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The aim of this study is to asses the blood loss in third period of labor according the method of its prophylactic. The material consist of 144 prospective and 192 retrospective cases. The blood loss is assessed visually and after that it is weighted. Up to the delivery of placenta the visually assessed blood loss is insignificantly greater than the weighted one. All cases are subdivided in three groups according the management of third period: -with methergin, with oxytocin and without uterostonic. The blood loss associated with the separation and delivery of the placenta is not different in the groups, but the early postpartum haemorrhage is significantly greater in the cases without uterostonics for the delivery of placenta. In premature labors the blood loss associated with the separation of placenta is significantly greater that in term labor.

On the base of 192 retrospective and 144 prospective cases are evaluated the side of routine prophylactic of the blood loss at the third period of labor. The control group consist of 50 labouring women with expective management of placental period. In normotensive women the methergine does not increase the blood pressure. The use of oxytocic drugs after the delivery of the head shorten the time of placental separation but make more difficult the cord traction method for the delivery of the placenta. The active management of the placental period decrease the rate of instrumental revision of the uterine cavity and the supplemental administration of oxytocic in the early postpartum period. This investigation confirms and justify the routine use of oxytocic after the delivery of the head as a prophylactic of the blood loss in the placental period.

During the period of January 1993 to February 1994, 70 pregnant women had an ultrasonic diagnosis of abnormal pregnancy. 111 ultrasound examinations were made--mean 1.6 of each woman. The ultrasonic diagnosis up to 70 women was: missed abortion--35 women (50%), blighted ovum--30 women (42.9%), other diagnosis--5 women (7.1%). Histological examination of material was made with 64 women (91.4%). Comparing the ultrasonic diagnosis to histological results, authors do not recommend a final diagnosis before eight gestation week.

The authors describe one case of quadruplet pregnancy create difficulties in diagnosis and conclude with unfavourable outcome. One of fetuses have hydrops foetus generalisatus, another foetus is malformative and the rest two fetuses are normal anatomy. Multifetal pregnancies require very early and exactly diagnosis and make up behaviour with goal is favour able outcome. In the end the authors recommended this cases must be turn to hospitals which are better possibilities for antenatal and intensive neonatal care.

In a retrospective study of 363 pregnancies with one foetus in breech presentation is evaluated the effect of foetal maturity and the route of delivery on the state of the newborn, assessed by the 5 min. Apgar score. The cases are allocated in subgroups according the foetal weight and height, gestational week and the route of delivery. The results show 37% small for gestational age in the subgroup with low birth weight (1500-2500 g). From the group with low weight SGA sustain better the labor and delivery than the eutrophic. The term newborn in breech presentation are with higher Apgar score than delivered by cesarean section. In the group of newborn with low weight the route of delivery has not effect on the Apgar score. The estimated weight and gestational week should be taken in account than managing breech labor.

The influence of woman's age on pregnancy outcome and delivery of 362 cases of pregnancies in breech presentation was studied retrospectively. The cases are distributed in 6 interval groups of 5 years each and are compared to the data of vertex presentation. The rate of antedated and pregnancy induced diseases are the same in breech and vertex presentation and do not depend on the type of presentation. There is an increase of premature breech deliveries with the decrease of woman's age. The frequency of Cesarean sections is increased with the woman's age, especially after the thirties. The ruptures of the soft birth canal and the need of oxytocin stimulation are increases with woman's age. In case of selected and successive breech labor the state of the newborn does not depend on the woman's age.

It is the purpose of this study to document the variegated appearance of endometriosis at laparoscopy, and select suitable cases indicated for microsurgery. Three-hundred and four patients undergo diagnostic laparoscopy between January 1991 and June 1992. Endometriosis diagnosed during laparoscopy is staged according to the classification of the American Fertility Society. Findings are established as follows: endometriosis--203 patients (66.77 per cent), adhesions without endometriosis--57 (18.75 per cent), Fitz-Hugh-Curtis syndrome--23 (7.56 per cent), leiomyomata--10 (3.28 per cent), ectopic pregnancy--3 (0.98 per cent). In eight women (2.63 per cent) there no peritoneal changes. Peritoneal endometriosis is characterized by the following morphological patterns: peritoneal pockets--38 patients (18.62 per cent), clear vesicles--26 (12.74 per cent), scarred white lesions--24 (11.76 per cent), raised red lesions--21 (10.29 per cent), flat red lesions--21 (10.29 per cent), black-purple lesions--20 (9.3 per cent), polypoid red lesions--10 (4.9 per cent), scarred black lesions--6 (2.44 per cent), and yellow-brown patches--4 (1.96 per cent).

