Ginekologia polska最新文献

Objectives: Improper gestational weight gain (GWG) causes many adverse obstetrical and neonatal outcomes. This study evaluates the relationship between weight gain in different phases and maternal outcomes or neonatal outcomes.

Material and methods: Finally, this study recruited 2,608 women delivered at Fujian Provincial Maternity and Child Health, affiliated hospital of Fujian Medical University from December 2017 to January 2019. To evaluate the relationship between maternal outcome and neonatal outcome, the participants were divided into four groups based on their baseline BMI and weight gain in the second/third trimester of pregnancy.

Results: This study demonstrated that neonate weight, small-for-gestational-age infants, macrosomia, neonatal death, cesarean delivery, and GDM significantly differed across the baseline BMI, weight gain in the second and third trimester. The umbilical cord's abnormality, bulging membrane, abruptio placentae, and postpartum hemorrhage were significantly related to baseline BMI. Furthermore, gestational hypertension and pre-eclampsia/eclampsia were significantly correlated with baseline BMI and weight gain in the second trimester. The maternal and infant outcomes are different, and the GWG curves are significantly different. Finally, multivariate regression analysis showed that baseline BMI and weight gain in the second/third trimester were the independent risk factors for GDM and macrosomia. Also, baseline BMI and weight gain in the third trimester were the independent risk factors for developing gestational hypertension and pre-eclampsia/eclampsia, respectively.

Conclusions: The baseline BMI and weight gain in the second/third trimester are significant with maternal outcomes and neonatal outcomes to a varying degree. Thus, maintaining appropriate baseline BMI and weight gain in different phases are essential in preventing pregnancy complications and maternal and neonatal prognosis.

Objectives: The ideal option of food for a newborn's nourishment has traditionally been human breast milk (HBM). Previous studies have demonstrated a connection between the length of exclusively breastfeeding and its preventive effects on several conditions in neonates. Considering the significance of HBM, the study aimed at detecting the expression of microRNA (miR126*, miR155, miR21, and miR29a) in the breast milk cell fraction of women with hypertension. This was a cohort study of 35 postpartum women.

Material and methods: Five ml of milk was collected into a sterile container from patients in the morning on the second and third days after the labor. The collected milk has been centrifuged, total cellular RNA has been isolated from cell fraction from the collected milk, isolated RNA has been subject to qualitative and quantitative analysis, next reverse transcription has been conducted, followed by that, evaluation of the expression of the selected microRNA has been conducted using the synthesized cDNA. Finally, the tested microRNA's relative expression level has been calculated.

Results: Among patients with hypertension, the analysis of cell fraction of breast milk reported lower mean expression of miR126*, miR155, miR21, and miR29a as compared to patients without hypertension. Strong and very strong positive correlation between the expression of miR126* and miR155, miR126* and miR21, miR155 and miR21, miR 155 and miR29a, and miR 21 and miR29a have been noted.

Conclusions: Comparing patients with and without hypertension, it has been noted that patients with hypertension had lower mean expression of miR126*, miR155, miR21, and miR29a.

Pelvic congestion syndrome (PCS) is a pain syndrome characterized by positional pelvic pain and is associated with pelvic and vulvar varicosities as well as symptoms of dyspareunia and postcoital pain. Since the etiology of PCS is complex, the treatment should be individualized. Despite both pharmacological and interventional methods being used, there is significant predominance of minimally invasive therapies e.g. embolization. The study considers the answer to the question of whether pharmacological therapy is altogether effective. Using a combination of keywords, a PubMed search was performed for the years 1987-2022. The relevant articles were appointed and included in this narrative review. Despite the multitude of alternatives for pharmacological treatment, the systemic side effects of the medications used, as well as the interactions between drugs, affect patients' compliance and persistence. Furthermore, the quality of the currently existing evidence, considering the efficacy of the given substances, is low. Because of the adverse effects and thus the limited drug administration period, there is currently insufficient research on long-term effectiveness of the PCS pharmacological treatment. Therefore, prospective, comparative studies with larger patient population sizes are necessary to provide the possibility of efficient pharmacological therapy.

Objectives: Leiomyomas are benign, highly prevalent gynecologic conditions that can cause abnormal uterine bleeding, pelvic pain, urinary difficulties, and/or bladder or rectal obstruction. With advances in medical technology, women are increasingly interested in treatments that avoid surgery and/or preserve the uterus, which has undoubtedly contributed to the development of minimally invasive approaches. This article reviews the literature and evaluates the effectiveness and safety of minimally invasive approaches for the treatment of leiomyomas and describes the current state of development of minimally invasive treatment modalities for leiomyomas.

Material and methods: Web of Science and PubMed were systematically evaluated using the following keywords: uterine artery embolization, high-intensity focused ultrasound, microwave ablation, radiofrequency ablation, myomectomy, hysterectomy, leiomyomas, fertility. English abstracts relevant to the topic were selected and full-text articles were carefully analyzed.

Results: Uterine artery embolization is an effective treatment modality that has been widely validated, and the remaining means each have their distinct advantages in clinical practice, but more practical and comparative studies are needed. Minimally invasive myomectomy and minimally invasive hysterectomy are technically advanced compared to classical open surgery and are widely used due to the completion of practical experience, but a continuous interest in non-invasive minimally invasive treatment modalities is retained.

Conclusions: Minimally invasive treatment modalities for leiomyomas have emerged as an important treatment option when considering patient requirements, and further research and practice are needed to support their development into a mainstream modality for the treatment of leiomyomas.

Objectives: Our study aimed to retrospectively analyse and present the clinical course of accessory cavitated uterine mass (ACUM), a rarely diagnosed uterine malformation.

Material and methods: The study group comprised 5 adolescents that were treated in the Division of Gynecology, Clinical Hospital of Obstetrics and Gynecology of Poznan University of Medical Sciences, between October 2017 and August 2022. Patients' age at diagnosis of ACUM ranged from 14.1 to 27.5 (mean 21.4) years. All patients complained of severe dysmenorrhea with significant lateralisation of the pain.

Results: Pelvic ultrasound (US) followed by pelvic magnetic resonance imaging (MRI) revealed the presence of a small cystic lesion surrounded by a ring of myometrium within or in connection with the regular uterine body. In four patients (80%), the lesion was on the right side, and in one patient (20%) on the left side. The volume of the ACUM cavity ranged from 0.04 to 2.4 (mean 0.8) cm³. Laparoscopic excision of ACUM, located near the uterine attachment of the round ligament, was performed in all five cases and resulted in the complete resolution of symptoms. None of the patients was diagnosed with adenomyosis or pelvic endometriosis.

Conclusions: ACUM is a small, surgically correctable cause of severe dysmenorrhea in young females with an otherwise normal uterus. The lateralisation of the menstrual pain should prompt the search for this malformation with imaging techniques (US, MRI). ACUM laparoscopic excision results in complete relief of symptoms. ACUM is not associated with pelvic endometriosis.

Objectives: Cervical adenofibroma is a rare form of mixed mesodermal tumor that can present as cervical polyps with a tendency for local recurrence and progression. Few cases progressing to adenosarcoma have previously been reported. We report a case of cervical adenofibroma progressing to adenosarcoma, and we seek to remind clinicians of the method and importance of the differential diagnosis of this disease. A fertile woman was admitted in our department for the eighth recurrence of a cervical polypoidal mass which for the past 10 years. Recurrence of cervical adenofibroma was confirmed by ultrasound and MRI. A wide local excision under hysteroscopy was performed due to her strong desire to preserve the uterus. Surgical pathology and immunohistochemical interpretation revealed cervical adenosarcoma. A hysterectomy with conservation of the ovaries was recommended, with regular follow-ups for evidence of disease recurrence.

Conclusions: Differential diagnoses of cervical adenofibroma are hard to prove. Adenosarcoma should be ruled out, especially in women presenting with recurrent cervical polypoidal masses. A combined histological/immunohistochemical investigation is mandatory.

Objectives: The purpose of the present study is to explore the effectiveness of a modified suspension method combined with gasless single-port laparoscopy (MS-GSPL) for the treatment of benign ovarian tumors. The aim of this approach is to provide a convenient, economical, and minimally invasive method that is suitable for widespread use, even in middle- and low-income countries or primary hospitals.

