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Aim: To assess the feasibility of Nutri-mag as an oral tocolytic for the treatment of preterm labor., Methods: 36 pregnant women in preterm labour participated in a prospective divided upon gestational age, number pregnancy, other therapy., Conclusion: Oral Nutri-mag--effective oral tocolytic in the management of preterm labor.

Premenstrual syndrome is a collection of physical, psychological and emotional symptoms related to a woman's menstrual cycle in the second phase. It have been described various symptoms occurring regularly during last week prior to menses. It have been observed in women with normal ovarian function. The exact causes of PMS are not fully understood. Many treatments have been suggested for PMS. Femifort is food supplement, containing vitamins and phytoproducts and has positive influence in PMS.

Unlabelled: The aim of the study is following up the pregnancy and delivery in women with cerebrospinal fluid shunts for hydrocephalus., Material and Methods: The study includes 12 pregnant women (9 nuliparous and 3 multiparous) ranging in age from 19 to 36 years which were initially shunted prior to the pregnancy. 9 of the patients had VP shunts and 3 with VA shunt. They were followed up for evolution of the pregnancy, the state of the shunts and the method of delivery., Results: It was found that the cerebrospinal fluid shunts does not affect the pregnancy outcome. Women with revision of the shunt during the pregnancy were not included in this study. We had 1 case of spontaneous abortion in 26 gestational week and two cases of preterm vaginal delivery. The other included in the study patients have live term births- 5 with vaginal delivery and 4 with caesarean sections. Spinal and epidural analgesia and general anesthesia was performed. Only in one case was performed revision and substitution of the shunt 6 weeks after the delivery due to obturation of the distal part of the shunt., Discussion: Presence of cerebral shunt does not affect essentially the pregnancy development. The vaginal delivery in women with cerebrospinal fluid shunts can be provide successfully with analgesic medicines that does not increase the intracranial pressure. The caesarean section should be performed by obstetrical indications and in cases with increased intracranial pressure.

Sacrococcygeal teratoma (SCT) is the most frequent solid congenital tumor in the fetus and newborn. We present a case report of prenatally detected SCT with a favorable outcome after vaginal birth complicated by mechanic dystocia.

Struma ovarii was first described in 1899 and is extremely rare, with only 150 reported cases in the medical literature. Struma ovarii is most common between the ages of 40 and 60 years. Women with struma ovarii usually present with a pelvic mass or, less frequently, with hyperthyroidism or ascites. As in follicular tumors of the thyroid gland, the thyroid epithelium in the teratoma may be organized in a solid, embryonal or pseudotubular pattern, rather than thyroid follicles. The authors present an extremely rare case of struma ovarii in 14-year-old girl.

Unlabelled: The diagnosis of male infertility is determinate after assessment of sperm quality and clinical study. In nearly 30% of the cases nevertheless detailed clinical and laboratory study it can't be discovered the cause and on the bases of exclusion criteria set the diagnosis idiopathic infertility. The object of our study was investigation of the group patients (n=50) with idiopathic infertility treated with Prelox and to be studied its effects on spermatozoa parameters., Material and Methods: The study design was double-blind, placebo-controlled, cross-over, randomized study, including introduction period (1 month), two therapeutic periods (each one of 1 month) separated with 1 month wash out period and concluding period of 1 month. There was applied a new method for treatment with mechanism of action stimulation the production cGMP of spermatozoa endothelial nitric oxide synthase (eNOS). This is not surprising achieving results show improvement of sperm quality. The methods of the study were: 1. Assessment of the conventional semen analysis (according the criteria of WHO, 1999). 2. Spermatozoa function tests. 3. Spermatozoa-cervical mucus penetration tests., Results: The obtained results showed improvement of sperm quality, in the middle-aged men the therapeutic answers was better than in younger. In conclusion the therapy with Prelox improve sperm parameters in men with idiopathic infertility. Pycnogenol (one of the constituents of Prelox) has powerful antioxidative influence ameliorating spermatozoa function.

The present study includes 50 infertile couples followed sperm parameters: morphology and others indices for ability of penetration in ovulatory cervical mucus during 12 months. It is discussed the possibility of which spermatozoa can participate in the fertilization and the impotence and place of the female genital tract for the selection of morphologically abnormal spermatozoa before reaching the place of fertilization.

