Invasive and metastatic hydatidiform moles in Slovakia in 1993‒2022.

OBJECTIVE: A retrospective analysis of invasive and metastatic hydatidiform moles (HM) in the Slovak Republic (SR)‒epidemiology, patient characteristics and treatment outcomes. BACKROUND: Invasive and metastatic mole is a highly curable type of gestational trophoblastic neoplasia. Both invasive and metastatic HM may be cured by hysterectomy without adjuvant chemotherapy. METHODS: Nineteen cases of histopathologically confirmed HM (10 invasive and 9 metastatic) were treated in SR from 1993 to 2022. Patients were divided into two groups according to treatment modality (hysterectomy only ‒ 8; hysterectomy and chemotherapy ‒ 11). The parameters included in the analysis were patient age, antecedent pregnancy, human chorionic gonadotropin level, tumor size and time to remission. RESULTS: The incidence of invasive and metastatic HM in the SR was 1:121,253 pregnancies, or 1:86,589 live births. The overall cure rate was 100%, without recurrence. Hysterectomy was performed as first-line therapy in 14 patients, with a cure rate of 57.1%. 4 out of 8 patients (50%) with metastatic moles, who underwent first-line hysterectomy, were cured without chemotherapy. There was no statistically significant difference between the two groups in all selected parameters. CONCLUSION: First-line hysterectomy may lead to remission without adjuvant chemotherapy or reduce the number of chemotherapies in invasive and metastatic HM (Tab. 4, Fig. 2, Ref. 21).

Post-mortem rapid aneuploidy testing for holoprosencephaly.

BACKGROUND: Abortion and fetal death are common in fetuses with holoprosencephaly, so genetic examinations often have to be made in a post-mortem setting. The efficiency of the conventional karyotyping using cultured fibroblasts in these situations is limited due to frequent culture failure. In the current study, archived cases of holoprosencephaly, where post-mortem genetic evaluation was requested and sufficient frozen material was available, were reevaluated using the quantitative fluorescence polymerase chain reaction (QF-PCR) technique. METHODS: Testing for aneuploidies of chromosomes 13, 15, 16, 18, 21, 22, X, and Y with the QF-PCR technique was carried out on DNA isolated from archived frozen chorionic villi in seven cases of holoprosencephaly. RESULTS: QF-PCR was successful in all seven cases. Two cases of trisomy 13, two cases of triploidy, and one case of trisomy 18 was found meaning a 71% diagnostic yield. The success rate of QF-PCR (100%, 7/7) was superior compared to conventional karyotyping (43%, 3/7). CONCLUSIONS: Rapid aneuploidy testing using the QF-PCR technique is a simple, reliable, time- and cost-effective method sufficient to conclude the etiologic investigation in the majority of holoprosencephaly cases post-mortem.

Short tandem repeats genotyping of gestational choriocarcinoma - our experiences.

OBJECTIVE: This short communication demonstrates how short tandem repeat genotyping can identify the origin of gestational choriocarcinoma. MATERIALS AND METHODS: The origin of gestational choriocarcinoma in our three cases was determined using the short tandem repeats genotyping technique, which involved quantitative fluorescent PCR and fragmentation analysis. RESULTS: In Case 1 despite no medical history of molar pregnancy, DNA analysis indicated that the choriocarcinoma originated from a homozygous complete hydatidiform mole. We conclude, that the patient's complete abortion 10 years prior to the choriocarcinoma diagnosis was an undiagnosed complete hydatidiform mole. In Case 2 and Case 3 the clinically presumed origin of choriocarcinoma was confirmed. CONCLUSION: Determining the origin of choriocarcinoma is essential for clinical application, as it affects the FIGO scoring system for gestational trophoblastic neoplasia, which determines the patient's prognosis and treatment approach.

Peripartum hysterectomy: A 9-year population-based study in Slovakia.

OBJECTIVE: To assess the incidence of peripartum hysterectomy (PH) in Slovakia. Additionally, we wanted to describe reasons for the procedure, associated clinical circumstances, and complications. METHODS: This was a descriptive, population-based study among women who underwent PH in Slovakia between January 2012 and December 2020. Peripartum hysterectomy was defined as surgical removal of the uterus from the peripartum period up to 42 days postpartum. Data were obtained retrospectively from the standardized questionnaires that are completed in Slovakia for any case of PH. The background population consisted of all other women who delivered during the study period. RESULTS: Of the 436 136 births, there were 397 cases of PH, giving an incidence of 0.91 per 1000 births. It was higher with advanced maternal age, multiparity, multiple pregnancies, and cesarean deliveries. The main reasons for the procedure were placental pathologies and uterine atony in 52.9% and 33.0%, respectively. A total of 150 (37.8%) women required admission to an intensive care unit. The mortality rate was 1.5%. CONCLUSION: The incidence of PH is relatively high in Slovakia when compared with other European countries, highlighting the need to improve prenatal diagnosis of morbidly adherent placenta and the management of peripartum hemorrhage.

Morbidly adherent placenta as a cause of peripartum hysterectomy in the Slovak Republic in the years 2012-2020.

OBJECTIVE: The main aim of this study was to analyze the cases of peripartum hysterectomy associated with morbidly adherent placenta in the Slovak Republic. MATERIALS AND METHODS: Cases of morbidly adherent placenta managed by peripartum hysterectomy in the Slovak Republic between January 2012 and December 2020 were retrospectively analyzed. Data were obtained from the standardized anonymous questionnaires. RESULTS: The incidence of morbidly adherent placenta was 0.39 per 1,000 births. A total of 151 (89.9%) women with morbidly adherent placenta were managed by peripartum hysterectomy (38.0% of all peripartum hysterectomies). Placenta accreta, increta and percreta were present in 56.3%, 28.5% and 15.2%, respectively. Placenta previa was present in 60 (39.7%) cases. Up to 112 (74.2%) cases of morbidly adherent placenta were diagnosed at the time of delivery. Hysterectomy was preceded by unsuccessful uterus-saving procedure in 23 (15.2%) of cases. The median of estimated blood loss was 1,500 mL. A packed red blood cells transfusion was used in 138 (91.4%), fresh frozen plasma in 118 (78.2%), fibrinogen concentrate in 39 (25.8%) and tranexamic acid in 25 (16.6%) women. A total of 58 (38.4%) women required admission to an intensive care unit. The mortality rate was 1.3%. CONCLUSION: In recent years, there was an increase in the incidence of morbidly adherent placenta, peripartum hysterectomy in the Slovak Republic, along with an increase in caesarean section rates, too. Case analysis highlights the need to improve the prenatal diagnosis and management of morbidly adherent placenta.

Severe maternal morbidity requiring intensive care units admission in the Slovak Republic - a 9-year population based study.

OBJECTIVE: Analysis of life-threatening maternal morbidities, the condition of which required subsequent treatment in Intensive Care Units (ICU) in the Slovak Republic in the years 2012-2020. METHODOLOGY: Retrospective analysis of 655 identified cases of mothers admitted to the intensive care units out of 436,136 births. The reasons for the transport were divided into nine categories: peripartum bleeding, hypertensive diseases, thromboembolism, cardiovascular diseases, sepsis/severe infections, metabolic diseases, complications of anaesthesiology, gastroenterological problems and others. RESULTS: The total incidence of admission to the intensive care units in the observed period was 1.5 per 1,000 births, but for mothers of Roma nationality it was 8.8 per 1,000 births. The average age of mothers was 30.7 years, while 29.7% were over 35 years old. Overweight and obesity was present by 70.4% of mothers. The most common reason for transport to the ICU (49.3%) was severe postpartum hemorrhage. The second most common cause (26.0%) was hypertensive diseases (preeclampsia, eclampsia and HELLP syndrome). The third most common cause (4.9%) was sepsis and severe maternal infections. The mortality rate of mothers admitted to the ICU was 2.3% and infant mortality of these mothers was 8.7%. CONCLUSION: The incidence of admission of mothers to the ICU in the monitored years was 1.5 per 1,000 births, which in international comparison ranks Slovakia among countries with a lower incidence.

