Quality assessment of fetal middle cerebral and umbilical artery Doppler images using an objective scale within an international randomized controlled trial.

OBJECTIVES: To determine the quality of Doppler images of the fetal middle cerebral artery (MCA) and umbilical artery (UA) using an objective scale, and to determine the reliability of this scale, within a multicenter randomized controlled trial (Revealed versus concealed criteria for placental insufficiency in unselected obstetric population in late pregnancy (Ratio37)). METHODS: The Ratio37 trial is an ongoing randomized, open-label, multicenter controlled study of women with a low-risk pregnancy recruited at 20 weeks. Doppler measurements of the fetal MCA and UA were performed at 37 weeks. Twenty patients from each of the six participating centers were selected randomly, with two images evaluated per patient (one each for the MCA and UA). The quality of a total of 240 images was evaluated by six experts, scored on an objective scale of six items. Inter- and intrarater reliability was assessed using the Fleiss-modified kappa statistic for ordinal scales. RESULTS: On average, 89.2% of MCA images and 85.0% of UA images were rated as being of perfect (score of 6) or almost perfect (score of 5) quality. Kappa values for intrarater reliability of quality assessment were 0.90 (95% CI, 0.88-0.92) and 0.90 (95% CI, 0.88-0.93) for the MCA and UA, respectively. The corresponding inter-rater reliability values were 0.85 (95% CI, 0.81-0.89) and 0.84 (95% CI, 0.80-0.89), respectively. CONCLUSION: The quality of MCA and UA Doppler ultrasound images can be evaluated reliably using an objective scale. Over 85% of images, which were obtained by operators from a broad range of clinical practices within a multicenter study, were rated as being of perfect or almost perfect quality. Intra- and inter-rater reliability of quality assessment was very good. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Management of pain associated with up-to-9-weeks medical termination of pregnancy (MToP) using mifepristone-misoprostol regimens: expert consensus based on a systematic literature review.

Evidence-based guidelines on the management of pain associated with first-trimester medical abortion are lacking. Most published clinical trials have failed to report on this important aspect of the procedure. The aim of this comprehensive work was to provide clinical advice based on a comprehensive literature review, supplemented by the clinical experience of a group of European experts in case no evidence is available. Pain level ranged from 5 to 8 in 80% of studies where pain was measured on a 0-10 visual analogue scale; severe pain was reported by 20-80% of women. Pain assessment was rarely reported in studies. Pain treatment should be preventive and avoidance of unnecessary uterine contractions should be considered. Analgesic treatment should follow the WHO three-step ladder, starting with the use of NSAIDs and allowing for easily available back-up treatment with weak opioids.

Immunological principle of development of red blood cell alloimmunization in pregnancy, hemolytic disease of the fetus and prevention of RhD alloimmunization in RhD negative women.

DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Palacky University Olomouc, Faculty of Medicine and Dentistry, University Hospital Olomouc. Methods, results: Every person exposed to a foreign red blood cell antigen (erythrocyte antigen) develops an antibody. If the contact with a foreign erythrocyte antigen occurs during pregnancy, the erythrocyte alloimmunization of the pregnant woman develops and, due to antibodies crossing through the placenta also Haemolytic disease of the foetus and newborn (HDFN) can occur. Antibodies are made by pregnant woman's immune system and their quantity and quality depend on many factors. Their function is to eliminate foetal "foreign" erythrocytes. Ways of elimination of antibody-labelled foetal erythrocytes are the same in the bloodstream of pregnant women and foetuses/newborns and their principle is type II hypersensitivity (cytotoxic), according to the Coombs and Gell classification. Severe forms of HDFN can lead to increased perinatal morbidity and mortality. Prevention of the development of RhD alloimmunization and severe forms of HDFN is based on the administration of polyclonal immunoglobulin (Ig) G anti-D in all potentially sensitizing events. It is assumed that the mechanism of anti-D IgG action is based on the rapid removal of the antigen by antibody overflow, and on antibody mediated immune suppression (AMIS). However, the exact immunological principle is not fully known yet. CONCLUSION: This article describes the development of irregular antibodies, methods of foetal erythrocytes destruction and the mechanism of prevention of anti-D immunoglobulin from the immunological point of view.

