Publications by authors named "Katarzyna Kosinska-Kaczynska"

54 Publications

Predictive Accuracy of Singleton Versus Customized Twin Growth Chart for Adverse Perinatal Outcome: A Cohort Study.

Int J Environ Res Public Health 2021 Feb 19;18(4). Epub 2021 Feb 19.

Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicza Square 1/3, 02-015 Warsaw, Poland.

Background: Fetal growth of twins differs from singletons. The objective was to assess the fetal growth in twin gestations in relation to singleton charts and customized twin charts, respectively, followed by a comparison of the frequency of neonatal complications in small-for-gestational-age (SGA) twins.

Methods: We performed an analysis of twin pregnancies with established chorionicity with particular emphasis on postnatal adverse outcomes in newborns classified as SGA. Neonatal birth weight was comparatively assessed using both singleton and twin growth charts with following percentile estimation. Using a statistical model, we established the prediction strength of neonatal complications in SGA twins for both methods.

Results: The dataset included 322 twin pairs (247 cases of dichorionic and 75 cases of monochorionic diamniotic gestations). Utilization of twin-specific normograms was less likely to label twins as SGA-nevertheless, this diagnosis strongly correlated with risk of observing adverse outcomes. Using a chart dedicated for twin pregnancies predicted newborn complications in the SGA group with higher sensitivity and had better positive predictive value regarding postnatal morbidity.

Conclusions: Estimating twin growth with customized charts provides better prognosis of undesirable neonatal events in the SGA group comparing to singleton nomograms and consequently might determine neonatal intensive care prenatal approach.
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http://dx.doi.org/10.3390/ijerph18042016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7921915PMC
February 2021

Micronutrients in Multiple Pregnancies-The Knowns and Unknowns: A Systematic Review.

Nutrients 2021 Jan 27;13(2). Epub 2021 Jan 27.

2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland.

Maternal diet and nutritional status are of key importance with regard to the short- and long-term health outcomes of both the mother and the fetus. Multiple pregnancies are a special phenomenon in the context of nutrition. The presence of more than one fetus may lead to increased metabolic requirements and a faster depletion of maternal macro- and micro- nutrient reserves than in a singleton pregnancy. The aim of this systematic review was to gather available knowledge on the supply and needs of mothers with multiple pregnancies in terms of micronutrients and the epidemiology of deficiencies in that population. It was constructed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). The authors conducted a systematic literature search with the use of three databases: PubMed/MEDLINE, Scopus and Embase. The last search was run on the 18 October 2020 and identified 1379 articles. Finally, 12 articles and 1 series of publications met the inclusion criteria. Based on the retrieved studies, it may be concluded that women with multiple pregnancies might be at risk of vitamin D and iron deficiencies. With regard to other microelements, the evidence is either inconsistent, scarce or absent. Further in-depth prospective and population studies are necessary to determine if nutritional recommendations addressed to pregnant women require adjustments in cases of multiple gestations.
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http://dx.doi.org/10.3390/nu13020386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912422PMC
January 2021

Biomarkers of angiogenesis in twin gestations and the risk of preeclampsia - review of the current literature.

Ginekol Pol 2020;91(12):773-776

Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Poland.

Twin pregnancy is one of the key risk factors for the development of preeclampsia. Soluble fms-like tyrosine kinase-1, placental growth factor, and soluble endoglin are molecules involved in the process of angiogenesis with a proven role in the pathogenesis of preeclampsia. The aim of the review was to summarize available data on maternal serum levels of the biomarkers of angiogenesis and their usefulness in predicting preeclampsia in twin pregnancies. Most of available data suggest biomarkers concentrations differ between singleton and twin gestation and are related to chorionicity of twin pregnancy. Several algorithms including biomarkers of angiogenesis in prediction of PE in twin pregnancy are available and seem promising, however more large prospective surveys are necessary to assess their usefulness in general clinic use.
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http://dx.doi.org/10.5603/GP.a2020.0133DOI Listing
January 2020

Impact of childbirth on women's sexuality in the first year after the delivery.

J Obstet Gynaecol Res 2021 Mar 28;47(3):882-892. Epub 2020 Dec 28.

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

Aim: The aim was to compare the quality of sexual life before pregnancy and after delivery and to find out whether and how selected factors affect women's sexuality during this period.

Methods: The study group consisted of 433 women who completed the survey containing basic demographic questions and two Female Sexual Function Index (FSFI) questionnaires: a retrospective one, regarding time before pregnancy and the current period. The inclusion criteria: time between 10 weeks and 1 year after delivery, vaginal intercourses before pregnancy and the resumption of vaginal intercourses after delivery.

Results: We observed the negative impact of labor on the total FSFI score, regardless of the time that had passed since birth and the delivery mode. The decrease by at least 10% of the initial FSFI score was noticed in 44.3% of the participants. FSD (Female Sexual Dysfunction) occurred statistically more commonly after delivery than before pregnancy (45.3% vs 17.1%; P < 0.001). The following factors had an impact on the risk of post-partum FSD: pre-pregnancy FSD (adjusted odds ratio [aOR] = 4.17 [95% confidence interval [CI] 2.38-7.31]) and nulliparity (aOR = 1.67 [95% CI 1.09-2.53]).

Conclusion: Childbirth has an undeniable impact on women's sexuality. The prevention and treatment of sexual dysfunctions is very important, especially in this crucial period of life.
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http://dx.doi.org/10.1111/jog.14583DOI Listing
March 2021

Wilms' tumor 1 antigen immunoreactivity in epithelial ovarian cancer - diagnostic and prognostic value.

Folia Histochem Cytobiol 2020 22;58(3):198-207. Epub 2020 Sep 22.

