Search

Objectives: To present anterior abdominal fixation — a new surgical technique for the treatment of pelvic organ prolaps (POP) and to evaluate the results of the treatment of patients with stage III and IV POP operated using this technique. Material and methods: Anterior abdominal fixation for treating stage III and IV POP was carried out in 42 women, who were qualified according to the Pelvic Organ Prolapse Quantification System (POP-Q) scale at baseline and after 12 months. The Pelvic Floor Disability Index-20 (PFDI-20), along with its symptom scales, were evaluated. Results: The mean age 42 operated women was 64.5 years, and the average BMI was 27.3 (83% women were overweight). At baseline, 29 (69%) women had POP stage IV, and 13 (31%) women had POP stage III. Overall, 14 (33%) underwent laparoscopy, 28 (67%) underwent laparotomy. At 12 months, 14 (33.3%) women had POP stage I; 21 (50%) women had POP stage II. Seven patients (16.6%) experienced a recurrence of disease with advancement at the degree of III/IV; 4 (9.5%) women required adjuvant surgery in the form of anterior and posterior vaginal wall surgery. No early complications after surgery were observed. The comparison of the results before and after surgery showed statistically significant improvement in terms of the P-QoL score as well as PFDI-20 along with its 3 symptom scales. Conclusions: Anterior abdominal fixation of the uterus to the anterior abdominal wall is effective, safe, and technically easy to perform in the treatment of POP of advanced stage.

Objectives: To evaluate the balloon occlusion of the internal iliac arteries during a caesarean section in the group of patients with placenta accreta spectrum. Material and methods: We analysed 29 pregnant women with placenta accreta spectrum. The study group consisted of 15 patients, who underwent a caesarean delivery with temporary bilateral internal iliac artery occlusion. In the control group, we examined 14 women who had a standard caesarean delivery without any radiologic procedure. We compared pre- and post-operative haemoglobin level, necessity of blood transfusion, intraoperative blood loss, intensive care requirement, complications, duration of surgery, anaesthesia and hospital stay. Results: The history and obstetric outcomes were similar in both groups. The study group required fewer blood transfusions than the control group (p = 0.0176). We administered less packed red blood cells and fresh frozen plasma. Complications were more frequent in the control group (p = 0.0014). Complications related to occlusion of the internal iliac arteries did not occur. The intensive care unit transfer was more frequent in the control group (p = 0.0329). The duration of surgery and hospital stay did not differ between groups. The anaesthesia time was longer in a study group, which related to the radiologic procedure. Conclusions: Caesarean delivery for placenta accreta spectrum with bilateral balloon occlusion of the internal iliac arteries requires fewer transfusions. It contributes to a decrease in the complication rate and maternal morbidity.

Placental mesenchymal dysplasia (PMD) is a rare benign vascular anomaly of the placenta. It can be misdiagnosed as a molar pregnancy resulting in unnecessary termination of pregnancy. A 30-year-old woman was referred to our hospital at 18 gestational weeks due to suspicion of molar pregnancy. The ultrasound showed a bulky placenta with multiple cysts. Oligohydramnion and fetal hypoechogenic cystic area without doppler flow were diagnosed at 23 weeks. The baby was operated on after delivery, and an 80 mm multifocal cyst originating from the right lobe of the liver was removed. The placenta demonstrated swelling stem villi with enlarged vessels and increased interstitial cells without trophoblast proliferation. PMD and fetal hepatic cyst can coexist; however, the relationship between those conditions remains to be elucidated. PMD is associated with adverse pregnancy outcomes but also with a good prognosis.

Objectives: For early miscarriage (pregnancy loss ≤ 12 weeks of gestation), two types of therapeutic treatment are offered (pharmacotherapy and curettage of the uterine cavity) depending on the presence and severity of clinical symptoms as well as patient choice. Our study aimed to assess the diagnostic value of the results of histopathological examinations of miscarriage products in relation to the administered treatments. Material and methods: 850 medical records from patients diagnosed with missed miscarriage or empty gestational sac were analyzed retrospectively. Patients underwent surgical treatment or pharmacotherapy. Inefficacy of pharmacotherapy resulted in subsequent curettage. The results of histopathology were evaluated for their diagnostic value and classified: subgroup 1 — high value specimen (the studied specimen included fetal tissues, and villi), and subgroup 2 — no-diagnosis (the studied specimen included maternal tissues, autolyzed tissues, blood clots). Data were compared with chi-squared test. Differences was considered significant at p < 0.05. Results: 1128 histopathological test results were analyzed; 569 (50.4%) were obtained during pharmacotherapy and 559 (49.6%) after curettage; out of the latter 497 after the initial pharmacotherapy and 62 after surgery. In the pharmacotherapy group, high value specimens comprised 231 cases (40.59%) while no diagnosis was obtained in 338 cases (59.4%). Considering specimens obtained in the course curettage, high value specimens were found in 364 cases (65.1%) while results that did not allow a diagnosis to be made were found in 195 cases (34.9%). Conclusions: Tissue specimens of high diagnostic value are obtained significantly more often during surgical treatment of miscarriage than during pharmacotherapy.

Study Objective The aim of the study was to present the results of a new surgical technique used for the treatment of stage 3 and 4 Pelvic organ prolapse according to the POP-Q scale. Design Group of 36 women has been qualified for the procedure of suspending the cervix to the rectus abdominis (RA) fascia with the insoluble sutures guided through the fascia via the polypropylene mesh placed above the fascia. The effectiveness of the treatment was assessed both: objectively - on the basis of improvement in gynecological examination - and subjectively using the certified questionnaires: PFDI-20 and POP-QL- 12 months after the surgery. Further control is planned 3 and 5 years after the procedure. Setting The study was conducted within the 2nd Department of Obstetrics and Gynaecology, Medical University in Wroclaw, Poland. Patients or Participants 36 women with the initial diagnosis of severe POP (3rd and 4th stage) has been qualified for the study Interventions The surgery was performed either by laparotomy (20) or laparoscopy (16). The insoluble monofilament suture was used to suspend cervix to the fascia of the RA. and additionally reinforced with polypropylene mesh placed above the fascia. The uterine body was either preserved, or in the case of any pathology, the suspension was preceded by supracervical hysterectomy. Measurements and Main Results Preliminary results are promising - 84.6% of objective and subjective improvement. Six women (16.6%) had a relapse and 4 women (11.1%) required reoperation. Conclusion Presented technique seems to be a safe and effective alternative to other POP treatment methods. It is associated with a negligible complications rate. Laparoscopic approach with it's superiority to laparotomy in some patients and a short learning curve, makes it even safer. Increasing the number of treated patients and continuing follow-up 3 and 5 years after the surgery is planned.