Nadišauskienė, Rūta Jolanta

Gimdos kaklelio vėžys (GKV) - dažniausiai diagnozuojama onkologinė liga 23 pasaulio šalyse ir dažniausia mirties nuo vėžio priežastis - 36 pasaulio šalyse. Lietuva pagal sergamumą GKV užima antrą vietą tarp visų Europos šalių (31,6 atvejai 100 000 moterų, apie 615 atvejų per metus) ir ketvirtą vietą pagal mištamumą (9,8 atvejai 100 000, apie 221 atvejis per metus). Darbo tikslas. Nustatyti sisteminio uždegimo raiškos ypatumus sergant gimdos kaklelio vėžiu (GKV) atsižvelgiant į rizikos veiksnius bei ligos stadiją, ir IL-6 geno polimorfizmų reikšmę ligos išsivystymui. Darbo uždaviniai: nustatyti ir įvertinti sisteminio uždegimo žymenų raiškos kontrolinės grupės ir GKV sergančiųjų ypatumus priklausomai nuo rūkymo įpročių, įvertinti sisteminio uždegimo žymenų raišką sergant GKV iri jų priklausomybę nuo ligos stadijos, nustatyti tirtų sisteminių uždegimo žymenų TNF-α, IFN-β, IFN-γ, IL-1β, IL-2, IL-6, IL-10, IL-12p70, LPC2 ir TREM-1 koncentracijos slenkstinę prognozinę reikšmę GKV ir ligos stadijai įvertinti bei nustatyti IL-6 geno polimorfizmą (rs1800795) tiriamųjų grupėse ir įvertinti jo įtaką polinkiui sirgti GKV. Išvados. Sisteminio uždegimo žymenų raiškos priklausomybės nuo rūkymo nei sveikoms nei sergančioms GKV mūsų tyrime nenustatėme. Uždegimo žymenų IL-1β, IL-6, LPC2 ir TREM-1 koncentracijos skyrėsi priklausomai nuo ligos stadijos. Nustatytos slenkstinės uždegimo žymenų LPC2, IL-6, TREM, vertės reikšmingos prognozuojant GKV buvimą ir pažengusias ligos stadijas ir reikšmingas IL-6 geno rs1800795 polimorfizmo C alelio ir CC genotipo ryšys su GKV.

Antroji vadovėlio dalis skirta ginekologijos temoms pažinti ir suprasti. Ginekologija, išvertus iš graikų kalbos, yra sudurtinis žodis, susidedantis iš žodžių moteris ir mokslas. Tai, kai pir akušerija, yra vienas seniausių medicinos mokslų. Pirmosios žinios apie moters ligas bei jų aprašymai aptinkami Egipto Kahun ginekologijos papiruse, datuojamame 1800 pr. Kr., dar senesnis literatūros apie moterų ligas šaltinis – šumerų molinės lentelės. Įdomu tai, kad šiuose senovės raštuose aptariamos tos pačios temos kai pir šiuolaikinėje ginekologijoje: įvairios moterų ligos, nevaisingumas ir net kontracepcija, aišku, tik konservatyvioji gydymo dalis. Ilgą laiką gimda įvardijama kaip daugelio moters sisteminių ligų priešastis, kaip pavyzdžiui, isterijos (gr. Hysteria – gimda). Taigi, ginekologija, kai pir kitomis medicinos mokslo šakomis, besidomintys gali rasti daug įdomios ir naudingos informacijos. Tačiau svarbiausias šio vadovėlio tikslas – padėti studentams suprasti ir pažinti pagrindines, specifines moterų sveikatos problemas. Trumpai, aiškiai ir vaizdžiai išdėstyti jų etiologiją, patogenezę, diagnostikos ir gydymo principus, riziką ir prognozes. Pastebėta, kad studentai sunkiai įsisavina onkoginekologijos, uroginekologijos, ginekologinės endokrinologijos ir net kontracepcijos pagrindus. Tikimasi, kad vadovėlis padės pažinti bei suprasti ir šias temas. Vadovėlį rengė klinikos dėstytojai, gydytojai, savo srities specialistai. Rengėjai tikisi, kad pavyko pabrėžti svarbiausius aspektus, kurie turėtų būti naudingi bet kurios srities specialistams klinikinėje praktikoje ateityje, iki tol – Sėkmingai išlaikyti modulio, o vėliau ir baigiamąjį egzaminą.

