Edyta Horosz

Maternal weight gain in women with gestational diabetes mellitus.

Abstract Objective: The aim of the study was to examine the perinatal outcomes in gestational diabetes in women with body mass index (BMI)-adjusted gestational weight gain (GWG) according to the Institute of Medicine (IOM) 2009 recommendations. Material and methods: The clinic’s database was used to analyze 675 singleton GDM pregnancy outcomes. GWG for the entire pregnancy was compared to IOM recommendations and adjusted for prepregnancy BMI categories: underweight <18.5; normal 18.5–24.9; overweight 25–29.9; and obese >30. The study group was divided into three categories: below IOM limits, within IOM limits and above IOM limits. Results: Only 37% of women achieved the proper weight gain (n=256). Almost 30% of women with GDM (n=196) had an excessive weight gain. GWG above limits was associated with a significantly higher neonatal measurements and a higher rate of large-for-gestational-age neonates. In underweight and normal-prepregnancy-weight women, no relation between GWG and birth-weight percentile was noted. For the overweight and obese women, a positive significant correlation between GWG until GDM diagnosis and birth-weight percentile was noted (P=0.002), which was not present when GWG until delivery was considered. Conclusions: Limited weight gain in overweight and obese women with gestational diabetes mellitus results in favourable pregnancy outcomes.

Does the suburethral sling change its location

To ascertain whether a phenomenon of sling migration exists after suburethral sling placement, whether this might be responsible for suboptimal sling location and persistent incontinence, and whether a link exists between sling dislocation or migration and risk factors, such as obesity or age.

Demographic features of female urethra length

To determine cohort urethral length, identify epidemiological factors influencing the parameter and to establish the percentage of cases with clinically relevant outsized urethras.

The Outcome of Repeated Mid Urethral Sling in SUI Treatment after Vaginal Excisions of Primary Failed Sling: Preliminary Study

Mid urethral sling is the standard in SUI treatment. Nevertheless, the risk of reoperation reaches 9%. There is no consensus as to the best treatment option for complications. A question is raised: what is the optimal way to achieve the best result in patients after primary failure? The aim of the study was to evaluate the outcomes of repeat MUS surgery in patients after excision of the sling with recurrent SUI. We compared its effectiveness with uncomplicated cases treated with TVT. 27 patients who underwent the repeated MUS and 50 consecutive patients after primary TVT were enrolled in the study. After 6 months, we have found that 24 (88.46%) patients from repeat sling group and 48 (96%) patients after primary sling were dry (1-hour pad test, 2 g or less). The difference between groups was not significant. We showed statistically significant improvement of quality of life in both groups. In conclusion, we showed that repeated sling after MUS excision is almost as effective as primary MUS. We postulate that sling excision and repeated MUS may be the best option for persistent SUI and/or complications after MUS procedures. Further multicenter observations are ongoing as to provide results on bigger group of cases.

Quality of life assessment in women after cervicosacropexy with polypropylene mesh for pelvic organ prolapse: a preliminary study.

Aim of the study Aim of the study was to assess the changes in the subjective perception of quality of life in patients who underwent abdominal cervicosacropexy for pelvic organ prolapse. Material and methods Forty patients with diagnosed pelvic organ prolapse (Pelvic Organ Prolapse – Quantification [POPQ] stage IV or IIIC) underwent abdominal supracervical hysterectomy and cervicosacropexy. The questionnaire concerning the quality of life was filled in before and 6 months after the surgery. Results In all patients, an accurate prolapse correction was achieved. In 42% of patients, stress urinary incontinence (SUI) was diagnosed prior to surgery, while after the surgery in 38.24% (p > 0.05). In 50% of women, symptoms of overactive bladder (OAB) occurred pre-surgery. These symptoms were reported by 17.65% of patients postoperatively (p < 0.05). Urinary retention was observed in 32.36% before and in 2.5% after the surgery (p < 0.05). The average score of the quality of sexual life was 5.75 (SD 2.52, 95% CI: 4.41-7.1) before and increased to 7.93 (SD 1.77, 95% CI: 6.9-8.95) after the procedure (p < 0.05). The mean score of the overall quality of life in relation to POP before and after the procedure was 2.77 (SD 2.39, 95% CI: 1.87-8.64) and 9.03 (SD 1.08, 95% CI: 8.66-9.43), respectively (p < 0.001). Conclusions These results show a highly significant improvement of the quality of life in patients who underwent abdominal cervicosacropexy for POP. The change in quality of their sexual life, reduced OAB and urinary retention rates, as well as improvement of the esthetic self-perception may have contributed to this positive effect.