Validation of the Lithuanian version of the Prolapse Quality-of-Life questionnaire.

INTRODUCTION AND HYPOTHESIS: We aimed to translate and validate the Lithuanian version of the Prolapse Quality-of-Life (P-QOL) questionnaire. METHODS: The P-QOL questionnaire was translated into Lithuanian and administered to women recruited from a gynaecology outpatient clinic at a tertiary referral centre. The scores of the final version were compared in symptomatic (n = 137) and asymptomatic (n = 137) women and with findings on vaginal examination using the Pelvic Organ Prolapse Quantification system. The reliability was assessed by calculating Cronbach's alpha and by performing a test-retest analysis. RESULTS: There was a significant difference in median score for each P-QOL domain between symptomatic and asymptomatic women (p < 0.001). P-QOL scores correlated significantly with the stage of urogenital prolapse in most domains. High internal consistency was shown in all domains with a Cronbach's alpha range of 0.775 to 0.958, except for the "social limitations" domain, which was shown to be acceptable (0.647). Test-retest reliability was also high in all domains (p < 0.05). CONCLUSION: The Lithuanian version of the P-QOL questionnaire has proven to be a valid, reliable and easily comprehensible instrument for assessing symptom severity and impact on the quality of life of Lithuanian-speaking women with urogenital prolapse.

Quality of Life after Treatment for Pelvic Organ Prolapse in Real-World Study: Recommendations, Vaginal Pessary, and Surgery.

Background and Objectives: Pelvic organ prolapse (POP) is a common condition in women, with its prevalence increasing with age, and can significantly impact the quality of life (QOL) of many individuals. The objective of this study was to assess the overall improvement, quality of life, and continuation of primary treatment for POP over a 24-month period in a real-world setting. Materials and Methods: This is a prospective, observational, follow-up study of women with symptomatic POP who, as a primary treatment, opted for recommendations (lifestyle changes and pelvic floor muscle training), pessary therapy, or surgery. The primary outcome measure was a subjective improvement at the 24-month follow-up, measured with the Patient Global Impression of Improvement (PGI-I) scale. Secondary outcome measures were the continuation rate of the primary treatment method, reason for discontinuation, and the quality of life evaluated with the P-QoL questionnaire. Results: We included 137 women, with 45 women (32.8%) in the recommendations group, 39 (28.5%) in the pessary group, and 53 women (38.7%) in the surgery group. After 24 months, surgery, in comparison with pessary treatment and recommendations, resulted in significantly more women reporting a subjective improvement: 89.6%, 66.7%, and 22.9% (p < 0.001), respectively. Overall, 52% of women from the recommendations group and 36.4% from the pessary group switched to another treatment or discontinued the primary treatment within 24 months. However, women who continued the primary treatment, pessary use, and surgery showed similar subjective improvements (90.5% and 89.6%, respectively) and quality-of-life improvement. Conclusions: The chance of significant improvement was higher following surgery. However, after 24 months, both vaginal pessaries and surgery showed an important quality-of life improvement and can be proposed as primary treatment methods for pelvic organ prolapse.

In-Depth Analysis of Caesarean Section Rate in the Largest Secondary Care-Level Maternity Hospital in Latvia.

There is no surgical intervention without risk. A high rate of caesarean sections (CSs) impacts on maternal and newborn mortality and morbidity. For optimisation of the CS rate, regular monitoring is necessary. In 2015, the World Health Organization recommended the Robson classification as a global standard for assessing, monitoring, and comparing CS rates. We analysed all births in 2019 in the Riga Maternity Hospital-a secondary-level monodisciplinary perinatal care hospital in Latvia-according to the Robson classification, seeking to identify which groups make the biggest contribution to the overall CS rate. In total, 5835 women were included. The overall CS rate was 21.5%. In our study, the largest contributors to the overall CS rate were as follows: Group 5 (33.3%); Group 2 (20.8%); and Group 1 (15.6%). The results of our deeper analysis of individual groups (Group 1 and 5) from our study may help to develop targeted interventions for specific subgroups of the obstetric population, effectively reducing both the overall rate of CS and the number of unnecessary CSs performed. The CS rate reduction strategy should be based on decreasing CSs in Group 1 and encouraging VBAC, thus decreasing the number of women undergoing two or more CSs in future.

