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Advancements in ultrasound technology and the integration of cell-free DNA testing into standard prenatal screening services have made it more feasible to identify fetal sex at an early stage. Fetal sex determination through sonography relies on different factors, depending on the gestational stage. In the late second trimester, it is determined by directly visualizing the external genitalia. However, in the late first and early second trimesters, it primarily relies on the direction of the genital tubercle, known as the sagittal sign. Other sonographic landmarks, like the fetal scrotum, midline raphe of the penis, labial lines, uterus, descended testis, and the direction or origin of the fetal micturition jet in males, can aid in the fetal sex determination accuracy. However, malformed external genitalia can lead to inaccurate results. This article focuses on the sonographic determination of fetal sex during the late first trimester, early second trimester and late second trimester, utilizing both transvaginal and transabdominal ultrasound techniques. Additionally, we explore various elements that have contributed to the precision of fetal sex determination. While ultrasound examination of the external genitalia is typically sufficient, there are certain situations where it becomes crucial to identify the internal genitalia for precise prenatal diagnosis and thorough counseling. This paper aims at reviewing these situations in which the evaluation of the external genital organs is necessary, as well as the ways in which ultrasound can be used in the diagnosis of genital malformations. [ABSTRACT FROM AUTHOR]

Pregnancy is a period characterized by numerous alterations of the body, to provide a proper environment for newborn development and growth and optimal conditions for the natural delivery. The changes that take place at the musculoskeletal system are subsequent to the increase in the ligament laxity secondary to hormonal changes, especially relaxin, and due to weight gain, which is predominantly distributed at the abdominal level, with the anteriorly movement of the center of gravity. The curvatures of the spinal column changes, with the accentuation of the lumbar lordosis and compensatory modifications at cervical and thoracic levels in order to facilitate the ambulation of the pregnant woman with a minimum risk of falls. The pelvic girdle adapts for natural delivery, with higher diameters due to an increased mobility in the sacroiliac and pubic articulations. Hydro saline retention may be accompanied by edema and secondary compression of the nervous structures, determining paresthesia and pain. It is important to know how these mechanisms work, because the common element is pain, which leads to invalidation and a decrement of the life quality, to provide with an adapted management, especially because the therapeutic resources are limited in pregnancy. [ABSTRACT FROM AUTHOR]

Lactation provides for the newborn the proper quantity and quality of food. There are no alimentary restrictions for the mother in the lactating period, but in case of complications such as obesity or gestational diabetes, nutrition counseling is necessary. The milk demand of the infant dictates the mother’s capacity of milk production and is influenced by age, growth rate and by any other medical conditions. Breastfeeding offers optimal nutritional intake, even when the mother’s food intake is limited, except for the case when the mother has a chronically deficient diet. Energy requirement depends on maternal age, weight, height and level of physical activity, alongside the necessary elements for milk synthesis. The micronutrients and macronutrients requirements depend on the maternal nutritional status, the mobilization of tissue deposits and on their rate in milk secretion, in order to provide a proper growth and development of the newborn. Weight gain or loss in lactation is similar as in nonpregnant women, but weight loss after pregnancy is influenced by factors such as weight before pregnancy, age, parity, race, smoking status, the amount of physical exercises and if the mother returns to work outside her home. Special situations such as multiple gestations, obesity or recent bariatric surgery require support and encouragement for a proper breastfeeding. [ABSTRACT FROM AUTHOR]

Lactation provides for the newborn the proper quantity and quality of food. There are no alimentary restrictions for the mother in the lactating period, but in case of complications such as obesity or gestational diabetes, nutrition counseling is necessary. The milk demand of the infant dictates the mother’s capacity of milk production and is influenced by age, growth rate and by any other medical conditions. Breastfeeding offers optimal nutritional intake, even when the mother’s food intake is limited, except for the case when the mother has a chronically deficient diet. Energy requirement depends on maternal age, weight, height and level of physical activity, alongside the necessary elements for milk synthesis. The micronutrients and macronutrients requirements depend on the maternal nutritional status, the mobilization of tissue deposits and on their rate in milk secretion, in order to provide a proper growth and development of the newborn. Weight gain or loss in lactation is similar as in nonpregnant women, but weight loss after pregnancy is influenced by factors such as weight before pregnancy, age, parity, race, smoking status, the amount of physical exercises and if the mother returns to work outside her home. Special situations such as multiple gestations, obesity or recent bariatric surgery require support and encouragement for a proper breastfeeding. [ABSTRACT FROM AUTHOR]

Pregnancy is a period characterized by numerous alterations of the body, to provide a proper environment for newborn development and growth and optimal conditions for the natural delivery. The changes that take place at the musculoskeletal system are subsequent to the increase in the ligament laxity secondary to hormonal changes, especially relaxin, and due to weight gain, which is predominantly distributed at the abdominal level, with the anteriorly movement of the center of gravity. The curvatures of the spinal column changes, with the accentuation of the lumbar lordosis and compensatory modifications at cervical and thoracic levels in order to facilitate the ambulation of the pregnant woman with a minimum risk of falls. The pelvic girdle adapts for natural delivery, with higher diameters due to an increased mobility in the sacroiliac and pubic articulations. Hydro saline retention may be accompanied by edema and secondary compression of the nervous structures, determining paresthesia and pain. It is important to know how these mechanisms work, because the common element is pain, which leads to invalidation and a decrement of the life quality, to provide with an adapted management, especially because the therapeutic resources are limited in pregnancy. [ABSTRACT FROM AUTHOR]

Intrauterine growth restriction or fetal growth restriction represents a fetal incapacity of achieving its entire growth potential in intrauterine life, as a result of maternal, fetal and/or placental causes, from hypertension, autoimmune diseases, drug consumption, hereditary thrombophilia to genetic syndromes, intrauterine infections, umbilical cord anomalies or placental insufficiency. The ultrasonographic evaluation of the fetus with intrauterine growth restriction identifies an estimated fetal weight or a fetal abdominal circumference below the 10 th percentile for gestational age; a severe fetal growth restriction is defined as an estimated fetal weight below the 3rd percentile. The Delphi consensus managed to classify fetal growth restriction as early, being diagnosed under 32 weeks of gestation, respectively late, after 32 weeks of gestation. Up to 10% of pregnancies are complicated by fetal growth restriction, which are then considered high-risk pregnancies for the morbidity and mortality risk carried for the fetus, requiring an accurate diagnosis of the cause, intensifying the fetal monitoring and timing the birth, in order to deliver the fetus in safe conditions. This paper proposes an algorithm for an initial evaluation of fetal growth restriction, with the aim of simplifying the medical approach when encountering a fetus with intrauterine growth restriction, in order to improve morbidity and mortality rates among pregnancies complicated by fetal growth restriction. [ABSTRACT FROM AUTHOR]

Fetal alcohol spectrum disorders (FASD) are preventable conditions secondary to the mother’s consume of alcohol during pregnancy, and include fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol-related birth defects and alcohol-related neurodevelopmental disorder. Their prevalence is not exactly known, due to a lack of knowledge regarding the correct diagnosis and due to the pregnant women’s alcohol consumption concealment, but the estimation is that one in ten pregnant women continue to drink during pregnancy. The importance of this group of disorders is represented by the involvement of the development and functioning of the central nervous system and due to predisposition of the product of conception to alcohol dependence in adulthood. FASD management involves prevention and treatment which are important to be initiated as early as possible. Prevention recommendations include cessation of alcohol consumption, nutritional supplementation and complications’ treatment, such as “secondary disabilities”, that include inappropriate sexual behavior, disrupted school experience, trouble with the law and incarceration, homelessness, unemployment, and chronic mental health problems. By offering an early diagnosis, a stable and nurturing living environment, along with the absence of exposure to physical, sexual or other types of violence, the eligibility for social and educational services is essential. Thus, prevention is the main key in the FASD management, alongside the screening to identify the high-risk pregnant females and their referral to appropriate programs. [ABSTRACT FROM AUTHOR]

Fetal alcohol spectrum disorders (FASD) are preventable conditions secondary to the mother’s consume of alcohol during pregnancy, and include fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol-related birth defects and alcohol-related neurodevelopmental disorder. Their prevalence is not exactly known, due to a lack of knowledge regarding the correct diagnosis and due to the pregnant women’s alcohol consumption concealment, but the estimation is that one in ten pregnant women continue to drink during pregnancy. The importance of this group of disorders is represented by the involvement of the development and functioning of the central nervous system and due to predisposition of the product of conception to alcohol dependence in adulthood. FASD management involves prevention and treatment which are important to be initiated as early as possible. Prevention recommendations include cessation of alcohol consumption, nutritional supplementation and complications’ treatment, such as “secondary disabilities”, that include inappropriate sexual behavior, disrupted school experience, trouble with the law and incarceration, homelessness, unemployment, and chronic mental health problems. By offering an early diagnosis, a stable and nurturing living environment, along with the absence of exposure to physical, sexual or other types of violence, the eligibility for social and educational services is essential. Thus, prevention is the main key in the FASD management, alongside the screening to identify the high-risk pregnant females and their referral to appropriate programs. [ABSTRACT FROM AUTHOR]

Umbilical cord cysts are rare anomalies, being associated in the first trimester most often with chromosomal defects or structural anomalies, while in the second and third trimesters, they are associated with urachal abnormalities. Umbilical cord cysts remain a pathology that could endanger the fetus by a rapid growth that could cause umbilical cord compression followed by fetal distress, torsion or thrombosis, with unfavorable consequences. We present the case of a pregnant patient diagnosed in the second trimester with umbilical cord cyst localized at the placental site of the umbilical cord, with a low-risk noninvasive prenatal test performed in the first trimester, with no other structural anomalies, who delivered a healthy baby at term. The intraoperative findings included the presence of an abnormally adherent placenta, respectively placenta accreta, in a patient with no surgical or obstetrical risk factors. The pathology report revealed an umbilical cord hematoma. The aim of this article is to debate whether an umbilical cord hematoma could be a marker for placental abnormalities. [ABSTRACT FROM AUTHOR]

Brest cancer represents the most common cancer worldwide, being the second deadliest cancer in women. There is no doubt regarding the importance of breast cancer screening. Mammography represents the primary imaging technique used to detect suspicious lesion for breast cancer. This imagistic method has been found to decrease the mortality related to breast cancer. Mammography may detect evidence of cancer one and a half to four years before cancer becomes clinically obvious. Patients with breast tissue augmentation need a routine screening mammography in order to evaluate the native breast tissue. The indications for breast cancer screening are the same as in women without implants, the only difference being that women with breast implants should be approached differently from a clinical point of view. Standard imaging technique for this type of patients involves four sections in alternative of the usual two sections per breast. In conclusion, women with breast augmentation should not be neglected and should undergo breast cancer screening alongside the targeted population, even though the required technique is more laborious and requires a more experienced eye. [ABSTRACT FROM AUTHOR]

The increase in the number of microorganisms that cause maternal-fetal infections has led to the need to update the acronym TORCH (Toxoplasma, Others, Rubella, Cytomegalovirus, Herpes) to SCRATVHEZ (Syphilis, Cytomegalovirus, Rubella, AIDS, Tuberculosis, Varicella, Herpes, Enterovirus, Zika). The multiple routes of transmission (transplacental, intrapartum, breast milk or posttransfusion), the multitude of microorganisms generating various and complex complications – from quasi-asymptomatic diseases to intrauterine growth restriction, neurological sequelae and to fetal death, the treatment that varies from case to case, between symptomatic and etiological and the possibility of preventing infections, outline their complexity and importance. A complete and correct early diagnosis involves clinical, biological and serological evaluation from the prenatal period, in order to prevent the evolution of infections, especially in the case of those in which there is an etiological treatment. The importance of knowing these infections and the effort to prevent their transmission, in order to limit the development of the consequences they can cause, are key elements in the optimal management of a pregnancy. [ABSTRACT FROM AUTHOR]

The increase in the number of microorganisms that cause maternal-fetal infections has led to the need to update the acronym TORCH (Toxoplasma, Others, Rubella, Cytomegalovirus, Herpes) to SCRATVHEZ (Syphilis, Cytomegalovirus, Rubella, AIDS, Tuberculosis, Varicella, Herpes, Enterovirus, Zika). The multiple routes of transmission (transplacental, intrapartum, breast milk or posttransfusion), the multitude of microorganisms generating various and complex complications – from quasi-asymptomatic diseases to intrauterine growth restriction, neurological sequelae and to fetal death, the treatment that varies from case to case, between symptomatic and etiological and the possibility of preventing infections, outline their complexity and importance. A complete and correct early diagnosis involves clinical, biological and serological evaluation from the prenatal period, in order to prevent the evolution of infections, especially in the case of those in which there is an etiological treatment. The importance of knowing these infections and the effort to prevent their transmission, in order to limit the development of the consequences they can cause, are key elements in the optimal management of a pregnancy [ABSTRACT FROM AUTHOR]

Transvaginal ultrasound and serum concentration of human chorionic gonadotropin are the main methods of prognostic evaluation of early pregnancies. Although these pregnancy investigation methods have proven their benefits, the interpretation is fundamental for a correct diagnosis, in order to avoid interventions that may affect pregnancies that would normally have had a physiologic course, as well as to apply an appropriate management in the case of nonviable pregnancies. Recent studies have shown the need to adopt rigorous criteria that minimize false positive results and thus decrease the frequency of diagnostic errors. Over time, a series of ultrasound features have been described which have proven effective in predicting nonviable pregnancies in the first trimester (cranio-caudal length in relation to the presence or absence of cardiac activity, yolk sac diameter, gestational sac diameter in relation to presence or absence of embryo with cardiac activity, embryonic heart rate, subchorionic hematoma etc.). In the context of the new prospects for the development of artificial intelligence softwares, the present work focuses on the description of the precise ultrasonographic aspects aboded by the latest studies that propose certain cut-off values dependent on the gestational age of the ultrasound parameters in the first trimester, increasing the sensitivity and the specificity of ultrasound in the diagnosis of nonviable early pregnancies, thus aiming to improve the reproductive prognosis of couples with recurrent abortions. [ABSTRACT FROM AUTHOR]

During pregnancy, gestational diabetes is the most common metabolic disorder, characterized by altered glucose tolerance. The prevalence of gestational diabetes is increasing, which is linked to the rise in maternal obesity rates in recent years. Despite numerous large-scale studies on the topic, there is still ongoing debate about the screening and treatment of gestational diabetes. The fetal and neonatal complications associated with gestational diabetes include fetal macrosomia, hyperinsulinemia, hypoglycemia, hypocalcemia, neonatal hyperbilirubinemia, increased risk of respiratory distress, and shoulder dystocia, especially in macrosomic babies. Additionally, children born to diabetic mothers are at a higher risk of developing obesity and diabetes in adolescence and adulthood. Maternal complications of gestational diabetes include an increased risk of developing hypertensive syndromes and the likelihood of requiring a caesarean section. Screening and treatment of gestational diabetes are crucial in ensuring healthy outcomes for both mother and child. In this article, we will explore the importance of early detection and effective management of gestational diabetes, highlighting the benefits of timely intervention, and the potential risks of untreated gestational diabetes. Furthermore, we will present the latest international guidelines and recommendations for the screening and management of gestational diabetes. [ABSTRACT FROM AUTHOR]