Presented are the results of a 2-year prospective study in patients with no other causes than endometriosis proved by laparoscopy between Jan. 1991 and June 1992. Fifty five patients completed 6-9 months of therapy of Orgametril alone and 15 women were pregnant (27.27%). Forty one patients had electro surgery of endometriosis by the time of laparoscopy and 21 patients of them received Orgametril. After electro surgery alone 5 women were pregnant (25%) and of 21 women with complex therapy 10 were pregnant (47.6%). Control group of 79 patients without therapy had pregnancy rates for 6 patients (7.59%). No differences were observed between three groups of patients with treatment. Pregnancy rates were statistically lower in group without therapy. This study reported conception rates for 18 months after laparoscopy.

The high frequency of the female endocrine sterility and the favorable therapy results are showing categorically the importance of the endocrine sterility as a medical and a social problem. For the period 1990-1993 in Third Gynaecological clinic--Sector of Gynaecological Endocrinology, were observed 584 patients with proved endocrine sterility. The present research has the goal to discuss the frequency of the different clinical forms of the endocrine sterility. The most frequent one is PCO--30.59%, followed by corpus luteum insufficiency--23.58%, and hyperprolactinaemia--20.05%. The results are interpreted on the basis of similar research for the period 1976-1985 with analog contingent. Conclusions are made for the essential directions of the diagnostic and therapy process in the clinic.

The performed clinic-statistical investigation has covered generally 2182 patients, 946 patients of common group make use of intrauterine contraceptive pessaries and 1236 patients have been included on the other occasion. Generally 14 832 menstrual cycles were followed up. There were used multivariational method and analysis for investigation of three and more risk factors at once. The essential connection between the presence of intrauterine pessary and increased risk of sharply inflammation of the genital apparatus had been established. The uterus was the most often affected--endometritis in sharp and chronic from in 31.39% of cases, and in 3 cases pelvioperitonitis was diagnosed. The appearance of genitals inflammation under the pessary presence is connected also with the age, parity, the application time and the pessary use.

The authors do clinic-laboratory investigation of the affect of four hormonal contraceptive preparations: Minisston, Gravistat 125, Rigevidon, Anteovin, on 179 patients in reproductive age for the period of 895 menstrual cycles. The investigation is specified with respect of investigation of 10 clinic indexes, which are considered as side effects in the reception of hormonal contraception, as well as with respect to reconstruction of ovary function after reception breaking in first, second and third month. The received results demonstrate high effectiveness of the experimented preparations with respect to pregnancy prevention, good acceptance - the appearance of side effects is under the accidentally error limit, as well as good reproductive ability of ovaries after tablet reception breaking. Especially to Anteovin preparation the authors accept that it is with minimum side effects. They considered that this is due to increasing dose of gestagen during the second phase of the menstrual cycle, which appears stabilizing factor with respect to the good acceptance of the preparation without difference in age and fertile realization of the investigated patients.

By means of the serum level of estradiol and the vaginal smear indexes the antigonadotropic activity of the preparation Danoval (2-3-isoxasol-17-ethinyltestosterone) is indirectly evaluated on 15 infertility patients with laparoscopic proved endometriosis. After 5 month's course of treatment with 400 mg daily the level of estradiol decreased from 1.54 to 0.31 nmol/l, IA from 20.8 to 10.4 and IP from 32 to 17.3. The side effects are slight and descend from the pharmacological properties of the preparation. Two patients became pregnant in three months after the treatment.

Fifty-two of 304 infertile women were surgically treated by the time of diagnostic laparoscopy. Table 1 represents surgical treatment via laparoscopy. Forty-one (78.84%) patients had electrosurgery or laser surgery of endometriosis. Salpingo-ovariolysis was performed in 6 patients (11.53%). Salpingostomy was performed in 2 patients. Fimbrioplasty was performed by incising the peritoneal band surrounding the terminal end of the fallopian tube in 2 patients. Bleeding of vascular adhesions was followed by electrocautery. No patient required laparotomy for control of bleeding. In two patients (3.84%) with ectopic pregnancy had light arterial bleeding along the salpingostomy incision and was controlled by bipolar cautery. In three patients (5.76%) cysts up to 7 cm in diameter were treated. The capsule were dissected and removed how possible. Any residual capsule was vaporized.

