[Birth hypoxia]. / Porodní hypoxie.

OBJECTIVE: Evaluation of the commonly used laboratory and clinical parameters of the newborn shortly after birth. Check thresholds acidemia, and in relation to the method of termination of pregnancy. DESIGN: Retrospective epidemiological study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Olomouc. METHODS: Of the 26,869 children born in the years 2000 to 2013 Inclusion criteria (complete clinical and laboratory findings after birth) fulfill 23,471 (87.4%) neonates. Methods for evaluation of newborns included Apgar score calculation and arterial umbilical cord blood pH and lactate analysis. RESULTS: A total of 0.7% (157) of the neonates had severe acidosis pH below 7.00 arterial umbilical cord blood, its prevalence varies annually between 0.1 to 1.1%. Cutoff lactate in relation to pH < 7.00 was 6.3 mmol/l (n = 23 471, the sensitivity of 92.99%, specificity 92.15%, AUC = 0.972). For children of low weight < 2500 g the cutoff value is lower, 5.3 mmol/l (n = 2592, 89.66% sensitivity, specificity 91.10% AUC = 0.912). Suprathreshold lactate values was 8.4% (1977) newborns. Correlation of pH and lactate to Apgar evaluation is very low and in the range from 1 to 10 minutes gradually decreases. Worse Apgar evaluation in children of low birth weight do not correspond to laboratory findings acidosis, which is probably related to prematurity and lower energy reserves. Operating cesarean births in particular accounts for more than half of those with worse clinical findings Apgar and pH <7.00, but only 30% supratreshold lactate values. Also worse clinical evaluation after caesarean section is not in accordance with the laboratory findings. Vaginal surgery, especially forceps have a significant share of severe acidosis than cesarean, regardless of their frequency. Risk factor of forceps to pH less 7.00,OR = 9.28 (5.39 -15.77), P = 0.0000000, while caesarean to pH less 7,00 had OR = 1.52 (1.08 to 2.14), P = 0.01408156. CONCLUSION: The results obtained confirm that acidosis after birth is quite common, although they may not have response on the clinical condition of the newborn after birth. Evaluation of Apgar is little objective for the detection of hypoxia during birth and is influenced by the immaturity of newborn and method of delivery. Lactate levels may contribute to an objective assessment of hypoxia during birth. Values above 6.3 mmol/l can be considered an important indicator of newborn acidosis and birth hypoxia.

[Births of children of low and very low weight at the University Hospital in Olomouc (1993-2011)]. / Porody detí nízké a velmi nízké porodní hmotnosti ve Fakultní nemocnici v Olomouci (1993-2011).

OBJECTIVE: Evaluation of the births of children of low and very low weight, analysis of factors that may influence low birth weight and selected indicators to assess the state of the neonate after birth. DESIGN: Retrospective epidemiological cohort study. SETTING: Department of Gynaecology and Obstetrics, Faculty of Medicine and University Hospital Olomouc. METHODS: Evaluation of maternal and newborn records from databases. The studied data set includes 33,126 births of children born in the period from 1. 1. 1993 to 31. 12. 2011 at the University Hospital in Olomouc. In sub-analyzes are compared subgroups of low and very low birth weight with a control group of children in the category from 2500 grams. Cohort of children under 2500 g contains a low birth weight infants with growth retardation. RESULTS: The frequency (prevalence) of the neonates LBW is 11.6% (3851 neonates). Perinatal mortality in the weight category less than 2500 g was 57 per thousand, in the category from and more than 2500 g 2 per thousand, relative risk, RR = 7.14 (95% CI 6.67 to 7.54). Perinatal mortality in the category in 1500 grams compared with the control group is 157 per mille vs 2 per mille RR = 26.20 (23.55 to 29.16) Children with low weight in the total perinatal mortality contributes 78.9%, stillbirth 1.6% vs 0.1%, RR = 5.48 (4.69 to 6.40). (Stillbirth rate is reported from 1,000 g fetal weight.) Congenital anomalies 4.3% vs 1.6%, RR = 2.32 (95% CI 2.03 to 2. 65) The frequency of caesarean births of low weight babies was 62, 6% vs control group 18.9% (RR 3.31, 95% CI 3.20 to 3.42, p = 0.00000000). Caesarean sections in a file with a very low fetal weight compared with the control group, 83.8% vs. 18.9% (RR 4.43, 95% CI 4.27 to 4.60, p = 0.00000000). Since the mid nineties, there was a significant increase in multiple pregnancies in relation to IVF (Cox-Stuart test p = 0.039); 31.6% of children of low birth weight in multiple pregnancies vs 2.4% of children in the control group, RR = 7.48 (95% CI 7.11 to 7.86). Multivariate analysis also confirmed the existence of independent risk factors, especially social nature (education, unmarried woman, body mass index, smoking, parity, maternal age). CONCLUSION: The analysis shows the increase in births of children in category 2000-2500 grams. There has been a significant increase and proportion of iatrogenic factors, multiple pregnancies and caesarean sections. Also show some influence social and health characteristics of the mother. Low weight children have higher mortality and worse health. Despite a significant decrease perinatal mortality contributes to three quarters of perinatal deaths. It is clear that it is not possible substantially affect the prevalence of low birth weight. Children with low and very low birth weight despite intensive obstetric and neonatal care are a continuing medical problem. Finding good practices can contribute to better health of children with disabilities.

[High birthweight births at University Hospital Olomouc (1993-2010)]. / Porody detí velkých hmotností ve Fakultní nemocnici v Olomouci (1993-2010).

OBJECTIVE: Evaluation of risk factors of fetal macrosomia and assess possible consequences of high birth weight at parturition and the newborn state. DESIGN: A retrospective epidemiological cohort study. SETTING: Department of Gynaecology and Obstetrics, Faculty of Medicine and University Hospital Olomouc. METHODS: Evaluation of 26 789 maternal and newborn records of the singleton pregnancy with birth weight of 2500 g and above in the time interval from 1. 1. 1993 to 12. 31. 2010 at University Hospital in Olomouc. The study was excluded multiple pregnancies and low birth weight children. Compare the neonate weighing 4000 g or more with a control group of infants 2500-3999 g. RESULTS: The prevalence of macrosomia in the selected set of 26 789 pregnant women was 10.3%(2747 newborns). Significant and multivariate analysis identified the independent risk of: 1. gestational age over 40 weeks 18.3% vs. 8.3% (RR = 1.26, 95% CI 1.22 to 1.29, P = 0.00000000), 2. male sex 13.5% vs. 6.8% (RR = 1.98, 95% CI 1.84 to 2.14, P = 0.00000000), 3. diabetes mellitus, 16.7% vs. 10.1% (RR = 1.65, 95% CI 1.38 to 1.98, P = 0.00000000), 4. weight gain over 19 kg (x + SD) 19.2% vs. 9.3% (RR = 2.05, 95% CI 1.87 to 2.24, P = 0.00000000), 5. multiparity 12.5% vs. 7.9% (RR = 1.59, 95% CI 1.47 to 1.71,P = 0.00000000), 6. BMI over 22.4 (cutoff) 14.6% vs. 7.2% (RR = 2.04, 95% CI 1.88 to 2.20,P = 0.00000000), 7. obesity (BMI over 30 kg/m2) 19.5% vs. 9.8% (RR = 1.91, 95% CI 1.70 to 2.15,P = 0.00000000), 8. weight gain over 14 kg (cutoff) 14.3% vs. 8.3% (RR = 1.78, 95% CI 1.65 to 1.93, P = 0.00000000), 9. marital status - married 10.8% vs. 8.8% (RR = 1.22, 95% CI 1.12 to 1.33,P = 0.00000271). Independent protective factor in relation to macrosomia was low maternal education (basic school) 7.0% vs. 10.5% (RR = 0.66, 95% CI 0.57 to 0.77, P = 0.00000010). Maternal age or other factors evaluated showed not to be independent risk factors. Operative delivery of a large babies were significantly more common compared with the control group, 27.3% vs. 22.1% (RR 1.24, 95% CI 1.16 to 1.32, P = 0.00000000). Caesarean section 20.8% vs. 16.6% (RR 1.25, 95% CI 1.16 to 1.36,P = 0.00000003), vacuum extraction 4.4% vs. 3.4% (RR = 1.30; 95% CI 1.08 to 1.57, P = 0.00622233).The frequency of forceps deliveries in both groups compared was the same, 2.1% (RR = 1.00, 95% CI 0.75 to 1.33, P = 0.95676855). Fetal macrosomia was not a major cause of rising invasive methods in obstetrics, which occurred in recent years. Evaluation of the newborn health status in both weight classes had not significant differences. CONCLUSION: There was no significant change in the prevalence of births of large babies over the study period. Gestational age over 40 weeks, male sex, parity, physique, higher maternal weight gain and diabetes mellitus are independent risk factors of high birthweight births. The increase in operative births in recent years is comparable in both groups.

[Laboratory and clinical indicators of the state of the newborn after birth]. / Laboratorní a klinické ukazatele stavu novorozence po porodu.

OBJECTIVES: Analysis of the prevalence of neonatal adaptation after birth. Evaluation of indicators used and determining the levels of laboratory findings. Evaluation of benefits of commonly used indicators of the newborn condition in clinical practice. DESIGN: Retrospective epidemiological study. SETTING: Gynaecology and Obstetrics Clinic Medical Faculty Palacky University and Faculty Hospital in Olomouc. METHODS: Analysis of records of 18,208 live births in the ten-year period from 1.1.2000 to 31.12.2009--Inclusion criteria (complete data) fulfill 15 755 (86.5%) neonates. RESULTS: In the whole set (n=15,755) the prevalence of pathological values of one-minute Apgar score (less than 7 points) was 5.4%, one per cent at 5 minutes and 0.2% at 10 minutes. Five-minute Apgar score of less than 4 points was in 23 (0.2%) newborns. Values below pH arterial cord blood under 7.00 (acidosis criterion ACOG) had 93 (0.6%) newborns. Analysis of lactate acidemia results relevant to a pH below 7.00 set lactate cutoff = 6.7 mmol/L (area under ROC curve 0.977). Prevalence findings lactate above 6.7 mmol/l is 7.2%. 93.5% of newborns in the group of newborns with a pH below 7.00 had a lactate above 6.7 mmol/l. In the whole set was moderate correlation of pH and lactate (r = -0.4318; 95% CI 0.4444 to -0.4190; P < 0.0001). Weak was the correlation of lactate and pH measurements to the clinical evaluation of the newborn. Comparing the two indicators of acidosis using method of "Gold standard" confirmed the higher sensitivity of lactate values above 6.7 mmol/l compared to pH < 7.00 in relation to very low values of Apgar at 5 minutes. CONCLUSION: The results obtained confirm that acidemia after birth is relatively frequent, but not always echoed in the clinical condition of the newborn after birth. Assessing the diagnostic importance of lactate shows better results in relation to the clinical status of newborns and values above 6.7 mmol/l can be regarded as an important clinical indicator of neonatal acidosis. Determination of lactate levels is not an alternative for the examination of the newborns, but in combination with other indicators improve standard for evaluation of newborns.

[Analysis of perinatal indicators of the Olomouc region in the period 1994-2008]. / Analýza perinatologických ukazatelu Olomouckého kraje v období 1994-2008.

OBJECTIVE: The aim of this study was to examine the evolution of the main perinatology outcomes in the last fifteen years and their comparison to the Czech Republic. Analysis belong to the control system of quality of care. DESIGN: Retrospective epidemiological study. SETTING: Gynaecology and Obstetrics Clinic Medical Faculty Palacky University and Faculty Hospital in Olomouc. METHODS: For analysis in this study were used results of perinatal databases of the Committee for Perinatal Medicine of the Czech Republic (10 million population) and all hospitals in Olomouc region (600,000 population). RESULTS: Since mid-90th years there is a significant improvement of perinatal indicators and very good results have been achieved since 2000, when the perinatal mortality rate dropped to 2 per mille (in 2008). The downward trend in perinatal mortality rate and early neonatal mortality rate was statistically significant (P for trend = 0.008). Comparison of major perinatal outcomes confirms that perinatal mortality rate exceeds in five years the national average in the reference interval.. Statistically significant worse results were in early neonatal mortality rate without congenital malformations in the year 1994 (P = 0.005) and the year 2001 (P = 0.0008). Stillbirth rate without congenital malformation fluctuated from 1.1 to 3.1 per mile and exceeded republic mean in the year 1998. Since 1994 increased in the Czech Republic frequency of preterm births of children of low birth weight (LBW--less than 2.5 kg) from 5.47% to 7.37%. In recent years, there was a problem with the lack of beds in the neonatology intensive care unists. CONCLUSION: Analysis of the main perinatology data of the last fifteen years acknowledges, that monitored indices of the Olomouc region were more often better than the national average. A major problem of this region, as well as the Czech Republic, is increased frequency of premature labour and associated insufficient capacity of neonatal intensive care unit in perinatal center.

[Trends in operative delivery rates]. / Trendy vývoje operacních porodu.

OBJECTIVE: The aim of this study was to identify trends in operative vaginal delivery rates and caesarean sections at Faculty Hospital in Olomouc and comparing with mean results of the Czech Republic. DESIGN: Retrospective epidemiological study. SETTING: Gynaecology and Obstetrics Clinic Medical Faculty Palacky University and Faculty Hospital in Olomouc. METHODS: Analysis of data drawn from obstetric medical records from 1. 1. 1993 to 31. 12. 2008--rating the frequency, evolutionary trends and associated risk factors. RESULTS: In this time period 26,679 children born, by caesarean section 5,916 (22.2%), ventouse 759 (2.8%) and forceps 526 (2.0%). The frequency of vaginal operations is higher than the average of the Czech Republic and from second half 90s of the 20th century no more increased. For caesarean section, however, is an upward trend (P for trend = 0.035, Cox-Stuart test). The increasing proportion of complex of 4 risk factors on the frequency of caesareans: 1 low birth weight below 2.5 kg (32.2%), 2 multiple pregnancy (18%), 3 caesareans in history (15.5%), 4 mothers over the age of 35 years (11.2%). Cumulative share of all four factors in the total number of abdominal delivery has reached a mean of 52.91% (95% CI 49.58-56.24), median = 53.75 (97.9% CI 48.64-57.32). CONCLUSION: Analysis of the development of operational termination of pregnancy confirms the significantly higher frequency of operational interventions in Olomouc compared to an average of the Czech Republic. Changes in risk profile of patients (often referred to the demographic factors) is not enough to explain the causes of the rising frequency of caesareans. The increase of invasive obstetrics undoubtedly contributes to changes in obstetric practice.

[Cervical cerclage. Results of the last ten year period (1997-2008) in Faculty Hospital Olomouc]. / Cervikální cerkláz. Výsledky ve FN Olomouc za posledních 10 let (1998-2007).

OBJECTIVE: To evaluate the effectiveness of the cervical cerclage in the last ten year period on pregnancy outcome. STUDY DESIGN: Retrospective study. SETTING: Gynaecological and Obstetric Clinic Medical Faculty Palacky University and Faculty Hospital Olomouc. METHODS: In the retrospective analysis of maternal and newborn records in the ten year period from 1.1. 1998 to 31. 12. 2007 were identified three groups of indications for operative cervical closure: elective--on the basis of history without objective evidence of cervical change, emergency cerclage--with objective manifestation of cervical insufficiency and rescue cerclage of a widely dilated cervix with prolapsed unruptured membranes. RESULTS: A total 102 patients underwent cerclage between 11 and 31 weeks gestation. The prevalence of operative intervention was 0.6% of all mothers. Cervical cerclage was done by the McDonald technique. 17 patients had elective operations, 57 emergency and 28 rescue cerclage. Median length of interval from cerclage to delivery was significantly shorter after rescue cerclage, 26 days, (range 2-126) compared to emergency cerclage patients, 74 days (range (7-148). (P = 0,000005). Median interval from cerclage to delivery in elective operation was 105 days (range 9-188). Newborn dates corresponds with earlies termination of pregnancy in rescue cerclage subjects, with median gestational age at time of delivery 28 weeks (range 19-41), after emergency operation median achieved 36 weeks (range 23-41). The median gestational age at delivery after elective cerclage was 36 weeks (range 22-41). Nine fetal losses were in the rescue group, sex abortions (from 260 to 560 grams) and three early neonatal deaths (530, 550, 1150 grams). CONCLUSION: These results confirm that the use of cervical cerclage in prevention of the premature labour is rather rare as well as achievement outcomes did not fulfil our expectations. This fact could have been considered in the care of pregnant and lead to restriction of unnecessary investigations of uterine cervix especially in non risk and asymptomatic population.

[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.

[Risk factors associated with high birthweight deliveries]. / Rizikové faktory porodu detí nejvyssí hmotnostní kategorie.

OBJECTIVE: To examine the influence of possible risk factors, mainly abnormal pregravid maternal body habitus, age, education, parity and pregnancy complications (especially diabetes) on the prevalence of infants with fetal weight 4000 grams and more. The study was also aimed to investigate pregnancy outcome among weight categories. STUDY DESIGN: Retrospective cohort study. SETTING: Gynaecological and Obstetric Clinic Medical Faculty Palacky University and Faculty Hospital Olomouc. METHODS: maternal and neonatal records for 7156 singleton deliveries of two fetal weight categories (2500-3999 grams and > or = 4000 grams) during the 5-year period from 1.1. 2000 to 31. 12. 2004 were reviewed. Univariate and multivariate analysis were performed. Multiple regression models, including maternal age, pregestational BMI (body mass index), education, smoking, alcohol consumption, IVF, anemia in pregnancy, preeclampsia, diabetes, gestational age, pregnancy weight gain, gender of the newborn were constructed to examine relative effect of these factors on the risk of the delivery of a big baby. RESULTS: The prevalence of high birth weight infants was 10.8% in the study sample. There were 774 deliveries of infants birth weight category > or = 4000 g and 6382 deliveries of the babies 2500-3999 g. Significant risk factors from the univariate analysis were gestational age more than 40 weeks (18.2% vs 8.6%, P = 0.00000000), pregnancy weight gain over 13 kg (cutoff) (14.3% vs 7.5%, P = 0.00000000). Compared with normal BMI subjects (19.8-25 kg/m2), obese women (BMI > 30 kg/m2) were at elevated risk for high birth weight delivery (18.1% vs 10.5%, P = 0.00000629) as were overweight women (BMI 25.1-30 kg/m2) (16.6% vs 10.5%, P = 0.00000004). Multiparity versus nulliparity (13.4% vs 8.1%, P = 0.00000000), male gender vs female (13.4% vs 8.0%, P = 0.00000). There were no significant difference with diabetes (12.6% vs 10.8%, P = 0.49089558). Smoking (5.4% vs 11.5%, P = 0.00000052) and low pregravid BMI (< 19.8 kg/m2) (5.7% vs 10.5%, P = 0.00000004) were associated with a lower risk of macrosomia Multiple logistic regression revealed the independent influence of gestational age, pregnancy weight gain, abnormal maternal body habitus, multiparity, male gender and smoking on the fetal growth. Excess fetal weight affects delivery in higher frequency of active management of labor, induction (20.2% vs 16.6%, P = 0.01560228) and cesarean section (20.3 % vs 15.1%, P = 0.00021215). No significant differences were in prolongation of first and second stage of labor and frequency rate of operative vaginal deliveries. No significant differences were noted between the groups regarding health status of live birth children. CONCLUSION: Gestational age over 40 weeks, increased pregnancy weight gain, pregravid maternal body habitus, multiparity and male gender are independent risk factors for high birthweight deliveries.

[Premature separation of the placenta--etiology and risk factors]. / Predcasné odlucování luzka--etiologie a rizikové faktory.

OBJECTIVE: Placental abruption complicates approximately 1% of all pregnancies and remains a significant cause of both maternal and fetal morbidity and mortality. Several risk factors are associated with this complications, but a clear causal relation is diffucult to establish. THE AIM OF THE STUDY: The aim of the study was to determine and identify risk factors for placental abruption. DESIGN: Retrospective cohort study. SETTING: Dept. of Obstetrics and Gynaecology, Medical Faculty of Palacký University, Olomouc. SUBJECT AND METHOD: Retrospectively gathered cohort of 180 women was compared to 198 healthy women. We have focused on anthropometric, sociodemographic, behavioral, obstetric and fetal parameters. Statistical evaluation was done by Statsoft, Inc. (2001) Statistika CZ (Software system data analysis), version 6. RESULTS: The incidence of the placental abruption was 0.89%. We have confirmed the following risk factors as statistically significant (p values are given): Low-degree education (0.00002), prepregnancy weight of the mother (0.00), weight gain in pregnancy (0.00), higher parity (0.0272), smoking (0.03847), preeclampsia (0.00889), chorioamnionitis (0.00), premature rupture of membranes (0.00), recurrent spontaneous abortions (0.00), positive family history of deep venous thrombosis (0.0007) and intrauterine growth retardation (0.0386). CONCLUSION: Placental abruption has a large number of potential risk factors. The true biological cause and its etiopathogenic role is still to be elucidated.

[Rescue cerclage in the treatment of cervical insufficiency]. / Záchranné cerkláze v lécbe cervikální insuficience.

OBJECTIVE: To evaluate the effectiveness of the cervical cerclage in the five year period on pregnancy outcome. The primary outcomes of interest was effectiveness of rescue cerclage in prolongation of pregnancy. STUDY DESIGN: Retrospective study. SETTING: Gynaecological and Obstetric Clinic Medical Faculty Palacky University and Faculty Hospital Olomouc. METHODS: In the retrospective analysis of maternal and newborn records in the five year period from 1. 1. 2000 to 31. 12. 2004 we identified three groups of indications for operative cervical closure: elective--on the basis of history without objective evidence of cervical change, emergency cerclage--with objective manifestation of cervical insufficiency and rescue cerclage of a widely dilated cervix with prolapsed unruptured membranes. RESULTS: A total of 50 patients underwent cerclage during the period from 1. 1. 2000 to 31. 12. 2004 between 12 and 30 weeks of gestation. The prevalence of operative intervention was 0.6% of all mothers. All patients had similar management (hospitalization, bed rest, antibiotics and tocolysis treatment). Cervical cerclage was done by the McDonald technique with single or double stich or Mersilene tape. Fourteen patients (28%) had rescue operations, 28 (56%) emergency and 8 (16 %) elective cerclage. In all groups there was no significant difference in the sociodemographic characteristics (age, BMI, education, number of previous pregnancies and parity). Also no significant difference we found in pregnancy complications. Only smoking in the pregnancy was a significant risk factor associated with rescue cerclage, relative risk = 3.30 (95% CI 1.57-6.96, P = 0.0272183). Critical gestational age 32nd week achieved 6 rescue cerclage subjects (42.9%), significantly less as for emergency cerclage subjects (85.7%), (P = 0.0089396) and elective ones (87.5%). Mean length of interval from cerclage to delivery was significantly shorter after rescue cerclage, 42.7 +/- 35.8 days, median 24, range (3-126) compared to emergency cerclage patients, 72.0 +/- 28.4 median 72, range (14-130), (P = 0.006247). Interval from cerclage to delivery in elective operation was 118 +/- 59.1, median 109, range (32-188), (P = 0.049818). Survival analysis also confirmed significantly shorter interval from cerclage to delivery in the rescue cerclage compared to other acute intervention. Log Rank test = 23.6205 (P = 0.000000), Wilcoxon = 20.299 (P = 0.000000). Newborn dates corresponds with earlies termination of pregnancy in rescue cerclage subjects, with mean gestational age at time of delivery 29.5 +/- 6.0 weeks, median 28, range (20-41), after emergency cerclage 35.4 +/- 3.4, median 37, range (26-41), (P = 0.000592). The mean gestational age at delivery after elective cerclage was 34.8 +/- 5.0, median 35, range, (25-41). There was no significant difference in hospitalization time between groups. Three fetal losses of extremly low birth weight babies were in rescue subjects, one abortion at 20 weeks gestation, fetal weight 260 grams with marked acute chorioamnionitis. Interval from cerclage to abortion was 24 days. Two female fetuses (twins) 530 anad 550 grams died early in life after caesarean section for placental abruption 34 days after the cerclage. CONCLUSION: Rescue cerclage occurs in 28% of all cervical closure. In comparison with other indications they have significantly worse outcomes in prolongation of pregnancy. Obviously, because they are extreme events of cervical insufficiency. Fetal losses were nevertheless minimal and connected with intrauterine infection and placental abruption. In combination with antibiotics and tocolysis rescue cerclage gives hopes that they can help in pregnancy prolongation.

[Early maternal and neonatal morbidity after spontaneous and surgically-assisted vaginal delivery]. / Casná materská a neonatální morbidita po spontánním a operativním vaginálním porodu.

OBJECTIVE: To evaluate the differences in early maternal and neonatal morbidity after spontaneous delivery, forceps delivery and vacuum-extraction. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Palacký University, Olomouc. METHODS: The database of 8196 deliveries at our department in the time period from January 1995 till September 2000 revealed 183 of forceps deliveries and 217 of vacuum-extractions. The control group included 200 randomly selected parturients with spontaneous vaginal delivery. The early maternal morbidity was evaluated according to the following parameters: perineal tears of the IIIrd + IVth degree, duration of hospitalization, average blood loss, the need of analgetics, dehiscence of episiotomy requiring resuture, febrilies and administration of antibiotics. The early neonatal morbidity evaluation was based on the incidence of cephalhematomas, the incidence of hyperbilirubinaemia, duration of hospitalization, signs of fetal hypoxia (pH, Apgar score), gestational age, birthweight and the presence of intracranial and retinal bleeding. The statistical significance of the differences in the frequency of the above parameters was evaluated. RESULTS: Spontaneous deliveries were associated with lower maternal morbidity according to the most of studied parameters. Vacuum-extraction had a lower frequency of maternal postpartum complications compared to forceps deliveries. Statistically valid differences were however found only at perineal tears of the IIIrd + IVth degree and at administration of analgetic and antibiotics. The use of vacuum-extraction seems to be connected with a higher risk of cephalhematomas (p = 0.0051) and longer duration of hospitalization. CONCLUSIONS: From the point of view of early maternal morbidity the assisted vaginal delivery by vacuumextraction gives better results than by forceps. However vacuum-extraction increases the risk of cephalhematomas at newborn.

[Antepartal cardiotocography and doppler flowmetry in the diagnosis of fetal hypoxia ]. / Antepartální kardiotokografie a dopplerovská flowmetrie v diagnostice hypoxie plodu.

OBJECTIVE: To evaluate by analysis of the most serious obstetric cases during a five-year period the contribution of ante-partum CTG and Doppler flowmetry in the diagnosis of foetal risk and to assess the part of risk factors of hypoxia during pregnancy. DESIGN: Retrospective epidemiological analysis. SETTING: Gynaecological and Obstetric Clinic Medical Faculty Palacký University and Faculty Hospital Olomouc. METHOD: In a retrospective analysis based on 6494 deliveries during a five-year period (1996-2000) the authors evaluate a selected sample of 1087 most serious conditions with the diagnosis of imminent foetal hypoxia. In the evaluated group 90.3% of the women had a cardiotocographic examination, 50.8% Doppler flowmetry with assessment of umbilical RI and PI indexes. The diagnosis of neonatal hypoxia was based on evaluation according to Apgar score < 7 and pH of arterial blood < 7.20. The authors compare both diagnostic methods with a common gold standard as regards their ability to predict hypoxia. In the logistic regression model they evaluate risk factors of pregnancy in relation to foetal hypoxia. RESULTS: Clinical manifestations of hypoxia were recorded in 114 neonates (10.5%). Perinatal deaths occurred in 46 infants, 16 were stillborn. Pathological ante-partum CCTG findings are associated with more active approaches (earlier termination of pregnancy, SC, preinduction by prostaglandins). Pathological ante-partum CTG and flowmetry was paradoxically more frequently associated with a better condition of the neonate. Pathological findings of ante-partum CTG were significantly less frequent in neonates with hypoxia than those without it (27%) vs. (40.9%), (relative risk 0.56 [95% CL 0.36-0.88], P = 0.01) while pathological findings of umbilical flowmetry were insignificantly more frequent (34.9%) vs. (33%), (relative risk 1.08 [95% Cl 0.59-1.97], P = 0.9). Both examinations were made in 547 (50.3%) women of the whole group, in 43 (7.9%) hypoxia of the foetus developed. Sensitivity: CTG 32.6%, Doppler 34.9%, Specificity: CTG 51.4%, Doppler 67.3%. Falsely positive CTG 48.6%, Doppler 32.7%. Analysis of risk factors of pregnancy in relation to foetal hypoxia defines by retrospective elimination as significant risks haemorrhage during pregnancy (n = 76, OR 2.35 [95% Cl 1.31-4.23], P = 0.01) and premature delivery (n = 258, OR 2.02 [95% Cl 1.34-3.05], P = 0.0004). CONCLUSION: The value of ante-partum CTG and Doppler flowmetry in the prognosis of neonatal hypoxia is low. The lower rate of pathological findings in affected neonates is probably associated with the fact that part of the hypoxias develop during delivery and cannot be predicted before delivery. The high number of falsely positive findings may by due by the adaptational abilities and reserves of the infant, by a more active approach when there are signs of danger and incorrect interpretation of findings. Premature delivery and haemorrhage are significant risks of neonatal hypoxia.

[Cervix length measured by transvaginal ultrasonography in women with twin pregnancy--prospective study]. / Sledování délky delozního hrdla u tehotných zen s dvojcaty transvaginální ultrasonografií--prospektivní studie.

OBJECTIVE: To evaluate cervical length in twin pregnancies measured by transvaginal ultrasonography. DESIGN: A prospective clinical study. SETTING: Department of Obstetrics and Gynecology, Medical Faculty of Palacky, Olomouc, Czech republic. METHODS: Clinical data of cervical length in twin pregnancies measured by transvaginal ultrasonography were summarized. RESULTS: 69% of patients delivered after 36th week of gestation, mean gestational age at the time of delivery was 35.5 week. Mean cervical length measured bi-weekly from the 16th till 34th week was 34.9, 34.6, 33.8, 33.2, 29.7, 28.7, 29.1, 28.4, 23.6, 22.8 mm. The creation of the funneling was recorded in more than 80% of patients with preterm delivery at the mean gestational age 23 week. Mean cervical length in patients delivered before 36th week was in the 23rd week of gestation 21.5 mm, while in woman delivered near term was average cervical length 33.1 mm. Genital infection in patients with preterm labours was present in 27%. CONCLUSION: Transvaginal ultrasonography seems to be a useful method in antenatal care of risk pregnancies with twins.

[EUROPOP--European Programme of Occupational Risks and Pregnancy Outcome--part II]. / EUROPOP--European Programme of Occupational Risks and Pregnancy Outcome--cást II.

As continuation of their previous paper the authors submit the results of the European study EUROPOP pertaining to the effect of occupation on the course and outcome of pregnancy. The paper contains the first part of results where the authors compare groups of women with premature deliveries (22nd-36th week of pregnancy) with control groups 1/10 deliveries in term (> or = 37 weeks). The groups of abortions in the second trimester which were studied by the authors were relatively small (Czech Republic 49 and in the all-European study 229). To keep the study within a reasonable limits the tables are not presented. Comparison of results describing home work, living conditions of pregnant women, prenatal care and medical problems as well as data on the outcome of pregnancy are presented in part III.

[EUROPOP--European Programme of Occupational Risks and Pregnancy Outcome--part III]. / EUROPOP--European Programme of Occupational Risks and Pregnancy Outcome--cást III.

As continuation of the previous paper ther authors submit the second part of the results of the European programme EUROPOP which evaluates the relationship between work, living conditions of pregnant women, prenatal care and medical data on the outcome of pregnancy. The authors compare groups of women, who had premature deliveries (22nd-36 week of gestation) with control groups 1/10 deliveries in term (> or = 37 weeks). Groups of abortions in the second trimester which were investigated were relatively small (Czech Republic 49 and all-European study 229). To keep the paper within reasonable limits the tables are not presented.

[The EUROPOP Project. European Programme of Occupational Risks and Pregnancy Outcomes]. / Projekt EUROPOP. European Programme of Occupational Risks and Pregnancy Outcome.

Efforts to obtain an objective view of the working and living conditions of European women and in particular the influence of these conditions on the course of pregnancy were the reason why in 1994 within research activities of the EC a project EUROPOP (European Programme of Occupational Risk and Pregnancy Outcome) was adopted and started. Seventeen countries incl. the Czech Republic were asked to participate. The research proper was conducted in 57 maternity institutions. In the Czech Republic the Olomouc region was selected with the Gynaecological and Obstetric Clinic in Olomouc as the coordinating centre. All 13 gynaecological and obstetric departments of the Olomouc catchment area were included in the trial.

Fetal fibronectin in patients at increased risk for premature birth.

OBJECTIVES: The objective of this prospective study was to evaluate fetal fibronectin bedside test (Mast Diagnostica) to rule out preterm labor. STUDY DESIGN: 46 patients from between 25 and 36 weeks were included in the study over a six months period. All patients underwent only one cervical sampling at the beginning of the study. The association between the fetal fibronectine test results and various outcomes were analysed. RESULTS: 5 of the 16 women whose test results were positive had early labor and 4 of the 30 patients with negative test results had preterm delivery. The bed side test had a sensitivity of 55.6%, a specificity of 70.3%, a positive predictive value of 31.3%, and a negative predictive value of 86.7%. The addition of tocolytic therapy and intensive care resulted probably in decrease of the predictive capacity of a positive fetal fibronectine test, odds ratio 2.95 (95% confidence interval 0.54-16.85). However interval from diagnosis to delivery was shorter (P < 0.025), cervical findings (Bishop score) worse and betamimetic treatment was more frequent (P < 0.01) in the group with positive test results. CONCLUSIONS: Positive fetal fibronectine test results indicates a significant risk for the subsequent early delivery and negative test result is a good indication that subsequent preterm labor and early delivery are unlikely to occur.