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Abstract Background To compare specific dietary and behavioral recommendations for hemorrhoids prevention during pregnancy. Methods This was a randomized, single-blind, multicenter trial conducted in three different clinical centers. Patients were randomly allocated into two groups in a ratio of 1:1. Intervention consisted of specific dietary and behavioral counseling. The primary outcome of this study was the rate of hemorrhoids at the time of discharge from the obstetrics unit. Categorical variables were compared by the Chi-Squared or Fisher exact tests, as appropriate. Continuous variables were compared using either the Student's t-test or the Mann–Whitney U test. Binary logistic regression model was used to identify independent predictors of hemorrhoids after delivery. This analysis was performed on factors with a p-value

Abstract Background To evaluate the role of the quality improvement course (QIC) to reduce the caesarean section (CS) rate among nulliparas (Robson groups 1 and 2) and to find out which group of women have reduced the CS rate following attendance at the course. Methods The QIC was organized in 2015. For the evaluation of the CS rate after the OIC, deliveries from the selected hospitals in 2014 and 2016 were compared using MS EXCEL and SPSS 23.0. Results Nulliparas accounted for 44.6% (3585/8046) and 42.9% (3628/8460) of all the deliveries in 2014 and 2016 years, respectively. The CS rate among nulliparas decreased from 19.0% (665/3502) in 2014 to 16.8% (593/3526) in 2016 (p = 0.018). The greatest decrease in absolute contribution to the overall CS rate was recorded in group 1 (p = 0.08). Perinatal mortality was 3.1 in 2014 and 3.9 in 2016 per 1000 deliveries (p = 0.569). Conclusion The QIC has helped to reduce the CS rate among nulliparas without a negative influence on perinatal mortality. The greatest decrease in the overall CS rate was recorded among nulliparous women who were treated with oxytocin and managed to reach a full cervical dilatation.

Abstract Background To evaluate the role of the TGCS to reduce the caesarean section (CS) rate among nulliparas (Robson groups 1 and 2) and to find out which group of women have reduced the CS rate by using this tool. Methods The Robson classification was introduced in Lithuanian hospitals prospectively classifying all the deliveries in 2012. The CS rate overall and in each Robson group was calculated and the results were discussed. The analysis was repeated in 2014 and the data from the selected hospitals were compared using MS EXCEL and SPSS 23.0. Results Nulliparas accounted for 43% (3746/8718) and 44.6% (3585/8046) of all the deliveries in 2012 and 2014 years, respectively. The CS rate among nulliparas decreased from 23.9% (866/3626) in 2012 to 19.0% (665/3502) in 2014 (p

Introduction: Pregnancy, delivery and postpartum periods are associated with fast changes leading to decreased self-confidence, anxiety, stress or even maternal depression impairing their quality of life (QOL). Although considered important, QOL of women during pregnancy is poorly understood. The aim of our study was to assess factors influencing QOL during first trimester of pregnancy. The secondary goal of our study was to evaluate whether QOL during first trimester of pregnancy is associated with newborn weight. Materials and methods: A prospective cohort study was performed including pregnant women during the first trimester visit. Our questionnaire consisted of the SF-36 QOL questionnaire, Wexner fecal incontinence scale, and other additional information. The SF-36 questionnaire mental (MCS) and physical (PCS) health scores were used in order to evaluate QOL of women during first trimester of pregnancy. Two multiple logistic regression models were created in order to determine independent variables that influence the QOL. Results: 440 pregnant women were included in the study. The two main domains that were used in the study were MCS and PCS, their medians were 50.0 (25.0; 50.0) and 50.1 (39.4; 59.0) points respectively. From the two logistic regression models we determined several independent factors that influence QOL of women during the first trimester of pregnancy. Additionally, we determined that women who reported worse QOL tended to give birth to newborns large for their gestational age. Conclusions: We found several significant variables that influence QOL of women during the first trimester of pregnancy. We also found that that lower MCS and PCS scores during the first trimester are associated with newborns large for gestational age.

Ectopia cordis is a rare congenital anomaly associated with the heart positioned outside of the thoracic cavity either partially or completely. It can be associated with other congenital abnormalities. Overall, the prognosis for infants with ectopia cordis is very poor but depends greatly on the type and severity of ectopia cordis and intracardiac and associated malformations. We present one case of a fetus with prenatally diagnosed thoracic ectopia cordis with intracardiac defects and omphalocele, all the abnormalities seen in pentalogy of Cantrell except a diaphragmatic defect. Considering poor prognosis for fetus, conservative management of prenatal care has been chosen. At the 42nd gestational week, during the active stage of labor, due to fetal distress, cesarean section was performed at a tertiary level hospital. The condition of the infant was impairing rapidly and the newborn succumbed within 24 hours. We discuss the perinatal care concerning this rare anomaly.

Background. Mature cystic teratomas (dermoid cysts) are the most common germ cell tumours with 10–25% incidence of adult and 50% of paediatric ovarian tumours. The aetiology of dermoid cysts is still unclear, although currently the parthenogenic theory is most widely accepted. The tumour is slow-growing and in the majority of cases it is an accidental finding. Presenting symptoms are vague and nonspecific. The main complication of a dermoid cyst is cyst torsion (15%); other reported complications include malignant transformation (1–2%), infection (1%), and rupture (0.3–2%). Prolonged pressure during pregnancy, torsion with infarction, or a direct trauma are the main risk factors for a spontaneous dermoid rupture that can lead to acute or chronic peritonitis. The diagnosis of mature cystic teratoma is often made in retrospect after surgical resection of an ovarian cyst, because such imaging modalities as ultrasound, computer tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign and malignant pathology. Materials and methods. We present a report of a clinical case of a 35-years-old female, who was referred to the hospital due to abdominal pain spreading to her feet for three successive days. She had a history of a normal vaginal delivery one month before. Abdominal examination revealed mild tenderness in the lower abdomen; no obvious muscle rigidity was noted. Transvaginal ultrasound showed a multiloculated cystic mass measuring 16 × 10 cm in the pelvis. In the absence of urgency, planned surgical treatment was recommended. The next day the patient was referred to the hospital again, with a complaint of stronger abdominal pain (7/10), nausea, and vomiting. This time abdominal examination revealed symptoms of acute peritonitis. The ultrasound scan differed from the previous one. This time, the transvaginal ultrasound scan revealed abnormally changed ovaries bilaterally. There was a large amount of free fluid in the abdominal cavity. The patient was operated on – left laparoscopic cystectomy and right adnexectomy were performed. Postoperative antibacterial treatment, infusion of fluids, painkillers, prophylaxis of the thromboembolism were administered. The patient was discharged from the hospital on the seventh postoperative day and was sent for outpatient observation. Results and conclusions. Ultrasound is the imaging modality of choice for a dermoid cyst because it is safe, non-invasive, and quick to perform. Leakage or spillage of dermoid cyst contents can cause chemical peritonitis, which is an aseptic inflammatory peritoneal reaction. Once a rupture of an ovarian cystic teratoma is diagnosed, immediate surgical intervention with prompt removal of the spontaneously ruptured ovarian cyst and thorough peritoneal lavage are required.

Ultrasound imaging in obstetrics and gynecology dates back to 1958 when The Lancet published the first article about the use of ultrasonography for fetal and gynecological assessments. It is now almost inconceivable, 60 years later, to think of effective performance in obstetrics and gynecology without the variety of ultrasound, for example, real time imaging, power and color Doppler, 3D/4D ultrasonography, etc. Such examinations facilitate the assessment of intrauterine fetal growth and development during pregnancy, provide alerts about the risk of pre-eclampsia and preterm birth, help identify anatomic reasons for infertility, diagnose ectopic pregnancies, uterine, ovary and tubal pathology. Ultrasonography is also used for diagnostic and treatment procedures during pregnancy or for the treatment of infertility. This article is an overview of the development of fetal ultrasound, the methodology and interpretation of ultrasound in the assessment of intrauterine fetal growth and fetal biometry standards both worldwide and in Lithuania. Keywords: Fetal biometry, Ultrasound, Intrauterine growth restriction

Background. Uterine sarcomas are rare gynaecologic tumours representing 3–7% of all uterine malignancies. The aetiology of sarcomas is still unclear: it is thought, that chromosomal translocations have influence on wide histological variety of sarcomas. Presenting symptoms are vague and nonspecific. Usually sarcoma causes abnormal vaginal bleeding, can cause abdominal or pelvic pain, or manifests as a rapidly growing uterine tumour. The diagnosis of sarcoma is often made retrospectively after surgical removal of a presumed benign uterine neoplasm, because imaging modalities such as ultrasound, computed tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign leiomyoma and malignant pathology. If there are certain clinical features that raise a suspicion of malignancy in the uterus, it is recommended to avoid the use of power morcellation through laparoscopic surgery in order to prevent disease dissemination. Materials and methods. We present a clinical case of a 64-year-old patient, who was referred to hospital due to abdominal pain and tenesmus that lasted for two days. From a past medical history it was known that previously the patient had been diagnosed with uterine myoma. Transvaginal ultrasonography showed a 10.4 cm × 9.8 cm uterine tumour of nonhomogeneous structure with signs of necrosis and good vascularization. The patient refused urgent hysterectomy, that was advised to her. The patient was operated on one month later and total hysterectomy with bilateral salpingooforectomy was performed. Postoperative histological evaluation showed undifferentiated sarcoma uterus pT1b L/V0. Imaging modalities were made to evaluate possible dissemination of the disease. In the absence of signs of disease progression, the patient received radiotherapy and brachytherapy and was followed-up by doctors. Results and conclusions. Uterine sarcomas are highly malignant tumours that originate from smooth muscles and connective tissue elements of the uterus and make up 1% of all malignant gynaecological tumours and about 3–7% of all malignant uterine tumours. Imaging modalities cannot yet reliably distinguish benign myomas from malignant sarcomas. It is important not to damage the wholeness of uterus during operation in order to prevent dissemination of the disease in the abdominal cavity. The low-grade endometrial stromal sarcoma has the best survival prognosis, while carcinosarcoma and undifferentiated uterine sarcoma have the lowest survival rates.

Background. As a result of improved diagnostic and reparative techniques, congenital heart diseases are becoming a significant problem for women of childbearing age. Nowadays, more pregnant women in the West are being diagnosed with an acquired heart disease because of the tendency to delay childbearing and increasing age-related risk of developing complications of hypertension, diabetes, obesity and other diseases. According to the Lithuanian Health Information Centre, the incidence of cardiovascular diseases in pregnancy is decreasing in Lithuania, from 1.4% in 2014 to 1% in 2016 (1). Heart diseases can aggravate maternal adaptive capabilities and complications that pose a threat to mother and foetus can occur. Management of such conditions presents a serious therapeutic challenge to multidisciplinary team. The aim of this article is to discuss the course of pregnancy and peculiarities of maternal and foetal care in a woman with hemodynamically significant heart disease. Materials and methods. We present a clinical case of a 30-year-old nuliparous woman who was diagnosed with mitral valve disease with critical stenosis, grade II/III mitral valve insufficiency, moderate-severe pulmonary hypertension, heart failure stage C, and NYHA functional class II. Results and conclusions. Pregnancy in conjunction with heart disease is a complicated condition that requires multidisciplinary prenatal care (consisting of an obstetrician gynaecologist, cardiologist, anaesthesiologist). Low molecular weight heparins should be the first choice medication for antithrombotic prophylaxis. Since pregnancy can aggravate a heart disease, preconception counselling and evaluation of the heart function are recommended.

[straipsnis ir santrauka lietuvių kalba; santrauka anglų kalba] Intrauterininės sąaugos – tai jungiamojo audinio formavimasis gimdos ertmėje. Šio proceso metu progresuoja endometriumo funkcijos sutrikimas, kuriam būdingi įvairūs klinikiniai simptomai, tokie kaip menstruacinio ciklo sutrikimai (hipomenorėja, dismenorėja ar amenorėja), pasikartojantys savaiminiai nėštumo nutrūkimai, nevaisingumas ir kt. Klinikinė intrauterininių sąaugų raiška yra vadinama Ašermano sindromu. Šio straipsnio tikslas – pristatyti Ašermano sindromo klinikinį atvejį, apžvelgti naujausius mokslinės literatūros šaltinius ir įvertinti problemos aktualumą. Pateikiamas 30 metų amžiaus pacientės klinikinis atvejis. Pacientė planine tvarka kreipėsi į gydytoją akušerį-ginekologą dėl nevaisingumo, kurio trukmė buvo 2 metai. Kitų nusiskundimų pacientė neišsakė, iš anamnezės buvo žinoma, kad moteris negimdžiusi, prieš dvejus metus pacientei buvo atliktas 8 savaičių trukmės nėštumo nutraukimas. Pirminės apžiūros metu, atlikus transvaginalinę (2D) sonoskopiją, gimdos ir gimdos priedų sonoskopinių pakitimų nenustatyta. Intrauterininės sąaugos pacientei diagnozuotos atlikus hidrosonografiją, atliktas papildomas tyrimas – HyFoSy (histerosalpingosonoskopija, angl.Hysterosalpingo Foam Sonography). Pacientei buvo atlikta operacija – histeroskopija, kurios metu pašalintos intrauterininės sąaugos. Pooperacinis laikotarpis buvo sklandus. Praėjus dviem mėnesiams po operacijos pacientei nustatytas nėštumas (pacientė konsultuota gydytojo akušerio-ginekologo). Nėštumo eiga buvo sklandi, cezario pjūvio operacijos metu gimė gyvas, vyriškos lyties naujagimis, pagal Apgar balų skalę įvertintas 9/10 balų. Pagrindinis etiologinis veiksnys, lemiantis intrauterininių sąaugų formavimąsi, yra tiesioginis endometriumo pažeidimas. Pateikiamos keturios intrauterininių sąaugų klasifikacijos sistemos, pagal kurias galima numatyti gydymo taktiką ir komplikacijų riziką bei įvertinti pacientės vaisingumo prognozę. Įtariant Ašermano sindromą, rekomenduojama atlikti sonoskopiją arba hidrosonografiją, histerosalpingosonoskopiją arba histerosalpingografiją ir histeroskopiją. Pagrindiniai gydymo etapai: diagnostinė histeroskopija, histeroskopinis intrauterininių sąaugų suardymas ir profilaktinės priemonės (balioninio kateterio, intrauterininės spiralės įvedimas, hialurono rūgšties gelio ar SprayGelʼio vartojimas), pooperacinė hormonų terapija ir, esant indikacijų, pagalbinis apvaisinimas. Kamieninių ląstelių transplantacija į gimdos ertmę, tikėtina, ateityje taps alternatyva chirurginiam gydymui. Nėštumą po Ašermano sindromo gydymo būtina vertinti kaip didelės rizikos nėštumą.

Tikslas. Palyginti nėščiųjų ir jaunų negimdžiusių moterų kūno ir krūtų dydžio rodiklius. Medžiaga ir metodika. 2008–2009 m. (I tyrimas) ištirti 82 jaunų negimdžiusių devyniolikos metų amžiaus merginų krūtų ir kūno dydžio rodikliai, jie palyginti su 2013–2015 m. (II tyrimas) Vilniuje tirtų nėščiųjų (pirmuoju nėštumo trečdaliu) tais pačiais kūno stambumo ir krūtų parametrais – ūgiu, svoriu, įvairių kūno dalių apimtimis, odos klostėmis, pasyviąja kūno mase ir krūtų tūriu. Kūno dydžio rodikliams palyginti visos tiriamosios buvo skirstomos į grupes pagal krūtų dydį ir kūno stambumą (procentiliniu metodu). Nėščiosios suskirstytos į gimdančias pirmą kartą ir pakartotinai. Abiejuose tyrimuose naudota standartinė antropometrinė metodika. Krūties tūris apskaičiuotas pagal R. Kramerio ir G. Dexlerio (1981) formulę. Pasyviosios kūno masės (riebalinio audinio) kiekis procentais – pagal odos ir poodžio riebalines klostes naudojant W. E. Sirio (1961), J. H. Wilmorės ir A. R. Behnkės (1970) formules. Rezultatai, nustatyti visų parametrų aprašomosios statistikos, įvairovės ir pasiskirstymo rodikliais, apdoroti naudojant SPSS 22.0 programą. Skirtumai tarp tiriamųjų grupių vertinti pagal Stjudento t kriterijų. Pasirinktas patikimumo lygmuo p

Background. The aim of this article is to present a rare clinical case of vasa praevia as well as to assess the relevance of the problem by reviewing the latest literature sources. Materials and methods. In this report we present a case of a 33-yearold woman diagnosed with vasa praevia at 33 weeks of pregnancy, after hospitalisation with preterm rupture of membranes following the delivery of a live healthy baby through a lower segment Caesarean section during 33rd week of gestation at Vilnius University Hospital Santariškių Clinics. We investigated all the documentation of the patient before and after delivery. Results and conclusions. Vasa praevia is a rather rare pathology which is likely to occur during pregnancy, may result in heavy bleeding and be particularly threatening to the fetus life. A timely diagnosis for these women is essential. The gold standard for vasa praevia diagnosis is the fetal ultrasound scan. Vasa praevia pathology is found during the routine second trimester ultrasound check-up. The selection of proper tactics applied during pregnancy care is essential. At the gestational age of 28–32, it is advisable to mature fetal lungs as well as the fetus condition should be investigated by a perinatologist. The mode of delivery is the C-section which tends to reduce the frequency of possible complications.

Pakartotinis gimdos plyšimas – tai reta ir itin pavojinga motinos bei vaisiaus gyvybei akušerinė komplikacija. Nepavėluota diagnostika ir gydymas svarbu tiek gelbstint motinos ir vaisiaus gyvybę, tiek užtikrinant gyvenimo kokybę. Šio straipsnio tikslas – pristatyti retą klinikinį pakartotinio gimdos plyšimo po buvusios cezario pjūvio operacijos ir laparoskopinės gimdos miomos pašalinimo operacijos atvejį ir apžvelgti literatūrą, nagrinėjančią gimdos plyšimo nėštumo metu aktualumą, rizikos veiksnius, klinikinius požymius bei gydymą.

Šio straipsnio tikslas – apžvelgti literatūrą, nagrinėjančią nėščiųjų hemorojaus ir išangės įplėšos paplitimą, priežastis, dažnį, rizikos veiksnius bei šių ligų įtaką moterų gyvenimo kokybei. Išangės ligos (hemorojus ir išangės įplėša) tiek nėštumo metu, tiek laikotarpiu po gimdymo yra dažna patologija, kuriai vis dar stinga tiek koloproktologų, tiek akušerių ginekologų dėmesio. Šiuo metu nėra tyrimų, kuriuose perspektyviuoju būdu nėštumo metu ir po gimdymo būtų vertinamas išangės ligų atsiradimas, nustatomi jų rizikos veiksniai. Labai svarbu ištirti ir įvertinti šių ligų paplitimą Lietuvoje ir rizikos veiksnius, jų ryšį su nėštumo ir gimdymo veiksniais, laiku šias ligas diagnozuoti ir gydyti bei atrasti priemonių, kaip jų išvengti, taip pagerinant moterų gyvenimo kokybę ne tik nėštumo ir gimdymo metu, bet ir laikotarpiu po gimdymo. Reikšminiai žodžiai: hemorojus, išangės įplėša, nėštumas, gimdymas, rizikos veiksniai, gyvenimo kokybė Hemorrhoids and anal fissures during pregnancy and after childbirth: prevalence, risk factors and impact on women’s quality of life Diana Bužinskienė, Gražina Drąsutienė, Tomas Poškus The aim of this study was to review the literature regarding the incidence, prevalence, risk factors of hemorrhoids and anal fissures during, before, and after pregnancy and their impact on the quality of life of women.Both hemorrhoids and anal fissures are common during and after pregnancy; however, they are frequently overlooked by both coloproctologists and gynecologists. There are no prospective cohort studies of perianal diseases during and after pregnancy with an emphasis on identifying the possible risk factors. Thus, it is important to identify the incidence and risk factors of perianal diseases in Lithuania and to find the factors of pregnancy and delivery that could be related to the occurrence or prevent the occurrence of these diseases. In this way, the possible areas of correction and intervention could be identified.Key words: hemorrhoids, anal fissure, pregnancy, delivery, risk factors, quality of life