Bozena Kociszewska-Najman

Medical University of Warsaw, Warszawa, Masovian Voivodeship, Poland

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Publications (18)21.23 Total impact

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    ABSTRACT: Abstract Material: From 2000 to 2012 seven pregnant were admitted. None had Ltx, the varicose have been in the 1st stage. Each of them has been consulted by the obstetrician, transplant surgeon and anesthetist. The patient condition during pregnancy, labor and postpartum period was analyzed.Results: Pregnancy in 5 cases proceeded physiologically. In 1 threatening miscarriage was diagnosed and treated with gestagens, two patients had tocolityc. One required variceal banding twice. In 3 thrombocytopenia worsened, with platelet count 70g/L(up to 59g/L). They received platelet transfusion before delivery. In one case significant hipoproteinemia (4.7g/L) occurred. In 1 case GDM G1 and oligohydramnios were found. All women delivered at term (37-40Hbd). In all general anesthesia with use of remifentanil was done. There was no fluctuations in MAP and HR. Incision to delivery time was 2.5min. Time from opioid administration to birth was <4min. All children were born in good condition, weight 10-90percentil.Regional anesthesia is contraindicated in patients with thrombocytopenia. In patients with esophageal varices sudden increase in heart rate and blood pressure can cause hemorrhage.Conclusion: Patients with portal hypertension can deliver at term. It is a high risk pregnancy. In this group it is desirable to shorten the second stage of labor or complete it by c-section under general anesthesia with remifentanyl which allows to get desired analgesia without complications in the newborn. Surveillance of pregnant with portal hypertension must include monitoring of liver function and coagulation disorders.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 03/2014; · 1.36 Impact Factor
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    ABSTRACT: We report a case of a hemolytic disease in a newborn from the first pregnancy due to anti-D antibodies. The maternal blood group was A Rhesus negative. She had an antibody screening test twice during the pregnancy (in the second trimester) and it was negative. The pregnancy was uneventful, without any invasive procedures and bleeding. The infant was born at 39 weeks of gestation in good overall condition. After the delivery the blood group of the neonate was indicated - A Rhesus positive, BOC positive. Anti-D antibodies were detected in maternal blood. Neonatal blood tests revealed severe anemia (hemoglobin level: 6.0g/dl, hematocrit: 22.2%, erythrocytes: 2.01T/L). During the first day of neonatal life, the newborn received two transfusions of red blood cells. Bilirubin level and rate of rise were not recommendation enough for exchange transfusion. The newborn was treated with continuous phototherapy since the delivery The perinatal period was complicated with intrauterine infection and respiratory failure. Hematopoietic vitamins and iron supplementation was initiated in the second week of neonatal life due to persistent anemia. The child remained under medical care of a hematologic clinic and received human recombinant erythropoietin treatment.
    Ginekologia polska 03/2014; 85(3):226-9. · 0.79 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate whether chronic use of immunosuppressive drugs during pregnancy in women after renal transplantation affects the concentration of immunoglobulin G (IgG) and IgM in the serum of their children.
    Transplantation Proceedings 01/2014; 46(8):2703-7. · 0.95 Impact Factor
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    ABSTRACT: Nowadays pregnancy after organ transplantation is possible due to advances in surgical and immunosuppressive therapies. One of the possible complications in pregnancy after organ transplantation is intrauterine growth restriction (IUGR). This may lead to various adverse perinatal outcomes. Prevalence of IUGR in the general population is estimated at 3%-10% with smoking being the most frequent maternal risk factor. The aim of this study was to determine the risk factors of IUGR in pregnant renal transplant recipients (RTR) or liver transplant recipients (LTR) in comparison with healthy pregnant women.
    Transplantation Proceedings 01/2014; 46(8):2794-7. · 0.95 Impact Factor
  • European Journal of Obstetrics & Gynecology and Reproductive Biology. 01/2014;
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    ABSTRACT: Immunosuppressive treatment used in pregnant liver recipients may have a negative impact on fetal development and successively a child.
    Transplantation Proceedings 01/2014; 46(8):2798-801. · 0.95 Impact Factor
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    ABSTRACT: BACKGROUND: The aim of the study was the analysis of ophthalmologic disorders in children born to mothers after liver transplantation (LTx) or renal transplantation (RTx) with the assessment of certain neonatal parameters. METHODS: In the period between 01 January 2010 and 30 June 2012, ophthalmologic examinations were performed in 37 children born to mothers after LTx and 35 children after RTx, as well as 66 children from a control group, born at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, from 01 January 2001 to 30 June 2012. Certain parameters of the neonatal period of the child and the mother were retrospectively analyzed. RESULTS: Good first-minute states of neonates were observed in 89.2% LTx and 97.1% RTx but in the fifth minute in more than 97% of neonates in both groups. In the LTx and RTx groups, the percentage of preterm deliveries was 48.8% (68.8% in the RTx and 43.2% in the LTx; P=0.0306). There were differences in the immunosuppressant drug therapy in monotherapy as well as two to three drug combinations between the two groups. Children from the LTx, RTx, and control groups had no ophthalmologic disorders in more than 80%. In the LTx and RTx groups, there were convergence insufficiency (6 of 72), strabismus (2 of 72), and hyperopia (2 of 72). The differences in disorders between LTx and RTx groups, as well as LTx+RTx and control groups, were not statistically significant (P=1.00 vs. 0.6206). Retinopathy of prematurity was diagnosed in only two neonates in the RTx group. CONCLUSIONS: Immunosuppressive treatment during pregnancy, regardless of kind, did not affect the ocular organ's development.
    Transplantation 01/2013; · 3.78 Impact Factor
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    ABSTRACT: Twin Reversed Arterial Perfusion (TRAP) sequence complicates about 1% of all monochorionic twin pregnancies and about 1 to 35000 of all pregnancies. It involves an acardiac twin whose structural defects are incompatible with life, and an otherwise normal "pump" co-twin. As the blood flow in the acardiac twin is reversed, it keeps on growing owing to the oxygenated blood from the co-twin. Here we report a case of monochorionic, diamniotic twin pregnancy after ICS/-ET complicated with TRAP sequence, diagnosed at 11 weeks of pregnancy The unusual finding in this case was the residual heart in the so called acardiac twin. Gradually the normal twin developed signs of hemodynamic compromise. Reversed a-wave in ductus venosus was observed. The acardiac twin showed subcutaneous oedema. On 24 November 2011 a successful interstitial ultrasound-guided laser coagulation was performed at 16 weeks of gestation. 17G needle and 0.6 mm laser fibre were used. The needle was introduced into the pelvic region of the acardiac twin through the abdominal wall. A series of laser bursts lasting 5-10 seconds were fired, until cessation of blood flow in the pelvic vessels and umbilical cord of the acardiac twin was confirmed using colour Doppler. The course of the intervention was uneventful. Routine steroid therapy was administered at 27 weeks of gestation. At 32 weeks the patient was hospitalized and oral antibiotics were administered due to premature rupture of the membranes and suspicion of intrauterine growth retardation of the pump twin. The patient delivered spontaneously at completed 33 weeks of pregnancy (weight 1805g, Apgar 10). After the delivery a stage 2 intraventricular hemorrhage and jaundice were observed in the neonate. Phototherapy was administered and the mother and the child were eventually discharged from the hospital, both in good general condition. Since then, two more successful interstitial laser coagulations in TRAP sequence were performed in our institution. The essence of the treatment of TRAP sequence is cessation of the blood flow from the pump to the acardiac twin. Fetoscopic cord ligature or coagulation, and laser or radiofreqency ablations of the acardiac twin vessels, are the possible methods of intervention. The interstitial laser coagulation of the acardiac twin is less invasive than fetoscopic umbilical cord coagulation, as the outer diameter of the 17G needle is much smaller. A meticulous comparison of these methods would require a randomised study but at 16 weeks of MCDA twin pregnancy interstitial laser coagulation seems to be the method of choice. The outcome of the procedure and possible treatment options in case of TRAP together with the review of literature, are presented in the article.
