Jugoslavenska ginekologija i opstetricija最新文献

From 1970 to 1979 the authors analysed 1721 vacuum extractions. The method was introduced into the Department in 1965 and performed in 0.96% of cases. From 1970 to 1980 the use of VE increased from 1.97% to 4.93%. The most frequent indication for its use was the prolonged expulsion phase (49.78%). While in premature children the method was applied rarely (2.32%), in children weighing over 4000 g it was indicated in 16.44% of cases. The newborns delivered by VE proved to have increased traumatic morbidity rates (anoxia perinatalis 25.56%, haemorrhagia intracranialis 20.39%, cephalhaematoma 33.58%). The mortality of newborns delivered by VE amounted to 6.39%. There was 1.10% of unsuccessful vacuum extractions (19 parturients: in 16 forceps and in 3 cesarean section were applied). In the authors' opinion, vacuum extraction is the method of choice in the vaginal operative completion of labour: VE does not diminish the pelvic cavity or fix the position of the head of the fetus but allows the flexion of the head by natural forces. After each unsuccessful vacuum extraction it is necessary to examine its causes. The choice of the method for completing labour depends on the obstetric situation. Intracranial hemorrhages amounting to 20.39% warn the authors to reexamine the methods of their work.

The incidence of significant asymptomatic bacteriuria was found in 8,14 per cent of 614 nonselected pregnant women's. The method of taking the "clean" middle stream urine is well accepted and valid one, but in some cases it is useful to do the suprapubic puncture of urinary bladder in order to avoid the contamination of urine. It is discussed about the incidence, aetiology, pathogenesis and prevention of urinary infection in pregnancy.

The modifications of urethrocystography developed by the authors aimed at reducing possible damages but securing a good diagnostic value of the method. They made it possible by applying only one instead of the originally applied six catheterizations. Previously used barium sulphate is now replaced by urographin which is less damaging to the mucous membrane of the urinary bladder. In addition, a string of metal balls, which causes injury to the urethra, is no longer used. In the first modification a catheter into which a stainless steel spiral is inserted is used. The second modification is even simpler, because it is based only on the use of different urographin concentrations. By these modifications possible iatrogenic uroinfections are significantly reduced, there is no injury of the urethra, and the time needed for the preparation and carrying out of the method is shortened to one third. In X-ray pictures contrast is not so intense as is the case with barium and metal; they are a little lighter but quite good for diagnostic purposes.

The author draws attention to difficulties in assessing the degree of fertility after the use of various contraception methods, because prior to their application the women's initial fertility is not exactly examined. He gives a critical review of the experience reported so far on fertility after the interruption of hormonal and intrauterine contraception, sterilization, and artificial abortions. His conclusions is that none of the temporary contraception methods represents a considerable risk relating to future fertility if in each woman contraindications for their use are strictly obeyed.

The study covered a total of 1,488 pregnant women who came for their first prenatal consultations in about the 19th week of pregnancy. The experimental group consisted of 416 women previous pregnancy ended with artificial abortion. In the control groups there were women who had neither a delivery nor abortion, then women whose previous pregnancy ended with the birth of a live child, and, finally, women in whom the previous pregnancy ended with spontaneous abortion. It has been shown that after artificial abortion, spontaneous abortion and premature deliveries in the subsequent pregnancy are just as frequent as in women who have not been pregnant (ili who had no delivery). Nor was there any higher percentage of low birth-weight children or perinatal mortality. A larger number of newborns weighing at birth less than 2,500 g was observed in women in whom abortion was performed by vacuum aspiration and not by curettage. In women with the abortion performed by vacuum aspiration and becoming pregnant in the first year following abortion, there was a significantly higher number of premature deliveries and low birth-weight children.

Birthweight estimation has clinical importance in routine practice. The method used at present is the measuring of the circumference of the fetal abdomen at the umbilical vein level. The aim of this study was to check the theoretical hypothesis that a simple method of the trunk area measurement is a better birthweight estimator than the circumference measurement (when elliptic elongation is changed). In order to make this measurement simple, an ellypsoid approximation of the trunk cross section was used, i.e. the longest and the shortest diameters were measured. The area is proportional to the product of the diameters while the circumference is proportional to the sum of the two. The longest and the shortest diameters were measured in 200 patients up to two days prior to delivery, perpendicular to the spine at the umbilical vein level. The results have shown that in fetuses whose cross-section of the abdomen is elongated, the product of the longest and the shortest diameter gives a significantly better correlation to birthweight than their sum.

Out of 845 Rh-negative parturients with Rh-positive children, 515 (60.64%) accepted the application of IgG-anti D serum. The rest refused it, because they had two or more children. Out of 82 Rh-negative pregnant women who had spontaneous abortion, 30 (36.58%) were covered by the IgG-anti D prophylaxis. Artificial abortion was applied in 3148 Rh-negative women, of whom 178 (5.60%) took IgG-anti D serum. Following spontaneous and artificial abortions IgG-anti D was applied mainly in women with no children or with one child. Parity influenced the application of prophylaxis and in artificial abortions also the fact that in these cases women were to pay for the preparation. The control was carried out in the subsequent pregnancy: after delivery only one Rh immunization (0.19%) has so far been recorded--none, however, after spontaneous and artificial abortions.

Nothing seems to slow down the postoperative passage of the intestines so much as an empty stomach. For this reason the authors have for three years been giving special attention to early food provision following cesarean section as a stimulus to peristaltic movements. They analysed 150 deliveries of women with cesarean section to whom light parenteral diet was applied immediately after the operation and compared the results obtained with those from the control group of 150 women with cesarean section treated from 1972 to 1973 when only intravenous infusion was administered. A significantly quicker appearance of gases was observed in the women on early parenteral diet than in the control group (the average time 34:74h) and the first stool was recorded much earlier in the first than in the second group (56:67h). Prostigmin was administered only exceptionally. Neither in the first nor in the second group did surgical intervention for postoperative ileus prove necessary.