АКУШЕРСТВО И ГИНЕКОЛОГИЯ -...

БЪЛГАРСКО ДРУЖЕСТВО ПО АКУШЕРСТВО И ГИНЕКОЛОГИЯBULGARIAN SOCIETY OF OBSTETRICS AND GYNECOLOGY

АКУШЕРСТВОИ

ГИНЕКОЛОГИЯOBSTETRICS & GYNECOLOGY

Volume 40 ISSN 0324-0959 4'2000

50 Акушерство и гинекология

КИСТА ПАРАОВАРИАЛИС ПЕРМАГНА ПРИ 18-ГОДИШНА ПАЦИЕНТКАН. Лазаров,Л. Лазаров, М. АнгеловаТракийски университет, Медицински факултет - Стара ЗагораКатедра по акушерство и гинекология, Ръководител доц. д-р Л. Лазаров, д. м.

Резюме: Авторите описват рядък случай на голяма параовариална киста при изключително млада 18-годишна пациентка, изпълваща цялата коремна кухина.

Те правят извод, че е необходима точна и прецизна диагностика, .както и опитен оперативен екип, защото по време на операцията могат да се получат големи изненади, нарушаващи хода и изхода й.

CYSTA PARAOVARIALIS PERMAGNA IN AN 18-YEAR PATIENTN. Lazarov, L. Lazarov, M. AngelovaSummary: A rare case of a large paraovarian cyst in an unusually young 18-age-old patient, filling up the whole

abdominal cavity, is described.It is concluded that an accurate and precise diagnostics, and also an experienced surgical team would be required in

such a surgery as complete surprises can take place effecting its course and outcome,

Яйчника е шампион по брой и варианти на туморите, които могат да възникнат първично в него или метастазират от друго първично огнище. Това се дължи на богатството на тъканите в него.

Туморите на яйчника се отличават един от друг по хистологичен строеж, хормонална активност и прогноза. Туморът може да започне своето развитие от различни части на яйчника. В повечето случаи развитието започва в близост със свободната повърхност и туморът расте към коремната кухина. По-рядко зародиша на тумора е разположен към хилуса на яйчника. При нарастване той разслоява двата листа на широката връзка и навлиза между тях. За подобен интралигаментарен тумор ще стане дума по-долу.

ЦЕЛ И ЗАДАЧИНие си поставяме за цел да ви представим рядък

случай на голяма параовариална киста, достигаща до епигастриума с общо тегло 7.300 кг при 18-годиш- на пациентка.

МАТЕРИАЛ И МЕТОДИКасае се за М. В. В., 18-годишна от град Сливен,

постъпила на 24.02.2000 г. с диагноза: Tu abdominis, изпълващ изцяло малкия, големия таз и коремната кухина, затрудняващ дишането на пациентката - та- хидиепнея. Менархе на 10 години, установила се отведнъж през 30 дни с продължение 5-6 дни. Досега е с редовни менструации и не е имала гинекологични оплаквания. Пет-шест месеца преди постъпването майката забелязала, че корема на момичето нараства и поради съмнение за укриване на нежелана бременност я довежда на гинекологичен преглед в АГ клиника - Стара Загора. След прегледа бе установено, че се касае за абдоминален тумор и пациентката се подготви за оперативно лечение.

От направената компютърна томография:СТ на абдомен: черен дроб - без огнищни проме

ни. Лиен - без СТ данни за патологични промени. Бъбреци - в пиелокаликсната система малък каликс на десен бъбрек - хиперденена находка с размер до 0.3 см Ляв бъбрек - б.о. В абдоминалната кухина до нивото на пикочния мехур се открива овална със СТ плътност до 15 НЕ с гигантски размери находка. Панкреас не се визуализира добре поради наличието на множество артефакти.

СТД: Киста абдоминис - възможно от ляв оварий. Микролитиазис декстра. Приложена СТ-грама.

Параклиника в границите на нормата. Консултирана с кардиолог и анестезиолог - може да бъде оперирана.

РЕЗУЛТАТИ И ОБСЪЖДАНЕНа 03.05.2000 г. пациентката бе оперирана. In situ:

параовариална киста, изхождаща от дясната широка връзка и изпълваща изцяло малкия таз, големия таз, стигаща до черния дроб и притискаща силно диафрагмата.

По време на оперативната интервенция се източи около 7 литра бистра серозна течност.

Направи се adnexectomia dextra et resectio partialis ovarii sinistra. По време на операцията се наложи да се проникне в ретроперитониалното пространство, за да се отлрепарира прирасналия към задната стена на кистозната формация, силно притиснат и деформиран уретер. Arteria uterina беше деформирана и разширена - диаметър 1.5-2 см. Гефрир-бенигнена киста.

Позволяваме си да ви представим този случай, за да напомним, че инралигаментарните кисти, противно на очакванията, могат да нарастват и да достигат огромни размери. Те могат да създадат изключително сложна оперативна обстановка, нарушавайки топиката на съседните органи (най-често уретер и съдове). За целта е необходима точна и прецизна диагностика, както и опитен оперативен екип, защото по време на операцията могат да се получат големи изненади, нарушаващи хода и изхода й. Ние считаме, че този случай ще бъде в полза на практикуващите акушер-гинеколози, поради което си позволихме и да го съобщим.

книгопис1. Василев, Б. Някои предполагаеми пренеоплазми на

яйчника, Акушерство и гинекология, С., 13,1974,5, 386-389.2. Василев, Б. Тумори на яйчниците. Гинекология, Ме

дицина и физкултура, 1983, 107-118.3. Доганов, Н. Овариални тумори. Гйнекология, Меди

цина и физкултура, София, 1994, 167-195.4. Такева, Цв. Яйчник в пубертетна възраст (непубли

куван материал), 1974.5. Юруков, Кр. и сътр. Овариални тумори. С., Медици

на и физкултура, 1978.6. Komondoska, A. and al. Ovarian tumors in youhg

females, IX-th World congres Obstetrics and Gynecologi, Tokyo, 1979, p. 45.

Българско Акушерство, Bulgarian Obstetrics,Гинекология и Семейно Gynaecology and Family

Планиране PlanningТом I, Брой 1,2_________________ 2002 Volume I, Number 1,2

БЪЛГАРСКА МЕДИЦИНСКА АКАДЕМИЯ

BULGARIAN MEDICAL ACADEMY

32 Семейно планиране • Family Planning_______________________ y 6 ________________

БЪЛГАРСКО А К У Ш ЕРС ТВ О , Г И Н ЕК О Л О ГИ Я И С Е М Е Й Н О ПЛ АН ИРА НЕ, ТОМ I, БР. 1,2 • 2002 • BULGARIAN OBSTETRICS, G Y NA ECO LO GY AND FAM ILY PLANNING. VOL I. N 1.2

NOVYNETTE - НОВА ВЪЗМОЖНОСТ В НИСКОДОЗИРАНАТА ОРАЛНА КОНТРАЦЕПЦИЯ СПРЯМО ЖЕНСКИТЕ фЕНОТИПОВЕ,

СПОРЕД ФИЗИЧЕСКИ И АНАМНЕСТИЧНИ ДАННИМ. Ангелова

К атедра по акушерство и гинекология, Тракийски университет, Медицински ф акултет, С тара Загора

NOVYNATTE - A NEW POSSIBILITY IN THE LOW-DOSED ORAL CONTRACEPTION TOWARDS THE FEMALE PHENOTYPES ACCORDING TO PHYSICAL AND ANAMNESTIC

DATA

are no cases of pregnancy

low frequency of intennenstrual bleedings (17%). aid guickly-passing side effects, itrogens, gestagenous component.

M. AngelovaDepartment of Obstetrics and Gynaecology, Medical Faculty, Thracian University, Stara Zagora, Bulgaria

SUMMARY: As a representative of the generation of the low-dosed oral contraceptives towards the female phenotype. Novynette provides a minimum dose of estrogens for woman Л organism upon availability of a new generation of a gestagenous component - desogestrel.

Novynette shows an c during the acceptance, Pi

Itprovides good conti Novynette is very well KEY WORDS: Novytu

ntraceptive 'ij0. 00.

•nthly ih mil con

Novynette представлява монофазен контра- цептив със значително намалено количество ес- трогенно съдържание и нова, подобрена геста- генна ком понента. Н и ската естрогенна съ став ка в съврем енната генерация нискодозирани кон- тр ац еп ти ви минимализира риска о т сърдечносъдови и чернодробни заболявания. О т друга страна, прогестаген ите са тези , к о и то в клинични условия се асоциират със странични еф екти върху ф а к то р и те на коагулацията, липидния и въглехидратн и я м етаболизъм . Е стр о ген н ата компонент а търпи количествени промени, докато геста- генната - качествено развитие. Н о в ата генерация гестагени има по- слаби м етаболитни въздействия върху организма. Те практически не упраж н яват еф ек т върху липидният профил, а заедно с естр о ген н ата ком понента дори м о гат да доведат до благоприятни промени в м а с т н а т а обмяна. По то зи начин "новите формули" орални кон трац ептиви м о га т да се о каж ат с едно желателн о п р о текти вн о влияние върху някои сърдечносъдови заболявания. О т клинична гледна точка

П одбраните жени са с естроген-доминантен хормонален тип.

Преди с т а р т а на кон трац епци ята са изследвани: кръвна картина; коагулационен с т а т у с ; биохимични показатели; чернодробни показатели и липиден с т а т у с . К о н тр о л ъ т на показателите бе повторен в края на изследването.

П рием ът е по строго спазвана стан д ар тн а схема: първата опаковка о т първия ден на менструалния цикъл, всяка следващ а - след 7 дни почивка, по една т а б л е т к а дневно в приблизително един и същи час.

РЕЗУЛТАТИ. К о н тр а ц е п ти в н а та еф ективн о ст на препарата Novynette бе оценена по индекса на Pearl = 0,00.

