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
Assoc. Prof. MUDr. Jaroslav Feyereisl, MD, CSc. – former director of the Institute for Mother and Child Care, has passed away
S hlubokým zármutkem oznamujeme, že nás opustil doc. MUDr. Jaroslav Feyereisl, CSc., významný český lékař, gynekolog a porodník, dlouholetý ředitel Ústavu pro péči o matku a dítě, který stál v jeho čele více než 25 let.
Epidemiology of obesity in pregnancy in the Czech Republic – demographic context and clinical implications
Objective: To describe the current epidemiology of overweight and obesity among pregnant women in Czechia in the context of demographic trends and basic perinatal outcomes. Materials and methodology: The analysis was based on data from the National Reproductive Health Registry (NRRZ) from April 1 to September 30, 2025, focusing on 1st trimester BMI. Since April 1, 2025, the new Registry Report systematically records women’s height and weight at the beginning and the end of pregnancy. First-trimester BMI and its associations with selected demographic characteristics (particularly age, education, and parity) and selected clinical indicators of pregnancy and delivery outcomes were evaluated. For comparison, data from the European Union Statistics on Income and Living Conditions (EU-SILC) and European Health Interview Survey (EHIS) were also used. A total of 23,573 women with complete 1st trimester BMI data were included in the analysis. Results and conclusion: Among the 23,573 pregnant women with available BMI data, 53.4% were normal weight, 24.3% were overweight, and 17.7% were obese. Overweight and obesity were more frequent among older women, had lower educational attainment, and higher parity. Higher BMI was associated with an increased risk of preterm birth, foetal macrosomia, caesarean section, gestational hypertension, preeclampsia, and gestational diabetes. Overweight and obesity affect more than 40% of pregnant women in Czechia representing a significant risk factor for adverse perinatal outcomes. Systematic data collection allows, for the first time, a detailed national analysis and provides a basis for preventive interventions.
Vulvodynia and persistent vulvar pain – diagnosis, treatment, and the role of laser vaporization
This article reviews the issue of persistent vulvar pain and vulvodynia, which are common conditions in women of reproductive age. Vulvodynia is defined as chronic vulvar pain lasting at least 3 months with no identified cause. It is characterized by increased sensitivity of the vulvar and vestibular tissues, neuroproliferation, increased vascularization, and structural changes of the mucosa. In contrast, persistent vulvar pain is usually associated with a specific, identifiable underlying condition. Both types of pain may coexist and overlap. This article comments on the current classification of vulvar pain according to the consensus of international societies dealing with this condition. It also summarizes the principles of differential diagnosis and therapeutic options for the management of vulvar pain. Treatment should be based on a comprehensive multidisciplinary approach including local and systemic pharmacotherapy, physiotherapy, psychotherapy, and in selected cases, surgical interventions. This article focuses on novel and promising therapeutic modalities in the treatment of vulvodynia, particularly various types of laser therapy. The review is supplemented by a case report of a patient with chronic provoked vestibulodynia treated by laser vaporization.
ESGO/ISUOG guidelines for needle biopsies in gynecologic oncology – the adapted version
The aim of this article is to summarize current knowledge on performing biopsies using a core needle, which have become a routine method in gynecologic oncology. The text is based on international guidelines focusing on the selection of imaging techniques for navigation, selection of approach, indications, and contraindications of this method. Additionally, the article addresses recommendations to minimize the risk of bleeding, proper management of anticoagulant or antiplatelet therapy, and provides an overview of the biopsy technique. Finally, it includes recommendations for the required expertise of physicians performing biopsies to ensure maximum safety.
Impact of angiogenic factors and maternal endothelial dysfunction on pregnancy outcome
Aim: To analyze the relationship between the fibroblast growth factor soluble receptor 1 (sFlt-1/PlGF) ratio and adverse perinatal outcomes. Materials and methods: Patients admitted between 22+0 and 34+6 weeks of gestation from February 2024 to June 2025 were included. The sFlt-1/PlGF ratio was measured and its relationship to pregnancy outcome was evaluated. We assessed whether patients with increased sFlt-1/PlGF ratios developed conditions leading to preterm birth (spontaneous or iatrogenic). Results: A total of 78 patients were included, of whom 47 delivered before 37 weeks of gestation and 31 after 37 weeks. The sFlt-1/PlGF ratio appeared significant in relation to the risk of preterm birth. Almost all women with an sFlt-1/PlGF ratio above 100 delivered before 37 weeks. Based on the collected data, we developed a model to estimate the probability of delivery within 3 or 7 days. The model showed low sensitivity (0.32 and 0.53), but high specificity (0.91 in both cases). It accurately identified patients who would not deliver within 3 or 7 days. Conclusion: The sFlt-1/PlGF ratio is a useful tool in assessing the further course of pregnancy.
