Ceska Gynekol [JOURNAL]
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200 papers
A rare childhood uterine malignancy combined with complete uterine inversion.
Klenovská L, Meixnerová I, Minář L … +1 more , Ježová M
Ceska Gynekol · 2025 · PMID 40663451 · Publisher ↗
OBJECTIVE: An overview of the types of uterine sarcoma, supplemented by an illustrative case report of a rare uterine childhood tumor. CASE REPORT: Our case report describes the case of a 9-year-old girl with a 15-cm tum...
OBJECTIVE: An overview of the types of uterine sarcoma, supplemented by an illustrative case report of a rare uterine childhood tumor. CASE REPORT: Our case report describes the case of a 9-year-old girl with a 15-cm tumor in the abdominal cavity, which prolapsed vaginally before introitus during a clinical examination of the abdominal wall causing life-threatening bleeding. This bleeding was stopped by ligation of the tumor pedicle and its resection. Histological examination of the resected specimen described Müllerian adenosarcoma of the uterus. Based on the staging, laparoscopic hysterectomy with bilateral salpingectomy was indicated by the oncogynecological committee. The operation was performed without complications, and intraoperatively, a complete inversion of the uterus was diagnosed.
Late prenatal diagnosis of complete pentalogy of Cantrell.
Albrecht MEM, Sevillano Filho R, Araujo Júnior E
Ceska Gynekol · 2025 · PMID 40663450 · Publisher ↗
Cantrell's pentalogy is a rare syndrome associated with a midline embryological defect involving a series of malformations: anomalies of the lower sternum, anterior diaphragm, heart, and anterior abdominal wall. It can b...
Cantrell's pentalogy is a rare syndrome associated with a midline embryological defect involving a series of malformations: anomalies of the lower sternum, anterior diaphragm, heart, and anterior abdominal wall. It can be classified as complete, probable or partial, but the most important thing is to describe and understand the anomalies involved. We describe a case of a late diagnosis of Cantrell's pentalogy at 35 weeks and 5 days of pregnancy in a woman from the interior of Pará state, an Amazon Brazilian region. Fetal echocardiography confirmed the diagnosis of Cantrell's pentalogy with tetralogy of Fallot and ultrasound examination showing a bilateral clubfoot. Cesarean section was performed at 36 weeks because of pre-eclampsia superimposed on chronic arterial hypertension with signs of severity. The male newborn was delivered weighting 2,320 grams. Postnatal echocardiography confirmed the diagnosis of Cantrell's pentalogy and karyotype was normal (46, XY). Infant was discharged at 47 days of age with good weight gain, artificial breastfeeding, and outpatient follow-up by the cardiology and cardiac surgery specialists.
Hysterosalpingographic evaluation following management of ectopic pregnancy.
Elboghdady AA, Ibrahim Mohamed M, Farahat MFAEA … +11 more , Mohamed MAM, Atalla EM, Eltabakh AAE, Ahmad AK, Diab YMS, Khalil GFAA, Metwally MM, El Makawy AR, Ghit AM, Abo Eldahab IMIM, Elsayed FM
Ceska Gynekol · 2025 · PMID 40663449 · Publisher ↗
OBJECTIVE: It is to assess the ipsilateral and contralateral tubal patency by hysterosalpingography following salpingostomy and methotrexate therapy for tubal pregnancy. PATIENTS AND METHODS: The study was conducted betw...
OBJECTIVE: It is to assess the ipsilateral and contralateral tubal patency by hysterosalpingography following salpingostomy and methotrexate therapy for tubal pregnancy. PATIENTS AND METHODS: The study was conducted between September 2021 and October 2023. It was conducted in the radiodiagnosis and obstetrics and gynecology departments of the Al-Hussin and Al-Azher university hospitals. Patients who had undergone salpingostomy or received methotrexate treatment were included in this research. Three months after being discharged, the individuals who were seeking for fertility were assessed again for Fallopian tube patency using hysterosalpingographs. Two groups of women participated in the study: group I (N = 50) received methotrexate treatment, while group II (N = 50) had undergone salpingostomy management. RESULTS: The two groups (medical and surgery) did not vary statistically significantly in preserving tubal patency. Following methotrexate therapy, the ipsilateral tubal patency was 72%, and following surgical management, it was 74%. Furthermore, following methotrexate therapy, contralateral tubal patency was 92%, and 90% following salpingostomy. CONCLUSION: The results point to comparable success rates with salpingostomy and methotrexate in preserving fallopian tube patency.
The association between 1st trimester serum kisspeptin level and antenatal complications.
Günday ÖK, Vurmaz A, Yılmazer M
Ceska Gynekol · 2025 · PMID 40663448 · Publisher ↗
OBJECTIVE: We aimed to evaluate the usefulness of serum kisspeptin (KP), measured in the 1st trimester (11-14 weeks), as a new biomarker that can predict antenatal complications. MATERIALS AND METHODS: A prospective case...
