INTRODUCTION: The aim of this study was to evaluate, in women with preterm prelabor rupture of membranes (PPROM), the impact on short-term neonatal outcome of microbial invasion of the amniotic cavity (MIAC), intra-amniotic inflammation (IAI), and the microorganisms isolated in women with MIAC, when gestational age is taken into account. MATERIAL AND METHODS: Prospective cohort study. We included women with PPROM (22.0-34.0 weeks of gestation) with available information about MIAC, IAI and short-term neonatal outcome. MIAC was defined as positive aerobic/anaerobic/genital Mycoplasma culture in amniotic fluid. Definition of IAI was based on interleukin-6 levels in amniotic fluid. Main outcome measures were Apgar score <7 at 5 min, umbilical artery pH ≤7.0, days in the neonatal intensive care unit, and composite neonatal morbidity, including any of the following: intraventricular hemorrhage grade III-IV, respiratory distress syndrome, early-onset neonatal sepsis, periventricular leukomalacia, necrotizing enterocolitis, and fetal or neonatal death. Labor was induced after 32.0 weeks if lung maturity was confirmed; and otherwise after 34.0 weeks. RESULTS: MIAC and IAI were found in 38% (72/190) and 67% (111/165), respectively. After adjustment for gestational age at delivery, no differences in short-term neonatal outcome were found between women with either MIAC or IAI, compared with the non-infection/non-inflammation ("No-MIAC/No-IAI") group. Furthermore, short-term neonatal outcome did not differ between the MIAC caused by Ureaplasma spp. group, the MIAC caused by other microorganisms group and the "No-MIAC/No-IAI" group. CONCLUSIONS: Gestational age at delivery seems to be more important for short-term neonatal outcome than MIAC or IAI in PPROM.

• Klíčová slova
• Interleukin-6, intra-amniotic inflammation, microbial invasion of the amniotic cavity, preterm birth, preterm prelabor rupture of membranes, short-term neonatal outcome,
• MeSH
• aerobní bakterie izolace a purifikace   MeSH
• anaerobní bakterie izolace a purifikace   MeSH
• Apgar skóre MeSH
• chorioamnionitida diagnóza   etiologie   mikrobiologie   MeSH
• gestační stáří * MeSH
• intenzivní péče o novorozence statistika a číselné údaje   MeSH
• lidé MeSH
• logistické modely MeSH
• Mycoplasma izolace a purifikace   MeSH
• nemoci nedonošenců etiologie   terapie   MeSH
• novorozenec nedonošený MeSH
• novorozenec MeSH
• plodová voda mikrobiologie   MeSH
• předčasný odtok plodové vody mikrobiologie   MeSH
• prospektivní studie MeSH
• těhotenství MeSH
• Ureaplasma izolace a purifikace   MeSH
• výsledek těhotenství MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: The aim of this single-center study was to identify factors that affect the short-term outcome of newborns delivered around the limits of viability. METHODS: A group of 137 pregnant women who gave birth between 22+0/7 and 25+6/7 weeks of gestation was retrospectively studied. The center supports a proactive approach to infants around the limits of viability. Perinatal and neonatal characteristics were obtained and statistically evaluated. RESULTS: A total of 166 live-born infants were enrolled during a 6-year period; 162 (97.6%) of them were admitted to the neonatal intensive care unit (ICU) and 119 (73.5%) survived until discharge. The decrease in neonatal mortality was associated with an advanced gestational age (P<0.001) and a completed course of corticosteroids (P=0.002). Neonatal morbidities were common among infants of all gestational ages. The incidence of severe intraventricular hemorrhage significantly depended on gestational age (P<0.001) and a completed course of corticosteroids (P=0.002). Survival without severe neonatal morbidities was 39.5% and occurred mostly after 24+0/7 weeks of gestation. CONCLUSION: The short-term outcome of newborns delivered around the limits of viability is mostly affected by gestational age and antenatal corticosteroid treatment. A consistently proactive approach improves the survival of infants at the limits of viability. This is most pronounced in cases where the delivery is delayed beyond 24 completed gestational weeks.

