[Body mass index in pregnant teenagers].

The frequency of obesity is increasing worldwide. Among the group of teenagers who are pregnant there is a tendency of increasing of BMI. We present BMI at the beginning and at the end of pregnancy at pregnant teenagers, according to the scheme of Institute of Medicine. The optimal weight gain during teenage pregnancy would minimize the risk of overweight and obesity postpartum and during subsequent pregnancy as well the associated complications.

[Pregnancy outcomes in women of advanced maternal age].

UNLABELLED: During the last decade there is a trend all over the world women at advanced age/older than 35 years old/ and especially educated ones to postpone their reproductive plans. Pregnancy and birth outcomes in women >35 years old I traditionally associated with increasing risk of complications both for the mother and the foetus. OBJECTIVE: To study the frequency and the obstetric outcome of pregnancy at advanced age women in the University Hospital "St. George" Plovdiv. SUBJECTS AND METHODS: Women who at the period of the delivery were at more than 35 years old and were seen at the obstetric unit of the above hospital were recruited into the study. Observed complications during the pregnancy and delivery were also calculated. RESULTS: For the period of 10 years the teenage pregnancy rate was 5.10% /n= 594/5.10% of all 11657 deliveries /94.90%/. 504 of the patients were aged 35 to 39 years /4. 32%/ while only 90 /0.78%/ were aged > 40 years old. In 54.88% of the cases the deliveries were not complicated; in the rest of the cases there were complications or the delivery ended surgicaly. CONCLUSIONS: The increasing frequency of the advanced age pregnancy and deliveries and improved pre and intranatal counseling has made advanced maternal age compatible with successful pregnancy for the great majority of such women.

[Obesity and pregnancy].

UNLABELLED: The increasing frequency of preobesity and obesity in all age groups worldwide can be characterized as a pandemia. Obesity is a public health problem because it is a major contributing factor in the development of hypertension, heart disease, type II diabetes, osteoarthritis, respiratory problems and certain cancer. THE OBJECTIVE OF THE STUDY: To describe the prevalence of preobesity and obesity among pregnant women and to evaluate the impact of preobesity and obesity upon pregnancy and delivery. SUBJECTS AND METHODS: 255 women, aged between 17 and 39 years old are conducted in the study. They have been admited to the Clinic of Obstetrics and Gynecology at the University Hospital "St. George" Plovdiv for the period of for months /January- April 2005/. The data of the patients are obtained from their history of the disease and the dokument of the newborn. BMI was calculated before and at the end of pregnancy. RESULTS: Preobesity and obesity are more frequent at more educated women, nuliparous women and women aged 30 years and more. Obese women had a higher frequency of preeclampsia, gestational diabetes, macrosomia, and operative delivery. 33.33% (n=85) of the pregnant women start their pregnancy with abnormal weight or obesity. At the end of the pregnancy 72.94% (n=186) of them are in condition of preobesity and obesity. CONCLUSION: As overweight and obesity are associate with adverse pregnancy outcomes, the attention of the obstetritian must be directed to so called preconceptual consulting in order to limit the gaining of wight upon the optimal limit before and during pregnancy.

[Myasthenia gravis and pregnancy--a case report and review of the literature].

Myasthenia gravis is an acquired immune-mediated neuromuscular disorder, characterised by muscle weakness and fatigabillity of the voluntary muscles. It often affects women in the second and third decade of life with predilection of childbearing years (incidence in pregnancy--1:20,000). We present a case of a pregnant woman with myasthenia gravis and review the literature upon the problem - association of myasthenia gravis and pregnancy.

[Diabetes insipidus and pregnancy].

Diabetes insipidus is a temporary or chronic disorder of the neurohypophyseal system, due to deficiency of vasopressin and is characterized of excessive quantities of very dilute urine, excessive thirst and profound electrolyte abnormalities. The association of diabetes insipidus and pregnancy is rare with incidence of about 1:300,000. We report two cases of pregnancy with accompanied disease--central diabetes insipidus. We discuss the pathogenesis, clinical manifestation and the terapeutic management during pregnancy.

[Mesenteric venous trombosis and pregnancy--a case report and a short review of the problem].

Mesenteric venous thrombosis is extremely rare surgical pathology during pregnancy and frequently is associated with hemoglobinopathies beta-thalassemia, congenital defects of the coagulation and antiphospholipide syndrome. It has nontypical clinical appearance, which hardens the timely diagnosis and the adequate surgical treatment. We present a case of a 22 year-old girl with hemozygote form of beta thalassemia, pregnant in ml II, with mesenteric venose thrombosis. The diagnosis was made on the 24th hour from the beginning of the disease. The patient was operated successfully by a resection of the necrotic changed part of the intestine. She noticed vaginal bleeding due to a missed abortion on the 22nd day after the operation.

