Quantitative system for diagnosis of vulvovaginal candidiasis.

INTRODUCTION: Vaginal infections are one of the most common reason for gynecological consultations. Many of them are the result of overgrowth of resident microorganisms. The clinical symptoms of vulvovaginal candidiasis are nonspecific and an accurate diagnosis is a problem that often leads to inadequate treatment or delays in treatment. The lack of an exact and practical diagnostic method is a common cause of misdiagnosis. AIM: To create a complex, quantitative method for the diagnosis of vulvovaginal candidiasis which to enables differentiation from vaginal fungal colonization. MATERIAL AND METHODS: A total of 2306 vaginal samples were examined. Clinical, microbiological, epidemiological methods and statistical models are used. RESULTS AND DISCUSSION: The proposed score system is a specific, sensitive and inexpensive method to routinely diagnose vulvovaginal candidiasis. Statistical processing of the obtained data shows the impact of the individual components on which the method is based: the presence of vaginal discharge, pruritus, direct microscopy and assessment of the fungal growth. The data analysis reveals good sensitivity (71%) and high specificity (98%) of the method. This allows accurate interpretation of the result of the clinical and microbiological examination of each patient. CONCLUSION: The system for diagnosing vulvovaginal candidiasis is complex and based on quantitative indicators. The method can be used to differentiate vulvovaginal candidiasis from vaginal fungal colonization (the cut-off value is 5.5 points) and to more accurately interpret a Candida positive result from quantitative real-time PCR in asymptomatic patients or in women with mixed vaginal infection.

[PREGNANCY AND DELIVERY IN A PATIENT WITH CHARCOT-MARIE-TOOTH DISEASE].

We report a case of a 34 years old primigravida with Charcot-Marie-Tooth disease (CMTD). The course of pregnancy was uneventful with no deterioration of symptoms due to the disease. Performed amniocentesis showed healthy fetus. Planned cesarean section with spinal anesthesia was performed because of the restricted pelvis. The possible issues of combination pregnancy and CMTD are discussed.

[CORIN - NEW HOPE FOR PREDICTION OF PREECLAMPSIA.]

Preeclampsia is one of the most severe complications of the pregnancy, and trials to estimate a panel of predictive markers are of big interest for multiple researches. Corin is a transmembrane serine protease, localized in the heart, which is converting pro-ANP in to active ANR. ANP is a hormone regulating salt haemostasis and arterial bood pressure. Corin-null experimental pregnant mices develop arterial hypertention and proteinuria, and increased Corin exprecion in to the decidua of human uterus suggests its potential role during pregnancy. It is proven it takes place in throphoblast invasion in humans. Further research of this brand new marker would've been adding a value in trials to settle a effective early screening panel for preeclapmsia prediction, but also would've helpful in understanding its complicated pathogenesis. Promising new field for research is to evaluate serum corin levels during first trimester in combination with other placental factors, markers of neoangiogenesis and Doppler of uterine arteries.

[LAPAROSCOPIC CERVICOISTHMIC CERCLAGE - OUR EXPERIENCE.]

The authors share their experience with 7 women to whom a laparoscopic cervical cerclage before pregnancy has been placed. No intraoperative or postoperative complications were experienced. The indications, technique, positive and negative features of vaginal, abdominal and laparoscopic cerclage are discussed.

[FIRST-TRIMESTER ULTRASOUND AND BIOCHEMICAL MARKERS AND THEIR PREDICTIVE RATE IN PREECLAMPSIA DEVELOPMENT].

Hypertensive disorders related to pregnancy and particularly preeclampsia are leading reasons for perinatal and maternal morbidity and mortality. The symptoms of preeclampsia are occurring during the second part of pregnancy, while the pathogenic processes start developing even in first trimester. This refers to the searching for the most reliable markers, that could prove those pathological processes happened and the combination of those markers in panel for early screening in order to predict the increased risk for developing of preeclampsia. Among multiple studied markers the most promising seam to be Doppler velosimetry of uterine arteries, PIGF, sFlt-1, sEndoglin, PAPP-A, PP-13. Their combined measurement increases the predictive rate and decreases the false positive results, but is also economically irrelevant. There are researches with different medications in order to argue their preventive effect in preeclampsia developing.

