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Biomedical subjects

A Roztocil

Publications and source records attributed to A Roztocil.

At least 19 recordsLinked to original sources
PubMed2006

[ST analysis of fetal ECG in premature deliveries during 30th-36th week of pregnancy].

OBJECTIVE: To determine the possibilities of ST analysis of fetal ECG (STAN) in premature deliveries between 30th to 36th week of pregnancy. To compare the results of a group of premature deliveries monitored by ST analysis with a control group of premature deliveries monitored by means of cardiotocography (CTG) and intrapartum fetal pulse oxymetry (IFPO). TYPE OF STUDY: A prospective study. SETTING: Department of Gynecology-Obstetrics, Masaryk University and Faculty Hospital Brno. METHODS: The authors evaluated 39 women with premature delivery between 30th and 36th week of pregnancy from a total cohort of 239 high-risk pregnant women, who had been monitored by means of ST analysis of fetal ECG. The control group included 229 pregnant women who gave birth between 30th and 36th week of pregnancy under the monitoring with CTG and IFPO. The allocation into individual groups was at random order. The authors evaluated the duration and way of termination of delivery, pH in arterial umbilical blood, Apgar score in the first, fifth and tenth minute, total duration of hospitalization, necessity and duration of stay at the Neonatologic Intensive Care Unit, Intermediatry Intensive Care Unit, the presence of sepsis, hyperbilirubinemia and neurological state of the newborn. The statistical analysis was performed by means of the Fisher's exact test, Kruskal-Wallis test, chi2 test and the parametric test Anova. RESULTS: Almost none of the observed parameters in both categories of premature deliveries (STAN vs. CTG+IFPO) exhibited a statistically significant difference except a mild neurological affection of the newborn. In the group of premature deliveries monitored by ST analysis there are only 33.3% of newborns with signs of light neurological damage as compared with the control group, where 56.3% subjects were so affected (p<0.01). CONCLUSION: It has become obvious that the ST analysis of fetal ECG in premature deliveries between 30th and 36th week of pregnancy provides the same results as the so far used monitoring by CTG and IFPO. In the group of premature deliveries monitored by the ST analysis, there were significantly less frequent neurological disturbances.

Apgar Score↗
PubMed2006

[Role of ST-analysis of fetal ECG in intrapartal fetus monitoring with presumed growth retardation].

OBJECTIVE: Evaluation of the role of ST analysis of fetus ECG for early detection of developing acute hypoxia in the course of delivery of fetuses with presumed growth retardation. A comparison with present way of intrapartal fetus monitoring. Impact on the number of surgical births for indications of threatening fetus hypoxia. Influence of the method on perinatal results and postnatal adaptation of the newborns. TYPE OF STUDY: A prospective study. SETTING: Gynecology-Obstetrics Clinic, Masaryk University and Teaching Hospital Brno. METHOD: Forty seven women with a growth retardation of the fetus diagnosed before delivery who gave birth in the Teaching Hospital in Brno during 2003-2005 and intrapartal ST analysis of fetus ECG was subsequently used, were enrolled into this prospective study (group A). The control group consisted of 87 deliveries taking place in the same period of time and concerning women with fetuses suffering from growth retardation and monitored by standard methods (group B). The standard methods included cardiotocography (CTG), supplemented with pulse oximetry (IFPO) if needed. The diagnosis of intrauterine fetus growth retardation was established on the basis of the results of repeated prepartal ultrasound fetus biometry with estimation of the mass, which corresponded to a group below 10 percentile for the given gestational age. The numbers of vaginal deliveries and surgically treated delivery due to threatening fetus hypoxia (Cesarean section, forceps delivery) were recorded. The authors evaluated postpartal pH from umbilical artery, independently for the group of values of pH < 7.00, the group of pH 7.00-0.10 and pH 7.10 or more. The values of Apgar score were evaluated for the first, fifth and tenth minute, respectively. The neonatologist followed the duration of stay of the newborn at the Newborn Intensive Care Unit, the Intermediate Care Unit, total duration of hospitalization, the occurrence of sepsis in the early newbotn period, the occurrence of hyperbilirubinemia, and the conclusion of neurological examination. All the results were evaluated statistically by the chi2 test, Kruskal-Wallis test or the Anova method. RESULTS: There was no statistically significantly difference in the number of delivery ended by surgery for threatening fetus hypoxia (p = 0.856) or the detection rate of intrapartal hypoxia according to pH values of umbilical blood divided into the three groups (p = 0.657, p = 0.958, p = 0.730, respectively). The values of Apgar score differed in favor of the group A significantly only in the first minute at the level of 5% opf significance (p = 0.018). The values of Apgar score in the fifth and tenth minute did not show any significant difference (P = 0301 and p = 0313, respectively). There was no statistically significant difference in neonatological results between the group A and B. CONCLUSION: The use of ST analysis of fetal ECG in the course of delivery of fetuses with presumed intrauterine growth retardation did not show any significant difference from the presently used methods (CTG supplemented with IFPO if needed). In using the method there was not any effect on the number of surgically treated deliveries for indications of threatening acute fetus hypoxia or perinatal results and postnatal adaptation of the newborns.

Cardiotocography↗
PubMed2000

[Continuous monitoring of fetal oxygen saturation (FSpO2) using intrapartum fetal pulse oximetry (IFPO) in the diagnosis of acute fetal hypoxia].

OBJECTIVE: The aim of the study was to evaluate the possibility of lowering the Caesarean Section rate in patients presenting the signs of intrauterine hypoxia on CTG tracing by evaluating the foetal oxygen saturation (FSpO2) by means of intrapartum foetal pulse oximetry (IFPO). DESIGN: Open prospective study. SETTING: 1st Department of Gynecology and Obstetrics, Medical Faculty of Masaryk University, Brno. METHODS: From January 1, 1999 to December, 1999 68 patients were enrolled in the study. For the application of the IFPO sensor the patient had to meet the following criteria: patient's informed consensus, pregnancy > or = 36 weeks, regular uterine contractions, rupture of membranes, cervical dilatation of > or = 2 cm, singleton pregnancy, cephalic occiput presentation, no sings of vaginal infection, acute foetal hypoxia on CTG tracing: (baseline heart rate < 100 beats/min of different patterns. Progressive bradycardia: baseline heart rate gradually decreases between contractions (DIP II, DIP 0). Persisting bradycardia, baseline < 80 beats/min. Baseline tachycardia (> 150 beats/min) with reduced variability and/or severe variable (DIP 0) and late decelerations (DIP II). The IFPO used--Nellcor N-400. In all patients that fulfilled the above mentioned criteria during the first stage of labor the sensor was applied preferably on the posterior cheek of the foetus and the FSpO2 values were continuously monitored up to the complete dilatation. The threshold of the intrapartum foetal hypoxia (FSpO2 values) was considered < 30% for more than 10 minutes. In cases of normal FSpO2 values the delivery was conducted vaginally even if the CTG tracing continued to signalise++ intrauterine hypoxia. In case of pathologic FSpO2 values, Caesarean Section was performed. RESULTS: IFPO is an easy feasible method and in all cases the values of FSpO2 were obtained. The method has no serious side effects neither in the mother nor in the foetus. Nevertheless the presence of the sensor in the uterine cavity provokes often unpleasant feelings and limits the mother in free movements. In all suspicious CTG tracings (17) no Caesarean Sections were performed after the verification of the foetal hypoxia by means of FSpO2 evaluation. In 51 patients a pathologic CTG tracing indicating the performance of Caesarean Section was present. After FSpO2 evaluation the Caesarean Section was performed only in 11 (21.6%) patients. The remaining 40 (78.4%) delivered vaginally. Between these two groups there was statistical difference in the values of FSpO2 and postpartum cord pH. The state of newborns evaluated according to the Apgar score did not significantly differ in the two groups. CONCLUSION: These preliminary results indicate that taking in an account foetal SpO2 evaluated by IFPO in the 1st stage of labor in cases of pathologic CTG tracing (late and variable deceleration) indicating Caesarean Section, > 50% of these may be saved with identical perinatal outcome (Apgar scores, cord pH).

Acute Disease↗
PubMed2000

[Effect of maternal O2 inhalation on oxygen saturation in the parturient (SpO2) and the fetus (FSpO2)].

OBJECTIVE: The aim of the study was to evaluate the impact of different concentrations of inspirated O2 on the SpO2 values of the foetus and the mother during the 1st and 2nd stages of labor. DESIGN: Prospective study. SETTING: 1st Department of Gynecology and Obstetrics, Medical Faculty of Masaryk University, Brno. METHODS: 17 non-risk patients were enrolled in the study. The SpO2 levels of the mother and the foetus were monitored simultaneously in 10 min intervals with the room air inspiration entrainment O2 mask and the inflatable face mask during 1st and 2nd stages of labor. RESULTS: No changes in maternal SpO2 values were revealed in the three different O2 inspiration regimens neither in the 1st, nor in the 2nd stages of labor. The mean value was 98% +/- 1.6 SD. As for the foetus the SpO2 values were increased by 6% (+/- 7.9 SD) after 40% concentration of O2 and 7.7% (+/- 8.8 SD) after 98% O2 inspiration during the 1st stage of labour. These values have decreased promptly after the cessation of the O2 inspiration. The mean SpO2 values at room O2 concentration were 46.3% +/- 7.9 SD for the 1st stage of labor and 43.7% +/- 4.8 SD for the 2nd stage of labor. CONCLUSION: The O2 inspiration during the labor has no impact on the maternal SpO2 values but increases the SpO2 values of the foetus during the 1st stage of labor. We were not able to evaluate the impact of the O2 inspiration on foetal SpO2 values during the 2nd stage of labor.

Adult↗
PubMed2000

[Validity of cardiotocography in acute fetal hypoxia--neonatal status after cesarean section].

OBJECTIVE: Judging the validity of CTG monitoring as a method of acute foetal hypoxia diagnosis (AFH), quantifying the number of cesarean section (SC), performed from the indication of acute fetal hypoxia and point out a number of surgeries based on false positive CTG results. DESIGN: Retrospective study. SETTING: 1st Department of Obsterics and Gynaecology Faculty of Medicine MU, Brno. METHODS: 100 women, patients of the 1st Department of Obstetrics and Gynaecology in Obilní trh, Brno, who had cesarean section due to foetal hypoxia indicated on the base of pathological or suspect CTG, were involved in the collection. In the next stage newborns were divided into 2 clinical groups: "Acidosis" and "Normal" depending on the pH value from a. umbilicalis and statistically analysed. RESULTS: From 100% suspect or pathological CTG, only 36.19% were valid (newborns showed depression after birth). Remaining 63.18% of newborns, although showed CTG signs of hypoxia were born normal and probably were not necessary to be born by cesarean section. CONCLUSION: Although CTG investigation is in most places the only "objective" method for diagnosis of AFH, this investigation cannot precisely determinate whether hypoxia is present or it is not. For true objectivity of foetal intrauterine condition and correct indication of SC is suitable to use further diagnostic methods of AFH in future, for example intrapartal foetal pulse oximetry or blood analysis from foetal scalp.

Acute Disease↗
PubMed1999

[Prenatal induction of lung maturation in the fetus. Betamethasone versus betamethasone+thyrotropin-releasing hormone].

During the period from May 1, 1994 till December 31, 1997 at the First and Second Departments of Gynaecology and Obstetrics Masaryk University Brno 311 neonates with birthweights from 500 to 2000 g were born. A retrospective study was made comparing neonatal results of three methods of prenatal induction of maturing of surfactant in premature neonates. The first group was without treatment, in the second group only betamethasone was administered and in the third group betamethasone and thyrotropin releasing hormone (TRH). The neonates were divided into three body weight groups: 500-999 g, 1000-1499 g and 1500 g and more. The most favourable results with administration of betamethasone and TRH were obtained in the group weighing 500-999 g. This pertained to the smaller number of post-partum administration of surfactant, reduction of the oxygenation index and period of artificial pulmonary ventilation. IVth grade RDS and other complications in the child. In the group of neonates weighing 1000-1499 g administration of betamethasone and TRH had a positive effect only on the oxygenation index and grade of RDS. In the group of neonates with weights above 1500 there were no statistically significant differences between the described three groups. It may be concluded that the greatest effectiveness was achieved by a combination of betamethasone and TRH in neonates weighing 500-999 g, this combination was less effective in the group weighing 1000-1499 g and without effect in those weighing 1500 g or more.

