Ginekologia polska最新文献

Objectives: The aim was to construct a reliable working model for patients with placenta previa (PP) that aids in the prediction of postpartum bleeding potential with data from antenatal imaging studies using both ultrasound (US) and magnetic resonance imaging (MRI).

Material and methods: Forty-three patients with PP were evaluated initially with the US and then by 3-Tesla MRI. The Placenta Accreata Index (PAI) was used during the US evaluation in order to define the risks. Uterine bulging, heterogeneous signal, dark placental bands, focal interruption of myometrium and tenting of bladder wall were regarded as predictive criteria in MRI evaluation. The correlation between the findings from US and MRI studies and subsequent haemorrhage, < 1000 mL, > 1000 mL and severe haemorrhage (> 2000 mL) and massive transfusion [> 5 units of red blood cells (RBC)] were used to build this predictive model. The findings from the imaging studies were also confirmed histopathologically.

Results: In the multivariate analysis of data from patients stratified by bleed size either < 1000 mL or > 1000 mL, none of the MRI and ultrasound findings were found to be predictive. The multivariate analysis was done using the second stratification cut-point of 2000 mL, in patients bleeding > 2000 mL PAI values [OR: 2.3 (1.4-3.8)] and overall MRI reported placenta accreata spectrum [OR: 4.9 (1.8-12.9)] were found to be predictive. While MRI findings were not discriminative between transfusion groups, grade 3 loculation on US examination was found to be predictive for the need of transfusion of > 5 units [OR: 67.5 (8.2-549.4)]. There were no cases needing hysterectomy.

Conclusions: Ultrasound and MRI findings in cases of PP can be helpful in predicting postpartum bleeding.

Objectives: The purpose of this study was to assess and compare the knowledge, attitudes, and practices of Polish midwives and obstetricians concerning external cephalic version (ECV), with particular attention to how professional qualifications, experience, and the reference level of the healthcare facility influenced these factors across both groups.

Material and methods: An author-created, 22-question online survey was distributed separately to midwives and obstetricians, with each group receiving a questionnaire customized to assess their specific knowledge of ECV, professional experience, and attitudes toward the procedure.

Results: The study included 839 participants: 378 midwives and 461 physicians. Knowledge and experience with ECV varied significantly based on work experience and the reference level of the workplace. When comparing the results between midwives and obstetricians, the median (Q1-Q3) score for correct answers on ECV was highest among obstetrics and gynecology residents (5, 3-6), while the lowest scores were seen among midwives with bachelor's degrees (2, 1-4).

Conclusions: The study identified significant considerable knowledge gaps regarding ECV, particularly among midwives. Educational initiatives targeting both midwives and obstetricians are recommended to encourage the greater use of ECV and potentially reduce the rates of elective cesarean sections in cases of non-cephalic fetal presentations.

Objectives: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age, often associated with metabolic alterations. This study assessed serum levels of adipsin, irisin, and osteopontin in patients with PCOS and examined their correlations with metabolic parameters.

Material and methods: A case-control study was conducted involving 96 women with PCOS and 80 healthy controls. Serum levels of adipsin, irisin, and osteopontin were measured; demographic, clinical, and metabolic characteristics were evaluated.

Results: Patients with PCOS were significantly younger than controls (p < 0.001). The PCOS group included a significantly greater proportion of obese individuals (p = 0.013). Patients with PCOS exhibited elevated serum adipsin (p = 0.020) and reduced osteopontin (p < 0.001) levels relative to controls; obesity and age influenced these differences. Osteopontin demonstrated superior predictive power for PCOS diagnosis [area under the curve (AUC) = 0.802] compared with adipsin (AUC = 0.602). A combination of osteopontin and adipsin yielded the highest predictive value (AUC = 0.817) among double or triple biomarker combinations.

Conclusions: This study identified potential associations among adipsin, osteopontin, irisin, and PCOS. Further research is warranted to elucidate their roles and clinical implications in PCOS and its metabolic alterations. The findings highlight the impact of age and obesity on these biomarkers and their relationships with PCOS, providing insight into the syndrome's complex pathophysiology.

