Application of a specific clinical pathway can affect the choice of trial of labor in patients with a history of cesarean delivery.

BACKGROUND: Mode of delivery in women with previous history of cesarean delivery (CD) is highly modifiable by the practices of the delivery unit. Vaginal birth after a cesarean (VBAC) delivery is a safe and preferred alternative in most cases. The aim of this study was to assess the impact of adopting a complex set of measures aimed at the mode of delivery in this group. METHODS: This was a retrospective observational study comparing two birth cohorts before and after the implementation of a series of quality improvement (QI) interventions. The study cohorts comprised women with a history of cesarean delivery who gave birth in the period before (January 2013 - December 2015) and after (January 2018 - December 2020) the adoption of the QI measures. The measures were focused on singleton term cephalic pregnancies with a low transverse incision in the uterus. Measures included approval of all planned CDs by a senior obstetrician, re-training staff on the use of the FIGO classification for intrapartum fetal cardiotocogram, establishing VBAC management guidelines, encouraging epidural analgesia during trial of labor after cesarean (TOLAC), establishing a labor ward team and introducing a monthly maternity audit. RESULTS: Term singleton cephalic pregnancies with previous history of CD accounted for 12.55% of all births in the pre-intervention period and 12.01% in the post-intervention period. The frequency of cesarean deliveries decreased from 89.94% in the pre-intervention period to 64.47% in the post-intervention period (p < 0.0001). We observed a significant increase in TOLAC from 13.18 to 42.12% (p<0.0001) and also an increase in successful VBAC from 76.27 to 84.35% (p < 0.0001). All changes occurred without statistically significant change in overall perinatal mortality. CONCLUSIONS: This study demonstrates the feasibility to safely increase trial of labor and vaginal birth after cesarean delivery by implementing a series of quality improvement interventions and clinical pathway changes.

Morphology of the immune cells in the wall of the human uterine tube and their possible impact on reproduction-uterine tube as a possible immune privileged organ.

The uterine tube, as well as other parts of the upper female reproductive system, is immunologically unique in its requirements for tolerance to allogenic sperm and semi-allogenic embryos, yet responds to an array of sexually transmitted pathogens. To understand this dichotomy, there is a need to understand the functional morphology of immune cells in the wall of the uterine tube. Thus, we reviewed scientific literature regarding immune cells and the human uterine tube by using the scientific databases. The human uterine tube has a diverse population of immunocompetent cells representing both the innate and adaptive immune systems. We describe in detail the possible roles of cells of the mononuclear phagocyte system (macrophages and dendritic cells), T and B lymphocytes, natural killer cells, neutrophils and mast cells in association with the reproductive functions of uterine tubes. We are also discussing about the possible "immune privilege" of the uterine tube, as another mechanism to tolerate sperm and embryo without eliciting an inflammatory immune response. In uterine tube is not present an anatomical blood-tissue barrier between antigens and circulation. However, the immune cells of the uterine tube probably represent a type of "immunological barrier," which probably includes the uterine tube among the immunologically privileged organs. Understanding how immune cells in the female reproductive tract play roles in reproduction is essential to understand not only the mechanisms of gamete transport and fertilization as well as embryo transport through the uterine tube, but also in improving results from assisted reproduction.

Pelvic floor muscle injuries in women with a history of Caesarean section.