Department of Tumor Pathology and Pathomorphology, Department of Oncology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland, Torun, Poland.

Objectives: Ovarian cancer is a heterogeneous disease, with a number of different histological subtypes with various responses to treatment. Wilms' tumor 1 (WT1) immunoreactivity is used to distinguish between OC's various subtypes. However, little is known about the protein's role as a prognostic factor. Thus, the main aim of our study was to evaluate the relationship between WT1 expression and patient overall survival (OS) and lymph node metastases.

Materials And Methods: Study group consisted of 164 women aged 22-84, diagnosed with epithelial ovarian cancer (EOC). WT1 expression in histological slides was assessed by immunohistochemistry.

Results: Serous tumors were the most common subtype among EOC (n = 126; 76.8%), followed by endometrioid (n = 20; 12.2%), clear-cell (n = 14; 8.5%) and mucinous cancer (n = 4; 2.4%). Of all serous EOC, WT1-positive tumors accounted for 75.6% of cases and this number was significantly higher than in other histological subtypes (p < 0.0001). Patients with lymph node metastases were more likely to have WT1-positive than WT1-negative tumors (p = 0.006). There was no significant correlation between WT1 immunoreactivity and OS across the whole study group of EOC patients (p = 0.6); however, in the group of non-serous (mucinous, endometrioid and clear-cell) EOC subjects, WT1 immunoreactivity was associated with shorter OS (p = 0.046).

Conclusions: WT1 immunoreactivity may be helpful in differentiating primary epithelial serous carcinomas from non-serous ovarian cancers; however, its prognostic role in EOC is rather uncertain.
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http://dx.doi.org/10.5603/FHC.a2020.0022DOI Listing
September 2020

Sleep Problems in Pregnancy-A Cross-Sectional Study in over 7000 Pregnant Women in Poland.

Int J Environ Res Public Health 2020 07 23;17(15). Epub 2020 Jul 23.

Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicza Square 1/3, 02-015 Warsaw, Poland.

The aim was to characterize sleep patterns in pregnant women in Poland and to analyze the relation between sociodemographic factors, pregnancy-related physical symptoms and sleep problems. A self-composed questionnaire, containing questions in Polish language, was distributed online via web pages and Facebook groups designed for pregnant women. The questionnaire included questions regarding sociodemographic data and information on the current pregnancy and sleep patterns over the past four weeks. Exactly 7207 respondents were included to the study. 77.09% reported sleep problems: nocturnal awakening (52.77%), sleep onset insomnia (20.23%), awakening too early (18.56%) and believed their sleep was too shallow (9.82%). Sleep onset insomnia (26.38%) and frequent awakening (62.88%) were most often reported in 3rd trimester, while daytime drowsiness (86.35%) and naps impeding daytime function (27.18%) in the 1st trimester of pregnancy. The analyzed demographic, socioeconomic and psychological issues had a small but significant influence on sleep problems occurrence (aOR 0.81-1.24). Time to conceive from 6 to 12 months of trying increased the risk of developing sleep problems during pregnancy (aOR 1.31). Pregnancy ailments increased the risk of sleep disturbances (aOR 1.53-2.59). Sleep disorders are prevalent among pregnant women in Poland. The evaluation of risk factors is essential in proper screening for sleep disorders in pregnant women.
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http://dx.doi.org/10.3390/ijerph17155306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432323PMC
July 2020

Levonorgestrel-Releasing Intrauterine System as a Contraceptive Method in Nulliparous Women: A Systematic Review.

J Clin Med 2020 Jul 3;9(7). Epub 2020 Jul 3.

2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland.

The aim of this review was to summarize the available evidence about the use of levonorgestrel-releasing intrauterine system (LNG-IUS) as a contraceptive method in nulliparous women. For this purpose, studies evaluating the efficacy, safety, bleeding pattern, satisfaction and discontinuation of the levonorgestrel-releasing intrauterine system in nulliparous women were analyzed. Only original research articles published in English between 1990-27th March 2020 were considered eligible. Reviews, book chapters, case studies, conference papers, opinions, editorials and letters were excluded. The systematic literature search of PubMed/MEDLINE, Scopus, Embase and Cochrane Library databases identified 816 articles, 23 of which were analyzed. The available evidence indicates that LNG-IUS is an effective and safe contraceptive method for nulliparous women that achieves high levels of satisfaction among patients. Moreover, nulliparous women seem to experience fewer expulsions than parous ones. Bleeding pattern is acceptable for the majority of patients, and bleeding disorders mainly occur in the first months after the insertion. More in-depth, long-term prospective studies are needed in this patient group to determine risk factors for the occurrence of side effects and associated discontinuations, which should not, however, delay the wider use of the method in this group, given the number of advantages.
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http://dx.doi.org/10.3390/jcm9072101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408997PMC
July 2020

Both Low and High PAPP-A Concentrations in the First Trimester of Pregnancy Are Associated with Increased Risk of Delivery before 32 Weeks in Twin Gestation.

J Clin Med 2020 Jul 3;9(7). Epub 2020 Jul 3.

Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-091 Warsaw, Poland.

