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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]

The aim of this study is to establish morphological, histological and ultrasonographic (US) correlations in the placenta of type 2 diabetes. This is a multicenter case-control study conducted on a lot of 21 selected cases diagnosed with type 2 diabetes, analyzed over a two year period. The clinical characteristics of the patients in the study group are represented by the average age of 34 years and diabetes associated with preeclampsia, hypertension, diabetic neuropathy, urinary infections, obesity or history of infertility. All the patients in the study group are Caucasian. US assessment of placental characteristics in our series revealed increased placental thickness from the second trimester and placentomegaly at the end of the third trimester. Immature appearance of placenta has been observed. Gross analysis of maternal and fetal surfaces of the placentas revealed basal plate and subchorionic fibrin depositions, placental infarction or intervillous thrombosis. Preconceptional glycemic control and its support during gestation are essential for pregnancy outcome. US findings have as a background the morphological changes. From morphological perspective there is about a combination of anomalies, otherwise unspecific which, in terms of association with various comorbidities could define a placental diabetic pattern. [ABSTRACT FROM AUTHOR]

The aim of the research was to assess the outcome of persistent (=two years) low-grade cervical intraepithelial neoplasia (CIN 1) medicated with loop electrosurgical excision procedure (LEEP). An analysis of 38 topics with persistent biopsy-confirmed CIN 1 diagnosed after low-grade squamous intraepithelial lesion (LSIL) or atypical squamous cells of undetermined significance (ASC-US) on Pap test and treated using LEEP was performed. Post-LEEP follow-up were scheduled in 6 months, 1 year, and yearly thereafter: cytology, colposcopy, and plasma diagnostic examinations. There were 38 LSIL patients treated with LEEP conization. About 6 patients were excluded from the study due to subsequent hysterectomy and 2 patients never attended the follow-up schedule in the rest. The remaining 30 patients were retrospective studied for the incidence of recurrent rate. The mean age of the patient was 44 years. About 50% of patients were multiparity and nearly one - third used oral contraceptive pill. The results of this study suggest that the incidence of CIN 2+ lesions during follow-up of persistent biopsy-confirmed CIN 1 after ASC-US/LSIL treated by LEEP is very low. [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]

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The spectacular evolution of the ultrasound equipment and techniques has allowed the assessment of the fetal heart increasingly earlier during the gestation, as well as the diagnosis of the fetal abnormalities in the first trimester of pregnancy. Transvaginal ultrasound and transabdominal ultrasound are used in early fetal echocardigraphy. Studies have shown that the heart defects diagnosed early in gestation are more complex and have a high degree of association with chromosomal abnormalities, compared to those diagnosed in the second trimester of pregnancy. There are many studies on the correlation between the increase in the nuchal translucency (NT) and congenital heart defects, NT being one of the most frequently studied and efficient screening parameters in maternal-fetal medicine. The morphology of the umbilical cord can be assessed in the first trimester of pregnancy by colour Doppler examination. Numerous anomalies associated with single umbilical artery are described. The principles of fetal echocardiography in the first trimester are similar to those of the morphological examination in the second trimester of pregnancy, with certain peculiarities and differences. The complete examination of the fetal heart, with minimal false results, can be done under the conditions of a trained and experienced examiner within the range of 12-13 gestational weeks. The examination route must be adapted to the particularities of the case. Early fetal echocardigraphy should be recommended only in the presence of a precise medical indication. [ABSTRACT FROM AUTHOR]

Copyright of Ginecologia.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Urinary incontinence (UI) represents a condition that, although not vital, has a significant impact that can interfere with the quality of life in a meaningful way for many women, its overall prevalence being of approximately 40%. Since 1920, urogynecologists showed an increasing interest in imaging techniques of the pelvic floor, ultrasound being the method of examination most frequently used with benefits that result from easy accessibility and reduced costs. At the beginning, B-mode ultrasound via transvaginal or transperineal route, was used to describe the urinary bladder and the anterior compartment and only later, the other pelvic compartments. Pelvic floor dysfunctions include several conditions among which UI. The main indications for transperineal ultrasound are: recurrent urinary tract infections, urgency-, frequency-, stress-UI, dysuria, prolapse of pelvic organs, dyspareunia, fecal incontinence, pelvic masses. This method proves its utility in assessing parameters like: residual urine, detrusor wall thickness, mobility of the bladder neck, anterior and posterior urethrovesical angle, urethral integrity. Stress UI may be highlighted by Color Doppler. Studying the pelvic floor during contractions or Valsalva maneuvre allows the assessment of the functional anatomy, keypoint for understanding the UI pathophysiology. The assessment of these specific objective and reproducible parameters is complementary to the diagnosis of UI and puts several therapeutic options in a different light. The progress in imaging permanently contributes to the improvement of therapeutic management either refining existing techniques or supporting the development of new procedures in urogynecology. [ABSTRACT FROM AUTHOR]