DNA analysis of partial hydatidiform mole revealing triandric monogynic tetraploidy.

The authors present a case of a partial hydatidiform mole where DNA analysis (STR - short tandem repeat genotyping) showed a triandric monogynic tetraploid genome composition with a XXXY gonosomal complement. This genetic finding clinicopathologically correlates with a partial hydatidiform mole, although it is rare in comparison with the typical, diandric monogynic triploid partial moles. The genetic analysis definitively confirmed the suspected diagnosis of a partial mole. To exclude the possibility that molar pregnancy represented retained products of conception after elective pregnancy termination, STR profiles from molar pregnancy and previous products of conception were compared. Short tandem repeats genotyping is a useful molecular genetic method in the differential diagnosis of partial hydatidiform moles, where clinical-pathological findings are frequently ambiguous.

Maternal mortality in eight European countries with enhanced surveillance systems: descriptive population based study.

OBJECTIVE: To compare maternal mortality in eight countries with enhanced surveillance systems. DESIGN: Descriptive multicountry population based study. SETTING: Eight countries with permanent surveillance systems using enhanced methods to identify, document, and review maternal deaths. The most recent available aggregated maternal mortality data were collected for three year periods for France, Italy, and the UK and for five year periods for Denmark, Finland, the Netherlands, Norway, and Slovakia. POPULATION: 297 835 live births in Denmark (2013-17), 301 169 in Finland (2008-12), 2 435 583 in France (2013-15), 1 281 986 in Italy (2013-15), 856 572 in the Netherlands (2014-18), 292 315 in Norway (2014-18), 283 930 in Slovakia (2014-18), and 2 261 090 in the UK (2016-18). OUTCOME MEASURES: Maternal mortality ratios from enhanced systems were calculated and compared with those obtained from each country's office of vital statistics. Age specific maternal mortality ratios; maternal mortality ratios according to women's origin, citizenship, or ethnicity; and cause specific maternal mortality ratios were also calculated. RESULTS: Methods for identifying and classifying maternal deaths up to 42 days were very similar across countries (except for the Netherlands). Maternal mortality ratios up to 42 days after end of pregnancy varied by a multiplicative factor of four from 2.7 and 3.4 per 100 000 live births in Norway and Denmark to 9.6 in the UK and 10.9 in Slovakia. Vital statistics offices underestimated maternal mortality by 36% or more everywhere but Denmark. Age specific maternal mortality ratios were higher for the youngest and oldest mothers (pooled relative risk 2.17 (95% confidence interval 1.38 to 3.34) for women aged <20 years, 2.10 (1.54 to 2.86) for those aged 35-39, and 3.95 (3.01 to 5.19) for those aged ≥40, compared with women aged 20-29 years). Except in Norway, maternal mortality ratios were ≥50% higher in women born abroad or of minoritised ethnicity, defined variously in different countries. Cardiovascular diseases and suicides were leading causes of maternal deaths in each country. Some other conditions were also major contributors to maternal mortality in only one or two countries: venous thromboembolism in the UK and the Netherlands, hypertensive disorders in the Netherlands, amniotic fluid embolism in France, haemorrhage in Italy, and stroke in Slovakia. Only two countries, France and the UK, had enhanced methods for studying late maternal deaths, those occurring between 43 and 365 days after the end of pregnancy. CONCLUSIONS: Variations in maternal mortality ratios exist between high income European countries with enhanced surveillance systems. In-depth analyses of differences in the quality of care and health system performance at national levels are needed to reduce maternal mortality further by learning from best practices and each other. Cardiovascular diseases and mental health in women during and after pregnancy must be prioritised in all countries.

Caesarean section, vaginal instrumental delivery and perineal morbidity in the Slovak Republic in the years 2007-2018.

