Ceska Gynekologie-Czech Gynaecology最新文献

Aim: The effect of platelet-rich autoplasma on endometrial thickness and receptor sensitivity to estrogen and progesterone.

Materials and methods: This prospective clinical study included 200 patients. The participants in the study were divided into two groups. The first control group received hormone replacement therapy (HRT). The second study group received an intrauterine infusion of platelet-rich autoplasma (PRP group). On the 19th day of the menstrual cycle, an ultrasound examination was performed to assess endometrial thickness, as well as an immunohistochemical analysis to determine receptor sensitivity to estrogen and progesterone.

Results: In the course of the study, we found that the use of platelet-rich autoplasma increased the thickness of the endometrium by 0.85 mm; the average thickness of the endometrium in the group who received PRP therapy was 8.25 (8.25-8.61)  mm; and in the group of patients who only received HRT, it was 7.40 (7.34-7.65)  mm. The sensitivity of receptors to estrogen in the experimental group increased by 3.5, in the experimental group it was 75.00 (71.43-74.22), and in the control group it was 71.50 (67.05-70.85). The sensitivity of receptors to progesterone also increased by 9.0, in the experimental group it was 95.0 (91.4-93.8), and in the control group it was 86.0 (83.47-86.27).

Conclusion: Due to the action of platelet factors, PRP therapy has a positive effect on the endometrium, increasing its thickness and improving its receptivity. Therefore, it can be concluded that this method can find great practical application to improve the outcomes of assisted reproductive technology programs.

Objective: In this study, we aimed to evaluate the diagnostic value of the HALP score, serum uric acid value, and uric acid-creatinine ratio, which are inflammatory markers, in the diagnosis of preeclampsia (PE).

Materials and methods: One hundred sixty-six pregnant women who met the inclusion and exclusion criteria were included in the study. They were divided into two groups: 81 pregnant women diagnosed with PE (PE group) and 85 pregnant women with healthy pregnancies (control group). Demographic and obstetric stories of the groups; weeks of pregnancy at diagnosis; hematological and biochemical parameters; hemoglobin, albumin, lymphocyte, and platelet (HALP) score and serum uric acid-creatinine ratio (sUA/sCr); and the results of the newborns were recorded and compared between groups.

Results: There was no significant difference between the groups in terms of age, gravidity, parity, and body mass index (P values = 0.533, 0.188, 0.085, 0.915, resp.). Mean gestational age, mean birth weight, 1st and 5th minute Apgar scores, and mean umbilical cord pH values were lower in the PE group compared to the control group (P values = 0.0001 for all). Percentage of NICU admissions was higher in the PE group (P = 0.0001). HALP score of the PE group was significantly lower than the control group (2.2 vs. 3.2; P = 0.0001). Uric acid and sUA/sCr ratios were significantly higher in the PE group compared to the control group (for uric acid, 6.2 ± 1.7 vs. 4.5 ± 1.2; P = 0.0001; for sUA/sCr, 12.0 ± 4.0 vs. 9.9 ± 3.1; P = 0.0001). In diagnosing PE, serum uric acid had a sensitivity of 82.7% at values of 4.7 and above, 58% sensitivity at values of sUA/sCr ratio of 10.9 and above, and 3.7% sensitivity at HALP score values of 6.6 and above (P values = 0.0001, 0.001, 0.001, resp.).

Conclusion: In our study, we found that the HALP score in PE was significantly lower than in healthy controls, and the uric acid value and sUA/sCr ratios were significantly higher. Diagnostic value of the serum uric acid value and then the sUA/sCr ratio were higher in PE. However, we found that the HALP score was insufficient for diagnosing PE.

Objective: The aim of the study was to evaluate the occurrence of stress urinary incontinence after pelvic organ prolapse surgery using the laparoscopic sacrocolpopexy method. This is a retrospective multicenter study.

Methods: The study included 131 patients who underwent laparoscopic sacrocolpopexy and underwent at least a one-year follow-up in the form of a clinical examination.

Results: The group included patients with an average age of 63.4 years (38-80 years), BMI 26.6 kg/m2 (19.4-36 kg/m2), and parity 2 (0-4). Before surgery, 30 (22.9%) patients showed stress incontinence, and after surgery there were 50 (38.2%); the difference was statistically significant (P = 0.0007). Thirty (22.9%) patients underwent subsequent anti-incontinence surgery, while 10 (7.6%) patients experienced significant improvement of stress incontinence.

Conclusion: Pelvic organ prolapse reconstruction surgery by laparoscopic sacrocolpopexy is associated with the risk of postoperative stress incontinence in 38.2%, of which de novo in 22.9% of cases.

Aim: The sperm activation method is a modern methodological approach that is used more and more often in practice. The number of studies focused on methods of artificial activation of human sperm motility are constantly increasing. Standard sperm selection methods can fail in some cases, among other things, because very young sperm are isolated that have not yet completed their development. In these cases, artificial stimulation of their movement can have a positive effect and greatly facilitate and faster the process of selecting suitable sperm. Methylxanthines are most often used as activating agents. However, opinions on the safety of using these substances on sperm are not uniform. The aim of the thesis is to present current knowledge about artificial activation of sperm motility for in vitro fertilization and subsequent embryonic development.

Methodology: Research of relevant literature in Web of Science, Scopus, PubMed/Medline databases.

Results and conclusion: The literature analysis shows that this method is safe and effective in the selection of immotile spermatozoa. Scientific studies have been conducted to verify the safety and reliability of this method. The conclusion of these studies is the positive impact of this method of selection, especially in cases of sperm obtained from testicular tissue after method testicular sperm extraction. In these cases, the method of artificial sperm activation facilitated and accelerated the selection of sperm before intracytoplasmic sperm injection. Undamaged spermatozoa, which are immobile due to incomplete maturation, were activated.

