Akusherstvo i ginekologii͡a
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Akush Ginekol (Sofiia) · Jan 2015
[Identification the risk of preterm labor :the role of fetal fibronectin].
Fibronectins represent a group of glycoproteins, which form "molecular glue" and are necessary in the interaction between a cell and a cell. The existence of fetal fibronectin in pregnant woman's vagina up to 22 g.w. is normal. In a normally proceeding pregnancy between 22 g.w. and 35 g.w. there is not supposed to be found fetal fibronectin in cervico-vaginal secretion. Its presence is a highly informative biological marker for the risk of premature birth. ⋯ From the total of 116 patients, in 78 we have received positive tests for fetal fibronectin; in 38 - negative test. With asymptomatic patients, having higher risk of preterm birth, the percent of positive tests has been lower (14%). With asymptomatic patients with higher percent of risk factors have been: short cervix (38%), multiple pregnancy (29%), followed by patients with diagnosis of preterm birth in the past (25%) and bleeding in earlier terms. Estimating positive and negative predictive rate, we have achieved following results: The test for fetal fibronectin has excellent predictive rate - 97%, which coincides with the great deal of research until this moment in the world. Referring to the positive predictive rate--it is not sufficient--only 19%.
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Akush Ginekol (Sofiia) · Jan 2015
Case Reports[Prenatal diagnosis and fetoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia. Case report].
We present a case of severe isolated congenital diaphragmatic hernia (CDH) diagnosed at 19 weeks of gestation and treated at 28 weeks with Fetal Endoscopic Tracheal Occlusion (FETO). The CDH was left-sided with part of the liver in the thorax and lung area to head circumference ratio (LHR) of 0.9. ⋯ The pregnancy is progressing uneventfully and ultrasound examination 10 days after the FETO demonstrated an increased LHR to 1.1. Treatment with FETO for severe CDH has been performed for the first time in Bulgaria and this procedure addressed several questions for optimal management by an experienced interdisciplinary team.
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Akush Ginekol (Sofiia) · Jan 2015
[LAPAROSCOPIC MYOMECTOMY WITH UTERINE ARTERY CLIPPING VERSUS CONVENTIONAL LAPAROSCOPIC MYOMECTOMY].
To evaluate the differences in the intraoperative blood loss during laparoscopic myomectomy with or without uterine artery clipping (UAC). ⋯ Concurrent UAC during laparoscopic myomectomy reduces the intraoperative blood loss and the frequency of excessive bleeding. This study demonstrated the superiority of laparoscopic uterine artery ligation combined with myomectomy in treatment of symptomatic myomas.
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Akush Ginekol (Sofiia) · Jan 2015
Case Reports[SECOND STAGE IN MINIINVASIVE FETAL SURGERY FOR SEVERE CONGENITAL DIAPHRAGMATIC HERNIA. CASE REPORT].
We present a case of miniinvasive fetal surgery for CDH treated at 28 and 34 weeks of gestation. The first step was successfully performed at 28 weeks with Fetal Endoscopic Tracheal Occlusion with ballon. The second step was performed at 34 weeks for balloon removal. ⋯ A planned SC and optimal neonatology management were followed by a surgical operation of the newborn. Experienced interdisciplinary team successfully provide a perinatal and postnatal surgery for severe CDH. The newborn was discharged from the hospital 3 weeks after the repairing operation in a good condition.