Publications by authors named "Ruta Nadisauskiene"

49 Publications

Experience of Managing Suspected Placenta Accreta Spectrum with or without Internal Iliac Artery Balloon Occlusion in Two Lithuanian University Hospitals.

Medicina (Kaunas) 2021 Apr 2;57(4). Epub 2021 Apr 2.

Department of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Klinikos, Santariskiu st. 2, 08661 Vilnius, Lithuania.

: 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. : 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. : 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; = 0.616) and the need for red blood cell transfusion during operation (26% vs. 23%; = 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 ( = 0.002). None of the patients had complications related to the endovascular procedure. : 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.
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http://dx.doi.org/10.3390/medicina57040345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065721PMC
April 2021

Performance of the IOTA ADNEX Model on Selected Group of Patients with Borderline Ovarian Tumours.

Medicina (Kaunas) 2020 Dec 11;56(12). Epub 2020 Dec 11.

Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania.

ultrasound is considered to be the primary tool for preoperative assessment of ovarian masses; however, the discrimination of borderline ovarian tumours (BOTs) is challenging, and depends highly on the experience of the sonographer. The Assessment of Different NEoplasias in the adneXa (ADNEX) model is considered to be a valuable diagnostic tool for preoperative assessment of ovarian masses; however, its performance for BOTs has not been widely studied, due to the low prevalence of these tumours. The aim of this study was to evaluate the performance of ADNEX model for preoperative diagnosis of BOTs. retrospective analysis of preoperative ultrasound datasets of patients diagnosed with BOTs on the final histology after performed surgery was done at a tertiary oncogynaecology centre during the period of 2012-2018. 85 patients were included in the study. The performance of ADNEX model based on absolute risk (AR) improved with the selection of a more inclusive cut-off value, varying from 47 (60.3%) correctly classified cases of BOTs, with the selected cut-off of 20%, up to 67 (85.9%) correctly classified cases of BOTs with the cut-off value of 3%. When relative risk (RR) was used to classify the tumours, 59 (75.6%) cases were identified correctly. Forty (70.2%) cases of serous and 16 (72.7%) cases of mucinous BOTs were identified when AR with a 10% cut-off value was applied, compared to 44 (77.2%) and 15 (68.2%) cases of serous and mucinous BOTs, correctly classified by RR. The addition of Ca125 improved the performance of ADNEX model for all BOTs in general, and for different subtypes of BOTs. However, the differences were insignificant. The International Ovarian Tumour Analysis (IOTA) ADNEX model performs well in discriminating BOTs from other ovarian tumours irrespective of the subtype. The calculation based on RR or AR with the cut-off value of at least 10% should be used when evaluating for BOTs.
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http://dx.doi.org/10.3390/medicina56120690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763161PMC
December 2020

Symptomatic Uterine Rupture: A Fifteen Year Review.

Medicina (Kaunas) 2020 Oct 29;56(11). Epub 2020 Oct 29.

Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania.

To assess the incidence of complete and partial uterine rupture during childbirth in a single tertiary referral centre as well as the significant risk factors, symptoms and peripartum complications. A retrospective single-centre study involved all cases of uterine rupture at the Kaunas Perinatal Centre in 2004-2019. Data were from a local medical database complemented with written information from medical records. We included 45,893 women with an intact uterus and 5630 with uterine scars. Women ( = 5626) with scarred uterus' after previous cesarean delivery. The diagnosis was defined by clinical symptoms, leading to an emergency cesarean delivery, when complete or partial uterine rupture ( = 35) was confirmed. Asymptomatic cases, when uterine rupture was found at elective cesarean section ( = 3), were excluded. The control group is represented by all births delivered in our department during the study period ( = 51,525). The outcome was complete (tearing of all uterine wall layers, including serosa and membranes) and partial uterine rupture (uterine muscle defect but intact serosa), common uterine rupture symptoms. Risk factors were parameters related to pregnancy and labour. 51,525 deliveries occurred in Kaunas Perinatal Centre during the 15 years of the study period. A total number of 35 (0.06%) symptomatic uterine ruptures were recorded: 22 complete and 13 partial, leading to an incidence rate of 6.8 per 10,000 deliveries. The uterine rupture incidence rate after a single previous cesarean delivery is 44.4 per 10,000 births. 29 (83%) cases had a uterine scar after previous cesarean, 4 (11%) had a previous laparoscopic myomectomy, 2 (6%) had an unscarred uterus. The most significant risk factors of uterine rupture include uterine scarring and augmentation or epidural anaesthesia in patients with a uterine scar after cesarean delivery. The most common clinical sign was acute abdominal pain in labour 18 (51%). No maternal, six intrapartum perinatal deaths (17%) occurred, and one hysterectomy (2.8%) was performed due to uterine rupture. Neonatal mortality reached 22% among the complete ruptures. Average blood loss was 1415 mL, 4 (11%) patients required blood transfusion. The incidence rate of uterine rupture (complete and incomplete) at Kaunas Perinatal Centre is 6.8 per 10,000 deliveries. In cases with a scar of the uterus after a single cesarean, the incidence of uterine rupture is higher, exceeding 44 cases per 10,000 births. The most significant risk factors were uterine scar and augmentation or epidural anaesthesia in a previous cesarean delivery. Acute abdominal pain in labour is the most frequent symptom for uterine rupture.
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http://dx.doi.org/10.3390/medicina56110574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693983PMC
October 2020

Circulating inflammatory markers in cervical cancer patients and healthy controls.

J Immunotoxicol 2020 12;17(1):105-109

Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.

There is increasing evidence that host inflammatory responses play an important role in the development and progression of cancers. There are some data that cancer is associated not only with inflammation at the site of the lesion, but also with dysregulations of the host overall systemic immune response. In the case of cervical cancer, inflammation is an important factor associated with the development, progression, and potential metastasis of the disease. What is unclear still in the potential for modifications of host responses to human papillomaviruses (HPV) - a known causative agent of CC, that could be induced by cigarette smoking. In particular, it remains to be determined how the inflammation induced by HPV infection could impact on CC incidence/severity. In this prospective study, serum levels of 10 cytokines were evaluated using Multiplex and ELISA assays. The samples were the sera of 43 CC patients and 60 healthy (NILM) controls. All outcomes were evaluated in relation to host HPV and to their smoking status. The results in indicated that serum sTREM-1, TNFα, IFNβ, IL-1β, and IL-6 levels were significantly increased in CC (HPV+) patients compared to healthy NILM controls. A similar trend was observed for IL-10 and IL-2 levels. Within the two groups, differences in cytokine levels between smokers and never smokers were not remarkable. The findings here support the hypothesized role of systemic inflammation in the pathophysiology of CC.
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http://dx.doi.org/10.1080/1547691X.2020.1755397DOI Listing
December 2020

Lithuania's experience in reducing caesarean sections among nulliparas: the impact of the quality improvement course.

BMC Pregnancy Childbirth 2020 Mar 12;20(1):152. Epub 2020 Mar 12.

Lithuanian University of Health Sciences, Eiveniu str. 2, 50167, Kaunas, Lithuania.

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.
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http://dx.doi.org/10.1186/s12884-020-2806-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069017PMC
March 2020

Tumor Suppression in Asymptomatic Postmenopausal Endometrial Polyps.

Anticancer Res 2020 Feb;40(2):789-794

Department of Obstetrics and Gynecology, University of Manchester and St. Mary's Hospital, Manchester, U.K.

Background/aim: To investigate tumor suppression as an indicator of malignization potential within endometrial polyps in asymptomatic postmenopausal women.

Materials And Methods: Immunohistochemical studies of the phosphatase and tensin homolog (PTEN) were performed. Cases included 52 benign postmenopausal polyps, 19 endometrioid carcinomas with coexisting benign polyps, and 12 polyps with foci of carcinoma. Controls included 31 atrophic endometria and 32 benign premenopausal polyps. PTEN was scored by quantitative methods according to staining intensity.

Results: The mean epithelial and stromal PTEN H-score in postmenopausal benign endometrial polyps (193.8 and 123.2, respectively) was significantly higher than that in the atrophic endometrium (135.5 and 90.2, p=0.008), and premenopausal benign endometrial polyps (100.7 and 198.7, p<0.001). Significant difference between postmenopausal endometrial polyps and endometrial carcinoma was noticed in the epithelial compartment (193.8 vs. 65.7, respectively, p<0.001).

Conclusion: Asymptomatic benign postmenopausal polyps have a distinctively high tumor suppression compared with endometrial cancer, suggesting low malignization potential.
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http://dx.doi.org/10.21873/anticanres.14010DOI Listing
February 2020

Is it necessary to postpone pregnancy after bariatric surgery: a national cohort study.

J Obstet Gynaecol 2020 Jul 3;40(5):614-618. Epub 2019 Sep 3.

Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.

The optimal interval between bariatric surgery (BS) and pregnancy remains clearly undefined. The aim of this study was to assess pregnancy outcomes according to the interval from BS to conception. The nationwide study cohort consisted of 130 women with previous BS and postoperative singleton delivery during 2005-2015 in Lithuania. Women who conceived within the first 12 months after BS were included in the early conception (EC) group ( = 30); who became pregnant after 1 year were included in the late conception (LC) group ( = 100). Mean surgery-to-conception time in the EC group was 6.9 ± 3.5 months; in the LC group was 41.4 ± 21.6 months. Anaemia was diagnosed significantly more frequently in women who conceived after 12 months compared with the EC group (56.0% versus 33.3%,  = .04). No significant differences were found between the EC and the LC group regarding gestational diabetes, preeclampsia, caesarean section rate, and adverse neonatal outcomes.Impact statement Bariatric surgery is recognized as a safe and highly effective approach to obesity treatment. Optimal interval between bariatric surgery and conception remains undefined, however most bariatric surgeons advise patients to delay pregnancy for 12-18 months. The results of our study did not show significant differences in pregnancy complications and neonatal outcomes in women who conceived within the first 12 postoperative months and in women who conceived later. Women who become pregnant within the first year after surgery, should be reassured that obstetric complication rates generally are low. Patients with prior BS should be provided with multidisciplinary prenatal care and screening for nutritional deficiencies during pregnancy. Further studies are needed to determine the optimal interval after BS and to assess the influence this interval has on perinatal outcomes.
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http://dx.doi.org/10.1080/01443615.2019.1634024DOI Listing
July 2020

Proliferation in Postmenopausal Endometrial Polyps-A Potential for Malignant Transformation.

Medicina (Kaunas) 2019 Aug 28;55(9). Epub 2019 Aug 28.

Department of Obstetrics and Gynaecology, University of Manchester and St. Mary's Hospital, Manchester M13 9WL, UK.

Endometrial polyps in asymptomatic postmenopausal women are often incidentally found, yet only 1.51% of them are malignant. Their potential for malignant transformation has not been adequately addressed. The aim of this study was to investigate the proliferation within endometrial polyps as one of the indicators of their malignization potential in asymptomatic postmenopausal women. Immunohistochemical studies of Ki-67 were performed. Cases included 52 benign postmenopausal polyps, 19 endometrioid carcinoma with coexisting benign polyps, 12 polyps with foci of carcinoma and 4 cases of polyps, which later developed carcinoma. The control group included 31 atrophic endometria and 32 benign premenopausal polyps. Ki-67 was scored in either 10 or 20 "hot spot" fields, as percentage of positively stained cells. Results: The median epithelial Ki-67 score in postmenopausal benign polyps (4.7%) was significantly higher than in atrophic endometria (2.41%, < 0.0001) and significantly lower than in premenopausal benign polyps (11.4%, = 0.003) and endometrial cancer (8.3%, < 0.0001). Where endometrial polyps were found in association with endometrial carcinoma, Ki-67 was significantly higher in cancer ( < 0.0001). No significant difference was found between Ki-67 scores of cancer focus and of the polyps tissue itself, respectively 2.8% and 4.55%, = 0.37. Ki-67 expression, where polyps were resected and women later developed cancer, was not significantly different ( = 0.199). Conclusion: Polyps from asymptomatic postmenopausal women showed significantly more proliferation in both epithelial and stromal components than inactive atrophic endometria but less than premenopausal benign polyps and/or endometrial cancer. Benign postmenopausal endometrial polyps exhibit low proliferative activity, suggesting low malignant potential and may not require resection in asymptomatic women.
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http://dx.doi.org/10.3390/medicina55090543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780687PMC
August 2019

Associations among Serum Lipocalin-2 Concentration, Human Papilloma Virus and Clinical Stage of Cervical Cancer.

Medicina (Kaunas) 2019 May 30;55(6). Epub 2019 May 30.

Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, LT 44307 Kaunas, Lithuania.

Lipocalin 2 (LCN2) has an oncogenic role in promoting tumorigenesis through enhancing tumor cell proliferation and the metastatic potential. The aim of our study was to determine whether serum LCN2 could serve as a diagnostic marker of cervical cancer (CC) and to evaluate the correlation between its serum concentration, the clinical stage of the cancer and Human Papilloma Virus HPV infections in women. A total of 33 women with histologically proven cervical cancer (CC), 9 women with high- grade cervical intraepithelial neoplasia (HSIL) and 48 healthy women (NILM) were involved in the study. A concentration of LCN2 was assayed with the Magnetic LuminexR Assay multiplex kit. An HPV genotyping kit was used for the detection and differentiation of 15 high-risk (HR) HPV types in the liquid-based cytology medium (LBCM) and the tissue biopsy. The majority (84.8%) of the women were infected by HPV16 in the CC group, and there was no woman with HPV16 in the control group ( < 0.01). Several types of HR HPV were found more often in the LBCM compared to in the tissue biopsy ( = 0.044). HPV16 was more frequently detected in the tissue biopsy than the LBCM ( < 0.05). The LCN2 level was higher in HPV-positive than in HPV-negative women ( = 0.029). The LCN2 concentration was significantly higher in women with stage IV than those with stage I CC ( = 0.021). Conclusions: Many HR HPV types, together with HPV16/18, can colonize the vagina and cervix, but often HPV16 alone penetrates into the tissue and causes CC. The serum LCN2 concentration was found to be associated not only with HR HPV infection, irrespective of the degree of cervical intraepithelial changes, but also with advanced clinical CC stage. LCN2 could be used to identify patients with advanced disease, who require a more aggressive treatment.
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http://dx.doi.org/10.3390/medicina55060229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6630730PMC
May 2019

Diagnosis of HELLP Syndrome: A 10-Year Survey in a Perinatology Centre.

Int J Environ Res Public Health 2019 01 3;16(1). Epub 2019 Jan 3.

Department of Anaesthesiogy, Lithuanian University of Health Sciences, Eivenių str. 2, LT-50009 Kaunas, Lithuania.

HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome is a severe and rapidly progressing condition that requires distinct diagnostic considerations. The aim of this study was to evaluate the impact of the Mississippi triple-class system on the HELLP syndrome diagnosis, treatment, and outcomes in a perinatology centre during a 10-year period, and consider its effectiveness and necessity in everyday practice. A retrospective observational cohort study was carried out using the medical records of a tertiary perinatology centre with the diagnosis of HELLP syndrome from the period of time between 2005 and 2014. The patients who fit the HELLP syndrome diagnosis were grouped by the Mississippi triple-class system. The means of diagnosis and treatment outcomes within those groups were analysed statistically. There was insufficient statistical evidence of the blood pressure levels corresponding to the severity of patients' condition ( > 0.05 in all of the groups). The clinical presentation varied within all of the classes, and the only objective means of diagnosis and evaluation of progression of the condition were laboratory tests. Even though HELLP syndrome is considered a hypertensive multi-organ disorder of pregnancy, the level of hypertension does not correlate to the severity of the condition; hence, the diagnosis should be based on biochemical laboratory evidence. Vigilance in suspicion and the recognition of HELLP syndrome and appropriate treatment are essential in order to ensure better maternal and neonatal outcomes.
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http://dx.doi.org/10.3390/ijerph16010109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339138PMC
January 2019

Lithuania's experience in reducing caesarean sections among nulliparas.

BMC Pregnancy Childbirth 2018 Oct 25;18(1):419. Epub 2018 Oct 25.

Vilnius University Hospital Santaros Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania.

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 < 0.001).The greatest decrease in absolute contribution to the overall CS rate was recorded in groups 1 (p = 0.005) and 2B (p < 0.001). Perinatal mortality was 3.5 in 2012 and 3.1 in 2014 per 1000 deliveries (p = 0.764).

Conclusion: The TGCS can work as an audit intervention that could help to reduce the CS rate without a negative impact on perinatal mortality.
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http://dx.doi.org/10.1186/s12884-018-2052-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202871PMC
October 2018

Comparison of midwife-led and obstetrician-led care in Lithuania: A retrospective cohort study.

Midwifery 2018 Oct 21;65:67-71. Epub 2018 Jun 21.

Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Objective: To compare midwife-led and obstetrician-led care and their relation to caesarean section rates and obstetric and neonatal outcomes in low-risk births.

Design: Hospital registry based retrospective cohort study.

Setting: Tertiary-care women's hospital in Kaunas, Lithuania.

Participants: A total of 1384 and 1283 low-risk delivering women in 2012 and 2014, respectively.

Methods: The women choose either a midwife as their lead carer (midwife-led group), or an obstetrician-gynaecologist (obstetrician-led group).

Main Outcome Measures: The primary outcome was caesarean birth. Secondary outcomes included instrumental vaginal births, amniotomy, augmentation of labour, epidural analgesia, episiotomy, perineal trauma, labour duration, birthweight and Apgar score < 7 at 5 min.

Results: The proportion of caesarean births was 4.4% in the midwife-led and 10.7% in the obstetrician-led group (p < 0.001) in 2012, and 5.2% and 11.8% (p < 0.001) in 2014, respectively. Younger maternal age (≤34 years) and midwife-led care was associated with a significantly decreased odds for caesarean section and nulliparity with a significantly increased odds for caesarean birth. Women in the midwife-led group had fewer amniotomies and labour augmentations compared with the obstetrician-led group. Episiotomy, perineal trauma, duration of labour and neonatal outcomes did not differ between the groups.

Conclusion: Midwife-led care for women with low-risk birth reduced the caesarean section and several medical interventions with no apparent increase in immediate adverse neonatal outcomes compared with obstetrician-led care.

Implications For Practice: Midwife-led care for low-risk women should be encouraged in countries with health care system where obstetrician-led care births dominates.
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http://dx.doi.org/10.1016/j.midw.2018.06.017DOI Listing
October 2018

Patient safety culture in obstetrics and gynecology and neonatology units: the nurses' and the midwives' opinion.

J Matern Fetal Neonatal Med 2019 Oct 22;32(19):3244-3250. Epub 2018 Apr 22.

e Faculty of Nursing , Lithuanian University of Health Sciences , Kaunas , Lithuania.

Patients treated in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology are especially vulnerable. Large multidisciplinary teams of physicians, multiple invasive and noninvasive diagnostic and therapeutic procedures, and the use of advanced technologies increase the probability of adverse events. The evaluation of knowledge about patient safety culture among nurses and midwives working in such units and the identification of critical areas at a health care institution would reduce the number of adverse events and improve patient safety. The aim of the study was to evaluate the opinion of nurses and midwives working in clinical departments that provide services in the fields of obstetrics, gynecology, and neonatology about patient safety culture and to explore potential predictors for the overall perception of safety. We used the Hospital Survey on Patient Safety Culture (HSOPSC) to evaluate nurses' and midwives' opinion about patient safety issues. The overall response rate in the survey was 100% ( = 233). The analysis of the dimensions of safety on the unit level showed that the respondents' most positive evaluations were in the Organizational Learning - Continuous Improvement (73.2%) and Feedback and Communication about Error (66.8%) dimensions, and the most negative evaluations in the Non-punitive Response to Error (33.5%) and Staffing (44.6%) dimensions. On the hospital level, the evaluation of the safety dimensions ranged between 41.4 and 56.8%. The percentage of positive responses in the outcome dimensions Frequency of Events Reported was 82.4%. We found a significant association between the outcome dimension Frequency of Events Reported and the Hospital Management Support for Patient Safety and Feedback and Communication about Error Dimensions. On the hospital level, the critical domains in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology were Teamwork Across Hospital Units, and on the unit level - Communication Openness, Teamwork Within Units, Non-punitive Response to Error, and Staffing. The remaining domains were seen as having a potential for improvement.
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http://dx.doi.org/10.1080/14767058.2018.1461831DOI Listing
October 2019

Perceived changes in knowledge and confidence of doctors and midwives after the completion of the Standardized Trainings in Obstetrical Emergencies.

Medicina (Kaunas) 2017 8;53(6):403-409. Epub 2018 Feb 8.

Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Background And Objectives: There are only few training programs in obstetric emergencies currently in use and only some of them were evaluated with an adequate sample of participants. Therefore, we present the evaluation of the novel Standardized Trainings in Obstetrical Emergencies (STrObE), conducted in Lithuania. The aim of this study was to analyze whether participants' self-reported knowledge and confidence increased after the trainings, and whether the impact of the trainings was long-lasting.

Materials And Methods: Data was collected across the majority of hospitals providing secondary and tertiary obstetrical care in Lithuania in 2015. A total of 650 obstetricians-gynecologists and midwives attended the trainings; 388 (response rate 59.7%) of them filled in the initial questionnaire before the trainings, 252 (64.9%) immediately after, 160 (41.2%) 6 weeks after, and 160 (41.2%) 6 months after the trainings, which was the final sample for the analyses. Participants used a Likert-type scale to evaluate their knowledge and confidence about management of urgent obstetrical situations: vacuum-assisted vaginal delivery, shoulder dystocia, postpartum hemorrhage, preeclampsia/eclampsia, early preterm labor, and dystocia. We assessed how participants' self-reported knowledge and confidence changed after the trainings (compared to before the trainings) and how long the effect was retained for.

Results: The mean score of self-reported knowledge in obstetrical emergencies increased immediately after the trainings comparing to the scores before the trainings (P<0.001) and it did not differ further between the three time points after the trainings (i.e. immediately, 6 weeks, and 6 months; P>0.05). The same pattern was observed for self-reported confidence scores. The increase in self-reported knowledge and confidence after the trainings was stable. Moreover, the self-reported knowledge and confidence gains were greater for those participants with lower work experience, although benefit was seen across all experience levels.

Conclusions: STrObE improved participants' self-reported knowledge and confidence and lasting positive effects were observed for at least 6 months after the initial trainings. Moreover, the trainings were more beneficial for those with lower work experience, although they benefited all the participants.
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http://dx.doi.org/10.1016/j.medici.2018.01.006DOI Listing
September 2019

The global maternal sepsis study and awareness campaign (GLOSS): study protocol.

Reprod Health 2018 Jan 30;15(1):16. Epub 2018 Jan 30.

UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.

Background: Maternal sepsis is the underlying cause of 11% of all maternal deaths and a significant contributor to many deaths attributed to other underlying conditions. The effective prevention, early identification and adequate management of maternal and neonatal infections and sepsis can contribute to reducing the burden of infection as an underlying and contributing cause of morbidity and mortality. The objectives of the Global Maternal Sepsis Study (GLOSS) include: the development and validation of identification criteria for possible severe maternal infection and maternal sepsis; assessment of the frequency of use of a core set of practices recommended for prevention, early identification and management of maternal sepsis; further understanding of mother-to-child transmission of bacterial infection; assessment of the level of awareness about maternal and neonatal sepsis among health care providers; and establishment of a network of health care facilities to implement quality improvement strategies for better identification and management of maternal and early neonatal sepsis.

Methods: This is a facility-based, prospective, one-week inception cohort study. This study will be implemented in health care facilities located in pre-specified geographical areas of participating countries across the WHO regions of Africa, Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific. During a seven-day period, all women admitted to or already hospitalised in participating facilities with suspected or confirmed infection during any stage of pregnancy through the 42nd day after abortion or childbirth will be included in the study. Included women will be followed during their stay in the facilities until hospital discharge, death or transfer to another health facility. The maximum intra-hospital follow-up period will be 42 days.

Discussion: GLOSS will provide a set of actionable criteria for identification of women with possible severe maternal infection and maternal sepsis. This study will provide data on the frequency of maternal sepsis and uptake of effective diagnostic and therapeutic interventions in obstetrics in different hospitals and countries. We will also be able to explore links between interventions and maternal and perinatal outcomes and identify priority areas for action.
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http://dx.doi.org/10.1186/s12978-017-0437-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791346PMC
January 2018

Implementation of the Robson classification in clinical practice:Lithuania's experience.

BMC Pregnancy Childbirth 2017 Dec 20;17(1):432. Epub 2017 Dec 20.

Lithuanian University of Health Sciences, Eiveniu str. 2, 50167, Kaunas, Lithuania.

Background: To determine the cesarean section (CS) rate in Lithuania, identify the groups of women that influence it using the Robson classification and to determine the impact of implementing the use of the Robson classification on the CS rate.

Methods: The Robson classification was introduced in Lithuanian hospitals prospectively classifying all the deliveries in 2012. The overall CS rate, sizes of the Robson groups of women, CS rate in each group and contribution to the overall CS rate from each group was calculated and the results were discussed. The analysis was repeated in 2014 and the data were compared using MS EXCEL and SPSS 23.0.

Results: Nineteen Lithuanian hospitals participated in the study. They represented 84.1% of the deliveries (23,742 out of 28,230) in 2012 and 88.5% of the deliveries (24,653 out of 27,872) in 2014. The CS rate decreased from 26.9% (6379/23,742) in 2012 to 22.7% (5605/24,653) in 2014 (p < 0.001). The greatest contributions to the overall CS rate were made by groups 1, 2 and 5. The greatest decrease in the CS rate was detected in group 2. The absolute contribution to the overall CS rate decreased from 4.9% to 3.8%.

Conclusion: The Robson classification can work as an audit tool to identify the groups that have the greatest impact on the CS rate. It also helps to develop a strategy focussing on the reduction of the CS rate.
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http://dx.doi.org/10.1186/s12884-017-1625-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738883PMC
December 2017

Initial neonatal resuscitation: skill retention after the implementation of the novel 24/7 HybridLab learning system.

J Matern Fetal Neonatal Med 2019 Apr 22;32(8):1230-1237. Epub 2017 Nov 22.

e Department of Emergency and Disaster Medicine , Lithuanian University of Health Sciences , Kaunas , Lithuania.

Background: Ensuring long-term retention of the acquired practical skills is one of the major aims of a medical school. This depends on the application of training techniques and their combinations. In order to standardize the teaching process, to acquire and maintain a broad array of technical, professional, and interpersonal skills and competencies, and to improve the retention of practical skills, we developed a new training technique - the HybridLab learning method. It consists of an e-learning platform, hands-on simulation, carefully elaborated learning algorithms (DRAKON), peer-to-peer teaching, and assessment and feedback by peers, and later - by a remote instructor. Summary of the work: The subjects of the study were fifth-year students of the Lithuanian University of Health Sciences Medical Academy who during 2014-2015 were studying the obstetrics and gynecology module in the neonatology cycle. We analyzed the retention of practical skills in the initial neonatal resuscitation among students who were training with the use of our developed HybridLab technique at 6 and 12 months after the completion of the cycle.

Summary Of Results: After 6 and 12 months, mean changes in the subjects' evaluation scores (percentage drop-off between the first and the second total score) dropped by, respectively, 31.8% (SD: 27.5) and 7.7% (SD: 25.6), and did not differ statistically significantly (p = .2). In the group of subjects who were not given a possibility to remember the skills and the course of initial neonatal resuscitation, the mean change between the first and the second total evaluation scores was 42.5% (SD: 26.7). In students who were given such possibility, the mean change between the first and the second total evaluation scores was significantly smaller -12.7% (SD: 13.8) (p < .001). Changes in the evaluation scores of individual skills (first steps, mouth-to-mouth ventilation, and chest compressions) between the first and the second evaluation also differed statistically significantly and were smaller in the group of students who were given a possibility to remember their skills (p < .001).

Discussion: The HybridLab learning method is a novel technique, and thus more studies are required to evaluate the significance of the HybridLab technique for long-time retention of practical skills.

Conclusion: As a result of the application of the HybridLab training technique, practical skill retention among medical students after 6 and 12 months dropped by only about 13%. A recall system significantly improved practical skill retention.
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http://dx.doi.org/10.1080/14767058.2017.1402881DOI Listing
April 2019

Response of OVCAR-3 Cells to Cisplatin and Hyperthermia: Does Hyperthermia Really Matter?

Anticancer Res 2017 09;37(9):5011-5018

Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) is proposed as a promising treatment method, but fundamental information about the contribution of hyperthermia to intraperitoneal chemotherapy is lacking. The purpose of this study was to investigate the cytotoxic effect of hyperthermia and cisplatin on OVCAR-3 cells in vitro.

Materials And Methods: Imitating the typical clinical conditions of HIPEC, OVCAR-3 cells were exposed to hyperthermia and cisplatin for 1 h. MTT viability test, flow cytometric analysis, and real-time cell and isobologram analysis were performed.

Results: Hyperthermia up to 42°C did not significantly increase the effect of cisplatin regarding the viability and apoptosis of OVCAR-3 cells. Moreover, an antagonistic effect of hyperthermia and cisplatin was revealed.

Conclusion: Our investigation of OVCAR-3 cells critically disputes the benefit of hyperthermia in ovarian cancer treatment. Further in vitro and in vivo research is essential for better understanding of the mechanisms of action of hyperthermia and its role in the treatment of epithelial ovarian cancer.
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http://dx.doi.org/10.21873/anticanres.11915DOI Listing
September 2017

Maternal obesity and obstetric outcomes in a tertiary referral center.

Medicina (Kaunas) 2017 19;53(2):109-113. Epub 2017 Apr 19.

Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Background And Aim: Obese women are at an increased risk of various adverse pregnancy outcomes. The aim of our study was to evaluate the impact of obesity on maternal and neonatal outcomes in a tertiary referral center and to compare obstetric outcomes by the level of maternal obesity.

Materials And Methods: A cohort study included 3247 women with singleton gestations who gave birth at the Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, in 2010. Pregnancy complications and neonatal outcomes were identified using the hospital Birth Registry database in normal weight (body mass index [BMI] 18.5-24.9kg/m, n=3107) and prepregnancy obese (BMI ≥30kg/m, n=140) women. Pregnancy outcomes were compared according to the level of obesity (BMI 30-34.9kg/m, n=94 and BMI ≥35kg/m, n=46).

Results: Obese women were significantly more likely to have gestational hypertension (OR=8.59; 95% CI, 5.23-14.14; P<0.0001), preeclampsia (OR=2.06; 95% CI, 1.14-3.73; P<0.0001), gestational diabetes (OR=5.56; 95% CI, 3.66-8.49; P<0.0001), dystocia (OR=2.14; 95% CI, 1.36-3.38; P<0.0001), induced labor (OR=2.64; 95% CI, 1.83-3.80; P<0.0001), failed induction of labor (OR=18.06; 95% CI, 8.85-36.84; P<0.0001), cesarean delivery (OR=1.76; 95% CI, 1.25-2.49; P=0.001), large-for-gestational-age newborns (OR=3.68; 95% CI, 2.51-5.39; P<0.0001). Significantly increased risk of gestational diabetes, preeclampsia, dystocia and newborns with Apgar score ≤7 after 5min was only observed in women with BMI ≥35kg/m.

Conclusions: Maternal obesity is significantly associated with an increased risk of gestational hypertension, preeclampsia, gestational diabetes, dystocia, labor induction, failed induction of labor, large-for-gestational-age newborns and cesarean delivery.
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http://dx.doi.org/10.1016/j.medici.2017.03.003DOI Listing
November 2018

The impact of the implementation of the postpartum haemorrhage management guidelines at the first regional perinatal centre in Southern Kazakhstan.

BMC Pregnancy Childbirth 2016 08 19;16:238. Epub 2016 Aug 19.

First Regional Perinatal Centre in Southern Kazakhstan, G. Iliaeva str. 142A, Enbekshinskii raion, Shymkent, 160011, South Kazakhstan Region, Republic of Kazakhstan.

Background: Postpartum haemorrhage (PPH) remains one of the most common causes of maternal morbidity and mortality. Therefore, clearly written PPH management guidelines should be used in clinical practice. The aim of this study was to evaluate the effectiveness of the implementation of PPH management guidelines at the First Regional Perinatal Centre of Southern Kazakhstan (FRPC).

Methods: Between 2012 and 2013 an interventional study was performed whereby the PPH management guidelines were implemented at the FRPC. All of the deliveries that were complicated by PPH 8 months before and 8 months after the intervention were analysed. Prevalence and severity of PPH, and the change in prevention, diagnostics and management of PPH was evaluated and statistical analysis using the SPSS 22.0 was performed.

Results: There were in total 5404 and 5956 deliveries in the pre- and post-intervention periods, respectively. The rates of PPH and severe PPH decreased from 1.17 to 1.02 % (p = 0.94) and from 0.24 to 0.22 % (p = 0.94), respectively. Blood loss on average increased from 1055 to 1170 ml in the post-intervention period. The pharmacological treatment of postpartum haemorrhage with uterotonics was administered most frequently during both periods. After the implementation of the guidelines, the number of transfused units of packed red blood cells decreased from 4.76 to 2.48 units/case. In addition, the amount of transfused fresh frozen plasma decreased by 20 %. The number of conservative interventions and conservative operations increased from 7.9 to 52.7 % and from 3.9 to 48.6 %, respectively. The number of hysterectomies decreased from 23.7 % in pre-intervention to 8.1 % in the post-intervention period.

Conclusions: The implementation of the PPH management guidelines had a positive effect on PPH prevention, diagnostics and management. It led to a more conservative aproach to the treatment of PPH. Therefore, clearly written PPH management guidelines, adapted for a particular hospital, should be developed and used in clinical practice.
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http://dx.doi.org/10.1186/s12884-016-1027-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4992266PMC
August 2016

Cesarean section rates in Lithuania using Robson Ten Group Classification System.

Medicina (Kaunas) 2015 Nov 14;51(5):280-5. Epub 2015 Sep 14.

Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Background And Objective: The aim of this study was to analyze cesarean section (CS) rates using Robson Ten Group Classification System (TGCS) and to identify the main contributors to the overall CS rate in Lithuania.

Materials And Methods: A prospective cross-sectional study was carried out. All women who delivered between January 1 and December 31, 2012, in Lithuania were classified using the TGCS. The CS rates overall and in each Robson group were calculated, as was the contribution of each group to the overall CS rate.

Results: The CS rate was 26.4% (6697 among 25,373 deliveries) in 2012. Nulliparous women with single cephalic full-term pregnancy in spontaneous labor (Group 1) or who underwent induction of labor or prelabor CS (Group 2) and multiparous women with a previous CS (Group 5) were the greatest contributors (67.7%) to the overall CS rate. In addition, significant variation of CS rates between different institutions was observed, especially in women with single cephalic full-term pregnancy without previous CS (Groups 1-4), showing big differences in obstetric care across country.

Conclusions: Women in Groups 1, 2 and 5 were the largest contributions to the overall CS rate in Lithuania. It seems that efforts to reduce the overall CS rate should be directed on increasing vaginal birth after CS and reducing CS rates in nulliparous women with single cephalic full-term pregnancy (Groups 1 and 2).
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http://dx.doi.org/10.1016/j.medici.2015.09.001DOI Listing
November 2015

Successfully treated severe obstetric sepsis and acute respiratory distress syndrome with extracorporeal membrane oxygenation.

Perfusion 2016 May 15;31(4):343-6. Epub 2015 Sep 15.

Department of Obstetrics and Gynaecology, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania.

We report a unique clinical case about an 18-year-old woman, immediately post-partum after an urgent C-section, who survived severe sepsis, acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC) and was successfully treated with 11 different antibiotics, massive blood transfusions and repetitive surgeries and was on extracorporeal membrane oxygenation (ECMO) support for 22 days. Although, ECMO is a time-limited procedure and most manufacturers do not advise more than 14 days of use, the situation for this patient was life-threatening and ECMO, despite the dangerous risks listed above, was the only way to win time for the lungs to recover and for treatment of the underlying disease, while maintaining adequate oxygenation and circulation. Fortunately, the condition of this woman was stabilized and she achieved complete physical recovery, despite minor neurological deficit in the fingers of her right hand.
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http://dx.doi.org/10.1177/0267659115605885DOI Listing
May 2016

The impact of postpartum haemorrhage management guidelines implemented in clinical practice: a systematic review of the literature.

Eur J Obstet Gynecol Reprod Biol 2014 Jul 13;178:21-6. Epub 2014 Apr 13.

Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, Kaunas, Lithuania. Electronic address:

Postpartum haemorrhage (PPH) is an urgent obstetric condition requiring an immediate response and a multidisciplinary approach. The aim of this study was to review PPH management guidelines implemented in clinical practice, to evaluate their impact regarding prevention, diagnosis and treatment, and to analyze how the numbers of PPH cases changed in the post-intervention period. A systematic search in the PubMed database was performed. The references of all included articles were examined. Studies evaluating the management of PPH and the impact on the numbers of cases of this pathology after the implementation of new or updated guidelines were involved in the analysis. Two reviewers independently examined the titles and abstracts of all identified citations, selected potentially eligible studies, and evaluated their full-text versions. Methodological quality was assessed using a checklist based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. We analyzed seven articles that evaluated the impact of new or updated guidelines for PPH management implemented in clinical practice. In four trials, the numbers of PPH cases declined after the intervention. Guidelines for PPH management can have a positive impact on the reduction of the number of PPH cases.
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http://dx.doi.org/10.1016/j.ejogrb.2014.03.051DOI Listing
July 2014

Low level maternal smoking and infant birthweight reduction: genetic contributions of GSTT1 and GSTM1 polymorphisms.

BMC Pregnancy Childbirth 2012 Dec 26;12:161. Epub 2012 Dec 26.

Department of Environmental Sciences, Vytautas Magnus University, Donelaicio st, 58, 44248, Kaunas, Lithuania.

Background: Genetic susceptibility to tobacco smoke might modify the effect of smoking on pregnancy outcomes.

Methods: We conducted a case-control study of 543 women who delivered singleton live births in Kaunas (Lithuania), examining the association between low-level tobacco smoke exposure (mean: 4.8 cigarettes/day) during pregnancy, GSTT1 and GSTM1 polymorphisms and birthweight of the infant. Multiple linear-regression analysis was performed adjusting for gestational age, maternal education, family status, body mass index, blood pressure, and parity. Subsequently, we tested for the interaction effect of maternal smoking, GSTT1 and GSTM1 genes polymorphisms with birthweight by adding all the product terms in the regression models.

Results: The findings suggested a birthweight reduction among light-smoking with the GSTT1-null genotype (-162.9 g, P = 0.041) and those with the GSTM1-null genotype (-118.7 g, P = 0.069). When a combination of these genotypes was considered, birthweight was significantly lower for infants of smoking women the carriers of the double-null genotypes (-311.2 g, P = 0.008). The interaction effect of maternal smoking, GSTM1 and GSTT1 genotypes was marginally significant on birthweight (-234.5 g, P = 0.078). Among non-smokers, genotype did not independently confer an adverse effect on infant birthweight.

Conclusions: The study shows the GSTT1-null genotype, either presents only one or both with GSTM1-null genotype in a single subject, have a modifying effect on birthweight among smoking women even though their smoking is low level. Our data also indicate that identification of the group of susceptible subjects should be based on both environmental exposure and gene polymorphism. Findings of this study add additional evidence on the interplay among two key GST genes and maternal smoking on birth weight of newborns.
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http://dx.doi.org/10.1186/1471-2393-12-161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562502PMC
December 2012

Promoting contraceptive use among female rural-to-urban migrants in Qingdao, China: a comparative impact study of worksite-based interventions.

Eur J Contracept Reprod Health Care 2012 Oct 30;17(5):363-72. Epub 2012 Jul 30.

International Centre for Reproductive Health (ICRH), Ghent University, Belgium.

Background: We conducted a comparative study in worksites to assess the impact of sexual health promoting interventions on contraceptive use among female rural-to-urban migrants.

Study Design: In Qingdao ten manufacturing worksites were randomly allocated to a standard package of interventions (SPI) and an intensive package of interventions (IPI). The interventions ran from July 2008 to January 2009. Cross-sectional surveys at baseline and end line assessed the sexual behaviour of young female migrants. To evaluate the impact of the interventions we assessed pre- and post-time trends.

Results: From the SPI group 721 (baseline) and 615 (end line) respondents were considered. Out of the IPI group we included 684 and 603 migrants. Among childless migrants, self-reported contraceptive use increased significantly after SPI and IPI (adjusted odds ratio [aOR] = 3.23; 95% confidence interval [CI] = 1.52-6.84; p < 0.01 and aOR = 5.81; 95% CI = 2.63-12.80; p < 0.001, respectively). Childless migrants older than 22 years reported a greater use after IPI than after SPI.

Conclusion: Implementing current Chinese sexual health promotion programmes at worksites is likely to have a positive impact on migrant women working in the manufacturing industry of Qingdao. More comprehensive interventions seem to have an added value if they are well targeted to specific groups.
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http://dx.doi.org/10.3109/13625187.2012.696752DOI Listing
October 2012

Escherichia coli colonization in neonates: prevalence, perinatal transmission, antimicrobial susceptibility, and risk factors.

Medicina (Kaunas) 2012 5;48(2):71-6. Epub 2012 Apr 5.

Department of Neonatology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Unlabelled: Escherichia coli is one of the leading causes of early-onset neonatal sepsis in many industrialized countries. However, there is a lack of studies on Escherichia coli colonization in women and neonates. The study aimed at determining the prevalence Escherichia coli among pregnant women and newborns, perinatal transmission, antimicrobial susceptibility, and risk factors for neonatal colonization.

Material And Methods: In this prospective, cross-sectional study, 827 infants born to 808 mothers were enrolled. The study was carried out from October 1, 2006, to June 30, 2007. Women were screened for E. coli carriage at 35-37 weeks of gestation or on admission for premature rupture of membranes and delivery; neonates, within 15 minutes of their lives. Risk factors for colonization were collected by a questionnaire and were recorded during labor.

Results: Maternal E. coli colonization rate was 19.9%; neonatal, 14.4%; and transmission rate, 21.4%. Less than one-fourth (22.7%) of neonatal E. coli strains were resistant to ampicillin. Logistic regression analysis revealed that anal sexual intercourse (OR, 3.91; 95% CI, 1.87-8.19), one sexual partner (OR, 2.01; 95% CI, 1.30-3.11), maternal vaginal Escherichia coli colonization (OR, 1.81; 95% CI, 1.12-2.93), maternal body mass index of ≤27 (OR, 1.77; 95% CI, 1.15-2.73), and maternal education lower than university level (OR, 1.70; 95% CI, 1.06-2.74) were associated with neonatal Escherichia coli colonization.

Conclusions: The prevalence of maternal Escherichia coli colonization was higher in this study than other studies (19.9%). Neonatal Escherichia coli colonization was 14.4%. The resistance of Escherichia coli isolates to ampicillin was not high (22.7%). Improvement of maternal education and modification of mothers' sexual habits need to be undertaken to prevent neonatal Escherichia coli colonization.
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September 2012

Prevalence of human papillomavirus types 16, 18, and 45 in women with cervical intraepithelial changes: associations with colposcopic and histological findings.

Medicina (Kaunas) 2012 ;48(1):22-30

Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, 50028 Kaunas, Lithuania.

The aim of the study was to determine the prevalence of human papillomavirus (HPV) types 16, 18, and 45 in women with cervical intraepithelial changes caused by high-risk HPV in relation to colposcopic and histological findings. MATERIAL AND METHODS. A prospective study of 393 women with cervical cytologic changes confirmed by the Papanicolaou test was undertaken from April 3, 2006, to April 3, 2007. The Hybrid Capture 2 assay was performed. HPV-positive women underwent genotyping for types 16, 18, and 45. Colposcopy and biopsy were performed in 317 (80.7%) and 249 women (63.4%), respectively. The results were analyzed by age groups. RESULTS. Of all the women with cervical intraepithelial changes, 59% were positive for HR HPV, and 62% were positive for HPV types 16, 18, and 45. HPV types 16, 18, and 45 were detected in 54.8% of women with ASC-US/AGUS/ASC-H, 50.0% of women with LSIL, and 75.6% of women with HSIL. After confirmation of any histological and colposcopic changes, HPV types 16, 18, and 45 were detected in 68.0% and 69.0% of women, respectively. Moreover, 84.2% of the women with HSIL and high-grade colposcopic changes, and 78.5% of the women with HSIL and CIN 2/CIN 2-3/CIN 3/carcinoma in situ were positive for HPV types 16, 18, and 45. The sensitivity of the Papanicolaou test together with the Hybrid Capture 2 test compared with the Papanicolaou test together with the HPV 16/18/45 test diagnosing CIN 2+ changes did not differ (96.7% vs. 97.1%), but the specificity was higher (40.3% vs. 8.0%). CONCLUSIONS. The majority of the cytologic, colposcopic, and histological changes were caused by HPV types 16, 18, and 45. Despite the high prevalence of HPV types 16, 18, and 45, testing for these genotypes together with the Papanicolaou test did not improve the diagnosis of high-grade cervical intraepithelial lesions.
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May 2012

The Diagnostic Properties of Medical History in the Diagnosis of Tubal Pathology among Subfertile Patients.

ISRN Obstet Gynecol 2012 22;2012:436930. Epub 2012 Jan 22.

Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, Eiveniu 2, 50009 Kaunas, Lithuania.

Objectives. To evaluate the diagnostic performance of medical history in the diagnosis of tubal pathology among subfertile patients. Patients and Methods. Prospective cross-sectional study was performed. Prior to tubal evaluation, medical history data were collected. Sensitivity, specificity, and likelihood ratios (LRs) for predicting tubal pathology as determined by laparoscopy and dye test were calculated for each issue of medical history. Results. 39.6 % (59/149) were diagnosed with tubal pathology. The sensitivity for the different issues ranged between 1.7 and 54.2% and the specificity between 75.6 and 97.8%. The estimated highest value of positive LR is attributed to the history of ectopic pregnancy and lowest of negative LR to pelvic inflammatory disease (PID) and abdominal surgery. Conclusion. The positive history of PID, sexually transmitted diseases (STDs), abdominal and laparoscopic surgery, and ectopic pregnancy are satisfactory screening tests for ruling the tubal pathology in. The negative history of evaluated issues is inappropriate for ruling the tubal damage out.
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http://dx.doi.org/10.5402/2012/436930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3302065PMC
August 2012

Group B streptococcus and Escherichia coli colonization in pregnant women and neonates in Lithuania.

Int J Gynaecol Obstet 2012 Apr 20;117(1):69-73. Epub 2012 Jan 20.

Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Objective: To evaluate the prevalence of maternal and neonatal colonization with group B streptococcus (GBS) and Escherichia coli, and examine GBS serotypes and susceptibility to antibiotics.

Methods: A prospective cross-sectional study was carried out in Lithuania between October 2006 and June 2007. Lower vaginal/rectal swabs were obtained from pregnant women (n=998) and ear canal/throat swabs were obtained from their newborns (n=827) for culture.

Results: Overall, maternal and neonatal GBS colonization rates were 15.3% and 6.4%, respectively. Serotypes III (34.5%) and Ia (29.7%) were most common. All GBS isolates were susceptible to penicillin and 4.1% were resistant to erythromycin. Overall, maternal and neonatal E. coli colonization rates were 19.9% and 14.4%, respectively. In total, 71.4% of newborns with E. coli colonization were born to E. coli-negative mothers. E. coli was resistant to ampicillin and piperacillin in 25.9% and 16.6% of cases, respectively. The majority of E. coli-colonized newborns were contaminated with maternal fecal, but not vaginal, E. coli strains.

Conclusion: Maternal and neonatal GBS colonization rates, serotypes, and susceptibility to antibiotics were comparable to those reported in previous studies. Population-based data regarding early-onset neonatal infection rates will enable the formulation of a prevention program for early-onset GBS disease in Lithuania.
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http://dx.doi.org/10.1016/j.ijgo.2011.11.016DOI Listing
April 2012

Maternal request is not to blame for an increase in the rate of Cesarean section.

Medicina (Kaunas) 2012 ;48(12):647-52

Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, 50028 Kaunas, Lithuania.

Background And Objective: The aim of this study was to establish whether Lithuanian women would request an elective cesarean section in a low-risk pregnancy and to compare how the women's opinion changed during the 5-year period.

Material And Methods: A study was conducted at the Hospital of Lithuanian University of Health Sciences from November 1 to December 31, 2006, and from January 1 to February 28, 2011. A total of 204 and 239 women were enrolled in 2006 and 2011, respectively. Self-administered anonymous questionnaires collected information on women's knowledge about the advantages of the different modes of delivery and their preferred type of birth in a low-risk pregnancy.

Results: Overall, 82.4% of the participants in 2006 and 74.5% in 2011 thought that women should be able to choose the mode of delivery in a low-risk pregnancy. If they had had such an opportunity, 15.2% of women in 2006 and 14.9% in 2011 would have chosen cesarean section without any medical indication. The most frequently mentioned advantage of vaginal delivery was that it is natural, while safety for the newborn and the possibility of avoiding delivery pain were the mentioned advantages of cesarean section.

Conclusions: Approximately 15% of Lithuanian women would request an elective cesarean section, and this percentage did not change during the 5-year period. While the national cesarean section rate is increasing with every year, it seems that "maternal request" cannot be blamed for this phenomenon. Despite all the available information about the different modes of delivery, women still lack professional and reliable knowledge about it.
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May 2014
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