Publications by authors named "Piotr Sieroszewski"

63 Publications

COVID-19 impact on perinatal care: risk factors, clinical manifestation and prophylaxis. Polish experts' opinion for December 2020.

Ginekol Pol 2021 ;92(1):57-63

Department of Newborns' Infectious Diseases, Poznan University of Medical Sciences, Poznan, Poland.

Rapid spread of severe acute respiratory syndrome coranovirus-2 virus (SARS-CoV-2) caused the pandemic of Coronavirus Disease 19 (COVID-19). Clinical course of the disease presents symptoms mainly from the respiratory system such as: cough, dyspnea and fever, and among some patients, can deteriorate even further to acute respiratory distress syndrome (ARDS), eventually leading to death. This outbreak, as well as previous ones (SARS, MERS) pose a significant challenge for health care managers, epidemiologists and physicians. Below we are presenting the clinical profile of the COVID-19 among special group of patients; pregnant women and newborns, who require special clinical management during hospitalization. In the summary of this manuscript, we present practical guidelines for managing pregnant women infected with SARS-CoV-2, labor and care of the newborn of a positive mother, as well as practical guidelines for COVID-19 vaccinations. It is important to stress, that this manuscript is based on information available as of December 2020.
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http://dx.doi.org/10.5603/GP.a2021.0023DOI Listing
February 2021

Polish Society of Gynecologists and Obstetricians recommendations on supplementation during pregnancy.

Ginekol Pol 2020 ;91(10):644-653

2nd Department of Gynecology and Obstetrics, Wroclaw Medical University, Wroclaw, Poland.

Polish Society of Gynecologists and Obstetricians recommendations on supplementation during pregnancy.
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http://dx.doi.org/10.5603/GP.2020.0159DOI Listing
January 2020

COVID-19 during pregnancy, delivery and postpartum period based on EBM.

Ginekol Pol 2020 ;91(7):417-423

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

The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become the reason of the global health crisis. Since the first case of diagnosed COVID-19 pneumonia was reported in Wuhan, Hubei Province, China, in December 2019, the infection has spread rapidly to all over the world. The knowledge gained from previous human coronavirus infection outbreaks suggests that pregnant women and their foetuses represent a high-risk population during infectious disease epidemics. Moreover, a pregnancy, due to the physiological changes involving immune and cardiopulmonary systems, is a state predisposing women to respiratory complications of viral infection. The constantly increasing number of publications regarding the course of COVID-19 infection in pregnant women has been published, however, the available data remains limited and many questions remain unanswered. The aim of this review was to summarize the literature data and adjusted to current recommendations regarding pregnancy care, delivery and postpartum period. An extremely important issue is the need to register all the cases of COVID-19 affected women and the course of these pregnancies to local, regional, or international registries, which will be helpful to answer many clinical and scientific questions and to create guidelines ensuring an adequate level of care for women affected by COVID-19 infection during pregnancy, delivery and during postpartum period, as well as their newborns.
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http://dx.doi.org/10.5603/GP.2020.0106DOI Listing
August 2020

Occurrence of c.976 G>T (p.Val326Leu) and c.452 G>A (p.Trp151Ter) variants in DHCR7 gene in population of polish women with recurrent miscarriage.

Eur J Obstet Gynecol Reprod Biol 2020 Sep 20;252:252-255. Epub 2020 Jun 20.

Department of Fetal Medicine and Gynaecology, the Medical University of Lodz, Poland.

Introduction: Recurrent miscarriage is a serious clinical problem that affects 1-5 % of all couples trying to conceive. Although the incidence of Smith-Lemli-Opitz Syndrome (SLOS, OMIM #270400), an autosomal recessive condition caused by variants in the DHCR7 gene, is very low, (1:83 000), the observed carrier frequency of DHCR7 gene variants in the Polish population is high, ranging from 1:24 to 1:31. It is possible that this carriage may be responsible for early pregnancy loss.

Objectives: The aim of the study is to determine the carrier frequency of the p c.976 G>T (p.Val326Leu) and c.452 G>A (p.Trp151Ter) variants in the DHCR7 gene in patients experiencing recurrent miscarriage.

Methods: The study group included 480 patients: a study group of 380 with at least 2 miscarriages before the 20th week of pregnancy, and a control group of 100 who had not experienced miscarriage. The variants were identified by genotyping: c.976 G>T (p.Val326Leu) by the TaqMan® SNP Genotyping Assay system, and c.452 G>A (p.Trp151Ter) using the BfaI restriction enzyme. Statistical analysis was performed using R software.

Results: No examples of c.976 G>T (p.Val326Leu) were found in either group. c.452 G>A (p.Trp151Ter) was found in 22 participants from the study group and 4 from the control group; however, this difference was not significant (Chi2 test p = 0.61).

Conclusions: Being a carrier of the c.976 G>T (p.Val326Leu) and c.452 G>A (p.Trp151Ter) variants in theDHCR7 gene is not a risk factor for recurrent miscarriage in the Polish population.
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http://dx.doi.org/10.1016/j.ejogrb.2020.05.063DOI Listing
September 2020

Right-sided ovarian ectopic pregnancy with Jaydess in situ.

Ginekol Pol 2020 ;91(5):294

Fetal Medicine and Gynecology Department, Medical University of Lodz, Poland.

The estimated prevalence of the ectopic pregnancy (EP) is 1-2% of all pregnancies. Ovarian pregnancy is a rare finding with an incidence rate of 0.15% of all pregnancies and 1-3% of ectopic gestations. The use of intrauterine device (IUD) is a significant risk factor of ectopic pregnancy. Jaydess levonorgestrel intrauterine system (LNG-IUS) is considered as an extremely reliable method of contraception with the cumulative Pearl index of approx. 0.9% after a three-year period of use. This study presents a case of failure of the Jaydess intrauterine device in situ in a female patient with positive Beta Human Chorionic Gonadotropin (serum b-HCG) who was diagnosed with right-sided ovarian ectopic pregnancy. Although LNG-IUS represents the group of the most efficient contraception methods, the risks of failure still exist and should be taken into consideration. Before the insertion, every female patient should be fully informed on the potential adverse effects by a health practitioner.
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http://dx.doi.org/10.5603/GP.2020.0059DOI Listing
January 2020

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

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

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

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

Unusually high plasma values of many tumour markers in a patient with idiopathic pulmonary fibrosis.

Ginekol Pol 2020 21;91(2):101. Epub 2020 Feb 21.

Department of Radiotherapy, Chair of Oncology, Medical University of Lodz, Poland, Poland.

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http://dx.doi.org/10.5603/GP.a2020.0013DOI Listing
February 2020

The absence of fetal nasal bones in ultrasound examination between 11 + 0 and 13 + 6 weeks of gestation versus the occurrence of trisomies 21, 18, and 13.

Ginekol Pol 2019 ;90(10):604-606

Gynaecology and Fetal Medicine Department Medical University of Lodz, Poland.

Objectives: One part of the ultrasound examination of fetuses in the first trimester of gestation is visualization of the nasal bones. Numerous studies have demonstrated a correlation between the absence of nasal bones and abnormal fetal karyotype.

Aim: To assess the utility of ultrasound visualization of nasal bones during the first trimester of pregnancy as a marker of the most common chromosomal trisomies.

Material And Methods: Ultrasound visualization of nasal bones was carried out in 941 fetuses from a high-risk group between 11 + 0 and 13 + 6 weeks of gestation. Amniocentesis was performed to determine karyotype in all 941 cases.

Results: Normal fetal karyotype was observed in 847 cases, trisomy 21 in 45 cases, trisomy 18 in 16 cases and trisomy 13 in 10 cases. Other abnormal karyotypes were detected in the remaining 23 cases. The absence of nasal bones demonstrated 27% sensitivity, 97% specificity and a positive predictive value of 35% as an indicator of trisomy 21 in the study group, and 12% sensitivity, 97% specificity and 12% positive predictive value for trisomies 18 and 13.

Conclusions: The absence of nasal bones in ultrasound examination in the first trimester of pregnancy is characterized by low sensitivity and high specificity as a marker of the most common trisomies. Visualization of fetal nasal bone is a poor marker of aneuploidy and should not be taken into account in risk calculation algorithms.
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http://dx.doi.org/10.5603/GP.2019.0104DOI Listing
May 2020

Treatment guidelines for acquired hemophilia A.

Ginekol Pol 2019 ;90(6):353-364

Fetal Medicine and Gynecology Department Medical University of Lodz, Poland.

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http://dx.doi.org/10.5603/GP.2019.0063DOI Listing
March 2020

Influence of human Papilloma Virus (hPV) infection on early pregnancy.

Ginekol Pol 2019 ;90(2):72-75

Medical University of Lodz, Poland.

Objectives: HPV infection in early pregnancy may be a cause of miscarriage. Pregnancy significantly increases the risk of HPV infection. While ascending intrauterine infection with colonization of the trophoblast is commonly observed, descend- ing hematogenous infection should also be considered. The aim of the study is to assess the prevalence of HPV infection and its influence on pregnancy.

