[ANTENATAL APPLICATION OF CORTICOSTEROIDS IN LATE PRETERM BIRTHS].

The aim of the following study is to present the current evidence of antenatal use of corticoids in premature birth. The benefits of antenatal use of corticosteroids after 34 week of gestation is still a process of discussion.

[CALCIUM LEVELS IN URINE SAMPLE IN PREGNANT WOMEN WITH PREECLAPMSIA].

Hypertensive disorders during pregnancy are still leading cause for maternal and perinatal death. Calcium metabolism is impaired significantly in women with preeclampsia. Measurement of calcium levels in 24 hours urine sample is easy, modern, fast and not expensive predictive test to reveal women in high risk of developing preeclampsia in late pregnancy. The severity of condition strongly correlates with decrease level of calcium excretion in urine.

[CHRONIC RENAL FAILURE AND PREGNANCY--A CASE REPORT].

Pregnancy in women with chronic renal failure is a complex therapeutic problem requiring a multidisciplinary approach. It is associated with a higher risk of many perinatal complications. The most common abnormalities are related to: progression of renal failure, development of preeclampsia development of nephrotic syndrome, anemic syndrome, IUGR and fetal death. The prognosis depends on the values of serum creatinine prior to pregnancy, the degree of deterioration of renal function, development of additional obstetric complications and the specific etiological reasons that have led to the occurrence of renal failure. Determining the optimum time for authorization birth depends on the condition of the mother, the condition of the fetus and the rate of progression of renal failure, and the deadline the pregnancy should be terminated is 35 weeks. We present a case of a patient with chronic renal failure, with favorable perinatal outcome.

[Glanzmann thrombasthenia and pregnancy--report of a case and literature review].

Glanzmann thrombasthenia (GT) is a rare autosomal recessive disorder which deficiency of the platelet glycoprotein IIb - III a. The disorder usually manifests as severe mucocutaneus bleeding in the chaildhood, menstrual patterns in pubertal--adolescent years, rarely life-threatening. Pregnancy and delivery in patients with TG are very rare and are associated with high risk for mother and fetus due to intra - and post-partum hemorrhage. We present a case 30, a patient with TG, emergency births by caesarean section, with intra- and postpartum haemorrhage managed through the use of recombinant factor VIIa, transfusion of packed red blood cells and platelets.

[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.

[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.

[The use of carboprost tromethamole for prevention and treatment of postpartal haemorrhage].

All around the world as well as in Bulgaria postpartal haemorrhage is a main reason of maternal death. The treatment of postpartal haemorrhage of which approximately 70% is caused by hypotony of the uterus is still a challenge for physician-obstetrician. In the following study we have used prostaglandin-Carboprost tromethamole (Prostin 15M) for treatment of this important obstetric pathology. One year investigation which includes 82 patients with hypotony during vaginal delivery or cesarian section. Results showed that the use of Carboprost tromethamole (Prostin 15M) in treatment of hypotony leads to fast and extended contraction of the uterus as well as significantly decreases blood loss and the necessity of haemotrasfusion.

[The use of Dinoproston for induction of delivery].

For the past decades induction of delivery is more often put in practice of modern obstetric. During the last couple of years it exceeds 20% of the vaginal deliveries. In the following study we have use Dinoprostone (Prepidil gel) as a remedy which stimulates labor. In 6 months 92 patients were selected. A 92 deliveries were stimulated with Prepidil gel. The results were satisfactory. Dinoprostone represents to be effective, safe and easy to use for induction of delivery.

[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.

[HELLP syndrome, complicated with DIC syndrome in the third trimester of pregnancy].

Defined as hemolysis, liver dysfunction and low platelets, HELLP syndrome is a severe complication of preeclampsia with worsening seriously the prognosis of mother and foetus. Frequently it is associated with the development of DIC syndrome. We present a case of HELLP syndrome developed in 30 gestational week, complicated with DIC syndrome.

[A clinical case of twin pregnancy with intrauterine death of one of the twin (foetus papiraceus)].

Multiple pregnancy is associated with some specific syndromes: twin to twin transfusion syndrome, syndrome of the disappeared twin, intrauterine loss of one of the twin, development of foetus papiraceus and syndrome of asymmetric growth of the twin. We present a case of term pregnancy with death of one of the twin and normal delivery of healthy baby and Foetus papiraceus.

[Ovarian cancer with metastatic lesion in the vagina (foetus papiraceus)].

Ovarian cancer spreads primarily by intraperitoneal implantation of exfoliated cancer cells, by lymphatic dissemination, and by haematogenous spread. Very rarely it metastasizes to cervix, vulva and vagina; this type of metastases present a diagnostic challenge to the gynecologist and pathologist. We present a case of ovarian cancer with initial clinical manifestation-lesion of the vagina.

[Changes in the variables of blood coagulation and fibrinolysis in preeclampsia and spontaneous abortion].

In the present study we present the changes in the variables of coagulation and fibrinolysis and spontaneous abortion in comparison to normal pregnancy. It is not yet clear if these changes are etiologic factor, pathogenetic link or result, explaining these frequent obstetric diseases.