Catecholamine-O-methyl transferase (COMT) catalyzes the O-methylation of catechol-structured compounds such as catecholamines and catecholestrogens. A genetic variation in the human COMT gene (rs4680 or Val158Met) significantly reduces three-to-four-fold catecholamine metabolism and influences neurotransmitter levels, thereby modulating preeclampsia (PE) susceptibility. The present meta-analysis was conducted to evaluate the link between the COMT Val158Met variant and PE risk. Case-control studies published until November 20, 2025 were systematically searched from PubMed, Google Scholar, and Web of Science databases. To assess the association between the COMT Val158Met variant and PE, Odds ratios and 95% confidence intervals were calculated under three genetic models. The results indicated no significant association between the COMT Val158Met variant and PE risk across three genetic models, including the allele (Met vs. Val: Overall OR 1.19, 95% CI 1.00-1.43, P = 0.052), recessive (Met/Met + Met/Val vs. Val/Val: Overall OR 1.16, 95% CI 0.95-1.40, P = 0.137), and dominant (Met/Met vs. Met/Val + Val/Val OR 1.39, 95% CI 0.97-2.00, P = 0.075) models. Furthermore, subgroup analyses based on ethnicity also indicated no association between the Val158Met variant and PE risk in Caucasian and Asian populations. Sensitivity analyses conducted using the leave-one-out method revealed that the results are robust. Asymmetry observed in Begg's funnel plot indicated a significant publication bias in the dominant model (P = 0.012). In summary, results showed that the COMT Val158Met variant is not associated with PE risk. As this meta-analysis contradicts the biological plausibility that COMT alleles influence catecholamine neurotransmitters and PE, the results warrant careful interpretation and further investigation.
OBJECTIVE:The aim of this pilot study was to evaluate and compare the diagnostic accuracy of digital vaginal examination versus intrapartum ultrasound (IUS) during the first and second stages of labor in women with cephalic presentation. MATERIALS AND METHODS:This prospective comparative study was conducted at the Department of Gynecology and Obstetrics, L. Pasteur University Hospital in Košice. The cohort included parturients (regardless of parity) with regular uterine contractions, cephalic presentation, and ruptured membranes. To ensure high data quality, all ultrasound examinations were performed by senior obstetricians with at least 8 years of clinical experience. Examining obstetricians were blinded to each other's findings. The assessment focused on fetal position, head position, head station, and progression during labor. IUS included a transabdominal approach (head position) and a transperineal approach, measuring head-perineum distance and angle of progression. In cases of discrepancy, the ultrasound finding was considered the reference standard. RESULTS:A total of 47 patients were included. Agreement between IUS and VE across all parameters was observed in 27 cases (57%). Discrepancies were noted in 20 patients (43%), with the most frequent errors occurring in the assessment of fetal head position. The statistical superiority of ultrasound over digital examination was highly significant (P < 0.0001). Presence of a caput succedaneum was a major confounding factor, which was present in 45% of non-correlated cases. The caesarean section rate in the cohort was 21% (N = 10). CONCLUSION:While vaginal examination remains the global gold standard in routine obstetrics, it is inherently subjective and prone to inter-observer variability. Our findings suggest that intrapartum ultrasound provides a more objective, accurate, and reproducible assessment. Incorporating IUS into labor management may reduce the need for frequent digital examinations, potentially lowering the risk of chorioamnionitis and enhancing patient comfort while optimizing clinical decision-making.
BACKGROUND:To investigate risk factors and clinical characteristics of recurrent ectopic pregnancies. The study specifically aims to compare demographic data, laboratory findings, and reproductive histories between patients with single and recurrent episodes to identify predictors for secondary prevention. METHODS:From December 2007 to December 2011, 199 women with single ectopic pregnancy and 51 women with recurrent ectopic pregnancy were identified from our hospital records. The information collected for each woman included age, smoking status, recurrent time, signs and symptoms, laboratory findings, and treatment parameters. RESULTS:The recurrence rate was 20.4%. Mean age was comparable between groups (30.2 ± 4.9 vs. 30.5 ± 5.7 years, P = 0.800). Gravidity was significantly higher in the recurrent group (3.4 ± 1.8 vs. 2.8 ± 1.5, P = 0.028), and gravida ≥ 4 was more frequent among recurrent cases (43.1 vs. 28.1%, P = 0.030). A history of abortion was significantly more common in the recurrent group (45.1 vs. 18.1%, P = 0.001), corresponding to an approximately fourfold increased risk (OR 3.9, 95% CI 1.7-7.9). Serum b-hCG levels were significantly higher in recurrent cases (5,135.8 ± 5,230 vs. 3,153.0 ± 5,643 mIU/mL, P = 0.040). b-hCG > 4,000 mIU/mL was more frequent in the recurrent group (33.3 vs. 18.1%, P = 0.017), whereas b-hCG levels between 2,001-4,000 mIU/mL were less frequent (7.8 vs. 23.1%, P = 0.015). Smoking status, intrauterine device use, prior cesarean section, ultrasonographic localization, rupture rates, treatment modalities, and complication rates did not significantly differ between groups (P > 0.05). In a multivariate analysis, only a history of abortion remained an independent predictor of recurrent ectopic pregnancy (OR 3.01, 95% CI 1.499-6.043, P = 0.002). CONCLUSION:When ectopic pregnancy is diagnosed early and appropriate treatment modality is selected, morbidity, mortality, radical intervention rate, and treatment costs are significantly reduced. Therefore, women of reproductive age should be informed about ectopic pregnancy symptoms by clinicians to increase community awareness. Moreover, for successful secondary prevention, identification of modifiable risk factors for recurrent ectopic pregnancy is important.
This article reviews current surgical options for treatment of stress urinary incontinence (SUI), focusing on Single Incision Sling (SIS) systems and the effect of infiltration anesthesia on implant fixation within the obturator complex. By analyzing the current literature, this study highlights the advantages of minimally invasive approaches - such as reduced surgical burden, shorter recovery time, and lower economic costs - while identifying their limitations in long-term efficacy. Anatomical and technical factors responsible for failure of different generations of SIS are discussed, particularly inadequate fixation and incompatibility with variable pelvic dimensions. Special attention is paid to infiltration anesthesia, which can alter tissue perfusion and cause local tissue loosening, thereby reducing anchor stability. Despite the procedural advantages of SIS, the retropubic approach remains the gold standard due to its higher long-term success rate and stability. The article emphasizes the importance of individualized surgical planning and calls for further studies aimed at optimizing both minimally invasive techniques and anesthetic protocols. It also emphasizes initial conservative therapy and the use of bulking agents to treat SUI.
OBJECTIVE:To evaluate whether intraovarian infusion of autologous adipose-derived mesenchymal stem cells (MSCs) improves ovarian reserve parameters and oocyte retrieval outcomes in women with poor ovarian response. MATERIALS AND METHODS:This retrospective pre-post cohort study included 29 women aged 25-40 years who met the European Society of Human Reproduction and Embryology (ESHRE) criteria for poor ovarian response and had experienced at least one previous Assisted Reproductive Technology (ART) cycle without oocyte retrieval. A total of 1 × 10⁶ autologous adipose-derived MSCs were laparoscopically infused into four cortical quadrants of each ovary. Serum anti-Müllerian hormone (AMH) levels were measured at baseline and 2 months after treatment. Controlled ovarian stimulation using a gonadotropin-releasing hormone (GnRH) antagonist protocol was initiated two months post-infusion, followed by oocyte retrieval. Paired comparisons were performed using the Wilcoxon signed-rank test. Multivariable linear regression evaluated factors associated with change in AMH (DAMH), and binomial logistic regression assessed predictors of successful oocyte retrieval. RESULTS:Serum AMH levels increased significantly following MSC therapy. Median AMH rose from 0.01 ng/mL (0.01-0.02) to 0.02 ng/mL (0.01-0.04) (P = 0.001). No baseline demographic or clinical variables were independently associated with DAMH (all P > 0.05). DAMH was the only variable significantly associated with successful oocyte retrieval (likelihood ratio c² = 6.54, P = 0.011). Higher DAMH values corresponded to progressively increased predicted probabilities of oocyte retrieval. CONCLUSION:Intraovarian administration of autologous adipose-derived MSCs was associated with modest but significant improvements in AMH levels and oocyte retrieval probability. These exploratory findings warrant confirmation in larger prospective controlled studies with definitive reproductive endpoints.
