[Fetal hypotrophy dopplerometry]. / Dopplerometrie u hypotrofických plodu.

OBJECTIVE: The aim of the study was the longitudinal analysis of the progression of dopplerometric abnormalities in intrauterine growth retardation (IUGR) since the onset of placental insufficiency. DESIGN: Prospective study. SETTING: Dept. of Gynaecology and Obstetrics, Medical Faculty and University Hospital, Olomouc. METHODS: The study group consisted of 77 pregnat women with intrauterine growth retardation resulting from placental insufficiency. Of these, in 59 women, the intervals of progression were followed from the early to the advanced dopplerometric abnormalities. According to the findings the patients were classified into one of the three types of placental insufficiency. RESULTS: In total, 486 dopplerometric measurements in 77 pregnant patients were performed. Mild placental insufficiency where abnormality of umbilical artery (UA) and cerebroplacental ratio (CPR) did not exceed 3 SD and the progressive interval was 31 days was found in 21 pregnat patients. Progressive placental insufficiency with a whole spectrum of abnormalities and the progressive interval of 18 days was found in 28 pregnat patients. Severe form of placental insufficiency (early onset of abnormalities before the 30th gestational week) a whole spectrum of abnormalities and progressive interval 8 days was found in 10 pregnat patients. CONCLUSIONS: Gestational week at the occurence of the first abnormality (elevation of the pulsatility index of UA over 2 SD) and the time interval to next abnormality (decrease of CPR under 2 SD) are important factors for the assessment of severity of placental insufficiency. Dynamic follow-up of abnormalities permits a better evaluation of the actual risk, the anticipation of the further development of placental insufficiency and in this way to apply suitable measures to prevent unfavourable perinatal outcomes.

[Pregnant women alloimmunisation of non-RhD erythrocyte antigens: review article]. / Aloimunizace tehotných zen non-RhD erytrocytárními antigeny: prehledový clánek.

OBJECTIVE: The aim of this review is to give comprehensive summary on alloimmunisation of non-RhD erythrocyte antibodies. DESIGN: Review. SETTING: Department of Obstetrics and Gynecology, University Hospital Ostrava, Department of Obstetrics and Gynecology, University Hospital Olomouc. SUBJECT AND METHOD: Based on literature analysis using database search engines PubMed, Google Scholar, Ovid and Proquest in field of non-RhD erytrocyte antibodies, there has been summarized up-to-date knowledge on irregular antibodies. CONCLUSION: Pregnant women alloimmunisation of non-RhD erythrocyte antigens gather importance in conjunction with relative increase of their occurence. Profylaxis is not possible. Although these erythrocyte antigens are able to induce antibody responce in mother and result in subsequent hemolytic disease of fetus and newborn. There are discussed most frequent non-RhD antibodies in the paper.

[Possibility to identify fetomaternal haemorrhage]. / Moznosti stanovení fetomaternální hemoragie.

UNLABELLED: Fetomaternal haemorrhage (FMH) is a status characterised by penetration of fetal blood into the maternal circulation which happens mostly at delivery. FMH may cause erythrocytal alloimmunisation of woman. That is why anti-D immunoglobulin (IgG anti-D) is being administered to RhD negative women after delivery of RhD positive fetus. IgG anti-D is administered to RhD negative women standardly and in much greater quantities than is actually necessary. However, on the other hand, it is not possible to diagnose cases where a greater dose is required. To optimalise prevention of RhD alloimmunization in RhD negative women, it is important to diagnose conditions where fetomaternal haemorrhage (FMH) occurs, precisely define its volume and consequently administer the required dose of IgG anti-D. The ability to reliably detect fetomaternal haemorrhage (FMH) and precisely define its volume would allow better and less expensive prevention of RhD alloimmunization in RhD negative women. IgG anti-D could thus be administered only in cases that are actually indicated and only in doses necessary for preventing RhD alloimmunization. Accurate quantification of FMH is determined by flow cytometry. DESIGN: Review. SETTING: Department of Obstetrics and Gynecology, Department of Alergology and Clinical Immunology, University Hospital Olomouc.

[Molecular prognostic factors and pathogenesis of endometrial cancer]. / Molekulární prognostické faktory a patogeneze endometriálního karcinomu.

