[The effect of antenatal corticosteroid prophylaxis in premature newborns with the use of surfactant therapy]. / Efekt ot antenatalnata kortikosteroidna profilaktika pri prematurni novorodeni sus surfaktant terapiia.

The study is retrospective aiming to elucidate the effect of antenatal corticosteroids (CS) for prevention of RDS in preterm deliveries, followed by surfactant therapy. 28 premature babies from 26 to 31 gest. weeks, receiving Curosurf at birth, were included in the study. They were divided in two groups: group A-17 babies of mothers with CS prophylaxis and group B-11 babies from deliveries without prenatal CS. All babies were followed for incidence and severity of RDS, duration of artificial ventilation and oxygen therapy. Although mean gestational age and body weight are lower in group A, incidence of severe RDS is lower (23.5% versus 36.4% in group B); duration of artificial ventilation with FiO2 > 0.60 and as a whole is smaller (mean 28.9 hrs and 186 hrs v/s 50.3 hrs and 228 hrs resp. in group B; p < 0.05), duration of oxygen therapy is shorter (mean 428 hrs v/s 540 hrs in group B; p < 0.05), smaller is the incidence of pneumothorax, IVH gr. III-IV, inborn infections and death rate although not statistically significant. The conclusion is made that antenatal use of CS improves lung function in premature babies and potentiates the effect of surfactant.

[The dynamics and trends in surgical delivery at the Maternity Home of the State Institutional Hospital]. / Dinamika i tendentsii na operativnoto rodorazreshenie v DIB "Maichin dom".

The study discusses the frequency of operative obstetric deliveries (cesarean section, forceps extraction and vacuum extraction) over a period of 18 years from 1976 till 1993. A total of 100,545 deliveries with 100,192 livebirths took place during this period with a decrease of the annual number of deliveries in the last years. The frequency of the various kinds of operative deliveries shows different tendencies. The frequency of cesarean section has increased from 4.87 per cent in 1976 to 19.58 per cent in 1993, this increase being particularly marked during the last 6 years. Meanwhile the vaginal operative deliveries have decreased their frequency. The decrease of forceps extraction is from 4.33 to 2.22 per cent (steadily about 2 per cent during the last years). The frequency of vacuum extraction has dropped from 1.89 per cent to 0 by the end of the 1980 and the beginning of the 1990. The tendencies of the development of obstetric operations are analysed as well as their influence on perinatal outcome.

[The static and dynamic profiles of urethral pressure in women with stress incontinence and in healthy controls]. / Statichni i dinamichni profili na uretralnoto naliagane pri zheni sus stres inkontinentsiia i pri zdravi kontroli.

The study presents the results of urethral pressure profile measurements in 3 groups of women: continent nulliparous, continent parous and stress incontinent women. The maximum urethral closure pressure, the functional urethral length and the length of continence zone are compared. The healthy control groups (both parous and nulliparous) show much higher maximum urethral closure pressures than those mentioned in literature. No difference is evident between continent parous and continent nulliparous which suggests that vaginal delivery at term does not necessarily impair urethral sphincteric function. On the other hand women with similar age and parity with stress incontinence have a marked decrease of maximum urethral closure pressure at rest and demonstrate inability to increase it by volitional contraction of the pelvic floor. These findings support the idea of the leading role of sphincteric incompetence in stress incontinence. The functional urethral length and the length of continence zone show no significant differences among the investigated groups which implies that they are of no importance for the occurrence of stress incontinence.

[The role of serum beta-HCG levels for the diagnosis of ectopic pregnancy]. / Rolia na serumnite niva na beta-ChKhG za diagnozata na ektopichnata bremennost.

The study includes 56 cases of women admitted at Second gynaecology clinic of the University Maternity Hospital Sofia with evidence or suspicion of having an ectopic pregnancy who had their serum beta-HCG levels determined quantitatively. 27 of them showed no beta-HCG in their sera and none turned out to have pregnancy, neither intrauterine nor ectopic. All cases of ectopic pregnancies (a total of 20) were associated with detectable beta-HCG levels in the serum. The great diagnostic value of serum beta-HCG is emphasized in the cases of old disturbed ectopic pregnancies accompanied by mild and uncommon symptoms and very low beta-HCG levels. In case of unruptured pregnancies or tubal rupture the diagnosis is verified before the result is available by the clinical and sonographic data. On the other hand the high sensitivity of the method leads to an increased number of cases with elevated beta-HCG in which the location of the pregnancy cannot be proven. The precise quantitative evaluation of serum beta-HCG enables us to follow the tendency of beta-HCG which may according to the clinical manifestations warrant invasive diagnostic procedures or just observation without active interference.

