[INFLUENCE OF DIANATALO OBSTETRIC GEL ON THE LENGTH OF SECOND STAGE OF LABOR.]

One of the risk factors for the occurrence of occult anal sphincter injuries (OASIS) and pelvic floordamage is the increased duration of the second stage of labor; leading to a relatively high incidence of perineal trauma, which in the majority of cases remains unrecognized. If we can decrease the duration of second stage of labor we could also expect a statistically significant decrease the incidence of OASIS in clinical practice. Purpose and Goals To identify changes in the length of the second slage of labor fater adminidtration of Dianatal® obstetric gel. Material and methods The study enrolled 33 primiparous women after vaginal delivery in General Hospital Trbovlje, Slovenia between January and June 2012. We also included 19 more patients, delivered between May and July 2011 in the Department of Obstetrics, University Hospital - Pleven, and 8 patients, delivered between February and October 2013 in Women's Health Hospital "Nadezhda" - Sofia Results We were able to observe a significant decrease in second slage of labor in relation with administration of Dianatal® obstetric gel. Discussion Shortening the period of expulsion of the fetus through the use of obstetric gel can significantly reduce the incidence of birth trauma and minimize complications related to delivery trauma - anal and urinary incontinence, changes in the statics of pelvic organs, sexual dysfunction and as a result poor quality of life.

[EVALUATION OF INCIDENCE OF POSTPARTUM OCCULT ANAL SPHINCTER INJURIES BY ENDOANAL ULTRASONOGRAPHY.]

The estimated overall risk of intrapartum damage of the anal sphincter (IUAS) is 1% of all vaginal births. The so called "occult" anal sphincter injuries (defects of the anal sphincter established by endoanal ultrasonography - OASIS) occur in 33% of primiparous women after vaginal birth. The most logical explanation for OASIS is that they are either completely missed or detected, but not mentioned in the patient's documentation, or erroneously classified as a low grade tear. Objectives To es7ablish the actual values of OASIS in the study population using endoanal ultrasonography. Material and methods The study included 29 vaginal deliveries in Porodnisnica Ljubljana in the January to June 2009 period, and 34 patients from July 2009 to May 2010, who gave birth in ObsTetric Clinic of the University Hospital - Pleven. Results The identified UAS frequency in our dtudy (25.4%) confirms the results of the incidence of such damage, cited in the literature. Discussion The results vary extensively from reported frequency of anal sphincter injuries among researched population, reflecting underesTimation of the problem, diagnostic gaps and inadequate clinical management behavior and tracking patients.

[RISK FACTORS FOR POSTPARTUM OCCULT INJURIES OF THE ANAL SPHINCTER.]

introduction The overall risk of intrapartum damage the anal sphincter (IUAS) is 1% of all vaginal births. In contrast, the so-called "occult" anal sphincter injuries (OASIS) (defects esablished by endoanal ultrasonography) occur in 33% of primiparous women after vaginal birth. Identifying the most common risk factors for OASIS can be the basis for selecting high-risk patients. These women should be targeted by early pospartum diagnosis and treatment, which could reduce the incidence of anal incontinence developed later in life. Objectives To determine the role of common risk factors for the occurrence of OASIS in selected population. Material and methods The study included 42 patients after vaginal birth, born in Maternity Ljubljana in the period January to June 2009, and 38 patients from July 2009 to November 2011, born in Obstetric Clinic of the University Hospital - Pleven, diagnosed with OASIS using endoanal ultrasonography. Results We demonstrated that all of the independent variables studied in our research (primiparity, gestational age over 41gw and fetal weight over 3500 g.) are risk factors for the occurrence of OASIS. Discussion This sudy shows that the sudied risk factors for the occurrence of OASIS may be included in a clinical practice guideline for eady diagnosis and proper treatment of posTpartal injuries affecting the pelvic floor.