Ceska Gynekologie-Czech Gynaecology最新文献

Negative pressure wound therapy is a modern and effective method for the prevention and treatment of postoperative wound healing complications, with growing applications in gynecology, especially in gynecologic oncology. Its mechanism of action includes enhanced drainage, reduction of edema, promotion of angiogenesis, and stimulation of granulation tissue formation, ultimately contributing to faster healing and a lower risk of infection, seroma, and wound dehiscence. Negative pressure wound therapy has been shown to be effective in the therapeutic management of complex, infected, or dehiscent wounds following gynecologic-oncologic surgery. Recent studies also suggest that its prophylactic application to primarily closed incisions after laparotomy or vulvectomy may significantly reduce surgical complications, shorten hospitalization, and accelerate recovery, which is particularly important in patients scheduled for adjuvant therapy. However, because most available evidence is based on retrospective studies, further prospective randomized trials are needed to confirm the role of this method in both therapeutic and prophylactic use and to guide its integration into standard perioperative care in gynecologic oncology.

Introduction: Endometrial carcinoma is the most common gynecological malignancy in developed countries, and its incidence has been increasing in recent decades. The prognosis of patients depends on a combination of clinical-pathological characteristics, and more recently, molecular indicators. The aim of this study was to analyze the influence of the selected prognostic markers - immunohistochemical (L1CAM, ER, PR) and classical (FIGO stage, grade, myometrial invasion, lymph node involvement, distant metastases) - on the survival of patients with endometrial carcinoma.

Materials and methods: A retrospective evaluation was performed on 143 women with histologically confirmed endometrial cancer treated between 2014 and 2018. All patients underwent primary surgical treatment. Resected specimens were subjected to immunohistochemical analysis of L1CAM, ER, and PR. Data were statistically processed using a Kaplan-Meier analysis and the Cox proportional hazards model, adjusted to age.

Results: L1CAM expression was detected in 14% of patients and was associated with shortened survival (HR ≈ 3.9). ER and PR positivity (89% and 85%, resp.) correlated with a more favorable prognosis (HR for ER positivity 0.21; PR 0.23). Classical factors such as higher grade, advanced FIGO stage, cervical and lymphovascular invasion, or presence in nodes were statistically associated with worse survival. An interesting finding was a significantly better prognosis in asymptomatic patients - the presence of symptoms increased the risk of death up to fourfold.

Conclusion: L1CAM positivity and loss of hormone receptors are significant adverse prognostic factors. Their inclusion in routine immunohistochemical panel testing improves risk stratification and treatment personalization, which at the time of publication of this paper is already included in the updated ESGO-ESTRO-ESP 2025 guidelines. At the same time, it has been shown that the absence of symptoms at diagnosis is a favorable survival indicator. The results support further research into prognostic markers and their integration into clinical decision-making algorithms.

Atypical placental site nodule (APSN) is a rare form of gestational trophoblastic disease (GTD) originating from the proliferation of intermediate trophoblasts, with uncertain clinical behavior. It is considered a potential precursor to rare forms of gestational trophoblastic neoplasia (GTN), such as placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). This report describes the first Brazilian case of APSN diagnosed via hysteroscopy in a 43-year-old woman following miscarriage. Histopathological analysis revealed a circumscribed, hyalinized aggregate of intermediate trophoblasts with nuclear atypia, positive immunostaining for PLAP and p63, and a Ki-67 index > 5%. The patient declined hysterectomy, opting for conservative management with close monitoring. After 12 months of follow-up, no progression was observed. This case emphasizes the diagnostic challenges of APSN, given its subtle presentation and overlap with benign placental site nodules or even PSTT/ETT. Hysteroscopy proved valuable for both diagnosis and fertility-preserving management. Although hysterectomy remains the definitive treatment in many cases, individualized approaches balancing oncologic safety and reproductive goals are increasingly considered. Long-term clinical vigilance is essential, as APSN may precede aggressive GTN forms. Multicenter studies and registries are urgently needed to establish evidence-based guidelines for the diagnosis, treatment, and follow-up of this rare lesion, improving patient outcomes in these uncommon forms of GTD.

Objective: To provide an overview of recent literature on the cost-effectiveness of mental health screening for women during pregnancy.

