BACKGROUND: Excisional treatment of cervical intraepithelial neoplasia or very early stages of cervical cancer increases the risk of preterm prelabor rupture of membranes in subsequent pregnancies. The risk increases with the length of the excised cone. The subset of cases with preterm prelabor rupture of membranes and a history of cervical excisional treatment could also be at higher risk of intraamniotic infection/inflammation. However, there is a paucity of relevant information on this subject. OBJECTIVE: This study aimed to assess the differences in the rates of intraamniotic infection/inflammation and early-onset neonatal sepsis between singleton preterm prelabor rupture of membranes pregnancies without and with a history of cervical excisional treatment, and to investigate the association between these complications of preterm prelabor rupture of membranes and the excised cone length. STUDY DESIGN: This retrospective cohort study included 770 preterm prelabor rupture of membranes pregnancies in which transabdominal amniocentesis was performed as part of standard clinical management to assess the intraamniotic environment. The maternal and perinatal medical records of all included women were reviewed to obtain information on the absence or presence of history of cervical excisional treatment and neonatal outcomes. Women whose records contained any information on history of cervical excisional treatment were contacted by phone and in writing to inform them of the study and request permission to collect relevant information from their medical records. Women were divided into 4 subgroups according to the presence of microorganisms and/or their nucleic acids (through culturing and molecular biology methods) in amniotic fluid and/or intraamniotic inflammation (through amniotic fluid interleukin-6 concentration evaluation): intraamniotic infection (presence of both), sterile intraamniotic inflammation (intraamniotic inflammation alone), microbial invasion of the amniotic cavity without inflammation (presence of microorganisms and/or their nucleic acids in amniotic fluid alone), and negative amniotic fluid for infection/inflammation (absence of both). RESULTS: A history of cervical excisional treatment was found in 10% (76/765) of the women. Of these, 82% (62/76) had a history of only 1 treatment, and information on cone length was available for 97% (60/62) of them. Women with a history of cervical excisional treatment had higher rates of intraamniotic infection (with, 25% [19/76] vs without, 12% [85/689]; adjusted odds ratio, 2.5; adjusted P=.004), microbial invasion of the amniotic cavity without inflammation (with, 25% [19/76] vs without, 11% [74/689]; adjusted odds ratio, 3.1; adjusted P<.0001), and early-onset neonatal sepsis (with, 8% [11/76] vs without, 3% [23/689]; adjusted odds ratio, 2.9; adjusted P=.02) compared with those without such history. Quartiles of cone length (range: 3-32 mm) were used to categorize the women into 4 quartile subgroups (first: 3-8 mm; second: 9-12 mm; third: 13-17 mm; and fourth: 18-32 mm). Cone length of ≥18 mm was associated with higher rates of intraamniotic infection (with, 29% [5/15] vs without, 12% [85/689]; adjusted odds ratio, 3.0; adjusted P=.05), microbial invasion of the amniotic cavity without inflammation (with, 40% [6/15] vs without, 11% [74/689]; adjusted odds ratio, 6.1; adjusted P=.003), and early-onset neonatal sepsis (with, 20% [3/15] vs without, 3% [23/689]; adjusted odds ratio, 5.7; adjusted P=.02). CONCLUSION: History of cervical excisional treatment increases risks of intraamniotic infection, microbial invasion of the amniotic cavity without inflammation, and development of early-onset neonatal sepsis in a subsequent pregnancy complicated by preterm prelabor rupture of membranes.

• MeSH
• chorioamnionitida epidemiologie   etiologie   MeSH
• lidé MeSH
• novorozenec MeSH
• novorozenecká sepse MeSH
• plodová voda MeSH
• předčasný odtok plodové vody epidemiologie   MeSH
• retrospektivní studie MeSH
• těhotenství MeSH
• zánět komplikace   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Feochromocytóm je v gravidite raritné ochorenie s možným závažným dopadom na zdravie tehotnej ženy a jej plodu. Skorá identifikácia, liečba a správne načasovanie ukončenia tehotnosti sú kľúčovým faktorom pre úspešné zvládnutie takéhoto stavu u tehotnej pacientky. V práci je popisovaný prípad 20-ročnej tehotnej kvartigravidy so zaťaženou pôrodníckou anamnézou a už známym feochromocytómom, ktorá je sledovaná pre akcelerovanú hypertenziu, zle reagujúcu na betaadrenergnú antihypertenzívnu liečbu, kardiomyopatiu a ťažkú anémiu v 28. gestačnom týždni. Predošlé tehotenstvo a pôrod boli komplikované postpartálnou hemorágiou, ťažkou hypotóniou uteru s nutnosťou relaparotómie, evakuáciou hematometry a naložením kompresnej B-Lynch sutúry maternice.

