[Again about the drug induced abortion].

Medical abortion is known as a non-aspiration or non-surgical abortion for terminating an unwanted pregnancy up to 63 days' gestation. It is not officially regulated in Bulgaria.

High levels of women's satisfaction and compliance with transdermal contraception: results from a European multinational, 6-month study.

OBJECTIVE: To investigate compliance, satisfaction, and preference in women using a transdermal contraceptive patch. METHODS: Women (18-46 years) from eight European countries used contraceptive patches (norelgestromin 6 mg, ethinylestradiol 600 µg) for six, 4-week treatment cycles. Compliance, satisfaction, and preference were assessed after 3 and 6 cycles and study completion using self-report methods. RESULTS: Of the 778 participants, 36.8% (n = 287) used no contraception at baseline. The most common methods were oral contraceptives (67.9%, n = 334) and barrier methods (21.5%, n = 106). Of oral contraception users, 63.5% (n = 212) were satisfied or very satisfied with their previous method, but compliance was poor with 77.8% (n = 260) reporting missed doses. After 3 and 6 cycles, >80% of all included women were satisfied or very satisfied with the patch. At study completion, most participants (73.7%) reported a preference for the patch compared to their previous method. Of 4107 cycles, 3718 (90.5%) were completed with perfect compliance. Two pregnancies occurred during this study, representing a Pearl Index of 0.63. No new safety issues were identified and the patch was well tolerated. CONCLUSION: Women were highly satisfied with transdermal contraception and preferred this form of family planning over their previous method. Transdermal contraception represents a valuable addition to contraceptive options with potential to offer high compliance and efficacy.

[Solifenacin in treatment of the overactive bladder syndrome--diagnosis, clinical management and results].

UNLABELLED: The overactive bladder syndrome (OAB) is a pathological condition that affects millions of people round the world. Its incidence increases with ageing. The main therapeutic option for OAB nowadays is anti-muscarinic drug therapy. AIM: To define and implement the diagnostic criteria, clinical guidelines in our country and to evaluate the results of Solifenacin therapy in patients with OAB. MATERIAL AND METHODS: Along a three years period (2006-2009) 163 OAB patients were analyzed followed and treated. In our group of patients 106 (65.2%) are females and 57 (34.8%)--males. The diagnosis is based mainly on the complaints of the patient, evaluated thoroughly with a detail anamnesis and questionnaires. Urodynamic studies were performed In some of the patients. The efficacy of Solifenacin therapy has been validated with the same methods used in SUNRISE and VENUS studies. RESULTS AND DISCUSSION: The mean age of female patients in our group is 63.8 years, and 65.6 years for males. The most commonly observed symptoms of OAB are urgency--88.3% and frequency--92%. Urge-incontinence is observed in 48.8% of the cases. Therapy with Solifenacin 5 and 10 mg has alleviated urgency in 82% and urge-incontinence in 88.9%. Mean number of pads used for 24 hours has decreased from 2.6 to 0.4 after therapy. CONCLUSION: Urgency is the main mandatory symptom for the diagnosis OAB. Therapy with Solifenacin 5 and 10 mg guarantees very good clinical results, and high degree of compliance of the patients.

[Autoimmune thrombocitopenic purpura in pregnancy].

The author deals with haematologists' and obstetricians' current views on acquired ATP in children and adults, characterised by a transient, acute or chronic decrease in platelets count (<50.109/l) due to premature destruction by the reticuloendothelial system. The most common questions arising in connection with this disease are: what is autoimmune thrombocytopenic purpura; is there any correlation between pregnancy and ATP; what are its symptoms; does pregnancy itself affect the autoimmune disease. If is of utter importance for women with ATP to be aware of the risks these symptoms pose both on the health of the mother and the foetus. Obstetricians and gynaecologists seldom object to pregnancy in women with ATP. Nevertheless, it is essential to point out that additional monitoring and therapy are needed. There is no medical evidence that supports the notion of terminating pregnancy due to ATP. Assessment is made only by an obstetrician, haematologist and pediatrician working in close collaboration. This collaborative work must be present throughout the whole pregnancy, delivery and puerperium. The treatment necessary for women with ATP aims to establish platelet count over 50.000 ppm when approaching the end of pregnancy, preferably between 80.000 ppm - 100.000 ppm taking into account vagina or surgical delivery as well as the administration of anaesthetic. Delivery management must be decided entirely on obstetrics consideration, but not on ATP ones. Pregnant women with ATP must be monitored and treated with caution by a highly specialised medical team.

