OBJECTIVES:To show the relationship between antral follicular count (AFC) levels and ovulation and pregnancy rates in sub-fertile women with polycystic ovarian syndrome who received clomiphene citrate and gonadotropin-based ovulation induction therapy. MATERIAL AND METHODS:A cohort study conducted from 1st February 2023 to 1st April 2025. A hundred sub-infertile women with polycystic ovarian syndrome were included. During days 3-5 of the menstrual cycle, a blood sample to measure basal anti-mullerian hormone (AMH), estradiol E (2), luteinizing hormone (LH) and follicular stimulating hormone (FSH).Antral follicular count (AFC) was measured for both ovaries through transvaginal ultrasound. All patients received Clomiphene citrate tablets and gonadotropins during a single cycle. Patients with at least 18 mm follicle received 5000 IU of human chorionic gonadotropin. Anovulation diagnosed when mid-luteal serum progesterone is below 10 pmol/L. Two weeks later, B-hCG levels were measured. RESULTS:The average number of antral follicles was 26.90 ± SD 9.73. The length of infertility was closely related to the groups of antral follicle count (p ≤ 0.001). Antral follicular count is a statistically significant predictor of ovulation (p =≤ 0.001). A strong association was found between antral follicular count and pregnancy, which was statistically significant (p ≤ 0.001). CONCLUSIONS:Antral follicular count can be used to assess response to treatment of subfertile polycystic ovarian syndrome women to ovulation induction by drugs, the rate of ovulation and pregnancy.
OBJECTIVES: To identify fetal growth trajectories between the second and third trimesters using changes in INTERGROWTH-21st estimated fetal weight (EFW) Z-scores and to evaluate their relationship with fetal size categories in uncomplicated singleton pregnancies. MATERIAL AND METHODS: This retrospective cohort study included 615 uncomplicated singleton pregnancies with routine ultrasound examinations performed in the second and third trimesters. EFW was calculated from standard biometric parameters and converted into gestational age-specific Z-scores according to the INTERGROWTH-21st standards. The change in EFW Z-score between the two examinations (ΔZ_EFW) was used to classify fetal growth trajectories as declining, stable, or increasing. Group comparisons were performed using one-way analysis of variance and Student's t-tests. RESULTS: A declining trajectory was identified in 336 fetuses (54.6%), a stable trajectory in 228 (37.1%), and an increasing trajectory in 51 (8.3%). Mean EFW Z-scores decreased significantly between the second and third trimesters in the overall cohort (0.80 ± 0.95 vs 0.20 ± 1.02; p < 0.001). Third-trimester EFW Z-scores differed significantly between trajectory groups (p < 0.001). SGA newborns were observed predominantly in the declining trajectory, whereas stable and increasing trajectories were mainly associated with AGA and LGA outcomes. CONCLUSIONS: Assessment of fetal growth trajectories based on changes in EFW Z-scores between two routine ultrasound examinations may complement conventional fetal growth assessment by identifying fetuses with slowing growth despite maintaining an estimated fetal weight within the normal range. This simple approach may provide additional clinically relevant information beyond a single cross-sectional fetal biometry measurement.
OBJECTIVES:Bacterial vaginosis (BV) is a recurrent condition with significant health implications. Microbiome transplantation has emerged as a potential treatment strategy. This meta-analysis assesses its efficacy in treating vaginosis and preventing recurrence. METHODS:A systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating microbiome transplantation for vaginosis treatment were conducted. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for short- and long-term efficacy. Sensitivity and publication bias analyses were performed. RESULTS:In the short-term follow-up, microbiome transplantation significantly reduced vaginosis recurrence (pooled RR = 0.628, 95% CI: 0.543-0.726, p < 0.001). However, heterogeneity was moderate (I² = 60.8%). Sensitivity analyses confirmed the robustness of findings. Long-term follow-up results showed a pooled RR of 0.746 (95% CI: 0.670-0.831, p < 0.001), though with higher heterogeneity (I² = 72.8%). After sensitivity adjustments, meta-analysis yielded a pooled RR of 0.865 (95% CI: 0.735-1.019, p = 0.083), suggesting reduced long-term efficacy. No significant publication bias was detected. CONCLUSIONS:Microbiome transplantation effectively reduces short-term vaginosis recurrence. However, long-term efficacy diminishes upon sensitivity adjustment, necessitating further investigation.
