[INFLUENCE OF STIMULATION PROTOCOL ON MATURITY AND MORPHOLOGICAL FEATURES OF OOCYTES IN PATIENTS WITH LOW OVARIAN RESERVE: STUDY OF 72 IVF/ICSI TREATMENT CYCLES].

UNLABELLED: The current study presents the results of a retrospective and prospective observation of the maturity and morphological features of the oocytes and the way they are influenced by the therapeutic approaches and the protocol for controlled ovarian hypersimulation (COH) in patients with low ovarian reserve. MATERIALS AND METHODS: The study includes 184 oocytes, derived from 72 patients with low ovarian reserve involved in an infertility treatment program through in vitro fertilization from February 2011 to February 2014. The applied therapeutic approaches and COH protocols are microdose agonist short protocol, antagonist short protocol, mild stimulation protocol and natural cycle in vitro fertilization. RESULTS: Our study hasn't found a statistically significant dependence between the applied ovarian stimulation protocol and the maturity and morphology.

[3D laparoscopy system in gynecological practice].

Laparoscopic gynecologic procedures have become increasingly popular but their widespread use has been limited by training issues. Recent technological advancements have led to the introduction of new three-dimensional (3D) cameras in laparoscopic surgery. The use of 3-dimensional (3 D) vision may aid in training and performance of laparoscopic tasks. 3-D visualization improves the learning curve forlaparoscopic surgery. Surgeons must consider 3D systems when leaming complex laparoscopic surgeries.

[Laparoscopic burch colposuspensio--our experience].

Stress incontinence is involuntary loss of urine that occurs during periods of increased intraabdominal pressure, such as sneezing, coughing or exercise. Retropubic Burch colposuspension has been considered by many to be the "gold standard" procedure for treatment of female stress urinary incontinence for almost 50 years. The firs reported retropubic surgery performed via the laparoscopic approach was described by Vancaillie and Schuessler in 1991. We present a clinical case of a female patient with stress incontinence who has been operated by laparoscopic approach by our team.

[Two autopsy cases with microchimerism].

Identification of chorionic villi in spiral arterioles and later in maternal circulation is known as maternal microchimerism. Distant consequences of this condition are unclear associated mainly with risk from autoimmune diseases. Our presentation is aiming at introducing the term microchimerism and to propose a connection between this phenomenon and the reasons for the death of the fetus.

[Oocyte quality as a predictive marker for assessment of IVF/ICSI procedure outcome].

The technology of in vitro fertilization consists mainly of pick up, selection and insemination of oocytes, embryo culture and their transfer into recipient's womb. Before any further manipulation of oocytes their quality has to be accurately evaluated as it has direct impact on the monospermic fertilization, early development, establishment and maintenance of pregnancy. Criteria applied for oocyte quality assessment are subdivided into morphological, cellular and molecular. Morphological ones include the structure of oocyte: cumulus-oocyte complex, cytoplasm, firstpolarbody, perivitelline space, zona pellucida, and meiotic spindle. Morphological alterations may be related to the particular patient and the treatment cycle characteristics, to affect most or all oocytes in the cohort. The aim of the resent review is by summarizing available data from literature to investigate if non-invasive observation of any morphological feature or group of features of MII phase human oocytes has strong predictive value for further development and the in vitro procedure outcome.

[Intrauterine fetal death in furcate insertion of umbilical cord].

Fatal complications associated with abnormal umbilical cord insertions occupy 7.7-11.4% of all stillbirths and only 0.06% of all pregnancies. We report a rare abnormality of umbilical cord insertions (furcated insertion) associated with hemodynamic disorders and intrauterine death of the fetus.

[In vitro maturation--a potential approach of infertility treatment of patients with PCOS].

Polycystic ovary syndrome (PCOS) affects about 15-20% of women of reproductive age. This is a heterogeneous condition characterized by a combination of menstrual cycle disturbances, hyperandrogenism and polycystic ovaries. A significant percent of these women comes to the necessity of assisted reproduction procedure. During the conventional procedure of in vitro fertilization (IVF) the patients are being exposed to a controlled ovarian hyperstimulation (COH) with gonadothropine hormones with the purpose of ensuring collection of numerous mature oocytes for fertilization and respectively obtaining numerous embryos for selection and embryotransfer. The supraphysiological doses of exogenous gonadothropines used for COH often lead to an excessive ovarian response, characterized by the development of numerous follicles of different size and different quality, aspiration of immature oocytes and higher risk of severe ovarian hyperstimulation syndrome (OHSS) in women with PCOS. The retrieval of immature oocytes from unstimulated ovaries followed by in vitro maturation (IVM) procedure appears a potential therapy which eliminates aforenamed risks and respectively is highly beneficial for application to women with PCOS.

[Radical trachelectomy -- surgery for preserving woman's fertility in patients with invasive cervical cancer].

For the past 15 years gynecological oncologists have been seeking ways to preserve woman's fertility when treating invasive cervical cancer. Many cases of cervical cancer are diagnosed in young woman who wish to preserve their fertility. As more women are delaying childbearing, fertility preservation has become an important consideration. The standard surgical treatment for stage IA2-IB1 cervical cancer is a radical hysterectomy and bilateral pelvic lymphadenectomy. This surgery includes removal of the uterus and cervix, radical resection of the parametrial tissue and upper vagina, and complete pelvic lymphadenectomy. Obviously, the standard treatment does not allow future childbearing. For some women with small localized invasive cervical cancers, there is hope for pregnancy after treatment. Radical trachelectomy is a fertility-sparing surgical approach developed in France in 1994 by Dr. Daniel Dargent for the treatment of early invasive cervical cancer. The radical trachelectomy operation has been described and performed abdominally, assisted vaginally by laparoscopy and robotically.

[Laparoscopic hysterectomy -- indications, technic, complications].

In recent decades, interest in laparoscopic gynecological practice increase. This technic applied first as a diagnostic tool in women with infertility. Subsequently starts to be used to perform surgery in small region of the fallopian tubes and ovaries, being increasingly developed and today, it is considered that any gynecological operation can be performed laparoscopically.

[Studies on the level of proinflammatory cytokines IIL-1a, IL-1b, IL-6, TNF-a in pregnant women with acute pyelonephritis].

UNLABELLED: Proinflammatory cytokines (IL-1a, IL-1b, IL-6, TNF-a) are important mediators of acute inflammation. We studied the levels of those cytokines in pregnant women with acute pyelonephritis. MATERIAL AND METHODS. We studied 30 women with clinical and microbiological evidence of acute pyelonephritis and 30 healthy controls Urinary cytokine levels were measured using an ELISA test. RESULTS: The mean urinary cytokine levels of pregnant women with acute pyelonephritis were higher compared with controls. We found evidence for higher clinical microbiological activity in women with acute pyelonephritis compared to controls. CONCLUSIONS. The urinary levels of proinflamatory cytokines can be used as reliable biomarkers for acute pyelonephritis in pregnant women.

[Clinical efficacy of a new method for LEEP conization with pistol-shaped electroknife].

The aim of this study is to establish clinical efficacy of a new method for LEEP conization of uterine cervix. The study is open, retrospective, performed at Department of General and Oncogynecology - Military Medical Academy (Sofia, Bulgaria) for the duration from 2007 till Mar 2010. The study includes 37 women at age from 19-50 years with proved high grade CIN (included Ca coil uteri in situ) by abrasion or biopsy. Medical history was collected from all patients enrolled in the study as well as gynecological examination and colposcopy was performed to them. A LEEP with short intra venues anesthesia was performed to the patients. An innovation system for LEEP conization and generator for monopolar currency ERBE VIO 300D was used. The follow up visit was performed one month after the treatment procedure and included gynecological examination and colposcopy (positive/negative atypical colposcopy results). The clinical efficacy of the method was evaluated on the base of histological results. The patients whose histological results show negative endocervical margins were accepted for cured. From 37 patients in total with different stage of dysplasia and carcinoma in situ hospitalized at Clinic of surgical gynecology for surgical treatment, in 33 (89%) there are negative endocervical margins. These patients formed the cured group. In four patients (10.8%) were discovered histological evidences for positive endocervical margins. The LEEP was not the final operative procedure for them. They were included in the uncured group. The final results achieved from the study about the efficacy of the used method LEEP has statistical significance (d.f .= 1, X2 = 2.82, p < 0.05). The data shows that the LEEP eliminate completely the affected by malignant process areas of cervix uteri. The LEEP can be used as a common surgical method in the treatment of the women with high stage of pre-carcinoma and carcinoma in situ coli uteri.