fibroblast growth factor soluble receptor 1
Status of a lipid accumulation product, triglycerides/glucose index and visceral adiposity index on cardiometabolic risk factors in young polycystic ovary syndrome patients
Objective: To determine whether the triglycerides/glucose index (TyG-index), lipid accumulation product (LAP), and visceral adiposity index (VAI) would differ in young polycystic ovary syndrome (PCOS) patients when compared to the non-PCOS group, and to investigate the relationship between these markers and cardiovascular disease (CVD) risk in PCOS patients. Materials and methods: One hundred and ninety two women with PCOS, and 148 age and body mass index (BMI) matched healthy women without PCOS were enrolled. Levels of serum androgens, sex hormones, lipids, fasting glucose, fasting insulin, and N-terminal pro-brain natriuretic peptide (Nt-probnp) were determined. The 75 g oral glucose tolerance test was performed. The Homeostatic Model Assessment-Insulin Resistance Index (HOMA–IR) and Matsuda insulin sensitivity index were calculated. Levels of TyG-index, LAP, and VAI were determined. Results: TyG, LAP, and VAI were significantly higher in PCOS patients than in the control group (P = 0.001 vs. P = 0.001 vs. P = 0.001, resp.). HOMA-IR was significantly higher in PCOS patients and Matsuda ISI was significantly lower in PCOS patients (P = 0.001 vs. P = 0.001, resp.). Levels of Nt-probnp were significantly higher in PCOS patients (P = 0.001). Serum total testosterone and androstenedione levels had significant correlations with TyG, LAP, and VAI. Nt-probnp was significantly correlated with TyG, LAP, and VAI. LDL was positively correlated and HDL was negatively correlated with TyG-index, LAP, and VAI. Conclusion: PCOS patients have increased values of TyG-index, LAP, and VAI. TyG index, LAP, and VAI may indicate an increased risk of CVD and hyperandrogenism in PCOS patients.
Clinically relevant histopathological features and biomarkers in endometrial cancer
Objective: To provide an overview of the most important histopathological characteristics and biomarkers of endometrial carcinoma that have clinical relevance for prognosis, prediction of treatment response, and decision-making regarding adjuvant therapy. Methods and results: Endometrial carcinoma represents the most common malignancy of the female reproductive tract in developed countries. Disease prognosis is determined not only by the anatomical extent, but also by a number of non-anatomical factors. The histological tumour type, presence of lymphovascular space invasion, and specific patterns of myometrial invasion (such as the MELF pattern) play major roles. Current molecular classification divides endometrial carcinomas into four groups (POLEmut, MMRd, NSMP, and TP53mut), which differ in prognosis as well as in therapeutic response. Additional clinically applicable biomarkers include oestrogen and progesterone receptors, L1CAM, HER2, CA125, and HE4. Emerging research focuses on novel biomarkers such as TROP2, circulating tumour DNA (ctDNA), circular RNA (circRNA), tumour-infiltrating lymphocytes (TILs), and folate receptor alpha (FR). These markers enable more precise risk stratification and identification of patients suitable for targeted therapies. Integration of multiple biomarkers with clinicopathological parameters further enhances the accuracy of risk assessment and prediction of treatment response. Conclusion: Incorporating histopathological features and biomarkers into routine clinical practice allows for a more accurate estimation of prognosis and a more rational selection of adjuvant therapy. An increasing number of non-anatomical biomarkers are becoming an integral part of the decision-making algorithm in endometrial carcinoma management.
Perinatal outcomes in severe preeclampsia with peritoneal ascites – a single tertiary center experience
Aim: This study aimed to evaluate maternal and neonatal outcomes of women with severe preeclampsia (PE) with and without peritoneal ascites. Methods: In this retrospective cohort study, 76 pregnant women diagnosed with severe PE between January 2019 and January 2024 were evaluated, including 23 with peritoneal ascites and 53 without. Maternal demographic, clinical, and laboratory parameters including neonatal outcomes were compared between the two groups. Results: Women with severe PE and peritoneal ascites had higher rates of previous preeclampsia (30.4 vs. 7.5%; P = 0.009), visual symptoms (52.2 vs. 22.6%; P = 0.011), and maternal blood transfusion (47.8 vs. 13.2%; P = 0.001). They also exhibited significantly higher urea levels and proteinuria (P < 0.05). In terms of neonatal outcomes, the ascites group delivered earlier (31.5 ± 3.9 vs. 33.8 ± 3.1 weeks; P = 0.008), had lower birth weights (median 1,400 g vs. 1,990 g; P = 0.015), and higher NICU admission (60.9 vs. 34.0%; P = 0.029) with longer NICU stays (P = 0.003). One case of HELLP syndrome was observed in the ascites group. Conclusion: Presence of peritoneal ascites in severe PE is associated with worse maternal and neonatal outcomes, including increased transfusion requirement and adverse perinatal indicators. Detection of ascites may serve as an important clinical marker of disease severity, highlighting the need for closer surveillance and timely intervention.