Copyright of Ginecologia.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Introduction. Ovarian tumors include masses with a fluid or parenchymal cystic character, characterized by typical or abnormal epithelial proliferation. They present an extreme diversity, the classification being realized according to several criteria. Ovarian tumors may be benign or malignant, cystic or solid, uni- or bilateral, secretory or non-secretory, primary or secondary. Ultrasound examination remains the gold standard imaging procedure used in ovarian mass evaluation. Doppler examination evaluates arterial and venous blood flow. The most commonly used Doppler spectral wave parameters are the resistivity index and the pulsatility index. The most commonly encountered complications of ovarian tumors are torsion of the ovary or adnexa, intracystic hemorrhage, as well as their malignant transformation. Although the diagnosis of adnexal torsion is most commonly based on the clinical examination of the patient, color Doppler evaluation may be useful by demonstrating the absence of arterial and venous flow. In case of intracystic hemorrhage, the resorption of the blood within the ovarian cyst determines the distinct ultrasound features, ranging from hyperecogenic aspects identified at the onset of hemorrhage, to hypo-/anecogenic images later. The model of the internal echoes will undergo changes with the passage of time and resorption of the clot. Doppler examination in the presence of intracystic hemorrhage will not reveal internal vascularization. Suggestive criteria for malignant ovarian masses are thick, multiple septations, papillary projections, solid stuctures within the tumor mass and ascites. Doppler ultrasound in malignant tumors identifies vessels of neoformation, which have low pulsatility and resistivity index. Conclusions. Color Doppler ultrasound can provide additional information to 2D ultrasound examination regarding the nature of the lesions, their malignant potential, and the presence of the torsion of the adnexa or ovary. The specificity and the positive predictive value of the 2D ultrasound examination in the diagnosis of the ovarian tumor complications increase when an extra examination using color and spectral Doppler is performed. [ABSTRACT FROM AUTHOR]

Introduction. The amount of fluid in the fetal stomach varies significantly in case of normal fetuses. Changes in fetal stomach volume may be associated with multiple malformations. In case of reduced fetal stomach size, the most frequent associated pathology is esophageal atresia. Although some studies have attempted to make nomograms regarding fetal stomach size, there is currently no consensus on this and many authors still describe a “small or absent” stomach bubble or an “absent or collapsed fetal stomach”, without quantification. The ultrasonographic evaluation of the size of the stomach bubble remains subjective, being operatordependent. This results in an increased number of false positive diagnoses, which leads to patient anxiety, an increase in the number of additional investigations, as well as to higher costs. The objective was to carry out a review of the literature regarding the lower limit of the normal size of the stomach bubble and the implications of this parameter in establishing the positive diagnosis. Methodology. We searched for articles from the last five years in the PubMed database using as keywords: small fetal stomach bubble, esophageal atresia, prenatal ultrasound, fetal anomaly scan. Results. Prenatal diagnosis of esophageal atresia remains a challenge for sonographers. The main signs identified at ultrasound examination are: small or absent fetal stomach, polyhydramnios and “pounch sign”. The prenatal detection rate of esophageal atresia using ultrasonography was reported to be between 24% and 32%. When analyzing the studies, most authors defined the small fetal stomach only as subjective, mentioning either only the “small stomach bubble” or “absent fetal stomach”. A quantitative measurement, according to the nomograms, is not used. Nine studies analyzed the detection rate of “absent fetal stomach” or “small stomach bubble” in identifying antenatal esophageal atresia. This ultrasound mark was identified in 50% of cases. The incidence of false positive diagnosis was about 70%. Conclusions. With the improvement of other diagnostic modalities in the case of esophageal atresia, the detection rate increases, but ultrasonography remains the easiest method of diagnosis, due to the increased availability. Certain diagnostic criteria, using nomograms of fetal structures, could increase the rate of detection of fetal abnormalities. [ABSTRACT FROM AUTHOR]

Introduction. Diaphragmatic hernia represents the presence of abdominal organs in the thoracic cavity. It has an incidence of 1 in 3500 births and it associates a high neonatal mortality. Left diaphragmatic hernia is the most frequent form. Case report. We present the case of a 32-year-old patient, G2P1, who had a fetal anatomy scan performed in our department. The first-trimester screening of the patient showed a combined risk of 1/5800. Our morphology scan showed a female fetus of 22 weeks and 5 days who presented a herniation of the abdominal organs (stomach, intestine, liver) in the thorax through a left diaphragmatic defect. The left fetal lung presented with a hyperechogenic mass with systemic vascularisation on Doppler exam, with origin from the descending aorta. We suspected a pulmonary sequestration. We excluded the presence of coexisting craniofacial or cardiac defects. An amniocentesis and investigations in order to exclude the Pallister-Killian syndrome were performed. We infirmed the presence of chromosomal anomalies. We performed a fetal MRI scan that confirmed our diagnostic. We evaluated the severity of the defect by calculating O-LHR which established a medium severity degree. The patient is advised to undergo FETO fetoscopic intervention, taking into consideration the inclusion and exclusion criteria of the TOTAL trial randomised international study. The patient refuses the fetoscopic intervention and benefits from antenatal follow-up with monitoring of the O-LHR, the volume of amniotic liquid and cervical length. Results. The birth took place by caesarean section at 38 weeks of gestation and the newborn deceased in the first day of life in the neonatal surgery department. Conclusions. The corroboration of imagistic techniques allows a complete evaluation and establishes the prognosis of fetuses with diaphragmatic hernia. [ABSTRACT FROM AUTHOR]