[The treatment of urinary stress incontinence with the sling and Pereyra's suspension]. / Lechenie na pikochnata stres-inkontinentsiia sus "Sling" i okachvane po Pereira.

Patients with proven stress incontinence were subjected to surgical treatment which combined both sling and Stamey-Pereyra techniques. A 3-4 cm long and 1,5-2 cm wide sling of Bulgarian polyamide mesh was placed under the urethrovesical junction using a small vaginal incision. Two long polyamide sutures were tied to either end of the mesh and were retrieved from the vagina to the abdomen by Pereyra needle inserted through two small suprapubic incisions and guided by the vaginal forefinger. The technique of the procedure is described. A total number of 27 patients were operated on. Two of them has their suspending sutures cut postoperatively because of prolonged urinary retention. The remaining 25 were continent. The technique proposed combines the advantages of the sling procedures (high efficiency especially in cases of severe and recurrent incontinence) and the simplicity of Stamey-Pereyra suspension technique. On the other hand the Bulgarian polyamide mesh showed very good qualities. No infection, rejection or sling erosion were observed.

[The early breast feeding of newborn infants]. / Ranno zakurmiane pri novorodenite.

Breast feeding was started at the age of 2 hours after birth, immediately after mother and baby were transported to the clinic for healthy term newborns. Our aim was to investigate the influence of the early start of breast feeding on the development of the newborns and on their mothers, as well as to compare the results with those, obtained when breast feeding had begun on the 6-th hour after birth. The results from our work show that the earlier the beginning of breast feeding, the earlier and the more effective the consolidation of the process. The physiological loss of weight with these babies shows a smaller percentage. The level of blood sugar varies in the normal limits. So far as mothers are concerned, the early beginning of breast feeding has a good impact on their after-birth period and helps the earlier initiation of the secretion of breast milk.

[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.

[Doppler study of the fetal and uteroplacental blood flows in IUGR]. / Doplerovo izsledvane na fetalniia i utero-platsentarniia kruvotok pri IUGR.

It was established during Doppler examination of the fetal and uteroplacental blood flow in intrauterine retardation in the growth of the fetus (IUGR) that the mean velocity of blood flow in the fetal aorta was 29.21 +/- 3.98 sm/s. It was statistically significantly lower than that in normal pregnancy. The mean velocity of the blood flow in the umbilical artery--30.90 +/- 5.82 cm/s and in the artery--54.22 +/- 15.48 cm/s were also lower than those in normal pregnancy, but the difference was not statistically significant. It is pointed out that the lack of terminal diastolic blood flow of the fetal aorta and the presence of double incisure of the artery arcuatus are pathological signs of Doppler wave. It is indicated the Doppler examination of the fetal and uteroplacental blood flow in IUGR is a new noninvasive method for early diagnosis of placental insufficiency.

[Doppler study of the fetal and uteroplacental blood flows in normal pregnancy]. / Doplerovo izsledvane na fetalniia i utero-platsentarniia kruvotok pri normalna bremennost.

The Doppler examination of the fetal and uteroplacental blood flow established that the mean velocity of the blood flow in the fetal aorta was 32.46 +/- 2.13 cm/s, in the arcuate artery--60.46 +/- 10.75 cm/s, in the umbilical artery--33.54 +/- 7.14 cm/s, but in the umbilical vena--15.83 +/- 1.00 cm/s. It was indicated that the volume of the blood flow of the fetal aorta in ml/min was increased with advancement of the gestational age, but it remained relatively constant during pregnancy when it was estimated in ml/min/kg. The characteristic of Doppler wave of the fetal aorta as well as of the umbilical artery and arcuate artery were analysed. It is pointed out that the Doppler examination of the fetal and uteroplacental blood flow is a new, noninvasive, valuable and objective method in the diagnosis of the fetal state.

[The importance of x-ray pelvimetry for the prognosis of pelvic dystocia]. / Znachenie na rentgenovata pelvimetriia za prognozirane na tazovata distokiia.

The frequency of roentgenological pelvimetry at the Research Institute of Obstetric and Gynecology during 1988 is 4.79%. Thirty-five pelvimetries out of 276 (12.68%) were urgent, but the remaining 241 (87.32%) were planned. Pelvimetries showed normal measurements in 113 of pregnant women (40.94%), but there was shortening in one or more diameters of the single planes of the pelvis in 163 women (59.06%). The measures of the diameters of the pelvic cavity were shortened most frequently, more rarely at the pelvic inlet and most rarely at the pelvic outlet. Changes in the bony pelvis were indicated after secondary traumatic deformity of the pelvis. The role of roentgenological pelvimetry in taking decision for delivery of breech presentation of the fetus was analyzed. It is pointed out that the roentgenological pelvimetry is the single, easy, convenient, safe and available method for determination of pelvic diameters, respectively for prognosis of pelvic dystocia.

[The effect of partusisten on the rate of blood flow in the fetal aorta]. / Vliianie na partusisten vurkhu skorostta na kruvotoka na fetalnata aorta.

It is established that the mean velocity of blood flow (Vmean) of the fetal aorta in pregnant women with pre-term deliveries during Doppler examination is 40.70-3.26 cm/s, but in women with normal pregnancy (a control group) is 32.46-2.13 cm/s. The difference is statistically significant (p less than 0.001). It is indicated that the tocolytic Partusisten passes through the placental barrier, penetrates in the fetal circulation and accelerates the velocity of the blood flow. This shows that it improves utero-placental circulation and fetal oxygenation and with this the general state of the fetus as well. It is pointed out that the results from this study support the rightness for usage of Partusisten in treatment of chronic and acute placental insufficiency for improvement of fetal hemodynamics as well as the general state of the fetus.

[X-ray diagnosis of submucosal fibromyoma]. / Otnosno niakoi aspekti ot rentgenovata diagnostika na submukoznata fibromioma.

Data on hysterographic examination are analysed in 57 women, in whom there are roentgenologic signs for myomatous nodes, localized submucosally. An attempt is made to systematize characteristic changes in this lesion (measures, location, form and outlines). A conclusion is reached that roentgenological examination with the possibility objectively to establish the existence of submucous myomas, on the one hand and to determine their typical morphological peculiarities, on the other, could help to diagnose cases with obscure clinical history.

[The place of x-ray pelvimetry in obstetrical practice]. / Miasto na rentgenovata pelvimetriia v akusherskata praktika.

The frequency of roentgenological pelvimetry, its changes in accordance with obstetric management of labour and its place in the obstetric practice were studied at the Research institute of Obstetric and Gynecology for the period of 1979-1988. It was established that its mean frequency for the investigated period was 7.0%, but its highest frequency--11.1% during 1982. During the following years its frequency gradually diminished and it was stabilized within the ranges of 3.5 to 5.0% during the last three years. It is indicated that roentgenological pelvimetry should be made compulsory in women with secondary deformed pelvis and in women with fetal breech presentation, whose parturition should be managed per vias naturales. It is stressed that the roentgenological pelvimetry has its place in the obstetric practice and it is a valuable diagnostic method.

[Comparative evaluation of methods for the diagnosis of submucosal myomatous nodules]. / Sravnitelna otsenka na niakoi metodi pri diagnozata na submukoznite miomni vuzli.

The authors examined 33 women at fertile age with complaints of dysfunctional uterine bleedings, not affected by medicamentous therapy and absence of convincing data for changes in the gynecological status. Probatory curettage was made in 18 out of 33 women, but ultrasonic examination was made on the other 15 patients. We compared the obtained results with the data from hysterographic examination. It was established that the diagnosis of submucous nodules was established in 44.4% of women after the probatory curettage, while this was true only in 1/5 of the patients by the method of echography as in diagnostic respect the results were in direct dependence upon the size and location of myomatous nodules.