Cíl: Poukázat na možnost endovaskulární léčby poporodního krvácení z důvodu reziduí fokálně abnormálně invazivní placenty pomocí selektivní embolizace uterinních arterií při selhání expektačního postupu. Metodika: Tento článek se zabývá zhodnocením výsledků u souboru čtyř pacientek (věk 29–38 let), které od ledna 2022 do února 2023 podstoupily terapii selektivní transarteriální embolizací uterinních arterií na angiointervenčním pracovišti ve FN Hradec Králové. Na základě multidisciplinárního konsenzu při sonograficky zjištěných reziduí fokální abnormálně invazivní placenty s typickou hypervaskularizací bylo po porodu dle angiografického nálezu rozhodnuto o provedení uni-/bilaterální embolizace a. uterina mikrokatétrem pomocí polyvinylalkoholových embolizačních částic, případně v kombinaci s želatinovou pěnou. Výsledky: Během následného sledování nebyla u žádné z pacientek zaznamenána epizoda opakovaného krvácení. Během embolizace nedošlo k žádným periprocedurálním komplikacím, nebyly pozorovány žádné časné postprocedurální komplikace. U dvou pacientek po embolizaci následovala plánovaná hysteroskopická revize s odstranění devaskularizova- ných reziduí placenty. Závěr: Na základě našich dosavadních zkušeností je embolizace uterinních tepen bezpečná a relativně technicky nenáročná metoda doplňující léčbu symptomatických pacientek s rezidui fokální abnormálně invazivní placenty.

Aim: To point out the possibility of endovascular treatment of postpartum haemorrhage due to remnants of focal abnormally invasive placenta using selective uterine artery embolization (UAE) after failure of the expectant management. Methods: This article deals with the evaluation of the results of four patients (29–38 y.o.), who underwent from January 2022 to February 2023 selective transarterial embolization of uterine arteries at our angio-intervention department at the University Hospital Hradec Králové. Based on a multidisciplinary consensus of sonographically detected residues of focal abnormally invasive placenta with typical hypervascularization, it was decided to perform uni-/bilateral embolization of a. uterina with a microcatheter using polyvinyl alcohol embolization particles, possibly in combination with gelatin foam, eventually in combination with gelatin foam. Results: During follow-up, none of the patients experienced an episode of recurrent bleeding. There were no periprocedural complications during embolization, no early post- proprocedural complications were observed. Two patients underwent surgical revision of the uterine cavity with extirpation of devascularized residual tissue. Conclusions: Based on our experience so far, uterine artery embolisation is a safe and relatively technically undemanding method supplementing the managment of symptomatic patients with residues of focal abnormally invasive placenta.

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
• Gynatresia * MeSH
• Cohort Studies MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Placenta MeSH
• Premature Birth * epidemiology   etiology   MeSH
• Prospective Studies MeSH
• Retrospective Studies MeSH
• Pregnancy MeSH
• Propensity Score MeSH
• Placenta, Retained * MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Treatment Adherence and Compliance MeSH
• Gynatresia therapy   MeSH
• Hysterectomy MeSH
• Clinical Decision-Making MeSH
• Infant Mortality MeSH
• Obstetric Labor Complications surgery   diagnostic imaging   pathology   therapy   MeSH
• Pregnancy Complications surgery   diagnostic imaging   pathology   therapy   MeSH
• Laparotomy MeSH
• Humans MeSH
• Placenta Diseases * surgery   diagnosis   pathology   therapy   MeSH
• Treatment Failure MeSH
• Patient Preference MeSH
• Patient Medication Knowledge MeSH
• Fetal Membranes, Premature Rupture * surgery   diagnostic imaging   mortality   therapy   MeSH
• Risk MeSH
• Salpingectomy MeSH
• Pregnancy MeSH
• Ultrasonography MeSH
• Uterus surgery   diagnostic imaging   pathology   MeSH
• Congenital Abnormalities epidemiology   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Cieľ štúdie: Informovať o medzinárodnej sieti sledovania závažnej materskej morbidity a mortality – INOSS.Typ štúdie: Prehľadová práca.názov a sídlo pracoviska: I. gynekologicko-pôrodnícka klinika LF UK a UNB, Bratislava.Metodika: Prehľad problematiky na základe publikovaných prác do augusta 2019. Výsledky: The International Network of Obstetric Survey Systems (INOSS) je medzinárodná sieť spájajúca krajiny s rovnakými alebo podobnými systémami sledovania závažnej akútnej materskej morbidity a materskej mortality. V roku 2010 dvanásť krajín sveta založilo INOSS. V súčasnosti je do činnosti INOSS zapojených 19 krajín sveta. Spolupráca členských krajín je zameraná na získanie dostatočného množstva údajov o zriedkavých závažných akútnych materských morbiditách. INOSS v roku 2017 Delphi metodikou zjednotil definície 8 závažných morbidít: eklampsia, embólia plodovou vodou, peripartálna hysterektómia, závažné primárne popôrodné krvácanie, ruptúra uteru, abnormálna invázia placenty, spontánne hemoperitoneum v gravidite, zastavenie srdca v gravidite. Záver: Medzinárodná spolupráca umožňuje získanie relevantných epidemiologických údajov a na ich základe optimalizovať možnosti liečby v súlade s "evicence based medicine".

Objective: To informed about international surveillance network severe maternal morbidity and mortality - INOSS. Design: Literature review. Settings: 1st Department of Gynaecology and Obstetrics Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic. Methods: Literate review of articles published till august 2019. Results: The International Network of Obstetric Survey Systems (INOSS) is an international network that connects countries with the same or similar system of surveillance of acute severe maternal morbidity and mortality. The INOSS was established in year 2010 by twelve countries. Nowadays 19 countries are involved in the INOSS. The cooperation between member countries is focused on the acquisition of relevant data about rare severe acute maternal morbidities. INOSS in 2017 year unified definitions of 8 severe acute maternal morbidities according Delphi method: eclampsia, amniotic fluid embolism, peripartum hysterectomy, severe primary postpartum haemorrhage, uterine rupture, abnormally invasive placenta, spontaneous hemoperitoneum in pregnancy, and cardiac arrest in pregnancy. Conclusion: The international cooperation allows the acquisition of relevant epidemiologic data and the optimalization of the treatment according the evidence-based medicine.

• Keywords
• INOSS,
• MeSH
• Obstetric Labor Complications * epidemiology   MeSH
• Pregnancy Complications * epidemiology   MeSH
• Humans MeSH
• Maternal Mortality * MeSH
• Evidence-Based Medicine methods   organization & administration   MeSH
• International Cooperation MeSH
• Morbidity * MeSH
• Surveys and Questionnaires MeSH
• Registries MeSH
• Data Collection * methods   MeSH
• Population Surveillance MeSH
• Pregnancy MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Review MeSH
• Geographicals
• Slovakia MeSH

Cíl práce: Prezentovat pacientku s nezvykle dlouhou potermínovou graviditou. Typ práce: Kazuistika. Název a sídlo pracoviště: Gynekologicko-porodnické oddělení Nemocnice Vyškov, p.o. Vlastní pozorování: Za potermínovou graviditu se podle odborné literatury považuje takové těhotenství, které přesahuje 42+0 týdnů. Prezentujeme kazuistiku 21leté primigravidy s extrémně dlouhou potermínovou graviditou a komplikacemi s tím spojenými. Pacientka opakovaně odmítá navrhované provokační a zátěžové testy. V termínu 43+1 již souhlasí s indukcí porodu prostaglandiny. Gravidita je ukončena císařským řezem po opakovaném pokusu o indukci porodu v termínu 43+3 pro nepostupující porod a suspektní CTG a potermínovou graviditu. Peroperačně zjištěno akretní lůžko zadní děložní stěny s nutností podvazu aa. iliacae internae z důvodu masivní krevní ztráty. Závěr: Těhotným ženám by měla být nabídnuta možnost indukce porodu při prodloužené graviditě. Žena by měla být podrobně poučena o rizicích potermínové gravidity.

