Ceska Gynekologie-Czech Gynaecology最新文献

{"title":"Low-volume regional lymph node metastasis in endometrial cancer - 2024 update.","authors":"Dita Münzová, Petra Bretová, Jitka Hausnerova, Markéta Bednaříková, Luboš Minář, Vít Weinberger","doi":"10.48095/cccg2025158","DOIUrl":"https://doi.org/10.48095/cccg2025158","url":null,"abstract":"<p><p>Due to the implementation of sentinel lymph node ultrastaging, the prevalence of isolated tumor cells and micrometastases have increased. This literature review comprises of articles published between January 2019 and September 2024 aiming at low-volume metastases in regional lymph nodes, their prognosis, and links to molecular classification. Micrometastases are currently considered as having metastatic lymph node involvement; however, they have a better prognosis than macrometastases. Accordingly, therapy is tailored. In contrast, isolated tumor cell presence is not considered metastatic involvement according to International Federation of Gynecology and Obstetrics (FIGO) 2023 staging and does not affect the therapeutic procedure because their significant prognostic importance has not been proven so far.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 2","pages":"158-162"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of various types of ectopic pregnancy - a questionnaire study.","authors":"Barbora Švédová, Martin Hruda, Vít Drochýtek, Michael Jiří Halaška, Kateřina Maxová, Nikola Janovská, Helena Součková, Anna Babková, Lukáš Rob, Borek Sehnal","doi":"10.48095/cccg2025141","DOIUrl":"https://doi.org/10.48095/cccg2025141","url":null,"abstract":"<p><strong>Objective: </strong>To map management of different types of ectopic pregnancies in the Czech Republic using a questionnaire-based study.</p><p><strong>Methods: </strong>In 2023, a total of 95 obstetrics and gynecology departments across the Czech Republic were surveyed using an online questionnaire, which inquired about the management strategies for various types of ectopic pregnancies. The departments were categorized based on the number of hysterectomies performed annually. Differences in responses between large centers and other departments were statistically compared.</p><p><strong>Results: </strong>A total of 45 departments of all sizes completed the questionnaire. Two-thirds of all departments always perform salpingectomy in cases of tubal pregnancy (78% of large, 58% of medium-sized, and 40% of small departments). Systemic methotrexate administration for the treatment of intact tubal pregnancy is used by one-fifth of departments (22% of large, 23% of medium-sized, and 0% of small departments). In cases of atypical ectopic pregnancy localization, methotrexate treatment is used by 33% of large, 42% of medium-sized, and 40% of small departments. A statistically significant difference was observed in the clearly preferred laparoscopic approach for surgical management of cesarean scar pregnancy in large centers compared to smaller departments (P = 0.036). No other statistically significant differences were observed between the departments in other parameters.</p><p><strong>Conclusion: </strong>In cases of intact tubal pregnancy, four-fifths of obstetric and gynecological departments perform laparoscopic salpingectomy, while only one-fifth utilize systemic methotrexate for treatment. On the other hand, methotrexate is used by one-third to two-fifths of departments of all sizes in cases of atypical ectopic pregnancy localization.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 2","pages":"141-148"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual function in women with pelvic organ prolapse.","authors":"Samuel Tvarožek, Martina Szypulová, Anežka Šteflová, Martin Huser, Zdeněk Rušavý","doi":"10.48095/cccg202564","DOIUrl":"10.48095/cccg202564","url":null,"abstract":"<p><p>A woman's sexuality is a complex phenomenon involving several factors, among which age and health are the most important. However, other aspects are not negligible. The impact of pelvic organ prolapse on sexual function cannot be ignored, as the reported prevalence of pelvic organ prolapse in female population exceeds 50%. This article presents a systematic review of articles dealing with the impact of pelvic organ prolapse on female sexual function. Sexual dysfunction is common in women with pelvic organ prolapse, regardless of prolapse stage or the compartment affected. Estrogen therapy has no effect on sexuality in women with prolapse, while pelvic floor muscle training may provide some improvement. There is no evidence that conservative therapy using a pessary is associated with negative impact on sexual function. Native tissue repair tends to improve sexual function in general, except for posterior colporrhaphy, which was frequently associated with dyspareunia. No correlation between postoperative vaginal length and change in sexual function was identified. The impact of transvaginal mesh repair on sexuality remains unclear. In contrast, there is enough evidence proving that sacrocolpopexy significantly improves sexual function in women.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 1","pages":"64-70"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and treatment of peripartum haemorrhage, consensus of the interdisciplinary working group by the modified ACCORD method.","authors":"Vladimír Černý, Antonín Pařízek, Jan Bláha, Jan Blatný, Petr Dulíček, Jaromír Gumulec, Petr Janků, Marian Kacerovský, Petr Křepelka, Marek Ľubušký, Jitka Mannová, Dagmar Seidlová, Ondřej Šimetka, Petr Štourač","doi":"10.48095/cccg202572","DOIUrl":"10.48095/cccg202572","url":null,"abstract":"&lt;p&gt;&lt;p&gt;of recommendations Preventive measures and procedures We recommend monitoring of blood loss in women with risk factors for PPH during labor using calibrated blood collectors or their equivalents. (Good Clinical Practice) We recommend that women with significant risk factors for PPH (e.g., placenta acrreta spectrum or hematologic disorders requiring consultative hematologic care) deliver in a perinatal intensive care center or perinatal intermediate care center. (Good Clinical Practice) We recommend formulating a plan of care in collaboration with a multidisciplinary team at a reasonable time prior to delivery for patients at high risk of PPH. (Good Clinical Practice) We recommend treating anemia antepartally. Pregnant women should be given iron supplements if the haemoglobin level falls to &lt; 110 g/L in the 1st trimester or &lt; 105 g/L at 28 weeks of pregnancy. (Good Clinical Practice) We suggest considering parenteral iron administration in women with sideropenic anemia unresponsive to oral iron supplementation. The cause of anemia should be identified as soon as possible after termination of pregnancy. (Weak recommendation) If the baby adapts well, we do not recommend cord ligation in less than 1 min. (Strong recommendation) In all vaginal deliveries, we recommend prophylactic administration of uterotonics in the third postpartum period after the delivery of the baby and cord ligation to reduce the risk of PPH. The first-choice drug is oxytocin. (Strong recommendation) If the third stage of labor has not been actively managed, we suggest that uterine massage and controlled umbilical cord traction be considered to shorten the duration of the third stage of labor and to reduce blood loss during vaginal delivery, if performed by a qualified healthcare professional. (Weak recommendation) We recommend the administration of uterotonics to prevent the development of PPH in women after the delivery of a child by caesarean section and umbilical cord ligation. (Strong recommendation) We suggest considering carbetocin administration in women at increased risk of PPH. (Weak recommendation) We recommend a single-dose administration of tranexamic acid (TXA) in women at increased risk of PPH undergoing a caesarean section. Clinical note: The use of TXA prior to the caesarean section is not explicitly stated in the product's SPC. A recent meta-analysis states the most common dosage to be 1 g i.v. (Strong recommendation) Organization of care We recommend that every health care facility with an OB/GYN unit should have the PPH management protocol (guided document is not specific or really used at all, I am not sure if my suggestion is sufficient) defining the organizational and professional procedure for PPH situations. (Good Clinical Practice) We recommend that the PPH management protocol (i.e. the crisis action plan) should clearly define the organizational and professional roles of the individual members of the crisis team in the event of PPH (non-medical s","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 1","pages":"72-89"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular mechanisms leading to fibrosis in endometriosis.","authors":"Zdeňka Lisá, Radoslav Janoštiak, Kristýna Hlinecká, Adéla Richtárová, David Kužel, Michal Mára, Michael Fanta","doi":"10.48095/cccg2025167","DOIUrl":"https://doi.org/10.48095/cccg2025167","url":null,"abstract":"<p><p>Endometriosis is a complex chronic disorder with a high prevalence among women of reproductive age, significantly affecting both their quality of life and ability to conceive. In clinical settings, there is an increasing incidence of advanced disease stages, particularly deep infiltrating endometriosis, which not only produces severe clinical symptoms, but also results in organ involvement. This article aims to synthesize current insights into the pathological mechanisms underlying fibrotic remodelling, which is associated with the most severe manifestations of the disease. Furthermore, it provides the theoretical framework for an ongoing research project aimed at identifying molecular biomarkers implicated in the most advanced forms of endometriosis, with the potential to enhance prediction of disease progression.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 2","pages":"167-172"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient satisfaction and ease of use of a novel method for electronic administration of validated quality of life questionnaires.","authors":"Zdeněk Rušavý, Martin Smažinka, Martin Havíř, Vladimír Kališ","doi":"10.48095/cccg2025149","DOIUrl":"https://doi.org/10.48095/cccg2025149","url":null,"abstract":"<p><strong>Background: </strong>Evaluation of the quality of life using validated measures is an essential part of urogynecology examination and follow-up. Questionnaires administered in paper form generate paper waste or high demands for storage. Score calculation for some questionnaires may be demanding and time-consuming. The electronic format of completing questionnaires simplifies data collection and processing, but may be challenging for older patients. We developed a Medical Electronic Survey System (MESS), which facilitates completion of questionnaires on a tablet PC with an emphasis on data protection and user-friendliness for the elderly.</p><p><strong>Objective: </strong>To compare patient satisfaction and ease of use between Google Forms and MESS.</p><p><strong>Methods: </strong>This was a prospective cohort study comparing the answers to a satisfaction questionnaire completed using Google Forms (193 questionnaires between 2013-2015) and MESS (329 questionnaires between 2019-2020), along with other clinically used validated questionnaires. The answers to the questionnaire were compared using a Fisher's Exact Test or a Wilcoxon Two Sample test, with a significance level of P &lt; 0.05.</p><p><strong>Results: </strong>The electronic form of questionnaire completion suited more women in case of MESS (84.5 vs. 65.6%; P &lt; 0.05). Completing questionnaires electronically was rated as easy or very easy by 89.1% of patients using MESS compared to 68.7% using Google Forms; P &lt; 0.05. The electronic form of filling-in the questionnaires was very difficult or impossible especially for women using Google Forms (31 vs. 11%; P &lt; 0.05). The major difference in questionnaire completion without any help was observed in the age group 60-69 years. No differences were observed in women under 60 years of age. All clinicians observed significant facilitation of their work.</p><p><strong>Conclusion: </strong>MESS has made the method of electronic questionnaire completion available even to elderly patients with pelvic floor disorders. It was positively accepted even by patients who are not familiar with any electronic devices.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 2","pages":"149-153"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infertility stress and coping strategies in women and men undergoing in vitro fertilization treatment.","authors":"Gabriela Ďurašková, Radek Hampl, Daniel Dostál","doi":"10.48095/cccg202514","DOIUrl":"10.48095/cccg202514","url":null,"abstract":"<p><strong>Aim: </strong>To describe coping strategies and infertility stress in men and women undergoing in vitro fertilization (IVF) treatment. To determine whether there are differences in coping strategies between men and women and to identify adaptive and non-adaptive coping strategies for infertility.</p><p><strong>Materials and methods: </strong>A correlational study, where 162 patients (99 women and 63 men) with primary infertility undergoing IVF treatment at Sanus Pardubice completed the Fertility Problem Inventory and COPE Inventory psychological questionnaires.</p><p><strong>Results: </strong>There were no significant differences between women and men in experiencing infertility stress. The coping strategies used most frequently by both men and women were Positive Reinterpretation, Planning, and Acceptance; men used the strategies Restraint, Suppression, and Planning significantly more frequently than women; and women used the strategies Using Emotional Social Support and Religious Coping significantly more frequently than men. For both women and men, level of Global infertility stress significantly correlated with Denial in the positive direction and with Positive Reinterpretation and Acceptance in the negative direction.</p><p><strong>Conclusion: </strong>Involuntarily childless women and men in IVF treatment experience similar infertility stress, but use slightly different coping strategies. For both men and women, Positive Reinterpretation and Acceptance emerged as adaptive strategies, while Denial emerged as non-adaptive.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 1","pages":"14-21"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Sheehan's syndrome.","authors":"Aurel Dobiaš, Andrea Klčovanská, Ivan Dečkov, Róbert Hlávek","doi":"10.48095/cccg202538","DOIUrl":"10.48095/cccg202538","url":null,"abstract":"<p><strong>Objective: </strong>To present a case of a patient who developed acute Sheehan's syndrome, despite adequate estimated blood loss.</p><p><strong>Case report: </strong>Sheehan's syndrome is a relatively rare disease with various incidences, mainly due to different obstetric care factors in individual countries. Pathogenetic mechanisms are not fully understood. An important factor is reduced blood flow through the pituitary arteries caused by hypotension in the setting of postpartum hemorrhage. Subsequent clinical manifestations depend on the extent of damage to the pituitary gland, and consequently, on the loss of individual hormones, the secretion of which is controlled by the pituitary gland. Most patients are diagnosed years later. Our case describes a patient with Sheehan's syndrome that developed in the early postpartum period. The patient was successfully diagnosed and adequate replacement therapy was started.</p><p><strong>Conclusion: </strong>In summary, acute Sheehan's syndrome is a rare occurrence. Agalactia, amenorrhea, fatigue, and other non-specific symptoms should be considered despite its rarity.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 1","pages":"38-43"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uterine torsion during cesarean section coinciding with HELLP syndrome.","authors":"Monika Skuhrovcová, Miroslava Sládková, Stanislav Martan","doi":"10.48095/cccg202548","DOIUrl":"10.48095/cccg202548","url":null,"abstract":"<p><p>Uterine torsion belongs to one of the most dangerous labor complications also because of its rarity. As it is not common for an obstetrician to come across this state, it is usually not at the very top of the differential diagnostics list when solving acute child delivery complications. However, it is serious enough to pose a lethal threat to both mother and child. In this case, the term gravidity was ended by acute cesarean section because of HELLP syndrome. During the operation, as well as after a complicated delivery and hysterotomy suture uterine torsion of 120 degrees to the right, the patient was diagnosed with detorsion. The rest of the operation was done according to normal standards. Thanks to this very prompt procedure, the aftermath of the described state meant little to no harm to the mother and her child. This case study should highlight the importance of including uterine torsion into differential diagnostics of acute abdominal pain and vomiting to prevent fatal labor complications for the mother and her child.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 1","pages":"48-51"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical significance of quantification and immunophenotyping of uterine NK cells in the diagnosis and treatment of infertility.","authors":"Karin Černá, Pavel Otevřel, Štěpánka Luxová, Lenka Sedláčková","doi":"10.48095/cccg20256","DOIUrl":"10.48095/cccg20256","url":null,"abstract":"<p><strong>Introduction and objective: </strong>Uterine NK (uNK) cells, a specialized subpopulation of natural killer (NK) lymphocytes located in the endometrium, play a crucial role in regulating the immune response and in the process of embryo implantation. This study aims to retrospectively analyze the outcomes of in vitro fertilization (IVF) treatment in a cohort of women who underwent uNK cell immunophenotyping with subsequent immunomodulatory therapy applied based on the results.</p><p><strong>Methods: </strong>The study included 122 patients who underwent uNK cell immunophenotyping between April and December 2023. Immunophenotyping was performed using flow cytometry. Patients were categorized into four groups according to their uNK cell phenotypes: normal findings, low absolute and relative numbers of uNK cells (LOW-IMMUNE profile), low numbers of uNK cells combined with the shift towards the cytotoxic uNKc dim immunophenotype (MIXED-IMMUNE profile), and normal numbers of uNK cells, but an undesirable shift in the ratio of cytotoxic to regulatory uNK cells towards the cytotoxic uNK dim phenotype (OVER-IMMUNE profile). Embryo transfer outcomes and the occurrence of miscarriages up to the 12th week of pregnancy were evaluated in each group.</p><p><strong>Results: </strong>The highest clinical pregnancy rate was observed in the treated OVER-IMMUNE group (70%), fol lowed by the MIXED-IMMUNE group (60%). The LOW-IMMUNE group did not differ significantly from the untreated NORMAL group (P = 0.205). Insufficient immune activation (LOW-IMMUNE profile) was significantly associated with first-trimester pregnancy loss (P &lt; 0.0001).</p><p><strong>Conclusion: </strong>This study provides new insights into the potential benefits of uNK cell immunophenotyping and subsequent immunomodulatory therapy in treating fertility disorders. While the results indicate possible clinical advantages, further research is necessary to confirm these findings and elucidate the mechanisms leading to improved outcomes in assisted reproductive techniques.</p>","PeriodicalId":43333,"journal":{"name":"Ceska Gynekologie-Czech Gynaecology","volume":"90 1","pages":"6-13"},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}