Jugoslavenska ginekologija i opstetricija最新文献

In 240 pregnant women the blood pressure mean value in the second trimester of pregnancy was determined after the method of Page and Christianson; in 40% the value was 11.3 kPa or higher, and 90% of all later manifest hypertensions in pregnancy came from this group. In 17% of pregnant women the blood pressure mean value exceeded 12 kPa and this group contained 63.2% of all later manifest hypertensions in pregnancy--among them 6 out of a total of 7 severe or very severe cases of hypertension.

An analysis was made of 1420 patients with threatened spontaneous or habitual abortions and pre-term deliveries, concerning the incidence of some etiological factors of infertility that might have been risk factors in the actual pregnancy. The number of pregnant women over 35 years of age in the treated series was significantly higher than in the control group. History data on sterility in the former group showed the incidence of 4.37% and in the control group 1.10%, the difference being highly significant (P less than 0.001). In the investigated series 154 patients (10.85%) had already had previous pre-term deliveries, while in the control group pre-term deliveries amounted to 3.20%, the difference being statistically highly significant (P less than 0.001). History data on spontaneous abortions in the first group showed the incidence of 69.57% (846 patients) and in the control group 16.20% (P less than 0.001). Uterine malformations were recorded in 69 gravidae (4.86%) in the treated group and in 1.20% in the control group, the difference being statistically highly significant (P less than 0.001). In addition to etiological factors, a high incidence of the following anomalies was also revealed: uterine hypoplasia and myoma, cervical laceration, cervico-isthmical insufficiency, and perinatal deaths in the history of the treated group. The importance of antenatal care of pregnant women with previous sterility and infertility is emphasized, as well as the need for considering the prophylactic use of beta-sympathomimetics.

The authors put forward their own scheme of investigating possible causes of infertility. In everyday clinical routine the results of such investigations are limited. Most useful data are obtained by a detailed anamnesis, hysterosalpingography, bacteriological analysis, and cytogenetics. In the therapy of spontaneous abortion strict rest is recommended. Gestagen therapy is applied in bleeding in the first trimester only when fetal life is proved (ultrasound). Early protecting cerclage is to be performed between the 14th and the 16th gestation week. The importance of a positive psychological relation between physician and patient is emphasized.

The authors describe the rare case of a triple primary malignant tumor in 59 old women. It consisted of squamous cell carcinoma of the cervix uteri, leiomyosarcoma of myometrium and granulocellular carcinoma of the ovary. The patient was treated by surgery and irradiation. No signs of recurrence have appeared in the four post-operative years.

The value of ultrasound (US) is analysed by means of ROC-curves (receiver operating curves) taking into consideration both the sensitivity and specificity of the method, as well as the prevalence of particular tumours in the examined group. US diagnosis is compared with clinical and surgical findings. The authors have found that the degree of reliability achieved by either the clinical or the US method of diagnosing myomas is almost the same. In the diagnosis of benign cysts and carcinomas, however, US has more advantages.

By a retrospective analysis the authors studied live-born twins by gestation weeks and birth weight and height: there were 1,195 first-born and 1,189 second-born twins, all from three neighbouring Dalmatian towns (Split, Sibenik and Zadar). A common curve was worked out of the intrauterine growth of both the first and the second twins and a separate curve of each of them. The curves have shown that the twins' birth weight was increassing up to the 40th week of pregnancy; in the 41st week the curve already went down. The authors conclude that twin pregnancy should not last more than 40 weeks.

Bacteriological findings obtained by the Cryo-method of cervical smears before and after the treatment of cervicitis and ectopia in the vaginal part of the uterine cervix of 64 women revealed certain essential changes. Before the Cryo-therapy, pathogenic microorganisms were verified in 49 patients (76.56%), while saprophytic flora was isolated from 15 patients (23.45%). After the treatment, this proportion was significantly changed: saprophytic flora was isolated from 45 patients (70.34%), while pathogenic flora continued persisting in 19 patients (29.67%). Eight weeks following the treatment, instead of a dense, non-elastic, opaque, cellular secretion before the Cryo-therapy, a clear elastic, acellular mucus was recorded.

The pH of the fetus and mother in the phase of pressing in 100 normal deliveries, which served as the control group, was analysed. An average decrease of the pH by 0.07 in both the fetus and the mother was recorded, starting from the full opening of the cervix until the termination of labour. This result is evaluated by the determination of the pH in 121 cases of disturbed pregnancies, singling out 9.9% of fetus in preacidosis and 11.6% of fetus in acidosis, which is significantly higher than in the control group. It is pointed out that the detection of acute fetal suffering in labour should not be limited to the time of opening only but that it should be carried out also in the phase of pressing.

In the uterus body of nongravid and gravid women, proportionally to the dose used, histamine, promethazine, and cimetidine produce an increased muscular tonus, which is more pronounced in gravid uteri. The blocking agent of histamine H-1 receptors, promethazine, and the blocking agent of histamine H-2 receptors, cimetidine, separately or jointly applied in a dose of 10 micrograms/ml, significantly decrease the tonicizing effect of histamine. Histamine exerts its influence on the muscular tonus of the body of nongravid and gravid human uteri through histamine H-1 and histamine H-2 receptors.

In addition to being the best method for the diagnosis of the hydatidiform mole, ultrasound is also used in the surgical treatment of the mole. The procedure of the evacuation of the complete hydatidiform mole by vacuum suction and continuous ultrasonic monitoring is described. The method is illustrated by three cases.