Objective: To present a patient with prolongated postterm pregnancy. Design: Case study. Setting: Department of Obstetrics and Gynecology, Vyškov Hospital. Case report: According to the literature, pregnancy that exceeds 42+0 weeks is considered to be a postterm pregnancy. We present a case of a 21-year-old primigravid women with extremely prolongated postterm pregnancy and associated complications. The patient repeatedly rejects the proposed prostaglandin induction of labor or iterative cesarean section. Pregnancy was terminated by cesarean section at 43+3 due to multiple unsuccessful attempts to induce labor in postterm pregnancy. During the surgery abnormally invasive placenta was found with massive blood loss and necessity of subsequent ligation of aa. iliacae internae. Conclusion: Pregnant women with postterm pregnancy should be offered the possibility of induction of labor. We should educate pregnant women in detail about the risks of postterm pregnancy.

• Keywords
• podvaz aa. iliacae internae,
• MeSH
• Cesarean Section MeSH
• Pregnancy Complications MeSH
• Humans MeSH
• Young Adult MeSH
• Pregnancy, Prolonged * MeSH
• Pregnancy MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Young Adult MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Reproductive Techniques, Assisted MeSH
• Gametogenesis genetics   MeSH
• Infertility MeSH
• Genitalia embryology   MeSH
• Preimplantation Diagnosis methods   MeSH
• Publication type
• Handbook MeSH

• Conspectus
• Obecná genetika. Obecná cytogenetika. Evoluce
• Učební osnovy. Vyučovací předměty. Učebnice
• NML Fields
• reprodukční lékařství
• molekulární biologie, molekulární medicína
• embryologie a teratologie
• NML Publication type
• kolektivní monografie

Cieľ štúdie: Analýza materskej morbidity a mortality v Slovenskej republike (SR) v rokoch 2007–2015. Typ štúdie: Prospektívna epidemiologická perinatologická celoštátna. Názov a sídlo pracoviska: I. gynekologicko-pôrodnícka klinika LF UK a UNB, Bratislava, Slovenská republika. Metodika: Analýza vybraných dát materskej morbidity a mortality v rokoch 2007 až 2015 z pôrodníc v SR. Výsledky: Frekvencia cisárskeho rezu v SR stúpla z 24,1 % v roku 2007 na 30,8 % v roku 2013 a do roku 2015 klesla na 30,2 %. Frekvencia vákuumextrakcie v roku 2007 bola 1,3 % a do roku 2015 stúpla na 1,6 %. Frekvencia forcepsu v roku 2007 aj v roku 2015 bola 0,6 %. V rokoch 2008–2015 stúpla frekvencia ruptúr hrádze 3. a 4. stupňa z 0,44 % na 0,68 % a frekvencia epiziotómií klesla zo 74,7 % na 57,2 % vaginálnych pôrodov. V rokoch 2012–2015 bola incidencia celkovej závažnej akútnej materskej morbidity na 1000 pôrodov 5,85, incidencia peripartálnych hysterektómií 0,78, závažného popôrodného krvácania 2,03, transportu na anestéziologicko-resuscitačné pracovisko/jednotku intenzívnej starostlivosti bola 1,26, eklampsie 0,2, HELLP syndrómu 0,6, abnormálnej invázie placenty 0,38, ruptúry uteru 0,45, závažnej sepsy v gravidite a puerpériu 0,14 a výskyt nonfatálnej embólie plodovou vodou 2 na 100 000 pôrodov. Celková materská úmrtnosť v rokoch 2007–2015 bola 11,5 a očistená materská úmrtnosť 9,9 na 100 000 živonarodených novorodencov. Záver: Historicky najvyššia frekvencia cisárskeho rezu v SR, 30,8 %, bola v roku 2013, ale v nasledujúcich rokoch pomaly klesala. Frekvencia epiziotómií sa v sledovanom období znížila. Incidencia závažnej akútnej materskej morbidity bola 5,85 na 1000 pôrodov. Materská úmrtnosť na Slovensku bola jedna z najvyšších v Európskej únii a nezodpovedá dobrej úrovni perinatálnej úmrtnosti. V SR je naďalej potrebné znižovanie frekvencie cisárskeho rezu, epiziotómií, závažnej akútnej materskej morbidity a materskej mortality.

Objective: Analysis of maternal morbidity and mortality in Slovak Republic in the years 2007–2015. Design: Prospective epidemiological perinatological nation-wide. Settings: 1st Department of Gynaecology and Obstetrics Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic. Methods: The analysis of selected maternal morbidity and mortality data prospective collected in the years 2007–2015. Results: Cesarean section rate progressively increased from 24.1% in the year 2007 up to 30.8% in the year 2013 and up to year 2015 decreased to 30.2%. Vacuumextraction frequency was 1.3% in the year 2007 and to the year 2015 increased up to 1.6%. Forceps frequency was the same in the year 2007 and 2015: 0.6%. In the years 2008–2015 frequency of perineal tears 3th and 4th degree increased from 0.44% to 0.68% and frequency of episiotomies decreased from 74.7% to 57.2%. In the years 2012–2015 incidence of total severe acute maternal morbidity per 1,000 births was 5.85, peripartum hysterectomy 0.78, severe postpartum bleeding 2.03, transport to anaesthesiology department/intensive care unit 1.26, eclampsia 0.2, HELLP syndrome 0.6, abnormal placental invasion 0.38, uterine rupture 0.45, severe sepsis in pregnancy and puerperium 0.14 and frequency of nonfatal amniotic fluid embolism was 2/100,000 maternities. Total maternal mortality ratio in this period was 11.5 and pregnancy-related deaths ratio 9.9 per 100,000 live births. Conclusion: The highest cesarean section rate in Slovakia, 30.8 %, was in the year 2013, but in the next years slowly decreased. Frequency of episiotomies decreased in followed period too. Incidence of severe acute maternal morbidity was 5.85 per 1,000 births. Maternal mortality ratio in Slovakia was one of the highest in European Union and not corresponding with good level of perinatal mortality. Improving of cesarean section rate and episiotomy, incidence of severe acute maternal morbidity and maternal mortality still need to be improved in Slovak Republic.

• Keywords
• embólia plodovou vodou, poporodní hysterektomie,
• MeSH
• Cesarean Section statistics & numerical data   MeSH
• Eclampsia epidemiology   MeSH
• Epidemiologic Studies MeSH
• Episiotomy statistics & numerical data   MeSH
• Obstetric Labor Complications * MeSH
• Pregnancy Complications MeSH
• Humans MeSH
• Maternal Mortality * MeSH
• Pregnancy MeSH
• Vacuum Extraction, Obstetrical statistics & numerical data   MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Geographicals
• Slovakia MeSH

The worldwide incidence of abnormally invasive placenta is rapidly rising, following the trend of increasing cesarean delivery. It is a heterogeneous condition and has a high maternal morbidity and mortality rate, presenting specific intrapartum challenges. Its rarity makes developing individual expertise difficult for the majority of clinicians. The International Society for Abnormally Invasive Placenta aims to improve clinicians' understanding and skills in managing this difficult condition. By pooling knowledge, experience, and expertise gained within a variety of different healthcare systems, the Society seeks to improve the outcomes for women with abnormally invasive placenta globally. The recommendations presented herewith were reached using a modified Delphi technique and are based on the best available evidence. The evidence base for each is presented using a formal grading system. The topics chosen address the most pertinent questions regarding intrapartum management of abnormally invasive placenta with respect to clinically relevant outcomes, including the following: definition of a center of excellence; requirement for antenatal hospitalization; antenatal optimization of hemoglobin; gestational age for delivery; antenatal corticosteroid administration; use of preoperative cystoscopy, ureteric stents, and prophylactic pelvic arterial balloon catheters; maternal position for surgery; type of skin incision; position of the uterine incision; use of interoperative ultrasound; prophylactic administration of oxytocin; optimal method for intraoperative diagnosis; use of expectant management; adjuvant therapies for expectant management; use of local surgical resection; type of hysterectomy; use of delayed hysterectomy; intraoperative measures to treat life-threatening hemorrhage; and fertility after conservative management.