We present a case of extrapelvic endometriosis of Bartholin’s gland in a healthy 40-year-old woman with two deliveries. After the last delivery 10 years ago, she had cyclical pain with swelling in the Bartholin’s gland area and dyspareunia with vulvodynia. Primary excision was performed, and Bartholin’s gland endometriosis was pathohistologically proven as an extremely rare gynaecological entity. A follow-up examination 2 months after surgery proved complete recovery without vulvodynia and dyspareunia.
Impact of selected dimensions of pelvic floor structures on the process of delivery – a review of the literature
Muscular and connective tissue structures of the pelvic floor play a crucial role throughout a woman‘s life, exerting significant influence on the course of childbirth. Injury to these soft tissues during delivery can substantially affect a woman‘s postpartum quality of life. In recent years, research has increasingly focused on evaluating pelvic floor structures prior to labor to determine whether functional or anatomical changes contribute to the labor process and its outcomes. Transperineal ultrasound has emerged as a promising tool for objectively assessing the preparedness of pelvic floor musculature for vaginal delivery. This paper summarizes current scientific evidence on the use of transperineal ultrasound in the assessment of selected dimensions of pelvic floor structures and their impact on labor progression. Several studies have demonstrated that significantly reduced dimensions of the genital hiatus are significantly associated with an increased risk of operative delivery and a prolonged second stage of labor. In the future, transperineal ultrasound may help identify women with an elevated risk of delivery-related complications. Such identification could support individualized strategies to mitigate these risks or guide the selection of the most appropriate mode of delivery, considering other clinical and obstetric factors. However, at present, pelvic floor assessment via transperineal ultrasound cannot be considered as a standalone marker for determining optimal delivery strategy. Childbirth remains a multifactorial process, and pelvic floor morphology represents only one of many variables influencing its course. Further research is needed to validate the clinical utility of this method and to establish its role in obstetric decision-making.
Robotic interposition of the mesorectum during low anterior resection of the rectum for endometriosis using tissue perfusion assessment with indocyanine green
Introduction: Rectal endometriosis is a serious disease, and its surgical treatment belongs among demanding procedures, often requiring a multidisciplinary approach. It is associated with a significant risk of peri- and postoperative complications, the most serious being the development of rectovaginal fistula, which may occur in up to 10% of resections for rectal endometriosis. Preventive measures include the choice of surgical technique, such as a two-stage procedure (resection with terminal stoma followed by stoma closure and bowel anastomosis), which is not optimal for the patient due to the necessity of having two surgeries. Another option is the interposition of the patient’s vital tissues into the site of anastomosis or intestinal wall suture. For this purpose, an omental flap is often used, or part of the mesorectum may be utilized. The ability to verify the vitality of such a flap should be considered crucial in preventing anastomotic leakage. Methods: A patient underwent robotic-assisted laparoscopic segmental resection of severe rectal endometriosis involving the rectovaginal septum and vagina, classified as #ENZIAN A3 and C3, with interposition of the mesorectum and intraoperative tissue perfusion assessment using indocyanine green. Conclusion: The use of tissue perfusion assessment when performing interposition of patient-derived flaps may, in the future, improve surgical precision, enhance success rates, and contribute to the prevention of rectovaginal fistula formation.
Limits of preeclampsia screening and prevention in a population of women after assisted reproductive technologies
Pregnancies resulting from assisted reproductive technologies are associated with an increased risk of developing preeclampsia. Available data indicate that one of the risk factors is frozen embryo transfer in an artificial cycle. Assessment of the pulsatility index of the uterine artery along with maternal factors and serum biomarkers form the basis for preeclampsia screening in the 1st trimester. Current evidence suggests that the method of endometrial preparation for embryo transfer may influence uterine artery pulsatility index values, thereby affecting the estimation of preeclampsia risk.
Cytological versus histological results in ASCUS cervical dysplasia – a retrospective study
Aim: The cytological category of atypical squamous cells of undetermined significance describes cellular abnormalities that are more severe than inflammatory changes, but are quantitatively or qualitatively insufficient to be included in the squamous intraepithelial lesion category. This study aims to determine the risk level for the presence of high-grade dysplasia in patients with this cytological abnormality. Methods: We retrospectively searched our database for women with cytologically proven atypical squamous cells of undetermined significance lesions between January 2020 and June 2024. A total of 104 patients who had undergone colposcopy-directed biopsies were included in the study. Results: Among the 104 women with confirmed atypical squamous cells of undetermined significance cytological lesions who had undergone biopsies, 56 cases (53.8%) were negative, while 48 cases (46.2%) demonstrated cervical intraepithelial neoplasia. Cervical intraepithelial neoplasia 2+ was present in 23.1% (N = 24) of the cases. Furthermore, among 77 human papillomavirus positive women, the precancerous condition was not histologically confirmed in almost half of the cases (N = 36), while in 16 of the 23 human papillomavirus negative biopsies, the precancerous condition was not confirmed. Human papillomavirus status was unknown in 4 cases. Conclusion: We identified a 23.1% presence of cervical intraepithelial neoplasia 2+ lesions in patients with atypical squamous cells of undetermined significance cytological findings. Our study also suggests a lower specificity, but a better negative predictive value of the human papillomavirus test in detecting cervical intraepithelial neoplasia in these patients.
