Role and Importance of Chlamydia Trachomatis in Pregnant Patients.

AIM: The aim of this study was to assess the prevalence of chlamydial infection among pregnant women and to determine the role of this infection in the fetus. MATERIAL AND METHODS: In the first phase of this study were reported 58 pregnant women with a positive test for active chlamydial infection by applying immunofluorescence. In the second phase of the study were reported pregnant with premature burst membranes (PBM), postnatal complications associated with chlamydial infection as puerperal endometritis, and newborns are monitored for low birth weight and growth retardation at birth. RESULTS: With a positive test are 58 patients in the first trimester or pregnancy registration in our consultation. After regimen with Sumamed (2 x 500 mg for three days and after 10 days again same scheme for them and their partner) at the beginning of the third trimester, the PCR test was made again. Of these, 5 were positive again, participants are between 20 and 30 years old. With premature rupture of OM are 20 patients. There was no increased incidence of premature births. Infants born to infected mothers have a higher risk of developing respiratory symptoms in the first 60 days of life. 3 of them have low for his age bodyweight. CONCLUSIONS: The scarcity of data on manifestations of chlamydial infection during pregnancy and neonatal outcomes justifies this study. Early diagnosis for registration of pregnancy and timely treatment of chlamydial infection as well as scrutinising the infection during the third trimester of pregnancy can prevent infection of the newborn. Therefore, preventive examinations should be considered as a priority for early detection of asymptomatic chlamydial infection in the conduct of antenatal care.

Early Prognostic Factors for the Progress of Preeclampsia - Our Experience in the Period 2010-2011.

AIM: To determine the prognostic value of the low Pregnancy-associated plasma protein A (PAPP-A) levels in the early stages of pregnancy (11-13 weeks GA) independently and in combination with a Doppler test of the uterine arteries during the second half of pregnancy (22-23 weeks GA). MATERIAL AND METHODS: The study covered the period 2010-2011 and included 106 pregnant women, aged 35-40, with a single child pregnancy. The research excluded pregnant women with anomalies of the fetus, smokers and women taking prophylactically low doses of aspirin. RESULTS: Thirty-six pregnant women had PAPP-A level below 0.4 MoM, whereas 20 of them developed preeclampsia and 7 - early preeclampsia. The combination of the low PAPP-A values and the abnormal Doppler test of the uterine arteries is with a considerably better prognostic value in regards to the risk of developing preeclampsia. CONCLUSION: The Doppler test is a non-invasive, quick and easy method for assessment of the uterine-placental blood flow.

Cytomegalovirus Infection during Pregnancy and Its Impact on the Intrauterine Fetal Development - Case Report.

AIM: The aim of this publication is to present a case of CMV infection during pregnancy, with clinical manifestations of the development of microcephaly and simultaneous dilatation of the 3rd and 4th brain ventricle at 23 weeks gestation. This article discusses the role of ultrasound screening in the second trimester of pregnancy. CASE PRESENTATION: We present the case of a 25-year-old woman with the initials S.K. in her second pregnancy that came to our antenatal Consulting Centre. The first screening for blood count, blood group, biochemistry and serology showed results within the reference range. The patient came for a second comprehensive biochemical screening at 17 - 18 weeks gestation. The results showed the low genetic risk of congenital anomalies. Fetal morphology of the fetus was normal. S.K. came again for consultation at 22 weeks gestation in connection with the admittance of her first 3-year-old child to the hospital because of pneumonia. Serological tests of the child had shown elevated CMV titer - specific IgM. Then we made new serological tests of the patient and the results have shown that the patient was most likely infected by CMV primarily in the first trimester of pregnancy. After consulting about the risk of transmission of CMV to the fetus, the woman chose monthly ultrasound scans and refused amniocentesis. At 36 weeks gestation, in addition to the microcephaly already established, enlargement of the IV brain ventricle at the expense of underdevelopment of the cerebellum was noticed. Also, 2nd to 3rd stage of placenta maturity and low quantity of amniotic fluid was established. A male fetus of weight 2,890 g and height 50 cm was delivered. The fetus was with skin petechiae and hepatosplenomegaly. Neurological examination showed no abnormalities. CONCLUSIONS: In the described case the time interval between infection and ultrasonic manifestations is more than 17 weeks. The long interval between infection and occurrence of ultrasound markers can be a good prediction sign, as it may reflect less aggressive viral infection than present in cases where similar ultrasound findings were obtained shortly after infection of the mother.

[Preparation of Cervical Dilatation Before with Misoprostol and Laminaria - Advantages and Disadvantages.]

The surgical hysteroscopy became popular as a minimally invasive approach to interuterine changes. Dilatation is a real challenge during surgical hyseroscopy especially in first delivery patients, women in menopause and women with cervical stenosis. Apart from this, some long hysteroscopy operations such as myomectomy require adequate dilatation in order to facilitate the multiple insertions and drawing pulling of the resectoscope. Another technical problem is the need for a significant degree of cervical dilatation, as well as softening of the cervix, which will allow the extraction of the excised endometrial polyps or myomatose parts. Mysoprostol is analogous to prostaglandin El, which is commonly used in obstetrics to induce an abortion and birth, as well as after birth to control the excessive vaginal bleeding. Its use in gynecology is limited. In our study it is of vital importance. The vaginal administration of MysoproStol before surgical hysteroscopy facilitates dilatation. The eased hysteroscopy minimizes cervical complications. On the other hand, the natural dilatators Laminaria, made of Laminariajaponica orLaminaria Digitata sticks, are attractive natural substances which can cause dilatation with minimally observed systemic side effects. They have shown efficient results during the cervical preparation before surgical hysteroscopy. Despite of that, there are no comparative studies on the efficiency of the two methods for cervical preparation. The aim of this Study is to compare the efficacy of internally vaginal Mysoprostol against endocervical dilatators Laminaria before surmical hvSterosconv in certain cases.

[New Low-Dose Oral Contraceptive with 28 Midiana.]

As a representative of the low dose generation of oral contraceptives, Midiana 28 provides minimal intake of estrogens for the female organism in the presence of a new generation getation component- Drospierenone. Midiana has an excellent contraceptive effect - the control group of women showed no cases of impregnation during the intake, Pearl index =0.00. It also exercises a good control over the menstrual cycle with low frequency of intementrual bleeding /17%/ Midiana 28 shows a very good tolerability with minimal, detected, rapidly transient side effects.

A Case of Unicornuate Uterus with Atypical Located Hyperstimulated Ovary after in Vitro Fertilization Pre-Embryo Transfer (IVF-ET).

The authors describe a case of a congenital Mullerian anomaly, uterus unicornis with missing right fallopian tube. An in Vitro Fertilization Pre-Embryo Transfer (IVF-ET) procedure was done and presently is known that the patient has left fallopian tube and left ovary, two kidneys, and right ovary is missing. No diagnostic laparoscopy and hysteroscopy were done, only hysterosalpingography (HSG) before the IVF procedure. Several days after the follicular puncture of the left ovary the patient was urgently admitted to the hospital for specialized gynaecology in Varna. Transabdominal ultrasonography showed right ovary atypically located immediately next to the liver and with emerging theca-lutein cysts.

A Case of Secondary Abdominal Pregnancy after in Vitro Fertilization Pre-Embryo Transfer (IVF-ET).

The authors describe a rare case of secondary abdominal pregnancy after in vitro fertilization pre-embryo transfer (IVF-ET). Ultrasonography was applied to image ectopic gestational sac containing a yolk vesicle and located adjacent to the anterior uterine wall and left adnexa. Laparoscopy was done on the same day followed by sinistral salpingectomy due to tubal abortion indications. Intraabdominal examination showed chorionic structures penetrating pl. vesicouterina. Histological tests confirmed the EP diagnosis in the second material, i.e. indications of secondary abdominal pregnancy.