Publications by authors named "Mariusz Dubiel"

40 Publications

The NLRP3 Inflammasome Role in the Pathogenesis of Pregnancy Induced Hypertension and Preeclampsia.

Cells 2020 07 8;9(7). Epub 2020 Jul 8.

Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland.

Pregnancy-induced hypertension and preeclampsia are associated with significant maternal and fetal mortality. A better understanding of these diseases, delineation of molecular pathomechanism, and efficient treatment development are some of the most urgent tasks in obstetrics and gynecology. Recent findings indicate the crucial role of inflammation in the development of hypertension and preeclampsia. Although the mechanism is very complex and needs further explanation, it appears that high levels of cholesterol, urate, and glucose activates NLRP3 inflammasome, which produces IL-1β, IL-18, and gasdermin D. Production of these proinflammatory chemokines is the beginning of a local and general inflammation, which results in sympathetic outflow, angiotensin II production, proteinuria, hemolysis, liver damage, immunothrombosis, and coagulopathy. The NLRP3 inflammasome is a critical complex in the mediation of the inflammatory response, which makes it crucial for the development of pregnancy-induced hypertension and preeclampsia, as well as its complications, such as placental abruption and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Herein, the presented article delineates molecular mechanisms of these processes, indicating directions of future advance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/cells9071642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7407205PMC
July 2020

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

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

Ultrasound measurements of umbilical cord transverse area in normal pregnancies and pregnancies complicated by diabetes mellitus.

Ginekol Pol 2014 Nov;85(11):810-4

Objective: A voluminous umbilical cord has been described in diabetic pregnancies. The aim of this studywas to see if measurements of cord diameters might be of value in the evaluation of diabetic pregnancies and especially those suspected of a large for gestational age (LGA) fetus.

Methods: In an observational, prospective study umbilical cord areas and vessel diameters were measured between gestational age of 22 and 40 weeks in transverse ultrasound images of the central part of the cord in 141 normal and 135 diabetic pregnancies of which 30 were suspected of being LGA. Wharton's jelly area was calculated by subtracting the vessel area from the total transverse cord area. Normal reference curves were constructed for gestational age.

Results: Umbilical cord and Wharton's jelly areas increased with gestation. The vessel area leveled out at 32-33 weeks of gestation and the umbilical vein area decreased after 36 weeks of gestation. The umbilical cord parameters in diabetic pregnancies did not differ from controls. Cord areas were enlarged in 1/3 of the LGA fetuses.

Conclusion: Umbilical cord area measurements are of limited value for the evaluation of diabetic pregnancies suspected having a LGA-fetus.
View Article and Find Full Text PDF

Download full-text PDF

Source
November 2014

Effect of LLLT on endothelial cells culture.

Lasers Med Sci 2015 Jan 18;30(1):273-8. Epub 2014 Sep 18.

Department of Pathophysiology, Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń (NCU), Ul. M. Skłodowskiej-Curie 9, 85-094, Bydgoszcz, Poland,

Growth factors as vascular endothelial growth factor (VEGF), produced by the endothelial cells, take an essential part in pathological and physiological angiogenesis. The possibility of angiogenesis modulation by application of laser radiation may contribute to the improvement of its use in this process. Thus, the aim of the study was to investigate the influence of low-level laser therapy (LLLT) on the proliferation of endothelial cells, secretion of VEGF-A and presence of soluble VEGF receptors (sVEGFR-1 and sVEGFR-2) in the medium after in vitro culture. Isolated human umbilical vein endothelial cells (HUVECs) were irradiated using a diode laser at a wavelength of 635 nm and power density of 1,875 mW/cm(2). Depending on radiation energy density, the experiment was conducted in four groups: I 0 J/cm(2) (control group), II 2 J/cm(2), III 4 J/cm(2), and IV 8 J/cm(2). The use of laser radiation wavelength of 635 nm, was associated with a statistically significant increase in proliferation of endothelial cells (p = 0.0041). Moreover, at 635-nm wavelength, all doses of radiation significantly reduced the concentration of sVEGFR-1 (p = 0.0197).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10103-014-1650-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289014PMC
January 2015

The biological role of Treg cells in ectopic endometrium homeostasis.

Histol Histopathol 2014 Oct 15;29(10):1217-33. Epub 2014 May 15.

Department of Gynecology and Oncology, Lukaszczyk Oncological Center, Bydgoszcz, and Chair of Gynecology, Oncology and Gynecological Nursing, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Torun, Poland.

Although retrograde menstruation is observed in up to 90% of women, endometriosis actually develops in only 15% of women. There is considerable evidence in the literature that ectopic endometrial cells are able to evade immune surveillance and that the immune response in the microenvironment of ectopic lesions is limited. Endometriosis develops when a deficiency in the local immune response has been generated, and progression of the disease is related to the intensity of this process. Over the last couple of decades it has been well known that T regulatory lymphocytes (Tregs) play a crucial role in controlling a variety of physiological and pathological immune responses. In this review we have focused on the physiological alteration of Treg cell infiltration into the endometrium during the reproductive processes of women. We discuss how a disturbance in Treg cell expansion is involved in generating such pathological processes as miscarriage and ectopic pregnancy development. We hypothesize about the role Treg cells might play in the survival of endometriosis foci in ectopic localization and in the evasion of such lesions from host immune surveillance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14670/HH-29.1217DOI Listing
October 2014

[Chorioangioma--a case study].

Ginekol Pol 2014 Mar;85(3):230-3

Chorioangioma (chorionic angioma) is the most common non-malignant placental tumor Taking into account its morphological structure, it can have significant influence on fetal condition and pregnancy depending on its size. In the presented case a substantial placental tumor was diagnosed and complications typical for chorioangioma, such as fetal hemodynamic disorders, polyhydramnios, gestational diabetes and premature labor were observed. The applied treatment led to normalization of the fetal and maternal condition and to prolongation of the pregnancy
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17772/gp/1719DOI Listing
March 2014

Fetal pulmonary and cerebral artery Doppler velocumetry in normal and high risk pregnancy.

Ginekol Pol 2014 Jan;85(1):26-30

Department of Obstetrics and Gynecology, Malmö University Hospital, Malmö, Sweden.

Unlabelled: Studies on fetal lung/brain circulation by means of power Doppler technique have suggested a marked reduction in lung perfusion in high-risk pregnancies as a sign of circulation redistribution. The ratio between lung/brain perfusion might therefore give a new method to predict fetal circulation centralization.

Objective: The aim of the present study was to obtain fetal lung and cerebral artery ratio in normal and high-risk pregnancies.

Study Design: Doppler samples from proximal right pulmonary artery blood velocities and middle cerebral artery (MCA) were recorded cross-sectionally in 228 normal singleton pregnancies at gestational age 22 to 40 weeks. MCA/right pulmonary artery pulsatility index (PI) ratio was calculated. Doppler samples from proximal right pulmonary artery and MCA were also recorded in 89 high-risk singleton pregnancies and the results related to perinatal outcome.

Results: In the normal controls, right pulmonary artery PI remained stable until 30 weeks of gestation with slight increase thereafter until term. The MCA to right pulmonary artery PI ratio increased between 22 and 28 weeks of gestation with the rapid fall towards term. In the high-risk pregnancies group, right pulmonary artery PI showed no significant correlation to perinatal outcome, but signs of brain-sparing in the MCA were correlated to all adverse outcome parameters.

Conclusion: Velocimetry of the middle cerebral artery is better than velocimetry of right pulmonary artery in predicting adverse outcome of pregnancy The brain/lung PI ratio does not improve the prediction of adverse outcome of pregnancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17772/gp/1686DOI Listing
January 2014

[Rupture of a splenic artery aneurysm in full term pregnancy--case report].

Ginekol Pol 2011 Dec;82(12):940-2

Collegium Medicum w Bydgoszczy Uniwersytet Mikołaja Kopemika w Toruniu, Polska.

A case of a primigravida with hypovolemic shock symptoms and acute intrauterine fetal hypoxia was described. Emergency caesarean section, during which a hemorrhage to the peritoneal cavity caused by an unrecognized splenic artery aneurysm rupture was diagnosed, was immediately performed.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2011

Hepatic aminotransferases of normal and IUGR fetuses in cord blood at birth.

Early Hum Dev 2012 Jul 2;88(7):461-5. Epub 2011 Dec 2.

