Przemysław Kosiński

First trimester maternal serum vitamin D and markers of preeclampsia

Abstract Objective: There is evidence that vitamin D deficiency is associated with preeclampsia. The aim of the study was to determine if maternal levels of vitamin D at 1st trimester were related to markers of preeclampsia. Material: Serum levels of 25-hydroxy-vitamin D (25OHD), PAPP-A, PlGF, uterine artery pulsatility index and mean arterial pressure were measured in 280 pregnant women. Results: Preeclampsia markers were not related to 25OHD concentration. Conclusion: First trimester maternal serum concentration of vitamin D does not seem to be connected with markers of preeclampsia.

Vaginal progesterone after tocolytic therapy in threatened preterm labor

Objective: The aim of this study was retrospective evaluation of progesterone efficacy in pregnant patients with preterm uterine contractions. Material: 190 women hospitalized at 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, in 2007–2010, with symptoms of threatened preterm labor were enrolled in the study. 94 women were treated with tocolytics and steroids (control group), while 96 women received additionally 200 mg of progesterone vaginally until delivery or 34th weeks of gestation (progesterone group). Results: The mean gestational age at admission was 27 weeks in progesterone group and 28 weeks in control group. Cervical length was similar in both groups. There were no significant differences in week of delivery between groups, but the progesterone group had significant increase in prolongation of pregnancy (7.6 versus 6.3 weeks, p = 0.039). Vaginal progesterone was associated with reduction of delivery before 34 weeks (9.8% versus 35.3%; p = 0.002) and neonatal birth weight <1500 g (3.2% versus 20.6%; p = 0.011) only in patients presenting with uterine contractions after 27 weeks. Conclusion: The administration of vaginal progesterone after tocolysis in threatened preterm labor is associated with prolongation of pregnancy. The reduction of deliveries before 34 weeks was observed in patients presenting with contractions after 27 weeks gestation.

Intrauterine Ultrasound-Guided Laser Coagulation of the Feeding Artery in Fetal Bronchopulmonary Sequestration

Bronchopulmonary sequestration (BPS) is a rare fetal lung anomaly. It is a nonfunctioning mass of lung tissue that lacks normal communication with the tracheobronchial tree and receives its blood supply from the systemic (rather than the pulmonary) circulation. Typically, it has the appearance of a solid homogeneous mass with a feeding vessel, originating from the descending aorta. The perinatal prognosis is poor in the case of development of fetal hydrops, massive pleural effusions with lung hypoplasia and the presence of polyhydramnios resulting in premature delivery. Laser coagulation of the feeding artery has been described as a minimally invasive fetal therapy (Oepkes et al. Ultrasound Obstet Gynecol 2007, 29: 457 – 459). This report describes two cases of BPS with successfully performed laser coagulation, resulting in complete remission of fetal hydrops and prevention of premature delivery without further necessity for neonatal surgery.

Congenital diaphragmatic hernia: pathogenesis, prenatal diagnosis and management — literature review

Congenital diaphragmatic hernia (CDH) is a developmental discontinuity of the diaphragm. It allows abdominal viscera to herniate into the chest and leads to lung hypoplasia. Congenital diaphragmatic hernia is one of the most severe birth defects, with extremely high neonatal mortality. This paper presents a review of the available literature on prenatal diagnosis, management and treatment options for CDH. In selected cases, a prenatal procedure to improve neonatal survival is possible. The authors of this manuscript believe their work might contribute to a better understanding of congenital diaphragmatic hernia and patient selection for the FETO (fetal endoscopic tracheal occlusion) surgery or expectant management.

Prenatal diagnosis of dural sinus malformation in fetus presenting with edema

Dural sinus malformation (DSM) is an extremely rare, congenital dilatation of the dural sinus pouch. DSM cases associated with arteriovenous shunt (AV shunt) usually have a poor pregnancy outcome due to an excessive hemodynamic load and progressive cardiac failure.

Foetoscopic endotracheal occlusion (FETO) for severe isolated left-sided congenital diaphragmatic hernia: single center Polish experience

Abstract Objective: To present early experience with foetoscopic endotracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH) in a new center in Poland. Methods: This was a prospective study in singleton pregnancies with CDH treated by FETO between 2014 and 2016 in the Medical University of Warsaw, Poland. FETO was carried out at 25.6–30.1 (median 27.7) weeks’ gestation in 28 consecutive cases of isolated left-sided CDH with observed over expected lung area to head circumference ratio (o/e LHR) of 20.7–22.6 (median 18.9). Results: Neonatal survival rate was 46.4% (13/28) at the time of discharge. The median o/e LHR the day before balloon removal was 33.4 (19.7–57.5) and median gestational age at delivery was 34.7 (29.0–38.1) weeks. Comparison of the survivors and perinatal deaths showed no significant differences in median gestational age at FETO or median o/e LHR before FETO, but higher median gestational age at delivery (35.9, range 32.7–38.1 weeks vs. 33.2, range 29.0–37.7 weeks; p = .007) and o/e LHR before balloon removal (33.7, range 28.3–57.5 vs. 30.9, range 19.7–37.5; p = .017). Conclusions: FETO was implemented successfully in Poland and the survival rate (46.4%) is similar to that reported in other centers. Important determinants of survival were gestational age at delivery and pulmonary response to FETO. The rate of preterm prelabor rupture of membranes (PPROM) in our series is similar to the larger series treated with FETO in the pioneering centers of this technique.

Early 2D/3D ultrasound diagnosis of pleural effusion in fetuses with Turner syndrome

Most guidelines on ultrasound examinations during pregnancy do not recommend routine early pregnancy scan in uncomplicated and asymptomatic pregnancies (ie, before 10 weeks based on last menstrual period). There is, however, a growing patients expectation to have an early scan to confirm dating and verify the pregnancy is intrauterine and viable. We present three well‐documented cases of patients who had an early (7‐8 weeks) dating transvaginal scan revealing pleural effusion in the embryo. In all cases cytogenetic analysis confirmed monosomy for the X chromosome, consistent with a clinical diagnosis of Turner syndrome.

Prenatal diagnosis of dural sinus malformation in a fetus presenting with general oedema

Dural sinus malformation (DSM) is an extremely rare, congenital dilatation of the dural sinus pouch. DSM cases associated with arteriovenous shunt (AV shunt) usually have a poor pregnancy outcome due to an excessive hemodynamic load and progressive cardiac failure.

The first trimester aneuploidy biochemical markers in IVF/ICSI patients have no additional benefit compared to spontaneous conceptions in the prediction of pregnancy complications

Abstract Objectives: The aim of this study was to determine if the levels of biochemical aneuploidy markers in in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) pregnancies differ from those in spontaneous pregnancies and to verify if biochemical markers could predict pregnancy outcome in IVF/ICSI gestations. Methods: This was a prospective observational study performed in a group of 551 patients who underwent a combined first trimester prenatal screening (ultrasound scan and serum markers). All patients were divided into two groups according to the mode of conception: IVF/ICSI pregnancies (study group) and spontaneous conceptions (control group). The concentrations of first trimester biochemical markers were presented as multiples of median (MoM) and were compared between the study and control groups. Analysed pregnancy complications included: preterm delivery (PTD), small for gestational age (SGA), gestational hypertension (GH), preeclampsia (PE) and gestational diabetes (GDM). Results: The analysis was performed on 183 IVF/ICSI and 368 spontaneously conceived gestations, with complete data regarding obstetric outcome. There were no significant differences in the concentrations of biochemical markers between the analysed groups. Pregnancy-associated plasma protein-A (PAPP-A) levels were lower in hypertensive than in normotensive patients, although the difference was not significant. Twenty-three patients had GDM (12.5%), 16 had GH or PE (8.7%), SGA was diagnosed in 18 (9.8%) and 25 delivered preterm (13.6%). Conclusions: The trend for lower PAPP-A MoM was visible in all affected patients, although the results did not reach statistical significance. The first trimester biochemical markers in assisted reproduction technique (ART) pregnancies do not seem to have additional effect on predicting the risk of pregnancy complications.

Intraoperative damage to the urinary bladder during cesarean section — literature review

Corresponding author: Andrzej Korniluk Mazovia Regional Hospital in Siedlce Poniatowski St. 26, 08–110 Siedlce, Poland tel.: +48 6045262474 e-mail: andrzej.m.korniluk@gmail.com INTRODUCTION The last years have brought a significant increase in the number of births by caesarean section, and as a result there is expected to be an increasing number of patients with adhesions in the pelvis minor on a more frequent basis. Intrauterine adhesions are the most significant risk factors of damage to the bladder. The incidence of damage to the bladder during the caesarean section is relatively small. However, it is extremely important to anticipate the possibility of this complication, its early intraoperative diagnosis and implementation of appropriate treatment when they occur. Damage to the urinary tract, which is a complication of caesarean section, is rarely described in the literature. However, the caesarean section is now the most frequently performed obstetric surgery in the world, and their number increases every year. Taking this into account, the obstetricians and their patients should be aware of the potential complications associated with carrying out this procedure. Over the last century, the reduced rates of morbidity and mortality of mothers during caesarean section are noticeable, but a growing number of urological complications are expected to be seen. The most common urological complication of caesarean section is the damage of the urinary bladder [1]. Incidence of bladder damage after cesarean section ranges from 0.08 to 0.94% [2–8]. The data on injuries of the urinary bladder during caesarean section, however, are divergent because the available manuscripts use inconsistent definitions of damage and do not specify the severity of damage. Although bladder damage during cesarean delivery is rare, obstetricians should be aware of the need to inform pregnant women about all the possible complications associated with this operation before giving informed consent for the caesarean section. The potential consequences of damage to the bladder are connected with the extension of the duration of operation, longer hospitalization time, the need to keep Foley catheter longer in the urinary bladder, the increase of infections and post-operative complications in the urinary tract, such as vesico-vaginal fistula. The possibility of this type of complications should be also expected and it is necessary to point out that the most important is to establish the diagnosis even during the caesarean section. In this paper, the following aspects are discussed: the risk factors, diagnosis and treatment options of damage to the bladder during caesarean section.