Ginekologia polska最新文献

Objectives: Streptococcus agalactiae (GBS) infection is significant in obstetric and neonatal complications. Maternal age, particularly adolescent pregnancy, may influence the prevalence of GBS colonization and associated clinical outcomes. This study aimed to evaluate the impact of maternal age on obstetric and neonatal outcomes, with a specific focus on the modifying effect of GBS status. The analysis explored whether the associations between maternal age and selected outcomes remained statistically significant after adjusting for GBS interactions.

Material and methods: A retrospective matched cohort study was conducted with 582 participants, comprising a study group and a matched control group selected through propensity score matching. The study group included adolescents (≤ 19 years, n = 194) and older individuals (> 19 years, n = 388). Inclusion criteria required GBS screening after the 35th week of gestation, bacterial culture upon hospital admission, and delivery during the same hospitalization. Statistical analyses included logistic and linear regression models adjusted for interactions with GBS.

Results: In unadjusted analyses, adolescent mothers showed a higher likelihood of postpartum hemorrhage (OR = 2.715, p = 0.02), uterine atony (OR = 3.594, p = 0.043), transient tachypnea of the newborn (TTN) (OR = 6.16, p = 0.027), and shorter neonatal length (Estimation = -0.791, p = 0.001). However, after adjusting for interactions with GBS, these associations lost statistical significance: postpartum hemorrhage (AOR = 0.67, p = 0.711), uterine atony (AOR = 2.417, p = 0.315), TTN (AOR = 4.87, p = 0.117), and neonatal length (Estimation = -0.207, p = 0.584).

Conclusions: These findings indicate that GBS colonization confounds the observed relationships between maternal age and these outcomes. These results underscore the importance of accounting for GBS status in assessing age-related risks during pregnancy and tailoring clinical management accordingly.

Objectives: The nursing and midwifery professions are potential influences on life satisfaction and self-efficacy, especially in obstetric settings dealing with fetal demise or severe congenital anomalies. This study aimed to assess how sociodemographic factors (e.g., workplace, marital status, financial situation, occupation, and tenure) and specific job exposures (frequency of neonatal death and caregiving for newborns with lethal defects) impact life satisfaction and self-efficacy among nurses and midwives. The study further explored the role of employer-provided psychological support in influencing job satisfaction and self-efficacy.

Material and methods: A diagnostic survey with a custom questionnaire, supplemented by the General Self-Efficacy Life satisfaction and self-efficacy (GSES) and Satisfaction with Life Scale (SWLS), was conducted in level II and III referral centers in Poland's Silesian region in 2023. Participants included nurses and midwives in various neonatal and obstetric departments. Statistical analyses encompassed descriptive statistics, chi-square tests, and Spearman correlations, with significance set at p < 0.05.

Results: A majority of participants reported moderate to high life satisfaction (41.7%) and self-efficacy (59.0%). Key factors impacting life satisfaction included marital status, financial situation, education, tenure, and caregiving frequency for newborns with lethal defects. High self-efficacy was significantly associated with job satisfaction, tenure, and workplace environment but was unaffected by marital status, financial situation, or psychological support.

Conclusions: The findings highlight the emotional burden on nurses and midwives in neonatal care. Enhanced psychological support, stress-coping training, and policy adjustments are recommended to support this workforce. Further studies should broaden regional scope and examine links between life satisfaction, self-efficacy, and job satisfaction.

Objectives: To evaluate the feasibility and outcomes of gasless single-port access (SPA) laparoscopy in overweight patients undergoing adnexal surgery.

Material and methods: A retrospective review was conducted on the medical records of 118 patients who underwent gasless SPA laparoscopic adnexal surgery using J-shaped or triangular-shaped retractors between May 2017 and June 2022. Patients were categorized into overweight (BMI ≥ 23) and standard-weight (BMI < 23) groups. Surgical characteristics and outcomes were compared between the two groups.

Results: Out of 118 patients, 41 were in the overweight group, and 77 were in the standard-weight group. Significant differences were observed in age (p = 0.001), the number of previous abdominal surgeries (p = 0.001), and the number of subjects who had given birth (p = 0.004), all higher in the overweight group. There were no significant differences between the groups in setup time from umbilical skin incision to abdominal wall retraction, use of additional TROCARS: operation time, estimated blood loss, or length of postoperative hospital stay. No serious intraoperative complications, such as urologic, bowel, and vessel injuries were noted in either group. Tumor diameter (p < 0.001), bilaterality (p < 0.001), presence of adhesion (p = 0.026), and setup diameter of the retractor (p = 0.001) significantly correlated with operation time in multivariate analysis (Adjusted R² = 0.645).

Conclusions: Gasless SPA laparoscopic adnexal surgery in overweight patients is a feasible and effective alternative to conventional SPA laparoscopy, mitigating the potential negative effects of carbon dioxide gas.

O: BJECTIVES: Circular RNAs (circRNAs) are known to be associated with the progression of gestational diabetes mellitus (GDM). Thus, the objective of this study was to unveil the influnce and potential mechanism of hsa_circ_0002768 in GDM. M: ATERIAL AND: METHODS: Levels of hsa_circ_0002768 were quantified by RT-qPCR. Placental hsa_circ_0002768 levels were analyzed after pregnancies. Trophoblast cell (HTR-8/SVneo) functions, including oxidative stress, mitochondrial dysfunction, cell viability, autophagy, and invasion, were evaluated upon hsa_circ_0002768 knockdown. Finally, the downstream miRNA for hsa_circ_0002768 was investigated. RESULTS: Hsa_circ_0002768 levels increased as high glucose-induced, and in GDM placenta. In vitro experiments showed that hsa_circ_0002768 knockdown positively regulated trophoblast oxidative stress and mitochondrial functions, thus inducing cell viability and invasion, but inhibiting autophagy. miR-339-5p was a downstream molecular for hsa_circ_0002768, which targeted to TLE3. CONCLUSIONS: This study reveals a physiological role for hsa_circ_0002768 during GDM.

Objectives: The aim was to construct a reliable working model for patients with placenta previa (PP) that aids in the prediction of postpartum bleeding potential with data from antenatal imaging studies using both ultrasound (US) and magnetic resonance imaging (MRI).

Material and methods: Forty-three patients with PP were evaluated initially with the US and then by 3-Tesla MRI. The Placenta Accreata Index (PAI) was used during the US evaluation in order to define the risks. Uterine bulging, heterogeneous signal, dark placental bands, focal interruption of myometrium and tenting of bladder wall were regarded as predictive criteria in MRI evaluation. The correlation between the findings from US and MRI studies and subsequent haemorrhage, < 1000 mL, > 1000 mL and severe haemorrhage ( > 2000 mL) and massive transfusion [ > 5 units of red blood cells (RBC)] were used to build this predictive model. The findings from the imaging studies were also confirmed histopathologically.

Results: In the multivariate analysis of data from patients stratified by bleed size either < 1000 mL or > 1000 mL, none of the MRI and ultrasound findings were found to be predictive. The multivariate analysis was done using the second stratification cut-point of 2000 mL, in patients bleeding > 2000 mL PAI values [OR: 2.3 (1.4-3.8)] and overall MRI reported placenta accreata spectrum [OR: 4.9 (1.8-12.9)] were found to be predictive. While MRI findings were not discriminative between transfusion groups, grade 3 loculation on US examination was found to be predictive for the need of transfusion of > 5 units [OR: 67.5 (8.2-549.4)]. There were no cases needing hysterectomy.

Conclusions: Ultrasound and MRI findings in cases of PP can be helpful in predicting postpartum bleeding.

Objectives: Vulvar lichen sclerosus (VLS) is defined as a chronic inflammatory skin disease that most often involves lesions on the mucous membranes of the vulva with a tendency to progress to the anal skin. The etiopathogenesis of VLS remains unknown and is likely multifactorial. Data emphasize the role of immunological factors - more than 25% of VLS cases coexist with autoimmune diseases. The purpose of the present study was to determine the correlation of the prevalence of anti-thyroid antibodies - IgG class antibodies against thyroid peroxidase and IgG class antibodies against thyroglobulin in women with vulvar lichen sclerosus, and the appropriateness of screening tests for autoimmune thyroid diseases in women with vulvar lichen sclerosus.

Material and methods: Fifty women with vulvar lichen sclerosus were enrolled in the study. The control group consisted of 41 healthy women. A detailed medical history was taken with all patients, followed by laboratory determinations - anti-thyroid antibodies - IgG class antibodies against thyroid peroxidase and IgG class antibodies against thyroglobulin.

Results: Antibodies to thyroid peroxidase were present in 12% of the study group with vulvar lichen sclerosus and 4.88% of the control group, and this difference was not statistically significant (p = 0.41). Anti-thyroglobulin antibodies were detected in 4% of the patients with vulvar lichen sclerosus and 4.88% of the control group, and this difference was not statistically significant either (p = 0.76).

Conclusions: The study did not confirm the association of VLS with autoimmune thyroid diseases. Undoubtedly, based on the data available in the literature, further studies are needed to determine the mechanisms behind the association between vulvar lichen sclerosus and autoimmune thyroid diseases.

Objectives: Inhibition of estradiol production by letrozole may interfere with physiological effects of progesterone necessary to maintain the pregnancy. Treatment of tubal pregnancy (TP) with letrozole would allow to avoid the disadvantages of methotrexate (MTX). The aim was to compare the effectiveness of letrozole with MTX in the management of TP.

Material and methods: A prospective open-label cohort study was conducted among women with TP and increasing B-human chorionic gonadotropin (B-hCG) concentrations. MTX was administered in a single dose of 100 mg intravenously, while letrozole in a dose of 5 mg orally for 10 days. Blood parameters (B-hCG, hemoglobin, creatinine, urea, transaminases, bilirubin) were tested on days 0, 4 and 7.

Results: Out of 22 eligible women, 14 received MTX and received 8 letrozole. Mean age, lesion diameter, gestation age in the MTX vs letrozole arm were: 31 vs 32 years (p = 0.3), 13.2 vs 16.3 mm (p = 0.1), 7 + 1 vs 7 + 0 weeks (p = 0.6), respectively. In case of 4 women treated with letrozole and in 2 treated with MTX (4/8, 50% vs 2/14, 14.3%, p = 0.07) the treatment was unsuccessful. There were no significant differences in blood parameters on days 0, 4 and 7 between both arms, except for the increasing urea concentration in the letrozole arm (p = 0.01).

Conclusions: Even though the results did not reach statistical significance, it is likely that a larger study sample would confirm the trend of letrozole being less effective. The results did not support the use of letrozole in the studied regimen as an alternative to MTX.

Objectives: Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition involving mainly the genital area with an undetermined aetiology. Recent studies show that in up to 34% of cases in adult women, VLS coexists with allergies or autoimmune diseases like celiac disease (CD), among others. However, literature data relating strictly to the co-occurrence of celiac disease and Duhring's disease (DH) in patients with VLS are very limited.

Material and methods: In our study, we sought to clarify the possible relationship between vulvar lichen sclerosus in adult women and celiac disease in its cutaneous form. The aim of the study was to demonstrate the presence of celiac disease-specific antibodies in women with VLS. The control group consisted of 41 healthy women, and the study group consisted of 50 women aged 24-83 years with diagnosed vulvar lichen sclerosus who were hospitalized in the Department of Gynaecology, Obstetrics and Gynaecologic Oncology of the Bonifraters Medical Centre in Katowice.

Results: There were no significant differences in blood serum levels of CD-specific antibodies between both groups.

Conclusions: The study conducted did not confirm the association between vulvar lichen sclerosus and celiac disease or Duhring's disease. The main limitation of the research was the small size of the study and control groups. Further studies on a larger group of patients are needed. They could clarify the possible mechanisms behind the co-occurrence of these two conditions. Earlier diagnostic will help prevent the development of severe and irreversible complications.

In women after hematopoietic stem cell transplantation (HSCT), complications associated with the original disease and therapies used both before and after transplantation often occur, which significantly affects their quality of life. The most common gynaecological complications include secondary cancers, premature ovarian insufficiency (POI), infertility and chronic graft-versus-host disease (cGVHD). Cervical cancer is the most common secondary genital cancer in patients after HSCT. Regular screening and vaccination against HPV (Human Papillomavirus) can significantly reduce the risk for its occurrence. The specific complication after allogeneic hematopoietic stem cell transplantation is graft-versus-host disease (GVHD), the genital form of which can lead to labial and vaginal adhesions, significantly reducing the women's quality of life. The basis of treatment is local steroid therapy and immunosuppression. A consequence of chemotherapy and radiation therapy may be damage to the gonads leading to premature ovarian insufficiency and the onset of menopause symptoms. The basis of treatment is systemic hormone therapy used until middle age when natural menopause is reached. Women after HSCT who are of reproductive age also suffer from infertility. An important role of the doctor is to educate patients about the risk for infertility and to suggest appropriate methods of preserving fertility before starting treatment. The recommended procedure for fertility preservation is cryopreservation of embryos or oocytes. The freezing and retransplantation of ovarian tissue is becoming an increasingly popular method of fertility protection. Preventive examinations and early detection and treatment of gynaecological complications significantly improve the comfort of life and health of women after HSCT.