Ceska Gynekologie-Czech Gynaecology最新文献

Aim: To describe coping strategies and infertility stress in men and women undergoing in vitro fertilization (IVF) treatment. To determine whether there are differences in coping strategies between men and women and to identify adaptive and non-adaptive coping strategies for infertility.

Materials and methods: A correlational study, where 162 patients (99 women and 63 men) with primary infertility undergoing IVF treatment at Sanus Pardubice completed the Fertility Problem Inventory and COPE Inventory psychological questionnaires.

Results: There were no significant differences between women and men in experiencing infertility stress. The coping strategies used most frequently by both men and women were Positive Reinterpretation, Planning, and Acceptance; men used the strategies Restraint, Suppression, and Planning significantly more frequently than women; and women used the strategies Using Emotional Social Support and Religious Coping significantly more frequently than men. For both women and men, level of Global infertility stress significantly correlated with Denial in the positive direction and with Positive Reinterpretation and Acceptance in the negative direction.

Conclusion: Involuntarily childless women and men in IVF treatment experience similar infertility stress, but use slightly different coping strategies. For both men and women, Positive Reinterpretation and Acceptance emerged as adaptive strategies, while Denial emerged as non-adaptive.

Uterine torsion belongs to one of the most dangerous labor complications also because of its rarity. As it is not common for an obstetrician to come across this state, it is usually not at the very top of the differential diagnostics list when solving acute child delivery complications. However, it is serious enough to pose a lethal threat to both mother and child. In this case, the term gravidity was ended by acute cesarean section because of HELLP syndrome. During the operation, as well as after a complicated delivery and hysterotomy suture uterine torsion of 120 degrees to the right, the patient was diagnosed with detorsion. The rest of the operation was done according to normal standards. Thanks to this very prompt procedure, the aftermath of the described state meant little to no harm to the mother and her child. This case study should highlight the importance of including uterine torsion into differential diagnostics of acute abdominal pain and vomiting to prevent fatal labor complications for the mother and her child.

Introduction and objective: Uterine NK (uNK) cells, a specialized subpopulation of natural killer (NK) lymphocytes located in the endometrium, play a crucial role in regulating the immune response and in the process of embryo implantation. This study aims to retrospectively analyze the outcomes of in vitro fertilization (IVF) treatment in a cohort of women who underwent uNK cell immunophenotyping with subsequent immunomodulatory therapy applied based on the results.

Methods: The study included 122 patients who underwent uNK cell immunophenotyping between April and December 2023. Immunophenotyping was performed using flow cytometry. Patients were categorized into four groups according to their uNK cell phenotypes: normal findings, low absolute and relative numbers of uNK cells (LOW-IMMUNE profile), low numbers of uNK cells combined with the shift towards the cytotoxic uNKc dim immunophenotype (MIXED-IMMUNE profile), and normal numbers of uNK cells, but an undesirable shift in the ratio of cytotoxic to regulatory uNK cells towards the cytotoxic uNK dim phenotype (OVER-IMMUNE profile). Embryo transfer outcomes and the occurrence of miscarriages up to the 12th week of pregnancy were evaluated in each group.

Results: The highest clinical pregnancy rate was observed in the treated OVER-IMMUNE group (70%), fol lowed by the MIXED-IMMUNE group (60%). The LOW-IMMUNE group did not differ significantly from the untreated NORMAL group (P = 0.205). Insufficient immune activation (LOW-IMMUNE profile) was significantly associated with first-trimester pregnancy loss (P < 0.0001).

Conclusion: This study provides new insights into the potential benefits of uNK cell immunophenotyping and subsequent immunomodulatory therapy in treating fertility disorders. While the results indicate possible clinical advantages, further research is necessary to confirm these findings and elucidate the mechanisms leading to improved outcomes in assisted reproductive techniques.

This is a short review about a rare metastatic physical finding of abdomino-pelvic malignancies that is called Sister Mary Joseph's nodule. It is cutaneous metastasis in the umbilical region and it was first used almost 200 years ago. Even though it is a rare finding, we should not forget it in the differential diagnosis of umbilical nodules. The article also includes two case reports.

Objective: To determine the profile of women undergoing uterine evacuation for suspected hydatidiform mole (HM) according to their clinical, laboratory, ultrasound, and anatomopathological characteristics at two referral centers in Northeastern Brazil.

Methods: Retrospective cohort study was performed in two referral centers between October 2016 and December 2022 with women undergoing uterine evacuation for suspected HM. Socio-demographic characteristics, clinics, biochemistry, ultrasound, anatomopathology, and outcome were evaluated.

Results: A total of 507 women were admitted with clinical suspicion of gestational trophoblastic disease, of which 334 were confirmed, with 107 being in Center-1 and 227 being in Center-2. Mean distance between the referral center and the patient's home was 88 km. Mean age of the women was 27 ± 9 years, with a predominance of 19 to 39 years (72%), and approximately 60% of the cases were diagnosed ≤ 12 weeks of gestation. Vaginal bleeding was observed in 79% of women. Transvaginal ultrasound showed a typical appearance in 90% of the examinations. The macroscopic aspect was described as a vesicle in 70% of cases. Uterine evacuation was mainly performed by uterine curettage (43%). The majority of women had no complications (69%). The outcome considered to be remission was achieved in 37.1% of cases, but 38.9% abandoned follow-up, and 9% did not start follow-up after hospital discharge.

Conclusion: The distance traveled by women to the referral centers was significant, but the majority of women had no complications. Remission was observed in 37.1% of women, but there was a high abandonment rate of 38.9%.

Objective: We report a case of ovarian torsion at 26 weeks of gestation that was successfully managed laparoscopically.

Case report: A 29-year-old woman at 26 weeks of pregnancy presented to the emergency department with left lower quadrant pain. Ultrasound examination revealed a 64 × 60 mm cyst in the left ovary, and Doppler imaging could not detect blood flow in the left ovary. The patient was diagnosed with left ovarian torsion and subsequently underwent laparoscopic left ovarian detorsion and cystectomy. The patient experienced no postoperative surgical or obstetric complications and had an uncomplicated vaginal delivery at 39 weeks of gestation.

Conclusion: In the surgical management of adnexal torsion during pregnancy, laparoscopy can be safely performed not only in the 1st and 2nd trimesters but also in the 3rd trimester, provided that adequate surgical expertise and appropriate equipment are available.

Objective: This study aims to present the methodological framework and analytical approaches for utilizing national individual-level data on diabetes mellitus in pregnancy, a condition that poses a significant risk to the health of both mother and child.

Materials and methodology: The National Health Information System serves as the central repository for data on the Czech healthcare system. Through the integration of various recorded datasets, it enables detailed analysis of the incidence of diabetes mellitus in connection with pregnancy, provided that an appropriate analytical algorithm is applied. The input dataset for the analysis consisted of births recorded between 2012 and 2023 in the National Register of Reproductive Health, specifically the Mothers module. In total, 1,240,227 births were included in the analysis. For each case, the presence of the disease was verified using records from the National Register of Reimbursed Health Services.

Results and conclusion: Based on the defined criteria, including specific medications, reported medical procedures, medical devices, and disease diagnoses, the prevalence of diabetes mellitus among parturient women was determined to be 15.4%. Thanks to the interconnected structure of the National Health Information System and newly established definition of a pregnant woman with diabetes, it will be possible to continue analyzing the prevalence and health impacts of this condition at the national level.

Aim: The aim of the study is to obtain valid data on the quality of life of women aged 18-30 years with endometriosis using the certified questionnaire the Endometriosis Health Profile-30 (EHP-30). The Czech version of the EHP-30 was used in the study. A total of 184 women completed the questionnaire. Mean age of the women was 26.6 years (± 2.8 years).

Materials and methods: Data were collected from 10 February 2023 to 8 October 2023 using the online platform Click4survey.

Results: Summary index of the EHP-30 group was 57.0 points (± 20.43 points). The domain of powerlessness to control the disease had the greatest impact on women's quality of life at 66.4 points, followed by Social support at 58.4 points, then Emotional well-being at 58.2 points. With Pain at 51.3 points, and Self-image at 50.7 points as the final domain. Results showed that perception of pain did not increase with increasing age, and on the contrary, women in the youngest age group of 18-20 years perceived pain as the worst. The age of women did not statistically significantly affect the final index of the questionnaire or its individual dimensions.

Conclusion: Based on the analysis and results obtained, we have obtained data on the domains of endometriosis, which can significantly contribute to a more effective understanding of the possibility of improving the quality of life of women aged 18-30 years with endometriosis and the procedures for their treatment.

Objective: To determine whether the triglycerides/glucose index (TyG-index), lipid accumulation product (LAP), and visceral adiposity index (VAI) would differ in young polycystic ovary syndrome (PCOS) patients when compared to the non-PCOS group, and to investigate the relationship between these markers and cardiovascular disease (CVD) risk in PCOS patients.

Materials and methods: One hundred and ninety two women with PCOS, and 148 age and body mass index (BMI) matched healthy women without PCOS were enrolled. Levels of serum androgens, sex hormones, lipids, fasting glucose, fasting insulin, and N-terminal pro-brain natriuretic peptide (Nt-probnp) were determined. The 75 g oral glucose tolerance test was performed. The Homeostatic Model Assessment-Insulin Resistance Index (HOMA-IR) and Matsuda insulin sensitivity index were calculated. Levels of TyG-index, LAP, and VAI were determined.

Results: TyG, LAP, and VAI were significantly higher in PCOS patients than in the control group (P = 0.001 vs. P = 0.001 vs. P = 0.001, resp.). HOMA-IR was significantly higher in PCOS patients and Matsuda ISI was significantly lower in PCOS patients (P = 0.001 vs. P = 0.001, resp.). Levels of Nt-probnp were significantly higher in PCOS patients (P = 0.001). Serum total testosterone and androstenedione levels had significant correlations with TyG, LAP, and VAI. Nt-probnp was significantly correlated with TyG, LAP, and VAI. LDL was positively correlated and HDL was negatively correlated with TyG-index, LAP, and VAI.

Conclusion: PCOS patients have increased values of TyG-index, LAP, and VAI. TyG index, LAP, and VAI may indicate an increased risk of CVD and hyperandrogenism in PCOS patients.

We present a rare case of a brain abscess in a pregnant woman due to an untreated dental abscess, initially presenting as a new-onset seizure. This article highlights the need for a broad differential diagnosis for seizures in pregnancy, extending beyond the common assumption of eclampsia, and further emphasizing the importance of thorough history-taking and physical examination. We suggest integrating routine dental care into prenatal healthcare to reduce the risk of such serious events. Informed consent was obtained, and all identifiable information has been de-identified to protect patient confidentiality.