Ceska Gynekologie-Czech Gynaecology最新文献

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.

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.

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.

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.

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

Vaginal fisting is an uncommon and risky sexual practice. It consists of penetrating the vagina with one or both hands. Fisting is practiced as heterosexual, homosexual, or autoerotic activity and may be the cause of vaginal injury and circumjacent organs. The article describes the case of a 33-year old pornographic film actress who developed vaginal injury and heavy bleeding during fisting while filming. Rupture of the vagina was sutured and blood loss was replenished with transfusions.