Publications by authors named "Bartosz Czuba"

32 Publications

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 Impact of COVID-19 on Female Sexual Health.

Int J Environ Res Public Health 2020 09 30;17(19). Epub 2020 Sep 30.

Chair and Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia in Katowice, Markiefki 87, 40-211 Katowice, Poland.

Introduction: Coronavirus disease (COVID-19), announced as a pandemic by the World Health Organization, recently has dominated people's lifestyle. The impact of COVID-19 seems to be relevant to the sexual health as well.

Methods: This prospective study was conducted on two occasions involving 764 female patients between March and April 2020-before and during the time of social quarantine. The sexual function was assessed using the Polish version of the Female Sexual Function Index (FSFI). Every patient filled out the survey concerning socio-demographic characteristics as well as the influence of SARS-CoV-2 pandemic on their lives.

Results: The overall FSFI score before the pandemic was 30.1 ± 4.4 and changed to 25.8 ± 9.7 during it. Scores of every domain: desire, arousal, lubrication, orgasm, satisfaction and pain decreased as well ( < 0.001). There was statistically significant association between the workplace and the change of FSFI scores before and during COVID-19 pandemic ( < 0.01). We noticed the biggest decrease in FSFI score in the group of women who did not work at all (5.2 ± 9.9). Religion had a statistically important impact on level of anxiety ( < 0.01).

Conclusion: The main finding of our study was the influence of COVID-19 pandemic on the quality of sexual lifestyle and frequency of intercourse among Polish women.
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http://dx.doi.org/10.3390/ijerph17197152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579227PMC
September 2020

Nasal bone in screening for Trisomy 18 and 13 at 11-13 + 6 weeks of gestation - own experiences.

Ginekol Pol 2020 ;91(5):256-261

Faculty of Health Sciences, Department of Obstetrics, Nicolaus Copernicus University in Torun, Collegium Medicum, Bydgoszcz, Poland.

Objectives: The objective of the paper is the suitability assessment of screening for Trisomy 18 and 13 on the basis of NT measurement, FHR, double test and assessment of Nasal Bone.

Material And Methods: The study was performed in 6,661 singleton pregnancies. In each fetus NT, FHR, DV-PIV were examined. Double test from maternal blood was examined. These ultrasound and biochemical factors were in combined screening investigated. Additional ultrasound marker - Nasal Bone was and its impact on Trisomies 18 and 13 screening was examined.

Results: Two groups of patients were compared - with chromosomal normal and chromosomal abnormalities - Trisomy 18 and 13. Detection Rate of Trisomies 18 and 13 at the risk cutoff 1/300 using combined screening was 84.1% and FPR was 7.1%. Detection Rates of examined chromosomal abnormalities using screening with additional marker - NB was 93.2% and False Positive Rate - 5.6%.

Conclusions: It should be noted that the qualitative analysis of the assessment of NB in the first trimester significantly influences the improvement of screening values focusing on Trisomy 18 and 13 detection. In summary, our research indicates a more effective type of Trisomy 13 and 18 screening using NT, double test, maternal age, CRL and FHR as well as nasal bone presence and absence.
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http://dx.doi.org/10.5603/GP.2020.0047DOI Listing
January 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

Quantitative and qualitative Ductus Venosus blood flow evaluation in the screening for Trisomy 18 and 13 - suitability study.

Ginekol Pol 2020 ;91(3):144-148

Department of Obstetrics and Perinatology, Faculty of Health Sciences, Medical University of Warsaw, Poland.

Objectives: The objective of the paper is the suitability assessment of screening for Trisomy 18 and 13 on the basis of nuchal translucency (NT) measurement, Fetal Heart Rate (FHR), double test, quantitative [Ductus Venosus (DV) Pulsatility Index for Veins (PIV)] and qualitative (the A-wave assessment) blood flow evaluation in the DV.

Material And Methods: The study was performed in 7296 singleton pregnancies. In each fetus NT, FHR, DV-PIV were examined. Double test from maternal blood was examined. These ultrasound and biochemical factors were in combined screening investigated. Additional doppler ultrasound markers such as abnormal a-wave in Ductus Venosus and Pusatility Index for Veins of Ductus Venosus were and their impact on Trisomies 18 and 13 screening were examined.

Results: Two groups of patients were compared - with chromosomal normal and chromosomal abnormalities - Trisomy 18 and 13. Detection Rate of Trisomies 18 and 13 at the risk cutoff 1/300 using combined screening was 90.2% and FPR was 6%. Detection Rates of examined chromosomal abnormalities using contingent screening were: 92.1% using DV abnormal a-wave and 94.84% using DV-PIV. FPR's for booths parameters 5.8% and 5.4% respectively.

Conclusions: Quantitative analysis of the flow - assessment of DV-PIV in the first trimester significantly influences the improvement of screening values focusing on Trisomy 18 and 13 detection.
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http://dx.doi.org/10.5603/GP.2020.0031DOI Listing
January 2020

A Retrospective Study on the Risk of Respiratory Distress Syndrome in Singleton Pregnancies with Preterm Premature Rupture of Membranes between 24+0 and 36+6 Weeks, Using Regression Analysis for Various Factors.

Biomed Res Int 2018 4;2018:7162478. Epub 2018 Oct 4.

Department of Obstetrics and Perinatology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland.

Aim: This study aimed to investigate the cause of respiratory distress syndrome (RDS) in neonates from singleton pregnancies with preterm premature rupture of membranes (pPROM) between 24+0 and 36+6 weeks by using regression analysis for various factors.

Methods: In 175 singleton pregnancies with pPROM, 95 cases of RDS (54,29%) were diagnosed. In all cases the following information was collected: latency period of PROM, gestational age at birth, Umbilical Artery Pulsatility Index (UA PI), Middle Cerebral Artery Pulsatility Index (MCA PI), fetal distress, antenatal steroids use, delivery type, pregnancy hypertension disease, gestational glucose intolerance or diabetes, neonatal laboratory parameters, gender, weight, Apgar score, and other neonatal complications. Logistic regression analysis was used to investigate the effect of variables on RDS.

Results: The results of logistic regression analysis showed that the following variables are closely correlated with RDS: female gender (OR=0.52; 95%CI:0.28-0,97), antenatal steroids use (OR=0,46; 95%CI:0,34-0,64), abnormal UA PI and MCA PI (OR=2.96; 95%CI:1,43-6,12) (OR=2.05; 95%CI:1,07-3,95), fetal distress (OR=2.33; 95%CI:1,16-4,71), maternal HGB (OR=0.69; 95%CI:0,5-0,96), and neonatal RBC, HGB (OR=0.32; 95%CI:0,19-0,55) (OR=0.75; 95%CI:0,65-0,88).

Conclusions: The main RDS risk factors in premature neonates are gender, abnormal fetoplacental circulation, and fetal distress. The laboratory parameters such as lower RBC and HGB count are observed in infants with RDS.
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http://dx.doi.org/10.1155/2018/7162478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6193337PMC
February 2019

Influence of first trimester biochemistry methodology on detection rate in screening for trisomy 21.

Ginekol Pol 2017 ;88(9):492-496

Department of Obstetrics and Perinatology, Medical University of Warsaw, Zwirki i Wigury Str 63a, 02-091, Warsaw, Poland.

Objectives: The purpose of the study was to compare detection rates (DR) of FMF-certified and non-certified biochemical tests (BC) in trisomy 21 screening at 11-13 + 6 weeks.

Material And Methods: In 2267 singleton pregnancies FMF-certified doctors measured crown to rump length (CRL) and nuchal translucency (NT). Serum samples were tested for free β-hCG and the PAPP-A using 2 analysers (Delfia - Perkin Elmer and Immulite 2000 - DPC), the results were expressed in MoM values and used for computer calculation of the risk for trisomy 21. The cut-off value for the high trisomy 21 risk was 1:300.

Results: Comparison of free β-hCG MoMs by DPC and Delfia demonstrated statistically significant differences in normal, and trisomy 21 fetuses respectively. Similarly, statistically significant differences were noted for PAPP-A MoMs. The above differences in MoMs resulted in altered sensitivity in screening for aneuploidy. The application of the FMF-certified method ensures a markedly higher DR = 74%, compared to non-certified tests (64%), both at 5% FPR. The ROC analysis was performed in order to assess the efficacy of both tests. Results of trisomy 21 BC + NT risk scales using the Delfia and DPC methods are highly significant (p < 0.0001), which means that their discrimination ability is > 90%. The difference between results obtained using the Delfia and DPC methods is AUC = 0.0150 and is statistically significant (Z = 2.4728, p = 0.0134).

Conclusions: The use of FMF-certified first trimester biochemistry analysers improves DR for trisomy 21. The use of non-certified analysers causes reduction of DR and an increase of invasive procedure rate.
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http://dx.doi.org/10.5603/GP.a2017.0090DOI Listing
July 2018

Screening for trisomy 21 based on maternal age, nuchal translucency measurement, first trimester biochemistry and quantitative and qualitative assessment of the flow in the DV - the assessment of efficacy.

Ginekol Pol 2017 ;88(9):481-485

Department of Obstetrics and Perinatology, Medical University of Warsaw, Zwirki i Wigury Str 63a, 02-091, Warsaw, Poland.

Objectives: The aim of the study was to compare effects of addition of two methods of ductus venosus (DV) flow assessment: qualitative - the assessment of shape of the A-wave (positive or negative), and quantitative - based on the pulsatility index for veins (DVPI) to the basic screening for trisomy 21 at 11 to 13 + 6 weeks of pregnancy.

Material And Methods: The ultrasound examination was performed in 8230 fetuses in singleton pregnancies at 11- -13 + 6 wks, as a part of a routine screening for chromosomal defects. In DV A-wave was assessed and DVPI was calculated. After the scan blood sample was taken for first trimester biochemistry (BC). Risk for chromosomal defects was calculated and high-risk patients were offered an invasive test for karyotyping.

