OBJECTIVE: Contemporary role of cerclage as a preterm birth treatment. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology of the First Faculty of Medicine and General Teaching Hospital in Prague. METHODS: Research of existing literature, predominantly foreign journal articles, but also Czech literature and personal experience with the method. RESULTS: Cerclage is one of the well-known surgical procedures carried out during pregnancy. Its aim is to provide a mechanical support to the cervical canal and to keep the cervix closed. The cervical mucous plug serves as a mechanical barrier between the vagina and the uterine cavity, but it also contains many immune components which protect the fetal compartment from ascendent infections. Application of a cervical stitch can help to retain the mucous plug and thus increases the immunity of the cervical canal. Results of 15 randomised studies (Cochraine Database of Systematic R) suggest that in women with increased risk of preterm birth, cerclage decreases the occurrence of preterm birth relative to the expectant management. CONCLUSIONS: Despite the decreasing numbers of cerclage surgeries, it is still a useful method of preterm birth prevention for a specific group of women. More recently, a progesterone treatment has gained popularity. Its application, however, must begin before the 16th week of pregnancy.

• Klíčová slova
• cerclage, cervical insufficiency, cervicometry, preterm birth,
• MeSH
• cerkláž cervikální metody   MeSH
• cervix uteri chirurgie   MeSH
• inkompetence hrdla děložního diagnóza   chirurgie   MeSH
• lidé MeSH
• měření délky hrdla děložního MeSH
• předčasný porod prevence a kontrola   MeSH
• prenatální péče MeSH
• randomizované kontrolované studie jako téma * MeSH
• těhotenství MeSH
• vagina MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Steroid profiling helps various pathologies to be rapidly diagnosed. Results from analyses investigating steroidogenic pathways may be used as a tool for uncovering pathology causations and proposals of new therapeutic approaches. The purpose of this study was to address still underutilized application of the advanced GC-MS/MS platform for the multicomponent quantification of endogenous steroids. We developed and validated a GC-MS/MS method for the quantification of 58 unconjugated steroids and 42 polar conjugates of steroids (after hydrolysis) in human blood. The present method was validated not only for blood of men and non-pregnant women but also for blood of pregnant women and for mixed umbilical cord blood. The spectrum of analytes includes common hormones operating via nuclear receptors as well as other bioactive substances like immunomodulatory and neuroactive steroids. Our present results are comparable with those from our previously published GC-MS method as well as the results of others. The present method was extended for corticoids and 17alpha-hydroxylated 5alpha/ß-reduced pregnanes, which are useful for the investigation of alternative "backdoor" pathway. When comparing the analytical characteristics of the present and previous method, the first exhibit by far higher selectivity, and generally higher sensitivity and better precision particularly for 17alpha-hydroxysteroids.

• MeSH
• biologické markery krev   MeSH
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• plynová chromatografie s hmotnostně spektrometrickou detekcí metody   normy   MeSH
• steroidy krev   MeSH
• tandemová hmotnostní spektrometrie metody   normy   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• biologické markery MeSH
• steroidy MeSH

Intrahepatic cholestasis of pregnancy (ICP) is a frequent liver disorder, mostly occurring in the third trimester. ICP is not harmful to the mothers but threatens the fetus. The authors evaluated steroid alterations in maternal and mixed umbilical blood to elucidate their role in the ICP development. Ten women with ICP were included in the study. Steroids in the maternal blood were measured by Gas Chromatography-Mass Spectrometry (GC-MS) (n=58) and RIA (n=5) at the diagnosis of ICP, labor, day 5 postpartum, week 3 postpartum and week 6 postpartum. The results were evaluated by ANOVA consisting of the subject factor, between subject factors ICP, gestational age at the diagnosis of ICP and gestational age at labor, within-subject factor Stage and ICP × Stage interaction. The 17 controls were firstly examined in the week 36 of gestation. ICP patients showed reduced CYP17A1 activity in the C17,20 lyase step thus shifting the balance between the toxic conjugated pregnanediols and harmless sulfated 5alpha/beta-reduced-17-oxo C19 steroids. Hence, more toxic metabolites originating in maternal liver from the placental pregnanes may penetrate backward to the fetal circulation. As these alterations persist in puerperium, the circulating steroids could be potentially used for predicting the predisposition to ICP even before next pregnancy.

