Biomedical subjects

P Velebil

Publications and source records attributed to P Velebil.

At least 19 recordsLinked to original sources

PubMed2006

[Analysis of stagnation of perinatal mortality in the Czech Republic].

OBJECTIVE: Analysis of stagnation of perinatal mortality level in the CR in 2000-2004. DESIGN: Retrospective nationwide epidemiological study of selected indicators of perinatal care level. SETTINGS: Institute for the Mother and Child Care, Prague, Czech Republic. METHODS: Comparison of selected indicators of perinatal care and conditions for such care during years period 2000-2002 and 2003-2004. RESULTS: Stagnation of perinatal mortality in the Czech republic since 2000 has been the result of two opposite process. On one side it is the continuous increase of newborns of low birth weight as a result of not only biological but also demographic and socio-economic risk factors, which create unfavorable envirement for provision of perinatal care. On the other side it is the improved professional care observed in two areas (prenatal diagnosis of congenital malformations and intensive care in newborns of extremely low birth weight). During 2003-2004 we were still able to observe odds of improvement of professional care against the deteriorating conditions which led to further decrease of perinatal mortality by 0.27 per thousand on average. However, there is a danger that negative factors will prevail in the near future, because reserves for the further improvement of professional care are exhausted and analyzed unfavorable factors are continuously on the rise. This could lead to an increase of the curently low perinatal mortality level. CONCLUSIONS: Stagnation of perinatal mortality in the Czech Republic during the last five years in a range of 4.0-4.4 per thousand is a result of two opposite processes. On one side it is due to improved level of professional care in prenatal diagnosis, and due to centralized intensive care of newborns of extremely low birth weight. However, the reserves in those two areas are already exhausted. On the other side there are the deteriorating conditions (demographic and social) for such care, which are continuously on rise. While the first process has been prevailing until now with the resulting minimal decrease of perinatal mortality by 0.4 per thousand, there is a danger that the ballance will change in the near future.

Birth Weight↗

PubMed2005

Congenital diaphragmatic hernia associated with esophageal atresia, tracheoesophageal fistula, and truncus arteriosus in a premature newborn.

The occurrence of coexisting congenital diaphragmatic hernia (CDH) and esophageal atresia (EA) with distal tracheoesophageal fistula (TEF) is extremely rare and is considered highly lethal. The combination of CDH with EA/TEF and truncus arteriosus communis (TAC) has not been reported in the literature to date. The authors describe a premature neonate with this association.

Esophageal Atresia↗

PubMed2005

[Importance of registry of aggregated data on women giving birth].

OBJECTIVE: Analysis of causes of unchanging level of national perinatal mortality and identification of potential for its further decrease. DESIGN: Retrospective epidemiological analysis of aggregated data on perinatal care. SETTING: Mother and Child Care Institute, Prague 4-Podolí. METHODS: Correlation of selected national aggregated data on the level of perinatal care under current system and under influence of changing conditions for care provision. RESULTS: The analysis of some criteria of perinatal care demonstrated the influence of several contradictory processes: 1) among newborns below 2500 grams the stillbirth increased while the early neonatal mortality decreased; there was also decrease of contribution of congenital malformation in this group, 2) although there were more live born babies under 500 grams, who suffered from high mortality, their contribution to perinatal mortality was compensated by further decrease of early neonatal mortality of newborns weighing 1000-1499 grams, 3) the increasing frequency of low birthweight newborns did not influence the total perinatal mortality due to improved perinatal care. We observed the improvement of results among half of the regional perinatal centres with formerly higher early neonatal mortality figures, which represents the decrease of one of the reserves for further decrease of early neonatal mortality. There is a similar situation in centralisation of preterm deliveries--transfer in utero--which reached its maximum. Up to now we did not succeed in early referral of women with serious pregnancy complications which lead to stillbirth to perinatal centres with lower stillbirth rates. However this represents only small potential for decrease of total perinatal mortality. CONCLUSION: The 4-year stagnation of national perinatal mortality is a result of contradictory influence of improving level of care on one side and worsening of conditions on the other side. The potential for improvement under current conditions is almost exhausted.

Birth Weight↗

PubMed2005

[Analysis of maternal mortality in the Czech Republic in 2001].