OBJECTIVE: Analysis of caesarean section, vaginal instrumental deliveries and severe perineal morbidity in the Slovak Republic in the years 2007-2018. METHODS: The analysis of prospectively collected caesarean section and vaginal instrumental delivery data in the years 2007-2018, and episiotomies and severe perineal morbidity data in the years 2008-2018 from obstetrics hospitals in the Slovak Republic. RESULTS: Caesarean section rate progressively increased from 24.1% in 2007 up to 30.8% in 2013 and decreased to 29.6% in 2018. Vacuum-extraction frequency was 1.3% in 2007 and increased up to 2.0% till 2018. Forceps frequency decreased since 2008-2018 from 0.56% to 0.43%. In the years 2008-2018, frequency of perineal tears of the 3rd and 4th degree increased from 0.4% to 0.8%. Frequency of episiotomies decreased in the years 2008-2018 from 74.7% to 47.7%. CONCLUSION: The highest caesarean section rate in the Slovak Republic - 30.8% occurred in 2013, but slowly decreased in the following years. The frequency of vacuum extraction increased and forceps decreased. Frequency of episiotomies had decreased and severe perineal tears held an increasing trend.

Maternal mortality in the Slovak Republic in the years 2007-2018.

OBJECTIVE: Analysis of maternal mortality in the Slovak Republic in the years 2007-2018. METHODS: The analysis of selected maternal mortality data in the years 2007-2018. RESULTS: In the years 2007-2018, 84 women died during pregnancy or within 42 days of the end of pregnancy - maternal mortality ratio was 12.57 per 100,000 live births. Direct maternal mortality ratio in this period was 4.64 (31 maternal deaths), indirect maternal mortality 6.74 (45 maternal deaths) and direct obstetrics death ratio was 11.38 per 100,000 live births. Pregnancy-associated but unrelated maternal death ratio was 1.19 (eight maternal deaths). The Slovak Gynecological and Obstetric Society revealed a 64% underestimation of maternal mortality data in comparison with routine statistical data. CONCLUSION: Maternal mortality ratio in the Slovak Republic was one of the highest in the European Union and was discordant with a good level of perinatal mortality. In the Slovak Republic, it is necessary to look for ways to reduce maternal mortality and improve data collection.

Severe maternal morbidity in the Slovak Republic in the years 2012-2018.

OBJECTIVE: Analysis of maternal morbidity in the Slovak Republic in the years 2012-2018. METHODS: The analysis of selected maternal morbidity data prospectively collected in the years 2012-2018 from all obstetric units in the Slovak Republic. RESULTS: In the years 2012-2018, incidence of severe peripartum bleeding was 2.17, peripartum hysterectomy was 0.89, maternal admission to intensive care units was 1.59, eclampsia was 0.21, HELLP syndrome was 0.73, abnormally invasive placentation was 0.37, uterine rupture was 0.68, severe sepsis in pregnancy and puerperium was 0.18 and nonfatal amniotic fluid embolism was 0.027 per 1,000 births. CONCLUSION: Incidence of total severe acute maternal morbidity in the Slovak Republic was 6.84 per 1,000 births. In Slovak local conditions, there is still room for reduction of severe acute maternal morbidity.

Results of treatment of gestational trophoblastic neoplasia in the Slovak Republic in the years 1993-2017.

OBJECTIVE: Gestational trophoblastic neoplasia epidemiology and treatment results in the Slovak Republic in the years 1993-2017. METHODS: Retrospective analysis results of gestational trophoblastic neoplasia treatment in the Centre for gestational trophoblastic disease in the Slovak Republic in Bratislava in the years 1993-2017 according to prognostic scoring and staging system FIGO/WHO (International Federation of Gynecology and Obstetrics/World Health Organization). RESULTS: The Centre for Gestational Trophoblastic Disease was created in the Slovak Republic in the year 1993, after the split of former Czechoslovakia. A total of 100 patients with gestational trophoblastic neoplasia were treated in this Centre in the years 1993­2017. According to prognostic scoring and staging system FIGO/ WHO, 74% patients were at a low risk and 26% of patients were at a high-risk of gestational trophoblastic neoplasia. There were 56, 2, 32 and 10% patients in stages I, II, III, and IV, respectively. The total curability and mortality rates were 96 and 4%, respectively. The curability rate 100% was achieved in stages I­III and in all placental site trophoblastic tumours, and the curability rate 60% was achieved in stage IV. In the years 1993 ­2017, the incidences were 1 in 59,315 pregnancies and 1 in 42,299 deliveries for choriocarcinoma, 1 in 489,348 pregnancies and 1 in 348,965 deliveries for placental site trophoblastic tumours, 1 in 139,814 pregnancies and 1 in 99,704 deliveries for invasive mole, and 1 in 39,947 pregnancies and 1 in 28,487 deliveries for persistent gestational trophoblastic neoplasia. In the Czech Republic in the same period of time, there were treated 281 (301) patients with the curability rate 98.6% (98.7%). CONCLUSION: The results of the treatment of gestational trophoblastic neoplasia in the Slovak Republic are comparable with those achieved by leading centers specialized for the treatment of this disease in Europe and in the world. Early detection and centralisation of the treatment are crucial points for successful treatment, as the high curability rate of gestational trophoblastic neoplasia is achieved by effective therapy.

Analysis of selected perinatological indicators in the Slovak Republic in the years 2007-2018.

OBJECTIVE: Analysis of perinatal mortality in the Slovak Republic during the years 2007-2018. METHODS: Analysis of prospectively collected selected perinatal data in the years 2007-2018. RESULTS: In the year 2007, there were 63 obstetrics units, 51,146 deliveries and that of live births 51,650 in the Slovak Republic. The number of obstetrics units decreased to 51 in the years 2018, the total number of deliveries increased to 57,085 and that of live births increased to 57,773. The total fertility rate in the years 2007-2018 increased from 1.27 to 1.54. The preterm deliveries rate increased from 7.3% in the year 2007 to 8.5% in the year 2010 and decreased to 7% in the year 2018. The perinatal mortality rate decreased from 6.2 in the year 2007 to 4.4 in the year 2017, increased again in the years 2018 to 5.0 and according to the criteria of WHO (World Health Organization) to 6.6 per 1,000 still- and live-births. During the years 2007-2018 at perinatal mortality stillbirth participate with 65%, low birth weight with 63% and severe congenital anomalies with 19%. Transport in utero to perinatological centers in the years 2007-2018 has decreased from 57 to 56% for infants 1,000-1,499 g and from 75 to 73% for infants below 1,000 g. CONCLUSION: In the year 2017, perinatology in the Slovak Republic reached the best result in the perinatal mortality rate - 4.4 (0.44%), but has increased to over 5 next year. To further reduce perinatal mortality in the Slovak Republic, it is necessary to improve the prenatal dia-gnosis of severe congenital abnormalities, transport in utero of very low birth weight fetuses, centralization of high-risk pregnancies, obstetric personnel and material-technical equipment of obstetricians and neonatal intensive care units.

Partial hydatidiform moles with unclear histopathological profile - importance of genetic diagnostics.

OBJECTIVE: The aim of the study was the genetic characterization of a set of cases with an unclear morphological profile of the placental tissue suspected of a partial hydatidiform mole. PATIENTS AND METHODS: This work presents the results of a genetic analysis of a group of 10 patients with various clinical manifestations of reproductive loss, where a partial hydatidiform mole was suspected on the basis of a histopathological examination. The composition of the genome of the products of conception was determined by short tandem repeats (STR) genotyping using a commercial kit;Devyser Compact v3 (Devyser). RESULTS AND CONCLUSIONS: Out of 10 analyzed cases, five had diandric monogynic triploid genome, characteristic for a partial mole. Aneuploidies of chromosomes 13, 18, 21, X and Y were excluded in four cases and Pataus syndrome was dia-gnosed in one case. In the case of an unclear histopathological profile, consultative DNA analysis (ideally STR genotyping) can significantly help the pathologist in the differential dia-gnosis of a partial mole. The histopathological profile of a partial hydatidiform mole may be in some cases incomplete and unclear, especially in the early weeks of gestation, which can lead to false negativity of the examination. On the other hand, other pathologies, for example aneuploides or digynic triploidy, may produce a histopathological profile similar to a partial mole, which leads to false positivity. Accurate dia-gnosis of a partial hydatidiform mole using molecular genetic methods contributes to the determination of adequate dispensary care for patients.

A proper placental sampling for syncytin-1 analysis.

Syncytin-1 (gene ERVW-1) has been proposed as a marker of pre-eclampsia and malfunctions in placental development. Placenta is heterogeneous tissue, hence the method of biopsy can significantly affect the outcome of analyses. A total of 44 placentae were analyzed by taking 3-30 samples from each. Relative levels of ERVW-1 expression in the placental biopsies were characterized by RT-qPCR. Evaluation of ten biopsies from one placenta individually (not pooling them) is recommended due to the high variability of expression. No significant correlation was found between biopsy localization and level of ERVW-1 expression; therefore, random sampling is recommended. A long cut from the umbilical cord to the edge of the placenta is a convenient approach to placental sampling.

Evaluation of cesarean delivery rates at three university hospital labor units using the Robson classification system.

OBJECTIVE: To analyze the frequency of cesarean delivery using the Robson 10-group classification. METHODS: A multicenter retrospective cohort study was conducted at three university hospital labor units in the Slovak Republic. The medical records of all women who gave birth at these centers from January 1 to December 31, 2017, were assessed. RESULTS: In all, 1437 of 3361 (42.8%), 729 of 2795 (26.1%), and 303 of 2080 (14.6%) births recorded at the three centers during the current study period were by cesarean delivery. Among the nulliparous term singleton vertex deliveries (Robson group 1 and 2), the frequency of cesarean delivery at the three centers was 613 of 1653 (37.1%), 278 of 1389 (20.0%), and 91 of 898 (10.1%). Among term multiparas with one fetus in a cephalic position and at least one previous cesarean delivery (Robson group 5), the frequency of cesarean delivery at the three centers was 405 of 418 (96.9%), 261 of 343 (76.1%), and 55 of 115 (47.8%). CONCLUSION: Analysis of the frequency of cesarean delivery by Robson classification could help to identify possibilities for safely decreasing cesarean delivery rates in the clinic. Robson groups 1, 2, and 5 were the most modifiable groups.

Amniotic fluid embolism--investigation of fatal cases in Slovakia in the years 2005-2010 compared with fatal cases in the United Kingdom.

BACKGROUND: Amniotic fluid embolism (AFE) is a rare, often severe complication of pregnancy. The clinical diagnosis is difficult to establish and is one of exclusion. The aim of this study was to investigate 6 fatal cases of AFE in Slovakia and compare the incidence, risk factors, course, management and neonatal outcomes with fatal cases of AFE in the United Kingdom (UK). MATERIALS AND METHODS: Data on fatal cases of AFE in Slovakia were analysed and compared with fatal cases in the UK in the years 2005-2010. RESULTS: The incidence in Slovakia was significantly higher than in the UK from 2005-2010 (RR 5.03, 95% CI 1.98-12.75, P=0.003). However, 5/6 deaths occurred in 2009 coinciding with the H1N1 flu virus pandemic in Slovakia. There were no significant differences in the characteristics of women who died, with the exception of gestational age at delivery; significantly higher in Slovakia (median 41 versus 39 weeks, P=0.01). In Slovakia most of the cases occurred after delivery, 83.3%, compared with 52.9% in the UK. There were no significant differences in clinical signs, use of recombinant factor VIIa or performance of obstetric hysterectomy. In Slovakia 83.3% and in the UK 94.7% of infants survived, but 20% and 27.8% had some long-term sequelae. CONCLUSION: AFE is now the leading cause of maternal deaths in Slovakia. However, we found no significant differences in the possible risk factors, course, management or outcomes between Slovakia and the UK. This analysis is limited by study power; we propose that establishment of a national register of cases of AFE in Slovakia would help further investigate and monitor mortality from this condition.

Comparison of outcomes of perinatal care in Slovakia and the UK.

OBJECTIVE: To investigate whether there are differences in maternal and perinatal outcomes between Slovakia and the UK, and whether any observed variations can be attributed to differences in perinatal care. METHODS: Data on outcomes of perinatal care in Slovakia and the UK between 2006 and 2010 were compared. Perinatal mortality figures included stillbirths weighing 1000g or more and early neonatal deaths. RESULTS: In Slovakia, the perinatal mortality rate was significantly higher than that in the UK (RR 1.12; 95% CI, 1.06-1.18). Cesarean delivery was significantly more frequent in Slovakia (RR 1.05; 95% CI, 1.05-1.06); instrumental vaginal delivery was less frequent (ventouse delivery, RR 0.20; 95% CI, 0.19-0.21; forceps delivery, RR 0.09; 95% CI, 0.09-0.10). Episiotomy and peripartum hysterectomy were performed more often in Slovakia (episiotomy, RR 4.10; 95% CI, 4.07-4.12; peripartum hysterectomy, RR 2.02; 95% CI 1.65-2.47). The incidence of eclampsia was significantly higher in Slovakia (RR 1.60; 95% CI, 1.26-2.04). There were no significant differences in the rates of maternal death. CONCLUSION: Perinatal care outcomes and intervention rates differ between Slovakia and UK. This may be explained by differences in outcome definitions, perinatal care, and official encouragement of medical complaints.

Classification and management of extensive obstetric perineal injuries in the Czech and Slovak Republics.

OBJECTIVE: To assess the classification, repair, and follow up of extensive obstetric perineal injuries in the Czech and Slovak Republics. METHODS: A survey conducted in 2009 using questionnaires distributed to obstetric departments regarding classification and management of obstetric perineal injuries. RESULTS: Although 15 centers in the Czech Republic and 2 in the Slovak Republic indicated use of a 4-degree classification system, none of these centers reported using the classification accepted by the Royal College of Obstetricians and Gynaecologists. Use of a 3-degree classification system in accordance with definitions in Czech textbooks was reported by 14 Czech and 3 Slovak maternity hospitals. There was significant heterogeneity in clinical practice regarding techniques to repair extensive obstetric perineal injuries, antibiotic prophylaxis, early postpartum care, and follow up. CONCLUSIONS: There is great inconsistency in the classification and management of extensive obstetric perineal injuries. Uniform recommendations should be created and accepted, not only in the Czech and Slovak Republics, but worldwide.

Expression of proliferation and apoptotic markers in human placenta during pregnancy.

Trophoblast has unique properties in relation to its wide range of metabolic, endocrine and angiogenic functions. Trophoblastic cells invade endometrium and adjacent myometrium in a way that is imitated by malignant tumours. The aim of the present study was to analyse the expression of markers of proliferation and apoptosis in trophoblastic cells in normal human placenta during pregnancy. A total of 22 placentas, 12 of which were obtained from curettage and induced legal abortion and 10 placentas obtained from normal deliveries or caesarean sections were included in this study. Proliferation markers were strongly expressed in cytotrophoblast in early stages of gestation. In late term placentas, a distinct decrease in expression of these markers was observed. Syncytiotrophoblast was negative for proliferation markers in all placentas. Positive immunostaining for bcl-2, an anti-apoptotic marker, was observed only in syncytiotrophoblastic cells in first-trimester but also in third-trimester placentas. Cytotrophoblast and stromal mesenchymal cells of chorionic villi were negative for bcl-2. Expression of bcl-2 protein in syncytiotrophoblast may be one of the major factors preventing these structures from early cell death, which is indispensable for the maintenance of physiological pregnancy.