Using Robson classification to analyze cesarean section and induction rates in relation to changes in the standards of perinatal care in one hospital in Poland

BACKGROUND

Poland has one of the highest cesarean birth (CB) rates in Europe. For this study, we used the Robson Ten-Group Classification System (TGCS) to analyze trends in the induction and CB rates in one hospital in Poland over a period of 11 years. We compare these trends with changes in National Legislative and Medical Guidelines introduced during this time that were aimed at lowering rates of unnecessary medical interventions.

METHODS

We conducted a retrospective study including all births after 24 weeks' gestation between 2010 and 2020 from one tertiary hospital (n = 66,716 births). After the deletion of records with missing data, 66,678 births were included in the analysis. All births were classified according to the Robson TGCS. The size, CB rate, and contribution of each group for every year were calculated. Linear regression analyses were used to analyze trends over time.

RESULTS

The total CB rate varied from 29.6% to 33.0% during the study period, with a linear increase of 0.045 percentage points annually (R2 = 0.021; F(1) = 0.189; p = 0.674). This study was considerably lower than the total CB rate for Poland, which rose from 33.9% in 2010 to 45.1% in 2020, increasing at a rate of 1.13 percentage points per year (R2 = 0.93; F(1) = 61.88; p < 0.001). Induction rates among both nulliparous (R1 + R2) and multiparous (R3 + R4) women at term also increased. Study groups R5 (previous cesarean birth), R2 (nulliparous in induced or prelabor cesarean delivery), and R1 (nulliparous women at term with single cephalic pregnancy in spontaneous labor) were the highest contributors to the overall CB rate. The greatest decrease in the CB rate was detected in group R5b (more than one previous CB). None of the groups showed statistically significant increases in CB rates over the study period.

CONCLUSIONS

The CB rate in the hospital where the study was conducted was considerably lower than the total CB rate in Poland. When compared with countries with similar CB rates, group R2b (women with nulliparous, prelabor cesarean birth) in our study was considerably larger. More comparisons across different hospital settings in Poland are needed. However, as hospitals are not encouraged to routinely collect the data needed to construct TGCS, such comparisons are very difficult to conduct.

Perinatal Outcomes and Level of Labour Difficulty in Deliveries with Right and Left Foetal Position-A Preliminary Study

BACKGROUND

Many studies have shown the negative influence of the foetus's occiput posterior position during birth on the final perinatal outcome. This study aims to add to the discussion on the impact of foetus positioning on the course of labour and subjective assessment of the level of labour difficulty.

METHODS

The cross-sectional study took place from February 2020 to September 2021, and consisted of filling out observation forms and the assessment by the midwives and women of the level of labour difficulty. This study is based on the observation of 152 labours in low-risk women.

FINDINGS

When compared to left foetal positioning, labours in which the foetus was in the right position were longer and more frequently failed to progress (in 11.3% vs. 37.5%), and epidural was more frequently administrated (in 30.4% vs. 52.7%). Both women and midwives subjectively evaluated deliveries with a foetus in the right position as more difficult.

CONCLUSIONS

The right positioning of the foetus was related to greater labour difficulty and worse perinatal outcomes. The position of the foetus' head in relation to the pelvis should be considered as an indicator of the difficulty of labour and a support plan for the woman should be offered accordingly.

Barley malt-based composition as a galactagogue - a randomized, controlled trial in preterm mothers

OBJECTIVES

Delayed or insufficient breast milk production, as well as low milk supply, is still a challenging problem to overcome, particularly in the case of preterm delivery. Herbal galactagogues might be a good way to increase milk supply, however, there is a lack of clinical studies confirming their efficacy and safety. The aim of this study was to verify the safety and effectiveness as a galactagogue of the unique galactagogue composition based on barley malt with β -glucan and lemon balm.

MATERIAL AND METHODS

The study included 117 mothers of preterm infants randomly divided into the Galactagogue Group given galactagogue and the Placebo Group. A complete data set was obtained for 80 participants, divided equally between two groups. Volume of milk expressed by mothers during the first two weeks after delivery was the primary outcome and safety of the product was the secondary outcome.

