[An analysis of the indications for episiotomy in current obstetrical practice]. / Analiz na indikatsiite za epiziotomiia v suvremennata akusherska praktika.

The aim is to analyze the accepted indications for episiotomy in nowadays practice. The investigations is retrospective for the period from April to May 1996. The material includes 459 term singleton pregnancy in vertex presentation and 46 cases of premature neonates with weight from 1300 to 1499 g. The results show high risk (77.1%) of episiotomy in nulliparous women. The multiparity, the length of second period and the high risk pregnancies have not effect on the use of episiotomy. The wight of the fetus is essential factor. The highest rate of episiotomy is at premature births (65.2%) followed by the group of neonates with weight over 4000 g (61.5%). The lowest rist of episiotomy is then the weight of newborn is between 2500 and 3800 g (21.8%). Almost hundred percent rate of episiotomy in operative vaginal and breech deliveries show that we accept the episiotomy as obligatory of these vaginal deliveries.

[The results of the limited use of episiotomy in managing the second stage of labor]. / Rezultati ot ogranicheno prilozhenie na epiziotomiia pri vodene na vtori period na razhdaneto.

The purpose is to asses the effect of restrictive use of mediolateral episiotomy on the spontaneous laceration of the low birth canal. The material includes 613 labors some of which gave birth with indication for episiotomy and control group of 441 retrospective cases with routine management of the second period of labor. The restrictive use of episiotomy decreases the rate from 45.6% in the routine practice to 32.8%. The reduced rate of episiotomy has as a consequent increase rate of second degree perineal laceration adn insignificant increase of vaginal lacerations. The management of restrictive and liberal use of mediolateral episiotomy has not effect on third and four degree perineal laceration, on the accessory tears of the vagina and on the rate of perineotomy. If from all labors are subtracted operative deliveries, surgical intervention for repairing the laceration of the birth canal and pathology of the placental period the rate of labors without any intervention is only 13.3%. Our results suggest that labor nowadays is operative activity.

[The side effects of the prevention of blood loss in the placental period]. / Stranichni efekti na profilaktikata na kruvozagubata v platsentarniia period.

On the base of 192 retrospective and 144 prospective cases are evaluated the side of routine prophylactic of the blood loss at the third period of labor. The control group consist of 50 labouring women with expective management of placental period. In normotensive women the methergine does not increase the blood pressure. The use of oxytocic drugs after the delivery of the head shorten the time of placental separation but make more difficult the cord traction method for the delivery of the placenta. The active management of the placental period decrease the rate of instrumental revision of the uterine cavity and the supplemental administration of oxytocic in the early postpartum period. This investigation confirms and justify the routine use of oxytocic after the delivery of the head as a prophylactic of the blood loss in the placental period.

[Blood loss in the placental period in relation to the type of prophylaxis]. / Kruvozaguba v platsentarniia period v zavisimost ot vida na profilaktikata ì.

The aim of this study is to asses the blood loss in third period of labor according the method of its prophylactic. The material consist of 144 prospective and 192 retrospective cases. The blood loss is assessed visually and after that it is weighted. Up to the delivery of placenta the visually assessed blood loss is insignificantly greater than the weighted one. All cases are subdivided in three groups according the management of third period: -with methergin, with oxytocin and without uterostonic. The blood loss associated with the separation and delivery of the placenta is not different in the groups, but the early postpartum haemorrhage is significantly greater in the cases without uterostonics for the delivery of placenta. In premature labors the blood loss associated with the separation of placenta is significantly greater that in term labor.