Screening of RHD fetal genotype in RhD negative women.

OBJECTIVE: In the Czech Republic in all women within a first trimester screening a laboratory testing for RhD blood group from the peripheral blood should be performed. The aim of the screening is to diagnose RhD negative pregnant women, who may be at risk of developing RhD alloimmunization if the fetus is RhD positive. Currently, the prevention of RhD alloimmunization is carried out regardless of the knowledge of RHD fetal status. Already at the beginning of pregnancy it is possible to determine the RHD genotype of the fetus non-invasively due to cell free fetal DNA circulating in maternal peripheral blood detection. The issue of screening examination of fetal RHD genotype is solved worldwide. In some European countries, the examination is routinely established and thus contributes to the optimization of prenatal care for RhD negative pregnant women, immunoglobulin administration is targeted only in pregnancies with RhD positive fetus. The aim of our study is to evaluate clinical and laboratory effectiveness of fetal RHD genotype screening in RhD negative women by TaqMan Real-time PCR method. Designe: Prospective cohort study. SETTING: Obstetrics and Gynecology Clinic of the Faculty of Medicine University Palacky and the University Hospital Olomouc; Institute of Medical Genetics of the Faculty of Medicine UP and the University Hospital Olomouc; Transfusion Department of the University Hospital Olomouc; Institute of Biophysics of the Faculty of Medicine UP Olomouc. MATERIAL AND METHODS: In 2011-2015 at the University Hospital Olomouc 337 examinations of RHD fetal genotype were performed in pregnant women in first and second trimester and evaluated by TaqMan Real-time PCR, followed by verification of the newborn RHD genotype. RESULTS: Methodology of fetal RHD genotype examination is accurate, reliable and useful in clinical practice. The sensitivity was 97.8%. The specificity was 98.7%. When assessing the effectiveness of the introduction of non- -invasive fetal RHD genotype screening in RhD negative women, it is necessary to assess the medical, organizational and economic aspects. More consistent prevention of RhD alloimmunization in the cases actually indicated may reduce the incidence of RhD alloimmunization. CONCLUSION: From the medical point of view the RHD genotype determination in all RhD negative women at the beginning of pregnancy seems effective. It allows to diagnose about 40% of pregnancies with RhD negative fetuses that do not require administration of IgG anti-D. IgG anti-D should be administered only in indicated cases. Determination of fetal RHD genotype by using TaqMan Real-time PCR is useful in clinical practice.

The effectiveness of KEL and RHCE fetal genotype assessment in alloimmunized women by minisequencing.

OBJECTIVE: To evaluate the effectiveness of the fetal KEL and RHCE genotype assessment in alloimmunized pregnant women by minisequencing. DESIGN: Prospective cohort study. SETTING: Obstetrics and Gynecology Clinic of the Faculty of Medicine UP and the University Hospital Olomouc; Institute of Medical Genetics of the Faculty of Medicine UP and the University Hospital Olomouc; Transfusion Department of the University Hospital Olomouc; Institute of Biophysics of the Faculty of Medicine UP Olomouc. SUBJECT AND METHOD: In the years 2001-2019, 366 samples of pregnant women in the first and second trimester were assessed KEL (n = 327) or RHCE (n = 39) genotype from the free fetal DNA circulating in the peripheral blood by minisequencing. The genotype of the fetus was verified from the buccal smear of the newborn. RESULTS: The KEL genotype was assessed in 327 women (the presence of a variant of the KEL1 alele, which corresponds to the presence of the erythrocyte antigen “K“. The analysis failed in 2 cases (2/327), 16 heterozygote women (KEL1/KEL2) were excluded and in the case of 309 homozygote women (KEL2/KEL2) the fetal KEL genotype was assessed. In the case of 95.8% of the fetuses (296/309) and 95.5% of the newborns (295/309), the KEL2/KEL2 genotype was assessed. In the case of 4.2 % of the fetuses (13/309) and 4.5% of the newborns (14/309), the KEL1/KEL2 genotype was assessed. The sensitivity was 92.86%. The specificity was 100%. The RHCE genotype was assessed in 39 women. In the case of 22 women, the presence of a variant of the RHCE gene, which corresponds to the presence of the erythrocyte antigen “C“/“c“, was assessed. 5 heterozygote women (C/c) were excluded. In the case of 11 homozygote women (C/C), the RHCE genotype was assessed. In the case of 64% (7/11) of the fetuses and newborns, the C/c genotype was assessed, in the case of 36% (4/11) the C/C genotype was assessed. In the case of 6 homozygote women (c/c), the RHCE genotype was assessed. In the case of 67% (4/6) of the fetuses and newborns, the C/c genotype was assessed, in the case of 33% (2/6) the c/c genotype was assessed. The sensitivity and specificity were 100%. In the case of 17 women, the presence of the variant of the RHCE gene, which corresponds to the presence of the erythrocyte antigen “E“/“e“, was assessed. 1 heterozygote woman (E/e) was excluded. In the case of 16 homozygote women (e/e), the RHCE genotype was assessed. In the case of 75% (12/16) of the fetuses and newborns, the e/e genotype was assessed, in the case of 25% (4/16) the E/e genotype was assessed. The sensitivity and specificity were 100%. CONCLUSION: The minisequencing method using the capillary electrophoresis enabled a reliable detection of the fetal KEL and RHCE genotype from the peripheral blood of pregnant women.

Impact of 3D ultrasound on fetal CNS examination.

OBJECTIVE: An overview of current knowledge about the use of 3D ultrasound examinations for the examination of fetal CNS. DESIGN: A review article. SETTING: Department of Gynecology and Obstetrics, Faculty of Medicine and Dentistry, Palacký University and Faculty Hospital Olomouc. METHODS: Literary sources related to the subject were used, especially articles indexed by Pubmed-Medline. CONCLUSION: 3D ultrasound is currently used for examination of fetal CNS structures that can be only very difficult displayed by conventional 2D ultrasound. The best for technique for visualisation of midline fetal CNS structures, respectively corpus callosum cerebellar vermis, appears to be 3D volume acquisition in a sagittal plane through the sagittal suture or large fontanel with further post-processing in multiplanar mode, OVIX (Samsung), TUI (GE Healthcare) etc.

First-trimester screening for preeclampsia.

DESIGN: Review article. SETTING: Department of Clinical Biochemistry, University Hospital Olomouc; Department of Obstetrics and Gynecology, Palacky University Olomouc, Faculty of Medicine and Dentistry, University Hospital Olomouc; The Institute for the Care of Mother and Child and 3rd Faculty of Medicine Charles University, Prague; G-CENTRUM Olomouc, Olomouc; Genetika Plzeň, Pilsen. Methods, results: Preeclampsia (PE) is a multisystem disorder complicating pregnancy. It is the leading cause of maternal and perinatal mortality and morbidity worldwide. Recent studies have shown that high-risk pregnant women may benefit from low-dose acetylsalicylic acid early therapy in prevention of the development of severe forms of the disease. The risk group of pregnant women should be identified in 11-13 gestational week for effective prevention. The only procedure validated in many studies for performing PE screening with sufficient diagnostic accuracy in the first trimester of pregnancy is given by The Fetal Medicine Foundation (FMF) and has been adopted and published in a new recommendation by The International Federation of Gynecology and Obstetrics (FIGO). CONCLUSION: This article summarizes the recent findings and recommendation for performing screening of preeclampsia in 1st trimester of pregnancy and how to prevent the development of severe forms of PE by low-dose acetylsalicylic acid therapy.

Robot assisted laparoscopic abdominal cerclage: two case reports.

OBJECTIVE: In this work we report the first use of robot-assisted preconceptual abdominal cerclage in the Czech Republic with subsequent live birth. We present two patients with a history of late pregnancy losses (late miscarriage) who underwent robotic abdominal cerclage. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký Univesity, Olomouc. METHODS: The da Vinci S surgical system was used for the robot-assisted abdominal cerclage. RESULTS: One robot-assisted laparoscopic transabdominal cerclage patient delivered at term a live infant and the second patient currently undergoes infertility treatment with in vitro fertilization. CONCLUSION: Robotic abdominal cerclage is a relatively new minimally invasive method for treatment of cervical insufficiency. This technique provides 3D visualization and better instrumentation than the conventional laparoscopic approach.

[Abdominal pregnancy at a patient after cesarean section, bilateral salpingectomy and embryotransfer]. / Abdominální tehotenství u pacientky po císarském rezu, oboustranné salpingektomii a embryotransferu.

OBJECTIVE: Presentation of rare complication following the assisted reproduction at a patient after cesarean section and bilateral salpingectomy. DESIGN: Case report. SETTINGS: Department of Obstetrics and Gynaecology, Regional Hospital Liberec, a. s.; Department of Obstetrics and Gynaecology, Palacky University Hospital, Olomouc. OBSERVATION: Pregnant woman, 26-years old, primiparous, with history of cesarean section and bilateral salpingectomy, was referred from the assisted reproduction centre to solve suspicion of molar intrauterine pregnancy. This diagnosis was settled on the basis of ultrasound scan of uterine cavity and high level of human choriogonadotropine. Instrumental revision of uterine cavity was performed, however there was not consequently demonstrated any histological prove of the pregnancy tissue in uterine cavity and decrease of human choriogonadotropine values. The verifying ultrasound examination was made and then the suspicion of ectopic pregnancy on the right side of the uterus was expressed. Laparoscopy diagnosed ectopic pregnancy localized in the right broad ligament. It was treated by exstirpation of the pregnancy tissue. CONCLUSION: The diagnosis of ectopic pregnancy should be based on personal history, human choriogonadotropine level assessment and pelvic ultrasound examination. Although it´s important to evaluate all the components globally, ultrasound examination is in a majority of cases the most important part for setting the right diagnosis.

Triple pregnancy with mixed chorionicity following in vitro fertilization: is fetal reduction neccesary?

OBJECTIVE: The increasing incidence and management of monozygotic twinning in patients undergoing in vitro fertilization (IVF) has been the subject of much debate. Here, we describe the management and outcome of two triple pregnancies with mixed chorionicity with a monochorionic-diamniotic twin pair and a singleton following the transfer of two embryos during IVF treatment. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, Palacký University Hospital, Olomouc, Czech Republic. METHODS: This study involved Patient A (30 years of age; 0 para) and Patient B (32 years of age; I Para), both with triplets of mixed chorionicity following the transfer of two embryos during IVF treatment, and treated in The Fetal Medicine Centre, Palacky University Olomouc. Detailed counselling led to the deployment of different management strategies for each case. RESULTS: The monochorionic twin component of Patient A was terminated by fetal reduction in the 15th week of gestation, while the remaining single pregnancy was delivered at term without complication. Patient B opted for expectant management. However, the pregnancy was complicated by severe maternal morbidity and was terminated in the 28th week of gestation following the death of one fetus. CONCLUSION: Fetal reduction should be offered as a management tool to patients carrying triplets in order to improve perinatal survival. In triplets with mixed chorionicity, the reduction of monochorionic twins is particularly advisable in preventing the additional risk posed by a shared placenta.

Management of Medical Termination of Pregnancy (MToP) up until the 7th week of gestation in the Czech Republic.

OBJECTIVE: In the Czech Republic (CR), it is possible, to carry out Medical Termination of Pregnancy (MToP) in the 1st trimester since June 2014, in case a woman submits a written request for it and in case the ultrasound examination confirms an intrauterine singleton prosperous pregnancy, between day 42 and 49 of gestation, crown-rump length (CRL) of the embryo 2-9 mm. The aim of the study is to analyze the management of MToP up until the 7th week of gestation in five centres in the CR. DESIGN: Multicenter cohort (prospective) study. SETTING: Department of Obstetrics and Gynecology, Palacky University Olomouc, Faculty of Medicine and Dentistry, University Hospital Olomouc; The Institute for the Care of Mother and Child, Charles University in Prague, Third faculty of Medicine; Department of Gynecology and Obstetrics, Charles University in Prague, First faculty of Medicine, General University Hospital in Prague; Department of Gynecology and Obstetrics, Charles University in Prague, First faculty of Medicine, Hospital Na Bulovce, Prague; Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine, University Hospital Brno. METHODS: In 2014-2016, a total of 1820 pregnant women requested MToP. The diagnosis of an intrauterine singleton prosperous pregnancy was set by transvaginal ultrasound, CRL 2-9 mm. MToP was carried out by combination of mifepristone (600 mg orally) and misoprostol (400 mcg orally) within 48 hours. MToP follow up (exclusion of ongoing pregnancy) after 2-3 weeks was carried out by transvaginal ultrasound as well. RESULTS: In 11.0% of women (201/1820) who requested MToP, CRL > 9 mm, unprosperous, multiple or ectopic pregnancy was diagnosed. In the remaining 1619 women MToP was carried out, but in 221 cases (13.7%) at least one additional pre-first visit was needed before the diagnosis of intrauterine singleton prosperous pregnancy CRL 2-9 mm could be established, in 19 cases (1.2%) two pre-first visits and in 5 cases (0.3%) even three. Gestational age was 42-49 days (average 47.1, median 47), the women were 14-47 years of age (average 30.7, median 30). In 20.8% of women (336/1619) MToP follow up was missed and of the remaining 1283 women, ongoing pregnancy (MToP failure) was diagnosed in 1.6% (24/1283), incomplete abortion in 6.5% (83/1283) and complete abortion in 91.9% (1179/1283). A subsequent surgical intervention was carried out in 7.1 % of women (91/1283). CONCLUSION: A medical facility performing MToP in the 1st trimester should develop its own methodology in accordance with the legislation in force, Summaries of Product Characteristics, and recommendations of professional associations. The methodology should also include a method of evaluation of the result and management. The subsequent surgical intervention should only be performed in indicated cases. The main goal of MToP follow up is to exclude ongoing pregnancy (MToP failure), and the patient should be informed in detail about the risks involved and possibilities of their solution, it is necessary to obtain an informed consent.

[Management of Medical Termination of Pregnancy (MToP) up until the 7th week of gestation in the Czech Republic]. / Management umelého ukoncení tehotenství Farmakologickou metodou, nepresahuje-li tehotenství 7 týdnu, v Ceské republice.

OBJECTIVE: In the Czech Republic (CR), it is possible, to carry out Medical Termination of Pregnancy (MToP) in the 1st trimester since June 2014, in case a woman submits a written request for it and in case the ultrasound examination confirms an intrauterine singleton prosperous pregnancy, between day 42 and 49 of gestation, crown-rump length (CRL) of the embryo 2-9 mm. The aim of the study is to analyze the management of MToP up until the 7th week of gestation in five centres in the CR. DESIGN: Multicenter cohort (prospective) study. SETTING: Department of Obstetrics and Gynecology, Palacky University Olomouc, Faculty of Medicine and Dentistry, University Hospital Olomouc; The Institute for the Care of Mother and Child, Charles University in Prague, Third faculty of Medicine; Department of Gynecology and Obstetrics, Charles University in Prague, First faculty of Medicine, General University Hospital in Prague; Department of Gynecology and Obstetrics, Charles University in Prague, First faculty of Medicine, Hospital Na Bulovce, Prague; Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine, University Hospital Brno. METHODS: In 2014-2016, a total of 1820 pregnant women requested MToP. The diagnosis of an intrauterine singleton prosperous pregnancy was set by transvaginal ultrasound, CRL 2-9 mm. MToP was carried out by combination of mifepristone (600 mg orally) and misoprostol (400 mcg orally) within 48 hours. MToP follow up (exclusion of ongoing pregnancy) after 2-3 weeks was carried out by transvaginal ultrasound as well. RESULTS: In 11.0% of women (201/1820) who requested MToP, CRL > 9 mm, unprosperous, multiple or ectopic pregnancy was diagnosed. In the remaining 1619 women MToP was carried out, but in 221 cases (13.7%) at least one additional pre-first visit was needed before the diagnosis of intrauterine singleton prosperous pregnancy CRL 2-9 mm could be established, in 19 cases (1.2%) two pre-first visits and in 5 cases (0.3%) even three. Gestational age was 42-49 days (average 47.1, median 47), the women were 14-47 years of age (average 30.7, median 30). In 20.8% of women (336/1619) MToP follow up was missed and of the remaining 1283 women, ongoing pregnancy (MToP failure) was diagnosed in 1.6% (24/1283), incomplete abortion in 6.5% (83/1283) and complete abortion in 91.9% (1179/1283). A subsequent surgical intervention was carried out in 7.1 % of women (91/1283). CONCLUSION: A medical facility performing MToP in the 1st trimester should develop its own methodology in accordance with the legislation in force, Summaries of Product Characteristics, and recommendations of professional associations. The methodology should also include a method of evaluation of the result and management. The subsequent surgical intervention should only be performed in indicated cases. The main goal of MToP follow up is to exclude ongoing pregnancy (MToP failure), and the patient should be informed in detail about the risks involved and possibilities of their solution, it is necessary to obtain an informed consent.

[Bronchopulmonary sequestration]. / Bronchopulmonální sekvestrace.

OBJECTIVE: To describe the case of prenatal diagnosis of bronchopulmonary sequestration and compelete spontaneous antenatal regresion of the lesion. DESIGN: Case report and review of the literature. SETTING: Complex Cancer Center Novy Jicin, Department of Obstetrics and Gynecology Palacky University Hospital Olomouc. CASE REPORT: We describe the case reports about the complete regression of a quite large bronchopulmonary sequestration during pregnancy. CONCLUSION: Bronchopulmonary sequestration is usually diagnosed in mid-trimester ultrasound fetal anomaly scan. In case of other fetal abnormalities are present the counceling by medical geneticist should be completed. In most cases complete spontaneous antenatal regresion of the lesion occur and the fetal surgery should be considered in adverse prognostic findings until 30 gestational weeks.

[Acute uterine inversion after delivery]. / Akutní inverze delohy po porodu.

OBJECTIVE: A case of acute inversion of the uterus after childbirth, in which we successfully perform a manual vaginal reposition of the uterus. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, Krajská nemocnice Liberec, a.s.; Department of Obstetrics and Gynaecology, Palacky University Hospital, Olomouc. OBSERVATION: Our case report describes acute post-partum uterine inversion of the second degree, which developed after delivery in a 36-year-old primigravida. The placenta was not delivered despite uterotonics administration, use of the Credé manoeuvre and controlled umbilical cord traction. We decided for manual removal of the placenta in general anaesthesia. After successful removal of the placenta, uterine inversion was diagnosed. Therefore, we immediately started with vaginal reposition and the manual reposition of the uterus successful. Total blood loss amounted to approx. 2500 ml and the patient fell into the shock state. Severe coagulopathy was diagnosed using rotational thrombelastography. We were able to stabilise the condition of the patient and on the eigth day after delivery she was discharged home. CONCLUSION: Uterine inversion is a rare complication of the third labour stage. Some obstetricians do not encounter this condition in their entire practice, but it can be cause of maternal mortality. Therefore, it is necessary that every obstetrician considers this possibility, knowing the risk factors and the therapeutic options in this critical situation.

[Original Bishop score with modifications]. / Cervix skóre dle Bishopa a jeho modifikace.

AIM: To review original Bishop score and its modifications in context of labour induction. DESIGN: A review article. SETTING: Department of Obstetrics and Gynecology, University Hospital, Palacky University, Olomouc. METHOD: Literature review of original Bishop score, simplified Bishop score, as well as modified Bishop scores as predictive factors of successful induction of labour. CONCLUSION: The Bishop score is the most commonly used method to rate the readiness of the cervix for induction of labour.

[Spontaneous antepartal RhD alloimmunization]. / Spontánní antepartální RhD aloimunizace.

AIM OF THE STUDY: Assess the incidence of spontaneous antepartal RhD alloimmunization in RhD negative pregnant women with an RhD positive fetus. DESIGN: Clinical study. SETTING: Department of Obstetrics and Gynecology, Medical School and University Hospital Olomouc. METHODS: A total of 906 RhD negative women with an RhD positive fetus and without the presence of anti-Dalloantibodies at the beginning of pregnancy were examined. Always it was a singleton pregnancy, RhD blood group of the pregnant women was assessed in the 1st trimester of pregnancy, RhD status of the fetus was determined after delivery. Screening for irregular antierythrocyte antibodies was performed in all women in the 1st trimester of pregnancy, at 28-32 weeks gestation and immediately prior to delivery at 38-42 weeks gestation. Screening for irregular antierythrocyte antibodies was performed also at 6 months following delivery in all cases of positive antibodies before delivery. Antibody screening was performed using the indirect antiglobulin (LISS/NAT) and enzyme (papain) test with their subsequent identification using a panel of reference erythrocytes by column agglutination method Dia-Med. After delivery, the volume of fetomaternal hemorrhage was assesed in all RhD negative women and RhD alloimmunization prophylaxis was performed by administering the necessary IgG anti-D dose; none of the women were administered IgG anti-D antepartally. RESULTS: During screening for irregular antierythrocyte antibodies at 28-32 weeks gestation, anti-D alloantibodies were diagnosed in 0.2% of the women (2/906); immediately prior to the delivery at 38-42 weeks gestation, anti-D alloantibodies were diagnosed in 2.3% of the women (21/906) and repeatedly even at 6 months following delivery (21/157). In 82.7% of the women (749/906), examination at 6 months following delivery was not performed, therefore in these women spontaneous antepartal RhD alloimmunization cannot reliably be ruled out. Alloimmunization may not be diagnosed yet at term of delivery. If anti-D alloantibodies were not present prior to the delivery, these women were all administered IgG anti-D in a dose of at least 125 µg after delivery. CONCLUSION: In RhD negative women with an RhD positive fetus, the incidence of spontaneous antepartal RhD alloimmunization was at least 2.3%. Most cases may theoretically be prevented by prophylactic administration of 250 µg of IgG anti-D to all RhD negative women at 28 weeks gestation.

[Prebioptic methods in the cervical cancer screening]. / Prebioptické metody pri screeningu karcinomu delozního hrdla.

OBJECTIVE: To evaluate the agreement between Pap smears, colposcopic findings and definitive excisional specimen in patients with abnormal Pap smears. DESIGN: Retrospective study. SETTING: Center of outpatient gynecology and primary care, Brno; Department of Obstetrics and Gynecology, University Hospital, Olomouc; Department of Medical Biophysics, Palacky University, Olomouc.Subjects and methods of the study: This retrospective study assessed the correlation between colposcopy and histopathology of woman who had abnormal Pap smears. Colposcopic chart review included participants from 2008 to 2012 who attended colposcopic clinic, center of outpatient gynecology care, Brno. RESULTS: One thousand nine hundred and twenty five patients screened by cytology, submitted to colposcopy and subjected to cone biopsy were selected. Cytopathological results were compared with colposcopic findings and results obtained on the basis of histological analyses of cone biopsy specimen. Agreement of cytology and histopathological diagnosis was in 1199 patients (62.3%). Agreement of colposcopic diagnosis and cervical pathology was matched in 1492 (93.5%). Agreement of colposcopy and cytology was found in 1022 pacientek (64.1%). False negatives of cytology in high grade lesions were in 36.4%. CONCLUSION: Strength of agreement between colposcopic diagnosis and cervical pathology was found to be very good while for cytology high percentage of false negative results was seen. Expert colposcopists and high quality standard cytopathologic and bioptic laboratories are necessary for nationwide cervical screening programmes. KEYWORDS: cervical cancer, colposcopy, oncological cytology, histology, CIN, cone biopsy.

[Bleeding disorders in pregnancy]. / Problematika krvácivých chorob v porodnictví

UNLABELLED: Bleeding disorders in pregnancy represent heterogenous and often serious group of diseases. Solving of this problems and proper treatment of the patiens requires close cooperation between obstetricians and hematologists. There are disorders specific for pregnancy (HELLP syndrom) and disorders occurring independently in pregnancy, but these can be modified in pregnancy as well. Bleeding and postpartum haemorrhage still remain the leading cause of maternal mortality. KEYWORDS: bleeding - pregnancy - thrombocytopenia - coagulopathy.

[Incidence of erythrocyte alloimmunization in pregnant women in olomouc region]. / Incidence erytrocytární aloimunizace u tehotných zen v olomouckém regionu.

OBJECTIVE: To determine the incidence of clinically significant anti-erythrocyte alloantibodies in pregnant women, which can cause severe hemolytic disease in the fetus and newborn. DESIGN: Retrospective-prospecitive clinical study. SETTING: Transfusion Department, University Hospital Olomouc, Department of Obstetrics and Gynecology, University Hospital Olomouc. SUBJECT AND METHOD: Between the years 2000-2011, a total of 45 435 pregnant women were examined at the Department of Transfusion Medicine at the University Hospital Olomouc. Screening for irregular anti-erythrocyte antibodies followed by identification of the alloantibody was performed in all women at the beginning of the pregnancy. RESULTS: Clinically significant anti-erythrocyte antibodies were diagnosed in 1.5% pregnant women (683/45435). The most common cause of maternal alloimmunization was antigen E with an incidence of 5.7 (258/45435), followed by antigen D 4.0 (181/45435), M 1.5 (70/45435), C 1.2 (54/45435), K 1.2 (55/45435), c 0.6 (26/45435), S 0.4 (20/45435), Jka 0.2 (9/45435), PP1pk (Tja) 0.1 (3/45435) and antigen Fya 0.0 (2/45435). CONCLUSION: Despite performing prophylaxis for RhD alloimmunization by administering anti-D immunoglobulin to RhD negative women during pregnancy and after the birth of an RhD positive child, antigen RhD still represents the 2nd most frequent cause of maternal erythrocyte alloimmunization. The remaining clinically significant alloimmunizations are caused by non-D antigens of the Rh system, antigens of the Kell system, and rarely observed antigens of the MNS and Kidd blood systems.

[Erythrocyte alloimmunization in pregnant women, clinical importance and laboratory diagnostics]. / Erytrocytární aloimunizace tehotných zen, klinický význam a laboratorní diagnostika.

OBJECTIVE: The aim of this review is to give comprehensive summary of erythrocyte alloimunization of pregnant women, laboratory dignostics and clinical importance. DESIGN: Review. SETTING: University Hospital Olomouc, Transfusion Department, Department of Obstetrics and Gynecology. SUBJECT AND METHOD: Based on literature analysis using database search engines PubMed, Google Scholar, Ovid in field of erythrocyte antibodies, laboratory diagnostics and clinical importance up-to-date knowledge. CONCLUSION: Erythrocyte alloimunization anti-D antibodies decreases in connection with the introduction of immunoprofylaxis. Immunization of non RhD antibodies with impossibility using of immunoprofylaxis remains still clinical problem.