[External cephalic version after 36th week of gestationAnalysis of women´s perspective]. / Zevní obrat plodu z polohy podélné koncem pánevním po 36. týdnu gravidity Analýza subjektivního hodnocení rodicek.

OBJECTIVE: Evaluation of opinions and subjective feelings of patients who have undergone an external cephalic version of a fetus in breech presentation after the 36th week of pregnancy. DESIGN: Observational analytic cohort study. SETTING: Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno. MATERIALS AND METHODS: We collected opinions and subjective evaluation from pregnant women who underwent an attempt of external cephalic version at the department of Gynecology and Obstetrics, Masaryk University in Brno in the period from 1st January 2015 to 31st December 2016 through a questionnaire. The questionnaire contained a total of 10 dichotomous, sampling, enumeration and scale questions. Questions were focused on the source and type of information on external cephalic version, expectations of the patients, evaluation of pain and feelings during the procedure and the overall impression. We also evaluated the differences between answers from patients after a successful and an unsuccessful version. RESULTS: In reported period 205 pregnant women underwent an attempt of external cephalic version. Procedure was successful in 105 (51.2%) cases of which 81 (77.1%) subsequently gave birth vaginally, 24 (22.9%) delivered by caesarean section, 10 (9.5%) out of all patients delivered in other hospitals. The total number of fully completed questionnaires was 187 (after a successful version 98 and 89 after an unsuccessful version). The most common source of information about the procedure was given to the patients from their gynecologists (40.5%) and doctors at the ambulance in the hospital where the patients are sent before delivery by their gynecologists (27.9%). Most mothers received mostly positive information (70.5%) - increased likelihood of vaginal delivery, high success rate, low risk to mother and child. Attitude of the gynecologists on the external cephalic version was positive in 52.6% and they recommended it. 14.4% of the patients had no fear before the procedure, 61% patients were nervous and 23% had fear. For 30.5% of the respondents was the version worse than expected. 33.7% of the patients expected that the procedure would be worse and for 35.8% of the women the procedure fulfilled their expectations. 42.2% of all patients rated the pain level on a scale from 0 (no pain) to 10 (maximum pain) in the range of 4-6 points, 28.9% evaluated the pain under 4 points and 28.9% over 6 points. Among other unpleasant feelings associated with external cephalic version were most frequently mentioned: nausea (15.9%), fear (39.8%), distress (7.5%). One-third of respondents, however, experienced no negative feelings (33.8%). 80.2% of the patients did not have any problems after the version. Out of all respondents 89.3% would undergo the procedure again and recommend it to others. Overall satisfaction rating on a scale from 0 (completely dissatisfied) to 5 (very satisfied) was 89.8% in the range from 4 to 5. When comparing the answers of patients after an external cephalic version there was no significant difference depending on the success of the version. CONCLUSION: The results show that the main source of information is given to the patients by their gynecologists and doctors in the hospital who recommend the procedure and significantly affect the attitude of patients towards external cephalic version. Fear and nervousness of the mothers is usually unfounded, most of the women evaluate the procedure positively and would recommend it to another pregnant women even in case of an unsuccessful attempt. Pain during the procedure is for most women bearable and in the overall ranking does not mean a significant problem.

[Pregnancy outcomes in women with gestational diabetes: specific subgroups might require increased attention]. / Pacientky s obezitou, hypertenzí a nutností aplikace inzulinu pri diagnóze gestacní diabetes mellitus vyzadují zvýsenou porodnickou péci.

OBJECTIVES: To compare peri-partal parameters between two groups of pregnant women - with and without gestational diabetes mellitus (GDM), to correlate degree of glucose abnormality with incidence of peri-partal morbidity and, finally, to analyse the potential effect of comorbidities (i.e. obesity, hypertension, thyreopathy, polycystic ovary syndrome, trombophylia, anemia, allergy, smoking) on pregnancy outcomes. DESIGN: Epidemiological observational "case-control" study. SETTING: Department of Obstetric and Gynaecology, Faculty Hospital Brno; Department of Internal Medicine, Diabetes Centre, Faculty Hospital Brno; Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno. METHODS: The study comprised 432 pregnant women (364 with GDM diagnosis, 68 healthy controls) followed during a period 2011-2013. GDM was diagnosed by oral glucose tolerance test in 24-28th week of gestation (by fasting plasma glucose >5,6 mmol/l or >8,8 mmol/l in 60th min or >7,8 mmol/l in 120th min post-75g glucose load). Following peri-partal parameters were studied: ultrasonographic examination before delivery, a date of delivery, length of childbirth, induction, perinatal complications, post-delivery complications, section, abnormity in pH, base excess, Apgar score, birth weight. RESULTS: Subjects with GDM had significantly increased rate of labour induction compared to healthy controls (P = 0.0035, chi-square test). Subgroup of GDM women classified as having a higher risk for adverse perinatal outcomes by a definition of Czech Obstetric and Gynaecology Society had significantly more labour inductions, more sections and instrumental deliveries. New-borns of those mothers had significantly more common worse perinatal outcomes (Apgar score and macrosomia). CONCLUSION: Based on our data risk stratification of GDM subjects according to Czech Obstetric and Gynaecology Society appears relevant and justified.

Establishment and evaluation of a post caesarean acute pain service in a perinatological center:retrospective observational study.

OBJECTIVE: The aim of this study was to determine the efficacy of establishing a Post Caesarean Acute Pain Service. DESIGN: Retrospective observational study. SETTING: University Hospital Brno. METHODS: We evaluated all patients undergoing delivery via Caesarean Section under anaesthesia in the periods 10/2009 - 9/2010 and 11/2010 - 10/2011. During the postoperative period at predefined times, we measured the Visual Analogue Scale, Additional Analgesic Requests, blood pressure, pulse rate and recorded any complications. We compared the Visual Analogue Scale Score and number of Additional Analgesic Requests in two groups of women, 212 patients before and 195 patients after the establishment of an Acute Pain Service in the first 72 hours after Caesarean Section. RESULTS: There was a statistically significant difference in Visual Analogue Scale Score between the groups (p<0.05). The number of Additional Analgesic Requests 24-72 hours after Caesarean Section decreased below one requirement per 24 hours. The most effective analgesic method after Caesarean Section during the first 24 hours postoperatively was epidural analgesia. There was no statistically significant difference 24-72 hours after Caesarean Section between the methods of analgesia used. CONCLUSION: In conclusion, implementation of a Post Caesarean Acute Pain Service led to decrease in Visual Analogue Scale Score postoperatively. KEYWORDS: Acute Pain Service, postoperative analgesia, Caesarean Section, non-opioid analgesia, opioid analgesia, epidural analgesia.