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UNLABELLED: Misoprostol (Cytotec) is a synthetic analogue of PGE1, not yet registered for Obstetric practice. Vowing to its low cost and high efficacy there is marked interest towards this medicament. MATERIALS AND METHODS: 47 patients with induction of labour are distributed into two groups: Gr.A (n = 25), receiving Misoprostol and Gr.B (n = 22) with Oxytocin in perfusion. RESULTS: Protocol of treatment with PGE, includes 50 microg per os every 2 hrs. and in Gr. B standard solution of Oxytocin 5 IU. Before the beginning of induction Bishop Score and NST for 20 mins. is evaluated. The interval induction--delivery is much shorter in Gr.A, with a median of 479.00 +/- 105.44 mins., in comparison with 727.00 +/- 88.87 mins. in Gr.B. Uterine tachysystole is registered more frequently in Gr.A--8%, with 4.54% in Gr.B. DISCUSSION: With receivers of Misoprostol, 76% deliver within 24 hrs. of induction. And there is no significant difference in the recorded monitor data for FDS and Apgar score of the neonate as well as the method of delivery. CONCLUSION: Oral Misoprostol is an effective method of induction of delivery with low Bishop Score. But there is a lack of sufficient data regarding the optimal regime and safety and with incorrect dosing may lead to unacceptable high incidence of complications.

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UNLABELLED: Leiomyoma is a benign tumor, with mesenchymal embryonal cell origin. During pregnancy 0.1 to 4% of cases are diagnosed. MATERIAL, METHODS AND RESULTS: During the period of 1999-2003, 59 pregnant and delivering women were registered with the diagnosis of Leiomyoma (0.5%) at the ObGyn complex, University Hospital, Pleven. In the observed group, were encountered significantly more often primary sterility, pathological positions of the fetus and placental pathologies. CONCLUSIONS: Leiomyoma frequently complicates the progress of pregnancy and delivery necessitating operative intervention by the means of Caesarean Section.

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Fibromas is relatively common in the patients in reproductive age and is exclusively responsible for infertility and abortions in 5% of the patients. Approximately 50% of the women with infertility and myomas become pregnant after myomectomy. The evidence suggests most of women who wish to become pregnant are able to do it in the first year, with a fall of these rates after this time. This can be attributed to the recurrence of fibromas. The site, number and size of myomas as well as the experience of the surgeon along with the preference of the patient can influence the management option. They are indications to make surgery in a woman who is considering the possibility of pregnancy by the natural methods or attended reproduction the presence of submucous or intramural fibroid that distorts the uterine cavity, fibromas greater of 3 cm. and manifold fibromas.

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Attempts to optimize quality of life in woman with epilepsy should include a reliable method for birth control, including oral contraceptives (OC). One of these methods is hormonal oral contraception. The classic antiepileptic drugs (AEDs)--Phenytoin, Phenobarbital, Ethosuximide and Carbamazepine induce hepatic microsomal enzymes and decrease the production of estradiol and progesterone, that may be compromise the effects of OC. Recommendation for women taking OC include possible use of noninducing AEDs (Valproic acid), new AEDs--Lamotrigine, Gabapentin, Topiramate, Tiagabine or for patients taking inducing AEDs use of an OC containing > or = 50 micrograms. estrogen. Patients should be warned that midcycle bleeding indicates possible OC failure and that the absence of such bleeding is not an indication of OC effectiveness. Additional contraceptive methods are also advised. The authors report their own experience in 12 women taking AEDs and OC.

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UNLABELLED: The purpose of the authors is to survey the effect that HRT has on uterine fibromas. METHODS: It was made a very prospective one-year study on 25 women with uterine fibromas, 33-55 years old (the majority of them had subserose uterine fibromas with normal sizes). We are used the HRT with Climent and Cyclo-proginova (Schering A.G.). According to the kind of the treatment that was used, two groups were formed: the 1st had treated with Climent (n = 18) and the 2nd--with Cyclo-proginova (n = 7). The changes in the growth of the fibromas were observed with echography at the 1st, 3rd, 6th and 12th months. RESULTS: The significant changes in the growth are absent in the 1st group, while in the 2nd group in 6 of the 7 cases showed a little increasing in the size of the fibromas (to 25 mm). However, in 2 of all women who had bleeding, were treated with abrasio residuorum, and the histological result is a simple glandular hyperplasia. The missing of important changes in the size of the fibromas can be explained with the progestogens compartment, which decreased of estrogen receptors and with the stimulating effect of the 17 beta-OH-steroiddehydrogenasis, which reduced the estradiol in the cells. CONCLUSION: HRT could be used at women having fibromas without significant changes in the growth, under very strict control by echograpry.

