Q106889417
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Shrnutí současných poznatků o použití skleroterapie v léčbě endometriomu a jejím vlivu na ovariální rezervu. Endometrióza postihuje 10–15 % žen ve fertilním věku. Přítomnost a terapie endometriomu ovlivňuje ovariální rezervu a díky tomu i koncepční možnosti pacientek. Management komplikují rovněž četné recidivy. Všechny standardně používané chirurgické metody vedou ke snížení ovariální rezervy. Současný klinický výzkum je zaměřen na vývoj metod, které by ovariální rezervu snižovaly co nejméně. Skleroterapie ethanolem je relativně novou alternativní metodou k dosud používaným chirurgickým metodám, převážně exstirpaci. Nejedná se zatím o standardní výkon. Tento článek si klade za cíl shrnout dosavadní poznatky o užití skleroterapie v léčbě endometriomu a její vliv na ovariální rezervu. Studie zahrnuté v tomto přehledovém článku vycházejí z databází PubMed a Scopus. Dle dosud publikovaných prací je skleroterapie relativně jednoduchou metodou, která umožňuje řešit endometriomy i bez operace a celkové anestezie, pokud je prováděna pod ultrazvukovou kontrolou. Má podobnou míru recidiv jako laparoskopická exstirpace a ve srovnání s ní při ní nedochází k většímu poklesu ovariální rezervy. Skleroterapii lze provádět transvaginálně, transabdominálně či laparoskopicky. Tato práce shrnuje dosavadní poznatky o vlivu skleroterapie na ovariální rezervu.
To summarize current knowledge on the use of sclerotherapy in the treatment of endometriomas and its effect on ovarian reserve. Endometriosis affects 10–15% of women of reproductive age. The presence and treatment of endometriomas influence ovarian reserve, and therefore the conception possibilities of patients. The management is further complicated by frequent recurrences. All standard surgical methods lead to a reduction in ovarian reserve. Current clinical research is focused on developing methods that minimize the reduction of ovarian reserve. Ethanol sclerotherapy is a relatively new alternative to the currently used surgical methods, mainly extirpation. It is not yet a standard procedure. This article aims to summarize the current knowledge regarding the use of sclerotherapy in the treatment of endometriomas and its effect on ovarian reserve. The studies included in this review article are based on PubMed and Scopus databases. According to published works, sclerotherapy is a relatively simple method that allows treating endometriomas without surgery and general anaesthesia if performed under ultrasound guidance. It has a similar recurrence rate as laparoscopic extirpation and does not lead to a greater reduction in ovarian reserve compared to the latter. Sclerotherapy can be performed trans-vaginally, trans-abdominally, or laparoscopically. This paper summarizes the current knowledge on the impact of sclerotherapy on ovarian reserve.
- MeSH
- antimülleriánský hormon analýza MeSH
- endometrióza * diagnóza farmakoterapie klasifikace MeSH
- gynekologické chirurgické výkony metody MeSH
- laparoskopie metody MeSH
- lidé MeSH
- ovariální rezerva MeSH
- skleroterapie * klasifikace metody MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
INTRODUCTION AND HYPOTHESIS: Pregnancy and delivery are commonly associated with ano-rectal dysfunction. In addition, vaginal delivery may impact both the structure and functionality of the pelvic floor. Herein, we systematically reviewed the literature for the potential association between levator ani muscle (LAM) avulsion and ano-rectal function after childbirth. METHODS: We systematically searched the PubMed, EMBASE, CINAHL, Web of Science Core Collection, CENTRAL (Cochrane), Clinicaltrials.gov, and ICTRP databases from inception. We selected studies reporting on the anatomy of the LAM and ano-rectal function within 24 months after childbirth, the former determined by imaging and the latter measured through validated questionnaires or ano-rectal manometry. Meta-analyses were used to pool data from studies reporting on the association between LAM avulsion and ano-rectal function, with subgroup analysis according to the presence or absence of anal sphincter trauma. Summary odds ratio (OR) and mean difference (MD) are reported with 95% confidence intervals. RESULTS: From the 7,621 studies identified, 11 were included, reporting on 2,146 women. Ten studies used transperineal ultrasound (TPUS) and one study used magnetic resonance imaging (MRI) for LAM assessment. Ano-rectal function was assessed through validated questionnaires in all but one study, in which ano-rectal manometry was used. There was no evidence for an association between LAM avulsion and symptoms of incontinence (OR 1.75 [0.74, 4.12]; MD 0.13 [-0.58, 0.85]), including in the subgroup of patients with concomitant anal sphincter injury (OR 1.83 [0.71, 4.71]). CONCLUSIONS: We did not identify an association between LAM avulsion and ano-rectal dysfunction following vaginal childbirth.
