[Use of cabergoline for prevention of ovarian hyperstimulation syndrome in assisted reproductive technologies].

Presentation of seven cases of patients at risk for moderate or severe OHSS, treated with Cabergoline.

[Oocyte and embryo donation and surrogacy. Religious, medico-social, ethical, financial and legal problems].

The authors quote and discuss the postulates of the Orthodox, Jewish, Catholic and Islamic religions towards ART as well as worldwide legislations and standards and the attitude of female students of medicine in Varna. Indications of oocyte and embryo donation and surrogacy are proposed but all kinds or surrogacy should be permitted. The ART legislation and standards in Bulgaria should be thoroughly revised.

[Ovulation induction in high risk IVF patients: GnRH-agonist, diminished dose of urinary or recombinant chorion gonadotropin].

In high risk IVF patients the ovulation triggering was done with agonist (0.2 mg), 1.gr., Pregnyl 5000 IE, 2. and 4.gr., Ovitrelle 0.250 mg, 3.gr., and Pregnyl 10000 IE in the fifth--non-risk group. The protocol of the first and fourth group included antagonist, the second and third group was with short and the fifth group with long agonist protocol. There was no grave OHSS in the first group, one case in each second, third and fourth group and 4 cases in the fifth group, as a whole 7 patients (3.3%). In all of them an abdominal drainage lasting 4 to 30 days was performed and all pregnancies were preserved. The average success rate was 50%, 71.4% in the fourth and 43.1% in the fifth group. A protocol with antagonist and ovulation triggering with agonist or reduced dose ChG in order to diminish OHSS in high risk IVF patients is recommended.

[Main principles and IVF-ET results of the centre for assisted reproduction "Varna", Bulgaria].

The authors formulate the main principles of IVF-ET, based on personal experience i.e. hormonal ovarian stimulation, ovarian puncture, fertilization and ET, prophylaxis and therapy of early complications. Clinical pregnancy was achieved in 287 of 612 patients (43.9% per cycle and 46.9% per transfer). The cancellation rate is 9.6% (42 patients), the miscarriage rate is 14.2% (41 patients). In three cases the pregnancy was ectopic. The multiple pregnancy rate is 32.7% (94 cases): 84 bigemini, 9 trigemini and 1 quadrigemini. In 2006 the multiple pregnancy rate was reduced to 28%. The mean number of transferred embryos was 3.2 and in 2006--2.8; 80.5% of the pregnant women were under 35 years of age. Severe complications occurred in 16 cases--2.6%: OHSS in 15 cases and one with massive intraabdominal hemorrhage from ruptured ovaries. In conclusion the authors stressed the necessity of undelayed resort to ART treatment. Hydrosalpinxes have to be removed preliminarily and partial resection of the ovaries should be done only in rare cases. In Bulgaria at least 6000 fully reimbursed IVF-ICSI procedures yearly ought to be done because of the considerable rate of the inflammatory female and male infertility.

[Massive vulvar edema in severe preeclampsia].

Massive vulvar edema in woman with severe preeclampsia is described.

[Torsion of adnexa--complication of quadruplet pregnancy reduction]. / Torziia na adneks--uslozhnenie sled reduktsiia na chetiriplodna bremennost.

A case of adnexal torsion after quadruplet pregnancy reduction is described.

[Role of Gardnerella vaginalis in the development of sexually transmitted diseases--diagnostic criteria]. / Rolia na Gardnerella vaginalis vuv vuznikvaneto na seksualno-transmisivno zaboliavane--diagnostichni kriterii.

The authors analyze the results from the clinical and microbiological investigations of Gardnerella vaginalis in two female groups: 28 patients with clinical manifestations of bacterial vaginosis (BV) and a control group of 25 females without any complaints. Along with the data from the anamnesis and the gynecological examination, the following parameters have been examined: a native preparation for "clue cells", pH of vaginal content, ratio between polymorphonuclear leukocytes and epithelial cells, specimens for the diagnosis by polymerase-chain reaction (PCR) as well as cultural examination by using HBT agar (human blood two-layer Tween agar). The authors discuss five diagnostic criteria and emphasize that the diagnosis of BV requires the presence of at least four of them. Every criterion possesses a high frequency (between 67.86 and 100 per cent) among the female patients with clinical evidence of BV.