Background ‒ Experts in many countries are recommending a scaling up midwifery-led care as a model to improve maternal and newborn outcomes, reduce rates of unnecessary interventions, realise cost savings, and facilitate normal spontaneous vaginal birth. Objective ‒ The aim of this study was to compare midwifery- led and obstetrician-gynaecologist-led care-related vaginal birth outcomes. Participants ‒ Pregnant women in Kaunas city maternity care facilities. Methods ‒ A propensity score-matched case–control study of midwifery-led versus physician-led low-risk birth outcomes. Patient characteristics and outcomes were compared between the groups. Continuous variables are presented as mean ± standard deviation and analysed using the Mann–Whitney U test. Categorical and binary variables are presented as frequency (percentage), and differences were analysed using the chi-square test. Analyses were conducted separately for the unmatched (before propensity score matched [PSM]) and matched (after PSM) groups.Results ‒ After adjusting groups for propensity score, postpartum haemorrhage differences between physicianled and midwifery-led labours were significantly different (169.5 and 152.6mL; p = 0.026), same for hospital stay duration (3.3 and 3.1 days, p = 0.042). Also, in matched population, significant differences were seen for episiotomy rates (chi2 = 4.8; p = 0.029), newbornApgar 5min score (9.58 and 9.76; p = 0.002), and pain relief (chi2 = 14.9; p = 0.002). Significant differences were seen in unmatched but not confirmed in matched population for obstetrical procedures used during labour, breastfeeding, birth induction, newborn Apgar 1 min scores, and successful vaginal birth as an overall spontaneous vaginal birth success measure. Conclusion ‒ The midwifery-led care model showed significant differences from the physician-led care model in episiotomy rates, hospital stay duration and postpartum haemorrhage, and newborn Apgar 5 min [....].

Background and Objectives: To investigate the prevalence of a Cesarean section (CS) scar niche during pregnancy, assessed by transvaginal ultrasound imaging, and to relate scar measurements, demographic and obstetric variables to the niche evolution and final pregnancy outcome. Materials and Methods: In this prospective observational study, we used transvaginal sonography to examine the uterine scars of 122 women at 11+0–13+6, 18+0–20+6 and 32+0–35+6 weeks of gestation. A scar was defined as visible on pregnant status when the area of hypoechogenic myometrial discontinuity of the lower uterine segment was identified. The CS scar niche (“defect”) was defined as an indentation at the site of the CS scar with a depth of at least 2 mm in the sagittal plane. We measured the hypoechogenic part of the CS niche in two dimensions, as myometrial thickness adjacent to the niche and the residual myometrial thickness (RMT). In the second and third trimesters of pregnancy, the full lower uterine segment (LUS) thickness and the myometrial layer thickness were measured at the thinnest part of the scar area. Two independent examiners measured CS scars in a nonselected subset of patients (n = 24). Descriptive analysis was used to assess scar visibility, and the intraclass correlation coefficient (ICC) was calculated to show the strength of absolute agreement between two examiners for scar measurements. Factors associated with the CS scar niche, including maternal age, BMI, smoking status, previous vaginal delivery, obstetrics complications and a history of previous uterine curettage, were investigated. Clinical information about pregnancy outcomes and complications was obtained from the hospital’s electronic medical database. Results: The scar was visible in 77.9% of the women. Among those with a visible CS scar, the incidence of a CS scar niche was 51.6%. [...].

Vadovėlį rengė didelis būrys akušerijos ir ginekologijos klinikos dėstytojų. Skirtas MF V kurso akušerijos studijų programai, daug iliustracijų, pabrėžiami svarbiausi teiginiai kiekvieno skyrelio pabaigoje, parengti ir savikontrolės klausimai. Naujas vadovėlis padės įgyti žinių, svarbių kasdieniniame kiekvieno gydytojo darbe. Vadovėlio dalį "Nėštumo fiziologija ir antenatalinė priežiūra" sudaro akušerijos pagrindai, nėštumo priežiūros principai ir rizikos vertinimo strategija paremta perinatalinės sistemos organizacija bei vis tobulėjantys nėščiosios ir vaisiaus būklės prenatalinės diagnostikos metodai. Kita dalis "Didelės rizikos nėštumas", būtina žinoti, kad nėštumas nepagerina jau esamos ligos eigos, o gydymo galimybės, atsižvelgiant į vaisiaus interesus, gali būti gerokai sumažėjusios. Žinodami nėštumo sukeliamus pavojus, kurie galimi sveikai jaunai moteriai, ir teikdami atitinkamą mokslo įrodymais pagrįstą priežiūrą, galisite išvengti daugelio motinai ir vaisiui povojingų komplikacijų, sėkmingai sulauksite ypatingo įvykio – kūdikio gimimo. Skyrelyje "Gimdymas" aprašoma gimdymo metu galima rizika, greitų netikėtų gyvybei grėsmingų komplikacijų pasireiškimas, kaip laiku užtikrinti adekvačią pagalbą, atidžiai įvertinti moters ir vaisiaus būkles kiekvieno gimdymo metu. Podimdyminis laikas ne mažiau sudėtingas nei nėštumo laikotarpis, jis gali trukti net 12 savaičių ar net 12 mėnesių. Infekcinės komplikacijos iki šių dienų išlieka vienos dažniaisių pogimdyminiu laikotarpiu. Šio laikotarpio ypatumai ir grėsmės turėtų būti žinomi ir suprantami bet kurios srities sveikatos priežiūros specialistui, kad būtų galima laiku suteikti reikiamą pagalbą ar nuraminti ir padrąsinti neseniai pagimdžiusią moterį ir jos artimuosius, aprašoma skyrelyje "Pogimdyminis laikotarpis".

Our study aimed to evaluate the distribution of genotypes and allele frequencies of IL-6 597A/G (rs1800797) and 174G/C (rs1800795) polymorphisms in HPV infected and uninfected healthy women and cervical cancer patients. A PCR based Multiplex HPV genotyping test kit was used for in vitro detection and differentiation of high risk HPV genotypes. Genotyping of two polymorphisms, IL-6 597A/G (rs1800797) and 174G/C (rs1800795), was performed using the KASP genotyping assay kit. Cervical cancer patients were more likely to be HPV positive than control patients. Allele C of IL-6 rs1800795 was associated with a higher risk of cervical cancer by 2.26-fold and genotype CC by 5.37-fold. Genotype CC of IL-6 rs1800795 was more frequent in the HPV positive group compared with the HPV negative group (p=0.002). Allele G of IL-6 rs1800797 was more frequently found in women with HPV16/HPV18 compared to other HPV types (p=0.045). Women with AA genotypes of IL-6 rs1800797 were less frequently infected with HPV16/HPV18 compared to other HPV types (p=0.045). The major finding of the study is the significant association of C allele and CC genotype of IL-6 1800795 gene with cervical cancer in the Lithuanian population. Genotype CC of IL-6 rs1800795 has a significant association with HPV infection as well.

Every year around 15 million premature neonates are born in the world, and this number is continuously increasing. The incidence of premature birth varies between 5% and 18% throughout the world. Despite advancements in medicine and technology and increased evidence-based diagnostic and treatment recommendations, prematurity is the most common cause of death among children under 5 years of age. The sequelae in the survivors of extreme prematurity are mental disability, cognitive impairment, cerebral palsy, blindness, deafness and chronic illness. Considering ethical and economic implications, neonatal survival and morbidity prognosis, resuscitation of neonates of borderline gestation differs in various countries and many international organisations do not recommend active resuscitation and treatment of newborns of up to 25 weeks of gestation. We present a case study of one of the smallest newborns in the world and the smallest newborn known to survive in Lithuania.

Background and objectives: Placenta previa and placenta accreta spectrum are considered major causes of massive postpartum hemorrhage. Objective: To determine whether the placement of an occlusion balloon catheter in the internal iliac artery could reduce bleeding and other related complications during cesarean delivery in patients with placenta previa and placenta accreta spectrum. Materials and Methods: A retrospective analysis was conducted at two tertiary obstetric units of Lithuania. From January 2016 to November 2019 patients with placenta previa and antenatally suspected invasive placenta were included in the intervention group and underwent cesarean delivery with endovascular procedure. From January 2014 to December 2015 patients with placenta previa and suspected placenta accreta spectrum were included in the non-intervention group. The primary outcomes were reduction in intraoperative blood loss and transfusion volumes in the intervention group. Secondary outcomes were the incidence of hysterectomy and maternal complications. Results: Nineteen patients underwent cesarean delivery with preoperative endovascular procedure, and 47 women underwent elective cesarean delivery. The median intraoperative blood loss (1000 (400–4500) mL vs. 1000 (400–5000) mL; p = 0.616) and the need for red blood cell transfusion during operation (26% vs. 23%; p = 0.517) did not differ significantly between the patients groups. Seven patients in the intervention group and two patients in the non-intervention group underwent perioperative hysterectomy (p = 0.002). None of the patients had complications related to the endovascular procedure. Conclusion: The use of intermittent balloon occlusion catheter in patients with placenta pathology is a safe method but does not significantly reduce intraoperative blood loss during cesarean delivery.

Objectives To evaluate the change in the number of caesarean sections (CS) in Lithuania following a multifaceted intervention. Materials and Methods The information system was used for CS and perinatal mortality rate data collection. The multifaceted intervention took place in 2012 – 2019 and consisted of 1) implementation of the Robson’s classification (2012); 2) implementation of a CS audit system as the quality of care indicator (2012); 3) national professional training courses (2012-2014), and 4) regular audit of recommended CS rates at different levels of maternities (according to WHO) by National Committee of Integrated Perinatal Care was performed (2012). Results In the period covered by the study, 217 523 women gave birth in Lithuania. The national CS rate edged down from 26.01 % to 20.43 % in 2012-2019 (p<0.001). The reduction was gradual: from 26.01 % to 25.21 % in 2012- 2013, from 25.21 % to 21.64 % in 2013-2014, from 21.64 % to 22.17 % in 2014-2015, from 22.17 % to 20.9 % in 2015-2016, from 20.9 % to 20.2 % in 2016-2017, from 20.2 % to 20.56 % in 2017-2018, from 20.56 % to 20.43 % in 2018-2019. The perinatal mortality was 5.3‰ in 2012, 6.26 ‰ in 2013, 6.2 ‰ in 2014, 5.66 ‰ in 2015, 5.85 ‰ in 2016, 4.9 ‰ in 2017, 5.41 ‰ in 2018, 5.42 ‰ in 2019. Conclusions • The CS rate decreased with statistical significance from 26% (2012) to 20,4% (2019. • The change in CS did not have a negative impact on perinatal mortality.