Betamethasone↗
PubMed1998

A comparison of three preinduction cervical priming methods: prostaglandin E2 gel, Dilapan S rods and Estradiol gel.

The aim of the study was to evaluate the efficacy of three cervical priming methods. From January 1, 1994 to December 31, 1996 247 patients presenting an indication for induction of labor with an unripe cervix were randomly assigned to one of the following preinduction protocols: 0.5 mg of Prostaglandin E2 gel administered intracervically (n = 83), four hygroscopic Dilapan S rods applied intracervically (n = 82), and 150 mg of Estradiol gel administered intravaginally (n = 82). The inclusion criteria were the patient's informed consent, singleton pregnancy of more than 36 weeks, cephalic presentation, Bishop score < 5 points and reactive non-stress test. If the cervical maturation (Bishop score > or = 5, and/or Bishop score augmentation by 2 points) did not occur after 14 hours of priming, the case was considered a failure. In the opposite case the patient was induced by means of extraamniotic PGE2 administration. The mean gain in the Bishop score was 3.7 points in the PGE2 group 3.9 points in the Dilapan S group, and 2.8 points in the Estradiol group. 71 patients (85.5%) were successfully preinduced in the PGE2 group, 73 (89.0%) in the Dilapan S group, and 63 (76.8%) in the Estradiol group. Labor was induced by preinduction only in 23 patients (31.3%) of the PGE2 group in 17 (20.7%) of the Dilapan S group, and in 14 (17.1%) of the Estradiol group. The mean induction to delivery interval was 7 h 27 min in PGE2 group, 7 h 49 min in the Dilapan S group and 9 h 15 min in the Estradiol group. The Caesarean section rate was 24.4% in the PGE2 group, 10.5% in the Dilapan S group, and 24.4% in the Estradiol group. PGE2 gel and Dilapan S rods proved higher efficacy than Estradiol gel. The highest frequency of labor induced by preinduction only was in the PGE2 group. There were shorter induction to delivery intervals in the PGE2, and Dilapan S groups. The lowest Caesarean section rate was in the Dilapan S group. Neither serious side effects nor negative neonatal outcome were noted in either group.

Adult↗
PubMed1997

[Hemostasis using vasopressin analogs during conization of the uterine cervix and minor vaginal operations].

Peroperative haemorrhage is a frequent complication of conization of the portio uteri by surgery-by a "cold knife" scalpel or another method (LEEP, laser, etc.). In a clinical study comprising 41 patients with the diagnosis CIN I-III or laceration of the portio uteri classical conization by means of a scalpel was made with concurrent haemostasis with terlipressin (TLP) by paracervical administration (400 micrograms-REMESTYP 2 amp.). Concurrently the blood loss in ml was followed, the Hb level and other effects of the preparation. From the results ensues that side-effects after local administration of TLP were observed only in 12.2%. Peroperative blood losses were on average under 15 ml. Local paracervical TLP administration appears effective from the clinical aspect with regard to the low frequency of side-effects and the favourable haemostatic effect.

Blood Loss, Surgical↗
PubMed1996

[Induction of cervix ripening with hydrophilic Dilapan rods in pregnancy at term].

During the period between July 1, 1993 and July 31, 1994 the authors preinduced 52 pregnant women in term using the cervical dilatator Dilapan. The group comprised patients with single pregnancies > 38 weeks, vertex presentation, cervical score < 5 and reactive NST. They introduced into the cervical canal 4 Dilapan rods for 12-18 hours and after extraction of the rods, depending on the finding, the patients were induced with Prostaglandin e.a. or oxytocin i.v. The preinduction was successful in 46 patients (88.5 per cent), in 16 patients (30.8 per cent) uterine contractions were induced by Dilapan alone. Forceps delivery was performed 4 times (7.7 per cent) and Caesarean section 12 times (23.1 per cent). Apart from pain in the hypograstrium resembling menstruation pain, no side-effects were recorded. There were no irregularities such as the length of labour stages, blood loss due to injury during labour and the incidence of neonatal hypoxia. Based on the described experience Dilapan can be recommended as a preinduction method for maturation of the portio uteri.

Adult↗
PubMed1996

[An active approach in membrane rupture before the 32nd week of pregnancy and perinatal results].

During the period from Jan. 1, 1991 to Dec. 31, 1994 at the Second Department of Gynaecology and Obstetrics in Brno 125 patients were delivered of babies after premature rupture of membranes (PROM) before the 32nd week of gestation. After verification of PROM the active approach involved the following steps administration of antibiotics, corticoids, tocolysis, monitoring of markers of inflammation, of the foetoplacental unit and side-effects of treatment. Unless the patient had a spontaneous delivery within three days, the pregnancy was terminated, if the portio uteri was mature, by induction, if it was not mature, by Caesarean section. The latter was performed in cases of a pathological position of the foetus, multiple pregnancy, foetal hypoxia, metrorrhagia or associated complications. The perinatal results were evaluated in four weight categories (500-749, 750-999, 1000-1249, 1250-1499). The early neonatal mortality rate in the different groups was 750/1000, 420/1000, 217/1000, and 90/1000, RDS IV 37%, 36%, 21%, 12% and adnatal infection 25%, 11%, 34% and 21%. According to the authors results an active approach in case of PROM before the 32nd week of gestation is another factor which reduces the perinatal mortality and morbidity.

Delivery, Obstetric↗
PubMed1996

[Labor induction with extra-amnial administration of PGE2 vaginal tablets].

UNLABELLED: During the period between Jan. 1 1992 and Dec. 31, 1995 at the Second Department of Gynaecology and Obstetrics in Brno labour was induced in 1159 patients by extraamnial fractionated administration of PGE2 vaginal tablets. After assessment of the indication and the baseline examination (NST, amnioscopy, US biometry and cervical score) according to the CS to the patient the first dose of PGE2 was administered into the extraamnial space beyond the inner os uteri (CS 5-8:1.0 mg PGE2, CS > 8 : 0.5 mg PGE2). After two hours the patient was examined again and if regular uterine contractions had started or the finding on the os uteri was larger than 2 cm, the amniotic sac was disrupted. If not, another dose was administered. After two hours the patient was re-examined and if the os was larger than 2 cm, and there were regular uterine contractions, the amniotic sac was disrupted. If the changes did not take place, the induction was considered a failure. RESULTS: there were 1007 successful inductions (95.5%), the mean period from the onset of induction to the onset of uterine contractions was < 120 mins-269 (24.6%), 120-180 mins.: 501 (45.9%) and > 180 mins.: 322 (29.5%). The mean period of the first stage of labour was 228 mins., stage II 10 mins., stage III 8 mins. Five times uterine hypertonus was recorded and a blood loss greater than 500 ml occurred in four patients. Forty-nine Caesarean sections were made (4.2%) and 51 (4.4%) forceps deliveries. The rate of epidural analgesia was 27 (2.3%). Revision of the uterine cavity was made in 39 patients (3.4%) and manual lysis of the placenta in 30 (2.6%). The Apgar score was inferior to 6 in 10 neonates (0.9%). The protocol of induction of labour described by the authors is effective and associated with a minimum of side-effects, safe for the mother and foetus, well tolerated by patients and cost-effective.

Dinoprostone↗
PubMed1996

[Programmed labor--beneficial for the mother and fetus or an obstetrical hazard?].

During the period between Jan. 1, 1992 and Dec. 31, 1995 at the Second Department of Gynaecology and Obstetrics 482 full-term pregnancies were terminated by elective induction of labour. Labour was induced by extraamnial administration of PGE2 (Prostin UPJOHN 3.0 mg tablets vag). Depending on the maturity of the portio uteri a maximum of two doses after two hours were administered: 0.5 mg PGE2 when the cervical score was > 8 and 1.0 mg PGE2 when the score was 5-8 points. The results were compared with 278 non-risk pregnant women who were delivered of babies between Jan. 1 and June 30, 1995. The first stage of labour was longer in patients with spontaneous labour. The second stage of labour was longer in patients with induced labour. From the results ensues that an elective induction of labour does not increase the perinatal risk for mother and foetus, and conversely if all conditions are respected it is better for the mother, her family and the staff of the labour ward.

Dinoprostone↗