OBJECTIVE: To provide an overview of recent literature on the cost-effectiveness of mental health screening for women during pregnancy. RESULTS: 1,988 publications were retrieved from databases, of which four were included in the systematic review. Models of care with screening are cost-effective compared with standard care without screening. Multi-level screening models are more cost-effective than single-level models. Effectiveness is affected by the number of false-positive cases, which decreases in multi-level models. CONCLUSION: Mental health screening in pregnancy appears to be cost-effective. We recommend its use in comprehensive health care for pregnant women in our country.
- Klíčová slova
- cost effectiveness, mental health, prenatal care, prenatal screening,
- MeSH
- analýza nákladů a výnosů MeSH
- duševní poruchy * diagnóza ekonomika MeSH
- komplikace těhotenství * diagnóza ekonomika MeSH
- lidé MeSH
- plošný screening * ekonomika MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
OBJECTIVE: The aim of this work is to summarize current scientific information focusing on the diagnosis, management, and treatment of intrahepatic cholestasis in pregnancy according to available literature. METHODOLOGY: Literature sources were searched using the Web of Science, Scopus, and PubMed/Medline databases. CONCLUSION: For the diagnosis and proper management of intrahepatic cholestasis of pregnancy, the postprandial serum bile acid value of the pregnant woman is crucial. Postprandial testing allows for a higher likelihood of identifying patients with significantly elevated bile acid levels. Bile acid values above 100 µmol/l, especially in the 3rd trimester, are associated with a significant risk of severe complications, particularly intrauterine fetal death. Ursodeoxycholic acid, the first-line treatment, according to available data, does not improve perinatal outcomes and has minimal effect on the sensation of itching in patients. The routine administration of ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy is controversial.
- Klíčová slova
- bile acids, intrahepatic cholestasis of pregnancy, ursodeoxycholic acid,
- MeSH
- intrahepatální cholestáza * diagnóza farmakoterapie terapie MeSH
- komplikace těhotenství * diagnóza farmakoterapie terapie MeSH
- kyselina ursodeoxycholová terapeutické užití MeSH
- lidé MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- kyselina ursodeoxycholová MeSH
OBJECTIVE: A case report of a 23-year-old pregnant woman diagnosed with Guillain-Barré syndrome in the 31st week of pregnancy. CASE REPORT: We present a case study of a patient in the 31st week of pregnancy hospitalized at the University Hospital in Brno for expressed bulbar syndrome, neck muscle weakness, paresthesia of the arms and medical history of diarrhea in the previous week. During hospitalization, there was a rapid progression of symptoms and respiratory failure, requiring orotracheal intubation. The diagnosis of Guillain-Barré syndrome was determined and intravenous immunoglobulin therapy was initiated. The pregnancy was terminated in the 32nd week of gestation based on the maternal indication after a completed lung maturation of the fetus. CONCLUSION: Guillain-Barré syndrome is a neurological disease that can rarely occur during pregnancy and puerperium. The syndrome presents a serious pregnancy complication with an uncertain prognosis and risk for both mother and fetus. If the syndrome is diagnosed in time and treated correctly, the prognosis is favorable despite the complicated course.
- Klíčová slova
- Guillain-Barre syndrome, anaphylaxis, intravenous immunoglobulins, maternal morbidity, neurological consequences, neurological symptomatology, respiratory failure in pregnancy,
- MeSH
- dospělí MeSH
- Guillainův-Barrého syndrom * komplikace diagnóza terapie MeSH
- komplikace těhotenství * diagnóza terapie MeSH
- lidé MeSH
- matky MeSH
- mladý dospělý MeSH
- plod MeSH
- poporodní období MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Recurrent pregnancy losses represent sensitive issue not only for the couple, but also for all healthcare professionals involved. In a broader context, they include not only recurrent miscarriages, but also the issue of periviable preterm birth with subsequent neonatal death and unexplained fetal death. This area requires an interdisciplinary approach. The field of reproductive immunology best answers questions related to pregnancy complications. However, there is currently no accurate recommendation as to who should care for such women. In this article I summarize the current state of knowledge about the issue, current experience with care management, including case studies.
- Klíčová slova
- Progesterone, immunoglobulin, immunomodulation, low molecular weight heparin, pregnancy, recurrent pregnancy loss,
- MeSH
- habituální potrat * etiologie terapie MeSH
- komplikace těhotenství * diagnóza terapie MeSH
- lidé MeSH
- novorozenec MeSH
- předčasný porod * MeSH
- těhotenství MeSH
- těhotné ženy MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
AIM: The aim of this study was to determine the prevalence of maternal hypothyroidism in the first trimester from 11 to 14 weeks of gestation according to the American Thyroid Association (ATA) guidelines from 2017 and to compare the rates for singleton and twin pregnancies. METHODS: A total of 4965 consecutive Caucasian singleton pregnancies and 109 Caucasian twin pregnancies were included in the investigation. Patients with a history of thyroid gland disorder were excluded. Subclinical maternal hypothyroidism was defined as a thyroid stimulating hormone (TSH) concentration above the 97.5th percentile and free thyroxine (fT4) within the range of a reference population of women at 11-14 weeks of gestation. Overt maternal hypothyroidism was defined as a TSH concentration above the 97.5th percentile and an fT4 below the 2.5th percentile of the reference population.TSH, fT4, and anti thyroid peroxidase antibody (TPOAb) were measured by immunochemiluminescent assays on an 16200 Abbott Architect analyzer. RESULTS: The prevalence of hypothyroidism for twin pregnancies was no higher than that for singleton pregnancies; 6.42% (7/109) vs. 5.32% (264/4965), respectively; P=0.61. All twin pregnancies were subclinical. Singleton hypothyroid pregnancies included 4.91% (244 cases) of subclinical and 0.41% (20 cases) of overt hypothyroidism. The prevalence of TPOAb positive hypothyroid women for twin pregnancies and singleton pregnancies was 71% (5/7) vs. 52% (137/264 cases), respectively but the differences were not statistically significant; P=0.31. CONCLUSION: Each first trimester screening center should establish its TSH and fT4 reference ranges. Our center had higher upper reference limits of TSH than that of the universally fixed limit of 2.5 mU/L, which led to a lower measured prevalence of maternal hypothyroidism. A large number of hypothyroid women were TPOAb positive.
- Klíčová slova
- gestation, hypothyroidism, immunoassay, pregnancy, thyroid disease,
- MeSH
- dospělí MeSH
- hypotyreóza krev diagnóza MeSH
- imunoanalýza metody MeSH
- jodidperoxidasa imunologie MeSH
- komplikace těhotenství krev diagnóza MeSH
- lidé MeSH
- protilátky metabolismus MeSH
- první trimestr těhotenství MeSH
- retrospektivní studie MeSH
- těhotenství s dvojčaty fyziologie MeSH
- těhotenství MeSH
- thyreotropin metabolismus MeSH
- thyroxin metabolismus MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- srovnávací studie MeSH
- Názvy látek
- jodidperoxidasa MeSH
- protilátky MeSH
- thyreotropin MeSH
- thyroxin MeSH
In the last decade there has been a dramatic increase in the availability and abuse of synthetic cathinones - new amphetamine-like stimulants. Even though their abuse during pregnancy could have serious adverse effects on the fetus, cathinones are not readily included in neonatal toxicological screenings. Meconium (first neonatal stool) is the specimen of choice to reveal long term drug exposure, however as it is a highly complex matrix, the sample preparation is a critical step before the instrumental analysis. The aim of this work was to develop a suitable meconium sample extraction technique using the advantages of salting-out assisted liquid-liquid extraction (SALLE) and using only MS-friendly organic ammonium salts. We further developed and validated liquid chromatography tandem-mass spectrometry method for the determination of 'traditional' stimulants (methamphetamine, amphetamine, MDMA) and cathinones (mephedrone, methylenedioxypyrovalerone (MDPV), α-pyrrolidinopentiophenone (α-PVP), methylone, butylone, flephedrone, and naphyrone). Matrix-matched calibration was prepared in the concentration range 10-2000 ng/g. The limits of quantification were determined as 10 ng/g, recoveries ranged from 48.2% to 94.3% and the matrix effect was between 60.2% and 101.4%. Accuracy (86.1-114.5%) and precision (4.9-14.9%) were determined and all validation criteria were met for all analytes except for naphyrone. Finally, our analytical method was tested on a set of real meconium samples, which were found positive for amphetamine, methamphetamine and methylone, thus demonstrating the validity of the method.
- Klíčová slova
- Amphetamines, Cathinones, Liquid chromatography tandem-mass spectrometry, Meconium, SALLE, Salting out assisted liquid-liquid extraction,
- MeSH
- amfetaminy analýza MeSH
- amoniové sloučeniny chemie MeSH
- extrakce kapalina-kapalina metody MeSH
- komplikace těhotenství diagnóza MeSH
- lidé MeSH
- limita detekce MeSH
- mekonium chemie MeSH
- novorozenec MeSH
- odhalování abúzu drog metody MeSH
- poruchy spojené s užíváním psychoaktivních látek diagnóza MeSH
- stimulanty centrálního nervového systému analýza MeSH
- studie proveditelnosti MeSH
- tandemová hmotnostní spektrometrie metody MeSH
- těhotenství MeSH
- vysokoúčinná kapalinová chromatografie metody MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- validační studie MeSH
- Názvy látek
- amfetaminy MeSH
- amoniové sloučeniny MeSH
- stimulanty centrálního nervového systému MeSH
BACKGROUND: Evidence of the impact of in utero exposure to anti-tumor necrosis factor (TNF)-alpha on long-term childhood development is limited. The aim was to assess the impact of in utero exposure to anti-TNF-alpha due to mothers' inflammatory bowel disease (IBD) on long-term postnatal development of exposed children. METHODS: We included consecutive children (≥12 months of age) born to mothers with IBD (2007-2016) treated with anti-TNF-alpha during pregnancy in 3 centers in the Czech Republic. A control group was comprised of unexposed children of non-IBD mothers undergoing mandatory check-ups at general pediatricians' offices. Data on perinatal period, psychomotor development, vaccination, infections, antibiotics, and allergy were collected by treating pediatricians using a predefined questionnaire. RESULTS: Seventy-two exposed and 69 unexposed children were included (median age, 35 and 50 months, respectively). Exposed children had growth and psychomotor development similar to controls. There was no significant difference in infectious complications within the first year of life (23.9% vs 17.4%; P = 0.36) or during the whole follow-up between exposed infants and controls (P = 0.32). Concomitant immunosuppressants during pregnancy and anti-TNF-alpha levels in cord blood were not associated with elevated infection rate within the first year of life (P > 0.05). Over 95% of exposed children had adequate serologic response to vaccination, except for haemophilus and mumps vaccines. Clinically manifested allergy was similar between the groups (P = 0.98). CONCLUSIONS: Anti-TNF-alpha exposure in utero does not seem to have a negative impact on postnatal development of children with regard to infectious complications, allergy, growth, or psychomotor development when compared with unexposed children of non-IBD women.
- Klíčová slova
- anti-TNF-alpha, children, infections, inflammatory bowel disease, vaccination,
- MeSH
- adalimumab aplikace a dávkování MeSH
- dítě MeSH
- gastrointestinální látky aplikace a dávkování MeSH
- idiopatické střevní záněty farmakoterapie imunologie MeSH
- infliximab aplikace a dávkování MeSH
- kohortové studie MeSH
- kojenec MeSH
- komplikace těhotenství diagnóza farmakoterapie imunologie MeSH
- lidé MeSH
- matky MeSH
- následné studie MeSH
- předškolní dítě MeSH
- prognóza MeSH
- studie případů a kontrol MeSH
- těhotenství MeSH
- TNF-alfa antagonisté a inhibitory MeSH
- zpožděný efekt prenatální expozice farmakoterapie imunologie MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- Názvy látek
- adalimumab MeSH
- gastrointestinální látky MeSH
- infliximab MeSH
- TNF-alfa MeSH
OBJECTIVE: To present two cases of patients with hyper-reactio luteinalis at the cesarean section. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, Hospital Trenčín; Medirex Group Academy n.o., Bratislava. CASE REPORT: We report two cases of women with preeclampsia who we diagnosed with bilateral multi-cystic ovarian enlargement by chance during cesarean section. At both of them the level of human chorionic gonadotropin was above normal, one of the patients had medical history of ovarian serous borderline tumor and this pregnancy was multiple after in vitro fertilization and embryo transfer. Adnexectomy, resection of ovaries and biopsy were carried out. Histologically hyperreactio luteinalis was confirmed in both patients. CONCLUSION: We discuss the necessity of surgical treat-ment, the authors want to emphasize the need for proper preoperative diagnosis and indication of conservative management of patients with hyperreactio luteinalis.
- Klíčová slova
- human chorionic gonadotropin, hyperreactio luteinalis, multicystic enlargement of ovaries,
- MeSH
- biopsie MeSH
- choriogonadotropin krev MeSH
- císařský řez * MeSH
- komplikace těhotenství diagnóza MeSH
- lidé MeSH
- náhodný nález MeSH
- ovariální cysty diagnóza patologie chirurgie MeSH
- ovarium patologie MeSH
- preeklampsie MeSH
- těhotenství MeSH
- výsledek těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- choriogonadotropin MeSH
Intrahepatic cholestasis of pregnancy (ICP) is a frequent liver disorder, mostly occurring in the third trimester. ICP is not harmful to the mothers but threatens the fetus. The authors evaluated steroid alterations in maternal and mixed umbilical blood to elucidate their role in the ICP development. Ten women with ICP were included in the study. Steroids in the maternal blood were measured by Gas Chromatography-Mass Spectrometry (GC-MS) (n=58) and RIA (n=5) at the diagnosis of ICP, labor, day 5 postpartum, week 3 postpartum and week 6 postpartum. The results were evaluated by ANOVA consisting of the subject factor, between subject factors ICP, gestational age at the diagnosis of ICP and gestational age at labor, within-subject factor Stage and ICP × Stage interaction. The 17 controls were firstly examined in the week 36 of gestation. ICP patients showed reduced CYP17A1 activity in the C17,20 lyase step thus shifting the balance between the toxic conjugated pregnanediols and harmless sulfated 5alpha/beta-reduced-17-oxo C19 steroids. Hence, more toxic metabolites originating in maternal liver from the placental pregnanes may penetrate backward to the fetal circulation. As these alterations persist in puerperium, the circulating steroids could be potentially used for predicting the predisposition to ICP even before next pregnancy.
- MeSH
- biologické markery krev MeSH
- dospělí MeSH
- genetická predispozice k nemoci genetika MeSH
- intrahepatální cholestáza krev diagnóza genetika MeSH
- jaterní testy trendy MeSH
- komplikace těhotenství krev diagnóza genetika MeSH
- lidé MeSH
- placentární oběh fyziologie MeSH
- steroidy krev MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- biologické markery MeSH
- steroidy MeSH
OBJECTIVE: To highlight a problem of eating disorders in pregnancy and the need for interdisciplinary cooperation in these cases. DESIGN: Case report. SETTING: Department of Gynecology and Obstetrics, 2nd Faculty of Medicine, University hospital Motol, Prague. CASE REPORT: We report the course of pregnancy in a 19-year-old woman with an atypical form of mental anorexia. The patient was repeatedly hospitalized for metabolic disruption. The pregnancy was finally terminated at the 27th week of pregnancy for fetal growth restriction of the fetus. CONCLUSION: Despite the frequent irregularities of the menstrual cycle in eating disorders, a spontaneous conception is possible. The prognosis of pregnancy is uncertain and may endanger the mother and fetus. Management of pregnant women with eating disorders requires the cooperation of a perinatologist, internist, nutritional therapist, psychiatrist or psychologist.
- Klíčová slova
- amenorrhoea, bulimia, fetal growth restriction, fetal growth restriction amenorrhoea., mental anorexia, pregnancy,
- MeSH
- komplikace těhotenství diagnóza psychologie MeSH
- lidé MeSH
- mladý dospělý MeSH
- poruchy příjmu potravy diagnóza psychologie MeSH
- potrat léčebný MeSH
- růstová retardace plodu MeSH
- těhotenství MeSH
- výsledek těhotenství MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
