Cardiotocography (CTG) is the most widely used method of monitoring fetal heart rate despite its low specificity for fetal acidosis and poor perinatal outcome [1]. It is derived from simple auscultation of the fetal heart, but currently Doppler ultrasound CTG is used for monitoring. Fetal electrocardiography has a greater potential for detecting impairment of fetal circulation; however, it is technically more difficult to perform than CTG.Methods of monitoring fetal well-being, both in the antepartum period and during labor, are constantly developed as they assist in identifying fetal hypoxia and reducing perinatal mortality and morbidity. From the first attempts of monitoring fetal heart rate and registering electrical activity of the fetal heart, researchers sought out a precise description of intrauterine fetal condition and an accurate assessment of the risk of fetal hypoxia. AbstractBackground. Cardiotocography (CTG) is the most widely used procedure despite its low specificity for fetal acidosis and poor perinatal outcome. Fetal electrocardiography (fECG) with transabdominal electrodes is a new, non--invasive and promising method with greater potential for detecting impairment of fetal circulation. This study is the first that attempts to assess the usefulness of fECG in comparison to CTG during antepartum period. Objectives. To determine if a single fECG examination along with CTG tracing and Doppler flow measurement in the fetal vessels has any additional clinical value in normal and intrauterine growth restricted (IUGR) fetuses. Material and Methods. The study included 93 pregnancies with IUGR, 37 pregnancies with IUGR and brain sparing effect, and 324 healthy pregnant women. The T/QRS ratio, cerebro-placental ratio (CRP), and CTG tracings were analyzed. One-way analysis of variance and Spearman's rank correlation coefficient were applied. The relationship between results of the T/QRS ratio and CTG examination among the study groups was analyzed. Results. The highest average mean value of the T/QRS ratio was recorded in the IUGR group with a normal CPR and a pathologic CTG (0.235 ± 0.014). The highest average maximum values were observed in the groups of IUGR pregnancies with a reduced CPR with normal (0.309 ± 0.100), suspicious (0.330 ± 0.102) and pathologic (0.319 ± 0.056) CTGs. Analysis of variance revealed differences between study groups regarding maximum values and the difference between maximum and minimal values of T/QRS. Correlations between groups were insignificant. Conclusions. Higher values of T/QRS ratio in IUGR pregnancies with normal and reduced CPR than in control group regardless of the result of CTG examination may indicate minimal worsening of intrauterine fetal well-being in growth retarded fetuses. No relationship between fECG examination and CTG tracings suggests that a single fECG does not provide any additional clinically significant information determining the condition of the fetus; however, further studies are required (Adv Clin Exp Med 2016, 25, 2, 309-316).

Background. Fetal electrocardiography is one of the methods for monitoring the well-being of the fetus. Signal loss limits the proper interpretation of electrocardiogram traces. Objectives. The aim of this study was to assess the average signal loss in non-invasive abdominal fetal electrocardiogram (fECG) monitoring using the KOMPOREL fetal monitoring system (ITAM, Zabrze, Poland) in women between 28 and 42 week of pregnancy. The results were compared to FIGO (International Federation of Gynaecology and Obstetric) and DGGG (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V.) recommendations concerning fetal heart monitoring. The correlation between fetal ECG signal quality, week of pregnancy and patient BMI was evaluated. Material and Methods. 773 pregnant women, hospitalized and diagnosed in the Department of Gynecology and Obstetrics, Wroclaw Medical University, underwent 30 min of abdominal fECG recordings using the KOMPOREL fetal monitoring system. Results. The average signal loss in abdominal fECG monitoring in the study group was 32%. FIGO recommendations describe an acceptable fetal signal loss of 20%. In our study, 46% (357/773) of the recordings were up to FIGO standards, with fetal heart rate success rates above 80%. According to DGGG guidelines, with acceptable fetal signal loss of 15%, only 39% (303/773) of the recordings could be assessed as accurate. No correlation between fECG signal quality, week of pregnancy and patient BMI was proved. Conclusions. The average signal loss in abdominal fECG monitoring in our study group was 32%. Low fECG signal quality may constitute a potentially limiting factor of the described fetal heart monitoring system. No relationship between fECG signal quality, week of pregnancy and patient BMI was proved (Adv Clin Exp Med 2014, 23, 5, 813-819).

