Ginekologia polska最新文献

Objectives: Inhibition of estradiol production by letrozole may interfere with physiological effects of progesterone necessary to maintain the pregnancy. Treatment of tubal pregnancy (TP) with letrozole would allow to avoid the disadvantages of methotrexate (MTX). The aim was to compare the effectiveness of letrozole with MTX in the management of TP.

Material and methods: A prospective open-label cohort study was conducted among women with TP and increasing B-human chorionic gonadotropin (B-hCG) concentrations. MTX was administered in a single dose of 100 mg intravenously, while letrozole in a dose of 5 mg orally for 10 days. Blood parameters (B-hCG, hemoglobin, creatinine, urea, transaminases, bilirubin) were tested on days 0, 4 and 7.

Results: Out of 22 eligible women, 14 received MTX and received 8 letrozole. Mean age, lesion diameter, gestation age in the MTX vs letrozole arm were: 31 vs 32 years (p = 0.3), 13.2 vs 16.3 mm (p = 0.1), 7 + 1 vs 7 + 0 weeks (p = 0.6), respectively. In case of 4 women treated with letrozole and in 2 treated with MTX (4/8, 50% vs 2/14, 14.3%, p = 0.07) the treatment was unsuccessful. There were no significant differences in blood parameters on days 0, 4 and 7 between both arms, except for the increasing urea concentration in the letrozole arm (p = 0.01).

Conclusions: Even though the results did not reach statistical significance, it is likely that a larger study sample would confirm the trend of letrozole being less effective. The results did not support the use of letrozole in the studied regimen as an alternative to MTX.

Objectives: The aim of this study was to investigate the prevalence of Group B Streptococcus (GBS) colonization in pregnancies between 35 and 37 weeks of gestation and to compare the effectiveness of polymerase chain reaction (PCR) method with gold standard technique of culture in antenatal GBS screening.

Material and methods: Vaginal and rectal swabs of a total of 106 pregnant women between 35th and 37th weeks of gestation, who were admitted to our clinic between January 2022 and August 2022, were evaluated using culture and PCR method. The prevalence of GBS was estimated. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the PCR method were analyzed.

Results: The prevalence of GBS was 10.4% and 21.69% using the culture and PCR method, respectively. Compared to the culture, the sensitivity, specificity, PPV, NPV and accuracy of PCR were found to be 100%, 87%, 47%, 100%, and 88%, respectively.

Conclusions: This study results suggest that the PCR method is a simple, effective and fast method with high sensitivity, specificity, PPV, and NPV in antenatal GBS screening.

Objectives: Free-of-charge vaccination against human papillomavirus (HPV-) of 12-13-year-old teenagers was introduced on the 1st of June 2023 in Poland. Data on baseline HPV- genotype cervical distribution are crucial to evaluate potential changes after full implementation of the vaccination program. We aimed at evaluating the status of HPV- infection and distribution of HPV- genotypes in cervical cytology of gynecological patients tested in one of the largest HPV- laboratories in Poland.

Material and methods: Data on all HPV- tests performed in ALAB Laboratoria Sp. z o. o. in Poland in 2018-2021 were analyzed, focusing on tests that identified genotypes: 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 70, 73, 81, 82, 83, 89. Distribution of HPV- genotypes was assessed among HPV--positive women.

Results: Among 11.151 medical records retrieved in women with valid HPV- test results, 5.681 were positive (50.9%), of whom 2.929 were infected with a single genotype (51.6%). At least one high-risk (HR) genotype was detected in 4.351 women (76.6%). Among all HPV--positive women, the most common HR genotypes were HPV--16, HPV--31 and HPV--66 (24.0%, 11.3%, 11.3%, respectively). HPV--53 was the most prevalent among non-HR types (10.5%).

Conclusions: HPV--16 followed by HPV--31 and HPV--66 were the most frequent genotypes in the studied cohort. These results may be compared with the same methodology after full roll-out of HPV- vaccination program in the future to track potential changes in HPV- genotype distribution.

This study reported the diagnosis, treatment and perinatal outcome of a novel coronavirus infection patient at 29+6 weeks pregnancy. The patient case came to the hospital with persistent fever and cough for 6 days. Patient's chest CT diagnosis showed double pneumonia, and viral infection was considered. Blood gas analysis revealed type I respiratory failure, and a throat swab nucleic acid test confirmed the novel coronavirus infection (critical type). After 13 days of isolation and supportive treatment, the patient recovered and was discharged from hospital after two consecutive negative nucleic acid tests. After discharge, the patient delivered a baby girl successfully by cesarean section on March 16, 2023. The newborn weighing 2050 g, with an Apgar score of 9-10 points /1-5 minutes. The newborn was transferred to the neonatology department for hospitalization and discharged 10 days later. The patient and her baby were followed up for nearly 1 year. Both mother and daughter were in good health.

Objectives: The integration of high-risk human papillomavirus (HPV) detection into cervical cancer screening in Poland aims to improve early detection, yet challenges in coverage and adherence persist. Innovative approaches, like sampling for HPV testing and cytology outside medical settings, have been proposed. This study assesses the feasibility and agreement of results between traditional and novel sampling methods.

Material and methods: A cohort of 50 women aged 25-74 underwent HPV DNA and liquid-based cytology sampling both in-office using standard method and outside the medical setting by trained personnel. Samples were analyzed for HPV DNA using Real-Time PCR and cytology according to the Bethesda System.

Results: Cytology and HPV DNA positivity rates showed substantial agreement between methods, with almost perfect agreement for high-risk HPV types. Visual assessment of the cervix was successfully conducted in all cases. Preliminary results suggest remote sampling for HPV DNA and cytology is a viable alternative to traditional methods, with the effectiveness in detecting HPV and cytological abnormalities comparable to this reported in literature, offering potential benefits for individuals with mobility limitations or logistical barriers to attending medical appointments.

Conclusions: The study highlights the potential role of remote sampling for HPV DNA and cytology in enhancing cervical cancer screening accessibility and adherence. Implementation of such methods could improve coverage, particularly among underserved populations. Further research is needed to validate and optimize these approaches for broader clinical use.

Objectives: This study investigates the relationship between pre-pregnancy body mass index (BMI), BMI before labor, and weight gain during pregnancy with the incidence of cesarean delivery (CD) in dinoprostone-induced labor versus spontaneous labor.

Material and methods: This retrospective analysis was carried out at the Jagiellonian University Hospital's Obstetrics and Perinatology Department, encompassing term singleton pregnancies from May 2019 to February 2021. BMI was categorized following WHO guidelines. Gestational weight gain was assessed against the Institute of Medicine's 2009 recommendations.

Results: Of the 366 cases reviewed, 183 were in the dinoprostone-induced labor group, and 183 were in the spontaneous labor group. The study identified a significant association between higher pre-pregnancy BMI and increased weight gain during pregnancy with elevated CD rates, especially in dinoprostone-induced labor compared to spontaneous labor. Specifically, the dinoprostone-induced labor group showed a 33.9% CD rate compared to 16.9% in the spontaneous labor group. Logistic regression analysis further established that for each 1 kg/m² increase in pre-pregnancy BMI, the odds of undergoing a CD increased by 10%.

Conclusions: Elevated pre-pregnancy BMI and excessive gestational weight gain significantly heighten the risk of cesarean delivery, particularly in induced labor. The findings underline the need for individualized labor management strategies for women with higher BMI to optimize maternal and neonatal outcomes.

Objectives: During the life cycle of a woman, pregnancy is the period when she is most open to changing her behaviour and lifestyle for the benefit of the child's development. Lifestyle changes include also the diet correction. The objective of the study was to assess, through identified dietary patterns, the diets of women in the second and third trimester of pregnancy in relation to their nutritional status before and during pregnancy.

Material and methods: The study was conducted among pregnant women, participants of childbirth education classes at the Institute of Mother and Child, based on food frequency questionnaire. The study involved 392 women in the age 19-40 years (first single pregnancy without complications). Dietary patterns were identified using the k-means method, based on groups of products.

Results: Three dietary patters were identified in the study group of women: dietary pattern 1 - cereal-milk diet, dietary pattern 2 - vegetable-fruit diet and dietary pattern 3 - cottage cheese-vegetable diet. Dietary pattern 3 occurred in 43.9% of underweight women, in 45.5% of women with normal weight and in 43.1% of women with excess body weight. Dietary pattern 1 occurred in about one third of women and dietary pattern 2 in about 20% in each group. A greater diversity in the frequency of identified dietary patterns was observed in relation to weight gain during pregnancy. The identified dietary patterns differed significantly in terms of the profile of macronutrients, most minerals and vitamins - E, C and B group vitamins.

Conclusions: The identified dietary patterns and their energy and nutritional profile indicate the need for monitoring the diets and nutritional education of pregnant women.

Objectives: Pregnancy is a special time that brings both joy and challenges. Among these challenges, anxiety and stress are emotions that can affect the mental wellbeing of the pregnant woman as well as the developing baby.

Material and methods: In response to these challenges, we present the Pregnancy Anxiety and Stress Rating Scale (PASRS), an innovative tool that aims to identify and assess anxiety and stress levels among pregnant women.

Results: The PASRS contains 15 questions that are more comprehensive and cover various aspects of pregnancy, including the health of the baby, the health of the mother, body changes, finances and social support.

Conclusions: In an era where mental health is just as important as physical health, SOLiSC is a step forward in recognising and addressing the unique mental challenges that pregnant women may face.

Objectives: To estimate the prevalence of UI and POP after hysterectomy for benign disease and gynecologic malignancy. This is a retrospective cohort chart review study. Two major urban tertiary care centers between 2006-2010. Women ≥ 18 years undergoing hysterectomy for benign or malignant indications.

Material and methods: Presence of UI and POP was based on patient report in clinic notes, ICD-9 UI and POP diagnosis codes, and CPT codes for treatment. Prevalence of UI and POP after hysterectomy and time to development of UI and POP after hysterectomy.

Results: 1363 (55%) women underwent hysterectomy for benign disease while 1107 (45%) had a hysterectomy for malignancy. Postoperative prevalence of UI and POP in the benign versus the malignant group was 15.1% vs 11.1% (p = 0.001), and 12.1% vs 2.8%, (p < 0.001), respectively. The median time to development of UI in the subset of patients without preoperative UI was 3.5 years in the benign group vs 3 years in the malignant group (p < 0.001). The median time to development of POP in the subset of patients without preoperative POP was 5 years in the benign group and 3.5 years in the malignant group (p < 0.001). There was no significant difference in the risk of developing UI or POP between groups after adjusting for confounders or when accounting for pre-hysterectomy UI or POP.

Conclusions: When pre-hysterectomy UI or POP is taken into consideration, there is no difference in the prevalence of post-hysterectomy UI or POP.

Objectives: This study aims to elucidate the expression patterns of LGALS1 (galectin-1) and LGALS9 (galectin-9) genes in placental tissues of pregnancies affected by preterm prelabor rupture of membranes (PPROM). The overarching goal is to understand the potential roles of these galectins in the pathophysiology of PPROM, particularly in maternal-fetal immune tolerance and placental development.

Material and methods: Conducted as a prospective, single-center study at the Gynecology and Obstetrics Clinical Hospital in Poznan, Poland, from June 2021 to May 2023, the research involved 25 participants, including 12 with PPROM and 13 healthy controls. Placental tissues were obtained, and RNA extraction was performed. Galectin gene expression (LGALS1 and LGALS9) was analyzed using quantitative real-time PCR. Demographic and clinical data were collected, and statistical analyses were employed to assess correlations between galectin expression and clinical parameters.

Results: While significant differences were observed in gestational age at delivery and birth weight between the PPROM and control groups, the expression levels of LGALS1 and LGALS9 did not show statistically significant variations. Correlation analyses revealed no significant associations between galectin expression and various clinical parameters.

Conclusions: Contrary to the hypothesis, this study did not identify significant alterations in galectin-1 and galectin-9 expression in placentas affected by PPROM. Despite the limitations of a small sample size, these findings provide initial insights into the potential roles of galectins in PPROM. Further research on larger cohorts is warranted to comprehensively understand the implications of galectin involvement in the pathophysiology of PPROM.