Results: Basic screening with following combination of markers: MA, NT and BC provided lowest detection rate (DR) 87.50% for FPR = 6.94%. After adding qualitative DV A-wave assessment DR increased to 88.75% for FPR = 5.65%. The best DR = 93.75% for FPR = 5.55% was achieved when quantitative DVPI was added. The application of the Receiver Operating Curves curve confirmed validity of the addition of DV flow assessment to the screening model. The highest diagnostic power of the test was achieved when DVPI was added, with the ROC AUC of 0.974.

Conclusions: The assessment of DV flow performed at 11-13 + 6 weeks increases DR for trisomy 21 and reduces FPR. The screening model based on the quantitative DV flow analysis (DVPI) gives better results compared to the qualitative flow assessment.
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http://dx.doi.org/10.5603/GP.a2017.0088DOI Listing
July 2018

Nasal bone in screening for T21 at 11-13 + 6 weeks of gestation - a multicenter study.

Ginekol Pol 2016 ;87(11):751-754

Department of Obstetrics and Perinatology, Medical University of Warsaw, Poland.

Objectives: Trisomy 21 is one of the most common chromosomal defects diagnosed prenatally. Screening for Down syndrome is based on maternal age, measurement of crown-rump length, nuchal translucency and fetal heart rate, together with free β-hCG and PAPP-A at 11 to 13 + 6 weeks. Introduction of additional ultrasound marker of trisomy 21 (evaluation of the nasal bone) may result in increased DR and decreased invasive diagnostic testing rates (FPR).

Material And Methods: Ultrasound scan with NB evaluation was performed in 5814 fetuses during routine screening for chromosomal defects at 11 to 13 + 6 weeks of gestation. DR and FPR coefficients were calculated for 4 levels of risk as cut-off points for screening model 1, based on MA, NT, and first trimester biochemistry, as well as for screening model 2, based on MA, NT, first trimester biochemistry and NB.

Results: There were 5708 normal cases, 71 cases of trisomy 21 and 35 cases of other chromosomal defects. NB was absent in 46 (64.8%) cases and present in 25 (35.3%) cases of trisomy 21, comparing to present NB in 5463 (95.7%) and absent in 245 (4.3%) of normal cases.

Conclusions: First-semester screening with additional NB assessment significantly increases the detection rate for trisomy 21 and decreases the rate of false-positive results. Adding NB evaluation at the risk level of 1:50 causes only a small increase in detection rate. Invasive procedures should be performed in that group regardless NB assessment.
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http://dx.doi.org/10.5603/GP.2016.0082DOI Listing
July 2018

Does prior knowledge of maternal age affect judgment of operators measuring nuchal translucency?

Ginekol Pol 2015 Dec;86(12):921-5

Objectives: To test the hypothesis that, in real life standard clinical practice, knowledge of maternal age (MA) by operators measuring nuchal translucency (NT) for screening of aneuploidy may influence their judgment, resulting in a tendency to over-measurement in older women.

Material And Methods: We retrospectively analyzed the correlation between MA and NT MoMs in data from a group of operators from several clinical practices, with different levels of experience.

Results: We assessed 66,918 measurements by 41 operators. There was no association between NT and MA in all the measurements analyzed together In 3 experienced operators (N > 1900), there was a significant association between the variables, although all were negative and its effect size was very small (0.004, 0.006 and 0.01). However one of the less experienced operators (N = 47) had a statistically significant (p = 0.0002) and strong (R2 = 0.2634) association. We tested the hypothesis that this bias could occur in less experienced operators but time/experience would correct it. We did the same analyses for each set of 50 tests, sorted by date, for each operator up to the 7th set. No significant progression was identified in association with increase in experience.

Conclusions: Our data does not support the hypothesis that operators might be biased towards over-measuring NT in older women.
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http://dx.doi.org/10.17772/gp/59272DOI Listing
December 2015

The evolution of fetal presentation during pregnancy: a retrospective, descriptive cross-sectional study.

Acta Obstet Gynecol Scand 2015 Jun 25;94(6):660-3. Epub 2015 Mar 25.

1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland.

We investigated changes in the frequencies of four primary types of singleton fetal lie/presentation for each gestational week from 18 to 39 weeks in a retrospective, cross-sectional study which analyzed ultrasound examination records of fetal positions, in the outpatient prenatal diagnosis clinics in two cities in Poland. We calculated the prevalence and 95% confidence intervals for each type of lie/presentation. We then identified the gestational age after which no statistically significant changes in terms of prevalence were observed, by comparing the results at each week with the prevalence of cephalic presentation at 39(+0) weeks, used as reference. A total of 18 019 ultrasound examinations were used. From 22 to 36 weeks of gestation, the prevalence of cephalic presentation increased from 47% (45-50%) to 94% (91-96%), before and after which times plateaus were noted. Spontaneous change from breech to cephalic is unlikely to occur after 36 weeks of gestation.
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http://dx.doi.org/10.1111/aogs.12626DOI Listing
June 2015

Frontomaxillary facial angle measurement in screening for trisomy 18 at 11 + 0 to 13 + 6 weeks of pregnancy: a double-centre study.

