It has been belived that changes in diastolic blood velocities in the fetal ductus venosus were due to increased central venous pressure secondary to increased fetal heart strain during hypoxia or heart failure. There have been recent reports of changes in ductus venosus blood velocity without signs of increased fetal heart strain. The aim of this evaluation was to compare blood velocity in the right hepatic vein as a marker of increased central venous pressure in relationship to changes in ductus venosus blood velocity.Fifty pregnancies suspected of fetal growth resitriction were evaluated by Doppler ultrasound. Blood velocity was recorded in the right hepatic vein, ducus venosus and in the umbilical vein. Placental blood flow was also recorded in the uterine and umbilical arteries as well as the fetal middle cerebral artery.Increased umbilical artery pulsatility index was recorded in 19 fetuses and 20 has signes of brain sparing according to recordings in the middle cerebral artery. Abnormal blood velocity in the ductus venosus was recorded in 5 fetuses, none of these fetuses had an abnormal pulsatility in the right hepatic vein.Opening of the ductus venosus is not only related to fetal cardiac strain. This might indicate that the ductus venosus does not primarily open due to increased central venous pressure in moderate fetal hypoxia. Increased fetal cardiac strain might be a late event in the process of chronic fetal hypoxia.
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.
To assess the value of cardiovascular profile score (CVPS) focusing on the cardiac function in the surveillance of both twins in twin-to-twin transfusion syndrome. In a retrospective study 16 recipient and 16 donor twins were examined between 18–26 (mean 21) weeks of gestation at the first echo exam with ultrasonographic evaluation of presence of hydrops, heart size, cardiac function, venous and arterial Doppler. The scores of the first and final examinations after treatment were compared in both twins and the relationship between these scores and the progress of developing the congestive heart failure (CHF) and fetal outcome was assessed. The median CVPS for recipients at the first assessment was 7.0 and 9.0 for donors. For these included to the longitudinal arm of the study (13 recipients, 13 donors) the CVPS was 7.0 for recipients who survived and 6.0 for those who died and 8.0 for donors who died and the same who survived. Cardiac function in recipients was impaired in 100% cases (minus 1 point in 10 cases, minus 2 points in 6 cases). Tricuspid valve regurgitation (16/100%), mild cardiomegaly (12/75%) and myocardial hypertrophy (9/56%) were the most frequent findings in the recipients. Functional pulmonary atresia in two cases and supravalvar pulmonary stenosis in one was recognized. Cardiac function was abnormal in one donor twin due to CHF after laser therapy. Most had abnormal arterial (8/50%) or arterial and venous (6/38%) Doppler flows. In utero treatment included: serial amnioreduction in 10 cases, laser therapy in 5 and digoxin therapy in 3 cases. Overall survival rate was 53% (15/32) (donors 53%, recipients 47%). 1. The CVPS can be used in the surveillance of recipients for prediction of the presence of congestive heart failure and fetal outcome. 2. Cardiac function was impaired in all recipients whereas donors showed peripheral flows abnormalities with similar mortality rate in both groups.
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.
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.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).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.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.
Sonographic evaluation of the cervical length and cervical canal width in 24th week of twin pregnancy in prediction of preterm delivery.43 primiparous patients with twin pregnancy. Group I (n = 16, 37.2%) with spontaneous delivery before 36 of gestation; group II (n = 27, 62.8%) delivering in term. Sonographic measurements of the cervical length and cervical canal width were done in 24th week of gestation.Mean values of cervical length in group I were: 25.6 mm (+/- 3.7 mm); and in group II--32.5 mm (+/- 6.0 mm). Corresponding values of canal width were: 14.6 mm (+/- 11.8 mm) and 6.2 mm (+/- 3.0 mm).We suggest, that cervical length is more valuable parameter in predicting risk of preterm delivery in twin pregnancy.
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.