In twin gestation, the relationship between pregnancy associated plasma protein (PAPP-A) and perinatal outcome is unclear. The aim of the study was to determine if low and high concentrations of PAPP-A in the first trimester are related to perinatal outcome in twins. A retrospective study was conducted. Medical data of women in twin pregnancies who delivered between 2013 and 2018 were analyzed. PAPP-A concentrations were measured between 10 + 0 and 13 + 6 weeks. The associations between low (<10th percentile) and high (>90th percentile) values of PAPP-A and pregnancy complications were analyzed. A total of 304 patients were included. PAPP-A <10th percentile was associated with a high risk of preterm delivery (OR 6.14; 95% CI 2.1-18), delivery <34 weeks (OR 2.39; 95% CI 1.1-5.1) or <32 weeks (OR3.06; 95% CI 1.4-6.8). Significant relations between PAPP-A >90th percentile and delivery <34 weeks (OR4.09; 95% CI 1.8-9.1) or <32 weeks (OR 2.83; 95% CI 1.2-6.6) were found. PAPP-A >90th percentile was related to high risk of intrauterine fetal demise (OR 10; 95% CI 2.4-42.5). Both low and high PAPP-A concentrations seem to be related to pregnancy outcome. Further research is needed to investigate evaluation of risk of pregnancy complications according to PAPP-A concentrations as a continuous variable.
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http://dx.doi.org/10.3390/jcm9072099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408854PMC
July 2020

Physical Activity Patterns among 9000 Pregnant Women in Poland: A Cross-Sectional Study.

Int J Environ Res Public Health 2020 03 9;17(5). Epub 2020 Mar 9.

1st Department of Obstetrics and Gynecology, First Faculty of Medicine, Medical University of Warsaw, Plac Starynkiewicza 1/3, 02-015 Warsaw, Poland.

The aim was to analyze the knowledge and experience of women regarding physical activity during their latest pregnancy. An anonymous questionnaire was completed electronically, in 2018, by 9345 women who gave birth at least once, with 52% of the women having performed exercises during pregnancy. Physically non-active respondents suffered from gestational hypertension (9.2% vs. 6.7%; < 0.01) and gave birth prematurely (9% vs. 7%; < 0.01) to newborns with a low birth weight significantly more often (6% vs. 3.6%; < 0.001). Physically active women delivered vaginally more often (61% vs. 55%; < 0.001) and were more likely to have a spontaneous onset of the delivery as compared with non-active women (73.8% vs. 70.7% = 0.001). The women who were informed by gynaecologist about the beneficial influence of physical activity during pregnancy exercised significantly more often (67% vs. 44% < 0.001). In addition, 13% of the women felt discrimination due to their physical activity during a pregnancy, 22% of respondents' physical activity was not accepted by their environment, and 39.1% of the women were told by others to stop physical exercise because it was bad for the baby's health. Physical activity during pregnancy is associated with improved fitness, decreased pregnancy ailments occurrence, and therefore influences the course of pregnancy and delivery in a positive way.
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http://dx.doi.org/10.3390/ijerph17051771DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084336PMC
March 2020

Post-zygotic diploidization of triploidy in human is possible? - a case of triploid partial molar pregnancy resulting in a premature live-born diploid female infant.

Neuro Endocrinol Lett 2019 Dec;40(5):227-232

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

Objective: During the treatment of our patient we found that reports covering possible complications and their treatment are very scarce. Due to advancement in ultrasound diagnosis most of molar pregnancies are terminated in first trimester of pregnancy. There is the gap in knowledge concerning pregnancy complications in case of partial mole discovered in advanced pregnancy. This is why we incorporated extensive and up-to-date review of literature in our manuscript.

Method: We described a case of previously healthy, 25 year old primigravida who delivered live daughter at 27 weeks of gestation, complicated with unusual ultrasound appearance of the placenta, severe hypotrophy, and subsequent post-partum eclampsia.

Results: Healthy diploid female infant, now two years old and healthy mother taking care of her.

Conclusions: In clinical practice early diagnosis of this complication usually lead to pregnancy termination. In modern medicine, decisions should be based on evidence and patient-doctor mutual understanding. Termination of pregnancy with suspicion of molar placenta can be specially difficult in gestation in older nulliparous women or after ART. We sincerely hope that this report will be useful for physicians across the world in counseling and treating their patients.
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December 2019

Maternal Serum Placental Growth Factor, Soluble Fms-Like Tyrosine Kinase-1, and Soluble Endoglin in Twin Gestations and the Risk of Preeclampsia-A Systematic Review.

J Clin Med 2020 Jan 9;9(1). Epub 2020 Jan 9.

Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, 01-809 Warsaw, Poland.

Multiple gestation is one of the key risk factors for the occurrence of preeclampsia (PE). Soluble fms-like tyrosine kinase-1, placental growth factor, and soluble endoglin are molecules involved in the process of angiogenesis with a proven role in the pathogenesis of PE. The aim of the review was to summarize available data on maternal serum levels of the above-mentioned factors and their usefulness in predicting PE in twin pregnancies. Only original research articles written in English were considered eligible. Reviews, chapters, case studies, conference papers, experts' opinions, editorials, and letters were excluded from the analysis. No publication date limitations were imposed. The systematic literature search using PubMed/MEDLINE, Scopus, Embase, and Cochrane Library databases identified 338 articles, 10 of which were included in the final qualitative analyses. The included studies showed significant differences in maternal serum levels of the discussed factors between women with twin pregnancies with PE and those who did not develop PE, and their promising performance in predicting PE, alone or in combination with other factors. The identification of the most effective algorithms, their prompt introduction to the clinical practice, and further assessment of the real-life performance should become a priority.
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http://dx.doi.org/10.3390/jcm9010183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019581PMC
January 2020

Occupational Burnout Syndrome in Polish Physicians: A Systematic Review.

Int J Environ Res Public Health 2019 12 10;16(24). Epub 2019 Dec 10.

Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, 01-809 Warsaw, Poland.