RESULTS

Volume of milk recorded on participants' last visit in the Galactagogue Group was significantly higher than in the Placebo Group (95 mL vs 62.5 mL, p = 0.049). The total expressed milk volume during the study was 4209 ± 335 mL in the Placebo Group vs 6036 ± 498 mL (p = 0.003) in the Galactagogue Group.

CONCLUSIONS

Supplementation with unique Galactagogue composition was safe and increased milk output which allowed achieving target minimal volume of 500 mL per day in first week of lactation in preterm mothers.

New Achievements in High-Pressure Processing to Preserve Human Milk Bioactivity

High-pressure processing (HPP) is a non-thermal technology that is being increasingly applied in food industries worldwide. It was proposed that this method could be used as an alternative to holder pasteurization (HoP; 62.5°C, 30 min) in milk banks but its impact on the immunologic, enzymatic and hormonal components of human milk has not yet been evaluated in detail. The aim of our study was to compare the effects of HPP in variants: (1) 600 MPa, 10 min (2) 100 MPa, 10 min, interval 10 min, 600 MPa, 10 min (3) 200 MPa, 10 min, interval 10 min, 400 MPa, 10 min (4) 200 MPa, 10 min, interval 10 min, 600 MPa, 10 min in temperature range 19-21°C and HoP on the leptin, adiponectin, insulin, hepatocyte growth factor (HGF), lactoferrin and IgG contents in human milk. HoP was done at the Regional Human Milk Bank in Warsaw at the Holy Family Hospital on S90 Eco pasteurizer (Sterifeed, Medicare Colgate Ltd). Apparatus U4000/65 (Unipress Equipment, Poland) was used for pascalization. Milk samples were obtained from women during 2-6 weeks of lactation. Post-treatment culture showed no endogenous bacterial contamination in any tested option. Concentrations of selected components were determined using ELISA tests. The level of all analyzed components were significantly decreased by HoP: leptin 77.86%, adiponectin 32.79%, insulin 32.40%, HGF 88.72%, lactoferrin 60.31@.%, IgG 49.04%. All HPP variants caused an increase in leptin concentration, respectively (1) 81.79% (2) 90.01% (3) 86.12% (4) 47.96%. Retention of insulin after HPP was (1) 88.20% (2) 81.98% (3) 94.76% (4) 90.31% HGF (1) 36.15% (2) 38.81% 97.15% (3) 97.15% (4) 43.02%, lactoferrin (1) 55.78% (2) 57.63% (3) 78.77% (4) 64.75%. Moreover, HPP variant as 200 + 400 MPa preserved IgG (82.24%) better than HoP and resulted not statistically significant change of adiponectin level (38.55%) compare to raw milk. Our results showed that HPP leads to preservation of adipokines, growth factor, and lactoferrin, IgG much better or comparable with HoP.

Content of fatty acids in a diet and the homocysteine levels in women with fertility disorders

OBJECTIVES

Assessment of the effects of consumption of fatty acids on the homocysteine levels in women with fertility disorders.

METHODS AND RESULTS

The study included 286 women at the age between 23 and 46 years (the mean 33.13±4.21 years) with a fertility disorders. We measured: levels of homocysteine [μmol/L] (n=171), body weight and height (n=286). Body mass index (BMI) was calculated. A diet was assessed by 3-day dietary food records method including one day of the weekend. The mean homocysteine (Hcy) levels were 10.02±2.98 μmol/L. Body weight excess was observed in 29.3% of subjects. The percentage of fatty acids in the total energy [%E] it was demonstrated that the mean rate of MUFAs and PUFAs was statistically significantly lower in diets of women with the homocysteine levels >15 μmol/L compared to the group with the Hcy <10 μmol/L. Based on the results of a correlation between the homocysteine levels and consumption of n-6 fatty acids and n-3 fatty acids it is possible to conclude that there are negative correlations observed indicating that higher consumption of these acids is associated with lower levels of homocysteine.

CONCLUSION

Increased consumption of PUFAs, including α-linoleic acid, in a diet seems to be an important factor preventing from hyperhomocysteinemia.

Quality of life in childhood epilepsy with lateralized epileptogenic foci

BACKGROUND

Measuring quality of life (QOL) helps to delineate mechanisms underlying the interaction of disease and psychosocial factors. In adults, epileptic foci in the left temporal lobe led to lower QOL and higher depression and anxiety as compared to the right-sided foci. No study addressed the development of QOL disturbances depending on the lateralization of epileptogenic focus. The objective of our study was to examine QOL in children with lateralized epileptiform discharges.

METHODS

Thirty-one parents of children with epilepsy filled the Health-Related Quality of Life in Childhood Epilepsy Questionnaire (QOLCE). Fifteen children had foci in the left hemisphere and sixteen in the right, as verified with Electroencephalography (EEG) examinations.

RESULTS

We found a significant correlation between foci lateralization and reduced QOL (Spearman's rho = 0.361, p < 0.046). Children with right hemispheric foci exhibited lower overall QOL, particularly in five areas: anxiety, social-activities, stigma, general-health, and quality-of-life.

CONCLUSIONS

We demonstrated for the first time that in children left- and right-hemispheric foci were associated with discordant QOL scores. Unlike in adults, foci in the right hemisphere led to worse emotional and social functioning demonstrating that seizures impact the brain differentially during development.

[Polish adaptation and validation of Health-Related Quality of Life in Childhood Epilepsy Questionnaire]

BACKGROUND AND PURPOSE

Epilepsy is a frequent chronic disease in children, having a strong impact on a child's psychosocial functioning. Effective therapy must take into account the wide range of physical, psychological and social needs of patients. The importance of assessing patients' quality of life is becoming increasingly acknowledged. In addition to providing better health care, it may reveal how the disease and its psychosocial outcome interact. Quality of life in epilepsy can be assessed most reliably by disease-specific measures. Health-Related Quality of Life in Childhood Epilepsy (QOLCE) is an English parental questionnaire for children aged between 4 and 18 years. It contains 87 questions that fall into five domains: physical function, emotional well-being, cognitive function, social function and behavioural function. The original scale has a well-grounded theoretical background and good psychometric properties. The aim of the study was to create a Polish version of QOLCE and evaluate its psychometric properties.

MATERIAL AND METHODS

Parents of 87 patients suffering from epilepsy were recruited in neurological clinics in the Warsaw area.

RESULTS

Reliability was very high (Cronbach's alpha = 0.97). The construct validity was confirmed by the correlation between subscales of QOLCE and the Child Behaviour Checklist, as well as selected clinical measures of child's health (duration of disease: r=-0.22, p=0.02; duration of treatment: r=-0.20, p=0.04; number of hospitalizations: r=-0.24, p=0.02). All the psychometric properties were similar to those of the original scale.

CONCLUSIONS

A Polish scale examining the quality of life was created that takes into account a wide range of psychosocial problems. We confirmed very high reliability and good validity, and thus we recommend the inventory for both research on and clinical diagnostics of Polish children with epilepsy.

[Polish adaptation and validation of beck youth inventories of emotional and social impairment]

INTRODUCTION

Psychiatric disorders are common among children and adolescents, affecting about 15-22% of this population. In order to fully develop emotional and cognitive skills, those children require professional care at early stages of the illness. Inventories addressing the broad range of emotional and social impairments, with high reliability and validity, can be of great help in early diagnostics. Self-report scales were proven valuable diagnostic tools even for young children. The Beck Youth Inventories (BYI) are five self-report measures for children between the ages of 7 and 14. They assess a child's experience of self-concept, depression, anxiety, anger and disruptive behaviour. BYI were created in response to epidemiological studies demonstrating significant prevalence of psychiatric disorders in children as well as the U.S. governmental report suggesting a high value of a brief questionnaires for early diagnostics of those disorders.

AIM

To our knowledge, there existed no Polish self-report scale for children examining a broad range of psychiatric disturbances. The aim of the study was to create a Polish version of BYI and to examine its psychometric properties.

METHOD

Using a culturally-adapted Polish translation, we examined 197 students of three primary schools in Warsaw.

RESULTS

The scales had high reliability (Cronbach's alpha from 0.87 to 0.93). The validity was confirmed by intercorrelations between scales. In addition, boys scored higher on theAnger and Disruptive behaviour scales and young children on the Self-concept scale.

CONCLUSION

Polish self-report inventories for children, examining emotional and social impairments have been created. Very high reliability and good validity of each scale qualify them as trustworthy tools both in scientific research and in individual diagnostics.

Discounting of Delayed and Probabilistic Losses of Different Amounts

Previous research has shown that the value of a larger future reward is discounted less steeply than the value of a smaller future reward. The value of probabilistic reward has been shown to have either an opposite effect on discounting (when a smaller reward is not certain its value was discounted less steeply than the value of a larger reward) or no effect on the rate of discounting at all. The present article shows the results for delayed and probabilistic losses: The same hyperbola-like functions describe temporal and probabilistic discounting of both rewards and losses. In the case of losses, larger delayed amounts are discounted less steeply than smaller delayed amounts (as in the case of delayed rewards). No relationship was found between the amount of probabilistic losses and the rate of discounting of their value. In summary, the results show that the description of the discounting process and the effect of amount on the rate of discounting are basically the same in case of both rewards and losses.

[Mechanisms of transcutaneous absorption. Pharmacologic and biochemical aspects]

Known and potential mechanisms of transcutaneous permeation or resorption of drugs are discussed. The relatively well documented transcellular route is passable for compounds with a low molecular mass (up to about 2000 Da) and sufficient lipid as well as water solubility. Because of the limited absorption capacity of the skin and the slow progress of absorption systemic effects of cutaneously applied drugs with the mentioned properties may be expected only, if they are acting in low concentrations and if a retarded onset of action is tolerable. Further compounds which do not fulfil these conditions sufficiently may be transported through the skin under the aid of exogenic factors such as permeation enhancers. Advantages, disadvantages and limitations of transdermal drug therapy as compared with other routes of application are discussed. Finally the question is dealt with, if the transcutaneous route can be opened also for polar compounds with a higher molecular mass. The permeation of such compounds could take place through intercellular clefts, which are reported to have dimensions permitting the passage of compounds with a molecular mass greater than 2000 Da. The transfer through the masses filling the clefts may require, however, the aid of sorption enhancers.

[The effect of benzenecarboxylic acids--in particular mellitic acid--in in vitro biological system]

Influence of Benzenecarboxylic Acids, Particularly Mellitic Acid, on Biological in vitro Systems. In a first part of the present paper influences of mellitic acid and some other benzenecarboxylic acids on reduplication of Ehrlich ascites tumor cells cultured in vitro are reported. Mellitic acid in the concentration range between 1 and 5 mmol/l caused an increase, in concentrations of 10 mmol/l and above an inhibition of cell multiplication. Benzoic acid, phthalic acid, hemimellitic acid and pyromellitic acid showed in concentrations above 6 to 10 mmol/l inhibitory effects on cell multiplication. The second part reports studies on potential influences of mellitic acid on growth and mesenchymal metabolism of explanted murine fetal tibiae cultured in vitro for six days. Mellitic acid effected in concentrations between 0.5 and 15 mmol/l as compared with control cultures a concentration dependent inhibition of calcification and in concentrations above 2 mmol/l significant increases of the glycosaminoglycan content and growth of the explants, whereas DNA-, total protein- and hydroxyprolin content were not significantly influenced by concentrations up to 10 mmol/l.

