Miklós Vizer

Changes of Maternal Serum Leptin Levels during Pregnancy

Maternal leptin levels in serum and urine, their relations to maternal weight and body mass index, were examined in 9 healthy pregnant women from the 12th week of gestation until term. Serum leptin concentration was found to increase progressively during the first two trimesters followed by a slight decline thereafter. The peak value of 27.6 ± 15.3 ng/ml (mean ± SD) concentration was reached at the 28th week. Serum leptin levels during the first two trimesters correlated significantly with maternal weight (p = 0.002) and body mass index (p = 0.002) but such a relationship was absent during the third trimester. Leptin could be detected only in about half of urine samples; its concentrations proved to be independent of serum values. No correlation was found between maternal serum leptin levels and the birth weight of neonates. Maternal leptin levels appear to refer to alterations in maternal fat tissue mass that occur during pregnancy.

Effects of maternal central hemodynamics on fetal heart rate patterns

Background. This study was undertaken to evaluate the effects of maternal central hemodynamics on fetal heart rate patterns near term, with special regard to the maternal body position. Methods. Brief non‐stress test and bioimpedance cardiography were carried out in the supine position, then repeated in a full left lateral decubitus position of mothers with singular, 36–39 week‐old normal pregnancies in 106 cases. Computer‐aided data were processed by SPSS statistic program. Results. Due to the appearance of inferior vena cava syndrome, examinations had to be interrupted in 6 cases. Analysis of 100 complete registrations revealed a significantly increased number of accelerations, overall and short‐term variations, and longer high episodes with lower basal fetal heart rates were found in the lateral decubitus than in the supine maternal position. Turning to the left resulted in a significant increase of the stroke volume; however, due to decreasing pulse rate, the cardiac output remained unchanged. Parameters of non‐stress test showed correlations to hemodynamic indices. In the supine position, the short‐term variation correlated with cardiac output (r = 0.232, p = 0.020); in the left lateral position, the number of accelerations correlated with stroke volume (r = 0.221, p = 0.027) and cardiac output (r = 0.220, p = 0.028). Changes of stroke volume due to altered body position correlated to similar changes of overall variation (r = 0.264, p = 0.018), and marginally to those of short‐term variation (r = 0.221, p = 0.051). Conclusion. Maternal central hemodynamics influences fetal heart rate patterns in connection with different maternal body position.

Correlation of prenatal clinical findings with those observed in fetal autopsies: pathological approach.

Our objective was to present a comprehensive description of the clinicopathological findings of 173 abortions, including 121 therapeutic and 52 spontaneous ones in the period between 1992 and 1998. In all of these fetuses pathological examination was carried out. It was complemented when indicated by immunohistochemistry, in situ hybridization, flow cytometry, and X‐ray examination. In the 121 therapeutic abortions the distribution of malformations was: 45 central nervous system anomalies (37%), 12 genitourinary anomalies (10%), 25 gastrointestinal anomalies (21%), two respiratory system anomalies (1.65%), eight cardiac anomalies (6.6%) and 28 other anomalies (17.2%) as revealed by autopsy. From the clinically selected 52 spontaneous abortions, major malformations were seen in 15/52 cases. With the comparison of the pathological and clinical findings in 121 therapeutic abortions, the percentage of cases with correct clinical designation and no missed anomalies amounted for 49%. However in 51% additional or different lethal, severe, or major malformations were revealed or excluded by fetopathological examinations. In 4% the clinical observation and diagnosis were modified, but without implications for the therapeutic termination of pregnancy. The clinical indication could not be supported in another 3% of the cases. Copyright

