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A novel coronavirus - SARS CoV-2 - outbreak has, for sure, been the greatest medical challenge in recent years. The maternal and neonatal consequences of the infection are still largely unknown.This prospective study aims to describe the perinatal care and outcomes of SARS-CoV-2 positive pregnant women and their newborn infants during the third wave of the pandemic, in a large tertiary university center in Wroclaw/Poland from 15 February to 1 May 2021.The paper describes a group of 83 women with confirmed SARS-CoV-2 infection during delivery, as well as their newborn infants (n = 84). The course of COVID-19 disease in pregnant patients was mostly asymptomatic (56%) but 31% women manifested mild to moderate symptoms and 14% had severe infection. The median gestational age at the delivery was 38 weeks. On average, 16.7% of mothers were separated from their newborns at birth, 83.3% practiced skin-to-skin, and roomed in with their babies, and 84.5% of the infants received any mother'smilk. Preterm infants were more often borne by mothers with symptomatic course of COVID-19 infection. Need for neonatal treatment was only due to prematurity. Neonates with acquired infection (after 14th day of life) had to be treated symptomatically with fever and loose stools, only 28.5% had symptoms of respiratory failure.Despite the confirmed SARS-CoV-2 infection, the majority of mother- infant dyads were in a good health condition. The data on perinatal care reported in the paper could be helpful contribution supporting childbirth physiology protection during the COVID-19 pandemic.

Objectives: To analyze and compare the bioelectric and mechanical activity of the uterus in pregnant women with threatening preterm delivery treated with tocolysis. Additionally, auxiliary parameters of the bioelectric signal, as registered by electrohysterography and characteristic only for this method, were measured and analyzed. Material and methods: Forty-five women with pregnancies from 24 to 36 weeks of gestation with typical clinical symptoms of threatening preterm delivery were given tocolytic therapy. Registration and analysis of bioelectric activity with electrohysterography was performed simultaneously with registration and analysis of mechanical activity with tocography. Results: After administration of tocolytic treatment, the presence of bioelectric activity was accompanied by the lack of or minimal occurrence of mechanical activity. All parameters of contraction recorded by electrohysterography had significantly greater values than those recorded by tocography. Conclusions: Measurement of bioelectric activity is more sensitive than measurement of mechanical activity of the uterus. Elevated bioelectric activity of the uterine muscle was observed despite the use of tocolysis, a lack of symptoms of threatening preterm delivery, as well as a lack of contraction in tocography. The presence of bioelectric activity may precede the occurrence of mechanical activity of the uterus, but further research is required on larger groups of patients.

The recommendations represent the current procedure, which may be modified and changed where justified, after a thorough analysis of the given clinical situation, which may be the basis for their modification and updating in the future.

Rooming-in is the WHO-recommended care system for mothers in the puerperium and their babies. This system allows the newborn to stay with the mother in the same room, 24 h a day. We aimed to investigate the need to entrust a newborn (NEN) in the care of maternity rooming-in staff during the COVID-19 pandemic, and its relationship to pain, anxiety, and blood loss after delivery. A prospective study of 200 adult women in the maternity ward operating in the rooming-in system focussed on NEN in the care of maternity rooming-in staff on the first (T1) and the second day of puerperium (T2). Women who declared having NEN were compared with women without NEN for anxiety, pain, and a drop in haemoglobin in the blood after delivery. In T1, 34% and in T2, 27% of women felt NEN in the care of maternity rooming-in staff. The NEN of women after a cesarean section was higher on both days than the NEN of women after vaginal delivery. Women with NEN had higher levels of pain, state anxiety, and higher levels of postpartum anxiety than women without NEN. Further research should be warranted to investigate whether women who give birth in hospitals that satisfy the NEN in the care of maternity rooming-in staff in their rooming-in units experience less pain and anxiety in comparison to those who give birth in hospital units without such a possibility and whether this factor is an important element in reducing anxiety and pain during puerperium.

