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Single nucleotide polymorphisms (SNPs) localised to the promoter region of the

A viral infection is detected through germline-encoded pattern-recognition receptors (PRRs) leading to the production of interferons (IFNs) and proinflammatory cytokines. The objective of this study was to investigate the expression of retinoic acid-inducible gene-I (RIG-I)-like receptors (RLRs) in response to viral infection and the selected cytokine responses in the human term placenta. Placental villi and decidual explants were infected with human cytomegalovirus (CMV) or vesicular stomatitis virus (VSV) and cultured ex vivo to study viral infection. To evaluate DDX58 (RIG-I), IFIH1 (MDA5), and DHX58 (LGP2) expression, quantitative real-time PCR (qRT-PCR) was used. The expression of RLRs was detected by Western blotting. Cytokine and chemokine production, as well as RLR protein levels, were quantified using ELISA. The increased expression of both RIG-I and MDA5 and the enhanced secretion of IFN-s were observed in response to VSV infection compared to mock-infected tissues. CMV infection resulted in higher transcript levels of DDX58 and IFIH1, while no changes in the cytokine production were observed. Our results indicate that RIG-I and MDA5 are specifically expressed in chorionic villi and deciduae in response to VSV infection. These findings suggest that RLRs may play a key role in pathogen recognition and the immune response against intrauterine viral transmission.

Ficolin-2 is regarded as an important innate immunity factor endowed with both lectin (carbohydrate recognition) qualities and ability to induce complement activation. The aim of this study was to investigate the association of the FCN2 3’-untranslated region (3’UTR) polymorphisms with ficolin-2 expression and perinatal complications in preterm neonates. The sequencing analysis allowed us to identify six 3’UTR polymorphisms with minor allele frequency (MAF) >1%: rs4521835, rs73664188, rs11103564, rs11103565, rs6537958 and rs6537959. Except for rs4521835, all adhered to Hardy-Weinberg expectations. Moreover, rs6537958 and rs6537959 were shown to be in perfect linkage disequilibrium (LD) with nine other genetic polymorphisms: rs7040372, rs7046516, rs747422, rs7847431, rs6537957, rs6537960, rs6537962, rs11462298 and rs7860507 together stretched on a distance of 1242 bp and very high LD with rs11103565. The 3’UTR region was shown to bind nuclear extract proteins. The polymorphisms at rs4521835 and rs73664188 were found to influence serum ficolin-2 concentration significantly. All polymorphisms identified create (together with exon 8 polymorphism, rs7851696) two haplotype blocks. Among 49 diplotypes (D1-D49) created from rs7851696 (G>T), rs4521835 (T>G), rs73664188 (T>C), rs11103564 (T>C), rs11103565 (G>A) and rs6537959 (T>A), twenty two occurred with frequency >1%. Two diplotypes: D13 (GTTTGT/GGTCGT) and D10 (GTTTGT/GGTCGA), were significantly more frequent among preterm neonates with early onset of infection and pneumonia, compared with newborns with no infectious complications (OR 2.69 and 2.81, respectively; both p

Ficolin-2 is regarded as an important innate immunity factor endowed with both lectin (carbohydrate recognition) qualities and ability to induce complement activation. The aim of this study was to investigate the association of the FCN2 3’-untranslated region (3’UTR) polymorphisms with ficolin-2 expression and perinatal complications in preterm neonates. The sequencing analysis allowed us to identify six 3’UTR polymorphisms with minor allele frequency (MAF) >1%: rs4521835, rs73664188, rs11103564, rs11103565, rs6537958 and rs6537959. Except for rs4521835, all adhered to Hardy-Weinberg expectations. Moreover, rs6537958 and rs6537959 were shown to be in perfect linkage disequilibrium (LD) with nine other genetic polymorphisms: rs7040372, rs7046516, rs747422, rs7847431, rs6537957, rs6537960, rs6537962, rs11462298 and rs7860507 together stretched on a distance of 1242 bp and very high LD with rs11103565. The 3’UTR region was shown to bind nuclear extract proteins. The polymorphisms at rs4521835 and rs73664188 were found to influence serum ficolin-2 concentration significantly. All polymorphisms identified create (together with exon 8 polymorphism, rs7851696) two haplotype blocks. Among 49 diplotypes (D1-D49) created from rs7851696 (G>T), rs4521835 (T>G), rs73664188 (T>C), rs11103564 (T>C), rs11103565 (G>A) and rs6537959 (T>A), twenty two occurred with frequency >1%. Two diplotypes: D13 (GTTTGT/GGTCGT) and D10 (GTTTGT/GGTCGA), were significantly more frequent among preterm neonates with early onset of infection and pneumonia, compared with newborns with no infectious complications (OR 2.69 and 2.81, respectively; both p

Rapid spread of severe acute respiratory syndrome coranovirus-2 virus (SARS-CoV-2) caused the pandemic of Coronavirus Disease 19 (COVID-19). Clinical course of the disease presents symptoms mainly from the respiratory system such as: cough, dyspnea and fever, and among some patients, can deteriorate even further to acute respiratory distress syndrome (ARDS), eventually leading to death. This outbreak, as well as previous ones (SARS, MERS) pose a significant challenge for health care managers, epidemiologists and physicians. Below we are presenting the clinical profile of the COVID-19 among special group of patients; pregnant women and newborns, who require special clinical management during hospitalization. In the summary of this manuscript, we present practical guidelines for managing pregnant women infected with SARS-CoV-2, labor and care of the newborn of a positive mother, as well as practical guidelines for COVID-19 vaccinations. It is important to stress, that this manuscript is based on information available as of December 2020.

