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Finding the proportion of levator and fascial trauma of the pelvic floor in the development of symptoms pelvic organ prolapse - the effect of vaginal birth
Horčička, Lukáš ; Krofta, Ladislav (advisor) ; Halaška, Michael (referee) ; Chmel, Roman (referee)
Determination of the proportion of levator and fascial trauma of the pelvic floor in the development of symptoms of the descent of pelvic organs - the influence of vaginal birth Abstract Injury of levator ani muscle (LAM) is a significant pelvic organ prolapse (POP) risk factor. The puborectalis (PRM) and pubvisceral (PVM) subdivisions are at Level III vaginal support structures. Null hypothesis - there were no significant differences in muscle injuries patterns among LAM subdivisions. This retrospective magnetic resonance imaging (MRI) study included: 64 nulligravidae controls without pelvic floor dysfunction (PFD) and 526 POP symptomatic women of different parity. Primary outcome was PVM and PRM morphology on axial planes 1/ the place of the attachment to the pubic bone, 2/ visible separation/border between PVM and PRM. The attachment was scored as "normal" or "abnormal". The "abnormal" was divided in two types: a) "Type I" - loss of the muscle substance, but maintenance of the overall muscle architecture, b) "Type II" - muscle detachment from the pubic bone. The puboanalis (PAM) subdivision was evaluated as representative part of PVM. PAM and PRM attachments and separation were distinguished in all control cases. PAM and PRM attachments did not significantly differ. POP group characteristics were:...
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Demonstration of Acute Interfetal Transfusion of Monochorionic Twins
Hašlík, Lubomír ; Krofta, Ladislav (advisor) ; Ľubušký, Marek (referee) ; Záhumenský, Jozef (referee)
Introduction: Thanks to shared circulation in monochorionic twins, single intrauterine fetal death (IUD) may lead to acute feto-fetal transfusion (FFTR). The objective of the study was to describe our model of FFTR simulation after IUD in monochorionic (MC) twins. Methods: Prospective study analyzed 99 fresh MC placentas with the physiological course. A specially designed protocol was used for the preparation and analysis of the placentas. A pair of infusion sets fixed together using a mechanical mercury sphygmomanometer cuff was connected to the cannulated umbilical arteries. The tonometer was pressurized up to 30 and 40 mmHg. A positive finding of FFTR was determined as the amount exceeding 1 ml of dye flowed out of the umbilical cord simulating a dead fetus. The number and types of anastomoses, types, and distances between cords insertions, and the size of the placental areas for each fetus were also statistically analyzed. The placental angioarchitecture with and without proven FFTR was statistically compared, odds ratio (OR) and multivariable logistic analysis were performed. Results: A total of 49/99 (49.5%) cases of FFTR was proven, and the average transfusion time of 1 ml was 30 s (19-46 s). FFTR was present in 49/78 (62.8%) of placentas with arterio-arterial (A-A) anastomosis. The median...
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Detection of fetal abnormalities in the I. trimester of pregnancy
Finkeová, Kristýna ; Krofta, Ladislav (advisor)
The presented thesis "Detection of fetal abnormalities in the 1st trimester of pregnancy" includes a list of methods used for the detection of fetal abnormalities in the first trimester. At the beginning it briefly summarizes the abnormalities, which can be detected. The second chapter is devoted to various detection methods, in particular, ultrasound examination, invasive methods and biochemical screening. It deals with the various indicators which are assessed during ultrasound examination and the biochemical markers, which can be detected. It describes the combination of detection methods used in practice. The final chapter presents the typical factors that are evaluated when calculating the risk of fetal abnormalities, and the methods used for this calculation.
