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The most frequent congenital developmental defect in the orofacial region are, no dount, facial clefts which are a serious stress for health professionals and the population. Depending on the type of cleft, the prevalence is between 1:1000 - 2800 births. According to contemporary views in the etiology of orofacial clefts participate genetic as well as environmental factors. That means that specific genetic factors create a certain „sensitivity" for specific factors of the external environment which act as a trigger mechanism and combined they produce the cleft. Cleft lip can be diagnosed already during the 13th week of gestation, while a cleft palate is not necessarily apparent till after the 18th week of gestation as the maxilla is in the process of joining. Presentation of the foetal face and its profile is thus important in particular during the second trimester of gestation and should be part of ultrasonographic screening between the 18th and 20th week of gestation. As more than 8% of facial clefts are associated with chromosomal abnormalities, in all affected foetuses karyotyping is done. The prognosis of satisfactory cosmetic and functional repair in cleft lip and in cleft lip and palate is favourable. In case of associated malformations all depends on the type and severity of these associated defects or on the diagnosis of the syndrome. If median clefts are extensive or associated with cerebral anomalies, the prognosis is as a rule poor. Prenatal diagnosis and management of defects of the orofacial area calls for collaboration of the obstetrician, neonatologist and plastic surgeon already in the stage when the defect is detected to give the expectant mother an opportunity to obtain accurate and unbiased information on possible treatment and prognosis for the foetus.

MeSH
dítě MeSH
genetické poradenství MeSH
lidé MeSH
novorozenec MeSH
prenatální diagnóza metody MeSH
rozštěp patra diagnóza etiologie genetika MeSH
rozštěp rtu diagnóza etiologie genetika MeSH
těhotenství MeSH
vrozené vady epidemiologie etiologie klasifikace MeSH
Check Tag
dítě MeSH
lidé MeSH
novorozenec MeSH
těhotenství MeSH
ženské pohlaví MeSH

Článek

Ukončení těhotenství ve 2. trimestru gravidity intraamniální aplikací prostaglandinů
[Termination of pregnancy during the second trimester by intraamniotic prostaglandin administration]

Česká gynekologie. 1998 ; Roč. 63 (č. 5) : s. 414-417.

ISSN 1210-7832
Medvik
Zdroj

Introduction: The method used to terminate pregnancy on medical grounds during the second trimester must be safe, rapid, psychologically feasible and associated with a minimal risk of long-term sequelae. The objective of the present work was a critical analysis of the author's standard protocol of termination of pregnancy during the second trimester. Material and methods: For induction of abortion during the second trimester the authors used a synthetic prostaglandin analogue (PG) P2 alpha-Dinoprost which was administered in a single dose of 30 mg by the intraamniotic route. At the time of onset of uterine contractions the authors administered peridural anaesthesia. The authors investigated indications, mean period of induction, correlation between the period of induction of abortion and the indications for termination of pregnancy, the week of pregnancy and parity of the mother. They recorded also the type and number of complications. Results: From January 1991 till June 1997 179 pregnancies were terminated by intraamniotic PG administration. After a single intraamniotic PG administration 72% women aborted within 24 hours. In 26% women the intraamniotic administration was repeated twice and in 2% women three times. The mean induction period, i.e. the interval between the administration and abortion of the foetus was 22.6 hours. The interval was significantly longer (28 hours) in foetuses where pregnancy was terminated because of a neural tube defect (p < 0.01). The authors did not detect a correlation between the period of induction and the indication, week of gestation and parity of the mother. Complications: once a general reaction to intraamniotic administration, in three patients a major blood loss replaced by transfusion of erythrocyte mass, no uterine rupture. Conclusion: In all instances the therapeutic effect was achieved and there was no need to perform sectio minor. The disadvantage of the method is the high price of the preparation and need of repeated intraamniotic administration of PG in 29% of the patients.