[Placenta accreta--prenatal diagnosis, treatment].

Placenta accreta is a potentially life threatening obstetric condition that requires a multidisciplinary management. Placenta praevia and previous Cesarean section are the two most important known risk factors for placenta accreta. This study presents two patients having both of the foremention risk factors diagnosed ultrasonographically with placenta accreta in the second trimester. Ultrasound findings considered suggestive of placenta accreta are: presence of placental lacunae (vascular spaces), loss of the hyperehoic uterine serosa-bladder wall interface, loss of the retroplacental hypoechoic clear space, hypervascularity of the interface between the uterine wall and the bladder wall/isthmico-cervical zone, presence of placenta praevia, either anterior or posterior, overlying the uterine scar. Both of the cases with suspected placenta accreta ended successfully by planned preterm Cesarean hysterectomy with the placenta left in situ. Placenta accreta is a significant cause of maternal morbidity and mortality and the most common reason for urgent postpartum hysterectomy.

[Prenatal diangosis of hypospadia--case reports].

Hypospadia is abnormal sex differentiation of the external genitalia with ventral and proximal displacement of the urethral orifice from its usual location on glans penis. Three prenatally diagnosed cases of hypospadia are presented and the major ultrasound findings of this entity are discussed.

[Laparoscopic hysterectomy--the initial experience in Bulgaria]. / Laparoskopska khisterektomiia--purvi opit v Bulgariia.

The paper presents the first cases of laparoscopic-assisted vaginal hysterectomy and laparoscopic hysterectomy with removal of the uterus through the vagina performed in Bulgaria as well as the experience gained by the team from II gynaecology clinic at State University Hospital "Maichin dom" in Sofia from seven patients operated on by these techniques. The indications, the conditions and the implemented technique with its advantages and difficulties are described. The procedures are associated with less trauma and blood loss than abdominal surgery and are followed by a very smooth postoperative period which is very well tolerated by the patients. No intraoperative complications occurred. The postoperative period was free of any problems in 5 of the patients while in two there were minor complications. Marked shortening of the duration of the procedures is achieved with the initial experience.

[The use of cefotetan for the prevention of infectious postoperative complications in gynecology]. / Prilozhenie na tsefotetan za profilaktika na infektsioznite postoperativni uslozhneniia v ginekologiiata.

The study presents the results from the use of cefotetan for perioperative prophylaxis in 43 gynaecology patients compared with 29 controls without perioperative antibiotic prophylaxis with similar diseases and operations. Both groups show equal percentage of the cases with smooth postoperative period (70 and 72% respectively). 13 of the patients on cefotetan prophylaxis received additional antibiotic treatment (9 because of temperature up to 37.5 degrees and 4 because of temperature from 37.6 to 38.5 degrees). Mo major infections postoperative complications occurred among the patients on cefotetan prophylaxis. 8 of the non-prophylacted patients needed antibiotic treatment postoperatively including 4 with temperature above 38.5 degrees. Two infections of the operative wounds also occurred in the same group. The conclusion is that cefotetan effectively prevents the major infection postoperative complications in gynaecology. The administration of additional antibiotic treatment is most often not warranted.

[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.

[Our experience with the use of the new Bulgarian intrauterine contraceptive device, the Venus Cu 300 (preliminary report)]. / Nashiiat opit ot prilozhenieto na novite bulgarski vutrematochni kontratseptivi Venus Cu 300 (predvaritelno suobshtenie).

A team of the family planning centre at the Research Institute of Obstetrics and Gynecology carried out a trial on a new Bulgarian intrauterine contraceptive device (ICD), produced by the firm Venus in the town of Varna: Venus Cu 300. This is a T-shaped device with horizontal arm of 30 mm, vertical arm of 34 mm, a copper thread with an area of 300 mm2 and two control threads. It is produced from PVC. Purity of copper is over 99.9% in the copper thread. The construction of Venus Cu 300 has the positive properties of other intrauterine contraceptive devices, used in our country during the last 15 years. 87 women have been followed in 320 cycles for a period of 6 months. A larger part of them are parous, mainly with one or two children. Venus Cu 300 has been used in seven nulliparas, presenting risk for frequent abortions. Three Venus Cu 300 have been placed immediately after abortion. No pregnancy occurs, which is explained by the careful choice of the patients. Extraction of ICD has been made only in one case due to medical causes: bleeding and pain. More abundant menstruation after ICD has been found in 11.5% of women, but there has been no need to extract ICD. Inferences are made that Venus Cu 300 is in every way equal to the known models of ICD, that the trial should include a larger group of women to accumulate data in dynamics, in order to improve Venus Cu 300 eventually.