Results: 1,988 publications were retrieved from databases, of which four were included in the systematic review. Models of care with screening are cost-effective compared with standard care without screening. Multi-level screening models are more cost-effective than single-level models. Effectiveness is affected by the number of false-positive cases, which decreases in multi-level models.

Conclusion: Mental health screening in pregnancy appears to be cost-effective. We recommend its use in comprehensive health care for pregnant women in our country.

Objective: To compare the effectiveness and safety of the methods of pharmacological induction of labor. To identify the advantages and disadvantages of oral and vaginal administration of misoprostol and intracervical administration of dinoprostone.

Materials and methods: Analysis of a group of women who gave birth at the Faculty Hospital Brno from 1st August 2019 to 31st January 2020, and one of the following labor induction schemes was used: group A: misoprostol 25 µg orally every 2 hours, group B: misoprostol 50 µg vaginally every 6 hours, group C: intracervical dinoprostone 1 mg every 2 hours. Inclusion criteria were: singleton pregnancy, completed 36th gestational week, live fetus, cephalic presentation, and cervix score ≥ 6. Exclusion criteria were uterine scars and fetal growth restriction. Time factors of induction, occurrence of acute hypoxia during labor, mode of delivery, use of tocolysis during labor, necessity of oxytocin infusion, use of epidural analgesia, blood loss, uterine rupture, umbilical artery pH, and Apgar score at the 5th min were evaluated.

Results: A total of 378 women were included (133 vs. 145 vs. 100). A statistically significantly higher success rate of vaginal delivery was demonstrated in group A compared to groups B and C (88 vs. 77.9 vs. 76%; P = 0.035). The longest time from the administration of the first dose of the preparation to delivery of the fetus was in group A (medians in minutes 700 vs. 565 vs. 375; P < 0.0001). There was no difference between the groups in the I. and II. labor stage duration. Cesarean delivery rate due to acute hypoxia was the lowest in group A (2.3 vs. 10.3 vs. 9%; P = 0.023). Uterine rupture was not recorded; there were no differences in neonatal outcome parameters.

Conclusion: The highest success rate of vaginal delivery was achieved with the use of low-dose oral misoprostol. The disadvantage of this method is a significant increase in the time from the start of induction to the delivery of the fetus. There was no difference in the occurrence of severe perinatal complications between the induction methods.

Objective: This study aimed to assess the reliability and educational value of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy videos on YouTube and their suitability for training surgeons.

Materials and methods: On June 12, 2024, YouTube was searched using the keywords "vNOTES hysterectomy," "TVNOTES hysterectomy," "transvaginal natural orifice transluminal endoscopic hysterectomy," "vNOTES," and "vaginal notes hysterectomy." A total of 73 videos met the inclusion criteria. Viewer engagement metrics, such as time since upload, number of views, likes, dislikes, comments, and video duration were recorded. Ratios such as a view ratio, a like ratio, and Video Power Index (VPI) were calculated. The videos were categorized by the modified Global Quality Scale (GQS) and evaluated based on a scoring system derived from a standardized 10-step vNOTES hysterectomy procedure, with scores ranging from 0 to 15.

Results: Out of 73 videos, 40 (53.8%) were categorized as poor quality, 13 (17.8%) as moderate, and 20 (27.4%) as good. No significant differences were found between groups in terms of time since upload, views, dislikes, comments, or a like ratio. However, videos in the good-quality group had a significantly higher number of likes and VPI scores. Critical elements such as patient preparation and positioning, setup of the operation room, circumcision of the cervix, and vault closure were inadequately addressed in lower-quality videos. Videos with a didactic voice had significantly more views, likes, and comments than those with music or no sound. No significant correlations were found between video length and engagement metrics.

Conclusion: The majority of vNOTES hysterectomy videos (53.8%) on YouTube lack comprehensive educational content, with only a small fraction deemed appropriate for surgical training. The interest rates of the viewers may not be correlated with the usefulness rates of the videos. Surgeons and organizations should focus on producing high-quality, peer-reviewed instructional videos to improve the educational value of YouTube as a resource.

Objective: It is to assess the ipsilateral and contralateral tubal patency by hysterosalpingography following salpingostomy and methotrexate therapy for tubal pregnancy.

Patients and methods: The study was conducted between September 2021 and October 2023. It was conducted in the radiodiagnosis and obstetrics and gynecology departments of the Al-Hussin and Al-Azher university hospitals. Patients who had undergone salpingostomy or received methotrexate treatment were included in this research. Three months after being discharged, the individuals who were seeking for fertility were assessed again for Fallopian tube patency using hysterosalpingographs. Two groups of women participated in the study: group I (N = 50) received methotrexate treatment, while group II (N = 50) had undergone salpingostomy management.

Results: The two groups (medical and surgery) did not vary statistically significantly in preserving tubal patency. Following methotrexate therapy, the ipsilateral tubal patency was 72%, and following surgical management, it was 74%. Furthermore, following methotrexate therapy, contralateral tubal patency was 92%, and 90% following salpingostomy.

Conclusion: The results point to comparable success rates with salpingostomy and methotrexate in preserving fallopian tube patency.

Congenital cystic adenomatoid malformation (CCAM) is a rare developmental anomaly of the fetal lung that can lead to severe respiratory distress in the neonatal period. Type III CCAM, characterized by solid, microcystic lesions, often poses diagnostic and therapeutic challenges, especially in progressive cases. We report a rare case of antenatal laser therapy used to treat a fetus diagnosed with type III CCAM. Despite two cycles of corticosteroid therapy, the lesion showed no significant regression, leading to the decision to perform ultrasound-guided intrauterine laser ablation. The procedure resulted in a reduction in lesion size, normalization of the fetal cardiac axis, and a favorable perinatal outcome, with the newborn discharged 5 days after birth in stable condition. This case highlights the potential role of fetal laser therapy as a less invasive and effective alternative to surgical excision for selected cases of progressive type III CCAM. Further studies are needed to validate the safety, efficacy, and long-term outcomes of this approach.

Objective: The ability to locate pelvic floor muscles (PFM) is essential for the effectiveness of pelvic floor muscle training programs. The aim of this study was to investigate the accuracy of a modified coccygeal movement test that incorporates an objective assessment of abdominal muscle co-activation (CMT+) (Index test) compared to transabdominal ultrasound (TAU) scanning (Gold standard) in diagnosing accurate PFM contraction.

Methods: Pregnant women attending the hospital for a routine in the middle 2nd trimester scan who are able to understand the study rationale and information were considered eligible for inclusion. TAUs were performed by one out of two trained operators. CMT+ was performed by an experienced physiotherapist. The CMT+ assessor and participants were blind to the TAU result.

Results: A total of 117 participants were recruited into the study with a mean BMI of 30.86 kg/m² (4.5) and 23.16 kg/m² (3.7), resp. CMT+ (Index test) correctly identified 5 out of the 9 participants who were not able to contract and 107 out of the 108 who were able to contract their PFM resp. (sensitivity = 55.6%, specificity = 99.1%, positive predictive value = 83.3% and negative predictive value = 96.4%; LR+ = 60 and LR- = 0.45).

Conclusion: CMT+ is an easy to perform test with high specificity and negative predictive value that has the additional benefit of assessing any concomitant abdominal muscle co-activation. Therefore, CMT+ is a potentially useful initial screening test to identify those who cannot perform a correct pelvic floor muscle contraction, and would benefit from specialized assessment and structured training.

The aim of this article was to summarize current knowledge regarding ultrasound-guided tru-cut biopsy, with a focus on its applicability in preoperative diagnosis of myometrial lesions. Tru-cut biopsy is used in gynecologic oncology for the management of pelvic and abdominal tumors; however, its application in the diagnostic algorithm for uterine tumors has been validated by only a limited number of studies. Nevertheless, this literature review highlights that tru-cut biopsy of uterine smooth muscle lesions demonstrates high sample adequacy for histological examination, diagnostic accuracy, and a low complication rate. Leiomyomas are among the most common benign uterine tumors, whereas uterine sarcomas are rare and aggressive malignancies. Symptoms of these conditions do not differ significantly. Their differentiation relies on imaging methods such as ultrasonography and magnetic resonance imaging. However, distinguishing between benign and malignant tumors remains challenging, as criteria for differentiating benign and malignant lesions using these imaging methods have not yet been sufficiently validated. Incorporating tru-cut biopsy into the standard diagnostic algorithm for uterine tumors could provide valuable insights into the oncological nature of atypical tumors on ultrasonography or magnetic resonance imaging, leading to optimized and personalized treatment strategies for each patient.