The role of connexin 37 polymorphism in spontaneous abortion.

Among unique cardiovascular risk factors in women are complications during pregnancy, including miscarriage. Important risk factor is also genetic background. One of powerful candidate genes for cardiovascular disease of atherosclerotic origin (aCVD) is gene for connexin 37 (Cx37) with strong gene-environment interaction including smoking status, that is also strong risk factor for complications in pregnancy including spontaneous abortion (SA). We analyzed association between SA and Cx37 gene polymorphism (1019C>T; Pro319Ser) in 547 fetuses and its potential interaction with smoking status of mothers. Using genetic analyses from women from general population as controls, ORs for T allele, found in our previous studies to be protective against aCVD, were calculated. T allele carriers (fetuses), had OR 0.91 (95 % CI 0.72-1.14) and no interaction with smoking was observed. In conclusion, no significant association between Cx37 polymorphism and SA was observed and no modifying effect of smoking status on this association was detected.

DT56a in treatment of climacteric syndrome in the Central European population sample.

OBJECTIVES: The aim of this study was to assess the possibility of using the DT56a for the therapy of acute climacteric syndrome in women in Slovakia and the Czech Republic. DESIGN: Prospective interventional unblinded study. RESULTS: A sample of 453 women with symptoms of acute climacteric syndrome took 644 mg of soybeans´ phyotestrogenes DT56a in the period of 4 weeks. In course of the therapy, the total number of hot flushes decreased by 48 %, and the intensity decreased by 35 % (p < 0.01). In 85 % of women, the quantity or intensity of hot flushes decreased. Sleep quality increased in 65 % of women, headaches improved or significantly improved in 51 % of women, muscle aches and joint pains decreased by 40 %. Life quality improved in 72 % of women. CONCLUSIONS: DT56a is a possible alternative for the treatment of acute climacteric syndrome. In the Central European population, the efficacy of a daily dose of 644 mg corresponds with the effects observed in the Mediterranean population (Tab. 2, Fig. 3, Ref. 21). Text in PDF www.elis.skKEY WORDS: DT56a, climacteric syndrome, menopause, non-hormonal treatment.

Sacrococcygeal teratoma.

OBJECTIVE: Description of newborn with early prenatal diagnosis of sacrococcygeal teratomia. Desing: Case report. SETTING: Department of Obstetrics and Gynecology, 2nd Faculty of Medicine and Faculty Hospital Motol Prague. CASE REPORT: In this case report a term neonate with a massive sacrococcygeal teratoma was delivered by a cesarean section (approach by Geppert) with an intrapartal relieving punction of the tumor. It was a type II SCT with both pelvic end extracorporal component with a size of 60×35 centimeters. The tumor was completely resected during the first day of life and was followed by a normal function of lower extremities, normal bowel function and only transitional urinary tract symptoms. CONCLUSION: A sacrococcygeal teratoma (SCT) is the most common congenital tumor in newborns with reported incidence of 1:35000-40000 live births affecting more frequently females (4:1). This germinal tumor is either benign (mature) or malignant (immature), mature types are more common in neonates. A SCT is usually diagnosed by prenatal ultrasound, magnetic resonance is performed to characterize its size and content, type of tumor (type I-IV Altman classification) and relation to surrounding tissues. Preemptive early delivery by cesarean section is recommended when the tumor exceeds the diameter of 5 centimeters to avoid complications during vaginal delivery (rupture, bleeding etc.). The primary treatment of SCT is an early surgical resection with a complete resection of the coccyx („en bloc“ resection), malignant tumors are indicated for adjuvant chemotherapy. Long term complications can be urinary tract or bowel dysfunctions, lower extremity muscle weakness or paralysis and recurrence of the tumor with potential malignancy.

Prenatally diagnosed patent urachus with umbilical cord cyst and early surgical intervention.

OBJECTIVE: Description of rare diagnosis of patent urachus. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, 2nd Faculty of Medicine and Faculty Hospital Motol Prague. CASE REPORT: Patent urachus is a rare diagnosis, which in this case was detected prenatally by ultrasound. Involution of the urachus is not fully completed upon birth, therefore in cases of small persisting communication between the urinary bladder and the umbilicus conservative approach and waiting for spontaneous closure is usually chosen. In our case surgery treatment has chosen as a prevention of urinary infection because of patent urachus manifested as a wide communication. CONCLUSION: This congenital defect usually manifests itself early after birth as a visible structural anomaly of the umbilicus and/or as urine leakage in the umbilicus opening area. It is important to keep in mind that urachus irregularities may be accompanied by other urinary system defects. Every child presenting with such an anomaly should therefore be thoroughly examined. If the procedure is performed by an experienced surgical team postoperative complications are uncommon and overall long-term prognosis for patients is excellent.

