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Endometriosis (E) and adenomyosis (A) are associated with a wide spectrum of symptoms and may present various histopathological transformations, such as the presence of hyperplasia, atypia, and malignant transformation occurring under the influence of local inflammatory, vascular and hormonal factors and by the alteration of tumor suppressor proteins and the inhibition of cell apoptosis, with an increased degree of lesion proliferation. Material and methods: This retrospective study included 243 patients from whom tissue with E/A or normal control uterine tissue was harvested and stained by histochemical and classical immunohistochemical staining. We assessed the symptomatology of the patients, the structure of the ectopic epithelium and the presence of neovascularization, hormone receptors, inflammatory cells and oncoproteins involved in lesion development. Atypical areas were analyzed using multiple immunolabeling techniques. Results: The cytokeratin (CK) CK7+/CK20− expression profile was present in E foci and differentiated them from digestive metastases. The neovascularization marker cluster of differentiation (CD) 34+ was increased, especially in areas with malignant transformation of E or A foci. T:CD3+ lymphocytes, B:CD20+ lymphocytes, CD68+ macrophages and tryptase+ mast cells were abundant, especially in cases associated with malignant transformation, being markers of the proinflammatory microenvironment. In addition, we found a significantly increased cell division index (Ki67+), with transformation and inactivation of tumor suppressor genes p53, B-cell lymphoma 2 (BCL-2) and Phosphatase and tensin homolog (PTEN) in areas with E/A-transformed malignancy. Conclusions: Proinflammatory/vascular/hormonal changes trigger E/A progression and the onset of cellular atypia and malignant transformation, exacerbating symptoms, especially local pain and vaginal bleeding. These triggers may represent future therapeutic targets. [ABSTRACT FROM AUTHOR]

Introduction. Placenta praevia (PP) is an obstetrical complication where the maturing placenta obstructs a part or all of the internal cervical os. Abnormal placenta invasion and development are associated with a spectrum of conditions rather than a single obstetric pathology. Objective. To review the ultrasound markers for placenta praevia in our experience and correlate the imagistic and histopathological findings. Methodology. This is a retrospective study including 259 patients admitted with the diagnosis of PP in the Obstetrics-Gynecology Clinic II of the County Emergency Clinical Hospital Craiova, Romania, between 2018 and 2023. Results. The most important ultrasound features associated with placenta praevia with accreta were loss of retroplacental hypoechoic area, presence of placental lacunae, presence of bladder wall discontinuity, placental bulge, exophytic mass, subplacental and/or uterovesical hypervascularity, placental lacunae feeder vessels, and bridging vessels. According to the degree of placental invasiveness, the histopathological evaluation showed disorganization of the uterine wall, myocytes anarchically distributed among the villi and decidual cells, neoformation vessels invading the myometrium, and these aspects were correlated with hyperadherence and significant antepartum and intrapartum bleeding. Conclusions. The aforementioned ultrasound features may put doctors on alert and, thus, dictate the appropriate therapeutic management to prevent complications that could endanger fetal or maternal life. [ABSTRACT FROM AUTHOR]

Ectopic endometrial epithelium associates a wide spectrum of symptomatology. Their evolution can be influenced by inflammatory and vascular changes, that affect not only the structure and cell proliferation rate, but also symptoms. This prospective study involved tissue samples from surgically treated patients, stained using classical histotechniques and immunohistochemistry. We assessed ectopic endometrial glands (CK7+, CK20−), adjacent blood vessels (CD34+), estrogen/progesterone hormone receptors (ER+, PR+), inflammatory cells (CD3+, CD20+, CD68+, Tryptase+), rate of inflammatory cells (Ki67+) and oncoproteins (BCL2+, PTEN+, p53+) involved in the development of endometriosis/adenomyosis. A CK7+/CK20− expression profile was present in the ectopic epithelium and differentiated it from digestive metastases. ER+/PR+ were present in all cases analyzed. We found an increased vascularity (CD34+) in the areas with abdominal endometriosis and CD3+−:T-lymphocytes, CD20+−:B-lymphocytes, CD68+:macrophages, and Tryptase+: mastocytes were abundant, especially in cases with adenomyosis as a marker of proinflammatory microenvironment. In addition, we found a significantly higher division index-(Ki67+) in the areas with adenomyosis, and inactivation of tumor suppressor genes-p53+ in areas with neoplastic changes. The inflammatory/vascular/hormonal mechanisms trigger endometriosis progression and neoplastic changes increasing local pain. Furthermore, they may represent future therapeutic targets. Simultaneous-multiple immunohistochemical labelling represents a valuable technique for rapidly detecting cellular features that facilitate comparative analysis of the studied predictors. [ABSTRACT FROM AUTHOR]

Uterine myomas affect 2-10% of pregnant women. They are hormone-dependent tumors, and 30% of them will increase in response to hormonal changes during pregnancy. Therefore, significant growth is expected in pregnancy, but, actually, most of them do not change in size. They are usually asymptomatic, but they may be associated with severe abdominal pain and adverse pregnancy outcomes. Conservative management is the first option. If the conservative treatment fails and the symptoms are severe, a myomectomy can be performed, with serious risks of severe hemorrhage, uterine rupture, miscarriage and preterm labor. We present the case of a 31-year-old primigravida presenting in our service for severe abdominal pain, pollakiuria and constipation. The ultrasound examination revealed a 13-week pregnancy, with no ultrasound signs of fetal structural abnormalities, and several fibroids, in contact with each other, developed as one fibroid mass, intramural and subserous, in the lower uterine segment and into both parametria, with a diameter of 100/95/87 mm. During the following weeks, the symptoms progressed, and the fibroid volume almost doubled. At 17 weeks of pregnancy, due to the severity of the symptoms, rapidly growing myomas and suggestive ultrasound aspect of degeneration, we performed a myomectomy. The surgery was uneventful. The patient was monitored weekly. Detailed second-trimester and thirdtrimester scans confirmed the normal pregnancy evolution. Doppler evaluation of both uterine arteries showed a normal spectrum. The fetal growth was favorable, at a percentile of 50 at 32 weeks of pregnancy. No short-term or long-term complications of the surgery have been noted so far. Myomectomy during pregnancy should be considered in cases of symptomatic uterine fibroids not responding to conservative management or in large or rapidly growing myomas, large or medium myomas located in the lower uterine segment, or deforming the placental site, following appropriate counseling of the patient regarding the associated risks. [ABSTRACT FROM AUTHOR]

Objectives-To evaluate ultrasound markers during a first-trimester (FT) routine ultrasound examination for an early detection of open spina bifida (OSB) and to correlate the sonographic findings with the morpho-histological ones. Materials and Methods: This retrospective research was performed using data from foetuses that underwent FT anatomy scans (FTAS) with a gestational age between 11 weeks and 13 weeks and 6 days in the Prenatal Diagnostic Unit of the Clinical Emergency County Hospital Craiova from October 2022 until September 2023. Results: The study included 648 FT singleton pregnancies and 5 OSB cases were detected. In the OSB group, we found abnormal aspects of the fourth ventricle, also named intracranial translucency (IT) in 4 out of 5 cases of OSB (80%), a brain stem anteroposterior diameter, and brain stem to occipital bone ratio abnormal in all 5 cases (greater than 1) (100%), the crash sign was present in 80% (4 out of 5 cases) and the spinal defect was visualized in 4 out of 5 patients (80%). Medical termination of pregnancy (MTOP) was the preferred option in all cases of OSB. This allowed us to include an extended histological study to confirm the ultrasound diagnosis. Conclusions: A combined detailed FTAS that includes both cranial ultrasound markers of the posterior fossa and also a good visualization of the foetal spine offers an early optimal detection rate of spine abnormalities. [ABSTRACT FROM AUTHOR]

After pregnancy termination or loss, histologic three-dimensional imaging can be used to confirm the presence of fetal cardiac malformations detected during first-trimester ultrasound examination. BACKGROUND: We aimed to evaluate the usefulness of three-dimensional (3D) reconstruction of histology slides to confirm congenital heart disease (CHD) detected by first-trimester fetal cardiac ultrasonography. Conventional autopsy is hindered by the small size of the first-trimester fetal heart, and current CHD confirmation studies employ the use of highly specialized and expensive methods. TECHNIQUE: An extended first-trimester ultrasound examination protocol was used to diagnose fetal heart anomalies. Medical termination of pregnancies was followed by fetal heart extraction. The specimens were sliced, and the histology slides were stained and scanned. The resulting images were processed, and volume rendering was performed using 3D reconstruction software. The volumes were analyzed by a multidisciplinary team of maternal–fetal medicine subspecialists and pathologists and compared with ultrasound examination findings. EXPERIENCE: Six fetuses with heart malformations were evaluated using histologic 3D imaging: two with hypoplastic left heart syndrome, two with atrioventricular septal defects, one with an isolated ventricular septal defect, and one with transposition of the great arteries. The technique allowed us to confirm ultrasound-detected anomalies and also identified additional malformations. CONCLUSION: After pregnancy termination or loss, histologic 3D imaging can be used to confirm the presence of fetal cardiac malformations detected during first-trimester ultrasound examination. Additionally, this technique has the potential to refine the diagnosis for counseling regarding recurrence risk and retains the advantages of standard histology. [ABSTRACT FROM AUTHOR]

