Publications by authors named "Tomasz Fuchs"

36 Publications

The clinical evaluation of internal iliac arteries balloon occlusion for placenta accreta spectrum.

Ginekol Pol 2021 Jan 15. Epub 2021 Jan 15.

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

Objectives: To evaluate the balloon occlusion of the internal iliac arteries during a caesarean section in the group of patients with placenta accreta spectrum.

Material And Methods: We analysed 29 pregnant women with placenta accreta spectrum. The study group consisted of 15 patients, who underwent a caesarean delivery with temporary bilateral internal iliac artery occlusion. In the control group, we examined 14 women who had a standard caesarean delivery without any radiologic procedure. We compared pre- and post-operative haemoglobin level, necessity of blood transfusion, intraoperative blood loss, intensive care requirement, complications, duration of surgery, anaesthesia and hospital stay.

Results: The history and obstetric outcomes were similar in both groups. The study group required fewer blood transfusions than the control group (p = 0.0176). We administered less packed red blood cells and fresh frozen plasma. Complications were more frequent in the control group (p = 0.0014). Complications related to occlusion of the internal iliac arteries did not occur. The intensive care unit transfer was more frequent in the control group (p = 0.0329). The duration of surgery and hospital stay did not differ between groups. The anaesthesia time was longer in a study group, which related to the radiologic procedure.

Conclusions: Caesarean delivery for placenta accreta spectrum with bilateral balloon occlusion of the internal iliac arteries requires fewer transfusions. It contributes to a decrease in the complication rate and maternal morbidity.
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http://dx.doi.org/10.5603/GP.a2020.0180DOI Listing
January 2021

Placental mesenchymal dysplasia and hepatic cyst.

Ginekol Pol 2020 ;91(12):779-780

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

Placental mesenchymal dysplasia (PMD) is a rare benign vascular anomaly of the placenta. It can be misdiagnosed as a molar pregnancy resulting in unnecessary termination of pregnancy. A 30-year-old woman was referred to our hospital at 18 gestational weeks due to suspicion of molar pregnancy. The ultrasound showed a bulky placenta with multiple cysts. Oligohydramnion and fetal hypoechogenic cystic area without doppler flow were diagnosed at 23 weeks. The baby was operated on after delivery, and an 80 mm multifocal cyst originating from the right lobe of the liver was removed. The placenta demonstrated swelling stem villi with enlarged vessels and increased interstitial cells without trophoblast proliferation. PMD and fetal hepatic cyst can coexist; however, the relationship between those conditions remains to be elucidated. PMD is associated with adverse pregnancy outcomes but also with a good prognosis.
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http://dx.doi.org/10.5603/GP.a2020.0129DOI Listing
January 2020

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

Polish Society of Gynecologists and Obstetricians recommendation on the use of antiseptics for treatment of inflammatory vaginitis.

Ginekol Pol 2020 ;91(7):432-437

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

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http://dx.doi.org/10.5603/GP.2020.0104DOI Listing
January 2020

[Perinatal palliative care performed in obstetrics and neonatology wards and hospices for children - own experience].

Dev Period Med 2019 ;23(4):253-262

Katedra Pediatrii, Zakład Propedeutyki Pediatrii i Chorób Rzadkich, Uniwersytet Medyczny we Wrocławiu, Polska.

Objective: Lethal defects lead to the intrauterine death of the fetus or the passing away of the child immediately after birth or in early infancy, regardless of the treatment used. In the case of lethal defects, it is not possible to effectively help the child, despite using the most modern equipment or medicines in the treatment or the progress made by medicine. Parents, who decide to continue the pregnancy, although the fetus has a lethal defect that cannot be cured, may be covered by perinatal hospice care, which is comprehensive and consists in supporting the pregnant woman during the prenatal time, during delivery and after delivery and support of her family, giving full information to the parents about their child's illness. Childcare after birth is focused on protecting the infant from persistent therapy and providing him with appropriate conditions. Aim: To demonstrate the role of perinatal palliative care for pregnant women in whom the results of prenatal tests pointed to a severe developmental disorder in the fetus with a potentially lethal prognosis, and to present a pattern of behavior for their hospitalization in the perinatal hospice.

Patients And Methods: Materials and methods: The retrospective analysis included documentation of 67 patients referred to the RAZEM (TOGETHER) Program in Wrocław in 2014-2018 due to abnormal results of (ultrasound and / or genetic) prenatal tests, which indicated a serious developmental disorder in the fetus with potentially lethal prognosis. Analysis was conducted of sociodemographic data, clinical data on fetal diagnosis, pregnancy and delivery, the procedure for prenatal delivery and postnatal birth.

