Objective: To synthesize current evidence on global maternal mortality trends, focusing on regional disparities, leading causes of maternal death, and methodological challenges in estimating maternal mortality across different health system contexts. Methods: A systematic review was conducted following PRISMA guidelines. Searches were performed in PubMed/MEDLINE and SciELO using terms related to maternal mortality, health systems, and social determinants. Observational studies, systematic reviews, meta-analyses, and institutional reports with explicit methodology were included. Studies focusing only on morbidity, lacking clear methodology, or those not available in English or Portuguese were excluded. Data on maternal mortality ratios, trends, causes of death, and structural determinants were extracted and synthesized narratively due to methodological heterogeneity. Results: A total of 513 records were identified; after removing 173 duplicates, 340 were screened. Following title and abstract review, 299 records were excluded. Forty-one full-text articles were assessed, and 30 were excluded. Eleven studies were included in the qualitative synthesis (three observational studies, three systematic reviews/meta-analyses, and five institutional reports). Maternal mortality declined substantially between 1990 and 2015, but progress slowed thereafter. Approximately 287,000 maternal deaths occurred in 2020. Major regional disparities persist, with the highest burden in Sub-Saharan Africa. Hemorrhage, hypertensive disorders, and sepsis remain the leading direct causes, while indirect causes – especially cardiovascular disease – are increasingly relevant. Conclusion: Although maternal mortality has declined since 1990, progress has slowed and major regional inequalities persist. Indirect causes are becoming more prominent, and methodological differences complicate global estimates. Further reductions will require stronger healthcare systems, improved surveillance, and policies addressing social determinants of maternal health. Key words: global – maternal mortality – healthcare systems – regional disparities
Women’s satisfaction with healthcare services and their childbirth experience represent an important dimension of maternity care quality alongside traditional indicators of maternal and perinatal morbidity and mortality. The aim of this review article is to summarize current evidence on the measurement of women’s satisfaction with maternity services, clarify the relationship between satisfaction, childbirth experience and quality of care, describe the most commonly used psychometric instruments, and identify clinical, organizational, and psychosocial predictors of positive and negative childbirth experiences. Childbirth experience is a multidimensional construct encompassing professional support, communication, participation in decision-making, perceived safety, personal competence, pain, stress, fulfilment of expectations, support from a companion, contact with the newborn, and the care environment. The instruments used include the Birth Satisfaction Scale-Revised and the Childbirth Experience Questionnaire 2, whereas the Wijma Delivery Expectancy/Experience Questionnaire is primarily focused on fear of childbirth. In the Czech context, questionnaires assessing the psychosocial climate of maternity units, the Czech version of the Birth Satisfaction Scale-Revised, its partner version, and the Czech adaptation of the Pregnancy and Maternity Care Patients’ Experiences Questionnaire have been developed, validated, or used in studies. Their use, however, has not yet been standardized or implemented systematically. A negative childbirth experience may be associated with women’s mental health, sexuality, breastfeeding, attitudes towards future pregnancy, and the preferred mode of subsequent birth. Systematic, standardized, and repeated measurement of women’s experiences should therefore be regarded as an integral component of clinical evaluation and quality management rather than as an isolated questionnaire survey. Key words: patient satisfaction – childbirth experience – perinatal care – quality of health care – respectful maternity care – communication – shared decision-making – patient experience
Oral menopause hormone therapy (MHT) is associated with a two- to four-fold increased risk of venous thromboembolism (VTE). According to the majority of studies, the increased risk of venous thromboembolic disease does not apply to transdermal administration. Transdermal MHT is considered safe even in women at a high risk of thromboembolic disease (such as those with overweight, obesity, thrombophilic conditions, recent surgery, immobilization, varicose veins, malignancy, or smoking). Acute VTE represents an absolute contraindication to both oral and transdermal administration of MHT. A personal history of VTE is an absolute contraindication to oral MHT, but only a relative contraindication for the transdermal route of MHT. Menopause hormone therapy must be personalized for each woman. Key words: menopause hormone therapy – transdermal application – venous thromboembolic disease – thrombophilic mutation – overweight – chronic estrogen deficiency
The aim of this review article is to summarize current possibilities for the preoperative prediction of lymphovascular space invasion in endometrial carcinoma, which represents an important prognostic factor associated with a higher risk of lymph node metastases, disease recurrence, and reduced overall survival. The text summarizes findings from clinical studies with a focus on imaging methods, role of histopathological and molecular markers, serum biomarkers, and predictive models. Imaging methods indicate an association between lymphovascular space invasion and deep myometrial invasion, cervical stromal involvement, and larger tumor size. Advanced approaches, such as quantitative analysis of magnetic resonance imaging data or magnetic resonance elastography, enable noninvasive assessment of tumor biological aggressiveness and improve estimation of the presence of lymphovascular space invasion. Histopathological and molecular tumor characteristics also play an important role. An increased risk of lymphovascular space invasion is observed in tumors with high chromosomal instability and impaired p53 protein function. Expression of the L1 cell adhesion molecule in tumor tissue and elevated serum levels of cancer antigen 125 and human epididymis protein 4 may further contribute to identifying patients at a higher risk. Integration of clinical, imaging, and molecular data into predictive models allows more precise risk stratification and potential individualization of surgical and adjuvant management; however, their routine use still requires further prospective validation. Key words: endometrial cancer – lymphovascular space invasion – magnetic resonance imaging – radiomics – L1 cell adhesion molecule – cancer antigen 125 – human epididymis protein 4 – prediction models
Objective: We assessed the relationship between oxidative and reductive stress (ORS), the quality of intra-acrosomal enzymes (Hs8 and Hs14), sperm-agglutinating antibodies, and other semen analysis parameters in the semen of men from couples with reduced fertility. Materials and methods: Semen samples from 112 men (aged 25–50 years, mean 35.5 years) were analyzed. Basic semen parameters were evaluated according to the manual of the World Health Organization. Presence of antisperm antibodies was assessed using the FertiPro direct mixed antiglobulin reaction test (MAR test IgA, IgG). Intra-acrosomal enzymes were evaluated by immunofluorescence using monoclonal antibodies labeled Hs8 and Hs14, and the redox potential of spermatozoa was measured using the MiOXYS analyzer. Results: ORS was within the normal range in 58.9% of men, while oxidative stress was present in 24.1% and reductive stress in 17%. A highly significant association was demonstrated between ORS status and normal/pathological semen analysis. A very strong relationship was observed between oxidative stress and oligozoospermia. Oxidative stress was significantly correlated with reduced levels of intra-acrosomal enzymes – only 37% of patients with oxidative stress had normal values of both Hs8 and Hs14, compared with approximately 80% in those with normal stress levels. The most frequent abnormalities occurred in patients with oligozoospermia (O), in whom no patient exhibited normal levels of both enzymes. In contrast, in normozoospermia (N), normal values predominated – 41 patients for Hs8 and 39 patients for Hs14. No significant association was found between ORS status and MAR test results. Conclusion: Oxidative and reductive stress, together with immunological factors in the semen, significantly affect sperm integrity and function. In our laboratory, ORS assessment is part of the diagnostic work-up of immunologically reduced male fertility, as antisperm antibodies may damage sperm directly through binding and indirectly via activation of inflammatory responses and increased production of reactive oxygen species. Therapy is individualized and combined with immunomodulatory, antioxidant, or redox-based approaches according to the identified pathology. Key words: oxidative stress – reductive stress – sperm – antisperm antibodies – intra-acrosomal enzymes – reactive oxygen species – immunological infertility in men
