[POLYGYNAX IN THE TREATMENT OF VAGINAL INFECTIONS IN PREGNANT AND NON-PREGNANT WOMEN--CLINICAL EXPERIENCE].

Vaginal infections /VI/ represent some of the most common diseases by infection of FGS. The aim of this study is to analyze clinical and bacteriological efficacy of Polygynax in the treatment of vaginal infections and to take into account the correlation between the results of microbiological controls and reduction of clinical symptoms. The study included 100 patients, including 50 pregnant and non-pregnant 50 for a period of 3 months. All of them was diagnosed with vaginitis clinical examination, taken material from vagina for microbiological testing. The studied women was conducted targeted therapy Polygynax 12 capsules, in the form of vaginal capsules for 12 days, after which the sample control microbiology. Behind the subjective complaints of the patient and to reduce them as a result of treatment. The effective implementation of Polygynax 12 capsules is equally good as in non-pregnant and pregnant women. In a summary of the survey data to make relevant analyzes and conclusions from the results.

[Reproductive problems in women with PCOS, the impact of PAI-1 carriers of 4G PAI-1 polymorphism and BMI].

Approximately 7-12% of women in reproductive age are affected by PCOS[2] and 40 to 70 percent of them are overweight contributing to the clinical picture of PCOS and increased reproductive and metabolic disorder. In order to investigate the role of PAl-1 as a possible risk factor for the development of PCOS a group of 67 women with polycystic ovarian disease and 70 healthy controls were investigated for levels of PAl-1 and carriage of the promoter polymorphism 675 4G/5G in gene of PAI-1. The correlation with BMI was checked. The results of the DNA analysis showed a high carriage of polymorphism 675 4G/4G in promoter of PAl-1 gene in women with PCOS but not significant (OR = 1.655; p = 0.141), as well in the total group of the patient (OR =1.474; p>0.05). Serum levels of PAI-1 were significantly higher in total group of patients compared to controls. The levels of PAI-1 is correlated with carriage of 675 4G/5G polymorphism in the gene for PAI-1 (r=0.534; p=0.03) as well as with BMI, like correlation coefficients were higherin the group with PCOS (0.572; p=0.04). Data from the disease history showed a higher percentage of women with reproductive problems: early pregnancy loss 48.5% and infertility 23.2%, significantly higher in the group with PCOS (58.1% compared to 32.4%). The carriers of polymorphism 4G are at greater risk for early pregnancy loss than those with 5G (61.45% as compared to 36.8%), which confirms that carriage of the polymorphism 4G/5G 675 gene PAl-1 has a specific in multifactorial pathogenesis and expression of PCOS.

[Reproductive problems in women with PCOS, the impact of PAL-1 CARRIERS OF 4G PAI -1 polymorphism and BMI].

Approximately 7-12% of women in reproductive age are affected by PCOS[2] and 40 to 70 percent of them are overweight contributing to the clinical picture of PCOS and increased reproductive and metabolic disorder. In order to investigate the role of PAl-1 as a possible risk factor for the development of PCOS a group of 67 women with polycystic ovarian disease and 70 healthy controls were investigated for levels of PAI-1 and carriage of the promoter polymorphism 675 4G/5G in gene of PAl-1. The results of the DNA analysis showed a high carriage of polymorphism 675 4G/4G in promoter of PAI-1 gene in women with PCOS but not as significant (OR = 1.6645, p = 0.141). Serum levels of PAI-1 were significantly higher in total group of patients compared to controls. The levels of PAI-1 is correlated with carriage of 675 4G/5G polymorphism in the gene for PAI-1 (R = 0.534, p = 0.03) as well as wih BMI, like correlation coefficients were higher in the group with PCOS (0.572, p = 0.04). Data from the disease history showed a higher percentage of women with reproductive problems: 61.5% (early pregnancy loss and infertility) significantly higher in the group with PCOS (70.1% compared to 54.1%). The carriers of polymorphism 4G are at greater risk for early pregnancy loss than those with 5G (61.45% as compared to 36.8%), which confirms that carriage of the polymorphism 4G/5G 675 gene PAI-1 has a specific in multifactorial pathogenesis and expression of PCOS.

[Sclerosing stromal ovarial tumor--a case report and review].

Sclerosing stromal tumor (SST) is a rare benign ovarian neoplasm of stromal origin with less than 100 cases reported in the literature. Unlike the other stromal tumors, the comas and fibromas, which tend to occur in the fifth and sixth decades, sclerosing stromal tumors predominantly affect females in the second and third decades. Several unique histologic features including pseudolobulation, sclerosis and prominent vascularity of the tumor are clearly reflected at ultrasonography. We present a case of SST of the ovary in a 26-year-old female, and describe the ultrasound findings with pathologic correlation.

[For and against non-obstetrical indications for cesarean section]. / Za i protiv neakysherskite indikatsii za sectio caesarea.

The authors have made a retrospective study on the nonobstetrical indications for SC from 1996-2000 year, with the help of special documents belonging to VMI, Obstetric Clinic, Pleven. There have been 10,465 deliveries in the same period, 1096 with SC (10.47%). The main indications in 56 cases (5.11%) were non-obstetrical complications of pregnancy and delivery. The most frequent non-obstetrical indications were: ophthalmological in 18 (32.14%), orthopedical in 10 (17.86%), cases CNS diseases in 5 (8.93%) and cancer in 3 (5.36%). We have included: Condylomata accuminata--5 (8.93%), acute thrombophlebitis and thromboembolic diseases--5 (8.93%), a condition after plastic repairs of the perineum, virgin and vulvae--3 (5.36%). Special interest was taken on another group of patients with some rare diseases about the other specialist recommended SC. The ovarian age of the patients was 20-29 years--in 36 (64.28%). The SC has been performed in 30 cases (53.57%) in the first stage, in 14 (25.00%) in the second stage of delivery and in 12 (21.43%) cases was emergency. The conclusions of the authors is that the Obstetricians, who manage the delivery, may not always been comparted with that of the other specialist. This comes from the fact that the responsibility is mainly for him.

[Rational method for prostaglandin use in cases with postpartal uterine hypotonia]. / Ratsionalen podkhod v upotrebata na prostaglandini pri sledrodova matochna khipotoniia.

The authors aim is to find out the most common dosages, roads of administration and the effect of 15-Methyl PgF2a (Prostin 15 M) during the treatment of postpartal uterine hypotony 1 to 3 amp. Of Prostin 15 M-1 ml. (250 mg Carboprost) were used deeply muscular, intracervical or intramyometrial, by 51 patients with postpartal hypotony. The most common risk factors associated with the development of postpartal haemorrhage are PIH, prolonged labour, the general anaesthesis and higli multiparity. The adequate treatment with Prostin 15 M woned reduse the life threatening complication in the Labour room. The most efficient is the intracervical way of administration, a good effect could be achieved even with 1 amp. Prostin 15 M when it is applied after the conventional methods and manipulations. The lacu of effect grow Prostin 15 M (in 5.88% in this study) shows that there is another pathology responsible for postpartal hemorrhage and life threatening hemorrhage and this usually requires Laparotomy. We offer every Obstetric Clinic to have 3 amp. Prostin 15 M available and these would spare a lot of negative feelings or emotions and it wont supply a better obstetric outcomes.

[The significance of the problem of umbilical cord prolapse during delivery]. / Znachenie na problema "prolaps na pupnata vruv pri razhdane".

The authors aimed at studying the significance of cord prolapse in modern obstetrics. 18836 deliveries were studied. These deliveries occurred during a 7 year period (1990-1996) and a rate of cord prolapse of 0.106% was found (1 case in 941.8 deliveries). Cord prolapse was found in 20 deliveries of which 16 were singleton pregnancies and 4 multiple. 7 of the women were nulliparous and 13 multiparous. The majority of patients were of gestational age 38-41 weeks--13 (65.0%) 4 (20.0%) were between 30-37 gestational weeks and 3 (15.0%) were 42 gestational weeks. Of the singleton pregnancies only one fetus was in a transverse lie, 8 were breech presentations and 7 vertex presentations. Delivery was accomplished by cesarean section in 2 (45.0%) cases. Of the 8 breeches 3 were delivered by CS, 4 vaginal manual delivery and one (1) by manual extraction. All multiple pregnancies were delivered vaginally normally. Of the singleton pregnancies only 2 were under 2000 g weight, Perinatal infant mortality rate in this group was 291.67% (7 of 24). Still births were 2 and they occurred intrapartially: one was a vertex presentation after refusal of CS, and the second--after breech extraction (1500 g birth weight). The authors conclude that in order to reduce the rate of cord prolapse indications for CS should be precisely revised for multiple pregnancies breech presentation.

[The effect of tobacco smoking on maternal weight gain and the neonatal results]. / Vliianie na tiutiunopusheneto vurkhu maichinoto naddavane na teglo i neonatalnite rezultati.

UNLABELLED: Our aim was to investigate the effects of smoking till term on maternal weight increase and on the foetus after delivery. The study is prospective and includes a group of 238 pregnant smokers consulted at the Antenatal clinics of the 3rd county polyclinic, Pleven. 115 of them smoked regularly until term at least 5 cigarettes weekly (48.32%), while 123 stopped smoking prenatally (45.9%). Utilizing a special test these two groups were compared based on their pre-delivery weight and the weight of their foetuses. RESULTS: The women who stopped smoking increased in weight with 16.6 kgs (SD-14.5), while those who smoked till term thrived with 13.2 kgs (SD-11.7) (Pt 0.001). This greater increase in maternal weight is connected with a 3.1 times more frequent delivery of babies weighing more than 4000 gr. All neonates with LBW were in the group of smokers, as well as those with foetal demise (perinatal deaths = 12.76%. CONCLUSION: In the studied group stoppage of smoking is connected with less risk of inadequate increase of weight, LBW and their foetuses more frequently weigh more than 4000 gr.

[The Materna preparation as an agent for iron prophylaxis and treatment in pregnancy disorders]. / Preparatut "Materna" kato sredstvo za zheliazoprofilaktika i lechenie na niakoi narusheniia prez bremennostta.

Quality proteins, salts and minerals are necessary for the well development of the foetus and the pregnant woman, one of the ways of supplementing or supplying these is via multivitamins. One of these is Materna, a preparation of 21 vitamins, minerals in a well-balanced formula. We used Materna for ferroprophylaxis during pregnancy recorded ist effects on the subjective feelings of the patients. This type of prophylaxis was used on 46 patients divided into 3 groups depending on the gestational week, in which the prophylaxis was commenced. We measured hemoglobin, hematocrit and serum iron concentration before++, during and after ingestion of Materna. We found a good effect of the preparation on the subjective feelings of the patients and also an effective ferroprophylaxis. We also discovered that for an effective ferroprophylaxis a long and intermittent use of the preparation is necessary in all and not some pregnancies. The authors believe that pending the current conditions in our country supplementary therapy with preparations such as Materna is essential.

[Ultrasonic screening of pregnant teenagers]. / Ultrazvukov skrining pri nepulnoletni bremenni.

Ultrasonography was applied to investigate 218 pregnant girls aged 11 to 16 for a period of 6 years, 70 of whom were examined in the first trimester and 148--in the second and third trimester. The girls presented the following disturbances: bleeding, expected premature birth, complications of pregnancy such as preeclampsia-eclampsia, suspected pelvio-fetal disproportions. Standard biometry was applied using automatic recording of body weigh by the formula of Campel. Missed abortion was diagnosed in 10 patients in the first trimester and 12 were found with blighted ovum. Ultrasound screening and cardiotocography are the most reliable to examine the status of the fetus.

[Prostaglandin E2--an effective alternative for the induction of labor]. / Prostaglandin E2--efektivna alternativa za induktsiia na razhdaneto.

The authors aimed at studying the local application of PgE2 as a method of labor induction. 50 pregnant women divided into 3 groups were studied: I with Prostin E2 - vaginal tablets of 3 mg. Dinoprostone. II with Prepidil gel - 0.5 mg. Dinfprostone, applied intracervically and III with additional stimulation with Oxytocin - 5 E as an i.v. infusion. The criteria used were: parity, gestational age, Bishop score indications for induction. Success is considered as normal delivery by the 24th hour. Indications for PgE2 application are prematurity praeeclampsia, fetal malformations, fetal death, grave obstetrics history, RH incompatibility. It was discovered that with Prostin E2, the active phase of labor is reduced thus leading to reduction of labor. The frequency of operative deliveries also reduced and there were better fetal outcome. Two important advantages were discovered--simple application and physiologic advantages--the woman in labor is mobile and thus not traumatised. The authors stress that PgE2 application can be considered an effective method for labor induction.

[Adolescent pregnancy and the development of pre-eclampsia--eclampsia]. / Adolestsentna bremennost i razvitie na preeklampsiia-eklampsiia.

The authors aim to investigate the incidence and severity of pre-eclampsia--eclampsia in adolescent pregnancies (age under 17 years) and to evaluate the outcome of pregnancy and birth in this patients. With this purpose we compare obstetric and neonatal results in 528 adolescents aged between 13 and 17 years with the results of a control group of mothers aged between 20 and 24 years. We used clinical observation, laboratory findings, instrumental diagnostics and scoring systems. Data were computer-processed. Pre-eclampsia and eclampsia was diagnosed in 17 cases (3.22%), with mild forms prevailing (2.46%). Eclampsia developed in 4 pregnant (0.76%)-an incidence differing from that cited in the literature. We are impressed by the outmost severity of eclampsia in the adolescents, with 1 case of fatal outcome. Seven of the newborns were retarded. The most frequent indications to caesarean section were placental ablation and foetal distress syndrome. Operative delivery was performed in 41.18%. One case of foetal antenatal death and one death in the early neonatal period were observed, both in mothers with eclampsia. The authors conclude that the incidence of pre-eclampsia and eclampsia in adolescents is lower than in general obstetric population, but if eclampsia develops, it is fulminant and in some cases is fatal for the mother or the foetus. This grave prognosis may be related to inappropriate antenatal care in this patient group.