Ceska Gynekologie-Czech Gynaecology最新文献

Objective: To determine the maternal epidemiological profile and perinatal outcomes of fetuses with gastroschisis at a reference center in Northeastern Brazil.

Methods: A retrospective cohort study was conducted between January 2014 and December 2022 using medical records. Inclusion criteria comprised of pregnancies ≥ 24 weeks, with a prenatal diagnosis of gastroschisis confirmed in the postnatal period.

Results: During the study period, 1,773 newborns with congenital anomalies were born at the service center, 50 were identified as having gastroschisis and four cases were excluded. Prevalence of gastroschisis was 11.5/10,000. Regarding the maternal sociodemographic profile, the mean age was 21 years, 38/46 (83%) were mixed, 34/46 (74%) had a partner, and 32/46 (70%) had high school education. Regarding associated maternal diseases, only 6/46 (13%) had hypertension, none had pre-existing diabetes mellitus, and 4/46 (8.7%) developed gestational diabetes mellitus. As for gastroschisis type, 33/46 (71%) were classified as simple, 11/46 (23.9%) as complex and 2/46 (4.4%) had no information. In 36/46 newborns with gastroschisis, primary closure was performed in the first surgery. The mean time of use of mechanical ventilation was 13 days, the mean time interval between surgery and ambient air was 8 days, the mean time of use of parenteral nutrition was 35 days, and the mean length of stay in the neonatal intensive care unit (NICU) was 39 days. Clinical complications in newborns with gastroschisis included neonatal infection in 35/46 (76%), blood transfusion in 33/46 (72%), hydroelectrolytic disorders and sepsis in 29/46 (63%), and cholestasis and fungal infection/sepsis in 8/46 (17%). Neonatal death occurred in 16/46 (34.8%).

Conclusion: Newborns with gastroschisis presented high rates of surgery with primary closure, blood transfusion and neonatal infection. Furthermore, we identified prolonged use of parenteral nutrition, long stay in the NICU, and prolonged use of antibiotic therapy.

Background: A common problem in women after childbirth is the frequent occurrence of pelvic girdle pain (PGP) and back pain (LBP). To date, no study has been conducted to determine the prevalence of these types of pain. The aim of our study was to compare the incidence of PGP and LBP in women after vaginal delivery and cesarean section in the Slovak Republic over the course of one year in 2024.

Methods: Cross-sectional study, the research sample consisted of 791 women 12 weeks to one year after delivery. The average age was 31.43 years. Standardized questionnaires were used for the Slovak version Pelvic Gridle questionnaire and Oswestry Disability Index.

Conclusion: Based on the type of delivery, the sample was divided into a group with spontaneous delivery comprising 633 women and a group with cesarean section comprising 158 women. Significant differences were observed in the incidence of pain and disability in the spine and in its intensity, with stronger pain in the cesarean section group. The type of delivery did not affect the incidence of pelvic girdle pain after delivery. Cesarean section was associated with greater pain intensity and disability in the spine. Disruption of the integrity of the abdominal wall, increased sensitivity in the area of the cesarean section scar, and a restricted movement regime may explain the higher incidence of pain in the spine in women after cesarean section.

The cytological category of atypical squamous cells of undetermined significance describes cellular abnormalities that are more severe than inflammatory changes, but are quantitatively or qualitatively insufficient to be included in the squamous intraepithelial lesion category. This study aims to determine the risk level for the presence of high-grade dysplasia in patients with this cytological abnormality.

Methods: We retrospectively searched our database for women with cytologically proven atypical squamous cells of undetermined significance lesions between January 2020 and June 2024. A total of 104 patients who had undergone colposcopy-directed biopsies were included in the study.

Results: Among the 104 women with confirmed atypical squamous cells of undetermined significance cytological lesions who had undergone biopsies, 56 cases (53.8%) were negative, while 48 cases (46.2%) demonstrated cervical intraepithelial neoplasia. Cervical intraepithelial neoplasia 2+ was present in 23.1% (N = 24) of the cases. Furthermore, among 77 human papillomavirus positive women, the precancerous condition was not histologically confirmed in almost half of the cases (N = 36), while in 16 of the 23 human papillomavirus negative biopsies, the precancerous condition was not confirmed. Human papillomavirus status was unknown in 4 cases.

Conclusion: We identified a 23.1% presence of cervical intraepithelial neoplasia 2+ lesions in patients with atypical squamous cells of undetermined significance cytological findings. Our study also suggests a lower specificity, but a better negative predictive value of the human papillomavirus test in detecting cervical intraepithelial neoplasia in these patients.

Cíl: Prezentovat vzácný případ částečného molárního těhotenství implantovaného do jizvy po předchozím císařském řezu a shrnout literaturu. Kazuistika: Žena, 33 let (gravida 5, dva předchozí císařské řezy, dva spontánní potraty), se dostavila s vaginálním špiněním a bolestmi v podbřišku v 6. týdnu těhotenství. Transvaginální ultrasonografie odhalila v místě jizvy po císařském řezu gestační váček o rozměrech 28 × 19 mm, který obsahoval 4-mm plod s pozitivní srdeční aktivitou. Pod ultrazvukovým dohledem byla provedena vakuová kyretáž. Deset dní po zákroku vzbudily rostoucí hladiny beta-hCG v séru a přetrvávající cystická masa na ultrazvuku podezření na molární těhotenství. Byla podána jednorázová systémová dávka methotrexátu. Histopatologie potvrdila částečné molární těhotenství. Hladiny beta-hCG v séru pacientky se normalizovaly do 8 týdnů. Závěr: Částečné molární těhotenství v jizvě po císařském řezu je extrémně vzácný stav, který se může projevovat vaginálním krvácením a bolestí v pánvi. Včasné rozpoznání pomocí ultrazvuku a laboratorního vyšetření v kombinaci s včasnou intervencí včetně kyretáže a léčby methotrexátem mohou vést k úplnému vyřešení. Lékaři by měli tuto diagnózu zvážit u pacientek s předchozími císařskými řezy, aby zajistili optimální výsledky.

Cervical cancer remains a major global health challenge, despite the availability of effective preventive measures such as human papillomavirus (HPV) vaccination, early detection and treatment of precancerous lesions, and timely management of early-stage disease. In recent years, several European countries have introduced substantial changes to their screening strategies -shifting from conventional cytology to primary HPV testing. This shift, supported by the World Health Organization and International Agency for Research on Cancer recommendations, is underpinned by numerous clinical studies demonstrating the superior sensitivity of HPV testing for detecting high-grade cervical lesions. This article provides an up-to-date overview of cervical cancer screening across Europe, with a focus on screening methods, testing intervals, program organization, and the emerging role of self-sampling.

Introduction: Rectal endometriosis is a serious disease, and its surgical treatment belongs among demanding procedures, often requiring a multidisciplinary approach. It is associated with a significant risk of peri- and postoperative complications, the most serious being the development of rectovaginal fistula, which may occur in up to 10% of resections for rectal endometriosis. Preventive measures include the choice of surgical technique, such as a two-stage procedure (resection with terminal stoma followed by stoma closure and bowel anastomosis), which is not optimal for the patient due to the necessity of having two surgeries. Another option is the interposition of the patient's vital tissues into the site of anastomosis or intestinal wall suture. For this purpose, an omental flap is often used, or part of the mesorectum may be utilized. The ability to verify the vitality of such a flap should be considered crucial in preventing anastomotic leakage.

Methods: A patient underwent robotic-assisted laparoscopic segmental resection of severe rectal endometriosis involving the rectovaginal septum and vagina, classified as #ENZIAN A3 and C3, with interposition of the mesorectum and intraoperative tissue perfusion assessment using indocyanine green.

Conclusion: The use of tissue perfusion assessment when performing interposition of patient-derived flaps may, in the future, improve surgical precision, enhance success rates, and contribute to the prevention of rectovaginal fistula formation.

Objective: The aim of this case report is to present the impact of multimodal prehabilitation on the quality of life, cognitive performance, physical fitness, and nutritional status in a patient with advanced ovarian cancer.

