The effect of prostaglandin induced labor and selected factors on the occurrence and extent of birth-canal injuries.

OBJECTIVES: To determine the effect of labor induction using prostaglandin, gestation period and delivery type on the cause and extent of birth-canal injuries. METHODS: A retrospective study based on the records of II. GPK UNB Ruzinov. The total set (n = 1377) consisted of patients who went into labor in second half of the year 2014 at this clinic. The research used categorical data divided into groups of factors (induction, week of delivery, type of delivery) and birth injuries. Using the chi-square test and Fisher's test we evaluated individual statistical dependences. The results with the highest level of significance are expressed through contingency tests (Phi coefficient, contingency coefficient, Cramer's V). Finally, because of the highest level of significance we have done a cohort study to express the incidence of relationship between non-operative delivery per vaginam and 1st degree ruptura perieni. RESULTS: Labor induction with prostaglandins has a positive impact on the cause and extent of birth-canal injuries, namely the increased risk of vaginal walls tearing and uterine ruptures. We confirmed that the induction of labor using PG carries a demonstrable risk of pregnancy termination by cesarean section (p = 6.17x10-9). Birth-canal injuries are also affected by the type of delivery. Non-operative vaginal delivery is a significant risk factor for first-degree perineal tear (RR = 25.52 95% CI 10.58, 61.60, OR = 33.06 95% CI 13.51, 80.90). Significant risk factors for third-grade perineal tear during vaginal delivery are forceps (p = 0.005534) / vacuum extractor (p = 0.03554). CONCLUSION: In a group of 1377 patients we have demonstrated that the labor induction with prostaglandins, gestation period and type of delivery significantly influence the occurrence and extent of birth-canal injuries (Tab. 3, Ref. 9).

Postpartum corticosteroids in HELLP syndrome - standard to prompt recovery.

OBJECTIVES: To perform a complex review of HELLP syndrome and its treatment from up to date scientific literature. Study of the interresting treatement regime of the patient. METHODS: Complex analysis of the syndrome, systematic search of medical scientific databases and Slovak Medical Library. Analysis of the life threatening state of the patient, retrospective analysis of the diagnostics, treatment, acute management, complications and clinical results. RESULTS: According to up to date literature and our good clinical experiences we can encourage the use of high-dose corticosteroid therapy in HELLP syndrome. CONCLUSION: The most recent studies definitely recommend the high dose corticosteroid treatment in recovery management by the HELLP syndrome. We have used the high-dose corticosteroid regime as a recovery management for the patient with postpartum HELLP with very good clinical and laboratory response followed by prompt recovery of the patient and without other complications. We want to support and empasize the indication of the Dexamethasone regiment by HELLP, becouse the clinical experiences with this treatment are not well-known and usually the corticosteroids are not given to the patients with HELLP, or the treatment is "daemonized". Our clinical experience with this treatment was successful and the patient definitely profited of it. We support the opinion, that the benefit of described regiment highly exceedes the possible adverse effects of the therapy (Fig. 8, Ref. 61).

Polycystic ovary syndrome - a risk factor of pre-eclampsia after in vitro fertilisation.

AIM: Taking into account an increasing number of pregnancies after the assisted reproduction, we tried to evaluate the risk of pre-eclampsia for mono-foetal pregnancy after IVF and to determine the degree of risk factors. MATERIAL AND METHODS: The study included 16,400 patients, while 15,874 of them were after spontaneous conception and 526 after conception using assisted reproductive technologies. For the basic statistical analysis, we used frequency tables and basic statistical characteristics for numeric and ordinary variables. To verify the statistical dependence, we used contingency tables, Fisher exact test and the odds ratio. RESULTS: In the group of women after in vitro fertilisation, a higher incidence of pre-eclampsia was recorded than in the group of women after spontaneous conception. Conception via in vitro fertilisation represents the 3.4-fold risk of pre-eclampsia development (OR 3.404 95% CI 2.407-4.8). CONCLUSION: The major causes of a higher incidence of pre-eclampsia in case of assisted reproduction include: polycystic ovary syndrome, insulin resistance, subfertility, age and obesity of patients. Assisted reproductive technologies are not the cause of a higher incidence of pre-eclampsia in case of the assisted reproduction (Tab. 4, Fig. 2, Ref. 22).

Defects of genes encoding inhibitors of coagulation and their application in early miscarriage aetiology.

Properly functioning coagulation in gravidity is not necessary only to provide the continuity of circulation in placenta. Today we recognize that proteins and cells of haemostasis in the maternal blood cooperate with the components of a coagulation cascade produced by embryonic trophoblast cells. Such coordination on the embryomaternal interface is necessary for an intact embryogenesis. Other findings discuss the ability of coagulation components to act also outside the hemocoagulation process, especially as signal molecules, regulators of immune reactions, cell proliferation and others. Haemostasis is thus a complex system and we still do not know all of its pathways. This is perhaps also the reason that in the case of known procoagulant mutations (FV Leiden, gene mutation for prothrombine G20210A) we cannot explain why some carriers suffer recurrent miscarriages and others have uncomplicated pregnancies. The expert community believes that the phenotype manifestation of these mutations in terms of pregnancy losses could be connected to the simultaneous presence (synergistic effect) of other polymorphisms of gene-encoding proteins of haemostasis or the lack thereof (antagonistic effect) (Ref. 59).

Sclerosis tuberosa and pregnancy.

OBJECTIVE: To perform a review of Tuberous sclerosis complex and its complications during the pregnancy from up to date scientific literature. DESIGN: Complex systematic review of the literature. SETTING: 2nd Department of Obstetrics and Gynaecology, University Hospital Bratislava, Comenius University, Bratislava, Slovak Republic. METHODS: Complex analysis of the syndrome, systematic search of MEDLINE and Slovak Medical Library. The reason to create a complex review of this syndrome was our clinical experience with one of the most acute lifethreatening condition of this syndrome - acute retroperitoneal haemorrhage in the pregnancy. CONCLUSION: Tuberous sclerosis can cause a rare, but potentially lifethreatening complications, especially during the pregnancy. These should be carefully dispesarized and in complicated cases acute radical management should be considered.

Myoma expulsion after uterine artery embolization.

Uterine artery embolization (UAE) has become a standard therapy in the treatment of symptomatic uterine myomas. The procedure is associated with a few complications. One of them is myoma expulsion. A 32-year-old woman was sent to our hospital with diagnosed intramural myoma with dysmenorrhea and pressure symptoms. UAE was performed since the patient preferred conservative treatment. The procedure was without any complications. Three weeks after embolization, she was readmitted because of vaginal discharge and minor bleeding. We diagnosed expulsion of necrotic myoma and performed transvaginal resection. Four months later, the patient is symptom free. Expulsion of intramural myoma can be thus considered as definite treatment and not a complication of embolization therapy.

Implants in operative therapy in women with pelvic organ prolapse--two years of experience.

OBJECTIVES: The authors present their first experience with a new operative method (within two years' period in 18 patients) solving pelvic prolapse in women by means of installation of polypropylene (Prolene) mesh implant. MATERIALS AND METHODS: The authors corrected various forms and stages of POP, particularly prolapse of the vaginal stump after hysterectomy, through the installation of Prolene mesh implants or the systems Prolift Anterior, Prolift Posterior and Prolift Total. RESULTS: Short-term results (follow-up 24 months) are promising. The patients present no significant subjective complaints and the objective findings are considerably improved. The authors report one particular case of point perforation of the urinary bladder with no side effects and they have not noticed any serious postoperative complications so far. CONCLUSION: Nowadays, considering a new methodology the following factors are required: multicentre data collection, determination of rational indicating criteria (together with contraindications), analysis of per- and postoperative complications and publishing continuous clinical outcomes. This is the way how to find an adequate place for implants in a wide spectrum of operations regarding pelvic floor repair (Tab. 4, Fig. 5, Ref. 13). Full Text (Free, PDF) www.bmj.sk.

["Nested" PCR for human papillomavirus detection and typing in samples from cervical lesions of gynecological patients]. / "Nested" PCR a jej vyuzitie pri detekcii a typizácii papilomavírusovej infekcie vo vzorkách z cervikálnych lézií gynekologických pacientok.

