Simple ultrasound evaluation of fetal adrenal glands as a marker of imminent preterm birth: a preliminary report.

OBJECTIVE: We present a simple 2D big ultrasound measurement of the fetal adrenal glands and their biometrical growth analysis highlighted as a potential preterm birth marker. METHODS: This was a prospective observational case-control study. Sixty-four patients were included in the study (32 with the diagnosis of imminent preterm birth before 37 and 32 controls) from January 2018 to May 2020. Anteroposterior dimensions and circumferences of the whole adrenal glands and their central zones were measured by simple B-mode ultrasound imaging. For the statistical analysis, StatsDirect 3.0 and ROC curves were used. As a studied descriptor, routine standard ultrasound cervical measurements were added (cervical length, funneling, sludge, cervical dilatation, and cervical glandular area). RESULTS: In biometrics of gestational age-related changes, a significant analysis of the overall growth of the adrenal gland was observed (circumference p < 0.001, anteroposterior diameter p = 0.02). The growth of the central zone was observed independently of gestational age. The growth of the central zone of the fetal adrenal glands revealed significant changes between the group of patients who delivered prematurely and control groups (p < 0.01). The ideal cut-off value of the proportion of enlargement of the fetal zone as a predictor of preterm delivery before week 37 was 45.1 %, with the sensitivity of 87.5 % and specificity of 85.4 %. CONCLUSIONS: A simple 2D B-mode measurement of the fetal adrenal glands´ central zone growth can be applied as an additional marker in the prediction of true preterm delivery. The natural biometrical overall growth of the adrenal glands seems to be dependent on gestational age, whereas that of the central adrenal gland zone seems to be independent on gestational age (Tab. 3, Fig. 5, Ref. 26).

Routine betamethasone therapy of non-hydropic fetuses with CPAM - the way to improve perinatal outcome?

Authors discuss novel approach to the management of fetal congenital pulmonary cystic malformation (CPAM) and possible benefit of routine administration of betamethasone, which is currently recommended only for severe cases. The article presents authors' own experience with antenatally diagnosed CPAM and describes 4 cases of prenatally diagnosed CPAM without hydrops treated by two doses of betamethasone at 21-31 weeks of gestation with the aim of improving the perinatal prognosis by effect on not only mortality but also postnatal morbidity. Article also summarizes current knowledge on all aspects of the prenatal CPAM focusing on its treatment options. Data were obtained from the literature search based on the PubMed and Scopus database with additional search of particular articles from reference list of the selected publications.All 4 patients from the case reports showed regression of the pulmonary mass after maternal administration of betamethasone with 100 % survival rate. Even though it is not possible to say if the CPAM regression was due to the betamethasone treatment, we did not observe any complication in relation to the treatment and all cases survived until discharge. During the literature search, we did not find any data on betamethasone administration in non-hydropic fetuses with CPAM in relation to the overall perinatal and postnatal morbidity, neither data comparing the outcome between the treated versus observed only fetuses.Routine betamethasone treatment should be discussed in antenatally diagnosed CPAM cases without fetal hydrops in order to reduce the perinatal morbidity associated with CPAM (Tab. 1, Ref. 47). Keywords: betamethasone, CPAM (congenital pulmonary adenomatoid malformation), fetal therapy.

Patients experiences after hospitalization at Gynecologic Obstetrics Department: Identifying parts for improvement.

OBJECTIVE: Evaluation of the quality of the hospital care at individual departments of the clinic from the patient's perspective using a standard questionnaire. DESIGN: Retrospective observational studies. SETTING: 2nd Department of Obstetrics and Gynecology, University hospital Bratislava, Faculty of Medicine, Comenius University Bratislava, Slovakia. MATERIAL AND METHODS: In the study we included all patients who were hospitalized in II. GPK from 1. 1. 2019 to 1. 3. 2019. When the patient was released, they received a HCAHPS questionnaire. Obtained results were statistically processed and compared with publicly available data from all USA hospitals. RESULTS: We received 481 questionnaires suitable for processing. 53.2% of patients evaluated the clinic as the best possible. 57.4% of patients would definitely recommend the clinic to their family and friends. The biggest difference between patients who rated the clinic as the best and those who rated it low were in nurse communication (OR: 6.19, CI: 4.46-8.63). At maternity ward we haven't found any statistical effect in impact of age, but in nurses communication, pain management, communiation about medicines we found significant statistical differences in impact of different education between women. CONCLUSION: The quality of nurses and doctors communication and instructing patients about medication has a significant impact on the clinic's evaluation. Women with university education at maternity ward evaluate quality of hospital care stricter, regardles of age.

