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Subtle but demonstrable movements in the expectant mother's pelvis occur during vaginal delivery in all the pelvic joints and anatomical planes of the body (sagittal, frontal, and transverse). The purpose of these movements is to gradually expand the space in the lesser pelvis via widening of the individual pelvic planes so that the newborn's head can enter the pelvic inlet, safely pass through the narrow planes of the pelvis, and through the pelvic outlet. From the point of view of biomechanics, these movements are described in literature as counternutation and nutation of the sacrum and iliac bone. The counternutation of the sacrum helps to expand the plane of the pelvic inlet. The nutation of the sacrum assists in expanding the plane of the pelvic width, height, and outlet. These physiological movements are affected by the body constitution, the state of the myofascial and skeletal systems of the mother, and furthermore, by hormonal disjunction of the connections in the expectant mother's pelvis together with the progress of the delivery mechanism itself. The main factor that determines the range of movement in the individual joints, and therefore adequate expansion of the individual pelvic planes, is the position of the mother during delivery. Engagement of active movements of the mother together with application of passive stretching of the soft tissues in the lower lumbar area and in the hip joints are both needed for maximum expansion of the individual pelvic planes and utilization of the maximum useful capacity of the mother's pelvis during delivery. These movements help invoke the abduction forces on muscles, tendons, and ligaments in the pelvis that lead to the optimum setting of the joints during which delivery movements happen. The specific movements in the pelvic joints predetermine whether nutation or counternutation is possible, and therefore if the newborn's head can progress to the pelvic inlet or pass through the narrow and wide pelvic planes, and the pelvic outlet. The knowledge of these biomechanical principles and movements in the pelvis during delivery enables obstetricians and midwives to understand how the movements in the hip joints of the expectant mother can positively impact the spatial ratios in the lesser pelvis, and how to support further progress in the event of non-progressive labour.

: Sacrococcygeal teratoma is a rare congenital malformation, the prognosis depends on factors affecting foetal development. The diagnosis is based on ultrasound examination, especially the evaluation of the detailed morphology of the foetus in the 20th week of pregnancy. Therefore, it is crucial to keep looking for ultrasound markers that would prenatally determine the most accurate prognosis for the foetus. Now, we rely on a small number of studies with a predominance of case reports. We offer a literature review of the essential information concerning sacrococcygeal teratoma diagnostics, therapy, and complications of sacrococcygeal teratomas in connection with prenatal diagnosis. It turns out that in cases with a favourable prognosis according to prenatal ultrasound examination and adequate surgical treatment after childbirth, the prognosis of this congenital malformation is excellent.

Introduction: Simulation medicine is no longer just a modern trend and has become a standard part of education and training of the medical staff and students in many countries around the world. Its validity and benefits have been acknowledged and its necessity is reflected in the recommendations of the European Board and College of Obstetrics and Gynaecology., Objectives: The aim of our work was to map the current state of simulation training at large obstetrics and gynaecology departments in the Czech Republic including the equipment available, teaching environment conditions and human resources and to find out to what extent individual teaching methods are being used in undergraduate and postgraduate education., Methods: We have collected the information using a questionnaire which focused on the equipment available to the departments, teaching environment conditions, human resources, and types of simulation methods being used in undergraduate and postgraduate training as well as the spectrum of courses being offered., Results and Conclusion: Our finding is that large obstetrics and gynaecology departments in the Czech Republic are well equipped, have good teaching environments available to them, and are able to use most of the current simulation teaching methods. On the other hand, except for an operative vaginal birth course, only a small number of other simulation courses are currently being offered. Data from the survey are further used to discuss the possibilities of developing simulation training in this field in the Czech Republic.

