Česká gynekologie je oficiální časopis České gynekologické a porodnické společnosti ČLS JEP. Hlavním zaměřením časopisu je postgraduální výuka a informace o současném stavu a vývoji této oblasti medicíny doma a v zahraničí, dále publikace původních studií a zkušeností z klinické praxe a informace o činnosti odborných společností. Dosud publikovaná čísla a informace o časopisu naleznete na této adrese: https://www.cs-gynekologie.cz
Comparative analysis of the histological architecture of ovarian tissue following slow-freezing cryopreservation
Objective: The aim of this study was to validate the methodology of ovarian tissue cryopreservation using the slow freezing technique as a fertility preservation approach and to assess its potential implementation in clinical practice at the Assisted Reproduction Centre of the University Hospital Olomouc. In parallel, the technical procedure of cryopreservation was optimized and standardized. Materials and methods: The study was conducted between April 2022 and December 2024 at the Department of Obstetrics and Gynecology, University Hospital Olomouc, and included six transgender patients aged 19–25 years who underwent laparoscopic hysterectomy with bilateral adnexectomy as part of gender--affirming surgery. Ovarian tissue obtained during the procedure was immediately processed and cryopreserved using the slow freezing method at the Assisted Reproduction Centre of the University Hospital Olomouc. Histopathological evaluation of the ovarian tissue was performed both prior to cryopreservation and after thawing at the Department of Clinical and Molecular Pathology. Results: Morphological assessment of the ovarian tissue after cryopreservation confirmed preservation of structural characteristics of follicles and stromal components, without signs of significant degeneration. Conclusion: The results confirm that the applied slow freezing protocol for ovarian tissue cryopreservation is appropriate and sufficiently gentle for clinical use. This method represents a reliable option for fertility preservation in patients undergoing gonadectomy, with potential applications in subsequent autologous transplantation or in vitro follicle culture.
Vaginal fisting and risk of anogenital injury
Vaginal fisting is an uncommon and risky sexual practice. It consists of penetrating the vagina with one or both hands. Fisting is practiced as heterosexual, homosexual, or autoerotic activity and may be the cause of vaginal injury and circumjacent organs. The article describes the case of a 33-year old pornographic film actress who developed vaginal injury and heavy bleeding during fisting while filming. Rupture of the vagina was sutured and blood loss was replenished with transfusions.
Placental insufficiency and late-onset growth restriction in fetuses appropriate for gestational age
Fetal growth restriction is a condition in which the fetus fails to reach its genetically determined growth potential, most often as a result of impaired placental function. The late-onset form, which develops after 32 weeks of gestation, poses a significant diagnostic challenge due to its subtle clinical and sonographic manifestations. Placental insufficiency is usually associated with pregnancies that meet the established diagnostic criteria for fetal growth restriction. However, there is increasing evidence to suggest that even fetuses with an estimated weight appropriate for gestational age may be affected by a subclinical form of this condition. Typical features of advanced placental dysfunction include abnormal Doppler flow patterns, a slowed fetal growth trajectory, altered levels of maternal serum biomarkers, and specific histopathological findings in the placenta. Despite advances in prenatal diagnostics, there is still no reliable tool capable of identifying pregnancies complicated by placental insufficiency in a timely manner, especially in cases without overt fetal growth deviation. This diagnostic gap limits our ability to identify fetuses at increased risk of adverse perinatal outcomes.
Diabetes mellitus and pregnancy, how to analyze national individual-level data
Objective: This study aims to present the methodological framework and analytical approaches for utilizing national individual- -level data on diabetes mellitus in pregnancy, a condition that poses a significant risk to the health of both mother and child. Materials and methodology: The National Health Information System serves as the central repository for data on the Czech healthcare system. Through the integration of various recorded datasets, it enables detailed analysis of the incidence of diabetes mellitus in connection with pregnancy, provided that an appropriate analytical algorithm is applied. The input dataset for the analysis consisted of births recorded between 2012 and 2023 in the National Register of Reproductive Health, specifically the Mothers module. In total, 1,240,227 births were included in the analysis. For each case, the presence of the disease was verified using records from the National Register of Reimbursed Health Services. Results and conclusion: Based on the defined criteria, including specific medications, reported medical procedures, medical devices, and disease diagnoses, the prevalence of diabetes mellitus among parturient women was determined to be 15.4%. Thanks to the interconnected structure of the National Health Information System and newly established definition of a pregnant woman with diabetes, it will be possible to continue analyzing the prevalence and health impacts of this condition at the national level.
