Ginekologia polska最新文献

Sperm DNA integrity assessment provides essential information that traditional semen parameters may not detect. Studies indicate that DNA fragmentation is an independent indicator of semen quality and fertility, which can explain cases of male infertility, especially when basic semen tests show normal results. Using sperm DNA fragmentation assessment techniques should be considered as an addition to traditional semen tests in male infertility diagnostics.

Objectives: Some studies indicate the role of transforming growth factor-beta 1 (TGF-beta 1) in the development of endometriosis. However, the lack is studies assessed its plasma levels as a biomarker of endometrioma. Therefore, this study aimed to analyze plasma, peritoneal, and endometrioma fluid TGF-beta 1 concentrations in women operated on for ovarian endometriosis.

Material and methods: A cross-sectional cohort study involved 56 women operated on for ovarian endometriosis. Body mass, height, and waist circumference were measured, as well as body mass index (BMI) being calculated. Plasma, peritoneal, and endometrioma fluid TGF-beta 1 concentrations were determined by enzyme-linked immunosorbent assay (ELISA).

Results: Levels TGF-beta 1 were significantly higher in plasma than in both fluids (1286.1 pg/mL vs 114.7 pg/mL; p < 0.001 and 114.7 pg/mL vs 33.6 pg/mL; p < 0.001) and in endometrioma fluid than in peritoneal fluid (114.7 pg/mL vs 33.6 pg/mL; p < 0.001). There were also positive correlations between TGF-beta 1 levels in endometrioma and peritoneal fluids and plasma (r = 0.46; p < 0.001; r = 0.30; p < 0.05, respectively). There were no associations between TGF-beta 1 in plasma, endometrioma, peritoneal fluid, and endometriosis stage.

Conclusions: Our results suggest that plasma TGF-beta 1 concentration can be considered as a biomarker of endometrioma.

Objectives: Irisin is an adipomyokine that has an inhibitory effect on inflammation and possesses anticancer activity. It inhibits cancer cell proliferation, metastasis, and invasion through various signaling pathways associated with carcinogenesis. It has been described to be associated with a number of malignancies in various locations. It has been recognized that it may be a biomarker and prognostic factor in some malignancies. In addition, studies indicate irisin's possible role in treating malignant lesions.

Material and methods: In material including 129 cases of endometrial cancer and normal endometrium in a control group of 18 women with uterine myomas.

Results: There were no statistical differences in irisin protein expression. There were also no differences in irisin expression according to clinical stage, type, and histopathological differentiation.

Conclusions: Further clinical studies are needed to evaluate irisin activity in endometrial cancer.

Objectives: Pregnant women are at higher risk of severe course of COVID-19. The vaccination against COVID-19 is recommended in pregnant and breastfeeding women. The aim of the study was to assess the attitude towards vaccination against COVID-19 among Polish pregnant or breastfeeding women.

Material and methods: A cross-sectional survey study was performed from April 20th, 2021, to October 23rd, 2021, using an online questionnaire distributed via social media. Women who weren't Polish or didn't live in Poland were excluded from the study.

Results: The study group consisted of 662 women. Their median age was 32.5 years (interquartile range IQR: 27.25-33.75 years). Most of the women lived in acity with over 500000 inhabitants (333/662, 50.30%), were in a relationship (658/662, 99.40%), had higher education (559/662, 84.44%), were currently employed (326/662, 49.25%), but not in a medical field (574/662, 86.71%). Willingness to be vaccinated was expressed in 231/662 (34.89%) of the surveyed women. A positive attitude towards vaccinations was more common among women working in the medical field (p = 0.006679), with higher education (p = 0.000054), who trusted their doctors (p = 0.003900), thought that vaccines against COVID-19 were effective (p < 0.00001), and those afraid of COVID-19 (p < 0.00001).

Conclusions: The study showed that only one third of the surveyed women wanted to be vaccinated against COVID-19. Women working in the medical field, with higher education, who trusted their doctors, thought that vaccines against COVID-19 were effective, and those afraid of COVID-19 were more prone to be vaccinated against COVID-19 with recommended vaccines. Educational role of healthcare workers might be crucial for increasing the COVID-19 vaccine coverage in pregnant and breastfeeding women.

Objectives: To evaluate the role of human chorionic gonadotropin (hCG) change in the 48 h prior to methotrexate treatment as a predictor for treatment success of ectopic pregnancy.

Material and methods: This was a retrospective cohort study. A total of 179 women who diagnosed with ectopic pregnancy and given a single dose (50 mg/m²) of methotrexate were included in this study from January 1, 2016 to December 31, 2017. Serum hCG levels and clinical data were collected and compared between the success and failure groups, the percentage increment of hCG levels during the 48 hours prior to methotrexate injection was used to create a receiver operating characteristic (ROC) curve to determine the optimal cut-off value for predicting treatment success.

Results: The success rate of treating ectopic pregnancy with a single dose of methotrexate was 70.9%. The optimal cut-off value for percentage increment of serum hCG levels before methotrexate injection was determined to be 12.56%, with a specificity of 60.66% and sensitivity of 55.69%. The area under the receiver operating characteristic curve (AUC) was 0.646 (p < 0.01).

Conclusions: A lower 2-day hCG percentage increment before methotrexate injection was found to be associated with successful treatment of ectopic pregnancy, with a cut-off value of 12.56%. However, caution should be exercised when deciding on methotrexate treatment versus surgery for ectopic pregnancy patients.

Objectives: The French Ambulatory Cesarean Section (FAUCS) is an extraperitoneal cesarean technique aimed at enhancing maternal recovery and reducing postoperative morbidity. While early trials suggest certain benefits over conventional cesarean section (CS), real-world data remains scarce. This study compares maternal and neonatal outcomes between FAUCS and CS in a prospective cohort, with emphasis on perioperative recovery.

Material and methods: This prospective study included women undergoing elective cesarean section (FAUCS or CS) at term (37-40 Hbd) between September 2023 and December 2024. Maternal outcomes included surgery duration, blood loss, time to mobilization, food oral intake, and initiation of breastfeeding. Neonatal outcomes included birth weight, Apgar scores, and umbilical cord arterial pH. Comparisons used t-tests, Wilcoxon tests, or Chi-square tests (p < 0.05; analysis in R).

Results: Sixty-six patients were included (FAUCS: 30; CS: 36). Baseline maternal or obstetric characteristics were comparable. No differences were found in gestational age or birthweight. FAUCS neonates had marginally lower umbilical pH (7.33 ± 0.07 vs 7.36 ± 0.06, p = 0.009). No difference was found in Apgar scores. FAUCS was associated with longer surgery (30.7 ± 4.1 min vs 26.4 ± 10.3 min, p = 0.006), but significantly faster mobilization, food oral intake, and breastfeeding (all p < 0.001). Fundal pressure was used less often (p < 0.001), and instrumental assistance more frequently (p < 0.001) in FACUS. The use of weak opioids was also lower (p = 0.036). The hospital stay was similar.

Conclusions: FAUCS appears to enhance early recovery without compromising maternal or neonatal outcomes, supporting its use in select patients.

Objectives: Pelvic organ prolapse (POP) is an important disease affecting the quality of life of women. We aimed to investigate the relationship of genital hiatus (GH) and anogenital distance (AGD) measurements with POP in patients with lower urinary tract symptoms.

Material and methods: 1696 Patients who underwent urodynamic investigations in our clinics were evaluated retrospectively. Demographic data, physical examination data and urodynamic investigation results of all patients were evaluated. Those beyond POPQ stage 2 and above were considered to have pelvic organ prolapse.

Results: The mean age was 49.44 ± 0.27 years, and the mean body-mass index was 30.08 ± 0.16 kg/m². While 682 patients (40.2%) were considered as having no POP, 1014 patients (59.8%) were considered as having POP. A statistically significant difference was found between the groups in terms of POP status respect of the parity, mean GH and AGD, and hysterectomy rate (p < 0.05). Mean GH, PB and AGD were significantly different among POP stage groups. (p < 0.05). In the correlation analysis, there was a positive correlation between POP stage parity (p = 0.0003, r = 0.059), GH (p < 0.0001, r = 0.353) and AGD (p < 0.0001, r = 0.299). The logistic regression revealed that genital hiatus distance and hysterectomy were statistically significant factors associated with POP. In ROC analysis, when the GH distance measurement is > 2.5 cm, the probability of POP status was found with sensitivity of 77.4% and specificity of 53.2% (p < 0.001).

Conclusions: GH measurement can be marker for POP in a population of women being evaluated for urinary incontinence. GH measurement > 2.5 cm may associated with POP status.

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.

Objectives: The cross-sectional survey was conducted aiming to evaluate the knowledge and experiences of the Polish obstetricians and gynecologists regarding the External Cephalic Version (ECV) and investigate their practices concerning this procedure.

Material and methods: An online survey constituting author-created questionnaire with 22 questions, was distributed among gynecologists and obstetricians. The questionnaire evaluated participants' knowledge about ECV, work experiences, and workplace practices.

Results: Out of 461 respondents, 56.20% were specialists in gynecology and obstetrics. Elective cesarean section (CS) was preferred by 78.70% for primiparas and 73.50% for multiparas with non-cephalic presentation, while ECV would be chosen by 21.3% and 23.6%, respectively. While 73.80% knew centers performing ECV, only 16.70% had actively participated in the procedure. Major differences in the experiences and knowledge regarding ECV were observed based on work experience, and workplace reference level. Experienced physicians showed higher concerns about ECV complications and emergency CS risks. The most common concerns regarding the procedure referred to periprocedural pain, perceived low efficacy, and complications, and were more prevalent among respondents with longer experience and from lower-reference centers.

Conclusions: The study demonstrated that among Polish obstetricians for term pregnancies with non-cephalic presentation, elective cesarean section is preferred over ECV, especially among experienced practitioners. Knowledge about ECV was relatively low, indicating a need for improved educational efforts. Addressing concerns about ECV's safety and efficacy, particularly through enhanced training and anesthesia options, could promote its adoption and reduce CS rates.