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The article discusses possible prevention and prophylaxis of infectious diseases affecting the course of pregnancy with respect to the mother, fetus and newborn. Also mentioned are diseases for which there is no vaccination. The options for prevention targeted at the periods before and during pregnancy and after delivery are explained. Finally, practical procedures related to vaccination and diagnosis of infectious diseases in women of childbearing age are presented.

INTRODUCTION The clubfoot ranks among the most frequent paediatric structural deformities of the lower extremity. Currently, the Ponseti method is considered the gold standard for the treatment. To evaluate the degree and severity of the deformity, clinical classification systems have been developed, commonly used in clinical practice. This study aims to verify whether the Pirani and Dimeglio clinical scoring systems can be used to predict the results of treatment by the Ponseti method. MATERIAL AND METHODS The study included 31 patients. The patients had been referred from the neonatal departments to the Department of Paediatric Surgery, Orthopaedics and Traumatology in Brno with the diagnosed clubfoot deformity, where they were treated by an erudite orthopaedist experienced in this field according to the Ponseti treatment standards. The Pirani and Dimeglio clinical scoring of the deformity were performed always before the commencement of the therapy and after the second plaster cast fixation. The number of plaster cast fixations, the necessity to carry out achillotomy and the relapse rate were set as the parameters of treatment results. In the first stage of statistical analysis, the respective clinical systems were correlated with the treatment results, in the second part of the study the patients were based on the clinical evaluation divided into 3 groups depending on the severity of the deformity, and these groups were subsequently compared. RESULTS 22 patients from the group (71%) underwent percutaneous achillotomy and in 3 patients (9.7%) a relapse occurred. To correct deformities 7.1 corrective casts were used on average. The correlation between the number of plaster cast fixations and classification systems was significant in all the cases, with the strongest dependency shown by the correlation with the Pirani score after the second corrective cast (r = 0.594, p0.001). Positive correlation was found also between the necessity to perform achillotomy and both the classification systems. In this case the strongest correlation was established in the case of the Pirani clinical scoring after the second plaster cast fixation (r = 0.488, p = 0.003). Conversely, significant correlation was not established between the relapse rate and the used classification systems, not even in a single case (p ≥ 0.05). In the second stage of the statistical analysis, in the case of the Pirani scoring before the therapy no difference was found between the individual groups with diverse severity of clubfoot deformity during the evaluation of the aforementioned parameters of treatment results. In the Pirani classification after the second plaster cast fixation, a statistically significant difference was established in the number of plaster cast fixations (p = 0.003) and the necessity to perform achillotomy (p = 0.012). When the Dimeglio scoring was applied before the therapy, a statistically significant difference between the groups was found in the number of plaster cast fixations (p = 0.031) and after the second plaster cast fixation in the relapse rate (p = 0.035). DISCUSSION Although the clinical scoring systems belong to key indicators of severity of the deformity and are commonly used in clinical practice, the current literature provides only an inconsistent picture of their application in predicting the course and the results of treatment. Concurrently, the authors opinions on this issue differ. The scoring in later stages of treatment shows a better predictive value than the scoring at the beginning of the treatment, which was confirmed also by the results of our study. CONCLUSIONS Even though the clinical scoring systems show a certain dependency on the parameters of the treatment results, in practice their predictive function can be used to a limited degree only. The complexity of the evaluation of the deformity itself and subsequently of the results of treatment requires also the use of other parameters than the clinical classifications only so that the prediction of the course and results of the treatment of clubfoot according to Ponseti shows a higher degree of reliability. Key words:clubfoot, Ponseti, Pirani classification, Dimeglio classification.

The aim of this work is to evaluate our own results of surgical treatment of retinal detachment in immature newborns. Retinopathy of prematurity (ROP) is one of the most complicated ocular disorders, both in terms of diagnosis and therapy. It is a potentially blinding illness that arises from the incomplete development of the bloodstream of the neuroretina of preterm infants. Currently, the most effective therapy is ablation of the avascular retina by laser photocoagulation or cryocoagulation. Despite this treatment, the immature retina may develop it´s detachment.We report 2 case-reports, retrospective results of 4-eyes in 2 patients with severe ocular and overall complications of prematurity. The ocular background of preterm babies was investigated in arteficial mydriasis by an indirect ophthalmoscope, and later with the RetCam photographic device. The ROP stages were evaluated according to the ICROP classification. All eyes were treated with cryo-retinopexy at the threshold stage of ROP, followed by intraocular surgery for progression of traction retinal detachment. The surgical technique was a 3-port 25-G PPV (pars-plicata vitrectomy) with insertion of ports 1.5 mm from limbus. The PPV was performed using the Constellation (ALCON) operating unit, controlling the intraocular pressure for 15 torr. The assessment of visual acuity was performed according to the scale: no light perception (no response of the child to light), light sensitivity (positive or negative reaction to illumination), fixation of light.The retina stayed attached in all operated eyes, more in each case-report.Contemporary vitreoretinal surgery allows for the anatomical success of traction retinal detachment surgery during ROP already in neonatal age.Key words: retinal detachment, retinopathy of prematurity, PPV, surgery.

Gastroschisis is the most common malformation among abdominal wall defects with the incidence of 1:45000 live birth neonates. Postoperative care for these patients is very difficult due to the risk of abdominal compartment syndrome. The identification of markers that correlate with bowel damage in gastroschisis may prevent this serious postoperative complication.Review of the literature.Prenatal ultrasound prediction of bowel damage followed by an appropriate surgical strategy is a possibility of optimizing care and outcomes in gastroschisis patients. The dynamics of I-FABP is a promising biomarker for the elimination of abdominal compartment syndrome during postoperative care.Key words: gastroschisis preformed silo intraabdominal dilatation I-FABP.

Evaluation of pregnancies and deliveries in women after solid organ transplantations with respect to the maternal and fetal risks.Overview article.Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague.Literature search using the Web of Science, Ovid, Cochrane, Google Scholar and Medline databases with keywords (transplantation, pregnancy, immunosuppression) and analysis of articles published in impact and reviewed journals from 1958 to 2017.Pregnancy in patients after solid organ transplantions is associated with the higher risk of complications, particularly preeclampsia, and high incidence of comorbidities. Women after transplantation have an increased risk of premature deliveries and low birth weight newborns. The highest risk of complications is documented after lung transplantation. For immunosuppression in pregnancy inhibitors of calcineurin, azathioprine and prednisone are used.Pregnancies and deliveries in women after solid organ transplants are in a high risk. With early transplantation, adequate patient health compensation, properly planned pregnancy, adequate immunosuppressive therapy and specialized prenatal and obstetric care, women can give birth to healthy newborns after transplantation.

