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  EbJIIAPCKO TIAYTIHO APYXECTBO TIO AKYIIIEPCTBO I{ I}IHEKOJIOII,Ifl BULGARIAN SCIENTIFIC SOCIETY OF OBSTETRICS AND GYNECOLOGY AKYMEPCTBOTVTHEKOIOTWfl OBSTETRICS ANT) GYNECOLOGY The official journal of the Bulgarian Scientific Society of Obstetrics and Gynecology Volume 52 tssN 0324-0959 3',20 13  AnyruepcrBo $ ru*eroflorrR - Epofi 3, 2013 cbqbHKAHUE OPNTUHAITHH CTATUN tDpaudeea 5., A. Maceea, T. f-apuusoe, Il. Baxpunoe, A.,Qumumpoe - Kpuea na $emanHuf, pacmelr( cnoped cpoxana 6peweHHocmma u 3penocmma Ha nnoda 3 Amauacoea 8., Snamxoe 8., Sopucoe Cm., Beneea f. pluaeuocmuqHa cmoitHocm na Truescree n, tlumoHaMa3Ka u KoflnocKonuf, Koeaqee C., Eo1peecKa-Baqeea P. KouduHupaHa 1-HumpouMudasonoea u npo6uomuqHa mepanue Ha eaeuHanHa duc6aKmepuo3a c douuHupaulu aHaepoduueufloee - KnuHuqHa u MuKpoduonoeuqHa eSunacHocm. 19 Haqeea A., B. Amauacoea, B, Munoutoe, A. l-auoecxa, Xp. CuueoHoea OeapuanHu mylvropu c epaHuqHaMaflueHeHocm: npeduseuKameflcmeama nped KnuHu- qucma 27 Kopuoecrcu Fl., E. l4cuaun, C. Cnaaqee - flpoeHocmuqHo 3HaqeHue Ha num$Hama ducexquf, no omHouteHue Ha o6tqa npqruef,ewocm npu uHeasueeH paK Ha MamoqHama uuilxa PMry 30Baxpunoea 17., E. Cnuuqeea, 3. Emunoea, B. Memo)ueea, A. Huxonoe, C.Xumposa, E. Eoilqeea - KpueeH naKmam Kamo duaenocmuqeH u fipoeHocmu,teH Kpumepu(t sa acSuKcue npu Hoeopodenu c eecmaquoHHa eb3pacm 34 u nad 34 e.c. 36 oE30PU Tpu$ouoe 14. - AunuomuqHa eudonttfl - dauoxnee Meq unu cnacumeileH nosc? 44 Kocmoea 11., B. SnamKoe - EpeueHHocm u par Ha )KeHcnume nofioeu opeaHu. tlacm V, Hnxou no-pf,dxo cpeulaHu euHeKonoeuqHu Heannasuu no epewe Ha dpeueHHocm corvrE rs ORIGINAL ARTICTESFrundeva 8., Musseva A., Gamisov 7., Vakilova L., Dimitrov A, Fetal Growth Curve Based on Gestational Age and Fetal Maturity Atanassova D., Zlatkov V., Borisov St., Veleva G. - Diagnosttcvalue of Truescreen, cytology and colpos copy 7 Kovachev S., Vatcheva-Dobrevsky R. - Efficacy of combined 5-nitroimidazole and probiotic therapy of bacterial vaginosis; randomized open trial 19 Nacheva A., Atanasova V., Miloshov V., Ganovska A.,Simeonova C. - Borderline Ovarian Tumours: a Challenge for Clinicians 27 KornovskiY., lsmail E., Slavchev S. - Prognostic significance of tymph node dr.ssection in terms of overall survival of invasive cervical cancer . 30Vakrilova L., Slancheva 8., Emilova 2., Nikolov A., Metodieva V., Hitrova S., Doicheva E. - Blood lactate measurementas a diagnostic and prognostic tool after bifth asphyxia innewborn with gestational age >34 gestational weeks 36REVIEWS Trifonov l. - Amniotic embolism - Damocles sword or lifebelt? .., 44 Kostova P., Zlatkov V. - Pregnancy and malignant diseases.Part V Som e rare gynecological turnors during pregnancy 48 514B Tauqee Il.- Auamomo-Qusuonoeuf, Ha aamoHowHama TanchevL.-Anatomyandphysiologyofautonomicpelvic masoeama uHepeaqufl 51 ,\eraeea A, - CmpeflmoKoKu epyna E - npultuHumenu Ha HeoHamanHu un$exquu npu xopama: enudervtuonoeuf,, namoeeHega, Kn uHuttHu Soptvtu, neqeHue u npo$unaKmuKaDecheva A. - Group B Sfreptococci as a cause of neonatal infections in humans: epidemiology, pathogenesis, clinical features, treatment and prophylaxis 55Lazarov N., Lazarov L., Lazarov S. - Laparoscopy and earlyovarian cancer . 60 Gateva A., Kamenov 2., Mondeshki k., Bilyukov R., Geo rgiev O. Polycystic ovarian syndrome and obstructivesleep apnea innervations 55I1aeapoe H., n. I1aeapoe, C. ITaeapoe - IlaflapocKontuf, u paHeH oeapuaneH paK 60 l-ameea A., 3. Kameuoe, U. MondeutKu, P. Eunrcxoe, O. l-eopeuee - Cundpow Ha noflunucmosHume nilunuqu uodcmpyxmusHa cbHHa anHef, 63 Oeusuoea f., C. l-eopeuee, U. xudpamupaHe npu cnuHanHa 63 Cuunoe - Xunomexeus u Ognyanova G., Georgiev S., Smr/ov l. - Hypotension and auecmesus sa lteeapoeo hydration durtng spinal anesthesia for Caesarcan section ceqeHue 6969  4 AryuepcrBo u rnueKorrorrn - Epolt 3,2013 O$};OFIf AMHUOTUqHA EMEoAUf, - AAM\aKMB MEq UrA CnACUTE EH nof,C? TpuQoHoe,U, MEAJI "Cr.Knpxoeuu" Cr apa 3aropaPegtoue. Aemopum pasenexda KnacuqecKume u cbepeMeHHume cxeat4aHuf, sa aMHuomuqHama eu6onun flp$ npwMama Ha ueduxo-neeafiHume acneKmu, cebpgaHu c moea nomeHquanHo nemanHo cbcmosHue. Knrcqoeu Oynu: Amniotic fluid embolism, AFE, Embolie amniotique, thromboses, embolies. AMNIOTIC EMBOLISM. DAMOCLES SWORD OR LIFEBELT? Trifonov,l. Genera Hospital of Stara ZagoraAbstract. The author deals with classical and contemporary concepts of amniotic embolism in terms of medical and legalaspecfs associated with this potentially lethal condition. Keywords: Amniotic fluid embolism, AFE, Embolie amniotique, thromboses, embolies.L[en Ha npoyqBaHero l-lenra Ha roBa npoyt{BaHe e Ea ce HanpaBm alffyanh3aqnfl Ha 3HaHrflTa HV 3aTasv Ho3onorilqHa etruHl4qa oT npaKTml{ecKa r Me,qrKo-.neranHa rneEHa TOqKa. Marepuan H MerotrHI-lpoy.teHr ca ny6nnKaqnn B pa3nHL{Hn cnncatnfl no reMara, $urJ[paHn B Medline, cochrane library, Nature, Science, Lancet, GyneWeb v np. [4enofl3BaHr ca