Summary The innate immune response in the placenta depends on the ability of maternal immune cells and fetal trophoblast cells to detect and eliminate invading pathogens through germline-encoded pattern recognition receptors (PRRs). In the present study, we analysed the transcripts and protein expression of interferon (IFN)-inducible protein (IFI)16, melanoma differentiation-associated protein 5 (MDA5), RIG-I-like receptor (RIG-I) and Toll-like receptor (TLR)-3 in third-trimester human placentas and investigated cytokine profiles generated during herpes simplex type 1 (HSV-1) infection. Decidual and chorionic villous biopsies (38–42 weeks of gestation) were obtained from healthy women immediately after a caesarean section. The expression of the DDX58 (RIG-I), IFIH1 (MDA5), IFI16 and TLR3 transcripts was measured using quantitative real-time polymerase chain reaction (qRT–PCR). Extracellular cytokine and PRRs levels were then quantified by enzyme-linked immunosorbent assays (ELISAs). All examined PRRs genes, including DDX58, IFIH1, IFI16 and TLR3, were expressed constitutively at the mRNA and protein levels in the placental biopsies. The concentration of the IFI16 protein was increased in HSV-1-infected decidual and chorionic villous explants compared to those of mock-infected tissues (P = 0·029). Higher protein expression levels of RIG-I in both the maternal and fetal parts of the placenta were found (P = 0·009 and P = 0·004, respectively). In addition, increased production of IFN-β by HSV-1-infected tissues was noticed (P = 0·004 for decidua, P = 0·032 for chorionic villi). No significant differences in the IFN-α, interleukin (IL)-6 and IL-8 levels were found. These results showed that HSV-1 infection can enhance the expression of IFI16 and RIG-I proteins in the human term placenta.

Introduction The aim of this study was to analyse a panel of 60 angiogenic factors (pro-angiogenic and antiangiogenic) in the plasma of women with mild preeclampsia. Materials and Methods We recruited 21 women between 25 and 40 weeks gestation with diagnosed mild preeclampsia into the study group and 27 healthy women with uncomplicated pregnancies of corresponding gestational age to that of the study to the control group. We used a quantitative protein macroarray method that allowed for analysis of 60 angiogenic proteins per sample simultaneously. Results We showed a statistically significant increase in the concentration of 8 proteins, interferon gamma (IFN-γ), interleukin 6 (IL-6), leukaemia inhibitory factor (LIF), heparin-binding EGF-like growth factor (HB-EGF), hepatocyte growth factor (HGF), C-X-C motif chemokine 10 (IP-10), leptin and platelet-derived growth factor BB (PDGF-BB), as well as a significant decrease in the concentration of 3 proteins, vascular endothelial growth factor (VEGF), placental growth factor (PlGF) and follistatin, in the plasma of women with preeclampsia. Conclusion Based on our findings, it seems that protein factors may play an important role in the pathogenesis of preeclampsia, and there are many proteins that have not been studied in PE to date. There are no previous studies assessing the LIF, follistatin, HGF, HB-EGF and PDGF-BB concentrations in the plasma of women with PE; therefore, our obtained results indicate that these proteins are new factors that can play an important role in the pathomechanisms of PE.

Short cervical length (SCL) should be defined as cervical length (CL) less than 25 mm between 18 and 22 weeks of gestation. This definition of SCL is fully applicable for singleton pregnancies but is not entirely correct for twin pregnancies. So far there are no explicit guidelines on the treatment of twin pregnancy with SCL. The use of progesterone in the treatment of SCL and preterm birth (PTB) prophylaxis is one of the interventions recommended by the Polish Ministry of Health for cervical shortening in singleton pregnancies. In twin pregnancies attention should be paid to the potential benefits of using vaginal progesterone in reduction of neonatal mortality and incidence of neonatal complications in a group of patients with twin pregnancies and CL less than 25 mm or below the 10th percentile for the gestational age, measured between 18 and 22 weeks of gestation. It is still difficult to identify the benefits of using pessaries in the prevention of PTB in twin pregnancies. The usage of pessaries appears to be beneficial only in selected subpopulations of patients with asymptomatic CL less than 25 mm or 10th percentile for gestational age. The use of cervical cerclage in PTB prevention in twin pregnancies is limited to cases where the external cervical dilation is >1 cm and

Objectives: Aim of this project is determination of the correlation between the level of vitamin D in blood serum and duration of pregnancy in population in central Poland. Material and Methods: 25-Hydroxyvitamin D (25(OH)D) level was determined in blood serum, using enzyme-linked immunosorbent assay (ELISA). Standardized history of each patient was recorded. The history included: general medical history, data regarding the course of pregnancy and information about health-related behavior that could influence vitamin D concentration. Two hundred-and-one Caucasian women at childbirth were qualified into the study. The study group was divided into 2 parts: 100 patients who had a spontaneous premature birth and 101 patients who had birth at full term. Results: Vitamin D deficiency (< 30 ng/ml) was very common for both groups (69.6% of patients in the premature group and 72% – in the control group). Patients who had a premature birth had severe vitamin D deficiency (less than 10 ng/ml) more often than in the control group (34% vs. 14.2%, p = 0.001). Severe vitamin D deficiency increased the risk of premature birth but the association was not statistically significant in the multivariate regression model (odds ratio (OR) = 2.47, 95% confidence interval (CI): 0.86–7.15, p = 0.094). Conclusions: Severe vitamin D deficiency (< 10 ng/ml) may be the factor increasing the risk of preterm birth. Int J Occup Med Environ Health 2017;30(6):933–941