Репродуктивната възм ож ност се възвръща още на първите един-два месеца след спирането на препарата. О т 35-те жени има две, кои то са спрели приема поради желание за бременност. Е дната о т т я х е забременяла на следващия месец.

К о тр о л ъ т върху менструалния цикъл бе пре-° ° ~ ” r r l r r s л Б / ~ . л п 1 / О Ц ' ) Г П Р Д U '



ГИНЕКОЛОГИЯOBSTETRICS & G Y N E C O LO G Y

Volume 42 ISSN 0324-0959 1 2 0 0 3

РЕДАКЦИОННА КОЛЕГИЯСт. Иванов - главен редактор Е. Рачев, Ат. Щерев - зам. гл. редактор Ил. Борисов - секретар

А куш ер ств о и ги н е к о л о ги я

ИЗХОД ОТ СЕДАЛИЩНО РАЖДАНЕ В АГ-КЛИНИКА - гр. СТАРА ЗАГОРА

ЗА ПЕРИОДА 1 9 9 8 -2 0 0 1 ГОДИНА

М. Ангелова, Л. Лазаров, Н. ЛазаровТракийски университет, Медицински факултет - Стара ЗагораКатедра по Акушерство и гинекология, ръководител - доц. д-р Л. Лазаров, д.м.

Т А ®

Резюме. Авторите са проследили изхода от седалищните раждания в АГ-клиника - Стара Загора, за четиригодишен период от 1998 до 2001 година. Те правят много задълбочен анализ на тенденциите за изхода от седалищните предлежания и си позволяват да предложат протокол за поведение при седалищно раждане.

OUTCOME OF BREECH DELIVERY AT THE CLINIC OF OBSTETRICS AND GYNECOLOGY IN STARAZAGORA FOR THE PERIOD 1998-2001M. Angelova, L. Lazarov, N. LazarovSummary. The authors have studied the outcome of breech deliveryes at the Clinic of Obstetrics and

Gynecology, Stara Zagora, for a four-wear period fron 1998 until 2001. They make a profound analysis of the trends for the outcome of the breech presentations and allow themselves to suggest a record of behaviour during breech delivery.

С е д а л и щ н о то п р е д л е ж а н и е е о п и с а н о и 4,7 % - една сравнително висока честота, която сравнително подробно и точно още шест века се дължи на това, че при нас става известно преди н. е. от J. Guillemeau. Парадоксално е, че концентриране на брем енни със седалищ но

------- --- ------ - rmonnowauMo тт,м кятп клиниката е методичен и



ГИНЕКОЛОГИЯ

OBSTETRICS & GYNECOLOGY

Volume 44 ISSN 0324-0959 5 2 0 0 5

РЕДАКЦИОННА КОЛЕГИЯСт. ИВАНОВ - главен редакторЕл. РАЧЕВ, Г. ГОРЧЕВ - зам. гл. редакториМ. СИРАКОВ - секретар

5 8 А ку ш е р с тв о и ги н екол о ги я - бр .5 , 2005

КАЗУИСТИКА h >4: ;i i < /г, 1

РАК НА МАТОЧНАТА ШИЙКА - ЕКЗОфИТНА фОРМА, ПРОМИНИРАЩ ПРЕД

ИНТРОИТУСА НА ВЛАГАЛИЩЕТО ПРИ 52-ГОДИШНА ПАЦИЕНТКА

М. Ангелова, П. Лазаров, Н, ЛазаровТракийски университет, Медицински факултет - Стара Загора Катедра по “ Акушерство и гинекология”Ръководител доц. д-р Л. Лазаров д.м.

1 МИННИ МИННИРезюме: Авторите описват рядък случай на карцином на маточната шийка с екзофитен растеж,

проминиращ пред интроитуса на влагалището при 52-годишна пациентка. Те правят извод, че е необходима точна, прецизна и ранна диагностика, както и опитен оперативен екип, защото по време на операцията могат да се получат изненади, нарушаващи хода и изхода й.

CANCER OF THE CERVIX UTERI - EXOPHYTIC FORM, PROMINAT1NG THROUGH THE VAGINALINTROITUS OF A 52-YEAR OLD PATIENTM. Angelova, L. Lazarov, N. LazarovThracian University, Faculty o f Medicine - Stara ZagoraDepartment o f O bstetrics and GynecologyChief: Ass. Prof. Dr. L. Lazarov, M.D.Abstract. The authors describe a rare case of carcinoma o f the cervix uteri with exophytic accretion,

prominating through the vaginai introitus o f a 52-year old patient. They make the conclusion that accurate,



ГИНЕКОЛОГИЯ


Volume 44 ISSN 0324-0959 6 2 0 0 5

Акушерство и гинекология - бр.6, 2005 41

КАЗУИСТИКА . ■ ■ в я шШ щ Ш Ш Ш

ЕДИН СЛУЧАЙ НА ПАПИЛИфЕРЕН КИСТАДЕНОМ С ГРАНИЧНА МАЛИГНЕНОСТ

ПРИ 29-ГОДИШНА ПАЦИЕНТКА, С ВИСОК ОПЕРАТИВЕН РИСК

М. Ангелова, Л. Лазаров, Н. Лазаров, М. Гълъбова*, Ив. Василев*

Медицински факултет, Тракийски университет гр. Стара ЗагораКатедра Акушерство и гинекология* Катедра Обща и клинична патоанатомия

Резюме. Представяме един случай на папилиферен серозен кистаденом с гранична малигненост при 29-годишна пациентка, със синдром на VCS - status post phlebothrombosis ileofemoralis dextra. Thrombosis vena cava superior.

Клю чови дум и: папилиферен серозен кистаденом, флеботромбоза, VCS синдром, висок оперативен риск

A CASE OF A PAPILLOFEROUS CYSTADENOMA OF BOUNDARY MALIGNANCY IN A 29-YEAROLD FEMALE PATIENT WITH HIGH SURGICAL RISKM. Angelova, L. Lazarov, N. Lazarov, M. Galabova*, Iv. Vasilev*Faculty o f Medicine, Trakia University o f Stara ZagoraDepartment o f O bstetrics and Gynaecology* Department o f General and C linical PathoanatomySummary. A case o f papilloferous serous cystadenoma o f boundary malignancy in a 29-year old female

patient, with VCS syndrome - status post phlebothrombosis ileofemoralis dextra. Thrombosis vena cava superior is presented.

Key words: papilloferous serous cystadenoma, phlebothrombosis, VCS syndrome, high surgical risk

Увод Status post phlebothrombosis ileofemoralis dextra.П а п и л и ф е р н и я с е р о з е н ки с т а д е н о м се Thrombosis vena cava superior. (Syndrom VCS)

п р и ч и сл я в а към гр уп а та на о б и кн о в е н и те От анамнезата има едно раждане през 2003 “епителни“ тумори, в подгрупата “серозни тумори“, година; Редовен менструален цикъл през 28 дни,

....... .............. ............- -------- -5 /< ™...Д П ^ „ _ г > 1 1 0 9 ЛПЛ г


А КУШЕРСТВОИ

ГИНЕКОЛОГИЯm

XXIV НАЦИОНАЛНА АКУШЕРСКА КОНФЕРЕНЦИЯ I НАЦИОНАЛНА КОНФЕРЕНЦИЯ НА АКУШЕРКИТЕ

КИТЕН 09-12 VI 2005 г.II част


Supplem ent 3 р е д а к ц и о н н а к о л е г и я. . . . . Ст. ИВАНОВ - главен редакторVolume 44 Ел. РАЧЕВ, Г. ГОРЧЕВ - зам. гл. редакториISSN 0324-0959 »*. СИРАКОВ - секретар

АНМИЗ НА РАЖДАНИЯТА В СЕДАЛИЩНО ПРЕДЛЕЖАНИЕВ АГ-КЛИНИКА СТАРА ЗАГОРА ЗА ПЕРИОДИТЕ 1990-1992 г. и 1998-2001 г.

П. Лазаров, Н. Лазаров, М. АнгеловаКатедра по Акушерство и гинекология. М.Ф., Т.У., Стара ЗагораРъководител: Доц. д-р Л. Лазаров, д.м.

:атттжттттштштттштжштш1тшшшшштяютттт тшт шРезюме. В ретроспективно и проспективно проучване авторите правят паралелен анализ на

седалищните раждания в началото и края на 12-годишен период, като вземат предвид относително един и същ брой седалищни раждания (с .р .) -366 за 1990-1992 г. и312с.р. За 1998-2001 г. Използвайки алтернативен и корелационен анализ, те изследват очерталите се тенденции.

Ключови думи: седалищно предлежание, цезарово сечение, вагинално раждане, перинатална смъртност.

ANALYSIS OF DELIVERIES WITH BREECH PRESENTATION IN THE CLINIC OF OBSTETRICSAND GYNECOLOGY IN STARAZAGORA DURING THE PERIODS 1990-1992 AND 1998-2001L. Lazarov, N. Lazarov, M. AngelovaSummary. It has been made parallel analysis o f breech deliveries in a retrospective and prospective re

search. We have studied relatively equal number o f breech deliveries (b.d.) at the beginning and at the end o f a twelve-years period, (366 b.d. for 1990-1992 and 312 b.d. for 1998 -2001). To study the tendencies we used alternative and correlative analysis.

Key words: breech presentation, Cesarean section, vaginal delivery, perinatal mortality



ГИНЕКОЛОГИЯOBSTETRICS & GYNECOLOGY

VI НАЦИОНАЛНА КОНФЕРЕНЦИЯ ПО АКУШЕРСТВО И ГИНЕКОЛОГИЯ

гр. Сандански 19-20Л 1.2004 г.

