[LEFT AND RIGHT UTERINE ARTERY DOPPLER AS EARLY SKREENING TEST OF THREATENED ABORTION OUTCOME.]

Human reproduction entails a fundamental paradox: although critical to the survival of the species, many aspects are inefficient and wastage seems excessive. Only 50-60% of all conceptions advance beyond 20 weeks of gestation. Miscarriage was defined by WHO as a loss of pregnancy before 20 weeks of gestation or weight of baby under 500 gr. Threatened abortion is the first, reversible phase of miscarriage. The pregnancy outcome doesn't always correlate to severe of its cardinal symptoms- vaginal bleeding and abdominal pain. The measure of HHG can't accurately predict the pregnancy outcome. Ultrasound scanning is probably the best single diagnosic and prognostic test in managing cases of threatened abortion. Uterine artery Dopler waveforms analysis in patients with threatened abortion is non-invasive method, which can find pathological signs in the beginning of pregnancy. Development of a molecular biology give an opportunity to find out problems of pregnancy in the process of implantation, a technical progress in ultrasound give a chance to sudy changes in uterine blood flew in early deadlines and to finding new addictions between uterine perfusion and embryo development.

[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.

[THE ROLE OF ESTROGENS IN THE CARCINOGENESIS OF LUNG CANCER].

Morbidity and mortality from lung cancer has dramatically increased in women as compared to men over the past few years. Historically, smoking has been considered the major risk factor for lung cancer regardless of gender. Several recent lines of evidence implicate gender differences in the observed differences in prevalence and histologic type which cannot be explained based on the carcinogenic action of nicotine. Several recent studies underscore the importance of reproductive and hormonal factors in the carcinogenesis of lung cancer Lung cancer morbidity and mortality in Bulgaria was 16.2/100000 women and 14.6/ 100000 women, resp. Lung cancer morbidity in Europe was 39/100000 women. Lung cancer is extremely sensitive to estrogens. The latter act directly or as effect modifiers for the relationship between smoking and lung cancer. Further research examining the relationship between serum estrogen levels and the estrogen receptor expression in normal and tumor lung tissue samples can help elucidate the importance of reproductive and hormonal (exogenous and endogenous) factors in the carcinogenesis of lung cancer.

[The role of insulin resistace in preeclampsia].

INTRODUCTION: Contemporary data show that there is a link between insulin resistance and preeclampsia (PE) due to many common features. MATERIAL AND METHODS: We examined 90 pregnant women at the clinic of Obstetrics and Gynecology at the University Hospital "St.George". 35 of them were preeclamptic and 55 normotensive. Glucose levels were measured at 0, 1, 2 h after OGTT (after 75 g. oral glucose administration). Insulin levels were also measured and HOMA IR was evaluated. RESULTS: Fasting glucose and insulin levels were similar in both groups and showed no statistical significance. HOMA IR was higher in the preeclamptic group 2.89 vs 2.09 for normotensive group no statistical significance was shown. CONCLUSION: Our results indicate that PE is not associated with insulin resistance.

[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.

[Anti-Mullerian hormone- its role in the pathogenesis of the polycystic ovary syndrome].

Anti-Mullerian hormone (AMH) is a glycoprotein produced by the granulosa ovarian cells with respect to the regulation of the follicular growth and development. Polycystic ovary syndrome (PCOS) is one of the most common endocrine disturbances affecting 6-7 of women in reproductive age. Women with PCOS exhibit a number of metabolic and endocrine disturbances some of which are paramount in the pathogenesis of PCOS. The studies examining the connection between AMH and PCOS are few and quite controversial. Women with PCOS are considered to have significantly lower levels of AMH as compared with controls which is interpreted as resulting from the greater number of pre-antral follicles, or a result of the specific synthesis of AMH by granulose cells causing follicular arrest in PCOS.

[Studies on the level of proinflammatory cytokines IIL-1a, IL-1b, IL-6, TNF-a in pregnant women with acute pyelonephritis].

UNLABELLED: Proinflammatory cytokines (IL-1a, IL-1b, IL-6, TNF-a) are important mediators of acute inflammation. We studied the levels of those cytokines in pregnant women with acute pyelonephritis. MATERIAL AND METHODS. We studied 30 women with clinical and microbiological evidence of acute pyelonephritis and 30 healthy controls Urinary cytokine levels were measured using an ELISA test. RESULTS: The mean urinary cytokine levels of pregnant women with acute pyelonephritis were higher compared with controls. We found evidence for higher clinical microbiological activity in women with acute pyelonephritis compared to controls. CONCLUSIONS. The urinary levels of proinflamatory cytokines can be used as reliable biomarkers for acute pyelonephritis in pregnant women.

[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.

[Changes in bone mineral density of postmenopausal women in relation to the menstrual cycle length].

UNLABELLED: There is a strong relationship between the age of menarche, the length of the menstrual cycle and menstrual bleeding and fracture risk in the postmenopausal period. OBJECTIVE: Evaluation of the menstrual cycle length and lumbar bone mineral density in postmenopausal women. MATERIALS AND METHODS: We investigated three groups of postmenopausal women (each - n = 50). The first group included women with menstrual duration of 27 days during reproductive age, the second group included postmenopausal women with menstrual duration of 28 days during the reproductive age, and the third group consisted of postmenopausal women with menstrual duration of 30 days during reproductive age. The average age of women was 58.80 +/- 0.94 y. in the first group, 60.36 +/- 5.12 y. in the second group and -61.84 +/- 0.80 y. in the third group. Age, age of menarche, number of childbirths, length of the menstrual cycle and menstrual bleeding, and lumbar bone density were assessed and registered for each woman. We used DXA in a anterior-posterior projection to assess the bone density of the lumbar spine; the obtained results are shown in gram/cm2. RESULTS: The women from the third group, with average menstrual cycle length of 30 days, reach menopause at a significantly later age, have longer menstrual cycle and shorter menstrual bleeding, and higher lumbar spine bone density, compared to the other two groups. CONCLUSION: The data from our research show that women with anamnesis for average normal menstrual cycle length of 30 days reach menopausal period at a significantly later age, have shorter menstrual bleeding, and higher lumbar spine bone density compared to those with shorter menstrual cycle duration (27 and 28 days).

Hypovolemic shock due to giant uterus leiomyoma detachment.

Uterine leiomyoma (UL) is the most common benign gynecologic tumor of the reproductive age females. It is symptomatic only in 25% of the patients causing dysmenorrhea, menorrhagia or anemia. In some patients it occurs just as a palpable abdominal mass. In this study, we report a 50-year-old woman with a giant mass, attached to the uterus, which was detached and therefore led to shock due to major hemorrhage. Surgical removal of both the mass and the uterus confirmed the diagnosis of a pedunculated uterine leiomyoma.

[Chemotherapy-sensitive uterine choriocarcinoma: a case report].

We report a case of uterine choriocarcinoma in a 42-year-old female presenting with abdominal pain, uterus enlargement, high serum levels of beta human chorionic gonadotropin (b-hCG) and a positive pregnancy test on two separate occasions. At laparatomy, blood and clots were observed in the abdomen, an enlarged uterus with tumor infiltrates in the uterus, appendix, bladder and plica vesico-uterina. Follwing hysterectomy and bilateral oophoorectomy, the patient received chemotherapy and was followed for two years. No tumor recurrences were observed and the b-hCG levels returned to normal. In conclusion, the condition responds favorably the chemotherapy and recurrences are rate when there are no metastases to the liver or the brain.

[Contraception among female students in Medical University of Plovdiv].

AIM: This study aimed to investigate the practice of contraception among female medical students in Medical University, Plovdiv. METHODS: Practice of contraception of 160 female medical students was assessed with an anonymous questionnaire. RESULTS: 152 students answer to the questionnaire (95%). 72.6% of the participants used condoms. Only 5.9% used oral contraception pill (OCP) as contraceptive methods. Nearly 9% of those participants don't used contraception. CONCLUSIONS: It is necessary to change teaching about contraception in the Medical University to insure the delivery of adequate family planning guidance by future practitioners.

[Emergency contraception knowledge among students in Medical University of Plovdiv].

OBJECTIVE: The purpose of this study was to evaluate the knowledge on emergency contraception (EC) by the students in Medical University of Plovdiv. METHODS: This is a cross-sectional study. Data was collected from 200 students from University of Plovdiv (Bulgaria) by a self-administered, anonymous questionnaire. RESULTS: One-hundred seventy-seven (85.5%) of participants respond that they are aware about EC as a method for preventing unwanted pregnancy after unprotected sexual intercourse. The main source for information is public media. Women are more informed than men; there is no difference in knowledge in the beginning and at the end of the study. A big part of the students have used EC. CONCLUSIONS: Students from Medical University are well informed about EC which is due mainly to media. In order to improve awareness and knowledge on the matter changes in teaching process are needed and also spreading of accurate information through medical and informational sources.

[Cause-effect relatioships between circulating placental angiogenic proteins and serum IL-2, IL-6 and IL-10 levels in pregnant women with preeclampsia].

AIM: The object of the present study was to cause-effect relationships between serum placental angiogenic proteins and IL-2, IL-6, IL-10 levels in pregnant women with preeclampsia. MATERIAL AND METHODS: We studied a total of 70 women, aget 18-36/25+/-4.1/40 women had preeclampsia, 30 had normal pregnancies and 30 women were healthy controls. We measured the serm levels of fms-like tyrosine kinase-1, placental growth factor (PLGF), IL-2, IL-6, IL-10 using ELISA. RESULTS: sFlt-1 serum levels were significantly higher and PLGF levels were significantly lower in women with preeclampsia as compare to those of healthy Pregnant women Likewise, IL-2, IL-6 levels were significantly higher in women with preeclampsia as compared to those of healthy pregnant women. IL-10 levels were not different between the two groups, sFlt-1, IL-2 and IL-6 were strongly correlated, PLGF and IL-2 were moderately correlated and there was no correlation with IL-10. There was a significant negative correlation between the two growth factors. CONCLUSIONS: The abnormal balance of circulating angiogenic factors is a major pathgenetic mechanism underlying the endothelial dysfunction and clinical manifestations of preeclampsia. Endothelial dysfunction activated the expression and production of IL-2, and IL-6. The correlation of sFlt-1 and PLGF on one hand, and IL-2 and IL-6, on the other, is probably an factor which supports the participation of angiogenic proteins and cytokines in the pathogenesis of preeclampsia.