Pelvic floor muscle injuries in women with a history of Caesarean section.

OBJECTIVE: The aim of the paper is to determine the prevalence of levator ani muscle injuries and identify risk factors among women undergoing vaginal birth after Caesarean section (VBAC) compared to those with elective repeat Caesarean section (ERCS). MATERIAL AND METHODS: This prospective observational comparative study was conducted at the 2nd Clinic of Gynaecology and Obstetrics of FM CU and UN Bratislava. Women with a history of one Caesarean section were included in the study. They were divided into those who had a successful VBAC and those who delivered by ERCS. The mothers underwent a 3D/4D ultrasound examination of the pelvic floor muscles 3‒5 days after childbirth. The study evaluates the frequency and risk factors of avulsion injury of the levator ani muscle (LAM) in a group of 46 women after a successful vaginal delivery after a previous Caesarean section and 32 women after ERCS using 3D/4D transperineal ultrasound examination of the pelvic floor. RESULTS: A total of 78 women were included in the study, 46 after VBAC and 32 after ERCS. In the first group, we recorded LAM avulsion injury in 13 cases (28.3 %); in the post-ERCS group, we did not record this injury (p < 0.0001). We also found an overdistended hiatal area (21.0 vs 19.4 cm2) and a more frequent occurrence of the area exceeding 25 cm2 (21.3 % vs 6.2 %, p = 0.0340) which was approaching the statistical significance. In the first group, we identified an increase in weight during pregnancy to 15 kg and a neonatal birthweight of 4,000 g or higher as risk factors for LAM injury. CONCLUSION: In the group of women with VBAC, there is a statistically significant risk of LAM avulsion and a higher occurrence of the overdistended area of ​​the hiatus urogenitalis, especially in women with larger foetuses and in those who experienced greater weight gain during pregnancy (Tab. 3, Ref. 50). Text in PDF www.elis.sk Keywords: pelvic floor, levator ani muscle avulsion, vaginal birth after Caesarean section.

Thoracopagus conjoined twins.

OBJECTIVE: We present a case report of conjoined twins. CASE REPORT: Secundigravida nullipara, 28-years old, admitted for profuse bleeding at 13 weeks of gestation. Ultrasound confirmed vital pregnancy of conjoined twins - thoracopagus. After prenatal diagnostic consultation the patient decided for termination of pregnancy. Molecular analysis confirmed a female fetus without any chromosomal anomalies. CONCLUSION: The occurrancce of conjoined twins is very rare. Early prenatal ultrasound diagnosis plays an important role. Presented case report describes conjoined twins with poor prognosis because of one shared malformed heart.

Prevalence and risk factors for serious birth concerns in unselected population of mothers.

AIM: The aim of the study was to determine the prevalence of severe fear of childbirth in a group of pregnant women, to determine the risk factors, and to prove the impact of the fear of childbirth on various obstetrics outcomes in this group. MATERIALS AND METHODS: The study population consists of pregnant women who gave birth at the 2nd Gynecology and Obstetrics Department of the Faculty of Medicine, Comenius University and University Hospital Bratislava, from January 1st, 2022, until April 31st, 2022. After signing an informed consent, the pregnant women were given a Slovak version of the Wijma Delivery Expectancy Questionnaire (S-WDEQ), which is a psychometric tool to evaluate the prevalence of severe fear of childbirth. They were given the S-WDEQ during the 36th and 38th week of gestational age. The childbirth data were collected from the hospital information system after the delivery of the baby. RESULTS AND CONCLUSION: The studied group consists of 453 pregnant women who fulfilled the inclusion criteria. Extreme fear of childbirth was identified using S-WDEQ in 10.6% (48) of them. Level of education and age were not considered to be significant predictors of fear of childbirth. Statistically significant difference was not found in terms of the age groups and groups with different levels of education. At the edge of the statistical significance were primiparas, who made up 60.4% (RR: 1.29; 95% CI: 1.00-1.68; P = 0.0525) of all women with severe fear of childbirth. Women with a history of cesarean section were significantly more frequent in the group of women with serious concerns about childbirth (RR: 3.83; 95% CI: 1.56-9.40; P = 0.0033). Women who gave birth by cesarean section due to the indication of non-progressive labour were also more often represented in the group of women with serious concerns about childbirth (RR: 3.01; 95% CI: 1.07-8.42; P = 0.0358). A higher S-WDEQ score at the 36th week of gestational age in a group of primiparous women increased the statistical probability of cesarean delivery (P = 0.0030). The statistical results are not showing the impact of fear of childbirth on the induction success and the duration of the first stage of labour in primiparous women. The fear of childbirth prevalence is relatively high and it has impact on the outcome of childbirth. The use of a validated questionnaire as a screening tool to search for women with childbirth fear could positively influence their concerns by following psychoeducational interventions in clinical care settings.

The effect of anti-pandemic measures on some aspects of obstetric care in a single obstetric unit in the Slovak Republic.

< pre style="margin-bottom: 6.0pt; line-height: 150%;" > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Objectives: < /span > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > In many countries, various anti-pandemic interventions were adopted in 2020, which also affected obstetric practices. The aim of this study is to determine their effect on the frequency of caesarean section (CS) according to Robson classification (RC). < /span > < /pre > < pre style="margin-bottom: 6.0pt; line-height: 150%;" > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Material and methods: < /span > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Deliveries in 2019 and 2020 were retrospectively analysed. Mothers were grouped according to RC, and the frequency of CR in the different groups were compared. < /span > < /pre > < pre style="margin-bottom: 6.0pt; line-height: 150%;" > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Results: < /span > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > We found a statistically significant increase in the frequency of CR in the pandemic year (20.0% vs 17.8%, p = 0.0242). When classified into RC groups, the increase in the different groups lost statistical significance. Nevertheless, the increase was most important in Robson group 5 due to maternal rejection of vaginal delivery after CR and in Robson group 2b with elective CR. In spite of our expectations, the frequency of caesarean section performed due to indication of protracted labour was not increased. < /span > < /pre > < pre style="margin-bottom: 6.0pt; line-height: 150%;" > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Conclusions: < /span > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Interventions that were implemented during the first and second waves of the pandemic were associated with increased frequency of planned caesarean sections. < /span > < /pre >.

Unilateral macrocystic dysplasia and contralateral agenesis in a monoamniotic twin.

OBJECTIVE: We present a case report of a congenital malformation of the uropoetic tract in one of the monoamniotic twins. CASE REPORT: A 24-year-old primigravida with male monochorionic monoamniotic twins was dia-gnosed with congenital malformation in fetus A at 24 weeks of gestation. Ultrasound verified macrocystic dysplasia and contralateral renal agenesis. Planned caesarean section was performed after the observational management of the patient in the 34th gestational week. In fetus B, a physiological finding was confirmed on the postpartum ultrasonography. In fetus A, CT examination of the abdomen confirmed the finding of left kidney agenesis and polycystic degeneration of the right kidney. Exitus letalis was stated on the newborns 5th day. CONCLUSION: The occurrence of the described combination of congenital malformation in monoamniotic twins is rare. When dysplasia significantly affects the function of the parenchyma, renal agenesis with multicystic dysplasia of the other kidney is a condition incompatible with life. For the intrauterine survival of the affected fetus, the normal renal function of the twin was important and thus the normal volume of amniotic fluid was maintained. As a result, the fetus did not develop extrarenal symptoms of the Potter sequence in the described case - especially pulmonary hypoplasia and the newborn was able to ventilate spontaneously. The death was caused by the consequences of renal failure associated with anuria.

Covert postpartum urinary retention: causes and consequences (PAREZ study).

INTRODUCTION AND HYPOTHESIS: Increased post-voiding residual volume (PVRV), known as covert postpartum urinary retention (PUR), is an asymptomatic condition with unknown long-term adverse effects. The objectives were to determine the frequency of this phenomenon 3 days after delivery and to examine the associated risk factors and consequences of the increased residuum on women´s health 6 weeks postpartum. METHODS: We carried out a prospective observational study including a total of 926 primiparous women, giving birth to singletons. All participants underwent ultrasound determination of PVRV on day 3 postpartum. Then, risk factors were determined using logistic regression analysis. After 6 weeks, participants were invited to return for PVRV determination and to complete urogynecological and general health questionnaires. Using these data, the consequences of increased PVRV were determined. RESULTS: A total of n=90 women were diagnosed with abnormal PVRV. Mean age in the studied population was 30.4 years, BMI prior to delivery 27.8, weight of the newborn 3,420 g, and percentage of cesarean sections 15.9%. Gestational week (p=0.043), vaginal tear (p=0.032), and induction of labor (p=0.003) were risk factors for covert PUR. Puerperal incidence of urinary tract infection was 1.1% (6 out of 526) and of urinary incontinence 29.2% (155 out of 530), with no differences between the groups. In the second examination, covert PUR was no longer present, and the values of residual urine decreased for all patients in the case group. No statistically significant differences were observed in questionnaire scores in general health and wellbeing perceptions between the groups. CONCLUSIONS: We have found a few significant obstetrical-pediatric risk factors for abnormal PVRVs. Data from the follow-up suggest that covert PUR has no impact on morbidity and quality of life 6 weeks postpartum. Therefore, abnormal PVRV is a self-limited phenomenon with a tendency toward self-correction. Our findings support those of previous studies that advocate against screening for asymptomatic retention in the postpartum period, despite some similar previous recommendations.