Uterus transplantation is a life-giving and quality-of-life enhancing transplantation. Life with transplanted uterus is a transitional phase of life for both recipients and their partners. Six deliveries of healthy children from five transplanted mothers out of 9 uterus transplantations in Sweden may encourage untimely hopes of thousands of women with absolute uterine factor infertility worldwide. Psychological evaluation might be included into all trials regarding new treatment methods and treatment procedures. Main psychological issues connected with the infertility treatment in women with absent uterus are clearly defined (especially in vitro fertilization, uterus transplantation, compliance with immunosuppressive treatment, ultrasound examinations of uterine vascular perfusion, rejection signs surveillance, embryo transfer, pregnancy, cesarean section, preterm delivery risk, puerperium, hysterectomy and immunosuppressive treatment termination). The role of psychological evaluation of participants before the admission to complicated treatment process is to choose those who will be able to cope all mentioned difficulties and unexpected complications including potential failure of the whole treatment without serious negative impact on their psychological situation. Up to now experience with psychological stability of our 7 uterus recipients and 3 uterus living donors are good although post-transplant period is especially in recipients connected with everyday psychological adaptation on the significant life changes. We are aware that psychological evaluation of our study participants will require further 3 years of follow up with publication of our results.

To examine the association between length of labour and womens attitudes towards pregnancy, childbirth and motherhood, while controlling for biomedical and maternal psychosocial characteristics.Original study.Department of Psychology, Faculty of Arts and Philosophy, Charles University, Prague.The sample consisted of 362 women who gave birth in one of the five maternity hospitals in Vysočina region (Havlíčkův Brod, Jihlava, Pelhřimov, Třebíč, Nové Město na Moravě) between October 2013 and September 2014. The data were collected at two points in time. In the third trimester of pregnancy, womens attitudes towards pregnancy, childbirth and motherhood and other psychosocial characteristics were surveyed using the range of validated tools. Within one week of delivery, women were asked about social support they received during labour. Data concerning the course of labour were extracted from medical records. The dependent variable was the active phase of the first stage of labour (time from 3 cm to full dilatation). The differences among women with prolonged/rapid labour (duration above 90th percentile/less than 10th percentile) with respect to their attitudes towards pregnancy, childbirth and motherhood and other characteristics were assessed using the Students t test and the χ2 test. Factors associated with length of labour were analysed using logistic regression. The results were adjusted for maternal age, marital status and newborn weight.In labours without oxytocin administration, the median of the duration of active phase of the first stage was 180 minutes for primiparas and 144 minutes for multiparas. Women with prolonged labour reported more frequently low maternal self-esteem compared to women with normal labour duration (34.0% vs. 19.1%; p = 0,021), but maternal self-esteem was not a significant predictor of prolonged labour in regression analysis. No other differences were found with respect to psychosocial and personality characteristics in women with prolonged and normal labour. Women with rapid labour did not differ from women with normal labour as for their attitudes towards pregnancy, labour and motherhood. Nevertheless, they reported clinically relevant scores for trait anxiety more frequently, a difference that approached statistical significance (52.6% vs. 38.3%; p = 0,090). Multiple regression analysis showed a trend towards trait anxiety being associated with rapid labour (p = 0,098). No significant predictor of labour duration was identified except newborn weight which predicted both prolonged and rapid labour.Our data indicate that the association between length of labour and womens attitudes towards pregnancy, childbirth and motherhood is rather weak and clinically less relevant. Our results portray the newborn weight as a key factor affecting labour duration.

Evaluation of success rate and the safety of external cephalic version after 36 weeks of gestation.Retrospective analysis.Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno.A retrospective analysis of external cephalic version attempts performed on a group of 638 singleton breech pregnancies after 36 weeks gestation in the years 2003-2016 at the Department of Gynecology and Obstetrics, Masaryk University, Brno. The effectiveness, number and type of complications, mode of delivery and perinatal result were observed.The effectiveness of external cephalic version from breech to head presentation was 47.8% (305 cases). After a successful external cephalic version 238 patients (78.0%) gave birth vaginally. After unsuccessful cephalic version 130 patients (39.0%) gave birth vaginally. The number of serious complications did not exceed 0,9% and did not affect perinatal outcomes. External cephalic version-related emergency cesarean deliveries occurred in 6 cases (2 placental abruption, 4 abnormal cardiotocography). The fetal outcome was good in all these cases. The death of the fetus in connection with the external version has not occurred in our file. Spontaneous discharge of amniotic fluid within 24 hours after procedure occurred in 5 cases (0.8%). The spontaneous onset of labor within 24 hours of procedure occurred in 5 cases (0.8%). The pH value of a. umbilicalis7.00 occurred in 2 cases in the group with a successful external version and in the group with unsuccessful external version in 9 cases. The Apgar score in the 5th minute5 was both in the successful and unsuccessful group in 1 case.The external cephalic version of the fetus in the case of breech presentation after the 36th week of pregnancy is an effective and safe alternative for women who have a fear of the vaginal breech delivery. Performing the external cephalic version can reduce the rate of elective caesarean sections due to breech presentation at term.

To describe the role of T-regulatory lymphocytes in pathogenesis of preterm delivery.Department of Obstetrics and Gynecology, General University Hospital and 1st Medical Faculty, Charles University, Prague.T-regulatory lymphocytes modulate the immune system, secure the tolerance to own antigens and prevent autoimmune disease. During pregnancy is maternal immunity in contact with the semi-allogeneic fetus due to the fetomaternal crosstalk. It seems that maternal immunity and T-regulatory lymphocytes have an effect on premature birth and other pregnancy pathologies. According to the latest data, their role in the immunomodulation of pregnant women seems to be very significant, although we still do not understand many mechanisms.

Evaluation of opinions and subjective feelings of patients who have undergone an external cephalic version of a fetus in breech presentation after the 36th week of pregnancy.Observational analytic cohort study.Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno.We collected opinions and subjective evaluation from pregnant women who underwent an attempt of external cephalic version at the department of Gynecology and Obstetrics, Masaryk University in Brno in the period from 1st January 2015 to 31st December 2016 through a questionnaire. The questionnaire contained a total of 10 dichotomous, sampling, enumeration and scale questions. Questions were focused on the source and type of information on external cephalic version, expectations of the patients, evaluation of pain and feelings during the procedure and the overall impression. We also evaluated the differences between answers from patients after a successful and an unsuccessful version.In reported period 205 pregnant women underwent an attempt of external cephalic version. Procedure was successful in 105 (51.2%) cases of which 81 (77.1%) subsequently gave birth vaginally, 24 (22.9%) delivered by caesarean section, 10 (9.5%) out of all patients delivered in other hospitals. The total number of fully completed questionnaires was 187 (after a successful version 98 and 89 after an unsuccessful version). The most common source of information about the procedure was given to the patients from their gynecologists (40.5%) and doctors at the ambulance in the hospital where the patients are sent before delivery by their gynecologists (27.9%). Most mothers received mostly positive information (70.5%) - increased likelihood of vaginal delivery, high success rate, low risk to mother and child. Attitude of the gynecologists on the external cephalic version was positive in 52.6% and they recommended it. 14.4% of the patients had no fear before the procedure, 61% patients were nervous and 23% had fear. For 30.5% of the respondents was the version worse than expected. 33.7% of the patients expected that the procedure would be worse and for 35.8% of the women the procedure fulfilled their expectations. 42.2% of all patients rated the pain level on a scale from 0 (no pain) to 10 (maximum pain) in the range of 4-6 points, 28.9% evaluated the pain under 4 points and 28.9% over 6 points. Among other unpleasant feelings associated with external cephalic version were most frequently mentioned: nausea (15.9%), fear (39.8%), distress (7.5%). One-third of respondents, however, experienced no negative feelings (33.8%). 80.2% of the patients did not have any problems after the version. Out of all respondents 89.3% would undergo the procedure again and recommend it to others. Overall satisfaction rating on a scale from 0 (completely dissatisfied) to 5 (very satisfied) was 89.8% in the range from 4 to 5. When comparing the answers of patients after an external cephalic version there was no significant difference depending on the success of the version.The results show that the main source of information is given to the patients by their gynecologists and doctors in the hospital who recommend the procedure and significantly affect the attitude of patients towards external cephalic version. Fear and nervousness of the mothers is usually unfounded, most of the women evaluate the procedure positively and would recommend it to another pregnant women even in case of an unsuccessful attempt. Pain during the procedure is for most women bearable and in the overall ranking does not mean a significant problem.

The objective of this study is to determinate the influence of oligohydramnios on perinatal outcome in term pregnancies.Retrospective case-control study.II. Gynecologic Obstetrics Department, Comenius University, Bratislava.Authors analysed a group of 372 single pregnancies after completed 37th week of gestation in years 2011 to 2015 with sonographic diagnosis of isolated oligohydramnios. A control group was created with matched patients by age and parity with normal amniotic fluid volume.We found significant differences in number of obstetric intervention between the two groups: patients with oligohydramnios had higher number of cesarean sections (71% compared to 33.9% in control group) and also the number of inductions was significantely higher (27.4% compared to 18.8%). The most common indication for cesarean delivery was presumed fetal hypoxia. We did not find any differences in numbers of neonates with low Apgar score, low umbilical cord pH and admission to neonatal intensive care unit.The finding of isolated oligohydramnios after 37th week of gestations is associated with higher risk of obstetric intervention without any association with adverse perinatal outcome.

Reported is a case of enteritis caused by Salmonella Oranienburg in an approximately one-month-old infant due to indirect contact with reptiles. An epidemiological investigation included tests of faeces of bearded dragons (Pogona vitticeps) kept in the patient's household that revealed Salmonella Oranienburg. The comparison of Salmonella isolates obtained from the infant's stools and the reptiles' faeces using macrorestriction analysis showed 100% similarity, confirming that the reptiles were the source of the infection. The transfer of Salmonella was probably indirect through the other family members. The detection of rare Salmonella serotypes should -lead to inclusion of less common sources of infection such as reptiles into epidemiological investigations.

The importance of early detection of hearing impairment in newborns and children and the early rehabilitation of hearing disorder with hearing aid or cochlear implant was demonstrated in a number of papers. As a result, newborn hearing screening was introduced in many countries around the world. The incidence of congenital hearing impairment has been underestimated for a long time, empirically determined incidence was 1:1000 neonates. Thanks to newborn hearing screening was revealed that incidence of congenital hearing impairment is 3 times higher. One out of 300 newborns has profound hearing loss (deafness) and 1 in 300 newborns has mild to moderate hearing loss. Moreover, in 1 out of 300 children hearing impairment would develop before the age of 18. In the Czech Republic, the screening of all newborns is still systematical and multilevel conducted in only three regions (Moravskoslezský, Královéhradecký, Pardubický). In these regions, statistics as well as assessments of individual stages of screening are carried out. In other regions, records of the number of screened children, number of rescreened children and detailed statistics of hearing impairment is missing. The authors summarize the basic information about the importance of screening, the history of screening and its organization. Provided information is based on experience with the gradual introduction of screening over recent years in the regions in which they work. Newborn hearing screening should be organized in several stages (1 - screening at maternity hospitals, 2 - rescreening on collaborating otolaryngology/phoniatric workplaces and 3 - detailed hearing examination in centers in children whose screening was negative). The authors focus on problems related to the organization of screening and offer practical advice (e.g. implementation of screening coordinators). They consider it is essential to have statistical evidence of examination at all levels. Introducing of newborn hearing screening is not a short-term task but a long-term (many years) challenge.

To analyze monochorionic twin pregnancies with twin anemia polycythemia sequence (TAPS) and acute peripartal twin to twin syndrome (aTTTS), to compare their prenatal management and perinatal outcome.Retrospective analysis of monochorionic biamniotic twin pregnancies without signs of chronic TTTS within a period 10/2010 to 10/2013. Further selection of cases with haemoglobin difference in neonates greater than 50 g/l was made, type of feto-fetal haemorrhage was determined and their prenatal and postnatal characteristics were described.Based on the criteria described above we selected four cases out of 55 monochorionic pregnancies. One case of prenatally diagnosed spontaneous TAPS which fulfilled all the diagnostic criteria with typical angioarchitecture inclusive, one case of spontaneous TAPS diagnosed postnatally, a case of postlaser TAPS with a spontaneous resolution and one unusual case of feto-fetal haemorrhage which does not fully meet criteria of TAPS or aTTTS. All the pregnancies were delivered by caesarean section. All the anaemic neonates required blood transfusion postpartum and two of the polycythemic neonates needed partial exsanguination.Rare forms of feto-fetal transfusion syndrome form a heterogenous group and it may be difficult to distinguish between TAPS and aTTTS in certain cases. A recommendation for a management of TAPS cases was published in recent literature. However, correct interpretation of dopplerometric measurments belongs to the hands of experienced ultrasonographers in perinatal centers.

To bring the most actual published findings of the influence of maternal microbiome on the development of pregnancy and possibilities of its adjusting.Review.2nd Department of Gyneacology and Obstetrics of the Faculty of Medicine and the University Hospital, Bratislava.Review of the literature.The appearance of microbes on various body surface areas determines the overall health status of the individual in significant manner. The change in composition of microbioma in pregnant woman is well known. It was believed that the placenta and the body of the newborn is sterile environment. Modern diagnostic methods proved the presence of microorganisms inside the fetoplacentar unit without the signs of inflammation. Mutual interaction between the immune system of the mother, microbioma and immune system of the newborn can decrease the risk of serious obstetrical syndromes as well as define the lifelong health status of the newborn. The risk can be decreased by the administration of probiotics during the pregnancy.

The aim of this review is to analyze the existing possibilities of using ultrasound in the diagnosis of the fetal inflammatory response.Review.Gynekologicko-porodnická klinika, Fakultní nemocnice Ostrava.Preterm delivery is defined as a delivery before completed 37 weeks of gestation. Approximately one-thirdof these cases is associated with preterm premature rupture of membranes. About forty percent of preterm premature rupture of membranes is complicated by the fetal inflammatory response syndrome, which is associated with the development of severe perinatal morbidity. Recent prenatal diagnosis of the fetal inflammatory response syndrome is based on the invasive methods (amniocentesis, cordocentesis), which are limited by several risk factors accompanying these procedures and technical difficulties. Therefore, there is an effort to replace them by non-invasive approach. The development of ultrasound, as a diagnostic method through the last decade, and knowledge of pathophysiological and morphological changes in fetal organs associated with the fetal inflammatory response may lead to more specific diagnosis in the future and improvement of neonatal outcome.Early identification of fetuses affected by FIRS in pregnancies with PPROM is necessary for right management of these pregnancy pathology. At this moment, ultrasonography examination of fetal lineal vein and fetal echocardiography, seems to be suitable for diagnosing FIRS.

PURPOSE OF THE STUDY The paper aimed to evaluate the long-term outcomes of the treatment of diaphyseal femur fractures in children treated with Bryant's vertical traction. Moreover, we also assessed the size of overgrowth in the injured femur. MATERIAL AND METHODS The study included 23 patients with 23 femoral shaft fractures treated with Bryant's vertical traction at our department in 2009-2014. The following parameters were assessed: sex, ïnjured side, weight, age, mechanism of injury, potential abuse, type of fracture, duration of traction, and total length of hospital stay. The healing time of the fracture was the same as the duration of traction. Also assessed was the size of femoral shortening after the removal of traction, the presence of skin complications in the course of treatment and potential development of compartment syndrome. At the mean follow-up of 47.8 months (range 22-85 months) from the date of injury the patients were evaluated clinically and radiologically for: length of limbs, presence of rotational deformity, range of motion of knee and hip joints, potential pain or limping, potential scoliosis of the spine and presence of scars after traction. Finally, through a questionnaire we learned about the opinions of parents as to the treatment method and about the possibility of home traction. RESULTS All the fractures healed. There was a total of 17 injured boys and 6 injured girls. Whereas 12 patients sustained a fracture of the left femur, 11 patients sustained a fracture of the right femur. The mean weight of patients at the time of injury was 13.9 kg (range 5-20 kg). The mean age at the time of traction was 30.8 months (range 1-70 months). The injury most frequently occurred from various falls, altogether in 15 cases (65.2%). Traffic accidents were registered as the cause of injury in 3 cases (13%). No abuse was confirmed. The average duration of traction was 19.8 days (range 8-26 days). The total length of hospital stay took on average 23.6 days (range 9-33 days). Skin excoriation and bullae due to irritation by the traction occurred in 21 children (91.3% cases). All the bullae healed, in 4 (17.4%) patients minor scars of 1x1 cm in size were formed around ankles. Not a single patient developed the compartment syndrome. The average femoral shortening after the removal of traction was 0.8 cm (range 0-2.3 cm). The follow-up examination, performed on average 47.8 months (range 22-85 months) from the date of injury revealed the average discrepancy of spinomalleolar distances in both the lower limps of 0 cm (range -1 to 1 cm). Radiographically measured lengths of both the femurs showed the average difference of 0 cm (range -1.4 to 0.9 cm). The resulting average overgrowth of injured femur was 0.9 cm (range 0.1 to 3.2 cm). Scoliosis of the spine was not reported in any of the patients. In 3 patients femur alignment demonstrated rotation, namely an external rotation of 10° in all the cases. All the children demonstrated full hip and knee joint mobility, identical to the uninjured side. After a heavy load one patient reported pain in the thigh and one walked with limp. The other patients showed no problems whatsoever. Treatment with the use of Bryant's traction was well tolerated by parents. Altogether 15 parents (65.2%) would opt for the same treatment method in case of a recurrent injury. The home traction option would be welcomed by 17 parents (73.9%). DISCUSSION The treatment by Bryant's vertical traction is condemned in Anglo-Saxon countries due to the risk for developing compartment syndrome, described in earlier studies. Neither our cohort, nor more recent studies reported the occurrence of compartment syndrome. The most frequent complication faced in our study was the skin complications underneath the traction, namely in a total of 91.3% of patients. In the literature, the other authors only make references to bullae occurrence, but do not provide any further specifications. Overgrowth after femoral shaft fractures is a very well described phenomenon. The size of femoral overgrowth described in our study was similar to that referred to in the available literature. A method frequently used abroad is the so-called home traction. This method, however, has so far failed to take root in our country, even though this therapeutic technique would be appreciated by parents. CONCLUSIONS The treatment of femoral shaft fractures by Bryant's vertical traction, in children up to the weight of 15 kg, is a simple and safe method with excellent functional outcomes and minimum serious complications. When treating the children with the body weight more than 15 kg, the risk of bullae formation increases, therefore in this weight category treatment shall be decided upon on a case by case basis. The resulting average overgrowth of injured femur was 0.9 cm which corresponds with the findings of other authors. The treatment method using the Bryant's traction is well tolerated by parents, even though most of them would welcome the option of home traction. Key words: traction, femur fracture, overgrowth, children.

To compare peri-partal parameters between two groups of pregnant women - with and without gestational diabetes mellitus (GDM), to correlate degree of glucose abnormality with incidence of peri-partal morbidity and, finally, to analyse the potential effect of comorbidities (i.e. obesity, hypertension, thyreopathy, polycystic ovary syndrome, trombophylia, anemia, allergy, smoking) on pregnancy outcomes.Epidemiological observational "case-control" study.Department of Obstetric and Gynaecology, Faculty Hospital Brno; Department of Internal Medicine, Diabetes Centre, Faculty Hospital Brno; Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno.The study comprised 432 pregnant women (364 with GDM diagnosis, 68 healthy controls) followed during a period 2011-2013. GDM was diagnosed by oral glucose tolerance test in 24-28th week of gestation (by fasting plasma glucose5,6 mmol/l or8,8 mmol/l in 60th min or7,8 mmol/l in 120th min post-75g glucose load). Following peri-partal parameters were studied: ultrasonographic examination before delivery, a date of delivery, length of childbirth, induction, perinatal complications, post-delivery complications, section, abnormity in pH, base excess, Apgar score, birth weight.Subjects with GDM had significantly increased rate of labour induction compared to healthy controls (P = 0.0035, chi-square test). Subgroup of GDM women classified as having a higher risk for adverse perinatal outcomes by a definition of Czech Obstetric and Gynaecology Society had significantly more labour inductions, more sections and instrumental deliveries. New-borns of those mothers had significantly more common worse perinatal outcomes (Apgar score and macrosomia).Based on our data risk stratification of GDM subjects according to Czech Obstetric and Gynaecology Society appears relevant and justified.

The article provides information on an outbreak of infection with a strain of Staphylococcus aureus resistant to gentamicin (SARG) and a hyperproducer of enterotoxins A and D at a neonatal intensive care unit of the University Hospital in Hradec Králové. A retrospective investigation was carried out that provided an overview of the presence of the SARG strain in the patients, staff and hospital environment. Subsequently, strict infection precautions were implemented and the importance of rational antimicrobial therapy was emphasized.

The complex influence of internal and external environmental factors on the individual and his/her immune system and the lack of suitable markers to assess and reduce the risk of the development of allergies during the lifetime can explain the continuous increase in the number of people affected by some form of allergy. According to the results of some studies, cord blood IgE level could be a useful early marker for assessing the risk of atopic diseases, but the studies showed controversial results. In addition, several authors discuss the origin of these antibodies (synthesis in utero, peripartum contamination from maternal blood or placental transfer). The aim of our pilot study was to investigate the possible influence of modifying factors on cord blood IgE level.Our group of patients consisted of 184 retrospectively selected neonates (98 boys, 53.3% and 86 girls, 46.7%) from whom cord blood was collected and cord blood IgE level was measured 25 years ago (PRIST method). The impact of selected modifying factors (sex, type of delivery or month of birth) on cord blood IgE level was assessed retrospectively.Higher cord blood IgE levels were found in boys than in girls, in neonates born by Caesarean section than in those born by natural delivery, and in those born in the winter months than in other seasons of the year. Our findings are in agreement with those of other authors.Based on our results and those of others, we assume that the selected factors affect the cord blood IgE levels to varying degrees. These facts should be taken into consideration while interpreting the cord blood IgE levels.

Congenital hyperinsulinism (CHI) is the most common cause of severe persistent hypoglycemia in neonates and infants. Early diagnosis and effective treatment (based on the principles of pharmacogenetics) play the key role for the prognosis. The DNA anlysis, which can identify mutation in one of the 11 genes causing MODY, is crutial in the diagnostics. Moreover, The genotype determines also the optimal therapy approach (medicaments, diet or rarely surgery). There was a large progress of novel medicaments treating particularly most severe (diazoxide-resistant) forms of CHI.Key words: congenital hyperinsulinism - diazoxid - DNA analysis - hypoglycemia - somatostatine analogues.

To highlight the risks associated with pregnancy at women with von Willebrand´s disease or hemophilia. Introduce the rules of multidisciplinary prenatal and peripartal care to minimalize these risks. The article is accompanied by case report where maladministration led to fatal consequences for the newborn.Review and case report.Seatings: Department Obstetric and Gynecology UJEP and Masaryk´s Hospital Ústí n/Labem, Institute Haematology and Blood Transfer Prague, Children´s Haemato-onkology Clinic University Hospital Prague Motol.Coclusions: The pregnancy in both above-mentioned diseases is risky. The close multidisciplinary collaboration is required.

To compare the incidence of primary and acute cesarean section (CS) and to compare success rate of vaginal delivery. To determine the frequency of maternal complications and evaluation of post-partum condition of the newborn.Prospective, pilot, cohort study.Department of Gynecology and Obstetrics Masaryk University and University Hospital Brno.Analysis of patients with physiologically ongoing singleton pregnancy and term delivery, vertex presentation. Women from the study group (n = 67) underwent myomectomy because of symptomatic, solitary uterine fibroid. Women from the control group (n = 4079) had no history of myomectomy. Analysis was aimed at comparing the incidence of primary and acute CS and comparing success rate of vaginal delivery in both groups and determing the frequency of maternal complications and evaluation of post-partum condition of the newborn.A significantly higher incidence of primary cesarean section was observed in the study group with a history of myomectomy compared to the control group (n = 20, 29.9%; versus n = 396, 9.7 %, p0.001). No statistically significant difference in the incidence of acute cesarean section in both groups was recorded (n = 7, 10.4%; versus n = 570, 14.0%, p = 0.079). No statistically significant difference in the success of vaginal delivery in both groups was recorded (n = 40, 85.1%; versus n = 3113, 84.5%, p = 0.079). The excessive blood loss was the most frequent complication in both group (n = 9, 13.4%; versus n = 214, 5.2%, p = 0.057). No statistically significant difference in the incidence of uterine rupture and postpartum hysterectomy was recorded. No maternal or fetal death related to childbirth was observed.The history of myomectomy does not increase the incidence of acute cesarean section in the group of strictly selected patients suitable for vaginal birth and has no impact on the success of vaginal delivery. Careful management of labor is a prerequisite for a low risk of maternal complications and good perinatal outcomes.

Comparison of perinatal mortality in Slovak Republic in the years 2007-2009 and in the years 2010-2012.Epidemiological perinatal nation-wide.1st Department of Gynaecology and Obstetrics School of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic.The analysis of selected perinatal data prospectively collected in the years 2007-2009 and in the years 2010-2012.In the year 2007 there were 63 maternity hospitals, 51,146 deliveries and that of live births 51,650 in Slovak Republic. In the years 2010-2012 decreased the number of maternity hospitals, total number of deliveries and that of live births from 57 to 55, from 55,362 to 54,996 and from 55,901 to 55,643 respectively. Preterm deliveries rate increased from 7.4 to 7.7% and multiple pregnancies rate from 1.4% to 1.5% in the years 2010-2012 compared to years 2007-2009. Perinatal mortality rate decreased from 6.2 in the year 2007 to 5.1 per 1,000 still and live births in the year 2012. During the years 2007-2012 stillbirth participate in perinatal mortality 64%, low birth weight 65% and severe congenital anomalies 19%. Transport in utero to perinatal centres decreased in the years 2007-2012. It was from 64% to 56% for infants with very low birth weight and from 75% to 70% for infants with extremely low birth weight.In the year 2012 Slovak perinatology reach the best result in perinatal mortality rate 5.1 (0.51%). Centralisation of high-risk pregnancies, transport in utero very low birth weight infants, prenatal detection of severe congenital abnormalities and obstetric and neonatal intensive care units equipment need still to be improved in Slovak Republic.

Diseases caused by Iodine deficit are preventable. Inter resort Commission for the solution of Iodine deficiency (MKJD) at State Institute for Health (SZU) in Prague has been taking effective measures which satisfied requirements of the Principles for sustainable elimination of diseases caused by Iodine deficiency ICCD WHO: 96 % of households is using iodized salt, average Iodine content is 25 mg/1 kg of salt. Data from studies show ioduria less 100 mcg/l in only 9 per cent of seniors, 5 % of children 7-10 years, 3 % of children 10-12 years. Under 50 mcg only 1 % of children 10-12 years. Median of iodurias is below 300 mcg/l (seniors 185 mcg/l, children 7-10 years 277 mcg/l, children 10-12 years 252 mcg/l). We satisfy 8 of 10 indicators of Principles for Sustainable elimination of diseases caused by Iodine deficiency. Results of screening for congenital hypothyroidism are in keeping with sufficient iodine intake in newborns. Unsatisfactory situation however persist in expectant and breast feeding mothers 16 % [11] 6 % [10] of women included in the respective studies had ioduria below 50 mpg/l. Milk and dairy produce became a rich dietary source of Iodine as cattle feeds are fortified with Iodine. No part of observed human population is exposed Iodine doses higher than 17 mcg/kg. Next target for prevention will be achieving optimal iodine concentration in milk and improvement of iodine saturation of expectant and nursing mothers. Integral part is the monitoring of iodine saturation of population.Key words: dietary exposition - dietary sources of iodine - Inter resort commission for elimination of iodine deficit - iodine deficiency - iodine supply - iodized salt - ioduria.

Comparison between particular methods of obstetrics analgesia, their analgetic efects and influence on progress of delivery and postpartum adaptation of fetus.Prospective study.The Department of Gynecology and Obstetrics of the Teaching Hospital and the 2nd Medical Faculty of the Charles University in Prague.A prospective study of 644 patients who received intravenous increments of nalbuphine (196 women) or epidural analgesia (217 women) or pethidin (231 women). Assessment of maternal analgesia, satisfaction was carried out. Apgar scores and resuscitative measures required for the neonate were noted at delivery.The best analgetic effect was in the group with using peridural analgesia, where max. score was 3. The highest value was in the group of women who received pethidin. The most decrease of score after aplication of analgesia was in group with epidural analgesia, the least decrease of score was in group with pethidin. The Apgar score at 1. minute was the lowest in the group with epidural analgesia, the highest score was in the group with nalbuphine.The mixed agonist/antagonist narcotic analgesic like nalbuphine have the place in clinical practice. The obstetric analgesia is very common in obstetrics practice. The epidural analgesia is very popular but not everytimes accessible. Nalbuphine is the option who is analgetic effective and have minimal side-effect.

Epidermolysis bullosa and Bart´s syndrome are fairly accurately documented diseases by histopathology. In the article the authors describe interesting and hitherto undescribed phenomenon in the lungs male infant with epidermolysis bullosa junctionalis and Barts syndrome, who died 17 days after birth and 13 days after surgery for pyloric atresia, on multiorgan failure within basic congenital diseases.Histologically in lung alveoli was found to the massive presence of foamy macrophages and numerous globoid formations resembling morphological and immunohistochemical "Hassall´s" bodies in a thymus of the newborn. It was a acidophillic spherical bodies concentric tracks in the connective tissue with focal presence of fibrin, as a unique proof CKAE1/AE3 and CKHMW positive epithelial cells and CD68-positive histiocytic elements. An interesting finding was the follicular skin structure in the center "hassalloid´s-like" body, which suggests an aspiration components of the skin during intrauterine life.Normal Apgar score at birth of the child (10/10/10 s.) and severe histological features on the death of the child testify for the first pathogenetic formation "hassalloid´s-like" bodies in the lungs during the 17-day life of a disabled child.

Pertussis is a respiratory disease caused by the Gram-negative encapsulated bacterium Bordetella pertussis. Despite the high vaccination coverage rate and addition of new booster doses to the immunisation scheme (in response to the epidemiological situation), pertussis is on the rise not only in the Czech Republic but also in many other countries. The age groups at highest risk are infants and, to a lower extent, newborns who can get infected before receiving the first dose of vaccine and develop a severe course of the disease, often requiring admission to hospital. The most common source of infection are adults or adolescents from the childs close environment who experience a mild course of the disease because of the previous vaccination. The immune response induced by the currently available acellular vaccines does not last. It can be reasonably assumed that pertussis has been underreported. Multiple studies have shown mutations in the causative bacterium that confer higher pathogenicity to it, either as a result of enhanced production of pertussis toxin or loss of some antigens. Possible strategies to control these negative trends are to develop novel more effective vaccines using new adjuvants or to use whole-cell vaccines. Maternal vaccination in pregnancy trimester 3 also turned out to be effective.pertussis - vaccination - epidemiology - diagnosis - newborns.

Monitoring of fetal heart rate is one of the basic components of obstetrical care, in which the cardiotocography remains the gold standard and screening method in early diagnosis of fetal hypoxia, even after introduction of other selective methods of intrauterine monitoring of fetal well-being. The review article is divided into several parts: pathophysiology of fetal oxygenation, fetal heart rate and changes of fetal hemodynamics, and rules for fetal heart rate auscultation. The main principles of cardiotocographic monitoring and evaluation of ante- and intrapartrum recordings according to the FIGO criteria from 1986 and evaluation of intrapartum recordings according to the 2015 FIGO recommendations are mentioned. At the end a comparative table of 1986 FIGO and 2015 FIGO criteria is presented.Review.

Fetal macrosomia is associated with an increased risk of perinatal mortality and morbidity for both, mother and fetus. The frequency of these births is between 1.3 to 1.5%. Macrosomic fetuses are defined with a weight of 4500 g and more. Diagnosis and prediction of macrosomia or fetal birth weight is key to determine the tactics of delivery. It is based on the combination and assessment of medical history, clinical parameters and ultrasound biometry. The limit for elective caesarean section is considered the estimated fetal weight in healthy mothers of more than 5000 g. For mothers with diabetes an indication of the caesarean section should be considered for fetal weight of more than 4000 g.A review of the literature.

This article is meant to be a complement to the new statement "Assisted vaginal delivery" of the Section of perinatal and fetomaternal medicine (SPFM) of the Czech Society of Gynecology and Obstetrics ČLS JEP, which is also published in this issue of Czech gynecology. The new statement has been formed as a synthesis of two previous separate statements of the SPFM "Vacuumextraction" and "Forceps delivery" and has also been updated based on new scientific knowledge. This review publication summarizes latest knowledge on vacuumextraction and forceps delivery and adds comments to certain points from the statement.A review of the literature.

Describing the course of pregnancy and perinatal outcomes in a patient with supraventricular tachycardia treated by electrical cardioversion.Case report.Department of Obstetrics and Gynaecology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital.We report a case of electrical cardioversion performed during pregnancy. Young patient with a history of surgical correction of congenital heart defect (double outlet right ventricle, aortic arch hypoplasia and coarctation) with implanted pacemaker for dysfunction of both SA and AV node was diagnosed with persistent atrial flutter leading to incipient heart failure during pregnancy. At 30 weeks of pregnancy, the electrical cardioversion was performed under continuous fetal monitoring. Rest of the pregnancy was uneventful, delivery via caesarean section with obstetric indication (breech presentation, premature rupture of membranes at 37+3/7 weeks) without any complications.

The use of laparoscopic abdominal cerclage in a patient with habitual miscarriage.Case report and literature review.Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine, Palacký University Olomouc, Department of Neonatology, University Hospital Olomouc, Faculty of Medicine, Palacký University Olomouc, Institute of Medical Genetics, University Hospital Olomouc, Faculty of Medicine, Palacký University Olomouc.The patient is a 37 years old woman with a history of recurrent miscarriages. She had one labor at term and six pregnancies that were lost in the second trimester despite McDonald cerclages. Abdominal cerclages are necessary when the standard transvaginal cerclages fail or anatomical abnormalities preclude the vaginal placement. The disadvantage of the transabdominal approach is that it requires at least 2 laparotomies with significant morbidity and hospital stays. We discuss a case of abdominal cerclage performed laparoscopically. A 5 mm Mersilene tape was placed laparoscopically at the level of the internal os as an interval procedure. We feel it offers less morbidity and in the proper hands eliminates or significantly shortens hospital stays. Subsequent pregnancy was terminated at 28 weeks by caesarean section after premature rupture of membranes.Laparoscopic abdominal cerclage seems to be relatively effective option for the prevention of habitual abortion patients, which fail conventional surgical procedures in dealing with cervical incompetence. The success of subsequent full term pregnancy is given as 70%.

To assess women's satisfaction with perinatal care provided in maternity hospitals in Vysočina region, to identify the areas with high satisfaction scores as well as those requiring improvement, and to describe the factors influencing women's satisfaction, i. e. dissatisfaction with the care provided during labor and birth and the early postpartal period.Original study.Department of Psychology, Faculty of Philo-sophy, Charles University, Prague.The satisfaction survey was conducted in all maternity hospitals in Vysočina region (Jihlava, Havlíčkův Brod, Třebíč, Pelhřimov, Nové město na Moravě) during the period between October 2013 and September 2014. All women who had given birth in those hospitals during the period were approached and asked to participate in this survey. The women evaluated the perinatal care not before 58 days after birth, so that the evaluation of perinatal care did not take place directly during their stay at maternity hospital. In total, 1366 women took part in the study. The original Czech questionnaire KLI-P was used for the data collection. The KLI-P measures psychosocial climate of maternity hospitals on the following six scales: helpfulness and empathy of caregivers; control and involvement in decision-making; communication of information and availability of caregivers; dismissive attitude and lack of interest; physical comfort and services. The satisfaction rates with component dimensions of intrapartal and postpartal care at the maternity hospitals in Vysočina region were compared to the satisfaction rates for the Czech Republic as a whole as obtained in our previous study. We used the Kruskal-Wallis test for this comparison. The ordinal logistical regression (cumulative logit model) was used to identify predictors of women's satisfaction with intrapartum and postpartum care in Vysočina region.The women who delivered at maternity hospitals in Vysočina region were significantly more satisfied with all dimensions of care received both at delivery (DU) and after-birth unit (ABU) as compared to the average parturient's satisfaction in the Czech Republic as specified in our previous study. The best rated scale at DU in Vysočina region was Physical comfort and services (93% vs. 85% for the whole country; P0,0001), while the worst evaluation score received the scale Control and involvement in decision-making (75% vs. 58% for the whole country; P0,0001). At ABU, the best rated scale was Control and involvement in decision-making (95% vs. 89% for the whole country; P0,0001), while the lowest evaluation score was found for the scale Physical comfort and services (85% vs. 76% for the whole Republic; P0,0001). The women perceived generally the caregivers as helpful and kind but they often missed sufficient emotional support. They considered the information received easy to understand, but they would welcome more information in general. Among the most important determinants of parturients satisfaction with care at DU were kind and helpful attitude of midwives (P0,0001), confidence in physicians (P0,0001), sufficient provision of information (P = 0,0016), pleasant appearance of the delivery room (P = 0,0010), kind and helpful attitude of physicians (P = 0,018). Among the most important determinants of satisfaction with care at ABU were sufficient provision of information (P = 0,0007), equipment of the room (P = 0,0014), informations regarding the care for the newborn (P = 0,0013), emotional support (P = 0,0039) and confidence in staff employed in newborn care (P = 0,025).Satisfaction with care received at maternity hospitals in Vysočina region was rated very high. However, despite its high quality, the perinatal care in Vysočina region suffers from several shortcomings. Regarding the significance of the individual determinants of parturient's satisfaction, improving the quality of care requires first of all better provision of information both during the labor and postpartal period. It would be beneficial to provide the health care professionals with the opportunities of attending a training in breastfeeding support and communication and of taking part in clinical supervision.

The case report focuses on the case of heavy Graves - Basedow thyreotoxicosis in 33 years old secundipara who was transferred to our departement from regional hospital for decompensation of gestational hypertension, oligohydramnios and the suspition on intrauterine growth restriction (IUGR). In our clinical praxis the problems of thyroid gland in terms of its reduced function in pregnant women are getting more frequent. The goal of this article is to describe the less often situation, the hyperthyroidism in the third trimestr of the pregnancy. Thyretoxicosis in pregnancy is associated with higher risk of preterm labour, preeclampsia, IUGR, heart failure and stillbirth. Some of these complications confirmes our case report.

Thyroid hormones play fundamental role in conception and pregnancy and are essential for normal adult health, fetus and childhood development. Many studies have shown an association between maternal thyroid diseases esp. hypothyroidism with obstetric problems and/or psychomotoric impairment in the offspring. The prevalence of undiagnosed lower thyroid function in pregnancy is present in about 4-8 % of pregnant women, and euthyroid women with thyroid autoimmunity (6-8 %) are further candidates for thyroid disorders in pregnancy. The thyroid gland needs to produce 50 % more thyroxine in pregnancy to maintain an euthyroid state to keep TSH ideally 2.5 mIU/l in the first trimester of pregnancy and TSH 3.0 mIU/l in the second and third trimester. Consequently, there is a need to start the substitution therapy as soon as diagnosis of subclinical and /or overt hypotyroidism is established, and in majority of euthyroid women with autoimmune thyroid disease there is a need to start therapy as well. Most women on levothyroxine therapy before pregnancy require an increase in dose when pregnant. As maternal thyroid disease is a quite prevalent condition and often asymptomatic, but easily diagnosed and for which an effective, safe and cheap treatment is available, endocrinological societies including ČES ČLS JEP worldwide are suggesting the need of thyroid dysfunction screening as a simple prevention attitude. Hormone determination of TSH and TPOab antibodies should be performed early during the first trimester, using trimester-specific reference values. Furthermore, adequate iodine supplementation during pregnancy is critical and if feasible it should be initiated before the woman attempts to conceive.

