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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]

The advantages of earlier diagnosis give the family more time to adjust to the fetal cardiac and related extracardiac diagnoses and to make informed pregnancy decisions. If a severe fetal CHD is detected in the first trimester and pregnancy termination is selected, the intervention may have a lower risk for the mother's physical and mental health. Training medical staff is a crucial part of implementing obstetric ultrasonography services well, since effective patient care depends on their ability to use the equipment skillfully and interpret results properly. In many low-and middle-income nations, there is a scarcity of healthcare professionals trained to offer ultrasound services and one of the reasons for this issue is the lack of available lectures, simulations and instruments to explain how ultrasound sections are acquired. We propose an alternative method of visualizing the ultrasound planes of interest using three-dimensional volumes of fetal hearts reconstructed from seriate histological slices. This method may aid trainees in understanding echocardiography. [ABSTRACT FROM AUTHOR]

Due to rapid technology advancement and increasing diagnostic expertise, fetal medicine is rapidly improving. Prenatal diagnostic advancements made it possible to identify structural abnormalities in fetuses as early as the first trimester of pregnancy. However, to validate the echocardiographic diagnosis that led to the pregnancy termination, the termination of pregnancy owing to severe fetal deformities should be audited in accordance with a correct anatomic diagnosis. Following the PRISMA declaration, a systematic literature search was done to find articles on post-mortem first trimester human fetal heart evaluation. Thirteen suitable studies were found using the search method. It is theoretically possible to examine the human fetal heart after death in early pregnancy however these methods are not widely available due the costs associated with the procedure and the equipment, the effects of tissue coloration and distortion brought on by the fixation and contrasting processes (for micro-CT), the current requirement for a skilled operator to acquire, reconstruct, and process the images, and data storage requirements greater than those of conventional clinical scans. [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]

Background and objectives. The risk of developing invasive cancer increased during the COVID-19 pandemic, especially in Romania, where the incidence of this disease is high due to limited medical education and broad screening. This study’s objective is to analyze the number of patients admitted with different types of cervical dysplasia and the treatment applied for the lesions during the SARS-CoV-2 pandemic compared to the same period for the year before the pandemic. Materials and methods: This is a retrospective study that took place in the Obstetrics and Gynecology Clinics I/II (OG I/II) of the Emergency County Hospital of Craiova during the SARS-CoV-2 pandemic (SP) (15.03.2020–14.03.2021) and in the 12 months before (non-pandemic period) (NPP) (15.03.2019– 14.03.2020). The study includes 396 patients with pathological PAP smear results. All the patients included in this study were clinically examined and with colposcopy. The patients with Low-Grade Dysplasia were managed in a conservatory manner and reevaluated after six months. The patients with High-Grade Dysplasia were admitted for an excisional biopsy of the lesion. The excised fragments were sent to the Pathological Anatomy Laboratory for a histopathological examination. Results: This study reveals a decrease of more than half in the number of patients admitted with cervical intraepithelial neoplasia (CIN) lesions during the pandemic compared to the same period of the year before. The number of biopsies and excisional procedures has been decreasing by more than a factor of three during the pandemic period compared to the year before. Conclusion: During the SARS-CoV-2 pandemic, we found that the patients’ admission rate, diagnosis, and treatment was almost four times lower. As hospital restrictions were not dictated for cancer/precancer management during SP, we may assume that the differences were due to the fear of becoming infected with SARS-CoV-2 due to hospitalization. In the context of poor screening performance and high cervical cancer incidence, the influence of the SP may result in a further increase of severe cases related to this condition. [ABSTRACT FROM AUTHOR]

