[Treatment of life-threatening bleeding in obstetrics and gynaecology --NovoSeven (recombinant factor VIIa)].

The study offers the results from the application of recombinant factor VIIa (NovoSeven) in 19 patients with obstetric or gynaecological problems showing severe haemorrhage of non-surgical origin, which could not be controlled by standard therapy (surgery and resuscitation). Haematological and haemostaseological values as well as final outcome are being monitored. The role of the drug and its special indications in complex urgent treatment of life-threatening bleeding are being discussed. Conclusions. The use of NovoSeven (recombinant factor Vlla) on time and when indicated guarantees rapid and effective haemostasis. Thus laparotomy or relaparotomy can be avoided. If no effect is observed after the application of NovoSeven indicates bleeding from a major blood vessel, demanding laparotomy and surgery. The use of the drug leads to reducing the incidence of blood derivatives transfusions and (being a recombinant product)--no risk of transmissive infections.

[A clinical and microbiological study of bacterial vaginosis and vaginitis in pregnant women]. / Kliniko-mikrobiologichno prouchvane na bakterialnite vaginozi i vaginiti pri bremenni zheni.

Infectious complications in pregnancy and delivery are still y serious problem in obstetrical, gynecological and neonatological practice. The main part of them are caused from the anaerobic organisms associated with bacterial vaginosis as well from sexually transmitted pathogens. In this study we present data about the frequency of spreading of bacterial vaginosis and vaginitis in pregnant women at different stages of pregnancy. We held y study of 106 pregnant women aged between 15 and 35, registrated at the Pregnancy Consultation Office in eleven. About half of the women did not have data for genital discharge and the microbiological analysis showed normal vaginal flora. Two thirds of the rest investigated women had data for candidiasis, bacterial vaginosis, or both. Only one case of Trichomonas vaginalis-vaginitis was detected. The results from the microscopic examination of the specimens from 10 (9.4%) of the women were suspected for N. gonorrhoeae and/or Chlamydia trachomatis-cervicitis. Group B streptococci in significant quantity was found in five cases. These results showed high frequency of spreading of bacterial vaginosis and cervico-vaginitis in pregnant women.

[The plasma concentrations of thiocyanates, estradiol (E2), follicle-stimulating hormone (FSH) and prolactin (Prl) in women smokers]. / Plazmeni kontsentratsii na tiotsianati, estradiol (E2), folikulostimulirasht khormon (FSH) i prolaktin (Prl) pri zheni pushachki.

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.

[A clinical study of the efficacy of and tolerance for the combined transdermal preparation Estracomb TTS (CIBA)]. / Klinichno prouchvane vukhu efektivnostta i ponosimostta na kombiniraniia transdermalen preparat "Estracomb TTS" (CIBA).

Result from the first study, carried out in our country an the therapeutic effects of Estracomb TTS in women with peri- and postmenopausal symptoms are reported. Seven women with postcastration syndrome and eight women with an intact uterus and no vaginal bleeding for a least 6 months were treated. In all women enrolled in the study the application of the preparation Estracomb TTS led to a significant improvement of peri- and postmenopausal symptoms without serious side effects.

[The testicular feminization syndrome combined with disseminated hemangiomatosis]. / Sindrom na testikularna feminizatsiia suchetan s diseminirana khemangiomatoza.

It is described a new born child with many hemangiomas on the liver. It is made a karyogram to exclude. The possibility of chromosome disease. We fixed male karyotype 46 XY--syndrome Morris. We found out that it is a rare combination of testicular feminization with disseminated hemangiomatosis. After the medical treatment with high doses of cortisone the hemangiomas decreased their sizes.

[Serum levels of prolactin, progesterone and estradiol in nursing mothers]. / Serumni niva na prolaktin, progesteron i estradiol u kurmachki.

The serum concentrations of prolactin, progesteron and estradiol affecting twenty-four parturients in the puerperium period are studied. The proportion of prolactin on one hand in accordance with progesteron on the other hand are examined. The required condition for lactogenesis is serum concentration of prolactin above 100 ng/ml and the low levels of progesteron and estradiol. The effect of primary breast feeding on the level of prolactin concerning ninety suckling mothers has been studied. The installment of a breast six hours after child-bearing stimulates the prolactin synthesis whereas the late breast feeding after seventy-two hours decreases the concentration of prolactin and suppresses lactation.

[The possibilities for stimulating lactation]. / Vuzmozhnosti za stimulirane na laktatsiiata.

The lactopoesis with Cerucal and by laser acupuncture is stimulated, concerning fifty-four women with an early milk insufficiency. An increase of the quantity of the secreted mother's milk and an increase of the serum level of prolactin have been ascertained. Both methods for stimulating the milk secretion have been recommended. The plan of medical treatment by Cerukal is suitable in an early milk insufficiency of hypoprolactinemic origin. Laser acupuncture is applied successfully in milk insufficiency owning to stagnant and inflammatory changes in the lacteal gland.

[An efficacy and tolerance study of transdermal estrogen replacement therapy with the preparation Systen R50 (Cilag)]. / Prouchvane vurkhu efikasnostta i ponosimostta na transdermalnata estrogen-zamestitelna terapiia s preparata Systen R50 (Cilag).

Results from the first study, carried out in our country on the therapeutic effects of Systen [correction of System] R50 TTS in women with peri- and postmenopausal symptoms are reported. Eight women with postcastration syndrome and seven women older than 50 years, with an intact uterus and no vaginal symptoms are reported. Eight women with postcastration syndrome and seven women older than 50 years, with an intact uterus and no vaginal bleeding for at least 6 months were treated. Progesterone was prescribed in the non-hysterectomised patients. In all women enrolled in the study the application of the preparation Systen [correction of System] R50 TTS led to a significant improvement of peri- and postmenopausal symptoms without serious side effects.

[Hysterectomy in obstetrical practice (1979-1990)]. / Khisterektomiia v akusherskata praktika (1979-1990).

Caesarean hysterectomy and hysterectomy after vaginal delivery from 1979 to 1990, the indications, the complications and the mother's outcome are retrospective investigated. By 41010 births the hysterectomy rate is 0.068%, caesarean hysterectomy-15 (0.056%), and hysterectomy after vaginal delivery-12 (0.030%). The common est caesarean hysterectomy indications are infected uterus, haemorrhage, myoma, carcinoma colli uteri (80%). Haemorrhage and rupture uteri (75%) are the general hysterectomy indications after vaginal birth. A low complication rate is found out, 3 women are deceased (11.11%) in the group of hysterectomy after vaginal delivery. The authors have underlined benefits of the preferred recently organ keeping approach.

[The effect of E2 and progesterone on the receptor status in endometrial carcinoma]. / Kum vuprosa za vliianieto na E2 i progesterona vurkhu retseptorniia status na endometrialniia kartsinom.

The authors study the plasma levels of E2 and progesterone in 62 women with EC. Parallelly the ER and PR in the same number of cases have been studied. The values of E2 in the plasma of ER+ are much lower than those of E2 in ER-. The quantity of E2 and progesterone influence the values of ER and PR in cancers of women in pre and postmenopausal age. In positive ER and PR patients the level of E2 and progesterone is lower in comparison of ER- and PR-.

[Surgical contraception after cesarean section]. / Khirurgichna kontratseptsiia sled tsezarevo sechenie.

Cesarean section is a routine operation in the obstetric practice and is performed by medical indications only taking into consideration life and functional integrity both of the mother and the fetus. Our studies show that operative contraception together with cesarean section is made in 92% of parturients over 30 years of age in accordance with the required practice. The physician proposes in 16% of women, but in the remaining parturients as in all cases the the consent is documented by the signature of the parturient. Death of children (it is assumed that 2 children are indication for sterilization) due to various causes and operative deprivation of the woman from her child-bearing capability raises moral, ethic and legal questions. On the first place-indications for sterilization during cesarean section. How such type of operation should be made either by the initiation of the physician or after premeditated desire of the parturient. Is it sufficient her consent orally or written. Is the consent of the husband needed and under what form, since he could raise the question about punishment of the physician-obstetrician. The question about danger of healthy and life is not on the last place as well. Our studies during the last 5 years show that this type of intervention is frequent phenomenon--16.34% of the undergone operative deliveries. Furthermore this type of intervention should be performed only by medical indications, having in mind their significance for the future mother, family and society.

PIP: Cesarean section is a routine operation in obstetric practices and is performed when medical indications are present. These studies show that operative contraception along with cesarean section covered 92% of the parturients over 30 years of age. Child mortality (it is assumed that 2 children are indication for sterilization) is due to various causes. Removing childbearing capability raises moral, ethical, and legal questions. Issues such as who should suggest this type of procedure (physician or patient), is oral consent sufficient or must it be written, is husband's consent necessary and in what form, and what are the indications for the procedure in the first place must be considered. The authors' studies over the last 5 years show that this type of intervention is a frequent phenomenon, 16.34% of the operative deliveries performed. This type of intervention should only be performed when there are medical indications, and should take into account the future mother, family and society. (author's modified)