Publications by authors named "Przemyslaw Kosinski"

46 Publications

Placenta praevia - does it really affect intrauterine fetal growth?

J Matern Fetal Neonatal Med 2020 Nov 13:1-5. Epub 2020 Nov 13.

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

Purpose: Placenta praevia affects about 0.5% of pregnancies and due to constant increase in operative deliveries may become an important, clinical challenge throughout the next decades. Location of the placental plate within lower uterine segment is associated with increased risk of adverse perinatal outcomes. There were several reports pointing increased risk of small-for-gestational-age (SGA)/fetal growth restriction (FGR) in patients affected with abnormal location of the placenta. On the other hand, some studies ended up with opposite conclusions.

Materials And Methods: Due to ambiguous results we have undertaken a case-control study to investigate intrauterine growth among this group. We ran a pilot study to precisely define maternal, obstetrical and neonatal characteristics in order to avoid cofounders. Our study incorporated 56 patients in singleton pregnancies affected with placenta praevia and 124 patients in the control group (between 35 and 37 weeks of gestation).

Results: Nonetheless, there were no statistical differences in the birthweight between the study and control group (2882.5 g vs. 2805 g, p = ns). Moreover, rates of the newborns with birthweight corresponding <10th percentile and >90th did not differ significantly. Even further analysis that included parity did not reveal any differences between both groups.

Conclusion: Placenta praevia does not affect the intrauterine growth and shall not be considered as a risk factor for SGA/FGR. In patients affected with abnormal location of the placenta additional scans for fetal well-being assessment are not indicated.
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http://dx.doi.org/10.1080/14767058.2020.1843152DOI Listing
November 2020

Performance of portable handheld ultrasound system in fetal therapy.

Ginekol Pol 2020 ;91(8):480-481

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

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http://dx.doi.org/10.5603/GP.a2020.0108DOI Listing
January 2020

Rising serum CA-125 levels within the normal range is strongly associated recurrence risk and survival of ovarian cancer.

J Ovarian Res 2020 Sep 2;13(1):102. Epub 2020 Sep 2.

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

Background: In clinical practice alterations in CA-125 concentration within normal range in patients with ovarian cancer after first-line treatment are common. Even minor increase in CA-125 concentration is associated with patients' anxiety and difficult interpretation and counselling for clinicians. The aim of this study was to evaluate the significance of CA-125 fluctuations within reference level in patients who suffered from ovarian cancer with complete response after first-line treatment.

Results: 168 patients with epithelial ovarian cancer, who achieved complete remission after first line treatment were enrolled in the study. CA-125 concentration assessment was carried out during follow up visits. The recurrence of the disease was diagnosed on the first appearance of symptoms: clinical, radiological or histopathological/cytological. PFS and 5-year survival rate was calculated with Kaplan-Meier plots. Statistical analysis was performed with SAS / STAT® 9.4 / 14.4, SAS Institute Inc., Cary, NC, USA, 2017. Median concentration of CA-125 after first-line therapy was 10 U/ml. Increasing CA-125 concentration by > 5 U/ml, 3 and 6 months after the treatment was associated with higher risk of relapse (HR = 7.6, p < 0.0001 and HR = 5.29, p < 0.0001 respectively). 5-year survival rate was significantly lower in patients with increased CA-125 by 5 U/ml, 3 and 6 months after therapy (56.79% vs 0 and 50.62% vs 15.55%).

Conclusions: Increased concentration of CA-125 by > 5 U/ml within normal range, 3 and 6 months after treatment was unfavorable prognostic factor in ovarian cancer patients with complete response to primary therapy.
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http://dx.doi.org/10.1186/s13048-020-00681-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469284PMC
September 2020

Longitudinal changes in maternal left atrial volume index and uterine artery pulsatility indices in uncomplicated pregnancy.

Am J Obstet Gynecol 2021 02 24;224(2):221.e1-221.e15. Epub 2020 Jul 24.

National Institute of Cardiology, Warsaw, Poland.

Background: Data on the relationship between longitudinal changes in maternal volume-dependent echocardiographic parameters and placentation in uncomplicated pregnancy are limited.

Objective: This study aimed to evaluate changes in volume-dependent echocardiographic parameters in uncomplicated pregnancy to test the hypothesis of the existence of an association between volume-dependent echocardiographic parameters and Doppler ultrasound parameters of fetal circulation and the uterine artery in uncomplicated pregnancy and to establish which of the volume-dependent echocardiographic parameters best depicts volume changes and correlates best with Doppler ultrasound of fetal circulation and the uterine artery in healthy pregnancy.

Study Design: Data from 60 healthy pregnant women were analyzed. A complete echocardiographic study was performed at 11 to 13, 20 to 22, and 30 to 32 weeks' gestation: left ventricular end-diastolic volume, early diastolic peak flow velocity, late diastolic peak flow velocity, left atrial area, and left atrial volume index were assessed. Obstetrical assessment was performed including fetal growth and uterine artery pulsatility index. Fetal well-being was assessed by umbilical and middle cerebral artery blood flow. Serum pregnancy-associated plasma protein A and free β-human chorionic gonadotropin were assessed during the routine first-trimester scan (11-13 weeks' gestation).

Results: Left ventricular end-diastolic volume and left atrial area increased significantly between 11 to 13 and 20 to 22 weeks' gestation but not between 20 to 22 and 30 to 32 weeks' gestation. Left atrial volume index measured at 30 to 32 weeks' gestation correlated with uterine artery pulsatility indices in 3 trimesters. Changes in the left atrial volume index between the third and first trimesters correlated significantly with the uterine artery pulsatility index measured at 20 to 22 weeks' gestation (r=-0.345; P=.020) and at 30 to 32 weeks' gestation (r=-0.452; P=.002). Changes in the left atrial volume index between the second and first trimesters significantly correlated with the uterine artery pulsatility index measured in the first trimester (r=-0.316; P=.025).

Conclusion: Our study showed that in an uncomplicated pregnancy, among volume-dependent echocardiographic parameters, left atrial volume index increased between both the first and second trimesters and the second and third trimesters and correlated with parameters of Doppler ultrasound of the fetal circulation and the uterine artery. Our results expand on the previous observation on the relationship between maternal cardiovascular adaptation and placentation in women with heart diseases to the population of healthy women with uncomplicated pregnancy.
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http://dx.doi.org/10.1016/j.ajog.2020.07.042DOI Listing
February 2021

Oxidative Stress Markers Differ in Two Placental Dysfunction Pathologies: Pregnancy-Induced Hypertension and Intrauterine Growth Restriction.

Oxid Med Cell Longev 2020 30;2020:1323891. Epub 2020 Jun 30.

Department of Bioanalysis and Drugs Analysis, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha Street, 02-097 Warsaw, Poland.

Aim: Pregnancy-induced hypertension (PIH) and intrauterine growth restriction (IUGR) are both multisystemic disorders of pregnancy that cause perinatal morbidity and mortality. Recently, researchers focused on the role of oxidative stress (OS) as a pathophysiological mechanism in the development of these pathologies. The aim of this study was to compare OS in placental-related pathologies (PIH and IUGR) and uncomplicated pregnancies. We also investigated which salivary OS markers reflect systemic oxidative status and which only reflect the state of the oral cavity. . A total of 104 pregnant women ( = 104; 27 with PIH, 30 with IUGR, and 47 controls) were evaluated. Malondialdehyde (MDA), total antioxidant capacity (ORAC), aldehyde dehydrogenase (ALDH), and activity of glutathione peroxidase (GPx) and glutathione transferase (GST) in plasma/whole blood and/or saliva were analysed. Dietary nutrient intake was calculated using a Semiquantitative Food Frequency Questionnaire (SFFQ). Oral health was assessed to eliminate patients with bleeding, severe periodontitis, and other dental pathologies.

Results: In the IUGR group, increased concentration of ORAC was observed both in saliva and plasma. Also, lower plasma levels of MDA in IUGR compared to the control group was detected. No sign of oxidative stress was confirmed in the PIH group. The examined groups did not differ regarding diet and markers of inflammation. ORAC in saliva was correlated with its level in plasma. No such correlations for MDA were observed. In the IUGR group, there were no differences in OS markers in plasma, but there was a lower ALDH level in the blood compared to the control group. It confirms OS occurrence in IUGR. In IUGR, a higher activity of salivary ALDH was probably due to worse oral health.

Conclusion: Oxidative stress differs between IUGR and PIH groups: the presence of oxidative stress was confirmed only in the IUGR group. Salivary ORAC can be used to estimate ORAC in plasma. The activity of salivary ALDH reflects the state of the oral cavity.
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http://dx.doi.org/10.1155/2020/1323891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7346256PMC
June 2020

Pregnancy-Related Complications in Patients With Fibromuscular Dysplasia: A Report From the European/International Fibromuscular Dysplasia Registry.

Hypertension 2020 08 8;76(2):545-553. Epub 2020 Jul 8.

Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu).

Current literature suggests a higher risk of pregnancy-related complications in patients with renal fibromuscular dysplasia (FMD). The aim of our study was to assess the nature and prevalence of pregnancy-related complications in patients subsequently diagnosed with FMD. A call for participation was sent to centers contributing to the European/International FMD Registry. Patients with at least 1 pregnancy were included. Data on pregnancy were collected through medical files and FMD characteristics through the European/International FMD Registry. Data from 534 pregnancies were obtained in 237 patients. Despite the fact that, in 96% of cases, FMD was not diagnosed before pregnancy, 40% of women (n=93) experienced pregnancy-related complications, mostly gestational hypertension (25%) and preterm birth (20%), while preeclampsia was reported in only 7.5%. Only 1 patient experienced arterial dissection and another patient an aneurysm rupture. When compared with patients without pregnancy-related complications, patients with complicated pregnancies were younger at FMD diagnosis (43 versus 51 years old; <0.001) and had a lower prevalence of cerebrovascular FMD (30% versus 52%; =0.003) but underwent more often renal revascularization (63% versus 40%, <0.001). In conclusion, the prevalence of pregnancy-related complications such as gestational hypertension and preterm birth was high in patients with FMD, probably related to the severity of renal FMD. However, the prevalence of preeclampsia and arterial complications was low/moderate. These findings emphasize the need to screen hypertensive women for FMD to ensure revascularization before pregnancy if indicated and appropriate follow-up during pregnancy, without discouraging patients with FMD from considering pregnancy.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.15349DOI Listing
August 2020

Nonimmune Hydrops Fetalis-Prenatal Diagnosis, Genetic Investigation, Outcomes and Literature Review.

J Clin Med 2020 Jun 8;9(6). Epub 2020 Jun 8.

Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland.

The aim of this paper is to review the outcomes and discuss the genetic and non-genetic aetiology of nonimmune hydrops fetalis in order to support differential ultrasound and genetic evaluations and family counselling. This single-centre study includes all cases of nonimmune hydrops fetalis diagnosed prenatally from 2009 to 2019. Two sources of data were used for this study (prenatal and neonatal) to compare and summarise the findings. Data from genetic testing and ultrasound scans were collected. In total, 33 pregnant women with prenatally diagnosed nonimmune hydrops fetalis were studied. The data included 30 cases of singleton (91%) and three cases (9%) of twin pregnancies. There were 14 survivors (43%), seven cases of postnatal deaths (21%), four cases of intrauterine foetal demises (12%), four cases of termination of pregnancy (12%), and four women without a follow up (12%). The total number of chromosomally normal singleton pregnancies was 29 (88%), and 14 foetuses had an anatomical abnormality detected on the ultrasound scan. The chance of survival was the highest in cases of isolated, idiopathic hydrops fetalis, which in most cases was due to an undetectable intrauterine infection. In many cases, the diagnosis could not be established throughout pregnancy. Each case of nonimmune hydrops fetalis should thus be analysed individually.
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http://dx.doi.org/10.3390/jcm9061789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356683PMC
June 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

Vascular anastomoses in intrauterine growth in monochorionic twins.

J Perinat Med 2020 Jul;48(6):539-543

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

Objectives To evaluate the impact of placental anastomoses on the intrauterine growth of monochorionic (MC) twins. Methods A prospective study was conducted in a group of 53 MC twins. Intrapartally umbilical cords were clamped to identify placental sides corresponding to each twin. The postnatal dye injection technique was administered to evaluate vascular anastomoses, their number and type and visualize placental territory sharing patterns. Data from digital analysis were correlated with obstetrical follow-up. Results Vascular anastomoses were revealed in 88.7% of cases. Arteriovenous (AV) anastomoses occurred in 75.4% and arterioarterial (AA) in 71.1% while venovenous (VV) in 26.4%. In the subgroup of MC twins without placental anastomoses, significantly higher birthweight difference and discordance were revealed when compared to MC twins without anastomoses (382.0 vs. 22 g; P = 0.03 and 49.14% vs. 16.02%; P = 0.03). On the other hand, in subgroups of MC twins with at least one AA anastomosis, twins' birthweights were similar (p = ns) despite significantly higher placental territory sharing discordance (30.44% vs. 15.81%; P = 0.31). Conclusions Vascular anastomoses have a major impact on the intrauterine growth of MC twins. In certain cases, they may cause specific complications; however, in general, they regulate intertwin blood exchange and may compensate unequal placental territory.
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http://dx.doi.org/10.1515/jpm-2020-0028DOI Listing
July 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

Role of sphingolipids in the pathogenesis of intrahepatic cholestasis.

Prostaglandins Other Lipid Mediat 2020 04 14;147:106399. Epub 2019 Nov 14.

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

Background & Aims: Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-related liver disorder that affects from 0.2% to 15.6% pregnant women. The disease is connected with increased risk of fetal morbidity and mortality, but is unfortunately detected quite late. The diagnosis of ICP is based on only one manifestation: pruritus which mainly affects soles and palms.

Methods: Twenty intrahepatic cholestasis of pregnancy (ICP) women and twenty healthy pregnant women (control group) took part in the study. In the study group, blood sampling for baseline measurements was performed on the first day of hospital stay - before the commencement of treatment with ursodeoxycholic acid (UDCA) - and repeated after 7 days of 900 mg UDCA per day. An additional blood sample was collected on the second day after childbirth. In the control group, blood samples were collected directly after hospital admission. We compared plasma sphingolipids in samples of the subjects from ICP and ICP + UDCA-treated groups as well as the ICP group after delivery with the healthy controls.

Results: Of all sphingolipids, the median values of C16-Cer and C18-Cer were significantly higher in the plasma of cholestasis patients not treated with UDCA as compared to the control. Following 7 days of UDCA treatment, a considerable decrease in C16-Cer, C18-Cer and the total concentration of bile acids was noted as compared to the baseline.

Conclusion: It is known that sphingolipids serve as modulators of liver regeneration. We assume these substances could be potential markers for detecting early onsets of intrahepatic cholestasis of pregnancy.
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http://dx.doi.org/10.1016/j.prostaglandins.2019.106399DOI Listing
April 2020

The use of atosiban prolongs pregnancy in patients treated with fetoscopic endotracheal occlusion (FETO).

J Perinat Med 2019 Nov;47(9):910-914

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

Objective To evaluate the impact of atosiban as a tocolytic agent in patients treated with the fetoscopic endotracheal occlusion (FETO) procedure due to congenital diaphragmatic hernia (CDH). As premature birth after fetoscopy remains a serious concern, an effort to reduce prematurity is required. Methods A total of 43 patients with severe CDH treated with FETO were enrolled in this study. The study group consisted of 22 patients who received atosiban during the FETO procedure and a control group of 21 patients who did not receive atosiban during the FETO procedure. Demographic data, gestational age (GA) at delivery, cervical length and GA at premature rupture of membranes (PROM) were evaluated. Results The GA at delivery was significantly different between the two groups studied. The median GA at delivery was 32.6 and 34.5 weeks in the no-atosiban vs. atosiban groups, respectively (P = 0.013). The median cervical length was 29.9 and 31.2 mm for the no-atosiban and atosiban groups, respectively, and was not statistically significant (P = 0.28). There were no significant correlations between groups for the occurrence of PROM, GA at the time of PROM, duration of the procedures, parity, maternal body mass index (BMI) or age. In the univariate linear regression model, the only factor independently associated with GA at delivery was the use of atosiban during FETO procedures (β = 0.375; P < 0.013). Conclusion In cases of severe CDH treated with FETO, the use of atosiban as a tocolytic agent during the procedure prolonged pregnancy by 2 weeks. Cervical length, duration of FETO or maternal characteristics were not associated with GA at delivery.
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http://dx.doi.org/10.1515/jpm-2019-0144DOI Listing
November 2019

Preferences and expectations among Polish women regarding prenatal screening.

Ginekol Pol 2019 ;90(9):544-548

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

Objectives: Patients' attitudes and expectations of prenatal screening for genetic abnormalities throughout pregnancy arerarely analyzed by researchers as emotions and fears are both important and challenging factors. Prenatal counselling hasnever been so difficult as we live in the era of detailed ultrasound scans, cell-free fetal DNA and detailed microarray testing.The aim of this study was to investigate Polish women's attitudes towards screening for chromosomal abnormalities andfetal defects.

Material And Methods: The study was a prospective survey conducted among a population of Polish women. An electronicquestionnaire regarding prenatal diagnostics was distributed to a total number of 1072 female volunteers.

Results: 1044 patients (97.30%) stated that they were motivated to undergo prenatal diagnostics and would want to beinformed about fetal abnormalities. Over 90% of the respondents would want to be informed about serious defects witha high mortality rate (including trisomy 13 or 18). More than half the Polish women (54.83%) stated they were willing toconsider terminating pregnancy in the case of a severe abnormality.

Conclusions: Polish women expect prenatal screening. Almost all Polish women would want to be informed about bothgenetic and anatomical abnormalities and over half of them would consider terminating pregnancy in the case of a severeabnormality. Willingness to learn about a defect increased with average household income, and the statement of a will toterminate pregnancy depended mostly on maternal age and type of fetal abnormality.
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http://dx.doi.org/10.5603/GP.2019.0094DOI Listing
May 2020

Saliva, hair, tears, and other biological materials obtained non-invasively for diagnosis in pregnancy: a literature review.

Ginekol Pol 2019 ;90(8):475-481

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

As medical technology evolves, clinicians are increasingly choosing relatively painless non-invasive methods of patientdiagnosis and treatment. There are two principles behind this: greater patient comfort and lower cost. Tears, hair, saliva,urine, and faeces can replace blood for diagnosis. The varied constituents in these biological materials can serve as biomarkersfor the detection of both local and systemic diseases. In this paper, we review a range of diagnostic techniques - allusing biological material obtained via non-invasive procedure - for detecting medical conditions in pregnant women.PubMed, Medline, Embase, and the Cochrane Library were searched from January 1996 until December 2018. Forty sevenstudies were included: thirty-five original articles, nine reviews and three meta-analysis.Analysis showed that saliva, hair, tears, and other biological material - obtained via non-invasive methods - may serveas clinically informative biomarkers. These biomarkers may be used for: toxicology, psychological studies, disease detection,biomonitoring, and drug abuse. The analysis of tears, hair, saliva, urine, and faeces is a safe, noninvasive and usefuldiagnostic tool within groups of pregnant women, but further investigation is necessary to fully realize the promise ofthese novel diagnostic tools.
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http://dx.doi.org/10.5603/GP.2019.0082DOI Listing
April 2020

Long-term outcomes of prenatally diagnosed ventriculomegaly - 10 years of Polish tertiary centre experience.

Ginekol Pol 2019 ;90(3):148-153

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

Objectives: To estimate the prevalence, associated anomalies, and postnatal outcomes in infants prenatally diagnosed with ventriculomegaly.

Material And Methods: All cases of ventriculomegaly that were examined and treated by the 1st Department of Obstet- rics and Gynecology, at the Medical University of Warsaw, from August 2007 until November 2017 were included in this study. Ultrasound data, and information on perinatal outcomes and long-term postnatal follow up were retrospectively collected by a standardised telephone survey. Ventriculomegaly was diagnosed when the atrial width of the lateral ventri- cles was ≥ 10 mm. The cases analyzed were divided into two subgroups: isolated ventriculomegaly (IVM) and non-isolated ventriculomegaly (NIVM). Neurodevelopmental complications were differentiated as either moderate or severe and were compared within each group and between groups.

Results: There were 118 cases of prenatally diagnosed ventriculomegaly. Complete follow up records were collected for 54 cases (45.8%). IVM was diagnosed in 29/54 (53.7%) cases, while NIVM was diagnosed in the remaining 25 (46.3%). The mean ventricular width for IVM was 16.93 mm (range 10.0 mm-73.0 mm) and 14.08 mm (range 9.0 mm-27.1 mm) for NIVM (p = 0.28). The mean gestational age at delivery for the IVM cases was 36 + 4 weeks and in the NIVM group 33 + 4 weeks (p = 0.022). Mild VM (10-12 mm) was diagnosed in 22/54 cases (40.7%), moderate VM (13-15 mm) in 12/54 (22.3%) and severe (≥ 15 mm) in 20/54 (37%). Among the infants with IVM the rate of severe medical complications was 29.6% (8/28) and for NIVM 667% (8/12) (p = 0.041). Less severe medical conditions affected 6/28 of the infants with IVM (21.4%) vs 9/12 NIVM cases (75%) (p = 0.012).

Conclusions: In terms of prenatal diagnosis, treatment of ventriculomegaly remains challenging due to a lack of specific prognostic factors and the significant risk of neurodevelopmental disorders. Nevertheless, isolated ventriculomegaly has significantly better long-term outcomes compared with non-isolated ventriculomegaly. In our material, the rate of severe neurodevelopmental disorders in the non-isolated ventriculomegaly cases was associated with a 52% rate of adverse perinatal outcomes. On the other hand, less severe medical conditions occurred in 21.4% of the infants with IVM and in 75% of the NIVM cases. Furthermore, obstetrical data suggest that the risks of premature delivery and caesarean section are significantly higher in cases of non-isolated ventriculomegaly.
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http://dx.doi.org/10.5603/GP.2019.0026DOI Listing
February 2020

Lung growth index and lung growth ratio - new ultrasound parameters for predicting neonatal survival in fetuses with isolated left sided congenital diaphragmatic hernia?

J Matern Fetal Neonatal Med 2019 Mar 25:1-4. Epub 2019 Mar 25.

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

Objective: To evaluate the accuracy of several ultrasound parameters used to predict neonatal survival in fetuses with isolated left-sided severe congenital diaphragmatic hernia. This study is to compare different measurement methods. Also, two new ultrasound parameters have been described: the lung growth ratio (LGR) and the lung growth index (LGI).

Methods: This was a retrospective study in pregnancies with a congenital diaphragmatic hernia (CDH) treated by fetoscopic tracheal occlusion (FETO). Pictures revealing four-chamber view of the fetal heart were reviewed and the right lung area was remeasured with several techniques: anterior-posterior, longest diameter, and tracing method. Based on the measurements, different parameters were obtained: lung-to-head ratio (LHR) (anterior-posterior), LHR (longest diameter), LHR (tracing method), o/e LHR (longest diameter), quantitative lung index (QLI) (longest diameter), and QLI (tracing method). All measurements were taken at the time of balloon insertion and at the time of balloon removal. In order to describe and compare fetal lung size indices in terms of their value as predictors of neonatal survival, receiver operating characteristic (ROC) analysis was applied.

Results: Lung-to-head ratio calculated at the time of balloon occlusion measured with the tracing method reached the most significant statistical difference (p < .01) and the best combination of sensitivity, specificity, and accuracy. Neither of the two new parameters (LGR and LGI) was better compared to previously described indices. Among all analyzed parameters, LHR measured with the tracing method at the time of balloon removal was the best predictor of neonatal survival.
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http://dx.doi.org/10.1080/14767058.2019.1594193DOI Listing
March 2019

Exploring the fetal brain: is Mri always better than ultrasound?

Ginekol Pol 2019 ;90(2):114

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

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http://dx.doi.org/10.5603/GP.2019.0020DOI Listing
January 2020

Is there a future for cell-free fetal dna tests in screening for preeclampsia?

Ginekol Pol 2019 ;90(1):55-60

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

CffDNA screening is a powerful diagnostic tool in the prenatal diagnosis algorithm for chromosomal abnormalities. With detailed ultrasound examination as the mainstay of first-trimester risk assessment, cffDNA has been shown to be superior to first-trimester combined screening (FTCS) in false-positive rates for trisomy 21 detection. In light of the growing interest in cffDNA testing and the possibility of it replacing first-trimester biochemistry, we decided to investigate the usefulness of cffDNA tests in early-pregnancy risk assessment for preeclampsia (PE). The aim of this review paper was to evaluate clinical application of first-trimester cfDNA in predicting PE, as well as to investigate its possible use in first-trimester PE screening enhancement, also in cases where biochemistry is not performed.
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http://dx.doi.org/10.5603/GP.2019.0009DOI Listing
January 2020

Oxidative stress markers in saliva and plasma differ between diet-controlled and insulin-controlled gestational diabetes mellitus.

Diabetes Res Clin Pract 2019 Feb 6;148:72-80. Epub 2018 Dec 6.

Department of Bioanalysis and Drugs Analysis, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha Street, 02-097 Warsaw, Poland.

Objectives: The aims of the study were as follows: to investigate possible differences between plasma oxidative status (OS) in late-onset GDM and well-characterized healthy pregnant women (oral health, diet); to verify the existence of possible differences between GDMG1 (diet-treated) and GDMG2 (insulin-treated GDM); to determine whether oxidative stress markers could be detected in saliva.

Material And Methods: A total of 89 pregnant women (n = 89; 59 with GDM and 30 controls) were evaluated. Malondialdehyde (MDA), total antioxidant capacity (ORAC), inactivation of aldehyde dehydrogenase (I), activity of glutathione peroxidase (GPx) and glutathione transferase (GST)) in plasma and/or saliva were analyzed.

Results: The activity of GPx and GST in plasma was higher in GDMG2 as compared to GDMG1 and controls. Also, in GDMG2, elevated concentrations of salivary MDA and higher I were observed. In contrast, GDMG1 had higher plasma ORAC and lower GPx activity as compared to controls, probably due to low-energy diet, high in antioxidants and fibers. Salivary and plasma OS were correlated and most significant for ORAC.

Conclusion: Oxidative stress were not observed in GDMG1 but were confirmed to be moderate in GDMG2. However, large variability of the analyzed markers in GDM groups encourages screening of all patients, regardless of the treatment option. Saliva may be considered useful for the estimation of oxidative stress levels in GDM populations.
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http://dx.doi.org/10.1016/j.diabres.2018.11.021DOI Listing
February 2019

Contemporary management of prenatally diagnosed spina bifida aperta - an update.

Ginekol Pol 2018;89(11):637-641

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

Spina bifida aperta is a relatively common congenital defect that occurs in the general population. Once the disorder has been diagnosed, a discussion, that can be emotionally-charged, ensues about whether to treat it prenatally or to only offer surgery postnatally. Given that there are good arguments for and against both options, it is of paramount importance to gain a good understanding of the major advantages and disadvantages of the various surgical approaches. The aim of our paper is to summarize current knowledge about spina bifida and the potential benefits of prenatal surgery.
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http://dx.doi.org/10.5603/GP.a2018.0108DOI Listing
February 2019

Cervical Measurement and Pessary Application in Relation to Gestational Age at Delivery in Patients Treated with Fetoscopic Endotracheal Occlusion.

Fetal Diagn Ther 2019 7;46(2):119-124. Epub 2018 Nov 7.

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

Objective: To evaluate the impact of cervical length and cervical pessary application in congenital diaphragmatic hernia (CDH) treated by the fetoscopic endotracheal occlusion (FETO) procedure.

Methods: The study group consisted of 80 patients with severe CDH treated by FETO. Cervical length measurement was performed by transvaginal ultrasound in all patients within the 24 h prior to the FETO procedure. The study group (n = 44) had cervical pessaries applied routinely within the 24 h following the FETO procedure, whereas the control group (n = 36) were not offered pessaries and only had cervical length measurement performed.

Results: The median cervical length was 31 (range 22-45) mm. The median gestational age at delivery was 34.7 (range 27.8-39.2) weeks. Gestational age at delivery correlated significantly with gestational age at balloon removal (r = 0.768; p < 0.0001) and premature rupture of membranes (r = 0.501; p = 0.003). There was no significant correlation between gestational age at delivery and cervical length before the procedure (r = 0.141; p = 0.26) or pessary application (r = 0.081; p = 0.51). In the multivariate linear regression model, the only factor independently associated with gestational age at delivery was gestational age at fetoscopic balloon removal (β = 0.713; p < 0.0001).

Conclusion: In cases of severe CDH treated by the FETO procedure, neither cervical length before the procedure nor cervical pessary application was associated with gestational age at delivery.
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http://dx.doi.org/10.1159/000493792DOI Listing
July 2020

Early 2D/3D ultrasound diagnosis of pleural effusion in fetuses with Turner syndrome.

J Clin Ultrasound 2018 Nov 19;46(9):585-587. Epub 2018 Sep 19.

Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois.

Most guidelines on ultrasound examinations during pregnancy do not recommend routine early pregnancy scan in uncomplicated and asymptomatic pregnancies (ie, before 10 weeks based on last menstrual period). There is, however, a growing patient's expectation to have an early scan to confirm dating and verify the pregnancy is intrauterine and viable. We present three well-documented cases of patients who had an early (7-8 weeks) dating transvaginal scan revealing pleural effusion in the embryo. In all cases cytogenetic analysis confirmed monosomy for the X chromosome, consistent with a clinical diagnosis of Turner syndrome.
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http://dx.doi.org/10.1002/jcu.22626DOI Listing
November 2018

Remarkable Hypermobility of the Ventricular Septum Diagnosed Prenatally.

J Ultrasound Med 2018 Dec 19;37(12):2959-2960. Epub 2018 Apr 19.

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

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http://dx.doi.org/10.1002/jum.14649DOI Listing
December 2018

Echocardiographic assessment of left ventricular morphology and function in patients with fibromuscular dysplasia: the ARCADIA-POL study.

J Hypertens 2018 06;36(6):1318-1325

Department of Congenital Heart Diseases.

Objective: To provide a comprehensive assessment of left ventricle (LV) structure, and function and to detect alterations in cardiac properties in relationship to presence, subtypes and extent of fibromuscular dysplasia (FMD).

Methods: We studied 144 patients with FMD. The control group consisted of 50 matched individuals. Office and ambulatory blood pressure levels were evaluated. Echocardiography was employed to assess: left ventricular mass index (LVMI), systolic function including speckle tracking echocardiography and diastolic function assessed by mitral flow and tissue Doppler imaging.

Results: There were no differences in LV morphology and function between patients with FMD and the control group. Among 128 patients with renal FMD, there were no differences in LVMI and LV systolic function between patients with unifocal and multifocal FMD. The patients with multifocal FMD were characterized by lower early diastolic velocity (e') as compared with unifocal FMD and control groups. However, in a multivariate regression model, e' was not independently correlated with FMD. There were no associations between echocardiographic indexes and vascular involvement of FMD. Also, there were no differences in LV morphology and function in patients with significant renal artery stenosis (RAS) compared with patients with history of significant RAS and patients with nonsignificant RAS.

Conclusion: Our study in contrast to those with atherosclerotic RAS, did not show differences in LV morphology and function between FMD patients and matched controls. Although FMD can result in hypertension and serious vascular complications, there is no proof that it can alter LV regardless of FMD type and its extent.
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http://dx.doi.org/10.1097/HJH.0000000000001706DOI Listing
June 2018

The practical use of acetylsalicylic acid in the era of the ASPRE trial. Update and literature review.

Ginekol Pol 2018 ;89(2):107-111

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

It is now well established that acetylsalicylic acid - one of the most widely prescribed drugs today - has brought a new era in maternal-fetal medicine. The History of medicine mentions several antecedents. Extracts made from willow contained in clay tablets are reported in both ancient Sumer and Egypt. In 400 BC, Hippocrates referred to the use of salicylic tea to reduce fevers. In the 1950s, acetylsalicylic acid entered the Guinness Book of Records as the highest selling painkiller. There is little doubt that acetylsalicylic acid - one of the first drugs to enter common usage - remains one of the most researched drugs in the world.
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http://dx.doi.org/10.5603/GP.a2018.0018DOI Listing
July 2018

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

Assessment of cerebral blood flow with magnetic resonance imaging in children with sickle cell disease: A quantitative comparison with transcranial Doppler ultrasonography.

Brain Behav 2017 11 14;7(11):e00811. Epub 2017 Oct 14.

Physiology & Experimental Medicine The Hospital for Sick Children Toronto ON Canada.

Introduction: Transcranial Doppler ultrasonography (TCD) is a clinical tool for stratifying ischemic stroke risk by identifying abnormal elevations in blood flow velocity (BFV) in the middle cerebral artery (MCA). However, TCD is not effective at screening for subtle neurologic injury such as silent cerebral infarcts. To better understand this disparity, we compared TCD measures of BFV with tissue-level cerebral blood flow (CBF) using arterial spin-labeling MRI in children with and without sickle cell disease, and correlated these measurements against clinical hematologic measures of disease severity.

Methods: TCD and MRI assessment were performed in 13 pediatric sickle cell disease patients and eight age-matched controls. Using MRI measures of MCA diameter and territory weight, TCD measures of BFV in the MCA [cm/s] were converted into units of CBF [ml min100 g] for comparison.

Results: There was no significant association between TCD measures of BFV in the MCA and corresponding MRI measures of CBF in patients (=.28, =.39) or controls (=.10, =.81). After conversion from BFV into units of CBF, a strong association was observed between TCD and MRI measures (=.67, =.017 in patients, =.86, =.006 in controls). While BFV in the MCA showed a lack of correlation with arterial oxygen content, an inverse association was observed for CBF measurements.

Conclusions: This study demonstrates that BFV in the MCA cannot be used as a surrogate marker for tissue-level CBF in children with sickle cell disease. Therefore, TCD alone may not be sufficient for understanding and predicting subtle pathophysiology in this population, highlighting the potential clinical value of tissue-level CBF.
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http://dx.doi.org/10.1002/brb3.811DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5698856PMC
November 2017