Ginekologia polska最新文献

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.

Objectives: The aim of this Guideline was to devise a standardized and simplified diagnostic overview of women with urinary urgency and other symptoms indicative of the overactive bladder (OAB) syndrome.

Material and methods: A review of the available literature about the diagnostic processes for the OAB syndrome, in-cluding current international guidelines, original and review articles, was conducted. Data quality, benefit-to-risk ratio, resource availability in Poland, and expert consensus were considered when developing this Guideline.

Results: Clinical evaluation of patients with symptoms suggestive of OAB should encompass medical history - general as well as focused, physical examination, and urinalysis. Ultrasound examination of the bladder, with the assessment of post-void residual measurement, as well as a voiding diary might be crucial supplementary diagnostic measures. If the abovementioned management allows us to exclude other causes of the symptoms, the diagnosis of OAB is established and pharmacotherapy may be initiated. Endoscopy, imaging tests other than bladder ultrasound, cytology and uro-dynamics may prove to be necessary if urinary urgency is accompanied by the following: hematuria, pelvic mass, voiding symptoms, pelvic pain, neurological diseases, or other diseases which may affect the functioning of the urinary tract.

Conclusions: A diagnostic scheme for the OAB syndrome, subdivided into the initial and specialized evaluation, was designed. The significance of each test was discussed in the Guideline.

Introduction: The most prevalent condition affecting the metabolism of carbohydrates during pregnancy is gestational diabetes mellitus (GDM). Continuous glycemia monitoring systems that use sensors are currently replacing the conventional self-monitoring of glycemia with a glucometer. Poland's insurance coverage has made new technologies possible for continuous glycemia monitoring. Our retrospective study compared the effects of two glycemic measurement techniques on patient preferences and maternal and pediatric clinical outcomes: traditional methods using a glucometer and utilizing a sensor for scanning continuous glycemic monitoring (flash glucose monitoring, or FGM).

Material and methods: In a retrospective analysis of 277 women with GDM treated in the Department of Metabolic Diseases, University Hospital in Cracow, Poland, in January 2023 we compared the effectiveness of using of sensor FreeStyle Libra (FGM) vs self-blood glucose monitoring (SBGM) by glucometer in improving clinical maternal outcomes measured by daily insulin dose, body weight gain, mean blood glucose and newborns outcomes assessed by body weight, APGAR score, caesarean sections.

Results: We examined 224 women from the SBGM group, 53 from the FGM group, and 277 from the GDM ladies. The SBGM group was diagnosed with GDM later in pregnancy [24 (10-25) vs 11 (8-23.5) weeks; p < 0.001], was admitted at the first pregnancy visit [26 (14-29) vs 20 (12-27) weeks; p = 0.001], and was slightly older [33 (30-36) vs 32 (29-34) years; p = 0,027]. The pre-pregnancy body weight [70 (60-83) vs 67 (59-79) kg; p = 0.358] and the number of pregnancies [2 (1-3) vs 2 (1-3); p = 0.118] did not differ between the two groups. Women who used SMGB gained less weight throughout pregnancy [10 (5.5-13.0) vs 12 (8-14.8) kg; p = 0.0333] and had fewer prenatal checkups [5 (4-7) vs 8 (5-9) weeks; p < 0.001], including fewer teleconsultations [1 (0-3)]. Women in the FGM group received insulin treatment earlier [15 (11.5-27) vs 27 (16-30) week of pregnancy; p < 0,001] and used it more often [52 (98.1%) vs 183 (81.3%); p = 0.005]. There was no significant difference in daily insulin dose per kg of weight [26.5 (11.5-39.2) vs 21 (9-39) U/d; p = 0.325]. The groups did not differ in birth weight [SBGM 3243 ± 485 vs FGM 3331 ± 359 g; p = 0.206] and a gestational week at delivery [38 (38-39) vs 39 (38-39) week; p = 0.092], There was no difference in obstetric outcomes: caesarean sections, preterm births, week of delivery, mean birth weight or prevalence of perinatal complications.

Conclusions: When comparing traditional SBGM to flash continuous glucose monitoring in this real-world observation, we have found no changes in the outcomes for mothers and newborns between the groups. There were more teleconsultations for women who used FCGM.

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.