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To assess the frequency of multiple thrombophilia-associated mutations and polymorphisms in a selected population of high-risk pregnancies.

Objectives Pregnancy is considered a real metabolic challenge and a key moment for the development of subsequent maternal overweight or obesity-related complications such as gestational diabetes mellitus (GDM). Literature studies constantly report certain risk factors for GDM: family history of diabetes, previous GDM, advanced maternal age, being overweight or obese, fetal macrosomia, smoking. Among these factors, diet and regular physical exercise are modifiable, therefore educating patients could help prevent GDM and its related maternal and fetal complications. The aim of this study is to present our experience in the prevention of GDM in a group of 204 pregnant patients with detected risk factors. Methods A group of 204 pregnant patients with detected risk factors for GDM was enrolled in the study between April 2016 and April 2017. All patients were admitted in the Emergency University Hospital in Bucharest and followed-up at regular visits during pregnancy. A questionnaire was given to record patients' family history of cardiovascular disease, obesity and diabetes, lifestyle, diet, smoking and self-medication. Data about patients' pre-pregnancy BMI and gestational weight-gain was also recorded. At 24-28 weeks of gestation, all patients performed a 75g oral glucose tolerance test and pregnant patients with impaired glucose tolerance (IGT) were selected. These patients were put on a prudent diet, with a high intake of vegetables and white meat and were advised to quit smoking. Results The prudent diet had a positive impact on the gestational weight gain in the third trimester of the pregnant woman found to have an IGT, lowering the risk for obesity. Interestingly, the patients who had an active life before pregnancy and a moderate physical activity during pregnancy, gained less weight. Those who quit smoking and who supplemented their diet with vitamin D, C and iron also had better pregnancy outcomes. Conclusions Changes in modifiable risk factors (healthy diet, exercise) among pregnant women, especially overweight or obese, may reduce the risk of GDM and subsequent complications for both mother and fetus. Moreover, action upon these risk factors should be taken earlier than second or third trimester for better results. [ABSTRACT FROM AUTHOR]

Peripartum hysterectomy refers to the hysterectomy performed during delivery or within 24 hours. This is a relatively rare procedure, that can be emergent or planed depending on the indication. In about 30-50% cases of emergency performed hysterectomies the cause is represented by severe uterine hemorrhage, which is impossible to control by the usual methods, as it happens in abnormal placentation or uterine atony. Conservative methods should always be attempted in order to avoid if possible the morbidity and sterilization implied by hysterectomy. Regarding the risk factors for peripartum hysterectomy, prior caesarean delivery increases the incidence of this procedure from 1 in 30.000 to 1 in 220. The associated mortality is declared to be <1 percent, and the most frequent complications are febrile morbidity, hemorrhage and urinary tract injury. We studied the incidence of peripartum hysterectomy and the most common associated condition of these cases in the Bucharest Emergency University Hospital for a period of six and a half years. Data were retrieved from the statistics department of the hospital. From January first, 2011 to June 26, 2017 in our hospital 21.746 deliveries were registered, of which 55 cases (0.25%) required peripartum hysterectomy. The associated pathologies analyzed were placental disorders (placenta accreta, increta, percreta), placenta previa, preeclampsia, uterine atony, uterine rupture, fibroids, cervical cancer and infection. Also, the rate of admission in the intensive care unit and mortality were analyzed. The obtained results matched with those declared in the literature. The anticipation of the need of peripartum hysterectomy with the proper preparation, counseling and timing is a key element for the future outcome of the case. Knowing the relation of various risk factors with the possible need of this procedure significantly increases the rate of success and decreases the incidence of complications. [ABSTRACT FROM AUTHOR]

Posterior urethral valves are a congenital anomaly of the lower urinary tract that occurs exclusively in male infants. In time, this can lead to varying degrees of renal or bladder dysfunctions. Most cases are sporadic, but there have been reported rare examples within the same families. Nowadays, thanks to modern ultrasound techniques in antenatal screening, most infants are diagnosed in utero, thus allowing early intervention by the ablation of the urethral obstruction. Almost half of the infants that require surgery for urinary obtruction have no evidence of hydronephrosis on prenatal ultrasound. This anomaly of the fetus can lead to various problems such as hydronephrosis, megacystis, renal dysplasia, oligohydramnios, pulmonary hypoplasia followed by pneumothorax, intrauterine growth restriction or preterm delivery. We present a complicated case of posterior urethral valves with marked distension of the bladder as well as a thickened wall and a dilated posterior urethra, hydronephrosis, renal parenchimal change with increased echogenicity, oligohydramnios, fetal growth restriction and asociated lung malformation. Megacystis, a potential early marker of bladder outlet obstruction, can be identified starting with 11 weeks of gestation, but most cases are not seen before 26 weeks, as our case. Postnatal ultrasound reveals the same findings. Several studies have shown a higher prevalence of renal impairement in children who had oligohydramnios, but in the same time, a normal amniotic index could not rule out renal impairement. Despite modern ultrasound tehnology, none of the mentioned antenatal ultrasound parameters can predict postnatal renal function. Keywords: antepartum ultraonoghraphy, posterior urethral valves [ABSTRACT FROM AUTHOR]

Background: Fetal environment, maternal characteristics and lifestyle play a role in the origin of several chronic diseases manifesting later in life. It is widely suspected that fetal growth is mediated by nutritional availability during critical periods of gestation, being controlled by complex mechanisms of "fetal programming". Gestational weight gain is thought to influence pregnancy outcomes and fetal development, although the actual mechanisms are not fully understood. Objectives: The aim of this study was to investigate the relationship between fetal weight, maternal gestational weight gain through pregnancy and maternal serum adipokines. Methods: We enrolled in our study 67 pregnant women who were followed throughout their pregnancy, recording data about pre-pregnancy body mass index, gestational weight gain at the end of each trimester, total gestational weight gain, fetal biometry, fetal weight and maternal serum levels of adiponectin and visfatin. All patient data was collected from patient files in the Bucharest University Emergency Hospital. Results: More thana half of the pregnant women enrolled in our study were classified as having an "excessive weight gain" or obesity. Obese women had a lower weight gain following the first trimester. These women exhibited lower levels of adiponectin and gave birth to larger babies. Fetal weight inversely correlated with maternal serum adiponectin. Visfatin levels showed inconstant results, but the highest levels were found in mothers who gave birth to large for gestational age neonates. Conclusion: Gestational weight gain is an important factor implied in fetal development, being known to influence fetal and pregnancy outcomes. Fetal weight is influenced by maternal adiposity, which may be investigated by evaluating the interplay of certain adipokines throughout pregnancy. [ABSTRACT FROM AUTHOR]