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Objectives: This study was conducted because of conflicting data on the role of corticosteroids administered before delivery in the late premature period. The aim of the study was to assess the frequency of respiratory disorders in 'late premature infants' and the impact of using prenatal steroid therapy., Material and Methods: The study included 513 newborns born between the 34-36 week of pregnancy. They were divided into two groups. In the first group, there were 439 newborns (85.58%) who did not receive prenatal steroid therapy, and in the second group, there were 74 newborns (14.42%) born after the prenatal steroid course. The frequency of occurrence of respiratory disorders requiring the use of non-invasive respiratory support methods as well as intubation and mechanical ventilation was compared in both groups., Results: In the group of premature infants after steroid therapy 43/74 (58.12%) did not require respiratory support compared to the group of infants without prenatal steroid therapy where in 368/439 (83.8%) cases no respiratory disorders were found., Conclusions: If there is a risk of preterm labor in the 34-36 week of pregnancy, the use of steroid therapy should be considered. Steroidotherapy at this moment of gestation may not be such beneficial, like in the more premature delivery, before 34 weeks of pregnancy.

Objective To evaluate the impact of atosiban as a tocolytic agent in patients treated with the fetoscopic endotracheal occlusion (FETO) procedure due to congenital diaphragmatic hernia (CDH). As premature birth after fetoscopy remains a serious concern, an effort to reduce prematurity is required. Methods A total of 43 patients with severe CDH treated with FETO were enrolled in this study. The study group consisted of 22 patients who received atosiban during the FETO procedure and a control group of 21 patients who did not receive atosiban during the FETO procedure. Demographic data, gestational age (GA) at delivery, cervical length and GA at premature rupture of membranes (PROM) were evaluated. Results The GA at delivery was significantly different between the two groups studied. The median GA at delivery was 32.6 and 34.5 weeks in the no-atosiban vs. atosiban groups, respectively (P = 0.013). The median cervical length was 29.9 and 31.2 mm for the no-atosiban and atosiban groups, respectively, and was not statistically significant (P = 0.28). There were no significant correlations between groups for the occurrence of PROM, GA at the time of PROM, duration of the procedures, parity, maternal body mass index (BMI) or age. In the univariate linear regression model, the only factor independently associated with GA at delivery was the use of atosiban during FETO procedures (β = 0.375; P < 0.013). Conclusion In cases of severe CDH treated with FETO, the use of atosiban as a tocolytic agent during the procedure prolonged pregnancy by 2 weeks. Cervical length, duration of FETO or maternal characteristics were not associated with GA at delivery.

Objective: To evaluate relationships between gestational weight gain (GWG) and adverse events during pregnancy among patients of normal weight with twin pregnancies., Methods: The present observational study included patients with dichorionic twin pregnancies with a pre-gravid body mass index of 18.5-24.99 kg/m 2 who underwent delivery at no earlier than 22 weeks of pregnancy between January 1, 2007, and June 30, 2016, at the Medical University of Warsaw, Warsaw, Poland. The GWG ratio was categorized as low (<0.45 kg/wk), adequate (0.45-0.66 kg/wk), or high (>0.66 kg/wk), and pregnancy outcomes were compared between the GWG ratio groups. Associations between GWG ratio and pregnancy outcomes were estimated using generalized additive models., Results: There were 201 patients included in the study. No differences in rates of preterm delivery, very preterm delivery (VPTD), small for gestational age fetus, pre-eclampsia, gestational diabetes, preterm premature rupture of membranes, or intrauterine fetal demise were observed between the patient groups. Linear relationships with GWG ratio were recorded for VPTD (P=0.019) and spontaneous VPTD (P=0.003); non-linear relationships with GWG ratio were recorded for pre-eclampsia (P=0.023) and perinatal mortality (P=0.015). A GWG ratio of 0.55-0.56 kg/wk appeared optimal in terms of twin pregnancy outcomes., Conclusion: The incidence of VPTD, pre-eclampsia, and perinatal mortality during dichorionic twin pregnancy were associated with GWG ratio., (© 2017 International Federation of Gynecology and Obstetrics.)