Material And Methods: The study was conducted in the years 2010-2015 on a group of 143 pregnant women. The study group consisted of 84 women with abnormal course of the first trimester of pregnancy. The control group consisted of 59 women with normal pregnancy who delivered healthy neonates. Samples of cervix tissue along with samples of tropho- blast or placenta were taken for the study. The presence and genotype of the HPV virus were detected using a BIOTOOL B&M Labs set. Statistical analysis was conducted using R software.

Results: The rate of HPV infection in the entire studied population was 13% (19/143): the virus was confirmed in 18% (15/84) of patients in the study group and in 7% (4/59) of the control group. HR HPV was detected in 13 patients in the study group and three patients in the control group. HR HPV infection was more frequent in patients with an abnormal course of the first trimester of pregnancy (p = 0.03). HR HPV trophoblast infection was found only in patients in the study group (p = 0.02). In two members of the study group, the HPV virus was found in the trophoblast only.

Conclusions: The obtained results may confirm the presence of adverse effects of HPV infection on early pregnancy. HR HPV trophoblast infection was observed only in women with 1st trimester complications. The presence of HPV only in trophoblast samples in some patients may suggest a descending - hematogenous route of primary infection.
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http://dx.doi.org/10.5603/GP.2019.0012DOI Listing
January 2020

Conservative treatment of abnormally located intrauterine pregnancies (cervical and cesarean scar pregnancies): a multicenter analysis (Polish series).

J Matern Fetal Neonatal Med 2020 Mar 20;33(6):993-998. Epub 2018 Sep 20.

Department of Fetal Medicine and Gynaecology, Medical University of Lodz, Lodz, Poland.

To analyze the effectiveness and outcome of conservative treatment in cases of abnormally located intrauterine pregnancies (cervical and cesarean scar). A retrospective analysis was performed of 30 pregnant women hospitalized due to abnormally located intrauterine pregnancies. The analyzed group comprised 24 pregnant women with abnormally located pregnancies. The patients were divided into two groups: the first group consisted of patients treated systemically with methotrexate, while the second of those treated locally by administration of methotrexate (MTX) and/or potassium chloride (KCl) by gestational sac puncture. The analyzed group comprised 24 pregnant women with abnormally located pregnancies. Eight patients were diagnosed with cervical pregnancy (CP) and 16 patients were diagnosed with cesarean scar pregnancy (CSP). Six patients were excluded from the study: two with spontaneous abortions, two heterotopic pregnancies, and two cornual pregnancies. Twelve analyzed patients underwent MTX systemic administration (five patients with CP, seven with CSP). In five patients, systemic treatment was ineffective; they were qualified for additional local therapy with gestational sac (GS) puncture and MTX or KCl administration to the sac and additional administration of MTX to the trophoblast area. In second group of 12 patients (three CP, nine CSP), local treatment (GS puncture with MTX or MTX + KCl) was used as the first line treatment. One patient underwent combined treatment (local + systemic). Conservative treatment should be the gold standard procedure in abnormally located intrauterine pregnancies. It is noticeable that MTX / KCl is more effective in a direct administration to the GS. In four cases, systemic MTX did not produce the desired effects. In these cases, the treatment was assisted by local administration of MTX or KCl, resulting in the termination of an abnormally located pregnancy.
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http://dx.doi.org/10.1080/14767058.2018.1514009DOI Listing
March 2020

Endometrial stromal tumor with sex-cord-like elements.

Ginekol Pol 2018 ;89(5):287

Gynaecology and Fetal Medicine Department Medical University of lodz, Lodz , ul. Wilenska 37, 94-029 Lodz, Poland.

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http://dx.doi.org/10.5603/GP.a2018.0049DOI Listing
September 2018

Usefulness of saline infusion sonohysterography and feeding artery imaging in endometrial polyp diagnosis.

Ginekol Pol 2017 ;88(6):285-288

Department of Fetal Medicine and Gynecology, First Chair of Gynecology and Obstetrics, Medical University of Lodz, Poland, Poland.

Objectives: The aim of this study was to assess the usefulness of sonohysterography with feeding artery visualization using transvaginal sonography to diagnose endometrial polyps.

