Biomedical subjects

Marek Bilar

Publications and source records attributed to Marek Bilar.

4 recordsLinked to original sources

PubMed2006

[Monoamnotic twin pregnancy. Multicenter study].

OBJECTIVE: The purpose of this study was to evaluate of perinatal mortality and morbidity of monoamniotic twins. STUDY DESIGN: This was a multicenter retrospective analysis of 26 monoamniotic twin gestations identified between 1985 and 2004 in a 3 perinatal departments. Of these 26 pregnancies, 11 women were admitted electively for inpatient fetal monitoring. Overall mortality rates, the risk of intrauterine fetal death and neonatal mortality and morbidity, pregnancy complications and fetal anomalies were calculated. RESULTS: Monoamniotic twin pregnancies were diagnosed reliably prenatally by ultrasound in 22 women and at delivery in 4 cases. Of the 26 gestations, spontaneous fetal losses before 22 weeks of gestation were 4 cases. The overall loss rate and the perinatal mortality rate were 52% and 19.4%, respectively. Twenty-two women had both twins alive at 24 weeks of gestation; 11 women were admitted electively for inpatient fetal monitoring at 26-27 week of gestation. In this group there were 2 neonatal deaths. No intrauterine fetal death occurred in any hospitalized patient. In our series there were 100% incidence of prematurity, 38,5% of umbilical cord entaglement, 23% of TTTS, 3.6% of TRAP and 9.6% fetal congenital anomalies. CONCLUSION: Monoamniotic twins are at extremly risk of pregnancy complications and fetal loss. These pregnancies can be diagnosed reliably by ultrasound in most cases. Electively admitted women for inpatient fetal monitoring could be improved neonatal survival and decreased perinatal morbidity.

Congenital Abnormalities↗

PubMed2003

[The relationship between intrapartum fetal heart rate disturbances, electrocardiographic changes and umbilical venous troponin-I (T-I)].

OBJECTIVE: To analyse the relationship between intrapartum fetal heart rate disturbances and electrocardiographic changes and umbilical venous troponin-I (T-I), concentrations as well. MATERIAL AND METHODS: 14 fetuses were continuously surveyed by CTG and ECG recordings in the first and second stage of labor, using STAN S-21 analyser. After birth, umbilical venous blood samples were collected for determination of acid-base balance, base excess and troponin-I concentrations. RESULTS: From among monitored fetuses, in 8 cases the CTG and FECG patterns were correct. Vaginally delivered neonates were born in good clinical status, with normal acid-base balance, base excess and T-I < 0.3 ng/ml. In 3 cases abnormal CTG patterns were observed with early decelerations but FECG patterns were correct. Vaginally delivered neonates were born in good clinical status, with normal acid-base balance, base excess and T-I < 0.3 ng/ml. In 2 cases abnormal CTG patterns were observed with variable decelerations but FECG patterns were correct. Vaginally delivered neonates were born in good clinical status, with normal acid-base balance, base excess and T-I < 0.3 ng/ml. In one case abnormal CTG pattern were observed with late decelerations but FECG patterns was correct. The pregnancy was terminated by caesarean section because of fetal distress. The neonate was born in good clinical status with normal acid-base balance and base excess but T-I concentration was increased (1.5 ng/ml).

Acid-Base Equilibrium↗

PubMed2003

[Evolution of indications for cesarean section between 1991 and 2000 in materials from the Pathology Clinic in the Department of Pregnancy and Labor, Pomeranian Medical University in Szczecin].

The present study was designed to analyze retrospectively the course of 2693 pregnancies and deliveries between 1999 and 2000 at the Department of Pathology of Pregnancy and Labor, Pomeranian Academy of Medicine in Szczecin. Attention was focused on the frequency of cesarean sections including preventive and urgent cases, obstetric and paraobstetric pathologies complicating pregnancy, perinatal and maternal mortality. The efficacy of diagnosing fetal distress in pregnancy and labor by continuous fetal monitoring with cardiotocography versus ultrasonography, in particular umbilical artery Doppler velocimetry, was studied. The material consisted of 2693 pregnant women (1476 (54.8%) primiparous and 1217 (45.2%) multiparous) aged 15-46 years, and their 2802 newborns. Gestational age varied between 23 and 43 weeks. Two groups were formed: I--1268 women delivering by cesarean section between 1991 and 1995; II--1425 women delivering by cesarean section between 1996 and 2000. In 1995/1996, complete ultrasonography supplemented with umbilical artery Doppler flow and intrauterine invasive intervention (cordocentesis, amnioinfusion, amnioreduction, intrauterine fetal blood transfusion) were introduced, as well as screening for diabetes in pregnancy and immunological tests for anticardiolipin antibodies. At that time, the Program of Improved Prenatal Care in Poland was fully implemented. Moreover, the Intensive Therapy of Newborns Uni was established at the Department of Pathology of Pregnancy and Labor. Depending on the moment the decision to perform cesarean section was taken, the prospective group was divided into two groups: antenatal (group P--1036 gravida) and intranatal (group S--1657 parturients). Depending on indications for cesarean section, urgent (N) were distinguished from preventive (Pr) cases. CTG interpretation was performe using qualitative and semi-quantitative Fischer's method. CTG recordings during labor were interpreted according to the qualitative method proposed by FIGO in 1987. An analysis of PI, S/D, RI, and flow curve (absence (AEDF) or reversion (REDF) of end-diastolic umbilical artery blood flow) in umbilical artery Doppler velocimetr was performed. A decrease of more than two standard deviations from average valu for several pregnancy time intervals was regarded as pathological. The absence (AEDF) or reversion (REDF) of end-diastolic umbilical artery blood flow was considered to be a high risk factor. The status of newborns was assessed using 5 min Apgar score and parameters o acid-base equilibrium in umbilical artery blood. The following conclusions were drawn: 1. Analysis of cases during the last decade of the 20th century revealed: --increased rate of cesarean sections with a shift in indications from urgent to preventive; --increase in obstetric risk associated with higher percentage of complication during pregnancy; --higher percentage of cesarean sections in premature labor; --correlation between premature labor and increased risk of poor newborn statu --decrease in perinatal mortality of newborns. 2. Analysis of methods for antepartum fetal monitoring revealed: --abnormal CTG patterns and abnormal blood flow in umbilical artery with ab sence or reversion of end-diastolic blood flow the coexistence of which were diagnostically effective for prediction of poor newborn status. 3. Analysis of fetal monitoring methods revealed: --normal intrapartum CTG patterns and normal antepartum blood flow in umbilical artery were markers of good newborn status; --abnormal CTG patterns and abnormal blood flow in umbilical artery had lim ited predictive value regarding poor newborn status. 4. Evolution of indications for cesarean section was multifactorial in character. New and more effective methods for fetal monitoring are needed.

Adolescent↗

PubMedDate not supplied

[Caesarean section in preterm labour].

The aim of this study was to estimate complications of pregnancy, indications to caesarean section, complications after caesarean operation and perinatal mortality of newborns who were delivered before the 37th week of gestation by caesarean section. The retrospective analysis of the total of 2693 deliveries (years 1991-2000) by caesarean section in the Department of Pregnancy and Labour Pathology in Pomeranian Academy of Medicine has been carried out. 590 women whose delivered before the 37th week of pregnancy have been chosen for subsequent examination. The patients have been divided into three groups: group I--patients with pregnancy completed before the 28th week, group II--patients with pregnancy completed between 29th and 32nd week, and group III--patients with pregnancy completed between the 33rd and 36th week. Obstetrical anamnesis, complications of pregnancy, indications to caesarean section and postoperative complications as well as newborns perinatal mortality have been analysed. Among women who experienced abortions, premature deliveries caesarean section a higher rate of caesarean section during subsequent premature delivery was stated. The increase of caesarean sections rate in premature deliveries after the 29th week of gestation is associated with a considerable decrease in newborns, mortality.

Cesarean Section↗