Conservative treatment options for polycystic ovary syndrome: the importance of exercise.

AIM: The main aim of the article is inform about benefits of rehabilitation in the treatment of polycystic ovary syndrome (PCOS). STUDY TYPE: Review article. METHODS: Search for meta-analyzes and systematic review in Pubmed, Medline, Scopus databases. RESULTS: Insulin resistance plays a potential role in the pathogenesis of PCOS. Lifestyle modification (including physical activity and diet) may help alleviate the symptoms of PCOS, as lifestyle factors may reduce insulin resistance and improve metabolism and reproductive function. The benefit of exercise in women with PCOS is also associated with other significant benefits such as improved anxiety, metabolic syndrome and improved regularity of the menstrual cycle. CONCLUSION: Rehabilitation is an important part of therapy in patients with PCOS. Aerobic, strength and interval exercises has a significant benefit in the treatment of polycystic ovary syndrome.

Benefits of exercise in the prenatal and postnatal period.

AIM: The main aim of the article is find benefits of exercise during and after pregnancy. STUDY TYPE: Review article. METHODS: Search for meta-analyzes and system reports in PubMed, JCR, Medline, Scopus databases. RESULT: Regular exercise is associated with a lower risk of macrosomy and caesarean section during childbirth. Depression is a  common complication in the prenatal and postnatal period due to increased stress and insufficient social support. Exercise is a potential non-pharmacological therapy. Regular exercise is also associated with lowering blood glucose and improving insulin sensitivity. To optimize weight and overweight, exercise is one of the main parts of treatment. Another therapeutic possibility of using the exercise is to influence the pain in the lumbosacral area and also the pain in the pelvic area. Another variant of exercises are exercises to strengthen the pelvic floor. Exercise of the pelvic floor muscles in the perinatal period is an effective method for preventing postpartum urinary incontinence. CONCLUSION: Exercise is an important part of therapy in the prenatal and postnatal period.

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.

Incidental occurrence of high grade serous tubal adenocarcinoma after prophylactic adnexectomy in benign gynecological surgery.

OBJECTIVE: Describtion of the case of incidental occurence of high grade serous tubal adenocarcinoma. DESIGN: Case study. SETTING: II. Department of Gynecology and Obstetrics, Medical Faculty of Comenius University and University Hospital, Bratislava. METHODS: Author observation, literature resources. RESULTS: Incidental occurrence of high grade serous tubal adenocarcinoma has been detected in patient after vaginal hysterectomy with bilateral adnexectomy and anterior colporhaphy. CONCLUSION: Case report confirms the importance of prophylactic salpingectomy in prevention of ovarian carcinoma.

Validation of the Slovak version of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), version A.

AIM: This study aimed to assess the psychometric characteristics of the Slovak translation of the version A of Wijma Delivery Expectancy/Experience Questionnaire (SW-DEQ) among healthy Slovak pregnant women. METHOD: Exploratory factor analysis (EFA) of the SW-DEQ was performed. Several coefficients of internal consistency were employed for the whole scale as well as for separate factors. Concurrent/convergent validity was assessed by correlation analysis of the overall SW-DEQ score with State-Trait Anxiety Inventory, Eysenck Personality Inventory - subscales Neuroticism and Extraversion, as well as with adjusted versions of Beck Depression Inventory and Internal-External Locus of Control Scale. EFA yielded seven factors: 'lack of composure', 'negative appraisal', 'lack of self-efficacy', 'lack of positive anticipation', 'fear and hopelessness', 'loneliness', and 'concern for the child'. RESULTS: The Cronbach's α of the whole scale was .93, while for the separate factors, it ranged between .68 and .87. The sum score of SW-DEQ correlated weakest with extraversion (in nulliparous women) and locus of control (in multiparous women), and strongest with trait anxiety (in both groups). CONCLUSIONS: The Slovak version could be considered a valid and reliable measure of fear of childbirth among pregnant Slovak women. However, the dimensional structure of the measure warrants further confirmation (Tab. 7, Ref. 33).