Covert postpartum urinary retention.

OBJECTIVES: This study was conducted to determine the frequency of increased postvoiding residual volumes (PVRV) 3 days after delivery and to examine the associated risk factors. BACKGROUND: Increased PVRV ‒ covert postpartum urinary retention, is an asymptomatic condition with possible long-term adverse effects. While early diagnosis and appropriate management can avoid long­term complications, screening is not routinely performed. By identifying risk factors, we could define the group of patients suitable for screening. MATERIAL AND METHODS: This was a prospective observational study carried out over a 3-month period at the university teaching hospital in Bratislava, Slovakia. All participants underwent ultrasound determination of PVRV while 80 ml and more on day 3 was considered pathological. RESULTS: A total of 429 women were included in the study. The prevalence of covert post-partum urinary retention was 9.2 %. Assisted vaginal delivery (ventouse, forceps) and episiotomy were risk factors for post-partum urinary retention (18.7 % vs 6.1 %; p = 0.0053; 52.1 % vs 35.7 %; p = 0.0483; respectively). CONCLUSION: Our observations confirmed the existence of PVRV of 80 ml and more on day 3 in almost 10% of women who had delivered at our clinic. The results of our study prove that instrumental delivery represents a considerable obstetrical-pediatric risk factor for PVRV. Our data support the need of adopting a risk-factor-based approach to PVRV screening as part of postpartum bladder care (Tab. 2, Fig. 1, Ref. 12).

The value of cordocentesis in current management of intrauterine patient.

OBJECTIVES: Analyzing the clinical group to evaluate current indications for cordocenteses, their complications and data obtained in further pregnancy management. METHODS: Retrospective analysis evaluated 92 cordocenteses (diagnostic and therapeutic) performed during the period of 2007‒2018. These were performed between 17 and 36 weeks of gestation under ultrasound guidance by a specialist at 2nd Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University. RESULTS: Out of 92 procedures, 78 were diagnostic and 14 were therapeutic. The diagnostic cordocentesis was successful in 97.4 % and intrauterine therapy was successful in 85.7 %. There were 2 (2.56 %) diagnostic cordocenteses complicated by fetal demise and 2 (14 %) intrauterine demises in therapeutic cordocentesis. The pathological karyotype was detected in 14.5 %. Aneuploidia was present in 4 cases (44.4 %), mosaicism in 4 cases (44.4 %) and triploidia in one case (11.1 %). CONCLUSION: Despite of novel molecular genetic technique cordocentesis still plays unreplaceable role in current prenatal diagnosis and treatment. The risk of complications of cordocentesis increases depending on the severity of fetal pathology in pathologic pregnancies. In some situations it can be used as a useful tool for original fetal diagnosis and therapy (Tab. 3, Ref. 20).

Long term follow-up of the patients with pelvic organ prolapse after the mesh implantation using strict indication criteria.

