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Preterm delivery is strongly associated with neurological impairments, such as cerebral palsy (CP), motor dysfunction, blindness, developmental delay and intellectual impairment. Antenatal administration of magnesium sulfate (MgSO4) has become a valuable approach of the neuroprotective strategy for preterm births. MgSO4 can prevent excitotoxicity via N-methyl-D-aspartic acid (NMDA) receptor antagonistic action and has an anti-inflammatory effect. There is still no international consensus on the dosage, time of administration and the need to repeat MgSO4 treatment. However, most studies report benefits for ≤31+6 weeks of gestation (GW) and imminent preterm birth, defined as active labor with ≥4 cm cervical dilation with either failure or contraindication to tocolysis, ≥4 cm dilatation with documented progressive change in cervical dilation, preterm pre-labor rupture of membranes with active labor, and for planned delivery for fetal or maternal indications. MgSO4 is recommended in a loading dose of 4 g intravenously (i.v.) for 30 minutes, followed by a 1 g/hour i.v. maintenance infusion for maximum 24 hours. It has been shown a significantly reduced rate of moderate and severe CP for the premature receiving MgSO4, but also a lower rate of motor dysfunction and a lower systemic vascular resistance and higher myocardial function in preterm infants born before 29 WG. One the other hand, several side effects have been reported and should be closely monitored. Maternal side effects include hypotension, tachycardia, respiratory depression, drowsiness, headache and muscle weakness. One trial reported a higher incidence of spontaneous intestinal perforation among extremely low birth weight infants. In conclusion, antenatal MgSO4 administration is a first step in preventing neurological damage, but further studies are mandatory to standardize its use. [ABSTRACT FROM AUTHOR]

Introduction. The etiology of embryonic demise is multifactorial, with chromosomal abnormalities being the most common (60%). The purpose of this study is to evaluate the correlation between a serum biomarker, placental growth factor (PlGF), and an ultrasonographic parameter, the distance between yolk sac (YS) and embryo (DYSE), in assessing the prognosis of pregnancy evolutivity in the first trimester. Method. The study is a case-control prospective analysis that includes two groups of patients: 81 patients with first-trimester pregnancy in evolution, and 89 patients with embryonic demise, all of the patients having amenorrhea between 6 and 11 weeks. The endovaginal ultrasonographic exploration was performed to evaluate the distance between the lower pole of the embryo and the yolk sac. From each subject enrolled in the study, 20 ml of blood was collected for PlGF dosing. Results. Regarding the DYSE in the case group, lower values were observed compared to the control group, the difference being statistically significant. In the statistical analysis of serum PlGF values, statistically significant differences were observed between the two groups (p<0.0001). Conclusions. DYSE has a high positive predictive value in identifying pregnancies with potentially reserved evolutivity, this study demonstrating that a DYSE<3 mm may lead to an unfavorable evolution of pregnancy. The low serum level of PlGF is associated with an increased rate of nonviable embryos. [ABSTRACT FROM AUTHOR]

Preeclampsia is a multisystemic disease, with a prevalence of 2-5%, that affects pregnant women. Every year, 76,000 women and 500,000 fetuses die due to the complications of this pathology. The prenatal screening for preeclampsia is constantly being updated. Globally, attempts are being made to identify easily reproducible, cost-effective screening markers that determine with great accuracy the patients prone to develop preeclampsia. Thus, there are differences between the described risk factors, the screening and prevention protocols recommended by world-recognized medical associations, such as the International Federation of Obstetrics-Gynecology (FIGO) and the American College of Obstetrics-Gynecology (ACOG). According to the latest FIGO recommendations, all pregnant patients should be screened in the first trimester for preeclampsia, including: maternal risk factors, mean blood pressure, placental growth factor and uterine artery pulsatility index. Patients at increased risk of developing preeclampsia will undergo preventive treatment with aspirin between 11- 14 weeks +/- 6 days and 36 weeks of pregnancy. ACOG presents patients with a history of preeclampsia, multiple pregnancy, chronic hypertension, type 1 or 2 diabetes, kidney disease or autoimmune diseases as having an increased risk of developing preeclampsia and a need for the prophylactic administration of aspirin. There is also a difference between the risk factors presented by the two associations. In conclusion, the determination of screening markers that provide an increased identification of patients at risk of developing preeclampsia, as well as the precise determination of risk factors for preeclampsia are imperative to anticipate and initiate the preventive treatment for women at risk, decreasing the prevalence of the disease, its complications and implicitly the costs. [ABSTRACT FROM AUTHOR]

With the development of ultrasonography, many placental lesions have become detectable since the first trimester of pregnancy. Some of the most common placental lesions diagnosed by ultrasound are hypoechoic images, causing controversy over differential diagnosis and possible damage to the fetus. Placental lakes are anechoic lesions with a diameter ≥1 cm surrounded by placental tissue with normal echogenicity, being frequently diagnosed in the second trimester of pregnancy. Their incidence varies between 2.2% and 17.8%, usually without impact on fetal development. Subchorionic cysts are anechoic lesions, without Doppler signal, that can be detected from the first trimester. Their content differs from amniotic fluid and histologically there are detected perivillous fibrin desposits and X cells. The association with intrauterine growth restriction (IUGR) assumes: cyst count >3, diameter >4.5 cm or their location near the placental cord insertion site (PCIS). Echogenic cystic lesions (ECL) are hypoechoic lesions ≥1 cm in diameter, characterized by an echogenic crown and an irregular border. They may be correlated with IUGR and preeclampsia, histologically identifying predominantly as inter-villous thrombi. Other possible differential diagnoses should be considered: chorioangiomas, hydatiform moles, placenta accreta, and "vanishing twin". In conclusion, a wide range of placental lesions can be detected by ultrasound, with a variable echo over the development of the fetus. The antenatal diagnosis of these entities is of particular importance. [ABSTRACT FROM AUTHOR]

The umbilical cord and placenta may be the site of tumor development, sometimes jeopardizing the physiological development of the fetus. The umbilical cord becomes detectable on ultrasound from 7-9 weeks of gestation, initially as a thickened and straight structure, which increases in length and acquires a spiral shape. Umbilical cord cysts are rare abnormalities detected incidentally during routine ultrasounds. These can be classified as true cysts or pseudocysts, the final diagnosis being represented by the histopathological examination, which describes an epithelial layer in the case of true cysts. Pseudocysts are more frequently associated with trisomy 18 and 13, the risk of malformations being higher if the lesion is multiple, persists after 12 weeks of amenorrhea if the localization is paraxial; at the fetal or placental insertion of the cord. The placenta may also present various tumors. Subchorionic cysts have a 5-7% incidence, arising on the fetal placental face as anechoic images without Doppler signal. It is considered that their localization near the placental cord insertion site (PCIS) can result in intrauterine growth restriction. Other placental tumors include echogenic cystic lesions, placental lakes, chorioangiomas, hydatiform moles. The antenatal diagnosis should include investigations aimed at detecting the possible association with chromosomal abnormalities. Thus, we present the case of a 29-yearold primiparous, which, at 12 weeks of amenorrhea, it was detected a 2.5-cm diameter cyst located near the PCIS, increasing in dimensions up to 5 cm diameter at 16 weeks of amenorrhea, then having a steady evolution. The fetal development has not been affected, the histopathological examination describing the lesion as a subchorionic cyst. [ABSTRACT FROM AUTHOR]