Introduction: Preterm birth (PTB) is a predictor of perinatal morbidity and mortality, and prematurity continues to burden public healthcare with growing expenses. First trimester bleeding (FTB) has a well-known association with PTB; however, the relationship with severity of PTB is less obvious., Aim: The primary aim of the study was to analyze the influence of FTB on the risk and severity of PTB, as well as to assess the connection of FTB and other pregnancy complications., Methods: It was an observational case control study. The material consisted of medical records of patients who delivered between 2010 and 2013. Two groups were formed - 497 women with FTB and 500 women without bleeding., Results: Women with FTB were more likely to deliver preterm in general (OR=2.11; 95% CI 1.43-3.10). The risk of extremely PTB (<28 weeks) was almost four-fold (OR=3.76; 95% CI 0.97-17.06) and very PTB (28-31 weeks) more than three-fold (OR=3.41; 95% CI 0.86-15.69). FTB increased the risk of placenta previa (OR=4.81; 95% CI 1.29-20.53; P=0.007)., Conclusion: FTB is a risk factor of PTB and is associated with greater risk of PTB-related pregnancy complications. Management of FTB pregnancies should include thorough screening for both preterm delivery and placental pathologies.

Objective: To review complications in pregnancy after liver transplantation and assess the time interval since transplantation on fetal development and preterm birth rate., Method: A retrospective review of 53 pregnancies after liver transplantation among 45 women who delivered at the Medical University of Warsaw between 2001 and 2013., Results: Mean duration of pregnancy was 37±2.3 weeks. Main complications were liver dysfunction, small-for-gestational-age, and preterm delivery. Mean time from transplant to pregnancy was 54±36 months for women who delivered before 34 weeks (n=9), 42±43 months for delivery at 34-36 weeks (n=10), and 57±36 months for delivery after 37 weeks. Mean neonatal weight was 2838±626 g (<34 weeks, 1897±382 g; 34-36, 2324±330 g; >37, 3125±474 g). Fourteen (26%) neonates had low birth weight (<2500 g) and 30 (56%) weighed <3000 g. Pregnancy proceeded without complication in 13 (29%), with a mean time from transplantation to conception of 52 months., Conclusion: Although physiological gestation and delivery at term are possible for women after liver transplantation, pregnancy is considered high risk. Counselling before pregnancy is required and patients must be managed by an obstetrician and a hepatologist., (Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

The study aimed at investigating the impact of late prematurity (LPT) on neonatal outcome in twins and neonatal morbidity and mortality within LPT with regard to the completed weeks of gestation. The study was conducted in six tertiary obstetric departments from different provinces of Poland (Warsaw, Lublin, Poznan, Wroclaw, Bytom). It included 465 twin deliveries in the above centers in 2012. A comparative analysis of maternal factors, the course of pregnancy and delivery and neonatal outcome between LPT (34 + 0-36 + 6 weeks of gestation) and term groups (completed 37 weeks) was performed. The neonatal outcome included short-term morbidities. The analysis of neonatal complication rates according to completed gestational weeks was carried out. Out of 465 twin deliveries 213 (44.8%) were LPT and 156 (33.55%) were term. There were no neonatal deaths among LPT and term twins. One-third of LPT newborns suffered from respiratory disorders or required antibiotics, 40% had jaundice requiring phototherapy, and 30% were admitted to NICU. The analysis of neonatal morbidity with regard to each gestational week at delivery showed that most analyzed complications occurred less frequently with the advancing gestational age, especially respiratory disorders and NICU admissions. The only two factors with significant influence on neonatal morbidity rate were neonatal birth weight (OR = 0.43, 95% CI = 0.2-0.9, p = .02) and gestational age at delivery (OR = 0.62, 95% CI = 0.5-0.8, p < .01). LPT have a higher risk of neonatal morbidity than term twins. Gestational age and neonatal birth weight seem to play a crucial role in neonatal outcome in twins.

Objective: The objective of this study was to investigate the composition of breast milk which had been gathered from mothers for over first 2 weeks of lactation and to compare the changes in composition of preterm and term milk., Methods: A prospective, single center study was provided in Warsaw, Poland. The samples of breast milk from 22 mothers who had delivered prematurely and 39 mothers who had given birth to term infants were collected. The creamatocrit, energy and fat concentration were estimated in each participant's breast milk sample twice a day (morning and night hours)., Results: The lowest creamatocrit, calories and fat concentration was indicated in the preterm milk obtained in the morning (4.86%, 663.8 kcal/L and 33.6 g/L, respectively). The highest milk parameters were observed in the night samples of full-term milk and measured (9.6%, 919.7 kcal/L, and 60.7 g/L, respectively). No significant differences in analysed parameters were observed between preterm and full-term milk (p>0.05). In summary, creamatocrit, calories and lipid concentration in breast milk shows the daily differences. Colostrum and mature milk from mothers of preterm neonates differed from colostum and mature milk from mothers of term neonates. They had lipid contents, creamatocrit level and calorific value.

