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INTRODUCTION: CONTROLLED OVARIAN HYPERSTIMULATION (COH) MAY HAVE A NEGATIVE IMPACT UPON THE ENDOMETRIAL ENVIRONMENT, THUS, A "FREEZE-ALL" (FET) STRATEGY WAS CONSIDERED. METHODS: REVIEW INCLUDING 44 STUDIES EVALUATING 278.000 NEWBORNS AFTER ART, COMPARING THE RESULTS OF THE CLASSIC VERSUS FREEZE-ALL STRATEGY. RESULTS: THE CUMULATIVE LIVE BIRTH RATE (LBR) AND PREGNANCY RATE (PR) WERE SIGNIFICANTLY HIGHER IN THE "FREEZE-ALL" (FET) VERSUS ET (LBR: 60.55% VS. 45%, PR: RR 1.30 [CI 95%]). FET IS ASSOCIATED WITH A LOWER OBSTETRIC RISK [CI 95%]: THE FETUS HAS A LOWER RISK OF BEING SMALL FOR GESTATIONAL AGE RR: 0.59, LOW GESTATIONAL WEIGHT RR: 0.74, PREMATURE BIRTH RR: 0.74 BUT MORE INCREASED RISK OF CESAREAN RR: 1.10 AND LARGE FOR GESTATIONAL AGE RR: 1.49. WITH REGARD TO THE RISKS OF ANTEPARTUM HAEMORRHAGE, PLACENTA PRAEVIA, PERINATAL MORTALITY, CONGENITAL ANOMALIES AND SPONTANEOUS ABORTION RATE, THERE ARE NO CONSISTENT FINDINGS: SOME STUDIES CONCLUDED THAT THE RISK IS LOWER IN FET (0.67, 0.68, 0.8 AND, RESPECTIVELY 0,83), BUT MOST CONSIDER THAT THERE IS NO SIGNIFICANT STATISTICAL DIFFERENCE. GESTATIONAL HYPERTENSION IS CONTROVERSIAL, SOME STUDIES HAVE FOUND THAT IT IS MORE COMMONLY LINKED TO FET (RR: 1.29), BUT THE RESULTS ARE INSIGNIFICANTLY STATISTICALLY DIFFERENT. HOWEVER, FET IS AN INDEPENDENT RISK FACTOR FOR PLACENTA ACCRETA, 3 TIMES HIGHER THAN ET. MONOZYGOTIC MONOCHORIONIC PREGNANCY AFTER SINGLE-EMBRYO IS LOWER IN FET IN GENERAL (0.8%), BUT MATERNAL AGE BELOW 35 YEARS IS A RISK FACTOR IN FET CYCLES. CONCLUSIONS: "FREEZE-ALL" IS AN ELIGIBLE PROTOCOL. [ABSTRACT FROM AUTHOR]

A lot of methods have been used to evaluate the lower uterine segment after cesarean section: hysterography of the uterine scar, pelvic examination, amniography, x-ray pelvimetry and ultrasonography. The present study consisted of 275 secondiparous with the gestational age between 36 and 38 weeks. All recruited patient were evaluated by transvaginal ultrasound in order to characterize the lower uterine segment (LUS). LUS thickness was measured as the distance between the two calipers placed at the urinary bladder - myometrium interface and at the myometrium - chorioamniotic membrane interface. The appearance of the LUS where classified into three categories, where class I and II are considered non-dehiscent and class III was considered dehiscent. Therefore, the intraoperative assessment results included 19.6% patients in class III (dehiscent LUS, uterine content visible) and 80.4% patients in class I and II (non-dehiscent LUS). In the intraoperative non-dehiscent group 25.8% patients were included in class I (normal, well-developed LUS) and 54.6% were included in class II (thin LUS, uterine content not visible). The results showed that at a LUS thickness less than 2 mm carries a higher risk for dehiscence (incomplete uterine rupture) than those with a thickness more than 2 mm. [ABSTRACT FROM AUTHOR]

Cystic hygroma represents a fluid accumulation in different structures, often cephalic, on the left side, with an incidence of 1/6000-1/16,000. Karyotype anomalies are found in 20-75% of cases, most frequently Turner, Down, Klinefelter, Edwards and Patau syndromes. Subchromosomal abnormalities include Noonan syndrome, Fryns syndrome, multiple pterygium syndrome and achondroplasia, and also maternal alcohol consumption. We report a series of cases diagnosed in the first trimester with cystic hygroma and their genetic determinacy. The first patient was diagnosed at 11.6 weeks of gestation with a large cystic lesion sheltering the entire fetus, with omphalocele, AVSD and arthrogryposis. The patient decided the termination of pregnancy and the karyotype confirmed the Down syndrome. The second patient, having a term birth by caesarean section followed by five first-trimester miscarriages, presented at 8.5 weeks of gestation, with an ultrasound image of large cystic hygroma causing double contour suggestive for fetal hydrops and no fetal heartbeat. The abortion product karyotype revealed Turner syndrome. Couple karyotyping and genetic counseling were recommended, showing a 46,XX/47,XXX mosaicism in the mother, respectively an addition in the 9th pair of chromosomes in the father – 46,XY,add(9)(p12), for which arrayCGH was recommended in order to detect a possible chromosomal balanced translocation, which was ruled out. The third patient, with history of two early pregnancy miscarriages and two failed IVF procedures, presented with a spontaneous 11.6-week pregnancy showing cystic hygroma, medium size omphalocele, micrognathia and hypoplastic nasal bone. The parents decided the termination of pregnancy and the karyotype revealed trisomy 18. The fourth patient was diagnosed in the first trimester with a large left laterocervical cystic mass, consistent with lymphangioma. The follow-up showed normal development and amniocentesis revealed a normal karyotype. An appropriate weight neonate was born at 38 weeks by caesarean section, with a good postnatal transition, expecting removal surgery of the cervical lymphatic cyst sized 12 cm. We suggest a significant association between cystic hygroma and karyotype anomalies, stronger in patients with obstetrical failure history, validated by invasive genetic testing. [ABSTRACT FROM AUTHOR]