The authors perform diagnostic-operative pelvioscopy on 32 patients with primary and secondary amenorrhea--87.5% and 12.5% respectfully. The follow-up included a comparison of the results from the gynaecologic examination, ultrasound evaluation of the ovaries, sex chromatin and histologic results from the gonadal biopsy material. No ovarian structures were scanned in 28.13% of the cases. In 15.63% of the cases 46XY karyotype was diagnosed and in 4 other cases--46 X iso Xq. The histologic results from ovarian biopsy are as follow: in 37.5% only primordial follicles, in 18.75%-fibrous tissue and in 6.25%-presence of testicular tissue. From the analysis of the results the authors conclude that pelvioscopy combined with gonadal biopsy in cases a distinct place in the diagnostic plan of evaluation.

The authors carried out studies retrospectively on 57 women, who became pregnant in insemination with donor frozen spermatozoa. Ovulation problems and luteal insufficiency were diagnosed in advance and treated before and during the occurring cycles. Women were divided into two groups. The first group of 25 women were examined by ultrasound transvaginal transducer for follow-up of follicle growth in the ovaries in addition to measurement of body temperature and determination of the cervical factor. The second group of 32 women, in whom follicle-metry was not performed. The frequency of conception was 0.24 in the first group, but 0.26 in the second group. It is concluded that inspite of the significance of follicle-metry for determination of ovulation the traditional methods are still valid criteria for ovulation and can be used as independent methods for determination of the time for insemination with therapeutic donor frozen spermatozoa.

The study was carried out on 40 women, admitted to the clinic for diagnostic laparoscopy. The mean age of the patients was 28.57 years. Duration of sterility was 5.7 years as 27 women suffered from primary sterility and 13 women-with secondary. Ultrasound diagnosis was made on all women before laparoscopy. The exactness of ultrasound diagnosis (USD) was 80.51% of women. Preovulatory follicles and polycystic disease of the ovaries was established by USD in 100% of women. High sensitivity of the method was achieved in women with leiomyomas and ovarian cysts. Discrepancy in the diagnosis was found in the following cases: a myoma was hyper-diagnosis, a hydrosalpinx was diagnosed as a cyst; a tubo-ovarian formation was found to be hydrosalpinx and vice versa; two hydrosalpinx women with diagnosed hydrosalpinx had tubo-ovarian formations. A hydrosalpinx was not diagnosed. USD was found to be almost non-valid in comparison of the two methods for diagnosis of endometriosis.

The authors discuss the results from roentgenological (cervical hysterography) examination of the uterine cavity, aiming to confirm the results from the treatment of intrauterine synechiae. It was established that there were no roentgenological data for synechiae after the conducted treatment in 73.9% of the examined hysterograms. The treatment had no substantial effect only in 8.7% of women as synechiae remained unchanged. Very good results were obtained after usage of the intrauterine contraceptive devices--Super Dana and Lippes, possessing volumetric and stretching form in respect to the uterine cavity. The authors conclude that the hysterography is exact diagnostic method for confirming the effect of treatment of synechiae in the uterine cavity with suitable intrauterine loops.

The results from a hysterographic study on women with bicornuate uterus are discussed. It is established that its frequency is 2.2% of 1623 performed hysterosalpingographies. A detailed analysis is made on the form and dimensions of the cornua [correction of corns], total isthmic part and cervical canal. Some metric parameters (height and width, sizes of the isthmus the an angle between the corns) are given with the purpose of greater precision of roentgenological interpretation.

Antithrombin III is one of the most important inhibitors of serine proteases of coagulation and fibrinolysis. It inhibits the activity of thrombin and factor X. Its congenital or acquired reduction leads to an increased risk of thrombosis. In their study the authors aimed to investigate the influence of oral contraceptive preparations--Gravistat and Nonovolan on the activity of antithrombin III. Thirty five women, receiving these drugs for a period of one month to ten years (on the average two and a half years were examined. All women received the drugs in accordance with the physician prescription, taking into consideration the lack of history data on increased frequency of thrombosis. Part of the examined group (the first ten on the table of the results) were smokers with mean usage of 15 cigarettes per day. The study was carried out on 25 women at the three stages of the hormonal cycle, but singly on the remaining 10 women in its beginning. Blood sample for examination was taken with anticoagulant (citrate) in the morning before breakfast and the activity of the inhibitor was determined by kinetic colorimetric method and chromatogenic Chromasin TN (a modification of Kamenov). The results were presented in percentages. The mean activity of antithrombin III was: means = 107.5%, which did not differ from the reference values. The activities at the three phases of the menstrual cycle did not differ significantly (p greater than 0.05). The results, obtained from the study, proved that hormonal contraceptive drugs did not reduce the activity of antithrombin III.

The author examined 153 women, using the intrauterine contraceptive device Copper T, and 120 women, using the intrauterine contraceptive device Nova T. 10.3% of all observed women are nonparous, the mean number of born children is 1.1% and the relative number of abortions is 2.9 in the group of parous women. The occurrence of side effects are registered by dispensary observation twice during the first year and once during the following period. The degree of conception in both groups is low below the accepted ranges. The same is also referred for the monthly risk of expulsion of the loop. The intramenstrual inflammatory and painful parameters are increased 1.5-2.1 times in comparison with women, using the intrauterine device Nova T. Menstrual bleedings in both groups of women is prolonged with 1.3 days on the average. There are no pathological complications during the whole period of observation.

Analyzing the findings in diagnostic laparoscopy the authors describe in details and interpret the results from the examined organs in the pelvis and abdominal cavity. Object of the study are 200 sterile women, admitted to the clinic of Sterility and Gynecological Endocrinology of Research Institute of Obstetrics and Gynecology for examination. The mean age of the patients is 29 years as 128 of the women suffer from primary sterility, but 72--from secondary sterility. The results are summarized and interpreted in 5 groups. Uterine body--form, size, motility, measurements, adhesions, fibrillary apparatus, patency; Ovaries--form, size, position, motility, surface, follicles; Adhesions--type, dimensions, vascularization, position (in the pelvis and abdominal cavity); Data for endometriosis--presence, size and localization of endometriomas, endometriotic cysts and outgrowths, an increased vascular line. The inference, which the authors make, is that laparoscopy is basic (and necessary) current diagnostic method for obtaining real notion for the state of internal genital organs (especially for tubal factor in female sterility) and furthermore also for evaluation of the necessity and possibility for performance of microsurgical reproductive operations.

The authors studied ultrastructural changes in the endometrium of 25 women, using intrauterine contraceptive devices, preventing conception, during various time limits. The material of the endometrial biopsy was fixed with glutar and osmium in a phosphate buffer and embedded in durcopan. Section were prepared by a microtome and observed under electron microscope of Hitachi type. Comparing the parameters duration of usage of loops and character of changes in the endometrium an impression was obtained that the usage of contraceptive intrauterine devices for one-year period did not induced changes of pathological character. Functional changes in the endometrium occurred after a two-year stay of the loop in the uterus as there were inflammatory changes of spot-like character in two of the sections. Local areas of inflammation of nonspecific character, manifested under the form of lymphocytes and leucocyte accumulation, were found in women with long usage of contraceptive intrauterine devices. The authors advise to remove the loop 2.5-3 years after its application and to wait for the complete regeneration of the endometrium.

Two cases are described, illustrating two varieties of comparatively little known, but not rarely encountered syndrome--the syndrome of Herlyn-Werner-Wunderlich. The characteristic and the symptoms of the syndrome are presented and various concepts on therapeutic management are discussed. The question about future fertile capability of the patients is discussed as well.

The authors analysed results from a hysterosalpingographic study on 58 women with primary sterility, on whom wedge resection of the ovaries was performed in the past. It was established that changes in the uterine tubes were found in more than 1/3 of the examined women and consisted mainly of periampullary adhesions as the two tubes were involved usually. On the basis of the obtained results an inference is made that the usage of resection of ovaries for treatment of some forms of female sterility should be applied only in cases, when conservative methods for treatment are completely inefficient.

Using hysterosalpingography an attempt was made to classify the changes occurring in the uterine tubes of 114 women with primary sterility, undergone appendectomy in the past. It was established that changes in the tubes presented various character and included 2/5 of the material. There was direct dependence between appendectomy with complications and the gravity of the tubal factor.

The authors examined 39 women with sterility varying in time. Their ovaries were follow-up during 68 menstrual cycles. Linear growth of the follicle, which detached the egg cell, was established. The size of the follicle varied between 15.4-21.4 mm during the separation of the egg cell. The follicles remained static in anovulation, after which they became regressive or formed follicular cyst with various measures.