[A comparative study of the prognostic pH values of the fetus in utero, generated by the "quantitative cardiotocography" computer method, and the actual pH values measured immediately after delivery].

INTRODUCTION: The presented methodology for quantitative evaluation of the cardiotocographic (CTG) findings unconditionally provides essential opportunities for improving the diagnostic potential in modern obstetric practice. Current literature data concerning the clinical application of this method are scarce. Credible clinical trials are needed to determine what is the correlation between estimated and actual values of the studied variables. MATERIALS AND METHODS: A prospective study on 110 pregnant women was performed. All patients were monitored via indirect cardiotocography. The recordings were stored and analyzed by the computerized method for "quantitative cardiotocography". We compared the last prognostic fetal pH value, generated by the "quantitative cardiotocography" software during labor, with the actual pH measured from the umbilical artery (UA) of the newborn. RESULTS: For each of the stored CTG recordings we quantified the difference between the last forecast and the actual pH of the newborn. In 82% of these cases this difference was in range of -0081/+0074 from the projected results. However during the study we discovered that there is a significantly better correlation between the arithmetic average of the last 6 (six) predicted results and the actual pH of the newborn. In 85% of these cases the difference between forecast and actual pH values lies a in range of -0037/+0046. CONCLUSION: Using the arithmetic average of the last 6 (six) predicted results for pH leads to a significant increase in the clinical value of the "quantitative cardiotocography". More studied are needed if we are to find opportunities to further reduce the existing prediction variability.

[Laparoscopy with low abdominal pressure]. / Laparoskopiia s nisko intraabdominalno naliagane.

The authors present their experience from operative laparoscopies performed with lower than usually accepted intaabdominal pressure.

[Utrogestan--an alternative for synthetic gestagen treatment in spontaneous abortion]. / Utrogestan--alternativa na sintetichnite gestageni v lechenieto na spontanniia abort.

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.

[Prophylaxis with tercef of infection-related complications after cesarean section]. / Profilaktika s Tercef na infektsioznite uslozhneniia sled tsezarovo sechenie.

The purpose of this prospective and case controlled study is to determine the effectiveness and safety of antibiotic prophylaxis with Tercef (ceftriaxone) in women undergoing cesarean section and to compare the results with those of 24 hours regiment of Cefazolin and also with a group without prophylaxis. The study includes 122 cases of elective and emergency CS: 41 with a single intravenous dose of 1.0 g Tercef after clamping of the umbilical cord; 41 cases of antibiotic prophylaxis with Cefazolin three times 2.0 g for 24 hours and 40 low infectious risk CS without antibiotic prophylaxis. We take in account the existing before the CS risk factors for postoperative infectious complications as: hours of PROM; length of labor, number of vaginal examinations before CS, previous sections, duration of the operation, anemia, bacteriuria and diabetes. For post CS infection-related complications we take: febrile morbidity, endometritis, wound infections, infection of urinary tract. The results show infection complication in the three groups as follow: 14.6% for tercef, 17.1% for cefazolin and 20.0% for the group without antibiotic. There is not statistically significant difference. According our study in cases of CS with increased risk of post-operative infectious complications the antibiotic prophylaxis reduce the rate of infection-related complications even below that of CS with low infectious risk. The single dose of 1 g tercef i.v. is effective and suitable in comparison with 24 hours regiment of cefazolin.

[Effect of mammary gland diseases, the act of sucking and machine milking on utering motility in cows during the early puerperal period. I]. / Vliianie na niakoi zaboliavaniia na mlechnata zhleza, akta na bozaene i mashinnoto doene vurkhu motorikata na matkata u kravata prez ranniia puerperalin period. I. Suobshtenie.

The effect of some mammary gland diseases, of the act of sucking and of machine milking on spontaneous uterine activity was studied in cows during their early puerperal period by use of the radiotelemetric method. It was established that clinical catarrhal and suppurating mastitis block spontaneous uterine activity. However, the uterus preserves its reactivity to oxytocin which is confirmed by injection of the hormone. The act of sucking and machine milking have a positive effect on spontaneous uterine activity up to the 5--7 days following calving. Uterine contractions are registered after reflectory influences too. The number and amplitude of uterine contractions 48 h after calving are closely correlated with the predisposition of uterine musculature to post calving complications.