Normal Course Of Pregnancy Research Articles

Diagnosis of preeclampsia and fetal growth restriction with the sFlt-1/PlGF ratio: Diagnostic accuracy of the automated immunoassay Kryptor®.

We aimed to characterize the diagnostic accuracy of the Kryptor® assay for sFlt-1 and PlGF in maternal serum samples of uneventful singleton pregnancies and subjects with preeclampsia (PE) and PE-related outcomes such as fetal growth restriction (FGR). Longitudinal reference ranges of the sFlt-1 and PlGF level in the course of normal pregnancies were generated. A cohort of subjects with PE and PE-related outcomes including FGR in the third trimester was compared to a cohort of women with uneventful outcome. Serum levels of sFlt-1, PlGF level as well as the sFlt-1/PlGF ratio was analysed with the Kryptor® assay and compared between the case- and control groups. Cut-off values were generated and diagnostic accuracy examined. Longitudinal reference ranges of the sFlt-1 and PlGF level in healthy pregnancies were in line with those levels measured with other immunoassays. Comparison of the sFlt-1/PlGF ratio between PE-related outcomes including FGR or PE and healthy controls showed a high diagnostic accuracy with an area under the curve (AUC) of 0.917 for PE-related outcomes and 0.919 for PE.

The influence of the perinatal chronic hyperglycaemia on the pattern of NOS isoforms expression in left ventricle myocardium in male rats of pre-pubertal age

The aim of our study was to find out the features of the nitric oxide synthase (NOS) isoforms expression in longitudinal and transversal layers of the myocardium of the left ventricle in male rats of 3 months, which are descendants of female rats with experimental gestational diabetes (EGD). Materials and methods. Study was carried out on 10 male rats descendants of female rats with normal course of pregnancy and 10 descendants of female rats with EGD. We evaluated the expression of neuronal, endothelial and inducible isoforms of NOS in histological sections both of transversal and longitudinal layers of the myocardium of left ventricle. With the aim to analyze the pattern of the NOS isoforms expression in 5 um histological slices of left ventricle myocardium we have carried out a complex of histochemical assays. Slices were allocated to 3 groups: 1 st one was incubated with rabbit IgG to neuronal NOS (Santa Cruz Biotechnology, USA) in dilution of 1:200; 2 nd group underwent the incubation with rabbit IgG to endothelial NOS (eNos) (Santa Cruz Biotechnology, USA) in dilution 1:200; 3 rd group was incubated with mice IgG to inducible NOS (iNos) conjugated with FITC (Santa Cruz Biotechnology, USA) in dilution of 1:200. The analysis of images was carried out with VIDAS-2.5 application package (Kontron Elektronik, Germany). Microimages of the left ventricle myocardium obtained with AxioScope (Carl Zeiss, Germany) and COHU 4922 (COHU Inc., USA) camera were processed in the system of digital image analysis VIDAS-386 (Kontron Elektronik, Germany). Results. In the study we have found that prenatal hyperglycaemia leads to the significant changes of the expression of NOS isoforms in the myocardium of left ventricle in male rats descendants of females with EGD, and the contain and the allocation of these enzymes are dependent both on type of the enzyme and its location in muscular layers. For eNOS the increase of the expression and the allocation in both transversal and longitudinal layers was typical, and for nNOS and iNOS we have found the significant decrease of the expression in transversal layers and the significant increase in longitudinal layers. Conclusion. We believe, the glucose homeostasis violation in foetus during the last trimester of the pregnancy changes the ratio of the NOS isoforms expression in the left ventricle myocardium and affects the balance of them in different layers, which could be a reason of the cardiovascular pathology development in adulthood.

Imaging of Neurologic Conditions in Pregnant Patients.

A number of physiologic, hormonal, immunologic, and hemodynamic changes take place in the maternal body during pregnancy. The majority of these changes are essential for maintaining the normal course of pregnancy. However, these changes may also cause acute or chronic conditions that affect various biologic systems in the mother. In addition, conditions of the central and peripheral nervous systems can cause a variety of neurologic symptoms and complications. Neurologic signs and symptoms in pregnant and postpartum women may be due to the exacerbation of a preexisting medical condition, the initial manifestation of a primary central nervous system-related problem, or a neurologic problem unique to pregnancy and the postpartum period. Because the symptoms of these conditions are either nonspecific or overlapping, it can be challenging to pinpoint the diagnosis clinically. These conditions can be classified into more commonly seen conditions such as headache, venous thrombosis, preeclampsia, subarachnoid hemorrhage, posterior reversible encephalopathy syndrome, and certain pituitary disorders; and less commonly seen entities such as aneurysm, arteriovenous malformation, primary or secondary neoplasm, Sheehan syndrome, and Wernicke encephalopathy. Imaging has an important role in the differentiation and exclusion of various neurologic conditions, and most of the time, imaging findings can point the clinician to a specific diagnosis. The imaging appearances of common and uncommon neurologic conditions that can occur during pregnancy and the early postpartum period are highlighted in this article. ©RSNA, 2016.

