Publications by authors named "Dariusz Borowski"

51 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000021279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387043PMC
July 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2018/7162478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6193337PMC
February 2019

The use of sonographic subjective tumor assessment, IOTA logistic regression model 1, IOTA Simple Rules and GI-RADS system in the preoperative prediction of malignancy in women with adnexal masses.

Ginekol Pol 2017 ;88(12):647-653

Department of Obstetrics and Gynecology, County Hospital, Minsk Mazowiecki, Poland.

Background: Sonography based methods with various tumor markers are currently used to discriminate the type of adnexal masses.

Objective: To compare the predictive value of selected sonography-based models along with subjective assessment in ovarian cancer prediction.

Material And Methods: We analyzed data of 271 women operated because of adnexal masses. All masses were verified by histological examination. Preoperative sonography was performed in all patients and various predictive models includ¬ing IOTA group logistic regression model LR1 (LR1), IOTA simple ultrasound-based rules by IOTA (SR), GI-RADS and risk of malignancy index (RMI3) were used. ROC curves were constructed and respective AUC's with 95% CI's were compared.

Results: Of 271 masses 78 proved to be malignant including 6 borderline tumors. LR1 had sensitivity of 91.0%, specificity of 91.2%, AUC = 0.95 (95% CI: 0.92-0.98). Sensitivity for GI-RADS for 271 patients was 88.5% with specificity of 85% and AUC = 0.91 (95% CI: 0.88-0.95). Subjective assessment yielded sensitivity and specificity of 85.9% and 96.9%, respectively with AUC = 0.97 (95% CI: 0.94-0.99). SR were applicable in 236 masses and had sensitivity of 90.6% with specificity of 95.3% and AUC = 0.93 (95% CI 0.89-0.97). RMI3 was calculated only in 104 women who had CA125 available and had sensitivity of 55.3%, specificity of 94% and AUC = 0.85 (95% CI: 0.77-0.93).

Conclusions: Although subjective assessment by the ultrasound expert remains the best current method of adnexal tumors preoperative discrimination, the simplicity and high predictive value favor the IOTA SR method, and when not applicable, the IOTA LR1 or GI-RADS models to be primarily and effectively used.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/GP.a2017.0116DOI Listing
July 2018

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/GP.a2017.0088DOI Listing
July 2018

Cell-free fetal DNA testing in prenatal diagnosis: Recommendations of the Polish Gynecological Society and the Polish Human Genetics Society.

Eur J Obstet Gynecol Reprod Biol 2017 Jul 12;214:190-191. Epub 2017 May 12.

Department of Clinical Genetics, Medical University of Lodz, Poland. Electronic address:

This paper contains a joint position of the Polish Gynecological Society and Polish Human Genetics Society on the cell-free fetal DNA testing in prenatal diagnosis. We present situations where the cell-free fetal DNA testing should be applied and cases in which performing of the test is not useful. We indicate what diagnostic steps should be performed before the test and how the test results should be interpreted and followed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejogrb.2017.05.009DOI Listing
July 2017

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/GP.2016.0082DOI Listing
July 2018

Analysis of the origin of birth defects in pregnant women from the Kujawy-Pomerania Region.

Ginekol Pol 2016 ;87(10):711-716

Multi-Specialty County Hospital in Bydgoszcz Division of Maternal-Fetal Medicine, Gynecology and Neonatology at Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum in Bydgoszcz.

Objectives: The aim of the study was to analyze the origin of birth defects in pregnant women from the Kujawy-Pomerania Region, and to identify factors affecting the formation of developmental disorders in the Province.

Material And Methods: The correlation between maternal age and fetal defects was investigated. We also attempted to determine whether environmental or family factors play a role in the formation of fetal abnormalities.

Results: The analysis confirmed a correlation between the incidence of chromosomal aberrations and maternal age.

Conclusions: Higher rates of neural tube defects were observed in fetuses born to mothers who did not take folic acid. The influence of other factors on developmental anomalies was not confirmed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/GP.2016.0073DOI 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17772/gp/59272DOI Listing
December 2015

Siamese twins--prenatal diagnosis in the first trimester of pregnancy. Case study and review.

