Invasive and metastatic hydatidiform moles in Slovakia in 1993‒2022.

OBJECTIVE: A retrospective analysis of invasive and metastatic hydatidiform moles (HM) in the Slovak Republic (SR)‒epidemiology, patient characteristics and treatment outcomes. BACKROUND: Invasive and metastatic mole is a highly curable type of gestational trophoblastic neoplasia. Both invasive and metastatic HM may be cured by hysterectomy without adjuvant chemotherapy. METHODS: Nineteen cases of histopathologically confirmed HM (10 invasive and 9 metastatic) were treated in SR from 1993 to 2022. Patients were divided into two groups according to treatment modality (hysterectomy only ‒ 8; hysterectomy and chemotherapy ‒ 11). The parameters included in the analysis were patient age, antecedent pregnancy, human chorionic gonadotropin level, tumor size and time to remission. RESULTS: The incidence of invasive and metastatic HM in the SR was 1:121,253 pregnancies, or 1:86,589 live births. The overall cure rate was 100%, without recurrence. Hysterectomy was performed as first-line therapy in 14 patients, with a cure rate of 57.1%. 4 out of 8 patients (50%) with metastatic moles, who underwent first-line hysterectomy, were cured without chemotherapy. There was no statistically significant difference between the two groups in all selected parameters. CONCLUSION: First-line hysterectomy may lead to remission without adjuvant chemotherapy or reduce the number of chemotherapies in invasive and metastatic HM (Tab. 4, Fig. 2, Ref. 21).

Peripartum hysterectomy: A 9-year population-based study in Slovakia.

OBJECTIVE: To assess the incidence of peripartum hysterectomy (PH) in Slovakia. Additionally, we wanted to describe reasons for the procedure, associated clinical circumstances, and complications. METHODS: This was a descriptive, population-based study among women who underwent PH in Slovakia between January 2012 and December 2020. Peripartum hysterectomy was defined as surgical removal of the uterus from the peripartum period up to 42 days postpartum. Data were obtained retrospectively from the standardized questionnaires that are completed in Slovakia for any case of PH. The background population consisted of all other women who delivered during the study period. RESULTS: Of the 436 136 births, there were 397 cases of PH, giving an incidence of 0.91 per 1000 births. It was higher with advanced maternal age, multiparity, multiple pregnancies, and cesarean deliveries. The main reasons for the procedure were placental pathologies and uterine atony in 52.9% and 33.0%, respectively. A total of 150 (37.8%) women required admission to an intensive care unit. The mortality rate was 1.5%. CONCLUSION: The incidence of PH is relatively high in Slovakia when compared with other European countries, highlighting the need to improve prenatal diagnosis of morbidly adherent placenta and the management of peripartum hemorrhage.

Morbidly adherent placenta as a cause of peripartum hysterectomy in the Slovak Republic in the years 2012-2020.

OBJECTIVE: The main aim of this study was to analyze the cases of peripartum hysterectomy associated with morbidly adherent placenta in the Slovak Republic. MATERIALS AND METHODS: Cases of morbidly adherent placenta managed by peripartum hysterectomy in the Slovak Republic between January 2012 and December 2020 were retrospectively analyzed. Data were obtained from the standardized anonymous questionnaires. RESULTS: The incidence of morbidly adherent placenta was 0.39 per 1,000 births. A total of 151 (89.9%) women with morbidly adherent placenta were managed by peripartum hysterectomy (38.0% of all peripartum hysterectomies). Placenta accreta, increta and percreta were present in 56.3%, 28.5% and 15.2%, respectively. Placenta previa was present in 60 (39.7%) cases. Up to 112 (74.2%) cases of morbidly adherent placenta were diagnosed at the time of delivery. Hysterectomy was preceded by unsuccessful uterus-saving procedure in 23 (15.2%) of cases. The median of estimated blood loss was 1,500 mL. A packed red blood cells transfusion was used in 138 (91.4%), fresh frozen plasma in 118 (78.2%), fibrinogen concentrate in 39 (25.8%) and tranexamic acid in 25 (16.6%) women. A total of 58 (38.4%) women required admission to an intensive care unit. The mortality rate was 1.3%. CONCLUSION: In recent years, there was an increase in the incidence of morbidly adherent placenta, peripartum hysterectomy in the Slovak Republic, along with an increase in caesarean section rates, too. Case analysis highlights the need to improve the prenatal diagnosis and management of morbidly adherent placenta.

Severe maternal morbidity requiring intensive care units admission in the Slovak Republic - a 9-year population based study.

OBJECTIVE: Analysis of life-threatening maternal morbidities, the condition of which required subsequent treatment in Intensive Care Units (ICU) in the Slovak Republic in the years 2012-2020. METHODOLOGY: Retrospective analysis of 655 identified cases of mothers admitted to the intensive care units out of 436,136 births. The reasons for the transport were divided into nine categories: peripartum bleeding, hypertensive diseases, thromboembolism, cardiovascular diseases, sepsis/severe infections, metabolic diseases, complications of anaesthesiology, gastroenterological problems and others. RESULTS: The total incidence of admission to the intensive care units in the observed period was 1.5 per 1,000 births, but for mothers of Roma nationality it was 8.8 per 1,000 births. The average age of mothers was 30.7 years, while 29.7% were over 35 years old. Overweight and obesity was present by 70.4% of mothers. The most common reason for transport to the ICU (49.3%) was severe postpartum hemorrhage. The second most common cause (26.0%) was hypertensive diseases (preeclampsia, eclampsia and HELLP syndrome). The third most common cause (4.9%) was sepsis and severe maternal infections. The mortality rate of mothers admitted to the ICU was 2.3% and infant mortality of these mothers was 8.7%. CONCLUSION: The incidence of admission of mothers to the ICU in the monitored years was 1.5 per 1,000 births, which in international comparison ranks Slovakia among countries with a lower incidence.

Caesarean section, vaginal instrumental delivery and perineal morbidity in the Slovak Republic in the years 2007-2018.

OBJECTIVE: Analysis of caesarean section, vaginal instrumental deliveries and severe perineal morbidity in the Slovak Republic in the years 2007-2018. METHODS: The analysis of prospectively collected caesarean section and vaginal instrumental delivery data in the years 2007-2018, and episiotomies and severe perineal morbidity data in the years 2008-2018 from obstetrics hospitals in the Slovak Republic. RESULTS: Caesarean section rate progressively increased from 24.1% in 2007 up to 30.8% in 2013 and decreased to 29.6% in 2018. Vacuum-extraction frequency was 1.3% in 2007 and increased up to 2.0% till 2018. Forceps frequency decreased since 2008-2018 from 0.56% to 0.43%. In the years 2008-2018, frequency of perineal tears of the 3rd and 4th degree increased from 0.4% to 0.8%. Frequency of episiotomies decreased in the years 2008-2018 from 74.7% to 47.7%. CONCLUSION: The highest caesarean section rate in the Slovak Republic - 30.8% occurred in 2013, but slowly decreased in the following years. The frequency of vacuum extraction increased and forceps decreased. Frequency of episiotomies had decreased and severe perineal tears held an increasing trend.

Maternal mortality in the Slovak Republic in the years 2007-2018.

OBJECTIVE: Analysis of maternal mortality in the Slovak Republic in the years 2007-2018. METHODS: The analysis of selected maternal mortality data in the years 2007-2018. RESULTS: In the years 2007-2018, 84 women died during pregnancy or within 42 days of the end of pregnancy - maternal mortality ratio was 12.57 per 100,000 live births. Direct maternal mortality ratio in this period was 4.64 (31 maternal deaths), indirect maternal mortality 6.74 (45 maternal deaths) and direct obstetrics death ratio was 11.38 per 100,000 live births. Pregnancy-associated but unrelated maternal death ratio was 1.19 (eight maternal deaths). The Slovak Gynecological and Obstetric Society revealed a 64% underestimation of maternal mortality data in comparison with routine statistical data. CONCLUSION: Maternal mortality ratio in the Slovak Republic was one of the highest in the European Union and was discordant with a good level of perinatal mortality. In the Slovak Republic, it is necessary to look for ways to reduce maternal mortality and improve data collection.

Severe maternal morbidity in the Slovak Republic in the years 2012-2018.

OBJECTIVE: Analysis of maternal morbidity in the Slovak Republic in the years 2012-2018. METHODS: The analysis of selected maternal morbidity data prospectively collected in the years 2012-2018 from all obstetric units in the Slovak Republic. RESULTS: In the years 2012-2018, incidence of severe peripartum bleeding was 2.17, peripartum hysterectomy was 0.89, maternal admission to intensive care units was 1.59, eclampsia was 0.21, HELLP syndrome was 0.73, abnormally invasive placentation was 0.37, uterine rupture was 0.68, severe sepsis in pregnancy and puerperium was 0.18 and nonfatal amniotic fluid embolism was 0.027 per 1,000 births. CONCLUSION: Incidence of total severe acute maternal morbidity in the Slovak Republic was 6.84 per 1,000 births. In Slovak local conditions, there is still room for reduction of severe acute maternal morbidity.