• MeSH
• biologické markery krev   MeSH
• dospělí MeSH
• genetická predispozice k nemoci genetika   MeSH
• intrahepatální cholestáza krev   diagnóza   genetika   MeSH
• jaterní testy trendy   MeSH
• komplikace těhotenství krev   diagnóza   genetika   MeSH
• lidé MeSH
• placentární oběh fyziologie   MeSH
• steroidy krev   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• biologické markery MeSH
• steroidy MeSH

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: To give attention to the rare complication of pregnancy. DESIGN: Case report. SETTINGS: Dept. of Obstetric and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital Prague. METHODS: Description of acute abdominal pain which imitated the appendicitis in case of the uterine rupture. CONCLUSION: The uterine rupture is the rare and very dangerous complication of pregnancy. In the time of increasing number of the cesarean section and the operation on the uterine wall, we must thing on the uterine rupture.

• MeSH
• akutní bolest břicha etiologie   MeSH
• apendicitida diagnóza   MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• komplikace těhotenství diagnóza   MeSH
• lidé MeSH
• odumření plodu etiologie   MeSH
• ruptura dělohy diagnóza   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

OBJECTIVE: To evaluate current knowledge about the management of preterm premature rupture of the membranes (PPROM). DESIGN: Review article. SETTING: Perinatological center, Department of Gynecology and Obstetrics, General Faculty Hospital and 1st Medical School of Charles University, Prague. METHODS AND RESULTS: Expectant management in case of PPROM increases the incidence of infection/ inflammation but does not statistically increase mortality and serious morbidity of the infants. The incidence of infants morbidity corresponds with gestational age. The most serious complications occur in the lower gestational age. It is necessary to take an individual approach. The acute management increases the number of operative deliveries and respiratory distress syndrome (RDS) in the infants. The combination of RDS, extremely prematurity and hypoxia during the labour decreases the infants survival rate. CONCLUSIONS: The prolongation of the latency period in pregnancies above 28th week does not deteriorate the neonatal mortality or morbidity.

• MeSH
• chorioamnionitida MeSH
• lidé MeSH
• nemoci nedonošenců etiologie   prevence a kontrola   MeSH
• novorozenec MeSH
• předčasná porodní činnost diagnóza   terapie   MeSH
• předčasný odtok plodové vody diagnóza   terapie   MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVE: Evaluation of antenatal care, perinatal mortality, neonatal mortality, maternal mortality, number of births, the incidence of low birth weight infants in Albania. DESIGN OF THE STUDY: Retrospective study. SETTING: Queen Geraldine University Hospital of Tirana, Albania. METHODS: The population of this country is estimated to be approximately 3,2 million and comprises very young people. Twenty five percent of the population is under 15 years of age and 46% is under 25 years [2]. The fertility rate in 2009 was 1.6 children per woman of childbearing age. The urban population accounts for 45% and the rural population for the remaining 55% of the total population [2]. The health care system is spread across nearly the entire territory and is classified as primary (villages and small towns), secondary (several cities) and tertiary (in the capital, University Hospital). Primary health care is provided at 2327 health care units. The chief activity of the family doctors and general practitioners working in such units are focused on providing health care for mother and children. Ten percent of the annual births are delivered at the Maternity Hospital of Tirana (tertiary care) which has 300 beds and another 40 beds particularly for premature infants. More than 50% of the high risk pregnancies from other districts are referred to the Maternity Hospital of Tirana. RESULTS: The annual live births in Albania was in (2010) 33,856. The total perinatal mortality rate is 10,9 per 1000 live births. The total neonatal mortality rate in 2010 was 9.7 per 1000 live births. The early postnatal mortality rate was 6.1 per 1000 births. Number of maternal deaths for 100, 000 live births was 6.0 in 2010.

