Ginekologia polska最新文献

Objectives: To compare the clinical characteristics of pregnant women with polycystic ovary syndrome (PCOS) and perinatal outcomes with or without preeclampsia (PE) and to factors that are potentially associated with the onset of PE.

Material and methods: This was a retrospective study of pregnant women diagnosed with PCOS from January 2017 to December 2021. Eligible patients were divided into two groups based on the presence or absence of preeclampsia: a PE group and a non-PE group. Demographics, clinical characteristics, maternal and perinatal outcomes, and potential factors linked to disease recurrence were analyzed.

Results: In total, 616 patients were enrolled and respectively classified into the PE group (n = 51) and the non-PE group (n = 565). The incidence of PE in pregnant women with PCOS was 8.28%; this was significantly higher than that in non-PCOS pregnant women (3.22%, p < 0.001). Logistic regression analysis of the predictive factors for PE in women with PCOS revealed that the combination of maternal hyperandrogenism, a pre-pregnancy BMI ≥ 24 kg/m², and a family history of cardiovascular disease (CVD) and assisted reproductive techniques (ART) exhibited the steepest receiver-operating characteristic (ROC) curve value at 0.797 [95% confidence interval (CI): 0.733-0.862].

Conclusions: Patients with PCOS have a higher incidence of PE. We identified a series of significant and independent factors associated with PE in PCOS: maternal hyperandrogenism, a pre-pregnancy BMI ≥ 24 kg/m², and a family history of CVD and ART.

Objectives: Tubo-ovarian abscess (TOA) is inflammation of the pelvic organs, mainly originating from the lower genital tract and intestinal tract. Treatment options include antibiotic therapy, surgical drainage, and radiologically guided (interventional) drainage. In our study, we aimed to evaluate the treatment method to be chosen and thus to manage patients with tuba ovarian abscesses (TOAs) most accurately.

Material and methods: This is a retrospective cohort study, and patients who applied to a tertiary center diagnosed with tuba ovarian abscess (TOA) were included. TOA size (cm), pre-treatment C-reactive protein (CRP) value, pre-treatment white blood cell (WBC) value, previous operation type, postoperative complication, and antibiotics used were screened.

Results: 305 patients were included in the study, and medical treatment was applied to 140 patients, organ-sparing surgical drainage to 50 patients, and surgical treatment to 115 patients. TOA dimensions measured at the time of diagnosis were significantly lower in patients for whom only medical treatment was sufficient. Pre-treatment CRP levels, WBC levels, and length of stay were significantly lower in patients for whom only medical treatment was sufficient. There was no significant difference between the pre-and post-procedure CRP difference, antibiotics, and hospitalization time.

Conclusions: Preferring minimally invasive treatment in cases requiring invasive treatment reduces the frequency of complications. Treatment of tuba ovarian abscesses (TOA) with minimally invasive methods will be more beneficial in terms of patient morbidity.

Objectives: Cesarean section is one of the most common operations worldwide since decades. However, the optimum surgical cesarean section technique is still being discussed. Closure or non-closure of the rectus muscles is also unclear among obstetricians. We aimed to evaluate the effect of rectus muscle re-approximation (RMR) in cesarean section on postoperative pain among singleton primi gravida elective cesarean sections at term.

Material and methods: The current study was planned as a prospective, blinded, randomized controlled trial. A total of 279 elective primi gravida singleton cesarean sections; 142 undergoing RMR and 137 not-undergoing RMR were included in the study. All participants were managed with our clinic's postoperative protocol and obstetric outcomes were also recorded. The patients' pain was assessed face to face 24 hours and 48 hours after operation by using visual analog scale (VAS) score.

Results: The elective singleton primi gravida cesarean sections with and without RMR exhibited no significant difference with respect to maternal age, Body Mass Index, delivery week and other obstetric outcomes. The VAS scores at 24th and 48th hours (67 ± 24 versus 69 ± 25, p: 0.635; 47 ± 25 versus 52 ± 26, p: 0,126, respectively) were similar between the RMR and non-RMR group.

Conclusions: RMR has not any negative effect on postoperative pain, operation time, analgesic use and hospital stay in singleton primi gravida elective CS at term. Additionally, RMR did not lead to any adverse postoperative risks such as increased blood loss and sub-rectus hematoma.

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: We aimed to evaluate feto-maternal blood flow parameters using Doppler ultrasonography (USG) in pregnant women with intrahepatic cholestasis of pregnancy (ICP) and the effect of ursodeoxycholic acid (UDCA) treatment on these parameters.

Material and methods: This prospective cohort study was performed at Dr. Sami Ulus Women's and Children's Health Teaching and Research Hospital, in Turkey between September 2022 and February 2023. Sixty pregnant women, 30 with ICP disease and 30 healthy women were included in the study. Obstetric Doppler parameters were measured by USG at diagnosis and after 48 hours of UDCA treatment for the ICP group.

Results: The obstetric Doppler parameters did not significantly differ in the ICP group and the healthy control group. The Doppler findings were similar after UDCA treatment in the ICP group. Gestational week at delivery and birth weight were lower in the ICP group in our study.

Conclusions: We demonstrated that pregnant women with ICP had similar obstetric Doppler parameters when compared with healthy pregnant women and that the UDCA agent used for treatment of ICP disease did not affect these parameters.

Objectives: Human papillomavirus (HPV) is the most widespread virus with oncogenic potential that infects humans and there is a need to look for the most effective screening method among the population. Understanding the role of HPV in cervical dysplasia and viruses typing increased the usage of HPV-based cervical cancer screening tests using genotyping.

Material and methods: We aim to assess the usefulness the Onclarity Test with extended genotyping and phenotyping of HPV in detecting cervical squamous intraepithelial lesions in 695 subjects who registered for regular cervical screening or due to abnormal LBC result or positive HPV results.

Results: Incidence of positive HPV depended significantly on biopsy outcome (p < 0.001). It was the highest for patients with HSIL (92.5%), lower for patients with LSIL (57.9%) and with HPV outcome of biopsy (50.0%). The sensitivity of positive HPV for detecting HSIL was equal to 92.50% (95% CI: 79.61%-98.43%), and specificity equalled 55.26% (95% CI: 43.41-66.69%). Sensitivity of HPV positive for any of 16, 18, 31, 45, 51 or 52 genotypes but not belonging to the P1, P2 or P3 group for detecting HSIL equalled 62.50% (95% CI: 45.80-77.27%), specificity equalled 72.37% (95% CI: 60.91-82.01%).

Conclusions: The Onclarity test is characterised by high sensitivity and specificity in detecting CIN2+ lesions. Extended genotyping enables the identification of the most common oncogenic HPV types in the population. It can be used as a basic tool for secondary prevention or together with LBC.

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.

Objectives: Genitourinary tract infections in pregnant women are one of the causes of abnormal pregnancy development including miscarriages, premature labor or premature rupture of membranes (PPROM). Atypical bacteria responsible for reproductive tract infections include Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum. Identification of pathogens and appropriately selected therapy can improve obstetric outcomes in patients with symptoms of threatened miscarriage or threatened preterm labor. The purpose of our study is to analyze the impact of reproductive tract infections with ureaplasma and mycoplasma bacteria during pregnancy.

Material and methods: In the presented study, we retrospectively analyzed the cases of 201 pregnant patients hospitalized in the Obstetrics and Gynecology Department of Poznan Regional Hospital in 2019-2022, who had a swab taken from external os area of the cervix for atypical bacteria - Ureaplasma and Mycoplasma. Only patients with symptoms of threatened miscarriage or threatened preterm labor were included in the study group. Microbiological tests were performed in the hospital laboratory with the Mycoplasma IST 3 test from Biomerieux.

Results: We found a higher incidence of preterm labor in patients with symptoms of threatened preterm labor and a genital tract infection with Ureaplasma/Mycoplasma bacteria, compared to patients not infected with Mycoplasma/Ureaplasma - 31.1% vs 20% (p = 0.098). This observation in the case of Ureaplasma/Mycoplasma monoinfection group applied to 6 patients. - 75% of the group. Pregnant patients who had co-infection with other types of bacteria (48 patients in total) gave birth before 37 weeks of pregnancy in 27.1% of cases. We obtained a significant difference (p = 0.007) when comparing groups with positive and negative cultures for Ureaplasma/Mycoplasma by the presence of monoinfection/coinfection and the week of pregnancy in which delivery occurred. We also noted the effect of atypical bacterial infection for PPROM - this complication preceded preterm delivery in 40% of ureaplasma-positive patients, compared to 20% of PPROM without infection. We found a similar rate of preterm labor and pregnancy loss in Ureaplasma/Mycoplasma-positive patients who received antibiotic therapy (35.7%) compared to a group of pregnant women who did not receive treatment (31.6%).

Conclusions: Infection of the genital tract with atypical bacteria Ureaplasma and Mycoplasma has a negative impact on the course of pregnancy. Identification of the type of microorganisms in cervical canal secretions of pregnant patients with symptoms of threatened miscarriage or preterm labor seems crucial. The impact of antibiotic therapy though, requires further analysis.