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For prevention of postoperative cystitis the authors tested currently used drugs which influence the adherence of bacteria to the urothelium, nitrofurantoin (FurantoinR), 3 x 1 tabl. per day and trimetroprim with clotrimoxazole (BiseptolR), one tablet in the evening before operation. They found that Furantoin reduced the frequency of the inflammation in patients subjected to abdominal operations from 12.3% in the control group to 2.3% and in those subjected to vaginal operations from 46.1% to 9.6%. The disadvantage of the drug is that it must be taken every day and that it is poorly tolerated by the patients. Biseptol is excreted more slowly and therefore 1 tablet before operation blocks the development for a maximum of 48 hours. In patients with abdominal operations the frequency of inflammation was similarly as in controls, 12%, in patients with vaginal operations the number of inflammations declined to 24.5%. Biseptol, 1 tablet before operation, is suitable only in patients where it is not assumed that the catheter will be inserted for a prolonged period.
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The authors investigated the relationship between histologically confirmed chorioamnionitis and the development of adnatal infection in the neonate. From a total of 4,144 deliveries during the investigation period-January 1, 1988 to December 31, 1989-252 placentas of neonates after pathological deliveries were examined. Chorioamnionitis was recorded in 28.6%, i.e. in 72 placentas inflammatory changes were found. Adnatal infections of neonates with chorioamnionitis were detected in 20.8%, i.e. 15 neonates. On the other hand, in the group of neonates where no inflammatory changes of the placenta were present adnatal infections were recorded in 8 infants, i.e. 4.4% (p = 0.00004). The mortality rate from adnatal infections in the group of neonates with chorioamnionitis was 4.16%. In the group of neonates without chorioamnionitis no death due to adnatal infection was recorded (p = 0.00000). Chorioamnionitis is thus associated with a significantly higher incidence of clinical adnatal infection in neonates and mortality due to this infection.
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Ten patients with multiple gestations, all resulting from in vitro fertilization, underwent multifoetal pregnancy reduction. In four cases transvaginal puncture was performed, six patients underwent transabdominal pregnancy reduction. Seven women delivered, all three pregnancy losses occurred in the transvaginal punction group--there was one early loss after the procedure and two abortions in the late second trimester. There were 5 sets of twins and two singletons were delivered. Multifoetal pregnancy reduction represents an important addition to the management of unplanned multifoetal pregnancy resulting from infertility treatment. The procedure is not without risks and these must be weighted against expected benefits.
By intracervical administration of 0.75 mg PGE2, using a butterfly needle, the authors preinduced 32 patients with an immature portio vaginalis cervicis (CS 5 points) who had indications for termination of a full-term pregnancy. Slow administration lasted cca 6 hours. Maturation of the portio vaginalis cervicis occurred in 93.5%, in 71% regular uterine contractions started. The length of labour stages, the loss of blood, frequency of injuries during labour and foetal hypoxia were similar as in spontaneous deliveries. Side-effects were recorded in 20.7%. The described method is a suitable alternative to administration of gel substances, in particular because it is cheaper because it is well tolerated by the patients and is simple.
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The authors examined the antispermatozoal activity of 123 sera of patients hospitalized at the Gynaecological and Obstetric Department in Plzen during the 8th-9th week with diagnosis of imminent abortion. They revealed markedly higher antibodies against spermatozoa in particular in IgG, but also in IgA and IgM in 17 (13%) patients, who eventually had spontaneous abortions. The authors investigated also the obstetric history in connection with the presence of antibodies against spermatozoa. The antibody levels were higher in primary pregnant women.