Supplem ent 1 Volume 44 ISSN 0324-0959 2005

А к у ш е р с т в о и г и н е к о л о г и я - S upp lem en t 1 £ I

пренаталнитв грижи на бременните в добол ничните институции - женската консултация и други форми на пренатално контролиране: колко прегледа (посещения) има бременната при лекар акушер-гинеколог, при личния лекар, от кой срок на бременността се контролира, какви изследвания и назначения има и пр. От документацията не личи много от тези бременни да са боледували от сериозни акушерски и неакуш ерски болести през настоящата бременност - само една бременна е отбелязана с прееклампсия и една с "вирусно заболяване“ , една с епилепсия, по 1 с IVF, астма и пиелонефрит.

Образованието на жените не е лошо: 34 от 49 имат средно и 13 виеше образование, а с основно са 6. Професията на немалко от тях видимо не спомага за много благоприятно развитие на бременността, а именно: "безработни" са 9, неграмотни - 9, перачки - 3,

"не работи'1 - 13, общо 34Известна слабост /lim ita tio n / на нашето

проучване може би е неголемият период на проучване • 4 и половина, 5 години, ресгт броя случаи. Затова ние ще продължим проучването. Към момента обаче бихме могли да кажем все пак, че и в тоя вид и обхватност проучването дава определена представа за тенденцията и мащабността на пренаталната смъртност.

Хистологичните и клинични данни споменати по-горе в значителен брои от случаите дават известни основания да смятаме, че бременността в тези случаи се развива при субоптимални условия, които накрая довеждат до хронична интраутеринна асфиксия на иначе нормалния анатомично и биологично плод. Трябва да се огледа дали пренаталните грижи за бременните жени и екологичните и трудово професионални фактори са оптимални, или поне дали не са вредни.

КИСТИЧЕН ТЕРАТОМ НА ЦЕКУМА, ПРЕДСТАВЯЩ СЕ КАТО ЯЙЧНИКОВ ТУМОР. СЛУЧАЙ ОТ ПРАКТИКАТА И ПРЕГЛЕД В ЛИТЕРАТУРАТА

Н. Л азаров ’, Л. Л а за р ов ’ , Ангелова. М ’, А. П опхарит ов2

1 - Тракийски университет, Медицински факултет, Катедра по Акушерство и Гинекология Ръководител — Доц. д-р Л.Лазаров , д.м.2 - Катедра по хирургия, неврохирургия и урология, Университетска болница - Стара Загора Ръководител- Доц. Д-р Недков, д.м.

Р езю м е : Туморна формация на 24-годишна пациентка, произхождаща от цекума и интерпретирана клинично като яйчников тумор. Авторите описват един изключително рядък случаи, които може да бъде от полза за гинекологичната теория, практика и диагностика.

К л ю ч о в и д у м и : Тератома на цекума, яйчников тумор

CYSTIC TERATOMA OF THE CAECUM, DEMONSTRATING AS AN OVARIAN TUMOR:CASE REPORT AND LITERATURE REVIEW N. Laza rov ’ , L Laza rev ', A n ge lova M .1, P opharitov*1- Tracian university, University hospital, Department of obstetrics and gynecology Chief of department - Prof, Lazarov, L., M.D.2 - Tracian University, University hospital, Department of surgery Chief of department - Prof. Nedkov, M.D.S um m ary: Benign cystic teratoma o f the caecum o f 24 year woman interpreted as an ovarian tumor. Rare

case that can contribute to the gynecology theory, practice and diagnostic Key w ords Teratoma o f the caecum, ovarian tumor

ВъведениеТератогенните тумори на гастроинтести-

налния тракт са значително редки, В литературата има описани единични случаи на доброкачествени кистични тератоми на дебелото

черво. Локализацията им в цекума е още по- рядка. По данни на M.J, Schuetz и Т.М. Elsheikh (1) в английската научна литература има описани само четири случая на тератом на цекума като последното съобщение е от 1977 г. A. Nirenberg и

БЪЛГАРСКО НАУЧНО ДРУЖЕСТВО ПО АКУШЕРСТВО И ГИНЕКОЛОГИЯBULGARIAN SCIENTIFIC SOCIETY OF OBSTETRICS AND G YNECO LO G Y


ГИНЕКОЛОГИЯО Ф ИЦИАЛН О ИЗДАНИЕ Н А БЪЛГАРСКОТО Н АУЧН О ДРУЖЕСТВО

ПО АКУШЕРСТВО И ГИНЕКОЛОГИЯ

Volume 55 ISSN 0324-0959

РЕДАКЦИОННА КОЛЕГИЯ Ст. ИВАНОВ - главен редактор Г. ГОРЧЕВ - зам. гл. редактор М. СИРАКОВ - секретар

Членове:Ил. КАРАГЬОЗОВ, А. ДИМИТРОВ,Т. ЧЕРНЕВ, И. КОЗОВСКИ, В. ЗЛАТКОВ Н. ВАСИЛЕВ, Н. ДОГАНОВ, А. НИКОЛОВ

EDITORSSt. IVANOV-Editor-in-chiefG. GORCHEV - Managing editor M. SIRAKOV - Scientific secretary

EDITORSI. KARAGIOZOV, A. DIMITROV,T. CHERNEV, I. KOZOVSKI, V. ZLATKOV N. VASSILEV, N. DOGANOV, A. NIKOLOV

РЕДАКЦИОНЕН СЪВЕТБ. Слънчева, Ж. Карагьозова, М. Янков,С. Божинова, Й. П о п о в а . Рачев,Б. Маринов, С. Иванов, Я. Корновски,Бл. Пехливанов, М. Малинова Е. Ковачев,В. Димитрова, Р. Димитров, Сл. Томов, Б. Славчев,И. Костов, Е. Димитракова, Р. ВелевГ. Креацас (Гърция), Уайнбаум (САЩ), X. Хошиай (Япония),В. Кесич (Сърбия и Черна гора), Н. Хакер (Австралия),Т. Чермели (Унгария)Технически редактор: Е. Павлова

EDITORIAL BOARDВ. Slancheva, Z. Karagiozova, M. Yankov, S. Bojinova, Y. Popov, E. Rachev, B. Marinov, S. Ivanov,Y. Kornovski, Bl. Pehlivanov,E. Kovachev, V. Dimitrova, R. Dimitrov, SI. Tomov, B. Slavchev,I. Kostov, E. Dimitrakova, R. Velev, M. MalinovaG. Creatsas (Greece), Weinbaum (USA), H. Hoshiai (Japan), V.Kesic (Serbia and Montenegro), N. Hacker (Australia),T. Csermely (Hungary)Technical editor E. Pavlova

Адрес на редакцията: ул. Здраве 2, София 1431

Тел. 02 / 91-72-353 Факс 02У 851-72-71

e-m ail: [email protected] М об. 0888 92 56 26

"АКУШЕРСТВО И ГИНЕКОЛОГИЯ" се индексира в MEDLINE

"AKUSHERSTVO I GINEC0L0GIA" is indexed in MEDLINE

mailto:[email protected]

16 Акушерство и гинекология - Брой 6, 2016

НОВА НИСК0Д03ИРАНА ОРАЛНА КОНТРАЦЕПЦИЯ С MIDIANA 28Д-р Ангелова М. дм1, Доц. д-р Е. Ковачев2, дмДоц. К. Митева, дп3, Атанасова, дм3

1 Медицински факултет на Тракийски Университет гр. Стара Загора,Катедра Акушерство и гинекология2 Медицински университет „Проф. д-р Параскев Стоянов“ , Катедра Акушерство и гинекология3 Медицински факултет на Тракийски Университет гр. Стара Загора, Катедра Здравни грижи

РезюмеКато представител на генерацията на нискодозирани орални контрацептиви Midiana28

осигурява минимален прием на естрогени за организма на жената при наличие на нова генерация гестагенна компонента - Drospirenone.

Midiana28 има отличен контрацептивен ефект - в групата наблюдавани жени няма забременели по време на приема, Pearl индекс = 0,00.

Осигурява добър контрол върху менструалния цикъл при ниска честота на интерменструалните кръвотечения /1 7 %/.

Midiana28 има много добра поносимост с минимални отчетени, бързопреходни странични явления.

NEW LOW-DOSE ORAL CONTRACEPTIVE WITH 28 MIDIANA

Dr. Angelova Mariya, P h d - Chief Assistant at the Department o f Obstetrics and Gynecology - Faculty o f Medicine - Trakia University- Stara Zagora

Prof. E. Kovachev,Phd--Associate Professor at the Department o f Obstetrics and Gynecology-Paraskev Stoyanov Medical University- Varna

Prof. Kremena Miteva DP - Chief Assistant at the Department o f Health care — Faculty o f Medicine - Trakia University- Stara Zagor

Zdravka Atanasova Phd - Chief Assistant at the Department o f Health care — Faculty o f Medicine - Trakia University- Stara Zagor

SummaryAs a representative o f the low dose generation o f oral contraceptives, Midiana 28 provides minimal intake of

eSlrogens for the female organism in the presence o f a new generation gestation component-Drospierenone.Midiana has an excellent contraceptive effect - the control group o f women showed no cases o f

impregnation during the intake, Pearl index =0.00.It also exercises a good control over the menstrual cycle with low frequency o f intermenSlrual bleeding /17%/.Midiana 28 shows a very good tolerability with minimal, detected, rapidly transient side effects.Key w o rd s : Midiana 28, Drospirenone, hormonal contraception, monophase medicines.

ВъведениеМ н о ж е с т в о н а у ч н и п р о у ч в а н и я д н е с

не о спо р и м о д о ка з в а т по л зата от оралната хормонална контрацепция за репродуктивното з д р а в е на ж е н а т а и р е д и ц а т а д р у г и н е ко н тр а ц е п ти в н и пр е и м ущ е ства . И деален моноф азен контрацептив, лиш ен напълно от нежелани странични ефекти, няма, но близо до оптималния вариант са контрацептивите със значително намалено количество естрогенно съ д ъ р ж а н и е и нова , по д об рена геста генна компонента. Еволюцията на контрацептивната таблетка се развива в два аспекта:

• нам аляване на дозата на естрогенната компонента - 50mg, 30 mg, 20 mg

• намаляване дозата на прогестагенната ком понента и нейната качествена пром яна- високо селективни прогестагени - “ трето “ поколение.