Sexual Function after Modified Laparoscopic Vecchietti’s Vaginoplasty

STUDY OBJECTIVE To report on minor modification of laparoscopic Vecchietti vaginoplasty and to examine the quality of sexual life after the operation. DESIGN A retrospective study to examine the role of minor modification during laparoscopic Vecchietti operation to prevent injuries and to evaluate the sexual function of patients with neovagina. SETTING Department of Obstetrics and Gynecology, University of Pécs, Faculty of Medicine, a tertiary supply center in Hungary. PATICIPANTS: Twenty-three adolescents or young adults, ages 16 to 26 with vaginal agenesis (Mayer-Rokitansky-Küster-Hauser syndrome) were operated. Twenty-five sexually active patients with matched age served as controls. INTERVENTIONS Laparoscopic Vecchietti operation was modified with the use of endovaginal ultrasound transducer to visualize the narrow vesico-rectal space. The quality of sexual life 2-11 years after the operation was measured by the Female Sexual Function Index (FSFI). MAIN OUTCOME MEASURES Complications occurring during operations; desire, arousal, orgasm, satisfaction, lubrication, and pain during sexual intercourse. RESULTS The technical modification of the operation, with endovaginal transducer, improved the method. Serious injuries of the bladder or rectum could be avoided. Anatomic and functional results shown by the total FSFI scores did not differ from that of the control group. Desire, arousal, orgasm, and satisfaction of the operated patients were similar to controls; however, patients with neovagina tended to have less lubrication and more pain during sexual intercourse. CONCLUSIONS Laparoscopic Vecchietti operation modified by the use of endovaginal transducer is a safe procedure to create a neovagina, which guarantees good quality of sexual life with high satisfaction for patients.

Two Successful Pregnancies following Eight Miscarriages in a Patient with Antithrombin Deficiency

Inherited thrombophilias are associated with an increased risk of maternal thromboembolism and certain adverse pregnancy outcomes, including second- and third-trimester fetal loss, placental abruption, severe intrauterine growth restriction, and early-onset, severe preeclampsia. Pregnant patients with severe thrombophilias, especially antithrombinopathies are at very high risk for both thromboembolism and adverse pregnancy outcomes. A case of a patient with antithrombin deficiency is reported, who had two successful pregnancies after eight miscarriages. Our case shows that a combined treatment with antithrombin substitution and a prophylactic, body-weight-adjusted dose of low-molecular-weight heparin may be successful in preventing pregnancy loss and thromboembolism in antithrombin deficiency during pregnancy, although other complications, such as preeclampsia and intrauterine growth restriction cannot always be prevented.

Calcium dobesilate lowers the blood pressure in mild to moderate midtrimester hypertension: a pilot study.

To test the effects of calcium dobesilate (Doxium) in pregnancies complicated with pregnancy-induced hypertension or mild/moderate pre-eclampsia a double-blind, placebo-controlled pilot study was carried out. Primigravida patients (gestational age ≤34 weeks) daily took 2 g Doxium or placebo until delivery. Twelve patients received placebo for 53 days, and 11 patients took the drug for 57 days on average. At the start of the study 2 patients in the placebo group (PG) and 8 in the Doxium group (DG) had pre-eclampsia. The mean arterial pressure (mean ± SD) significantly decreased from 118 ± 7 to 99 ± 9 mm Hg in the DG (p = 0.003), while in the PG it had slightly increased by the end of the study. Proteinuria was higher in the DG at the start but not at the end; however, significant changes of this parameter were detected in neither of the groups throughout the study. Fibronectin decreased significantly in both groups but it was more pronounced in the DG (23.8 vs. 9.4%). Changes of platelet count, plasma and blood viscosity, and erythrocyte deformability were favourable in the DG but in the PG these parameters had deteriorated although the alterations were not significant. No marked differences were found between the two groups regarding fetal well-being, courses of deliveries, and the neonatal period. Neither maternal nor fetal/neonatal side effects were noticed. It seems that Doxium favourably influences the blood pressure and consequently decreases the requirement for medication and hospitalisation in cases of mild to moderate midtrimester hypertension.

Assessment of postoperative postvoid residual bladder volume using three-dimensional ultrasound volumetry.

The aim of our prospective study was to assess the concordance between postvoid residual volumes (PVR) of the urinary bladder obtained by two different three-dimensional (3-D) ultrasound (US) volumetric methods (VOCAL and XI VOCAL) and with measurement by the catheter in postoperative patients who have undergone radical hysterectomy. The 3-D sonographic volume-determination of PVR with both methods correlated significantly with the actual amount of PVR by the catheter. The accuracy of both 3-D US volumetric methods was significantly higher under 300 mL of PVR. Bland-Altman plots were generated to examine limits of agreement. Both noninvasive 3-D sonographic methods are appropriate for the correct volume-determination of PVR following radical hysterectomy. Thus, we may avoid routine, albeit often unnecessary, catheterization to measure postoperative residual bladder volumes and subsequently the incidence of lower urinary tract infection may be reduced and better postoperative comfort for patients may be permitted.

Simultaneous use of intrapartum fetal pulse oximetry and amnioinfusion in meconium stained amniotic fluid

OBJECTIVE Fetal pulse oximetry is a minimally invasive, simple technique which continuously helps to reflect in utero well-being. The presence of meconium in the amniotic fluid may be a clinical sign of fetal hypoxaemia. Amnioinfusion has a beneficial effect on the incidence of meconium aspiration syndrome (MAS), and the presence of meconium below the level of the vocal cords. STUDY DESIGN We studied the impact of amnioinfusion combined with fetal pulse oximetry on the incidence of meconium aspiration syndrome and operative delivery. RESULTS The retrospective analysis revealed that the presence of meconium below the level of vocal cords was significantly reduced. The frequency of cesarean section is decreased, however, it did not reach statistical significance. CONCLUSION Fetal pulse oximetry may be used in combination with amnioinfusion and cardiotocography (CTG) to reduce the risk of meconium aspiration syndrome and the number of instrumental deliveries and improve perinatal outcome.

Hydrops foetus universalis – a retrospective study

A szerzők a hydrops foetus előfordulasi gyakorisagat, letrejottenek okait vizsgaltak. Ot ev alatt 555 foetalis es neonatalis autopszias vizsgalatot vegeztek. Hydropsot igazoltak 28 magzatnal. Harom esetben Rh-izoimmunizacio allt a hatterben, 25 foetusnal nem immun hydrops kerult megallapitasra. Huszonot esetben sikerult a hydrops kivalto okat tisztazni, az ok 3 esetben felderitetlen maradt. Tizenket esetben kozepidős spontan veteles, illetve in utero elhalas tortent, mig 12 foetusnal orvosi indok alapjan tortent a terhesseg terminalasa. Emellett 4 ujszulottkorban meghalt beteget is vizsgaltak. Az orvosi indok alapjan tortenő terhessegmegszakitasnal a foetusok atlagos kora a 16. es a 20. gesztacios het kozott volt, mig a kozepidős spontan veteles es in utero elhalas eseten ez a 24. terhessegi hetet jelentette. A patologiai vizsgalat valamennyi esetben a terhessegi korhoz kepest varhato testsulynovekedeset, periferias oedemat, ascitest, illetve hydrothoraxot igazolt. Az esetek feleben hydropericardium is la...

The application of 'endovaginal' sonography during a laparoscopy-assisted Vecchietti operation

Background. Many types of operations are described to create a neovagina in a patient with Mayer‐Rokitansky‐Küster‐Hauser (MRKH) syndrome, that sometimes result in injury of the surrounding organs. Many trials are detailed in the literature to avoid these complications. Our goal was to examine the benefit of ‘endovaginal’ sonography during a laparoscopy‐assisted Vecchietti operation to avoid bladder injuries. Methods. A neovagina was created in 15 women with MRKH syndrome by the method of Vecchietti assisted by laparoscopy. The method was modified with the use of ‘endovaginal’ sonography, in order to reduce bladder and rectal injuries. The vaginal ultrasound transducer, placed in front of the vaginal dimple, can guide penetration from the perineum into the peritoneal cavity. With this technique, the narrow space between the bladder and rectum can be well identified. Results. All operations were successful, without any complication, forming a well‐functioning 8–10 cm long neovagina, allowing easy introduction of two fingers in all cases, and with good quality of sexual life for the couples. Conclusion. Creation of a neovagina by any method in MRKH syndrome may sometimes result in injury of the bladder or rectum due to the narrow space between the bladder and rectum. The placement of the endovaginal ultrasound transducer in front of the vaginal dimple seems to be a promising method to avoid these complications during a laparoscopy‐assisted Vecchietti operation.