• MeSH
• Cesarean Section * MeSH
• Delphi Technique MeSH
• Gestational Age MeSH
• Adrenal Cortex Hormones therapeutic use   MeSH
• Hospitalization MeSH
• Hysterectomy * MeSH
• Conservative Treatment MeSH
• Humans MeSH
• Disease Management MeSH
• Oxytocin therapeutic use   MeSH
• Placenta Accreta therapy   MeSH
• Patient Positioning MeSH
• Postpartum Hemorrhage prevention & control   therapy   MeSH
• Watchful Waiting MeSH
• Stents MeSH
• Pregnancy MeSH
• Ureter MeSH
• Oxytocics therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Practice Guideline MeSH

Cieľ štúdie: Analýza materskej morbidity a mortality v Slovenskej republike (SR) v rokoch 2007–2012. Typ štúdie: Epidemiologická perinatologická celoštátna. Názov a sídlo pracoviska: I. gynekologicko-pôrodnícka klinika LF UK a UNB, Bratislava. Metodika: Analýza prospektívneho zberu vybraných ukazovateľov materskej morbidity a mortality v rokoch 2007 až 2012 zo všetkých pôrodníc v SR. Výsledky: V sledovanom období frekvencia cisárskeho rezu v SR stúpla z 24,1 % v roku 2007 na 30,3 % v roku 2012. V roku 2012 bola frekvencia vákuumextrakcie 1,4 %, forcepsu 0,6 %, ruptúr hrádze 3. a 4. stupňa 0,49 % a epiziotómií 65 %. Incidencia celkovej závažnej akútnej materskej morbidity bola 6,34 na 1000 pôrodov. Incidencia (na 1000 pôrodov) transportu na anesteziologicko-resuscitačné pracovisko/jednotku intenzívnej starostlivosti bola 2,32, popôrodných hysterektómií 0,72, HELLP syndrómu 0,63, eklampsie 0,29, abnormálnej invázie placenty 0,37, ruptúry uteru 0,27 a závažnej sepsy v gravidite a puerpériu 0,21. V rokoch 2007–2012 bol výskyt fatálnej embólie plodovou vodou 2,46 na 100 000 pôrodov, resp. 2,43 na 100 000 živonarodených novorodencov. Celková materská úmrtnosť v tomto období bola 14 a očistená materská úmrtnosť 11,9 na 100 000 živonarodených novorodencov. Záver: V roku 2012 dosiahlo Slovensko najvyššiu frekvenciu cisárskeho rezu v histórii – 30,3 %. Incidencia závažnej akútnej materskej morbidity bola 6,34 na 1000 pôrodov. Materská úmrtnosť na Slovensku bola jedna z najvyšších v Európskej únii. Slovenská republika má značné rezervy v znižovaní frekvencie cisárskeho rezu, epiziotómií, závažnej akútnej materskej morbidity a materskej mortality.

Objective: Analysis of maternal morbidity and mortality in Slovak Republic (SR) in the years 2007–2012. Design: Epidemiological perinatological nation-wide. Settings: 1st Department of Gynaecology and Obstetrics School of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic. Methods: The analysis of selected maternal morbidity and mortality data prospective collected in the years 2007–2012 from all obstetrics hospitals in the Slovak Republic. Results: Caesarean section rate progressively increased from 24.1% in the year 2007 up to 30.3% in the year 2012. In the year 2012 the frequency of vacuum-extraction was 1.4%, forceps 0.6%, perineal tears 3th and 4th degree 0.49% and episiotomy 65%. Incidence of total severe acute maternal morbidity was 6.34 per 1,000 births. Incidence (per 1,000 births) of transport to anaesthesiology department/intensive care unit was 2.32, postpartum hysterectomy 0.72, HELLP syndrome 0.63, eclampsia 0.29, abnormal placental invasion 0.37, uterine rupture 0.27, severe sepsis in pregnancy and puerperium 0.21. In the years 2007–2012 frequency of fatal amniotic fluid embolism was 2.46/100,000 maternities or 2.43/100,000 live-births. Maternal mortality ratio in this period was 14 per 100,000 live births and pregnancy-related deaths ratio was 11.9 per 100,000 live births. Conclusion: In the year 2012 Slovakia reached the highest caesarean section rate in her own history – 30.3%. Incidence of severe acute maternal morbidity was 6.34 per 1,000 births. Maternal mortality ratio in Slovakia was one of the highest in European Union. Decreasing of caesarean section rate and episiotomy, incidence of severe acute maternal morbidity and maternal mortality still need to be improved in Slovak Republic.

• MeSH
• Cesarean Section MeSH
• Eclampsia MeSH
• Embolism, Amniotic Fluid MeSH
• Epidemiologic Studies MeSH
• Episiotomy MeSH
• Hysterotomy methods   MeSH
• Incidence MeSH
• Data Interpretation, Statistical MeSH
• Obstetric Labor Complications MeSH
• Humans MeSH
• Maternal Mortality * MeSH
• Morbidity * MeSH
• Perineum injuries   MeSH
• Postpartum Period MeSH
• Rupture MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Geographicals
• Slovakia MeSH

Abnormálně invazivní placenta (AIP) představuje jedno z nejaktuálnějších témat současného porodnictví. Na zvýšené incidenci AIP má vliv narůstající počet výkonů na děloze, v první řadě císařský řez, ale i operace myomů a další. Nejvýznamnějším opatřením v předporodní péči je ultrazvuková diagnostika, především u žen s rizikovými faktory abnormální invaze trofoblastu. Problematika vyžaduje mezioborovou spolupráci a individuální přístup ke každé pacientce. Hlavním cílem managementu je minimalizovat riziko život ohrožujícího krvácení v souvislosti s porodem. Pokud se během císařského řezu potvrdí trofoblastická invaze do stěny děložní, zejména plošně rozsáhlá, volíme nejčastěji hysterektomii s ponecháním placenty v děloze. Tam, kde je k dispozici zkušený operatér, nejspíše s onkologicko-gynekologickou erudicí, je možné postupovat chirurgicky. Pokud je čistě operační řešení spojeno s vyšším rizikem pro pacientku a zkušený operatér není vždy k dispozici, lze uvažovat o zajištění omezením cévního zásobení metodami intervenční radiologie. Podmínkou je ale zkušený a vždy dostupný intervenční radiolog na hybridním operačním sále. Konzervativní přístup s vyjmutím placenty a ošetřením zdrojů krvácení volíme jen v případech fokální placenta accreta a při přání žen zachovat fertilitu.

Abnormal placental invasion (AIP) is one of the obstetrics most actual topics today. Increased incidence is caused through increased number of surgeries performed on uterus, caesarean sections but also myomectomies. Prenatal ultrasound diagnostics can predict the risk of AIP with increasing sensitivity and specificity, AIP management requires an individual multidiscipline approach. Main goal of the management is to eliminate the risk of life threatening bleeding. When during the cesarean section the invasion of trophoblast to uterine wall is obvious (especially if widespread) we rather choose to perform hysterectomy without removing the placenta from the uterus. If a skilled operator, usually with onco-gynecologic background is available; we can proceed with surgical removal of the uterus. If the surgical approach would be connected with higher risk for the patient, and the skilled operator would not always be available, it is possible to limit the threatening bleeding by means of interventional radiology. In this case, a skilled and available radiologist, together with necessary equipment (hybrid operation theatre) must be available. Conservative approach with placenta removal and treatment of sources of bleeding can be chosen only in cases of focal placenta accreta or when the patient pretends on fertility preservation.

• MeSH
• Cesarean Section * MeSH
• Hysterectomy * MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Metrorrhagia etiology   prevention & control   MeSH
• Interdisciplinary Communication MeSH
• Myometrium surgery   MeSH
• Peripartum Period MeSH
• Placenta Accreta * diagnosis   etiology   surgery   MeSH
• Prenatal Care MeSH
• Risk Factors MeSH
• Pregnancy MeSH
• Patient Care Team MeSH
• Ultrasonography, Prenatal MeSH
• Ultrasonography MeSH
• Delivery, Obstetric MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH