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This study evaluates differences in first and second-trimester maternal serum biomarkers for aneuploidy screening among women with placenta accreta spectrum (PAS) disorders, placenta previa, and those with normal placentation.

The presence of one or more intraplacental fetal vessels with a diameter of 2 mm or greater at MRI was associated with placental invasiveness in pregnant women.

Aim: The study aimed to provide an overall view of current data considering the presence of microRNAs in amniotic fluid. Methods: The available literature in MEDLINE, regarding the role of the amniotic fluid in pregnancy and fetal development, was searched for related articles including terms such as “microRNA”, “Amniotic fluid”, “Adverse outcome” and others. Results: The amniotic fluid has an undoubtedly significant part in fetal nutrition, with a protecting and thermoregulatory role alongside. MicroRNAs have proven to be highly expressed during pregnancy in many body liquids including amniotic fluid and are transferred between cells loaded in exosomes, while they are also implicated in many processes during fetal development and could be potential biomarkers for early prediction of adverse outcomes. Conclusion: Current knowledge reveals that amniotic fluid microRNAs participate in many developmental and physiological processes of pregnancy including proliferation of fibroblasts, fetal development, angiogenesis, cardioprotection, activation of signaling pathways, differentiation and cell motility, while the expression profile of specific microRNAs has a potential prognostic role in the prediction of Down syndrome, congenital hydronephrosis and kidney fibrosis.

Aim: To provide a review considering microRNAs regulating oncogenes and tumor suppressor genes during the different stages of cell cycle, controlling carcinogenesis. Methods: The role of microRNAs involved as oncogenes’ and tumor suppressor genes’ regulators in cancer was searched in the relevant available literature in MEDLINE, including terms such as “microRNA”, “oncogenes”, “tumor suppressor genes”, “metastasis”, “cancer” and others. Results: MicroRNAs determine the expression levels of multiple cell cycle regulators, such as cyclins, cyclin dependent kinases and other major cell cycle activators including retinoblastoma 1 (RB- 1) and p53, resulting in alteration and promotion/inhibition of the cell cycle. Conclusion: MicroRNAs are proven to have a key role in cancer pathophysiology by altering the expression profile of different regulator proteins during cell division cycle and DNA replication. Thus, by acting as oncogenes and tumor suppressor genes, they can either promote or inhibit cancer development and formation, revealing their innovative role as biomarkers and therapeutic tools.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2006.06.094 Byline: Kalliopi I. Pappa (1)(3), George Vlachos (1), Marianna Theodora (1), Maria Roubelaki (3), Konstantina Angelidou (2), Aris Antsaklis (1) Keywords: branched-chain amino acids; free fatty acids; gestational diabetes; [beta]-hydroxybutyrate; ketogenic amino acids Abstract: The aim of this study was to investigate the levels of fasting maternal plasma amino acids in normal pregnant women and compare them with those in gestational diabetes controlled by diet only. We also wished to delineate the alterations occurring in intermediate metabolic pathways in gestational diabetes. Author Affiliation: (1) First Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra University Hospital, Athens, Greece (2) Department of Hygiene and Epidemiology, University of Athens, School of Medicine, Athens, Greece (3) Foundation for Biomedical Research of the Academy of Athens and Laboratory of Biology, University of Athens School of Medicine, Athens, Greece. Article History: Received 7 March 2006; Revised 25 April 2006; Accepted 21 May 2006 Article Note: (footnote) Cite this article as: Pappa KI, Vlachos G, Theodora M, et al. Intermediate metabolism in association with the amino acid profile during the third trimester of normal pregnancy and diet-controlled gestational diabetes. Am J Obstet Gynecol 2007;196;65.e1-65.e5.

•Cesarean scar pregnancy is a rare but dangerous form of ectopic pregnancy.•Laparoscopic management is a potential effective treatment of cesarean scar pregnancy with high success rate and low complications.•Laparoscopy offers concomitant treatment of the ectopic pregnancy and the uterine isthmocele.•Laparoscopic management of cesarean scar pregnancy presents favorable postoperative reproductive outcomes.

Fallopian tube cancer is an extremely rare gynecological condition, accounting for just 1 to 2% of all female tract malignancies. The mean age of diagnosis is similar to that of ovarian cancer, between 60 and 75 years, but it can affect a wide spectrum of ages. Advanced age and family history of ovarian and breast cancer are the main risk factors, since they are associated with increased incidence of this uncommon entity. In this study, we report a rare case of an elderly, 89-year-old patient that presented to our clinic due to vaginal bleeding.

Background. The coexistence of an intrauterine pregnancy and an ectopic pregnancy (heterotopic pregnancy) is an extremely rare, yet major, complication during pregnancy. The early diagnosis of a heterotopic pregnancy is of great importance for fetal viability, maternal safety, and the progression of an uncomplicated intrauterine pregnancy. Case Presentation. We report a case of a naturally conceived heterotopic tubal pregnancy in a 37-year-old primigravida. The patient presented with continuous, dull, lower abdominal pain and a positive urine pregnancy test which was conducted a week prior to the start of the pain. The patient was hospitalized, and based on the clinical image and after strict monitoring, she was diagnosed with a heterotopic pregnancy. She was treated with laparoscopic salpingectomy after the rupture of the ectopic pregnancy while the desired intrauterine gestation continued without any complications. The pregnancy resulted in the birth of a healthy infant through vaginal delivery. Discussion. Strict monitoring with multiple sonographic evaluations should always be conducted in women with abnormal serum beta-hCG, adnexal abnormalities, or clinical symptoms, while heterotopic pregnancy should be in differential diagnosis and treatment should not be delayed since emerge management is important for the progression of the intrauterine pregnancy.

Background. Gynecologic melanomas are extremely rare malignancies, and primary malignant melanoma of the cervix (PMMC) is the rarest among them all, with less than 100 cases reported so far. Although some conditions have been correlated with the pathogenesis of this entity, no specific risk factor has been yet identified, with vaginal bleeding being the most common symptoms. The diagnosis is based on physical examination with speculum assessment and cytologic and histopathologic findings accompanied with immunohistochemical staining of lesion’s biopsies. Case Presentation. We report a case of PMMC in a 34-year-old para-2 patient, among the youngest cases of PMMC reported, that presented to our clinic for routine examination. Gynecologic examination demonstrated a dark, heavily fully pigmented cervical growth completely covering the entire external cervical os. Biopsy obtained and showed malignant melanoma. She underwent radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. The pathological diagnosis was FIGO stage IB1 PMMC. Despite 2 courses of anti-PD-1 antibody (Nivolumab) treatment, the patient passed away 13 months after diagnosis (12 months after surgery). Conclusions. Early diagnosis and subsequently early treatment are of high importance regarding patients’ prognosis and survival. No standardized protocols or treatment guidelines specific for this rare cancer have been issued; thus, clinicians are called to assess each case individually. Current treatment options are based on surgical excision mostly with radical hysterectomy, but in advanced or recurrent state of the disease, other treatment modalities, such as chemotherapy, radiotherapy, and immunotherapy, can be employed. Prognosis for these patients is very poor, and survival rate remains extremely low, with the median OS reported being less than 2 years. Reporting and publishing of such cases are both of paramount importance for the better understanding of this uncommon cervical malignancy, and further biological and clinical investigations are required for more suitable and effective therapies to be determined. A new staging system, specific to PMMC, could be of great use for the better correlation of the disease’s stage and prognosis of these patients.