[Does the asymptomatic carriage of FV Leiden and FII prothrombin in heterozygous configuration represent the increased risk of thrombembolic complications during pregnancy, childbirth and postpartum?]. / Predstavuje asymptomatické nosicství mutace FV Leiden a FII protrombin v heterozygotní. Konfiguraci zvýsené riziko trombembolických komplikací v prubehu tehotenství, porodu a sestinedelí?

OBJECTIVE: To evaluate the course of pregnancy and puerperium in asymptomatic carriers of FV Leiden and FII prothrombin mutation in heterozygous configuration in terms of risk of thrombembolic disease and late pregnancy complications. To evaluate whether global prophylactic LMWH administration already during pregnancy has brought some benefit to these women. TYPE OF STUDY: Prospective study. METHODS: From June 2007 to June 2011, we monitored the incidence of thrombembolic events (TED) and severe late pregnancy complications in 473 asymptomatic carriers of FV Leiden and FII prothrombin mutation in heterozygous configuration. We also compared the ongoing changes of commonly clinically available hemocoagulation tests. In selected women, we added to coagulation tests a thrombin generation test (TGA) and thrombin-antithrombin test (TAT). In 253 women (Group A), preventive LMWH application was introduced already during pregnancy. In 220 women (Group B), the application of LMWH was commenced as late as on the delivery day. In both groups application of LMWH continued during the puerperium. RESULTS: The incidence of TED in the whole group of carriers of thrombophylic mutations accounted for 0.19%. The incidence of severe late pregnancy complications was very low - 3%. Medians of the monitored parameters of the hemocoagulation in compared groups and 'healthy' controls did not show statistically significant differences at any stage of pregnancy, labor or end of puerperium, with the exception of the results of TAT test at the end of puerperium. CONCLUSIONS: No direct causal relationship has been established between asymptomatic carriage of Leiden and prothrombin mutation in heterozygous configuration and the occurrence of severe late pregnancy complications. These types of mutation represent only a slightly increased risk in terms of development of thrombophylic events. General LMWH prophylaxis during pregnancy is not indicated. However, individual careful monitoring of hemocoagulation changes and early detection of associated transient situations potentiating risk of thrombembolic events is desirable. Statistically significant differences in the TAT results between group A and B at the end of puerperium revealed that the recommended extended LMWH prophylaxis until the end of puerperium was not followed by a number of women who started the prophylaxis on the date of labor.

[Thrombophilic mutation by women with serious pregnancy complications]. / Výskyt trombofilních mutací zen se závaznými tehotenskými komplikacemi.

OBJECTIVE: The purpose of this study was to determine whether maternal or fetal genotype frequencies of the inherited thrombophilic gene mutation (F V Leiden, F II) are altered in adverse pregnancy outcomes - severe preeclampsia, IUGR, abruption of placenta and stillbirth. DESIGN OF THE STUDY: Retrospective study. SETTING: Department of Gynecology and Obstetrics of the Teaching Hospital and the 2nd Medical Faculty of the Charles University in Prague. METHODS: We studied 232 women who had pregnancy complications. All women were tested postpartum for mutation of factor V Leiden and G20210A prothrombine gene. At the same time were tested the newborns of those women. RESULTS: In the group of women with preeklampsia (n=141) we have demonstrated 5 women with mutation encoding for F V, 5 women with mutation encoding for F II and 1 combination of both. In the group of IUGR 2 women with mutation F V, 1 with mutation F II a 1 combination of both were found. In women after stillbirth occure two mutation of F V, one mutation of F II and one combination of both. In the group with abruptio of placenta was 1 case of mutation F V and 3 cases of mutation F II. When we tested a newborn we found 4 cases of mutation F V and 3 cases of F II in the group with preeclampsia, 4 cases of mutation F V 3 cases od mutation of F II in the group with IUGR, no case in the group with abruptio of placenta and 1 case in a death fetus. There was no assotiation between any severe pregnancy complications and any of the maternal or fetal inherited thrombophilia. CONCLUSION: Factor V Leiden and prothrombin gene mutations did not seem play a significant role in adverse pregnancy outcome in our population.

[Use of psychoactive substances and risk sexual behavior]. / Vede uzívání psychotropních látek k rizikovému sexuálnímu chování?

OBJECTIVE: Present influence of illicit drug and alcohol on risk sexual behavior of young women in Prague and Central Bohemia. DESIGN OF THE STUDY: Prospective study. SETTING: Department of Gynecology and Obstetrics, Teaching Hospital and 2nd Medical Faculty of Charles University in Prague. METHODS: The study participants were 400 sexual active women between 16 and 35 years of age living in Prague and Central Bohemia. All participants were asked via questionnaire illicit drugs and alcohol experience, number of sexual partners, sexual behavior and use condom. RESULTS: Women using illicit drugs or alcohol had higher number of sexual partners. 1/3 said that drinking or drug use has influenced their decisions about sex and sexual behavior and unprotected sex. CONCLUSION: Use of psychoactive substances including alcohol influence negative sexual behavior. Cause escalated sexual activity and promiscuity, more frequently have risk and unprotected sex.

[Nalbuphine at maternal analgesia]. / Vyuzití nalbuphinu v porodnické analgezii.

OBJECTIVE: Comparison between particular methods of obstetrics analgesia, their analgetic efects and influence on progress of delivery and postpartum adaptation of fetus. DESIGN OF THE STUDY: Prospective study. SETTING: The Department of Gynecology and Obstetrics of the Teaching Hospital and the 2nd Medical Faculty of the Charles University in Prague. METHODS: A prospective study of 644 patients who received intravenous increments of nalbuphine (196 women) or epidural analgesia (217 women) or pethidin (231 women). Assessment of maternal analgesia, satisfaction was carried out. Apgar scores and resuscitative measures required for the neonate were noted at delivery. RESULTS: The best analgetic effect was in the group with using peridural analgesia, where max. score was 3. The highest value was in the group of women who received pethidin. The most decrease of score after aplication of analgesia was in group with epidural analgesia, the least decrease of score was in group with pethidin. The Apgar score at 1. minute was the lowest in the group with epidural analgesia, the highest score was in the group with nalbuphine. CONCLUSION: The mixed agonist/antagonist narcotic analgesic like nalbuphine have the place in clinical practice. The obstetric analgesia is very common in obstetrics practice. The epidural analgesia is very popular but not everytimes accessible. Nalbuphine is the option who is analgetic effective and have minimal side-effect.

[The effect of substitution therapy on the birth weight of the newborn, its postpartum adaptation, trophic and course of the neonatal abstinence syndrome]. / Vliv substitucní terapie na porodní hmotnost novorozence, poporodní adaptaci, trofiku a prubeh abstinencního syndromu novorozence.

OBJECTIVE: Evaluation of the effect of substitution therapy on the birth weight of the newborn, its postpartum adaptation and course of the neonatal abstinence syndrome. DESIGN OF THE STUDY: A three-year prospective study. SETTING: The Department of Gynecology and Obstetrics of the Teaching Hospital and the 2nd Medical Faculty of the Charles University, Prague. METHODS: This prospective study was carried out in the period of 2005-2007. Included in the study were heroin-addicted pregnant women and pregnant women who undergoing methadone and buprenorphine substitution therapy. During the 3 years we followed-up 47 heroin-addicted women and 60 women under substitution therapy for prenatal screening. Of this number, 36 pregnant women were methadone-substituted and 24 buprenorphine-substituted. Individual groups were compared using the Kruskal-Wallis ANOVA test. Correlation of dichotomic variables was evaluated by means of longlinear models. Calculations were done by means of NCSS 2002 statistical software (Number Cruncher Statistical Systems, Kaysville, UT, USA). RESULTS: Statistically birth weight of newborns was significantly lowest in the group of heroin-addicted women as compared to the group receiving substitution with buprenorphine p<0.01 and as compared to the group of methadone-substituted patients p<0.05. Having monitores changes in the placenta the statistically highest number of changes was exhibited by heroin users, both when compared to methadone users (p<0.01) and buprenorphine users (p<0.001). The highest statistically significant number of newborns with IUGR symptoms were born to heroin-addicted women. The lowest Apgar score was recorded in all three evaluations in the group of buprenorphine users and the highest in methadone-substituted women. CONCLUSION: Substitution therapy provides pregnant women with the possibility of social stabilization, adaptation, and adequate prenatal care. With regard to the fact that methadone substitution protracts the newborn's abstinence syndrome, attention has been recently focused on substitution with buprenorphine that seems to be a more considerate option, from this point of view.

[Socioeconomic datas, the course of pregnancy and delivery in opioid-addicted women and women under substitution therapy]. / Socioekonomická data, prubeh tehotenství a porodu u zen záivislých na opioidech a na substitucní terapii.

OBJECTIVE: Mapping of the socioeconomic background of opioid-addicted pregnant women and women included in substitution therapy. Determination of the effect of substitution on the course of pregnancy and delivery in drug-addicted pregnant women. DESIGN OF THE STUDY: A three-year prospective study. SETTING: The Department of Gynecology and Obstetrics of the Teaching Hospital and the 2nd Medical Faculty of the Charles University Prague. METHODS: During the 3 years we followed-up 47 heroin-addicted women and 60 women under substitution therapy for prenatal screening. Of this number, 36 pregnant women were methadone-substituted and 24 buprenorphine-substituted. All women were screened for socioeconomic indicators, for duration of pregnancy, weight gain during pregnancy, number of visits in the prenatal centre, complications associated with intravenous application of drugs and the way of delivery. Individual groups were compared using the Kruskal-Wallis ANOVA test. Correlation of dichotomic variables was evaluated by means of longlinear models. Calculations were done by means of NCSS 2002 statistical software. RESULTS: Statistically, the age of heroin-dependent women is significantly lower as compared to women receiving substitution therapy. Unemployment was statistically significantly higher in the group using heroin as compared to both groups of women receiving substitution therapy (p < 0.001). Attending the prenatal centre were all buprenorphine-substituted women, 14 of 44 heroin-addicted women and 32 of 36 methadone-ubstituted women. Statistically no significant difference was found when comparing duration of pregnancy of heroin-addicted women and the buprenorphine- or methadone substituted women. Weight gain during pregnancy was statistically significantly higher in the buprenorphine users as compared to the heroin users (p < 0.01) as well as with the methadone users (p < 0.05). CONCLUSION: Clients in substitution programme stabilized in the long run often start to work, complete their education and are able to be involved in normal social activities. In these women, pregnancy is significantly more often wanted and planned, as well. As a result they have a responsible approach to the prenatal care.

[Nalbuphine in obstetrical analgesia]. / Nalbuphine v porodnické analgezii.

OBJECTIVE: Comparison between particular methods of obstetrics analgesia, their analgetic efects and influence on the progress of delivery and postpartum adaptation of fetus. DESIGN OF THE STUDY: Prospective study. SETTING: The Department of Gynecology and Obstetrics of the Teaching Hospital and the 2nd Medical Faculty of the Charles University in Prague. METHODS: A prospective study of 92 patients who received intravenous infusion nalbuphine (28 women) or epidural analgesia (31 women) or pethidin (33 women). Assessment of maternal analgesia, satisaction was carried out. Apgar scores and resuscitative measures required for the neonate were note at delivery. RESULTS: The best analgesic effect was in the group with using peridural analgesia, where max. score was 3. The highest value was in the group of women who received pethidin. The most significant decrease of score after application of analgesia was in group with epidural analgesia, the least decrease of score was in the group with pethidin. The Apgar score at 1. minute was the lowest in the group with epidural analgesia, the highest score was in the group with nalbuphine. CONCLUSION: The mixed agonist/antagonist narcotic analgesic like nalbuphine have the place in clinical practice. The obstetric analgesia is very common in obstetrics practice. The epidural analgesia is very popular but not always accessible. Nalbuphine is the option which is effective in analgesia and have minimal side-effects.

[Characteristics of a population of drug dependent pregnant women in the Czech Republic]. / Charakteristika populace drogove závislých tehotných zen v CR.

OBJECTIVE: The aim of the study was to characterise the population of drug abused pregnant women in Czech republic and chart their socioeconomic situation. DESIGN: Prospective study. SETTING: The Department of Gynaecology and Obstetrics of the General Teaching Hospital and the 1st Medical Faculty of Charles University in Prague. METHODS: This prospective study coursed since January 1998 till the end of the year 2000. This study covered a group of pregnant women addict on illegal drugs (heroin, pervitin). The group was set in close cooperation with Prague's contact anti-drugs centers (DROP-IN, K-centrum, Sanopin), Dependence therapy department and Department for genetics Teaching hospital Prague and of course in cooperation with the district gynaecologists. During 3 years we succeeded in gathering 41 addict women for prenatal care. Twenty of them were heroin and 18 pervitin addict. The control groups were selected by method of accidental choice. We compared each group with its control and both groups of addicted mutually. We focused mainly on characteristics which could have a negative impact on the course of pregnancy, labour and lying-in period and the health condition of the foetus and the neonate (age, status, employment, parity, length of drug abuse, mode of application, attempt of therapy or abstinence, STD, hepatitis B and C, quality of prenatal care). RESULTS: We proved, that drug abused pregnant women are statistically significantly younger than pregnant women from control groups (by equal parity), mostly single and unemployed. The majority of them prefer intravenous way of drug application. The heroin--addict choose this type of application statistically significantly more often (94.4%) and also more often they report efforts at abstinence or therapy. A big part of drug abused pregnant women has insufficient prenatal care. 33% of heroin-addict and 25% of pervitin-addict never attended the obstetrician during their pregnancy. We revealed a significantly higher incidence of HBsAg a mainly anti HCV and active hepatitis C among women from both "drugs" groups compared to their controls. We did not encounter any HIV positive case among the Czech addict pregnant. CONCLUSION: The population of drugs-addict pregnant women may be characterised as a high risk group from the view of prenatal care. The pregnancy is not a sufficient impulse for the majority of drugs-addict women to change their life stereotypes.

[Placental and umbilical cord changes in drug-addicted women]. / Placentární a pupecníkové zmeny u zen závislých na tvrdých drogách.

OBJECTIVE: The aim of the study was to gauge the impact of drugs on placental changes in heroin and pervitin addict pregnant women as one of the influence factors supporting the lower birth-weight of the neonate. DESIGN OF THE STUDY: Prospective study. SETTING: The Department of Gynaecology and Obstetrics and the Department of Pathology of the General Teaching Hospital and the 1st Medical Faculty of Charles University in Prague. METHODS: The drugs-addict pregnant women were included in the study in the period between January 1998 till the end of the year 2000. We succeeded to concentrate in total 39 drug abused pregnant women and 39 their placentas and umbilical cords were examined (19 heroin and 20 pervitin addict). The placentas were sent for the histological examination in total without the chemical fixation. There were 3 placental samples, 2 cord and 2 membranes samples examined. The controls groups were formed by non-abused pregnant women and their placentas by method of accidental choice. RESULTS: We found the statistically significant higher incidence of placental and cords abnormalities in among the addict women compared to their non abused controls (P < 0.05). In heroin addict group in 16 from 19 cases were the abnormalities present. We registrated increased intervillous and perivillous microfibrin deposits (6 times), an increased number of trophoblastic proliferation buds (7 times) increased vascularization of the villi (7 times) mikrovilli (6 times) and their necrosis (5 times). In umbilical cord we enregistered in 3 cases the only one artery, in two case the thrombosis of the vein. In 5 cases we also found the signs of infection. In pervitin addict group we registered placental changes in 9 from 20 cases. The majority of them presented as increased microfibrin deposits on the surface and also in the choriotic board (9 times), in five cases we enregistered the intervillous haemorrhage manifested in 2 cases clinically as abruption of placenta. The placental changes participate in low birth weight of neonates, IUGR and the abbreviation of the gestational duration. CONCLUSION: The microscopic changes in placenta is the expression of the circulatory disorder during the attack of the drug. They are not four-square specific, rather quantitatively expressed. In heroin abused women is the incidence of placental changes much more higher comparing to pervitin-addict. Heroin led more frequently to preterm labour, lower birth-weight and IUGR. The pervitin-addict mothers are higher risk of placental abruption.