Ginekol Pol 2015 Jun;86(6):477-9

Conjoined twins are a unique type of monozygotic twins. All monozygotic twins should be thoroughly evaluated for incomplete separation and, if incomplete separation is diagnosed, the extent of internal organ connection and the presence of additional developmental anomalies of the foetuses should be assessed. Common heart of foetuses is particularly difficult to diagnose and crucial for prognosis. We present an example of female thoracoomohalopagus twins with a common triventricular heart, connate livers, and joined hepatic vessels, diagnosed in week 12 of pregnancy Due to the high complexity of foetal connection, separation was not possible and following interdisciplinary consultation, the pregnancy was aborted upon the patient's request in week 16.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17772/gp/2408DOI Listing
June 2015

[Postpartum levator ani muscle injuries. Diagnosis and treatment].

Ginekol Pol 2015 Jan;86(1):67-71

Levator ani muscle (LAM) injuries are much more frequent than trauma to sphincter ani muscles, but so far they have been omitted in obstetric handbooks. Levator ani avulsion is observed only after vaginal delivery. Forceps delivery second stage of labor ≥ 110 min., fetal head circumference ≥ 35 cm, episiotomy and coincidence of anal sphincter trauma are risk factors for levator ani avulsion. The most vital issue in that type of trauma is pelvic organ prolapse and 2-4-fold higher risk of recurrence after prolapse surgery. The current level of evidence does not allow to conclusively determine the of role of levator avulsion in urinary incontinence. Levator injuries are occult, what constitutes the main diagnostic problem. Until recently magnetic resonance imaging has been the only diagnostic method until the development of 3-dimensional ultrasound. Nowadays, 3-D ultrasound is an essential technique in static and functional diagnosis of the levator ani. There are no effective methods of levator trauma prevention. Except the risk factors reduction, there are some pilot data about positive role of antepartal perineal muscle training. Physiotherapy plays the main role in reducing the effects of levator trauma. Mesh techniques are the most effective operative methods in coincident pelvic organ prolapse with levator avulsion, but there is still a 2-fold higher risk of recurrence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17772/gp/1902DOI Listing
January 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/aogs.12626DOI Listing
June 2015

[Fetal hepatic artery flow assessment in prenatal diagnostics--a review of the literature].

Ginekol Pol 2014 Jul;85(7):532-5

Standards of screening tests for the most frequent fetal chromosomal defects in modern non-invasive prenatal diagnostics provide sensitivity of about 93-96%, with the false positive rate of 2.5%. During the first trimester scan, routinely performed between 11 and 13+6 week of pregnancy the calculation of the risk for chromosomal aberrations is based on maternal age (MA), nuchal translucency (NT), levels of free beta human chorionic gonadotropin (free beta-hCG), pregnancy associated plasma protein A (PAPP-A) in maternal blood, as well as the parameters from extended ultrasound examination like evaluation of the nasal bone (NB), blood flow in ductus venosus (DV), visualization of the tricuspid valve with potential regurgitation (TR) or measurement of the frontomaxillary facial angle (FMFA). The 100% detection rate remains unachievable at present, despite constantly improving guidelines for specialists, quality of imaging, and advancement in ultrasound technology Therefore, several studies have been undertaken to establish the group of 'additional markers' of chromosomal defects which, when combined with basic markers of routine screening tests, might increase the detection rate and approach it to 100%. Results of recent studies imply that evaluation of blood flow in fetal hepatic artery performed during the first trimester scan may become a new additional marker for chromosomal defects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17772/gp/1766DOI Listing
July 2014

The chorionic bump associated with acrania--case report.

Ginekol Pol 2013 Dec;84(12):1055-8

First Department and Unit of Obstetrics and Gynecology, Medical University of Warsaw, Poland.

