[The pregnancy outcome in patients WITH ß-thalassemia minor].

UNLABELLED: Thalassemia syndromes are heterogenic group hereditary hemoglobinopathies, provoking chronic hemolytic anemia. They affect approximately 100 million people, mostly in the Mediterranean (including Bulgaria), South-eastern Asia and Africa. Thalassemia syndromes are the second reason for hypochromic anemia and anemia in pregnancy after iron deficiency. OBJECTIVE: To determine pregnancy outcome of women with ß-thalassemia minor. MATERIALS AND METHODS: It is an ambispective study in University Hospital of Obstetrics and Gynecology" Maichin dom", Sofia, for a year. Patients are divided in two groups regarding the presence of ß-thalassemia minor. Preeclampsia, gestational diabetes mellitus, olygo- and polyhydramnion, preterm labor intrauterine growth retardation (IUGR), Cesarean section delivery are recorded in study groups. RESULTS: Cases with ß-thalassemia minor have significantly higher prevalence of oligohydramnion and Cesarean section delivery. There is no significant difference regarding Apgar score in 1st and 5th minute, IUGR, gestational diabetes mellitus and preeclampsia between two study groups. CONCLUSION: ß-Thalassemia minor does not significantly influence the pregnancy in negative way.

[Preterm birth in Bulgaria--changes in aetiology and incidence in the last decade].

There is no decrease in the incidence of preterm birth in Bulgaria and in the world, despite of all the therapeutic and prophylactic efforts. The rate of prematurity in University Maternity Hospital 'Maichin dom' in the last decade has increased significantly- from 11.6% in 2003 to 17.5% in 2013. The numbers are higher than the national average due to the essence of the Hospital being a leading clinical and scientific center. Thorough analysis demonstrates significant increase in the first grade prematurity being 5.8% of all live births in 2003 and 10.2% of all live births in 2013. In fact 58% of all premature births result in first grade preterm newborn. There is no significant increase in the forth grade- severe prematurity in the last decade. We believe that this increase in preterm birth rate is due to several reasons: the success of assisted reproductive technologies, which in Bulgaria leads to a significant increase in the number of multiple pregnancies; destructive/ablative methods of treatment of cervical intraepithelial neoplasia, especially LLETZ (LEEP), postponing of first pregnancy, increase in the number of adult primiparous women and as a whole pregnancy at later age, pregnancy in puberty. All these impose changes in the protocol for pregnancy follow up. Furthermore, we believe it is high time to increase the effectiveness of this service, as lack of adequate follow up is a reason for preterm birth on its own.

[Case of intrauterine retardation and fetal death during labor].

The case concerns to a 37 years old pregnant woman with a history of three miscarriages. Ultrasound biometry in early pregnancy corresponds to the term calculated according the last menstrual period (LMP). At 37 week of gestation was determined retardation of 5 weeks. Doppler velocimetry and quantity of amniotic fluid were in normal ranges and the pregnant refused hospitalization. She was admitted to the hospital three days after the appointed term without uterine contractions. The fetal ultrasound biometry meets 33 weeks and the Doppler examination of a. umbilicalis found resistance index (RI) of the upper limit of normal. The cardiotocography record shows: baseline fetal heart rate--143 beats/min, good variability and reactivity. There was one deceleration for 3 minutes, and then the recording returns to normal. Re-monitoring after 30 minutes establishes of a periodic decelerations and a tendency to bradycardia with reserved variability. At the start of the emergency Cesarean Section fetal heart beats are single. The delivered babe was with Apgar O. The reanimation was not successful and the fetus died. From the autopsy signs of severe asphyxia. In conclusion, it can be assumed that in strongly retarded fetuses, cardiotocography recording and Doppler velosimetry are not sufficiently reliable methods for continued monitoring. In late-onset and severe intrauterine growth retardation (IUGR) desirable delivery time is after reaching biological maturity at 36-37 week.

[Febris puerperalis -- contemporary aspects].

TArticle contains a historical overview of the problem Febris puerperalis, as well as contemporary issues. Presented a case with typical clinical picture.

[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.

[Listeria monocytogenes infection during pregnancy--modern aspects].

During a ten years period (1997-2006) at the delivery ward of Maychin dom university hospital were admitted 31,430 parturients. Among all of them we indentified and evaluated only 4 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 0,068%. All of our four cases were admitted with clinical symptoms of preterm birth and had premature labor. One of the four examined births underwent urgent Caesarean Section because of intrapartal fetal distress, which makes 25% of the operative birth deliveries. All the maternity patients are diagnosed during the postpartum period whilst searching for the microbial reason of the severe infection of the newborns. All of the four newborns experience infection complications. Septic condition of one of the neonates was not possible to be overcome and was followed by an exitus. The observed neonatal mortality among the group is 25%.

[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.

[Participation of the genital mycoplasmas: Ureaplasma urealyticum and Mycoplasma hominis in the processes of preterm birth].

According to contemporary data Ureaplasma urealiticum and Mycoplasma hominis are considered to be the most frequently isolated causative microorganisms from the amniotic cavity. They cause intrauterine infection on preterm birth. The genital mycoplasma are detected in vaginal smears more than 25% of healthy pregnant women and the reason for their invasion towards the uterine cavity in some cases are still unknown. The aim of this study is to investigate the relation between vaginal mycoplasmal contamination and preterm birth. The observed cases are distributed into 2 groups:--patients with preterm birth--35 pregnant women,--term birth--31 pregnant women. The vaginal secretion was tested with a standard microbiological methods and with specific test mycoplasma detection and quantitative assessment. In the first group in five patients (14.3%) Ur. urealiticum was detected in association with other vaginal pathogens (bacterial vaginosis and GBS). In the term birth group 2 patients were mycoplasma positive (6.5%) and associated Enterococcus and Lactobacillus was found in them. All neonates of the mycoplasma positive mothers had sings of infection and underwent antimicrobial therapy course. The results did not demonstrate statistically significant difference in the incidence of vaginal mycoplasmal presence in preterm and term delivery but shows possible relationship between preterm birth caused by ascending mycoplasmal infection which is in association with other vaginal pathogens.

[Vaginal candida infection in the third trimester of pregnancy].

The aim of this study is the determination of the frequency of vaginal Candida colonization in pregnant women in the third trimester, the status of the vaginal ecosystem, the grade and the subspecies of the candidal colonization, clinical manifestations and the therapeutic effect of the local antimycotic treatment. In this study it has been followed 172 pregnant women with a normal pregnancy at the end of the third trimester. It has been estimated that about 28.4% of all women get a vaginal yeast colonization - Candida spp. In 89.7% (44 women) of the cases, the colonization was caused by an overgrowth of the yeast Candida albicans. The remaining cases are caused by other subspecies of Candida - 5 cases (10.3%) - C. tropicalis /2/, C. parapsilosis /2/, C. glabrata/1/. The women in the first group were with symptoms of active candidosis (25.6%) and 88.3% of the cases were confirmed by microscopy, and 90.6% after a bacterial growth in a culture. In 7.7% of the cases was specified a mild to moderate colonization without a clinical signs of infection (II group). The local treatment with antimycotic vaginal globules and crème for 5 to 7 days alleviates the clinical symptoms. It was not observed a case of maternal - fetal transmission of this infection not a clinical manifestation in the early postpartal period.

[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.