    Ginekologia polska 11/2012; 83(11):865-70. · 0.79 Impact Factor
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    ABSTRACT: The objective of this study was to investigate the composition of breast milk which had been gathered from mothers for over first 2 weeks of lactation and to compare the changes in composition of preterm and term milk. A prospective, single center study was provided in Warsaw, Poland. The samples of breast milk from 22 mothers who had delivered prematurely and 39 mothers who had given birth to term infants were collected. The creamatocrit, energy and fat concentration were estimated in each participant's breast milk sample twice a day (morning and night hours). The lowest creamatocrit, calories and fat concentration was indicated in the preterm milk obtained in the morning (4.86%, 663.8 kcal/L and 33.6 g/L, respectively). The highest milk parameters were observed in the night samples of full-term milk and measured (9.6%, 919.7 kcal/L, and 60.7 g/L, respectively). No significant differences in analysed parameters were observed between preterm and full-term milk (p>0.05). In summary, creamatocrit, calories and lipid concentration in breast milk shows the daily differences. Colostrum and mature milk from mothers of preterm neonates differed from colostum and mature milk from mothers of term neonates. They had lipid contents, creamatocrit level and calorific value.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 12/2011; 25(9):1599-602. · 1.36 Impact Factor
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    ABSTRACT: Pregnancies in renal transplant patients are considered to be high risk. Anemia is one of the major complications of pregnancy occurring among 65% to 85% of cases in this setting, especially since these patients carry additional risk factors. Herein we have presented five renal transplant recipients who were women who were treated with human recombinant erythropoietin due to severe anemia that developed during pregnancy. Hemoglobin levels below 9 g/dL after 3 weeks of oral iron administration were assumed to be qualifying criteria for erythropoietin treatment. No complication was observed to be associated with the treatment. Two of the five patients required blood transfusions despite erythropoietin administration. Two cases delivered small for gestational fetus age. Erythropoietin therapy in pregnant kidney transplant recipients should be considered to be a safe method to reduce the need for blood transfusions.
    Transplantation Proceedings 10/2011; 43(8):2970-2. · 0.95 Impact Factor
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    ABSTRACT: Neonates born to mothers, who underwent organ transplantation require close medical monitoring. It is unknown how chronically diseased mother's organs or immunosuppressive drugs affect fetal growth and development; some immunosuppressants are teratogenic and contraindicated during pregnancy. The aim of this study was to determine the prevalence of prematurity and intrauterine growth restriction in neonates born to women who have undergone renal or liver transplantation. Our retrospective analysis identified 53 (25 renal and 28 liver) cases of neonates delivered by female graft recipients between January 2005 and December 2009. Hypotrophy was defined as a birth weight<10th percentile for gestational age. We excluded newborns diagnosed with severe hypotrophy (<5th percentile). Neonates born prematurely were predominate in the renal (16/25, 64%), but less than half of the liver cohort (13/28, 46%). Hypotrophy less than the 10th percentile was noted significantly more often among renal than liver recipients; 36% versus 14% (P<.05). Severe hypotrophy was also observed significantly more often among renal than liver transplant neonates: 28% versus 3.6% (P<.001). Compared with liver insufficiency, chronic kidney diseases have stronger effects on the fetus, leading to adverse neonatal complications. A greater prevalence of preterm births, as well as hypotrophic newborns, especially less than the 5th percentile, was observed among neonates delivered by mothers after kidney transplantation.
    Transplantation Proceedings 10/2011; 43(8):3048-51. · 0.95 Impact Factor
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    ABSTRACT: We present a case of a female kidney recipient who was infected with 3 types of high-risk human papilloma viruses. An infection in the lower genital tract led to the development of both neoplastic cervical lesions and vulvar cancer.
    Transplantation Proceedings 10/2011; 43(8):2994-6. · 0.95 Impact Factor
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    ABSTRACT: Congenital diaphragmatic hernia is a very serious congenital defect associated with high mortality rate. The syndrome is characterized by migration of abdominal viscera to thoracic cavity a variable degree of pulmonary hypoplasia associated with pulmonary hypertension caused by alteration of pulmonary vessels diameter increased muscularisation of pulmonary arteries and decreased compliance of the lungs resulting in increased afterload of the right ventricle, decreased cardiac output and impaired oxygenation. We describe a case of congenital diaphragmatic hernia with migration of the stomach, the small and the large bowels and the left hepatic lobe into the left pleural space, diagnosed by ultrasound in utero at 24 weeks of gestation. The child was initially placed on high-frequency oscillation and nitric oxide and required vigorous inotropic support. The defect was repaired after stabilization of the cardiac output and gas exchange. The patient made successful recovery.
