[Peculiarities of maternal mortality in the University Hospital of Pleven for period 1977-2001].

The authors report retrospective investigation of causes for maternal mortality in the Department of Obstetric and Gynecology in Hospital in Pleven for the period 1977-2001 and comparison between indexes for a different period of time. Objects of investigation were patient histories necropsy report and forensic expertise. Vital births were 73922 for a period of 25 years in Pleven. Dead pregnant and maternity were 45 and the rate of maternal mortality was 60,07/per 100 000 vital births. Causes of maternal mortality were divided in immediate 40 cases (88,88%) and indirect--5 cases (11,11%). The hemorrhage was the most common cause of maternal mortality--18 cases (45%). The authors mention that the absolute number of maternal losses is comparatively constant but the rate of maternal mortality in creases because of tendency of decrease of birthrate and concentration of pathology in Department of Obstetric and Gynecology in Pleven.

[Incidence and indications for cesarean section in the Obstetrics Clinic in the University Hospital of Obstetrics and Gynecology "Maichin Dom" in Sofia].

The incidence and the indications for Cesarean section in the Obstetric Clinic of the University Hospital of Obstetrics and Gynecology were analysed and compared to a study carried out 20 years ago In 2003 - 2004 there were 2700 pregnant women treated in the clinic 558 had Cesarean section (incidence 20.7%). For comparison the incidence of Cesarean section in 1985 was 6.67% (160 Cesarean sections for 2096 patients) and for 1986 the incidence was 7.63% (131 Cesarean Sections for 1865 patients. The leading indication for the both studies was "previous Cesarean section" the indication "contracted pelvis" was the second and infertility and breech presentation were on the third and forth place. There was no change in the indications for Cesqarean section in the present study and the study carried out 20 years ago. There was a relative increase of the indications 'contracted pelvis' and 'increased age in a nulliparous patiet' compared to the previous years.

[Highlighting some clinical aspects of the association of myoma with pregnancy]. / Vurkhu niakoi klinichni aspekti na asotsiatsiiata mioma i bremennost

UNLABELLED: Leiomyoma is a benign tumor, with mesenchymal embryonal cell origin. During pregnancy 0.1 to 4% of cases are diagnosed. MATERIAL, METHODS AND RESULTS: During the period of 1999-2003, 59 pregnant and delivering women were registered with the diagnosis of Leiomyoma (0.5%) at the ObGyn complex, University Hospital, Pleven. In the observed group, were encountered significantly more often primary sterility, pathological positions of the fetus and placental pathologies. CONCLUSIONS: Leiomyoma frequently complicates the progress of pregnancy and delivery necessitating operative intervention by the means of Caesarean Section.

[Characteristics of maternal mortality in the university hospital of Pleven for the period of 1977-2001 years]. / Osobennosti na maichinata smurtnost v MBAL na gr. Pleven prez peroida 1977-2001 godina.

The authors report retrospective investigation of causes for maternal mortality in the Department of Obstetric and Gynecology in Hospital in Pleven for the period 1977-2001 and comparison between indexes for a different period of time. Objects of investigation were patient histories necropsy report and forensic expertise. Vital births were 73922 for a period of 25 years in Pleven. Dead pregnant and materinity were 45 and the rate of maternal mortality was 60,07/per 100 000 vital births. Causes of maternal mortality were divided in immediate 40 cases (88,88%) and indirect - 5 cases (11,11%). The hemorrhage was the most common cause of maternal mortality - 18 cases (45%). The authors mention that the absolute number of maternal losses is comparatively constant but the rate of maternal mortality in creases because of tendency of decrease of birthrate and concentration of pathology in Department of Obstertic and Gynecology in Pleven.

[Paraurethral cysts--diagnosis, differential diagnosis and treatment (a case report)]. / Parauretalni kisti--diagnoza, diferentsialna diagnoza i lechenie (s prinos ot edin sluchai).

The aim of the authors is to reflect clinically upon a rare pathology of the female genital system vaginal cysts. The presentation includes description, diagnostical methods, differential diagnosis and treatment of the paraurethral cysts and urethral diverticulum. It was fully described on the basis of clinical case from the gynecological practice on a patient with paraurethral cyst, which was removed surgically with good outcome and result.

[Rupture of follicular and corpus luteum ovarian cysts--the cause of acute gynecological abdomen]. / Ruptura na folikularni i korpus-luteum iaichnikovi kisti--prichina na ostur ginekologichen korem.

The symptomatology of the ruptured follicular and corpus luteum cysts varies from clinical occult status to haemorrhagic shock according to clinical studies for a ten years period. The syndrome frequency is higher in women over 30 years of age at rate 1:2 of the follicular to luteum cysts affecting mainly the right ovary. Twenty percent of the patients have been treated conservatively. Preoperative and intraoperative diagnosis coincides in 92% of the cases.

[The prevalence of the HBsAg carrier state among pregnant women and its effect on newborn infants. V. A follow-up of the processes of HBsAg clearance in pregnant women discovered as antigen carriers]. / Razprostranenie na nositelstvoto na HBsAg sred bremenni zheni i vliianieto mu vurkhu novorodenite detsa. V. Proslediavane na protsesite na ochistvane na vremenni zheni ot HBsAg, otkriti kato nositelki na antigena.

When studying the process of cleaning from HBsAg of 43 women, discovered as carriers during 8 1.m. is found essential continuity of persisting of the antigen from 1 to 6 years. The full cleaning from the antigen is found in 13 women (30.23%) and in the other 30 (69.77%) is found lasting persisting as of HBsAg and of the other markers of viral hepatitis B and viral hepatitis D. In the enlarged serological investigation for presence of the markers of viral hepatitis B and viral hepatitis D and complex clinical and paraclinical investigation is found that in the form of carriers of HBsAg are hidden different manifestations of the hepatitis B and hepatitis D viral infection--starting stages of viral hepatitis B, acute or chronic hepatitis B and hepatitis D viral infection and passed hepatitis B and hepatitis D viral infection. The obtained results allow to be admitted that women carriers of HBsAg appear to be potential sources of infection from viral hepatitis B and viral hepatitis D.

[The motivation for deciding on keeping or terminating a pregnancy. II. The socioeconomic factors, the self-assessment of health status and the attitude towards the future]. / Kum vuprosa za motivatsiia na reshenieto za zapazvane ili prekusvane na bremennostta. II. Sotsialno-ikonomicheski faktori, samootsenka na zdravoslovnoto sustoianie, otnoshenie kum budeshteto.

Subject of investigation are peculiarities of emotional and motivational sphere of women in a fertile age (women recently confined or terminating pregnancy by wish). They are divided according to their attitude towards real pregnancy. Results of investigation show that double-pole attitude towards pregnancy is in direct dependence on the employment, on the security of working place. Marriage and its duration are mutually connected with the negative attitude toward pregnancy. Pregnancy becomes unwished for when the number of children desired coincides with the real one. There is a considerable interconnection between pessimistic expectations and attitude toward pregnancy in the both groups (p < 0.05). As a whole 72 per cent of tested persons would like to have two children without special preferences regarding their sex. According to the data made out of the investigation desired number of children is connected with the satisfaction from living conditions, the woman's age and marriage duration, with the professional realization and faith in future. The authors consider that towards every pregnancy an individual approach is necessary with careful search and investigation of factors which define woman's attitude toward pregnancy.

[The motivation for deciding to preserve or to terminate a pregnancy]. / Kum vuprosa za motivatsiiata na reshenieto za zapazvane ili prekusvane na bremennostta.

With 68 women recently confined and terminating pregnancy by wish a study was made about anxiety in its two varieties: (i) as a mental condition connected with an actual and significant for the person life situation and (ii) as a personal feature--a way of perception and interpretation of the events as threatening. Anxiety's level is measured by a psychological test adapted to the Bulgarian conditions. The high average estimation of anxiety shows that termination of pregnancy is suffered as a stress. Subject to anxiety are also family's incomes when investigating both groups--women recently confined and women going to have an abortion. Level of anxiety of women recently confined is connected with the attitude towards future which definitely bothers 67.6 per cent of them. Analysis of indices shows that anxiety in connection with the decision for keeping or terminating of pregnancy as well as with the expected future after confinement is subject to many factors. Data interpretation confirms the well-known thesis that reproductive health protection is not only of a medical and biological but of very wide interdisciplinary interest when the woman is on the brink of the important for her personally and finally for the society as well decision pro and con real pregnancy.

[Malignant neoplasms of the ovaries. The diagnostic and therapeutic results]. / Zlokachestveni novoobrazuvaniia na iaichnitsite. Vurkhu niakoi diagnostichni i lechebni rezultati.

The study included 291 women, who suffered from malignant ovarian tumours, hospitalized and treated in the gynecological clinic of the Higher Medical Institute in the town of Pleven during two period: of 1984-1988-168 patients and of 1980-1983-123 patients. A total 5-year survival was estimated for those women. The mean age of women was 55.08 +/- 15.79 years with a mean number of deliveries 1.82 +/- 0.78 and a number of abortions 2.03 +/- 0.75. The great relative part of epithelial tumours--91.66% was noted in the general structure similar to other distributions. The age groups of 40-49, 50-59 and 60-69 were mostly represented. An interesting case of a woman with an ovarian carcinoma at late stages with more than an 8-year survival was described. The total 5-year survival, estimated by the authors, for the period of 1980-1983, was 26.19%. The principles of combined treatment are discussed in accordance with the clinical stage, operative and histological results. The significance of some risk and prognostic factors are evaluated.

[The treatment of tubal pregnancy with methotrexate]. / Lechenie na tubarna bremennost s metotreksat.

After a brief review on the possibilities for conservative treatment of tubal pregnancy the authors described a woman with left tubal pregnancy, in whom metotrexat was used successfully in a dose of 20 mg 4 times every other day administered intramuscularly. The right uterine tube of the woman was removed during the preceding ectopic pregnancy. The patency of the remaining tube was examined after a 2-month period, during which anti-inflammatory treatment was performed as well. An opinion is given that such conservative treatment should be used only in strictly diagnosed patients and with the single aim-preservation of reproductive capabilities of the woman, when there is no other way of treatment. When there are no reproductive aims, the operative method is recommended.