Introduction: The most prevalent condition affecting the metabolism of carbohydrates during pregnancy is gestational diabetes mellitus (GDM). Continuous glycemia monitoring systems that use sensors are currently replacing the conventional self-monitoring of glycemia with a glucometer. Poland's insurance coverage has made new technologies possible for continuous glycemia monitoring. Our retrospective study compared the effects of two glycemic measurement techniques on patient preferences and maternal and pediatric clinical outcomes: traditional methods using a glucometer and utilizing a sensor for scanning continuous glycemic monitoring (Flash Glucose Monitoring, or FGM).

Material and methods: In a retrospective analysis of 277 women with GDM treated in the Department of Metabolic Diseases, University Hospital in Cracow, Poland, in January 2023 we compared the effectiveness of using of sensor FreeStyle Libra (FGM) vs self-blood glucose monitoring (SBGM) by glucometer in improving clinical maternal outcomes measured by daily insulin dose, body weight gain, mean blood glucose and newborns outcomes assessed by body weight, APGAR score, caesarean sections.

Results: We examined 224 women from the SBGM (self-blood glucose monitoring) group, 53 from the FGM group, and 277 from the GDM ladies. The SBGM group was diagnosed with GDM later in pregnancy [24 (10-25) vs 11 (8-23.5) weeks; p < 0.001], was admitted at the first pregnancy visit [26 (14-29) vs 20 (12-27) weeks; p = 0.001], and was slightly older [33 (30-36) vs 32 (29-34) years; p = 0,027]. The pre-pregnancy body weight [70 (60-83) vs 67 (59-79) kg; p = 0.358] and the number of pregnancies [2 (1-3) vs 2 (1-3); p = 0.118] did not differ between the two groups. Women who used SMGB gained less weight throughout pregnancy [10 (5.5-13.0) vs 12 (8-14.8) kg; p = 0.0333] and had fewer prenatal checkups [5 (4-7) vs 8 (5-9) weeks; p < 0.001], including fewer teleconsultations [1 (0-3)]. Women in the FGM group received insulin treatment earlier [15 (11.5-27) vs 27 (16-30) week of pregnancy; p < 0,001] and used it more often [52 (98.1%) vs 183 (81.3%); p = 0.005]. There was no significant difference in daily insulin dose per kg of weight [26.5 (11.5-39.2) vs 21 (9-39) U/d; p = 0.325]. The groups did not differ in birth weight [SBGM 3243 +/- 485 vs FGM 3331 +/- 359 g; p = 0.206] and a gestational week at delivery [38 (38-39) vs 39 (38-39) week; p = 0.092], There was no difference in obstetric outcomes: caesarean sections, preterm births, week of delivery, mean birth weight or prevalence of perinatal complications.

Conclusions: When comparing traditional SBGM to flash continuous glucose monitoring in this real-world observation, we have found no changes in the outcomes for mothers and newborns between the groups. There were more teleconsultations for women who used FCGM.

Objectives: To investigate the effects of gestational diabetes mellitus (GDM) with different birth weights on neonatal genetic metabolism.

Material and methods: 1252 patients with GDM diagnosed at Changzhou Maternal and Child Health Care Hospital from 2017 to 2021 were categorized into three groups: fetal growth restriction (G1), normal birth weight (G2), and macrosomia (G3). The levels of amino acids, free carnitine (CO) and acylcarnitine in neonates were detected using tandem mass spectrometry.

Results: There were no differences in age, height, predelivery weight or gravida across groups. G3 had the highest parity and fasting blood glucose levels (p < 0.0001). G1 exhibited the highest rates of cesarean section, neonatal asphyxia, and insulin utilization (p < 0.0001). Neonatal genetic metabolism analysis revealed that in G1 citrulline levels were the highest, with significantly elevated levels of leucineornithine and valine (p < 0.001). CO was also the highest (p < 0.001). The levels of isovalerylcarnitine, octanoylcarnitine and 18-carbodienoylcarnitine increased, while malonylcarnitine/3-hydroxy-butyrylcarnitine, hexadecanoylcarnitine, hexadecenoylcarnitine, 3-hydroxy-hexadecenoylcarnitine and 3-hydroxy-hexadecanoylcarnitine decreased (p < 0.05). In G2, methionine levels decreased (p < 0.001), whereas decenoylcarnitine, dodecanoylcarnitine, dodecenoylcarnitine and myristoylcarnitine levels increased (p < 0.001). In G3, proline decreased significantly (p < 0.001), and CO was the lowest (p < 0.001). Propionylcarnitine and octenoylcarnitine levels increased, whereas butyrylcarnitine decreased (p < 0.05).

Conclusions: Gestational diabetes mellitus with different birth weights influences neonatal genetic metabolism in distinct ways. Therefore, neonatal screening for inherited metabolic disorders provides insights into the metabolic levels of offspring of patients with GDM in early life.

Objectives: Turner syndrome (TS) is associated with ovarian dysgenesis leading to infertility in most of the cases. There are some options for fertility preservation (FP) in patients with sufficient follicle numbers. The most recently studied are oocyte and ovarian tissue preservation. Due to premature ovarian failure among TS girls, the procedure should be performed as early as possible. The aim of this study is to gain the opinions of women with TS about motherhood based on the web-survey.

Material and methods: The survey, hosted on SurveyMonkey.com, targeted women over 18 years with TS. It comprised 16 single-choice questions, ensuring anonymity and consent for data usage.

Results: The answers of a total of 152 women were analyzed. When asked if they had discussed motherhood options with their physicians, 72/152 of the participants responded negatively. Asked about the desire of maternity, 85/152 expressed a desire to have children. 5/152 had biological children from spontaneous pregnancies, 5/152 had biological children through oocyte donation, 1/152 through embryo donation, and 12/152 had adopted children. 75/150 respondents answered yes to the question of whether they desired to use ovarian tissues if they had been preserved during adolescence.

Conclusions: The findings suggest that a significant number of women with TS who aspire to become mothers would be inclined to use preserved cells if this option were available. This underscores the necessity for further exploration of FP techniques for individuals with TS.

Objectives: This study aimed to summarize nonpharmacological mental health interventions that are beneficial for adolescent patients with polycystic ovary syndrome (PCOS) and to identify the limitations of existing studies.

Material and methods: Following the recommendations of the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-SCR), we conducted a scoping review of nonpharmacological interventions aimed at improving mental health in adolescents with PCOS.

Results: Six randomized controlled trials (RCTs), two quasiexperimental studies, two case reports, one prospective study, one predictive correlation study, and one field trial study were included, resulting in 13 articles. Nonpharmacological interventions encompass a range of psychotherapies, dietary modifications, physical exercise, and traditional Chinese medicine therapies. Except for one study that has not yet reported findings, all included studies reported significant improvements in patients' mental health through nonpharmacological interventions.

Conclusions: The evidence summarized in this study suggests that nonpharmacological interventions may be efficacious in improving the mental well-being of adolescent patients with PCOS. However, existing studies have limitations, including small sample sizes, the limited use of outcome indicators, and a lack of postintervention follow-up evaluations. Therefore, further RCTs should be conducted to validate the effectiveness and safety of current or alternative nonpharmacological interventions.

Objectives: The present meta-analysis evaluated the value of miRNAs in the diagnosis of gestational diabetes mellitus (GDM).

Material and methods: Eligible studies were gathered from MEDLINE, EMBASE, PubMed, Chinese National Knowledge Infrastructure (CNKI), WanFang, and CQVIP information databases. Combined sensitivity, specificity, and summary receiver operating characteristic (SROC) curves of enrolled studies were analyzed using STATA 12.0. Diagnostic accuracy was examined by diagnostic likelihood ratio (DLR), diagnostic score, and diagnostic odds ratio (DOR). Publication bias was calculated using Deeks' funnel plot.

Results: 18 articles (29 studies) were included in this meta-analysis. The pooled sensitivity of overall miRNAs was 0.83 (95% CI = 0.77-0.88), and the specificity was 0.79 (95% CI = 0.72-0.84). The area under SROC curve (AUC) was 0.88 (95% CI = 0.85-0.90). The positive DLR was 3.94 (95% CI = 2.98-5.21), and the negative DLR was 0.22 (95% CI = 0.16-0.30). The diagnostic score was 2.91 (95% CI = 2.44-3.37), and the DOR was 18.27 (95% CI = 11.44-29.17). These results suggest that miRNAs have high diagnostic accuracy for GDM. High heterogeneity may be caused by study design, gestational age, and cutoff value. Subgroup analysis indicates that sensitivity and specificity are higher in case-control studies than in cohort studies. Specificity differs significantly in the cutoff value subgroup.

Conclusions: Overall, miRNAs showed high accuracy in diagnosing of metabolic changes in GDM patients. High heterogeneity may be caused by study design, sampling gestational age, and cutoff value.

Introduction: Placenta increta is a serious complication of pregnancy that needs a variety of intraoperative hemostatic methods to stop bleeding. However, the efficacy of different hemostatic methods is still not known. This study aimed to evaluate the efficacy of different hemostatic methods in placenta increta.

Material and methods: A total of 187 placenta increta patients that underwent treatment at Xiangya Hospital Central South University from March 1, 2017 to January 31, 2021 were included in this retrospective study. Perioperative data of patients with placenta increta were retrospectively analyzed. The patients were distributed into two groups according to the hemostasis methods, namely permanent group (n = 29), permanent plus temporary group (n = 158). Permanent hemostasis included the subgroups of uterine hemostasis (e.g., uterine tamponade, B-Lynch suture, and uterine local suture) and vascular hemostasis (e.g., uterine artery ligation and internal iliac artery ligation). The clinical information and maternal-fetal outcomes of the groups and subgroups were analyzed.

Results: A significant difference in blood loss was detected between the permanent hemostasis group and the permanent plus temporary hemostasis group. Compared with the uterine hemostatic, the vascular, and combined hemostatic methods had a significant reduction in postpartum blood loss (p < 0.05). No differences were found within these subgroups in the permanent plus temporary group. Pregnancy outcomes did not differ significantly among the subgroups.

Conclusions: Vascular hemostasis and combined hemostasis may be better than uterine hemostasis alone for placenta increta without temporary hemostasis. Prospective and large-scale studies are needed to investigate long-term outcomes and confirm the efficacy of these hemostatic techniques.

Objectives: A causal relationship has been found between the abundance of some flora in the gut microbiota and the development of pre-eclampsia (PE). Short-chain fatty acids in gut microbes are an important source of lipids. The causal effect of lipid metabolism/fatty acid metabolism pathways on PE exposure is unknown.

Material and methods: This study was based on single nucleotide polymorphism (SNP) data related to lipid metabolism/fatty acid metabolism and PE from the genome-wide association study (GWAS) in the GWAS Catalog database and finngen database, and a two-sample mendelian randomization (MD) analysis was performed to explore the causal relationship between lipid/fatty acid metabolism and PE exposure. Five MD analysis methods were used in this study, inverse-variance weighted (IVW), MR-Egger regression, weighted median (WM), weighted median estimator (WME), MR-PRESSO. The intercept term of MR-Egger regression was tested for the presence of genetic pleiotropy between SNPs and PEs. Cochran's Q test was performed to investigate the heterogeneity between variables. The leave-one-out method was used for sensitivity analysis to determine the robustness of the results.

Results: Inverse-variance weighted results showed that gamma-glutamyl glutamine levels [odds ratio (OR) = 0.40, 95% confidence interval (CI): 0.21-0.78; p = 0.01], 1-arachidonoylglycerophosphocholine [1-arachidonoyl-sn-glycero-3-phosphocholine levels (OR = 0.57; 95% CI: 0.38-0.87; p = 0.01), X-14304--leucylalanine levels (OR = 0.72; 95% CI :0.56-0.93; p = 0.01), citrulline levels (OR = 0.48; 95% CI: 0.26-0.89; p = 0.02), inosine levels (OR = 0.88; 95% CI: 0.78-0.98; p = 0.02), and HWESASXX levels (OR = 0.64; 95% CI: 0.42-1.00; p = 0.05) were negatively correlated with PE. There was a positive trend for X-14205--alpha-glutamyltyrosine levels (OR = 1.55; 95% CI: 1.12-2.14; p = 0.01), X-11787 levels (OR = 3.29; 95% CI: 1.23-8.78; p = 0.02) to be associated with PE. No significant heterogeneity or pleiotropy was found for instrumental variables or levels pleiotropy.

Conclusions: This study demonstrated a causal relationship between eight fatty acid metabolisms and PE. Follow-up in-depth randomized controlled trials are needed to reveal the promotional or protective effects of fatty acid metabolism on PE.