Aim. We present our experience in the prenatal diagnosis of umbilical-portal-systemic venous shunts (UPSVS) and their prognostic factors. Materials and method. A prospective study was conducted in our center between January 2017 and January 2022, regarding the detection of UPSVS during pregnancy. In all UPSVS diagnosed cases, a detailed evaluation of the fetal abdominal veins was performed. We analyzed the type of the shunt and the integrity of the portal venous system. We analyzed the incidence of the UPSVS types, their associations and outcome predictors. Results. Thirtyone UPSVS cases were diagnosed in 14,793 scanned fetuses, with a prevalence of 0.2%. The gestational age at diagnosis ranged from 13 to 30 weeks. UPSVS were diagnosed in all first-trimester presented cases, except one. We detected 19 type I umbilical-systemic shunts (USS; 61.2%) that associated major morphological and genetic anomalies which worsened the outcome for this group. Also, anomalies of the portal venous system (PVS) were found in 87.5% of the assessed cases. Type II, ductus venosus-systemic shunt (DVSS), was found in 12.9%. PVS was normal in all cases, but half of them associated other structural anomalies. Type IIIa (intrahepatic portal-systemic shunt) was detected in five cases (16.1%); three of them presented an intact PVS, and two associated partial portal venous system agenesis (PPVSA) and intrauterine growth restriction (IUGR). In three cases (9.6%) we diagnosed a new category of complex umbilical-portal-systemic venous anomalies, with multiple shunts Karyotyping was performed in 25 diagnosed cases, with abnormal results in ten (40%) of them. Conclusions. The prevalence of this pathology in a tertiary unit is higher than reported, 0.2%. The early detection of UPSVS is feasible. The postnatal outcome in cases with UPSVS mainly depends on the presence of major structural, genetic and portal abnormalities and on the complexity of the shunt. Care should be given in monitoring the fetal well-being, as intrahepatic portalsystemic shunts are associated with intrauterine growth restriction (IUGR). [ABSTRACT FROM AUTHOR]

Mixed malignant mesoderm sarcomas (MLMS) are a rare subtype of malignant tumors with a myometrial origin. Usually, this pathology is diagnosed in menopausal women and has a fast evolution, with an unfavorable prognosis. This study analyzed data from the literature, which were subsequently correlated with a case of MLMS confirmed by classical histopathological examination and immunohistochemistry. It was performed total hysterectomy with bilateral adnexectomy. The clinical manifestations found in MLMS are the presence of a pelvic-abdominal tumor mass, accompanied by abdominal pressure, discomfort and vaginal bleeding. Imaging investigations such as pelvic ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) may suggest the diagnosis, but only the histopathological exam confirms it. From a macroscopic point of view, MLMS has a soft, gelatinous structure, compared to leiomyofibromas, with a hard and spiral structure. Another feature of MLMS is the infiltrative, irregular-looking tumor margin. The microscopic aspects of this malignant tumor are nuclear pleomorphism, necrosis of tumor cells, the presence of myxoid matrix, and variable mitotic activity. Due to the classic hematoxylin-eosin staining, the uterine smooth muscle has a leiomyomatosis structure, with the presence of multiple nodular formations suggestive for malignant tumor proliferation, probably of mesenchymal origin. We have shown that tumor cellularity is highly reactive to the anti-Vimentin antibody, an immunolabeled type III intermediate filament (IF) protein found in mesenchymal cells through special immunohistochemical techniques, demonstrating the mesenchymal origin of the tumor. The positivity of myocytes in the immunoreaction with the anti-alpha-actin antibody of smooth muscle (αSMA) shows that the tumor belongs to the myometrial structure. Tumor-transformed cells were genetically altered and mutated in the p53 tumor suppressor gene, thus escaping standard tissue control, aspects identified by immunolabeling with the anti-Ki67 antibody, which revealed cells in division. Tumor growth and development were supported by protein activation of cyclin-dependent kinase (CDK) and the presence of immunolabeled hematopoietic stem cells using the anti-cluster antibody of differentiation 117 (c-kit). The use of an anti-Desmin antibody in combination with anti- αSMA demonstrates the involvement of smooth muscle cells in tumor growth and development. The following microscopic features established the basis for the diagnosis of MLMS: irregular myometrial invasion the myxoid appearance that highlights rare cells dividing on sea fields. The following microscopic features laid the foundations for MLMS diagnosis: irregular myometrial invasion, rare mitosis on high power field (HPF: an average of 2.6 cells/×400 (±0.96 cells/×400) due to the presence of abundant myxoid matrix, rich in proteoglycans and glycosaminoglycans, especially hyaluronic acid, which offers a hypocellular appearance, but also through cell pleiomorphism. [ABSTRACT FROM AUTHOR]

