[Assessment of the role of some risk factors for preterm birth and benefit of screening implement].

The occurrence of preterm birth (PTB) is dependent on the effects and interaction of various risk factors. The purpose of this study was to determine the role of some of the multiple known risk factors for the onset of spontaneous PTB. Our results show that: the age (<18 and >40) and the weight of the pregnant woman (low weight or overweight), a history of miscarriages before 12 gestation week and mild anaemia (100-110 g/l) are not independent factors for PTB. A more significant dependence exists between PTB and a history of previous PTB, moderate and severe anaemia (Hb below 100 g/l); more than 50% cervical effacement and more than 2.5 cm cervical dilatetion, but their effect on PTB is less manifested compared to the impact of infection (particularly intraamniotic). Directed search for several risk factors in most cases detects pregnant women at high-risk for PTB and makes its prevention possible.

[Finding a developing intrauterine infection in preterm birth by using classic and modern infection indices].

A significant part of preterm births (PTB) are due to a developing intrauterine infection (IUI). This infection is often of subclinical nature, and its diagnosis is mainly based on laboratory measurements. The objective of our study was to compare the diagnostic potential of classic (clinical picture, leukocyte count, CRP) and modern (IL-6) indices of an infectious and inflammatory process. We found the established clinical symptoms of IUI in 4.2% of the women with PTB, and if symptoms such as subfebrile body temperature (37'-37.5 degrees C), and mother's pulse of 90-100 beats/minute are taken into consideration, then with them this infection were diagnosed 23% of the women with PTB. Based on reference values of blood markers, the following incidence rates of infection were established for the studied pregnant women: increased Leu--26.7% for PTB, and 3% for the full-term birth group; based on increased CRP--51.7% for PTB, and no available data on infection for the control group; based on IL-6 over 11 pg/ml--66.7% for the PTB group, and 16.7% for the full-term women. Laboratory markers have the following sensitivity, specificity and accuracy in finding an intrauterine infection (histologically confirmed): for Leu--93.3%, 25%, and 47.8%, respectively; for CRP--100%, 53.4%, and 69.3%; and IL-6--90%, 70%, and 76.7%, respectively. Obtained results demonstrate that clinical symptoms are rarely indicative of IUI. Of all laboratory measurements, IL-6 has the best diagnostic profile, followed by CRP and leukocyte count.

[Impact of infection with Listeria monocytogenes on the pregnancy].

During a ten years period (06.1998a.-06.2007) at the delivery ward of Maychin dom university hospital were admitted 31 627 parturients. Among all of them we indentified and evaluated only 6 pregnant patients with Listeria monocytogenes infection. During the first 8 years of the investigated period there was no even single case of the infection, whilst during the last 2 years the frequency of the Listeria infection among all birth deliveries was 0.10%. The first five of our cases were admitted with clinical symptoms of therapeutically uninfluenced preterm birth and had premature labor. One of the five examined births underwent urgent Caesarean Section because of intrapartial fetal distress, which makes 20% of the operative birth deliveries. All five maternity patients are diagnosed during the postpartum period whilst searching for the microbial reason of the severe infection of the newborns. All of the five newborns experience infection complications. Septic condition of two of the neonates was not possible to be overcome and was followed by an exitus. The observed neonatal mortality among the group is 33.3%. The last observed case of infection was diagnosed by detecting the level of antibodies against Listeria monocytogenes in 11th week of gestation. The enhanced antibodies level was accompany by clinical symptoms. Patient was treated with Penicillin 4 x 2.0 g i.v. for fourteen days Repeated serological results was normal. The pregnancy was followed up till the term.

[A case report of two incidents of acute abdomen in a woman during pregnancy and in the early puerperium].

The authors present a case of a 32 year old pregnant woman who is admitted to the Obstetric clinic in the 16th gestational week with a pain in the ileoceacal region of the abdomen and vomitting. The woman has clinical signs of acute abdomen. A clinical diagnosis of acute appendicitis was suggested. During the operation under general anesthesia was found a phlegmonous inflammation of a Mekel diverticulus with perforation as well as local peritonitis and a catharal inflammation of the appendix. The appendix and the Mekel diverticle were removed during the operation. No comlications were observed during the post operative period. No fetal distress was observed during and after the operation Three months later the same patient was admitted to the obstetric clinic in the 32nd gestational week with a diagnosis Threatened premature delivery in ml VIII status post resection of a Mekel diverticle and appendectomy. The patient had pain to the right of the umbilicus and vomiting. The labor was induced and a viable premature infant was born. Two days after delivery there was again a clinical symptoms and signs of an acute abdomen due to ileus. A strangulation of the terminal ileum was found due to adhesions A Debridman and a lavage were performed No complications were observed during the postoperative period. The authors discuss the difficulties which might ensue when the diagnosis acute abdomen is made in a pregnant woman

[Prophylaxis of neonatal sepsis caused by group B streptococci--fast method of positivity detection and its clinical use].

