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OBJECTIVE: To compare the efficacy of 100 mg and 200 mg of mifepristone and 24- and 48-hour intervals to administration of 800 microg vaginal misoprostol for termination of early pregnancy. DESIGN: Placebo-controlled, randomized, equivalence trial, stratified by centre. SETTING: 13 departments of obstetrics and gynecology in nine countries. POPULATION: 2,181 women with 63 days or less gestation requesting medical abortion. METHODS: Two-sided 95% CI for the risk differences of failure to complete abortion were calculated and compared with 5% equivalence margin between two doses of mifepristone and two intervals to misoprostol administration. Proportions of women with adverse effects were compared between the regimens using standard testes for proportions. OUTCOME MEASURES: Rates of complete abortion without surgical intervention and adverse effects associated with the regimens. RESULTS: Efficacy outcome was analysed for 2,126 women (97.5%) excluding 55 lost to follow up. Both mifepristone doses were found to be similar in efficacy. The rate of complete abortion was 92.0% for women assigned 100 mg of mifepristone and 93.2% for women assigned 200 mg of mifepristone (difference 1.2%, 95% CI: -1.0 to 3.5). Equivalence was also evident for the two intervals of administration: the rate of complete abortion was 93.5% for 24-hour interval and 91.7% for the 48-hour interval (difference -1.8%, 95% CI: -4.0 to 0.5). Interaction between doses and interval to misoprostol administration was not significant (P = 0.92). Adverse effects related to treatments did not differ between the groups. CONCLUSIONS: Both the 100 and 200 mg doses of mifepristone and the 24- and 48-hour intervals have a similar efficacy to achieve complete abortion in early pregnancy when mifepristone is followed by 800 micrograms of vaginally administered misoprostol.

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INTRODUCTION: Adolescent sexuality is not a new phenomenon, but it has been accepted differently at various times and societies. In modern times, adolescents start sexual life early, not well educated and not prepared for possible consequences. The period between the first sexual relationship, marriage and having children is prolonged with a greater possibility of having artificial abortions or sexually transmitted diseases (STD). It is of great importance to work on proper education of children and adolescents on sexual life and contraception. MATERIAL AND METHODS: An inquiry into the knowledge of sex and contraception was performed in an elementary school in Novi Sad, comprising 134 children from VII and VIII grade (aged 13-14, 77 girls and 57 boys) in order to prepare a lecture on these topics. RESULTS: Most of the knowledge on these topics children aged 13 and 14 got watching TV and reading magazines (44.15% girls and 70.17% boys) and from their friends (42.1%). Communication about sex and contraception exists mostly among friends (51.95% girls and 82.46% boys). One third of girls talk with parents and one quarter got knowledge from them. Only four boys (2.98%) had sexual intercourse without complications: artificial abortion or STD. Almost every child (96.95%) knows about AIDS and 89.25% children know about at least one method of contraception (mostly condom). Three quarters claim artificial abortion is harmful. 50% of children want more education about sex and contraception. DISCUSSION AND CONCLUSIONS: Most of the knowledge on sexual life and contraception children get from various forms of mass-media and from one another which is unreliable and incomplete. Unfortunately, parents and teachers play a minor role in sex education of children. In order to prevent spreading of sexually transmitted diseases and to decrease the percentage of adolescent pregnancy and artificial abortions, it is of great importance to investigate knowledge, attitudes and practice of children and adolescents in regard to sexual life and contraception and to prepare acceptable and efficient programs for education on these topics. However, not only education is important, but also acceptance and behavior of children and adolescents resulting from these programs.

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This study investigated the efficacy of Zoladex depot 3.6 mg (goserelin acetate) during a 4-month treatment of infertile patients with uterine myomas of different size and location. The investigation comprised 30 patients aged 22-42 years, distributed into 2 groups regarding uterine and myoma volume. The first group included patients with uterine myomas less than 70 ml and uterus less than 300 ml. The second group included patients in whom these volumes exceeded the above mentioned values. Zoladex depot was administered every 28 days for 4 months with ultrasonographic follow-up of volume decrease, whereas patients with submucous myomas underwent control hysteroscopy. The obtained results point to efficacy of Zoladex in decreasing the volumes of both myomas and uterus by more than 50%, which correlates with literature data. Of particular interest is complete disappearance of myomas in about 60% of patients of the first group. Serum concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) were followed-up prior to and during Zoladex therapy where multivariate variance analysis showed statistically significant differences. The side effects were recorded and are similar to those of other GnRH analogues.

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The study presents a retrospective analysis of the data on pregnancy, delivery and cerebral dysfunction in 296 premature infants of singleton pregnancies, body weight > 1000 g, delivered at the Department of Obstetrics and Gynaecology in Novi Sad during 1997. Preterm newborns are exposed to a high risk of perinatal pathology, with 66.55% newborns from pathological course of pregnancy. Vaginal delivery--vertex presentation was registered in 69.93%, breech presentation in 6.41% and cesarean section in 23.65%. The preterm children have lower Apgar Scores and umbilical artery Ph values than term children. Cerebral dysfunction was diagnosed in 32.09%, whereas the incidence is inversely proportionate to gestational age and body weight at birth. The mode of delivery does not significantly affect cerebral dysfunction (p < 0.05) which means that intrapartal trauma is not a frequent cause of cerebral distress of preterm newborns. The labor occurring before the 34th gestational week can be performed vaginally if the fetus is either in vertex or complete breech presentation, if the course of labor is regular and cardiotocography findings within physiologic values.

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INTRODUCTION: Adolescent sexual activity has increased in the last 30 years. Nowadays approximately 73% of male adolescent had sexual intercourse by the age of 18. Practice is not always followed by adequate knowledge and behavior. Therefore, it is of utmost importance to have appropriate education on sexual life and contraception in order to prevent unwanted pregnancies, abortions and spreading of sexually transmitted diseases. MATERIAL AND METHODS: Sexual behavior and knowledge was surveyed in a high school in Novi Sad among 520 male students, aged 15-19, in order to prepare lectures on sexual topics. RESULTS: Most information male teenagers got from different forms of mass-media (63.65%) and through communication with friends (50.58%). The communication with parents (5%) and experts (1%) is poor. According to their opinion, 69% have enough knowledge about sexuality and 62% about contraception, but 75.77% want further education from experts. 90% participated in some kind of sexual activity by the age of 18, and 84.3% had sexual intercourse for the first time at the age of 15.55 years, on average. artificial abortion occurred only in one case of pregnancy. Almost all young men knew about AIDS. The most common known means of contraception was condom (90%) and 70% consider it as the best method. 90% of male students consider abortion harmful, because it can cause infertility (51.38%). DISCUSSION: Most knowledge on sex life and contraception male adolescents gain from magazines, TV and friends, which can not be accepted as appropriate and undoubtedly can be incorrect and inadequate. Communication with parents and teachers is poor. Male adolescents are aware of their need for more education on these subjects and they want it from experts. CONCLUSION: Young men are not educated about sexual life and contraception well enough. Proper sexual education among adolescents is of great importance for psychic and reproductive health of young people.

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INTRODUCTION: Anemia is the most common puerperal complication which increases the risk of maternal morbidity in postpartal period with incidence of up to 56% of women. In 90% cases the etiology of postpartal anemia is decreased serum iron level. Postpartal hemorrhage (loss of blood more than 0.5 L during labor) is the cause of anemia in 5-10% of women. MATERIAL AND METHODS: This prospective study included 4009 postpartal women with normal pregnancy and delivery who gave birth during the year 1997 at our Department. There were 3305 women with vaginal delivery and 704 women who had cesarean section. Anemia was diagnosed when the hemoglobin serum concentrations were less than 100 g/L (6.21 mmol/L) and hematocrit less than 0.31. RESULTS AND DISCUSSION: Although about three quarters of pregnant women had 8 and more obstetrical controls and 3 and more ultrasound examinations during pregnancy, only half of them had blood count control 3 or more times. Blood count was checked 3 or more times during pregnancy in 54.98% women and 32.9% of all women took iron medication during pregnancy but no longer than 12 weeks. Before pregnancy 0.6% of women had anemia, and after the delivery that number increased to 25.41% with no significant differences between those who had vaginal delivery and those with cesarean section. The incidence of newborns with anemia was 5.11% in both groups. These results show that anemia of mother has no influence on anemia of the newborn who has its own mechanisms of compensation. The etiology of puerperal anemia was in 79.18% women caused by low serum iron levels with no differences between both groups, but infection caused anemia was more frequent in women with cesarean section (11.8%) than in women with vaginal delivery (0.36%). CONCLUSION: Although one third of pregnant women take iron medication during pregnancy, every third woman has anemia after delivery, both vaginal delivery and cesarean section. Women who had cesarean section had anemia more frequently caused by infection. Anemia is 5 times more frequent in the mother than in her newborn. Prophylactic iron medications during pregnancy are not recommended, but more frequent control of blood count during pregnancy is required, as well as adequate therapy of anemia.

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Legal pregnancy interruptions in juvenile and adolescent age performed at the Department of Obstetrics and Gynaecology in Novi Sad, during the period from 1985 to 1995, have been analyzed and presented. The authors point out the following methods of choice for pregnancy interruptions: interception to 7 weeks of pregnancy, electric vacuum aspiration from 8 to 13 weeks of pregnancy, a combination of parenteral and local application of prostaglandins from 14 to 20 weeks of pregnancy.

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This study analyzes occurrence of ectopic pregnancies in women using intrauterine contraceptive devices. During a 5-year period, 1990-1994, 524 women with ectopic pregnancies underwent surgery at our Clinic, while 22 (4.2%) had intrauterine devices. At admission most patients had signs of heavy intraabdominal bleeding, so in 77.27% cases the diagnosis was made by punction of the Douglas area, and only in 9.09% by laparoscopy, that is other methods for early detection of diseases. Rupture of the fallopian tube occurred in 50% of patients, tubal abortions in 36.36% and ovarian pregnancies in 13.64%, whereas 18 salpingectomies and 4 adnexectomies were performed. Late diagnosis and impossibility of performing conservative operations on fallopian tubes are the consequence of disregarding the possibility of getting pregnant by the users of intrauterine devices themselves, as well as by physicians whose help is asked for after symptoms appear.

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In 79 women with regular menstrual cycle and giving birth to children on the 274th to 287th day of gestational age, prolactin was determined in mother's serum, umbilical artery serum and in the amniotic fluid, by using radioimmunity method in mg/l. Two groups of women and their newborn infants were examined. In the first group (n - 36) were women with hypertension, in the second (n - 43) healthy women. The average values of prolactin (X +/- SD) in mother's serum (214.3 +/- 98.6 micrograms/l and 189.4 +/- 94.7 micrograms/l) in examined women do not differ significantly (p > 0.05). The level of prolactin in the serum of embryo is much higher (p < 0.01) in women with hypertension (338.2 +/- 106.5 micrograms/l) than it is the case in normal pregnancies (251.6 +/- 99.2 micrograms/l). The values of prolactin are significantly higher (p < 0.01) in the amniotic fluid in women from the examined group (527.3 +/- 188.6 micrograms/l) than in the control group (398.1 +/- 156.3 micrograms/l). The difference between the level of prolactin in the amniotic fluid of women with meconium and clear amniotic fluid in both examined groups is not significant (p > 0.05). Values of correlation coefficient are small (r < 0.317) and point that the mutual dependence among the prolactin in mother's serum, umbilical artery serum and serum of the amniotic fluid is not significant.

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A poll was conducted among 50 primary sterile women, 50 secondary sterile women and 70 fertile women, to question their motivation for parenthood, with assumption that innate "maternal instinct" does not exist, but that the wish to have a child is socially conditioned and it might differ in women having children and those without them. According to the gathered results it can be said that the fatalistic motivation for parenthood ("reproduction is the fate of every person") is more expressed in fertile women than in sterile ones, while the instrumental motivation (the child is there to enable achieving certain aims, not narcisistic) is more expressed in sterile that in fertile women. Primary sterile women wish to have a child for themselves, without concrete reasons being the main initiators for the beginning of sterility treatment, while secondary sterile women, especially those who already have one child, consider family and marriage incomplete without children and in the latter the husbands are usually initiators for the beginning of sterility treatment or the wish is mutual. However, the altruistic motivation for parenthood is the first and most important for all three groups of women (affection for children, a wish to protect them).

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In 1978, an investigation on alcohol consumption by women, before and during pregnancy, was carried out at Clinic for Gynecology and Obstetrics of the Medical Faculty in Novi Sad. This investigation studied 350 women during their stay in the hospital, after delivery and their newborns regarding birth weight, prematurity, stillbirths, operative interventions for delivery (vacuum extraction, Caesarean section, vaginal breech) and hormonal therapy during pregnancy. Ten years later, in 1988, at the same clinic, a similar investigation took place within the framework of the "Drugs and Pregnancy" project of the WHO Regional Bureau for Europe which included the study of 297 women and their newborns (average birth weight and Apgar-score study). Newborns whose mothers had been drinking before and during pregnancy had lower birth weight and length compared to the newborns whose mothers had never consumed alcohol, but these differences are not of statistical significance (X2 = 2.504; X2 = 0.922). There is no statistical significance either in the incidence of prematurity (X2 = 0.461) or in the incidence of operative interventions during delivery (X2 = 0.632). The stillbirth rate was significantly higher with a 4.3% incidence (p less than 0.05) in women consuming alcohol in contrast to the non-alcohol consumption group (0.5%). More women who had been drinking before and during pregnancy had been receiving hormonal therapy during pregnancy (X2 = 8.195 p less than 0.01). Nowadays, more women drink alcohol (60.6%) than ten years ago (48%) (X2 = 13.874 p less than 0.01). Also, nowadays more women drink during pregnancy (47.5%), than in 1978 - 27.7% (X2 = 26.979 p less than 0.01).

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A retrospective analysis undertaken at the University of Kiel by the Department of Obstetrics and Gynaecology, consisted of a 3-year study of cases of tubal surgery with operative pelviscopy (laparoscopy). In the period from 1987 to 1989, 529 patients underwent selective operative laparoscopy specifically because of a tubal factor of infertility. The type of surgery performed was aimed at the conservation and salvaging of the tubes whenever possible, according to the principles of 'Minimally Invasive Surgery'.

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This study was designed to estimate the incidence of infertility of immune origin in a group of 102 married couples with unexplained infertility, out of a total of 1346 couples being treated for infertility. The tests included microagglutination of spermatozoa, microzone sera immunoelectrophoresis and sera immunodiffusion methods. In this group the sera of 23 (22.55%) women and 21 (20.58%) men contained antibodies, and these seemed to be the only cause of infertility. In relation to the total number of 1346 couples, infertility of immune origin was found in 1.70% of female and 1.56% of male partners. Conjugal immune-origin infertility was present in 0.56% of marriages. Out of 1346 treated infertile marriages, an immunologic factor was evidently the only cause of infertility in 2.57%.

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