Ewa Romejko-Wolniewicz

Vaginal birth after cesarean section (VBAC) is a safe option for both mothers and children. Currently available prediction tools have not been validated in

Background: Gestational diabetes mellitus (GDM) is associated with metabolic disturbances extending beyond glucose homeostasis, including alterations in lipid metabolism. However, evidence on the fatty acid composition of maternal serum lipids in GDM remains inconsistent, and data on placental fatty acid transfer are limited. This study aimed to explore associations between maternal serum lipid fatty acid composition, selected FA indices, and transplacental transfer of fatty acids derived from maternal serum lipids in pregnancies complicated by GDM. Methods: A cross-sectional study was conducted among 139 pregnant women, including 104 healthy controls and 35 women with GDM. Maternal serum and umbilical cord blood samples were collected at delivery. FA composition was analyzed using gas chromatography. Selected FA indices and the transplacental transport index (TTI) were calculated. Statistical analyses included group comparisons, multivariable models adjusted for maternal age and pre-pregnancy BMI, and false discovery rate correction. Results: Modest differences were observed in selected fatty acids and FA indices, particularly palmitoleic acid (C16:1) and the C16:1/C16:0 ratio. Principal component analysis suggested partial separation between groups, although substantial overlap was present. A difference in transplacental transport was observed for α-linolenic acid; however, high variability was noted. No consistent associations between reported dietary patterns and fatty acid composition of circulating serum lipids were identified. Conclusions: This exploratory study suggests potential differences in fatty acid composition and selected indices in GDM; however, findings should be interpreted with caution. The observed patterns may reflect late-pregnancy metabolic adaptations rather than causal mechanisms. Further studies in larger and more diverse populations are required to confirm these findings.

Background Vaginal birth after cesarean section (VBAC) is a safe option for both mothers and children. Currently available prediction tools have not been validated in the Polish population. Dobrowolska-Redo proposed a model for predicting VBAC success, and the aim of this study was to evaluate its clinical utility. Methods This retrospective analysis of data collected from 462 pregnant women with a history of one previous cesarean section, all qualified for a VBAC attempt. Deliveries occurred between January 1, 2021, and December 31, 2023, at the II Department of Obstetrics and Gynecology, Medical University of Warsaw. Inclusion criteria were: previous low transverse cesarean section, singleton pregnancy, no indication for elective cesarean delivery, and live birth. Ethical approval was granted by the local committee (reference no. AKBE/300/2024). The data were anonymized before analysis. Results Among the cohort of 462 women, 271 (58.7%) had successful VBAC, whereas 191 (41.3%) underwent intrapartum cesarean section. The prediction model for preterm births (pTi) showed no clinical utility. The median Ti score differed significantly between the VBAC group and the cesarean group. Removing two parameters (manual labor and place of residence) improved model performance. Higher BMI increased the likelihood of cesarean delivery, both before pregnancy (23.43 vs. 24.54 kg/m²; p = 0.006) and at delivery (27.99 vs. 29.36 kg/m²; p = 0.007). Prior vaginal birth was a strong predictor of successful VBAC (31.5% vs. 11.2%; p = 0.000), as was a history of fetal macrosomia (15.5% vs. 8.7%; p = 0.047). Gestational diabetes was more common in women who ultimately required cesarean delivery (34.2% vs. 23.7%; p = 0.023). Epidural anesthesia use correlated with a lower cesarean rate (26.6%; p = 0.000). Conclusions In this single-center cohort, the Polish index model for full-term VBAC (Ti) prediction showed moderate accuracy. A refined version demonstrated improved performance compared with the original. Several predictors of successful VBAC were confirmed, including prior vaginal delivery and history of macrosomia, while high BMI and gestational diabetes increased the risk of intrapartum cesarean section. Trial registration Retrospectively registered.

Background: Pertussis is a respiratory infection that represents a significant threat worldwide, especially for infants. The global incidence of pertussis is on the rise, with 20–40 million cases occurring every year. Maternal vaccination offers protection to newborns and, therefore, is recommended by numerous healthcare organizations. The aim of this study was to systematically assess the level of knowledge regarding pertussis and the pertussis vaccine, as well as the willingness to receive the vaccine among pregnant women, and identify the most significant reasons for vaccine hesitancy among the obstetric population. Methods: A systematic literature search was conducted in the Web of Science, Embase, and Scopus databases between 1 April 2024, and 31 July 2024. Our search strategy aimed to identify studies published from 1 January 2014 to July 2024 in order to capture a decade’s worth of the most recent evidence and updates in maternal pertussis vaccination. Results: We screened 955 articles altogether, with 11 studies included in the analysis. The general awareness of pertussis infection prior to participation in the study varied from 5% in a study performed in Turkey to 95.9% in the Norwegian population. Moreover, the willingness to receive the vaccine ranged from 11.2% in the Turkish population to 94.8% in the Netherlands. Several statistically important factors affecting the decision have been identified, such as belief in safety and effectiveness, fear of adverse reactions, or healthcare professional recommendation. Conclusions: The general awareness regarding pertussis vaccine in pregnant women differs significantly depending on the population studied. However, it remains unsatisfactory even in populations with a high declared level of knowledge if asked specific questions. Presented results may indicate the need for studies on the efficacy of educational interventions for raising awareness about the meaning of pertussis immunization during pregnancy and preventing infection among neonates.

