DOI: 10.3897/jbcr.e184929

Authors: Ahamed Akkeel Anzaar, Antonia Andreeva, Kamelia Dimitrova

Abstract: Objective: To summarize contemporary clinical algorithms for the management of high-risk pregnancy and to integrate international recommendations with regional clinical experience.Methods: Narrative review of international guidelines (ACOG, FIGO, NICE, WHO) and peer-reviewed literature, including data from Bulgarian obstetric practice.Results: Algorithm-based management improves early risk stratification, standardizes care, and supports individualized decision-making in hypertensive disorders, gestational diabetes, fetal growth abnormalities, and combined maternal–fetal risk.Conclusion: Clinical algorithms represent a cornerstone of modern high-risk pregnancy management. Integration of regional data enhances applicability without compromising international relevance.

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DOI: 10.3897/jbcr.e183593

Authors: Zlatko Kirovakov, Elitsa H. Gyokova, Nadezdha Hinkova, Nikolay Kostadinov, Antonia Andreeva

Abstract: The review critically synthesizes existing evidence on optimizing gestational diabetes mellitus (GDM) diagnostic procedures, focusing on best practices for early detection of at-risk mothers to address related obstetric complications. The review adopts the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic literature reviews and dissemination of study findings. The methodological framework follows three stages: planning, conducting the review, and reporting outcomes. The International Association of Diabetes and Pregnancy Study Group (IADPSG) screening criteria were more inclusive than those of other protocols, but no significant differences in maternal outcomes were reported between the protocols. One-step (75-g OGTT) performed relatively accurately compared with two-step screening (50-g GCT plus 75-g OGTT), even though no significant differences were reported, and the two-step screening was the more preferred diagnostic approach among participants. We found no statistically significant difference between early and routine Oral Glucose Tolerance Tests (OGTTs) in pregnancy outcomes. The review findings highlight the significant role of optimized diagnostic approaches in early detection of GDM to minimize the effects on pregnancy and related obstetric outcomes, as well as to reduce the incidence of diabetes mellitus later in life.

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DOI: 10.3897/jbcr.e169349

Authors: Kalina Razlozhka, Vasilen Gitsov, Tatyana Bodurska-Petkova, Nadya Stancheva, Konstantin Gospodinov, Georgi Dotsinski, Snezhanka Tisheva-Gospodinova

Abstract: We present a case of a 25-year-old primiparous woman with eclampsia imminens and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, requiring a cesarean section. Through efficient collaboration between obstetricians, neonatologists, cardiologists, resuscitators and neurologists, a successful therapeutic outcome was achieved for both the mother and the newborn.

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DOI: 10.3897/jbcr.e166617

Authors: Zlatko Kirovakov, Nadezdha Hinkova

Abstract: Objective: To perform a comprehensive and updated review of prevention and treatment of HPV infections during pregnancy, focus on existing research in Bulgaria and the United Kingdom, as well as any existing literature on the topic of research within the regional scope.Methodology: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic literature review. It adopted the methodological framework proposed by the Joanna Briggs Institute (2015) and by Arksey and O’Malley’s (2005) approach of summary and dissemination of research findings. The research methodology consisted of three primary steps: planning, conducting, and reporting the review findings.Findings: The prevalence of HPV infection is higher in pregnant women as compared to non-pregnant women, and increases with the progression of the pregnancy. HPV infection of the intrauterine environment translates to adverse pregnancy outcomes, including preterm birth, intrauterine growth restriction, preeclampsia, and preterm premature rupture of membranes. Behavioural and therapeutic programs, as well as vaccination efforts, enhance effective prevention and treatment measures for HPV.Conclusion: There is a direct correlation between HPV infection and adverse pregnancy outcomes. HPV vaccination is an effective prevention and treatment measure for adverse pregnancy outcomes. Surgical or laser excision or application of trichloroacetic acid treatments are effective treatment options.

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DOI: 10.3897/jbcr.e166383

Authors: Zlatko Kirovakov, Elitsa Petkova

Abstract: Background: Vitamin D is essential for maternal health, fetal development, and pregnancy outcomes. Despite its importance, vitamin D deficiency is highly prevalent among pregnant women, increasing the risk of gestational diabetes mellitus (GDM), preeclampsia, preterm birth, and fetal growth restriction.Objective: This article explores the impact of maternal vitamin D deficiency on pregnancy outcomes and evaluates current strategies for its management and prevention, and supplementation.Methods: We onducted a comprehensive literature review of clinical trials, meta-analyses, and systematic reviews, focusing on the association between vitamin D levels and pregnancy complications and the effectiveness of supplementation and public health interventions.]Results: Studies suggest that vitamin D deficiency is linked to poor pregnancy outcomes, including hypertension, GDM, low birth weight, and neonatal health complications. Vitamin D supplementation (600–4,000 lU/day) has shown potential benefits in reducing these risks, but the optimal dosage and screening strategies remain debated. Food fortification and sunlight exposure may be complementary approaches to improve maternal vitamin D status.Conclusion: Managing vitamin D deficiency during pregnancy requires a multifaceted approach, including early screening, appropriate supplementation, dietary interventions, and public health policies. However, further large-scale clinical trials are needed to establish standardised guidelines for universal supplementation. Addressing vitamin D deficiency can significantly enhance maternal and neonatal health outcomes, making it a crucial public health priority.

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DOI: 10.3897/jbcr.e144426

Authors: Elitsa H. Gyokova, Ahamed Akkeel Anzaar

Abstract: Introduction: Abortion is the termination of pregnancy, whether spontaneous or intentional. Attitude regarding abortion varies widely according to culture or religion and even political siding. Restricted access to abortion leaves women in need vulnerable to seeking unsafe termination methods. Objectives: To gauge medical students‘ attitude regarding abortion and their willingness to carry out terminations as qualified doctors, and to establish factors that impacted their attitude towards it. A secondary aim was to assess students‘ knowledge of Bulgarian abortion laws. Methods: A cross-sectional study was conducted in the form of a self-administered questionnaire, which was then distributed and collected online. It consisted of five distinct sections: (A) sociodemographic data; (B) personal experience of abortion; (C) attitude; (D) knowledge of Bulgarian laws regarding abortion; and (E) willingness to perform abortions as qualified doctors. Results: Being Christian or Agnostic/Atheist, being in clinical years, and believing that life begins at birth showed a higher positive attitude toward abortion. On the converse, being in preclinical years, being religious, and believing that life begins at the time of conception lends itself to having a poorer attitude towards abortion. Individuals with negative attitudes denied performing abortions if the need arose during their professional careers. Conclusion: By appreciating the differences and understanding the relationships with attitudes towards abortion, we can create strategies to minimize the stigmatization of women and reduce the harm they may encounter with unsafe abortions.

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DOI: 10.3897/jbcr.e145118

Authors: Nadezhda Hinkova, Kamelia Tsvetanova, Tihomir Totev, Margarita Nikolova, Teodora Semova, Dimitar Dimitrov, Elitsa Petkova

Abstract: Endometrial carcinoma remains one of the leading places in terms of frequency among oncogynecological diseases, both in countries with developed primary and secondary prevention and in countries with poorly functioning prevention. The implementation of screening programs would lead to the detection of oncological diseases in outpatient settings at an early stage, which would lead to positive socio-economical effects for society. This study aims to determine the test’s validity through the following criteria: sensitivity, specificity, and negative and positive predictive value of endometrial cytology compared with the histological result of examined tissue samples. We studied 300 women with abnormal uterine bleeding examined at the Clinic of Obstetrics and Gynecology at Saint Marina University Hospital– Pleven. Specimens for endometrial cytology were taken from all patients before invasive intervention. We compared the cytological results to evaluate the test validity, including sensitivity, specificity, and negative and positive predictive value in the cases with endometrial carcinoma. Statistical data processing was performed using the software programs MS Office Excel 2019 and IBM SPSS Statistics 28.0. The significance of results, findings and conclusions was determined at p < 0.05. A comparative analysis was performed on the cytological and histological results we obtained before and after the invasive manipulation. The study found statistical significance between the Pipelle biopsy results and cytological results (χ2 = 50.05, df = 24, p = 0.01, Cramer’s v = 0.439). Data analysis showed that endometrial cytology had a high specificity in proving endometrial carcinoma and a low positive predictive value (Se = 80%; Sp = 98%; PV = 66.7%; NV = 96.9%). Endometrial cytology could be an effective diagnostic method and can be applied to diagnose endometrial pathology. The combination of the two methods - cytological examination and transvaginal ultrasound would undoubtedly improve the detection rate of endometrial carcinoma. Additionally, cytology is an appropriate outpatient procedure that can be recommended for endometrial screening, especially in patients at high risk of developing endometrial cancer.

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DOI: 10.3897/jbcr.e144006

Authors: Georgi Danielov Prandzhev, Grigor Angelov Gortchev, Dobromir Dimitrov Dimitrov, Radoslav Iliev Miltchev, Dimitar Rangelov, Slavcho Tomov Tomov

Abstract: Cervical cancer remains a leading cause of morbidity and mortality among women worldwide, particularly in regions with limited access to advanced medical care. Accurate and timely diagnosis of precancerous changes in the cervix is critical for effective prevention and treatment. This study introduces a deep learning algorithm for colposcopic analysis of the transformation zone of the uterine cervix. Intel & MobileODT Cervical Cancer Screening competition provided a comprehensive dataset designed to advance the application of artificial intelligence (AI) in classifying transformation zones (TZ) of the cervix, a key site where precancerous changes develop due to Human Papillomavirus (HPV) infection. This study highlights the significance of TZ classification for targeted biopsy during colposcopy, a gold-standard diagnostic method. However, challenges such as clinician’s subjectivity and interobserver variability, false negatives and positives interpretations limited accessibility, and resource intensity have spurred the integration of AI into colposcopic evaluations. The dataset comprises diverse cervical images, categorized into three types of TZs, enabling the development of AI models to distinguish between these categories. By leveraging deep learning algorithms, AI has demonstrated potential in enhancing the sensitivity and specificity of colposcopic findings while mitigating subjectivity and observer dependency. This abstract outlines the anatomical basis of cervical pathology, the critical role of colposcopy in diagnosing transformation zone abnormalities, and the transformative potential of AI in improving cervical cancer screening processes. The integration of AI-assisted tools could significantly improve diagnostic accuracy, reduce invasive procedures, and enhance access to cervical cancer prevention measures, particularly in underserved regions.

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DOI: 10.3897/jbcr.e138140

Authors: Dimitar Dimitrov, Nadezhda Hinkova, Teodora Semova, Zornitsa Gorcheva, Mirela Vasileva, Elitsa Petkova

Abstract: The main methods of histological diagnosis of endometrial carcinoma are dilatation and curettage, fractional curettage, and diagnostic hysteroscopy with endometrial biopsy. This retrospective study aims to compare the preoperative histological results obtained by different diagnostic methods with the postoperative ones in patients with endometrial carcinoma and determine the most accurate and safest method for diagnosing the disease. From 06.2020 to 09.2023, a retrospective study was conducted on 80 patients with histologically proven carcinoma of the endometrium, treated at University Hospital Saint Marina-Pleven. The mean age of the patients was 58.04 ± 10.46, ranging from 28 to 78. The comparative analysis of the discrepancies of the histological verification methods in the evaluation of the preoperative and postoperative histological result showed that a statistically significantly higher percentage of discrepancies (19.5%) had the dilatation and curettage compared to the zero discrepancy of the hysteroscopy (0.0%). The relative proportion of discrepancies of the fractional curettage is 14.3%. The cytological result was negative for tumor cells in 97.5% and positive in 2.5%. In all patients with a positive cytological result for tumor cells, the method of histological verification was dilatation and curettage. Performing diagnostic hysteroscopy and observing safety principles such as creating low intrauterine pressure and short operative time is a safe and reliable method for diagnosing endometrial carcinoma.

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DOI: 10.3897/jbcr.e138141

Authors: Teodora Semova, Slavcho Tomov, Tihomir Totev, Dimitar Dimitrov, Zornitsa Gorcheva, Valeria Racheva

Abstract: Standard treatment for ovarian cancer includes optimal cytoreduction, followed by chemotherapy in most cases. This study aimed to evaluate the role of minimally invasive approaches in diagnosing and treating ovarian carcinoma. We conducted a retrospective analysis of patients diagnosed with ovarian carcinoma who underwent surgery at the Department of Obstetrics and Gynecology at St. Marina University Hospital–Pleven from January 2020 to April 2023. The study included 213 patients; the average age was 58.90 years. Out of all patients in the study, 64 initially received only diagnostic intervention. Of these patients, 53 (24.9%) underwent minimally invasive diagnostic intervention, while 11 (5.2%) had diagnostic intervention through conventional laparotomy. Among the patients who had surgery, the most common procedure (53.1%) was total abdominal hysterectomy with bilateral salpingo-oophorectomy, followed by diagnostic laparoscopy with subsequent laparotomy (14.6%). Thirty-one (14.6%) of the patients had interval surgery. Twenty-seven (87.1%) patients underwent minimally invasive diagnostic intervention. Moreover, 21 (67.7%) patients who had interval surgery also underwent surgery using a minimally invasive approach. The obtained results show that minimally invasive approaches are widely used in the diagnosis and treatment of ovarian carcinoma. The increasing adoption of interval surgery will expand another application of minimally invasive surgery - robot-assisted interval surgery after neoadjuvant chemotherapy.

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DOI: 10.3897/jbcr.e123690

Authors: Zlatko Kirovakov, Elitsa Gyokova, Nadezdha Hinkova, Emiliana Konova

Abstract: Compared with non-pregnant women, pregnancy alone carries a three- to fivefold higher risk of venous thromboembolism (VTE). Despite the increasing use of low-molecular-weight heparin in identified high-risk patients, pulmonary embolism is still the leading cause of maternal mortality. However, evidence for optimal use of thromboprophylaxis is scarce. Thrombophilia (hereditary or acquired) is thought to predispose to both VTE and is also associated with complications of pregnancy, such as recurrent miscarriages and preeclampsia. This review discusses the current evidence for optimal thromboprophylaxis during pregnancy by focusing primarily on VTE prevention strategies, the potential to prevent recurrent complications during pregnancy with low molecular weight heparin (LMWH), aspirin, and Nattokinase in pregnant women with congenital thrombophilia.

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DOI: 10.3897/jbcr.e126698

Authors: Elitsa Y. Stoyanova, Mariela Kamburova

Abstract: The main risk factors for Human papillomavirus (HPV) infection, and the development of associated diseases are related to sexual behavior and health literacy of the population. The study aimed to investigate the impact of risk and protective factors for HPV infection and the development of associated diseases in adult women. A case-control study was conducted from January 2020 to May 2022A. Respondents had sought outpatient and/or inpatient obstetric-gynecological care in the city of Pleven. The significance of results, findings, and conclusions was determined at p

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