[Cesarean section and perinatal mortality 1993-1996 in a regional perinatology center]. / Císarský rez a perinatální úmrtnost v letech 1993-1996 v regionálním perinatologickém centru.

During the period between 1993-96 the authors made at the Second Gynaecological and Obstetric Clinic 1099 caesarean sections. The investigated group was subjected to frequency analysis. The relationship with perinatal mortality and early neonatal mortality was assessed. In a group of 287 caesarean sections in 1996 the authors analyzed indication spectra and maternal morbidity. The results were compared with data in the literature. From the assembled data ensues that although the rate of caesarean sections practically does not change, perinatal mortality decreased significantly. This positive result is due mainly to better perinatal and neonatological care. In the indications for caesarean section the authors did not reveal statistically significant deviations from nationwide average figures.

[Hemostasis and levels of cytoadhesion molecules in gestational diabetes]. / Hemostáza a koncentrace cytoadhezivních molekul u gestacního diabetu.

OBJECTIVE OF STUDY: Assess interrelations between parameters of haemostasis, fibrinolysis, acute stage proteins and cytoadhesive molecules in gestational diabetes (GDM), which in susceptible women is actively induced by insulin resistance. METHODS: In 33 pregnant women where based on the glucose tolerance test (75 g glucose) GDM was revealed, repeatedly fibrinogen values were assessed (FBG 4.38 +/- 0.98 g/l), the antithrombin III activity (ATIII% 103.83 +/- 14.9), t-PA Ag(4.82 +/- 3.35 ng/ml), PAI-1 Ag (158.04 +/- 57.7 ng/ml), D-dimer (234.99 +/- 455.36 ng/ml), plasma proteins-orosomucoid (ORM 0.506 +/- 0.14 g/l), C reactive protein (1.34 +/- 0.96 g/l), transferrin (3.77 +/- 0.79 g/l), prealbumin (1.86 +/- 0.83 g/l) and alpha-2-macroglobulin (A2M 2.01 +/- 0.62 g/l) and cytadhesive molecules sICAM-1 (230.8 +/- 57.76 ng/ml) and sE-selectin (35.50 +/- 16.55 ng/ml). These findings were compared with parameters of the glucose and lipid metabolism and some anthropometric data (BMI, weight increments during pregnancy and birth weight of the infant). RESULTS: After statistical evaluation in GDM positive correlations of FBG and BMI were found (r = 0.871, p = 0.007) and also with the weight increment during pregnancy (r = 0.934, p = 0.0007). Hyperfibrinogenaemia is however probably compensated in stabilized cases of GDM by a higher production of t-PA (FBG:t-PA Ag, r = 0.782, p = 0.003). In GDM a marginal positive correlation between the value of the "atheroindex" and the infant's length was found r = 0.744 p = 0.0547). sE-selectin levels in GDM correlated inversely with ATIII activity (r = -0.905, p = 0.0028). CONCLUSION: The higher body weight of pregnant women with GDM is probably associated with a higher risk of thrombophilia (elevated fibrinogen). If in pregnant women infection develops with release of inflammatory cytokines, inducing on the endothelium expression of E-selectin, deterioration of thrombophilia (due to a decline of ATIII) activity must be foreseen.

Preconcentration of platinum group metals on modified silicagel and their determination by inductively coupled plasma atomic emission spectrometry and inductively coupled plasma mass spectrometry in airborne particulates.

Modified silicagel (C18) was studied for separation and preconcentration of platinum group metals (Ru, Rh, Pd, Os, Ir and Pt) as ion associates of their chlorocomplexes with cation of onium salt N(1-carbaethoxypentadecyl)-trimethyl ammonium bromide. Sample containing HCl and the onium salt was pumped through the column. After elution with ethanol the eluate was evaporated in the presence of HCl. Resulting aqueous solutions were analysed with inductively coupled plasma atomic emission spectrometry (ICP-AES) and inductively coupled plasma mass spectrometry (ICP-MS). Recovery values of 1-20 mug Pt and Pd from 50 ml of synthetic pure solution were 100+/-3 and 100+/-1%, respectively, however, they diminished with increasing sample volume and in the presence of the real sample matrix or nitrate ions. Samples of engine soot (NIES No. 8), decomposed by low pressure oxygen high-frequency plasma, and airborne particulates from dust filters of meteorological stations, leached with HNO(3) and H(2)O(2), were analysed. A reasonable agreement was found between ICP-MS and ICP-AES results for airborne dust samples and the values comparable with those in literature were determined in NIES No. 8.

[Detection of cadmium and zinc in the blood and follicular fluid in women in the IVF and ET program]. / Detekce kadmia a zinku v krvi a folikulární tekutine zen zarazených do programu IVF + ET.

Scientific and technical development contributed on the one hand greatly to easier living conditions, on the other hand there is however substantially greater danger threatening not only the life of man but also of nature, of the entire living environment. At present the problem of the possible part played by this phenomenon in reproductive disorders is in the foreground. Via the food chain heavy metals, toxic trace elements and polyhalogenic hydrocarbons penetrate into the organism. They accumulate in the organism and thus also in the reproductive tract and may have an impact on fertility. Some elements with a possible negative impact on reproductive health are in such low concentrations in tissues that only contemporary methods of their detection make it possible to map their presence in the organism. They are called trace elements. Toxic ones comprise cadmium, mercury, lead and arsenic. The mechanism of the negative action of cadmium in the organism is most probably due to its competition with the vitally important trace element--zinc. It was therefore the objective of the present investigation to trace the presence of cadmium and zinc in the organism of 100 sterile women included in an IVF programme: in blood and follicular fluid (i.e. in a medium which surrounds the gamete--the oocyte) and to follow up their concentrations in relation to achievement pregnancy. Cadmium and zinc in blood and follicular fluid were assessed on a mass spectrometer with induction bound plasma as the source of ions (ICP-MS), Varian Co. produced in 1994. The assessed mean levels (microgram/l) of cadmium in blood (2.88 s 2.71) and follicular fluid (1.25 s 0.55) in the group of conception cycles did not differ significantly from mean blood levels (2.82 s 2.22) and follicular levels (1.16 s 0.55) of non-conception cycles. The mean zinc levels in blood and follicular fluid did not differ either in the group of conception and non-conception cycles. Very significant are the differences in the blood and follicular fluid levels, the levels in follicular fluid being significantly lower. We may speak of a protective barrier of the oocyte formed by the follicle (probably the cells of the granulosa) against blood. Thus no relationship was found between the cadmium concentration in blood and follicular fluid of women where pregnancy was achieved and non-pregnant women. The possible cause of fertility disorders in conjunction with toxic elements is probably in damage of the granulosa cells and thus their dysfunction as regards production of steroid hormones with full impact on female fertility (hormone disruptors).

[Changes in hemostasis and fibrinolysis in gestational diabetes]. / Zmeny hemostázy a fibrinolýzy pri gestacním diabetu.

BACKGROUND: The most serious complication of diabetes is the progressive development of vascular changes in which impaired hemocoagulation and fibrinolysis participate. The latter were investigated in diabetes type 1 and 2, but les is known about them in gestational diabetes (GDM). The objective of the submitted work was to assess wither these disorders occur also during GDM and to compare the assessed changes of haemostasis and fibrinolysis with findings in a) non-pregnant healthy controls (n = 58), b) healthy pregnant women (n = 41) and c) groups of pregnant women with impaired haemostasis during gestation/gestational hemorrhage (n = 15), preeclampsia (n = 22), varicosities (n = 15) and dead foetus syndrome (n = 16), but normal carbohydrate metabolism. The changes in GDM were moreover compared with changes found in diabetes type 1 and 2. METHODS AND RESULTS: In pregnant women with GDM (n = 29) which was diagnosed according to WHO criteria the following parameters were examined: number of thrombocytes, APTT, fibrinogen-Fbg (according to Clauss), euglobulin fibrinolysis-ECLT, t-PA concentration, PAI-I (Coaliza, Kabi) and by microturbidimetry the concentration of plasma proteins/orosomucoid (ORM), alpha-1-antitrypsin (A1AT), prealbumin (PREA), transferrin (TRF) and alpha-2-macroglobulin (A2M). In patients with GDM a high Fbg level was found (4.51 +/- 0.98 g/l, p<0.01) not only as compared with Fbg in non-pregnant women (2.42 +/- 0.40 g/l), Fbg in healthy pregnant women (3.63 +/- 0.70 g/l) but also Fg in other patient groups with a pathological pregnancy. In pregnant women with GDM a reduced fibrinolytic activity - ECLT (464 +/- 98 min., p<0.01) was observed as compared with the finding in non-pregnant women (273 +/- 98 min.) but also in healthy pregnant women (303 +/- 106 min.). Another important deviation as compared with findings in healthy pregnant women in GDM is the reduced value of two proteinase inhibitors: A2M (2.04 +/- 0.59 g/l vs. 2.89 +/- 0.90 g/l, p < 0.01) and A1AT (2.98 +/- 0.80 g/l vs. 3.96 +/- 0.85 g/l, p < 0.01). The rise of t-PA (Ag), PAI-1 (Ag), fibrinogen and reduction of fibrinolytic activity (longer ECLT) made the changes the haemostasis and fibrinolysis in GDM closer to findings in DM type 2 than type 1. CONCLUSIONS: In GDM a higher thrombophilia was found (higher Fbg, longer ECLT) than in other groups of pregnant women. Another pathological finding is the reduced A2M level (proteinase inhibitor but also of PDGF and interleukins) and A1AT (inhibitor of leucocytic proteinases). The authors assume that these deviations favour the development of possible vascular changes in GDM and possibly also diabetic foetopathy (reduced A2M).

[Maternal hyperphenylalaninemia in a population of healty Czech women. 18 years' experience with mass screening, diet therapy and metabolic monitoring]. / Materské hyperfenylalaninémie v ceské populaci zdravých tehotných zen. 18leté zkusenosti s fakultativním screeningem, dietní lécbou a metabolickým sledováním.

BACKGROUND: Elevated phenylalanine levels in maternal blood (hyperphenylalaninaemia) during pregnancy damages the developing foetal tissues. Early detection of pregnant women with hyperphenylalaninaemia and adherence to a low phenylalanine diet already before conception and throughout pregnancy can prevent this damage. The objective of the investigation are results achieved screening and strict monitoring of low phenylalanine dietetic treatment in detected pregnant women of the Prague population. METHODS AND RESULTS: 186 350 healthy women of the Prague population were examined by the chromatographic screening test in a venous blood sample during their first visit in a maternity welfare centre and 22 positive cases were detected (incidence 1:8470). In 86% mild, persistent or benign forms of phenylketonuria were involved. Nineteen patients were treated by a low phenylalanine diet and the phenylalanine tolerance was monitored as well as the nitrogen balance, amino acids in serum and urine, protein markers, trace elements, vitamins, lipids, the body mass index-BMI, changes of body weight after introduction of the dietetic treatment and treatment during pregnancy. A significant increase of the phenylalanine tolerance by 20 to 200% was found, mostly in the second half of pregnancy and reduced values of serum and urinary selenium. The decrease of body weight when the diet was introduced and the increment during pregnancy correlated with the BMI value. In the other investigated parameters no significant deviations were found. CONCLUSION: Fifteen healthy children with normal psychomotor development delivered by 12 mothers with hyperphenylalaninaemia provide evidence of the effectiveness of prenatal screening for hyperphenylalaninaemia during pregnancy.

[Cytodiagnosis and premature birth in light of the Bethesda system]. / Cytodiagnostika a predcasný porod ve svetle Bethesda systému.

1. Evaluation of cytological cervico-vaginal smears by the Bethesda system enlisted cytodiagnostics among important laboratory methods which can be used also in risk pregnancies. 2. Vaginal cytology makes it possible to test at the same time the hormonal situation during pregnancy, which reflects the placental function, and to evaluate also the vaginal biocenosis. 3. The authors provided evidence that the large number of superficial cells on the cytological smear (more than 10%) is associated with low oestriol and pregnandiol levels which are warning signs of the approaching termination of pregnancy. 4. By the action of microorganisms on the vaginal epithelium typical morphological changes develop in the cell nucleus and in the cytoplasm. By polychromatic staining also the causal agents of inflammations and infections threatening the mother and foetus are apparent. 5. The authors assume that cytological examination and evaluation according to the Bethesda system should be included in the complex of antenatal examinations also in women without clinical symptoms of premature delivery or without signs of vaginal infection.

[Diagnosis and therapy in fetuses at risk in Rh isoimmunization]. / Diagnostika a terapie plodu ohrozeného Rh izoimunizací.

The objective of the work was to evaluate the importance of antenatal examination of amniotic fluid and foetal blood in case of suspected Rh isoimmunization of the foetus. In 1991-1992 in 16 patients with a rise of the titre of anti-D antibodies to > 1:8 between the 24th and 36th week of gestation 32 punctures of the umbilicus by means of a 22 gauge needle were made under continual ultrasonic control. In two instances intraumbilical transfusion was indicated. The authors revealed that with the rising titre of anti-D antibodies in maternal blood the foetal haematocrit value in the umbilical blood declines. With the rising bilirubin level the haematocrit declines. In foetuses with a haematocrit of < 31% severe forms of jaundice are encountered more frequently with the necessity of long-term phototherapy and exchange transfusion. The authors did not find a correlation between the haematocrit of foetal blood and the bilirubinoid concentration in amniotic fluid, assessed by Liley's method. Foetuses with a haematocrit higher than 31% are not threatened by severe forms of jaundice and therefore the authors do not use transfusions in these foetuses. Based on hitherto assembled experience, the authors confirmed that cordocentesis is associated with a comparable risk as amniocentesis but provides more accurate information on the state of the foetus.

[Pregnancy and obesity. II. Hormonal and metabolic changes]. / Tehotenství a obezita. II. Hormonální a metabolické zmeny.

28 obese women were investigated in the course of the 21st (A) and 30th (B) week of pregnancy. Increased serum levels of GH, T4 and T3 were found in both samples of blood (A and B), while serum insulin, cholesterol and triacylglycerols were increased only at time B. It was suggested that the similar increase of GH, T4 and T3 at time A and B was due to pregnancy because the level of these hormones is usually not increased in non-pregnant obese women, while hyperinsulinemia and often increased values of cholesterol and triacylglycerols are a common finding in non-pregnant obesity. This presumption was confirmed only partially--body weight and the skin folds correlated only with insulin and T3, while GH, cortisol, T4, cholesterol and triacylglycerols correlated only exceptionally. High levels of insulin and T3 may be due to overeating.