Ceska Gynekologie-Czech Gynaecology最新文献

The number of patients with an implanted shunt reaching reproductive age and planning pregnancy is increasing thanks to advances in the treatment of hydrocephalus. Changes in the mother's organism, which are mainly related to the accumulation of water in the organism and the elevation of intra-abdominal pressure, contribute to the increased incidence of complications during pregnancy and childbirth. Therefore, it is necessary to make a preconception exam and specify pregnancy management, a suitable method of childbirth dealing with potential complications. Possible malfunction of the shunt is solved individually according to the current neurological findings and taking into account the patient's overall condition and gestational age. Vaginal delivery is considered safe and preferred by most authors. Primary caesarean section is indicated only in patients with a history of rapidly progressing deterioration of the neurological condition due to shunt malfunction or serious complications related to its impaired shunt function. In an uncomplicated pregnancy with normal values of intracranial pressure, both general and epidural or spinal anesthesia can be used when choosing anesthesia.

Objectives: To assess the diagnostic rates of forensic case patients who sought gynecological and obstetrics care, as well as the differences in forensic report production based on the event.

Study design: The following factors were looked into: age of the patients, time between the incident and consultation, reason for consultation (pregnancy determination during the post-divorce waiting period, sexual assault, hymen examination, physical violence, other), time of the consultation (in-hours or out-of-hours), place of referral (prosecutor's office/court, police station, own request), and type of report (final or preliminary). The data were obtained retrospectively.

Results: When 651 forensic cases admitted to the emergency department were examined, 234 (36%), 199 (30.6%), 66 (10.6%), and 34 (5.2%) requested waiting period removal, physical assault against women, sexual assault, and hymen examination, respectively. The study revealed that 62.1% of sexual assault incidents were perpetrated by an acquaintance, 19.1% by a distant relative, and 12.1% by a first-degree family member. It was determined that the patient's partner was responsible for 63.8% of the physical violence against women, while 24.6% was committed by a first-degree relative and 6.5% was perpetrated by other acquaintances.

Conclusion: If the legislator revises the provision on the modern legal system's waiting period, which prevents women from remarrying, judicial reports may drop rapidly. Examining cases referred to gynecologists and obstetricians in centers with forensic medicine specialists and medical staff trained in forensic medicine will ensure safer forensic examinations and medical investigations.

Objective: To create a comprehensive overview of imaging methods for diagnosing pudendal neuralgia.

Methodology: Literature review.

Conclusion: Pudendal neuralgia is a chronic pain condition that is difficult to diagnose. On average, it takes 5 years from the onset of symptoms to the correct diagnosis. Diagnosis is based on symptoms described by the patient, neuropelveological physical examination, and presence of the 5 Nantes criteria. Imaging methods, especially ultrasound and magnetic resonance imaging of the pudendal nerve, show great promise for a more accurate and faster diagnosis. These methods can assist in diagnosing issues and excluding other pathologies that may cause symptoms.

Subtle but demonstrable movements in the expectant mother's pelvis occur during vaginal delivery in all the pelvic joints and anatomical planes of the body (sagittal, frontal, and transverse). The purpose of these movements is to gradually expand the space in the lesser pelvis via widening of the individual pelvic planes so that the newborn's head can enter the pelvic inlet, safely pass through the narrow planes of the pelvis, and through the pelvic outlet. From the point of view of biomechanics, these movements are described in literature as counternutation and nutation of the sacrum and iliac bone. The counternutation of the sacrum helps to expand the plane of the pelvic inlet. The nutation of the sacrum assists in expanding the plane of the pelvic width, height, and outlet. These physiological movements are affected by the body constitution, the state of the myofascial and skeletal systems of the mother, and furthermore, by hormonal disjunction of the connections in the expectant mother's pelvis together with the progress of the delivery mechanism itself. The main factor that determines the range of movement in the individual joints, and therefore adequate expansion of the individual pelvic planes, is the position of the mother during delivery. Engagement of active movements of the mother together with application of passive stretching of the soft tissues in the lower lumbar area and in the hip joints are both needed for maximum expansion of the individual pelvic planes and utilization of the maximum useful capacity of the mother's pelvis during delivery. These movements help invoke the abduction forces on muscles, tendons, and ligaments in the pelvis that lead to the optimum setting of the joints during which delivery movements happen. The specific movements in the pelvic joints predetermine whether nutation or counternutation is possible, and therefore if the newborn's head can progress to the pelvic inlet or pass through the narrow and wide pelvic planes, and the pelvic outlet. The knowledge of these biomechanical principles and movements in the pelvis during delivery enables obstetricians and midwives to understand how the movements in the hip joints of the expectant mother can positively impact the spatial ratios in the lesser pelvis, and how to support further progress in the event of non-progressive labour.

This article presents a comprehensive review of factors that increase the risk of malignancy in ultrasound findings of an endometrial polyp. We collected original studies, reviews, and meta-analyses that dealt with the topic of endometrial polyps and the risk of developing endometrial cancer. Each presumed risk factor was analysed individually. According to searched studies, abnormal uterine bleeding, old age, and body mass index are valid risk factors for developing endometrial cancer in endometrial polyps. Lynch syndrome patients are also in a high-risk group for endometrial cancer. On the other hand, the number of polyps, their size, diabetes mellitus, hypertension, and positive family history are factors with inconclusive results. There are either not enough data or different results among several studies.

Objective: To compare cervical stroma in advanced cervical cancer with the control group; to compare, in the pre-treatment period, hemogram parameters in patients with advanced cervical cancer with the same parameters as the control group; and to verify if there is an association of stromal markers with prognostic factors in cervical cancer.