Its etiology remains uncertain, its pathogenesis disputed and its treatment poor. Most medical treatment is based on ovulation suppression and inducing amenorrhoea. New findings on the genetics, the possible roles of the environment and the immune system, intrinsic abnormalities in the endometrium and secreted products of endometriotic lesions have given explanation into the pathogenesis of this disorder and give us new trends for treatment the disease.

Objective: To determinate the effectiveness of treatment with gonadotrophine releasing hormone agonist., Methods: We investigated 164 patients with laparoscopy divided in two groups. Women in first group received Dipherelin 3. 75 mg /lpsen/ for 3 months. Second group had received Dipherelin 3.75 mg for 6 months. Preparation was done i.m. every 28 days. All patients in the study had endometriosis grade I-II using the AFS classification after laparoscopy. The measures according to compare in the 2 groups was as following: 1. Dysmenorhoea, dyspareunia and pelvic pain before and after treatment. 2. Rate of pregnancy. 3. Bleeding during the treatment. 4. Amenorhoea after treatment., Conclusions: After analysis of the patients in the 2 groups we decided that Dipherelin 3.75 mg is an effective treatment of sterility related to endometriosis.

The authors attempted with this trial to confirm the necessity of periabortal antibiotic prophylaxis after spontaneous and induced abortion. The trial included 172 patients with abortion; 53 of them with induced abortion and 119 with spontaneous abortion. The term of gestation was between 5 and 22 week. Three therapeutic groups were compared to a control no-treatment group. The first group was given Ampicillin orally 4 x 500 mg for 5 consecutive days. The second group was administered a combination of Ampicillin orally 4 x 500 mg plus Gentamycin 2 x 80 mg i.m. for 3 to 5 days postoperatively. The third group was given 3 x 2 g i.v. Cefazolin intraoperatively and 24 hours following the manipulation. The trial aimed at establishing the efficiency and cost-effectiveness of the antibiotic prophylaxis. The results tend to prove the perioperative prophylaxis with Cefazolin is preferable since it is most efficient and cost-effective.

The authors discuss the treatment with Azatril for Chlamydia trachomatis infection in patients with tubar sterility. The study includes 85 women, treated for three months. The authors achieved 57.6% negativation of the results that gives a reason to propose the use of Azatril (Balkanpharma) in the treatment of Chlamydial infection.

A clinical trial is conducted with 32 pregnant patients with a history of sterility and infertility, uterine malformations as well as progesterone deficiency. The mean week of gestation is 9-10. All patients were treated with Utrogestan in the usual doses 2 x 100 mg for vaginal application. No side effects were observed which is encouraging to its routine use.

A rare case of successful pregnancy and delivery of a patient with Hereditary angioedema is described. The complications of the disease during pregnancy are described as well as the possibilities for their prevention. The delivery was accomplished without complications and the preoperative preparations are listed. The treatment of HAE in general is divided into two groups: short-term (Fresh frozen plasma) and long-term prophylaxis (antifibrinolytic agents, androgen therapy) and acute treatment (epinephrine, steroids, antihistamines, eventually tracheotomy).

Candidiasis of the lower female genital tract during pregnancy is a leading cause for seeking medical help. During pregnancy candidiasis is encountered about 30% more often compared to non-pregnant (by the time of delivery about 18-22% of the pregnant women would have the infection). It is clinically manifested especially after 36 w.g. This might be the cause of a series of pregnancy complications. Most serious are considered prematurity, chorioamnionitis, descending infection from mother to the newborn during delivery. Significantly less attention has been paid to the birth canal injury and its higher rate if a Candida colpitis is present at the time of delivery.

Unlabelled: In climacteric women with contraindications and fear or lack of compliance for taking hormonal replacement therapy as well as in those cases where risks exceed benefits, the use of phytoestrogens is appropriate having in mind their especially good effect on neurovegetative symptoms., Aim: The present randomized prospective study is aimed at estimating the possibility for ameliorating climacteric symptoms with Melbrosia and at assessment of its effect on different symptoms in order to individualize the therapeutical approach., Patients and Methods: Two groups of women with climacteric complaints were followed-up--control group (n = 32) and treatment group (n = 34). Climateric symptoms were assessed in the beginning and at the end of the study using Kupperman menopausal index. The levels of FSH, LH, oestradiol as well as some parameters of lipid metabolism were determined., Results: A significant decrease of Kupperman index was observed in Melbrosia treatment group in contrast to the control group. No significant changes in gonadotropins, oestradiol and lipid parameters were found in both groups., Conclusion: The preparation Melbrosia, consisting of phytoestrogens and amino acids exerts a good therapeutic effect on climacteric symptoms mainly on the nervousness, anxiety, irritability, headache, and hot flashes.

A case of pregnancy, malformation of the foetus--Spina bifida, and hydatidosis hepatis is discussed. The patient is 19-year old, primigravida, pregnant in the 31st gestational week who was admitted to the ward with an observation of Hydrocephalia and fetal compromise (low beat-to-beat variability and lack of accelerations of the fetal heart rate). Un ultrasound scan of the foetus proved hydrocephalia and Spina bifida in the lumbal segment of the fetal spine. Un extended ultrasound scan proved a hydatid cyst of the liver with a 10 mm diameter, corresponding with the data of the serological tests--RAHA 1:400.

A case of a multiple pregnancy in each of the horns of a double uterus with a double cervix and a vaginal septum is discussed. The uterine malformation was known prior to pregnancy. In 34 g. w. a Ceasarean section was performed because of premature rupture of membranes. Two premature infants were born with no evidence of present pathology.

The use of nonhormonal drugs in order to ameliorate climacteric symptoms makes it possible to treat also those women in whom there are some contraindications or lack of compliance for taking hormonal replacement therapy. The drugs with complex effects on the whole body functions are more widely used recently. The aim of the present study is to assess the therapeutic effect of Cavinton (vinpocetin) on the degree of climacteric symptoms and to verify its complex beneficial influence. The study comprises of three groups of women in early menopause--control group (n = 30), treatment groups with normolipidaemia (n = 32) and with hyperlipidaemia (n = 29). All women presented with moderately expressed climacteric symptoms as assessed by Kupperman menopausal index and Hamilton-Anxiety-Skala (HAMA). The women in the 2nd and 3rd groups have been taking Cavinton in an oral dose of 5 mg three times daily for 3 months. The following parameters of lipid metabolism were determined in the beginning and at the end of the study: total, HDL- and LDL-cholesterol, triglycerides, and two indexes of lipid atherogenic risk--total/HDL-cholesterol ratio and atherogenic index (AI) = total--HDL/LDL-cholesterol. The menopausal complaints were assessed by Kupperman index and HAMA. Blood vessels reactivity was determined by pulsation index (PI). Statistically significant decrease in total cholesterol and LDL-cholesterol levels as well as amelioration of atherogenic indexes was observed in the 3rd group. Kupperman index and HAMA decreased significantly on the 45th day and the 3rd month in the women under treatment. No significant changes in PI were observed but a tendency towards a decrease was seen in the 3rd group. Our data suggest that Cavinton possesses complex beneficial effects in climacteric women significantly ameliorating climacteric symptoms as well as some parameters of lipid metabolism in women with hyperlipidaemia.

The diagnostic accuracy of hysterosalpingography and laparoscopy was compared. One hundred fourty three infertile women were prospectively investigated in two years duration. Laparoscopic chromopertubation using methylen blue dye performed on days 8-16. Hysterosalpingography performed on days 7-10 with water soluble contrast medium. There was agreement between the results of both methods in 66.4 per cent /95/ of the patients. In 15 of the 63 patients with a normal hysterosalpingography, however, peritubal or tubal disease was observed at the time of laparoscopy/false-negative results, 10.4%/Eighty patients with tubal obstructions were detected by hysterosalpingography, but 33 obstructions were not confirmed by laparoscopy/false-positive results, 23%/. The greatest discrepancy between the hysterosalpingography and laparoscopy was found in peritubal adhesions--58.7%. Laparoscopic evaluation demonstrated also endometriosis in 41 cases, poly cystic ovaries in 12, ovarian cyst in 9, and uterine fibroids in 15. Intrauterine abnormalities were diagnosed by hysterosalpingography in only 2.9% per cent of the patients. No significant laparoscopic complications were noted. The results suggest that hysterosalpingography is useful as a primary screening procedure, but laparoscopy provides a more accurate assessment of tubal patency and peritoneal factors in the investigation of infertility.

