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Disseminated peritoneal leiomyomatosis (DPL) is a rare condition marked by multiple leiomyomas in the peritoneal cavity, predominantly affecting women of reproductive age. Although typically benign, DPL can present significant diagnostic challenges and, in rare cases, may progress to malignancy. A primary contributing factor to DPL is iatrogenic, particularly due to surgical interventions such as morcellation during myomectomy. This scoping review explores the pathogenesis, epidemiology, diagnosis, and management of DPL, highlighting the crucial role of hormonal influences and iatrogenic factors. Diagnostic methods include computed tomography, ultrasound, magnetic resonance imaging, and histopathological evaluation, which are essential for assessing disease extent and guiding treatment. Management strategies encompass surgical intervention—with a focus on minimizing iatrogenic risks—conservative approaches for asymptomatic patients, and advancements in hormonal treatments. Emphasis is placed on preventing iatrogenic dissemination through refined surgical techniques and patient education. Despite its rarity, with fewer than 200 cases reported globally, understanding DPL's clinical presentation and iatrogenic origins is vital for optimal patient outcomes. This review underscores the importance of early diagnosis, personalized treatment plans, and ongoing research to address the challenges associated with DPL. [ABSTRACT FROM AUTHOR]

Obesity, characterized by an excess of adipose tissue, has become a significant global health issue. The prevalence of obesity has increased markedly in recent decades worldwide, with a sharp rise also observed in developing countries, particularly in urban areas. Addressing obesity during pregnancy is crucial for several reasons and presents challenges for specialists in obstetrics and gynecology. Objectives: The aim of the present study was to investigate the correlation between obesity and its implications for childbirth. Materials and Methods: We conducted a retrospective study involving 1513 patients, grouped into normal-weight, overweight, and obese categories using corrected BMI values. We performed comparative analyses to explore the association between BMI and various outcomes: the method of delivery, the Apgar score at birth, the incidence of fetal distress, fetal birth weight, the presence of pregnancy-associated pathologies, and the occurrence of postpartum hemorrhage. Descriptive statistical analysis was utilized to characterize the demographic and clinical features of the patients and newborns. Results: By examining variables such as the occurrence of fetal distress during labor, the Apgar score at delivery, and the mode of delivery, we identified an association between increasing BMI and complications during labor and delivery. The results indicate that a higher BMI is linked with increased complications and variations in the mode of delivery. Conclusions: Obesity is the most common health issue among women of reproductive age and requires long-term care. It can contribute to numerous pregnancy-associated pathologies and affect both mother and child during labor and delivery. Obesity is associated with lower Apgar scores, the increased incidence of fetal distress, and a higher rate of cesarean section deliveries. Although the absolute risk of serious complications for mother, fetus, and newborn is low among women with obesity, adopting healthy eating and exercise behaviors prior to pregnancy, ideally, or as early in pregnancy as possible, can help minimize excessive weight gain during pregnancy. [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]

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]

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. Herlyn-Werner-Wunderlich syndrome (HWW) is a rare congenital anomaly of the urogenital tract characterized by the triad: uterus didelphys, obstructed hemivagina and unilateral renal agenesis, which is two times more common on the right side than on the left side. The incidence of this syndrome is 0.1-3.8% and, so far, in less than 10 cases the association of this pathology with acute urinary retention has been reported. Materials and method. We present the case of a 13-year-old girl who came to our emergency room accusing pain of increased intensity in the lower abdominal floor, started insidiously a week before, accompanied by nausea, pallor, sweating, anxiety and moderate vaginal bleeding (menstrual status). The anamnesis revealed absent diuresis for about 6 hours, menarche at 12 years old, regular menstruation, oligomenorrhea and dysmenorrhea. The clinical examination revealed respiratory movements of the abdomen, distension caused by a pseudotumoral mass located subumbilically, reluctant, painful; normal external genitalia. The paraclinical examination (ultrasound and MRI) revealed: voluminous cystic mass of 155/100/100 mm located between the bladder and the rectum, suggestive of hematometrocolpos; lower it protruded into the vagina, the image being suggestive of the transverse vaginal septum; uterus didelphys; normal ovaries and fallopian tubes. Unseen left kidney – left renal agenesis. Results. Surgery was performed with urinary bladder catheterisation, incision of the septum and continuous aspiration – about 1000 ml of chocolate-like fluid, suggestive of old blood, followed by resection of the vaginal septum. Conclusions. A high rate of awareness and clinical suspicion of HWW syndrome among adolescents is necessary for both the diagnosis and the prompt surgical treatment, leading to remission of symptoms, prevention of complications and to preservation of fertility. [ABSTRACT FROM AUTHOR]

