[Relationship between the levels of toxic polychlorinated biphenyls in blood and follicular fluid of sterile women]. / Vztah mezi hladinami toxických polychlorovaných bifenylu v krvi a ve folikulární tekutine sterilních zen.

OBJECTIVE: The aim of this study was to confirm the possibility of detection of toxic polychlorinated biphenyls in blood and follicular fluid of infertile women undergoing IVF+ET program and determine the levels of some congeners. To confirm their cumulation in follicular fluid. DESIGN: Pilot study. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague, AXYS Varilab s.r.o., Vrané nad Vltavou, Institute of Hygieny and Epidemiology, 1st Faculty of Medicine Charles University and General Faculty Hospital, Prague, Euromise Centrum, Charles University, Prague. METHODS: We detected the level of polychlorinated biphenyls in blood and follicular fluid of infertile women undergoing IVF+ET program. We recieved the follicular fluid by transvaginal punction of follicles under ultrasonography control. The blood was taken before begining of anestezia. The follicular fluid and blood were frozen and transported to the laboratory. The samples were examined there by methods of gas chromatography and mass spectrometry. We were able to find all PCBs with 3-7 atoms of chlorine. RESULTS: We confirmed the possibility of detection of polychlorinated biphenyls (PCBs) in blood and follicular fluid of infertile women. We examineted the levels of PCB 77, 81, 105, 114, 118+123, 126, 156, 157, 167, 169, 189. The levels of PCBs were in ng/gram of fat. The levels of polychlorinated biphenyls differed from 0 to 400 ng/g of fat. Statistical analysis was made by t test a Wilcox test. All PCBs are cumulated in follicular fluid, except of PCB 126. CONCLUSION: The possibility of detection of PCBs in blood and follicular fluid of infertile women undergoing IVF+ET program was confirmed. The cumulation of these xenobiotics in follicular fluid was found. In the future we will analyse the relationship between the presence of these xenobiotics and achieving succesful pregnancy.

[Embolization of uterine arteries during myoma treatment from the patient's point of view]. / Embolizace delozních tepen pri lécbe myomu z pohledu pacientek.

OBJECTIVES: To acquire information about the patient's follow-up evaluation of treating fibroids by uterine artery embolization (UAE). DESIGN: A retrospective multicenter clinical trial. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague. METHODS: 45 women who underwent the UAE due to uterine fibroids from 1999 to 2003 were asked to complete a questionnaire. The questionnaire included 26 questions asking how the women had been informed and what they had expected. Further questions were focused on the course of embolization itself, early post-procedural difficulties (post-embolization syndrome) and patient's overall evaluation of treatment in a longer term. Those women who had completed the questionnaire and had been ready to co-operate were thereafter examined and included in the follow-up monitoring and, if necessary, further treatment was recommended. RESULTS: Thirty one out of 45 patients from 26 to 48 years of age, who had been addressed (68.9%) answered the questionnaire. UAE was indicated 12 times (38.7%) on account of symptoms, 10 times (32.3%) because of sterility, 5 times (16.1%) as a preventive measure within the framework of family planning and 4 times (12.9%) for an asymptomatic but growing leiomyoma. Twenty seven (87.1%) women were also offered an alternative treatment, which they refused. As far as problems are concerned, 18 (58%) women described the course of treatment as corresponding with what they had expected, 5 times it was less painful, and 8 times it was worse than expected. The long-term results were considered as positive by 87.1% of responders, only 12.9% considered the treatment as failure. 5 in 11 women planning pregnancy became pregnant, 3 of them gave birth in term and 2 miscarried in the 1st trimester. CONCLUSION: From the point of view of the patients, the evaluated method proves highly successful, it is well tolerated and it involves a low risk of complications. It is not possible, at this point, however, to give an unequivocal answer to the question whether the method should also be routinely offered to women who are planning pregnancy.

[Threatening uterine rupture in pregnancy after previous laparoscopic myoma enucleation. Case report]. / Hrozící delozní ruptura v gravidite po predchozí laparoskopické enukleaci myomu. Kazuistika.

OBJECTIVE: To evaluate the negative effect of uterine myoma enucleation forcompact structure of the uterus. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Pronatal Sanatoruim, Prague METHODS: In this study, the authors analyze their experience of the course of pregnancy in a patient who had uterine myoma enucleation with penetration to the uterine cavity and large coagulation. The pregnancy was terminated by caesarean section for the indication of prior uterine surgery and the risk of uterine rupture in 38 week of pregnancy. CONCLUSION: This case report demonstrates the risk of uterine rupture in pregnancy after laparoscopy myoma enucleation.

[Delivery of a healthy child from pregnancy after IVF complicated hyperstimulation syndrome, phlebothrombosis and resection of uterine horn. Case report]. / Porod zdravého plodu v gravidite po IVF komplikované hyperstimulacním syndromem, flebotrombózou a resekcí rohu delozního. Kazuistika.

OBJECTIVE: To evaluate the negative effect of uterine horn resection for heterotopic pregnancy in the uterine horn in the first trimester on the course of pregnancy and labor. To point out the increased incidence of other complications in pregnancy after IVF+ET (ovarian hyperstimulation syndrome, phlebothrombosis of the pelvic veins). DESIGN: Case study. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague. METHODS: In this study, the authors analyze their experience with the course of pregnancy of a patient who had uterine horn resection for a heterotopic uterine horn pregnancy after IVF+ET. The course of pregnancy was associated with further complications such as ovarian hyperstimulation syndrome and the resulting occurence of thrombosis in the 2nd trimester of pregnancy. The pregnancy was terminated by caesarean section for the indication of prior uterine surgery-resection of the uterine horn in the first trimester. A healthy infant was delivered. CONCLUSION: This case study demonstrates the multiple occurrence of serious complications in pregnancy after IVF+ET, which are associated with ovarian hyperstimulation and the transfer of multiple embryos. The pregnancy was terminated with the delivery of a healthy term infant.

[Analysis of present diagnostic methods of intrapartum fetal hypoxia]. / Analýza soucasných diagnostických metod intrapartální hypoxie plodu.

OBJECTIVE: To evaluate specificity of present diagnostic methods of intrapartal fetal hypoxia (cardiotocography--CTG, fetal pulse oxymetry--FpO2, ST-ECG analysis). DESIGN: A prospective study. SETTING: Gynecology-Obstetrics Clinic, 1st Medical Faculty and General Faculty Hospital in Prague. METHODS: The results of synchronic fetus monitoring by means of CTG, FpO2 and STAN-ST 21 were followed in 53 mothers with a risk and pathological delivering of birth in the period of April 2003 to March 2004. The study investigated, which of the methods provided the best prediction of the intrapartal fetal hypoxia. The statistical evaluation (p-mark test and Mc Namara test) was based on the assessment of correct or incorrect prediction of the Apgar score values in the first minute after birth, pH in umbilical artery and the lactate level. We also investigated results of three methods during postpartum depression, turbid or mushy amniotic fluid and the way the individual methods were made useful in indication for ending the delivery. RESULTS: In comparison with CTG there was a statistically significantly higher specificity in FpO2 and STAN in the evaluation of Apgar score in the newborn in the first minute after birth, FpO2 (p=0.007) and STAN-ST (p<0.001), in the determination of pH (a) from umbilical blood FpO2 (p=0.029) and STAN (p=0.001) and the occurrence of postpartum depression of the newborn in minute 30-60 after birth FpO2 (p=0.019) and STAN (p=0.0005). The changes in lactate level in umbilical blood were better predicated by STAN (p=0.001). FpO2 evaluated the changes in the same way as CTG. The threatening hypoxia in strongly turbid or even mushy amniotic fluid was correctly evaluated by STAN only (p=0.002). The FpO2 evaluation was not statistically significant. There was not any statistically significant difference in the indication of operation for ending the delivery among the individual methods. CONCLUSIONS: The results univocally demonstrated that the used of other method for diagnosis on intrapartal fetus hypoxia--Fetal pulse oxymetry and ST--analysis of ECG of the fetus give more precision to the diagnosis. The introduction of these methods requires a correct interpretation and the effort of the obstetrician to use these methods in clinical practice.

[Comparison of organochlorine pesticide levels in blood and follicular fluid of infertile women]. / Porovnání hladin organochlorovaných pesticidu v krvi a ve folikulární tekutine neplodných zen.

