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Maternal immunization during pregnancy provide protection for the mother and the fetus against certain pathogens. Immunizations during pregnancy are divided to routine immunizations recommended for all pregnant women, immunizations for certain medical indications and vaccines that are potentially harmful during pregnancy and should be avoided. We conducted a comprehensive review of the literature regarding immunizations during pregnancy. The search terms used were immunization, vaccine, pregnancy, influenza, pertussis, safety and efficacy. We gathered all available guidelines on vaccination during pregnancy. Generally, vaccines are allowed during pregnancy when the benefits outweigh the risks. Tdap and inactivated flu vaccines are routinely recommended during pregnancy. Vaccines containing live attenuated viruses are contraindicated during pregnancy. These are LAIV influenza, MMR, Varicella, Zoster, BCG and smallpox pre-exposure. All other vaccines are given when medically indicated and the possible benefits outweigh the risks. Obstetricians and gynecologists should be familiar with the indications of vaccination during pregnancy. Vaccination coverage of pregnant women with routinely recommended vaccines has increased but further efforts are needed. Our aim is to review vaccination practices during pregnancy, demonstrate the benefits and dangers of different vaccines, evaluate their effectiveness and define the proper timing of vaccination.

Background Promoter region SNPs in TNF-α have been studied in association with Recurrent Pregnancy Loss (RPL) occurrence in various populations. Among them, −238G > A, −308G > A and − 376G > A have been frequently investigated for their potential role in recurrent abortions. The aim of the present study is to evaluate the correlation among TNF-α 238, TNF-α 308 and TNF-α 376 polymorphisms and recurrent pregnancy loss risk in Greek women. Methods This study included 94 Caucasian women with at least two miscarriages of unexplained aetiology, before the 20th week of gestation. The control group consisted of 89 Caucasian women of proven fertility, with no history of pregnancy loss. DNA samples were subjected to PCR amplification using specific primers. Sanger sequencing was applied to investigate the presence of TNF-α 238, TNF-α 308, TNF-α 376 polymorphisms in all samples. Results The TNF-α 238 and TNF-α 308 variants were both detected in RPL and control groups (7.45% vs 4.49 and 45.16% vs 36.73%, respectively), but with no statistically significant association (p-value 0.396 and 0.374, respectively). The TNF-α 376 variant was not detected at all in both control and RPL groups. When TNF-α 238 and TNF-α 308 genotypes were combined no association with RPL was detected (p-value = 0.694). In subgroup analysis by parity, RPL patients carrying the A allele reported less previous births. Conclusions This is the first study demonstrating TNF-α 238 and TNF-α 308 gene expression and the absence of TNF-α 376 variant in Greek women with RPL. However, no association emerged between each polymorphism studied and the occurrence of recurrent pregnancy loss. Accordingly, TNF-α -308G > A, −238G > A and -376G > A variants are not considered genetic markers for identifying women at increased risk of recurrent pregnancy loss in the Greek population.

Objectives The aim of our study is to present the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy and evaluate its impact on maternal and neonatal outcomes. Methods We retrospectively reviewed the medical records of all COVID-19 positive pregnant women who were admitted to “Alexandra” maternity hospital from March to December 2020 (n=40). The infection status was determined via real-time polymerase chain reaction (RT-PCR) of nasopharyngeal swab specimen. We documented the demographic features, clinical status, pregnancy characteristics and maternal and fetal outcomes. Results Forty COVID-19 positive pregnant women were admitted to our clinic during the study period. Mean maternal age was 27.6 years. Gestational age (GA) ranged from 10–42 weeks of pregnancy with mean GA calculated at 38+3 weeks. Associated comorbidities included hypertension, hypothyroidism, epilepsy, hepatitis B and asthma. Thirty-five out of 40 women delivered within the study period. Cesarean section was performed in 57.1% of the cases. Most of the cases (87.5%) were asymptomatic while ventilation was required for only one patient. All neonates tested negative for SARS-CoV-2. Neither maternal nor neonatal deaths occurred. Conclusions In alignment to other studies, our data show that the course of coronavirus disease 2019 (COVID-19) during pregnancy in the majority of cases is mild and neonatal outcomes also appear favorable.