- MeSH
- anální kanál * patofyziologie zranění diagnostické zobrazování MeSH
- fekální inkontinence etiologie patofyziologie MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- manometrie MeSH
- nemoci rekta * etiologie patofyziologie MeSH
- pánevní dno * patofyziologie diagnostické zobrazování zranění MeSH
- poporodní období MeSH
- těhotenství MeSH
- vedení porodu * škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
PURPOSE: The pudendal nerve is an anatomical structure arising from the ventral branches of the spinal roots S2-S4. Its complex course may be affected by surrounding structures. This may result in irritation or entrapment of the nerve with subsequent clinical symptoms. Aim of this study is to review the anatomy of the pudendal nerve and to provide detailed photographic documentation of the areas with most frequent clinical impact which are essential for surgical approach. METHODS: Major medical databases were searched to identify all anatomical studies investigating pudendal nerve and its variability, and possible clinical outcome of these variants. Extracted data consisted of morphometric parameters, arrangement of the pudendal nerve at the level of roots, formation of pudendal nerve, position according to sacrospinal and sacrotuberal ligaments and its terminal branches. One female cadaver hemipelvis was dissected with common variability of separate course of inferior rectal nerve. During dissection photodocumentation was made to record course of pudendal nerve with focus on areas with recorded pathologies and areas exposed to iatrogenic damage during surgical procedures. RESULTS: Narrative review was done to provide background for photodocumentation. Unique photos of course of the pudendal nerve was made in areas with great clinical significance. CONCLUSION: Knowledge of anatomical variations and course of the pudendal nerve is important for examinations and surgical interventions. Surgically exposed areas may become a site for iatrogenic damage of pudendal nerve; therefore, unique picture was made to clarify topographic relations.
- MeSH
- disekce MeSH
- iatrogenní nemoci MeSH
- kloubní ligamenta MeSH
- lidé MeSH
- mrtvola MeSH
- pánev MeSH
- pudendální nerv * anatomie a histologie MeSH
- pudendální neuralgie * chirurgie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
OBJECTIVES: Postpartum retained products of conception are a relatively rare diagnosis occurring in approximately 1% of cases after spontaneous deliveries and abortions. The most common clinical signs are bleeding and abdominal pain. The diagnosis is based on clinical signs and ultrasound examination. MATERIAL AND METHODS: Retrospective analysis of 200 surgical procedures for the diagnosis of residua postpartum obtained in 64 months. We correlated the method and accuracy of diagnosis with definitive histological findings. RESULTS: During 64 months, we performed 23 412 deliveries. The frequency of procedures for diagnosis of retained products of conception (RPOC) was 0.85%. Most (73.5%) of the D&C were performed within six weeks of delivery. Histologically, the correct diagnosis was confirmed in 62% (chorion + amniotic envelope). There was interestingly lower concordance of histologically confirmed RPOC in post-CS patients (only 42%). In women after spontaneous delivery of the placenta, the diagnosis of RPOC was confirmed by histological correlate in 63%, and the highest concordance occurred in women after manual removal of the placenta in 75%. CONCLUSIONS: Concordance with histological findings of chorion or amnion was seen in 62% of cases; this means that the incidence rate in our study was around 0.53%. The lowest concordance is after CS deliveries, 42%. D&C for RPOC should be performed after adequate clinical evaluation and in the knowledge of 38% false positivity. There is certainly more space for a conservative approach under appropriate clinical conditions, especially in patients after CS.
