Background: The incidence of cervical cancer in Latvia is one of the highest among European countries. An organized cervical cancer screening program in Latvia was introduced in 2009. Women’s knowledge and attitude regarding cervical cancer is the key component for successful prevention of this disease. The aim of this study was to evaluate women’s knowledge about the risk factors, prevention and diagnostic methods of precancerous and invasive disease of the uterine cervix in the main colposcopy clinic in Latvia and to compare women's knowledge before and after their first colposcopy visit.Methods: This was a cross sectional study where 100 women were included while attending their first colposcopy visit at Colposcopy Clinic of Riga East Clinical University Hospital. Study was performed in the period September 2017 to November 2017. Exclusion criteria were colposcopy follow-up examination and pregnancy. The most common reason for a planned colposcopy was suspected precancerous changes during cytology testing.Results: The most common information resources regarding reproductive health were gynaecologist (79%) and mass media (51%). Women knowledge about the risk factors of cervical precancerous changes were as follows: 30% marked smoking and 26% - early onset of the first sexual intercourse. 31% of women knew that vaccination against HPV is an effective prevention. 53% of women considered cervical cytology and 52% - colposcopy as a diagnostic method for precancerous changes. Higher number of women evaluated their general knowledge as sufficient after the visit (10% vs. 30%, p<0.05), but only smoking as a risk factor was recognized significantly more often (30% vs. 42%, p<0.05).Conclusions: Although current study presented specific population of women attending Colposcopy clinic because of suspected precancerous disease, less than a half of women knew risk factors, prevention and diagnostics of these changes. Overall women were satisfied with information they received during their first colposcopy visit, but afterward only knowledge about smoking as a possible risk factor improved significantly. It is important to improve women's knowledge about the meaning of prevention methods in order to increase the awareness of cervical cancer in Latvia.

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Loop electrosurgical excision procedure (LEEP) is the first-line treatment for cervical intraepithelial neoplasia (CIN). It is effective, easy to perform and relatively safe for the patient. However, 1-2% of patients experience complications such as hemorrhage and infection, which usually are effectively treated using cauterization and antibiotics. We are presenting a case of repeated cervical and vaginal hemorrhage after the cervical LEEP for a patient without previous medical history of severe bleeding or detected bleeding disorders. A generally healthy 38-year-old female underwent planned LEEP of cervix because of CIN II-III. Procedure was successful. Afterwards she was admitted to the Emergency department several times because of recurrent vaginal and cervical bleeding. She received suturing and coagulation of the cervix and vaginal wall combined with desmopressin and tranexamic acid therapy. Because of suspected bleeding disorder hematologist was invited. Laboratory analysis showed positive results for von Willebrand disease. After VIII/von Willebran factor concentrate treatment bleeding was stopped completely. Before any surgical interventions it is important to take a detailed medical history. If atypical, recurrent and/or severe secondary hemorrhage after the surgical manipulations occur, coagulation disorders should be excluded.

Objective Lesbian couples must resort to adoption or donated semen to achieve parenthood, the latter usually involving assisted reproductive technology. The aim of this study is to assess homosexual women’s knowledge about assisted reproductive techniques, the importance of perceived genetic and gestational relationships for their future mother-child bond, as well as their reproductive plans. Methods This is an observational study based on an anonymous survey disseminated online in several countries on different continents, addressed to homosexual women. Results From the 549 participants, most reported being well informed about reproductive options including assisted reproductive technology. The majority want to be a mother as part of a couple, mainly through assisted reproduction or step adoption of their partner’s child. The importance of a genetic or gestational relationships with their future child varies greatly between women. Among the sampled women, pregnancy was believed to have a slightly greater impact on the future mother-child connection compared to genetics. Conclusions Homosexual women are well informed about the assisted reproductive technology treatments. The majority considers it important to become a mother as a couple, mainly through assisted reproduction or step adoption of their partner’s child. The importance given to gestation or genetic mother-child relationships varies greatly between women, and it seems they believe pregnancy may have a slightly greater impact on the future mother-child connection compared to genetics.