Publications by authors named "Wojciech Cnota"

28 Publications

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Author Correction: Factors associated with fear of childbirth among Polish pregnant women.

Sci Rep 2021 Mar 4;11(1):5605. Epub 2021 Mar 4.

Clinical Ward of Obstetrics and Gynecology, Department of Women's Health in Ruda Śląska, Medical University of Silesia, W. Lipa Street 2, Ruda Śląska, Poland.

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http://dx.doi.org/10.1038/s41598-021-85445-6DOI Listing
March 2021

Factors associated with fear of childbirth among Polish pregnant women.

Sci Rep 2021 Feb 23;11(1):4397. Epub 2021 Feb 23.

Clinical Ward of Obstetrics and Gynecology, Department of Women's Health in Ruda Śląska, Medical University of Silesia, W. Lipa Street 2, Ruda Śląska, Poland.

The purpose of our study was to elucidate the association between obstetric and psychological factors and fear of childbirth (FOC) during the third trimester of pregnancy and to identify women at risk of severe FOC in Poland. An additional goal of the study was to verify the Polish version of the Wijma Delivery Expectancy Questionnaire (W-DEQ) and to establish its psychometric characteristics. Cross-sectional study with a total of 359 women recruited during routine visits to an antenatal clinic in Poland during the third trimester (≥ 27 weeks gestation). The survey included obstetric details (parity, obstetric history and preferred mode of delivery), and standardized psychological measures: the W-DEQ (fear of childbirth) and the EPDS (depressive symptoms). We demonstrated the satisfactory psychometric properties of the Polish version of the W-DEQ. Our findings confirm the one-factor structure found by the authors of the original version of the scale. A greater FOC was reported by women with unplanned pregnancies, women whose preferred mode of delivery was a cesarean section, and women who had previously undergone psychiatric treatment. The risk factors for severe FOC were depression, unplanned pregnancy or parity, and disagreement with the birth plan proposed by the obstetrician. The W-DEQ is a widely used, valid instrument for the assessment of FOC in pregnant women and can be used in Poland. Findings support the key role of obstetric and psychological variables in predicting fear of childbirth.
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http://dx.doi.org/10.1038/s41598-021-83915-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902668PMC
February 2021

Nasal bone in screening for Trisomy 18 and 13 at 11-13 + 6 weeks of gestation - own experiences.

Ginekol Pol 2020 ;91(5):256-261

Faculty of Health Sciences, Department of Obstetrics, Nicolaus Copernicus University in Torun, Collegium Medicum, Bydgoszcz, Poland.

Objectives: The objective of the paper is the suitability assessment of screening for Trisomy 18 and 13 on the basis of NT measurement, FHR, double test and assessment of Nasal Bone.

Material And Methods: The study was performed in 6,661 singleton pregnancies. In each fetus NT, FHR, DV-PIV were examined. Double test from maternal blood was examined. These ultrasound and biochemical factors were in combined screening investigated. Additional ultrasound marker - Nasal Bone was and its impact on Trisomies 18 and 13 screening was examined.

Results: Two groups of patients were compared - with chromosomal normal and chromosomal abnormalities - Trisomy 18 and 13. Detection Rate of Trisomies 18 and 13 at the risk cutoff 1/300 using combined screening was 84.1% and FPR was 7.1%. Detection Rates of examined chromosomal abnormalities using screening with additional marker - NB was 93.2% and False Positive Rate - 5.6%.

Conclusions: It should be noted that the qualitative analysis of the assessment of NB in the first trimester significantly influences the improvement of screening values focusing on Trisomy 18 and 13 detection. In summary, our research indicates a more effective type of Trisomy 13 and 18 screening using NT, double test, maternal age, CRL and FHR as well as nasal bone presence and absence.
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http://dx.doi.org/10.5603/GP.2020.0047DOI Listing
January 2020

Vaginal delivery or caesarean section - Severity of early symptoms of postpartum depression and assessment of pain in Polish women in the early puerperium.

Midwifery 2020 Aug 7;87:102731. Epub 2020 May 7.

Clinical Ward of Obstetrics and Gynecology, Department of Women's Health in Ruda Śląska, Medical University of Silesia, W. Lipa Street 2, Ruda Śląska, Poland. Electronic address:

Objectives: The primary objective of this study is to examine the differences between women following vaginal delivery and caesarean section (elective or emergency) in terms of early symptoms of postpartum depression, and to evaluate pain during labour and in the early puerperium. An additional goal was to determine if pain evaluation is associated with depressive symptoms.

Materials And Methods: A cross-sectional study was conducted among 224 women in the early puerperium recruited from a public hospital in Poland, who were divided into three groups by method of delivery: caesarean section - elective and emergency, and a vaginal delivery. The measurement tools used in the research were the Edinburgh Postnatal Depression Scale (EPDS) and a Numerical Rating Scale (NRS). A Pearson correlation analysis, a Student's t-test, a Mann-Whitney U test for independent groups and nonparametric multivariate analyses of variance (Kruskal-Wallis test) were carried out.

Results: The number of early symptoms of postpartum depression and the level of pain experienced vary depending on type of delivery. Following a caesarean section, women have more early symptoms of depression (M = 7.40; SD= 5.18 vs M 5.98; SD = 4.19; p = 0.03) (especially an emergency CS: Mean rank=141.41 vs Mean rank = 100.94 vs Mean rank = 100.93; p < 0.01) and more pain on discharge (Mean rank=126.51 vs Mean rank = 84.11; p < 0.01) (especially after Em-CS: Mean rank =130.38 vs Mean rank=123.62 vs Mean rank = 84.11; p < 0.01), compared to women following a vaginal delivery. Pain in a time of discharge from hospital was found to be associated with increased frequency of EPSD but only in El-CS group (r = 0.24; p = 0.02).

Conclusions: Caesarean section (especially emergency CS) is a risk factor for postpartum depression, and the level of pain experienced is a marker of its potential severity. Evaluation of factors associated with postpartum pain and depressive symptoms can help midwives to counsel women better about their delivery alternatives and can promote improved management of women undergoing both types of delivery experiences.
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http://dx.doi.org/10.1016/j.midw.2020.102731DOI Listing
August 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

Quantitative and qualitative Ductus Venosus blood flow evaluation in the screening for Trisomy 18 and 13 - suitability study.

Ginekol Pol 2020 ;91(3):144-148

Department of Obstetrics and Perinatology, Faculty of Health Sciences, Medical University of Warsaw, Poland.

Objectives: The objective of the paper is the suitability assessment of screening for Trisomy 18 and 13 on the basis of nuchal translucency (NT) measurement, Fetal Heart Rate (FHR), double test, quantitative [Ductus Venosus (DV) Pulsatility Index for Veins (PIV)] and qualitative (the A-wave assessment) blood flow evaluation in the DV.

Material And Methods: The study was performed in 7296 singleton pregnancies. In each fetus NT, FHR, DV-PIV were examined. Double test from maternal blood was examined. These ultrasound and biochemical factors were in combined screening investigated. Additional doppler ultrasound markers such as abnormal a-wave in Ductus Venosus and Pusatility Index for Veins of Ductus Venosus were and their impact on Trisomies 18 and 13 screening were examined.

Results: Two groups of patients were compared - with chromosomal normal and chromosomal abnormalities - Trisomy 18 and 13. Detection Rate of Trisomies 18 and 13 at the risk cutoff 1/300 using combined screening was 90.2% and FPR was 6%. Detection Rates of examined chromosomal abnormalities using contingent screening were: 92.1% using DV abnormal a-wave and 94.84% using DV-PIV. FPR's for booths parameters 5.8% and 5.4% respectively.

Conclusions: Quantitative analysis of the flow - assessment of DV-PIV in the first trimester significantly influences the improvement of screening values focusing on Trisomy 18 and 13 detection.
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http://dx.doi.org/10.5603/GP.2020.0031DOI Listing
January 2020

A Retrospective Study on the Risk of Respiratory Distress Syndrome in Singleton Pregnancies with Preterm Premature Rupture of Membranes between 24+0 and 36+6 Weeks, Using Regression Analysis for Various Factors.

Biomed Res Int 2018 4;2018:7162478. Epub 2018 Oct 4.

Department of Obstetrics and Perinatology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland.

Aim: This study aimed to investigate the cause of respiratory distress syndrome (RDS) in neonates from singleton pregnancies with preterm premature rupture of membranes (pPROM) between 24+0 and 36+6 weeks by using regression analysis for various factors.

Methods: In 175 singleton pregnancies with pPROM, 95 cases of RDS (54,29%) were diagnosed. In all cases the following information was collected: latency period of PROM, gestational age at birth, Umbilical Artery Pulsatility Index (UA PI), Middle Cerebral Artery Pulsatility Index (MCA PI), fetal distress, antenatal steroids use, delivery type, pregnancy hypertension disease, gestational glucose intolerance or diabetes, neonatal laboratory parameters, gender, weight, Apgar score, and other neonatal complications. Logistic regression analysis was used to investigate the effect of variables on RDS.

Results: The results of logistic regression analysis showed that the following variables are closely correlated with RDS: female gender (OR=0.52; 95%CI:0.28-0,97), antenatal steroids use (OR=0,46; 95%CI:0,34-0,64), abnormal UA PI and MCA PI (OR=2.96; 95%CI:1,43-6,12) (OR=2.05; 95%CI:1,07-3,95), fetal distress (OR=2.33; 95%CI:1,16-4,71), maternal HGB (OR=0.69; 95%CI:0,5-0,96), and neonatal RBC, HGB (OR=0.32; 95%CI:0,19-0,55) (OR=0.75; 95%CI:0,65-0,88).

Conclusions: The main RDS risk factors in premature neonates are gender, abnormal fetoplacental circulation, and fetal distress. The laboratory parameters such as lower RBC and HGB count are observed in infants with RDS.
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http://dx.doi.org/10.1155/2018/7162478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6193337PMC
February 2019

The usefulness of determination of the procalcitonin (PCT) concentration in GBS piositive pregnant womens blood serum for anticipations of infections in newborns

Przegl Epidemiol 2018;72(1):25-32

Department of Gynaecology and Obstetrics of the Municipal Hospital in Ruda Śląska

Group-B streptococci (GBS) are commensal bacteria of the human body. They may, however, pose a serious life hazard to pregnant women. During labour, newborns of GBS-positive mothers run the risk of infections that may eventually lead to severe complications, sepsis or even death. For this reason, it is very important to find new diagnostic markers that will enable fast and effective diagnostics and control of the disease process. The level of procalcitonin emerges as a promising diagnostic parameter. AIM. Analysis of the impact of the procalcitonin (PCT) level in GBS-positive pregnant women on the possibility of complications and infections in mothers and newborns MATERIAL AND METHODS. The study group consisted of 115 GBS-positive pregnant women. For each mother-to-be, the CRP and the PCT concentration levels were determined. The clinical state of 117 newborns (2 twin pregnancies) was also assessed. After delivery, the CRP concentration level was determined in the newborns. The examinations had a retrospective character. RESULTS. 30 women showed a raised concentration of CRP and 13 – of PCT. No correlation was found between the two diagnostic markers. Similarly, no relation was found between a raised concentration of PCT and the occurrence of a bacterial infection or other complications in the parturient. A raised concentration of procalcitonin in the mother did not translate into the development of an infection in the newborn, either. CONCLUSIONS. The results of the study indicate that there is no correlation between a raised concentration of PCT in GBS-positive pregnant women and a raised CRP level. Abnormal PCT levels in the women covered by the study did not involve a higher frequency of the occurrence of complications or bacterial infections either in the mothers or in the newborns.
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July 2019

Influence of first trimester biochemistry methodology on detection rate in screening for trisomy 21.

Ginekol Pol 2017 ;88(9):492-496

Department of Obstetrics and Perinatology, Medical University of Warsaw, Zwirki i Wigury Str 63a, 02-091, Warsaw, Poland.

Objectives: The purpose of the study was to compare detection rates (DR) of FMF-certified and non-certified biochemical tests (BC) in trisomy 21 screening at 11-13 + 6 weeks.

Material And Methods: In 2267 singleton pregnancies FMF-certified doctors measured crown to rump length (CRL) and nuchal translucency (NT). Serum samples were tested for free β-hCG and the PAPP-A using 2 analysers (Delfia - Perkin Elmer and Immulite 2000 - DPC), the results were expressed in MoM values and used for computer calculation of the risk for trisomy 21. The cut-off value for the high trisomy 21 risk was 1:300.

Results: Comparison of free β-hCG MoMs by DPC and Delfia demonstrated statistically significant differences in normal, and trisomy 21 fetuses respectively. Similarly, statistically significant differences were noted for PAPP-A MoMs. The above differences in MoMs resulted in altered sensitivity in screening for aneuploidy. The application of the FMF-certified method ensures a markedly higher DR = 74%, compared to non-certified tests (64%), both at 5% FPR. The ROC analysis was performed in order to assess the efficacy of both tests. Results of trisomy 21 BC + NT risk scales using the Delfia and DPC methods are highly significant (p < 0.0001), which means that their discrimination ability is > 90%. The difference between results obtained using the Delfia and DPC methods is AUC = 0.0150 and is statistically significant (Z = 2.4728, p = 0.0134).

Conclusions: The use of FMF-certified first trimester biochemistry analysers improves DR for trisomy 21. The use of non-certified analysers causes reduction of DR and an increase of invasive procedure rate.
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http://dx.doi.org/10.5603/GP.a2017.0090DOI Listing
July 2018

Screening for trisomy 21 based on maternal age, nuchal translucency measurement, first trimester biochemistry and quantitative and qualitative assessment of the flow in the DV - the assessment of efficacy.

Ginekol Pol 2017 ;88(9):481-485

Department of Obstetrics and Perinatology, Medical University of Warsaw, Zwirki i Wigury Str 63a, 02-091, Warsaw, Poland.

Objectives: The aim of the study was to compare effects of addition of two methods of ductus venosus (DV) flow assessment: qualitative - the assessment of shape of the A-wave (positive or negative), and quantitative - based on the pulsatility index for veins (DVPI) to the basic screening for trisomy 21 at 11 to 13 + 6 weeks of pregnancy.

Material And Methods: The ultrasound examination was performed in 8230 fetuses in singleton pregnancies at 11- -13 + 6 wks, as a part of a routine screening for chromosomal defects. In DV A-wave was assessed and DVPI was calculated. After the scan blood sample was taken for first trimester biochemistry (BC). Risk for chromosomal defects was calculated and high-risk patients were offered an invasive test for karyotyping.

Results: Basic screening with following combination of markers: MA, NT and BC provided lowest detection rate (DR) 87.50% for FPR = 6.94%. After adding qualitative DV A-wave assessment DR increased to 88.75% for FPR = 5.65%. The best DR = 93.75% for FPR = 5.55% was achieved when quantitative DVPI was added. The application of the Receiver Operating Curves curve confirmed validity of the addition of DV flow assessment to the screening model. The highest diagnostic power of the test was achieved when DVPI was added, with the ROC AUC of 0.974.

Conclusions: The assessment of DV flow performed at 11-13 + 6 weeks increases DR for trisomy 21 and reduces FPR. The screening model based on the quantitative DV flow analysis (DVPI) gives better results compared to the qualitative flow assessment.
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http://dx.doi.org/10.5603/GP.a2017.0088DOI Listing
July 2018

Nasal bone in screening for T21 at 11-13 + 6 weeks of gestation - a multicenter study.

Ginekol Pol 2016 ;87(11):751-754

Department of Obstetrics and Perinatology, Medical University of Warsaw, Poland.

Objectives: Trisomy 21 is one of the most common chromosomal defects diagnosed prenatally. Screening for Down syndrome is based on maternal age, measurement of crown-rump length, nuchal translucency and fetal heart rate, together with free β-hCG and PAPP-A at 11 to 13 + 6 weeks. Introduction of additional ultrasound marker of trisomy 21 (evaluation of the nasal bone) may result in increased DR and decreased invasive diagnostic testing rates (FPR).

Material And Methods: Ultrasound scan with NB evaluation was performed in 5814 fetuses during routine screening for chromosomal defects at 11 to 13 + 6 weeks of gestation. DR and FPR coefficients were calculated for 4 levels of risk as cut-off points for screening model 1, based on MA, NT, and first trimester biochemistry, as well as for screening model 2, based on MA, NT, first trimester biochemistry and NB.

Results: There were 5708 normal cases, 71 cases of trisomy 21 and 35 cases of other chromosomal defects. NB was absent in 46 (64.8%) cases and present in 25 (35.3%) cases of trisomy 21, comparing to present NB in 5463 (95.7%) and absent in 245 (4.3%) of normal cases.

Conclusions: First-semester screening with additional NB assessment significantly increases the detection rate for trisomy 21 and decreases the rate of false-positive results. Adding NB evaluation at the risk level of 1:50 causes only a small increase in detection rate. Invasive procedures should be performed in that group regardless NB assessment.
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http://dx.doi.org/10.5603/GP.2016.0082DOI Listing
July 2018

Evaluation of selected ultrasonography parameters in the second stage of labor in prediction mode of delivery.

Ginekol Pol 2016 ;87(6):448-53

Clinical Ward of Obstetrics and Gynecology in Ruda Śląska, Silesian Medical University, Poland.

Objectives: The aim of the study is to determine the usefulness of ultrasound parameters in the second stage of labor in prediction of the method of delivery and to evaluate the benefits to be derived from this study.

Material And Methods: Ultrasound scan was performed with Convex transabdominal probe on 68 pregnant women in labor at term with fetuses in cephalic presentation at the beginning of the second stage of labor and parameters such as angle of progression, head progression distance, head-symphysis distance and head-perineum distance were measured. The parameters were observed in two scans: a midline scan visualizing the pubic symphysis with the head of the fetus and a transverse scan approximately 1-2 cm below the pubic symphysis visualizing the head of the fetus.

Results: The ultrasound parameters measured at the beginning of the second stage of labor, differed in the group in which women have delivered vaginally and in the group, in which caesarean section was performed: angle of progression and head progression distance were greater in group of women who delivered naturally and head-perineum distance and head-symphysis distance were smaller in this group. Some relations between each measured parameter and time left to delivery were observed as well as strong relations among parameters were also observed.

Conclusions: Intrapartum sonography is a useful and objective tool to assess the progress of labor. Transperineal ultra-sound scans performed in the second stage of labor may play a role in making the decision about the mode of delivery.
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http://dx.doi.org/10.5603/GP.2016.0024DOI Listing
July 2018

Human embryonic cardiovascular function.

Acta Obstet Gynecol Scand 2016 06 1;95(6):621-8. Epub 2016 Mar 1.

Clinical Department of Obstetrics and Gynecology, Chair of Women's Health, School of Health Sciences, Medical University of Silesia, Katowice, Poland.

Introduction: This review presents an overview of descriptive knowledge on human embryonic cardiovascular physiology mostly based on noninvasive assessment by Doppler ultrasonography. Our objective was to identify and analyze published studies on embryonic cardiovascular function, and summarize available knowledge in this field.

Material And Methods: Citations related to human embryonic cardiovascular function were searched in PubMed, EMBASE, CINAHL and Web of Science using keywords and MeSH terms without any time limitation. The search was restricted to English language articles. Abstracts were screened and full texts of relevant articles were obtained. All articles that reported on physiological aspects of human embryonic cardiovascular function were included. Studies reporting on cardiovascular function after 10 weeks of gestation were excluded. Data were synthesized and presented narratively.

Results: We identified 10 studies that had evaluated cardiovascular function and/or hemodynamics in human embryos at ≤10 weeks of gestation. All of these reported only certain aspects of embryonic cardiovascular function. Embryonic heart rate is associated significantly with gestational age and increases from 6 to 10 weeks of gestation. Cardiac inflow is monophasic during the embryonic period and atria appear to generate higher force during contraction compared with ventricles. Both ventricular inflow and outflow velocities increase with advancing gestation, whereas the Tei index decreases significantly. During the embryonic period, placental blood flow increases with gestation, but absent umbilical artery diastolic flow and umbilical venous pulsations are normal phenomena.

Conclusion: There are important differences in normal cardiovascular function between the embryonic and fetal stages of human in utero development.
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http://dx.doi.org/10.1111/aogs.12860DOI Listing
June 2016

The evolution of fetal presentation during pregnancy: a retrospective, descriptive cross-sectional study.

Acta Obstet Gynecol Scand 2015 Jun 25;94(6):660-3. Epub 2015 Mar 25.

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

We investigated changes in the frequencies of four primary types of singleton fetal lie/presentation for each gestational week from 18 to 39 weeks in a retrospective, cross-sectional study which analyzed ultrasound examination records of fetal positions, in the outpatient prenatal diagnosis clinics in two cities in Poland. We calculated the prevalence and 95% confidence intervals for each type of lie/presentation. We then identified the gestational age after which no statistically significant changes in terms of prevalence were observed, by comparing the results at each week with the prevalence of cephalic presentation at 39(+0) weeks, used as reference. A total of 18 019 ultrasound examinations were used. From 22 to 36 weeks of gestation, the prevalence of cephalic presentation increased from 47% (45-50%) to 94% (91-96%), before and after which times plateaus were noted. Spontaneous change from breech to cephalic is unlikely to occur after 36 weeks of gestation.
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http://dx.doi.org/10.1111/aogs.12626DOI Listing
June 2015

Frontomaxillary facial angle measurement in screening for trisomy 18 at 11 + 0 to 13 + 6 weeks of pregnancy: a double-centre study.

Biomed Res Int 2013 1;2013:168302. Epub 2013 Oct 1.

Teaching Department of Obstetrics and Gynecology in Ruda Slaska, Medical University of Silesia, Ulica Lipa 2, 41-703 Ruda Slaska, Poland.

Objective: The aim of this study was to evaluate the effectiveness of prenatal screening for trisomy 18 with the use of the frontomaxillary facial angle (FMF angle) measurement.

Material And Methods: The study involved 1751 singleton pregnancies at 11-13 + 6 weeks, examined between 2007 and 2011. Serum PAPP-A and free beta-hCG levels were assessed, and crown-rump length, nuchal translucency, and FMF angle were measured in all patients. 1350 fetuses with known follow-up were included in the final analysis.

Results: Highly significant (P < 0.01) negative correlation between the CRL and the FMF angle was found. There were 30 fetuses with trisomy 18. FMF angle was highly significantly larger (P < 0.0001) in fetuses with trisomy 18 as compared to chromosomally normal fetuses. Two models of first trimester screening were compared: Model 1 based on maternal age, NT, and first trimester biochemistry test (DR 80-85% and FPR 0.3-0.6%), and Model 2 = Model 1 + FMF angle measurement (DR 87.3-93.3% and FPR 0.8-1.3%).

Conclusions: The use of FMF angle measurement increases the effectiveness of the screening for trisomy 18. Introduction of the FMF angle as an independent marker for fetal trisomy 18 risk requires further prospective research in large populations.
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http://dx.doi.org/10.1155/2013/168302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806356PMC
June 2014

[Agenesis of the ductus venosus--an irrelevant anomaly or a severe clinical problem?].

Ginekol Pol 2013 Aug;84(8):676-81

Oddział Kliniczny Połoznictwa i Ginekologii w Rudzie Slaskiej, Slaski Uniwersytet Medyczny, Polska.

Background: Ductus venosus is the fetal blood vessel connecting the abdominal portion of the umbilical vein with the inferior vena cava. Numerous studies have confirmed the important role of this vessel in fetal circulation. There are, however cases when finding the ductus venosus during an ultrasound examination is impossible.

Objective: The objective of the study was to assess the fate of fetuses with known ductus venosus agenesis and its severity in fetal life.

Material And Methods: 17 fetuses from singleton pregnancies with agenesis of the ductus venosus were observed and followed up.

Results: A total of 3 intrauterine deaths, preceded by fetal hydrops and signs of heart failure, were observed in the study group. One newborn required cardiac care after birth. In the majority of cases with ductus venosus agenesis, where no accompanying developmental anomalies were found, prognosis for the fetus and the newborn was good.

Conclusions: Cases of ductus venosus agenesis should be directed to and followed up in referral centers, where adequate diagnostic and therapeutic procedures can be undertaken.
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http://dx.doi.org/10.17772/gp/1623DOI Listing
August 2013

[Frontomaxillary facial angle measurement at 11+0 to 13+6 weeks' gestation. Application in every day prenatal diagnosis of trisomy 21].

Ginekol Pol 2013 Jul;84(7):624-9

Oddział Kliniczny Połoznictwa i Ginekologii w Rudzie Slaskiej, Slaski Uniwersytet Medyczny, Polska.

Objective: The aim of the study was to evaluate the effectiveness of prenatal screening for trisomy 21 with the use of the FMF angle measurement, depending on the disease risk group.

Material And Methods: The study included 2,026 single pregnancy fetuses, examined in years 2009-2011. The crown-rump length, nuchal translucency and frontomaxillary facial angle were measured for each of the fetuses according to the Fetal Medicine Foundation guidelines. All ultrasound exams were performed using trans-abdominal probes paired with Voluson 730 Expert and Expert E8 systems. All physicians conducting the exams were FMF-certified professionals. Maternal age at the time of the study was also reported. In 1621 pregnant women serum concentration of PAPP-A was determined using Delfia Express system (Perkin Elmer). Astraia software was used to assess fetal risk of trisomy 21. The final analysis included 791 fetuses which were followed up for the occurrence of trisomy 21. Data were analyzed using PQStat package ver 1.4.2.324. Highly significant likelihood was set at p < 0.01 and significant likelihood at p < 0.05.

Results: Average maternal age was 31.42 years (median: 32 in a range from 27 to 45). Average FMF angle was 76.24 degrees (median: 75 degrees in a range from 69 to 04). Average CRL measurements was 63.70 mm (median: 64.10 mm in a range from 45 to 84). Average NT measurement was 1.91 mm (median: 1.6 mm in a range from 0.50 to 9.3). There was no significant (p > 0.05) correlation between maternal age and FMF. Highly significant (p < 0.01) negative correlation between the CRL and the FMF angle was found. There were 41 fetuses with trisomy 21 (Down syndrome) in the study group. In the normal karyotype group, the FMF angle was highly significantly lower (p < 0.0001) than in the trisomy 21 group. 95th percentile of the each of four separated CRL ranges was calculated. Detection rate and false positive rate for each of four different risk levels were estimated. They were used as cutoff points for two models of first trimester screening compared: Model 1, including maternal age, NT measurement and PAPP-A test, and Model 2, including maternal age, NT measurement, PAPP-A test and Frontomaxillary facial angle measurement.

Conclusions: 1. Detection rate (DR) of the Down syndrome increases after the introduction of FMF angle measurement as an additional component of screening including maternal age, NT measurement and PAPP-A test. 2. Introduction of the FMF angle as an independent marker for fetal trisomy 21 risk requires further research on large populations.
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http://dx.doi.org/10.17772/gp/1615DOI Listing
July 2013

[Transabdominal chorionic villus sampling (CVS) for prenatal diagnosis of chromosomal disorders--own experiences].

Ginekol Pol 2013 Jun;84(6):412-7

Niepubliczny Zakład Opieki Zdrowotnej Genom, Ruda Slaska, Polska.

Objective: To present the authors' own experiences on transabdominal Chorionic Villus Sampling (CVS) for prenatal diagnosis of genetic disorders.

Design: Descriptive study PATIENS AND METHODS: A total of 290 couples with request for prenatal diagnosis of various genetic disorders were studied. The most common indications were: fetal abnormalities suspected in an ultrasound scan and biochemistry positive family history on genetic disorders, maternal age. Transabdominal CVS was done under local anesthesia and ultrasound guidance. The genetic analysis was possible in 264 cases (241 with abnormal ultrasound scan and/or biochemistry 11 with positive family history 12 with maternal age). Results were recorded and analyzed for descriptive statistics.

Result: A total of 290 CVSs were done in the outdoor Most procedures (76%) were done between 12 and 14 weeks (range 11-16 weeks). All placental positions including both anterior and posterior were approachable through the trans-abdominal route. The overall success rate was 100%. Abnormal fetal karyotype was diagnosed in 39% of cases. In 12.9% of cases inconclusive results were observed (due to placental mosaicism or maternal cells contamination). More aneuploidies were observed in group with abnormal first trimester screening (us scan and/or biochemistry) compared to any other indications.

Conclusion: Transabdominal CVS is a useful outdoor procedure for prenatal diagnosis. However indications for the procedure should be carefully considered since some risk of inconclusive results occurred.
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http://dx.doi.org/10.17772/gp/1597DOI Listing
June 2013

[Evaluation of selected serum protein markers as early detectors of ovarian cancer].

Ginekol Pol 2008 Apr;79(4):271-5

Zakład Analityki i Biochemii Klinicznej, Centrum Onkologii Instytut im. Marii Skłodowskiej-Curie, Oddział w Gliwicach, Gliwice.

Objective: an attempt to determine the value of the simultaneous quantization of osteopontin (OPN), insulin-growth factor II (IGF II), leptin, prolactin and CA 125 for early detection of ovarian cancer.

Materials And Methods: Prospective study of 69 women including: 15 females with ovarian cancer; 33 females with benign ovarian neoplasm; 21 disease-free females; The levels of IGF II, prolactin, leptin and CA 125 were determined in serum, while the level of OPN was checked in plasma.

Results: The concentrations of IGF II, leptin and prolactin do not let us distinguish among disease-free females, females with ovarian cancer and those with benign ovarian neoplasms on the basis of biochemical markers. The comparison of OPN and CA 125 levels showed significant differences in the concentrations of the biomarkers between disease-free females and females with ovarian cancer, as well as between females with benign ovarian neoplasms and females with ovarian cancer. The ROC curves for two groups: disease-free females and females with ovarian cancer, proved the diagnostic value of OPN and CA 125.

Conclusions: The simultaneous quantization of OPN, IGF II leptin and prolactin has not been proved useful for the early detection of ovarian cancer. Statistically significant increase of OPN & CA 125 levels was noted in case of women with ovarian cancer diagnosed through microscopic examination. The analysis of ROC curves showed comparable diagnostic usefulness of both markers. Quantization of OPN may have an additional value for treatment monitoring of women diagnosed with ovarian cancer but with concentration of CA 125 within the reference value.
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April 2008

[Single umbilical artery: what does it mean for the fetus?].

Ginekol Pol 2007 Nov;78(11):869-72

Oddział Kliniczny Ginekologii i Połoznictwa w Rudzie Slaskiej Katedry Zdrowia Kobiety Wydziału Opieki Zdrowotnej, Slaskiej Akademii Medycznej w Katowicach.

Unlabelled: Single umbilical artery (SUA) is the most common anomaly of the umbilical cord which affects between 0.5 and 2.5% of all pregnancies.

Aim: Our purpose was to determine whether there was a significant relationship between SUA and other anatomical anomalies.

Material And Methods: All cases of fetal single umbilical artery identified in our hospital between 2002-2005 were reviewed for other ultrasound detected abnormalities.

Results: 18 cases of single umbilical artery were diagnosed on the basis of initial sonograms. 17 cases formed the study population (in 10 cases the left artery and in 7 the right artery was absent). In one case we diagnosed an umbilical cord tumor. 33.3% had other anatomical anomalies. The mean of women in the study was 30.5 years, the mean gestational age at examination was 28 weeks.

Conclusions: In most cases the SUA occurs to be an isolated anomaly. In cases of SUA, the detailed ultrasound examination should be performed. Left artery absence is more common and also in these cases other anatomical anomalies are more likely to be observed as well. In our study we did not find a correlation between SUA and IUGR.
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November 2007

[Heart defects and other anomalies in fetuses conceived by assisted reproduction techniques].

Ginekol Pol 2007 Nov;78(11):865-8

Oddział Kliniczny Ginekologii i Połoinictwa w Rudzie Slaskiej, Katedry Zdrowia Kobiety Wydziału Opieki Zdrowotnej Slaskiej Akademii Medycznej w Katowicach.

Aim: The aim of the work was to evaluate the frequency of occurrence of structural, chromosome defects and developmental disorders in fetuses conceived with the help of different assisted reproduction techniques.

Material And Methods: The research group consisted of 30 patients, aged from 25 to 37, subjected to various techniques of assisted reproduction from 2003 to 2006, who reported for consultation in the referral centre. 13 (43%) of the patients underwent the IVF procedure, 12 (40%) the ICSI procedure, 5 patients underwent interuterine insemination. Ultrasonographic examination with the evaluation of the fetal heart was conducted on average in the 22nd week of gestation.

Results: Multiple pregnancies constituted 14 (47%) of the examined pregnancies. In total, fetal anomalies were diagnosed in 3 fetuses (6%). Cardiovascular anomalies occurred in 2 fetuses (atrioventricular septal defect--AVSD and ventricular septal defect--VSD), each with diagnosed trisomy of chromosome pairs 21 and 18 respectively. In one case an anomaly within the urinary system was diagnosed.

Conclusions: Multiple pregnancies constituted nearly half of the researched group. Structural defects were diagnosed in 3 (6%) fetuses, which slightly exceeds population risk. A higher anomaly percentage occurred in fetuses from twin pregnancies and in the group after ICSI. In the study the risk is related to the selected group of patient undergoing fetal echocardiography exam. To estimate the risk in the ART group precisely, all pregnancies conceived with implementation of ART should be examined. Multi-centre studies are our future goal.
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November 2007

Blood flow in ductus venosus in early uncomplicated pregnancy.

Neuro Endocrinol Lett 2007 Oct;28(5):713-6

Obstetrics and Gynecology Clinic Ruda Slaaka, Silesian Medical Academy Katowice, Poland.

Unlabelled: The ductus venosus is the very important part of fetal venous circulation. It plays a central role in return of venous blood from the placenta. This unique shunt carries well-oxygenated blood from the umbilical vein through the inferior atrial inlet on its way across the foramen ovale. Using Doppler ultrasound, it is possible to assess the blood flow in fetal vessels including ductus venosus. It is observed, in animal and human studies, that the typical waveform for blood flow in ductus venosus in early pregnancy can be different depending on numerous conditions e.g. fetal karyotype. This study is performed to assess the physiologic parameters of blood flow in ductus venosus in uncomplicated early pregnancy.

Material And Methods: 404 women were examined between 11+0 and 13+6 weeks (+ days) of gestation by ultrasound. Fetal crown-rump length (CRL) was measured to assess the gestational age. The assessment of risk of fetal abnormalities was based on nuchal translucency (NT) measurement. The ductus venosus blood flow with color and spectral Doppler was obtained in all patients. The following features were assessed: pulsatility index (PI), and direction of flow (positive/negative) during atrial contraction (wave A). All cases were followed up to 22 weeks of gestation when the control scan was performed.

Results And Conclusions: 30 cases were excluded from the uncomplicated group due to: high risk of fetal abnormalities, fetal loss, confirmed fetal abnormalities and utero-placental pathology. 374 women were considered as uncomplicated pregnancy. In both uncomplicated and complicated groups the mean values for pulsatility index (PI) were established. The mean PI value in uncomplicated pregnancies was: 0.91 (SD +/- 0.32). No significant differences between groups were noticed. In 370 cases of uncomplicated pregnancy the A wave direction was positive but in 1.1% of cases the reverse flow in atrial contraction was observed.
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October 2007

[Evaluation of pregnancy-associated plasma protein A (PAPP-A) and free beta subunit of human chorionic gonadotropin (beta hCG) levels and sonographic assesement of fetal nuchal translucency (NT) in singleton pregnancies between 11 and 14 weeks of gestation--Polish multi-centre research].

Ginekol Pol 2007 May;78(5):384-7

Klinika Terapii Płodu ICZMP w łodzi.

Unlabelled: Evaluation of pregnancy-associated plasma protein A (PAPP-A) and free beta subunit of human chorionic gonadotropin (beta hCG) levels and sonographic assessment of fetal nuchal translucency (NT) in singleton pregnancies between 11 and 14 weeks of gestation--Poland's multi-centers research.

Objectives: Pregnancy-associated plasma protein A has been reported to be low in Down syndrome affected pregnancies during the first trimester of pregnancy. Enlarged nuchal translucency (NT) is observed in about 80% of fetuses affected with chromosomal abnormalities and congenital heart defects (CHD).

Material And Methods: The aim of this study were to determine value and the medians of free beta-human chorionic gonadotropin (beta-hCG) and pregnancy associated plasma protein-A (PAPP-A) and nuchal translucency thickness in the first trimester in a prospective study of a non-selected Polish population.

Results: All examinations have been performed according to the Fetal Medicine Foundation (FMF) rules. We have included 800 women between 11 weeks 0 days and 13 weeks 6 days gestation into a biochemical examination. Women booked into the clinic were offered screening, using a combination of maternal serum free beta-hCG and pregnancy-associated plasma protein-A (PAPP-A) and fetal nuchal translucency thickness. The maternal serum were measured using the Kryptor analyzer (Brahms Diagnostica). All pregnant women have been divided into 2 groups younger than (first group) and older than (second group) 35 years of age.

Conclusions: Nomogrames for free beta-hCG and PAPP-A levels in physiological pregnancy between 11(+0) and 13(6) weeks were determined in the examined population. A positive correlation between PAPP-A and CRL levels, as well as a weak negative correlation between free beta-hCG and CRL, were demonstrated.
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May 2007

Ultrasonographic assessment of fetal nuchal translucency (NT) at 11th and 14th week of gestation--Polish multicentre study.

Neuro Endocrinol Lett 2007 Apr;28(2):175-81

Obstetrics and Gynecology Clinic Ruda Slaaka, Silesian Medical Academy Katowice, Poland.

Unlabelled: THE AIMS OF THE STUDY WERE: To evaluate range and median values of NT in a large, unselected Polish population; to determine the value of the 95th percentile and the median values for NT for given weeks of late 1st trimester pregnancy and to determine the level of chromosomal aberration risk corresponding to the values of the 95th percentile in the examined groups; to examine the possible correlation between CRL, NT width as well as the mother's age with the risk of the most frequent chromosomal aberrations.

Material & Methods: We have retrospective analyzed 7,866 pregnant women. All fetuses of this women had NT measurement performed, as well as CRL and assessed of the most frequent chromosomal abnormalities. The group of pregnant women was divided into 2 subgroups: until and above 35 years old. All population group was divided into 3 subgroups depending on gestational age (11, 12 and above 13th weeks of gestation).

Results: The median of NT in all population group was 1.5 mm and 95th percentile was 2.4 mm, whilst in group with low risk median of NT and 95th percentile were the same and in group with high risk of chromosomal abnormalities respectively 1.5 mm and 2.5 mm. There were strong correlations between maternal age and the risk of most frequent chromosomal abnormalities from NT.

Conclusions: The obtained results of median values and the 95th percentiles of NT in the examined group and the age groups under 35 and 35 plus are similar to these quoted by FMF. The risk levels of trisomy of 21st chromosome were similar to the reference values used by FMF. With gestational age, NT value increases in a non-linear way, therefore it is incorrect to use the term "a normal value" for NT, therefore, only the risk level calculated with the dedicated software using NT and CRL measurements with maternal age should be stated.
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April 2007

[Prevention of viral hepatitis B and C infections--jurisdiction and certification difficulties].

Wiad Lek 2004 ;57 Suppl 1:238-42

Z Oddziału Klinicznego Połoznictwa i Ginekologii w Rudzie Slaskiej.

The number of the cases for payment because of viral hepatitis B and C inflammation is significant. Because of the greater patients' notice of the disease and portal of infection, lawyer's opinion accessibility and poor economical situation of society the claims for damages seems to be more popular. The lawyers specialize in medical law. This is the reason to pay more attention to prevention of infections. Besides the hospital infections there is problem of viral hepatitis B and C infection as the occupational disease with all health and juridical consequences. These problems concern specially operative specialties therefore gynecology and obstetrics among the others. The aim of our study was to analyze jurisdiction and certification difficulties in context of occupational disease and cases for payment because of viral hepatitis B and C infections. We also try to answer the question what are possibilities to prevent infections and to defence in law suits.
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July 2005

[Program for early detection of ovarian cancer for women as prophylaxis provided at a municipal hospital].

Wiad Lek 2004 ;57 Suppl 1:43-7

Z Oddziału Klinicznego Połoznictwa i Ginekologii w Rudzie Slaskiej.

Neoplasms are still severe social problem; they are one of the most common causes of death (30-40%), they last for a very long time and the symptoms are characterized by significant intensity. There have been many attempts of introducing an effective screening program for early detection of ovarian cancer. This paper describes one of them, taking place in municipal hospital. To create and introduce a complex prophylactic program considering early diagnosis of ovarian cancer (with use of Doppler transvaginal sonography and serologic markers--CA125); to assess the value of various features (TVS, CA125 levels, family history) for sensitivity and specificity of screening method; to assess the effectiveness of Doppler TVS as a screening method; and to describe the group of participants that is of the best benefit in screening program. From October 1997 to December 2000 the Program for Early Detection of Ovarian Cancer, introduced by Foundation "Godula HOPE", gathered 3775 women aged 46 +/- 9.5. Most of the participants were self-referred, but there was the group of doctor-referred patients. Bimanual pelvic examination and Doppler TVS were performed in all participants; in case of doubtful results of TVS--serum CA 125 was obtained. The form created by author was used to gather the most important information of medical and family history. The most of participating women were: above 45 yr. old, married, on middle education level, non-working or mental worker, living in town. 365 adnexal tumors were detected among examined women. Using our own criteria 228 patients were chosen to laparotomy--16 of operated tumors were histologically confirmed to be malignant. Our sensitivity of PI was 93.75%, specificity--89.62%. The values for RI were respectively: 89.61% and 73.72%. Program of early detection of ovarian cancer using transvaginal sonography can be organized in municipal hospital; the most important feature of the examination (for screening program) is the grayscale sonographic morphology and the Doppler parameters are of additional value. The best cut-off values of PI and RI were 0.8 and 0.5 respectively. The great meaning of family history of ovarian cancer was confirmed. Demographic results suggest that program should be modified to be available for older patients on low level of education with family history of ovarian or breast cancer.
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July 2005