Pheochromocytoma is a rare disease in pregnancy with a possible serious impact on the health of the pregnant woman and her fetus. Early identification, treatment and correct timing of termination of pregnancy is a key factor for the successful management of such a condition in a pregnant patient. The work describes the case of a 20-year-old pregnant woman with her fourth child with a complicated obstetric history and a known pheochromocytoma, who is being monitored for accelerated hypertension, poorly responsive to beta-adrenergic antihypertensive treatment, cardiomyopathy and severe anemia in the 28th week of gestation. The previous pregnancy and delivery were complicated by postpartum hemorrhage, severe hypotony of the uterus with the necessity of relaparotomy, evacuation of the hematoma, and placement of a compression B-Lynch uterine suture.

• MeSH
• antihypertenziva aplikace a dávkování   terapeutické užití   MeSH
• feochromocytom diagnóza   komplikace   terapie   MeSH
• gravidita MeSH
• hypertenze diagnóza   etiologie   farmakoterapie   MeSH
• komplikace těhotenství diagnóza   etiologie   terapie   MeSH
• lidé MeSH
• mladý dospělý MeSH
• počítačová rentgenová tomografie metody   MeSH
• poporodní krvácení prevence a kontrola   MeSH
• rizikové těhotenství MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

PURPOSE: To assess the longitudinal variation of the ratio of umbilical and cerebral artery pulsatility index (UCR) in late preterm fetal growth restriction (FGR). MATERIALS AND METHODS: A prospective European multicenter observational study included women with a singleton pregnancy, 32+ 0-36+ 6, at risk of FGR (estimated fetal weight [EFW] or abdominal circumference [AC] < 10th percentile, abnormal arterial Doppler or fall in AC from 20-week scan of > 40 percentile points). The primary outcome was a composite of abnormal condition at birth or major neonatal morbidity. UCR was categorized as normal (< 0.9) or abnormal (≥ 0.9). UCR was assessed by gestational age at measurement interval to delivery, and by individual linear regression coefficient in women with two or more measurements. RESULTS: 856 women had 2770 measurements; 696 (81 %) had more than one measurement (median 3 (IQR 2-4). At inclusion, 63 (7 %) a UCR ≥ 0.9. These delivered earlier and had a lower birth weight and higher incidence of adverse outcome (30 % vs. 9 %, relative risk 3.2; 95 %CI 2.1-5.0) than women with a normal UCR at inclusion. Repeated measurements after an abnormal UCR at inclusion were abnormal again in 67 % (95 %CI 55-80), but after a normal UCR the chance of finding an abnormal UCR was 6 % (95 %CI 5-7 %). The risk of composite adverse outcome was similar using the first or subsequent UCR values. CONCLUSION: An abnormal UCR is likely to be abnormal again at a later measurement, while after a normal UCR the chance of an abnormal UCR is 5-7 % when repeated weekly. Repeated measurements do not predict outcome better than the first measurement, most likely due to the most compromised fetuses being delivered after an abnormal UCR.

• MeSH
• arteriae umbilicales diagnostické zobrazování   MeSH
• gestační stáří MeSH
• hmotnost plodu MeSH
• hypotrofický novorozenec MeSH
• lidé MeSH
• novorozenec MeSH
• předčasný porod MeSH
• prospektivní studie MeSH
• růstová retardace plodu MeSH
• těhotenství MeSH
• ultrasonografie dopplerovská MeSH
• ultrasonografie prenatální MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH

Cieľ: Hlavným cieľom práce bolo posúdiť prípady peripartálnych hysterektómií v súvislosti s morbídne adherentnou placentou v Slovenskej republike. Súbor a metodika: Retrospektívne boli analyzované prípady morbídne adherentnej placenty riešené peripartálnou hysterektómiou v Slovenskej republike od 1. januára 2012 do 31. decembra 2020. Údaje boli získané zo štandardizovaných anonymných dotazníkov. Výsledky: Incidencia morbídne adherentnej placenty bola 0,39 na 1 000 pôrodov. Peripartálna hysterektómia bola vykonaná u 151 (89,9 %) žien s morbídne adherentnou placentou (38,0 % všetkých peripartálnych hysterektómií). Placenta accreta bola zastúpená v 56,3 %, increta v 28,5 % a percreta v 15,2 %. V 60 (39,7 %) prípadoch išlo o kombináciu s placentou praeviou. V 112 (74,2 %) prípadoch bola morbídne adherentná placenta diagnostikovaná až v čase pôrodu. Neúspešný výkon na záchranu uteru predchádzal hysterektómiu v 23 (15,2 %) prípadoch. Medián odhadovanej straty krvi bol 1 500 ml. Transfúzia erytrocytov bola podaná u 138 (91,4 %), čerstvá mrazená plazma u 118 (78,2 %), koncentrát fibrinogénu u 39 (25,8 %) a kyselina tranexámová u 25 (16,6 %) pacientok. Prijatie na jednotku intenzívnej starostlivosti potrebovalo 58 (38,4 %) žien. Úmrtnosť pacientok bola 1,3 %. Záver: V posledných rokoch na Slovensku stúpol výskyt morbídne adherentnej placenty, peripartálnej hysterektómie, ale aj cisárskych rezov. Analýza prípadov poukazuje na potrebu zlepšenia prenatálnej diagnostiky a manažmentu morbídne adherentnej placenty.

Objective: The main aim of this study was to analyze the cases of peripartum hysterectomy associated with morbidly adherent placenta in the Slovak Republic. Materials and methods: Cases of morbidly adherent placenta managed by peripartum hysterectomy in the Slovak Republic between January 2012 and December 2020 were retrospectively analyzed. Data were obtained from the standardized anonymous questionnaires. Results: The incidence of morbidly adherent placenta was 0.39 per 1,000 births. A total of 151 (89.9%) women with morbidly adherent placenta were managed by peripartum hysterectomy (38.0% of all peripartum hysterectomies). Placenta accreta, increta and percreta were present in 56.3%, 28.5% and 15.2%, respectively. Placenta previa was present in 60 (39.7%) cases. Up to 112 (74.2%) cases of morbidly adherent placenta were diagnosed at the time of delivery. Hysterectomy was preceded by unsuccessful uterus-saving procedure in 23 (15.2%) of cases. The median of estimated blood loss was 1,500 mL. A packed red blood cells transfusion was used in 138 (91.4%), fresh frozen plasma in 118 (78.2%), fibrinogen concentrate in 39 (25.8%) and tranexamic acid in 25 (16.6%) women. A total of 58 (38.4%) women required admission to an intensive care unit. The mortality rate was 1.3%. Conclusion: In recent years, there was an increase in the incidence of morbidly adherent placenta, peripartum hysterectomy in the Slovak Republic, along with an increase in caesarean section rates, too. Case analysis highlights the need to improve the prenatal diagnosis and management of morbidly adherent placenta.

• Klíčová slova
• morbidně adherentní placenta,
• MeSH
• dospělí MeSH
• hysterektomie mortalita   statistika a číselné údaje   MeSH
• komplikace porodu chirurgie   epidemiologie   mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• nemoci placenty chirurgie   epidemiologie   mortalita   MeSH
• průzkumy a dotazníky MeSH
• retrospektivní studie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Slovenská republika MeSH

Cíl: Tato studie si klade za cíl porovnat mateřské a fetální výsledky u následujících těhotenství pacientek, které podstoupily konzervativní (fertilitu šetřící) operaci placenta accreta spektra (PAS) a současných těhotenství pacientek po předchozím císařském řezu. Jeho cílem je zhodnotit proveditelnost konzervativní operace. Metody: Studie byla provedena v období od ledna 2011 do září 2021 na Porodnicko-gynekologické klinice Necmettin Erbakan University Meram Medical University Hospital. Soubory pacientek, které podstoupily segmentální resekci dělohy s diagnózou PAS a poté znovu otěhotněly a které podstoupily císařský řez, byly retrospektivně naskenovány z nemocničního systému elektronických záznamů pacientek bez diagnózy PAS, ale s alespoň jednou předchozí anamnézou. Císařský řez. Výsledky: Gestační týden, porodní hmotnost, intrauterinní růstová retardace a hodnoty APGAR byly porovnány s ohledem na výsledky plodu a mezi těmito dvěma skupinami nebyl nalezen žádný statisticky významný rozdíl. Sedm pacientek ve studijní skupině a jedna pacientka v kontrolní skupině vyžadovalo poporodní transfuzi (p = 0,026), infekce močových cest byly častější u pacientek s PAS v anamnéze (p = 0,038). Závěr: I když je císařský řez standardní léčebnou metodou v případech anomálie placentární invaze, konzervativní (uterus šetřící) operace se zdá být použitelná u pacientek s fertilitou i přes chirurgické komplikace. Konzervativní operace typu acar je důležitá jak z hlediska zachování fertility u PAS.

