[External cephalic version of breech fetus after 36 weeks of gestation - evaluation of efectiveness and complications]. / Obrat plodu zevními hmaty z polohy podélné koncem pánevním po 36. týdnu gravidity - hodnocení úspesnosti a komplikací.

OBJECTIVE: Evaluation of success rate and the safety of external cephalic version after 36 weeks of gestation. DESIGN: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno. METHODS: A retrospective analysis of external cephalic version attempts performed on a group of 638 singleton breech pregnancies after 36 weeks gestation in the years 2003-2016 at the Department of Gynecology and Obstetrics, Masaryk University, Brno. The effectiveness, number and type of complications, mode of delivery and perinatal result were observed. RESULTS: The effectiveness of external cephalic version from breech to head presentation was 47.8% (305 cases). After a successful external cephalic version 238 patients (78.0%) gave birth vaginally. After unsuccessful cephalic version 130 patients (39.0%) gave birth vaginally. The number of serious complications did not exceed 0,9% and did not affect perinatal outcomes. External cephalic version-related emergency cesarean deliveries occurred in 6 cases (2 placental abruption, 4 abnormal cardiotocography). The fetal outcome was good in all these cases. The death of the fetus in connection with the external version has not occurred in our file. Spontaneous discharge of amniotic fluid within 24 hours after procedure occurred in 5 cases (0.8%). The spontaneous onset of labor within 24 hours of procedure occurred in 5 cases (0.8%). The pH value of a. umbilicalis < 7.00 occurred in 2 cases in the group with a successful external version and in the group with unsuccessful external version in 9 cases. The Apgar score in the 5th minute < 5 was both in the successful and unsuccessful group in 1 case. CONCLUSION: The external cephalic version of the fetus in the case of breech presentation after the 36th week of pregnancy is an effective and safe alternative for women who have a fear of the vaginal breech delivery. Performing the external cephalic version can reduce the rate of elective caesarean sections due to breech presentation at term.

[Sexual morbidity of cervical carcinoma survivors]. / Sexuální morbidita pacientek po lécbe karcinomu delozního hrdla.

OBJECTIVE: We are aware that patients with cervical carcinoma in the Czech Republic are poorly informed about sexual aspects of their therapy and there is also very poor attention paid to this problem in the Czech literature. Therefore we decided to evaluate the situation in a group of patients from our department using our own questionaire. We compared our results with contemporary world literature. DESIGN: Questionnaire survey, comparison with world literature. SETTING: Department of Gynecology and Obstetrics, Jihlava Hospital. METHODS: Analysis of group of 25 patients with invasive cervical carcinoma, who had undergone radical hysterectomy, radiotherapy or both between 2009 and 2015. Patients were asked retrospectively using our own questionaire. CONCLUSION: Worldwide, the care of these patients is focusing also on their sexuality after therapy and various studies concentrate for several years on sexual morbidity in relation with performed therapeutic modality - radical hysterectomy or radiotherapy. Our group confirmed the worldwide results, mainly the lack of sexual interest and vaginal dryness, especially in women treated with radiotherapy. Also very poor knowledgeableness of the patients was confirmed.

[Peripartal life-threatening hemorrhage - interdisciplinary consensus opinion]. / Peripartální zivot ohrozující krvácení - mezioborové konsenzuální stanovisko.

22 experts from the fields of gynecology and obstetrics, anesthesiology and resuscitation, intensive care, hematology and transfusion medicine has developed recommendations for diagnosis and procedure for life-threatening peripartum haemorrhage, which is still one of the most common causes of maternal mortality in childbirth. This guidelines, which is valid for the Czech Republic, supported by a total of 10 professional medical societies. There are based on new knowledge applicable at this time and is focused mainly on eliminating the most common causes of bleeding during delivery and prevention of haemorrhagic shock.

[Analysis of uterine ruptures in Vysocina region in 5 years period]. / Analýza dlozních ruptur v kraji Vysocina v petiletém období.

OBJECTIVE: To evaluate the number and circumstances of uterine ruptures in five years period from 2005 to 2009 in five regional departments of gynecology and obstetrics of Vysocina region. To describe the uterine ruptures in case reports and to compare them with literature datas. DESIGN: Retrospective, multicenter, descriptive study. SETTING: Jihlava, Havlíckuv Brod, Pelhrimov, Nové Mesto na Morave and Trebíc departments of gynecology and obstetrics. METHODS: Retrospective data collection, statistical evaluation, case description and the system leading to prevention of uterine ruptures. RESULTS: In the evaluated period from 2005 to 2009 there were 25,195 deliveries in the 5 above mentioned departments of gynecology and obstetrics of Vysocina region. There were 4440 (17.6%) C. sections performed, 20 postpartum hysterectomies and 6 uterine ruptures (1/4200 deliveries). One case of uterine rupture was letal. CONCLUSION: The above mentioned results prove that the frequency of uterine ruptures in the Vysocina region (1/4200) is lower than in US (1/1519). Early diagnosis of uterine rupture is very often difficult, that may lead to the delay of adequate treatment.

[Role of ST-analysis of fetal ECG in intrapartal fetus monitoring with presumed growth retardation]. / Význam ST-analýzy fetálního EKG pri intrapartálním monitorování plodu s predpokládanou rustovou retardací.

OBJECTIVE: Evaluation of the role of ST analysis of fetus ECG for early detection of developing acute hypoxia in the course of delivery of fetuses with presumed growth retardation. A comparison with present way of intrapartal fetus monitoring. Impact on the number of surgical births for indications of threatening fetus hypoxia. Influence of the method on perinatal results and postnatal adaptation of the newborns. TYPE OF STUDY: A prospective study. SETTING: Gynecology-Obstetrics Clinic, Masaryk University and Teaching Hospital Brno. METHOD: Forty seven women with a growth retardation of the fetus diagnosed before delivery who gave birth in the Teaching Hospital in Brno during 2003-2005 and intrapartal ST analysis of fetus ECG was subsequently used, were enrolled into this prospective study (group A). The control group consisted of 87 deliveries taking place in the same period of time and concerning women with fetuses suffering from growth retardation and monitored by standard methods (group B). The standard methods included cardiotocography (CTG), supplemented with pulse oximetry (IFPO) if needed. The diagnosis of intrauterine fetus growth retardation was established on the basis of the results of repeated prepartal ultrasound fetus biometry with estimation of the mass, which corresponded to a group below 10 percentile for the given gestational age. The numbers of vaginal deliveries and surgically treated delivery due to threatening fetus hypoxia (Cesarean section, forceps delivery) were recorded. The authors evaluated postpartal pH from umbilical artery, independently for the group of values of pH < 7.00, the group of pH 7.00-0.10 and pH 7.10 or more. The values of Apgar score were evaluated for the first, fifth and tenth minute, respectively. The neonatologist followed the duration of stay of the newborn at the Newborn Intensive Care Unit, the Intermediate Care Unit, total duration of hospitalization, the occurrence of sepsis in the early newbotn period, the occurrence of hyperbilirubinemia, and the conclusion of neurological examination. All the results were evaluated statistically by the chi2 test, Kruskal-Wallis test or the Anova method. RESULTS: There was no statistically significantly difference in the number of delivery ended by surgery for threatening fetus hypoxia (p = 0.856) or the detection rate of intrapartal hypoxia according to pH values of umbilical blood divided into the three groups (p = 0.657, p = 0.958, p = 0.730, respectively). The values of Apgar score differed in favor of the group A significantly only in the first minute at the level of 5% opf significance (p = 0.018). The values of Apgar score in the fifth and tenth minute did not show any significant difference (P = 0301 and p = 0313, respectively). There was no statistically significant difference in neonatological results between the group A and B. CONCLUSION: The use of ST analysis of fetal ECG in the course of delivery of fetuses with presumed intrauterine growth retardation did not show any significant difference from the presently used methods (CTG supplemented with IFPO if needed). In using the method there was not any effect on the number of surgically treated deliveries for indications of threatening acute fetus hypoxia or perinatal results and postnatal adaptation of the newborns.

[ST analysis of fetal ECG in premature deliveries during 30th-36th week of pregnancy]. / ST analýza fetálního EKG u predcasných porodu ve 30.-36. týdnu tehotenství.

OBJECTIVE: To determine the possibilities of ST analysis of fetal ECG (STAN) in premature deliveries between 30th to 36th week of pregnancy. To compare the results of a group of premature deliveries monitored by ST analysis with a control group of premature deliveries monitored by means of cardiotocography (CTG) and intrapartum fetal pulse oxymetry (IFPO). TYPE OF STUDY: A prospective study. SETTING: Department of Gynecology-Obstetrics, Masaryk University and Faculty Hospital Brno. METHODS: The authors evaluated 39 women with premature delivery between 30th and 36th week of pregnancy from a total cohort of 239 high-risk pregnant women, who had been monitored by means of ST analysis of fetal ECG. The control group included 229 pregnant women who gave birth between 30th and 36th week of pregnancy under the monitoring with CTG and IFPO. The allocation into individual groups was at random order. The authors evaluated the duration and way of termination of delivery, pH in arterial umbilical blood, Apgar score in the first, fifth and tenth minute, total duration of hospitalization, necessity and duration of stay at the Neonatologic Intensive Care Unit, Intermediatry Intensive Care Unit, the presence of sepsis, hyperbilirubinemia and neurological state of the newborn. The statistical analysis was performed by means of the Fisher's exact test, Kruskal-Wallis test, chi2 test and the parametric test Anova. RESULTS: Almost none of the observed parameters in both categories of premature deliveries (STAN vs. CTG+IFPO) exhibited a statistically significant difference except a mild neurological affection of the newborn. In the group of premature deliveries monitored by ST analysis there are only 33.3% of newborns with signs of light neurological damage as compared with the control group, where 56.3% subjects were so affected (p<0.01). CONCLUSION: It has become obvious that the ST analysis of fetal ECG in premature deliveries between 30th and 36th week of pregnancy provides the same results as the so far used monitoring by CTG and IFPO. In the group of premature deliveries monitored by the ST analysis, there were significantly less frequent neurological disturbances.

[Continuous monitoring of fetal oxygen saturation (FSpO2) using intrapartum fetal pulse oximetry (IFPO) in the diagnosis of acute fetal hypoxia]. / Prínos kontinuálního monitorování kyslíkové saturace plodu (FSpO2) pomocí intrapartální fetální pulzní oxymetrie (IFPO) k diagnostice akutní hypoxie plodu.

OBJECTIVE: The aim of the study was to evaluate the possibility of lowering the Caesarean Section rate in patients presenting the signs of intrauterine hypoxia on CTG tracing by evaluating the foetal oxygen saturation (FSpO2) by means of intrapartum foetal pulse oximetry (IFPO). DESIGN: Open prospective study. SETTING: 1st Department of Gynecology and Obstetrics, Medical Faculty of Masaryk University, Brno. METHODS: From January 1, 1999 to December, 1999 68 patients were enrolled in the study. For the application of the IFPO sensor the patient had to meet the following criteria: patient's informed consensus, pregnancy > or = 36 weeks, regular uterine contractions, rupture of membranes, cervical dilatation of > or = 2 cm, singleton pregnancy, cephalic occiput presentation, no sings of vaginal infection, acute foetal hypoxia on CTG tracing: (baseline heart rate < 100 beats/min of different patterns. Progressive bradycardia: baseline heart rate gradually decreases between contractions (DIP II, DIP 0). Persisting bradycardia, baseline < 80 beats/min. Baseline tachycardia (> 150 beats/min) with reduced variability and/or severe variable (DIP 0) and late decelerations (DIP II). The IFPO used--Nellcor N-400. In all patients that fulfilled the above mentioned criteria during the first stage of labor the sensor was applied preferably on the posterior cheek of the foetus and the FSpO2 values were continuously monitored up to the complete dilatation. The threshold of the intrapartum foetal hypoxia (FSpO2 values) was considered < 30% for more than 10 minutes. In cases of normal FSpO2 values the delivery was conducted vaginally even if the CTG tracing continued to signalise++ intrauterine hypoxia. In case of pathologic FSpO2 values, Caesarean Section was performed. RESULTS: IFPO is an easy feasible method and in all cases the values of FSpO2 were obtained. The method has no serious side effects neither in the mother nor in the foetus. Nevertheless the presence of the sensor in the uterine cavity provokes often unpleasant feelings and limits the mother in free movements. In all suspicious CTG tracings (17) no Caesarean Sections were performed after the verification of the foetal hypoxia by means of FSpO2 evaluation. In 51 patients a pathologic CTG tracing indicating the performance of Caesarean Section was present. After FSpO2 evaluation the Caesarean Section was performed only in 11 (21.6%) patients. The remaining 40 (78.4%) delivered vaginally. Between these two groups there was statistical difference in the values of FSpO2 and postpartum cord pH. The state of newborns evaluated according to the Apgar score did not significantly differ in the two groups. CONCLUSION: These preliminary results indicate that taking in an account foetal SpO2 evaluated by IFPO in the 1st stage of labor in cases of pathologic CTG tracing (late and variable deceleration) indicating Caesarean Section, > 50% of these may be saved with identical perinatal outcome (Apgar scores, cord pH).

[Effect of maternal O2 inhalation on oxygen saturation in the parturient (SpO2) and the fetus (FSpO2)]. / Vliv inhalace O2 matkou na hodnoty kyslíkové saturace rodicky (SpO2) a plodu (FSpO2).

OBJECTIVE: The aim of the study was to evaluate the impact of different concentrations of inspirated O2 on the SpO2 values of the foetus and the mother during the 1st and 2nd stages of labor. DESIGN: Prospective study. SETTING: 1st Department of Gynecology and Obstetrics, Medical Faculty of Masaryk University, Brno. METHODS: 17 non-risk patients were enrolled in the study. The SpO2 levels of the mother and the foetus were monitored simultaneously in 10 min intervals with the room air inspiration entrainment O2 mask and the inflatable face mask during 1st and 2nd stages of labor. RESULTS: No changes in maternal SpO2 values were revealed in the three different O2 inspiration regimens neither in the 1st, nor in the 2nd stages of labor. The mean value was 98% +/- 1.6 SD. As for the foetus the SpO2 values were increased by 6% (+/- 7.9 SD) after 40% concentration of O2 and 7.7% (+/- 8.8 SD) after 98% O2 inspiration during the 1st stage of labour. These values have decreased promptly after the cessation of the O2 inspiration. The mean SpO2 values at room O2 concentration were 46.3% +/- 7.9 SD for the 1st stage of labor and 43.7% +/- 4.8 SD for the 2nd stage of labor. CONCLUSION: The O2 inspiration during the labor has no impact on the maternal SpO2 values but increases the SpO2 values of the foetus during the 1st stage of labor. We were not able to evaluate the impact of the O2 inspiration on foetal SpO2 values during the 2nd stage of labor.

[Validity of cardiotocography in acute fetal hypoxia--neonatal status after cesarean section]. / Validita kardiotokografie pri akutní hypoxii plodu--stav novorozencu po císarském rezu.

OBJECTIVE: Judging the validity of CTG monitoring as a method of acute foetal hypoxia diagnosis (AFH), quantifying the number of cesarean section (SC), performed from the indication of acute fetal hypoxia and point out a number of surgeries based on false positive CTG results. DESIGN: Retrospective study. SETTING: 1st Department of Obsterics and Gynaecology Faculty of Medicine MU, Brno. METHODS: 100 women, patients of the 1st Department of Obstetrics and Gynaecology in Obilní trh, Brno, who had cesarean section due to foetal hypoxia indicated on the base of pathological or suspect CTG, were involved in the collection. In the next stage newborns were divided into 2 clinical groups: "Acidosis" and "Normal" depending on the pH value from a. umbilicalis and statistically analysed. RESULTS: From 100% suspect or pathological CTG, only 36.19% were valid (newborns showed depression after birth). Remaining 63.18% of newborns, although showed CTG signs of hypoxia were born normal and probably were not necessary to be born by cesarean section. CONCLUSION: Although CTG investigation is in most places the only "objective" method for diagnosis of AFH, this investigation cannot precisely determinate whether hypoxia is present or it is not. For true objectivity of foetal intrauterine condition and correct indication of SC is suitable to use further diagnostic methods of AFH in future, for example intrapartal foetal pulse oximetry or blood analysis from foetal scalp.

[Prenatal induction of lung maturation in the fetus. Betamethasone versus betamethasone+thyrotropin-releasing hormone]. / Antenatální indukce plicní zralosti plodu. Betametazon versus betametazon+tyrotropin releasing hormon.

During the period from May 1, 1994 till December 31, 1997 at the First and Second Departments of Gynaecology and Obstetrics Masaryk University Brno 311 neonates with birthweights from 500 to 2000 g were born. A retrospective study was made comparing neonatal results of three methods of prenatal induction of maturing of surfactant in premature neonates. The first group was without treatment, in the second group only betamethasone was administered and in the third group betamethasone and thyrotropin releasing hormone (TRH). The neonates were divided into three body weight groups: 500-999 g, 1000-1499 g and 1500 g and more. The most favourable results with administration of betamethasone and TRH were obtained in the group weighing 500-999 g. This pertained to the smaller number of post-partum administration of surfactant, reduction of the oxygenation index and period of artificial pulmonary ventilation. IVth grade RDS and other complications in the child. In the group of neonates weighing 1000-1499 g administration of betamethasone and TRH had a positive effect only on the oxygenation index and grade of RDS. In the group of neonates with weights above 1500 there were no statistically significant differences between the described three groups. It may be concluded that the greatest effectiveness was achieved by a combination of betamethasone and TRH in neonates weighing 500-999 g, this combination was less effective in the group weighing 1000-1499 g and without effect in those weighing 1500 g or more.