• MeSH
• centra péče o matku a dítě MeSH
• kojenecká mortalita * trendy   MeSH
• lidé MeSH
• mateřská mortalita * trendy   MeSH
• novorozenec MeSH
• porodnost MeSH
• prenatální péče MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Albánie epidemiologie   MeSH

Pregnant women are often threatened by hypertension, symptoms of preterm labour, hepatopathy, and other. These complications might be the consequence of genetic factors together with involvement of environmental factors. We were searching for three polymorphisms Arg654Lys, Ala678Pro and Thr686Ala in exon 5, and two polymorphisms Phe802Leu, Ser827Ser/Leu in exon 7, and for the new mutations in exons 5 and 7 of the pregnancy-associated plasma protein A gene in the studied group consisting of 203 women - 79 pregnant women in time of preterm labour, 24 pregnant women suffering from preeclampsia, and 100 healthy pregnant and non-pregnant women serving as controls. We did not find any divergence from wild-type form of these polymorphisms in any of the studied groups, which led us to the hypothesis that these polymorphisms are not associated with our studied group of Caucasian origin. However, further studies with a larger group of subjects are needed to confirm our results.

• MeSH
• dospělí MeSH
• exony genetika   MeSH
• lidé MeSH
• novorozenec MeSH
• polymorfismus genetický genetika   MeSH
• předčasná porodní činnost genetika   MeSH
• preeklampsie genetika   MeSH
• rizikové faktory MeSH
• těhotenský plazmatický protein A genetika   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• těhotenský plazmatický protein A MeSH

OBJECTIVE: Review of the physiological role of neuroactive and neuroprotective steroids in human pregnancy. DESIGN: A review article. SETTING: Gynecological-Obstetrical Clinic, 1st Medical Faculty, Charles University and General Hospital, Prague. CONCLUSION: Human parturition is a multi-factorial process. Various mechanisms related to the onset of labor were suggested. Estrogens show accelerating increase in late pregnancy, which probably reflect the increasing activity of fetal zone of the fetal adrenal. This zone is stimulated by progressive increase of placental CRH resulting in excessive production of conjugated 3beta-hydroxy-5-en-steroids, which are transported by circulation to placenta and further metabolized to active hormones. Some progesterone metabolites probably participate in pregnancy sustaining via modulation of ligand-gated ion channels in the CNS and periphery. In this review, the question was addressed whether the catabolism of pregnancy sustaining progesterone metabolites accelerate like the estrogen formation.

• MeSH
• estrogeny fyziologie   MeSH
• hormon uvolňující kortikotropin fyziologie   MeSH
• lidé MeSH
• porodní děj fyziologie   MeSH
• progesteron analogy a deriváty   fyziologie   MeSH
• těhotenství MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• estrogeny MeSH
• hormon uvolňující kortikotropin MeSH
• progesteron MeSH

A specific pathogenic process of premature delivery represents the inflammation. Birth canal infections seem to play a key role in the ethiopathogenesis of premature delivery; the related biochemical changes significantly affect perinatal morbidity and mortality. Other potential causes, particularly hormone metabolism disorders or uteroplacental ischaemia have been intensively studied. This process is related both to the mother and fetus. Fetal inflammatory response (FIRS)--can occur without maternal response--and it is related to a significant increase in perinatal morbidity. FIRS has definite laboratory, histological and clinical criteria. Effective primary prevention of premature delivery does not exist at present. The sensitivity and specificity of so far used laboratory markers is low. Thus, the research is focused on finding new inflammation markers allowing the early identification of pregnant women at a high risk of premature delivery and fetal inflammation. The screening of women at a high risk by means of new laboratory and ultrasound tests belongs to the most important steps in secondary and tertiary prevention of premature delivery. Intensive research of potential trigger mechanisms has been carried out, including a variety of gene types, which are potentially related to the process of premature delivery.

• MeSH
• lidé MeSH
• předčasná porodní činnost etiologie   patofyziologie   MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH