Search PubMed⌕ Search

Biomedical subjects

B Srp

Publications and source records attributed to B Srp.

At least 19 recordsLinked to original sources
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↗
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↗
PubMed1999

Proportion of caesarean sections and main causes of maternal mortality during 1978-1997 in the Czech Republic.

OBJECTIVE: To analyze changes in frequency of caesarean section in the Czech Republic during period 1978-1997. DESIGN: Descriptive epidemiology. METHODS, RESULTS, DISCUSSION, CONCLUSION: The total cohort of all maternal deaths was analyzed regarding the main causes of death and the mode of delivery. Since 1978, a systematic analysis of individual cases of maternal deaths has been performed, in terms of their causes, course and avertabiliy (446 direct, specific and indirect, unspecific deaths). Thromboemboly, which was the main cause of maternal mortality until 1993, factually ceased to occur in the last four years. Currently, hemorrhage is rated as the 2nd cause, followed by cardiovascular--and further post-surgical complications, toxicosis, infections etc. In 34% of all cases in the period beginning from 1978, we strictly stated inadequate medical procedures. These cases are analyzed at medical fora and, subsequently, disclosed and published, anonymously. The increase in the number of caesarean sections from 3.5% to 11.9% in the course of years 1978 to 1997 presents a remarkable share of maternal mortality in the CR. While the share of intra- and postnatal deaths in connection with CS was 44% in 1978-1990, in the years 1991-1997 it increased to 61%. Out of which, the number of deaths in direct relation with surgery increased from 22 to 29%. By means of nation-wide enforced prophylactics of tromboembolia and DIC, the lethality in direct relation with CS was reduced from 0.44% in the years 1988-90 down to 0.24% in the years 1991-97. Total lethality 0.49% in the last five years is 4.4 times higher than after a total number of deliveries, which is the main argument against further unreasonable growth of CS, and for improvement of general surgical conditions in the nation wide perspective.

Cause of Death↗
PubMed1997

[Fetal motor activity during pregnancy and labor].

The authors examined by actocardiography a group of 98 women in the third trimester of pregnancy. They evaluated the duration, frequency of different movements and the frequency of FHR accelerations in three groups of pregnant women (normal controls, pregnant women with retarded foetal growth and normal PI and finally women with retarded foetal growth and raised PI values). Progression of intrauterine stress led in the investigated group to a gradual decline of motor activity of the foetus along with a decline of the frequency and ratio of FHR accelerations in the total movements and isolated movements of the head and extremities. Statistical significance was proved in four basic parameters. The authors confirmed the priority of the flowmetric diagnosis as compared with actocardiographic recording of developing foetal stress. In the submitted preliminary communication the authors present data on actocardiographic findings during normal delivery. They revealed in particular a marked coincidence of general foetal movements and uterine contractions.

Female↗
PubMed1995

[Actocardiography in obstetrics].

Introduction of ultrasonic techniques made more detailed follow-up of the motor activity of the foetus in its natural environment possible. The objective of the submitted paper is to present actocardiography as a method which makes it possible to visualize differences of motor activity of the foetus, in particular during the third trimester and to map different types of movements. The authors obtained thus objective records in a group of pregnancies which will be suitable for comparison with the motor activity of foetuses with signs of hypoxia, with foetuses with retarded growth or foetuses threatened by other risks. This method can be thus included and used as a method of routine in the spectrum of examinations of imminent foetal stress.

Female↗
PubMed1994

[Antibiotic prophylaxis in cesarean section].

Childbirth by Caesarean section is associated with 7-10x more complications than spontaneous childbirth [28] whereby the second place is held by infection. One of the possible ways how to prevent these infectious complications is antibiotic prophylaxis. Views on the latter still differ as regards selection of the antibiotic, its effectiveness, onset of administration, dosage, period of administration etc. Prophylaxis should meet the following demands; it should be aimed, of short-term character, bactericide and non-toxic-these demands are met by cephalosporins of the second generation [11]. The objective of the present work was to evaluate the contribution of the prophylactic administration of antibiotics, i.e. a cephalosporin of the second generation-Zinacef (Cefuroxime). The group was formed by 23 women to whom a dose of Zinacef was administered after childbirth by Caesarean section and subsequently twice after 8-hour intervals (1.5-0.75-0.75 i.m.). The control group (23 women) did not have this prophylaxis. In both groups the authors compared the indication of s.c., time of loss of amniotic fluid before s.c., results of cultivations from the cervix, vagina, amniotic fluid, lochiae and sutures. The authors evaluated the postoperative course where they were interested in infectious complications, the temperature curve, period of hospitalization, the necessity to administer another antibiotic or to proceed with the antibiotic therapy after the prophylactic dose. The results are clearly in favour of the prophylactic administration of antibiotics to the risk group of patients delivering by Caesarean section.

Adult↗