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Antibiotic prophylaxis of extensive obstetric perineal injuries repair
Menzlová, Erika ; Záhumenský, Jozef (advisor) ; Procházka, Martin (referee) ; Roztočil, Aleš (referee)
Objective Our aim was to compare two regimens of antibiotic prophylaxis at the time of repair of obstetric anal sphincter injury. Benefit of long regimen of antibiotic prophylaxis in comparison with short regimen of antibiotic administration haven't been till now proven. Material and Methods Women who gave vaginal birth in department of gynaecology and obstetrics of the First Faculty of Medicine of Charles University and Hospital Bulovka from 1.1.2008 to 30.6.2013 and who sustained third - or fourth - degree perineal tears have been enrolled in our trial. All women who fulfilled trial criteria received at the time of repair antibiotic prophylaxis which was cefuroxim (second - generation cephalosporin). This antibiotic has good sensitivity to vaginal gram-positive flora and to rectal gram-negative microorganisms too. Suture technique and following postpartum care have been standardized. All enrolled women were checked 2 weeks and 3 months after delivery. We evaluated subjective and objective parameters of healing of the obstetric perineal injury and 3 months postpartum we looked for symptomps regarding anal incontinence. The Manchester questionnaire was used for evaluation of anal incontince occurance. Results Incidence of third - and fourth - degree perineal tears was 1,4 % during period of our...
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Technical Aspects of the Second Stage of Labor
Karbanová, Jaroslava ; Kališ, Vladimír (advisor) ; Procházka, Martin (referee) ; Záhumenský, Jozef (referee)
Obstetrical intervantion`s goal is to normalize an abnormal or pathological course of labour. In a certain case (e.g. fetal distress) this is not fully achievable. Then the goal is to accelerate the delivery without inadequate increase of risk of maternal or neonatal trauma. The aim of this dizertation thesis was to offer an up-to-date definition and to outline a proper performance of these interventions. Therefore, it was necessary to properly and timely describe the labour layout in which the accoucheur and/or the parturient happen to occurr when an intervention is to take place. It was essential to describe the quantity of perineal loading as well as to define the main vector of perineal strain and deformation. Based on the range of this deformation it was subsequently possible to adequately describe and execute some obstetrical interventions (e.g. a variety of types of episiotomy) or to evaluate a variety of modifications by means of computational modelling (e.g. manual perineal protection) that might have so tiny nuances between each other or differences that are difficult to measure because the clinical evaluation is impossible due to interindividual imprecision or very short duration of the intervention. We described the maximum strain on the perineal surface during vaginal delivery that...
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Obstetric interventions and pelvic floor disorders
Rušavý, Zdeněk ; Kališ, Vladimír (advisor) ; Roztočil, Aleš (referee) ; Mašata, Jaromír (referee)
Obstetric interventions and pelvic floor disorders - Abstract One of the principal objectives of obstetric interventions in the second stage of labor is prevention of pelvic floor trauma and associated pelvic floor disorders. The most commonly used and also most frequently discussed interventions are manual perineal protection and episiotomy. The majority of pelvic floor disorders are of subjective nature. Therefore, tools for objectification and severity quantification of these disorders are the key to reliable comparison and identification of the most effective interventions. The aim of the dissertation was to find the most effective modification of manual perineal protection, to compare two frequently used types of episiotomy regarding all pelvic floor disorders and finally to find a consensus on the most suitable instrument for anal incontinence severity assessment. Our studies concerning manual perineal protection experimentally described the direction and extent of perineal deformation during vaginal delivery. The subsequent studies on biomechanical model demonstrated that the most effective method of manual perineal protection in peak perineal strain reduction is when the fingers are placed on the perineum 6 cm laterally and 2 cm ventrally from the posterior commissure at both sides and are...
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Antibiotic prophylaxis of extensive obstetric perineal injuries repair
Menzlová, Erika ; Záhumenský, Jozef (advisor) ; Procházka, Martin (referee) ; Roztočil, Aleš (referee)
Objective Our aim was to compare two regimens of antibiotic prophylaxis at the time of repair of obstetric anal sphincter injury. Benefit of long regimen of antibiotic prophylaxis in comparison with short regimen of antibiotic administration haven't been till now proven. Material and Methods Women who gave vaginal birth in department of gynaecology and obstetrics of the First Faculty of Medicine of Charles University and Hospital Bulovka from 1.1.2008 to 30.6.2013 and who sustained third - or fourth - degree perineal tears have been enrolled in our trial. All women who fulfilled trial criteria received at the time of repair antibiotic prophylaxis which was cefuroxim (second - generation cephalosporin). This antibiotic has good sensitivity to vaginal gram-positive flora and to rectal gram-negative microorganisms too. Suture technique and following postpartum care have been standardized. All enrolled women were checked 2 weeks and 3 months after delivery. We evaluated subjective and objective parameters of healing of the obstetric perineal injury and 3 months postpartum we looked for symptomps regarding anal incontinence. The Manchester questionnaire was used for evaluation of anal incontince occurance. Results Incidence of third - and fourth - degree perineal tears was 1,4 % during period of our...
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Endosonography of anal sphincters
JURÁK, Pavel
Endosonography of anus is an ultrasound method which provides a full image of external and internal anal sphincter and its defects, gaping of free edges, weakening or degenerative changes. There are many expressions denoting the mentioned examination, some of them can be even misleading as to the instruments used (endoscopic ultrasonography is not the same as endosonography). After studying domestic and foreign literature and articles in medical journals, I found out that the concrete examination can be denoted by different names but it is just the matter of differently viewed terminology. Thus the anal sphincter can be examined by endosonography, endoanal sonography, endoanal ultrasonography, transrectal ultrasonography, rectal sonography. However, all of these terms relate to the examination of rectum or anus with the use of a rigid high-frequency ultrasound probe. The thesis deals with injuries to anal sphincter and their diagnostics. Apart from the examination based on endosonography I also describe other related methods. It was necessary to mention some anatomical structures of the pelvic floor, the knowledge of which makes it possible to interpret the ultrasound records. The objective of the thesis was to evaluate the quality of anal sphincter imaging in dependence on the technical standard of the ultrasound devices. I elaborated questionnaires and sent them to chosen workplaces. Each workplace is thus represented by a questionnaire with replies and a supplement which includes the pictures of technical equipment and a concrete image of anal sphincters. These images were described and assessed subjectively, on the basis of obtained parameters and personal experience. According to the results of the thesis it is possible to state that the technical standard of the equipment considerably influences the quality of anal sphincter images. The contribution of the bachelor thesis can be seen in providing the professionals as well as the public with more information on the theme in question.
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