[Therapeutic approach in pregnant women with an autoimmune thrombocytopenic purpura].

The case presented herein aim to update the existing information about the common diagnostic problems and therapeutic approach in pregnant women that have autoimmune thrombocytopenic purpura (ATP).

[Autoimmune thrombocytopenia during pregnancy (case report and review of literature)].

A case of autoimmune thrombocytopenia [AIT], diagnosed in the first trimester of pregnancy is described. Despite the active treatment with steroids and IVIG the platelet count dropped to extremely low levels in the third trimester--8 x 10(9)/l. Labor was induced in 34 w.g. because of the ineffective treatment of AIT, clinical and sonographic evidence of IUGR and favorable pelvic score. Before and during labor induction platelets were transfused and recombinant factor VIIa (rFVIIa) was applied. After delivery antifibrinolytics as well as low molecular weight heparin [LMWH] were applied also. Laboratory tests demonstrated transient fibrinolysis activation after delivery. Mild transient thrombocytopenia of the newborn was found that was successfully treated with steroids. Review of contemporary literature is made with analysis of the therapeutic approaches in cases of AIT during pregnancy. The impact of thrombocytopenia on pregnancy, labor and delivery, the fetus and the newborn and the route of delivery are discussed. The clinical course and the therapeutic strategies in the particular case are analyzed. A nouvelle approach during labor and after delivery was the application of rFVIIa (because of the tendency for elevation of the titers of allogenic antibodies due to platelet transfusions) and of antifibrinolytics (preserving platelet functions).

[Changes of activation in T-lymphocyte subpopulations in peripheral blood during pregnancy].

From an immunological point of view during pregnancy the interactions between the steroid sex hormones and immunocompetent cells as a part of the dynamic local and peripheral immune response is of a particular interest. The aim of our study is to investigate the expression of the early activation marker CD69 in T-lymphocytes subpopulation: CD4+ and CD8+ in peripheral blood from pregnant and non-pregnant women. Our data clearly demonstrate an increase of the percentage of activated CD4+ lymphocytes in pregnant women in comparison to non-pregnant and this difference is statistically significant. A similar but not statistically significant dependency is observed in CD8+ and CD69+ lymphocytes. From the obtained results we conclude that during pregnancy the activation of CD4+ lymphocytes is increased, which probably leads to an increased production of cytokines that shifts the immune response to Th2 type which is protective for pregnancy. This could be partly due to the increased levels of progesterone.

[Hormonal treatment of recurrent spontaneous abortions].

A retrospective study with 79 pregnant women was conducted. All of them were diagnosed as spontaneous abortion. The patients were separated in two group and the women have been treated in two schemes--51%--Utrogestan and 49%--Utrogestan and Profasi. The medication was applied only into the first trimester of the pregnancy. The duration of the therapy was 15.0 +/- 12.34 days. The mean gestational age in this study was 7.6 +/- 3.0 gestational weeks. Women with a first pregnancy and spontaneous abortion were excluded from the study. The number of this hormonal treated pregnancy was 2.84 +/- 1.13. 10.2% of the followed women had 3 and more than 3 miscarriages. The followed group of women was historically and clinically heterogenic. For that reason we think that many other factors could play a role in the optimum outcome of this pregnancy. The criteria for positive result we accepted the vital embryo/fetus on the time of dehospitalization. From these pregnancy only 3 terminated with miscarriage--3.79%. The rest of 96.2% went at home with intact pregnancy. The authors try to find a theoretical support for use of micronized progesterone Utrogestan--there could be some changes in the cellular and humoral immunity at repeated abortions, related to the change of the cytokine production. It could be find an ability to realize a readjustment of the endocrine system of the mother and to control the immune reaction in the fetoplacental unit.

[First trimester nuchal translucency thickness in normal fetuses in the Bulgarian population].

Nuchal translucency (NT) measurement between 11-14 weeks of gestation is an effective method of ultrasound screening for chromosomal fetal anomalies. The aim of the present study is to construct normal reference ranges of NT thickness for the Bulgarian population. The choice of cut-off NT thickness above which an invasive procedure should be offered is discussed.

[Increased nuchal translucency at 11-14 weeks of gestation in congenital heart disease, genetic syndromes and adverse pregnancy outcome].

Nuchal translucency (NT) measurement between 11-14 weeks of gestation is an'effective method of ultrasound screening for chromosomal fetal anomalies, congenital heart disease, some other structural abnormalities, rare genetic syndromes, skeletal dysplasia and adverse pregnancy outcome (spontaneous abortion and intrauterine fetal demise). The aim of the present study is to assess the prognostic value of increased first trimester NT in fetuses with normal karyotype in relation to pregnancy outcome.

[Localization of leiomyoma with respect to the placenta--factor for complications during pregnancy?].

We are presenting two cases of pregnant women with leiomyoma of the uterus, diagnosed antepartum. In both cases the patients were admitted on an emergency basis due to premature uterine contractions. In both cases preterm hemorrhage and fetal malpresentations were observed. The complications of pregnancy in both of the cases were primarily based on the location of the leiomyoma with respect to the placenta--intramural or submucosal disposition of the leiomyoma, retroplacentarily situated.

[Impact of inherited thrombophilia on the development of some pregnancy complications].

AIM: To assess the clinical significance of inherited thrombophilia [IT] for the development of some pregnancy complications. MATERIAL AND METHODS: The incidence of the following factors was studied in 97 pregnant women with pregnancy complications and in 103 controls: R506Q mutation encoding Factor V Leiden [FVL] synthesis, Prothrombin G20210A mutation, T677 methylenetetrahydropholate reductase mutation [MTHFR], 4G/4G polymorphism of the plasminogen activator inhibitor [PAI 4G/4G]. Among 97 patients in the group studied 39 had early onset severe preeclampsia [PE], 14--placental abruption [AP] without PE, 18--intrauterine growth restriction [IUGR] without PE, 12--stillbirth [SB] without PE, 14--habitual spontaneous abortions [HSA]. The control group included 103 clinically healthy pregnant women with at least one previous uneventful pregnancy, without history of thromboembolic disorders. In addition, patients with severe PE with and without IT were compared regarding g. a. and birthweight at delivery and intrauterine fetal loss rate. DNA analysis was performed according to internationally accepted standards. Pregnancy outcomes were ascertained from hospital records. Statistical significance (p < 0.05) was assessed by means of Student's t-test. RESULTS: FVL mutation was found in 23.7% (23/97) of the patients from the studied group and in 5.8% (6/103) of the controls. Prothrombin G20210A carriers were 11% (11/97) of the studied and 3.8% (4/103) of the controls, while with PAI 4G/4G polymorphism they were 30.9% (30/97) and 14.5% (15/103) respectively. MTHFR T677 was not more frequent in the studied group (8.2%) compared to the control one (29%). Eight of the patients (9.6%) were carriers of more than one mutation. In 22 cases with early onset severe PE and IT gestational age and birthweight at delivery were lower than in the cases with severe PE without IT while intrauterine fetal loss rate did not differ significantly between the two groups. CONCLUSIONS: Inherited thrombophilia is found more frequently in women with pregnancy complications like PE, IUGR, AP, SB, HSA. The incidence of homozygous MTHFR T677 is not higher in these cases. IT worsens the prognosis of severe PE. The diagnosis of IT is important since anithrombotic therapy has to be considered to protect the mother and the fetus.

[Attitude of pregnant women towards prenatal screening for chromosomal and structural fetal anomalies between 11-14 weeks of gestation].

AIM: The aim of the present survey is to analyze the attitude of pregnant women towards the possibilities of prenatal screening and diagnosis between 11-14 weeks of gestation (w.g.). MATERIAL AND METHODS: Overall 109 pregnant women, hospitalized in SBALAG "Maichin dom", received written information about the possibilities for prenatal screening and diagnosis between 11-14 w.g. and 16-20 w.g., as well as a comprehensive description of the potential advantages and disadvantages of the different approaches/methods of screening/diagnosis. Consequently, the patients were asked to answer 13 closed and semi-closed questions in an anonymous enquiry. RESULTS: Overall 97,2% (106/109) of the women agreed to perform an ultrasound examination for fetal nuchal translucency measurement as a screening tool for chromosomal anomalies between 11-14 w.g. Furthermore, 82,6% (90/109) preferred the option of first trimester biochemical screening, rather than screening in the second trimester. On the other hand only 62,4% (68/109) accepted chorionic villous sampling between 11-14 w.g. in comparison to 83,5% (91/109) who agreed to perform an amniocentesis between 16-20 w.g. CONCLUSION: The vast majority of women prefer prenatal screening programs to be scheduled in the first, rather than in the second trimester. However, most women would still choose for a relatively safer second trimester invasive procedure instead of the option of earlier prenatal diagnosis.