Background The impact of lifestyle factors including health-promoting physical activity on complication rate following amniocentesis is unclear. Objectives To examine the further course of pregnancy in patients undergoing amniocentesis in relation to selected risk factors including the level of health-promoting activity and occupational work on the complication rate after genetic amniocentesis. Material and methods Medical records from 317 diagnostic amniocenteses were analyzed and 230 procedures carried out on 219 pregnant women were included in the study. Results The mean maternal age was 34.50 ±5 years (range: 22-47 years). In the patients studied, amniocentesis was performed at 12-24 gestational weeks with a median at 16 gestational weeks (mean: 16.13 ±2.02 weeks). Overall, 174 amniocenteses (75.6%) did not reveal any genetic disorder while 56 (24.4%) confirmed a genetic disorder. One hundred procedures (43.5%) were followed by at least 1 complication, while 130 procedures (56.5%) were uneventful. The following complications were observed: general pain - 37 (16%), fever - 5 (2.2%), dizziness - 7 (3%), amniotic fluid leakage - 5 (2.2%), vaginal bleeding - 3 (1.3%), and fetal death - 11 (4.8%). The following lifestyle factors were reported: use of stimulants - 12 (5.2%), occupational work - 158 (68.7%), commuting - 137 (59.6%), and physical activity - 62 (27%). Abdominal pain/uterine contractions were significantly more frequent with generalized pain, fever, vaginal bleeding, and physical activity. The presence of dizziness correlated with generalized pain in women who were working and commuting. Working occupationally when pregnant correlated positively with practicing sport. Better newborn condition was significantly correlated with older gestational age and longer sick leave. Conclusions Physical activity performed by pregnant women after amniocentesis increases the risk of post-procedural complications such as abdominal pain, uterine contractions, dizziness, and syncope. Reducing physical effort 2 weeks after the procedure is recommended. Further studies are warranted.

It has been reported that female sex hormones influence on allergic inflammation and ventilation parameters in asthma but conclusions drawn by different researchers are divergent. The aim of our study was to assess the impact of progesterone (Pg) and estradiol (E) on the dynamics of allergic inflammation and spirometry test results in regularly menstruating women with stable allergic asthma. 13 women (28 days menstrual cycle), aged 18-45, taking no hormonal contraceptives, with mild and moderate asthma, without reported exacerbations at the near-ovulation and/or menstruation time, were monitored during two consecutive menstrual cycles. They had 4 visits per cycle (the first day of menstruation was assumed to be day 1 of the cycle; visits were carried out on days: 3-4, 10-11, 13-14 and 23-24). At each visit asthma symptoms, asthma control test (ACT) results, asthma treatment, fractioned nitric oxide (FENO) levels, spirometry test results, Pg and E, levels were analyzed. As a result of the study, no essential variability in FENO values and ventilation parameters' values in the course of menstruation cycle were observed. Negative correlation between FENO values and Pg concentrations was demonstrated (r = 0.27), but no correlation between FENO values and E levels was shown. No relationship between the ACT values and ventilation parameters and the levels of the sex hormones under investigation was detected. We conclude that changing levels of estradiol and progesterone (regardless of the negative correlation of progesterone and FENO values) affect neither the dynamics of allergic inflammation nor pulmonary function in women with stable allergic mild/moderate asthma.

Background Pelvic organ prolapse is the most frequent medical condition in women in the postmenopausal age. The pathophysiology is multifactorial. Objectives The purpose of this paper was to analyze the prevalence of selected anamnestic factors in the population of women treated due to pelvic organ prolapse in the 2nd Department and Clinic of Obstetrics and Gynecology Wroclaw Medical University (Poland). Material and methods A total of 104 medical histories of women treated in the 2nd Department and Clinic of Obstetrics and Gynecology in the years 2012-2013 due to pelvic organ prolapse were analyzed. Results The most frequent type of defect was the complex defect concerning both cystocele and rectocele. Intensity of dysfunctions was determined by age, obstetric history (parity, newborn's body mass and process of labor), and woman's constitutional characteristic (her BMI and height). A comparison based on the type of defect revealed no differences between the groups except for BMI, which was the highest in the rectocele group (31.15 ±5.84; p = 0.0069). Conclusions The multifactorial ethology and differential clinical presentation including several types of this defect make this disorder difficult to prevent and treat. The obtained results confirm that there exists a relation between the data from the medical history and the prevalence of pelvic organ prolapse. Anamnesis can be useful when predicting prevalence and, in the future, may even help to decrease the prevalence of this type of disorder.

