Ginekologia polska最新文献

Objectives: Placenta accreta spectrum (PAS) is usually treated by hysterectomy performed through a midline incision. We hypothesize that PAS surgery can be performed through a Joel-Cohen incision with adequate sight and safety.

Material and methods: The data on women having a hysterectomy due to PAS between 2013-2021 was collected retrospectively. Operation length, baby's pre-delivery general anesthesia exposure time, transfusion rates, complication rates, postoperative admission to the intensive care unit (ICU), postoperative hospital stay, and neonatal outcomes were collected. In addition, the data investigated whether the operation was performed under emergent conditions and in the early (2013-2016) or late (2017-2021) years.

Results: 161 patients met the inclusion criteria. The median gestational age at delivery was 34 weeks (27-39). The mean operation length was 150 minutes (75-420), and the anesthesia-to-delivery interval was 32 minutes (5-95). Twenty-three (14%) patients did not receive any blood product, 73 (45%) received less than three packs of erythrocyte, and only seven (4%) had a massive transfusion. Bladder injuries occurred in 24 (15%). Preoperative anemia, hypogastric artery ligation, transfusion, ICU admission, and maternal and neonatal complications were more frequent in emergent cases. Comparison between the early and late groups showed a decrease in the rate of anemia, maternal ICU admission, hypogastric artery ligation, and neonatal complications. In addition, infectious complications were relatively rare in all groups.

Conclusions: The Joel-Cohen incision and bladder dissection before the baby's delivery reduce transfusion rates and avoid midline incision, which is prone to complications and unpleasant cosmetic appearance while performing a hysterectomy for PAS surgery.

Objectives: The corpus callosum is the main pathway that connects interhemispheric communication. Agenesis of corpus callosum (ACC) have not consistently detected replicate genetic risk factors, potentially due to Etiological heterogeneity of this trait. This study aimed to retrospectively analyze the molecular basis for the ACC and the potential genotyping-phenotyping association and provide the basis for genetic counselling.

Material and methods: Karyotyping and chromosomal microarray analysis were performed for copy number variants.

Results: Three cases had 1p36 deletions, two cases had 2q31.2 and 2p16.3 microdeletions, one case had microdeletion of Xq26.3q27.1, five cases involved derived chromosomes due to unbalanced translocations. These cases had variable deletions and duplications with partial overlapping. Phenotypically, besides agenesis of corpus callosum and other brain morphological abnormalities as well as heart abnormalities.

Conclusions: ACC may occur alone or be related to other abnormal clinical phenotypes, and its genetic mechanism is very complicated. These results revealed ACC is associated with a variety of chromosomal abnormalities. The findings of the present study expand the genotypes associated with ACC, and further delineation of the genotype-phenotype correlations for ACC. With current applications of chromosome microarray analysis, congenital submicroscopic copy-number variations in fetuses can be detected more effectively.

Objectives: To assess the experience and knowledge of Polish women up to 50 years of age about fertility and its disorders.

Material and methods: A self-composed questionnaire consisting of 44 questions, divided into six sections, was available in social media from January until February 2020. The answers to 13 single-choice questions were analyzed to assess the level of knowledge. Statistical analysis was performed with the use of Statistica 13.0, with p value < 0.05 considered significant.

Results: A total of 3,321 correctly filled out questionnaires were obtained. The average result was 8.88 out of 13 single-choice questions regarding the basics of the menstrual cycle and infertility (median 9, standard deviation [SD] 2.21). As many as 65.2% of respondents did not know which days in the cycle were fertile days. The women who had been and/or were pregnant at the time of survey, more often answered better than those, who had never given birth. They had a better mean score of 13 single-choice questions compared to those who had never been pregnant (9.02 vs 8.61, p < 0.001). Respondents who obtained information about infertility from doctors in 86.97% knew that regular intercourse meant 2-3 times per week in comparison to 79.7% of those who were not educated by medical practitioners (p < 0.0001). 69.8% respondents from the first group knew that the test of ovarian reserve existed in comparison to 55.63% of women from the second group (p < 0.0001).