We examined the possibility of treatment of premenstrual syndrome (PMS) with Periodin (Walmark). Periodin is a combination of polyvitamins, oligoelements and phytoextracts which have a relation with prostaglandin's synthesis and regulation of prolactin secretion. A group of 24 women with PMS and regular cycles in premenopausal period (mean age of 44.7) was examined and took Periodin 1-2 caps daily for a period of 3 months as a food supplement. The assessment was made by modified J. Mortola score system. After treatment the PMS symptoms decreased with 52.3% compared with the beginning. The authors conclude that Periodin has a considerable influence on PMS symptoms, no contraindications and could be useful widely in gynecological practice.

The association of intrauterine filling defects on hysterosalpingogram with endometriosis was evaluated. One hundred twenty patients were prospectively investigated with both methods, hysterosalpingography (HSG) and laparoscopy (LSC), for period of two years. HSG was performed on days 7-10 with water-soluble contrast medium. The presence of endometriosis was proved laparoscopically and scored according to the American Fertility Society classification. Forty-one women had endometriosis at LSC. In 25 of all 30 women with filling defects on hysterosalpingogram endometriosis was found. The presence of intrauterine filling defects on HSG is significantly associated with the presence of pelvic or peritoneal endometriosis.

The study was carried out on 280 infertile women (185 with primary and 95 with secondary infertility), patients of the University Clinic of Gynecologic Endocrinology and Infertility, Sofia. The present study was designed to estimate which is the most suitable test for detection of chlamydial infection in women with infertility. Evidence of past chlamydial infection was determined by the presence of antichlamydial IgG antibodies by commercial ELISA test. From 196 of the patients examined, 101 were positive for antichlamydial IgG antibodies (62.7%). 84 women were examined by means of direct antigen test for Chlamydia trachomatis from the endocervix (DIF. ELISA). Tubal patient was examined by means of hysterosalpingography and/or laparoscopy. In 34 women with unilateral or bilateral tubal occlusion the endocervical direct antigen test was positive in 4 (11.8%) and in 30 women with patient tubes 2 were positive by this test (6.7) In 38 women with tubal occlusion 29 of the women with unilateral or bilateral tubal occlusion had a presence of IgG antichlamydial antibodies in their sera (76.3%) compared to 17 of 38 women with patient tubes (44.7%). The results of the present study indicate that the examination antichlamydial IgG antibodies in the sera of women with infertility has a better predictive value with regard to tubal pathology compared to the direct antigen test for detection Chlamydia trachomatis in the endocervix. Examination for latent infection or reinfection has to be carried out before the administration of more invasive methods for the management of infertility.

The study was carried out on 162 infertile women (110 with primary and 52 with secondary infertility), patients of the University Clinic of Gynecologic Endocrinology and Infertility, Sofia. The present study was designed to estimate the effect of chlamydial infection as a cause of tubal pathology in infertile women. Evidence of past chlamydial infection was determined by the presence of antichlamydial IgG antibodies by commercial ELISA test. 101 of the patients examined were positive for antichlamydial IgG antibodies (62.3%). 76 women were examined for tubal patience by means of hysterosalpingography and/or laparoscopy. 38 women had patient tubes and 38 women had tubal occlusion (20 had bilateral and 18 unilateral occlusion). 29 of the women with unilateral or bilateral tubal occlusion had a presence of IgG antichlamydial antibodies in their sera (76.3%) compared to 17 of the women with patient tubes (44.7%). The risk for tubal obstruction in women with positive serology for Chlamydia is 3.22 compared to 0.85 risk in the women with negative serology for chlamydia. The results of the present study indicate that women with evidence of past chlamydial infection are 4 times more likely to have obstructed fallopian tubes compared to women who had no such evidence. It is mandatory to examine the patient for chlamydial serology at the beginning of the diagnostic protocol in order to ensure adequate management prior to more invasive procedures such as hysterosalpingography or laparoscopy.

The choice of optimal time, the technique and limitations of the post-coital test (PCT) have been described. They are of important significance for getting reliable information both concerning the cervical mucus, quality and migration of spermatozoa in female genital tract. It has been stressed that a negative PCT does not necessary exclude pregnancy. There are shown data for prognostic value of the PCT. The observation of more than 20 motility spermatozoa per HPF and higher frequency of pregnancy is common finding in comparison to low motility and number of spermatozoa in cervical mucus. The data support the hypothesis of "filtering" mechanism, excluding entrance of abnormal spermatozoa. Observing "shaking" phenomenon directs to searching immunological factor (local or systemic) against male gametes.

Unlabelled: The present prospective study is aimed at estimating the therapeutic effect of a biphasic oestrogen dominated contraceptive pill Anteovin in certain forms of dysfunctional uterine bleeding (DUB) and in polycystic ovary syndrome (PCOS) which is associated with dysfunctional bleeding. Two groups of women were studied--the first group (n = 34) consisted of women with DUB; the second group (n = 31) comprised PCOS. The nature and dynamics of uterine bleeding, contraceptive effectiveness and occurrence of side effects were followed up. In the second group the changes in the levels of testosterone (T), dehydroepiandrosterone sulfate (DHEA-S) and prolactin (Prl) were additionally investigated., Results: A significant decrease in bleeding was observed in both groups. In the second group it is in parallel with a significant decrease of T even as early as on the third month and of DHEA-S on the sixth month of treatment. No significant changes in prolactin levels were found out during the treatment., Conclusion: The biphasic contraceptive pill Anteovin has a very good therapeutic effect in DUB and metrorrhagic forms of PCOS while at the same time the side effects are slightly expressed and transitory and an excellent contraception is achieved.

Unlabelled: The present prospective study is aimed to estimate the effect of a low-dose combined oestrogen drug Cyclo-Menorette on climacteric syndrome in women with early menopause., Material and Methods: The criteria for inclusion in the study were ac follows: 9-12 months of menopause, increased FSH levels, moderately expressed climacteric syndrome confirmed by the menopausal index of Kupperman and Hamilton-Anxiety-Scale /HAMA/. According to acceptance of hormone replacement therapy /HRT/ the women were divided into 2 groups--control T /n = 31/ and Cunder treatment T /n = 35/. The degree of climacteric syndrome expression after Kupperman and HAMA was estimated in all patients at the beginning as well as on the 3-d, 6-th 12-d months. The presence and dynamics of side effects were followed in the patients treated with HRT., Results: Spontaneous improvement of complaints was found out in the control group with an increase of intragroup differences during the follow-up period. Most expressed improvement in the group under treatment was established during the first 3-6 months, the beneficial effect being preserved until the end of the study., Conclusion: The use of 1 mg oestradiol valerat in combination with 2 mg oestriol results in a significant decrease of climacteric syndrome manifestation with slightly expressed and transient side effects.

The trial present the results for the incidence and histology of tumours in patients below 18 years, examined at the State University Hospital Maĭchin Dom in Sofia for two consequent periods of 4 years each. An increase is registered in the incidence of neoplastic disease from 1.85% to 3.42%. There is no significant difference in hystological characteristics of the tumours when comparing I and II period: 85.7% versus 77.4% benign tumours (mucous cysts, dermoid ovarian cysts and polyps) and 14.3% versus 22.6% malignant tumours (ill differentiated teratomas, cystadenocarcinomas, dysgerminomas, ovarian embryocarcinomas and rhabdomyosarcomas). Accurate diagnostics requires detailed gynaecological examination, including a rectal one, vaginal probing, vaginal scopia, ultrasound, laparoscopy. Early discovery followed by surgery provides a possibility for adequate and definite treatment.

Unlabelled: We investigated 25 women with anovulation or defects in the follicular growth after treatment with Serpafar for period of 6 months. During the first cycle investigation is without treatment and the patients were analysed for BBT follicular maturation endometrial thickness, cervical mucus, FSH, LH. For next 5 month the patients are treated with Serpafar. We established that endometrial thickness is dynamic changes in every cycle. The comparison was done when the leading follicular diameter was 18-24 mm., Conclusion: There was not difference in endometrial thickness in treatment cycles nor a trend for thickness to increase or decrease. Probably the mechanism of ovulation and pregnancy rates after Serpafar is not connected with thickness of the endometrium.

