Women "healthcare" and obstetrics - "thoughts of farewell"

Medicine, and so within also gynecology and obstetrics is shaped in the process of the last decade by changes of interaction between female-patient and physician in "Arbeitszeitgesetz" (law upon daily working time), the introduction of payment-system an case by case based lump-sums and intrusion (interference) of the political administration into autonomy of medical faculties. The contribution concerns with these prevailing economical required changes, interacting and beyond inter-disciplinarity. The progress in medicine by research is causing potential capacity and secondary costs explosion. Including financing of health service and decisive determinants: the demographic development of society, the change in working sphere and particularly law-dominated prenatal-medicine. This, future of medicine determining political, ethical and legal challenge must be accepted by medical professions. Solutions are pointed out.     

"For" and "against" the use of cytotec in obstetrics and gynaecology

The aim of this outlook was to study the application of Misoprostol in obstetrics and gynaecology. Because this preparation is not approved for use in Bulgaria, publications on the topic from various journals cited in Medline, Cochrane library, Nature, Science, Lancet, GyneWeb and others have been taken into consideration. Indications, methods of administration, dosages and side effects in use of this drug were described.     

"Planned" and "unplanned" pregnancy: deconstructing experiences of conception

This paper seeks to explore women's experiences of conception, and to deconstruct the dichotomy between the terms "planned" and "unplanned" pregnancy. It draws on interviews with 19 primagravidae conducted as part of a wider qualitative study of women's experiences of pregnancy and childbirth. Although the concept of pregnancy intention is widely regarded as ambiguous, and by some immeasurable, this paper draws on interview data to develop four categories of pregnancy intention. The first category (the planned pregnancy) is unambiguous and reflects the type of planned approach currently advocated by health professionals. The second category (the laissez-faire pregnancy) reflects the experiences of women who stop using contraception but adopt a more relaxed approach to pregnancy planning. The third category (the recalcitrant pregnancy) is far more ambiguous and describes the experiences of those who want to be pregnant but for whom it would not be socially acceptable to plan a pregnancy. The final category (the accidental pregnancy) is unambiguous and deals with pregnancies that could be described as unexpected, and arising due to genuine contraceptive failure. This paper concludes by highlighting the significance of pregnancy intention for health policy, health research, and for the health care providers. The importance of adopting a subjective approach to improve our understanding of women's experiences of conception is also highlighted.     

"Principles and practice of hysteroscopy"

In recent years the hysteroscopic method of examination has not become as widespread as we hoped. Its field of indication has not yet been clearly defined. In the diagnostic field hysteroscopy has not yet been utilized to the full. Colpo-hysteroscopy or contact hysteroscopy will possibly open up new opportunities for its use.     

Benign ovarian serous tumors: a re-evaluation and proposed reclassification of serous "cystadenomas" and "cystadenofibromas"

OBJECTIVE: Serous cystadenomas and cystadenofibromas of the ovaries are currently regarded as neoplasms and are considered the most common ovarian neoplasms. The purpose of this study is to determine what proportion of benign serous tumors contain an epithelial proliferation (the hallmark of a neoplastic process in nearly all other sites) that can be considered neoplastic as opposed to reactive in nature. METHODS: An unselected series of 113 ovarian serous tumors (76 serous cystadenomas and 37 serous cystadenofibromas) were histologically evaluated. A 1-mm in diameter area of epithelial proliferation was considered potentially neoplastic. RESULTS: Eight tumors (7%) displayed at least 1 mm of epithelial proliferation (1% of serous cystadenomas and 19% of serous cystadenofibromas). CONCLUSION: The vast majority of benign serous tumors may not be bona fide epithelial neoplasms, but rather, may represent cystically dilated glandular inclusions (cystadenomas) and fibromas with epithelial inclusions (cystadenofibromas). A recently published study evaluating clonality in serous cystadenomas found that the vast majority are polyclonal and thus supports this hypothesis. These findings have important implications for the pathogenesis of ovarian cancer, for the distribution of ovarian neoplasms, and for the interpretation of molecular biological studies of ovarian tumors.     

"Typhoid Mary" and "HIV Jane": responsibility, agency and disease prevention

The construction of disease risks as knowable, calculable and preventable in dominant social science and public health discourses has fostered a certain kind of logic about individual risk and the responsibility for infection. Disease control measures that have developed out of this logic typically fail to recognise the socio-structural roots of many high-risk behaviours that are linked to the spread of infection. Instead, they hold the disease carrier responsible for managing his/her own risk of infection of others, and rely on constraining the agency of the carrier (e.g. by constraining movement, contact or occupation). In occupations associated with a high risk of infection, the idea of responsibility of the actor implicitly raises issues of "professional responsibility". Using the case of "Typhoid Mary" and a hypothetical case of "HIV Jane", this paper explores some of the problems with making sex workers responsible for the prevention of HIV transmission. It argues that for the notion of "responsibility" to make any sense, the HIV-positive person must be in a position to exercise responsibility, and for this they must have agency.     

