Cieľ: Cieľom tejto práce je analýza faktorov, ktoré môžu ovplyvniť spôsob vedenia pôrodu u žien s viacplodovou graviditou. Súbor a metodika: Retrospektívna analýza vybraných parametrov u žien s viacplodovou graviditou, ktoré porodili na II. Gynekologicko-pôrodníckej klinike Lekárskej fakulty Univerzity Karlovy (LF UK) a Univerzitnej Nemoncice (UN) Bratislava v rokoch 2010–2022. Výsledky: Za obdobie 2010–2022 na II. Gynekologicko-pôrodníckej klinike LF UK a UN Bratislava bolo 1,13 % pôrodov viacplodovej gravidity. Po spracovaní štatistických údajov sa štatisticky významne javila primiparita ako riziko akútneho cisárskeho rezu, multipary mali vyššiu pravdepodobnosť porodiť vaginálne. Od roku 2017 mal na klinike počet cisárskych rezov klesajúci trend. Ženy s akútnym cisárskym rezom mali priemerne nižšie pH oboch plodov oproti vaginálnemu pôrodu, avšak výskyt asfyktických plodov nebol štatisticky významne rozdielny. Nezistili sme žiadny rizikový faktor zvyšujúci pravdepodobnosť akútneho cisárskeho rezu na plod B u gemín. Záver: Viacplodová gravidita má vyššiu morbiditu nielen pre ženu ale aj pre plody. Výskyt viacplodovej gravidity je ovplyvnený asistovanou reprodukciou. Spôsob vedenia pôrodu závisí na rôznych faktoroch ako chorionicita, poloha plodov a anamnéza predošlého cisárskeho rezu.

Objective: This paper aims to analyze the factors that can influence the method of childbirth in women with multiple pregnancies. Materials and methods: Retrospective analysis of selected parameters in women with multiple pregnancies who gave birth at the 2nd Clinic of Gynecology and Obstetrics of the Faculty of Medicine (FM), Comenius University (CU) and University Hospital (UH) Bratislava in the years 2010–2022. Results: Between 2010 and 2022, at the 2nd Clinic of Gynecology and Obstetrics of the FM CU and UH in Bratislava, 1.13% of births were multiple pregnancies. After statistical data processing, primiparity appeared statistically significant as a risk of acute caesarean section (C-section); multiparous women had a higher probability to give birth vaginally. Since 2017, the clinic has had a decreasing trend in the number of caesarean sections. Women with an acute caesarean section, in turn had on average a lower pH of both fetuses compared to vaginal delivery. However, the incidence of asphyxia in fetuses was not statistically significantly different. We found no risk factor increasing the likelihood of acute caesarean section for fetus B in twins. Conclusion: Multiple pregnancy has a higher morbidity not only for the woman but also for the fetuses. The incidence of multiple pregnancies is influenced by assisted reproduction. Delivery method depends on various factors such as chorionicity, fetal presentation, and history of a previous caesarean section.

• MeSH
• Cesarean Section statistics & numerical data   MeSH
• Adult MeSH
• Humans MeSH
• Labor Presentation MeSH
• Risk Factors MeSH
• Pregnancy, Multiple * statistics & numerical data   MeSH
• Pregnancy, Twin statistics & numerical data   MeSH
• Pregnancy MeSH
• Delivery, Obstetric methods   statistics & numerical data   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH

• Keywords
• zygotic splitting,
• MeSH
• Twins, Monozygotic MeSH
• Fertilization in Vitro methods   MeSH
• Gravidity MeSH
• Incidence MeSH
• Humans MeSH
• Embryo Transfer methods   instrumentation   MeSH
• Twinning, Monozygotic MeSH
• Pregnancy, Multiple * statistics & numerical data   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Review MeSH