[Characteristics of postpartum thyroid dysfunction].

INTRODUCTION: The risk factors and mechanisms for the development of postpartum thyroid dysfunction have been widely discussed. However data on patients suffered spontaneous or induced abortion during early pregnancy are scarce. OBJECTIVE: To reveal the characteristics of thyroid dysfunction in women after an abortion in the first trimester of pregnancy. PATIENTS AND METHODS: A total of 28 women (18 euthyroid, 10 with thyroid dysfunction), mean age 30.46 ± 1.01 years following abortion in the first trimester have been included in the study. Thyroid-stimulating hormone (TSH), free triiodthyronine (FT3), free thyroxine (FT4), thyreoglobulin antibodies (TgAb), thyroid peroxidase antibodies (TPOAb) were measured and ultrasound assessment of the thyroid was performed 3 and 9 months after the interruption of pregnancy. RESULTS: Hypothyroidism was found in 6 of the women with thyroid dysfunction and thyrotoxicosis--in 4. Clinical features of thyroid dysfunction were observed in 3 patients while in the remaining 7 cases, diagnosis was made on the basis of hormonal levels. Positive titers of thyroid autoantibodies were detected in the majority of the cases with functional disordes. In 6 patients thyroid dysfunction was transient and in 4 hormonal abnormalities persisted on by the 9th month after the abortion. The comparative analysis showed that the volume of the thyroid gland and the degree of hypoehogenicity were significantly higher in patients with thyroid dysfunction compared to euthyroid women. CONCLUSION: Thyroid dysfunction after abortion in the first trimester is mainly of autoimmune pathogenesis and its characteristics do not differ from those of postpartum thyroiditis. In the majority of patients these disorders are subclinical and may remain unrecognized. A close active follow up of patients at increased risk of functional thyroid disorders after an abortion is required in order to prevent morbidity and identify the cases developing permanent thyroid dysfunction.

[Fertility-sparing surgery in borderline ovarian tumours].

Borderline ovarian tumours (BOTs) account for 10-15% of all ovarian tumours. They affect a younger age group than the ovarian carcinoma and have a much better prognosis. Over the last decades, the management of borderline ovarian tumors has changed from radical surgery to more conservative therapy as a result of the need for fertility-sparing surgery and the increasing use of laparoscopy. Fertility-sparing surgery is defined as surgery with complete staging, but where the uterus and at least a part of one ovary are preserved. It presents a good option in young patients with early-stage disease or in selected cases with noninvasive implants, since long-term survival does not seem to be negatively influenced by conservative surgery. This review will outline the most recent information regarding fertility sparing surgery and controversial issues of BOT.

[EPIDEMIOLOGICAL, CLINICAL AND MICROBIOLOGICAL FINDINGS IN WOMEN WITH AEROBIC VAGINITIS].

Aerobic vaginitis (AV) is an alterarion of the normal lactobacillic flora accompanied by signs of inflammation, presence of mainly aerobic microorganisms from intestinal commensals or other aerobic pathogens. Clinical symptoms may vary by type and intensity and are marked by a high tendency for recurrence and chronification. Inflammation and ulcerations in AV could increase the risk of contracting HIV or other sexually transmitted infections. The aim is to study some epidemiological, clinical and microbiological features of the aerobic vaginitis in patients of the specialized Obstetric and Gynecological Clinic in Plovdiv, Bulgaria. In a retrospective research 4687 vaginal smears have been gathered in Microbiological laboratory at "St. George" Hospital - Plovdiv. We used clinical, microbiological and statistical methods. Information processing is performed by variation, alternative, correlation and graphical analysis using specialized package SPSS v13.0. The overall prevalence rate of AV in the studied population is 11.77%. The levels of prevalence of AV in pregnant and non-pregnant women are respectively 13.08% and 4.34%. The highest frequency of AV is in the age group 21-30 years (32.3%). The results show a marked association between Escherichia coli and the cases of AV (p < 0.001). AV is a common cause of vaginal symptoms in patients of specialized ambulatory outpatient. One in ten women with vaginal complaints suffers from AV Streptococcus agalactiae and Escherichia coli are most often isolated aerobic microorganisms.

[The vitamin D deficiency--an independent risk factor for developing preeclampsia].

Increasing number of studies during the last years reveal that steroid hormone vitamin D not only regulate calcium metabolism but it influences and other biological processes like glucose metabolism, neural function, cardio-vascular and reproductive systems. More and more clinical data suggests that normal plasma vitamin D levels are required for physiological pregnancy. Vitamin D deficiency is considered as an independent risk factor for developing preeclampsia. Specific pathophysiological mechanisms are not established yet.

[A rare case of successfully pregnancyand delivery in a woman with paroxysmal nocturnal hemoglobinuria].

We report a case of a pregnant woman with PNH. She was at 31 w.g. During the pregnancy our patient was hypertransfused and used anticoagulation treatment. The patient developed Preeclampsia, Intra-uterine growth retardation and Oligohydramnion. An induced vaginal delivery was done. A healthy child was delivered. There were no other postpartum complications. She was discharged from hospital in satisfactory condition.

[Anti-Mullerian hormone in the major phenotypes of polycystic ovary syndrome].

UNLABELLED: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and the leading cause of oligo/anovulatory infertility. The incidence of PCOS in the population is 5-10% depending on the phenotypic expression of the syndrome as use criteria for diagnosis Anti- Mullerian Hormone may be defined as a glycoprotein growth factor having autocrine and paracrine deystvie. Prodused in granulosa cells of the ovary and related to the growth and development of follicles. Studies devoted to the relationship between AMH and PCOS and hormone levels in the main phenotypes of PCOS are conflicting and few. OBJECTIVES: Comparison of the serum levels of Anti-Mullerian Hormone (AMH) in major phenotypes of polycystic ovarian syndrome (A, B, C, D). As to study of correlation between serum levels of anti-Mullerian Hormone (AMH) and the other hormonal parameters DESIGN: Prospective comparative study. MATERIAL AND METHODS: Material and Methods. This study was conducted in the Department of Obstetrics and Gynecology, University Hospital St. George, Plovdiv and Clinic of Endocrinology, University Hospital St. George - Plovdiv. We studied 100 women aged between 18-35 years with polycystic ovary syndrome (PCOS) have been selected according to the criteria of the American Society of Reproductive Medicine (ASRM) - Rotterdam, 2003. Distributed by phenotypic characterization into four groups: Phenotype A (OA, HA and PCOS)--42 women; Phenotype B (OA and H)--23 women; Phenotype C (OA and PCOS)--20 women; Phenotype D (PCOS and OA)--15 women. Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, androstenedione, estradiol (E2) and the Anti-Mullerian Hormone (AMH) are measured during the early follicular phase (day 3-5) of spontaneous menstrual cycle or progestin--induced uterine bleeding. RESULTS: Record the difference in the values of AMH in the main phenotypes subject of the study. We found different in strength and direction of correlations between the levels of AMH and other hormonal parameters studied. CONCLUSION: These data on serum AMH levels in four major phenotypes of PCOS allow its use as an additional diagnostic criterion for diagnosis. Furthermore, differences in serum proven its level at the leading phenotypic expression may serve as a reliable tool to characterize the severity of the syndrome, monitoring and forecasting.

[Serum levels of anti-muller hormone in women with polycystic ovary syndrome and healthy women of reproductive age].

UNLABELLED: Polycystic Ovary Syndrome is the most common endocrine disorder in women of reproductive age, whose final pathogenesis remains unclear. PCOS is a distinctive disorder of follicular growth leading to obstruction of the selection of the dominant follicle, and as a result--arrest at small antral follicles. Anti-Mullerian hormone (AMH) is a glycoprotein produced in the granulosa cells of the ovary and having regard to the regulation of growth and development of follicles. Study of the relationship between AMH and PCOS are conflicting and few. It is believed that women with PCOS had significantly higher levels of AMH compared with healthy, which is associated with an increased number of antral follicles pre-or is the result of a specific offense of AMH synthesis by the granulosa cells causes follicular arrest in PCOS. OBJECTIVES: Comparison of serum anti-Mullerian hormone (AMH) in women with polycystic ovary syndrome (PCOS) and healthy women (control group). As too study of correlation between serum Anti-Mullerian hormone (AMH) and other hormonal parameters. DESIGN: Prospective comparative study. MATERIAL AND METHODS: This study was conducted in the Department of Obstetrics and Gynecology at the Medical University of Plovdiv and the Department of Endocrinology at the Medical University of PIovdiv. We studied the 100 women aged between 18-35. Divided into two groups: 50 women with polycystic ovary syndrome (PCOS) selected according to the criteria of the American Society of Reproductive Medicine (ASRM)--Rotterdam in 2003 and control group of 50 healthy women. 15 women with PCOS and amenorrhea. Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, androstenedione, estradiol (E2) and Anti-Mullerian hormone (AMH) were measured during the early follicular phase (3-5 days) of spontaneous menstrual cycle or progestin-induced uterine bleeding. RESULTS: There was a statistically significant difference in serum AMH when compared to the values in the two groups subject to the study. In group of women with PCOS are found positive correlation between serum levels of AMH and androstenedione, testosterone and luteinizing hormone and negative correlation between AMH, FSH and E2. CONCLUSION: In this study group of women with PCOS had significantly higher serum levels of AMH compared with the control group. The presence of positive and negative correlations with other hormonal parameters revealed parts of AMH involvement in the pathogenesis of PCOS. These data on serum AMH levels in PCOS allow its use as a diagnostic criterion, but also the study of the level can serve as a reliable tool to characterize the severity of the syndrome, monitoring and forecasting.

[The role of insulin resistace in preeclampsia].

INTRODUCTION: Contemporary data show that there is a link between insulin resistance and preeclampsia (PE) due to many common features. MATERIAL AND METHODS: We examined 90 pregnant women at the clinic of Obstetrics and Gynecology at the University Hospital "St.George". 35 of them were preeclamptic and 55 normotensive. Glucose levels were measured at 0, 1, 2 h after OGTT (after 75 g. oral glucose administration). Insulin levels were also measured and HOMA IR was evaluated. RESULTS: Fasting glucose and insulin levels were similar in both groups and showed no statistical significance. HOMA IR was higher in the preeclamptic group 2.89 vs 2.09 for normotensive group no statistical significance was shown. CONCLUSION: Our results indicate that PE is not associated with insulin resistance.

[Stillbirth rate and perinatal mortality--criteria for quality of prenatal obstetric care].

AIM: To determine the frequency and structure of stillbirth rate, its relative share compared to PM, the trends for the period of 2007-2012 and their dependence to birth weight of the fetus and newborn. MATERIAL AND METHODS: The birth rate, stillbirth rate and PM for the period of 2007-2012 have been followed up retrospectively according to data provided by the department of Obstetrics & Gynecology in University hospital "St. George" Plovdiv. The trends of those two indicators have been established, their relationship to and dependence of fetal and newborn birth weight. Representative and correlative analyses have been used. RESULTS: During the period being analyzed 13 558 deliveries have been registered. 13.4 per thousand (183) of them are stillbirths, and 92.3% (169) died antenatal. After 2010 the birth rate decreases. Stillbirth rate increases from 13 per thousand in 2009 to 20.6 per thousand in 2012. It is mostly due to prematurity, which for the past two years are mostly with extremely low birth weight (57.2%). Antenatal stillbirth rate prevails. Intranatal fetal death is being observed significantly less, but in those cases where it is, the premature with weight 600-999 grams play a major role. Increased stillbirth rate maintains a high PM and constitute more than 2/3 of it. CONCLUSIONS: Against the backdrop of lower birth rate, the stillbirth rate and PM remain high. In the last 2 years they are presented mainly by premature weighing 600-999 grams. The prevalence of antenatal stillbirth rate means good control of delivery but refers to the prenatal period, which is related to the quality of the obstetric care.

[Case of atypical polypoid adenomyoma of the uterine cevix].

Atypical polypoid adenomyoma (APA) is a rare benign polypoid tumor occuring in young reproductive age women. There are no specific clinical features of APA. Grossly the tumor presents as a small polypoid lession in the low uterin cavum segment and cervical canal, mimicring infiltative endocervical or endometrial carcinoma. Microscopicaly APA consists of irregular glands, as endometrial with mild cellular atypia and diffuse smooth-mussle stroma. We present a case of APA of the uterine cervix in a young woman in regard to the diagnostical and treatment obstacles usually accompaning this rare pathology.

[The effect of vitamin D on pregnancy].

Vitamin D is a steroid hormone which plays an essential role in regulation of calcium metabolism. Many recent studies suggest that vitamin D is taking part in regulation of numerous physiological processes-glucose and neural metabolism, cardiovascular and sexual systems. Normal plasma levels of Vitamin D3 are needed for physiological development of pregnancy, normal skeletal mineralization of the fetal skeleton and lactation. Deficiency of vitamin D during pregnancy is associated with increased risk of serious complications like gestational diabetes and preeclampsia.

[The role of Dianatal Obstetric Gel in normal labor].

In the following study we present Dianatal Obstetric Gel and its role in normal labor. We would like to determine the effect of the Obstetric gel on first and second stage of labor as well as prevention of perineal trauma.

[Anti-Mullerian hormone- its role in the pathogenesis of the polycystic ovary syndrome].

Anti-Mullerian hormone (AMH) is a glycoprotein produced by the granulosa ovarian cells with respect to the regulation of the follicular growth and development. Polycystic ovary syndrome (PCOS) is one of the most common endocrine disturbances affecting 6-7 of women in reproductive age. Women with PCOS exhibit a number of metabolic and endocrine disturbances some of which are paramount in the pathogenesis of PCOS. The studies examining the connection between AMH and PCOS are few and quite controversial. Women with PCOS are considered to have significantly lower levels of AMH as compared with controls which is interpreted as resulting from the greater number of pre-antral follicles, or a result of the specific synthesis of AMH by granulose cells causing follicular arrest in PCOS.

[Insulin resistance in preeclampsia].

Contemporary scientific data show that there is a link between insulin resistance and preeclampsia. Many features of the insulin resistance syndrome are common with this condition. These include hypertension, hyperinsulinemia, glucose intolerance, obesity and lipid abnormalities. The women with preeclampsia are more insulin resistant than those with normal pregnancy. The surrogate markers of insulin resistance like leptin, TNF-alpha, tissue plasminogen activator, SHBG etc are also changed in preeclampsia. Whether these changes are connected with etiology or with the pathogenesis of preeclampsia is still not clear.

[Cornual heterotopic pregnancy: a case report].

Heterotopic pregnancy is the simultaneous development of an intrauterine pregnancy and ectopic pregnancy. We report a rare case of corneal heterotopic pregnancy at 9 weeks of amenorrhoea in a 30-year-old woman, after IVF. Because of the massive intraabdominal hemorrhage laparotomy was performed. Cornual resection and suture was performed and intrauterine pregnancy was evacuated. Doctors must be alert to the fact that confirming an intrauterine pregnancy does not exclude the coexistence of an ectopic pregnancy, particularly after IVF.