[Role of ST-analysis of fetal ECG in intrapartal fetus monitoring with presumed growth retardation]. / Význam ST-analýzy fetálního EKG pri intrapartálním monitorování plodu s predpokládanou rustovou retardací.

OBJECTIVE: Evaluation of the role of ST analysis of fetus ECG for early detection of developing acute hypoxia in the course of delivery of fetuses with presumed growth retardation. A comparison with present way of intrapartal fetus monitoring. Impact on the number of surgical births for indications of threatening fetus hypoxia. Influence of the method on perinatal results and postnatal adaptation of the newborns. TYPE OF STUDY: A prospective study. SETTING: Gynecology-Obstetrics Clinic, Masaryk University and Teaching Hospital Brno. METHOD: Forty seven women with a growth retardation of the fetus diagnosed before delivery who gave birth in the Teaching Hospital in Brno during 2003-2005 and intrapartal ST analysis of fetus ECG was subsequently used, were enrolled into this prospective study (group A). The control group consisted of 87 deliveries taking place in the same period of time and concerning women with fetuses suffering from growth retardation and monitored by standard methods (group B). The standard methods included cardiotocography (CTG), supplemented with pulse oximetry (IFPO) if needed. The diagnosis of intrauterine fetus growth retardation was established on the basis of the results of repeated prepartal ultrasound fetus biometry with estimation of the mass, which corresponded to a group below 10 percentile for the given gestational age. The numbers of vaginal deliveries and surgically treated delivery due to threatening fetus hypoxia (Cesarean section, forceps delivery) were recorded. The authors evaluated postpartal pH from umbilical artery, independently for the group of values of pH < 7.00, the group of pH 7.00-0.10 and pH 7.10 or more. The values of Apgar score were evaluated for the first, fifth and tenth minute, respectively. The neonatologist followed the duration of stay of the newborn at the Newborn Intensive Care Unit, the Intermediate Care Unit, total duration of hospitalization, the occurrence of sepsis in the early newbotn period, the occurrence of hyperbilirubinemia, and the conclusion of neurological examination. All the results were evaluated statistically by the chi2 test, Kruskal-Wallis test or the Anova method. RESULTS: There was no statistically significantly difference in the number of delivery ended by surgery for threatening fetus hypoxia (p = 0.856) or the detection rate of intrapartal hypoxia according to pH values of umbilical blood divided into the three groups (p = 0.657, p = 0.958, p = 0.730, respectively). The values of Apgar score differed in favor of the group A significantly only in the first minute at the level of 5% opf significance (p = 0.018). The values of Apgar score in the fifth and tenth minute did not show any significant difference (P = 0301 and p = 0313, respectively). There was no statistically significant difference in neonatological results between the group A and B. CONCLUSION: The use of ST analysis of fetal ECG in the course of delivery of fetuses with presumed intrauterine growth retardation did not show any significant difference from the presently used methods (CTG supplemented with IFPO if needed). In using the method there was not any effect on the number of surgically treated deliveries for indications of threatening acute fetus hypoxia or perinatal results and postnatal adaptation of the newborns.

[ST analysis of fetal ECG in premature deliveries during 30th-36th week of pregnancy]. / ST analýza fetálního EKG u predcasných porodu ve 30.-36. týdnu tehotenství.

OBJECTIVE: To determine the possibilities of ST analysis of fetal ECG (STAN) in premature deliveries between 30th to 36th week of pregnancy. To compare the results of a group of premature deliveries monitored by ST analysis with a control group of premature deliveries monitored by means of cardiotocography (CTG) and intrapartum fetal pulse oxymetry (IFPO). TYPE OF STUDY: A prospective study. SETTING: Department of Gynecology-Obstetrics, Masaryk University and Faculty Hospital Brno. METHODS: The authors evaluated 39 women with premature delivery between 30th and 36th week of pregnancy from a total cohort of 239 high-risk pregnant women, who had been monitored by means of ST analysis of fetal ECG. The control group included 229 pregnant women who gave birth between 30th and 36th week of pregnancy under the monitoring with CTG and IFPO. The allocation into individual groups was at random order. The authors evaluated the duration and way of termination of delivery, pH in arterial umbilical blood, Apgar score in the first, fifth and tenth minute, total duration of hospitalization, necessity and duration of stay at the Neonatologic Intensive Care Unit, Intermediatry Intensive Care Unit, the presence of sepsis, hyperbilirubinemia and neurological state of the newborn. The statistical analysis was performed by means of the Fisher's exact test, Kruskal-Wallis test, chi2 test and the parametric test Anova. RESULTS: Almost none of the observed parameters in both categories of premature deliveries (STAN vs. CTG+IFPO) exhibited a statistically significant difference except a mild neurological affection of the newborn. In the group of premature deliveries monitored by ST analysis there are only 33.3% of newborns with signs of light neurological damage as compared with the control group, where 56.3% subjects were so affected (p<0.01). CONCLUSION: It has become obvious that the ST analysis of fetal ECG in premature deliveries between 30th and 36th week of pregnancy provides the same results as the so far used monitoring by CTG and IFPO. In the group of premature deliveries monitored by the ST analysis, there were significantly less frequent neurological disturbances.

Influence of maternal active and passive smoking during pregnancy on birthweight in newborns.

Many studies have documented a strong association of active smoking during pregnancy with fetal growth retardation. Increasing interest has also been focused on whether there is an association between exposure of pregnant women to environmental tobacco smoke (ETS) and low birthweight of their babies. In the intervention controlled study "Healthy Pregnancy--Healthy Child", mothers after delivery were interviewed by medical students who collected data about their smoking and nutrition. Students were also trained to stimulate non-smoking behaviour and to explain the risks related to smoking and exposure to ETS. Data from 1147 mothers after delivery were collected but only single births were included in the analysis of birthweight. In our study, 63.4% women never smoked and 32.2% women reported they had stopped smoking either before pregnancy or during the first trimester. Only 4.4% of mothers (n = 50) smoked during the whole pregnancy. Women with the history of smoking were exposed to ETS more often than mothers who never smoked (51.6% vs 17.4%; p < 0.001). The number of heavily exposed both at home and workplaces was more than twice higher among former smokers compared with never smokers (22.4% versus 9.4%, p < 0.01). The average birthweight of babies born to women who had stopped smoking was higher than that born to never smokers. The average birthweight of babies born to women who smoked during pregnancy was lower by 119 g and 171 g than that of the babies born to never smokers and former smokers, respectively. When pre-term neonates were excluded, differences in birthweight between babies born to never smokers and either formerly smoking or still smoking mothers were slightly lower. The greatest effect of ETS exposure on birthweight was recorded in never smoking mothers; an average reduction in birthweight was 88 g. A strong dose-effect was observed; in mothers heavily exposed to ETS both at home and at work, the babies' birthweight was lower by 189 g in comparison with the group of non-exposed, never smoking mothers and even by 70 g compared with mothers smoking during pregnancy.

[Effect of maternal O2 inhalation on oxygen saturation in the parturient (SpO2) and the fetus (FSpO2)]. / Vliv inhalace O2 matkou na hodnoty kyslíkové saturace rodicky (SpO2) a plodu (FSpO2).

OBJECTIVE: The aim of the study was to evaluate the impact of different concentrations of inspirated O2 on the SpO2 values of the foetus and the mother during the 1st and 2nd stages of labor. DESIGN: Prospective study. SETTING: 1st Department of Gynecology and Obstetrics, Medical Faculty of Masaryk University, Brno. METHODS: 17 non-risk patients were enrolled in the study. The SpO2 levels of the mother and the foetus were monitored simultaneously in 10 min intervals with the room air inspiration entrainment O2 mask and the inflatable face mask during 1st and 2nd stages of labor. RESULTS: No changes in maternal SpO2 values were revealed in the three different O2 inspiration regimens neither in the 1st, nor in the 2nd stages of labor. The mean value was 98% +/- 1.6 SD. As for the foetus the SpO2 values were increased by 6% (+/- 7.9 SD) after 40% concentration of O2 and 7.7% (+/- 8.8 SD) after 98% O2 inspiration during the 1st stage of labour. These values have decreased promptly after the cessation of the O2 inspiration. The mean SpO2 values at room O2 concentration were 46.3% +/- 7.9 SD for the 1st stage of labor and 43.7% +/- 4.8 SD for the 2nd stage of labor. CONCLUSION: The O2 inspiration during the labor has no impact on the maternal SpO2 values but increases the SpO2 values of the foetus during the 1st stage of labor. We were not able to evaluate the impact of the O2 inspiration on foetal SpO2 values during the 2nd stage of labor.

[Evaluation of resistance patterns of gram-negative rods from personal clinical materials]. / Ocena stanu lekoopornosci paleczek Gram-ujemnych wyosobnionych z materialu klinicznego.

1862 clinical specimens from neonates with infection risk factors treated in the Department of Neonatology, University of Cracow were examined. The aim of this study was to investigate the participation of clinically important Gram-negative rods in hospital infections and to check the resistance patterns of these pathogens. The strains were identified in automatic ATB system using ID 32E and ID 32GN strips with biochemical tests. The susceptibility of isolates of antibacterial agents was determined in automatic ATB system using ATB G- and ATB PSE strips. 436 strains of Gram-negative rods were cultured. 289 strains (66.3%) belonging to Entero-bacteriaceae family and 147 strains (33.7%) non-fermenting rods were isolated. Among Gram-negative aerobic fermenting rods (mainly K. pneumoniae and E. cloacae), increasing resistance to aminoglycosides and beta-lactams, due to new broad spectrum and so called inducible beta-lactamases, was observed. The contribution of non-fermenting rods, especially Pseudomonas spp. and Acinetobacter spp. to the aetiology of infections in hospitalized newborns has increased. Carbapenems and fluoroquinolones are highly active in vitro against the examined strains of multiresistant Gram-negative rods.

[Participation of multiresistant gram-negative rods in systemic infections of newborns treated in the Neonatal Clinics of the University Hospital in Krakow in 1993-1997]. / Udzial wieloopornych paleczek gram-ujemnych w zakaeniach uogólnionych u noworodków leczonych w Klinice Neonatologii Szpitala Uniwersyteckiego w Krakowie w latach 1993-1997.

Results of blood cultures in 1187 newborns hospitalized in the Department of Neonatology, University Hospital in Kraków in furing the last five years were analysed. A trial of monitoring the presence of multi-resistant strains of Enterobacteriaceae with new mechanisms of resistance to antibiotics as well as analysed of their antibiotics susceptibility patterns were undertaken. Surprisingly high percentage of Gram-negative rods E. cloacae and K. pneumoniae strains resistant to the 3rd generation of cephalosporins and participating in septic complications in the investigated hospital environment was demonstrated. There were identified 53 strains of Enterobacter sp., 35 strains of Klebsiella sp. and 3 strains of E. coli extremely resistant to ceftazidine, accounting for 72%, 56% and 5% of all isolated of the given kind, respectively. Dynamic increase in a number of multiresistant strains of K. pneumoniae from 11.1% of isolates in 1993 to 83% in 1997 was shown as well as remaining on a very high level frequency of isolation of Enterobacter sp. rods capable of producing chromosomal cephalosporinases was demonstrated. Full efficacy of carbapenems and high usefulness of ciprofloxacine in the treatment of infections were confirmed. The authors emphasize necessity for constant monitoring of susceptibility to antibiotics in resistant strains as well as for liquidating their sources and ways of their transmission.

[Relation between smoking in reproductive-age women and disorders in reproduction]. / Souvislost kuráctví zen v reproduktivním veku s poruchami reprodukce.

In a retrospective anamnestic study a total of 3180 women teachers from primary schools in seven districts of the Czech Republic with a different incidence of statistically recorded reproductive disorders were examined. A professionally and socially homogeneous group was selected on purpose to standardize to a maximum extent exposure to detectable and undetectable risk factors and confounding factors in the working environment and living conditions. The respondents were classified according to their statements on smoking habits up to the age of 45 years, which was taken as the reproductive period. Although the majority of smokers belonged into the group of mild smokers with a mean consumption of 10 cigarettes per day, in this group significantly more frequent heavy menstrual bleeding, early and spontaneous abortions, deliveries of premature infants and infants born in term but with a low birthweight were recorded. Smokers had significantly more often induced abortions of unwanted pregnancies in the case-history as compared with non-smokers. After elimination of women who by the time of the survey had never been pregnant yet, heavy smokers, as compared with non-smokers had a more than twofold risk as regards difficulty to become pregnant, of spontaneous abortions, deliveries of premature infants: there was an almost double risk of delivery of a low birthweight infant even among medium heavy smokers.

[Evaluation of treatment results for anemia of prematurity treated with various doses of human recombinant erythropoietin]. / Ocena wyników leczenia niedokrwistosci wczesniaków z zastosowaniem róznych dawek rekombinowanej ludzkiej erytropoetyny.

We evaluated the results of administering recombinant human erythropoietin (rHuEPO) and iron in 19 randomly selected premature infants, who had no infections, did receive oxygen support or aminophylline. rHuEPO was administered intravenously from days to 37 (biweekly) in a dose of 100 U/kg (group I) or 400 U/kg (group II). Also, infants in both groups were supplemented with 10 mg/kg/week of iron intravenously. Seven of 19 infants did not receive either rHuEPO or iron (group III). Infants of all groups had similar birth weights, gestational age and hematocrit, RBC count as well as total and fetal hemoglobin concentrations in blood obtained within the first hour of life. However, infants treated with 400 U/kg of rHuEPO required a significantly (p < 0.04) lower volume of packed erythrocytes in comparison to untreated infants, both between days 7 and 37 of life (18.6 ml vs 46.8 ml; p < 0.04) and between day 7 of life and the day of discharge (35.8 ml vs 94.2 ml; p < 0.04). No difference in neutrophil count, fetal hemoglobin concentration and no toxicity were observed in infants treated with rHuEPO in comparison to untreated prematures.