Ceská gynekologie / Ceská lékarská spolecnost J. Ev. Purkyne
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Controlled Clinical Trial
[Role of ST-analysis of fetal ECG in intrapartal fetus monitoring with presumed growth retardation].
Evaluation of the role of ST analysis of fetus ECG for early detection of developing acute hypoxia in the course of delivery of fetuses with presumed growth retardation. A comparison with present way of intrapartal fetus monitoring. Impact on the number of surgical births for indications of threatening fetus hypoxia. Influence of the method on perinatal results and postnatal adaptation of the newborns. ⋯ The use of ST analysis of fetal ECG in the course of delivery of fetuses with presumed intrauterine growth retardation did not show any significant difference from the presently used methods (CTG supplemented with IFPO if needed). In using the method there was not any effect on the number of surgically treated deliveries for indications of threatening acute fetus hypoxia or perinatal results and postnatal adaptation of the newborns.
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To determine the possibilities of ST analysis of fetal ECG (STAN) in premature deliveries between 30th to 36th week of pregnancy. To compare the results of a group of premature deliveries monitored by ST analysis with a control group of premature deliveries monitored by means of cardiotocography (CTG) and intrapartum fetal pulse oxymetry (IFPO). ⋯ It has become obvious that the ST analysis of fetal ECG in premature deliveries between 30th and 36th week of pregnancy provides the same results as the so far used monitoring by CTG and IFPO. In the group of premature deliveries monitored by the ST analysis, there were significantly less frequent neurological disturbances.
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To ascertain how the Burch colposuspension affects the value and position of MUCP in women without any previous uro-gynaecological operation. If possible, also to determine how the values of these parameters differ between groups of women who are free from problems after the operation, women who suffer urgency, and women who continue to suffer from stress incontinence. Furthermore, to ascertain whether the pre-operation values of MUCP and VLPP have any predictive value in determining the success rate of the Burch colposuspension. In addition, to ascertain whether in ultrasound examination we can observe any differences in urethra mobility between subgroups of women with various operation results. ⋯ The results of our study imply that Burch colposuspension, if properly placed and not tight, does not change MUCP either at rest or at Valsalva. The distance of the point of MUCP from the inner urethral orifice was significantly shorter only for bladder volume of 300 ml during Valsalva. No statistically significant differences in these parameters were observed between subgroups A, B, C. From the ultrasound parameters we can conclude that the operation changed the position of UVJ and the middle of the urethra forward at rest and restricted the mobility of the urethra during Valsalva maneuver. There is a slight paradoxical diminishing of the gamma angle during the Valsalva maneuver in the subgroups of patients with de novo urgency or where the urgency symptoms were worse (B), implying different movement of the urethra. Pre-operation values of MUCP and VLPP cannot be used to predict the effect of the operation, though we are aware of the fact that our results were ascertained on a rather small number of patients in the groups of patients with complications.
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Randomized Controlled Trial Comparative Study
[Ursodeoxycholic acid, S-adenosyl-L-methionine and their combinations in the treatment of gestational intrahepatic cholestasis (ICP)].
SEATING: Department of Obstet. Gynecol., 2nd Medical School Charles University and Teaching Hospital Motol, Prague, Institute of Haematology and Blood Transfusion Prague, Department of Clin. Bioch. General Teaching Hospital and 1st Medical School, Charles University Prague, Czech Republic. ⋯ Ursodeoxycholic acid is effective in improving the biochemical parametres during the treatment of ICP. There is probably the synergistic effect with S adenosyl-L-methione. Whether the successful treatment influence the conditions of the fetus is not clear. The good perinatal outocome is probably more due to the precise monitoring of the intrauterine well-being of the fetus.
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Review
[Obstetric operation, instrumental delivery and 3rd degree perineal tear and anal incontinence].
Summary of the mutual relationship between obstetric operations, instrumental vaginal delivery and the third degree tear and anal incontinence. ⋯ Review of the current international literature covering the given problem. Midline episiotomy is a recognized risk factor. The role of mediolateral episiotomy is not quite clear. This could be a preventive factor in 20-30% of all deliveries (particularly at the first delivery). The use of forceps is the most significant risk factor of the third degree tear and anal incontinence. Vacuumextraction should be preferred when possible. There is a paucity of literature addressing the problem of fundal pressure and perineal trauma. In the largest study the relative risk of fundal pressure of the third degree was 1.27. Elective Caesarean is considered to be a prevention of pelvic floor injury and the development of urine and anal incontinence for a certain length of time. Its protective effect seems to die down and ultimately cease over a period 6 years. Endoanal sonography is a reliable method of anal sphincter defect detection. Primary and secondary prevention of anal incontinence is outlined.