Ceska Gynekologie-Czech Gynaecology最新文献

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.

Objective: To evaluate whether serum anti-Müllerian hormone (AMH) levels can predict sperm retrieval (SR) outcomes in men with idiopathic non-obstructive azoospermia (iNOA) undergoing microdissection testicular sperm extraction (mTESE), and to develop a predictive model that may inform clinical decision-making.

Materials and methods: This retrospective, multicenter cohort study included 72 men diagnosed with iNOA who underwent mTESE between December 2022 and May 2023 at two IVF centers in Turkey. Serum AMH and follicle stimulating hormone (FSH) levels were measured prior to surgery. Patients were categorized into TESE-positive (+SR) and TESE-negative (-SR) groups based on the presence of spermatozoa in testicular tissue. Hormonal and clinical parameters were compared between groups, and a multivariate logistic regression model was constructed to identify independent predictors of SR outcome. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic accuracy and optimal cutoff values for AMH and FSH.

Results: Out of 72 patients, 37 (51.4%) had successful SR and 35 (48.6%) did not. Median AMH and FSH levels were significantly higher in the -SR group (P = 0.001 and P = 0.044, resp.). Multivariate logistic regression analysis identified serum AMH as the only independent predictor of positive SR outcome (P < 0.001). ROC analysis revealed excellent diagnostic performance for AMH (AUC = 0.909), with an optimal cutoff value of 3.4 ng/mL yielding 75.68% sensitivity, 91.43% specificity, 90.32% positive predictive value, and 78.05% negative predictive value (P = 0.001). Higher AMH levels were significantly associated with negative SR outcomes.

Conclusion: Serum AMH level is a reliable, non-invasive biomarker for predicting SR outcomes in men with iNOA undergoing mTESE. An AMH level > 3.4 ng/mL is significantly associated with a lower probability of sperm retrieval. Incorporating AMH into preoperative assessment may help avoid unnecessary surgical procedures and guide clinical counseling in male infertility management.

Uterine arteriovenous malformations (AVMs) are a rare cause of severe uterine bleeding. Uterine traumas, such as cesarean section or abortion, are known risk factors. In this article, we present a rare case of an AVM that developed in a patient with a history of a previous cesarean section and recent abortion. In this case, we review the pathogenesis, diagnosis, and treatment strategies of AVMs that develop in cesarean scars in light of the current literature. The patient presented with 2 months of vaginal bleeding that led to life-threatening anemia. Doppler ultrasound identified an AVM in the cesarean scar. Given the hemodynamic status of the patient, an emergency surgical intervention was performed and the AVM was successfully treated. This case highlights that AVM should be primarily considered in the differential diagnosis of severe bleeding in patients with a "double-hit" risk, such as a cesarean section followed by subsequent uterine trauma, and that emergency surgical intervention can be life-saving.

Endometriosis is a complex chronic disorder with a high prevalence among women of reproductive age, significantly affecting both their quality of life and ability to conceive. In clinical settings, there is an increasing incidence of advanced disease stages, particularly deep infiltrating endometriosis, which not only produces severe clinical symptoms, but also results in organ involvement. This article aims to synthesize current insights into the pathological mechanisms underlying fibrotic remodelling, which is associated with the most severe manifestations of the disease. Furthermore, it provides the theoretical framework for an ongoing research project aimed at identifying molecular biomarkers implicated in the most advanced forms of endometriosis, with the potential to enhance prediction of disease progression.

