Considering obstetrical management we should have always in mind advantages and disadvantages of vaginal birth after cesarean (VBAC) and elective cesarean section after a previous one, financial part ...of the elected mode of delivery in the particular case, psychological aspect of the matter (especially after an unsuccessful trial of labour--TOL) and not on the last position-patient's right to choose the way how to deliver. We performed an inquiry of 3-year-period and 50 women with a prior cesarean section, by which we studied the factors contributed in different extent to the choice of the following approach to delivery: patient's preliminary choice, the impact of medical staff during pregnancy and when entering the Department of Obstetrics, the impact of non-medical persons, complications after the previous cesarean section, patient's acquaintance with complications and consequences associated with the operative mode of delivery, as well as doctor's personal attitude to the different modes of delivery. The aim of our research is to show that by careful selection (according to the established indices) of women, who have a high probability (more than 80%) to deliver their babies vaginally and offering adequate information by educational literature and including the woman in the decision making process, the growing rate of cesarean section will be decreased by increasing the number of VBAC--undoubtedly one of the most important issue in modern obstetrics.
Considering obstetrical management we should have always in mind advantages and disadvantages of vaginal birth after cesarean (VBAC) and elective cesarean section after a previous one, financial part ...of the elected mode of delivery in the particular case, psychological aspect of the matter (especially after an unsuccessful trial of labour--TOL) and not on the last position-patient's right to choose the way how to deliver. We performed an inquiry of 3-year-period and 50 women with a prior cesarean section, by which we studied the factors contributed in different extent to the choice of the following approach to delivery: patient's preliminary choice, the impact of medical staff during pregnancy and when entering the Department of Obstetrics, the impact of non-medical persons, complications after the previous cesarean section, patient's acquaintance with complications and consequences associated with the operative mode of delivery, as well as doctor's personal attitude to the different modes of delivery. The aim of our research is to show that by careful selection (according to the established indices) of women, who have a high probability (more than 80%) to deliver their babies vaginally and offering adequate information by educational literature and including the woman in the decision making process, the patient resistance to vaginal delivery will be reduced. In this way, the growing rate of cesarean section will be decreased by increasing the number of VBAC--undoubtedly one of the most important issue in modern obstetrics.
To compare and analyze the pain profiles of patients with endometriosis /E/, adenomyosis /A/, and pelvic congestion syndrome /PCS/ in order to specify the factors that make closer the profiles of ...these conditions, and the factors, that make the differences between them clearer.
A prospective study was conducted in the Clinic of Gynaecology, Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004-01.02.2006. It included 98 patients consequently admitted in the Clinic--66 patients suspected of or with proven E, and 32 patients with PCS. For the purpose of the study the following methods were used: pain chart, visual-analogue scale /VAS/, monthly pain calendar, documentary method, R-AFS classification of endometriosis and inquiry method.
The object of interest in this study were the pain profiles of E, A and PCS, and the dependence and association of severity of manifestation of the particular components of the pelvic pain syndrome /dysmenorrhoea, dyspareunia, postcoital ache, etc./ of the conditions mentioned above, on: stage of endometriosis, localization of endometriotic foci, diameter of maximal dilation and location of varicosely altered pelvic veins in women with PCS. It was found that the intensity and specificity of component demonstration of pelvic pain syndrome of women with endometriosis were not dependent on the stage of the disease, but on location of endometriotic lesions. In patients with PCS the severity and specific character of chronic pain syndrome were dependent on diameter of maximal dilation and site of varicose pelvic veins. According to its characteristics, pain profile of women A takes a specific place between the peculiar profiles of patients with E and PCS.
Pain is a general symptom in the clinical evolution of endometriosis /E/, particularly of adenomyosis /A/, and pelvic congestion syndrome /PCS/-conditions with different incidence and contingent of ...women with specific characteristics.
To build up and compare the pain profiles of patients with E, A, and PCS by the use of quantitative and qualitative characteristics.
A prospective study was conducted in the Clinic of Gynaecology, Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004-01.02.2006. It included 98 patients--66 consequently admitted in the Clinic patients /for diagnostic specification or operative treatment/, suspected of or with proven E, and 32 patients with PCS. For the purpose of the study the following methods were used: pain chart, visual-analogue scale /VAS/, monthly pain calendar, documentary method, R-AFS classification of endometriosis and inquiry method.
It was made a specification of and comparison between qualitative, quantitative and topical characteristics of chronic pelvic pain syndrome of women with E, A and PCS. Factors that aggravate and alleviate pain symptomatic were determined and the most frequent additional symptoms besides pain were pointed out. Discriminating between pain profiles of patients with E, A and PCS contributes to more precise differential-diagnostic specification together with other diagnostic means.
