of recommendations Preventive measures and procedures We recommend monitoring of blood loss in women with risk factors for PPH during labor using calibrated blood collectors or their equivalents. (Good Clinical Practice) We recommend that women with significant risk factors for PPH (e.g., placenta acrreta spectrum or hematologic disorders requiring consultative hematologic care) deliver in a perinatal intensive care center or perinatal intermediate care center. (Good Clinical Practice) We recommend formulating a plan of care in collaboration with a multidisciplinary team at a reasonable time prior to delivery for patients at high risk of PPH. (Good Clinical Practice) We recommend treating anemia antepartally. Pregnant women should be given iron supplements if the haemoglobin level falls to < 110 g/L in the 1st trimester or < 105 g/L at 28 weeks of pregnancy. (Good Clinical Practice) We suggest considering parenteral iron administration in women with sideropenic anemia unresponsive to oral iron supplementation. The cause of anemia should be identified as soon as possible after termination of pregnancy. (Weak recommendation) If the baby adapts well, we do not recommend cord ligation in less than 1 min. (Strong recommendation) In all vaginal deliveries, we recommend prophylactic administration of uterotonics in the third postpartum period after the delivery of the baby and cord ligation to reduce the risk of PPH. The first-choice drug is oxytocin. (Strong recommendation) If the third stage of labor has not been actively managed, we suggest that uterine massage and controlled umbilical cord traction be considered to shorten the duration of the third stage of labor and to reduce blood loss during vaginal delivery, if performed by a qualified healthcare professional. (Weak recommendation) We recommend the administration of uterotonics to prevent the development of PPH in women after the delivery of a child by caesarean section and umbilical cord ligation. (Strong recommendation) We suggest considering carbetocin administration in women at increased risk of PPH. (Weak recommendation) We recommend a single-dose administration of tranexamic acid (TXA) in women at increased risk of PPH undergoing a caesarean section. Clinical note: The use of TXA prior to the caesarean section is not explicitly stated in the product's SPC. A recent meta-analysis states the most common dosage to be 1 g i.v. (Strong recommendation) Organization of care We recommend that every health care facility with an OB/GYN unit should have the PPH management protocol (guided document is not specific or really used at all, I am not sure if my suggestion is sufficient) defining the organizational and professional procedure for PPH situations. (Good Clinical Practice) We recommend that the PPH management protocol (i.e. the crisis action plan) should clearly define the organizational and professional roles of the individual members of the crisis team in the event of PPH (non-medical staff), obstetrician, anesthetist, hematologist, etc.) and define the minimum scope of equipment for the care of patients with PPH. (Good Clinical Practice) We recommend regular simulation training of PPH crisis by the entire crisis team with a subsequent debriefing or its formalized equivalent. (Good Clinical Practice) We recommend defining quality indicators for the diagnosis and treatment of PPH and their formalized evaluation at regular intervals, at least once a year. (Good Clinical Practice) Diagnostic and treatment procedure at PPH When hypotonia or atony of the uterus is found, we recommend using a structured procedure. (Good Clinical Practice) At departments with an option of endovascular interventions, we suggest considering the preferential use of radiological interventional methods (selective pelvic artery embolization) in cases of PPH due to uterine hypotonia or atony, if the current clinical context allows it. (Weak recommendation) For all stages of PPH development, we recommend a pre-transfusion examination. In addition to standard laboratory tests, point-of-care-testing methods, especially viscoelastic methods, are preferred to assess the current coagulation status. (Good Clinical Practice) Each obstetric unit should ensure a sufficient stock of blood products and blood derivatives for their immediate availability 24/7 in collaboration with the transfusion department and the inpatient pharmacy. In case of PPH development, we recommend securing initial availability of 4 units of plasma (solvent/detergent-treated plasma is preferred), 4 units of erythrocytes