Abnormal uterine bleeding (AUB) is a common gynecologic complaint that accounts for one-third of outpatient visits to gynecologists and for more than 70% of all gynecologic consults in the perimenopausal and postmenopausal years, leading to increased healthcare costs and to decreased quality of life. AUB describes any variation from normal bleeding patterns in non-pregnant, reproductive-aged women beyond menarche lasting for at least 6 months. Transvaginal ultrasound is the firstline imaging test for the evaluation of AUB in both premenopausal and postmenopausal women. Transvaginal ultrasound can be used to diagnose structural causes of abnormal bleeding such as polyps, adenomyosis, leiomyomas, hyperplasia and malignancy, and can also be beneficial in making the diagnosis of ovulatory dysfunction. Traditional 2-dimensional imaging is often enhanced by the addition of 3-dimension imaging with coronal reconstruction and saline infusion sonohysterography. The availability of newer diagnostic tools has made it possible to promptly diagnose and treat an increasing number of such AUBs in an office setting. Once a proper diagnosis has been established, appropriate management must be implemented. Therefore, AUB should not be under-/overestimated, and diagnosis, investigations and treatment should be proposed as early as possible, taking into account the scientific data available in the current state of medical knowledge. [ABSTRACT FROM AUTHOR]

Introduction. Cervical-facial fetal tumors are an entity. Head and neck tumors are able to influence the vital prognosis at postnatal birth due to respiratory obstruction. The teratoma is most commonly seen in the neonatal solid, but only about 5% of the teratomas are located in the cervical-facial region. Early ultrasound imaging is the gold standard for the diagnosis of fetal abnormalities, while prenatal 3D ultrasound and prenatal nuclear magnetic resonance imaging (MRI) are complementary tools to establish a more accurate diagnosis. Methodology. We present a clinical case of prenatalversus- nasal suspected pathology, predominantly on the right side of the face, diagnosed by ultrasound at 26 weeks and 6 days of gestation. In addition to 2D and 4D ultrasound, the patient was referred to a reference hospital, where a fetal MRI was performed. The presumptive diagnosis was teratoma and fibrochondroma, tumors that can be solitary associated with one of the PAI or Goldenhar syndromes, but without a morphological facial argument for one of these syndromes. Postnatally, the established diagnosis was teratoma/nasal dermoid, with intrathermoid extension. During the postnatal period, the option of performing the surgical section of the tumor was discussed and adopted by a multidisciplinary team. The histopathological examination confirmed our suspicion and had the objective of a maturated frontonasal teratoma. Conclusions. The clinical significance of these births comes from the postnatal complications that they can cause, due to the over-the-air birth effects of the newborn. [ABSTRACT FROM AUTHOR]

The vitelline duct is the structure that can be visualized early inside the gestational sac, allowing the ultrasound diagnosis of intrauterine pregnancy. Embryological aspects. The vitelline duct begins to form at approximately 14 days post-conception. In the fourth week of embryological development, the vitelline duct wall consists of three thin cell layers: the outer layer (the ectoderm); the inner layer, lined by the endodermal epithelium; the mesodermal layer, consisting of island blood formations where hematopoietic stem cells can be identified. Aspects of 2D ultrasound. The ultrasound aspect of the vitelline duct initially appears as two parallel lines. Subsequently, from 5.5 weeks it appears as a round, transonic structure, with a diameter of 3-5 mm. Certain ultrasound parameters of the vitelline duct can be described, which can be used to evaluate the evolutionary prognosis of the pregnancy: early visualization, dimensions, number, form, persistence of visualization in the second trimester, calcification. Aspects of 3D ultrasound. Performing the volumetry of the vitelline duct allows a more accurate estimation of the relationship between the vitelline duct and the volume of the gestational sac, as well as the correlation between the volume of the vitelline duct and the cranial- caudal length of the embryo. The VOCAL method allows a detailed evaluation of the external surface of the vitelline duct. Aspects of Doppler ultrasound. The vascularization of the vitelline duct is related to the intervillous circulation and plays an essential role in the early maternal-embryonic exchange. Under normal conditions, the velocimetry profile of the vitelline duct is characterized by: low velocity, absence of diastolic flow, the average IP value of 3.24. In a pregnancy with reserved evolutionary potential, the vascular flow is characterized by: irregular vascular flow, permanent diastolic flow, signs of venous blood flow. The combination of 2D, 3D and Doppler ultrasound allows the identification of important moments in the development of pregnancy, allowing at the same time the thoroughgoing study of physiological and physiopathological mechanisms, characteristic of the first trimester pregnancy. [ABSTRACT FROM AUTHOR]

