AIMS: To assess whether vaginal labor after a previous caesarean section in a low gestational week performed by means of a high placed U-section technique could be recommended by obstetricians as a sufficiently safe method of choice for pregnant women. METHODS: Of 309 pregnant women with a history of a high placed U-section, 166 (53.7%) met the criteria for the subsequent vaginal delivery and agreed with it. In 78%, vaginal labor started spontaneously and in 22% it was induced due to postterm pregnancy or preterm rupture of membranes. RESULTS: Vaginal labor was successful in 72.3% of women. Deliveries after spontaneous onset of uterine contractions (80%) were considerably more successful. In the group of women with induced labor, the success rate was below 50%. Uterine rupture was not encountered in the study group. CONCLUSIONS: Vaginal labor after a previous high placed U-section is a sufficiently safe method of choice for selected groups of pregnant women, but it has to be mentioned that selecting criteria can only minimize and not entirely exclude the risk of uterine rupture.

• MeSH
• císařský řez metody   MeSH
• lidé MeSH
• novorozenec nedonošený MeSH
• novorozenec MeSH
• porodní hmotnost MeSH
• prospektivní studie MeSH
• ruptura dělohy prevence a kontrola   MeSH
• studie případů a kontrol MeSH
• těhotenství MeSH
• vaginální porod po císařském řezu metody   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: The aim of the study was to evaluate the effect of substitution therapy in heroin addicted pregnant women on the course of pregnancy, perinatal outcomes and course of the neonatal abstinence syndrome. DESIGN OF THE STUDY: A five-year randomised prospective comparative study METHODS: The study was carried out in the period of 2002-2007. The group of patients included 147 i.v. heroin-addicted pregnant women. All of them were outpatients of our Perinatal Care Unit. Their daily dose of heroin was approximately lg. Later, 30 women were disqualified from the study for breaking the randomised criteria engagement. The substitution therapy in women who agreed to undergo it, started during the I. trimester of pregnancy. Finally, 47 heroin, 32 methadone and 38 buprenorphine addicted women were enrolled in the study. Birthweight of newborns was compared with the national birthweight tables. Severity and duration of neonatal abstinence syndrome (NAS) were evaluated by Finnegan s score scale. RESULTS: None of the women delivered before the end of 34th gestational week. We did not encounter any perinatal death or developmental defect. The lowest birthweight, the highest number of newborns with IUGR and the most numerous placental changes were found in the group of heroin-addicted women. The differences compared to the two groups receiving substitution therapy were statistically significant (p < 0.05). The severity and course of NAS were the most severe (p < 0.001) in newborns of women from the methadone group. CONCLUSION: Comparison of the groups of outpatients is in many ways questionable because of the restricted possibility of the patients' control. The lifestyle of addicted women has the same impact as the drug use alone. This is probably the main reason for differences in some of the monitored parameters between individual groups. Based on our results we can state that substitution therapy provides pregnant women with the possibility of social stabilization and adequate prenatal care. substitution therapy decreases the street heroin consumption. Methadone notably protracts the newborn's abstinence syndrome. With regard to this fact, attention has been recently focused on substitution with buprenorphine that seems to be from this viewpoint a more considerate option.

• MeSH
• buprenorfin škodlivé účinky   terapeutické užití   MeSH
• dospělí MeSH
• heroin aplikace a dávkování   škodlivé účinky   MeSH
• lidé MeSH
• methadon škodlivé účinky   terapeutické užití   MeSH
• narkotika škodlivé účinky   terapeutické užití   MeSH
• novorozenec MeSH
• novorozenecký abstinenční syndrom patofyziologie   prevence a kontrola   MeSH
• pacienti ambulantní MeSH
• poporodní období účinky léků   MeSH
• porodní hmotnost účinky léků   MeSH
• prospektivní studie MeSH
• růstová retardace plodu chemicky indukované   patofyziologie   MeSH
• stupeň závažnosti nemoci MeSH
• těhotenství MeSH
• výsledek těhotenství MeSH
• závislost na heroinu rehabilitace   MeSH
• životní styl MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Názvy látek
• buprenorfin MeSH
• heroin MeSH
• methadon MeSH
• narkotika MeSH

AIM: To compare the efficacy of the ursodeoxycholic acid (UDCA) and S-adenosyl-L-methionine (SAMe) monotherapy with their combined effect on intrahepatic cholestasis of pregnancy (ICP). PATIENTS AND METHODS: We studied singleton pregnancies at <36 weeks with a moderate or severe form of ICP between January 1999 and March 2004. Patients were randomized to either oral UDCA 3x250 mg daily or 500 mg SAMe twice daily in slow running infusion for twelve days followed by oral administration of 500 mg twice daily until delivery. Intensive hematological, biochemical and fetal monitoring were carried out. RESULTS: Of the 78 women enrolled, 25 received SAMe monotherapy, 26 received UDCA, and 27 received combined therapy. Groups were initially comparable in terms of gestational age, duration of therapy, parity and biochemical characteristics. All therapies improved the pruritus. The combined therapy and the monotherapy with UDCA (later) led to improving of the serum concentrations of bile acids and transaminases compared with SAMe monotherapy (P<0.01). Combined therapy led to a faster decrease of serum concentrations of bile acids and transaminases compared with UDCA monotherapy (borderline significance). Gestational ages were similar in all groups. No adverse effects were noted on the fetuses or neonates with either therapy. CONCLUSIONS: UDCA is an effective drug in the treatment of ICP, and combined with SAMe, has probably a synergistic effect on biochemical parameters. This mode of treatment seems more effective but the effect of the successful treatment on the fetus is unclear. Therefore, the ante- and intrapartum monitoring of the fetus should be part of the management of severe forms of ICP. The project is supported by IGA MZ CR (No. NH/7376-3).

• MeSH
• cholagoga a choleretika terapeutické užití   MeSH
• dospělí MeSH
• intrahepatální cholestáza krev   farmakoterapie   MeSH
• kombinovaná farmakoterapie MeSH
• komplikace těhotenství krev   farmakoterapie   MeSH
• kyselina ursodeoxycholová terapeutické užití   MeSH
• lidé MeSH
• novorozenec MeSH
• S-adenosylmethionin terapeutické užití   MeSH
• těhotenství MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Názvy látek
• cholagoga a choleretika MeSH
• kyselina ursodeoxycholová MeSH
• S-adenosylmethionin MeSH