A comparison of the incidence of early postoperative infections between patients using synthetic mesh and those undergoing traditional pelvic reconstructive surgical procedures.

New mesh-related complications such as erosion, etc., can result from abnormal postoperative healing due to surgical site infection. The aim of our study was to compare systemic inflammatory responses and the incidence of early infectious complications after reconstructive surgery using synthetic mesh and after traditional vaginal wall repair. In this prospective observational study 99 women with symptomatic pelvic organ prolapse were included; 55 women underwent traditional repair and 44 repair using mesh. After the procedure infectious complications were monitored. The patients who underwent reconstructive surgery using mesh material were more likely to have febrile morbidity in the postoperative period than the patients who had been treated with traditional repair (p=0.031); there was a higher incidence of combination febrile morbidity with elevated C-reactive protein (CRP) > 50 mg/l; p=0.046, and a higher incidence of CRP increase over 30 mg/l; p=0.005. Reconstructive procedures using synthetic mesh are accompanied by a higher incidence of early post-operative infectious complications.

[Modified classification of microscopic evaluation of vulvovaginal infections]. / Modifikovaná klasifikace mikroskopického hodnocení posevních infekcí.

OBJECTIVE: The objective of the study is to examine the role of microscopy using stained smears for diagnosis of vulvovavaginal infections: DESIGN: Description of different scoring systems. SETTINGS: Department of Gynecology and Obstetrics, First Medical Faculty, Charles University; General Teaching Hospital, Prague; Institute of Clinical Chemistry and Laboratory Medicine; Clinical Microbiology and Antibiotic Center, First Medical Faculty, Charles University. MATERIAL AND METHODS: Presentation of our practical skills in microscopic diagnoses of vulvovaginal infections. CONCLUSIONS: Vulvovaginal infections are a common problem which we encounter in daily gynaecological practice. Microscopic examination represents the gold standard in the diagnosis of vulvovaginal infections. However, providing microscopy in an outpatient setting is very time-consuming. The vaginal smear can be sent to a laboratory to stain and to be microscopically examined under oil immersion. For this purpose we recommend taking two smears for Gram and Giemsa stain and combining microscopical examination with cultures for detecting the presence of Candida species and for Trichomonas vaginalis. Where appropriate, it is also necessary to obtain cervical smears for detection of C. trachomatis and N. gonnorhoeae infection.

[Current possibilities for diagnosis of vulvovaginal infection]. / Soucasné moznosti diagnostiky vulvovaginálních infekcí.

OBJECTIVE OF THE STUDY: The objective of the study was to describe current possibilities of proper diagnosis of vulvovaginal infections. DESIGN: Review article. SETTINGS: Department of Gynecology and Obstetrics, First Medical Faculty, Charles University and the General Teaching Hospital, Prague, Institute of Clinical Chemistry and Laboratory Medicine, Clinical microbiology and antibiotic center, First Medical Faculty, Charles University and General Teaching Hospital in Prague. MATERIAL AND METHODS: Presentation of literature review information and our practical skills in diagnosing vulvovaginal infections. CONCLUSIONS: Vulvovaginal infections are a common problem which we encounter in daily gynaecological practice. Most women with those conditions need only basic investigation and treatment. However, in order to offer the appropriate care for those women it is necessary to understand the basic pathophysiology of vulvovaginal disorders. A fundamental step is to make the correct diagnosis. All too often our decisions are influenced by clinical dogmas which are even found repeatedly in gynaecological textbooks. Microscopic examination represents the gold standard in the diagnosis of vulvovaginal infections.

[A role of prenatal diagnostics in birth defects occurrence in the Czech Republic in 2004]. / Podíl prenatální diagnostiky na výskytu vrozených vad v Ceské republice v roce 2004.

OBJECTIVE: An analysis of prenatal diagnostics of birth defects in the Czech Republic in 2004 and a comparison to data from 1996 - 2003. TYPE OF STUDY: A retrospective analysis of data from a Register of Prenatal Diagnostics of the Czech Republic. METHODOLOGY: Data on birth defects in the Czech Republic from particular departments of medical genetics and prenatal diagnostics from 1996 to 2004 time period was used. An analysis of data on prenatal diagnostics of selected type of birth defects was performed. RESULTS: During 1996 to 2004 period, a total of 4,126 prenatally diagnosed and terminated cases were reported. In 2004, 597 cases were reported, which presents 61.1 cases per 10 000 live births. (The mean rate from the total period under the study was 49.8 per 10 000 live births.) CONCLUSIONS: Current data on birth defects in a 9-year period in the Czech Republic are presented. The role of prenatal diagnostics in decrease of some severe types of birth defects is underlined.

[Infant mortality due to birth defects in the Czech Republic in 1994-2004]. / Mortalita detí v prubehu prvního roku zivota v dusledku vrozených vad v CR v období 1994-2004.

UNLABELLED: AIM AND TYPE OF STUDY: A retrospective data study with an analysis of pre- and postnatal occurrence of selected types of birth defects in the Czech Republic during 1994 to 2004 period. An analysis of infant mortality rate in children with selected types of birth defects during their first year of life is described. METHODOLOGY: Data on prenatal diagnostics were obtained from particular departments of medical genetics. Data on birth defects incidences were obtained from National Health registers - Institute of Health Information and Statistics (National Register of Congenital Anomalies and National Newborns Register) from the 1996-2004 period were used. A case analysis of incidences of 14 types of pre- and postnatally diagnosed birth defects was performed for the period 1994-2004. In postnatally diagnosed cases, an analysis of survival and extinction of particular types of defects during the first year of life was also performed. RESULTS: During 1994-2004, there were 1 030 069 children born in the Czech Republic. Including prenatally diagnosed cases, we registered 305 cases of anencephaly, 454 spina bifida, 156 encephalocele, 528 cases of congenital hydrocephalus, 304 omphalocele and 302 cases of gastroschisis, 241 oesophageal defects, 302 anorectal malformations, 312 cases of diaphragmatic hernia, 518 renal agenesis/hypoplasia cases, 529 cases of cystic kidneys and 1764 Down syndrome cases. Secondary prevention rate was high in neural tube defects (61-100%), abdominal wall defects (60-79%) and Down syndrome (63%). In operable defects, a first-year survival was lowest in congenital hydrocephalus (63%) and neural tube defects -excluding anencephaly - (82%). In abdominal wall defects, diaphragmatic hernia, oesophageal and anorectal malformations, the survival rate was, however, 76-91% of children. CONCLUSIONS: Birth defects present a major contribution to infant mortality and morbidity. Prematurity in a combination with a birth defect prolongs inpatient days and increases a need of a total parenteral feeding in a newborn and it also makes a worse prognosis for the infants with birth defects. An improvement of prenatal diagnostics with an early detection of the most severe types along with the associate ones could decrease incidences of such cases. A progress in surgical techniques and a special neonatal and infant intensive health care would also contribute an improvement of survival.

[Birth defects' occurrence in offspring of mothers taking 1st trimester medication in the Czech Republic in 1996-2004]. / Vrozené vady v Ceské republice v roce 2004 u detí matek uzívajících v I. trimestru gravidity léky.

OBJECTIVE: An analysis of birth defects incidence in offspring of mothers taking 1st trimester medication in the Czech Republic in 1996-2004. TYPE OF STUDY: A retrospective demographical-epidemiological analysis of data from a National Register of Congenital Anomalies of the Czech Republic. METHODOLOGY: Data on birth defects in the Czech Republic from the Institute of Health Information and Statistics--National Register of Congenital Anomalies from the 1996-2004 period and a control group data on healthy children born to mothers taking medications from the same time period. Data on medication were analyzed in relation to particular defects and were also used in international databases. RESULTS: There were 1,125 children born with a birth defect to mothers taking 1st trimester medication making a total of 1,456 particular birth defects. A control group covered 1,321 exposed women giving birth to a child without any birth defect. Some types of congenital heart defects, cleft lip with cleft palate and limb reduction defects. A significantly higher risk was found also in following 5 types of drugs: anticoagulants, antihypertensives, peripheral vasodilatants, urologics and antiepileptics. CONCLUSIONS: A significantly higher risk was found for the following defects: anencephaly, spina bifida, congenital hydrocephalus, anophthalmia/microphthalmia and auricular and limb reduction defects. Although the results are not always unambiguous and are probably influenced by both information and recall bias, they complement data on adverse effects of drugs in pregnancy in the Czech Republic. They also stress the need for a high preliminary caution in drug prescription and for a complex and individual risk assessement by a clinical geneticist.

[Birth defects occurrence and their role in perinatal mortality in the Czech Republic in 2004]. / Výskyt vrozených vad v Ceské republice a jejich podíl na perinatální úmrtnosti v roce 2004.

OBJECTIVE: An analysis of birth defects occurrence in the Czech Republic in 2004 and a comparison to data from 1996-2003. TYPE OF STUDY: A retrospective analysis of data from a National Register of Congenital Anomalies of the Czech Republic. METHODOLOGY: Data on birth defects in the Czech Republic from the Institute of Health Information and Statistics--National Register of Congenital Anomalies from the 1996-2004 period were used. An analysis of incidence of selected type of birth defects was performed along with their contribution to perinatal mortality according to particular types of defects. RESULTS: There were 29 186 children born with a birth defect, out of it were 17,063 boys and 12,116 girls, an undetermined sex was reported in 7 cases. A mean incidence of birth defects 2004 in was 367.9/10,000 live births. Corresponding data from years 2003, 2002 and 2001 were 405.2, 4043 and 407.9/10,000 live births. CONCLUSIONS: Current data on birth defects in 2004 in the Czech Republic are presented with a comparison to a 8-year period. An analysis of temporal and demographic changes in birth defects incidence is given along with data on birth defects contribution to perinatal mortality in selected types of defects.

[Prenatal diagnostics of birth defects in the Czech Republic--gestational week at the time of diagnosis]. / Prenatální diagnostika vrozených vad v Ceské republice--týdny tehotenství pri diagnostice.

UNLABELLED: AIM AND TYPE OF STUDY: A retrospective study and analysis of data on gestational week at the time of the birth defect diagnoses of both invasive and non-invasive type as well as on gestational week at the time of pregnancy termination in the Czech Republic over the 1996-2003 period. METHODOLOGY: Data on prenatal diagnostics were obtained from particular departments of medical genetics. Data were collected for both birth defects as a total as well as for selected particular types: anencephaly, spina bifida, omfalocele, gastroschisis and Down syndrome. An analysis on gestational weeks at the time of diagnosis and/or pregnancy termination was performed. RESULTS: Mean gestational week at the time of diagnosis was 19.49 for total birth defects and 20.02 for pregnancy termination. Corresponding values (diagnosis x termination) in gestational weeks were as follows: Anencephaly 17.01 and 17.69, spina bifida 19.41 and 19.68, omfalocele 17.64 and 17.99, gastroschisis 17.63 and 1836, Down syndrome 19.81 and 20.43. CONCLUSIONS: Results of aggregate data analysis contribute to a better knowledge of different methods of prenatal diagnosis during different gestational periods. All values of mean gestational week at the time of diagnosis/pregnancy termination slightly decreased during the time of the study in all presented types of birth defects.

[Birth defects occurrence in the Czech Republic in 2003]. / Výskyt vrozených vad v Ceské republice v roce 2003.

OBJECTIVE: An analysis of birth defects occurrence in the Czech Republic in 2003 and a comparison to data from 1996-2002. TYPE OF STUDY: A retrospective analysis of data from a National Register of Congenital Anomalies of the Czech Republic. METHODOLOGY: Data on birth defects in the Czech Republic from the Institute of Health Information and Statistics-National Register of Congenital Anomalies from the 1996-2003 period were used and an analysis of incidences of selected types of birth defects was performed. RESULTS: There were 25,593 children born with a birth defect (14,896 boys and 10,690 girls, in 7 cases the sex was undetermined). A mean incidence of birth defects was 405.2/10,000 live births and remains more or less stable compared to the years 2002 and 2001 (4043/10,000 and 407.9/10,000 live births respectively). CONCLUSIONS: Current data on birth defects in 2003 in the Czech Republic are presented with a comparison to a 8-year period. An analysis of temporal and demographic changes in birth defects incidences is given along with data on prenatal diagnostics and its role in birth defects decrease.