Introduction. Adenomyosis is a benign pathology defined by the presence of endometrial glands in the miometrium, accompanied by chronic pelvic pain, infertility and vaginal bleeding. It is a hormonal dependent condition and is common in reproductive age. Adenomyosis areas differ from the normal endometrium by increased local production of estrogen or prostaglandins and resistance to progesterone action. Materials and method. The study included 23 patients, aged 26-52 years old, diagnosed with adenomyosis. Postoperatively obtained specimens were included in paraffin and studied histologically and immunohistochemically. The blocks were cut by the microtome, the sections were applied on simple slides for histological staining of Hematoxylin-Eosin and on Poly-L-lysin slides for the immunohistochemical stains. The antibodies were: anti-estrogen receptors (ER), anti-progesterone receptors (PR), anticytokeratin 7 (CK7), anti-cytokeratin 20 (CK20). Results. Classical Hematoxylin-Eosin staining showed the presence of mono-layered, cylindrical glandular epithelial tissue in the structure of the myometrium, and with immunohistochemistry we showed that these glands were of endometrial origin, being CK7-positive and negative at CK20, making a differential diagnosis with an eventual metastasis from the digestive tract. The receptors for estrogen and progesterone are present in the structure of these glands. Conclusions. Adenomyosis is a benign pathology diagnosed with certainty by histopathological examination. Receptors for estrogen and progesterone are features for endometrial tissue, and cytokeratins make the differential diagnosis with digestive epithelium. [ABSTRACT FROM AUTHOR]

Background. This study aims to describe the omphalocele, hypospadias, bifid scrotum and micropenis association characteristics, along with the care, prenatal diagnosis strategies and postnatal outcomes. We also present a case with this unusual association of malformations in a fetus with a normal male karyotype. Methodology. For this study, we present a case with detailed imaging and follow-up investigations before and after birth. Also, we searched the literature regarding the management of this complex malformation, and we present the review results. Results. According to literature, the following syndromes were linked to the spectrum of omphalocele-hypospadias: trisomy 13, trisomy 18, trisomy 21, 45X, 47XXY and 47XXX, Beckwith-Wiedemann syndrome, and 2q22.1q22.3 deletion. According to our complex investigations, the omphalocele, bifid scrotum, hypospadias and micropenis, in the case of our patient, were isolated, despite literature findings. In the absence of associated major structural or genetic abnormalities, the management was conservative, with a good outcome. Conclusions. Structural anomalies can often appear alone, spontaneously or in association with other structural anomalies as part of syndromes. According to the detailed prenatal and postnatal evaluation, micropenis-hypospadias and omphalocele associations were isolated in our case, despite the literature findings. Fetal growth and well-being should be monitored, as intrauterine fetal growth restriction may occur. [ABSTRACT FROM AUTHOR]

Introduction. Caesarean scar pregnancy (CSP) is a life-threatening and iatrogenic disease due to the rising number of caesarean sections (CS) in the last decades. The most practical and effective technique for the early diagnosis of CSP is transvaginal ultrasound (TVUS), complemented with color Doppler. The optimal approach is yet to be standardized. Methodology. This is a monocentric, prospective, observational study performed in the one tertiary hospital - the prenatal unit of the County Emergency Clinical Hospital Craiova and Medgin/GinEcho Clinic Craiova. The study enrolled four patients, based on specific inclusion criteria: diagnosis of CSP using transvaginal ultrasound. We described the particularities of the conservative therapeutic approach in those cases correlated with the data from the literature. Results. Four CSP cases were identified during 2022-2023 at the standard dating scan. The treatment approaches involved conservative local methotrexate associated with various procedures - systemic methotrexate, embolization, Folley catheter compression and eventually aspiration, leading to a decrease of ßHCG levels and to favorable ultrasound findings of pregnancy involution, indicating positive outcomes. Conclusions. Caesarean scar pregnancy is an increasing pathology worldwide. The management of CSP represents a challenge that should be individualized and sometimes assessed by a multidisciplinary team for the safest therapeutic option. [ABSTRACT FROM AUTHOR]

