Karolina Gruca-Stryjak

Conservative management of placenta previa complicated by abnormal placentation.

Abstract Objective: Abnormal implantation of placenta previa is life-threatening condition. The purpose of this study was to evaluate the impact of the conservative management of pregnancies with such complication on maternal morbidity rate and the chance for uterine preservation (fertility). Methods: Eleven patients with abnormal implantation of placenta previa were analyzed prospectively. This complication was diagnosed antenatally by two-dimensional ultrasound and color flow Doppler. The following outcomes were analyzed: need for blood transfusion, admission and duration of stay in intensive care unit, infections, coagulopathies, time between cesarean section and delivery of placenta, hysterectomy and preservation of uterus. Results: Among the 20 085 women who had a singleton gestation, 11 (0.054%) were identified with placenta previa with abnormal placentation. In five patients (group A), hysterectomy was performed because of hemorrhage or placenta ablation. In six patients (group B), conservative management succeeded and placenta were preserved. In group A, placenta were delivered earlier (2 d–8 weeks) in comparison with group B (6–15 weeks). Estimated blood loss during the delayed delivery of placenta was higher in the group with hysterectomy (respectively, 450–1600 and 300–500 ml). Conclusions: Conservative management of placenta previa with abnormal implantation decreases the risk of severe hemorrhage at the time of delivery and can preserve fertility.

Acquired uterine arteriovenous malformation — a diagnostic dilemma

Uterine arteriovenous malformations are uncommon but potentially life-threatening condition. They can be congenital or acquired and should be suspected in cases of severe or persistent uterine bleeding. In recent years, there has been an increasing number of reports of acquired vascular lesions of the uterus following pregnancy, abortion, caesarean delivery and curettage. This paper presents the case of unexplained vaginal bleeding with subsequent suspicion and diagnosis of uterine arteriovenous malformation. Unexplained uterine bleeding should be always an indication for colour Doppler ultrasonography and the presence of AVM should be always excluded.

Is there a relationship between pregnancy induced hypertension and obstructive sleep apnea? Case report

The paper examines the case of a pregnant woman in a twin pregnancy complicated by pre-eclampsia and sleep disordered breathing. The patient was admitted to hospital with high blood pressure, proteinuria and increasing oedema. Laboratory tests revealed proteinuria and reduced total protein concentration in serum. The patient was diagnosed with mild pre-eclampsia. Due to the observed severe daytime sleepiness of the patient, loud snoring and pauses in breathing during sleep, polysomnography was performed. The test revealed a number of episodes of obstructive apnea and hypopnea. The AHI (apnea-hypopnea index) value was 82.1. A number of episodes of desaturation were observed. The lowest saturation had a value of 82%. When the patient was diagnosed with severe obstructive sleep apnea, treatment with CPAP (continuous positive airway pressure) was introduced. The use of CPAP allowed a reduction of the AHI to 1.2, and the blood pressure value normalised. The patient used CPAP between the 33rd and 35th weeks of gestation. At the 35th week of gestation, caesarean section was performed due to life-threatening symptoms of the first foetus in the CTG-recording. Two male infants were delivered in good condition. During the postpartum period, the patient discontinued the use of CPAP. Following this, an increase in AHI to 45.3 and an increase in blood pressure to a maximum of 180/100mmHg were observed. The patient was discharged from hospital in good general condition on the 7th day postpartum with recommendation for further diagnostic and therapy. The conclusion that may be drawn from the case is that sleep disorders adversely affect the health of the mother and the foetus. Also, the mood and quality of life of the pregnant woman deteriorate. It has been proven that there are many relationships between sleep and health. Sleep disorders and disorders of breathing during sleep contribute to the development of various diseases or they degrade the overall phenomena. A disease, on the other hand, additionally negatively affects the quality of sleep. Therefore, it is essential to treat not only the primary disease, but also the accompanying sleep disorders.

Symptomatology of carpal tunnel syndrome during pregnancy and puerperium

OBJECTIVES Epidemiology of the carpal tunnel syndrome (CTS) during pregnancy remains to be fully elucidated. The purpose of the following study is to determine occurrence of that complication in a population of pregnant women. So far the literature in Polish lacks information that might enable adequate diagnosis and proper therapy. MATERIAL AND METHODS The study included 301 women who delivered at term (between 37 and 41 weeks of pregnancy) at the Gynecological and Obstetrical University Hospital in Poznań. An original questionnaire about CTS symptoms was prepared for the purpose of the study The tool included questions about general health, current and previous pregnancies, CTS symptoms, as well as the Boston Carpal Tunnel Questionnaire (BCTQ), modified for the purpose of the study. The original BCTQ includes questions about symptoms frequency during the last 2 weeks, while in our modified BCTQ we asked about symptoms during the whole pregnancy The respondents filled in the questionnaire with the help of a physician. A part of the research group underwent Phalen sign evaluation. RESULTS Ninety-eight patients (32.6%) reported occurrence of at least one CTS symptom during pregnancy and 22 patients (22.4%) had similar symptoms in previous pregnancies. Only 3 patients had received any form of therapy The number of patients with CTS symptoms who reported extremities edema was significantly higher than in the group without CTS symptoms (26.3% vs. 6.1%; p < 0.05). The frequency of occurrence of diabetes and pregnancy induced hypertension was similar in both groups. The results of the first part of the modified BCTQ (symptom severity) were significantly higher in the CTS group as compared to non-CTS group (2.1 +/- 0.8 vs. 1.0 +/- 0.1; p < 0.05). The results of the second part of the modified BCTQ (impairment of daily life activities) were similar (1.7 +/- 0.8 vs. 1.0 +/- 0.1; p < 0.05). Out of 74 patients with CTS symptoms who underwent Phalen sign examination, 50% had positive Phalen sign. Patients with positive Phalen sign had significantly higher scores for both parts of the modified BCTQ. CONCLUSIONS CTS symptoms are quite common during pregnancy (32% in the study group). However symptom intensity remains rather moderate. Some of the patients had those symptoms during previous pregnancies. Although the frequency of CTS symptoms is quite high in the population of pregnant women, only few have any form of treatment. Early detection of CTS symptoms in pregnant women is very important, because it allows introduction of conservative treatment, which is successful in most cases.