Objectives: Vitamin D receptor (VDR) is expressed in the placenta and tissues related to the immune system occurrence of various variants of VDR may modify the effects of vitamin D on pregnancy. The aim of this study was to evaluate the association between the parturients’ Apa1, Taq1, and Bsm1 polymorphisms of the VDR and their combinations and the risk of preterm birth in the Polish population. Material and methods: Determination of polymorphism for VDR was assayed using the RT-PCR method. 199 Caucasian women at childbirth were qualified:100 patients who had a spontaneous preterm birth and 99 patients who had a term birth. Results: Three separate genotypes of the Apa1, Taq1, and Bsm1 polymorphisms were detected. No significant differences in the frequency of particular genotypes in the compared groups were found. Some of the genotype combinations were significantly more frequent in the preterm group — the bb/AA/TT genotype (28.0% vs. 10.1%; p = 0.0013) and the BB/aa/tt genotype (14.0% vs. 4.04% p = 0.0277). The Bb/AA/Tt and the BB/Aa/tt genotypes were found only in the control group (16.1% and 7.0% of patients, respectively). The bb/aa/TT was significantly more frequent in the control group (2.0% vs. 11.1%; p = 0,0207). Two genotype combinations reduced the risk of preterm birth — the Bb/AA/Tt genotype by 94% (OR = 0.43, 95% CI: 0.002–0.885, p = 0.041) and the BB/Aa/tt genotype by 98% (OR = 0.029, 95% CI: 0.001–0.838, p = 0.039). Conclusions: Our result suggests that there may be a relationship between certain VDR genotype combinations and the risk of preterm birth. Further research is needed in order to substantiate this finding.

We present a rare case of a complication after pessary insertion during pregnancy due to short cervix. A woman in the 35th week of gestation was admitted to the Department of Perinatology due to preterm labor. The patient's history revealed cervical pessary insertion during the 29th week of pregnancy due to a cervix of 18 mm in length. Because of threatened preterm labor, the pessary was removed. After pessary removal, a rupture of the cervix was diagnosed. Because of active labor and cervical rupture, a cesarean section was performed and a healthy newborn was delivered. After cesarean section the cervical rupture was sutured. Five days after the operation, the patient underwent surgery again due to a necrotically changed part of the cervix. This part of the cervix was removed. We present this case to emphasize that cervical pessaries can cause serious complications during pregnancy. Clinicians should take this into consideration before qualifying patients for pessary insertion.

Objectives: The aim of this study was to compare the costs of using carbetocin in the prevention of uterine atony following delivery of the infant by Cesarean section (C-section) under epidural or spinal anesthesia with standard methods of prevention (SMP). Material and methods: This retrospective multicenter study was based on data from three medical centers. A questionnaire was developed to gather patient records on consumption and costs of resources related to C-section, prevention of uterine atony and postpartum hemorrhage (PPH) treatment. Six subpopulations were considered, depending on patient characteristics. The analysis covered two perspectives: that of the hospital and of the public payer. Results: The subpopulations were homogenous, which was a premise for pooling the data. The use of carbetocin in the prevention of uterine atony following Cesarean section generates savings for hospital in comparison with SMP (oxytocin) in 5 of 6 subpopulations. The biggest savings were observed amongst patients who experienced severe PPH and reached 2.6–6.2 thousand PLN per patient. Costs of services related to C-section borne by the hospitals were higher than the refund received from a public payer. The greatest underestimation reached 12.1 thousand PLN per patient. Nevertheless, loss generated by this underfunding was lower in carbetocin versus oxytocin group. Conclusions: The use of carbetocin instead of SMP gives hospitals an opportunity to make savings as well as to reduce losses resulting from the underfunding of the services provided by the National Health Fund.

Intrauterine growth restriction (IUGR) is one of the most important problems in current perinatology. The number of complications such as intrauterine fetal hypoxia, preterm and operative labours, intrauterine demises and neonatal deaths are signifcantly higher among pregnant women with IUGR. The proper monitoring and assesement of the fetal well-being are crucial to make the right decision about optimal time and mode of delivery.

Periodical medical examinations are mandatory for employees in Poland. This rule makes a unique opportunity during occupational health services for implementation of prophylactic activities focused on early diagnosis of various diseases, including cancers. Epidemiological data about cancers is alarming and what is more, further increase in development of cancers is being predicted in population overall. The highest incidence of cancers in the case of Polish women belongs to breast cancer (21.7% of diagnosed cancers in general), while the morbidity rate for uterine cancer, ovarian cancer and cervical cancer amounts to 7.4%, 4.7% and 3.5%, respectively. The aim of this study was to elaborate an algorithm of prophylactic activities integrated with the occupational healthcare system, based on medical literature review and guidelines concerning prophylaxis of selected cancers. Polish cancers' prophylaxis programs related to risk factors were presented in this publication and practical indications for occupational healthcare physicians were worked out. Med Pr 2018;69(4):439-455.

Pregnancy after organ transplantation is becoming relatively common. We present the case of a heart transplant recipient who gave birth to a second child. Despite the fact that the transplanted heart seems to adapt well to the changes caused by pregnancy, gestation in patients after heart transplantation may be complicated by hypertension, pre-eclampsia, or preterm labor. In this article, we consider the issues of preterm uterine contractions, anemia, thrombocytopenia, and several other complications in pregnant patients with transplanted hearts. We also present current opinions regarding the use of glucocorticoids as a form of preventing breathing disorders in neonates as well as breast-feeding by mothers receiving immunosuppressive agents. Pregnancies in heart transplant recipients should be considered high-risk. A second successful delivery of a healthy child remains a challenge for such patients and their doctors.

Problem Bacteria activates Toll-like receptor 4 on immune system cells leading to preterm birth (PTB). The aim of study was to evaluate the impact of maternal and fetal carriage of TLR4 gene polymorphisms on the risk of PTB. Method of Study Frequency of TLR4 (896A>G, 1196C>T) variants was determined in 121 women who delivered preterm, 152 women who delivered at term, 49 term newborns and 35 preterm newborns with the use of PCR-RFLP. Results We found no associations between frequency of TLR4 polymorphic alleles in mothers and fetuses and the risk of delivery before 37th week of pregnancy. However significantly lower frequency of TLR4 1196T allele was observed in subgroup of mothers who delivered before 33rd week comparing with those who delivered later (4,4% versus 14,2%, OR = 0,28 (95%CI: 0,04–0,99). Conclusions Maternal carriage of TLR4 1196T allele may be associated with reduced risk of PTB before 33rd week of gestation in Polish population.

Objective(s) and design The aim of the study was to analyse a panel of 11 sphingolipids in plasma and three blood fractions (platelet-poor plasma, platelets and red blood cells) of women with mild preeclampsia. Materials and methods We recruited 21 women between 25–40 weeks gestation with diagnosed mild preeclampsia to the study group and 36 healthy women with uncomplicated pregnancies, who corresponded with the study group according to gestational age, to the control group. To assess the concentration of 11 sphingolipids in the blood plasma and blood fractions, we used ultra-high performance liquid chromatography coupled with triple quadrupole mass spectrometry (UHPLC/MS/MS). Results We showed a significant increase in the concentration of eight sphingolipids in the plasma of women with preeclampsia in comparison to the control group: Sph (p = 0.0032), S1P (p = 0.0289), C20-Cer (p < 0.0001), C18-Cer (p < 0.0001), C16-Cer (p = 0.012), C18:1-Cer (p = 0.003), C22-Cer (p = 0.0071), and C24:1-Cer (p = 0.0085). Conclusion We showed that selected sphingolipids, especially C20-Cer and C18-Cer, are totally new factors in the pathomechanism of PE and that these bioactive lipids may play an important role in apoptosis and autophagy.

Intrauterine growth restriction (IUGR) is one of the most important problems in current perinatology. The number of complications such as intrauterine fetal hypoxia, preterm and operative labours, intrauterine demises and neonatal deaths are signifcantly higher among pregnant women with IUGR. The proper monitoring and assesement of the fetal well-being are crucial to make the right decision about optimal time and mode of delivery.

Introduction Our previous study revealed that anti-inflammatory cytokine gene polymorphisms increase the risk of spontaneous preterm delivery (PD) in a population of Polish women. Different genetic background of PD due to preterm premature rupture of membranes (pPROM) than PD without pPROM has been suggested. The aim of this study was to examine the relationship between the maternal carriage of polymorphic alleles of the following genes: interleukin 1β(IL-1β [+3953C>T]), interleukin 6 promoter (IL-6 [−174G>C]), tumour necrosis factor promoter (TNF-α [–308G>A]) and interleukin 1 receptor antagonist (IL-1RN) and the risk of PD caused exclusively by pPROM in a population of Polish women.

Problem The initiation of labor is accompanied by alterations in the level of maternal immune tolerance toward fetal antigens. It is a complex molecular response leading to a brief activation of the maternal immune system with an accompanying capacity to restrict this same activation. The aim of our study was to evaluate the subpopulation of regulatory T cells (Tregs) and B7-H4 macrophages in the decidua basalis during cesarean sections performed on patients in various stages of labor. Method of study The decidual tissue samples evaluated in our study were obtained from 23 pregnant women who underwent cesarean sections at term. Moreover, the patients were divided into three subgroups according to the progression of labor at the time of the cesarean. The presence of Treg cells and B7-H4 positive macrophages were analysed by fluorescence-activated cell sorter. Results The percentages of FOXP3+ cells in the subpopulation of CD25+ CD4+ T lymphocytes found in the deciduas of patients decreased with the successive stages of labor, while the percentages of B7-H4 positive cells in the macrophage subpopulation remained almost constant. Conclusion These changes in the Treg cell subpopulation in the decidua would seem to be related to a brief activation of the maternal immune system as labor begins and lack of analogical changes in the subpopulation of decidual suppressive B7-H4+ macrophages that enable the restriction of this same activation as labor progresses.

Problem Alterations in RCAS1 (a receptor-binding cancer antigen expressed on SiSo cells) expression in the placenta and decidua may be related to the regulation of the process of maternal immune tolerance against fetal antigens. Moreover, it has been demonstrated that the occurrence of the spontaneous beginning of stillbirth is related to a decrease in the placental expression of RCAS1. There are no data currently available on the immune processes in decidua during stillbirth. The aim of this study was to evaluate the RCAS1 immunoreactivity level in decidua and to identify the cytotoxic immune cells present during labor, induced after intrauterine fetal death either with a combination of oxytocin (OT) and prostaglandins or with OT alone; a further objective was to assess the potential impact of these molecular alterations on the effectiveness of stillbirth induction. Methods The immunoreactivity of RCAS1, CD3, CD56, CD69, and CD25 was assessed by immunohistochemistry in 31 decidual samples derived from patients in whom the stillbirth occurred before the onset of labor. Results The RCAS1 immunoreactivity level was higher in a statistically significant manner in decidual tissue samples derived from patients in whom OT alone proved insufficient to induce labor after the diagnosis of intrauterine fetal death but required additionally the use of prostaglandins when compared with samples from women in whom stillbirth was induced successfully with OT alone. However, we did not observe any differences either in CD56 and CD3 positive cell presence or in CD25 and CD69 antigen immunoreactivity in the respective decidua of these two groups of patients. Conclusion The level of RCAS1 in decidua seems to influence the effectiveness of stillbirth induction.

Problem RCAS1 (a receptor-binding cancer antigen expressed on SiSo cells) is a membrane protein present also in a soluble form that seems to be responsible for the suppression of the cytotoxic immune response during gestation. The present study evaluates the decidual immunoreactivity level of RCAS1 and the serum level of RCAS1 with respect to the progression of labor at the time of cesarean section. Method of study RCAS1 immunoreactivity was assessed by immunohistochemistry in 47 decidual samples, and the RCAS1 serum level was established in 47 blood serum samples derived from patients on whom cesarean sections were performed. The patients were divided into three groups according to the progression of their labor at the time when the cesarean was performed. Results The highest RCAS1 serum concentration and the highest RCAS1 decidual immunoreactivity were found in patients on whom cesarean sections were performed during advanced labor and were statistically, significantly higher than in cases where cesarean sections were performed without labor or after the spontaneous beginning of labor. Conclusion Alterations in the RCAS1 serum and decidua levels seem to be associated with immune response changes during the progression of labor.

Problem Pre-eclampsia seems to be related to the disturbance of immune tolerance regulation during pregnancy. Receptor-binding cancer antigen expressed on SiSo cells (RCAS1) decidual level alterations were concomitant with changes in immune cell number and activity in decidua. As decidual immunomodulating activity participates in the development of immune tolerance during pregnancy, we aimed to evaluate the immunoreactivity level of decidual RCAS1 with respect to the presence and activity of immune cells. Method of study RCAS1, CD3, CD56, CD69, and CD25 immunoreactivity was assessed by immunohistochemistry in 30 decidual samples derived from patients with severe pre-eclampsia (sPE) and from a healthy control group. Results RCAS1 immunoreactivity was statistically significantly higher in decidual tissue samples derived from patients with sPE tissue than in those derived from healthy patients in whom elective cesarean section at term was performed. A statistically significantly lower number of CD56+ and CD3+ cells and lower immunoreactivity level of CD69 were found in patients with sPE compared with those from the control group. Conclusion The limited immune cells infiltration in decidua during sPE is associated with increase in RCAS1 decidual level.

Problem The role of increased Th1 cytokine expression in pregnancy failure has been questioned recently. The therapeutic value of progestogens in threatened abortion (TA) is still debated. The aim of this prospective study was to compare serum cytokine [tumor necrosis factor (TNF)-α, interleukin (IL)-12 and IL-10] concentrations in women with TA to those in women with normal pregnancy and to evaluate the impact of dydrogesterone supplementation in the former group on cytokine concentration. Methods of study Twenty-seven threatened aborters were treated for 10 days with dydrogesterone (30–40 mg/day). Sixteen healthy pregnant controls received no treatment. Serum cytokine concentrations were measured twice in both groups by enzyme-linked immunosorbent assay. Results Mean serum concentrations of Th1- and Th2-type cytokines in women with TA did not differ from those in women with normal pregnancy at first and second sampling. After dydrogesterone supplementation, mean TNF-α/IL-10 ratio changed from 1.08 to 1.75 while IL-12/IL-10 ratio remained almost the same (0.56–0.61) in the threatened aborters group and did not differ from those in healthy women. Conclusions The results of this study indicate that peripheral cytokine production in threatened aborters does not differ from that observed among healthy pregnant women. The protective effect of dydrogesterone supplementation in threatened aborters is manifested via restoring progesterone-induced blocking factor concentration rather than controlling cytokine production.

Problem The main aim of this study was to investigate the relationship between selected proinflammatory cytokines [interleukin IL-1 alpha (IL-1α), IL-1 beta (IL-1β), IL-6 and IL-8] concentrations in cervicovaginal fluid, as measured in midgestation, and the risk of subsequent preterm delivery. Method of study Cervicovaginal fluids were obtained from a cohort of 114 pregnant women at 22–34 weeks’ gestation and analyzed for the concentrations of IL-1α, IL-1β, IL-6 and IL-8 using enzyme-linked immunosorbent assay technique. Lower genital tract microbiology was diagnosed using Gram stain method and by culture. Results Mean gestational age at the time of sampling was 29.0 weeks. Mean time between sampling and delivery was 9.3 weeks (S.D. 4.7). Median cervicovaginal concentrations of IL-1α, IL-1β, IL-6 and IL-8 did not differ between preterm and term delivery group. Women with lower genital tract pathological flora and IL-1α concentration below 25th percentile presented significant risk of subsequent preterm delivery as compared with women with no low cytokines (OR = 10.7; 95% CI, 2.0–58.1). Women with more than one cytokine’ low concentration (below 25th percentile) presented an increased risk of preterm delivery – OR = 11.8 (95% CI, 1.8–78.0). Conclusions The midgestation cytokines’ measurement in cervicovaginal fluid of pregnant women could be useful for prediction of preterm delivery only among women with lower genital tract pathological flora.

Problem: The therapeutic value of progestogens in threatened abortion is still under debate. In the presence of sufficient progesterone levels during pregnancy, lymphocytes synthesize a mediator [progesterone-induced blocking factor (PIBF)] that is anti-abortive in mice. The aim of this study was to evaluate the effect of dydrogesterone on pregnancy outcome of threatened aborters. Method of study: Twenty-seven threatened aborters were treated for 10 days with dydrogesterone (30-40 mg/day). Sixteen healthy pregnant controls received no treatment. Serum progesterone and estradiol concentrations as well as urine PIBF concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Results: Pregnancy outcomes in dydrogesterone-treated threatened aborters did not statistically differ from those in healthy controls. Serum progesterone concentrations in control patients, but not those in threatened aborters increased as pregnancy progressed. Following dydrogesterone treatment, initially low PIBF concentrations of threatened aborters significantly increased (P = 0,001) to reach the PIBF level found in healthy controls.

Problem: The therapeutic value of progestogens in threatened abortion is still under debate. In the presence of sufficient progesterone levels during pregnancy, lymphocytes synthesize a mediator [progesterone-induced blocking factor (PIBF)] that is anti-abortive in mice. The aim of this study was to evaluate the effect of dydrogesterone on pregnancy outcome of threatened aborters. Method of Study: Twenty-seven threatened aborters were treated for 10 days with dydrogesterone (30–40 mg/day). Sixteen healthy pregnant controls received no treatment. Serum progesterone and estradiol concentrations as well as urine PIBF concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Results: Pregnancy outcomes in dydrogesterone-treated threatened aborters did not statistically differ from those in healthy controls. Serum progesterone concentrations in control patients, but not those in threatened aborters increased as pregnancy progressed. Following dydrogesterone treatment, initially low PIBF concentrations of threatened aborters significantly increased (P = 0.001) to reach the PIBF level found in healthy controls. Conclusions: These data suggest that by inducing PIBF production, dydrogesterone might improve pregnancy success rates in threatened aborters.

The aim of this prospective cohort study was to evaluate the impact of tobacco smoke exposure, measured by maternal serum concentration of cotinine, on fetal midgestation biometric parameters and umbilical artery (UA) qualitative blood flow indices. The study population consisted of 114 healthy women in 20 to 24 weeks gestation who were recruited from the patients of two antenatal care units in Lodz, Poland. Significant negative correlation was found between fetal biparietal diameter (BPD) and serum cotinine concentration. Serum cotinine positively correlated with all blood flow indices under study (systolic/diastolic index [S/D], resistance index, and pulsatility index) after controlling for gestational age, gender, and femur length. The midgestation UA S/D ratio > 3 was found to be a significant risk factor for decreased birthweight. Tobacco smoke exposure is a significant factor inducing increased resistance of umbilical blood flow as measured in 20 to 24 weeks gestation. This could be one of the main mechanisms leading to decreased birthweight observed among infants with prenatal exposure to tobacco smoke.

Since the 1950s, beta hemolytic streptococcus group B have constituted the major etiological factor of perinatal infections. GBS colonization of the genital tract among pregnant women is diagnosed between 35 and 37 weeks of gestation, and is associated with approximately 25% risk of neonatal early-onset infections (EOD). The infection is severe among 1-3% of the newborns, and usually results in sepsis or pneumonia. beta-lactam antibiotics are drugs of choice to prevent vertical infection of group B streptococcus. In case of hypersensitivity to penicillin among pregnant women, second line drugs are macrolides and lincosamides.In light of numerous reports on the decreasing susceptibility of GBS, the aim of this study was to characterize the isolated strains of Streptococcus agalactiae in terms of their resistance to antibiotics.The study included 395 pregnant women in the third trimester of pregnancy hospitalized in the Department of Perinatology and Department of Gynecology and Obstetrics, Medical University of Lodz, between 02.2010 -02.2012.Vagino-rectal swabs were collected from all pregnant women. We recovered 121 GBS positive isolates. Identification was based on the streptococcal agglutination test. Antimicrobial susceptibility was determined by disk diffusion method.A positive result for GBS colonization was found among 89 patients, representing 22.5% of the studied population. Inducible MLSB resistance to erythromycin and clindamycin was 23.1% and 10.7% of the isolated strains, respectively Constitutive MLSB resistance was detected in 14.9% of the cases.The obtained results confirm that all GBS isolates are sensitive to beta-lactam antibiotics and prove that phenotypes resistant to macrolides and clindamycin are becoming more widespread. This leads to the conclusion that regular supervision of drug sensitivity of Streptococcus agalactiae is necessary

