The Impact of HPV Diagnosis and the Electrosurgical Excision Procedure (LEEP) on Mental Health and Sexual Functioning: A Systematic Review.

The impact of HPV diagnosis and subsequent treatment with the electrosurgical excision procedure (LEEP) on anxiety, depression, psychosocial quality of life, and sexual functioning has not been thoroughly investigated. The aim of this review was to systematically summarize the available knowledge on this topic, according to PRISMA guidelines. Data from observational and intervention studies were analyzed. A total of 60 records were included, of which 50 papers addressed the impact of HPV diagnosis on patients' psychosocial status, while 10 studies addressed the impact of the implemented LEEP procedure on patients' mental health and sexual functioning. The results indicated a negative impact of HPV diagnosis on the occurrence of depressive and anxiety symptoms, poorer quality of life, as well as on the sexual functioning of the affected women. The results of the studies to date have not confirmed the negative impact of the LEEP procedure on mental health and sexual life, although more research is needed in this area. It is necessary to implement additional procedures to minimize anxiety and distress in patients receiving a diagnosis of HPV or abnormal cytology and to improve awareness of sexually transmitted pathogens.

A Six-Year Gynecological Follow-Up of Immunosuppressed Women with a High-Risk Human Papillomavirus Infection.

Immunocompromised women are at an increased risk of developing malignancies, especially those that are viral-induced, such as invasive cervical cancer caused by the human papillomavirus (HPV). The aim of the study was to describe gynecological follow-up of women undergoing chronic immunosuppressive therapy for various reasons (e.g., kidney/liver transplant, systemic lupus erythematosus), diagnosed with a high-risk HPV (hrHPV) infection based on a self-sampling test. Twenty-six hrHPV-positive women were invited to take part in a gynecological follow-up, including a visual assessment of the anogenital region, two-handed gynecological examination, and cervical cytology as well as a colposcopy and cervical biopsy when necessary. Four women declined taking part in the study. Over six years of observation, low-grade squamous intraepithelial lesions (LSIL) were detected at least once in 7/22 women (31.8%), and a cervical intraepithelial lesion 1 (CIN 1) histopathologic result was obtained five times in 3/22 women. No cases of high-grade squamous intraepithelial lesions, CIN 2/3, or invasive cervical cancers were observed. Loop electrosurgical excision procedure (LEEP) was performed in three patients. As immunocompromised women are prone to persistent hrHPV infections, they should be under strict gynecological supervision because only vigilant surveillance enables fast detection and treatment of early dysplasia and, therefore, provides a chance for the reduction of the cervical cancer burden.

Evaluation of a real-time optoelectronic method in the diagnostics of CIN over four years of observations.

Cervical cancer is considered to be particularly amenable to prevention and highly treatable in its early stages. The real-time optoelectronic method of cervix examination seemed to be very promising in the detection of cervical squamous intraepithelial lesions and demonstrated relatively good efficacy. Although this method was introduced into clinics almost 10 years ago, it has not found its place in diagnostic schemes. At the moment, cytological smears and HPV detection with genotyping are still essential. TruScreen seems to be a slightly forgotten test. The aim of the study was to evaluate the efficacy and accuracy of TruScreen in detecting cervical pathology: CIN and cervical cancer confirmed with a histopathological diagnosis in comparison with other methods-cytology and colposcopy over four years of observations. The study was conducted on 130 women with abnormal Pap smear results. We can conclude that a real-time optoelectronic method like TruScreen can be useful as an effective initial cervical cancer screening in developing countries, possibly in combination with other methods. The combination of cytology and TruScreen examination may help clinicians to take decision about the next diagnostics steps (e.g. colposcopy) and contribute to better primary screening for cervical cancer.

Does pregnancy influence eye parameters? Assessment of choroidal thickness using EDI-OCT before and after labour depending on the way of delivery method.

