Ginekologia polska最新文献

Objectives: To evaluate and compare maternal and neonatal outcomes in dichorionic diamniotic (DCDA) twin pregnancies conceived via assisted reproductive technology (ART) versus those conceived spontaneously (SC).

Material and methods: This single-center, retrospective cohort study included 852 DCDA twin pregnancies, with 591 conceived spontaneously (SC group) and 261 conceived via ART (ART group). Maternal and neonatal outcomes were extracted from the hospital's automation system and analyzed using statistical methods, including chi-square and Mantel-Haenszel chi-square tests, to account for potential confounding factors.

Results: Our findings indicate that ART twin pregnancies have significantly poorer outcomes compared to SC twin pregnancies. The risk of cerclage application is 12.6 times higher in the ART group. Furthermore, ART pregnancies exhibit a 19.2-fold increased risk of intrahepatic cholestasis of pregnancy (ICP). The rates of preterm birth, including late preterm, moderate preterm, very preterm, and extremely preterm, are significantly higher in the ART group. Moreover, ART pregnancies are associated with higher incidences of very low birth weight (VLBW), NICU admissions, and neonatal death. The ART group also experiences significantly higher rates of gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), postpartum hemorrhage, and cesarean section, with postpartum atony occurring 4 times more frequently.

Conclusions: Maternal and neonatal outcomes in ART-conceived DCDA twin pregnancies are markedly worse compared to those conceived spontaneously. The observed disparities underscore the necessity for intensive monitoring and tailored management strategies in ART twin pregnancies. Further research is essential to uncover the mechanisms driving these adverse outcomes.

Emotional disorders during pregnancy and the postpartum period affect many women worldwide and present a significant challenge in perinatal care. The first year after childbirth is particularly demanding for a woman's emotional well-being, asitismarked by profound physical, emotional, and social changes. The aim of this article is to review and compare the latest data on the prevalence, risk factors, and treatment options for baby blues and postpartum depression. For this purpose, the electronic databases - including PubMed, NLM, MDPI, Europe PMC, and Google Scholar - were searched for recent English-language articles with full-text availability. The search terms included: postpartum depression, baby blues, maternity blues, postpartum depression prevalence, postpartum depression risk factors, postpartum depression treatment, online psychotherapy, and postpartum depression covid. The review was compiled and evaluated using SANRA (Scale for the Assessment of Narrative Review Articles).

Objectives: Magnetic resonance imaging (MRI) imaging can be useful when fetal central nervous system (CNS) anomalies are detected by ultrasound (USG). This study aims to compare the findings from USG and MRI with post-natal results in cases of fetal CNS anomalies.

Material and: METHODS: This is a retrospective/prospective study that analyzed the records of 55 pregnant women who underwent both fetal MRI and USG and whose birth results were obtained due to suspected CNS abnormalities between 2020 and 2023.

Results: Pearson correlation analysis and Blant-Altman analysis showed that USG and MRI results of right lateral ventricle measurement were more similar compared to left lateral ventricle measurement. When the cut-off value for lateral ventricle measurement was 10 mm, there was a difference in the USG and MRI results of only 1 pregnant woman in the right lateral ventricle USG-MRI comparison, whereas no difference was observed in 9 pregnant women in the left lateral ventricle analysis. One pregnant woman with healthy USG results was found to have corpus callosum hypoplasia by MRI and one pregnant woman with posterior fossa anomaly by USG had healthy MRI results. All other measurements showed similar results between USG and MRI.

Conclusions: Fetal MRI, when performed with appropriate indications in selected cases evaluated by USG, is useful for measuring the lateral ventricles and detecting various CNS anomalies. The advancing technology of USG and MRI devices, along with the experience of the physicians interpreting these examinations, will always be important.

Objectives: Diagnostic hysteroscopy (DH) is a gold standard diagnostic imaging tool in gynecology. There is insufficient data in the literature regarding the reduction of pain felt during the DH and there is no study in the literature that examines the relationship between the measurement of uterine version or flexion angles and the pain felt during DH procedure. The aim of this study was to investigate the effects of uterine version or flexion angles on pain severity during DH and to identify predictive factors for severe pain experienced during the procedure.

Material and methods: This prospective single-center cohort study included patients who were eligible for DH within medical indications. Exclusion criteria comprised menopausal status, congenital uterine anomalies, uterine fibroids larger than 2 cm detected on ultrasonography, suspected malignancy, or retroverted uterus. Before hysteroscopy, all patients underwent transperineal ultrasonography to measure uterine version and flexion angles. Patients were asked to rate their pain levels using a 0-10 numerical visual analog scale (VAS). Patients with VAS scores ≥ 6 were categorized into the severe pain group, while those with scores < 6 were classified into the moderate pain group.

Results: The study comprised 98 women undergoing DH. Multivariate binary logistic regression analysis identified anteversion angle and nulliparity as significant predictors of severe pain during DH. The optimal cut-off value for predicting severe pain during DH was identified as 74.5°, providing a sensitivity of 66.7% and specificity of 69.0% [area under curve (AUC) = 0.722, p = 0.001].

Conclusions: This study demonstrates that a uterine anteversion angle narrower than 74.5° is associated with severe pain during DH.

Uterine fibroids (UFs) are the most common benign tumors of the myometrium, affecting up to 70% women by age 50. Although many cases remain asymptomatic, symptomatic UFs can significantly reduce quality of life through excessive bleeding, anemia, pelvic pain, infertility, and obstetric complications. Despite the availability of various conservative treatments - including pharmacotherapy, uterine artery embolization, and ultrasound thermoablation - surgical interventions, particularly hysterectomy, remain the dominant approach in many countries. This discrepancy between evidence-based recommendations and routine practice highlights the persistence of a paternalistic model of care, where patients are often excluded from treatment decisions and not informed about alternatives. Emerging concepts such as shared decision making (SDM) and personalized therapy emphasize the need to adapt treatment plans to each woman's clinical profile, reproductive goals, and preferences. SDM fosters trust, better adherence to therapy, and improved acceptance of complications by actively involving patients in choosing their care. The development of modern pharmacological options, like GnRH analogs, further expands possibilities for effective, reversible, fertility-preserving treatments. A paradigm shift toward patient-centered, individualized management is essential to address ethical challenges, reduce unnecessary hysterectomies, and improve outcomes. Implementing SDM and expanding access to conservative therapies require systemic changes in reimbursement, training, and patient education to ensure that care focuses not only on the disease but on the woman as a whole.

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging minimally invasive technique that combines natural orifice access with endoscopic visualization and instrumentation. Minimally invasive surgery has revolutionized gynecologic practice by reducing postoperative morbidity and enhancing recovery. vNOTES represents a novel advancement, utilizing the vaginal route to access the peritoneal cavity without abdominal incisions. This technique offers potential benefits including scarless surgery, decreased postoperative pain, and shortened hospital stays. This review summarizes the surgical technique, clinical applications, advantages, limitations, and future perspectives of vNOTES in gynecologic surgery.

Objectives: This meta-analysis aims to explore the association between MMP-9-C1562T polymorphism and susceptibility to preeclampsia (PE).

Material and methods: Four English databases were searched to collect relevant records up to April 2024. The pooled odds ratio (OR) was calculated using Stata 15.0.

Results: A total of 10 studies were enrolled in our systematic review. The results showed that genotype CT at MMP-9-C1562T locus increased the risk of PE versus genotype TT (Genotype CT vs TT: OR = 2.32, 95% CI: 1.27-4.24, P = 0.006), but no significant differences were found in other gene models (C vs T: OR = 0.88, 95% CI: 0.71-1.08, P = 0.225; Genotype CC vs TT: OR = 1.51, 95% CI: 0.87-2.61, P = 0.139; Genotype CC + CT vs TT: OR = 1.63, 95% CI: 0.95-2.81, P = 0.079; Genotype CC vs CT + TT: OR = 0.80, 95% CI: 0.63-1.03, P = 0.086). Subgroup analysis by ethnicity showed a statistically significant difference in the heterozygous model in China (Genotype CT vs TT: OR = 2.38, 95% CI: 1.15 -4.91, P = 0.019).

Conclusions: Association of MMP-9-C1562T polymorphism with susceptibility to PE exists. Specifically, genotype CT increases the risk of PE versus genotype TT, particularly in Caucasian populations.

Bone mineral density (BMD) is crucial for bone strength, with even a modest decrease significantly elevating fracture risk. Calcium imbalance during pregnancy contributes to BMD loss, as maternal stores are mobilized to support fetal skeletal development. Vitamin D deficiency exacerbates this issue, with prevalence rates alarming in various populations. Supplementation with vitamin D and calcium aims to mitigate BMD decline; however, optimal dosing and efficacy remain debated. Studies utilizing innovative diagnostic tools like radiofrequency echographic multi spectrometry (REMS) and quantitative ultrasonometry (QUS) shed light on BMD changes during pregnancy, offering safer alternatives to traditional methods such as dual-energy X-ray absorptiometry (DEXA), prohibited during pregnancy due to fetal radiation risks. Despite methodological challenges, research reveals significant BMD reductions during pregnancy, particularly in weight-bearing bones. In conclusion, maintaining maternal bone health during pregnancy and postpartum is critical, requiring comprehensive monitoring and support. Further research is needed to elucidate optimal strategies for preserving BMD throughout the reproductive lifespan, reducing fracture risk and enhancing maternal well-being.

Objectives: To compare the effects of using 11 mm trocar and 5 mm trocar as primary ports on postoperative pain in benign gynecological laparoscopic surgeries.

Material and methods: The patients were divided into two groups as the primary port, group I (5 mm trocar) and group II (11 mm trocar) by block randomization.

Results: In the 5 mm trocar group, postoperative pain score and need for analgesia were less in level I and level II operations. Patient satisfaction was significantly higher in the 5 mm trocar group. The postoperative pain score was higher in patients who had trocar insertion attempts 3 times with the direct trocar method compared to patients with 1 or 2 trocar entry attempts.

Conclusions: The use of a 5 mm laparoscope in benign gynecological operations is an advantageous method due to low postoperative pain score, analgesic requirement, and high patient satisfaction.

Objectives: Cardiotocography (CTG) is widely used for continuous or intermittent assessment of fetal heart function. This study aimed to compare the effects of continuous and intermittent CTG during labour on selected variables.

Material and methods: In a retrospective study, 4172 medical records of Warsaw Hospital (Poland) patients were analysed. The study group consisted of 2111 women with continuous CTG during labour and the control group of 2061 women with intermittent CTG.

Results: In the group with intermittent CTG, a higher odds ratio of caesarean section (OR = 1.06, 95% CI = 0.87-1.30), second-degree perineal tear (OR = 1.65, 95% CI = 1.07-2.55),third- and fourth-degree perineal tears (OR = 5.13, 95% CI = 1.12-23.53) and oxygen therapy (OR = 1.76, 95% CI = 1.19-2.59) were noted. In the group with intermittent CTG, a lower odds ratio of a newborn with an Apgar score of ≤ 7 points in the fifth minute of life (OR = 0.34, 95% CI = 0.12-0.94), nCPAP (Nasal Continuous Positive Airway Pressure) (OR = 0.56, 95% CI = 0.36-0.86) and resuscitation (OR = 0.37, 95% CI = 0.17-0.79)) were observed. The analysis shows that in the group of women with intermittent CTG during labour, the odds ratio of abnormal BE result was lower (OR=0.45, 95% CI = 0.21-0.98).

Conclusions: Continuous CTG during labour in high-risk women increases the likelihood of instrumental delivery (using vacuum) and perineal incision compared with intermittent CTG. The use of intermittent CTG during labour reduces the number of newborns with Apgar scores ≤ 7 points and decreases the number of neonatal interventions such as nCPAP and resuscitation.