Biomed Res Int 2013 1;2013:168302. Epub 2013 Oct 1.

Teaching Department of Obstetrics and Gynecology in Ruda Slaska, Medical University of Silesia, Ulica Lipa 2, 41-703 Ruda Slaska, Poland.

Objective: The aim of this study was to evaluate the effectiveness of prenatal screening for trisomy 18 with the use of the frontomaxillary facial angle (FMF angle) measurement.

Material And Methods: The study involved 1751 singleton pregnancies at 11-13 + 6 weeks, examined between 2007 and 2011. Serum PAPP-A and free beta-hCG levels were assessed, and crown-rump length, nuchal translucency, and FMF angle were measured in all patients. 1350 fetuses with known follow-up were included in the final analysis.

Results: Highly significant (P < 0.01) negative correlation between the CRL and the FMF angle was found. There were 30 fetuses with trisomy 18. FMF angle was highly significantly larger (P < 0.0001) in fetuses with trisomy 18 as compared to chromosomally normal fetuses. Two models of first trimester screening were compared: Model 1 based on maternal age, NT, and first trimester biochemistry test (DR 80-85% and FPR 0.3-0.6%), and Model 2 = Model 1 + FMF angle measurement (DR 87.3-93.3% and FPR 0.8-1.3%).

Conclusions: The use of FMF angle measurement increases the effectiveness of the screening for trisomy 18. Introduction of the FMF angle as an independent marker for fetal trisomy 18 risk requires further prospective research in large populations.
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http://dx.doi.org/10.1155/2013/168302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806356PMC
June 2014

[Agenesis of the ductus venosus--an irrelevant anomaly or a severe clinical problem?].

Ginekol Pol 2013 Aug;84(8):676-81

Oddział Kliniczny Połoznictwa i Ginekologii w Rudzie Slaskiej, Slaski Uniwersytet Medyczny, Polska.

Background: Ductus venosus is the fetal blood vessel connecting the abdominal portion of the umbilical vein with the inferior vena cava. Numerous studies have confirmed the important role of this vessel in fetal circulation. There are, however cases when finding the ductus venosus during an ultrasound examination is impossible.

Objective: The objective of the study was to assess the fate of fetuses with known ductus venosus agenesis and its severity in fetal life.

Material And Methods: 17 fetuses from singleton pregnancies with agenesis of the ductus venosus were observed and followed up.

Results: A total of 3 intrauterine deaths, preceded by fetal hydrops and signs of heart failure, were observed in the study group. One newborn required cardiac care after birth. In the majority of cases with ductus venosus agenesis, where no accompanying developmental anomalies were found, prognosis for the fetus and the newborn was good.

Conclusions: Cases of ductus venosus agenesis should be directed to and followed up in referral centers, where adequate diagnostic and therapeutic procedures can be undertaken.
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http://dx.doi.org/10.17772/gp/1623DOI Listing
August 2013

[Frontomaxillary facial angle measurement at 11+0 to 13+6 weeks' gestation. Application in every day prenatal diagnosis of trisomy 21].

Ginekol Pol 2013 Jul;84(7):624-9

Oddział Kliniczny Połoznictwa i Ginekologii w Rudzie Slaskiej, Slaski Uniwersytet Medyczny, Polska.

Objective: The aim of the study was to evaluate the effectiveness of prenatal screening for trisomy 21 with the use of the FMF angle measurement, depending on the disease risk group.

Material And Methods: The study included 2,026 single pregnancy fetuses, examined in years 2009-2011. The crown-rump length, nuchal translucency and frontomaxillary facial angle were measured for each of the fetuses according to the Fetal Medicine Foundation guidelines. All ultrasound exams were performed using trans-abdominal probes paired with Voluson 730 Expert and Expert E8 systems. All physicians conducting the exams were FMF-certified professionals. Maternal age at the time of the study was also reported. In 1621 pregnant women serum concentration of PAPP-A was determined using Delfia Express system (Perkin Elmer). Astraia software was used to assess fetal risk of trisomy 21. The final analysis included 791 fetuses which were followed up for the occurrence of trisomy 21. Data were analyzed using PQStat package ver 1.4.2.324. Highly significant likelihood was set at p < 0.01 and significant likelihood at p < 0.05.

Results: Average maternal age was 31.42 years (median: 32 in a range from 27 to 45). Average FMF angle was 76.24 degrees (median: 75 degrees in a range from 69 to 04). Average CRL measurements was 63.70 mm (median: 64.10 mm in a range from 45 to 84). Average NT measurement was 1.91 mm (median: 1.6 mm in a range from 0.50 to 9.3). There was no significant (p > 0.05) correlation between maternal age and FMF. Highly significant (p < 0.01) negative correlation between the CRL and the FMF angle was found. There were 41 fetuses with trisomy 21 (Down syndrome) in the study group. In the normal karyotype group, the FMF angle was highly significantly lower (p < 0.0001) than in the trisomy 21 group. 95th percentile of the each of four separated CRL ranges was calculated. Detection rate and false positive rate for each of four different risk levels were estimated. They were used as cutoff points for two models of first trimester screening compared: Model 1, including maternal age, NT measurement and PAPP-A test, and Model 2, including maternal age, NT measurement, PAPP-A test and Frontomaxillary facial angle measurement.