Dept. of Obstet. and Gynecol., Poznan University of Medical Sciences, Poland.

Background: The accepted standard for assessing the wellbeing of the newborn is the Apgar score and blood gas analysis. However, the prediction of neonatal morbidity or mortality is limited. In small-for-gestation (SGA) fetuses at 18-38 weeks of gestation, pO(2) is <5th centile both in the umbilical artery and vein in 30%. In a previous study in singleton term neonates cardiac specific enzymes (B-type natriuretic peptide, BNP and cardiac troponin T, cTnT) are increased in growth-restricted fetuses compared with normals.

Aims: To test the hypothesis, that fetuses with intra uterine growth restriction (IUGR) have elevated AST (GOT) and ALT (GPT) aminotransferases as a result of hypoxic liver cell injury, and to establish references ranges.

Study Design: Prospective cohort study, serum of umbilical artery (n=156) and vein (n=180), 599 normal singletons at 37(+0)-42(+0)weeks, neonates with IUGR (n=41), analysis for pH, birthweight and maternal weight, spontaneous vs cesarean section, vein vs artery and for the sex.

Outcome Measures: Aspartate aminotransferase (AST, GOT) and Alanine aminotransferase (ALT, GPT) were measured in normals and IUGR neonates.

Results: Neonates with IUGR (n=41) had AST values that were not different from the reference group, but had significantly lower ALT (-1.49, 95% CI -1.98 to -1.00 vs 0.14, 95% CI -0.42-0.13), (p<0.001), (Fig. 3).

Conclusions: In neonates with IUGR, hypoxic hepatic injury markers in cord blood were not elevated. Rather, a substantially reduced ALT suggests a down-regulated hepatic activity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.earlhumdev.2011.11.001DOI Listing
July 2012

[Holoprosencephaly--a case report].

Ginekol Pol 2010 Dec;81(12):940-3

Collegium Medicum w Bydgoszczy Uniwersytet Mikołaja Kopernika w Toruniu.

Holoprosencephaly is a brain malformation caused by abnormal division of the forebrain into two separate hemispheres. Abnormal structures of the central nervous system often occur with other midline forebrain and face failures. In this report we present a case of a prenatal diagnosis of holoprosencephaly.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2010

[Genetically-determined familial recurrent thanatophoric dysplasia].

Ginekol Pol 2010 Aug;81(8):629-32

Oddział Ginekologii, Połoznictwa i Patologii Ciqzy Wielospecjalistycznego Szpitala Miejskiego im. E. Warmińskiego w Bydgoszczy.

Thanatophoric dysplasia was first described in 1967 by Maroteaux. It is one of the most common lethal neonatal dwarfisms. Estimated incidence of thanatophoric dysplasia is 0.2-0.5 per 10,000 births. In the following report we have described a prenatally diagnosed case of recurrent thanatophoric dysplasia in the same patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2010

[Prenatal diagnosis of Smith-Lemli-Opitz syndrome--case report].

Ginekol Pol 2009 Oct;80(10):778-81

Oddział Ginekologii, Połoznictwa i Patologii Ciazy Wielospecjalistycznego Szpitala Miejskiego im. E. Warmińskiego w Bydgoszczy.

Smith-Lemli-Opitz syndrome (SLOS) is a hereditary, autosomal recessive abnormality of cholesterol metabolism, leading to malformations of multiple organs. It is probably one of the most frequent metabolic disorders but variable clinical presentation makes the diagnosis of the syndrome difficult. The authors of the following work present a case report of prenatal diagnosis of SLOS in fetus with malformations of multiple organs and negative family history.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2009

Placental morphologic and functional imaging in high-risk pregnancies.

Semin Perinatol 2009 Aug;33(4):270-80

Department of Obstetrics and Gynaecology, University Hospital MAS, Malmö, Sweden.

The placenta is vital for fetal growth and development. Improvement in ultrasound and magnetic resonance imaging have improved our understanding of placental morphology that can be important as in the case of placental accrete/percreta. Functional imaging is presently mainly performed by the use of Doppler ultrasound and can give information on placental perfusion, which can be vital for clinical diagnosis. This review summarizes the present knowledge on placental imaging and it's clinical value in high-risk pregnancies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.semperi.2009.04.005DOI Listing
August 2009

Signs of fetal brain sparing are not related to umbilical cord blood gases at birth.

