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Introduction. Cervical incompetence (cervical insufficiency) is the inability of the uterine cervix to retain a pregnancy in the absence of uterine contractions. It typically presents as acute, painless dilatation of the cervix, which can lead to a midtrimester pregnancy loss. Transvaginal ultrasound can be used as a diagnostic tool and to monitor cervical changes in cases of cervical incompetence. Materials and method. We have searched the literature on articles published on this aspect on PubMed, Google Scholar and Cochrane, by using the following keywords: “cervical incompetence”, “cervical shortening”, “ultrasound measurements”. We found that some of the ultrasound aspects used in the evaluation of cervical incompetence are: cervical length measurement, funneling assessment and bulging of the fetal membranes into a widened internal os. Conclusions. Cervical shortening is a prognostic indicator for the risk of preterm labor progressing into preterm delivery. [ABSTRACT FROM AUTHOR]

Introduction. The choroid plexus, or plica choroidea, is a plexus of cells that arise from tela choroidea in each of the ventricles of the brain. Regions of the choroid plexus produce and secrete most of the cerebrospinal fluid of the central nervous system. The prevalence of choroid plexus cyst (CPC) is 1:50 fetuses at 20 weeks of gestation and more than 90% resolve by 26 weeks, usually being asymptomatic, but large cysts can cause hydrocephalus. Ultrasound diagnosis is characterized by single or multiple cystic areas (>2 mm in diameter) in one or both choroid plexuses of the lateral cerebral ventricles in biparietal diameter section. The differential diagnosis should exclude an intraventricular hemorrhage penetrating into the choroid plexus and other rare types of cysts like colloid or ependymal cysts. Methodology. We compared two cases of fetuses with CPC, the first one being a fetus with aneuploidy and a series of anomalies detected at the ultrasound examination (intracardiac echogenic focus, increased nuchal fold and absent nasal bone), and the second one being a fetus with normal karyotype where CPC represented a transitory factor. Results. Choroid plexus cysts, also called “soft signs”, are associated with a risk for trisomy 18 and, possibly, trisomy 21. When they are isolated, the risk for aneuploidy is low. If they are present, a detailed ultrasound examination should be performed, with particular attention to the heart, brain and hands. If the ultrasound is abnormal, the next step should be a noninvasive prenatal test (NIPT) to determine the fetal karyotype. Conclusions. In the vast majority of cases, CPC are benign transient variants of normal intracranial anatomy. Chromosomal studies are strongly recommended whenever associated anatomic abnormalities are detected and when choroid plexus cysts are large, bilateral and persistent. [ABSTRACT FROM AUTHOR]

Introduction. Conjoined twins, also known as Siamese twins, represent one of the rarest anomalies of monozygotic pregnancies that have fascinated both medical world and the general public. The incidence of this anomaly varies between 1:50.000 and 1:100.000 births, and there is a higher predisposition toward female gender, with a ratio of 3:1. Conjoined twins appear from abnormal embryogenesis, the two main theories proposed for explaining the occurrence of this anomaly being fusion and fission. Conjoined twins were classified by Spencer (1996), and are named according to the most prominent site of fusion. The conjoined site may be in the ventral, dorsal or lateral groups. The extent of organ sharing, especially the heart, determines the possibility and prognosis of a separation procedure. Materials and method. The aim of this paper is to offer an overview of the literature regarding this rare anomaly of monoamniotic monochorionic twin pregnancy and to present the case of a 35-year-old multiparous patient (six previous pregnancies) who was referred to our hospital for the confirmation of the thoracopagus conjoined twins diagnosis and for management. Results. With the current findings, the diagnosis of thoracopagus twin pregnancy was established. The family was informed and counseled on the various management options. Due to the presence of a common heart, the termination option was offered and the family accepted. The termination of pregnancy was made through caesarean section, resulting two female twins of approximately 500 g in total which were sent to the pathologist. Conclusions. Conjoined twin pregnancy is a rare finding. Establishing a diagnosis using ultrasound examination early during pregnancy offers the possibility of assessing the prognosis of the pregnancy, based on the organs that are shared by the fetuses, to offer the patient and her family a prognostic and, if possible, the treatment options. [ABSTRACT FROM AUTHOR]

