Ginekologia polska最新文献

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.

Objectives: Caring for newborns with life-limiting conditions represents one of the most demanding professional and emotional challenges for healthcare staff, particularly nurses and midwives. The aim of this study was to examine the relationship between empathy levels, professional competence, occupational stress, and psychosomatic symptoms among professionals working in neonatal care settings.

Material and methods: This quantitative, cross-sectional study was conducted in the second quarter of 2023 in level II and III referral centres in the Silesian region of Poland. A total of 307 nurses and midwives participated. Data were collected using a proprietary questionnaire comprising sociodemographic data, self-assessment of empathy and professional competence, factors shaping attitudes towards death, and the Perceived Stress Scale (PSS-10). Statistical analysis was performed using non-parametric tests and Spearman's rank correlation.

Results: Results indicated that higher self-reported empathy and professional preparedness were significantly associated with lower levels of stress and fewer psychosomatic symptoms. Respondents who felt unprepared to provide emotional support were more likely to report chronic fatigue, headaches, and gastrointestinal disturbances.

Conclusions: These findings highlight the need for structured education focused not only on clinical skills but also on emotional preparedness. Psychological support systems should be integrated into neonatal care environments to mitigate occupational stress and prevent burnout.

The high survival rate of pediatric cancer patients has prompted a growing research focus on the long-term sequelae of cancer treatment. Premature ovarian insufficiency (POI) and infertility, which are the consequences of the gonadotoxic effects of anticancer therapy, have a profound impact on the quality of life of the affected individuals. A rapidly evolving field of oncofertility has emerged in an attempt to establish a structured approach to fertility preservation in oncologic patients. This study presents the practical aspects of fertility preservation strategies, in accordance with the latest guidelines for young female patients undergoing cancer treatment during childhood and adolescence, as well as the experience of the Gdansk Center in harvesting ovarian tissue for cryopreservation.