Material And Methods: We conducted an observational study of 60 perimenopausal patients referred to the Department of Fetal Medicine and Gynaecology, Medical University of Lodz with abnormal uterine bleeding or suspicion of endometrial pathology based on sonography scan. In all 60 patients transvaginal sonography scan showed a possibility of an endometrial polyp. Of these, 46 underwent saline infusion sonohysterography with sonography visualization of a feeding artery. Pathological examination was performed on material collected during hysteroscopy.

Results: Sonography detection of endometrial polyp based on feeding artery visualization had a 40% sensitivity, whereas sonohysterographic polyp detection had a sensitivity of 75% and a specificity of 100%. The positive and negative predictive values of saline infusion sonohysterography in diagnosing endometrial polyps were estimated at 75% and 72% (95% CI: 52-86%), respectively. The combination of sonohysterography and feeding artery imaging in transvaginal sonography was 84% sensitive and 95% specific in detecting endometrial polyps. The positive and negative predictive values were: PPV = 96% and NPV = 89%.

Conclusion: Saline infusion sonohysterography with feeding artery visualization may become a standard method in the diagnostics of endometrial polyps in perimenopausal women.
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http://dx.doi.org/10.5603/GP.a2017.0054DOI Listing
September 2018

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

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

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

This paper contains a joint position of the Polish Gynecological Society and Polish Human Genetics Society on the cell-free fetal DNA testing in prenatal diagnosis. We present situations where the cell-free fetal DNA testing should be applied and cases in which performing of the test is not useful. We indicate what diagnostic steps should be performed before the test and how the test results should be interpreted and followed.
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http://dx.doi.org/10.1016/j.ejogrb.2017.05.009DOI Listing
July 2017

Genetic causes of recurrent miscarriages.

Ginekol Pol 2016 ;87(10):722-726

Department of Fetal Medicine and Gynecology, Medical University of Lodz, Poland.

Recurrent miscarriage is an important problem in reproductive health, which affects 1-5% of couples. The aim of this article is to summarize current knowledge on the genetic causes of recurrent miscarriage. It presents the most common parental genetic disorders (karyotype abnormalities, recessive diseases carrier status, dominant diseases and thrombophilia) connected with recurrent pregnancy loss, as well as research into other possible genetic causes. This review also sets out to demonstrate changes in the embryonic/fetal genome that may lead to abortions, and discusses the methods used to assess miscarried material, together with their advantages and disadvantages. Knowledge of the genetic background of miscarriages is important for prognosis, as well as the potential planning of prenatal diagnostics in subsequent pregnancies.
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http://dx.doi.org/10.5603/GP.2016.0075DOI Listing
July 2018

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

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

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

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

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

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

The evaluation of the predictive value of TNF-alpha concentration in maternal serum in the prediction of neonatal and maternal infection.

Ginekol Pol 2015 Jan;86(1):26-32

Introduction: The consequences of uncomplicated PPROM are serious, and the presence of overt intraamniotic infection (IAI) is associated with a significant increase in both, the maternal and fetal morbidity and mortality rate. TNF-alpha is a cytokine involved in systemic inflammation and plays an important role in modulating the acute phase reaction.

Aim: The aim of this study was to evaluate the predictive value of TNF-alpha levels in maternal serum within 6 hours after pprom and in the period of up to 12 hours after delivery in the prediction of neonatal and maternal infection.

Material And Methods: The investigation was conducted on a group of 56 women diagnosed with PPROM between 30+0 and 36+6 weeks gestational age. In the period of up to 6 hrs from pprom first sample of 10 ml of maternal venous blood for laboratory testing was taken and the level of TNF-alpha was measured. A second sample of venous blood was taken within 12 hrs from delivery to reassess the TNF-alpha levels. All the participants were divided retrospectively into four groups depending on the occurrence of adverse neonatal and maternal outcome. Measuring the concentration of TNF-alpha in maternal serum was performed using the elisa method (enzyme-linked immunosorbent assay).

Results: A statistically significant difference in the second assay (up to 12 hours after delivery) between the patients with and without signs of maternal infection was observed concerning the TNF-alpha serum level. The concentration of this cytokine in maternal serum after delivery was 1.79 and 1.36 pg/ml (p < 0.05) respectively whereas within 6 hours from the PPROM in those two groups it was comparable (1.25 vs. 7.37 pg/ml - ns). Analogous observations were made in case of adverse neonatal outcome, where the TNF-alpha serum level within 12 hours after delivery was 1.70 and 1.45 pg/ml (p < 0.05) and in the period of up to 6 hours from pprom was 1.25 vs. 1.38 pg/ml (ns) respectively