Due to the nature of their work, physicians are exposed to chronic stress. This may potentially lead to the widespread occurrence of occupational burnout syndrome (BS). The aim of this systematic review study was to summarize available published data concerning the prevalence of BS in Polish doctors. The literature search was performed using the following databases: PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar. The last search was performed on September 27th, 2019. Only articles in English or Polish on graduated doctors practicing in Poland were taken into account. All types of original research were considered eligible. However, review articles, book chapters, case reports, case series, conference papers, study protocols and articles in languages other than English and Polish were excluded. There were no restrictions on age, seniority or specialty of study participants. The literature search revealed a total of 21 studies that met the inclusion criteria. The results of individual studies were very diverse, which makes it difficult to draw specific conclusions. However, the problem of burnout among Polish doctors is valid and worth special attention from society, health policy leaders, and doctors themselves. High-quality research is essential to for a better understanding of this topic.
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http://dx.doi.org/10.3390/ijerph16245026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950131PMC
December 2019

The efficacy of misoprostol in the first trimester miscarriage treatment - an individual patients' data analysis.

Neuro Endocrinol Lett 2019 Nov;40(3):152-158

Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.

Introduction: The study aimed to detect factors predicting a successful pharmacological induction of first-trimester miscarriage.

Material And Methods: A prospective, cohort research was conducted at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, between years 2011-2015. 642 women diagnosed with first trimester miscarriage qualified for pharmacological induction with misoprostol were included in the study. Each patient underwent repeatable doses of 800mcg misoprostol vaginally. The endpoint was complete excretion of all tissues, with no need to perform surgical curettage. Type of miscarriage, gravidity, parity, number of doses, time of drug administration and side effects were analysed as possible factors influencing the results. The statistical analysis was performed with STATISTICA 10.0 software.

Results: The percentage of successful miscarriage induction was 83.6%. Two main factors corresponded with successful pharmacological treatment in regression analysis: number of administered doses (adjusted OR 1.64; 95% CI 1.18-2.29) and week of gestation (aOR 1.22; 95%CI 1.03-1.44). The success of the pharmacological induction of miscarriage was significantly decreased if the woman had a history of caesarean section (aOR 0.34; 95% CI 0.2-0.57). 2.2% of patients experienced benign side effects of the therapy.

Conclusions: Pharmacological induction is an effective and safe treatment method of first trimester abortion in the majority of cases. The knowledge of factors influencing the efficacy of misoprostol may help clinicians in proper counselling and individualisation of therapy.
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November 2019

Contraceptive Behaviors in Polish Women Aged 18-35-a Cross-Sectional Study.

Int J Environ Res Public Health 2019 07 30;16(15). Epub 2019 Jul 30.

st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland.

The aim was to evaluate contraceptive behaviors, and factors affecting them, in the population of Polish-speaking women. A cross-sectional study was performed on 6763 women, current contraceptive users, aged 18 to 35. An anonymous and voluntary questionnaire written in Polish, containing 33 questions, was distributed online from January to February 2017. The Internet and doctors were the most popular sources of information about contraception (82% and 73%, respectively). Upon choosing contraception, women paid the most attention to its efficacy (85%) and its impact on health (59%). The most common methods were combined oral contraceptives (38%) and condoms (24%). In total, 51% had chosen hormonal contraception, of which 68% experienced side effects. The most frequent were decreased libido (39%) and weight gain (22%). Factors associated with the usage of hormonal or non-hormonal contraception were: education, relationship status, parenthood, number of sexual partners, frequency of intercourses, sources of information about contraception, and factors considered most important when choosing a contraceptive method. The choice between short-acting and long-acting reversible contraception was influenced by age, relationship status, parenthood, smoking, sources of information about contraception, and factors considered most important when choosing a contraceptive method. Wide access to contraception, high-quality education, and counselling should become priorities in family planning healthcare.
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http://dx.doi.org/10.3390/ijerph16152723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695758PMC
July 2019

Sex education in Poland - a cross-sectional study evaluating over twenty thousand polish women's knowledge of reproductive health issues and contraceptive methods.

BMC Public Health 2019 Jun 3;19(1):689. Epub 2019 Jun 3.

1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Pl. Starynkiewicza 1/3, 02-015, Warsaw, Poland.

Background: Reproductive health is a part of a comprehensive definition of complete physical, mental and social well-being. Sex education is an important aspect of public health. Ignorance, due to the lack of sex education leads to risky sexual behaviors.

Methods: Our cross-sectional study was aimed at investigating a representative group of Polish women's knowledge about the physiology of the menstrual cycle, contraceptive methods, infertility and cervical cancer prevention. The data were collected by face-to-face interviews and an anonymous electronic questionnaire.

Results: The study group involved 20,002 respondents. Most of the women were of reproductive age (mean 27.7), parous (60.8%), of higher education (71%) and living in large cities (> 500 k citizens, 36.8%). 62.2% of the women gave correct answers to at least 5 of 7 questions concerning the physiology of the menstrual cycle. Three factors had a significant influence on the number of correct answers: higher education (p = 0.0001), more frequent gynecological appointments (p = 0.0001) and living in a larger city (p = 0.002). Women of higher education level had more often used some form of contraceptive method previously (87% vs. 78.4%, p = 0.001), recommended natural family planning methods to their peers (18.4% vs. 15%, p = 0.001) and regularly attended gynecological appointments (85.7% vs. 78.8%, p = 0.001) when compared with those women with lower educational levels. The three most effective contraceptive methods identified by respondents were: oral contraceptives (71.1% answers), intrauterine devices (50.2%) and parenteral hormonal contraceptives (30.4%). The effectiveness of natural family planning was more often emphasized by women who had never used any contraceptives before (20.1% vs 6.7%). Most of the participants (80.8%) believed that in-vitro fertilization is an effective infertility treatment and should be reimbursed in Poland. Also, 95.2% of the respondents reported that they had undergone a Papanicolaou test within the past 3 years, but only 3% of these women were aware of all the risk factors for cervical cancer mentioned in our survey.

