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Grzegorz H Breborowicz

Publications and source records attributed to Grzegorz H Breborowicz.

At least 19 recordsLinked to original sources
PubMed2006

Flow index evaluation of 3-D volume flow images: an in vivo and in vitro study.

Three-dimensional (3-D) ultrasound imaging has improved evaluation of organ circulation and might contribute new information on maternal and fetal blood supply. Flow index (FI) of 3-D color images has been proposed as a measure of perfusion. The aim of this study was to evaluate whether the 3-D FI is a parameter of volume flow and flow velocity in a human vessel and in a flow phantom. A 1-cm-long strip of the uterine artery was recorded in 3-D power Doppler (3D-PD) mode in a cross-sectional study of 170 normal singleton pregnancies between 26 and 42 weeks' gestation. A fixed ultrasound system installation was used during the examination. The VOCAL software integrated in the ultrasound unit calculated vessel volume and FI. Reproducibility of the measurements was tested. The method was also tested on a commercially available flow phantom. Reproducibility measurements gave satisfactory results, both in terms of inter- and intraobserver variation. Unexpectedly, in normal pregnancy, the uterine artery FI decreased slightly with gestation. Uterine artery vessel volume increased, however, with gestational age. A poor correlation was found between the FI and both flow velocity and volume flow in the flow phantom. In conclusion, 3D-PD imaging can give impressive anatomical pictures of organ vascular tree. However, the new FI is poorly related to flow velocity or volume of flow.

Arteries↗
PubMed2006

Recombinant factor VIIa in the management of postpartum bleeds: an audit of clinical use.

BACKGROUND: This paper presents an analysis of 25 patient cases in which recombinant factor VIIa was used in the management of postpartum hemorrhage, including severe and/or life-threatening bleeds. Anecdotal experiences in the empirical use of this agent are described and dosing regimens, effects on bleeding, and safety data are presented. METHODS: Data were extracted from the international, internet-based, voluntary registry, haemostasis.com. Search results were manually cross-checked against monthly summary reports and cases of confirmed postpartum hemorrhage were analyzed by the authors. Case providers were contacted individually to approve the use of their cases, supply any missing data, and validate the data already held. RESULTS: Of 43 reported gynecological admissions for hemorrhage, 13 were excluded as they did not relate to childbirth, and 5 due to insufficient data. The remaining 25 records, all associated with postpartum hemorrhage, were submitted by 14 doctors from 5 countries. Following administration of recombinant factor VIIa, bleeding stopped in 18 cases (72%), markedly decreased in 2 (8%), and decreased in 4 (16%). Bleeding increased following recombinant factor VIIa administration in only 1 patient (4%). Requirements for replacement blood products and crystalloids/colloids were also greatly curtailed. A full recovery was achieved by most patients (22/25, 88%) with few complications, even when recombinant factor VIIa was administered as salvage therapy. There were no thrombotic complications associated with recombinant factor VIIa administration. CONCLUSIONS: This review provides the largest aggregate of cases in which recombinant factor VIIa has been used to control obstetrical bleeding. A review of these cases suggests that this agent may be a useful and safe adjunctive therapy in the management of postpartum hemorrhage.

Adult↗
PubMed2005

Computer analysis of three-dimensional power angiography images of foetal cerebral, lung and placental circulation in normal and high-risk pregnancy.

Three-dimensional (3-D) ultrasound (US) has greatly improved evaluation of organ circulation. The aim of this study was to explore the possible use of this new technique in normal and high-risk pregnancies. Fetal brain, lung and placenta 3-D power Doppler signal intensity were recorded in 115 normal singleton pregnancies (24 to 42 weeks gestation) and in 67 high-risk pregnancies. Mean image pixel signal intensity was calculated for each organ and a brain-lung ratio. In normal pregnancy, placental and lung signal intensity increased until 33, with a rapid decrease after 38, weeks of gestation. Fetal cerebral signal intensity increased with gestational age. Placental and fetal lung signal intensity was significantly lower in high-risk pregnancies than in the control group, with increased fetal brain and brain-lung ratios. The present results suggest a reduction of placental perfusion after 38 weeks of gestation in normal pregnancy, with redistribution of fetal circulation. Lung signal intensity increased abruptly at 32 weeks of gestation, which might reflect lung maturity. The new method showed signs of centralization of fetal circulation at the end of gestation. The results might suggest a possible clinical use for fetal surveillance in high-risk pregnancies.

Brain↗
PubMed2005

1166C mutation of angiotensin II type 1 receptor gene is correlated with umbilical blood flow velocimetry in women with preeclampsia.

OBJECTIVE: To ascertain the frequency of polymorphic variants of the gene coding for angiotensin II type 1 receptor (AT1) and its correlation with umbilical artery (UA) blood flow velocity in a group of women with preeclampsia (PE). STUDY DESIGN: AT1 polymorphism, pulsatility index (PI) in UA, and perinatal outcome in 47 women with PE and in 113 healthy pregnant women were investigated. Investigation of AT1 receptor genotypes was performed by PCR/RFLP assays. PI value has been measured by Doppler velocimetry technique. RESULTS: The overrepresentation of CC homozygotic genotype in PE group (6.4% vs. 2.7%) and the overrepresentation of mutated C allele in the PE group were observed (28.7% vs. 23.0%). Analyzing PI index we observed statistically significant differences between PE and control groups. Comparing PI values in PE group between genotypes: AA vs. AC + CC statistically significant differences (p < 0.05) have been observed. CONCLUSIONS: Observed overrepresentation of mutated C allele of the AT1 gene was correlated with increased blood flow in umbilical artery in women with preeclampsia. Doppler velocimetry might be a useful tool for indication in the high-risk group with overrepresentation of C alleles.

Adult↗
PubMed2005

Fetal and maternal Doppler velocimetry and cytokines in high-risk pregnancy.

OBJECTIVE: Fetal hypoxia and preterm delivery are reported to be strongly associated with brain damage and neurodevelopmental delay. Doppler signs of fetal brain sparing have been described during chronic hypoxia, but whether they are related to brain damage is unknown. The aim of this study was to evaluate if markers of tissue injury, i.e., tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) are related to signs of increased perinatal vascular impedance and/or fetal brain sparing in high-risk pregnancies. STUDY DESIGN: TNF-alpha and IL-6 levels were evaluated in maternal blood serum of 67 high-risk pregnancies. Serum samples were taken at the time of umbilical, middle cerebral artery and uterine artery Doppler velocimetry examination. The values for TNF-a and IL-6 were correlated with reference median values obtained with gestational age in the form of a Z-score. RESULTS: TNF-alpha levels showed values within the normal range in only four cases. IL-6 values were found normal in 14 cases. The Z-score for mean middle cerebral artery pulsatility index (PI) showed a significant correlation to TNF-alpha and IL-6 levels, P < 0.0001 and P < 0.003, respectively. This might suggest a strong correlation between signs of fetal brain sparing and increased maternal serum TNF-alpha and IL-6 levels. Abnormal uterine artery PI and the presence of a "notch" were also highly significantly related to TNF-alpha and IL-6 levels, which were nearly two-fold higher compared to normal uterine artery blood flow and the absence of a "notch". Abnormal cerebro/placental ratios showed significant correlations to TNF-alpha and IL-6 levels. CONCLUSION: The present results suggest a strong correlation between levels of TNF-alpha and IL-6 not only for signs of fetal brain sparing, but also for uteroplacental blood flow. This finding supports the role of tissue injury in cases of fetal brain sparing, but whether this is a reflection of brain damage or secondary to placental pathology needs further evaluation.

Blood Flow Velocity↗
PubMed2004

[Use of a questionnaire and biomarkers for evaluation of tobacco smoking in parturient women].

According epidemiological study tobacco smoking is popular addiction around the world. It was estimated, that one third of world population smoking tobacco. The statistical data from 2002 show that in Poland 42% of men and 22% of women smoke tobacco on a daily basis. As many as 60% of non-smokers are exposed to environmental tobacco smoke (ETS). The aim of the study was verification the answer on a standardised survey questionnaire (related to tobacco smoking) by laboratory method--determination of cotinine in urine. In the study participated 244 delivering women. In the tested group 23.8% of surveyed declared smoking during their pregnancy and around 28% of non-smoking women were exposed to passive inhalation of tobacco smoke. More than 15% of women, which declared non smoking has concentration of cotinine higher than 50 ng/mg creatinine (mean 227.3 ng/mg creatinine) what indicated active smoking of cigarettes. From these results we can conclude that as much as 35.6% of women smoking tobacco during pregnancy and is higher than suggested the questionnaire examination.

Adult↗
PubMed2004

[The socio-economic status of women smoking during pregnancy and birth weight of their newborns].

In this survey, socio-economic status of pregnant women smoking during pregnancy and influence of this status on birth weight of their newborn were assessed. The research was done on the group of 1328 pregnant women. Smoking habit was declared by 18.6% of women and passive exposure to tobacco smoke was stated by 30.6% of respondents. Significant association between active and passive smoking and socioeconomic status of respondents was observed. Cigarette smoking during pregnancy was the main cause of lower birth weight of newborns. The newborns of actively smoking mothers were lighter of about 357 g according to those ones of mothers who did not smoke and were not exposed to passive smoking, and were lighter than newborns of mothers who were not exposed to passive smoking of about 330 g. The passive exposure to the tobacco smoke was not significant considering effect on the birth weight.

Adult↗
PubMed2004

[The awareness of health consequences of active and passive smoking and access to information about these consequences in the population of pregnant women].

Despite of significant progress in the area of perinatal care, there have been numerous perinatal complications still existing. The health status of mother and newborn is affected by many factors, namely: socio-economical; medical prior to pregnancy and medical through the pregnancy; dietary customs, substance use, including tobacco smoking; health service quality; and risk factors that may occur through fertilization. The active and passive exposure to tobacco smoke in utero have been linked to numerous gestation and delivery complications, including low birth weight, preterm delivery and low Apgar score. In this survey, the awareness of health consequences of active and passive smoking in the population of pregnant women and access to the information of this consequence was assessed. Among of women smoking through their pregnancies, the only 19.7% got the information from their doctors about harmful effect of active and passive smoking, and 16.5% of respondents declared self-awareness on health effects of exposure to the tobacco smoke.

Attitude to Health↗
PubMed2004

[Perioperative anxiety in female smokers subjected to gynaecological surgery--a preliminary report].

UNLABELLED: Anxiety constitutes one of the most important psychological factors influencing body reaction to surgical injury; in gynecological patients anxiety ratings appear especially high. Cigarette smoking belongs to essential risk factors in the perioperative period and may result in increased levels of anxiety. A pilot study has been carried out with the aim of evaluating the impact of smoking habit on the perioperative anxiety level and postoperative pain in women undergoing gynecological surgical procedures. In 9 smokers and 10 non-smokers, anxiety was assessed by means of the State Anxiety Score of the Spielberger State-Trait Anxiety Inventory (STAI) and the visual analog scale (VAS), preoperatively and on the second day after surgery. Additionally, intraoperative and postoperative opioid analgesic uses were analyzed and on the second day after surgery patients rated their recall of postoperative pain with the use of the VAS. Postoperative State anxiety was lower than that reported preoperatively only in non-smokers (median: 53.0-40.0, p=0.02, Wilcoxon p=0.02). Smoking did not significantly influence intra- and postoperative opioid analgesic requirements and postoperative pain. CONCLUSIONS: This study suggests that in female smokers subjected to gynaecological surgery cigarette smoking may contribute to altered anxiety kinetics in the perioperative period.

Adult↗
PubMed2004

[Effect of tobacco smoke exposure on urine lead concentration of pregnant women].

Among other toxic compounds, tobacco smoke contains also heavy metals, for example lead. Lead can cross the placenta barrier and have negative influences on fetus development. In the study compared urine lead concentration of pregnancy women exposed to tobacco smoke (active smokers and exposed to environmental tobacco smoke--ETS) with unexposed. There was find that mean urine lead concentrations in groups of pregnant women exposed and unexposed to tobacco smoke was no different (F2,189=0.2 p>0.8). However it was found that in urine of women exposed to tobacco smoke the concentration of lead increase with increase the concentration of cotinine (r2=0.14, t106=4.2, p<<0.0001).

Case-Control Studies↗
PubMed2003

Evaluation of fetal circulation redistribution in pregnancies with absent or reversed diastolic flow in the umbilical artery.

AIM: To record blood flow velocimetry in the superior mesenteric, hepatic and middle cerebral arteries for detection of circulation redistribution and prediction of perinatal outcome in fetuses with absent or reversed diastolic flow in the umbilical artery. STUDY DESIGN: The fetal superior mesenteric, hepatic and middle cerebral artery blood velocimetry was recorded in 33 pregnancies complicated by pregnancy-induced hypertension and/or intra-uterine growth retardation between 27 and 41 weeks of gestation. Uterine artery and umbilical vein velocimetries were also recorded. RESULTS: An abnormal mesenteric artery pulsatility index (PI) was found in four cases; two newborns died due to prematurity, growth retardation and necrotizing enterocolitis. An abnormal fetal hepatic artery PI was found in 17 cases. The brain-sparing effect in the middle cerebral artery was found in 16 cases; three newborns died after delivery. Signs of redistribution in mesenteric, hepatic and middle cerebral artery velocimetry were not related to most of the perinatal outcome variables. Umbilical vein velocimetry correlated with low arterial and venous pH. All perinatal mortalities had umbilical venous pulsations. CONCLUSIONS: Signs of visceral circulation redistribution could not predict adverse outcome. Umbilical venous pulsations were, however, seen in nearly all fetuses; this was the only variable suggesting adverse outcome in the present study of severely compromised fetuses.

Birth Weight↗
PubMed2003

[Successful pregnancy outcome in the woman with thrombophilia and multiple miscarriages].

OBJECTIVES: The case of a 25 year-old pregnant woman with a history of miscarriage (8 week) and a triple intrauterine fetal death (35, 25, 21 week) was reported. RESULTS: Personal and family history did not revealed any abnormalities. In the 25th week of gestation routine ultrasonographic examination showed abnormal pulsation indexes in the umbilical artery, as well as the right and left uterine artery. Also extremely high vascular resistance was confirmed in both uterine arteries (notch). The routine laboratory tests were normal. Because of high risks of stillbirth and preliminary pregnancy termination the screening tests for thrombophilia were performed. The presence of a heterozygous form of factor V Leiden mutation and C677T polymorphism of a methylenetetrahydrofolate reductase gene were confirmed. The low doses of LMWH (nadroparine) subcutaneously and aspirin (150 mg per day, orally) were administered until pregnancy termination. In the 35th week of gestation the pregnancy was terminated by cesarean section due to fetus intrauterine asphyxia (boy 1180 g, Apgar 1 min-6, Agar 5 min 9 points). Three months' follow-up after delivery did not revealed any complication in the mother or in the child. CONCLUSIONS: Successful pregnancy outcome in the woman with thrombophilia and multiple miscarriages confirms the necessity for both prophylactic anticoagulant treatment and detailed laboratory testing.

Abortion, Habitual↗
PubMed2003

[Wernicke's encephalopathy due to hyperemesis gravidarum].

A report of 33 years old female with Wernicke's encephalopathy is presented. The disease was secondary to hyperemesis gravidarum, started from the 6th week of pregnancy. Neurological symptoms as nystagmus, headache, vertigo, disturbance of consciousness and ataxia are described, as well as difficulties in finding out the right diagnosis. We present the therapy with vitamin B1. The subsequent course of the pregnancy was uncomplicated and resulted in a birth--by caesarean section of a healthy male infant, weighted 2790 grams. However, four months later after the delivery, the patient is not yet completely recovered and still demands thiamine supplementation.

Adult↗
PubMed2003

[Evaluation of fetal right coronary artery blood flow velocimetry].

OBJECTIVES: In the present study fetal right coronary artery blood flow velocimetry was assessed. DESIGN: The prognostic value of the fetal right coronary artery blood flow velocimetry was evaluated in relationship with parameters of newborn's condition after birth. MATERIAL AND METHODS: The study was performed in 102 cases of pregnancies complicated by pregnancy induced hypertension. Blood flow velocimetry was visualized from fetal right coronary artery and correlated with perinatal outcome parameters. RESULTS: Fetal coronary blood flow velocimetry was visualized only in 11 cases. Coronary blood flow velocimetry visualisation correlated with each parameter of after-birth evaluation. The method has the highest specificity (97.7%) and positive prognostic value (85%) concerning evaluation of newborn's condition. CONCLUSIONS: Fetal right coronary artery blood flow velocimetry visualisation is a late sign of chronic fetal hypoxia. This seems to be a factor which causes maximal coronary vessels dilatation and allows oxygenation of fetal heart muscle.

Adult↗
PubMed2003

[Obstetrical hysterectomy].

OBJECTIVE: Obstetrical hysterectomy still remains life saving operation. The aim of study was to determinate the frequency, indications and complications after the operation in the hospital in Zielona Góra, Poland. MATERIALS AND METHODS: A retrospective review based on hospital data of 36 patients undergoing obstetrical hysterectomy over the period of 11 years was undertaken. RESULTS: The incidence of obstetrical hysterectomy during 1990-2001 et the Department of Obstetrics and Gynaecology in the district hospital in Zielona Góra was 1: 593 deliveries. Post partum hysterectomy occurred in 0.021% of normal deliveries and 1.03% of cesarean sections. The most common indications were placenta increta and placenta accreta /61.1%/, followed by uterine atony /13.8%/ and rupture of the uterus /11.1%. The most frequent complications were shock and lesion of the urinary bladder/both 5.6%/. The maternal mortality was 2.8%. CONCLUSIONS: 1. The most common indications for the obstetrical hysterectomy are: placenta's pathologies; uterine atony and rupture of the uterus. 2. Obstetrical hysterectomy is connected with high risk of complications and maternal mortality.

Abruptio Placentae↗
PubMed2002

[Effect of recombinant activated factor VII (RFVIIA; NovoSeven) in a patient in haemorrhagic shock after obstetrical hysterectomy].

Perinatal bleeding may lead to a fatal outcome in about 10% of cases. We present a case of a 29 year old woman in childbirth, in whom a preparation of recombinant activated factor VII (rFVIIa, NovoSeven, Novo Nordisk A/S, Bagsvaerd, Denmark) was used with success to control intraoperative bleeding during haemorrhagic shock after caesarean section and obstetrical hysterectomy, in the course of the patient's third abdominal cavity revision for continuing blood loss. Administration of the preparation enabled for quick intraoperative control of haemorrhage, which allowed safe and clear identification and elimination of the cause of bleeding. No significant clotting abnormalities were noted at postoperative monitoring of the coagulation system. rFVIIa seems to be an effective alternative treatment of life-threatening haemorrhages in obstetrics, allowing for quick arrest of bleeding, and thus safe control of intraoperative local hemostasis.

Adult↗
PubMed2002

[Clinical value of hypoxanthine concentration assays in diagnosis of hypoxia in newborns].

The purpose of this study was to asses the usefulness of hypoxanthine (HYP) concentration as an indicator of hypoxia. Concentration of HYP (HPLC method) in the umbilical arterial cord blood was determined in 145 newborns. Newborns were studied in four groups: premature asphyxiated, term asphyxiated, premature non-asphyxiated, term non-asphyxiated. Newborns were classified as hypoxic if they had: pH < 7.15, BE < -7.0 mmol or PaO2 < 10 mmHg. Reduced umbilical arterial pH, PaO2 and BE correlated directly with increased concentrations of HYP. The highest correlations were observed for HYP and PaO2. The levels of HYP for asphyxiated and non-asphyxiated newborns were different. The results show that HYP concentration is an important indicator in detection of asphyxia in newborns. Strong correlation between parameters of acid base balance and HYP concentration was observed in the studied groups. Increased concentration of HYP confirms intrauterine hypoxia independently of maturity.

Apgar Score↗