Conclusions: 1. Detection rate (DR) of the Down syndrome increases after the introduction of FMF angle measurement as an additional component of screening including maternal age, NT measurement and PAPP-A test. 2. Introduction of the FMF angle as an independent marker for fetal trisomy 21 risk requires further research on large populations.
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http://dx.doi.org/10.17772/gp/1615DOI Listing
July 2013

[Prenatally reported fetal ovarian cysts--treatment and prognosis].

Ginekol Pol 2008 Oct;79(10):706-9

Katedra Zdrowia Kobiety Wydziału Opieki Zdrowotnej, Slaski Uniwersytet Medyczny w Katowicach.

We present 6 case reports of ovarian cysts, diagnosed in the prenatal and postnatal period, as well as treatment. There was no need for invasive prenatal therapy in any of the reported fetuses. Most of the cysts disappeared spontaneously (in one case uncomplicated cyst rupture in fetus have been observed), only in one case laparoscopy was performed after birth.
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October 2008

[Genital warts associated with HPV infection during II and III trimester of pregnancy--a case report and analysis of treatment options].

Ginekol Pol 2007 Nov;78(11):888-91

Oddział Kliniczny Ginekologii i Połoznictwa, Katedry Zdrowia Kobiety w Rudzie Slaskiej, Wydział Opieki Zdrowotnej Slaskiej Akademii Medycznej w Katowicach.

More than 30 HPV types can infect the genital tract. Viral infection can be present in clinical, subclinical or latent form. A visible genital form of HPV infection are genital warts, which are commonly caused by HPV types 6 and 11, and appear on the vulva, cervix, vagina, urethra and anus. Oncogenic HPV types 16, 18, 31, 33 and 35 are also found in genital warts and are associated with vulval (VII), cervical (CIN) and anal (AIN) intraepithelial neoplasia. The general prevalence of HPV infection in the form of visible genital warts estimates to about 1% of sexually active adults. Approximately 15% of the infected group / of all adults have a subclinical or latent infection and at least 80% had been infected with one or more genital HPV types at some point in their lives. The highest rate of frequency of infections occurs in the group of adults, aged from 18 to 28. Over the last twenty years figures have shown a constant growth of the infection rate, which also includes pregnant women. Genital warts can proliferate during pregnancy due to altered immunity and increased blood supply. Cryotherapy, electrocautery, laser therapy, surgery or trichloroacetic acid may be used to remove the warts. In the paper a case report on genital warts associated with HPV infection during II and III trimester of pregnancy and analysis of treatment options has been presented.
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November 2007

[Heart defects and other anomalies in fetuses conceived by assisted reproduction techniques].

Ginekol Pol 2007 Nov;78(11):865-8

Oddział Kliniczny Ginekologii i Połoinictwa w Rudzie Slaskiej, Katedry Zdrowia Kobiety Wydziału Opieki Zdrowotnej Slaskiej Akademii Medycznej w Katowicach.

Aim: The aim of the work was to evaluate the frequency of occurrence of structural, chromosome defects and developmental disorders in fetuses conceived with the help of different assisted reproduction techniques.

Material And Methods: The research group consisted of 30 patients, aged from 25 to 37, subjected to various techniques of assisted reproduction from 2003 to 2006, who reported for consultation in the referral centre. 13 (43%) of the patients underwent the IVF procedure, 12 (40%) the ICSI procedure, 5 patients underwent interuterine insemination. Ultrasonographic examination with the evaluation of the fetal heart was conducted on average in the 22nd week of gestation.

Results: Multiple pregnancies constituted 14 (47%) of the examined pregnancies. In total, fetal anomalies were diagnosed in 3 fetuses (6%). Cardiovascular anomalies occurred in 2 fetuses (atrioventricular septal defect--AVSD and ventricular septal defect--VSD), each with diagnosed trisomy of chromosome pairs 21 and 18 respectively. In one case an anomaly within the urinary system was diagnosed.

Conclusions: Multiple pregnancies constituted nearly half of the researched group. Structural defects were diagnosed in 3 (6%) fetuses, which slightly exceeds population risk. A higher anomaly percentage occurred in fetuses from twin pregnancies and in the group after ICSI. In the study the risk is related to the selected group of patient undergoing fetal echocardiography exam. To estimate the risk in the ART group precisely, all pregnancies conceived with implementation of ART should be examined. Multi-centre studies are our future goal.
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November 2007

[Assessment of fetal circulation in the late first trimester--preliminary study].

Ginekol Pol 2007 Nov;78(11):861-4

Klinika Perinatologii i Ginekologii Instytutu Centrum Zdrowia Matki Polki 93-338 Lódi.

Objectives: to confirm that fetal echocardiography is indeed possible in late first trimester and that it improves the standard of the so-called "genetic" ultrasound scan.

