Ceska Gynekologie-Czech Gynaecology最新文献

Due to the implementation of sentinel lymph node ultrastaging, the prevalence of isolated tumor cells and micrometastases have increased. This literature review comprises of articles published between January 2019 and September 2024 aiming at low-volume metastases in regional lymph nodes, their prognosis, and links to molecular classification. Micrometastases are currently considered as having metastatic lymph node involvement; however, they have a better prognosis than macrometastases. Accordingly, therapy is tailored. In contrast, isolated tumor cell presence is not considered metastatic involvement according to International Federation of Gynecology and Obstetrics (FIGO) 2023 staging and does not affect the therapeutic procedure because their significant prognostic importance has not been proven so far.

Objective: To map management of different types of ectopic pregnancies in the Czech Republic using a questionnaire-based study.

Methods: In 2023, a total of 95 obstetrics and gynecology departments across the Czech Republic were surveyed using an online questionnaire, which inquired about the management strategies for various types of ectopic pregnancies. The departments were categorized based on the number of hysterectomies performed annually. Differences in responses between large centers and other departments were statistically compared.

Results: A total of 45 departments of all sizes completed the questionnaire. Two-thirds of all departments always perform salpingectomy in cases of tubal pregnancy (78% of large, 58% of medium-sized, and 40% of small departments). Systemic methotrexate administration for the treatment of intact tubal pregnancy is used by one-fifth of departments (22% of large, 23% of medium-sized, and 0% of small departments). In cases of atypical ectopic pregnancy localization, methotrexate treatment is used by 33% of large, 42% of medium-sized, and 40% of small departments. A statistically significant difference was observed in the clearly preferred laparoscopic approach for surgical management of cesarean scar pregnancy in large centers compared to smaller departments (P = 0.036). No other statistically significant differences were observed between the departments in other parameters.

Conclusion: In cases of intact tubal pregnancy, four-fifths of obstetric and gynecological departments perform laparoscopic salpingectomy, while only one-fifth utilize systemic methotrexate for treatment. On the other hand, methotrexate is used by one-third to two-fifths of departments of all sizes in cases of atypical ectopic pregnancy localization.

A woman's sexuality is a complex phenomenon involving several factors, among which age and health are the most important. However, other aspects are not negligible. The impact of pelvic organ prolapse on sexual function cannot be ignored, as the reported prevalence of pelvic organ prolapse in female population exceeds 50%. This article presents a systematic review of articles dealing with the impact of pelvic organ prolapse on female sexual function. Sexual dysfunction is common in women with pelvic organ prolapse, regardless of prolapse stage or the compartment affected. Estrogen therapy has no effect on sexuality in women with prolapse, while pelvic floor muscle training may provide some improvement. There is no evidence that conservative therapy using a pessary is associated with negative impact on sexual function. Native tissue repair tends to improve sexual function in general, except for posterior colporrhaphy, which was frequently associated with dyspareunia. No correlation between postoperative vaginal length and change in sexual function was identified. The impact of transvaginal mesh repair on sexuality remains unclear. In contrast, there is enough evidence proving that sacrocolpopexy significantly improves sexual function in women.

Objective: This study aimed to analyse the risk factors differentiating small for gestational age (SGA) and appropriate for gestational age (AGA) neonates.

Materials and methods: A retrospective-prospective cohort study was conducted from 2019 to 2024 at the 2nd Department of Obstetrics and Gynaecology, University Hospital Bratislava. The study involved 174 term neonates from singleton pregnancies, including 125 SGA and 49 AGA infants. Various maternal, foetal, and placental risk factors were analysed, with a particular focus on congenital cytomegalovirus infection (cCMV).

Results: Neonates' birth weights ranged from 1,480 to 4,470 grams. Of the risk factors assessed, only maternal COVID-19 infection during pregnancy was significantly associated with AGA outcomes (P = 0.009). No significant associations were found between common risk factors (e. g. hypertension, diabetes mellitus) and foetal growth restriction. Congenital CMV infection was not significantly associated with SGA. Logistic regression analysis confirmed the association of COVID-19 infection with foetal weight, while no significant effect was observed for CMV.

Conclusion: Maternal COVID-19 infection was associated with AGA outcomes, potentially due to enhanced medical surveillance and immune responses. However, the study's small sample size limits the interpretation of these findings, and further research is required to fully understand the impacts of COVID-19 on pregnancy. No significant association between congenital CMV infection and foetal growth restriction was found in this cohort, which was most likely due to the low prevalence of cCMV. Moreover, documented risk factors for foetal growth restriction, including hypertension and diabetes mellitus, were not statistically significant in our study population.

The increasing number of caesarean sections represents a significant health, economic, and psychological problem on a global scale. Robson's classification is a comprehensive approach to regularly analyse every operative abdominal delivery. It appears that particularly promoting the vaginal births after a previous caesarean section and reducing this mode of delivery among primiparas, is one of the ways of stopping the rising trend of caesarean sections. Slovak maternity facilities that have adopted Robson's classification reveal a decrease in the number of these obstetric surgeries.

Objective: Analysis of coincidental maternal mortality in Slovakia in the years 2007-2024 from the database of the Slovak Gynecological and Obstetric Society (enhanced surveillance system).

