Ginekol Pol
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The aim of the study was to evaluate changes in the course of twin deliveries over the years, with particular emphasis on the history of infertility duration of pregnancy mode of delivery indications for caesarean section (CS) and infant condition. ⋯ Twin pregnancy rate almost doubled over the years, mostly due to a growing popularity of the infertility treatment. Cesarean section is increasingly being chosen to deliver twins. The non-cephalic position of the 2nd fetus has become an important indication for cesarean section. Change in the mode of twin deliveries can be beneficial for the condition of the 2nd twin.
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Practice Guideline
[Recommendations of Polish Gynecological Society concerning perinatal care in obese pregnant women].
Maternal obesity (defined as prepregnancy maternal BMI> or = 30 kg/m2) is a risk factor strongly associated with serious perinatal complications and its prevalence has increased rapidly in a general population during the last decades. Therefore, following international approach to regulate perinatal care in this population, Group of Experts of Polish Gynecological Society developed these new guidelines concerning perinatal care in obese pregnant women, including women after bariatric surgery. The recommendations cover detailed information on specific needs and risks associated with obesity in women of reproductive age, pregnancy planning, antenatal care, screening, prophylaxis and treatment for other pregnancy complications characteristic for maternal obesity fetal surveillance, intrapartum care and post-partum follow-up. ⋯ Medical staff taking intrapartum care for obese parturient should be also aware of reduced reliability of methods used for intrapartum fetal surveillance, increased risk for intrapartum fetal death, maternal injuries, postpartum haemorrhage, shoulder dystocia, thrombophlebitis and infection. Pediatrician should be also available due to increased neonatal morbidity mainly due to meconium aspiration syndrome, hypoglycemia, and respiratory distress syndrome. In puerperium, medical staff should be prepared to deal with breastfeeding disturbances and increased maternal mortality.
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Case Reports
[Laparoscopic management of an ectopic pregnancy in a previous caesarean section scar].
Pregnancy in a caesarean section scar is the rarest form of an ectopic pregnancy English language literature up to 2007 reports only about 70 cases, including three cases treated laparoscopically. A 25-year-old woman in the sixth week of pregnancy was admitted to our hospital due to profuse vaginal bleeding. ⋯ The treatment plan included two phases. Three days after a Methotrexate injection (80mg), the pregnancy was removed laparoscopically Laparoscopy enabled a successful treatment of the unruptured ectopic pregnancy in a previous caesarean scar and made it possible to preserve the reproductive capability of the patient.
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Hypoxic-ischemic encephalopathy (ENN) concerns neonates born after 35 completed weeks of gestation. The incidence rate has been shown to be 1-6/1000 births and can lead to significant permanent neurological damage, cerebral palsy and even death. ⋯ Currently both methods--whole body hypothermia and selective brain cooling--offer a chance for a normal neurological development and a better life for children born with ENN. Both methods are accessible in a few centers in Poland.
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Multicenter Study
Retrospective analysis of placenta accreta: management strategies--evaluation of 41 cases.
The aim of the study was to evaluate maternal characteristics, surgical treatment options, and morbidity of patients with placenta accreta. ⋯ Placenta accreta is highly associated with the existence of placenta previa, especially in cases with previous cesarean delivery When placenta accreta is diagnosed or suspected, the patient should be referred to a tertiary center for optimum care, where the obstetrical team should include experienced pelvic surgeons who are capable of performing emergent hysterectomy internal iliac artery ligation, and uterine devascularization procedures.