Right aortic arch (RAA) is an abnormal embryologic development of the aorta characterized by its descendance on the right side of the trachea. This anomaly is accompanied often by other intracardiac and extracardiac anomalies and it is also known for potential association with genetic aberrations, most common being 22q11.2 deletion. The aim of the study was to evaluate the incidence of chromosomal anomalies and in particular 22q11.2 deletion in RAA. Moreover, we assessed the prognosis of fetuses with isolated RAA. Our second objective was to evaluate the prevalence of hypoplastic or absent thymus in RAA fetuses diagnosed with 22q11.2 deletion. We conducted a retrospective study of all fetuses with RAA over a period of 10 years diagnosed prenatally in a tertiary referral center in Romania. A detailed ultrasound was obtained in each case. We extracted the cases that were investigated genetically and selected the cases positive for 22q11.2 deletion. These fetuses were followed up until pregnancy termination or birth to confirm the ultrasound findings. Deletion 22q11.2 was present in 23.52% (4/17) cases. The incidence was particularly high when the fetuses presented a small thymus. In conclusion, we believe that all cases of RAA, including when isolated, should be referred for genetic testing and especially 22q11.2 deletion exclusion. Also, we suggest considering hypoplastic thymus to be a soft marker for this deletion. [ABSTRACT FROM AUTHOR]

Objective. To share our experience in the prenatal diagnosis of agenesis of ductus venosus (ADV) secondary to interrupted inferior vena cava (IIVC) and how does this affect the outcome. Methodology. A prospective study has been conducted in our center regarding the ADV outcome, since October 2016. In all cases, the main features of abdominal fetal circulation were evaluated in all secondtrimester ultrasound scans, including the presence of a normal drainage of the umbilical vein, via ductus venosus, and the normal location of inferior vena cava (IVC). We present an analysis regarding the outcome of the ADV cases secondary to IIVC and we compare our data with those from the literature. Results. A total of five cases with prenatally diagnosed ADV and IIVC were identified. The gestational age at diagnosis ranged from 18 to 27 weeks. Karyotyping was performed in all cases but one, with an abnormal result in one case. Two cases were part of left isomerism syndrome and had an unfavorable outcome. Two cases did not present other anomalies and had a good outcome, according to the neonatal and pediatric cardiology follow-up. Conclusions. Postnatal outcome in cases with ADV and IIVC mainly depends on the presence of concomitant malformations. In isolated cases, the prognosis is generally good, but counseling is often difficult in such cases, and it is very important to exclude other structural or genetic anomalies. [ABSTRACT FROM AUTHOR]

CONGENITAL HEART DEFECTS (CHDs) ARE FOUND IN UP 1% OF ALL PREGNANCIES. THE PRENATAL DIAGNOSIS OF CHDs PLAYS AN IMPORTANT ROLE IN THE MANAGEMENT OF THE DISEASE AFTER BIRTH, THIS VAST PATHOLOGY IS RESPONSIBLE FOR HIGH MORBIDITY AND MORTALITY RATES AMONG NEONATES AND INFANTS. THE FIRST TRIMESTER(FT) ANOMALY SCAN AT 11+0 to 13+6 GESTATIONAL WEEKS OFFERS TIME FOR THE FETAL CARDIOLOGIST AND FOR THE PARENTS TO OPT FOR MORE INVESTIGATIONS, SUCH AS GENETIC TESTING AND EXTENSIVE ULTRASOUND EVALUATION BEFORE THE DECIDE THE COURSE OF THE PREGNANCY. EXTENSIVE FT SCANNING PROTOCOLS ARE IMPLEMENTED IN SOME NATIONAL HEALTH SERVICES TO ALL OR IN HIGH RISK PREGNANCY. [ABSTRACT FROM AUTHOR]

Colposcopy is today the gold standard investigation to diagnose cervical intraepithelial neoplasia (CIN) following a modified Pap smear. It is used for cervical image magnification and to guide cervical biopsy. Still, there can be other techniques that could facilitate the diagnosis of cervical neoplastic lesions and cervical cancer. This paper aims to analyze the advantages of modern cervical imaging techniques, namely confocal microscopy and digital automated colposcopy, in detecting and staging cervical neoplasia lesions. Confocal microscopy has a wide applicability as an endoscopic imaging technique and already proved useful in cases with cervical lesions. While colposcopy focuses on the macroscopic aspect of the cervical lesions, the advantage of confocal microscopy is that it provides information regarding the microscopic histological changes: architectural changes, increased volume or an increased ratio between the nuclear and cytoplasmic volumes in serial planes tangential to the epithelium, that can be reconfigured 3D. These changes are routinely diagnosed by histopathological examination of a biopsy specimen; however, the confocal microscopy has the ability to visualize these changes in vivo. This helps the diagnosis process and therapeutic decision by eliminating the time required for biopsy and histopathological examination. However, confocal microscopy is an expensive method, therefore digital colposcopy is more appropriate for the screening and diagnosis process, especially in low-income countries. In conclusion, confocal microscopy has the potential to become an important diagnostic and staging tool in cervical neoplastic lesions. The greatest benefit of this method is the ability to visualize in vivo changes that are currently detected by histopathological examination and thus to favorize a faster therapeutic management. However, because its limited accessibility, colposcopy remains the standard imaging method in the diagnosis of cervical lesions. [ABSTRACT FROM AUTHOR]

We present a case of a patient diagnosed with severe intrauterine growth restriction and periconceptional severe anemia, where the fetal well‐being features, including reversal of umbilical artery end‐diastolic flow and abnormal cerebroplacental ratio, remained stationary for 12 weeks. We are not aware of reports with similar findings, and the professionals should take into consideration the possibility of a "frozen" fetal well‐being for a long time. Possibly, in our case, the evolution may be due to the prompt correction of the chronic severe maternal anemia. This approach may offer the opportunity to prolong the pregnancy, even in cases with apparently imminent delivery, as the association of reversal of umbilical artery end‐diastolic flow. [ABSTRACT FROM AUTHOR]

Turner syndrome (TS) is a genetic disease with a female phenotype and the most frequent 45,XO karyotype. Prenatal diagnosis is based on ultrasound examination, which can suggest structural abnormalities and genetic assessment. Fifty percent of the cases are detected by ultrasound examination with major anomalies. Case presentation. A 29-year-old patient, with a caesarean section delivery four years before, referred for routine screening of a first-trimester pregnancy. The ultrasound exam revealed a 12-weeks of gestation singleton pregnancy, with increased nuchal translucency (6 mm), left heart hypoplasia, septal interventricular defect, mitral regurgitation and mitral valve dysplasia, with the reversed aortic flow. After counseling, the couple decided the termination of pregnancy due to its unfavorable prognosis. The suspected ultrasound anomalies were confirmed by autopsy. Also, a new computed fetal heart reconstruction technique was used for confirming fetal heart defects, as for this gestational age is barely impossible to correctly assess the anatomical structures. Turner syndrome (45,XO) karyotype was confirmed. Conclusions. The first-trimester structural ultrasound screening is important, as severe structural anomalies can be identified. With an early diagnosis and proper counseling, the couple may decide the termination of pregnancy. The fetal autopsy evaluation confirms the data obtained through the ultrasound examination, and with a proper technique, the microscopic evaluation, with special software reconstruction, can confirm fetal heart disorders, in a proper manner. [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]

Spontaneous preterm birth (SPTB), defined as delivery before 37 weeks of gestation, remains a significant obstetric dilemma even after decades of research in this field and the leading cause of neonatal mortality and morbidity in developed countries. A short cervix is an important predictor of SPTB and several treatment strategies have been proposed. The cervical pessary has been tested as a possible intervention to prevent SPTB in singleton pregnancies. There is still conflicting evidence regarding the efficacy of it. The prevailing thought is that the pessary works similar to a mechanical device that keeps the cervix closed during pregnancy and also alleviates the amount of pressure on the cervix by shifting the angle of the cervix. The purpose of this case series is to provide preliminary proof on the utility of cervical pessary application in women with short cervix, especially during the COVID-19 pandemic. Between March 2020 and March 2022, 42 pregnant women were followed-up with Arabin pessaries in our clinic. Cervical pessary proved to be an inexpensive and less invasive option to cervical cerclage in pregnant women with shortened cervix. Pessary application and removal did not require anesthesia. Almost all the pessary users complained of increased vaginal discharge due to foreign body irritation after the use of a cervical pessary. No vaginal infections were demonstrated. Forty patients delivered after 34 weeks of gestation and only two patients delivered before 34 weeks of gestation. During the pandemic, the pessary use, instead of cervical suturing, has decreased hospital stays and reduced healthcare costs and proved to be a feasible alternative for the prevention of preterm delivery. Regarding the compliance and the tolerance, most women reported having a positive experience and that they were motivated to continue the treatment when they were continuously followed-up by an experienced clinic. This limited case series underlines that cervical pessary can be a trustworthy option for the prolongation of pregnancy and may represent special importance to health services in low-resource countries. [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]

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]

