Prof. Dr. Ivan Kostov, MD completed his higher medical education at MU-Sofia in 1997. He specializes in obstetrics and gynecology, and obtained a master’s degree in health management in 2005. Prof. Dr. Ivan Kostov has extensive postgraduate qualifications in ultrasound in obstetrics and gynecology, colposcopy, gynecological endocrinology, operative gynecology, pediatric-adolescent gynecology, laparoscopy in gynecology, robotic surgery in gynecology on the Da Vinci robot, as well as numerous specializations in Germany, Israel, France, Slovenia, Italy, Turkey, USA. His career began at “Mother’s Home” as a specialist in obstetrics and gynecology and the surgical gynecology clinic of “Pirogov” already as a specialist doctor. In 2008 – 2010 he was the executive director of the Second General Hospital “Sheynovo”, from 2012 – 2017 he was the executive director of the First General Hospital “St. Sofia”, and since April 2017 he has been the executive director of the University General Hospital “Mother’s House” – Sofia. From 2014 to the present, he is a member of the expert council at the State Fund for Assisted Reproduction at the Ministry of Health. Prof. Dr. Ivan Kostov is also the chairman of the “Electronic Health Bulgaria” Foundation in the period 2004 – 2013, as well as an active member of the European Association for Telemedicine and Electronic Health in Brussels. – Prof. Kostov, what year was 2021 for obstetricians and gynecologists? What did the specialty face? For obstetricians and gynecologists, 2021 was full of challenges, mainly because of the ongoing pandemic crisis with covid-19. In particular, for the specialists of “Mother’s House” this was a year in which we once again proved ourselves as the leading obstetrics and gynecology hospital in the country, as we took the most serious blow from the number of sick mothers and gynecologically ill women from all over the country. Since the beginning of this crisis, we have already had over 100 women who have given birth with covid-19, as well as approximately the same number of gynecologically ill women with covid-19. The year was full of challenges, but at the same time it was also a very good year, because more than 3,000 babies were born here. The hospital is once again in the leading position in the country, as well as in terms of the number of gynecological operations. I also use this opportunity to thank all the staff of the hospital for their dedicated work and care for women and babies, and because we are all one big team, one united family. – What trends have been observed regarding women’s health in recent years? The trends can be summarized in several directions. If we talk about childbirth and obstetrics, we can say that there is a tendency to return to normal birth before the desire to perform a cesarean section. This trend is clearly noticeable, at least on the territory of Sofia. Of course, the hospital also matters – still in private clinics, the rate of caesarean sections is very high. But we can clearly say that the Bulgarian mother’s desire to give birth normally is returning.On the other hand, there is an upward trend in the births of babies who are premature, especially in “Mother’s Home”, perhaps precisely because we accumulate the most severe cases in the field of high-risk pregnancy and obstetrics. We also have the best neonatology, led by Prof. Dr. Sunnycha. There are more and more cases of premature babies with extremely low weight that we manage to save and raise and from these children we eventually have healthy adolescent children. Also, in terms of gynecology, the tendency is to move more and more noticeably in the direction of endoscopic operations, the so-called bloodless operations. For the last three years, they have grown nearly three times in our country. It can be said that about 60% of the operations at the hospital take place endoscopically, including robotically, with which the hospital stands alongside the leading European gynecological centers. In terms of technical equipment, there is really nothing to complain about – the hospital has everything modern in terms of equipment that exists in the world in terms of endoscopic surgery, from ultrasound knives, through bipolar clamps, laparoscopic towers of the latest generation, including the Da Vinci robotic system . So, there is certainly a serious growth in this type of operations, which shows the modern thinking of our colleagues, and this also has its beneficial effect on patients – the trauma for them is less, the stay in the hospital is shorter. – Can we boast of news in your direction? Where is our country compared to the larger Western European countries? Our country, if we talk about the specialty of obstetrics and gynecology in general, is unfortunately not at the forefront, but rather at the tail, if we compare it with the developed countries of the European Union and North America. Why is this so? First of all, in terms of gynecology, especially if we include breast cancer, which is the most common cancer in women and about 6 times more common than all other gynecological cancers, de facto we still do not have an organized screening for breast cancer breast and others such as cervical cancer, endometrial cancer, ovarian cancer. In the absence of such organized screening, the morbidity and mortality from oncological gynecological diseases is very high compared to Europe. We are at the forefront of both morbidity and mortality. With regard to births, we must note here that there is already a decent competition between hospitals, I mean public and private hospitals. In big cities, there is a good level of pregnancy monitoring, the so-called women’s counseling. Unfortunately, this is not the case in small towns. It should be noted that general practitioners should have a much more serious role. It should also be mentioned that different birth cohorts have different results regarding women’s counseling. In some of these groups, for example the Roma population, such consultations are hardly sought, of course.it leads to its results. We are a motley society, with its minority groups, and our performance in midwifery can be explained by this fact as well. Also, despite the reduced numbers, “Tsarism”, i.e. the number of cesarean sections performed in Bulgaria is clearly higher compared to developed European countries. The large number of such procedures also lead to subsequent pathology, especially in subsequent pregnancies – the placenta has the property of sticking exactly where the uterus was cut, and hence the cases of placenta previa, ingrown or overgrown placenta in subsequent pregnancies also increase. These things can cost the life of the woman in labor and represent a serious pathology, and therefore one should think more and more. If unrecognized cases like this happen in a small town, if there is no adequately trained staff, it can really cost the woman and her relatives a lot. In general, there is much to work on at the national level, and here is the role of the scientific society of obstetrics and gynecology, of the expert council at the Ministry of Health. However, we as a country are moving in the right direction. I would say that technically, speaking of equipment, we are not behind, we are even perhaps more advanced than some countries in Europe, but in terms of building personnel and in terms of thinking, in terms of training, there is a lot to overcome is being worked on. Speaking of the aforementioned screening, both in pregnancy tracking and cancer, there is a lot to work on. We cannot fail to note the lack of midwives throughout the country – a problem that is becoming more and more serious every year, which cannot but affect the quality of medical care. If the state and various organizations do not start working on this issue, I do not see how we will have adequate medical care. – And regarding the pandemic, what new did we learn about covid-19 and pregnancy? Regarding the pandemic, a lot has changed, logically and quite reciprocally to the information that was scarce at the beginning, and now there is a lot of knowledge about this virus and the course of the infection. We can certainly say that we have gained a lot of experience – at the very least, we already have a prepared organization and working algorithms. Mother Home is the leading expert force in this field, with our experts participating in all Ministry of Health working groups. We built the algorithms for diagnosis, treatment and behavior in covid-19 and gynecological diseases, covid and pregnancy, covid and childbirth. We can really boast of some incredibly good results that absolutely rival the leading AG hospitals in Europe. The fact is that at the beginning there was very little information, there was insufficient knowledge, we had one behavior, for example, the recommendation to always give birth by caesarean section. Now our behavior is different, this is no longer mandatory, and normal birth is even recommended.Our specialists use protocols approved by the European Society of Obstetrics and Gynecology and the American College of Obstetrics and Gynecology. Certainly, we use the knowledge of our colleagues from other countries, but we also share ours with them, so it can be said that our level of knowledge is at the highest level, which has its beneficial results. I can’t help but urge colleagues from all over the country and pregnant women not to worry when they see a pregnant woman with covid-19 or a woman giving birth with covid-19. There is sufficient organization throughout the country, both in terms of behavior algorithms and in terms of equipment, so that these women can give birth in the nearest obstetric and gynecological centers, and not necessarily be sent to Sofia. – What can we expect in the new year in obstetrics and gynecology? In the new year, we expect to see what will happen with the covid-19 pandemic. After the enormous virulence and the next wave, currently with Omicron, will the incidence decrease in the second half of the year, as many virologists and infectious disease specialists around the world predict, or will new variants appear. God forbid that there are no variants that vaccines do not affect, or those with more severe symptoms. We are all waiting for this pandemic to end. In our clinic, we have set ourselves ambitious goals to increase the number of births and reduce the rate of cesarean sections. We have opened the most modern postpartum clinic in the country and all mothers are welcome. Categorically, in terms of equipment and technical support, this is the most powerful vanguard of the specialty in the province. The key departments in the specialty, as well as in neonatology, are also located here, so here is also the most serious forge for personnel and specialists. Last but not least, we set ourselves the goal of increasing the number of performed endoscopic surgeries and minimally invasive procedures. We are also starting to apply sentinel lymph node technology, ie. to use immunofluorescent dyes to stain suspicious lymph nodes in oncological diseases and endoscopically remove only them. We are confidently moving forward and I sincerely hope that with the support of the state and the love of our patients, we will continue to defend the name of the best obstetrics and gynecology hospital in the country.so that these women can give birth in the nearest obstetric and gynecological centers, and not necessarily be sent to Sofia. – What can we expect in the new year in obstetrics and gynecology? In the new year, we expect to see what will happen with the covid-19 pandemic. After the enormous virulence and the next wave, currently with Omicron, will the incidence decrease in the second half of the year, as many virologists and infectious disease specialists around the world predict, or will new variants appear. God forbid that there are no variants that vaccines do not affect, or those with more severe symptoms. We are all waiting for this pandemic to end. In our clinic, we have set ourselves ambitious goals to increase the number of births and reduce the rate of cesarean sections. We have opened the most modern postpartum clinic in the country and all mothers are welcome. Categorically, in terms of equipment and technical support, this is the most powerful vanguard of the specialty in the region. The key departments in the specialty, as well as in neonatology, are also located here, so here is also the most serious forge for personnel and specialists. Last but not least, we set ourselves the goal of increasing the number of performed endoscopic surgeries and minimally invasive procedures. We are also starting to apply sentinel lymph node technology, ie. to use immunofluorescent dyes to stain suspicious lymph nodes in oncological diseases and endoscopically remove only them. We are confidently moving forward and I sincerely hope that with the support of the state and the love of our patients, we will continue to defend the name of the best obstetrics and gynecology hospital in the country.so that these women can give birth in the nearest obstetric and gynecological centers, and not necessarily be sent to Sofia. – What can we expect in the new year in obstetrics and gynecology? In the new year, we expect to see what will happen with the covid-19 pandemic. After the enormous virulence and the next wave, currently with Omicron, will the incidence decrease in the second half of the year, as many virologists and infectious disease specialists around the world predict, or will new variants appear. God forbid that there are no variants that vaccines do not affect, or those with more severe symptoms. We are all waiting for this pandemic to end. In our clinic, we have set ourselves ambitious goals to increase the number of births and reduce the rate of cesarean sections. We have opened the most modern postpartum clinic in the country and all mothers are welcome. Categorically, in terms of equipment and technical support, this is the most powerful vanguard of the specialty in the region. The key departments in the specialty, as well as in neonatology, are also located here, so here is also the most serious forge for personnel and specialists. Last but not least, we set ourselves the goal of increasing the number of performed endoscopic surgeries and minimally invasive procedures. We are also starting to apply sentinel lymph node technology, ie. to use immunofluorescent dyes to stain suspicious lymph nodes in oncological diseases and endoscopically remove only them. We are confidently moving forward and I sincerely hope that with the support of the state and the love of our patients, we will continue to defend the name of the best obstetrics and gynecology hospital in the country.which stain suspicious lymph nodes in oncological diseases and endoscopically remove only them. We are confidently moving forward and I sincerely hope that with the support of the state and the love of our patients, we will continue to defend the name of the best obstetrics and gynecology hospital in the country.which stain suspicious lymph nodes in oncological diseases and endoscopically remove only them. We are confidently moving forward and I sincerely hope that with the support of the state and the love of our patients, we will continue to defend the name of the best obstetrics and gynecology hospital in the country.