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A Nikolov

Publications and source records attributed to A Nikolov.

At least 37 records · Page 2Linked to original sources
PubMed2005

[Treatment of life-threatening bleeding in obstetrics and gynaecology --NovoSeven (recombinant factor VIIa)].

The study offers the results from the application of recombinant factor VIIa (NovoSeven) in 19 patients with obstetric or gynaecological problems showing severe haemorrhage of non-surgical origin, which could not be controlled by standard therapy (surgery and resuscitation). Haematological and haemostaseological values as well as final outcome are being monitored. The role of the drug and its special indications in complex urgent treatment of life-threatening bleeding are being discussed. Conclusions. The use of NovoSeven (recombinant factor Vlla) on time and when indicated guarantees rapid and effective haemostasis. Thus laparotomy or relaparotomy can be avoided. If no effect is observed after the application of NovoSeven indicates bleeding from a major blood vessel, demanding laparotomy and surgery. The use of the drug leads to reducing the incidence of blood derivatives transfusions and (being a recombinant product)--no risk of transmissive infections.

Factor VIIa↗
PubMed2005

[Contraception in women with diabetes mellitus].

Contraception in women suffering of diabetes mellitus is an important question mainly due to it has been proven that pregnancy outcome both for the fetus and for the mother depends on glycemic control before conception right to delivery. That's made planning of future pregnancy mandatory for patients with diabetes mellitus. Patients are advised for contraception until optimization of metabolic control has been achieved or until complete and contemporary treatment of the diabetes complications has been fulfilled. Incorrect contraceptive method could extend metabolic disorders and to reinforce vascular complications of the diabetes. Choice of contraception depends on the aim: short lasting contraception aiming on future pregnancy planning or long lasting contraception aiming on family planning. In women with diabetes mellitus it is extremely important to take into consideration such factors as type of the diabetes, its lasting, degree of metabolic compensation, presence of diabetic complications, body-mass index of the patient, presence of risk factors for cardiovascular diseases and future pregnancy planning. In cases when pregnancy is planning it has been preferred local contraception, such as condoms, diaphragms. In cases of nullipara or in women with plenty of partners, condoms are method of choice. In women who gave birth intrauterine device is such a method. In women with diabetes mellitus type I (insulin dependent diabetes mellitus) it is possible to use hormonal contraception depending on patient's request or on medical indications only in cases when diabetes has less than 15 years duration and microangiopathic complications and other vascular risk factors lack. Combined hormonal contraceptive preparations have to contain less than 30 microg ethinylestradiol and gestagen of "third" or "fourth" generation. This contraception has to be prescribed together with insulin dosage correction and demands on strict metabolic control of the diabetes and body weight. When the combined preparations are contraindicated it could be suggested progestagenic oral hormonal contraception if gynecologic contraindications lack and if this not leads to menstrual disturbances. In women with diabetes mellitus type II (non insulin dependent diabetes mellitus) combined hormonal contraceptives has not to be used, because they could provoke clinical manifestation and deteriorate progress of the diabetes mellitus.

Contraception↗
PubMed2005

[Cesarean section for fetal distress--is the decision interval for delivery significant?].

UNLABELLED: The recommended Interval between the decision to perform emergency cesarean section and the delivery itself is 30 minutes. There is not enough clinical evidence in maintenance of this opinion. AIM: to study the interval from the decision of the cesarean section for fetal distress to delivery itself, as well as to analyze fetal and mother's outcome. METHODS: Prospective 13-month-study for the period 2003-2004 in Delivery room "Majchin Dom" included observation of 125 women. Cesarean section is classified in 3 Categories--1st--deemed highly hazardous for mother or/and fetus (crush); 2nd--not directly hazardous for mother or/and fetus (emergency); and 3dt--not direct mother or/and fetal distress, but the delivery is necessary in a short period of time (urgency). The Interval and the Categories are comparable with the presence or absence of fetal distress (Apgar < 7, pH < 7.20). RESULTS AND DISCUSSION: Positive results are found in the 1st category when the C-section is performed in 30 minutes. There are significant differences between the three Categories--the percentage of fetal distress is growing up comparable to prolongation of the time interval. Prolongation of the time interval for more than 60 minutes lead to poor fetal outcome.

Apgar Score↗
PubMed2005

[Optimization of prenatal screening for group B streptococcus].