Material And Methods: Early echocardiography was performed in 75 fetuses from high and low risk pregnancies. All fetuses underwent echocardiography examination in 18-22 weeks of gestation and established follow up.

Results: The most suitable method of visualization seems to be transabdominal examination, between 13.0-13.6 weeks of gestation, an transvaginal one, between 12.0-12.6 weeks of gestation, with 90% effectiveness. In researched group of 75 fetuses (with established follow up) there were four heart defects (5.3%). Three of them were diagnosed before 14th week of gestation. One case (tetralogy of Fallot) was overlooked. There were two false positive diagnosis verified at 20th week of gestation.

Conclusions: Early echocardiography, especially between 12.0-13.6 weeks of gestation, is a possible and valuable method of diagnosis. Reference evaluation should be performed between 18 and 22 weeks of gestation. In cases with suspected anomalies karyotyping is recommended. Congenital heart disease diagnosed at late first trimester should be treated as the next potential marker of genetic disorder.
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November 2007

Laparoscopic treatment of uterine myomas in women of reproductive age.

Neuro Endocrinol Lett 2008 Feb;29(1):163-7

1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.

Objectives: To analyze the indications, safety and feasibility of laparoscopic myomectomies performed during the last 10 years.

Material And Methods: The studied material consisted of 187 typically performed laparoscopies, mostly due to uterine myomas. All the patients underwent an ultrasound examination at the time of admission and those with the maximum of 3 tumors, where the largest tumors were less than 10cm in diameter, were qualified for endoscopic surgery.

Results: Out of 187 women, 39 patients had laparoscopy performed twice, with a 3-4 months interval for GnRH analogues treatment. Among 164 operative laparoscopies myomas were enucleated in 132 of the women (80.5%). In the case of 18 patients (9.6%) there was a need for laparoconversion resulting from the difficulties with enucleation, adhesions, and the size or localization of the tumor. There were also 62 cases of diagnostic laparoscopy, where myomas were either too large or too small to be enucleated. On analyzing the number and size of the tumors it occurred that a single myoma was the most frequent finding, while more than half of all the enucleated uterine tumors found during diagnostic and operative endoscopies were up to 2cm in diameter.

Conclusions: Laparoscopic myomectomy is a safe and reliable surgical alternative for women suffering from symptomatic myomas and is a method of choice in young patients of reproductive age. Beside skillful surgical techniques, a proper qualification for the operation is essential for the desired outcome.
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February 2008

Blood flow in ductus venosus in early uncomplicated pregnancy.

Neuro Endocrinol Lett 2007 Oct;28(5):713-6

Obstetrics and Gynecology Clinic Ruda Slaaka, Silesian Medical Academy Katowice, Poland.

Unlabelled: The ductus venosus is the very important part of fetal venous circulation. It plays a central role in return of venous blood from the placenta. This unique shunt carries well-oxygenated blood from the umbilical vein through the inferior atrial inlet on its way across the foramen ovale. Using Doppler ultrasound, it is possible to assess the blood flow in fetal vessels including ductus venosus. It is observed, in animal and human studies, that the typical waveform for blood flow in ductus venosus in early pregnancy can be different depending on numerous conditions e.g. fetal karyotype. This study is performed to assess the physiologic parameters of blood flow in ductus venosus in uncomplicated early pregnancy.

Material And Methods: 404 women were examined between 11+0 and 13+6 weeks (+ days) of gestation by ultrasound. Fetal crown-rump length (CRL) was measured to assess the gestational age. The assessment of risk of fetal abnormalities was based on nuchal translucency (NT) measurement. The ductus venosus blood flow with color and spectral Doppler was obtained in all patients. The following features were assessed: pulsatility index (PI), and direction of flow (positive/negative) during atrial contraction (wave A). All cases were followed up to 22 weeks of gestation when the control scan was performed.

Results And Conclusions: 30 cases were excluded from the uncomplicated group due to: high risk of fetal abnormalities, fetal loss, confirmed fetal abnormalities and utero-placental pathology. 374 women were considered as uncomplicated pregnancy. In both uncomplicated and complicated groups the mean values for pulsatility index (PI) were established. The mean PI value in uncomplicated pregnancies was: 0.91 (SD +/- 0.32). No significant differences between groups were noticed. In 370 cases of uncomplicated pregnancy the A wave direction was positive but in 1.1% of cases the reverse flow in atrial contraction was observed.
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October 2007

[Evaluation of pregnancy-associated plasma protein A (PAPP-A) and free beta subunit of human chorionic gonadotropin (beta hCG) levels and sonographic assesement of fetal nuchal translucency (NT) in singleton pregnancies between 11 and 14 weeks of gestation--Polish multi-centre research].

Ginekol Pol 2007 May;78(5):384-7

Klinika Terapii Płodu ICZMP w łodzi.

Unlabelled: Evaluation of pregnancy-associated plasma protein A (PAPP-A) and free beta subunit of human chorionic gonadotropin (beta hCG) levels and sonographic assessment of fetal nuchal translucency (NT) in singleton pregnancies between 11 and 14 weeks of gestation--Poland's multi-centers research.

