Analyzing the clinical group to evaluate current indications for cordocenteses, their complications and data obtained in further pregnancy management.
Retrospective analysis evaluated 92 ...cordocenteses (diagnostic and therapeutic) performed during the period of 2007‒2018. These were performed between 17 and 36 weeks of gestation under ultrasound guidance by a specialist at 2nd Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University.
Out of 92 procedures, 78 were diagnostic and 14 were therapeutic. The diagnostic cordocentesis was successful in 97.4 % and intrauterine therapy was successful in 85.7 %. There were 2 (2.56 %) diagnostic cordocenteses complicated by fetal demise and 2 (14 %) intrauterine demises in therapeutic cordocentesis. The pathological karyotype was detected in 14.5 %. Aneuploidia was present in 4 cases (44.4 %), mosaicism in 4 cases (44.4 %) and triploidia in one case (11.1 %).
Despite of novel molecular genetic technique cordocentesis still plays unreplaceable role in current prenatal diagnosis and treatment. The risk of complications of cordocentesis increases depending on the severity of fetal pathology in pathologic pregnancies. In some situations it can be used as a useful tool for original fetal diagnosis and therapy (Tab. 3, Ref. 20).
This study was conducted to determine the frequency of increased postvoiding residual volumes (PVRV) 3 days after delivery and to examine the associated risk factors.
Increased PVRV ‒ covert ...postpartum urinary retention, is an asymptomatic condition with possible long-term adverse effects. While early diagnosis and appropriate management can avoid long‑term complications, screening is not routinely performed. By identifying risk factors, we could define the group of patients suitable for screening.
This was a prospective observational study carried out over a 3-month period at the university teaching hospital in Bratislava, Slovakia. All participants underwent ultrasound determination of PVRV while 80 ml and more on day 3 was considered pathological.
A total of 429 women were included in the study. The prevalence of covert post-partum urinary retention was 9.2 %. Assisted vaginal delivery (ventouse, forceps) and episiotomy were risk factors for post-partum urinary retention (18.7 % vs 6.1 %; p = 0.0053; 52.1 % vs 35.7 %; p = 0.0483; respectively).
Our observations confirmed the existence of PVRV of 80 ml and more on day 3 in almost 10% of women who had delivered at our clinic. The results of our study prove that instrumental delivery represents a considerable obstetrical-pediatric risk factor for PVRV. Our data support the need of adopting a risk-factor-based approach to PVRV screening as part of postpartum bladder care (Tab. 2, Fig. 1, Ref. 12).
OBJECTIVEWe present a simple 2D big ultrasound measurement of the fetal adrenal glands and their biometrical growth analysis highlighted as a potential preterm birth marker. METHODSThis was a ...prospective observational case-control study. Sixty-four patients were included in the study (32 with the diagnosis of imminent preterm birth before 37 and 32 controls) from January 2018 to May 2020. Anteroposterior dimensions and circumferences of the whole adrenal glands and their central zones were measured by simple B-mode ultrasound imaging. For the statistical analysis, StatsDirect 3.0 and ROC curves were used. As a studied descriptor, routine standard ultrasound cervical measurements were added (cervical length, funneling, sludge, cervical dilatation, and cervical glandular area). RESULTSIn biometrics of gestational age-related changes, a significant analysis of the overall growth of the adrenal gland was observed (circumference p < 0.001, anteroposterior diameter p = 0.02). The growth of the central zone was observed independently of gestational age. The growth of the central zone of the fetal adrenal glands revealed significant changes between the group of patients who delivered prematurely and control groups (p < 0.01). The ideal cut-off value of the proportion of enlargement of the fetal zone as a predictor of preterm delivery before week 37 was 45.1 %, with the sensitivity of 87.5 % and specificity of 85.4 %. CONCLUSIONSA simple 2D B-mode measurement of the fetal adrenal glands´ central zone growth can be applied as an additional marker in the prediction of true preterm delivery. The natural biometrical overall growth of the adrenal glands seems to be dependent on gestational age, whereas that of the central adrenal gland zone seems to be independent on gestational age (Tab. 3, Fig. 5, Ref. 26).
To analyze a rare triad of intracranial fetal pathologies and clinical study of the novel defined sequence pathogenesis based on prenatal and postmortem findings.
Complex multidisciplinary clinical ...analysis and review of up-to-date literature.
In an 18-gestational-week fetus the screening ultrasound scan resembled the semilobar type of holoprosencephaly and oral tumor. After the indicated termination of pregnancy, the histopathology results confirmed another pathologies - oral meningoencephalocele, teratoma of the sellar area and large arachnoidal cyst of the anterior cerebral fossa. The surprising final results were evaluated by specialists in prenatal diagnosis, histopathology, genetics, neurology, and radiology.
We defined the final diagnosed triad oral meningoencephalocele - intracranial sellar teratoma- arachnoidal cyst as a novel sequence defect malformation. In the detailed sequence pathogenesis, the intracranial sellar teratoma created an aperture for meningoencephalocele in the cranial base and the arachnoidal cyst facilitated, by its growth and pressure, the protrusion of the brain tissues (Fig. 4, Ref. 10). Text in PDF www.elis.sk.
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.
Transvaginal polypropylene mesh implantation is one of the techniques used for pelvic organ prolapse (POP) repair. The surgery outcomes depend on the indication criteria used. The aim of our study ...was to evaluate the outcomes of the mesh implantation using the strict indication criteria.
In 47 women aged 61.7±8.3 years with pelvic organ prolapse (POP-Q≥2) and a history of other surgery in the pelvic region outcomes of the mesh implantation were evaluated for up to 7 years (range 1-7 years).
Forty six of 47 patients (97.8%) had a successful mesh implantation (10 anterior, 22 posterior, 14 combined). Peroperative complications occurred in 3 of 47 patients (6.4%). The anatomic cure (POP-Q≤1) was achieved in 93.5% patients with mesh at 6 months after surgery. Any of the postoperative complications occurred in 16 of 46 women (34.8%). Significantly lower risk of complications was found in the group aged over 65 years compared to the younger patients (p=0.005).
This is the first study on the mesh implantation including women only with the history or other surgery in the pelvic region, achieving high anatomic success rate and low risk of complications. Thus, our data support the use of the strict indication criteria for this procedure (Tab. 2, Fig. 2, Ref. 14).
The aim of this study was to investigate the prevalence of orofacial clefts (OC) in live newborns from 2001 to 2007 in Western Slovakia and correlate their occurrence with a number of relevant ...seasonal and geographical factors and epidemiological trend of this condition. In this study we used retrospective active survey collecting clinical data of 220 children with OC registered and operated at the cleft centre in Bratislava. Our study group included 67 patients from Bratislava region and 151 patients from the remaining Western Slovakia (Nitra, Trnava, Trenčín regions). Data of live births was obtained from Health Statistics of the Slovak Republic.
Total incidence (TI) of 1.49/1000 live births (LB) in the region of Western Slovakia in 2001-2007 marked a decrease of prevalence compared to 1.64/1000 LB in the years 1985-2000. Bratislava region dominated in total prevalence of 1.82/1000 LB compared to the rest of Western Slovakia regions with 1.37/1000 LB. Most observed cleft type was the CP with 38.6 % frequency, followed by CLP with 35.5 % and CL with a frequency of 24.1 %. The frequency of AM with 1.82 % was the lowest.
The results showed that the frequency risk rate of a birth of a child with OC was 1 to 671 LB in Western Slovakia. The data proved a higher prevalence of OC in Bratislava region with 1 child with this type of congenital anomaly to 549 LB compared with 1 child with OC to 730 LB in the rest of the Western Slovakia regions (Tab. 7, Ref. 16).
Abstract
Background
Several studies have focused at the risk factors of postoperative complications in Crohn’s disease (CD) patients with no conclusive results. Thus far, it is unclear whether immune ...suppression should be adjusted in a CD patient awaiting surgery for CD complications. Therefore, we aimed to determine the risk factors associated with the postoperative complications in CD patients operated for luminal disease complications.
Methods
All consecutive CD patients operated on in one tertiary centre between January 2015 and September 2017 were included. Complications within 30 days following surgery were categorised according to Clavian–-Dindo classification. Patients’ demographics, nutritional status, disease localisation and behaviour, type of medication, previous surgical interventions, type of surgical approach, and duration of surgical intervention were noted. The association of postoperative complications with these factors was analysed.
Results
In total, 91 procedures were performed in 86 CD patients (47.3% males; mean age 38 years, range 19–71; 56 patients (61.5%) with ileo-colonic disease, 11 patients (12.1%) with small bowel and 21 patients (23.1%) large bowel localisation; 62 (68.1%) with stricturing disease). Based on body mass index, 23 (25.3%) patients had underweight, 42 (46.2%) had normal weight, and 21 (23.1%) were overweighed. Minority of patients had steroids (16 patients; 17.6%); 36 patients (39.6%) were using azathioprine; 33 (36.3%) anti-TNF; 7 (7.7%) vedolizumab; and 1 patient was using trial medication. The procedure was elective in 60.4% and one third had repetitive surgery. Median duration of the procedure was 150 min (range 30–335) and median hospital stay was 6 days (range 3–32). Fifty-one patients (56%) had simple resection, 24 (26.4%) had multiple resections, in 16 cases an ostomy was created. Laparoscopic approach was used in 44 cases (48.4%; 8 patients had single port laparoscopic procedure), 46 patients (50.5%) had laparotomy. There were 10 complications (11%); out of which, five (5.5%) major complications (Clavian-–Dindo IIIb and above). There was a significant difference in BMI between patients with major complications compared with patients without complications (respective medians 26 and 21 in the group with major complications vs. group without complications; p = 0.035). None of the other factors was associated with unfavourable postoperative outcomes.
Conclusions
Overweight represents a risk factor for postoperative complications in Crohn’s disease patients operated for luminal disease complications. Immune suppressive therapy, including systemic corticosteroids and anti-TNF biologics does not seem to confer an increased risk for surgical complications.
To outline possibility of successful treatment of spontaneous previable rupture of membranes in the second trimester of pregnancy.
Spontaneous previable rupture of membranes (SPROM) in the second ...trimester of pregnancy is one of the most alarming problems in current obstetrics. Perinatal mortality is about 60 %, one third of which represents intrauterine fetal demise. Surviving neonates suffer from various complications. There are different clinical approaches regarding treatment of SPROM.
We present a case of a 30 year old secundigravida with a history of SPROM at 19+1 weeks gestation. Ultrasonographic examination revealed anhydramnios. Genital cultures and laboratory studies ruled out infectious etiology of SPROM. Due to expected poor neonatal outcome, decision to attempt amniopatch as an experimental therapeutic alternative was made at 21+1 weeks gestation (two weeks after SPROM had occurred). Autologous concentrated platelets followed by autologous cryoprecipitate were administered into the amniotic cavity transabdominally under ultrasound guidance. After 3 days sonographic examination showed normal volume of amniotic fluid. On 22 postoperative day, patient notice some leaking of fluid vaginally. Fetal growth was appropriate, amniotic fluid volume was decreased, however, oligohydramnios never progressed to anhydramnios. Pregnancy ended with primary cesarean delivery at 33+1 weeks gestation. Live born male infant with 1750 g birth weight was delivered. Postnatal development was within normal limits.
Intraamniotic application of "amniopatch" may represent a possibly successful treatment of spontaneous previable rupture of membranes. This case reports the longest stop of the leaking of amniotic fluid and total prolongation of pregnancy with favorable perinatal outcome after "amniopatch" treatment of spontaneous previable rupture of membranes in the second trimester so far published in available literature.
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