[Acute hysterectomy for huge submucous leiomyoma prolaps]. / Akutní hysterektomie pro prolaps velkého submukózního myomu do pochvy.

OBJECTIVE: To present a case of huge submucous leiomyoma prolaps to the vagina with severe haemorrhage and its management and to analyse current articles with this rare complication. DESIGN: A case report, review article. SETTING: Department of Gynecology and Obstetrics Trinec Hospital. RESULTS: A case report of huge submucous leiomyoma prolaps in 49-year-old woman. The patient presented at our department with sudden onset of profuse vaginal bleeding. The vaginal and utrasound examination was performed with diagnosis of huge submucous leiomyoma obturating upper third of the vagina. The cervix was not palpable, rised up. While manipulating with the leiomyoma the bleeding exceeded. The patient agreed with abdominal hysterectomy without adnexectomy. Then the patinent colapsed and the operation was performed immediately, taking care of changed anatomy--the line between the vaginal wall and the uterus was almost invisible caused by "non-existing cervix" and the uterus was partialy inverted into the vagina. The haemoglobin level failed from 124 g/l to 95 g/l with no need of tranfusion. The patient quickly recovered and was dimised the sixth day after the operation. CONCLUSION: Uterine myomas in their submucous localisation may protrude through the cervix into the vagina and cause rare but very serious complications--profuse vaginal bleeding and non-puerperal inversion of the uterus, and thus need very urgent management.

[Premature separation of the placenta--etiology and risk factors]. / Predcasné odlucování luzka--etiologie a rizikové faktory.

OBJECTIVE: Placental abruption complicates approximately 1% of all pregnancies and remains a significant cause of both maternal and fetal morbidity and mortality. Several risk factors are associated with this complications, but a clear causal relation is diffucult to establish. THE AIM OF THE STUDY: The aim of the study was to determine and identify risk factors for placental abruption. DESIGN: Retrospective cohort study. SETTING: Dept. of Obstetrics and Gynaecology, Medical Faculty of Palacký University, Olomouc. SUBJECT AND METHOD: Retrospectively gathered cohort of 180 women was compared to 198 healthy women. We have focused on anthropometric, sociodemographic, behavioral, obstetric and fetal parameters. Statistical evaluation was done by Statsoft, Inc. (2001) Statistika CZ (Software system data analysis), version 6. RESULTS: The incidence of the placental abruption was 0.89%. We have confirmed the following risk factors as statistically significant (p values are given): Low-degree education (0.00002), prepregnancy weight of the mother (0.00), weight gain in pregnancy (0.00), higher parity (0.0272), smoking (0.03847), preeclampsia (0.00889), chorioamnionitis (0.00), premature rupture of membranes (0.00), recurrent spontaneous abortions (0.00), positive family history of deep venous thrombosis (0.0007) and intrauterine growth retardation (0.0386). CONCLUSION: Placental abruption has a large number of potential risk factors. The true biological cause and its etiopathogenic role is still to be elucidated.

[Coagulation factor VIII in the early postpartum period]. / Hladina faktoru VIII v casném poporodním období.

OBJECTIVE: Pregnancy is accompanied by changes in the coagulation and fibrinolytic systems. There is a marked increase in some of the coagulation factors, particularly fibrinogen and factor VIII. A high plasma levels of coagulation factor VIII is an important risk factor for thrombotic complications during pregnancy and puerperium. The aim of the study was to determine changes of the VIII:C in the early postpartum period. SETTING: Dept. of Obstetrics and Gynaecology, Medical Faculty of Palacký University, Olomouc. DESIGN: A longitudinal prospective study of 197 healthy women. Primi or multigravidas whose pervious pregnancies had been uncomplicated, aged 18-41 years. All of the deliveries were spontaneous and vaginal. First samples were taken between 24-72 hours postpartum. Women whose factor VIII plasma levels were higher than 150 (percentage of standard) were tested again after 6 weeks. Factor VIII:C was investigated by the one-step coagulation method. Statistical evaluation was done by Statsoft, Inc. (2001) Statistika Cz (Software system data analysis), version 6. RESULTS: Pregnancy is associated with increased levels of VIII:C. Mean value was 194.09 percentage of standards. 119 (60.4 %) of the tested women had VIII:C higher than 150%. The post-puerperal tests were done in 59 women and showed values similar to those from formerly published data in age-matched non-pregnant group. Mean value was 139.76%. CONCLUSION: Normal pregnancy is connected with increased levels of factor VIII. However elevated plasma levels of VIII:C is not associated with poor pregnancy outcome. The highest level of the clotting factor VIII was associated with patient's blood group A. Post-puerperal data showed distinct decrease of factor VIII. There is a necessity to rule out thrombophilia, in the case of the outlasting elevation of the factor VIII.

Intraperitoneal and extraperitoneal anastomoses of spleen arteries.

The importance of supporting the spleen with blood is enormous especially from the surgical point of view. The main vessel of spleen is the splenic artery. In this study we would like to extend current knowledge of anastomoses between the splenic artery and surrounding arteries. Seven donor bodies of both sexes were used for detailed dissection. We were concerned with both the intraperitoneal and extraperitoneal anastomoses. In another 100 donor bodies, the relationship between the spleen and the anterior surface of the posterior body wall was studied. The superficial anastomoses were found mainly in the peritoneal duplications. They were the short gastric arteries; the epiploic branches of the left gastroepiploic artery; branches of the middle and left colic arteries and arteries from the region of the pancreatic tail. Deep anastomoses were found between the spleen and the parietal branches of the aorta, i.e. the superior and inferior phrenic arteries and the arteries of the anterior surface of the posterior body wall: the posterior intercostal artery and lumbar arteries. Authors also expect small anastomoses in 40-50% of spleens that lie directly on the anterior surface of the posterior body wall. Our findings correspond with the clinical observations that after ligation of the splenic artery necroses in the spleen do not occur.