Threatened preterm labor is a risk factor for impaired cognitive development in early childhood

Threatened preterm labor is a leading cause of hospital admission during pregnancy. Patients with an episode of threatened preterm labor who deliver at term are considered to have false preterm labor. However, threatened preterm labor has been proposed as a pathologic insult that is not always sufficient to induce irreversible spontaneous preterm birth but that could alter the normal course of pregnancy. The aim of this study was to evaluate threatened preterm labor during pregnancy as a risk factor of neurodevelopmental deficits of children at 2 years of age. Two-year-old children who were born late preterm (n=22) or at term after threatened preterm labor (n=23) were compared with at-term control children (n=42). Neurodevelopment was evaluated at a corrected age of 24-29 months with the use of the Merrill-Palmer-Revised Scales of Development. Children who were born at term after threatened preterm labor had lower scores than control children on global cognitive index (95.4 vs 104.2; P=.011), cognition (95.1 vs 103.1; P=.021), fine motor (95.2 vs 103.4; P=.003), gross motor (84.7 vs 99.8; P=.001), memory (92.9 vs 100.4; P=.015), receptive language (93.9 vs 102.9; P=.03), speed of processing (105.7 vs 113.3; P=.011), and visual motor coordination (98.8 vs 106.7; P=.003) subtests. Children born at term after threatened preterm labor had an increased risk of mild neurodevelopmental delay compared with control children (odds ratio for global cognitive index, 2.06; 95% confidence interval, 1.09-3.88; P=.033). There were no significant differences in any cognitive domain between children who were born late preterm and children who were born at term after threatened preterm labor. Threatened preterm labor is a risk factor for impairedcognitive development at 2 years of age, even if birth occurred atterm.

Why non-invasive maternal hemodynamics assessment is clinically relevant in early pregnancy: a literature review.

BackgroundThe maternal cardiovascular system adapts quickly when embryo implantation is recognized by the body. Those adaptations play an important role, as a normal cardiovascular adaptation is a requirement for a normal course of pregnancy. Disturbed adaptations predispose to potential hypertensive disorders further in pregnancy [1–3]. This report aims to briefly inform the obstetricians, general practitioners and midwives, who are the key players in detecting and treating hypertensive disorders during pregnancy.MethodsThe PubMed database was used as main tool to find studies involving clearly defined first trimester hemodynamic changes in normal pregnancies and hypertensive pregnancies. In addition, the bibliographies of these studies were investigated for further relevant literature.ResultsA comprehensive overview is given concerning the normal adaptations in the cardiovascular tree in a first trimester pregnancy. Additionally, signs of abnormal cardiovascular changes observed in first trimester are described together with the normal reference range for each non-invasive, easily applicable technique for maternal hemodynamics assessment.ConclusionsWith a combination of techniques, it is possible to integrate and evaluate the maternal heart, veins and arteries at 12 weeks of pregnancy. Applying those techniques into the daily clinic opens perspectives to prevention and prophylactic treatment, aiming for a reduction of the risk for hypertension during pregnancy.

The Role of Vitamin D in the Transcriptional Program of Human Pregnancy.