This paper presents two case reports of amniotic fluid embolism quite identical in the onset of symptoms, 1,20 hr, respectively 1,40 hr after extraction of the fetus during delivery by caesarean section, both births were induced by prostaglandins. Both newborns were male. One patient died with autopsy providing evidence of massive pulmonary embolism, laboratory findings showed hemolysis. The second patient survived with neurological disorders, laboratory findings temporarily showed nonspecific antibodies. Both patients were subdued to hysterectomy, no trace of amniotic fluid components were found in the uterine vessels in either one of them.

Epidermolysis bullosa represents a group of mechanobullous diseases which are most commonly genetically determined. We describe the case of a 15-day-old female newborn with congenital epidermolysis bullosa which was inflicted on aproximately 1/3 of her skin surface, who died because of incorrigible sepsis with multiorgan failure. The main topic of our report is a description of an unusual pulmonary finding of massive alveolar filling with foamy macrophages after amnion fluid aspiration, which contained a excessive amount of desquamated epidermal cells. Introduced case shows outstanding discrepancy of negative clinical finding on one side and massive histopathological finding on the other.

Evaluation of the commonly used laboratory and clinical parameters of the newborn shortly after birth. Check thresholds acidemia, and in relation to the method of termination of pregnancy.Retrospective epidemiological study.Department of Obstetrics and Gynecology, University Hospital, Olomouc.Of the 26,869 children born in the years 2000 to 2013 Inclusion criteria (complete clinical and laboratory findings after birth) fulfill 23,471 (87.4%) neonates. Methods for evaluation of newborns included Apgar score calculation and arterial umbilical cord blood pH and lactate analysis.A total of 0.7% (157) of the neonates had severe acidosis pH below 7.00 arterial umbilical cord blood, its prevalence varies annually between 0.1 to 1.1%. Cutoff lactate in relation to pH7.00 was 6.3 mmol/l (n = 23 471, the sensitivity of 92.99%, specificity 92.15%, AUC = 0.972). For children of low weight2500 g the cutoff value is lower, 5.3 mmol/l (n = 2592, 89.66% sensitivity, specificity 91.10% AUC = 0.912). Suprathreshold lactate values was 8.4% (1977) newborns. Correlation of pH and lactate to Apgar evaluation is very low and in the range from 1 to 10 minutes gradually decreases. Worse Apgar evaluation in children of low birth weight do not correspond to laboratory findings acidosis, which is probably related to prematurity and lower energy reserves. Operating cesarean births in particular accounts for more than half of those with worse clinical findings Apgar and pH7.00, but only 30% supratreshold lactate values. Also worse clinical evaluation after caesarean section is not in accordance with the laboratory findings. Vaginal surgery, especially forceps have a significant share of severe acidosis than cesarean, regardless of their frequency. Risk factor of forceps to pH less 7.00,OR = 9.28 (5.39 -15.77), P = 0.0000000, while caesarean to pH less 7,00 had OR = 1.52 (1.08 to 2.14), P = 0.01408156.The results obtained confirm that acidosis after birth is quite common, although they may not have response on the clinical condition of the newborn after birth. Evaluation of Apgar is little objective for the detection of hypoxia during birth and is influenced by the immaturity of newborn and method of delivery. Lactate levels may contribute to an objective assessment of hypoxia during birth. Values above 6.3 mmol/l can be considered an important indicator of newborn acidosis and birth hypoxia.

Hyperechogenic bowel (HB) occurs in 0.1 to 1.8% of normal pregnancies. In most cases it has no consequence for the foetus, but can be associated with cystic fibrosis (CF), chromosomal defects, genetic syndromes, viral infections, gastrointestinal pathology, missed gravidity, IUGR and preterm labour.Assessment the risk of the foetus having CF or other abnormalities when HB was detected during ultrasound screening in the second trimester of pregnancy in our centre.Retrospective study.Department of Obstetrics and Gynecology, Centre of Fetal Medicine and Genetics, KNTB a.s. Zlín.Retrospective analysis of 149 cases of HB between 17 to 22 weeks of pregnancy detected from January 2008 to April 2012. HB was evaluated according to its degree of echogenicity (Slotnik/Abuhamed classification), presence or absence of other ultrasound markers and the result of first trimester combined screening result. When stage II or III HB and/or borderline risk in first trimester screening, and presence of other ultrasound markers was detected, amniocentesis (AMC) was performed to investigate the karyotype, mutations in the CFTR gene and presence of viral infections (cytomegalovirus and parvovirus B19). If stage I or II HB and/or negative I. trimester screening and no other ultrasound markers, viral infections and mutations in the CFTR gene were investigated form maternal blood. If positive, paternal blood sampling testing for mutation in the CFTR gene was performed. If a mutation was detected in both parents, AMC was performed. Mutations of the CFTR gene was investigated with a commercial panel of 33 to 50 most common mutations. Postnatally the outcome of neonatal screening for CF(IRT) and any newborns with congenital malformations were ascertained.HB was seen in 149 foetuses, AMC was performed in 94 (63%), and blood sampling in 55 (37%). Two mutations in the CFTR gene associated with a severe form of CF (deltaF508/3849 KBC +10 T) were found in one foetus from the AMC group with stage III HB. The parents decided to terminate the pregnancy. The incidence of HB in our group was 0.7%. In 4 foetuses (2.7%) with stage II HB heterozygous deltaF508 mutation was found, in the rest no mutations were detected. Parents of heterozygous carriers underwent genetic consultation. Postnatal CF screening (IRT level from a heel prick sample) was negative; therefore no further molecular genetic analysis was performed. Infection was detected in three foetuses; one case was managed with intrauterine transfusion and in the other two cases parents decided for termination. Four cases (2.7%) were terminated because of severe congenital anomalies. Minor congenital abnormalities were detected in seven (4.7%) cases. Intrauterine death was detected in three (2%) pregnancies.Based on our results, HB can be considered as a significant marker for the risk of CF, especially in HB stages II and III. It also demonstrates the importance of this marker for the risk of other foetal abnormalities.

Barts syndrome, in literature also known under the name CLAS (Congenital Localised Absence of Skin), first described by Bart in 1966 as congenital localized absence of skin, epidermolysis bullosa congenita and nail abnormalities. The authors present a macroscopic and histological findings of a newborn with Barts syndrome, with epidermolysis bullosa junctionalis and atresia pylori, who died 17 days after birth and 13 days after surgery for pyloric stenosis.