Salivary gland adenocarcinoma not otherwise specified (NOS) is a malignant epithelial tumor composed of ductal/glandular structures with or without cystic formation. Histologically it is classified as high grade with relevant biological behavior. Although both minor and major glands may be involved, the majority (60%) implicate the parotid gland. Location, regional lymph node status, and histological grade are some of the factors that predict the progress of the disease and the development of metastases. Long follow-up is considered the standard option as distant metastases (DM) may occur despite regional control. Primary sites of DM, besides lymph nodes, include bone, lung, and liver. Herein we report a unique case of a 68-year-old female with a previous history of high-grade adenocarcinoma NOS of her right parotid gland. On her biannual follow-up examination, MRI revealed an abnormal increase in the size of a known uterine leiomyoma of the posterior uterine wall. Positron emission tomography-CT (PET-CT) showed increased uptake in the uterus and lungs. On frozen section, adenocarcinoma was found at the center of the leiomyoma. Histological and immunohistochemical findings were consistent with secondary involvement by the salivary gland adenocarcinoma NOS. Treatment consisted of cyclophosphamide, adriamycin, and cisplatin with poor outcome. The patient was lost to follow-up. Review of the literature indicates that no similar case has been reported in the English literature.

Bowel preparation traditionally refers to the removal of bowel contents via mechanical cleansing measures. Although it has been a common practice for more than 70 years, its use is based mostly on expert opinion rather than solid evidence. Mechanical bowel preparation in minimally invasive and vaginal gynecologic surgery is strongly debated, since many studies have not confirmed its effectiveness, neither in reducing postoperative infectious morbidity nor in improving surgeons’ performance. A comprehensive search of Medline/PubMed and the Cochrane Library Database was conducted, for related articles up to June 2019, including terms such as “mechanical bowel preparation,” “vaginal surgery,” “minimally invasive,” and “gynecology.” We aimed to determine the best practice regarding bowel preparation before these surgical approaches. In previous studies, bowel preparation was evaluated only via mechanical measures. The identified randomized trials in laparoscopic approach and in vaginal surgery were 8 and 4, respectively. Most of them compare different types of preparation, with patients being separated into groups of oral laxatives, rectal measures (enema), low residue diet, and fasting. The outcomes of interest are the quality of the surgical field, postoperative infectious complications, length of hospital stay, and patients’ comfort during the whole procedure. The results are almost identical regardless of the procedure’s type. Routine administration of bowel preparation seems to offer no advantage to any of the objectives mentioned above. Taking into consideration the fact that in most gynecologic cases there is minimal probability of bowel intraluminal entry and, thus, low surgical site infection rates, most scientific societies have issued guidelines against the use of any bowel preparation regimen before laparoscopic or vaginal surgery. Nonetheless, surgeons still do not use a specific pattern and continue ordering them. However, according to recent evidence, preoperative bowel preparation of any type should be omitted prior to minimally invasive and vaginal gynecologic surgeries.

Background Chronic hepatitis C virus (HCV) infection is associated with autoimmune phenomena and is often complicated by anemia. Circulating autoantibodies to endogenous erythropoietin (anti-EPO) have been detected in patients with chronic viral infections and were correlated to anemia. The present study aimed to determine anti-EPO prevalence in patients with chronic HCV infection and investigate its possible association with anemia. Methods Ninety-three consecutive patients (62 males and 31 females) with chronic HCV infection, who had never received antiviral therapy or recombinant EPO, were enrolled in the study. Circulating anti-EPO were detected in the serum by using an ELISA assay. Quantitative determination of serum EPO levels was done by radioimmunoassay. HCV RNA viral load measurement and genotype sequencing were also performed. Results Circulating anti-EPO were detected in 10.8% of HCV-infected patients and the prevalence of anti-EPO was significantly higher in patients with anemia (19.4% vs 5.3%, P=0.040) compared to that in those without anemia. Compared to anti-EPO negative cases, anti-EPO positive patients had higher frequency of anemia (70.0% vs 34.9%, P=0.030), lower EPO concentrations (median 16.35 vs 30.65 mU/mL, P=0.005), and higher HCV RNA viral load (median 891.5×103 vs 367.5×103 IU/mL, P=0.016). In multivariate regression analysis the presence of anti-EPO remained an independent predictor of anemia (adjusted OR: 14.303, 95% CI: 1.417–36.580, P=0.024). EPO response to anemia was less prominent among anti-EPO positive patients (P=0.001). Conclusions Circulating anti-EPO are detected in a significant proportion of treatment-naive HCV-infected patients and are independently associated with anemia, suggesting a further implication of autoimmunity in the pathophysiology of HCV-related anemia.