The dust professional exposition of the above ground workers in the mines "Obrochishte" at the village of Tsŭrkva, Varna Province has been evaluated as well as the dust pollution in the atmosphere of ...the village in respect to the hygienic standards for quartz-containing sand and manganic aerosol. The results show that the pollution with quartz-containing dust is in the normal ranges according to all hygienic parameters for fibrogenic dusts in working environment and the workers are not exposed to risk of silicosis. A greater than the standard exposition to manganic aerosol (from 1.1 to 5 PDK) has been found out in some groups of workers in the ore-dressing plant, in truck drivers of the intra-fabric transport, in fadromists and heavy scraper workers. The manganic aerosol is found to be a pollutant of the atmosphere also, and the cause of this is thought to be the mine storages in the open-air and the poor state of the intra-fabric roads.
Endometriosis /E/ is a frequently met disease in women in reproductive age. One of its most typical clinical manifestations is chronic pelvic pain /CPP/ and as components of the chronic pain ...syndrome- dysmenorrhoea, dyspareunia, intermenstrual pain, and sometimes dyschezia and dysuria.
To build up pain profile of patients with E by using quantitative and qualitative characteristics.
The study was conducted in the Clinic of Gynaecology at the Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004-01.02.2006 Sixty-six patients were included in the study. They were consecutively admitted in the Clinic for diagnostic specification or operative treatment, and in whom E was suspected or proved before. The patients were grouped according their age, fertility, body mass index, blood group affiliation, stage of the disease, etc. The following methods were used for the purpose of the study: pain map, monthly pain calendar, inquiry method-by a questionnaire /form/, based on instruments for pain assessment, which are accepted worldwide; documentary method, R-AFS classification of E. Factors that provoke appearance and manifestation of pain, and factors that alleviate pain were studied too.
The obtained results were statistically processed and were presented by the means of tables, graphics and numerical quantities. They corroborated the hypothesis for typical pain profile of women with E.
The building up of pain profile in total with other diagnostic methods /ultrasonography, magnetic resonance imaging/ has a determining role in the further diagnostic and therapeutic management of women with E and CPP. Pain profile can also be used as an assessment tool of conducted treatment /conservative or surgical/.
To determine the severity of the separate components of chronic pelvic pain syndrome/dysmenorrhoea, dyspareunia, dysuria, dyschezia ,etc/ in the different stages of the disease and according to the ...localization of endometriotic lesions. To determine to what extent the severity of the separate chronic pain components correlates with stage of the disease and localization of endometriomas.
The study was conducted in the Clinic of Gynaecology at the Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004 - 01.02.2006 Sixty-six patients were included in the study. They were consecutively admitted in the Clinic for diagnostic specification or operative treatment, and in whom E was suspected or proved before. The patients were grouped according their age, fertility, type of the disease - internal or external genital endometriosis, adenomyosis, stage of the disease, localization of endometriotic lesions. The following methods were used for the purpose of the study: visual analogue scale, documentary method, R-AFS classification of E, inquiry method-by a questionnaire /form/, based on instruments for pain assessment, which are accepted worldwide.
The obtained results were statistically processed and were presented by the means of tables, graphics and numerical quantities. When the mean value of pain assessment was reported, there was noted a non-correspondence between severity of pain and stage of the disease. It was found no significant correlation between the extent of manifestation of the separate components of the pain syndrome according to the stage of the disease. The severity of the separate components of the pain syndrome was determined according to the localization of the E-lesions. Statistically significant correlation was found between the extent of manifestation of dyspareunia, postcoital ache and dyschezia, and the localization of the E- lesions /p<0,05/ and that correlation was strongly supported in cases of adenomyosis and the components mentioned above. Statistically significant differences were found between the extent of manifestation of the relevant component of the chronic pain syndrome and some of the localization of E foci.
It was established a correlation between localization of E lesions and the severity of the separate components of the chronic pain syndrome. No correlation was found between the extent of pain manifestation, when assessed in total and in each pain component, and the stage of endometriosis.
To determine the frequency and analyze the findings during laparoscopy in women with chronic pelvic pain /CPP/.
The study was conducted in the period 01.03.2004-01.07.2007 in the Gynaecological ...clinic at the Department of Obstetrics and Gynaecology, MU-Pleven. Eighty-six women were consecutively admitted in the Clinic, presenting with pelvic pain with duration more than 6 months and who underwent laparoscopy in order to be diagnostically defined more accurately or operatively treated. They were classified according to their socio-demographic characteristics, reproductive history/fertility and parity/, presence of preceding operative interventions, and findings during laparoscopy.
The most frequent findings in women with CPP during laparoscopy were endometriosis /56,98%/ and adhaesion syndrome /39,53%/, and with a lower frequency-pelvic varicosis /17.44%/ and Allen-Masters syndrome /24,42%/. The most common localization of endometriotic foci was on ovaries/40,7%/and plica vesicouterina /18,6 %/, and of the varicose dilated veins-along vv.ovaricae and in the basis of the broad ligaments/resp. 89,96 and 60%/.
Laparoscopy is an exceptionally valuable and useful method in diagnosing and differentiating the etiology of chronic pelvic pain symptoms, because of the frequent presence of more than one cause with pelvic localization for its appearance.