Introduction. The evaluation of fetal long bone measurements, particularly femur length, is essential in assessing fetal biometry, gestational age, size, growth, and in identifying various abnormalities. This study explores the diagnostic value of long bones length in detecting conditions such as Down syndrome and skeletal dysplasia. A femur length below the 10th percentile for gestational age is consistently associated with Down syndrome, while an extremely short femur length often indicates skeletal dysplasia. Humeral length, particularly when small compared to the biparietal diameter, serves as an additional marker for Down syndrome risk. The accurate diagnosis requires measuring all long bone segments, while the femur/abdominal circumference ratio serves as a discriminator for lethal skeletal dysplasia. Complete fetal anatomic evaluation is crucial in the presence of a short femur. This poster presents the current state of the art in the ultrasonography of fetal long bone evaluation. Materials and method. The present paper was realized by synthesizing the data published in the last 30 years regarding fetal long bones ultrasound assessment found on Google Scholar and PubMed, using for filtering the keywords: “femur length”, “humerus length”, “ultrasound”, “trisomy”, and “skeletal dysplasia”. Results. Femur length is a standard parameter measured during fetal biometry assessment. A shortened femur for gestational age may raise the suspicion for fetal growth restriction, trisomy 21 or skeletal dysplasia. In certain cases, it may be the first hint for aneuploidies or skeletal dysplasia. Femur and humerus length can be used to adjust the risk for trisomy 21. When facing a shortened femur, a complete survey of all fetal long bones is mandatory, as it may unveil a potentially severe skeletal anomaly. Conclusions. Ultrasound measurement of fetal long bones and the ratio between different skeletal measurements can be the key for the prenatal diagnosis of fetal skeletal dysplasia or can rise the suspicion of a fetal aneuploidy that can determine further investigations for establishing or excluding such a condition of the fetus. [ABSTRACT FROM AUTHOR]

Abdominal cystic masses are diagnosed during the intrauterine period and have a relatively low incidence. Fetal ovarian cysts are the most common form diagnosed prenatally or immediately after birth. The pathophysiology of the development of these types of tumors is not fully elucidated, with ovarian hyperstimulation caused by maternal and placental hormones being the most accepted hypotheses. We conducted a scoping review with the aim to map the current knowledge regarding the treatment of fetal ovarian cysts diagnosed in the intrauterine period. Focusing on the articles published in the last 10 years in the specialized literature, we tried to identify a conceptualization regarding the surveillance and treatment of these anomalies. We describe the case of a 38-year-old patient, in her second pregnancy, with a physiological course of pregnancy until 29 weeks of gestation, when a cystic mass of 52/48 mm was detected in the abdomen during the routine ultrasound examination. The most likely origin was established to be the right ovary. Applying the diagnostic criteria described by Nussbaum, the detected cystic mass was of a simple type, with a thin wall, transonic content, without the presence of septa, vegetations or the appearance of intracystic hemorrhage. We observed a linear growth trend from the time of diagnosis when the diameter measured 52 mm, until 38 weeks of gestation when it reached 76 mm. A female fetus was born, weighing 3570 g, with an Apgar score of 10, with a good postnatal adaptation. On the eighth day of life, the newborn was transferred to the pediatric surgery unit where ovarian cystectomy was performed. Intraoperatively, a cystic mass was found belonging to the right ovary, with a size of 80/70/70 mm. Ovarian cystectomy was performed, with the successful preservation of ovarian tissue. The postoperative recovery had a favorable outcome. [ABSTRACT FROM AUTHOR]

Late first-stage or second-stage caesarean section is commonly associated with fetal head impaction, leading to maternal and neonatal complications. This situation requires safe delivery techniques, but the optimal management remains controversial. The aim of this meta-synthesis was to compare maternal and neonatal outcomes associated with delivery techniques via caesarean section. Methodology. An electronic search of three databases, from inception to June 2021, was conducted. Cohort and randomized comparative studies on maternal and neonatal outcomes associated with techniques to deliver an impacted fetal head during caesarean section were included. The methodological quality of the primary studies was assessed. Review Manager 5.4 was used for statistical analyses. Nineteen articles, including 2345 women, were analyzed. Results. Three fetal extraction techniques were identified. Meta-analyses showed that the “pull” technique carries lower risks as compared to the “push” technique, and that the Patwardhan technique is safer compared to the “push” or the “push and pull” technique. Nine out of 11 quality criteria of the included studies were fully met. The “push” and the “pull” techniques were investigated by most included studies. The “pull” technique showed lower risks of blood transfusion (p=0.03), extension of uterine incision (p<0.00001), infection (p=0.003) and pyrexia (p<0.00001) compared to the “push” method. Conclusions. In the absence of robust evidence to support the use of a specific technique, the choice of the obstetrician should be based on best available evidence. Our study suggests that the “pull”, as well as the Patwardhan technique represent safe options to deliver an impacted fetal head. [ABSTRACT FROM AUTHOR]

Introduction. It is well known that severe obstetric lacerations are associated with anxiety disorders or even with postpartum depression among women. Very few studies investigated the levels of intrapartum anxiety caused by the eventuality of childbirth perineal trauma. This study aimed to evaluate maternal anxiety scores, intrapartum or during the first two hours postpartum, in different patient groups. Methodology. In March 2022, 44 consecutive primiparous women completed an anxiety visual scale, from 1 to 10, intrapartum or during the first two hours postpartum, reflecting their anxiety associated with obstetric lacerations. Six to 18 months postpartum, they will complete an International Consultation on Incontinence Questionnaire Vaginal Symptoms Module (ICIQ-VS), a standardized questionnaire to quantify the mid-term impact of perineal lacerations on vaginal symptoms, prolapse symptoms, sexual problems and quality of life. Moreover, correlations between the anxiety scores and ICIQ-VS scores will be sought. Results. GraphPad Prism 8 was used for statistical analysis. Mann-Whitney test was used for comparisons among groups and Pearson coefficient was used for correlations. The women reported significantly higher anxiety scores correlated with childbirth perineal trauma during labor, compared to immediate postpartum (p=0.0008). Women receiving epidural analgesia reported higher anxiety scores compared to women without epidural, but the difference of scores did not reach the statistical significance (p=0.142). No statistically significant correlation was found between the age or Body Mass Index (BMI) of the included women and the reported anxiety scores (p=0.142 and p=0.494, respectively). Conclusions. Anxiety correlated with childbirth trauma is significantly higher during labor compared to the postpartum period in primiparous women. Patients with epidural analgesia did not report significantly different anxiety scores compared to patients without analgesia. In addition, demographic or anthropometric factors, such as age or BMI, did not significantly correlate with the anxiety scores in primiparous women. [ABSTRACT FROM AUTHOR]

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]

Obesity is currently an important public health issue, registering a rapid increase in recent decades and affecting young people more and more frequently. The result is an increasing number of overweight or obese patients who reach reproductive age and become pregnant. Obesity is considered as an increased volume of adipose tissue which has well-known negative effects on multiple systems, but also on reproductive function. This piece of information led to the search for the existence of a connection between an increased Body Mass Index and the dysfunction of uterine contractility. Most cases of post-term pregnancy which usually require the induction of childbirth are observed in patients with increased Body Mass Index. The most important adipokines are represented by adiponectin, leptin, ghrelin, visfatin and apelin. Leptin has been demonstrated to act at smooth muscle fiber level in the vascular wall where it produces a decrease in calcium release from the sarcoplasmic reticulum, thus reducing the uterine contractile force. Leptin has an inhibitory effect on the frequency and amplitude of uterine contractions. Increased serum levels of leptin in obese women are involved in the inhibition of the apoptotic phenomenon involved in uterine involution. Visfatin exerts a more potent inhibitory effect compared to leptin upon uterine contractions. The inhibitory effect of ghrelin on uterine contractility involves a possible role in the regulation of myometrial activity. Apelin exerts a potent inhibitory effect on myometrial cells, causing a reduction in both the amplitude and the frequency of uterine contractions. Adipose tissue is currently regarded as a real endocrine organ, responsible for the production of bioactive polypeptides, adipocytokins. Adipokines exert modulating effects during pregnancy and there is evidence of their involvement in the pathophysiology of pregnancy-related complications. [ABSTRACT FROM AUTHOR]

Preeclampsia (PE), a multisystem pregnancy-associated disease, has a major contribution to maternal morbidity and mortality worldwide, affecting approximately 10 million women worldwide. PE is thought to occur as a consequence of several factors, including defective spiral artery remodeling, placental oxidative stress, endothelial dysfunction and systemic inflammation. Recently, microRNAs (miRNAs) have been associated with the pathogenesis of PE and could play an important role in the development of PE. MicroRNAs are intensely expressed in the placenta during a normal pregnancy. Thus, analyzing miRNAs in the sera of PE patients could enrich knowledge about the pathophysiological mechanisms of this disease. Recent articles highlight the relationship between the aberrant expressions of several miRNAs and negative pregnancy outcomes. A number of miRNAs, including miR-16, miR-29b, miR-34a, miR- 155, miR-210 and miR-675, have been shown to decrease the proliferation and migration of trophoblasts. At the same time, recent studies have shown that miR-210 and miR-155 are constantly aberrantly expressed in women with PE. Thus, by elucidating the functional role of these modified miRNAs, important pathways involved in PE could be identified and potential predictive/diagnostic biomarkers could be brought to light, which could be used in PE. Moreover, enriching our knowledge about the role of miRNAs in pregnancy-associated diseases is necessary in order to develop therapeutic strategies in the future. [ABSTRACT FROM AUTHOR]