Neuroblastoma is the most common malignant extracranial solid tumor in infancy with an incidence rate of 58 per million infants younger than one year old. It originates from the neural crest during fetal development and may arise from the sympathetic ganglia or the adrenal medulla (Gurney JG, et al. J Pediatr Hematol Oncol. 1997; 19: 428). Prenatal detection of neuroblastoma was first described in 1983 (Fenart D, et al. Journalde Radiologie 1983; 64: 359). In the majority of antenatally diagnosed cases, neuroblastomas are adrenal in origin and right-sided. Differentiating neuroblastomas from other fetal suprarenal masses such as extralobar pulmonary sequestration, congenital adrenal hyperplasia, renal duplication, urinoma, gastric duplication cyst, and splenic cyst may be very difficult. However, improvements in ultrasound technology have made early detection possible and, combined with fetal MRI, facilitate differential diagnosis. Finally, prenatal diagnosis of a neuroblastoma is associated with a better prognosis, as it can resolve spontaneously either in utero or shortly after birth (Maki E, et al. J Ultrasound Med 2014; 33:895–904). This is a case of a mixed cystic and solid suprarenal tumor that was identified during a routine antenatal visit in the third trimester of pregnancy and was diagnosed as an adrenal neuroblastoma. Case description A 27-year-old pregnant woman presented to the outpatient clinic of Alexandra Maternity Hospital in Athens, Greece during the third trimester of her pregnancy. The woman was Gravida 2 Para 0 (G2P0). The gestational age of the pregnancy was 38 weeks and 2 days. The woman’s past medical history was uneventful. During her pregnancy, she underwent prenatal testing including first trimester scan, anomaly scan, 3 rd trimester Doppler scan without any abnormal findings. During the initial ultrasound scan we detected one fetus in occiput anterior position. All growth parameters (biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal weight) and the amniotic fluid index were within normal range for the gestational age. During the scan a well circumscribed mass was detected over the left kidney ( Fig. 1 ). The mass appeared to have both cystic and solid areas and appeared to originate from the left adrenal gland ( Fig. 1 ). The anatomy of the left kidney was not altered. The mass measured 4.40 × 4.12 cm ( Fig. 2 ). Doppler evaluation did not reveal increased blood flow towards the mass nor a single feeding vessel ( Fig. 3 ). The right kidney and right adrenal gland appeared normal ( Fig. 4a and b). Extensive ultrasound examination of the fetus revealed no other abnormalities. After careful evaluation of the ultrasound appearance of the tumor, the diagnosis of adrenal neuroblastoma was suggested. Open in a separate window Fig. 1 The mass is well circumscribed with both cystic and solid areas and appears to originate from the left adrenal gland.

Objective To evaluate the compliance of healthcare professionals with national guidelines and the hesitancy of pregnant women to be immunized against influenza and pertussis. Study design We conducted a two-stage study. The first stage of our study included all women (n = 197) who gave birth in Alexandra Maternity Hospital in Athens, Greece during a 3-month period (April–June) 2018. They completed a questionnaire regarding their immunization status against influenza and pertussis. If pertinent, they detailed their reasons for not getting immunized. During the second stage of our study, we actively recommended both vaccines to the outpatients of Alexandra Maternity Hospital (n = 195) between September 2018 and January 2019. Results The majority of women (92.9%) were immunized during childhood according to Greek national immunization guidelines. Almost all the women (98%) stated that they will vaccinate their children. More than half (65.5%) responded that they would have been vaccinated during pregnancy if their doctor had recommended it, but in 73.6% of cases, their doctor did not do so. Only a small proportion of women (16.2%) were immunized against influenza during pregnancy while none of them (0%) received the Tdap vaccine. In most cases (65%), study participants stated they were not immunized because their doctor did not recommend vaccination. Additionally, 9.7% of participants feared possible side effects. During the second stage of our study 94.9% out of 195 women agreed to get vaccinated against influenza and 92.8% against pertussis. Conclusions It is apparent that the compliance with the immunization guidelines during pregnancy is surprisingly low. However, health professionals appear to be reluctant to recommend vaccination during pregnancy. Women appear to trust their doctors and usually agree with their recommendations.

Hemiscrotal Agenesis (HSA) is the rarest developmental malformation of the scrotum. It is characterized by the absence of either half of the scrotal rugae with an intact midline raphe. We report the case of a 16-month-old boy with HSA, with an island of scrotal tissue in the pubic tubercle region and ipsilateral cryptorchidism. To our knowledge, this is the first case of HSA with heterotopic development of scrotal tissue.