Since the 1950s, β hemolytic streptococcus group B have constituted the major etiological factor of perinatal infections. GBS colonization of the genital tract among pregnant women is diagnosed between 35 and 37 weeks of gestation, and is associated with approximately 25% risk of neonatal early-onset infections (EOD). The infection is severe among 1-3% of the newborns, and usually results in sepsis or pneumonia. β-lactam antibiotics are drugs of choice to prevent vertical infection of group B streptococcus. In case of hypersensitivity to penicillin among pregnant women, second line drugs are macrolides and lincosamides. Objective: In light of numerous reports on the decreasing susceptibility of GBS, the aim of this study was to characterize the isolated strains of Streptococcus agalactiae in terms of their resistance to antibiotics. Material: The study included 395 pregnant women in the third trimester of pregnancy, hospitalized in the Department of Perinatology, and Department of Gynecology and Obstetrics, Medical University of Lodz, between 02.2010– 02.2012. Methods: Vagino–rectal swabs were collected from all pregnant women. We recovered 121 GBS positive isolates. Identification was based on the streptococcal agglutination test. Antimicrobial susceptibility was determined by disk diffusion method. Results: A positive result for GBS colonization was found among 89 patients, representing 22.5% of the studied population. Inducible MLSB resistance to erythromycin and clindamycin was 23.1% and 10.7% of the isolated strains, respectively. Constitutive MLSB resistance was detected in 14.9 % of the cases. Conclusions: The obtained results confirm that all GBS isolates are sensitive to β-lactam antibiotics and prove that phenotypes resistant to macrolides and clindamycin are becoming more widespread. This leads to the conclusion that regular supervision of drug sensitivity of Streptococcus agalactiae is necessary.

Background: Unemployment is one of the consequences of the ongoing transformation of the Polish economy. The main objective of the present study was to investigate the relationship between women's employment status and preterm delivery (PD) and/or small-for-gestational-age (SGA) infants, in Central Poland during the socio-economic transition. Methods: The study population comprised 8% random sample of 2,080 women from the Lodz macro region who gave birth to a child during a one-year period (1996-1997). Based on the employment status, three groups were distinguished: the employed (n=1238), the unemployed (n=128) - women who lost their job before pregnancy (at least 12 months prior to delivery) and were actively seeking employment, and the housewives (n=714). Women with chronic medical problems diagnosed before pregnancy were excluded from the study. Results: The rates of preterm delivery were found to be 6.3%, 11.7% and 4.9%, respectively for the employed, unemployed, and housewives. After adjustment for age, marital status, education, maternal height, smoking, own apartment, presence of cervical insufficiency and uterine irritability, an excess risk of PD was observed among the unemployed women (OR=1.92, 95% Cl: 1.01-3.64). Unemployment was associated, though not significantly, with higher rates of SGA births. Conclusion: In Central Poland, the unemployed pregnant women are characterised by an excess risk of preterm delivery. The impact of unemployment on the community's health, which seems to be underestimated, should be given more consideration in the national and local policies for public health.

1 The present investigation was undertaken to evaluate the effect of environmental tobacco smoke (ETS) on the risk of preterm delivery (PD) and small-for-gestational age (SGA) infants in a female non-smoking population of central Poland. 2 The study group were 1751 women classified as non-smokers in the comprehensive project on 'ocio-economic and environmental risk factors of preterm delivery and small-for-gestational-age babies in cen-tral Poland' conducted on a randomly selected population of 2080 women who gave birth to a child between June 1, 1996 and May 31, 1997. The PD group comprised 95 non-smoking women who delivered before 37 weeks of pregnancy and the SGA group included 111 non-smoking mothers of babies with birthweight below the loth percentile of the standard curves for central Poland. Passive exposure to tobacco smoke was determined based on a structured interview. 3 In the stepwise multiple logistic regression model maternal passive smoke exposure lasting 7 h or more was found to be a significant risk factor for preterm delivery. No significant effect of passive smoking on the risk of SGA was observed. 4 The information about the adverse effects of ETS exposure on pregnancy duration and outcome should be incorporated in the health promotion programmes for women.

The study was undertaken to analyze the course of pregnancy and delivery in women after previous cesarean section.The study group consisted of 1272 pregnant women after one cesarean section, who delivered at the 1st Department of Gynecology and Obstetrics, Medical University of Lodz between 1st January 2007 and 31st December 2010.Among patients after previous cesarean section, the most numerous group constituted women whose pregnancy was resolved with an elective repeat cesarean section, without the attempt to deliver vaginally - 58,96% whereas the remaining 41,04% of the women were qualified to make an attempt at vaginal delivery 48,28% of them succeeded to gave birth vaginally and 51,72% underwent repeat cesarean section.Proper qualification of patients after previous caesarean section for a natural vaginal birth allows a successful vaginal delivery. A critical analysis of the indications for surgical delivery needs to be performed in order to lower the rate of cesarean sections.