Background: Clinically silent uterine rupture with complete fetal expulsion into the abdominal cavity is an extremely rare complication. Diagnosis can be difficult and the risk to the mother and fetus is high. Conservative management has been described only in a few cases of partial expulsion of the fetus so far., Case Presentation: We present a case of 43-year-old tercigravida with a history of previous laparotomic myomectomy and subsequent cesarean section. The subsequent pregnancy was complicated by uterine wall loosening and rupture at the site of the previous uterine scar after myomectomy and complete fetal expulsion into the abdominal cavity. The diagnosis was made at 24 + 6 weeks of gestation. Considering the absence of clinical symptomatology and the good condition of the fetus, a conservative approach was chosen with intensive monitoring of the maternal and fetal conditions. The pregnancy ended by elective cesarean section and hysterectomy at 28 + 0 weeks of gestation. The postpartum course was uneventful and the newborn was discharged to home care 63 days after delivery., Conclusions: Fetal expulsion into the abdominal cavity after silent uterine rupture of the scarred uterus may be accompanied by minimal symptomatology making early diagnosis difficult. This rare complication must be considered in the differential diagnosis in women after major uterine surgery. In selected cases and under conditions of intensive maternal and fetal monitoring, conservative management may be chosen to reduce the risks associated with prematurity., (© 2023. The Author(s).)

Pregnant and lactating women (PLW) represent a particular population subset with increased susceptibility for COVID-19 morbidity and mortality, even though the evidence about the safety and efficacy of COVID-19 vaccines was delayed due to their initial exclusion from development trials. This unclear situation could have led to increased COVID-19 vaccine hesitancy levels among PLW; therefore, this study aimed to evaluate the attitudes of Czech PLW towards COVID-19 vaccines and the determinants of their attitudes. An analytical cross-sectional survey-based study was carried out in the University Hospital Brno (South Moravia, Czechia) between August and October 2021. The study utilised a self-administered questionnaire (SAQ) adapted from previous instruments used for the same purpose. The SAQ included closed-ended items covering demographic characteristics, clinical and obstetric characteristics, attitudes towards COVID-19 vaccination, and potential psychosocial predictors of vaccine acceptance. Out of the 362 included participants, 278 were pregnant (PW) and 84 were lactating women (LW). The overall COVID-19 vaccine acceptance (immediate and delayed) level was substantially high (70.2%), with a significant difference between PW (76.6%) and LW (48.8%). Out of the 70.2% who agreed to receive the vaccine, 3.6% indicated immediate acceptance, and 66.6% indicated delayed acceptance. Only 13.3% of the participants indicated their acceptance of their physician's vaccination recommendation during pregnancy or while lactating, and 62.2% were against it. Our results agreed with the recent studies that revealed that PW tended to have a high level of COVID-19 vaccine acceptance, and they were also inclined to resist professional recommendations because they predominantly preferred to delay their vaccination. The pregnancy trimester, education level, employment status, and previous live births were significant determinants for COVID-19 vaccine acceptance. The most commonly preferred vaccine type was mRNA-based vaccines, followed by viral vector-based and inactivated virus vaccines. The first top priority of PLW was vaccine safety for their children, followed by vaccine safety for the PLW and vaccine effectiveness. Regarding psychosocial predictors, media/social media, trust in the government, the pharmaceutical industry, and healthcare professionals, partners, and a positive risk-benefit ratio were significant promoters for COVID-19 vaccine acceptance. Findings from this study suggest that promotional interventions targeting PLW should use web platforms and focus on vaccine safety evidence, the expected benefits of vaccines and potential harms of the infection.

