• MeSH
• dilatace přístrojové vybavení   MeSH
• lidé MeSH
• pánevní dno * zranění   MeSH
• parita MeSH
• pilotní projekty MeSH
• randomizované kontrolované studie jako téma MeSH
• těhotenství MeSH
• vedení porodu * škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• dopisy MeSH
• komentáře MeSH

• MeSH
• hlava * MeSH
• lidé MeSH
• naléhání plodu MeSH
• perineum * MeSH
• plod MeSH
• vedení porodu MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• komentáře MeSH

• MeSH
• diabetes mellitus MeSH
• vnitřní lékařství * MeSH
• Publikační typ
• biografie MeSH

• O autorovi
• Rušavý, Zdeněk, 1952- Autorita

• MeSH
• vnitřní lékařství MeSH
• Publikační typ
• biografie MeSH

• O autorovi
• Rušavý, Zdeněk, 1952- Autorita

OBJECTIVE: To conduct an international survey of anal incontinence assessment tools and the need to evaluate frequency of occurrence of fecal urgency. METHODS: A questionnaire on the use of anal incontinence assessment tools was distributed between May and December 2012 among clinicians and researchers dealing with anal incontinence, primarily in North America, Europe, and Asia. RESULTS: A total of 143 responses were collected from 56 (39.2%) obstetricians, gynecologists, and urogynecologists; 71 (49.7%) colorectal surgeons, proctologists, and general surgeons; and 16 (11.2%) physiotherapists, theoretical scientists, and gastroenterologists. Fourteen different tools were reported-most commonly Wexner score (n=78; 48.8%) and St Mark's score (n=29; 18.1%). No scoring system was used by 24 (16.8%) respondents. Thirty-four (28.6%) used multiple tools. There was variation in the reasons given for scoring the frequency of fecal urgency as 4 points when using St Mark's score. Of 96 respondents responding to a query about modifying the St Mark's score, 88 (91.7%) agreed that fecal urgency should be scored according to the frequency of occurrence. CONCLUSION: Although the Wexner score neglects fecal urgency, it is the most commonly used scoring system. The study contributes to the standardization of terminology and reproducibility of results in research and clinical management of anal incontinence.

• MeSH
• celosvětové zdraví MeSH
• fekální inkontinence klasifikace   MeSH
• lidé MeSH
• průzkumy a dotazníky MeSH
• stupeň závažnosti nemoci * MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

INTRODUCTION: The aim of this study was to compare to compare immediate delivery outcome as well as healing, pain, anal incontinence and sexuality in a short-term and a long-term follow up after episiotomy performed before or at crowning in nulliparous women. MATERIAL AND METHODS: This cohort study is a comparison of prospectively collected data evaluating the importance of the timing of episiotomy. Patients with episiotomy performed before crowning (n = 86) and at crowning (n = 404) were compared. Obstetric anal sphincter injuries rate, additional perineal or vaginal trauma, neonatal outcome, episiotomy length, 2nd stage of labor duration, blood loss, infection, hematoma, dehiscence, need for resuturing, pain, painful defecation, resumption of sexual intercourse, dyspareunia, anal incontinence and constipation were assessed immediately after delivery or from responses to questionnaires 24 and 72 h, 10 days, 3 and 6 months postpartum. RESULTS: The groups did not differ in age, body mass index, birthweight, occipito-posterior presentation, shoulder dystocia, or episiotomy type. Significant differences between before crowning and at crowning groups were observed in additional vaginal trauma [26 (30.2%) vs. 66 (16.3%), respectively, p < 0.001], mean episiotomy length (42 mm vs. 36 mm, p < 0.001), and mean estimated blood loss (367 mL vs. 344 mL, p < 0.001). Difference in obstetric anal sphincter injuries rate did not reach statistical significance [0 (0.0%) vs. 7 (1.7%), p = 0.61]. The groups did not differ in additional perineal trauma, pain (Visual Analogue Scale, Verbal Rating Scale and Activities of Daily Living scales), healing complications, sexual functions or anal incontinence in short-term or long-term follow up. CONCLUSIONS: Our results suggest that episiotomy performed at crowning is not associated with worse anatomical or functional delivery outcome, and support a restrictive approach to episiotomy. The effect of episiotomy timing on pelvic organ prolapse development remains to be determined.

• MeSH
• časové faktory MeSH
• dospělí MeSH
• epiziotomie metody   MeSH
• fekální inkontinence MeSH
• hojení ran MeSH
• lidé MeSH
• měření bolesti MeSH
• pooperační komplikace MeSH
• prospektivní studie MeSH
• průzkumy a dotazníky MeSH
• sexuální chování MeSH
• těhotenství MeSH
• výsledek těhotenství * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

• MeSH
• laparoskopie * MeSH
• leiomyom * chirurgie   MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony MeSH
• myomektomie * MeSH
• nádory dělohy * chirurgie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

OBJECTIVE: To analyze deformation of the perineum during normal vaginal delivery in order to identify clinical steps that might be beneficial when executing manual perineal protection. METHODS: The present prospective study at Charles University Hospital, Pilsen, Czech Republic, enrolled 10 primiparous women at term undergoing non-instrumental vaginal delivery assisted by the same obstetrician between September 2009 and September 2010. A modified hands-poised technique performed concurrently with stereophotogrammetry was used to analyze and quantify perineal deformation and strain at the final stage of delivery. RESULTS: The highest tissue strain (mean, 177%; 95% confidence interval [CI], 106.3-248.5) was in a transverse direction and occurred at the level of the fourchette (i.e. 1cm was transversely stretched and deformed to 2.77 cm during the final stage of vaginal delivery). This strain was more than 4 times higher than the maximum anteroposterior strain (mean, 43%; 95% CI, 28.6-57.4). CONCLUSION: On the basis of these stereophotogrammetry data, a technique of perineal protection executed by fingers of the posterior (right) hand can be proposed. Further experimental and clinical studies are needed to evaluate whether this technique might assist in reducing obstetric perineal trauma.

• MeSH
• dospělí MeSH
• fotogrammetrie * MeSH
• komplikace porodu prevence a kontrola   MeSH
• lidé MeSH
• mladý dospělý MeSH
• perineum zranění   MeSH
• prospektivní studie MeSH
• těhotenství MeSH
• vedení porodu škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

INTRODUCTION AND HYPOTHESIS: Laparoscopic sacrocolpopexy is the preferred contemporary procedure for the surgical management of a significant apical pelvic organ prolapse. In the presence of a uterus it is possible for the patient to have subtotal hysterectomy and cervicopexy, total hysterectomy with colpopexy or uterine conservation and hysteropexy. However, hysteropexy seems to be associated with a higher risk of anterior compartment failure compared with cervicopexy or colpopexy. It is not uncommon for an asymmetrically large anterior compartment defect to co-exist with a symptomatic apical pelvic organ prolapse. In a cervicopexy or colpopexy, this asymmetry can be balanced by creating a de novo vaginal apex from the superior part of the anterior vaginal wall. However in a hysteropexy the attachment of the base of the anterior mesh to the vagina and cervical isthmus limits the ability to do this. METHODS: In this video we present a solution where the shape of the posterior mesh is modified to include two horizontal arms that are passed through openings in the broad ligament and attached to the cervical isthmus anteriorly. RESULTS: This frees the anterior Y-shaped mesh to be fixed to the anterior vaginal wall only and hence provides the required tension to create the de novo apex. CONCLUSION: Prior to wide adoption, this technique should be further investigated in the context of robustly designed comparative studies.

• MeSH
• chirurgické síťky MeSH
• gynekologické chirurgické výkony MeSH
• laparoskopie * MeSH
• lidé MeSH
• prolaps pánevních orgánů * chirurgie   MeSH
• uterus chirurgie   MeSH
• vagina chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• audiovizuální média MeSH
• časopisecké články MeSH

INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) in pregnancy is a rare condition with decreasing incidence and improved management and outcome world-wide recently. Systematic review of the literature for cases of POP in pregnancy published since 1990 was carried out to identify common factors in presentation, management and outcomes. One case from our own practice was added to the analysis. METHODS: An extensive search of the Pubmed/Medline, Scopus and Google Scholar databases was performed to identify all cases of POP in pregnancy since 1990. Published case reports of POP in pregnancy were reviewed and summarized in tables to find similarities in history, course, management and outcome of the pregnancies. RESULTS: Of the 43 cases and one case series, 41 case studies were eligible for analysis. Two types of POP in pregnancy were identified: preexisting is less common (14 vs 27 cases), often resolves during pregnancy (5 out of 14) and always recurs after delivery (14 out of 14); acute onset of POP in pregnancy rarely resolves in pregnancy (2 out of 27), but often resolves after delivery (18 out of 27). Most patients were managed with bed rest (20 out of 41), pessary (15 out of 41), manual reduction (6 out of 41) and local treatment (6 out of 41). The most common complications reported include preterm labour (14 out of 41), cervical ulcerations (9 out of 41), infection (3 out of 41) and obstructed labour (4 out of 41). About a half of the women delivered vaginally (22 out of 41), caesarean section due to prolapse was required in 15 cases. CONCLUSIONS: Two distinct entities were identified based on similarities regarding onset, course and outcome of POP in pregnancy. Concise recommendations for practice were derived from the analysis of case studies published since 1990.

• MeSH
• císařský řez MeSH
• dystokie etiologie   MeSH
• infekční komplikace v těhotenství etiologie   MeSH
• klid na lůžku MeSH
• komplikace těhotenství etiologie   MeSH
• lidé MeSH
• pesary MeSH
• předčasná porodní činnost etiologie   MeSH
• prolaps pánevních orgánů komplikace   diagnóza   terapie   MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH