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To analyze the relationship between the fibroblast growth factor soluble receptor 1 (sFlt-1/PlGF) ratio and adverse perinatal outcomes. Patients admitted between 22+0 and 34+6 weeks of gestation from February 2024 to June 2025 were included. The sFlt-1/PlGF ratio was measured and its relationship to pregnancy outcome was evaluated. We assessed whether patients with increased sFlt-1/PlGF ratios developed conditions leading to preterm birth (spontaneous or iatrogenic). A total of 78 patients were included, of whom 47 delivered before 37 weeks of gestation and 31 after 37 weeks. The sFlt-1/PlGF ratio appeared significant in relation to the risk of preterm birth. Almost all women with an sFlt-1/PlGF ratio above 100 delivered before 37 weeks. Based on the collected data, we developed a model to estimate the probability of delivery within 3 or 7 days. The model showed low sensitivity (0.32 and 0.53), but high specificity (0.91 in both cases). It accurately identified patients who would not deliver within 3 or 7 days. The sFlt-1/PlGF ratio is a useful tool in assessing the further course of pregnancy.
To analyze the incidence and mortality of cervical cancer in individual age cohorts in the Czech Republic using nationwide data and data from the largest national gynecological oncology center. Analysis of a single-institution cohort of newly treated cervical cancer cases from 2022-2024, and analysis of incidence and mortality trends in individual age groups using data from the Czech National Cancer Registry (ÚZIS - Institute of Health Information and Statistics) from 2000-2023. The incidence and mortality of cervical cancer in the Czech Republic have declined significantly over the last 20 years. The decline correlates well with measures that have led to better organization and implementation of changes within the screening program. Analysis in individual age cohorts shows that the largest decline in incidence and mortality occurred in the cohort up to 34 years of age, yet in more than 50% of women with carcinomas in this cohort, cytological screening and subsequent management failed. The upward trend in incidence in the 35-44 and 45-54 age cohorts raises questions about the causes. The high percentage of invasive carcinomas in women examined by a gynecologist in the last three years requires an analysis of the quality of cytology laboratories and management by registering gynecologists. The introduction of high-risk human papillomavirus (HR HPV) testing and referral to expert colposcopy for discrepant findings is one way to improve the situation. Furthermore, audits of diagnosed carcinomas in women who have undergone screening should be introduced. The biggest challenge will be to activate the resistant population of women who underestimate the importance of regular screening examinations. Even though we can see an overall decline in incidence and mortality, when individual age cohorts are analyzed, it shows us ways for improvement in each specific age group of women individually.
The cytological category of atypical squamous cells of undetermined significance describes cellular abnormalities that are more severe than inflammatory changes, but are quantitatively or qualitatively insufficient to be included in the squamous intraepithelial lesion category. This study aims to determine the risk level for the presence of high-grade dysplasia in patients with this cytological abnormality. We retrospectively searched our database for women with cytologically proven atypical squamous cells of undetermined significance lesions between January 2020 and June 2024. A total of 104 patients who had undergone colposcopy-directed biopsies were included in the study. Among the 104 women with confirmed atypical squamous cells of undetermined significance cytological lesions who had undergone biopsies, 56 cases (53.8%) were negative, while 48 cases (46.2%) demonstrated cervical intraepithelial neoplasia. Cervical intraepithelial neoplasia 2+ was present in 23.1% (N = 24) of the cases. Furthermore, among 77 human papillomavirus positive women, the precancerous condition was not histologically confirmed in almost half of the cases (N = 36), while in 16 of the 23 human papillomavirus negative biopsies, the precancerous condition was not confirmed. Human papillomavirus status was unknown in 4 cases. We identified a 23.1% presence of cervical intraepithelial neoplasia 2+ lesions in patients with atypical squamous cells of undetermined significance cytological findings. Our study also suggests a lower specificity, but a better negative predictive value of the human papillomavirus test in detecting cervical intraepithelial neoplasia in these patients.
To provide an overview of the most important histopathological characteristics and biomarkers of endometrial carcinoma that have clinical relevance for prognosis, prediction of treatment response, and decision-making regarding adjuvant therapy. Endometrial carcinoma represents the most common malignancy of the female reproductive tract in developed countries. Disease prognosis is determined not only by the anatomical extent, but also by a number of non-anatomical factors. The histological tumour type, presence of lymphovascular space invasion, and specific patterns of myometrial invasion (such as the MELF pattern) play major roles. Current molecular classification divides endometrial carcinomas into four groups (POLEmut, MMRd, NSMP, and TP53mut), which differ in prognosis as well as in therapeutic response. Additional clinically applicable biomarkers include oestrogen and progesterone receptors, L1CAM, HER2, CA125, and HE4. Emerging research focuses on novel biomarkers such as TROP2, circulating tumour DNA (ctDNA), circular RNA (circRNA), tumour- -infiltrating lymphocytes (TILs), and folate receptor alpha (FRa). These markers enable more precise risk stratification and identification of patients suitable for targeted therapies. Integration of multiple biomarkers with clinicopathological parameters further enhances the accuracy of risk assessment and prediction of treatment response. Incorporating histopathological features and biomarkers into routine clinical practice allows for a more accurate estimation of prognosis and a more rational selection of adjuvant therapy. An increasing number of non-anatomical biomarkers are becoming an integral part of the decision-making algorithm in endometrial carcinoma management.
In general, most common localizations of endometriosis are the pelvic organs, until recently, the spleen was mentioned as the only abdominal organ resistant to the development of endometriosis. Our case report describes the differential diagnosis of a splenic cyst as an incidental finding during the examination of endometriosis, its interdisciplinary solution within surgery, gynaecology, radiology and infectious medicine, using robotic-assisted minimally invasive surgery.
Adenomyosis is a prevalent gynecologic disorder involving ectopic endometrial tissue within the myometrium. Magnetic resonance imaging (MRI) enables non-invasive diagnosis, yet the role of junctional zone (JZ) thickness in predicting coexisting intrauterine pathologies remains uncertain. This study evaluated the diagnostic and predictive value of MRI-based JZ thickness in hysterectomy-confirmed adenomyosis. This retrospective study included 420 patients who underwent hysterectomy with preoperative MRI between 2020 and 2025. JZ thickness was measured on sagittal T2-weighted images, and histopathological findings were recorded. Logistic regression analyses were performed to identify independent predictors of intrauterine pathologies. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves. The mean JZ thickness was 17.5 ± 3.8 mm. Histopathological evaluation confirmed adenomyosis in 97.1% of cases, with coexisting lesions including myomas (44.5%), endometrial polyps (7.9%), simple hyperplasia (6.2%), atypical hyperplasia (1.9%), and endometrial cancer (2.4%). JZ thickness demonstrated strong positive correlations with polyps (R = 0.46; P < 0.001), simple hyperplasia (R = 0.55; P < 0.001), atypical hyperplasia (R = 0.49; P < 0.001), and myomas (R = 0.38; P < 0.001). Logistic regression identified JZ thickness as the most consistent independent predictor of intrauterine lesions, with an odds ratio of 1.70 for atypical hyperplasia (95% CI 1.11-2.60; P = 0.014). ROC analysis revealed excellent discriminative ability for simple hyperplasia (AUC = 0.842), atypical hyperplasia (AUC = 0.888), and polyps (AUC = 0.840), while predictive performance for myomas was moderate (AUC = 0.661). MRI-based measurement of JZ thickness is a reliable, non-invasive biomarker for adenomyosis, demonstrating an additional predictive value for coexisting premalignant intrauterine pathologies. Incorporating JZ thickness thresholds into routine imaging evaluation may enhance risk stratification, reduce unnecessary invasive procedures, and inform about personalized management strategies in women with adenomyosis.
To determine the maternal epidemiological profile and perinatal outcomes of fetuses with gastroschisis at a reference center in Northeastern Brazil. A retrospective cohort study was conducted between January 2014 and December 2022 using medical records. Inclusion criteria comprised of pregnancies ≥ 24 weeks, with a prenatal diagnosis of gastroschisis confirmed in the postnatal period. During the study period, 1,773 newborns with congenital anomalies were born at the service center, 50 were identified as having gastroschisis and four cases were excluded. Prevalence of gastroschisis was 11.5/10,000. Regarding the maternal sociodemographic profile, the mean age was 21 years, 38/46 (83%) were mixed, 34/46 (74%) had a partner, and 32/46 (70%) had high school education. Regarding associated maternal diseases, only 6/46 (13%) had hypertension, none had pre-existing diabetes mellitus, and 4/46 (8.7%) developed gestational diabetes mellitus. As for gastroschisis type, 33/46 (71%) were classified as simple, 11/46 (23.9%) as complex and 2/46 (4.4%) had no information. In 36/46 newborns with gastroschisis, primary closure was performed in the first surgery. The mean time of use of mechanical ventilation was 13 days, the mean time interval between surgery and ambient air was 8 days, the mean time of use of parenteral nutrition was 35 days, and the mean length of stay in the neonatal intensive care unit (NICU) was 39 days. Clinical complications in newborns with gastroschisis included neonatal infection in 35/46 (76%), blood transfusion in 33/46 (72%), hydroelectrolytic disorders and sepsis in 29/46 (63%), and cholestasis and fungal infection/sepsis in 8/46 (17%). Neonatal death occurred in 16/46 (34.8%). Newborns with gastroschisis presented high rates of surgery with primary closure, blood transfusion and neonatal infection. Furthermore, we identified prolonged use of parenteral nutrition, long stay in the NICU, and prolonged use of antibiotic therapy.
We present a case of extrapelvic endometriosis of Bartholin's gland in a healthy 40-year-old woman with two deliveries. After the last delivery 10 years ago, she had cyclical pain with swelling in the Bartholin's gland area and dyspareunia with vulvodynia. Primary excision was performed, and Bartholin's gland endometriosis was pathohistologically proven as an extremely rare gynaecological entity. A follow-up examination 2 months after surgery proved complete recovery without vulvodynia and dyspareunia.
This study aims to compare the outcomes of laparoscopic hysterectomy (LH) and vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) hysterectomy (vNH) in obese patients undergoing the procedure for benign gynaecological indications, with results classified according to obesity class (class I, II, and III). We retrospectively reviewed the data of patients with a body mass index (BMI) ≥ 30 kg/m² who underwent either LH or vNH for benign indications at a tertiary teaching and research hospital between January 2020 and December 2024. A total of 134 patients (70 LH, 64 vNH) were included in this single-centre study. The median operative time was significantly longer in the vNH group (205 min vs. 178 min; P < 0.01). Overall, major complication rates were similar between the two groups. The most striking finding of the study was that in patients with class III obesity (BMI ≥ 40 kg/m²), the vNOTES approach significantly reduced the conversion rate to laparotomy compared to laparoscopy (0 vs. 23.5%; P = 0.035). Our study demonstrates that the most significant advantage of vNOTES surgery in obese patients undergoing benign hysterectomy is the reduction in the conversion rate to laparotomy, particularly within the class III obesity group. vNOTES statistically eliminated the risk of conversion to laparotomy compared to laparoscopy in patients with class III obesity (OR 0.08; 95% CI 0.00-0.91; P = 0.035). These findings underscore the importance of risk stratification based on patient BMI when selecting a minimally invasive surgical approach for obese patients.
This article reviews the issue of persistent vulvar pain and vulvodynia, which are common conditions in women of reproductive age. Vulvodynia is defined as chronic vulvar pain lasting at least 3 months with no identified cause. It is characterized by increased sensitivity of the vulvar and vestibular tissues, neuroproliferation, increased vascularization, and structural changes of the mucosa. In contrast, persistent vulvar pain is usually associated with a specific, identifiable underlying condition. Both types of pain may coexist and overlap. This article comments on the current classification of vulvar pain according to the consensus of international societies dealing with this condition. It also summarizes the principles of differential diagnosis and therapeutic options for the management of vulvar pain. Treatment should be based on a comprehensive multidisciplinary approach including local and systemic pharmacotherapy, physiotherapy, psychotherapy, and in selected cases, surgical interventions. This article focuses on novel and promising therapeutic modalities in the treatment of vulvodynia, particularly various types of laser therapy. The review is supplemented by a case report of a patient with chronic provoked vestibulodynia treated by laser vaporization.
Pelvic radiotherapy is an integral part of treatment of many gynecological and other pelvic malignancies; however, it is associated with a risk of late urogynecological complications that can significantly affect the patients' quality of life. The most common problems include lower urinary tract symptoms, particularly urgency, urinary incontinence, and radiation cystitis, as well as vaginal stenosis, dryness, dyspareunia, lymphedema, and chronic pelvic pain. The incidence of these complications depends on the total radiation dose, radiotherapy technique used, combination with surgical treatment or brachytherapy, and individual patient-related risk factors. The underlying pathophysiology involves post-radiation inflammatory and fibrotic changes, vascular damage, and impaired innervation of irradiated tissues. Diagnosis requires long-term follow-up, targeted medical history taking, physical examination, and the use of functional and imaging methods. Prevention and management are based on modern radiotherapy techniques, patient education, conservative and pharmacological approaches, physiotherapy, and in selected cases, surgical treatment. An essential component of care is also addressing psychosocial consequences, which significantly affect sexuality, partner relationships, and psychological well-being.
The aim of this article is to summarize current knowledge on performing biopsies using a core needle, which have become a routine method in gynecologic oncology. The text is based on international guidelines focusing on the selection of imaging techniques for navigation, selection of approach, indications, and contraindications of this method. Additionally, the article addresses recommendations to minimize the risk of bleeding, proper management of anticoagulant or antiplatelet therapy, and provides an overview of the biopsy technique. Finally, it includes recommendations for the required expertise of physicians performing biopsies to ensure maximum safety.
The rising incidence of breast cancer represents a serious medical problem. Women diagnosed with breast cancer before the age of 45 - that is, those who were not included in mammography screening programs - constitute a specific patient group. Identification of risk factors for the pathogenesis of breast cancer has led to the development of triage models based on both medical history data and genetic testing, as well as imaging methods; their updated versions are based on a combination of these modalities. The oldest empirical Gail model relies solely on basic medical history. The IBIS model, on the other hand, incorporates an expanded family history, as well as mammographic breast tissue density. The BOADICEA model enables the calculation of lifetime risk and risk of being a carrier of BRCA1/2 and other major mutations (BRCA1/2, TP53, PTEN, CHEK2, ATM). The Pecný model represents a Czech contribution. With new possibilities in genetic testing, the latest versions of these models now include the polygenic risk score (PRS), which increases their predictive value. With the growing integration of artificial intelligence (AI) and deep learning into clinical medicine, we can expect the emergence of new, AI-dependent triage models. A major limitation of the aforementioned models is their restriction to the Caucasian population. Calibration based on statistical data for other populations often does not work. This article will present current statistical data for the GAIL model, IBIS and its variants, and the BOADICEA model. The aim of this article is to present predictive models to the professional community and to highlight their potential applications in routine gynecological outpatient practice.
In this study, we aimed to present the demographic, ultrasonographic, genetic, obstetric, and postpartum results of 14 patients diagnosed with radial ray defects. Fourteen patients diagnosed with radial ray defects. Non-development or hypoplasia of any preaxial part of the upper extremity on ultrasonography was considered a radial ray defect. Maternal age, gestational week at diagnosis, laterality of the radial ray defect, genetic results, presence of comorbid anomalies, termination status, and postpartum prognosis were obtained. The range of maternal age at the time of diagnosis was 17-38 years and the gestational age ranged between 14-26 weeks. Four of the radial ray defects were bilateral, and ten were unilateral. Trisomy 18 was identified in two cases. Eight cases accepted the termination procedure. Three cases rejected termination and had spontaneous intrauterine death during pregnancy follow-up. One case was diagnosed with VACTERL association and died postpartum on the 13th day. One case was monitored due to Fanconi aplastic anemia and one case had amniotic band syndrome in etiology and lives with a prosthetic arm. The frequency of a radial ray defect accompanied by syndromic and congenital anomalies was high, and visualization of the radial bone or other preaxial bone structures on the 1st trimester fetal ultrasonography will ensure the diagnosis of a radial ray defect in early gestational weeks. In the case of a radial ray defect diagnosis, systemic organ screening should be performed with detailed ultrasonography and the necessary invasive procedure for karyotype examination should be advised to all families.
Human reproductive efficiency is relatively low compared with that of other mammals, a phenomenon that may be linked to evolutionary factors. One of the principal biological contributors is the high incidence of aneuploidy in oocytes and embryos, a risk that increases markedly with advancing maternal age. Successful implantation requires not only a genetically normal embryo, but also a receptive endometrium and a functional feto-maternal dialogue. Nevertheless, even after the transfer of a euploid embryo, implantation occurs in only 60-70% of cases, underscoring the importance of the uterine environment for successful embryo attachment. A key element in the implantation process is the immunological balance at the feto-maternal interface. Uterine natural killer (uNK) cells constitute the dominant lymphocyte population within the decidua and play essential roles in implantation, placentation, and fetal immunotolerance. Their function is mediated, among other mechanisms, by interactions with trophoblast cells through killer-cell immunoglobulin-like (KIR) receptors and human leukocyte antigen C (HLA-C) antigens. Imbalances in these interactions can contribute to pregnancy pathologies such as implantation failure, miscarriage, preeclampsia, and fetal growth restriction. Although current diagnostic methods enable assessment of immunological conditions in reproductive tissues, interpreting these findings in the context of fertility or infertility remains challenging. Emerging research directions include the application of molecular genetics and detailed characterization of distinct NK cell subpopulations. Despite recent advances, therapeutic modulation of immunological mechanisms in reproduction remains limited and warrants further investigation.
Eclampsia remains one of the most severe obstetric emergencies associated with substantial maternal and perinatal morbidity and mortality. Although classically regarded as a hypertensive complication of pre-eclampsia, atypical presentations without sustained hypertension or severe clinical features may occur, complicating risk prediction and timely intervention. We report a case of atypical eclampsia in a 21-year-old woman hospitalized with a diagnosis of pre-eclampsia without severe features. Despite predominantly normal blood pressure values and initially stable laboratory findings, the sFlt-1/PlGF ratio and Doppler assessment of the uterine and ophthalmic arteries revealed significant abnormalities. The patient subsequently developed generalized tonic-clonic seizures, requiring urgent obstetric intervention. This case underscores the limitations of conventional diagnostic criteria in identifying patients at risk for sudden neurological deterioration and highlights the potential value of angiogenic biomarkers and targeted Doppler evaluation in refining risk stratification among women with pre-eclampsia.
Amniotic band syndrome (ABS) includes a rare group of fetal congenital anomalies with various phenotypic manifestations. Early prenatal diagnosis is essential in pregnancy management, including termination of pregnancy for severe forms of disability. Systematic postnatal multidisciplinary care of the newborn with disability induced by the amniotic band should maximize its quality of life. This report describes the case of a 28-years-old primigravida with intrauterine amputation of the fetal upper limb detected in week 31 of an otherwise uneventful pregnancy.
A common problem in women after childbirth is the frequent occurrence of pelvic girdle pain (PGP) and back pain (LBP). To date, no study has been conducted to determine the prevalence of these types of pain. The aim of our study was to compare the incidence of PGP and LBP in women after vaginal delivery and cesarean section in the Slovak Republic over the course of one year in 2024. Cross-sectional study, the research sample consisted of 791 women 12 weeks to one year after delivery. The average age was 31.43 years. Standardized questionnaires were used for the Slovak version Pelvic Gridle questionnaire and Oswestry Disability Index. Based on the type of delivery, the sample was divided into a group with spontaneous delivery comprising 633 women and a group with cesarean section comprising 158 women. Significant differences were observed in the incidence of pain and disability in the spine and in its intensity, with stronger pain in the cesarean section group. The type of delivery did not affect the incidence of pelvic girdle pain after delivery. Cesarean section was associated with greater pain intensity and disability in the spine. Disruption of the integrity of the abdominal wall, increased sensitivity in the area of the cesarean section scar, and a restricted movement regime may explain the higher incidence of pain in the spine in women after cesarean section.
Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) represents a minimally invasive surgical approach that combines the principles of vaginal surgery and endoscopy, utilizing natural transvaginal access to the peritoneal cavity. This review aims to summarize the historical development of the vNOTES technique, its current indications, contraindications, safety, and clinical outcomes in benign gynecological surgery. Based on a systematic review of the available literature, current evidence suggests that vNOTES is comparable to laparoscopic approaches in terms of safety and perioperative complications in patients with benign gynecological conditions. Several studies have reported potential advantages of vNOTES, including reduced postoperative pain, shorter length of hospital stay, and faster recovery. However, the technique has certain limitations, particularly with regard to patient selection, technical complexity, and a relatively long learning curve. vNOTES appears to be a promising evolution of the vaginal surgical approach in benign gynecology, and its wider implementation requires appropriate surgical expertise and further high-quality clinical research.
Objective: To present a rare case of partial molar pregnancy implanted in a previous cesarean section scar and summarize the literature. Case report: A 33-year-old woman (gravida 5, two prior cesarean deliveries, two spontaneous abortions) presented with vaginal spotting and lower abdominal pain at 6 weeks of gestation. Transvaginal ultrasonography revealed a 28 × 19 mm gestational sac at the cesarean scar site, containing a 4mm fetus with positive cardiac activity. Vacuum curettage was performed under ultrasonographic guidance. Ten days postprocedure, rising serum beta-hCG levels and a persistent cystic mass on ultrasound raised suspicion for molar pregnancy. A single systemic dose of methotrexate was administered. Histopathology confirmed a partial molar pregnancy. The patient’s serum beta-hCG levels normalized within 8 weeks. Conclusion: Partial molar pregnancy in a cesarean section scar is an extremely rare condition that may present with vaginal bleeding and pelvic pain. Early recognition through ultrasonography and laboratory evaluation, combined with timely intervention including curettage and methotrexate therapy, can lead to complete resolution. Clinicians should consider this diagnosis in patients with previous cesarean sections to ensure optimal outcomes.