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Tousty P, Fraszczyk-Tousty M, Golara A, Zahorowska A, Sławiński M, Dzidek S, Jasiak-Jóźwik H, Nawceniak-Balczerska M, Kordek A, Kwiatkowska E, Cymbaluk-Płoska A, Torbé A, Kwiatkowski S. Screening for Preeclampsia and Fetal Growth Restriction in the First Trimester in Women without Chronic Hypertension. J Clin Med 2023; 12:5582. [PMID: 37685649 PMCID: PMC10488103 DOI: 10.3390/jcm12175582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Nowadays, it is possible to identify a group at increased risk of preeclampsia (PE) and fetal growth restriction (FGR) using the principles of the Fetal Medicine Foundation (FMF). It has been established for several years that acetylsalicylic acid (ASA) reduces the incidence of PE and FGR in high-risk populations. This study aimed to evaluate the implementation of ASA use after the first-trimester screening in a Polish population without chronic hypertension, as well as its impact on perinatal complications. MATERIAL AND METHODS A total of 874 patients were enrolled in the study during the first-trimester ultrasound examination. The risk of PE and FGR was assessed according to the FMF guidelines, which include the maternal history, mean arterial pressure (MAP), uterine artery pulsatility index (UtPI), pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PLGF). Among patients with a risk higher than >1:100, ASA was administered at a dose of 150 mg. Perinatal outcomes were assessed among the different groups. RESULTS When comparing women in the high-risk group with those in the low-risk group, a statistically significantly higher risk of pregnancy complications was observed in the high-risk group. These complications included pregnancy-induced hypertension (PIH) (OR 3.6 (1.9-7)), any PE (OR 7.8 (3-20)), late-onset PE (OR 8.5 (3.3-22.4)), FGR or small for gestational age (SGA) (OR 4.8 (2.5-9.2)), and gestational diabetes mellitus type 1 (GDM1) (OR 2.4 (1.4-4.2)). The pregnancies in the high-risk group were more likely to end with a cesarean section (OR 1.9 (1.2-3.1)), while the newborns had significantly lower weights (<10 pc (OR 2.9 (1.2-6.9)), <3 pc (OR 10.2 (2.5-41.7))). CONCLUSIONS The first-trimester screening test for PE and FGR is a necessary and effective tool in identifying high-risk pregnancies. ASA prophylaxis among high-risk patients may have the most beneficial effect. Furthermore, this screening tool may significantly reduce the incidence of early-onset PE (eo-PE).
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Affiliation(s)
- Piotr Tousty
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Magda Fraszczyk-Tousty
- Department of Neonatology and Neonatal Intensive Care, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Anna Golara
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Adrianna Zahorowska
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Michał Sławiński
- Department of Laboratory Diagnostics, Public Clinical Hospital No. 2, 70-111 Szczecin, Poland
| | - Sylwia Dzidek
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Hanna Jasiak-Jóźwik
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | | | - Agnieszka Kordek
- Department of Neonatology and Neonatal Intensive Care, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Ewa Kwiatkowska
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Aneta Cymbaluk-Płoska
- Department of Reconstructive Surgery and Gynecological Oncology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Andrzej Torbé
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Sebastian Kwiatkowski
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
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Kotfis K, Wojciechowska A, Zimny M, Jamioł-Milc D, Szylińska A, Kwiatkowski S, Kaim K, Dołęgowska B, Stachowska E, Zukowski M, Pankowiak M, Torbé A, Wischmeyer P. Preoperative Oral Carbohydrate (CHO) Supplementation Is Beneficial for Clinical and Biochemical Outcomes in Patients Undergoing Elective Cesarean Delivery under Spinal Anaesthesia-A Randomized Controlled Trial. J Clin Med 2023; 12:4978. [PMID: 37568381 PMCID: PMC10419905 DOI: 10.3390/jcm12154978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Preoperative fasting and surgery cause metabolic stress, insulin resistance with ketosis, and postoperative nausea and vomiting (PONV). Oral carbohydrate loading strategy (CHO) improves outcomes in labor and general surgery. We aimed to compare the effectiveness of CHO with standard fasting in patients undergoing elective cesarean delivery (CD) under spinal anesthesia. METHODS A single-center, parallel, prospective randomized controlled trial (RCT) was conducted in a tertiary university obstetrics department at Pomeranian Medical University in Szczecin, Poland. Patients were randomly assigned (1:1 ratio) to the CHO group (oral carbohydrate 2 h before elective CD, n = 75) or the SF group (control-standard fasting, n = 73). The main outcome measures were incidence and severity of PONV at 6 and 24 h after CD, time to the first peristalsis, time to first bowel movement, and biochemical parameters indicating ketosis in mothers and their children. RESULTS A total of 148 adult females with singleton pregnancies undergoing elective CD under spinal anesthesia (ASA I and II) were included in the final analysis. At 24 h after CD, 8.0% from the CHO group vs. 20.55% reported three or more episodes of vomiting or dry retching as compared to patients in the SF group (p = 0.041). Preoperative CHO supplementation decreased preoperative feelings of hunger (p < 0.001) and thirst (p < 0.001). Laboratory results in the CHO group showed higher plasma pH (p = 0.001) and glucose (p < 0.001), lower F2-isoprostane in plasma (p = 0.049) and urine (p = 0.018), lower urine F2-isoprostane/creatinine ratio (p = 0.045) than in the SF group. HOMA-IR (p < 0.001) and lactate (p < 0.001) were higher in the CHO group than in the control group. CONCLUSIONS There was no significant difference in the incidence or severity of early PONV at 6 h. The incidence of vomiting or dry retching at 24 h after cesarean delivery was lower in the CHO group as compared to standard starvation, but the combined results of PONV frequency and severity on the Wengritzky scale did not differ between the two study groups. Preoperative CHO supplementation decreased preoperative feelings of hunger and thirst, enhancing the comfort of pregnant women. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04069806.
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Affiliation(s)
- Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (K.K.); (M.Z.); (M.P.)
| | - Arleta Wojciechowska
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (A.W.); (M.Z.); (S.K.); (A.T.)
| | - Małgorzata Zimny
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (A.W.); (M.Z.); (S.K.); (A.T.)
| | - Dominika Jamioł-Milc
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland; (D.J.-M.); (E.S.)
| | - Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland;
| | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (A.W.); (M.Z.); (S.K.); (A.T.)
| | - Karolina Kaim
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (K.K.); (M.Z.); (M.P.)
| | - Barbara Dołęgowska
- Department of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland; (D.J.-M.); (E.S.)
| | - Maciej Zukowski
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (K.K.); (M.Z.); (M.P.)
| | - Maria Pankowiak
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (K.K.); (M.Z.); (M.P.)
| | - Andrzej Torbé
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (A.W.); (M.Z.); (S.K.); (A.T.)
| | - Paul Wischmeyer
- Department of Anesthesiology and Surgery, Duke University School of Medicine, Durham, NC 27710, USA;
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Tousty P, Fraszczyk-Tousty M, Dzidek S, Jasiak-Jóźwik H, Michalczyk K, Kwiatkowska E, Cymbaluk-Płoska A, Torbé A, Kwiatkowski S. Low-Dose Aspirin after ASPRE-More Questions Than Answers? Current International Approach after PE Screening in the First Trimester. Biomedicines 2023; 11:1495. [PMID: 37371598 DOI: 10.3390/biomedicines11061495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
Preeclampsia (PE) is a multi-factorial disorder of pregnancy, and it continues to be one of the leading causes of fetal and maternal morbidity and mortality worldwide. Aspirin is universally recommended for high-risk women to reduce preeclampsia risk. The purpose of this review is to summarize the recommendations of various scientific societies on predicting preeclampsia and their indications for the inclusion of acetylsalicylic acid (ASA) prophylaxis. Fourteen guidelines were compared. The recommended dose, screening method, and gestational age at the start of the test vary depending on the recommendation. The societies are inclined to recommend using increasingly higher doses (>75 mg) of ASA, with many encouraging doses from 100 mg upward. Most societies indicate that the optimal time for implementing aspirin is prior to 16 weeks' gestation. Following the publication of the Aspirin for Evidence-Based Preeclampsia Prevention (ASPRE) trial results and other papers evaluating the Fetal Medicine Foundation (FMF) screening model, a large number of societies have changed their recommendations from those based on risk factors alone to the ones based on the risk assessment proposed by the FMF. This allows for the detection of a high-risk pregnancy population in whom aspirin will be remarkably effective in preventing preterm PE, thereby decreasing maternal and fetal morbidity.
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Affiliation(s)
- Piotr Tousty
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Magda Fraszczyk-Tousty
- Department of Neonatology and Neonatal Intensive Care, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Sylwia Dzidek
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Hanna Jasiak-Jóźwik
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Kaja Michalczyk
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Ewa Kwiatkowska
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Aneta Cymbaluk-Płoska
- Department of Reconstructive Surgery and Gynecological Oncology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Andrzej Torbé
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Sebastian Kwiatkowski
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
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Bednarek-Jędrzejek M, Dzidek S, Tousty P, Kwiatkowska E, Cymbaluk-Płoska A, Góra T, Czuba B, Torbé A, Kwiatkowski S. Birth Weight < 3rd Percentile Prediction Using Additional Biochemical Markers-The Uric Acid Level and Angiogenesis Markers (sFlt-1, PlGF)-An Exploratory Study. Int J Environ Res Public Health 2022; 19:15059. [PMID: 36429778 PMCID: PMC9690634 DOI: 10.3390/ijerph192215059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
(1) Aim: Ultrasound is the gold standard for assessing fetal growth disorders. The relationship between high sFlt-1/PlGF scores and LBW (low birth weight) was described. In this study, we attempted to assess whether uric acid could be used as a secondary marker in estimating the pregnancy risk associated with LBW. (2) Material and methods: 665 pregnant women with a suspected or confirmed form of placental insufficiency were enrolled. In each of the patients, sFlt-1 and PlGF and uric acid levels were determined. Patients were divided into two groups according to birth weight below and above the third percentile for the given gestational age with the criteria of the neonatal definition of FGR (fetal growth restriction). (3) Results: A significant negative correlation between neonatal birth weight and the uric acid level across the entire study group was observed. We found a significant negative correlation between neonatal birth weight and the uric acid level with birth weights < 3rd percentile. (4) Conclusions: There is a significant link between the uric acid concentration and LBW in the group with placental insufficiency. Uric acid can improve the prediction of LBW. An algorithm for LBW prognosis that makes use of biophysical (ultrasound) and biochemical (uric acid level, angiogenesis markers) parameters yields better results than using these parameters separately from each other.
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Affiliation(s)
| | - Sylwia Dzidek
- Department of Obstetrics and Gynecology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Piotr Tousty
- Department of Obstetrics and Gynecology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Ewa Kwiatkowska
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Tomasz Góra
- Clinical Department of Gynecology and Obstetrics, John Paul 2nd Municipal Hospital, 35-241 Rzeszow, Poland
| | - Bartosz Czuba
- Department of Obstetrics and Gynecology, Medical University of Silesia, 40-055 Ruda Slaska, Poland
| | - Andrzej Torbé
- Department of Obstetrics and Gynecology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Pomeranian Medical University, 70-204 Szczecin, Poland
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Tousty P, Fraszczyk-Tousty M, Ksel-Hryciów J, Łoniewska B, Tousty J, Dzidek S, Michalczyk K, Kwiatkowska E, Cymbaluk-Płoska A, Torbé A, Kwiatkowski S. Adverse Neonatal Outcome of Pregnancies Complicated by Preeclampsia. Biomedicines 2022; 10:biomedicines10082048. [PMID: 36009597 PMCID: PMC9405653 DOI: 10.3390/biomedicines10082048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022] Open
Abstract
Despite many available treatments, infants born to preeclamptic mothers continue to pose a serious clinical problem. The present study focuses on the evaluation of infants born to preeclamptic mothers for the occurrence of early-onset complications and attempts to link the clinical status of such infants to the angiogenesis markers in maternal blood (sFlt-1, PlGF). The study included 77 newborns and their mothers diagnosed with preeclampsia. The infants were assessed for their perinatal outcomes, with an emphasis on adverse neonatal outcomes such us infections, RDS, PDA, NEC, IVH, ROP, or BPD during the hospitalization period. The cutoff point was established using the ROC curve for the occurrence of any adverse neonatal outcome and it was 204 for the sFlt-1/PlGF and 32 birth week with AOC 0.644 and 0.91, respectively. The newborns born to mothers with high ratios had longer hospitalization times and, generally, were more frequently diagnosed with any of the aforementioned adverse neonatal outcomes. Also, the neonates born prior to or at 32 wkGA with higher sFlt-1/PlGF ratios were statistically significantly more common to be diagnosed with any of the adverse neonatal outcomes compared to those with lower ratio born prior to or at 32 wkGA. The sFlt-1/PlGF ratio can be a useful tool in predicting short-term adverse neonatal outcomes. Infants born after a full 33 weeks gestation developed almost no severe neonatal complications. Appropriate screening and preventive healthcare for preeclampsia can contribute significantly to reducing the incidence of neonatal complications.
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Affiliation(s)
- Piotr Tousty
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
- Correspondence: ; Tel.: +48-735-923-533
| | - Magda Fraszczyk-Tousty
- Department of Neonatology and Neonatal Intensive Care, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Joanna Ksel-Hryciów
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Beata Łoniewska
- Department of Neonatology and Neonatal Intensive Care, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Joanna Tousty
- Department of Neonatology and Neonatal Intensive Care, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Sylwia Dzidek
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Kaja Michalczyk
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Ewa Kwiatkowska
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Andrzej Torbé
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Sebastian Kwiatkowski
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
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Kosinska-Kaczynska K, Torbé A, Kwiatkowski S, Borowski D, Breborowicz G, Czajkowski K, Czuba B, Huras H, Janiak K, Kajdy A, Kalinka J, Kosinski P, Leszczynska-Gorzelak B, Mierzynski R, Ropacka-Lesiak M, Sieroszewski P, Swiatkowska-Freund M, Wielgos M, Zimmer M. The Polish Society of Gynecologists and Obstetricians Guideline for the diagnostic assessment and management of multiple-gestation pregnancy complicated by fetal growth restriction. Ginekol Pol 2022; 93:256-263. [PMID: 35315031 DOI: 10.5603/gp.a2021.0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/25/2022] Open
Abstract
The aim of the Guideline is to unify the diagnostic-therapeutic management of multiple-gestation pregnancies complicated by fetal growth restriction in at least one fetus.
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Affiliation(s)
| | - Andrzej Torbé
- Chair of Obstetrics, Gynecology and Neonatology, Faculty of Medicine and Dentistry, Pomeranian Medical University in Szczecin, Poland
| | - Sebastian Kwiatkowski
- Chair of Obstetrics, Gynecology and Neonatology, Faculty of Medicine and Dentistry, Pomeranian Medical University in Szczecin, Poland.
| | - Dariusz Borowski
- Chair of Obstetrics, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland.,I Chair of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - Grzegorz Breborowicz
- Chair of Perinatology and Gynaecology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Bartosz Czuba
- Chair of Woman's Health, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, Poland
| | - Hubert Huras
- Chair of Gynaecology and Obstetrics, Medical College, Jagiellonian University in Cracow, Poland
| | - Katarzyna Janiak
- Department of Gynaecology, Procreation and Therapy of Fetus Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Anna Kajdy
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jaroslaw Kalinka
- I Chair of Gynecology and Obstetrics, Medical University of Lodz, Poland
| | | | | | - Radzislaw Mierzynski
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, Poland
| | - Mariola Ropacka-Lesiak
- Chair of Perinatology and Gynaecology, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Sieroszewski
- I Chair of Gynecology and Obstetrics, Medical University of Lodz, Poland
| | | | - Miroslaw Wielgos
- I Chair of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - Mariusz Zimmer
- I Chair and Clinic of Gynecology and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
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Kajdy A, Modzelewski J, Cymbaluk-Płoska A, Kwiatkowska E, Bednarek-Jędrzejek M, Borowski D, Stefańska K, Rabijewski M, Torbé A, Kwiatkowski S. Molecular Pathways of Cellular Senescence and Placental Aging in Late Fetal Growth Restriction and Stillbirth. Int J Mol Sci 2021; 22:4186. [PMID: 33919502 PMCID: PMC8072706 DOI: 10.3390/ijms22084186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/20/2022] Open
Abstract
Abnormally accelerated, premature placental senescence plays a crucial role in the genesis of pregnancy pathologies. Abnormal growth in the third trimester can present as small for gestational age fetuses or fetal growth restriction. One differs from the other by the presence of signs of placental insufficiency and the risk of stillbirth. The majority of stillbirths occur in normally grown fetuses and are classified as "unexplained", which often leads to conclusions that they were unpreventable. The main characteristic of aging is a gradual decline in the function of cells, tissues, and organs. These changes result in the accumulation of senescent cells in mitotic tissues. These cells begin the aging process that disrupts tissues' normal functions by affecting neighboring cells, degrading the extracellular matrix, and reducing tissues' regeneration capacity. Different degrees of abnormal placentation result in the severity of fetal growth restriction and its sequelae, including fetal death. This review aims to present the current knowledge and identify future research directions to understand better placental aging in late fetal growth restriction and unexplained stillbirth. We hypothesized that the final diagnosis of placental insufficiency can be made only using markers of placental senescence.
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Affiliation(s)
- Anna Kajdy
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Żelazna 90 St., 01-004 Warsaw, Poland; (J.M.); (M.R.)
| | - Jan Modzelewski
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Żelazna 90 St., 01-004 Warsaw, Poland; (J.M.); (M.R.)
| | - Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland;
| | - Ewa Kwiatkowska
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, Al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland;
| | - Magdalena Bednarek-Jędrzejek
- Department Obstetrics and Gynecology, Pomeranian Medical University, Al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (M.B.-J.); (A.T.)
| | - Dariusz Borowski
- Clinic of Fetal-Maternal, Gynecology and Neonatology, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz, Łukasiewicza 1 St., 85-821 Bydgoszcz, Poland;
| | - Katarzyna Stefańska
- Department of Obstetrics, Medical University of Gdańsk, Mariana Smoluchowskiego 17 St., 80-214 Gdańsk, Poland;
| | - Michał Rabijewski
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Żelazna 90 St., 01-004 Warsaw, Poland; (J.M.); (M.R.)
| | - Andrzej Torbé
- Department Obstetrics and Gynecology, Pomeranian Medical University, Al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (M.B.-J.); (A.T.)
| | - Sebastian Kwiatkowski
- Department Obstetrics and Gynecology, Pomeranian Medical University, Al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (M.B.-J.); (A.T.)
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Jakubowski D, Salloum D, Maciejewski M, Bednarek-Jędrzejek M, Kajdy A, Cymbaluk-Płoska A, Kwiatkowska E, Torbé A, Kwiatkowski S. Comparison of application of Fenton, Intergrowth-21st and WHO growth charts in a population of Polish newborns. CLIN EXP OBSTET GYN 2021. [DOI: 10.31083/j.ceog4804150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Dzidek S, Jasiak H, Bednarek-Jędrzejek M, Tousty P, Fraszczyk-Tousty M, Kwiatkowska E, Cymbaluk-Płoska A, Torbé A, Kwiatkowski S. The temporal link between prenatal steroid therapy and labor. Pol Merkur Lekarski 2020; 48:394-398. [PMID: 33387425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
UNLABELLED Prematurity has been one of the greatest challenges faced by perinatal medicine for many years. The recommended therapy for women with threatened preterm labor at 24 to 34 weeks' gestation is a single course of glucocorticoids. The greatest benefits have been proven when labor occurs at least 24 hours, but no later than 7 days after steroid administration. Applied treatment is not without influence on neonates' development. AIM The aim of this study is to analyze the time between the administration of a course of glucocorticoids to patients with threatened preterm labor between 24 and 34 weeks of gestation and labor. MATERIALS AND METHODS 459 deliveries by patients between 24 and 34 weeks' gestation who had received betamethasone (two 12 mg doses) or dexamethasone (four 6 mg doses) were analyzed. Their indications for glucocorticoid therapy were divided into four categories: the signs of threatened preterm labor, premature rupture of membranes, iatrogenic prematurity and cervical incompetence. The neonates (n=530) were divided into two main groups: group 1 of those born within the first 7 days (n1=127) and group 2 of those born more than 7 days (n2=403) after the glucocorticoids therapy. Statistical analysis was performed using the Statistica 13.3 software with calculations performed using the Mann- Whitney U and χ2 tests, assuming the level of statistical significance of <0.05 (p<0.05). RESULTS The neonates born within the first 7 days after the glucocorticoid therapy accounted for 23.96% (127 children). The average time of delay between the course of glucocorticoids and labor was 33 days, with the longest interval being 116 days. The most common indications for glucocorticoids were iatrogenic causes in group 1 (35.40%) and the signs of threatened preterm labor (67.63%) in group 2. CONCLUSIONS The percentage of births at the recommended time after steroidotherapy (not later than 7 days) was lower than expected. The prenatal steroid therapy qualification methods, should be reanalyzed, especially when signs of preterm labor are observed.
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Affiliation(s)
- Sylwia Dzidek
- Pomeranian Medical University of Szczecin, Poland: Student Science Group at the Department of Gynecology and Obstetrics
| | - Hanna Jasiak
- Pomeranian Medical University of Szczecin, Poland: Student Science Group at the Department of Gynecology and Obstetrics
| | | | - Piotr Tousty
- Pomeranian Medical University of Szczecin, Poland: Department of Gynecology and Obstetrics
| | | | - Ewa Kwiatkowska
- Pomeranian Medical University of Szczecin, Poland: Department of Nephrology, Transplantology and Internal Medicine
| | - Aneta Cymbaluk-Płoska
- Pomeranian Medical University of Szczecin, Poland: Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents
| | - Andrzej Torbé
- Pomeranian Medical University of Szczecin, Poland: Department of Gynecology and Obstetrics
| | - Sebastian Kwiatkowski
- Pomeranian Medical University of Szczecin, Poland: Department of Gynecology and Obstetrics
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10
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Sokołowska M, Jagielska K, Konstanty-Kurkiewicz V, Mikołajek-Bedner W, Lebdowicz-Knul J, Rajewska A, Torbé A. Pregnancy and childbirth during the coronavirus pandemic - current stage of knowledge. Pol Merkur Lekarski 2020; 48:459-463. [PMID: 33387438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
SARS-CoV-2 (Severe Respiratory Syndrome Coronavirus-2), is a new strain of β-coronavirus. At the time of the current pandemic, pregnant women fear of infection by this pathogen and related consequences both for themselves and for their children. Adaptive changes occurring in the body of a pregnant woman can increase her susceptibility to infections, especially when it concerns the cardiopulmonary system. Clinical data relating to infection by this pathogen, referred to as Coronavirus Disease 2019 (COVID-19) in pregnant women are still limited. Most of the cases in which these data are available apply to the third trimester of pregnancy. This article provides an overview of a current knowledge and recommendations regarding the management of SARS-CoV-2 infection during pregnancy and its impact on the pregnancy outcome.
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Affiliation(s)
- Małgorzata Sokołowska
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Poland
| | - Kinga Jagielska
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Poland
| | | | | | - Joanna Lebdowicz-Knul
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Poland
| | - Aleksandra Rajewska
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Poland
| | - Andrzej Torbé
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Poland
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11
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Rajewska A, Mikołajek-Bedner W, Lebdowicz-Knul J, Sokołowska M, Kwiatkowski S, Torbé A. COVID-19 and pregnancy - where are we now? A review. J Perinat Med 2020; 48:428-434. [PMID: 32452195 DOI: 10.1515/jpm-2020-0132] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022]
Abstract
The new acute respiratory disease severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is highly contagious. It has caused many deaths, despite a relatively low general case fatality rate (CFR). The most common early manifestations of infection are fever, cough, fatigue and myalgia. The diagnosis is based on the exposure history, clinical manifestation, laboratory test results, chest computed tomography (CT) findings and a positive reverse transcription-polymerase chain reaction (RT-PCR) result for coronavirus disease 2019 (COVID-19). The effect of SARS-CoV-2 on pregnancy is not already clear. There is no evidence that pregnant women are more susceptible than the general population. In the third trimester, COVID-19 can cause premature rupture of membranes, premature labour and fetal distress. There are no data on complications of SARS-CoV-2 infection before the third trimester. COVID-19 infection is an indication for delivery if necessary to improve maternal oxygenation. Decision on delivery mode should be individualised. Vertical transmission of coronavirus from the pregnant woman to the fetus has not been proven. As the virus is absent in breast milk, the experts encourage breastfeeding for neonatal acquisition of protective antibodies.
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Affiliation(s)
- Aleksandra Rajewska
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72 Av, 70-111 Szczecin, Poland
| | - Wioletta Mikołajek-Bedner
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72 Av, 70-111 Szczecin, Poland
| | - Joanna Lebdowicz-Knul
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72 Av, 70-111 Szczecin, Poland
| | - Małgorzata Sokołowska
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72 Av, 70-111 Szczecin, Poland
| | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72 Av, 70-111 Szczecin, Poland
| | - Andrzej Torbé
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72 Av, 70-111 Szczecin, Poland
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12
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Bednarek-Jędrzejek M, Kwiatkowski S, Ksel-Hryciów J, Tousty P, Nurek K, Kwiatkowska E, Cymbaluk-Płoska A, Torbé A. The sFlt-1/PlGF ratio values within the <38, 38-85 and >85 brackets as compared to perinatal outcomes. J Perinat Med 2019; 47:732-740. [PMID: 31339858 DOI: 10.1515/jpm-2019-0019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/11/2019] [Indexed: 11/15/2022]
Abstract
Background Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are used as markers of preeclampsia. The aim of this paper was to assess the correlations between the sFlt-1/PlGF ratio values within the <38, 38-85 and >85 brackets and perinatal outcomes in pregnancies that require determination of these markers. Methods A total of 927 pregnant patients between 18 and 41 weeks' gestation suspected of or confirmed with any form of placental insufficiency (preeclampsia, intrauterine growth restriction [IUGR], gestational hypertension, HELLP syndrome, placental abruption) were included in the study. In each of the patients, the sFlt-1/PlGF ratio was calculated. Patients were divided into three groups according to the sFlt-1/PlGF ratio brackets of <38, 38-85 and >85. Results Significantly worse perinatal outcomes were found in the sFlt-1/PlGF >85 group, primarily with lower cord blood pH, neonatal birth weight and shorter duration of gestation. Statistically significant correlations between the values of these markers and the abovementioned perinatal effects were found. Conclusion An sFlt-1/PlGF ratio value of >85 suggests that either preeclampsia or one of the other placental insufficiency forms may occur, which is associated with lower cord blood pH, newborn weight and earlier delivery. Determining the disordered angiogenesis markers and calculating the sFlt-1/PlGF ratio in pregnancies complicated by placental insufficiency may lead to better diagnosis, therapeutic decisions and better perinatal outcomes.
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Affiliation(s)
- Magdalena Bednarek-Jędrzejek
- Department of Gynecology and Obstetrics, Pomeranian Medical University, Clinical Hospital nr 2, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Sebastian Kwiatkowski
- Department of Gynecology and Obstetrics, Pomeranian Medical University, Szczecin, Poland
| | - Joanna Ksel-Hryciów
- Department of Gynecology and Obstetrics, Pomeranian Medical University, Szczecin, Poland
| | - Piotr Tousty
- Department of Gynecology and Obstetrics, Pomeranian Medical University, Szczecin, Poland
| | - Karolina Nurek
- Department of Gynecology and Obstetrics, Pomeranian Medical University, Szczecin, Poland
| | - Ewa Kwiatkowska
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland
| | - Andrzej Torbé
- Department of Gynecology and Obstetrics, Pomeranian Medical University, Szczecin, Poland
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13
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Kordek A, Torbé A, Tousty J, Łoniewska B, Podraza W, Nikodemski T, Rudnicki J. The Determination of Procalcitonin Concentration in Early-Onset Neonatal Infection. Clin Pediatr (Phila) 2017; 56:333-340. [PMID: 27356631 DOI: 10.1177/0009922816656622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to assess the clinical usefulness of blood procalcitonin (PCT) levels for the diagnosis and therapeutic monitoring of early-onset neonatal sepsis (EONS). PCT as well as C-reactive protein (CRP) levels and white blood cell (WBC) count were measured in venous blood from 57 infected and 72 uninfected neonates. Differences between groups for PCT, CRP, and WBC levels were significant. The threshold value on the receiver operating characteristic curve in the prediction of EONS was 5.33 ng/mL for PCT, 9.3 mg/L for CRP, and 14.9 × 109/L for WBC. There was no effect of antibiotic administered to the mother on PCT, CRP, and WBC levels in neonatal blood sampled before treatment of EONS. Evidently reduced PCT levels are observed after 2 days of treatment. The authors conclude that prenatal antibiotic therapy does not reduce the value of PCT levels in blood for the diagnosis of EONS.
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14
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Torbé A, Ustianowski P, Ustianowska M, Celewicz Z, Torbé D. [Outline of the history of caesarean section – from ancient times to the end of 17th Century]. Przegl Lek 2017; 74:48-50. [PMID: 29694003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Problems with the childbirth accompanied the human civilization since its beginning. From the ancient times, physicians and other people specializing in healing, tried to help women in this special moment of life. At the base of this exceptional meaning of childbirth for humans lies the fact, that if something is going wrong there are two victims - mother and the child. As a result, many times there had been very dramatic attempts of help in this the most difficult journey which in his life every man is undergoing. In this paper a comprehensive review of literature about the history of caesarean section from ancient times to the end of 17th century was done.
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15
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Rzepka R, Dołęgowska B, Sałata D, Rajewska A, Budkowska M, Domański L, Kwiatkowski S, Mikołajek-Bedner W, Torbé A. Soluble receptors for advanced glycation end products and receptor activator of NF-κB ligand serum levels as markers of premature labor. BMC Pregnancy Childbirth 2015; 15:134. [PMID: 26059227 PMCID: PMC4461927 DOI: 10.1186/s12884-015-0559-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 05/18/2015] [Indexed: 01/12/2023] Open
Abstract
Background This study aimed to determine the relationships between secretory and endogenous secretory receptors for advanced glycation end products (sRAGE, esRAGE), sRANKL, osteoprotegerin and the interval from diagnosis of threatened premature labor or premature rupture of the fetal membranes to delivery, and to evaluate the prognostic values of the assessed parameters for preterm birth. Methods Ninety women between 22 and 36 weeks’ gestation were included and divided into two groups: group A comprised 41 women at 22 to 36 weeks’ gestation who were suffering from threatened premature labor; and group B comprised 49 women at 22 to 36 weeks’ gestation with preterm premature rupture of the membranes. Levels of sRAGE, esRAGE, sRANKL, and osteoprotegerin were measured. The Mann–Whitney test was used to assess differences in parameters between the groups. For statistical analysis of relationships, correlation coefficients were estimated using Spearman’s test. Receiver operating characteristics were used to determine the cut-off point and predictive values. Results In group A, sRAGE and sRANKL levels were correlated with the latent time from symptoms until delivery (r = 0.422; r = −0.341, respectively). The sensitivities of sRANKL and sRAGE levels for predicting preterm delivery were 0.895 and 0.929 with a negative predictive value (NPV) of 0.857 and 0.929, respectively. In group B, sRAGE and sRANKL levels were correlated with the latent time from pPROM until delivery (r = 0.381; r = −0.439). The sensitivity of sRANKL and sRAGE for predicting delivery within 24 h after pPROM was 0.682 and 0.318, with NPVs of 0.741 and 0.625, respectively. Levels of esRAGE and sRANKL were lower in group A than in group B (median = 490.2 vs 541.1 pg/mL; median = 6425.0 vs 11362.5 pg/mL, respectively). Conclusions Correlations between sRAGE, sRANKL, and pregnancy duration after the onset of symptoms suggest their role in preterm delivery. The high prognostic values of these biomarkers indicate their usefulness in diagnosis of pregnancies with threatened premature labor.
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Affiliation(s)
- Rafał Rzepka
- Department of Obstetrics and Gynecology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland.
| | - Barbara Dołęgowska
- Department of Laboratory Diagnostics and Molecular Medicine, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland.
| | - Daria Sałata
- Department of Laboratory Diagnostics and Molecular Medicine, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland.
| | - Aleksandra Rajewska
- Department of Obstetrics and Gynecology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland.
| | - Marta Budkowska
- Department of Laboratory Diagnostics and Molecular Medicine, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland.
| | - Leszek Domański
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland.
| | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland.
| | - Wioletta Mikołajek-Bedner
- Department of Obstetrics and Gynecology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland.
| | - Andrzej Torbé
- Department of Obstetrics and Gynecology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland.
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16
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Torbé A, Chłapowska E, Szymańska-Pasternak J, Sulecka A, Bober J, Kwiatkowska E, Kwiatkowski S, Rzepka R, Konstanty-Kurkiewicz W, Torbé B. Urinary lysosomal enzyme excretion in pregnant women with hypertensive disorders. Hypertens Pregnancy 2014; 33:349-59. [PMID: 24724946 DOI: 10.3109/10641955.2014.898305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The authors assessed proximal renal tubular dysfunction and/or damage in pregnant women with various types of hypertension by measuring the three urinary lysosomal enzyme levels: N-acetyl-β-d-glucosaminidase (NAG), arylsulfatase A and β-glucuronidase. METHODS The study consisted of 120 pregnant women divided into four groups: 41 women in 20th week of gestation or more, with pregnancy-induced hypertension (PIH group), 28 pregnant women after 20 weeks of pregnancy with pre-eclampsia (PE group), 21 pregnant women with chronic hypertension, identified before 20th week of pregnancy (CH group) and 30 healthy, pregnant women (healthy controls (HC) group). RESULTS Statistical analysis showed significantly higher levels of all the three of lysosomal enzymes in the urine of patients with PE compared with the healthy pregnant women, pregnant women with PIH and the ones with chronic hypertension. Additionally, significantly higher values of NAG were found in the group of pregnant women with PIH compared with healthy pregnancies. No correlation was found between the concentration of enzymes in urine and values of blood pressure in any of the analyzed groups of pregnant women. CONCLUSIONS The authors conclude that higher values of all the studied enzymes in PE group, in the comparison with the other groups, indicate proximal tubular damage at the cellular level. The lack of correlation between the concentration of lysosomal enzymes and blood pressure suggests that the damage to these parts of kidney is complex. In addition, mechanisms other than hypertension realizing intracellular enzymes may be involved in this process.
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Skoczylas MM, Walat A, Kordek A, Loniewska B, Rudnicki J, Maleszka R, Torbé A. Congenital candidiasis as a subject of research in medicine and human ecology. Ann Parasitol 2014; 60:179-189. [PMID: 25281815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Congenital candidiasis is a severe complication of candidal vulvovaginitis. It occurs in two forms,congenital mucocutaneous candidiasis and congenital systemic candidiasis. Also newborns are in age group the most vulnerable to invasive candidiasis. Congenital candidiasis should be considered as an interdisciplinary problem including maternal and fetal condition (including antibiotic therapy during pregnancy), birth age and rare genetic predispositions as severe combined immunodeficiency or neutrophil-specific granule deficiency. Environmental factors are no less important to investigate in diagnosing, treatment and prevention. External factors (e.g., food) and microenvironment of human organism (microflora of the mouth, intestine and genitalia) are important for solving clinical problems connected to congenital candidiasis. Physician knowledge about microorganisms in a specific compartments of the microenvironment of human organism and in the course of defined disorders of homeostasis makes it easier to predict the course of the disease and allows the development of procedures that can be extremely helpful in individualized diagnostic and therapeutic process.
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Mikołajek-Bedner W, Torbé A, Kwiatkowski S, Michalczyk M, Gizewska M, Rokicki D, Rzepka R, Konstanty-Kurkiewicz V, Domański M, Czajka R. Pregnancy delivery and puerperium in a patient with lysinuric protein intolerance--a case report. Ginekol Pol 2013; 84:654-6. [PMID: 24032281 DOI: 10.17772/gp/1621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The paper presents the course of pregnancy delivery and early postpartum period in a 23-year-old woman with lysinuric protein intolerance (LPI). The pregnancy was uneventful and resulted in a caesarean birth to a healthy baby at 37 weeks gestation. Nevertheless, the course of pregnancy in women with LPI is associated with a significantly increased risk of serious complications, including acute hyperammonemia, preeclampsia and postpartum bleeding, as well as fetus intrauterine growth retardation. In many cases, intensive metabolic monitoring and a proper diet with protein limitation and appropriate amino acids supplementation may significantly reduce the risk for both the mother and the newborn.
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Rzepka R, Zukowski M, Michalczyk M, Nikodemski T, Torbé A, Kwiatkowski S, Mikołajek-Bedner W, Czajka R. [The influence of patient-controlled epidural analgesia on labor progress and neonatal outcome]. Ginekol Pol 2012; 83:92-98. [PMID: 22568352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
AIM The aim of the study was to check the influence of patient control epidural analgesia on labor progress and neonatal outcome. MATERIAL AND METHODS 144 parturients were included into the clinical trial. In 73 cases patient control epidural analgesia was used and in 71 cases pethidine (meperidine) solution was given intravenously. Apgar score, umbilical artery pH, pain intensity the time of the first, second and third stage of labor the rate of episiotomy and uterine postpartum abrasions and the rate of caesarean sections and vaginal operative delivery were compared. RESULTS The time of the second stage of labor was significantly longer in the study group (40.99 vs 26.49 min, p- < 0.005), the neonatal outcome was comparable in both groups. There were no differences in the time of the first and the second stage of labor in primiparas and multiparas analyzed separately. Visual Analogue Score was lower in the study group (Ch(2)-12,48, p-0.25), especially in the subgroups of primiparas and multiparas. CONCLUSIONS Patient control epidural analgesia does not affect the time of the first and second stage of labor, oxytocin augmentation of labor may be the reason of that. This method is a more effective way of relieving labor pain. An increase of operative delivery is not observed after patient control epidural analgesia on condition that low doses and concentrations of analgesic drugs are used.
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Affiliation(s)
- Rafał Rzepka
- Klinika Połoźnictwa i Ginekologii Pomorskiego Uniwersytetu Medycznego, Szczecin, Polska.
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Torbé A, Mikołajek-Bedner W, Kałużyński W, Gutowska-Czajka D, Kwiatkowski S, Błogowski W, Rzepka R, Czajka R. Uterine rupture in the second trimester of pregnancy as an iatrogenic complication of laparoscopic myomectomy. Medicina (Kaunas) 2012; 48:182-185. [PMID: 22836290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Uterine rupture is one of the most dangerous obstetric emergencies carrying a high risk for the mother and the fetus. Reports about uterine rupture in pregnancy following previous laparoscopic surgery have not been frequent; however, an increasing rate of the occurrence of this complication has been observed and reviewed in contemporary literature. We report a case of a spontaneous uterine rupture at 22 weeks of gestation in a 25-year old primigravida, who had had a laparoscopic removal of a small, peduncular, asymptomatic myoma located in the right uterine horn 20 months earlier. Ultrasound examination and subsequent urgent laparotomy confirmed a spontaneous uterine rupture with a nonviable fetus in the peritoneal cavity. Women planning to become pregnant should be qualified for laparoscopic myomectomy with special carefulness. Special attention must be paid to the potential solutions that limit the risk of postoperative uterine rupture, if the absolute necessity for the enucleation of myomas during the reproductive age occurs and a decision about laparoscopic intervention is made.
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Affiliation(s)
- Andrzej Torbé
- Department of Obstetrics and Gynecology, Pomeranian Medical University, 72 Powstańców Wielkopolskich Avenue, 70-111 Szczecin, Poland.
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Kędzierska K, Kwiatkowski S, Torbé A, Marchelek-Myśliwiec M, Marcinkiewicz O, Bobrek-Lesiakowska K, Gołembiewska E, Kwiatkowska E, Rzepka R, Ciechanowski K, Czajka R, Santer R. Successful pregnancy in the patient with Fanconi-Bickel syndrome undergoing daily hemodialysis. Am J Med Genet A 2011; 155A:2028-30. [DOI: 10.1002/ajmg.a.34099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 04/15/2011] [Indexed: 11/06/2022]
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Kordek A, Torbé A, Podraza W, Łoniewska B, Jursa-Kulesza J, Rudnicki J. Does prenatal antibiotic therapy compromise the diagnosis of early-onset infection and management of the neonate? J Perinat Med 2011; 39:337-42. [PMID: 21534881 DOI: 10.1515/jpm.2011.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To assess the impact of prenatal antibiotic treatment on procalcitonin (PCT) and C-reactive protein (CRP) concentrations in cord blood, and on the rate of positive neonatal blood cultures. METHODS Neonates with early-onset infection (Group A; n=46) were compared with healthy controls (Group B; n=240). We evaluated the relationship between prenatal antibiotic therapy and early-onset infection, and for interactions with antibiotic therapy in the neonate immediately after birth. RESULTS In the Group A antibiotics were administered significantly more often prenatally and more often to neonates just after birth. The percentage of negative blood cultures in infected neonates was higher when antibiotic treatment was instituted prenatally. Differences in cord blood PCT and CRP concentrations were significant between both groups and were independent of prenatal antibiotic treatment. Streptococcus agalactiae was the most frequent species. CONCLUSIONS Almost one-third of neonates present with early-onset infection in spite of prenatal antibiotic therapy. Cord blood PCT and CRP measurements may be helpful in the diagnosis of infection also in cases when antibiotic therapy was started prenatally. Prenatal antibiotic administration reduced the number of positive blood cultures in neonates with early-onset infection and was associated with a greater rate of antibiotic treatment after birth in neonates without infection.
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Affiliation(s)
- Agnieszka Kordek
- Department of Neonatal Diseases, Pomeranian Medical University, Szczecin, Poland
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Torbé A, Sokołowska M, Kwiatkowski S, Rzepka R, Torbé B, Czajka R. Maternal plasma lipopolysaccharide binding protein (LBP) concentrations in pregnancy complicated by preterm premature rupture of membranes. Eur J Obstet Gynecol Reprod Biol 2011; 156:153-7. [PMID: 21353369 DOI: 10.1016/j.ejogrb.2011.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 01/07/2011] [Accepted: 01/27/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To compare maternal plasma LBP concentrations in pregnancies complicated by preterm premature rupture of membranes (pPROM), and PROM at term, with their levels in uncomplicated pregnancy, and to determine whether LBP concentrations are of value in the diagnosis of subclinical intra-amniotic infection (IAI) in the prediction of the length of the pPROM-to-delivery interval, and in the prediction of neonatal congenital infection. STUDY DESIGN Thirty-one patients with pPROM, 35 with PROM at term, 33 healthy women at preterm gestation and 35 healthy women at term were included. In the pPROM group, analysis of maternal plasma LBP concentrations with reference to leukocytosis, C-reactive protein, vaginal fluid culture, neonatal infection and pPROM-to-delivery interval was carried out. RESULTS LBP concentrations in the four studied groups were comparable. Although in 58.1% of pPROM cases at least one laboratory parameter of infection was observed, the only difference concerned the subgroup with CRP above 10mg/L, in which LBP concentrations were higher. Comparison of LBP concentrations in patients delivered within 24 and 72h of pPROM and after these times showed no differences, or between patients who gave birth to newborns with and without congenital infection. The predictive values of these measurements were poor. CONCLUSION The predictive value of maternal LBP determinations in the diagnostics of pPROM cases suspected of IAI is unsatisfactory. LBP measurements performed shortly after pPROM, are not of value either in the prediction of newborn's infection, or in the prognosis of latency period duration.
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Affiliation(s)
- Andrzej Torbé
- Department of Obstetrics and Gynecology, Pomeranian Medical University, Szczecin, Poland.
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Torbé A, Czajka R, Gutowska-Czajka D, Sipak-Szmigiel O, Ronin-Walknowska E, Andrysiak-Mamos E, Syrenicz A. Successful outcome of pregnancy complicated by Werner's syndrome. J Matern Fetal Neonatal Med 2010; 23:1056-8. [PMID: 19895352 DOI: 10.3109/14767050903177151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Werner's syndrome is an extremely rare genetic disorder of the autosomal recessive type, characterized by features suggesting premature aging in young adulthood. Because of the concomitant hypogonadism, pregnancy among patients with Werner's syndrome occurs extremely rarely. We present a case of a successful outcome of pregnancy complicated by Werner's syndrome in a 34-year-old primigravida. The reason for early delivery by caesarean section, at 34th week of pregnancy, was exacerbation of coronary symptoms, with early signs of cardiac insufficiency. A healthy female child was born in a good condition, with birth weight of 1950 g.
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Affiliation(s)
- Andrzej Torbé
- Department of Obstetrics and Gynecology, Pomeranian Medical University, Szczecin, Poland.
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Rzepka R, Torbé A, Kwiatkowski S, Blogowski W, Czajka R. Clinical Outcomes of High-risk Labours Monitored Using Fetal Electrocardiography. Ann Acad Med Singap 2010. [DOI: 10.47102/annals-acadmedsg.v39n1p27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objectives: The aim of the study was to review clinical and laboratory outcomes of a cohort of fetuses monitored during high-risk labours, simultaneously by fetal electrocardiography (FECG) and routine cardiotocography (CTG). Materials and Methods: Eighty-three parturients from the Department of Obstetrics and Gynecology of Medical University were included in the clinical study. Inclusive criteria to the study group were: (i) singleton pregnancy at term (between 37 and 42 weeks’ gestation), (ii) longitudinal fetal lying, (iii) more than 2500 g of estimated fetal weight, (iv) meconium-stained liquor, and (v) induction of labour due to fetal indications. Fetal outcome parameters analysed included Apgar scores at 1st, 5th and 10th minute after birth, cord artery acid-base assessment and lactate concentrations analysis. FECG was performed during labour, until the neonate was born, with the use of single spiral scalp electrode connected to the STAN S21 heart monitor. Immediately after delivery, arterial cord blood gas and venous cord blood lactate’s concentrations were analysed. Results: The sensitivity (100%), specificity (97%), negative predictive value (NPV) (100%) and positive predictive value (33%) were higher for FECG than for CTG. Moreover, several significant correlations between episodic/baseline T/QRS ratio rises and cord artery acid-base as well as lactate concentrations were demonstrated. Conclusions: Correlations between episodic/baseline T/QRS ratio rises and fetal outcome parameters indicate that observed changes in FECG reflect neonatal metabolic lactate acidosis. The high sensitivity, specificity and especially very high NPV are proof that FECG serves as a reliable method for electronic fetal monitoring during high-risk labours.
Key words: Fetal asphyxia, STAN system
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Rzepka R, Torbé A, Kwiatkowski S, Blogowski W, Czajka R. Clinical outcomes of high-risk labours monitored using fetal electrocardiography. Ann Acad Med Singap 2010; 39:27-32. [PMID: 20126811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES The aim of the study was to review clinical and laboratory outcomes of a cohort of fetuses monitored during high-risk labours, simultaneously by fetal electrocardiography (FECG) and routine cardiotocography (CTG). MATERIALS AND METHODS Eighty-three parturients from the Department of Obstetrics and Gynecology of Medical University were included in the clinical study. Inclusive criteria to the study group were: (i) singleton pregnancy at term (between 37 and 42 weeks' gestation), (ii) longitudinal fetal lying, (iii) more than 2500 g of estimated fetal weight, (iv) meconium-stained liquor, and (v) induction of labour due to fetal indications. Fetal outcome parameters analysed included Apgar scores at 1st, 5th and 10th minute after birth, cord artery acid-base assessment and lactate concentrations analysis. FECG was performed during labour, until the neonate was born, with the use of single spiral scalp electrode connected to the STAN S21 heart monitor. Immediately after delivery, arterial cord blood gas and venous cord blood lactate's concentrations were analysed. RESULTS The sensitivity (100%), specificity (97%), negative predictive value (NPV) (100%) and positive predictive value (33%) were higher for FECG than for CTG. Moreover, several significant correlations between episodic/baseline T/QRS ratio rises and cord artery acid-base as well as lactate concentrations were demonstrated. CONCLUSIONS Correlations between episodic/baseline T/QRS ratio rises and fetal outcome parameters indicate that observed changes in FECG reflect neonatal metabolic lactate acidosis. The high sensitivity, specificity and especially very high NPV are proof that FECG serves as a reliable method for electronic fetal monitoring during high-risk labours.
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Affiliation(s)
- Rafal Rzepka
- Department of Obstetrics and Gynecology, Pomeranian Medical University, Szczecin, Poland.
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Kwiatkowski S, Torbé A, Dołegowska B, Błogowski W, Czajka R, Chlubek D, Rzepka R. Isoprostanes 8-iPF2alpha-III: risk markers of premature rupture of fetal membranes? Biomarkers 2009; 14:406-13. [PMID: 19548773 DOI: 10.1080/13547500903045583] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS Isoprostanes may serve as sensitive and specific markers of in vivo oxidative stress intensity. We wanted to determine, whether or not isoprostane concentration may be considered as a risk marker of premature rupture of fetal membranes (PROM). METHODS On the basis of the presence of PROM and gestational maturity, a total of 128 patients were divided into: (1) preterm PROM (pPROM) group; (2) PROM at term group; (3) control preterm (C1) group and (4) control at term (C2) group. The concentrations of 8-iPF(2alpha)-III were determined using the enzyme-linked immunosorbent assay method. RESULTS The mean free isoprostane concentrations, examined in amniotic fluid and maternal plasma in the PROM at term patients were significantly higher than in C2 individuals (p < 0.01). The mean concentrations of free 8-iPF(2alpha)-III measured in blood plasma from women in the C1 group were significantly lower than in patients from the pPROM, PROM at term and C2 groups (p < 0.001, p < 0.00001 and p < 0.00001, respectively). CONCLUSION The measurement of free isoprostane concentration in maternal plasma and amniotic fluid may be considered as a laboratory marker of a PROM-risk pregnancy.
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Affiliation(s)
- Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Pomeranian Medical University, Szczecin, Poland
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Rzepka R, Torbé A, Czajka R, Kwiatkowski S, Bartoszek M, Cymbaluk A. [Rapid assessment of the IL-6 cervico-vaginal fluid level in threatening preterm labor]. Ginekol Pol 2009; 80:678-681. [PMID: 19886241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES The aim of the study was to check the cervico-vaginal fluid IL-6 levels using rapid, quantitive test in patients with threatening preterm labor before and after tocolytic treatment. MATERIAL AND METHODS Sixty seven singular pregnant women, between 24 and 36 weeks of gestation, were included into the clinical trial. 35 women who were admitted to the Department due to clinical symptoms of threatened preterm labor formed the study group. 32 women between 24 and 36 gestational week, with uncomplicated pregnancy formed the control group. Levels of IL-6 were measured just after material collection, using fast, quantitative spectrofotometric test. RESULTS The cervico-vaginal IL-6 level was higher in the study group (458 pg/mL vs 123 pg/mL; p < 0.05). A significant reduction of cervico-vaginal IL-6 level was observed after two days of tocolytic treatment. CONCLUSION A bedside, quantitative spectrofotometric method allows for a quick and repeatable assessment of cervico-vaginal IL-6 levels to establish the risk of preterm labor as well as enables the monitoring of the effectiveness of tocolytic treatment.
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Affiliation(s)
- Rafał Rzepka
- Klinika Połoznictwa i Ginekologii, Pomorska Akademia Medyczna, Szczecin.
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Torbé B, Falco M, Torbé A, Ciepiela P, Kurzawa R. Radiotherapy versus radiochemotherapy with cisplatin in treatment of cervical cancer. Med Oncol 2009; 27:1-8. [PMID: 19130321 DOI: 10.1007/s12032-008-9159-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 12/17/2008] [Indexed: 11/26/2022]
Abstract
AIM To compare effects of concomitant radiochemotherapy (RCTh) and radiotherapy (RTh) alone in patients with cervical carcinoma and with 36-months follow-up analysis. MATERIAL AND METHODS 106 stage IIA-IVA cervical carcinoma women were divided in two groups. RCTh group was treated with teleradiotherapy (50.4 Gy/T), intracavitary brachytherapy (46 Gy), and iv cisplatin (40 mg/m(2)). RTh group was treated with pelvic teletherapy (52-54 Gy/T) and intracavitary brachytherapy (50-55 Gy). RESULTS In RCTh group absorbed radiation dose was significantly lower (50.4 vs. 52.7 Gy) and the duration of treatment was significantly shorter (45.1 days vs. 47.8 days). There were no statistical differences in both groups in survival (59% in RCTh group vs. 56% in RTh group), response to treatment (86% vs. 90%), local recurrence (42% vs. 49%) metastasis occurrence (21% vs. 17%), anemia (40% vs. 26%), early postradiation reactions in intestines (77% vs. 65%) and bladder (71% vs. 61%) as well as in incidence of rectovaginal (10% vs. 4%) and vesicovaginal formation of fistulas (6% vs. 4%), respectively. There were significant differences between two groups in: nausea (77% vs. 6%), vomiting (65% vs. 3.7%), leucopenia (69% vs. 26%) and thrombocytopenia (35% vs. 9%), and late postradiation bladder effects (94% vs. 74%). RCTh patients with anemia had lower 36-months survival rates (42% vs. 71%), more frequent local recurrences (77% vs. 31%) and metastasis-free survival rates (61% vs. 90%) than RCTh patients without anemia. CONCLUSIONS RCTh gives better treatment results in patients without than in patients with anemia and higher overall survival rates than RTh in patients without anemia. The only clinical prognostic factor for advance cervical carcinoma is the clinical stage of the disease.
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Affiliation(s)
- Bogdan Torbé
- Department of Radiotherapy, Pomeranian Medical University, Szczecin, Poland
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Czajka R, Kwiatkowski S, Chlubek D, Dołegowska B, Torbé A, Rzepka R. [The assessment of neutrophil elastase measurements usefulness in pregnant women with premature rupture of fetal membranes and chorioamnionitis suspicion]. Ginekol Pol 2009; 80:19-24. [PMID: 19323055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES The evaluation of neutrophil elastase (NE) levels and its usefulness in pregnant women with premature rupture of foetal membranes (PROM) and chorioamnionitis suspicion. MATERIAL AND METHODS We evaluated the relationship between maternal plasma and amniotic fluid NE levels with the presence of chorioamnion infection in sixty pregnant women, divided into two groups--with and without PROM. The diagnostic performance of NE evaluations in discrimination of suspected intraamniotic infection was calculated. RESULTS NE levels in PROM patients are significantly higher than in the control group (p < 0.000001). Significantly higher NE concentrations are also observed in the case of chorioamnionitis. Moreover, if at least two clinical markers of infection were present, the diagnostic value of amniotic fluid NE levels proved to be 100% sensitive and of 100% negative predictive value. CONCLUSIONS NE levels may be used as clinical markers which enable the obstetricians to exclude chorioamnionitis.
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Affiliation(s)
- Ryszard Czajka
- Katedra Połoznictwa, Ginekologii i Neonatologii, Klinika Połoznictwa i Ginekologii PAM w Szczecinie.
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Torbé A. Maternal plasma procalcitonin concentrations in pregnancy complicated by preterm premature rupture of membranes. Mediators Inflamm 2008; 2007:35782. [PMID: 17710246 PMCID: PMC1940053 DOI: 10.1155/2007/35782] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 04/17/2007] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Our objective is to compare maternal plasma procalcitonin concentrations in preterm premature rupture of membranes (pPROM) and premature rupture of membranes (PROM) at term with their levels in uncomplicated pregnancy, and to determine whether these concentrations are useful in the diagnosis of pPROM cases suspected of infection and in the prediction of pPROM-to-delivery interval. STUDY DESIGN Forty eight patients with pPROM, 30 with PROM at term, 31 healthy women at preterm gestation, and 33 healthy women at term were included. In pPROM group, analysis of procalcitonin concentrations with reference to leucocytosis, serum C-reactive protein, vaginal fluid culture, neonatal infection, histological chorioamnionitis and pPROM-to-delivery interval was carried out. RESULTS Procalcitonin concentrations in pPROM and PROM at term cases were comparable. However, in both groups procalcitonin values were significantly higher than in healthy controls in approximate gestational age. In pPROM group, procalcitonin concentrations between the patients with and without laboratory indices of infection were comparable, as well as between patients who gave birth to newborns with and without congenital infection, and between patients with and without histological chorioamnionitis. The predictive values of procalcitonin determinations were poor. CONCLUSION The value of maternal plasma procalcitonin determinations in the diagnostics of pPROM cases suspected of intraamniotic infection, as well as for the prediction of pPROM-to-delivery interval, newborn's infection or histological chorioamnionitis is unsatisfactory. However, procalcitonin concentrations are elevated, both in patients with preterm and term PROMs in comparison to healthy pregnants, and therefore further evaluations are necessary to establish the role of procalcitonin in the pathophysiology of pregnancy.
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Affiliation(s)
- Andrzej Torbé
- Department of Obstetrics and Gynecology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
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Torbé A, Gutowska-Czajka D, Chudecka-Głaz A, Czajka R. [Giant benign ovarian tumor coexisting with late pregnancy--a case report]. Ginekol Pol 2008; 79:441-444. [PMID: 18652134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
We have reported a rare case of a giant ovarian tumor which, due to the lack of proper health care on the side of the patient, had not been diagnosed until 27 weeks of pregnancy. The patient did not demonstrate any clinical symptoms till the moment of the diagnosis. Peripheral blood analysis showed severe anemia at the admission. The right adnex with the multilocular cystic tumor containing bloody fluid and measuring 40 cm in diameter, was removed in the course of the surgical procedure. The histological diagnosis of the tumor was: serous cyst. Surgical removal of the giant tumor allowed for further development of pregnancy and enabled vaginal delivery of healthy newborn at term.
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Affiliation(s)
- Andrzej Torbé
- Klinika Połoznictwa i Ginekologii Katedry Połoznictwa, Ginekologii i Neonatologii Pomorskiej Akademii Medycznej w Szczecinie.
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Kwiatkowski S, Czajka R, Dołegowska B, Chlubek D, Torbé A. [Evaluation of neutrophile elastase and isoprostane 8epiPGF2alpha concentrations in maternal and umbilical cord blood serum and in amniotic fluid in pregnancies complicated by premature rupture of membranes]. Ginekol Pol 2008; 79:281-286. [PMID: 18592867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVES To evaluate the total isoprostane 8-epi-PGF2alpha and neutrophil elastase (NE) concentrations in pregnancies complicated by premature rupture of membranes (PROM). MATERIAL AND METHODS 128 pregnant women were divided into four groups: pregnancies complicated by PROM between 24.-36.(PPBP-N) and between 38 a 41 weeks of gestation (PPBP-D), uncomplicated pregnancies between 24-36 gestation weeks (K1) and pregnancies delivered by cesarean section (before uterine contractions had started) after 38 weeks (K2). The concentrations of NE and isoprostane 8-epi-PGF2alpha were measured in maternal serum, cord blood serum and in the amniotic fluid. RESULTS The following study revealed higher concentrations of NE in maternal serum and in the amniotic fluid than in the umbilical cord blood in PROM cases, and lower amniotic fluid than maternal serum concentrations in the control groups. Also, the levels of isoprostane differentiated between compartments in particular groups. In both groups complicated with PROM, higher maternal serum and amniotic fluid NE concentrations than in controls were found. There were no differences in isoprostane levels between the groups. CONCLUSIONS 1. Higher concentrations of NE in maternal blood serum and in the amniotic fluid than in the umbilical cord blood in PROM cases, as well as lower amniotic fluid than maternal serum concentrations in the controls, may be connected with pathogenesis of PROM. 2. Differentiated maternal serum, cord serum and amniotic fluid isoprostane concentrations may suggest various intensity of oxidative stress in particular compartments. 3. Lack of differences in maternal serum, cord serum and amniotic fluid isoprostane concentrations may suggest similar intensity of oxidative stress in cases with PROM and intact membranes.
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Affiliation(s)
- Sebastian Kwiatkowski
- Klinika Połoznictwa i Ginekologii Katedry Połoznictwa, Ginekologii i Neonatologii Pomorskiej Akademii Medycznej w Szczecinie.
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Torbé A, Czajka R, Kordek A, Rzepka R, Kwiatkowski S, Rudnicki J. Value of vaginal fluid proinflammatory cytokines for the prediction of early-onset neonatal infection in preterm premature rupture of the membranes. J Interferon Cytokine Res 2007; 27:393-8. [PMID: 17523871 DOI: 10.1089/jir.2006.0127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The usefulness of vaginal fluid proinflammatory cytokine assays in the prediction of neonatal congenital infection was evaluated. Sixty-two women between 24 and 34 weeks of pregnancy, complicated by premature rupture of the membranes, were divided into those who delivered newborns with (n = 21) and without (n = 41) signs of infection. Concentrations of all studied cytokines were higher in women who delivered babies with infection. The cutoff values of interleukin-1alpha (IL-1alpha) and IL-1beta > or = 400, IL-6 > or = 2000, and IL-8 > or = 2100 pg/mL predicted infection with a sensitivity of 57%, 57%, 33%, and 76%, a specificity of 73%, 73%, 93%, and 59%, a positive predictive value of 52%, 52%, 70%, and 48%, and a negative predictive value of 77%, 77%, 73%, and 83%, respectively. Receiver operating characteristic (ROC) curve analysis revealed that the predictive performance of the four studied cytokines was comparable. In conclusion, vaginal fluid cytokines after premature rupture of the membranes have moderately predictive value of whether or not a neonate will develop early sepsis.
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Affiliation(s)
- Andrzej Torbé
- Department of Obstetrics and Perinatology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland.
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Torbé A, Czajka R, Kordek A, Rzepka R, Kwiatkowski S, Rudnicki J. Maternal serum proinflammatory cytokines in preterm labor with intact membranes: neonatal outcome and histological associations. Eur Cytokine Netw 2007; 18:102-7. [PMID: 17594943 DOI: 10.1684/ecn.2007.0092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2007] [Indexed: 11/17/2022]
Abstract
Our aim was to compare maternal serum concentrations of interleukin(IL)-1alpha IL-1beta, IL-6 and IL-8 in pregnancies complicated by preterm labor (PTL), with the levels in healthy controls at comparable gestational age, and to determine if these assays have any value in the prediction of early-onset neonatal infection or histological chorioamnionitis. The study population consisted of 65 women with new-onset PTL, and 31 healthy controls. Maternal serum concentrations of IL-6 (8.40 versus 3.30 pg/mL; p = 0.002) and IL-1beta (2.20 versus 0.50 pg/mL; p = 0.003) were significantly higher in patients with PTL as compared to healthy pregnant women. The IL-1beta concentration (13.60 versus 1.20 pg/mL; p = 0.02) was significantly higher in the serum of mothers whose babies developed early-onset infections, than in mothers of newborns that were healthy. However, its predictive value, and the value of the other cytokines studied, was poor. In addition, IL-1beta levels (28.79 versus 5.19 pg/mL; p = 0.001) were significantly higher in patients with histological chorionamnionitis, than in those without the condition,. The cut-off value of >or= 14 pg/mL predicted inflammatory changes with a sensitivity of 80%, specificity of 86%, PPV of 80% and NPV of 86%. IL-1beta seems to be of moderate value in the prediction of histological chorioamnionitis.
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Affiliation(s)
- Andrzej Torbé
- Department of Obstetrics, Gynecology and Neonatology of Pomeranian Medical University, 70-111 Szczecin, Powstańców Wielkopolskich 72, Poland.
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Abstract
BACKGROUND To compare procalcitonin (PCT) concentrations between maternal blood and levels in umbilical cord or venous blood of neonates who were born with or without infection. METHODS Forty-six women with singleton pregnancies, complicated by premature rupture of membranes, preterm delivery and/or chorioamnionitis, were enrolled in this study. The study group comprised 15 patients and their infected newborns. The control group consisted of 31 women and their healthy newborns. We compared PCT concentrations between maternal, umbilical cord and neonatal serum, in both study and control groups. Additionally, PCT levels were compared between the corresponding compartments. RESULTS PCT concentrations in the umbilical cord and venous blood in infected newborns, but not in non-infected neonates, were significantly higher than maternal serum PCT levels. PCT concentrations of mothers who delivered infected newborns were comparable to those in the controls. However, PCT concentrations in the umbilical cord and in the venous blood of the infected newborns were higher than in healthy newborns. CONCLUSION Measurement of maternal PCT concentration during labor does not contribute to early prediction of infection in the neonate. However, umbilical cord PCT concentrations, as well as its neonatal venous levels on the second day of life, seem to be related to intrauterine infection, and may be a useful tool in the diagnosis of early neonatal infection.
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Affiliation(s)
- Agnieszka Kordek
- Department of Obstetrics and Perinatology, Pomeranian Medical University, Szczecin, Poland.
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Torbé A, Czajka R. Are vaginal fluid procalcitonin levels useful for the prediction of subclinial infection in patients with preterm premature rupture of membranes? J Obstet Gynaecol Res 2005; 31:464-70. [PMID: 16176519 DOI: 10.1111/j.1447-0756.2005.00321.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To compare vaginal fluid procalcitonin concentrations in cases of preterm premature rupture of membranes (pPROM) and premature rupture of membranes (PROM) at term, and to determine whether the procalcitonin concentrations are of value in the diagnosis of pPROM cases suspected of subclinical intrauterine infection or in the prediction of the pPROM-to-delivery interval. METHODS Forty-eight patients with pPROM and 30 with PROM at term were enrolled in this study. In pPROM group, analysis was conducted of procalcitonin concentrations with reference to serum leucocytosis, serum C-reactive protein levels and vaginal fluid culture, as well as to the presence/absence of neonatal congenital infection or histological chorioamnionitis. The outcomes of pPROM cases were also recorded with reference to pPROM-to-delivery interval. RESULTS Procalcitonin levels in the pPROM group were significantly higher than in cases of amniorrhexis at term (1.50 vs 0.83 ng/mL; P < 0.001). In the pPROM group procalcitonin concentrations between the patients with and without positive laboratory indices of infection were comparable. Also, no significant correlation was observed between procalcitonin and leucocytosis (r = -0.14; P = 0.33) or C-reactive protein (r = -0.17; P = 0.24). Procalcitonin concentrations of patients who gave birth to newborns with infection were comparable to those in women whose newborns were healthy. In patients with histological chorioamnionitis, procalcitonin concentrations were comparable to those without inflammatory changes. CONCLUSION These findings suggest that the value of vaginal fluid procalcitonin determinations is unsatisfactory in the diagnostics of pPROM cases suspected of subclinical intrauterine infection, as well as for the prediction of pPROM-to-delivery interval, newborn's congenital infection or histological chorioamnionitis.
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Affiliation(s)
- Andrzej Torbé
- Department of Obstetrics and Perinatology, Pomeranian Medical University, Szczecin, Poland.
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Torbé A, Czajka R. Maternal plasma procalcitonin concentrations in patients with preterm labor and intact membranes--prediction of preterm delivery and admission-to-delivery interval. J Perinat Med 2004; 32:332-6. [PMID: 15346819 DOI: 10.1515/jpm.2004.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to evaluate procalcitonin (PCT) plasma levels in pregnancy complicated by preterm labor and to determine their value in the prediction of preterm delivery and the length of the admission-to-delivery interval. The study population consisted of 53 patients with preterm labor and 31 healthy pregnants. The study patients were divided according to the delivery time and to the admission-to-delivery interval. Plasma PCT concentrations were higher in preterm labor than in healthy pregnants. Although at the onset of preterm labor plasma PCT concentrations in patients who delivered prematurely were higher than in patients who, after tocolytic treatment, delivered at term, the difference was not significant. Also in cases of preterm labor delivered within and after three and seven days of admission no differences were observed. The highest values in the prediction of preterm delivery and the length of admission-to-delivery interval corresponded to a PCT concentration of 1.7 ng/ml. These findings suggest that although preterm labor is associated with increased PCT concentrations in maternal plasma, there is no significant association either between plasma concentration of PCT at the moment of threat and preterm delivery, or the admission-to-delivery interval. The predictive value of plasma PCT determinations is unsatisfactory.
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Affiliation(s)
- Andrzej Torbé
- Department of Obstetrics and Perinatology, Pomeranian Medical University, Szczecin, Poland.
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Torbé A, Czajka R. Procalcitonin in cervicovaginal secretion in pregnancies complicated by preterm labor--a preliminary report. Eur J Obstet Gynecol Reprod Biol 2004; 116:177-81. [PMID: 15358460 DOI: 10.1016/j.ejogrb.2003.12.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2003] [Accepted: 12/29/2003] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Although the usefulness of procalcitonin (PCT) in clinical practice is increasing, no data are available on procalcitonin during pregnancy. The purpose of this study was to investigate whether procalcitonin was present in the cervicovaginal secretion of pregnant women and, if so, to evaluate the practical value of determining the concentration. STUDY DESIGN A total of 53 patients in whom preterm labor (PTL) was expected and 31 healthy pregnant women were enrolled in this study. In the preterm labor group procalcitonin concentrations were analyzed with reference to laboratory indices suggestive of infection. The outcome of pregnancy was recorded in each case, with mention of the gestational age at delivery and of the time between admission to hospital and delivery. RESULTS Concentrations of procalcitonin in the preterm labor group were comparable to those in the healthy pregnant women. In the preterm labor group no significant correlations were observed between procalcitonin concentration and laboratory indices of infection. Nor were any correlations observed between procalcitonin concentration at the onset of preterm labor and gestational age either at the onset of labor or at delivery. However, procalcitonin concentrations at the onset of preterm labor were higher in patients who delivered prematurely than in those who delivered near term after treatment to delay labor. Procalcitonin concentrations in women whose babies were delivered within 3, 7 and 14 days of admission and in those whose babies were born at later times were comparable. CONCLUSIONS In this study, procalcitonin was determined in the cervicovaginal secretion of pregnant women for the first time. However, no association was observed either between procalcitonin concentration at the onset of preterm labor and laboratory signs of infection or between procalcitonin concentration and time between admission to hospital and delivery. Procalcitonin determination would be unsatisfactory as a prognostic indicator of the length of time between admission to hospital and delivery.
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Affiliation(s)
- Andrzej Torbé
- Chair and Department of Obstetrics and Perinatology, Al. Powstañców Wielkopolskich 72, 70-111 Szczecin, Poland.
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Torbé A, Czajka R. Proinflammatory cytokines and other indications of inflammation in cervico-vaginal secretions and preterm delivery. Int J Gynaecol Obstet 2004; 87:125-30. [PMID: 15491556 DOI: 10.1016/j.ijgo.2004.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Revised: 07/14/2004] [Accepted: 07/14/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To compare the usefulness of evaluating cervico-vaginal concentrations of proinflammatory cytokines (interleukin [IL]-1alpha, IL-1beta, IL-6 and IL-8) and procalcitonin (PCT), as well as serum levels of C-reactive protein (CRP), leucocytosis and band form granulocytes in the prediction of preterm delivery (PTD). METHODS A total of 65 pregnant women experiencing preterm labor (PTL) were enrolled in the study. Concentrations of the studied markers in women who delivered prematurely and in women who, after treatment, delivered at term were compared. Receiver operator characteristic (ROC) curve analysis was used for all study parameters. RESULTS Cervico-vaginal IL-6 and procalcitonin as well as serum CRP concentrations were higher in women who delivered prematurely than in those who delivered near term. A cervico-vaginal IL-6 level greater than 660 pg/ml was the best predictive value of preterm delivery (sensitivity, 50%; specificity 90%; positive predictive value [PPV], 85%; NPV, 62%; likelihood ratio, 5.17). Moreover, the area under the ROC curve of 0.75 for cervico-vaginal IL-6 was greater than for other markers. CONCLUSION Although cervico-vaginal concentrations of procalcitonin and serum concentration of CRP are higher in women who deliver prematurely, only cervico-vaginal concentration of IL-6 is a good predictor of preterm delivery.
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Affiliation(s)
- A Torbé
- Department of Obstetrics and Perinatology of Pomeranian Medical University, Powstañców Wielkopolskich 72, 70-111 Szczecin, Poland.
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Czajka R, Torbé A, Zebiełowicz D, Rzepka R, Kwiatkowski S. [Clinical analysis of pregnancy complicated by hypertension in the material of the Department of Obstetrics and Perinatology of the Pomeranian Academy of Medicine]. Ginekol Pol 2004; 75:361-6. [PMID: 15524409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
OBJECTIVES The aim of this study was retrospective analysis of arterial hypertension during pregnancy in the Department of Obstetrics and Perinatology of Pomeranian Academy of Medicine in Szczecin, and severe PIH intensive obstetrical care optimization. DESIGN The retrospective analysis of 81 pregnancies complicated by arterial hypertension in the years 1995-2000 was performed. MATERIAL AND METHODS The retrospective analysis of 81 pregnancies was performed. Patients were divided into two groups. In the first pregnancy was ended by caesarean section (n = 43), in the second by vaginal delivery. The mean gestational age, the way of delivery, accompanying diseases, uric acid levels, short term variability, Dawes - Reedman's criteria, presence of decelerations in CTG, Doppler PI, S/D, RI parameters in umbilical artery and cerebral arteries, presence of AEDVF and REDVF in umbilical artery were analyzed. RESULTS Caesarean section was performed in 53.1% of all cases, in 46.9% vaginal delivery took place. Absolute range of short-term variability was more often less than 6 ms in caesarean section group (41.9%). Uric acid level was also higher in caesarean section group (p = 0.000194) CONCLUSIONS 1. The caesarean rate in pregnancies complicated by arterial hypertension is over 50% and during severe PIH is approximately 100%. 2. Caesarean section takes place before estimated delivery date and indications to it are in most cases connected with a main disease 3. Short-term variability is lower among patients from caesarean section group. 4. Uric acid level is a relevant parameter of a degree of arterial hypertension, and the level is higher in first group. 5. Doppler velocimetry of umbilical artery and middle cerebral artery are valid part of obstetrical care among patients with PIH.
