Total laparoscopic hysterectomy - clinical comparison of the method using two types of uterine manipulators.

AIM OF THE STUDY: Comparison of two types of uterine manipulators used in total laparoscopic hysterectomy (TLH) and clinical evaluation of the method in patients in a two-year group supplemented by subjective evaluation. DESIGN: Prospective observational study. SETTING: Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine and University Hospital Brno. MATERIAL AND METHODS: A group of patients operated in the years 2018-2019 by the TLH method using one of two types of uterine manipulators - Karl Storz HOHL (group No. 1) vs. plastic ring of Koh's manipulator (group No. 2). We compared surgical time (min), blood loss (ml), perioperative complications, length of hospital stay (days), early and late complications. We were interested in the possible influence of BMI, uterine on these parameters. Subjective evaluation of the method by patients took place before the procedure and 12 weeks after the operation with a standardized questionnaire. RESULTS: A total of 134 patients were enrolled in the study (75 in group 1 vs. 59 in group 2). The monitored parameters: age, BMI, operative time, blood loss and length of hospitalization did not differ statistically significantly. When comparing the individual groups with different manipulators, the total number of complications (mild difficulties, serious complications) was without statistical significance (p = 0.58), but the spectrum of symptoms was different in both groups. More than a third of the patients in the group were obese. There were more serious complications than non-obese ones, the performance was longer, however, for a small number it was statistically insignificant (p = 0.11). In patients with uterine surgery, we recorded more adhesiolysis. We did not show that previous surgery on the uterus was associated with a higher incidence of complications (p = 0.6). We did not notice any statistically significant difference in the subjective evaluation (p = 0.3). CONCLUSION: TLH is the dominant method of uterine removal in our workplace. In a group of 134 women, we did not show a statistically significant difference in the monitored parameters. The HOHL manipulator has proved to be more user-friendly due to its technical parameters and better clarity of the operating field. Subjective evaluation of the method was positive in patients.

Efficacy of dienogest treatment of clinical symptoms of rectovaginal endometriosis.

OBJECTIVE: The aim of this prospective, unicentric, cohort study was to evaluate the effect of dienogest use in the therapy of symptomatic endometriosis of rectovaginal septum in patients of fertile age. STUDY DESIGN: Prospective, unicentric, cohort study. SETTING: Department of Obstetrics and Gynaecology, Brno University Hospital and Masaryk University Medical School, Brno. MATERIAL AND METHODS: Prospective analysis of the group of 32 patients in reproductive age who have previously been diagnosed with endometriosis of rectovaginal septum. These patients were treated conservatively with dienogest 2 mg per day during a 24-week period. Through questionnaires and clinical assessment, we have studied the presence of symptoms like dyspareunia, diffuse pelvic pain, Biberoglu-Behrman(B-B) score assessment and subjective pain perception using Visual Analogue Scale (VAS) of pain. Data were collected at the beginning of therapy, after 4, 12 and 24 weeks of dienogest use. RESULTS: Continual use of dienogest during the 24-week period diminishes symptoms of dyspareunia by 62% (p.

Radiofrequency endometrial ablation - new possibility of heavy menstrual bleeding conservative treatment.

OBJECTIVE: Evaluation of radiofrequency endometrial ablation (RFEA) clinical efficacy in patients with heavy menstrual bleeding (HMB). DESIGN: Original article. SETTING: Department of Gynecology and Obstetrics, University Hospital and Masaryk University Medical School, Brno. METHODS: Study included 20 patients with HMB who had failed hormonal therapy and met the study inclusion criteria. All RFEA procedures were performed in the operating theater in general anesthesia by two experienced surgeons according to a standardized protocol. All RFEA were performed using specific disposable electrodes and radio frequency generator M-3004 (RF Medical Co., South Korea). Study outcomes were evaluated three months post-surgery included percentage of women with amenorrhoea or menstrual bleeding persistence measured by the modified Pictorial Blood Assessment Chart (PBAC) score. Furthermore, chronic pelvic pain intensity assessed by visual analogue scale (VAS), patient satisfaction (Patient Global Impression of Improvement, PGI-I score), and the incidence of complications were evaluated. RESULTS: All RFEAs were performed without operational or technical complications, the average age being operated was 43.0 ± 2.9 years and the operating time did not exceed ten minutes. In the early postoperative follow-up, patients did not require any analgesics and were all released to outpatient care the following day. Percentage of amenorrhea at three months post-treatment was 35.0%, mean PBAC score for women with menstrual bleeding was 1.8 ± 0.6. Patients satisfaction with the treatment was evaluated by 1.6 ± 0.6 on the PGI-I scale and long-term pelvic pain was on average 2.1 ± 0.8 by VAS, which counts an improvement of 31.0%. CONCLUSION: The HMB treatment with RFEA achieves good clinical results in three-month evaluation with objective and also subjective parameters. The technique is suitable for outpatient treatment and is an alternative to hysteroscopy endometrial ablation. Its wider clinical usage is limited by the high cost of the radiofrequency generator and disposable probes. Keywords heavy menstrual bleeding, hysteroscopy, radiofrequency endometrial ablation, amenorrhoea, complication.

