• Publikační typ
• tisková chyba MeSH

BACKGROUND: Clinically silent uterine rupture with complete fetal expulsion into the abdominal cavity is an extremely rare complication. Diagnosis can be difficult and the risk to the mother and fetus is high. Conservative management has been described only in a few cases of partial expulsion of the fetus so far. CASE PRESENTATION: We present a case of 43-year-old tercigravida with a history of previous laparotomic myomectomy and subsequent cesarean section. The subsequent pregnancy was complicated by uterine wall loosening and rupture at the site of the previous uterine scar after myomectomy and complete fetal expulsion into the abdominal cavity. The diagnosis was made at 24 + 6 weeks of gestation. Considering the absence of clinical symptomatology and the good condition of the fetus, a conservative approach was chosen with intensive monitoring of the maternal and fetal conditions. The pregnancy ended by elective cesarean section and hysterectomy at 28 + 0 weeks of gestation. The postpartum course was uneventful and the newborn was discharged to home care 63 days after delivery. CONCLUSIONS: Fetal expulsion into the abdominal cavity after silent uterine rupture of the scarred uterus may be accompanied by minimal symptomatology making early diagnosis difficult. This rare complication must be considered in the differential diagnosis in women after major uterine surgery. In selected cases and under conditions of intensive maternal and fetal monitoring, conservative management may be chosen to reduce the risks associated with prematurity.

• MeSH
• břišní dutina * MeSH
• císařský řez škodlivé účinky   MeSH
• dospělí MeSH
• konzervativní terapie škodlivé účinky   MeSH
• lidé MeSH
• novorozenec MeSH
• ruptura dělohy * etiologie   chirurgie   diagnóza   MeSH
• těhotenství MeSH
• uterus MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

During the first wave of the COVID-19 pandemic in the spring of 2020, the government of the Czech Republic issued a nationwide ban on visitors to maternity wards. We studied whether the absence of a close person during labor due to this ban impacted perinatal indicators. This study was performed using an administrative observational questionnaire focused on absolute frequencies of events sent to maternity facilities across the Czech Republic. Completed answers were received from 33 facilities covering 4805 births during the study period in 2019 and 4514 births in 2020. The differences in individual parameters were tested using Pearson's chi-squared homogeneity test. There were no significant differences between the two periods in spontaneous pre-term births (p = 0.522) or in the number of cesarean sections (p = 0.536). No significant changes were seen in either local or systemic analgesia. Data showed a significantly shorter (p = 0.026) first stage of labor in 2020 compared to 2019, while there was no significant difference (p = 0.673) in the second stage of labor. There was no statistically significant difference found for newborn perinatal adaptation. There were also no significant differences in intrapartum maternal injuries. Overall, we found no significant differences in basic perinatal indicators during the first wave of COVID-19 in 2020 compared to 2019. Although the absence of a close person may cause stress for the laboring women, it does not impair objective clinical outcomes.

• MeSH
• COVID-19 * epidemiologie   MeSH
• lidé MeSH
• novorozenec MeSH
• pandemie MeSH
• porod v termínu MeSH
• porodní děj * MeSH
• těhotenství MeSH
• vedení porodu MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

Předkládaná kazuistika popisuje nález Trichomonas vaginalis u pacientky (34 let) s předčasným odtokem plodové vody a následnou sekcí v 25. týdnu těhotenství, kde přítomnost T. vaginalis nebyla jediným rizikovým faktorem předčasného porodu. I když se jedná o vzácný nález u gravidní ženy, je nutné na přítomnost tohoto mikroorganismu při obdobných situacích pomýšlet.

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• MeSH
• antibakteriální látky terapeutické užití   MeSH
• dospělí MeSH
• hypertenze MeSH
• lidé MeSH
• methamfetamin škodlivé účinky   MeSH
• perinatální smrt etiologie   MeSH
• předčasný odtok plodové vody etiologie   MeSH
• předčasný porod etiologie   MeSH
• rizikové faktory MeSH
• růstová retardace plodu etiologie   farmakoterapie   MeSH
• těhotenství MeSH
• Trichomonas vaginalis * patogenita   MeSH
• trichomoniáza diagnóza   farmakoterapie   komplikace   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

OF RECOMMENDATIONS1. Oxytocin for induction or augmentation of labor should not be started when there is a previous scar on the body of the uterus (such as previous classical cesarean section, uterine perforation or myomectomy when uterine cavity is reached) or in any other condition where labor or vaginal delivery are contraindicated. (Moderate quality evidence +++-; Strong recommendation).2. Oxytocin should not be started before at least 1 h has elapsed since amniotomy, 6 h since the use of dinoprostone (30 min if vaginal insert) and 4 h since the use of misoprostol (Low quality evidence ++- -; Moderate recommendation).3. Cardiotocography (CTG) should be performed and a normal pattern without tachysystole should be documented for at least 30 min before oxytocin is used. Continuous CTG, with adequate monitoring of both fetal heart rate and uterine contractions, should be maintained for as long as oxytocin is used, and thereafter until delivery (Low ++- - to moderate +++- quality evidence; Strong recommendation).4. For labor induction, at least 1-h should be allowed after amniotomy before oxytocin infusion is started, to evaluate whether adequate uterine contractility has meanwhile ensued. For augmentation of labor, if the membranes are intact and there are conditions for a safe amniotomy, the latter should be considered before oxytocin is started (Very low quality evidence +- --; Weak recommendation).5. Oxytocin should be administered intravenously using the following regimen: 5 IU oxytocin diluted in 500 mL of 0.9% normal saline (NaCl) (each mL contains 10 mIU of oxytocin), in an infusion pump at increasing rates, as shown in Table 1, until a frequency of 3-4 contractions per 10 min is reached, a non-reassuring CTG pattern ensues, or maximum rates are reached (Low quality evidence ++ - -; Strong recommendation). If the frequency of contractions exceeds 5 in 10 min, the infusion rate should be reduced, even if a normal CTG pattern is present. With a non-reassuring CTG pattern, urgent clinical assessment by an obstetrician is indicated, and strong consideration should be given to reducing or stopping the oxytocin infusion. The minimal effective dose of oxytocin should always be used. (Low ++- - to Moderate +++- - quality evidence; Strong recommendation).[Table: see text]6. Use of oxytocin for induction and augmentation of labor should be regularly audited (Low quality evidence ++--; Strong recommendation).

• MeSH
• císařský řez MeSH
• indukovaný porod * MeSH
• lidé MeSH
• misoprostol MeSH
• novorozenec MeSH
• oxytocin terapeutické užití   MeSH
• perinatální péče MeSH
• těhotenství MeSH
• uterotonika * terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Gestational diabetes mellitus (GDM) represents a risk factor for both mother and her offspring in a short-term (perinatal morbidity) and long-term horizon (postpartum diabetes or foetal programming). Several studies focused at peri/postnatal outcomes of GDM mother ́s offspring, however relatively few (and none in Czech population) were designed as prospective. The aim of the study was to ascertain eventual anthropometric and developmental abnormalities and/or morbidity in offspring of GDM mothers compare to controls in a 5-year follow-up using a parent-reported parameters related to psychomotor development and common paediatric morbidities including a sub-study of offspring of GDM mothers experiencing adverse perinatal outcomes. METHODS: A 5 year follow up study of offspring of GDM mothers (n = 26) vs those with a normal pregnancy (n = 63). An electronic questionnaire was used to obtain the parameters (such as growth, psychomotor development, vaccination, morbidity history etc.) available to parents from the parent-held infant health record. Data on pregnancy and delivery were available from the previous study. RESULTS: Offspring of GDM mothers had delayed psychomotor development in early childhood, but in 5 years of age they seemed to gradually achieve results of a control group. Children with macrosomia had a higher percentile of weight-for-height and were significantly more frequently ill than those with a normal birth weight. Offspring of obese mothers had worse verbal language skills in early childhood and a higher percentile of weight-for-height. CONCLUSION: Maternal gestational diabetes and obesity can be considered an important determinant of postnatal offspring development and health status, which further advocates for broader implementation of preventive strategies.

• MeSH
• dítě MeSH
• gestační diabetes * MeSH
• index tělesné hmotnosti MeSH
• kojenec MeSH
• lidé MeSH
• morbidita MeSH
• následné studie MeSH
• obezita epidemiologie   MeSH
• porodní hmotnost MeSH
• předškolní dítě MeSH
• prospektivní studie MeSH
• těhotenství MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• předškolní dítě MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• Publikační typ
• abstrakt z konference MeSH

Pregnant and lactating women (PLW) represent a particular population subset with increased susceptibility for COVID-19 morbidity and mortality, even though the evidence about the safety and efficacy of COVID-19 vaccines was delayed due to their initial exclusion from development trials. This unclear situation could have led to increased COVID-19 vaccine hesitancy levels among PLW; therefore, this study aimed to evaluate the attitudes of Czech PLW towards COVID-19 vaccines and the determinants of their attitudes. An analytical cross-sectional survey-based study was carried out in the University Hospital Brno (South Moravia, Czechia) between August and October 2021. The study utilised a self-administered questionnaire (SAQ) adapted from previous instruments used for the same purpose. The SAQ included closed-ended items covering demographic characteristics, clinical and obstetric characteristics, attitudes towards COVID-19 vaccination, and potential psychosocial predictors of vaccine acceptance. Out of the 362 included participants, 278 were pregnant (PW) and 84 were lactating women (LW). The overall COVID-19 vaccine acceptance (immediate and delayed) level was substantially high (70.2%), with a significant difference between PW (76.6%) and LW (48.8%). Out of the 70.2% who agreed to receive the vaccine, 3.6% indicated immediate acceptance, and 66.6% indicated delayed acceptance. Only 13.3% of the participants indicated their acceptance of their physician's vaccination recommendation during pregnancy or while lactating, and 62.2% were against it. Our results agreed with the recent studies that revealed that PW tended to have a high level of COVID-19 vaccine acceptance, and they were also inclined to resist professional recommendations because they predominantly preferred to delay their vaccination. The pregnancy trimester, education level, employment status, and previous live births were significant determinants for COVID-19 vaccine acceptance. The most commonly preferred vaccine type was mRNA-based vaccines, followed by viral vector-based and inactivated virus vaccines. The first top priority of PLW was vaccine safety for their children, followed by vaccine safety for the PLW and vaccine effectiveness. Regarding psychosocial predictors, media/social media, trust in the government, the pharmaceutical industry, and healthcare professionals, partners, and a positive risk-benefit ratio were significant promoters for COVID-19 vaccine acceptance. Findings from this study suggest that promotional interventions targeting PLW should use web platforms and focus on vaccine safety evidence, the expected benefits of vaccines and potential harms of the infection.

• MeSH
• COVID-19 * MeSH
• dítě MeSH
• laktace MeSH
• lidé MeSH
• odkládání očkování MeSH
• průřezové studie MeSH
• SARS-CoV-2 MeSH
• těhotenství MeSH
• těhotné ženy MeSH
• účinost vakcíny MeSH
• vakcinace MeSH
• vakcíny proti COVID-19 * MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

Cíl studie: Zhodnocení perinatálních výsledků v souboru gravidit komplikovaných eklampsií. Metodika: Analýza 67 304 porodů odvedených na Gynekologicko-porodnické klinice LF MU a FN Brno v letech 2008–2018. Za dané období byla diagnostikována eklampsie u 16 rodiček (0,2 ‰). Hodnoceno bylo časové období výskytu eklampsie (týden gestace, výskyt prepartálně, intrapartálně, postpartálně), stav plodu a novorozence (známky intrauterinní tísně, pH pupečníkové arterie, Apgar skóre, intrauterinní úmrtí plodu, úmrtí v časném neonatálním období). Sledovány byly symptomy a průběh eklamptického záchvatu, mateřské komorbidity, přidružené porodnické komplikace (abrupce placenty, operační komplikace, krevní ztráta, nutnost postpartální hysterektomie) a neporodnické komplikace (koagulopatie, porucha funkce ledvin a jater, neurologické komplikace). Výsledky: Z celkového souboru 16 případů eklampsie bylo 13 případů (81,3 %) potvrzeno v průběhu gravidity, jeden případ (6,2 %) za porodu a dva případy (12,5 %) do 24 hod po porodu. Průměrný gestační týden výskytu eklampsie byl 33 týdnů a 3 dny. Typický průběh eklamptického záchvatu charakterizovaný cefaleou a poruchami vizu s následným rychlým nástupem křečí byl zaznamenán v pěti případech (31 %). Hypoxie plodu s hodnotou pH z pupečníkové arterie < 7,10 se vyskytla ve čtyřech případech (25 %). Byla prokázána závislost poklesu hodnoty pH na časovém intervalu od stanovení diagnózy eklampsie do ukončení gravidity. Hodnota pH pupečníkové arterie poklesla průměrně o 0,054 každých 30 min od začátku eklamptického záchvatu do ukončení gravidity. V souboru byly zaznamenány 3 perinatální úmrtí (19 %). K intrauterinnímu úmrtí plodu došlo v jednom případě z důvodu parciální abrupce placenty v průběhu eklamptického záchvatu, dva novorozenci zemřeli v časném neonatálním období. Příčinou úmrtí byla v jednom případě sepse a ve druhém případě perforace střeva při nekrotizující enterokolitidě. Úmrtí rodičky v souboru nebylo zaznamenáno. Četnost výskytu preeklampsie v další graviditě dosáhla 18,8 %. Z neporodnických komplikací se v souboru vyskytly neurologické obtíže (amauróza, subarachnoidální krvácení, amnézie) ve třech případech (18,8 %) a renální selhání ve dvou případech (12,5 %). Závěr: Incidence eklampsie na Gynekologicko-porodnické klinice LF MU a FN Brno dosáhla 0,2 ‰ a je dlouhodobě stálá. Přidružené závažné mateřské komplikace se vyskytly ve 38 % případů a neonatální komplikace ve 31 % případů. Nutným předpokladem snížení rizika výskytu přidružených komplikací je především časné stanovení diagnózy eklampsie a minimalizace časové prodlevy do ukončení gravidity. V rámci léčby eklampsie a následných komplikací je nezbytný interdisciplinární přístup.

Objective: Evaluation of perinatal results in a set of pregnancies complicated by eclampsia. Methods: Analysis of 67,304 births performed at the Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine and University Hospital, Brno from 2008–2018. During the given period, eclampsia was diagnosed in 16 mothers (0.2‰). The during the time of eclampsia (week of gestation, prepartum, intrapartum, postpartum) fetal and neonatal status (signs of intrauterine distress, pH of the umbilical artery, Apgar score, intrauterine fetal death, death in the early neonatal period) were evaluated. Symptoms and course of the eclamptic attack, maternal comorbidities, associated obstetric complications (placental abruption, surgical complications, blood loss, hysterectomy) and non-obstetric complications (coagulopathy, renal and hepatic impairment, neurological complications) were monitored. Results: Out of a total of 16 cases of eclampsia, 13 cases (81.3%) were confirmed during pregnancy, one case (6.2%) during childbirth, and two cases (12.5%) within 24 hours after childbirth. The mean gestational week of eclampsia was 33 weeks and 3 days. The typical course of an eclamptic attack characterized by headache and visual disturbances followed by a rapid onset of convulsions was noted in five cases (31%). Fetal hypoxia with a pH of the umbilical artery less than 7.10 occurred in four cases (25%). The dependence of the decrease in pH value on the time interval from the diagnosis of eclampsia to the termination of pregnancy was demonstrated. The pH of the umbilical artery decreased on average by 0.054 every 30 minutes from the onset of the eclamptic attack until the end of pregnancy. There were 3 perinatal deaths in the group (19%). Intrauterine fetal death occurred in one case due to partial abruption of the placenta during an eclamptic attack; two newborns died in the early neonatal period. The cause of death was sepsis in one case and perforation of the intestine in necrotizing enterocolitis in the other. The death of the mother was not recorded in the file. The incidence of preeclampsia in subsequent pregnancies reached 18.8%. Non-obstetric and neurological complications (amaurosis, subarachnoid hemorrhage, amnesia) occurred in the group in three cases (18.8%), and renal failure occurred in two cases (12.5%). Conclusion: The incidence of eclampsia at the Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine and University Hospital, Brno reached 0.2‰ and was stable for a long time. Associated serious maternal complications occurred in 37.5% of cases and neonatal complications in 31.3% of cases. Early diagnosis of eclampsia and minimization of the time delay until the end of pregnancy is a prerequisite for reducing the risk of associated complications. An interdisciplinary approach is needed.

• Klíčová slova
• urgentní stavy v porodnictví, perinatální výsledky,
• MeSH
• císařský řez MeSH
• dospělí MeSH
• eklampsie * patologie   terapie   MeSH
• hypoxie MeSH
• komplikace těhotenství MeSH
• lidé MeSH
• porod MeSH
• retrospektivní studie MeSH
• těhotenství MeSH
• výsledek terapie MeSH
• záchvaty MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

National screening programs use dried blood specimens to detect metabolic disorders or aberrant protein functions that are not clinically evident in the neonatal period. Similarly, gut microbiota metabolites and immunological acute-phase proteins may reveal latent immune aberrations. Microbial metabolites interact with xenobiotic receptors (i.e., aryl hydrocarbon and pregnane-X) to maintain gastrointestinal tissue health, supported by acute-phase proteins, functioning as sensors of microbial immunomodulation and homeostasis. The delivery (vaginal or cesarean section) shapes the microbial colonization, which substantially modulates both the immune system's response and mucosal homeostasis. This study profiled microbial metabolites of the kynurenine and tryptophan pathway and acute-phase proteins in 134 neonatal dried blood specimens. We newly established neonatal blood levels of microbial xenobiotic receptors ligands (i.e., indole-3-aldehyde, indole-3-butyric acid, and indole-3-acetamide) on the second day of life. Furthermore, we observed diverse microbial metabolic profiles in neonates born vaginally and via cesarean section, potentially due to microbial immunomodulatory influence. In summary, these findings suggest the supportive role of human gut microbiota in developing and maintaining immune system homeostasis.

• Publikační typ
• časopisecké články MeSH