[Surrogate maternity--literature review and practice]. / Surogátní materství--literární názory a praxe.

OBJECTIVE: This review summarizes opinions on surrogacy including internatinal and governmental organizations attitudes, as well as some religious concerns. DESIGN: Literature review. SETTING: Reprofit International, Brno, Reproductive medicine and gynecology centre, Zlin, Department of obstetrics and gynecology, Palacky University, Olomouc. BACKGROUND: The developments in the field of assissted reproduction during the last twenty years have attracted unexpected public interest in some of its ethical and moral aspects. It is very difficult to find a uniform attitude to ethical concerns of assisted conception in plural society. Surrogate mother is defined as a woman who bears and relinquishes a child for another person. CONCLUSION: The european congress on human reproduction in Barcelona 2008 adopted following résumé on surrogacy: Public opinion has shifted to a position where surrogacy is recognized as an appropriate response to infertility in some circumstances and it is to be expected that this approach will be further strenghtened with stress on positive aspects of familiar life.

A comparison of three preinduction cervical priming methods: prostaglandin E2 gel, Dilapan S rods and Estradiol gel.

The aim of the study was to evaluate the efficacy of three cervical priming methods. From January 1, 1994 to December 31, 1996 247 patients presenting an indication for induction of labor with an unripe cervix were randomly assigned to one of the following preinduction protocols: 0.5 mg of Prostaglandin E2 gel administered intracervically (n = 83), four hygroscopic Dilapan S rods applied intracervically (n = 82), and 150 mg of Estradiol gel administered intravaginally (n = 82). The inclusion criteria were the patient's informed consent, singleton pregnancy of more than 36 weeks, cephalic presentation, Bishop score < 5 points and reactive non-stress test. If the cervical maturation (Bishop score > or = 5, and/or Bishop score augmentation by 2 points) did not occur after 14 hours of priming, the case was considered a failure. In the opposite case the patient was induced by means of extraamniotic PGE2 administration. The mean gain in the Bishop score was 3.7 points in the PGE2 group 3.9 points in the Dilapan S group, and 2.8 points in the Estradiol group. 71 patients (85.5%) were successfully preinduced in the PGE2 group, 73 (89.0%) in the Dilapan S group, and 63 (76.8%) in the Estradiol group. Labor was induced by preinduction only in 23 patients (31.3%) of the PGE2 group in 17 (20.7%) of the Dilapan S group, and in 14 (17.1%) of the Estradiol group. The mean induction to delivery interval was 7 h 27 min in PGE2 group, 7 h 49 min in the Dilapan S group and 9 h 15 min in the Estradiol group. The Caesarean section rate was 24.4% in the PGE2 group, 10.5% in the Dilapan S group, and 24.4% in the Estradiol group. PGE2 gel and Dilapan S rods proved higher efficacy than Estradiol gel. The highest frequency of labor induced by preinduction only was in the PGE2 group. There were shorter induction to delivery intervals in the PGE2, and Dilapan S groups. The lowest Caesarean section rate was in the Dilapan S group. Neither serious side effects nor negative neonatal outcome were noted in either group.

[Preinduction priming of the cervix. Comparison of the intracervical administration of PGE2 gel and vaginal administration of estradiol]. / Preindukcní zrání cípku. Srovnání intracervikální aplikace PGE2 gelu s vaginální aplikací estradiolu.

During the period between Jan.1, 1994 and May 31, 1996 at the Second Department of Gynaecology and Obstetrics in Brno preinduction was performed in 40 patients by means of PGE2 gel (Prepidil Upjohn) and in 38 patients by means of an estradiol gel (Biotika). The inclusion criteria in the group were: singleton pregnancy, 38 or more weeks of gestation, cephalic presentation, unripe cervix (Bishop score less than 5) and reactive NST. The gel was introduced into the cervical canal and left in situ for 12 hours. If maturation of the cervix occurred, induction was implemented by extraamnial administration of PGE2. In the group of patients preinduced with Prepidil there was a significantly greater increase of Bishop score and the first stage of labour was shorter during subsequent induction of delivery. As to other investigated parameters, the two methods did not differ significantly.

[Programmed labor--beneficial for the mother and fetus or an obstetrical hazard?]. / Programovaný porod, prospech pro matku a plod nebo porodnický hazard?

During the period between Jan. 1, 1992 and Dec. 31, 1995 at the Second Department of Gynaecology and Obstetrics 482 full-term pregnancies were terminated by elective induction of labour. Labour was induced by extraamnial administration of PGE2 (Prostin UPJOHN 3.0 mg tablets vag). Depending on the maturity of the portio uteri a maximum of two doses after two hours were administered: 0.5 mg PGE2 when the cervical score was > 8 and 1.0 mg PGE2 when the score was 5-8 points. The results were compared with 278 non-risk pregnant women who were delivered of babies between Jan. 1 and June 30, 1995. The first stage of labour was longer in patients with spontaneous labour. The second stage of labour was longer in patients with induced labour. From the results ensues that an elective induction of labour does not increase the perinatal risk for mother and foetus, and conversely if all conditions are respected it is better for the mother, her family and the staff of the labour ward.

[Labor induction with extra-amnial administration of PGE2 vaginal tablets]. / Indukce porodu extraamniální aplikací vaginálních tablet PGE2.

UNLABELLED: During the period between Jan. 1 1992 and Dec. 31, 1995 at the Second Department of Gynaecology and Obstetrics in Brno labour was induced in 1159 patients by extraamnial fractionated administration of PGE2 vaginal tablets. After assessment of the indication and the baseline examination (NST, amnioscopy, US biometry and cervical score) according to the CS to the patient the first dose of PGE2 was administered into the extraamnial space beyond the inner os uteri (CS 5-8:1.0 mg PGE2, CS > 8 : 0.5 mg PGE2). After two hours the patient was examined again and if regular uterine contractions had started or the finding on the os uteri was larger than 2 cm, the amniotic sac was disrupted. If not, another dose was administered. After two hours the patient was re-examined and if the os was larger than 2 cm, and there were regular uterine contractions, the amniotic sac was disrupted. If the changes did not take place, the induction was considered a failure. RESULTS: there were 1007 successful inductions (95.5%), the mean period from the onset of induction to the onset of uterine contractions was < 120 mins-269 (24.6%), 120-180 mins.: 501 (45.9%) and > 180 mins.: 322 (29.5%). The mean period of the first stage of labour was 228 mins., stage II 10 mins., stage III 8 mins. Five times uterine hypertonus was recorded and a blood loss greater than 500 ml occurred in four patients. Forty-nine Caesarean sections were made (4.2%) and 51 (4.4%) forceps deliveries. The rate of epidural analgesia was 27 (2.3%). Revision of the uterine cavity was made in 39 patients (3.4%) and manual lysis of the placenta in 30 (2.6%). The Apgar score was inferior to 6 in 10 neonates (0.9%). The protocol of induction of labour described by the authors is effective and associated with a minimum of side-effects, safe for the mother and foetus, well tolerated by patients and cost-effective.

[Induction of cervix ripening with hydrophilic Dilapan rods in pregnancy at term]. / Induktion der Zervixreifung mit hydrophilen Dilapan -Stäbchen bei einer Terminschwangerschaft.

During the period between July 1, 1993 and July 31, 1994 the authors preinduced 52 pregnant women in term using the cervical dilatator Dilapan. The group comprised patients with single pregnancies > 38 weeks, vertex presentation, cervical score < 5 and reactive NST. They introduced into the cervical canal 4 Dilapan rods for 12-18 hours and after extraction of the rods, depending on the finding, the patients were induced with Prostaglandin e.a. or oxytocin i.v. The preinduction was successful in 46 patients (88.5 per cent), in 16 patients (30.8 per cent) uterine contractions were induced by Dilapan alone. Forceps delivery was performed 4 times (7.7 per cent) and Caesarean section 12 times (23.1 per cent). Apart from pain in the hypograstrium resembling menstruation pain, no side-effects were recorded. There were no irregularities such as the length of labour stages, blood loss due to injury during labour and the incidence of neonatal hypoxia. Based on the described experience Dilapan can be recommended as a preinduction method for maturation of the portio uteri.

[Induction of cervical maturation using hydrophilic Dilapan rods in term pregnancy]. / Indukce zrání cípku hydrofilními tycinkami Dilapan u termínové gravidity.

During the period between July 1, 1993 and July 31, 1994 the authors preinduced 52 pregnant women in term using the cervical dilator Dilapan. The group comprised patients with single pregnancies > or = 38 weeks, vertex presentation, cervical score < 5 and reactive NST. They introduced into the cervical canal 4 Dilapan rods for 12-18 hours and after extraction of the rods, depending on the finding, the patients were induced with Prostin e.a. or oxytocin i.v. The preinduction was successful in 46 patients (88.5%), in 16 patients (30.8%) uterine contractions were induced by Dilapan alone. Forceps delivery was performed 4 times (7.7%) and Caesarean section 12 times (23.1%). Apart from pain in the hypogastrium resembling menstruation pain, no side-effects were recorded. There were no irregularities such as the length of labour stages, blood loss due to injury during labour and the incidence of neonatal hypoxia. Based on the described experience Dilapan can be recommended as a preinduction method for maturation of the portio uteri.

[Dilatation of the cervical canal with Dilapan before induced abortion in the first trimester of pregnancy in primigravidas]. / Dilatace cervikálního kanálu Dilapanem pred umelým ukoncením tehotenství v prvním trimestru u primigravid.

During the period between Oct. 1, 1993 and June 30, 1994 the authors inserted by the intracervical route in 32 primogravidae with unwanted pregnancies before abortion with pregnancies shorter than 8 weeks a hydrophil dilator Dilapan. After 12 hours the rod was removed under general anaesthesia and the pregnancy terminated by vacuum aspiration. In three instances after Dilapan insertion slight haemorrhage occurred which, however, did not call for removal of the rod. Apart from slight tenderness in the hypogastrium, similar as during menses, no side-effects were observed. In two instances during Dilapan extraction the rod was disrupted and the residue had to be removed by means of Kocher's forceps. In all patients the dilation of the cervical canal was sufficient for a 6 mm suction curette and further dilation of the cervix by means of metal dilators was not necessary. On examination after menstruation the patients did not report more massive bleeding nor febrile complications or residues. Based on the described results, the authors are of the opinion that gradual dilation of the cervix before abortion in the first trimester should be part of the procedure and all women who must face this situation should be given this opportunity.

Lifespan of subcutaneous glucose sensors and their performances during dynamic glycaemia changes in rats.

Performances of a glucose sensor have been investigated during dynamic variations of plasma glucose levels. Subcutaneous glucose concentrations measured by the sensors were calculated by a one-point calibration, performed in basal conditions. A first group of sensors were chronically implanted in the subcutaneous tissue of normal rats. The animals were submitted to glucagon and insulin injection, in order to induce rapid modifications of their glycaemia. This test was repeated at different days after implantation in order to investigate the lifespan and the performance of the sensors. All the sensors were working 1 or 2 days after implantation, and 70% adequately responded to glycaemia variations at day 3 or 4. The quality of the sensors' performance remained constant as a function of the time. With a second group of sensors, we demonstrated that an efficient sterilization procedure did not alter the sensors' characteristics. At the day of implantation, the sterilized sensors' performance, during dynamic variations of plasma glucose levels, was closely similar to that of the non-sterilized sensors. The animals bearing the sterilized devices were rendered diabetic by streptozotocin (STZ) injection. Once the rats had developed a severe hyperglycaemia (1-3 days after STZ), they were injected with intravenous insulin. The subcutaneously implanted glucose sensors correctly followed the decline in plasma glucose levels. We therefore conclude that our sensor could represent a useful tool for short-term continuous blood monitoring.

In-vivo behaviour of hypodermically implanted microfabricated glucose sensors.

The in-vivo behaviour of microfabricated GOD (glucose oxidase)/H2O2 glucose sensor implanted subcutaneously in normal anaesthetized rats has been studied. The sensor consists of a planar, three-electrode microcell, an enzyme membrane (glucose oxidase and bovine serum albumin cross-linked with glutaraldehyde) and an outer diffusion limiting polyurethane membrane. The sensor behaviour during hyperglycaemic (13.8 mM and 11.2 mM), euglycaemic (7.8 mM) and hypoglycaemic (3.5 mM) plateau levels was determined. The values of the in-vivo sensitivity (0.64 +/- 0.05 nA/mM) and background current (1.25 +/- 0.4 nA) were determined using a two-point calibration method and then used to calculate apparent subcutaneous glucose concentrations. The results show the presence of a good correlation between all the plasma glucose levels (G) and the apparent subcutaneous tissue concentrations (G'), with G' = 0.997.G - 0.066, r = 0.9782.

In vivo response of microfabricated glucose sensors to glycemia changes in normal rats.

A planar glucose sensor based on an amperometric detection of H2O2 is presented. The transducer part which is a planar three-electrode cell consisting of two Pt-electrodes and one Ag/AgCl-thin film electrode is realized using microelectronic technology. The overall dimensions are 0.8 mm x 3 mm x 0.38 mm and the working electrode area is 0.1 mm2. GOD is immobilized using glutaraldehyde as a cross-linking agent and bovine serum albumin as a carrier protein. The resulting membrane has a typical thickness of 25 microns. Also, an outer polyurethane membrane is dip-coated all around the tip of the electrode. The influence of pO2 on the sensor response as well as the sensor temperature coefficient, sensitivity and linear range have been investigated. The sensor has been tested in vivo in a subcutaneous tissue of anaesthetised rats. During experiments, blood sampling allows to measure changes in venous plasma glucose using a Beckman analyzer. The sensor response following hyperglycaemic clamps as well as intravenous glucose loads is discussed.