Ovarian vascular malformation – clinical presentation of Cowden syndrome
Objective: We describe a case of a young girl diagnosed with vascular malformation of the left ovary and genetically confirmed Cowden syndrome. Case report: Clinically, the girl had no gynecological problems, but there was swelling of the right knee after physical exercise. The predominant finding on imaging was a venolymphatic malformation arising from the musculus vastus medialis detected by magnetic resonance imaging. After puncture of the lesion, the biopsy specimen was subjected to genetic examination, which revealed a heterozygous PTEN gene mutation. This proved Cowden syndrome at the molecular level. At the same time, heterogeneous expansion in the region of the left ovary was described on magnetic resonance imaging. Based on staging, diagnostic laparoscopy with lavage was indicated. Perioperatively, multiple adhesions in the small pelvis and a tumor arising from the left ovary were detected. Partial resection of the left ovary was performed, and perioperative cryobiopsy confirmed a vascular malformation, with no concomitant findings of a benign tumor or malignancy. Definitive histological examination of the resected left ovary showed the presence of vascular malformations, which clinically corresponds to possible symptoms of Cowden syndrome. Conclusion: Cowden syndrome is a rare genetic disorder whose diagnosis is based on clinical manifestations, imaging studies, and subsequent genetic testing. Follow-up of patients abides by the National Comprehensive Cancer Network recommendations and requires a multidisciplinary approach.
Effect of kisspeptin, neurokinin, and dynorphin neurons on regulation of reproduction
Gonadotropin-releasing hormone pulsatility is under the influence of hypothalamic neuropeptides, especially neurons expressing kisspeptin, neurokinin B, and dynorphin. These hypothalamic cells are called KNDy neurons. By integrating hormonal and environmental stimuli in the brain, they modulate the effects on neuropeptide release and control the frequency and amplitude of pulses. The relationship between KNDy neurons and gonadal hormones is essential for the initiation of puberty, regulation of the menstrual cycle, and reproduction. Steroid hormones have a feedback effect on the modulation of the activity of KNDy neurons, as their membrane and cell nucleus express receptors for estradiol, progesterone, and testosterone. Recent research suggests a close relationship with the pathophysiology of infertility, pathological pregnancy, menstrual cycle disorders, polycystic ovary syndrome, endometriosis, and vasomotor symptoms in perimenopause.
Determination of markers of ethyl alcohol consumption in pregnancy
Prenatal alcohol exposure (PAE), with a global prevalence of approximately 10%, is the most common preventable cause of fetal morbidity, with fetal alcohol syndrome representing its most severe manifestation. The current gold standard for diagnosing PAE relies on self-reported questionnaires; however, underreporting remains a significant limitation. Consequently, there is a need for objective diagnostic methods. Among the most promising biomarkers are ethanol metabolites present in the first stool of newborns (meconium). In this preliminary study, we quantified ethyl glucuronide (EtG) and ethyl sulfate (EtS) in meconium samples and compared the results with self-reported PAE data from questionnaires. The study included 51 pregnant women. A meconium sample was collected from each newborn and analyzed using liquid chromatography-mass spectrometry. All participants were asked to complete a questionnaire regarding alcohol consumption during pregnancy. EtG was detected in 41 samples (80.3%) and EtS was present in all 51 samples (100%). Three of the 51 women did not complete the questionnaire. Of the remaining 48, six (11.7%) reported alcohol consumption during pregnancy. The median concentrations of EtG and EtS were 49.6 ng/g and 13.9 ng/g, respectively. Median levels of both biomarkers were higher among women who reported alcohol use compared to those who denied it. Notably, EtG concentrations exceeding 30 ng/g – previously suggested in the literature as a potential cutoff for PAE – were found in 82.35% of women who reported no alcohol use. This study confirms that EtG and EtS are reliable markers of ethanol exposure in meconium. However, we were unable to determine definitive cutoff values for PAE based on these biomarkers. Elevated EtG levels in women who denied alcohol consumption may be attributable to alternative sources of ethanol exposure or endogenous ethanol production. The possibility of underreporting PAE also cannot be ruled out.
Radiation-induced angiosarcoma of the breast – experience from clinical practice
Angiosarcoma (AS) is a rare malignant tumor originating from the endothelial cells of blood or lymphatic vessels. It is characterized by an aggressive course with a high risk of generalization. The most frequent sites of metastasis include the skin, soft tissues, breasts, liver, and heart. Clinical symptoms vary depending on the site of origin. The most common include erythema, skin efflorescence, swelling, and tenderness. Diagnosis of AS is established based on histopathological examination with evidence of atypical endothelial cells and vascular structures. Imaging methods are used as supplementary examinations and help in determining the location and extent of the tumor. In this publication, we focus on the secondary type of angiosarcoma, which has been increasingly described in recent years in the irradiated breast area after breast-conserving surgery. We describe three case reports of patients comprehensively treated at our institution. A relatively long remission, spanning several years, is typical. The essential basis of AS treatment is surgical removal of the tumor with intact resection margins. Due to the size of the defect after resection, simple suturing of the skin cover is often insufficient, and collaboration with a plastic surgeon is necessary for the reconstruction of the resulting defect. Professional literature does not unequivocally state the sufficient width of the healthy tissue margin during resection. The benefit of adjuvant chemotherapy or radiotherapy is debatable. Prognosis is generally poor due to insufficient sensitivity to non-surgical treatment modalities and the speed of metastasis.
radiation-induced angiosarcoma of the breast
Can anti-Müllerian hormone predict positive sperm retrieval in men with idiopathic non-obstructive azoospermia?