We aimed to assess if tobacco smoke, as measured by the serum concentration of cotinine and blood concentration of cadmium, influences the fetal, sac, and trophoblast volume in the first trimester of pregnancy. We enrolled women in weeks 11 to 14 of pregnancy: 35 smokers, 24 passive smokers, and 98 nonsmoking healthy women. We found that the fetus volume was similar in all groups (18.70 ± 6.29, 17.11 ± 5.4, 18.97 ± 7.55 cm3). The trophoblast was significantly smallest in smokers (50.27 ± 19.56, 56.71 ± 23.50, 61.95 ± 22.94 cm3). The trophoblast volume was correlated with cotinine and cadmium concentration ( r = -0.54, r = -0.44). In passive smokers, gestational sac and trophoblast volume grew systematically and were correlated with the mean parental height. In smokers, only the gestational sac grew systematically and was correlated with the mean parental height. The fetus volume was independent of mean parental height and intensity of exposure to tobacco smoke. Volumetric changes of the fetus, trophoblast, and sac may be observed in the first trimester; however, their consequences require further research.

Placental mesenchymal dysplasia (PMD) is a rare benign vascular anomaly of the placenta. It can be misdiagnosed as a molar pregnancy resulting in unnecessary termination of pregnancy. A 30-year-old woman was referred to our hospital at 18 gestational weeks due to suspicion of molar pregnancy. The ultrasound showed a bulky placenta with multiple cysts. Oligohydramnion and fetal hypoechogenic cystic area without doppler flow were diagnosed at 23 weeks. The baby was operated on after delivery, and an 80 mm multifocal cyst originating from the right lobe of the liver was removed. The placenta demonstrated swelling stem villi with enlarged vessels and increased interstitial cells without trophoblast proliferation. PMD and fetal hepatic cyst can coexist; however, the relationship between those conditions remains to be elucidated. PMD is associated with adverse pregnancy outcomes but also with a good prognosis.

Background The aim of the study was to assess the clinical outcomes of surgical repair of uterine cesarean scar defects with sonography (US). Methods Seven nonpregnant women with history of cesarean section and a large uterine scar defect were enrolled. The surgical repair was performed by minilaparotomy. The US assessment of the uterine scar was performed using a standardized approach at baseline, then at a first visit 2–3 days following the surgical intervention (V1) and at a follow-up visit 3 months later (V2). Residual myometrial thickness (RMT), width, and depth of the scar defect were measured. Results The mean RMT increased significantly from 1.9 mm at baseline to 8.8 mm at V1 and 8.0 mm at V2. No intraoperative complications were observed. Postmenstrual spotting and abdominal pain reported preoperatively resolved after the operation. Conclusions A surgical repair procedure for an incompletely healed uterine cesarean scar is effective in increasing RMT thickness, decreasing the depth of the scar, and reducing symptoms related to the cesarean section scar defect. Further studies on post-repair pregnancy outcomes are required to evaluate whether the procedure affects the rate of cesarean scar pregnancy, morbidly adherent placenta, and/or uterine scar dehiscence and rupture. The repair of a cesarean scar defect is recommended only for symptomatic women. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:455–460, 2017

Fucose, the monosaccharide frequent in N- and O-glycans, is a part of Lewis-type antigens that are known to mediate direct sperm binding to the zona pellucida. Such interaction was found to be inhibited in vitroby fucose-containing oligo- and polysaccharides, as well as neoglycoproteins. The objective of this study was to screen seminal plasma proteins of infertile/subfertile men for the content and density of fucosylated glycoepitopes, and compare them to samples of fertile normozoospermic subjects. Seminal proteins were separated in polyacrylamide gel electrophoresis and blotted onto nitrocellulose membrane and probed with fucose-specific Aleuria aurantia lectin (AAL). Twelve electrophoretic bands were selected for quantitative densitometric analysis. It was found that the content, and especially the density of fucosylated glycans, were higher in glycoproteins present in seminal plasma of subfertile men. No profound differences in fucosylation density were found among the groups of normozoospermic, oligozoospermic, asthenozoospermic, and oligoasthenozoospermic subfertile men. According to the antibody probing, AAL-reactive bands can be attributed to male reproductive tract glycoproteins, including prostate-specific antigen, prostatic acid phosphatase, glycodelin and chorionic gonadotropin. Fibronectin, α1 -acid glycoprotein, α1 -antitrypsin, immunoglobulin G and antithrombin III may also contribute to this high fucosylation. It is suggested that the abundant fucosylated glycans in the sperm environment could interfere with the sperm surface and disturb the normal course of the fertilization cascade.

