Search

The results of phytoestrogen drug SoyaVital on the climacteric symptoms are presented. The preparation consists of 35 mg isoflavones with high content of genistein in one capsule. A group of 26 patients having climacteric symptoms have been treated by one capsule per day for a period of 12 weeks. The evaluation of the symptoms by Kuppermann score decreased statistically significant by 30.06%. The authors recommend SoyaVital as an alternative to the hormonal replacement therapy.

The purpose of this study is to define the time for different steps of Caesarean section from the moment the women lays on the operating table to the last stitch on the skin. The study is prospective and include 82 elective and emergent CS. The traditional surgical technique is used without omitting any step. The mean stay of the women in the operating theater is 90 min. The preparation for the anesthesia/analgesia is 23 min (range 8-41). The proper time of the operation is 44.3 min. The laparotomy by Pannenstiel incision takes 3 min. The opening time of the uterus is 37 sec (10-190) and the closer on two layers is 17 min (10-35). The extraction of the foetus takes 53 sec (15-180). The exteriorization of the uterus doesn't affect the repair time. Leaving the visceral and parietal peritoneum unsutured can spare 5.5 min. The elective CS takes more time than the emergent one. The time from the beginning of the operation to the extraction of the foetus is longer in resection (7 min) than in first CS (5 min).

The purpose of this prospective study is to assess the possibility of myomectomy during CS as a routine method. The material includes 21 cases of myomectomy during CS. 162 consecutive CS without myomectomy are control group for hemorrhage during the operation. The myomectomy is accomplish according classical technique. Our data show that the myomas and pregnancy is found mainly in women after 30 years of age and is prevalent in nulliparas (70%). Single myomas were found in 85% of cases, 63% located in the corpus uteri and 46% of all myomas are confined to the myometrium. Related to the isthmus uteri are 23% of myomas. Myomectomy as a separate operation during CS increases the hemorrhage by 10%. The analysis of the cases with severe hemorrhage point to the placental disorders (abruptio placentae and placenta praevia) as a main cause of overall increased blood lost. Our limited experience with myomectomy as a protocol during CS irrespective of number and magnitude of myomas shows that this is possible. The postoperative period is without complications.

The purpose of this prospective work is to communicate the experience with preinduction treatment with Folly's catheter on the Pelvic score (Ps), labor and neonatal outcome in 52 cases in 27 to 34 wg, preterm premature labor and unfavourable cervix. The first control group consist of 24 pregnancies with the same characteristics but with favourable cervix at the begging of labor induction and the second control group include 31 cases with spontaneous premature labor. The Folly's catheter is introduced through the cervical canal and the bulb inflated with 75 ml of sterile normal saline. After the Foley's catheter dropped out the Ps is reassessed and proceed with oxytocin infusion. In the first control group with favourable cervix the induction of labor is only with oxytocin via infusion pump. More than half of all patients are treated with with tocolysis. The results show that for the period of tocolysis and/or PPROM there is significant improvement of the Ps (from 0.90 +/- 0.9 to 2.35 +/- 1.5). The change in the Ps doesn't depend on the g.w., the length of tocolysis or on the initial Ps. The balloon catheter improve the Ps from 2.35 +/- 1.5 to 6.24 +/- 1.3 for y period of 3 h 20 min (2 h 40 min to 4 h, 95% confidence). After the Foley catheter dropped out the duration of labor with oxytocin infusion is 6 h (5 to 7 h, 95% confidence) and is not different from this in the control groups. The time for the catheter to drop out, the achieved Ps and especially the effacement of the cervix are essential features in the prognosis of the difficulties in the labor process and the neonate state.

In the first part of publication the authors make a profound review of history of development and qualities of Intra Uterine Devices/IUD's/. There are reflected the first steps dated from the ancient times to come to modern IUD's (Multiload, Copper T. Slimline). In Table 1 and 2 (on W.A.A. van Os) are represented single cases (pregnancy, expulsion and extracted IUD's) related to the modern intrauterine devices: MLCu 250 and MLCu 375 for the periods of 1, 3 and 5 years. In the second part the authors represent their scientific and practical results which has been obtained at the Bulgarian Family Planning and Sexual Health Association and the Ob./Gyn. Department of Medical University-Sofia. A retrospective research has been conducted on 406 women who delivered between 18 and 42 years of age and to which MLCu 375 have been inserted. The so analyzed and presented results show very good qualities of MLCu 375 IUD. The cases' frequency corresponds to the one announced by the world leading practice of contraception.

The aim is to analyze the accepted indications for episiotomy in nowadays practice. The investigations is retrospective for the period from April to May 1996. The material includes 459 term singleton pregnancy in vertex presentation and 46 cases of premature neonates with weight from 1300 to 1499 g. The results show high risk (77.1%) of episiotomy in nulliparous women. The multiparity, the length of second period and the high risk pregnancies have not effect on the use of episiotomy. The wight of the fetus is essential factor. The highest rate of episiotomy is at premature births (65.2%) followed by the group of neonates with weight over 4000 g (61.5%). The lowest rist of episiotomy is then the weight of newborn is between 2500 and 3800 g (21.8%). Almost hundred percent rate of episiotomy in operative vaginal and breech deliveries show that we accept the episiotomy as obligatory of these vaginal deliveries.

The purpose is to asses the effect of restrictive use of mediolateral episiotomy on the spontaneous laceration of the low birth canal. The material includes 613 labors some of which gave birth with indication for episiotomy and control group of 441 retrospective cases with routine management of the second period of labor. The restrictive use of episiotomy decreases the rate from 45.6% in the routine practice to 32.8%. The reduced rate of episiotomy has as a consequent increase rate of second degree perineal laceration adn insignificant increase of vaginal lacerations. The management of restrictive and liberal use of mediolateral episiotomy has not effect on third and four degree perineal laceration, on the accessory tears of the vagina and on the rate of perineotomy. If from all labors are subtracted operative deliveries, surgical intervention for repairing the laceration of the birth canal and pathology of the placental period the rate of labors without any intervention is only 13.3%. Our results suggest that labor nowadays is operative activity.