Methods: A 74-year-old woman with high grade serous ovarian carcinoma pT3bN1a was scheduled for radical surgery following three cycles of neoadjuvant chemotherapy. She underwent a three-week intensive multimodal prehabilitation program in a 4/7 regimen involving physiotherapy, occupational therapy, nutritional counselling, psychological support, and supervision by a rehabilitation physician. The effect was evaluated using functional and cognitive tests, stress and disability scales, and body composition analysis (InBody).

Results: Improvement was observed across all major domains: reduction in disability (WHODAS 20 → 5%), enhancement of cognitive function (MoCA 22 → 25), decreased perceived stress (PSS-10 17 → 11), reduction in frailty (FI 3 1), and restoration of full independence in activities of daily living (Katz Index 6/6). Physical performance showed marked gains (6MWT +42 m, 5×SST -6.5 s, handgrip strength +4 kg), while pulmonary function tests confirmed improved ventilatory capacity (FVC, FEV1, PEF). Nutritional assessment indicated a reduced risk of malnutrition according to the MUST screening tool, although bioimpedance analysis demonstrated a mild increase in total body fat and visceral adipose tissue.

Conclusion: Intensive multimodal prehabilitation positively influenced the patient's psychosensory-motor potential, reduced disability, enhanced perioperative fitness, and confirmed its indispensable role in oncogynecology.

Objective: In many countries, the incidence of vulvar intraepithelial neoplasia as a precursor of vulvar squamous cell carcinoma has highly increased over the last 3 decades, while the incidence of cancer remained relatively unchanged. Among risk factors for recurrence, resp. progression, usually involve positive excision margins. The aim of the paper is to evaluate the risk of recurrence and progression of high-grade vulvar precancerosis in patients with histological margins "non in sano" - analysis of our own data.

Materials and methods: The retrospective study included 62 women after surgical resection of high-grade vulvar precancerosis with histological results of positive excision margins. Using the PubMed database, the results were compared with literary data.

Results: Total of 35 (56.5%) patients underwent repeated surgery on the vulva. Inhalf of them (18-51.4%), histological results showed recurrence at the same stage, and in the second half of the women, no dysplastic changes were detected. There was no progression to invasive cancer in any of the patients.

Conclusion: Beyond positive excision margins, the other predictive factors seem to be even more important for recurrence or progression of vulvar precancerosis including age, smoking, immunosuppression, radiotherapy, concomitant lesions in the vagina or cervix, and bioactivity of the human papilloma-virus. Instead of repeated resection to reach histological negative margins, we prefer the long-time, resp. long-life dispensarisation.

In general, most common localizations of endometriosis are the pelvic organs, until recently, the spleen was mentioned as the only abdominal organ resistant to the development of endometriosis. Our case report describes the differential diagnosis of a splenic cyst as an incidental finding during the examination of endometriosis, its interdisciplinary solution within surgery, gynaecology, radiology and infectious medicine, using robotic-assisted minimally invasive surgery.

Objective: In this study, we aimed to present the demographic, ultrasonographic, genetic, obstetric, and postpartum results of 14 patients diagnosed with radial ray defects.

Materials and methods: Fourteen patients diagnosed with radial ray defects. Non-development or hypoplasia of any preaxial part of the upper extremity on ultrasonography was considered a radial ray defect. Maternal age, gestational week at diagnosis, laterality of the radial ray defect, genetic results, presence of comorbid anomalies, termination status, and postpartum prognosis were obtained.

Results: The range of maternal age at the time of diagnosis was 17-38 years and the gestational age ranged between 14-26 weeks. Four of the radial ray defects were bilateral, and ten were unilateral. Trisomy 18 was identified in two cases. Eight cases accepted the termination procedure. Three cases rejected termination and had spontaneous intrauterine death during pregnancy follow-up. One case was diagnosed with VACTERL association and died postpartum on the 13th day. One case was monitored due to Fanconi aplastic anemia and one case had amniotic band syndrome in etiology and lives with a prosthetic arm.

Conclusion: The frequency of a radial ray defect accompanied by syndromic and congenital anomalies was high, and visualization of the radial bone or other preaxial bone structures on the 1st trimester fetal ultrasonography will ensure the diagnosis of a radial ray defect in early gestational weeks. In the case of a radial ray defect diagnosis, systemic organ screening should be performed with detailed ultrasonography and the necessary invasive procedure for karyotype examination should be advised to all families.