Introduction. The aim of the study is to analyze the utility of real-time elastography (RTE) in diagnosing cervical cancer (CC) and cervical intraepithelial neoplasia (CIN), using an experimental device (ED) made from a synthetic material as benchmark of rigidity. Methodology. Seventy-nine patients were involved in the study, being divided into three groups: Group 1 – benign cervix (n=39); Group 2 – CIN (n=32); Group 3 – CC (n=8). Seventy-nine identical silicone DEs were created. RTE was performed and the strain ratio (SR) method was used to quantify stiffness, representing the ratio of stiffness between the analyzed cervical tissue and ED. The average SR values corresponding to each group were compared. The diagnostic performance of the method was evaluated by generating the ROC curve and analyzing the area under the curve (AUC). Cut-off values were set. The histopathological results were the benchmark for data interpretation. Results. The average value of SR for Group 1 was significantly different from that of Groups 2 and 3 (p=0.001). After the exclusion of two aberrant values from Group 3, attributed to complicated cases with hemorrhagic necrosis, significant differences of the average SR between Groups 2 and 3 were observed (p=0.02). For Groups 1 and 3, the AUC was 0.966, with 95% CI (0.914-1.000); the cut-off value of the SR was 1.42, with a sensitivity of 100% and a specificity of 94.9%. The AUC was 0.752, with 95% CI (0.629-0876) for Groups 1 and 2; the sensitivity and specificity were 75%, respectively 74% for the cut-off value of 1.03. Conclusions. RTE, quantified by SR, using a synthetic reference material, seems a reliable method of differentiating the benign cervix from the malignant one; the technique proves promising results as a complementary method in CIN evaluation and diagnosis. Nevertheless, SR becomes inoperative in cases of cancer complicated by extensive hemorrhagic necrosis. [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]

Introduction. The incidence of embryonic demise is 25%. Complications of the first trimester pregnancy are a current health problem. The etiology of the embryonic demise is multifactorial, with chromosomal abnormalities being the most common (40%). In prenatal monitoring, it is desirable to increase the effectiveness of screening methods and improve diagnostic methods for first-trimester pregnancies whose outcome can be reserved. Materials and method. The paper is a prospective case-control analysis that took place at the "Dominic Stanca" Clinic of Obstetrics and Gynecology in Cluj-Napoca between 2015 and 2017, and comprised two groups of patients: 81 patients with first-trimester pregnany in evolution and 89 of patients with a potentially reserved outcome pregnancy, both groups having amenorrhea between 6 and 11 weeks. Endovaginal ultrasounds were performed to assess the distance between the yolk sac and the embryo (DYSE), and venous blood was harvested for serum dosing of the soluble vasculo-endothelial growth factor (sFlt-1). Results. Significant statistical differences were observed between the serum level of the serological follow-up observed in the two groups, respectively a significantly lower serum level in the reserved outcome pregnancies compared to the favorable ones (p<0.001). Conclusions. The identification of low serum levels of sFlt-1 followed in this study can be considered as a screening prediction test of potentially reserved outcome pregnancies. [ABSTRACT FROM AUTHOR]

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Copyright of Ginecologia.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pe măsură ce structurile fetale şi cele placentare se dezvoltă, reţeaua lor vasculară devine mai pronunţată. Prin urmare, pe timpul sarcinii este posibilă observarea a trei unităţi separate şi totuşi unite: circulaţia maternă, placentară şi fetală. Partea maternă a circulaţiei placentare este reprezentată de arterele uterine şi de ramurile acestora, care se ramifică până la placa deciduală a placentei. Cu ajutorul ecografiei Doppler se poate identifica şi caracteriza, chiar din trimestrul I de sarcină, fluxul vascular de la nivelul arterei uterine, arterelor arcuate, radiale, precum şi de la nivelul arterelor spiralate. Placenta este organul unde se întâlnesc două sisteme circulatorii perfect distincte: unul deschis - matern şi altul închis - fetal. În nicio parte a placentei nu există o comunicare directă între sângele matern şi cel fetal. Aceste evenimente pot fi studiate cu acurateţe prin ecografia 2D, 3D color sau power Doppler. Analiza Doppler pulsat arată două tipuri de unde obţinute din spaţiul intervilos: unda pulsatilă arterială şi flux venos continuu. Trimestrul I de sarcină permite evaluarea circulaţiei fetale la diferite niveluri: circulaţia ombilicală, vasele arteriale periferice (aorta descendentă, vasele intracerebrale), cordul, structuri venoase (vena cavă inferioară, ductul venos). Circulaţia ombilicală este prezentă începând de la şase săptămâni de amenoree, când vascularizaţia viloasă confluează cu tubul cardiac primitiv. Spectrul Doppler obţinut din circulaţia centrală venoasă a embrionului aduce informaţii referitoare la aspectul fiziologic al ventriculului drept. Astfel, informaţii specifice legate de presarcină, complianţa miocardului şi de presiunea la sfârşitul diastolei pot fi obţinute prin urmărirea Doppler a DV, precum şi a venei cave inferioare (VCI). După şase săptămâni de gestaţie, pot fi detectate semnale spectrale şi de culoare Doppler de flux pulsatoric de sânge în inima fetală şi vasele mari. În ultima parte a primului trimestru de sarcină, ultrasonografia şi înregistrarea Doppler pot fi realizate transabdominal. [ABSTRACT FROM AUTHOR]

Introducere. La nivelul compartimentului pelvian anterior există trei grupe de ligamente care au rol suportiv pentru uretră: ligamentele periuretrale, parauretrale şi pubouretrale. Acestea împreună cu peretele vaginal anterior asigură continenţa urinară. O leziune a structurilor menţionate poate determina apariţia cistocelului, a hipermobilităţii uretrale sau a incontinenţei urinare de efort (IUE). Cuantificarea leziunilor se poate realiza prin examinarea clinică, în asociere cu ultrasonografia transperineală. Materiale şi metodă. A fost realizat un studiu transversal în care au fost incluse 70 de paciente cu disfuncţii ale compartimentului pelvian anterior şi paciente de control. Pacientele au fost evaluate clinic, utilizând sistemul de cuantificare a prolapsului organelor pelviene (POP-Q), şi ultrasonografic, prin abord transperineal. Parametrii prin care s-a definit mobilitatea colului vezical au fost diferenţa dintre distanţa simfiză pubiană (SP) - col vezical (CV) în repaus şi în timpul manevrei Valsalva şi deplasarea înspre posterior a colului vezical (DPCV). În aceleaşi condiţii s-a evaluat şi modificarea unghiului uretro-vezical posterior (UVP). Rezultate. Din totalul pacientelor, 52% au prezentat stadiul POP-Q ≥2. Cel mai frecvent simptom asociat a fost pierderea involuntară de urină. La pacientele cu POP-Q≥2 care au prezentat IUE, distanţa SP-CV s-a redus în medie cu 13,8 mm, PCV a crescut în medie cu 5,59 mm, iar media diferenţelor UVP (repaus versus Valsalva) a crescut cu 27,69°. La pacientele cu POP-Q≥2 fără IUE, distanţa SP-CV s-a redus în medie cu 19,5 mm, PCV a crescut în medie cu 14 mm, iar media diferenţelor UVP (repaus versus Valsalva) a crescut cu 7°. Concluzii. În grupul pacientelor cu IUE s-a înregistrat o creştere semnificativ mai mare a unghiului UVP, comparativ cu grupul fără IUE. În grupurile studiate comparativ, reducerea distanţei SP-CV şi, respectiv, creşterea DPCV nu au fost semnificative statistic. [ABSTRACT FROM AUTHOR]

Introducere. Puţine tehnici de investigaţie paraclinică au avut în medicină impactul pe care l-a avut ecografia. Aprecierea unei dezvoltări normale a embrionului şi ulterior a fătului este completată de tehnici 3D care au deschis noi posibilităţi de cercetare a diferenţierii şi creşterii embrionare şi fetale, oferind perspectiva unei vizualizări mai detaliate a produsului de concepţie in utero. 3D HD Live este o tehnică de obţinere a unor imagini „realiste” printr-o postprocesare a imaginilor care se bazează pe recunoaşterea automată a componentelor structurale analizate cu augmentarea elementelor de suprafaţă şi utilizarea unui spectru de culori asemănător cu cel al ţesuturilor examinate. Silhouette este un algoritm de dată relativ recentă care permite vizualizarea interfeţelor tisulare cu densităţi diferite, permiţând obţinerea unor imagini tridimensionale în care sunt conturate cavităţile care apar sub forma unui conţinut transparent. Materiale şi metodă. Au fost evaluate săptămânal, între 6 şi 12 săptămâni, 31 de cazuri în 2D şi concomitent, prin diferite tehnici tridimensionale, pentru aprecierea corectă a aportului ecografiei 3D. De asemenea, au fost analizate informaţiile din literatură pe această temă pentru compararea datelor. Rezultate şi concluzii. 3D HD Live şi 3D HD Live Silhouette permit constant evidenţierea primelor structuri cerebrale la embrioni măsurând lungimi craniopodale de la 9,3-23,9 mm. Numeroasele tehnici tridimensionale au permis îmbunătăţirea evaluării 2D, cu apariţia progresivă a unor algoritmi care permit evidenţierea unor aspecte inaccesibile vizualizării până nu de mult. Trebuie însă menţionat că aportul ecografiei 3D este aditiv, existând în literatură un impresionant număr de articole care dezbat utilitatea reală a ecografiei 3D în primele 12 săptămâni de sarcină. Totuşi, progresul constant al tehnologiei, cu îmbunătăţirea periodică a imaginilor obţinute, vor impune cu siguranţă tot mai mult utilizarea 3D în prima parte a sarcinii. [ABSTRACT FROM AUTHOR]

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Copyright of Ginecologia.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ginecologia.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ginecologia.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Adenomyosis is a benign pathology defined by the presence of endometrial glands in the miometrium, accompanied by chronic pelvic pain, infertility and vaginal bleeding. It is a hormonal dependent condition and is common in reproductive age. Adenomyosis areas differ from the normal endometrium by increased local production of estrogen or prostaglandins and resistance to progesterone action. Materials and method. The study included 23 patients, aged 26-52 years old, diagnosed with adenomyosis. Postoperatively obtained specimens were included in paraffin and studied histologically and immunohistochemically. The blocks were cut by the microtome, the sections were applied on simple slides for histological staining of Hematoxylin-Eosin and on Poly-L-lysin slides for the immunohistochemical stains. The antibodies were: anti-estrogen receptors (ER), anti-progesterone receptors (PR), anticytokeratin 7 (CK7), anti-cytokeratin 20 (CK20). Results. Classical Hematoxylin-Eosin staining showed the presence of mono-layered, cylindrical glandular epithelial tissue in the structure of the myometrium, and with immunohistochemistry we showed that these glands were of endometrial origin, being CK7-positive and negative at CK20, making a differential diagnosis with an eventual metastasis from the digestive tract. The receptors for estrogen and progesterone are present in the structure of these glands. Conclusions. Adenomyosis is a benign pathology diagnosed with certainty by histopathological examination. Receptors for estrogen and progesterone are features for endometrial tissue, and cytokeratins make the differential diagnosis with digestive epithelium. [ABSTRACT FROM AUTHOR]

Diabetes is the most common medical complication associated with pregnancy. During pregnancy complicated with maternal diabetes (DM), the placenta suffers certain pathological, functional and structural changes. DM was correlated with a rapid progressive microangiopathy and this, in turn, may be associated with capillary hypertension and changes in capillary permeability. The objective of the study is to identify the clinical correlations with influence on gestation in general, and on the placental structure in particular, in pregnancy associated with type 1 (T1DM), type 2 (T2DM) and gestational diabetes mellitus (GDM). The impact of the clinical conditions associated with DM on placenta has been analyzed and correlated with the ultrasound (US), morphological, histological and immunohistochemical study of the placental structure. Preexisting maternal hypertension, preeclampsia and obesity were the main associated conditions. The US examination of placental characteristics revealed an increase in placental thickness in the second trimester. The macroscopic analysis showed that the placentas of women with diabetes are heavier. Gross pathological analysis of maternal and fetal surfaces of placentas revealed subcortical or basal plaque fibrin deposition, and placental infarction or intervillous thrombosis. From the microscopic point of view, the findings include fibrinoid necrosis, intervillous fibrosis, focal hyaline degeneration, villous immaturity, chorangiosis, placental calcifications, placental infarction or decidual vasculopathy. Maternal hypertensive disorders amplify the spectrum of morphological changes in the placenta. Placental immaturity and villous capillary dysfunction are characterized by increased angiogenesis and enhanced vascular permeability. The diabetic placenta does not show specific changes, but different associations may be a diabetic pathological pattern influenced by associated conditions, especially preeclampsia, obesity, dyslipidemias and the lack of euglycemia during pregnancy. [ABSTRACT FROM AUTHOR]

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În chirurgia vaginală reconstructivă, rezultatele funcţionale nu se corelează liniar cu rezultatele anatomice. Prolapsul genital și incontinenţa urinară se asociază cu reducerea excitării sexuale, cu raritatea orgasmelor și dispareunie. Dispareunia și disfuncţia sexuală după chirurgia vaginală sunt raportate diferit de către diferiţi autori. Dimensiunile fizice ale vaginului nu influenţează semnificativ funcţia sexuală. Locul chirurgiei vaginale are un impact mai semnificativ asupra ratelor dispareuniei postoperatorii. Repararea peretelui vaginal posterior a fost asociată cu o rată mai mare a dispareuniei postoperatorii, mai ales atunci când se efectuează o plicaturare a mușchilor ridicători anali. Din cauza datelor contradictorii în ceea ce privește repararea cu meșă, trebuie cântărite cu atenţie beneficiile rezultatelor durabile comparativ cu impactul posibil negativ asupra funcţiei sexuale. Activitatea sexuală, cât și satisfacţia sexuală trebuie să constituie criterii de măsurat după tratamentul chirurgical reconstructiv vaginal. [ABSTRACT FROM AUTHOR]

