Single­incision mesh vs sacrospinous ligament fixation in posthysterectomy women at a three-year follow-up: a randomized trial.

OBJECTIVES: The primary clinical objective was to prospectively compare the effectiveness of the "single­incisionMESH" technique versus sacrospinous ligament fixation (ACSSF) in correcting the defect of pelvic organ prolapse(POP) in the anterior and apical compartments, Their effectiveness was assessed at a 1-year/3-year follow-up (FU). METHODS: In the period of 2013-2015, we have randomized 146 women into two groups, namely 73 into ACSSF group and 73 into MESH groupRESULTS: At 1-year/3-year FU, we achieved an effectiveness of 92 %/87 % in the point Ba (≤‒1 cm) in the MESH group (48/52; 40/46) vs 70 %/66 % in the ACSSF group (35/50; 30/45); (p = 0.005/p = 0.021). At 1-year/3-year FU, in the area of point C (≤‒1 cm), we achieved a 94 %/91 % effectiveness in the MESH group (49/52; 42/46) vs 90 %/80 % in the ACSSF group (45/50; 36/45); (p = 0.005/p = 0.192). In the MESH group, we observed a more frequent occurrence of "de novo" SUI (11 % vs 6 %) and a defect in the unoperated (posterior) compartment (18 % vs 8 %); the difference was not statistically significant. CONCLUSION: Our study showed that the vaginal synthetic mesh repair of POP did not improve women's outcomes in terms of effectiveness or adverse effects, while the patient satisfaction is the same as compared to that with sacrospinous ligament fixation at a 3­year FU. In gynecology, there are situations in which the comparison replaces the scientific solution (Tab. 5, Fig. 2, Ref. 50). Text in PDF www.elis.sk Keywords: sacrospinous ligament fixation, quality of life index, synthetic mesh, randomized trial, prolapse.

Selected physicochemical properties of amniotic fluid according to week of pregnancy.

BACKGROUND: A hundred years ago, scientists believed that amniotic fluid is a yellowish hypotonic mixture of foetal urine and maternal transudate with peculiar odour. Current knowledge shows that it represents a dynamic, complex mixture of inorganic and organic compounds. OBJECTIVES: Despite modern technological procedures, information is still lacking about the composition and properties of amniotic fluid. We focused on dynamics of selected physical and chemical properties of the amniotic fluid with the increasing gestational week. METHODS: The physicochemical characteristics of 89 amniotic fluid samples were determined according to the week of pregnancy. The determination of pH, specific gravity, glucose and nitrites was performed immediately, at room temperature. RESULTS: Our results show a significant negative correlation between week of pregnancy and semi-quantitative determined parameters of specific gravity (p < 0.001), pH (p < 0.01) and glucose (p < 0.001) values. Within the whole group of samples (n = 89), 29 % (n = 26) were nitrites positive (N+) and 71 % (n = 63) nitrites negative (N-). CONCLUSION: In this study were determined basic parameters of amniotic fluid, which could be related to a wide range of pathological states (Tab. 2, Fig. 1, Ref. 27).

Analysis of transcriptional activities of angiogenic biomarkers during intrauterine complications leading to preterm birth.

OBJECTIVE: Pre-eclampsia, growth retardation and preterm delivery are the most common reasons leading to increased maternal and perinatal mortality. The increased expression of hypoxia induced factors, such as HIF-1, triggers the overexpression of anti-angiogenic genes. The aim of this study was to determine the transcriptional activity of individual pro- and anti-angiogenic markers (VEGF, HIF-1, sEng, Flt-1, PlGF-1) in maternal blood samples from patients with spontaneous preterm labor, preterm labor in combination with pre-eclampsia and fetal growth restriction in comparison with physiologically terminated pregnancies. PATIENTS AND METHODS: The transcriptional activity of specific genes was detected from the blood of patients using the chromatin immunoprecipitation capture method coupled with quantitative real-time PCR. RESULTS: The maximum differences in mRNA levels of PlGF-1 and VEGF-A were detected in two groups: the group of normal-term birth with complications and the group of preterm labor with complications (both significantly lower than the control, p < 0.001). In contrast, a marked increase of mRNA levels was found in the same groups of patients for the HIF-1, endoglin and Flt-1 genes (p < 0.001). CONCLUSIONS: According to our results, we can conclude that increased oxidative stress, increasing the expression levels of anti-angiogenic genes and reduction of the transcriptional activity of pro-angiogenic genes can provide additional information during diagnostics of pathological complications of labor.