = 0,004, resp.). High prognostic values were found in both groups for plasma sRAGE concentration and the latent time from symptoms up to delivery. Groups B and C presented higher levels of esRAGE than group A (526,315 ± 129,453 pg/mL and 576,212 ± 136,237 pg/mL versus 485,918 ± 133,127 pg/mL, p< 0,05). The conclusion is that sRAGE concentration can be a favorable prognostic factor in the presence of symptoms of threatened premature labor. Higher esRAGE plasma level in case of the rupture of membranes in mature and premature pregnancy suggests its participation in fetal membranes destruction.
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http://dx.doi.org/10.1155/2015/568042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4564602PMC
July 2016

Development of a focal segmental glomerulosclerosis after pregnancy complicated by preeclampsia: case report and review of literature.

J Matern Fetal Neonatal Med 2016 11;29(10):1566-9. Epub 2015 Jun 11.

a Department of Obstetrics and Gynecology and.

The global incidence of preeclampsia has been estimated at 3-5% of all pregnancies. It is the main cause of morbidity and mortality among pregnant women and their fetuses worldwide. In preeclampsia, the incorporation of cytotrofoblast into the spiral arteries is incomplete. Changed placenta releases into the mother's circulation soluble VEGF receptor-1 (sFlt-1) which causes many disorders including kidney damage. VEGF is produced by glomerular podocytes and is necessary for their normal function. The damage of podocytes leads to a glomerulosclerosis development. The damage of the critical number of podocytes contributes to the development of focal segmental glomerulosclerosis - kind of glomerulonephritis. We present a case of woman who as a result of preeclampsia developed focal segmental glomerulosclerosis manifested as nephritic syndrome. We describe a mechanism for the development of such changes in glomeruli in the course of preeclampsia.
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http://dx.doi.org/10.3109/14767058.2015.1053865DOI Listing
December 2016

Soluble receptors for advanced glycation end products and receptor activator of NF-κB ligand serum levels as markers of premature labor.

BMC Pregnancy Childbirth 2015 Jun 10;15:134. Epub 2015 Jun 10.

Department of Obstetrics and Gynecology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland.

Background: This study aimed to determine the relationships between secretory and endogenous secretory receptors for advanced glycation end products (sRAGE, esRAGE), sRANKL, osteoprotegerin and the interval from diagnosis of threatened premature labor or premature rupture of the fetal membranes to delivery, and to evaluate the prognostic values of the assessed parameters for preterm birth.

Methods: Ninety women between 22 and 36 weeks' gestation were included and divided into two groups: group A comprised 41 women at 22 to 36 weeks' gestation who were suffering from threatened premature labor; and group B comprised 49 women at 22 to 36 weeks' gestation with preterm premature rupture of the membranes. Levels of sRAGE, esRAGE, sRANKL, and osteoprotegerin were measured. The Mann-Whitney test was used to assess differences in parameters between the groups. For statistical analysis of relationships, correlation coefficients were estimated using Spearman's test. Receiver operating characteristics were used to determine the cut-off point and predictive values.

Results: In group A, sRAGE and sRANKL levels were correlated with the latent time from symptoms until delivery (r = 0.422; r = -0.341, respectively). The sensitivities of sRANKL and sRAGE levels for predicting preterm delivery were 0.895 and 0.929 with a negative predictive value (NPV) of 0.857 and 0.929, respectively. In group B, sRAGE and sRANKL levels were correlated with the latent time from pPROM until delivery (r = 0.381; r = -0.439). The sensitivity of sRANKL and sRAGE for predicting delivery within 24 h after pPROM was 0.682 and 0.318, with NPVs of 0.741 and 0.625, respectively. Levels of esRAGE and sRANKL were lower in group A than in group B (median = 490.2 vs 541.1 pg/mL; median = 6425.0 vs 11362.5 pg/mL, respectively).

Conclusions: Correlations between sRAGE, sRANKL, and pregnancy duration after the onset of symptoms suggest their role in preterm delivery. The high prognostic values of these biomarkers indicate their usefulness in diagnosis of pregnancies with threatened premature labor.
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http://dx.doi.org/10.1186/s12884-015-0559-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4461927PMC
June 2015

Congenital candidiasis as a subject of research in medicine and human ecology.

Ann Parasitol 2014 ;60(3):179-89

Congenital candidiasis is a severe complication of candidal vulvovaginitis. It occurs in two forms,congenital mucocutaneous candidiasis and congenital systemic candidiasis. Also newborns are in age group the most vulnerable to invasive candidiasis. Congenital candidiasis should be considered as an interdisciplinary problem including maternal and fetal condition (including antibiotic therapy during pregnancy), birth age and rare genetic predispositions as severe combined immunodeficiency or neutrophil-specific granule deficiency. Environmental factors are no less important to investigate in diagnosing, treatment and prevention. External factors (e.g., food) and microenvironment of human organism (microflora of the mouth, intestine and genitalia) are important for solving clinical problems connected to congenital candidiasis. Physician knowledge about microorganisms in a specific compartments of the microenvironment of human organism and in the course of defined disorders of homeostasis makes it easier to predict the course of the disease and allows the development of procedures that can be extremely helpful in individualized diagnostic and therapeutic process.
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December 2014

Urinary lysosomal enzyme excretion in pregnant women with hypertensive disorders.

Hypertens Pregnancy 2014 Aug 11;33(3):349-59. Epub 2014 Apr 11.

Department of Obstetrics and Gynecology .

Background: The authors assessed proximal renal tubular dysfunction and/or damage in pregnant women with various types of hypertension by measuring the three urinary lysosomal enzyme levels: N-acetyl-β-d-glucosaminidase (NAG), arylsulfatase A and β-glucuronidase.

Methods: The study consisted of 120 pregnant women divided into four groups: 41 women in 20th week of gestation or more, with pregnancy-induced hypertension (PIH group), 28 pregnant women after 20 weeks of pregnancy with pre-eclampsia (PE group), 21 pregnant women with chronic hypertension, identified before 20th week of pregnancy (CH group) and 30 healthy, pregnant women (healthy controls (HC) group).

Results: Statistical analysis showed significantly higher levels of all the three of lysosomal enzymes in the urine of patients with PE compared with the healthy pregnant women, pregnant women with PIH and the ones with chronic hypertension. Additionally, significantly higher values of NAG were found in the group of pregnant women with PIH compared with healthy pregnancies. No correlation was found between the concentration of enzymes in urine and values of blood pressure in any of the analyzed groups of pregnant women.

Conclusions: The authors conclude that higher values of all the studied enzymes in PE group, in the comparison with the other groups, indicate proximal tubular damage at the cellular level. The lack of correlation between the concentration of lysosomal enzymes and blood pressure suggests that the damage to these parts of kidney is complex. In addition, mechanisms other than hypertension realizing intracellular enzymes may be involved in this process.
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http://dx.doi.org/10.3109/10641955.2014.898305DOI Listing
August 2014

Pregnancy delivery and puerperium in a patient with lysinuric protein intolerance--a case report.

Ginekol Pol 2013 Jul;84(7):654-6

Department of Obstetrics and Gynecology, Pomeranian Medical University, Szczecin, Poland.

The paper presents the course of pregnancy delivery and early postpartum period in a 23-year-old woman with lysinuric protein intolerance (LPI). The pregnancy was uneventful and resulted in a caesarean birth to a healthy baby at 37 weeks gestation. Nevertheless, the course of pregnancy in women with LPI is associated with a significantly increased risk of serious complications, including acute hyperammonemia, preeclampsia and postpartum bleeding, as well as fetus intrauterine growth retardation. In many cases, intensive metabolic monitoring and a proper diet with protein limitation and appropriate amino acids supplementation may significantly reduce the risk for both the mother and the newborn.
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http://dx.doi.org/10.17772/gp/1621DOI Listing
July 2013

Uterine rupture in the second trimester of pregnancy as an iatrogenic complication of laparoscopic myomectomy.

Medicina (Kaunas) 2012 ;48(4):182-5

Department of Obstetrics and Gynecology, Pomeranian Medical University, 72 Powstańców Wielkopolskich Avenue, 70-111 Szczecin, Poland.

Uterine rupture is one of the most dangerous obstetric emergencies carrying a high risk for the mother and the fetus. Reports about uterine rupture in pregnancy following previous laparoscopic surgery have not been frequent; however, an increasing rate of the occurrence of this complication has been observed and reviewed in contemporary literature. We report a case of a spontaneous uterine rupture at 22 weeks of gestation in a 25-year old primigravida, who had had a laparoscopic removal of a small, peduncular, asymptomatic myoma located in the right uterine horn 20 months earlier. Ultrasound examination and subsequent urgent laparotomy confirmed a spontaneous uterine rupture with a nonviable fetus in the peritoneal cavity. Women planning to become pregnant should be qualified for laparoscopic myomectomy with special carefulness. Special attention must be paid to the potential solutions that limit the risk of postoperative uterine rupture, if the absolute necessity for the enucleation of myomas during the reproductive age occurs and a decision about laparoscopic intervention is made.
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January 2013

[The influence of patient-controlled epidural analgesia on labor progress and neonatal outcome].

Ginekol Pol 2012 Feb;83(2):92-8

Klinika Połoźnictwa i Ginekologii Pomorskiego Uniwersytetu Medycznego, Szczecin, Polska.

Aim: The aim of the study was to check the influence of patient control epidural analgesia on labor progress and neonatal outcome.

Material And Methods: 144 parturients were included into the clinical trial. In 73 cases patient control epidural analgesia was used and in 71 cases pethidine (meperidine) solution was given intravenously. Apgar score, umbilical artery pH, pain intensity the time of the first, second and third stage of labor the rate of episiotomy and uterine postpartum abrasions and the rate of caesarean sections and vaginal operative delivery were compared.

Results: The time of the second stage of labor was significantly longer in the study group (40.99 vs 26.49 min, p- < 0.005), the neonatal outcome was comparable in both groups. There were no differences in the time of the first and the second stage of labor in primiparas and multiparas analyzed separately. Visual Analogue Score was lower in the study group (Ch(2)-12,48, p-0.25), especially in the subgroups of primiparas and multiparas.

Conclusions: Patient control epidural analgesia does not affect the time of the first and second stage of labor, oxytocin augmentation of labor may be the reason of that. This method is a more effective way of relieving labor pain. An increase of operative delivery is not observed after patient control epidural analgesia on condition that low doses and concentrations of analgesic drugs are used.
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February 2012