The prophylaxis of endogen B streptococcal infections (GBS are part of the normal flora of the gastrointestinal and genital tract) in the presence of predisposed conditions for development of experience for every delivery (tissues' damage, time of delivery, loss of blood, obstetrics manipulations) has been a complicated objective. In the University Hospital of Obstet. Gynecol. "Maichin dom" have been delivered annually on the average 0,6-0,9/1000 born alive with GBS sepsis. The medium Granada shortens the duration for detection of GBS by 24 hours. On entrance of a pregnant woman the direct inoculations of cervico-vaginal secretions and the fast positive reactions of GBS can assist the therapeutical behavior of the mother as well as the newborn.

Female↗
PubMed2004

[Emergency contraception with levonorgestrel for teenagers--efficacy, tolerability, and level of information awareness].

OBJECTIVE: Assessment of efficacy and side effects of emergency contraception for teenagers with levonorgestrel (LNG) and the level of users' informedness about possibilities and practical application. METHODS: The subjects are healthy girls (n = 49) with regular menstrual cycles at the age between 15 and 19, having had one unprotected or faultily protected sexual intercourse. All of them have administered 0.75 mg LNG within the 72nd hour, repeated after 12 hours. The data have been processed by variational analysis. RESULTS: One pregnancy was registered of a girl with firstintake at the 67th hour - pregnancy rate - 2,0%. The most frequent side effect was nausea - 26,5%, folowed by breast tenderness - 22,4% and fatigue - 20,4%. An up to 7th day delay in menstrual cycle is non significantly more frequent - 14,3%, followed by a delay of more than 7 days breakthrough bleeding - 8,2%. No significant changes were established in the lenght of the menstrual cycle. Emergency contraception is sought for after unprotected sexual intercourse in 69,4%, and condom failure problems in 30,6%. Only 18,4% have sufficient information about the possibilities and practical use of emergency contraception. CONCLUSION: LNG provides effective, highly tolerable contraception with a small number of side effects. Need is felt for serious popularization of the application of emergency contraception with teenagers.

Adolescent↗
PubMed2004

[Immunostimulation as a part of urologic infection therapy in pregnancy].

Twenty-six pregnant women (group I) with uroinfection were treated with Urostim and antibiotic. The effect of treatment was compared to that of 20 pregnant women (group II) treated with antibiotic only. In group I recurrence of infections was found out in 15.3%, while in group II in 55%. We would like to offer it as part of the treatment of uroinfections with pregnant women, because it will reduce the usage of antibiotics and the recurrence of the uroinfections in postpartum period.

Anti-Bacterial Agents↗
PubMed2004

[Study of women preference regarding mode of delivery].

The aim of this inquiry study is to assess the women's preference for abdominal or vaginal delivery in 113 women, divided in tree subgroups: 38 nonpregnant, 38 pregnant with one more births and 37 puerperas. All women are with high education and 49.6% of them had past at least one university exam of obstetrics and gynecology. 42.1% of nonporous women and 40.9% from parous would like to deliver CS. With the time from vaginal delivery the preference for vaginal deliver again decreases from 84.2% to 60.9% of cases. All women delivered by CS prefer CS again. Complications of vaginal delivery are factor for increasing CS rate. The pain relief of vaginal delivery does not increase the preference for vaginal deliver again. In 40% of women there is steady desire for vaginal delivery despite previous complications or full medical information for the concrete conditions. 88.5% of inquired women agree with "CS on request".

Adult↗
PubMed2004

[Shoulder dystocia--risk factors and fetal outcome].

The purpose of this retrospective study is to evaluate the perinatal outcome in cases with birth injuries, suggesting shoulder dystocia. This survey involves 92 cases of live newborns (gestational age between 37 and 42 weeks) with shoulder injuries. Another control group of 120 cases of live mature newborns without any shoulder injuries is studied for comparison. There are no significant differentialities between those two groups, regarding age, parity, weight and height of the parturients. Shoulder dystocia is most frequently found in newborns of 3500-4000 g birthweight. Antepartum, risk factors for shoulder dystocia are: diabetes, obesity of the mother and chronological postterm pregnancy. Intrapartum, the evaluated risk factors prove to be unreliable because the same were found in as many as one half of the non-traumatic vaginal deliveries. In 27% of the cases, shoulder dystocia occurs most probably after the passage of the shoulder through the pelvic inlet. The most frequent type of shoulder injury is fracture of the clavicle (90.2%), followed by paresis of the brachial plexus (7.6%). Severe shoulder dystocia both from obstetrical and neonatological point of view is found in 2-3% of the cases.