Objective: This study aims to compare the maternal and fetal outcomes in subsequent pregnancies of patients who underwent conservative surgery (fertility-sparing) for placenta accreta spectrum (PAS) and the current pregnancies of patients who had a previous cesarean section. It aims to evaluate the feasibility of conservative surgery. Methods: The study was carried out between January 2011 and September 2021 at the Gynecology and Obstetrics Clinic of Necmettin Erbakan University Meram Medical Faculty Hospital. The files of patients who underwent uterine segmental resection surgery with the diagnosis of PAS and then became pregnant again and who underwent cesarean section were retrospectively scanned from the hospital electronic registry system of patients without a PAS diagnosis but with a history of at least one previous cesarean section. Results: Gestational week, birth weight, intrauterine growth retardation, and APGAR values were compared regarding the fetal outcomes and no statistically significant difference was found between the two groups. Seven patients in the study group and one patient in the control group required postpartum transfusions (P = 0.026), and urinary system infections were more frequent in patients with a history of PAS (P = 0.038). Conclusion: Although cesarean hysterectomy is the standard treatment method in cases of placental invasion anomaly, conservative (uterus-sparing) surgery seems to be applicable in fertile patients despite surgical difficulties. Acar-style conservative surgery is important in terms of both fertility preservation in PAS cases.

• MeSH
• císařský řez MeSH
• dospělí MeSH
• lidé MeSH
• placenta accreta chirurgie   MeSH
• porodnické chirurgické výkony metody   statistika a číselné údaje   MeSH
• prognóza MeSH
• těhotenství MeSH
• výsledek těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• srovnávací studie MeSH

STUDY QUESTION: Do the perinatal outcomes of patients following hysteroscopic treatment for Asherman syndrome (AS) differ from that of a control population? SUMMARY ANSWER: Perinatal complications including placental issues, high blood loss, and prematurity in women after treatment for AS should be considered as moderate to high risk, especially in patients who have undergone more than one hysteroscopy (HS) or repeated postpartum instrumental revisions of the uterine cavity (Dilation and Curettage; D&C). WHAT IS KNOWN ALREADY: The detrimental impact of AS on obstetrics outcomes is commonly recognized. However, prospective studies evaluating perinatal/neonatal outcomes in women with AS history are sparse, and the characteristics accounting for the respective morbidity of AS patients remain to be elucidated. STUDY DESIGN, SIZE, DURATION: We conducted a prospective cohort study utilizing data from patients who underwent HS treatment for moderate to severe AS in a single tertiary University-affiliated hospital (enrolled between 01 January 2009 and March 2021), and who consequently conceived and progressed to at least 22nd gestational week of pregnancy. Perinatal outcomes were compared to a control population without an AS history, retrospectively enrolled concomitantly at the time of delivery for each patient with AS. Maternal and neonatal morbidity was assessed as well as the characteristics-related risk factors of AS patients. PARTICIPANTS/MATERIALS, SETTING, METHODS: Our analytic cohort included a total of 198 patients, 66 prospectively enrolled patients with moderate to severe AS and 132 controls. We used multivariable logistic regression to calculate a propensity score to match 1-1 women with and without AS history based on demographic and clinical factors. After matching, 60 pairs of patients were analysed. Chi-square test was used to compare perinatal outcomes between the pairs. Spearman's correlation analysis was utilized to investigate the correlation between perinatal/neonatal morbidity and the characteristics-related factors of AS patients. The odds ratio (OR) for the associations was calculated by logistic regression. MAIN RESULTS AND THE ROLE OF CHANCE: Among the 60 propensity matched pairs, the AS group more frequently experienced overall perinatal morbidity, including abnormally invasive placenta (41.7% vs 0%; P < 0.001), retained placenta requiring manual or surgical removal (46.7% vs 6.7%; P < 0.001), and peripartum haemorrhage occurrence (31.7% vs 3.3%; P < 0.001). Premature delivery (<37 gestational weeks) was reported more frequently also for patients with AS (28.3% vs 5.0%; P < 0.001). However, no increased frequency of intra-uterine growth restriction or worsened neonatal outcomes were observed in AS group. Univariable analysis of risk factors for AS group morbidity outcomes revealed that the main factor related to abnormally invasive placenta was two or more HS procedures (OR 11.0; 95% CI: 1.33-91.23), followed by two or more D&Cs preceding AS treatment (OR 5.11; 95% CI: 1.69-15.45), and D&C performed postpartum as compared to post abortion (OR 3.0; 95% CI: 1.03-8.71). Similarly, two or more HS procedures were observed as the most important factor for retained placenta (OR 13.75; 95% CI: 1.66-114.14), followed by two or more preceding D&Cs (OR 5.16; 95% CI: 1.67-15.9). Premature birth was significantly associated with the number of preceding D&Cs (OR for two or more, 4.29; 95% CI: 1.12-14.91). LIMITATIONS, REASONS FOR CAUTION: Although the cohort of patients with AS was enrolled prospectively, a baseline imbalance was intrinsically involved in the retrospective enrolment of the control group. However, to reduce the risk of bias, confounding factors were adjusted for using propensity score matching. The limitation to the generalization of our reported results is the single institution design in which all patients were treated for AS in one tertiary medical centre. WIDER IMPLICATIONS OF THE FINDINGS: Within our search scope, our study represents one of the first and largest prospective studies of perinatal and neonatal outcomes in moderate to severe AS patients with a prospectively analysis of the risks factors of characteristics significantly influencing reported morbidities among patients with AS. STUDY FUNDING/COMPETING INTEREST(S): The study was supported by the Charles University in Prague [UNCE 204065] and by the institutional grant of The General Faculty Hospital in Prague [00064165]. No competing interests were declared. TRIAL REGISTRATION NUMBER: N/A.

• MeSH
• gynatrézie MeSH
• kohortové studie MeSH
• lidé MeSH
• novorozenec MeSH
• placenta MeSH
• předčasný porod epidemiologie   etiologie   MeSH
• prospektivní studie MeSH
• retrospektivní studie MeSH
• těhotenství MeSH
• tendenční skóre MeSH
• zadržená placenta MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Reproductive health in state socialism is usually viewed as an area in which the broader contexts of women's lives were disregarded. Focusing on expert efforts to reduce premature births, we show that the social aspects of women's lives received the most attention. In contrast to typical descriptions emphasising technological medicalisation and pharmaceuticalisation, we show that expertise in early socialism was concerned with socio-medical causes of prematurity, particularly work and marriage. The interest in physical work in the 1950s evolved towards a focus on psychological factors in the 1960s and on broader socio-economic conditions in the 1970s. Experts highlighted marital happiness as conducive to healthy birth and considered unwed women more prone to prematurity. By the 1980s, social factors had faded from interest in favour of a bio-medicalised view. Our findings are based on a rigorous comparative analysis of medical journals from Hungary, Poland, Czechoslovakia and East Germany.

• MeSH
• lidé MeSH
• manželství MeSH
• předčasný porod MeSH
• socialismus MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH
• Polsko MeSH

Postpartum haemorrhage (PPH) remains the leading cause of pregnancy-related deaths worldwide. Typically, bleeding is controlled by timely obstetric measures in parallel with resuscitation and treatment of coagulopathy. Early recognition of abnormal coagulation is crucial and haemostatic support should be considered simultaneously with other strategies as coagulopathies contribute to the progression to massive haemorrhage. However, there is lack of agreement on important topics in the current guidelines for management of PPH. A clinical definition of PPH is paramount to understand the situation to which the treatment recommendations relate; however, reaching a consensus has previously proven difficult. Traditional definitions are based on volume of blood loss, which is difficult to monitor, can be misleading and leads to treatment delay. A multidisciplinary approach to define PPH considering vital signs, clinical symptoms, coagulation and haemodynamic changes is needed. Moreover, standardised algorithms or massive haemorrhage protocols should be developed to reduce the risk of morbidity and mortality and improve overall clinical outcomes in PPH. If available, point-of-care testing should be used to guide goal-directed haemostatic treatment. Tranexamic acid should be administered as soon as abnormal bleeding is recognised. Fibrinogen concentrate rather than fresh frozen plasma should be administered to restore haemostasis where there is elevated risk of fibrinogen deficiency (e.g., in catastrophic bleeding or in cases of abruption or amniotic fluid embolism) as it is a more concentrated source of fibrinogen. Lastly, organisational considerations are equally as important as clinical interventions in the management of PPH and have the potential to improve patient outcomes.

• MeSH
• fibrinogen MeSH
• hemostatika terapeutické užití   MeSH
• lidé MeSH
• poporodní krvácení diagnóza   terapie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Cieľ: Analýza život ohrozujúcich materských morbidít, ktorých stav si vyžadoval následnú liečbu na jednotkách intenzívnej starostlivosti (JIS) v Slovenskej republike v rokoch 2012–2020. Metodika: Retrospektívna analýza prípadov 655 rodičiek transportovaných na JIS z počtu 436 136 pôrodov. Dôvody transportu boli rozdelené do deviatich kategórií: peripartálne krvácanie, hypertenzné ochorenia, tromboembólia, kardiovaskulárne ochorenia, sepsa/ťažké infekcie, metabolické ochorenia, anestéziologické komplikácie, gastroenterologické problémy a iné. Výsledky: Celková incidencia transportu na jednotky intenzívnej starostlivosti v sledovanom období bola 1,5 na 1 000 pôrodov, ale u rodičiek rómskej národnosti 8,8 na 1 000 pôrodov. Priemerný vek rodičiek bol 30,7 rokov, pričom vo veku nad 35 rokov bolo 29,7 %. Nadhmotnosť a obezitu malo 70,4 % rodičiek. Najčastejšou príčinou transportu na JIS (49,3 %) bolo závažné popôrodné krvácanie. Druhou najčastejšou príčinou (26,0 %) boli hypertenzné ochorenia (preeklampsia, eklampsia a HELLP syndróm). Treťou najčastejšou príčinou (4,9 %) bola sepsa a závažné infekcie matky (pôrodníckej aj nepôrodníckej genézy). Úmrtnosť matiek prijatých na JIS bola 2,3 % a úmrtnosť ich novorodencov 8,7 %. Záver: Incidencia transportu rodičiek na JIS v sledovaných rokoch bola 1,5 na 1 000 pôrodov, čo v medzinárodnom porovnaní radí Slovenskú republiku ku krajinám s nižšou incidenciou.

Objective: Analysis of life-threatening maternal morbidities, the condition of which required subsequent treatment in Intensive Care Units (ICU) in the Slovak Republic in the years 2012–2020. Methodology: Retrospective analysis of 655 identified cases of mothers admitted to the intensive care units out of 436,136 births. The reasons for the transport were divided into nine categories: peripartum bleeding, hypertensive diseases, thromboembolism, cardiovascular diseases, sepsis/severe infections, metabolic diseases, complications of anaesthesiology, gastroenterological problems and others. Results: The total incidence of admission to the intensive care units in the observed period was 1.5 per 1,000 births, but for mothers of Roma nationality it was 8.8 per 1,000 births. The average age of mothers was 30.7 years, while 29.7% were over 35 years old. Overweight and obesity was present by 70.4% of mothers. The most common reason for transport to the ICU (49.3%) was severe postpartum hemorrhage. The second most common cause (26.0%) was hypertensive diseases (preeclampsia, eclampsia and HELLP syndrome). The third most common cause (4.9%) was sepsis and severe maternal infections. The mortality rate of mothers admitted to the ICU was 2.3% and infant mortality of these mothers was 8.7%. Conclusion: The incidence of admission of mothers to the ICU in the monitored years was 1.5 per 1,000 births, which in international comparison ranks Slovakia among countries with a lower incidence.

• Klíčová slova
• závažná akutní mateřská morbidita, transport rodičky na jednotku intenzivní péče,
• MeSH
• epidemiologické studie MeSH
• komplikace porodu MeSH
• komplikace těhotenství MeSH
• lidé MeSH
• mateřská mortalita MeSH
• péče o pacienty v kritickém stavu MeSH
• poporodní krvácení MeSH
• puerperální infekce MeSH
• retrospektivní studie MeSH
• těhotenství MeSH
• transport pacientů MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Slovenská republika MeSH

Drenáž pupočníka zahŕňa uvoľnenie Peánových klieští z pupočníka po oddelení novorodenca z maternálneho konca pupočníka. Následne dochádza k vyprázdňovaniu krvi z placenty. Tento postup je súčasťou aktívneho vedenia III. doby pôrodnej (TSL – third stage of labor). Cieľ: Táto štúdia je určená na poskytnutie poznatkov o dĺžke trvania tretej doby pôrodnej a riziku retencie placenty pri použití drenáže pupočníka, a pri postupe bez drenáže pupočníka. Materiál a metodika: Prospektívnej randomizovanej štúdie manažmentu TSL sa zúčastnilo 600 pacientiek. Pacientky boli rovnomerne rozdelené do dvoch skupín s drenážou pupočníka (300) a bez drenáže pupočníka (300). TSL bola aktívne vedená odporúčaniami FIGO (the International Federation of Gynecology and Obstetrics). Sledovali sme trvanie TSL a retenciu placenty po 30 min. Výsledky: Priemerné trvanie TSL bolo 6,8 ± 0,4 min v skupine s drenážou a 11,6 ± 0,8 min v kontrolnej skupine. Dospeli sme k záveru, že drenáž pupočníka významne skracuje trvanie TSL (p = 0,026), ako aj znižuje riziko retencie placenty. V skupine, s použitou drenážou pupočníka sa retencia placenty 30 min po pôrode plodu vyskytla v čtyroch prípadoch, kým v druhom súbore sa vyskytla v 14 prípadoch (RR 3,62; 95% CI 1.18–11.14). Záver: Predpokladáme, že pri drenáži pupočníka dochádza ku kolabovaniu tenkostenných uteroplacentárnych ciev skôr, čo spôsobuje krvácanie z týchto ciev medzi placentu a stenu maternice, a týmto mechanizmom dochádza k včasnejšiemu odlúčeniu placenty. Samozrejme, že drenáž pupočníka je len jedným z krokov algoritmu aktívneho vedenia tretej doby pôrodnej podľa FIGO.

Umbilical cord drainage involves releasing the cord clam from the umbilical cord after separation of the newborn from the maternal end of the umbilical cord. Consequently, there is emptying of blood from the placenta. This procedure is part of the active management of the third stage of labor (TSL). Objective: This study is intended to provide knowledge about the duration of TSL and the risk of retention of the placenta using umbilical cord drainage and the no-drainage procedure. Materials and methods: A prospective randomized study of the management of the third stage of labor in 600 patients. The patients were equally divided into two groups with umbilical cord drainage (300) and without umbilical cord drainage (300). TSL was actively managed by FIGO (the International Federation of Gynecology and Obstetrics) recommendations. We monitored the duration of TSL and retention of the placenta after a 30 min period. Results: The mean duration of TSLwas 6.8 ± 0.4 min in the drainage group and 11.6 ± 0.8 min in the control group. We conclude that umbilical cord drainage significantly shortens the duration of TSL (P = 0.026) as well as reduces the risk of placental retention. In a group where we use the drainage of the umbilical cord, placental retention 30 min after delivery of the fetus occurred in four cases while the second set occurred in 14 cases (RR 3.62; 95% CI 1.18–11.14). Conclusion: We assume that during umbilical cord drainage, the collapse of thin-walled uteroplacental vessels occurs earlier causing bleeding from these vessels between the placenta and the uterine wall, and therefore, earlier separation of the placenta occurs. Of course, the drainage of the umbilical cord is only one step in the algorithm of active management at the third stage of labor according to FIGO.

• Klíčová slova
• drenáž placenty, manuální vybavenií placenty,
• MeSH
• lidé MeSH
• novorozenec MeSH
• placenta MeSH
• podvázání pupeční šňůry MeSH
• poporodní krvácení MeSH
• porod MeSH
• prospektivní studie MeSH
• těhotenství MeSH
• vedení porodu MeSH
• zadržená placenta MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH