The authors investigated by interviews in Frantiskovy Láznĕ the sexual development and sex life in 614 Czech girls aged 16 to 18 years. It was revealed that the sexual development in 311 girls, where in the course of the year before convalescent treatment in Frantiskovy Láznĕ appendectomy was performed and in 89 probands who were operated twice or more frequently, was highly significantly retarded as compared with 163 probands who had no surgery so far. Comparison of the findings in 426 girls from complete and emotionally balanced families and 140 probands of divorced parents did not reveal a significant difference in their sexual development.
By intracervical administration of 0.75 mg PGE2, using a butterfly needle, the authors preinduced 32 patients with an immature portio vaginalis cervicis (CS 5 points) who had indications for termination of a full-term pregnancy. Slow administration lasted cca 6 hours. Maturation of the portio vaginalis cervicis occurred in 93.5%, in 71% regular uterine contractions started. The length of labour stages, the loss of blood, frequency of injuries during labour and foetal hypoxia were similar as in spontaneous deliveries. Side-effects were recorded in 20.7%. The described method is a suitable alternative to administration of gel substances, in particular because it is cheaper because it is well tolerated by the patients and is simple.
The objective of the work was to evaluate the importance of antenatal examination of amniotic fluid and foetal blood in case of suspected Rh isoimmunization of the foetus. In 1991-1992 in 16 patients with a rise of the titre of anti-D antibodies to > 1:8 between the 24th and 36th week of gestation 32 punctures of the umbilicus by means of a 22 gauge needle were made under continual ultrasonic control. In two instances intraumbilical transfusion was indicated. The authors revealed that with the rising titre of anti-D antibodies in maternal blood the foetal haematocrit value in the umbilical blood declines. With the rising bilirubin level the haematocrit declines. In foetuses with a haematocrit of < 31% severe forms of jaundice are encountered more frequently with the necessity of long-term phototherapy and exchange transfusion. The authors did not find a correlation between the haematocrit of foetal blood and the bilirubinoid concentration in amniotic fluid, assessed by Liley's method. Foetuses with a haematocrit higher than 31% are not threatened by severe forms of jaundice and therefore the authors do not use transfusions in these foetuses. Based on hitherto assembled experience, the authors confirmed that cordocentesis is associated with a comparable risk as amniocentesis but provides more accurate information on the state of the foetus.
In 1992 at least 12 million people were infected with the human immunodeficiency virus (HIV). According to Centers for Disease Control and Prevention data in 1992 over 500000 cases of AIDS were reported. Every third clinical patient was female. The median incubation period between infection with HIV and development of AIDS is about 8-10 years. Regarding the geographical breakdown the prevalence of HIV positivity among women is 1/40 in Sub-Saharan Africa 1/500 in South America 1/700 in North America and 1/400 in western Europe. The World Health Organization estimated that half a million women and children died in the first decade of the AIDS pandemic. In the 1990s about 3 million women died leaving behind millions of orphans. As of June 30 1992 a total of 3168487 people were tested for HIV in the Czech Republic of which there were 153 seropositives (139 men and 14 women) 38 with sign of AIDS (2 women) and 4 pregnant seropositive women. About 70-80% of HIV infection is contracted via heterosexual intercourse 8-15% parenterally and 5-10% by the perinatal route. The risk of HIV infection is high among patients with STDs drug addicts blood transfusion recipients before 1985 and those having sex without using condoms especially those whose HIV status is unknown. The effects of HIV on pregnancy include: spontaneous abortion induced abortion since 40% of fetuses get infected from the mother. When the number of CD4 lymphocytes drops to 200/square mm complications and opportunistic infections develop during pregnancy. There are three vertical mechanisms whereby HIV infection can be transmitted to the fetus or newborn: 1) via intrauterine transplacental primary infection of the syncytiotrophoblast; 2) via intrapartum blood cervical and vaginal secretions; and 3) via postpartum breast feeding. HIV has been demonstrated in milk although in low infectious doses. Fetal diagnosis of HIV infection is contraindicated because of the risks involved and early diagnosis in the newborn has to occur within 18 months by following up antibody tests with polymerase chain reaction examination. Therapy with azidothymidine the prevention of nosocomial infection the steep rise of HIV/AIDS in central and eastern Europe future prospects for a vaccine and treatment costs are also addressed.