The chorionic bump is a rare abnormality of the gestational sac, presenting as a convex bulge from the choriodecidual surface into the sac, correlated with poor prognosis for the pregnancy We report a case of a 36-year-old pregnant woman, with a history of spontaneous abortion, who presented for an early scan a 6 weeks and 4 days of gestation. The pregnancy was spontaneous and unplanned. The patient conceived in less than 3 months after discontinuing oral contraceptives. No folic acid was taken before or in the pregnancy An ultrasound scan revealed a chorionic bump with a hypoechoic center and echogenic border, measuring 18.3 x 14.7 x 21.9 mm. No motion within the chorionic bump was detected upon color and power Doppler examination. The second scan was performed a week later at 7+4 wks. The chorionic bump had not changed in terms of size and sonographic appearance. An acranial fetus of CRL 45.5 mm was diagnosed at 11 + 2 wks. The concentration of free beta-hCG was 17.2 IU/L, corresponding to 0.37 MoM and PAPP-A levels were 1.31 IU/L, corresponding to 0.82 MoM. After counseling the patient opted for termination of pregnancy Very few cases of chorionic bumps have been described so far and, to the best of our knowledge, its coexistence with neural tube defects has been reported for the first time. We postulate a possibility of an underlying pathological mechanism for such coexistence. The chorionic bump is a focal convex bulge with irregular borders, protruding from the choriodecidual surface into the gestational sac and with different degrees of echogenicity usually a hypoechoic middle and echogenic border The chorionic bump might represent the following: a hematoma, an area of hemorrhage, a non-embryonic gestation, or a demise of an embryo in a twin pregnancy The presence of the bump is associated with a four-fold increase in the spontaneous abortion rate as compared with the general population. Decreased folate levels increase the incidence of neural tube defects. Oxidative stress resulting from folic acid deficiency may be responsible for neural tube defects through impairment of factors inhibiting apoptosis in the neuroepithelium. Fetuses with neural tube defects are at an increased risk of being aborted spontaneously Furthermore, women who deliver children with neural tube defects frequently have a history of miscarriage. Our patient did not take any folic acid and also had a history of spontaneous miscarriage. In the case we herein presented, the coexistence of acrania and placental pathology could be attributed to folate deficiency Such coexistence is described for the first time and could be accidental, but there is possible theoretical association between these two pathologies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17772/gp/1680DOI Listing
December 2013

Prenatal diagnosis of Down syndrome in dizygotic twin pregnancy.

Ginekol Pol 2013 Nov;84(11):974-8

First Department of Obstetrics and Gynecology -- Medical University of Warsaw, Poland.

We present a case of a 33-year-old pregnant woman who had a transvaginal ultrasound performed at week 9 of gestation. A dichorionic diamniotic twin pregnancy with symmetrically developing fetuses, was confirmed. Chromosomal defect markers (NT NB, DV TV) were analyzed in the first genetic test, performed according to the Fetal Medicine Foundation (FMF) criteria, and the double marker test was performed (PAPP-A protein and free beta-hCG concentrations in patient serum were determined). In the subsequent diagnostic procedures, the patient was offered and consented to amniopuncture after week 15 of gestation. The material obtained in the course of that invasive procedure allowed to identify a normal male karyotype - 46, XY in the first fetus (Fetus I). Cytogenetic analysis of the material from the second fetus (Fetus II) resulted in the diagnosis of an abnormal female karyotype - 47, XX, +21. Based on the analyzed clinical case, we present the difficulties of performing prenatal diagnosis in a dizygotic twin pregnancy The results prove the applicability and efficacy of prenatal diagnostics tests based on the FMF criteria also in twin pregnancies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17772/gp/1670DOI Listing
November 2013

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2013/168302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806356PMC
June 2014

[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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17772/gp/1615DOI Listing
July 2013

[Interstitial laser coagulation in Twin Reversed Arterial Perfusion sequence].

Ginekol Pol 2012 Nov;83(11):865-70

I Katedra i Kinika Połoznictwa i Ginekologii Warszawskiego Uniwersytetu Medycznego, Polska.