Lithuania's experience in reducing caesarean sections among nulliparas: the impact of the quality improvement course.

BACKGROUND: To evaluate the role of the quality improvement course (QIC) to reduce the caesarean section (CS) rate among nulliparas (Robson groups 1 and 2) and to find out which group of women have reduced the CS rate following attendance at the course. METHODS: The QIC was organized in 2015. For the evaluation of the CS rate after the OIC, deliveries from the selected hospitals in 2014 and 2016 were compared using MS EXCEL and SPSS 23.0. RESULTS: Nulliparas accounted for 44.6% (3585/8046) and 42.9% (3628/8460) of all the deliveries in 2014 and 2016 years, respectively. The CS rate among nulliparas decreased from 19.0% (665/3502) in 2014 to 16.8% (593/3526) in 2016 (p = 0.018). The greatest decrease in absolute contribution to the overall CS rate was recorded in group 1 (p = 0.08). Perinatal mortality was 3.1 in 2014 and 3.9 in 2016 per 1000 deliveries (p = 0.569). CONCLUSION: The QIC has helped to reduce the CS rate among nulliparas without a negative influence on perinatal mortality. The greatest decrease in the overall CS rate was recorded among nulliparous women who were treated with oxytocin and managed to reach a full cervical dilatation.

Lithuania's experience in reducing caesarean sections among nulliparas.

BACKGROUND: To evaluate the role of the TGCS to reduce the caesarean section (CS) rate among nulliparas (Robson groups 1 and 2) and to find out which group of women have reduced the CS rate by using this tool. METHODS: The Robson classification was introduced in Lithuanian hospitals prospectively classifying all the deliveries in 2012. The CS rate overall and in each Robson group was calculated and the results were discussed. The analysis was repeated in 2014 and the data from the selected hospitals were compared using MS EXCEL and SPSS 23.0. RESULTS: Nulliparas accounted for 43% (3746/8718) and 44.6% (3585/8046) of all the deliveries in 2012 and 2014 years, respectively. The CS rate among nulliparas decreased from 23.9% (866/3626) in 2012 to 19.0% (665/3502) in 2014 (p < 0.001).The greatest decrease in absolute contribution to the overall CS rate was recorded in groups 1 (p = 0.005) and 2B (p < 0.001). Perinatal mortality was 3.5 in 2012 and 3.1 in 2014 per 1000 deliveries (p = 0.764). CONCLUSION: The TGCS can work as an audit intervention that could help to reduce the CS rate without a negative impact on perinatal mortality.

Comparison of midwife-led and obstetrician-led care in Lithuania: A retrospective cohort study.

OBJECTIVE: To compare midwife-led and obstetrician-led care and their relation to caesarean section rates and obstetric and neonatal outcomes in low-risk births. DESIGN: Hospital registry based retrospective cohort study. SETTING: Tertiary-care women's hospital in Kaunas, Lithuania. PARTICIPANTS: A total of 1384 and 1283 low-risk delivering women in 2012 and 2014, respectively. METHODS: The women choose either a midwife as their lead carer (midwife-led group), or an obstetrician-gynaecologist (obstetrician-led group). MAIN OUTCOME MEASURES: The primary outcome was caesarean birth. Secondary outcomes included instrumental vaginal births, amniotomy, augmentation of labour, epidural analgesia, episiotomy, perineal trauma, labour duration, birthweight and Apgar score < 7 at 5 min. RESULTS: The proportion of caesarean births was 4.4% in the midwife-led and 10.7% in the obstetrician-led group (p < 0.001) in 2012, and 5.2% and 11.8% (p < 0.001) in 2014, respectively. Younger maternal age (≤34 years) and midwife-led care was associated with a significantly decreased odds for caesarean section and nulliparity with a significantly increased odds for caesarean birth. Women in the midwife-led group had fewer amniotomies and labour augmentations compared with the obstetrician-led group. Episiotomy, perineal trauma, duration of labour and neonatal outcomes did not differ between the groups. CONCLUSION: Midwife-led care for women with low-risk birth reduced the caesarean section and several medical interventions with no apparent increase in immediate adverse neonatal outcomes compared with obstetrician-led care. IMPLICATIONS FOR PRACTICE: Midwife-led care for low-risk women should be encouraged in countries with health care system where obstetrician-led care births dominates.

