[Specific placental complications of monochorionic diamniotic twins born after 24 weeks of pregnancies - restrospective analysis]. / Specifické placentární komplikace u monochoriálních biamniálních dvojcat porozených po 24. týdnu gravidity - retrospektivní analýza.

OBJECTIVE: Purpose of this study was to determine the frequency of occurence of specific complications of monochorionic diamniotic twins born after 24 weeks of pregnancies and the effect of these complications on perinatal morbidity and mortality. TYPE OF STUDY: Restrospective analysis. SETTING: Dpt. of Obstetrics and Gynecology Masaryk University and University Hospital Brno. METHODOLOGY: A retrospective analysis of 175 monochorionic diamniotic pregnancies (mo-bi), which were terminated after the 24th week of pregnancy at the Department of Obstetrics and Gynecology Masaryk University and University Hospital Brno between the years 2008-2013. The specific complications such as twin-to-twin syndrome (TTTs), twin anemia polycytemia sequens (TAPS), selective intrauterine growth restriction (sIUGR), twin-arterial revers perfusion sequence (TRAP), single intrauterine fetal death (IUFD), placental insufficiency with both twins were identified using prenatal ultrasound examinations, perinatal results and the result of pathological anatomical examinations. Perinatal morbidity, neonatal mortality and neurological development were evaluated. The numbers of late detections of specific complications were observed. RESULTS: Specific complications in our group were identified in 50 pregnancies (28.6%). TTTs was diagnosed most often, by 18 pregnancies (10.3%), next most frequent diagnosis were sIUGR (9.7%) and TAPS (3.4%). The placental insufficiency with both twins complicated 2.6% pregnancies. 10 children had abnormal neurological development. Pregnancies with late detection had the worst perinatal results. No acute TTTs during delivery was detected. CONCLUSION: Specific placental complication reached 29.7% in our file. The most frequent complication was TTTs (10.3%) and selective growth restriction (9.7%). Pregnancies with late diagnosis of these complications had the worst results. The prenatal care by monochorial biamnial pregnancies should be at specialized centres from the 16th week of pregnancy every two weeks.

[The influence of breach position of the second twinon perinatal outcomes in vaginal births of bichorial - biamniotic twins after 33rd week of gravidity]. / Vliv naléhání druhého dvojcete koncem pánevním na perinatální výsledky pri vaginálním vedení porodu bichoriálních biamniálních dvojcat po 33. týdnu gravidity.

OBJECTIVE: The objective is to evaluate whether a breach presentation of the second twin has an influence on the perinatal results in vaginal births of bichorial-biamniotic twins after 33rd week of pregnancy. DESIGN: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology, Masaryk University and University Hospital Brno. SAMPLE AND METHODS: The current study is a retrospective analysis of 695 vaginal births of bichorial-biamniotic twins after 33rd week of pregnancy. All births were conducted at the Department of Obstetrics and Gynecology, Masaryk University and University Hospital Brno during the span of 2004-2013. The sample was divided into2 groups. Group A consisted of 550 births of both twins in vertex presentation, group B consisted of 145 births in which the second twin happened to be in the breach presentation. The factors that have been evaluated include the percentage of births finished vaginally, perinatal results (pH a. umbilicalis below 7.0 and Apgar score in the 5th minute below 5) and early neonatal mortality and morbidity. Data from both groups have been compared with the use of Fishers exact test. RESULTS: For the group A, 81.3% of births were finished vaginally, as opposed to 85.5% in group B. Acute Caesarean sections conducted on the second twin consisted 4% (22 cases) in group A and 3.4% (5 cases) in group B. No significant difference has been found between the two groups in both perinatal results (p = 0.6 for pH from a. umbilicalis below 7.0 and p = 0.7 for Apgar score in the 5th minute below 5; both two-tailed) and in the frequency of early neonatal mortality and morbidity. In total,5 neonatal deaths have occured in 28 days after birth, out of which 2 have occured in group A and 3 in group B. CONCLUSION: It was concluded that breach presentation of the second twin does not influence perinatal results in vaginal births of bichorial-biamniotic twins. KEYWORDS: bichorial-biamniotic twins, vaginal birth, breach presentation, perinatal mortality, perinatal morbidity.

[Vaginal breech delivery after 36 week of pregnancy in a selected group of pregnancy - analysis of perinatal results in years 2008-2011]. / Vaginální vedení porodu koncem pánevním po ukonceném 36. týdnu gravidity u selektované skupiny tehotenství - analýza perinatálních výsledku let 2008-2011.

OBJECTIVE: To determine intrapartum mortality, neonatal mortality and serious neonatal morbidity in selected group of planed vaginal breech deliveries after 36 week of pregnancy. Compare vaginal breech deliveries with primary cesarean deliveries.Designe: Retrospective study. SETTINGS: Department of Obstetrics and Gynaecology, Masaryk University, University Hospital Brno; Department of neonatology, University Hospital Brno; Faculty of Economics and Management, University of Defence in Brno. METHODS: Retrospective analysis of 1013 births of singleton pregnancies with breech position of the fetus after 36 completed week of pregnancy at University Hospital Brno in the years 2008-2011. Vaginal delivery was planed for 430 women (42.4%). Elective caesarean section was performed in 583 women (57.6%). An assessment of intrapartum and neonatal mortality and serious neonatal morbidity and incidence of umbilical artery pH < 7.00. We also evaluated non-serious neonatal morbidity. RESULTS in the group of vaginal breech deliveries, including births completed by acute caesarean section, were compared with results in the group of elective caesarean sections. RESULTS: In the group of 430 women with planned vaginal breech delivery, 347 delivered vaginally (80.7%), by acute caesarean section 83 women (19.3%). In the group of planned vaginal births, including births completed by acute caesarean section, pH < 7.00 in umbilical artery occurred in 9 cases (2.1%). In the group of elective caesarean deliveries pH < 7.00 does not occurred. Death of the fetus during labor or before 28 day after birth does not occurred. A statistically significant difference in the incidence of serious neonatal morbidity between the group of planned vaginal births and births by elective caesarean section was found in Apgar score in 5th minute < 5 (2 versus 0), peripheral nerve injury persisting at discharge (2 versus 0) and admission to the neonatal intensive care unit for longer than 24 hours (2 versus 10). When comparing all cases of serious neonatal morbidity between the two groups, the difference was not statistically significant (1.2% versus 1.9%, NS). CONCLUSION: When strict criteria are met during selection of women appropriate for vaginal breech delivery and during labor, planned vaginal breech delivery at term is save option. The incidence of severe neonatal morbidity when compared with elective caesarean section is not increased. KEYWORDS: breech presentation, vaginal delivery, caesarean section, neonatal morbidity, neonatal mortality.

Brain-derived neurotrophic factor and ciliary neurotrophic factor in maternal plasma and umbilical cord blood from pre-eclamptic and physiological pregnancies.

The aim of the study was to investigate the circulating levels of ciliary neurotrophic factor (CNTF) and brain-derived neurotrophic factor (BDNF) in maternal serum and umbilical cord blood from respective pregnancies in pre-eclampsia (PE) cases and a control cohort. A total of 12 pre-eclampsia cases and 34 healthy controls were enrolled and the maternal peripheral blood - umbilical cord blood duos, were examined for BDNF and CNTF levels. BNDF levels were significantly higher in umbilical cord blood from pre-eclamptic pregnancies; there was also significant difference between maternal plasma and umbilical cord blood levels of BDNF (p < 0.001) in the controls. The CNTF levels in umbilical cord blood (CNTF-UCB) were significantly higher in PE cases than in the controls (p = 0.03). Significant differences were observed in expression of BDNF and CNTF proteins in maternal peripheral blood and umbilical cord blood between pre-eclampsia cases and healthy controls.

[Laparoscopically assisted neovagina formation--updated Vechieti surgery]. / Laparoskopicky asistovaná neoplastika pochvy podle Vecchiettiho.

UNLABELLED: AIMS OF THE WORK: To evaluate the file o patients operated for the agenesis of uterus and vagina by laparoscopic assisted neoplastic of vagina according to Vecchietti. TYPE OF THE STUDY: Original study. SETTING: Gynecologic-Obstetrics Dpt, Medical Faculty of Masaryk University and University Hospital, Brno. MATERIALS AND METHODS: The study included 13 patients operated from September 2000 until April 2011. The patients were operated for the agenesis of the uterus and vagina by laparoscopic assisted neoplastic of vagina with gradual retraction of the special "olive" into the retrovesical space. RESULTS: All of the operations were performed without any serious complication. The retraction of the olive was done once in 2 to 3 days. The dilatation period varied between 10 to 14 days. The length of the vagina, after removing the olive, was 8 to 10 cm. During examination, 2 to 4 months later, the length of the neovagina varied from 8 to 10 cm. During later follow-up controls, 11 patients reported regular sexual intercourse with which they were satisfied. CONCLUSION: This operation technique enables patients, with undeveloped vagina, satisfactory sexual life. Our results are comparable to the ones of the other authors.

[Adrenocorticotropin hormone--possible marker of pregnancy pathologies]. / Kortikotropin-releasing hormon a adrenokortikotropní hormon--mozné markery nekterých tehotenských patologií.

Adrenocorticotropin hormone (ACTH) is produced from the anterior pituitary gland and can be considered as one of the main elements of the hypothalamic-pituitary-adrenal axis. ACTH secretion is controled by corticotropin-releasing hormone (CRH) from hypothalamus. ACTH stimulates the adrenal cortex. It's affects synthesis and releasing of glucocorticoids, precursors of aldosterone, which affects the synthesis of mineralocorticoids. Preeclampsia and intrauterine growth retardation (IUGR) is one of the major pregnancy pathologies. The aetiology of these states are not clearly known, it is assumed that factors pathogenetic chain has been operating in early pregnancy. These factors are generally similar for both diseases. It is assumed that these pathologies will activate the hypothalamic-pituitary-adrenal stress axis both for mother and fetus. In research studies, mathernal plasma CRH concentrations are elevated in complicated pregnancies. Etiopathogenesis of severe pregnancy pathologies such as IUGR, or preeclampsia is still unclear. Therefore, the research focuses on finding new markers that contribute to early diagnosis of serious states.

[Vaginal birth after previous caesarian section--outcomes analysis 2007-2010]. / Vedení porodu po predchozím císarském rezu, analýza výsledku z let 2007-2010.

OBJECTIVE: Analysis of births after previous caesarean section (SC) at Department of Obstetrics and Gynaecology, Masaryk University, Brno. Determination of successful vaginal deliveries after previous SC (complete vaginal birth) and the factors that influence success. Risk identification and determination of the frequency of complications. Comparison of vaginal births after previous SC (VBAC) with elective repeat caesarean section (ERCS). MATERIALS AND METHODS: Retrospective analysis of 24,342 births, which were conducted in 2007-2010 at Department of Obstetrics and Gynaecology, Masaryk University, Brno. For the reporting period a total of 1391 pregnant women with a history of caesarean section gave birth (100.0%). The distribution of births after previous caesarean section into 2 groups according to a method of delivery. Trying to line vaginal birth (VBAC) with 986 mothers (70.9%). Elective repeat caesarean section (ERCS) was performed in 405 mothers (29.1%). Analysis and comparison of results in both groups. RESULTS: The overall success of VBAC (complete vaginal births after previous SC) in our group reached 80.8%. When evaluating the success of the subgroups was the strongest positive predictive factor the onset of spontaneous contractile activity (89.5% success rate) and vaginal delivery in history (88.2% success rate). The most significant negative predictive factor was a history of previous caesarean birth because of failure mechanism of birth (success rate 72.0%). The most common complication in both groups VBAC and ERCS group was blood loss (5.1% versus 2.0%, p = 0.045). Detection of dehiscence at the previous uterotomy (0.4% versus 0.5%, NS). In our group has been reported no case of uterine rupture. The frequency of postpartum hysterectomy was comparable in both groups (0.3% versus 0.5%, NS). In both groups, VBAC and ERCS was reported one case of bladder lesion, as surgical complications during the acute or planned caesarean section. No maternal or fetal death in relation to birth in our cohort occurred. CONCLUSION: Vaginal birth after previous caesarean section is a safe way of delivery in selected groups of mothers. An essential requirement is careful monitoring during labor to the exclusion of excessive uterine activity and protracted labor.

Rocuronium versus suxamethonium for rapid sequence induction of general anaesthesia for caesarean section: influence on neonatal outcomes.

BACKGROUND: In a previous study we compared rocuronium and suxamethonium for rapid-sequence induction of general anaesthesia for caesarean section and found no difference in maternal outcome. There was however, a significant difference in Apgar scores. As this was a secondary outcome, we extended the study to explore this finding on a larger sample. METHODS: We included 488 parturients of whom 240 were women from the original study. Women were randomly assigned to receive either rocuronium 1mg/kg (ROC n=245) or suxamethonium 1mg/kg (SUX n=243) after propofol 2mg/kg. Anaesthesia was maintained with up to 50% nitrous oxide and up to one minimum alveolar concentration of sevoflurane until the umbilical cord was clamped. We compared neonatal outcome using Apgar scores and umbilical cord blood gases. RESULTS: Data were analysed for 525 newborns (ROC n=263vs. SUX n=262). There was a statistically significant difference in the proportion of Apgar scores <7 at 1min (ROC 17.5% vs. SUX 10.3%, P=0.023) but no difference at 5min (ROC 8% vs. SUX 4.2%, P=0.1) or 10min (ROC 3.0% vs. SUX 1.9%, P=0.58). There was no difference between groups in other measured outcomes. CONCLUSION: The use of rocuronium was associated with lower Apgar scores at 1min compared with suxamethonium. The clinical significance of this is unclear and warrants further investigation.