Ginekologia polska最新文献

Objectives: Low ovarian reserve is a major concern as older women seek pregnancy. Women 35 and older who want to conceive have fewer high-quality oocytes, which is linked to a drop in Anti-Müllerian Hormone (AMH). Women in this age bracket may need hysterectomy for abnormal uterine bleeding, leiomyomas, and pre-/malignant reasons. Those with preserved ovaries after hysterectomy nevertheless experience menopause. This circumstance impacts women's sexuality. Interventions to improve ovarian function in this age group may illuminate both concerns.

Material and methods: We did an observational case-control study of 35-50-year-old individuals who had hysterectomy for a benign disease. The trial group received perioperative PRP for their ovaries, while the control group received no treatment. Patients' preoperative AMH and Female Sexual Function Index (FSFI) scores were compared to those 3 months following surgery.

Results: Our study found a substantial drop in postoperative AMH levels in the control group (p < 0.001), whereas the PRP group showed a slight increase in AMH levels. The PRP group has a significant difference in preoperative and postoperative AMH levels (p = 0.0001). The PRP group had a much higher total FSFI score. Subgroup analysis shows this variation in lubrication, orgasm, contentment, and pain. The PRP group had substantial differences in orgasm, pleasure, and pain pre- and post-operation.

Conclusions: PRP supports ovarian regeneration but has limited benefits. This information should be used to build standardized PRP protocols and undertake more extensive investigations by applying PRP to numerous organs, including the ovaries.

Objectives: Congenital uterine anomalies are the result of abnormal development of the Müllerian ducts and occur in approximately 5% of the general female population. These malformations often remain asymptomatic and undiagnosed until complications arise, especially during reproductive years. Accurate diagnosis and classification are crucial for counseling, reproductive planning, and appropriate surgical management. Recent advances in three-dimensional (3D) imaging and printing technology have enhanced diagnostic and therapeutic strategies in complex gynecologic cases. This report aims to present a rare postpartum complication associated with a congenital uterine anomaly, characterize the histopathological and radiological features of the case, and assess the role of printed three-dimensional (3D) anatomical modeling in supporting accurate post hoc classification and surgical decision-making.

Material and methods: A 25-year-old primiparous woman with a congenital uterine malformation underwent cesarean section at 28 weeks of gestation due to premature rupture of membranes and regular uterine contractions. One month postpartum, the patient presented with vaginal discharge and reported a palpable resistance in the vagina. Pelvic examination revealed a lobulated, dark pink, nonbleeding, firm mass measuring approximately 15 × 10 cm protruding into the vagina, along with an intact vaginal septum located 2-3 cm from the introitus. Ultrasound demonstrated an irregular mass in the right uterine cavity with indistinct margins suggestive of a necrotic fibroid. The patient underwent surgery involving removal of the vaginal mass and resection of the vaginal septum. Histopathological examination revealed fascicularly arranged, shadowed spindle cells consistent with necrotic smooth muscle tissue of myometrial origin, indicative of degenerative tissue of the uterine septum. Subsequently, a patient-specific 3D printed uterine model was generated using imaging and surgical data to facilitate detailed postoperative anatomical assessment.

Results: Postoperative assessment using the 3Dprinted model enabled a precise classification of the malformation as a "double septate uterus with cervix and septate vagina" (ESHRE/ESGE classification U2bC2V1) with an intracavitary FIGO type 2 submucosal leiomyoma. The 3D model provided a tangible visualization of the uterine architecture, improving anatomical understanding, facilitating retrospective diagnosis, and supporting interdisciplinary evaluation.

Conclusions: This case demonstrates the diagnostic and educational utility of 3D printing in the management of rare Müllerian anomalies. Integration of patient-specific 3D models into clinical practice may improve diagnostic precision and surgical planning, particularly in complex gynecological malformations.

Objectives: Quality of life (QoL) is a subjective assessment of various aspects of daily functioning - physical health, mental state, sexuality, level of independence and self-sufficiency, relationships, and the alignment of one's life with personal beliefs and values. Sexuality is an essential element of human existence, regardless of age or health condition.