- MeSH
- komplikace těhotenství * MeSH
- lidé MeSH
- poporodní období MeSH
- retrospektivní studie MeSH
- samovolný potrat * MeSH
- těhotenství MeSH
- zadržená placenta * diagnostické zobrazování chirurgie epidemiologie MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: The good healing of the hysterotomy after cesarean section is important for subsequent pregnancies. However, the factors which improve this healing have not been completely described, yet. In this study, we focused on factors which may affect healing of hysterotomy within one year after delivery, such as menstruation, breastfeeding, and the use of the contraception. MATERIAL AND METHODS: Following delivery, total of 540 women were invited for three consecutive visits at six weeks, six months, and 12 months postpartum. The presence of menstruation, frequency of breastfeeding and contraception use were recorded. The scar was evaluated by vaginal ultrasound as already described. The impact of menstruation, breastfeeding, and contraception method on presence of niche was evaluated. RESULTS: The presence of menstruation increased odds to have niche by 45% (CI 1.046-2.018, p = 0.026). Secondarily, our results demonstrated a statistically significant protective effect of breastfeeding on the incidence of niche with OR 0.703 (CI 0.517-0.955, p = 0.024). Breastfeeding decreases odds to have niche by 30%. Also, the use of gestagen contraception lowered the odds by 40% and intrauterine device (IUD) or combine oral contraceptive (COC) by 46.5%. The other possibly intervening factors were statistically controlled. CONCLUSIONS: Amenorrhea, breast-feeding and progesterone-contraceptive decreases the risk of uterine niche within one year follow up.
- MeSH
- amenorea * MeSH
- antikoncepce metody MeSH
- císařský řez MeSH
- hysterotomie MeSH
- laktace * MeSH
- lidé MeSH
- ochranné faktory MeSH
- poporodní období MeSH
- retrospektivní studie MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Cíl: Cílem studie bylo popsat monochoriální gravidity sledované v Ústavu pro péči o matku a dítě v Praze ve čtyřletém období (2012–2015) a porozené mezi 24. a 37. gestačním týdnem gravidity s ohledem na komplikace vázané na tento typ gravidity. Typ studie: Retrospektivní. Název a sídlo pracoviště: Ústav pro péči o matku a dítě, Praha. Metodika: Soubor tvořilo celkem 177 pacientek s dvojčetnými monochoriálními graviditami, které na našem pracovišti porodily ve sledovaném období dva nebo jeden vitální plod, popř. došlo k úmrtí obou plodů in utero. Výsledky: Z celkového počtu 177 žen porodilo v kohortě do gestačního týdne 25+6 celkem 12 žen (6,8 %), v rozmezí 26+0 až 27+6 porodily čtyři ženy (2,3 %), v rozmezí 28+0 až 31+6 porodilo 37 žen (20,9 %), od 32+0 do 35+6 porodilo 84 žen (47,8 %), po 36+0 porodilo 40 žen (22,6 %). Průměrný týden porodu byl 33,8. Gravidita byla v 11,9 % ukončena z důvodu předčasného odtoku plodové vody (PPROM), ve 12,4 % došlo k nástupu pravidelné děložní činnosti a v 53,3 % byla těhotenství ukončována z důvodu jiné iatrogenní indikace. Ve 23,3 % se jednalo o nekomplikované gravidity ukončené po 36. gestačním týdnu. Celkem 5,7 % pacientek porodilo vaginálně, u 94,3 % bylo těhotenství ukončeno císařským řezem. Po umělém oplodnění otěhotnělo 19,9 % pacientek, 80,1 % otěhotnělo spontánně. Věk rodiček se pohyboval v rozmezí 20 až 43 let, s mediánem 32,3. Průměrná hmotnost většího plodu byla 2047,6 g (min. 520 g, max. 3530 g), průměrná hmotnost menšího plodu byla 1799,5 g (min. 350 g, max. 2790 g). V 30 případech (16,9 %) jsme prováděli intrauterinní intervenci. Ve 21 případech z 30 jmenovaných (11,9 %) pro TTTS (twin to twin transfusion syndrome), v pěti případech (2,8 %) pro VVV (CNS, gastroschíza) či TRAP (twin reversed arterial perfusion) a ve čtyřech případech (2,2 %) pro sIUGR typ III. V našem souboru se jako nejčastější komplikace vyskytovala sIUGR (36/177 pacientek – 20,3 %), dále TTTS (21/177 pacientek – 11,9 %) a nejméně často vrozená vývojová vada plodu včetně TRAP sekvence (5/177 pacientek – 2,8 %) Celkem 19 pacientek porodilo pouze jeden vitální plod, ve dvou případech došlo k úmrtí obou plodů in utero. Jednou došlo k úmrtí plodu ihned po porodu – jednalo se o plod s mnohočetnými vývojovými vadami, kde nebylo možné pro anhydramnion provést bipolární okluzi pupečníku. Po porodu byla tomuto plodu podána pouze paliativní péče. Závěr: Studie poskytla shrnutí informací o rizikovosti monochoriálních gravidit s důrazem na nutnost pečlivého sledování rodiček ve stanovených intervalech a nutnost okamžitého odeslání pacientky do perinatologického centra k dalšímu sledování v případě suspektního či patologického nálezu.
Objective: The purpose of this study was to describe monochorionic twin pregnancies and their complications, born between 24th and 37th week of gestation in the Institute for the Care of Mother and Child in years 2012–2015. Design: Retrospective cohort. Setting: The Institute for the Care of Mother and Child, Praha. Methods: From 2012 to 2015 we observed 177 monochorionic twin pregnancies from which two or one viable fetuses were born, or both fetuses died in utero. Results: From a total of 177 women, 12 (6.8%) gave birth before 26th week of gestation, between 26+0 – 27+6 four women (2.3%) gave birth, 37 women (20.9%) between 28+0 – 31+6, 84 women (47.8%) between 32+0 – 35+6 and after 36th week of gestation 40 women (22.6%) gave birth. Mean week of delivery was 33.8. Indications for termination of pregnancies were premature rupture of membranes (PPROM) in 11.9%, onset of spontaneus uterine contractions in 12.4% and in 53.3% other iatrogenic indication. 23.3% of pregnancies in our cohort were uncomplicated and terminated after 36th week of gestation. We performed caesarean section in 94.3%, in 5.7% patients gave birth vaginally. In vitro fertilization had 19.9% women, 80.1% conceived spontaneously. The age range of pregnant women in our cohort was 20–43, with median 32.3. Mean weight of bigger fetus was 2047.6 g (min. 520 g, max. 3530 g), mean weight of smaller fetus was 1799.5 g (min. 350 g, max. 2790 g). In 30 cases (16.9%) we performed intrauterine intervetion. In 21/30 cases (11.9%) for TTTS diagnose, in 5/30 cases (2.8%) for congenital abnormalities or TRAP sequence and in 4/30 cases (2.2%) for sIUGR type III. The most frequent complication in our cohort was sIUGR (36 patients – 20.3%), TTTS (21 patients – 11.9%) and on the third place congenital abnormality or TRAP sequence (five patients – 2.8%) Nineteen patients gave birth to one viable fetus, in two cases both fetuses died in utero. In one case, in twin pair, one new-born died shortly after the birth – it had several congenital abnormalities and due to anhydramnion it was impossible to perform amnioinfusion and umbilical cord occlusion. After the birth it was given palliative care. Conclusion: The study brought data about specific risks in monochorionic twin pregnancies and suggests careful observation of women in fixed intervals and necessity of immediate referral to perinatal centre in case of any suspicious or pathological finding.
- MeSH
- dvojčata * MeSH
- fetofetální transfuze MeSH
- interpretace statistických dat MeSH
- komplikace těhotenství MeSH
- lidé MeSH
- myelodysplastické syndromy MeSH
- odumření plodu MeSH
- retrospektivní studie MeSH
- růstová retardace plodu MeSH
- samovolný potrat MeSH
- těhotenství mnohočetné * MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