Acute enteroviral meningoencephalitis as unusual cause of diplopia in pregnancy and puerperium.

OBJECTIVE: To describe unusual cause of diplopia in early puerperal period. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, 2nd Faculty of Medicine and Faculty Hospital Motol. CASE REPORT: 34-year-old patient at 39 weeks of gestation complaining fever, headache and blurring of vision was referred to our medical center. She underwent caesarean section for tachycardia of fetus. Symptoms remained during early puerperium. We describe diagnostic and treatment hesitations. CONCLUSION: The cause of her complains was viral meningoencephalitis which led in postencephalitic syndrome.

The use of estradiol metered-dose transdermal spray in clinical practice.

OBJECTIVE: The aim of this study was to evaluate the use of novel estradiol metered-dose transdermal spray (EMDTS) in the treatment of acute climacteric syndrome. METHODS: A multicenter open-label trial was conducted with a 24-week intervention. EMDTS 1.53 mg was given to symptomatic menopausal women. The Menopause Rating Scale (MRS) was used to assess the climacteric syndrome severity. The Friedman non-parametric test and a post-hoc test with Bonferroni correction were used for statistical evaluation. RESULTS: A total of 132 women were enrolled in 20 centers, of whom 123 (93.2%) completed the study. The average age of patients was 53.8 years (37-65 years). The study was discontinued by 6.8% of women. The patients were checked at the beginning of the study, and after 12 and 24 weeks. There was a statistically significant drop (p < 0.001) in MRS values both after 12 and 24 weeks of therapy. The average MRS values improved by 66.2% between the first and the third visits. The most significant improvement was manifested in patients with initial moderate climacteric syndrome (70.9%). CONCLUSION: This study confirms that application of EMDTS offers a novel treatment option for climacteric symptoms.

Advance maternal age - risk factor for low birhtweight.

OBJECTIVE: To determinate correlation between childbearing postponement and low birthweight prevalence in Czech population. DESIGN: Population study. METHODS: Year books of Czech Statistical Office from 1990 to 2015 were used as sources of data. Analysis was done by simple linear regression method. RESULTS: The proportion of children borned by women older than 35 years have rised from 4% to 21% from 1990 to 2015. In the same time the percentage of low birthweight have increased from 5,7 do 7,6. The coefficient of determination, which shows the ratio of explained variability to common variability of this ratio, reach R2 = 0,88. Coclusion: The enlargement of life-borned low birthweight children is owing by 88% on account of childbearing postponement.

Eating disorders in pregnancy.

OBJECTIVE: To highlight a problem of eating disorders in pregnancy and the need for interdisciplinary cooperation in these cases. DESIGN: Case report. SETTING: Department of Gynecology and Obstetrics, 2nd Faculty of Medicine, University hospital Motol, Prague. CASE REPORT: We report the course of pregnancy in a 19-year-old woman with an atypical form of mental anorexia. The patient was repeatedly hospitalized for metabolic disruption. The pregnancy was finally terminated at the 27th week of pregnancy for fetal growth restriction of the fetus. CONCLUSION: Despite the frequent irregularities of the menstrual cycle in eating disorders, a spontaneous conception is possible. The prognosis of pregnancy is uncertain and may endanger the mother and fetus. Management of pregnant women with eating disorders requires the cooperation of a perinatologist, internist, nutritional therapist, psychiatrist or psychologist.

[Spontaneus delivery after two previous caesarean sections - case report]. / Spontánní porod po dvou císarských rezech a jeho mozné komplikace - kazuistika.

OBJECTIVE: To demonstrate the higher risk of the uterine dehiscence/rupture in spontaneously delivering women with scared uterus. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, General Teaching Hospital in Prague and First Medical School, Charles University. CASE REPORT: We demonstrate the risk of uterine dehiscence on the example of 36 year-old woman with two previous caesarean sections who decided to give birth spontaneously. CONCLUSION: The scars on uterus are the risk factor for uterine dehiscence and rupture. In present, the rising number of caesarean sections leads to increasing number of women with scars on uterus. Despite the potential risk of scars on the uterus, small number of women with history of surgery on uterus plans to give birth spontaneously. We demonstrate the higher risk of the uterine dehiscence after spontaneous delivery in woman with history of two caesarean sections and successful conservative therapy.

[Transdermal estrogen spray in therapy of postmenopausal syndrome]. / Postavení transdermálního estrogenního spreje v lécbe klimakterického syndromu.

OBJECTIVE: To show possibilities of new application method of estrogen replacement therapy - mettered-dose transdermal spray. DESIGN: Review articleResults: Transdermal spray contains 1.53 mg estradiol in one dose. It gives possibility of individual aproach in estradiol application 1, 2 or 3 doses daily. About 85% of patients showed the significant reduction of hot flushes. Perfect safety profile is predicted especially in cardiovascular point.

[Nine-valent HPV vaccine - new generation of HPV vaccine]. / Nonavalentní HPV vakcína - nová generace ockování proti HPV.

OBJECTIVE: To evaluate current knowledge about new generation of HPV vaccine - nine-valent vaccine Gardasil9. DESIGN: Review article. RESULTS: The nine-valent vaccine against HPV 6/11/16/18/31/33/45/52/58 could improve efficacy of quadrivalent vaccine from 70 to 90 percent for cervical cancer. In addition this vaccine has covered around85-90% of HPV-related vulvar, vaginal and anal cancers. Efficacy and immunogenicity against HPV 6/11/16/18 is the same as for quadrivalent vaccine. Efficacy against HPV 31/33/45/52/58 associated lesions is 97%.

The most valuable predictorsof endometrial receptivity.

OBJECTIVE: To investigate the predictive factors of insufficient endometrial quality. DESIGN: Review. SETTING: Department of Obstetrics and Gynecology, General Faculty Hospital Prague, 1st Faculty of Medicine, Charles University. RESULTS: This is the review on predictive factors of endometrial receptivity. There is a collected data on homeobox genes family, especially HOX 10 and HOX 11 members, that ensure implantation process by means of their interaction with estrogen and progesterone receptors via stimulatory proteins in the luminal epithelium in different periods of luteal phase. Moreover, the article describes appropriate secretion of osteoponin, cadherin, selectin, apopoliprotein D, mucin and balanced macrophage activity in endometrial epithelium in the proliferative phase of the menstrual cycle provide optimal conditions for implantation. CONCLUSION: Endometrial genes expressions along with the intrauterine environment macrophages activity maintain the tiny mechanism of endometrial receptivity.

[Atypical pain in the uterine rupture]. / Netypická bolest pri rupture delozní

OBJECTIVE: To give attention to the rare complication of pregnancy. DESIGN: Case report. SETTINGS: Dept. of Obstetric and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital Prague. METHODS: Description of acute abdominal pain which imitated the appendicitis in case of the uterine rupture. CONCLUSION: The uterine rupture is the rare and very dangerous complication of pregnancy. In the time of increasing number of the cesarean section and the operation on the uterine wall, we must thing on the uterine rupture.

[Epidemiology of genital warts in female population of Czech Republic]. / Epidemiologie genitálních bradavic mezi zenami v Ceské republice.

OBJECTIVE: The aim of study was to evaluate prevalence of genital warts in Czech Republic. SUBJECT: Multicentric prospective observation study. SETTING: HPV College. METHODS: During 6 month (February 2010 - July 2010) 20 private gynaecological centers in all Czech Republic were counting up the number of genital warts cases. Risk factors, therapy and knowledges about genital warts were evaluated. RESULTS: There were 637 patients with genital warts in cohort of 70 980 patients. The prevalence of genital warts was 0.89%. The most frequent risk factor was cigarette smoking in 37%. Main strategy for treatment were podophyllin local application and cold knife excision. CONCLUSION: The prevalence of genital warts in our study has shown importance for its prevention by rules of safety sex and HPV vaccination against HPV type 6 and 11.

[Accuracy of placenta accreta ultrasound prediction in clinical work]. / Moznosti ultrazvukové predikce placenta accreta v klinické praxi.

OBJECTIVE: To evaluate accuracy of placenta accreta ultrasound prediction in own group of patients. DESIGN: Retrospective analysis. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague. METHODS: We retrospectively evaluated a group of 12 patients, that had undergone ultrasound examination during pregnancy at our department and afterwards had been diagnosed during caesarean section (CS) with placenta accreta (years 2010-2011). RESULTS: 11 out of 12 women in our group had at least one of the risk factors (placenta praevia, previous SC, history of uterine surgery). During US examination, suspicion of placenta accreta was raised at 7 out of 12 women. In 5 cases we have performed elective CS and in 7 cases CS was done after onset of the labour (in 4 cases the reason was severe bleeding). The peripartal blood loss ranged from 500 ml to 7000 ml. Due to life threatening bleeding in 5 cases (42%), abdominal hysterectomy was performed. Placenta accreta was successfully diagnosed in cases with hysterectomy by US in 80 percent (4/5). Histological examination of the uterus confirmed in 2 cases placenta accreta, in 2 cases placenta increta and in 1 case placenta percreta. CONCLUSION: US diagnosis of placenta accreta is possible, with success rate of 58 percent (7/12). Early diagnosis helps to properly set up CS and consult the patient about the risk of unavoidable hysterectomy.