Implementation of the Robson classification in clinical practice:Lithuania's experience.

BACKGROUND: To determine the cesarean section (CS) rate in Lithuania, identify the groups of women that influence it using the Robson classification and to determine the impact of implementing the use of the Robson classification on the CS rate. METHODS: The Robson classification was introduced in Lithuanian hospitals prospectively classifying all the deliveries in 2012. The overall CS rate, sizes of the Robson groups of women, CS rate in each group and contribution to the overall CS rate from each group was calculated and the results were discussed. The analysis was repeated in 2014 and the data were compared using MS EXCEL and SPSS 23.0. RESULTS: Nineteen Lithuanian hospitals participated in the study. They represented 84.1% of the deliveries (23,742 out of 28,230) in 2012 and 88.5% of the deliveries (24,653 out of 27,872) in 2014. The CS rate decreased from 26.9% (6379/23,742) in 2012 to 22.7% (5605/24,653) in 2014 (p < 0.001). The greatest contributions to the overall CS rate were made by groups 1, 2 and 5. The greatest decrease in the CS rate was detected in group 2. The absolute contribution to the overall CS rate decreased from 4.9% to 3.8%. CONCLUSION: The Robson classification can work as an audit tool to identify the groups that have the greatest impact on the CS rate. It also helps to develop a strategy focussing on the reduction of the CS rate.

The impact of the implementation of the postpartum haemorrhage management guidelines at the first regional perinatal centre in Southern Kazakhstan.

BACKGROUND: Postpartum haemorrhage (PPH) remains one of the most common causes of maternal morbidity and mortality. Therefore, clearly written PPH management guidelines should be used in clinical practice. The aim of this study was to evaluate the effectiveness of the implementation of PPH management guidelines at the First Regional Perinatal Centre of Southern Kazakhstan (FRPC). METHODS: Between 2012 and 2013 an interventional study was performed whereby the PPH management guidelines were implemented at the FRPC. All of the deliveries that were complicated by PPH 8 months before and 8 months after the intervention were analysed. Prevalence and severity of PPH, and the change in prevention, diagnostics and management of PPH was evaluated and statistical analysis using the SPSS 22.0 was performed. RESULTS: There were in total 5404 and 5956 deliveries in the pre- and post-intervention periods, respectively. The rates of PPH and severe PPH decreased from 1.17 to 1.02 % (p = 0.94) and from 0.24 to 0.22 % (p = 0.94), respectively. Blood loss on average increased from 1055 to 1170 ml in the post-intervention period. The pharmacological treatment of postpartum haemorrhage with uterotonics was administered most frequently during both periods. After the implementation of the guidelines, the number of transfused units of packed red blood cells decreased from 4.76 to 2.48 units/case. In addition, the amount of transfused fresh frozen plasma decreased by 20 %. The number of conservative interventions and conservative operations increased from 7.9 to 52.7 % and from 3.9 to 48.6 %, respectively. The number of hysterectomies decreased from 23.7 % in pre-intervention to 8.1 % in the post-intervention period. CONCLUSIONS: The implementation of the PPH management guidelines had a positive effect on PPH prevention, diagnostics and management. It led to a more conservative aproach to the treatment of PPH. Therefore, clearly written PPH management guidelines, adapted for a particular hospital, should be developed and used in clinical practice.

The impact of postpartum haemorrhage management guidelines implemented in clinical practice: a systematic review of the literature.

Postpartum haemorrhage (PPH) is an urgent obstetric condition requiring an immediate response and a multidisciplinary approach. The aim of this study was to review PPH management guidelines implemented in clinical practice, to evaluate their impact regarding prevention, diagnosis and treatment, and to analyze how the numbers of PPH cases changed in the post-intervention period. A systematic search in the PubMed database was performed. The references of all included articles were examined. Studies evaluating the management of PPH and the impact on the numbers of cases of this pathology after the implementation of new or updated guidelines were involved in the analysis. Two reviewers independently examined the titles and abstracts of all identified citations, selected potentially eligible studies, and evaluated their full-text versions. Methodological quality was assessed using a checklist based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. We analyzed seven articles that evaluated the impact of new or updated guidelines for PPH management implemented in clinical practice. In four trials, the numbers of PPH cases declined after the intervention. Guidelines for PPH management can have a positive impact on the reduction of the number of PPH cases.

Maternal request is not to blame for an increase in the rate of Cesarean section.

BACKGROUND AND OBJECTIVE: The aim of this study was to establish whether Lithuanian women would request an elective cesarean section in a low-risk pregnancy and to compare how the women's opinion changed during the 5-year period. MATERIAL AND METHODS: A study was conducted at the Hospital of Lithuanian University of Health Sciences from November 1 to December 31, 2006, and from January 1 to February 28, 2011. A total of 204 and 239 women were enrolled in 2006 and 2011, respectively. Self-administered anonymous questionnaires collected information on women's knowledge about the advantages of the different modes of delivery and their preferred type of birth in a low-risk pregnancy. RESULTS: Overall, 82.4% of the participants in 2006 and 74.5% in 2011 thought that women should be able to choose the mode of delivery in a low-risk pregnancy. If they had had such an opportunity, 15.2% of women in 2006 and 14.9% in 2011 would have chosen cesarean section without any medical indication. The most frequently mentioned advantage of vaginal delivery was that it is natural, while safety for the newborn and the possibility of avoiding delivery pain were the mentioned advantages of cesarean section. CONCLUSIONS: Approximately 15% of Lithuanian women would request an elective cesarean section, and this percentage did not change during the 5-year period. While the national cesarean section rate is increasing with every year, it seems that "maternal request" cannot be blamed for this phenomenon. Despite all the available information about the different modes of delivery, women still lack professional and reliable knowledge about it.

[Surgical treatment of female pelvic organ prolapse at the Clinic of Obstetrics and Gynecology, Hospital of Kaunas University of Medicine]. / Moteru dubens organu nusileidimo chirurginio gydymo metodai KMU Akuserijos ir ginekologijos klinikoje.

OBJECTIVE: To compare surgical methods, complications, and outcomes in the treatment of female pelvic organ prolapse at the Clinic of Obstetrics and Gynecology, Hospital of Kaunas University of Medicine, and to disclose the risk factors that influence female pelvic organ prolapse. MATERIAL AND METHODS: A retrospective analysis of surgeries for pelvic organ prolapse performed during the period of 2003-2007 was carried out. A total 823 women were operated on for pelvic organ prolapse. RESULTS: During 2003-2007, 823 surgical procedures for the correction of female pelvic organ prolapse were performed at the Clinic of Obstetrics and Gynecology, Hospital of Kaunas University of Medicine. Eighty (9.7%) patients underwent vaginal hysterectomy; 372 (45.3%), vaginal plastic operations (out of them, 23 were combined with TVT and 47 with TVT-O procedure); 360 (43.7%), vaginal hysterectomy with vaginal plastic surgeries; and 11 (1.3%), Prolift operations. The mean age of females was 62 years. Mean blood loss during operations was 162.1 mL. Patients undergoing vaginal plastic operations lost significantly less blood than those undergoing vaginal hysterectomy or combined operations (P<0.05). Mean time in surgery was 60.3 min. The duration of Prolift operations and vaginal plastic operations was significantly shorter than that of vaginal hysterectomy or combined procedures (vaginal hysterectomy + vaginal plastic surgery) (P<0.05). Mean hospital stay was 8.1 days. Hospital stay after vaginal plastic operations was significantly shorter than after vaginal hysterectomy or combined operations. The shortest hospital stay was after Prolift operation (P<0.05). Complications were related to the type of operation performed. CONCLUSIONS: The most common operations in the surgical treatment of female pelvic organ prolapse were vaginal plastic operations and combined operations. The shortest time in surgery and lowest blood loss was in case of vaginal plastic operations. The shortest hospital stay was after Prolift operations. The highest rate of complications was observed in patients who underwent vaginal hysterectomies, the lowest - after Prolift operations.

[Thickness of cerebral cortex measured using anatomical mesoscopic imaging and magnetic resonance imaging]. / Zmogaus galvos smegenu apsiausto zieves storis, ismatuotas anatominiu mezoskopiniu ir magnetinio rezonanso tomografijos tyrimo metodais.

OBJECTIVE: Magnetic resonance imaging method opened up the possibility for in vivo examination of the anatomy of human brain. For this reason it is interesting and relevant to compare the knowledge accumulated over a number of years during the examination of the composition of dead brain to that obtained from magnetic resonance images. The aim of this study was to determine and compare the thickness of cerebral cortex in human of different age and sex, measured in different sites of the hemispheres when applying anatomical mesoscopic imaging and magnetic resonance imaging. MATERIAL AND METHODS: The thickness of cerebral cortex was measured in symmetrical Brodmann's areas of both hemispheres. The anatomical mesoscopic imaging technique was used for the examination of 2x2-cm cortex samples obtained during autopsy and fixed for 4 weeks in 10% paraformaldehyde. In these samples, cortex thickness was measured in sections perpendicular to the convolution, using an operative microscope, in a mesoscopic image at x16 magnification and with an accuracy of 0.01 mm. Using cerebral magnetic resonance imaging, the thickness of cerebral cortex in live subjects was measured on T1-weighted images of patients examined at the Clinic of Radiology, Kaunas University of Medicine Hospital. The measured cortical field image was magnified to the smallest element of digital image - the pixel - and measured with an accuracy of 0.01 mm. Each of the two techniques was applied for the examination of 20 men and women who were divided into age groups of 20-60 years (n=10) and older than 60 years (n=10). RESULTS AND CONCLUSIONS: Both examination methods yielded a statistically significant difference in the thickness of cerebral cortex between Brodmann's areas 1, 4, and 19. No significant difference in cortex thickness was found between different age and sex groups; however, the findings showed that the difference in cortex thickness between the different age male groups was 4.6% and female - 1.6%. No significant difference using different techniques was found, but the cortex thickness in the fixed samples was reduced by 0.5 cm on average.

[Staphylococcus aureus prevalence among preschool- and school-aged pupils]. / Staphylococcus aureus paplitimas tarp ikimokyklinio ir mokyklinio amziaus vaiku.

OBJECT: To determine the prevalence and incidence of Staphylococcus aureus strains among preschool- and school-aged pupils and susceptibility of these strains to antimicrobial materials. MATERIAL AND METHODS: A study of 243 preschool- and 300 school-aged pupils was conducted during 2003-2004. Identification of Staphylococcus aureus was made with plasmacoagulase and DNase tests. The resistance of Staphylococcus aureus to antibiotics, beta-lactamase activity, phagotypes, and phage groups were determined. The isolated Staphylococcus aureus strains were tested for resistance to methicillin by performing disc diffusion method using commercial discs (Oxoid) (methicillin 5 microg per disk and oxacillin 1 microg per disk). RESULTS: A total of 292 (53.8%) Staphylococcus aureus strains were isolated and identified (113 (46.5%) from preschool- and 179 (59.7%) from school-aged pupils). The prevalence of Staphylococcus aureus strains among preschool-aged pupils varied from 46.5% to 47%. It increased to 59.0% (P>0.05) among schoolchildren aged from 11 to 15 years and to 73.0% (P<0.001) among schoolchildren aged from 16 to 19 years. Six methicillin-resistant Staphylococcus aureus strains were isolated: two (1.8%) of them were from preschool-aged and four (2.2%) from school-aged pupils. The prevalence of Staphylococcus aureus strains with beta-lactamase activity increased from 70.7 to 76.6% in preschool-aged pupils, and it varied from 72.0 to 79.0% in school-aged pupils (P>0.05). Staphylococcus aureus strains of phage group II (32.2-43.4%) were prevailing; nontypable Staphylococcus aureus strains made up 19.2-33.6%. CONCLUSIONS: The prevalence of Staphylococcus aureus among preschool-aged children is 41.7 to 48.8%, and it increases among 9th-12th-grade pupils (73.0%, P<0.001). Some Staphylococcus aureus strains (2.1%) were resistant to methicillin. Staphylococcus aureus strains of phage group II (39.0%, P<0.05) are most prevalent among preschool- and school-aged pupils. Pupils were colonized with methicillin-resistant Staphylococcus aureus strains belonging to phage group III phagotype 83A and 77.