BACKGROUND The care and management of brain-dead pregnant women is surrounded by legal and ethical controversies. Gestational age is directly proportional to newborn survival. We report a case of a brain-dead pregnant woman at the 16th week of gestation and the successful delivery of a healthy child after 117 days of maternal somatic support. CASE REPORT A 27-year-old pregnant woman at 16 weeks' gestation with large intracerebral hematoma after rupture of an arteriovenous malformation was admitted to our intensive care unit. Signs of brain death developed early, and the woman was confirmed to be brain dead after day 6 of hospitalization. The decision-making process regarding course of medical treatment was complex and accompanied by uncertainties arising from the absence of a legal, ethical, and professional framework. A complex multidisciplinary approach was followed. The main aim was to maintain the brain-dead woman's homeostasis to allow for proper development of the fetus. Monitoring of fetal growth was considered the best endpoint, and satisfactory fetus development was achieved. A healthy child was delivered with a birth weight of 2140 g. Her Apgar score was 10/10/10 at 1, 5, and 10 minutes, respectively, and favorable outcomes were observed at a 1-year follow-up. CONCLUSIONS Brain death during pregnancy is an extremely rare but increasingly common condition. Guidelines for care management are lacking, and reporting these cases may help establish medical treatment in future cases. We show that somatic support of the body of a brain-dead pregnant woman for an extended period of time can lead to successful delivery of a healthy child.

Objectives: External cephalic version (ECV) is a useful method helping to reduce the incidence of planned caesarean deliveries for fetal malpresentation. There is an effort to look for the best predictors for a successful ECV, the effect of maternal weight is still unclear. The aim of our study is to determine maternal body mass index (BMI) in association with the ECV success rate and the risk of complications., Material and Methods: A retrospective observational cohort study in 981 women after the 36th week of gestation with a fetus in a breech presentation who had undergone an ECV attempt. We evaluated the success rate and complications of ECV in association with BMI categories according to the WHO classification of obesity., Results: ECV was successful in 478 cases (48.7%). In the category of overweight patients (BMI > 25; n = 484), ECV was successful in 51% and unsuccessful in 49% (p = 0.28) of cases. In obese patients (BMI > 30; n = 187), ECV was successful in 44.8% and unsuccessful in 55.2% (p = 0.28) of cases. The effect of BMI on the success rate of ECV for the category of overweight and obesity was not proven by statistical analysis. Serious complications occurred in seven cases in similar numbers in all three subgroups according to BMI., Conclusions: BMI in the categories of overweight and obesity is not a factor influencing the success rate and risk of complications of ECV. These results can be helpful when consulting pregnant women the chance of successful ECV.

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

Objectives: This study aims to identify the differences in the use of HPV vaccination between female medical students in the Czech and Slovak Republics and their possible causes., Methods: We performed a cross-sectional survey among female students of general medicine in all faculties of medicine in the Czech and Slovak Republics., Results: We obtained 630 questionnaires from the Czech Republic and 776 questionnaires from the Slovak Republic. In the Czech Republic, 65.4% of female medical students underwent HPV vaccination, while in the Slovak Republic, the figure was 21.1%. In the Czech Republic, residency and religion of students did not influence their rate of vaccination. However, in the Slovak Republic, village residency with less than 5,000 inhabitants lowered the probability of vaccination with OR = 0.56 (95% CI: 0.38-0.84), and the Catholic religion lowered the probability of vaccination with OR = 0.40 (95% CI: 0.28-0.57). Czech students were informed about the possibility of vaccination by a paediatrician in 55.7% of cases, while the figure for Slovak students was 26.8%. In the Czech Republic, 75.7% of students participated in regular cervical oncologic screening, while in the Slovak Republic, the figure was 57.7%. Vaccination of relatives would be recommended by 86.5% and 80.5% of Czech and Slovak students, respectively., Conclusions: The adoption of an oncologic prevention programme and the more extensive propagation by paediatricians are probably the medical reasons for the higher HPV vaccination among Czech students. Demographic factors - village residency and religion - are also important.

The study objectives were to (1) identify risk factors related to stress urinary incontinence (SUI) and postnatal depression (PD) after birth, and (2) investigate both possible directions of association between SUI and PD in population-based sample of Czech mothers. 3,701 nulliparous and multiparous women completed the self-reported questionnaires at 6 weeks and 6 months after birth and were included into the analyses of this prospective cohort study. Unadjusted and adjusted logistic regressions examined relationship between SUI a PD accounting for range of other risk factors. During the first 6 months after birth, 650 mothers (17.6%) developed SUI and 641 (17.3%) displayed signs of PD. The mode of delivery, parity and higher BMI were associated with SUI. The rate of PD symptoms was higher in mothers with positive history of prenatal depression, and in divorced or widowed mothers. Both conditions were associated with worse self-reported health, back pain and stop-smoker status. Initially, SUI at 6 weeks was slightly, but significantly associated with onset of PD at 6 months (OR 1.51, 95% CI 1.02-2.23) while PD at 6 weeks was not significantly related to new cases of SUI at 6 months (OR 1.48, 95% CI 0.91-2.39). After full adjustment these OR reduced to 1.41 and 1.38 (both non-significant), respectively. SUI and PD are common conditions in women postpartum that share some risk factors. Our study suggests that both directions of their relationship are possible although a larger study is needed to confirm our findings.

Objective: To evaluate the determinants of vaginal delivery and safety in women undergoing cervical ripening with a synthetic osmotic dilator (Dilapan-S) prior to induction of labor., Methods: We conducted a secondary analysis of an international multicenter prospective observational study of Dilapan-S for cervical ripening in pregnancies greater than 32 weeks. Data were obtained in a standardized fashion and entered into a centralized electronic data capture system. The association between Bishop score and vaginal delivery was further evaluated with a multivariate receiver-operating characteristic (ROC) curve analysis. A Wilcoxon rank test and multivariable logistic regression were used for statistical analysis (significance: P < .05)., Results: Between May 2015 and July 2016, 444 pregnant women were included. Three hundred ten (70 %) delivered vaginally. Compared to patients who underwent cesarean delivery, those who delivered vaginally were more likely to have a history of prior vaginal delivery. Vaginal delivery rates were significantly correlated with Bishop scores of pre and post Dilapan-S and difference. After adjusting for age, BMI, number of dilators, cervical ripening time, and gestational age, both prior vaginal delivery and post-Dilapan-S Bishop scores were strong predictors of vaginal delivery (estimate coefficient: 0.1275 ± 0.03 P = .0002; 0.049 ± 0.01 P = .0001; respectively). Aggregate ROC accounting for these variables further supported these findings (AUC = 0.734). The lower confidence interval limit of vaginal delivery rates was above 50 % when post-Dilapan-S Bishop scores were ≥ 5. Cox regression analyses demonstrated that the duration of labor was significant shorter in women that had vaginal delivery., Conclusion: Bishop scores after cervical ripening with Dilapan-S are good predictors of vaginal delivery. Bishop scores < 5 post Dilapan-S may warrant further cervical ripening. Further level 1 trials are needed to compare osmotic dilators to other ripening methods., Competing Interests: Declaration of Competing Interest None of the authors have a conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: To evaluate the effect of transient fetal bradycardia and other heart rate changes during and after external cephalic version (ECV) on perinatal outcomes. To determine factors associated with a higher risk of occurrence of transient fetal bradycardia during and after ECV., Study Design: Prospective study in 286 women after the 36th week of gestation with a fetus in breech presentation who have undergone an ECV attempt. The study analyses the incidence of transient fetal bradycardia during and immediately after ECV, the time interval to complete adjustment of fetal bradycardia, the factors associated with the occurrence of transient fetal bradycardia, cardiotocography (CTG) changes after ECV and perinatal outcomes. All the data were statistically analyzed., Results: The ECV was successful in 51 % (146/286). Transient fetal bradycardia occurred during and after ECV in 81 cases (28.3 %). A successful version was a factor significantly associated with fetal bradycardia (54; 37.0 % versus 27; 19.3 %; p < 0.01). Clinically significant hypotension of the mother was accompanied by transient fetal bradycardia in 12 cases (4.2 %). After the successful ECV there was no significant difference in the percentage of vaginal deliveries between subgroups with and without transient fetal bradycardia (85.2 % versus 83.7 %; p = 1.00). Nor in occurrence of acute fetal distress during labor (18.5 % versus 15.6 %; p = 0.65). In cases of a successful ECV transient CTG changes after ECV had no effect on the incidence of acute fetal distress during labor (23.5 % versus 15.7 %; p = 0.49)., Conclusions: Transient fetal bradycardia and other heart rate changes during and immediately after ECV was not associated with a higher incidence of acute fetal distress during labor and did not affect perinatal outcomes. Higher occurrence of transient bradycardia after ECV was associated only with successful ECV. Transient hypotension of the mother as one of the causes of transient fetal bradycardia during ECV should be considered., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: To analyze cases of uterine rupture during pregnancy and delivery. To report risk factors, maternal and neonatal outcomes., Design: Restrospective cohort study., Setting: Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno., Methods: This study used data from medical records of 36 195 labours between 2011-2016 in the Department of Obstetrics and Gynecology Masaryk University Hospital Brno. We identified all cases of complete and incomplete uterine rupture diagnosed during pregnancy, delivery and puerperium. We analyzed risk factors, symptoms and signs and maternal and neonatal outcomes., Results: We identified 15 uterine ruptures. Three cases occurred during pregnancy in absence of labour, ten cases in association with delivery, one case during puerperium and one case of uterine rupture was associated with induction of abortion in the 2nd trimester. Eight patients had a previous cesarean section. Other uterine surgery was reported in history of four cases, including myomectomy, perforation of uterine fundus during hysteroscopy, curretage. Three patients had unscarred uterus. Most of the cases presented with abnormal fetal heart rate tracing, abdominal pain, vaginal bleeding and hypotension. There were two perinatal deaths associated with uterine rupture and perinatal asphyxia was observed in five infants. No mother died in association with uterine rupture. Estimated blood loss higher than 1000 ml occurred in 11 cases. Three patients underwent hysterectomy., Conclusion: Overall prevalence of uterine rupture during pregnancy and delivery was 0,04%, in women with previous cesarean section was 0.2%, in women with unscarred uterus was 0.08. Suspicious fetal heart rate tracing and acute abdominal pain are the most common symptoms. Adverse neonatal outcomes were identified in seven cases.

Objective: Evaluation of maternal and neonatal outcomes in operative vaginal deliveries in prospective study analysis., Design: Prospective case-control study analysis., Setting: Prospective analysis of 292 operative vaginal deliveries (VEX, forceps) for the period June 2016 - August 2017 from overall 6056 vaginal deliveries. Type and frequency of maternal and neonatal trauma occurence was observed in connection with using vacuum-assisted delivery and forceps delivery, mainly the cephalohematomas and their complications. Collected data were statistically analysed., Results: In the reported period from overall 6056 deliveries there were 216 vacuumextractions (3.6%) and 72 forceps deliveries (1.2%) performed. Both methods were used in four patients (VEX and forceps). The most frequent trauma in newborns were cephalohematomas. Remarkable cephalohematoma, requiring further observation has occured in 40 newborns (18.5%) after vacuum-assisted delivery and in 5 newborns (6.9%), (p = 0,017) after forceps delivery. Consequential punction of cephalohematoma occured only after vacuumextraction delivery and in 6 newborns (15.0 %). The third degree perineal rupture occured after vacuumextraction in 20 patients (9.3%) and after forceps delivery in 12 patients (16.7%), (p = 0,091). The fourth degree perineal rupture occured only after vacuumextraction and in 1 case (0.5%)., Conclusion: The vacuumextraction compared with forceps is more likely to be associated with the statistically significant incidence of cephalohematomas and their further treatment. Forceps deliveries compared with vacuumextraction are more likely to be associated with the maternal perineal trauma, but the diference was not statistically significant.

Objective: To explore whether miR-210 expression can be used as a diagnostic and prognostic marker in acute fetal hypoxia., Methods: Whole blood samples of 29 women and their fetuses without hypoxia and 24 women and their fetuses with hypoxia were analysed in this study. Reverse transcription and quantitative real-time PCR were used to measure the expression of miR-210. Expression level differences between the control and hypoxic group in labour time and postpartum change fold were analyzed by standard statistical tests., Results: We confirmed that miR-210 is significantly more upregulated in fetal blood with acute hypoxia when compared to maternal blood (P Conclusions: Our study confirmed miR-210 upregulation in the blood of pregnant women with acute fetal hypoxia at the time of labour compared to pregnant women without acute fetal hypoxia. Additional investigation should be done to determine miR-210 clearance and the possibility of using miR-210 as a diagnostic and prognostic marker.

Introduction: To evaluate the effects of synthetic osmotic dilators (Dilapan-S/ Dilasoft) in women who required induction of labour in a large prospective multicentre international observational study., Materials and Methods: Primary outcomes were duration of Dilapan-S/Dilasoft insertion (hours), total induction - delivery interval (hours) and the rate of vaginal deliveries within 24 h (%). Secondary outcomes were the number of dilators inserted, Bishop score increase after extraction of Dilapan-S/Dilasoft, complications during induction (uterine contractions, uterine tachysystole and hyperstimulation, effect on the fetus) and post induction (infections and neonatal outcomes), agents / procedures used for subsequent induction of labour, immediate rate of spontaneous labours following cervical ripening period, rate of spontaneous vaginal deliveries, rate of instrumental vaginal deliveries and caesarean sections., Results: Total of 543 women were recruited across 11 study sites, of which, 444 women were eligible for analysis. With Dilapan-S/Dilasoft use of <12 h (n = 188) the overall vaginal delivery rate was 76.6% with 45.7% of these births occurring within 24 h, 66% within 36 h and 75.5% within 48 h from insertion of Dilapan-S/Dilasoft. The mean insertion-delivery interval for this group was 24.3(±10.4) hours. With Dilapan-S/Dilasoft use of >12 h (n = 256), the overall vaginal delivery rate was 64.8%, with 16% of these births occurring within 24 h, 48.4% within 36 h and 54.7% within 48 h from insertion of Dilapan-S/Dilasoft. The mean insertion-delivery interval for this group was 39.1(±29.2) hours. The mean gain in the Bishops score was +3.6(±2.3). The mean number of Dilapan-S/Dilasoft dilators used was 3.8 (±1.1). The overall rate of caesarean section was 30.1%. The overall complication rate was low including infection risk. No adverse neonatal outcome was attributable to the use of Dilapan-S/Dilasoft., Conclusion: Dilapan-S/Dilasoft are safe and effective methods for cervical ripening. Their use is associated with low maternal and neonatal complication rates. Future research should aim at level I clinical trials comparing Dilapan-S to other mechanical or pharmacological cervical ripening agents., Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02318173., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: 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., Design: Observational analytic cohort study., Setting: Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno., Materials and Methods: 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., Results: 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., Conclusion: 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.

Objective: Evaluation of success rate and the safety of external cephalic version after 36 weeks of gestation., Design: Retrospective analysis., Setting: Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno., Methods: 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., Results: 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. umbilicalis < 7.00 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 minute < 5 was both in the successful and unsuccessful group in 1 case., Conclusion: 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.

Unlabelled: 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., Design: Review.

Rationale, Aims and Objectives: To evaluate obstetricians' inter- and intra-observer agreement on intrapartum cardiotocogram (CTG) recordings and to examine obstetricians' evaluations with respect to umbilical artery pH and base deficit., Methods: Nine experienced obstetricians annotated 634 intrapartum CTG recordings. The evaluation of each recording was divided into four steps: evaluation of two 30-minute windows in the first stage of labour, evaluation of one window in the second stage of labour and labour outcome prediction. The complete set of evaluations used for this experiment is available online. The inter- and intra-observer agreement was evaluated using proportion of agreement and kappa coefficient. Clinicians' sensitivity and specificity was computed with respect to umbilical artery pH, base deficit and to Apgar score at the fifth minute., Results: The overall proportion of agreement between clinicians reached 48% with 95% confidence intervals (CI) (CI: 47-50). Regarding the different classes, proportion of agreement ranged from 57% (CI: 54-60) for normal to 41% (CI: 36-46) for pathological class. The sensitivity of clinicians' majority vote to objective outcome was 39% (CI: 16-63) for the umbilical artery base deficit and 27% (CI: 16-42) for pH. The specificity was 89% (CI: 86-92) for both types of objective outcome., Conclusions: The reported inter-/intra-observer variability is large and this holds irrespective of clinicians' experience or work place. The results support the need of modernized guidelines for CTG evaluation and/or objectivization and repeatability by introduction of a computerized approach that could standardize the process of CTG evaluation within the delivery ward., (© 2015 John Wiley & Sons, Ltd.)

Objective: Purpose of this study was to determine the frequency of occurence of specific complications of monochorionic diamniotic twins born after 24 weeks of pregnancies and the effect of these complications on perinatal morbidity and mortality., Type of Study: Restrospective analysis., Setting: Dpt. of Obstetrics and Gynecology Masaryk University and University Hospital Brno., Methodology: A retrospective analysis of 175 monochorionic diamniotic pregnancies (mo-bi), which were terminated after the 24th week of pregnancy at the Department of Obstetrics and Gynecology Masaryk University and University Hospital Brno between the years 2008-2013. The specific complications such as twin-to-twin syndrome (TTTs), twin anemia polycytemia sequens (TAPS), selective intrauterine growth restriction (sIUGR), twin-arterial revers perfusion sequence (TRAP), single intrauterine fetal death (IUFD), placental insufficiency with both twins were identified using prenatal ultrasound examinations, perinatal results and the result of pathological anatomical examinations. Perinatal morbidity, neonatal mortality and neurological development were evaluated. The numbers of late detections of specific complications were observed., Results: Specific complications in our group were identified in 50 pregnancies (28.6%). TTTs was diagnosed most often, by 18 pregnancies (10.3%), next most frequent diagnosis were sIUGR (9.7%) and TAPS (3.4%). The placental insufficiency with both twins complicated 2.6% pregnancies. 10 children had abnormal neurological development. Pregnancies with late detection had the worst perinatal results. No acute TTTs during delivery was detected., Conclusion: Specific placental complication reached 29.7% in our file. The most frequent complication was TTTs (10.3%) and selective growth restriction (9.7%). Pregnancies with late diagnosis of these complications had the worst results. The prenatal care by monochorial biamnial pregnancies should be at specialized centres from the 16th week of pregnancy every two weeks.

Objective: To determine intrapartum mortality, neonatal mortality and serious neonatal morbidity in selected group of planed vaginal breech deliveries after 36 week of pregnancy. Compare vaginal breech deliveries with primary cesarean deliveries.Designe: Retrospective study., Settings: Department of Obstetrics and Gynaecology, Masaryk University, University Hospital Brno; Department of neonatology, University Hospital Brno; Faculty of Economics and Management, University of Defence in Brno., Methods: Retrospective analysis of 1013 births of singleton pregnancies with breech position of the fetus after 36 completed week of pregnancy at University Hospital Brno in the years 2008-2011. Vaginal delivery was planed for 430 women (42.4%). Elective caesarean section was performed in 583 women (57.6%). An assessment of intrapartum and neonatal mortality and serious neonatal morbidity and incidence of umbilical artery pH < 7.00. We also evaluated non-serious neonatal morbidity. RESULTS in the group of vaginal breech deliveries, including births completed by acute caesarean section, were compared with results in the group of elective caesarean sections., Results: In the group of 430 women with planned vaginal breech delivery, 347 delivered vaginally (80.7%), by acute caesarean section 83 women (19.3%). In the group of planned vaginal births, including births completed by acute caesarean section, pH < 7.00 in umbilical artery occurred in 9 cases (2.1%). In the group of elective caesarean deliveries pH < 7.00 does not occurred. Death of the fetus during labor or before 28 day after birth does not occurred. A statistically significant difference in the incidence of serious neonatal morbidity between the group of planned vaginal births and births by elective caesarean section was found in Apgar score in 5th minute < 5 (2 versus 0), peripheral nerve injury persisting at discharge (2 versus 0) and admission to the neonatal intensive care unit for longer than 24 hours (2 versus 10). When comparing all cases of serious neonatal morbidity between the two groups, the difference was not statistically significant (1.2% versus 1.9%, NS)., Conclusion: When strict criteria are met during selection of women appropriate for vaginal breech delivery and during labor, planned vaginal breech delivery at term is save option. The incidence of severe neonatal morbidity when compared with elective caesarean section is not increased., Keywords: breech presentation, vaginal delivery, caesarean section, neonatal morbidity, neonatal mortality.