Materials and methods: We prospectively evaluated 16 patients diagnosed with advanced invasive cervical cancer. A control group of 22 patients was used (uterine leiomyoma). Immunohistochemistry was performed to verify the stromal immunostaining of alpha-smooth muscle actin (SMA) and fibroblast activation protein alpha (FAP). Immunostainings and hemogram parameters were compared using Fisher's exact and Mann-Whitney Test, respectively.

Results: Strong FAP immunostaining was more frequent in patients with cervical cancer when compared with patients with leiomyoma (P = 0.0002). Regarding SMA, strong immunostaining was also found more in the group of cancer patients compared to the control group (P < 0.00001). The neutrophil-lymphocyte ratio (NLR) values were higher in the cancer patient group compared to the control group (P = 0.0019). There was no association of the parameters studied with prognostic factors.

Conclusions: Strong FAP and SMA immunostaining was found more in patients with cervical cancer when compared to the control group. NLR values were also higher in cervical cancer.

Abruptio placenta can be a catastrophic event with a high association with adverse maternal and fetal outcomes. We present a case of massive abruptio placenta occurring in a young asymptomatic mother at 30 weeks' gestation. Although electronic fetal monitoring and ultrasound allowed a prompt diagnosis of an 8 × 5 cm retroplacental hematoma, the fetus died at the time of emergency cesarean section. The fetus was intubated, but could not be resuscitated. Histologic examination of the placenta documented thinning and stacked hypercapillarized villi, with syncytial buds and foci of fibrinoid necrosis in the presence of hyaline streaks on both the maternal and fetal sides.

Objective: This paper aims to analyze the factors that can influence the method of childbirth in women with multiple pregnancies.

Materials and methods: Retrospective analysis of selected parameters in women with multiple pregnancies who gave birth at the 2nd Clinic of Gynecology and Obstetrics of the Faculty of Medicine (FM), Comenius University (CU) and University Hospital (UH) Bratislava in the years 2010-2022.

Results: Between 2010 and 2022, at the 2nd Clinic of Gynecology and Obstetrics of the FM CU and UH in Bratislava, 1.13% of births were multiple pregnancies. After statistical data processing, primiparity appeared statistically significant as a risk of acute caesarean section (C-section); multiparous women had a higher probability to give birth vaginally. Since 2017, the clinic has had a decreasing trend in the number of caesarean sections. Women with an acute caesarean section, in turn had on average a lower pH of both fetuses compared to vaginal delivery. However, the incidence of asphyxia in fetuses was not statistically significantly different. We found no risk factor increasing the likelihood of acute caesarean section for fetus B in twins.

Conclusion: Multiple pregnancy has a higher morbidity not only for the woman but also for the fetuses. The incidence of multiple pregnancies is influenced by assisted reproduction. Delivery method depends on various factors such as chorionicity, fetal presentation, and history of a previous caesarean section.

Background: Vaginal atresia (VA) is a rare female genital tract malformation characterized by the absence or incomplete development of the vagina, often leading to cyclic abdominal pain and menstrual blood retention in adolescent patients. Vaginal atresia is often accompanied by multiple organ malformations. The condition poses significant challenges in diagnosis and management, requiring a multidisciplinary approach.

Case description: Herein, we report a case of type I congenital VA in a 13-year-old female presenting with congenital biliary atresia and urinary system malformation. Upon initial evaluation, the patient exhibited VA incision and laparoscopic excision of a left ovarian cyst under general anesthesia. By the 2-month follow-up, the patient reported normal menstrual flow without accompanying abdominal pain.

Conclusion: This case underscores the complexity of type I congenital VA concurrent with multiple organ malformations. Timely identification and proper management strategies are crucial for securing the best possible patient outcomes. Further research is warranted to elucidate the underlying mechanisms and improve treatment modalities for such cases.

Objective: To compare the subjective and objective results of laparoscopic sacrocolpopexy (LSC) with and without the introduction of a vaginal packing one year after surgery. Methodology: This is a retrospective cohort study of 125 women after laparoscopic sacrocolpopexy operated on in 2013-2016 with complete annual follow-up. Patients with a total hysterectomy were excluded from the study. Basic patient characteristics, preoperative POP-Q and surgery data were collected. The subjective outcome of the surgery was assessed using the PGI-I (patient global impression of improvement). The anatomic outcome of the surgery was evaluated using the composite definition of surgical failure based on POP-Q (Ba ≥ -1, C ≥ -3, Bp ≥ -1). Patients were divided into two groups according to whether or not they had vaginal packing after surgery. Statistical analysis was performed using c2, Wilcoxon and Fischer test according to the distribution of normality. Results: A total of 125 women were enrolled in the study; 48 (38.4%) after LSC, 58 (46.4%) with concomitant supracervical hysterectomy and 19 (15.2%) after sacrohysterocolpopexy. Vaginal packing was introduced for 24-48 hours after surgery in 86 (68.8%) women. The groups did not differ in age, body mass index, smoking or preoperative pelvic organ prolapse quantification system. We did not observe statistically significant differences in PGI-I first year after surgery. The difference in anatomic surgical failure did not reach statistical significance, although more failures were observed in the group without packing (12.8 vs. 3.5%; P = 0.09). The mean C-point value one year after surgery was lower in the non-tamponade group (-7 vs. -7.5; P < 0.009). No mesh extrusion or serious complications were recorded in the monitored group. Conclusion: Vaginal packing after LSC probably does not affect patient satisfaction after surgery, however, it may be associated with better anatomical outcome one year after the surgery. The results of the study must be confirmed by a more detailed prospective evaluation.