Human papillomavirus (HPV) is the most common sexually transmitted viral infection worldwide, which may result in the development in benign lesions or malignant tumors. The prevalence of HPV infection is twice as high in pregnancy as in non-pregnant women. Additionally, there is a risk of vertical transmission of HPV from mother to fetus during pregnancy or childbirth. Various studies have reported an increased risk of adverse pregnancy outcomes in HPV-positive women, including miscarriage, preterm birth, premature rupture of membranes, preeclampsia, fetal growth restriction, and fetal death. HPV vaccination is not currently recommended during pregnancy. On the other hand, there is no evidence linking HPV vaccination during pregnancy with adverse pregnancy outcomes and termination of pregnancy is not justified in this case.
- Klíčová slova
- HPV, adverse pregnancy outcomes, human papillomavirus, human papillomavirus– pregnancy complications, vaccination in pregnancy,
- MeSH
- infekce papilomavirem * přenos diagnóza prevence a kontrola MeSH
- infekční komplikace v těhotenství * epidemiologie virologie MeSH
- lidé MeSH
- těhotenství MeSH
- vakcíny proti papilomavirům MeSH
- vertikální přenos infekce * MeSH
- výsledek těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- vakcíny proti papilomavirům 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.
- Klíčová slova
- Anatomical variation, Entrapment, Pudendal nerve, Pudendal neuralgia, Sacrospinous ligament, Sacrotuberous ligament,
- 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
The management of breast cancer during pregnancy (PrBC) is a relatively rare indication and an area where no or little evidence is available since randomized controlled trials cannot be conducted. In general, advances related to breast cancer (BC) treatment outside pregnancy cannot always be translated to PrBC, because both the interests of the mother and of the unborn should be considered. Evidence remains limited and/or conflicting in some specific areas where the optimal approach remains controversial. In 2022, the European Society for Medical Oncology (ESMO) held a virtual consensus-building process on this topic to gain insights from a multidisciplinary group of experts and develop statements on controversial topics that cannot be adequately addressed in the current evidence-based ESMO Clinical Practice Guideline. The aim of this consensus-building process was to discuss controversial issues relating to the management of patients with PrBC. The virtual meeting included a multidisciplinary panel of 24 leading experts from 13 countries and was chaired by S. Loibl and F. Amant. All experts were allocated to one of four different working groups. Each working group covered a specific subject area with two chairs appointed: Planning, preparation and execution of the consensus process was conducted according to the ESMO standard operating procedures.
- Klíčová slova
- (neo) adjuvant therapy, pregnancy management during cancer, pregnancy-related breast cancer,
- Publikační typ
- směrnice pro lékařskou praxi MeSH
- Klíčová slova
- Clinical Practice Guidelines, cancer, fertility, pregnancy,
- MeSH
- kryoprezervace MeSH
- lidé MeSH
- nádory * terapie MeSH
- těhotenství MeSH
- zachování plodnosti * MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- směrnice pro lékařskou praxi MeSH
OBJECTIVE: To evaluate the risk of involvement of sentinel lymph nodes in cervical cancer stage IA1 with lymphovascular space invasion and IA2 using the detection of sentinel lymph nodes. DESIGN: Original article. SETTINGS: Department of Gynecology and Obstetrics 3rd Faculty of Medicine, Charles University, Faculty Hospital Královské Vinohrady, Prague; Oncogynecological centrum; Department of Pathology 3rd Faculty of Medicine, Charles University, Faculty Hospital Kralovské Vinohrady, Prague. METHODS: The study included women from prospective protocols LAP I and LAP II with cervical cancer stage IA1 with lymphovascular space invasion and stage IA2 from 2002 to 2018 classified according to FIGO 2014 staging, TNM 8. Detection of sentinel lymph nodes throughout this period was performed using ultra-short protocol with Tc and patent blau and also by histopathological examination. RESULTS: In the first group (28 women) with stage IA1 and lymphovascular space invasion diagnosed from cone biopsy there were two women with positive lymph nodes (7.1%). In the group stage IA2 (34 women) there were 13 women (38.2%) with positive lymphovascular space invasion and two women had positive lymph nodes (5.9%). The risk of positive lymph nodes for stage IA1 with lymphovascular space invasion and for stage IA2 is not statistically significant OR = 0.8125 (95% CI 0.1070-6.172). CONCLUSION: The detection of sentinel lymph nodes aids to individualize the therapy of early stage cervical cancer and helps to reduce the radicalization of surgery. The risk of positive lymph nodes in stage IA1 with lymphovascular space invasion and stage IA2 with/without lymphovascular space invasion is the same. The results confirm, that the detection of sentinel lymph nodes in stage IA1 with lymphovascular space invasion is fully indicated.
- Klíčová slova
- cervical uterine cancer, sentinel lymph node biopsy,
- MeSH
- biopsie sentinelové lymfatické uzliny * MeSH
- lidé MeSH
- lymfadenektomie MeSH
- lymfatické metastázy MeSH
- nádory děložního čípku patologie chirurgie MeSH
- prospektivní studie MeSH
- sentinelová uzlina patologie MeSH
- staging nádorů MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.cancerinpregnancy.org) and the creation of national tumor boards with multidisciplinary teams of care providers (supplementary Box S1, available at Annals of Oncology online) is encouraged.
- Klíčová slova
- cancer, chemotherapy, cognitive, gynecologic, offspring, pregnancy,
- MeSH
- lidé MeSH
- mezinárodní spolupráce MeSH
- nádorové komplikace v těhotenství terapie MeSH
- nádory ženských pohlavních orgánů terapie MeSH
- prognóza MeSH
- směrnice pro lékařskou praxi jako téma normy MeSH
- společnosti lékařské MeSH
- těhotenství MeSH
- zpožděný efekt prenatální expozice etiologie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
BACKGROUND: Colorectal cancer in pregnancy is rare, with an incidence of 0.8 per 100,000 pregnancies. Advanced disease (stage III or IV) is diagnosed more frequently in pregnant patients. We aimed to review all cases of colorectal cancer in pregnancy from the International Network on Cancer, Infertility and Pregnancy database in order to learn more about this rare disease and improve its management. METHODS: Data on the demographic features, symptoms, histopathology, diagnostic and therapeutic interventions and outcomes (obstetric, neonatal and maternal) were analysed. RESULTS: Twenty-seven colon and 14 rectal cancer cases were identified. Advanced disease was present in 30 patients (73.2%). During pregnancy, 21 patients (51.2%) received surgery and 12 patients (29.3%) received chemotherapy. Thirty-three patients (80.5%) delivered live babies: 21 by caesarean section and 12 vaginally. Prematurity rate was high (78.8%). Eight babies were small for gestational age (27.6%). Three patients (10.7%) developed recurrence of disease. Overall 2-year survival was 64.4%. CONCLUSION: Despite a more frequent presentation with advanced disease, colorectal cancer has a similar prognosis in pregnancy when compared with the general population. Diagnostic interventions and treatment should not be delayed due to the pregnancy but a balance between maternal and foetal wellbeing must always be kept in mind.
- Klíčová slova
- Colon, cancer, outcome, pregnancy, rectum, treatment,
- MeSH
- adjuvantní chemoterapie MeSH
- dospělí MeSH
- kohortové studie MeSH
- kolorektální nádory mortalita patologie chirurgie MeSH
- kombinovaná terapie MeSH
- lidé MeSH
- lokální recidiva nádoru mortalita MeSH
- míra přežití MeSH
- nádorové komplikace v těhotenství mortalita patologie chirurgie MeSH
- novorozenec MeSH
- porodní hmotnost MeSH
- registrace MeSH
- staging nádorů MeSH
- těhotenství MeSH
- výsledek těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- Geografické názvy
- Československo MeSH
OBJECTIVE: To present actual complex review of diagnosis and treatment of breast cancer during pregnancy, demonstrated on particular case report. DESIGN: Case report and review article. SETTING: University Hospital Královské Vinohrady, Prague Department of Obstetrics and Gynaecology, Department of Radiotherapy and Oncology. CASE REPORT: Patient with breast cancer diagnosed in early pregnancy, her oncological treatment. Circumstantial finding was endometriosis of rectovaginal septum and dehiscence of uterotomy after C-section. DISCUSSION: On this case we demonstrate importance of all early diagnosis, prompt examination management and early therapy onset already during the pregnancy. CONCLUSION: Breast cancer therapy results are equal in pregnant and non-pregnant women, when we compare patients of same age, with same stage and same biological characteristics of tumor. The obstacle during pregnancy is often late diagnosis, which causes bigger size of tumor and more extensive affection of lymphatics in time of therapy onset.
- Klíčová slova
- Endometriosis, breast cancer, breast carcinoma, chemotherapy, pregnancy,
- MeSH
- císařský řez MeSH
- endometrióza MeSH
- lidé MeSH
- nádorové komplikace v těhotenství * diagnóza terapie MeSH
- nádory prsu * diagnóza terapie MeSH
- těhotenství MeSH
- výsledek těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
OBJECTIVE: The aim of this work is to present a case of traumatic bladder rupture in a patient with total uterine prolapse. Additionally, we provide a brief description of this issue. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, 3rd Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague; Departement of Radiology, 3rd Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague. RESULTS: We present a case report of a patient with a total uterine prolapse that has been examined for a lower abdominal pain, hematuria and difficulties with urination. The problems arose suddenly after the fall on the ground. These symptoms are typical for bladder rupture, but other more frequent causes have to be ruled out. CT scan showed a contrast agent leak from the bladder. The patient was indicated for surgical revision and suture of the bladder wall. CONCLUSION: Separately, rupture of the bladder occurs rarely. Most often, this injury is part of a wider trauma - especially after car crashes. However, our case report suggests that this option should be considered.
- Klíčová slova
- bladder rupture, hematuria, uterine prolapse,
- MeSH
- lidé MeSH
- močový měchýř * MeSH
- nemoci močového měchýře * etiologie MeSH
- prolaps dělohy * MeSH
- ruptura MeSH
- těhotenství MeSH
- úrazy pádem * MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