of recommendations Preventive measures and procedures We recommend monitoring of blood loss in women with risk factors for PPH during labor using calibrated blood collectors or their equivalents. (Good Clinical Practice) We recommend that women with significant risk factors for PPH (e.g., placenta acrreta spectrum or hematologic disorders requiring consultative hematologic care) deliver in a perinatal intensive care center or perinatal intermediate care center. (Good Clinical Practice) We recommend formulating a plan of care in collaboration with a multidisciplinary team at a reasonable time prior to delivery for patients at high risk of PPH. (Good Clinical Practice) We recommend treating anemia antepartally. Pregnant women should be given iron supplements if the haemoglobin level falls to < 110 g/L in the 1st trimester or < 105 g/L at 28 weeks of pregnancy. (Good Clinical Practice) We suggest considering parenteral iron administration in women with sideropenic anemia unresponsive to oral iron supplementation. The cause of anemia should be identified as soon as possible after termination of pregnancy. (Weak recommendation) If the baby adapts well, we do not recommend cord ligation in less than 1 min. (Strong recommendation) In all vaginal deliveries, we recommend prophylactic administration of uterotonics in the third postpartum period after the delivery of the baby and cord ligation to reduce the risk of PPH. The first-choice drug is oxytocin. (Strong recommendation) If the third stage of labor has not been actively managed, we suggest that uterine massage and controlled umbilical cord traction be considered to shorten the duration of the third stage of labor and to reduce blood loss during vaginal delivery, if performed by a qualified healthcare professional. (Weak recommendation) We recommend the administration of uterotonics to prevent the development of PPH in women after the delivery of a child by caesarean section and umbilical cord ligation. (Strong recommendation) We suggest considering carbetocin administration in women at increased risk of PPH. (Weak recommendation) We recommend a single-dose administration of tranexamic acid (TXA) in women at increased risk of PPH undergoing a caesarean section. Clinical note: The use of TXA prior to the caesarean section is not explicitly stated in the product's SPC. A recent meta-analysis states the most common dosage to be 1 g i.v. (Strong recommendation) Organization of care We recommend that every health care facility with an OB/GYN unit should have the PPH management protocol (guided document is not specific or really used at all, I am not sure if my suggestion is sufficient) defining the organizational and professional procedure for PPH situations. (Good Clinical Practice) We recommend that the PPH management protocol (i.e. the crisis action plan) should clearly define the organizational and professional roles of the individual members of the crisis team in the event of PPH (non-medical s

Posterior urethral valves (PUV) account for most cases of lower urinary tract obstruction (LUTO) in male fetuses, with a prevalence of 1 in 5,000 live births. Prenatal ultrasound findings include bladder wall thickening, keyhole sign, oligohydramnios, and ureteral dilatation. If untreated, PUV can cause pulmonary hypoplasia and renal failure, often requiring dialysis or transplantation. Treatment options include vesicoamniotic shunting and fetoscopic laser fulguration. PUV is rarely associated with anorectal malformations, posing a diagnostic and therapeutic challenge. This case report describes a neonate diagnosed prenatally with PUV who underwent intrauterine procedures, followed by preterm cesarean section at 32 weeks. Postnatally, he exhibited renal dysplasia, cryptorchidism, and developed necrotizing enterocolitis. Despite multiple laparotomies and colostomy, the infant improved and was then discharged. At 4 months, imaging confirmed rectal stenosis. We highlight the diagnostic limitations of prenatal ultrasound in differentiating PUV from other LUTO causes and the benefits of fetal magnetic resonance imaging. Anorectal malformations have diverse phenotypic presentations and are linked to environmental risk factors. The rare association of PUV with anorectal anomalies requires careful prenatal counseling due to potential complications. This case highlights the importance of early diagnosis and multidisciplinary management for improved outcomes.

Objectives: To evaluate whether there is an association between the colposcopic lesion area and hematological parameters in patients with cervical intraepithelial neoplasia (CIN) 2/3.

Material and methods: Women with CIN 2/3 were included in the study (N = 62). Colposcopic lesion area was measured by Image J software. Genotyping for human papillomavirus (HPV) 16, 18, 45 and 52 was performed by PCR. Hematologic parameters were evaluated.

Results: The cut-off value of monocytes was ≤ 490.77/mm3, with a sensitivity of 92.3%, and a specificity of 44% (AUC = 0.662; P = 0.048). For red cell distribution width (RDW), the cut-off value was > 12.9%, with a sensitivity of 84.6% and a specificity of 55.1% (AUC = 0.661; P = 0.028). In univariate analysis, monocyte count ≤ 490.77/mm3 and RDW > 12.9% were associated with a colposcopic area > 0.88 cm2 (P = 0.035; P = 0.015, resp.). After multivariate analysis, considering the cofactors age, CIN grade, smoking and HPV type, only RDW remained independent factor OR (95% CI) = 12.825 (1.348-121.971), P = 0.026.

Conclusion: Monocyte count and RDW are associated with the lesion colposcopic area. The blood count is a simple, minimally invasive and inexpensive test, associated with the growth of precursor lesions of cervical cancer, and may, in the future, have the potential to be used in the public health system.

Background: Evaluation of the quality of life using validated measures is an essential part of urogynecology examination and follow-up. Questionnaires administered in paper form generate paper waste or high demands for storage. Score calculation for some questionnaires may be demanding and time-consuming. The electronic format of completing questionnaires simplifies data collection and processing, but may be challenging for older patients. We developed a Medical Electronic Survey System (MESS), which facilitates completion of questionnaires on a tablet PC with an emphasis on data protection and user-friendliness for the elderly.

Objective: To compare patient satisfaction and ease of use between Google Forms and MESS.

Methods: This was a prospective cohort study comparing the answers to a satisfaction questionnaire completed using Google Forms (193 questionnaires between 2013-2015) and MESS (329 questionnaires between 2019-2020), along with other clinically used validated questionnaires. The answers to the questionnaire were compared using a Fisher's Exact Test or a Wilcoxon Two Sample test, with a significance level of P < 0.05.

Results: The electronic form of questionnaire completion suited more women in case of MESS (84.5 vs. 65.6%; P < 0.05). Completing questionnaires electronically was rated as easy or very easy by 89.1% of patients using MESS compared to 68.7% using Google Forms; P < 0.05. The electronic form of filling-in the questionnaires was very difficult or impossible especially for women using Google Forms (31 vs. 11%; P < 0.05). The major difference in questionnaire completion without any help was observed in the age group 60-69 years. No differences were observed in women under 60 years of age. All clinicians observed significant facilitation of their work.

Conclusion: MESS has made the method of electronic questionnaire completion available even to elderly patients with pelvic floor disorders. It was positively accepted even by patients who are not familiar with any electronic devices.

Background: Cesarean section (CS) rates are rising globally, with associated postpartum complications significantly higher compared to vaginal delivery. Addressing these complications through optimized management and targeted physiotherapy is crucial for improving maternal outcomes and quality of life.

Objective: This study aimed to evaluate the effectiveness of physiotherapy on pain relief and restoration of functional activity in women after CS.

Material and methods: 91 patients, who were admitted to an obstetric hospital for elective CS, were involved in the study. The control group (47 women) received standard pre- and postoperative supervision. The intervention group (44 patients), in addition to standard care, underwent physiotherapy, which included preoperative care (physiotherapy training, educational training), and postoperative exercises (breathing, circulation, and pelvic exercises, along with connective tissue massage). The results were analyzed after CS for 3 days.

Results: A lower intensity of postoperative pain and easier walking from the 1st day, a lower level of difficulty in performing functional activities on the 2nd day (easier turning in bed and transition to a sitting position), faster recovery of intestinal motility due to the passage of flatus in 3.5 hours and the act of defecation after 10.0 hours, decreased requirement of extra analgesics by 4.21-fold (OR = 0.24; 95% CI 0.10-0.58; P = 0.02), and a significant reduction in the length of hospital stay (OR = 0.24; 95% CI 0.09-0.57; P = 0.02) were established.

Conclusion: The study revealed the effectiveness of the proposed physiotherapy program in the early post-cesarean period in terms of reducing pain and improving restoration of the body's functional activity.

Objective: We aimed to evaluate the usefulness of serum kisspeptin (KP), measured in the 1st trimester (11-14 weeks), as a new biomarker that can predict antenatal complications.

Materials and methods: A prospective case-control study of prospectively collected data. Blood samples of all patients (N = 124) were preserved at -70 °C for the assessment of serum KP-10 and KP-54 levels. The KP levels were analyzed for comparison among women who experienced complications including fetal growth retardation (FGR), pregnancy-induced hypertension (PIH), preterm delivery, gestational diabetes, and fetal death. The control group consisted of matching subjects who completed their pregnancies without problems. The predictive effect of serum KP on adverse pregnancy outcomes was investigated.

Results: Among all adverse pregnancy outcomes, the KP-10 level was significantly higher in patients who developed FGR (P = 0.025). In the patient cohort affected by PIH, either accompanied by preeclampsia or standalone, there was a trend towards higher KP-10 levels (P = 0.059), although statistical significance was not achieved. However, regarding KP-10, the calculated cut-off value and the area under the curve (AUC) for predicting the onset of FGR were statistically significant (AUC: 0.684; P = 0.006). The model established with KP-10, PIH, and pregnancy associated plasma protein-A (PAPP-A) was found to be significant in predicting the development of FGR (P = 0.006; NPV: 98%; PPV: 21.4%; OR: 0.10; 95% CI 0.016-0.611).

Conclusions: First trimester maternal serum KP levels may have the potential to be used as a 1st trimester biomarker that can predict the development of FGR.