Biomedical subjects

Jerzy Zwoliński

Publications and source records attributed to Jerzy Zwoliński.

5 recordsLinked to original sources

PubMed2005

[Preterm delivery by cesarean section in patient with polycythemia vera].

Polycythemia vera is a myeloproliferative disease most commonly diagnosed in male 60-70 years old patients. It is associated with a higher risk of thrombosis and bleeding. It is very rarely diagnosed in young patients, and thus only few cases of pregnant women have been reported in the literature. These reports show that polycythemia vera may have a detrimental effect on outcome of the pregnancy (PIH, spontaneous miscarriages, preterm delivery, and stillbirth). We report a 33-year-old woman with polycythemia vera who underwent caesarean delivery in 34 weeks gestation. This case demonstrates fully successful result of our intensive perinatal care.

Adult↗

PubMed2005

[Conjoined twins--diagnostic problems, difficult decisions in choosing the most optimal management in one of the rarest pathologies of pregnancy].

Conjoined twins are the rarest type of monozygotic, monochorionic, monoamniotic twins--incidence about 1:50000 - 1:100000. A conjoined twin pregnancy is a very special pathology in obstetrics and usually ends prematurely. 40% of twins are stillborn, while 35% die within 24 hours after delivery. The development of ultrasonography and in the last years also MRI, allows earlier detection and diagnosis of fetal malformation and enables precise evaluation of the anatomy, type of malformation and how the twins are conjoined. Chances of survival and way of delivery depends on the degree of fusion of the organs and possibilities of surgical separation. Obstetric care for a women with conjoined twins does not differ from that in a normal twin pregnancy, but the newborns require special medical care after delivery. We would like to stress the diagnostic problems and the difficult decisions that we encountered. The degree of conjoinment in this case excluded surgical separation of the twins. A multidisciplinary team of experts decided to end the pregnancy at 31 wks by cesarean section. Delivery at a later term could increase the risk of uterine rupture and surgical complications.

Abnormalities, Multiple↗

PubMedDate not supplied

[Fibrinolytic therapy of pulmonary embolism in pregnant women].

Fibrinolytic therapy has an established position in the treatment of pulmonary embolism. Its use has proven to decrease patients' mortality. However, in pregnant women such treatment is considered risky, due to possible fatal haemorrhagic events. In spite of such disadvantages, fibrinolytic therapy has been used in pregnant women with good results: from definite improvement of clinical status to complete recovery. No severe haemorrhagic events were observed in these cases and overall mortality was significantly decreased. These findings show that the use of fibrinolytic therapy in emergency situations is an efficient and safe method, when applied in accordance with standard procedures. In this publication we present the general review of current knowledge regarding the use of fibrinolytic therapy in pregnant women.

Anticoagulants↗

PubMedDate not supplied

[External cephalic version at term].

About 3 - 4 % of all pregnancies reach term with a foetus in the breech presentation. Because of higher risk of complications for mother and foetus during the vaginal breech birth, only 50% of patients try to deliver vaginally - at the end 40 - 70% of labours are finished by caesarean section. In other cases planned caesarean sections are performed, and finally 10 - 20% of patients with breech presentation at term deliver vaginally. Prenatal mortality and serious complications after breech vaginal birth are 5% and after planned caesarean section 1.6%. This is the reason why the caesarean section is chosen as a final way of delivery with breech presentation. At present, after a period of increasing percentage of caesarean section one can observe a tendency to decrease this number. One of the procedures performed to decrease the number of complications and cost of perinatal management is external cephalic version (ECV). An indication to ECV is breech presentation at term, while there is no contraindication to ECV. Multiple pregnancy, significant third - trimester bleeding, uteroplacental insufficiency, IUGR, oligohydramnion, PROM, PIH, nonreassuring foetal monitoring patterns and all contraindications to vaginal birth are concerned to execute ECV. The real number of patients with breech presentation at term, after ECV, is according to the literature about 1 - 1.5%. The risk of serious complications during ECV, which are the indications for urgent caesarean section, is 1 - 3%. The risk of intrauterine death of foetus after ECV is about 0.0001%. According to the literature it appears that ECV at term seems to be useful and it is safe both for the mother and the foetus and helps to avoid a significant number of caesarean sections.

Breech Presentation↗

PubMedDate not supplied

[Intraamniotic surfactant supply as RDS prevention].

The importance of steroids given antenatally to the mothers in prevention of the respiratory distress syndrome (RDS) is unquestionable. Also intra tracheal surfactant application in newborn is proven method of prevention and treatment of RDS. However both options have some limitations and new methods useful in prevention of RDS are still needed. The aim of the study was to evaluate the efficiency and safety of the procedure of the intraamniotic surfactant supply as RDS prevention. Natural surfactant (Alveofact - Boehringer Ingelheim) has been given to 15 women at 24-32 weeks of pregnancy, two hours before expected childbirth (mainly cesarean section). To 8 of these women corticosteroids have been earlier administered. Just before surfactant injection amniotic liquid samples were taken to confirm lung immaturity and the patients were administered Aminophilline intravenously to provoke fetal breathing movements. Surfactant has been administered through the needle under direct ultrasound guidance into the amniotic cavity as close as possible to the fetal mouth and nose. Patients with the evidence of chorionamnionitis and fetal malformations were excluded from the study. No complications were observed during and after the procedure. None of the newborns had symptoms of severe asphyxia, the birth weight comprised between 670-1650 g (mean 1207). There was radiological evidence of RDS in two newborns and in 7 mechanical ventilation was needed. Of 15 newborns 13 survived (86.6%). There was no need for postpartum surfactant therapy in any case. Some authors expressed their view that this method is promising and further studies are desirable. In our study surfactant has been injected into the amniotic cavity shortly before childbirth, and Aminophilline has been administered intravenously in order to provoke fetal breathing movements before surfactant injection. The safety of the procedure was confirmed and the results of intraamniotic surfactant supply seems to be favourable to newborns. Small number of cases does not allow to draw any far-reaching conclusions. Still our preliminary results are encouraging and the study should be continued.

Adrenal Cortex Hormones↗