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The author shows, that pregnant women may give birth vaginally without compromise when they have spent one to three and more cesarean births.

The authors report three cases with postpartum hemorrhage in the immediate puerperium and their management.

We studied retrospectively the delivery of 202 pregnant women with foetus in breech presentation. Caesarian deliveries have had 79.2% from primiparas and 31.3% from multiparas. Planned caesarian deliveries have been performed to two thirds (63.7%) from the primiparas (n = 135). In the context of cotemporary literature and practice we consider, that we do not make enough "trial of vaginal labour" for women with breech presentation of the foetus and we think, that caesarian delivery frequency in these cases is too high.

The authors induct the labor of 88 pregnant women by Misoprostol /Cytotec/ tablette 50 mcgr accepted every four hour per vaginam. The results are the same as/or better/ than the results per os. Our results are in agreement with experimental one of R.-U. Khan et al,. 2004, fig. 1.

The author describes a case of vaginal delivery in which the mother dies. Because of a retained placenta parts in cavum uteri, the physician peroformed revisio cavi uteri instrumentalis, in which wall of the uterus is perforated, about 3 cm in length. A justice commission of seven persons associate the bleeding out of the uterus and the death of the mother with the perforation of the uterus. We consider that the death of the mother is due to amniotic embolism and not due to the perforation of the uterus. We cite contemporary scientific data.

Retrospective research. In the period 01.01.2000 - 30.06.2004, we investigated 49 women, hospitalized in the third trimester with death fetus. We found out that for the specified period, the rate of such women had been increased two times - from 8 women for the whole year 2000 to 9 women for the first half of year 2004. We think a predominant factor for this increase is the suboptimal cares for the pregnant women out of the hospital regimen.

The Bulgarian obstetricians always consider the recommendations of their non-obstetrician colleagues when a pregnant woman has a non-obstetrician disease. However the practice in the foreign countries is not the same. The modern obstetrician literature and our own experience tell us that the obstetrician must have his own opinion which might be different from the opinion of the "other" specialists.

From January 2002 up to June 2003 year we performed 19 amniocentesis during second trimester of pregnancy, upon medical indications. There was only one complication--flow out of amniotic fluid after the amniocentesis. We adopted the conservative treatement--bed rest and antibiotics: the flow stopped 18 days after the amniocentesis and te pregnancy reached uncomplicated termin with a healthy newborn.

The authors describe a case of traumatic disorder of the left eye during the childhood--Staphyloma corneae et sclerae (protrusio bulbi). During the present pregnancy the ophtalmologists have recommended caesarian section. The authors have prepared successfully spontaneous vaginal delivery.

We made a study of 106 women in childbirth from our hospital with myopia for the period from 2003 to 2003. Vaginal delivery have had 38 and Cesarean delivery 68 (64.2%). Only 18 women have had severe myopia (more than 6 d.), which is equal to 17%. We consider that the myopia is an ungrounded common indication for Caesarian section.

The authors present a modern review on the early oral intake after cesarean section and gynecological operations and their own experience with 130 cesarean and 100 gynecological operated women. This is for the first time on our (Bulgarian) practice. Early oral intake was well tolerated by the patients, there were no more postoperative complications associated with the new method of postoperative care. The authors recommended this approach for the clinical practice.

There are scanty of available data about the management of myoma of the uterus during pregnancy and birth. The authors describe two cases of such a pathology--big myoma of the uterus > 10 sm diameter (d.), who were treated conservatively and ended successfully, without serious complications. The pregnant women were done cesarean section and during the operation the myomas were excisiert. There were no complications intra- and postoperationem. The authors suggest that myectomy during pregnancy and cesarean section must not be don routinely.

The authors make a review on this problem for first time in Bulgarian literature and for the first time by us operated with the Misgav Ladach method--cesarean section. The authors describe 50 cases wit Ladach method and as control 20 with Pfannenstiel. The authors establish shorter duration of the operation-Si] and 56.3 min. respective in benefit for Misgav method; the babies were extracted at 5.5 and 12.3 min. respect. The mothers with Misgav had better prognosis at the time of dehospitalization.

The authors describe 7 cases of pregnant women with high myopia to 15 diopters, who have been delivered vaginally without worsening of the vision and especially of the myopia. That's why the authors practice and recommend a vaginal delivery to women with a myopia, including high-degree myopia.

On the basis of current literary data the author presents clinical, laboratory and histomorphological parameters, which show that HELLP syndrome and acute fatty dystrophy of liver during pregnancy have equal clinical picture, equal laboratory results, equal clinical management, equal therapeutic treatment, equal early and late prognosis for the mother and fetus (infant). The indicated up to now "specific" histological finding in the liver during fatty dystrophy of the liver of pregnant women is not sufficient foundation for division of these syndromes, because it is found in the HELLP syndrome as well, because fatty vacuoles depositions in the kidneys are discovered in (grave) preeclampsia. The author concludes that the acute fatty dystrophy during pregnancy is a manifestation, a form of HELLP syndrome, but not a disease, a syndrome sui generis.

The authors described the pregnancy and delivery of a woman with unstable angina pectoris (ECG data for ischemic disease of the heart). Delivery occurred through the vagina without complications for the mother and fetus. The literary references treat the question about course of pregnancy, way of delivery and analgesia in women with myocardial infarction during pregnancy.

Eight women with deliveries after undergone two and more cesarean section are described. Delivery occurred vaginally in 6 of them, but cesarean section was performed in two of them, whose indications were diagnosed after full dilatation of the cervical canal because of nonadvancement of delivery. A review of literature on this question is presented. Taking into consideration the literary data and their own observations an opinion is expressed that there is basis for a change in the present management of pregnant women with two and more undergone cesarean sections and is proposed to accept the concept for "trial of labor"--evaluation of the cases for vaginal delivery and those for elective cesarean section, taking into consideration criteria for delivery after cesarean section.

The authors studied the level of some amino acids in the plasma of 10 women with normal pregnancy as well as of 16 women with moderate form of pre-eclampsia. 21 amino acids were determined by a liquid chromatograph, consisting of an automatic controller of the gradient, nonautomatic injector, fluorimetric detector and recording device. The results showed that there were differences in amino-amides of women with normal pregnancy and of nonpregnant women. Concentrations of a large part of amino acids were not changed, but some of them increased--aspargic acid, glutamate, threonine and phenylalanine or reduced--cytroline, methionine, ornithine, glycine, aspargine, alpha-amino acid during pregnancy. The values of amino-acids in women with normal pregnancy and in women with moderate form of preeclampsia did not differ. Ethanol-amine is the only exception and it is found in almost half of the women with preeclampsia. This is an original finding, which deserves further study.

The short-lived antibiotic prophylaxis finds wider and wider usage in the present obstetric practice. The authors aim to examine clinically and to use in the obstetric practice short-lived antibiotic prophylaxis with doxycycline after interruption of pregnancy and residual abrasion due to incomplete abortion. The treatment of women from the experimental group was 500 mg of doxycycline per os at once, but 100 mg twice for 6 days in women from the control group in accordance with the common usage. Attention was paid to 3 basic symptoms: temperature over 37 degrees C, pains at the lower part of the abdomen and need of additional treatment. An inference i made that inflammatory complications after the two types of antibiotic prophylaxis does not differ in frequency (p greater than 0.05). The advantages of short-lived usage are evaluated as well.