UNLABELLED: Asymtomatic infection with group B streptococci in pregnant women, the screening methods concerning colonized patients and the therapeutic approach towards then are still under discussion. PURPOSE: To determine the effectiveness and clinical use of the selective media Granada in the diagnosis of beta-haemolytic contamination in pregnant women. MATERIALS AND METHODS: The study is prospective and it comprises one year period. The patients included are pregnant women in the second half of the pregnancy, with or without sings of preterm delivery. Vaginal smear was collected by both standard microbiological technique and selective media Granada. Sensitivity, time of first positive results and the practical use of both methods were compared. The effect of intrapartal prophylaxis with Cefazolin 3 x 2.0 g i.v. was taken into consideration. RESULTS AND DISCUSSION: The obtained results demonstrate that for the period of investigation the incidence of asymptomatic contamination with GBS in patients admitted to "Maichin Dom" Hospital is 6.2% for all pregnant women and 16% for the selected study group. The application of both microbiological methods demonstrated similar sensitivity. For the selective media the time needed for diagnose the presence of beta-haemolytic agent was significantly shorter (approximately 16 h). This results defines the media Granada as appropriate for clinical screening and selective prophylaxis of neonatal streptococcal infection.

[Utrogestan and high risk pregnancy]. / Utrogestan i zastrashena bremennost.

Utrogestan is a modern progesterone, which shows maximal effectiveness with minimal side effects. It is a natural progesterone in micronized form, which makes it suitable for oral administration and vaginal application with same effectiveness. The aim of our retrospective study was to evaluate the therapeutical effects of Utrogestan in women with threatened abortion in the first trimester. Our experience dated from about one year and a half. Sixty eight women were treated for threatened abortion with a daily dose of 400 mg Utrogestan. The treatment continued at least 14 days/average 21 days/. Utrogestan was administered orally twice daily. The main indications were first or consecutive threatened spontaneous abortion in first trimester. For the period of time no side effects and subjective complaints were established except particular cases of slight headache and dizziness after morning application. Sixty one of the sixty eight women were dehospitalised with healthy pregnancy with no side effects. In our experience we preferred to use the drug in women with lutein insufficiency before pregnancy. We conclude that Utrogestan can be widely applied in Obstetrics with the proper indications, such as threatened abortion in the first trimester. The prophylactic treatment in women with slighter complaints like dull pain and weight Utrogestan is applied one tablet twice daily. In graver cases the starting dosage is two tablets two or three times daily.

[Placenta previa--from the past to the present]. / Placenta previa--ot minaloto kum nastoiashteto.

The author present contemporary methods for diagnosis of placenta praevia. He compare old methods as X-ray placentography, radioisotope placentography with using ultrasound to determine the location of placenta. Placenta praevia can be diagnosed prenatally using ultrasound through transabdominal, afterwards with transvaginal ultrasound. This decrease prolonged hospitalization and needless Cesarian section. The author made parallel between frequency in beginning of pregnancy with frequency at term. With advance of gestational age the frequency of placenta praevia decrease. This decreasing incidence with increasing gestational age is attributable to the concept of placental migration. When the placental edge was inicially > 2 cm from cervical os, migration occurred in all cases and no Cesarean sections were necessary for placenta praevia. When the placenta overlapped the cervical os by > 20 mm at 26 weeks, all the women required Cesarian delivery. The author present basic strategies to reduce maternal and fetal mortality and morbidity from placenta praevia. All pregnant women should have a routine sonogram at 20 weeks gestation. When the area over the internal os cannot be identified, a transvaginal sonogram should be performed. Women who have a lower placental edge which is < 1 cm from internal os should have a sonogram at about 34-35 weeks gestation. When placenta praevia is present should be perform prior Cesarian delivery.

[Characteristics of neonates whose mothers have congenital and acquired heart disease]. / Kharakteristika na novorodeni ot maiki s vrodeni pridobiti porotsi na surtseto.

It was made a study of the body dimensions, Apgar evaluation, and frequency of innate body defects in 141 new-borns by mothers with innate and acquired heart valvular defects. It was found that the average values of body weight, height, and the evaluation with Apgar of the new-borns by mothers with heart defects do not deviate from the average values of the same indices of new-borns by healthy mothers. Despite that 90% of the young mothers with heart defects are with light to moderate degree of the heart defect, and with I or II functionality class, the percent of their new-borns born prematurely is big--31.9, compared to 6.6 for new-borns by healthy mothers. In 2.8% of the new-borns by mothers with heart defects, hypotrophy is observed, and in 3.5%--clinical criteria for immaturity. Perinatal death rate is 0.7% and zero for the control group of new-borns--ones born by healthy women. Six cases (6.7%) of new-borns by mothers with heart defects had innate body defects, 4 (4.5%) of which were innate heart defects. The frequency and the kind of the congenital defects in new-borns by mothers with heart defects is discussed.

[Treatment with human chorion-gonadotropin (pregnyl) of patients with vaginal bleeding in the first trimester of pregnancy]. / Lechenie s choveshki khorion-gonadotropin (preparata pregnil) pri patsientki s kurvene v purvoto trimesechie na bremennostta.

The author present a few years opinion for treatment of patients with vaginal bleeding in first trimester of pregnancy and obstetrical complications with Pregnyl(Organon). The basics factors for inclusion in examination group are pregnant women in early pregnancy complicated with vaginal bleeding, with or not a pain. Overall 34 patients whose be treatment, 31 delivered lived and health child, one patient delivered baby with osteogenesis imperfecta and 2 patients the pregnancy is bracked with spontaneous abortion. The treatment with Pregnyl is very good method in patients with infertilitas, polycystosis ovarii and vaginal bleeding in early pregnancy. The doses of Pregnyl is 10,000 E i.m. (bolus dose), 5,000 E i.m. two times weekly between the first dose and 10 weeks of pregnancy, 5,000 E i.m. weekly between 10 and 14 weeks of pregnancy.

[Polycystic ovaries--their ultrasonic diagnosis]. / Polikistozni iaichnitsi--ultrazvukova diagnoza.

Polycystic ovaries are present like a two type: peripheral and cystic form. At the first cystic formations are disposed subcapsularis, at the second they are in the stromal zone. To have polycystic ovary syndrome the patient must have polycystic ovaries on (MI ultrasound and one or more of the following: oligo/amenorrhea, hirsutism/acne, raised LH:FSH ratio, higher of 2.5 or raised circulation androgens. The LH:FSH ration is higher in patient--with peripheral form. The basal morphological changes for estimation of the ovarian structure are: doubly ovarian volume, approximately in 50%, increased in number of atretic follicules, 30% increased the cortical stroma and five enlarging of the medullar stroma. Early Doppler studies have demonstrated increased stromal vascularity if correlated with raised LH/FSH ratio and raised androgens level. It was found increased impedance in uterine artery and decreased of PI (pulsatility index). There are difference between patient with peripheral and cystic form on Doppler examinations. In the first group have lower pulsatility index in the ovarian artery, higher stromal vascularity and LH/FSH ratio and increased score 2. All present results of investigations determine the criteria to present ovarian structure in context of PCOS as using conventional and Doppler ultrasonographic.

[Influence of elective abortion, up to the 12th week of pregnancy, on the dimensions of the cervix]. / Vliianie na aborta po zhelanie do 12-ta sedmitsa na bremennosta v'rkhu razmerite na matochnata shiika.

The conflicting data in the literature about the influence of the voluntary abortion on the cervix uteri and its effects has lead us to the idea to examine by ultrasound the changes in the cervix uteri as a result of elective abortion. 137 healthy women at the average age of 26.7 years have been examined, out of which 31 were pregnant for the first time. 15 with no child-births but with one previous voluntary abortion, 30 with no child-births but with more than one voluntary abortion, 35 with one child-birth and 26 with more than one child-birth. Out of the total 76 women, 64 come back for ultrasound examination of the parameters of the cervix uteri between the first and the second week after the abortion (10 + 3 days). The abortion has been done up to 12 guest. week under intravenous anesthesia, I Hegar dilatation of the cervical canal and vacuum aspiration. Each ease has been examined with an ultrasound (Kontron--France), supplied with a 7.5 MHz vaginal transducer. The results show that the measured length and width of the cervix uteri among the groups with differing number of elective abortions but with no child-births do not reveal a great statistical difference. With the increase of the number of abortions the width of the cervical canal shows a tendency to expand minimally. With women pregnant for first time and having elective abortion, of all parameters of the cervix only OECC remains a little wider than before the abortion. Child-births change dramatically the dimensions of the cervix uteri--the cervical canal expands, the cervix shortens and at the same time becomes wider. We can safely assume that the elective abortion under intravenous anesthesia within 8-9 g.w. with Hegar dilatation about 10 mm and vacuum aspiration has not shown traumatic effect on the cervix uteri according to its dimensions.

[Quadruplet pregnancy--the difficulties in its diagnosis and management with a case report]. / Chetiriplodna bremennost--trudnosti v diagnozata i povedenieto s prinos na edin sluchai.

The authors describe one case of quadruplet pregnancy create difficulties in diagnosis and conclude with unfavourable outcome. One of fetuses have hydrops foetus generalisatus, another foetus is malformative and the rest two fetuses are normal anatomy. Multifetal pregnancies require very early and exactly diagnosis and make up behaviour with goal is favour able outcome. In the end the authors recommended this cases must be turn to hospitals which are better possibilities for antenatal and intensive neonatal care.

[The ultrasonic diagnosis of an early abnormal pregnancy]. / Ultrazvukova diagnoza na ranna abnormalna bremennost.

During the period of January 1993 to February 1994, 70 pregnant women had an ultrasonic diagnosis of abnormal pregnancy. 111 ultrasound examinations were made--mean 1.6 of each woman. The ultrasonic diagnosis up to 70 women was: missed abortion--35 women (50%), blighted ovum--30 women (42.9%), other diagnosis--5 women (7.1%). Histological examination of material was made with 64 women (91.4%). Comparing the ultrasonic diagnosis to histological results, authors do not recommend a final diagnosis before eight gestation week.