OBJECTIVE: We present a rather rare case of isolated fetal ascites. We summarize its possible causes and diferential diagnostic procedure, our pregnancy managment and final outcome of the child. STUDY DESIGN: Case report. SETTINGS: Gynekologicko-porodnická klinika, Masarykova nemocnice, Ústí nad Labem; Neonatologická klinika, Masarykova nemocnice, Ústí nad Labem. METHODS: The pacient 18-years-old, I/0, was admitted to our clinic in the 32nd week of pregnancy with the dia-gnosis of significant isolated fetal ascites. Gradually, the most common causes of isolated ascites were excluded by the examination algorithm: developmental defects of GIT, urogenital tract and heart defects, genetic disorders, metabolic defects and immune and nonimmune causes of fetal hydrops. During the hospitalization, ascites lightening puncture was performed twice because of the significant lung tissue compression - without significant long-term effect. At the gestational age of 33+4, caesa-rean delivery was indicated for extreme ascites growth and significant lung tissue relapse. A boy of 2150 g with a serious respiratory distress was born. Immediately after delivery in the operating theatre a relieving ascites puncture was performed and the ventilation parameters improved immediately thereafter. During the following hospitalization the ascites has spontaneously, completely and definitely resorbed. The newborn was released into home care 49 days after delivery. CONCLUSION: Idiopatic isolated fetal ascites is a relatively rare diagnosis with a favourable outcome. The etiology of ascites could not be identified.
- Klíčová slova
- fetal ascites, isolated,
- MeSH
- ascites * MeSH
- dítě MeSH
- gestační stáří MeSH
- hydrops fetalis MeSH
- lidé MeSH
- mladiství MeSH
- nemoci plodu * MeSH
- novorozenec MeSH
- těhotenství MeSH
- ultrasonografie prenatální metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
OBJECTIVE: The article reviews the causes of thrombocytopenia in pregnancy and the basic examination scheme. Further, it deals in more details with diagnosis of immune thromocytopenic purpura (ITP) and presents a case report of a rare case of acute severe ITP in pregnant adolescent. DESIGN: Review article and case report. SETTINGS: Department Obstet/Gynecol Uni J. A. Purkyně and Masaryk´s Hospital, Ústí nad Labem; Children and adolescent dep. Hospital Most; Institute of Hematology and Blood Transfusion Prague; Department of Children Med. Uni J. A. Purkyně and Masaryk´s Hospital, Ústí nad Labem; Department of Clinic Hematology Masaryk´s Hospital, Ústí nad Labem; Department of Neonatology Uni J. A. Purkyně and Masaryk´s Hospital, Ústí nad Labem. METHODS: Based on a review of the published papers, general rules for diagnosis, treatment, fetal risks, pregnancy management and labor in women with immune thrombocytopenic purpura (ITP) are given. Further we present the case of a 16-year-old pregnant girl with an acute severe form of ITP not responding to corticosteroid treatment who underwent twice critical decline of platelets up to 1×109 and repeatedly it was necessary to access the application of IVIG and Azathioprim (Imuran) was also used in her treatment. Pregnancy was unplanned terminated for dg. placental abortion in gestational age 32+4.The girl of 1740 g/42 cm was born with Apgar score 10-10-10 with no signs of thrombocytopenia. Surgery and postoperative course in the mother without complications. The newborn was discharged from the hospital into home care at a gestational age of 36+1 along with his mother. RESULTS: We present a case of acute severe form of ITP in pregnancy with a successful though somewhat dramatic end. CONCLUSIONS: These rare cases are demanding in terms of logistical, personnel and material provision. The aim of the treatment is to achieve a satisfactory maturity of the fetus, the treatment is financially demanding and is not without risks. Therefore, these cases should only be dealt with at Perinatology Centers in close cooperation with hematologists and neonatologists.
