Background: The ophthalmic Doppler is a reliable and impartial way to assess the severity of preeclampsia (PE). The study aimed to assess the potential utility of Doppler measurements of the maternal ophthalmic arteries during the weeks 19–23 of gestation, both independently and in combination with established biomarkers for PE. Methods: A prospective cohort study was conducted involving women who were recruited from a variety of standard appointments, including booking, scanning, and regular prenatal visits. A total of 200 women that were divided into high-risk and low-risk groups for developing PE were involved during the period between April 2023 and November 2023. Results: The ophthalmic ratio had significantly higher values in high-risk patients than in low-risk women (p = 0.000). There was a significant relationship between PSV2/PSV1 and gestational age at birth in women with PE compared to the ones who did not develop PE. Conclusions: An ophthalmic artery Doppler can play a crucial role in the early detection of PE, allowing for timely intervention and management. Incorporating the ophthalmic artery Doppler as a screening tool for PE in Bulgaria has the potential to improve early detection, risk stratification, and overall maternal and fetal health outcomes.

Background: Preconception care (PCC) is a key element of preventive reproductive health, aiming to optimise maternal and child outcomes by addressing biomedical, behavioural, psychosocial, and genetic risks before conception. International frameworks provide clear guidance, yet implementation in many low- and middle-income countries remains inconsistent. Methods: A structured narrative review was conducted across PubMed, Web of Science, Cochrane Library, and Google Scholar, focusing on literature published between 2010 and 2025. Eligible sources included empirical studies, clinical guidelines, policy documents, and high-quality grey literature from health authorities. Quality, relevance, and applicability were assessed, with particular emphasis on European and Bulgarian contexts. Results: Evidence from diverse settings demonstrates that PCC interventions—such as chronic disease management, vaccination, lifestyle optimisation, and expanded carrier screening (ECS)—can reduce adverse pregnancy outcomes and prevent severe genetic disorders. Effective international models integrate PCC into primary care, leverage digital health tools, and ensure equitable access through public funding. In Bulgaria, PCC remains underdeveloped: genetic screening is not part of routine care, there are no national guidelines or surveillance systems, and only ~4% of women initiate folic acid supplementation before pregnancy. NGOs and EU-funded digital initiatives provide partial outreach but cannot replace state-supported services. Conclusions: Bulgaria urgently requires a coordinated national PCC strategy, incorporating standardised guidelines, provider training, digital platforms, and phased ECS introduction. Strengthening PCC delivery can reduce preventable maternal and neonatal morbidity, advance reproductive justice, and enhance the long-term sustainability of public health systems. These findings support the development of a publicly funded, guideline-driven national PCC strategy with phased introduction of expanded carrier screening under NHIF to improve equity and long-term system sustainability.

Background: Advances in genome-wide DNA-based technologies have fundamentally transformed prenatal genetic diagnostics, enabling detection of clinically significant submicroscopic chromosomal abnormalities that are not identifiable by conventional cytogenetic methods. These developments have important implications for the diagnosis and management of pregnancies complicated by fetal structural abnormalities, as they enable more accurate etiological diagnosis, improved prognostic assessment, and more informed clinical decision-making and reproductive counselling. Methods: This narrative review synthesizes contemporary international evidence on prenatal genetic diagnostic approaches, including conventional karyotyping, chromosomal microarray analysis (CMA), and genome-wide sequencing technologies. The review focuses on diagnostic performance, clinical utility, ethical considerations, and implementation within diverse healthcare systems. Results: Accumulating evidence demonstrates that genome-wide approaches—particularly CMA and sequencing-based methods—provide a higher diagnostic yield in fetuses with structural anomalies, with an incremental yield of approximately 3–5% over conventional karyotyping. This is mainly due to their ability to detect pathogenic copy number variants below the cytogenetic resolution of karyotyping. These technologies improve etiological insight, enhance genotype–phenotype correlation, and support more precise prognostication and reproductive counselling, especially in pregnancies with fetal structural anomalies. Emerging sequencing platforms further expand the diagnostic spectrum by integrating copy number and sequence-level variant detection. Conclusions: Genome-wide Copy Number Variation (CNV) analysis represents a critical component of contemporary prenatal diagnostics and should be integrated into invasive prenatal testing pathways in accordance with international recommendations. Genome-wide approaches need robust counselling frameworks and equitable health policy implementation to spread. The expense, lack of required experience, and variation in healthcare infrastructure across locations make widespread deployment difficult.

Background: Antenatal depression and anxiety contribute significantly to maternal morbidity and adverse pregnancy outcomes. However, structured screening and targeted interventions are largely absent from standard prenatal care in many Eastern European countries, including Bulgaria. This study examines the prevalence and psychosocial predictors of antenatal psychosocial risk using the validated Antenatal Risk Questionnaire–Revised (ANRQ-R) in a nationally underrepresented population. Methods: A cross-sectional survey was conducted among 216 third-trimester pregnant women in Bulgaria. Data on sociodemographic characteristics, health behaviours, and reproductive history were collected. Multivariate logistic regression identified predictors of elevated psychosocial risk. Results: A total of 65.7% of participants met the criteria for elevated psychosocial risk. Significant risk factors included passive smoking exposure during pregnancy (OR = 5.03, p < 0.001), physical activity prior to pregnancy (OR = 1.81, p = 0.004), and a family history of hereditary disease (OR = 42.67, p < 0.001). Protective factors were better self-rated current health (OR = 0.37, p = 0.004), the presence of chronic illness (OR = 0.42, p = 0.049), previous childbirth experience (OR = 0.11, p = 0.032), and residence in Northwestern Bulgaria (OR = 0.31, p = 0.028). Despite the high prevalence of psychosocial vulnerability, only 9.5% of affected women sought professional help. Conclusions: While our findings point to important unmet needs in antenatal mental health, further research is required before national screening policies can be implemented. Pilot programs, cultural validation of tools, and system-level readiness assessments should precede broad adoption.

The current article aims to provide an analytical review of the aetiology, pathophysiology, diagnosis, and treatment of recurrent pregnancy loss (RPL) with a focus on Bulgaria. RPL has become an important reproductive health issue worldwide and affects 2%–3% of reproductive-aged women. The findings showed that the etiological factors can be biological, hereditary or environmental, and in approximately 50% of RPL cases, these factors remain unknown. In relation to pathophysiological processes associated with the condition, the findings showed that different etiological factors affect different gestational processes, such as alteration of the structural and nanomechanical abnormalities of the platelets and disruption of the ANXA5 protective shield that prevents adverse pregnancy outcomes. Also, acquired uterine structural defects such as submucosal uterine leiomyomas, endometrial synechiae, and polyps disrupt the implantation and embryonic development processes, which can result in recurrent miscarriages. A common factor for diagnostic approaches to recurrent pregnancy loss is the examination of historical medical records of patients who have experienced the condition and the identification of possible etiological and risk factors. The management and treatment of recurrent pregnancy loss are often based on the results of the diagnostic tests used to determine the underlying etiological factors associated with the condition.