    Ginekologia polska 10/2011; 82(10):788-91. · 0.79 Impact Factor
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    ABSTRACT: Liver transplantations give female recipients an ability to carry pregnancies successfully. However, solid organ transplantations exacerbate the pregnancy including maternal and neonatal outcomes. The aim of our study was to evaluate and identify the obstetric outcomes in women with a prior liver transplantation. We analyzed all pregnant woman who had undergone a prior liver transplantation and afterward delivered from 2001 to 2011. Complete data were assessed in 39 deliveries and 40 live births. Three women were pregnant twice after liver transplantation. The mean gestational age at birth measured 37.2±2.2 weeks. The most common obstetric complications were premature labor (12/39,30.8%), hypertension (10/39, 25.6%), and symptomatic urinary tract infections (7/39, 18%). Other complications were pregestational diabetes (n=1), cholestasis (n=3), and of severe anemia treated with blood transfusions (n=2). The mean time from organ transplantation to delivery was 67.6±47.2 months. Acute graft rejections occurred among pregnant women 7.7% (3/39) of studied. Only 8 (20.5%) deliveries were finished vaginally. Infants small for gestational age were diagnosed in 20% (8/40). One case displayed a congenital urinary tract malformation. None of the neonates died neonatally. Pregnancies are possible after liver transplantation and likely end with successful maternal and newborn outcomes. Some cases experience an increased risk of obstetric complications. Therefore, posttransplant pregnancies must be regularly monitored with a multidisciplinary approach.
    Transplantation Proceedings 10/2011; 43(8):3043-7. · 0.95 Impact Factor
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    ABSTRACT: To determine and compare maternal, neonatal and graft outcomes in pregnant women after kidney or liver transplantation, who had delivered from 1 January 2005 to 1 February 2010. A retrospective, single-center study provided in Warsaw, Poland. Complete data were collected in 38 deliveries in 37 women. Preexisting hypertension was present in 15 of 19 (79%) pregnant kidney recipients and in 2 of 19 (10.5%) women after liver transplantation (p < 0.000). The incidence of preeclampsia was also more often in pregnant kidney recipients (p = 0.04). Mean gestational age at labor was lower in the kidney group (34.9 ± 3.56 vs. 37.5 ± 1.62, p = 0.000). A similar relation was observed in the frequency of preterm deliveries before 37 weeks of gestation (42% vs. 11%, respectively, p = 0.02) and neonates small for gestational age (47% vs. 11%, respectively, p = 0.008). Cesarean sections were performed in approximately 79% (15/19) and 95% (18/19) liver and kidney posttransplant pregnancies, respectively. Four of 38 infants presented structural malformations. Pregnancies after kidney transplantation are complicated with a higher prevalence of prematurity and worse neonatal prognosis, which depends mainly on the underlying condition.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 09/2011; 25(7):1090-5. · 1.36 Impact Factor
  • Bozena Kociszewska-Najman, Beata Borek-Dzieciol, Ewa Sanczyk
    Fuel and Energy Abstracts 01/2011; 87.
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    ABSTRACT: Group B Streptococcus (GBS) infection is a leading cause of neonatal complications. The aim of the following work was to assess the efficacy of the intrapartum antibiotic prophylaxis (IAP) of the GBS infection, together with the diagnostic and therapeutic management of the newborn, based on the type and frequency of neonatal complications in the children of GBS carriers. 2212 patients, who gave birth at the 1st Department of Obstetrics and Gynecology Medical University of Warsaw, between January 2007 and March 2008, were included in the study. In accordance with current recommendations, all patients were screened for GBS colonization and carriers were qualified for IAR In the end, the study group consisted of 250 GBS-positive parturients and their children (253). Retrospective analysis of the chosen variables and statistical analysis were performed. GBS colonization rate in the studied population reached 11.4%. 199 parturients were qualified for IAP (79.56% of 250 women). Optimal chemoprophylaxis was administered in 87.9% of GBS carriers. Intrauterine infection was diagnosed in 13.04% of 253 newborns. In 2 cases (0.8%) GBS was the etiological factor of the infection. The neonatal infection rate was significantly lower among children of GBS-positive mothers who received IAP in comparison to those not qualified for prophylaxis (11.05% vs. 21.56%; p = 0.036). The rate of intrauterine infection was also lower among newborns of mothers who had received prophylaxis with ampicillin in comparison to macrolides administration (8.2% vs. 37.5%; p = 0.001). Optimal intrapartum antibiotic prophylaxis of GBS infection in carriers does not eliminate GBS-related neonatal complications. Intrapartum penicillin administration seems to be more efficient than macrolides administration in GBS infection prophylaxis.
    Ginekologia polska 12/2010; 81(12):913-7. · 0.79 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 10/2010; 36(S1):132-133. · 3.56 Impact Factor