Prenatal sonographic features and outcomes of radial ray defects – a 14 case series with a literature review
Objective: In this study, we aimed to present the demographic, ultrasonographic, genetic, obstetric, and postpartum results of 14 patients diagnosed with radial ray defects. Materials and methods: Fourteen patients diagnosed with radial ray defects. Non-development or hypoplasia of any preaxial part of the upper extremity on ultrasonography was considered a radial ray defect. Maternal age, gestational week at diagnosis, laterality of the radial ray defect, genetic results, presence of comorbid anomalies, termination status, and postpartum prognosis were obtained. Results: The range of maternal age at the time of diagnosis was 17–38 years and the gestational age ranged between 14–26 weeks. Four of the radial ray defects were bilateral, and ten were unilateral. Trisomy 18 was identified in two cases. Eight cases accepted the termination procedure. Three cases rejected termination and had spontaneous intrauterine death during pregnancy follow-up. One case was diagnosed with VACTERL association and died postpartum on the 13th day. One case was monitored due to Fanconi aplastic anemia and one case had amniotic band syndrome in etiology and lives with a prosthetic arm. Conclusion: The frequency of a radial ray defect accompanied by syndromic and congenital anomalies was high, and visualization of the radial bone or other preaxial bone structures on the 1st trimester fetal ultrasonography will ensure the diagnosis of a radial ray defect in early gestational weeks. In the case of a radial ray defect diagnosis, systemic organ screening should be performed with detailed ultrasonography and the necessary invasive procedure for karyotype examination should be advised to all families.
Ovarian cancer and multimodal prehabilitation options – a case study
Objective: The aim of this case report is to present the impact of multimodal prehabilitation on the quality of life, cognitive performance, physical fitness, and nutritional status in a patient with advanced ovarian cancer. Methods: A 74-year-old woman with high grade serous ovarian carcinoma pT3bN1a was scheduled for radical surgery following three cycles of neoadjuvant chemotherapy. She underwent a three-week intensive multimodal prehabilitation program in a 4/7 regimen involving physiotherapy, occupational therapy, nutritional counselling, psychological support, and supervision by a rehabilitation physician. The effect was evaluated using functional and cognitive tests, stress and disability scales, and body composition analysis (InBody). Results: Improvement was observed across all major domains: reduction in disability (WHODAS 20 → 5%), enhancement of cognitive function (MoCA 22 → 25), decreased perceived stress (PSS-10 17 → 11), reduction in frailty (FI 3 → 1), and restoration of full independence in activities of daily living (Katz Index 6/6). Physical performance showed marked gains (6MWT +42 m, 5×SST −6.5 s, handgrip strength +4 kg), while pulmonary function tests confirmed improved ventilatory capacity (FVC, FEV1, PEF). Nutritional assessment indicated a reduced risk of malnutrition according to the MUST screening tool, although bioimpedance analysis demonstrated a mild increase in total body fat and visceral adipose tissue. Conclusion: Intensive multimodal prehabilitation positively influenced the patient’s psychosensory-motor potential, reduced disability, enhanced perioperative fitness, and confirmed its indispensable role in oncogynecology.
Endometriosis of the spleen – multidisciplinary surgical solution in a patient with a complex picture of deep infiltrating pelvic endometriosis
In general, most common localizations of endometriosis are the pelvic organs, until recently, the spleen was mentioned as the only abdominal organ resistant to the development of endometriosis. Our case report describes the differential diagnosis of a splenic cyst as an incidental finding during the examination of endometriosis, its interdisciplinary solution within surgery, gynaecology, radiology and infectious medicine, using robotic-assisted minimally invasive surgery.
Molar ectopic pregnancy in a cesarean scar treated with methotrexate – a case report and review of the literature
Objective: To present a rare case of partial molar pregnancy implanted in a previous cesarean section scar and summarize the literature. Case report: A 33-year-old woman (gravida 5, two prior cesarean deliveries, two spontaneous abortions) presented with vaginal spotting and lower abdominal pain at 6 weeks of gestation. Transvaginal ultrasonography revealed a 28 × 19 mm gestational sac at the cesarean scar site, containing a 4mm fetus with positive cardiac activity. Vacuum curettage was performed under ultrasonographic guidance. Ten days postprocedure, rising serum beta-hCG levels and a persistent cystic mass on ultrasound raised suspicion for molar pregnancy. A single systemic dose of methotrexate was administered. Histopathology confirmed a partial molar pregnancy. The patient’s serum beta-hCG levels normalized within 8 weeks. Conclusion: Partial molar pregnancy in a cesarean section scar is an extremely rare condition that may present with vaginal bleeding and pelvic pain. Early recognition through ultrasonography and laboratory evaluation, combined with timely intervention including curettage and methotrexate therapy, can lead to complete resolution. Clinicians should consider this diagnosis in patients with previous cesarean sections to ensure optimal outcomes.