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The authors aim is to find out the most common dosages, roads of administration and the effect of 15-Methyl PgF2a (Prostin 15 M) during the treatment of postpartal uterine hypotony 1 to 3 amp. Of Prostin 15 M-1 ml. (250 mg Carboprost) were used deeply muscular, intracervical or intramyometrial, by 51 patients with postpartal hypotony. The most common risk factors associated with the development of postpartal haemorrhage are PIH, prolonged labour, the general anaesthesis and higli multiparity. The adequate treatment with Prostin 15 M woned reduse the life threatening complication in the Labour room. The most efficient is the intracervical way of administration, a good effect could be achieved even with 1 amp. Prostin 15 M when it is applied after the conventional methods and manipulations. The lacu of effect grow Prostin 15 M (in 5.88% in this study) shows that there is another pathology responsible for postpartal hemorrhage and life threatening hemorrhage and this usually requires Laparotomy. We offer every Obstetric Clinic to have 3 amp. Prostin 15 M available and these would spare a lot of negative feelings or emotions and it wont supply a better obstetric outcomes.

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The aim of the authors is to confirm the efficiency of the Dostinex for prevention an inhibition of the puerparal Lactation. Dostinex is a dopamine ergoline derivation that strongly decrease the Prolactin secretion and has a long-lasting effect. 20 parturients were treated with Dostinex and the most common indication was: death fetus (12 cases), disorders of the nipples (2 cases) and 1 occasion with epilepsy, thrombophlebitis and thromboembolic disease of the V. ileofemoralis, polymastia and polythelia and fetal malformations and in 2 women with hypergalactemy was given for inhibition of the lactation (1/2 table. For 4 days). The treatment is based on two tablets daily in the first 24 h. after delivery in 6 cases and for the other--2 x 1/2 table. daily for 2 days. Our conclusion is that Dostinex is the most effective agent for prevention of the postpartal lactation given once a day (2 table.) in the first 24 h. post delivery. We read good effect when the medicine was taken twice daily x 1/2 table. for 2 days. Dostinex shows vary good compliance and low rate of relapse of the Lactation.

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The authors have made a retrospective study on the nonobstetrical indications for SC from 1996-2000 year, with the help of special documents belonging to VMI, Obstetric Clinic, Pleven. There have been 10,465 deliveries in the same period, 1096 with SC (10.47%). The main indications in 56 cases (5.11%) were non-obstetrical complications of pregnancy and delivery. The most frequent non-obstetrical indications were: ophthalmological in 18 (32.14%), orthopedical in 10 (17.86%), cases CNS diseases in 5 (8.93%) and cancer in 3 (5.36%). We have included: Condylomata accuminata--5 (8.93%), acute thrombophlebitis and thromboembolic diseases--5 (8.93%), a condition after plastic repairs of the perineum, virgin and vulvae--3 (5.36%). Special interest was taken on another group of patients with some rare diseases about the other specialist recommended SC. The ovarian age of the patients was 20-29 years--in 36 (64.28%). The SC has been performed in 30 cases (53.57%) in the first stage, in 14 (25.00%) in the second stage of delivery and in 12 (21.43%) cases was emergency. The conclusions of the authors is that the Obstetricians, who manage the delivery, may not always been comparted with that of the other specialist. This comes from the fact that the responsibility is mainly for him.

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UNLABELLED: To asses the efficiency of the 2% clindamycin phosphate creme given in 3 and 7 daily courses officially designer for the treatment of bacterial vaginosis (BV). METHODS: The study includes 65 patients who have microbiological data for BV 11 of the women are pregnant (18.46%). The microbiological study includes there agent: Streptococcus agalactiae, E. colli, Gardnerella vaginalis, Peptostreptococcus species, Prevotella species, Mobiluncus species, Staphylococcus epidermidis et Enterococcus fecalis. The controls visit was assessed on the 7'] and 28'] day after the therapy. RESULTS: There were successful results on the 84.3% of the patients after 7 day course but in the 3-day course the good results were showed in 73.91% of the women. After the 28"] day there were only few successful results 43%. CONCLUSIONS: The clindamycin phosphate is more preferable method for the treatment of BV.

