OBJECTIVE: To present a case of a patient who developed acute Sheehan's syndrome, despite adequate estimated blood loss. CASE REPORT: Sheehan's syndrome is a relatively rare disease with various incidences, mainly due to different obstetric care factors in individual countries. Pathogenetic mechanisms are not fully understood. An important factor is reduced blood flow through the pituitary arteries caused by hypotension in the setting of postpartum hemorrhage. Subsequent clinical manifestations depend on the extent of damage to the pituitary gland, and consequently, on the loss of individual hormones, the secretion of which is controlled by the pituitary gland. Most patients are diagnosed years later. Our case describes a patient with Sheehan's syndrome that developed in the early postpartum period. The patient was successfully diagnosed and adequate replacement therapy was started. CONCLUSION: In summary, acute Sheehan's syndrome is a rare occurrence. Agalactia, amenorrhea, fatigue, and other non-specific symptoms should be considered despite its rarity.

• Klíčová slova
• acute Sheehan syndrome, hypopituitarism, puerperium,
• MeSH
• akutní nemoc MeSH
• dospělí MeSH
• hypopituitarismus * diagnóza   etiologie   komplikace   MeSH
• lidé MeSH
• poporodní krvácení etiologie   diagnóza   MeSH
• poruchy v puerperiu diagnóza   etiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

OBJECTIVE: The description of rare case of the Cushings syndrome in pregnancy resulting in the spontaneous rupture of uterus. DESIGNS: A case report. SETTING: Department of Gynecology and Obstetrics, 1st Medical Faculty of Charles University and Hospital Na Bulovce. CASE REPORT: The authors report the case of a 33 year old woman, who was admitted to the clinic in 30th week of pregnancy for elevated blood pressure and hypokalemia. Arterial hypertension was corrected with the combination of Vasocardin and Dopegyt. In 36th week of pregnancy the patient was admitted to the hospital with premature rupture of membranes. In less than sixteen hours the patient spontaneously gave birth to a healthy girl. Subsequently the patient suffered from abdominal pain. CT scan showed haemoperitoneum and a right adrenal mass and the surgical revision was performed. During the surgery uterine rupture was identified and the patient uderwent abdominal hysterectomy. Based on the endocrinological examination the diagnosis of Cushings syndrome was made. Three months after the delivery she underwent laparoscopic right adrenalectomy. Histological examination revealed adrenocortical oncocytoma. CONCLUSION: Cushings syndrome is rare in pregnancy and misdiagnosis is common. Symptoms mimic pregnancy complications. The disease is often diagnosed with delay even after delivery. The sonography and magnetic resonance are dominant imaging methods. Laboratory diagnosis is difficult due to pregnancy related changes. In spite of rarity of Cushings syndrome in pregnancy we should think about it in terms of the differential diagnosis of hypertension, diabetes, dysbalance of mineralogram and typical cushingoid habitus.

• Klíčová slova
• Cushings syndrome in pregnancy, adrenocotical oncocytoma, hypertension uterine rupture.,
• MeSH
• adrenalektomie MeSH
• adrenokortikální nádory diagnóza   MeSH
• Cushingův syndrom diagnóza   chirurgie   MeSH
• dospělí MeSH
• hemoperitoneum diagnóza   chirurgie   MeSH
• hysterektomie škodlivé účinky   MeSH
• laparoskopie MeSH
• lidé MeSH
• nádorové komplikace v těhotenství diagnóza   chirurgie   MeSH
• oxyfilní adenom diagnóza   chirurgie   MeSH
• počítačová rentgenová tomografie MeSH
• poruchy v puerperiu diagnóza   chirurgie   MeSH
• reoperace MeSH
• ruptura dělohy diagnóza   chirurgie   MeSH
• spontánní ruptura MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

