[On-line evaluation of the cardiotocogram using computer technology]. / Hodnocení kardiotokogramu on-line pomocí výpocetní techniky.

For an analysis of the cardiotocogram obtained by the fetal monitor HP 8040A the authors used original hardware and software means, i.e. PC XT IBM compatible in connection with an intelligent analog input periphery, which preprocesses the basic information, and with a programme using a scheme originating from the Maeda's evaluation of CTG modified by Srp. After having obtained 25 tracings (more than 8.5 hours), a detailed analysis of the computer interpretation of each course was performed, i.e. of the description of individual pathogenomic phenomena of the type of baseline heart rate, amplitude of variability, accelerations and decelerations including time parameters and mutual correlations. The results of the statistic evaluation are discussed, above all those concerning the decelerations, where the interpretation is so far burdened by a higher false negativity. Proposals for further elaboration of the programme means are presented including the optimalisation of the scheme used in evaluation, the running graphic presentation of the results and further graphic outputs for documentation purposes.

[Determination of gestational age by ultrasound]. / Overování gestacního stárí ultrazvukem.

The authors elaborated a procedure for correction of the gestation age by ultrasonic examination in pregnant women in the second and third trimester of gestation. The method was tested in a group of 500 pregnant women who were examined within the framework of a special ultrasound screening. In 5% of the group the gestation age calculated according to the last menstrual bleeding was not consistent with the results of the ultrasound examination. In these instances a correction was made in case the difference between the ultrasonic finding and the gestation age according to menstruation was two weeks or more, in the first as well as second trimester. In these instances the correction was made with regard to the difference in the first trimester. In the group of women where the correction was made there was in 44% a case-history of irregular menstrual cycles, as compared with 13% in the group where the ultrasonic finding was consistent with the gestation age according to the date of menstruation. In the majority of women (73%) with a shift of the conceiving ovulation the difference of the ultrasonic finding, as compared with the gestation age according to the last menstruation was three weeks or more.

[Evaluation of the suitability of labor induction using the oxytocin stress test]. / Stanovení vhodnosti indukce porodu pomocí zátezového oxytocinového testu.

The authors elaborated an oxytocin loading test with a continual increase of oxytocin, which was used not with regard to the antepartal threat to the foetus but at the same time also for assessing whether induction of labour is advisable. This criterion was not mentioned in the literature so far. For evaluation of the sensitivity of the uterus the mutual association of the index of the uterine cervix, the number of days before childbirth and the necessary dose of oxytocin was used. If the required three contractions developed within the time interval of 10 mins. after the smallest oxytocin dose, the sensitivity of the uterine muscle was evaluated as good, after the double dose as medium, after the largest dose of oxytocin as weak sensitivity. The results of the thus arranged oxytocin loading test are above the borderline of the screening test and pass into the zone of a diagnostic method. To verify this important fact it is necessary to test according to epidemiological criteria the results attained in this so-called "preliminary" group in a more extensive "test" group.

Countrywide analysis of perinatal outcome.

The computer laboratory of the Research Institute for the Care of Mother and Child in Prague performs annually a countrywide analysis of perinatal outcome in order to obtain a background for the preparation of the optimal strategy for improving perinatal care in CSR in the future. The total as well as weight specific perinatal mortality rate further sub-divided into early neonatal death rate and late fetal death rate and differentiated according to the birthweight, was correlated with the incidence of different factors influencing the perinatal mortality rate both countrywide and for each of the eight provinces of CSR. This way a correlation was found between some of the mentioned perinatal outcomes and e.g. instrumental equipment of obstetrical departments and neonatal intensive care units, frequency of caesarean sections, or transport of LBW newborns in incubators or "in utero" etc. The results of this analysis have proved that there still remain in some provinces opportunity for further decrease in perinatal mortality due to the incomplete observance of the two intervention strategies "Risk approach" and "New technology" which were introduced in the whole country during the last 10 years.