Role of lateral suspension for the treatment of pelvic organ prolapse: a Delphi survey of expert panel.

INTRODUCTION AND HYPOTHESIS: Lateral suspension is an abdominal prosthetic surgical procedure used to correct apical prolapse. The procedure involves the placement of a T-shaped mesh on the anterior vaginal wall and on the isthmus or uterine cervix that is suspended laterally and posteriorly to the abdominal wall. Since its description in the late 90s, modifications of the technique have been described. So far, no consensus on the correct indications, safety, advantages, and disadvantages of this emerging procedure has been reached. METHODS: A modified Delphi process was used to build consensus within a group of 21 international surgeons who are experts in the performance of laparoscopic lateral suspension (LLS). The process was held with a first online round, where the experts expressed their level of agreement on 64 statements on indications, technical features, and other aspects of LLS. A subsequent re-discussion of statements where a threshold of agreement was not reached was held in presence. RESULTS: The Delphi process allowed the identification of several aspects of LLS that represented areas of agreement by the experts. The experts agreed that LLS is a safe and effective technique to correct apical and anterior prolapse. The experts highlighted several key technical aspects of the procedure, including clinical indications and surgical steps. CONCLUSIONS: This Delphi consensus provides valuable guidance and criteria for the use of LLS in the treatment of pelvic organ prolapse, based on expert opinion by large volume surgeons' experts in the performance of this innovative procedure.

Factors Affecting Women's Assessment and Satisfaction with Their Childbirth.

Background and Objective: Childbirth is one of the most significant experiences in a woman's life. The manner in which childbirth unfolds and is experienced can be influenced by various factors, including the birthing environment and the woman's attitude and preparation. Taking a holistic view of childbirth, it becomes apparent that addressing the basic physiological needs during childbirth can significantly influence the comfort and sense of security of laboring women. The aim of this research was to assess the level of satisfaction among women with their experience during childbirth and to identify its determinants. Materials and Methods: This study included 275 women who had given birth within the past 15 years and were up to 40 years of age. The research method employed was a diagnostic survey, involving a self-designed questionnaire. Results: discussing the birth plan with the midwife, the ability to ask questions during labor, consuming meals during labor, water immersion, listening to music during labor, assuming vertical positions during the second stage of labor, and skin-to-skin contact are associated with increased satisfaction with the childbirth experience. Conclusions: The study findings revealed that the highest levels of satisfaction were reported in connection with the interactions with medical staff during childbirth and the quality of facilities available during delivery. Conversely, the lowest levels of satisfaction were associated with the possibility of using pain relief methods during labor.

Quality of Life of Women with Polycystic Ovary Syndrome.

Background and Objectives: Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by multiple hormonal and metabolic abnormalities, including insulin resistance, hyperandrogenism, and disturbances in lipid and carbohydrate metabolism. The objective of this study is to assess the quality of life of women diagnosed with polycystic ovary syndrome (PCOS) and to identify any factors within the study group that may impact the scores related to quality of life. Materials and Methods: This research was carried out among women diagnosed with PCOS. An original questionnaire, developed through an online Google Forms survey, was utilized as the research instrument and distributed through social networks and support groups to women facing PCOS. This study encompassed a participant pool of 200 women with PCOS, aged 24 years or older. For the analytical component, Pearson's χ2 test was employed-a nonparametric test designed to assess the relationship between two variables measured on a qualitative scale. The chosen level of statistical significance was set at p < 0.05. Results: The analysis revealed that the quality of life of the women under study was not linked to the duration of the disease or comorbidities. However, a significant association was observed with the inconvenience caused by PCOS symptoms. Women experiencing very bothersome symptoms of PCOS reported a lower quality of life compared to those with symptoms rated as not very bothersome. Despite the majority of women with PCOS rating their quality of life as good or very good, they often find the associated symptoms of PCOS bothersome. Women reporting lower quality of life tend to acknowledge the impact of PCOS on their lives, experience a sense of lack of control over the disease, struggle with depression, and do not accept their physical appearance. Conclusions: Hence, the support from specialists like endocrinologists, gynecologists, and nutritionists becomes crucial for many women dealing with PCOS. Adopting a healthy lifestyle, incorporating a balanced diet, and engaging in regular physical activity can assist in managing the troublesome symptoms of PCOS, thereby enhancing overall quality of life. In instances of emotional difficulties, seeking psychological support is equally important, and the significance of support and acceptance from loved ones should not be overlooked.

Women's Awareness of Reproductive Health.

Background and Objectives: reproductive disorders are a serious global concern in medical, social, and demographic contexts. According to estimates, approximately 10-15% of couples around the world suffer from infertility. Numerous studies have shown that modifiable lifestyle factors, such as a high-fat diet, a postponed decision to start a family, tobacco smoking, alcohol consumption, risky sexual behavior, psychiatric diseases, and chronic stress, have a negative influence on the fertility of women. The main goal of this study is to assess the knowledge of women about reproductive health, infertility risk factors, and causes of infertility and to determine whether the level of this knowledge varies based on sociodemographic variables. Materials and Methods: a survey was conducted among 111 patients who anonymously filled in a questionnaire comprising questions regarding fertility and its deficiencies. The results were analyzed using the Chi-square test and Fisher's test. Results: the survey results indicated that women had a good or very good level of knowledge of the causes of infertility. The obtained test results were statistically significant (p < 0.05), but the studied group did not possess sufficient knowledge of the symptoms characterizing the diseases related to limited fertility (p > 0.05). The level of knowledge on the diagnosis of infertility did not depend on the age of the examined people, their educational level, or personal experience in this field (p > 0.05). The results also revealed that the awareness of women on reproductive health was poor. The studied women had a low level of knowledge of infertility risk factors, and their knowledge did not correlate with age, educational level, or personal experiences. Conclusions: information on the aspects of reproductive health should be widely disseminated through public educational campaigns, aimed at correcting erroneous convictions among women about the risk factors for infertility and assisting them in improving fertility.

Interstitial Ectopic Pregnancy-Case Reports and Medical Management.

The term intramural (interstitial) ectopic pregnancy refers to a pregnancy developing outside the uterine cavity, with a gestational sac implanted into the interstitial part of the Fallopian tube, surrounded by a layer of the myometrium. The prevalence rate of interstitial pregnancy (IP) is 2-4% of all ectopic pregnancies. Surgery is the primary treatment for interstitial ectopic pregnancy; the pharmacological management of ectopic pregnancy, including IP, in asymptomatic patients includes systemic administration of methotrexate. In this report, we present two cases of this rare pregnancy type, reviewing our management technique and treatment ways presented in the literature. In our patients, the management was initially conservative and included methotrexate, administered as intravenous bolus injection, regular beta-human chorionic gonadotropins (ß-HCG) level measurements in peripheral blood, and monitoring of the patient's general condition. Due to signs of intra-abdominal bleeding in patient A and inadequate ß-HCG level reduction in patient B, both patients eventually underwent laparoscopic cornual resection. Pregnancy, implanted into the interstitial part of the Fallopian tube and surrounded by myometrial tissue with myometrial invasion of the trophoblast, poses a serious diagnostic challenge to modern gynecology due to particularly low sensitivity and specificity of symptoms, and may require both pharmacological and surgical treatment.

The Influence of Oral Drotaverine Administration on Materno-Fetal Circulation during the Second and Third Trimester of Pregnancy.

Background and Objectives: The study aimed to evaluate the effect of the oral administration of drotaverine on maternal and fetal circulation as measured by Doppler sonography in women with a risk of preterm birth. Materials and Methods: The present prospective study was conducted on 34 women with singleton pregnancy at 26-36 weeks of gestation. Doppler flow and pulsatility index (PI) assessments of the umbilical artery, fetal middle cerebral artery, and uterine arteries were performed before and 90-120 min after oral drotaverine administration. Results: There were no statistically significant differences between the Doppler assessment (PI Uma-umbilical artery, MCA-middle cerebral artery, and ltUta-left uterine artery) before drotaverine administration and 90-120 min after oral intake, but there were statistically significant differences between the PI assessment of the rtUta (right uterine artery, 0.55 vs. 0.75, p = 0.05) and the mean of the Uta (0.66 vs. 0.74, p = 0.03). For changes in the CUR (cerebro-umbilical ratio) and % changes in the CUR and mean PI of the Uta, there was no correlation with obstetric history, AFI (amniotic fluid index), gestation week, infertility history, systolic pressure, or diastolic pressure. There was a statistically positive correlation between changes in the CUR and % change in the CUR and body weight and in height. Conclusions: Drotaverine has no statistically significant influence on the MCA and Uma PI. The oral administration of drotaverine has an impact on PI rtUta and the mean PI Uta.

Uterine rupture at 28 weeks of gestation after laparoscopic myomectomy - a case report.

There are many reasons for sterility, and uterine malformations are of the greatest concern. Among uterine disorders, myomas play a significant role and are present in 27% of infertile women. The occurrence of myomas is frequent - 20-40% in women of reproductive age. Thus, for those infertile patients surgical treatment may be needed to preserve an opportunity to conceive. This case report refers to an uterine rupture at 28 weeks of gestation after laparoscopic myomectomy (3 months before conceiving). The myomectomy was conducted correctly and two layers of sutures on the myometrium were performed. The purpose of the myomectomy in a young woman should be well considered. In cases of infertility, removal of the lesions is usually necessary to give the patient a chance of pregnancy. At the same time, the risk of uterine rupture is increased. There are some suggestions referring to myomectomy to reduce the risk of uterine rupture in a subsequent pregnancy. It seems that the method of sewing the uterine closure is crucial. For example, multilayer uterine stitches, preservation of the endometrial cavity, and avoidance of using electrosurgery to prevent devascularization (to avoid haematoma formation) should be taken into consideration to prevent weakness of the wall of the uterus. Uterine scars differ histologically and biochemically.

Pregnancy in a woman with acromegaly after transsphenoidal partial resection of pituitary macroadenoma - a case report.

Acromegaly is a systemic disease caused by an excessive release of growth hormone and the hypopituitarism, which is induced by macroadenoma local mass effect. The gynecological and obstetric disorders include irregular menstrual cycles, anovulatory cycles and infertility. Therefore, pregnancy in patients affected by the disease is rare. A CASE REPORT: Patient described in this study became pregnant after pharmacological, surgical and infertility treatment. Hence, the following paper presents the course of pregnancy and the discussion of the impact of acromegaly on female fertility, pregnancy, and concerns related to the diagnosis and treatment.

The use of synthetic materials in the treatment of stress urinary incontinence.

Stress urinary incontinence is a very serious problem which has been noticed by the WHO. This difficult medical condition poses a serious problem as it affects c.a. 20% of the female population and it increases up to 35% in the group of females over 60 years of age. Since there is no single standard surgical procedure which could solve this problem, numerous synthetic materials are used for the operations. It seems that the materials are effective as they improve the condition of women suffering from stress urinary incontinence. Unfortunately these materials have their shortcomings which might lead to certain post-operative complications. Stress urinary incontinence is a disease which affects the social life of the patients. It has a high percentage of recurrence and causes the patient substantial difficulties with keeping high standards of personal hygiene which is consequence makes it impossible to fulfill their social roles. The etiology of this disease is complex and calls for a cross-disciplinary approach to the problem. As there are no standardized or unanimous treatment methods of stress urinary incontinence, numerous sources based on the clinical experience of many medical centers suggest performing TVT and TOT procedures as the most effective treatment methods. The efficacy of the TOT procedure is about 90.8%.

Have we achieved progress in tocolytic treatment?--results of a retrospective cohort study in a tertiary university hospital.

OBJECTIVES: Beta-agonists play an important role in tocolytic treatment. In light of recent changes in the Polish medical care system, we decided to assess the effectiveness of oral continuous treatment (in 2012) and compare it with a 3-day intravenous administration of fenoterol (in 2013). The aim of our study was to contrast cost and effectiveness of fenoterol therapy in pregnant women at risk of preterm labor during two consecutive years: 2012 - when fenoterol had been widely used (group A), and 2013 when its extensive use had been withdrawn (group B). MATERIAL AND METHODS: Retrospective cohort study of 129 pregnant women: 76 treated with intravenous fenoterol, followed by continuous oral administration (November 2012; group A), and 53 treated with intravenous fenoterol only for 48-72 hours (November 2013; group B). RESULTS: Perinatal outcomes (based on the Apgar score and neonatal weight) were comparable in both groups. Continuous oral application of fenoterol resulted in earlier gestational age at delivery and lower cost of hospitalization among women from group A as compared to group B. Regardless, the difference was not statistically significant (37 hbd vs. 35 hbd, p = 0.626; 4334,700PLN vs. 5232,470PLN, p = 0.533). CONCLUSIONS: A 3-day intravenous application of fenoterol is as effective as oral continuous therapy and is characterized by reduced risk of negative side effects.

Self-directed learning in high-quality antenatal screening.

OBJECTIVES: To compare first-trimester scan results between audited (AS), according to the Fetal Medicine Foundation criteria, and non-audited sonographers (NAS). MATERIAL AND METHODS: Retrospective observational study of N = 629 and N = 1290 NT and CRL measurements done by AS and NAS, respectively. RESULTS: For similar examined populations (similar CRL and maternal age at examination) NT values were significantly lower in NAS with NT of 1.0 mm or less in 26.9% of measurements taken by NAS (vs. 0.3% in AS). NT differed significantly between NAS and AS in all maternal age groups, except for patients below 24 years of age and in all CRL categories. CONCLUSIONS: Training of sonographic skills in fetal medicine needs to be complemented by a regular audit to ensure adequate quality of the measurements.

The role of chemokine and non-chemokine factors in pain-related complaints in patients with endometrial cysts.

OBJECTIVES: Endometriosis is a chronic disease manifested as peritoneal endometrial implants and adhesions, as well as endometrial cysts, with pain as the dominant component. THE AIM: The aim of the study was to evaluate the role of chemokine (MCP-1, MCP-2, MIP-1, MIP-1 and RANTES) and non-chemokine (urocortin, ghrelin, and leptin) factors in the intensity of pelvic pain in women with endometrial cysts. MATERIAL AND METHODS: A total of 86 women, aged 18-38, treated laparoscopically between September 2009 and November 2012, due to adnexal changes, i.e. endometrial cysts and mature teratomas, were recruited for the study. On a numeric rating scale, i.e. PSS (Pain Sensation Scale--according to Johnson), the patients rated pain intensity. The level of pain-related stress was investigated with the Pain Distress Scale (PDS, according to Johnson). RESULTS: Medians for MCP-1, MCP-2, MIP-1, MIP-1 and RANTES concentrations were not statistically significantly different. The respondents rated pain intensity during menses as 6 and 3 points in the E and T groups, respectively (6 vs. 3 points; p=0.001). Statistically significant differences were also observed for pain intensity during work (apart from menses), (2 vs. 2 points, p=0,014) and during sexual intercourse (apart from menses) (3 vs. 1 points, p=0.006). Pain-related stress levels were higher in the T group as compared to the E group (3 vs. 5 points; p=0.007). CONCLUSIONS: It seems safe to conclude that chemokines and leptin may play a significant role in the occurrence of pain complaints among women with endometrial cysts. Further research might result in implementation of new treatment methods for pain management, especially in terms of pharmacotherapy.

Overweight, obesity and female sexuality in perimenopause: a preliminary report.

INTRODUCTION: The research was conducted among patients of the Department of Perinatology and Gynaecology of the Poznan University of Medical Sciences. Its aim was to investigate the influence of overweight and obesity on female sexuality during the perimenopausal period. Preliminary results of the research are presented in the thesis, which was as a matter of fact intended as a preliminary report. The examination of sexual functions of the patients was performed with the use of the Female Sexual Function Index (FSFI) form. MATERIAL AND METHODS: Sixty-one women during the perimenopausal period filled out the survey, with the average age of these women being 51 years. Forty-two of the examined women had an appropriate body mass index (BMI), i.e. between 18.5 and 25, while for 19 of the women, the BMI was above normal. For statistical analysis and in order to assess the differences between the two above-mentioned groups of patients, the nonparametric Mann-Whitney test was applied. A statistically significant value was assumed at p < 0.05. The results of the conducted research indicated no such difference between the women with differing BMI for the specific domains of the FSFI test. RESULTS: The results obtained show that research in the area needs to be continued. CONCLUSIONS: All the hitherto existing scientific studies also seem to indicate that the influence of overweight and obesity on female sexuality during the perimenopause has not yet been unambiguously proven. Beyond any doubt, however, sexual disorders appear in women at this time of life and the factors which determine them can vary greatly. Given the character of the situation, women ought to be supported both by a team of specialists representing different branches of medicine as well as by their relatives. The whole situation also calls for more research of the important subject matter.

Single nucleotide polymorphisms (SNPs) of ERCC2, hOGG1, and XRCC1 DNA repair genes and the risk of triple-negative breast cancer in Polish women.

Triple-negative breast cancer (TNBC) refers to about 15-20% of all breast cancer cases. It is characterized by worse clinical outcome, poor prognosis, and absence of prognostic indicators. Several polymorphisms in the nucleotide excision repair (NER) and base excision repair (BER) gene have been extensively studied in association with various human cancers. The aim of this study was to evaluate the role of the hOGG1-Ser326Cys (rs13181), XRCC1-Arg194Trp (rs1799782), and ERCC2-Lys751Gln (rs13181) gene polymorphisms with clinical parameters and the risk for development of triple-negative breast cancer. Our research included 70 patients with TNBC and 70 healthy controls. Gene polymorphisms were genotyped by the PCR-RFLP (restriction fragment length polymorphism) method. The genotype distributions were contrasted by the chi-square test, and the significance of the polymorphism was assessed by multiple logistic regression producing odds ratios (ORs) and 95% confidence intervals (CIs). In the present work, a relationship was identified between ERCC2-Lys751Gln polymorphism and the incidence of triple-negative breast cancer. An association was observed between triple-negative breast carcinoma occurrence and the presence of Gln/Gln genotype (OR = 5.71 (2.12-5.43), p = 0.0007). A tendency for an increased risk of TNBC was detected with the occurrence of 751Gln allele of ERCC2 polymorphism. No significant associations between Ser326Cys and Arg194Trp genotype and TNBC were observed. We suggest that the Lys751Gln polymorphism of the ERCC2 gene may be risk factors for triple-negative breast cancer development in Polish women.

[Breast elastography--new diagnostic quality or technologic bubble]. / Elastografia gruczolu piersiowego--nowa jakosc w diagnostyce czy technologiczna banka mydlana.

Breast elastography consist of static and dynamic method. The paper deals with morphologic characterization of breast lesions and typical symptoms like: mass ventralisation, size change, switch-off sign and posterior boundary imaging. The recent studies of dynamic elastography implementation into breast cancer screening are presented. In the shear wave elastography red colour, irregular shape or maximum stiffnes above 160kPa the upgrade from BIRADS 3 to 4a should be made. If the lesion is homogenous, blue and with stiffness < 80kPa them safe downgrade to BIRADS 3 could be considered.

Safety of Progestogen Hormonal Contraceptive Methods during Lactation: An Overview.

BACKGROUND: Breastfeeding is a process for not only nourishing infants but also for building a unique emotional bond between mother and child. Therefore, the ideal contraception during lactation should not affect lactation (milk composition, milk volume) and offspring development. OBJECTIVES: This study aims to analyze the literature on the safety of progestogen hormonal contraceptive methods during lactation. METHODS: We conducted a thorough search across various databases, including the National Library of Medicine (PubMed), and the Cochrane Database, Drugs and Lactation Database (LactMed). Our search utilized specific phrases such as: "lactation" and "breastfeeding" and "oral contraception" with "drospirenone" or "desogestrel", with "subcutaneous etonogestrel implant" or "etonogestrel implant", with "levonorgestrel-releasing intrauterine system", and "emergency contraception", with "levonorgestrel" or "ulipristal acetate". CONCLUSIONS: Based on published scientific reports, progestogen hormonal contraceptives can be considered a relatively safe solution for women desiring to continue feeding their infant with their milk while using hormonal contraception. It is important to seek guidance on selecting the best contraception method based on the latest medical knowledge, tailored to the individual needs and clinical circumstances of each woman and place of residence. A woman should always be informed of the potential risks of such a treatment and then allowed to make her own decision based on the knowledge received from a specialist.

Eating Behaviors and Physical Activity versus the Big Five Personality Traits in Women with a Hereditary Predisposition to Breast or Ovarian Cancer.

The Big Five personality traits-neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness-represent continuous, individual features that affect a number of vital health aspects, including morbidity, self-reported health status, or lifestyle. The aim of this study was to analyze the relationship between the eating behaviors and engagement in physical activity of women with a hereditary predisposition to breast or ovarian cancer and the Big Five personality traits. A total of 357 women, participants of 'The National Program for Families With Genetic/Familial High Risk for Cancer', were included in the study. In the healthy group, the following statistically significant predictors were found in variables: agreeableness-meal frequency (ß = 0.151; p = 0.030); neuroticism-consumption of fruits and vegetables (ß = -0.177; p = 0.016) and cereal products (ß = -0.223; p = 0.002); openness to experience-consumption of plant-based fats (ß = 0.141; p = 0.034) and physical activity (ß = 0.153; p = 0.021). In the cancer group, the frequency of dairy consumption (ß = 0.286; p = 0.003) and physical activity (ß = 0.370; p = 0.000) were found to be statistically significant predictors for the openness to experience variable. Neuroticism is associated with less frequent consumption of fresh fruits and vegetables as well as cereal products. Openness to experience was more often linked with a higher frequency of dairy consumption, plant-based fats, and physical activity. Women with breast or ovarian cancer and a higher openness to experience consumed dairy and engaged in physical activity more often than their peers with the remaining personality traits.

New Possibilities for Hormonal Vaginal Treatment in Menopausal Women.

Hormonal vaginal therapy is an effective treatment option for women who experience vaginal symptoms related to hormonal changes. Estrogen and prasterone are widely used as vaginal treatments, particularly for urogenital atrophy. These symptoms may include vaginal dryness, itching, burning, and pain during sexual intercourse, all of which can significantly affect a woman's quality of life. Previous studies have indicated that such treatment improves tissue elasticity, moisturizes the vagina, and can have a substantial impact on urine incontinence and vaginal microflora and decreases dyspareunia. Hormonal therapy is also useful and commonly used before vaginal surgical treatment. Prasterone is quite a new option for vaginal therapy in Poland and is mainly recommended for dyspareunia in menopausal women. The study related to prasterone therapy emphasizes its effectiveness and safety, making it advantageous to explore its beneficial impact. This paperwork aims to summarize the mechanism of action as well as the effects of both drugs and their beneficial action during vaginal treatment.

Peripartum prolactin and cortisol level changes. A prospective pilot study.

OBJECTIVES: Although the role of prolactin and cortisol in the human lactation process seems to be undisputed, the changes in postpartum serum concentrations in mothers make data interpretation difficult. MATERIAL AND METHODS: To determine the factors that possibly influence these hormones, we examined a group of patients who were admitted to the Gynecology-Obstetrics Clinical Hospital in Poznan for labor induction and/or in the active phase of the first labor period. The serum levels of cortisol and prolactin were assessed in these full-term pregnant women during admission to labor, in the third stage of labor, and on the second day postpartum. The prolactin and cortisol levels were also measured in the umbilical cord for the assessment of newborn babies. RESULTS: The results showed a significant relationship between maternal age and the level of prolactin measured before childbirth and fluctuations in cortisol level with respect to labor duration. In addition, we observed a strong correlation between the level of prolactin assessed before childbirth and the pH and base excess of the umbilical cord artery. Most importantly, a correlation was noted between breastfeeding within 2 hours after the labor and the level of cortisol measured after childbirth. CONCLUSIONS: We observed a significant correlation between a summarized labor duration and maternal and umbilical cord cortisol levels measured right after the labor. The fact of breastfeeding within 2 hours after the labor strongly correlated with lower levels of maternal cortisol as well as a cortisol level in umbilical cord blood and it suggests that immediate initiation of breastfeeding reduces stress level for both, mother and newborn.