Objectives: Pregnancy-associated plasma protein A has been reported to be low in Down syndrome affected pregnancies during the first trimester of pregnancy. Enlarged nuchal translucency (NT) is observed in about 80% of fetuses affected with chromosomal abnormalities and congenital heart defects (CHD).

Material And Methods: The aim of this study were to determine value and the medians of free beta-human chorionic gonadotropin (beta-hCG) and pregnancy associated plasma protein-A (PAPP-A) and nuchal translucency thickness in the first trimester in a prospective study of a non-selected Polish population.

Results: All examinations have been performed according to the Fetal Medicine Foundation (FMF) rules. We have included 800 women between 11 weeks 0 days and 13 weeks 6 days gestation into a biochemical examination. Women booked into the clinic were offered screening, using a combination of maternal serum free beta-hCG and pregnancy-associated plasma protein-A (PAPP-A) and fetal nuchal translucency thickness. The maternal serum were measured using the Kryptor analyzer (Brahms Diagnostica). All pregnant women have been divided into 2 groups younger than (first group) and older than (second group) 35 years of age.

Conclusions: Nomogrames for free beta-hCG and PAPP-A levels in physiological pregnancy between 11(+0) and 13(6) weeks were determined in the examined population. A positive correlation between PAPP-A and CRL levels, as well as a weak negative correlation between free beta-hCG and CRL, were demonstrated.
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May 2007

Ultrasonographic assessment of fetal nuchal translucency (NT) at 11th and 14th week of gestation--Polish multicentre study.

Neuro Endocrinol Lett 2007 Apr;28(2):175-81

Obstetrics and Gynecology Clinic Ruda Slaaka, Silesian Medical Academy Katowice, Poland.

Unlabelled: THE AIMS OF THE STUDY WERE: To evaluate range and median values of NT in a large, unselected Polish population; to determine the value of the 95th percentile and the median values for NT for given weeks of late 1st trimester pregnancy and to determine the level of chromosomal aberration risk corresponding to the values of the 95th percentile in the examined groups; to examine the possible correlation between CRL, NT width as well as the mother's age with the risk of the most frequent chromosomal aberrations.

Material & Methods: We have retrospective analyzed 7,866 pregnant women. All fetuses of this women had NT measurement performed, as well as CRL and assessed of the most frequent chromosomal abnormalities. The group of pregnant women was divided into 2 subgroups: until and above 35 years old. All population group was divided into 3 subgroups depending on gestational age (11, 12 and above 13th weeks of gestation).

Results: The median of NT in all population group was 1.5 mm and 95th percentile was 2.4 mm, whilst in group with low risk median of NT and 95th percentile were the same and in group with high risk of chromosomal abnormalities respectively 1.5 mm and 2.5 mm. There were strong correlations between maternal age and the risk of most frequent chromosomal abnormalities from NT.

Conclusions: The obtained results of median values and the 95th percentiles of NT in the examined group and the age groups under 35 and 35 plus are similar to these quoted by FMF. The risk levels of trisomy of 21st chromosome were similar to the reference values used by FMF. With gestational age, NT value increases in a non-linear way, therefore it is incorrect to use the term "a normal value" for NT, therefore, only the risk level calculated with the dedicated software using NT and CRL measurements with maternal age should be stated.
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April 2007

[Spontaneus ductal closure in a fetus postnatally diagnosed as Adams-Olivier syndrome].

Ginekol Pol 2006 Aug;77(8):629-33

Oddzial Kliniczny Połoznictwa i Ginekologii, Slaska Akademia Medyczna.

In utero isolated ductal closure is uncommon and can lead to congestive heart failure, fetal hydrops and death if not recognized. A case report of premature spontaneus ductal closure in the third trimester of pregnancy in a fetus postnatally diagnosed as Adams-Olivier Syndrome is presented. On ultrasound examination an intrauterine growth restriction, defects of bones of hands and feet as well as ventriculomegaly were found. No nonsteroid drug treatment during pregnancy was applied. Fetal echocardiography was performed following an abnormal four-chamber view. Premature ductal closure was diagnosed. Fetal echocardiogram showed absent flow in the ductus arteriosus, dilated right ventricle with decreased function, and moderate tricuspid and pulmonary valve insufficiency with no signs of fetal hydrops. An elective cesarean section was performed. All abnormalities observed on former echocardiogram exam withdrew within 3 months of infant's life. The infant stays in the tertiary care centre due to the extracardiac malformations.
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August 2006

[PI index value in fetal ductus venosus blood flow at 11-14 weeks in normal course of pregnancy].

Ginekol Pol 2006 May;77(5):345-51

Klinika Połoznictwa i Ginekologii Instytutu Matki i Dziecka w Warszawie.

Objective: Development of ultrasound diagnostic with Doppler examination allows early and and more precise assessement of fetal anatomy and well-being.

Design: Evaluation of blood flow parameters in fetal ductus venosus between 11 and 14 weeks of pregnancy was performed.