[Birth defects in the Czech Republic--expected incidence in the coming years]. / Vrozené vady v Ceské republice--odhady incidencí v prístích letech.

OBJECTIVE: The study was aimed to analyze expected incidence of birth defects as a whole and some selected types of birth defects on the basis of the mean values over the period of 1983-2002 in the Czech Republic. A possible incidence of birth defects in the Czech Republic in the coming years was evaluated. DESIGN: A statistical estimate and analysis of the expected incidence based on retrospective values of incidence of birth defects from the data of the Institute of the Care of Mother and Child (UPMD) and the Institute of Medical Information and Statistics of the Czech Republic (UZIS). METHODS: The estimate of incidence of birth defects as a whole as well as according to individual selected types with the application of exponential adjustment of time series with the time-weighted parameter for individual years of the retrospective period of time. RESULTS AND CONCLUSIONS: The statistical estimate indicates that 1,244,767 children should be born in the Czech Republic over the period of 2003-2015. In this period of time there should be 50,706-67,628 prenatally and postnatally diagnosed cases of birth defects in this republic. These our results represent an estimate of birth defects in the Czech Republic in the coming years and draw attention to the importance of registry of birth defects in the Czech Republic. The epidemiology of birth defects actually represents a multidisciplinary branch, which is primarily aimed at and providing data for the evaluation of quality of prenatal and postnatal care in the Czech Republic.

[Condition of children after assisted reproduction in the Czech Republic in the period of 1995-1999]. / Stav detí po asistované reprodukci v Ceské republice za období let 1995-1999.

INTRODUCTION AND PROBLEM: Since the introduction of in vitro fertilization (IVF) there has been continuing discussion on possible genetic defects and malformations in children in connection with the technique of assisted reproduction. These data have not been so far analyzed in the all-state scale of the Czech Republic and our contribution thereby contributes by present complex analysis of the data to the knowledge of this problem in this country. MATERIAL AND METHODS: The paper analyzes data of children from IVF Registry for the years 1995-1998 and compares the results obtained with those of children born after spontaneous pregnancy in the Czech Republic in the period of 1995-1999. The incidence of inborn defects in children born after IVF methods has been confronted with data from the VV Registry after spontaneous conception. It is a retrospective analysis of individual anonymous data. RESULTS: In the period of 1995-1998 there were 3,782 successful pregnancies after IVF, which ended by successful delivery of the children. In the period of 1995-1999, 367,735 children were born in the Czech Republic on the whole. In the total number of 3,782 successful pregnancies, 5,126 children were born, 5,108 being born alive and were stillborn. The frequency of children having been delivered with an inborn defect were 2.98% in the IVF children and 2.77% in other born children, the difference not being statistically significant. CONCLUSION: The analysis of our cohort of IVF children has not revealed increased rate of inborn defects in comparison with children born after spontaneously conception.

[The incidence of birth defects in Czech Republic in 2002]. / Výskyt vrozených vývojových vad v Ceské republice v roce 2002.

OBJECTIVE: Analysis of incidence of birth defects prenatally and postnatally diagnosed in the Czech Republic during 2002 and a comparison with the years 1996-2001. TYPE OF STUDY: Retrospective demographic-epidemiologic study. METHODS: Analysis of incidence of birth defects (BD) in live- and still-born children and the number of prenatally diagnosed cases of birth defects and chromosomal aberrations in the Czech Republic in 2002. The incidence data of BD were obtained from those registered in statistical reports, birth defect of foetus or child, which have been registered in the Institute for Medical Information and Statistics of Czech Republic. Those data, which became available to the authors by the end of October 2003, were processed. Supplementary data on prenatally diagnosed cases were obtained from individual workplaces of medical genetics in the Czech Republic. RESULTS: A total of 93,047 children were born in 2002 in the Czech Republic. There were reports on 3673 children with BD detected up to one year of life. There were 2131 boys ad 1542 girls affected with BD. The representation for 10,000 live-born children was 395.9 in comparison with 418.3 in the year 2000 and 405.0 in the year 2001. CONCLUSION: The total numbers of BD have not changed in the last three years, while the increase in 1998-2000 came to a halt in 2001 and 2002. The prenatal diagnostics for severe congenital defects in the Czech Republic prove to be at high level, which is comparable with advanced countries of the world.

[History of registration of prenatally and postnatally diagnosed congenital defects in the Czech Republic]. / Historie registrace prenatálne a postnatálne diagnostikovaných vrozených vad v Ceské republice.

OBJECTIVE: Analysis of incidence of birth defects in general and the proportion of individual types of birth defects within the framework of registration of inborn defects in the period of 1961-2000 in the Czech Republic. DESIGN: A retrospective analysis based on registered birth defects from the material of Institute of Care for Mother and Child and IHIS from the period of 1961-2000. METHODS: The authors compared the real frequency of birth defects in the eighties and nineties with expected frequency calculated on the basis of mean values from the sixties and seventies. RESULTS AND CONCLUSIONS: The results between the expected and estimated values of the overall frequency of birth defects are based on two reasons. First of all there are changes in registration as such--increased numbers of registered types of birth defects, prolonged period of reporting the inborn defects up to 15 years old children, decreased levels of foetus viability and other factors. There is also the change of frequency caused by all-population changes (eradication of some infections, vaccination rate in the population, improved nutrition of the population, year-around availability of vitamins), the development of diagnostic methods (ultrasonographic methods) and, especially, the role of prenatal screening and prenatal diagnostic methods in practice.

[Occurrence and survival in children with selected types of congenital defects in the Czech Republic 1994-2001. Part 2]. / Výskyt a prezívání detí s vybranými typy vrozených vad v Ceské Republice v období 1994-2001. 2. cást.

OBJECTIVE: Analysis of prenatal and postnatal incidence of selected types of birth defects in the Czech Republic in the period of 1994-2001. In the postnatally diagnosed cases the survival in the course of the first year of life was analyzed. Selected birth defects--omphalocele, gastroschisis, abdominal wall defects, renal agenesis and hypoplasie, cystic kidney disease, diaphragm hernia. TYPE OF STUDY: Retrospective analysis from registry of birth defects in the Institute of Health Information and Statistie of the Czech Republic in the period of 1994-2001. METHOD: The authors analyzed frequency of prenatally and postnatally diagnosed cases of 6 selected types of birth defects in the period of 1994-2001 in the Czech Republic. In cases where the diagnosis was established after birth, analysis of survival and death rate during the first year of life was performed for selected birth defects. RESULTS: In the period of 1994-2001, 745,410 children were born in the Czech Republic. There were 22,711 children with one or more birth defects diagnosed in this cohort during the first year of life. The mean incidence of all cases in this period of observation was 304.52 per 10,000 live born children. The percentage of prenatally diagnosed cases, ended for this diagnosis in the above mentioned period of observation, was 66% in abdominal wall defects, 55% in omphalocele and 77% in gastroschisis. In cases where the diagnosis was established after birth, 93.55% of children survived the first year of life. In cases of birth cystic kidney 25% were diagnosed prenatally and ended for renal agenesis and hypoplasie of the kidneys and 27% due to cystic kidney. In cases of diaphragmatic hernia, 31% of cases were diagnosed an ended prematurely after positive prenatal diagnosis, and about one third of affected children died during the first year of life. CONCLUSION: Incidence of these types of birth defects in newborns in the Czech Republic is presently lower than in previous years particularly due to successful prenatal diagnostics. Cases where the diagnosis is established after delivery represent an important part of perinatal, neonatal and post-neonatal mortality and morbility.

[Incidence and survival in children with selected types of congenital defects in the Czech Republic from 1994 to 2001. (Part 1)]. / Výskyt a prezívání detí s vybranými typy vrozených vad v Ceské republice v období 1994-2001 (1. Cást).

OBJECTIVE: Analysis of prenatal and postnatal incidence of selected types of birth defects in the Czech Republic in the period of 1994-2001. In the postnatally diagnosed cases the survival in the course of the first year of life was analyzed. Selected birth defects--anencephaly, spina bifida, encephalocele, neural tube defects, congenital hydrocephalus, Down syndrome, were investigated. TYPE OF STUDY: Retrospective analysis from registry of birth defects in the UZIS Czech Republic in the period of 1994-2001. METHOD: The authors analyzed frequency of prenatally and postnatally diagnosed cases of 6 selected types of birth defects in the period of 1994-2001 in the Czech Republic. In cases where the diagnosis was established after birth, analysis of survival and death rate during the first year of life was performed for selected birth defects. RESULTS: In the period of 1994-2001, 745,410 children were born in the Czech Republic. There were 3,572 children with one or more birth defects diagnosed in this cohort during the first year of life. The mean incidence of all cases in this period of observation was 304.52 per 10,000 live born children. The percentage of prenatally diagnosed cases, ended for this diagnosis in the above mentioned period of observation, was on the average 72.5% in neural tube and the highest in anencephaly--more than 96%. In cases of congenital hydrocephalus it was higher than 45% and in Down syndrome it represented 56.5%. The survival in children with neural tube defects was 82.5% on the average, being obviously zero in anencephaly. The children with congenital hydrocephalus survive in more than 75% and those with Down syndrome survive in almost 95%. CONCLUSION: Incidence of these types of birth defects in newborns in the Czech Republic is presently lower than in previous years particularly due to successful prenatal diagnostics. Cases, where the diagnosis is established after delivery, represent an important part of perinatal, neonatal and post-neonatal mortality and morbidity.

[Incidence of birth defects in children of mothers using medications in the 1st trimester of pregnancy in the Czech Republic 1996-2002]. / Výskyt vrozených vad u detí v potomstvu matek uzívajících v I. trimestru gravidity medikaci v Ceské republice v období 1996-2002.

OBJECTIVE: To process the results on the incidence of birth defects in the children of mothers using medicines in the first trimester of pregnancy in the Czech Republic during 1996-2002. DESIGN: A retrospective analysis of data from the National Register of birth Defects in the Czech Republic. METHODS: The data from the nationwide register of birth defects administrated in the Institute of Health Information and Statistics of the Czech Republic for the period 1996-2002 were used for the study. The data on the incidences of selected types of birth defects identified in children born to mothers using medicines in the first trimester of pregnancy were compiled and an analysis of these medicines was carried out in relation to the diagnosed types of birth defects. The data on healthy children born to mothers using medicines during the 1st trimester of pregnancy were used as the control sample. RESULTS: In our retrospective analysis covering the years 1996-2002, a total of 1,146 birth defects were identified in children of women using medication in the 1st trimester of pregnancy and a total of 891 children affected in this way were identified. CONCLUSION: The study presents the updated results of these analyses based on nationwide registration of birth defects for a seven-year period. It analyses the types of birth defects in the children of women using medication in the 1st trimester of pregnancy and the types of medicines used by these women. In our study, we have found a significantly higher incidence in the population of the children born to women using medicines in the 1st trimester of pregnancy in several cases. From among the group of cleft defects affecting the central nervous system, this concerns for example anencephalia and spina bifida, as well as congenital hydrocephalus, anophthalmy/microphthalmy, auricle abnormalities and limb reduction deformities. From these results that we produced, it is of course not possible to draw significant conclusions with a clinical impact. However, pregnant women should avoid any medicines in the first trimester of pregnancy, except for those cases, which are strictly indicated from the medical point of view and which are recognised as reasonably safe. As concerns the use of other medicines, their genetic and teratogenic risk should be assessed comprehensively by a specialised clinical geneticist on a case-by-case basis.

[Condition of the children born after assisted reproduction in Czech Republic]. / Stav detí narozených po asistovan reprodukci v CR.

OBJECTIVE: A retrospective study of data, with an analysis of bio-social factors and the incidence of birth defects in the children born out of pregnancy resulting from assisted reproduction in the Czech Republic in the period from 1995 to 2002. Also, the objective was to analyse these factors in comparison with a group of children born during the same period after spontaneous conception. DATA SOURCE AND METHODS: The data were obtained from the National Health Registers, the administration of which has been entrusted to the Institute of Health Information and Statistics of the Czech Republic (IHIS CR). Specifically, the National Register of Birth Defects and the National Register of Neonates were used. Groups of children born after spontaneous conception and after assisted reproduction were analysed. We analysed the frequency of pregnancy, the gestation week at birth and birth weight, the incidence of immaturity at birth, hypotrophy, hypertrophy, the incidence of birth defects in prenatally and postnatally diagnosed cases and the mortality rate during the 1st year of life. RESULTS: In the period 1995-2002, a total of 731,617 children were born in the Czech Republic. During the same period, a total of 14,243 children were born after assisted reproduction. A statistically significant higher (p<0.0001) proportion of the children born out of multiple pregnancies (40% in the assisted reproduction group as compared with 1.7% in the spontaneous conception group) was identified. The overall mortality rates (early neonatal mortality and infant mortality) are significantly influenced by the number of children within a pregnancy, and as a consequence of the unfavourable distribution in the assisted reproduction group (statistically significant higher representation of children from multiple pregnancies), the rates are higher in the assisted reproduction group. CONCLUSION: The frequencies of children born with a birth defect in the assisted reproduction group and in the group of other born children were not statistically significant. The differences in mortality rates, birth weights and the gestation week are caused by the unfavourable demographic distribution in the assisted reproduction group.

[Survival of children born with selected types of birth defects in Czech Republic]. / Prezívání detí narozených s vybranými typy vrozených vad v Ceské republice.

OBJECTIVE: A retrospective study of data with an analysis of the prenatal and postnatal incidence of selected types of birth defects in the Czech Republic during the period from 1994 to 2003. The objective was also to analyse the percentage of deceased children born with selected types of congenital defects from the total number of deceased children. DATA SOURCE AND METHODS: The data on prenatal diagnostics were obtained from particular department of medical genetics in the Czech Republic. The data on the incidences of birth defects in the born children were obtained from the data of the National Health Registers, the administration of which has been entrusted to the Institute of Health Information and Statistics of the Czech Republic (IHIS CR). Specifically, the data from the National Register of Congenital Defects and the National Register of Neonates were used. The analysis of the frequencies of prenatally and postnatally diagnosed cases of twelve selected types of birth defects was carried out for the Czech Republic for the period from 1994 to 2003. For the cases of postnatally diagnosed defects, an analysis of survival and mortality of the affected individuals during the 1st year of life was carried out for selected types of birth defects. RESULTS: In the period 1994-2003, a total of 932,153 children were born in the Czech Republic. Including the cases of successful prenatal diagnostics, we analysed 268 cases of anencephalia, 384 cases of spina bifida and 80 cases of encephalocele, 425 cases of congenital hydrocephalus, 261 cases of omphalocele and 258 cases of gastroschisis, 225 cases of congenital defects of oesophagus and 279 anorectal malformations; 232 cases of diaphragmatic hernia, 411 cases of agenesis/hypoplasia of kidneys and 438 cystic kidneys; and 1,412 cases of Down's Syndrome. The success rate of secondary prevention was high for the defects of neural tube (55-96%), for the defects of abdominal wall (55-78%) and for the Down's Syndrome (59%). As concerns the defects treatable by surgery, the survival rate in the first year of life of the born children was lowest in the case of congenital hydrocephalus (63%) and in the case of neural tube defects (75-84%). However, in the case of GIT congenital defects (the defects of abdominal wall, diaphragmatic hernia, congenital defects of oesophagus and anorectal malformations), 82 to 91% of the born children survived. CONCLUSION: Immaturity and concurrent incidence of additional birth defects prolong the period of hospitalisation, UPV and total parenteral nutrition in the case of the affected neonates. This deteriorates the prognosis of the children born with birth defects. Possible reduction of the incidence of these cases could be achieved through improvement in prenatal diagnostics, specifically through more timely identification of mainly the serious types of defects with the presence of associated congenital defects. Another possibility to improve the survival rate of children is the development of surgical procedures and specialised neonatal and infant intensive care.

