Evidence-based guidelines on the management of pain associated with first-trimester medical abortion are lacking. Most published clinical trials have failed to report on this important aspect of the procedure. The aim of this comprehensive work was to provide clinical advice based on a comprehensive literature review, supplemented by the clinical experience of a group of European experts in case no evidence is available. Pain level ranged from 5 to 8 in 80% of studies where pain was measured on a 0-10 visual analogue scale; severe pain was reported by 20-80% of women. Pain assessment was rarely reported in studies. Pain treatment should be preventive and avoidance of unnecessary uterine contractions should be considered. Analgesic treatment should follow the WHO three-step ladder, starting with the use of NSAIDs and allowing for easily available back-up treatment with weak opioids.
- MeSH
- abortiva steroidní škodlivé účinky farmakologie MeSH
- antiflogistika nesteroidní aplikace a dávkování MeSH
- ibuprofen aplikace a dávkování MeSH
- indukovaný potrat škodlivé účinky metody MeSH
- konsensus MeSH
- lidé MeSH
- management bolesti metody MeSH
- měření bolesti metody MeSH
- mifepriston škodlivé účinky farmakologie MeSH
- misoprostol škodlivé účinky farmakologie MeSH
- první trimestr těhotenství MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- systematický přehled MeSH
OBJECTIVES: To determine the quality of Doppler images of the fetal middle cerebral artery (MCA) and umbilical artery (UA) using an objective scale, and to determine the reliability of this scale, within a multicenter randomized controlled trial (Revealed versus concealed criteria for placental insufficiency in unselected obstetric population in late pregnancy (Ratio37)). METHODS: The Ratio37 trial is an ongoing randomized, open-label, multicenter controlled study of women with a low-risk pregnancy recruited at 20 weeks. Doppler measurements of the fetal MCA and UA were performed at 37 weeks. Twenty patients from each of the six participating centers were selected randomly, with two images evaluated per patient (one each for the MCA and UA). The quality of a total of 240 images was evaluated by six experts, scored on an objective scale of six items. Inter- and intrarater reliability was assessed using the Fleiss-modified kappa statistic for ordinal scales. RESULTS: On average, 89.2% of MCA images and 85.0% of UA images were rated as being of perfect (score of 6) or almost perfect (score of 5) quality. Kappa values for intrarater reliability of quality assessment were 0.90 (95% CI, 0.88-0.92) and 0.90 (95% CI, 0.88-0.93) for the MCA and UA, respectively. The corresponding inter-rater reliability values were 0.85 (95% CI, 0.81-0.89) and 0.84 (95% CI, 0.80-0.89), respectively. CONCLUSION: The quality of MCA and UA Doppler ultrasound images can be evaluated reliably using an objective scale. Over 85% of images, which were obtained by operators from a broad range of clinical practices within a multicenter study, were rated as being of perfect or almost perfect quality. Intra- and inter-rater reliability of quality assessment was very good. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
- MeSH
- arteria cerebri media diagnostické zobrazování embryologie MeSH
- arteriae umbilicales diagnostické zobrazování embryologie MeSH
- dospělí MeSH
- lidé MeSH
- plod krevní zásobení diagnostické zobrazování embryologie MeSH
- randomizované kontrolované studie jako téma MeSH
- reprodukovatelnost výsledků MeSH
- ultrasonografie dopplerovská normy MeSH
- ultrasonografie prenatální normy MeSH
- zajištění kvality zdravotní péče MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
- multicentrická studie MeSH
The aim of the study was the analysis of the new molecular genetic immunomarkers (p53, c-erbB-2, Ki 67, bcl-2) hormonal receptors (ER, PR) and ploidy disturbances and their relation to the most important prognostic factors for endometrial cancer. The study group consisted of 135 endometrial cancer patients. Biopsies of the tumours obtained at operations were routinely histopathologically examined. Subsequenly, the immunohistochemical tumour markers were determined. The same biopsies were examined by microdissection and flow cytometric ploidy analysis and karyotyping. The findings were compared with the most important prognostic factors for endometrial cancer, mainly with clinical stage of the disease and grade. RESULTS: High expression of p53, Ki 67, c-erbB-2 and low rate of progesterone receptors was found in the prognostically unfavourable group (G 3). Aneuploidy was found in 72% in the group of poorly differentiated endometrial cancers (G 3) in contrast to 27% in the group of G1 and G2 tumours, but this difference was not statistically significant. CONCLUSIONS: Identification of p53, Ki 67, c-erbB-2, PR and determination of DNA ploidy is a useful tool to specify a group of prognostically unfavourable patients.
- MeSH
- aneuploidie MeSH
- antigen Ki-67 metabolismus MeSH
- endometroidní karcinom genetika metabolismus patologie MeSH
- karyotyp MeSH
- lidé MeSH
- nádorové biomarkery metabolismus MeSH
- nádorový supresorový protein p53 metabolismus MeSH
- nádory endometria genetika metabolismus patologie MeSH
- prognóza MeSH
- protoonkogenní proteiny c-bcl-2 metabolismus MeSH
- receptor erbB-2 metabolismus MeSH
- receptory pro estrogeny metabolismus MeSH
- receptory progesteronu metabolismus MeSH
- staging nádorů MeSH
- stupeň nádoru MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- autoprotilátky diagnostické užití imunologie MeSH
- erytrocyty imunologie MeSH
- financování organizované MeSH
- hematologické komplikace těhotenství prevence a kontrola MeSH
- hematologické testy MeSH
- imunoglobuliny MeSH
- lidé MeSH
- nemoci plodu diagnóza prevence a kontrola MeSH
- plod MeSH
- prenatální diagnóza MeSH
- Rh izoimunizace MeSH
- Rho(D) imunoglobulin diagnostické užití krev MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- abstrakty MeSH
- MeSH
- anemie diagnóza MeSH
- antigeny diagnostické užití krev MeSH
- erytrocyty imunologie MeSH
- financování organizované MeSH
- hematologie MeSH
- komplikace těhotenství diagnóza MeSH
- krevní transfuze MeSH
- lidé MeSH
- nemoci plodu diagnóza MeSH
- plod MeSH
- prenatální diagnóza metody MeSH
- protilátky diagnostické užití krev MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- abstrakty MeSH