Immunological and biochemical analysis on cervical mucus requested application of micromethods on sindle small specimens. The following micro-methods in agar gel are applied: immunoelectrophoresis--the normal cervical mucus developed by antiserum against total human serum is presented with 5 precipitin lines: prealbumin, albumin, a1-antitrypsin, transferrin and IgG. The single immunodiffusion technique in agar gel (Mancini et al., 1964) is suitable method to assess these proteins. The same diffusion method is applied for enzyme assessment with special importance like a-amilase and muraminidase (lysozyme). The assessment of these proteins shows pre-ovulatory decrease and post-ovulatory remarkable increase. These changes are not simply due to the increased water content of the cervical mucus during the fertile period but reflects estrogen effect on cervical secretions.

A correct diagnosis of a unicornuate uterus with rudimentary noncommunicating horn, complicated with haematometra in a 12-year-old patient, was established after a detailed sonographic examination. The diagnosis was confirmed by diagnostic laparoscopy and surgical excision the rudimentary horn was undertaken. The case is interesting with the fact that several months before the patient's referral to our hospital laparotomy was performed because of persistent and progressive abdominal pain and suspicion for acute appendicitis. The uterine anomaly present was described as uterus duplex. It may be concluded that: The diagnosis of uterine anomalies may be extremely difficult for the inexperienced operator even at laparotomy. This is important since the management of congenital uterine anomalies depends on their type and differs a lot. Any mistakes in this aspect may be fatal for the patient in her further life. The ultrasound examination performed by an experienced sonographer may give precise information about the nature of the defect thus making the task of the operator easier. The final diagnosis of the uterine anomalies is based on the combined interpretation of the data from the patient's history, the sonographic examination, the diagnostic laparoscopy and other methods of investigation if necessary.

The author tells his experience from the operative pelvioscopy performed on 350 women. Using different surgery techniques he coagulates endometrial sites, he performs cystectomy, salpingostomy, myomectomy and ovarian biopsy. The most often diagnosis in these 350 cases is external endometriosis (43.14%), followed by an adhesiolysis of the Fallopian tubes end the ovaries (23.43%) and salpingoneostomy (10.57%). The percentage of pregnancy after an operative pelvioscopy performance is 27.89%. The author thinks a wide spectrum of interventions can be performed on the female internal genital organs with no need of more serious and damaging operations.

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.

Over a three-year period (1990-1993), a total of 410 diagnostic laparoscopies are performed. The series includes female patients with a minimum one year longstanding of sterility. Diagnostic laparoscopy is taken to be a routine method of making exact diagnosis in female sterility cases, and as a filtering procedure in forthcoming reconstructive operation or in the event of poor outlooks of eventual conception. The commonest finding is endometriosis (in 58.2 per cent), next ranking adhesions free of endometriosis (31.4 per cent) and bilateral obstruction of the uterine tubes (38.5 per cent). Endometriosis is usually located in the uterine body 27.5 per cent, uterine tubes 26.1 per cent and pelvic peritoneum 14.9 per cent.

The authors have performed an ovary fenestration in 220 women with primary or secondary amenorrhea. This was made with the help of instrumentation for laparoscopy and a monopolar electrodiathermic coagulator with differently shaped endings. The power supply was provided from Martin Elektrotom 2000. A spontaneous recovers of the menstruation was achieved in 36.84% of the cases as a result of the endoscopic intervention. A follows up pregnancy was achieved in 12.4% of the women. Considering the obtained results, the authors recommend the use of a laparoscopic ovary fenestration when a women with ovarian cysts is treated.

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.

We present the data of analysis of 9 cases (girls and young women) aged 14 to 20 years, with syndrome of testicular feminisation. The patients were diagnosed and treated at the departments of Paediatric and Adolescent Gynaecology and of Gynaecological Endocrinology at the University Ob. & Gyn. hospital in Sofia. The diagnosis was based on the clinical picture, karyogram and radioimmunoassay of gonadotropic and sex hormones. Described were some data as family history, clinical picture, from of the disease, appearance, genital and hormonal status, and histodiagnosis of the removed gonads. Out of nine, primarily diagnosed as a syndrome of testicular feminisation girls and women one ws with an incomplete from, in another further investigations evoked a suspicion of Swyer syndrome (a 14-years-old girl, on whom surgical treatment due to big gonadoblastoma was performed, she died a year later). One patient also developed an ovarian tumour, in six we performed gonadectomy. One patient did not come for any treatment. The differential diagnosis with some relatively rare syndromes, as well as the treatment of this patients were discussed.