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Objective: We present a simple 2D big ultrasound measurement of the fetal adrenal glands and their biometrical growth analysis highlighted as a potential preterm birth marker., Methods: This was a prospective observational case-control study. Sixty-four patients were included in the study (32 with the diagnosis of imminent preterm birth before 37 and 32 controls) from January 2018 to May 2020. Anteroposterior dimensions and circumferences of the whole adrenal glands and their central zones were measured by simple B-mode ultrasound imaging. For the statistical analysis, StatsDirect 3.0 and ROC curves were used. As a studied descriptor, routine standard ultrasound cervical measurements were added (cervical length, funneling, sludge, cervical dilatation, and cervical glandular area)., Results: In biometrics of gestational age-related changes, a significant analysis of the overall growth of the adrenal gland was observed (circumference p < 0.001, anteroposterior diameter p = 0.02). The growth of the central zone was observed independently of gestational age. The growth of the central zone of the fetal adrenal glands revealed significant changes between the group of patients who delivered prematurely and control groups (p < 0.01). The ideal cut-off value of the proportion of enlargement of the fetal zone as a predictor of preterm delivery before week 37 was 45.1 %, with the sensitivity of 87.5 % and specificity of 85.4 %., Conclusions: A simple 2D B-mode measurement of the fetal adrenal glands´ central zone growth can be applied as an additional marker in the prediction of true preterm delivery. The natural biometrical overall growth of the adrenal glands seems to be dependent on gestational age, whereas that of the central adrenal gland zone seems to be independent on gestational age (Tab. 3, Fig. 5, Ref. 26).

Objective: To assess the impact of a multifaceted intervention on reducing the rate of cesarean section (CS) without negatively affecting the rate of perinatal mortality., Methods: A retrospective analysis of CS was performed before and after the implementation of a quality-improvement (QI) intervention in a university-affiliated teaching hospital in the Slovak Republic. All women who gave birth in 2015 (pre-intervention) and 2018 (post-intervention) were included. The different components of the intervention were introduced from September 2016. The main outcome was the overall rate of CS. A subanalysis by Robson groups was undertaken., Results: After the implementation of the QI intervention, there was a 33.5% reduction in the rate of CS compared to the pre-intervention period where the rate reduced from 33.7% to 22.4% (P<0.001; relative risk 0.66, 95% confidence interval [CI] 0.61-0.72; Number Needed to Treat (NNT) 8.8, 95% CI 7.3-11.2). The main contributors were the reduction in elective CS for non-obstetric reasons, a reduction in intrapartum CS for failure to progress, and an increase in the number of vaginal births after CS in the post-intervention period., Conclusion: The implementation of the composite QI intervention led to a significant reduction in the rate of CS without affecting the rate of perinatal mortality., (© 2020 International Federation of Gynecology and Obstetrics.)

Objectives: This study was conducted to determine the frequency of increased postvoiding residual volumes (PVRV) 3 days after delivery and to examine the associated risk factors., Background: Increased PVRV ‒ covert postpartum urinary retention, is an asymptomatic condition with possible long-term adverse effects. While early diagnosis and appropriate management can avoid long‑term complications, screening is not routinely performed. By identifying risk factors, we could define the group of patients suitable for screening., Material and Methods: This was a prospective observational study carried out over a 3-month period at the university teaching hospital in Bratislava, Slovakia. All participants underwent ultrasound determination of PVRV while 80 ml and more on day 3 was considered pathological., Results: A total of 429 women were included in the study. The prevalence of covert post-partum urinary retention was 9.2 %. Assisted vaginal delivery (ventouse, forceps) and episiotomy were risk factors for post-partum urinary retention (18.7 % vs 6.1 %; p = 0.0053; 52.1 % vs 35.7 %; p = 0.0483; respectively)., Conclusion: Our observations confirmed the existence of PVRV of 80 ml and more on day 3 in almost 10% of women who had delivered at our clinic. The results of our study prove that instrumental delivery represents a considerable obstetrical-pediatric risk factor for PVRV. Our data support the need of adopting a risk-factor-based approach to PVRV screening as part of postpartum bladder care (Tab. 2, Fig. 1, Ref. 12).

Objectives: Analyzing the clinical group to evaluate current indications for cordocenteses, their complications and data obtained in further pregnancy management., Methods: Retrospective analysis evaluated 92 cordocenteses (diagnostic and therapeutic) performed during the period of 2007‒2018. These were performed between 17 and 36 weeks of gestation under ultrasound guidance by a specialist at 2nd Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University., Results: Out of 92 procedures, 78 were diagnostic and 14 were therapeutic. The diagnostic cordocentesis was successful in 97.4 % and intrauterine therapy was successful in 85.7 %. There were 2 (2.56 %) diagnostic cordocenteses complicated by fetal demise and 2 (14 %) intrauterine demises in therapeutic cordocentesis. The pathological karyotype was detected in 14.5 %. Aneuploidia was present in 4 cases (44.4 %), mosaicism in 4 cases (44.4 %) and triploidia in one case (11.1 %)., Conclusion: Despite of novel molecular genetic technique cordocentesis still plays unreplaceable role in current prenatal diagnosis and treatment. The risk of complications of cordocentesis increases depending on the severity of fetal pathology in pathologic pregnancies. In some situations it can be used as a useful tool for original fetal diagnosis and therapy (Tab. 3, Ref. 20).

Objectives: Transvaginal polypropylene mesh implantation is one of the techniques used for pelvic organ prolapse (POP) repair. The surgery outcomes depend on the indication criteria used. The aim of our study was to evaluate the outcomes of the mesh implantation using the strict indication criteria., Patients and Methods: In 47 women aged 61.7±8.3 years with pelvic organ prolapse (POP-Q≥2) and a history of other surgery in the pelvic region outcomes of the mesh implantation were evaluated for up to 7 years (range 1-7 years)., Results: Forty six of 47 patients (97.8%) had a successful mesh implantation (10 anterior, 22 posterior, 14 combined). Peroperative complications occurred in 3 of 47 patients (6.4%). The anatomic cure (POP-Q≤1) was achieved in 93.5% patients with mesh at 6 months after surgery. Any of the postoperative complications occurred in 16 of 46 women (34.8%). Significantly lower risk of complications was found in the group aged over 65 years compared to the younger patients (p=0.005)., Conclusion: This is the first study on the mesh implantation including women only with the history or other surgery in the pelvic region, achieving high anatomic success rate and low risk of complications. Thus, our data support the use of the strict indication criteria for this procedure (Tab. 2, Fig. 2, Ref. 14).

Objective: To outline possibility of successful treatment of spontaneous previable rupture of membranes in the second trimester of pregnancy., Introduction: Spontaneous previable rupture of membranes (SPROM) in the second trimester of pregnancy is one of the most alarming problems in current obstetrics. Perinatal mortality is about 60 %, one third of which represents intrauterine fetal demise. Surviving neonates suffer from various complications. There are different clinical approaches regarding treatment of SPROM., Material and Methods: We present a case of a 30 year old secundigravida with a history of SPROM at 19+1 weeks gestation. Ultrasonographic examination revealed anhydramnios. Genital cultures and laboratory studies ruled out infectious etiology of SPROM. Due to expected poor neonatal outcome, decision to attempt amniopatch as an experimental therapeutic alternative was made at 21+1 weeks gestation (two weeks after SPROM had occurred). Autologous concentrated platelets followed by autologous cryoprecipitate were administered into the amniotic cavity transabdominally under ultrasound guidance. After 3 days sonographic examination showed normal volume of amniotic fluid. On 22 postoperative day, patient notice some leaking of fluid vaginally. Fetal growth was appropriate, amniotic fluid volume was decreased, however, oligohydramnios never progressed to anhydramnios. Pregnancy ended with primary cesarean delivery at 33+1 weeks gestation. Live born male infant with 1750 g birth weight was delivered. Postnatal development was within normal limits., Conclusion: Intraamniotic application of "amniopatch" may represent a possibly successful treatment of spontaneous previable rupture of membranes. This case reports the longest stop of the leaking of amniotic fluid and total prolongation of pregnancy with favorable perinatal outcome after "amniopatch" treatment of spontaneous previable rupture of membranes in the second trimester so far published in available literature.

Uterine artery embolization (UAE) has become a standard therapy in the treatment of symptomatic uterine myomas. The procedure is associated with a few complications. One of them is myoma expulsion. A 32-year-old woman was sent to our hospital with diagnosed intramural myoma with dysmenorrhea and pressure symptoms. UAE was performed since the patient preferred conservative treatment. The procedure was without any complications. Three weeks after embolization, she was readmitted because of vaginal discharge and minor bleeding. We diagnosed expulsion of necrotic myoma and performed transvaginal resection. Four months later, the patient is symptom free. Expulsion of intramural myoma can be thus considered as definite treatment and not a complication of embolization therapy.

Objective: The aim of this study was to evaluate the influence of Group B streptococcus (GBS) screening and intrapartum antibiotic prophylaxis to the incidence of GBS disease in newborns., Design: Prospective non-randomised study., Setting: IInd Clinic of Obstetric and Gynaecology LFUK and FNsP Ruzinov, Bratislava, Slovakia., Methods: We enrolled 3023 newborns (754 in the study group, 2269 in the control group), which were born between 1.9.2000 and 31.3.2003. In both groups we compared following variables: total number of infectious diseases in newborns, number and forms of GBS neonatal disease, number of perinatal death due to GBS disease., Results: There was no GBS disease in the study group of 754 newborns. Mothers of these newborns had one screening culture in 35-36th week of gestation. One swab was taken from vagina and anus. GBS carriers (161-21.4%) were administered i.v. intrapartum antibiotic prophylaxis with Penicillin G i.v., or, when allergy to penicillin was in history, with Clindamycin i.v. In the control group of 2269 newborns, whose mothers had no prevention, the incidence of GBS neonatal disease reached 7.5/1000 newborns (17 cases). The incidence of invasive GBS neonatal disease was 2.6/1000 newborns., Conclusion: The authors have noticed a significant decrease in incidence of GBS neonatal disease after implication of GBS screening and intrapartum antibiotic prophylaxis.