Ginekol Pol
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Most pregnant women have little interest in thinking about the prospect of death. Mortality related to the pregnancy itself is rare, occurring in an estimated 1 of every 30 000 deliveries. Although cardiopulmonary arrest rarely occurs in pregnant women, it is important that the health care team knows the appropriate actions to take in such an event, to promote positive outcomes for both mother and fetus. ⋯ As in all emergency care, knowledge must precede the crisis rather than await it. Second, indications for PMCD have broadened considerably since 1980s, and the procedure may attain a more prominent role in the future. We believe that prompt cesarean delivery is the key to maternal and infant survival in such cases.
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The ductus venosus plays an important role in the oxygenated blood supply from the placenta directly to the fetal heart. Uterine blood flow restriction and placental insufficiency can cause intrauterine grow restriction. Permanent hypoxia triggers compensatory mechanisms to protect vital organs. Increased placental resistance and constriction of the fetal peripheral vessels, as evidenced by blood redistribution and increased right ventricular afterload and end-diastolic pressure lead to increased pulsatility in precordial veins. Doppler flow analysis of the DV allows the indirect estimation of the fetal heart function. Because it is not always possible to achieve correct ultrasound beam insonation there have been attempts to use angle-independent indices. The aim of the study was: to compare the Doppler indices in DV in growth restricted and normal fetuses. ⋯ The improvement of maternal and fetal Doppler techniques allows us to distinguish the subgroups of IUGR fetuses with the uteroplacental insufficiency that will have an increased perinatal morbidity and mortality. Alterations in the venous blood velocity waveforms have a more precise relationship with the risk of adverse perinatal outcome than changes in the arterial blood flow usually recognized relatively early in placental function disorders.
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The aim of the study was to find out parturients' evaluation of epidural analgesia (EA) during labor and factors influencing their opinion. ⋯ The majority of patients gives labor EA very positive opinion. Insufficient pain control in the II stage of labor and perineum pain are the main factors lowering EA evaluation--it seems important to pay more attention to that fact in the future. Time of making a decision about EA and women's opinion depend on parity. As press is the main source of information for patients, the wider promotion of EA by medical staff seems necessary.
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Risk factors of obstetrical brachial plexus palsy include: (1) large birth weight, (2) shoulder dystocia and prolonged second stage of labour, (3) instrumental vaginal delivery (forceps delivery, vacuum extraction), (4) diabetes mellitus and mother's obesity, (5) breech presentation, (6) delivery and infant with obstetrical brachial plexus palsy in antecedent delivery. The purpose was analysis of the classical risk factors for brachial plexus palsy based on our own clinical material. ⋯ (1) Fetal macrosomia is the important risk factor of the obstetrical brachial plexus palsy. (2) Obstetrical brachial plexus palsy may occur also in the absence of the classical risk factors.
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Comparative Study
[Influence of increased carbon dioxide pressure used to establish pneumoperitoneum in laparoscopy on safety of the operation].
To evaluate the influence of increased CO2 pneumoperitoneum pressure on the safety of laparoscopic operation and the patients' condition. ⋯ Creation of pneumoperitoneum with the increased pressure of CO2 up to 18 mmHg until the insertion of the first trocar to the abdominal cavity is safe, well tolerated by the patients and more comfortable for the surgeon.