Material and methods: The study was conducted among 84 women diagnosed with breast cancer and took place from September to October 2025. The diagnostic survey method was employed, along with the following research tools: Female Sexual Function Index (FSFI), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core-30 (EORTC-QLQ-C30), Breast Cancer 23 (QLQ-BR23), and self-administered questionnaire.

Results: Breast cancer and its surgical treatment can have a negative impact on women's quality of life, especially in areas such as fatigue, financial stress, and emotional well-being. More specific concerns related to breast cancer include arm-related symptoms and anxiety about the future. Although the overall QoL measured by the EORTC-QLQ-C30 - did not significantly differ depending on the type of surgery, certain symptoms did show variation. The QLQ-BR23 symptom scale revealed differences in areas: side-effects from treatment and breast-related discomfort. Differences were noted in sexual functioning and sexual satisfaction. Studies show that women who had breast-conserving surgery reported more sexual difficulties.

Conclusions: Among examined patients after breast-conserving surgery, 89.7% of people reported sexual dysfunction. Among all domains of FSFI, only the orgasm domain showed a statistically significant difference depending on the type of surgery performed. The QLQ-BR23 symptom scale revealed differences in areas: side-effects from treatment, breast-related discomfort, and sexual functioning and sexual enjoyment.

Obstetric forceps have played a pivotal role in perinatal medicine for centuries, representing one of the most significant innovations in the history of obstetrics. As a life-saving instrument, forceps revolutionized the management of complicated labours by offering an alternative to destructive procedures and maternal mortality, thereby transforming the outlook for both mothers and newborns. Throughout their history, however, forceps have provoked both admiration and controversy -praised for their ability to facilitate safe delivery, yet criticized for their potential risks and the technical skill required for their proper use. This article provides a comprehensive overview of obstetric forceps, addressing not only their origins and the secretive circumstances of their invention by the Chamberlen family, but also the successive stages of their design evolution, from early concealed prototypes to the sophisticated instruments used in modern practice. We also examine the cultural, social, and medical impact of forceps across different eras, highlighting their central role in shaping the practice of operative vaginal delivery and the broader history of perinatal care. Finally, current debates surrounding the role of forceps in contemporary obstetrics are discussed, offering insight into the future of this instrument in the context of alternative techniques such as vacuum extraction and cesarean section.

Objectives: Folates and choline are vital nutrients crucial for the development of the fetus, especially for the central nervous system (CNS) Adequate intake during preconception and pregnancy is essential to prevent neural tube defects (NTDs) and promote cognitive development. This review synthesizes current recommendations regarding folate and choline supplementation during preconception and pregnancy. It focuses on differences between folic acid and active folates like 5-MTHF and provides practical guidance for clinicians.

Material and methods: A comprehensive review of the literature was conducted, focusing on guidelines and recommendations from leading scientific societies, including the Polish Society of Gynecologists and Obstetricians (PTGiP), the European Food Safety Authority (EFSA), and the American College of Obstetricians and Gynecologists (ACOG). The review includes meta-analyses, randomized clinical trials, and observational studies.

Results: Folate supplementation is universally recommended to reduce the risk of NTDs, with dosage recommendations typically ranging from 0.4 to 0.8 mg daily. Active folates like 5-MTHF are particularly important for women with MTHFR mutations. Choline supplementation recommendations vary, with EFSA suggesting 400-480 mg daily for pregnant women, while other societies prioritize dietary intake over supplementation on a daily basis. Adequate choline intake supports fetal brain development and may enhance cognitive function in children.

Conclusions: Adequate folate and choline supplementation during preconception and pregnancy is essential for optimal fetal development. Supplementation with active folates (5-MTHF) is particularly beneficial for women with MTHFR mutations, who may have difficulty converting folic acid into the active form. Additional research is necessary to determine optimal choline dosages and evaluate the long-term effects on cognitive development.

Addison's disease (AD) is a rare condition, but its prevalence in Europe has been steadily rising. Its initial presentation might be a life-threatening event termed adrenal crisis (AC), which is particularly likely to happen during situations of increased biological stress, such as septic illness, general anesthesia, surgery, or trauma. AD can appear as an isolated clinical entity or together with other autoimmune conditions, such as autoimmune thyroiditis, pernicious anemia, or autoimmune primary ovarian insufficiency (POI). In this review, we underline the relationship between AD and POI with a special regard for patients with POI who might develop AD. Due to the nonspecific symptoms of AD, patients often consult multiple specialists before receiving a proper diagnosis, which delays the recognition of AD Ordering basic screening tests might facilitate an early detection of AD and prevent possibly fatal complications of the disease.

Objectives: Pelvic organ prolapse is an extremely important therapeutic problem and affects up to 50% of nulliparous women. Its frequency increases with age parity, and it is more common after menopause. This ailment has a negative impact on many aspects of life, significantly reducing its quality. Nowadays, not only the cure of the problem, but also the improvement of the quality of life and life satisfaction of patients is of great importance for doctors, therefore the assessment of these aspects should also be constantly evaluated. The objective of this study was to determine the quality of life and satisfaction with life of patients before, 1 year and 3 years after performing the surgery of an isolated apical defect using BSC synthetic mesh.

Material and methods: Of 60 patients with an isolated apical defect, 45 had sufficient medical records for the analysis. Evaluation comprised the perceived quality of life (P-QOL) and the SWLS questionnaires conducted three times.

Results: The results obtained for the P-QOL questionnaire carried out after 3 years show that the quality of life of the patients improved. A statistically significant increase in the quality of life was achieved in almost all domains (p < 0.05).

Conclusions: The results obtained after completing the satisfaction with life scale (SWLS) questionnaire indicate that 3 years after the surgery, patients' satisfaction with life showed an upward trend. Surgical treatment of an isolated apical defect using the bilateral sacrospinous colposuspension kit (AMI BSC) results in an improvement in the quality of life in most patients, even in a long-term evaluation.

Objectives: Engaging in sexual activity prematurely can lead to adverse emotional consequences for women. Current observational study suggests that such behavior may increase self-esteem sensitivity and trigger heightened feelings of remorse among adolescent girls. Additionally, insufficient contraceptive measures after sexual activity could potentially result in pregnancy and childbirth. Nevertheless, there is a noticeable lack of focused research on the significant reproductive issue of a potential connection between early sexual activity and postpartum depression in females. To address this gap, we have conducted a Mendelian randomization analysis, using the initiation of sexual activity as the exposure variable and postpartum depression as the outcome variable.

Material and methods: Using genome-wide association studies (GWAS) summary data that includes information from 194,174 samples regarding the age at first sexual intercourse, as well as GWAS summary data involving 231,644 samples for postpartum depression, and employing methods such as CAUSE, the inverse variance weighting method, MR-Egger, MR-PRESSO, and similar approaches, we conducted a Mendelian randomization analysis to investigate the potential relationship between the age at first sexual intercourse and postpartum depression. To validate the robustness of our findings derived from methods using genome-wide significant loci, we also conducted various sensitivity analyses.

Results: The findings revealed that the age at which individuals initiated their first sexual intercourse exhibited a negative correlation with vulnerability to postpartum depression. To clarify, for each additional year in the age of first sexual intercourse, the susceptibility to postpartum depression decreased by 11.3% (OR, 0.887; 95% CI, 0.852-0.932; p = 0.013). Additionally, when applying the inverse variance weighting (IVW) method, we also discovered an association between the age at first sexual intercourse and postpartum depression (OR, 0.859; 95% CI, 0.771-0.957; p = 0.0060). Furthermore, the final IVW model did not reveal any evidence of horizontal pleiotropy or heterogeneity, suggesting that our results may support a potential causal relationship.

Conclusions: A deferred age of initial sexual intercourse enhances efforts to reduce the risk of postpartum depression in women. Hence, it might be a necessary to integrate this content into sex education aimed at adolescents.

Objectives: This study aims to explore the efficacy and safety of vaginal natural orifice transluminal endoscopic surgery (vNOTES), laparoscopy, and robot-assisted laparoscopic myomectomy (RALM) for uterine fibroid removal.

Material and methods: Computer searches were conducted in the Cochrane Library, Embase, Web of Science, PubMed, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Database, and other databases until May 2023. Randomized controlled trials, cohort studies, case-control studies, and other relevant studies comparing the safety and efficacy of vNOTES, laparoscopy, and RALM for uterine fibroid treatment were included.

Results: A total of 28 studies involving 3247 subjects were included. Fifteen studies compared laparoscopy and RALM, thirteen studies compared laparoscopy and vNOTES, and there were no direct comparisons between RALM and vNOTES. In terms of surgical time, vNOTES had significantly shorter surgical time than laparoscopy (MD = 29, 95% CI: 0.89-47) and RALM (MD = 60, 95% CI: 30-90). RALM had significantly shorter surgical time than laparoscopy (MD = -33, 95% CI: -56, -92). There was no significant difference in intraoperative blood loss among the three treatment methods. Regarding hospital stay, vNOTES had a significantly shorter duration than laparoscopy (MD = 0.59, 95% CI: 0.32-0.89) and RALM (MD = 0.51, 95% CI: 0.027-1.00). Laparoscopy had a significantly higher laparotomy rate than vNOTES (OR = 0.27, 95% CI: 0.64-8.4). The rate of postoperative complications was significantly higher in laparoscopy compared to vNOTES (OR = 0.54, 95% CI: 0.23-1.0) and RALM (OR = 0.39, 95% CI: 0.17-0.92).

Conclusions: In patients with uterine fibroids, vNOTES demonstrated significantly shorter surgical time, shorter hospital stay, lower laparotomy rate, and lower rate of postoperative complications compared to laparoscopy. However, vNOTES did not show significant advantages over RALM, except for shorter surgical time.

Objectives: To assess the diagnostic efficacy of integrated chromosomal microarray analysis (CMA) and whole-exome sequencing (WES) in prenatal CHD diagnosis among diabetic pregnancies and examine potential gene-environment interactions affecting cardiac morphogenesis.

Material and methods: This prospective investigation enrolled 160 diabetic gravidae (Type 1, Type 2, or gestational) whose fetuses demonstrated CHD on echocardiography. All specimens underwent both CMA and WES analyses. Maternal glycemic parameters were quantified, with HbA1c stratified as < 6.5%, 6.5-8.0%, or > 8.0%. Genetic findings were correlated with CHD severity and glycemic control. A multivariate risk prediction model was constructed.

Results: Molecular analysis identified pathogenic variants in 87 cases (54.4%): 27 (16.9%) via CMA, 38 (23.8%) via WES, and 22 (13.8%) through both methodologies. Detection rates varied significantly across diabetes subtypes (66.7%, 54.2%, 50.0% for Type 1, Type 2, and gestational diabetes, respectively; p = 0.039). Cardiac transcription factor genes demonstrated significant enrichment in severe CHD (p = 0.011). Notably, fetuses harboring identical genetic variants exposed to poor glycemic control (HbA1c > 8.0%) exhibited significantly higher rates of severe CHD compared with adequately controlled cohorts (p = 0.033). Even in genetically negative specimens, severe CHD prevalence correlated directly with hyperglycemia (p = 0.003). The combined risk prediction model achieved AUC = 0.771.

Conclusions: Concurrent implementation of CMA and WES substantially enhances diagnostic yield in prenatal CHD detection associated with maternal diabetes. Our data demonstrates significant gene-environment interactions wherein maternal hyperglycemia potentiates phenotypic expression of cardiac developmental gene variants, elucidating pathogenetic mechanisms and supporting individualized risk stratification.