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Affiliation(s)
- Ryszard Czajka
- Katedra i Klinika Połoznictwa i Perinatologii, PAM w Szczecinie
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Witczak M, Torbé A, Czajka R. [Maternal serum and amniotic fluid IL-1 alpha, IL-1 beta, IL-6 and IL-8 levels in preterm and term labor complicated by PROM]. Ginekol Pol 2003; 74:1343-7. [PMID: 14669441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
UNLABELLED Cytokines may be implicated in the pathophysiologic mechanisms of preterm and term labor. Many studies indicate cytokines as predictors of preterm delivery and explain partially mechanism of preterm uterine contractions. Complicated relations between mediators in systemic fluids of a fetomaternal unit require further explorations. The right diagnosis and management require better understanding of these relationships. OBJECTIVES The comparison of IL-1 alpha, IL-1 beta, IL-6 and IL-8 levels in maternal serum and amniotic fluid in term and preterm labor complicated by PROM. MATERIAL AND METHODS In 44 patients in premature labor with PROM (group I) and 33 patients in labor at term with PROM (group II) cytokines levels were estimated one time in amniotic fluid: just after PROM, and two times in maternal serum: just after PROM and during labor. RESULTS Amniotic fluid cytokines levels were significantly higher in group I than in group II. Maternal serum cytokines concentrations of IL-1 alpha and IL-1 beta in group I were significantly higher than in group II. IL-6 level was significantly higher in group II than in group I. In both groups maternal serum IL-6 levels during labor significantly increased in comparison to IL-6 levels just after PROM. No correlations between amniotic fluid and maternal serum cytokine levels at PROM were observed. CONCLUSIONS Higher amniotic fluid cytokines levels in patients with preterm labor complicated by PROM than in labor at term with PROM indicate possible differences between PROM mechanisms in preterm and term labor. The increase of IL-6 level during labor can be related with the possible role of this cytokine in the immunological mechanism of the labor beginning. No relationships between amniotic fluid and maternal serum levels of investigated cytokines in PROM suggest the presence of the barrier stopped cytokines transfer by the placenta and the complete separation of these two compartments.
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Affiliation(s)
- Magdalena Witczak
- Katedry i Kliniki Połoznictwa i Perinatologii Pomorskiej AM w Szczecinie
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Torbé A, Bartkowiak E, Czajka R. [Maternal serum procalcitonin concentrations in preterm labour complicated with premature rupture of membranes]. Med Wieku Rozwoj 2003; 7:335-41. [PMID: 15537280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The aim of this study was the evaluation of serum procalcitonin (PCT) concentrations in pregnancy complicated by premature rupture of membranes (PROM) before 36 weeks of gestation. The study group consisted of 42 women with PROM between 25. and 35. week of pregnancy. The control group comprised 38 patients between 24.-35. weeks of pregnancy in acute phase of imminent preterm labor with intact membranes. All of them, after successful treatment in the hospital, delivered near term. In both groups serum PCT concentrations were higher than in healthy patients without pregnancy as compared to literature data. It was also stated that in women with PROM before 36. week of gestation serum PCT concentrations are significantly higher than in pregnant women in acute phase of imminent preterm labor with intact membranes who after successful treatment deliver near term.
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Affiliation(s)
- Andrzej Torbé
- Katedra i Klinika Połoznictwa i Perinatologii, Pomorskiej Akademii Medycznej w Szczecinie
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Kordek A, Giedrys-Kalemba S, Nikodemski T, Bartkowiak E, Torbé A, Czajka R. [Procalcitonin as a marker of perinatal infection in newborn--preliminary data]. Ginekol Pol 2002; 73:727-31. [PMID: 12369301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
UNLABELLED Intrauterine and intrapartum infections in newborn infants are still difficult to recognise. The newborn does not manifest the classic clinical signs of infection usually observed in children and adults and up to now there is no good laboratory marker. In the last few years, procalcitonin (PCT) has been found to increase during different inflammatory processes, especially bacterial ones. In this study we analysed the clinical value of PTC in parturient, umbilical cord and newborn blood for predicting perinatal infection. MATERIAL AND METHODS Thirty parturients with symptoms of intrauterine infection were classified for this study. Blood samples were obtained from the mother, the umbilical cord and the newborn on the second day of life. Serum was stored at -70 degrees C and thawed at the time of analysis. Among the newborns there were 21 infants without and 9 with symptoms and signs of infection. PCT concentration was measured by immunoluminometric assay--LUMI test PCT (BRAHMS). RESULTS Statistically significant results were found on the second day of life: 5.83 (4.70) ng/ml in ill, 1.41 (0.68) ng/ml in healthy (p < 0.0005). We observed a significant correlation between PCT concentration in mother and umbilical cord blood (y = 0.40x + 1.06; p < 0.05), as well as between umbilical cord blood and venous blood on the second day of life in newborns (y = 0.16x 1.21; p < 0.01). CONCLUSIONS Measurement of PCT concentration in perinatal period in the mother and in umbilical cord blood of the newborn may be useful for early diagnosis and monitoring of infectious complications in neonates. We need more data on reference ranges of PCT concentration in pregnant women, parturients and umbilical cord blood.
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Affiliation(s)
- Agnieszka Kordek
- Kliniki Połoznictwa i Perinatologii Pomorskiej Akademii Medycznej w Szczecinie
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Czajka R, Torbé A, Rzepka R, Witczak M. [Clinical analysis of preterm labor]. Ginekol Pol 2000; 71:724-7. [PMID: 11082910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
576 patients with preterm deliveries that occurred between the 22nd to 37th gestation weeks were undergone clinical analysis. The material was collected in the years 1995 to 1999 at Clinic of Obstetric and Perinatology of Pomeranian Academy of Medicine in Szczecin. In our study the rate of preterm delivery was 10.5%. Special attention was paid to mother's age, obstetrics history, socioeconomic, medical and psychogenic conditions of pregnant women, condition of infants, infant mortality and their birth-weight. The rate of premature preterm rupture of fetal membranes was 52.7%. The frequency of caesarean sections in our study in preterm births was about 50% like in other publications and the most important indication for them was amnionitis. In almost 40% the general state of infants was poor and medium. Almost 25% of preterm deliveries is connected with other systemic diseases during pregnancy.
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Affiliation(s)
- R Czajka
- Kliniki Połoznictwa i Perinatologii IPG PAM w Szczecinie
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Lange-Konior K, Rajewska B, Torbé A, Czajka R, Drechsler D, Kornacewicz-Jach Z. [Labor in women with heart and great vessel diseases]. Ginekol Pol 1997; 68:281-8. [PMID: 9599082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The way of termination of pregnancy was retrospectively analysed in 95 pregnant women with heart and/or great vessels diseases, hospitalised in years 1989-1991 and 1995-1996 in the Department of Obstetrics and Perinatology of Pomeranian Medical Academy. The condition of cardiovascular system was assessed according to NYHA classification on admission and just before delivery with participation of an experienced cardiologist. Kind of heart disease, mode and period of delivery, perinatal cardiovascular symptoms, duration of delivery and duration of hospitalisation, weight and clinical condition of the newborns were taken under consideration. In more than half of cases (60%) cesarean sections were performed. Among the indications for elective cesarean section cardiological indications formed the dominant group (29.5%). During perinatal period deterioration of circulatory system sufficiency associated with increase of number of cesarean sections were observed.
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Affiliation(s)
- K Lange-Konior
- Kliniki Połoznictwa i Perinatologii IPG PAM w Szczecinie
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Mizgiert W, Torbé A, Głaz A, Zebiełowicz D, Czajka R. [Significance of doppler ultrasound examination in successful termination of pregnancy with arterial hypertension in the course of chronic proliferative glomerulonephritis]. Ginekol Pol 1995; 66:297-301. [PMID: 8522229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Diagnostic and therapeutic management in pregnant woman with severe arterial hypertension in course of glomerulonephritis proliferativa chronica at kidney insufficiency stage was presented. Ultrasonic biometry, biophysical fetal profile and Doppler ultrasound velocimetry were performed for antenatal fetal surveillance. Relation between a degree of fetal compromise (abnormal qualitative Doppler velocimetry indices and pre-pathological or even pathological NST) and a long-drawn increase of both diastolic and systolic blood pressure was stated. Doppler ultrasound examination gave possibility of monitoring and evaluation of fetal distress and verification of its treatment efficacy, what would allow to prolong the pregnancy for 12 days and was a definite contribution to its successful outcome.
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Affiliation(s)
- W Mizgiert
- Kliniki Połoznictwa Instytutu Połoznictwa i Ginekologii PAM w Szczecinie
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Torbé A. [Characteristics of uterine contraction curve registered by external tocography in imminent premature delivery with tocolytic treatment being given special consideration]. Ann Acad Med Stetin 1993; 39:167-183. [PMID: 8154617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Characteristics of uterine contraction curve was evaluated from recordings obtained by means of external topography in imminent premature delivery, as well as from comparative analysis of changes of the said characteristics in the course of tocolytic therapy. The study covered 19 pregnant women with imminent premature delivery symptoms and 12 giving birth "at term", in whom respectively 433 and 142 uterine contractions were recorded topographically. After digital processing of the records with the aid of original software, 10 features of curves for changes in the uterine wall tonus, registered in the course of tocolytic therapy by using magnesium sulphate, salbutamol and fenoterol, were subjected to retrospective computer analysis. It has been disclosed that fenoterol caused the earliest and most strikingly expressed changes in the area of analyzed features of the uterine contraction curves, while applying higher doses there was a significant shortening of overall contraction length, and of the time at respective levels of amplitude. Contractions registered in patients with imminent premature pregnancies before the onset of tocolytic treatment were characterized by higher values of features reflecting changes in intrauterine pressure, but by lower values of features associated with the duration of contraction in confrontation with the recordings, accomplished for comparison purposes, of delivery "at term" in the latent phase.
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Affiliation(s)
- A Torbé
- Kliniki Połoznictwa Instytutu Połonictwa i Ginekologii Pomorskiej Akademii Medycznej
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