[Posterm pregnancy]. / Potermínové tehotenství.

UNLABELLED: This review presents the up-to-date information from published resources on the issue of Posterm pregnancy (Medline, Cochrane Database, ACOG, RCOG, SOGC) and complements the presented guidelines. The most of resources are using the term "postterm pregnancy" for pregnancy reaching or exceeding 42+0 weeks and days of gestation, while late pregnancy is defined as a period in between 41+0 and 41+6.The exact determination of gestational age is necessary for exact diagnosis and appropriate management of late and postterm pregnancy, because these pregnancies have increased risk of perinatal morbidity and mortality. DESIGN: Review.

[Current status and recommendations for intrapartum monitoring of fetal heart rate]. / Soucasné moznosti a doporucení pro intrapartální monitorování ozev plodu.

UNLABELLED: Monitoring of fetal heart rate is one of the basic components of obstetrical care, in which the cardiotocography remains the gold standard and screening method in early diagnosis of fetal hypoxia, even after introduction of other selective methods of intrauterine monitoring of fetal well-being. The review article is divided into several parts: pathophysiology of fetal oxygenation, fetal heart rate and changes of fetal hemodynamics, and rules for fetal heart rate auscultation. The main principles of cardiotocographic monitoring and evaluation of ante- and intrapartrum recordings according to the FIGO criteria from 1986 and evaluation of intrapartum recordings according to the 2015 FIGO recommendations are mentioned. At the end a comparative table of 1986 FIGO and 2015 FIGO criteria is presented. DESIGN: Review.

[Intrauterine fetal death syndrome: analysis of cases from 2008 to 2012 in Institute for the care of mother and child]. / Syndrom intrauterinního úmrtí plodu: analýza souboru za období 2008-2012 v Ústavu pro péci o matku díte

OBJECTIVE: We made an analysis of number of intrauterine fetal deaths in our institute, it's causes, risk factors and patient's main complaints. METHODS: Retrospective study of all intrauterine fetal deaths in Institute for the care of mother and child in years 2008-2012. RESULTS: We had 60 cases of intrauterine fetal death from 2008 to 2012 which represented 2.4 of all deliveries (24884). The examination started in 45% of cases due to information about decreased fetal movements, 28.3% was diagnosed during regular visit, 13.3% came for contractions, 10% because of PPROM and 3.3% due to vaginal bleeding. In 58.3% we used induction of delivery, in 10% delivery started spontaneously and in 31.7% a caesarean section was performed. CONCLUSION: Decrease in fetal movements was the most frequent complaint of our patients. Spontaneously delivered 68.3% patients, caesarean section was indicated in twins, due to maternal diseases or from vital indication. In 70% of cases we approved the cause of intrauterine fetal death. Mostly umbilical cord or placental abnormalities were present.

Immunological and biochemical markers in preeclampsia.

A basic precondition for the development of preeclampsia is the presence of placental trophoblast cells in the maternal blood circulation. On the other hand, while trophoblast cells are present in the blood of all pregnant women, preeclampsia occurs in only 2-5% of them. Evidently, other factors play a crucial role. The aim of this study was to compare a set of selected immunological factors (anti-cardiolipin autoantibodies, trophoblast-induced cell-mediated immunity, C3 and C4 complement components) and biochemical factors (serum immunoglobulins IgA, IgG, IgM) among three groups of women with uncomplicated pregnancy, gestational hypertension, or preeclampsia. Blood samples were taken 2-12h before delivery. In the preeclampsia group, there was a significantly higher number of women positive for anti-cardiolipin autoantibodies, trophoblast-induced cell-mediated immunity was elevated, serum IgG was elevated and C4 complement component was reduced. We conclude that both elevated autoimmune reactivity and the higher immune reactivity to trophoblast may contribute to the onset of preeclampsia.

[Peripartal life-threatening hemorrhage - interdisciplinary consensus opinion]. / Peripartální zivot ohrozující krvácení - mezioborové konsenzuální stanovisko.

22 experts from the fields of gynecology and obstetrics, anesthesiology and resuscitation, intensive care, hematology and transfusion medicine has developed recommendations for diagnosis and procedure for life-threatening peripartum haemorrhage, which is still one of the most common causes of maternal mortality in childbirth. This guidelines, which is valid for the Czech Republic, supported by a total of 10 professional medical societies. There are based on new knowledge applicable at this time and is focused mainly on eliminating the most common causes of bleeding during delivery and prevention of haemorrhagic shock.

[Use of ultrasound in labor]. / Vyuzití ultrazvuku v peripartálním období.

In the managing of labor, the obstetrician gets often to the border situations especially at the end of the second stage of labor, where only accurate diagnosis allows the make correct decisions on how to end the delivery. Since clinical vaginal examination does not always give complete informations about station and rotation of the head, the intrapartum fetal ultrasound showing the fetus inside the birth canal can refine and document the diagnosis and help us to decide.

[Monitoring of endothelial activation markers during physiological pregnancy]. / Monitorování hladin markeru aktivace endotelu behem fyziologické gravidity.

AIM OF THE STUDY: To establish endothelial activation markers which could uncover endothelial damage during physiological pregnancy. TYPE OF STUDY: Prospective study. METHOD: We examined 403 pregnant women with a physiological pregnancy. Venous blood samples were collected from the women at the beginning of the pregnancy, a second sample was collected in the interval 24-28 weeks gestation. Parameters were examined using methods: t-PA--ELISA, PAI-1--ELISA, vWF Ag--EIA ePCR--ELISA, MMP-2,9--ELISA with fluorogenic detection, TIMP-2--ELISA, endothelial microparticles - flow cytometry. RESULTS: The level of vWF antigen increased during the entire course of pregnancy (in the I. trimester the average level was 152.32%, in the II. and III. trimester 173.34% and 216.20% respectively). At the same time, vWf activity also increased (I. trimester average level 130.20%, II. and III. trimester 150.09% and 181.91% respectively). The level of thrombomodulin significantly increased during pregnancy (I. trimester average level 19.05 ng/ml, II. and III. trimester 28.47 ng/ml and 39.86 ng/ml respectively). The level of soluble form of EPCR increased during pregnancy (I. trimester average level 201.76 ng/ml, II. and III. trimester 274.68 ng/ml and 324.07 ng/ml respectively). The level of PAI-1 increased during the entire course of pregnancy (I. trimester average level 36.14 ng/ml, II. and III. trimester 50.07 ng/ml and 60.12 ng/ml respectively). The level of t- PA did not change significantly during the course of pregnancy (I. trimester average level 2.48 ng/ml, II. and III. trimester 2.97 and 3.34 ng/ml respectively). The levels of MMP-2 (I. trimester average level 9043.76 RFU, II. and III. trimester 9315.38 and 8800.27 RFU respectively), MMP-9 (I. trimester average level 8371.90, II. and III. trimester 8290.81 and 7470.50 respectively), TIMP-2 (I. trimester average level 92.5 ng/ml, II. and III. trimester 98.5 and 96.5 ng/ml respectively) or endothelial microparticles (I. trimester average level 3838.38 particles/microl, II. and III. trimester 3836.59 and 3650.59 particles/microl respectively) did not change significantly throughout the individual trimesters. CONCLUSION: We confirmed the hypothesis regarding the significant influence pregnancy has on changes in levels of these markers.

[Endotelial activation markers--possibilities of their detection and clinical signification in gynaecology and obstetric]. / Markery aktivace endoteliálních bunek--moznosti jejich vysetrení a klinický význam v gynekologii a porodnictví.

OBJECTIVE: Summary of the current knowledge of the role of endotelial activation markers in the pathogenesis of the selected diseases and high-risk pregnancy. DESIGN: Review article. METHODS: Compilation of the published data from scientific literature. CONCLUSIONS: The endothelium functions in a multitude of physiological processes including the control of cellular trafficking, the regulation of vasomotor tone and maintenance of blood fluidity. Preeclampsia is compared by the the insufficient trofoblastic invasion to the maternal spiral arteries. This changes lead to the insufficiency of the fetoplacental blood flow. The ischaemia of the fetoplacental unit cause the release of specific factors into maternal vessels and subsequent activation of the endothelium and vasoconstriction. We present a short summary of the clinically important endothelial markers and current possibilities of laboratory testing.

[Influence of antenatal steroids on perinatal mortality and morbidity in extremely low birth weight newborns]. / Vliv antenatálních steroidu na perinatální mortalitu a morbiditu u novorozencu extrémne nízké porodní hmotnosti.

UNLABELLED: Recently used antenatal steroids for induction of fetus lung maturity remain as standard procedure in the treatment of premature labour. However, the effect of antenatal steroids to the fetus may not be only the positive one. OBJECTIVE: Investigate the role of antenatal steroids on total mortality and severe morbidity in extremely low birth weight newborns under 1000 grams. DESIGN: Comparative case-control study. SETTING: Institute for the Care of Mother and Child, Prague, Czech Republic. METHODS: Antenatal steroids were used in 55 cases (group ANS+) and no steroids were used in 65 control newborns (group ANS-). Both study groups were comparable in birth weight, gestational age, gender, mode of delivery and presence of intrauterine growth retardation. Statistical significant difference was in time of premature rupture of membrane (ANS+ 108+/-228 hrs versus ANS- 27+/-56 hrs, p<0.007). The Epi Info 6 (CDC, U.S.) software package and ANOVA was used for statistical analysis. RESULTS: We have found statistical significant differences in total mortality (ANS+ 22%, ANS- 45%, p<0.008), in severity of respiratory distress syndrome (ANS+ median 2, ANS- median 3, p<0.0008), in total cumulative dose of surfactant (ANS+ 73 mg, ANS- 111 mg, p<0.0003), in the incidence of periventricular-intraventricular haemorrhage (ANS+ median 1, ANS- median 2, p<0.005) and posthaemorrhagic hydrocephalus (ANS+ 6%, ANS- 23%, p<0.008). Statistical significant differences were also in CRIB value (ANS+ median 7, ANS- median 11, p<0.007) and NEOMOD value (ANS+ median 5, ANS- median 7, p<0.002). In the other parameters (pneumothorax, sepsis, patent ductus arteriosus, necrotizing enterocolitis, periventricular leukomalacia) no statistical differences were found. CONCLUSIONS: Our study confirmed positive effect of antenatal steroids on mortality, severe respiratory morbidity and incidence of intraventricular haemorrhage. No negative effect of antenatal steroids to higher frequency of infection complications and/or periventricular leukomalacia was observed.

[Premature rupture of fetal membranes]. / Predcasný odtok plodové vody.

OBJECTIVE: Review of issues of premature rupture of membranes. DESIGN: Review article. SETTING: Institute for the Care of Mother and Child, Prague, Czech Republic, Department of Gynaecology and Obstetrics, Institute for Postgraduate Medical Education, Prague, Czech Republic, Department of Gynaecology and Obstetrics, Charles University Hospital, Pilsen, Czech Republic. METHODS: Critical review of available information on issues of premature rupture of membranes with special attention to recommended procedures. RESULTS: Incidence of premature rupture of membranes varies from 4.5% to 14% and in about 30% of cases it is a cause of preterm delivery, and therefore it contributes substantially to perinatal and infant mortality and morbidity. To minimize this effect, recommended procedures are stipulated. Different types of clinical situations are evaluated and specific measures listed to provide practical guidelines based on available information. CONCLUSIONS: Premature rupture of membranes is an important topic in perinatology and proper management can affect pregnancy outcome. This article provides up-to-date recommended procedures in particular situation during pregnancy with focus on practical measures.

[Pregnancy and labor in diabetes from the viewpoint of the obstetrician]. / Tehotenství a porod diabeticky z pohledu porodníka.

Diabetes of all types is a known complication of pregnancy and is a risk for mother and foetus. Despite significantly improved care of pregnancies complicated by diabetes the perinatological results are still somewhat worse than in the healthy population. Therefore in the further improvement of perinatological indicators preconception care participates as well as systematic compensation of insulin dependent diabetes, preventive admission on hospital and correct timing of termination of pregnancy in pregestational as well as in gestational diabetes. All care of these pregnancies is shared by the obstetrician and diabetologist.

[Problems in inducing pulmonary maturation in relation to premature delivery]. / Problematika indukce plicní zralosti ve vztahu k predcasnému porodu.

At presents efforts are made to find valid early markers of premature delivery and if it is inevitable to use an optimal therapeutic protocol for induction of pulmonary maturity which may lead to reduction of early neonatal mortality and morbidity (intraventricular-periventricular haemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, air-leak syndrome, respiratory distress syndrome--RDS). Hitherto used corticoid monotherapy reduced the incidence of RDS in neonates with a birth weight lower than 1500 g but the incidence is still relatively high and RDS is still one of the main causes of death of immature neonates. Even the use of thyrotropic hormones did not reduce its incidence. Another possible therapeutic approach is ambroxol administration in combination with corticoids. In the presented review the authors discuss the problem of optimal induction of pulmonary maturity in relation to premature delivery.

Activity of the antioxidant enzymes superoxide dismutase and glutathione peroxidase in fetal erythrocytes.

It is generally accepted that the balance between the formation and inactivation of reactive oxygen species may be abolished within the perinatal period, as a consequence of rapid changes in tissue oxygen concentration and the development of antioxidant defence enzyme activities. We studied the ontogeny of the antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx) in fetal blood samples. The activity of SOD in fetal erythrocytes taken in the 17th gestational week was the same as that in erythrocytes of healthy blood donors. On the other hand, GPx activity was significantly lower between the 17th and 25th gestational week and at the time of delivery, compared with the healthy adult control. Our results suggest that the supposed underdevelopment of the antioxidant system in the lungs or in the other organs of premature infants cannot be monitored by SOD and GPx activities in erythrocytes, because these reach adult levels before the 17th week for SOD and from the 26th to the 35th gestational week for GPx, with lower levels from the 17th to the 25th week and at term.