OBJECTIVE: The aim of the paper is to determine the prevalence of levator ani muscle injuries and identify risk factors among women undergoing vaginal birth after Caesarean section (VBAC) compared to those with elective repeat Caesarean section (ERCS). MATERIAL AND METHODS: This prospective observational comparative study was conducted at the 2nd Clinic of Gynaecology and Obstetrics of FM CU and UN Bratislava. Women with a history of one Caesarean section were included in the study. They were divided into those who had a successful VBAC and those who delivered by ERCS. The mothers underwent a 3D/4D ultrasound examination of the pelvic floor muscles 3‒5 days after childbirth. The study evaluates the frequency and risk factors of avulsion injury of the levator ani muscle (LAM) in a group of 46 women after a successful vaginal delivery after a previous Caesarean section and 32 women after ERCS using 3D/4D transperineal ultrasound examination of the pelvic floor. RESULTS: A total of 78 women were included in the study, 46 after VBAC and 32 after ERCS. In the first group, we recorded LAM avulsion injury in 13 cases (28.3 %); in the post-ERCS group, we did not record this injury (p < 0.0001). We also found an overdistended hiatal area (21.0 vs 19.4 cm2) and a more frequent occurrence of the area exceeding 25 cm2 (21.3 % vs 6.2 %, p = 0.0340) which was approaching the statistical significance. In the first group, we identified an increase in weight during pregnancy to 15 kg and a neonatal birthweight of 4,000 g or higher as risk factors for LAM injury. CONCLUSION: In the group of women with VBAC, there is a statistically significant risk of LAM avulsion and a higher occurrence of the overdistended area of ​​the hiatus urogenitalis, especially in women with larger foetuses and in those who experienced greater weight gain during pregnancy (Tab. 3, Ref. 50). Text in PDF www.elis.sk Keywords: pelvic floor, levator ani muscle avulsion, vaginal birth after Caesarean section.

Mitochondria-induced formation of neutrophil extracellular traps is enhanced in the elderly via Toll-like receptor 9.

Neutrophil extracellular traps are potent antimicrobial weapons; however, their formation during sterile inflammation is detrimental, and the mechanism of induction is still unclear. Since advanced age is the primary clinical risk factor for poor outcomes in inflammatory diseases, we hypothesized that sterile stimuli, represented by mitochondria, would induce neutrophil extracellular trap formation in an age-dependent manner. Therefore, we analyzed induction of neutrophil extracellular traps in patients grouped according to age or immune status and observed that neutrophils from elderly patients responded to the presence of mitochondria with enhanced neutrophil extracellular trap formation. These neutrophil extracellular traps were also found to be more oxidized and exhibited higher resistance to DNase I degradation. Additionally, a higher concentration of residual neutrophil extracellular traps was detected in the plasma of the elderly. This plasma was capable of priming neutrophils through TLR9-mediated signaling, leading to further neutrophil extracellular trap formation, which was successfully inhibited with chloroquine. Finally, in a mouse model of mitochondria-induced acute lung injury, we observed that neutrophils from aged mice displayed impaired chemotactic activity but exhibited a trend of higher neutrophil extracellular trap formation. Thus, we propose that residual neutrophil extracellular traps circulating in the elderly preactivate neutrophils, making them more prone to enhanced neutrophil extracellular trap formation when exposed to mitochondria during sterile inflammation. Further investigation is needed to determine whether this vicious circle could be a suitable therapeutic target.

Effect of SARS-CoV-2 Infection and COVID-19 Vaccination on Oxidative Status of Human Placenta: A Preliminary Study.

Infection with SARS-CoV-2 during pregnancy increases the risk of pregnancy complications associated with inflammation, which could lead to oxidative stress in the placenta. Whether vaccination against COVID-19 has any effect is unclear. This study aimed to analyze the effects of SARS-CoV-2 infection and vaccination against COVID-19 during pregnancy on oxidative stress in the placenta and on extracellular DNA (ecDNA) in umbilical cord plasma. Placenta samples from healthy uninfected and unvaccinated control patients who recovered from COVID-19 and women vaccinated against COVID-19 during pregnancy were collected. Biomarkers of oxidative damage and antioxidant capacity were assessed in the placenta homogenates. EcDNA and deoxyribonuclease activity were quantified in umbilical cord plasma using real-time PCR and the single radial enzyme diffusion method, respectively. Markers of oxidative damage to lipids and proteins as well as antioxidant capacity in the placenta did not differ between the study groups. No differences were observed in total, nuclear or mitochondrial ecDNA, or deoxyribonuclease activity in the umbilical cord plasma. Taking into account the limits of a small observational study, our results suggest that the infection with SARS-CoV-2 and vaccination against COVID-19 do not induce any major disturbances in the balance between the production of free radicals and antioxidant activity in the placenta. This is in line with the minor effects on fetal outcomes and ecDNA as a suggested marker of fetal well-being.

