Malakauskienė, Laura

Introduction Caesarean section (CS) is a surgical procedure when a newborn is delivered through laparotomy and hysterotomy. In some medical conditions CS is a crucial procedure to ensure a safe delivery [1]. Over the years CS rates have increased significantly in the whole world. Lithuania follows this global trend, with CS rates increasing from 9.49% in 1995 to 26.01% in 2012 [2], and reaching 24.0% in 2024 [3]. Current risk factors contributing to CS include advanced maternal age, previous CS, and other obstetric factors [4]. Aim To analyse and compare tendencies in caesarean section in the years 1970 and 2020. Methods Data about the course of labor, neonates and mothers was collected from the Hospital of the Lithuanian University of Health Sciences, Kaunas Clinics, birth records of July - September months of 1970 and 2020. The study included only singleton gestations: 307 births in 1970 and 285 in 2020. Newborns were grouped by weight: Group 1 < 2500 g, Group 2 2500 - 3999 g, Group 3 ≧ 4000 g. Chi-square test was used to identify differences, 𝛂=0.05. Results The incidence of CS increased from 3.3% in 1970 to 26% in 2020 (p<0.001). This increase was particularly pronounced in preterm deliveries (from 9.1% to 43.3%, p=0.04) and term deliveries (from 3.1% to 23.9%, p<0.001). Among preterm deliveries, the youngest neonate in 1970 was 33 weeks of gestation, compared to 27 weeks in 2020. The proportion of preterm deliveries increased significantly over the study period, from 3.6% in 1970 to 10.5% in 2020 (p<0.001). Differences in delivery type were also observed according to neonatal weight. The increased incidence of CS in term labours was mainly observed in the second weight category, rising from 3.1% to 24.8% (p<0.001). In the third weight group, the increase was statistically significant but smaller, from 3.4% to 23.1% (p=0.003). Among documented causes of CS in 1970, placental pathologies and transverse fetal presentation were the most common (5/10 cases). In 2020, the leading indications for CS were previous CS (20.3%), cephalopelvic disproportion (18.9%), breech presentation (13.5%), and maternal pathology (9.5%). In 1970, 14 cases of complete breech presentation were recorded, all delivered vaginally, compared to 12 cases in 2020, of which 9 (75%, p<0.001) were delivered by CS. Three cases of footling breech presentation occurred in both years; in 1970 all were delivered vaginally, whereas in 2020 all were delivered by CS (p=0.014). Conclusions The prevalence of caesarean deliveries has increased by more than 7 times between 1970 and 2020. This change is observed in pre-term and full-term deliveries. The rise in CS rates was particularly pronounced among preterm deliveries and in neonates of higher weight categories, suggesting that gestational age and fetal size remain important determinants for operative delivery.

Pykinimas, vėmimas ir pilvo skausmas nėštumo laikotarpiu gali tapti diagnostiniu iššūkiu pacientėms po chirurginio nutukimo gydymo. Pacientei 15 nėštumo savaitę pasireiškus minėtiems simptomams buvo atlikta laparoskopinė operacija, kurios metu rastas pasmukęs skrandžio žiedas ir per žiedo kanalą susiformavusi skrandžio išvarža.

Background and Objectives: To assess pregnancy and delivery complications in obese women with gestational diabetes mellitus (GDM) and neonatal weight and condition after birth. Materials and Methods: A retrospective tertiary referral centre study included all cases of GDM in the Department of Obstetrics and Gynaecology of the Lithuanian University of Health Sciences (LUHS) Birth Registry from 1 January 2019 to 31 December 2019. We included 583 women with GDM and singleton pregnancies. Women were divided into two groups according to their pre-pregnancy weight: 202 were obese (BMI ≥ 30 kg/m2 ), and 381 were weight (BMI 18.5–24.9 kg/m2 ). Survey data were analysed using IBM SPSS Statistics 26.0 and MS Excel 2016 software. A value of p < 0.05 was considered significant. Results: Fasting glycaemia was significantly higher in obese women with GDM than in normal-weight women with GDM (p < 0.001). In addition, fasting glycaemia was higher in obese women with GDM requiring insulin correction than in normal-weight women (p = 0.006). OGTT 0-min glycaemia was higher in obese than in non-obese women with gestational diabetes (p < 0.001). Women with pre-pregnancy obesity had a higher incidence of primary hypertension (p < 0.001), hypertensive disorders in pregnancy (p < 0.001), gestational cholestasis (p = 0.002), polyhydramnios (p < 0.001), induced labour (p < 0.001), and caesarean section (p = 0.015), with emergency caesarean sections being more frequent than planned caesarean sections (p = 0.011) compared to normal-weight women with GDM. Labour dystocia (p = 0.003) and foetal distress (p = 0,019) were more common during labour in obese women. Neonates of these women more often had macrosomia (p < 0.001) and lower Apgar scores at 1 min (p = 0.024) and at 5 min (p = 0.024) compared to neonates of normal-weight women. Conclusions: Obese women with GDM experience more pregnancy complications than normal-weight women with GDM.

Background and Objectives: This study aims to report the location of the placenta in the first trimester of pregnancy in groups of women according to the number of previous caesarean deliveries and the visibility of the caesarean scar niche. Materials and Methods: The prospective observational research included adult women aged 18 to 41 years during pregnancy after one or more previous caesarean sections (CSs). Transvaginal (TVS) and transabdominal sonography (TAS) was used to examine the uterine scar and placental location during 11–14 weeks. The CS scar niche (“defect”) was bordered in the sagittal plane as a notch at the previous CS scar’s site with a depth of 2.0 mm or more. A comparative analysis of the placental location (high or low and anterior or posterior) was performed between groups of women according to the CS number and the CS scar niche. Results: A total of 122 participants were enrolled during the first-trimester screening. The CS scar defect (“niche”) was visible in 40.2% of cases. In cases after one previous CS, the placenta was low in the uterine cavity (anterior or posterior) at 77.4%, and after two or more CSs, it was at 67.9%. Comparing the two groups according to the CS scar niche, the placenta was low in 75.5% of cases in the participant group with a CS scar niche and in 75% of cases without a CS scar niche (p = 0.949). Conclusions: The number of previous caesarean deliveries has no effect on the incidence rate of low-lying placentas in the first trimester. Moreover, the presence of the CS scar niche is not associated with anterior low-lying placentas.

Introduction and Aims of the study: Every surgical procedure has the possible risk for complications, caesarean section (CS) is no exception. We present a case of rare CS complication that led to re-laparotomy. Methods case presentation: A 25-year-old patient came to our hospital with twin pregnancy for labour induction. An urgent CS was performed through Pfannenstiel incision due to labour dystocia. Uterus was sutured using single layer continuous suture. Visceral peritoneum was sutured separately using continuous suture. Parietal peritoneum was left unsutured while rectus muscles were re-approximated with three interrupted stitches. On the third postoperative day patient complained about diffuse, spastic abdominal pain and vomiting. Abdominal CT scan revealed an infraumbilical abdominal wall defect with an eventration containing distal loops of ileum, occupying area of 12.3x6.9 cm. During urgent re-laparotomy, after disassembling aponeurotic suture, small bowel loops were noted to be strangulated in approximately 2 cm defect which had been left open when re-approximating abdominal muscles with interrupted sutures. Discussion: Re-laparotomy after CS in early postoperative period is extremely rare. According to guidelines, visceral, parietal peritoneum and rectus muscles should not be sutured as this reduces operating time, the need for postoperative analgesia and is not associated with more adhesion formation. However, there are conflicting results whether re-approximation of rectus muscles has a positive effect on the prevention of diastasis recti. In our case rectus muscles were closed separately from other layers with interrupted stitches while parietal peritoneum was left unsutured. It led to intestinal protrusion and strangulation in between two separate muscular sutures. Conclusions: Although there are discussions about CS technique, most guidelines recommend to not re-approximate rectus muscle. This case stands out as an example of a complication which most likely could have been avoided if rectus muscles were left unsutured.

Background and Objectives: Every surgical procedure has the possible risk of complications, and caesarean sections (CSs) are no exception. As CS rates are increasing worldwide, being familiar with rare but possible complications has become extremely important. Case report: We present a case of 25-year-old nulliparous patient who came to our hospital with twin pregnancy for a scheduled induction of labour. An urgent CS was performed due to labour dystocia. On the second postoperative day, the patient started to complain about pain in the epigastrium, but initially showed no signs of bowel obstruction, passing gas, and stools, and could tolerate oral intake. After a thorough examination, an early postoperative complication—small-bowel strangulation at the incision site—was diagnosed. Small bowels protruded in between sutured rectus abdominis muscle causing a strangulation which led to re-laparotomy. During the surgery, there was no necrosis of intestines, bowel resection was not needed, and abdominal wall repair was performed. After re-laparotomy, the patient recovered with no further complications. Conclusions: Although there are discussions about CS techniques, most guidelines recommend leaving rectus muscle unsutured. This case demonstrates a complication which most likely could have been avoided if the rectus muscle had not been re-approximated.

Background: Physical exercise has a direct impact on the women's well-being, comfort, physiological adaptation during pregnancy and delivery. The aim: To evaluate the possible influence of physical exercise before conception and during pregnancy on the women's subjective well-being during pregnancy and delivery. Materials and methods: An original questionnaire about sports experiences before and during pregnancy was created. The questionnaire was distributed in a third-level hospital, the Hospital of Lithuanian University of Health Sciences Kaunas Clinics, in the Clinic of Obstetrics and Gynecology for women after delivery. Altogether 108 women participated in the study. For data comparison, women were divided into two groups according to physical activity experience: active and inactive before and during pregnancy. Research data were systematized using “Excel Microsoft 365”, data analysis was performed using “IBM; SPSS 27”. The permission of the Bioethics Center of the Lithuanian University of Health Sciences was granted, no. BEC-MF-301 (2022-03-07). Results: Before pregnancy 1,9% (n = 2) of women did sports professionally, 40,7% (n = 44) were physically active, 57,4% (n = 63) did not do sports. During pregnancy 41,7% (n = 45) exercised regularly, 58,3% (n = 63) did not. A large proportion of women (82,2 %) who were physically active during pregnancy rated their state of well-being during pregnancy as “good” or better in comparison of women who did not exercise (58,7 %, p = 0,028). Half of women (55,5 %) who were physically inactive during pregnancy evaluated their state of well-being during delivery just as “moderate” and below in comparison to physically active women (35,5 %, p = 0,033). Conclusions: Physical activity during pregnancy significantly improves women's subjective wellbeing during pregnancy and delivery, though about a half of participants were not physically active neither before or during the pregnancy.

Aim. To compare the impact of the time and method of diagnosis on gestational diabetes mellitus (GDM) in women who gave birth at the Hospital of the Lithuanian University of Health Sciences (LUHS) Kauno klinikos. Methods. A retrospective study was performed using data from the Department of Obstetrics and Gynecology of the LUHS Birth Registry to analyze the data of women who gave birth and had GDM in 2020–2021. The subjects were divided based on the type of diagnosis: GDM was diagnosed either at the first antenatal visit when fasting plasma glycemia (FPG) was ≥5.1 mmol/L (early diagnosis group) or after OGTT at 24 + 0 − 28 + 6 weeks of gestation when at least one pathological glycemic index was observed: fasting glycemia 5.1–6.9 mmol/L or 1-h glycemia ≥10.0 mmol/L or 2 h glycemia 8.5–11.0 mmol/L (late diagnosis group). The results were processed using IBM SPSS. Results. The early diagnosis group had 1254 (65.7%) women, the late diagnosis group had 654 (34.3%). More primigravida women were in the late diagnosis group (p = 0.017) while more multigravida were in the early diagnosis group (p = 0.033). The early diagnosis group had more obese women (p = 0.001), including those with a BMI > 40 (p = 0.001). In the early diagnosis group, GDM was more frequently diagnosed in women who gained <11 kg (p = 0.005), while in the late diagnosis group—>16 kg (p = 0.001). FPG was higher in the early diagnosis group (p = 0.001). Glycemia was more commonly corrected with lifestyle changes in the late diagnosis group (p = 0.001), and with additional insulin therapy in the early diagnosis group (p = 0.001). Polyhydramnios and preeclampsia were more common in the late diagnosis group (p = 0.027 and p = 0.009). There were more large-for-gestational-age neonates in the late diagnosis group (p = 0.005). Macrosomia was more common in the late diagnosis group (p = 0.008). Conclusions. GDM is more commonly diagnosed with OGTT in primigravida women. Higher pregestational weight and BMI has an impact on the early diagnosis of GDM and need for insulin therapy with lifestyle changes. Late diagnosis of GDM is connected with obstetric complications.

Temos aktualumas. Menstruacinis ciklas yra kontroliuojamas endokrininių, autokrininių bei parakrininių veiksnių, reguliuojančių kiaušidžių folikulų formavimąsi, ovuliaciją bei endometriumo remodeliaciją. Vienas iš veiksnių, darančių įtaką hormonų disbalansui yra infekcija, kuri gali lemti ir menstruacinio ciklo pokyčius. 2019 m. pasirodęs SARS-CoV-2 virusas, palieka ne tik trumpalaikį, bet ir ilgalaikį poveikį žmogaus organizmui. Nuo pandemijos pradžios yra atliekami moksliniai tyrimai analizuojantys pandemijos ir vakcinacijos nuo COVID-19 įtaką menstruaciniam ciklui. Tiek Lietuvoje, tiek visame pasaulyje kol kas dar trūksta mokslinių tyrimų apie SARS-CoV-2 infekciją ir menstruacinio ciklo pokyčius. Tyrimo metodai (1). 2022 m. vasarį atliktas kiekybinis tyrimas. Internetinėje erdvėje buvo viešai pateikta oroginali anketa, sudaryta iš 37 klausimų. Anketa buvo paskelbta platformoje Facebook ir pasidalinta uždarose socialinėse grupėse, kuriose aptariama žmonių, persirgusių COVID-19, sveikata.. Anketą užpildė 851 moteris. 812 moterų įtrauktos į tyrimą. 39 moterys neįtrauktos į tyrimą. 19. nėščiųjų, 16 žindančių moterų, 4 moterys, kurių liga ar būklė galėjo daryti įtaką MC. Tyrimo metodai (2). Tiriamosios buvo suskirstytos į dvi grupes pagal tai, ar joms buvo nustatyta COVID-19 liga PGR testu. Tiriamoji grupė (TG) - sirgo COVID-19 liga (n=311); Kontrolinė grupė (KG) - nesirgo COVID-19 liga (n=501). [...].

Introduction and importance: Obesity is a major health problem. Obese women have an increased risk of pregnancy-related complications. Weight loss before conception is associated with improved fertility rates and pregnancy outcomes. Bariatric surgery (BS), such as laparoscopic adjustable gastric banding (LAGB), was a popular option for obese women planning pregnancy. However, long-term follow-up studies indicate high rate of failure and reoperations. The work has been reported in line with the SCARE 2020 criteria. Case presentation: We present a case of a 41-years-old multigravida who was diagnosed with intragastric penetration of the gastric band on the 27th week. Diagnostic laparoscopy and intraoperative esophagogastroduodenoscopy were performed. Gastric band was not removed and no other surgical interventions were performed. The patient underwent a caesarean section on the 37th week, due to the remaining risk of repeated gastric-band-related complications. Clinical discussion: The management of pregnancy following LAGB has not been well defined yet. Gastric band erosion with intragastric band migration is considered to be one of the most worrisome of all LAGB-related complications. Conclusion: International treatment consensus for pregnancy after BS is still missing. This case illustrates a need for practitioner to maintain a high index of suspicion of gastric-band-related complications during pregnancy. Gastric-band-related complications during pregnancy are rare with only limited number of published reports. To our knowledge, this is the first reported intragastric penetration of the gastric band in a pregnant woman, which was managed without gastric band removal during pregnancy and which had a good outcome for both, the patient and her baby.