[Radical fertility preserving surgery of gynaecological malignancies - five-year-old file]. / Radikální fertilitu zachovávající operacní výkony u gynekologických malignit - petiletý soubor.

OBJECTIVE: Analysis of radical fertility preserving surgery, oncogynaecological treatment including their pregnancy effort. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynaecology, Masaryk University and Faculty Hospital Brno. METHODS: The group of 13 patients in age fifteen to thirty-six, who underwent radical fertility preserving surgery of oncogynecological tumors (cervix, ovarium), 9 patients with ovarian cancer and 4 patients with carcinoma of cervix. RESULTS: Histology showed seven times ovarial epithelial carcinoma, twice nonepithelial ovarial carcinoma, twice spinocelular cervical carcinoma, one adenosquamous and one lymfoepithelioma like carcinoma. We reported lymphocele as the most often postoperative complication by five patients with ovarial carcinoma, lymphoedema of lower limbs in one case and one of them complicated by bilateral hydronephrosis. After surgery procedures of cervical carcinoma, there was a stenosis of cervical canal with postoperative correction. In one case there was provided vaginal revision of cervix followed by embolisation of uterine arteries because of heavy bleeding in early postoperative period. After two years follow up, there are 12 patients in remission. There were four patients with fertlity plan, two with ovarial carcinoma, two with cervical carcinoma. The first group describes two pregnancies - one misscariage and one spontaneus labour in the date of delivery. There were 4 pregnancies in two patients wit cervical carcinoma. One patient has an intrapartal cesarean section because of scarring of the cervix after the operation. Next patients has two labours in due date, three labours in 34-37th week of pregnancy and one misscariage in 23 week of pregnancy. One patient has ovarial cancer during pregnancy, so the radical fertility preserving surgery was done after delivery. CONCLUSION: Methods and procedures of surgery with fertility preserving goals in our oncogynecological centre are in concordance with actual knowledge of medicine and respect oncological safety of patients with malignancies, who currently wish for fertility preserving treatment. Presented group of patients is relatively small, but results of oncological treatment and fertility plan demonstrate right-fulness of this treatment.

[Efficacy of surgical treatment of stress urinary incontinence with mini-invasive single incision sling]. / Výsledky operacní lécby stresové inkontinence moci mini-invazivní transobturatorní páskou z jedné inc.

OBJECTIVE: The purpose of this study is to evaluate the surgical treatment of stress urinary incontinence by the single incision sling Ophira (Promedon). DESIGN: Prospective observational study. SETTING: Department of Obstetrics and Gynaecology, Masaryk University and University Hospital Brno, Brno. METHODS: Patients with confirmed urodynamic stress urinary incontinence (SUI) were included in the study. Patients with urgent urinary incontinence or mixed incontinence with predominance of urgent folder, patients with insufficiency of internal sphincter of the urethra and pelvic organ prolapse, as well as after previous surgical treatment, patients with pelvic organ prolapse or with other serious pathology of organs of small pelvis were excluded. All patients included in the study received single incision sling (SIS) Ophira (Promedon). The length of the surgery and blood loss and complication was observed. Postoperative observation one year after the treatment was set and evaluated objective and subjective parameters of SUI. RESULTS: In the study were 138 patients examined, total of 45 (34.8%) were included. Postoperative observation completed 44 (97.7%) patients. Mean age was 62.3 years. The mean follow-up was 12.9 months, when 40 patients (90.9%) had a negative cough standardized test (CST). Total of 41 patients (93.1%) evaluated the operation as a major improvement by using a questionnaire Patient Global Impression of Improvement (PGI-I). Quality of life scores were evaluated by International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Before the surgery ranged from 14.8 ± 2.5 points, after the surgery 3.3 ± 2.0 which is an improvement of 11.5 ± 3.1 points. There weren't serious perioperative and postoperative complications. CONCLUSION: Our results are comparable with literary data and are correlated with other studies evaluating the effectiveness of other types of SIS. The method seems to be safe and efficient enough. Observing the group of patients will be continued in order to assess the short- and long-term results.

