Jugoslavenska ginekologija i opstetricija最新文献

Cervical pregnancy in a 23-year-old patients is presented. The local finding corresponded to criteria for the diagnosis of cervical pregnancy. The diagnosis was confirmed by an immunological test (Gonavislide) and ultrasound. Conization was applied, and in the conization material the pathologist found chorial villi with a great many trophoblasts in direct contact with the muscular cervical layer.

In 53 normal pregnant women the alphafetoprotein value (AFP) was determined by two parallel methods: immunological and radioimmunological. The results of this comparative analysis have shown a high significance, the coefficient o the linear correlation r being 1.0002 and the level of agreement obtained by the t test amounting to P less than 0.01. The use of the AFP test in the course of pregnancy depends on the stage of pregnancy. In the first trimester the AFP test is useful as a test for the early detection of fetal disorders. In the second trimester the test is important for the detection of the already existing disorders of the fetus in the course of gravidity and also for the follow-up of the fetal condition. In the third trimester the AFP test could be used for the assessment of gestation age, for the prediction of the death of the fetus, and for the detection of some fetal distress. The AFP level in the mother's blood can provide information about the condition of the fetus within the feto-placental unit.

Out of a total of 618 followed-up pregnant women, 154 (24.91%) had never used contraception, while 464 (75.08%) had used it until the pregnancy at the time of this study. Among those who came to the first examination only after the 12th week of pregnancy there were 21.98% of the users and as many as 68.83% of the nonusers of contraception. Five or fewer examinations during pregnancy were performed in 11.63% of the users and in 41.55% of the non-users of contraception. There were 9.48% of the users and 27.27% of the non-users of contraception who did not attend prenatal consultation courses. These three parameters were applied for assessing the quality of prenatal care. A better quality of prenatal care in the users of contraception could be explained by their greater concern for the problems of reproduction.

A study was made of the pH value of uterine secretion in 100 women at the age of 18-50 years and with a normal menstrual cycle (28 +/- 2 days). Fifty women had inserted medicated IUDs (Copper T and Multiload Cu 250) and 50 women served as a control group. In the proliferation phase of menstrual cycle 22 women were with the IUDs (of whom 14 had group II and 8 women group III vaginal secretion) and 21 women without any IUD of whom 8 had group II and 13 women group III vaginal secretion. In the secretion phase 28 women were with IUDs, (8 had group II and 20 women group III vaginal secretion) and 29 women from the control group, of whom 17 had group II and 12 women had group III. For the sampling of the intrauterine fluid the aspiration method and for the pH determination the colorimetric method were used. It can be seen that there is no correlation between the group of vaginal secretion and the pH of the uterine fluid, that the presence of a medicated IUD induced an insignificant change in the intrauterine pH, and that the pH value of the uterine fluid ranges from 3.0-9.0 which may be an important factor in the elucidation of certain mechanisms that occur in the uterus in the presence of intrauterine devices.

The authors present 11 patients with ovarian dysgerminoma treated at the Institute of Oncology and the University Hospital Department of Gynecology and Obstetrics in Novi Sad. The average age of the patients was 33.90 years (the mean value 27). In most of them the disease was in an advanced stage, with considerable local findings at the beginning of the treatment. In only three 3 patients was the disease relatively limited. The results of the treatment were unsatisfactory: three patients have been alive for 8, 11, and 12 years after the beginning of the treatment, three patients after 6 and 26 months and are still under treatment but with suspect clinical or laboratory findings, whereas the remaining five died in the period between 3 and 4 months following the beginning of the treatment. All these patients were treated surgically in the first place, but radiotherapy proved of great help, because this tumour is markedly radiosensitive, and also chemotherapy was useful in some of the women treated. In general, therapy should be strictly adjusted to individual cases, primarily because the disease appears more frequently in younger women.

A parturient who had never been examined during pregnancy was admitted to the maternity ward at the end of the first phase of labour. Owing to a stoppage in the expulsion of the regularly rotated head, the forceps was applied. The extraction of the head was followed by the collision of the shoulders. Behind the fetus's neck, in the uterine canal, there was the head of the other fetus. The attempt of the reposition of the head of the other twin in general anesthesia was a failure. Since auscultation revealed no heart tones in any of the twins, the perforation of the head of the other fetus was performed, and in this way the extraction of the first and then of the second fetus was possible. The authors emphasize the importance of the echographic detection of the position and site of the fetuses in twin pregnancy.

Three patients with the primary carcinoma of the fallopian tube, aged 51, 68, and 42, are presented. The disease was diagnosed in the period from 1971 to 1980. In all three patients there was a triad of symptoms: bleeding, adnexal tumour, and pain, but the diagnosis was made only during surgery. The operative therapy with consecutive radiation was applied in all three patients.

Serum total oestriol concentration was estimated by radioimmunoassay in 370 healthy pregnant women during the 27th and 41st week of gestation. The rise of the serum oestriol was noted from 230,4 +/- 128,2 nmol/L in the 27th week to the peak value of 732,8 +/- 322,4 nmol/L obtained in the 39th week. The changes in the urine total oestrogens measured by immunochemical method were similar but the increase was more uniform and stable. Low correlation (r = 0,25) was found between serum total oestriol and total oestrogens in urine. The results comparison of total oestrogens from urine determined by immunochemical method and obtained by radioimmunoassay has shown excellent and significant accordance (r = 0,98 p less than 0,01).

Analysing 540 cases of caesarean sections and comparing them with the equal number of vaginal delivery, the author concludes that operative trauma is the main reason of infection. Other reasons are prolonged delivery and the prolonged time between the rupture of the membrane and delivery. Other factors (number of vaginal examinations, amnioscopy, internal CTG) in the author's material did not significantly influence the incidence of infection. Antibiotic prophylaxis, general by speaking, significantly influenced the diminishing of the frequency of puerperal infection.