Distal trisomy or duplication of 15q is a very rare chromosomal disorder; most of the previously reported cases were derived from unbalanced translocations involving chromosome 15 and another chromosome, whereas other mechanisms (e.g. duplication) have rarely been reported. We herein report a very rare prenatal case of a partial 15q trisomy, a 42.64-Mb duplication of 15q22.2-q26.3, arising from a maternal pericentric inversion of chromosome 15 (p11q22) that was not the result of an unbalanced translocation or duplication, and was not associated with concomitant partial monosomy. Fetal ultrasound revealed isolated thickened nuchal translucency at 12 weeks and multiple abnormalities in the second trimester, including early growth restriction, unilateral ventriculomegaly, narrow cavum septi pellucidi with hypoplasia of the corpus callosum, unilateral postaxial polydactyly, clenched hands and clubfoot with clawing of the toes, and a particular general dysplastic and hypotrophic aspect of the heart. The distinctive aspects of the present case may help to refine the phenotype associated with distal duplication 15q. To the best of our knowledge, this is the first report of a prenatal diagnosis with a 15q22.2-q26.3 duplication that did not result from an unbalanced translocation and did not have a concomitant monosomic component. [ABSTRACT FROM AUTHOR]

Introduction. The anomalies of the fetal venous system are anomalies with a variable prognosis, which is mostly based on the presence of associated malformations. Close follow-up of fetuses with different cardiac or extracardiac malformations may result in detection of abnormal venous systems. In this paper we present the experience of our center. We also intend to review the recent data from the specialized literature. Methodology. We present the report of two new cases of anomalies of the fetal venous system diagnosed in our center and the associated malformations. Results and conclusions. Abnormal venous system is associated with a high incidence of fetal anomalies and adverse outcomes, including associated malformations, chromosomal aberrations. These results are in accordance with the results of the specialized studies. [ABSTRACT FROM AUTHOR]

Introducere. Exploarea ecografică a sistemului venos fetal a dus la expunerea unui spectru larg de malformaţii care îl afectează. Aceste anomalii ale sistemului venos, în special ale venelor cave, pot fiasociate cu anomalii ale inimii, tractului intestinal şi anomalii de simetrie a corpului, aşa-numitul izomerism atrial stâng şi drept. În această lucrare prezentăm experienţa centrului nostru. De asemenea, ne propunem să trecem în revistă datele recente din literatura de specialitate. Materiale şi metodă. Utilizând baza de date online, am identificat studii ce au raportat fiziopatologia acestui sistem, precum şi aspectul ecografic al diferitelor sale anomalii. De asemenea, vom prezenta raportul a două cazuri de anomalii ale sistemului venos fetal diagnosticate în centrul nostru. Rezultate şi concluzii. Au fost raportate puţine cazuri, cu aspecte variate ale malformaţiilor. Prognosticul celor două cazuri ale centrului nostru a fost diferit. Este vorba despre un caz cu malformaţie a sistemului venos izolată, care a avut un prognostic bun, şi despre un caz în care au fost asociate şi alte anomalii, prognosticul fiind unul nefavorabil. Aceste rezultate sunt în concordanţă cu rezultatele din studiile de specialitate. [ABSTRACT FROM AUTHOR]

Objective. Prenatal testing holds a central role in pregnancy evaluation and monitoring. It unites different investigation methods to determine the best possible outcome and management of a case. This paper emphasises the importance of prenatal testing by presenting a case with multiple congenital anomalies. Method. We report a case diagnosed antenatally in the Imagistic Department of Obstetrics and Gynecology, ENDOGYN AM, and confirmed together with the University Prenatal Diagnosis Unit team. We used an extended fetal morphologic protocol. We correlated the antenatal data with the anatomopathological examination. Genetic tests were performed due to the possibility of genetic abnormalities. Results. The outcome of our case was unfavourable, due to the presence of multiple anomalies at the detailed morphological assessment. No genetic abnormality was found. The anatomopathological examination confirmed the antenatal fetal findings. Conclusions. Prenatal testing represents the most important pylon in pregnancy evaluation. Multiple tests should be performed for a correct case management. [ABSTRACT FROM AUTHOR]

Obiectiv. Ductul venos este un canal vascular care face conexiunea dintre porţiunea intraabdominală a venei ombilicale cu vena cavă inferioară. Anomaliile ductului venos sunt rare şi au un prognostic variabil, în funcţie de prezenţa altor malformaţii. Metodologie. Lucrarea de faţă reprezintă un review al literaturii de specialitate privind incidenţa acestor anomalii şi îşi propune evaluarea prognosticului sarcinii atât în perioada prenatală, cât şi postnatal. Sunt menţionate cazuri din literatură şi sunt prezentate cazuri diagnosticate în Unitatea Universitară de Diagnostic Prenatal. Concluzii. Anomaliile ductului venos, deşi rare, trebuie investigate folosind un protocol extins de morfologie fetală pentru punerea în evidenţă a anomaliilor asociate. Prognosticul este nefavorabil atunci când sunt asociate mai multe malformaţii fetale. Investigaţiile genetice sunt necesare pentru stabilirea unui management corect, aceste anomalii fiind deseori incluse în anumite sindroame genetice (trisomia 21, trisomia 18, monosomia X). [ABSTRACT FROM AUTHOR]

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Introduction. Increased nuchal translucency (NT) at a gestational age of 11-14 weeks frequently represents the fenotipical expression of some chromosomal anomalies. Moreover, many of these syndromes associate morphological anomalies, especially in the context of an increased NT. First-trimester ultrasound scan remains the basis of prenatal care, and one of the objectives is represented by the major fetal anomalies detection. The purpose of this study is to evaluate the significance of an increased NT in fetuses with normal first-trimester morphology. Materials and method. We did a retrospective study in the Prenatal Diagnosis Center of the Emergency County Hospital of Craiova and at MEDGIN Craiova. In this study we included cases which presented for a first-trimester ultrasound genetic screening, where a detailed morphological examination protocol was followed. The patients who presented fetuses with a NT of over 3 mm underwent an invasive maneuver - chorionic villus sampling (CVS) or amniocentesis. The genetic counseling was performed prior to the maneuver. Results. Over the course of two years, 527 patients were examined, and 5% of them presented a NT of more than 3 mm. In more than 50% of these cases, an increased NT represented an isolated ultrasound marker, without any other associations, and the genetic test results were normal. In cases where increased NT and structural anomalies were present, major genetic and morphological modifications were diagnosed, with an absolute indication for the therapeutic termination of the pregnancy. Conclusions. Increased NT without any other morphological anomalies in the first-trimester ultrasound scan is associated in the majority of the cases with normal fetus karyotype and normal fetus prognosis on short and medium term (birth). However, a detailed morphological evaluation at the end of the first trimester is required in these situations, performed in a specialised center. [ABSTRACT FROM AUTHOR]

Introduction: Over the last decades, a large body of literature has shown that intrapartum clinical digital pelvic estimations of fetal head position, station and progression in the pelvic canal are less accurate, compared with ultrasound (US) scan. Given the increasing evidence regarding the advantages of using US to evaluate the mechanism of labour, our study protocol aims to develop sonopartograms for fetal cephalic presentations. They will allow for a more objective evaluation of labour progression than the traditional labour monitoring, which could enable more rapid decisions regarding the mode of delivery., Methods/analysis: This is a prospective observational study performed in three university hospitals, with an unselected population of women admitted in labour at term. Both clinical and US evaluations will be performed assessing fetal head position, descent and rotation. Specific US parameters regarding fetal head position, progression and rotation will be recorded to develop nomograms in a similar way that partograms were developed. The primary outcome is to develop nomograms for the longitudinal US assessment of labour in unselected nulliparous and multiparous women with fetal cephalic presentation. The secondary aims are to assess the sonopartogram differences in occiput anterior and posterior deliveries, to compare the labour trend from our research with the classic and other recent partogram models and to investigate the capability of the US labour monitoring to predict the outcome of spontaneous vaginal delivery., Ethics and Dissemination: All protocols and the informed consent form comply with the Ministry of Health and the professional society ethics guidelines. University ethics committees approved the study protocol. The trial results will be published in peer-reviewed journals and at the conference presentations. The study will be implemented and reported in line with the Strengthening the Reporting of Observational Studies in Epidemiology statement., Trial Registration Number: ClinicalTrials.gov Registry (NCT02326077)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)