[Microbiology of open surgical wounds after delivery--episiotomy and cesarean section]. / Mikrobiologichni nakhodki v otvoreni operativni rani sled razhdane--epiziotomii i pri tsezarovo sechenie.

UNLABELLED: The aim of the study is to assess the microbe find in the secretion of the open surgical wounds of the Cesarean Section and the perineal wounds. 81 young mothers have been examined--57 with open perineal wounds on 5th day after the delivery and 24 with open surgical wounds of Cesarean Section on the 7th day after the operation. RESULTS: The west frequent microbe find in the open perineal wounds is Streptococcus group "D" (enterococcus sp.)--53% of the cases and E. coli--26% of the cases. The most frequent microbe find in the open surgical wounds in the Cesarean Section is Enterococcus sp.--42% of the cases and St. aureus--21% of the cases. Considering the effectiveness of Penicillins (Ampicillin, Augmentin, Azlocillin, Karbencillin)--94%-99% against Enterococcus spp. and of Gentamycin against E. coli and St. aureus--90%-95% their application is recommended if is necessary.

[Endometriosis in the surgical scar from cesarean section]. / Endometrioza v operativen tsikatriks ot tsezarovo sechenie.

The frequency of endometriosis in and around the surgical scar from cesarean section is from 0.03%-0.04% to 0.8% in some reports. It is difficult to be diagnosed, in spite of the typical symptoms: aching swelling in the area of the surgical scar, which is influenced by the phases of menstruation. Sonography and fine-needle biopsy can be used, but it is usually diagnosed through the surgical treatment. Hystological diagnosis can also be a matter of some difficulty, as sometimes it is necessary to differentiate from adenocarcinoma, pseudomyxoma peritonei and metastatic carcinoma. The treatment is surgical. It is examined a case of endometriosis, which occurred in the surgical scar from a cesarean section about a year after the operation. The treatment is surgical by means of wide cutting-out of damaged musculus rectus abdominis and the surrounding tissues. After the operation a seroma is formed, which is healed with aspiration drainage and compressive bandage. Three years after operation a recurrence is not established.

[Choice of delivery method in multiple pregnancy. I. Twins]. / Izbor na metoda na rodozareshenie pri mnogoplodna bremennost I. Dvuplodna bremennost.

From 1995 till 1998 year 174 twin pregnancies were delivery at the SUH "Majchin Dome" in Sofia. The methods, applied for delivery was: per vies naturalis 78 (51, 32%) women (normal vaginal delivery 63 pregnancies, breech delivery--12, with vacuum extractor--2 and with forceps--1); by cesarean section was delivered 74 (48, 68%). The 80 pregnancies with premature delivery (under 37 g.w.) were delivered by: normal vaginal delivery--(55.13%) and cesean section--37 (50%). Indication for operative delivery were: irregular position--45, sterilitas primaria--13, EPH Gestosis--12, asphyxia intrpartum--9, previous cesarean section--3, luxatio coxe congentia--4, age over 31 years--4, abruptio placente--2, condilomata acuminata--2. We not find significant difference in experience on new-born depending on the method for delivery after 35 g.w. We find the best experience by new-born, delivered with cesarean section between 28-33 g.w. and 33-35 g.w. (50% and respectively 100%) compared to delivered per vies naturalis (43.75% and 86.36%). The authors consider the it is desirable liberation on indications for delivery with cesarean section by the twins between 28-35 g.w.

[Choice of delivery method in multiple pregnancy: twins, triplets and quadruplets]. / Izbor i metod na rodorazreshenie pri mnogoplodna bremennost - dve-, tri- i chetiriplodna bremennost.

From February 1996 tice May 1998 year 7 patients (5 with trigemini and 2 with quadrigemini) were delivery at the State University Hospital "Majchin Dome" The methods applied for delivery were: per vies naturalis--1 pregnancy with trigemini in 32 gestation wick and 1 spontaneous abortion due to hydramnions on guadrigemini in 23 g.w.; by cesarean section--4 pregnancies with trigemini in 29 g.w.--1, 32 g.w.--2 and in 36 g.w.--1 patients and 1 pregnancy with guadrigemini in 32 g.w. The trigemini delivery per vies naturalis was discharged from Hospital alive. From delivered by cesarean section (1 in 32 g.w. was fetus mortus), the rest--live, but this delivered in 29 g.w.--prematurely III and IV grade died up to 26 hour after delivery in spite off neonatal care. The remaining were discharged from Hospital alive. The guardigemini in 32 g.w. delivered by cesarean section were discharge from Hospital alive. The authors consider that by trigemini and quadrigemini after 32 g.w. the prefer method for delivery is cesarean section.

[Causes for healing complications in episiotomy]. / Prichini za uslozhneno zarastvane na epiziotomiite.

UNLABELLED: The aim of the study is to look for the most probable causes of disturbed healing of episiotomy. The study is prospective and includes 33 early puerperal women without data of infection disease or risk factor like: PPROM, vulvovaginitis, chorioamnionitis, diabetes, obesity and others. The cases are divided in two groups: the first group are 12 women with normal healing of episiotomy; the second group 21 cases with wound healing complications, divided in three subgroups: 13 with edematous and erythematous edges; 5 with superficial dehiscence in me aria of introitus vaginae; 3 with entirely open episiotomies. RESULTS: For a period of 5 years the mean rate of entirely open episiotomy is 1.07%. According our data the process of episiotomy healing is not influence by: age of me women, parity, duration of labor, the weight of the neonate. For the episiotomy outcome is important the experience of the obstetrician. The shorter time between ROM during labor and delivery and use of cat-gut stitches on the skin of the perineum show tendency of poor healing of the episiotomy.

[Endometriosis in adolescence - characteristic features]. / Endometriozata v adolestsentna v'zrast - kharakterni chert.

Retrospectively it is established that the beginning of the endometriosis is 3-4 years after menarche. It can be found between 12-20 years of age in girls with congenital abnormality of the uterus and the urinary tract as well as with menarche before 11 years of age. Primary predilection areas are ligamentum sacrauterine and pelvic peritoneum in cavum Duglassi. Predominant appearance are the red lesions, that are cause for complaints--menstrual cyclic pain, nausea, vomiting, constipation or diarrhea and abdominal pain. The most used diagnostic methods are: from uninvasive methods--Sonographya and Tu marker CA-125 and from the invasive methods--laparoscopy.

[Endometriosis in adolescence - treatment]. / Endometriozata v adolestsentna v'zrast - lechenie.

Endometriosis is treatment when has expressed symptomatic. In spite of increased possibility the current treatment is provisionally. It is applied Danazol, Ru 486, GnRh agonists. Nafarelin diminishes the pain syndrome in 70% of the cases. The relapses are 53.4% for 5 years. However, the GnRH agonists provoke suppress on E2, which lead to transient bones demineralization. Therefore they are impracticable in adolescent age when the bone growth occurs. Therefore in adolescent age for treatment on the endometriosis is recommend low-dose oral contraceptive drugs and in a case of inadequate effect to make Laparoscopic vaporization on the endometriomas by trained operator.

[The effect of acupuncture in dysmenorrhea]. / Efekt ot akupunkturata pri dismenoreia.

The author assumed the task study the effect of treatment dysmenorrhoea by acupuncture. Object of the study were 48 women in reproductive age divided in 2 groups: 1st group--24 women with primary dysmenorrhoea, 2nd group--24 women with secondary dysmenorrhoea. Acupuncture treatment included acupuncture points: LI4, SP6, 10, S30, 36 CV2, 3, CX5, 6, B20, 23 applied via torment method for 30 min. RESULTS. In the 1st group effect was very well after one course of 2-4 acupuncture procedures before menstruation. In the 2nd group effect was satisfactory in 50% of the cases after two courses acupuncture treatment. In conclusion effect of acupuncture treatment on dysmenorrhoea depend on its kind--primary dysmenorrhoea is influenced very well, while secondary dysmenorrhoea is influenced satisfactory.

[An alternative method for treating headache after spinal anesthesia in cesarean section]. / Alternativen metod za lechenie na glavobolieto sled spinalna anesteziia pri tsezarovo sechenie.

From pregnant women, delivered with section caesarean and spinal anaesthesia 22%-36% have complained of headache. Its treatment is difficult. A group of 35 pregnant women aged between 22-34 years have received headache after spinal anaesthesia for caesarean section. They were subjected to acupuncture in the points S8, Li4, G11,14, B10, GV14,20 by the scheme. The number of procedures varied between 1 and 3. The author reports the following results: headache passed in 30 women after 1 procedure, in 4--after 2 and in 1--after 3 procedures. The author concluded that the method is effective.

[The impact of premature rupture of the amniotic sac on uterine involution in the early puerperium]. / Otrazhenie na prezhdevremenno puknatiia okoloploden mekhu vurku involutsiiata na matkata v ranniia puerperium.

UNLABELLED: The object investigation is determination premature rupture velamentorum ovi relation with uterus involution in early puerperium (1st-5th day). The object of study are 86 young mothers 17-34 years old after normal delivery divided into four groups 1st group (control)-56 young mothers with rupture velamentorum ovi up to 6 hours before delivery; 2nd-15 young mothers with rupture velamentorum ovi from 6 to 12 hours before delivery 3rd-12 young mothers with premature rupture velamentorum ovi 12-24 hours before delivery and 4th group-3 young mothers with premature rupture velamentorum ovi over 72 hours before delivery. RESULTS: It was found significance steady uterus involution in 4th group (p < 0.001) and in the 1st day in the 3rd group (p < 0.005) Tere is large deviations on individual value in all group. Authors discuss probable mechanism on uterus involution Conclusion: The premature rupture velamentorum ovi over 24 hours before delivery provoke steady uterus involution in early puerperium, but without pathological deviation most probably as a result young mothers exchange mechanisms.

[Experience in treating episiotomies after labor with ice]. / Opit za tretirane s led na epiziotomiite sled razhdane.

It is known from literature influence on cryotherapy on the tissue structures. It's application cause vessel constriction factor for decrease exudative inflammations and edema), save enzyme and immune activity at the cells levels and increases regenerative processes in tissues On the 324 young mothers we fix ice over episiotomies from 1st puerperal day for 3 days. As a control group were episiotomies on the 254 young mothers one cryoprophylaxis. Complications (oedema, inflammatio, or suppuratio) at the 1st group was 5.55% and in the 2nd (control) group was 9.45%. These results give us reason to suppose, that cryoprophylaxis have even non essential effect on the processes on recovery on episiotomies after delivery.

[Diagnostic methods in endometriosis]. / Vurkhu niakoi diagnostichni metodi pri endometriozata.

The overall accuracy of preoperative diagnosis is approximately 20% with a range of 4-83%. We investigated 100 women at the age between 27-61 years, operated with histologically proven endometriosis and we made an attempt to analyse some of the diagnostic methods. Abrasio probatoria was made in 17 of the operated women prior to operation. The hystological result from the abrasive material was not indicative for the presence of endometriosis. Ultrasound examination was made on 24 operated women with endometriosis, but no one diagnosed endometriosis despite the description by many authors of characteristic ultrasound picture of endometriosis. Hysterosalpingography was made in 3 women with the endometriosis but despite the specific x-ray picture for endometriosis they were not diagnosed correctly. These data support the opinion of some authors that these diagnostic methods are not specific for endometriosis.

[Thromboembolic disease in the puerperium (is thrombotic prophylaxis necessary in the puerperium)]. / Vurkhu niakoi aspekti na tromboemboliinata bolest v puerperiuma (neobkhodima li e tromboprofilaktika v puerperiuma).

The author makes retrospectively investigation in 3064 young mothers about determination on dependence between thromboembolism and varices in early puerperium. He finds varices in 1.01% of cases from which 84% are without prophylaxis. In 42% of them with complaints are applied medicine. In 0.13% of cases in puerperium develops thrombophlebitis (0.08-1.35% in bibliography information). The author finds in 0.098% of cases pulmonary thromboembolism (0.04-0.05% in bibliography information). In 77% of them he find out birth traumatism. In conclusion the author recommends prophylaxis with Heparin in early puerperium by cases with previous thromboembolism, traumatic parturition and doubt for infection.

[Endometriosis--the features of its clinical characteristics]. / Endometrioza--niakoi osobenosti v klinichnata ì kharakteristika.

The authors present the clinica; characterization to 100 women that operate in the Institute in Obstetrics and Gynaecology with histological diagnosis endometriosis, compare with 20 women, operate on the occasion of myoma uteri. The authors find that endometriosis happen more often than endometriosis externa (69%). The both most frequently are in combination with myoma uteri (68% and 52%). In the combination with Ca are a little (3%) with Ca corporis uteri. Sterility has in 14% on cases with endometriosis interna and twice more (32%) in the cases with endometriosis externa. Hypermenorrhea occurs in 43% on the cases and dysmenorrhea--in 25%. Asymptomatic endometriosis occurs in 68% on the cases. In conclusion the endometriosis is a unique disease with no characteristics symptomatic, that help us no much for the exact diagnosis.

[The treatment of the repercussion diencephalic syndrome in gynecology. Acupuncture therapy]. / Lechenie na reperkusionniia dientsefalen sindrom v ginekologiiata. Igloterapiia.

The obstetricians have to know the repercussion diencephalic syndrome because the diseases of genital organ can provoke it. Moreover its treatment is many difficult. The most efficient is earlier, complete and adequate treatment. Ordinary the treatment is symptomatic. The author presents 3 cases with repercussion diencephalic syndrome after gynaecology diseases treating with acupuncture and electroacupuncture: Liv1.7, CV1.3.6, Sp6.15. The effect is very good.