OBJECTIVE: To evaluate the importance of molecular markers for prognosis and pathogenesis of endometrial carcinoma. DESIGN: A review article. SETTING: Department of Medical Genetics and Fetal Medicine, University Hospital, Olomouc, Department of Obstetrics and Gynecology, University Hospital, Olomouc. METHODS: This article reviews the current knowledge of the molecular changes in the development of endometrial cancer, and their possible importance for the patient's prognosis. CONCLUSION: The new molecular biomarkers are apparently going to play a significant role in the management of endometrial carcinoma treatment in the near future.

[Discrepancy of ultrasound biometric parameters of the head (HC--head circumference, BPD--biparietal diameter) and femur length in relation to sex of the fetus and duration of pregnancy]. / Diskrepance ultrazvukových biometrických parametru hlavicky (HC--head circumference, BPD--biparietal diameter) a délky stehenní kosti (FL--femur lenght) v závislosti na pohlaví plodu a délce tehotenství.

OBJECTIVE: To compare female and male fetuses in terms of intrauterine ultrasound growth measurements (HC--head circumference, BPD--biparietal diameter, FL--femur lenght) depending on gestational age. DESIGN: A prospective study. SETTING: Department of Obstetrics and Gynecology, Department of Medical Genetics and Fetal Medicine, Department of Preventive Medicine, University Hospital, Olomouc. METHODS: All ultrasound biometric measurements were performed according to the methodology published with the reference charts. Risk pregnancies, multiple pregnancies and breech presentations were excluded. RESULTS: Fetal HC, BPD and FL were measured in 427 ultrasound examinations at 16-38 weeks. Male fetuses had significantly larger HC and BPD measurements compared to female fetuses and these differences increased with advancing gestation. In the 16-21 week scans estimated difference was (HC + 3.9 days, 3.0% and BPD + 4.1, 3.2%), during the 21-30 week scans (HC + 6.8 days, 4.3% and BPD + 6.9, 4.4%) and in the 31-38 week scans (HC + 12.3 days, 5.6% and BPD + 12.9, 5.9%) for males. Male fetuses had significantly larger HC compared to FL measurements. In the 16-21 week scans, estimated difference was + 2.1 days (95%CI 1.7-2.6, P < 0.001), during the 21-30 week scans + 3.4 days (95%CI 2.5-4.2, P < 0.001) and in the 31-38 week scans + 9.7 days (95%CI 7.3-12.1, P < 0.001). CONCLUSION: This study suggests that male fetuses have significantly larger head circumference (HC) and biparietal diameter (BPD) measurements compared to female fetuses. These prenatal sex-related differences are established by as early as 16 weeks of gestation and tend to increase with advancing gestational age. In the case of discrepancy finding between head (HC, BPD) and femur lenght (FL) measurements the fetal gender should be taken into account.

[Prevention of Rh (D) alloimmunization in Rh (D) negative women in pregnancy and after birth of Rh (D) positive infant]. / Prevence Rh (D) aloimunizace u Rh (D) negativních zen v tehotenství a po porodu Rh (D) pozitivního dítete.

OBJECTIVE: The objective of this review was to assess the effects of antenatal anti-D immunoglobulin on the incidence of Rhesus D alloimmunization when given to Rh-negative women without anti-D antibodies and assess the effects of giving anti-D to Rhesus negative women, with no anti-D antibodies, who had given birth to a Rhesus positive infant. DESIGN: A review article. SETTING: Department of Obstetrics and Gynecology, Department of Medical Genetics and Fetal Medicine, University Hospital, Olomouc, Ministry of Health, Czech Republic. SUBJECT AND METHOD: We searched the Cochrane Pregnancy and Childbirth Group trials register, refence lists of relevant articles and bibliographies. CONCLUSION: The risk of Rhesus D alloimmunization during or immediately after a first pregnancy is about 1%. Administration of 100 microg (500 IU) anti-D to women in their first pregnancy can reduce this risk to about 0.2% without, to date, any adverse effects. Anti-D, given within 72 hours after childbirth, reduces the risk of RhD alloimmunization in Rhesus negative women who have given birth to a Rhesus positive infant. However the evidence on the optimal dose is limited.

[Development of incidence of post-dural puncture headache in patients undergoing caesarean section in spinal anaesthesia at the Department of Obstetrics and Gynecology in Olomouc during 2003-2004]. / Vývoj incidence postpunkcní cefalei po spinální anestezii pro císarský rez v olomouci v letech 2003-2004.

BACKGROUND: Paper gives the analyse of the incidence of post-dural puncture headache in patients undergoing caesarean section in spinal anaesthesia at the Department of Obstetrics and Gynecology in Olomouc in 2003-2004. METHODS AND RESULTS: Post-dural puncture headache following caesarean section in spinal anaesthesia in 2003 was retrospectively analysed. Subsequently, measures to reduce the incidence of this complication (use of Whitacre and Atra ucan needles) were implemented. 2004 patients were followed prospectively. 54 caesarean sections - 16.3% (54/331) were performed in spinal anaesthesia in 2003. Following needles were used to establish spinal blockade: Quincke 22G - 35.2% (19/54), Quincke 25G - 50% (27/54), Atraucan 26G - 14.8% (8/54). Post-dural puncture headache occurred in 9 cases - 16.6% (9/54) (22G - 7x, 25G - 2x), the onset of symptoms occurred after 24 to 65 hours after the spinal blockade (mean 41.7). It was necessary to perform epidural blood patch (EBP) in 7 cases - 77% (7/9) - 12.9% (7/54) (22G - 5x, 25G - 2x). Epidural blood patch (EBP) was performed after 7 to 45 hours after the onset of symptoms (median 28.4). The age of patients at the time of delivery ranged between 22 to 43 years (median 34.5). 36 caesarean sections - 8.4% (36/426) were performed in spinal anaesthesia in 2004. Following needles were used to establish spinal blockade: Whitacre 27G - 63,9% (23/36), Atraucan 26G - 13,9% (5/3), Quincke 25G - 11,1 (4/36), Quincke 22G - 11,1% (4/36). Post-dural puncture headache (PDPH) occurred in 3 cases - 8.3 (3/36) (25G - 1x, 22G - 2x), the onset of symptoms occurred after 24 to 54 hours after spinal blockade (median 36.0). It was not necessary to perform epidural blood patch. The age of patients at the time of delivery ranged between 22 to 39 years (median 28.5). CONCLUSIONS: Incidence of post-dural puncture headache (PDPH) is significantly higher in pregnant women and in puerperal period compared to general population. The use of appropriate needles for spinal blockade and adequate level of anaesthesiologist's skills lead to lower incidence of post-dural puncture headache (PDPH) after caesarean section performed in spinal anaesthesia.

[Prenatal parvovirus B19 infection in fetus]. / Prenatální infekce plodu parvovirem B19.

OBJECTIVE: To analyse 3 cases of parvovirus B19 infection in a pregnant woman followed by transplacental transmission to the fetus. DESIGN: A reprospective study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Olomouc. METHOD: Parvovirus B19 vertical transmission from a pregnant woman to the fetus was diagnosed in 3 cases. Serologic testing of IgG and IgM antibodies against parvovirus B19, cytological bone marrow examination and parvovirus B19 DNA analysis by PCR methods were performed. The fetal anemia was predicted by measurements of peak systolic velocities in the middle cerebral artery (MCA-PSV). RESULTS: There were three pregnancies in all (1st - single, 2nd and 3rd - dizygotic twins). In the 1st and 2nd pregnancy the diagnosis of parvovirus B19 infection was set on the basis of erythroblastopenia diagnosed in the neonatal period or early infancy. In the 2nd pregnancy (dizygotic twins) intrauterine death of one twin occured. In the 3rd case (dizygotic twins) the diagnosis was already set in the 20th week of pregnancy. Subsequently the fetal anemia was predicted by doppler examination. The fetuses did not require invasive intrauterine intervention and mild anemia was diagnosed after delivery. Progressive intrauterine growth retardation of one twin was observed. Neither cardiomegaly nor fetal hydrops did not occur. All mothers were asymptomatic during the whole pregnancy. CONCLUSION: Parvovirus B19 infection should be excluded in all cases of nonimmune fetal hydrops, severe fetal anemia, cardiomegaly, intrauterine growth retardation (IUGR) and chronic erythroblastopenia diagnosed in the neonatal period or early infancy. The presence of IgM and IgG antibodies against parvovirus B19 is highly specific but their negativity is insufficient for the exclusion of a parvovirus B19 infection. Viral DNA testing by PCR method is the only reliable method available.

[Contribution of Doppler examination in pregnancy at risk of alloimune fetus anemia]. / Prínos dopplerovského vysetrení pro tehotenství s rizikem alloimunní anémie plodu.

