Ginekologia polska最新文献

Objectives: In recent years, advances in prenatal diagnostics have enabled the identification of congenital abnormalities, including genetically determined disorders, at an early stage of fetal development. Diagnosing a lethal fetal anomaly affects the entire family and is often a traumatic experience for the parents. Perinatal palliative care provided by perinatal hospice is a model of specialized care for families following the prenatal diagnosis of a lethal fetal condition.

Material and methods: After ten years of operation, we analyzed the perinatal palliative care protocol implemented in the Hospital of the Brothers Hospitallers in Katowice, a part of Bonifratres Medical Centre.

Results: We aimed to present the model of perinatal and postnatal care developed at the hospital for families receiving such support in the Silesian agglomeration.

Conclusions: We also wanted to show the importance of perinatal palliative care provided by one team from the prenatal period through delivery until the child's death or until the pediatric hospice provides the care of the child.

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: This study aims to present the postoperative results of patients who underwent a hysteroscopic isthmocele resection, identify factors affecting patients who experienced surgical failure, and develop a new treatment algorithm for managing an isthmoceles, whose treatment remains unclear.

Material and methods: The hospital records of women who underwent hysteroscopic istmocele resection due to postmenstrual spot-bleeding at a tertiary central university hospital were examined. The patients were divided into two groups: successful surgery (Group 1) and unsuccessful surgery (Group 2) after hysteroscopic isthmocele resection. To evaluate the results of unsuccessful surgery in patients with failed hysteroscopic isthmocele resection, the number of caesarean sections, BMI and isthmocele area were considered as candidate predictors.

Results: During the study period, 53 patients who met the inclusion criteria and underwent hysteroscopic isthmocele resection were evaluated. Surgical success was detected in 34 patients (64.1%), while unsuccessful surgery was detected in 19 patients (35.9%). In the ROC analysis performed to predict an unsuccessful surgery, AUC was detected as 0.717, sensitivity was 79%, specificity was 68% and p value was 0.009 in patients with a BMI > 27.5. In patients with previous caesarean sections, the number > 2.5; AUC was 0.765, sensitivity was 58%, specificity was 91% and p value was 0.002 in the receiver operating characteristic (ROC) analysis. In patients with isthmocele area > 23.5 mm2, AUC was 0.781, sensitivity was 63%, specificity was 91% and p value was 0.001 in the ROC analysis. In the multivariate regression analysis, the effect of the isthmocele area in predicting unsuccessful surgery was determined to be a statistically significant independent variable (OR: 1.239, 95% CI: 1.050-1.462, p = 0.011).

Conclusions: Although a hysteroscopic isthmocele resection is recommended for patients with an RMT over 3 mm, certain factors increase the risk of surgical failure. If an isthmocele area exceeds 23.5 mm², the number of previous caesarean sections is three or more or a person's BMI is 27.5 or higher, the risk of unsuccessful hysteroscopic surgery is high. In these patients, isthmocele repair should be performed via the laparoscopy, laparotomy or vaginal approach.

Objectives: To investigate the impact of systemic lupus erythematosus (SLE) disease activity on neonatal outcomes and analyze risk factors associated with fetal loss in SLE pregnancies.

Material and methods: This retrospective study analyzed 102 pregnancies in 99 women with SLE at the First Affiliated Hospital of Fujian Medical University, China, between 2013 and 2020. Demographic data, live birth outcomes, and fetal loss were evaluated.

Results: Significant differences were observed among SLE disease activity groups in early preterm birth (χ² = 9.825, p < 0.05), term birth (χ² = 13.320, p < 0.05), neonatal birth weight (F = 8.688, p < 0.05), small for gestational age (χ² = 12.291, p < 0.05), neonatal intensive care unit (NICU) admission (χ² = 9.820, p < 0.05), neonatal infection (χ² = 9.227, p < 0.05), and neonatal myocardial injury (χ² = 7.033, p < 0.05). Multivariate logistic regression analysis identified unplanned pregnancy [adjusted odds ratio (aOR) = 2.772, 95% confidence interval (CI): 1.321-5.814], moderate-to-severe SLE activity (aOR = 4.537, 95% CI: 2.103-9.789), preeclampsia (aOR = 6.223, 95% CI: 2.845-13.615), 24-hour urinary protein > 1.0 g (aOR = 3.682, 95% CI: 1.726-7.854), and positive antiphospholipid antibodies (aOR = 5.250, 95% CI: 2.437-11.308) as independent risk factors for fetal loss (all p < 0.05). Medication initiated at least six months before pregnancy, particularly hydroxychloroquine, was associated with reduced fetal loss (aOR = 0.378, 95% CI: 0.185-0.772, p < 0.05).

Conclusions: Planned pregnancy, early initiation of hydroxychloroquine treatment, and close monitoring of disease activity, urinary protein, antiphospholipid antibodies, and blood pressure are crucial strategies to reduce fetal loss in SLE pregnancies. Early intervention for abnormal parameters may improve outcomes.

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.