OBJECTIVE: The authors tested PCR--so called nested (N-PCR) for the detection of HPV in cervical lesions of uterus. This method is based on repeated amplification of specific viral DNA fragments. The sensitivity of N-PCR was compared to the sensitivity of the hybridization method. In the second part of the experiment positive samples underwent HPV typing by PCR. BACKGROUND: The effectiveness of N-PCR for HPV detection was verified on 30 samples from cytologically/histologically suspected cervical lesions. In these cases, previous detection by hybridization method was unsuccessful. The second group consisted of 21 samples acquired by conisation, in which HPV presence was confirmed by hybridization method. Post surgery HPV detection using hybridization technique was negative in this group of patients. RESULTS: By means of N-PCR the presence of HPV DNA was confirmed in all 30 samples from the first group (100%) and in 8 (38%) cases from the group of samples obtained after conisation. Type-specific PCR detection indicated HPV type 16 in 20 cases, HPV type 18 in 6 cases (from the first series). In the remaining 4 cases typing for HPV 16, 18, 31 and 33 was negative. In the second series all 8 samples were HR-HPV type 16. CONCLUSION: At the present time, N-PCR is probably the most sensitive HPV detection method. The only real disadvantages of the given technique are relatively high costs of diagnostics equipment and the requirement of highly qualified personel.

[Screening for hemolytic streptococcus group B in pregnancy and prevention of infection in neonates]. / Skríning hemolytického streptokoka skupiny B v tehotnosti a prevencia infekcie novorodencov.

OBJECTIVE: The aim of this study was to evaluate the influence of Group B streptococcus (GBS) screening and intrapartum antibiotic prophylaxis to the incidence of GBS disease in newborns. DESIGN: Prospective non-randomised study. SETTING: IInd Clinic of Obstetric and Gynaecology LFUK and FNsP Ruzinov, Bratislava, Slovakia. METHODS: We enrolled 3023 newborns (754 in the study group, 2269 in the control group), which were born between 1.9.2000 and 31.3.2003. In both groups we compared following variables: total number of infectious diseases in newborns, number and forms of GBS neonatal disease, number of perinatal death due to GBS disease. RESULTS: There was no GBS disease in the study group of 754 newborns. Mothers of these newborns had one screening culture in 35-36th week of gestation. One swab was taken from vagina and anus. GBS carriers (161-21.4%) were administered i.v. intrapartum antibiotic prophylaxis with Penicillin G i.v., or, when allergy to penicillin was in history, with Clindamycin i.v. In the control group of 2269 newborns, whose mothers had no prevention, the incidence of GBS neonatal disease reached 7.5/1000 newborns (17 cases). The incidence of invasive GBS neonatal disease was 2.6/1000 newborns. CONCLUSION: The authors have noticed a significant decrease in incidence of GBS neonatal disease after implication of GBS screening and intrapartum antibiotic prophylaxis.

Semi-quantitative RT-PCR assessment of molecular markers in breast large-core needle biopsies.

Large-core needle biopsies are frequently used for the preoperative evaluation of the breast lesions. In addition to initial diagnostic information, they can show the status of molecular markers with predictive and prognostic value and further contribute to an optimal selection of treatment strategy. So far, the potential use of large-core needle biopsies in assessment of marker profile of the breast lesions was studied using the immunostaining approaches. In this work, we sought to determine whether analysis of the large-core needle biopsy by semi-quantitative reverse-transcription polymerase chain reaction reveals molecular data that correspond with the marker status of the subsequently removed tumor. Five molecular markers including ER, PR, c-erbB-2/HER-2/neu, c-erbB-3/HER-3, and CD44 were assessed on mRNA isolated from 23 large-core needle biopsies and corresponding surgical breast cancer specimens using beta2- microglobulin as an internal standard. Significant or highly significant correlation between core biopsies and excised tumors was observed for each marker when the mRNA expression status was scored as positive or negative, with the concordance of the data ranging from 73.9% to 86%. Using the dichotomous scoring, majority of the biopsies (75%) displayed molecular profile that was either identical to the profile of the related tumor specimen, or with the difference in one marker. However, no significant correlation was found when the levels of the markers were expressed as continuous variables, possibly due to intratumoral cell heterogeneity. These results suggest potential usefulness and reliability of semi-quantitative RT PCR in the evaluation of large-core needle biopsies with regard to marker positivity or negativity. On the other hand, the marker-related data expressed as continuous variables cannot be accurately assessed on the large- core needle specimens using this approach, indicating the need for methodological improvements.

[Premature fetal membrane rupture after amniocentesis in the second trimester and successful use of fibrin glue--case report]. / Predcasný odtok plodovej vody po amniocentéze v II. trimestri a úspesné vyuzitie fibrínového lepidla--kazuistika.

OBJECTIVE: The aim of this study was to evaluate fibrin sealing in management of premature rupture of membranes after amniocentesis in early second trimester. DESIGN: Case report. SETTING: II. gynekologicko-pôrodnícka Klinika LFUK NsP Ruzinov, Bratislava; Department of Obstetrics and Gynecology, Spectrum Health--Blodgett Campus, Grand Rapids, USA. SUBJECT AND METHOD: In this case report authors report the use of fibrin sealant (Tissucol KIT, Immuno, A) in management of premature rupture of membranes after genetic amniocentesis. The sealing was performed in 19 + 0 week of pregnancy, 15 days after amniocentesis. The pregnancy was terminated by caesarean section in 34-th week, 98 days after sealing. The newborn was in stable condition, without clinical or laboratory signs of infection. No skeletal deformities or adverse effects of fibrin sealant were observed. Neurological examination in 3 month of age evaluates the psychomotorical development as normal. CONCLUSION: We consider the perinatal outcome of this pregnancy as positive.

[Changes in serum levels of lipid peroxidation products during labor and in the puerperium]. / Zmeny sérových hladín produktov lipoperoxidácie pocas pôrodu a v sestonedelí.

OBJECTIVE: To determine the activity of reactive oxygen species (ROS) during labour by characterizing changes in maternal serum levels of lipid peroxidation end-products--MDA and lipofuscin during labour and the early post-partum period. We also tried to evaluate the relationship between levels of lipid peroxides and some clinical characteristics of labour. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynaecology LFUK, Bratislava; Department of clinical laboratories, Ministry of defense SR, Bratislava. METHODS: Blood samples were obtained from 66 pregnant women with uncomplicated pregnancy at the end of labour and during the early post-partum period. The control group consisted of 19 pregnant women delivering by primary Cesarean section. Blood samples were examined for MDA and lipofuscin by HPLC method. We used paired and unpaired Student's t-test to statistically evaluate our results. RESULTS: MDA and lipofuscin levels in pregnant women delivering spontaneously compared to those delivering by C-section were significantly elevated (P < 0.05). MDA and lipofuscin levels in pregnant women during spontaneous labour or during by C-section compared to the levels in early post-partum period were not significantly increased. We have not found any correlation between the length of the labour and lipoperoxides concentration.

[Diagnosis of Chlamydia trachomatis using PCR in gynecology patients in Slovakia]. / Skúsenosti s diagnostikou Ch. trachomatis pomocou PCR u gynekologických pacientok na Slovensku.

The authors examined using the polymerase chain reaction (PCR) more than 2700 gynaecological patients for the presence of Ch. tracheomatis. The patients were mostly from Bratislava and surroundings. The material used were cervical smears or morning urine. The most frequent diagnoses associated with Chlamydia infection were adnexitis (38%), cervicitis (22%), pelvic pain (9%), sterility (9%), cystitis and ureteritis (3%) abortus imminenes (4%) partus prematurus imminenes (9%). There was a marked seasonal character of chlamydias with the peak during the summer period. The mean age of the patients was 29.2 years and thus the assumed higher incidence of younger age groups was not confirmed. PCR proved to be an accurate, reliable and perspective method for the detection of Ch. trachomatis in Slovak gynaecological patients.

The normal female and the male breast epithelium does not express prostate-specific antigen. Preliminary immunohistochemical observations of autopsy breast tissues.

In the normal female and male breast epithelial structures any prostate-specific antigen (PSA) immunohistochemical positivity was observed. Variable PSA expression, which often borders the positivity, was observed in membranes of adipocytes of fat tissue and in the endothelium of small vessels in a female and a male breast. Based on these initial observations, tissue of the normal breast, male or female, can not be considered to be the principal source of PSA.