Objective: The aim of this study was retrospective evaluation of progesterone efficacy in pregnant patients with preterm uterine contractions., Material: 190 women hospitalized at 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, in 2007-2010, with symptoms of threatened preterm labor were enrolled in the study. 94 women were treated with tocolytics and steroids (control group), while 96 women received additionally 200 mg of progesterone vaginally until delivery or 34th weeks of gestation (progesterone group)., Results: The mean gestational age at admission was 27 weeks in progesterone group and 28 weeks in control group. Cervical length was similar in both groups. There were no significant differences in week of delivery between groups, but the progesterone group had significant increase in prolongation of pregnancy (7.6 versus 6.3 weeks, p = 0.039). Vaginal progesterone was associated with reduction of delivery before 34 weeks (9.8% versus 35.3%; p = 0.002) and neonatal birth weight <1500 g (3.2% versus 20.6%; p = 0.011) only in patients presenting with uterine contractions after 27 weeks., Conclusion: The administration of vaginal progesterone after tocolysis in threatened preterm labor is associated with prolongation of pregnancy. The reduction of deliveries before 34 weeks was observed in patients presenting with contractions after 27 weeks gestation.

Background: Neonates born to mothers, who underwent organ transplantation require close medical monitoring. It is unknown how chronically diseased mother's organs or immunosuppressive drugs affect fetal growth and development; some immunosuppressants are teratogenic and contraindicated during pregnancy. The aim of this study was to determine the prevalence of prematurity and intrauterine growth restriction in neonates born to women who have undergone renal or liver transplantation., Methods: Our retrospective analysis identified 53 (25 renal and 28 liver) cases of neonates delivered by female graft recipients between January 2005 and December 2009. Hypotrophy was defined as a birth weight<10th percentile for gestational age. We excluded newborns diagnosed with severe hypotrophy (<5th percentile)., Results: Neonates born prematurely were predominate in the renal (16/25, 64%), but less than half of the liver cohort (13/28, 46%). Hypotrophy less than the 10th percentile was noted significantly more often among renal than liver recipients; 36% versus 14% (P<.05). Severe hypotrophy was also observed significantly more often among renal than liver transplant neonates: 28% versus 3.6% (P<.001)., Conclusions: Compared with liver insufficiency, chronic kidney diseases have stronger effects on the fetus, leading to adverse neonatal complications. A greater prevalence of preterm births, as well as hypotrophic newborns, especially less than the 5th percentile, was observed among neonates delivered by mothers after kidney transplantation., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: To verify the relation between pregnancy duration and cervical length (CL) at 22-24 wks of spontaneous and IVF singleton gestations and to assess its predictive value for preterm delivery (< 37 wks)., Material & Methods: CL at 22-24 wks was performed according to FMF recommendations in 344 women who conceived spontaneously and in 107 IVF singleton pregnancies. The results of CL in both groups were divided into subgroups: ≤ 29 mm, 30-34 mm; 35-39 mm; 40-44 mm; 45-49 mm and ≥ 50 mm. They were subsequently correlated with mean durations of gestation within subgroups and parameters of accuracy were calculated. Correlation and regression analysis was performed., Results: The average age of women in both groups was 28.1 y.o. (SD=4.2 years) and 33.4 y.o. (SD=4.1 years), respectively. The mean gestation age at delivery was 38.9 wks (SD=2.1 wks) vs. 37.9 wks (SD=2.3 wks) and the rate of prematurity equaled 7% vs. 15%, respectively. Regardless the method of conception there is a positive correlation between the CL and the duration of gestation. The regression analysis showed that the significant increase in pregnancy duration was correlated with CL ≥ 35 mm (correlation coefficient greater for spontaneous vs. IVF: rxy=0.418 vs rxy=0.341; p<0.001). All CL parameters of accuracy were better for spontaneous in comparison to IVF pregnancies., Conclusions: IVF singleton pregnancy carries additional risk factors for preterm delivery. Therefore mid-gestational cervical length is less sensitive predictor than in spontaneous singleton gestations.