• Klíčová slova
• Gray zone, limits of viability, neonatal morbidity, neonatal mortality, preterm delivery, proactive approach,
• MeSH
• kojenec MeSH
• kojenecká mortalita * MeSH
• lidé MeSH
• novorozenci extrémně nezralí * MeSH
• novorozenec MeSH
• retrospektivní studie MeSH
• těhotenství MeSH
• výsledek těhotenství * MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: To evaluate the influence of microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA) on short-term neonatal outcome in women with preterm prelabor rupture of membranes before 34 weeks of gestation. METHODS: A prospective observational cohort study including 122 pregnant women with PPROM between 24+0 and 34+0. MIAC was defined as a positive PCR result for Ureaplasma species, Mycoplasma hominis and Chlamydia trachomatis and/or positive PCR result for the 16S rRNA gene in the amniotic fluid. HCA was defined according to the Salafia classification. Maternal and short-term neonatal outcomes were evaluated according to the presence or absence of MIAC and/or HCA. RESULTS: The presence of both MIAC and HCA was observed in 36% (45/122) of women, HCA alone in 34% (41/122) and MIAC in 5% (6/122). A significantly higher incidence of early onset sepsis was observed in newborns born from women with both MIAC and HCA [33% (15/45)] compared with women with HCA alone [12% (5/41)] or MIAC alone [0% (0/6)] or women without MIAC or HCA detected [0% (0/30); p = 0.001]. CONCLUSIONS: The presence of both MIAC and HCA increases the risk of early onset sepsis in pregnancies complicated by preterm prelabor rupture of membranes before 34 weeks of gestation.

• Klíčová slova
• Histological chorioamnionitis, microbial invasion of the amniotic cavity, preterm delivery, short-term neonatal outcome,
• MeSH
• chorioamnionitida epidemiologie   mikrobiologie   MeSH
• dospělí MeSH
• gestační stáří MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• novorozenecká sepse epidemiologie   MeSH
• plodová voda mikrobiologie   MeSH
• předčasný odtok plodové vody epidemiologie   MeSH
• prospektivní studie MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

BackgroundTo characterize the influence of microbial invasion of the amniotic cavity (MIAC) and/or intra-amniotic inflammation (IAI) on the intensity of the fetal inflammatory response and the association between the presence of the fetal inflammatory response syndrome (FIRS) and short-term neonatal morbidity in the preterm prelabor rupture of membranes (PPROM) between the gestational ages of 34 and 37 weeks.MethodsOne hundred and fifty-nine women were included in the study. The umbilical cord blood interleukin (IL)-6 concentrations were determined using enzyme-linked immunosorbent assay kits. FIRS was defined based on the umbilical cord blood IL-6 concentration and the presence of funisitis and/or chorionic plate vasculitis.ResultsWomen with both MIAC and IAI had the highest median umbilical cord blood IL-6 concentrations and highest rates of FIRS. Women with FIRS had the higher rates of early-onset sepsis and intraventricular hemorrhage grades I and II when FIRS was characterized based on the umbilical cord blood IL-6 concentrations and the histopathological findings.ConclusionThe presence of both MIAC and IAI was associated with a higher fetal inflammatory response and a higher rate of FIRS. Different aspects of short-term neonatal morbidity were related to FIRS when defined by umbilical cord blood IL-6 concentrations and the histopathology of the placenta.

• MeSH
• Chlamydia trachomatis MeSH
• chorioamnionitida mikrobiologie   MeSH
• dospělí MeSH
• ELISA MeSH
• fetální krev chemie   MeSH
• gestační stáří MeSH
• interleukin-6 krev   MeSH
• lidé MeSH
• Mycoplasma hominis MeSH
• novorozenec MeSH
• placenta patologie   MeSH
• plodová voda mikrobiologie   MeSH
• předčasný odtok plodové vody mikrobiologie   MeSH
• prospektivní studie MeSH
• těhotenství MeSH
• Ureaplasma metabolismus   MeSH
• vaskulitida mikrobiologie   MeSH
• výsledek těhotenství MeSH
• zánět mikrobiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• IL6 protein, human MeSH Prohlížeč
• interleukin-6 MeSH

PURPOSE: Congenital club foot is one of the most common birth defects involving the musculoskeletal system. At present two methods are used for the treatment of this deformity: French and Ponseti method. The purpose of this study was to compare the short-term (up to three years) and long-term (three to seven years) results of treatment with the Ponseti method. METHODS: A total of 195 consecutive infants (143 boys and 52 girls) with idiopathic club foot treated with the Ponseti method in the period of 2005-2012 were included in this study; the total number of feet was 303. The severity of the foot deformity was classified according to Diméglio. When relapse occurred up until three years of age, we started with the casting again. If conservative treatment was unsuccessful we proceeded to surgical treatment. RESULTS: Primary correction was attained in all cases. Surgical correction of relapses was performed in 30 % of patients according to the Ponseti method (re-tenotomy of the Achilles tendon and transposition of the tibialis anterior) and in 70 % by alternative techniques. The number of relapses indicated for surgery increased with increasing period of follow-up: whereas in patients where the treatment started already in 2005 relapses occurred in 72 %, in patients included in 2011 the number of recurrences only reached 3 %. CONCLUSIONS: It follows from our results that it is impossible to cure all club feet with casting, tenotomy of the Achilles tendon and transposition of the tibialis anterior only.

• MeSH
• Achillova šlacha chirurgie   MeSH
• časové faktory MeSH
• kojenec MeSH
• lidé MeSH
• manipulace ortopedická MeSH
• novorozenec MeSH
• osteotomie MeSH
• pes equinovarus chirurgie   MeSH
• recidiva MeSH
• sádrové obvazy MeSH
• tenotomie MeSH
• výsledek terapie MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

INTRODUCTION: The aim of this study was to compare to compare immediate delivery outcome as well as healing, pain, anal incontinence and sexuality in a short-term and a long-term follow up after episiotomy performed before or at crowning in nulliparous women. MATERIAL AND METHODS: This cohort study is a comparison of prospectively collected data evaluating the importance of the timing of episiotomy. Patients with episiotomy performed before crowning (n = 86) and at crowning (n = 404) were compared. Obstetric anal sphincter injuries rate, additional perineal or vaginal trauma, neonatal outcome, episiotomy length, 2nd stage of labor duration, blood loss, infection, hematoma, dehiscence, need for resuturing, pain, painful defecation, resumption of sexual intercourse, dyspareunia, anal incontinence and constipation were assessed immediately after delivery or from responses to questionnaires 24 and 72 h, 10 days, 3 and 6 months postpartum. RESULTS: The groups did not differ in age, body mass index, birthweight, occipito-posterior presentation, shoulder dystocia, or episiotomy type. Significant differences between before crowning and at crowning groups were observed in additional vaginal trauma [26 (30.2%) vs. 66 (16.3%), respectively, p < 0.001], mean episiotomy length (42 mm vs. 36 mm, p < 0.001), and mean estimated blood loss (367 mL vs. 344 mL, p < 0.001). Difference in obstetric anal sphincter injuries rate did not reach statistical significance [0 (0.0%) vs. 7 (1.7%), p = 0.61]. The groups did not differ in additional perineal trauma, pain (Visual Analogue Scale, Verbal Rating Scale and Activities of Daily Living scales), healing complications, sexual functions or anal incontinence in short-term or long-term follow up. CONCLUSIONS: Our results suggest that episiotomy performed at crowning is not associated with worse anatomical or functional delivery outcome, and support a restrictive approach to episiotomy. The effect of episiotomy timing on pelvic organ prolapse development remains to be determined.

• Klíčová slova
• Episiotomy, childbirth, crowning, delivery outcome, timing,
• MeSH
• časové faktory MeSH
• dospělí MeSH
• epiziotomie metody   MeSH
• fekální inkontinence MeSH
• hojení ran MeSH
• lidé MeSH
• měření bolesti MeSH
• pooperační komplikace MeSH
• prospektivní studie MeSH
• průzkumy a dotazníky MeSH
• sexuální chování MeSH
• těhotenství MeSH
• výsledek těhotenství * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

Licit and illicit drug use in pregnant women constitutes a long lasting and serious problem worldwide. Information on long-term effects of maternal drug use on the child is limited. Nationwide registers provide a great potential to study short and long-term consequences for children exposed to licit and illicit drugs during pregnancy. We discuss this potential, with a special emphasis on exposure to methamphetamine, heroin and prescription drugs used for opioid maintenance treatment (OMT). We also discuss the advantages of register data and of merging such data from different regions. The Czech and Scandinavian registers are largely comparable and provide great opportunities to conduct innovative research. For instance, using Czech and Scandinavian cohorts we can compare groups with similar characteristics, such as mothers in OMT and mothers addicted to other drugs while also controlling for important confounding factors such as health and socio-economic status.

• Klíčová slova
• children, drug use, methamphetamine, national health registry, opioid maintenance treatment, pregnancy, registry-linkage study,
• MeSH
• dospělí MeSH
• heroin toxicita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• methamfetamin toxicita   MeSH
• narkotika - antagonisté toxicita   MeSH
• novorozenec MeSH
• opiátová substituční terapie MeSH
• opioidní analgetika toxicita   MeSH
• poruchy spojené s užíváním psychoaktivních látek epidemiologie   MeSH
• registrace MeSH
• těhotenství MeSH
• výsledek těhotenství MeSH
• zakázané drogy MeSH
• zpožděný efekt prenatální expozice * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Skandinávie a severské státy epidemiologie   MeSH
• Názvy látek
• heroin MeSH
• methamfetamin MeSH
• narkotika - antagonisté MeSH
• opioidní analgetika MeSH
• zakázané drogy MeSH

INTRODUCTION: Following the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring invariably leading to delivery. Indices derived from fetal cerebral Doppler examination may guide such decisions although there are few studies in this area. We propose a randomised, controlled trial to establish the optimum method of timing delivery between 32 weeks and 36 weeks 6 days of gestation. We hypothesise that delivery on evidence of cerebral blood flow redistribution reduces a composite of perinatal poor outcome, death and short-term hypoxia-related morbidity, with no worsening of neurodevelopmental outcome at 2 years. METHODS AND ANALYSIS: Women with non-anomalous singleton pregnancies 32+0 to 36+6 weeks of gestation in whom the estimated fetal weight or abdominal circumference is <10th percentile or has decreased by 50 percentiles since 18-32 weeks will be included for observational data collection. Participants will be randomised if cerebral blood flow redistribution is identified, based on umbilical to middle cerebral artery pulsatility index ratio values. Computerised cardiotocography (cCTG) must show normal fetal heart rate short term variation (≥4.5 msec) and absence of decelerations at randomisation. Randomisation will be 1:1 to immediate delivery or delayed delivery (based on cCTG abnormalities or other worsening fetal condition). The primary outcome is poor condition at birth and/or fetal or neonatal death and/or major neonatal morbidity, the secondary non-inferiority outcome is 2-year infant general health and neurodevelopmental outcome based on the Parent Report of Children's Abilities-Revised questionnaire. ETHICS AND DISSEMINATION: The Study Coordination Centre has obtained approval from London-Riverside Research Ethics Committee (REC) and Health Regulatory Authority (HRA). Publication will be in line with NIHR Open Access policy. TRIAL REGISTRATION NUMBER: Main sponsor: Imperial College London, Reference: 19QC5491. Funders: NIHR HTA, Reference: 127 976. Study coordination centre: Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS with Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University. IRAS Project ID: 266 400. REC reference: 20/LO/0031. ISRCTN registry: 76 016 200.

• Klíčová slova
• fetal medicine, maternal medicine, ultrasonography,
• MeSH
• dítě MeSH
• hmotnost plodu MeSH
• kardiotokografie MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• předčasný porod * MeSH
• randomizované kontrolované studie jako téma MeSH
• růstová retardace plodu MeSH
• srdeční frekvence plodu fyziologie   MeSH
• těhotenství MeSH
• ultrasonografie prenatální * MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• protokol klinické studie MeSH

OBJECTIVE: To report our experience with long-term parenteral nutrition in pregnancy. SUBJECT: Case report. SETTING: Department of Obstetrics and Gynecology, Department of Geriatrics and Metabolism, Department of Paediatrics, Medical Faculty of Charles University and Faculty Hospital, Hradec Králové. SUBJECT AND METHOD: We describe successful pregnancy in a woman on long-term parenteral nutrition. CONCLUSION: Total parenteral nutrition is effective and safe method, which can solve maternal malnutrition and provide optimal conditions for fetal growth and development.

• MeSH
• dospělí MeSH
• komplikace těhotenství terapie   MeSH
• lidé MeSH
• novorozenec MeSH
• parenterální výživa doma * MeSH
• syndrom krátkého střeva terapie   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

The aim of the present article was to perform a systematic review with meta-analysis of available scientific evidence regarding the role of different intravenous lipid emulsions (ILE) in the pathogenesis of cholestasis and parenteral nutrition-associated liver disease. A systematic review of the literature (up to March 2015) identified 23 randomized controlled trials (RCTs). Of these, 17 were performed in preterm infants or critically ill neonates with a short duration of intervention, 2 in older children with short-term use (following surgery or bone marrow transplantation), 1 in neonates with long-term use, and 3 in infants and children receiving long-term parenteral nutrition (PN). Meta-analysis showed no differences in the rate of cholestasis or bilirubin levels associated with short-term use of different ILEs. Because of high heterogeneity of the long-term studies no meta-analysis could be performed. Available studies found that the use of multicomponent fish oil (FO)-containing ILE compared with pure soya bean oil (SO), ILE-reduced liver enzymes, and bilirubin levels in noncholestatic children on long-term PN and one other RCT found that FO-based ILE-reversed cholestasis in a proportion of patients. The ESPGHAN Committee on Nutrition concludes that there is no evidence of a difference in rates of cholestasis or bilirubin levels between different ILE for short-term use in neonates. The use of multicomponent FO-containing ILE may contribute to a decrease in total bilirubin levels in children with IF on prolonged PN. Well-designed RCTs are, however, lacking and long-term effects have not been determined.

• MeSH
• cholestáza epidemiologie   etiologie   MeSH
• dítě MeSH
• hodnocení rizik MeSH
• jaterní testy MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• parenterální výživa MeSH
• poradní výbory MeSH
• předškolní dítě MeSH
• randomizované kontrolované studie jako téma MeSH
• tukové emulze intravenózní aplikace a dávkování   škodlivé účinky   toxicita   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• přehledy MeSH
• systematický přehled MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH
• Názvy látek
• tukové emulze intravenózní MeSH