Cíl: Porovnat účinnost a bezpečnost perorálního ( p. o.) a vaginálního (vag.) podání misoprostolu a intracervikálního (i.c.) podání dinoprostonu při farmakologické indukci porodu. Identifikovat výhody a nevýhody jednotlivých metod indukce porodu. Metodika: Analýza souboru rodiček, které porodily na Gynekologicko-porodnické klinice LF MU a FN Brno v období od 1. 8. 2019 do 31. 1. 2020, u nichž bylo využito jedno z následujících schémat indukce porodu: skupina A: misoprostol 25 μg p. o. ? 2 hod, skupina B: misoprostol 50 μg vag. ? 6 hod, skupina C: dinoproston 1 mg i.c. ? 2 hod. Podmínkou pro zařazení do studie byla tato vstupní kritéria: jednočetné těhotenství, ukončený 36. gestační týden, živý plod, poloha podélná hlavičkou a cervix skóre ≥ 6. Vylučujícím kritériem byla jizva na děloze, závažná vrozená vývojová vada plodu a růstová restrikce plodu. Hodnoceny byly časové faktory indukce, výskyt známek akutní hypoxie v průběhu porodu, způsob porodu, nutnost podání akutní tokolýzy za porodu, nutnost podání infuze s oxytocinem v I. nebo II. době porodní, využití epidurální analgezie, mateřská krevní ztráta, porodní poranění matky, závažné mateřské komplikace včetně ruptury dělohy, hodnota pH z pupečníkové arterie < 7,1; hodnota Apgar skóre v 5. min < 5. Výsledky byly vzájemně porovnány a statisticky zpracovány. Výsledky: Celkem bylo zařazeno 378 žen (skupina A: 133 žen, skupina B: 145 žen, skupina C: 100 žen). Byla prokázána statisticky významně vyšší úspěšnost vaginálního dokončení porodu ve skupině A oproti skupinám B a C (88 vs. 77,9 vs. 76 %; p = 0,035). Nejdelší časový úsek od podání první dávky preparátu do porodu plodu byl zaznamenán ve skupině A (medián: 700 vs. 565 vs. 375 min; p = 0,0001). Mezi skupinami nebyl prokázán rozdíl v délce trvání I. a II. doby porodní. Četnost ukončení porodu císařským řezem z důvodu akutní hypoxie plodu byla nejnižší ve skupině A (2,3 vs. 10,3 vs. 9 %; p = 0,023). Děložní ruptura nebyla v souboru zaznamenána. Mezi skupinami nebyl zaznamenán statisticky významný rozdíl ve velikosti celkové krevní ztráty při porodu, stejně jako ve výskytu hodnoty pH z a. umbilicalis < 7,10 a Apgar skóre v 5. min < 5. Závěr: Nejvyšší úspěšnost s ohledem na vaginální dokončení porodu byla dosažena při využití nízkodávkovaného perorálního misoprostolu. Nevýhodou této metody indukce porodu je významné prodloužení času od zahájení indukce do porodu plodu. Mezi jednotlivými metodami indukce porodu nebyl nalezen statisticky významný rozdíl ve výskytu závažných perinatálních komplikací.

Objective: To compare the effectiveness and safety of the methods of pharmacological induction of labor. To identify the advantages and disadvantages of oral and vaginal administration of misoprostol and intracervical administration of dinoprostone. Materials and methods: Analysis of a group of women who gave birth at the Faculty Hospital Brno from 1st August 2019 to 31st January 2020, and one of the following labor induction schemes was used: group A: misoprostol 25 μg orally every 2 hours, group B: misoprostol 50 μg vaginally every 6 hours, group C: intracervical dinoprostone 1 mg every 2 hours. Inclusion criteria were: singleton pregnancy, completed 36th gestational week, live fetus, cephalic presentation, and cervix score ≥ 6. Exclusion criteria were uterine scars and fetal growth restriction. Time factors of induction, occurrence of acute hypoxia during labor, mode of delivery, use of tocolysis during labor, necessity of oxytocin infusion, use of epidural analgesia, blood loss, uterine rupture, umbilical artery pH, and Apgar score at the 5th min were evaluated. Results: A total of 378 women were included (133 vs. 145 vs. 100). A statistically significantly higher success rate of vaginal delivery was demonstrated in group A compared to groups B and C (88 vs. 77.9 vs. 76%; P = 0.035). The longest time from the administration of the first dose of the preparation to delivery of the fetus was in group A (medians in minutes 700 vs. 565 vs. 375; P < 0.0001). There was no difference between the groups in the I. and II. labor stage duration. Cesarean delivery rate due to acute hypoxia was the lowest in group A (2.3 vs. 10.3 vs. 9%; P = 0.023). Uterine rupture was not recorded; there were no differences in neonatal outcome parameters. Conclusion: The highest success rate of vaginal delivery was achieved with the use of low-dose oral misoprostol. The disadvantage of this method is a significant increase in the time from the start of induction to the delivery of the fetus. There was no difference in the occurrence of severe perinatal complications between the induction methods.

• MeSH
• Administration, Intravaginal MeSH
• Administration, Oral MeSH
• Dinoprostone * administration & dosage   pharmacology   therapeutic use   MeSH
• Abortion, Induced methods   MeSH
• Pregnancy Complications drug therapy   MeSH
• Humans MeSH
• Misoprostol * administration & dosage   pharmacology   therapeutic use   MeSH
• Retrospective Studies MeSH
• Pregnant People MeSH
• Drug Administration Routes MeSH
• Check Tag
• Humans MeSH
• Female MeSH

Cíl: Cílem je nalyzovat hlavní indikace pro indukci porodu vaginálním misoprostolem u vysoce rizikových těhotenství, a také hlavní proměnné související se selháním indukce v terciárním centru v metropolitní oblasti města Rio de Janeiro v Brazílii. Metodika: Retrospektivní kohortová studie analyzovala lékařské záznamy těhotných žen, které podstoupily indukci porodu. Kritéria pro zařazení byla jednočetné těhotenství, gestační věk ≥ 34 týdnů, Bishopovo skóre ≤ 6, plody v cefalické prezentaci a žádné kontraindikace pro použití vaginálního misoprostolu. Protokol indukce porodu sestával z vaginálního misoprostolu 25 mcg každých 6 hod, s maximálně osmi dávkami (200 mcg) k dozrání děložního čípku, pokud bylo Bishopovo skóre ≤ 6. Výsledky: Celkem bylo analyzováno 88 případů indukce porodu. Hlavními indikacemi pro indukci porodu byly preeklampsie a gestační hypertenze (n = 28; 31,8 %), chronická arteriální hypertenze (n = 19; 21,6 %) a gestační diabetes mellitus (n = 12; 13,6 %). Pozorovali jsme, že vaginální porod byl spojen s počtem dávek vaginálního misoprostolu (p = 0,000348). Nejčastější indikací k císařskému řezu bylo selhání indukce porodu (n = 21; 40 %) a podezření na akutní tíseň plodu (n = 17; 33 %). Statistický rozdíl mezi indikací vyvolání porodu a způsobem porodu jsme nezaznamenali. Nedošlo k žádnému úmrtí plodu. Šest novorozenců bylo přijato na neonatální jednotku intenzivní péče (NICU), jeden pro dechovou tíseň, jeden pro předčasný porod a čtyři pro hypoglykemii. Mezi jednotlivými způsoby porodu nebyl statistický rozdíl v míře přijetí na NICU (p = 0,692). Závěr: Hlavní indikací pro císařský řez v této studii bylo selhání indukce, což ukazuje na nutnost revize a průběžné sledování protokolu pro zvýšení úspěšnosti bez ohrožení perinatálních výsledků.

Objective: To analyze the main indications for induction of labor with vaginal misoprostol in high-risk pregnancies as well as the main variables associated with failed induction in a tertiary center in the metropolitan region of Rio de Janeiro, Brazil. Methods: A retrospective cohort study analyzed the medical records of pregnant women who underwent induction of labor. Inclusion criteria were singleton pregnancy, gestational age ≥ 34 weeks, Bishop score ≤ 6, fetuses in cephalic presentation, and no contraindications for the use of vaginal misoprostol. The labor induction protocol consisted of vaginal misoprostol 25 mcg every 6 hours, with a maximum of eight doses (200 mcg) to ripen the cervix if Bishop‘s score was ≤ 6. Results: A total of 88 cases of labor induction were analyzed. Main indications for labor induction were preeclampsia and gestational hypertension (N = 28; 31.8%), chronic arterial hypertension (N = 19; 21.6%), and gestational diabetes mellitus (N = 12; 13.6%). We observed that vaginal delivery was associated with the number of vaginal misoprostol doses (P = 0.000348). The most common indications for cesarean section were failure of labor induction (N = 21; 40%) and suspected acute fetal distress (N = 17; 33%). We did not observe a statistical difference between indication of labor induction and mode of delivery. There were no fetal deaths. Six neonates were admitted to the neonatal intensive care unit (NICU), one for respiratory distress, one for preterm delivery, and four for hypoglycemia. There was no statistical difference in the rate of NICU admission between delivery modes (P = 0.692). Conclusion: The main indication for cesarean section in this study was induction failure, indicating the need to review and continuously monitor the protocol to increase success rates without compromising perinatal outcomes.

• MeSH
• Cesarean Section methods   MeSH
• Abortion, Induced * classification   methods   MeSH
• Cohort Studies MeSH
• Humans MeSH
• Misoprostol * administration & dosage   pharmacology   classification   therapeutic use   MeSH
• Perinatal Care classification   methods   MeSH
• Retrospective Studies MeSH
• Pregnancy, High-Risk MeSH
• Pregnant People MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Geographicals
• Brazil MeSH

OBJECTIVE: Given Iran's recent shift towards pronatalist population policies, concerns have arisen regarding the potential increase in abortion rates. This review study examines the trends of (medical), intentional (illegal), and spontaneous abortions in Iran over the past two decades, as well as the factors that have contributed to these trends. METHODS: This paper reviewed research articles published between 2005 and 2022 on abortion in Iran. The study employed the PRISMA checklist for systematic reviews. Articles were searched from international (Google Scholar, PubMed, Science Direct, and Web of Science) and national databases (Magiran, Medlib, SID). Once the eligibility criteria were applied, 42 records were included from the initial 349 records. RESULTS: Abortion is influenced by a variety of socioeconomic and cultural factors and the availability of family planning services. Factors that contribute to unintended pregnancy include attitudes toward abortion, knowledge about reproductive health, access to reproductive health services, and fertility desires, among others. In addition to health and medical factors, consanguineous marriage plays an important role in spontaneous and therapeutic abortion. A higher number of illegal abortions were reported by women from more privileged socioeconomic classes. In comparison, a higher number of medical and spontaneous abortions were reported by women from less privileged socioeconomic classes. CONCLUSION: Iranian policymakers are concerned about the declining fertility rate and have turned to pronatalist policies. From a demographic standpoint, this seems to be a reasonable approach. However, the new population policies, particularly, the Family Protection and Young Population Law, along with creating limitations in access to reproductive health services and prenatal screening tests as well as stricter abortion law could potentially lead to an increase in various types of abortions and their associated consequences.

