Ginekologia polska最新文献

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.

Pelvic organ prolapse (POP) involves the descent of vaginal walls, uterus, or vaginal apex. Traditional native tissue repair techniques, while low in complications, exhibit significant relapse rates. To enhance durability of surgical repair, synthetic mesh systems were adopted. However, early generations faced complications such as vaginal mesh exposure and dyspareunia, leading to critical reevaluation and regulatory actions. The Food and Drug Administration issued first warning in 2008 and reclassified mesh as high-risk in 2016, banning it for transvaginal anterior compartment prolapse in 2019. European and Canadian regulations similarly increased scrutiny, with prominent professional organizations and regulatory bodies endorsing limited use and thorough counseling. Subsequent innovations introduced lighter mesh systems with sacrospinous ligament fixation, which improved anatomical outcomes and reduced adverse effects. Recent studies on these systems demonstrate promising success rates, with notable reductions in prolapse recurrence and improved quality of life. Given these developments, current perspectives advocate for selective use of advanced mesh systems in POP surgery, emphasizing rigorous patient selection, informed consent, and meticulous surgical technique. This careful approach, as opposed to a categorical ban, aims to balance the therapeutic benefits with potential risks, ensuring optimized patient outcomes in POP management.

Sexual education is a vital process of teaching and learning about various aspects of human sexuality, including physical, emotional, social, and cultural dimensions. Its primary goal is to equip individuals, especially adolescents, with the necessary knowledge, skills, and values to make informed, responsible, and safe decisions regarding their sexual and reproductive lives. This article examines sexual education programs in Australia, Oceania, and Europe, addressing the current state, the unique challenges, and recommendations for enhancing these programs to meet the needs of modern society.

Objectives: Colonization with Group B Streptococcus (GBS) during pregnancy can lead to invasive GBS disease (iGBS) in neonates, including meningitis, pneumonia or sepsis, which carries a high mortality risk. American College of Obstetricians and Gynecologists (ACOG) recommends universal GBS screening for all pregnant individuals between 36 0/7 and 37 6/7 weeks of gestation. However, due to the insufficient population-based studies on universal screening and GBS colonization rates in late periods of pregnancy in Türkiye, we aimed to evaluate the prevalence of GBS and its antibiotic resistance to enhance awareness regarding GBS screening and prophylaxis during pregnancy and promote the use of appropriate antibiotics.

Material and methods: This prospective, single-center study was conducted between May 2017 and December 2017 on 518 pregnant women (363 Turkish and 155 Syrian). Vaginal and rectal samples were collected and cultured in Todd-Hewitt broth. Standard microbiological protocols were used to assess GBS colonization and antibiotic susceptibility.

Results: In the study, we found that 10.6% (n = 55) of pregnant women were colonized with GBS asymptomatically. Group B Streptococcus colonization rates did not differ significantly between Turkish patients (11%, n = 40) and Syrian patients (9.7%, n = 15) (p = 0.756, p > 0.05). All patients colonized with GBS were penicillin-sensitive. However, resistance to at least one non-penicillin antibiotic was observed in 42.5% (n = 17) of Turkish patients and 60% (n = 9) of Syrian patients. Although not statistically significant (p > 0.05), Syrian patients exhibited relatively higher rates of antibiotic resistance, especially to erythrosine and clindamycin.

Conclusions: In our country, implementing universal screening for asymptomatic GBS in pregnant women, as recommended by the Centers for Disease Control and Prevention (CDC), would be more beneficial than a risk-based screening approach. Given the increased resistance patterns observed in antibiogram results, GBS prophylaxis at delivery, especially in patients with penicillin allergies, should be planned based on antibiotic susceptibility testing.

Objectives: In this pilot study the proton Nuclear Magnetic Resonance (¹H NMR)-based metabolomics was applied to explore the serum metabolomes of the patients with high-grade serous ovarian carcinoma (HGSOC) and the patients with benign gynaecological disease and to identify the characteristic biomarkers.

Material and methods: We analyzed serum samples from 17 HGSOC patients and 14 control patients with benign gynecological conditions. Serum metabolites were profiled using 1H NMR spectroscopy, and multivariate data analyses, including Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA), were performed to identify discriminating metabolites.

Results: The multivariate analysis revealed the lower levels of the lipid compounds, choline, branched-chain amino acids, 3-hydroxybutyrate (3HB), acetoacetate, and the higher level of lactate in the sera of the HGSOC patients compared to the control group.

Conclusions: NMR-based metabolomic analysis can serve as a supporting method for the detection of ovarian cancer and may be useful as an adjunct to molecular diagnostics.

Objectives: The purpose of this study was to assess and compare the knowledge, attitudes, and practices of Polish midwives and obstetricians concerning external cephalic version (ECV), with particular attention to how professional qualifications, experience, and the reference level of the healthcare facility influenced these factors across both groups.

Material and methods: An author-created, 22-question online survey was distributed separately to midwives and obstetricians, with each group receiving a questionnaire customized to assess their specific knowledge of ECV, professional experience, and attitudes toward the procedure.

Results: The study included 839 participants: 378 midwives and 461 physicians. Knowledge and experience with ECV varied significantly based on work experience and the reference level of the workplace. When comparing the results between midwives and obstetricians, the median (Q1-Q3) score for correct answers on ECV was highest among obstetrics and gynecology residents (5, 3-6), while the lowest scores were seen among midwives with bachelor's degrees (2, 1-4).

Conclusions: The study identified significant considerable knowledge gaps regarding ECV, particularly among midwives. Educational initiatives targeting both midwives and obstetricians are recommended to encourage the greater use of ECV and potentially reduce the rates of elective cesarean sections in cases of non-cephalic fetal presentations.