Adult↗
PubMed2004

[Causes of urinary tract infection in pregnant women].

Data of etiology characteristics of uroinfections with pregnant women are presented treated at University Hospital of Obstetrics and Gynecology "Maichin dom" in three periods. Gram negative species of microorganisms (E. coli, proteus, Klebsiella) are the agens of uroinfections in 95.4% of cases in the period 1988/89. After 10-year period gram (-) are the uroinfection in 66.1% of the cases. The growing etiologycal importance of Gram positive species of microorganisms (S. aureus, Enterococcus, GBS) is 33,9% in the period 1997/98 and it is preserved in june 2001/may 2003 too. In cases of long lasting hospitalization or after repeated treatment with antibiotics the probability grows that the agents of uroinfections be polyresistant strains. In the period june 2001/may 2003 in 7% of the cases polyresistant E. coli are isolated, in 2.6% MRSaureus, in 7.6% Ampicillin - R Enterococcus spp. That suggest exact identification of the agen and therapy according to sensitivity to antibiotics.

Anti-Bacterial Agents↗
PubMed2004

[Intrapartum oxygen saturation in fetus with symptoms of distress shown during fetal cardiotocograph monitoring].

The aim of the study is to establish the mean values of SpO2, during labour with symptoms of fetal distress and to find out when fetal hypoxia is expected to develop as well as unsatisfactory clinical status of the newborn. The study includes 62 women on labour at term with pathological decelerations from the fetal heart rate (FHR). SpO2 is monitored by means of fetal pulse oxymeter Nellcor N 400. Simultaneously FHR is monitored by means of cardiotocography. Fetal well-being is verified by pH u blood gas analysis from fetal scalp while the newborn well-being is proven by pH from umbilical artery and Apgar score at minute 1 and 5 after birth. The mean continuity of SpO2 recording during the first period of labour is 107.84 +/- 25.77 min., with mean 86.74 +/- 7.06% reliability of the recordings; for the second period--26 +/- 8.98 min. with reliability of the recordings 77.07 +/- 9.96%. During the first period of labour the mean value of SpO2 is 43.00 +/- 6.75%. With dilation of 4-5cm SpO2 is 46.25 +/- 5.92%, with 6-7CM SpO2 is 44.43 +/- 6.39% and with 8-9cm dilation SpO2 is 42.69 +/- 6.80%. During second period of labour the mean value of SpO2 is 39.14 +/- 8.41%. There is a statistically significant fall of SpO2 during the second period compared to the first period of labour (p<0.05). A correlation exists between the values of SpO2 and the well-being of the newborn and a fall of SpO2 equal or less than 30% is a sign of developing abnormal condition of the newborn.

Adult↗
PubMed2004

[Diagnostic value of the Doppler ultrasound of kidney vessels in pregnancy complicated with preeclampsia].

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

Adult↗
PubMed2004

[The significance of parameters of the acid-base status, blood gas and blood lactate level for the adequate resuscitation and prognosis in newborns with very low birth weight].

UNLABELLED: The aim of this prospective study was to optimize the resuscitation guidelines for VLBW and ELBW premature newborns, to improve their life prognosis and to minimize the permanent complications of the perinatal asphyxia. RESULTS: The newborns were divided in 2 groups: main group--28 ELBW and 55 VLBW infants born from 01.10.01 to 30.06.02; and control group--52 ELBW and 78 VLBW infants, born in year 2000 in "Maichin dom". More intensive resuscitation was given to the VLBW newborns in the mean group--58% of them were intubated and ventilated in Delivery room (DR) infants compared with 40% from the controls. In the ELBW groups the rate of the assisted ventilation (AV) remains high (85% and 82%) but more often we insufflated Surfactant for prophylaxis of the RDS (71% compared with 52% in the controls). This, as well as the precisely monitoring of the early postnatal adaptation--pulsoxymetry, parameters of acid-base status (ABS) and homeostasis, resulted in significantly reduction of the mortality rate in ELBW infants from 46% to 18%. We found a reduction of the severe neurological injuries and high degree retinopathy of prematurity too. We evaluated the lactate values and the ABS parameters in blood from umbilical artery (u.a.) and from arterial blood 1 hour after birth. We found out that the low lactate levels in u.a. didn't correlate with the degree of the metabolic acidosis (pH and BE). Correlation between high lactate levels in u.a, low pH and BE were found predominantly in newborns with significant intrauterine retardation and chronic placental insufficiency. Levels > 5.0 mmol/l 1h after birth and the persistence of the metabolic acidosis despite an adequate resuscitation determinated in principle bad outcome and severe complications. CONCLUSIONS: The adequate DR resuscitation under strict monitoring of the cardio-pulmonary adaptation and the prophylactic Surfactant application improve the survival rate and the prognosis of the ELBW newborns. The persistence of high lactate levels in combination with a metabolic acidosis and intrauterine retardation are bad prognostic criteria for outcome.

Acid-Base Equilibrium↗
PubMed2004

[Endometriosis during postmenopausal period--probable causes for its origin and development].

A very rare--casuistic--case of endometriosis is presented, which appeared ten years after surgical menopause (hysterectomy and ovariectomy) without concomitant use of hormone replacement therapy or phytoestrogens. The possibilities of endogenous production and exogenous supply of estrogens in the female organism are discussed as well as the possible causes of proliferation of endometrial lesions during postmenopausal period. When menopause is induced by surgery (a stress for the organism) without exogenous supply of estrogens (HRT, phytoestrogens, xenoestrogens) the production of suprarenal hormones, including androgens, increases. The peripheral conversion of androgens into estrogens in fat tissue is increased and implanted during hysterectomy endometrial lesions in vagina walls are stimulated.

Aged↗
PubMed2003

[Maternal insulin-dependent diabetes and congenital malformations in the newborn].

Congenital malformations (CM) are one of the leading causes of perinatal morbidity and mortality in infants of insulin dependent diabetic mothers (IDM). The aim of the present study is to determinate the incidence and structure of CM in this high risk population. The study included 14,325 newborns born between 1997-2000. 157 of them were IDM. The incidence of CM in IDM is 4-8 times higher than in general newborn population. The most frequent CM are congenital heart disease and polimalformation syndrome. The duration of mothers insulin dependent diabetes and poor glycemic control before and during pregnancy increases the risk of CM.

Abnormalities, Multiple↗
PubMed2003

[Study of the effect of Propess for ripening of the unfavorable cervix for the induction of labor due to medical indications].

The purpose of this study is to proceed and estimate the effect of Propess for cervical ripening for induction of labor due to medical indications. Seventy pregnant women are included divided in two groups-36 of them with vaginally applicated Propess and the other 34 are at the control group. Changes in the cervix, induction of uterine activity, labor, status of the fetus and the side effects are proceeded. In the group with vaginally applicated Propess 9 of the patients gave birth till the twelfth hour from the application of the pessar. The Bishop score increased over 6 points in 7 of them and increased by 3 points in 11 of the cases within 12 hours. In the control group no delivery is registered till the twelfth hour, in two of the cases there is an increase of the Bishop score over 6 points and only in 5 of the cases is estimated an increase of the Bishop score with 3 points. There is one case of uterine hyperstimulation. There was no other side effects.

Administration, Intravaginal↗
PubMed2003

[Submucosal isthmicocervical myoma--problems of diagnosis, labor and puerperium].

A case of submucosal isthmicocervical myoma, 85 mm in diameter, diagnosed for first time during CS. The neonate is with atrophy of left m. sternocleidomastoideus and facial asymmetry due to impression in the left temporoparietal region, without neurological impairment. Multiple ultrasound examinations were done but the fibroids vas not diagnosed. During one examination we presume that the fibroid was mistaken for the head because the BPD was in great discrepancy with other ultrasound parameters of the fetus. During the operation OICC was not found that is why the dilatation was made through the vagina. A myomectomy was not made during the operation. Because of the pressure and the deformation of the cervical canal from the myoma a drain was inserted through the canal to facilitate the evacuation of the lochia. The post operative period passed without any complications, the drainage was taken off on the 7th post operative day and the patient was discharged on the 8th day.

Adult↗