Endometrial polyps (EPs) are a common benign gynecologic condition associated with abnormal uterine bleeding (AUB), infertility and recurrent pregnancy loss. Transvaginal ultrasound (TVU) provides an excellent diagnostic technique to identify the size and the anatomic location of endometrial polyps. Its accuracy increases when color Doppler, 3D investigation and saline-infused sonohysterography are used. However, hysteroscopy showed the highest diagnostic accuracy in infertile patients with suspected endometrial polyps and provides a safe and feasible opportunity for EPs removal. Objectives. This study aims to demonstrate the effectiveness of hysteroscopic polyps' removal in infertile young female patients. Methodology. This study, conducted over a period of one year, included women who addressed our clinic for infertility. These patients were clinically examined and evaluated using transvaginal ultrasound (TVUS). Hysteroscopy was performed on all cases where TVUS raised the suspicion of endometrial polyps. Additionally, the incidence of pregnancies obtained within the first 12 months after the hysteroscopic removal of endometrial polyps was recorded. Results. Out of the cohort of 97 infertile patients, endometrial polyps were suspected in 33 patients. Before hysteroscopy, seven patients additionally underwent a sonohysterography (SHG) procedure. Abnormal uterine bleeding was the primary clinical manifestation (21 cases; 63.63%). EPs were histologically confirmed in 31 cases, and leiomyoma, in two cases. Of the 31 EPs cases, in 20 cases (64.51%) the localization was at the utero-tubal junction. Out of the 30 patients diagnosed with EPs and where the follow-up was possible, 18 individuals, constituting 60% of the group, successfully attained intrauterine pregnancies within the initial 12 months following their hysteroscopic procedure. Conclusions. Our study revealed a significant improvement in reproductive outcomes within the first year following EP resection. The prevalence of endometrial polyps has increased due to improved ultrasound techniques. SHG can potentially increase the ultrasound detection of endometrial polyps, especially in cases where the imagistic information is unclear. Nonetheless, hysteroscopy, known for its high diagnostic accuracy, remains the gold standard. Our research supports the importance of hysteroscopy for uterine cavity assessment and lesion management, and it highlights the increased chances of pregnancy after the lesion's removal. [ABSTRACT FROM AUTHOR]

Objective. Evaluation of Intraplacental Villous Artery Doppler (IPVA) as a predictive factor compared to umbilical artery (UA) Doppler in placenta-mediated disease (PMD). Methods. This prospective study included a group of 106 pregnant women, of which 76 patients constituted the PMD group: preeclampsia (PE) and small for gestational age (SGA), and 30 pregnant women constituted the control group. IPVA and UA Doppler evaluation was performed in 2 pregnancy periods: 20.0-23.6 weeks, and 28.0-32.6 weeks of gestation. Results. From the study of maternal characteristics and risk factors for the presented pathology, we found that no studied risk factor was statistically involved in the evolution toward PMD during pregnancy. In the control group, we noticed a decrease in IPVA PI and RI, along with an increase in gestational age, while in the PMD group, these indices increased. Both in the 2nd and the 3rd trimester, we had a significant statistical difference between the two groups (p<0.001). Regarding the degree of prediction of the changes that occurred at this level, we found a good statistical correlation. A higher degree of positive predictability is noted, for IPVA-PI, but also for UA-PI, but with better sensitivity (72.27%) for UA PI in the 2nd trimester. Conclusions. We can conclude that both Doppler measurements, IPVA and UA can be used to evaluate and detect pregnancy complications that belong to PMD, preeclampsia, and/or fetal growth restriction. [ABSTRACT FROM AUTHOR]

Placental morphology is very important in both single and multiple pregnancies. It can dictate certain aspects such as: fibrin depositions, calcifications, infarctions, type of vascularization, which can be directly related to placental weight and implicitly to foetal weight, both in single and twin pregnancy. Our study highlighted the macroscopic morphological aspects and through the classical and immunohistochemical colours the microscopic placental morphological aspects, both in single and in dichorionic diamniotic twin pregnancy and showed that the placenta of the foetuses from the twin pregnancy has a higher vascular density compared to the single pregnancy, and the areas of placental fusion are poor in blood vessels, but rich in fibrin depositions, calcifications and placental infarctions. We also pointed out that maternal weight can increase with age, foetal weight can be directly proportional to maternal weight, as well as placental weight is directly proportional to foetal weight and implicitly to maternal weight, but in terms of vascularization, we observed that there is an inversely proportional connection between placental, foetal weight and vascular density. [ABSTRACT FROM AUTHOR]

It is widely accepted that thrombophilia in pregnancy greatly increases the risk of venous thromboembolism. Pregnancy complications arise, at least partly, from placental insufficiency. Any change in the functioning of the gestational transient biological system, such as inherited or acquired thrombophilia, might lead to placental insufficiency. In this research we included 64 pregnant women with trombophilia and 70 cases of non-trombophilic pregnant women, with or without PMPC, over a two-year period. The purpose of this multicenter case-control study is to analyze the maternal-fetal management options in obstetric thrombophilia, the impact of this pathology on the placental structure, and the possible correlations with placenta-mediated pregnancy complications. Maternalfetal management in obstetric thrombophilia means preconceptional or early diagnosis, prevention of pregnancy morbidity, specific therapy as quickly as possible, and fetal systematic surveilance to identify the possible occurrence of placenta-mediated pregnancy complications. [ABSTRACT FROM AUTHOR]

Introduction. Adnexal masses (AM) detected during pregnancy require a prompt and accurate diagnosis to ensure fetal safety and good outcomes. Adnexal masses in pregnant women are most commonly detected during ultrasonographic (US) examination, routinely performed early in pregnancy. The incidence of adnexal masses in pregnancy has a rate of 0.01-15%. Obstetricians should decide between expectant management with a risk of rupture, torsion, need for emergent surgery, labor obstruction and progression of malignancy, or surgical removal during pregnancy. We present a case report of unilateral adnexal mass diagnosed early in pregnancy. Materials and method. A 24-year-old female patient addressed an obstetrics-gynecology private practice for dating a first pregnancy. A single intrauterine sevenweek viable pregnancy was confirmed with a corpus luteum present in the right ovary. The examination of the left adnexa found an unilocular tumor of 18-20 cm, with no papillary structures, no solid components or acoustic shadows. There was no ascites, nor increased blood flow to the tumor. The imagistic criteria pleaded for a benign huge ovarian cyst. Results. In the second trimester, about 20 weeks of gestation, after proper counselling, we decided to perform open surgery to remove the adnexal mass. Intraoperatively, we were not able to find any normal ovarian tissue. We performed a unilateral adnexectomy. The patient was discharged 48 hours later, with no complications and no symptoms at all. Conclusions. The complex diagnosis of adnexal masses in pregnancy is now accessible due to clear and specific US guidelines that help differentiate between benign and malignant masses. The management of adnexal masses during pregnancy is still a subject of debate, with no consensus regarding the best management plan. Tumor size, nature, location, symptomatology and the first trimestre mass detection are all crucial aspects for a proper care. [ABSTRACT FROM AUTHOR]

Introduction. One of the most significant factors contributing to major obstetric hemorrhage is placenta accreta spectrum (PAS). The incidence of PAS is increasing, being now approximately 3 per 1000 deliveries, due to the epidemic rise of caesarean section (CS) rate and to pregnancies resulting from assisted reproductive technology. This pathologic adherence of the placenta to the uterine myometrium can be associated with significant maternal-fetal risks. The antenatal diagnosis includes ultrasonographic (US) assessment and magnetic resonance imaging (MRI) spectrum, but still remains imperfect. This paper aims to offer a short review regarding the proper evaluation and management of PAS. In addition, we present our clinic experience with placenta accreta in the last year. Methodology. We conducted a PubMed search including reviews, case reports and original papers regarding PAS in the last 10 years. We also performed a 12-month retrospective study that included 42 pregnant women, aged between 18 and 46 years old. The inclusion criteria were: bleeding during the third trimester of pregnancy and history of caesarean section delivery. Results and discussion. All patients benefited from a transvaginal and transabdominal US. All suspected PAS cases were evaluated using the new International Federation of Gynecology and Obstetrics (FIGO) classification. Two patients also benefited from an MRI examination and cystoscopy due to high suspicion of PAS. In two cases, the delivery was followed by a hysterectomy. In three cases, the caesarean section was complicated by postpartum hemorrhage, yet controlled with ligation of the uterine artery unilateral or bilateral. Conclusions. Placenta accreta spectrum is impacting maternal health outcomes globally and should be managed by experienced multidisciplinary teams. The correct antenatal diagnosis of PAS includes a combination of ultrasound, MRI examination and cystoscopy. Hysterectomy is the accepted management of PAS, and the conservative or expectant management of placenta accreta spectrum should be considered investigational. [ABSTRACT FROM AUTHOR]

Introduction. One of the most significant factors contributing to major obstetric hemorrhage is placenta accreta spectrum (PAS). The incidence of PAS is increasing, being now approximately 3 per 1000 deliveries, due to the epidemic rise of caesarean section (CS) rate and to pregnancies resulting from assisted reproductive technology. This pathologic adherence of the placenta to the uterine myometrium can be associated with significant maternal fetal risks. The antenatal diagnosis includes ultrasonographic (US) assessment and magnetic resonance imaging (MRI) spectrum, but still remains imperfect. This paper aims to offer a short re view regarding the proper evaluation and management of PAS. In addition, we present our clinic experience with placenta accreta in the last year. Methodology. We conducted a PubMed search including reviews, case reports and original papers regarding PAS in the last 10 years. We also performed a 12 month retrospective study that included 42 pregnant women, aged between 18 and 46 years old. The inclusion criteria were: bleeding during the third trimester of pregnancy and history of caesarean section delivery. Results and discussion. All patients benefited from a transvaginal and transabdominal US. All suspected PAS cases were evaluated using the new International Federation of Gynecology and Obstetrics (FIGO) classification. Two patients also benefited from an MRI examination and cystoscopy due to high suspicion of PAS. In two cases, the delivery was followed by a hysterectomy. In three cases, the caesarean section was complicated by post partum hemorrhage, yet controlled with ligation of the uterine artery unilateral or bilateral. Conclusions. Placenta accreta spectrum is impacting maternal health outcomes globally and should be managed by experienced multidisciplinary teams. The correct antenatal diagnosis of PAS includes a combination of ultrasound, MRI examination and cystoscopy. Hysterectomy is the accepted management of PAS, and the conservative or expectant management of placenta accreta spectrum should be considered investigational. [ABSTRACT FROM AUTHOR]

Introduction. Adnexal masses (AM) detected during pregnancy require a prompt and accurate diagnosis to ensure fetal safety and good outcomes. Adnexal masses in pregnant women are most commonly detected during ultrasonographic (US) examination, routinely performed early in pregnancy. The incidence of adnexal masses in pregnancy has a rate of 0.01 15%. Obstetricians should decide between expectant management with a risk of rupture, torsion, need for emergent surgery, labor obstruction and progression of malignancy, or surgical removal during pregnancy. We present a case report of unilateral adnexal mass diagnosed early in pregnancy. Materials and method. A 24 year old female patient addressed an obstetrics gynecology private practice for dating a first pregnancy. A single intrauterine seven week viable pregnancy was confirmed with a corpusluteum present in the right ovary. The examination of the left adnexa found an unilocular tumor of 18 20 cm, with no papillary structures, no solid components or acoustic shadows. There was no ascites, nor increased blood flow to the tumor. The imagistic criteria pleaded for a benign huge ovarian cyst. Results. In the second trimester, about 20 weeks of gestation, after proper counselling, we decided to perform open surgery to re move the adnexal mass. Intraoperatively, we were not able to find any normal ovarian tissue. We performed a unilateral adnexectomy. The patient was discharged 48 hours later, with no complications and no symptoms at all. Conclusions. The complex diagnosis of adnexal masses in pregnancy is now accessible due to clear and specific US guidelines that help differentiate between benign and malignant masses. The management of adnexal masses during pregnancy is still a subject of de bate, with no consensus regarding the best management plan. Tumor size, nature, location, symptomatology and the first trimestre mass detection are all crucial aspects for a proper care. [ABSTRACT FROM AUTHOR]

Objective. The main objective of our study was to demonstrate the potential of the first-trimester anomaly scan to identify components of the portal venous system (PVS), and to describe the potential of microscopic evaluation of the PVS in the FT. Materials and method. We evaluate the appearance of PVS in 200 scan examinations performed in fetuses between 12 and 13.6 gestational weeks (GW). The scans were performed in half of the cases by two operators who had extensive experience in obstetric ultrasound (Group I) and in the other half of the cases by two sonographers with less experience (Group two). The examinations were performed via transabdominal and, in selected cases, via transvaginal approaches. We performed macroscopic and microscopic examination of the liver in one case of interrupted pregnancy. Results. Group I successfully assessed all PVS features by transabdominal approach in 27% of the cases. The assessment rate was lower for Group II (14%). The transvaginal approach or reschedule showed a better rate of detection for both groups (88% in Group I and 72% in Group II). Unfavorable fetal position, BMI greater than 24, abdominal scar, retroverted uterus, fibroids and combinations of the above were reasons for the reschedule or using the transvaginal approach. Following reevaluations, the rate of detection of the L-shaped UV confluence increased from 91% to 98% in Group I, and from 79% to 95% in Group II, on transabdominal approach. The visualization of a normal L-shaped UV confluence, that excludes major PVS abnormalities, is achievable in approximately 80% of cases, regardless the examiners experience. The microscopic examination confirmed the normal aspect of portal venous system. Conclusions. Early fetal PVS assessment is feasible. The experience of the sonographer, uterus anomalies or the Body Mass Index (BMI) may be factors that affect the rate of detection. Combining the abdominal and vaginal approach or rescanning, a higher rate can be achieved. The first-trimester pathology can be performed only microscopically. [ABSTRACT FROM AUTHOR]

Objective: To investigate the feasibility of the first trimester (FT) ultrasound scan (US) for the evaluation of the fetal portal venous system (PVS) anatomy, and to evaluate the potential of microcopy for a proper pathology evaluation for the PVS in the FT. Methods: We evaluated the PVS in 200 scan examinations performed in FT pregnancy. Half of the cases were scanned by two operators with extensive experience in obstetric ultrasound—Group I, and the other half was evaluated by two sonographers with less experience—Group II. Second-trimester US and autopsy in terminated pregnancies were used as follow-up. The pathologic evaluation was supported by microscopy. Results: all PVS features were successfully assessed by transabdominal ultrasound (TAUS) in 27% of the Group I cases and 14% in Group II. These rates increased to 88% in Group I and in 72% in Group II, after rescanning and using transvaginal ultrasound (TVUS). The conditions that led to rescanning and TVUS were: BMI greater than 24 in 26% cases, unfavorable fetal position (12.32%), retroverted uterus (12.32%), abdominal scar (10.96%), fibroids (4.11%), and combinations of the above (34.23%). The L-shaped UV confluence was identified transabdominally in 91% in Group I and in 79% in Group II and increased to 98% and 95%, respectively, following reevaluations. Microscopy represented a useful audit in all FT investigated cases. Conclusions: At the end of the FT, the visualization of a normal L-shaped UV confluence, that excludes major PVS abnormalities, is achievable in approx. 80%, indifferently the examiners experience. The sonographers experience, pregnant women BMI, and uterine anomalies as fibroids or retroversion significantly affect the rate of visualization, and necessitates vaginal approach and reexamination. The FT pathology, the audit of the ultrasound findings can only be performed microscopically, with relatively little resources involved and good results. [ABSTRACT FROM AUTHOR]

Diabetes is the most common medical complication associated with pregnancy. During pregnancy complicated with maternal diabetes (DM), the placenta suffers certain pathological, functional and structural changes. DM was correlated with a rapid progressive microangiopathy and this, in turn, may be associated with capillary hypertension and changes in capillary permeability. The objective of the study is to identify the clinical correlations with influence on gestation in general, and on the placental structure in particular, in pregnancy associated with type 1 (T1DM), type 2 (T2DM) and gestational diabetes mellitus (GDM). The impact of the clinical conditions associated with DM on placenta has been analyzed and correlated with the ultrasound (US), morphological, histological and immunohistochemical study of the placental structure. Preexisting maternal hypertension, preeclampsia and obesity were the main associated conditions. The US examination of placental characteristics revealed an increase in placental thickness in the second trimester. The macroscopic analysis showed that the placentas of women with diabetes are heavier. Gross pathological analysis of maternal and fetal surfaces of placentas revealed subcortical or basal plaque fibrin deposition, and placental infarction or intervillous thrombosis. From the microscopic point of view, the findings include fibrinoid necrosis, intervillous fibrosis, focal hyaline degeneration, villous immaturity, chorangiosis, placental calcifications, placental infarction or decidual vasculopathy. Maternal hypertensive disorders amplify the spectrum of morphological changes in the placenta. Placental immaturity and villous capillary dysfunction are characterized by increased angiogenesis and enhanced vascular permeability. The diabetic placenta does not show specific changes, but different associations may be a diabetic pathological pattern influenced by associated conditions, especially preeclampsia, obesity, dyslipidemias and the lack of euglycemia during pregnancy. [ABSTRACT FROM AUTHOR]