OBJECTIVE: To evaluate the utilisation measurements of peak systolic velocities in the middle cerebral artery (MCA-PSV) to predict fetal anemia in pregnancies complicated by alloimmune antibodies known to cause immunological hydrops. DESIGN: A prospective study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Olomouc. METHODS: In 38 pregnancies at risk for fetal anemia due to maternal red-cell alloimmunization MCA-PSV had been assessed and fetal blood sampling for measurement of hemoglobin concentration was obtained subsequently, either by cordocentesis or at delivery. RESULTS: 66 examinations were performed at 19-37 week's gestation. An MCA-PSV >1.5 MoM detected 100% of severely anemic fetuses with a hemoglobin concentration <0.65 MoM that required invasive intervention. In 18 cases a cordocentesis was performed and intrauterine blood transfusion was given alternatively. Remaining fetuses did not require invasive intrauterine intervention and no or mild hemolytic anemia and hyperbilirubinemia were diagnosed after delivery. No false positive case was identified (enregistered). The median maternal age at the term of delivery was 29.1 (range, 19-41) years. CONCLUSION: Middle cerebral artery peak systolic velocity is a highly sensitive non-invasive means for determining the degree of anemia. A Doppler interval of seven days is recommended.

[The effectiveness and complications of ovarian transposition in young women with cervical cancer]. / Prínos a rizika transpozice ovarií u mladých zen s ca cervicis uteri.

OBJECTIVE: To discuss the indications, effectiveness, and complications of ovarian transposition before pelvic irradiation for cervical cancer. DESIGN: A review article. SETTING: Department of Obstetric and Gynecology, University Hospital, Olomouc. SUBJECT AND METHOD: A review from literature and bibliographic databases. CONCLUSION: Ovarian transposition gives an option for preserving ovarian function in patients treated by radiosurgical combination. In young women preservation of ovarian function by means of ovarian transposition brings them some positive benefits compared to conventional HRT. The main risk of ovarian transposition--a possibility of ovarian or distant metastasis--increases particularly depending on clinical stage and histopathological type of the tumor. However the risk of ovarian metastasis is very low for patients with squamosus cell carcinoma of the cervix in stages IA-B.

[Doppler blood flow velocity in the evaluation of fetal anemia]. / Dopplerometrie pri posouzení fetální anémie.

OBJECTIVE: To review (summarize), in maternal red blood cell alloimmunization, the diagnostic value of Doppler blood flow velocity in the evaluation and prediction of fetal anemia. DESIGN: A review article. SETTING: Department of Obstetric and Gynecology, University Hospital, Olomouc. SUBJECT AND METHOD: A review from literature and bibliographic databases. CONCLUSION: Invasive techniques such as amniocentesis and cordocentesis traditionally are used for diagnosis and treatment in fetuses at risk for anemia due to maternal red-cell alloimmunization. Middle cerebral artery peak systolic velocity is a highly sensitive non-invasive means for determining the degree of anemia. The interval of seven days between two Doppler tests is recommended. The widespread use of the Doppler method will minimize fetal complications associated with amniocentesis and fetal blood sampling and may significantly lower health care cost.

[Color and duplex Dopplerometry in the prenatal diagnosis of congenital developmental defects]. / Barevná a duplexní dopplerometrie pri prenatální diagnostice vrozených vývojových vad.

OBJECTIVE: Impact of Doppler system in detection of congenital malformations during prenatal diagnosis. DESIGN: Prospective clinical study. SETTING: Department of Medical Genetics and Foetal Medicine, Department of Obstetrics and Gynaecology University Hospital Olomouc. METHODS: In 34 pregnancies with prenataly diagnosed congenital malformation the umbilical artery pulsatility index (PI) and middle cerebral artery PI were assessed. RESULTS: Abnormal Doppler patterns were obtained in 18 patients (chromosomal abnormalities--3x, gastroschisis--2x, diaphragmatic hernia--2x, urinary tract abnormalities--2x, internal hydrocephalus--4x, microcephaly, anencephaly, encephalocoele, non-immune hydrops of the fetus, thoracopagus--1x). CONCLUSIONS: In accordance to the literature abnormal Doppler patterns in umbilical artery were obtained in trisomy 21 foetuses. The use of umbilical artery PI or ductus venosus PI in the first trimester of pregnancy as an additional parameter for screening purposes needs to be confirmed by further investigation (needs to be further explored). Pulsed Doppler waveform analysis gives a possibility to appreciate the functional state of the foetus. In our patient group abnormal Doppler patterns were found in such substantial congenital malformations that they indicated pregnancy termination themselves. On the other hand in several similar morphological defects normal Doppler patterns were found. In these cases, in regard to the type of malformation, the Doppler appreciation of foetal functional state was not prognostically significant.