Acute appendicitis in pregnancy — do we treat correctly, or do we delay unnecessarily?

Objectives: Acute appendicitis is the most common non-gynaecological indication for surgical intervention during pregnancy. The aim of this study was to compare perioperative and postoperative results of surgical treatment of acute appendicitis in the early and late stage of pregnancy. Material and methods: This is a retrospective study focused on the evaluation of perioperative and postoperative results of appendectomy in pregnancy. The study included all pregnant patients who underwent laparoscopic or open appendectomy at the University Hospital Ostrava during the observed 10-year period (January 2012–December 2021). The patients were divided into two subgroups according to the stage of pregnancy in relation to the expected viability of the foetus (the viability limit was defined as the 23rd week of pregnancy). Results: In the monitored 10-year period, a total of 25 pregnant patients underwent appendectomy. Comparing the two subgroups of patients, there were no statistically significant differences in any of the admission parameters. Laparoscopy was performed in 100% of the patients in the lower stage of pregnancy (< 23 g.w.) and in 61% of the subgroup of patients with more advanced pregnancy (> 23 g.w.); this difference was statistically significant (p = 0.039). Differences in subgroups regarding duration of surgery, risk of revision and 30-day postoperative morbidity were not statistically significant. In the subgroup of patients < 23 g.w., uncomplicated forms of appendicitis predominated (66%), whereas in the subgroup > 23 g.w., complicated forms predominated (69%); this difference was statistically significant (p = 0.026). When comparing the two subgroups of patients, there was a statistically significant difference in the length of hospitalization (p = 0.006). The mortality rate of the group was zero. Conclusions: The results of the study confirm the fact that advanced pregnancy may be related to complicated forms of appendicitis. Therefore, early appendectomy is still the method of choice. In accordance with the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) recommendations, laparoscopic approach is preferred in pregnant patients, even in advanced pregnancy

Ultrazvukové markery infekčních komplikací u předčasného odtoku plodové vody

Preterm prelabour rupture of membranes (PPROM) represents a serious pregnancy complication associated with approximately 30% of preterm deliveries. PPROM might be complicated by the presence of microorganisms and/or their nucleic acids in amniotic fluid termed microbial invasion of the amniotic cavity (MIAC), and the elevation of various inflammatory mediators in the amniotic fluid referred to as intra-amniotic inflammation (IAI). Based on their presence or absence, four subgroups of PPROM can be defined: i) intra-amniotic infection (presence of both MIAC and IAI), ii) sterile IAI (IAI alone), iii) colonisation of the amniotic cavity (MIAC alone), and iv) absence of both MIAC and IAI. Although gestational age at delivery is the most important factor affecting the risk of neonatal morbidity and mortality, the presence of MIAC and/or IAI might worsen neonatal outcomes. Therefore, precise assessment of the intra-amniotic environment seems essential for ideal personalised management of PPROM pregnancies. Modern ultrasound machines allow a very detailed examination of the foetus. The effort to identify surrogate ultrasound markers of MIAC and/or IAI represents a logical research step in this field. One of the most promising results has been found on doppler assessment on blood flow in the foetal splenic...SOUHRN Předčasný odtok plodové vody před termínem porodu (preterm prelabor rupture of membranes, PPROM) představuje závažnou komplikaci těhotenství a je odpovědný za přibližně 30 % předčasných porodů. PPROM může být komplikován přítomností mikroorganismů a/nebo jejich nukleových kyselin v plodové vodě - tento stav se nazývá mikrobiální invaze dutiny děložní (microbial invasion of the amniotic cavity, MIAC). PPROM může být také doprovázen zvýšenou hladinou různých ukazatelů zánětlivu v plodové vodě - tento stav se nazývá intra- amniální zánět (intra-amniotic inflammation, IAI). Na základě přítomnosti MIAC a IAI lze definovat čtyři podskupiny PPROM: i) intra-amniální infekce (jsou přítomny MIAC a IAI), ii) sterilní IAI (přítomen pouze IAI), iii) kolonizace amniální dutiny (přítomen pouze MIAC), iv) nepřítomnost MIAC i IAI. Ačkoliv gestační stáří v době porodu představuje nejdůležitější faktor ovlivňující novorozeneckou morbiditu a mortalitu, přítomnost MIAC a/nebo IAI může tyto novorozenecké výsledky zhoršit. Na základě těchto informací se diagnosticko-terapeutický postup založený na precizním posouzení intra-amniálního prostředí jeví jako optimální u těhotenství komplikovaných PPROM. Moderní ultrazvukové přístroje umožnují vyšetřit plod velice podrobně. Snaha o nalezení robustního ultrazvukového markeru...Department of Obstetrics and GynecologyPorodnická a gynekologická klinikaLékařská fakulta v Hradci KrálovéFaculty of Medicine in Hradec Králov

Marketing cestovního ruchu

Práce na základě marketingového výzkumu stanovuje možnosti rozvoje cestovního ruchu v hradeckém regionu a navrhuje optimalizaci obchodní politiky cestovních kanceláří v tomto okrese a určuje možný dopad na ekonomickou situaci okresu.Dokončená práce s úspěšnou obhajobo

Ultrasonographic Markers of Infection-Related Complications in Preterm Prelabour Rupture of Membranes

Preterm prelabour rupture of membranes (PPROM) represents a serious pregnancy complication associated with approximately 30% of preterm deliveries. PPROM might be complicated by the presence of microorganisms and/or their nucleic acids in amniotic fluid termed microbial invasion of the amniotic cavity (MIAC), and the elevation of various inflammatory mediators in the amniotic fluid referred to as intra-amniotic inflammation (IAI). Based on their presence or absence, four subgroups of PPROM can be defined: i) intra-amniotic infection (presence of both MIAC and IAI), ii) sterile IAI (IAI alone), iii) colonisation of the amniotic cavity (MIAC alone), and iv) absence of both MIAC and IAI. Although gestational age at delivery is the most important factor affecting the risk of neonatal morbidity and mortality, the presence of MIAC and/or IAI might worsen neonatal outcomes. Therefore, precise assessment of the intra-amniotic environment seems essential for ideal personalised management of PPROM pregnancies. Modern ultrasound machines allow a very detailed examination of the foetus. The effort to identify surrogate ultrasound markers of MIAC and/or IAI represents a logical research step in this field. One of the most promising results has been found on doppler assessment on blood flow in the foetal splenic..

Parents’ request for termination of pregnancy due to a congenital heart defect of the fetus in a country with liberal interruption laws

Objectives:This study aimed to evaluate the prenatal rate of congenital heart defects (CHDs) and the frequency of termination of pregnancy (TOP) due to a CHD, depending on the severity of the defect and concomitant diseases of the fetus. Methods:The data were assessed retrospectively between 2002 and 2017. Ultrasound examination was performed mostly in the second trimester. For analysis, the CHDs were divided into three groups of severity and three groups of fetus impairment. Results:A total of 40,885 fetuses underwent echocardiography. The CHDs were detected in 1.0% (398/40,885) and were an isolated anomaly in 69% (275/398). Forty-nine percent (197/398) of families decided to TOP. In all groups of severity, the rate of TOP rose linearly when comparing isolated defects and cases with associated morphological and genetic impairments. The TOP was significantly dependent on the associated anomalies in patients with the most correctable defects (p < .001) and the severity of CHDs in isolated cases without any other impairment (p < .001). Conclusion:The parents' decision to terminate increased with the severity of the defect and the associated anomalies of the fetus. The parents were mostly influenced by the associated anomalies when the CHD was correctable, and genetic factors played a more important role than morphological ones.Web of Science33172926291