Early Hum Dev 2009 Jul 22;85(7):467-70. Epub 2009 Apr 22.

Department of Obstetrics and Gynaecology, University Hospital MAS, Malmö, Sweden.

Background: Fetal chronic hypoxia leads to centralization of circulation in order to spare the vital organs brain, adrenals and the heart. This can be documented by Doppler ultrasound. Increased blood velocity in the fetal middle cerebral artery (MCA) is an acknowledged sign of centralization of circulation in chronic hypoxia, and is called brain sparing.

Aim: Our aim was to assess the relationship between signs of brain sparing in the MCA and umbilical cord blood gases at birth.

Study Design: A prospective study.

Subjects: Singleton 57 high-risk pregnancies (outcome was compared with 21 normal pregnancies).

Methods: MCA Doppler was performed within 24 h of elective caesarean section in high-risk pregnancies. Umbilical cord blood gases were analysed at birth.

Main Outcome Measures: Cord blood gases were related to signs of centralization of fetal circulation in the MCA.

Results: No correlation between signs of brain sparing in the MCA and cord blood gases. Apgar score at 5'<7 was seen in three newborns, but only one of these had antenatal signs of brain sparing. Newborns with antenatal brain sparing were admitted more often (p<0.04) and had a longer duration of stay in NICU (p<0.03) compared to newborns without brain sparing.

Conclusion: Decreased pulsatility index in MCA is an acknowledged sign of fetal centralization of circulation during chronic hypoxia. However, signs of brain sparing are not related to cord blood gases at birth, which might suggest that redistribution of fetal circulation can maintain normal blood gases for a long time during chronic hypoxia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.earlhumdev.2009.04.003DOI Listing
July 2009

Biochemical tissue-specific injury markers of the heart and brain in postpartum cord blood.

Am J Obstet Gynecol 2009 Mar 24;200(3):273.e1-273.e25. Epub 2009 Jan 24.

Department of Obstetrics and Gynecology, Poznan University of Medical Sciences, Poznan, Poland.

Objective: We sought to establish references ranges and to test the hypothesis that biochemical tissue-specific markers for the heart in umbilical cord blood of newborns with cardiac defects and intrauterine growth restriction (IUGR) are abnormal.

Study Design: A prospective study was conducted. Serum samples of the umbilical vein (n = 280) and artery (n = 156) from 599 healthy newborns at 37(+0)-42(+0) weeks of gestation were collected. Total creatine kinase (CK), CK-MB heart type (CK-MB), cardiac troponin T (cTnT), myoglobin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and S100 were measured. Reference ranges for each marker were constructed. Concentrations of tissue-specific markers from umbilical cord blood of neonates with cardiac defects (n = 10) and IUGR (n = 41) were plotted against the established reference ranges.

Results: Reference ranges for each studied marker were established for both umbilical artery and vein. In fetuses with cardiac defects, both NT-proBNP (4/6 [66%] in the artery, 7/10 [70%] in the vein) and cTnT (2/10 [20%] in the vein) were increased. In fetuses with IUGR in the vein, NT-proBNP (10/41 [24%]) and cTnT (5/41 [12%]) were increased, whereas S100 (9/41 [21%]) was decreased.

Conclusion: In a subset of neonates with cardiac defects or growth restriction, irrespective of the pH at birth, tissue-specific injury markers for the heart in umbilical cord blood are abnormal.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajog.2008.10.009DOI Listing
March 2009

Fetal biometry between 20-42 weeks of gestation for Polish population.

Ginekol Pol 2008 Nov;79(11):746-53

Department of Obstetrics and Gynecology, Collegium Medicum Nicolaus Copernicus University, Torun, Poland.

Objective: Ultrasound estimating of fetal weight is one of the most frequent examinations during pregnancy. Hitherto, foreign fetometry curves have mostly been used in Poland as there are no national available reference charts that are based on ultrasound fetal biometry. The aim of the present study was to construct new charts based on ultrasound fetometry reference for Polish population.