Preeclampsia is a multisystemic disease, with a prevalence of 2-5%, that affects pregnant women. Every year, 76,000 women and 500,000 fetuses die due to the complications of this pathology. The prenatal screening for preeclampsia is constantly being updated. Globally, attempts are being made to identify easily reproducible, cost-effective screening markers that determine with great accuracy the patients prone to develop preeclampsia. Thus, there are differences between the described risk factors, the screening and prevention protocols recommended by world-recognized medical associations, such as the International Federation of Obstetrics-Gynecology (FIGO) and the American College of Obstetrics-Gynecology (ACOG). According to the latest FIGO recommendations, all pregnant patients should be screened in the first trimester for preeclampsia, including: maternal risk factors, mean blood pressure, placental growth factor and uterine artery pulsatility index. Patients at increased risk of developing preeclampsia will undergo preventive treatment with aspirin between 11- 14 weeks +/- 6 days and 36 weeks of pregnancy. ACOG presents patients with a history of preeclampsia, multiple pregnancy, chronic hypertension, type 1 or 2 diabetes, kidney disease or autoimmune diseases as having an increased risk of developing preeclampsia and a need for the prophylactic administration of aspirin. There is also a difference between the risk factors presented by the two associations. In conclusion, the determination of screening markers that provide an increased identification of patients at risk of developing preeclampsia, as well as the precise determination of risk factors for preeclampsia are imperative to anticipate and initiate the preventive treatment for women at risk, decreasing the prevalence of the disease, its complications and implicitly the costs. [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]

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]

The umbilical cord and placenta may be the site of tumor development, sometimes jeopardizing the physiological development of the fetus. The umbilical cord becomes detectable on ultrasound from 7-9 weeks of gestation, initially as a thickened and straight structure, which increases in length and acquires a spiral shape. Umbilical cord cysts are rare abnormalities detected incidentally during routine ultrasounds. These can be classified as true cysts or pseudocysts, the final diagnosis being represented by the histopathological examination, which describes an epithelial layer in the case of true cysts. Pseudocysts are more frequently associated with trisomy 18 and 13, the risk of malformations being higher if the lesion is multiple, persists after 12 weeks of amenorrhea if the localization is paraxial; at the fetal or placental insertion of the cord. The placenta may also present various tumors. Subchorionic cysts have a 5-7% incidence, arising on the fetal placental face as anechoic images without Doppler signal. It is considered that their localization near the placental cord insertion site (PCIS) can result in intrauterine growth restriction. Other placental tumors include echogenic cystic lesions, placental lakes, chorioangiomas, hydatiform moles. The antenatal diagnosis should include investigations aimed at detecting the possible association with chromosomal abnormalities. Thus, we present the case of a 29-yearold primiparous, which, at 12 weeks of amenorrhea, it was detected a 2.5-cm diameter cyst located near the PCIS, increasing in dimensions up to 5 cm diameter at 16 weeks of amenorrhea, then having a steady evolution. The fetal development has not been affected, the histopathological examination describing the lesion as a subchorionic cyst. [ABSTRACT FROM AUTHOR]

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Incidenţa sarcinii oprite în evoluţie este de 25%. Complicaţiile sarcinii de prim trimestru reprezintă o problemă actuală de sănătate. Etiologia opririi în evoluţie a sarcinilor este plurifactorială, anomaliile cromozomiale fiind cele mai frecvente (40%). Alte cauze pot fi reprezentate de: defecte de fază luteală, anomalii tiroidiene materne, diabet zaharat matern, infecţii, trombofilii ereditare sau dobândite, precum şi agenţi exogeni. În cadrul monitorizării prenatale se doreşte creşterea eficienţei metodelor de screening şi îmbunătăţirea metodelor de diagnostic în cazul sarcinilor de prim trimestru al căror potenţial evolutiv poate fi rezervat. Iniţial, embrionul este detectat imediat adiacent veziculei ombilicale (VO). Dacă embrionul este separat de aceasta, separarea se datorează dezvoltării sale. Pe măsură ce creşte lungimea cranio-caudală (LCC), creşte şi distanţa dintre embrion şi VO. Pentru embrionii cu un LCC de 5 mm sau mai mic, nu ar trebui să fie nicio separare a embrionului de VO sau una foarte mică (<2 mm). O distanţă mică (evaluată în literatura de specialitate de 2 mm) între un embrion cu LCC mai mare de 5 mm şi VO este un marker ecografic de prognostic nefavorabil. Astfel, s-a studiat distanţa dintre embrion şi VO (apreciată prin ecografie endovaginală) pentru embrionii cu LCC mai mare de 5 mm şi s-a identificat o corelaţie între aceasta şi nivelul seric al β-Human Chorionic Gonadotropin (beta-HCG), progesteron, forma solubilă a factorului de creştere endotelial (sFlt1), Human Inhibin A, Human Placental-Like Growth Factor şi Human Pregnancy Specific Beta 1 Glycoprotein, evidenţiindu-se corelaţii importante între aceşti factori serologici şi cel ultrasonografic în cazul pacientelor cu sarcină cu evoluţie nefavorabilă. [ABSTRACT FROM AUTHOR]

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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]

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.)

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.)

Background and aims. Perimenopause is marked by clinical manifestations which disturb everyday life and which may also hide a pathomorphological, more precisely endometrial, substrate. An accurate early diagnosis established by accessible, non-invasive methods is very important for the therapeutic management. Method. The study included 103 patients aged between 41.5-55.11 years, divided into 3 age groups: 40-44 years (n=10), 45-49 years (n=54) and ≥50 years (n=39). Results. Certain risk factors of endometrial neoplasm or premalignant conditions were evidenced, their accurate identification being useful in limiting the number of patients with abnormal uterine bleeding (AUB) submitted to diagnostic screening. The most common cause of AUB in our study was fibroma, followed by functional causes. Conclusions. Transvaginal ultrasound (TVUS) represents a minimally invasive method for the screening of perimenopausal patients with AUB, especially to rule out endometrial adenocarcinoma (EAC). TVUS sensitivity was higher than clinical diagnosis in case of leiomioma, polypi and EAC. TVUS was more accurate in the diagnosis of EAC, polypi and leiomioma. [ABSTRACT FROM AUTHOR]

Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP) is a rare uterine tumor primarily affecting perimenopausal and postmenopausal women, typically aged between 45 and 55 years. Characterized by ambiguous histological features, STUMPs present diagnostic challenges as they cannot be definitively classified as benign or malignant based on morphology alone. This systematic review aims to elucidate the clinical, pathological, immunohistochemical, and treatment-related characteristics of STUMPs through an analysis of the literature from the past 20 years. The study follows PRISMA guidelines, utilizing comprehensive searches of PubMed and Scopus databases, yielding 32 studies that meet the inclusion criteria. From the analysis of these studies, it was revealed that the clinical presentations vary from common symptoms such as abnormal uterine bleeding and pelvic pain to incidental detection of uterine mass. Histologically, STUMPs demonstrate features overlapping with both leiomyomas and leiomyosarcomas, including mild nuclear atypia, low mitotic indices, and focal necrosis. Immunohistochemical markers such as p16 and p53 have been investigated for prognostic significance. Elevated p16 expression, often associated with aggressive behavior, was observed in a subset of STUMPs. Surgical management, typically involving hysterectomy or tumorectomy, is the primary treatment, though the extent of resection is variable. Adjuvant therapies are not routinely recommended, but long-term surveillance is advised, especially for high-risk patients. Recurrence rates for STUMPs are approximately 12%, with factors such as high mitotic counts and coagulative necrosis indicating higher risk. This review highlights the complexity of STUMP diagnosis and management, emphasizing the need for more precise diagnostic criteria and individualized treatment strategies. Understanding the morphological, immunohistochemical, and clinical behavior of STUMPs can improve patient outcomes and guide future research in this diagnostically challenging area.

Background and objectives : As pelvic floor disorders are often difficult to assess thoroughly based on clinical examination alone, the use of imaging as a complementary technique is helpful. This study's aim was to investigate by transperineal ultrasound (US) if there was any significant difference in the mobility of the bladder neck in women with stress urinary incontinence (SUI) without a cystocele and in those with SUI and an associated cystocele. The study also investigated whether the number of vaginal births and/or the heaviest newborn's birth weight was correlated with the bladder neck mobility. Materials and Methods : A total of 71 women suffering from SUI were included in the study and divided into two groups based on the presence of a cystocele. Their bladder neck mobility was evaluated by transperineal US, calculating the distance from the inferior margin of the symphysis pubis to the bladder neck (SPBN), and the dorsocaudal linear movement (DLM), term used to illustrate the displacement of the bladder neck by subtracting rest and Valsalva values. GraphPad Prism 8 was used for statistical analysis. Results : Within both study groups, the SPBN values were significantly higher and the DLM values were significantly lower at rest as compared to Valsalva maneuver ( p < 0.05). No significant difference between the groups regarding SPBN and DLM values at rest, Valsalva, or subtraction was demonstrated. A significant positive correlation was found between the bladder neck mobility and the heaviest newborn's birth weight, regardless of the presence of a cystocele ( p = 0.042). Conclusions : The presence of a cystocele had no significant impact on the bladder neck mobility measurements in patients with SUI. The heaviest newborn's birth weight positively correlated with bladder neck hypermobility, as quantified by SPBN.