Comparison between "short" and "long" protocols in an ICSI programme

In the present retrospective study we compare the efficacy of gonadotropin-releasing hormone (GnRH) agonist in a long protocol and a GnRH agonist in a short protocol administration for controlled ovarian hyperstimulation (COH) in an ICSI program. A total of 424 consecutive patients with a history of male factor were included in the present study. Three hundred and three patients were included in the long protocol and 121 in the short protocol. Patients treated with the short protocol were stimulated in a shorter time and achieved lower estradiol levels. A significantly higher percentage of oocytes transferred were found in the long protocol. The clinical pregnancy rate per embryo transfer was 39.3% in the long protocol and 19.2% in the short protocol (p=0.001).     

Comparison of "instrument-associated" and "spontaneous" obstetric depressed skull fractures in a cohort of 68 neonates

OBJECTIVE: A depressed skull fracture is an inward buckling of the calvarial bones and is referred to as a "ping-pong" fracture. This study aimed to look at differences between "spontaneous" and "instrument-associated" depressed skull fractures. STUDY DESIGN: This retrospective, case-control analysis included every neonate who was admitted with a depressed skull fracture between 1990 and 2000. Cases after a spontaneous vaginal delivery, elective cesarean delivery, or cesarean delivery that was performed during labor without previous instrument use were classified as "spontaneous" (n = 18 cases). Cases after a delivery in which forceps or a vacuum cup had been used either successfully or unsuccessfully were classified as "instrument-associated" (n = 50 cases). Continuous data were analyzed with 2-tailed unpaired t tests; chi 2 analysis was used for nominal data. A probability value of <.05 was considered statistically significant. RESULTS: Fifty depressed skull fractures were associated with an instrument delivery, and 18 depressed skull fractures were classified as "spontaneous." The only obstetric parameter that differed significantly between the 2 groups was the length of the active phase. Among the 68 neonates, 15 neonates underwent prolonged second stage, forceps or manual head rotation, or forceps use during elective cesarean delivery. All "instrument-associated" cases were caused by forceps application or sequential instrument use; depressed skull fractures never occurred after isolated vacuum extraction. Every type of forceps was involved. Intracranial lesions were significantly more frequent in the instrument-associated group (30% vs 0%; P = .02). Two infants sustained persistent severe motor disabilities. CONCLUSION: Depressed skull fractures occur in the setting of spontaneous and operative deliveries, although the incidence is higher in the latter case. Depressed skull fractures that are associated with instrumental deliveries are significantly more likely to be associated with intracranial lesions. Persistent disabilities are rare.     

"Ts and Blues" in pregnancy

Data on the prenatal and postnatal effects of Talwin and Pyribenzamine ("Ts and Blues") abuse in pregnancy were compared with those from a control group. Anemia, syphilis, hepatitis and gonorrhea were more common in mothers abusing Ts and Blues. Their infants were more often growth retarded. Neonatal withdrawal was seen in 35%.     

The feeding of newborns with low birth weight with milk formula "Nenatal" and "Nutrilon-premium"

The aim of the study is to make retrospective analysis of 9 years experience in the feeding of praematuries and high risk newborn in that ward in First City Hospital-Sofia with formula milks "Nenatal" and "Nutrilon-premium". 721--42.4% from all babies in this period were feed with those formulas. With Nenatal only--11.8%, with Nutrilon-premium 88.2%. This the fact is due that all babies under 2000 gr. were fed with Nenatal, and after reaching 2000 gr.--with Nutrilon-premium. The results confirm that Nenatal is right formula for feeding of low and very low birth weight infant, due to its special content and qualities. The results from Nutrilon-premium illustrated that mean gain weight is the biggest in I grade of prematurity--33 grams, followed by matures--30 gr, after them II grade--29 gr., III grade--27 gr., IV grade--26 gr. As a conclusion we may say that mean gain weight for all groups is 29 grams. Consuming all gain weight of the babies feeding with Nutrilon-premium data appear that the biggest is in III of prematurity--1499 grams, followed by IV grade--1418 gr., I grade--1341 spama, II grade--1219 gr., and last matures--745 gr.     

Comparison of "push" and "pull" methods for impacted fetal head extraction during cesarean delivery

ObjectiveTo compare maternal and neonatal outcomes associated with the “push” and “pull” methods for impacted fetal head extraction during cesarean delivery.MethodsA prospective study was conducted at Imam Reza Hospital, Kermanshah, Iran, from April 2006 to March 2008. After failed vacuum extraction, women with obstructed labor caused by impacted fetal head were randomly assigned to deliver via the push method (n = 35) or the pull method (n = 37). The outcomes investigated included operation time, operative blood loss, incidence of extension of the uterine incision, and postpartum fever. Data were analyzed using χ² and Student t tests.ResultsMean operative time and incidence of extension of the uterine incision were significantly increased in the group that delivered via the push method (P < 0.001). There were no significant differences in the other maternal and neonatal morbidities between the groups, although there was 1 case of neonatal femoral fracture in the pull group.ConclusionAlthough the pull method may lead to some neonatal complications, it is associated with lower maternal morbidity than the push method when used for impacted fetal head extraction during cesarean delivery.