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OBJECT: To evaluate the compliance and efficient of C-Film Lucchini. METHODS: 20 sexually active women were treated for the period of 3 months. There were used condoms in 1/3 of the women. It was made a microbiological study to all the patients on the vaginal flora colposcopy and it was controlled their kidney function. RESULTS: During the treatment with C-Film Lucchini 10% of the patients complained about a vaginal discharge 5% of the women have a problem with the application. CONCLUSION: C-Film Lucchini is a high quality and well-tolerated local spermicidal contraceptive with a few side effects. Despite the complaints of the local irritation the tolerance of the C-Film Lucchini is excellent. But the main problem with C-Film Lucchini is need of its insertion the 10-15 minutes before coitus and its application in front of the cervix.

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We studied systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse frequency (P.F) and mean blood pressure (MBP) among 30 pregnant women in 39.5 +/- 0.3 gestational weeks of pregnancy, age 23 +/- 0.9 years, height 162.0 +/- 1.4 cm and weight 75.5 +/- 2.55 kg. The above indices were studied dynamically in the Ist, 2nd, 3rd, 5th, 7th, 9th, 12th and 15th minute from the onset of the analgesia. We founded that SBP an DBP in the 7th min (the time for spinal block) were lowest. PF and MBP also decreased significantly in the 7th minute in comparison to the inmal values. We can conclude that the haemodynamic indices of the pregnant woman decrease wrong initiation of spinal analgesia for c.s., but remain in the region of normal reference values.

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The authors aimed at studying the significance of cord prolapse in modern obstetrics. 18836 deliveries were studied. These deliveries occurred during a 7 year period (1990-1996) and a rate of cord prolapse of 0.106% was found (1 case in 941.8 deliveries). Cord prolapse was found in 20 deliveries of which 16 were singleton pregnancies and 4 multiple. 7 of the women were nulliparous and 13 multiparous. The majority of patients were of gestational age 38-41 weeks--13 (65.0%) 4 (20.0%) were between 30-37 gestational weeks and 3 (15.0%) were 42 gestational weeks. Of the singleton pregnancies only one fetus was in a transverse lie, 8 were breech presentations and 7 vertex presentations. Delivery was accomplished by cesarean section in 2 (45.0%) cases. Of the 8 breeches 3 were delivered by CS, 4 vaginal manual delivery and one (1) by manual extraction. All multiple pregnancies were delivered vaginally normally. Of the singleton pregnancies only 2 were under 2000 g weight, Perinatal infant mortality rate in this group was 291.67% (7 of 24). Still births were 2 and they occurred intrapartially: one was a vertex presentation after refusal of CS, and the second--after breech extraction (1500 g birth weight). The authors conclude that in order to reduce the rate of cord prolapse indications for CS should be precisely revised for multiple pregnancies breech presentation.

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UNLABELLED: In the last decade delivery by continuous epidural analgesia (CEA) has become a golden standard in most modem perinatal centers. The aim of this study is to find the effect of CEA on the quality of labor, mode of delivery and the condition of mother and fetus after delivery. The study is prospective and includes 15 parturients. CEA was delivered with 0.25% solution of Marcaine. RESULTS: The average age of the parthers was 23 +/- 5.05 years and their body weights 63 +/- 9.82 kg. 13 of the women were nulliparous and 2 multiparous. All were delivered vaginally normally. The average length of the first period of labor was 4 Hours (+/- 3.18 h) and of the second period 20 minutes (+/- 11.06) q which is different from data from current literature. Labor was estimated in the cases with i.v. infusion of oxytocin. Apgar scores of the newborns was 8-10 points. We can conclude that deliveries with CEA are eutocic, shorter and promote and excellent psychoemotional state of the parturients.

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UNLABELLED: Our aim was to investigate the effects of smoking till term on maternal weight increase and on the foetus after delivery. The study is prospective and includes a group of 238 pregnant smokers consulted at the Antenatal clinics of the 3rd county polyclinic, Pleven. 115 of them smoked regularly until term at least 5 cigarettes weekly (48.32%), while 123 stopped smoking prenatally (45.9%). Utilizing a special test these two groups were compared based on their pre-delivery weight and the weight of their foetuses. RESULTS: The women who stopped smoking increased in weight with 16.6 kgs (SD-14.5), while those who smoked till term thrived with 13.2 kgs (SD-11.7) (Pt 0.001). This greater increase in maternal weight is connected with a 3.1 times more frequent delivery of babies weighing more than 4000 gr. All neonates with LBW were in the group of smokers, as well as those with foetal demise (perinatal deaths = 12.76%. CONCLUSION: In the studied group stoppage of smoking is connected with less risk of inadequate increase of weight, LBW and their foetuses more frequently weigh more than 4000 gr.

