Cíl studie: Využití modifikované Robsonovy klasifikace k retrospektivní analýze počtu císařských řezů, srovnání roku 2013 a 2016. Hodnocení faktorů ovlivňujících snížení počtu císařských řezů. Typ studie: Retrospektivní analýza dat. Název a sídlo pracoviště: Gynekologicko-porodnické oddělení KNL, a.s., Liberec. Metodika: Srovnávali jsme počty císařských řezů v KNL v roce 2013 a 2016. Využito bylo modifikované Robsonovy klasifikace. Jednotlivé skupiny byly porovnány a data analyzována ke stanovení faktorů vedoucích ke snížení počtu císařských řezů v každé skupině. Výsledky: Došlo k poklesu počtu císařských řezů z 24,6 % na 14,5 %. Závěr: Robsonova klasifikace je vhodnou klasifikací k objektivnímu srovnání počtu císařských řezů. Je výhodnou metodou k analýze dosažených výsledků a je vhodným nástrojem ke stanovení strategie vedoucí k dosažení optimálního počtu císařských řezů.

Objective: A retrospective analysis of caesarean section rates using modified Robson classification in years 2013–2016. Discussion of factors influencing the decrease of caesarean section rate. Design: Restrospective data analysis. Setting: Gynecology and obstetrics department Krajská nemocnice Liberec. Methods: We compared the caesarean section rates at our department between years 2013–2016 using the modified Robson classification system. The groups were analysed both separately and mutually to identify the factors contributing to the decrease of caesarean section rate in concrete subgroups. Results: We experienced a remarkable reduce in caesaren section rate from 24.6% in 2013 to 14.5% in 2016. Conclusion: The Robson classification provides objective caesarean section rates comparisons. This method enables further interpretation of outcomes and policy assessment to reach the optimal caesarean section rate.

• Keywords
• indikace císařského řezu, , Robsonova modifikovaná klasifikace,
• MeSH
• Cesarean Section * MeSH
• Humans MeSH
• Natural Childbirth * MeSH
• Retrospective Studies MeSH
• Statistics as Topic MeSH
• Pregnancy MeSH
• Delivery, Obstetric * methods   MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Cesarean Section * classification   standards   utilization   MeSH
• Gestational Age MeSH
• Humans MeSH
• Parity MeSH
• Attitude of Health Personnel MeSH
• Unnecessary Procedures * MeSH
• Medical Audit * MeSH
• Decision Making MeSH
• Pregnancy MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH

• MeSH
• Disease Management MeSH
• Liver Diseases MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• hepatologie
• management, organizace a řízení zdravotnictví
• NML Publication type
• kolektivní monografie

OBJECTIVE: To assess changes in caesarean section (CS) rates in Europe from 2015 to 2019 and utilise the Robson Ten Group Classification System (TGCS) to evaluate the contribution of different obstetric populations to overall CS rates and trends. DESIGN: Observational study utilising routine birth registry data. SETTING: A total of 28 European countries. POPULATION: Births at ≥22 weeks of gestation in 2015 and 2019. METHODS: Using a federated model, individual-level data from routine sources in each country were formatted to a common data model and transformed into anonymised, aggregated data. MAIN OUTCOME MEASURES: By country: overall CS rate. For TGCS groups (by country): CS rate, relative size, relative and absolute contribution to overall CS rate. RESULTS: Among the 28 European countries, both the CS rates (2015, 16.0%-55.9%; 2019, 16.0%-52.2%) and the trends varied (from -3.7% to +4.7%, with decreased rates in nine countries, maintained rates in seven countries (≤ ± 0.2) and with increasing rates in 12 countries). Using the TGCS (for 17 countries), in most countries labour induction increased (groups 2a and 4a), whereas multiple pregnancies (group 8) decreased. In countries with decreasing overall CS rates, CS tended to decrease across all TGCS groups, whereas in countries with increasing rates, CS tended to increase in most groups. In countries with the greatest increase in CS rates (>1%), the absolute contributions of groups 1 (nulliparous term cephalic singletons, spontaneous labour), 2a and 4a (induction of labour), 2b and 4b (prelabour CS) and 10 (preterm cephalic singletons) to the overall CS rate tended to increase. CONCLUSIONS: The TGCS shows varying CS trends and rates among countries of Europe. Comparisons between European countries, particularly those with differing trends, could provide insight into strategies to reduce CS without clinical indication.

• MeSH
• Cesarean Section * MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Parity MeSH
• Labor, Obstetric * MeSH
• Pregnancy, Multiple MeSH
• Pregnancy MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH
• Geographicals
• Europe MeSH

Úvod: Robsonova klasifikácia rodičiek nemá samostatnú kategóriu pre predčasný odtok plodovej vody (PROM) v termíne pôrodu. V našej štúdií sme chceli overiť, nakoľko sa odlišujú rodičky s PROM od rodičiek so spontánnym nástupom činnosti a od skupiny indukovaných rodičiek. Materiál a metodika: Do štúdie sme zahrnuli rodičky, ktoré porodili na našej klinike v období od 1.1.2018 do 30.9.2019. Na základe dokumentácie sme vybrali skupinu rodičiek v termíne, jeden plod hlavičkou a rozdelili sme ich na skupiny podľa dôvodu prijatia – spontánny nástup kontrakcií, spontánny odtok plodovej vody ale-bo indukcia pôrodu. Zvlášť sme hodnotili prvorodičky a viacrodičky bez anamnézy cisárskeho rezu. Výsledky: Frekvencia cisárskych rezov v skupine prvorodičiek prijatých s PROM bola 14,7 %, v skupine prija-tých s rozvinutou činnosťou bola 8,0 % (OR: 0,51; 95% CI: 0,37 – 0,70; p < 0,0001), v skupine žien s indukciou pôrodu bola 20,7 % (OR: 1,51; 95% CI: 1,08 – 2,12; p = 0,0156). Cisárske rezy z indikácie nepokračujúci pôrod tvorili v skupine žien s PROM 10,6 % pôrodov, v skupine s rozvinutou činnosťou 5,4 % pôrodov (OR: 0,48; 95% CI: 0,33 – 0,71; p = 0,0002), v skupine s indukciou pôrodu 13,3 %, rozdiel nebol štatisticky významný. Z indiká-cie hypoxia nebol rozdiel významný medzi PROM a spontánnym začiatkom pôrodu (3,6 % vs 2,3 %), ale oproti indukcii pôrodu (7,1 %) bol rozdiel významný (OR: 2,03; 95% CI: 1,11 – 3,70; p = 0,0217). Podobné výsledky sme zaznamenali aj v skupine viacrodičiek.Záver: Skupina rodičiek s predčasným odtokom plodovej vody vykazuje rozdielne výsledky ukončenia pôro-du aj u prvorodičiek aj u viacrodičiek a zaslúžila by si samostatnú skupinu v Robsonovej klasifikácií.

Introduction: The premature rupture of membranes (PROM) in term pregnancy is not categorized separate-ly in the Robson Classification. The aim of this study is to identify differences between parturiens who were admitted to the labor unit with PROM, spontaneous onset of labor (contractions) and induced labor. Materials and methods: All parturients who delivered at our department were included. The data were obtained from medical records of patients from 1.1.2018 to 30.9.2019. The population of parturiens in term with one fetus in cephalic position was then selected and subdivided according to the cause of admission: spontaneous onset of labor (contractions), spontaneous rupture of membranes and induction of labor. Primi-paras and multiparas without a history of cesarean section where evaluated separately.Results: The frequency of cesarean section in the population of primiparas admitted to the labor unit with PROM was 14.7%, in those admitted with contractions was 8.0% (OR: 0.51, 95% CI: 0.37 – 0.70, p < 0.0001). In the population of parturiens with induced labor, the frequency of cesarean section was 20.7% (OR: 1.51, 95% CI: 1.08 – 2.12, p = 0.0156). Cesarean sections performed out of the indication “prolonged labor” represented 10.6% of all deliveries in the population of parturiens admitted with PROM, 5.4% in the population admitted with contractions (OR: 0.48, 95% CI: 0.33 – 0.71, p = 0.0002). In the population with induced labor those ce-sarean sections represented 5.4% of all deliveries, the difference was not statistically significant. In cesarean sections performed out of the indication “fetal hypoxia”, no significant difference was observed between populations with PROM and spontaneous onset of labor (3.6% vs 2.3%). Comparing to the population with induced labor (7.1%), the difference was statistically significant (OR: 2.03, 95% CI: 1.11 – 3.70, p = 0.0217). Similar results were obtained in the population of multiparas.Conclusion: Different outcomes were recorded in the population of primiparas and multiparas with PROM. A separate category in the Robson Classification for those parturiens would be beneficial.

• Keywords
• robsonova klasifikace,
• MeSH
• Cesarean Section MeSH
• Humans MeSH
• Fetal Membranes, Premature Rupture * MeSH
• Delivery, Obstetric MeSH
• Check Tag
• Humans MeSH

Stúpajúci počet cisárskych rezov predstavuje závažný zdravotný, ekonomický a psychologický problém v globálnom meradle. Robsonova klasifikácia predstavuje komplexný prístup, ako na pôrodníckych pracoviskách realizovať pravidelne analýzu každého operačného abdominálneho pôrodu. Ukazuje sa, že najmä podpora vaginálnych pôrodov po predošlom cisárskom reze a redukcia cisárskych rezov u primipár je jednou z ciest, ako zastaviť stúpajúci trend cisárskych rezov. Aj slovenské pracoviská, ktoré akceptovali Robsonovu klasifikáciu, vykazujú pokles cisárskych rezov.

The increasing number of caesarean sections represents a significant health, economic, and psychological problem on a global scale. Robson’s classification is a comprehensive approach to regularly analyse every operative abdominal delivery. It appears that particularly promoting the vaginal births after a previous caesarean section and reducing this mode of delivery among primiparas, is one of the ways of stopping the rising trend of caesarean sections. Slovak maternity facilities that have adopted Robson’s classification reveal a decrease in the number of these obstetric surgeries.

BACKGROUND: BRCA1 and, more commonly, BRCA2 mutations are associated with increased risk of male breast cancer (MBC). However, only a paucity of data exists on the pathology of breast cancers (BCs) in men with BRCA1/2 mutations. Using the largest available dataset, we determined whether MBCs arising in BRCA1/2 mutation carriers display specific pathologic features and whether these features differ from those of BRCA1/2 female BCs (FBCs). METHODS: We characterised the pathologic features of 419 BRCA1/2 MBCs and, using logistic regression analysis, contrasted those with data from 9675 BRCA1/2 FBCs and with population-based data from 6351 MBCs in the Surveillance, Epidemiology, and End Results (SEER) database. RESULTS: Among BRCA2 MBCs, grade significantly decreased with increasing age at diagnosis (P = 0.005). Compared with BRCA2 FBCs, BRCA2 MBCs were of significantly higher stage (P for trend = 2 × 10(-5)) and higher grade (P for trend = 0.005) and were more likely to be oestrogen receptor-positive [odds ratio (OR) 10.59; 95 % confidence interval (CI) 5.15-21.80] and progesterone receptor-positive (OR 5.04; 95 % CI 3.17-8.04). With the exception of grade, similar patterns of associations emerged when we compared BRCA1 MBCs and FBCs. BRCA2 MBCs also presented with higher grade than MBCs from the SEER database (P for trend = 4 × 10(-12)). CONCLUSIONS: On the basis of the largest series analysed to date, our results show that BRCA1/2 MBCs display distinct pathologic characteristics compared with BRCA1/2 FBCs, and we identified a specific BRCA2-associated MBC phenotype characterised by a variable suggesting greater biological aggressiveness (i.e., high histologic grade). These findings could lead to the development of gender-specific risk prediction models and guide clinical strategies appropriate for MBC management.

• MeSH
• Adult MeSH
• Genetic Predisposition to Disease MeSH
• Polymorphism, Single Nucleotide MeSH
• Middle Aged MeSH
• Humans MeSH
• Mutation MeSH
• Breast Neoplasms, Male genetics   pathology   MeSH
• Breast Neoplasms genetics   pathology   MeSH
• BRCA1 Protein genetics   MeSH
• BRCA2 Protein genetics   MeSH
• Aged MeSH
• Neoplasm Staging MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

• MeSH
• Liver Diseases therapy   MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• hepatologie
• NML Publication type
• kolektivní monografie

• MeSH
• Medical Informatics MeSH
• Publication type
• Congress MeSH
• Collected Work MeSH

• Conspectus
• Lékařské vědy. Lékařství
• NML Fields
• lékařská informatika