OBJECTIVE: Analysis of maternal mortality in the Czech Republic in 2001. DESIGN: Retrospective statistical and clinical analysis. SETTING: Mother and Child Care Institute, Prague-Podoli. METHODS: We used database of 9 cases of maternal deaths in the Czech Republic during 2001 to analyze their causes, clinical courses especially related to obstetrical surgery, adequacy of provided care, and characteristics of their occurrence. RESULTS: There were total of 9 reported maternal deaths in pregnancy, during labor or within 42 days after delivery in the Czech Republic in 2001. During the same period there were 90,715 live births in the Czech Republic, and Pregnancy-related mortality ratio (A+B+C) was 0.0992/1000, i.e. 9.92 deaths per 100,000 live births. This is about 1.08/1000 better than in 2000 (the table 5 demonstrates the development of maternal mortality during the last 11 years). One reported death was unrelated to gestation (category C), therefore adjusted maternal mortality rate (A+B) was 0.0882/1000, i.e. 8.82 deaths per 100,000 live births versus 9.9 deaths per 100,000 live births in 2000. Group A (specific risk-direct maternal mortality) contributed to adjusted maternal mortality by 5 maternal deaths and direct maternal mortality was 5.5 per 100,000 live births. Group B (non-specific risk-undirect maternal mortality) contributed by 3 maternal deaths and undirect maternal mortality was 3.3 per 100,000 live births.

Adult↗

PubMed2004

[Incidence of birth defects in children of mothers using medications in the 1st trimester of pregnancy in the Czech Republic 1996-2002].

OBJECTIVE: To process the results on the incidence of birth defects in the children of mothers using medicines in the first trimester of pregnancy in the Czech Republic during 1996-2002. DESIGN: A retrospective analysis of data from the National Register of birth Defects in the Czech Republic. METHODS: The data from the nationwide register of birth defects administrated in the Institute of Health Information and Statistics of the Czech Republic for the period 1996-2002 were used for the study. The data on the incidences of selected types of birth defects identified in children born to mothers using medicines in the first trimester of pregnancy were compiled and an analysis of these medicines was carried out in relation to the diagnosed types of birth defects. The data on healthy children born to mothers using medicines during the 1st trimester of pregnancy were used as the control sample. RESULTS: In our retrospective analysis covering the years 1996-2002, a total of 1,146 birth defects were identified in children of women using medication in the 1st trimester of pregnancy and a total of 891 children affected in this way were identified. CONCLUSION: The study presents the updated results of these analyses based on nationwide registration of birth defects for a seven-year period. It analyses the types of birth defects in the children of women using medication in the 1st trimester of pregnancy and the types of medicines used by these women. In our study, we have found a significantly higher incidence in the population of the children born to women using medicines in the 1st trimester of pregnancy in several cases. From among the group of cleft defects affecting the central nervous system, this concerns for example anencephalia and spina bifida, as well as congenital hydrocephalus, anophthalmy/microphthalmy, auricle abnormalities and limb reduction deformities. From these results that we produced, it is of course not possible to draw significant conclusions with a clinical impact. However, pregnant women should avoid any medicines in the first trimester of pregnancy, except for those cases, which are strictly indicated from the medical point of view and which are recognised as reasonably safe. As concerns the use of other medicines, their genetic and teratogenic risk should be assessed comprehensively by a specialised clinical geneticist on a case-by-case basis.

Abnormalities, Drug-Induced↗

PubMed2004

[Prognosis of the reproduction health care in the Czech Republic until 2010. I. Perinatal care].

OBJECTIVE: A prognosis of the development of perinatal care in the Czech Republic until 2010 DESIGN: An epidemiological study to be used as a basis for the prognosis. SETTING: Mother and Child Care Institute, Prague. METHODS: The primary source data on the indicators of the level of perinatal care as well as on some circumstances under which this care is being developed and on which their prognosis is based were drawn from the information obtained from their annual nationwide analysis. RESULTS: The prognosis of the development of perinatal care until 2010 builds on the previous prognosis from the period 1980-2000, whose results, when analysed retrospectively, proved a significant dependence of professional development on political, demographic, social and economic circumstances. Increase of the level of perinatal care, evaluated according to internationally recognised criteria, resulted in decreasing the maternal, perinatal and infant mortality rates to levels reported by a few countries in the world. The fact that these levels have been stagnating since 2000 is a result of two conflicting processes. On one hand, there is the improvement in the standard of care; on the other hand, there is deterioration in some of the above-mentioned circumstances. The fact that the reserves for further decrease in professional care have been used up and, conversely, the risk that some of the above-mentioned circumstances will deteriorate have raised concerns that some of the indicators of this care will deteriorate as shown by the extrapolation of the trend in these indicators prevalent in the last years carried out for the period until 2010. Two prognoses with differently serious impacts were formulated on the basis of this extrapolation. CONCLUSION: The development of perinatal care is dependent on the circumstances under which it is being developed. The fact that the reserves in development and organisation of this specific field have been used up, which resulted in decreasing the maternal, perinatal and infant mortality rates to levels, which are among the lowest ones in the world, and, conversely, the deterioration in some of the above-mentioned circumstances have raised concerns that the internationally recognised indicators of this care will deteriorate.