[Effects of antirheumatics on the glycosaminoglycan distribution pattern of fetal tibia cultured in vitro]

The glycosaminoglycan (GAG) distribution pattern of murine fetal tibiae cultured for 6 days in vitro was determined and the effects of drugs on the growth of the tibia explants in vitro, on their total GAG content and on their GAG distribution pattern were studied. The explants contained chondroitin-4-sulfate and chondroitin-6-sulfate in a relation of about 4:1; hyaluronic acid was not detected. During the incubation period of 6 days in vitro a mean increase in size of 47% and of the total GAG content of about 80-90% was observed; the GAG distribution pattern was practically unchanged. Incubation of the explants in a medium without ascorbic acid by contrast to a medium containing ascorbic acid (5 and 50 micrograms/ml) lead to a reduction of growth and total GAG content. The nonsteroidal antiphlogistic drugs phenylbutazone (20 and 200 micrograms/ml), ibuprofen (25 and 200 micrograms/ml) and alclofenac (25 and 400 micrograms/ml) effected a concentration dependent decrease of the growth and of the GAG content of the explants mainly due to a reduction of chondroitin-4-sulfate. Prednisolone (10 micrograms/ml) caused a significant increase of the GAG content of the explants leaving their GAG distribution pattern nearly unchanged. Aurothioglucose (400 micrograms/ml) induced a reduction of the growth and of the GAG content of the explants without altering the GAG distribution. Under low concentrations of Na-pentosanpolysulfate (5 micrograms/ml) an increase in growth and in the GAG content by a nearly unaltered GAG distribution pattern was observed, high concentrations (200 micrograms/ml), however, caused a reduction of growth and of the GAG content.

Effects of mellitic acid (MA) and sodium fluoride (NaF) on the histological appearance of murine fetal tibiae cultured in vitro

The aim of this study was to develop a standardized image analysis method for localization and quantitative measurement of calcified structures of murine fetal tibiae cultured in vitro as a completion and verification of previous biochemical studies. The calcified structures of bone stained by von Kossa silver technique and the epiphyseal cartilages showing intensive metachromasia with toluidine-blue staining were converted with grey-value window programs and afterwards the areas of the selected structures were measured. The histomorphological investigations showed that the murine tibiae, incubated for a period of 6 days in a medium with addition of 5 mmol mellitic acid, showed both a significant reduction of calcium deposits and an increase of epiphyseal intercellular cartilage matrix. The tibiae incubated in a medium with addition of 0.5 mmol sodium fluoride significantly showed an increase of calcium deposits in the thickened lamellae of the compacta. These histomorphological results confirm previous biochemical studies.

[Effect of hexosamine derivatives on mesenchymal metabolic processes of in vitro cultured fetal bone explants]

The effects of hexosamine derivatives, glucuronic acid, chondroitin sulfate, and oxyphenbutazone on growth and glycosaminoglycan metabolism of murine fetal bone explants cultured for 6 days in vitro were studied. Glucosamine hydrochloride, glucosamine hydroiodide and glucosamine sulfate (at concentrations of 100 micrograms/ml) caused a significant increase in the growth of the explants; this effect was not due to an increase in cell multiplication, as can be concluded from the DNA content of the explants, but rather to an increase in the glycosaminoglycans in the extracellular cartilage matrix. In addition, the three glucosamine salts induced an increase in the secretion of glycosaminoglycans from the surface of the explants into the culture medium. N-acetylgalactosamine, sodium glucuronide and chondroitin sulfate showed lesser or nonsignificant effects as compared to the glucosamine derivatives or the controls. Galactosamine hydrochloride (100 micrograms/ml) exerted inhibitory actions on the bone explants. Oxyphenbutazone (10 micrograms/ml), also, led to a significant inhibition of the growth and glycosaminoglycan metabolism of the explants without influencing (at this concentration) their DNA content. From the results obtained it is concluded that in the treatment of degenerative joint diseases nonsteroidal antiphlogistics acting similarly to oxyphenbutazone should be used, if at all, as cautiously as possible, whereas drugs with the type of action observed in the three glucosamine derivatives could be expected to exert a beneficial effect.