• MeSH
• Abortion, Induced * statistics & numerical data   legislation & jurisprudence   trends   MeSH
• Humans MeSH
• Abortion, Illegal statistics & numerical data   MeSH
• Abortion, Spontaneous epidemiology   MeSH
• Socioeconomic Factors MeSH
• Pregnancy MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Systematic Review MeSH
• Geographicals
• Iran MeSH

• MeSH
• Contraception methods   MeSH
• Abortion, Induced MeSH
• Contraceptive Agents, Female MeSH
• Humans MeSH
• Contraception, Postcoital methods   MeSH
• Sterilization methods   legislation & jurisprudence   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Review MeSH

OBJECTIVE: Access to family planning services is a human right that plays an essential role in society's health, particularly women's health. The COVID-19 pandemic has affected all aspects of human life including access to family planning services. Accordingly, the main goal of this study was to explore the experiences of women and service providers from the main challenges and obstacles of access to family planning services and abortion services in Bangladesh, Iran, and the Netherlands during the COVID-19 pandemic. METHODS: In this qualitative study, the data were collected through online, telephone, or in-person semi-structured interviews with key informants. Participants selected by purposive sampling method. The participants included women aged 15 to 49 (n = 63) and service providers (n = 54) in the 3 abovementioned countries. These individuals were included from October 2020 until December 2020. Conventional thematic analysis was employed to analyze the collected data. RESULTS: The main extracted themes were challenges (reduction of referral; disruption of access to services; insufficient knowledge; worries among staff; rising prices; and unavailability of some contraceptives), measures (time extension and visit scheduling; telephone, online, and door to door services; and support of the media) and recommendations (health facility improvements; free, online, and closer services; and ongoing trainings and awareness campaigns). CONCLUSION: The COVID-19 pandemic has affected family planning and reproductive health services in different ways and has uncovered existing inequalities in access to these services. However, in Iran, the reported challenges were also rooted in new population policies that have further limited access to family planning and abortion services.

• MeSH
• COVID-19 * epidemiology   MeSH
• Abortion, Induced * MeSH
• Humans MeSH
• Pandemics MeSH
• Family Planning Services methods   MeSH
• Pregnancy MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Bangladesh MeSH
• Iran MeSH
• Netherlands MeSH

Kostní dysplazie jsou širokou, heterogenní skupinou chorob. Thanatoforická dysplazie patří mezi nejčastější letální kostní dysplazie. Základem diagnostiky je kvalitní ultrazvukové vyšetření ve II. trimestru a nejnovější metody genetického testování vč. vyšetření klinického exomu. Znalost správné diagnózy je klíčová pro budoucnost plodu i páru.

Bone dysplasias are a broad, heterogeneous group of diseases. Thanatophoric dysplasia is a rare bone dysplasia, but it is the most common lethal skeletal dysplasias. The major role in diagnostics plays a high-quality ultrasound examination in the 2nd trimester and the latest methods of genetic testing, including clinical exome testing. Knowing the correct diagnosis is crucial for the future of the fetus and the couple.

• MeSH
• Adult MeSH
• Abortion, Induced MeSH
• Humans MeSH
• Fetal Diseases diagnostic imaging   genetics   pathology   MeSH
• Disease Progression MeSH
• Exome Sequencing * MeSH
• Pregnancy MeSH
• Thanatophoric Dysplasia * diagnostic imaging   genetics   pathology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