The reliability and tolerance of 3 oral contraceptive preparations were investigated. Neogest (ethinyl estradiol [EE] 0.03 mg and levonorgestrel [LNS] 0.15 mg) was used by 86 women 18-35 years old for 3 years. Trisiston (6 tablets of EE 0.03 mg and LNS 0.05; 6 tablets of EE 0.04 mg and LNS 0.075; 9 tablets of EE 0.03 mg and LNS 0.125) was used by 148 women 16-42 years old for 3 years. Cilest (EE 0.035 mg and norgestimate 0.250 mg) was used by 52 women 16-44 years old for one year. Gynecological and laboratory investigations were also carried out in these women. In the Neogest group the most frequent complications were diarrhea and weak bleeding mainly towards the end of the cycle however bleeding was not rare already from the 18th day. These complications were observed most often in women under 30 years old (in 39/54 i.e. 72.23%). In 11 cases (28.20%) the use of Neogest was halted. Among women over 30 years old 8/30 (25%) had diarrhea and one of them discontinued its use. In one case weight gain of 4 kg was recorded which however did not result in discontinuation. In another case after the third menstrual cycle there was a significant loss of hair and Neogest was immediately discontinued. Trisiston caused diarrhea in 32 cases in the first 2-3 cycles and therefore 4 women stopped using the preparation. 28 women continued using it until the fourth cycle when the diarrhea ceased. 42 users under 30 years old acknowledged diarrhea in the second half of the cycle after 18-20 months of Trisiston usage. In 8 cases these symptoms within the first two months disappeared spontaneously. In 11 cases there was considerably shortened pseudomenstrual bleeding and 3 of these had bleeding lasting one and a half days. In one case there was an allergic exanthem and use was halted. Among Cilest users 8 women (15.39%) had problems in the first cycle including nausea. Other side effects comprised vomiting (3 women 5.78%) diarrhea intermenstrual bleeding (6 women 11.53%) and mycosis (2 cases 3.85%) which halted Cilest use in the fourth cycle.
A total of 1500 questionnaires were distributed to girls 14-19 years old attending secondary schools of economics (30%) secondary health care schools (58%) and trade schools (12%) in the Prague metropolitan region in order to assess their knowledge about contraceptive methods. The number of respondents was 1021. Regarding their initial sources of information about contraception 24% stated parents 29% literature 23% friends and only 14% mentioned schools. 71% of girls reported that their gynecologist had the greatest influence on the choice of contraceptive and 23% said their sexual partner. Regarding whom they would turn to for counseling about contraception 28% of 15-year-old girls chose a male gynecologist while 41% of 18-year-old girls did likewise. On the other hand 68% of 15-year-old girls chose a female gynecologist compared to 59% of 18-year-old girls. In answer to the question about the most suitable type of contraceptive 77% said the condom 28% chose hormonal contraception and 5% each chose coitus interruptus and natural contraceptive methods. Only 1% selected the IUD despite the fact that their knowledge about the IUD was substantially better than about hormonal contraceptives. The question about undesirable side effects of the IUD were answered correctly by 98% while the same question about hormonal contraceptives was answered correctly by 43%. It was surprising that 21% mentioned depression and only 22% referred to circulatory diseases. Regarding other adverse effects of oral contraceptives 38% mentioned the development of congenital anomalies in a subsequent pregnancy 15% sterility 28% the inflammation of internal reproductive organs and 17% the tumors of internal reproductive organs. Regarding the eventual use of hormonal contraceptives 36% of girls expressed anxiety about bleeding disorders 33% weight gain 22% depression 21% the necessity of regular use 14% nausea 6% headache and 5% decreased libido. The condom was the second most favored method in spite of the fear of unreliability (56%) loss of sensitivity (30%) disturbance of intimacy (12%) and other reasons (3%) such as allergy from the rubber material.
35 patients with malignant tumours were examined. In 4 of them comprehensive therapy was initiated in the course of the first five years of life. In the remaining 31 cases the first symptoms of the disease appeared between the ages of 9 to 16 years. In the entire group spermiogenic function was insufficient in about 65% of the afflicted. Subnormal values of plasma testosterone were found only in 9%.
An ultra-rapid method for cryopreservation of human embryos, using 1,2-propane-diol, was developed. 280 spare embryos obtained in the IVF program were frozen by this method. 91 embryos were thawed and 68 of them (74.7%) survived the procedure with more than half the blastomeres intact. 65 embryos were transferred in 28 cycles. Two pregnancies developed (7.1%), one of which ended by the birth of a healthy girl (the first birth after transfer of a frozen/thawed embryo in the Czech Republic). The other pregnancy is ongoing.