Purpose The aim of the study was to determine reference values for placental vascular indices and placental volume according to gestational age. Material/methods The assessment of placental vascular indices and placental volume using 3D Power Doppler and the Virtual Organ Computer-aided Analysis (VOCAL) technique was performed on 100 normal fetuses between 22 and 41 weeks of gestation. In this study the method of the individual setting of the power Doppler gain value was used. Only patients with entirely visualized placenta were included in the study. Results No statistically relevant difference in the values of placental vascular indices and placental volume between different localizations of the placenta was detected. No statistically significant changes to placental vascular indices depending on gestational age were found. It enabled to determine the 10th, 50th and 90th percentile values for the vascularization index (VI), flow index (FI), vascularization-flow index (VFI), which are independent of gestational age. No correlation was found between placental volume and placental vascular indices. Conclusions The values of placental vascular indices are constant between the 22nd and 41st week of a normal pregnancy. Placental volume measured with the use of the VOCAL program increases between 22nd and 41st week of a normal pregnancy. In a normal pregnancy the placental vasculature increases adequately to the increase of its volume. The method of the individual setting of the power Doppler gain value makes it possible to achieve comparable values of placental vascular indices regardless of the distance between the probe and the placenta.

Study Objective The aim of the study was to present the results of a new surgical technique used for the treatment of stage 3 and 4 Pelvic organ prolapse according to the POP-Q scale. Design Group of 36 women has been qualified for the procedure of suspending the cervix to the rectus abdominis (RA) fascia with the insoluble sutures guided through the fascia via the polypropylene mesh placed above the fascia. The effectiveness of the treatment was assessed both: objectively - on the basis of improvement in gynecological examination - and subjectively using the certified questionnaires: PFDI-20 and POP-QL- 12 months after the surgery. Further control is planned 3 and 5 years after the procedure. Setting The study was conducted within the 2nd Department of Obstetrics and Gynaecology, Medical University in Wroclaw, Poland. Patients or Participants 36 women with the initial diagnosis of severe POP (3rd and 4th stage) has been qualified for the study Interventions The surgery was performed either by laparotomy (20) or laparoscopy (16). The insoluble monofilament suture was used to suspend cervix to the fascia of the RA. and additionally reinforced with polypropylene mesh placed above the fascia. The uterine body was either preserved, or in the case of any pathology, the suspension was preceded by supracervical hysterectomy. Measurements and Main Results Preliminary results are promising - 84.6% of objective and subjective improvement. Six women (16.6%) had a relapse and 4 women (11.1%) required reoperation. Conclusion Presented technique seems to be a safe and effective alternative to other POP treatment methods. It is associated with a negligible complications rate. Laparoscopic approach with it's superiority to laparotomy in some patients and a short learning curve, makes it even safer. Increasing the number of treated patients and continuing follow-up 3 and 5 years after the surgery is planned.

The aim of the study was to investigate the role of oestrogens in free radical detoxication upon exposure to fluoride. Interactions between xenobiotics and oestrogens need to be investigated, especially as many chemicals interact with the oestrogen receptor. It is still unknown whether free radical-generating xenobiotics can influence the antioxidative ability of oestradiol (E(2)). In an in vitro examination of human placental mitochondria, thiobarbituric active reagent species (TBARS), hydroxyl radical ((*)OH) generation and protein thiol (-SH) groups were detected. 17beta-E(2) was examined in physiological (0.15-0.73 nM) and experimental (1-10 microM) concentrations and sodium fluoride (NaF) in concentrations of 6-24 microM. E(2) in all the concentrations significantly decreased lipid peroxidation measured as the TBARS level, in contrast to NaF, which increased lipid peroxidation. Lipid peroxidation induced by NaF was decreased by E(2). The influence of E(2) on (*)OH generation was not very significant and depended on the E(2 )concentration. The main mechanism of E(2) protection in NaF exposure appeared to be connected with the influence of E(2 )on thiol group levels, not (*)OH scavenging ability. The E(2) in concentrations 0.44-0.73 nM and 1-10 microM significantly increased the levels of -SH groups, in contrast to NaF, which significantly decreased them. E(2) at every concentration reversed the harmful effects of NaF on -SH group levels. No unfavourable interactions in the influence of E(2) and NaF on TBARS production, (*)OH generation, or -SH group levels were observed. The results suggest that postmenopausal women could be more sensitive to NaF-initiated oxidative stress.