Study Design: A group of 959 healthy volunteers with uncomplicated singleton pregnancy joined in a cross-sectional study. The study was designed prospectively to evaluate normal reference charts for fetal ultrasound measurements and estimated fetal weight. Four biometric parameters were studied: biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). Estimated fetal weight (EFW) was calculated using Hadlock et al. formula from 1985.

Results: In the course of normal pregnancy an acceleration of growth rate was seen, but with a slight decline at the end of pregnancy. Reference curves for mean, 90th and 95th percentile were constructed for BPD, HC, AC and FL. Estimated fetal weight curves were outlined for both boys and girls.

Conclusion: Reference charts for Polish population are similar to foreign curves. Less variation was seen in comparison with national charts based on postnatal weight. Ultrasound method seems to be better than birthweight curves especially in preterm pregnancies. This will improve the diagnosis of a small for gestational age newborn.
View Article and Find Full Text PDF

Download full-text PDF

Source
November 2008

TNF-alpha gene polymorphism and fetal Doppler velocimetry in intrauterine growth restriction.

Neuro Endocrinol Lett 2008 Aug;29(4):493-9

Department of Perinatology and Gynecology, University of Medical Sciences, Poznan, Poland.

Objectives: The intrauterine growth restriction (IUGR) frequently is a cause of fetal morbidity and mortality, and influences perinatal outcome. Several genes have been identified to explain aetiology of IUGR, beside others the gene coding for tumour necrosis factor alpha (TNF-alpha).

Design: To investigate frequency of AlwI polymorphism of TNF-alpha gene and its correlation with TNF-alpha level in maternal serum, Doppler velocimetry and perinatal outcome in pregnancies suspected for IUGR.

Setting: 42 pregnancies with IUGR and 50 matched healthy pregnant women were included in the study. Maternal venous blood samples were investigated in relationship to blood flow Doppler velocimetry in umbilical (UA) and middle cerebral (MCA) arteries. AlwI polymorphism was analysed using PCR/RFLP assays. TNF-alpha level was evaluated by immunoelectophoretic method.

Results: A higher frequency of mutated -238A alleles (13.1% vs. 7.0%) and genotypes containing at least one mutated -238A allele (23.8% vs. 14.0%) were found in the IUGR group. The tendency to the higher TNF-alpha level in IUGR subgroups with the presence of at least one mutated A allele (258.9+/-231.3 vs. 174.1+/-145.6 pg/ml) was detected. No statistical differences were detected for PI values in UA and MCA arteries considering particular genotypes (GG vs. GA + AA) separately in IUGR group.

Conclusion: Increased UA vascular impedance and signs of brain sparing in MCA are related to IUGR and increased TNF-alpha level in maternal serum. AlwI polymorphism might play a role in IUGR aetiology and influence TNF-alpha expression in maternal serum, but was not related to Doppler velocimetry or with perinatal outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2008

Fetal brain sparing is strongly related to the degree of increased placental vascular impedance.

J Perinat Med 2006 ;34(4):318-22

Department of Obstetrics and Gynecology, Malmö University Hospital, Malmö, Sweden.

Background: Doppler ultrasound examination has become an established method of clinical surveillance in high-risk pregnancies. Doppler indication of fetal brain sparing (BS) is an acknowledged sign of circulation redistribution during chronic hypoxia.

Objectives: To evaluate the relationship between placental vascular resistance and signs of BS in middle cerebral artery (MCA) blood flow velocity.

Methods: The MCA, uterine artery, and umbilical artery (UA) were located by color Doppler ultrasound in 103 high-risk pregnancies at risk for intrauterine fetal hypoxia. The blood velocity spectrum was analyzed for the following parameters: pulsatility index (PI) and signs of notching in the uterine arteries. Z-score was calculated for the MCA PI.

Results: Signs of BS in the MCA were correlated to increased placental vascular impedance. The degree of BS in the MCA expressed as Z-scores was correlated to increasing vascular impedance, both in the umbilical and uterine arteries, and to adverse outcome of pregnancy. The greatest deviation in MCA PI Z-scores was seen in preterm pregnancies.

Conclusion: A clear correlation exists between increasing placental vascular impedance and BS in the MCA. Preterm pregnancies express the greatest deviation from the mean MCA PI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/JPM.2006.061DOI Listing
January 2007

[Laparoscopic management of ovarian teratoma adultum cysticum in second trimester of pregnancy (case report)].