- Klíčová slova
- immune trobocytopenic purpura, pregnancy,
- MeSH
- gestační stáří MeSH
- hematologické komplikace těhotenství * krev terapie MeSH
- idiopatická trombocytopenická purpura * komplikace terapie MeSH
- komplikace těhotenství MeSH
- lidé MeSH
- mladiství MeSH
- novorozenec MeSH
- porod MeSH
- rizikové faktory MeSH
- těhotenství MeSH
- trombocytopenie * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
THE AIM OF THE STUDY: To highlight the risks associated with pregnancy at women with von Willebrand´s disease or hemophilia. Introduce the rules of multidisciplinary prenatal and peripartal care to minimalize these risks. The article is accompanied by case report where maladministration led to fatal consequences for the newborn. DESIGN: Review and case report.Seatings: Department Obstetric and Gynecology UJEP and Masaryk´s Hospital Ústí n/Labem, Institute Haematology and Blood Transfer Prague, Children´s Haemato-onkology Clinic University Hospital Prague Motol.Coclusions: The pregnancy in both above-mentioned diseases is risky. The close multidisciplinary collaboration is required.
- Klíčová slova
- pregnancy, von Willebrad´s disease hemophilia.,
- MeSH
- dospělí MeSH
- hematologické komplikace těhotenství krev MeSH
- hemofilie A krev MeSH
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- von Willebrandova nemoc krev MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
UNLABELLED: Fetal macrosomia is associated with an increased risk of perinatal mortality and morbidity for both, mother and fetus. The frequency of these births is between 1.3 to 1.5%. Macrosomic fetuses are defined with a weight of 4500 g and more. Diagnosis and prediction of macrosomia or fetal birth weight is key to determine the tactics of delivery. It is based on the combination and assessment of medical history, clinical parameters and ultrasound biometry. The limit for elective caesarean section is considered the estimated fetal weight in healthy mothers of more than 5000 g. For mothers with diabetes an indication of the caesarean section should be considered for fetal weight of more than 4000 g. DESIGN: A review of the literature.
- Klíčová slova
- caesarean section, fetal macrosomia, induction., vaginal delivery,
- MeSH
- císařský řez škodlivé účinky MeSH
- lidé MeSH
- makrosomie plodu etiologie MeSH
- novorozenec MeSH
- perinatální mortalita MeSH
- porodnost MeSH
- rizikové faktory MeSH
- těhotenství MeSH
- ultrasonografie prenatální MeSH
- vedení porodu škodlivé účinky metody MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The case report focuses on the case of heavy Graves - Basedow thyreotoxicosis in 33 years old secundipara who was transferred to our departement from regional hospital for decompensation of gestational hypertension, oligohydramnios and the suspition on intrauterine growth restriction (IUGR). In our clinical praxis the problems of thyroid gland in terms of its reduced function in pregnant women are getting more frequent. The goal of this article is to describe the less often situation, the hyperthyroidism in the third trimestr of the pregnancy. Thyretoxicosis in pregnancy is associated with higher risk of preterm labour, preeclampsia, IUGR, heart failure and stillbirth. Some of these complications confirmes our case report.
- Klíčová slova
- hyperthyroidism., pregnancy, thyreotoxicosis,
- MeSH
- dospělí MeSH
- hypertenze indukovaná těhotenstvím * MeSH
- hypertyreóza * MeSH
- komplikace těhotenství * MeSH
- lidé MeSH
- narození mrtvého plodu MeSH
- novorozenec MeSH
- oligohydramnion * MeSH
- předčasná porodní činnost MeSH
- preeklampsie MeSH
- růstová retardace plodu * MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
OBJECTIVE: The analysis of perinatal results in pregnant women with multiple sclerosis (MS) and the assessment of the influence of pregnancy on this chronic disease in the population of pregnant women in our hospital in the years 2003-2011. DESIGN: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology and Department of Neurology, 2nd Faculty of Medicine, Charles University and the Motol Hospital, Prague. METHODS: Sixty-six women with the diagnosis of MS were included in our study in the years 2003-2011. All these women delivered at our clinic and were neurologically followed until the end of six months post partum. We evaluated the influence of pregnancy on the activity of the disease during the pregnancy and 6 months after delivery, the impact on the disability progression, the influence of the mode of delivery, the analgesia used, and breastfeeding, on the relapse rate post partum. We also assessed the impact of multiple sclerosis on the course of the pregnancy, where we looked for pregnancy complications in patients with multiple sclerosis, differences in the management of labor, and the results of newborns of mothers with this disease. We performed a statistical analysis. RESULTS: Relapse during pregnancy occurred in 4 of the 66 women (6.1%, relapse rate - RR 0.1);17 women experienced a post partum relapse in the first six months after delivery (25.7%, RR 0.5). From our sample of 44 women breastfed (66.7%), 10 had relapse (10/44, 22.7%) in comparison with the 7 women out of a total of 22 who did not breastfed (7/22, 31.8%). No statistical significance was established, OR = 0.6 (0.2-2.0), p = 0.5518. Epidural analgesia (EDA) was used by 16 women (24.2%). Post partum relapse experienced 3 women that used EDA (3/16, 18.8%) and 14 women that did not use EDA (14/50, 28 %). OR = 0.6 (0.1-2.4), p = 0.5325. Neither breastfeeding, nor epidural analgesia correlated with presence of a post partum relapse. Pregnancy did not influence disability progression, EDSS (Disability status scale, Kurtzke`s scale) before pregnancy and after delivery was stable (EDSS 1.5 or EDSS 1.6). Vaginal delivery had 77% women, post partum relapse had 15 of them (15/50, 30%), 12 women (18.1%) had a caesarean section, relapse occure at 2 of them (2/16, 12.5%), three births (4.5%) were completed by vaginal extraction operations. Five women (7.6%) delivered before 37th week of pregnancy. Birth weight under 2500 g was found in 9 women (13.6%). The incidence of serious pregnancy complications was not increased, intrauterine growth retardation (IUGR) was confirmed in 4 births (6%). CONCLUSION: There is no need to worry about pregnancy in patients with multiple sclerosis. Therapy provides long-term remission of the disease, and during pregnancy itself due to hormonal changes it is stabilized and the relapse rate decreases. In the post partum period relapse rate increases, however, the pregnancy did not influence disability progression. The mode of delivery in women with this disease is not different from the general population. Neither breastfeeding, nor epidural analgesia correlated with presence of a post partum relapses. The number of complications in pregnancy is not increased and the overall perinatal outcomes are comparable with the general population.
22 experts from the fields of gynecology and obstetrics, anesthesiology and resuscitation, intensive care, hematology and transfusion medicine has developed recommendations for diagnosis and procedure for life-threatening peripartum haemorrhage, which is still one of the most common causes of maternal mortality in childbirth. This guidelines, which is valid for the Czech Republic, supported by a total of 10 professional medical societies. There are based on new knowledge applicable at this time and is focused mainly on eliminating the most common causes of bleeding during delivery and prevention of haemorrhagic shock.
- MeSH
- lidé MeSH
- poporodní krvácení diagnóza etiologie terapie MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- konsensus - konference MeSH
- směrnice pro lékařskou praxi MeSH
- Geografické názvy
- Česká republika MeSH
OBJECTIVE: The purpose of this study was to determine whether maternal or fetal genotype frequencies of the inherited thrombophilic gene mutation (F V Leiden, F II) are altered in adverse pregnancy outcomes - severe preeclampsia, IUGR, abruption of placenta and stillbirth. DESIGN OF THE STUDY: Retrospective study. SETTING: Department of Gynecology and Obstetrics of the Teaching Hospital and the 2nd Medical Faculty of the Charles University in Prague. METHODS: We studied 232 women who had pregnancy complications. All women were tested postpartum for mutation of factor V Leiden and G20210A prothrombine gene. At the same time were tested the newborns of those women. RESULTS: In the group of women with preeklampsia (n=141) we have demonstrated 5 women with mutation encoding for F V, 5 women with mutation encoding for F II and 1 combination of both. In the group of IUGR 2 women with mutation F V, 1 with mutation F II a 1 combination of both were found. In women after stillbirth occure two mutation of F V, one mutation of F II and one combination of both. In the group with abruptio of placenta was 1 case of mutation F V and 3 cases of mutation F II. When we tested a newborn we found 4 cases of mutation F V and 3 cases of F II in the group with preeclampsia, 4 cases of mutation F V 3 cases od mutation of F II in the group with IUGR, no case in the group with abruptio of placenta and 1 case in a death fetus. There was no assotiation between any severe pregnancy complications and any of the maternal or fetal inherited thrombophilia. CONCLUSION: Factor V Leiden and prothrombin gene mutations did not seem play a significant role in adverse pregnancy outcome in our population.
- MeSH
- faktor V genetika MeSH
- lidé MeSH
- mutace * MeSH
- narození mrtvého plodu genetika MeSH
- novorozenec MeSH
- předčasné odlučování placenty genetika MeSH
- preeklampsie genetika MeSH
- protrombin genetika MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Názvy látek
- factor V Leiden MeSH Prohlížeč
- faktor V MeSH
- protrombin MeSH
