Ewa Romejko-Wolniewicz

Antenatal steroids: can we optimize the dose?

Purpose of review The beneficial effects of antenatal steroids in women at risk of preterm birth are evident. A dose of 24 mg appears sufficient, but there are insufficient data to recommend betamethasone or dexamethasone, a single steroid dose, the optimal interval between doses and repeated courses, the gestational age at which treatment is beneficial and the long-term effects of steroid treatment. This review addresses these aspects of antenatal steroid treatment. Recent findings Although the 12-h and 24-h dosing intervals are equivalent with respect to prevention of respiratory distress syndrome, the former enables the completion of treatment in 50% more neonates delivered prematurely. Reducing the single steroid dose in patients at risk for premature birth reduces the associated maternal side effects. An inverse relationship has been demonstrated between the number of corticosteroid courses and foetal growth. The reduced size of exposed foetuses has been attributed to birth at earlier gestational ages and decreased foetal growth. Evidence suggests that antenatal exposure to synthetic glucocorticoids in term-born children has long-lasting effects, which may have important implications in the recommendation of steroids before elective caesarean at term. Summary The short-term and long-term effects of the dosage regimen on the pregnant mother and foetus remain unclear.

BMI of the firstborn offspring at age 12 reflects maternal LDL and HDL cholesterol levels at term pregnancy and postpartum

Abstract Objective: The aim of this study was to assess the relationship between the body mass index (BMI) of the firstborn offspring at age 12 and maternal lipid levels at term and at 6 months postpartum. Design and Methods: The study included children born in the 2nd Department of Obstetrics and Gynecology of the Medical University of Warsaw between 1 November 1991 and 31 May 1993. The end point was BMI in the upper quartile – considered high BMI of the firstborn offspring at age 12. Results: The risk of high BMI in the offspring at age 12 significantly increased with an increase in the LDL-C level at term (OR = 2.41 per SD increase, 95% CI: 1.01–5.80; p < 0.049), a decrease in the HDL-C% at term (OR = 0.35 per SD increase, 95% CI: 0.14–0.84; p < 0.019) and a decrease in the HDL-C level at 6 months postpartum (OR = 0.25 per SD increase, 95% CI: 0.08–0.82; p < 0.022), regardless of maternal weight status before pregnancy and at 6 months postpartum, gestational weight gain, the offspring’s gender and birth weight. Conclusion: LDL and HDL cholesterol levels at term are markers of maternal adaptation to a first pregnancy and predict the future growth of firstborn offspring.

Women’s knowledge on activities associated with maternal hyperthermia during pregnancy. A cross-sectional study of the sample of Polish women

Abstract Introduction. Hyperthermia during the first trimester increases the risk of miscarriage and birth defects. A variety of activities predisposing to hyperthermia during pregnancy such as attending sauna, hot tubs or solarium may lead to irreversible abnormalities of the developing fetus. Aim. The aim of the study was to assess women‘s knowledge on the risks of maternal hyperthermia during each trimester of pregnancy. Material and methods. It was a cross-sectional study conducted by means of an anonymous questionnaire. The study group included 302 women aged 17-65 who were admitted to a tertiary referral hospital. The questionnaire was designed on the basis of the Committee Opinion formulated by the American College of Obstetricians and Gynecologists and was consisted of two sections: demographic data and respondents‘ opinions on activities associated with hyperthermia in pregnancy. Statistical analysis was conducted to estimate the association of age, level of education and obstetrical status. Results. The lowest percentage of given proper answers was observed in case of questions about early pregnancy. There was no association between respondents‘ level of education and choice of correct answers. Current pregnancy was associated with higher awareness of contraindicated using of hot tubs and steam rooms. Conclusions. Patients‘ education concerning hyperthermia in pregnancy should focus on information about high risk of birth defects caused by overheating in the early pregnancy and a variety of activities linked with temperature elevation.

The use of sensory perception of blind and visually impaired masseurs for the purpose of early-stage breast cancer screening by palpation (the “Breast-POL” project)

Introduction. Methodological assumptions as well as the initial stage of the execution of the project entitled “Breast-POL” — the use of sensory perception of blind and visually impaired masseurs for the purpose of breast cancer screening by palpation were presented. Materials and methods. A list of incentives to conduct this methodologically adequate study includes: 1. Encouraging and widely disseminated German reports (these reports, however, were of high generality and they did not provide the adequate methodology); 2. Theoretical data on the hypercompensation of other senses than vision in the blind; 3. Preliminary information on the involvement of the blind in breast cancer screening by palpation in developing countries. Results. Compared to people with normal vision, a statistically significant higher sensitivity (63.0 vs 47.5%) and lower specificity (89.6 vs 93.7%) in the detection of pathological lesions, using a phantom, was reported in the blind. Conclusion. Our study confirms that the detection of pathological breast lesions by the blind is highly effective, however, the ability to exclude such lesions was not of clinical significance.

Concentration of amoxicillin in maternal serum, cord blood, amniotic fluid and the placenta after vaginal administration

Abstract Objective: The aim of this study was to assess the amoxicillin concentration in maternal serum, cord blood, amniotic fluid and the placenta, 2 h following vaginal administration and the factors influencing the drug level. Methods: Twenty-eight full-term pregnant women who qualified for elective cesarean delivery were included in the study. Vaginal suppositories containing 250 mg of amoxicillin were administered 2 h prior to the operation. Amoxicillin levels were determined using the diffusion microbial assay. Results: The amoxicillin level in amniotic fluid was significantly higher in comparison to that of maternal serum, cord blood or the placenta. Maternal age positively and gestational weight gain negatively correlated with the amoxicillin concentration in maternal serum. The maternal serum hemoglobin level and red blood cell count were positively correlated with amoxicillin concentration in the amniotic fluid. Neonatal birth weight was positively correlated with maternal serum and cord blood amoxicillin levels. Hypertensive women had significantly higher amoxicillin concentrations in amniotic fluid, and women with thrombocytopenia presented significantly higher cord blood amoxicillin concentrations. Conclusions: Amoxicillin presented poor concentration in maternal–fetal compartments after vaginal administration, but the factors influencing the drug level in different compartments require further investigation.