OBJECTIVE: The aim of this study was to detect DDT and its metabolites, lindane and its conformers (alfa, beta, gama and delta conformers of hexachlorocyklohexane - HCH) and hexacyclobenzene (HCB) in blood and follicular fluid of infertile women undergoing IVF+ET program. In the case if their detection, to confirm their cumulation in follicular fluid. DESIGN: Pilot study. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague, AXYS Varilab s.r.o., Vrané nad Vltavou, Institute of Hygiene and Epidemiology, 1st Faculty of Medicine Charles University and General Faculty Hospital, Prague, Euromise Centrum, Charles University and Academy of Arts, Prague, Czech republic. METHODS: We detected the level of DDT, DDE, DDD, lindane and its conformers (alfa, beta, gama and delta conformers of hexachlorocyklohexane - HCH) and hexacyclobenzene (HCB) in blood and folicular fluid of 30 infertile women undergoing IVF + ET program. We recieved the follicular fluid by transvaginal punction of follicular fluid under ultrasonography control. The venous blood was taken before begining of anestesia. The follicular fluid and blood were frozen and transported to the laboratory. There the samples were examinated by the methods of gass chromatography and mass spectrometry. RESULTS: We confirmed the possibility of detection of DDT, DDE, DDD, lindane and its conformers (alfa, beta, gama and delta conformers of hexachlorocyclohexane - HCH) and hexacyclobenzene (HCB) in blood and follicular fluid of infertile women. The differences in concentrations in blood and follicular fluid were statistically analysed. We confirmed the cumulation of DDT, DDE, DDD, lindane and its conformers (alfa, beta, gama and delta conformers of hexachlorocyclohexane - HCH) and hexacyclobenzene (HCB) in follicular fluid of infertile women. The levels of these compounds in blood differed from 2.8 to 6399.3 ng/g of fat, in follicular fluid from 1.4 to 4 099.8 ng/g of fat. CONCLUSION: It is possible to detect DDT, DDE, DDD, lindane and its conformers (alfa, beta, gama and delta conformers of hexachlorocyclohexane - HCH) and hexacyclobenzene (HCB) in blood and follicular fluid of infertile women. The cumulation of these xenobiotics in follicular fluid was found.

[Thromboembolic complications in patients undergoing in vitro fertilization: retrospective clinical study]. / Tromboembolické komplikace u pacientek z programu IVF-ET: retrospektivní klinická studie.

OBJECTIVE: To determine the incidence and the type thromboembolic complications in patients undergoing in vitro fertilization (IVF). To evaluate their clinical course, the influence on reproductive outcomes, and the prevalence of thrombophilia in these women. DESIGN: Retrospective clinical study. SETTING: Assisted Reproduction Center, Department of Obstetrics and Gynecology, 1st Faculty of Medicine and General Faculty Hospital, Charles University, Prague. METHODS: The data, reflecting the diagnosis of thromboembolism (TE), were collected from all patients, who have undergone the IVF cycle in our clinic for the last 7 years. The following data were analyzed in these patients: medical history, type and course of TE, type and effect of ovarian stimulation, clinical pregnancy achievement, occurrence of ovarian hyperstimulation syndrome (OHSS), results of testing for thrombophilia, pregnancy course and outcome. RESULTS: From 2748 IVF cycles 3 cases of TE were found (0.11%). In all cases the unilateral thrombosis of internal jugular vein associated with OHSS, manifesting in 1st trimester of pregnancy and not complicated with pulmonary embolism occurred. At least two thrombophilic markers have been detected in all these women. The clinical course of TE, as well as of the whole gestation was favorable. Prevalence of TE in patients with severe OHSS was 4.1% (2 women from 49). CONCLUSION: The incidence of thromboembolism in women undergoing IVF is low. It appears almost exclusively in association with OHSS and the typical finding is deep venous thrombosis in the neck area. In our opinion, while screening of thrombophilia in all patients from IVF program is not indicated, the routine testing of most common thrombophilic markers in pregnant women with OHSS could decrease the risk of these serious complications.

[Effect of toxic substances in the environment on reproduction]. / Vliv toxických látek ze zivotního prostredí na reprodukci.

OBJECTIVE: To summarize the findings about the influence of some xenobiotics on human reproduction, especially infertility. TYPE OF STUDY: Review article. SETTING: The Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University and the General Faculty Hospital, Prague METHODS: Analysis of literature. RESULTS: A review about the influence of some xenobiotics on human reproduction was given. In some there is a possible negative influence on the results of in vitro fertilisation program. It is a question of hormone disruptors, some heavy metals, some organic solvents, pesticides and smoking of cigarettes. CONCLUSION: In most of these xenobiotics there is direct evidence of their negative influence on reproduction and the results of in vitro fertilisation program. Therefore it is worth to continue in this evaluation.

[Pregnancy in myelodysplastic syndrome]. / Gravidita pri myelodysplastickém syndromeu.

OBJECTIVE: Evaluation of the influence of myelodysplastic syndromee (MDS) on the course of pregnancy and delivery. DESIGN: Case report. SETTING: Gynecological and Obstetric Department 1st Medical Faculty Charles University and General Faculty Hospital, Prague. SUBJECTS AND METHODS: The authors analyze their experience with the course of pregnancy and delivery in a patient with MDS and refractory anaemia who was treated on account of the disease for several years before pregnancy in the Institute of Haematology and Blood Transfusion. Pregnancy was not associated with progression of the basic disease and complications which developed during pregnancy were not associated with MDS. Pregnancy was terminated in this patient on account of preeclampsia gravis per sectionem caesarean by delivery of a healthy foetus. CONCLUSION: The example draws attention to a serious haematological disease while during pregnancy and delivery deterioration of the basic disease was not observed.

[The spectrum of lipids in the intrauterine growth retarded fetus and in the parents]. / Spektrum lipidu u intrauterinne retardovaných plodu a u jejich rodicu.

OBJECTIVE: The aim of this study was to determine the relationship between the parameters of individual serum lipids and the degree of intrauterine growth retardation (IUGR) of the fetus. The lipid levels were compared in fetuses with IUGR and in eutrophic fetuses and it was determined in which studied variable IUGR newborns differ from healthy newborns. METHODS: The group under study consisted of 53 pregnant women in whom IUGR of the fetus was diagnosed by ultrasound during pregnancy. The control group consisted of 26 women who gave birth to eutrophic newborns. The cases in the control group were chosen by the method of matched control so that the results could be statistically evaluated in both groups at the same gestational age and at the same maternal age. In both groups blood samples from the umbilical cord were taken after delivery and the whole spectrum of lipid levels were evaluated (cholesterol-CH, triglycerides-TGA, high-density lipoprotein--HDL, low-density lipoprotein--LDL, Lp(a) lipoprotein, and apolipoproteins-ApoB, ApoAI, ApoE). The same parameters were evaluated in maternal and paternal blood samples. In several cases, intrauterine lipid levels of the fetus were determined by cordocentesis. The incidence of hyperlipoproteinemia in the families of both groups was surveyed. SETTING: Department of Obstetrics and Gynaecology, 1st medical Faculty, Charles University, Prague. RESULTS: There was a significant incidence of hyperlipoproteinemia in the families of the mothers in the group studied (chi-square test: p < 0.001). In the mothers of the groups studied, there were statistically significant higher levels of HDL, LDL, and Lp(a) in comparison to the mothers in the control group. A significant dependence was determined between the levels of ApoAI and Lp(a) of the mothers and newborns. In the regression analysis of the dependence of lipid levels on the birth weight of the newborns, a statistical correlation was determined for the values of ApoB and Lp(a). CONCLUSION: The more increased the intrauterine growth retardation of the fetus and the lower its birth weight in relation to its gestational age, the higher its lipid levels, specifically apolipoproteins. Apolipoproteins are under genetic control and present a genetic risk for changes in the metabolism of cholesterol, hemocoagulation, and cardiovascular disease in adulthood.

[Perinatal outcome of twin pregnancies after fertilization in vitro and after spontaneous conception]. / Perinatální výsledky dvojcetných tehotenství po IVF a po spontánní koncepci.

OBJECTIVE: To compare the obstetric outcome of twin pregnancies after IVF with spontaneously conceived twins and thus determine whether IVF twins require greater care. TYPE OF STUDY: A retrospective study. SETTING: The Department of Obstetrics and Gynaecology, 1st Faculty of Medicine of Charles University, Prague. METHODS: Statistical evaluation of obstetric outcome between the group of 46 twin pregnancies after IVF and 85 spontaneously conceived twins. We evaluated the following parameters: signs of abortion and premature delivery, bleeding in pregnancy, premature rupture of membranes, performed cerclage, incidence of praeclampsia, gestational diabetes mellitus and hepatopathy of the mother. Pathological ultrasound findings were also evaluated--disturbances in foetal growth and the amount of amniotic fluid. In these parameters we also evaluated the time of the first signs of their development. Further, we evaluated the type of delivery, the gestational age at delivery, birth weight, birth weight discordance and perinatal mortality. RESULTS: We found statistically significant differences in the method of delivery--more cesarean sections in the IVF group (71.7%) than in spontaneous ones (44.7%). Another difference was the gestational age at which cerclage were performed--earlier in the IVF group (average 22.8 weeks) than in spontaneous ones (average 25.7 weeks). In the other evaluated parameters we did not find any statistically significant differences between the two groups. CONCLUSION: In our retrospective analysis of twin pregnancies, deliveries and neonatal outcome, except for the method of delivery and time of performing cerclage, we did not find any important significant differences between the IVF and spontaneously conceived twins. However, it is necessary to remember the generally worse obstetric outcome of twin compared to singleton pregnancies.

[Comprehensive treatment of ileofemoral thrombosis at the end of pregnancy with cesarean section in combination with thrombectomy]. / Komplexní resení ileofemorální trombózy na konci tehotenství provedením císarského rezu v kombinaci s trombektomií.

Acute deep ileofemoral thrombosis was treated at the end of pregnancy in four pregnant women. A multidisciplinary approach was selected. During a single anaesthesia the team of obstetricians and neonatologists made a Caesarean section followed by thrombectomy with a Fogarty catheter. This operation was performed by a team of specialists in cardiovascular surgery. Two women developed rethrombosis: one woman on the following day, the second one two weeks after surgery. In both instances repeated thrombectomy was performed. In one woman the cause of ileofemoral thrombosis was malignant disease of the uterine cervix II and this woman is, after oncological treatment, in a serious condition due to the basis disease. The remaining three women were repeatedly subjected to phlebographic examinations and complete patency of the deep vascular system was found. These women are free from subjective and objective complaints and can look after their children. Pregnant women where a serious ileofemoral thrombosis was diagnosed had high fibrinogen and thrombocyte levels. In two women an AT III deficiency was found. There was also a high cholesterol level and positive antiphospholipid antibodies. Thrombectomy has according to the authors' experience very good results when the operation is implemented within 72 hours after initial symptoms. This procedure reduces the risk of chronic venous insufficiency.

[The effect of endometrial infection on embryo implantation in the IVF and ET program]. / Vliv infekce endometria na implantaci embrya v programu IVF + ET.

The results of the IVF and ET programme depend on a number of known and hitherto unknown factors. One of them is implantation of the embryo. Only 10-15% of the embryos transferred into the uterus are implanted. The most important factors affecting implantation are quality of the embryo and receptivity of the endometrium. The receptivity of the endometrium depends on hormonal changes, vascularization of the uterus, infectious environment and other factors. Part of them can be influenced to a certain extent. Infection of the endometrium as the cause of unsuccessful implantation could be resolved by therapeutic administration of antibiotics. The objective of the present work was to prove the possible effect of bacterial contamination of the endometrium on results of IVF + ET programmes. During 1996-1997 120 sterile women included in the IVF + ET programme were examined at the First Gynaecological and Obstetric Clinic (transport system-Pronatal, Prague). In all women the author performed during the cycle preceding the stimulated one (the IVF cycle proper) microabrasion of the endometrium by a method which prevents as much as possible contamination of the specimen by the endocervical flora. A smear from the endocervix and vagina was made. The samples were examined for the presence of aerobic and anaerobic flora, Chlamydiae. The endometrium was evaluated also from the histopathological aspect. Results of the examination of the endometrium: 62% of the specimens were positive on cultivation. Most frequently Pseudomonas spec. and Staph. epidermidis were found. Of 34 women who became pregnant 10 had a positive cultivation (29.4%). Of 86 women where pregnancy was not achieved, cultivation was positive in 64 (74.4%). This difference is statistically significant. The same cultivation finding from the endocervix and endometrium was observed only in 21% patients. From the trial where more than twice as many positive cultivations were recorded in non-conceptive cycles as compared with conceptive ones, the following preliminary conclusions can be drawn: 1. Elimination of endometrial infection has its place in the preparation of patients in the IVF + ET programme. 2. It is advisable to treat with antibiotics a positive cultivation of the endometrium or administer antibiotics prophylactically (62% positive) to all patients during a stimulated IVF cycle.

[Ultrasonography of pelvic floor muscles in women with urinary stress incontinence]. / UZ vysetrení svalu pánevního dna u zen s GSI.

Ultrasound examinations have become since beginning of the eighties one of the auxiliary examination methods in urogynaecology. Evaluation of the position and mobility of the neck of the urinary bladder practically replaced lateral chain urethrocystography. With the improving differentiating capacity of ultrasound equipment it is possible to visualize some periurethral and paravaginal structures which participate in the support of the urethra and urethrovesical junction by paravaginal and periurethral structures in women (fig. 1). In recent years many papers were published where for visualization nuclear magnetic resonance (NMR) is used [1, 12, 19]. The functional and physiological condition of these tissues is assessed by physical, urodynamic and ultrasonographic examinations and also by cystourethroscopy and manometry [7, 11, 10, 13, 14, 15, 16]. Despite this the greater part of anatomical knowledge of the supporting apparatus is derived from pathological studies and peroperative observations.

[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).

[Effect of oocyte transportation (IVF transport) on effectiveness of the IVF and ET program]. / Sledování vlivu transportu oocytu (transportní IVF) na efektivitu programu IVF + ET.

The programme of in vitro fertilization helps at present an ever increasing number of married couples to resolve successfully the problem of sterility. It is however a method pretentions technically, as regards time, material and in particular funds. This applies above all to embryological laboratories. The transport system of the IVF programme makes possible care of patients indicated for sterility treatment by the IVF method in departments without their own embryological laboratory and thus it is possible to include more patients in the programme and save money. In the author's department the first two stages of the IVF programme are implemented, i.e. stimulation of the ovaries and aspiration of follicular fluid. Then this material is taken in a transport box of the K-system Co., Denmark, type G-81E to a centre with full accreditation where the subsequent stages of the IVF programme take place (selection of the oocyte, fertilization, cultivation of embryos and embryo transfer). The transport system has operated now for three years (1995-1997) and at present the authors evaluate the system. The fertility rate and pregnancy rate in individual years was compared and the following conclusions were reached: The fertility rate is significantly (at the 1% level) lower in the transport centre in 1995 and 1996 (47%, 54%) as compared with the other centre the laboratory of which is used by the authors (57%, 61%). In 1997 the difference is no longer significant (63% x 64%). The difference in the pregnancy rate in centres for aspiration and embryo transfer in both centres is insignificant in the years of investigation. It may thus be stated that the oocyte transport does not have a negative influence on the effectiveness of the IVF + ET programme (same pregnancy rate) and thus makes it possible to include a greater and ever increasing number of patients in the IVF programme by making use of reserve capacities of embryological laboratories and thus reduce the total costs of this programme.

[Fetal motor activity during pregnancy and labor]. / K problematice pohybové aktivity plodu v tehotenství a pri porodu.

The authors examined by actocardiography a group of 98 women in the third trimester of pregnancy. They evaluated the duration, frequency of different movements and the frequency of FHR accelerations in three groups of pregnant women (normal controls, pregnant women with retarded foetal growth and normal PI and finally women with retarded foetal growth and raised PI values). Progression of intrauterine stress led in the investigated group to a gradual decline of motor activity of the foetus along with a decline of the frequency and ratio of FHR accelerations in the total movements and isolated movements of the head and extremities. Statistical significance was proved in four basic parameters. The authors confirmed the priority of the flowmetric diagnosis as compared with actocardiographic recording of developing foetal stress. In the submitted preliminary communication the authors present data on actocardiographic findings during normal delivery. They revealed in particular a marked coincidence of general foetal movements and uterine contractions.

The invasive prenatal diagnosis in perinatal centre.

Three main methods of prenatal diagnosis (Amniocentesis AMC, Chorionic villi sampling CVS and Cordocentesis FBS) have been used in Perinatal Centre of Central Bohemia. The chromosomal abnormalities in a group of 3,098 patients have been detected in 1.4% of fetuses. The inherited disorders were diagnosed using DNA analysis and biochemical examination of amniotic fluid. X-linked diseases in a group of 68 patients in 30.8% of fetuses have been diagnosed and inborn error of metabolism in a group of 29 indicated patients in 17.2% of fetuses were diagnosed. The incidence of fetal losses before 28th week of gestation was 0.4%.