BackgroundPatterns of gene expression of human pregnancy are poorly understood. In a trial of vitamin D supplementation in pregnant women, peripheral blood transcriptomes were measured longitudinally on 30 women and used to characterize gene co-expression networks.ObjectiveStudies suggest that increased maternal Vitamin D levels may reduce the risk of asthma in early life, yet the underlying mechanisms have not been examined. In this study, we used a network-based approach to examine changes in gene expression profiles during the course of normal pregnancy and evaluated their association with maternal Vitamin D levels.DesignThe VDAART study is a randomized clinical trial of vitamin D supplementation in pregnancy for reduction of pediatric asthma risk. The trial enrolled 881 women at 10–18 weeks of gestation. Longitudinal gene expression measures were obtained on thirty pregnant women, using RNA isolated from peripheral blood samples obtained in the first and third trimesters. Differentially expressed genes were identified using significance of analysis of microarrays (SAM), and clustered using a weighted gene co-expression network analysis (WGCNA). Gene-set enrichment was performed to identify major biological pathways.ResultsComparison of transcriptional profiles between first and third trimesters of pregnancy identified 5839 significantly differentially expressed genes (FDR<0.05). Weighted gene co-expression network analysis clustered these transcripts into 14 co-expression modules of which two showed significant correlation with maternal vitamin D levels. Pathway analysis of these two modules revealed genes enriched in immune defense pathways and extracellular matrix reorganization as well as genes enriched in notch signaling and transcription factor networks.ConclusionOur data show that gene expression profiles of healthy pregnant women change during the course of pregnancy and suggest that maternal Vitamin D levels influence transcriptional profiles. These alterations of the maternal transcriptome may contribute to fetal immune imprinting and reduce allergic sensitization in early life.Trial Registrationclinicaltrials.gov NCT00920621

PREVENTION OF COMPLICATIONS OF PLACENTA DYSFUNCTION

Introduction. The frequency of placental dysfunction (DP) ranges from 20% to 50% depending on factors that complicate the normal course of pregnancy. Despite the rather large range of drugs used to prevent and treat DP, frequency of occurrence, the number of complications and the development of adverse side effects in the treatment of DP is not reduced, which requires effective and safe treatment.Aim. To achieve a decrease of DP through preventive treatment during the initial appearance of symptoms DP (compensated form).Materials and methods. Clinical and laboratory examination of pregnancy, an ultrasound of the fetus, fetal biophysical profile, Doppler blood vessels of the umbilical cord, immunoenzyme method using of blood serum, statistical method.Research results. Conducted the examination and treatment of 50 pregnant females with a compensated form of placental dysfunction. Was performed prevention of placental dysfunction using of treatment of the underlying disease and long-term oral administration of α -lipoic acid (tiohama) and α -amino-d-huanidynovalerianovoyi acid (tivortyn) (first subgroup of pregnancy) or through the appointment of a-lipoic intravenously for 5 days with the transition to tablet form within 7-10 days, while using tivortyn.Conclusions. Еeffectiveness of treatment depends on the route of administration of drugs. With long-term use of drugs until the end of pregnancy the effectiveness of treatment was significantly higher than the treatment for several weeks.

G5. 12-week cardiovascular profiles differ between patients with essential hypertension, gestational hypertension, late preeclampsia and intra-uterine growth retardation

Introduction: Maternal cardiovascular adaptations are mandatory for a normal course of pregnancy. Disturbed adaptations predispose to gestational complications further in pregnancy such as hypertension disorders and/or fetal growth restriction. We aim to explore the early gestational cardiovascular profile in uncomplicated pregnancy, in gestational hypertensive disorders and isolated intra-uterine growth retardation.Methods: Cardiovascular assessments were done using a standard protocol with impedance cardiography (Niccomo, SonoSite, MedisMedinizinischeMesstechnik GmbH, Ilmenau, Germany) and bio-impedance (Maltron BIOSCAN 920-II; Maltron International LTD, Essex, UK) around 12 weeks of gestation. Only singleton pregnancies were included. After delivery, gestational outcome was categorized in essential hypertension (EH), gestational hypertension (GH), early preeclampsia (EPE), late preeclampsia (LPE), HELLP, intra-uterine growth retardation (IUGR; <10th percentile) or uncomplicated pregnancy (UP). Independent sampled t-tests at nominal level a < 0.05 were performed using SPSS for comparison between UP and other groups. Pathologies with <5 inclusions were not considered.Results: A total of 777 women were measured: 17 EH, 21 GH, 19 LPE, 74 IUGR and 643 UP. Three patients were excluded from the diagnosis HELLP (n = 1) and early preeclampsia (n = 2). Results are shown in Table 1. Parameters are marked " or # when measurements in pathology groups were higher (") or lower (#) then in UP. The combination of abnormal parameters is different between groups.Conclusions: Cardiovascular profiling around 12 weeks could be useful to specify the type of cardiovascular dysfunction before the onset of gestational hypertensive disorder and/or a growth restriction.

Cardiorhythmogramme in evaluation of vegetative nervous system within different terms of normal course of pregnancy

Cardiorhythmogramme in evaluation of vegetative nervous system within different terms of normal course of pregnancy

Primary Hyperparathyroidism in a Twin Pregnancy: A Case Report

The primary hyperparathyroidism during pregnancy is an infrequent disorder but it is rarer in a twin gestation. Often it is not suspected because the symptomatology is overlapped with the normal course of pregnancy and it is usually discovered after a routine blood test. Ultrasound is the best option to identify the adenoma, while the gold-standard is technetium-99 m sestamibi but is contraindicated in this situation. The treatment is controversial and depends of the time of the gestation: the medical therapy is accepted in the first and third trimester, and the surgery is reserved for the second trimester, where the side effects are low. We present a case of primary hyperparathyroidism in a twin pregnancy treated by a minimally invasive parathyroidectomy in the second trimester without consequences for both, mother and newborns.

Психологический способ коррекции эмоционального состояния беременной женщины на стоматологическом приеме

Dental treatment of a pregnant woman plays an important role in normal course of pregnancy&#x0D; and fetal development. It is proved that there is a relationship between the foci of chronic infection in the oral&#x0D; cavity and a chronic sepsis development of the fetus and the expectant mother. According to the order of the&#x0D; Ministry of health of the Russian Federation from November 1, 2012 № 572н &amp;#34;On approval of the procedure of&#x0D; medical aid in the field of &amp;#34;Obstetrics and Gynecology&amp;#34; (except, the assisted reproductive technologies)&amp;#34;, the&#x0D; dental examination of pregnant women is carried out 2 times during the entire pregnancy. Often pregnant women&#x0D; experience intense fear, excitement and tension before dental interventions, because of this, they can postpone&#x0D; the visit to the dentist that, in turn, will affect the deterioration of the oral cavity and cause exacerbation of&#x0D; chronic infection foci. In outpatient dental practice there are known pharmacological and psychological distress&#x0D; correction methods, their efficiency is proven by objective methods of research. However, the use of pharmacological&#x0D; agents during pregnancy is not always prescribed and secure, therefore, the authors justify the use of psychological&#x0D; distress correction methods, including cognitive behavioral methods of psychotherapy, the effectiveness&#x0D; of their application is impossible without taking into account individual characteristics. To develop a new&#x0D; method of anxiety correction before dental treatment, the authors took into account the temperament of a pregnant&#x0D; woman. To ensure a safe and effective dental treatment it requires using a distress correction and motivation’s&#x0D; formation for treatment adherence, including methods of behavioral psychotherapy. The effectiveness of&#x0D; the developed method is determined subjectively by testing the level of situational anxiety according to the scale&#x0D; Spielberg-Hanin. It is found that the use of this method increases the safety of dental treatment for the pregnant woman and the unborn child. This article presents the results of the developed psychological distress correction&#x0D; method for pregnant woman before dental interventions.

Second trimester maternal plasma and amniotic fluid adipokines in women who will develop gestational diabetes mellitus

Objective: To study the adipokines concentration and glucose homoeostasis in the early-second trimester of women who will develop gestational diabetes mellitus (GDM).Materials and methods: Maternal plasma and fetal amniotic fluid samples were prospectively collected between 2006 and 2007 at the time of mid-trimester amniocentesis. Eight patients found to be affected by GDM were compared with 10 control patients with a normal pregnancy course. Adipokines leptin and adiponectin, as well as insulin and glucose concentration both in amniotic fluid and maternal plasma were compared between cases and controls. HOMA-IR (homeostatic model assessment for insulin resistance) was also calculated both for amniotic fluid and maternal serum.Results: The amniotic fluid adiponectin concentration was higher in women who would develop GDM than in controls (29.9 ng/ml, 95% CI 26.7–49.8 ng/ml, versus 14.9 ng/ml, 95% CI 13.5–18.8 ng/ml), p < 0.05). No difference was shown for leptin both in amniotic fluid and maternal serum. Insulin concentrations in the amniotic fluid were found to be lower in GDM than in controls, while HOMA-IR-index resulted lower in amniotic fluid and higher maternal serum (p < 0.05).Conclusions: Our data suggests that an earlier alteration in the fetal glucose metabolism will precede the glucose dysmetabolism in pregnancies later complicated by GDM.

Prenatal diagnosis of periventricular venous infarction in utero: a case with hereditary protein C deficiency

Abstract A 36-year-old primigravida woman with a normal pregnancy course presented with fetal unilateral focal ventriculomegaly on routine ultrasonography performed at 28 weeks of gestation. Periventricular venous infarction (PVI) in utero was diagnosed with fetal magnetic resonance imaging (MRI). The neonate was born at term uneventfully and in utero PVI was confirmed by MRI after birth. The neonate was diagnosed with hereditary protein C deficiency after coagulation laboratory studies. At 10 months of age, the infant presented with mild retardation of motor development. This is the first report about prenatally diagnosed PVI in utero by fetal MRI. When focal, unilateral enlargement of the ventricles is detected in utero by prenatal ultrasonography, it is important to consider PVI and perform confirmatory fetal MRI.

Galectin 2 (gal-2) expression is downregulated on protein and mRNA level in placentas of preeclamptic (PE) patients

IntroductionGalectin 2 (gal-2) belongs to the proto type group and consists of two homologous carbohydrate recognition domains (CRDs) resulting in multiple sugar binding sites. The expression of gal-2 has been shown to be involved in processes of angiogenesis and inflammation but was not analyzed before in preeclamptic (PE) placentas. Therefore the aim of this study was an analysis of expression and localization of gal-2 in placentas from patients suffering from PE. MethodsPlacental tissues were obtained from 14 women following a normal course of pregnancy and 13 women with PE. Expression of gal-2 was evaluated with immunohistochemistry and a semi quantitative score. Gal-2 mRNA expression was quantified in placental tissue using real time TaqMan PCR. Identification of gal-2 expressing cells in the decidua was achieved by double immunofluorescence microscopy. ResultsExpression of gal-2 is downregulated in the syncytiotrophoblast of preeclamptic placentas. Downregulation of gal-2 could also be identified in the decidua of PE patients. These findings on protein level could be supported by the results of TaqMan PCR. Gal-2 is downregulated in PE placentas on mRNA level. Finally, gal-2 expressing cells could be identified as extravillous trophoblast cells in both normal pregnancy and PE. DiscussionGal-2 was identified as an inhibitor of arteriogenesis in a murine model supposedly via modulation of the monocyte/macrophage population. In PE, both the formation of spiral arteries as well as influx of macrophages are dramatically changed. Therefore we might speculate that disturbed transformation of spiral arteries in PE might correlate with the downregulated gal-2 expression by the trophoblast.

Thyroid function parameters in normal pregnancies in an iodine sufficient population

BackgroundThe aim of this retrospective observational study was to describe thyroid function parameters (fT3, fT4 and TSH) in the course of normal pregnancies. MethodsData were obtained between 2006 and 2007 at the University Hospital in Innsbruck, Austria. The starting point was the identification of women who had had a normal birth as recorded in the birth registry of Tyrol. Thyroid function parameters were determined using methods implemented at the Department of Nuclear Medicine in Innsbruck. ResultsThe fT3 and fT4 values were normally distributed. Grouping the results by trimester revealed the following values: 4.93±0.59, 4.54±0.48, and 4.27±0.45pmol/l for fT3; and 15.23±2.43, 13.79±1.99, and 13.32±0.2.01pmol/l for fT4, respectively. The values corresponding to the 10th-percentile were 3.9pmol/l for fT3 and 11.3pmol/l for fT4, respectively. TSH values showed a typical left skewed distribution, thus the mean values were calculated after log transformation of the data. The corresponding mean trimestral values for TSH were 1.46±1.29, 1.68±1.23, and 1.70±2.22mIU/l, respectively. ConclusionIn an iodine sufficient population, thyroid function parameters in normal pregnancies do not differ from those in non-pregnant women. Our previously defined reference range for TSH of 0.3 to 3.5mIU/l is equally valid for normal pregnancies. General significanceThe question of cognition and IQ development of children has been proposed to be associated with thyroid function. The addition of data regarding normal thyroid function during pregnancy will contribute to this research.

Risk factors for pregnancy-induced hypertension

Objective. The aim of the research was to investigate if the two groups of patients, women with pregnancy-induced hypertension (PIH) and women with normal pregnancy differed in some studied risk factors. Methods. The study has been carried out in Health Centre 'Sid' in Sid, Serbia, at Department for Women Primary Health Care. In order to collect data necessary for the research the survey questionnaire was used that was created by the study authors. The study sample consisted of 200 pregnant women divided in two groups. The first one included 100 pregnant women with hypertension. The second group included 100 pregnant women with normal pregnancy. The study subjects of two groups were selected randomly from the larger pool of pregnant women, which were followed regularly at the Department. Results. PIH occurred between 26-30 years of age in total of 34% of pregnant women. The average age of pregnancy when the disorder was firstly observed was 29.7 gestational weeks. In the group of women with PIH, 37% of them had the body mass index (BMI) between 25 and 29.99 kg/ m2, and 38% of women had BMI over 30 kg/m2. The total of 35% of pregnant women with PIH frequently consumed salty and spicy foods, while 42% of pregnant women such food consumed only occasionally. Conclusion. There were no significant differences in age between the patients with PIH and pregnant women with normal course of pregnancy. PIH was more common in primiparous mothers, pregnant women with elevated body mass index, among pregnant women with reduced physical activity, pregnant women who smoked and in pregnant women who consumed salty and spicy foods.

“Eli-P-Complex” Diagnostic Test for Preconception Care in Women with History of Adverse Pregnancy Outcome: A Randomized Multicenter Trial

Background: ELI-P-Complex is the most advanced diagnostic test designed to assess whether the female body is ready (or unready) for the normal pregnancy course and for giving birth to a healthy child. ELI-P-Complex enables the perceived abnormalities to be individually treated even prior to the pregnancy planning, thus minimizing the risk of gestational and delivery-related complications. This prospective study shows the effectiveness of ELI-P-Complex testing during preconception care in women with a history of adverse pregnancy outcomes (APO). Methods: The data were reviewed from 4519 women with a history of APO and who planned to get pregnant. Following randomization, subjects of Group A were tested with ELI-P-Complex and treated before the pregnancy based on the results obtained. Group B subjects were not examined using the ELI- P-Complex test and were prepared for pregnancy in accordance with the standard strategy of pre- conception care [1]. Results: In Group A, gestational complications (GC) were revealed in 20% of women compared to 88.7% of Group B subjects; the relative risk (RR) of GC was 11.67 (95% CI: 9.9851 to 13.6392; P < 0.0001). APO was reported in 12% of Group A subjects vs. 38.1% of Group B ones; RR of APO was 5.8908 (95% CI: 4.9365 to 7.0296; P < 0.0001). Absolutely healthy children were born from 88.1% of Group A subjects compared to 50.3% of Group B ones; RR was 7.9601 (95% CI: 6.6110 to 9.5845; P < 0.0001). The positive predictive value, sensitivity, and specificity of the test for GC were 93.82% (95% CI: 92.72% to 94.80%), 93.17% (95% CI: 92.03% to 94.20%), and 92.62% (95% CI: 91.31% to 93.78%), respectively. Conclusions: The use of ELI-P-Complex for examination and further preconception care in women with a history of APO considerably reduces GC, improves pregnancy outcomes, and increases chances of giving birth to a healthy child.

Local treatment of chloasma in pregnant women

Goal. To assess the efficacy and safety of Azelic (15% gel of azelaic acid for topical administration) for the treatment of chloasma in pregnant women. Materials and methods. The study involved 28 pregnant women aged 18-36 (mean age: 24.7) with a normal course of pregnancy. The patients consulted a doctor in the spring, summer or fall complaining of focal skin hyperpigmentation on the face, chin and chest area. Ten patients (35.7%) developed hyperpigmentation prior to their pregnancy and 18 women (64.3%) - during the pregnancy. As of the consultation date, the pregnancy terms in all of the patients were 18-20 weeks. Chloasma was diagnosed by using dermatoscopy and skin examination with the Wood’s lamp. The patients were informed about the content and procedure of the study and gave their consent to take part in the study. Thin layers of Azelic (15% gel of azelaic acid for topical administration) were applied to the hyperpigmented skin of the patients and gently rubbed twice a day (in the morning and evening) as topical treatment for four months. The treatment results were assessed taking into consideration the patient’s subjective assessment, study group structure depending on the clinical efficacy, percentage of adverse events, and survey results based on the Dermatology Life Quality Index questionnaire. To reveal any potential general toxicological effects of the treatment, hepatic samples, total blood count and coagulogram results were analyzed as a part of obstetrical and gynecologic care for pregnant women. Key findings. Positive dynamics of the following characteristics was revealed: subjective assessment of treatment results by the patients, clinical efficacy of treatment and life quality index. Therapeutic results were observed as early as after one month but not later than three months after the treatment began. The therapeutic efficacy was recorded in 92.9-96.4% of all cases after four months of treatment: pigment spots disappeared or became paler, and their dimensions and their contrast as compared to the healthy skin reduced, the skin texture and life quality improved (the Dermatology Life Quality Index reduced from 15.5 ± 1.8 to 6.7 ± 0.5 points against the background of the treatment efficacy: from severe to moderate impact of the disease on the patient’s life, respectively). Five women (17.9%) developed erythema and burning sensations in the drug application site within the first two weeks immediately after the gel application (one of the patients had the same symptoms for six weeks of the treatment); the symptoms were weak and transient and did not require any additional treatment. Hepatic samples, total blood count and coagulogram results were within physiological standards during the treatment. Conclusion. Topical application of Azelic (15% gel of azelaic acid for topical administration) twice a day for four months is an efficient and safe method to treat chloasma in pregnant women.

Measurement of women’s prenatal attitudes towards maternity and pregnancy and analysis of their predictors

&lt;b&gt;Background&lt;/b&gt;&lt;br /&gt; Research shows that the ability of a woman to adapt to motherhood can be influenced by her attitude towards motherhood and the unborn child during pregnancy. The main goal of the current article is to analyse the maternal attitudes shaped during the prenatal period of the child’s development. This goal was associated with fulfilling two research tasks. The first task was to adapt a tool to measure prenatal attitudes towards motherhood and pregnancy to Polish conditions, including some modifications of the tool, and to present the results of that adaptation. The second research task was to investigate selected factors influencing the development of prenatal attitudes.&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Participants and procedure&lt;/b&gt;&lt;br /&gt; The study was carried out in two stages. The first stage of the research, conducted with 227 pregnant women, was to adapt the PRE-MAMA questionnaire. All of the subjects were primiparous women aged between 18 and 39 years (M = 26.84), inhabitants of southern Poland. 137 pregnant women from the Silesian Voivodeship in Poland were questioned in the second part of the study. These women were divided into two groups (68 women with a normal course of pregnancy and 69 women with high-risk pregnancies). The mean age of the women approached 30 years (M = 29.78).&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;&lt;br /&gt; The results of the first stage of the current research indicate satisfactory psychometric properties of the Kwestionariusz Postaw wobec Macierzyństwa i Ciąży (Polish for: Attitudes towards Motherhood and Pregnancy Questionnaire, abbreviated as PRE-MAMA), composed of 11 statements. Stepwise multiple regression analysis used in the second stage of research revealed that predictors of attitudes towards motherhood and pregnancy include prenatal worries of the pregnant women, planning of the pregnancy and a medical history of miscarriage.&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Conclusions&lt;/b&gt;&lt;br /&gt; Our research points at two important results. First, the PRE-MAMA questionnaire was assessed positively, and it can be stated that this tool can be used in further scientific research concerned with the issues of functioning of pregnant women and their attitudes towards motherhood and pregnancy. Second, the preliminary results suggest, among other things, the importance of fears/concerns, perception of the pregnancy as planned or unplanned as well as previously experienced miscarriages for the formation of women’s attitudes towards motherhood and pregnancy.

Development of microbiota in the large intestine of newborns depending on various delivery methods

We have examined 96 conditionally healthy primigravidae and 96 newborns. Group 1 (n = 51): gravidae with normal course of preg-nancy and delivery, group 2 (n = 45): gravidae with normal course of pregnancy and deliveries by caesarian section (indications for the operation - severe myopia), group 3 (n = 51): newborns from gravidae of group 1, group 4 (n = 45): newborns from gravidae of group 2. Purpose: study of the development of microbiota in the large intestine of newborns depending on various delivery methods. Enterococcus sp. (58,2 %), S. epidermidis (55,7 %), Corynebacterium sp. (53,1 %), E. coli (41,7 %) dominated in meconium microbiota. By the day 5 in group 3 we registered more frequently (p &lt; 0,05) Bifidobacterium sp., Corynebacterium sp., E. coli, in group 4 - Klebsiella sp. Independently from the delivery method, by day 5 we observed in the feces of newborns increased (р &lt; 0,5) content of Bifidobacterium sp., Lactobacillus sp., E. coli, Enterococcus sp., and S. aureus.