Ginekol Pol 2006 Feb;77(2):151-5

Klinika Niepłodności i Endokrynologii Rozrodu Katedry Ginekologii i Połoznictwa AM w Poznaniu.

Ovarian tumors complicating clinical course of pregnancy are rare (approximately 1 per 1000 deliveries). Conservative management, as well as surgical intervention could be associated with high risk for the mother and fetus. In this report we describe diagnosis and therapy of 26 years old primary gravida with 7 cm ovarian teratoma. Extensive ultrasound examination assessing localization and risk of malignancy of the tumor was done before operation. Laparoscopy was performed at 16 weeks gestation and no intra- and postoperative complications were observed. The outcome of the pregnancy was normal. Laparoscopic treatment of ovarian tumors during pregnancy, by experienced team, after appropriate diagnostic process, seems to be safe and effective.
View Article and Find Full Text PDF

Download full-text PDF

Source
February 2006

Flow index evaluation of 3-D volume flow images: an in vivo and in vitro study.

Ultrasound Med Biol 2006 May;32(5):665-71

Department of Perinatology and Gynecology, University School of Medical Sciences, University Hospital, Poznan, Poland.

Three-dimensional (3-D) ultrasound imaging has improved evaluation of organ circulation and might contribute new information on maternal and fetal blood supply. Flow index (FI) of 3-D color images has been proposed as a measure of perfusion. The aim of this study was to evaluate whether the 3-D FI is a parameter of volume flow and flow velocity in a human vessel and in a flow phantom. A 1-cm-long strip of the uterine artery was recorded in 3-D power Doppler (3D-PD) mode in a cross-sectional study of 170 normal singleton pregnancies between 26 and 42 weeks' gestation. A fixed ultrasound system installation was used during the examination. The VOCAL software integrated in the ultrasound unit calculated vessel volume and FI. Reproducibility of the measurements was tested. The method was also tested on a commercially available flow phantom. Reproducibility measurements gave satisfactory results, both in terms of inter- and intraobserver variation. Unexpectedly, in normal pregnancy, the uterine artery FI decreased slightly with gestation. Uterine artery vessel volume increased, however, with gestational age. A poor correlation was found between the FI and both flow velocity and volume flow in the flow phantom. In conclusion, 3D-PD imaging can give impressive anatomical pictures of organ vascular tree. However, the new FI is poorly related to flow velocity or volume of flow.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ultrasmedbio.2006.01.016DOI Listing
May 2006

Placental Doppler velocimetry in gestational diabetes mellitus.

J Perinat Med 2006 ;34(2):108-10

Karol Marcinkowski University of Medical Sciences, Poznan, Poland.

Objective: To evaluate if maternal glucose level and growth of the fetus were related to placental vascular impedance in pregnancy complicated by gestational diabetes mellitus.

Material And Methods: A retrospective study of 146 gestational diabetic women of which 117 needed insulin therapy. Glycosylated hemoglobin (HbA1c) was evaluated as well as umbilical and uterine artery Doppler velocimetry. The results were related to adverse outcome of pregnancy including newborn birthweight.

Results: Abnormal umbilical artery blood flow velocity was seen in 5% of the cases and abnormal uterine artery flow in 16%. Uterine and umbilical artery vascular impedance was significantly lower in macrosomic newborns. There was a poor correlation between HbA1c, vascular impedance and birthweight. There were 11 cases that developed preeclampsia, all having abnormal uterine artery Doppler and two abnormal umbilical artery Doppler.

Conclusion: Uterine and umbilical artery vascular impedance in pregnancies complicated by gestational diabetes is related to birthweight and placental weight, but not to maternal HbA1c levels. Placental Doppler ultrasound does not seem to be of clinical value for fetal surveillance in these pregnancies unless the pregnancy is complicated by preeclampsia and/or intrauterine fetal growth restriction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/JPM.2006.019DOI Listing
September 2006

[Genetic polymorphism of the calcitonin receptor gene and bone mineral density in Polish population of postmenopausal women].

Ginekol Pol 2005 Aug;76(8):612-8

Klinika Perinatologii i Chorób Kobiecych, Katedry Perinatologii i Ginekologii AM w Poznaniu.

