Agnieszka Kordek

Background and Objectives: Despite the development of medicine, there is no clearly established scheme for the prediction of intra-amniotic infection (IAI). In this study, evaluation of some predictors of IAI confirmed in histopathological examination was performed. Materials and Methods: The study population included 70 patients all giving birth by cesarean section divided into two groups: study (n = 34) consisting of patients with histologically confirmed IAI and control (n = 36) without IAI. Biological material included the mother’s venous blood to determine C-reactive protein (CRP), interleukin-6 (IL-6) and procalcitonin (PCT) concentrations; vaginal discharge to determine IL-6; cervical canal swabs to perform cultures for bacteria and fungi and polymerase chain reaction (PCR) for Ureaplasma urealyticum, Mycoplasma hominis, and Chlamydia trachomatis; amniotic fluid to perform cultures for aerobic and anaerobic bacteria and PCR for atypical pathogens, and to determine glucose, IL-6, and PCT concentrations; umbilical cord blood to determine PCT, CRP, Il-6 and blood culture. A fragment of the placenta and fetal membranes was taken for histopathological assessment of the inflammatory infiltrate. Results: Mothers’ serum CRP assessments as well as serum PCT assessments are of poor diagnostic value in the prediction of IAI confirmed in histopathological examination. Conclusions: The best predictive values of IAI confirmed in histopathological examination were amniotic fluid glucose and vaginal fluid IL-6 determinations.

Background/Objectives: The aim of this study is to analyze the frequency and type of subjective adverse events reported after the use of oxytocin and carbetocin in women giving birth by cesarean section. Methods: A total of 70 pregnant women, previously scheduled for elective cesarean section, were enrolled in this study and divided into two groups. One group (OXY) received intrapartum oxytocin at a dose of 5 IU intravenously, and the other group (CARBE) received intrapartum carbetocin at a dose of 100 μg intravenously. Both drugs were used alternately to contract the uterus immediately after the expulsion of baby during the cesarean section. Results: An analysis of reported subjective adverse symptoms associated with the administration of uterotonic drugs showed a higher incidence of adverse effects in the group of women receiving oxytocin compared to those receiving carbetocin. Statistical significance was observed for all of the following reported symptoms: headache, chest pain, burning sensation and heaviness in the chest, and palpitations. Conclusions: Although chest pain, burning and heaviness in the chest, palpitations, and headaches are more common in women giving birth by cesarean section after administration of oxytocin than after administration of carbetocin, this fact appears to be of limited clinical significance from a clinical point of view.

Introduction. Congenital infection in a newborn is an infection caused by pathogens passed on to the child by the mother intrauterine or perinatally. Sepsis is the most common form of early-onset infection in newborns. The diagnosis in the newborn is difficult due to the absence of characteristic clinical signs as well as specific and infection-specific laboratory deviations. Objective. The study was conducted to estimate the predictive value of cord blood plasma concentration of lipopolysaccharide-binding protein, and neutrophil elastase in the prediction of early onset sepsis in preterm and full-term neonates. Correlation with C-reactive protein was assessed. Materials and methods. Patients enrolled in the study (n=153) were divided in 4 groups: B-I- 39 infected preterm; B-II- 24 infected full-term; K-I- 45 non-infected preterm and K-II- 45 full-term neonates without signs of infection. The research material was umbilical cord taken immediately after delivery in the presence of risk factors for infection and without risk factors for obtaining a control group. The concentration of lipopolysaccharide binding protein, activity of neutrophilic elastase and CRP concentration were determined in the collected samples. Results. The cord blood plasma LBP and neutrophil elastase concentration was higher in infected preterm and term neonates. Cord blood LBP is a highly specific and sensitive biomarker of sepsis immediately after birth. High levels of LBP and neutrophil elastase in cord blood correlate with CRP. Conclusions. Measuring the concentration of LBP and neutrophil elastase in cord blood plasma may help in the detection of early onset sepsis in newborns with prenatal risk factors.

Pregnancy complicated by cancer is one of the most serious challenges of modern perinatology. The increasing number of cancers diagnosed and treated during pregnancy requires a multidisciplinary approach to optimize the treatment of the person who is pregnant and deliver a healthy child. The aim of the study is to analyze the course of the neonatal period in children of mothers suffering from cancer during pregnancy, treated in a specialist hospital for women and children. Being diagnosed with cancer during pregnancy significantly increases the risk of premature delivery, prematurity and intrauterine growth restriction. Our own observations show no significant differences during the neonatal period in children of mothers suffering from a malignant tumor during pregnancy compared to children of healthy mothers. This applies to both full-term and premature babies. Modern treatment of malignant tumors during pregnancy seems to be safe for the fetus and newborn. It is optimal to conduct oncological, obstetric and neonatological treatment in one center. It seems advisable to conduct long-term follow-up observations in children of pregnant people with cancer. Since the described groups of patients and their newborns are small and heterogeneous, in order to develop appropriate standards, it is recommended to report these cases to central registers. Pregnancy complicated by cancer is one of the most serious challenges of modern perinatology. The increasing number of cancers diagnosed and treated during pregnancy requires a multidisciplinary approach to optimize the treatment of the person who is pregnant and deliver a healthy child. The aim of the study is to analyze the course of the neonatal period in children of mothers suffering from cancer during pregnancy, treated in a specialist hospital for women and children. Being diagnosed with cancer during pregnancy significantly increases the risk of premature delivery, prematurity and intrauterine growth restriction. Our own observations show no significant differences during the neonatal period in children of mothers suffering from a malignant tumor during pregnancy compared to children of healthy mothers. This applies to both full-term and premature babies. Modern treatment of malignant tumors during pregnancy seems to be safe for the fetus and newborn. It is optimal to conduct oncological, obstetric and neonatological treatment in one center. It seems advisable to conduct long-term follow-up observations in children of pregnant people with cancer. Since the described groups of patients and their newborns are small and heterogeneous, in order to develop appropriate standards, it is recommended to report these cases to central registers.