[Perforation of duodenal ulcer in the puerperium--a case report]. / Perforatsiia na duodenalna iazva v puerperiuma--s prinos na edin sluchai.

The authors present a case of perforated duodenal ulcer in the puerperium at a patient who underwent Ceaserian section. Urgently 12 hours after the perforation relaparotomy was made. The exit of the illness depends on the precise and early diagnosis and subsequent surgical treatment.

[Effect of the monophase oral contraceptive combination with 20 ug ethinyl estradiol/150 ug desogestrel on haemostasis]. / Vliianie na monofazniia oralen konratseptiv s 20 ug ethinyl estradiol/150 ug desogestrel vurkhu khemostazata.

The authors examined the changes in the haemostasis during the use of the oral contraceptive combination with 20 microg ethynil estradiol/150 microg desogestrel at 35 women, a basic group, who used the oral contraceptive in the duration of 12 months and a control group (n=35), who do not use the pills. We found statistically significant increase of Antithrombin III (ATIII) (p<0.011), Cofactor II of Heparin (HCII) (p<0.001), the activity of plasminogen (p<0.026) and beta2-antiplasmin (0.026), significant decrease of Protein C (PrC) (p<0.0001) and of total Protein S (TPrS) (p<0.03) in the basic group in comparision with the control one. We do not observe significant changes in the rest of the haemostatic variables between the two groups. During the use of the oral contraceptive combination with 20 microg ethynil estradiol/150 microg desogestrel the changes in the system of the natural inhibitors are balanced by these in the system of fibrinolysis.

[Postoperative nausea and vomiting--possibility to prevent after long-lasting gynecological operations]. / Postoperativno gadene i povrushtane--vusmozhnosti za povliiavane pri golemi ginekologichni operatsii.

The aim of this study is to establish the possibilities for effective influence upon the postoperative nausea and vomiting and to summarize the existing literature data. The observation is carried out upon 361 patients with performed hysterectomy, who were hospitalised at the Department of Obstetrics and Gynecology of the University Hospital "Saint George" Plovdiv for the period January-December 2003 year. We performed randomized study about the effect of the application of dexamethasone used in the introduction of anaesthesia and its effect upon the postoperative nausea and vomiting. Our observation confirms the literature data about the safe and effective application of dexamethasone as a method of choice for minimizing the frequency of the postoperative nausea and vomiting

[Acute pancreatitis and pregnancy--analysis of a 10 year period of time]. / Ostup pankreatit i bremennost--analiz na 10-godishen period.

Acute pancreatitis during pregnancy is rare and complicates one in 1000 to 5000 pregnancies. The commonest reasons during pregnancy are: biliary disease, congenital or acquired hypertriglyceridemia and very rarely acute pancreatitis is associated with preeclampsia-eclampsia or HELLP syndrome. We presented in the research the clinical course of 14 women who developed acute pancreatitis and were treated at the Clinic of Thoraco-abdominal and Hepato-Biliary Surgery at the University Hospital Plovdiv for a tenth year of a period. The leading etiology was biliary disease. Eleven of 14 patient were successfully treated conservatively during pregnancy; 5 of them underwent surgery after pregnancy. Only one patient underwent operative treatment during pregnancy. Although acute pancreatitis is a rare disease during pregnancy, in order to improve the prognosis and to decrease the maternal and fetal morbidity and mortality, a timely diagnosis and an adequate conservative or surgical treatment is necessary.

[The effect of two low dose oral contraceptive with gestodene on the systems of natural inhibitors of coagulation]. / Vliianie na dva niskodozirani oralni kontratseptiva, sudurzhashchi gestoden, vurkhu sistemata ot estestveni inkhibitori na koagulatsiiata.

AIM: The authors investigated the influence of two monophasic oral contraceptives with 30 and 20 microg ethynilestradiol (EE) with combination with 75 microg gestodene (GSD) upon the system of natural inhibitors of coagulation. MATERIALS AND METHODS: The study is prospective for a period of 12 months and was conducted upon 105 clinically healthy women, who use 30 microg EE/75 microg GSD (n = 35), 20 microg EE/75 microg GSD (n = 35) and a control group (n = 35). RESULTS: The continuous use of the contraceptive combination with 20 g EE/75 g GSD leads to statistically significant elevation of protein C (PrC), total protein S (TPrS) and Heparin Cofactor II (HCII). The use of the contraceptive combination with 30 microg EE/75 microg GSD is associated with statistically significant increase of Pr C and HC II. There were no statistically significant changes in the other variables. CONCLUSION: The use of both oral contraceptive combinations is associated with increased anticoagulant activity, which status prevents from thrombosis.

[Cytotec: an effective drug for the induction of labor]. / Cytotec: efektivno sredstvo za induktsiia na razhdaneto.

OBJECTIVE: Our purpose was to compare the safety and efficacy of intravaginal Cytotec versus Oxytocin for induction of labor. STUDY DESIGN: Two hundredth seventy six of patients with indications for induction of labor were assigned to receive either intravaginal Cytotec or Oxytocin. Cytotec were placed in the posterior vaginal fornix every three (3) hours with a potential maximum of six (6) doses. Oxytocin were administered to a standard protocol of our clinic. RESULTS: Among those evaluated 138 received Cytotec and 137 received Oxytocin. The overage interval from start of induction to vaginal delivery was shorter in the Cytotec group (1332.4 +/- 846.5 min) than in the Oxytocin group (1523 +/- 705.6 min). There were no significant differences in the routes of delivery. 20.7% of the Cytotec treated patients and 28% of the Oxytocin treated patients required abdominal delivery. CONCLUSIONS: Intravaginal administration of Cytotec appears to be as effective as Oxytocin labor induction.

[Endometrial hyperplasia--hysteroscopy findings]. / Khiperplaziia na endometriuma--khisteroskopski nakhodki.

Endometrial hyperplasia is considered to be a frequent cause of metrorrhagia. Traditionally diagnosis of this pathology was made on specimens obtained by uterine curettage or after hysterectomy performed for benign diseases. Recently, hysteroscopy has enabled to offer suggestive images of this pathology, in fact it allows to visualize directly the uterine cavity and to perform guided biopsies on the endometrial mucosa. The aim of this study is to evaluate the reliability of the hysteroscopy procedures in the diagnosis of the endometrial hyperplasia. 479 panoramic hysteroscopies were performed in a four-year period for different indications and we found endometrial hyperplasia in 129 patients. We compared the results with the histological findings. On the base be able the possible diagnose and the follow-up procedure for endometrial hyperplasia.

[Our first experience with the flexible office hysteroscopy]. / Nashiiat purvi opit ot prilagane na fleksibelna ofis khisteroskopiia.

Authors analyzed 200 women with the help of flexible office hysteroscopy without anaesthesia and cervical dilatation in ambulatoric conditions. Basic purpose of this scientific checkout is to estimate diagnostic value of the method and also the ability of application in out of hospital net. 194 cases of all ware successfully having in mind that all investigations were carries out without previous premedication and anaesthesia. As a result of this first attempt using this method authors can conclude that flexible office hysteroscopy is highly sensitive, specific, harmless and tolerable method.

[Hysteroscopic findings in women with abnormal uterine bleeding according to the materials from the department of obstetrics and gynecology, medical university--Plovdiv]. / Khisteroskopski nakhodki pri zheni s abnormno matochno kruvotechenie po materiali na AG katedra, meditsinski universitet -- Plovdiv

The results of a four-year period are analyzed. For this time 479 diagnostic panoramic hysteroscopies were performed. By 152 patients (31.7%) the main complaint was abnormal uterine bleeding. All hysteroscopies were followed by histological examination. The specimens have been taken by target biopsy and curretage. The age of the patients ranged from 40 to 75 years. Pointed is a frequency of this pathology and its distribution by age. The authors show the priority of the diagnostic panoramic hysteroscopy in consideration with the other methods of investigation--D & C and sonography, in fact-exactly diagnosis and avoiding unnecessary curretage.

[The hysteroscopic diagnosis of endometrial carcinoma]. / Khisteroskopska diagnoza na endometrialniia kartsinom.

Panoramic hysteroscopy as a testing method was introduced into the Department of Obstetrics and Gynaecology at the Medical University--Plovdiv in 1995. For four years the authors have performed 308 panoramic hysteroscopies. With 19 of these cases (6.17%) the diagnosis cancer of the endometrium has been confirmed histologically, too. Using the advantages of this method within the complex of modem screening testing methods for early diagnosing of this kind of cancer, the authors have described its typical hysteroscopic image.