Reactive oxygen species play a significant role in male fertility and infertility. They are essential for physiological processes, but when their concentration becomes excessive, they can be a cause of various sperm pathologies. Seminal leukocytes and pathologically abnormal sperm are the primary sources of oxygen radicals in ejaculate. They negatively affect sperm quality, including DNA fragmentation and sperm motility impairment. Addressing increased concentrations of reactive oxygen species involves various appropriate lifestyle modifications and measures, including the use of antioxidants, treatment of urogenital infections, management of varicocele, weight reduction, and others. In many cases, these interventions can lead to adjustments in the condition and improvement in sperm quality. Such improvements can subsequently lead to enhanced outcomes in assisted reproduction or even an increased likelihood of natural conception. In some instances, the need for donor sperm may be eliminated. However, a key factor is adhering to a sufficiently prolonged treatment, which requires patience on the part of both, the physician and the patient.

The number of cycles of assisted reproduction using donor body parts is increasing significantly. In Europe alone, around one hundred thousand children are born each year who have some relationship to three or more parents. The European expert guarantor European Society of Human Reproduction and Embryology therefore issued a recommendation in 2022 to inform donors, recipients and children born in this way. Our article analyses developments in this area and proposes a solution for the Czech Republic. It is necessary for providers to immediately respond to the fact that the anonymity of donation can no longer be guaranteed, and to adapt the content of consultations and informed consents of potential donors and applicants accordingly. Legislation then has two possible solutions: first to adopt a system of "polyparenthoods" or second to fundamentally limit donation cycles.

Endometriosis is a common gynecological disease caused by the implantation of active endometrial cells outside the uterine cavity. In most cases, endometriosis occurs in the pelvic area, such as the ovary, Douglas' pouch, or uterine sacral ligament. Some rare cases of extrapelvic endometriosis can also occur in the perineum, urinary system, gastrointestinal tract, nervous system, chest, subcutaneous tissue, and skin. Endometriosis of the perineum is usually secondary to obstetric trauma, such as perineal laceration or episiotomy. To date, few cases of spontaneous perineal endometriosis have been reported. Herein, we report a rare case of spontaneous deep perineal endometriosis. Notably, the patient had typical symptoms of regular pain during menstruation with no history of delivery or perineal trauma. The patient recovered well after postoperative gonadotropin releasing hormone agonist injection.

Aim: To investigate the quality of life of women with endometriosis before treatment and 3 months after the start of surgical and/or conservative treatment.

Sample and methodology: The sample comprised of 38 patients, of whom 26 underwent surgical treatment, 6 had pharmacological treatment, and 6 had both surgical and pharmacological treatment. The Endometriosis Health Profile (EHP-30) questionnaire in the Czech version and the Numeric Rating Scale (NRS) were used to assess quality of life. The questionnaires were completed before treatment and 3 months into the treatment.

Results and discussion: When comparing quality of life with the EHP-30 questionnaire, 3 months after the start of treatment, significantly better quality of life scores were found in all domains except the domain "Infertility." Statistically significant improvement was observed in the domains of "Control and powerlessness," "Emotional well-being," and "Pain" (P < 0.0001). Pain assessment using NRS showed subjective improvement in pain during menstruation, outside menstruation, during intercourse, micturition, and defecation. Statistically significant improvement was reported in pain during menstruation and outside menstruation (P < 0.0001).

Conclusion: Treatment of endometriosis improves the quality of life and also leads to a subjective reduction of pain intensity as one of the main symptoms of the disease.

Aim and methodology: To provide a comprehensive review on new findings and current recommendations regarding antiphospholipid antibodies with particular emphasis on clinical impact on gestation.

Conclusion: Antiphospholipid antibodies are an important risk factor for the development of a series of pregnancy-related complications. Early diagnosis and appropriate therapy can reduce the incidence of pregnancy loss and pregnancy-related complications.

Objectives: The presented research aimed to identify prenatal factors involved in abnormal neurodevelopment and postnatal manifestation of an autistic phenotype in 107 boys (average age 4.31 ± 2.24 years).

Materials and methods: Their biological mothers were asked to fill out a comprehensive questionnaire about their reproductive health, infections during pregnancy, oral contraceptive intake before conception, and potential substance abuse before and during pregnancy as well as delivery and newborn information. The boys were subsequently diagnosed with autism spectrum disorder (ASD) using the combination of Autism Diagnostic Observation Schedule (ADOS-2) and Autism Diagnostic Interview - Revised (ADI-R). Based on the ADOS-2 module chosen during diagnosis, boys diagnosed with Module 1 can be classified as nonverbal or minimally verbal (N = 68), while those diagnosed using Module 3 are fully verbal (N = 39).

Results: According to our results, reproductive health related to the length of the menstrual cycle before pregnancy with the autistic child seems to play a role with regards to the severity of the disorder (P = 0.017) as well as the number of previous pregnancies (P = 0.026). Mothers of nonverbal children reported to have had a much shorter menstrual cycle (27.35 ± 6.60 days) than those with verbal children (30.14 ± 4.44 days) and reported more previous pregnancies (0.93 ± 1.07 vs. 0.51 ± 0.91), while not reporting the number of live births before they had the autistic child. Children who were later diagnosed as non-verbal had a longer delivery time (from 2 to 48 hours; on average 11.13 hours, SD = 9.49) than verbal ones (between 1 and 27 hours, which was on average 7.09 hours, SD = 8.91), P = 0.0182. Delivery method didn't play a role in this context, and neither did the type of conception (natural, insemination, etc.).

Conclusion: Studying the involvement of prenatal factors in the etiology of autism based on the speech of the child seems to be a promising approach.