Conclusions: The research has shown that the knowledge about fertility and its disorders is not satisfying among Polish women.

Introduction: Amniocentesis (AC) is the most used interventional procedure for prenatal diagnosis. The study aims to evaluate the pregnancy outcomes undergoing AC and the potential of amnion progesterone receptor (aPR) to alfa fetoprotein (AFP) rate for predicting the probability of neonatal intensive care unit (NICU).

Material and methods: This prospective cross-sectional study population consisted of 85 pregnant women who underwent mid-trimester AC. All cases were screened by ultrasound before AC. Maternal venous and amniotic samples were obtained simultaneously to evaluate the serum progesterone (sPRG), aPR, and aAFP and analyzed with patient results.

Results: Unlike sPRG and aAFP, aPR showed a positive correlation with NICU and a negative correlation with parity. In linear regression, the aPR-AFP rate showed strong linearity with NICU and parity. In an aPR-AFP rate analysis, we saw a strong predictivity for NICU compared to the other three parameters. It presented 73.4% specificity and 79% sensitivity at 0.0075 cut-off (AUC: 0.78; p = 0.003; 95% CI: 0.608-0.914).

Conclusions: Evaluating the PR either alone or in a rational combination with AFP will provide physicians with valuable information about the advanced process of pregnancy and postpartum complications. The physicians might use the aPR-AFP rate to predict NICU potential for pregnancy and need further studies to make more vital predictions on postpartum complications.

Vulvar lichen sclerosus is chronic and difficult to treat disorder, which offer is recurrent and leads to multiple complications. The limited efficacy of pharmacologic treatment directed the search for new therapies including use of CO₂ laser. In our study we focused on collagen and elastin gene expression as well as heat shock proteins and p53 expression in two patients with vulvar lichen sclerosus who underwent CO₂ laser therapy. In both patients we observed decreased clinical symptoms observed by an experienced gynecologist as well as significant changes in gene expression before and after laser treatment.

Objectives: The aim of this study is to analyze correlation between vitamin D level and BMI in polycystic ovary syndrome (PCOS) women.

Material and methods: The study group consisted of 311 patients with PCOS. Patients were categorized according to four phenotypes. All of the women participating in the study had their blood tested in the appropriate phase of the menstrual cycle and after proper preparation for the tests. The ultrasound examination and anthropometric measurements were performed.

Results: Vitamin D concentration was assessed in all study subgroups. The majority of patients had vitamin D deficiency or insufficient level. Variables included in the study, such as level of vitamin D, low density lipoprotein (LDL), sex hormone binding globulin (SHBG), testosterone, androstenedione, Anti-Müllerian Hormone (AMH) and BMI were correlated. A negative correlation was observed with the the level of SHBG, vitamin D and AMH. Subsequently, positive correlations were shown with testosterone, LDL and free testosterone level. An analysis of the correlation between BMI and vitamin D concentration showed that in phenotype I of PCOS this correlation was statistically significant and in the remaining PCOS phenotypes the correlation was close to statistical significance.

Conclusions: Most PCOS patients have a deficiency or insufficient level of vitamin D. Women with PCOS have shown a significant negative correlation between BMI and SHBG serum level and between BMI and AMH level. A positive correlation exists between BMI and total and free testosterone and LDL. There is a negative correlation between BMI and vitamin D level in PCOS patients and in phenotype I this correlation was statistically significant.

Objectives: To investigate the prevalence and influencing factors of stress urinary incontinence (SUI) within 6-8 weeks postpartum in Jiangsu Province.

Material and methods: We designed a multi-center cross-sectional study involving seven hospitals in Jiangsu province, and enrolled women who underwent postpartum examination at 6-8 weeks in these hospitals between July 2019 and June 2021. According to the presence or absence of SUI, the enrolled patients were divided into two groups: the SUI group and the non-SUI group, respectively. We assessed the general health status, noted the details of delivery, and checked the pelvic floor electromyographic parameters of the postpartum women in both groups.