OBJECTIVES: LBN is a rare variant of uterine smooth muscle tumors. Although LBN is a benign variant of leiomyoma, recurrent cases have been reported. In our study, we aimed to evaluate the clinicopathological features of LBN cases and to define the characteristics of recurrent cases. MATERIAL AND METHODS: Seventy-six cases with LBN identified in the final pathology were included in the study. The patients’ physical examination findings, imaging reports, postoperative complications, and medical data related to recurrence, metastasis, disease-free survival, and overall survival after LBN diagnosis were retrospectively evaluated. An immunohistochemical evaluation of the cases was conducted. RESULTS: Average patient age: 42.3 years. Myomectomy: 46.1%; hysterectomy: 53.9%. Mean follow-up: 40.4 months. Recurrence: 2 cases (2.6%), both in the uterus and myomectomy group. Post-myomectomy pregnancies: 8 out of 35 cases (22.9%). Mitotic count: 2.7. ER positivity: 30%; PR positivity: 33.8%. Ki-67: negative in 56.6%, focal positivity in 42.1%, diffuse positivity in 1.3%. p16 positivity: 14.5%; p53 positivity: 22.4%. PHH3 distribution: various levels from 0/10 to 9/10 BBA. Both recurrences managed with myomectomy, identified as LBN recurrences. CONCLUSIONS: LBN is a rare type of uterine smooth muscle tumor with a low recurrence rate, primarily affecting women of reproductive age, making conservative treatments like myomectomy appropriate. However, concerns about morcellation remain. While immunohistochemistry markers and the mitotic index help differentiate between LBN and LMS, their effectiveness in predicting recurrence and prognosis in LBN is limited.
OBJECTIVES:Intraoperative frozen section (FS) analysis is widely used during surgery for ovarian tumors to guide the extent of the operative procedure. It plays a particularly significant role in young women, in whom fertility-sparing surgery is considered. Despite its high clinical utility, FS has technical limitations that may result in discrepancies compared with final histopathological diagnosis. To assess the concordance between intraoperative frozen section diagnosis and final histopathological examination of ovarian tumors, and to evaluate the diagnostic accuracy, sensitivity, specificity, and predictive values of FS. MATERIAL AND METHODS:The analysis included finally 100 women aged 11-78 years from among 114 who were hospitalized and underwent surgery for ovarian tumors conducted at a tertiary Gynecology and Obstetrics Clinical Hospital from January to June 2025. Frozen section diagnoses were compared with final histopathological results. Concordance rates, patterns of diagnostic discrepancies, and diagnostic performance parameters (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) were calculated using final histopathology as the reference standard. RESULTS:Overall concordance between frozen section and final histopathology was 85%. Diagnostic discrepancies were observed in 15% of cases, with only 2% considered clinically significant. Frozen section showed excellent diagnostic performance for benign tumors (sensitivity 100%, specificity 94.1%) and malignant tumors (specificity and PPV 100%). The lowest diagnostic accuracy was observed for borderline tumors, which accounted for most clinically relevant discrepancies. The most frequent source of discordance involved hemorrhagic cysts, which were ultimately diagnosed as endometriotic cysts on final histopathology. CONCLUSIONS:Intraoperative frozen section analysis is a reliable and safe diagnostic tool that effectively supports surgical decision-making in ovarian tumors. Its high diagnostic accuracy and predictive values confirm its clinical value, particularly in tailoring the extent of surgery. Special caution is warranted in the interpretation of borderline tumors, for which final histopathological examination remains essential.
OBJECTIVES:To investigate serum brown adipokine BMP8b levels in polycystic ovary syndrome (PCOS) and their association with metabolic parameters. MATERIAL AND METHODS:The present cross-sectional analysis enrolled 80 PCOS-diagnosed women alongside 40 matched controls. Serum levels of BMP8b, lipids, glucose metabolism, and reproductive hormones were assayed. Insulin resistance was assessed by HOMA-IR. RESULTS:Patients with PCOS exhibited significantly lower serum BMP8b levels compared to controls (43.11 ± 13.09 vs 106.45 ± 52.32, p < 0.001). In the PCOS group, BMP8b showed significant negative correlations with both BMI (r = -0.240, p < 0.05) and HOMA-IR (r = -0.246, p < 0.05), while in the control group, BMP8b was negatively correlated with TG (r = -0.436, p < 0.05). Notably, pooled analysis of all subjects revealed a strong inverse correlation between BMP8b and total testosterone (T) (r = -0.468, p < 0.001). CONCLUSIONS:Reduced BMP8b in PCOS correlates with metabolic dysfunction, suggesting brown adipose tissue as a potential therapeutic target.
OBJECTIVES:Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder linked to metabolic disturbances and increased cardiovascular risk. While the Rotterdam criteria classify PCOS into distinct phenotypes, the impact of percentage body fat (PBF) on lipid profiles across these subtypes remains unclear. This study aims to assess whether the association between PBF and lipid parameters differs among PCOS phenotypes. The research question is: "Does the relationship between PBF and lipid profile vary across PCOS phenotypes defined by the Rotterdam criteria?". MATERIAL AND METHODS:A cross-sectional analysis was conducted on 343 PCOS patients, categorized into four phenotypes using the Rotterdam criteria. Body composition was assessed using bioelectrical impedance analysis (InBody 170). Clinical and laboratory data were analyzed to explore phenotype-specific metabolic differences. RESULTS:Results show that higher PBF correlates with adverse lipid profiles, including elevated triglycerides (TG) and low-density lipoproteins (LDL) levels and decreased high-density lipoproteins (HDL) levels. Phenotype A exhibited the strongest inverse relationship between PBF and HDL, while Phenotype D showed the most pronounced positive correlation between PBF and triglycerides. These findings highlight the heterogeneity in metabolic risk among Rotterdam phenotypes of PCOS patients. CONCLUSIONS:There is phenotype-specific association between PBF and lipid components in PCOS. Phenotype A is particularly vulnerable to HDL reduction, while phenotype D shows the strongest triglyceride elevation. This study underscores the importance of individualized management strategies targeting body fat reduction to improve lipid profiles and reduce cardiovascular risk in PCOS patients. Specific interventions tailored based on phenotype and body composition may optimize treatment outcomes.
Objectives: Fetal and placental growth are influenced by multiple maternal and fetal factors, including fetal sex and maternal parity. Accurate knowledge of these determinants is essential for growth monitoring and perinatal risk assessment. This study aimed to evaluate the effects of fetal sex and maternal parity on birth weight, placental weight, and the fetal-to-placental weight ratio in a large single-center cohort. Material and methods: We conducted a retrospective cohort study of 4,642 singleton live births between 28 and 40 weeks of gestation at a tertiary hospital in the Wielkopolska region, Poland. Birth weight, placental weight, and fetal-to-placental weight ratios were analyzed according to fetal sex and maternal parity. Percentile charts were generated, and differences were assessed using appropriate statistical tests with p < 0.05 considered significant. Results: Male newborns had higher birth weights than females, with significant differences from 36 to 40 weeks. Placental weight increased with gestational age, with males showing higher values at 38-40 weeks. Fetal-to-placental weight ratios were higher in males at 30, 36, 37, and 40 weeks, indicating greater placental efficiency. Multiparous women delivered newborns with higher birth and placental weights compared to primiparas, particularly in late gestation. Correspondingly, fetal-to-placental ratios were higher among multiparas, reflecting enhanced placental efficiency in subsequent pregnancies. Conclusions: Fetal sex and maternal parity significantly influence fetal and placental growth and fetoplacental efficiency. Male newborns and offspring of multiparas had higher birth weights and more favorable fetal-to-placental weight ratios. The provided percentile charts may serve as practical references for obstetric and neonatal care in the Wielkopolska region.
OBJECTIVES: To gain insight into the attitudes of bereaved mothers targeting the impact of the autopsy on parents experiencing stillbirth. MATERIAL AND METHODS: The design was a population based, cross-sectional study using semi-structured interviews. Setting included mothers with confirmed stillbirth in a Tertiary University Hospital involving the Department of Pastoral and Spiritual Care and the Department of Pathology. Participants included forty-five mothers, who were interviewed. RESULTS: Postmortem examinations are accepted if communication between healthcare providers and mothers is maintained. In 39 out of 45 mothers, the stillbirth was experienced as a sudden unexpected event. Thirty-two of 45 mothers found the interview with the pathologist helpful in clarifying the autopsy report. In 37 out of 45, the in-person meeting was found beneficial for the grieving process. CONCLUSIONS: The pathologist may represent an integral component for the grieving process of families experiencing loss. Despite misconceptions, pathologists may play a crucial role in the well-being of families experiencing stillbirth.
OBJECTIVES: HPV vaccines have been proven effective against genital warts and various cancers, including cervical, anal, penile, vulvar, vaginal, and oropharyngeal cancers. This study aimed to evaluate the cost-effectiveness of including the 9-valent HPV vaccine in the Turkish National Immunization Program (NIP). MATERIAL AND METHODS: The Papillomavirus Rapid Interface for Modeling and Economics (PRIME) framework was applied to project the potential financial and societal outcomes of introducing HPV vaccination into Turkiye’s 2024 National Immunization Schedule. Demographic data were obtained from the Turkish Statistical Institute (TUIK, Turkiye Istatistik Kurumu). The cost of vaccine was gathered from Ministry of Health. Epidemiologic inputs, treatment expenditure data, and additional modeling parameters were derived from previously published research sources. Model outputs included projected vaccination expenses, savings from avoided treatment, net costs, prevented cases and deaths, gained life-years, averted disability-adjusted life-years (DALYs), and estimated incremental cost-effectiveness ratios. Potential variability in model projections was examined through deterministic sensitivity testing. RESULTS: At the national level, with the 9-valent HPV vaccination of a single age cohort in the base year, an estimated 772 cervical cancer cases and 369 related deaths could be avoided through implementation of the vaccination program. With an estimated US$13,754 per DALY gained, the 9-valent HPV vaccine fell within the acceptable cost-effectiveness threshold, defined as three times the GDP per capita. Sensitivity testing confirmed consistent outcomes across parameter variations, identifying the discount rate as the major driver influencing baseline estimates. CONCLUSIONS: Findings from this analysis support the inclusion of HPV vaccination within the National Immunization Program (NIP) as a cost-effective public health strategy capable of reducing the burden of cervical cancer. Even when considering only cervical cancer, HPV vaccination proves to be cost-effective; when benefits against genital warts and other HPV-related cancers are included, the overall impact increases significantly.
OBJECTIVES:Circadian rhythm (CR) is a 24-hour biological cycle regulated by endogenous and environmental factors. Altered CR gene expression has been associated with gestational diabetes mellitus (GDM), potentially affecting vascular regulation and fetal hemodynamics. This study aimed to evaluate the effect of circadian rhythm on Doppler ultrasonographic parameters in pregnancies complicated by GDM. MATERIAL AND METHODS:This prospective cross-sectional study included 80 pregnant women between 32-39 gestational weeks classified into control, diet-regulated GDM, and insulin-regulated GDM groups. Doppler measurements of the umbilical artery (UA), middle cerebral artery (MCA), and uterine arteries (UtA) were performed twice daily at sunrise and sunset. Peak systolic velocity (PSV), systole/diastole ratio (S/D), pulsatility index (PI), and resistance index (RI) were analyzed. RESULTS:In the control group, MCA S/D and PI demonstrated significant diurnal variation (p = 0.03 and p = 0.01, respectively). In insulin-regulated GDM, MCA PI showed significant variation between morning and evening measurements (p = 0.006), whereas MCA PSV, S/D, and RI remained unchanged (p > 0.05). Right uterine artery S/D, PI, and RI values also differed significantly in insulin-regulated GDM (p = 0.014, p = 0.008, and p = 0.001, respectively). No significant variation was detected in the diet-regulated GDM group or in umbilical and left uterine artery Doppler parameters. Intraclass correlation coefficient analysis demonstrated moderate-to-good reproducibility for MCA and UA measurements and very good reliability for uterine artery S/D, PI, and RI indices. DISCUSSION:The findings suggest that circadian rhythm influences Doppler parameters, particularly in insulin-regulated GDM pregnancies. These results are consistent with previous studies demonstrating vascular and metabolic alterations in GDM. CONCLUSIONS:Doppler parameters vary during the day, reflecting circadian influence, especially in insulin-regulated GDM.
Growing teratoma syndrome (GTS) is a rare condition classically associated with platinum-based chemotherapy for malignant ovarian germ cell tumors. However, post-treatment findings following ovarian immature teratoma may represent a broader spectrum of entities that mimic recurrent malignancy and create substantial diagnostic challenges. Given the rarity of these conditions and their diverse clinical presentations, we present two illustrative cases managed at the Department of Gynecology and Gynecologic Oncology, University Hospital in Cracow, and review of the available literature. The first case involved a patient with ovarian immature teratoma who developed a classical post-chemotherapy GTS requiring surgical resection. During follow-up, a subsequent suspicious lesion demonstrated increased metabolic activity on positron emission tomography and was associated with mildly elevated tumor markers, raising concern for recurrent disease. Histopathological examination ultimately revealed a foreign-body granulomatous reaction. The second case involved a patient treated surgically for ovarian immature teratoma without adjuvant chemotherapy who subsequently developed peritoneal gliomatosis coexisting with deep infiltrating endometriosis, initially raising suspicion of intraperitoneal dissemination. These cases highlight the broad spectrum of post-treatment manifestations that may occur following ovarian immature teratoma. Enlarging masses, peritoneal implants, metabolically active lesions, and elevated tumor markers do not necessarily indicate malignant recurrence. Accurate diagnosis frequently requires correlation of imaging findings with surgical and histopathological assessment, and awareness of these rare entities is essential for appropriate management and surveillance.
OBJECTIVES: In the course of the study the differences regarding both C-reactive protein immune-expression and Lysophosphatidic Acid immune-expression between the stages and histologic grades of the vulvar cancer and the differences between the group of patients diagnosed with lichen sclerosus and the group of patients diagnosed with the vulvar cancer were assessed and verified. MATERIAL AND METHODS: Thirty patients with histopathological confirmed vulvar cancer and 32 women with histologically confirmed lichen sclerosus were enrolled into the study. The representative sections of tissues suspended in a 10% buffered formalin were examined regarding immunohistochemistry for C-reactive protein immune-expression and Lysophosphatidic Acid. RESULTS: There were no differences in intra-tumour nor peri-tumour depending on vulvar cancer stage defined following the International Federation of Gynecology and Obstetrics guidelines nor grading. The highest median C-reactive protein immune-expression was observed in intra-tumour and peri-tumour vulvar cancer specimens. Median peri-tumoral C-reactive protein immune-expression was significantly higher comparing to median C-reactive protein immune-expression in lichen sclerosus samples, but there were not significant differences in median C-reactive protein immune-expression between peri-tumour and intra-tumour samples nor between intra-tumour and lichen sclerosus specimens. CONCLUSIONS: In peri-tumour specimens C-reactive protein immune expression was significantly higher than in lichen sclerosus specimens. No statistically significant differences were found between intratumour and lichen sclerosus specimens. No statistically significant difference between each type of specimens acquired in the group of patients diagnosed with lichen sclerosus and the specimens acquired in the group of patients diagnosed with vulvar cancer regarding Lysophosphatidic Acid immune expression was detected.
OBJECTIVES: The aim of this study was to present three adult cases of obstructed hemivagina, and ipsilateral renal anomaly (OHVIRA) syndrome diagnosed in different gynecological centers in Poland. The clinical presentations, diagnostic imaging, surgical treatment, and outcomes were analyzed to highlight the diagnostic challenges and variability in clinical course. MATERIAL AND METHODS: This retrospective case series included three female patients aged 19,20 and 30 diagnosed in adulthood with OHVIRA syndrome. RESULTS: All three patients were diagnosed with uterus didelphys. Two had confirmed congenital right renal agenesis, while one had undergone nephrectomy in infancy. One patient presented with severe dysmenorrhea and purulent content in the right hemivagina, initially suspected to be hematocolpos. Another patient, with a history of adolescent hematocolpos, was diagnosed postpartum during assessment following cesarean section. The third case was identified incidentally during nephrological imaging. The patient had undergone the right nephrectomy in infancy. All patients underwent resection of the vaginal septum and drainage of hematocolpos. CONCLUSIONS: These cases show the variable clinical presentation of OHVIRA syndrome and emphasize the importance of a detailed history and imaging evaluation. Early diagnosis remains essential to prevent complications and provide treatment.
OBJECTIVES: To compare the predictive performance of four risk of malignancy index (RMI) in patients with adnexal masses. MATERIAL AND METHODS: This retrospective study included 703 patients who underwent surgery for adnexal masses. Preoperative ultrasonographic findings, menopausal status, and serum CA-125 levels were used to calculate RMI-1, -2, -3, and -4. Histopathology served as the reference standard. Sensitivity, specificity, positive and negative predictive values, and overall accuracy were analyzed. RESULTS: Among 703 patients, 77.2% had benign lesions, 3.3% borderline tumors, and 19.5% malignant disease. RMI-1 demonstrated sensitivity 74.4%, specificity 91.3%, PPV 71.7%, NPV 92.4%; RMI-2 sensitivity 80.6%, specificity 86.2%, PPV 63.2%, NPV 93.8%; RMI-3 sensitivity 75.6%, specificity 90.1%, PPV 69.1%, NPV 92.6%; and RMI-4 sensitivity 78.8%, specificity 89.9%, PPV 69.6%, NPV 93.5%. ROC analysis showed areas under the curve of 0.900, 0.896, 0.893, and 0.893 for RMI-1 to RMI-4, respectively. RMI-1 had the highest specificity and overall accuracy, whereas RMI-2 achieved the highest sensitivity. Pairwise comparisons revealed statistically significant differences among RMIs. CONCLUSIONS: All four RMIs effectively differentiate benign from malignant adnexal masses. RMI-1 offers the highest overall accuracy and specificity, and RMI-2 the highest sensitivity. These indices provide valuable preoperative risk stratification to guide clinical management and referral to specialized care. Institutional resources should inform the choice of RMI.
OBJECTIVES:The study aimed to analyze maternal and neonatal outcomes of women with a history of three or four caesarean sections (CS) and to evaluate the feasibility and safety of vaginal birth after multiple caesarean sections (VBAC ≥ 3) in Polish clinical practice. MATERIAL AND METHODS:A retrospective analysis was conducted on medical records of 186 women with three or four prior CS who delivered at St. Sophia Specialist Hospital in Warsaw between 2017 and 2024. Data on delivery mode, obstetric management, complications, and neonatal outcomes were assessed. Multivariate logistic regression was applied to identify factors associated with successful VBAC. RESULTS:Of the study group, 62 women attempted trial of labour after caesarean (TOLAC), resulting in 32 successful vaginal births (success rate 53.2%). 124 women chose Elective CS. Logistic regression showed that prior vaginal birth (OR = 20.34; p = 0.008) and the use of epidural anaesthesia (OR = 22.88; p = 0.006) significantly increased the likelihood of successful VBAC. Spontaneous onset of labour showed a positive but non-significant trend (OR = 2.52; p = 0.230). The model demonstrated a classification accuracy of 77.4% and a good overall fit (Nagelkerke R² = 0.456). Uterine rupture occurred in three cases (4.8%), while no maternal or neonatal deaths were reported. CONCLUSIONS:Vaginal birth after three or more CS may be a viable option for carefully selected women, provided it is offered in tertiary centers with immediate surgical readiness. Key predictors of success include prior vaginal birth and epidural anaesthesia. Further large-scale studies are needed to refine guidelines and inform clinical practice in this high-risk group.