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The role of 3D and 4D ultrasound diagnosis and screening in first trimester
Hillenbrand, Nicola Birgit ; Krofta, Ladislav (advisor)
Early spontaneous abortions occur in 6-20% of all pregnancies; however, the exact mechanisms involved in these losses remain unclear. In this context, several 2D ultrasonographic parameters have been tested as predictors of early gestational losses including the shape and diameter of the yolk sac, and embryonic heart rate. The mean gestational sac diameter has also been correlated with gestational age and fetal growth. There have been first trimester studies on the volumetric examination of the gestational sac, amniotic fluid, placenta and yolk sac. This dissertation will focus on early pregnancy loss and the investigation of its etiology. Conventional ultrasonographic methods will be reviewed and compared with novel, more sophisticated methods in order to evaluate if scientific research as come closer to the etiology and early diagnosis of miscarriage. Special focus will be put on the predictive value of gestational sac shape and volume.
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Relationship between screening marker PAPP-A and pathological pregnancy
Stádníková, Lucie ; Krofta, Ladislav (advisor)
Biochemical screening biochemical testing verified indicators of increased risk of failure of gestation and fetal pregnancy has become an important part of prevention of certain těžkých congenital defects (congenital anomalies) in the population scale. the following interact with the ultrasound screening THAT increases diagnostic efficiency, but also by the positive results are becoming indications for in-depth, targeted and repeated ultrasound examinations throughout the pregnancy. Pathological findings of these two expand the range of diagnostic tests prenatal effective prevention těžkých anomalies. There are indications for invasive methods of prenatal genetic diagnostics, but also to increased clinical care of these risk of pregnancy. a The nejpoužívanější biochemical markers that can indicate a higher risk of embryonic or fetal postižení těžkými chromosome anomalies and other contingent závažnými disorders prenatal development are: AFP (alpha-fetoprotein), hCG (human chorionic gonadotropin, human chorionic gonadotropin), uE3 (unconjugated estriol) and PAPP-A (preganancy-associated plasma A protein, plasma protein-A associated with pregnancy).
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Novel treatment modalities for pelvic floor dysfunction
Macková, Kateřina ; Krofta, Ladislav (advisor) ; Džupová, Olga (referee) ; Čelko, Alexander (referee)
We aimed to test selected novel treatment modalities for pelvic floor dysfunctions and genitourinary syndrome of menopause. Both conditions are common in female, they negatively affect their quality of life, and current treatment options are not optimal. We started our research with an extensive literature search. First, we summarized the information on animal models for, and the utility they may have in the investigation of the pathophysiology of POP and novel therapies. We systematically searched 7426 articles from which 51 fulfilled the inclusion criteria. From all screened animals, only the non-human primate develops POP spontaneously, however their use is controversial. We concluded that many studies have methodological shortcomings and lack standardization in reporting outcomes. Also, several other animals can be used as a model of surgery for POP, each of them with different purposes. For our later research we chose the rat model to simulate POP repair with synthetic mesh. We also systematically reviewed the literature on the objective effects of non-ablative Er:YAG LASER on the skin and vaginal wall. We identified 7187 articles of which we included 15 in our review, including four that tested Er:YAG LASER on vaginal tissue. Er:YAG LASER energy induces measurable changes in the deeper skin...
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Multiple Sclerosis and Pregnancy
Hanulíková, Petra ; Rob, Lukáš (advisor) ; Binder, Tomáš (referee) ; Krofta, Ladislav (referee)
Introduction: Multiple sclerosis (MS) is an autoimmune disorder of the CNS that typically affects young women of childbearing age. Due to the international published data, safety for pregnant women with MS can be assumed. However, no study has been published in the Czech Republic to address the effect of MS on pregnancy and perinatal outcomes. Objective: Analysis of the clinical course of patients with MS during and after pregnancy, and perinatal outcomes in comparison with healthy pregnant women. Methods: A single centre prospective observational study in the period 2006-2015 was conducted. Complete data from 68 patients with MS were analyzed (85 deliveries) and were compared with a control cohort of 68 age- and parity - matched healthy pregnancies. Results: The comparison between relapse rate and EDSS before, during and after delivery showed no statistically significant difference (relapse in 7.4% and 9.5%, EDSS 1.27 and 1.49). Perinatal outcomes were comparable in both cohorts. The weight of newborns differed by 159 g, (p = 0.295), complications in pregnancy were represented in 16.2% in the group with MS and in 27.9% in controls (p = 0.295), caesarean section was performed in 16.2% in patients with MS and in 23.5% of controls (p = 0.629), 79.4% of patients with MS were breast-feeding. In the MS...
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Effect of hysterotomy suture techniques after cesarean on its healing
Hanáček, Jiří ; Krofta, Ladislav (advisor) ; Ľubušký, Marek (referee) ; Kacerovská Musilová, Ivana (referee)
Introduction: This prospective randomised study compared healing of the scars after cesarean section during the first postpartum year using a single or double layer suturing technique. Material and methods: Women with uncomplicated singleton pregnancies indicated for elective or acute cesarean section were randomly allocated to the uterine closure technique group. During the first postpartum year, their lower uterine segment was examined with a transvaginal ultrasound in 3 consecutive visits at 6 weeks, 6 months, and 12 months. Results: 324 women had the 12 months visit, out of these 149 underwent single layer closure of the uterine incision, 175 underwent double-layer technique. A higher proportion of the defects is seen in the single layer closure technique of suturing. Defects in the single layer group were wider (0.002) and the residual myometrial thickness in the single layer group were thinner (0.019). Women who underwent cesarean section at the stage of full cervical dilation had scars that were closer to the external cervical os (0.000). Conclusions: The findings of this study demonstrate that double layer technique with the first continuous nonlocking suture followed by a second continuous nonlocking suture is associated with better suture healing and greater residual myometrial thickness.
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Modern technologies in the assessment and treatment of pelvic organ prolapse - experimental and clinical studies
Urbánková, Iva ; Krofta, Ladislav (advisor) ; Mašata, Jaromír (referee) ; Kachlík, David (referee)
This project has shown that pelvic organ prolapse is linked with maternal age and delivery-related injuries. Up to every eight women may have a symptomatic prolapse already one year after their first delivery. Moreover, those with muscle injury have a higher short-term risk of pelvic organ prolapse development. To improve our knowledge we further explored the potential of an ovine model for prolapse and vaginal surgery. We showed that many anatomical and morphological features and vaginal wall changes induced by specific lifespan factors (first delivery, artificial menopause, and hormonal replacement) are similar to what is observed in women. We further used this model for testing novel implants and mesh visualization techniques. We believe that the ovine model can be used in future research on pelvic organ prolapse pathophysiology and novel treatment modalities.t
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Variation of abnormalities of foramen obturatum and retropubic space and its relation to complications of tape surgery
Hubka, Petr ; Mašata, Jaromír (advisor) ; Smetana, Karel (referee) ; Krofta, Ladislav (referee)
Introduction: The knowledge of anatomy is crucial for introduction of new surgical methods. It is also of especial use while dealing with surgical complications during surgeries with limited surgical field, where the way of approach limits the management of complications. It was assumed that common anatomical variations would influence different efficacy of surgeries and would explain potential complications. Methods: During anatomical dissections fifty female cadavers were dissected and tension-free vaginal tapes TVT-S H, TVT-S U, TVT Abbrevo and Ajust were studied. A novel descriptive system for localisation of the tape was created. During the dissection the tape was located and its localisation and fixation was described. Results: Common anatomical variation in the sample was corona mortis with frequency of 72 %. Preperitoneal fatty plug, which is recognized by some authors as the first stage of obturator hernia, was found in 40 % in obturator canal. The proper fixation of TVT-S H was achieved in 53.6 %. In 10.5 % urinary bladder was injured. In case of TVT-S U the proper fixation occurred in 63.8 %. In two cases the inserter was nearby corona mortis. Within the group of TVTO Abbrevo the tape was fixated properly into the obturator complex (consists of the obturator membrane and obturator muscles) in...
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