OBJECTIVE: We aimed to evaluate the usefulness of serum kisspeptin (KP), measured in the 1st trimester (11-14 weeks), as a new biomarker that can predict antenatal complications. MATERIALS AND METHODS: A prospective case-control study of prospectively collected data. Blood samples of all patients (N = 124) were preserved at -70 °C for the assessment of serum KP-10 and KP-54 levels. The KP levels were analyzed for comparison among women who experienced complications including fetal growth retardation (FGR), pregnancy-induced hypertension (PIH), preterm delivery, gestational diabetes, and fetal death. The control group consisted of matching subjects who completed their pregnancies without problems. The predictive effect of serum KP on adverse pregnancy outcomes was investigated. RESULTS: Among all adverse pregnancy outcomes, the KP-10 level was significantly higher in patients who developed FGR (P = 0.025). In the patient cohort affected by PIH, either accompanied by preeclampsia or standalone, there was a trend towards higher KP-10 levels (P = 0.059), although statistical significance was not achieved. However, regarding KP-10, the calculated cut-off value and the area under the curve (AUC) for predicting the onset of FGR were statistically significant (AUC: 0.684; P = 0.006). The model established with KP-10, PIH, and pregnancy associated plasma protein-A (PAPP-A) was found to be significant in predicting the development of FGR (P = 0.006; NPV: 98%; PPV: 21.4%; OR: 0.10; 95% CI 0.016-0.611). CONCLUSIONS: First trimester maternal serum KP levels may have the potential to be used as a 1st trimester biomarker that can predict the development of FGR.
Effectiveness of physiotherapy on pain relief and functional recovery post-cesarean section.
Ostafiichuk S, Drohomyretska N, Kusa O … +3 more , Zhukuliak O, Neiko O, Kotyk T
Ceska Gynekol · 2025 · PMID 40663447 · Publisher ↗
BACKGROUND: Cesarean section (CS) rates are rising globally, with associated postpartum complications significantly higher compared to vaginal delivery. Addressing these complications through optimized management and tar...
BACKGROUND: Cesarean section (CS) rates are rising globally, with associated postpartum complications significantly higher compared to vaginal delivery. Addressing these complications through optimized management and targeted physiotherapy is crucial for improving maternal outcomes and quality of life. OBJECTIVE: This study aimed to evaluate the effectiveness of physiotherapy on pain relief and restoration of functional activity in women after CS. MATERIAL AND METHODS: 91 patients, who were admitted to an obstetric hospital for elective CS, were involved in the study. The control group (47 women) received standard pre- and postoperative supervision. The intervention group (44 patients), in addition to standard care, underwent physiotherapy, which included preoperative care (physiotherapy training, educational training), and postoperative exercises (breathing, circulation, and pelvic exercises, along with connective tissue massage). The results were analyzed after CS for 3 days. RESULTS: A lower intensity of postoperative pain and easier walking from the 1st day, a lower level of difficulty in performing functional activities on the 2nd day (easier turning in bed and transition to a sitting position), faster recovery of intestinal motility due to the passage of flatus in 3.5 hours and the act of defecation after 10.0 hours, decreased requirement of extra analgesics by 4.21-fold (OR = 0.24; 95% CI 0.10-0.58; P = 0.02), and a significant reduction in the length of hospital stay (OR = 0.24; 95% CI 0.09-0.57; P = 0.02) were established. CONCLUSION: The study revealed the effectiveness of the proposed physiotherapy program in the early post-cesarean period in terms of reducing pain and improving restoration of the body's functional activity.
Educational value of surgical videos on YouTube - quality assessment of and set of standards for hysterectomy using vaginal natural orifice transluminal endoscopic surgery videos.
Ayanoglu E, Tekin AB, Birol Ilter P … +4 more , Mutlu MA, Yassa M, Kaya C, Tug N
Ceska Gynekol · 2025 · PMID 40663446 · Publisher ↗
OBJECTIVE: This study aimed to assess the reliability and educational value of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy videos on YouTube and their suitability for training surgeons....
OBJECTIVE: This study aimed to assess the reliability and educational value of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy videos on YouTube and their suitability for training surgeons. MATERIALS AND METHODS: On June 12, 2024, YouTube was searched using the keywords "vNOTES hysterectomy," "TVNOTES hysterectomy," "transvaginal natural orifice transluminal endoscopic hysterectomy," "vNOTES," and "vaginal notes hysterectomy." A total of 73 videos met the inclusion criteria. Viewer engagement metrics, such as time since upload, number of views, likes, dislikes, comments, and video duration were recorded. Ratios such as a view ratio, a like ratio, and Video Power Index (VPI) were calculated. The videos were categorized by the modified Global Quality Scale (GQS) and evaluated based on a scoring system derived from a standardized 10-step vNOTES hysterectomy procedure, with scores ranging from 0 to 15. RESULTS: Out of 73 videos, 40 (53.8%) were categorized as poor quality, 13 (17.8%) as moderate, and 20 (27.4%) as good. No significant differences were found between groups in terms of time since upload, views, dislikes, comments, or a like ratio. However, videos in the good-quality group had a significantly higher number of likes and VPI scores. Critical elements such as patient preparation and positioning, setup of the operation room, circumcision of the cervix, and vault closure were inadequately addressed in lower-quality videos. Videos with a didactic voice had significantly more views, likes, and comments than those with music or no sound. No significant correlations were found between video length and engagement metrics. CONCLUSION: The majority of vNOTES hysterectomy videos (53.8%) on YouTube lack comprehensive educational content, with only a small fraction deemed appropriate for surgical training. The interest rates of the viewers may not be correlated with the usefulness rates of the videos. Surgeons and organizations should focus on producing high-quality, peer-reviewed instructional videos to improve the educational value of YouTube as a resource.
Analysing risk factors for foetal growth outcomes - the influence of maternal conditions and congenital cytomegalovirus infection.
Mandžáková M, Záhumenský J, Vajdová E … +3 more , Matušíková Z, Rosoľanková M, Papcun P
Ceska Gynekol · 2025 · PMID 40663445 · Publisher ↗
OBJECTIVE: This study aimed to analyse the risk factors differentiating small for gestational age (SGA) and appropriate for gestational age (AGA) neonates. MATERIALS AND METHODS: A retrospective-prospective cohort study...
OBJECTIVE: This study aimed to analyse the risk factors differentiating small for gestational age (SGA) and appropriate for gestational age (AGA) neonates. MATERIALS AND METHODS: A retrospective-prospective cohort study was conducted from 2019 to 2024 at the 2nd Department of Obstetrics and Gynaecology, University Hospital Bratislava. The study involved 174 term neonates from singleton pregnancies, including 125 SGA and 49 AGA infants. Various maternal, foetal, and placental risk factors were analysed, with a particular focus on congenital cytomegalovirus infection (cCMV). RESULTS: Neonates' birth weights ranged from 1,480 to 4,470 grams. Of the risk factors assessed, only maternal COVID-19 infection during pregnancy was significantly associated with AGA outcomes (P = 0.009). No significant associations were found between common risk factors (e. g. hypertension, diabetes mellitus) and foetal growth restriction. Congenital CMV infection was not significantly associated with SGA. Logistic regression analysis confirmed the association of COVID-19 infection with foetal weight, while no significant effect was observed for CMV. CONCLUSION: Maternal COVID-19 infection was associated with AGA outcomes, potentially due to enhanced medical surveillance and immune responses. However, the study's small sample size limits the interpretation of these findings, and further research is required to fully understand the impacts of COVID-19 on pregnancy. No significant association between congenital CMV infection and foetal growth restriction was found in this cohort, which was most likely due to the low prevalence of cCMV. Moreover, documented risk factors for foetal growth restriction, including hypertension and diabetes mellitus, were not statistically significant in our study population.
Molecular mechanisms leading to fibrosis in endometriosis.
Lisá Z, Janoštiak R, Hlinecká K … +4 more , Richtárová A, Kužel D, Mára M, Fanta M
Ceska Gynekol · 2025 · PMID 40420598 · Publisher ↗
Endometriosis is a complex chronic disorder with a high prevalence among women of reproductive age, significantly affecting both their quality of life and ability to conceive. In clinical settings, there is an increasing...
Endometriosis is a complex chronic disorder with a high prevalence among women of reproductive age, significantly affecting both their quality of life and ability to conceive. In clinical settings, there is an increasing incidence of advanced disease stages, particularly deep infiltrating endometriosis, which not only produces severe clinical symptoms, but also results in organ involvement. This article aims to synthesize current insights into the pathological mechanisms underlying fibrotic remodelling, which is associated with the most severe manifestations of the disease. Furthermore, it provides the theoretical framework for an ongoing research project aimed at identifying molecular biomarkers implicated in the most advanced forms of endometriosis, with the potential to enhance prediction of disease progression.
Sclerotherapy of endometrioma and its impact on ovarian reserve - a narrative review.
Ivánková K, Heřman H, Drahoňovský J … +1 more , Hájková Hympánová L
Ceska Gynekol · 2025 · PMID 40420597 · Publisher ↗
To summarize current knowledge on the use of sclerotherapy in the treatment of endometriomas and its effect on ovarian reserve. Endometriosis affects 10-15% of women of reproductive age. The presence and treatment of end...
To summarize current knowledge on the use of sclerotherapy in the treatment of endometriomas and its effect on ovarian reserve. Endometriosis affects 10-15% of women of reproductive age. The presence and treatment of endometriomas influence ovarian reserve, and therefore the conception possibilities of patients. The management is further complicated by frequent recurrences. All standard surgical methods lead to a reduction in ovarian reserve. Current clinical research is focused on developing methods that minimize the reduction of ovarian reserve. Ethanol sclerotherapy is a relatively new alternative to the currently used surgical methods, mainly extirpation. It is not yet a standard procedure. This article aims to summarize the current knowledge regarding the use of sclerotherapy in the treatment of endometriomas and its effect on ovarian reserve. The studies included in this review article are based on PubMed and Scopus databases. According to published works, sclerotherapy is a relatively simple method that allows treating endometriomas without surgery and general anaesthesia if performed under ultrasound guidance. It has a similar recurrence rate as laparoscopic extirpation and does not lead to a greater reduction in ovarian reserve compared to the latter. Sclerotherapy can be performed trans-vaginally, trans-abdominally, or laparoscopically. This paper summarizes the current knowledge on the impact of sclerotherapy on ovarian reserve.
Low-volume regional lymph node metastasis in endometrial cancer - 2024 update.
Münzová D, Bretová P, Hausnerova J … +3 more , Bednaříková M, Minář L, Weinberger V
Ceska Gynekol · 2025 · PMID 40420596 · Publisher ↗
Due to the implementation of sentinel lymph node ultrastaging, the prevalence of isolated tumor cells and micrometastases have increased. This literature review comprises of articles published between January 2019 and Se...
Due to the implementation of sentinel lymph node ultrastaging, the prevalence of isolated tumor cells and micrometastases have increased. This literature review comprises of articles published between January 2019 and September 2024 aiming at low-volume metastases in regional lymph nodes, their prognosis, and links to molecular classification. Micrometastases are currently considered as having metastatic lymph node involvement; however, they have a better prognosis than macrometastases. Accordingly, therapy is tailored. In contrast, isolated tumor cell presence is not considered metastatic involvement according to International Federation of Gynecology and Obstetrics (FIGO) 2023 staging and does not affect the therapeutic procedure because their significant prognostic importance has not been proven so far.
Sister Mary Joseph's nodule - rare umbilical cutaneous metastasis.
Polková M, Kabele P, Koliba P … +4 more , Asres TM, Dubová O, Brtnický T, Zikán M
Ceska Gynekol · 2025 · PMID 40420595 · Publisher ↗
This is a short review about a rare metastatic physical finding of abdomino-pelvic malignancies that is called Sister Mary Joseph's nodule. It is cutaneous metastasis in the umbilical region and it was first used almost...
This is a short review about a rare metastatic physical finding of abdomino-pelvic malignancies that is called Sister Mary Joseph's nodule. It is cutaneous metastasis in the umbilical region and it was first used almost 200 years ago. Even though it is a rare finding, we should not forget it in the differential diagnosis of umbilical nodules. The article also includes two case reports.
Patient satisfaction and ease of use of a novel method for electronic administration of validated quality of life questionnaires.
Rušavý Z, Smažinka M, Havíř M … +1 more , Kališ V
Ceska Gynekol · 2025 · PMID 40420594 · Publisher ↗
BACKGROUND: Evaluation of the quality of life using validated measures is an essential part of urogynecology examination and follow-up. Questionnaires administered in paper form generate paper waste or high demands for s...
BACKGROUND: Evaluation of the quality of life using validated measures is an essential part of urogynecology examination and follow-up. Questionnaires administered in paper form generate paper waste or high demands for storage. Score calculation for some questionnaires may be demanding and time-consuming. The electronic format of completing questionnaires simplifies data collection and processing, but may be challenging for older patients. We developed a Medical Electronic Survey System (MESS), which facilitates completion of questionnaires on a tablet PC with an emphasis on data protection and user-friendliness for the elderly. OBJECTIVE: To compare patient satisfaction and ease of use between Google Forms and MESS. METHODS: This was a prospective cohort study comparing the answers to a satisfaction questionnaire completed using Google Forms (193 questionnaires between 2013-2015) and MESS (329 questionnaires between 2019-2020), along with other clinically used validated questionnaires. The answers to the questionnaire were compared using a Fisher's Exact Test or a Wilcoxon Two Sample test, with a significance level of P < 0.05. RESULTS: The electronic form of questionnaire completion suited more women in case of MESS (84.5 vs. 65.6%; P < 0.05). Completing questionnaires electronically was rated as easy or very easy by 89.1% of patients using MESS compared to 68.7% using Google Forms; P < 0.05. The electronic form of filling-in the questionnaires was very difficult or impossible especially for women using Google Forms (31 vs. 11%; P < 0.05). The major difference in questionnaire completion without any help was observed in the age group 60-69 years. No differences were observed in women under 60 years of age. All clinicians observed significant facilitation of their work. CONCLUSION: MESS has made the method of electronic questionnaire completion available even to elderly patients with pelvic floor disorders. It was positively accepted even by patients who are not familiar with any electronic devices.
Management of various types of ectopic pregnancy - a questionnaire study.
Švédová B, Hruda M, Drochýtek V … +7 more , Halaška MJ, Maxová K, Janovská N, Součková H, Babková A, Rob L, Sehnal B
Ceska Gynekol · 2025 · PMID 40420593 · Publisher ↗
OBJECTIVE: To map management of different types of ectopic pregnancies in the Czech Republic using a questionnaire-based study. METHODS: In 2023, a total of 95 obstetrics and gynecology departments across the Czech Repub...
OBJECTIVE: To map management of different types of ectopic pregnancies in the Czech Republic using a questionnaire-based study. METHODS: In 2023, a total of 95 obstetrics and gynecology departments across the Czech Republic were surveyed using an online questionnaire, which inquired about the management strategies for various types of ectopic pregnancies. The departments were categorized based on the number of hysterectomies performed annually. Differences in responses between large centers and other departments were statistically compared. RESULTS: A total of 45 departments of all sizes completed the questionnaire. Two-thirds of all departments always perform salpingectomy in cases of tubal pregnancy (78% of large, 58% of medium-sized, and 40% of small departments). Systemic methotrexate administration for the treatment of intact tubal pregnancy is used by one-fifth of departments (22% of large, 23% of medium-sized, and 0% of small departments). In cases of atypical ectopic pregnancy localization, methotrexate treatment is used by 33% of large, 42% of medium-sized, and 40% of small departments. A statistically significant difference was observed in the clearly preferred laparoscopic approach for surgical management of cesarean scar pregnancy in large centers compared to smaller departments (P = 0.036). No other statistically significant differences were observed between the departments in other parameters. CONCLUSION: In cases of intact tubal pregnancy, four-fifths of obstetric and gynecological departments perform laparoscopic salpingectomy, while only one-fifth utilize systemic methotrexate for treatment. On the other hand, methotrexate is used by one-third to two-fifths of departments of all sizes in cases of atypical ectopic pregnancy localization.
Analysis of the epidemiologic, clinical, laboratory, ultrasonographic, and anatomopathological profile of women with hydatidiform mole at two referral centers in Northeastern Brazil.
Moura Linhares EV, de Lucena Feitosa FE, Braga A … +4 more , Araujo Júnior E, Traina E, Ponte Ribeiro CM, Sun SY
Ceska Gynekol · 2025 · PMID 40420592 · Publisher ↗
OBJECTIVE: To determine the profile of women undergoing uterine evacuation for suspected hydatidiform mole (HM) according to their clinical, laboratory, ultrasound, and anatomopathological characteristics at two referral...
OBJECTIVE: To determine the profile of women undergoing uterine evacuation for suspected hydatidiform mole (HM) according to their clinical, laboratory, ultrasound, and anatomopathological characteristics at two referral centers in Northeastern Brazil. METHODS: Retrospective cohort study was performed in two referral centers between October 2016 and December 2022 with women undergoing uterine evacuation for suspected HM. Socio-demographic characteristics, clinics, biochemistry, ultrasound, anatomopathology, and outcome were evaluated. RESULTS: A total of 507 women were admitted with clinical suspicion of gestational trophoblastic disease, of which 334 were confirmed, with 107 being in Center-1 and 227 being in Center-2. Mean distance between the referral center and the patient's home was 88 km. Mean age of the women was 27 ± 9 years, with a predominance of 19 to 39 years (72%), and approximately 60% of the cases were diagnosed ≤ 12 weeks of gestation. Vaginal bleeding was observed in 79% of women. Transvaginal ultrasound showed a typical appearance in 90% of the examinations. The macroscopic aspect was described as a vesicle in 70% of cases. Uterine evacuation was mainly performed by uterine curettage (43%). The majority of women had no complications (69%). The outcome considered to be remission was achieved in 37.1% of cases, but 38.9% abandoned follow-up, and 9% did not start follow-up after hospital discharge. CONCLUSION: The distance traveled by women to the referral centers was significant, but the majority of women had no complications. Remission was observed in 37.1% of women, but there was a high abandonment rate of 38.9%.
Investigation of serum phoenixin-14 and phoenixin-20 levels in pregnant women with preeclampsia.
Baki Z, Kale İ
Ceska Gynekol · 2025 · PMID 40420591 · Publisher ↗
OBJECTIVE: Phoenixin has endothelial protective and anti-inflammatory properties, but has been associated with the development of hypertension. Given that endothelial dysfunction plays a significant role in the pathophys...
OBJECTIVE: Phoenixin has endothelial protective and anti-inflammatory properties, but has been associated with the development of hypertension. Given that endothelial dysfunction plays a significant role in the pathophysiology of preeclampsia, we aimed to investigate the serum levels of phoenixin-14 and phoenixin-20 in pregnant women diagnosed with preeclampsia. MATERIALS AND METHODS: In this cross-sectional case-control study, 45 pregnant women diagnosed with preeclampsia comprised the preeclampsia group, while 45 healthy pregnant women, matched to the preeclampsia group by age, body mass index, and gestational age, served as the control group. Commercial kits were used to analyze phoenixin-14 and phoenixin-20 levels in serum samples. RESULTS: Serum phoenixin-14 level was 390.3 pg/mL in the preeclampsia group and 393.2 pg/mL in the control group (P = 0.434). While the serum phoenixin-20 level was 346.6 pg/mL in the preeclampsia group, it was 379.9 pg/mL in the control group (P = 0.278). When the preeclampsia group was divided into subgroups according to the severity of the disease and the onset of the disease and compared with the control group, no significant difference was found between the groups regarding serum phoenixin-14 and phoenixin-20 levels. CONCLUSION: In this study, serum levels of phoenixin-14 and phoenixin-20 were similar in both the preeclampsia and control groups. Although the sample size is too small to draw a definitive conclusion, findings suggest that phoenixin-14 and phoenixin-20 do not play a role in the pathophysiology of preeclampsia.
Occupational therapy in oncogynecology - a pilot study.
Sládková P, Brtnický T, Hormandlová L … +8 more , Polková M, Malina V, Koliba P, Zikán M, Hubka P, Kabele P, Dubová O, Tichá M
Ceska Gynekol · 2025 · PMID 40420590 · Publisher ↗
OBJECTIVE: Overview of the possibilities of using non-medical occupational therapy in oncogynecology, description of the role of an occupational therapist in prehabilitation, and evaluation of data from a pilot study. ME...
OBJECTIVE: Overview of the possibilities of using non-medical occupational therapy in oncogynecology, description of the role of an occupational therapist in prehabilitation, and evaluation of data from a pilot study. METHODS: The study cohort consisted of 18 patients enrolled between November 2023 and October 2024. The prospective study was conducted over a period of nine months. Patients were admitted for a 3-week intensive multimodal prehabilitation program scheduled on a 4/7 basis prior to elective surgery for primary or recurrent malignant ovarian, endometrial, or cervical cancer. In addition to the physicians, patients received prehabilitation by a physiotherapist, psychologist, nutritionist, and occupational therapist. Clinical work of the occupational therapist was measured upon examination and subsequent therapy in the areas of cognitive function, fine motor skills of the upper limbs, self-sufficiency, and quality of life. The occupational therapist applied selected functional tests and questionnaires (MKF classification, Hand grip test, MoCA test, 5× Sit-to-Stand test, WHODAS 2.0) to determine the effect of the rehabilitation intervention. RESULTS AND CONCLUSIONS: Important indicators were selected functional abilities that have a significant impact on the quality of life of patients. The results of functional tests showed a significant improvement of key parameters due to intensive prehabilitation, confirming the essential role of occupational therapist intervention in oncogynecological prehabilitation.
Comparison of perinatal outcomes using oral misoprostol, vaginal misoprostol, and intracervical dinoprostone for induction of labor.
Szekeresová P, Hruban L, Jouzová A … +3 more , Janků P, Gerychová R, Huptych M
Ceska Gynekol · 2025 · PMID 40420589 · Publisher ↗
OBJECTIVE: To compare the effectiveness and safety of the methods of pharmacological induction of labor. To identify the advantages and disadvantages of oral and vaginal administration of misoprostol and intracervical ad...
OBJECTIVE: To compare the effectiveness and safety of the methods of pharmacological induction of labor. To identify the advantages and disadvantages of oral and vaginal administration of misoprostol and intracervical administration of dinoprostone. MATERIALS AND METHODS: Analysis of a group of women who gave birth at the Faculty Hospital Brno from 1st August 2019 to 31st January 2020, and one of the following labor induction schemes was used: group A: misoprostol 25 µg orally every 2 hours, group B: misoprostol 50 µg vaginally every 6 hours, group C: intracervical dinoprostone 1 mg every 2 hours. Inclusion criteria were: singleton pregnancy, completed 36th gestational week, live fetus, cephalic presentation, and cervix score ≥ 6. Exclusion criteria were uterine scars and fetal growth restriction. Time factors of induction, occurrence of acute hypoxia during labor, mode of delivery, use of tocolysis during labor, necessity of oxytocin infusion, use of epidural analgesia, blood loss, uterine rupture, umbilical artery pH, and Apgar score at the 5th min were evaluated. RESULTS: A total of 378 women were included (133 vs. 145 vs. 100). A statistically significantly higher success rate of vaginal delivery was demonstrated in group A compared to groups B and C (88 vs. 77.9 vs. 76%; P = 0.035). The longest time from the administration of the first dose of the preparation to delivery of the fetus was in group A (medians in minutes 700 vs. 565 vs. 375; P < 0.0001). There was no difference between the groups in the I. and II. labor stage duration. Cesarean delivery rate due to acute hypoxia was the lowest in group A (2.3 vs. 10.3 vs. 9%; P = 0.023). Uterine rupture was not recorded; there were no differences in neonatal outcome parameters. CONCLUSION: The highest success rate of vaginal delivery was achieved with the use of low-dose oral misoprostol. The disadvantage of this method is a significant increase in the time from the start of induction to the delivery of the fetus. There was no difference in the occurrence of severe perinatal complications between the induction methods.
Diagnosis and treatment of peripartum haemorrhage, consensus of the interdisciplinary working group by the modified ACCORD method.
Černý V, Pařízek A, Bláha J … +11 more , Blatný J, Dulíček P, Gumulec J, Janků P, Kacerovský M, Křepelka P, Ľubušký M, Mannová J, Seidlová D, Šimetka O, Štourač P
Ceska Gynekol · 2025 · PMID 40117262 · Publisher ↗
of recommendations Preventive measures and procedures We recommend monitoring of blood loss in women with risk factors for PPH during labor using calibrated blood collectors or their equivalents. (Good Clinical Practice)...
of recommendations Preventive measures and procedures We recommend monitoring of blood loss in women with risk factors for PPH during labor using calibrated blood collectors or their equivalents. (Good Clinical Practice) We recommend that women with significant risk factors for PPH (e.g., placenta acrreta spectrum or hematologic disorders requiring consultative hematologic care) deliver in a perinatal intensive care center or perinatal intermediate care center. (Good Clinical Practice) We recommend formulating a plan of care in collaboration with a multidisciplinary team at a reasonable time prior to delivery for patients at high risk of PPH. (Good Clinical Practice) We recommend treating anemia antepartally. Pregnant women should be given iron supplements if the haemoglobin level falls to < 110 g/L in the 1st trimester or < 105 g/L at 28 weeks of pregnancy. (Good Clinical Practice) We suggest considering parenteral iron administration in women with sideropenic anemia unresponsive to oral iron supplementation. The cause of anemia should be identified as soon as possible after termination of pregnancy. (Weak recommendation) If the baby adapts well, we do not recommend cord ligation in less than 1 min. (Strong recommendation) In all vaginal deliveries, we recommend prophylactic administration of uterotonics in the third postpartum period after the delivery of the baby and cord ligation to reduce the risk of PPH. The first-choice drug is oxytocin. (Strong recommendation) If the third stage of labor has not been actively managed, we suggest that uterine massage and controlled umbilical cord traction be considered to shorten the duration of the third stage of labor and to reduce blood loss during vaginal delivery, if performed by a qualified healthcare professional. (Weak recommendation) We recommend the administration of uterotonics to prevent the development of PPH in women after the delivery of a child by caesarean section and umbilical cord ligation. (Strong recommendation) We suggest considering carbetocin administration in women at increased risk of PPH. (Weak recommendation) We recommend a single-dose administration of tranexamic acid (TXA) in women at increased risk of PPH undergoing a caesarean section. Clinical note: The use of TXA prior to the caesarean section is not explicitly stated in the product's SPC. A recent meta-analysis states the most common dosage to be 1 g i.v. (Strong recommendation) Organization of care We recommend that every health care facility with an OB/GYN unit should have the PPH management protocol (guided document is not specific or really used at all, I am not sure if my suggestion is sufficient) defining the organizational and professional procedure for PPH situations. (Good Clinical Practice) We recommend that the PPH management protocol (i.e. the crisis action plan) should clearly define the organizational and professional roles of the individual members of the crisis team in the event of PPH (non-medical staff), obstetrician, anesthetist, hematologist, etc.) and define the minimum scope of equipment for the care of patients with PPH. (Good Clinical Practice) We recommend regular simulation training of PPH crisis by the entire crisis team with a subsequent debriefing or its formalized equivalent. (Good Clinical Practice) We recommend defining quality indicators for the diagnosis and treatment of PPH and their formalized evaluation at regular intervals, at least once a year. (Good Clinical Practice) Diagnostic and treatment procedure at PPH When hypotonia or atony of the uterus is found, we recommend using a structured procedure. (Good Clinical Practice) At departments with an option of endovascular interventions, we suggest considering the preferential use of radiological interventional methods (selective pelvic artery embolization) in cases of PPH due to uterine hypotonia or atony, if the current clinical context allows it. (Weak recommendation) For all stages of PPH development, we recommend a pre-transfusion examination. In addition to standard laboratory tests, point-of-care-testing methods, especially viscoelastic methods, are preferred to assess the current coagulation status. (Good Clinical Practice) Each obstetric unit should ensure a sufficient stock of blood products and blood derivatives for their immediate availability 24/7 in collaboration with the transfusion department and the inpatient pharmacy. In case of PPH development, we recommend securing initial availability of 4 units of plasma (solvent/detergent-treated plasma is preferred), 4 units of erythrocytes and 6 g of fibrinogen. We consider 8 g to be a minimum supply of fibrinogen and additional 8 g should be available within 1 h. (Good Clinical Practice) We recommend the initiation of immediate fluid resuscitation in all patients with PPH. We recommend the use of balanced crystalloid solutions to initiate fluid resuscitation. (Strong recommendation) We propose considering the use of synthetic colloid solutions containing gelatin when hemodynamic goals of fluid resuscitation have not been achieved or are not being achieved using crystalloid solutions and when a fluid deficit persists. (Weak recommendation) Until the source of bleeding is controlled, we recommend aiming for a systolic blood pressure in a range of 80-90 mmHg in patients with PPH. (Strong recommendation) We recommend the use of vasopressors as soon as possible in PPH when target arterial blood pressure values cannot be reached by ongoing fluid resuscitation. (Strong recommendation) We recommend cooperation with a hematologist in the diagnosis and treatment of coagulopathy in PPH unresponsive to standard therapies. (Good Clinical Practice) In addition to the above-mentioned panel laboratory tests (at least KO, aPTT, fibrinogen), we also recommend using viscoelastic methods (ROTEM, TEG) to identify the type of coagulation disorder in PPH, to monitor it and for targeted treatment of hemostasis disorders. (Strong recommendation) To achieve/restore the efficacy of endogenous hemostatic mechanisms and coagulation support therapies, we recommend the maximum possible correction of hypothermia, acidosis and ionized calcium levels. (Strong recommendation) Early initiation of all available procedures to prevent hypothermia and maintain or achieve normothermia is recommended. (Strong recommendation) It is recommended monitoring and maintaining ionized calcium levels within the normal range when administering transfusion products. Preferably, calcium chloride should be administered for correction. (Strong recommendation) Fibrinogen replacement is recommended in patients with PPH when fibrinogen levels fall to < 2 g/L and/or when there is a functional fibrinogen deficiency detected by viscoelastic methods and/or when there is a reasonable clinical assumption of fibrinogen deficiency even without knowledge of fibrinogen levels. We recommend a minimum of 4 g of fibrinogen as an initial dose in PPH. (Strong recommendation) It is recommended to administer tranexamic acid (TXA) at an initial dose of 1 g i.v. as soon as possible after the onset of PPH. An identical dose may be repeated (after 30 min at the earliest) if bleeding continues and if hyperfibrinolysis is demonstrated and/or if hyperfibrinolysis is highly likely in the current clinical context. (Strong recommendation) We do not recommend further administration of TXA in patients with PPH after bleeding control has been achieved. (Strong recommendation) We recommend administration of plasma at a dose of 15-20 mL/kg in PPH conditions where coagulopathy of a different etiology than fibrinogen deficiency is suspected and/or abnormal coagulation test results are present, and where the results do not reliably identify the predominant mechanism of the coagulation disorder and its targeted correction. (Strong recommendation) We recommend the administration of prothrombin complex factors (PCC) in patients with PPH where there is a laboratory evidence of a deficiency of PCC factors. We do not recommend routine administration of PCC in patients with PPH. (Strong recommendation) We suggest considering administration of rFVIIa before making a decision on an endovascular or a surgical intervention. (Weak recommendation) In patients with PPH, we recommend administration of erythrocyte blood products to achieve a target hemoglobin value in the range 70-80 g/L. (Strong recommendation) In patients with PPH, we recommend platelet administration to achieve a target value of at least 50 × 109/L and/or when platelet function impairment is suspected or demonstrated. (Strong recommendation) We do not recommend routine measurement of antithrombin III levels in patients with PPH. (Strong recommendation) We do not recommend routine antithrombin III replacement in patients with PPH. (Strong recommendation) We recommend initiating pharmacological prophylaxis for thromboembolic disease as soon as possible after control of the source of PPH is achieved. We recommend initiating mechanical thromboprophylaxis (intermittent pneumatic compression or elastic stockings) as soon as the clinical condition permits. (Strong recommendation).
Sexual function in women with pelvic organ prolapse.
Tvarožek S, Szypulová M, Šteflová A … +2 more , Huser M, Rušavý Z
Ceska Gynekol · 2025 · PMID 40117261 · Publisher ↗
A woman's sexuality is a complex phenomenon involving several factors, among which age and health are the most important. However, other aspects are not negligible. The impact of pelvic organ prolapse on sexual function...
A woman's sexuality is a complex phenomenon involving several factors, among which age and health are the most important. However, other aspects are not negligible. The impact of pelvic organ prolapse on sexual function cannot be ignored, as the reported prevalence of pelvic organ prolapse in female population exceeds 50%. This article presents a systematic review of articles dealing with the impact of pelvic organ prolapse on female sexual function. Sexual dysfunction is common in women with pelvic organ prolapse, regardless of prolapse stage or the compartment affected. Estrogen therapy has no effect on sexuality in women with prolapse, while pelvic floor muscle training may provide some improvement. There is no evidence that conservative therapy using a pessary is associated with negative impact on sexual function. Native tissue repair tends to improve sexual function in general, except for posterior colporrhaphy, which was frequently associated with dyspareunia. No correlation between postoperative vaginal length and change in sexual function was identified. The impact of transvaginal mesh repair on sexuality remains unclear. In contrast, there is enough evidence proving that sacrocolpopexy significantly improves sexual function in women.
Cost-effectiveness of mental health screening in pregnancy.
Hrdličková K, Nováková L, Němcová H … +1 more , Šebela A
Ceska Gynekol · 2025 · PMID 40117260 · Publisher ↗
OBJECTIVE: To provide an overview of recent literature on the cost-effectiveness of mental health screening for women during pregnancy. RESULTS: 1,988 publications were retrieved from databases, of which four were includ...
OBJECTIVE: To provide an overview of recent literature on the cost-effectiveness of mental health screening for women during pregnancy. RESULTS: 1,988 publications were retrieved from databases, of which four were included in the systematic review. Models of care with screening are cost-effective compared with standard care without screening. Multi-level screening models are more cost-effective than single-level models. Effectiveness is affected by the number of false-positive cases, which decreases in multi-level models. CONCLUSION: Mental health screening in pregnancy appears to be cost-effective. We recommend its use in comprehensive health care for pregnant women in our country.
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