Conclusions: 1. In our investigation the maternal serum TNF-alpha concentration testing within 6 hours from PPROM between 30+0 and 36+6 weeks of gestation did not allow for the identification of patients who are more likely to develop signs of maternal infection and whose infant was at risk of neonatal infection after delivery 2. In case of pprom between 30+0 and 36+6 weeks of gestation maternal serum TNF-alpha concentration testing in the period of up to 12 hours after delivery may be a useful diagnostic tool for identification of patients with an increased risk of maternal and neonatal infection. 3. The lower the gestational age at PPROM and at delivery the risk of neonatal infection was greater.
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http://dx.doi.org/10.17772/gp/1895DOI Listing
January 2015

Surfactant administration without intubation in preterm infants with respiratory distress syndrome--our experiences.

J Matern Fetal Neonatal Med 2015 Jul 14;28(10):1161-4. Epub 2014 Aug 14.

a Department of Neonatology , Pirogow's Hospital , Lodz , Poland and.

Background: Surfactant replacement therapy is crucial in the management of respiratory distress syndrome (RDS) in preterm infants. Classic strategies of surfactant administration required intubation. To reduce the need of intubation and mechanical ventilation (MV), we applied surfactant via a thin endotracheal catheter without intubation.

Patients And Methods: We compared 26 preterm infants threatened by RDS treated with surfactant via a thin endotracheal catheter without intubation (studied group - SG) with a retrospective group of preterm infants managed on MV with early surfactant treatment using INtubation SURfactant Extubation (INSURE) method (control group - CG). Study had an approval from the ethics committee (RNN/6/14/KE).

Results: In the SG, 26 preterm infants were treated with one dose of surfactant (Curosurf®) administered via endotracheal catheter without intubation while receiving nasal continuous positive airway pressure (nCPAP)/SiPAP (Infant Flow). After surfactant administration, significantly less patients in SG required intubation and MV (19.2%) versus 65% necessity of second intubation in the CG. The median of time of MV in SG was 5 d versus 3.5 d in CG. Median time spent on nCPAP was 5.5 d versus 4.0 d in CG. The incidence of intraventricular hemorrhage (IVH) in the SG was 53.9%, including 50% with ≥ IVH II versus 36.7% (30% ≥ IVH II) in CG. The incidence of other complications of prematurity in the SG, such as necrotizing enterocolitis was 11.5% versus 23.3% in CG, the hemodynamically important patent ductus arteriosus was observed in 53.9% in SG versus 45% in CG. Bronchopulmonary dysplasia level in SG was significantly lower (15.4%) than in CG (40%), and the incidence of retinopathy of prematurity in SG was also lower (3.9%) versus 11.7% in MV group.

Conclusion: Surfactant application via a thin endotracheal catheter without intubation seems to be a beneficial therapy for preterm infants with slight and mild degree of RDS. This new method of surfactant application was associated with a lower prevalence of intubation and MV and better pulmonary outcome than implementation of traditional surfactant therapy (INSURE) and MV. Prospective randomized controlled trial is required.
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http://dx.doi.org/10.3109/14767058.2014.947571DOI Listing
July 2015

[Prognostic significance of subchorionic hematoma for the course of pregnancy].

Ginekol Pol 2013 Nov;84(11):944-9

Klinika Medycyny Płodu i Ginekologii I Katedry Ginekologii i Połoznictwa Uniwersytetu Medycznego w Łodzi, Polska.

Objectives: the aim of this retrospective study was to assess if a first trimester subchorionic hematoma (SCH) influences the pregnancy outcome and whether pv bleeding can be a prognostic factor for the pregnancy course.

Material And Methods: the study included 185 pregnant women hospitalized due to symptoms of a threatening miscarriage. Patients were divided into 2 groups: 119 women with SCH (study group) and 66 patients with normal prenatal scan (control group), further subdivided into cases with and without pv bleeding, irrespectively of the outcome of the ultrasound scan. Obstetric and neonatal data were analyzed.

