[A delay in the HELLP syndrome diagnosis]. / Opozdení diagnózy HELLP syndromu.

HELLP syndrome is a serious obstetrical complication that tends to occur in the second half of pregnancy that complicates six promiles of pregnancies. The term HELLP syndrome is derived from the beginning letters of the English words indicating laboratory changes, which is occurs as a specific illness in pregnancy. There is hemolysis, elevated liver enzymes and a decreased platelet count. It can present itself with preeclampsia or without it. The most serious complications are disseminated intravascular coagulation, liver rupture or various organ failures. The pathogenesis at the moment is not completely known. The basic approach to care is delivery at the earliest possible term. HELLP syndrome generally arises in the second or third trimester of pregnancy, but can also occur after delivery. It has typical signs, which can also arise due to other liver diseases, but more frequently in diseases of the gall bladder, which in pregnancy given the physiological changes in the body of the pregnant women is also predisposed. In this context, woman with this problem can seek out other physicians than obstetricians. In our case, we wanted to refer to the needs of early diagnosis of this frequently diagnosed illness, since in the case of late diagnosis and a woman not sent to the obstetrical department can lead to a serious life threatening state for the mother and child.

[Sexual assault in the woman]. / Sexuální násilí na zenách.

OBJECTIVE: Retrospective analysis of the population of women examined for suspicion of sexual assault to compare the situation in the Czech Republic with the world's published works. DESIGN: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology, 1st Medical Faculty of Charles University and the Faculty Hospital Na Bulovce Prague. METHODS: Retrospective analysis of medical reports for all women examined for suspicion of sexual violence during the period from January 2007 to December 2008. RESULTS: During observed period 37 women were examined, average age of examined women was 26.2 years, range 15-51 years, 76% of females younger than 29 years, 16% of examined women were from abroad. We have found no differences in occurrence throughout the year. In 3 cases there were more aggressors, in 30% of cases the alleged perpetrator was a known person or relative. In 54% of cases completed vaginal intercourse with ejaculation allegedly took place. We detected one case of forced oral sex and one case of forced anal sex. In 19% touching was involved. 22% of women did not know whether coitus really occurred--in 14% the alleged victim was under the influence of alcohol, in 3 cases under the influence of drugs, including one case of drinking an unknown substance in a beverage. Obvious signs of violence were found in 27% of cases, of which mostly in the face (14%), the extremities (8%) and only in two cases on the genitals (5%). No woman did require medical treatment of injuries. CONCLUSION: Our experience is similar to the published world data. In our group there were more strangers among the perpetrators. We did not record any use of a weapon in the enforcement of sexual contact. It is necessary to examine the alleged victims whole body thoroughly, signs of violence were more frequent in extragenital localization.

[Uterine rupture in pregnancy--case study]. / Ruptury delohy v tehotenství--kazuistiky.

OBJECTIVE: Analysis of two cases uterine rupture following caesarian section. SUBJECT: Two case studies. SETTING: Gynecological obstetrics clinic, First Medical Faculty and Faculty Hospital Bulovka, Prague. SUBJECT AND METHODS: The authors in their article describe two cases of rupture of the uterus in pregnancy prior to delivery. In both cases there was a history of cervicocorporal caesarian section. CONCLUSION: In the first case the patient was admitted from her home with bleeding, and signed a nonconsent form. The second case concerned a hospitalized patient, in which the first signs of uterine rupture were indicated by fetal heart rate. Both women underwent hysterectomy, paradoxically, in the first case the child was saved and discharged home in good health.

[New Single-Incision Sling System MiniArc in treatment of the female stress urinary incontinence]. / První zkusenosti s novou minipáskou k lécbe stresové inkontinence moci u zen--MiniArc.

OBJECTIVE: The aim of this paper is to introduce the new Single-Incision Sling System MiniArc in treatment of the female stress urinary incontinence. SUBJECT: Prospective follow up. SETTING: Department of Obstetrics and Gynaecology, The First Faculty of Medicine, Charles University in Prague. SUBJECT AND METHOD: Prospective follow up of the first set of 38 patients treated with the new method MiniArc. CONCLUSION: We performed initial 38 cases of MiniArc under the local anesthesia. There was neither the complication during procedure, nor during the early postoperative period. No patient required urine derivation. Late postoperative period showed neither obstruction, nor ,,de novo urgency". One asymptomatic sub-urethral tape protrusion into the vagina was found. No late postoperative pain occurred. Subjective cure rate was investigated in 33 ladies with follow up from 6 weeks through 19 months. 23 females declared full dryness (i.e., 76.7%), 6 patients were very satisfied and declared improvement of more than 70% (i. e. 20.0%); thus we obtained efficacy in 29 cases of 30 (i. e. 96.7%). We have not seen any vanishing of the sling effect. Based on our initial experience we judge the new single incision tape as very promising.

Adhesive bowel strangulation after caesarean section, the rare puerperal complication.