Background: Continuous glucose monitoring (CGM) has changed the clinical practice in diabetes management during pregnancy; however, its application during caesarean section remains understudied. This feasibility study evaluates the performance, reliability, and clinical utility of two CGM systems—FreeStyle Libre 2 and Medtronic Guardian Connect—during caesarean delivery and the early postpartum period in a patient with pregestational diabetes mellitus (PGDM). Methods: A prospective, single-patient study was conducted. A 32-year-old woman with type 1 diabetes underwent elective caesarean section at 38 weeks of gestation. Both CGM systems were applied over 18 h prior to surgery and monitored continuously through the intraoperative and five-day postpartum period. Glucose data, device performance, and usability were assessed. Results: Both CGM systems provided uninterrupted, high-quality glucose data throughout the perioperative period, including during spinal anaesthesia, surgical manipulation, and postoperative recovery. No sensor displacement nor signal loss occurred. Glycaemic readings remained within the normoglycaemic range (90–100 mg/dL) during surgery, with mild elevations observed during anaesthesia initiation. Postoperatively, both systems showed comparable glucose trends, with slightly lower readings from FreeStyle Libre 2. Conclusions: CGM is feasible and reliable during caesarean section in PGDM patients. These findings support the integration of CGM into obstetric surgical care and highlight the need for larger studies to validate clinical benefits.

Background: Influenza is an acute viral disease that primarily affects the airways. It is caused by influenza A and B—RNA viruses. The disease is associated with significant morbidity and mortality. The prevention of influenza includes chemoprophylaxis and vaccination, which are the primary preventive measures against influenza infection and should be highly considered by everyone during influenza season. Methods: A systematic literature search was performed in the databases of PubMed, Web of Science, Scopus, and Embase until September 2024. The review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Results: Eventually, a total of 20 publications were included in the final analysis of this systematic review. While general awareness of influenza was moderate, detailed understanding of complications and vaccine safety was frequently lacking. Misconceptions—such as fears of fetal harm and confusion between antiviral and antibiotic treatments—were widespread. Vaccine uptake was generally low but strongly correlated with receiving a healthcare provider recommendation. Willingness to vaccinate was higher in settings where participants were educated during the study process, indicating a crucial role of health communication. Discussion: According to the reviewed literature, the reluctance to receive maternal vaccination often stems primarily from fears or concerns about adverse reactions or misconceptions about the vaccine’s effectiveness, as well as the absence of a physician’s recommendation. Misconceptions regarding vaccine safety, limited understanding of influenza severity, and a lack of clear communication from healthcare professionals are key contributors to low vaccination uptake. Importantly, multiple studies confirmed that recommendation by a trusted healthcare provider significantly increases vaccine acceptance. Conclusions: These findings highlight the urgent need for targeted educational strategies, improved antenatal counseling, and systems-level support to ensure that maternal influenza vaccination becomes a standard and trusted component of prenatal care worldwide.

BACKGROUND Type B aortic dissection occurring after labor can be life-threatening. Severe hypertension is among the main risk factors. This report highlights the role of early intervention and special monitoring of pregnant women, and their effects on symptoms. CASE REPORT A 28-year-old women with a history of hypertension was admitted to the obstetrics hospital. Two attempts at labor induction were unsuccessful. A decision was made to proceed with a cesarean section. Due to the patient's deteriorating condition, 2 laparotomies were performed, 1 at the initial hospital and another after transfer. Postoperatively, she required intensive care monitoring. Based on imaging studies, a diagnosis of type B thoracoabdominal aortic dissection complicated by malperfusion was established. Endovascular aortic repair involved placement of an aortic stent graft under imaging guidance. A Zenith TX2 Dissection endovascular stent graft with a Pro Form Z-Track Plus delivery system was introduced. Afterward, the patient underwent 2 more surgeries: duodenum resection and creation of a gastro-descending colon anastomosis. Upon hospital admission, the patient was in very serious general condition. However, after 2 months of treatment and improvement, she was discharged. CONCLUSIONS This report demonstrates that hypertension during pregnancy, combined with unsuccessful attempts at delivery, may be a significant risk factor for aortic dissection. Effective diagnosis and management of these patients is challenging and requires multidisciplinary care, including the use of computed tomography with contrast as soon as possible due to its higher benefits, and the immediate endovascular approach as the safest method of treating postpartum aortic dissection.

Objectives: The aim of the study was to analyze and compare the possible effect of cervical conization and the loop electrosurgical excision procedure (LEEP) on female sexual function up to one year after intervention, as existing studies provide incoherent results. Methods: This prospective cohort study enrolled patients who underwent either LEEP (n = 35) or surgical conization of the cervix (n = 44). Patients completed the questionnaire before the intervention and at three, six, and twelve months after the end of the postoperative period. The questionnaire included the Polish version of the Female Sexual Function Index (FSFI) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire of Cancer Patients with the module Cervix-24. Results: In the LEEP group, significant deterioration was observed in the FSFI orgasm subscale after three and six months in comparison to the baseline (3.98 ± 2.08 vs. 3.19 ± 2.29 vs. 3.09 ± 2.24; p < 0.02). The difference in the orgasm subscale compared to the baseline score was not reported after twelve months of follow-up. In the surgical conization group, significant deterioration was observed in the general FSFI score between the baseline and three months after (22.37 ± 12.38 vs. 20.82 ± 12.02; p < 0.003) and in the arousal subscale between the baseline and three months after (3.69 ± 2.14 vs. 3.01 ± 2.02; p < 0.001). In the orgasm subscale, there was a significant improvement between three and twelve months of observation (3.05 ± 2.22 vs. 3.63 ± 2.29; p < 0.003). A significant deterioration was observed in the sexual activity subscale of the EORTC QLQ-C30 + CX24 between baseline and after three months (49.42 ± 36.12 vs. 39.09 ± 36.81; p < 0.03). All reported deteriorations had a tendency to resolve within twelve months of observation. Conclusions: Both LEEP and surgical conization of the cervix seem to have a mild, transient negative impact on female sexual function, which normalizes one year after the procedure. Long-term consequences of both procedures are similar. Further research with larger sample sizes is necessary to confirm these findings.

Objectives: Exclusive breastfeeding is recommended until the child is six months of age. However, there are many myths about breastfeeding. The aim of our study was to assess the knowledge of Polish women about breastfeeding. Material and methods: A cross-sectional survey study was conducted among 1536 Polish women. A self-administered questionnaire was created using Google Forms survey management software and distributed online. The participants were asked about the most common myths in society regarding breastfeeding. Results: The highest number of correct answers in all age groups were given to questions related to the nutritional value of breast milk (80.9–94.9%). The fewest correct answers in each age group were recorded to questions concerning the possibility of getting pregnant during the first 6 months of breastfeeding (16.1–35.3%), the safety of drinking non-alcoholic beer during lactation (24.4–37.1%), the benefits of brushing the breast while breastfeeding (16.0–37.1%), and the effectiveness of compresses made of cabbage leaves or sage infusions in relieving ailments during milk rush (6.8–12.4%). Higher education and being a mother were associated with a higher number of correct answers. Age below 25 years was associated with lower number of correct answers. Conclusions: The results of the survey regarding breastfeeding suggest the existence of various beliefs in the population of Polish women which are not evidence based. This indicates the need for spreading adequate information about breastfeeding, especially among younger women and those who did not obtain higher education. Keywords: breastfeeding breast milk lactation nutritional value

Background: Cytomegalovirus (CMV) infection represents a major issue worldwide, since it constitutes the most common viral congenital infection, with a prevalence of 0.58% and 1–5% in developed and developing countries, respectively. According to recent studies, prenatal treatment significantly decreases the risk of vertical CMV transmission, and early intervention may even prevent the termination of pregnancy. This study aimed to investigate the level of awareness of CMV among pregnant patients through a semi-systematic review. Methods: We included all of the original articles investigating knowledge and awareness about CMV infection among pregnant women. Our research included the PubMed database. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, the Covidence system automatically guided us to screen the titles and/or abstracts, and then full-texts, followed by data extraction from the eligible studies. Results: We screened 764 studies altogether, with 13 studies included in this analysis. Knowledge about the existence of CMV infection risk varied between the articles, ranging from 11.4% in a study performed in Ireland to 60% reported in a study on the French population. Studies analyzing the impact of educational interventions on patients’ knowledge about preventive measures reported significant improvement compared to their level of awareness before the intervention. Conclusions: Patients’ awareness and knowledge about CMV seemed to be generally low or very low during the last decade before the development of effective secondary prevention methods. Educational interventions seem to be effective, and therefore their wide use could be of potential benefit. In the era of available secondary prevention of vertical transmission, it is crucial to concentrate the efforts of different stakeholders to increase the awareness of cCMV among pregnant women.