Objective: To eval<span class="NormalTextRun SpellingErrorV2Themed SCXW76582303 BCX8" data-ccp-charstyle="nedelit" data-ccp-charstyle-defn="{"ObjectId":"386dc8c1-255b-5a14-a7f1-5777b3628f91|1","ClassId":1073872969,"Properties":[469775450,"nedelit",201340122,"1",134233614,"true",469778129,"nedelit",335572020,"99",134224902,"false",201334293,"17",201342446,"1",201342447,"5",201342448,"1",201342449,"1",469777841,"Calibri",469777842,"",469777843,"Calibri",469777844,"Calibri",201341986,"1",469769226,"Calibri",268442635,"22"]}">uate whether serum anti-Müllerian hormone (AMH) levels can predict sperm retrieval (SR) outcomes in men with idiopathic non-obstructive azoospermia (iNOA) undergoing microdissection testicular sperm extraction (mTESE), and to develop a predictive model that may inform clinical decision-making. Materials and methods: This retrospective, multicenter cohort study included 72 men diagnosed with iNOA who underwent mTESE between December 2022 and May 2023 at two IVF centers in Turkey. Serum AMH and follicle stimulating hormone (FSH) levels were measured prior to surgery. Patients were categorized into TESE-positive (+SR) and TESE-negative (−SR) groups based on the presence of spermatozoa in testicular tissue. Hormonal and clinical parameters were compared between groups, and a multivariate logistic regression model was constructed to identify independent predictors of SR outcome. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic accuracy and optimal cutoff values for AMH and FSH. Results: Out of 72 patients, 37 (51.4%) had successful SR and 35 (48.6%) did not. Median AMH and FSH levels were significantly higher in the −SR group (P = 0.001 and P = 0.044, resp.). Multivariate logistic regression analysis identified serum AMH as the only independent predictor of positive SR outcome (P < 0.001). ROC analysis revealed excellent diagnostic performance for AMH (AUC = 0.909), with an optimal cutoff value of 3.4 ng/mL yielding 75.68% sensitivity, 91.43% specificity, 90.32% positive predictive value, and 78.05% negative predictive value (P = 0.001). Higher AMH levels were significantly associated with negative SR outcomes. Conclusion: Serum AMH level is a reliable, non-invasive biomarker for predicting SR outcomes in men with iNOA undergoing mTESE. An AMH level > 3.4 ng/mL is significantly associated with a lower probability of sperm retrieval. Incorporating AMH into preoperative assessment may help avoid unnecessary surgical procedures and guide clinical counseling in male infertility management.
microdissection testicular sperm extraction
Robotic-assisted cesarean scar defect repair
The rising global incidence of cesar<span class="NormalTextRun SpellingErrorV2Themed SCXW154722919 BCX8" data-ccp-charstyle="nedelit" data-ccp-charstyle-defn="{"ObjectId":"386dc8c1-255b-5a14-a7f1-5777b3628f91|1","ClassId":1073872969,"Properties":[469775450,"nedelit",201340122,"1",134233614,"true",469778129,"nedelit",335572020,"99",134224902,"false",201334293,"17",201342446,"1",201342447,"5",201342448,"1",201342449,"1",469777841,"Calibri",469777842,"",469777843,"Calibri",469777844,"Calibri",201341986,"1",469769226,"Calibri",268442635,"22"]}">ean deliveries has led to a marked increase in associated obstetric and gynecological complications, notably the cesarean scar defect. Clinical management decisions are predominantly guided by patient-reported symptoms, reproductive goals, and individual anatomical considerations. The literature currently lacks definitive guidelines recommending a singular optimal approach. The recent advent and incremental adoption of robotic surgery has introduced a promising new technique, characterized by enhanced surgical precision, improved visualization, reduced morbidity, and rapid patient recovery. Ultimately, embracing robotic-assisted surgery for cesarean scar defect repair represents a critical advancement in gynecological surgery.
Cesarean scar defect, Cesarean scar syndrome, scar defect repair, robotic- assisted scar repair, isthmocele repair
defekt jazvy po cisárskom reze, syndróm jazvy po cisárskom reze, oprava jazvy, roboticky asistovaná oprava jazvy, oprava istmokély
Prevalence and hormonal profiling of secondary amenorrheic patients presenting to a fertility clinic – an observational study
Objective: Amenorrhea is a menstrual disorder than can arise as a result of hormonal dysfunction of the hypothalamic-pituitary--gonadal axis. There is limited data on the most common causes of secondary amenorrhea in Pakistan. Therefore, this study aimed to assess various causative factors along with hormone profiling in patients with secondary amenorrhea. Patients and methods: The present cross- -sectional study was conducted in different fertility clinics of Abbottabad. Patients with secondary amenorrhea were included by a non-probability sampling technique. Data related to demographic and other clinical variables were collected via a data collection form. Serum progesterone, estradiol, luteinizing hormone, follicle stimulating hormone, and prolactin were determined using commercially available enzyme-linked immunosorbent assay kits. This study was conducted on 126 patients with a mean age of 28.5 ± 7.8 years. Results: Drug-related amenorrhea was observed in 14.3% of patients. Hyperprolactinemia-induced amenorrhea was observed in 31.7% and in 54% of patients with unknown etiology. Of the patients with drug-induced amenorrhea, 38.9% used oral contraceptives, 27.8% used omeprazole, and 33.3% used other drugs. Headache (79.4%) and fatigue (78.6%) were the main symptoms reported in amenorrheic women, while hair loss was reported in 65.9% of patients. Both loss of libido and hirsutism were observed in 45.2% and 42.9% of patients, resp. Breast pain and vaginal dryness occurred in 35.7% and 23.8% of patients, resp. Conclusion: The current study showed that hyperprolactinemia is the most common cause of secondary amenorrhea followed by drug-induced amenorrhea, which must be considered in the clinical management of hormonal imbalances and subsequent amenorrhea.
Laser therapy for type III fetal congenital cystic adenomatoid malformation
Congenital cystic adenomat<span class="NormalTextRun SpellingErrorV2Themed SCXW265162325 BCX8" data-ccp-charstyle="nedelit" data-ccp-charstyle-defn="{"ObjectId":"386dc8c1-255b-5a14-a7f1-5777b3628f91|1","ClassId":1073872969,"Properties":[469775450,"nedelit",201340122,"1",134233614,"true",469778129,"nedelit",335572020,"99",134224902,"false",201334293,"17",201342446,"1",201342447,"5",201342448,"1",201342449,"1",469777841,"Calibri",469777842,"",469777843,"Calibri",469777844,"Calibri",201341986,"1",469769226,"Calibri",268442635,"22"]}">oid malformation (CCAM) is a rare developmental anomaly of the fetal lung that can lead to severe respiratory distress in the neonatal period. Type III CCAM, characterized by solid, microcystic lesions, often poses diagnostic and therapeutic challenges, especially in progressive cases. We report a rare case of antenatal laser therapy used to treat a fetus diagnosed with type III CCAM. Despite two cycles of corticosteroid therapy, the lesion showed no significant regression, leading to the decision to perform ultrasound-guided intrauterine laser ablation. The procedure resulted in a reduction in lesion size, normalization of the fetal cardiac axis, and a favorable perinatal outcome, with the newborn discharged 5 days after birth in stable condition. This case highlights the potential role of fetal laser therapy as a less invasive and effective alternative to surgical excision for selected cases of progressive type III CCAM. Further studies are needed to validate the safety, efficacy, and long-term outcomes of this approach.
congenital cystic adenomatoid malformation
Coincidental maternal mortality in Slovakia in the years 2007–2024
Objective: Analysis of c<span class="NormalTextRun SpellingErrorV2Themed SCXW2120621 BCX8" data-ccp-charstyle="nedelit" data-ccp-charstyle-defn="{"ObjectId":"386dc8c1-255b-5a14-a7f1-5777b3628f91|1","ClassId":1073872969,"Properties":[469775450,"nedelit",201340122,"1",134233614,"true",469778129,"nedelit",335572020,"99",134224902,"false",201334293,"17",201342446,"1",201342447,"5",201342448,"1",201342449,"1",469777841,"Calibri",469777842,"",469777843,"Calibri",469777844,"Calibri",201341986,"1",469769226,"Calibri",268442635,"22"]}">oincidental maternal mortality in Slovakia in the years 2007–2024 from the database of the Slovak Gynecological and Obstetric Society (enhanced surveillance system). Methods: Retrospective population analysis of maternal mortality from 2007 to 2024 focused on coincidental maternal deaths. Analysis of coincidental maternal death cases was carried out according to the International Classification of Diseases (ICD-10) for Maternal Mortality (ICD-MM). Results: Between 2007 and 2024, a total of 123 women died. The maternal mortality ratio (MMR) was 12.46 per 100,000 live births. Fifteen women (12.20%) died from coincidental causes (MMR 1.52 per 100,000 live births). From direct causes, 51 women died (41.46%), from indirect causes, 54 women died (43.90%), and three women died (2.44%) from an unknown cause of death. Out of the coincidental deaths, 80.0% were due to polytrauma – car accidents (66.67%), train accident (6.67%), and entrapment in an elevator shaft (6.67%). Three cases of deaths were due to homicide (domestic violence) – 20%. Conclusion: The study highlights the problem of under-recognition of coincidental maternal deaths, despite its significant impact on public health. The Slovak Gynecological and Obstetrics Society attempts to identify and collect data on coincidental maternal mortality in Slovakia, which is not included in vital statistics. Addressing this overlooked issue is crucial for enhancing maternal health outcomes and ensuring comprehensive maternal safety worldwide.