Material and methods: Retrospective analysis of patients who underwent laparoscopic unilateral ovarian cystectomy due to benign ovarian tumors from January 2019 to December 2019.Thirty-six cases were treated with MS-GSPL, and 36 cases were treated with single-port laparoscopy (SPL). The patients' medical records, perioperative surgical outcomes, postoperative pain scores and complications were reviewed and compared.

Results: There are no significant differences in age, body mass index, previous pelvic surgery, tumor diameter, and tumor pathologic outcomes between MS-GSPL group and SPL group. The median operation times were 50 (Q1~Q3, 44~62.25) min in the MS-GSPL group and 60.5 (Q1~Q3, 57.25~78) min in the SPL group with a significant difference. The median estimated blood loss was 40 (Q1~Q3, 30~50) mL in the MS-GSPL group and 50(Q1~Q3, 30~60) mL in the SPL group with no significant difference. Compared with SPL group, patients in MS-GSPL group had earlier postoperative exhaust times, shorter hospital stays and lower costs, and all these differences were statistically significant (p < 0.05). There was a strong positive correlation between operation time and BMI in the MS-GSPL groups.

Conclusions: The patients receiving MS-GSPL treatment have quick postoperative recoveries. MS-GSPL is a novel, safe and economical surgical method that is suitable for extensive clinical development in middle- and low-income countries or primary hospitals.

Objectives: A number of reports on the role of selectin in the process of carcinogenesis, at the stage of proliferation and metastasis, have been available. The aim of the study was to analyze (s)P- and (s)L-selectin serum concentrations in women with EC and to compare these concentrations to clinical/pathological parameters and disease progression using surgical-pathological staging data.

Material and methods: A total of 46 patients with EC and 50 healthy controls were included in the study. Serum concentrations of sL- and sP-selectins were measured in all participants. The oncologic protocol was implemented in all women from the study group.

Results: Significantly higher serum concentrations were found in EC women as compared to controls. No statistically significant differences were found between the concentrations of the soluble forms of selectins and the following parameters: histologic type of EC, histologic tumor differentiation, depth of myometrial infiltration, cervical involvement, distant metastases, vascular space invasion, and disease advancement. Slightly higher (s)P-selectin concentrations were observed in serous carcinoma, in women with cervical involvement, in the sera of women with vascular space invasion and with advanced stages of the disease. Slightly higher mean (s)P-selectin concentrations correlated with lower differentiation of the tumor. Slightly higher mean (s)P-selectin concentration was detected in the sera of women with lymph node metastases and with the serosal and/or adnexal involvement. The results were statistically insignificant, but they almost reached statistical significance.

Conclusions: L- and P-selectins play a role in the biology of EC. The absence of an unambiguous relationship between differences in (s)L- and (s)P-selectin levels and disease advancement suggests that they do not play a vital role in tumor progression in endometrial cancer.

Objectives: It has been belived that changes in diastolic blood velocities in the fetal ductus venosus were due to increased central venous pressure secondary to increased fetal heart strain during hypoxia or heart failure. There have been recent reports of changes in ductus venosus blood velocity without signs of increased fetal heart strain. The aim of this evaluation was to compare blood velocity in the right hepatic vein as a marker of increased central venous pressure in relationship to changes in ductus venosus blood velocity.

Material and methods: Fifty pregnancies suspected of fetal growth resitriction were evaluated by Doppler ultrasound. Blood velocity was recorded in the right hepatic vein, ducus venosus and in the umbilical vein. Placental blood flow was also recorded in the uterine and umbilical arteries as well as the fetal middle cerebral artery.

Results: Increased umbilical artery pulsatility index was recorded in 19 fetuses and 20 has signes of brain sparing according to recordings in the middle cerebral artery. Abnormal blood velocity in the ductus venosus was recorded in 5 fetuses, none of these fetuses had an abnormal pulsatility in the right hepatic vein.

Conclusions: Opening of the ductus venosus is not only related to fetal cardiac strain. This might indicate that the ductus venosus does not primarily open due to increased central venous pressure in moderate fetal hypoxia. Increased fetal cardiac strain might be a late event in the process of chronic fetal hypoxia.