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Background. Mother’s attachment to her unborn child has a strong impact on a pregnant woman’s attitude towards her health, postnatal attachment, and the child’s physical and emotional growth. The purpose of our study was to identify the factors that impact the maternal-foetal relationship. Materials and methods. The study was conducted at the Centre of Obstetrics and Gynaecology of the tertiary-level Vilnius University Hospital Santaros Klinikos in Vilnius, Lithuania. An original questionnaire of nine parts was developed that the questionnaire included information on demographical data, gynaecological and obstetrical history, a relationship assessment scale, the index of happiness, an antenatal depression risk questionnaire, and the Maternal-Antenatal Attachment Scale. Results. The study included 388 pregnant women. It was found that the level of education, obstetrical issues during pregnancy, and the risk of postnatal depression negatively impacted the maternal-foetal relationship (p < 0.05). Mothers who were elder in family birth order, also those whose pregnancy was of a longer duration, who had a better-quality romantic relationship with partner, and whose socioeconomic fulfilment was higher were all found to have a better quality of maternal-foetal bonding (p < 0.05). Conclusions. The early recognition of low attachment and right application of various means of psychologic intervention might improve the quality of pregnancy, maternity, and childhood.

Background. Invasive placenta is a rare obstetrical pathology that is life-threatening to mother and child. It is important to diagnose this pathology as early as possible and to plan further optimal care of patients in order to minimize life-threatening complications. The aim of this study was to analyze the frequency of cases of invasive placenta, the peculiarities of their clinical manifestation in women who gave birth from 2006 to 2015, to evaluate diagnostic and treatment options of this pathology, and to review their changes when the level of services provided by the institution changes. Materials and methods. A retrospective study was performed of the ten-year period of 2006 to 2015. The study consisted of examining the data of medical records of a group of 14 women. Results. The incidence of invasive placenta at the secondary level hospital was 1/2170 births, 1:934 births at the tertiary level. There were only three patients (21.4%) diagnosed with invasive placenta during pregnancy at Vilnius University Hospital Santaros Klinikos Obstetrics and Gynaecology Centre. Before the surgery, pre-occlusive balloons were ushered into the internal iliac artery and inflated to reduce bleeding after the newborn delivery. The amount of blood loss in the whole group ranged from 1000 to 6500 ml (avg. 3130.7 ml). Radical treatment was given to eleven patients. Conclusion. Invasive placenta is a life-threatening condition. Tertiary-level hospitals have a greater capacity for antenatal diagnostics. Timely diagnosis of placental invasion and evaluation of the level of the myometrium damage before delivery is instrumental in planning patient care and preparing for delivery and operation.

Background. Placenta percreta is a very rare, but extremely life-threatening obstetrical pathology for the mother and the child, especially in the cases when it is not diagnosed before the birth and when it results in massive bleeding and a dramatic deterioration of condition. It is extremely important to diagnose this pathology as early as possible and plan further optimal care of patients in order to minimize life-threatening complications. Case report. The paper presents an illustrated clinical case of placenta percreta determined before the birth. Features of visual diagnostics are discussed. A 32-year-old pregnant woman with a history of two caesarean deliveries arrived at the tertiary level hospital at 22 weeks of gestation due to abdomen pain. Placenta previa was diagnosed and ultrasound, magnetic resonance imaging suggesting placenta percreta were seen. On the 32nd week, the planned caesarean hysterectomy was performed. The balloon catheters to occlude the internal iliac arteries and minimize bleeding during the surgery were used. Conclusions. Antenatal diagnosis of placenta percreta is especially important. Methods of visual diagnostics are complementary. The optimal surgical approach during caesarean hysterectomy remains controversial. In the case of the slow oozing without a clearly identified source of bleeding after hysterectomy and internal iliac arteries balloons deflation, ligation of one of the internal iliac arteriescan be reasonable to avoid residual haemorrhage and relaparotomy.

Background. Radical vulvectomy accompanied by bilateral inguinal lymph nodes dissection (ILND) has been performed to treat cancer for a long time but, due to various short and long term postoperative complications, alternatives have been found. The objective was to compare the clinical results of vulvar cancer treatment in early stages based on sentinel lymph node(s) biopsy (SLNB) and classic surgical treatment and to evaluate the radiological safety of SLNB. Materials and methods. Retrospective study involved 26 patients with clinical stage I–II of vulvar carcinoma treated in the Institute of Oncology, Vilnius University, between 2011 and 2013. The women were divided into two groups: 14 patients underwent a reduced surgical treatment based on the SLNB method, and 12 patients underwent a classic surgical treatment. Results. After SLNB and intraoperative histological examination, 9 patients in the first group underwent radical tumour excision, while the others underwent ipsilateral or bilateral ILND. Final histological examination detected metastases in lymph nodes in 4 patients from the first group and 3 patients from the second group. The average surgery duration on the patients undergoing only SLNB and radical tumour excision was 77.2 minutes, and the classical surgery took 177.7 minutes. Average exposure levels measured in the first group reached up to 1 µSv/hour. Conclusions. Surgery treatment based on SLNB for patients with early stages of vulvar carcinoma can reduce the extent of surgical interventions. Exposure limits to the patients and staff were safe.