M Vĕtr

Palacký University of Olomouc, Olomouc, Olomoucky kraj, Czech Republic

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Publications (21)0 Total impact

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    ABSTRACT: Placental abruption complicates approximately 1% of all pregnancies and remains a significant cause of both maternal and fetal morbidity and mortality. Several risk factors are associated with this complications, but a clear causal relation is diffucult to establish. The aim of the study was to determine and identify risk factors for placental abruption. Retrospective cohort study. Dept. of Obstetrics and Gynaecology, Medical Faculty of Palacký University, Olomouc. Retrospectively gathered cohort of 180 women was compared to 198 healthy women. We have focused on anthropometric, sociodemographic, behavioral, obstetric and fetal parameters. Statistical evaluation was done by Statsoft, Inc. (2001) Statistika CZ (Software system data analysis), version 6. The incidence of the placental abruption was 0.89%. We have confirmed the following risk factors as statistically significant (p values are given): Low-degree education (0.00002), prepregnancy weight of the mother (0.00), weight gain in pregnancy (0.00), higher parity (0.0272), smoking (0.03847), preeclampsia (0.00889), chorioamnionitis (0.00), premature rupture of membranes (0.00), recurrent spontaneous abortions (0.00), positive family history of deep venous thrombosis (0.0007) and intrauterine growth retardation (0.0386). Placental abruption has a large number of potential risk factors. The true biological cause and its etiopathogenic role is still to be elucidated.
    Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 06/2005; 70(3):175-9.
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    ABSTRACT: To evaluate the differences in early maternal and neonatal morbidity after spontaneous delivery, forceps delivery and vacuum-extraction. Retrospective clinical study. Department of Obstetrics and Gynecology, University Hospital, Palacký University, Olomouc. The database of 8196 deliveries at our department in the time period from January 1995 till September 2000 revealed 183 of forceps deliveries and 217 of vacuum-extractions. The control group included 200 randomly selected parturients with spontaneous vaginal delivery. The early maternal morbidity was evaluated according to the following parameters: perineal tears of the IIIrd + IVth degree, duration of hospitalization, average blood loss, the need of analgetics, dehiscence of episiotomy requiring resuture, febrilies and administration of antibiotics. The early neonatal morbidity evaluation was based on the incidence of cephalhematomas, the incidence of hyperbilirubinaemia, duration of hospitalization, signs of fetal hypoxia (pH, Apgar score), gestational age, birthweight and the presence of intracranial and retinal bleeding. The statistical significance of the differences in the frequency of the above parameters was evaluated. Spontaneous deliveries were associated with lower maternal morbidity according to the most of studied parameters. Vacuum-extraction had a lower frequency of maternal postpartum complications compared to forceps deliveries. Statistically valid differences were however found only at perineal tears of the IIIrd + IVth degree and at administration of analgetic and antibiotics. The use of vacuum-extraction seems to be connected with a higher risk of cephalhematomas (p = 0.0051) and longer duration of hospitalization. From the point of view of early maternal morbidity the assisted vaginal delivery by vacuumextraction gives better results than by forceps. However vacuum-extraction increases the risk of cephalhematomas at newborn.
    Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 08/2003; 68(4):227-31.
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    ABSTRACT: To evaluate by analysis of the most serious obstetric cases during a five-year period the contribution of ante-partum CTG and Doppler flowmetry in the diagnosis of foetal risk and to assess the part of risk factors of hypoxia during pregnancy. Retrospective epidemiological analysis. Gynaecological and Obstetric Clinic Medical Faculty Palacký University and Faculty Hospital Olomouc. In a retrospective analysis based on 6494 deliveries during a five-year period (1996-2000) the authors evaluate a selected sample of 1087 most serious conditions with the diagnosis of imminent foetal hypoxia. In the evaluated group 90.3% of the women had a cardiotocographic examination, 50.8% Doppler flowmetry with assessment of umbilical RI and PI indexes. The diagnosis of neonatal hypoxia was based on evaluation according to Apgar score < 7 and pH of arterial blood < 7.20. The authors compare both diagnostic methods with a common gold standard as regards their ability to predict hypoxia. In the logistic regression model they evaluate risk factors of pregnancy in relation to foetal hypoxia. Clinical manifestations of hypoxia were recorded in 114 neonates (10.5%). Perinatal deaths occurred in 46 infants, 16 were stillborn. Pathological ante-partum CCTG findings are associated with more active approaches (earlier termination of pregnancy, SC, preinduction by prostaglandins). Pathological ante-partum CTG and flowmetry was paradoxically more frequently associated with a better condition of the neonate. Pathological findings of ante-partum CTG were significantly less frequent in neonates with hypoxia than those without it (27%) vs. (40.9%), (relative risk 0.56 [95% CL 0.36-0.88], P = 0.01) while pathological findings of umbilical flowmetry were insignificantly more frequent (34.9%) vs. (33%), (relative risk 1.08 [95% Cl 0.59-1.97], P = 0.9). Both examinations were made in 547 (50.3%) women of the whole group, in 43 (7.9%) hypoxia of the foetus developed. Sensitivity: CTG 32.6%, Doppler 34.9%, Specificity: CTG 51.4%, Doppler 67.3%. Falsely positive CTG 48.6%, Doppler 32.7%. Analysis of risk factors of pregnancy in relation to foetal hypoxia defines by retrospective elimination as significant risks haemorrhage during pregnancy (n = 76, OR 2.35 [95% Cl 1.31-4.23], P = 0.01) and premature delivery (n = 258, OR 2.02 [95% Cl 1.34-3.05], P = 0.0004). The value of ante-partum CTG and Doppler flowmetry in the prognosis of neonatal hypoxia is low. The lower rate of pathological findings in affected neonates is probably associated with the fact that part of the hypoxias develop during delivery and cannot be predicted before delivery. The high number of falsely positive findings may by due by the adaptational abilities and reserves of the infant, by a more active approach when there are signs of danger and incorrect interpretation of findings. Premature delivery and haemorrhage are significant risks of neonatal hypoxia.
    Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 10/2002; 67(5):244-51.
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    ABSTRACT: To evaluate cervical length in twin pregnancies measured by transvaginal ultrasonography. A prospective clinical study. Department of Obstetrics and Gynecology, Medical Faculty of Palacky, Olomouc, Czech republic. Clinical data of cervical length in twin pregnancies measured by transvaginal ultrasonography were summarized. 69% of patients delivered after 36th week of gestation, mean gestational age at the time of delivery was 35.5 week. Mean cervical length measured bi-weekly from the 16th till 34th week was 34.9, 34.6, 33.8, 33.2, 29.7, 28.7, 29.1, 28.4, 23.6, 22.8 mm. The creation of the funneling was recorded in more than 80% of patients with preterm delivery at the mean gestational age 23 week. Mean cervical length in patients delivered before 36th week was in the 23rd week of gestation 21.5 mm, while in woman delivered near term was average cervical length 33.1 mm. Genital infection in patients with preterm labours was present in 27%. Transvaginal ultrasonography seems to be a useful method in antenatal care of risk pregnancies with twins.
    Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 08/2000; 65(4):240-2.
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    ABSTRACT: As continuation of their previous paper the authors submit the results of the European study EUROPOP pertaining to the effect of occupation on the course and outcome of pregnancy. The paper contains the first part of results where the authors compare groups of women with premature deliveries (22nd-36th week of pregnancy) with control groups 1/10 deliveries in term (> or = 37 weeks). The groups of abortions in the second trimester which were studied by the authors were relatively small (Czech Republic 49 and in the all-European study 229). To keep the study within a reasonable limits the tables are not presented. Comparison of results describing home work, living conditions of pregnant women, prenatal care and medical problems as well as data on the outcome of pregnancy are presented in part III.
    Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 11/1998; 63(5):366-70.
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    ABSTRACT: Efforts to obtain an objective view of the working and living conditions of European women and in particular the influence of these conditions on the course of pregnancy were the reason why in 1994 within research activities of the EC a project EUROPOP (European Programme of Occupational Risk and Pregnancy Outcome) was adopted and started. Seventeen countries incl. the Czech Republic were asked to participate. The research proper was conducted in 57 maternity institutions. In the Czech Republic the Olomouc region was selected with the Gynaecological and Obstetric Clinic in Olomouc as the coordinating centre. All 13 gynaecological and obstetric departments of the Olomouc catchment area were included in the trial.
    Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 07/1998; 63(3):167-9.
  • M Vĕtr, M Kudela, S Machac
    Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 03/1998; 63(1):48-50.
  • Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 01/1998; 62 Suppl:39-42.
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    ABSTRACT: The objective of this prospective study was to evaluate fetal fibronectin bedside test (Mast Diagnostica) to rule out preterm labor. 46 patients from between 25 and 36 weeks were included in the study over a six months period. All patients underwent only one cervical sampling at the beginning of the study. The association between the fetal fibronectine test results and various outcomes were analysed. 5 of the 16 women whose test results were positive had early labor and 4 of the 30 patients with negative test results had preterm delivery. The bed side test had a sensitivity of 55.6%, a specificity of 70.3%, a positive predictive value of 31.3%, and a negative predictive value of 86.7%. The addition of tocolytic therapy and intensive care resulted probably in decrease of the predictive capacity of a positive fetal fibronectine test, odds ratio 2.95 (95% confidence interval 0.54-16.85). However interval from diagnosis to delivery was shorter (P < 0.025), cervical findings (Bishop score) worse and betamimetic treatment was more frequent (P < 0.01) in the group with positive test results. Positive fetal fibronectine test results indicates a significant risk for the subsequent early delivery and negative test result is a good indication that subsequent preterm labor and early delivery are unlikely to occur.
    Acta Universitatis Palackianae Olomucensis Facultatis Medicae 02/1996; 140:55-7.
  • Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 11/1994; 59(5):272-4.
  • M Vĕtr, M Talas
    Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 07/1994; 59(3):153-5.
  • M Vĕtr, M Kudela
    Ceskoslovenská gynekologie 10/1993; 58(4):188-9.
  • M Vĕtr, A Sobek
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    ABSTRACT: Thirty one women with hyperandrogenism, clinically divided into polycystic ovary syndrome (PCOS)--28 women and idiopathic hirsutism (I.H.)--3 women, were treated with low dose spironolactone (50 mg or 75 mg daily) for average five months. There was an excellent clinical response in 19 (61%), incomplete response in 8 (26%), no response in 5 women. Six of 18 patients with sterility became pregnant during the one year after treatment and delivered a healthy infant at term. Two patients dropped out of the trial because of intolerance of the therapy. Remarkable change of the menstrual pattern characterised as polymenorrhea was major side effect of the therapy. Other side effects were not problem. Spironolactone caused statistically significant reduction in testosterone, luteinizing hormone and prolactin values at the end of the treatment. Our results demonstrate that low-dose spironolactone is effective in the treatment of hyperandrogenism in women.
    Acta Universitatis Palackianae Olomucensis Facultatis Medicae 02/1993; 135:55-7.
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    ABSTRACT: We followed 124 cycles and compared the preovulatory rise of progesterone in the groups of spontaneous ovulation and stimulated ovulation with those of ovulation of small follicles and cycles with LUF syndrome. No significant differences were found between normal and abnormal cycles.
    Acta Universitatis Palackianae Olomucensis Facultatis Medicae 02/1991; 130:253-6.
  • Acta Universitatis Palackianae Olomucensis Facultatis Medicae 02/1991; 131:317-23.
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    ABSTRACT: Ovarian growth was monitored by ultrasound and plasma hormonal levels (E2, LH, FSH, progesterone) in 124 cycles of 71 patients. Providing a direct view of follicular maturation, ultrasound can help in the determination of the best time for the induction of ovulation. Examining the speed of follicular growth we can predict some ovulatory dysfunction.
    Acta Universitatis Palackianae Olomucensis Facultatis Medicae 02/1991; 130:247-52.
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    ABSTRACT: Afternoon serum PRL levels and PRL responsiveness to metoclopramide (MCP) were determined in 36 women, aged 30.5 +/- 4.5, with normoprolactinemic anovulation. All women underwent a bilateral ovarian wedge resection with diagnosis polycystic ovarian disease (PCO) 2.9 +/- 2.0 years ago. After operation only four women had been pregnant. A bolus i.v. dose of 10 mg metoclopramide was given and serum PRL was estimated before, 30 and 60 min. after MCP administration. Diurnal serum PRL levels were approximately 9 ng in all patients. The PCO patients were classified into 2 groups in terms of the responsiveness to metoclopramide test. MCP induces rapid and marked elevation in serum PRL levels in all subjects. The maximum post MCP PRL value in the group I patients (n = 16) was 143.0 +/- 37.7 ng/ml, which was significantly higher than the maximum value in the II group patients (104.3 +/- 32.5 ng/ml) (P less than 0.005). Nine (56.2%) of the I group patients had maximum PRL values higher than 150 ng/ml; the proportion was statistically higher than 10 percent maximum PRL values in the group II (P less than 0.01). This finding suggests that the patients who had enhanced PRL responsiveness to MCP test have latent hyperprolactinemia, which can not be detected by analyzing PRL levels in blood samples taken randomly. This latent hyperprolactinemia presumably might be normalized by dopamine agonist therapy, resulting in resumption of ovulatory cycles in these women.
    Acta Universitatis Palackianae Olomucensis Facultatis Medicae 02/1991; 130:257-64.
  • Ceskoslovenská gynekologie 01/1991; 55(10):758-61.
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    ABSTRACT: Thirty-two women with ovarian dysfunction due to hyperprolactinemia were treated with a new derivative of lisuride-terguride. Twenty-three patients were treated for infertility. A microadenoma was confirmed in five, and three other patients had had a macroprolactinoma surgically removed. The finding in one of the patients was diagnosed as the syndrome of empty sella. Galactorrhea was present in 18 women. The duration of treatment ranged from 2 to 33 months. The determination of therapeutic dosages was based on individual responses on the prolactin levels within a range from 0.1 to 4.5 mg per day. Increased prolactin levels were successfully normalized in twenty-one treated patients. Regular periods were reappeared in 59% of the women. Thirteen (56%) became pregnant, seven gave birth to healthy babies, two of the patients aborted in the first trimester. Four women are still in later stages of pregnancy. Galactorrhea disappeared in 56% of the patients, being markedly inhibited in the remaining ones. In two cases, microadenoma disappeared after treatment, and in those after surgery the postoperative findings were decreased, in one patients there is no alteration in the pathology. Side effects were seen in 34% of the patients, being mostly mild in nature, and including in most cases nausea, headache and stomach pain. The complaints were transient, receding after prolonged treatment.
    Acta Universitatis Palackianae Olomucensis Facultatis Medicae 02/1990; 125:155-60.
  • M Vĕtr, M Talas
    Acta Universitatis Palackianae Olomucensis Facultatis Medicae 02/1988; 120:289-94.