Comment on the article "Accuracy and reliability of fetal heart rate monitoring using maternal abdominal surface electrodes" Sir, We found the article by Cohen et al. in the November issue of AOGS, regarding fetal heart function monitoring with electrodes placed on the abdomen of a pregnant woman during labor (fetal electrocardiography), very interesting (1). We are particularly interested in the ratio of cases in which achievement of an electric signal from the fetal heart was successful enough for it to be read, recorded and evaluated; and therefore satisfactory for application of the method for antelabor and intralabor monitoring of the fetal condition. In a study at our center we applied transabdominal monitoring to 612 women between 28 and 42 weeks of gestation in an uncomplicated pregnancy, and in 91 cases of a pregnancy complicated by fetal intrauterine growth restriction or pregnancy-induced hypertension, as well as in 84 cases complicated by imminent preterm delivery. Examinations were performed using the KOMPOREL â system (ITAM, Zabrze, Poland), with an electrode placement scheme almost identical to the scheme applied in the Santa Monica system (2). The mean value of electric signal loss was 32%. This value is comparable with those reported by Cohen et al. and obtained during monitoring on the first stage of delivery, which may be assumed to be similar to the conditions for examination applied by our team. However, in many cases the loss was much more pronounced. From the practical point of view, a loss of fetal heart rate signals in between 20% and 30% of cases, results in a cardiotocography record quality that makes any interpretation of results of the examination impossible. FIGO recommendations mention 20% as an acceptable signal loss (3). In our material we did not find any correlation between the value of signal loss and body mass index of the pregnant women. A slightly better ratio of patients with loss below 20% during the first stage of the delivery has been presented by Reinhard et al.; however, there were only 144 patients included in the study (4). In our opinion, application of transcutaneous fetal electrocardiography as a method of fetal heart rate monitoring may be limited both before and during delivery, because of the impossibility of foreseeing the value of signal loss, which hinders or even makes impossible proper fetal supervision. References 1. Cohen WR, Ommani S, Hassan S, Mirza FG, Solomon M, Brown R, et al. Accuracy and reliability of fetal heart rate monitoring using maternal abdominal surface electrodes. Acta Obstet Gynecol Scand 2012;91(11):1306-13. 2. Fuchs T, Pomorski M, Grobelak K, Tomiałowicz M, Zimmer M. Signal loss during fetal heart rate monitoring using maternal abdominal surface electrodes between 28 and 42 weeks of pregnancy. Ginekol Pol 2013; In Press. 3. Rooth G, Huch A, Huch R. Guidelines for the use of fetal monitoring. Int J Gynaecol Obstet 1987;25(3):159-67. 4. Reinhard J, Hayes-Gill BR, Schiermeier S, Hatzmann W, Herrmann E, Heinrich TM, et al. Intrapartum sig...

115 StreszczenieWstęp: Jednostronne cysty proste przydatków stanowią istotny problem współczesnej ginekologii. W okresie menopauzalnym ok. 10% rozpoznawanych guzów przydatków ma charakter złośliwy. Istotna jest zatem odpowiedź na pytanie, czy stwierdzana w badaniu ultrasonograficznym (USG) torbiel prosta wymaga każdorazowo leczenia operacyjnego, czy też można przyjąć postawę wyczekującą.Cel pracy: Ocena częstości występowania nowotworów złośliwych jajnika w przypadku jednostronnych, jednokomorowych cyst prostych przydatków stwierdzanych w przezpochwowym badaniu USG u kobiet w wieku menopauzalnym.Materiał i metody: Badaniem objęto 90 pacjentek w okresie menopauzy, w wieku 50-81 lat, u których stwierdzono obecność zmian w obrębie przydatków, poddanych badaniu USG przezpochwowemu w skali szarości z zastosowaniem kolorowego dopplera, następnie leczonych chirurgicznie w Katedrze i Klinice Ginekologii i Położnictwa Uniwersytetu Medycznego we Wrocławiu.Wyniki: W materiale pooperacyjnym w 89 przypadkach (98,89%) rozpoznano zmiany o charakterze łagod-nym. Najczęściej stwierdzano cystis serosa ovarii (65,6%). W jednym preparacie (1,1%) rozpoznano zmianę nowotworową o granicznej złośliwości cystadenofibroma papillare serosum ovarii casus limitans.Wnioski: Częstość występowania nowotworów o charakterze złośliwym w zmianach opisywanych w badaniu USG jako jednostronne cysty proste przydatków u kobiet w wieku menopauzalnym w badanej grupie była niska. Większość guzów okazała się zmianami łagodnymi. Pozwala to rozważać odstąpienie od leczenia chirurgicznego u kobiet w okresie menopauzalnym, zwłaszcza obciążonych internistycznie, u których stwierdzono w obrębie przydatków zmiany o charakterze jednostronnych cyst prostych, szczególnie gdy ich największy wymiar nie przekracza 50 mm.Słowa kluczowe: menopauza, cysty proste przydatków, rak jajnika. SummaryIntroduction: Unilateral and unilocular ovarian cysts are an important problem in contemporary gynecology. Due to the fact that 10% of ovarian tumors are malignant, it is important to answer the question if the ovarian cyst detected in ultrasound examination requires surgical procedures or just further follow-up.The aim of this study was to estimate the rate of malignancy in adnexal lesions described during transvaginal scan as a unilateral and unilocular cyst in postmenopausal women.Material and methods: Ninty postmenopausal women, aged 50 to 81, with presence of adnexal masses were examined using transvaginal ultrasound in gray scale and color Doppler, and pulsed Doppler as well, and then treated surgically in the Department of Gynecology and Obstetrics, Medical University in Wroclaw. Each lesion was tested histologically.Results: In the postoperative pathological examination, 89 (98.89%) lesions were characterized as benign. The most common diagnosis was cystis serosa ovarii (65.6%). Only one lesion (1.1%) turned out to be tumor of borderline malignancy: cystadenofibroma papillare serosum ovarii casus limitans.Jednostronne cysty proste przydatków u kobiet w wieku menopauzalnympro...

The T/QRS ratio is one of the methods used for non-invasive foetal distress assessment that can be used in antepartum foetal monitoring in complicated pregnancies. Raised values of the T/QRS ratio in the foetus during tocolysis with fenoterol and next its fall to values observed in physiological pregnancies may indicate transient worsening of fetal well-being, however, additional research is required.