AbstractThe new acute respiratory disease severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is highly contagious. It has caused many deaths, despite a relatively low general case fatality rate (CFR). The most common early manifestations of infection are fever, cough, fatigue and myalgia. The diagnosis is based on the exposure history, clinical manifestation, laboratory test results, chest computed tomography (CT) findings and a positive reverse transcription-polymerase chain reaction (RT-PCR) result for coronavirus disease 2019 (COVID-19). The effect of SARS-CoV-2 on pregnancy is not already clear. There is no evidence that pregnant women are more susceptible than the general population. In the third trimester, COVID-19 can cause premature rupture of membranes, premature labour and fetal distress. There are no data on complications of SARS-CoV-2 infection before the third trimester. COVID-19 infection is an indication for delivery if necessary to improve maternal oxygenation. Decision on delivery mode should be individualised. Vertical transmission of coronavirus from the pregnant woman to the fetus has not been proven. As the virus is absent in breast milk, the experts encourage breastfeeding for neonatal acquisition of protective antibodies.

The aim of the study was to compare sRAGE and esRAGE plasma levels in pregnant women with (A) threatened premature labor (n = 41), (B) preterm premature rupture of membranes (n = 49), and (C) preterm rupture of membranes at term (n = 48). The relationship between these and classic intrauterine infection markers and the latent time from symptoms up to delivery depending on RAGE's concentration were investigated. In groups A and B, a positive correlation was found between plasma sRAGE and latent time (r = 0,422; p = 0,001; r = 0,413, p = 0,004, resp.). High prognostic values were found in both groups for plasma sRAGE concentration and the latent time from symptoms up to delivery. Groups B and C presented higher levels of esRAGE than group A (526,315 ± 129,453 pg/mL and 576,212 ± 136,237 pg/mL versus 485,918 ± 133,127 pg/mL, p< 0,05). The conclusion is that sRAGE concentration can be a favorable prognostic factor in the presence of symptoms of threatened premature labor. Higher esRAGE plasma level in case of the rupture of membranes in mature and premature pregnancy suggests its participation in fetal membranes destruction.

(1) Analyses of disordered angiogenesis markers in early- and late-onset preeclampsia patients and patients with physiological pregnancies allow for a suggestion that natural "ageing of the placenta" and placental hypoperfusion lesions exacerbating with the advancing gestational age are some of the causes of late-onset preeclampsia. (2) Cases of early-onset preeclampsia are associated with more severe changes of disordered angiogenesis marker concentrations, which may be indicative of a more considerable impairment of placental perfusion in such patients. (3) In the course of the physiological pregnancy, there is a gradual increase in sFlt-1 and decrease in PlGF, which implies an elevated angiogenesis disorder that progresses with the gestational age.

BackgroundThis study aimed to determine the relationships between secretory and endogenous secretory receptors for advanced glycation end products (sRAGE, esRAGE), sRANKL, osteoprotegerin and the interval from diagnosis of threatened premature labor or premature rupture of the fetal membranes to delivery, and to evaluate the prognostic values of the assessed parameters for preterm birth.MethodsNinety women between 22 and 36 weeks’ gestation were included and divided into two groups: group A comprised 41 women at 22 to 36 weeks’ gestation who were suffering from threatened premature labor; and group B comprised 49 women at 22 to 36 weeks’ gestation with preterm premature rupture of the membranes. Levels of sRAGE, esRAGE, sRANKL, and osteoprotegerin were measured. The Mann–Whitney test was used to assess differences in parameters between the groups. For statistical analysis of relationships, correlation coefficients were estimated using Spearman’s test. Receiver operating characteristics were used to determine the cut-off point and predictive values.ResultsIn group A, sRAGE and sRANKL levels were correlated with the latent time from symptoms until delivery (r = 0.422; r = −0.341, respectively). The sensitivities of sRANKL and sRAGE levels for predicting preterm delivery were 0.895 and 0.929 with a negative predictive value (NPV) of 0.857 and 0.929, respectively. In group B, sRAGE and sRANKL levels were correlated with the latent time from pPROM until delivery (r = 0.381; r = −0.439). The sensitivity of sRANKL and sRAGE for predicting delivery within 24 h after pPROM was 0.682 and 0.318, with NPVs of 0.741 and 0.625, respectively. Levels of esRAGE and sRANKL were lower in group A than in group B (median = 490.2 vs 541.1 pg/mL; median = 6425.0 vs 11362.5 pg/mL, respectively).ConclusionsCorrelations between sRAGE, sRANKL, and pregnancy duration after the onset of symptoms suggest their role in preterm delivery. The high prognostic values of these biomarkers indicate their usefulness in diagnosis of pregnancies with threatened premature labor.

The global incidence of preeclampsia has been estimated at 3-5% of all pregnancies. It is the main cause of morbidity and mortality among pregnant women and their fetuses worldwide. In preeclampsia, the incorporation of cytotrofoblast into the spiral arteries is incomplete. Changed placenta releases into the mother's circulation soluble VEGF receptor-1 (sFlt-1) which causes many disorders including kidney damage. VEGF is produced by glomerular podocytes and is necessary for their normal function. The damage of podocytes leads to a glomerulosclerosis development. The damage of the critical number of podocytes contributes to the development of focal segmental glomerulosclerosis - kind of glomerulonephritis. We present a case of woman who as a result of preeclampsia developed focal segmental glomerulosclerosis manifested as nephritic syndrome. We describe a mechanism for the development of such changes in glomeruli in the course of preeclampsia.

To this day, haemorrhage, complicating up to 5% of labours, is one of the most common obstetric causes of morbidity and mortality in women [1]. Due to the speed of its development, peripartum haemorrhage can, in a very short time, lead to life-threatening hypovolaemic shock [2, 3]. Excessive blood loss requires comprehensive treatment to maintain peripheral tissue oxygenation, adequate volume of the intravascular compartment and coagulation [1]. In such circumstances there is an indication to transfuse red blood, plasma and platelets. Currently no other equally effective treatment is known. Jehovah's Witness (JW) women are in a high obstetric risk group. British data indicate that in the UK the risk of death related to obstetric complications is 65 times higher in this group than in the general population; in the USA such risk is estimated at 44 times higher [1-5]. Russo et al., describing a case of a JW pregnant multipara after two caesarean sections with placenta praevia invading her urine bladder, found the risk of death to be 130-fold higher than in a patient who would accept blood transfusion [6]. It is estimated that every year 1000 JW die because of blood refusal [4].

Uterine rupture is one of the most dangerous obstetric emergencies carrying a high risk for the mother and the fetus. Reports about uterine rupture in pregnancy following previous laparoscopic surgery have not been frequent; however, an increasing rate of the occurrence of this complication has been observed and reviewed in contemporary literature. We report a case of a spontaneous uterine rupture at 22 weeks of gestation in a 25-year old primigravida, who had had a laparoscopic removal of a small, peduncular, asymptomatic myoma located in the right uterine horn 20 months earlier. Ultrasound examination and subsequent urgent laparotomy confirmed a spontaneous uterine rupture with a nonviable fetus in the peritoneal cavity. Women planning to become pregnant should be qualified for laparoscopic myomectomy with special carefulness. Special attention must be paid to the potential solutions that limit the risk of postoperative uterine rupture, if the absolute necessity for the enucleation of myomas during the reproductive age occurs and a decision about laparoscopic intervention is made.

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