Twin Reversed Arterial Perfusion (TRAP) sequence complicates about 1% of all monochorionic twin pregnancies and about 1 to 35000 of all pregnancies. It involves an acardiac twin whose structural defects are incompatible with life, and an otherwise normal "pump" co-twin. As the blood flow in the acardiac twin is reversed, it keeps on growing owing to the oxygenated blood from the co-twin. Here we report a case of monochorionic, diamniotic twin pregnancy after ICS/-ET complicated with TRAP sequence, diagnosed at 11 weeks of pregnancy The unusual finding in this case was the residual heart in the so called acardiac twin. Gradually the normal twin developed signs of hemodynamic compromise. Reversed a-wave in ductus venosus was observed. The acardiac twin showed subcutaneous oedema. On 24 November 2011 a successful interstitial ultrasound-guided laser coagulation was performed at 16 weeks of gestation. 17G needle and 0.6 mm laser fibre were used. The needle was introduced into the pelvic region of the acardiac twin through the abdominal wall. A series of laser bursts lasting 5-10 seconds were fired, until cessation of blood flow in the pelvic vessels and umbilical cord of the acardiac twin was confirmed using colour Doppler. The course of the intervention was uneventful. Routine steroid therapy was administered at 27 weeks of gestation. At 32 weeks the patient was hospitalized and oral antibiotics were administered due to premature rupture of the membranes and suspicion of intrauterine growth retardation of the pump twin. The patient delivered spontaneously at completed 33 weeks of pregnancy (weight 1805g, Apgar 10). After the delivery a stage 2 intraventricular hemorrhage and jaundice were observed in the neonate. Phototherapy was administered and the mother and the child were eventually discharged from the hospital, both in good general condition. Since then, two more successful interstitial laser coagulations in TRAP sequence were performed in our institution. The essence of the treatment of TRAP sequence is cessation of the blood flow from the pump to the acardiac twin. Fetoscopic cord ligature or coagulation, and laser or radiofreqency ablations of the acardiac twin vessels, are the possible methods of intervention. The interstitial laser coagulation of the acardiac twin is less invasive than fetoscopic umbilical cord coagulation, as the outer diameter of the 17G needle is much smaller. A meticulous comparison of these methods would require a randomised study but at 16 weeks of MCDA twin pregnancy interstitial laser coagulation seems to be the method of choice. The outcome of the procedure and possible treatment options in case of TRAP together with the review of literature, are presented in the article.
View Article and Find Full Text PDF

Download full-text PDF

Source
November 2012

[First trimester diagnosis of encephalocele--report of two cases and review of the literature].

Ginekol Pol 2011 Sep;82(9):700-4

Katedra i Klinika Połoznictwa i Ginekologii Warszawskiego Uniwersytetu Medycznego, Warszawa, Polska.

The authors present two cases of encephalocele, diagnosed at 11(+0)-13(+6) wks scan. Case 1: Occipital encephalocele (max diameter 14 mm) without brain tissue was diagnosed at 12 wks. At 35 wks bilateral ventriculomegaly was additionally found. The course of pregnancy was uneventful. Encephalocele was closed surgically soon after delivery Normal neonatal development at 6 months of age was confirmed. Case 2: Occipital encephalocele (max diameter 34 mm) containing brain tissue was diagnosed at 12 wks. Two weeks later fetal demise was confirmed during ultrasound examination. Uncomplicated induction of abortion was performed locally. The outcome and possible clinical scenarios in both cases, together with review of literature, are presented in the article.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2011

[Pregnancy and possible complications in a patient with Sjögren's syndrome--a case report].

Ginekol Pol 2011 Apr;82(4):291-6

Oddział Połozniczo-Ginekologiczny SPZOZ w Mińsku Mazowieckim, Polska.

This article presents a case of a 29-year-old pregnant woman with Sjögren's syndrome, regardless of her first pregnancy loss, conceived and delivered a healthy baby. The authors have also reviewed available medical literature and have indicated problems that typically occur in such patients. Diagnostic methods, therapeutic possibilities, and common complications that obstetrician have to deal with while taking care of pregnant women with Sjögren's syndrome have been shown.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2011

[Pregnancy and possible complications in a patient with systemic sclerosis--a case report].

Ginekol Pol 2011 Jan;82(1):64-7

Oddział Połozniczo-Ginekologiczny SPZOZ w Mińsku Mazowieckim.

The report describes a case of a 28-year-old woman who, despite many problems with scleroderma, was able to conceive and deliver a healthy baby The main symptoms, problems, treatment and consequences of the disease that the patient experienced were presented. The authors paid attention to interdisciplinary medical care that such a patient should get. Apart from a gynecologist, a rheumatologist and a dermatologist should be involved in medical treatment. Although our patient did not demonstrate intensified symptoms of the main disease and did not need drugs, the authors showed problems, possible difficulties of treatment and consequences of sclerosis that every obstetrician can encounter in such cases. To increase the value of this article the authors included data from available literature to lay emphases on problems with scleroderma that can be met with a patient who needs treatment with a preconception, during pregnancy and afterwards, during lactation.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2011

Maternal obesity as a perinatal risk factor.

Ginekol Pol 2009 May;80(5):334-7

Department of Maternal-Fetal Medicine & Gynecology, Polish Mother's Memorial Hospital, Lod, Poland.

Objective: The aim of the study was to estimate the effect of maternal obesity on pregnancy course, delivery and newborn well-being.

Material And Methods: Data about women who delivered in PMMH was analyzed and obese pregnant women (pre-pregnancy BMI > or =30) were included in the study group; the rest of the mothers constituted the control group. The pregnancy course, labor and delivery, and newborn well-being were taken into consideration.

Results: 4648 women were found in our delivery database, among them 208 (4.48%) were classified as obese. In this group, pregnancy-associated hypertension was common, either non-proteinuric one (8.65% vs 2.39%, p=0.001) or preeclampsia (4.81% vs 1.58 %, p<0.05). There were also more cases of gestational diabetes mellitus requiring insulin therapy (9.62% vs 1.48%, p<0.001) and polyhydramniosis (4.81% vs 2.11%, p<0.05) than in case of controls. The mean gestational age at delivery and newborn general health (estimated by Apgar score, mean umbilical cord pH and the incidence of cases with pH < or =7.10) were similar in both groups. The mean birthweight (3266 g vs 3100 g, p<0.05) and the incidence of macrosomia (20.19% vs 5.69%, p<0.001) were significantly higher in the study group. The delivery mode was comparable in both groups, with the marked tendency towards higher incidence of elective cesarean sections in case of obese mothers (27.88% vs 19.90%, p=0.01).

Conclusion: Maternal obesity is a significant perinatal risk factor; with pregnancy-associated hypertension and gestational diabetes requiring insulin therapy in obese mothers and macrosomia in newborns as most common complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
May 2009

[Effect of maternal smoking on concentrations of the pregnancy-associated plasma protein A (PAPP-A) and free beta subunit of chorionic gonadotropin (beta hCG) in the first trimester of pregnancy].

Przegl Lek 2008 ;65(10):479-82

Zakład Badań Przesiewowych, Pracownia Biochemii, Instytut Matki i Dziecka w Warszawie.

A combination of maternal serum levels of free beta human chorionic gonadotropin (free beta hCG) and pregnancy-associated plasma protein-A (PAPP-A) and fetal nuchal transluency thickness (fetal NT) has been shown to be an effective approach to screening for fetal trisomies in the first trimestr of pregnancy. A maternal smoking habit is known to influence these serum markers in singleton pregnancies however it has not been yet completely explained. The aim of this study was the investigation of PAPP-A and beta hCG concentrations in smoking women in the first trimester of pregnancy. The study comprised 215 women between 11th and 14th weeks of gestation: 135 cigarette smokers (age range 19-43 years) and 80 nonsmokers (age range 21-42 years). Only normal singleton pregnancies were included. Smoking women were divided into two groups: 75 women smoking during all along the first trimester and 60 women, who stopped smoking before 6 week of gestation. Maternal serum levels of PAPP-A and beta hCG were measured with the KRYPTOR rapid random-access immunoassay analyser (Brahms GmbH, Germany) using time-resolved amplified cryptate emission technology (TRACE). Combinated fetal nuchal translucency (NT), maternal age and biochemical risk estimates were calculated using the Fetal Medicine Foundation risk algorithm. We observed the lower of PAPP-A median values in both smoking groups by about 20% than in nonsmokers (0.86 MoM; 0.84 MoM versus 1.04 MoM; p < 0.01). We also indicated the lower values of beta hCG in smoking women in comparison to the nonsmoking controls, but this difference was not statistically significant. The concentrations of PAPP-A as well as beta hCG were similar in both groups of smoking women. Further studies will be continued to assessment of smoking influence before conception on maternal serum PAPP-A and beta hCG in the first trimester of pregnancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2009