{"id":866,"date":"2015-02-17T07:47:17","date_gmt":"2015-02-17T06:47:17","guid":{"rendered":"http:\/\/sumperkgynekolog.cz\/?p=866"},"modified":"2015-02-23T13:25:46","modified_gmt":"2015-02-23T12:25:46","slug":"cisarsky-rez-nebo-prirozeny-porod","status":"publish","type":"post","link":"https:\/\/sumperkgynekolog.cz\/?p=866","title":{"rendered":"C\u00edsa\u0159sk\u00fd \u0159ez nebo p\u0159irozen\u00fd porod?"},"content":{"rendered":"<p><em>MUDr. Milo\u0161 Vyslou\u017eil,<\/em><\/p>\n<p><em>Prim\u00e1\u0159 por,. gyn. odd. \u0160umpersk\u00e1 nemocnice, a.s.<\/em><\/p>\n<p><em>Souhrn:<\/em><\/p>\n<p><em>C\u00edsa\u0159sk\u00fd \u0159ez, nejstar\u0161\u00ed a a dnes z\u0159ejm\u011b nej\u010dast\u011bji prov\u00e1d\u011bn\u00e1 operace v\u016fbec pro\u0161el historick\u00fdm v\u00fdvojem. Od v\u00fdkonu, umo\u017e\u0148uj\u00edc\u00edho poh\u0159b\u00edt nenarozen\u00e9 d\u00edt\u011b zem\u0159el\u00e9 matky, p\u0159es operaci zachra\u0148uj\u00edc\u00ed \u017eivot matce a posl\u00e9ze d\u00edt\u011bti a\u017e po jistou alternativu p\u0159irozen\u00e9ho vagin\u00e1ln\u00edho porodu. N\u00e1zory ve\u0159ejnosti, i odborn\u00e9, na c\u00edsa\u0159sk\u00fd \u0159ez na p\u0159\u00e1n\u00ed se r\u016fzn\u00ed, faktem je trval\u00fd n\u00e1r\u016fst frekvence t\u00e9to operace.<\/em><\/p>\n<p><em>Kl\u00ed\u010dov\u00e1 slova: c\u00edsa\u0159sk\u00fd \u0159ez, p\u0159irozen\u00fd porod, sekce na p\u0159\u00e1n\u00ed<\/em><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>Historie<\/strong><\/p>\n<p>V\u00a0d\u00e1vn\u00fdch dob\u00e1ch bylo zvykem, \u017ee \u017eeny p\u0159iv\u00e1d\u011bly na sv\u011bt svoje d\u011bti v\u00a0okruhu nejbli\u017e\u0161\u00edch p\u0159\u00edbuzn\u00fdch a zn\u00e1m\u00fdch, obvykle \u017een. V\u011bt\u0161inou t\u011bch, kter\u00e9 samy m\u011bly za sebou v\u00edce \u00fasp\u011b\u0161n\u00fdch porod\u016f.\u00a0 Z\u00a0nich se \u010dasem rekrutovaly prvn\u00ed zku\u0161en\u00e9 \u201eb\u00e1by pupko\u0159ezn\u00e9\u201c \u2013 p\u0159edch\u016fdkyn\u011b porodn\u00edch asistentek. Porody prob\u00edhaly v\u00a0dom\u00e1c\u00edm prost\u0159ed\u00ed rodi\u010dek nebo u jejich p\u0159\u00edbuzn\u00fdch. V\u00a02. polovin\u011b 18. stolet\u00ed byly na na\u0161em \u00fazem\u00ed z\u0159izov\u00e1ny terezi\u00e1nsk\u00e9 \u0161pit\u00e1ly, jejich\u017e sou\u010d\u00e1st\u00ed b\u00fdvaly i sl\u00e9h\u00e1rna (porodnice), nalezenec a sirot\u010dinec.