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Michal Zygarowicz,1,* Joanna Kacperczyk-Bartnik,2,3,* Janusz Sierdzinski,4 Cezary Wojtyla,5,6 Piotr Pierzynski,5,6 Grzegorz Manka,7 Mariusz Kiecka,7 Robert Z Spaczynski,8 Piotr Piekarski,9 Beata Banaszewska,10 Artur Jakimiuk,11,12 Tadeusz Issat,13 Wojciech Rokita14,15 ,† Jakub Mlodawski,14,15 Maria Szubert,3,16,17 Piotr Sieroszewski,16,18 Grzegorz Raba,19,20 Kamil Szczupak,19,20 Tomasz Kluz,21 Marek Kluza,21 Michal Lipa,3,22 Damian Warzecha,5,22 Miroslaw Wielgos,23,24 Ewa Koc-Zorawska,25,26 Marcin Zorawski,26,27 Piotr Laudanski5,6,28 1Students’ Scientific Group Affiliated to the Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, Warsaw, Poland; 2II Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland; 3Club 35. Polish Society of Gynecologists and Obstetricians, Wrocław, Poland; 4Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland; 5OVIklinika Infertility Center, Warsaw, Poland; 6Women’s Health Research Institute, Calisia University, Kalisz, Poland; 7Angelius Provita Hospital, Katowice, Poland; 8Center for Gynecology, Obstetrics and Infertility Treatment Pastelova, Poznan, Poland; 9Division of Infertility and Reproductive Endocrinology, Department of Gynecology, Obstetrics and Gynecological Oncology, Poznan University of Medical Sciences, Poznan, Poland; 10Chair and Department of Laboratory Diagnostics, Poznan University of Medical Sciences, Poznan, Poland; 11Department of Obstetrics and Gynecology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland; 12Center of Reproductive Health, Institute of Mother and Child in Warsaw, Warsaw, Poland; 13Department of Obstetrics and Gynecology, Institute of Mother and Child in Warsaw, Warsaw, Poland; 14Collegium Medicum Jan Kochanowski University in Kielce, Kielce, Poland; 15Clinic of Obstetrics and Gynecology, Provincial Combined Hospital in Kielce, Kielce, Poland; 16Department of Gynecology and Obstetrics Medical University of Lodz, Lodz, Poland; 17Department of Surgical Gynecology and Oncology, Medical University of Lodz, Lodz, Poland; 18Department of Fetal Medicine and Gynecology, Medical University of Lodz, Lodz, Poland; 19Clinic of Obstetrics and Gynecology, Provincial Hospital, Przemysl, Poland; 20Department of Obstetrics and Gynecology, University of Rzeszow, Rzeszow, Poland; 21Department of Gynecology, Gynecology Oncology and Obstetrics, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland; 22Department of Obstetrics and Gynaecology, Warsaw Southern Hospital, Warsaw, Poland; 23Premium Medical, Warsaw, Poland; 24Faculty of Medicine, Lazarski University, Warsaw, Poland; 25II Department of Nephrology, Hypertension and Internal Medicine with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland; 26The Academy of Applied Medical and Social Sciences, Elbląg, Poland; 27Department of Cardiology, Lipidology and Internal Medicine with Cardiac Intensive Care Unit, Medical University of Bialystok, Bialystok, Poland; 28Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, Warsaw, Poland*These authors contributed equally to this work†Professor Wojciech Rokita passed away on March 18, 2020Correspondence: Piotr Laudanski, Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, Kondratowicza Street 8, Warsaw, 03-242, Poland, Tel +48 22 326 53 80, Email piotr.laudanski@wum.edu.plIntroduction: Endometriosis is an inflammatory-related reproductive age disease characterized by the presence of endometrial cells outside the uterine cavity. Current laboratory practice does not provide specific markers for detecting and assessing the advancement of endometriosis in either plasma or peritoneal fluid. The severity of disease is assessed in stages from I to IV based on the results of laparoscopic inspection. The protein annexin A2 (ANXA2) has been reported to be associated with inflammatory processes.Aim of the Study: The study aimed to investigate and compare ANXA2 protein concentration using the ELISA method in plasma and peritoneal fluid in a group of women with endometriosis compared to controls.Materials and Methods: Biological material was collected during a multicenter, cross-sectional study, which was conducted at eight departments during elective laparoscopy from 53 women with and 40 women without endometriosis. Patients were divided by endometriosis stage and infertility status, and then compared with subgroups. Analysis included the Chi-square test for categorical variables, Mann–Whitney U-test and two-sided Wilcoxon rank-sum test for continuous variables.Results: Women with endometriosis had significantly elevated plasma ANXA2 levels compared to women without endometriosis (mean concentrations 28.69 vs 19.61 ng/L, p=0.01). Differences in peritoneal fluid ANXA2 levels were statistically insignificant (mean concentrations of 23.7 vs 22.97 ng/L, p=0.06). Plasma concentrations in patients with stage III and IV endometriosis were significantly higher compared to controls (mean concentrations of 24.19 vs 19.71 ng/L, p=0.03). No such differences were observed in plasma when comparing stages I–II vs III–IV, and stages I–II vs controls (mean concentrations of 33.82 vs 24.19 ng/L, p=0.72 and 33.82 vs 19.71 ng/L, p=0.12, respectively). Comparison of samples from patients with or without infertility, primary or secondary infertility, endometriosis with or without infertility, and non-endometriosis with or without infertility showed no significant differences in the plasma nor in the peritoneal fluid concentrations.Conclusion: ANXA2 is possibly involved in the pathogenesis of endometriosis, especially in advanced stages. Due to the limited group of tested samples, further studies are needed to confirm its role.Keywords: annexin A2, endometriosis, infertility

Objectives: There have been significant advances in the medical management of severe postpartum hemorrhage (sPPH) over recent decades, which is reflected in numerous published guidelines. To date, many of the currently available national and international guidelines recommend recombinant factor VIIa (rFVIIa) to be used only at a very late stage in the course of sPPH, as a "last resort", before or after hysterectomy. Based on new safety data, rFVIIa has recently been approved by the European Medicines Agency (EMA) and Swissmedic for use in sPPH, if uterotonics are insufficient to achieve hemostasis, which in fact is significantly earlier in the course of postpartum hemorrhage (PPH). We therefore aimed to develop expert consensus guidance as a step toward standardizing care with the use of rFVIIa for clinicians managing women experiencing life-threatening sPPH. Methods: The consensus process consisted of one face-to-face meeting with a group of nine experts, including eight obstetrician-gynecologists and a hematologist highly experienced in sPPH care in tertiary care perinatal centers. The panel was representative of multidisciplinary expertise in the European obstetrics community and provided consensus opinion in answer to pre-defined questions around clinical practice with rFVIIa in the management of sPPH. Recommendations have been based on current national and international guidelines, extensive clinical experience, and consensus opinion, as well as the availability of efficacy and new safety data. Results: The expert panel developed 17 consensus statements in response to the 13 pre-defined questions on the use of rFVIIa in the management of sPPH including: available efficacy and safety data and the need for interdisciplinary expertise between obstetricians, anesthesiologists, and hematologists in the management of sPPH. Based on novel data, the experts recommend: (1) earlier administration of rFVIIa in patients with sPPH who do not respond to uterotonic administration to optimize the efficacy of rFVIIa; (2) the importance of hematological parameter prerequisites prior to the administration of rFVIIa to maximize efficacy; and (3) continued evaluation or initiation of further invasive procedures according to standard practice. Furthermore, recommendations on the timing of rFVIIa treatment within the sPPH management algorithm are outlined in a range of specified clinical scenarios and settings, including vaginal delivery, cesarean section, and smaller birthing units before transfer to a tertiary care center. The panel agreed that according to available, and new data, as well as real-world experience, there is no evidence that the use of rFVIIa in patients with sPPH increases the risk of thromboembolism. The authors acknowledge that there is still limited clinical effectiveness data, as well as pharmacoeconomic data, on the use of rFVIIa in sPPH, and recommend further clinical trials and efficacy investigation. Conclusions: This expert panel provides consensus guidance based on recently available data, clinical experience, and expert opinion, augmented by the recent approval of rFVIIa for use in sPPH by the EMA. These consensus statements are intended to support clinical care for sPPH and may help to provide the impetus and a starting point for updates to existing clinical practice guidelines. [ABSTRACT FROM AUTHOR]

The article offers guidelines from the European Association of Perinatal Medicine for preterm labor and birth management. Topics discussed include the etiology of spontaneous preterm delivery (PTD), a study suggesting that placenta is not sterile, and the studies that published the risk factors for spontaneous PTD.

To compare the clinical effectiveness of the two most commonly used LMWHs, dalteparin (DALT) and enoxaparin (ENOX), in thromboprophylaxis of elective total hip replacement (THR) or total knee replacement (TKR).

Group B streptococcus (GBS) remains worldwide a leading cause of severe neonatal disease. Since the end of the 1990s, various strategies for prevention of the early onset neonatal disease have been implemented and have evolved. When a universal antenatal GBS screening-based strategy is used to identify women who are given an intrapartum antimicrobial prophylaxis, a substantial reduction of incidence up to 80% has been reported in the USA as in other countries including European countries. However recommendations are still a matter of debate due to challenges and controversies on how best to identify candidates for prophylaxis and to drawbacks of intrapartum administration of antibiotics. In Europe, some countries recommend either antenatal GBS screening or risk-based strategies, or any combination, and others do not have national or any other kind of guidelines for prevention of GBS perinatal disease. Furthermore, accurate population-based data of incidence of GBS neonatal disease are not available in some countries and hamper good effectiveness evaluation of prevention strategies. To facilitate a consensus towards European guidelines for the management of pregnant women in labor and during pregnancy for the prevention of GBS perinatal disease, a conference was organized in 2013 with a group of experts in neonatology, gynecology-obstetrics and clinical microbiology coming from European representative countries. The group reviewed available data, identified areas where results were suboptimal, where revised procedures and new technologies could improve current practices for prevention of perinatal GBS disease. The key decision issued after the conference is to recommend intrapartum antimicrobial prophylaxis based on a universal intrapartum GBS screening strategy using a rapid real time testing. [ABSTRACT FROM AUTHOR]

Aim: Retrospective analysis of the course of pregnancy, labor and mode of anesthesia in women with portal hypertension and esophageal varices induced by portal vein thrombosis. Material: From 2000 to 2012 seven pregnant were admitted. None had liver transplantation (Ltx), the varicose have been in the 1st stage. Each of them has been consulted by the obstetrician, transplant surgeon and anesthetist. The patient condition during pregnancy, labor and postpartum period was analyzed. Results: Pregnancy in five cases proceeded physiologically. In one threatening miscarriage was diagnosed and treated with gestagens, two patients had tocolytic. One required variceal banding twice. In three thrombocytopenia worsened, with platelet count < 70 g/L (up to 59 g/L). They received platelet transfusion before delivery. In one case, significant hipoproteinemia (4.7 g/L) occurred. In a case, GDM G1 and oligohydramnios were found. All women delivered at term (37-40 Hbd). In all general anesthesia with the use of remifentanil was done. There were no fluctuations in MAP and HR. Incision to delivery time was 2.5 min. Time from opioid administration to birth was <4 min. All children were born in good condition, weight 10-90 percentile. Regional anesthesia is contraindicated in patients with thrombocytopenia. In patients with esophageal varices sudden increase in heart rate and blood pressure can cause hemorrhage. Conclusion: Patients with portal hypertension can deliver at term. It is a high-risk pregnancy. In this group it is desirable to shorten the second stage of labor or complete it by c-section under general anesthesia with remifentanyl which allows getting desired analgesia without complications in the newborn. Surveillance of pregnant with portal hypertension must include monitoring of liver function and coagulation disorders. [ABSTRACT FROM AUTHOR]