Material And Methods: Fetal anatomy, nuchal translucency, nasal bone and ductus venosus blood flow has been studied with transabdominal probe in 225 consecutive fetuses according to Fetal Medicine Foundation recommendations.

Results: From total number of 225 cases finally ten women were excluded from analysis due to absent or reversed A-wave in DV blood flow. In remaining 215 cases mean value of PI was 0,94 (range 0,53-1,88), mean value of Vmax (S-wave) was 42,48cm/s (range 18,7-102,9cm/sek), and mean value of Vmin (A-wave)--11,91cm/s (range 1,13- 37,32 cm/sek).

Conclusions: PI index value slightly decreased with increasing CRL. There was no differences in mean blood flow velocity with CRL for S-wave. A decrease in mean blood flow velocity with CRL was noted for A-wave.
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May 2006

[Actual treatment options of twin-to-twin transfusion syndrome].

Ginekol Pol 2006 Apr;77(4):317-22

Oddział Kliniczny Połoinictwa i Ginekologii w Rudzie Slaskiej, Katedry Zdrowia Kobiety, Slaskiej Akademii Medycznej w Katowicach.

Twin-to-twin transfusion syndrome -TTTS is observed in 10-15% of monochorionic twin pregnancies. The pathogenesis of the syndrome is still unknown, and the mortality reaches 80-90% if not treated. There are two invasive treatment options of TTTS: Fetoscopic laser coagulation of the placental anastomoses and serial amniodrainages. Endoscopic laser coagulation of anastomoses is a more effective first-line treatment than serial amnioreduction for severe TTTS. The rate of major neurologic complications is higher in amnioreduction group, than in Fetoscopic group.
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April 2006

[Risk of fetal cytomegaly virus infection depending on number of CMV genome in mother's blood and amniotic fluid].

Ginekol Pol 2006 Apr;77(4):269-75

Klinika Perinatologii i Ginekologii Slaskiej Akademii Medycznej, Zabrze.

The cytomegalovirus infection is most common causes of intrauterine infection of the fetus. Using of serologic diagnostic methods the kind of infection is unknown. The aim of the study was assessment of the risk of CMV infection depending of genome account in mother's blood and I amniotic fluid. The study was performed in choosen pregnancies, in which we expected cytomegalovirus infection using serological criteria. In prenatal diagnostic CMV infection using QPCR, the best material is amniotic fluid. Mother's blood assessment of CMV genome count does not make growth diagnostic possibility of the assesement of transmission the infection from mother to fetus.
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April 2006

[Assessment of blood flow in the middle cerebral artery and the umbilical artery in fetuses with umbilical venous pulsations].

Ginekol Pol 2006 Mar;77(3):190-6

Zakład USG Ginekologiczno-Poloiniczej, Instytut Centrum Zdrowia Matki Polski, Lódź.

Objectives: Umbilical venous pulsation is an important sign of hemodynamic compromise, especially during fetal heart failure and asphyxia.

Design: The aim of this study was to determine of the blow flow in the middle cerebral artery and the umbilical artery in fetuses with umbilical venous pulsations.

Materials And Methods: The investigation included 18 fetuses with signs of the intrauterine growth restriction and umbilical venous pulsations after 28th weeks of gestation. We evaluated cerebral-placental ratio (CPR) and pulsation index (PI) in the middle cerebral artery (MCA) and the umbilical artery (UA).

Results: We observed brain sparring effect in all cases of analyzing fetuses. There were 77,8% of abnormal flow pattern in umbilical artery. 13 fetuses had a single pulsation pattern in umbilical vein and another 5 had double pulsation pattern.

Conclusions: The coexistence of umbilical vein pulsation and abnormal flow pattern in umbilical artery is closely related to increased perinatal mortality.
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March 2006

[Doppler assessment of the fetal asphyxia in pregnancies complicated by gestational hypertension and intrauterine growth retardation].

Ginekol Pol 2006 Mar;77(3):184-9

Zakład Ultrasonografii Ginekologiczno-Połoiniczej, Instytut Centrum Zdrowia Matki Polki, Lódź.

Objectives: Gestational hypertension is associated with a high morbidity for both mother and fetus. Doppler ultrasound has allowed the fetal circulation to be examined. Now it is possible to monitor the response of the fetal circulation to hypoxia.

Design: The aim of this study was to determine flow patterns in fetal circulation from pregnancies complicated by gestational hypertension and intrauterine growth restriction.

Materials And Methods: The investigation included 23 fetuses with signs of the gestational hypertension and intrauterine growth restriction. We evaluated cerebral-placental ratio (CPR) and pulsation index (PI) in the middle cerebral artery (MCA) and the umbilical artery (UA). We also evaluated flows in umbilical vein.

Results: We observed abnormal flow pattern in all cases of analyzing fetuses. The most common abnormal flow was vein pulsation (48%).

Conclusions: All analyzing fetuses shown signs of the hypoxia. Present of the umbilical vein pulsation or decompensate of the brain sparing effect is closely related o increased perinatal mortality.
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March 2006