Pelvic floor dysfunction after vaginal and cesarean delivery among singleton primiparas.

OBJECTIVE: To compare the prevalence of pelvic floor dysfunction symptoms, including pelvic organ prolapse (POP), urinary incontinence (UI), and fecal incontinence (FI) among primiparous women after vaginal and cesarean delivery. METHODS: In a prospective cohort study at a University hospital in the Czech Republic, singleton primiparas with cephalic presentation who delivered at term were enrolled between 2002 and 2007. In 2013, 5-10 years after delivery, women who had not delivered again completed an internet-based survey about current symptoms of POP, UI, and FI, which were evaluated using validated questionnaires. The relative risk (RR) of POP, UI, and FI symptoms was calculated. RESULTS: Complete questionnaire data were obtained from 641 women who delivered vaginally and 224 who delivered by cesarean. The mean UI score (ICIQ-SF) was 2.3 ± 3.6 in the vaginal group and 1.0 ± 2.7 in the cesarean group (P=0.005). The mean POP scores (POPDI-6) were 2.2 ± 2.3 and 2.1 ± 2.0, respectively (P=0.944). The mean Wexner scores to evaluate FI were 1.3 ± 1.7 and 1.0 ± 1.5, respectively (P=0.220). The RR of pelvic floor dysfunction after vaginal delivery was highest for women with UI symptoms (RR 1.15, 95% confidence interval 0.92-1.42). CONCLUSION: Significant differences in the occurrence of symptoms of UI were observed after vaginal delivery as compared with cesarean delivery. ClinicalTrials.gov: NCT02661867.

Factors influencing women's selection of combined hormonal contraceptive methods after counselling in 11 countries: results from a subanalysis of the CHOICE study.

OBJECTIVES: To investigate which characteristics of women and healthcare professionals (HCPs) were associated with changing to another combined hormonal contraceptive (CHC) method after contraceptive counselling. METHODS: CHOICE was a cross-sectional survey in which 18,787 women were counselled about combined hormonal contraceptives, during which their contraceptive methods preferred both prior to and after counselling were recorded. In this subanalysis, characteristics associated with changing the method after counselling were determined using logistic regression models. RESULTS: The probability of intending to change from the pill to another method was associated with being older; university-educated; being in a steady relationship; a prior unintended pregnancy; a younger HCP or one who recommended methods other than the pill. Changing to the patch was associated with a female HCP or a HCP who recommended the patch or an injectable. Changing to the ring was associated with being over 21 years; university-educated; being in a relationship; previous hormonal method use; and counselling by a female HCP, a HCP < 60 years old, or a HCP who recommended the ring or an implant. The country of residence influenced these changes in a complex pattern. CONCLUSIONS: Women's choice of CHC methods after contraceptive counselling are influenced by their age, educational background, relationship status, prior unplanned pregnancies and country of residence, as well as age, gender and preferences of their HCP.

A comparison of dequalinium chloride vaginal tablets (Fluomizin®) and clindamycin vaginal cream in the treatment of bacterial vaginosis: a single-blind, randomized clinical trial of efficacy and safety.

AIMS: To investigate if vaginal application of dequalinium chloride (DQC, Fluomizin®) is as effective as vaginal clindamycin (CLM) in the treatment of bacterial vaginosis (BV). METHODS: This was a multinational, multicenter, single-blind, randomized trial in 15 centers, including 321 women. They were randomized to either vaginal DQC tablets or vaginal CLM cream. Follow-up visits were 1 week and 1 month after treatment. Clinical cure based on Amsel's criteria was the primary outcome. Secondary outcomes were rate of treatment failures and recurrences, incidence of post-treatment vulvovaginal candidosis (VVC), lactobacillary grade (LBG), total symptom score (TSC), and safety. RESULTS: Cure rates with DQC (C1: 81.5%, C2: 79.5%) were as high as with CLM (C1: 78.4%, C2: 77.6%). Thus, the treatment with DQC had equal efficacy as CLM cream. A trend to less common post-treatment VVC in the DQC-treated women was observed (DQC: 2.5%, CLM: 7.7%; p = 0.06). Both treatments were well tolerated with no serious adverse events occurring. CONCLUSION: Vaginal DQC has been shown to be equally effective as CLM cream, to be well tolerated with no systemic safety concerns, and is therefore a valid alternative therapy for women with BV [ClinicalTrials.gov, Med380104, NCT01125410].

Contraceptive behaviour of Czech and Romanian women: comparison of representative national samples.

OBJECTIVE: To investigate the contraceptive behaviour of Czech and Romanian women and their attitudes towards different forms of contraception. STUDY DESIGN: Anonymous questionnaire research among 1011 Czech and 1001 Romanian women between 15 and 50 years of age. The samples were representative of both the Czech and Romanian female populations with respect to age, education and the size of their place of residence. RESULTS: The majority of women use contraception when in a stable sexual relationship. We found a higher percentage of women using contraception among Czech women. Romanian women more often use less reliable methods in a stable relationship, and condoms. Czech women use hormonal contraception much more. Women in the Czech Republic would more often agree to use a condom and, in particular, to use hormonal and intrauterine contraception. More Romanian women than Czech women prefer the method of infertile days. The use of contraception is influenced by the factors of age, education and size of the place of residence. CONCLUSION: The majority of Czech and Romanian women protect themselves against unwanted pregnancy. Czech women are more frequent users of contraceptives in general and, in particular, of hormonal contraception. Romanian women tend to use less reliable methods of contraception but on the other hand, they more often use condoms as a means of protection.

Abortions and contraception use among Czech and Romanian women: comparison of representative national studies.

INTRODUCTION: This article presents the results of representative national studies comparing the behavior and attitudes of Czech and Romanian women regarding abortion and contraception use. AIM: Describe the attitudes to abortion and incidence of abortion in female population of these countries. METHODS: Independently and anonymously conducted questionnaire with 1,011 Czech and 1,001 Romanian women, with the participants' age from 15 to 50 years. The sample represented both Czech and Romanian female populations with respect to age, education, and the size of their place of residence. MAIN OUTCOME MEASURES: Questionnaire studies awareness, attitudes, and behavior related to the area of sexual life, contraception, and family planning. RESULTS: Based on the acquired information, it can be postulated that Romanian women, despite having a less liberal opinion on abortions than their Czech peers, undergo abortion more often than Czech women (Romanian 28%, Czech 16%), are less informed about potential side effects, and more often use less reliable methods of contraception (the so-called "natural contraception"-vs. hormonal contraception, which is the method of choice of Czech women). CONCLUSION: These results indicate that despite more liberal attitudes toward abortion, Czech women have less frequent incidence of abortion than Romanian women and they have more relevant information about contraception and their sexual behavior is more conscious and responsible.

Sexual and reproductive health of adolescents in Belgium, the Czech Republic, Estonia and Portugal.

OBJECTIVES: This pilot study, within the REPROSTAT 2 Project, aimed at investigating the sexual and reproductive health (SRH) of school-based youths in four countries of the European Union. METHODS: Students of either sex, aged between 16 and 19 years and entering grade 10, 11 or 12 during the 2005-2006 school year participated in a cross sectional survey. A structured questionnaire was administered to a convenience sample of students from selected schools in Belgium, the Czech Republic, Estonia and Portugal. RESULTS: In each country, more than three quarters of respondents had previously had a boyfriend or girlfriend and almost half had heterosexual intercourse. More than 85% of sexually experienced youths in each country had used contraception at coital debut. Mean age at coital debut varied between 15.2 (Belgium) and 16.4 years (Czech Republic). While 51% of respondents in Estonia knew of Chlamydia trachomatis infection, the corresponding figure in Portugal was only 12%. CONCLUSIONS: Sexual activity is common among school-going youths in all four countries. This highlights the need for Member States to systematically collect indicators of SRH in this population. Use of a common measurement framework can inform the establishment of common targets for joint initiatives such as reducing teenage pregnancy and STIs in adolescents.

Is there any link between severe pre-eclampsia and defined polymorphisms in leptin and adiponectin genes?

AIM: The pathophysiology of pre-eclampsia, one of the leading causes of maternal mortality worldwide, still remains unclear. Recently, it has been suggested that impaired regulation of complex interactions among various adipokines plays an important role in the development of pre-eclampsia. The aim of this study was to investigate whether the two common polymorphisms of the leptin (LEP) and adiponectin (APM1) genes are associated with the development of pre-eclampsia and its related traits (gestational hypertension, proteinuria and various measures of reduced fetal growth ) in the Czech pre-eclamptic population. METHODS: The case-control study comprised a total of 123 pre-eclamptic women and 150 healthy controls of similar age and parity distribution. They were genotyped for the LEP -2548G/A (5'-untranslated region) and APM1 T94G (exon 2) polymorphisms using polymerase chain reaction. RESULTS: The allele frequency of the LEP -2548G polymorphism was 0.541 in the pre-eclamptic group versus 0.583 in the control group (P=0.578); the frequency of the APM1 94G polymorphism was 0.073 and 0.079 (P=0.628), respectively. No significant associations were detected between either of the two single nucleotide polymorphisms or any of the parameter biomarkers related to pre-eclampsia, such as gestational hypertension or proteinuria. However, the APM1 T94G polymorphism was significantly associated with a low birth weight in pre-eclamptic pregnancies, with mothers carrying the T-allele having an almost three-fold increase in the likelihood of giving birth to a child with a low birth weight for its gestational age (odds ratio, 2.7; 95% confidence interval, 0.18-5.9; P=0.004). CONCLUSIONS: The APM1 T94G and LEP -2548G/A polymorphisms do not seem to be major genetic determinants of susceptibility to pre-eclampsia in the Czech Caucasian population. However, evidence has been provided for possible APM1 T94G involvement in controlling the birth weight of children from pre-eclamptic pregnancies, thus supporting the hypothesis of T94G involvement in controlling the birth weight of newborns.

Chlamydiae in the ejaculate: their influence on the quality and morphology of sperm.

BACKGROUND: Given the lack of information concerning the role of Chlamydia trachomatis in male fertility, the aim of this study was to ascertain and analyze the quality of Chlamydiae-positive and -negative semen. MATERIAL AND METHODS: Sperm count was performed according to the 1999 World Health Organization (WHO) laboratory manual for examination of human semen and sperm-cervical mucus interaction, and sperm survival was assessed by a 120-min test. The evaluation of the morphological examination of ejaculates was carried out using the sasmo (strict morphological analysis of ejaculates) computer program. Chlamydiae were detected by immunofluorescent reaction using the Progen Biotechnik GmbH diagnostic set. Fisher's exact test and the chi-quadrate test were used for statistical analysis. RESULTS: Of the total of 627 sperm samples examined, Chlamydiae were detected in 136 cases (21.7%). Sperm analysis showed significant differences between Chlamydiae-positive and -negative samples. The Chlamydiae-contaminated group showed normal sperm morphology 14.4% lower, volume 6.4% lower, concentration 8.3% lower, motility 7.8% and velocity 9.3% lower than in Chlamydiae-negative samples. The average values for normal spermatozoa and motility in the Chlamydiae-positive group were also significantly reduced. CONCLUSION: Chlamydia trachomatis was found to be a possible factor in sperm pathology. These results could help to elucidate the role of Chlamydia trachomatis in male infertility.