Prenatal treatment of posterior urethral valves in a newborn with anorectal stenosis
Poster<span class="NormalTextRun SpellingErrorV2Themed SCXW233982101 BCX8" data-ccp-charstyle="nedelit" data-ccp-charstyle-defn="{"ObjectId":"386dc8c1-255b-5a14-a7f1-5777b3628f91|1","ClassId":1073872969,"Properties":[469775450,"nedelit",201340122,"1",134233614,"true",469778129,"nedelit",335572020,"99",134224902,"false",201334293,"17",201342446,"1",201342447,"5",201342448,"1",201342449,"1",469777841,"Calibri",469777842,"",469777843,"Calibri",469777844,"Calibri",201341986,"1",469769226,"Calibri",268442635,"22"]}">ior urethral valves (PUV) account for most cases of lower urinary tract obstruction (LUTO) in male fetuses, with a prevalence of 1 in 5,000 live births. Prenatal ultrasound findings include bladder wall thickening, keyhole sign, oligohydramnios, and ureteral dilatation. If untreated, PUV can cause pulmonary hypoplasia and renal failure, often requiring dialysis or transplantation. Treatment options include vesicoamniotic shunting and fetoscopic laser fulguration. PUV is rarely associated with anorectal malformations, posing a diagnostic and therapeutic challenge. This case report describes a neonate diagnosed prenatally with PUV who underwent intrauterine procedures, followed by preterm cesarean section at 32 weeks. Postnatally, he exhibited renal dysplasia, cryptorchidism, and developed necrotizing enterocolitis. Despite multiple laparotomies and colostomy, the infant improved and was then discharged. At 4 months, imaging confirmed rectal stenosis. We highlight the diagnostic limitations of prenatal ultrasound in differentiating PUV from other LUTO causes and the benefits of fetal magnetic resonance imaging. Anorectal malformations have diverse phenotypic presentations and are linked to environmental risk factors. The rare association of PUV with anorectal anomalies requires careful prenatal counseling due to potential complications. This case highlights the importance of early diagnosis and multidisciplinary management for improved outcomes.
Posterior urethral valves; Prenatal diagnosis; Intrauterine treatment; Associated anomalies; Postnatal follow-up
Accuracy of a modified CMT+ for assessing pelvic floor muscle contraction in pregnancy
Objective: The ability to locate pelvic fl<span class="NormalTextRun SpellingErrorV2Themed SCXW71503138 BCX8" data-ccp-charstyle="nedelit" data-ccp-charstyle-defn="{"ObjectId":"386dc8c1-255b-5a14-a7f1-5777b3628f91|1","ClassId":1073872969,"Properties":[469775450,"nedelit",201340122,"1",134233614,"true",469778129,"nedelit",335572020,"99",134224902,"false",201334293,"17",201342446,"1",201342447,"5",201342448,"1",201342449,"1",469777841,"Calibri",469777842,"",469777843,"Calibri",469777844,"Calibri",201341986,"1",469769226,"Calibri",268442635,"22"]}">oor muscles (PFM) is essential for the effectiveness of pelvic floor muscle training programs. The aim of this study was to investigate the accuracy of a modified coccygeal movement test that incorporates an objective assessment of abdominal muscle co-activation (CMT+) (Index test) compared to transabdominal ultrasound (TAU) scanning (Gold standard) in diagnosing accurate PFM contraction. Methods: Pregnant women attending the hospital for a routine in the middle 2nd trimester scan who are able to understand the study rationale and information were considered eligible for inclusion. TAUs were performed by one out of two trained operators. CMT+ was performed by an experienced physiotherapist. The CMT+ assessor and participants were blind to the TAU result. Results: A total of 117 participants were recruited into the study with a mean BMI of 30.86 kg/m² (4.5) and 23.16 kg/m² (3.7), resp. CMT+ (Index test) correctly identified 5 out of the 9 participants who were not able to contract and 107 out of the 108 who were able to contract their PFM resp. (sensitivity = 55.6%, specificity = 99.1%, positive predictive value = 83.3% and negative predictive value = 96.4%; LR+ = 60 and LR– = 0.45). Conclusion: CMT+ is an easy to perform test with high specificity and negative predictive value that has the additional benefit of assessing any concomitant abdominal muscle co-activation. Therefore, CMT+ is a potentially useful initial screening test to identify those who cannot perform a correct pelvic floor muscle contraction, and would benefit from specialized assessment and structured training.
Early detection of recurrent ovarian cancer, current use of oncomarkers, imaging methods, and future perspectives
Ovar<span class="NormalTextRun SpellingErrorV2Themed SCXW143741059 BCX8" data-ccp-charstyle="nedelit" data-ccp-charstyle-defn="{"ObjectId":"386dc8c1-255b-5a14-a7f1-5777b3628f91|1","ClassId":1073872969,"Properties":[469775450,"nedelit",201340122,"1",134233614,"true",469778129,"nedelit",335572020,"99",134224902,"false",201334293,"17",201342446,"1",201342447,"5",201342448,"1",201342449,"1",469777841,"Calibri",469777842,"",469777843,"Calibri",469777844,"Calibri",201341986,"1",469769226,"Calibri",268442635,"22"]}">ian carcinoma is one of the most serious types of gynecological tumors. It is usually diagnosed in advanced stages, mainly due to an asymptomatic course or non-specific symptoms in the early stages. It is also characterized by a tendency to recur frequently, thus reducing the overall survival of patients. This article focuses on the possibility of detecting recurrence of the disease during follow-up of patients after complete remission. According to the analyzed literature, the monitoring of CA-125 and HE4 oncomarker levels in combination with imaging methods such as expert ultrasonography, CT, and positron emission techniques offers the potential for early detection of recurrence. The most advanced type of computed tomography, photon-counting CT, with high detection capability and lower radiation burden, also holds promise. The question of further management of early-detected asymptomatic recurrence is open for further discussion.
