Ginekologia polska最新文献

Objectives: To compare the effects of using 11 mm trocar and 5 mm trocar as primary ports on postoperative pain in benign gynecological laparoscopic surgeries.

Material and methods: The patients were divided into two groups as the primary port, group I (5 mm trocar) and group II (11 mm trocar) by block randomization.

Results: In the 5 mm trocar group, postoperative pain score and need for analgesia were less in level I and level II operations. Patient satisfaction was significantly higher in the 5 mm trocar group. The postoperative pain score was higher in patients who had trocar insertion attempts 3 times with the direct trocar method compared to patients with 1 or 2 trocar entry attempts.

Conclusions: The use of a 5 mm laparoscope in benign gynecological operations is an advantageous method due to low postoperative pain score, analgesic requirement, and high patient satisfaction.

Objectives: To evaluate and compare the treatment results of folinic acid (FA) and folic acid (F) added to the chemotherapy protocol to reduce the toxicity due to methotrexate (MTX) in the treatment of low-risk gestational trophoblastic neoplasia (GTN) patients.

Material and methods: Patients treated for low-risk GTN at two reference centers between January 2000 and March 2023 were included in this retrospective study. Patients were divided into two groups, MTX/FA and MTX/F. Both groups received 50 mg/day MTX on days 1, 3, 5, 7 of treatment. On days 2, 4, 6, 8 of treatment 0.1 mg/kg folinic acid was administered to the MTX/FA group, and 20 mg/day folic acid was administered to the MTX/F group to reduce MTX toxicity. The groups were compared according to treatment success, resistance, and the development of toxicity.

Results: Among 102 low-risk GTN patients included in the study, 64.7% (n = 66) were in the MTX/FA, while the remaining 35.3% (n = 36) were in the MTX/F group. There was no significant difference between MTX/FA and MTX/F groups regarding treatment success, resistance, and toxicity rates (84.8%, 13.6%, 1.6% vs 83.3%, 13.8%, 2.7%), respectively.

Conclusions: Replacement of folinic acid with folic acid in low-risk GTN patients to reduce the toxicity that may develop associated with MTX treatment resulted in similar treatment success rates. Still, no significant change was observed regarding toxicity and resistance. There is a need for comprehensive prospective studies to further elucidate this relationship.

Hernia is a well-known problem by almost every surgeon, often showing symptoms during pregnancy. There are a lot of discussions regarding the tactics of treating hernias in pregnancy. For this purpose, we made a detailed review of the literature data in PubMed, Web of Science, Scopus, as well as an additional article found in the references of each reviewed article and analysed it synthesized to give a guideline for fast and correct treatment. The approach is strictly individualized and depends on two main and important factors: the state of emergency and the gestational week of the pregnancy.

Objectives: This study aimed to identify the effects of acute aerobic exercise combined with resistance exercise on maternal glucose metabolism and sympathetic nervous system-regulated cardiovascular function in overweight or obese pregnancies.

Material and methods: We conducted a randomized controlled trial of aerobic exercise combined with resistance training (aerobic + resistance; n = 25) compared with aerobic exercise (aerobic, n = 21) beginning at 16 wk and continuing until 36 wk of gestation in overweight or obese pregnant women. At preintervention and postintervention assessments, the glycometabolism, muscle sympathetic nervous system activity (MSNA) and cardiovascular parameters were measured and analyzed, containing fasting blood glucose (FBG), fasting blood insulin (FBI), 2 h glucose, glycosylated hemoglobin (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), MSNA bursts/min, MSNA bursts/100 heartbeats, resting heart rate (HR); diastolic blood pressure (DBP), mean arterial pressure (MAP), systolic blood pressure (SBP), cardiac index (CI), cardiac output (CO), stroke volume (SV), total peripheral resistance (TPR) and total peripheral resistance index (TPRI).

Results: Compared to aerobic group, the overweight or obese pregnant women in aerobic + resistance group showed lower FBG, FBI, 2 h glucose, HbA1c and HOMA-IR (p < 0.05). Moreover, both MSNA bursts/min and MSNA burst/100 heartbeats level were reduced in aerobic + resistance group compared to aerobic group (p < 0.0001). Finally, the resting HR, DBP, SBP, MAP, CI, CO and TPRI were significantly decreased in aerobic + resistance group compared to aerobic group (p < 0.05).

Conclusions: In summary, aerobic exercise combined with resistance training was associated with improved glycometabolism, MSNA and cardiovascular function in overweight or obese pregnant women compared to aerobic exercise alone.

Objectives: Cardiotocography (KTG) is widely used for continuous or intermittent assessment of fetal heart function. This study aimed to compare the effects of continuous and intermittent KTG during labour on selected variables.

Material and methods: In a retrospective study, 4172 medical records of Warsaw Hospital (Poland) patients were analysed. The study group consisted of 2111 women with continuous KTG during labour and the control group of 2061 women with periodic KTG. The median age of the women was 30 years, and the median gestation period was 40 Hbd. Most of the women lived in urban areas (87.15%), were in a relationship (82.05%) and had a higher education (86.60%).

Results: In the group with intermittent OCT, delivery by caesarean section was indistinguishably more frequent (OR = 1.06; 95% CI = 0.87-1.30), there were significantly fewer grade II perineal ruptures (OR = 1.65, 95% CI = 1.07-2.55), grade III- and IV perineal ruptures (OR = 5.13, 95% CI = 1.12-23.53) and oxygen therapy (OR = 1.76, p = 0.004). More infants with Apgar scores ≤ 7 points at the fifth minute (OR = 0.34, 95% CI = 0.12-0.094), requiring nCPAP (Nasal Continuous Positive Airway Pressure) (OR = 0.56, 95% CI = 0.39-0.86) and resuscitation [OR = 0.37, 95% CI = 0.17-0.79]) were born in the group with periodic ECG. The analysis showed that the group of women with continuous OCT during labour had a lower risk of acid-base disorders (OR = 0.45, 95% CI = 0.21-0.98) CONCLUSIONS: Continuous KTG during labour in high-risk women increases the likelihood of instrumental delivery (using vacuum) and perineal incision compared with periodic KTG. The use of intermittent ECG during labour reduces the number of newborns with Apgar scores ≤ 7 points and decreases the number of neonatal interventions such as nCPAP and resuscitation.

Objectives: To evaluate relationship between sFlt-1/PlGF ratio, clinical characteristics and outcomes of pre-eclampsia.

Material and methods: Retrospective analysis of 29 pregnant women with pre-eclampsia who had measured sFlt-1/PlGF ratio was conducted using electronic medical records from Obstetrics and Perinatology ward of University Hospital in Cracow.

Results: Women median age: 33.5 years, number of pregnancies: one 52%, two 15%, three 18%,more than three 15%, number of deliveries: one 59.3%, two 37%, three 3.7%, median body mass index during hospitalization: 29.4 kg/m². Chronic diseases apart from hypertension: 67% of women (diabetes 37%, hypothyroidism 26%, obesity 11%). Median newborns birth weight: 1640 g, median Apgar score at 5 minutes: 8, median umbilical cord blood pH: 7.32. Fetal growth restriction: 28.6% of cases. All deliveries were by c-section. Median gestational age at delivery: 32 weeks. sFlt-1/PlGF ratio was inversely correlated with gestational age at delivery (r = -0.42, p = 0.02). The median sFlt-1/PlGF ratio was higher in women with severe pre-eclampsia (n = 15) than in those with mild pre-eclampsia (n = 14) (211 vs. 57, p < 0.001). sFlt-1/PlGF ratio of > 85 had a sensitivity of 80% and a specificity of 71% for predicting severe pre-eclampsia.

Conclusions: sFlt-1/PlGF ratio is useful in assessing the severity and prognosis of pre-eclampsia. sFlt-1/PlGF ratio should not be used as a sole criterion for making clinical decisions, but as an adjunct to other clinical and laboratory parameters.

Anti-Müllerian hormone (AMH), also known as Müller duct inhibitory factor and primarily known for its role in sexual differentiation. In female fetuses, AMH production by granulosa cells begins around the 36th week of gestation and continues in women until menopause. It is becoming more significant in the endocrine and gynecological diagnosis of adult women. The suppressive effect of AMH on follicle-stimulating hormone (FSH)-induced aromatase production likely plays a role in hyperandrogenism in polycystic ovary syndrome (PCOS) and may increase insulin resistance. Female adolescent with type 1 diabetes (T1D) have an increased likelihood of developing PCOS, but it is not known whether they also show elevated AMH levels. The elevated AMH levels observed in prepubertal girls with T1D suggest that there are more small follicles in their ovaries, probably in response to insulin treatment. Elevated levels of androgens and anti-Müllerian hormone have been previously reported in non-pregnant women with diabetes. The increased AMH concentrations can be associated with reduced systemic inflammation [lower c-reactive protein (CRP) values], irrespective of the type of diet and greater insulin sensitivity in old obese males. AMH can also serve as a valuable marker for granulosa cell tumors (folliculomas) and their recurrence. In these clinical scenarios, AMH levels can be significantly elevated and correspond with the size of the tumor.

O: BJECTIVES: Circular RNAs (circRNAs) are known to be associated with the progression of gestational diabetes mellitus (GDM). Thus, the objective of this study was to unveil the influnce and potential mechanism of hsa_circ_0002768 in GDM. M: ATERIAL AND: METHODS: Levels of hsa_circ_0002768 were quantified by RT-qPCR. Placental hsa_circ_0002768 levels were analyzed after pregnancies. Trophoblast cell (HTR-8/SVneo) functions, including oxidative stress, mitochondrial dysfunction, cell viability, autophagy, and invasion, were evaluated upon hsa_circ_0002768 knockdown. Finally, the downstream miRNA for hsa_circ_0002768 was investigated. RESULTS: Hsa_circ_0002768 levels increased as high glucose-induced, and in GDM placenta. In vitro experiments showed that hsa_circ_0002768 knockdown positively regulated trophoblast oxidative stress and mitochondrial functions, thus inducing cell viability and invasion, but inhibiting autophagy. miR-339-5p was a downstream molecular for hsa_circ_0002768, which targeted to TLE3. CONCLUSIONS: This study reveals a physiological role for hsa_circ_0002768 during GDM.

Objectives: Postpartum depression is a common and serious mental health problem which is associated with maternal distress and negative consequences for the offspring. Research confirms the presence of differences in the prevalence of postpartum depression in different social groups. The aim of this study was to compare the severity of maternal symptoms in Poland and Zimbabwe and to identify risk factors occurring in both groups.

Material and methods: The survey was conducted in 2022 among mothers who gave birth at the Department of Neonatology and Rare Diseases and at the Mpilo Central Hospital Maternity Clinic. The Edinburgh Postnatal Depression Scale was used to assess the risk of postnatal depression. A total of 945 patients were included.

Results: The study indicated statistically significant differences in the percentage of women with an increased risk of postpartum depression, with the percentage for the Polish group being 13.54 % and the Zimbabwean group 35.74 %. For the Zimbabwean group, the risk of depression was associated with a problem in obtaining breastmilk and these were women in informal partnerships or those without a stable partner. In the group of Polish patients there was evidence of a correlation between increased risk and having a stable, non-formalised relationship.

Conclusions: According to the analysis, women in Zimbabwe are more likely to be at risk of postpartum depression than Polish women. PPD remains an important issue in obstetric practice, and it is necessary to sensitize health care personnel to the risk of PPD to make timely and appropriate clinical interventions.

Objectives: Due to the increasingly faster pace of life and responsibilities, stress has become an integral part of daily life. Every year, numerous social campaigns in the media raise the issue of increasing alcohol consumption. Endometriosis is a chronic, causally incurable, estrogen-dependent and inflammatory gynecological disorder, described as presence of ectopic endometrial tissue outside the uterine cavity. Some studies suggest that alcohol may aggravate the symptoms of the disease. The aim of the study is to present a comprehensive review reffering to the role of ethanol in the course of endometriosis.

Material and methods: A review of the literature available in the PubMed database between 2000 and 2024 was conducted, using the following keywords: "endometriosis", "alcohol", "ethanol". The search included articles published in English. Publications without full text access and duplicates were rejected. 247 records were screened of which 15 met the eligilibity criteria, and 12 were included in this article.

Results: Alcohol may affect estrogen production (by increasing the activity of aromatase and interacting with luteinizing hormone), promotes pro-inflammatory pathways and oxidative stress. It is also perceived as a form of self-management therapy resulting from pain, anxiety, and low self-esteem. Patients who are alcohol-dependent more often experience infertility, miscarriages, anovulation and ovarian pathologies.

Conclusions: Although there is no clear evidence suggesting the adverse effect of ethanol on the course of endometriosis, the substance may be life-destroying in alcohol-dependent women. It may cause more severe course of endometriosis affecting many ascpectcts of life.