Objective: The objective is to evaluate whether a breach presentation of the second twin has an influence on the perinatal results in vaginal births of bichorial-biamniotic twins after 33rd week of pregnancy., Design: Retrospective analysis., Setting: Department of Obstetrics and Gynecology, Masaryk University and University Hospital Brno., Sample and Methods: The current study is a retrospective analysis of 695 vaginal births of bichorial-biamniotic twins after 33rd week of pregnancy. All births were conducted at the Department of Obstetrics and Gynecology, Masaryk University and University Hospital Brno during the span of 2004-2013. The sample was divided into2 groups. Group A consisted of 550 births of both twins in vertex presentation, group B consisted of 145 births in which the second twin happened to be in the breach presentation. The factors that have been evaluated include the percentage of births finished vaginally, perinatal results (pH a. umbilicalis below 7.0 and Apgar score in the 5th minute below 5) and early neonatal mortality and morbidity. Data from both groups have been compared with the use of Fishers exact test., Results: For the group A, 81.3% of births were finished vaginally, as opposed to 85.5% in group B. Acute Caesarean sections conducted on the second twin consisted 4% (22 cases) in group A and 3.4% (5 cases) in group B. No significant difference has been found between the two groups in both perinatal results (p = 0.6 for pH from a. umbilicalis below 7.0 and p = 0.7 for Apgar score in the 5th minute below 5; both two-tailed) and in the frequency of early neonatal mortality and morbidity. In total,5 neonatal deaths have occured in 28 days after birth, out of which 2 have occured in group A and 3 in group B., Conclusion: It was concluded that breach presentation of the second twin does not influence perinatal results in vaginal births of bichorial-biamniotic twins., Keywords: bichorial-biamniotic twins, vaginal birth, breach presentation, perinatal mortality, perinatal morbidity.

Interpretation of cardiotocogram (CTG) is a difficult task since its evaluation is complicated by a great inter- and intra-individual variability. Previous studies have predominantly analyzed clinicians' agreement on CTG evaluation based on quantitative measures (e.g. kappa coefficient) that do not offer any insight into clinical decision making. In this paper we aim to examine the agreement on evaluation in detail and provide data-driven analysis of clinical evaluation. For this study, nine obstetricians provided clinical evaluation of 634 CTG recordings (each ca. 60min long). We studied the agreement on evaluation and its dependence on the increasing number of clinicians involved in the final decision. We showed that despite of large number of clinicians the agreement on CTG evaluations is difficult to reach. The main reason is inherent inter- and intra-observer variability of CTG evaluation. Latent class model provides better and more natural way to aggregate the CTG evaluation than the majority voting especially for larger number of clinicians. Significant improvement was reached in particular for the pathological evaluation - giving a new insight into the process of CTG evaluation. Further, the analysis of latent class model revealed that clinicians unconsciously use four classes when evaluating CTG recordings, despite the fact that the clinical evaluation was based on FIGO guidelines where three classes are defined., (Copyright © 2014 Elsevier Inc. All rights reserved.)