Role of tru-cut biopsy in the management of myometrial lesions
The aim of this article was to summarize current knowledge regarding ultras<span class="NormalTextRun SpellingErrorV2Themed SCXW135965931 BCX8" data-ccp-charstyle="nedelit" data-ccp-charstyle-defn="{"ObjectId":"386dc8c1-255b-5a14-a7f1-5777b3628f91|1","ClassId":1073872969,"Properties":[469775450,"nedelit",201340122,"1",134233614,"true",469778129,"nedelit",335572020,"99",134224902,"false",201334293,"17",201342446,"1",201342447,"5",201342448,"1",201342449,"1",469777841,"Calibri",469777842,"",469777843,"Calibri",469777844,"Calibri",201341986,"1",469769226,"Calibri",268442635,"22"]}">ound-guided tru-cut biopsy, with a focus on its applicability in preoperative diagnosis of myometrial lesions. Tru-cut biopsy is used in gynecologic oncology for the management of pelvic and abdominal tumors; however, its application in the diagnostic algorithm for uterine tumors has been validated by only a limited number of studies. Nevertheless, this literature review highlights that tru-cut biopsy of uterine smooth muscle lesions demonstrates high sample adequacy for histological examination, diagnostic accuracy, and a low complication rate. Leiomyomas are among the most common benign uterine tumors, whereas uterine sarcomas are rare and aggressive malignancies. Symptoms of these conditions do not differ significantly. Their differentiation relies on imaging methods such as ultrasonography and magnetic resonance imaging. However, distinguishing between benign and malignant tumors remains challenging, as criteria for differentiating benign and malignant lesions using these imaging methods have not yet been sufficiently validated. Incorporating tru-cut biopsy into the standard diagnostic algorithm for uterine tumors could provide valuable insights into the oncological nature of atypical tumors on ultrasonography or magnetic resonance imaging, leading to optimized and personalized treatment strategies for each patient.
Results of the Endometriosis Health Profile-30 questionnaire in women aged 18–30 years in the Czech Republic
Aim: The aim of the study is to obtain valid data on the quality of life of women aged 18–30 years with endometriosis using the certified questionnaire the Endometriosis Health Profile-30 (EHP-30). The Czech version of the EHP-30 was used in the study. A total of 184 women completed the questionnaire. Mean age of the women was 26.6 years (± 2.8 years). Materials and methods: Data were collected from 10 February 2023 to 8 October 2023 using the online platform Click4survey. Results: Summary index of the EHP-30 group was 57.0 points (± 20.43 points). The domain of powerlessness to control the disease had the greatest impact on women‘s quality of life at 66.4 points, followed by Social support at 58.4 points, then Emotional well-being at 58.2 points. With Pain at 51.3 points, and Self-image at 50.7 points as the final domain. Results showed that perception of pain did not increase with increasing age, and on the contrary, women in the youngest age group of 18–20 years perceived pain as the worst. The age of women did not statistically significantly affect the final index of the questionnaire or its individual dimensions. Conclusion: Based on the analysis and results obtained, we have obtained data on the domains of endometriosis, which can significantly contribute to a more effective understanding of the possibility of improving the quality of life of women aged 18–30 years with endometriosis and the procedures for their treatment.
Laparoscopic management of ovarian torsion at 26 weeks of gestation
Objective: We report a case of ovarian torsion at 26 weeks of gestation that was successfully managed laparoscopically. Case report: A 29-year-old woman at 26 weeks of pregnancy presented to the emergency department with left lower quadrant pain. Ultrasound examination revealed a 64 × 60 mm cyst in the left ovary, and Doppler imaging could not detect blood flow in the left ovary. The patient was diagnosed with left ovarian torsion and subsequently underwent laparoscopic left ovarian detorsion and cystectomy. The patient experienced no postoperative surgical or obstetric complications and had an uncomplicated vaginal delivery at 39 weeks of gestation. Conclusion: In the surgical management of adnexal torsion during pregnancy, laparoscopy can be safely performed not only in the 1st and 2nd trimesters but also in the 3rd trimester, provided that adequate surgical expertise and appropriate equipment are available.
Diagnosis and treatment of peripartum haemorrhage, consensus of the interdisciplinary working group by the modified ACCORD method
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)
pressure and subpressure intrauterine devices
Isolated fallopian tube torsion – case reports of one symptomatic and one asymptomatic patient
Objective: We present two cases of isolated tubal tors<span class="NormalTextRun SpellingErrorV2Themed SCXW60834824 BCX8" data-ccp-charstyle="nedelit" data-ccp-charstyle-defn="{"ObjectId":"386dc8c1-255b-5a14-a7f1-5777b3628f91|1","ClassId":1073872969,"Properties":[469775450,"nedelit",201340122,"1",134233614,"true",469778129,"nedelit",335572020,"99",134224902,"false",201334293,"17",201342446,"1",201342447,"5",201342448,"1",201342449,"1",469777841,"Calibri",469777842,"",469777843,"Calibri",469777844,"Calibri",201341986,"1",469769226,"Calibri",268442635,"22"]}">ion, one was asymptomatic in the postmenopausal period and the other was symptomatic in the reproductive period. Case reports: Case 1: A 66-year-old asymptomatic postmenopausal woman underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy for atypical endometrial hyperplasia. Intraoperatively, the left fallopian tube was found to have isolated torsion. Case 2: A 36-year-old female presented to the emergency department with acute abdominal symptoms. Diagnostic laparoscopy revealed isolated torsion of the left fallopian tube. Conclusion: Isolated tubal torsion, a rare condition in both reproductive and postmenopausal periods, may be asymptomatic or present with acute abdominal symptoms.
HIV infection and adverse perinatal outcomes – a meta-analysis of premature births, low birth weights, and small for gestational age newborns
<span class="NormalTextRun SpellingErrorV2Themed SCXW142824162 BCX8" data-ccp-parastyle="Souhrn" data-ccp-parastyle-defn="{"ObjectId":"eb5535c0-4671-5c64-ab5b-9b094333747e|1","ClassId":1073872969,"Properties":[469777841,"Myriad Pro",469777842,"Myriad Pro",469777844,"Myriad Pro",469769226,"Myriad Pro",335551500,"0",268442635,"17",335559740,"240",201341983,"2",335559739,"57",201342446,"1",201342447,"5",201342448,"1",201342449,"1",469777843,"Calibri",201341986,"1",469775450,"Souhrn",201340122,"2",134233614,"true",469778129,"Souhrn",335572020,"99",335551550,"6",335551620,"6",469775498,"Klíčová slova",469778324,"[Bez odstavcového stylu]"]}">Summary: HIV remains a significant global public h<span class="NormalTextRun SpellingErrorV2Themed SCXW142824162 BCX8" data-ccp-charstyle="nedelit" data-ccp-charstyle-defn="{"ObjectId":"386dc8c1-255b-5a14-a7f1-5777b3628f91|1","ClassId":1073872969,"Properties":[469775450,"nedelit",201340122,"1",134233614,"true",469778129,"nedelit",335572020,"99",134224902,"false",201334293,"17",201342446,"1",201342447,"5",201342448,"1",201342449,"1",469777841,"Calibri",469777842,"",469777843,"Calibri",469777844,"Calibri",201341986,"1",469769226,"Calibri",268442635,"22"]}">ealth challenge, affecting millions of individuals with a disproportionate burden in sub-Saharan Africa. Despite advancements in antiretroviral therapy (ART) and global efforts to control transmission, the impact of HIV on pregnancy outcomes remains a topic of concern. Aim: This study aims to evaluate the association between maternal HIV infection and adverse pregnancy outcomes, specifically preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) infants through a comprehensive meta-analysis. Materials and methods: A systematic search of English-language databases, including Medline, Web of Science, Ovid, Scopus, and Google Scholar, was conducted to identify relevant studies published between 2014 and 2024. Eligible studies included retrospective and prospective cohort studies with well-defined control groups of HIV-negative mothers. Studies that lacked appropriate control groups, included multiple pregnancies, or did not report adjusted statistical outcomes were excluded. A total of eight studies met the inclusion criteria for PTB analysis, five studies for LBW analysis, and five studies were selected for SGA analysis. Results: Meta-analysis using a random-effects model demonstrated a statistically significant association between maternal HIV infection and PTB (OR = 1.55; 95% CI 1.38–1.74; p < 0.001), LBW (OR = 1.57; 95% CI 1.24–1.98; p < 0.001), and an increased risk of SGA (OR = 1.24; 95% CI 1.10–1.40; p < 0.001). Heterogeneity was moderate for PTB (I² = 38.2%) and LBW (I² = 55.9%) while it was low for SGA (I² = 7.6%), indicating consistency across studies. Egger’s test showed minimal publication bias. Discussion: These findings highlight the adverse effects of HIV on pregnancy outcomes, emphasizing the need for continued monitoring and optimization of ART regimens to mitigate risks. Further research is warranted to explore the influence of different ART combinations and immune system dynamics on fetal development.