The paper presents a case of pregnancy childbirth and postpartum of a 47-year-old woman with secondary infertility and obstetric history. In vitro fertilization with oocyte derived from a 21-year donor (IVF-OD) was performed due to premature ovarian failure and age of the patient. The treatment resulted in unifetal pregnancy complicated by among others: hypertension, cardiac problems, varicose veins in the lower limbs, elevated concentration of bile acids and anxiety neurosis. A healthy newborn was delivered at 37 hbd by cesarean section. Due to the development of techniques of assisted reproduction, pregnancies of perimenopausal women will pose a growing problem in modern obstetrics.

The aim of this study was to evaluate the efficacy of carbetocin in prevention of PPH in women after cesarean section.We enrolled 60 patients who had undergone cesarean section in tertiary referential center, Department of Perinatology, Medical University of Lodz, Poland, between January and June 2008. Each patient obtained a single 100 microg dose of carbetocin intravenously during cesarean section, immediately after the delivery of the baby and prior to the delivery of the placenta. We evaluated postoperative blood parameters in 2 and 12 hours after the operation, the proportion of patients requiring additional uterotonic agents and adverse events in the whole population and in the group of women with high risk of PPH.58.1% of patients underwent emergency and 41.3% elective cesarean section delivery. The risk factor of PPH was identified in 38 women (63.3%). The results of this study indicate that carbetocin produces rapid and long-lasting uterine tone. A small drop in mean hemoglobin and hematocrit levels 2 and 12 hours after the operation was observed. 15% of patients required the use of additional uterotonic agents. In the group of women with high risk of PPH, carbetocin appeared to be effective in 79% of the patients. Only 11.4% of patients had minor adverse events.Carbetocin appears to be an effective new drug in the prevention of postpartum hemorrhage, not only among women undergoing cesarean section but also in the group of women with PPH risk factors.

Recent studies suggest that preterm delivery might be conditioned genetically. The main aim of this study was to examine the relationship between spontaneous preterm delivery (PTD) and the carriage of polymorphic genes that code the following cytokines: interleukin-1beta [IL1beta (+3953CT)], interleukin-6 promoter [IL6 (-174GC)], tumour necrosis factor-alpha promoter [TNFalpha (-308GA)] and interleukin-1 receptor antagonist (IL1RN) in the population of Polish women.A case-control study. 125 Caucasian women were examined, among them 62 cases and 63 controls. Case subjects were defined as those who had a delivery at less than 366 weeks of gestation due to either preterm premature rupture of membranes or preterm labour while control subjects gave birth at term. Detailed demographic, medical and obstetric data based on structured questionnaire and medical record were collected. Maternal venous blood samples were collected after the delivery and analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFPL) techniques for the presence of each of the allelic variants. Logistic regression model was used to compute odds ratio and its 95% confidence intervals.Women that carried IL1RN*2 were found to be at an increased risk of preterm delivery OR = 2.75 (95% CI: 1.02-4.13). No correlation between IL-1beta, IL-6 and TNF-alpha gene polymorphisms and the risk of PTD was found. Coincidence of IL1RN polymorphism (genotype IL1RN*1/ IL1RN*2, IL1RN*1/ IL1RN*3, IL1RN*2/ IL1RN*3) with IL-6 promoter polymorphism (genotype GG, GC) multiplied the risk of preterm delivery OR = 3.02 (95% CI: 1.00-8.91).Maternal carriage of the IL1RN*2 allele appears to be associated with an elevated risk of preterm delivery in the population of Polish women. Coincidence of IL1RN*2 with at least one copy of IL-6 allele G might increase the risk of preterm delivery even further.

to determine the relationship between the initial nucleated red blood cells (nRBC) count during the first 12 hours after birth and inborn infection in neonates.The retrospective study comprised of 306 neonates born in the Department of Perinatology of the I Chair of Gynaecology and Obstetrics in Łódź, Poland, in the years 2002-2007, among whom the nucleated red blood cells count were calculated within the first 12 hours after birth. Two categories of nRBC count: the normal and the elevated value, were statistically elaborated by a Mann-Whitney test and a chi-square test with two clinical outcome categories: the presence and the absence of inborn infection in the analyzed neonates. Statistical significance was indicated by p value lower than 0,05.Among 306 newborns, there were 127 mature neonates (41.5%) and 179 prematures (58.5%). The mean of the initial nRBC count in the analyzed newborn population was 40, 15. The mean of the nRBC count in the infected neonates was three times higher (52.56) than the mean of the nRBC count in newborns without inborn infection (16.76) - (p=0.00001). Inborn neonatal infection concerned a vast majority of cases with an elevated value of the nRBC count (86.4%), but in 13.6%, inborn infection was not observed. Among the cases with a normal nRBC count, the presence and the absence of inborn infection was diagnosed in about 50% of the analyzed babies (50.83% vs 49.17%). The elevated value of the nRBC count in infected neonates concerned mainly premature babies, rather than mature neonates, and similarly in neonates with a lower Apgar score than in babies born in good condition.1. The positive association between elevated initial nucleated red blood cells count after birth and inborn infection in newborns has been revealed. 2. An elevated nucleated red blood cells count may be an auxiliary, early indicator for inborn infection in neonates. 3. Prematurity and perinatal asphyxia favour the elevation of a nucleated red blood cells count in cases with inborn infection.