Results: Results: 67 women aged 20-43 years (mean 31.2) were referred to the RAZEM Program. Out of these, 57 women were enrolled for palliative care, which accounted for 85% of those referred to the program. Palliative care was continued in 51 patients, because 6 women decided to terminate their pregnancy during the diagnostic process (10.5%). The most common abnormalities in the fetuses were chromosomal aberrations, CNS defects and kidney defects. In 95% of the cases, intrauterine fetal death or neonatal death occurred.

Conclusion: Conclusions: Perinatal palliative care is an indispensable form of care for pregnant women in whom the results of prenatal tests indicate a serious developmental disorder in the fetus with potentially lethal prognosis. The in-hospital model of a perinatal hospice is a beneficial form of care, as it ensures consistency and good communication in the team, which favourably affects its quality.
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July 2020

Use of electrical impedance spectroscopy as an adjunct to colposcopy in a pathway of cervical intraepithelial neoplasia diagnostics.

Ginekol Pol 2019 ;90(11):628-632

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

Objectives: Screening with cytology decreases cervical cancer burden, but new methods have emerged. We assessed thediagnostic value of electrical impedance spectroscopy (EIS) in the real-world gynecological setting. The study aimed todetermine the diagnostic usefulness of EIS used as an adjunct to colposcopies in the diagnosis of high-grade squamousintraepithelial lesions in women with abnormal cytology findings.

Material And Methods: A cross-sectional, single center, observational study considered 143 women. All were subjected toa colposcopy and EIS with ZedScan. ZedScan-guided or colposcopically-guided biopsies were carried out.

Results: Data from 118 women were analyzed. The average age of the included women was 38.29 } 12.52 years (range:22-86 years). Overall, 27 had a diagnosis of CIN2+ and above on histopathological examination, 99 had low-grade colposcopyresults, 18 had high-grade colposcopy results, and 80 had positive ZedScan examination. No adverse events relatedto the examination with ZedScan were observed. EIS used as an adjunct to colposcopies showed sensitivity of 96.30%(95% CI: 81.03-99.91) and specificity of 39.56% (95% CI: 29.46-50.36), and accuracy of 52.54% (95% CI: 43.15-61.81). Theprocedure allowed to detect 11 additional cases with positive histo-pathological result in comparison to colposcopies alone.

Conclusions: Colposcopies performed with ZedScan as an adjunct were effective in detecting high-grade cervical lesions.Advantages of ZedScan include real-time result display, no additional diagnostic burden posed on the patient, andgood safety profile. Studies on large patient cohorts are needed for further evaluations of this diagnostic procedure andfactors which may affect its diagnostic accuracy.
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http://dx.doi.org/10.5603/GP.2019.0107DOI Listing
June 2020

Laparoscopic treatment of an intrauterine device mislocated in the abdominal region.

Ginekol Pol 2019 ;90(8):490

Medical University of Wroclaw, Departament of Obstetrics and Gynecology, Wroclaw, Poland.

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http://dx.doi.org/10.5603/GP.2019.0084DOI Listing
April 2020

Polish Society of Gynecologists and Obstetricians Guidelines for the application of hysteroscopy in gynecology.

Ginekol Pol 2019 ;90(8):482-489

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

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http://dx.doi.org/10.5603/GP.2019.0083DOI Listing
April 2020

The impact of chorionicity and the type of twin growth on the early neonatal outcome in twin pregnancies - 20 years of experience from one tertiary perinatal center.

Taiwan J Obstet Gynecol 2019 Jul;58(4):482-486

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

Objective: Twin pregnancies are associated with higher neonatal mortality and morbidity. Growth discordance and monochorionicity are among the factors that worsen the course of pregnancy. The study aimed to assess neonatal conditions and mortality in relation to growth type and chorionicity.

Materials And Methods: Data from 820 pregnant women with twin pregnancies and their 1640 newborns were analyzed. The Apgar score and umbilical artery blood pH, as well as the rate of complications, were compared between dichorionic diamniotic (DCDA) and monochorionic diamniotic (MCDA) twins with symmetric and discordant growth. The Student's t-test and the Pearson chi-square test were used for comparisons.

Results: There were 576 (70.2%) DCDA pregnancies, including 421 (73.1%) with symmetric growth and 155 (26.9%) with discordant growth, and 244 (29.8%) MCDA pregnancies, including 110 (45.1%) with symmetric growth and 134 (54.9%) with discordant growth. A significantly greater percentage of twins with discordant growth occurred in women older than 34 years than in those that were younger. An Apgar score of ≤7 was significantly more common among MCDA discordant twins, while an arterial umbilical blood pH of <7.2 was more common among MCDA twins with symmetric growth. Early neonatal deaths (n = 29; 1.8%), respiratory disorders, and a birth weight of <1500 g were significantly more common in MCDA twins than in DCDA twins.

Conclusion: MCDA twins with growth discordance are burdened with a higher risk of neonatal morbidity and mortality than symmetric DCDA twins. Chorionicity and growth discordancy are important determinants of the outcome of twin pregnancy.
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http://dx.doi.org/10.1016/j.tjog.2019.05.009DOI Listing
July 2019

Natural history of caesarean scar pregnancy.

Ginekol Pol 2019 5;90(6):351-352. Epub 2019 Jun 5.

2nd Department and Clinic of Gynaecology, Obstetrics and Neonatology, Wroclaw Medical University, Wroclaw, Poland.

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http://dx.doi.org/10.5603/GP.a2019.0054DOI Listing
March 2020

Postnatal condition of the second twin in respect to mode of delivery, chorionicity and type of fetal growth.

Adv Clin Exp Med 2019 Feb;28(2):237-242

Clinic of Gynecology and Obstetrics, Jan Mikulicz-Radecki University Teaching Hospital, Wrocław, Poland.

Background: The increased use of assisted reproductive techniques (ART) contributes to the increased rate of twin pregnancies, which are burdened with a higher risk of complications. Factors that affect the condition of the second twin are understudied.

Objectives: The objective of this study was to assess the impact of the delivery mode, chorionicity, amnionicity, and the type of fetal growth on the postnatal condition of the second twin.

Material And Methods: The study included data from 475 pregnant women with twin pregnancies. Maternal age, parity, chorionicity, amnionicity, type of fetal growth, mode of delivery, gestational weeks at delivery, Apgar score, and umbilical arterial blood pH were retrospectively analyzed. Data normality was checked with the Kolmogorov-Smirnov test. The paired Wilcoxon signed-rank test and χ2 test were used for comparisons between groups. To check predictive value of the analyzed variables multiple linear regression was used.

Results: The mean maternal age was 29.22 (standard deviation (SD) ±5.19) years. The maternal age and gestational age at delivery did not differ significantly between women who delivered by cesarean section (CS) and vaginal delivery (VD). In the second twin, the Apgar score and values of arterial umbilical blood pH were lower in infants delivered by VD than in those delivered by CS (6.30 ±2.83 and 7.30 ±0.12; p = 0.0209 and 7.26 ±0.12 and 7.30 ±0.11; p = 0.0236, respectively). In monochorionic diamniotic twins with asymmetric growth, the second twin achieved significantly lower outcome than the first twin. Vaginal delivery was a predictive factor for a lower Apgar score and lower values of umbilical arterial blood pH in second twins, while not in first twins. Symmetrical fetal growth of twins was a predictive factor for better postnatal condition for both twins.

Conclusions: In twin pregnancies, VD, but not CS, is associated with increased risk of worse postnatal condition of the second twin. In monochorionic diamniotic pregnancies complicated by growth discordance, CS seems to be a reasonable mode of delivery.
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http://dx.doi.org/10.17219/acem/90765DOI Listing
February 2019

The analgesic efficiency of transversus abdominis plane (TAP) block after caesarean delivery.

Ginekol Pol 2018 ;89(8):421-424

Katedra i Klinika Anestezjologii i Intensywnej Terapii, ul. Borowska 213, 50-556 Wrocław, Poland.

Objectives: The ultrasound-guided transversus abdominis plane (TAP) block is a supporting method of pain relief after different types of surgical and gynecological procedures. The aim of the present study was to evaluate the analgesic effects of the TAP-block in patients undergoing caesarean section.

Material And Methods: 88 women undergoing elective caesarean section under spinal anaesthesia were prospectively randomized into two groups. In the first group, an ultrasound-guided bilateral TAP block was performed using 40 mL 0.25% bupivacaine, while the second group was treated without a regional nerve block. Both groups received a standard analgesia protocol with intravenous paracetamol administered every 6 hours and intravenous tramadol on-demand, delivered using the Patient Controlled Analgesia (PCA) method. Pain intensity was assessed according to the visual analogue scale (VAS) directly after the TAP block and at 3, 6 and 12 hours postoperatively. Any patient complaints and side-effects during the postoperative period were recorded.

Results: The TAP block resulted in a significant reduction of pain intensity using the visual analogue scale after 3, 6 and 12 hours (p < 0.05) and a significant decrease in tramadol administration (p < 0.05) during the first 12 hours postoperatively. No significant differences in the heart rate and blood pressure were noted between groups (p > 0.05). There were no complications related to the TAP block.

Conclusions: The TAP block is a safe and effective adjunctive method of pain relief after caesarean delivery.
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http://dx.doi.org/10.5603/GP.a2018.0072DOI Listing
April 2019

Management of placenta percreta with temporary balloon occlusion of the internal iliac arteries.

Eur J Obstet Gynecol Reprod Biol 2018 Jul 14;226:71-72. Epub 2018 May 14.

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

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http://dx.doi.org/10.1016/j.ejogrb.2018.05.014DOI Listing
July 2018

Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section.

Ginekol Pol 2017 ;88(4):174-179

Objectives: A growing number of studies suggest that the incomplete healing of the CS scar in the uterus increase the risk of uterine dehiscence or rupture during subsequent pregnancies. Thus, the factors that affect wound healing should be evaluated. We aimed to determine whether the morphology of the CS scar in non-pregnant women after one elective CS was affected by the site of the uterine incision, uterine flexion, maternal age, and fetal birth weight.

Material And Methods: 208 non-pregnant women were invited for participation in the study, but only 101 of them met inclusion criteria. Standardized scar parameters (residual myometrial thickness (RMT), depth (D) and width (W) of the hypoechoic niche) were measured using ultrasonography at least 6 weeks after the CS.

Results: Scar defect was detected in 26 of 101 subjects. Women without scar defect had significantly higher RMT values (1.87 vs. 0.87), lower newborn birth weight (3127 g vs. 3295 g), and higher scar location above the internal cervical os (62% vs. 16%), than those with scar defect. Maternal age was significantly correlated with D value (R = 0.40). Uterine retroflexion was significantly correlated with a larger D value (R = 0.63) and a larger D/RMT ratio (R = 0.24).

Conclusions: In low-risk women who have undergone one elective CS, several risk factors are associated with development of the scar defect, but only scar location can be modified during surgery. Future research is needed to determine whether a relatively higher incision location in the uterus can ensure optimal healing of the CS scar.
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http://dx.doi.org/10.5603/GP.a2017.0034DOI Listing
July 2018

Sonographic evaluation of surgical repair of uterine cesarean scar defects.

J Clin Ultrasound 2017 Oct 10;45(8):455-460. Epub 2017 Feb 10.

2nd Department of Gynecology and Obstetrics, Wroclaw Medical University, Ul. Borowska 213, 50-556, Wroclaw, Poland.

Background: The aim of the study was to assess the clinical outcomes of surgical repair of uterine cesarean scar defects with sonography (US).

Methods: Seven nonpregnant women with history of cesarean section and a large uterine scar defect were enrolled. The surgical repair was performed by minilaparotomy. The US assessment of the uterine scar was performed using a standardized approach at baseline, then at a first visit 2-3 days following the surgical intervention (V1) and at a follow-up visit 3 months later (V2). Residual myometrial thickness (RMT), width, and depth of the scar defect were measured.

Results: The mean RMT increased significantly from 1.9 mm at baseline to 8.8 mm at V1 and 8.0 mm at V2. No intraoperative complications were observed. Postmenstrual spotting and abdominal pain reported preoperatively resolved after the operation.

Conclusions: A surgical repair procedure for an incompletely healed uterine cesarean scar is effective in increasing RMT thickness, decreasing the depth of the scar, and reducing symptoms related to the cesarean section scar defect. Further studies on post-repair pregnancy outcomes are required to evaluate whether the procedure affects the rate of cesarean scar pregnancy, morbidly adherent placenta, and/or uterine scar dehiscence and rupture. The repair of a cesarean scar defect is recommended only for symptomatic women. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:455-460, 2017.
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http://dx.doi.org/10.1002/jcu.22449DOI Listing
October 2017

Fetal Heart Rate Monitoring Using Maternal Abdominal Surface Electrodes in Third Trimester: Can We Obtain Additional Information Other than CTG Trace?

Adv Clin Exp Med 2016 Mar-Apr;25(2):309-16

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

Background: Cardiotocography (CTG) is the most widely used procedure despite its low specificity for fetal acidosis and poor perinatal outcome. Fetal electrocardiography (fECG) with transabdominal electrodes is a new, non-invasive and promising method with greater potential for detecting impairment of fetal circulation. This study is the first that attempts to assess the usefulness of fECG in comparison to CTG during antepartum period.

Objectives: To determine if a single fECG examination along with CTG tracing and Doppler flow measurement in the fetal vessels has any additional clinical value in normal and intrauterine growth restricted (IUGR) fetuses.

Material And Methods: The study included 93 pregnancies with IUGR, 37 pregnancies with IUGR and brain sparing effect, and 324 healthy pregnant women. The T/QRS ratio, cerebro-placental ratio (CRP), and CTG tracings were analyzed. One-way analysis of variance and Spearman's rank correlation coefficient were applied. The relationship between results of the T/QRS ratio and CTG examination among the study groups was analyzed.

Results: The highest average mean value of the T/QRS ratio was recorded in the IUGR group with a normal CPR and a pathologic CTG (0.235 ± 0.014). The highest average maximum values were observed in the groups of IUGR pregnancies with a reduced CPR with normal (0.309 ± 0.100), suspicious (0.330 ± 0.102) and pathologic (0.319 ± 0.056) CTGs. Analysis of variance revealed differences between study groups regarding maximum values and the difference between maximum and minimal values of T/QRS. Correlations between groups were insignificant.

Conclusions: Higher values of T/QRS ratio in IUGR pregnancies with normal and reduced CPR than in control group regardless of the result of CTG examination may indicate minimal worsening of intrauterine fetal well-being in growth retarded fetuses. No relationship between fECG examination and CTG tracings suggests that a single fECG does not provide any additional clinically significant information determining the condition of the fetus; however, further studies are required.
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http://dx.doi.org/10.17219/acem/60842DOI Listing
December 2016

Standardized ultrasonographic approach for the assessment of risk factors of incomplete healing of the cesarean section scar in the uterus.

Eur J Obstet Gynecol Reprod Biol 2016 Oct 24;205:141-5. Epub 2016 Aug 24.

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

Objective: To identify factors related to the healing of a Cesarean uterine incision using the standardized ultrasonographic approach of scar assessment in the non-pregnant uterus.

Study Design: Measurements of the uterine scar were taken from 409 women with a history of at least one low transverse cesarean section (CS) with a single layer uterine closure. Residual myometrial thickness (RMT), width (W) and depth (D) of the triangular hypoechoic scar niche, D/RMT ratio and clinical characteristics were analyzed. For statistical analysis, the Mann-Whitney U test, chi-square test, Spearman's rank correlation coefficient, ANOVA test, and logistic regression were used.

Results: 268 women presented with a scar defect. RMT values were significantly correlated with the number of CSs (R=-0.17) and uterus retroflection (R=-0.15). The presence of a scar defect was significantly associated with lower RMT values (R=-0.33), greater gestational age (R=0.10), and younger maternal age (R=-0.11). The mean RMT value was significantly smaller in women with CSs performed in the second stage of labor (0.62) when compared to women with CSs in the first stage of labor (0.97) or without cervical dilatation (0.91).

Conclusion: A standardized approach of CS scar assessment in the non-pregnant uterus helps to identify women at risk of long-term complications of CS.
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http://dx.doi.org/10.1016/j.ejogrb.2016.08.032DOI Listing
October 2016

Values of T/QRS ratio in pregnancies complicated by intrauterine growth restriction.

Authors:
Tomasz Fuchs

J Perinat Med 2016 Oct;44(7):751-757

Aims: To evaluate values of T/QRS ratio in normal pregnancies and those complicated by intrauterine growth restriction (IUGR) using non-invasive method with transabdominal electrodes. Assessment of fetal well-being in IUGR pregnancies.

Methods: Fetal electrocardiograms were recorded and analyzed by KOMPOREL software from ITAM (Zabrze, Poland) and T/QRS ratios were automatically calculated. Doppler velocimetry of the middle cerebral artery and umbilical artery was carried out. The study group consisted of IUGR pregnancies with normal cerebroplacental ratios (CPRs) (n=110), IUGR pregnancies with decreased CPRs (n=29), and healthy controls (n=549). Analyses were performed between the study groups and by gestational age. T/QRS ratio variables and CPRs were calculated. Analysis of variance and linear regression were performed.

Results: Maximum values, maximum minimal value differences, and standard deviations of T/QRS ratio were significantly different between the IUGR group with reduced CPRs and normal CPRs (P=0.0009, P=0.0000, P=0.0034, respectively) as well as between the IUGR group with reduced CPRs and healthy controls (P=0.0000, P=0.0001, P=0.0009, respectively). Mean maximum values in the IUGR group with reduced CPRs exceeded normal values.

Conclusions: T/QRS ratio may be useful in assessing fetal well-being in IUGR pregnancies; however, future studies are needed to determine typical ranges of T/QRS ratio in pregnancies complicated by IUGR.
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http://dx.doi.org/10.1515/jpm-2014-0305DOI Listing
October 2016

Signal loss during fetal heart rate monitoring using maternal abdominal surface electrodes between 28 and 42 weeks of pregnancy.

Adv Clin Exp Med 2014 Sep-Oct;23(5):813-9

2nd Department and Clinic of Gynaecology, Obstetrics and Neonatology, Wroclaw Medical University, Poland.

Background: Fetal electrocardiography is one of the methods for monitoring the well-being of the fetus. Signal loss limits the proper interpretation of electrocardiogram traces.

Objectives: The aim of this study was to assess the average signal loss in non-invasive abdominal fetal electrocardiogram (fECG) monitoring using the KOMPOREL fetal monitoring system (ITAM, Zabrze, Poland) in women between 28 and 42 week of pregnancy. The results were compared to FIGO (International Federation of Gynaecology and Obstetric) and DGGG (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V.) recommendations concerning fetal heart monitoring. The correlation between fetal ECG signal quality, week of pregnancy and patient BMI was evaluated.

Material And Methods: 773 pregnant women, hospitalized and diagnosed in the Department of Gynecology and Obstetrics, Wroclaw Medical University, underwent 30 min of abdominal fECG recordings using the KOMPOREL fetal monitoring system.

Results: The average signal loss in abdominal fECG monitoring in the study group was 32%. FIGO recommendations describe an acceptable fetal signal loss of 20%. In our study, 46% (357/773) of the recordings were up to FIGO standards, with fetal heart rate success rates above 80%. According to DGGG guidelines, with acceptable fetal signal loss of 15%, only 39% (303/773) of the recordings could be assessed as accurate. No correlation between fECG signal quality, week of pregnancy and patient BMI was proved.

Conclusions: The average signal loss in abdominal fECG monitoring in our study group was 32%. Low fECG signal quality may constitute a potentially limiting factor of the described fetal heart monitoring system. No relationship between fECG signal quality, week of pregnancy and patient BMI was proved.
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http://dx.doi.org/10.17219/acem/37258DOI Listing
December 2014

The T/QRS ratio values in pregnancies complicated by threatened preterm labour treated with intravenous infusions of fenoterol.

J Perinat Med 2015 Jul;43(4):467-72

Aims: To evaluate values of foetal T/QRS ratios in pregnancies complicated by threatened preterm labour treated with intravenous infusions of fenoterol using non-invasive methods with transabdominal electrodes.

Materials And Methods: The study group consisted of 451 Caucasian women (63 preterm pregnancies and 327 healthy controls) whose pregnancies ranged from 28 to 37 gestational weeks. Foetal electrocardiograms were recorded and T/QRS ratios were calculated by KOMPOREL software (ITAM, Zabrze, Poland). The first recording was performed 30 min after the start of fenoterol infusion and the second 2 days after finishing tocolysis. T/QRS ratio variables were calculated. One-way analysis of variance was carried out.

Results: Significantly higher mean values of the T/QRS ratio were observed in pregnancies during tocolytic treatment in comparison to controls and pregnancies after tocolysis (P=0.0158 and P=0.0071, respectively). The T/QRS ratio values fall again shortly after finishing intravenous tocolysis.

Conclusions: The T/QRS ratio is one of the methods used for non-invasive foetal distress assessment that can be used in antepartum foetal monitoring in complicated pregnancies. Raised values of the T/QRS ratio in the foetus during tocolysis with fenoterol and next its fall to values observed in physiological pregnancies may indicate transient worsening of fetal well-being, however, additional research is required.
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http://dx.doi.org/10.1515/jpm-2014-0042DOI Listing
July 2015

Quantitative assessment of placental vasculature and placental volume in normal pregnancies with the use of 3D Power Doppler.

Adv Med Sci 2014 Mar 21;59(1):23-7. Epub 2014 Mar 21.

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

Purpose: The aim of the study was to determine reference values for placental vascular indices and placental volume according to gestational age.

Material/methods: The assessment of placental vascular indices and placental volume using 3D Power Doppler and the Virtual Organ Computer-aided Analysis (VOCAL) technique was performed on 100 normal fetuses between 22 and 41 weeks of gestation. In this study the method of the individual setting of the power Doppler gain value was used. Only patients with entirely visualized placenta were included in the study.

Results: No statistically relevant difference in the values of placental vascular indices and placental volume between different localizations of the placenta was detected. No statistically significant changes to placental vascular indices depending on gestational age were found. It enabled to determine the 10th, 50th and 90th percentile values for the vascularization index (VI), flow index (FI), vascularization-flow index (VFI), which are independent of gestational age. No correlation was found between placental volume and placental vascular indices.

Conclusions: The values of placental vascular indices are constant between the 22nd and 41st week of a normal pregnancy. Placental volume measured with the use of the VOCAL program increases between 22nd and 41st week of a normal pregnancy. In a normal pregnancy the placental vasculature increases adequately to the increase of its volume. The method of the individual setting of the power Doppler gain value makes it possible to achieve comparable values of placental vascular indices regardless of the distance between the probe and the placenta.
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http://dx.doi.org/10.1016/j.advms.2013.06.002DOI Listing
March 2014

Sonoelastography of the uterine cervix.

Acta Obstet Gynecol Scand 2014 May;93(5):524

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

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http://dx.doi.org/10.1111/aogs.12356DOI Listing
May 2014

Neonatal outcome from triplet interval delayed delivery: a case report.

Case Rep Obstet Gynecol 2013 9;2013:451360. Epub 2013 Dec 9.

Department of Neonatology, Medical University of Wrocław, ul. Borowska 213, 50-556 Wrocław, Poland.

In the past decades, we have observed a large increase in the number of multifetal pregnancies, which is mainly associated with the introduction of assisted reproductive techniques. Even though neonatal intensive care of very premature infants has improved significantly, the risk of mortality and long-term morbidity is still much higher among these newborns. A longer interdelivery period may reduce perinatal mortality and morbidity. The authors report the case of a delayed interval delivery in trichorionic, triamniotic triplet pregnancy. After the labor of the first fetus in the 22nd week of gestation, a 75-day interval was achieved before the delayed delivery. To save the surviving fetuses, the umbilical cord was ligated at the cervical level immediately after the first delivery. The patient received antibiotics, tocolytics, and corticosteroids. A baby boy who weighed 1750 g and a girl who weighed 1700 g were successfully delivered by cesarean section in the 33rd week of pregnancy. The babies were discharged home at the age of 28 days. A follow-up examination 20 weeks later showed that their neurological development was normal and without any major problems. The maternal postpartum course was uneventful; the patient stayed in hospital taking care of the babies.
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http://dx.doi.org/10.1155/2013/451360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872106PMC
January 2014

Prediction of uterine dehiscence using ultrasonographic parameters of cesarean section scar in the nonpregnant uterus: a prospective observational study.

BMC Pregnancy Childbirth 2014 Oct 29;14:365. Epub 2014 Oct 29.

Background: Every year 1.5 million cesarean section procedures are performed worldwide. As many women decide to get pregnant again, the population of pregnant women with a history of cesarean section is growing rapidly. For these women prediction of cesarean section scar performance is still a serious clinical problem.

Methods: Starting in 2005, the study included 308 nonpregnant women with a history of low transverse cesarean section. The following ultrasonographic parameters of the cesarean section scar in the nonpregnant uterus were assessed: the residual myometrial thickness (RMT) and the width (W) and the depth (D) of the triangular hypoechoic scar niche. During 8 years of follow-up, 41 of these women were referred to our department for delivery. In all cases, a repeat cesarean section was performed and the lower uterine segment was assessed. Two independent statistical methods namely the logit model and Decision Tree analysis were used to determine the relation between the appearance of the cesarean section scar in the nonpregnat state and the performance of the scar in the next pregnancy.

Results: The logit model revealed that the D/RMT ratio showed significant correlation with cesarean section scar dehiscence (P-value of 0.007). Specifically, a D/RMT ratio value greater than 1.3035 indicated that the likelihood of dehiscence was greater than 50%. The Decision Tree analysis revealed that a diagnosis of dehiscence versus non-dehiscence could be based solely on one criterion, a D/RMT ratio of at least 0.785. The sensitivity of this method was 71%, and the specificity was 94%.

Conclusions: Assessment of the cesarean section scar in the nonpregant uterus can be used to predict the occurrence of scar dehiscence in the next pregnancy.
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http://dx.doi.org/10.1186/s12884-014-0365-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212089PMC
October 2014

Values of T/QRS ratios measured during normal and post-term pregnancies.

Authors:
Tomasz Fuchs

J Perinat Med 2014 May;42(3):349-57

Aim: To evaluate values and variability of T/QRS ratios between 28 and 42 weeks' gestation in term and post-term pregnancies using non-invasive methods with electrodes placed over the maternal abdomen.

Methods: Fetal electrocardiograms were recorded from 657 women with singleton pregnancies. Recorded signals were analyzed by KOMPOREL software from ITAM (Zabrze, Poland) and the T/QRS ratios were automatically calculated. The analyses were performed in subgroups according to gestational age. The T/QRS ratio variables were calculated; one-way analysis of variance (ANOVA test) and linear regression were carried out.

Results: The T/QRS ratio was successfully measured in 95.4% (n=627) of patients during 30 min recordings. Values of T/QRS ratio variables changed during pregnancy. The mean T/QRS ratio ranged between 0.134 in the 41st gestational week and 0.178 in the 35th gestational week. Mean minimal and maximum values of the T/QRS ratio ranged between 0.02 and 0.29 [x=0.09; standard deviation (SD)=0.05] and 0.08 and 0.5 (x=0.27; SD=0.1), respectively. The highest values occurred in pre-term and post-term pregnancies.

Conclusions: Measurement of the T/QRS ratio is one of the techniques used for non-invasive fetal distress assessment that can be used in antepartum fetal monitoring. Values of T/QRS ratio variables changed during pregnancy from higher in pre-term pregnancies, lower in the peripartum period and rose again in post-term pregnancies. The study provides more insight into the values of T/QRS ratios during pregnancy; however, additional research is required.
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http://dx.doi.org/10.1515/jpm-2013-0181DOI Listing
May 2014

The role of ductus venosus Doppler flow in the diagnosis of chromosomal abnormalities during the first trimester of pregnancy.

Adv Clin Exp Med 2013 May-Jun;22(3):395-401

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

Background: The ductus venosus (DV) is an intrahepatic end-part of the umbilical vein. Inappropriate first trimester DV Doppler blood flow patterns correspond to a higher risk of chromosomal abnormalities.

Objectives: The aim of the study was to assess the usefulness of ductus venosus Doppler flow in a first trimester screening for aneuploidies.

Material And Methods: A prospective study included 1526 singleton pregnancies with increased risk of chromosomal abnormalities who underwent prenatal first trimester screening between the years 2006-2009. All ultrasound scans were performed by experienced sonographers and included an assessment of fetal growth, nuchal translucency (NT), nasal bone assessment (NB) and ductus venosus (DV) blood flow. Reversed a-wave (atrial diastole) in the ductus venosus flow pattern was recognized as abnormal. In addition to DV blood flow, the levels of pregnancy-associated plasma protein-A (PAPP-A) and free β - human chorionic gonadotropin (β-hCG) in maternal serum were measured. The risk of chromosomal abnormalities was calculated using the Fetal Medicine Foundation software. The following risk levels were assumed: high risk results - 1:100 or lower, intermediate risk 1:100 - 1:1000, and low risk above 1:1000. In 523 pregnancies, patients underwent amniocentesis and karyotyping.

Results: The authors diagnosed 46 cases with chromosomal abnormalities (using amniocentesis and karyotyping). 29 patients had spontaneous miscarriage, in 21 cases they reported fetuses with congenital malformations (mostly heart defects). Abnormal DV blood flow was recognized in 113 pregnant women (7.4%). The majority of cases affected by abnormal DV blood flow were classified as intermediate and high disorder risk groups - 100 (6.5%). The comparison between a combined test with and without DV assessment revealed that the addition of DV flow pattern results increased sensitivity from 84% to 92% in screening for aneuploidies. The false-positive ratio was between 0.4% and 2.4%.

Conclusions: Ductus venosus Doppler blood flow examination is useful in the first trimester prenatal diagnostic since it increases the sensitivity of the combined test in the assessment of risk for chromosomal abnormalities. The authors recommend assessing DV blood flow during the first trimester screening in all pregnancies, irrespectively of the chromosomal abnormalities background risk. This procedure in clinical practice seems to be favorable and less complicated.
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August 2013

Sonoelastography of the uterine cervix as a new diagnostic tool of cervical assessment in pregnant women - preliminary report.

Ginekol Pol 2013 Jan;84(1):12-6

Department of Gynecology, Obstetrics and Neonatology, Wroclaw Medical University, Poland, ul. Borowska 213, 50-556 Wroclaw, Poland.

Objectives: The study aimed at determining whether there exists a correlation between the cervical cohesion parameters assessed in the elastography and the length of the cervix.

Material And Methods: Assessment of cervical cohesion parameters with the use of real-time sonoelastography was performed on 59 patients between 28 and 39 weeks of gestation.

Results: The analysis showed that there exists a statistically significant (p=0.033) correlation between the cervical length and the elasticity of the front cervical labium (strain ratio A). Correlation coefficient (r) stood at (-) 0.28.

Conclusions: 1. There exists a negative correlation between the condition on the front cervical labium in elastographic imaging and the length of the cervical canal in USG imaging. 2. Elastography of the uterine cervix may be helpful in assessing the risk of premature labour or cervical insufficiency. 3. There is a need to perform a study on a larger group of patients in order to determine whether elastography may find its place among routine obstetric diagnostic methods.
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http://dx.doi.org/10.17772/gp/1534DOI Listing
January 2013

Comparative analysis of placental vasculature and placental volume in normal and IUGR pregnancies with the use of three-dimensional Power Doppler.

Arch Gynecol Obstet 2012 Feb 9;285(2):331-7. Epub 2011 Jul 9.

Department of Gynecology, Obstetrics and Neonatology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland.

Objectives: To evaluate the differences in placental vascular indices and placental volume between normal and IUGR pregnancies.

Methods: A prospective study was conducted on a group of 100 normal and 20 IUGR pregnancies between 22 and 42 weeks of gestation. For the purpose of evaluation of placental volume and placental vascular indices, we applied 3D Power Doppler and VOCAL technique. Only patients with entirely visualized placenta were included in the study.

Results: A comparative analysis of vascularization index (VI), vascularization flow index (VFI), flow index (FI), and placental volume (PV) revealed statistically significant differences between normal and IUGR pregnancies. In normal pregnancies, the volume of the placenta was on average 92.42 cm(3) larger than in pregnancies complicated by IUGR. Receiver operating characteristic (ROC) curves were used to evaluate the clinical usefulness of placental vascular indices and placental volume for discriminating IUGR and normal pregnancies. It was concluded that the VI, VFI, PV, FI parameters are the best discriminants, with the cut-off values of 5.30, 2.30, 199, and 36.0, respectively.

Conclusions: The quantitative assessment of placental vasculature and placental volume by means of 3D Power Doppler and VOCAL technique is an adjunctive modality for differentiation between normal and IUGR pregnancies. Our findings further suggest that the vascularization index (VI) and vascularization flow index (VFI) are the best parameters with the most favorable discriminating potential for proper identification of IUGR pregnancies.
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http://dx.doi.org/10.1007/s00404-011-1968-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257431PMC
February 2012