OBJECTIVES: Transvaginal polypropylene mesh implantation is one of the techniques used for pelvic organ prolapse (POP) repair. The surgery outcomes depend on the indication criteria used. The aim of our study was to evaluate the outcomes of the mesh implantation using the strict indication criteria. PATIENTS AND METHODS: In 47 women aged 61.7±8.3 years with pelvic organ prolapse (POP-Q≥2) and a history of other surgery in the pelvic region outcomes of the mesh implantation were evaluated for up to 7 years (range 1-7 years). RESULTS: Forty six of 47 patients (97.8%) had a successful mesh implantation (10 anterior, 22 posterior, 14 combined). Peroperative complications occurred in 3 of 47 patients (6.4%). The anatomic cure (POP-Q≤1) was achieved in 93.5% patients with mesh at 6 months after surgery. Any of the postoperative complications occurred in 16 of 46 women (34.8%). Significantly lower risk of complications was found in the group aged over 65 years compared to the younger patients (p=0.005). CONCLUSION: This is the first study on the mesh implantation including women only with the history or other surgery in the pelvic region, achieving high anatomic success rate and low risk of complications. Thus, our data support the use of the strict indication criteria for this procedure (Tab. 2, Fig. 2, Ref. 14).

Prevalence of cleft lip and palate in western Slovakia in the years 2001-2007.

OBJECTIVES: The aim of this study was to investigate the prevalence of orofacial clefts (OC) in live newborns from 2001 to 2007 in Western Slovakia and correlate their occurrence with a number of relevant seasonal and geographical factors and epidemiological trend of this condition. In this study we used retrospective active survey collecting clinical data of 220 children with OC registered and operated at the cleft centre in Bratislava. Our study group included 67 patients from Bratislava region and 151 patients from the remaining Western Slovakia (Nitra, Trnava, Trencín regions). Data of live births was obtained from Health Statistics of the Slovak Republic. RESULTS: Total incidence (TI) of 1.49/1000 live births (LB) in the region of Western Slovakia in 2001-2007 marked a decrease of prevalence compared to 1.64/1000 LB in the years 1985-2000. Bratislava region dominated in total prevalence of 1.82/1000 LB compared to the rest of Western Slovakia regions with 1.37/1000 LB. Most observed cleft type was the CP with 38.6 % frequency, followed by CLP with 35.5 % and CL with a frequency of 24.1 %. The frequency of AM with 1.82 % was the lowest. CONCLUSION: The results showed that the frequency risk rate of a birth of a child with OC was 1 to 671 LB in Western Slovakia. The data proved a higher prevalence of OC in Bratislava region with 1 child with this type of congenital anomaly to 549 LB compared with 1 child with OC to 730 LB in the rest of the Western Slovakia regions (Tab. 7, Ref. 16).

Myoma expulsion after uterine artery embolization.

Uterine artery embolization (UAE) has become a standard therapy in the treatment of symptomatic uterine myomas. The procedure is associated with a few complications. One of them is myoma expulsion. A 32-year-old woman was sent to our hospital with diagnosed intramural myoma with dysmenorrhea and pressure symptoms. UAE was performed since the patient preferred conservative treatment. The procedure was without any complications. Three weeks after embolization, she was readmitted because of vaginal discharge and minor bleeding. We diagnosed expulsion of necrotic myoma and performed transvaginal resection. Four months later, the patient is symptom free. Expulsion of intramural myoma can be thus considered as definite treatment and not a complication of embolization therapy.

[Plastic adjustment in hypertrophy of labia minora]. / Plastická uprava hypertrofie malých pyskov ohanbia.

OBJECTIVE: Advantages of clinical resection for the correction of hypertrophy of labii minores are described. SETTING: 2nd Gynecological-Obstetrical Clinic, Medical Faculty, UK and Faculty Hospital and Policlinic, Bratislava, and Clinic of Plastic Surgery, Medical Faculty, UK and Faculty Hospital and Policlinic, Bratislava, Slovakia. METHODS: 26 plastic adjustments of labia minoris pudendi have been made in the course of two years. Hypertrophy of labia minoris decreased the quality of life from both physical and psychical points of view, resulting in the requirement of plastic adjustment. The authors refer to the details of surgical procedure for the correction of hypertrophy of labia minoris pudendi. The wedge-shaped resection may be recommended as the most suitable mode of correction with subsequent suture of individual leaves of mucosal duplicity of labia minoris. CONCLUSION: The wedge-shaped resection and plastic correction saves natural color, sensitivity, shape and size of labia minoris. There was a high satisfaction with the intervention. In the control examination after two months, up to 98% of the patients were satisfied with the results of the operation. The resection of the margins of the hypertrophy of labia minoris is most frequently complicated by postoperative edema, scars, deformities and changed sensitivity. The simple uncomplicated operation procedure incorporates this surgical procedure into one-day surgery in gynecology and plastic surgery.

[Screening for hemolytic streptococcus group B in pregnancy and prevention of infection in neonates]. / Skríning hemolytického streptokoka skupiny B v tehotnosti a prevencia infekcie novorodencov.

OBJECTIVE: The aim of this study was to evaluate the influence of Group B streptococcus (GBS) screening and intrapartum antibiotic prophylaxis to the incidence of GBS disease in newborns. DESIGN: Prospective non-randomised study. SETTING: IInd Clinic of Obstetric and Gynaecology LFUK and FNsP Ruzinov, Bratislava, Slovakia. METHODS: We enrolled 3023 newborns (754 in the study group, 2269 in the control group), which were born between 1.9.2000 and 31.3.2003. In both groups we compared following variables: total number of infectious diseases in newborns, number and forms of GBS neonatal disease, number of perinatal death due to GBS disease. RESULTS: There was no GBS disease in the study group of 754 newborns. Mothers of these newborns had one screening culture in 35-36th week of gestation. One swab was taken from vagina and anus. GBS carriers (161-21.4%) were administered i.v. intrapartum antibiotic prophylaxis with Penicillin G i.v., or, when allergy to penicillin was in history, with Clindamycin i.v. In the control group of 2269 newborns, whose mothers had no prevention, the incidence of GBS neonatal disease reached 7.5/1000 newborns (17 cases). The incidence of invasive GBS neonatal disease was 2.6/1000 newborns. CONCLUSION: The authors have noticed a significant decrease in incidence of GBS neonatal disease after implication of GBS screening and intrapartum antibiotic prophylaxis.

[Premature fetal membrane rupture after amniocentesis in the second trimester and successful use of fibrin glue--case report]. / Predcasný odtok plodovej vody po amniocentéze v II. trimestri a úspesné vyuzitie fibrínového lepidla--kazuistika.

OBJECTIVE: The aim of this study was to evaluate fibrin sealing in management of premature rupture of membranes after amniocentesis in early second trimester. DESIGN: Case report. SETTING: II. gynekologicko-pôrodnícka Klinika LFUK NsP Ruzinov, Bratislava; Department of Obstetrics and Gynecology, Spectrum Health--Blodgett Campus, Grand Rapids, USA. SUBJECT AND METHOD: In this case report authors report the use of fibrin sealant (Tissucol KIT, Immuno, A) in management of premature rupture of membranes after genetic amniocentesis. The sealing was performed in 19 + 0 week of pregnancy, 15 days after amniocentesis. The pregnancy was terminated by caesarean section in 34-th week, 98 days after sealing. The newborn was in stable condition, without clinical or laboratory signs of infection. No skeletal deformities or adverse effects of fibrin sealant were observed. Neurological examination in 3 month of age evaluates the psychomotorical development as normal. CONCLUSION: We consider the perinatal outcome of this pregnancy as positive.

Autoimmune thyroiditis with severe hypothyroidism resistant to the treatment with high peroral doses of thyroxine: case report.

Female patient (42 yr) suffered from autoimmune thyroiditis resulting in severe hypothyroidism. She was treated for several years by district physician with the dose of 150 microg L-thyroxine daily. Since the level of TSH was repeatedly very high and no improvement of clinical signs has been observed, she was referred to the Medical Faculty Hospital. Thyroid ultrasound showed remarkable diffuse hypoechogenicity, thyroid scintigraphy showed enlarged thyroid with low 99mTc uptake, TRH test was normal, thin needle biopsy supported autoimmune thyroiditis. X-ray examination showed normal sella turcica and no changes in the pituitary were observed with computer tomography. In spite of increasing the dose of peroral L-thyroxine to 300 microg/d and later to 500 microg/d the clinical status and TSH level did not improve. The patient was originally suspected from malabsorption of thyroxine. However, the test with a large single peroral dose (1000 microg) of L-thyroxine showed a rapid decrease of TSH level (from 126 to 75 mU/l) and increase of total T4 level (from 18 to 64 nmol/l) within 4 hr. Later the patient has been treated with intravenous L-thyroxine (500 microg every 3-4 days for 4 weeks) which resulted in the decrease of TSH level to 10 mU/l and increase of T4 level to 80-100 nmol/l. After that it was concluded that the problem is a poor compliance of the patient who apparently does not actually take the medication, although she always claimed that she is doing so. Referring to some similar cases described in the literature the case was classified as thyroxine pseudomalabsorption. In spite that this problem has been explained to her and her relatives, she refused to take any medication and is consistently neglecting all invitations to further examinations.

Vitamin 1,25-(OH)2 D3 concentrations in patients hospitalized long-term.

Vitamin D deficiency may be one reason for the onset and development of osteoporosis. The aim of the present study was to determine the occurrence rates of hypovitaminosis D in an unselected group of individuals presenting with common medical conditions and hospitalized for long periods. Concentrations of 1,25-(OH)2 D3 were measured in 89 patients (38 males and 51 females). Mean age was 70 years. Thirty-eight patients were tested in the spring and the remaining 51 patients in the autumn. Vitamin D3 levels were significantly reduced in patients tested in the autumn (p < 0.001). The reason for this surprising observation may have been the small number of sunny days and the long hospital stays during the study period, differences in the composition of both groups and the fact that 1,25-(OH)2 D3 reflects the actual vitamin D3 levels rather than those of its reserve in the human body. The results obtained suggesting hypovitaminosis D in an unselected group of elderly patients hospitalized with common diseases, even after the summer season, suggest the need for general supplementation of this vitamin throughout the year, regardless of the risk factors.

[Phospholipids in the human myometrium in various stages of contraction before and during labor]. / Fosfolipidy humánneho myometria pri rôznych stavoch kontrakcnej cinnosti pred termínom a v termíne pôrodu.

A detailed analysis of the myometrium showed that the physical state of phospholipids--fluidity--depends on the ratio of their individual components and changes in relation to the state of contractile activity. The results indicate that before term of labor changes in the fluidity of myometrial phospholipids as well as increased availability of arachidonic acid for prostaglandin synthesis can induce preterm onset of contractile activity. Possibilities of affecting these mechanisms, which belong to the many potential factors inducing preterm labor, are discussed.

[Lipid composition of the myometrium during labor]. / Lipidické zlozky myometria pocas pôrodnej cinnosti.

Lipids represent one of the basic components of each cellular and subcellular membrane of the myometrium and their fluidity has a strong influence upon membrane function. Human myometrium was obtained at cesarean sections. Lipids were separated by one-dimensional thin layer chromatography. The chromatoplates were determined on the densitometer Shimadzu CS 930. Lipid profile of the myometrium was studied before the 37th week of pregnancy, at term without contractile activity, further during at term labor with normal contractile activity and at failure of myometrial contractility. Analysis of the obtained data showed changes in lipid fluidity, namely a decrease before the 37th week of pregnancy and at failure of myometrial contractions during at term labor. The decrease of fluidity was caused by a higher content of total cholesterol and a lower content of total phospholipids in the myometrium.

[Incidence of macroscopic changes in the placenta in intrauterine growth retardation in neonates]. / Výskyt makroskopických zmien placent u intrauterinne rastovo retardovaných novorodencov.

Advances in noninvasive imaging techniques allow to visualize the placenta and changes of its structure in the course of gestation. Macroscopic examination of the placenta in newborns with intrauterine growth retardation reveals changes responsible for reduced placental functions. These can then be diagnosed in utero, e.g. by ultrasonographic examination. The most serious defects include reduced weight an insertion area of the placenta and infarcts covering more than 6% of the placental area. Extrachorial placentas also have adverse effects. Other macroscopic changes do not appear to be causally associated with intrauterine growth retardation and have been recorded to a comparable extent also in placentas of eutrophic newborns.