[Screening for gestational diabetes in Bulgaria--preliminary results].

Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance with onset or first recognition during pregnancy. There is no data regarding the prevalence of GDM in Bulgaria. The aim of this study is to present the preliminary results from a pilot study for GDM in Bulgaria, including the prevalence and the epidemiological differences between women with or without this disorder. A 2 h oral glucose tolerance test (OGTT) with 75g glucose was performed on 330 pregnant women between 24 and 28 weeks of gestation, using ADA criteria to define pregnancies complicated by GDM. Blood glucose levels, insulin levels, HbA1c, hsCRP and lipid parameters were evaluated. GDM was found in 11.3% of the patients. Women with GDM were older than the ones without the disorder (p < 0.006), had higher fasting glucose levels (p < 0.0001), higher fasting insulin levels (p < 0.0001), higher HOMA index (p < 0.0001) and higher HbA1c (p < 0.001). There was a significant difference in body mass index (BMI) before pregnancy (p < 0.003) and at the time of screening (p < 0.001) between GDM and control groups (p < 0.001). GDM women more frequently had thyroid disease, developed early preeclampsia, had family history of type 2 diabetes mellitus and history of PCOS. In conclusion the prevalence of GDM in high risk Bulgarian population is relatively high--11.3%. This confirms the necessity of establishing of a national screening program. If financial recourses are limited selective screening in high risk patients should be considered.

[Prediction of adverse pregnancy outcome by first-trimester maternal serum PAPP-A].

Preeclampsia occurs in 2 to 5% of all pregnancies in developed countries. Together with IUGR it consists one of the leading reasons for perinatal death and childhood handicap. This is why many authors are looking for a widely usable and easy to perform test for evaluation of the patients at risk for preeclampsia an IUGR. PAPP-A is a protein complex produced by the developing trophoblast which is used as a marker for Downs' syndrome. Previous studies have shown an association between low first trimester maternal serum PAPP-A and subsequent development of pregnancy complications.

[Velamentous insertion of the umbilical cord--diagnosis and management].

OBJECTIVE: To assess the feasibility of ultrasound to identify velamentous insertion of the umbilical cord in B-mode, combined with Color/Power Doppler and 3D Power Angio Doppler during routine obstetric ultrasound follow up. DESIGN: This was a prospective cross-sectional ultrasound study in 145 second and third trimester high-risk singleton pregnancies. Color/Power Doppler ultrasound was done in all cases to identify the placental cord insertion site. Evaluation with three-dimensional (3D) ultrasound combined with Power Doppler (3D Power Angio Doppler) was also performed in all cases with suspected velamentous insertion. RESULTS: The insertion placental site of the umbilical cord was identified in 143/145 (98.6%) cases by conventional gray-scale ultrasound, combined with Color/Power Doppler. Visualization was not accomplished in 2 third trimester cases (beyond 30 w.g.) with a posterior placenta, intrauterine growth restriction (IUGR) and tendency of oligohydramnios. Velamentous insertion of the umbilical cord was suspected prenatally in 9 cases, including 2 cases with vasa previa. Three-dimensional ultrasound was of little clinical value and compared poorly with conventional gray-scale and Color Doppler imaging. CONCLUSIONS: Velamentous insertion of the umbilical cord can be reliably detected prenatally by gray-scale and Color/Power Doppler ultrasound. Three-dimensional imaging has limited clinical value in the evaluation of the placental cord insertion site. Its systematic assessment during routine obstetric ultrasound follow up has the potential of identifying most pregnancies with velamentous insertion and, therefore, those at risk for some important obstetric complications, including vasa previa.

[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%.

[Effect of the blood pressure on the perinatal fetal outcome in patients with preeclampsia].

No matter the fact that the changes in the blood pressure are quite often the first clinical feature of preeclampsia, is known that they are not early, but are quite late preeclampsia symptom. Close follow-up of the blood pressure trough whole pregnancy and in preeclamptic patients plays an important role in the improvement of the perinatal outcome. Five hundred forty four singleton pregnant women were enrolled in the study. Of them 334 were with mild preeclampsia and 210 were with severe form of the disease. The analysis of correlations shows a correlation between the blood pressure at admititon and before delivery of the women with mild and severe form of preeclampsia and the perinatal fetal outcome. The fifth minute Apgar score is significantly lower in the patients with severe preeclampsia in comparison with women with mild disease. The represented data confirm the hypothesis about the influence of the maternal blood pressure on the perinatal fetal outcome.

[Serum homocysteine levels in pregnant women with preeclampsia].

