[Intrahepatic cholestasis of pregnancy]. / Intrahepatální cholestáza v tehotenství

The review of intrahepatic cholestasis of pregnancy attempts to summarize the current knowledge of this disease by analysing available literary sources. Intrahepatic cholestasis of pregnancy is a disease that typically appears in the third trimester of pregnancy, sometimes already at the end of the second trimester of pregnancy. The main symptom of the disease is pruritus. In addition, the disease is characterized by increased levels of liver enzymes and bile acids. The symptoms of the disease disappear spontaneously after delivery. The disease is associated with high incidence of fetal distress, as well as with a high risk of premature labour. The most serious obstetric complication is antenatal sudden fetal death. Fetal complications are probably caused by elevated levels of bile acids. Therefore the aim of treatment should be to minimize negative effects of bile acids on the fetus, to prolong pregnancy and reduce maternal symptoms at the same time.

[Acute or expectant management in premature labour with preterm premature rupture of the membranes?]. / Akutní, nebo expektacní prístup u predcasného porodu s predcasne odteklou plodovou vodou?

OBJECTIVE: To evaluate current knowledge about the management of preterm premature rupture of the membranes (PPROM). DESIGN: Review article. SETTING: Perinatological center, Department of Gynecology and Obstetrics, General Faculty Hospital and 1st Medical School of Charles University, Prague. METHODS AND RESULTS: Expectant management in case of PPROM increases the incidence of infection/ inflammation but does not statistically increase mortality and serious morbidity of the infants. The incidence of infants morbidity corresponds with gestational age. The most serious complications occur in the lower gestational age. It is necessary to take an individual approach. The acute management increases the number of operative deliveries and respiratory distress syndrome (RDS) in the infants. The combination of RDS, extremely prematurity and hypoxia during the labour decreases the infants survival rate. CONCLUSIONS: The prolongation of the latency period in pregnancies above 28th week does not deteriorate the neonatal mortality or morbidity.

[Spontaneous preterm birth in mother in an artificial sleep on ECMO with severe form of H1N1 infection]. / Spontánní predcasný porod u rodicky v umelém spánku na ECMO pri závazné forme infekce H1N1.

OBJECTIVE: The authors demonstrate a premature birth of a pregnant woman, who was for heavy Respiratory Distress Syndrome (ARDS), on the basis of pulmonary infection H1N1, connected to venovenous extracorporeal membrane oxygenation (ECMO). Patient spontaneously delivered after being connected to the ECMO for 30 hours. SETTING: Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague. DESIGN: Case report. CONCLUSION: Preterm birth at 24 week of pregnancy. During pregnancy, the labor and postpartum was the pregnant woman connected to extracorporeal membrane oxygen therapy.