Sindromul vezicii urinare hiperactive (VUH) include imperiozitatea și incontinenţa urinară prin imperiozitate (IUI) și apare frecvent în urma corecţiei chirurgicale a incontinenţei urinare de efort (IUE). Identificarea factorilor de risc pentru apariţia simptomelor VUH este importantă pentru a putea informa pacienta în mod corespunzător înainte de intervenţia chirurgicală. Postoperator, incidenţa imperiozităţii persistente este de 15%, iar cea a IUI este de 30%. Femeile diagnosticate cu incontinenţă urinară mixtă, predominantă prin imperiozitate, prezintă persistenţa simptomatologiei după intervenţia chirurgicală, comparativ cu pacientele cu IUE. Vârsta înaintată constituie, de asemenea, un factor de risc pentru apariţia simptomelor de VUH. Parametrii urodinamici ai VUH (presiunea crescută a detrusorului, presiunea intraluminală uretrală, fluxul urinar) pot prezice apariţia imperiozităţii postoperator sau a IUI. Gestionarea simptomelor VUH după intervenţia chirurgicală efectuată pentru IUE este aceeași ca și în cazul VUH idiopatice. Cu toate acestea, înainte de începerea tratamentului, este esenţial să excludem alţi factori care pot determina imperiozitate: obstrucţiile tractului urinar, infecţia tractului urinar sau eroziunea bandeletei. Simptomele VUH sunt frecvent raportate după intervenţia chirurgicală. Severitatea simptomelor de imperiozitate, lipsa complicaţiilor intraoperatorii și cura chirurgicală concomitentă a prolapsului sunt predictori importanţi ai imperiozităţii persistente sau ai apariţiei IUI postoperator. [ABSTRACT FROM AUTHOR]

Incontinenţa urinară (IU) reprezintă o afecţiune cu un impact negativ semnificativ asupra pacientelor, reflectat atât în plan fizic și psihic, cât și social, prevalenţa globală a acestei patologii fiind de 40%. În prezent, nicio metodă imagistică nu este considerată gold standard în diagnosticul și conduita impusă de IU. Ecografia transperineală este o metodă ușor accesibilă în vederea evaluării IU. Conform recomandărilor elaborate în urma întrunirii forurilor specializate în IU, ecografia transperineală nu este recomandată în cadrul evaluării primare la paciente cu IU (nivel de evidenţă 3/grad de recomandare C), fiind considerată un test opţional în cazul pacientelor cu IU recurentă sau mixtă. Pentru efectuarea ecografiei transperineale se utilizează un transductor convex de 3,5-6 MHZ. Printre elementele care pot fi cuantificate prin această tehnică în cazul IU se evidenţiază: mobilitatea colului vezical, unghiul uretro-vezical posterior/anterior, joncţiunea vezico-uretrală, grosimea peretelui vezical, evaluarea fiind efectuată comparativ, în condiţii de repaus și în timpul manevrei Valsalva. De asemenea, pot fi decelate aspecte incidentale, precum prezenţa unor diverticuli uretrali, care pot fi cauze ale IU. Standardizarea determinărilor efectuate poate contribui la evaluarea exhaustivă a cazurilor cu IU și la alegerea algoritmului ideal în conduita impusă de această entitate patologică. [ABSTRACT FROM AUTHOR]

Incontinenţa urinară de efort (IUE) este o afecţiune frecventă care afectează global una din trei femei. În urmă cu mai mult de trei decenii, colposuspensiile retropubiene și bandeletele pubovaginale cu fascie autologă au fost principalele metode chirurgicale utilizate pentru tratarea IUE. Pe măsură ce tehnologia a avansat, tratamentul chirurgical al IUE s-a îmbunătăţit, prin implementarea materialului sintetic. În ultimii zece ani, tehnica standard acceptată a fost operaţia de suspensie suburetrală. În prezent, majoritatea femeilor cu IUE optează pentru bandeleta suburetrală, existând peste 3,6 milioane de astfel de bandelete montate în întreaga lume. În ceea ce privește tipul de bandeletă care trebuie folosit pentru femeia incontinentă, se consideră că atât bandeletele sintetice, cât și cele nesintetice au rezultate bune pentru majoritatea pacientelor. Obezitatea și vârsta înaintată nu influenţează rezultatul intervenţiei. Montarea unei bandelete sintetice pentru IUE trebuie evitată în caz de eroziune uretrală sau vaginală în antecedente, diverticul uretral, fistulă uretro-vaginală sau leziuni uretrale anterioare. În aceste cazuri, pentru a scădea morbiditatea, bandeleta pubovaginală fascială ar trebui să fie alegerea optimă. Pentru a elimina unele dintre efectele secundare, a fost dezvoltată o nouă generaţie de bandelete, numite „mini-slinguri”. Acestea sunt de dimensiuni mai reduse și nu penetrează ţesuturile la fel de profund comparativ cu cele standard. Materialul sintetic, alături de dimensiunea porilor reprezintă alte caracteristici care trebuie luate în considerare la alegerea bandeletei. Rezultatele pe termen lung ale utilizării bandeletelor în cura IUE sunt corelate cu experienţa chirurgului, particularităţile biologice ale pacientelor, dar și cu caracteristicile bandeletei. [ABSTRACT FROM AUTHOR]

Preeclampsia (PE) rămâne o problemă majoră a obstetricii, reprezentând una dintre principalele cauze de mortalitate și morbiditate materno-fetală. Obiectivele acestei cercetări au fost evaluarea parametrilor Doppler la nivelul arterei uterine (IP, notch-ul și combinațiile acestora) la gravidele cu risc, în trimestrul I și al II-lea de sarcină, cu scopul de a realiza o predicție cât mai precoce a PE. S-au considerat aspecte anormale ale Dopplerului arterei uterine prezența notch-ului bilateral și/sau a mediei IP >percentila a 95-a. Din lotul total de 120 de gravide luate în studiu, 26 au dezvoltat PE, reprezentand lotul I, iar 94 de paciente cu evoluție fiziologică a sarcinii au consituit lotul al II-lea. Examinarea Doppler a arterei uterine în trimestrul I de sarcină a evidențiat IP patologic la 26,9% gravide din lotului I și la 13,8% din lotul al II-lea. Prezenta notchului bilateral la nivelul arterei uterine în trimestrul I de sarcina a fost evidenţiata la 61,5% gravide din lotul I, și 41,5% din lotul al II-lea. Modificările globale ale parametrilor Doppler studiați în trimestrul I, au fost prezente la 65,4% gravide din lotul I și 48,9% din lotul al II-lea. Examinarea Doppler a arterei uterine în trimestrul al II-lea de sarcină a evidențiat IP patologic la 53,8% gravide din lotul I și 13.8% din lotul al II-lea. Analiza globală a parametrilor Doppler modificați în trimestrul al II-lea a evidenţiat IP patologic, notch sau asocierea acestora la 73,1% gravide din lotul I și la 23,4 % din lotul al II-lea. Examinarea Doppler a arterei uterine constituie un test de screening non-invaziv eficient pentru apariția PE la sarcinile cu risc. Persistența notch-ului bilateral și constatarea unei valori anormale a IP din primul în al doilea trimestru au identificat grupul de paciente cu riscul cel mai mare de a dezvolta PE. [ABSTRACT FROM AUTHOR]

Malformațiile cardiace sunt cele mai frecvente anomalii congenitale, acestea putând fi întâlnite atât izolat, cât și în asociere cu anomalii cromozomiale. Prima examinare a cordului fetal este recomandată în timpul screeningului pentru anomalii cromozomiale de trimestrul I și aceasta trebuie să fie urmată de o reevaluare între 20 și 23 de săptămâni de sarcină. Astfel, pacientelor care nu prezintă factori de risc pentru malformații cardiace li se va efectua o evaluare de bază a cordului fetal. Pacientele care prezintă oricare dintre următorii factori de risc: translucența nucală >= 3,5 mm, suspiciunea absenței ductului venos, suspiciunea unei malformații cardiace la evaluarea de bază a cordului fetal, antecedente de defecte cardiace severe la făt/copil, beneficiază de evaluarea în detaliu a cordului fetal. Principiile de bază ale examinării cordului în primul trimestru de sarcină sunt similare cu cele utilizate la vârste gestaționale avansate, fiind recomandată examinarea în dinamică a secțiunilor transverse, pornind de la nivelul abdomenului superior până la nivelul toracelui. Examenul Doppler color facilitează evidențierea anatomiei cordului fetal, a conexiunilor vasculare, precum și a direcției fluxului sangvin. Asocierea ecografie 2D - ecografie Doppler color îmbunătățește calitatea examinării cordului fetal. Evaluarea situsului cardiac, a imaginii de 4 camere, a ductului venos, a căilor de ejecție a ventriculului stâng și drept, a imaginii de 3 vase, a arcului aortic, a arterei subclavivulare drepte, a septului interventricular și a încrucișării arterei aorte cu artera pulmonară permit aprecierea normalității structurilor examinate sau identificarea unor elemente patologice. Aceste aspecte sunt sugestive pentru prognosticul antepartum și permit decizia informată privitoare la opțiunile terapeutice. [ABSTRACT FROM AUTHOR]

Examinarea cu ultrasunete este metoda de elecție în diagnosticul sarcinii oprite în evoluție, precum și a sarcinii cu potențial evolutiv rezervat. Incidența evoluției nefavorabile a sarcinii este crescută în primul trimestru. Înainte ca embrionul să fie identificat prin ultrasonografie, caracteristicile ecografice ale sacului gestațional pot fi utilizate ca factori de prognostic. Odată vizualizat embrionul și vezicula vitelină, se pot utiliza de asemenea ca markeri ecografici de prognostic: dimensiunea sacului gestațional raportată la cea a embrionului, rata de creștere a embrionului din momentul identificării activității cardiace, aspectul și dimensiunea veziculei viteline, fluxul diastolic permanent sau semnalele vasculare anormale de la nivelul veziculei viteline. Un element explorat insuficient rămâne distanța dintre embrion și vezicula vitelină, din momentul în care aceste structuri devin vizibile. Distanța dintre embrion și vezicula vitelină ≤ 2 mm reprezintă un parametru ecografic cu rol predictiv important, care sugerează o posibilă evoluție nefavorabilă a sarcinii. Corelațiile dintre această distanță și alți parametrii ecografici (lungimea cranio- caudală a embrionului, aspectul, dimensiunea și vascularizația veziculei viteline) sau dintre această distanță și anumiți parametrii serologici (nivelul plasmatic al progesteronului și al β hCG-ului), pot constitui factori predictivi pentru evoluția nefavorabilă a sarcinii de prim trimestru. [ABSTRACT FROM AUTHOR]

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