Thoracopagus conjoined twins.

OBJECTIVE: We present a case report of conjoined twins. CASE REPORT: Secundigravida nullipara, 28-years old, admitted for profuse bleeding at 13 weeks of gestation. Ultrasound confirmed vital pregnancy of conjoined twins - thoracopagus. After prenatal diagnostic consultation the patient decided for termination of pregnancy. Molecular analysis confirmed a female fetus without any chromosomal anomalies. CONCLUSION: The occurrancce of conjoined twins is very rare. Early prenatal ultrasound diagnosis plays an important role. Presented case report describes conjoined twins with poor prognosis because of one shared malformed heart.

Prevalence and risk factors for serious birth concerns in unselected population of mothers.

AIM: The aim of the study was to determine the prevalence of severe fear of childbirth in a group of pregnant women, to determine the risk factors, and to prove the impact of the fear of childbirth on various obstetrics outcomes in this group. MATERIALS AND METHODS: The study population consists of pregnant women who gave birth at the 2nd Gynecology and Obstetrics Department of the Faculty of Medicine, Comenius University and University Hospital Bratislava, from January 1st, 2022, until April 31st, 2022. After signing an informed consent, the pregnant women were given a Slovak version of the Wijma Delivery Expectancy Questionnaire (S-WDEQ), which is a psychometric tool to evaluate the prevalence of severe fear of childbirth. They were given the S-WDEQ during the 36th and 38th week of gestational age. The childbirth data were collected from the hospital information system after the delivery of the baby. RESULTS AND CONCLUSION: The studied group consists of 453 pregnant women who fulfilled the inclusion criteria. Extreme fear of childbirth was identified using S-WDEQ in 10.6% (48) of them. Level of education and age were not considered to be significant predictors of fear of childbirth. Statistically significant difference was not found in terms of the age groups and groups with different levels of education. At the edge of the statistical significance were primiparas, who made up 60.4% (RR: 1.29; 95% CI: 1.00-1.68; P = 0.0525) of all women with severe fear of childbirth. Women with a history of cesarean section were significantly more frequent in the group of women with serious concerns about childbirth (RR: 3.83; 95% CI: 1.56-9.40; P = 0.0033). Women who gave birth by cesarean section due to the indication of non-progressive labour were also more often represented in the group of women with serious concerns about childbirth (RR: 3.01; 95% CI: 1.07-8.42; P = 0.0358). A higher S-WDEQ score at the 36th week of gestational age in a group of primiparous women increased the statistical probability of cesarean delivery (P = 0.0030). The statistical results are not showing the impact of fear of childbirth on the induction success and the duration of the first stage of labour in primiparous women. The fear of childbirth prevalence is relatively high and it has impact on the outcome of childbirth. The use of a validated questionnaire as a screening tool to search for women with childbirth fear could positively influence their concerns by following psychoeducational interventions in clinical care settings.

The effect of anti-pandemic measures on some aspects of obstetric care in a single obstetric unit in the Slovak Republic.

< pre style="margin-bottom: 6.0pt; line-height: 150%;" > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Objectives: < /span > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > In many countries, various anti-pandemic interventions were adopted in 2020, which also affected obstetric practices. The aim of this study is to determine their effect on the frequency of caesarean section (CS) according to Robson classification (RC). < /span > < /pre > < pre style="margin-bottom: 6.0pt; line-height: 150%;" > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Material and methods: < /span > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Deliveries in 2019 and 2020 were retrospectively analysed. Mothers were grouped according to RC, and the frequency of CR in the different groups were compared. < /span > < /pre > < pre style="margin-bottom: 6.0pt; line-height: 150%;" > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Results: < /span > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > We found a statistically significant increase in the frequency of CR in the pandemic year (20.0% vs 17.8%, p = 0.0242). When classified into RC groups, the increase in the different groups lost statistical significance. Nevertheless, the increase was most important in Robson group 5 due to maternal rejection of vaginal delivery after CR and in Robson group 2b with elective CR. In spite of our expectations, the frequency of caesarean section performed due to indication of protracted labour was not increased. < /span > < /pre > < pre style="margin-bottom: 6.0pt; line-height: 150%;" > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Conclusions: < /span > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Interventions that were implemented during the first and second waves of the pandemic were associated with increased frequency of planned caesarean sections. < /span > < /pre >.

Traditional and contemporary views on the functional morphology of the fallopian tubes and their importance for gynecological practice.

The uterine tube, belonging to the female internal reproductive organs, is the only tubular organ in the human body that has, under physiological conditions, a transport function occurring in two opposite directions. It transports the picked-up oocyte released during ovulation and early embryo towards the uterine cavity. At the same time, it can transport spermatozoa towards the abdominal opening of the fallopian tube. Moreover, the uterine tube has many other vital functions as sperm selection (one of the crucial factors preventing polyspermy) and the production of tubal fluid. This unique secretion is essential not only for the process of fertilization but also for sperm activation and the nourishment of the early embryo during its transport into the uterine cavity. The first part of our review is focused on the historical introduction to the topic in which the reader will become familiar with the views and understanding of these peculiar organs by famous anatomists of the 16th and 17th centuries, namely Gabriele Falloppio and Renier de Graaf. The following section will cover the overview of the latest anatomical, embryological, and histological knowledge, which are also crucial for a better understanding of pathological processes affecting the fallopian tube, such as tubal infertility or tubal pregnancy. Interestingly, recent years have been very fruitful regarding uterine tube morphology, e. g. the discovery of an unique mechanism of lymphatic flow within the uterine tube mucosa, the first description of immunologically-active intraepithelial suppressor T-lymphocytes, or the observation of pacemaker cell population - telocytes - in the muscle layer.

Autovaccines - potent tool against chronic vulvovaginal candidiasis.

OBJECTIVE: Our aim was to determine the effect of immunomodulatory therapy in women with chronic and recurrent vulvovaginal candidiasis (RVVC). BACKGROUND: We present recent highlights in the research into vaginal microbiome and consequences of chronic inflammation such as vulvovaginal candidiasis (VVC). VVC is a widespread vaginal infection primarily caused by Candida albicans. Experience of more than three episodes per year is defined as RVVC. METHODS: The strains were isolated from women suffering from the above infections as for the period of 2017 to 2021 and subsequently used in immunomodulatory treatment. The preparation and administration of autovaccination therapy was performed using standard methodology and procedures cited in the manuscript. RESULTS: In total, autovaccines were produced for 73 patients of whom 30 (41 %) were successfully cured by this treatment, 29 (40 %) experienced a partially successful treatment, and in the remaining 14 (19 %), the autovaccination therapy was ineffective. CONCLUSION: We provide current knowledge about alternative (autovaccine) treatment options for female patients with VVC and RVVC diseases and our experience with the outcomes after autovaccine administration that currently has a promising therapeutic potential (Tab. 2, Ref. 18). Text in PDF www.elis.sk Keywords: autovaccines, chronic infections, vulvovaginal candidiasis, recurrent, Candida albicans.

Analysis of factors influencing ultrasound-based fetal weight estimation.

OBJECTIVES: Determining the mean deviation between estimated fetal weight (EFW) measured by ultrasound biometry and the real final birth weight and defining the factors influencing the accuracy of weight estimation. BACKGROUND: Estimated weight of the fetus before birth is valuable information for obstetricians particularlyin choosing the method, management, and timing of delivery. METHODS: The retrospective study analyzed 331 medical records of induced labor between January and June 2021. Fetal weight estimation was calculated using Hadlock formulas. The anamnestic data were obtained from medical records, namely: maternal age, maternal BMI, parity, date of the last ultrasonography (USG) before delivery, fetal presentation, placental location, EFW (including the physician's name performing the measurement, and time of the measurement), gestational age of the fetus, date of birth, fetal gender, neonatal weight and length. The correlations between the weight deviation and other factors were expressed using the Pearson and Phik (Φk) correlation coefficients. The Bland Altman method was used to visualize the correspondence between the two variables. The hypotheses were based on the acquired knowledge and then tested by Mann-Whitney U, Kruskal-Wallis, and ANOVA statistical tests, as required by the hypotheses and input data. RESULTS: The mean EFW in the studied group was 3,459 ± 435 g, and the mean actual birth weight was 3,508 ± 508 g. The mean absolute deviation between monitored weight parameters was 260.27 g. The mean real birth weight was higher compared to EFW by 4.873 g. A significant effect on EFW was observed for the following factors: time interval between sonographic weight estimation and delivery (less than 7 days), high maternal BMI (> 30 kg/m2), maternal age, and neonatal weight and length. The factors of fetal presentation, placental location, amniotic fluid volume, fetal gender, gestational age, parity, or those of examiner did not seem to impact EFW accuracy in our study. CONCLUSION: The time interval between sonographic weight estimation and delivery (shorter than 7 days), maternal BMI over 30 kg/m2, maternal age, neonatal weight and length are all factors significantly associated with the accuracy of ultrasound-based fetal weight estimation (Tab. 2, Ref. 13). Text in PDF www.elis.sk Keywords: ultrasound, biometry, fetal weight estimation.

Unilateral macrocystic dysplasia and contralateral agenesis in a monoamniotic twin.

OBJECTIVE: We present a case report of a congenital malformation of the uropoetic tract in one of the monoamniotic twins. CASE REPORT: A 24-year-old primigravida with male monochorionic monoamniotic twins was dia-gnosed with congenital malformation in fetus A at 24 weeks of gestation. Ultrasound verified macrocystic dysplasia and contralateral renal agenesis. Planned caesarean section was performed after the observational management of the patient in the 34th gestational week. In fetus B, a physiological finding was confirmed on the postpartum ultrasonography. In fetus A, CT examination of the abdomen confirmed the finding of left kidney agenesis and polycystic degeneration of the right kidney. Exitus letalis was stated on the newborns 5th day. CONCLUSION: The occurrence of the described combination of congenital malformation in monoamniotic twins is rare. When dysplasia significantly affects the function of the parenchyma, renal agenesis with multicystic dysplasia of the other kidney is a condition incompatible with life. For the intrauterine survival of the affected fetus, the normal renal function of the twin was important and thus the normal volume of amniotic fluid was maintained. As a result, the fetus did not develop extrarenal symptoms of the Potter sequence in the described case - especially pulmonary hypoplasia and the newborn was able to ventilate spontaneously. The death was caused by the consequences of renal failure associated with anuria.

Covert postpartum urinary retention: causes and consequences (PAREZ study).

INTRODUCTION AND HYPOTHESIS: Increased post-voiding residual volume (PVRV), known as covert postpartum urinary retention (PUR), is an asymptomatic condition with unknown long-term adverse effects. The objectives were to determine the frequency of this phenomenon 3 days after delivery and to examine the associated risk factors and consequences of the increased residuum on women´s health 6 weeks postpartum. METHODS: We carried out a prospective observational study including a total of 926 primiparous women, giving birth to singletons. All participants underwent ultrasound determination of PVRV on day 3 postpartum. Then, risk factors were determined using logistic regression analysis. After 6 weeks, participants were invited to return for PVRV determination and to complete urogynecological and general health questionnaires. Using these data, the consequences of increased PVRV were determined. RESULTS: A total of n=90 women were diagnosed with abnormal PVRV. Mean age in the studied population was 30.4 years, BMI prior to delivery 27.8, weight of the newborn 3,420 g, and percentage of cesarean sections 15.9%. Gestational week (p=0.043), vaginal tear (p=0.032), and induction of labor (p=0.003) were risk factors for covert PUR. Puerperal incidence of urinary tract infection was 1.1% (6 out of 526) and of urinary incontinence 29.2% (155 out of 530), with no differences between the groups. In the second examination, covert PUR was no longer present, and the values of residual urine decreased for all patients in the case group. No statistically significant differences were observed in questionnaire scores in general health and wellbeing perceptions between the groups. CONCLUSIONS: We have found a few significant obstetrical-pediatric risk factors for abnormal PVRVs. Data from the follow-up suggest that covert PUR has no impact on morbidity and quality of life 6 weeks postpartum. Therefore, abnormal PVRV is a self-limited phenomenon with a tendency toward self-correction. Our findings support those of previous studies that advocate against screening for asymptomatic retention in the postpartum period, despite some similar previous recommendations.

Chlamydia trachomatis and Neisseria gonorrhoeae PCR detection in women treated for ectopic pregnancy.

The aim of this study was to determine the presence of Chlamydia trachomatis (ChT) and Neisseria gonorrhoae (NG) in the genital tract of women with ectopic pregnancy and to compare the positive results with patients' self-reported history of PID. Overall 40 women were eligible for the study. The samples for the ChT and NG Polymerase Chain-reaction (PCR) detection were obtained from the cervix, endometrium and fallopian tube. The results of testing for NG at all sites were negative as were the results from cervical testing for ChT. The prevalence of ChT in the upper genital tract was 12.5%. No statistically significant correlation was found between the positive cases and the previous signs of PID and laparoscopic findings. We found statistically significant relationship between signs of pelvic inflammation in a pacients' history and histopathological findings of tubal inflammation. 12.5% prevalence of ChT confirms the ascending genital infection. There was no association between the positive PCR result and clinical history of pelvic inflammation.IMPACT STATEMENTWhat is already known on this subject? Pelvic inflammatory disease, Chlamydia trachomatis and Neisseria gonorrhoae infections are the main risks for ectopic pregnancy. Clinical history of PID and perioperative adhesions may suggest prior upper genital infection.What do the results of this study add? Chlamydia trachomatis positive PCR result can be found in the upper genital tract without the positivity of cervical smear in women with ectopic pregnancy. Our study is unique in assessing the endometrial biopsy for the presence of Chlamydia trachomatis and Neisseria gonorrhoae.What are the implications of these findings for future clinical practice and/or future clinical research? There is no statistically significant association between positive PCR result and clinical history of PID or pelvic adhesions found during laparoscopy for tubal pregnancy. Therefore there is no need for the preventive antibiotic treatment in patients with these findings.

Conservative possibilities influencing PCOS syndrome - the importance of nutrition.

Polycystic ovary syndrome (PCOS) is a common pathological condition in women. Conservative treatment is used in the treatment of polycystic ovary syndrome. Conservative treatment options include increased physical activity and diet. The main aim of the article is to discuss the therapeutic treatment of influencing PCOS from a nutritional point of view. PCOS is associated with several comorbidities, including infertility, metabolic syndrome, obesity, impaired glucose tolerance, diabetes mellitus II, and increased cardiovascular risk. Several therapeutic diets can be used in the treatment of PCOS, such as the DASH diet, the low-carbohydrate diet, and a diet based on a low glycemic index. A change in eating habits is associated with improvement in PCOS symptoms.

Religion Affects Future Female Doctors' Approach to HPV Vaccination in Czech and Slovak Republics.

The objective of this study is to summarize the factors, including religion, affecting an individual's decision to get vaccinated or reject vaccination. Anonymous questionnaire-based electronic study is conducted in all faculties of medicine in Czech and Slovak republics. One thousand four hundred and six (1406) questionnaires were analyzed. Responders not practicing any religion received vaccination more often and would recommend vaccination more often. Catholic religion was the most important demographic factor affecting the rate of vaccination. In the group of Catholic female students, 21.9% were vaccinated. In the group of non-Catholic female students, 55.5% were vaccinated. In conclusion, female medical students' approach to vaccination depends, among other factors, on their individual beliefs.

Deoxyribonuclease activity negative correlates with extracellular DNA in uncomplicated singleton pregnancies in the third trimester.

OBJECTIVES: It is not clear, which factors affect extracellular DNA (ecDNA) concentrations in healthy women with singleton uncomplicated pregnancies, although deoxyribonucleases (DNases) are hypothesized to be responsible for the cleavage of plasma ecDNA. The aim of this study was to analyze potential determinants of total ecDNA including plasma DNase activity. METHODS: Plasma samples were collected from 48 healthy women with singleton uncomplicated pregnancies in the third trimester (gestation week 37). DNA was isolated and quantified using fluorometry and real time PCR. DNase activity was assessed using the single radial enzyme-diffusion method. RESULTS: Neither ecDNA, nor DNase activity were affected by maternal age or BMI. DNase activity negatively correlated with total plasma ecDNA (r=-0.40, p=0.007). Similar associations were found for ecDNA of nuclear and mitochondrial origin, but not with fetal DNA quantified using Y-targeted PCR in male fetus-bearing pregnancies. CONCLUSIONS: The role of plasma ecDNA of fetal and maternal origin is studied in the pathogenesis of pregnancy-complications. The results indicate that plasma DNase activity could negatively regulate ecDNA concentrations and should, thus, be analyzed in preeclampsia, preterm birth and other ecDNA-related pregnancy complications.

The risk of urine bacterial colonisation in patients with a permanent catheter after caesarean section.

We present an observational study, conducted in Slovakia, concerning the occurrence of newly acquired urine colonisations in women with Foley catheters after a Caesarean section. A sample of urine was taken from each patient when the Foley catheter was first inserted, before the operation and was sent to the lab for culture. Later, a sample of urine was taken during the removal of the Foley catheter. Out of 176 women, the second urine sample culture result was positive in 13 women. Of those nine women had a positive pathogenic strain (5.1%). The prevalence of asymptomatic bacteriuria in our cohort was 7.7%. De novo acquired colonisation of urine was confirmed in 5.1% of cases. The only confirmed risk factor was delivery by an acute Caesarean section.Impact statementWhat is already known on this subject?: It is well known that catheterisation increases risk of colonisation of lower urinary tract by pathogens. However, the extent of this risk is not determined because there are no studies of de novo colonisation in women with sterile urine before catheterisation. According to literature approximately 8% of women have asymptomatic bacteriuria, which could be confounding factor in previous studies.What do the results of this study add?: Our study excluded women with positive bacteriuria before insertion of Foley catheter. Therefore, the study only assesses de novo colonisation, dependent on insertion of Foley catheter during caesarean section.What are the implications of these findings for clinical practice and/or further research?: De novo colonisation was observed in 5.1% of women in our cohort, with emergency caesarean section as a confirmed risk factor. Therefore, practitioners should consider avoiding catheterisation during caesarean section.

Comparison of opinions of Slovak and Czech female medical students on HPV vaccination.

OBJECTIVES: This study aims to identify the differences in the use of HPV vaccination between female medical students in the Czech and Slovak Republics and their possible causes. METHODS: We performed a cross-sectional survey among female students of general medicine in all faculties of medicine in the Czech and Slovak Republics. RESULTS: We obtained 630 questionnaires from the Czech Republic and 776 questionnaires from the Slovak Republic. In the Czech Republic, 65.4% of female medical students underwent HPV vaccination, while in the Slovak Republic, the figure was 21.1%. In the Czech Republic, residency and religion of students did not influence their rate of vaccination. However, in the Slovak Republic, village residency with less than 5,000 inhabitants lowered the probability of vaccination with OR = 0.56 (95% CI: 0.38-0.84), and the Catholic religion lowered the probability of vaccination with OR = 0.40 (95% CI: 0.28-0.57). Czech students were informed about the possibility of vaccination by a paediatrician in 55.7% of cases, while the figure for Slovak students was 26.8%. In the Czech Republic, 75.7% of students participated in regular cervical oncologic screening, while in the Slovak Republic, the figure was 57.7%. Vaccination of relatives would be recommended by 86.5% and 80.5% of Czech and Slovak students, respectively. CONCLUSIONS: The adoption of an oncologic prevention programme and the more extensive propagation by paediatricians are probably the medical reasons for the higher HPV vaccination among Czech students. Demographic factors - village residency and religion - are also important.