О р а л н и т е к о н т р а ц е п т и в и са л и д е р в хормоналната контрацепция.

По отношение на ефективност - PI - 0,05 - 0,5- за сравнение при доброволната хирургическа кастрация PI е 0,1 — 0,4.

Освен това имат следните неконтрацептивни приимущества:

• по добър контрол на менструалния цикъл• намаляване симптомите на дисменореята• намаляване на желязо-дефицитната анемия• намаляване риска от овариален карцином

ф-

БЪЛГАРСКО НАУЧНО ДРУЖЕСТВО ПО АКУШЕРСТВО И ГИНЕКОЛОГИЯBULGARIAN SCIENTIFIC SOCIETY OF OBSTETRICS AND G YNECOLOG Y


ГИНЕКОЛОГИЯО Ф ИЦИАЛН О ИЗДАНИЕ Н А БЪЛГАРСКОТО Н АУЧН О ДРУЖЕСТВО

ПО АКУШЕРСТВО И ГИНЕКОЛОГИЯ

Volume 55 ISSN 0324-0959

"АКУШЕРСТВО И ГИНЕКОЛОГИЯ" се индексира в MEDLINE

"AKUSHERSTVO I GINECOLOGIA" is Indexed in MEDLINE

Адрес на редакцията.- ул. Здраве 2, София 1431

Тел. 02 / 91-72-353 Факс 02 / 851-72-71

e-m ail: [email protected] М об. 0888 92 56 26

РЕДАКЦИОННА КОЛЕГИЯ Ст. ИВАНОВ - главен редактор Г. ГОРЧЕВ - зам. гл. редактор М. СИРАКОВ - секретар

Ljj-jg Q Q0 •Ил. КАРАГЬОЗОВ, А. ДИМИТРОВ,Т. ЧЕРНЕВ, И. КОЗОВСКИ, В. ЗЛАТКОВH. ВАСИЛЕВ, Н. ДОГАНОВ, А. НИКОЛОВ

EDITORSSt. IVANOV - Editor-in-chief G. GORCHEV - Managing editorM. SIRAKOV - Scientific secretary

EDITORSI. KARAGIOZOV, A. DIMITROV,T. CHERNEV, I. KOZOVSKI, V. ZLATKOVN. VASSILEV, N. DOGANOV, A. NIKOLOV

РЕДАКЦИОНЕН СЪВЕТБ. Слънчева, Ж. Карагьозова, М. Янков,С. Божинова, Й. Попов, Е. Рачев,Б. Маринов, С. Иванов, Я. Корновски,Бл. Пехливанов, М. Малинова Е. Ковачев,В. Димитрова, Р. Димитров, Сл. Томов, Б. Славчев,И. Костов, Е. Димитракова, Р. ВелевГ. Креацас (Гърция), Уайнбаум (САЩ), X. Хошиай (Япония),В. Кесич (Сърбия и Черна гора), Н. Хакер (Австралия),Т. Чермели (Унгария)Технически редактор: Е. Павлова

EDITORIAL BOARDВ. Slancheva, Z. Karagiozova, M. Yankov, S. Bojinova, Y. Popov, E. Rachev, B. Marinov, S. Ivanov,Y. Kornovski, Bl. Pehlivanov,E. Kovachev, V. Dimitrova, R. Dimitrov, SI. Tomov, B. Slavchev,I. Kostov, E. Dimitrakova, R. Velev, M. MalinovaG. Creatsas (Greece), Weinbaum (USA), H. Hoshiai (Japan), V.Kesic (Serbia and Montenegro), N. Hacker (Australia),T. Csermely (Hungary)Technical editor E. Pavlova


10

endometriomas: intraperitoneal cydlectomy versus fenedtration and coagulation. Tunis Med. 2013; 91(12): 709-14.

8. Keyhan, S. et al. An update on surgical versus expectant management of ovarian endometriomas in infertile women. BioMed Research International Vol. 2015, Article ID 204792.

9. Urman, B. et al. Removal o f unilateral endometriomas is associated with immediate and sustained reduction in ovarian reserve. Reprod Biomed Online, 2013, 27: 212-216.

10. Celik, H .G .et at. Effect of laparoscopic excision of endometriomas on ovarian reserve: serial changes in the serum antimQllerian hormone levels. Fertil Steril, 2012, 97: 1472-1478.

11. Yuan, M. et al. Risk factors for recurrence of ovarian endometriomas after surgical excision. J

Акушерство и гинекология - Брой 6, 2016

Huazhong Univ Sci Technolog Med Sci, 2014 Apr, 34(2): 213-219.

12. Koninckx, P. R. etal. Deep endometriosis: definition, diagnosis, and treatment Fertil Steril, 2012 Sep, 98(3): 564-571.

13. Rimbach, S., U. Ulrich, W. Schweppe Surgical therary of endometriosis: challenges and controversies. Geburtsh Frauenheilk, 2013, 73: 918-923.

14. Moini, A. et. al. Fertility outcome after operative laparoscopy versus no treatment in infertile women with minimal or mild endometriosis. Int J Fertil Steril, 2012, Vol. 5(4), 235-240.

15. Stegmann B. et al. Using location, color, size, and depth to characterize and identify endometriosis lesions in a cohort of 133 women. Fertil Steril 2008;89(6): 1632-36.

ПОДГОТОВКА HA МАТОЧНАТА ШИЙКА ПРЕДИ ДИААТАЦИЯ С МИ30ПР0СТ0Л ИААМИНАРИЯ - ПРЕДИМСТВА И НЕДОСТАТЪЦИ

Ангелова М., дм1, Доц. д-р Е. Ковачев2, дм, Доц. К. Митева, дп3, 3.Атанасова, дм3

1 Медицински факултет на Тракийски Университет гр. Стара Загора,Катедра Акушерство и гинекология2 Медицински университет „Проф. д-р Параскев Стоянов“ , Катедра Акушерство и гинекология3 Медицински факултет на Тракийски Университет гр. Стара Загора, Катедра Здравни грижи

РезюмеОперативната хистероскопия придоби популярност като минимално инвазивен подход

към вътрематочните изменения. Дилатацията е истинско предизвикателство по време на оперативната хистероскопия, особено при нераждали пациентки, жени в менопауза и жени с цервикална стеноза. Освен това някои дълги хистероскопски операции като миомектомия изискват адекватна дилатация, за да улеснят многократните вмъквания и тегления на резектоскопа. Друг технически проблем е необходимостта от значителна степен на цервикална дилатация, както и на размекчаване на маточната шийка, за да е възможна екстракцията на изрязаните ендометриални полипи или миоматозни части. Misoprodlol е аналог на простагландин Е1, който обикновено се използва в акушерството за предизвикване на аборт и раждане, както и след раждането, за да контролира прекомерното вагинално кървене. Неговото използване е гинекологията е ограничено.В нашето изследване е от особено важно значение.

Вагиналното приложение на Мизопростола преди оперативната хистероскопия улеснява дилатацията. А улеснената хистероскопия минимизира цервикалните усложнения. От друга страна, естествените дилататори Laminaria, направени от дръжките на Laminaria japomica или Laminaria DIGITATA (кафяви водорасли), са атрактивни природни вещества, които могат да причинят дилатация с минимално наблюдавани системни странични ефекти. Те са показали, че са ефективни при подготовка на шийката на матката преди оперативна хистероскопия. Въпреки това, не е имало сравнителни проучвания за ефикасността на двата метода за цервикална подготовка. Целта на това изследване е да се сравни ефикасността на вътрешно вагиналния Мизопростол, срещу ендоцервикалните дилататори Laminaria преди оперативна хистероскопия в определени случаи.

Ключови думи : хистероскопия,Мизопростол, ламинария,дилатация, маточна шийка

Акушерство и гинекология - Брой 6, 2016 11

PREPARATION OF CERVICAL DILATATION BEFORE WITH MISOPROSTOL AND LAMINARIA - ADVANTAGES AND DISADVANTAGESAngelova Mariya, P h d - Chief Assistant at the Department o f Obstetrics and G ynecology-Faculty

o f Medicine - Trakia U n ive rs ity - Stara ZagoraProf. E. Kovachev,Phd - - Associate Professor at the Department o f Obstetrics and Gynecology-

Paraskev Stoyanov Medical University - VarnaProf. Kremena Miteva DP - Chief Assistant at the Department o f Health care — Faculty o f Medicine

- Trakia U n ivers ity - Stara ZagorZdravka Atanasova Phd - Chief Assistant at the Department o f Health care — Faculty o f Medicine

- Trakia U n ivers ity - Stara Zagor

SummaryThe surgical hySleroscopy became popular as a minimally invasive approach to interuterine changes.

Dilatation is a real challenge during surgical hySleroscopy, especially in first delivery patients, women in menopause and women with cervical Stenosis. Apart from this, some long hySleroscopy operations such as myomectomy require adequate dilatation in order to facilitate the multiple insertions and drawing pulling o f the resectoscope. Another technical problem is the need for a significant degree o f cervical dilatation, as well as softening o f the cervix, which will allow the extraction o f the excised endometrial polyps or myomatose parts. MysoproSlol is analogous to prostaglandin E1, 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 o f vital importance.

The vaginal administration o f MysoproSlol before surgical hySleroscopy facilitates dilatation. The eased hySleroscopy minimizes cervical complications. On the other hand, the natural dilatators Laminaria, made o f Laminaria japonica or Laminaria Digitata Slicks, are attractive natural substances which can cause dilatation with minimally observed sySlemic side effects. They have shown efficient results during the cervical preparation before surgical hySleroscopy. Despite o f that, there are no comparative Studies on the efficiency o f the two methods for cervical preparation.

The aim o f this Study is to compare the efficacy o f internally vaginal MysoproSlol against endocervical dilatators Laminaria before surgical hySleroscopy in certain cases.

Key words : hySleroscopy, MysoproSlol, Laminaria, dilatation, cervix

Материали и методиПроучването включва 44 пациентки, с различни

и н д и ка ц и и за о п е р а ти в н а х и с те р о с к о п и я . Критериите за вклю чване са нераждали или мултипари със цервикална стеноза (дефинирани като трудно или невъ зм ож на д илатация на маточната ш ийка), които бяха насрочени за оперативна хистероскопия. Избраните случаи са били с пълна анамнеза, задълбочени изследвания и трансвагинална ехография за определяне на характера, мястото и степента на вътрематочните и зм е н е н и я . П а ц и е н тки те бяха пр оизвол но разделени на две групи. Група А (22 случая) третирани с 200 mg М изопростол (C ito tec) в задния ф о р н и кс 8 часа преди операци ята . Пациентките от група В (22 случая) са обработени еднократно с Ламинария като 2 см. се вкарва в цервикалния канал. Пациентката се поставя в гинекологична позицията и след като се постави стерилен спекулум на Куско шийката на матката се почисти с Braunol. Ламинарията се освобождава асептично от опаковката й и се захваща от края, където е прилож ен конеца . Той се вкарва в

цервикалния канал, докато премине вътрешния отвор на канала, а конеца се оставя да стои в покой във влагалището за лесно отстраняване. В операционната зала, степента на първоначалната дилатация се оценява чрез въвеждане Hegar дилатори под обща анестезия. Тя се определя от максималния номер дилататор, който премине без съпротива във възходящ ред. Продължителността на ди л атац и ята до д о сти га н е на 10 mm, и възможностите за реализация на процедурата, са записани. В края на процедурата са записани всички услож нения от рода на: перф орации, фалшиви ходове до невъзможност на дилатация.

Същ о така са отразен и и и нд и ви д уал но дилатациите на всяка пациентка под формата на трудности при дилатацията, удобство и страх от двата метода. Всички операции се извършват само от ендоскописти със сходно ниво на опит.

Резултати44 случая са включени в това проучване.

Събраните данни бяха ревизирани и кодирани за компютърно въвеждане на данни. А обработените данни се въведоха във файл, създаден на EPI

Volume 10, Supplement 2, 2012

Trakia Journal o f Sciences, Vot. 10, Suppl. 2, 266-26Copyright © 2012 Trakia University

Available online at:http:/Avw\y.uni-sz.b;i

ISSN 1313-7050 (print)ISSN 1313-3551 (online)

BIOPHYSICAL AND 8IGCHEMIIAL SCREWING OF THE FETUS FIRST AND SECOND PART OF THE PREGNANCY

I. Todorov, M. Todorova, V. Cankova, M. Angelova, S. Mangarova, I. Koleva,S. Stoyanov, B. Popov

Department of Obstetrics and Gynecology, Medical Faculty, Trakia University, University Hospital,Stara Zagora, Bulgaria

ABSTRACTWith every pregnant woman, despite her age and parity, there is a potential risk of giving birth to a child with inborn or hereditary pathology. For the early prevention of chromosome abnormality CVS and EAC /early amniocentesis are used. These, though, are invasive methods and are related to some risk for the mother and the fetus - an infection, leakage of amniotic fluid, death of the fetus, etc. In the last years, with the purpose of decreasing the invasive procedures, new and safe methods are being searched. One such method is the so called biochemical screening of the fetus, which is a combined score system consisting of sonographic data and biochemical markers taken from the blood of the pregnant woman and define the risk for the birth of a child with chromosomal abnormality. When the risk is higher than 1:250 CVS or EA is applied and if the pathology is proved abortion is offered on medical grounds.

For the last 1, 5 - 2 years, biochemical screening is being performed in Bulgaria, and since October it is being performed in the Department o f Obstetrics and Gynecology and the Department o f Biology, the Genetics Ccvtraig" " Ath “Мг/йсш "T dariiy*' ъ г *7xSkiU: * University o f Stara Zagora.

For 7 months 79 pregnant women were tested during the 11 - 13 gestational weeks and in 15 - 19 gestational weeks, selected at random. The research was performed in two stages:1. Ultrasound screening for fetal morphology examining:

1. The gestational weeks.2. The nuchal translucency / NT /3. The NB / nasal bones /4. The Front - maxillary angle5. The fetal heart rate and heart rate6. The blood flow through the tricuspid valve7. The blood flow through the Ductus venozus.8. Search for abnormalities in the morphology of the fetal umbilical cord, the amniotic fluid and the placenta.

During the second stage laboratory tests were performed for PAPP-A and ЧХГ in the Department of Genetics and Biology.

With 50 of the pregnant women / 62% /, the research was performed during the 11 - 13 gestational weeks , and with 29 pregnant women / 38 % / it was performed dining the 15 — 19 gestational weeks. With 8 of the women icrtahg-pan In' шй researcn,’ me screening was redone; in 11 - 13 gestational weeks with the purpose to define the so called combined risk. 2 of the pregnant women, due to a high risk of under 1:250, were directed to the Maternity Home in Sofia for EAC, but the results of both were within the norm. Termination of pregnancy due to chromosomal abnormality was not performed.

The authors can make the following conclusion:. 1. With the 79 studies preformed, the so called

Fetal Medicine was founded at the Medical Faculty in Stara Zagora

2. Experience was gained in the ultrasound screening o f the morphology o f the fetus

3. A significant amount o work was done for raising the awareness and increasing the knowledge o f pregnant women on how to monitor pregnancy and tire early prevention of fetal anomalies.

4. The pregnant women examined were saved considerable time and resources necessary

266 Trakia Journal o f Sciences, Vol. 10. Suppl. 2, 2012

im m u n o lo g yThe journal of edit, molecule*, systems and technologic*—

investigated whether the loss of Nrf2 alters basal ROS levels in DCs. Additionally; we tested whether the increase in the co-stimulatory molecule expression is directly due to any changes in ROS levels in Nrf2 knockout DCs.Materials and methods: Bone marrow-derived immature DCs from Nrf2 knockout and Nrf2 wild type mice were assayed for ROS levels by flow cytometry. ROS levels were lowered by treatment with vitamins C and E (ROS scavengers) followed by evaluation of co-stimulatory molecule expression and ability of DC to stimulate T cell proliferation. Results: Nrf2 knockout DCs have higher levels o f basal ROS compared to Nrf2 wild DCs. Vitamin C & E treatment reduced the levels of ROS in Nrf2 knockout DCs to levels comparable to that of the wild type. However, elevated co-stimulatory molecule (MHCII and CD86) expression of Nrf2 knockout DCs could not be reversed by vitamins treatment.Conclusions: Our results indicate that the increase in ROS levels in Nrf2 knockout DCs does not contribute to the increase in the costimulatory molecule expression.

Amelioration of experimental autoimmune encephalomyelitis by quinoline-3-carboxamide ABR-215757 is due to target of T cell activation

S. Helmersson,* A. Sundstedt/ P. Andersson,* T. Leanderson*& F. Ivars**Lund University, Immunology, Lund, Sweden, *Active Biotech AB, Active Biotech AB, Lund, Sweden

Purpose/Objective: ABR-215757 (5757) is a quinoline-3-carboxamide (Q-compound) currently in clinical development for systemic lupus erythematosus (SLE). Q-compounds have shown efficacy in different autoimmune diseases where they ameliorate the disease. However, the mechanism of action is still unknown.Materials and methods: Experimental autoimmune encephalomyelitis (EAE) is a T cell dependent mouse model of multiple sclerosis. We have used this model to try to understand the mechanism underlying the amelioration by 5757.Results: Of the 5757 effectively reduces induction of EAE. This mechanism is an early effect since treatment with 5757 during the first 5 days of the disease also reduces EAE development. Influx of T cells and myeloid cells to the brain is significantly reduced by 5757. EAE is a T cell dependent disease and the activation o f T cells occurs early in the peripheral lymphoid organs. T cells show a reduced proliferation in the presence of 5757. The effector function of the T cells is affected since T cells firom treated animals show a reduced production of IFN-y and IL- 17. The ex vivo antigen specific recall response is also heavily reduced in cells from 5757 treated animals.Conclusions: Taken together, this suggests that 5757 treatment affects T cell activation and maturation of effector cells, thereby reducing EAE development.