[Stepwise uterine devascularization in postpartum hemorrhages]. / Stupalovidna devaskularizatsiia na matkata pri postpartalnite khemoragii.

The authors reported the results from a retrospective investigation of 10121 deliveries for a three-year period (1981-1983) as well as from a prospective study of 6239 child-births during a three-year period after a 20-year-long time lag, i.e., in 2000-2002. The cases with early post-partum hemorrhages (EPH) and with accomplished laparotomy were examined. The causes for EPH, the obstetric therapeutic measures and manipulations prior to the laparotomy as well as the surgical interventions after opening the abdomen were considered. The authors emphasized that 20 years ago three uteri only could be "saved" by means of ligation of the uterine vessels. A hysterectomy was carried out in 21 cases with massive EPH after the laparotomy. After two decades the situation changed dramatically. The hysterectomies amounted to only 22.22% of the cases (n = 4) while in the rest females (n = 14) the copying of the massive hemorrhages was performed by means either of stepwise ligation of the uterine vessels, or of ligation of the hypogastric ones in 3 cases with additional vaginal lacerations. It was outlined that mother's mortality rate was zero during these two periods. The conclusion has been drawn that the ligation of the uterine vessels represents an alternative to the hysterectomy when copying the EPH and preserves the child-bearing functions of some females because of the subsequent vascular recanalization.

[The importance of the sonographic control for a successful embryotransfer after in vitro fertilization]. / Znachenie na ekhografskiia kontrol za uspeshen embriotransfer sled in-vitro fertilizatsiia.

Two groups of patients have been assessed for a period from January 2000 till Mai 2004. In the first group of 222 patients the Embryotransfer was performed without sonographic control. In the second group of 253 patients the transfer was sonographically controlled. The results of the second group - 54,1% pregnancy rate per transfer are statistically better than of the first group - 29,3% pregnancy rate. ET performed under sonographic control improves significantly the results.

[Haemostatic postpartal problems in Kasabach-Merritt syndrome. Case report]. / Problemi na khemostazata sled razhdane pri sindroma na Kazabakh-Merit. Opisanie na edin sluchai.

A recurrent postpartal haemorrhage in Kasabach-Merritt sd. which continued in spite of hysterectomy is described. The bleeding was controlled only after ligation of the hypogastric arteries.

[Eikenella corrodens in the etiology of tubo-ovarian abscesses in patients with intrauterine devices]. / Eikenella corrodens v etiologiiata na tubo-ovarialnite abstsesi pri patsientki s intrauterinni pesari.

The authors analyzed the microbiological findings in 39 female patients with tubo-ovarian abscesses and intrauterine devices (IUD). An anaerobic microflora was isolated in 66.67% of the aspirates after puncture of cavum Douglasi (CD) as well as in 41.67% of the abdominal exudates or abscesses during laparotomy. Eikenella corrodens was isolated from CD in three patients while in two of them the same bacterium was intraoperatively isolated from the abdominal exudate, too. All the three patients had IUD and regular sexual intercourses, orogenital inclusive, with a lot of partners. Eikenella corrodens is an opportunistic pathogenic agent. It causes infection in case of disturbed local and general immunity under the conditions of traumatic mucosal lesions. It is resistant to numerous antibiotics.

[A case of severe HELLP syndrome associated with multiple organ insufficiency]. / Multiorganna insufitsientsiia pri tezhka forma na HELLP sd. s prinos na edin sluchai.

A case of severe HELLP sd. Was associated with cerebral oedema, anuria, retinal ablation, ascites and hydrothorax. The mother survived after intensive care and therapy, including 10 times haemodialysis. The acute fatty liver of pregnancy (M. Sheehan II) with a much poorer prognosis should be excluded. A diagnostical corticosteroids and prompt delivery is pointed out.