Retroperitoneal bleeding caused by spontaneus rupture of renal angiomyolipoma following cesarean section treated with selective embolisation.

OBJECTIVE: To describe management of a spontaneus rupture of renal angiomyolipoma after cesarean section. DESIGN: Case report. SETTING: Department of Gynaecology and Obstetrics, Hospital Šternbek; Department of Obstetrics and Gynaecology, Palacky University and University Hospital, Olomouc. CASE REPORT: 29-year-old patient underwent acute cesarean section at 35 weeks of gestation for pPROM, placenta praevia marginalis, suspicion of placenta accreta by ultrasound and MRI and transverse position of the fetus. The next morning was found out a spontaneus rupture of renal angiomyolipoma causing progressive anemisation. We describe the following management. CONCLUSION: Incidention of tumors complicating gravidity may occur more often due to changes in population characteristics. Methods of interventional radiology are ordinarily used for severe hemorrage postpartum or for prophylactic occlusion of illiac arteries before cesarean section with morbidly adherent placenta. We show here usage of selective embolisation in not so common obstetrical complications.

Prophylactic bilateral iliac artery balloon occlusion during cesarean section in Jehova´s Witnesses patient.

OBJECTIVE: To describe a case report with prophylactic bilateral iliac artery balloon occlusion during cesarean section in Jehova´s Witnesses patient. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, University Hospital, Olomouc; Department of Radiology, University Hospital, Olomouc; Department of Health Care Sciencies, Bata University, Zlín. CASE REPORT: We describe case report with prophylactic bilateral iliac artery balloon occlusion during cesarean section in Jehova´s Witnesses patient in attempt to decrease the risk of heavy peroperative bleeding. Twenty eight years old primigravida underwent prophylactic internal iliac artery balloon catheterization with interventional radiology preoperatively. Two 6-Fr balloon catheters transfemorally bilaterally up to internal iliac artery with position a “cross over“ were introduced, according to Seldingers standard technique. The procedure was without complications, estimated blood loss was 500 ml. CONCLUSION: Prophylactic placement of intravascular balloon catheters is a feasible treatment for Jehova´s Witnesses patients in efforts to decrease the risk of heavy bleeding during cesarean section.

Laparoscopic hysterosacropexy with subsequent pregnancy and delivery by cesarean section: case report with short term follow-up.

OBJECTIVE: To report a case of laparoscopic hysterosacropexy with subsequent pregnancy complicated by car accident, and terminated by cesarean section due to gestational hypertension. DESIGN: Case report and literature review. SETTING: Department of Obstetrics and Gynecology, University Hospital and Faculty of Medicine Olomouc, Palacký University. CASE REPORT: The patient is a 38 years old woman diagnosed with prolapse of the uterus POP-Q III. She had history of three spontaneous vaginal deliveries. In 2016 she underwent laparoscopic hysterosacropexy using Alyte mesh. There were no intraoperative complications, operating time was 80 min and blood loss 60 ml. Three moths after surgery patient became pregnant spontaneously. In 30th week of gestation patient had a car accident with intact pregnancy. During the third trimester patient has developed gestational hypertension which lead in 2017 to termination of pregnancy by cesarean section at 37 weeks. Mesh was found to be intact in the lower uterine segment. Follow up at 30 months after hysterosacropexy and 18 months after cesarean section revealed well supported cervix and no vaginal prolapse. CONCLUSION: Laparoscopic hysterosacropexy is feasible and safe method for treatment of the uterine prolapse. In young women it can be used to spare reproductive function.

Robot assisted laparoscopic abdominal cerclage: two case reports.

OBJECTIVE: In this work we report the first use of robot-assisted preconceptual abdominal cerclage in the Czech Republic with subsequent live birth. We present two patients with a history of late pregnancy losses (late miscarriage) who underwent robotic abdominal cerclage. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký Univesity, Olomouc. METHODS: The da Vinci S surgical system was used for the robot-assisted abdominal cerclage. RESULTS: One robot-assisted laparoscopic transabdominal cerclage patient delivered at term a live infant and the second patient currently undergoes infertility treatment with in vitro fertilization. CONCLUSION: Robotic abdominal cerclage is a relatively new minimally invasive method for treatment of cervical insufficiency. This technique provides 3D visualization and better instrumentation than the conventional laparoscopic approach.

[Original Bishop score with modifications]. / Cervix skóre dle Bishopa a jeho modifikace.

AIM: To review original Bishop score and its modifications in context of labour induction. DESIGN: A review article. SETTING: Department of Obstetrics and Gynecology, University Hospital, Palacky University, Olomouc. METHOD: Literature review of original Bishop score, simplified Bishop score, as well as modified Bishop scores as predictive factors of successful induction of labour. CONCLUSION: The Bishop score is the most commonly used method to rate the readiness of the cervix for induction of labour.

[Acute myocardial infarction complicated pregnancy of patient after kindey transplantation and knee osteosarcoma]. / Akutní infarkt myokardu komplikující graviditu u pacientky po transplantaci ledviny a osteosarkomu kolene.

OBJECTIVE: Case report describes a patient with acute ST elevation myocardial infarction with Q wave in 26 weeks gestation. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, University Hospital, Palacky University, Olomouc. CASE REPORT: Medical history is complicated with a cadaveric transplantation of kindey, osteosarcoma of the left knee with a joint extraction and chemotherapy, serious hypothyreosis after spontaneous discontinuation of medication and missing fetal nasal bone at the ultrasound examination. CONCLUSION: Myocardial infarction complicating pregnancy is an important cause of maternal morbidity and mortality. The coexistence of obesity, diabetes, chronic hypertension, and delayed age at pregnancy is expected to increase the prevalence of myocardial infarction during pregnancy. Timely treatment in the form of percutaneous coronary intervention has dramatically improved outcomes.

[Acute pancreatitis in pregnancy, complicated by rupture of aneurysm of artery lienalis]. / Akutní pankreatitida v gravidite komplikovaná rupturou aneuryzmatu arteria lienalis.

OBJECTIVE: We present a case of pregnant woman with acute pacreatitis in 38th week comlicated by acute rupture of aneurysm of artery lienalis. DESIGN: Case report. SETTING: Department of Gynaecology and Obstetrics, Faculty Hospital and Palacky University, Olomouc. CASE REPORT: 28-years-old primipara in 38th week of gestation was admitted to our department for acute pancreatitis caused by gallstones. Subsequent conservative treatment was complicated by rupture of aneurysm of lienal artery and haemorrhagic shock. Urgent caesarean section was performed with two subsequent revisions and peroperative 5l of blood loss. Operation was followed by intensive anesthesiology-resuscitate care of ARDS, gradual realimentation and conservative care of acute pancreatitis. Patient was discharged in good condition 20th day. CONCLUSION: Acute pancreatitis is rare in pregnancy. In severe and complicated cases maternal and perinatal morbidity and mortality may be elevated, despite early diagnosis and intensive treatment.

[Laparoscopic abdominal cerclage in a patient with recurrent miscarriages abortions - case report]. / Laparoskopická abdominální cerkláz u pacientky s habituálním potrácením - kazuistika.

OBJECTIVE: The use of laparoscopic abdominal cerclage in a patient with habitual miscarriage. DESIGN: Case report and literature review. SETTING: Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine, Palacký University Olomouc, Department of Neonatology, University Hospital Olomouc, Faculty of Medicine, Palacký University Olomouc, Institute of Medical Genetics, University Hospital Olomouc, Faculty of Medicine, Palacký University Olomouc. CASE REPORT: The patient is a 37 years old woman with a history of recurrent miscarriages. She had one labor at term and six pregnancies that were lost in the second trimester despite McDonald cerclages. Abdominal cerclages are necessary when the standard transvaginal cerclages fail or anatomical abnormalities preclude the vaginal placement. The disadvantage of the transabdominal approach is that it requires at least 2 laparotomies with significant morbidity and hospital stays. We discuss a case of abdominal cerclage performed laparoscopically. A 5 mm Mersilene tape was placed laparoscopically at the level of the internal os as an interval procedure. We feel it offers less morbidity and in the proper hands eliminates or significantly shortens hospital stays. Subsequent pregnancy was terminated at 28 weeks by caesarean section after premature rupture of membranes. CONCLUSION: Laparoscopic abdominal cerclage seems to be relatively effective option for the prevention of habitual abortion patients, which fail conventional surgical procedures in dealing with cervical incompetence. The success of subsequent full term pregnancy is given as 70%.

[Benefits and the accuracy of the intra-operative frozen section at suspected ovarian tumours]. / Prínos a validita peroperacní frozen section u suspektních ovariálních tumoru.

OBJECTIVE: To assess benefits and the accuracy of the intra-operative frozen section for the operative strategy at suspected ovarian tumours. TYPE OF STUDY: Retrospective study. SETTING: Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University in Olomouc. MATERIALS AND METHODS: Intraoperative frozen section and final histopathology were compared in 53 patients who underwent operative treatment for suspected ovarian neoplazma. The accuracy of the frozen section findings was evaluated according to the histopatological type of tumours and categories - benign, malignant and borderline tumours. CONCLUSION: In accordance with literature reports a good reliability of the frozen section as for the sensitivity, specificity, positive and negative predictive values were proved. The majority of errors occured in diagnosing mucinous and borderline tumours.