Ginekologia polska最新文献

Objectives: Recurrent miscarriage is a multifactorial condition, with immune dysregulation proposed as a potential contributing factor. This study investigates the causal relationship between immune cell phenotypes and miscarriage risk using Mendelian randomization (MR).

Material and methods: We performed a two-sample MR analysis using genome-wide association study (GWAS) summary statistics from publicly available datasets. The exposure data for immune cell phenotypes were obtained from the ebi-a-GCST90001599 dataset in the IEU GWAS database, which included over 3,000 individuals of predominantly European ancestry from multiple cohorts within the UK Biobank. The outcome data for miscarriage risk were sourced from the UKB-B-419 dataset in the MRC-IEU GWAS database, which analysed the number of spontaneous miscarriages in 78,700 individuals of predominantly European ancestry from the United Kingdom. The primary MR analysis was conducted using inverse-variance weighted (IVW) regression, complemented by Wald ratio and MR-Egger regression methods to assess robustness. MR-PRESSO was used to test for pleiotropy, while sensitivity analyses evaluated instrument validity and heterogeneity.

Results: MR-Egger regression did not provide statistically significant evidence for a causal association between immune cell phenotypes and miscarriage risk. However, IVW and Wald ratio analyses identified statistically significant associations between specific immune cell profiles and miscarriage risk. A higher proportion of HLA DR+ CD4+ and CD8+ T cells was associated with an increased risk of miscarriage (p < 0.005), while a higher absolute lymphocyte count was linked to a decreased risk (p = 0.011). Additionally, elevated levels of TCRgd T cells and FSC-A on CD4+ T cells were potentially protective against miscarriage (p < 0.01). Conversely, lower proportions of granulocytes and FSC-A on myeloid dendritic cells were associated with an increased miscarriage risk (p < 0.05). MR-PRESSO detected significant pleiotropy (global test p < 0.001), suggesting that some genetic variants may influence other traits, potentially biasing the initial MR estimates.

Conclusions: Our findings suggest a complex interplay between immune cell composition and miscarriage risk, providing new insights into the immunological mechanisms contributing to pregnancy loss. These results highlight the need for further research to confirm these associations and explore potential therapeutic targets for immune-related pregnancy complications.

Objectives: To identify novel marker genes to predict potential gestational diabetes mellitus (GDM) patients.

Material and: METHODS: Based on Gene Expression Omnibus (GEO) datasets, the differentially expressed genes (DEGs) between control and GDM were identified, followed by enrichment analysis and protein-protein interaction (PPI) network construction. Then, Weighted gene co-expression network analysis (WGCNA) was conducted to screen the key module genes, then the important genes were obtained. In addition, Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression, Support Vector Machine - Recursive Feature Elimination (SVM-RFE), and random forest (RF) were employed to identify the key genes. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic efficacy of key genes, and a nomogram was developed. The correlation between key genes and immune cells was analyzed, and miRNA-mRNA-TF network was constructed.

Results: A total of 257 DEGs were screened between control and GDM groups, and these DEGs were involved in p53 signaling pathway, cell cycle and oocyte meiosis pathways. Then PPI network was constructed, including 163 nodes and 5502 interaction relationships. After WGCNA and machine learning, a total of 4 key genes were obtained, including SNRPD3, NGDN, ANKRD36 and TAS2R20, followed by a nomogram was constructed. SNRPD3 was positively correlated with CD8 T cells. miRNA-mRNA-TF network was conducted, including 56 miRNAs, 4 mRNAs, and 32 TFs. Besides, luteolin PC3 UP, alsterpaullone PC3 UP, and solanine HL60 UP were associated with NGDN, and MeIQx CTD 00001739 was related to TAS2R20.

Conclusions: Four key marker genes for predicting potential GDM were identified, including SNRPD3, NGDN, ANKRD36 and TAS2R20, and a nomogram was established for predicting potential GDM patients.

Objectives: Obesity negatively affects female fertility and pregnancy outcomes. Bariatric surgery improves weight, metabolism, and fertility, but concerns remain about maternal and neonatal outcomes. To evaluate reproductive and perinatal outcomes in Polish women who conceived after bariatric surgery (MOMBARIS 2).

Material and methods: A retrospective study (2015-2024) in 11 bariatric centers included 160 women post-surgery; 154 conceived and were analyzed for fertility, pregnancy, and neonatal outcomes.

Results: Pregnancy occurred in 97.5% of participants, mostly spontaneous (83.8%) and planned (58.7%). BMI dropped from 43.1 to 30.45 kg/m².

Complications: anemia (35.9%), gestational diabetes (16.2%), hypertension (10.2%). Cesarean rate: 52.7%. Neonatal outcomes were favorable: median birth weight 3,330 g, gestational age 39 weeks, 97.9% had Apgar 10, and 3.0% had anomalies.

Conclusions: Despite maternal risks, neonatal outcomes were excellent. Bariatric surgery improves fertility without compromising fetal health.

Objectives: We aimed to evaluate the effect of continuous epidural block combined with free positioning on the genital tract injury in parturients undergoing vaginal delivery.

Material and methods: A total of 146 women who underwent vaginal delivery between January 2021 and December 2022 were divided into control and research groups (n = 73) using a random number table. Based on continuous epidural block, vaginal delivery was performed in a routine obstetric position for the control group and in free positions (sitting, walking, standing, kneeling, squatting, and lying on the side) for the research group. The duration of labor, neonatal asphyxia rate, genital tract injury rate, delivery outcomes, sense of control during childbirth, fear of childbirth, and postpartum fatigue were compared.

Results: The research group had significantly shorter first stage of labor, second stage of labor, third stage of labor and total stage of labor than those of the control group (p < 0.05). The two groups had similar Apgar scores of neonates (p > 0.05). In the research group, the neonatal asphyxia rate and genital tract injury rate were significantly lower than those of the control group (p < 0.05). The research group had a higher natural delivery rate and lower rates of conversion to cesarean section and assisted vaginal delivery than those of the control group (p < 0.05). The score of internal control sense, score of external control sense and total score of control sense of the research group were higher than those of the control group (p < 0.05). In the research group, the scores of fears of neonatal health, delivery control, pain and hospital intervention and total score of fear were lower than those of the control group (p < 0.05). The research group had lower scores of immediate postpartum fatigues, 1-h postpartum fatigue, and 2-h postpartum fatigue than those of the control group (p < 0.05).

Conclusions: Continuous epidural block combined with free positions can significantly shorten the duration of labor, reduce the incidence rate of genital tract injuries, increase the sense of control during childbirth, and ease the fear of childbirth and postpartum fatigue.

Objectives: This article aimed to systematically review the literature on smooth muscle tumors of uncertain malignant potential, known as STUMPs. These tumors pose both diagnostic and therapeutic challenges.

Material and methods: A literature search was conducted in PubMed using the keyword STUMP, covering articles from the last 5 years. Relevant articles were retrieved in full format and reviewed for additional references, from which further eligible articles were also included RESULTS: STUMPs often resemble leiomyomas or leiomyosarcomas. While they typically have a benign course, some patients may experience recurrence and distant metastasis. There are no standardized guidelines for treatment; however, hysterectomy is commonly performed, or myomectomy may be considered to preserve fertility.

Conclusions: The findings highlight the necessity for additional studies to standardize the diagnosis and treatment of these tumors. Continuous monitoring of patients post-surgery is essential to identify any recurrence or metastasis.

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.