Kfitot{oBrre tryMta Amniotic fluid embolism, AFE,Embolie amniotique, thromboses, embolies. O6cur(AaHe An,tHuorvlqHara eM6ofivfl e BHe3anHo, 6pyraflHo, HeoqaKBaHo yt ApaMaT[ttHo cbcroflHue, Bb3HuK- Bar]{o o5uKHoBeHo BbB Qaaara Ha HanpeAHaflo pasurpeHre npn paxEaHe r r3pa3flBau{o ce c rexKa Ka pE il o- pecnnpaTo p H a H eEocTaTbq H o cT, n ocn eABa H a o5wKHoBeHHo or EWK-crHEpoM. Arra Huorvr{Hara eM6onrfi e aryuJepcxa Kara- cTposa, KoflTo qecTo SaBbptxBa cbc cMbprTa Ha MafiKara r EereTo. HnKoH aBropt4 npegnarar repMnHa AE Ea ce SaMecrn c "AHa$nnaKToupte1 crHfqpoM Ha 6peueHHocrra", KofiTo onrcBa roBa clrcroflHue no- cKopo KaTo MynTrcilcTeMHa peaKql4fi Ha ToKcl,lHV, orKoflKoro Karo eM6onHqeH SeHoMeH.(3) CnopegHaqroHafl Hvlfl perilcrbp Ha sa6onnBaH nflra B USA npn 41% or naqheHTKr4Te c aMHhoTt4qHa eru6onrs ca perHcTpnpaHn npeAuecTByBa[qil afiepfu'.{HH nHqnneHTr. [-1 pmcucrBrero Ha $eranHr K.nerbqHr eneMe HTvl B Mailrl[HaTa qrpKyna$un, cBrrpSaHo c ycnoxHeHmfl nph paxEaHeTo, 33 nbpBH nbr e cbo6u{eHo oT Ricardo Meyer or Spasra nnn npea 1926 t.(2) [1pes 1941 r. EBaMa naroaHaroMr4 or L{rKarcKrfl yl{vlBepcHrer Dr.Paul Steiner n Dr.Clarence Lushbaugh HaMHpar aMHrorrqeH MarepnanB 6enogpo6nhre cbgoBe Ha xeHV, noqvtanvl or nepnnapTafleH vnn nocTnapraneH [uoK.Te npeEnonaraT, qe cnnHVTe MaToqHH KoHTpaKqHil MoraT Ea npr4L{nqflT HaxnyBaHe Ha aMHroTnqHa TeqHocT B MaTOqHHTe BeHh nO BpeMe Ha paXEaHeTO Unn B nnaueHra pHnn nepHotr. ( 1 ) EnngeMnonorur Au HrorvlqHara eM6onhn (AE) /Amniotic fluidembolism (AFE/ e e,qHa or nbpBmre rpr nprqrHh 3a E[peKTHaTa Mailr{hHa cMrrpTHocT, Sae,qHo c nocTnapTanHaTa xeMoparnfl u npeeKnaMncufl- eKfiaMncnnTa. u{ecrorara h cnopefl pa3ru4r{HilTe aBTopu Bapnpa or 1/B 000 no 1/80 000 paxflaHun. fiopagr 3HaL{ urenHrTe pasfl n.v,nfl B Knacta$m- qmpaHero Ha EaEeH Knt{HHqeH cnyqar Karo AE, Clark(3), a no KbcHo u Tuffnell(23) BbBexgar KOHKpeTHH KpHrepnn 3a notroop B HaqroHajrHl4Te perHcrbpH Ha 3aoonfiBalHunra cborBerHo B USA t B O6egrHeHoro KpancrBo. l-loseorrsBaM cv tra Br nprnoMHn Tesv Kpumepuui 1 . 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CuqecrBeHo sHaqeHme HMa cbgbpxaHnero Ha rbKaHeH rporu6o- nflacrrH B OT. KnnHfiKa AE HacrbnBa npe4hMHo nph MHoropaxga ntt. B 9A% or cnyl{ahre l11aa KoHTpaKLlHH, Karo B 113 cacunHn, c noBhlueH ToHyc Ha MaTKaTa. CrnanroMarrKara ce pa3BilBa ocmpo, o6uKHoBeHo B XO,qa Ha KbCHOTO pa3uHpeHne Ha LlepBhKanHUA KaHafl unn Ha m3roHBaHero, [rpaKThqecKm 6eg npogpoM14. Tmnr{qHara KnnHrqHa KaprtAHa ce xapaKTeph3upa c ducnHefl, maxunHefl u quaHo3a. O6upKaHocrra n nlnrarenHoro HecnoKoficrBhe ca qecrrr. KbM cHMnroMnre Ha ocrpa rqrxarenHa Herqocrarbl{Hocr ce npr6aBflT cbpgeL{Ho-cbiqoBrcMyuteHnn (A%) vr KpaMnH (10%). 6upso cnmpa EnwaHero v1 4v1p Kyna L#AATa. Or 30 MHHfrn tro 9 .{aca cneg Haqanoro Ha ocrpara Saea ce pasBHBa wpa3eua Koaeyfloflamufl.B 12%arxeHfiTe KpbBoreqeHHero e 6tafio nbpBr,rf;T pa3nogHarcHMnroM. l-lpr,r H3pa3eHo KpbBoreL{eHhe or MarKara cneg nefi Horo H3npa3BaHe xeMoparfiqHara rqharega o5uKHoBeHHo ce 6upKa c aroH ttfr. Kpueorel{eH nfl or BeHqnre, Hoca w y6ognnre Mecra ce Ha6npgaBarnph oxolro 50% or xeHilre c AE.I-lpoRpoManHrre cHMnroMH npil AE ca peEKH t HernnrqHu. O6r,rKHoBeHHo ce cbo6qaea 3a rpbnKr, pa3TpmcaHe, noBpbqaHe. ulecro eEHoBpeMeHHo ceycraHoBflBa r ac$wKctnfl Ha nno,qa, Konro onperqenrr aKTUBHOCTTa Ha aKyuept4Te. Bce naK HnKoH aBTopt4 cuo6qaBar 3a HnKoH npoflpoMarrHl,r npH3HaqH, KoHTo Morar EanpeAruecTByBaT Kflacl4qecKaTa KapTHHa Ha ToBa ga6onsBaHe: 1 . SesnoxoficrBo Hnil gug6yEa 7,12,13,14,17,1e,22,23,24 2. [-lporranHa Ha noBe4eHilerl 23,24 3. t{yacrBo Ha crpg;1 1o'1e 4. CxoaaHocr 18 5. Enegocr Ha Koxarg 18,22 6. TaxrnHefl nfin HapyueHre Ha trti*uaHerg 4,25 7. HeebgMoxHocr fia orroBopr Ha Brrnpocm 8'25 B. flcwxwl{ecKo o6uprBaHe 11,14,22 9. 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ErSepeH qlran Ha p1ua rH o3a 1. Seno,qpo6Ha eu6onrs npm HeH 6onKrre B rb pE 14 Te, Cb n bTCT Ba U{ r rq r XaTen H aTa H eEO CTaTrrL{ H O CT, ca Borqetr4h, EoKaro npr AE HflMa 6onrr; 2. Ocrpara nflBa cbpgeqHa He4ocrarbr{Hocr ceua6nloiqaBa caMo nph npeguecrByBau{o crrp4eqHosa6onflBaHe; 3. Acn vlpaL$inra Ha croMarueH coK (Mendelson syndrome) qecro ce nprnpyxaBa or ocrbp 6ponxocnasbM, xofiro npm AE e hsBrrHpegHo pfl,qbK; 4. FlHee[aoropaKc; 5. ExnananrhL{eH nptacrbn;6. Abruptio placentae; 7 . Ruptura uteri. fleqexHe Hnua cnequSuuna mepaflufl na AE. 1. fle.{enre Ha Kapgho-qt4pKynaropHara Hegoc- TATbqHOCT. 3anoqBa ce qpe3 o6trwtuBaHe c MacKa.EHgo- rpaxearrH ara umy6aqnn ce npaBr KonKomo e eb3MoKHo no-6bp3o, o6grurBaHero rpnOaa Aa e c nonoxr4TenHo HanHraHe B Kpafl Ha hHcnvpuyua. Tpn6aa tra ce BHrMaBa sa eBeHTyanHo HaManABaHe Ha crrpEg{Hl4fi MrHrren o6ena, KaTo nocneEHoTo Moxe Aa 6u,qe KopurvpaHo L{pes o6eraHo saMecTBane wlwnw Dopamin. Aro npes rasn Sasa Ha neqeHnero Hacrbnm cnrpaHe Ha qrpKyn aL{AflTa, rpn6ea BeEHara Aa ce3anoqHe HenpflK cbpEeqeH Macax. EEHoepeMeHHo ce ocrrypnBa UeHrpaneH BeHoseH crrE 3a hsMepBaHe Ha qBH u 3a 6upso BnnBaHe Ha rofleMr KonhqecTBa TeqHocTvl vl MeEmKaMeHTt . flpenopbqBa ce KaHlonrpaHe Ha nepra$epHa BeHa nnn na w.jugulares. He ce npenopbqBa nyHtcrrpaHero Ha v.subclavia, nopagm oqaKBaHoro cMyu{eHhe B KpbBocbcHpBaHero t4 cBbp3a|/.ufl c ToBa pHcK oT xeMoropaKc. t-lpn Hp4qa ce npilnara,qonaMfrH, a npm naera6oflhrH a aqrgosa - HarpneB 6rarcap6oHar. 2. CnetrcneruHVre MepKH rpn6aa da ce u3npa3HuMamKama KonKomo e erf Mo,ffio no-6upso. Ilpr,rBb3MOXHOCT paXflaHeTO SaBbptUBa BafttHanHo, HO no-qecro L{pes CS. 3. l-lo-HararbuHoro neqeHhe L{ecro ce onpe- Eenfi oT ct(rlara Ha MaroqHoTo KpbBoTeqeHHe. HacrunBaHero Ha cMylrterufl B KplrBocrrct4pBaHero npil ,qharHo3ara AE rpn6ea tra ce oqaKBa Eoprl npnnunca Ha cKrroHHocr KbM rGpBeHB, aKo 6peueHHara e npexmBfifla nbpBara $a3a, pecneKTlrBHo nbpBmfl L{ac. O6erraHoro 3aMecrBaHe ce gano'.{Ba orHaqano c KOflOl,l Aanl{n pa3TBOpH,fleE TOBa C KpbB,O Bb3MOXHOCT "npf;cHa". CucupBaeMocrra Ha KpbBTa ce BbgcraHoBRBa L{pe3 nphnaraHe Ha n3n, Kp14onpeUHnHTor, Qw5puHoreH, Novo7, Octaplex. l-lpyr rexKr cMyn{eHhfl B KpIrBoCbcHpBaHeTO HSpa3eHaTa xeMoparrqHa rqHaTffia Ce onpeflenfl BCI>IJJHOCT oT npeKoMepHaTa $vt6pwH on H s a u Su6p n n o re H on Nsa . 3aroBa e yM ecrH o cned ufiu ednoepereHro cbc aaMecrrrenH ara Tepannn na ce npl4narar tA aHrn$w6puHonuruqtt: A. Trasylol amp. 100 000 KIE (ranhKpenH-HHxw6uropHn eRHnw4u) u amp. 250 000KlE B HaqafiHa Eoaa 500 000-1 000 000 KIE iv, nocnegBaHo or 200 000 KIE/qac aa 4-6 L{aca. E. Contrycal amp. 10 000 vl 50 000 ATpE (aHrr- TpttnctvtnHoBH eAH HvltJu) - n pvnara ce B rpofino no- ManKH EO3H. 3a onrhManHo KoHTpaxvpaHe Ha MarKara ce nprnarar BHcoKu Eost4 Mereprnt lA OrcNroUmH.Aro KpbBoreL{eHrero He Moxe Ea 6utre oBn atrAHo, e noKa3aHa xeMocTaTmqHaTa xhcTepeKTounn.[-lo.{rh Bcr4r{KH xeHil, npeKapanr ocrpo cMyrrleHhe B KplrBOCbCnpBaHerO npe3 opeMeHHocTTa nntA paxtraHero, ce HyxEafiT or oco6eHHH rpn>Kvl nopagr Thnuv.HnTe ycnoxHeHHfl B pa3nhqHnTe opraHil. Ocrpara 6u6peqHa Hegocrarbl{Hocr e qecra v ttgttcKBa xeM onnantA3a. l-IpoS nnaKTh Kara Ha rporu6oena6onilqHara 6onecr c H vlclrtt Eosr4 xenaprHrpn6ea Aa 3anoqne 24-48 qaca cfie,q ocrpt4fl crarqvlil.Me,qr Ko-flerafl H H acneKTH. I-peuKU, Koumo mpfldea da ce uedneeam om*ted u Ko-floean Ha en ed u a mo.,t Ka : 1. HersebpuBaHero Ha cneuHr Meponpnnrvn 3a Kapgvlo-nynMoHanHa pecycqrralylr. AFE elurltHl,trtHa AHarHo3a. Tpn6aa tra ce B3eMar MepKr 3a cra6unustApaHe Ha naqreHTa, BeAHara cneA Karo
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