[In vitro studies on the influence of volatile anaesthetics on cell number, cell volume, and cellular protein, DNA, and RNA content (author's transl)]

The aim of the present investigations was to see, if halothane (h), enflurane (e), isoflurane (i), and methoxyflurane (m) exert cytostatic or cytotoxic effects. The experiments were performed on suspension cultures of an established line of Ehrlich ascites tumor cells, which were gased by a mixture of N2 (78%), O2 (20%), and CO2 (2%) to which the volatile anaesthetics in 5 different concentrations were added by vaporizers. Under standardized conditions (incubation time: 24 or 48 hrs; initial cell density: 2 X 10(5) cells/ml culture medium) the following results were obtained: 1. All anaesthetics exerted dose dependent cytostatic effects, which were reversible up to concentrations of 2.0 vol% (m), 3.0 vol% (h), and 5.0 vol% (e, i). The cytostatic ID50 values (mmol/l) were found to be 0.50 (h), 1.00 (e), 0.72 (i), 1.25 (m). 2. In cell cultures, which were exposed to anaesthetics for 48 hrs cytotoxic effects were observed after doses of 2.0 vol% (m), 3.0 and 4.0 vol% (h), 4.0 and 5.0 vol% (e and i). 3. In contrast to colchicine, which was studied in comparison to the volatile anaesthetics, the mean cell volume of anaesthetic treated cultures showed only minimal deviations from control values. 4. With exception of m, which produced a significant decrease of the cellular protein content in the dose range 1.5-2.0 vol% and of the cellular DNA content in all concentrations applied the 3 other anaesthetics caused an increase of the cellular protein content and a somewhat smaller increase of the cellular nucleic acids content. The obtained results indicate that the effect of anaesthetic agents on dividing cells is not due to the same mode or site of action, but to an influence on different stage of the cell cycle, particularly the interphase. Colchicine-like c-mitosis were not obtained.

[Suspension cultures of Ehrlich ascites tumor cells as a test system for the study of cytotoxic effects of anaesthetics (author's transl)]

Cultures of a permanently in suspension growing line of Ehrlich ascites tumor cells (EATC) were studied regarding their use as a test system for the determination of cytotoxic effects of anaesthetics. These cells, having a comparatively high reduplication rate, are cultured at 37 degrees C in vitro in a chemically defined liquid medium supplemented by 15% horse serum without agitation in a closed system. In order to detect drug effects on the cultures various cellular parameters can be determined due to the suspension character of the cultures without complicated preparatory measures, e.g. cell number or multiplication rate, cell volume, cell volume distribution. Moreover biochemical parameters, such as protein or nucleic acid content, may be estimated after centrifugation of the cultures separately in the cell sediment and the medium supernatant. Applying drugs of various pharmacological groups (cytostatic and anti-inflammatory drugs, local and general anaesthetics) the usefulness of some of these parameters for the detection of cytotoxic effects was studied.

[Glucosamine: its importance for the metabolism of articular cartilage. 2. Studies on articular cartilage]

In healthy individuals there exists a balance between cartilage proteoglycan synthesis and degradation. In arthrotic cartilage this metabolic balance is deteriorated in spite of a sometimes enhanced proteoglycan synthesis, since the catabolic rate exceeds the anabolic rate corresponding to the severity of the disease. The extracellular organic matrix of the cartilage is destroyed. With different experimental models it could be demonstrated, that the non steroidal anti-inflammatory drugs commonly used in the treatment of arthrosis inhibit the synthesis of mucopolysaccharides, intensify the already existing metabolic disorder, prevent a normalization of cartilage composition and thus impair the function of the cartilage. Glucosamine on the other hand increases in a dose-dependent way the ability of cartilage to synthesize both sulfated mucopolysaccharides and protein, thus restoring the catabolic-anabolic balance of the cartilage.

[Glucosamine: its value for the metabolism of articular cartilage. 1. Biochemistry of proteoglycans, studies on in-vitro cultures of embryonal mouse fibroblasts and bone germs]

Mucopolysaccharides (glycosaminoglycanes) are essential constituents of the cartilage (chondroitin sulfate) and the synovial fluid (hyaluronic acid). They are formed within the chondrocyte preferably from glucosamine or from glucose and bound to protein constituting proteoglycanes. Non steroidal anti-inflammatory drugs and corticosteroids inhibit this synthesis. Primary fibroblast cultures and in vitro cultured mouse embryo tibiae show a dose-dependent increased synthesis of mucopolysaccharides and an enhanced growth of the bones after addition of glucosamine to the culture medium. This finding underlines the importance of a sufficient supply of the joints with glucosamine.