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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.

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 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.

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.

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 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.

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 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 uterus10 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 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.Therapeutic efficacy of premedication with a single dose (500 mg) of broad-spectrum antibiotic doxycycline (vibramycin) was studied in 90 women undergoing abrasion residuorum following incomplete abortion. A group of 72 women subjected abortion on demand by means of vacuum aspiration and treated with conventional dose of doxycycline (100 mg, 2 times a day, for 6 days) was used as controls. The test and control groups were comparable with respect to age and duration of pregnancy. Complications included fever (5.6%, compared with 8.3% in control group) and pain in the lower abdomen (19.0%, compared with 20% in control group); 3.3% of the patients required additional treatment with antibiotics, compared with 4.1% in control group. These findings indicated that short-term administration of doxycycline was as effective in preventing inflammatory complications of abortion as conventional 6- day course.

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 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.

Complications after abortifacient use of potassium permanganate in a 22-year old woman are described. Approximately 1 month prior to admission, the patient placed in the vagina a bag with potassium permanganate for 12 hours. Gynecological examination showed stenosis of the vagina, enlargement of the uterus, and adhesions in the cervix and vagina. The patient underwent surgical separation of the vagina, daily irrigations of the vagina, and postoperative administration of ampilillin. Microbiological analysis of the vaginal discharge showed the presence of bacteroides melaninogenics and Peptostreptococcus sensitive to ampicillin, chloramphenicol, and cephalosporin. These findings indicate the role of chemical injury of the vagina in pathogenesis of the endogenous anaerobic genital infection.

The authors examined the amount of blood in the vessels of the placenta, uterus, liver and kidneys of white rats with prolonged pregnancy. The model of prolonged gestation is obtained after administration of progesterone during the last days of pregnancy. The results reveal that the amount of blood in the vessels of the uterus and placenta of rats with prolonged pregnancy is statistically significantly reduced (in the uterus 3,7 and 4,8 gammas per 100 mg of tissue, but in the placenta 3,76 and 8,8 gammas respectively and p less than 0,05). the authors explain these changes in the altered permeability of the vessels of the uterus and placenta in rats with prolonged pregnancy. These results clarify the high percentage of hypoxia in rats with prolonged pregnancy, which is of clinical significance.