Publications by authors named "Anna Kajdy"

22 Publications

  • Page 1 of 1

Fetal Growth Diagnosis and Management among Perinatal Medical Professionals: A Survey of Practice and Literature Review.

Fetal Diagn Ther 2021 Apr 6:1-11. Epub 2021 Apr 6.

Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland.

Introduction: This paper aimed to assess the knowledge of healthcare professionals (obstetric and gynecology residents, specialists, and midwives) in the field of perinatal medicine regarding fetal growth diagnosis and management.

Methods: A questionnaire was created consisting of a set of questions regarding demographic data, methods of growth assessment, and management. It was a handout survey. The results were analyzed with the use of descriptive statistics and χ2 analysis using the program Statistica.

Results: 190 medical professionals have participated in the questionnaire. 86.3% of respondents agreed that pregnancy dating should be modified based on first-trimester ultrasound. 90.9% agreed that III trimester ultrasound has a ±15% margin of error. When asked which growth charts are best fit for assessing growth in a studied population, 10.7% marked standard, 37.4% reference, 26.2% customized, and 26.2% did not know the difference between the three choices. 60.3% stated that they use a growth chart to assess growth and qualify fetuses for monitoring. 70.2% used the 10th centile as a cutoff, 20.1% 5th centile, and 9.7% 3rd centile. Only 40.9% would diagnose fetal growth restriction based on fetal weight only. 28.7% using the 10th centile cutoff, 16.1% 5th centile, and 54.0% 3rd centile. Only a quarter of the respondents were able to name the growth chart or tool that they use for assessment. The most common responses were Yudkin, Hadlock, and online calculators of Fetal Medicina Barcelona and the Fetal Medicine Foundation.

Discussion: A lot of confusion is observed primarily in the aspect of cutoff values for identification, subsequent monitoring, and management of fetal growth restriction. There is a need for extensive training and education in this field and uniform national recommendations.
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http://dx.doi.org/10.1159/000514504DOI Listing
April 2021

Fetal Growth Acceleration-Current Approach to the Big Baby Issue.

Medicina (Kaunas) 2021 Mar 2;57(3). Epub 2021 Mar 2.

Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004 Warsaw, Poland.

: Fetal overgrowth is related to many perinatal complications, including stillbirth, cesarean section, maternal and neonatal injuries, and shoulder dystocia. It is related to maternal diabetes, obesity, and gestational weight gain but also happens in low-risk pregnancies. There is ongoing discussion regarding definitions, methods of detection, and classification. The method used for detection is crucial as it draws a line between those at risk and low-risk popula-tions. : For this narrative review, relevant evidence was identified through PubMed search with one of the general terms (macrosomia, large-for-gestational-age) combined with the outcome of interest. : This review summarizes evidence on the relation of fetal overgrowth with stillbirth, cesarean sections, shoulder dystocia, anal sphincter injury, and hem-orrhage. Customized growth charts help to detect mothers and fetuses at risk of those complica-tions. Relations between fetal overgrowth and diabetes, maternal weight, and gestational weight gain were investigated. : a substantial proportion of complications are an effect of the fetus growing above its potential and should be recognized as a new dangerous condition of Fetal Growth Acceleration.
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http://dx.doi.org/10.3390/medicina57030228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001449PMC
March 2021

Large-for-gestational-age or macrosomia as a classifier for risk of adverse perinatal outcome: a retrospective cross-sectional study.

J Matern Fetal Neonatal Med 2021 Feb 18:1-8. Epub 2021 Feb 18.

Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland.

Objective: Small for gestational age (SGA) fetuses and neonates are of great interest, while those who are too big are much less studied. The aim was to analyze the classifiers described by ACOG "Fetal macrosomia" practice bulletin as predictors of adverse perinatal outcomes for overgrown fetuses and their mothers.

Materials: From a database of 53,586 singleton term births, appropriate-for-gestational-age (AGA), large for gestational age (LGA), and macrosomic deliveries were selected. AGA served as a control. The crude and adjusted odds ratios (aORs) were calculated for large-for-gestational-age >90th centile, and macrosomia >4000 g, >4250 g, and >4500 g. Patients with and without diabetes were analyzed separately

Results: Macrosomia >4000 g performed poorer than other classifiers. LGA performed comparably to other definitions of macrosomia. Diabetes carries a severe risk of complications for overgrown neonates, but those non-diabetic also have increased risk.

Conclusions: Definition of macrosomia as weight >4000 g should be reconsidered. LGA >90th centile should be used as a definition of fetal overgrowth along with other definitions of macrosomia.
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http://dx.doi.org/10.1080/14767058.2021.1887127DOI Listing
February 2021

A unique case of diagnosis of a heterotopic pregnancy at 26 weeks - case report and literature review.

BMC Pregnancy Childbirth 2021 Jan 18;21(1):61. Epub 2021 Jan 18.

Department of Reproductive Health, Centre of Postgraduate Medical Education, 90 Żelazna St, 01-044, Warsaw, Poland.

Background: Heterotopic pregnancy (HP) is a rare condition when at least two pregnancies are present simultaneously at different implantation sites and only one located in the uterine cavity. The majority of cases are diagnosed in the first trimester.

Case Presentation: We present a unique case of HP diagnosed at 26 weeks of spontaneous pregnancy in a patient without any relevant risk factors. We performed an extensive review of HP cases from MEDLINE (PUBMED) published in English between 2005-2019 to prove this case's uniqueness. A 24-year-old woman presented because of threatened preterm birth. Despite treatment, pain aggravated, without progression of labor. An emergency ultrasound exam revealed free fluid in the abdominal cavity. Suspicion of active bleeding prompted the medical team to perform an exploratory laparotomy. The surgery team found a ruptured heterotopic pregnancy. This was an unexpected cause of nontraumatic hemoperitoneum at such advanced gestational age. The postoperative period was uneventful, and the intrauterine pregnancy continued to term. The final review included 86 out of 124 records. A total number of 509 cases were identified, but not all of them had complete data. The maximum reported gestational age at the time of diagnosis was 16 weeks of pregnancy, while our case became symptomatic and was diagnosed at 26 weeks of pregnancy.

Conclusions: Regardless of pregnancy age, HP can be a cause of hemoperitoneum, and it should be included in the differential diagnosis of acute abdomen in the second trimester.
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http://dx.doi.org/10.1186/s12884-020-03465-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7814709PMC
January 2021

Uterine Artery Doppler Reference Ranges in a Twin Caucasian Population Followed Longitudinally From 17 to 37 Weeks Gestation Compared to Singletons.

J Ultrasound Med 2021 Jan 13. Epub 2021 Jan 13.

Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland.

Objectives: The primary aim was to measure uterine artery (UtA) indices in twin pregnancies of Polish Caucasian women and compare it with a previously published study by Geipel et al for DC twins (2011). The secondary aim was to find differences in UtA indices in MC, DC twins, and singletons.

Methods: A prospective longitudinal evaluation of UtA Doppler indices in 1462 examinations of twins and 5766 examinations of singletons between 17 and 37 gestational age (GA). Pulsatility index (PI) and resistance index (RI) were calculated.

Results: UtA PI and RI are lower in the twins than singletons but the analyzed mean values throughout gestation are higher than the study presented by Geipel et al. Obtained curves for DC twins and singletons had the same form as Geipel's curves. In MC twins, curves are flatter and characterized by lower differences throughout pregnancy than Geipel's curves for DC twins. They tend to be more similar about 32 weeks of gestations, resulting from different placenta structure in MC than DC twin pregnancies.

Conclusions: UtA Doppler indices in twin pregnancies are lower than in singletons. Obtained data have higher values for twins than reference charts proposed by Geipel's for dichorionic twins. We observed some differences between monochorionic and dichorionic twins' curves throughout pregnancy, but they were not significant.
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http://dx.doi.org/10.1002/jum.15627DOI Listing
January 2021

Application of artificial intelligence in screening for adverse perinatal outcomes: A protocol for systematic review.

Medicine (Baltimore) 2020 Dec;99(50):e23681

Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw.

The article presents a systematic review protocol. The aim of the study is an assessment of current studies regarding the application of artificial intelligence and neural networks in the screening for adverse perinatal outcomes. We intend to compare the reported efficacy of these methods to improve pregnancy care and outcomes. There are more and more studies that describe the role of machine learning in facilitating the diagnosis of adverse perinatal outcomes, like gestational diabetes or pregnancy hypertension. A systematic review of available literature seems to be crucial to compare the known efficacy and application. Publication of a systematic review in this category would improve the value of future studies. The studies reporting on artificial intelligence application will have a major impact on future prenatal practice.
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http://dx.doi.org/10.1097/MD.0000000000023681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738040PMC
December 2020

What are the Critical Elements of Satisfaction and Experience in Labor and Childbirth-A Cross-Sectional Study.

Int J Environ Res Public Health 2020 12 12;17(24). Epub 2020 Dec 12.

Educational Research Institute (IBE), 01-180 Warsaw, Poland.

The labor experience and satisfaction with childbirth are affected by the care provided (external factors) and individual variables (internal factors). In this paper, we present a descriptive analysis that aims to indicate the strongest correlates of birth experience among a wide range of indicators. The study is a prospective, cross-sectional, self-report survey. It includes the experiences of women giving birth in public and private hospitals in Poland. The two main variables were birth experience and satisfaction with care. The analysis consists of three parts: data pre-processing and initial analysis, explorative investigation, and regression analysis. Among the 15 variables with the highest predictive value regarding birth experience were being informed by the medical personnel, communication, and birth environment. The most significant variables among 15 variables, with the highest predictive value regarding care, were those concerning support, information, and respectful care. The strongest predictor for both, birth experience and satisfaction with care, is the sense of information, with logit coefficients of 0.745 and 1.143, respectively, for birth experience and satisfaction (0.367 and 0.346 for standardized OLS coefficient). The findings demonstrate that by using explanatory variables, one can predict a woman's description of her satisfaction with perinatal care received in the hospital. On the other hand, they do not have such a significant and robust influence on the birth experience examined by the variables. For both the birth experience and satisfaction with care, the sense of being informed is the highest predictor.
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http://dx.doi.org/10.3390/ijerph17249295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764244PMC
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

Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: A web-based cross-sectional survey.

Medicine (Baltimore) 2020 Jul;99(30):e21279

Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR.

Introduction: The article presents a protocol of a cross-sectional study of mental health of pregnant women in relation to the coronavirus disease 19 (COVID-19) pandemic. The primary aim is to compare differences in anxiety and depression scores of pregnant women between countries affected by the COVID-19 pandemic. The secondary aim is to assess demographic, economic, and social aspects affecting maternal anxiety and depression scores among pregnant women worldwide in the time of the COVID-19 pandemic. Finally, we will be able to compare differences in perception of the different aspects of the COVID-19 pandemic (social distancing, restrictions related to delivery) between countries and according to the epidemic status (number of infected patients, number of reported deaths). The comparisons will also be done according to the COVID-19 status of the participants.

Methods And Analysis: It is a web-based anonymous survey of pregnant women living in countries affected by the COVID-19 pandemic. The survey is comprised of 3 sections:Web-based recruitment for health research has proven to be cost-effective and efficient. At current times with the COVID-19 pandemic, limited resources and social distancing restrictions, performing a mental health study involving pregnant women on a large international scale cannot be safely conducted without involving social-media.The fears of pregnant women fall into 3 categories: the medical condition, the economic status and the organization of daily activity.The study has received approval of the medical ethics committee and has been registered on Clinicaltrials.gov. Results will be published in peer-reviewed journals and made public through all available media.
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http://dx.doi.org/10.1097/MD.0000000000021279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387043PMC
July 2020

Polish Society of Gynecology and Obstetrics statement on safety measures and performance of ultrasound examinations in obstetrics and gynecology during the SARS-CoV-2 pandemic.

Ginekol Pol 2020 ;91(4):231-234

Second Department of Gynaecology and Obstetrics, Wroclaw Medical University, Wroclaw, Poland.

We present recommendations on performance and safety measures of ultrasound examinations in obstetrics and gynecology during the SARS COV-2 pandemic. The statement was prepared based on the current knowledge on the coronavirus by the Ultrasound Section of the Polish Society of Obstetrics and Gynecology. It has to be noted that the presented guidance is based on limited evidence and is primarily based on experiences published by authors from areas most affected by the virus thus far, such as China, Singapore, Hong Kong, and Italy. We realize that the pandemic situation is very dynamic. New data is published every day. Despite the imposed limitations related to the necessity of social distancing, it is crucial to remember that providing optimal care in safe conditions should remain the primary goal of healthcare providers. We plan to update the current guidelines as the situation develops.
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http://dx.doi.org/10.5603/GP.2020.0045DOI Listing
May 2020

Growth charts and prediction of abnormal growth - what is known, what is not known and what is misunderstood.

Ginekol Pol 2019 ;90(12):717-721

Department of Reproductive Health, Center of Postgraduate Medical Education.

Objectives: Assessment of fetal growth has an important effect on perinatal morbidity and mortality. To understand what tool to choose best for a given population a basic knowledge of how growth charts are developed and used has to be acquired. For this reason, this literature review was performed.

Material And Methods: An extensive literature review aimed at identifying articles related to the development of growth assessment in both spectrums of abnormal fetal growth - large and small. The analyzed articles were chosen and presented to show both the historical aspects of growth assessment, current trends and future considerations.

Results: Identification of both large and small fetuses and neonates is equally crucial. Definitions and methodology vary worldwide and there is an ongoing discussion on the best tool to choose for a given population. An important part of the debate is how to differentiate between the physiologically small fetus and the truly growth restricted fetus who is at risk of perinatal complication. Similarly, the diagnosis of a large fetus is important in prevention of perinatal complications and surgical deliveries. Many clinical settings still lack growth standards.

Conclusions: Birthweight for gestational age charts are biased for weight in preterm birth. Prediction and management of outcome cannot be based solely on fetal size. Small is not the only problem, we have to think large as well. A common misunderstanding in clinical practice is not using uniform charts in defining growth.
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http://dx.doi.org/10.5603/GP.2019.0123DOI Listing
July 2020

Is there respectful maternity care in Poland? Women's views about care during labor and birth.

BMC Pregnancy Childbirth 2019 Dec 23;19(1):520. Epub 2019 Dec 23.

School of Nursing and Midwifery, RGU University, Garthdee Road, Aberdeen, Scotland, AB10 7AQ.

Background: Abuse against women in labor starts with subtle forms of discrimination that can turn into overt violence. Therefore it is crucial to work towards prevention and elimination of disrespect and ill-treatment in medical facility perinatal care in which staff allows such abuse. The aim of the study was to analyze the experiences of women related to perinatal care. Special emphasis was put on experiences that had traits indicating disrespectful and offensive care during childbirth in medical facilities providing perinatal care.

Methods: This was a cross-sectional survey. A questionnaire was prepared for respondents who gave birth in medical facilities. Information about the study was posted on the website of a non-governmental foundation dealing with projects aimed at improving perinatal care. The respondents gave online consent for processing the submitted data. 8378 questionnaires were submitted. The study was carried out between February 06 and March 20, 2018. The results were analyzed using the Chi-square independence test. The analysis was carried out at the significance level of 0.05 in Excel, R and SPSS.

Results: During their hospital stay, 81% of women in the study experienced violence or abuse from medical staff on at least one occasion. The most common abuse was having medical procedures without prior consent. Inappropriate comments made by staff related to their own or a woman's situation were reported in 25% of situations, whilst 20% of women experienced nonchalant treatment. In the study 19.3% of women reported that the staff did not properly care for their intimacy and 1.7% of the respondents said that the worst treatment was related to feeling anonymous in the hospital.

Conclusions: The study shows that during Polish perinatal care women experience disrespectful and abusive care. Most abuse and disrespect involved violation of the right to privacy, the right to information, the right to equal treatment, and the right to freedom from violence. The low awareness of abuses and complaints reported in the study may result from women's ignorance about relevant laws related to human rights.
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http://dx.doi.org/10.1186/s12884-019-2675-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929297PMC
December 2019

Effect of antenatal detection of small-for-gestational-age newborns in a risk stratified retrospective cohort.

PLoS One 2019 31;14(10):e0224553. Epub 2019 Oct 31.

Centre of Postgraduate Medical Education, Department of Reproductive Health, Warsaw, Poland.

Objective: Small-for-gestational-age (SGA) are neonates born with birth weight below the 10th centile for a given week of pregnancy. It is a risk factor of perinatal and neonatal morbidity and mortality. There is an ongoing debate whether prenatal detection of SGA neonates is good predictor of perinatal outcome especially in low risk populations. Our primary aim was to compare the odds ratios for unfavorable outcome in a risk stratified cohort of SGA neonates in regard to prenatal detection status.

Methods: This is a retrospective cohort study analysing the effect of prenatal detection on perinatal outcome. This cohort has been divided into a predefined low-risk and high-risk population. Electronic records of 39,032 singleton deliveries from 2010 through 2016 were analysed. SGA was defined as newborn weight below the 10th percentile on the Fenton growth chart. Detected SGA (dSGA) neonates were those that were admitted for delivery with a prenatal ultrasound diagnosis of abnormal growth. Undetected SGA (uSGA) were neonates that were found to be below the 10th percentile after birth. Perinatal and neonatal outcome was compared.

Results: The detection rate in high-risk pregnancies was almost 45.7% versus low risk where it amounted to 18.9%. In both the high-risk and low-risk populations there was a significantly higher risk of composite mortality for undetected SGA compared to approporiate-for-gestational-age (AGA) (OR 7.95 CI 4.76-13.29; OR 14.4 CI 4.99-41.45 respectively). The odds for the composite neonatal outcome were significantly higher for dSGA and uSGA than for AGA in all the studied populations except for the uSGA in high risk population (OR 1.57 CI 0.97-3.53). Importantly, there was not a single case of intrauterine fetal death among detected SGA, in the low risk group.

Conclusions: Prenatal detection of SGA status is related to perinatal outcomes, especially mortality. Therefore, assessment of SGA status even in low-risk pregnancies could help predict potential perinatal and neonatal complications.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224553PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822749PMC
March 2020

Development of birth weight for gestational age charts and comparison with currently used charts: defining growth in the Polish population.

J Matern Fetal Neonatal Med 2019 Oct 16:1-8. Epub 2019 Oct 16.

Department of Reproductive Health, Centre of Postgraduate Medical Education, St. Sophia Hospital , Warsaw , Poland.

This study aimed to obtain the reference curves of birth weight for gestational age percentiles for the Polish population and to compare them to published charts in terms of detected proportions of small for gestational age (SGA) and large for gestational age (LGA). The reference curves of birth weight from 24 to 42 weeks of gestation were computed based on 39,092 singleton deliveries. The nomograms included the 3rd to the 97th percentiles and standard deviations. The percentiles were calculated for female and male newborns. The theoretical and true proportions of percentiles for the studied population were estimated based on six growth charts (Fenton, Intergrowth Project, global reference chart, Yudkin, Dubiel, and the World Health Organization chart). The 50th percentile male and female newborns at 40 weeks weighed 3645.8 and 3486.7 g, respectively. The difference was 159.1 g. The ranges between the 3rd and 97th percentile at 40 weeks were 1481.5 g for males and 1423.5 for females. A total of 9.8% SGA and 10.27% LGA were defined, higher than that identified using the Fenton chart and even higher than that identified using the Intergrowth Project. Population growth charts identify more newborns with abnormal growth (both LGA and SGA). The similarity between charts in LGA above the 95th percentile is observed. The discrepancies in SGA are significantly greater, specifically in preterm births than in term births. Similar coverage is found in term pregnancies, regardless of birth weight for gestational age or intrauterine charts. The feasibility of a Polish population growth chart needs to be validated for predicting adverse perinatal outcomes.
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http://dx.doi.org/10.1080/14767058.2019.1676412DOI Listing
October 2019

Safety and success rate of vaginal birth after two cesarean sections: retrospective cohort study.

Ginekol Pol 2019 ;90(8):444-451

Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland.

Objectives: Cesarean section is a lifesaving procedure with short and long-term consequences. Growing rates of cesareansections worldwide arise problems for subsequent birth. The aim of this study was to compare safety of vaginal birthafter two cesarean sections with repeat third cesarean section to help healthcare providers and patients make well informeddecisions about mode of subsequent delivery.

Material And Methods: This was a retrospective cohort study conducted in a tertiary reference hospital. Database of alldeliveries (2010-2017) after two previous cesarean sections was created from electronic and paper medical records. Pretermdeliveries, abnormal karyotype and neonates with congenital anomalies were excluded from the study. The final analysisincluded 412 cases for maternal outcome analysis and 406 cases for neonatal outcome analysis.

Results: Trial of labor after two cesareans in comparison to repeat cesarean section increases the risk of hemorrhage(OR: 10.84) and unfavorable composite maternal outcome (OR: 2.58). Failed trial of labor increases this risk of hemorrhage(OR: 15.27) and unfavorable composite maternal outcome (OR: 4.59) even further. There were no significant differences in neonataloutcomes. 22 out of 35 trials of labor ended in successful delivery giving a success rate of 62.85%. 5 of 7 labor inductionsended in repeat cesarean section giving 28.6% success rate. There were no maternal deaths and emergency hysterectomies.

Conclusions: Trial of labor, especially failed trial of labor, is associated with an increased risk of perinatal complications.
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http://dx.doi.org/10.5603/GP.2019.0076DOI Listing
April 2020

Spontaneous resolution of prenatally diagnosed isolated pleural effusion: An unusual early sign of a newborn disease.

J Obstet Gynaecol Res 2019 Dec 2;45(12):2466-2469. Epub 2019 Sep 2.

Department of Prenatal Cardiology and Congenital Defects, Center of Postgraduate Medical Education, Warsaw, Poland.

We present a case report of a fetus with a diagnosed pleural effusion in the first trimester on nuchal translucency scan. The effusion resolved spontaneously by 17 weeks of pregnancy. Toxoplasmosis, rubella, cytomegalovirus, herpes simplex (TORCH) - negative. Array comparative genomic hybridization (aCGH) - normal. Serial Doppler scans normal - no prenatal signs of anemia. Maternal antibodies against red cell antigens - negative. Delivery at term by cesarean section because of macrosomia. Neonate suffered from prolonged jaundice. At 3 weeks of life diagnosed with hereditary spherocytosis. Literature review shows that this may be the first connection between this disease and prenatal life.
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http://dx.doi.org/10.1111/jog.14113DOI Listing
December 2019

The role of lymphocytes in fetal development and recurrent pregnancy loss.

Ginekol Pol 2019 ;90(2):109-113

Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland.

Fetal survival and development is supported by the maternal immune system. Questions regarding those mechanisms have risen from development of transplantation medicine and observation of graft rejection. Initial theories of anatomic division, fetal immune immaturity and maternal immune system inertia were found incorrect. Rejection of fetal "semi-allograft" by maternal immune system could result in pregnancy loss. Two pregnancy losses of any etiology are considered recurrent and effort should be made to name the probable cause. Immune causes of pregnancy loss are probably multifactorial, thus difficult to research and implement findings in clinical practice. Although a full understating of pregnancy loss is not established, new therapies are being developed. This review summarizes the role of lymphocytes in pregnancy develop- ment, presents data from studies on recurrent pregnancy loss patients, evidence of new therapies and ESHRE guidelines regarding immunologic investigations.
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http://dx.doi.org/10.5603/GP.2019.0019DOI Listing
January 2020

Post-finasteride syndrome - does it really exist?

Aging Male 2019 Dec 16;22(4):250-259. Epub 2019 Jan 16.

The Department of Reproductive Health, Centre of Postgraduate Medical Education , Warsaw , Poland.

Inhibitors of 5α-steroid reductase are drugs used to treat androgen-dependent conditions including prostate diseases and androgenic alopecia. Finasteride was the first on the market and is currently the most widely used inhibitor. Dutasteride was the second inhibitor to be approved and has a similar safety profile. Common adverse events of treatment consist of sexual disorders and a negative affect balance. It was described that the prolonged use of 5α-steroid reductase inhibitors in patients with alopecia can cause persistent side effects called a post-finasteride syndrome (PFS), that is not just a simple coexistence of events, but rather a definite syndrome with an iatrogenic background. PFS occurs in susceptible individuals even after small doses of the drug and can last for a long time after the discontinuation of treatment. A deterioration in the quality of life in affected individuals does not justify use of the drug. Wider recognition of PFS symptoms, its incidence, course, prevention, and treatment possibilities will allow the indications for drug use to be reconsidered and treatment to be more personalized. Knowledge about PFS will also help to provide the best treatment for affected individuals and to properly educate patients before obtaining an informed consent for therapy with 5α-steroid reductase inhibitors.
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http://dx.doi.org/10.1080/13685538.2018.1548589DOI Listing
December 2019

The Relationship Between Health-Related Quality of Life and Anabolic Hormone Levels in Middle-Aged and Elderly Men With Prediabetes: A Cross-Sectional Study.

Am J Mens Health 2018 09 8;12(5):1593-1603. Epub 2018 Jun 8.

1 Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland.

The aim of this study was to compare health-related quality of life (HRQoL) between men with prediabetes (PD) and a control group as well as to investigate the relationship between HRQoL and anabolic hormones. The analysis was carried out in 176 middle-aged (40-59 years) and elderly (60 80 years) men with PD, and 184 control peers. PD was defined according the American Diabetes Association and HRQoL was assessed by the SF-36 questionnaire. Total testosterone (TT), calculated free testosterone, dehydroepiandrosterone sulfate (DHEAS), and insulin-like growth factor 1 (IGF-1) were measured. Analysis of the standardized physical and mental component summary scores (SF-36 and SF-36) revealed that patients with PD had lower SF-36 and SF-36 than control group ( p < .02 and p < .001). Middle-aged men with PD had lower SF-36 and SF-36 than control peers, whereas elderly men with PD had lower only SF-36. In men with PD negative correlations between glycated hemoglobin (HbA1c) and SF-35 score ( r = -0.3768; p = .02) and between HbA1c and SF-36 score ( r = -0.3453; p = .01) were reported. In middle-aged prediabetic men, SF-36 was associated with high free testosterone and low HbA1c while SF-36 with high TT and high DHEAS. In elderly patients with PD, SF-36 was associated with high TT, high IGF-1, and low HbA1c, while SF-36 correlated with high free testosterone and high DHEAS. In conclusion, PD in men is associated with decreased HRQoL in comparison with healthy men, and generally better quality of life is associated with higher testosterone, higher free testosterone, higher DHEAS, and lower HbA1c.
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http://dx.doi.org/10.1177/1557988318777926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142157PMC
September 2018

Post-menopausal vulvovaginal atrophy - an overview of the current treatment options.

Ginekol Pol 2018 ;89(1):40-47

1st Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland.

Sex hormone deficiency in post-menopausal women causes changes in the lower urinary tract. Vulvovaginal atrophy is a pathology resulting from those changes. VVA has a negative effect on the quality of life therefore prompting a search for new therapeutic options. The aim of this article is to summarize the current treatment modalities, both hormonal and non-hormonal for post-menopausal vaginal atrophy. Topical oestrogen therapy remains the "golden standard". Alternatives, although promising, require well-designed control studies.
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http://dx.doi.org/10.5603/GP.a2018.0008DOI Listing
August 2019

[Homocysteine metabolism disorders as a potential predictor of preeclamsia].

Ginekol Pol 2008 Nov;79(11):775-9

Szpital Specjalistyczny Sw. Zofii, Warszawa.

Preeclampsia is one of the main causes of maternal and fetal mortality. We lack a reliable test that would identify the "at risk" group of pregnant women, thus allowing us to implement a specific prevention, management and treatment program. Recently, a number of theories regarding the pathophysiology of preeclampsia has been published. The role of vascular pathology as a result of an increase in homocysteine level is often mentioned. The aim of this paper is to review the current literature related to the pathology of preeclampsia and to evaluate the usefulness of assessment of homocysteine level and homocysteine metabolism disorders as a potential predictor of preeclamsia. Hiperhomocysteinemia is a known risk factor of cardiovascular diseases and hypertension. Different sources report a similar correlation between an increase in homocysteine level and the incidence of preeclampsia. As far as the topic of homocysteine in pregnancy is concerned, numerous questions and problems remain unanswered and unsolved. Although there exists a relationship between an increased values of homocysteine and the incidence of preeclampsia, there is not enough information about what group of patients should be included in the screening test to increase the rate of diagnosis and prevention of the most dangerous sequele.
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November 2008