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OBJECTIVES: The purpose is to improve the neonatal outcome and to prognosticate the risk for developing respiratory problems. For that reason the serum concentrations of 1-inhibitor of proteolysis (alpha 1-IP) and 2-macroglobuline (alpha 2-M) at very low birth weight infants (< 1500 g) were investigated. STUDY DESIGN: The research is prospective and it is made for the period from January 1st 1995 up to December 31st 1995.17 very low birth weight infants (VLBWI) were the main group and 19 full term babies were the control group. The method of so called 'rocket' immunoelectrophoresis was used (this method was an innovation of D. Nankova [correction of P. Nancova], V. Kamenova, 1990). Blood was taken from babies just after delivery and at 3rd-4th day. Alternative, variantative and graphic analyses were used. RESULTS: The average value of alpha 1-IP for VLBWI was 2.036 g/l (SD +/- 0.44 g/l) for the 1st test and 2.31 g/l (SD +/- 0.41 g/l) for the 2nd test. The average value of the healthy full term babies was 2.055 g/l (SD +/- 0.37 g/l) for both tests. The lowest values of alpha 1-IP (from 0.6 g/l to 1.9 g/l) were in babies with genetic and respiratory problems. The main group had an average value of alpha 2-M 3.44 g/l (SD +/- 0.92 g/l) for the 1st test and a little higher values for the 2nd test -4.99 g/l (SD +/- 0.72 g/l) with significant differences p(t) < 0.0001. The lower levels of alpha 2-M were founded in VLBWI and they were significant for decreased protective reactions against pathologic micro-organisms. CONCLUSIONS: Control of serum concentrations of alpha 1-IP and alpha 2-M are an additional diagnostic and prognostic criterion in VLBWI for developing respiratory problems.

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Quality proteins, salts and minerals are necessary for the well development of the foetus and the pregnant woman, one of the ways of supplementing or supplying these is via multivitamins. One of these is Materna, a preparation of 21 vitamins, minerals in a well-balanced formula. We used Materna for ferroprophylaxis during pregnancy recorded ist effects on the subjective feelings of the patients. This type of prophylaxis was used on 46 patients divided into 3 groups depending on the gestational week, in which the prophylaxis was commenced. We measured hemoglobin, hematocrit and serum iron concentration before++, during and after ingestion of Materna. We found a good effect of the preparation on the subjective feelings of the patients and also an effective ferroprophylaxis. We also discovered that for an effective ferroprophylaxis a long and intermittent use of the preparation is necessary in all and not some pregnancies. The authors believe that pending the current conditions in our country supplementary therapy with preparations such as Materna is essential.

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By the help of biochemical methods we examined the plasma concentrations of thiocyanate during the placental period of the delivery both in mothers and the umbilical vein of the newborn babies. Using radiological methods we simultaneously examined the levels of E2, FSH, and Prl. The results suggest high correlation, between the plasma levels of thiocyanate both and newborn babies. We observed a low positive correlation, conserving the concentration of thiocyanates in mothers and E2 and Prl. There was a negative correlation, concerning the plasma FSH. We also observed similar interrelations in the blood examinations of the umbilical vein of the newborns. To define the level of intoxication of women smokers during gestation it is recommended to define plasma concentration of thiocyanates which influence specifically the production of E2, FSH, and Prl.

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Nineteen adolescent patients with eclampsia were studied in the course of 6 years. In 68% of the cases eclampsia (E) occurred antepartum, in 5% intrapartum. Maternal mortality was 52.65% (one patient with HELLP syndrome). Serious maternal morbidity included disseminated intravascular coagulations (10.52%), abruptio placentae (15.8%), pulmonary edema (5.26%) and acute renal failure (5.26%). Abruptio placentae was strongly correlated with the development of disseminated intravascular coagulation (p 0.0001), acute renal failure (p 0.001) and pulmonary edema (p 0.001). Eclampsia and HELLP syndrome were the most dangerous complications in adolescent pregnancies. They are associated with a serious maternal morbidity, especially when it arises in the postpartum period.

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