BACKGROUND: Gestational surrogacy, is a treatment option for women with certain clearly defined medical problems, usually an absent uterus, to help them have their own genetic children. The aim of our study was to review, evaluate and share our experience and outcomes over the last 13 years of the largest surrogacy program in the Czech republic. METHODS: A total of 75 intended mothers and 82 surrogate mothers participated in this study. A retrospective cohort study was performed. Anonymized data were collected on 130 cycles of gestational surrogate (2004-2017) directly from the Clinic database. RESULTS: We performed 130 in vitro fertilization cycles with gestational surrogacy which involved 73 fresh embryo transfers and 57 frozen embryo transfers. We achieved 57 (43.9%) pregnancies and 42 (32.3%) live births. The rate of multiple pregnancies was only 2.3 %. The most common indication for using was an absent or damaged uterus (65%), followed by medical conditions precluding pregnancy (23%) and repeated in vitro fertilization cycles or pregnancy failure (12%). CONCLUSION: In the 14 years of our experience, we have shown that treatment of young women with specific indications for gestational surrogacy is beneficial, successful and relatively free of complications. However, it is imperative to follow the medical indications for this treatment and specialist recommendations.

• MeSH
• Chronic Disease MeSH
• Adult MeSH
• Mullerian Ducts abnormalities   MeSH
• Fertilization in Vitro * MeSH
• Hysterectomy MeSH
• Humans MeSH
• Gestational Carriers * MeSH
• Live Birth epidemiology   MeSH
• 46, XX Disorders of Sex Development MeSH
• Embryo Transfer MeSH
• Single Embryo Transfer MeSH
• Retrospective Studies MeSH
• Abortion, Spontaneous epidemiology   MeSH
• Pregnancy, Multiple statistics & numerical data   MeSH
• Pregnancy MeSH
• Organ Transplantation MeSH
• Pregnancy Rate * MeSH
• Congenital Abnormalities MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

Cieľ štúdie: Porovnanie perinatálnej mortality v Slovenskej republike (SR) v rokoch 2007-2015. Typ štúdie: Epidemiologická perinatologická celoštátna. Názov a sídlo pracoviska: I. gynekologicko-pôrodnícka klinika LF UK a UNB, Bratislava. Metodika: Analýza prospektívneho zberu vybraných ukazovateľov pôrodníckej starostlivosti v rokoch 2007 až 2015. Výsledky: V roku 2007 bolo v SR 63 pôrodníc, 51 146 pôrodov a narodilo sa 51 650 živých novorodencov. Do roku 2015 klesol počet pôrodníc na 54, ale počet pôrodov sa zvýšil na 55 139 a počet živonarodených novorodencov na 55 643. Frekvencia predčasných pôrodov v roku 2007 bola 7,3 %, v roku 2010 sa zvýšila na 8,5 % a v roku 2015 klesla na 7,5 %. Perinatálna mortalita klesala zo 6,2 promile v roku 2007 na 4,8 promile v roku 2013, ale opäť sa zvýšila v rokoch 2014 a 2015 na 5,3 promile a 5,6 promile. Na perinatálnej mortalite v rokoch 2007-2015 sa podieľala mŕtvorodenosť 64 %, nízka pôrodná hmotnosť 64 % a závažné vrodené vývojové chyby 20 %. V rokoch 2007 až 2015 sa zvýšil transport "in utero" novorodencov s hmotnosťou 1000 g a 1499 g do perinatologických centier z 57 % na 66 % a novorodencov s hmotnosťou do 1000 g zo 75 % na 79 %. Záver: SR dosiahla historicky najlepší výsledok perinatálnej mortality v roku 2013 - 4,8 promile, ale v nasledujúcich dvoch rokoch sa zvýšila nad 5 promile. SR stále potrebuje zlepšiť prenatálnu diagnostiku vrodených vývojových chýb, transport plodov s veľmi nízkou pôrodnou hmotnosťou "in utero", centralizáciu vysokorizikových gravidít, personálne a materiálno-technické vybavenie pôrodníc a novorodeneckých jednotiek intenzívnej starostlivosti.