[Histological types of uterine fibroids in reproductive age and postmenopausal women]. / Histologické typy delozních myomu u pacientek v reprodukcním veku a postmenopauze.

OBJECTIVE: To review the incidence of histologic variants of uterine fibroids of patients in reproductive age and postmenopause. Analysis of potential relations between histological fibroids variants and hormonal activity of the patient. DESIGN: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology, Masaryk University and University Hospital Brno. MATERIAL AND METHODS: Retrospective analysis of 2,397 women who underwent myomectomy or hysterectomy at the Department of Obstetrics and Gynecology, Masaryk University and University Hospital Brno in years 2008-2014. According to input criteria - age of patients between 18-65 years, ultrasound confirmed uterine fibroid. Exclusion criteria was irregular menstrual cycle, hormonal therapy in history or hysterectomy performed for tumors of the small pelvis or for cancer of the uterus or cervix.Group A consisted of 235 patients with regular menstrual cycles, between ages 18-40. Myomectomy was chosen for these patients.Group B consisted of 433 postmenopausal patients between ages 50-65. Laparoscopic and abdominal hysterectomy was performed to these patients. RESULTS: A statistically significant difference was observed in the occurrence of epithelioid type of leiomyoma between women age groups 18-40 and 50-65. In the group of postmenopausal women four malignant forms of leiomyoma were recorded, which were not statistically relevant. CONCLUSION: After evaluating statistical analysis it was found, that there is a statistically significant difference in epithelioid type of uterine leiomyoma. Four patients were detected malignant variant of leiomyoma - leiomyosarcoma in the group of postmenopausal women.

[Dysplasia and cervical cancer: current diagnostic possibilities]. / Soucasné moznosti diagnostiky prekanceróz a karcinomu delozního hrdla.

OBJECTIVE: To review current methods in the diagnosis of dysplasia and cervical cancer. DESIGN: Review article. SETTING: Reprofit International Ltd., Brno; Department of Gynecology and Obstetrics, University Hospital and Faculty of Medicine, Masaryk University, Brno; Biopticka laborator Ltd., Pilsen. METHODS AND RESULTS: Nowadays, there are non-invasive methods for more accurate and timely detection of uterine cervix lesions. Digital images of the uterine cervix can be analysed by a computer for characteristic features and colour patterns, which may enhance the objectivity of the colposcopic examination. Digital image processing technology and biomarkers detection (p16/Ki-67) are useful in liquid based cytology (LBC). At the molecular genetic level different tests are used to detect deoxy- or ribonucleic acid (DNA, RNA) of high-risk types of human papillomavirus (HR HPV). The introduction of HPV testing in screening procedures in the Czech Republic will further in-crease the sensitivity of screening. However, the most specific identification of cervical high-grade lesions appears to be an mRNA detection of oncogenes E6 and E7. The advanced method for the assessment of cervical lesion progress in HR HPV positive women is to determine the methylation of tumor supressor genes that normally prevents the cancer growth. CONCLUSION: Screening programs, inviting women to direct preventive gynecological examinations by health insurance, but also efficient utilization of available methods could lead to early detections of cervical dysplasias. KEYWORDS: cervical dysplasia and cancer, SIL, colposcopy, LBC, HPV, methylation, mRNA.

[Effect of GnRH analogues pre-treatment on myomectomy outcomes in reproductive age women]. / Vliv aplikace GnRH analog na peroperacní a postoperacní výsledky myomektomie u zen v reprodukcním veku.

OBJECTIVE: To evaluate the role of three-monthly pre-treatment with gonadothropin releasing hormone (GnRH) analogues prior to myomectomy for women in comparison with control group of patients with no application. Analysis is focused on peroperative and postoperative results of surgery treatment for women with clinically symptomatic uterine fibroids in reproductive age with interest in getting pregnant. DESIGN: Prospective clinical study. SETTING: Gynecological and Obstetric Clinic of Medical Faculty of Masaryk University and the University Hospital Brno. MAIN MEASURES: The group of 212 patients with symptomatic uterine fibroids detected by ultrasound. 90 patients (42.5%) underwent laparoscopic myomectomy (LM) and 122 patients (57.5%) underwent open laparotomic myomectomy (OM). In the selected group we were observing the common number of exstirpated uterine fibroids, their size, anatomical localisation, depth of invasion of dominant exstirpated uterine fibroid in relation to uterine wall. METHODS: Both groups of patients were randomised into two parts. The group LM with GnRH pretreatment contained 42 patients (19,8 %) and control group with no pre-treatment 48 patients (22.7%). Laparotomic part of study was divided into two groups with preoperative application of GnRH analogues 44 patients (36,7 %) and control group OM with no application 44 patients (20.8%). The main outcome measures were peroperative blood loss, duration of surgery, the length of hospital stay, evidence of per- and postoperative complications and the final results by second look laparoscopy (SLL). RESULTS: In the observed group LM with pre-treatment of GnRh analogues there was significantly higher volume of blood loss (p = 0.0003), significantly longer duration of surgery (p = 0.0063) and significantly higher lenght of hospital stay (p = 0.0025) compared with control group. We have not found a significant difference in the incidence of peroperational converse to laparotomy, final result of neoformation of uterus wall and occurrence of postoperative adhesions by SLL in observed LM group compared with control group. In the observed OM group with pre-treatment of GnRH analogues there was no significant difference in: peroperative blood loss (p = 0.5324), duration of surgery (p = 0.3927) neither average length of hospital stay compared with control group. In the OM group, there was significantly lower incidence of recidives of uterine fibroids observed by SLL (p = 0.0025) and no significant difference of occurrence of postoperative adhesions compared with control group. We have not found significant difference in the incidence of peroperative complications, early and late postoperative complications in group of LM and OM in comparison with control groups. CONCLUSION: Application of GnRH analogues in observed group of patients before LM and OM have not lead to improvement of peroperative results in comparison with control group. Pre-treatment of GnRh analogues before OM have lead to significant drop in recidives of uterine fibroids observed by SLL (p = 0.0025) compared with control group.

Combination of fertility preservation strategies in young women with recently diagnosed cancer.

BACKGROUND/AIMS: The study describes clinical management and outcomes of currently available fertility preservation techniques in a set of 154 young female cancer patients. METHODS: Patients in reproductive age with newly diagnosed cancer were offered embryo or oocyte cryopreservation, ovarian tissue cryopreservation and the administration of GnRH analogues during chemotherapy. Particular attention was given to the technical aspects and clinical application of these fertility preservation techniques. RESULTS: During the study period (2004-2009), 154 young female cancer patients were offered fertility preservation counseling. Patient's average age was 29.4 years and average parity was 0.7 children. Administration of GnRH analogues (n = 123, 79.9%) and ovarian tissue cryopreservation (n = 15, 9.7%) were the most commonly used fertility preservation strategies. In 20 cases (16.1%), the combination of several fertility preservation techniques was offered to individually selected patients. CONCLUSIONS: Combination of fertility preservation techniques gives young cancer patients the best chance for future fertility and should be concentrated in specialized centers.

Prevention of ovarian function damage by a GnRH analogue during chemotherapy in Hodgkin lymphoma patients.

BACKGROUND: Frequent negative consequence of chemotherapy (CHT) is ovarian damage and premature ovarian failure (POF). Aim of this prospective case-control study is evaluation of GnRH analogue (GnRH-a) administration to patients with Hodgkin lymphoma (HL) during CHT and prevention of ovarian damage depending upon CHT regimen. METHODS: Study group consists of 72 patients in fertile age (18-35 years) with HL diagnosis treated in 2004-2005 by curative CHT together with GnRH analogue (Triptorelin) administration according to a standardized protocol. Patients were divided into three groups according to the stage of disease and treated by three types of CHT regimens (A,B,C) with increased cytotoxicity. Ovarian function of all patients was assessed by gonadotrophin levels (FSH, LH) analysis from peripheral blood before treatment and also 6 and 12 month after it. The number of women with POF after CHT in study group was compared with control group (n = 45, age 18-35 years) of patients treated in 2002-2003 according to the same protocol but without protective GnRH analogue application. RESULTS: In study group with GnRH analogue administration during CHT, there was significantly (P < 0.001) fewer cases with POF 6 and 12 month after the end of CHT (37.5% and 20.8%, respectively) than in control group (73.3% and 71.1%, respectively). Comparative analysis depending on cytotoxicity of CHT regimen used showed significant differences in percentage of patient with acquired POF between study and control group only in less aggressive CHT protocols. CONCLUSIONS: Study showed a significant reduction of ovarian failure risk in women with HL treated with less aggressive CHT regimens plus a GnRH analogue.