Introduction: In recent years the influence of genetic factors in the pathogenesis of osteopenia and osteoporosis was indicated. The investigations focused on the gene coding for calcitonin receptor. The goal of our analysis was to determine the genotype frequencies of AluI polymorphism of the calcitonin receptor gene (CTR) in the group of Polish postmenopausal women and its possible contribution to osteoporosis development.

Material And Methods: 139 postmenopausal women with osteopenia (t-score value from -1.0 to -2.5) (mean age 58.5 +/- 5.9 years, mean age of menopause 49.8 +/- 3.9 years) have been investigated. AluI polymorphism of the CTR gene was determined using PCR/RFLP assay. We have analysed 3 subgroups: CC, CT, and TT. In each subgroup mean weight, height, body mass index (BMI), mean age of menopause and years since menopause (YSM) and parameters of bone turnover: bone mineral density (BMD), t-score, index: young adults (YA) and--age matched (AM) have been analysed. Additionally the group of 138 selected women (mean age 26.5 +/- 4.3 years) as general population has been analysed.

Results: In investigated group the frequency of all 3 genotypes was determined as follows: CC: CT : TT = 8.6 : 45.3 : 46.1. Analysing BMD in particular subgroups the higher value for the CT genotype (0.967 +/- 0.161 g/cm2) was found. Similarly t-score (-1.94), YA (80.6%) and AM (90.8%) index were higher in CT genotype carriers.

Conclusion: Our results suggest possible connection of the AluI polymorphism of the CTR gene with osteopenia and osteoporosis development. To confirm this tendency further investigations in the large number population are necessary.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2005

Abnormal uterine Doppler is related to vasculopathy in pregestational diabetes mellitus.

Circulation 2005 Oct;112(16):2496-500

Division of Obstetrics and Maternal Diseases, Karol Marcinkowski University of Medical Sciences, Poznan, Poland.

Background: The aim of the study was to evaluate the relation between maternal placental Doppler velocimetry, levels of the maternal glucose, and clinical signs of vasculopathy in pregnancy complicated by pregestational diabetes mellitus.

Methods And Results: A retrospective study of 155 pregestational diabetic women between the 22nd and 40th weeks of pregnancy, categorized in White classification as B, 49; C, 40; D, 22; R, 20; F, 5; and RIF, 19. Cases in classes R, F, and R/F were defined as having vasculopathy. Doppler velocimetry of umbilical and uterine arteries was evaluated for vascular impedance, both in terms of pulsatility index (PI) for both arteries and a notch in early diastole in the uterine arteries. The last examination before delivery was used for analysis. Increased umbilical artery PI was seen in 19 and a uterine artery abnormality in 45 cases. There was a correlation between levels of HbA(1c) and increased vascular impedance in the uterine and umbilical arteries. Signs of increased uterine artery vascular impedances were significantly related to pregestational vasculopathy. In cases of small-for-gestational-age newborn infants, PI was significantly increased in uterine and umbilical arteries. Furthermore, PI in macrosomic fetuses was significantly lower than in normal infants. Abnormal uterine artery Doppler was also strongly related to adverse outcome.

Conclusions: Abnormal uterine artery Doppler is related to pregestational vasculopathy and adverse outcome of pregnancy. The results suggest that the uterine arteries are affected in women with clinical signs of pregestational vasculopathy. This may influence placental perfusion and fetal well-being.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCULATIONAHA.104.492843DOI Listing
October 2005

1166C mutation of angiotensin II type 1 receptor gene is correlated with umbilical blood flow velocimetry in women with preeclampsia.

J Matern Fetal Neonatal Med 2005 Feb;17(2):117-21

Department of Perinatology and Gynecology, University School of Medical Sciences, Poznań, Poland.

Objective: To ascertain the frequency of polymorphic variants of the gene coding for angiotensin II type 1 receptor (AT1) and its correlation with umbilical artery (UA) blood flow velocity in a group of women with preeclampsia (PE).

Study Design: AT1 polymorphism, pulsatility index (PI) in UA, and perinatal outcome in 47 women with PE and in 113 healthy pregnant women were investigated. Investigation of AT1 receptor genotypes was performed by PCR/RFLP assays. PI value has been measured by Doppler velocimetry technique.