Results: 1. A pregnancy complicated by SCH is more often associated with a poor outcome -- 23.78% of the study group patients had a miscarriage versus 7.62% of the controls. 2. Pregnancy with SCH is more likely to be lost before 9 weeks of gestation. 3. The "N" ratio, that expresses the maximal length of the hematoma to the maximal length of the fetus, equal to 2.5 or more, is associated with a risk of miscarriage. 4. The surface area of SCH equal to 280mm(2) or more is more likely to reveal with vaginal bleeding. 5. Vaginal bleeding can be a prognostic factor for the mode of delivery -- a higher rate of the Cesarean section is observed in patients with pv bleeding. 6. SCH is a complication that occurs in older women, with the limit of 30 years of age. 7. In this study there were no significant correlations between subchorionic hematoma or pv bleeding and PTL, IUGR, PIH, abnormal volume of the amniotic fluid, parity and order of gestation and delivery

Conclusions: subchorionic hematoma can be associated with poor pregnancy outcome and the "N" index may be a useful predictor of the further course of a pregnancy Pv bleeding may be a prognostic factor for the delivery mode.
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http://dx.doi.org/10.17772/gp/1664DOI Listing
November 2013

Assessment of interleukin-6, interleukin-8 and interleukin-18 count in the serum of IUGR newborns.

J Matern Fetal Neonatal Med 2014 Jul 29;27(11):1142-5. Epub 2013 Nov 29.

Department of Neonatology, Medical University of Lodz , Lodz , Poland .

Aim: Aim of this study was to assess concentrations of interleukin-6 (IL-6), interleukin-8 (IL-8) and interleukin-18 (IL-18) in the serum of newborns with diagnosed intrauterine growth restriction (IUGR) in comparison to concentrations in serum of newborns with weight appropriate for gestational age (AGA).

Materials: Research was conducted at the Lodz Medical University Clinic of Neonatology during 2010-2011. Surveyed group consisted of 50 hypotrophic full-term infants of single pregnancies (average weight: 2329 ± 287 g); control group, enclosing 50 infants AGA (average weight: 3544 ± 2161 g). Both groups received average Apgar score of 9 points. Concentrations of analysed cytokines were marked between 4-6 hours after birth. The enzyme-linked immunosorbent assay (ELISA) test was used to determine interleukins concentrations. Study was prospective. Statistics on the data were conducted with the Kolmogorov-Smirnov test. Significance level: p < 0.05.

Results: Concentrations of IL-6 and IL-18 were elevated in the IUGR group in a statistically significant manner in comparison to the control group.

Conclusions: An elevated level of IL-6 and IL-18 in the IUGR group, comparing to control group, signifies the existence of inflammation in the process of developing IUGR, therefore, screening tests estimating levels of interleukins as IL-6 and IL-18 might be clinically useful in predicting the occurrence of IUGR and help preventing it.
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http://dx.doi.org/10.3109/14767058.2013.851186DOI Listing
July 2014

[Concentration of selected cytokines in women with premature rupture of membranes and preterm delivery--preliminary study].

Ginekol Pol 2011 Aug;82(8):576-84

Klinika Perinatologii i Chorób Kobiecych, Uniwersytet Medyczny w Poznaniu, Polska.

Introduction: For years much attention has been paid to the possible role of cytokines in the etiology of preterm delivery (PTD) in relation to anticipation of delivery in women with premature rupture of membranes (PROM). There are no clear indications introducing this observation to clinical practice. The goal of this study was to evaluate interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), G-colony stimulating factor (G-CSF) concentration in serum of women with PROM in connection with the occurrence of the delivery

Material And Methods: 35 patients with PROM (average age 29.6 +/- 3.8 years, average time of gestation 35.2 +/- 1.5 weeks) were analyzed. The pregnant women were divided into 2 groups: 15 women delivered < 24 h and 20 women delivered > 24 h since the appearance of PROM. In both analyzed subgroups, the levels of IL-6, TNF-alpha, G-CSF CRP and leucocytosis have been compared. The concentration of IL-6, TNF-alpha and G-CSF in serum was measured by immunoenzymatic ELISA method, CRP concentration by immunoturbimetric method.

Results: In the whole group of women with PROM, the differences in average serum concentration of IL-6 before and after delivery (6.01 +/- 3.71 pg/mL and 7.98 +/- 3.44 pg/mL p < 0.05) and G-CSF (130.92 +/- 110.32 pg/mL and 79.59 +/- 52, 13 pg/mL, p < 0,05) have been observed. Moreover, average TNF-alpha concentration before and after the delivery was 1.43 +/- 0.63 pg/mL and 1.72 +/- 1.06 pg/mL (p > 0.05), respectively. It is particularly interesting that the authors have observed higher concentration of G-CSF in women who delivered within 24 h since PROM (147.05 +/- 103.88 pg/mL), if compared to the women who delivered after 24 h since PROM (118.81 +/- 115.71 pg/mL, without statistically significant difference p > 0.05). The same remark was connected with difference of IL-6 concentration in analogical groups of women (6.42 +/- 4.14 pg/mL vs 5.71 +/- 3.42 pg/mL, p > 0.05). Equally interesting observation were statistically significant differences in G-CSF concentration before and after delivery (147.06 +/- 103,88 vs 74.67 +/- 46.84, p < 0.05) in the event of the delivery < 24 h since PROM, such as in IL-6 concentration (5.71 +/- 3.42 vs 8.11 +/- 3.41, p < 0.05) in case of the delivery > 24 h since PROM.

Conclusions: Statistically significant differences in IL-6, G-CSF, and CRP concentration before and after the delivery suggest the participation of these factors in the etiology of preterm delivery in women with PROM. The higher IL-6 and G-CSF concentration in women delivering within 24 h since the appearance of PROM suggest that these cytokines could be involved in the processes leading to delivery Statistically significant differences in IL-6 and G-CSF concentration before and after the delivery in a group of women delivering < 24 h or > 24 could indicate an important contribution of changes in proportions of these cytokines in PTD the etiology in PROM.
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August 2011

Association between uterine leiomyomas and the biochemical screening test results in the first and second trimester of pregnancy: a pilot study.

J Matern Fetal Neonatal Med 2011 Jul 4;24(7):904-6. Epub 2011 Apr 4.

Fetal Medicine and Gynecology Department, Medical University of Łódź, Poland.

Objectives: The presence of the uterine leiomyomas may change the concentrations of the screening serum markers and so after the risk calculation of the fetal chromosomal abnormalities.

Purpose: To estimate the influence of the uterine leiomyomas on the first and second trimester serum markers concentrations.

Material And Methods: The studied group consisted of 127 women between 11 and 20 weeks of normal singleton pregnancy. In each patient, the uterine leiomyomas were diagnosed - over 20 mm in the diameter and located in the uterine wall. Seventy-seven patients had undergone the first trimester screening, 50 patients the second trimester screening. The control group consisted of 1020 women between 11 and 20 weeks of normal singleton pregnancy without uterine leiomyomas.

Results: In the first trimester group, the pregnancy-associated plasma protein A serum concentrations were not different from the controls. The median concentrations of free beta-human chorionic gonadotrophin (β-hCG) were significantly higher (1.43 MoM). In the second trimester group, no significant differences in AFP and estriol median concentrations were observed, while the median value for free β-hCG was significantly higher (2.01 MoM) than in control group.

Conclusions: The presence of the uterine leiomyomas may increase maternal serum concentration of the β-hCG and so after the rate of the false positive results of the prenatal screening tests.
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http://dx.doi.org/10.3109/14767058.2010.536864DOI Listing
July 2011

The significance of -786T > C polymorphism of endothelial NO synthase (eNOS) gene in severe preeclampsia.

J Matern Fetal Neonatal Med 2011 Mar 7;24(3):432-6. Epub 2010 Sep 7.

Division of Perinatology and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland.

Objective: Preeclampsia (PE) is believed to be induced by endothelial cell dysfunction in placenta. Highly polymorphic endothelial nitric oxide synthase (eNOS) activity belongs to the factors significantly influencing vaso-motor tone in placenta and PE susceptibility. The aim of this study was to evaluate prevalence of -786T/C polymorphism of eNOS gene in the groups of women with mild and severe PE.

Study Design: The study was performed in the group of 218 preeclamptic (including 136 with severe PE) and of 400 normotensive healthy women delivered normally after a healthy gestation. The eNOS -786T/C polymorphism was determined using PCR/RFLP assay. Additionally, detailed correlation between eNOS genotypes and clinical/laboratory data in the PE group has been analyzed.

Results: The higher frequency of mutated homozygous CC genotypes (17.4% vs. 11.5% in controls, OR 1.62, n.s.) and of C alleles (allelic frequency 44.1 vs. 36.6%; OR 1.36, p = 0.012) in the group of PE has been determined. Furthermore, in the group of severe PE the overrepresentation of mutated CC genotypes (23.5% vs. 11.5%, OR 2.37, p = 0.0014) and mutated C alleles (47.8 vs. 36.6%, OR 1.58, p = 0.0016) has been found.

Conclusions: The presence of mutated homozygous CC genotype and C allele of -786T/C polymorphism of eNOS gene influences the higher susceptibility to develop severe PE development.
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http://dx.doi.org/10.3109/14767058.2010.511329DOI Listing
March 2011

[Biochemical prenatal tests and uterine artery Doppler examination in prediction of PIH and IUGR in the third trimester of pregnancy].

Ginekol Pol 2010 May;81(5):352-7

Klinika Medycyny Płodu i Ginekologii, I Katedra Ginekologii i Połoznictwa w Łodzi.

Objectives: PIH and IUGR are serious complications in the third trimester of pregnancy. Many publications claim a connection between false positive prenatal tests and subsequent occurrence of PIH and IUGR.

Design: The aim of the study was to estimate the usefulness of the biochemical markers of fetal defects and uterine Doppler examination in predicting PIH and IUGR in the third trimester of pregnancy.

Methods: We examined 156 pregnant patients in The Department of the Fetal Medicine and Gynecology Medical University of Lodz, between 2006-2009. In case of each pregnant woman we estimated biochemical markers in the first (PAPP-A + beta-hCG) and second trimester (AFP, beta-hCG, uE3 - triple test). Each patient underwent three ultrasonographic examinations in the first, second and third trimester (between 11-13, 15-20, and 22-27 weeks gestation, respectively) with uterine artery Doppler examination. We monitored these pregnancies for PIH and IUGR and divided them into three groups: 28 patients with PIH (study group 1), 14 patients with IUGR (study group 2), and 114 patients with uncomplicated pregnancies (controls).

Results: In both study groups we observed: higher concentration of beta-hCG, higher percentage of the positive biochemical prenatal tests and abnormal uterine artery Doppler waveform. Positive triple test was the strongest predictor of PIH and IUGR (PPV=60.87% for PIH and PPV = 30.77% for IUGR).

Conclusions: Biochemical markers and abnormal uterine artery Doppler waveform are associated with PIH and IUGR. These parameters can be the base for the test identifying pregnant patients with high risk of PIH and IUGR.
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May 2010

[Interpretation of false positive results of biochemical prenatal tests].

Ginekol Pol 2010 Mar;81(3):210-4

Klinika Medycyny Płodu i Ginekologii I Katedry Ginekologii i Połoznictwa Uniwersytetu Medycznego w Łodzi.

Modern, non-invasive prenatal diagnostics based on biochemical and ultrasonographic markers of fetal defects allows us to calculate the risk of fetal chromosomal aneuploidies with high sensitivity and specificity An introduction of biochemical, non-invasive prenatal tests turned out to result in frequent false positive results of these tests in cases when invasive diagnostics does not confirm fetal defects. However prospective analysis of these cases showed numerous complications in the third trimester of the pregnancies.
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March 2010

[The role of fetal nuchal translucency (NT) and ductus venosus blood flow (DV) in the detection of congenital heart defects].

Ginekol Pol 2010 Apr;81(4):272-6

Klinika Medycyny Płodu i Ginekologii, I Katedra Ginekologii i Połoznictwa, Uniwersytetu Medycznego w Łodzi.

Unlabelled: Cardiac defects, the most common forms of congenital defects, are found in 3-8 of every 1000 pregnancies. Currently only 15-30% of CHD in newborns is detected prenatally. There are different strategies to increase the prenatal detection of cardiac abnormalities. Nuchal translucency screening and ductus venosus blood flow have been suggested to be useful methods of identifying cardiac anomalies in chromosomally normal fetuses.

Objective: To examine the association between nuchal translucency thickness and ductus venosus blood flow between 11-13.6 week of pregnancy and CHD in chromosomally normal fetuses.

Material And Methods: Patients with singleton pregnancies at 11 to 13.6 weeks of gestation were recruited to undergo nuchal translucency sonography. The prevalence of major cardiac defects was determined and the utility of screening for nuchal translucency thickness including sensitivity, specificity, and positive and negative predictive values, were calculated for the NT thickness cut off points of the 95th and 99th centile for CRL. Ductus venosus Doppler ultrasound blood flow velocity waveforms were obtained at 10-13.6 weeks gestation.

Results: 4720 gestations were analyzed, of which 13 newborn infants had CHD. The incidence of major CHD increased with increasing NT. Sensitivity specificity and positive predictive values were 45.4%, 92% and 1.5% at 99.8th percentile, and 25%, 98.5%, 3.2% and 99.8% at 99th percentile. Reverse or absent flow during atrial contraction was observed in 8 out of the 13 (61.5%) chromosomally normal fetuses with CHD.

Conclusion: Measurement of fetal nuchal translucency thickness and ductus venosus blood flow at 11-13.6 weeks of pregnancy is a sensitive method of screening for CHD. The prevalence of CHD increases with increasing fetal NT and abnormal ductus venosus blood flow. Increased NT or abnormal ductus venosus blood flow is a strong indication for fetal echocardiography.
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April 2010