Results of treatment of gestational trophoblastic neoplasia in the Slovak Republic in the years 1993-2017.

OBJECTIVE: Gestational trophoblastic neoplasia epidemiology and treatment results in the Slovak Republic in the years 1993-2017. METHODS: Retrospective analysis results of gestational trophoblastic neoplasia treatment in the Centre for gestational trophoblastic disease in the Slovak Republic in Bratislava in the years 1993-2017 according to prognostic scoring and staging system FIGO/WHO (International Federation of Gynecology and Obstetrics/World Health Organization). RESULTS: The Centre for Gestational Trophoblastic Disease was created in the Slovak Republic in the year 1993, after the split of former Czechoslovakia. A total of 100 patients with gestational trophoblastic neoplasia were treated in this Centre in the years 1993­2017. According to prognostic scoring and staging system FIGO/ WHO, 74% patients were at a low risk and 26% of patients were at a high-risk of gestational trophoblastic neoplasia. There were 56, 2, 32 and 10% patients in stages I, II, III, and IV, respectively. The total curability and mortality rates were 96 and 4%, respectively. The curability rate 100% was achieved in stages I­III and in all placental site trophoblastic tumours, and the curability rate 60% was achieved in stage IV. In the years 1993 ­2017, the incidences were 1 in 59,315 pregnancies and 1 in 42,299 deliveries for choriocarcinoma, 1 in 489,348 pregnancies and 1 in 348,965 deliveries for placental site trophoblastic tumours, 1 in 139,814 pregnancies and 1 in 99,704 deliveries for invasive mole, and 1 in 39,947 pregnancies and 1 in 28,487 deliveries for persistent gestational trophoblastic neoplasia. In the Czech Republic in the same period of time, there were treated 281 (301) patients with the curability rate 98.6% (98.7%). CONCLUSION: The results of the treatment of gestational trophoblastic neoplasia in the Slovak Republic are comparable with those achieved by leading centers specialized for the treatment of this disease in Europe and in the world. Early detection and centralisation of the treatment are crucial points for successful treatment, as the high curability rate of gestational trophoblastic neoplasia is achieved by effective therapy.

Analysis of selected perinatological indicators in the Slovak Republic in the years 2007-2018.

OBJECTIVE: Analysis of perinatal mortality in the Slovak Republic during the years 2007-2018. METHODS: Analysis of prospectively collected selected perinatal data in the years 2007-2018. RESULTS: In the year 2007, there were 63 obstetrics units, 51,146 deliveries and that of live births 51,650 in the Slovak Republic. The number of obstetrics units decreased to 51 in the years 2018, the total number of deliveries increased to 57,085 and that of live births increased to 57,773. The total fertility rate in the years 2007-2018 increased from 1.27 to 1.54. The preterm deliveries rate increased from 7.3% in the year 2007 to 8.5% in the year 2010 and decreased to 7% in the year 2018. The perinatal mortality rate decreased from 6.2 in the year 2007 to 4.4 in the year 2017, increased again in the years 2018 to 5.0 and according to the criteria of WHO (World Health Organization) to 6.6 per 1,000 still- and live-births. During the years 2007-2018 at perinatal mortality stillbirth participate with 65%, low birth weight with 63% and severe congenital anomalies with 19%. Transport in utero to perinatological centers in the years 2007-2018 has decreased from 57 to 56% for infants 1,000-1,499 g and from 75 to 73% for infants below 1,000 g. CONCLUSION: In the year 2017, perinatology in the Slovak Republic reached the best result in the perinatal mortality rate - 4.4 (0.44%), but has increased to over 5 next year. To further reduce perinatal mortality in the Slovak Republic, it is necessary to improve the prenatal dia-gnosis of severe congenital abnormalities, transport in utero of very low birth weight fetuses, centralization of high-risk pregnancies, obstetric personnel and material-technical equipment of obstetricians and neonatal intensive care units.

A proper placental sampling for syncytin-1 analysis.

Syncytin-1 (gene ERVW-1) has been proposed as a marker of pre-eclampsia and malfunctions in placental development. Placenta is heterogeneous tissue, hence the method of biopsy can significantly affect the outcome of analyses. A total of 44 placentae were analyzed by taking 3-30 samples from each. Relative levels of ERVW-1 expression in the placental biopsies were characterized by RT-qPCR. Evaluation of ten biopsies from one placenta individually (not pooling them) is recommended due to the high variability of expression. No significant correlation was found between biopsy localization and level of ERVW-1 expression; therefore, random sampling is recommended. A long cut from the umbilical cord to the edge of the placenta is a convenient approach to placental sampling.