The Colton (Coa) antigen is of high frequency; its incidence in Caucasians is about 99.8%. Reports on haemolytic transfusion reactions and haemolytic disease of the foetus/newborn (HDFN) due to anti-Coa are rare. We report a severe HDFN due to anti-Coa. The first child of the mother was healthy. The second died a few hours after delivery because of hydrops fetalis, likely due to HDFN; anti-Coa in the maternal serum, the father typed as Co(a+). The third pregnancy was followed up by the measurements of anti-Coa titre (additional antibodies were excluded), its functional activity by the chemiluminescence test (CLT) and the Doppler flow in the middle cerebral artery of the foetus. Increased values of antibody titre up to 128, the CLT to 30% and multiplex of median of the peak systolic velocity to 1·71 indicated haemolytic disease and the necessity for an intrauterine transfusion. The foetus received the maternal red blood cells (RBCs). Delivery had to be by Caesarean section for obstetrical reasons at 34-week gestation. The newborn (anti-Coa on red cells and in plasma, the rise of the bilirubin concentration up to 333 μmol L−1) had four exchange transfusions: the first of maternal RBCs, the remaining of donor’s Co(a+) cells and one top-up transfusion. The baby was discharged in good health. Anti-Coa was responsible for severe HDFN. Proper monitoring during pregnancy and antenatal and post-natal therapy were successful. This is the second severe published HDFN due to anti-Coa. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 35-year-old gravida suffering from Galen aneurysmal malformation. The patient underwent ultrasound scan which showed fetal hydrops, impaired contractility and cardiomegaly. She was also diagnosed with dural sinus malformation (DSM) in the fetus indicating edema.

An abstract of the conference paper "Transvaginal cervical length measurement as a predictor of preterm delivery in IVF patients," by M. Wielgos and colleagues is presented.

Abstract Background Immunosuppressive therapy protects the transplanted organ but predisposes the recipient to chronic infections and malignancies. Transplant patients are at risk of cervical intraepithelial neoplasia (CIN) and cervical cancer resulting from an impaired immune response in the case of primary infection or of reactivation of a latent infection with human papillomavirus of high oncogenic potential (HR-HPV). Methods The aim of this study was to assess the prevalence of HR-HPV cervical infections and CIN in 60 female kidney graft recipients of reproductive age in comparison to that in healthy controls. Cervical swabs were analyzed for the presence of HR-HPV DNA. HR-HPV-positive women remained under strict observation and were re-examined after 24 months for the presence of transforming HR-HPV infection by testing for HR-HPV E6/E7 mRNA. All the HR-HPV-positive patients were scheduled for further diagnostic tests including exfoliative cytology, colposcopy and cervical biopsy. Results The prevalence of HR-HPV did not differ significantly between the study group and the healthy controls (18% vs 25%, p = 0.37). There was no correlation between HR-HPV presence and the immunosuppresive regimen, underlying disease, graft function or time interval from transplantation. A higher prevalence of HR-HPV was observed in females who had had ≥2 sexual partners in the past. Among HR-HPV-positive patients, two cases of CIN2+ were diagnosed in each group. In the course of follow-up, transforming HR-HPV infections were detected in two kidney recipients and in one healthy female. Histologic examination confirmed another two cases of CIN2+ developing in the cervical canal. Conclusions Female kidney graft recipients of reproductive age are as exposed to HR-HPV infection as are healthy individuals. Tests detecting the presence of HR-HPV E6/E7 mRNA offer a novel diagnostic opportunity in those patients, especially in those cases where lesions have developed in the cervical canal.

An abstract of the conference paper "Is mid-gestational cervical length measurement as sensitive prediction factor of preterm delivery in IVF as in spontaneous singleton pregnancies?," by I. Szymusik and colleagues is presented.

An abstract of the conference paper "Cervical bacterial colonization and cervical length in women with threatening preterm labor," by D. A. Bomba-Opon and colleagues is presented.

An abstract of the conference paper "Thrombocytopenia in neonates treated by repeated intrauterine transfusions," by R. Bartkowiak and colleagues, is presented.

An abstract of the conference paper "The evolution of indications for amniocentesis-four years experience after introduction of skrining programme," by P. Wegrzyn and colleagues is presented.

An abstract of the conference paper "NT-proBNP concentrations and MCA velocimetry in fetuses severely affected by feto-maternal isoimmunisation-preliminary report," by K. Luterek and colleagues is presented.

An abstract of the conference paper "Comparison of conventional and three-dimensional sonohysterography in the assessment of submucous uterine myomas before their hysteroscopic resection," by R. Bartkowiak and colleagues is presented.

An abstract of the conference paper "Placental measurements in the first trimester and adiponectin, leptin and insulin plasma concentrations," by D. A. Bomba-Opon and colleagues is presented.