OBJECTIVE: To assess the risk factors and clinical symptoms related to the complete separation of the cesarean section (CS) scar in the nonpregnant uterus. DESIGN: Observational study. MATERIALS AND METHODS: The study group included twenty-five women with a history of low transverse CS in whom a complete separation of the CS scar was diagnosed using saline infusion sonohysterography (SIS) and hysteroscopy (HSC). The diagnosis of complete separation of the CS scar was made when at the site of the scar no myometrial tissue could be visualized. RESULTS: Fifteen women (60%) had a history of one CS, six (24%) had a history of two CSs and four women (16%) of three CSs. No statistically important difference was found between the number of previous CSs and complete separation of the CS scar (p>0.05). The type of the last CS before the diagnosis of the scar separation was as follows: in 8 cases (32%) elective CS, in 17 cases (68%) emergency intrapartal CS (p

Objectives: To assess the association between ultrasonographic parameters of the Cesarean scar in non-pregnant uterus and the number of previously performed Cesarean sections. Methods: The study group included 310 non-pregnant women with a history of low transverse Cesarean section with single-layer uterine closure. The transvaginal ultrasound was performed to assess the following parameters of the Cesarean section scar: the thickness of the knit tissue scar segment (G) and in case of visualization of a triangular shaped anechoic scar defect the basis (P) and height (W) of this triangle. G/P index and G/W index values were also calculated. Results: Transvaginal sonography enabled the visualization of the Cesarean section scar in 308/310 of the examined women (99.4%). In 55/310 cases (17.7%) the completely knit hysterotomy scar tissue was identified. In the remaining group of 255/310 women (82.2%) an anechoic triangle, defined as scar defect, was observed. The mean thickness of the knit tissue scar segment (G) after single, two and three Cesarean sections was: 9.9 mm, 8.0 mm and 4.1 mm, respectively. Statistically important decrease in the G values with the number of previous performed Cesarean sections was observed. The mean G/P index values after single, two and three Cesarean sections were as follows: 1.68, 1.53 and 0.8. The mean G/W index values were: 2.8, 1.9, 0. 9, respectively. No significant difference in the G/P index values was found between patients after one and two Cesarean sections. Statistically important decrease in G/P index values in the group of patients after three Cesarean sections comparing to the patients after one (0.80 vs. 1.68, P < 0.05) and two Cesarean sections (0.8 vs. 1.53, P < 0.05) was observed. Statistically important decrease in the G/W index values was found between the groups of women after one, two and three Cesarean sections. Conclusions: The thickness of the knit tissue scar segment (G) and the G/W index values decrease with the number of previous performed Cesarean sections.

Background Every year 1.5 million cesarean section procedures are performed worldwide. As many women decide to get pregnant again, the population of pregnant women with a history of cesarean section is growing rapidly. For these women prediction of cesarean section scar performance is still a serious clinical problem. The purpose of the study was to assess whether the parameters of cesarean section scar in the nonpregnant uterus as determined using ultrasound can be used to predict uterine dehiscence in the next pregnancy. Methods Starting in 2005, the study included 308 nonpregnant women with a history of low transverse cesarean section. The following ultrasonographic parameters of the cesarean section scar in the nonpregnant uterus were assessed: the residual myometrial thickness (RMT) and the width (W) and the depth (D) of the triangular hypoechoic scar niche. During 8 years of follow-up, 41 of these women were referred to our department for delivery. In all cases, a repeat cesarean section was performed and the lower uterine segment was assessed. Two independent statistical methods namely the logit model and Decision Tree analysis were used to determine the relation between the appearance of the cesarean section scar in the nonpregnat state and the performance of the scar in the next pregnancy. Results The logit model revealed that the D/RMT ratio showed significant correlation with cesarean section scar dehiscence (P-value of 0.007). Specifically, a D/RMT ratio value greater than 1.3035 indicated that the likelihood of dehiscence was greater than 50%. The Decision Tree analysis revealed that a diagnosis of dehiscence versus non-dehiscence could be based solely on one criterion, a D/RMT ratio of at least 0.785. The sensitivity of this method was 71%, and the specificity was 94%. Conclusions Assessment of the cesarean section scar in the nonpregant uterus can be used to predict the occurrence of scar dehiscence in the next pregnancy.