Methods: Retrospective population analysis of maternal mortality from 2007 to 2024 focused on coincidental maternal deaths. Analysis of coincidental maternal death cases was carried out according to the International Classification of Diseases (ICD-10) for Maternal Mortality (ICD-MM).

Results: Between 2007 and 2024, a total of 123 women died. The maternal mortality ratio (MMR) was 12.46 per 100 000 live births. Fifteen women (12.20%) died from coincidental causes (MMR 1.52 per 100 000 live births). From direct causes, 51 women died (41.46%), from indirect causes, 54 women died (43.90%), and three women died (2.44%) from an unknown cause of death. Out of the coincidental deaths, 80.0% were due to polytrauma - car accidents (66.67%), train accident (6.67%), and entrapment in an elevator shaft (6.67%). Three cases of deaths were due to homicide (domestic violence) - 20%.

Conclusion: The study highlights the problem of under-recognition of coincidental maternal deaths, despite its significant impact on public health. The Slovak Gynecological and Obstetrics Society attempts to identify and collect data on coincidental maternal mortality in Slovakia, which is not included in vital statistics. Addressing this overlooked issue is crucial for enhancing maternal health outcomes and ensuring comprehensive maternal safety worldwide.

Gastroschisis is a congenital abdominal wall defect characterized by the eventration of bowel loops through a right-sided paraumbilical opening. Prenatal detection of gastroschisis is generally straightforward due to advanced ultrasound techniques, and it is essential for optimizing both prenatal care and subsequent management. The prognosis for this condition is generally favorable, with positive long-term outcomes for most children. However, 10-15% of cases may follow a complicated course with an elevated risk of neonatal mortality or significant morbidity. Early detection enables effective monitoring of fetal development, risk assessment for potential complications, and risk minimization by planning childbirth at a tertiary center equipped with intensive neonatal care and the possibility of prompt surgical intervention.

Objective: To assess the effect of normalization of the hormone, human chorionic gonadotropin, on anxiety, symptoms of depression, and quality of life in patients with gestational trophoblastic disease, and to identify risk factors associated with these outcomes.

Methods: This longitudinal study included 51 women under postmolar follow-up or during treatment for gestational trophoblastic neoplasia between 2017 and 2019 in two Brazilian trophoblastic disease centers.

Results: The normalization of human chorionic gonadotropin led to a significant reduction in the depression scores and increased physical health domain scores in both study groups, namely the hydatidiform mole and gestational trophoblastic neoplasia groups. Having children and the desire for children were associated with lower scores for depression and anxiety, and higher scores for the psychological health domain of quality of life. Perceiving health as "very poor" was associated with higher scores for depression and anxiety, and lower scores for quality of life with respect to physical health, psychological health, and social relationship domains.

Conclusion: Disease remission was associated with reduced depression symptoms and better quality of life in the physical health domain. While having a negative perception of health was associated with higher anxiety and depression scores and poor quality of life, having children and the desire for children improved anxiety and depression symptoms and quality of life in the psychological health domain.

Ovarian carcinoma is one of the most serious types of gynecological tumors. It is usually diagnosed in advanced stages, mainly due to an asymptomatic course or non-specific symptoms in the early stages. It is also characterized by a tendency to recur frequently, thus reducing the overall survival of patients. This article focuses on the possibility of detecting recurrence of the disease during follow-up of patients after complete remission. According to the analyzed literature, the monitoring of CA-125 and HE4 oncomarker levels in combination with imaging methods such as expert ultrasonography, CT, and positron emission techniques offers the potential for early detection of recurrence. The most advanced type of computed tomography, photon-counting CT, with high detection capability and lower radiation burden, also holds promise. The question of further management of early-detected asymptomatic recurrence is open for further discussion.

Objective: Amenorrhea is a menstrual disorder than can arise as a result of hormonal dysfunction of the hypothalamic-pituitary--gonadal axis. There is limited data on the most common causes of secondary amenorrhea in Pakistan. Therefore, this study aimed to assess various causative factors along with hormone profiling in patients with secondary amenorrhea.

Patients and methods: The present cross-sectional study was conducted in different fertility clinics of Abbottabad. Patients with secondary amenorrhea were included by a non-probability sampling technique. Data related to demographic and other clinical variables were collected via a data collection form. Serum progesterone, estradiol, luteinizing hormone, follicle stimulating hormone, and prolactin were determined using commercially available enzyme-linked immunosorbent assay kits. This study was conducted on 126 patients with a mean age of 28.5 ± 7.8 years.

Results: Drug-related amenorrhea was observed in 14.3% of patients. Hyperprolactinemia-induced amenorrhea was observed in 31.7% and in 54% of patients with unknown etiology. Of the patients with drug-induced amenorrhea, 38.9% used oral contraceptives, 27.8% used omeprazole, and 33.3% used other drugs. Headache (79.4%) and fatigue (78.6%) were the main symptoms reported in amenorrheic women, while hair loss was reported in 65.9% of patients. Both loss of libido and hirsutism were observed in 45.2% and 42.9% of patients, resp. Breast pain and vaginal dryness occurred in 35.7% and 23.8% of patients, resp.

Conclusion: The current study showed that hyperprolactinemia is the most common cause of secondary amenorrhea followed by drug-induced amenorrhea, which must be considered in the clinical management of hormonal imbalances and subsequent amenorrhea.