\u00a0 \u017deny rodily v\u00a0p\u0159ev\u00e1\u017en\u00e9 v\u011bt\u0161in\u011b\u00a0 nad\u00e1le doma, v\u00a0\u00fastavech jen opu\u0161t\u011bn\u00e9, nemajetn\u00e9 nebo ty, kter\u00e9 se cht\u011bly po porodu sv\u00e9ho d\u00edt\u011bte z\u0159\u00edci a \u00a0zanechat je v\u00a0sirot\u010dinci. Od za\u010d\u00e1tku 20, stolet\u00ed nar\u016fst\u00e1 po\u010det \u00fastavn\u00edch porod\u016f, zejm\u00e9na ve m\u011bstech, a to i u dob\u0159e situovan\u00fdch rodi\u010dek. Venkovsk\u00e9 \u017eeny rodily i nad\u00e1le doma v\u00a0p\u0159\u00edtomnosti porodn\u00ed b\u00e1by. Ta, v\u00a0p\u0159\u00edpad\u011b komplikac\u00ed p\u0159ivolala l\u00e9ka\u0159e, pokud si ani ten neporadil, za\u0159\u00eddil p\u0159evoz do porodnice. Je logick\u00e9, \u017ee perinatologick\u00e9 v\u00fdsledky takov\u00fdchto \u00fastavn\u00edch porod\u016f daleko zaost\u00e1valy nejen za dne\u0161n\u00edmi ukazateli, ale i za dom\u00e1c\u00edmi porody. Tato praxe trvala a\u017e do roku 1948, kdy bylo zru\u0161eno babictv\u00ed jako svobodn\u00e9 povol\u00e1n\u00ed. Od t\u00e9 doby rodily na na\u0161em \u00fazem\u00ed v\u00a0porodnic\u00edch prakticky v\u0161echny\u00a0 rodi\u010dky. T\u00edmto opat\u0159en\u00edm se tehdej\u0161\u00ed \u010ceskoslovensko stalo zem\u00ed s\u00a0nejni\u017e\u0161\u00ed novorozeneckou i mate\u0159skou \u00famrtnost\u00ed<\/p>\n<p>C\u00edsa\u0159sk\u00fd \u0159ez \u2013 jedna z\u00a0nejstar\u0161\u00edch operac\u00ed, byl, pro sv\u00e9 riziko,\u00a0 dlouho prov\u00e1d\u011bn jen u rodi\u010dek mrtv\u00fdch \u010di um\u00edraj\u00edc\u00edch. To proto, \u00a0aby bylo mo\u017eno d\u00edt\u011b pok\u0159t\u00edt a poh\u0159b\u00edt, pozd\u011bji i pro z\u00e1chranu\u00a0 rod\u00edc\u00ed \u017eeny. A\u017e po 2. sv\u011btov\u00e9 v\u00e1lce, zdokonalen\u00edm anestezie, antisepse, zaveden\u00edm antibiotik se stal c\u00edsa\u0159sk\u00fdch \u0159ez rutinn\u00ed operac\u00ed, prov\u00e1d\u011bnou i v\u00a0z\u00e1jmu d\u00edt\u011bte. Tak tomu bylo a\u017e do konce stolet\u00ed, p\u0159i\u010dem\u017e procento c\u00edsa\u0159sk\u00fdch \u0159ez\u016f pozvolna stoupalo.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Extr\u00e9my sou\u010dasnosti<\/strong><\/p>\n<p>V\u00a0posledn\u00edch letech se setk\u00e1v\u00e1me \u00a0se dv\u011bma protich\u016fdn\u00fdmi sm\u011bry v\u00a0n\u00e1zorech rodi\u010dek a jejich bl\u00edzk\u00fdch na veden\u00ed porodu. Ten prvn\u00ed, jako reakce na odosobn\u011bnou a p\u0159etechnizovanou medicinalizaci porodnictv\u00ed\u00a0 hl\u00e1s\u00e1 n\u00e1vrat k\u00a0p\u0159irozen\u00fdm porod\u016fm. Prosazov\u00e1ny jsou porody v\u00a0dom\u00e1cnosti, bez l\u00e9ka\u0159sk\u00e9 asistence, bez jak\u00fdchkoli podan\u00fdch l\u00e9k\u016f,\u00a0 bez tlumen\u00ed porodn\u00edch bolest\u00ed. Jakkoli tento postup odborn\u00edci nedoporu\u010duj\u00ed a s\u00e1m s\u00a0n\u00edm nesouhlas\u00edm, nepova\u017euji jej za mimo\u0159\u00e1dn\u00e9 celospole\u010densk\u00e9\u00a0 zdravotn\u00ed riziko. \u017deny t\u00edhnouc\u00ed k\u00a0t\u011bmto \u201ep\u0159\u00edrodn\u00edm porod\u016fm\u201c jsou obvykle vzd\u011blan\u00e9,\u00a0 dob\u0159e informovan\u00e9 a na sv\u016fj porod dob\u0159e p\u0159ipraven\u00e9. \u00a0Nechci v\u00a0\u017e\u00e1dn\u00e9m p\u0159\u00edpad\u011b podce\u0148ovat rizika vypl\u00fdvaj\u00edc\u00ed z\u00a0porod\u016f mimo dosah l\u00e9ka\u0159sk\u00e9 p\u00e9\u010de. Nejde ale o masov\u00fd jev,\u00a0 nav\u00edc vytv\u00e1\u0159\u00ed p\u0159\u00edzniv\u00fd tlak na kultivaci samotn\u00fdch porodnic.\u00a0 Modern\u00ed porodn\u00ed s\u00e1ly a odd\u011blen\u00ed se v\u00a0reakci na tyto tendence st\u00e1vaj\u00ed prost\u0159ed\u00edm s\u00a0v\u00fdbavou a provozem, kter\u00e9 by p\u0159ed p\u00e1r des\u00edtkami let byly nemysliteln\u00e9. Vzpome\u0148me jen kas\u00e1rensk\u00e9ho re\u017eimu star\u00fdch porodnic a spou\u0161t\u011bn\u00ed ko\u0161\u00edk\u016f z\u00a0oken \u0161estined\u011bl\u00ed! B\u011b\u017enou prax\u00ed je dnes\u00a0\u00a0 p\u0159\u00edtomnost partnera \u010di bl\u00edzk\u00e9 osoby\u00a0 rodi\u010dky, volba porodn\u00ed polohy, porodn\u00ed pl\u00e1n.<\/p>\n<p>Druh\u00fdm dne\u0161n\u00edm extr\u00e9mem je nar\u016fstaj\u00edc\u00ed ned\u016fv\u011bra k p\u0159irozen\u00fdm porod\u016fm a snaha p\u0159iv\u00e9st na sv\u011bt d\u00edt\u011b c\u00edsa\u0159sk\u00fdm \u0159ezem z\u00a0jin\u00e9 ne\u017e medic\u00ednsk\u00e9 indikace. D\u016fvod\u016f je mnoho, strach z\u00a0bolesti, \u00a0obava z\u00a0po\u0161kozen\u00ed plodu porodn\u00edm d\u011bjem,\u00a0 ze zm\u011bny anatomie porodn\u00edch cest a t\u00edm n\u00e1sledk\u016f v\u00a0sexu\u00e1ln\u00edm \u017eivot\u011b. A tak trend postupn\u00e9ho nar\u016fst\u00e1n\u00ed procenta c\u00edsa\u0159sk\u00fdch \u0159ez\u016f, patrn\u00fd v\u00a02. polovin\u011b minul\u00e9ho stolet\u00ed, v\u00a0posledn\u00edch letech akceleroval.\u00a0 Marn\u00e9 jsou v\u011bdeck\u00e9 studie prokazuj\u00edc\u00ed, \u017ee zvy\u0161ov\u00e1n\u00ed po\u010dtu c\u00edsa\u0159sk\u00fdch \u0159ez\u016f nad 10% ji\u017e nevede ke zlep\u0161en\u00ed perinatologick\u00fdch ukazatel\u016f, naopak zvy\u0161uje se nemocnost, komplikace a n\u00e1sledky u matek.\u00a0 Sou\u010d\u00e1st\u00ed t\u00e9to dne\u0161n\u00ed \u201echirurgizace porodu\u201c je p\u0159\u00edsn\u00e9 kontinu\u00e1ln\u00ed monitorov\u00e1n\u00ed stavu plodu,\u00a0 rozvoj metod tlum\u00edc\u00edch \u00a0bolesti i bohat\u00e1\u00a0 medikace p\u0159i porodu.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Kter\u00fd je lep\u0161\u00ed?<\/strong><\/p>\n<p>Co je tedy vhodn\u011bj\u0161\u00ed pro matku a pro d\u00edt\u011b? Spont\u00e1nn\u00ed p\u0159irozen\u00fd vagin\u00e1ln\u00ed porod, nebo abdominal delivery \u2013\u00a0 porod c\u00edsa\u0159sk\u00fdm \u0159ezem? Odpov\u011b\u010f nen\u00ed tak jednozna\u010dn\u00e1, jak by se na prvn\u00ed pohled zd\u00e1lo.<\/p>\n<p>Pro vagin\u00e1ln\u00ed porod hovo\u0159\u00ed n\u00e1sleduj\u00edc\u00ed argumenty. Jde o fyziologick\u00fd p\u0159\u00edrodn\u00ed d\u011bj,\u00a0 rekonvalescence \u0161estined\u011blky po n\u011bm je nepochybn\u011b rychlej\u0161\u00ed a m\u00e9n\u011b bolestiv\u00e1 ne\u017e po b\u0159i\u0161n\u00ed operaci. Je men\u0161\u00ed riziko tromboembolick\u00e9 nemoci, infekce i v\u011bt\u0161\u00ed krevn\u00ed ztr\u00e1ty. Nezanedbateln\u00fdm faktem je i absence viditeln\u00e9 jizvy v\u00a0podb\u0159i\u0161ku. Pro zdrav\u00e9 dono\u0161en\u00e9 d\u00edt\u011b je nav\u00edc p\u0159irozen\u00fd porod prosp\u011b\u0161n\u00fd. Pr\u016fchod porodn\u00edm kan\u00e1lem m\u00e1 p\u0159\u00edzniv\u00fd vliv na jeho imunitn\u00ed syst\u00e9m i dozr\u00e1n\u00ed plicn\u00ed tk\u00e1n\u011b.<\/p>\n<p>Na druh\u00e9 stran\u011b i porod pl\u00e1novan\u00fdm c\u00edsa\u0159sk\u00fdm \u0159ezem m\u00e1 sv\u00e9 v\u00fdhody. Porod lze napl\u00e1novat \u2013 obvykle na pracovn\u00ed den, kdy jsou rodi\u010dka, partner i porodn\u00edci optim\u00e1ln\u011b p\u0159ipraveni \u2013 person\u00e1ln\u011b i technicky.\u00a0 Je minimalizov\u00e1no \u00a0po\u0161kozen\u00ed d\u00edt\u011bte nespr\u00e1vn\u00fdm nal\u00e9h\u00e1n\u00edm a pr\u016fchodem porodn\u00edmi cestami. Co se t\u00fd\u010de rodi\u010dky, je ni\u017e\u0161\u00ed riziko\u00a0 poran\u011bn\u00ed\u00a0 zevn\u00edch rodidel, \u00a0prakticky vylou\u010deno po\u0161kozen\u00ed kone\u010dn\u00edku a an\u00e1ln\u00edho sv\u011bra\u010de. Siln\u00fdm \u00a0argumentem je taky obava z\u00a0 porodn\u00edch bolest\u00ed.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Jak\u00e1 je realita?<\/strong><\/p>\n<p>Jedn\u00edm z\u00a0faktor\u016f, pod\u00edlej\u00edc\u00edm se na n\u00e1r\u016fstu po\u010dtu c\u00edsa\u0159sk\u00fdch \u0159ez\u016f jsou sami l\u00e9ka\u0159i . Nen\u00ed tajemstv\u00edm, \u017ee v\u00edce ne\u017e polovina st\u00ed\u017enost\u00ed, \u017ealob a soudn\u00edch p\u0159\u00ed se t\u00fdk\u00e1\u00a0 oboru porodnictv\u00ed a gynekologie , nejvy\u0161\u0161\u00ed od\u0161kodn\u00e9 se vypl\u00e1c\u00ed a nejv\u00edce medializovan\u00e9 jsou kauzy pr\u00e1v\u011b z\u00a0porodnic.\u00a0 Je to snad t\u00edm, \u017ee v\u00a0oboru pracuj\u00ed\u00a0 ti nejhor\u0161\u00ed l\u00e9ka\u0159i?\u00a0 Nikoli. Modern\u00ed diagnostick\u00e9 a z\u00e1znamov\u00e9 p\u0159\u00edstroje neum\u011bj\u00ed zajistit stoprocentn\u011b bezpe\u010dn\u00fd porod, dok\u00e1\u017e\u00ed v\u0161ak zaznamenat sign\u00e1ly, kter\u00e9 \u0161ikovn\u00fd znalec um\u00ed ex post ozna\u010dit jako varov\u00e1n\u00ed, na jeho\u017e z\u00e1klad\u011b by zav\u010das proveden\u00fd c\u00edsa\u0159sk\u00fd \u0159ez mohl komplikaci p\u0159edej\u00edt. \u00a0Opatrn\u00fd porodn\u00edk tak rad\u011bji ukon\u010d\u00ed porod opera\u010dn\u011b, t\u0159eba\u017ee v\u00ed, \u017ee podobn\u00e9 sign\u00e1ly prov\u00e1zej\u00ed zhruba ka\u017ed\u00fd t\u0159et\u00ed fyziologick\u00fd porod.\u00a0 D\u016fsledkem\u00a0 t\u011bchto obav je nap\u0159\u00edklad i nepom\u011brn\u011b vy\u0161\u0161\u00ed po\u010det c\u00edsa\u0159 \u0159ez\u016f p\u0159i porodech VIP a celebrit. Nezanedbatelnou roli hraje odsouv\u00e1n\u00ed t\u011bhotenstv\u00ed do vy\u0161\u0161\u00edho v\u011bku \u017eeny a \u00a0\u00a0rostouc\u00ed po\u010det l\u00e9\u010den\u00fdch neplodnost\u00ed metodami asistovan\u00e9 reprodukce.\u00a0 M\u00f3dn\u00ed je i\u00a0 po\u017eadavek konkr\u00e9tn\u00edho porodn\u00edka u porodu. Ten je l\u00e9pe zajistiteln\u00fd u pl\u00e1novan\u00e9 operace ne\u017e v\u00a0p\u0159\u00edpad\u011b spont\u00e1nn\u00edho porodu\u00a0 v\u00a0ne\u010dekanou dobu.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Jak d\u00e1l?<\/strong><\/p>\n<p>Odborn\u00e1 ve\u0159ejnost je do jist\u00e9 m\u00edry polarizovan\u00e1. Odp\u016frci c\u00edsa\u0159sk\u00fdch \u0159ez\u016f na p\u0159\u00e1n\u00ed\u00a0 poukazuj\u00ed na vy\u0161\u0161\u00ed rizika operac\u00ed a stagnaci perinatologick\u00fdch ukazatel\u016f\u00a0 p\u0159i nar\u016fstaj\u00edc\u00edm po\u010dtu \u0159ez\u016f. Op\u00edraj\u00edce se o tyto data po\u017eaduj\u00ed p\u0159\u00edsn\u011b dodr\u017eovat medic\u00ednsk\u00e9 indikace k\u00a0opera\u010dn\u00edm porod\u016fm.\u00a0 Porodni\u010dt\u00ed liber\u00e1lov\u00e9 naopak zd\u016fraz\u0148uj\u00ed\u00a0 skute\u010dnost, \u017ee rodi\u010dky, odm\u00edtaj\u00edc\u00ed spont\u00e1nn\u00ed porod \u010dasto agravuj\u00ed sv\u00e9 pot\u00ed\u017ee tak d\u016fkladn\u011b, \u017ee si operaci v\u00a0pr\u016fb\u011bhu porodu vynut\u00ed. Ta je pak nepom\u011brn\u011b rizikov\u011bj\u0161\u00ed ne\u017e klidov\u00fd pl\u00e1novan\u00fd \u0159ez.<\/p>\n<p>S\u00e1m se hl\u00e1s\u00edm sp\u00ed\u0161 k\u00a0t\u00e9to druh\u00e9 skupin\u011b. P\u0159ipadne mi absurdn\u00ed, \u017ee \u017eeny si mohou nechat od\u0159ezat z\u00a0t\u011bla r\u016fzn\u00e9 tk\u00e1n\u011b, nechat vst\u0159\u00edknout jedovat\u00e9 toxiny, voperovat implant\u00e1ty, a to zcela svobodn\u011b. P\u0159itom m\u00e1lokter\u00fd takov\u00fd v\u00fdkon klientk\u00e1m a jejich zdrav\u00ed objektivn\u011b prosp\u00edv\u00e1 Sou\u010dasn\u011b \u00a0si \u017eeny \u00a0nemohou zvolit zp\u016fsob, jak p\u0159iv\u00e9st sv\u00e9 d\u00edt\u011b na sv\u011bt.\u00a0 Up\u0159\u00edmn\u011b jsem p\u0159esv\u011bd\u010den, \u017ee metodou volby\u00a0 je p\u0159irozen\u00fd porod a zdrav\u00fdm rodi\u010dk\u00e1m jej jednozna\u010dn\u011b doporu\u010duji. Obzvl\u00e1\u0161\u0165, pl\u00e1nuje-li \u017eena v\u00edce d\u011bt\u00ed, m\u011bla by preferovat spont\u00e1nn\u00ed porod. Stejn\u011b tak je t\u0159eba si uv\u011bdomit, \u017ee b\u0159i\u0161n\u00ed operace m\u016f\u017ee m\u011bnit anatomick\u00e9 pom\u011bry v p\u00e1nvi a komplikovat v\u00a0budoucnosti gynekologick\u00e9 i chirurgick\u00e9 v\u00fdkony. Pokud v\u0161ak dostate\u010dn\u011b pou\u010den\u00e1 rodi\u010dka spont\u00e1nn\u00ed porod odm\u00edt\u00e1 a po\u017eaduje opera\u010dn\u00ed, m\u011bla by, podle m\u00e9ho, m\u00edt mo\u017enost volby.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><em>Literatura<\/em><\/p>\n<p><em>Kolektiv autor\u016f: Stolet\u00e9 \u00fasil\u00ed o zrozen\u00ed nov\u00e9ho \u017eivota<\/em><\/p>\n<p><em>K\u00daNZ Brno, 1988<\/em><\/p>\n<p><em>\u00a0<\/em><\/p>\n<ol>\n<li><em>Dole\u017eal: Technika porodnick\u00fdch operac\u00ed<\/em><\/li>\n<\/ol>\n<p><em>Grada Publishing\u00a0 1998<\/em><\/p>\n<p><em>\u00a0<\/em><\/p>\n<p><em>Modern\u00ed gynekologie a porodnictv\u00ed<\/em><\/p>\n<p><em>Vol. 17 \u010d. 1, b\u0159ezen 2008<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>MUDr. Milo\u0161 Vyslou\u017eil, Prim\u00e1\u0159 por,. gyn. odd. \u0160umpersk\u00e1 nemocnice, a.s. Souhrn: C\u00edsa\u0159sk\u00fd \u0159ez, nejstar\u0161\u00ed a a dnes z\u0159ejm\u011b nej\u010dast\u011bji prov\u00e1d\u011bn\u00e1 operace v\u016fbec pro\u0161el historick\u00fdm v\u00fdvojem. Od v\u00fdkonu, umo\u017e\u0148uj\u00edc\u00edho poh\u0159b\u00edt nenarozen\u00e9 d\u00edt\u011b zem\u0159el\u00e9 matky, p\u0159es operaci zachra\u0148uj\u00edc\u00ed \u017eivot matce a posl\u00e9ze d\u00edt\u011bti a\u017e po jistou alternativu p\u0159irozen\u00e9ho vagin\u00e1ln\u00edho porodu. N\u00e1zory ve\u0159ejnosti, i odborn\u00e9, na c\u00edsa\u0159sk\u00fd \u0159ez [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":907,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[2],"tags":[],"_links":{"self":[{"href":"https:\/\/sumperkgynekolog.cz\/index.php?rest_route=\/wp\/v2\/posts\/866"}],"collection":[{"href":"https:\/\/sumperkgynekolog.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sumperkgynekolog.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sumperkgynekolog.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sumperkgynekolog.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=866"}],"version-history":[{"count":2,"href":"https:\/\/sumperkgynekolog.cz\/index.php?rest_route=\/wp\/v2\/posts\/866\/revisions"}],"predecessor-version":[{"id":911,"href":"https:\/\/sumperkgynekolog.cz\/index.php?rest_route=\/wp\/v2\/posts\/866\/revisions\/911"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sumperkgynekolog.cz\/index.php?rest_route=\/wp\/v2\/media\/907"}],"wp:attachment":[{"href":"https:\/\/sumperkgynekolog.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=866"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sumperkgynekolog.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=866"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sumperkgynekolog.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=866"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}