Laparoscopic trans teres vault suspension, a new laparoscopic method of treatment of female genital prolapse - a preliminary report.

INTRODUCTION: Pelvic organ prolapse (POP) is treated with a great variety of procedures and none is fully satisfactory. The aim of the study was to introduce and evaluate the effectives of laparoscopic trans teres vault suspension (LTTVS) technique as a new method for POP treatment. MATERIAL AND METHODS: In the years 2013-2014, eight symptomatic women with grades II-IV POP underwent LTTVS procedure. The mean age of patients was 65.25 years (range from 52 to 76 years). The surgery encompassed total hysterectomy, suturing the vagina and fixation of uterosacral ligaments to the vaginal stump, fixation of stumps of round ligaments to the vaginal stump, and fixation of the vaginal stump to the anterior rectus fascia. Mean follow-up was 17.75 months (range from 6 to 27 months). RESULTS: Eight patients were successfully operated. The symptoms of POP resolved after surgery and subjective quality of life increased. In one case a complication such as common fibular nerve injury appeared; however, it resolved after one month of physiotherapy. The other patient reported radiating pain down the leg after three months. No recurrence of vaginal stump prolapse was observed during the follow-up. CONCLUSIONS: LTTVS is a promising method for POP treatment. Due to repair with the use of native tissues, physiological placement of vaginal stump, and high efficacy it can be considered as an alternative to other POP surgeries. The method requires additional research on larger groups of patients.

Transferrin Sialylation in Smoking and Non-Smoking Pregnant Women with Intrauterine Growth Restriction.

Transferrin (Tf) is a glycosylated protein responsible for transporting iron. Various sialylation levels of Tf are observed during physiological and pathological processes. We studied if the changes in iron stores as well as tobacco smoke may have an impact on foetal development and in consequence lead to intrauterine growth restriction (IUGR). In the third trimester of pregnancy, lower levels of 4-sialoTf isoform and higher levels of 5-sialoTf were observed in the serum of non-smoking women with IUGR in comparison to the control group. On the day of labour, level of 2-sialoTf was significantly lower and level of 3-sialo was Tf higher in the serum of non-smoking women. Level of 4-sialo was found lower in the serum of smoking women with IUGR than in the control group. The observed changes may suggest a connection between iron stores, transport of iron to the foetus and foetal development.

Indocyanine Green for Assessment of Ureteral Vascularity Can Reduce the Rate of Ureteral Complications in Patients Undergoing Extended Hysterectomy.

Objectives: This study aimed to evaluate the effectiveness of using indocyanine green (ICG) for assessing ureteral vascularity to reduce ureteral complications in patients undergoing extended hysterectomy for deep endometriosis or oncological indications. Methods: A retrospective-prospective cohort study was conducted at the Centre of Gynecology in Opole, Poland, involving 555 patients who underwent hysterectomy from 2020 to 2023. Patients were categorized based on the Querleu-Morrow classification. ICG was used intraoperatively for vascular assessment in patients with deep endometriosis undergoing wide ureter dissection typical of Type C hysterectomy. Results: Ureteral complications occurred in 12 (2.2%) patients, with a significantly lower complication rate in those who underwent ICG testing (1.7%) compared to those who did not (22.7%, p = 0.001). Prophylactic double-J stenting further reduced the risk of complications. Conclusions: The use of ICG for intraoperative assessment of ureteral vascularity significantly reduces the risk of ureteral complications in complex hysterectomies. Further studies are needed to confirm these findings.

Sonoelastography of the uterine cervix as a new diagnostic tool of cervical assessment in pregnant women - preliminary report.

OBJECTIVES: The study aimed at determining whether there exists a correlation between the cervical cohesion parameters assessed in the elastography and the length of the cervix. MATERIAL AND METHODS: Assessment of cervical cohesion parameters with the use of real-time sonoelastography was performed on 59 patients between 28 and 39 weeks of gestation. RESULTS: The analysis showed that there exists a statistically significant (p=0.033) correlation between the cervical length and the elasticity of the front cervical labium (strain ratio A). Correlation coefficient (r) stood at (-) 0.28. CONCLUSIONS: 1. There exists a negative correlation between the condition on the front cervical labium in elastographic imaging and the length of the cervical canal in USG imaging. 2. Elastography of the uterine cervix may be helpful in assessing the risk of premature labour or cervical insufficiency. 3. There is a need to perform a study on a larger group of patients in order to determine whether elastography may find its place among routine obstetric diagnostic methods.

Comparative analysis of placental vasculature and placental volume in normal and IUGR pregnancies with the use of three-dimensional Power Doppler.

OBJECTIVES: To evaluate the differences in placental vascular indices and placental volume between normal and IUGR pregnancies. METHODS: A prospective study was conducted on a group of 100 normal and 20 IUGR pregnancies between 22 and 42 weeks of gestation. For the purpose of evaluation of placental volume and placental vascular indices, we applied 3D Power Doppler and VOCAL technique. Only patients with entirely visualized placenta were included in the study. RESULTS: A comparative analysis of vascularization index (VI), vascularization flow index (VFI), flow index (FI), and placental volume (PV) revealed statistically significant differences between normal and IUGR pregnancies. In normal pregnancies, the volume of the placenta was on average 92.42 cm(3) larger than in pregnancies complicated by IUGR. Receiver operating characteristic (ROC) curves were used to evaluate the clinical usefulness of placental vascular indices and placental volume for discriminating IUGR and normal pregnancies. It was concluded that the VI, VFI, PV, FI parameters are the best discriminants, with the cut-off values of 5.30, 2.30, 199, and 36.0, respectively. CONCLUSIONS: The quantitative assessment of placental vasculature and placental volume by means of 3D Power Doppler and VOCAL technique is an adjunctive modality for differentiation between normal and IUGR pregnancies. Our findings further suggest that the vascularization index (VI) and vascularization flow index (VFI) are the best parameters with the most favorable discriminating potential for proper identification of IUGR pregnancies.

Transvaginal hydrolaparoscopy for diagnosis of tubal infertility.

OBJECTIVE: Infertility problem affects more than 70 million couples worldwide, 5-15% of which are couples in their reproductive age. Less and less invasive endoscopic methods like transvaginal hydrolaparoscopy have been developed by technological progress. This method enables not only precise identification, but is now increasingly used for treatment of tubal and peritoneal factor pathology, which cause approximately 35 per cent of female infertility. AIM: Evaluation of transvaginal hydrolaparoscopy (HLTV) usefulness for diagnosis of tubal infertility comparing to standard laparoscopy and hysterosalpingography (HSG). RESULTS: In evaluation of patent fallopian tubes results of HLTV and HSG examinations are coincide in 87%, while obstruction diagnosed in HSG is confirmed only in 37% during HLTV examination. Transvaginal hydrolaparoscopy and HSG have similar sensitivity and specificity in diagnosis of hydrosalpinx, which is up to 100% . In comparison with HLTV histerosalpingography is less effective in evaluation of peritubal dilatations and adhesions. Both laparoscopic surgery and transvaginal laparoscopy have the same high sensitivity in diagnostics of the fallopian tubes patency and hydrosalpinx, which is up to 100%. In evaluation of peritubal adhesions and dilatations the results are very similar. CONCLUSIONS: 1. HLTV is a highly useful method in evaluation of the fallopian tubes pathologies which is significantly more sensitive than HSG in evaluation of such lesions as peritubal adhesions and obstructed fallopian tubes. 2. HLTV is as effective as laparoscopy in evaluation of patency and lesions of the fallopian tubes. 3. HLTV is a less invasive method, much better tolerated than laparoscopy and more suitable for the group of overweight patients. 4. Final assessment of HTLV technique will be possible following performance of a greater number of studies, where the foregoing conclusions present only initial observations.

The Impact of Early Pregnancy and Exposure to Tobacco Smoke on Blood Antioxidant Status and Copper, Zinc, Cadmium Concentration-A Pilot Study.

The aim of the study was to evaluate the impact of early pregnancy and exposure to tobacco smoke on antioxidant status and copper, zinc, and cadmium concentrations in the blood of non-smoking and smoking, as well as non-pregnant or pregnant women. The study included 213 women. More specifically, 150 women in first trimester of pregnancy and 63 non-pregnant women. Women were divided into subgroups according to exposure to tobacco smoke. Pregnancy significant influences higher copper and lower zinc concentration in the serum, whereas exposure to tobacco smoke during pregnancy is mainly associated with an elevation in cadmium and zinc concentration. It seems that metallothionein, superoxide dismutase, and glutathione peroxidase are the important antioxidants during early pregnancy, when exposure to tobacco smoke occurs, whereas the pregnancy itself is associated with a higher concentration of metallothionein and activity of catalase. Both pregnancy in the first trimester and exposure to tobacco smoke decrease glutathione concentration. In addition, active and passive maternal smoking have a similarly negative effect on antioxidant status in the first trimester. Early pregnancy as well as exposure to tobacco smoke is associated with significant alteration in antioxidant status and copper, zinc, and cadmium concentration. Due to a small number of smoking subjects (11 cases of non-pregnant, active smokers and 14 pregnant active smokers), the obtained results should be treated as a pilot, and this should be considered for future studies.

Umbilical cord morphology in pregnancies complicated by IUGR in cases of tobacco smoking and pregnancy-induced hypertension.

OBJECTIVE: The aim of this study was to determine the characteristic features of the umbilical cord morphology in selected cases of intrauterine growth restriction (IUGR): tobacco smoking, pregnancy-induced hypertension and idiopathic IUGR. MATERIALS AND METHODS: 136 pregnant women were included in the study - 86 patients with IUGR (IUGR group) and 50 women with uncomplicated course of pregnancy (control group). In the IUGR group 31 women were smokers, 27 suffered from pregnancy-induced hypertension, and 28 had an unknown reason for IUGR. Each of them underwent ultrasound examination to measure fetal growth and to assess morphological parameters of the umbilical cord. RESULTS: Significant differences between the control group and the whole IUGR group in terms of the diameter of the umbilical cord and diameter of the umbilical vein - smaller diameters in the IUGR group than in the control group. Significant differences among IUGR subgroups in terms of area of Wharton's jelly and diameters of the umbilical cord, vein and artery. Significant difference in the length of the uncoiled section among the IUGR subgroups. CONCLUSIONS: 1. The umbilical cord in IUGR and concomitant tobacco smoking is hyper-coiled with coiling index independent of fetal weight and high content of Wharton's jelly. 2. The umbilical cord in IUGR and concomitant pregnancy-induced hypertension is thinnest with thinnest vessels and the smallest content of Wharton's jelly. 3. The assessment of umbilical cord morphology should become an integral part of ultrasound exam in pregnancies complicated by IUGR.

Pregnancy coexisting with a uterine abscess in a double uterus: a case report and review of literature.

A 20 year old primigravida with a double uterus was admitted with a viable fetus in the right uterus and pus oozing from the left one. Management consisted of a regimen of intravenous antibiotics and intravaginal antibiotic tablets. Tocolysis was used to arrest imminent preterm labor. In the course of pregnancy IUGR was diagnosed. At 38 weeks of pregnancy a SGA baby boy of 2,440 g was delivered by cesarean section. The mother and the baby were discharged from the hospital in good general condition.

Pregnancy in a woman with treated bladder extrophy, split pelvis and hypoplasia of ischial bones. Case report.

We present a case of a pregnancy in a 24 year old woman who was born with ectopia vesicae, split pelvis and hypoplasia of ischial bones. From childhood to adulthood she had undergone reconstructive surgeries of the abdomen and perineum, as well as urine diversion surgery. During pregnancy she experienced recurrent urinary tract infections which were treated with antibiotics. In spite of tocolysis, she delivered by cesarean section a premature baby boy at 35th week of gestation due to premature uterine contractions. The postoperative period was uneventful and they were discharged from the hospital in a good general condition.

How Does Tobacco Smoke Affect Fetal Growth Potential in the First Trimester of Pregnancy as Measured by Volume Parameters of the Fetus, Trophoblast, and Gestational Sac?

We aimed to assess if tobacco smoke, as measured by the serum concentration of cotinine and blood concentration of cadmium, influences the fetal, sac, and trophoblast volume in the first trimester of pregnancy. We enrolled women in weeks 11 to 14 of pregnancy: 35 smokers, 24 passive smokers, and 98 nonsmoking healthy women. We found that the fetus volume was similar in all groups (18.70 ± 6.29, 17.11 ± 5.4, 18.97 ± 7.55 cm3). The trophoblast was significantly smallest in smokers (50.27 ± 19.56, 56.71 ± 23.50, 61.95 ± 22.94 cm3). The trophoblast volume was correlated with cotinine and cadmium concentration ( r = -0.54, r = -0.44). In passive smokers, gestational sac and trophoblast volume grew systematically and were correlated with the mean parental height. In smokers, only the gestational sac grew systematically and was correlated with the mean parental height. The fetus volume was independent of mean parental height and intensity of exposure to tobacco smoke. Volumetric changes of the fetus, trophoblast, and sac may be observed in the first trimester; however, their consequences require further research.

How does tobacco smoke influence the morphometry of the fetus and the umbilical cord?-Research on pregnant women with intrauterine growth restriction exposed to tobacco smoke.

Proper structure of the umbilical cord is important for the fetal development. We evaluated effects of toxic factors from tobacco smoke on fetal and umbilical cord morphometry. 109 women in weeks 29-40 of pregnancy (31 smokers with intrauterine growth restriction (IUGR); 28 non-smoking women with IUGR; 50 healthy pregnancies) were included. In smokers with IUGR, cotinine, cadmium and lead concentrations were significantly higher than in controls (mean 55.23ng/l; 1.52ng/ml; 14.85ng/ml vs 1.07; 0.34; 9.42) and inverse correlation between lead concentration and uncoiled umbilical cord was significant (r=-0.80). In smokers with IUGR, area of Wharton's jelly was increased compared to nonsmokers and controls. Inverse correlations occurred between cotinine and cadmium concentration and fetal percentile in smokers (r=-0.87; r=-0.87) and non-smokers (r=-0.47; r=-0.78) with IUGR. Exposure to tobacco smoke measured by cotinine, cadmium and lead concentration has an impact on fetal growth and umbilical cord morphometry and correlates with intensity of IUGR.

[Ultrasonographic morphometry of the umbilical cord during physiological and pathological pregnancy]. / Ultrasonograficzna morfometria pepowiny w wybranych stanach patologii ciazy i w ciazy fizjologicznej.

OBJECTIVES: To evaluate the relation among the ultrasonographic, morphometric parameters of the umbilical cord during physiological and pathological pregnancy. DESIGN: Ultrasonographic morphometric parameters were prospectively evaluated in 29 consecutive cases of physiological and 42 cases of pathological pregnancies. MATERIALS AND METHODS: 71-ultrasonographic examinations was performed between 28-40 weeks of gestation. The examined group consisted of 29-physiological pregnancies and 42-pathologic. 15-was complicated with the risk of preterm delivery. 27-was complicated with hypotrophy caused by Pregnancy Induced Hypertension (PIH) in 14 cases and by exposure to tobacco smoke in 13 cases. RESULTS AND CONCLUSIONS: We showed no statistically important correlation between the umbilical parameters and the period of pregnancy except of A/B index, measuring Doppler flow in umbilical artery which value was decreasing together with the period of gestation (r = -0.6185, p < 0.05). Hypocoiling umbilical cord characterised the group of patients which pregnancy was complicated with premature delivery. Statistically important decreasing of diameter value of umbilical cord and umbilical vein in cases of pregnancy complicated with hypotrophy was revealed. We found out the strong correlation between hypercoiling of umbilical cord as well as diameter of umbilical cord and degree of intensification of hypotrophy in smoking women (r = -0.8, p < 0.05).

Effect of cigarette smoking on vascular flows in pregnancies complicated by intrauterine growth restriction.

Exposure to tobacco smoke during pregnancy may result in intrauterine growth restriction (IUGR). In the study, the effect of tobacco smoke on vascular flows in the middle cerebral artery, umbilical artery, ductus venosus in fetuses and uterine artery in pregnancies complicated by IUGR was investigated. The study subjects were divided into three groups: smoking women with IUGR (n=31), women with idiopathic IUGR (n=28) and healthy controls (n=50). Fetal biometry and flow parameters were measured. Concentration of heavy metals and antioxidants was tested in maternal blood and fetal umbilical cord blood. The Student t test and multiple regression analysis were used. Cotinine and cadmium concentrations were significantly higher in smokers (55.23±54.23, 1.52±0.9), while metallothionein was significantly higher (22.94±8.64) in the idiopathic IUGR group. Strong correlations between cotinine and cadmium concentrations and cerebral-umbilical index were found. Long-term exposure to tobacco smoke deteriorates flows in vital fetal vessels.

Quantitative assessment of placental vasculature and placental volume in normal pregnancies with the use of 3D Power Doppler.

PURPOSE: The aim of the study was to determine reference values for placental vascular indices and placental volume according to gestational age. MATERIAL/METHODS: The assessment of placental vascular indices and placental volume using 3D Power Doppler and the Virtual Organ Computer-aided Analysis (VOCAL) technique was performed on 100 normal fetuses between 22 and 41 weeks of gestation. In this study the method of the individual setting of the power Doppler gain value was used. Only patients with entirely visualized placenta were included in the study. RESULTS: No statistically relevant difference in the values of placental vascular indices and placental volume between different localizations of the placenta was detected. No statistically significant changes to placental vascular indices depending on gestational age were found. It enabled to determine the 10th, 50th and 90th percentile values for the vascularization index (VI), flow index (FI), vascularization-flow index (VFI), which are independent of gestational age. No correlation was found between placental volume and placental vascular indices. CONCLUSIONS: The values of placental vascular indices are constant between the 22nd and 41st week of a normal pregnancy. Placental volume measured with the use of the VOCAL program increases between 22nd and 41st week of a normal pregnancy. In a normal pregnancy the placental vasculature increases adequately to the increase of its volume. The method of the individual setting of the power Doppler gain value makes it possible to achieve comparable values of placental vascular indices regardless of the distance between the probe and the placenta.

Changes in pro/antioxidant balance in smoking and non-smoking pregnant women with intrauterine growth restriction.

The aim of this study was to investigate the influence of cigarette smoking on the pro/antioxidant balance in pregnant women with intrauterine growth restriction (IUGR). The studies have shown a 2-fold increase of Cd concentration in blood of women with IUGR in labour and a 10-fold increase in smoking pregnant women with IUGR. The increase of malondialdehyde concentration in plasma and 8-hydroxydeoxyguanosine in serum and Cu/Zn superoxide dismutase activity in erythrocyte lysate of pregnants with IUGR, reinforced by smoking, was revealed. We observed a decrease in the concentration of glutathione in blood and glutathione peroxidase activity in plasma and in erythrocyte lysate. A 4-fold higher metallothionein concentration in the plasma of women with IUGR in labour suggests that metallothionein may be one of the IUGR markers. Metallothionein concentration was intensified by smoking up to 7-fold in comparison to the controls. The pro/antioxidant balance during pregnancy is significantly affected by smoking.