Conclusions: It is very important to improve comprehensive reproductive health education in Poland, especially among women of lower educational levels and living in small centers. In future, educational programs and gynecologists should focus on implementing and improving these aforementioned issues.
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http://dx.doi.org/10.1186/s12889-019-7046-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547576PMC
June 2019

Perinatal outcome of fertilization singletons - 10 years' experience of one center.

Arch Med Sci 2019 May 30;15(3):666-672. Epub 2019 Jan 30.

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

Introduction: fertilization (IVF) singletons have a worse perinatal outcome than spontaneously conceived singletons, especially in terms of preterm birth and its complications.

Material And Methods: An observational retrospective case control study was carried out. The study population consisted of 644 women in singleton pregnancies (336 IVF/intracytoplasmic sperm injection (ICSI); 308 controls) who delivered > 22 weeks of gestation at the 1 Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland, between 2004 and 2014. Controls were initially matched by age and parity and drawn from the group of deliveries following each IVF delivery. Collected data included maternal characteristics, incidence of pregnancy complications, time and mode of delivery, and neonatal outcome at delivery.

Results: The two study groups were initially matched for age and parity and were also similar with regard to BMI and gestational weight gain. The IVF treatment increased the odds of having vaginal bleeding in the first trimester (OR = 1.68; 95% CI: 1.0-2.86), placenta previa (OR = 5.15; 95% CI: 1.1-33.9), preterm delivery (OR = 2.06; 95% CI: 1.16-3.68), newborn's low birth weight (OR = 2.27; 95% CI: 1.19-4.36) and elective cesarean section (OR = 2.39; 95% CI: 1.7-3.4).

Conclusions: The IVF singleton pregnancies have an increased risk of adverse perinatal outcome, among which prematurity remains the greatest problem. Therefore, they should be managed as high risk not only due to psychological reasons.
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http://dx.doi.org/10.5114/aoms.2019.82670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6524192PMC
May 2019

Cervical cancer - causes and prevention of hpv infections in the opinions of young polish women: a cross-sectional survey.

Wiad Lek 2019 ;72(3):327-335

Cardinal Stefan Wyszyński University, Warsaw, Poland.

Objective: Introduction: Cervical cancer is an important issue of gynecologic oncology. The awareness of this disease, the attitude towards HPV vaccination and cytological screening play an important role in decreasing morbidity and mortality due to cervical cancer. The aim: To assess the various aspects of knowledge regarding cervical cancer, risk factors for this disease, the role of HPV infection and the attitude to primary (vaccination) and secondary (cytological screening) prevention among young women.

Patients And Methods: Materials and methods: The study was performed using CAWI method based on original questionnaire in electronic form. Online completing of the survey was voluntary and anonymous.

Results: Results: The study was conducted in a group of 2058 women aged 19-33. In total 98.4% of respondents came across the term "cervical cancer", 84.1% knew that cervical cancer could be prevented and the following were identified as the main risk factors: cervical cancer in closest relatives (85.3%) and HPV infection (81.9%). Although according to 82.0% of women HPV infection can be prevented by vaccination, only 18.4% of respondents were vaccinated. The main reason for non-vaccination was lack of knowledge about the availability of the vaccine (41.2%) and high price (32.0%). Of the unvaccinated people, 63.5% declare their will to be vaccinated in the future. Concerning secondary prevention, 98.6% of the respondents admitted that they knew the term "cytological examination", 89.0% indicated that this examination detected the presence of pre-cancerous lesions, and according to 58.4% of respondents, this test should be performed after sexual initiation. Despite the fact that 80.5% of respondents confirmed the fact of beginning sexual activity (44.4% of them had more than 1 partner), 17.1% of the respondents admitted that they didn't go to gynecologist yet. Approximately 84% of respondents believe that the amount of information on cervical cancer prophylaxis and HPV infections currently providing is insufficient.

Conclusion: Conclusions: The basic terms regarding primary (vaccination) and secondary (prophylactic tests) prevention of cervical cancer have been widely known. However, the knowledge about specific risk factors, sexual behaviors contributing to HPV infection and, consequently, the ability to self-identify as belonging to higher risk group is insufficient. It is justified to conduct educational activities regarding the assessment of risks related to cervical cancer addressed to young women. Together with education, HPV vaccination and secondary prevention programs require financial support.
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August 2019

How to identify pregnant women at risk of pre-eclampsia? - a review of the current literature.

Ginekol Pol 2018 ;89(6):335-338

Pre-eclampsia remains a major cause of poor perinatal outcome worldwide. As administering acetylsalicylic acid in a high risk population reduces the risk of PE, it is essential to identify women at risk of PE. Several algorithms for PE risk assessment have been developed. They include maternal factors combined with uterine artery pulsatility index, mean arterial pressure, serum pregnancy-associated plasma protein-A, placental growth factor, and serum soluble fms-like tyrosine kinase-1. Beside PE prophylaxis with acetylsalicylic acid, a proper management of women considered at a high risk of PE is essential. The sFlt-1:PlGF ratio between 20 and 34 + 6 weeks may be used to predict a short-term absence of PE or to predict the risk of PE diagnosis within 4 weeks and a significant shortening of the duration of pregnancy associated with it. The sFlt-1:PlGF ratio may be helpful in deciding about hospitalization or choosing the optimal time for corticosteroid administration in women at risk of PE. It may also help to reduce overall healthcare costs.
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http://dx.doi.org/10.5603/GP.a2018.0057DOI Listing
November 2018

Rapid cervical phIGFBP-1 test in asymptomatic twin pregnancies is inefficient in predicting preterm delivery prior to 34 gestational weeks.