Analysis of in vitro T-cell responses of PBMCs from patients with pemphigus vulgaris and healthy controls using desmoglein 3 peptides and peptide conjugates as antigens

H. Szabados,* K. Uray,* P. S illo / F. H udecz/ S. Karpati* & S. Bosze* "*Eotvos Lorand University, Research Group o f Peptide Chemistry Hungarian Academy o f Sciences, Budapest, Hungary, tDepartment of Dermato-Venereolog)' and Skin Oncology, Semmelweis University, Budapest, Hungaty, * Department of Organic Chemistry, Eotvos Lorand University, Budapest, Hungary

Purpose/Objective: Pemphigus vulgaris (PV) is a rare, life-threatening autoimmune bullous skin disorder. The presence of autoreactive serum

antibodies (igGl and lgG4) against desmosoma! adhesion proteins, desmogiein 1 (Dsgl) and desmoglein 3 (Dsg3), results in mucosa! lesions, mucocutaneous blisters and erosions. Autoantigen-specific T- cells also play a crucial role in the initiation and perpetuation of Dsg3/ Dsgi-spedfic T-cell responses. In PV the CD4+ autoreactive T-cells recognize specific immunodominant regions from proteins Dsg3 and/ or Dsgl. Patients show autoimmunity only to protein Dsg3 in the early stage of disease, while at the later stage, non-crossrenctive immunity' appears to both proteins Dsg3 and Dsgl. Protein Dsg3 is the primary target antigen in PV.Materials and methods: In our study T-cell epitope regions have been selected and represented by synthetic oligopeptides. Synthetic peptides with distinct in vitro T-cell response on the peripheral blood monomorphonuclear cells (PBMC) isolated from PV patients have been chosen for conjugation. Conjugating the T-cell peptides to carrier molecules can increase their in vitro stimulating activity on PBMC- The selected peptides were conjugated to oligotuftsin [(TKPKG)-tj carrier. These peptides and peptide conjugates were used for in vitro stimulation of the PBMC from PV patients and healthy controls. After 24 and 48 h of incubation the produced IFN-y was determined from the supernatants by ELISA.Results: The synthetic Dsg3 peptides and peptide-oligotuftsin conjugates induced different in vitro IFN-y production rate on PBMC obtained from PV patients and healthy controls determined by ELISA. The in vitro stimulatory activity of oligopeptides and peptide- conjugates will be discussed.Conclusions: Our approach identified promising oligopeptide conjugate candidates as synthetic antigens.

Analysis of peripheral blood CD56+ and CD57+ NK and NKT cells subsets in pregnant women

K. Halacheva,* S. Bazalov/ M. Angelova/ B. Popov* & E, Slavov* *Trakia University Medical faculty, Molecular biology immunology and medical genetics, Stara Zagora, Bulgaria, f Trakia University Medical faculty, Obstetrics and Gynecology, Stara Zagora, Bulgaria

Purpose/Objective: Increased peripheral blood natural killer (NK) cells have been associated with unexplained reproductive failures. Data about the functional role of different NK cells and natural killer T cells (NKT) subsets during pregnancy are contradictory. The aim of this study was to investigate the differences in the relative distribution and the phenotype characteristic of peripheral blood subpopulations of NK and NKT cells in pregnant women with unexplained pregnancy loss compared to healthy pregnant women.Materials and methods: Fifteen women in the first trimester of pregnancy with a history ofpregnancy loss (Group I), 12 healthy women in the first trimester of pregnancy (Group II), and 27 nonpregnant fertile women with a history of successful pregnancies (Controls) were included in this study. Five-color flow cytometry was used to assess the percentage of peripheral blood CD3" CD56+ cells (CD56-NK), CD3‘ CD57+ cells (CD57'NK), CD3' CD56 + (С056Т4КТ, CD3+ CD57+ cells (CD57'NKT).Results: CD56-NK and CD57-NK as a mean percentage of total peripheral lymphocytes were significantly decreased in the healthy pregnant women (8.97 ± 3.09 and 3.42 + 1,75, respectively) compared to controls (12.64 ± 4.4 and 5.73 + 2.63) and to Group I (13.32 ± 4.92 and 6.22 ± 2.81). Pregnant women with a history of pregnancy loss had significantly higher percentage of CD56-NK and CD57-NK (13.32 ± 4.92 and 6.22 ± 2.81) than those of Group II (8.97 ± 3.09 and 3.42 ± 1.75), but no differences were found when compared to controls 02.64 ± 4.4 and 5.73 ± 2.63). CD56-NKT percentage was nearly equal in all study groups (Group I — 5.66 ± 3.08, Group II — 4.64 ± 2.97, Controls — 4.50 ± 2.71). CD-57-NKT was significantly decreased in healthy pregnant women (6.02 ± 4.35) compared to

© 2012 The Authors) © 2012 Blackwell Publishing Ltd, Immunology, 137 (Suppl. 1), 1 8 5 -7 7 2

ID Design 2012/DOOEL SkopjeOpen Access Macedonian Journal of Medical Sciences. 2015 Sep 15; 3(3):420-422. http://dx.doi.Org/10.3889/oamjms.2015.069 elSSN: 1857-9655 Case Report

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

Mariya Angelova Angelova1', Emil Georgiev Kovachev2, Stefan Vasilev Kisyov2, Vilislava Robert Ivanova2

1 Department o f Obstetrics and Gynaecology, Medical Faculty, Trakia University o f Stara Zagora, Stara Zagora, Bulgaria; 2Department o f Obstetrics and Gynaecology, Medical University o f Varna, Varna, Bulgaria

Abstract

Citation: Angelova MA, Kovachev EG, Kisyov SV, Ivanova VR. A Case of Unicornuate Uterus with Atypical Located Hyperstimulated Ovary after in Vitro Fertilization Pre-Embryo Transfer (IVF-ET). OA Maced J Med Sci. 2015 Sep 15; 3(3):420-422.http://dx.doi.org/10.3889/oamjms.2015.069

Key words: uterus unicornis: IVF; atypical located ovary.

Correspondence: Dr. Mariya Angelova Angelova. Department of Obstetrics and Gynaecology, Trakia University of Stara Zagora, Medical Faculty, Stara Zagora, Bulgaria. E-Mail: [email protected]

Received: 14-Mar-2015; Revised: 02-Jun-2015;Accepted: 03-Jun-2015; Online first: 17-Jun-2015

Copyright: © 2015 Mariya Angelova Angelova, Emil Georgiev Kovachev, Stefan Vasilev Kisyov, Vilislava Robert Ivanova. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Competing Interests: The authors have declared that no competing interests exist.

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.

Introduction

Unicornuate uterus or uterine hypoplasia occurs in agenesis or hypoplasia of one Mullerian duct. It is situated laterally and is smaller compared to the normal uterus, and loses its typical pear-like shape and obtains cylindrical shape. A typical feature is that the transverse and anterior-posterior diametre are smaller. Normally, there is one ovary at the side of location of the uterus. Two main varieties can be found, a rudimentary horn with communication or without communication, and also without a rudimentary horn. The latter variant can be found in aplasia of one Mullerian duct and accounts for 7-13 % of the Mullerian anomalies [1-3]. Uterus unicornis involves serious reproductive problems which are often associated with urological anomalies (renal agenesis, pelvic kidney). The presence of uterine horn

without communication can be a major clinical problem, with formation of haematometra and subsequent surgical excision. According to literature, incidence of miscarriage is between 40% and 45%, and premature births are about 20% [2, 4]. In this anomaly incidence of primary sterility is between 5 - 20% .

The aim of this study was to describe a case of congenital Mullerian anomaly, uterus unicornis with missing right fallopian tube.

Clinical case

This is a 36-year-old patient with primary sterility, with HSG indications of uterine anomaly

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a history of successful pregnancies (controls) were included in the study. Five-color flow cytometric analysts was used to assess (he percentage of CD3' CD56+ cells (NK), CD3* CD56+ T cells (NKT), CDS' CD1lb1' cells (CD8/CDllb) and their subsets: CD3‘CD56* CD8* CDllb* NK cells (CD8+NK), CD3‘ CD56T CD8bright CD lib " NK cells (CD8brNK), CD3‘ CD56* CDS' CD1 lb* NK cells (CD8-NK), CD3* CD56* CD8* CD llb* NKT cells (CD8+NKT), CD3* CD56* CD8bright CDllb* NKT cells (CD8brNKT), CD3* CD56* CD8‘ CD llb* NKT cells (CD8-NKT), and CD3* CD56' CD8* C D llb* T cells (CD8+T).Results: We found that the percentage of NK (8.9 ± 3.0) and CD8/ C D llb (9.4 ± 4.7) in Group III was significantly lower compared to controls (12.6 ± 4.4; 13.4 ± 4.8 respectively). The percentage of these populations in Group 1 and Group П did not differ compared to controls. The percentage of NK in Group I (13.3 ± 4.9) was significantly higher, compared to Group Ш. The percentage of NKT in all the groups was nearly equal. A significantly lower percentage of CD8*T was detected in Group III compared to controls (3.2 ± 2.4 versus 5.0 ± 1.8) and to Group II (3.2 ± 2.4 versus 6.6 ± 4.8). The percentage of CD8-NK and CD8-NKT cells was lower in Group III compared to Group I and Group II. The percentage of CD8+NK and CD8+NKT in all the groups was nearly equal. A significantly lower percentage of CD8brNK and CD8brNKT cells was detected in Group III compared to Group II.Conclusions: Our results can suggest that, in addition to NK cells, T cells svith a phenotype CD3* CD56' CD8* CD!lb+ could be involved in the immune response during normal pregnancy. Further studies are needed to clarify the role o f CD8* C D llb+ T cells, CD8+NK and CD8+NKT cell populations in complications of pregnancy.

Assessment of CD8 positive NK cells and T cells subsets In pregnant women

E. Slavov,* S. Buzalov,* M. Angelova,* B. Popov* 8t K. Halacheva**Trakia University Medical faculty, Molecular biology immunology and medical genetics, Stara Zagora, Bulgaria, *Trakia University Medical faculty, Obstetrics and Gynecology, Stara Zagora, Bulgaria

Purpose/Objective: The purpose of the study svas to estimate the phenotype alterations in the peripheral blood NK and T lymphocyte subsets of women with unexplained pregnancy loss compared to healthy pregnant svomen.Materials and methods; Fifteen women in the first trimester of pregnancy with a history of previous pregnanq' loss (Group I), 11 nonpregnant women with a history of previous pregnancy loss (Group II), 12 women in the first trimester of pregnancy with no history of previous pregnancy loss (Group III), and 27 healthy fertile women with

Astrocytic Fast induces apoptosis of autoimmune T cells and is crucial for recovery from EAE

X. Wang,* F. Haroon,* S. Karray,* M. Decker! * 8r D. Schliiter**Institute o f Medical Microbiology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany, *INSERM U753, Institut Gustave Rouss)': Villejuif, France, *Institute o f Neuropathology, University o f Cologne, Cologne, Germany

Purpose/Objective: Experimental autoimmune encephalomyelitis (EAE) is an autoimmune disease characterized by accumulation of T cells in the CNS and its recovery requires the termination of inflammation and apoptosis of infiltrating T cells in the CNS. However, the T cell apoptosis inducing cell population still remains to be identified. To address the role of astrocytic FasL in the regulation of T cell apoptosis in EAE, astrocyte-specific FasL deficient mice were generated and investigated for EAE.Materials and methods: Astrocyte-specific FasL knockout mice were generated by utilizing the Сге/loxP system under control of the human glial fibrillar)' acid protein (GFAP) promoter. EAE was induced by immunizing mice with MOG)5_s5 peptide and assessed daily by clinical score. Demyelination was detected by histology. Infiltrating leukocytes were isolated from spinal cord and characterized by flow cytometry. Expression of cytokines in spinal cord was analyzed by qRT-PCR. In vitro co-cultures of FasL* and FasL" astrocytes, respectively, with T cells were used to study the induction of T cell apoptosis as determined by annexin V and caspase-3 staining.Results: FasL was efficiently and specifically deleted in astrocytes of GFAP-cre FasLn/B (KO) mice, while its expression was not affected in FasLn,n (control) mice. Compared with FasLfl,n littermates, GFAP-cre FasLfl,n mice developed significantly more severe EAE accompanied with widespread demyelination and more T cell infiltration. At day 22 post immunization, mRNA levels of IL-17, IFN-g, TNF and GM-CSF were also significantly elevated in the spinal cord of GFAP-cre FasLn,f

© 2012 The Authors) © 2012 Blackwell Publishing Ltd, Immunology, 137 (Suppl. 1), 18 5 -7 7 2

ID Design 2012/DOOEL SkopjeOpen Access Macedonian Journal of Medical Sciences. 2015 Sep 15; 3(3):426-428. http://dx.doi.Org/10.3889/oamjms.2015.070 elSSN: 1857-9655 Case Report id-design

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

Mariya Angelova Angelova1’, Emil Georgiev Kovachev2'3, Ivan Kozovski3, Yavor Dimitrov Kornovski2, Stefan Vasilev Kisyov2,3, Vilislava Robert Ivanova2

1 Department o f Obstetrics and Gynaecology, Medical Faculty, Trakia University o f Stara Zagora, Stara Zagora, Bulgaria; 2Department o f Obstetrics and Gynaecology, Medical University o f Varna, Varna, Bulgaria; 3Varna OOD Medical Centre for Assisted Reproduction, Varna, Bulgaria

Abstract

Citation: Angelova MA, Kovachev EG, Kozovski I, Kornovski YD, Kisyov SV, Ivanova VR. A Case of Secondary Abdominal Pregnancy after in Vitro Fertilization Pre-Embryo Transfer (IVF-ET). OA Maced J Med Sci. 2015 Sep 15; 3(3):426-428.http://dx.doi.org/10.3889/oamjms.2015.070

Key words: ectopic pregnancy; abdominal pregnancy; assisted reproductive technologies.

Correspondence: Dr. Mariya Angelova Angelova.Department of Obstetrics and Gynaecology, Trakia University of Stara Zagora, Medical Faculty, Stara Zagora, Bulgaria. E-Mail: [email protected]

Received: 14-Mar-2015; Revised: 23-Apr-2015;Accepted: 03-Jun-2015; Online first: 25-Jun-2015

Copyright: © 2015 Mariya Angelova Angelova, Emil Georgiev Kovachev, Ivan Kozovski, Yavor Dimitrov Kornovski, Stefan Vasilev Kisyov, Vilislava Robert Ivanova. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


The authors describe a rare case of secondary abdominal pregnancy after in vitro fertilization preembryo 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 pi. vesicouterina. Histological tests confirmed the EP diagnosis in the second material, i.e. indications of secondary abdominal pregnancy.

Introduction

There are some specific risk factors for ectopic pregnancy (EP) in assisted reproductive technology (ART) such as reduced tubal contractility as a result of high levels of progesterone produced by multiple corpora lutea, hypervascular ovaries after hyperstimulation and follicular puncture, deep fundic embryo transfer (ET), large number of transferred embryos, uterine anomalies [1,2].

It is believed that even at adequately performed ET embryos can migrate into the fallopian tubes due to the retrograde effect of uterine

contractions. Upon performance of ET, the pressure exerted by the medium containing the embryos, may also contribute to the embryo migration in the fallopian tubes and at more than 80 microliters of medium, the risk is increased [3].

Genital chlamydiosis is one of the most common sexually transmissible diseases and a major cause of pelvic inflammatory disease (PID). Due to the extreme tropism of chlamydia to endosalpingauma, it can cause obturation, hydrosalpinx and diverticulitis in the fallopian tubes [4, 5]. Peritubal adhesions due to salpingitis, post abortion and puerperal infections, appendicitis are risk factors for ectopic pregnancy [6, 7].

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Available online at http://www.iournalcra.comINTERNATIONAL JOURNAL

OF CURRENT RESEARCHInternational Journal o f Current Research

Vol. 8, Issue, 06, pp.32614-32615, June, 2016

RESEARCH ARTICLE

CLINICAL SIGNIFICANCE OF ULTRASOUND DIAGNOSED PLACENTAL LAKES

L*Dr. M ariya A ngelova PhD, 2Dr. Ivan T odorov and 3Dr. Emil K ovachev PhD

iChief Assistant at the Department of Obstetrics and Gynecology, Medical Faculty, Trakia University,11 Armeiska Str., 6000 Stara Zagora, Bulgaria

2Chief Assistant at the Department of Obstetrics and Gynecology - Medical Faculty,Trakia University, 11 Armeiska Str., 6000 Stara Zagora, Bulgaria

Associate Professor at the Department of Obstetrics and Gynecology, Paraskev StoyanovMedical University, Varna

ARTICLE INFO ABSTRACT

The study included 1,850 pregnant women between 22 and 36 gestation week. In 21 patients placental lakes were noticed by ultrasound. No statistically significant difference was found between the pregnant patients with ultrasound diagnosed placental lakes and the control group in terms of gestation age at the time of delivery, fetal weight and its condition (Apgar score) and uteroplacental complications within the placental period.

Key words:

Placental lakes (P.L.), pregnant women, IUGR,Doppler scanq, Ultrasound.

Copyright©2016, Dr. Mariya Angelova et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Citation: Dr. M ariya Angelova, Dr. Ivan Todorov, Dr. Emil Kovachev, 2016. “Clinical significance of ultrasound diagnosed placental lakes”, International Journal o f Current Research, 8. (061. 32614-32615.

Article History:Received 27* March, 2016 Received in revised form 27* April, 2016 Accepted 18* May, 2016 Published online 15* June, 2016

ISSN: 0 9 7 5 -8 3 3 X

INTRODUCTION

Placental lakes (P.L.) are placental cysts filled with blood. On sonography they are visualized as echo negative fields o f oval or irregular shape on the surface or inside o f the placenta. When or under pressure on the uterus, Their shape may change with uterine contractions or when the uterus is subjected to pressure. Placental lakes are common and occur in about 20% of all pregnancies. Normally, sonographers attach no significance to them and the funding is not reported as it is not associated with any specific pathology o f pregnancy. Placental lakes generally occur in thicker placentas and are considered as more enlarged intervillous spaces filled with maternal blood.

Aim of the Study

There is an opinion that the presence o f P.L. does not mean that pregnant women with such placenta will have more pregnancy complications than other pregnant women.

Corresponding author: Dr. Mariya Angelova,Chief Assistant at the Department of Obstetrics and Gynecology, Medical Faculty, Trakia University, 11 Armeiska Str., 6000 Stara Zagora, Bulgaria.

In placentas with P.L., however, the level o f AFP is higher than normal. The presence o f P.L. causes anxiety and poses to the doctor certain suspected occurrence o f some complications related to the progress o f the pregnancy, condition of the fetus or the mother. Our task within this context was to determine whether placentas with P.L. involve more often the following pathology:

• Placental abruption• Preterm birth• IUGR• Increased risk o f preeclampsia• Babies o f a low birth weight• Increased incidence o f Caesarean section• Increased maternal blood loss before placental expulsion• APGAR score rating o f newborn babies

MATERIALS AND METHODS

We observed 1,850 pregnant women within a period o f one year.

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

Mariya Angelova1*, Ivan Todorov1, Emil Kovachev2

departm ent o f Obstetrics and Gynecology, Trakia University, Faculty o f Medicine, Stara Zagora, Bulgaria; 2Department o f Obstetrics and Gynecology, Paraskev Stoyanov Medical University, Varna, Bulgaria

Abstract

Citation: Angelova M, Todorov I, Kovachev E. Early Prognostic Factors for the Progress of Preeclampsia - Our Experience in the Period 2010-2011. Open Access Maced J Med Sci. 2016 Sep 15; 4(3):420-422. http://dx.doi.org/10.3889/oamjms.2016.065

Keywords: Preeclampsia: Doppler test; Pregnancy- associated plasma protein A; Body Mass Index.

'Correspondence: Mariya Angelova. Department of Obstetrics and Gynecology, Trakia University, Faculty of Medicine, Stara Zagora, Bulgaria. E-mail: [email protected]

Received: 27-Apr-2016; Revised: 20-May-2016;Accepted: 25-May-2016; Online first: 06-Aug-2016

Copyright: © 2016 Mariya Angelova, Ivan Todorov, Emil Kovachev. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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 prophylacticaliy 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.

Introduction

Preeclampsia (PE) is one of the most serious complications during the second half of pregnancy [1]. The high perinatal maternal mortality and the children's pathology make it a priority in the research of a number of scientists and researchers [2].

Our main goal was on the grounds of separate factors or a group of factors to determine who of the pregnant women display a high risk of developing preeclampsia with a view to the subsequent antenatal cares for them. In addition, we aimed to select markers that are comparatively easy, accessible and cost-effective for us and for our patients.

Our task was to determine the prognostic value of the low 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

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ID Design 2012/DOOEL Skopje, Republic of MacedoniaOpen Access Macedonian Journal of Medical Sciences. 2016 Sep 15; 4(3):449-452.http://dx.doi.org/10.3889/oamjms.2016.078elSSN: 1857-9655Case Report ■

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

Mariya Angelova1", Emil Kovachev2, Nikolai Todorov1

departm ent o f Obstetrics and Gynecology, Trakia University, Faculty o f Medicine, Stara Zagora, Bulgaria; departm ent of Obstetrics and Gynecology, Paraskev Stoyanov Medical University, Varna, Bulgaria

Citation: Angelova M, Kovachev E, Todorov N. Cytomegalovirus Infection during Pregnancy and Its Impact on the Intrauterine Fetal Development - Case Report. Open Access Maced J Med Sci. 2016 Sep 15; 4(3):449-452. http://dx.doi.org/10.3889/oamjms.2016.078

Keywords: Cytomegalovirus infection; pregnancy; a case report.

’ Correspondence: Mariya Angelova. Department of Obstetrics and Gynecology, Trakia University, Faculty of Medicine, Stara Zagora, Bulgaria. E-mail: [email protected]

Received: 27-Apr-2016; Revised: 19-Jul-2016;Accepted: 25-Jul-2016; Online first: 08-Aug-2016

Copyright: © 2016 Mariya Angelova, Emil Kovachev, Nikolai Todorov. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Abstract

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.

Introduction

The cytomegalovirus infection is caused by a DNA virus of the viral family known as herpes viruses. Presently, CMV can be encountered in every fourth woman in childbirth age [1]. Once in the body, the virus remains for a lifetime. Usually, the cytomegalovirus “sleeps” in the body and does not cause any damages [2]. However, when the immunity drops, in cases of frequent colds, stress situations and pregnancy, the virus becomes active [3]. It is important to note that infecting the fetus or the newborn infant can happen only with active virus infection. During pregnancy, the virus attacks the

nervous system of the fetus which is connected with early miscarriages or with the development of a number of defects in the newborn infants, whereas 20-30% of them die [4].

The low pathogenicity of the virus in the adult human body is sharply contrasting with the impact on the fetus which can cause serious damages. The harm for the fetus is even more serious when the mother has recently had a primary infection and has not developed any specific CMV antibodies. The clinical forms of fetal damages are: congenital cytomegalic infection acquired perinatal infection and acquired postnatal infection [5].

The focus of this publication is a case of CMV

Open Access Maced J Med Sci. 2016 Sep 15; 4(3):449-452. 449




ID Design 2012/DOOEL Skopje, Republic of MacedoniaOpen Access Macedonian Journal of Medical Sciences. 2016 Sep 15; 4(3):410-412.http://dx.doi.org/10.3889/oamjms.2016.077elSSN: 1857-9655Clin ica l Science I

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Role and Importance of C h la m y d ia T ra c h o m a t is in Pregnant Patients

Mariya Angelova1", Emil Kovachev2, Veselina Tsankova1, lliana Koleva1, Silvia Mangarova1

1Department o f Obstetrics and Gynecology, Trakia University, Faculty o f Medicine, Stara Zagora, Bulgaria; 2Department of Obstetrics and Gynecology, Paraskev Stoyanov Medical University, Varna, Bulgaria

Citation: Angelova M, Kovachev E, Tsankova V, Koleva I, Mangarova S. Role and Importance of Chlamydia Trachomatis in Pregnant Patients. Open Access Maced J Med Sci. 2016 Sep 15; 4(3):410-412.http://dx.doi.Org/10.3889/oamjm s. 2016.077

Keywords: Chlamydia trachomatis; pregnancy; neonatal infections; respiratory symptoms; polymerase chain reaction.

‘Correspondence: Mariya Angelova. Department of Obstetrics and Gynecology, Trakia University, Faculty of Medicine, Stara Zagora, Bulgaria. E-mail: [email protected]

Received: 27-Apr-2016; Revised: 25-May-2016;Accepted: 05-Jul-2016; Online first: 05-Aug-2016

Copyright: © 2016 Mariya Angelova, Emil Kovachev, Veselina Tsankova, lliana Koleva, Silvia Mangarova. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Abstract

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.

Introduction

According to SZO genital chlamydiosis, today is considered the most common sexually transmissible infection. Various studies have been used for diagnosis of chlamydial infection in pregnant women; the frequency varies in different countries. Chlamydia Trachomatis during pregnancy can lead to miscarriage, premature birth, and premature rupture of membranes, intrauterine growth retardation, and puerperal endometritis [1-5].

Infection with C hlam yd ia trachom atis with the mother is associated with increased morbidity in newborns and infants up to three months. Approximately two-thirds of infants born vaginally to infected mothers will be infected at birth. These infections may lead to conjunctivitis, otitis media, pharyngitis and pneumonia in neonates. Moreover, neonatal infection with C hlam yd ia trachom atis may cause long-term consequences such as chronic obstructive pulmonary disease.

The scarcity of data on manifestations of chlamydial infection during pregnancy and neonatal

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Available online at http://www.journalcra.comINTERNATIONAL JOURNAL

OF CURRENT RESEARCHInternational Journal o f Current Research

Vol. 8, Issue, 09, pp.38949-3895i, September, 2016

REVIEW ARTICLE

A LOCAL CASE OF PENTALOGY OF CANTRELL IN 2 0 1 3 (CLINICAL CASE STUDY)

*Mariya A ngelova

Department of Obstetrics and Gynecology, Faculty of Medicine, Trakia University, Stara Zagor, Bulgaria

ARTICLE INFO ABSTRACT

Article History:Received I811' June, 2016 Received in revised form 22nd July, 2016 Accepted 18U’ August, 2016 Published online 30“’ September, 2016

Key words:

Pentalogy of Cantrell, Diaphragmatic defect, Echographic, Ectopical heart, Screening, Karyotype.

Qualified as a very rare disease, the Pentalogy of Cantrell comprises a number of defects, such as: anterior abdominal wall defect, lower sternum defect, diaphragmatic and pericardial defects, and congenital heart malformations. The typical form of the pentalogy includes all these five defects. The cases of the complete pentalogy described in the existing literature are only a few. The first description of the pentalogy was made by Cantrell et al. in 1958, who gave an account of 5 cases presented with this abnormality. Cases with only two, three or four of the defects are more frequent. The case we present here involves the 16-year-old A.M.A., pregnant in the 18th gestation week. The fetus is male with bilateral cleavage of lip and palate; low-set ears, congenitally deformed feet (pes equinovanis), absent little toe of the right foot, complete absence of sternum and whole abdominal wall defect. The heart, liver and intestinal loops, as well as the kidneys and urinary bladder are ectopically located outside their corresponding cavities. A lack of pericardium is noted, together with ventricular septal defect, and atrial septal defect. My colleagues and I believe this case is typical for Pentalogy of Cantrell.

Copyright©2016, Mariya Angelova. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Citation: Mariya Angelova, 2016. “A local case o f pentalogy of cantrell in 2013 (clinical case study)”, International Journal o f Current Research, 8, (09), 38949-38951.

INTRODUCTION

A.M.A., age 16, pregnant in 18th gestation week, o f Roma ethnic origin. Admitted to the university clinic with a suspected abortion, and frequent painful contractions. The patient hasn’t visited women’s consultation centre regularly. No screening has been performed in the first trimester. In the hospital, during the echographic study, I found the heart was outside the chest cavity and the liver, the kidneys and intestines were outside the abdominal cavity (Pictures 1, 2, 3). Furthermore, the echograph study showed bilateral cleavage o f the palate and lip and congenitally deformed feet. An increased quantity of amniotic fluid; heart - turned upwards and to the left. The fetus was male. At the sight o f the ectopical heart I suspected the Pentalogy of Cantrell. The presence of the remaining structural defects gave enough evidence for genetic study. There were no chromosome abnormalities. The study showed a normal male cryotype. (Skin biopsy after discarding the fetus.) Because of the found abnormalities, which revealed an impossible life after birth, as well as due to the minor age o f the pregnant, we contacted her relatives. It was decided that the pregnancy should be terminated. After birth, the fetus did not show any vital signs, apart from occasional heartbeat. During the post mortem we found out cleavage o f the lip and palate, low-set

* Corresponding author: Mariya Angelova,Department of Obstetrics and Gynecology, Faculty of Medicine, Trakia University, Stara Zagor, Bulgaria

ears, congenitally deformed feet (pes equinovarus), absent little toe of the right foot, complete absence of sternum and whole abdominal wall defect. Absence o f pericardium, ventricular septal defect, and atrial septal defect were found as well. (Pictures 4,5,6,7) Prenatal diagnosis o f Pentalogy of Cantrell could have been made even during the first trimester of pregnancy. Differential diagnosis then could have been made with omphalocoele, which is observed physiologically up to the 10-12 gestation week. However, if in the sac, apart from the intestinal loops, other organs can be seen, especially if this is ectopically situated heart, we will suspect Pentalogy of Cantrell. The prognosis for the Pentalogy of Cantrell depends on the severity of the internal and additional heart defects, pulmonary hypoplasia, the degree o f abdominal wall defect, brain abnormalities and diaphragmatic hernia. The average survival period without operation is about 36 hours. Studies have shown that even with special care in professional centres and multiple correction operations, mortality still remains high.

DISCUSSION

The case presented here has all defects typical for Pentalogy of Cantrell, including bilateral deep cleavage of lip/palate and congenitally deformed feet (equinovarus). Pentalogy of Cantrell is characterized by a combination of congenital defects.

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