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 finding of isolated oligohydramnios after 37th week of gestation and its association with perinatal outcome]. / Vplyv nálezu izolovaného oligohydramnia po 37. týzdni tehotnosti na perinatálne výsledky.

OBJECTIVE: The objective of this study is to determinate the influence of oligohydramnios on perinatal outcome in term pregnancies. DESIGN: Retrospective case-control study. SETTING: II. Gynecologic Obstetrics Department, Comenius University, Bratislava. METHODS: Authors analysed a group of 372 single pregnancies after completed 37th week of gestation in years 2011 to 2015 with sonographic diagnosis of isolated oligohydramnios. A control group was created with matched patients by age and parity with normal amniotic fluid volume. RESULTS: We found significant differences in number of obstetric intervention between the two groups: patients with oligohydramnios had higher number of cesarean sections (71% compared to 33.9% in control group) and also the number of inductions was significantely higher (27.4% compared to 18.8%). The most common indication for cesarean delivery was presumed fetal hypoxia. We did not find any differences in numbers of neonates with low Apgar score, low umbilical cord pH and admission to neonatal intensive care unit. CONCLUSION: The finding of isolated oligohydramnios after 37th week of gestations is associated with higher risk of obstetric intervention without any association with adverse perinatal outcome.

[The importance of maternal microbiome in pregnancy]. / Význam materského mikrobiómu v tehotnosti.

OBJECTIVE: To bring the most actual published findings of the influence of maternal microbiome on the development of pregnancy and possibilities of its adjusting. DESIGN: Review. SETTING: 2nd Department of Gyneacology and Obstetrics of the Faculty of Medicine and the University Hospital, Bratislava. METHODS: Review of the literature. CONCLUSIONS: The appearance of microbes on various body surface areas determines the overall health status of the individual in significant manner. The change in composition of microbioma in pregnant woman is well known. It was believed that the placenta and the body of the newborn is sterile environment. Modern diagnostic methods proved the presence of microorganisms inside the fetoplacentar unit without the signs of inflammation. Mutual interaction between the immune system of the mother, microbioma and immune system of the newborn can decrease the risk of serious obstetrical syndromes as well as define the lifelong health status of the newborn. The risk can be decreased by the administration of probiotics during the pregnancy.

Conservative management of biopsy confirmed high-grade squamous intraepithelial lesions.

OBJECTIVES: Follow-up of women with biopsy-confirmed CIN2+ who were either treated immediately with LLETZ or managed conservatively to determine the rates of patients back on routine screening programme after a median of three years in two groups. METHODS: In this retrospective study, 310 patients were involved who had undergone biopsy with result of CIN2+ between January 2011 and December 2014. Depending on the management, i.e. based on whether cytology and colposcopy follow-up or immediate treatment were performed, they were divided in two groups. Then the number of patients back on routine screening up to 15/2/2016 as well as the results of last cytology were compared within both groups. RESULTS: A total of 310 women at average age of 30 years met the inclusion criteria. Of them, 230 (74 %) had immediate treatment whereas 80 (26 %) were managed conservatively. There were no statistically significant demographic differences between the two groups. The mean time of follow up was 1.091 days (2.98 years). The patients managed conservatively required more follow-up visits at colposcopy clinic (p<0.001). The last documented cytology in the immediate treatment group was negative in 93 % and low-grade/borderline in 7 % of patients, while in the conservative management group, it was negative in 84 %, low-grade/borderline in 15 % and high-grade in 1 % of patients (p = 0.015). Overall, the proportions of patients who are back on routine screening recall are 96 % and 87.5 % for the immediate treatment and conservatively managed groups, respectively (p=0.022). CONCLUSION: The conservative management of high-grade CIN with cytology and colposcopic follow up is an OPTION in selected group of patients, but it cannot be routinely recommended (Tab. 2, Ref. 20).

The impact of physiological peripartal stress on the lifelong health of newborn.

In the last decades the exponential increase in frequency of Caesarean sections is being observed. At the same time, there is growing amount of epidemiologic data showing higher lifetime risk of incidence of several diseases in offspring who do not experience natural labour. These findings lead to investigation of mechanisms which are responsible for maladaptation of several organ systems. Authors of this article describe these mechanisms, focusing especially on epigenetic programming, production of microbiome and positive effect of peripartal stress on successful beginning of extrauterine life.The best prevention strategy is following the strict indications of elective Caesarean sections. The current trend worldwide is to prepare the chronically ill patient for vaginal birth instead of indicating elective Caesarean section. From obstetric point of view it is possible to offer the external version of the foetus in breech presentation, the possibility of vaginal birth after Caesarean section and leave out controversial indications. The inevitable elective Caesarean sections should be planned close to term or after the beginning of spontaneous labour. The composition of intestinal microbiome could be partially influenced by application of vaginal secretion on newborn born by Caesarean section but there is not enough data proving long term positive outcomes (Ref. 48).

[Management of care of HIV-positive pregnant women in the period 1996-2014]. / Management péce o HIV pozitivní tehotné v období let 1996-2014.

OBJECTIVE: The evaluation of multidisplinary care about HIV positive pregnant women in the Czech Republic. DESIGN: Review. SETTINGS: Gynekologicko-porodnická klinika 1. LF UK a Nemocnice na Bulovce, Praha. METHODS: The vertical transmission of HIV infection from mother to fetus occurs most often during birth, still 1-2% of HIV-positive pregnant women will transfer the virus transplacenta. Due to careful screening for HIV during pregnancy, counselling, combination antiretroviral (cART) therapy, childbirth planning and its performance by C-section there appears a significant decrease of the virus transmission to the fetus, its occurrence is around 2%. If the HIV infection is detected in the context of screening for sexually transmitted infections (STIs), we begin with combined antiretroviral therapy (cART) depending on the level of viremia and CD4 as soon as possible. All HIV-positive pregnancies are tested for possible coinfection with hepatitis C. Since the first application of the antiretroviral treatment, the therapy is applies throughout the duration of the pregnancy. The labours of the HIV- positive women in the Czech Republic are scheduled. The primary choice is a caesarean section during the 38th week of pregnancy. CONCLUSION: From 1996-2014 the HIV positive status at 18 months of child age was confirmed in 4 cases in the Czech Republic. Three children were born to mothers whose HIV status was unknown at the time of the birth. Thanks to strict adherence to the interdisciplinary care, HIV positive woman have a chance to deliver a HIV-negative newborn and the risk of the transmission of the virus is significantly low.

[The issue of certain infectious diseases of pregnant women in everyday practice Part II. Viral infections]. / Problematika niektorých infekcných ochorení tehotných zien v kazdodennej praxi Cast II. Vírusové ochorenia.

OBJECT: Authors in their text are bringing the latest published findings on the impact of some of the most common infectious diseases on the course and outcome of pregnancies. DESIGN: Review. CONCLUSIONS: Recommendations for examination, treatment, and management of viral infection in pregnant women, especially from the view of a primary contact gynecologist.

[The issue of certain infectious diseases of pregnant women in everyday practice Part I. Bacterial and parasitic infections]. / Problematika niektorých infekcných ochorení tehotných zien v kazdodennej praxi Cast I. Bakteriálne a parazitárne ochorenia.

AIM OF STUDY: Authors in their text are bringing the latest published findings on the impact of some of the most common infectious diseases on the course and outcome of pregnancies. TYPE OF STUDY: Review. RESULTS: Proposals and recommendations for examination, treatment, and management of infected pregnant womans, especially from the view of a primary contact gynecologist.

Predicting axillary sentinel node status in patients with primary breast cancer.

The aim of this study is to determine the combination of characteristics in early breast cancer that could estimate the risk of occurrence of metastatic cells in axillary sentinel lymph node(s). If we were able to reliably predict the presence or absence of axillary sentinel involvement, we could spare a considerable proportion of patients from axillary surgery without compromising therapeutic outcomes of their disease. The study is based on retrospective analysis of medical records of 170 patients diagnosed with primary breast cancer. These women underwent primary surgery of the breast and axilla in which at least one sentinel lymph node was obtained. Logistic regression has been employed to construct a model predicting axillary sentinel lymph node involvement using preoperative and postoperative tumor characteristics. Postoperative model uses tumor features obtained from definitive histology samples. Its predictive capability expressed by receiver operating characteristic curve is good, area under curve (AUC) equals to 0.78. The comparison between preoperative and postoperative results showed the only significant differences in values of histopathological grading; we have considered grading not reliably stated before surgery. In preoperative model only the characteristics available and reliably stated at the time of diagnoses were used. The predictive capability of this model is only fair when using the data available at the time of diagnosis (AUC = 0.66). We conclude, that predictive models based on postoperative values enable to reliably estimate the likelihood of occurrence of axillary sentinel node(s) metastases. This can be used in clinical practice in case surgical procedure is divided into two steps, breast surgery first and axillary surgery thereafter. Even if preoperative values were not significantly different from postoperative ones (except for grading), the preoperative model predictive capability is lower compared to postoperative values. The reason for this worse prediction was identified in imperfect preoperative diagnostic.

[Antibiotic profylaxis in obstetrics]. / Profylaktické uzití antiinfekcních léciv v porodnictví

Nosocomial infections increase health care costs significantly and they are a real threat for all hospitalised patients as well. Surgical procedures affect imunological integrity in patients and increase risk of contamination and subsequent incidence of surgical site infections (SSIs). Antibiotic profylaxis according to recent trials has been shown to be effective in reducing the risks of postoperative infectious complications particularly in women undergoing cesarean section, termination of pregnancy in I. and II. trimester and repair of extensive obstetric perineal injuries. Benefit of antibiotic profylaxis hasn t been proven in procedures such as amniocentesis, cerclage and manual uterine evacuation. The routine antibiotic administration isnt recommanded in cases of spontaneous preterm labour without membrane rupture due to an increased risk of worse long-term outcome of children.The authors present also recent studies regarding antivirotic profylaxis in pregnant women with hepatitis B and herpes genitalis recidivans. In the end of the article differences in antimicrobial administration in obese women and in patients with penicillin allergy anamnesis are mentioned.

[Antibiotical prophylaxy in gynecology]. / Profylaktické uzití antiinfekcních léciv v gynekologii.

Gynecological surgery is considered to be clear with possible contamination by gram-positive cocci from the skin, gram-negatives from the perineum or groins or polymicrobial biocenosis from vagina, depending on the surgical approach. Antibiotical prophylaxy enforces the natural mechanisms of immunity and helps to exclude present infection. There were presented many studies comparing useful effect of prophylaxis in gynecological surgery. The benefits of antibiotical prophylaxy before IUD insertion, before the cervical surgery and before hysteroscopies were not verified. On the other hand the prophylaxy of vaginal surgery including vaginal hysterectomy decreases the number of postoperative febrile complications. The positive influence of prophylaxis before the simple laparoscopy and laparoscopy without bowel injury or the opening of the vagina was not evidently verified. In abdominal hysterectomy the antibiotical prophylaxy decreases the incidence of postoperative complications significantly. The administration of 2 g of cefazolin can be recommended. In procedures taking more than 3 hours the repeated administration of cefazolin is suitable. New urogynecological procedures, using mesh implants, were not sufficiently evaluated as for postoperative infections and the posible antibiotical effect. The presence of implant in possibly non sterile area should be considered as high risc of postoperative complications.

[Laparoscopic treatment of borderline ovarian tumorsin fertile women]. / Laparoskopické resení borderline tumoru ovaria u zen ve fertilním veku.

OBJECTIVE: Evaluation of the benefits of laparoscopy and the fertility preserving approach in the borderline ovarian tumors. These tumors often occur in young women of childbearing age. The patient and the surgeon face a serious problem, especially for women who wish to maintain the possibility of pregnancy. Laparoscopy in these situations appear to be one of the preferred treatment methods. DESIGN: Retrospective study. SETTING: Third Faculty of Medicine, Charles University Prague, Gynecology and Obstetrics Department; P. J. Safarik University, L. Pasteur University Hospital, Kosice, Gynecology and Obstetrics Department; Hospital Ceské Budejovice. METHODS: Analysis of the data in 23 women who desired fertility and were operated laparoscopically for borderline ovarian tumors. We evaluated the extend of laparoscopic surgery, peri- and postoperative complications and final results of histopathological findings. RESULTS: Mean age of the patients was 30,4 years. All patients were completely staged during second laparoscopic operation. In 14 of 23 (60.9%) cases serous borderline tumor was identified, in 8 of 23 (34.8%) cases mucinous borderline tumor was identified and in one case Brenner tumor was diagnosed. Peritoneal implants were present in 5/14 (35.7%) of serous tumors and in 3/8 (25%) of mucinous tumors. Involvement of contralateral ovary is also calculated. CONCLUSION: Borderline ovarian tumors occur in women who wish to maintain the possibility of pregnancy. For these patients, we choose based on their desire, conservative surgery. This treatment can be done by laparoscopy. Intraoperative ruptures of the tumor are more likely during lapaparoscopic procedures compared with laparotomy. In contrast, laparoscopy provides, besides well-known advantages, better optical evaluation of the abdominal cavity, including the detection of superficial peritoneal implants. For the objective evaluation of the laparoscopic approach in patients with fertility desire, further prospective comparative study are needed.

[Retrospective analysis of effectiveness of transvaginal ultrasound in the detection of ectopic pregnancy]. / Retrospektivní analýza efektivity diagnostiky ektopické gravidity transvaginálním ultrazvukovým vysetrením.

OBJECTIVE: To evaluate the effectiveness of transvaginal ultrasonographic (US) scan in own group of patients. DESIGN: Retrospective analysis. SETTING: Department of Gynaecology and Obstetrics, 3rd Faculty of Medicine, Charles University and Faculty Hospital Kralovské Vinohrady, Prague. METHODS: We retrospectively evaluated the history, laboratory and ultrasound findings in a group of 115 patients, that have undergone a surgical procedure due to a positive diagnose or suspicion of ectopic pregnancy (EP). In all cases the diagnose of ectopic pregnancy was histologically confirmed. RESULTS: 67% of our patients were nulliparous, 10% of patients had a positive personal history of previous ectopic pregnancy, only 5% of pacients had a record of pelvic inflammatory disease in the past. Histological examination confirmed 96.5% (111/115) tubal, 1.7% (2/115) interstitial, 0.9% (1/115) ovarian and 0.9% (1/115) cervical ectopic pregnancy. Our transvaginal ultrasonography (TVUS) scan was successful in 76.5% (88/115). A pathological adnexal mass was visualised in 67% (77/115) cases. A negative ultrasound finding was observed in 23.5% (27/115) cases. CONCLUSION: The US detection of ectopic pregnancy by a single TVUS examination was successful in 76.5% (88/115) cases. Early detection of ectopic pregnancy by TVUS decreases the risk of rupture of different types of EP, decreases the rate of surgical interventions and also promotes conservative management of ectopic pregnancies.

[Medical, legal and ethical aspects of fertility preservation in cancer survivor]. / Medicínské, právní a etické aspekty zachování fertility u onkologických pacientek.

In recent years the number of the young women in fertile age which are oncologically treated is increasing. For these women chemotherapy and radiotherapy introduces potential risk of reproductive dysfunctions. Present techniques of assisted reproduction are offering possibilities to save reproductive functions even after the oncological treatment. As a perspective outlook seems to be frozen premature oocytes with IVM and fertilisation. With these fertility savings methods are naturally coming up some of the ethical and legal issues.