Czech Republic↗

PubMed2004

[Prognosis of the reproduction health care in the Czech Republic until 2010: II. Planned parenthood].

OBJECTIVE: To prepare a prognosis of development of contraception, artificial termination of pregnancy and asisted reproductive technologies until 2010, based on the trend in their indicators in the previous years. DESIGN: A retrospective epidemiological study to be used as a basis for the prognosis SETTING: Mother and Child Care Institute, Prague - Podolí METHODS: For outlining the probable trend in the use of various types of contraceptives (IUD) as well as for artificial termination of pregnancy, evaluated according to their internationally recognised indicators, the extrapolation of the trends in these criteria prevalent in the period 1995-2002 was used. RESULTS: The prognosis of increase in the number of female users of hormonal contraception at the expense of IUD as well as the decrease in the number of women solving their problem with unwanted pregnancy by artificial termination of pregnancy (ATP), based on the said extrapolation of their indicators with a prospect until 2010, is probably overly optimistic. Due to probable changes in the political, social and economic circumstances as well as in the women's attitudes, it is expected that this trend will slow down. This is why it is expected that the number of female users of hormonal contraception will increase merely to 500 and that the women using IUD will decrease to 50 per 1,000 fertile women. Also, as concerns the number of ATPs, it is expected that it will decrease merely just below 10 for every 1,000 fertile women and to 20 for every 100 births. Even if the trends of all these indicators slow down, it can be expected that they will reach the average levels reported in the countries of Western Europe. As for the trend in asisted reproductive technologies (ART), whose share in the total number of births will rise, the main emphasis will be put on consistent nationwide registration, amendments to legislation and research mainly in the area of psycho-neurological development of these children, as recommended by the WHO. CONCLUSION: The expected rate of growth of the number of female users of effective contraception and the expected rate of decline of the number of ATPs, corresponding to the trend of the recent years, will probably decrease by 2010 but the average levels reported by the countries of Western Europe will still be reached. According to the recommendation of the WHO, the trend in some forms of ART will require research in the field of psycho-neurological development of the children from these pregnancies until they reach adulthood as well as some amendments to legislation.

Abortion, Induced↗

PubMed2004

[Psychomotor development of children with signs of intrapartum hypoxia and monitored by intrapartum fetal pulse oxymetry].

OBJECTIVE: The following questions were investigated: 1) the psychomotor development in newborns with pathological cardiotocographic recording (CTG), having been born spontaneously due to a normal oxygen saturation monitored by intrapartum pulse oxymetry (IFPO)(group I), 2) possible difference in development of children in group I in comparison with those with pathological CTG without IFPO monitoring delivered by cesarean section (group II), 3) possible differences in children in these two groups with signs of intrapartum hypoxia (groups I and II, respectively) from children delivered spontaneously during physiological delivery without signs of hypoxia (group III). DESIGN: A prospective clinical study SETTING: Institute for the Care of Mother and Child METHODS: There have been 88 children born in the years 2000-2001 from singleton pregnancies in gestational ages > 36 weeks. Three groups of children were established: 1) in the group I (IFPO, n=32) there were children born spontaneously having pathological CTG detected by cardiotocograph HP50A and simultaneously monitored by intrapartum fetal pulse oxymeter NELLCOR Puritan Benett A400 with the NELLCOR FE 14 sensor with normal values of oxygen saturation. The children of group II (CTG-SC, n=25) were born by cesarean section due to acute intrapartum fetal hypoxia (IH) indicated by CTG recording without IFPO. The group III (physiological, n=31) was formed by children from physiological deliveries without signs of IH. All children underwent psychological examination at the average age of 21.8 months by the Bayley Scales of Infant Development (BSID-II). The statistical analysis of data was performed according to the variables using t-test or chi-square test, respectively. RESULTS: Group I (IFPO) did not differ significantly from group II (CTG-SC) in any area of psychological evaluation. The prevention of cesarean section due to IFPO method in the group I therefore prevented a significant increase of psychological morbidity in children of this early age. In spite of that the children of the group I (IFPO) reached the lowest evaluation and differed significantly from the most favorably evaluated group III (physiological) in motor development, behavior, and in a total number of deviations. Group II (CTG-SC) was evaluated significantly worse in comparison with group III (physiological) only in behavior items. On the other hand the occurrence of children of above-average mental development in the groups I and II were the same as in group III. The results indicate complex character of the problem. CONCLUSION: The prevention of CS due to IFPO prevented a development of psychological morbidity in children. The increased occurrence of deviations in psychomotor development of children with signs of acute IH (groups I and II) in comparison with children of group III (physiological) will be analyzed in detail in relation to further data.

Cardiotocography↗

PubMed2003

[The main tasks of Czech perinatology at the beginning of the 21st century].

OBJECTIVE: To identify the main goals of the Czech perinatology at the beginning of the 21st century. DESIGN: Retrospective epidemiologic analysis of selected perinatal care quality indicators. SETTING: Institute for the Care of Mother and Child, Prague. METHODS: Analysis of selected indicators of perinatal care and their trends in the Czech Republic and comparison with other countries. RESULTS: When we reached the same low level of perinatal mortality as the other most developed countries, we have observed unchanged values for last three years. The priorities established 15 years ago are still important to preserve the current situation, however the further development in perinatology requires now goals related to development of selected indicators of perinatal care and their international comparisons. These are: 1) change of definition of stillbirth including newborns of 500-999 grams (currently registered as spontaneous abortions), 2) termination of the continuous increase of Caesarean section, 3) inclusion of the criteria of quality of perinatal care, especially a) deaths during late neonatal and postneonatal periods with perinatal causes; b) perinatal morbidity (impaired neuro-sensoric and psychological development of the child due to perinatal causes). Both these tasks will require collaboration of professionals from obstetrics and neonatology with specialists from other fields. CONCLUSIONS: The 4 main tasks were established on the basis of development of selected perinatal care quality indicators and their international comparisons: the change of definition of stillbirth, the termination of continuous increase of Caesarean sections, and inclusion of other indicators of perinatal care, first related to mortality after 7th day of life due to perinatal causes, and second the perinatal period related morbidity in later periods of infant life.

Cesarean Section↗

PubMed2003

[Incidence of congenital defects in the children of mothers who used medications in the first trimester of pregnancy in the Czech Republic 1996-2001].

OBJECTIVE: Analysis of the results from registration of congenital defects in children of mothers taking therapeutic drugs in the first trimester of pregnancy and comparison with a control group in the Czech Republic in the period of 1996-2001. DESIGN: A retrospective analysis of data from the registry of congenital defects in the Czech Republic. SETTING: Institute for the Care of Mother and Child, Prague. METHODS: Analysis of incidences of selected types of congenital defects detected in newborns of mothers taking therapeutic drugs during the first three months of pregnancy. The paper employed data from the all-state registration of congenital defects held in the Institute of Medical Information and Statistics of the Czech Republic in the period of 1996-2001. Data from healthy children born to mothers who took therapeutic drugs during the first trimester of pregnancy were used as a control set. RESULTS: In the period we observed, a total of 17,674 cases of children with diagnosed congenital defect were detected in the registration of congenital defects in the Czech Republic. In this number there were 784 cases of children whose mothers used therapeutic drugs during the first trimester of pregnancy. The control group included 1,034 women who gave birth to healthy children without congenital defects, although they took therapeutic drugs during the first trimester of pregnancy. Statistically significantly higher risk was found in 13 groups of diagnoses: anencephaly, inborn hydrocephalus, spina bifida, inborn defects of eyelids, lacrimal system and orbita, anoftalmus, microphthalmus and macrophthalmus, inborn defects of ear, congenital defects of the heart septum, congenital defects of great veins, cleft palate with cleft lip, congenital defect of gall bladder, biliary pathways and liver, congenital deformities of the hip, reduction deformities of upper extremity, congenital defects of muscular and skeletal system. Significantly higher risks were found for five groups of therapeutic drugs: anticoagulants, antihypertensive drugs, peripheral vasodilatants, urological drugs and antiepileptic drugs. CONCLUSION: It is obviously impossible to draw significant conclusions with clinical consequences on the basis of these results. Nevertheless, our results supplemented international databases of untoward effects of drugs and the conclusions may become a part of data set necessary for analysis of possible teratogenic effects of drugs used in the critical developmental period during the first trimester. The pregnant women should avoid, during the first trimester, all drugs except those, which are carefully medically indicated and accepted as adequately safe. The administration of other drugs should be evaluated by a clinical geneticist, who should take into account genetic and teratogenic risk in individual cases.

Abnormalities, Drug-Induced↗

PubMed2003

[Influence of antenatal steroids on perinatal mortality and morbidity in extremely low birth weight newborns].

UNLABELLED: Recently used antenatal steroids for induction of fetus lung maturity remain as standard procedure in the treatment of premature labour. However, the effect of antenatal steroids to the fetus may not be only the positive one. OBJECTIVE: Investigate the role of antenatal steroids on total mortality and severe morbidity in extremely low birth weight newborns under 1000 grams. DESIGN: Comparative case-control study. SETTING: Institute for the Care of Mother and Child, Prague, Czech Republic. METHODS: Antenatal steroids were used in 55 cases (group ANS+) and no steroids were used in 65 control newborns (group ANS-). Both study groups were comparable in birth weight, gestational age, gender, mode of delivery and presence of intrauterine growth retardation. Statistical significant difference was in time of premature rupture of membrane (ANS+ 108+/-228 hrs versus ANS- 27+/-56 hrs, p<0.007). The Epi Info 6 (CDC, U.S.) software package and ANOVA was used for statistical analysis. RESULTS: We have found statistical significant differences in total mortality (ANS+ 22%, ANS- 45%, p<0.008), in severity of respiratory distress syndrome (ANS+ median 2, ANS- median 3, p<0.0008), in total cumulative dose of surfactant (ANS+ 73 mg, ANS- 111 mg, p<0.0003), in the incidence of periventricular-intraventricular haemorrhage (ANS+ median 1, ANS- median 2, p<0.005) and posthaemorrhagic hydrocephalus (ANS+ 6%, ANS- 23%, p<0.008). Statistical significant differences were also in CRIB value (ANS+ median 7, ANS- median 11, p<0.007) and NEOMOD value (ANS+ median 5, ANS- median 7, p<0.002). In the other parameters (pneumothorax, sepsis, patent ductus arteriosus, necrotizing enterocolitis, periventricular leukomalacia) no statistical differences were found. CONCLUSIONS: Our study confirmed positive effect of antenatal steroids on mortality, severe respiratory morbidity and incidence of intraventricular haemorrhage. No negative effect of antenatal steroids to higher frequency of infection complications and/or periventricular leukomalacia was observed.

Fetal Organ Maturity↗

PubMed2002

[Changes in causes of mortality in very low birth weight neonates].

OBJECTIVE: Investigate the total mortality and changes in cause-specific mortality among very low birth weight (VLBW) infants. DESIGN: Retrospective epidemiological study. SETTING: Institute for the Care of Mother and Child, Prague, Czech Republic. METHODS: Five hundred and fourteen inborn patients (1/1996-12/2001) were retrospectively analysed from our database. We divided our study group into two sub-groups according to their birth weight: under 999 grams (extremely low birth weight group, ELBW, n = 193) and 1000-1499 grams (very low birth weight group, VLBW, n = 321). For statistical analysis the Epi Info 6 (CDC, U.S.) software package was used. RESULTS: Total mortality was 9.5% (23.0% in ELBW group, 1.2% in VLBW group). The main causes of death in ELBW group were (in order to magnitude): sepsis (49%, early to late onset sepsis ratio 1:4), severe periventricular-intraventricular haemorrhage grade III and IV (PVH-IVH, 20%), respiratory distress syndrome (13%) and other causes (bronchopulmonary dysplasia, renal failure, non-oliguric hyperkalemia: 18%). While in the VLBW group there were three cases of death due to sepsis and one due to PVH-IVH (1.2%). CONCLUSIONS: According to frequency analysis, sepsis is the leading cause of death among ELBW and severe PVH-IVH and other causes follow. While looking for strength of association in two most often causes (sepsis, PVH-IVH) we found highest risk of death among ELBW newborns with PVH-IVH, but not statistically significant (OR 2.63; 95% CI 0.68, 9.83). Respiratory distress syndrome, formerly reported leading cause of infant death, seems to move to lower order, probably due to introduction of new therapeutic tools into clinical perinatal practice (corticosteroids, surfactant, new modes of artificial ventilation).

Causality↗

PubMed2002

[Perinatology in the Czech Republic at the end of the millenium. II. Intrauterine fetal transportation].

OBJECTIVE: To evaluate contribution of organizational changes in perinatal care among newborns below 1500 grams in Czech Republic in 1990-2000 and international comparison of results. DESIGN: Retrospective analysis of selected indicators of perinatal care. SETTING: Institute for the care of Mother and Child, Prague. METHODS: Analysis of selected national data and their comparison to international data from EAPM project "Perinatal Transport in European Countries". RESULTS: Due to findings that birth-weight specific early neonatal mortality is substantially lower among newborns transported in utero to perinatal centres than among newborns transported after birth, the organization of perinatal transport of pregnant women with preterm delivery was main task for system of perinatal care. The network of perinatal centers and organization of transport "in utero" led to high percentage of newborns below 1500 grams treated in specialized centres, even compared to other countries. However, according to number of treated patients in one centre per year the Czech Republic belongs among countries with small centres. CONCLUSION: Organizational measures in system of perinatal care led to high percentage of newborns below 1500 grams treated in perinatal centres. This concentration contributed together with improved clinical perinatal care to important decrease of total perinatal mortality to 4.4@1000 in the Czech Republic in 2000. According to number of treated newborns with birth-weight 1500 grams and more there are too many perinatal centers of intermediary care in the Czech Republic.

Czech Republic↗

PubMed2002

[Analysis of maternal mortality in the Czech Republic in 2000].

OBJECTIVE: Analysis of maternal mortality in the Czech Republic in 2000. DESIGN: Retrospective statistical and clinical analysis. SETTING: Department of Obstetrics and Gynecology of the 1st Medical School of Charles University and General University Hospital, Prague 2, Institute for the Care of Mother and Child, Prague. INTRODUCTION: We present an annual analysis of maternal mortality in the Czech Republic, organized into two parts: 1) international statistical part, and 2) clinical part in Czech only with abbreviated anonymous analysis of individual cases of maternal death. We are aware that follow-up analysis cannot fully express dramatic situations around all cases or reproduce in details all their aspects. We though believe that this form will help to our gynecologists to learn about courses of the deaths, particularly when the frequency of such cases is low and circumstances are unusual. Individual analyses include also conclusions of expert committees or analyses performed by the Czech Medical Chamber. Comments and notes however are not for forensic purposes and are used only for medical ones. METHODS: We used a database of 10 cases of maternal deaths in the Czech Republic in 2000. We analyzed their causes, clinical courses, especially in connection to obstetrical surgery, and adequacy of provided care. RESULTS: There were 10 reported maternal deaths in connection to pregnancy, labor and delivery or within 42 days after delivery in the Czech Republic in 2000. There were 90,910 live-born babies and total, gross maternal mortality (A + B + C) was 0.11 per 1000, i.e. 11 deaths per 100,000 live-born babies. This is only 0.02 per 1000 better than results in 1999 (Table 3 shows data on maternal mortality for last 10 years). In 2000, there was one maternal death unrelated to gestation--category C, therefore maternal mortality in connection to gestation (A + B) was 0.099 per 1000 i.e. 9.9 deaths per 100,000 live-born babies compared to 10.1 deaths in 1999. The causes of deaths were different. Only two women were within group A (specific risk--direct maternal mortality), therefore direct maternal mortality was 2.2 per 100,000 live-born babies. Seven maternal deaths were in the group B (non-specific risk--indirect maternal mortality) and indirect maternal mortality was unusually high, 7.7 per 100,000 live-born babies. It is difficult to judge the difference due to possible error of small numbers. The demographic part of the report has been sent to the Office of Health Statistics and Information and detailed report to the Department of Health Care of the Ministry of Health of the Czech Republic. CONCLUSIONS: Since 1994, when we introduced nationwide organization measures to identify risk groups of pregnant women and use of micro-heparinization among those, we have succeeded to lower the frequency of thrombolism, till then leading cause of maternal deaths, especially in links to operative deliveries and in smaller extent among high-risk women during pregnancy. The decrease of maternal mortality was substantial, by 50%, however only temporary, followed by a partial increase to about 10 maternal deaths per 100,000 live-born babies. This increase was to increased frequency of coagulopathies, HELLP syndrome, and, in 2000, due to non-specific cardiovascular causes and some neurologic complications. The majority of these cases and especially those with non-adequate obstetrical care will be anonymously analyzed together with responsible chiefs of ob/gyn departments during perinatology conference in 2002 and results will be consequently published. Increase of non-specific causes of maternal deaths in 2000, especially of those with cardiovascular complications, indicate a necessity to be careful especially with older parturients, diabetic women, obese women and "dangerous" multiparae, where the possibility of cardiovascular complications might require need concentrated medical diagnosis. Primary attention, though, should be aimed at impaired coagulation of blood. The cases of complications of DIC persistently show insufficient diagnostic and therapeutic measures especially in small facilities with limited laboratory compartments, outdated and wrong therapeutic measures and almost missing potential for consultancy. In spite of this it is particularly necessary to concentrate on prevention among cases with higher risk for DIC. We have concentrated on publications in collaboration with hematologists and anesthesiologists in this field, although some measures are lacking the universal consent, especially some therapeutic means. It is very important to us that chiefs of ob/gyn departments are open for professional discussions, although some situations are prone to forensic evaluation. We believe that our approach of anonymous analyses with two-year delay is sufficient for necessary audit of maternal mortality.