Caesarean section is the most frequent abdominal operation carried out in obstetric practice. Parturients undergoing this operation are still exposed to a substantial rate of short- and long-term complications. The incidence of re-laparotomy after caesarean section is 0.12-0.70%. The most common indication for re-laparotomy is intra-abdominal bleeding, uterine atony, eventration, haematoma in the muscle and intra-abdominal abscesses. We present the case report of an unusual life-threatening complication of caesarean section that led to re-laparotomy. Caesarean section rate has been continually increasing globally in the last few decades, thus we also have to take into account unusual complications e.g. intestinal complication.

[Analysis of the set of pregnancy women with asthma bronchiale]. / Analýza souboru rodicek s asthma bronchiale.

OBJECTIVE: The set of pregnant females suffering from bronchial asthma-retrospective analysis. TYPE OF STUDY: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology, University Hospital Na Bulovce, First Medical Faculty, Charles University in Prague, Czech Republic. SUBJECT AND METHOD: Our set consists of pregnant women suffering from bronchial asthma and attending our Antenatal Clinic & delivering at our Maternity Hospital from January 2008 through December 2009. Retrospective analysis of the set based on the medical records was performed. RESULTS: 80 females suffering from bronchial asthma gave birth at our Hospital during the studied time span, i.e., 1.7% of all deliveries at our Maternity Hospital. In 4 females (i.e. 5%) the asthma attack was observed during the pregnancy. 33% of all females suffering from bronchial asthma did not require any bronchodilator medication, 22% were just on betamimetics, 23% required inhalational betamimetics with intermittent inhalational corticosteroid and 21% use both regularly. Perorally corticosteroids or leukotrien inhibitors were not used at all. There was no negative influence on subjective felling of the female during her pregnancy and labor in 71% of cases. 24% of all females suffering from bronchial asthma delivered by Caesarean Section but just in two of them it was indicated due to the bronchial asthma itself. We observed no case of IUGR or congenital defect. No change in the length of the hospital stay in comparison to the other females was shown. CONCLUSION: The nowadays standard treatment of bronchial asthma during pregnancy is based on local inhalative bronchodilator and anti-inflammatory medication. Pregnant females are usually well compensated, and thus their perinatal outcome shows no difference compared to the healthy population.

[Abortion induction in IInd trimester]. / Indukce potratu ve II. trimestru na Gynekologicko porodnické klinice FN na Bulovce.

STUDY AIM: Analysis of the set of women that underwent the termination of pregnancy in IInd trimester at the OBGYN clinic, Teaching Hospital Na Bulovce at interval of years 2006-2007. We appreciated the effect of method and compared with references in the literature. TYPE STUDY: Retrospective descriptive study. SEATTING: OBGYN clinic of the 1st faculty of Charles University, teaching hospital Na Bulovce, Prague. METHOD: Retrospective analysis of the set of women that underwent termination of pregnancy in the IInd trimester. Data are obtained from medical documentation and statistically processed. The analysis treats with 50 cases, in all of them, cervix was prepared with hydrophile dilators. In 37 cases were subsequently handed up prostaglandins intraamnially, in two cases generally intravenously, in two cases vaginally and 9 pregnancies were finished directly by dilatation and curettage without endeavour about expulsion. RESULTS: From 37 women after intraamnial administration of prostaglandins, 35 (94.6%) aborted successfully. Average time from amniocentesis to expulsion was 13 hours 45 minutes, 23 women aborted to 24 hours (62.2%). Undesirable effects were present in 12 cases (32.4%). CONCLUSION: Our record of local intraamnial administration of prostaglandins appears to be effective method. On the other hand, other methods are described in recent literature, which appear to be more efficient and have smaller occurrence of adverse effects.

Unrecognized primary genital herpes infection (case report).

The authors present a case report of unrecognized herpes genitalis, which was caused by primary HSV-1 infection. The 28-year old female was examined by three board certified gynaecologist and initially treated as mycotic vulvitis. The authors point out the atypical course in the patient without anti-HSV-1 and HSV-2 antibodies. This infection is rather very painful, extensive and with complications. Thus, it is necessary to consider the diagnosis and to begin antiviral therapy as soon as possible.

[Analysis of a group of HIV positive women who gave birth in the Czech Republic]. / Analýza souboru HIV pozitivních rodicek v Ceské republice.

OBJECTIVE: An analysis of HIV positive women who gave birth between 1st January 1985 to 31st December 2006 in the Czech Republic. SUBJECT: A retrospective descriptive analysis. SETTING: Teaching Hospital Bulovka, 1st Faculty of Medicine, Charles University, Prague. SUBJECT AND METHODS: The study included HIV positive women that gave birth between 1st January 1985 to 31st December 2006 at Bulovka hospital. The group of 62 HIV positive women (including 7 secundiparae) gave birth to 71 new-borns (twice twins). The deliveries were performed by C-section. We interrupted breast-feeding by all these women. RESULTS: All new-borns were born alive, no one had Apgar score less than 7 at five minutes. No congenital disorders were found. Three new-borns were transfered to Intensive care unit for new-born babies, two due to dysmaturity and one due to abstinence syndrome. 3 new-borns out of total 71 new-borns were HIV positive (4.2%). CONCLUSION: Routine prenatal screening for HIV and high-quality cooperation between obstetricians and infection control doctors are the basic condition of low rate of vertical trasmission HIV infection in the Czech Republic.

[Intravenous treatment of postpartum anemia with trivalent ferrum preparation]. / Intravenózní aplikace lécebného prípravku trojmocného zeleza pri lécbe poporodní anémie.

AIM OF THE STUDY: To assess the effectivity and safeness of intravenous treatment of pospartal anemia with trivalent ferrum preparation. TYPE OF THE STUDY: Prospective randomized study. SETTING: Department of Obstetric and Gynecology 2nd Medical Faculty Charles University and Teaching Hospital Motol, Prague, and Department of Obstetric and Gynecology 1st Medical Faculty and Teaching Hospital Bulovka, Prague. METHODS: 500 mg of sacharose ferric oxide (Venofer) was intravenously administered in two days regimen to 50 women with clinical and lab signs of postpartal anemia. The effect of administered drug was determined by comparsion of values of red blood count recovered before the treatment, 2nd or 3rd day post administration and two weeks later. The serum values of soluble transferrin receptors and ferritin were observed as markers of iron cell saturation and body iron reserves, too. Integral part of the study was the monitoring of adverse events during the treatment. RESULTS: Venofer came in sight as effective drug in the treatment of pospartal anemia and could become as the alternative to blood transfusion in mid-severe cases. It should be emphasized that we have not encountered any serious adverse event with intravenous trivalent saccharose ferric oxide treatment.

[Choroid plexus cysts and risk of trisomy 18. Modifications regarding maternal age and markers]. / Cysty choroidálního plexu a riziko trizomie 18. Modifikace ve vztahu k veku a markerum.

OBJECTIVE: Our aim was to evaluate the risk of chromosomal abnormalities esp. trisomy 18, associated with isolated choroid plexus cyst(s) in pregnant women undergoing second-trimester ultrasonographic examination. DESIGN: A review article. SETTING: OBGYN clinic of the 1st faculty of medicine, Prague, Teaching hospital Bulovka. SUBJECT: Choroid plexus cyst(s) (CPC) are more common in fetuses with chromosomal aneuploidies, particularly trisomy 18. Although it is accepted that the risk of karyotypic abnormality justifies amniocentesis in the case of other associated abnormalities are present, disagreement continues as to the risk of trisomy 18 in a fetus with an isolated choroid plexus cyst. We evaluated additional consideration of maternal age and multiple-marker screening for chromosomal aneuploidy in the assessment of risk. CASE REPORT: We report a trisomy 18 case that was diagnosed on the basis of CPC detection by ultrasound, NMR, and further amniocentesis. CONCLUSION: It is well accepted that choroid plexus cyst(s) in association with other congenital anomalies warrant amniocentesis to determine fetal karyotype. The presence of isolated CPC varies around 1% in general population, but around 30% in fetuses with trisomy 18 where the prevalence is 3 per 10,000 pregnancies. Metaanalyses reported incidence of trisomy 18 of 1 in 374 in fetuses with isolated CPC. These risks do not exceed the 1:200 risk of pregnancy loss after amniocentesis and also the 1:270 risk of Down syndrome (DS) in a 35-year-old woman, but exceeds the risk for DS of a 37-year-old woman. Thus these findings suggest that amniocentesis should not be offered to pregnant women in the presence of isolated fetal choroid plexus cyst(s), but in the absence of other pathologies. Amniocentesis is then justified only in the patient with advanced maternal age.

[Pneumonia in pregnancy]. / Pneumonie v tehotenství.

OBJECTIVE: Review of the latest informations about etiology, patophysiology and management of pulmonal infections in pregnant women. DESIGN: Review. SETTING: Clinic of Obstetrics and Gynecology, 1st Medical Faculty of Charles University and Teaching Hospital Na Bulovce, Praque. METHODS: Summary of datas from articles in scientific press and textbooks, self experience. CONCLUSION: Acute pneumonia of various etiology can be a serious complication in pregnancy. An X-ray photograph has still an unsubstituable part in diagnosis.

[Methods of assisted reproduction in HIV positive patients]. / Metody asistované reprodukce u HIV pozitivních pacientu.

AIM OF THE STUDY: Analysis of treatment possibilities of infertility in HIV positive patients and solution of child desire in discordant pairs. Authors also present their own case. TYPE OF STUDY: Literature review and two case report. NAME AND SETTING OF DEPARTMENT: Department of Obstetrics and Gynaecology, The First Medical Faculty of Charles University in Prague. MATERIALS AND METHODS: Review of papers published on risk of HIV transmission during sexual intercourse, fertility of HIV positive patients and possible solution of their child desire. Summary of papers published on safety and effectivity of artificial insemination and IVF ET in HIV discordant pairp. Analysis of our own cases of artificial insemination in pairs of HIV negative female and HIV positive male. CONCLUSION: Artificial insemination seems to be safe, relatively cheap and effective solution of child desire in HIV discordant pair.