Pelvic floor muscles High-Intensity Tesla Stimulation
Introduction: Stress urinary incontinence (SUI) represents a significant health problem for women, which fundamentally reduces the quality of life. Conservative treatment mainly includes pelvic floor muscle training, where the effectiveness is limited by the patient’s ability to actively engage the muscles and long-term compliance. An alternative is electrical stimulation of the pelvic floor, which, however, is sometimes painful and requires invasive application of probes to the pelvic floor. A new option is high-frequency electromagnetic stimulation using High-Intensity Tesla Stimulation (HITS) technology, which induces intense muscle contractions without the need for insertion of probes or electrodes and with higher patient tolerance. The aim of the study was to evaluate the effectiveness of six HITS sessions in women with SUI – based on subjective assessment by patients and objective assessment of muscle strength according to the modified Oxford scale (MOS) and electromyographic activity of the pelvic floor using the Multiple Array Probe Leiden (MAPLe) probe). Methods: A prospective study was conducted at the urogynecological center Gyn-Line in Brno from February to September 2025. Twenty women with urodynamically proven SUI who did not wish to undergo surgical treatment of the disease were included. Patients underwent six sessions of high-frequency electromagnetic stimulation HITS on the MagRex Pelvic Seat device over 4–5 weeks. The protocol included contractions at frequencies of 25 Hz, 35 Hz, and 35–75 Hz according to tolerance. Evaluation of effectiveness included MOS, electromyographic activity of the pelvic floor muscles measured by the MAPLe probe, and a subjective Patient Global Impression of Improvement (PGI-I) questionnaire. Statistical analysis was performed using a Student’s t-test at a significance level of P < 0.05. Results: All patients (N = 20; age 62.5 ± 9.4 years; parity 2.4 ± 2.7; BMI 29.2 ± 6.4 kg/m²; 90% postmenopausal) completed the series of six sessions without adverse effects. The procedure was evaluated as painless and well tolerated. Muscle strength according to MOS increased from 2.4 to 3.8 (increase of 58.3%). Electromyographic activity of the pelvic floor muscles measured by MAPLe increased from 7.0 to 9.9 μV/s (increase of 41.4%). Subjective assessment according to PGI-I improved from 4.0 to 5.9 (increase of 47.5%). All differences were statistically significant (P < 0.05). Conclusion: The results demonstrated that high-frequency electromagnetic stimulation HITS of the pelvic floor is a safe and effective method of conservative treatment of stress urinary incontinence in women. This therapy led to statistically significant improvement in muscle strength assessed by the Oxford scale, electromyographic activity of the pelvic floor according to MAPLe, and also subjective perception of difficulties by patients. HITS may thus represent as an alternative or adjunct therapy to traditional pelvic floor muscle training. To confirm long-term efficacy, larger randomized clinical studies are recommended.
Significance of positive excision margins in therapy of high-grade vulvar precancerosis – analysis of own data and literary review
Objective: In many countries, the incidence of vulvar intraepithelial neoplasia as a precursor of vulvar squamous cell carcinoma has highly increased over the last 3 decades, while the incidence of cancer remained relatively unchanged. Among risk factors for recurrence, resp. progression, usually involve positive excision margins. The aim of the paper is to evaluate the risk of recurrence and progression of high-grade vulvar precancerosis in patients with histological margins “non in sano” – analysis of our own data. Materials and methods: The retrospective study included 62 women after surgical resection of high-grade vulvar precancerosis with histological results of positive excision margins. Using the PubMed database, the results were compared with literary data. Results: Total of 35 (56.5%) patients underwent repeated surgery on the vulva. Inhalf of them (18–51.4%), histological results showed recurrence at the same stage, and in the second half of the women, no dysplastic changes were detected. There was no progression to invasive cancer in any of the patients. Conclusion: Beyond positive excision margins, the other predictive factors seem to be even more important for recurrence or progression of vulvar precancerosis including age, smoking, immunosuppression, radiotherapy, concomitant lesions in the vagina or cervix, and bioactivity of the human papilloma-virus. Instead of repeated resection to reach histological negative margins, we prefer the long-time, resp. long-life dispensarisation.
The influence of selected immunohistochemical and clinical-pathological markers on the prognosis of patients with malignant uterine tumors
Introduction: Endometrial carcinoma is the most common gynecological malignancy in developed countries, and its incidence has been increasing in recent decades. The prognosis of patients depends on a combination of clinical-pathological characteristics, and more recently, molecular indicators. The aim of this study was to analyze the influence of the selected prognostic markers – immunohistochemical (L1CAM, ER, PR) and classical (FIGO stage, grade, myometrial invasion, lymph node involvement, distant metastases) – on the survival of patients with endometrial carcinoma. Materials and methods: A retrospective evaluation was performed on 143 women with histologically confirmed endometrial cancer treated between 2014 and 2018. All patients underwent primary surgical treatment. Resected specimens were subjected to immunohistochemical analysis of L1CAM, ER, and PR. Data were statistically processed using a Kaplan-Meier analysis and the Cox proportional hazards model, adjusted to age. Results: L1CAM expression was detected in 14% of patients and was associated with shortened survival (HR ≈ 3.9). ER and PR positivity (89% and 85%, resp.) correlated with a more favorable prognosis (HR for ER positivity 0.21; PR 0.23). Classical factors such as higher grade, advanced FIGO stage, cervical and lymphovascular invasion, or presence in nodes were statistically associated with worse survival. An interesting finding was a significantly better prognosis in asymptomatic patients – the presence of symptoms increased the risk of death up to fourfold. Conclusion: L1CAM positivity and loss of hormone receptors are significant adverse prognostic factors. Their inclusion in routine immunohistochemical panel testing improves risk stratification and treatment personalization, which at the time of publication of this paper is already included in the updated ESGO-ESTRO-ESP 2025 guidelines. At the same time, it has been shown that the absence of symptoms at diagnosis is a favorable survival indicator. The results support further research into prognostic markers and their integration into clinical decision-making algorithms.
Cryopreservation of oocytes to preserve female fertility
Objective: The aim of the study is to obtain information on the possibilities and success rate of cryopreservation of human oocytes. In the Czech Republic, this method is used to prolong women‘s reproductive health to a limited extent due to low awareness among women and also due to the high cost of this method. Materials and methods: Ninety-three oocyte retrievals were evaluated in women with oocyte retrievals intended for vitrification and long-term storage to extend reproductive age. Clients were divided according to age into two groups: under 35 years old and over 35 years old. At the same time, each age group was divided into two groups according to the number of vitrified oocytes: under 4 oocytes and over 4 oocytes. Furthermore, the success rate of the oocyte vitrification method was compared with the success rate of oocyte vitrification in healthy anonymous donors. Results: In order to obtain information on the success rate of the oocyte vitrification method, we evaluated the survival rate (SR), fertilization rate (FR) and utilization rate (UR) in each group. SR was 61.5–89.3%, with the lowest value in older clients with a low oocyte count. FR was 50.0–80.0%, where the lowest value was again seen in older clients with a low oocyte count. UR was 34.9–75.0%, where the lowest value was seen in the group of older clients with a higher vitrified oocyte count compared to the other groups. Conclusion: In conclusion, the age at the time of oocyte freezing and the number of stored oocytes remain the two key factors that determine the success rate to secure the possibility of having a child in the future.
Which causes less pain? A comparison of misoprostol and dinoprostone in labor induction
Objective: Effective labor pain management is essential in prenatal care. Identifying factors that contribute to increased pain in patients undergoing labor induction is essential for optimizing pain control. This study assesses pain levels in labor induction patients receiving vaginal misoprostol or dinoprostone for cervical ripening using a visual analogue scale (VAS). Materials and methods: This prospective study includes 60 volunteer women who received either vaginal dinoprostone (50%) or vaginal misoprostol (50%) as cervical ripening agents. Group 1 consists of patients who received misoprostol, while Group 2 includes those who were administered dinoprostone. VAS scores were recorded during both active labor and crowning. In addition to these pain assessments, birth outcomes and patient characteristics were documented, and comparative analyses were conducted between the groups. Results: According to VAS scores, pain intensity was significantly lower in Group 1 compared to Group 2 at both stages of labor (during active labor: 6.67 ± 2.68 vs. 7.77 ± 1.59, P < 0.05; during crowning: 8.9 ± 1.32 vs. 9.8 ± 0.55, P < 0.05). All participants’ pain scores recorded during crowning were significantly higher than those recorded during active labor (P < 0.05). No statistically significant difference was observed between the two agents in terms of oxytocin administration or the interval from drug administration to delivery (P > 0.05). Conclusions: Pain scores should be considered when selecting a cervical ripening agent. Misoprostol may be associated with lower pain levels.
Comparison of the incidence of pelvic girdle pain and back pain in women after vaginal delivery and cesarean section in the Slovak female population
Background: A common problem in women after childbirth is the frequent occurrence of pelvic girdle pain (PGP) and back pain (LBP). To date, no study has been conducted to determine the prevalence of these types of pain. The aim of our study was to compare the incidence of PGP and LBP in women after vaginal delivery and cesarean section in the Slovak Republic over the course of one year in 2024. Methods: Cross-sectional study, the research sample consisted of 791 women 12 weeks to one year after delivery. The average age was 31.43 years. Standardized questionnaires were used for the Slovak version Pelvic Gridle questionnaire and Oswestry Disability Index. Conclusion: Based on the type of delivery, the sample was divided into a group with spontaneous delivery comprising 633 women and a group with cesarean section comprising 158 women. Significant differences were observed in the incidence of pain and disability in the spine and in its intensity, with stronger pain in the cesarean section group. The type of delivery did not affect the incidence of pelvic girdle pain after delivery. Cesarean section was associated with greater pain intensity and disability in the spine. Disruption of the integrity of the abdominal wall, increased sensitivity in the area of the cesarean section scar, and a restricted movement regime may explain the higher incidence of pain in the spine in women after cesarean section.
Age-specific incidence and mortality of cervical cancer in the Czech Republic – analysis of nationwide data and data from a gynecologic oncology center
Objective: To analyze the incidence and mortality of cervical cancer in individual age cohorts in the Czech Republic using nationwide data and data from the largest national gynecological oncology center. Materials and methods: Analysis of a single-institution cohort of newly treated cervical cancer cases from 2022–2024, and analysis of incidence and mortality trends in individual age groups using data from the Czech National Cancer Registry (ÚZIS – Institute of Health Information and Statistics) from 2000–2023. Results: The incidence and mortality of cervical cancer in the Czech Republic have declined significantly over the last 20 years. The decline correlates well with measures that have led to better organization and implementation of changes within the screening program. Analysis in individual age cohorts shows that the largest decline in incidence and mortality occurred in the cohort up to 34 years of age, yet in more than 50% of women with carcinomas in this cohort, cytological screening and subsequent management failed. The upward trend in incidence in the 35–44 and 45–54 age cohorts raises questions about the causes. The high percentage of invasive carcinomas in women examined by a gynecologist in the last three years requires an analysis of the quality of cytology laboratories and management by registering gynecologists. The introduction of high-risk human papillomavirus (HR HPV) testing and referral to expert colposcopy for discrepant findings is one way to improve the situation. Furthermore, audits of diagnosed carcinomas in women who have undergone screening should be introduced. The biggest challenge will be to activate the resistant population of women who underestimate the importance of regular screening examinations. Conclusion: Even though we can see an overall decline in incidence and mortality, when individual age cohorts are analyzed, it shows us ways for improvement in each specific age group of women individually.
Cervical cancer screening in the European context – from cytology to primary HPV testing
Cervical cancer remains a major global health challenge, despite the availability of effective preventive measures such as human papillomavirus (HPV) vaccination, early detection and treatment of precancerous lesions, and timely management of early-stage disease. In recent years, several European countries have introduced substantial changes to their screening strategies –shifting from conventional cytology to primary HPV testing. This shift, supported by the World Health Organization and International Agency for Research on Cancer recommendations, is underpinned by numerous clinical studies demonstrating the superior sensitivity of HPV testing for detecting high-grade cervical lesions. This article provides an up-to-date overview of cervical cancer screening across Europe, with a focus on screening methods, testing intervals, program organization, and the emerging role of self-sampling.
HLA-C and KIR interactions as a possible cause of reproductive failures
Objective: Despite advancements in assisted reproduction, the cause of up to 50% of cases of idiopathic fertility disorders remains unclear. The immune system, particularly the interaction between human leukocyte antigen-C (HLA-C) molecules on the trophoblast and killer--cell immunoglobulin-like receptors (KIR) on uterine natural killer (NK) cells, plays a crucial role in implantation and placental development. The aim of this analysis was to evaluate our experience with testing KIR/HLA-C compatibility and its potential role in personalizing infertility treatment. Methods: This is an interventional study examining the success of therapy in 23 couples who underwent infertility treatment with donated gametes between 1/2023 and 12/2024, with additional consideration of KIR/HLA-C compatibility between the recipient and the donor. For better homogeneity of the sample, patients in the intervention group were divided into two subgroups. The first subgroup consisted of 14 couples undergoing their first therapy with donated gametes. The second subgroup consisted of 9 couples with a history of repeated unsuccessful embryo transfers from donated gametes. A control group of 320 single embryo transfers with donated gametes from couples treated using standard methods between 1/2023 and 12/2024 was used for comparison. Results: In both intervention subgroups, success rates were comparable. Clinical pregnancy was achieved in 62.5% and 63.6%, resp., which exceeded the average success rate of 55.2% in the control group. Conclusion: The high number of achieved clinical pregnancies in a prognostically unfavorable group, burdened by repeated unsuccessful embryo transfers, appears to be a therapeutic success. It is important to bear in mind the low number of evaluated transfers; however, this result suggests that testing KIR/HLA-C compatibility between the recipient and the donor and taking it into account when selecting a donor may significantly increase the success of therapy in indicated cases.
killer-cell immunoglobulin-like receptors
vNOTES hysterectomy reduces laparotomy conversion rates in class III obesity – a retrospective comparative study
Objective: This study aims to compare the outcomes of laparoscopic hysterectomy (LH) and vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) hysterectomy (vNH) in obese patients undergoing the procedure for benign gynaecological indications, with results classified according to obesity class (class I, II, and III). Materials and methods: We retrospectively reviewed the data of patients with a body mass index (BMI) ≥ 30 kg/m² who underwent either LH or vNH for benign indications at a tertiary teaching and research hospital between January 2020 and December 2024. Results: A total of 134 patients (70 LH, 64 vNH) were included in this single-centre study. The median operative time was significantly longer in the vNH group (205 min vs. 178 min; P < 0.01). Overall, major complication rates were similar between the two groups. The most striking finding of the study was that in patients with class III obesity (BMI ≥ 40 kg/m²), the vNOTES approach significantly reduced the conversion rate to laparotomy compared to laparoscopy (0 vs. 23.5%; P = 0.035). Conclusion: Our study demonstrates that the most significant advantage of vNOTES surgery in obese patients undergoing benign hysterectomy is the reduction in the conversion rate to laparotomy, particularly within the class III obesity group. vNOTES statistically eliminated the risk of conversion to laparotomy compared to laparoscopy in patients with class III obesity (OR 0.08; 95% CI 0.00–0.91; P = 0.035). These findings underscore the importance of risk stratification based on patient BMI when selecting a minimally invasive surgical approach for obese patients.
Negative pressure wound therapy in gynecologic oncology – current knowledge and clinical applications
Negative pressure wound therapy is a modern and effective method for the prevention and treatment of postoperative wound healing complications, with growing applications in gynecology and especially in gynecologic oncology. Its mechanism of action includes enhanced drainage, reduction of edema, promotion of angiogenesis, and stimulation of granulation tissue formation, ultimately contributing to faster healing and a lower risk of infection, seroma, and wound dehiscence. Negative pressure wound therapy has been shown to be effective in the therapeutic management of complex, infected, or dehiscent wounds following gynecologic‑oncologic surgery. Recent studies also suggest that its prophylactic application to primarily closed incisions after laparotomy or vulvectomy may significantly reduce surgical complications, shorten hospitalization, and accelerate recovery, which is particularly important in patients scheduled for adjuvant therapy. However, because most available evidence is based on retrospective studies, further prospective randomized trials are needed to confirm the role of this method in both therapeutic and prophylactic use and to guide its integration into standard perioperative care in gynecologic oncology.
Epidemiological profile of pregnant women and perinatal outcomes of newborns with gastroschisis from a single reference center in Northeastern Brazil
Objective: To determine the maternal epidemiological profile and perinatal outcomes of fetuses with gastroschisis at a reference center in Northeastern Brazil. Methods: A retrospective cohort study was conducted between January 2014 and December 2022 using medical records. Inclusion criteria comprised of pregnancies ≥ 24 weeks, with a prenatal diagnosis of gastroschisis confirmed in the postnatal period. Results: During the study period, 1,773 newborns with congenital anomalies were born at the service center, 50 were identified as having gastroschisis and four cases were excluded. Prevalence of gastroschisis was 11.5/10,000. Regarding the maternal sociodemographic profile, the mean age was 21 years, 38/46 (83%) were mixed, 34/46 (74%) had a partner, and 32/46 (70%) had high school education. Regarding associated maternal diseases, only 6/46 (13%) had hypertension, none had pre-existing diabetes mellitus, and 4/46 (8.7%) developed gestational diabetes mellitus. As for gastroschisis type, 33/46 (71%) were classified as simple, 11/46 (23.9%) as complex and 2/46 (4.4%) had no information. In 36/46 newborns with gastroschisis, primary closure was performed in the first surgery. The mean time of use of mechanical ventilation was 13 days, the mean time interval between surgery and ambient air was 8 days, the mean time of use of parenteral nutrition was 35 days, and the mean length of stay in the neonatal intensive care unit (NICU) was 39 days. Clinical complications in newborns with gastroschisis included neonatal infection in 35/46 (76%), blood transfusion in 33/46 (72%), hydroelectrolytic disorders and sepsis in 29/46 (63%), and cholestasis and fungal infection/sepsis in 8/46 (17%). Neonatal death occurred in 16/46 (34.8%). Conclusion: Newborns with gastroschisis presented high rates of surgery with primary closure, blood transfusion and neonatal infection. Furthermore, we identified prolonged use of parenteral nutrition, long stay in the NICU, and prolonged use of antibiotic therapy.
Cinthia Maria Gomes da Costa Escoto Esteche
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.