[Ultrasound screening for Down syndrome and other chromosomal abnormalities by fetal nuchal translucency measurement between 11-14 weeks of gestation].

AIM: To assess the feasibility of nuchal translucency [NT] measurement as a screening tool for Down syndrome [DS] and other chromosomal anomalies [ChA] between 11-14 weeks of gestation [w.g.]. MATERIALS AND METHODS: A longitudinal prospective follow up study was carried out at a tertiary referral center including 408 singleton pregnancies between 11+0 and 14+0 w.g. Three experienced sonographers performed transabdominal and/or transvaginal scans using high-resolution ultrasound equipment. The ultrasound examinations included assessment of fetal number and viability, NT measurement and fetal anatomy survey. Down syndrome [DS] risk was calculated using the specialized computer program provided by the Fetal Medicine Foundation [FMF], UK. In cases of estimated DS risk > or = 1:300 invasive prenatal diagnosis was offered--chorionic villus sampling [CVS] between 11-14 w.g. or amniocentesis [AC] after 15 w. g., as well as follow-up scans including fetal echocardiography. The samples were tested by cytogenetic analysis, DNA analysis and/or FISH. When chromosomal fetal abnormality was detected termination of pregnancy was an option. Pregnancy outcome was ascertained from hospital records, referring physicians or the patients themselves. RESULTS: 108 (26%) out of the 408 women were ?35 years and 300 (74%)--below that age. A total number of 9 fetal chromosomal anomalies [ChA] were found including 6 cases with DS, 2--with trisomy 18 [T18] and 1--with Turner syndrome. The overall sensitivity for DS was 66.7% for a false-positive rate [FPR] of 13.4%. The figures for all ChA were 77.7% and 12.8%, respectively. All three cases of ChA other than DS were in the screen-positive group. The overall sensitivity and FPR for ChA for patients > or = 35 years was 80% and 35%, while for patients < 35 years it was 75% and 5.1 %, respectively. Diagnostic invasive procedures were performed in 50 out of 58 screen-positive cases, including 7 of the cases with ChA. In all 7 cases with prenatal diagnosis of fetal ChA the parents chose to terminate the pregnancy. CONCLUSIONS: First trimester DS screening by NT measurement has high sensitivity and specificity. Screening for other chromosomal abnormalities missed by second trimester biochemical serum tests is also possible. Invasive prenatal diagnosis is performed at an early gestational age when termination of affected pregnancies by D&C is still an option. Other important advantages are the possibility of screening for ChA in multiple gestations, as well as early diagnosis of major fetal anomalies.

Preoperative sonographic evaluation of patients with endometrial carcinoma.

OBJECTIVE: The aim of the study was to evaluate the possibilities of endovaginal ultrasound in the preoperative clinical assessment of patients with endometrial carcinoma. METHOD: Sixty-four postmenopausal women with a diagnosis of endometrial carcinoma after dilatation and curettage were scanned before operation with a 7.5-MHz endovaginal probe. RESULTS: The location of the process and depth of myometrial invasion were estimated correctly in the vast majority of patients. Spread beyond the uterus and distance from the serosa could not be estimated precisely. CONCLUSION: Preoperative evaluation and staging of endometrial carcinoma are possible and useful for gynecologists, as they provide information on tumor location, depth of myometrial invasion, and involvement, if present, of the lower uterine segment or cervix.

[Drug interactions with oral contraceptive steroids]. / Vzaimodeistvie na medikamenti s oralni kontratseptivni steroidi.

PIP: Various drugs are capable of enhancing or inhibiting the effect of oral contraceptives (OCs). Drugs of the rifampicin group are active enzyme inductive agents which affect both the estrogenic and progestagenic components of OCs. This was demonstrated by the following pharmacokinetic study. 8 women received a single dose of Minovlar (50 mg of ethinyl estradiol and 1 mg of norethindrone acetate) during a rifampicin course, and another dose of the same OC was administered after the completion of the drug course. Rifampicin reduced the half-life of ethinyl estradiol from 6.2 to 3.2 hours and that of norethindrone acetate from 6.5 to 2.9 hours. Anticonvulsive drugs, e.g., phenytoin, phenobarbital, methylphenobarbital, and carbamazepine, often cause failures of contraceptive programs using OCs. A recent study followed the effect of phenobarbital in 4 women taking OCs. In two cases, the concentration of estrogen in blood plasma decreased significantly and hemorrhages occurred. In such cases, other methods of contraception should be recommended. Statistics show that, in 1982, 38 English women experienced unsuccessful contraception because they took various antibiotics simultaneously with OCs. This effect was reported for ampicillin, tetracycline, erythromycin, nitrofurantoin, and other antibiotics. On the other hand, ascorbic acid (Vitamin C) enhances the effect of OCs. The above studies prove that the interactions of rifampicin, anticonvulsive drugs, and antibiotics with OCs are pharmacodynamic, rather than pharmacokinetic, interactions. There is no clinical evidence to prove that OCs interfere with the metabolism of certain drugs. Future clinical and paraclinical studies are needed for a better understanding of these effects.^ieng

[Modern noninvasive methods for terminating pregnancy in the 2nd trimester]. / Moderni neinvazivni metodi za prekusvane na bremennostta prez II-iia trimestur.

Pregnancy interruption upon medical indications between the 13th and 21st gestational weeks is carried out mainly by two-phase invasive techniques including intraamnial application of NaCl and vaginally prostaglandins, laminarie or solutio rivanoli, followed by a surgical treatment (instrumental revision). Because of its invasive character these techniques can cause severe complications. The application of prostaglandin analogues (P.G.) is safer but it is connected with gastrointestinal side effects and their action is often protrachirated especially "primigravida" with a undeveloped infantile P.V.C.U. the author proposes a highly effective non-invasive technique implementing the following combination: sensibilization with an antiprogestin (synthetic norsteroid--Ru 486), applied perorally: 1 tablet 200 mg; 24 hours before the intracervical (vaginal) insertion of the PGO2 tablet or gel. Results are extremely effective and good: the time for pregnancy interruption is reduced to more than 50% (average 5 to 10 hours), side effects and complications are minimized and the hospital stay is significantly reduced.

[Screening for chromosomal anomalies of the fetus between 11-14 gestational weeks. Review of literature]. / Skrining za khromozomni anomalii na ploda mezhdu 11-14 g.s. Literaturen obzor.

The aim of the review is to provide an up-to-date overview of the possibilities for prenatal screening for chromosomal fetal anomalies between 11-14 weeks of gestation. A specific ultrasound marker in the first trimester, known as fetal nuchal transluceny [NT], is described. The usefulness of fetal NT as a screening tool for chromosomal anomalies, some structural anomalies, rare genetic syndromes and adverse pregnancy outcome is discussed.

[Sterilization as a contraceptive method]. / Sterilizatsiiata kato kontratseptiven metod.

PIP: Sterilization has been recognized as an efficient method of contraception and has been used worldwide in recent years. Indications and contraindications for the sterilization of men and women are described as well as the legal and ethical aspects of the problem. The authors describe the most modern surgical methods utilized: conventional laparotomy, minilaparotomy, colpotomy, and vasectomy, and also discuss the biological and side effects of the manipulations. The advantages of the method are also discussed. (Authors' modifeid)^ieng

[Cardiotocographic control during labor]. / Kardiotokografski kontrol po vreme na razhdaneto.

The authors discuss different aspects of intrapartum foetal monitoring. The scientific basis of foetal intrapartum foetal monitoring are pointed out. The authors present three groups of cardiotocographic signs which should alarm the obstetricians: warning signs, threatening signs and clear signs for foetal distress. The authors discuss also the specific characteristics of the cardiotocographic record of premature fetus during pregnancy and labour. It is pointed out that the intrapartum foetal monitoring and the correct interpretation of the cardiotocographic record lead to better perinatal results.