Preeclampsia is one of the most common and severe pregnancy complications, which ethiology remains unclear. It is certain that endothelial dysfunction plays a key role in the development of preeclampsia. Homocysteine is an important independent cardiovascular risk factor, which might induce the endothelial dysfunction observed in preeclampsia. 26 pregnant women--14 with preeclampsia (group 1) and 12 healthy term pregnant controls (group 2) were enrolled in the study between December 2003 and August 2004. Six of the women in this group had a superimposed preeclampsia. The mean homocysteine level in the first group was 11,04 mol/l, while in the control group it was 6,24 micromol/l (p < 0.05). The women with a severe preeclampsia had a significantly higher serum homocysteine levels than those with mild form (F = 0.025). Seven of the patients (50%) gave birth before 34th weeks of gestation. The study finds a link between the serum homocysteine as an endothelial dysfunction marker and the development of preeclampsia and a relation between the severity of preeclampsia and the degree of the elevation of the serum homocysteine levels.

[Association between the protein loss and the perinatal outcome in preeclamptic pregnant women].

Proteinuria is one of the two main criteria for the diagnosis of preeclampsia. But except an important diagnostic it is also an important prognostic factor of the maternal perinatal outcome. 544 pregnant women were enrolled in a prospective study between 1995 and 2005. Of all of them the protein loss was measured by a qualitative or quantitative assay. It was ascertained that the higher protein loss was associated with a lower fetal birth weight and lower 5 minute Apgar score no matter of the laboratory test type. These data suggest that the protein loss in preeclampsia could be used as a prognostic not only for the maternal, but also for the fetal perinatal outcome.

[Diagnostic value of the Doppler ultrasound of kidney vessels in pregnancy complicated with preeclampsia]. / Diagnostichna stoinost na Doplerovoto izsledvane na bubrechnite sudove pri bremenni s preeklampsiia.

Preeclampsia (PE) is a complication of the second half of the pregnancy whose clinical course is hypertension and proteinuria with or without edema. Its pathogenesis is characterized with generalized vasoconstriction and endothelial dysfunction. The aim of this study is to evaluate the diagnostic value of the Doppler ultrasound examination of the renal interlobar vessels in pregnancy complicated with preeclampsia in the context of the theory of the increased vessel resistance in this pregnancy disorder.

[Retrospective study of the pregnancy course in preeclamptic patients]. / Retrospektivno prouchvane na bremennostta pri zheni, razvili preeklampsiia.

105 women had been evaluated using a retrospective analysis for the period 1999-2000. Clinical and laboratory data indicated development of preeclampsia and the pregnancy progress, antenatal complications, mode of delivery and perinatal outlet has been observed. The group has been divided using the following criteria: preexisting disease, severity of preeclampsia, mode of delivery, gestational age and prematurity rate. The present trial is important for optimizing management of women with preexisting disease before, during pregnancy and after delivery.

[Acute renal insufficiency during pregnancy with acute pancreatitis]. / Ostra bubrechna nedostatuchnost pri bremenna s ostur pankreatit.

According to current data the incidence of acute pancreatitis is from 1:1000 to 1:5000. Symptoms vary a lot, one of rare but most severe complications being acute renal failure. The case is a 24-year-old pregnant patients--30-th gestational week with symptoms of acute pancreatitis based most probably on hereditary hypertriglyceridemia and hypercholesterolemia. Parallel to acute inflammation of pancrease a hypercoagulation syndrome developed. It is possible that acute renal failure was caused by active thrombus formation. Because of danger for the life of mother and baby, an urgency preterm Cesarean Section was performed. Resussitation post-surgery care and drug therapy (lowmolecular anticoagulants, antibiotics, spasmolytics and analgetics, protease--inhibitors, inhibitors of protome pump, regulators and inhibitors of pancreas secretion normalize renal and pancreatic function if based on special dietary regimr. Coagulation status also normalizes.

[Lipid metabolism and its changes in pregnancy]. / Lipidniiat metabolizum i promenite prez bremennostta.

A survey is made on physiology of lipid metabolism and its variations during pregnancy. The mechanisms leading to an increase in triglycerides and cholesterol during pregnancy are explained. These changes induce increased aterogenic risk, higher risk for developing pathologic 1 changes in blood vessels on microcirculation level on the basis of endothelial disfunction. A multiorgan pathology may possibly be provoked--kidneys, pancreas or occurrence of praeeclampsia.

[Chemical composition of different sorts of soybeans and changes under the influence of weather and soil-climatic conditions]. / Khimicheskii sostav semian nekotorykh sortov soi i ego izmenenie pod vliianiem pogodnykh i pochvenno-klimaticheskikh uslovii

The biochemical composition (the content of protein and lipids, the content of essential amino acids in the protein complex, the fatty acid composition of lipids) of seeds of eighteen soyabean varieties cultivated in different soil-climatic zones under various weather conditions was examined. Changes in the biochemical parameters were primarily associated with the genotype of the variety. The effect of weather, soil and climatic conditions was less marked. With an increase of the protein content the concentration of lysine and methionine in proteins tended to decrease. As long as the oil content in seeds grew, the concentration of oleic acid increased and that of linoleic and linolenic acids decreased.