Results: The overrepresentation of CC homozygotic genotype in PE group (6.4% vs. 2.7%) and the overrepresentation of mutated C allele in the PE group were observed (28.7% vs. 23.0%). Analyzing PI index we observed statistically significant differences between PE and control groups. Comparing PI values in PE group between genotypes: AA vs. AC + CC statistically significant differences (p < 0.05) have been observed.

Conclusions: Observed overrepresentation of mutated C allele of the AT1 gene was correlated with increased blood flow in umbilical artery in women with preeclampsia. Doppler velocimetry might be a useful tool for indication in the high-risk group with overrepresentation of C alleles.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14767050500043400DOI Listing
February 2005

Fetal and maternal Doppler velocimetry and cytokines in high-risk pregnancy.

J Perinat Med 2005 ;33(1):17-21

University School of Medical Sciences, Department of Perinatology and Gynecology, University Hospital, Poznan, Poland.

Objective: Fetal hypoxia and preterm delivery are reported to be strongly associated with brain damage and neurodevelopmental delay. Doppler signs of fetal brain sparing have been described during chronic hypoxia, but whether they are related to brain damage is unknown. The aim of this study was to evaluate if markers of tissue injury, i.e., tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) are related to signs of increased perinatal vascular impedance and/or fetal brain sparing in high-risk pregnancies.

Study Design: TNF-alpha and IL-6 levels were evaluated in maternal blood serum of 67 high-risk pregnancies. Serum samples were taken at the time of umbilical, middle cerebral artery and uterine artery Doppler velocimetry examination. The values for TNF-a and IL-6 were correlated with reference median values obtained with gestational age in the form of a Z-score.

Results: TNF-alpha levels showed values within the normal range in only four cases. IL-6 values were found normal in 14 cases. The Z-score for mean middle cerebral artery pulsatility index (PI) showed a significant correlation to TNF-alpha and IL-6 levels, P < 0.0001 and P < 0.003, respectively. This might suggest a strong correlation between signs of fetal brain sparing and increased maternal serum TNF-alpha and IL-6 levels. Abnormal uterine artery PI and the presence of a "notch" were also highly significantly related to TNF-alpha and IL-6 levels, which were nearly two-fold higher compared to normal uterine artery blood flow and the absence of a "notch". Abnormal cerebro/placental ratios showed significant correlations to TNF-alpha and IL-6 levels.

Conclusion: The present results suggest a strong correlation between levels of TNF-alpha and IL-6 not only for signs of fetal brain sparing, but also for uteroplacental blood flow. This finding supports the role of tissue injury in cases of fetal brain sparing, but whether this is a reflection of brain damage or secondary to placental pathology needs further evaluation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/JPM.2005.002DOI Listing
May 2005

Computer analysis of three-dimensional power angiography images of foetal cerebral, lung and placental circulation in normal and high-risk pregnancy.

Ultrasound Med Biol 2005 Mar;31(3):321-7

University School of Medical Sciences, Department of Perinatology and Gynecology, University Hospital, Poznan, Poland.

Three-dimensional (3-D) ultrasound (US) has greatly improved evaluation of organ circulation. The aim of this study was to explore the possible use of this new technique in normal and high-risk pregnancies. Fetal brain, lung and placenta 3-D power Doppler signal intensity were recorded in 115 normal singleton pregnancies (24 to 42 weeks gestation) and in 67 high-risk pregnancies. Mean image pixel signal intensity was calculated for each organ and a brain-lung ratio. In normal pregnancy, placental and lung signal intensity increased until 33, with a rapid decrease after 38, weeks of gestation. Fetal cerebral signal intensity increased with gestational age. Placental and fetal lung signal intensity was significantly lower in high-risk pregnancies than in the control group, with increased fetal brain and brain-lung ratios. The present results suggest a reduction of placental perfusion after 38 weeks of gestation in normal pregnancy, with redistribution of fetal circulation. Lung signal intensity increased abruptly at 32 weeks of gestation, which might reflect lung maturity. The new method showed signs of centralization of fetal circulation at the end of gestation. The results might suggest a possible clinical use for fetal surveillance in high-risk pregnancies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ultrasmedbio.2004.12.008DOI Listing
March 2005