Ginekol Pol 2018 ;89(6):321-325

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

Objectives: To assess the effectiveness of a rapid second trimester test for cervical phIGFBP-1 in the prediction of sponta-neous preterm delivery prior to 34 weeks in asymptomatic twin pregnancies.

Material And Methods: A prospective observational study conducted on 232 twin pregnancies tested for phIGFBP-1 at 20-24 weeks of gestation. 151 patients assessed as asymptomatic, with cervical length > 25 mm at 20-24 weeks were analysed. The primary outcome was the delivery < 34 weeks of gestation.

Results: The spontaneous preterm delivery before completing 34 weeks occurred in 23 patients (15.2%), including 9 in dichorionic and 14 in monochorionic pregnancies. The sensitivity of phIGFBP-1 test was 0.39 and specificity 0.63 in predicting delivery before 34 gestational weeks. phIGFBP-1 had a low positive predictive value of 0.16 and high negative predictive value (0.85). Both positive and negative predictive values of delivery < 34 weeks were close to 1.

Conclusions: A test for phIGFBP1 presence is not an effective additional tool for predicting preterm delivery before 34 weeks in twin gestation.
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http://dx.doi.org/10.5603/GP.a2018.0055DOI Listing
November 2018

Sudden Fetal Hematologic Changes as a Complication of Amnioreduction in Twin-Twin Transfusion Syndrome.

Fetal Diagn Ther 2018 20;44(4):311-314. Epub 2018 Mar 20.

Division of Neonatology, Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands.

We present the first case of a monochorionic twin pregnancy in which sudden hematologic changes occurred as a complication of the amnioreduction procedure for twin-twin transfusion syndrome (TTTS). At 33 weeks of gestation, 4 days after the amnioreduction, the recipient developed severe anemia while the donor developed severe polycythemia. Postnatal placental examination revealed several arteriovenous and venoarterial anastomoses, a pale placental mass of the recipient and a congested and plethoric placental mass of the donor. We speculate on the pathophysiologic changes and potential deleterious effects provoked by the decompressive amnioreduction. Decompression of the placenta and anastomoses after the amnioreduction may have led to an acute blood shift from recipient to donor (thus also a reversal of feto-fetal transfusion), resulting in anemia in the recipient and polycythemia in the donor twin. In the past 15 years, 13 TTTS cases with late presentation were treated with amnioreduction. This is the first time we encountered this severe complication, yielding an incidence of 8%. Although the optimal treatment in TTTS with late presentation is not known, perinatologists should be aware that treatment with amnioreduction can lead to sudden hematologic changes.
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http://dx.doi.org/10.1159/000487187DOI Listing
March 2019

The first trimester aneuploidy biochemical markers in IVF/ICSI patients have no additional benefit compared to spontaneous conceptions in the prediction of pregnancy complications.

J Perinat Med 2018 Nov;46(9):953-959

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

Objectives: The aim of this study was to determine if the levels of biochemical aneuploidy markers in in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) pregnancies differ from those in spontaneous pregnancies and to verify if biochemical markers could predict pregnancy outcome in IVF/ICSI gestations.

Methods: This was a prospective observational study performed in a group of 551 patients who underwent a combined first trimester prenatal screening (ultrasound scan and serum markers). All patients were divided into two groups according to the mode of conception: IVF/ICSI pregnancies (study group) and spontaneous conceptions (control group). The concentrations of first trimester biochemical markers were presented as multiples of median (MoM) and were compared between the study and control groups. Analysed pregnancy complications included: preterm delivery (PTD), small for gestational age (SGA), gestational hypertension (GH), preeclampsia (PE) and gestational diabetes (GDM).

Results: The analysis was performed on 183 IVF/ICSI and 368 spontaneously conceived gestations, with complete data regarding obstetric outcome. There were no significant differences in the concentrations of biochemical markers between the analysed groups. Pregnancy-associated plasma protein-A (PAPP-A) levels were lower in hypertensive than in normotensive patients, although the difference was not significant. Twenty-three patients had GDM (12.5%), 16 had GH or PE (8.7%), SGA was diagnosed in 18 (9.8%) and 25 delivered preterm (13.6%).

Conclusions: The trend for lower PAPP-A MoM was visible in all affected patients, although the results did not reach statistical significance. The first trimester biochemical markers in assisted reproduction technique (ART) pregnancies do not seem to have additional effect on predicting the risk of pregnancy complications.
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http://dx.doi.org/10.1515/jpm-2017-0199DOI Listing
November 2018

Observational study of associations between gestational weight gain and perinatal outcomes in dichorionic twin pregnancies.

Int J Gynaecol Obstet 2017 Jul 2;138(1):94-99. Epub 2017 May 2.

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

Objective: To evaluate relationships between gestational weight gain (GWG) and adverse events during pregnancy among patients of normal weight with twin pregnancies.

Methods: The present observational study included patients with dichorionic twin pregnancies with a pre-gravid body mass index of 18.5-24.99 kg/m who underwent delivery at no earlier than 22 weeks of pregnancy between January 1, 2007, and June 30, 2016, at the Medical University of Warsaw, Warsaw, Poland. The GWG ratio was categorized as low (<0.45 kg/wk), adequate (0.45-0.66 kg/wk), or high (>0.66 kg/wk), and pregnancy outcomes were compared between the GWG ratio groups. Associations between GWG ratio and pregnancy outcomes were estimated using generalized additive models.

Results: There were 201 patients included in the study. No differences in rates of preterm delivery, very preterm delivery (VPTD), small for gestational age fetus, pre-eclampsia, gestational diabetes, preterm premature rupture of membranes, or intrauterine fetal demise were observed between the patient groups. Linear relationships with GWG ratio were recorded for VPTD (P=0.019) and spontaneous VPTD (P=0.003); non-linear relationships with GWG ratio were recorded for pre-eclampsia (P=0.023) and perinatal mortality (P=0.015). A GWG ratio of 0.55-0.56 kg/wk appeared optimal in terms of twin pregnancy outcomes.

Conclusion: The incidence of VPTD, pre-eclampsia, and perinatal mortality during dichorionic twin pregnancy were associated with GWG ratio.
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http://dx.doi.org/10.1002/ijgo.12171DOI Listing
July 2017

Risk factors for depressive symptoms in early postpartum period and after puerperium - are they the same?

Neuro Endocrinol Lett 2016 Nov;37(6):452-460

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

Objectives: Correlation between the occurrence of postnatal depressive symptoms at 5 days and 6 weeks postpartum is well established. The objective of the study was to determine the influence of psychosocial and perinatal factors on the occurrence of postpartum depressive symptoms 2 to 5 days and 6 weeks after delivery.

Methods: 373 women in early postpartum (EPG) and 107 women 6 weeks after delivery (late postpartum group - LPG) completed a questionnaire including questions concerning mothers' characteristics, obstetric and neonatal complications during pregnancy, psychiatric factors and Edinburgh Postnatal Depression Scale (EPDS).

Results: 21.6% of mothers from EPG and 14.2% in LPG achieved ≥10 points in EPDS. In both groups patients with ≥10 points reported stressful situations during pregnancy, sedative agents usage and a history of suicidal attempts. In EPG women with ≥10 points significantly more frequent delivered preterm, were hospitalized during pregnancy and their newborns had more health problems. In LPG mothers with ≥10 points more often reported several obstetric complications. Maternal comorbidity or sociodemographic factors did not correlate with the risk of depressive symptoms.

Conclusion: The risk factors for depressive symptoms after delivery vary in different time intervals. Therefore screening for PD should not be performed once in a single selected risk group.
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November 2016

Placental examination with dye injections in post-delivery chorionicity assessment in dichorionic triplet pregnancy.

Ginekol Pol 2016 ;87(2):157-60

I Katedra i Klinika Położnictwa i Ginekologii, I Katedra i Klinika Położnictwa i Ginekologii Warszawski Uniwersytet Medyczny.

The incidence of spontaneous triplet pregnancy is approximately 1 in 7000 deliveries. Due to the fact that every presentation of a triplet and higher order pregnancy is associated with high rate of morbidity and preterm delivery, chorionicity and amnionicity remain significant predictive factors which determine specific management throughout the pregnancy. Ultrasound chorionicity assessment in triplet pregnancies is more complex than in twins, and in many cases it remains unknown. We present a case report of a 24-year-old primipara in a spontaneous dichorionic triplet pregnancy, qualified for a cesarean section at 33 weeks of gestation, with subsequent placental examination with dye injections and post-delivery chorionicity assessment.
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http://dx.doi.org/10.17772/gp/60555DOI Listing
July 2018

Perinatal outcome according to chorionicity in twins - a Polish multicenter study.

Ginekol Pol 2016 ;87(5):384-9

Objectives: The aim of the study was to analyze the perinatal outcome of twin gestations and estimate the influence of chorionicity on the outcome in a large cohort of twin pregnancies in Poland.

Material And Methods: A retrospective analysis of 465 twin deliveries in 6 Polish centers in 2012 was conducted. Baseline characteristics, the course of pregnancy and labor, as well as the neonatal outcome were analyzed in the study group and according to chorionicity.

Results: A total of 356 twin pregnancies were dichorionic (DC group) (76.6%), and 109 were monochorionic (MC group) (23.4%). There were no differences in the occurrence of pregnancy complications according to chorionicity, except for IUGR of at least one fetus (MC 43.1% vs. DC 34.6%; p = 0.003). 66.5% of the women delivered preterm, significantly more in the MC group (78% vs. 62.9%; p = 0.004). Cesarean delivery was performed in 432 patients (92.9%). Mean neonatal birthweight was statistically lower in the MC group (2074 g vs. 2370 g; p < 0.001). Perinatal mortality of at least one twin was 4.3% (2.8% in the DC group vs. 9.2% in the MC group; p = 0.004). Neonatal complications, including NICU admission, respiratory disorders, and infections requiring antibiotic therapy, were significantly more often observed among the MC twins.

Conclusions: The overall perinatal outcome in the presented subpopulation of Polish twins and its dependence on cho-rionicity is similar to the reports in the literature. Nevertheless, the rates of preterm and cesarean deliveries remain higher. It seems that proper counselling of pregnant women and education of obstetricians may result in reduction of these rates.
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http://dx.doi.org/10.5603/GP.2016.0009DOI Listing
July 2018

Twin Chorionicity and the Risk of Hypertensive Disorders: Gestational Hypertension and Pre-eclampsia.

Twin Res Hum Genet 2016 08 10;19(4):377-82. Epub 2016 May 10.

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

Twin gestation is known to be a risk factor for hypertensive disorders of pregnancy. However, the relationship between hypertensive disorders (pre-eclampsia (PE) and gestational hypertension (GH)) and chorionicity of twin pregnancy is unclear, and published data is conflicting. We decided to analyze the relationship between placentation and prevalence of hypertensive disorders. It was a retrospective cohort study. 312 twin pregnancies delivered between 2009 and 2014 were analyzed, 79 of which were monochorionic and 233 dichorionic. The occurrence of PE and GH was established according to American College of Obstetricians and Gynecologists' (ACOG) guidelines. Hypertensive disorders were diagnosed significantly more often in dichorionic than in monochorionic twin pregnancies (19.7% vs. 8.9%; OR = 2.53 95% CI 1.04-6.45; p = .03). PE occurred more frequently in DCP (13.3% vs. 3.8%; OR = 3.88 95% CI 1.09-16.46; p = .02). There were no differences between those two groups in the prevalence of GH (6.4% vs. 5.1%; p = .79). The logistic regression model for the occurrence of PE included chorionicity, mother's age lower than 18 or higher than 40, pre-gestational obesity, in vitro fertilization, primiparity, gestational age at delivery, gestational diabetes, and active smoking. It showed that dichorionicity remained an independent risk factor for PE (adjusted OR = 4.97.0 95% CI 1.06-23.38; p = .04). Dichorionicity seems to be a risk factor for PE but not for GH development.
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http://dx.doi.org/10.1017/thg.2016.17DOI Listing
August 2016

Relation between time interval from antenatal corticosteroids administration to delivery and neonatal outcome in twins.

J Obstet Gynaecol Res 2016 Jun 23;42(6):625-31. Epub 2016 Mar 23.

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

Aim: The aim of this study was to evaluate the perinatal outcome in twins, who were administered one complete course of antenatal corticosteroids (ACS) depending on the time interval from corticosteroids to delivery.

Methods: We carried out a retrospective analysis of medical data of women with twins who received a course of ACS and delivered before 34 weeks within or beyond 7 days after ACS were given. Among 652 twin deliveries between 2006 and 2014, 106 met the criteria (50 patients delivered <7 days and 56 ≥ 7 days after ACS administration).

Results: There were no differences in the mean gestational age at labor, mean birthweight, perinatal mortality or newborns' general condition between women who delivered <7 and ≥7 days after corticosteroids. Newborns in the ≥7 days group suffered from respiratory disorders significantly more often (74.1% vs 54.5%, P = 0.003) and were hospitalized longer (42.6 ± 19.1 vs 33.4 ± 21.7 days, P < 0.001). Significantly more infants in the <7 days group were administered antibiotics (55.6% vs 25%, P = 0.001). In the multiple logistic regression analysis, the only factors significantly influencing the incidence of respiratory complications in twins were delivery following ACS therapy within 7 days (adjusted odds ratio, 0.16; 95% confidence interval, 0.02-0.90) and female sex (adjusted odds ratio, 0.71; 95% confidence interval 0.40-0.90).

Conclusion: There is a relation between neonatal outcomes in twins and time interval between ACS administration and birth. Therefore, a single ACS course should be administered with caution in order to allow for the completion of the treatment without exceeding an interval of 7 days to delivery. © 2016 Japan Society of Obstetrics and Gynecology.
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http://dx.doi.org/10.1111/jog.12966DOI Listing
June 2016

Do normal-weight women pregnant with twins are at the lowest risk of developing preeclampsia?

J Matern Fetal Neonatal Med 2017 Jan 29;30(2):191-193. Epub 2016 Mar 29.

a 1st Department of Obstetrics and Gynecology , Medical University of Warsaw , Starynkiewicza Square 1/3, Warsaw , Poland.

Objective: To determine the relation between preeclampsia (PE) and pregravid body mass index (BMI) in twin pregnancy.

Methods: Retrospective cohort study of 542 women pregnant with twins.

Results: Forty-nine patients developed PE (9%). Underweight, overweight and obese women were at a higher risk of PE than normal-weight mothers. There was no linear (p = 0.7) but significant U-shaped relation between BMI and PE (p < 0.006). The lowest risk of PE development was related to BMI of about 23 kg/m.

Conclusions: Nonlinear relation between PE occurrence and BMI suggests that using homogeneous PE risks of BMI groups may be incorrect.
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http://dx.doi.org/10.3109/14767058.2016.1166358DOI Listing
January 2017

Pregnancy beyond the age of 40 - the influence of parity on perinatal outcome.

Neuro Endocrinol Lett 2015 ;36(4):387-93

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

Objective: The aim of the study was to compare the pregnancy course and neonatal outcome in women at least 40 years old during conception.

Design: Data were collected on the basis of medical records of patients who gave birth between 2009-2014 at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw. Women enrolled were at least 40 years old at the moment of conception and delivered after 22 completed weeks of gestation - they were also assigned into 2 groups: primiparas and multiparas. Demographic features, pregnancy and delivery complications, mode of delivery and neonatal outcome were analyzed and compared.

Results: 9760 women delivered at the Department during the study period, among them 193 met the inclusion criteria for the study: 40 primiparas (average age 40.9 ± 1.14) and 153 multiparas (average age 41.3 ± 1.35). No relation between parity and preterm delivery was observed (5% primiparas vs 11.1% multiparas; p>0.05). However, gestational age at delivery was associated with the number of pregnancies - the higher the pregnancy number, the lower the gestational age (p=0.009; R=-0.188). Primiparity was associated with an increased rate of oligohydramnios (RR=4.78; 95% CI 1.15-20.63) and pregnancy induced hypertension (RR=2.34; 95% CI 0.93-5.58). Primiparas had a significantly greater risk of operative delivery (RR=1.83; 95% CI 1.42-2.12) and unsuccessful labor inductions (RR=3.60; 95% CI 1.04-5.29). They were more often diagnosed with fibroids (RR=3.04; 95%CI 1.15-7.81). No relations between parity and birth weight, fetal abnormalities or Apgar score were observed.

Conclusions: Delayed childbearing of a first child seems to increase the risk of perinatal complications, which is important for counseling purposes.
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March 2016