Results: Among 6,302 cases of postpartum women in Jiangsu province, there were 1,579 cases of SUI, with a prevalence of 25.06%. The prevalence of SUI increased significantly with age, BMI, increasing parity, coexisting constipation, organ prolapse, and diastasis recti abdominis. Compared to the non-SUI group, the SUI group had a lower mean value of the pre-baseline rest phase, shorter rise and fall times of fast muscle contractions, and a lower mean value of the endurance contraction phase. Multiple regression analysis revealed associations with weight (especially overweight and obesity), coexisting organ prolapse, constipation, parity, gestational week of delivery, mode of delivery, and mean value of endurance contraction phase.

Conclusions: The prevalence of postpartum stress urinary incontinence in Jiangsu Province was 25.06%, and was linked to being overweight, parity > 2, coexisting organ prolapse, constipation, and a decrease in the mean value of the endurance contraction phase of the electromyograph. In this report, we offer a theoretical basis for the effective prevention of postpartum SUI clinically.

Physical activity is associated with beneficial health effects for both mother and her future child, as well as the course of pregnancy. The aim of this review was the comparison of international guidelines with Polish recommendations. Data were collected from PubMed platform and international guidelines and narrowed to open access studies published between 1990-2023 in English, German and Polish. The existing literature shows an increase of interest in the impact of body activity during pregnancy and pelvic floor muscle training (PFMT). The recommendations move away from the more conservative approach, that previously suggested limitation of all exercise-related activities. Recently, The Polish Society of Gynecologists and Obstetricians and Polish Society of Sports Medicine announced a planned release of joint recommendations on physical activity during pregnancy and after childbirth, as well as the translation of the "Get Active Questionnaire for Pregnancy", a screening tool for pregnant women, doctors and midwives, developed in accordance with the recommendations of international gynecological societies.

Objectives: To explore the relationship between the distance from the lower edge of the gestational sac to the internal cervical os in early pregnancy and placenta previa.

Material and methods: A prospective cohort study of women who underwent pregnancy examination in Weifang People's Hospital or Sunshine Union Hospital from January 2020 to June 2021. The distance from the lower edge of the gestational sac to the internal cervical os was measured at 5-6 weeks' gestation. There were 86 women with distance < 2.5 cm, and 105 women with distance ≥ 2.5 cm were randomly selected. There were 92 cases of scarred uterus and 99 cases of non-scarred uterus among the 191 women. They were divided into six groups according to the distance: (1) < 1.0 cm; (2) 1.0 cm to < 1.5 cm; (3) 1.5 cm to < 2.0cm; (4) 2.0 cm to < 2.5 cm; (5) 2.5 cm to < 3.0 cm; (6) ≥ 3.0 cm. All included women were followed-up during pregnancy and pregnancy outcome, and the likelihood ratio of different distances in early pregnancy was calculated and risk stratification was performed, and ROC curve was constructed.

Results: There were 15 women in the included studies who were lost to follow-up, 47 had a scarred uterus with placenta previa and 29 had a non-scarred uterus with placenta previa after delivery at 28 weeks or later. The distance from the lower edge of the gestational sac to the internal cervical os in early pregnancy of the scarred uterus < 1.5 cm, and the likelihood ratio was ∞; and the distance ≥ 3.0 cm, the likelihood ratio was 0. The distance from the lower edge of the non-scarred gestational sac to the internal cervical os < 1.0 cm, and the likelihood ratio was ∞; and the distance ≥ 3.0 cm, the likelihood ratio was 0. The ROC curve showed that when the area AUC under the curve was 87%, the optimal diagnostic cut-off value was 2.4 cm.

Conclusions: When the distance from the lower edge of the gestational sac to the internal cervical os was < 1.5 cm and the distance between the non-scarred uterus was < 1.0 cm, it eventually developed into placenta previa; the distance from the lower edge of the gestational sac to the internal cervical os in the first trimester of pregnancy between the scarred uterus and the non-scarred uterus was ≥ 3.0 cm, and it would hardly develop into placenta previa. When the distance from the lower edge of the gestational sac to the internal cervical os in early pregnancy was ≤ 2.4 cm, it could be used as a predictor of placenta previa.