OBJECTIVES: The aim of this study is to assess the choroidal thickness (CT) with use of EDI-OCT in patients before and after delivery depending on the mode of delivery. MATERIAL AND METHODS: The study involved 146 eyes of 73 patients aged 20-34 years, after natural labour (66 eyes) and C-section (80 eyes). Main inclusion criteria: Informed consent to participate in the study, age 18-35 years, single pregnancy, spherical refraction error -4.00 to +4.00 D, no eye pathologies, no surgery and ophthalmic procedures-including refractive surgery, childbirth after 36 weeks of pregnancy, BCVA = 1.0. Patients were examined twice: in 36 WG and on 6th week after the birth. All examinations were carried out between 8:00 am and 10:00 am in order to avoid daily cycle fluctuations. CT measurements were made manually by two independent researchers at: subfoveal and 500 µm, 1000 µm, 1500 µm, 3000 µm temporally and nasally. The student's t-test was made. RESULTS: In C-section group CT differences before and after delivery were statistically significant in 7/9 of the analysed areas. Mean subfoveal choroidal thickness was 370.86 µm vs 388.71 µm in 36 WG and in 6th week postpartum respectively (p = 0.0003). In women after natural labour, differences were statistically significant in 3/9 of the analysed areas. Mean subfoveal choroidal thickness was 303.27 µm vs 308,34 µm in 36 WG and in 6th week postpartum respectively (p = 0.4800). CONCLUSIONS: The thickness of the choroid was lower in women in 36 WG in comparison to 6th week after birth. Changes in the thickness of the choroid are particularly noticeable in women after caesarean section.

Human Papillomavirus (HPV) DNA Detection Using Self-Sampling Devices in Women Undergoing Long Term Immunosuppressive Therapy.

Immunosuppression is a risk factor of persistent human papillomavirus (HPV) infections, which might lead to development of (pre)malignant lesions of the cervix and lower anogenital tract. Results of HPV DNA testing using cervicovaginal self-samples are comparable to those that are clinician-obtained and therefore might be used in cervical screening. The aim of this study was to assess the prevalence of high-risk HPV (hrHPV) infections, their risk factors and the genotypes distribution among women undergoing immunosuppressive therapy. Women undergoing immunosuppressive therapy for at least three months due to solid organ transplantation or autoimmune disorders were asked to self-collect samples for HPV testing using cervicovaginal brushes and complete questionnaires regarding cervical cancer risk factors. HPV DNA detection and genotyping were performed using Genotyping kit HPV GP version 2. hrHPV was detected in 26/90 (28.9%) specimens. Genotyping revealed a broad range of hrHPV, with type 16 being the most common genotype (11/26). The components of bivalent/quadrivalent or nonavalent vaccines cover all genotypes present in 4.4% and 17.8% women, respectively, and occur as a co-infection with other types in 12.2% and 23.3% of women, respectively. The only feature significantly associated with being hrHPV-positive was having at least two lifetime sexual partners. The high prevalence of hrHPV infections among immunosuppressed women emphasizes the need for regular cervical cancer screening with HPV DNA testing, which might be performed on self-collected specimen.

Cervical intraepithelial neoplasia during pregnancy.

OBJECTIVES: The aim was to analyze the unaffected course of cervical intraepithelial neoplasia (CIN) in pregnant women and to compare the rates of lesion persistence, progression, and regression. MATERIALS AND METHODS: Patients with abnormal cytology included in the study underwent colposcopy, followed by a biopsy of the cervix. At the end of the postpartum period, all patients underwent Pap smear, colposcopy, and endocervical curettage to obtain tissue samples. The findings were compared to the baseline to assess the rates of persistence, regression, and progression of CIN. RESULTS: The study group were 53 pregnant women. CIN was confirmed in 35 (66%) of them: CIN1 (n = 8, 22.9%); CIN 2+ (n = 26, 74.3%); and stage IA1 cervical cancer (n = 1, 2.9%). At the end of the postpartum period in 50% cases, there was no change compared to the baseline. Progression was seen in 2.9% and regression in 47.1%. A tendency for persistence and spontaneous regression of the lesions was observed. CONCLUSIONS: Although in many cases CIN tends to regress spontaneously after delivery, such outcome is not to be expected in all patients. When invasive cervical cancer has been excluded, definitive treatment for cervical dysplasia may be deferred to the postpartum period without any harm to the mother.

Changes in the parameters of the anterior segment of the eye in pregnant women - literature review.

The physiology of pregnancy is a curious issue for specialists from different branches of medicine and science. In this systematic review, the attention was focused on changes in eyes during pregnancy and confinement. To summarise and systematize actual knowledge in eyes' changes during pregnancy, publications from years 2011-2017 were analysed. Stud-ies about parameters of corneal endothelial cells, corneal biomechanical parameters, keratometric variables, intraocular pressure and biometry of the anterior chamber were compared. The conducted studies demonstrated the unambiguous character of changes only in case of intraocular pressure, which decreased during the II and III trimesters of pregnancy. Inconsistent study methods and low number of examined patients did not enable to draw explicit conclusions in context of other parameters of the anterior segment of the eye in pregnant women. It is indicated to perform further studies on a representative and homogeneous group of female patients.

Recurrent miscarriage is associated with increased ghrelin mRNA expression in the endometrium- a case-control study.

Ghrelin has been found to be expressed in the human endometrium. Emerging evidence links ghrelin and its receptor with the reproductive system. Certain associations between ghrelin and angiogenesis have also been established. The aim of this small case-control study was to quantify and compare the expression of mRNA encoding ghrelin, ghrelin receptor (GHS-R), vascular endothelial growth factor A (VEGF A) and its receptors (VEGFR1-3) in the endometrium of women with recurrent miscarriage compared to parous controls. Correlations between the expression of particular genes were also investigated. Endometrial samples were obtained during the secretory phase of the menstrual cycle from 15 women with a history of recurrent miscarriage (first trimester pregnancy loss without a known cause) and 10 healthy parous controls. Ghrelin, GHS-R, VEGF A and VEGFR1-3 mRNA expression was analyzed by quantitative RT-PCR. The expression of mRNA for ghrelin and VEGF A was significantly higher in the study group than the control group. In the control group, the expression of ghrelin mRNA was positively correlated with the expression of VEGF A and VEGFR1 mRNA. In the study group, no such associations were observed. These results show that the expression of mRNA for ghrelin and VEGF A may be increased in the endometrium of women with recurrent miscarriage thus suggesting that ghrelin may play a role in the pathogenesis of recurrent miscarriage.

Pregnancy and the eye. Changes in morphology of the cornea and the anterior chamber of the eye in pregnant woman.

OBJECTIVES: The main goal of the study was to determine whether uncomplicated pregnancy and natural labor exert influence on the cornea and the anterior chamber of the eye. MATERIAL AND METHODS: The study included 114 eyes of 57 women in age of 21-35 years old. Only patients in the physiological pregnancy and giving natural birth were recruited into study. Prospective observative examination was performed. Patients were diagnosed twice: in 36 HBD and 6 weeks after labor. Using the Scheimpflug camera (Pentacam system) the following parameters were assessed: central corneal thickness (CCT), keratometric parameters: flat (K1) and steep (K2), astigmatism value and axis, anterior chamber depth (ACD), anterior chamber volume (ACV) and anterior chamber angle (ACA). The statistical analysis was carried out in the StatSoft Statistica 13 program. RESULTS: CCT value is greater in the third trimester than in 6th week after the labour. ACD and ACA values are higher in 36 HBD than in the post-partum period but the difference is not statistically important (p > 0.05). K1, K2, cylindrical refraction error, axis of cylindrical refraction error do not change. CONCLUSIONS: Authors claim that it is the result from an increase in water retention in the corneal stroma as a response to hormonal changes. The plasticity of the anterior chamber seen before delivery can be a natural adaptive mechanism of the female body, which counteracts the excessive increase in intraocular pressure in the second stage of delivery.

Cervical human papillomavirus infection in the early postoperative period after liver transplantation: Prevalence, risk factors, and concordance with anal infections.

Solid organ transplant recipients are at increased risk of developing several human papillomavirus (HPV)-related malignancies, including cervical and anal cancers. The purpose of this prospective study was to assess the initial prevalence and risk factors for high-risk HPV (HR-HPV) cervical infections in liver transplant recipients, as well as their concordance with anal infections. A total of 50 female patients were enrolled in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw (center with >1600 liver transplantations). The initial prevalence of cervical HR-HPV infection was 10.0% (5/50). The only significant risk factor for cervical HR-HPV infection was ≥4 lifetime sexual partners (P=.037). Statistical tendencies toward higher prevalence of cervical HR-HPV infections were found for patients with hepatitis B virus (HBV, P=.082) and with model for end-stage liver disease (MELD) score ≤8 (P=.064). Cervical cytology was abnormal in 10 patients, including three with HR-HPV. Out of 12 patients with available data on anal HR-HPV, one had concordant HPV 16 infection. In conclusion, the initial prevalence of high-risk HPV infection is relatively low, except for patients with ≥4 previous sexual partners and potentially in those with HBV and/or low MELD score.

The course of pregnancy and delivery in a patient after a double-outlet right ventricle Fontan repair and the influence of this procedure on her general condition: report of a case.

The course of pregnancy and delivery in a patient after Fontan repair of double-outlet right ventricle is herein presented. She uneventfully delivered a healthy infant in good general condition at 38 weeks of gestation through a caesarean section, at 24 years after cardiosurgery. Although the patient demonstrated a good hemodynamic state after the operation and conceived while being clinically stable, a worsening of her general condition was observed. After a 4-year follow-up it was clear that pregnancy and delivery had a harmful effect on her cardiovascular function.

Cancer of the urinary bladder neovagina in a patient with Morris' syndrome.

BACKGROUND: Vaginal agenesis is a rare condition, therefore the incidence of a malignant transformation in the neovagina is extremely low. CASE REPORT: We report on a 42-year-old patient with Morris' syndrome and urinary bladder neovagina with a history of prolonged infections of the urinary bladder and intertrigo of the perineal region. The biopsy revealed a squamous cell carcinoma arising from the neovagina. The patient underwent combined radio- and chemotherapy and was disqualified from surgical treatment because of the advanced stage of the disease. CONCLUSIONS: Because of the high risk of malignant transformations regular follow-ups are necessary in patients with neovagina creation, including gynecological examination, cytological screening, and biopsy if necessary. In addition, urinary bladder does not seem to be a good material for a functional vagina.

The influence of dinoprostone on uterine cervix ripening and the course of labor.

OBJECTIVES: The aim of the study was to estimate the influence of dinoprostone in two different forms on the ripening of uterine cervix and the course of labor. MATERIAL AND METHODS: 128 pregnant women with indications for labor induction and uterine cervix Bishop's scores <6, divided into 2 groups: I--62 patients who had dinoprostone in the form of a gel applied for labor preinduction; II--66 women who were administered dinoprostone in the form of vaginal inserts. The effectiveness of both forms of dinoprostone were estimated and compared. RESULTS: No differences in Bishop's score changes were noticeable between the groups after 6-8 hours from application, however they were significant at the beginning of induction: I - 7.8+/-1.3 vs. II - 6.9+/-1.6 (p=0.0007). Almost half of the patients from group II had spontaneous contractions and required no labor induction at all. The average time from dinoprostone application till delivery was shorter in group II. CONCLUSIONS: Dinoprostone vaginal inserts seem to influence both uterine cervix and muscle, while gel-prepare uterine cervix for delivery more effectively.

[Concentration of bilirubin in the umbilical blood as an indicator of hyperbilirubinemia in newborns]. / Stezenie bilirubiny we krwi pepowinowej jako wskaznik wystapienia hiperbilirubinemii noworodków.

UNLABELLED: The aim of this study was to estimate the correlation between concentration of bilirubin in the umbilical blood and occurrence of icterus in newborns. MATERIAL AND METHOD: The study investigations covered 187 healthy, full-term newborns in good general condition. Newborns with serological incompatibility were not included into the study. In 155 (83%) cases babies were born through natural passages, in 32 (17%) by Caesarean section. The umbilical blood was taken immediately after delivery and the venous blood on the 3rd day of life to determine concentration of bilirubin. The concentration of bilirubin was determined by spectrophotometry. Bilirubin values lower than 12.9 mg% were considered physiological. Hyperbilirubinemia was recognized when the concentration of bilirubin was over 12.9 mg%. Pearson test was used to estimate the correlation between bilirubin value in the umbilical blood and the venous blood. In case when the value of correlation coefficient was statistically significant the linear regression equation was determined. RESULTS: The mean value of total bilirubin in the umbilical blood was 1.30 mg% +/- 0.47 and in venous blood on the 3rd day of life 8.07 mg% +/- 3.08. The value of concentration coefficient between concentration of total bilirubin, unconjugated and conjugated bilirubin was adequately 0.49 (p < 0.001), 0.31 (p<0.005) and 0.5 (p<0.001). No one with umbilical bilirubin concentration lower than 1 mg% developed hyperbilirubinemia. CONCLUSION: The concentration of bilirubin in the umbilical blood can be useful indicator of risk of icterus in newborns. The special care is need for newborns whose concentration of bilirubin in umbilical blood is over 1 mg%.

[Course of twin pregnancies and labors in the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw]. / Przebieg ciazy i porodu w ciazy blizniaczej w materiale i Kliniki Poloznictwa i Ginekologii Akademii Medycznej w Warszawie.

DESIGN: The aim of the study was to analyze the course of twin pregnancies and labors in the I Department of Obstetrics and Gynaecology, Medical University of Warsaw. MATERIALS AND METHODS: 124 cases of multiple pregnancy and labor that occurred in the I Department of Obstetrics and Gynecology within the period from 1994 to 2001 were retrospectively analyzed. RESULTS: The study revealed high risk of premature labor, premature rupture of the membranes (PROM), intrauterine growth retardation (IUGR) and pregnancy induced hypertension (PIH) in twin pregnancy. High incidence of cesarean sections was seen both in premature and at-term labors. Significant differences between the mean birth weight and Apgar score of I and II twin were observed. Differences in condition of the neonates were smaller in the group of twins born by cesarean section. CONCLUSIONS: The higher incidence of both obstetrical complications and cesarean sections is associated with twin pregnancies. An increased obstetrical risk and lower Apgar score are observed in case of vaginal delivery of the second twin. Cesarean section seems to improve obstetric results and diminish the differences in condition between the neonates.

[Maternal and umbilical bilirubin concentration at the time of delivery depending on course of pregnancy and labour]. / Stezenie bilirubiny calkowitej w surowicy matki podczas porodu a stezenie bilirubiny we krwi pepowinowej w zaleznosci od przebiegu ciazy i porodu.

OBJECTIVES: Newborns hyperbilirubinemia is an interesting, complicated and controversial clinical problem. An elevated concentration of it can be connected with increased risk of jaundice. Also, maternal bilirubin can play a part in the development of jaundice in mature newborns. MATERIAL AND METHODS: The research included a group of 173 healthy, full-term newborns in generally good condition, with body mass between 5 and 95 percentile. Infants were born in 2002 at 1st Department of Obstetrics and Gynaecology Medical University in Warsaw. The maternal blood was collected during labour and the umbilical blood was collected immediately after delivery. RESULTS: The mean value of maternal bilirubin was 0.62 mg/dl, and of total bilirubin in the umbilical blood was 1.61 mg/dl. CONCLUSION: The differences between respective values in children delivered by caesarean section, whose mothers suffered from the infection during pregnancy or narcotic analgetic drugs that had been administered during labour were not statistically significant. Maternal bilirubin was higher in mothers with proteins < 6.0 g/dl. The umbilical bilirubin was statistically increased in children whose mothers oxytocin received.

[Pregnancy and labor in obese women]. / Ciaza i poród u pacjentek z nadmierna masa ciala.

DESIGN: An assessment of the course of pregnancy, labour and perinatal outcome in obese women was performed. MATERIAL AND METHODS: 127 obese (BMI > 27) and 1315 non-obese healthy women with singleton pregnancy were compared. All the women gave birth in 1st Department of Obstetrics and Gynecology, Medical University in Warsaw. RESULTS: Weight gain during pregnancy was markedly lower in obese women. The total percentage of gestational complications was significantly higher in pre-pregnancy obese women as well as the rate of cesarean deliveries. The birth weight and neonatal outcome was similar in analyzed groups. CONCLUSIONS: Pregnancy in obese women is associated with increased risk of complications reflecting the higher rate of cesarean deliveries.

[Use of misoprostol in the termination of missed abortion]. / Zastosowanie misoprostolu w indukcji poronienia u kobiet z ciaza obumarla.

The efficiency of misoprostol in the termination of missed abortion was estimated. The group of 66 patients aged 19 - 37, who received 400 microg of vaginal misoprostol for termination of missed abortion was subjected. The overall success rate for a complete abortion was 30.3%, for incomplete abortion 25.8% and in a group of 27.2% women there was no need for cervix canal dilatating during the excochleation of uterus cavity. 16.7% cases failed. The results obtained in this study led us to the conclusion that 400 microg of vaginal misoprostol can induce the termination of missed abortion or dilatation of the uterus' canal.

[Disorders of glucose tolerance among women with pregnancy induced hypertension]. / Zaburzenia tolerancji weglowodanów u pacjentek z nadcisniem tetniczym indukowanym ciaza.

OBJECTIVES: Gestational diabetes is observed to coexist with pregnancy induced hypertension. Insulin resistance might be associated with both of these diseases. DESIGN: To assess the association between glucose intolerance and subsequent development of hypertension in pregnancy. MATERIAL AND METHODS: Glucose levels at the time of routine screening for gestational diabetes among 79 women with pregnancy induced hypertension and 79 normotensive women have been compared. RESULTS: Hypertensive women were statistically more often obese, their pregravid BMIs were greater and their pregnancy weight gain was higher. Among hypertensive women gestational diabetes has been more often diagnosed. As compared with normotensive, women developing PIH had significantly higher glucose levels after 50 g and 75 g of glucose load. CONCLUSIONS: Women with pregnancy induced hypertension are at increased risk of gestational diabetes. Even within the normal range, levels of plasma glucose levels were higher among hypertensive women.