Objective: Comparison of perinatal mortality in Slovak Republic in three periods during the years 2007-2015. Design: Epidemiological perinatal nation-wide. Settings: 1st Department of Gynaecology and Obstetrics Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic. Methods: The analysis of prospectively collected selected perinatal data in the years 2007-2015. Results: In the year 2007 there were 63 obstetrics units, 51,146 deliveries and that of live births 51,650 in Slovak Republic. The number of obstetrics units decreased to 54 in the years 2015, but total number of deliveries increased to 55,139 and that of live births increased to 55,643. Preterm deliveries rate increased from 7.3% in the year 2007 to 8.5% in the year 2010 and decreased to 7.5% in the year 2015. Perinatal mortality rate decreased from 6.2 in the year 2007 to 4.8 in the year 2013, and increased again in the years 2014 and 2015 to 5.3 and 5.6 per 1,000 still- and live-births respectively. During the years 2007-2015 stillbirth participate at perinatal mortality with 64%, low birth weight with 64% and severe congenital anomalies with 20%. Transport in utero to perinatological centres in the years 2007-2015 has increased from 57% to 66% for infants 1000-1499 g and from 75% to 79% for infants below 1000 g. Conclusion: In the year 2013 perinatology in Slovak Republic reached the best result in perinatal mortality rate 4.8 promiete (0.48%), but in next two years has increased over 5 promite. Prenatal detection of severe congenital abnormalities, transport in utero very low birth weight infants, centralisation of high-risk pregnancies and obstetric and neonatal intensive care units equipment need still to be improved in Slovak Republic.

• MeSH
• Epidemiologic Studies MeSH
• Intensive Care Units, Neonatal statistics & numerical data   MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Perinatal Mortality * MeSH
• Birth Weight MeSH
• Premature Birth epidemiology   MeSH
• Pregnancy, Multiple statistics & numerical data   MeSH
• Pregnancy MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Geographicals
• Slovakia MeSH

• MeSH
• Reproductive Techniques, Assisted * economics   nursing   trends   utilization   legislation & jurisprudence   MeSH
• Child MeSH
• Humans MeSH
• Infant, Low Birth Weight MeSH
• Pregnancy, Multiple statistics & numerical data   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Newspaper Article MeSH
• Geographicals
• Czech Republic MeSH

PURPOSE: To prevent multiple pregnancies the goal of ovulation induction by gonadotropins is to achieve only mono-follicular development. The most important issue is therefore to determine the starting dose. The aim of this study is to compare three different starting doses of follitropin beta to assess the lowest effective dose. METHODS: We evaluated 92 cycles with ovarian stimulation for patients with unexplained infertility, anovulatory disorder or mild male factor. We prospectively divided patients into 50, 75 and 100 IU groups based on patients' response to clomiphene citrate treatment. RESULTS: We performed 87 intrauterine inseminations (95 % of cycles with ovulation induction). Five cycles were cancelled. We achieved 15 pregnancies; total pregnancy rate was 18 %. Pregnancy rate was 22, 10 and 28 % in 50, 75 and 100 IU follitropin beta groups. The average number of follicles was 2.0 ± 0.8, 2.2 ± 1.1 and 2.5 ± 1.8 (ns), total dose of gonadotropins (IU) 483 ± 192, 600 ± 151 and 830 ± 268 (p < 0.001), respectively. We observed one case of twins in 75 and 100 IU treatment group, as well (25 % risk). CONCLUSIONS: This study suggests that based on the dose which was chosen according to clomiphene citrate response, all treatment regimes were effective for ovulation induction. 50 IU of follitropin beta daily is the appropriate starting dose to support ovulation for clomiphene citrate-sensitive women. The disadvantage may be an increased risk of cycle cancellation due to low ovarian response. Daily doses 75 or 100 IU of rFSH increase total consumption of gonadotropins.

• MeSH
• Adult MeSH
• Endometrium drug effects   MeSH
• Follicle Stimulating Hormone, Human administration & dosage   MeSH
• Ovulation Induction methods   MeSH
• Humans MeSH
• Ovarian Follicle drug effects   MeSH
• Ovarian Hyperstimulation Syndrome epidemiology   MeSH
• Prospective Studies MeSH
• Recombinant Proteins administration & dosage   MeSH
• Pregnancy, Multiple statistics & numerical data   MeSH
• Pregnancy MeSH
• Pregnancy Rate * MeSH
• Insemination, Artificial MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial MeSH
• Comparative Study MeSH

• Keywords
• vícečetné těhotenství, nezralost,
• MeSH
• Apgar Score MeSH
• Reproductive Techniques, Assisted standards   utilization   MeSH
• Cesarean Section MeSH
• Child MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Neonatal Screening MeSH
• Birth Weight MeSH
• Premature Birth MeSH
• Pregnancy, Multiple physiology   statistics & numerical data   MeSH
• Pregnancy MeSH
• Triplets physiology   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH

Cíl studie: Analýza faktorů neplodnosti, průběhu těhotenství a perinatálního období po intracytoplazmatické injekci spermie (ICSI). Typ studie: Prospektivní otevřená průřezová klinická studie. Pracoviště: Pediatrická klinika 2. LF UK a FN Motol a Sanatorium Pronatal, Praha. Metodika: Sledovány byly faktory neplodnosti, průběh těhotenství, perinatální období a údaje o novorozenci u 135 dětí porozených po ICSI z jednočetných a dvoučetných těhotenství a porovnány s populační normou. Výsledky: Podíl dětí z vícečetných těhotenství po ICSI je proti spontánně počatým vyšší (31 % proti 1,7 %; p<0,001), stejně jako celkový podíl porodů císařským řezem (31 % versus 17,8 %; p<0,001). V perinatálním období se vyskytl problém u 21,5 % novorozenců (18 z 42 dvojčat, 12 z 93 u jednočetných gravidit; p<0,001). Komplikace provázely 50,9 % těhotenství. Závěry: Při vzájemném srovnání jednočetných a dvoučetných těhotenství v populaci a u dětí počatých po ICSI se gestační věk, porodní hmotnost a porodní délka neliší. Komplikace v těhotenství a v perinatálním období jsou však u dětí počatých po ICSI častější.

Objective: To analyze the type of infertility, pregnancy and neonatal outcome in children conceived after intracytoplasmic sperm injection (ICSI children). Design: Prospective open cross-sectional clinical study. Setting: University hospital and private IVF unit. Methods: Type of infertility, pregnancy complications, neonatal period and neonatal characteristics were evaluated in 135 newborns conceived after ICSI from singleton and twin pregnancies and compared to general population. Results: The percentage of twins was significantly higher after ICSI compared to general population (31% versus 1.7%; p<0.001) as well as the percentage of caesarean section deliveries (31% versus 17.8%; p<0.001). Some complication in neonatal period was found in 21.5% ICSI newborns (18 out of 42 twins and 12 out of 93 singletons; p< 0.001). Some complication during the course of pregnancy was found in 50.9% ICSI children. Conclusions: no differences in gestational age, birth weight and birth length were found when ICSI and spontaneously conceined (sc) singletons and ICSI and SC twins were compared. However, complications during the course of pregnancy and in the neonatal period were more frequent in ICSI conceived children.

• MeSH
• Reproductive Techniques, Assisted utilization   MeSH
• Child MeSH
• Financing, Organized MeSH
• Infertility etiology   MeSH
• Data Interpretation, Statistical MeSH
• Sperm Injections, Intracytoplasmic methods   utilization   MeSH
• Pregnancy Complications etiology   classification   MeSH
• Humans MeSH
• Parturition physiology   MeSH
• Prospective Studies MeSH
• Cross-Sectional Studies MeSH
• Risk Factors MeSH
• Vital Statistics MeSH
• Pregnancy, Multiple physiology   statistics & numerical data   MeSH
• Pregnancy physiology   statistics & numerical data   MeSH
• Child Development physiology   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Male MeSH
• Pregnancy physiology   statistics & numerical data   MeSH
• Female MeSH

Cíl studie: Analyzovat výskyt vrozených vad, zdravotní stav a somatický vývoj dětí počatých po intracytoplazmatické injekci spermie (ICSI). Typ studie: Prospektivní otevřená průřezová klinická studie. Název a sídlo pracoviště: Pediatrická klinika 2. LF UK a FN Motol a Sanatorium Pronatal, Praha. Metodika: V období let 2004-2006 bylo vyšetřeno 135 českých dětí z jedno- a dvoučetných těhotenství (věk 0,3-9,5 r.; medián 5,9) (59 dívek, 76 chlapců) počatých po ICSI. Sledován byl výskyt strukturálních vývojových vad, zdravotní stav a somatický vývoj, výsledky byly porovnány s českou dětskou populací. Výsledky: Vrozená strukturální vada se vyskytla u 13,3 % dětí (4,6 % v referenčním souboru; p<0,001). Běžná nemocnost není sice u dětí v našem souboru proti populaci zvýšená, je ale velká sledovanost (69,6 % dětí) v odborných poradnách. Tělesná výška a hmotnost je v normě, růst je v souladu s dědičným růstovým potenciálem, poněkud větší je obvod hlavy (0,43 SD, p<0,001). Závěry: Děti počaté po ICSI mají proti populaci vyšší výskyt strukturálních vrozených vad a častěji navštěvují odborné poradny. Nemocností a tělesným vývojem se od české dětské populace významně neliší.

Objective: To analyze the incidence of birth defects, medical outcome and somatic development in children conceived after intracytoplasmic sperm injection (ICSI). Design: Prospective open cross-sectional clinical study. Setting: University hospital and private IVF unit. Methods: 135 Czech children (59 girls, 76 boys) from singleton and twin pregnancies conceived after ICSI (age 0.3-9.5 years; median 5.9) were assessed during the period 2004-2006. The incidence of birth defects, medical outcome and somatic development were evaluated and compared with data of general population and/or with control group matched for sex and age. Results: Birth defects were found in 13.3% of ICSI children (compared to 4.6% in children after spontaneous conception; p<0.001). The general health of ICSI children did not differ significantly compared to general population. ICSI children required more surgery or hospitalization compared to general population data. There is high rate (69.6%) among ICSI children in the care of various specialised clinics. Body height and weight in ICSI children is in normal range and corresponds to their growth potential. Head circumference in ICSI children is larger compared to reference data (0.43 SD; p<0.001). Conclusions: No clinically important differences in somatic development between ICSI and general population of Czech children were found. Birth defects were more frequent in ICSI children. The overall general health in ICSI children seems satisfactory but ICSI children were more likely to need health care compared to general population.

• MeSH
• Reproductive Techniques, Assisted utilization   MeSH
• Child MeSH
• Financing, Organized MeSH
• Data Interpretation, Statistical MeSH
• Sperm Injections, Intracytoplasmic methods   utilization   MeSH
• Humans MeSH
• Prospective Studies MeSH
• Cross-Sectional Studies MeSH
• Pregnancy, Multiple physiology   statistics & numerical data   MeSH
• Pregnancy physiology   statistics & numerical data   MeSH
• Congenital, Hereditary, and Neonatal Diseases and Abnormalities etiology   classification   MeSH
• Child Development physiology   MeSH
• Health Status MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Male MeSH
• Pregnancy physiology   statistics & numerical data   MeSH
• Female MeSH

• MeSH
• Twins, Dizygotic physiology   MeSH
• Twins, Monozygotic physiology   MeSH
• Fetofetal Transfusion diagnosis   MeSH
• Financing, Organized MeSH
• Humans MeSH
• Premature Birth etiology   MeSH
• Pre-Eclampsia etiology   MeSH
• Fetal Growth Retardation diagnosis   ultrasonography   MeSH
• Pregnancy, Multiple statistics & numerical data   MeSH
• Ultrasonography, Prenatal methods   utilization   MeSH
• Check Tag
• Humans MeSH
• Female MeSH