Background: Nowadays, it is possible to identify a group at increased risk of preeclampsia (PE) and fetal growth restriction (FGR) using the principles of the Fetal Medicine Foundation (FMF). It has been established for several years that acetylsalicylic acid (ASA) reduces the incidence of PE and FGR in high-risk populations. This study aimed to evaluate the implementation of ASA use after the first-trimester screening in a Polish population without chronic hypertension, as well as its impact on perinatal complications. Material and methods: A total of 874 patients were enrolled in the study during the first-trimester ultrasound examination. The risk of PE and FGR was assessed according to the FMF guidelines, which include the maternal history, mean arterial pressure (MAP), uterine artery pulsatility index (UtPI), pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PLGF). Among patients with a risk higher than >1:100, ASA was administered at a dose of 150 mg. Perinatal outcomes were assessed among the different groups. Results: When comparing women in the high-risk group with those in the low-risk group, a statistically significantly higher risk of pregnancy complications was observed in the high-risk group. These complications included pregnancy-induced hypertension (PIH) (OR 3.6 (1.9–7)), any PE (OR 7.8 (3–20)), late-onset PE (OR 8.5 (3.3–22.4)), FGR or small for gestational age (SGA) (OR 4.8 (2.5–9.2)), and gestational diabetes mellitus type 1 (GDM1) (OR 2.4 (1.4–4.2)). The pregnancies in the high-risk group were more likely to end with a cesarean section (OR 1.9 (1.2–3.1)), while the newborns had significantly lower weights (<10 pc (OR 2.9 (1.2–6.9)), <3 pc (OR 10.2 (2.5–41.7))). Conclusions: The first-trimester screening test for PE and FGR is a necessary and effective tool in identifying high-risk pregnancies. ASA prophylaxis among high-risk patients may have the most beneficial effect. Furthermore, this screening tool may significantly reduce the incidence of early-onset PE (eo-PE).

Background: The intestinal microbiota of pregnant women and factors disturbing the microbial balance of their gastrointestinal tract during the perinatal period may be the cause of dysbiosis and thus intestinal permeability syndrome in their children. The purpose of this study was to analyze the implications of intestinal permeability parameters in the stools of newborns and infants with perinatal risk factors for intestinal colonization disorders (the route of delivery, antibiotic therapy in the neonatal period and the abandonment of breastfeeding). Methods: The study included 100 mother–child pairs. All children were born from uncomplicated and term pregnancies (between 37 and 42 weeks of gestation). In order to determine the parameters of dysbiosis and intestinal permeability, we determined the concentrations of zonulin and occludin in stool samples taken from all children at 0 (i.e., at birth), 3, 6 and 12 months of age. Elevated levels of lipopolysaccharide (LPS) are associated with metabolic diseases and its presence may be indicative of TJ injury and the onset of leaky gut syndrome. To indirectly determine the presence of endotoxemia, the concentrations of lipopolysaccharide were also measured in stool samples taken from all children at 0, 3, 6 and 12 months of age. We analyzed the relationship between the markers studied and perinatal risk factors for impaired intestinal colonization, including the mode of delivery, the method of feeding, and a family history of allergy. Results: During the first 3 months of infant life, higher concentrations of fecal occludin and zonulin were most often accompanied by higher values of fecal LPS. Similarly, higher concentrations of zonulin were accompanied by higher values of occludin. There were no significant differences in the stool concentrations of the studied markers during the first year of life between children born by caesarean section and those born naturally. In addition, the method of feeding had no significant effect on the changes in the concentrations of the determined fractions. Antibiotic therapy was associated only with an increase in the fecal occludin concentration after birth, without any effect on zonulin, occludin or LPS levels. The use of probiotic therapy in infants resulted in a decrease in only LPS concentrations at 3 months of age, with no effect on zonulin or occludin concentrations at 0, 6 and 12 months. Conclusions: Perinatal factors related to intestinal permeability are important during the first 3 months of infant life. However, we found that the mode of delivery had no influence on the parameters of infant intestinal leakage during the first year of life. In addition, the mode of infant feeding—breast or exclusively formula—did not significantly affect the changes in the concentrations of LPS, zonulin or occludin in the stools of children. A short-term increase in occludin concentrations after delivery in the stools of children from mothers undergoing antibiotic therapy indicates a negative but reversible influence of intrapartum antibiotics on the intestinal integrity of children in the perinatal period. Probiotic therapy seems to have a positive effect on reducing endotoxemia in children during the first 3 months of life. The presence of LPS at 3 months did not affect intestinal tightness at any of the later measured periods of the infants’ lives.

Inflammatory bowel disease (IBD) includes Crohn’s disease (CD) and ulcerative colitis (UC). The prevalence of both in pediatric populations has been constantly increasing. This study aimed to analyze the diet of adolescent patients with IBD in comparison to healthy controls and the current dietary standards for the Polish population to further their optimal supplementation regimen. The study group consisted of 53 patients (21 girls and 32 boys) with IBD (CD: n = 27; UC: n = 26) at a mean age of 15.4 ± 2.4 and 14.7 ± 2.2, years for girls and boys, respectively. The control group (CG) consisted of 20 patients, and 72 h of recall diaries on nutrition were collected. The nutritional data were analyzed in the Dieta 6D dietary program. When compared to Polish dietary standards, the largest differences girls with IBD and boys with IBD were found for the intake of energy (61.9 and 71.9%), iodine (61.9 and 62.6%), folates (76.2 and 87.5%), vitamin D (100 and 96.9%), potassium (61.9 and 59.4%), and calcium (85.7 and 93.8%). The overconsumption of saturated fatty acids (SFA) (61.9 and 56.3%) and sodium (76.2 and 90.6%) in girls and boys, respectively, was noted. In relation to girls with CG, girls with IBD showed a significantly higher intake of energy (1751. 3 vs. 1558.6 p = 0.0224), total protein (71.3 vs. 56.2 p = 0.0217), animal protein (47.8 vs. 34.5 p = 0.0183), total carbohydrates (237.3 vs. 196.1 p = 0.0442), and assimilable carbohydrates (219.8 vs. 180.5 p = 0.7921). Boys in the CG consumed significantly more calcium (851.8 vs. 432 p = 0.0006), phosphorus (1024.3 vs. 1357.5 p = 0.0431), lactose (11.6 vs. 6.1 p = 0.0016), and riboflavin (1.7 vs. 1.3 p = 0.0123) compared to boys with IBD. Dietician care should therefore be mandatorily provided alongside outpatient care. Based on our results, we suggest that supplementation with the selected components be considered.

Functional hypothalamic amenorrhea (FHA) is a very common condition affecting women of procreative age. There are many reasons for this disorder, including a low availability of energy in the diet, low micro- and macronutrient intake, overly intensive physical activity, disturbed regeneration processes, sleep disorders, stress, and psychological disorders. The main determinant is long-term stress and an inability to handle the effects of that stress. FHA is a very complex disorder and often goes undiagnosed. Moreover, therapeutic interventions do not address all the causes of the disorder, which could have implications for women’s health. As shown by scientific reports, this condition can be reversed by modifying its causes. This review of the literature aims to update the current knowledge of functional hypothalamic amenorrhea and underscores the complexity of the disorder, with particular emphasis on the nutritional aspects and potential interventions for restoring balance.

Carcinosarcoma, leiomyosarcoma, melanoma and carcinoid as primary tumors in the ovary are extremely rare. In this paper, the authors reviewed the literature from 2010 to 2021, based on specific criteria, to analyze the treatment of these rare ovarian neoplasms. We also aimed to verify whether modern therapies have been found in recent years. For this article, 80 papers were finally selected. The vast majority of the articles were clinical case reports. Despite single mentions of new potential pharmacological treatments, surgery (radical or fertility-sparing) is definitely the mainstay of treatment. There are currently no treatment guidelines for these tumors. A review of the literature has revealed the use of various adjuvant treatments. We, therefore, believe that a more detailed understanding of the biology of these tumors is necessary in order to find new target points for treatment. We would like to emphasize the importance of creating an international database of rare ovarian tumors which would make it possible to gather data from various oncological centers and enable further research into these neoplasms.

Incontinentia pigmenti (IP, dye incontinence), or Bloch–Sulzberger syndrome, is a rare genodermatosis (1:40,000 to 1:50,000 births), inherited through a dominant X-linked conjugate, caused by mutations in the IKBKG/NEMO gene located on Xq28, often with eosinophilia. In most cases, the disease affects the female sex. In male fetuses, it is usually lethal.Incontinentia pigmenti is a multi-system disease. Changes occur in tissues and organs derived from the ectoderm and neuroectoderm and may affect the skin and appendages, eyes, central nervous system, skeleton, and teeth. It is usually diagnosed neonatally or during infancy when a characteristic 4-stage evolution of skin lesions materializes – accompanied by abnormalities in other organs. Skin defects can occur in utero, in which case they are visible at birth.The only treatment is symptomatic and involves proper skin care and prevention of secondary infections. The patient should have interdisciplinary care (dermatologist, neurologist, ophthalmologist, dentist) for the early diagnosis and treatment of possible disorders within other organs.The low incidence of the syndrome may delay diagnosis.The aim of this study is to present the characteristic symptoms of the disease, help clinicians make the right diagnosis and to emphasize the legitimacy of multi-specialist care.