INTRODUCTION: Women with previous gestational diabetes mellitus (GDM) have increased risk of developing glucose abnormality, but current diagnostic criteria are evidence-based for adverse pregnancy outcome. THE AIMS OF OUR STUDY WERE: (i) to ascertain a frequency of early conversion of GDM into permanent glucose abnormality, (ii) to determine predictive potential of current GDM diagnostic criteria for prediction of postpartum glucose abnormality and (iii) to find optimal cut-off values of oral glucose tolerance test (oGTT) to stratify GDM population according to postpartum risk. MATERIALS AND METHODS: Electronic medical records of an ethnically homogenous cohort of women diagnosed and treated for GDM in a single medical centre during the period 2005-2011 who completed postpartum oGTT up to 1 year after the index delivery were retrospectively analysed (N=305). RESULTS: Postpartum glucose abnormality was detected in 16.7% subjects. Mid-trimester oGTT values, respective area under the curve and HbA1c were significantly associated with early postpartum glucose abnormality (P<0.05, Mann-Whitney) and exhibited significant predictive potential for postpartum glucose abnormality risk assessment. Optimal cut-off values for discrimination of at-risk sub-population were identified using ROC analysis and their comparison with WHO and IADPSG criteria exhibited superiority of IADPSG for risk-stratification of GDM population. CONCLUSION: Risk-based stratification at the time of GDM diagnosis could improve efficiency of the post-gestational screening for diabetes. IADPSG criteria seem to optimally capture both perinatal and maternal metabolic risks and are therefore medically and economically justified.

• Klíčová slova
• diagnosis, gestational diabetes, glucose intolerance, oral glucose tolerance test, postpartum period,
• MeSH
• dospělí MeSH
• druhý trimestr těhotenství krev   MeSH
• gestační diabetes diagnóza   epidemiologie   MeSH
• glukózový toleranční test * MeSH
• glykovaný hemoglobin analýza   MeSH
• hodnocení rizik MeSH
• lidé MeSH
• náchylnost k nemoci MeSH
• omezení příjmu potravy krev   MeSH
• plocha pod křivkou MeSH
• porucha glukózové tolerance diagnóza   epidemiologie   MeSH
• poruchy v puerperiu diagnóza   epidemiologie   MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• ROC křivka MeSH
• screeningové krevní testy v těhotenství * MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Názvy látek
• glykovaný hemoglobin MeSH

OBJECTIVES: To compare the laboratory course of HELLP syndrome between patients who recover and those who progress to postpartum thrombotic microangiopathic syndrome (PTMS) and require postpartum plasma exchange (PPEX) and to describe maternal characteristics and morbidity in women with PTMS. METHODS: In this retrospective analysis, 81 patients recovered and 5 progressed. Values for aspartate aminotransferase (AST), lactate dehydrogenase (LDH), bilirubin, platelets (Plt), urea, and creatinine at 0, 8, 16, 24, 48, and 72 hours postpartum in both groups were analyzed and compared. We also described maternal characteristics and morbidity of patients who progressed to PTMS. RESULTS: Patient groups differed significantly at 72 hours postpartum for Plt and LDH values and at 24 and 48 hours for bilirubin. Trends for AST and Plt differed significantly between the recovery and progression groups in the first 48 hours. Patients who progressed had acute kidney injury and other severe maternal morbidity, including one case of maternal death. CONCLUSIONS: Women with HELLP syndrome without clear Plt and AST improvement in the first 48 hours and with acute kidney injury, neurological impairment, or respiratory distress syndrome are at risk of progressing to PTMS. They should be administered PPEX between 24 and 72 hours postpartum.

• Klíčová slova
• HELLP syndrome, Maternal morbidity, Plasmapheresis, Postpartum plasma exchange, Postpartum thrombotic microangiopathic syndrome,
• MeSH
• časové faktory MeSH
• dospělí MeSH
• HELLP syndrom * krev   diagnóza   terapie   MeSH
• lidé MeSH
• narození živého dítěte * MeSH
• poporodní období krev   MeSH
• poruchy v puerperiu * krev   diagnóza   terapie   MeSH
• těhotenství MeSH
• trombotické mikroangiopatie * krev   diagnóza   terapie   MeSH
• výměna plazmy * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH

Cerebral venous thrombosis (CVT) is a serious condition affecting mostly women. This report concerns two cases of women who developed CVT within 14 days of cesarean delivery. Magnetic resonance angiography of the brain (venous phase) is the best modality to diagnose the condition, and parenteral application of low-molecular-weight heparin is the most beneficial treatment. The first patient was found to have an elevated factor VIII level. In the second patient, homozygosity of the C677T mutation in the 5,10-methylenetetrahydrofolate reductase gene was found. The puerperal period and Cesarean Section (CS) are risk factors for thrombotic complications, including CVT. It is necessary to search for risk factors in a patient's history and within the group of at-risk patients to prolong preventive administration of low molecular weight heparin (LMWH). CVT (including puerperium related) is not a detrimental to future pregnancies.

• MeSH
• císařský řez škodlivé účinky   MeSH
• dospělí MeSH
• faktor VIII analýza   MeSH
• lidé MeSH
• magnetická rezonanční angiografie MeSH
• methylentetrahydrofolátreduktasa (NADPH2) genetika   MeSH
• mutace MeSH
• poruchy v puerperiu diagnóza   etiologie   MeSH
• rizikové faktory MeSH
• těhotenství MeSH
• trombóza nitrolebních žilních splavů diagnóza   etiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• faktor VIII MeSH
• methylentetrahydrofolátreduktasa (NADPH2) MeSH

OBJECTIVE: To analyze the course and delivery outcomes of pregnancies complicated by HELLP syndrom and compare them to previously published data. DESIGN: Retrospective cohort study. SUBJECT AND METHOD: We analyzed pregnancy outcomes of 34 pregnancies complicated by HELLP syndrom of women who delivered at our hospital between years 2004 and 2009. SETTING: Department of Obstetrics and Gynecology, University Hospital Ostrava. RESULTS: There were 34 pregnancies and deliveries complicated by HELLP syndrom between the years 2004 and 2009 (64 months). The average age of mothers was 28.5 years, the average gestational age at delivery time was 33 weeks and 4 days. Only 2 women delivered vaginaly, the other 32 delivered by cesarean section and the average weight of the newborn was 1930 g. There were 3 twin pregnacies. Twenty two (65%) patients had laboratory abnormalities in coagulation parameters but clinical signs of coagulation disorder were noted in 8 patients only (23.5%). Six patients recevied blood transfusions (18 units in total) and 9 patients received plasma transfusions (20 units in total). The average length of stay of mothers at intensive care unit was 3.2 days. There was no maternal mortality. One fetus was stillborn and 12 newborns (33.3%) had their early postnatal period complicated by severe morbidity. CONCLUSION: Early diagnosis and active management is a major factor for the prevention of severe forms of HELLP syndrom which still remains one of the most severe complications of pregnancy.

• MeSH
• dospělí MeSH
• HELLP syndrom * krev   diagnóza   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nemoci novorozenců etiologie   MeSH
• novorozenec MeSH
• poruchy v puerperiu diagnóza   MeSH
• těhotenství MeSH
• vedení porodu MeSH
• výsledek těhotenství * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Caesarean section is the most frequent abdominal operation carried out in obstetric practice. Parturients undergoing this operation are still exposed to a substantial rate of short- and long-term complications. The incidence of re-laparotomy after caesarean section is 0.12-0.70%. The most common indication for re-laparotomy is intra-abdominal bleeding, uterine atony, eventration, haematoma in the muscle and intra-abdominal abscesses. We present the case report of an unusual life-threatening complication of caesarean section that led to re-laparotomy. Caesarean section rate has been continually increasing globally in the last few decades, thus we also have to take into account unusual complications e.g. intestinal complication.

• MeSH
• adheze tkání komplikace   MeSH
• císařský řez škodlivé účinky   MeSH
• dospělí MeSH
• laparotomie MeSH
• lidé MeSH
• nemoci ilea diagnóza   chirurgie   MeSH
• poruchy v puerperiu diagnóza   chirurgie   MeSH
• reoperace MeSH
• střevní obstrukce diagnóza   etiologie   chirurgie   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Pregnancy-associated breast cancer (PABC) is a rare and challenging problem. We sought to describe epidemiology, management and outcome of women in whom breast cancer was diagnosed during pregnancy or within one year after delivery. Thirty-two women with PABC were referred to two European Union oncology centers between 1995 and 2007, 16 during pregnancy and 16 within 1 year after delivery. Data concerning diagnosis, management, delivery and fetal and maternal outcome were recorded. A group of 32 patients (matched controls) presenting with nonpregnancy-associated breast cancer (non-PABC) was matched for age at diagnosis, tumor size and stage to each PABC patient. Differences in outcome between the PABC and non-PABC groups were then assessed. Histological features were similar in both groups, except that estrogen receptor-negative tumors were more common in the PABC group. Three patients received chemotherapy and two others underwent surgery during pregnancy, with no excess toxicity or severe maternal/fetal adverse effects. All children in the PABC group were healthy, except for one exposed to epirubicin in utero and born with rectal atresia. Overall survival was similar in PABC and non-PABC patients (p = 0.449). The subgroup of patients with breast cancer diagnosed within one year after delivery showed a shorter time to relapse than controls or patients with gestational cancer (p = 0.0178). PABC is a special situation, necessitating individualized, multi-disciplinary management. Prognosis is similar for women with nongestational cancer matched for age and stage though poorer outcome postpartum should be further investigated.

