Biomedical subjects

V Kalis

Publications and source records attributed to V Kalis.

7 recordsLinked to original sources

PubMed2005

[Risk factors for 3rd and 4th degree perineal ruptures during delivery].

OBJECTIVE: Summary of the mutual relationship between vaginal delivery and anal incontinence. DESIGN: Retrospective case-control study. SETTING: Department of Gynaecology and Obstetrics, Charles University and Faculty Hospital Pilsen, Czech Republic. METHODS: 9600 vaginal deliveries between January 1997 and March 2004 were evaluated. The aim of the study was to observe the incidence of the 3rd degree tear and identification of the risk factors. The recognition of the perineal injury was open to the individual interpretation and assessment of the doctors involved. RESULTS: The incidence of the 3rd degree tear was 0.84%. The diagnostics of the 3rd degree tear was significantly more frequent if the evaluation of the perineal injury was performed by the urogynaecologists (p<0.001). Statistically significant risk factors of the 3rd degree tear in the univariate and multivariate analysis were: forceps, shoulder dystocia, the length of the 2nd stage of labour and maternal cooperation at the final phase of delivery. Parturity (primiparity), birth weight and episiotomy (when all types of episiotomy were included) were statistically significant only in the univariate analysis. Mediolateral episiotomy was not proved to be either the risk or the protective significant factor. SUMMARY: The diagnostics of the 3rd degree tear demands a detailed knowledge of the structure and anatomy of the pelvic floor. A sufficient amount of experience and erudition are the requirements for the prevention, diagnostics and subsequent treatment of this injury.

Adult↗

PubMed2005

[The perineal body length and injury at delivery].

OBJECTIVE: Evaluation of mutual relationship between the perineal length, vaginal delivery and perineal injury. DESIGN: Prospective study. SETTING: Department of Gynaecology and Obstetrics, Charles University and Faculty Hospital Pilsen. METHODS: 318 women (92%) entered the study after their first vaginal delivery having given their consent. Instrumental vaginal deliveries were excluded. According to the perineal length, the women were divided into three study groups: short perineum (less or equal 30 mm), normal perineum (> 30 mm and < 60 mm), long perineum (equal to 60 mm and longer). Parameters evaluated: incidence of episiotomy, length of episiotomy, angle of episiotomy of the midline, shortest distance between episiotomy and anus, episiotomy and perineum length ratio. If episiotomy was not performed, the perineal tear has been evaluated in grades. RESULTS: The total proportion of episiotomy makes up 75%. The proportion of episiotomy and its angle has not reached statistical significance amongst the study groups. The length of episiotomy has been statistically significant amongst all study groups--the shortest being in the group of short perineum and the longest in the group of long perineum (p = 0.001). However the shortest distance between episiotomy and anus was statistically significant in the group of short perineum compared to normal perineum (p = 0.026) and long perineum (p = 0.005). If episiotomy was not performed, the total average perineal tear (in grades) was minimum in the group of short perineum and maximum in the group of long perineum (p = 0.018). SUMMARY: The short perineum does not appear to be the risk factor in the higher rate of episiotomy and perineal tears in this study. However if episiotomy was performed, the part of perineum which was not injured was found significantly shorter than in the other study groups. This could subsequently lead to postpartum anal incontinence. In this group the use of episiotomy as a prevention of perineal injury seems unjust. The group of long perineum has a significantly longer episiotomy and grade of perineal tear. This could contribute to the development of dyspareunia.

Adult↗

PubMed2003

[Indication criteria for surgical treatment of thoracic outlet syndrome].

When formulating indications for surgery of the thoracic outlet syndrome (TOS) the authors use as a basis their own experience with treatment of 42 patients and data from the literature. The basis is the fact that to the great majority of patients at the time after establishment of the diagnosis comprehensive and systematic rehabilitation care was not available either because lack of time or due to the absence of a department within their reach which could ensure adequate care. The authors discuss the reasons why they prefer after accurate establishment of the diagnosis a primary surgical approach and elimination of the cause of further mechanical damage of the neurovascular bundle with necessary and obvious continuation with long-term intensive rehabilitation. This is a reverse procedure than that recommended by some others concerned with this problem.

Adolescent↗

PubMed2003

[Delivery and anal incontinence: definition, classification, prevalence and pathophysiology].

OBJECTIVE: Summary of the mutual relationship between vaginal delivery and anal incontinence. DESIGN: Review. SETTING: Department of Gynecology and Obstetric, Charles University and Faculty Hospital Pilsen. SUMMARY: Review of the current international literature covering the given problem. Anal incontinence is defined as an unvoluntary leakage of flatus, liquid or solid stool. Fecal incontinence means the leakage of liquid and solid stool only. Women are at eighttimes higher risk of developing anal incontinence (the leakage of flatus, fluid or hard stool). The main reason considered to be the cause of this difference is a birth. Postnatal anal incontinence is a disabling problem for as much as 13-20% of women. Review describes classification, prevalence, incidence and cause of AI in women considering maternal position at birth, second stage of labor, breastfeeding, anal sexual intercourse and multiple births. Two main pathogenetic mechanisms are presented. 1) Perineal neurological injury is described in earlier studies. This looks to be the major reason for 3rd and following vaginal births. 2) An apparent or occult anal sphincter tear seems to be the main factor particularly for the 1st vaginal birth. 2.3% of primigravidae have an apparent tear and 35% sonographically detected occult anal sphincter tear. Anal incontinence develops nearly exclusively in these groups. 42% of afflicted women complain of impaired quality of life. Anal incontinence appears to be improved within the time (in 36-76%). Longterm outcome is not known yet. The postnatal check-up should also include the question of de novo developed anal and urine incontinence or impaired sexual health.

Delivery, Obstetric↗

PubMed2003

[Vaginal delivery in primiparas and anal incontinence].

OBJECTIVE: An investigation of incidence and degree of anal incontinence after vaginal delivery among primiparas and characterizing of the risk factors. DESIGN: Prospective observational study. SETTING: Department of Gynecology and Obstetrics, Charles University and Faculty Hospital Pilsen. METHODS: 346 primiparas after consecutive vaginal delivery between May 2000 and February 2001 were included. All delivered in lithotomy position. Questionnaires were sent few days after delivery and then two and 6-9 months later. Analysis of the returned questionnaires. 28 obstetric parameters assessed. RESULTS: 46.5% women responded. 23 women registered leakage of flatus before delivery. Two months postpartum one (0.6%) patient reported fecal incontinence and 22 (14.3%) flatus incontinence de novo or impaired already present incontinence. 6-9 months after delivery the same patient (0.6%) reported fecal incontinence and 16 women (10.4%) incontinence of flatus. Ten of them felt impaired quality of life. Anal incontinence gradually improved during the time (in 76%). Risk factors of developing (worsening) of anal incontinence were antenatal anal incontinence (in two months period) and women weight (or BMI) measured at 6-9 months after birth. None of nine patients after forceps delivery (Breus traction forceps) which responded reported signs of anal incontinence. Neither the range of episiotomy nor the length of perineum had any relation to the development of anal incontinence. However episiotomy has been shown to be a protective factor of 3rd degree tear in primiparas (RR 0.24). Third degree tear was diagnosed in seven cases (2%), three out of 6 women reported anal incontinence postpartum. CONCLUSION: This study shows relatively frequent development of flatus incontinence after vaginal delivery in primiparas. These symptoms usually improve within the time. Only minimum of women after vaginal delivery suffers of fecal incontinence. 42% of women with anal incontinence feel impaired quality of life. At the first postpartum check every woman should be asked, whether she has any symptoms of anal or urine incontinence or impaired sexual health. If positive the answer, the woman should get information where to find a help.

Adult↗

PubMed2001

[Meconium and postnatal neurologic handicaps].

OBJECTIVE: A review of meconium pathophysiology and its contribution to the incidence of postnatal neurological handicap. DESIGN: Reviewed article. SETTING: Department of Gynaecology and Obstetrics, Charles University and Faculty Hospital Plzen, Czech Republic. SUBJECT AND METHOD: Meconium can be a cause of infant neurological handicap. Two main pathogenetic pathways are mentioned. 1. Meconium (and its components: bile acids) may have a direct vasoconstrictive effect on umbilical and placental vessels. This way still remains controversial. 2. Meconium as a possible cause of intraamniotic infection results in a release of fetal cytokines (TNF alpha, IL-1 beta, IL-6), which can damage myelinogenesis in periventricular white matter. RESULTS: Meconium in premature labour is a higher risk factor compared to term delivery. 41% of premature infants were diagnosed as having CP when meconium was present compared to 10% in the same group with clear amniotic fluid. The incidence in term pregnancy with meconium present is 0.4% compared to 0.3% in a population without any obstetrical risk. CONCLUSION: Ultrasonographically found periventricular leukomalacia is the most reliable sign of subsequent cerebral palsy or other neurological sequelae.

Amniotic Fluid↗

PubMed2000

[Meconium and its significance].

OBJECTIVE: A review of meconium patophysiology and its contribution to the incidence of perinatal infection. DESIGN: Review article. SETTING: Department of Gynaecology and Obstetrics, Charles University and Faculty Hospital Plzen, Czech Republic. METHOD: The reported incidence of meconium-stained amniotic fluid varies between 7 and 22%. The patophysiology of the presence of meconium in the amniotic fluid is not sufficiently explained. Meconium in fetal bowels is under hormonal and neurol control. The presence of the meconium-stained amniotic fluid was always considered to be a potential risk for the fetal and neonatal well-being. The review is further divided in to three chapters. (II. Meconium and meconium aspiration syndrome, III. Meconium and postnatal neurological handicap). RESULTS AND CONCLUSION: The first chapter on deals with meconium risk in the development of perinatal infection: intraamniotic infection/chorioamnionitis, postnatal endometritis, infection of the abdominal wound after Caesarean and neonatal infection. The incidence of clinical chorioamnionitis is 15% with the presence of meconium compared to 3% in controls. The incidence of puerperal endometritis is 10% in comparison to 3% under normal conditions. Two main mechanisms of development (or coincidence) of intraamniotic infection in the presence of meconium exist. 1) Infection may be a cause of meconium passage. 2A) Alteration of Zn/P ratio in the amniotic fluid can promote bacterial growth. 2B) Meconium attached to macrophages or absorbed by phagocytosis can impair cellular immune response. The antibiotic prophylaxis is discussed.

Amniotic Fluid↗