[Week of pregnancy in which birth defects were prenatally diagnosed in the Czech Republic in 1996-2002]. / Týden tehotenství pri prenatální diagnostice vrozených vad v Ceské republice v období let 1996-2002.

OBJECTIVE: To evaluate the week of pregnancy in which birth defects were prenatally identified and the week of pregnancy in which pregnancy was terminated due to these defects in the Czech Republic in the period from 1996 to 2002. As regards data on Down's Syndrome, comparison to the data from other countries. DESIGN: A retrospective study, which identifies the week of pregnancy when congenital defects are identified through invasive as well as non-invasive prenatal diagnostics and the week of pregnancy when the pregnancy is terminated because of these defects. METHODS: The data were obtained from individual medical genetics facilities. The data are stated for all defects prenatally diagnosed as well as for the defects, which are most frequently prenatally diagnosed - from among neural tube defects, anencephaly and spina bifida were covered; from among abdominal fissures, omphalocele and gastroschisis were covered. Out of inborn chromosomal aberrations, the most frequently diagnosed chromosomal aberration - Down's Syndrome - was covered. RESULTS: The average time of prenatal diagnostics of the birth defects was 19.48 week and the average time of termination of pregnancy due to these defects was 20.11 week. Anencephaly was diagnosed after 17.16 weeks and terminated after 17.84 weeks of the pregnancy on the average. Prenatal diagnostics of spina bifida was carried out after 19.25 weeks and terminated after 19.70 weeks. Omphalocele was identified after 17.55 weeks and terminated after 17.99 weeks. The second type of defect of abdominal wall - gastroschisis was identified after 17.93 weeks and terminated after 18.65 weeks. On the average, Down's Syndrome was diagnosed after 19.81 weeks and terminated after 20.43 weeks. It can be said about all the defects that during the monitored years there was a slight reduction of the period after which the defect was identified as well as of the period after which pregnancy was terminated. CONCLUSION: For all the presented selected birth defects as well as for the defects as a whole, it can be said that during the monitored years there was a slight reduction of the average period after which the defects were identified and as well as of the average period after which pregnancy was terminated.

[The incidence of serious complications in neonates with birth weight < 1,500 g in the Czech Republic (in the period 2000-2002)]. / Incidence závazných komplikací u novorozencu s porodní hmotností < 1500g v CR (období 2000-2002).

OBJECTIVE: To analyse the incidence of serious complications in neonates with birth weight lower than 1,500 g in the Czech Republic in the years 2000-2002. DESIGN: A retrospective epidemiological study. METHODS: Frequency analysis of the data from the National Register of Neonates, administrated by the Institute of Health Information and Statistics of the Czech Republic. RESULTS: The incidence of PIVH of level III-IV in neonates with weight of up to 1,500 g in the Czech Republic in the years 2000-2002 was 6.8-10.3%; the incidence of cPVL reached 6.4-7.6%; the incidence of ROP of level III and of a higher level was 6.6-7.9% and the incidence of NEC was between 4.3 and 5.7% of all live births. Among the surviving neonates, the percentages of those who did not have any of the PIVH, ROP, HIE or meningitis diagnoses in the reference period were as follows (according to their birth weights): 500-749g 50-63.8%; 750-999 g 69.7-74.8%; 1,000-1,499 g 86.8-91.4%; 1,500-1,999g 98-98.2%; 2,000-2,499 g 99.4-99.5%; and in the group with weight above 2,500g, the percentage was 99.9%. CONCLUSION: The incidence of serious complications in neonates with birth weight of up to 1,500 g in the Czech Republic in the years 2000-2002 was comparable with the data stated in the literature, except for cPVL, the incidence of which was higher in the Czech Republic. The proportion of neonates, who were released and did not have any of the complications, which pose a risk to normal neurosensory development, does not virtually change for birth weights higher than 1,500 g and reaches 98 and more percent. However, among the surviving neonates with birth weight of up to 750, their proportion is mere 50-64%.