Ovarian tissue cryopreservation--new opportunity to preserve fertility in female cancer patients.

INTRODUCTION: Malignant disease and the therapy are major factors that may result in complete loss of fertility. There are several strategies for fertility preservation in fertile women faced with cancer. A modern and potentially effective method of reproductive function protection is ovarian tissue cryopreservation. MATERIALS AND METHODS: This paper summarizes the medical and scientific knowledge in this interesting multidisciplinary medical field. Furthermore, the authors' own experience with this novel and interesting method of ovarian tissue protection is presented. Ovarian tissue was obtained during laparoscopic surgery in five nuliparous women (aged 19-33) with a diagnosis of lymphoma before chemotherapy from 2004 to 2006. After laboratory preparation, tissue was frozen by a slow cooling technique and stored in liquid nitrogen. RESULTS: In total 75 women with malignant lymphoma before chemotherapy were referred to our center for consultation--68 chose ovarian inactivation by GnRH analogues during chemotherapy, two IVF cycles with embryo or oocyte cryopreservation and five ovarian tissue cryopreservation. In these five women one to two slices of ovarian cortex from both ovaries were recovered. Totally 20 cryotubes with three pieces of tissue in each were cryopreserved. In no case was metastasis of cancer cells found by histological evaluation. CONCLUSIONS: Cryopreservation of ovarian tissue represents an effective alternative or addition to the cryopreservation of embryos or oocytes for women at risk of premature ovarian failure due to chemotherapy. Reproductive function protection requires close cooperation between oncology departments and assisted reproduction centers.

[Ovarian tissue cryopreservation--an opportunity to preserve fertility in women with cancer]. / Kryokonzervace ovariální tkáne--sance na záchranu fertility zen s nádorovým onemocnením.

Chemoterapy is one of the basic modalities of oncological therapy and usually leads to permanent consequences. Infertility is one of the most common consequences resulting from irreversible gonadal damage. The potentially effective method of reproductive function protection in women undergoing chemotherapy is ovarian tissue cryopreservation. This paper summarizes the medical and scientific knowledge in this interesting multidisciplinary medical field an also presents authors own experience with this novel and interesting method of ovarian tissue protection.

[Evaluation of the ectopic pregnancies developed after in vitro fertilisation in the Center of Assisted Reproduction CAR 01 Brno between 1988-2006]. / Incidence ektopické gravidity po technikách in vitro fertilizace ve dvacetiletém klinickém materiálu Centra asistované reprodukce CAR 01 LF MU a FN Brno.

OBJECTIVE: To review prevalence and management of ectopic and heterotopic pregnancies developed after in vitro fertilisation and embryotranfer in the Center of Assisted Reproduction CAR 01 LF MU a FN Brno in a 20-year period. An analysis of their management and therapy. DESIGN: A retrospective analysis. SETTING: Obstetrics and Gyneacology Department, University Hospital Brno. METHODS: The collection of 1487 pregnancies arisen after IVF/ET cycles accomplished in the period of 1988-2006 in the Center of Assisted Reproduction CAR 01 Brno, in which the prevalence and the therapy of extrauterine and heterotopic pregnancies was observed. Also the therapeutic procedures of ectopic pregnancies and developement of heterotopic pregnancies were analysed. RESULTS: In the follow-up file the numbers of ectopic pregnancies was 84 from 1487 (5.65%) clinical pregnancies. Heterotopic pregnancy occured in seven cases (0.47%). Both ectopic and heterotopic pregnancy rate is higher than in a common population. From the seven heterotopic pregnancies two resulted in the delivery of the intrauterine pregnancy. From the total number of 84 ectopic pregnancies 68 (88.10%) resulted in laparoscpic salpingectomy as the therapy, only nine of them (11.90%) were treated conservatively with the tube preservation. CONCLUSION: Evaluation of the ectopic and heterotopic rate prevalence after assisted conception treatment in the Centre of Assisted Reproduction CAR 01 Brno in the period of 1988 - 2006 shows higher appearance of these complications in pregnancies, which origin is in IVF and ET as an infertility treatment.

[Analysis of factors affecting the results of assisted reproduction using a system for information mining of the SHLUK database]. / Analýza faktoru ovlivnujících výsledky asistované reprodukce pomocí systému pro dolování znalostí z databází SHLUK.

OBJECTIVE: To retrospective explorating computer analysis of data about therapeutic cycles in assisted reproduction technology (ART) to confirm applicability of system for data mining SHLUK in partial analysis of fertilisation phase of therapeutic cycle. Relations between parameters of sperm count analysis and outcome of in vitro fertilisation were analyzed. DESIGN: Retrospective analysis. SETTING: 1st Depart of Obstet. and Gynaecol., Masaryk University, Brno; FEI, VSB, Ostrava. METHODS AND MATERIAL: Conditions of successful therapy in single phases of ART therapeutic cycles, were analysed using system SHLUK, which included a lot of methods for data mining. Analysis of relation between reasons and results in ART therapeutic cycles was done through method IMPL and method of group implication GRIMPL. Analysed file included data about 8516 therapeutic cycles ART in 4470 patients and data about 666 clinical pregnancies stored in electronical form in clinical data register. The model analysis of fertilisation tested relations between parameters of sperm analysis and outcome of in vitro fertilisation. Fertilisation rate (FR)--ratio of fertilized oocytes/obtained oocytes was evaluated as fertilisation stage outcome. RESULTS: Significantly higher FR--60.9% was in the group with sperm concentration before preparation 41-60 mil/ml. When sperm concentration before preparation was under 10 mil/ml--FR was significantly lower--42.2%. Motility of sperm before preparation under 10%--FR was significantly lower--45.3%. Motility of sperm before preparation 41-50%--FR was significantly higher--56.9%. Significantly higher FR--minimal 56.0% was in group of examinations with sperm after preparation was 41-90%, then FR was significantly higher--53.5%. In sperm survival test, where more than 30% of sperm survive 24 hours of cocultivation with oocytes FR was significantly higher--minimal 55.9%. CONCLUSION: Applicability of system for data mining SHLUK in the analysis of factors with influence on assisted reproduction outcome was proved. System for data mining SHLUK makes possible to define statistically significant relations between attributes of fertilisation stage of ART cycles and it is able to postulate basic hypothesis about existing reasons and results in therapeutic cycles of ART.

[The National Register for Assisted Reproduction: results and analysis of complications]. / Národní registr asistované reprodukce: výsledky a analýza komplikací.

1. Analysis of achieved results of assisted reproduction provides evidence of a steadily increasing success of ART methods in the Czech Republic. 2. Analysis of results and complications makes it possible a) to prove optimal therapeutic procedures in different groups of patients b) to recommend preventive measures to avoid complications c) assess possible side-effects on women and the foetus.

[The effect of spasmolytics on dilatation of the uterine cervix]. / Vliv spazmolytik na dilataci delozní branky.

UNLABELLED: Spasmolytics and spasmoanalgetic mixtures are administered to facilitate dilatation of the cervix during delivery and to shorten the first stage of labour. This medication is used in 70% deliveries at the 1st Dept. of Obstetrics and Gynaecology Masaryk University in Brno. The aim of the study was to analyze the spasmolytic effect on the process of cervix dilatation. The study comprises 108 uncomplicated deliveries (52 deliveries with spasmolytics and 56 deliveries without). We analyzed the effect of spasmolytics on the cervix, process of labour and outcome of delivery. Six kinds of spasmolytics were used, administered from once to four times during labour and most of them (85%) in the latent phase of the first stage of labour. In the group with spasmolytics there was statistically insignificant by prolonged active phase of the first stage of labour (126 vs 104 minutes) and more frequent administration of Oxytocin. Others parameters such as length of the second stage of labour, rate of birth injuries, the 1st minute Apgar score less than 7 and the necessity of neonatal resuscitation did not differ in the two groups. CONCLUSIONS: The application of spasmolytics did not significantly affect the process of delivery.