Adult↗

PubMed2002

[Population analysis of pregnant women in the Czech Republic at the end of the millennium. I. Trends of selected demographic indicators and data from birth records from 1997 to 2000].

OBJECTIVE: To evaluate whether social-economic changes in the Czech Republic in 90's influenced selected demographic indications in population of mothers. DESIGN: Retrospective comparative epidemiological study. SETTING: Institute for the Care of Mother and Child, Praha 4-Podolí, Office of Health Information and Statistics, Praha. METHODS: Comparative analysis of selected demographic data and pregnancy history data collected according to the WHO recommendations on the innovated "Report on mother" of the Office of Health Information and Statistics database in 1997-2000. RESULTS: Nation-wide return rate of 99.89% of "Report on mother" forms confirms the representativeness of analyzed data. During the 4-year-period we demonstrated increase of maternal age, level of education, and proportion of single mothers. We observed decrease in proportion of mothers with second baby and mothers with induced abortion in history. The proportion of mothers with drug abuse during pregnancy was increasing and their age was decreasing. Characteristics of these changes suggest possible association with social and economic changes in the Czech Republic in 1990's. CONCLUSIONS: In second-half of 90's we observed increase of maternal age, educational level, proportion of single mothers and decrease of proportion of mothers delivering for the second time and mothers with history of induced abortion. Drug abuse during pregnancy is most frequent among youngest mothers.

Adult↗

PubMed2002

[Population analysis of pregnant women in the Czech Republic at the end of the millennium. II. Pregnancy complications].

OBJECTIVE: To evaluate incidence of selected pregnancy complications and their importance towards clinical status of fetus and newborn. DESIGN: Retrospective comparative epidemiological study. SETTING: Institute for the Care of Mother and Child, Praha4-Podolí; Office of Health Information and Statistics, Praha. METHODS: Comparison of incidence of selected pregnancy complications according to the WHO recommendations and related perinatal mortality using the data from innovated "Report on mother" of the Office of Health Information and Statistics database in 2000. RESULTS: Pregnancy complications were observed among 17.6% of all pregnant women in 2000 and participated on 47.1% of total perinatal mortality, which was 4.4@1000. Incidence of pregnancy complications varied from 0.2% of placenta praevia up to 5.6% of threatening preterm labor. Their severity, according to complication-specific perinatal mortality, varied from 2.6@1000 for gestational hypertension up to 103.5@1000 for premature separation of placenta. Every sixth mother had more than one complication; the most frequent combination was threatening preterm labor with another complication. The incidence of pregnancy complications increases with age of mother and is also associated with lower gestational age of newborn. Complications related to placental dysfunction tend to lead to stillbirths while complications related to preterm labor result more in early neonatal mortality. CONCLUSIONS: We identified the contribution of particular pregnancy complication to perinatal mortality which varies substantially according to its incidence in population and the negative effect on fetus at particular gestational age.

Czech Republic↗

PubMed2002

[Fatal complications in pre-eclampsia and eclampsia].

OBJECTIVE: Analysis of preeclampsia and eclampsia--one of the major contributor to life-threatening maternal morbidity frequently leading to maternal mortality in the Czech Republic till late 70's. Our goal was to mention major causal links in clinical courses of individual maternal death and to highlight main mistakes and faults, and to provide frequencies and basic characteristics of risk groups. DESIGN: Retrospective epidemiological study. SETTING: Department of Obstetrics and Gynecology of the 1st Medical School of Charles University and General University Hospital, Prague. Institute for the Care of Mother and Child, Prague-Podoli; 1st Intern Department of the 1st Medical School of Charles University and General University Hospital, Prague. METHODS: Analysis of 31 cases of maternal deaths associated with severe preeclampsia and eclampsia in the Czech Republic during 1978-2000, using a database of 470 maternal deaths during the observed period. We analyzed clinical course with special attention to obstetrical surgery and clinical management. We considered timelines of life-threatening events, age of mother, parity, and place of death. RESULTS: There were 36 maternal deaths associated with severe preeclampsia and eclampsia in the Czech Republic in 1978-2000, contributing 7.7% to total maternal mortality. Group A1 was 5th most frequent cause of maternal death. We analyzed 31 cases closely related to severe preeclampsia and eclampsia. During 1978-1990 there was 1 death per 74,263 live-born babies in this category, while during 1991-2000 we observed only 1 death per 171,137 live-born babies. Clinical management was not adequate in 15 cases of death (48%) and content of care did not reflect possibilities of prevention, diagnosis and therapy. Severe preeclampsia and eclampsia was more frequent among older women and multiparae. First group (61%) is composed of women with manifest convulsions, 25% of them experienced convulsion after delivery, and only few cases had mild preeclampsia ante partum. Eclampsia with convulsions leading to coma were in 10 cases complicated with DIC, two cases in this group had premature separation of placenta. Besides classic symptoms of preeclampsia there were within this group 5 cases of multiple pregnancy, history of unstable hypertension, hepatopathy in previous pregnancy and chronic nephrosis. The second group (39%) were cases without convulsions. These cases were complicated with severe liver disorders and renal failure, and 5 cases of intra-cranial hemorrhage. Several cases had combination of symptoms. DIC was present in 6 cases. In both groups there were 5 cases with hemorrhagic skin symptoms, thrombopenia, symptoms of DIC and liver and renal failure, which would fall into HELLP syndrome according to current classification. The most of women died during the postpartum period (87%) mostly after emergency operative deliveries. The fact that no women died during pregnancy indicates the effort to perform life-saving operative delivery. Forty two percent of women were in term. Especially at the beginning of observed period we noticed tendency to prolong gestation in order to save the baby. The mortality of fetuses or newborns was 71%. Operative deliveries accounted for 71%, the majority of them were caesarean sections. More than 50% of cases were operated in coma. We indicate major mistakes and failures in organization of care, primary prevention, diagnosis, and consequent care. CONCLUSION: Positive results in area of maternal deaths in association with severe preeclampsia and eclampsia during last 10 years are due to improved diagnostic and therapeutic measures in our field, especially in neonatology, because obstetricians currently terminate pregnancies early than before while symptoms of preeclampsia get worse. We focus on early recognition of symptoms of coagulopathy in combination with symptoms of preeclampsia, especially on early detection and treatment of HELLP syndrome.

Adult↗

PubMed2001

[Analysis of maternal mortality in the Czech Republic in 1999].

OBJECTIVE: Analysis of maternal mortality in the Czech Republic in 1999. DESIGN: Retrospective statistical and clinical analysis. SETTING: Department of Obstetrics and Gynecology of the 1st Medical School of Charles University and General University Hospital, Prague 2; 2. Institute for Care of Mother and Child, Prague-Podoli. METHODS: We used database of 10 cases of maternal deaths in the Czech Republic during 1999 to analyze their causes, clinical courses especially related to obstetrical surgery, adequacy of provided care, and characteristics of their occurrence. RESULTS: There were total 10 reported maternal deaths in pregnancy, during labor or within 42 days after delivery in the Czech Republic in 1999. During the same period there were 89,471 live births in the Czech Republic, and Pregnancy-related mortality ratio (A + B + C) was 0.11@1000, i.e. 11.2 deaths per 100,000 live births. This is about 0.044@1000 worse than in 1998 (the last table demonstrates the development of maternal mortality during last 9 years). One reported death was unrelated to gestation (category C), therefore adjusted maternal mortality rate (A + B) was 0.10@1000, i.e. 10.1 deaths per 100,000 live births versus 6.63 deaths per 100,000 live births in 1998. Group A (specific risk--direct maternal mortality) contributed to adjusted maternal mortality by 6 maternal deaths and direct maternal mortality was 6.7 per 100,000 live births. Group B (non-specific risk--undirect maternal mortality) contributed by 3 maternal deaths and undirect maternal mortality was 3.3 per 100,000 live births. CONCLUSION: The increase of maternal mortality in 1999 and forensic impact of some cases indicate the necessity to respect established guideline for obstetrics and gynecology. Currently established complex prophylactic measures to prevent development of thrombembolic complications provede, if fully implemented, possibility to minimize these threatening and formerly very frequent situations leading to death. However, there is ongoing danger of hemorrhagic complications related to the DIC, which despite the modern therapy represent the major factor in maternal mortality and morbidity.

Adolescent↗