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.

[Antibiotic therapy in pregnancy]. / Antibiotická terapie v gravidite.

OBJECTIVE: This article reviews up-to-date data on antibiotic therapy in pregnancy. DESIGN: Review article. SETTING: Department of Infectious Diseases, Military University Hospital Prague; Institute for the Care of Mother and Child, Prague. MATERIAL AND METHODS: Relevant literary sources have been considered, including articles in English indexed in Pubmed, monographies in English and articles in Czech. CONCLUSIONS: Antibiotic therapy in pregnancy must be rational. Antibiotics with favorable risk-benefit ratio should be used whenever possible. To achieve this, physicians must be well versed in the topic of toxicity and teratogenicity of the most commonly used antibiotics. Several pharmacokinetic parameters are altered in pregnant women. Thus, dosage of some antibiotics should be adjusted (usually increased) accordingly. Antibiotic therapy in perinatal period and in early childhood might increase the risk of developing atopy and obesity.

[Selective feticide in monochorionic twin pregnancies with discordant fetal anomalies: management and outcome]. / Selektivní fetoredukce u monochoriálních gravidit komplikovaných vrozenou vývojovou vadou jednoho z plodu: management a výsledky péce.

OBJECTIVE: To analyze results and outcome after selective feticide for discordant anomalies in monochorionic twins. DESIGN: Prospective cohort study. SETTING: Fetal medicine center, Institute for the Care of Mother and Child, Praha. METHODS: Analysis of outcome of monochorionic pregnancies after intrauterine surgery for structural abnormalities between January 2013 and June 2016. RESULTS: We performed 13 intrauterine operations in monochorionic twins with structural anomalies during the period. There were 12 monochorionic diamniotic and one monochorionic monoamniotic twins. We encountered four cases of Twin Reversed Arterial Perfusion sequence (TRAP), six central nervous system lesions, two abdominal wall defects and one heterokaryotypic pregnancy with trisomy 13. In seven cases we performed bipolar cord occlusion, in four cases of TRAP sequence we performed radiofrequency ablation (RFA). We also performed laser photocoagulation of placental anastomoses in a case of gastroschisis complicated with twin-to-twin transfusion syndrome. One operation was unsuccessful for technical reasons - failing to perform amnioinfusion in a fetus with eventeration and anhydramnios. All procedures were performed in local anesthesia. Fetuses were born between 26 a 41 weeks of gestation (mean 35 weeks; 77% of fetuses were delivered after 32 weeks). Mean neonatal weight 2260 g. We encountered no intrauterine demise of a healthy fetus. CONCLUSION: Patients with discordant fetal anomalies in monochorionic twins can be offered a selective feticide via bipolar umbilical cord occlusion or radiofrequency ablation that are proven to be safe and effective.

[Retrospective analysis of monochorionic twin pregnancies born in the Institute for the Care of Mother and Child between 2012-2015]. / Analýza prípadu monochoriálních dvojcat porozených v Ústavu pro péci o matku a díte ve ctyrletém období (2012-2015).

OBJECTIVE: The purpose of this study was to describe monochorionic twin pregnancies and their complications, born between 24th and 37th week of gestation in the Institute for the Care of Mother and Child in years 2012-2015. DESIGN: Retrospective cohort. SETTING: The Institute for the Care of Mother and Child, Praha. METHODS: From 2012 to 2015 we observed 177 monochorionic twin pregnancies from which two or one viable fetuses were born, or both fetuses died in utero. RESULTS: From a total of 177 women, 12 (6.8%) gave birth before 26th week of gestation, between 26+0 - 27+6 four women (2.3%) gave birth, 37 women (20.9%) between 28+0 - 31+6, 84 women (47.8%) between 32+0 - 35+6 and after 36th week of gestation 40 women (22.6%) gave birth. Mean week of delivery was 33.8. Indications for termination of pregnancies were premature rupture of membranes (PPROM) in 11.9%, onset of spontaneus uterine contractions in 12.4% and in 53.3% other iatrogenic indication. 23.3% of pregnancies in our cohort were uncomplicated and terminated after 36th week of gestation. We performed caesarean section in 94.3%, in 5.7% patients gave birth vaginally. In vitro fertilization had 19.9% women, 80.1% conceived spontaneously. The age range of pregnant women in our cohort was 20-43, with median 32.3. Mean weight of bigger fetus was 2047.6 g (min. 520 g, max. 3530 g), mean weight of smaller fetus was 1799.5 g (min. 350 g, max. 2790 g). In 30 cases (16. 9%) we performed intrauterine intervetion. In 21/30 cases (11.9%) for TTTS diagnose, in 5/30 cases (2.8%) for congenital abnormalities or TRAP sequence and in 4/30 cases (2.2%) for sIUGR type III. The most frequent complication in our cohort was sIUGR (36 patients - 20.3%), TTTS (21 patients - 11.9%) and on the third place congenital abnormality or TRAP sequence (five patients - 2.8%) Nineteen patients gave birth to one viable fetus, in two cases both fetuses died in utero. In one case, in twin pair, one new-born died shortly after the birth - it had several congenital abnormalities and due to anhydramnion it was impossible to perform amnioinfusion and umbilical cord occlusion. After the birth it was given palliative care. CONCLUSION: The study brought data about specific risks in monochorionic twin pregnancies and suggests careful observation of women in fixed intervals and necessity of immediate referral to perinatal centre in case of any suspicious or pathological finding.

[Ultrasound imaging of normal fetal central nervous system at 8 to 12 weeks of gestation]. / Sonoanatomie CNS plodu v 8. az 12. týdnu gravidity.

With ongoing evolution of advanced ultrasound diagnostic in prenatal care the trend is to detect potential fetal anomalies in the first trimester if possible. Complex knowledge of normal fetal anatomy, embryology and ultrasound anatomy is important to be able to identify subtle abnormalities. In this review we demonstrate the possibilities of ultrasound imaging of fetal brain at late first trimester and describe normal central nervous system development week by week. Original images are presented.

[Analysis of the set of pregnancy women with asthma bronchiale]. / Analýza souboru rodicek s asthma bronchiale.

OBJECTIVE: The set of pregnant females suffering from bronchial asthma-retrospective analysis. TYPE OF STUDY: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology, University Hospital Na Bulovce, First Medical Faculty, Charles University in Prague, Czech Republic. SUBJECT AND METHOD: Our set consists of pregnant women suffering from bronchial asthma and attending our Antenatal Clinic & delivering at our Maternity Hospital from January 2008 through December 2009. Retrospective analysis of the set based on the medical records was performed. RESULTS: 80 females suffering from bronchial asthma gave birth at our Hospital during the studied time span, i.e., 1.7% of all deliveries at our Maternity Hospital. In 4 females (i.e. 5%) the asthma attack was observed during the pregnancy. 33% of all females suffering from bronchial asthma did not require any bronchodilator medication, 22% were just on betamimetics, 23% required inhalational betamimetics with intermittent inhalational corticosteroid and 21% use both regularly. Perorally corticosteroids or leukotrien inhibitors were not used at all. There was no negative influence on subjective felling of the female during her pregnancy and labor in 71% of cases. 24% of all females suffering from bronchial asthma delivered by Caesarean Section but just in two of them it was indicated due to the bronchial asthma itself. We observed no case of IUGR or congenital defect. No change in the length of the hospital stay in comparison to the other females was shown. CONCLUSION: The nowadays standard treatment of bronchial asthma during pregnancy is based on local inhalative bronchodilator and anti-inflammatory medication. Pregnant females are usually well compensated, and thus their perinatal outcome shows no difference compared to the healthy population.

[New Single-Incision Sling System MiniArc in treatment of the female stress urinary incontinence]. / První zkusenosti s novou minipáskou k lécbe stresové inkontinence moci u zen--MiniArc.

OBJECTIVE: The aim of this paper is to introduce the new Single-Incision Sling System MiniArc in treatment of the female stress urinary incontinence. SUBJECT: Prospective follow up. SETTING: Department of Obstetrics and Gynaecology, The First Faculty of Medicine, Charles University in Prague. SUBJECT AND METHOD: Prospective follow up of the first set of 38 patients treated with the new method MiniArc. CONCLUSION: We performed initial 38 cases of MiniArc under the local anesthesia. There was neither the complication during procedure, nor during the early postoperative period. No patient required urine derivation. Late postoperative period showed neither obstruction, nor ,,de novo urgency". One asymptomatic sub-urethral tape protrusion into the vagina was found. No late postoperative pain occurred. Subjective cure rate was investigated in 33 ladies with follow up from 6 weeks through 19 months. 23 females declared full dryness (i.e., 76.7%), 6 patients were very satisfied and declared improvement of more than 70% (i. e. 20.0%); thus we obtained efficacy in 29 cases of 30 (i. e. 96.7%). We have not seen any vanishing of the sling effect. Based on our initial experience we judge the new single incision tape as very promising.

[Sexual assault in the woman]. / Sexuální násilí na zenách.

OBJECTIVE: Retrospective analysis of the population of women examined for suspicion of sexual assault to compare the situation in the Czech Republic with the world's published works. DESIGN: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology, 1st Medical Faculty of Charles University and the Faculty Hospital Na Bulovce Prague. METHODS: Retrospective analysis of medical reports for all women examined for suspicion of sexual violence during the period from January 2007 to December 2008. RESULTS: During observed period 37 women were examined, average age of examined women was 26.2 years, range 15-51 years, 76% of females younger than 29 years, 16% of examined women were from abroad. We have found no differences in occurrence throughout the year. In 3 cases there were more aggressors, in 30% of cases the alleged perpetrator was a known person or relative. In 54% of cases completed vaginal intercourse with ejaculation allegedly took place. We detected one case of forced oral sex and one case of forced anal sex. In 19% touching was involved. 22% of women did not know whether coitus really occurred--in 14% the alleged victim was under the influence of alcohol, in 3 cases under the influence of drugs, including one case of drinking an unknown substance in a beverage. Obvious signs of violence were found in 27% of cases, of which mostly in the face (14%), the extremities (8%) and only in two cases on the genitals (5%). No woman did require medical treatment of injuries. CONCLUSION: Our experience is similar to the published world data. In our group there were more strangers among the perpetrators. We did not record any use of a weapon in the enforcement of sexual contact. It is necessary to examine the alleged victims whole body thoroughly, signs of violence were more frequent in extragenital localization.