ABSTRACT
Presentation of seven cases of patients at risk for moderate or severe OHSS, treated with Cabergoline.
Subject(s)
Dopamine Agonists/therapeutic use , Ergolines/therapeutic use , Ovarian Hyperstimulation Syndrome/etiology , Ovarian Hyperstimulation Syndrome/prevention & control , Ovulation Induction/adverse effects , Cabergoline , Female , Humans , Ovarian Hyperstimulation Syndrome/pathology , Ovary/drug effects , Ovary/pathology , PregnancyABSTRACT
The authors quote and discuss the postulates of the Orthodox, Jewish, Catholic and Islamic religions towards ART as well as worldwide legislations and standards and the attitude of female students of medicine in Varna. Indications of oocyte and embryo donation and surrogacy are proposed but all kinds or surrogacy should be permitted. The ART legislation and standards in Bulgaria should be thoroughly revised.
Subject(s)
Fertilization in Vitro/legislation & jurisprudence , Oocyte Donation/legislation & jurisprudence , Surrogate Mothers/legislation & jurisprudence , Bulgaria , Embryo Transfer/economics , Embryo Transfer/ethics , Embryo Transfer/standards , Female , Fertilization in Vitro/economics , Fertilization in Vitro/ethics , Fertilization in Vitro/standards , Humans , Oocyte Donation/economics , Oocyte Donation/ethics , Oocyte Donation/standards , Pregnancy , ReligionABSTRACT
In high risk IVF patients the ovulation triggering was done with agonist (0.2 mg), 1.gr., Pregnyl 5000 IE, 2. and 4.gr., Ovitrelle 0.250 mg, 3.gr., and Pregnyl 10000 IE in the fifth--non-risk group. The protocol of the first and fourth group included antagonist, the second and third group was with short and the fifth group with long agonist protocol. There was no grave OHSS in the first group, one case in each second, third and fourth group and 4 cases in the fifth group, as a whole 7 patients (3.3%). In all of them an abdominal drainage lasting 4 to 30 days was performed and all pregnancies were preserved. The average success rate was 50%, 71.4% in the fourth and 43.1% in the fifth group. A protocol with antagonist and ovulation triggering with agonist or reduced dose ChG in order to diminish OHSS in high risk IVF patients is recommended.
Subject(s)
Chorionic Gonadotropin , Fertilization in Vitro/methods , Gonadotropin-Releasing Hormone/agonists , Ovulation Induction/methods , Adult , Chorionic Gonadotropin/administration & dosage , Chorionic Gonadotropin/therapeutic use , Chorionic Gonadotropin/urine , Drug Administration Schedule , Drug Therapy, Combination , Female , Glycoprotein Hormones, alpha Subunit/administration & dosage , Glycoprotein Hormones, alpha Subunit/therapeutic use , Glycoprotein Hormones, alpha Subunit/urine , Gonadotropin-Releasing Hormone/administration & dosage , Gonadotropin-Releasing Hormone/analogs & derivatives , Gonadotropin-Releasing Hormone/antagonists & inhibitors , Gonadotropin-Releasing Hormone/therapeutic use , Humans , Ovarian Hyperstimulation Syndrome/prevention & control , Recombinant Proteins/administration & dosage , Recombinant Proteins/therapeutic use , Recombinant Proteins/urine , Treatment OutcomeABSTRACT
The authors formulate the main principles of IVF-ET, based on personal experience i.e. hormonal ovarian stimulation, ovarian puncture, fertilization and ET, prophylaxis and therapy of early complications. Clinical pregnancy was achieved in 287 of 612 patients (43.9% per cycle and 46.9% per transfer). The cancellation rate is 9.6% (42 patients), the miscarriage rate is 14.2% (41 patients). In three cases the pregnancy was ectopic. The multiple pregnancy rate is 32.7% (94 cases): 84 bigemini, 9 trigemini and 1 quadrigemini. In 2006 the multiple pregnancy rate was reduced to 28%. The mean number of transferred embryos was 3.2 and in 2006--2.8; 80.5% of the pregnant women were under 35 years of age. Severe complications occurred in 16 cases--2.6%: OHSS in 15 cases and one with massive intraabdominal hemorrhage from ruptured ovaries. In conclusion the authors stressed the necessity of undelayed resort to ART treatment. Hydrosalpinxes have to be removed preliminarily and partial resection of the ovaries should be done only in rare cases. In Bulgaria at least 6000 fully reimbursed IVF-ICSI procedures yearly ought to be done because of the considerable rate of the inflammatory female and male infertility.
Subject(s)
Embryo Transfer/methods , Fertilization in Vitro/methods , Infertility, Female/therapy , Infertility, Male/therapy , Academic Medical Centers , Bulgaria , Embryo Transfer/adverse effects , Female , Fertilization in Vitro/adverse effects , Humans , Male , Maternal Age , Pregnancy , Sperm Injections, Intracytoplasmic/adverse effects , Sperm Injections, Intracytoplasmic/methodsSubject(s)
Androgen-Insensitivity Syndrome/pathology , Adult , Androgen-Insensitivity Syndrome/diagnostic imaging , Androgen-Insensitivity Syndrome/surgery , Angiofibroma/diagnostic imaging , Angiofibroma/pathology , Angiofibroma/surgery , Female , Genitalia, Female/diagnostic imaging , Humans , Laparoscopy , Male , Testicular Neoplasms/diagnostic imaging , Testicular Neoplasms/pathology , Testicular Neoplasms/surgery , Testis/diagnostic imaging , Testis/pathology , Testis/surgery , UltrasonographyABSTRACT
Massive vulvar edema in woman with severe preeclampsia is described.
Subject(s)
Edema/etiology , Pre-Eclampsia/complications , Vulvar Diseases/etiology , Adolescent , Cesarean Section , Female , Humans , PregnancyABSTRACT
A case of adnexal torsion after quadruplet pregnancy reduction is described.
Subject(s)
Adnexal Diseases/etiology , Pregnancy Complications/etiology , Pregnancy Reduction, Multifetal/adverse effects , Pregnancy, Multiple , Adnexal Diseases/surgery , Female , Humans , Laparoscopy , Pregnancy , Pregnancy Complications/surgery , Pregnancy Outcome , Quadruplets , Torsion AbnormalityABSTRACT
The authors analyze the results from the clinical and microbiological investigations of Gardnerella vaginalis in two female groups: 28 patients with clinical manifestations of bacterial vaginosis (BV) and a control group of 25 females without any complaints. Along with the data from the anamnesis and the gynecological examination, the following parameters have been examined: a native preparation for "clue cells", pH of vaginal content, ratio between polymorphonuclear leukocytes and epithelial cells, specimens for the diagnosis by polymerase-chain reaction (PCR) as well as cultural examination by using HBT agar (human blood two-layer Tween agar). The authors discuss five diagnostic criteria and emphasize that the diagnosis of BV requires the presence of at least four of them. Every criterion possesses a high frequency (between 67.86 and 100 per cent) among the female patients with clinical evidence of BV.
Subject(s)
Gardnerella vaginalis/isolation & purification , Sexually Transmitted Diseases, Bacterial/diagnosis , Vagina/microbiology , Vaginosis, Bacterial/diagnosis , Exudates and Transudates/cytology , Exudates and Transudates/microbiology , Female , Humans , Hydrogen-Ion Concentration , Leukocyte Count , Neutrophils/cytology , Sexually Transmitted Diseases, Bacterial/microbiology , Vaginal Smears , Vaginosis, Bacterial/microbiologyABSTRACT
The authors reported the results from a retrospective investigation of 10121 deliveries for a three-year period (1981-1983) as well as from a prospective study of 6239 child-births during a three-year period after a 20-year-long time lag, i.e., in 2000-2002. The cases with early post-partum hemorrhages (EPH) and with accomplished laparotomy were examined. The causes for EPH, the obstetric therapeutic measures and manipulations prior to the laparotomy as well as the surgical interventions after opening the abdomen were considered. The authors emphasized that 20 years ago three uteri only could be "saved" by means of ligation of the uterine vessels. A hysterectomy was carried out in 21 cases with massive EPH after the laparotomy. After two decades the situation changed dramatically. The hysterectomies amounted to only 22.22% of the cases (n = 4) while in the rest females (n = 14) the copying of the massive hemorrhages was performed by means either of stepwise ligation of the uterine vessels, or of ligation of the hypogastric ones in 3 cases with additional vaginal lacerations. It was outlined that mother's mortality rate was zero during these two periods. The conclusion has been drawn that the ligation of the uterine vessels represents an alternative to the hysterectomy when copying the EPH and preserves the child-bearing functions of some females because of the subsequent vascular recanalization.
Subject(s)
Arteries/surgery , Hemostasis, Surgical/methods , Hysterectomy , Postpartum Hemorrhage/surgery , Uterus/blood supply , Bulgaria/epidemiology , Female , Humans , Hysterectomy/mortality , Ligation , Maternal Mortality , Postpartum Hemorrhage/epidemiology , Pregnancy , Prospective Studies , Retrospective Studies , Suture Techniques , Treatment Outcome , Uterus/surgeryABSTRACT
Two groups of patients have been assessed for a period from January 2000 till Mai 2004. In the first group of 222 patients the Embryotransfer was performed without sonographic control. In the second group of 253 patients the transfer was sonographically controlled. The results of the second group - 54,1% pregnancy rate per transfer are statistically better than of the first group - 29,3% pregnancy rate. ET performed under sonographic control improves significantly the results.
Subject(s)
Embryo Implantation , Embryo Transfer , Fertilization in Vitro/methods , Uterus/diagnostic imaging , Abortion, Spontaneous/epidemiology , Abortion, Spontaneous/etiology , Adult , Case-Control Studies , Embryo Transfer/statistics & numerical data , Female , Fertilization in Vitro/statistics & numerical data , Humans , Pregnancy , Pregnancy, Ectopic/epidemiology , Pregnancy, Ectopic/etiology , UltrasonographySubject(s)
Obstetric Labor Complications , Pregnancy Outcome/epidemiology , Umbilical Cord , Female , Gestational Age , Humans , Infant, Newborn , Obstetric Labor Complications/diagnostic imaging , Obstetric Labor Complications/epidemiology , Obstetric Labor Complications/therapy , Pregnancy , Prolapse , Ultrasonography , Umbilical Cord/diagnostic imagingSubject(s)
Indomethacin/therapeutic use , Polyhydramnios/drug therapy , Premature Birth/prevention & control , Tocolytic Agents/therapeutic use , Chronic Disease , Female , Gestational Age , Humans , Infant, Newborn , Polyhydramnios/diagnostic imaging , Polyhydramnios/etiology , Pregnancy , Pregnancy Outcome , UltrasonographyABSTRACT
A recurrent postpartal haemorrhage in Kasabach-Merritt sd. which continued in spite of hysterectomy is described. The bleeding was controlled only after ligation of the hypogastric arteries.
Subject(s)
Disseminated Intravascular Coagulation/complications , Postpartum Hemorrhage/etiology , Postpartum Hemorrhage/surgery , Pregnancy Complications, Hematologic , Adult , Arteries/surgery , Female , Humans , Hysterectomy , Ligation , Pregnancy , Stomach/blood supply , Syndrome , Treatment OutcomeABSTRACT
The authors analyzed the microbiological findings in 39 female patients with tubo-ovarian abscesses and intrauterine devices (IUD). An anaerobic microflora was isolated in 66.67% of the aspirates after puncture of cavum Douglasi (CD) as well as in 41.67% of the abdominal exudates or abscesses during laparotomy. Eikenella corrodens was isolated from CD in three patients while in two of them the same bacterium was intraoperatively isolated from the abdominal exudate, too. All the three patients had IUD and regular sexual intercourses, orogenital inclusive, with a lot of partners. Eikenella corrodens is an opportunistic pathogenic agent. It causes infection in case of disturbed local and general immunity under the conditions of traumatic mucosal lesions. It is resistant to numerous antibiotics.
Subject(s)
Abscess/microbiology , Bacteria, Anaerobic/isolation & purification , Eikenella corrodens/isolation & purification , Fallopian Tube Diseases/microbiology , Gram-Negative Bacterial Infections/microbiology , Intrauterine Devices/adverse effects , Ovarian Diseases/microbiology , Fallopian Tube Diseases/diagnosis , Fallopian Tube Diseases/pathology , Female , Humans , Intrauterine Devices/microbiology , Ovarian Diseases/diagnosis , Ovarian Diseases/pathologyABSTRACT
A case of severe HELLP sd. Was associated with cerebral oedema, anuria, retinal ablation, ascites and hydrothorax. The mother survived after intensive care and therapy, including 10 times haemodialysis. The acute fatty liver of pregnancy (M. Sheehan II) with a much poorer prognosis should be excluded. A diagnostical corticosteroids and prompt delivery is pointed out.