Effect of hCG follow-up on anxiety, depression, and quality of life in women with gestational trophoblastic disease
Objective: To assess the effect of normalizat<span class="NormalTextRun SpellingErrorV2Themed SCXW177249246 BCX8" data-ccp-charstyle="nedelit" data-ccp-charstyle-defn="{"ObjectId":"386dc8c1-255b-5a14-a7f1-5777b3628f91|1","ClassId":1073872969,"Properties":[469775450,"nedelit",201340122,"1",134233614,"true",469778129,"nedelit",335572020,"99",134224902,"false",201334293,"17",201342446,"1",201342447,"5",201342448,"1",201342449,"1",469777841,"Calibri",469777842,"",469777843,"Calibri",469777844,"Calibri",201341986,"1",469769226,"Calibri",268442635,"22"]}">ion of the hormone, human chorionic gonadotropin, on anxiety, symptoms of depression, and quality of life in patients with gestational trophoblastic disease, and to identify risk factors associated with these outcomes. Methods: This longitudinal study included 51 women under postmolar follow-up or during treatment for gestational trophoblastic neoplasia between 2017 and 2019 in two Brazilian trophoblastic disease centers. Results: The normalization of human chorionic gonadotropin led to a significant reduction in the depression scores and increased physical health domain scores in both study groups, namely the hydatidiform mole and gestational trophoblastic neoplasia groups. Having children and the desire for children were associated with lower scores for depression and anxiety, and higher scores for the psychological health domain of quality of life. Perceiving health as “very poor” was associated with higher scores for depression and anxiety, and lower scores for quality of life with respect to physical health, psychological health, and social relationship domains. Conclusion: Disease remission was associated with reduced depression symptoms and better quality of life in the physical health domain. While having a negative perception of health was associated with higher anxiety and depression scores and poor quality of life, having children and the desire for children improved anxiety and depression symptoms and quality of life in the psychological health domain.
Possible use of indocyanine green in the management of endometriosis
Endometr<span class="NormalTextRun SpellingErrorV2Themed SCXW87785951 BCX8" data-ccp-charstyle="nedelit" data-ccp-charstyle-defn="{"ObjectId":"386dc8c1-255b-5a14-a7f1-5777b3628f91|1","ClassId":1073872969,"Properties":[469775450,"nedelit",201340122,"1",134233614,"true",469778129,"nedelit",335572020,"99",134224902,"false",201334293,"17",201342446,"1",201342447,"5",201342448,"1",201342449,"1",469777841,"Calibri",469777842,"",469777843,"Calibri",469777844,"Calibri",201341986,"1",469769226,"Calibri",268442635,"22"]}">iosis affects approximately 10% of women of fertile age and its deep infiltrating form causes serious consequences for fertility, clinical problems depending on which organs are affected (urinary and digestive tract) and causes serious pain which seriously impairs quality of life. Resection of the affected tissue tend to be complex and often require multidisciplinary approach. Resection in the field of severe deep infiltrating endometriosis is complicated by the difficulty of resection line identification. Although we are able to perform most of the resections laparoscopically, there is still significant risk of intra and postoperative complications, the most serious of which is the formation of rectovaginal fistulas. Identification of boundaries of the endometrial nodule and preservation of tissue vitality is crucial in resection procedures. Endometriotic nodules, based on the pathogenesis of the lesion, have various vascularity and therefore different perfusion patterns. According to nature of tissue and the degree of vascularization, most deep infiltrating nodules have rather hypoperfusion pattern. A substance that would be able to guide the resection by live monitoring of the tissue perfusion, could have useful therapeutic applications. Such substance could be the fluorescent dye indocyanine green. With resection guidance by fluorescence dye, we could be able of pathogenesis oriented management of the disease and therefore perform more gentle tissue preparation, with less collateral damage, reduction of intra and postoperative complications, and thus improvement of the quality of life of patients in terms of pain, risk of recurrence, and preservation of fertility.
Occupational therapy in oncogynecology – a pilot study
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.
Patient satisfaction and ease of use of a novel method for electronic administration of validated quality of life questionnaires
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.
Low-volume regional lymph node metastasis in endometrial cancer – 2024 update
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.
Analysing risk factors for foetal growth outcomes – the influence of maternal conditions and congenital cytomegalovirus infection
Objective: This study aimed to analyse the risk factors different<span class="NormalTextRun SpellingErrorV2Themed SCXW173334421 BCX8" data-ccp-charstyle="nedelit" data-ccp-charstyle-defn="{"ObjectId":"386dc8c1-255b-5a14-a7f1-5777b3628f91|1","ClassId":1073872969,"Properties":[469775450,"nedelit",201340122,"1",134233614,"true",469778129,"nedelit",335572020,"99",134224902,"false",201334293,"17",201342446,"1",201342447,"5",201342448,"1",201342449,"1",469777841,"Calibri",469777842,"",469777843,"Calibri",469777844,"Calibri",201341986,"1",469769226,"Calibri",268442635,"22"]}">iating 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.
perinatal outcomes in COVID-19 pregnancies
Estrogenic treatment and liver functions
Estrogens are key hormones that play a vital role in the physiology of the reproductive system in women. However, their therapeutic use in hormonal treatment, contraception, and the treatment of hormone-dependent dis eases may be associated with a number of side effects, especially on the liver. This article focuses on the mechanisms of action of estrogens and their potential hepatotoxic effects, as well as risk factors and possible differences between representatives.