[Identification the risk of preterm labor :the role of fetal fibronectin].

UNLABELLED: Fibronectins represent a group of glycoproteins, which form "molecular glue" and are necessary in the interaction between a cell and a cell. The existence of fetal fibronectin in pregnant woman's vagina up to 22 g.w. is normal. In a normally proceeding pregnancy between 22 g.w. and 35 g.w. there is not supposed to be found fetal fibronectin in cervico-vaginal secretion. Its presence is a highly informative biological marker for the risk of premature birth. AIM: The aim of this research was to determine the risk for premature birth through applying fetal fibronectin test as a specific marker to pregnant women with or withthout symptoms of threatened birth. METHODS: A prospective longitudinal study has been carried out. The tests have been applied to hospitalized patients in University hospital "Majchin dom", Clinic of Pathologic pregnancy and Delivery room. Tests have been applied on 116 patients in totally). The pregnant have been separated in two groups depending on the fact of presence or absence of premature birth symptoms. The screening methods used were: the fFN test and the cervical length measurement by transvaginal according to an established protocol. CONCLUSION: From the total of 116 patients, in 78 we have received positive tests for fetal fibronectin; in 38 - negative test. With asymptomatic patients, having higher risk of preterm birth, the percent of positive tests has been lower (14%). With asymptomatic patients with higher percent of risk factors have been: short cervix (38%), multiple pregnancy (29%), followed by patients with diagnosis of preterm birth in the past (25%) and bleeding in earlier terms. Estimating positive and negative predictive rate, we have achieved following results: The test for fetal fibronectin has excellent predictive rate - 97%, which coincides with the great deal of research until this moment in the world. Referring to the positive predictive rate--it is not sufficient--only 19%.

[Saforelle - a new approach to treat vaginitis].

Infections of the vulva and vagina are one of the most common gynecological diseases. They can be determined by a variety of physical, chemical and biological factors. The main risk factors contributing to vaginitis are aerobic and anaerobic bacterias, fungal and viral infections, and irritants. Subjective complaints are pruritus, vulvar and/or perivulvar erytema and different in volume and characterization discharge. Excepting etiological treatment in most cases it is necessary to use additional agents, for example Saforelle.

[Tocolysis with nifedipin; its use in current practice].

AIM: The aim of the study is to establish the safety and efficacy of calcium channel blocker- Nifedipin as tocolytic agents. A wide range of tocolytics have been utilized for the management of preterm labor Calcium channel blockers, namely nifedipine, gained popularity as tocolytics due to the oral route of administration, availability of immediate- and slow-release preparations, the low incidence of maternal adverse effects associated with their use, and the fact that they are inexpensive. METHODS: 88 pregnant women in preterm labor participated in a prospective longitudinal study Inclusion criteria were: gestational age between 24 and 34 weeks gestation; uterine contractions in 10-15 min interval; single pregnancy, lack of contraindications for tocolysis. In all cases the calcium antagonist Nifedipine was used in dosage 4 x 10 mg per os. The clinical response to tocolysis, gestational age at delivery and potential side effects were analyzed. RESULTS: 91 pregnant women participated in the study. Three were excluded because they refused to participate. 88 pregnancies were finally analyzed. In nine of them maternal contractions persisted despite of treatment. The other 79 pregnancies were delayed 48 hours to receive antenatal corticosteroids. From all these 79 pregancies 66 delayed 7 days. The most common adverse effects were tachycardia, hypotonia, headache, dizziness, but they escape soon after the first dose. CONCLUSION: Nifedipine is an effective oral tocolytic with few maternal side effects.

[Perinatal mortality of IUGR neonates].

This study was conducted to evaluate the role of intrauterine fetal growth restriction (IUGR) in the perinatale mortality. A prospective study was designed, including 329 consecutive singleton pregnancies between 24 to 40 weeks' gestation, whose body weight is under 10th percentile for the gestational week. The control group consist of 530 appropriate for the gestational week (AGA) in the same period of gestation. The fetuses are without inborn malformations. The results show grater stillbirth rate in the group of hypotrophic than in the eutrophic neonates. In the group under 27th week of gestation is 2.6% forAGA and 8.3% for IUGR, for the group between 28-31 w.g. is 9.6% and 21.1% respectively and for 32-35 wg. is 2.3% against 13.1%. Perinatal mortality rate (stillbirth and demised before discharged) for the group before 27th w.g. is 65.8% for AGA and 72.2% for IUGR (P > 0.05). Between 28-31 w.g. is 28.4% and 50.0%, for 32-35 is 6.9% and 27.8% respectively (P > 0.01). After 37th w.g. perinatal mortality rate is less in AGA than in SGA fetuses. In conclusion the stillbirth rate is more frequent in IUGR fetuses than in AGA and frequencies is more pronounce in late preterm pregnancy. The fetal hypotrophy has deleterious effect on neonatal survival rate.

[Identification of preterm labor: the role of fetal fibronectin in parents with symptoms].

AIM: To determine whether the presence of fetal fibronectin in vaginal secretions of patients with symptoms suggestive of preterm labor predicts preterm delivery. Fetal fibronectin, a large molecular weight glycoprotein produced in the chorion, is expressed in cervical and vaginal secretions in women with disruption of the choriodecidual junction by labor or by inflammation. METHODS: A prospective observational longitudinal study from January 2013 till December 2013 was performed on patients between 24 and 32 weeks of gestation with symptoms of preterm labor, intact membranes, and cervical dilation < 4 cm (total patients = 86). The endpoint was the delivery at 34 weeks or more. The screening methods used were: the fFN test and the cervical length measurement by transvaginal according to an established protocol. CONCLUSION: The presence of FFN in vaginal or cervical secretions before 35 weeks is a is a strong predictor that preterm delivery is unlikely within the next 7 to 14 days. The predictive power of FFN is stronger at earlier gestation ages (24-29 wks) than it is later in pregnancy and is stronger for short-term prediction (7-14 d).

[Preterm birth--incidence and etiology].

Preterm birth is a major societal and economic problem. To him is accounting for 80 to 90% of neonatal morbidity and mortality worldwide. It is recognized as a complex multifactorial condition with different underlying etiologies. Paramount in the prevention of preterm birth is physician education regarding known risk factors, signs and symptoms of preterm labor and the role of close follow-up in the patients identified as high risk.

[HIV infection in pregnant women and risk of preterm birth].

According to estimates by WHO and UNAIDS, 34 million people were living with HIV at the end of 2011. Transmission of the human immunodeficiency virus (HIV) from mother to child can occur in utero, during labour or after delivery from breastfeeding. The majority of infants are infected during delivery. Clinical records have found more evidence of an increased rate of preterm delivery in HIV-positive women in low income countries.

[Effect of different co-culture systems on human sperm motility and longevity]. / Vliianie na razlichni sistemi za ko-kultivirane vurkhu motiliteta i prezhiviaemostta na choveshki spermatozoidi.

The experiments were conducted to evaluate the ability of different somatic-cell monolayers (human oviductal cells, granulose cells, MDBK-cells) for supporting motility and survival rates of human spermatozoa in-vitro. Results indicate that co-culture with epithelial cells enhanced human sperm longevity.

[Laparoscopic hysterectomy--the initial experience in Bulgaria]. / Laparoskopska khisterektomiia--purvi opit v Bulgariia.

The paper presents the first cases of laparoscopic-assisted vaginal hysterectomy and laparoscopic hysterectomy with removal of the uterus through the vagina performed in Bulgaria as well as the experience gained by the team from II gynaecology clinic at State University Hospital "Maichin dom" in Sofia from seven patients operated on by these techniques. The indications, the conditions and the implemented technique with its advantages and difficulties are described. The procedures are associated with less trauma and blood loss than abdominal surgery and are followed by a very smooth postoperative period which is very well tolerated by the patients. No intraoperative complications occurred. The postoperative period was free of any problems in 5 of the patients while in two there were minor complications. Marked shortening of the duration of the procedures is achieved with the initial experience.

[The use of cefotetan for the prevention of infectious postoperative complications in gynecology]. / Prilozhenie na tsefotetan za profilaktika na infektsioznite postoperativni uslozhneniia v ginekologiiata.

The study presents the results from the use of cefotetan for perioperative prophylaxis in 43 gynaecology patients compared with 29 controls without perioperative antibiotic prophylaxis with similar diseases and operations. Both groups show equal percentage of the cases with smooth postoperative period (70 and 72% respectively). 13 of the patients on cefotetan prophylaxis received additional antibiotic treatment (9 because of temperature up to 37.5 degrees and 4 because of temperature from 37.6 to 38.5 degrees). Mo major infections postoperative complications occurred among the patients on cefotetan prophylaxis. 8 of the non-prophylacted patients needed antibiotic treatment postoperatively including 4 with temperature above 38.5 degrees. Two infections of the operative wounds also occurred in the same group. The conclusion is that cefotetan effectively prevents the major infection postoperative complications in gynaecology. The administration of additional antibiotic treatment is most often not warranted.

[The CO2 laser treatment of extensive skin changes to the vulva caused by the human papillomavirus (HPV) and refractory to other types of therapy]. / Lechenie s CO2-lazer na obshirni kozhni izmeneniia po vulvata, prichineni ot choveshkiia papilomen virus (HPV) i nepoddali se na drug vid terapiia.

The authors describe three cases of large vulvar lesions caused by HPV. One patient has condylomata covering entirely the labia majora and minora, the clitoris, the perineum and the perianal area. The lesions made the structures of the vulva hard to distinguish. She was treated with podophyllin, Solcoderm and diathermy without effect. After 2 applications of Laser vaporisation 40 days apart she was completely cured. The other patient had two big squamous papillomata 3.5 by 3.5 cm and 0.5 cm thick situated on both sides of commissura posterior. She was also treated unsuccessfully with Podophyllin, Solcoderm and surgical excision. She was completely cured by a single-stage CO2-laser treatment. The third patient had condylomata acuminata of the labia minora and majora, fossa navicularis, the perineum and the perianal area. No other treatment had been attempted before. After two sessions of laser vaporisation she was cured, too.

[A case of mesenteric thrombosis occurring in a woman with a uterine myoma during her hospital stay]. / Sluchai na mezenterialna tromboza nastupila prez vreme na bolnichniia prestoi u zhena s mioma na matkata.

The paper describes a case of a 40-year old woman who presented with complaints of crampy abdominal pain, weight loss, hypermenorrhea, anaemia, fever and peritoneal effusion which were attributed to a large solid pelvic tumour. During the preoperative investigations she had an attack of acute abdominal pain with bloody diarrhea assumed to be caused by gastrointestinal infection. The attack ceased quickly after intravenous infusions and antispasmodics were started. Several days later a second even stronger attack of abdominal pain with evidence of intestinal obstruction necessitated urgent laparotomy which revealed extensive necrosis of the small intestine with a coexistent large uterine myoma. A resection of the small intestine with a side-to-side anastomosis and hysterectomy with bilateral salpingo-oophorectomy were performed. The patient had an uncomplicated recovery gaining weight but still experienced mild discomfort after meals. The symptoms, the diagnostic difficulties as well as the therapeutic approaches in mesenteric ischaemia are discussed.

[Gynecological operations in high-risk patients (a preliminary report)]. / Ginekologichni operatsii pri bolni s visok risk (predvaritelno suobshtenie).

The incidence of post-operative complication has been studied in women with concurrent nor-gynaecological and gynecological diseases, such as: vascular diseases (varices, phlebothromboses, thrombophlebitis), hypertension, changes in cardiac status (age-associated. Angina pectoris, cardiac decompensations). ECG changes,valvular defects, increased blood sugar, pulmonary diseases, etc. The study was held retrospectively over 326 female patients who had undergone operations for the period 1992-1993.

[The role of serum beta-HCG levels for the diagnosis of ectopic pregnancy]. / Rolia na serumnite niva na beta-ChKhG za diagnozata na ektopichnata bremennost.

The study includes 56 cases of women admitted at Second gynaecology clinic of the University Maternity Hospital Sofia with evidence or suspicion of having an ectopic pregnancy who had their serum beta-HCG levels determined quantitatively. 27 of them showed no beta-HCG in their sera and none turned out to have pregnancy, neither intrauterine nor ectopic. All cases of ectopic pregnancies (a total of 20) were associated with detectable beta-HCG levels in the serum. The great diagnostic value of serum beta-HCG is emphasized in the cases of old disturbed ectopic pregnancies accompanied by mild and uncommon symptoms and very low beta-HCG levels. In case of unruptured pregnancies or tubal rupture the diagnosis is verified before the result is available by the clinical and sonographic data. On the other hand the high sensitivity of the method leads to an increased number of cases with elevated beta-HCG in which the location of the pregnancy cannot be proven. The precise quantitative evaluation of serum beta-HCG enables us to follow the tendency of beta-HCG which may according to the clinical manifestations warrant invasive diagnostic procedures or just observation without active interference.

[The treatment of urinary stress incontinence with the sling and Pereyra's suspension]. / Lechenie na pikochnata stres-inkontinentsiia sus "Sling" i okachvane po Pereira.

Patients with proven stress incontinence were subjected to surgical treatment which combined both sling and Stamey-Pereyra techniques. A 3-4 cm long and 1,5-2 cm wide sling of Bulgarian polyamide mesh was placed under the urethrovesical junction using a small vaginal incision. Two long polyamide sutures were tied to either end of the mesh and were retrieved from the vagina to the abdomen by Pereyra needle inserted through two small suprapubic incisions and guided by the vaginal forefinger. The technique of the procedure is described. A total number of 27 patients were operated on. Two of them has their suspending sutures cut postoperatively because of prolonged urinary retention. The remaining 25 were continent. The technique proposed combines the advantages of the sling procedures (high efficiency especially in cases of severe and recurrent incontinence) and the simplicity of Stamey-Pereyra suspension technique. On the other hand the Bulgarian polyamide mesh showed very good qualities. No infection, rejection or sling erosion were observed.