and 6 g of fibrinogen. We consider 8 g to be a minimum supply of fibrinogen and additional 8 g should be available within 1 h. (Good Clinical Practice) We recommend the initiation of immediate fluid resuscitation in all patients with PPH. We recommend the use of balanced crystalloid solutions to initiate fluid resuscitation. (Strong recommendation) We propose considering the use of synthetic colloid solutions containing gelatin when hemodynamic goals of fluid resuscitation have not been achieved or are not being achieved using crystalloid solutions and when a fluid deficit persists. (Weak recommendation) Until the source of bleeding is controlled, we recommend aiming for a systolic blood pressure in a range of 80-90 mmHg in patients with PPH. (Strong recommendation) We recommend the use of vasopressors as soon as possible in PPH when target arterial blood pressure values cannot be reached by ongoing fluid resuscitation. (Strong recommendation) We recommend cooperation with a hematologist in the diagnosis and treatment of coagulopathy in PPH unresponsive to standard therapies. (Good Clinical Practice) In addition to the above-mentioned panel laboratory tests (at least KO, aPTT, fibrinogen), we also recommend using viscoelastic methods (ROTEM, TEG) to identify the type of coagulation disorder in PPH, to monitor it and for targeted treatment of hemostasis disorders. (Strong recommendation) To achieve/restore the efficacy of endogenous hemostatic mechanisms and coagulation support therapies, we recommend the maximum possible correction of hypothermia, acidosis and ionized calcium levels. (Strong recommendation) Early initiation of all available procedures to prevent hypothermia and maintain or achieve normothermia is recommended. (Strong recommendation) It is recommended monitoring and maintaining ionized calcium levels within the normal range when administering transfusion products. Preferably, calcium chloride should be administered for correction. (Strong recommendation) Fibrinogen replacement is recommended in patients with PPH when fibrinogen levels fall to < 2 g/L and/or when there is a functional fibrinogen deficiency detected by viscoelastic methods and/or when there is a reasonable clinical assumption of fibrinogen deficiency even without knowledge of fibrinogen levels. We recommend a minimum of 4 g of fibrinogen as an initial dose in PPH. (Strong recommendation) It is recommended to administer tranexamic acid (TXA) at an initial dose of 1 g i.v. as soon as possible after the onset of PPH. An identical dose may be repeated (after 30 min at the earliest) if bleeding continues and if hyperfibrinolysis is demonstrated and/or if hyperfibrinolysis is highly likely in the current clinical context. (Strong recommendation) We do not recommend further administration of TXA in patients with PPH after bleeding control has been achieved. (Strong recommendation) We recommend administration of plasma at a dose of 15-20 mL/kg in PPH conditions where coagulopathy of a different etiology than fibrinogen deficiency is suspected and/or abnormal coagulation test results are present, and where the results do not reliably identify the predominant mechanism of the coagulation disorder and its targeted correction. (Strong recommendation) We recommend the administration of prothrombin complex factors (PCC) in patients with PPH where there is a laboratory evidence of a deficiency of PCC factors. We do not recommend routine administration of PCC in patients with PPH. (Strong recommendation) We suggest considering administration of rFVIIa before making a decision on an endovascular or a surgical intervention. (Weak recommendation) In patients with PPH, we recommend administration of erythrocyte blood products to achieve a target hemoglobin value in the range 70-80 g/L. (Strong recommendation) In patients with PPH, we recommend platelet administration to achieve a target value of at least 50 × 109/L and/or when platelet function impairment is suspected or demonstrated. (Strong recommendation) We do not recommend routine measurement of antithrombin III levels in patients with PPH. (Strong recommendation) We do not recommend routine antithrombin III replacement in patients with PPH. (Strong recommendation) We recommend initiating pharmacological prophylaxis for thromboembolic disease as soon as possible after control of the source of PPH is achieved. We recommend initiating mechanical thromboprophylaxis (intermittent pneumatic compression or elastic stockings) as soon as the clinical condition permits. (Strong recommendation).

• Klíčová slova
• crisis management, hemorrhage prevention, hemostatic intrauterine devices, peripartum hemorrhage, pressure and subpressure intrauterine devices, recombinant factor VIIa, simulation medicine, uterotonic prophylaxis, viscoelastic methods,
• MeSH
• lidé MeSH
• poporodní krvácení * diagnóza   terapie   prevence a kontrola   MeSH
• rizikové faktory MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Publikační typ
• tisková chyba MeSH

BACKGROUND: Clinically silent uterine rupture with complete fetal expulsion into the abdominal cavity is an extremely rare complication. Diagnosis can be difficult and the risk to the mother and fetus is high. Conservative management has been described only in a few cases of partial expulsion of the fetus so far. CASE PRESENTATION: We present a case of 43-year-old tercigravida with a history of previous laparotomic myomectomy and subsequent cesarean section. The subsequent pregnancy was complicated by uterine wall loosening and rupture at the site of the previous uterine scar after myomectomy and complete fetal expulsion into the abdominal cavity. The diagnosis was made at 24 + 6 weeks of gestation. Considering the absence of clinical symptomatology and the good condition of the fetus, a conservative approach was chosen with intensive monitoring of the maternal and fetal conditions. The pregnancy ended by elective cesarean section and hysterectomy at 28 + 0 weeks of gestation. The postpartum course was uneventful and the newborn was discharged to home care 63 days after delivery. CONCLUSIONS: Fetal expulsion into the abdominal cavity after silent uterine rupture of the scarred uterus may be accompanied by minimal symptomatology making early diagnosis difficult. This rare complication must be considered in the differential diagnosis in women after major uterine surgery. In selected cases and under conditions of intensive maternal and fetal monitoring, conservative management may be chosen to reduce the risks associated with prematurity.

• Klíčová slova
• Abdominal pregnancy, Fetal expulsion, Silent uterine rupture, Uterine scar,
• MeSH
• břišní dutina * MeSH
• císařský řez škodlivé účinky   MeSH
• dospělí MeSH
• konzervativní terapie škodlivé účinky   MeSH
• lidé MeSH
• novorozenec MeSH
• ruptura dělohy * etiologie   chirurgie   diagnóza   MeSH
• těhotenství MeSH
• uterus MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

OBJECTIVES: The presented study aimed to describe the dynamics of the serum levels of the complement components C3, C4, and C1 inhibitor in women immediately before and after giving birth by caesarean section (CS). DESIGN AND SETTING: 57 pregnant women undergoing caesarean section were included in this prospective observational study. Blood samples were taken 30 minutes before CS and 30 minutes after the delivery. C3, C4, and C1 inhibitor levels were analysed and the functional C1 inhibitor test performed. Angiotensin-converting enzyme concentrations before delivery were also determined. RESULTS: Before delivery, C3 value was elevated above the reference limits for the healthy adult population in 39% of patients. Following birth, C3 median value dropped from 1.4 to 1.2 g/L. C1 inhibitor concentrations were also reduced - the median value of the C1 inhibitor before the birth was 222 mg/L, dropping to 198 mg/L after delivery. Even before the CS, C1 inhibitor concentrations were below reference range in 40% of patients, which increased to 56% after delivery; its activity however did not significantly change. In two patients with perioperative uterine hypotonia, notable complement activation was detected. ACE levels were below the normative values for adult population in 25% of patients. CONCLUSION: Concentrations of all analysed components significantly decreased after delivery, which was not associated with blood loss or amount of intravenous liquids. This highlights the necessity of proper reporting of the time point of blood sampling in any studies or case reports detailing the immunological condition of patients in the peripartal period.

• MeSH
• biologické markery MeSH
• císařský řez * MeSH
• dospělí MeSH
• lidé MeSH
• prospektivní studie MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Názvy látek
• biologické markery MeSH

• MeSH
• anesteziologie MeSH
• císařský řez statistika a číselné údaje   trendy   MeSH
• dospělí MeSH
• lidé MeSH
• porodnická anestezie statistika a číselné údaje   trendy   MeSH
• průzkumy a dotazníky 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 MeSH
• Slovenská republika MeSH

Hemorrhagic shock is a severe complication of conditions that are accompanied by massive bleeding and is associated with high mortality and morbidity. The authors summarize the recent knowledge in the pathophysiology of coagulopathy in the course of its development and some options in treatment strategy.

• Klíčová slova
• coagulopathy, diagnosis, etiology, hemorrhagic shock, pathophysiology, treatment,
• MeSH
• hemoragický šok * etiologie   terapie   MeSH
• krvácení komplikace   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

AIMS: The purpose of this international survey was to describe the impact of current practices and techniques of caesarean section on the neonatal Apgar score in the Czech Republic (CZE) and Slovakia (SVK). METHODS: All Czech and Slovak departments that provide obstetric anaesthesia were invited to participate in a one-month (November 2015) prospective study that monitored in details all peripartum anaesthetic practices, delivered by anaesthesiologists. Participating centers recorded all data on-line in the CLADE-IS database (Masaryk University, CZE). RESULTS AND DISCUSSIONS: We collected data of 10119 women who delivered 10226 newborns. A caesarean section was recorded in 25.1% of deliveries (CZE 23.2%; SVK 30%). General anaesthesia was used for caesarean section in 37.5% of the cases (CZE 40%, SVK 33%). There was no statistically significant difference in the Apgar score lower than 7 in the 1, 5 or 10 min in groups of general and regional anaesthesia for caesarean section, when only elective sections of in-term babies with birth weight over 2500 g were analyzed. We found no statistically significant differences in the Apgar score in newborns of women intubated for caesarean section in rocuronium (n=21; 2.2%) and suxamethonium (n=889; 93%). CONCLUSION: We found no difference in neonatal outcomes in groups of general and regional anaesthesia for caesarean section when only out-of-risk newborns were analyzed. The risk factors were identified as follows: an acute caesarean section, preterm babies, birth weight less than 2 500 g, born in perinatological center and multiple pregnancy - second baby. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NCT02380586) https://clinicaltrials.gov/ct2/show/NCT02380586.

• Klíčová slova
• Apgar score, caesarean section, general anaesthesia, international survey, neonatal outcome, rapid sequence induction, rocuronium, suxamethonium,
• MeSH
• Apgar skóre * MeSH
• celková anestezie statistika a číselné údaje   MeSH
• císařský řez metody   MeSH
• depolarizující myorelaxancia terapeutické užití   MeSH
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• nedepolarizující myorelaxancia terapeutické užití   MeSH
• novorozenec MeSH
• porodnická anestezie MeSH
• retrospektivní studie MeSH
• rokuronium terapeutické užití   MeSH
• sukcinylcholin terapeutické užití   MeSH
• svodná anestezie statistika a číselné údaje   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Slovenská republika MeSH
• Názvy látek
• depolarizující myorelaxancia MeSH
• nedepolarizující myorelaxancia MeSH
• rokuronium MeSH
• sukcinylcholin MeSH

BACKGROUND: Rocuronium for cesarean delivery under general anesthesia is an alternative to succinylcholine for rapid-sequence induction of anesthesia because of the availability of sugammadex for reversal of neuromuscular blockade. However, there are no large well-controlled studies in women undergoing general anesthesia for cesarean delivery. The aim of this noninferiority trial was to determine whether rocuronium and sugammadex confer benefit in time to tracheal intubation (primary outcome) and other neuromuscular blockade outcomes compared with succinylcholine, rocuronium, and neostigmine in women undergoing general anesthesia for cesarean delivery. METHODS: We aimed to enroll all women undergoing general anesthesia for cesarean delivery in the 2 participating university hospitals (Brno, Olomouc, Czech Republic) in this single-blinded, randomized, controlled study. Women were randomly assigned to the ROC group (muscle relaxation induced with rocuronium 1 mg/kg and reversed with sugammadex 2-4 mg/kg) or the SUX group (succinylcholine 1 mg/kg for induction, rocuronium 0.3 mg/kg for maintenance, and neostigmine 0.03 mg/kg for reversal of the neuromuscular blockade). The interval from the end of propofol administration to tracheal intubation was the primary end point with a noninferiority margin of 20 seconds. We recorded intubating conditions (modified Viby-Mogensen score), neonatal outcome (Apgar score <7; umbilical artery pH), anesthesia complications, and subjective patient complaints 24 hours after surgery. RESULTS: We enrolled 240 parturients. The mean time to tracheal intubation was 2.9 seconds longer in the ROC group (95% confidence interval, -5.3 to 11.2 seconds), noninferior compared with the SUX group. Absence of laryngoscopy resistance was greater in the ROC than in the SUX groups (ROC, 87.5%; SUX, 74.2%; P = 0.019), but there were no differences in vocal cord position (P = 0.45) or intubation response (P = 0.31) between groups. No statistically significant differences in incidence of anesthesia complications or in neonatal outcome were found (10-minute Apgar score <7, P = 0.07; umbilical artery pH, P = 0.43). The incidence of postpartum myalgia was greater in the SUX group (ROC 0%; SUX 6.7%; P = 0.007). The incidence of subjective complaints was lower in the ROC group (ROC, 21.4%; SUX, 37.5%; P = 0.007). CONCLUSIONS: We conclude that rocuronium for rapid-sequence induction is noninferior for time to tracheal intubation and is accompanied by more frequent absence of laryngoscopy resistance and lower incidence of myalgia in comparison with succinylcholine for cesarean delivery under general anesthesia.

• MeSH
• androstanoly aplikace a dávkování   škodlivé účinky   MeSH
• antidota aplikace a dávkování   škodlivé účinky   MeSH
• časové faktory MeSH
• celková anestezie * škodlivé účinky   MeSH
• cholinesterasové inhibitory aplikace a dávkování   škodlivé účinky   MeSH
• císařský řez * škodlivé účinky   MeSH
• dospělí MeSH
• gama-cyklodextriny aplikace a dávkování   škodlivé účinky   MeSH
• intratracheální intubace MeSH
• jednoduchá slepá metoda MeSH
• laryngoskopie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• myalgie etiologie   prevence a kontrola   MeSH
• nedepolarizující myorelaxancia aplikace a dávkování   škodlivé účinky   MeSH
• neostigmin aplikace a dávkování   škodlivé účinky   MeSH
• nervosvalová blokáda škodlivé účinky   metody   MeSH
• pooperační bolest etiologie   prevence a kontrola   MeSH
• porodnická anestezie škodlivé účinky   metody   MeSH
• rokuronium MeSH
• sugammadex MeSH
• sukcinylcholin aplikace a dávkování   MeSH
• těhotenství MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• androstanoly MeSH
• antidota MeSH
• cholinesterasové inhibitory MeSH
• gama-cyklodextriny MeSH
• nedepolarizující myorelaxancia MeSH
• neostigmin MeSH
• rokuronium MeSH
• sugammadex MeSH
• sukcinylcholin MeSH

BACKGROUND: The purpose of this national survey was to determine current anesthesia practices for cesarean delivery in the Czech Republic. METHODS: In November 2011, we invited all departments of obstetric anesthesia in the Czech Republic to participate in a prospective study to monitor consecutive peripartum obstetric anesthesia procedures. Data were recorded online in the TrialDB database (Yale University, New Haven, CT). RESULTS: The response rate was 51% (49 of 97 departments); participating centers represented 60% of all births in the country during the study period. There were 1943 cases of peripartum anesthesia care, of which 1166 cases (60%) were anesthesia for cesarean delivery. Estimates were weighted based on population distribution of cesarean delivery among types of participating centers. Neuraxial anesthesia was used in 55.6% (95% confidence interval [CI], 52.8%-58.5%); the distribution of anesthesia techniques differed among type of participating center. The rate of neuraxial anesthesia in university hospitals was 55.6% (95% CI, 51.5%-59.6%), 32.4% (95% CI, 26.4%-39.0%) in regional hospitals, and 60.7% (95% CI, 55.2%-66.0%) in local hospitals. The reasons for cesarean delivery under general anesthesia were emergency procedure (67%), refusal of neuraxial blockade by parturient (30%), failure of neuraxial anesthesia (6%), and preoperative administration of low-molecular-weight heparin (3%). Postcesarean analgesia was primarily provided by systemic opioid (66%) and nonopioid analgesics (61%), solely or in combination. Epidural postoperative analgesia was used in 14% of cases. Compared with national neuraxial anesthesia rate data published in the 1990s (6.7% in 1993), there has been an upward trend in the use of neuraxial anesthesia for cesarean delivery during the 21st century (40.5% in 2000) in the Czech Republic. CONCLUSIONS: The rate of neuraxial anesthesia use for cesarean delivery has increased in the Czech Republic in the last 2 decades. However, the current rate of general anesthesia is high compared with other Western countries.

• MeSH
• časové faktory MeSH
• celková anestezie trendy   MeSH
• centra s nižším počtem specializovaných operací trendy   MeSH
• císařský řez škodlivé účinky   trendy   MeSH
• elektivní chirurgické výkony MeSH
• epidurální analgezie trendy   MeSH
• lékařská praxe - způsoby provádění trendy   MeSH
• lidé MeSH
• náhlé příhody MeSH
• nemocnice univerzitní trendy   MeSH
• pooperační bolest prevence a kontrola   MeSH
• porodnická analgezie trendy   MeSH
• porodnická anestezie škodlivé účinky   trendy   MeSH
• průzkumy zdravotní péče MeSH
• specializovaná centra se zvyšujícím se počtem výkonů a tím zvyšující se kvalitou léčby trendy   MeSH
• spinální anestezie trendy   MeSH
• svodná anestezie škodlivé účinky   trendy   MeSH
• těhotenství MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVE: To analyze the data related to the treatment of 80 Czech patients with life threatening postpartum haemorrhage recorded in the clinical registry UniSeven during years 2004-2009. DESIGN: Retrospective, observational, multicentre study. SETTINGS: ICU and Obstetrics departments of University and Regional hospitals in Czech Republic. MATERIAL AND METHODS: UniSeven is an international academic project of Masaryk University in Brno, Czech Republic, focused on recording of clinical data related to "off-label" use of rFVIIa (Novo Seven) in life threatening bleeding. Data of 80 case reports of post partum haemorrhage from the registry was analysed from the clinical (efficacy and safety) as well as laboratory aspects. RESULTS: In 97.5% of our patients the treatment with rFVIIa was able to control the bleeding. In 53 women (66.3%) only one dose of rFVIIa was sufficient to control the bleeding. The rest of the patient received two or more rFVIIa doses. First dose of rFVIIa given to patients who needed more than one dose was significantly lower (96.6 microg/kg) compared to patient succesfully treated with one dose only (110.6 microg/kg; p = 0.048). The mortality rate in our cohort of patients was 2.5%. We have not recorded any thrombembolic event as and adverse event related to the rFVIIa treatment. In 74.3% of patients where rFVIIa was administered before considering the hysterectomy, it was able to avoid hysterectomy what we consider to be a significant improvement of the patients' quality of life. CONCLUSIONS: Our data were also considered during the work up of national guidelines for the treatment of life threatening post-partum haemorrhage in the Czech Republic.

• MeSH
• dospělí MeSH
• faktor VIIa škodlivé účinky   terapeutické užití   MeSH
• krvácení farmakoterapie   MeSH
• lidé MeSH
• poporodní krvácení terapie   MeSH
• registrace MeSH
• rekombinantní proteiny škodlivé účinky   terapeutické užití   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• faktor VIIa MeSH
• recombinant FVIIa MeSH Prohlížeč
• rekombinantní proteiny MeSH