IMPORTANCE: Prenatal cardiac screening of the first and second trimesters has had a major impact on postnatal prevalence of congenital heart defects (CHDs), rates of termination of pregnancy (TOP), and outcomes among children born alive with CHDs. OBJECTIVE: To examine the prenatal and postnatal incidence of major CHDs (ie, necessitating intervention within the first year of life), detection rate trends, rates of TOP, and the association of cardiac screening with postnatal outcomes. DESIGN, SETTINGS, AND PARTICIPANTS: In this cross-sectional study, 3827 fetuses with antenatally diagnosed major CHDs in the Czech Republic (population 10.7 million) between 1991 and 2021 were prospectively evaluated with known outcomes and associated comorbidities. Prenatal and postnatal prevalence of CHD in an unselected population was assessed by comparison with a retrospective analysis of all children born alive with major CHDs in the same period (5454 children), using national data registry. Data analysis was conducted from January 1991 to December 2021. MAIN OUTCOMES AND MEASURES: Prenatal detection and postnatal prevalence of major CHDs and rate of TOPs in a setting with a centralized health care system over 31 years. RESULTS: A total of 3 300 068 children were born alive during the study period. Major CHD was diagnosed in 3827 fetuses, of whom 1646 (43.0%) were born, 2069 (54.1%) resulted in TOP, and 112 (2.9%) died prenatally. The prenatal detection rate increased from 6.2% in 1991 to 82.8% in 2021 (P < .001). Termination of pregnancy decreased from 70% in 1991 to 43% (P < .001) in 2021. Of 627 fetuses diagnosed in the first trimester (introduced in 2007), 460 were terminated (73.3%). Since 2007, of 2066 fetuses diagnosed in the second trimester, 880 (42.6%) were terminated, resulting in an odds ratio of 3.6 (95% CI, 2.8-4.6; P < .001) for TOP in the first trimester compared with the second trimester. Postnatal prevalence of major CHDs declined from 0.21% to 0.14% (P < .001). The total incidence (combining prenatal detection of terminated fetuses with postnatal prevalence) of major CHD remained at 0.23% during the study period. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, the total incidence of major CHD did not change significantly during the 31-year study period. The prenatal detection of major CHD approached 83% in the current era. Postnatal prevalence of major CHD decreased significantly due to early TOPs and intrauterine deaths. The introduction of first trimester screening resulted in a higher termination rate in the first trimester but did not revert the overall decreasing trend of termination for CHDs in general.

• MeSH
• Child MeSH
• Abortion, Induced * MeSH
• Humans MeSH
• Prevalence MeSH
• Cross-Sectional Studies MeSH
• Retrospective Studies MeSH
• Pregnancy MeSH
• Heart Defects, Congenital * diagnosis   epidemiology   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Publikácia sa zameriava na rôzne témy reprodukčných a sexuálnych práv. Určené odbornej aj širokej verejnosti.; Téme reprodukčných, ako aj sexuálnych práv sa na našom knižnom trhu doteraz komplexne nevenuje žiadna publikácia a už vôbec nie ako výsledok spolupráce odborníkov z oblasti medicíny, práva a psychológie. Pochopiť túto zložitú a citlivú tému, ako aj orientovať sa v nej umožňuje práve publikácia Reprodukčné a sexuálne práva. Zameriava sa na otázky spojené s ľudskou reprodukciou, transrodových ľudí, ženské zdravie a ochranu maloletých. Rieši zaujímavé diskurzy na tému cisárskeho rezu na žiadosť pacientiek, pôrodného plánu, domácich pôrodov či histórie a praxe sterilizácií. Ponúka okrem toho aj pohľad na vývoj dejín sexuality, sexualitu menšín a aj manažment ochrany sexuálneho zdravia. Renomovaný autorský kolektív je zostavený z lekárov, popredných odborníkov v oblasti gynekológie, psychiatrie – sexuológie a psychológie, ale aj právnikov, ktorí sa týmto témam dlhodobo venujú a vnímajú ich cez prizmu garancie základných práv a slobôd jednotlivca a záväzkov Slovenskej republiky v oblasti medzinárodného práva. Citlivé a vysoko odborné témy sú napriek tomu podané zrozumiteľne a čitateľsky prijateľnou formou, aby publikácia plnila aj vzdelávací a osvetový cieľ. Autori publikácie vyjadrujú svoje úprimné prianie, aby bola prínosná pre všetkých, ktorí s témou ľudskej reprodukcie a sexuality prichádzajú do kontaktu, teda lekárov, právnikov, psychológov, študentov medicíny, práva, sociálnej práce, psychológie, terénnych pracovníkov, politikov – tvorcov legislatívy, učiteľov, ale aj pre všetkých, ktorých téma zaujíma a vnímajú jej nedostatočnú podporu a vzdelávanie.

• MeSH
• Reproductive Techniques, Assisted legislation & jurisprudence   MeSH
• Gender Identity MeSH
• Abortion, Induced legislation & jurisprudence   MeSH
• Gender-Affirming Procedures MeSH
• Patient Rights legislation & jurisprudence   MeSH
• Reproductive Behavior MeSH
• Sexual and Gender Minorities legislation & jurisprudence   MeSH
• Publication type
• Monograph MeSH
• Popular Work MeSH

• Conspectus
• Právo
• NML Fields
• lidská práva
• reprodukční lékařství

Intrauterinní adheze jsou závažnou komplikací, která vzniká po intrauterinních výkonech, nejčastěji v souvislosti s graviditou. Projevy jako amenorea, pellipatia a neplodnost jsou pro ženu závažné obzvláště v reprodukčním věku a nazýváme je spolu s intrauterinními adhezemi Ashermanovým syndromem. Důležitá je primární prevence po intrauterinních výkonech. Z publikovaných studií vyplývá, že použití gelu kyseliny hyaluronové především po abortech vede k prevenci vzniku středních a těžkých intrauterinních adhezí a zvyšuje také míru otěhotnění.

Intrauterine adhesions are a serious complication that occurs after intrauterine procedures, most often in connection with pregnancy. Manifestations such as amenorrhea, pelvic pain, and infertility for a woman, especially in reproductive age, are serious and together with intrauterine adhesions we call them Asherman’s syndrome. Primary prevention after intrauterine procedures is important. Published studies show that the use of hyaluronic acid gel, especially after abortions, leads to the prevention of moderate and severe intrauterine adhesions and also increases the pregnancy rate.

• MeSH
• Tissue Adhesions * etiology   prevention & control   MeSH
• Gynatresia * prevention & control   MeSH
• Hysteroscopy MeSH
• Abortion, Induced MeSH
• Hyaluronic Acid * administration & dosage   therapeutic use   MeSH
• Humans MeSH
• Uterine Diseases complications   MeSH
• Postoperative Complications prevention & control   MeSH
• Pregnancy MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Review MeSH

Edwards syndrome is a significant genetic abnormality with an unfavorable prognosis. It has a high rate of prenatal detection, which significantly affects its occurrence in the pediatric population. Postnatally, the dominant organ pathology is heart defects, clinically these patients always present with psychomotor impairment and failure to thrive. Despite the high percentage of early lethality, some patients may live longer than one year, and it is, therefore, to set up complex care for them. This care is available, including the management of organ pathologies. Complex or palliative care concepts are of considerable benefit in these children.

Edwardsův syndrom je významnou genetickou abnormitou s nepříznivou prognózou. Má vysokou míru prenatální detekce, která významně ovlivňuje jeho výskyt v populaci narozených dětí. Postnatálně jsou dominující orgánovou patologií srdeční vady, klinicky jsou tito pacienti vždy psychomotoricky opožděni a mají výživové problémy. Přes vysoké procento časné letality někteří pacienti přežijí jeden rok věku a je nutné pro ně nastavit celkovou péči. Tato je možná, včetně intervencí a řešení orgánových abnormalit. Pro tyto děti jsou výhodné koncepty komplexní nebo paliativní péče.

• MeSH
• Abortion, Induced MeSH
• Humans MeSH
• Abnormalities, Multiple MeSH
• Infant, Newborn MeSH
• Postnatal Care MeSH
• Prenatal Diagnosis MeSH
• Infant Death MeSH
• Trisomy 18 Syndrome * diagnosis   genetics   MeSH
• Heart Defects, Congenital diagnosis   MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Female MeSH
• Publication type
• Case Reports MeSH