Ginekologia polska最新文献

Objectives: Large for gestational age (LGA) is defined as a birth weight equal to or higher than the 90th centile for a certain gestational age. Despite the efforts to optimize therapeutic goals to stabilize diabetes, there is still a high rate of LGA in type 1 diabetes mellitus (T1DM) mothers. The aim of this paper is a literature review of the data on predictors of LGA incidence in pregnancies complicated by type 1 diabetes mellitus.

Results: Potential LGA predictors in pregestational diabetes include glucose concentration during pregnancy, maternal age, diabetes duration, increased body weight both at the beginning of gestation and at the time of delivery, as well as the weight gain in pregnancy. LGA risk is also associated with the use of an insulin pump (CSII), especially without the support of a continuous glucose monitoring system (CGMS). Significant glycaemic control parameters among others include average fasting glycaemia in the 3rd trimester, HbA1c in the 1st and 3rd trimesters, and among CGMS parameters - shorter TIR (time in range), shorter TBR (time below range) in the 2nd and 3rd trimesters, longer TAR (time above range) > 140 and average glycaemia in each trimester of gestation.

Conclusions: There is still a need for identification of new predictors and theraputic goals in pregnancy in T1DM women to reduce the prevalence of LGA newborns.

Objectives: Fetal echocardiography (FE) is a critical diagnostic tool for assessing cardiac and extracardiac abnormalities in high-risk pregnancies. In this paper we evaluate indications and findings of FE in a high-risk cohort at a Polish fetal echocardiography clinic.

Material and methods: This retrospective, observational cohort study included 991 patients undergoing FE between January 2023 and December 2024. A single prenatal cardiologist with extensive FE experience performed all examinations. Indications and findings were analyzed, with results categorized into subgroups.

Results: Mean maternal age was 31.6 years (SD 5.3), with a median gestational age of 26 weeks (IQR = 4). The most frequent indications were intermediate risk of chromosomal aberrations from first-trimester screening (17.76%), intra-cardiac echogenic foci (13.32%), and elevated risk of chromosomal aberrations (12.82%), comprising 43.69% of referrals. Normal FE results were observed in 88.49% of cases (n = 877). Abnormalities (cardiac or extracardiac) occurred in 11.51%, with cardiac abnormalities in 7.16% (71 cases: 3.12% structural, 4.03% functional). Ventricular septal defect (1%) and arrhythmias (1.31%) were the most common structural and functional findings, respectively. Extracardiac abnormalities with normal cardiac imaging occurred in 4.3%. No significant differences in abnormality prevalence were found between high/intermediate chromosomal risk groups and the cohort (odds ratios: 0.47-1.14).

Conclusions: First-trimester screening results and soft markers predominantly drove FE referrals. The 11.51% abnormality rate underscores the importance of FE in high-risk pregnancies, despite no significant association with chromosomal risk levels.

Objectives: The aim of this study is to introduce a new technique, endoscopic sacrospinous ligament fixation (e-SSLF), and to present its success rate and advantages.

Material and methods: The hospital records of women who underwent e-SSLF and simultaneous vaginal hysterectomy due to stage 4 pelvic organ prolapse (POP) were evaluated. Unlike the classical SSLF technique, in e-SSLF the sacrospinous ligament (SSL) was exposed with two retractors, then visualized with a 5 mm diagnostic hysteroscope. The SSLF was performed endoscopically with Deschamps ligature needles. In the 24th postoperative hour, a contrast-enhanced pelvic computerized tomography (CT) was performed, and images were taken to confirm that the suture was passed to the correct location (2 cm medial to the sacrospinous process). Patient demographic and clinical data, surgery duration,total operation time, pre- and postoperative Pelvic Organ Prolapse Quantification (POP-Q) levels, and complications were evaluated.

Results: Based on the evaluated medical records, 26 patients underwent e-SSLF. Postoperative CT images showed that the suture had passed to the correct place in all cases. There were no intraoperative complications, and only 2 patients experienced transient leg pain in the postoperative period. The median surgery duration was 101 seconds (25th percentile 96 seconds, 75th percentile 110 seconds). The median total operation time was 62 minutes (25th percentile 52 minute, 75th percentile 78 minute). Upon POP-Q staging at the 6-month postoperative follow-up, 24 patients (92.3%) were found to be in stage 0 and 2 (7.7%) were found to be in stage 1 POP.

Conclusions: e-SSLF is a new surgical technique that is reliable and highly effective, showing fewer complications and good postoperative results due to the imaging, it provides. Imaging in SSLF will make significant contributions to gynaecology assistant training and reduce the learning curve of SSLF.

Objectives: We assessed the diagnostic parameters of cytodiagnosis as a screening method used in the National Population-Based Cervical Cancer Screening Program compared to out-program screening.

Material and methods: A retrospective analysis of 800 results obtained during routine screening for the National Population-Based Cervical Cancer Screening Program and out-program samples. Abnormal cytologic interpretations, which were an indication for colposcopy as well as HPV DNA HR test and the final histopathology test, both from in- and out-program patients, were statistically analyzed.

Results: Out of 800 abnormal cytologic results, we obtained 7 - suspicion of squamous cell carcinoma, 105 - HSIL, 152 - ASC-H, 269 - LSIL, 254 - ASCUS, and 13 - AGC. Cervical pathology was confirmed on histopathology in 422 patients: cervical cancer was detected in 21 patients, with the following findings in the remaining women: 103 - CIN 3, 126 - CIN 2, 173 - CIN 1, koilocytosis without CIN - 143, and lesion-free histopathology - 378. Out of 800 abnormal cytologic results, HPV DNA was detected in 539 women, including 387 - HPV DNA HR, 240 - HPV DNA 16, and only 22 - HPV DNA 18.

Conclusions: The prevention program significantly improved the detection parameters of the in-program as compared to out-program cytodiagnostics. The goal of the screening programs should be to identify lesions consistent with ≥ CIN2. Molecular testing, which can identify at least 14 HPV HR genotypes, should be the first-line screening tool. A positive molecular test result should not be an indication for advanced diagnostics. Other than conventional or liquid-based cytology, an ultimate detection test is necessary.

Objectives: To investigate the effects of antenatal magnesium sulfate administration on preterm gastrointestinal feeding intolerance and necrotizing enterocolitis in preterm infants.

Material and methods: This observational cohort, single-centre study included preterm infants < 30 weeks gestational age or < 1250 g, who were admitted to the neonatal intensive care unit of a university hospital. These infants were divided into two groups on the basis of having received antenatal magnesium sulfate or not.

Results: Overall, 118 preterm infants were enrolled. Fifty-four of these infants had received prenatal magnesium sulfate (Group 1), and 64 (42%) had not (Group 2) before their neonatal intensive care unit (NICU) admission. The number of days to full eneteral feeding and the days of total parenteral nutrition were significantly higher in Group 2 than in Group 1 (p < 0.05). When gestational age, birth weight, and small for gestational age (SGA) were included as factors affecting feeding intolerance, the logistic regression analysis results showed that the administration of magnesium sulfate was an independent risk factor (adjusted OR: 3.5; 95% CI: 1.462-8.615; p < 0.05). Antenatal magnesium sulfate administration was not observed to have an effect on spontaneous intestinal perforation and necrotising enterocolitis.

Conclusions: The administration of antenatal magnesium sulfate has proven tocolytic and neuroprotective effects on preterm births. However, it must be taken into consideration that it can cause feeding intolerance in preterm infants without causing intestinal injury.

Objectives: The goal is for investigating the correlation between ultrasound features and molecular pathological markers such as estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), tumor protein p53, nuclear proliferation factor Ki-67, DNA topoisomerase IIα (Topo II), and cytokeratin CK5/6 in non mass infiltrating ductal carcinoma of the breast.

Material and methods: A total of 125 sufferers with non mass infiltrating ductal carcinoma of the breast were included in the ultrasound images and immunohistochemical results. This study analyzed the characteristics of ultrasound images, including maximum cross-sectional diameter, morphology, peripheral hyperechoic halo, hair prick sign, and micro-calcification, as well as the positive expression of molecular pathological markers (ER, PR, HER-2, p53, Ki-67, Topo II, CK5/6); It uses statistical methods for evaluating the correlation between ultrasound features and molecular pathological markers.

Results: In 125 patients, the maximum cross-sectional diameter was markedly related to positive expression of CK5/6 (r = 0.176, p < 0.05), Ki-67 (r = 0.328, p < 0.05), and HER-2 (r = 0.468, p < 0.05). There is a marked relation between posterior echo attenuation and ER positivity (r = 0.096, p < 0.05) and Topo II positivity (r =-0.021, p < 0.05). However, there was no marked relation in morphology, peripheral hyperechoic halo, hairline sign, and micro-calcification with prognostic molecular pathological markers (p > 0.05).

Conclusions: This study found a marked relation in the maximum cross-sectional diameter of non mass infiltrating ductal carcinoma of the breast and the positive expression of CK5/6, Ki-67, and HER-2. This finding suggests that the maximum cross-sectional diameter may serve as a potential indicator for prognostic evaluation and is closely related to the expression of cytokeratin CK5/6, nuclear proliferation factor Ki-67, and HER-2 in tumors. Posterior echo attenuation is closely related to ER positive and Topo II expression. No significant correlation was observed between morphology, peripheral hyperechoic halo, hairline sign, and micro-calcification with prognostic molecular pathological markers. These results provide new insights for the prognosis evaluation of patients with non mass infiltrating ductal carcinoma of the breast and contribute to the development of individualized treatment strategies, but further research and validation are still needed.

Objectives: We investigated the correlation of plasma Afamin levels with gestational diabetes mellitus (GDM) during pregnancy and assessed its predictive value for the risk and prognosis of GDM.

Material and methods: A total of 993 pregnant women were included in this nested case-control study. The fasting blood samples in their first trimester were collected. Ninety-one women were diagnosed with GDM, and they were subdivided into insulin treatment group (Group A1, 30 cases) and non-insulin treatment group (Group A2, 61 cases) according to whether they needed to treat with insulin. Another 91 pregnant women with normal glucose tolerance were as the control group (NC group). The plasma and umbilical cord blood levels of Afamin were measured in the first and second trimesters using enzyme-linked immunosorbent assay (ELISA). The correlation of Afamin levels with GDM during pregnancy and its predictive value were assessed.

Results: Plasma Afamin levels in both GDM groups (A1 and A2) were significantly higher than in the control group at all pregnancy stages (p < 0.01). Afamin levels in the second trimester were significantly higher in Group A1 than those in Group A2 (p < 0.05). Multivariate logistic regression identified that plasma Afamin levels in the first trimester (OR = 1.126, 95% CI: 1.032-1.228, p = 0.008) and in the second trimester (OR = 1.173, 95% CI: 1.092-1.259, P = 0.000) were the independent risk factors for GDM, along with insulin resistance index (OR = 1.62, 95% CI: 1.036-2.534, p = 0.034). ROC analysis showed optimal cut-off value of plasma Afamin was 65.90 mg/L in the first trimester (AUC = 0.858, sensitivity = 75.8%, specificity = 85.7%) and 85.09 mg/L in the second trimester (AUC = 0.874, sensitivity = 92.3%, specificity = 76.9%).

Conclusions: Elevated plasma Afamin levels during the first and second trimesters are associated with GDM, supporting Afamin level as a potential biomarker for early GDM risk prediction.

Iatrogenic endometriosis, a rare form of endometriosis resulting from surgical interventions, has become increasingly recognized as a complication of cesarean sections. This study examines the development of clear cell carcinoma (CCC) arising from endometrial tissue implanted in cesarean section scars. Based on a review of 41 clinical cases, the study highlights the challenge in diagnosis and management of this uncommon aggressive malignancy. The average delay from cesarean section to diagnosis was 18 years, with common symptoms being painful masses and scar tenderness. Imaging modalities such as magnetic resonance imaging (MRI) and computed tomography (CT) were the first diagnostic tools, while biopsy confirmed malignancy in most cases. The outlook for patients who had CCC in cesarean scars was extremely poor, and scant long-term survival data existed. These observations serve to reemphasize the necessity of increased awareness by gynecologists and obstetricians of the risk potential associated with cesarean delivery. Improved diagnostic scrutiny, especially in the patient who comes to the doctor with unexplained symptoms involving the scar, is recommended in this study. A strong role is also supported in informed choice before surgical modes of delivery are attempted.