Cystic hygroma or lymphangioma was first described in 1843 and represents a lesion that can occur in any anatomical structure of the fetus, but is most frequently found in the cephalic region (75%), especially on the left side of the body. The incidence of the condition is reported as ranging from 1/6000 to 1/16,000 cases. Karyotype abnormalities are found in 20-75% of cases, the most frequently involved conditions being Turner, Down, Klinefelter, Edwards and Patau syndomes. Other nonchromosomal abnormalities associated with cystic hygroma are Noonan, Fryns, multiple pterygium syndomes and achondroplasia. Also, an important association between maternal alcohol consumption and this condition has been observed. We present a series of four cases diagnosed in the first trimester with cystic hygroma and their genetic determinance. The first patient, aged 42, IG, IP, was diagnosed at 11.6 weeks of gestation with a large cystic hygroma covering the entire fetus, omphalocele, atrio-ventricular septal defect, and arthrogriposis. The patient decided to terminate the pregnancy and the karyotype of the abortion product revealed Down syndrome. The second patient, aged 33, VIIG, IIP, with a personal history of a term birth by caesarean section followed by five misscariages in the first trimester, presented at 8.5 weeks of gestation an ultrasound aspect of large cystic hygroma causing double contour suggestive for fetal hydrops and no fetal heartbeat. The karyotype of the abortion product revealed Turner syndrome. Couple karyotyping and genetic counselling were recommended, showing a 46,XX/47,XXX mosaicism in the mother, respectively an addition in the 9th pair of chormosomes in the father – 46,XY,add(9)(p12), for which arrayCGH was recommended in order to detect a possibile chromosomal balanced translocation. The third patient, aged 38, IIIG, IP, with a personal history of two first-trimester misscariages and two failed IVF procedures, presented with a spontaneous pregnancy. At 11.6 weeks of gestation, the ultrasound revealed cystic hygroma, medium size omphalocele, microgratia and small nasal bone. The parents decided pregnancy termination and kayrotyping, which is still in progress. The fourth patient, aged 32, IG, IP, was diagnosed in the first trimester with a large latero-cervical cystic mass, consistant with a lymphatic cyst. The periodic follow-up showed no other abnormalities, and amniocentesis revealed a normal fetal karyotype. The neonate was born at 38 weeks of gestation by caesarean section and presented a normal weight and good adaptation to neonatal life, being programmed for surgery in order to remove the left sided cervical lympahtic cyst sized 12 cm. In conclusion, our small number of cases of fetuses with cystic hygoma suggests a relatively high association with genetic defects, especially in patients with personal history of obstetrical failure, which justifies us to recommend in these cases the genetic testing. [ABSTRACT FROM AUTHOR]

We present a rare case of postpartum umbilical cord hematoma with unknown cause in a term newborn. The neonate was born by caesarean section indicated for failure of medical induction of labour in a 28-year-old primipara with a 41-week pregnancy. The mother did not suffer from any pathology throughout gestation, presenting a morphologically normal foetus and negative urine and cervical cultures. She delivered a 3690-gram male newborn, with an Apgar score of 9 at one minute and 10 at five minutes, following an uncomplicated caesarean section. The newborn presented good postnatal adaptation, and breast alimentation was initiated in the first day of life. The C-reactive protein (CRP) of the newborn was negative and his evolution was favourable in the first two days of life. In the third day of life, the neonate presented swelling of the umbilical cord stump, with a dark-red coloration, suggestive for hematoma. Antibiotic prophylaxis and local antiseptic therapy were initiated, CRP was repeated and bacteriological samples were collected, the results being negative. After two days of local antiseptic treatment, the umbilical stump fell and the umbilicus presented normal appearance. The evolution of the neonate was good, and he was discharged in the fifth day of life. The mother did not present any sign of infection or thrombosis, with a physiological recovery. The particularity of the case is represented by the rarity of the pathology, until present only a few cases of umbilical cord haematoma being described in the specialty literature. The etiology in this case is idiopathic, the infectious, malformative, thromboembolic and mechanical causes being ruled out. The only risk factor in our case could be represented by the advanced gestational age (41 weeks of pregnancy), which could explain partially the frailty of the umbilical cord vessels. [ABSTRACT FROM AUTHOR]