[Predictors of combined hormone contraception choice between Czech and Slovak women]. / Kritéria ceských a slovenských zen pri výberu kombinované hormonální antikoncepce.

OBJECTIVE: The aim of the project was to evaluate criterias for women's contraception application way choice. DESIGN: Non-interventional, multicentric, prospective project. SETTING: Dept. of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University Prague. METHODS: The choice of application way of combined hormone contraception was evaluate in group of 1944 women in 183 centers before and after doctor's consultation. Women's opinions, knowledges and socio-demografic predictors were corelated with final decision. RESULTS: The most important factor choice of application way is minding that application is easy. It elevates probability of final choice by 65% for combined oral contraception and by 90% for path and vaginal ring. Vote for vaginal ring and patch is growing with age. CONCLUSIONS: Easibility of application, efficacy and cycle control are the most important predictors for contraception choice. The biggest fears are connected with adverse events for pills and low frequency of usage in population for patch and ring.

[Importance of the consultation for combined hormonal contraception's choice--results of CHOICE project in Czech and Slovak Republic]. / Význam konzultace pri výberu kombinované hormonální antikoncepce--výsledky projektu CHOICE (Contraception Health Research Of Informed Choice Experience) v Ceské a Slovenské republice.

OBJECTIVE: The aim of this project was to evaluate influence of standardised information on patient's choice of combined hormonal contraception application way. DESIGN: Non-interventional, multicentric, prospecive study. SETTING: Dept. of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University Prague. METHODS: The choice of application form of combined hormone contraception was evaluate in group of 1944 women in 183 centers of Czech and Slovak republic before and after doctor's consultation. RESULTS: The 1911 women have given replay for all questions. Percentage of women preferring combined oral contraception (46.6%, CI 95% 44%-50%, 906 women) and transdermal patch (4.5%, CI 95% 3%-6%, 87 women) were unchanged. Choice of vaginal ring grew up from 6.2% to 42.6% (CI 95% 40%-46%, 837 women). It means significant elevation by 36.4% (CI 97.5% 33.9% - 38.9%, p < 0.0001). Vaginal ring was choosen by 54.2% of women without any intention and 39.1% from women with preference of nonhormonal contraception. CONCLUSION: Project show to increase the preference of vaginal ring by information about all application forms of combined hormonal contraception.

[Genital warts and HPV vaccination]. / Genitální bradavice a HPV vakcinace.

OBJECTIVE: To present and overview of incidence of, and cost of care for, genital warts. SUBJECT: Review. SETTING: Department of Obstetrics and Gynecology, Palacky University and Faculty University, Olomouc; Office gynecology and primary care centre, Brno; Department of Obstetrics and Gynecology, Charles university in Prague-First Faculty of Medicine and General Faculty Hospital, Prague. METHOD: Literature review of incidence of, and cost of care for, genital warts in some european countries, North America and Australia. CONCLUSION: Genital warts exert a considerable impact on health services, a large proportion of which could be prevented through immunisation using the quadrivalent human papillomavirus vaccine.

Th1/Th2 cytokine gene polymorphisms in patients with uterine fibroid.

Uterine fibroid or leiomyoma is a frequent non-malignant tumour with unknown aetiology and pathogenesis. The aim of our study was to look for possible genetic markers which could be used as prognostic tools for evaluation of an increased risk for development of uterine fibroid. A large spectrum of Th1/Th2 cytokine gene polymorphisms in 102 patients with uterine leiomyoma was compared with 145 healthy controls. An association between polymorphisms of the IL4 gene promotor at positions -590 C/T and -33 C/T, and the risk of leiomyoma was observed. The CC genotype of IL4 -590 and at position -33 was less frequent in the patient group than in the control group (P = 0.03). Besides IL-4, we observed different genotype distribution of the TNFA gene -308 A/G. The frequency of genotype AA was higher in the younger (≤ 35 years) patient group (P = 0.02). Our study thus suggests that certain cytokine gene polymorphisms, especially of the IL4 and TNFA genes, may be associated with increased risk for development of uterine fibroid. Further investigation would be needed to elucidate the mechanisms responsible for these associations.