• MeSH
• císařský řez MeSH
• indukovaný potrat statistika a číselné údaje   MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• nádorové komplikace v těhotenství diagnóza   mortalita   chirurgie   terapie   MeSH
• nádory prsu diagnóza   mortalita   patologie   terapie   MeSH
• poruchy v puerperiu diagnóza   mortalita   patologie   terapie   MeSH
• protinádorové látky terapeutické užití   MeSH
• radioterapie MeSH
• receptor erbB-2 analýza   MeSH
• receptory pro estrogeny analýza   MeSH
• receptory progesteronu analýza   MeSH
• retrospektivní studie MeSH
• těhotenství MeSH
• vedení porodu MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Řecko MeSH
• Názvy látek
• ERBB2 protein, human MeSH Prohlížeč
• protinádorové látky MeSH
• receptor erbB-2 MeSH
• receptory pro estrogeny MeSH
• receptory progesteronu MeSH

AIM: This case study reports an occurence of a mammary gland carcinoma in woman during her pregnancy and puerperium. CASE REPORT: Patient was 29 years old woman, without any familiar or personal history of cancer or cancer risk factors. There was a finding of palpable resistance in the lateral superior quadrant of right breast in 30 week of gestation, which was considered to be hormonal changes in pregnancy. The third day after delivery a breast ultrasonography was performed because of persisting mastodynia, moderate oedema in described area and resistance nonresponding to the typical finding in period of incipient lactation. The result was suspicious of tumor. The core cut biopsy revealed invasive ductal carcinoma grade 3 and the staging was determinated as T4b N2 M1 (liver). Because of the high clinical stage of the disease, primary sugical therapy (modified radical mastectomy) was not indicated and the patient underwent neoadjuvant chemotherapy followed byradiotherapy. There was a control PET scan after the chemotherapy which confirmed only residual tumor in the area of affected breast and no viable tumor cells in the area of the liver. Additional reduction of the primary tumor lesion occured after the radiotherapy. The control examination 3 months after the treatment found the statement of the relapse of disease. At the present time, 14 months after the delivery, the paliative chemotherapy is planned. CONCLUSION: Obstetricians should take care not only for routine examinations of pregnant women, but also of the breast changes and when there are uncertain, they must use appropriate diagnostic methods.

• MeSH
• dospělí MeSH
• duktální karcinom prsu diagnóza   terapie   MeSH
• lidé MeSH
• nádorové komplikace v těhotenství diagnóza   terapie   MeSH
• nádory prsu diagnóza   terapie   MeSH
• poruchy v puerperiu diagnóza   terapie   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: A case report describing postpartal nontraumatic sacral fracture. DESIGN: A case report and biomechanical commment. SETTING: Institute of anatomy, 2nd Medical faculty, Charles University at Prague. SUMMARY: Nontrauma--related stress fractures of the sacrum are rare complications of the pregnancy and postpartal period. We report a new case of nontrauma-related postpartal sacral fracture. A 36-year-old woman after second delivery presented symptoms of left L 5 radiculopathy. MRI of the lumbar spine and pelvis demonstrated a vertical fracture through the left sacral wing, paralel to the left sacroiliac joint (type Denis I). Fracture was surrounded by prominent bone marrow oedema. Biomechanical factors contributing to the stress fractures of the pelvic girdle in pregnancy and post partum are discussed.

• MeSH
• dospělí MeSH
• fraktury páteře diagnóza   etiologie   MeSH
• komplikace porodu * MeSH
• křížová kost zranění   MeSH
• lidé MeSH
• poruchy v puerperiu diagnóza   MeSH
• stresové fraktury diagnóza   etiologie   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH