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Umbilical cord cysts are rare anomalies, being associated in the first trimester most often with chromosomal defects or structural anomalies, while in the second and third trimesters, they are associated with urachal abnormalities. Umbilical cord cysts remain a pathology that could endanger the fetus by a rapid growth that could cause umbilical cord compression followed by fetal distress, torsion or thrombosis, with unfavorable consequences. We present the case of a pregnant patient diagnosed in the second trimester with umbilical cord cyst localized at the placental site of the umbilical cord, with a low-risk noninvasive prenatal test performed in the first trimester, with no other structural anomalies, who delivered a healthy baby at term. The intraoperative findings included the presence of an abnormally adherent placenta, respectively placenta accreta, in a patient with no surgical or obstetrical risk factors. The pathology report revealed an umbilical cord hematoma. The aim of this article is to debate whether an umbilical cord hematoma could be a marker for placental abnormalities. [ABSTRACT FROM AUTHOR]

The corpus callosum serves as a link between the two hemispheres, with an important role in cognitive mechanisms, also integrating motor and sensitive information and processing stimuli. Evaluation of the morphologic structure of the corpus callosum in order to diagnose structural anomalies such as hyperplasia, hypoplasia, as well as indirect signs of corpus callosum agenesia can be realised using ultrasonography during the mid-trimester screening. At present, it is recommended to perform a targeted evaluation only in high-risk cases of central nervous system abnormalities; the International Society of Ultrasound in Obstetrics and Gynaecology has not included the corpus callosum evaluation in the routine secondtrimester screening. Callosal anomalies present uncertainty in the fetal prognosis: 75% of cases of isolated corpus callosum agenesis develop normally; on the other hand, they could develop various degrees of neurological impairment from language or social deficiency to autism or schizophrenia. We, therefore, highlight the importance of corpus callosum evaluation, as the agenesis of the corpus callosum can be an isolated defect, but it can also be associated with other extracerebral anomalies or it could be a part of a syndrome. Completing the diagnosis often requires magnetic resonance imaging and genetic tests. [ABSTRACT FROM AUTHOR]

Objectives. Currently, there is no established gold standard for the treatment of caesarean scar pregnancy (CSP). This study aims to propose a new standard of care for managing CSP. Caesarean scar pregnancy is classified into two types: type 1 (on the scar) and type 2 (in the niche). There is currently no international standard for predicting invasion extent or for determining the most effective management approach for CSP. Materials and method. Our protocol involved intramuscular methotrexate injection, followed by uterine artery embolization and suction evacuation as part of a conservative approach. This protocol was applied to seven patients diagnosed with CSP. Only patients with caesarean scar pregnancy at an early gestational age (≤9 weeks) who provided written consent for the combined treatment method were included. Results. All cases had positive outcomes, without any complications such as uterine perforation, emergency hysterectomy, severe hemorrhage or endometritis. Early diagnosis of CSP and the location of invasive trophoblast opposite the uterine scar were significant predictors for a favorable outcome. Conclusions. This series of CSP cases demonstrates that the combination of systemic methotrexate and uterine artery embolization ensures effective and minimally invasive management of caesarean scar pregnancy. This treatment protocol is suitable for both types of CSP. The early identification of pregnancy location, particularly after caesarean delivery, should be mandatory to prevent CSP-related complications. [ABSTRACT FROM AUTHOR]

Advancements in ultrasound technology and the integration of cell-free DNA testing into standard prenatal screening services have made it feasible to identify fetal sex at an early stage. Fetal sex determination through sonography relies on different factors depending on the gestational stage. In the late second trimester, it is determined by directly visualizing the external genitalia. However, in the late first and early second trimester, it primarily relies on the direction of the genital tubercle, known as the “sagittal sign”. Other sonographic landmarks, like the fetal scrotum, midline raphe of the penis, labial lines, uterus, descended testis and the direction/ origin of the fetal micturition jet in males, can aid in the accurate fetal sex determination. However, malformed external genitalia can lead to inaccurate results. This article focuses on the sonographic determination of fetal sex during the late first trimester, early second trimester and late second trimester, using both transvaginal and transabdominal ultrasound techniques. Additionally, we explore various elements that have contributed to the accuracy of fetal sex determination. While ultrasound examination of the external genitalia is typically sufficient, there are certain situations where it becomes crucial to identify the internal genitalia for precise prenatal diagnosis and thorough counseling. This paper aims to review these situations in which the evaluation of the internal genital organs is necessary, as well as the ways in which ultrasound can be used in the diagnosis of genital malformations. [ABSTRACT FROM AUTHOR]

Objectives. Currently, there is no established gold standard for the treatment of caesarean scar pregnancy (CSP). This study aims to propose a new standard of care for managing CSP. Caesarean scar pregnancy is classified into two types: type 1 (on the scar) and type 2 (in the niche). There is currently no international standard for predicting invasion extent or for determining the most effective management approach for CSP. Materials and method. Our protocol involved intramuscular methotrexate injection, followed by uterine artery embolization and suction evacuation as part of a conservative approach. This protocol was applied to seven patients diagnosed with CSP. Only patients with caesarean scar pregnancy at an early gestational age (≤9 weeks) who provided writ ten consent for the combined treatment method were included. Results. All cases had positive outcomes, without any complications such as uterine perforation, emergency hysterectomy, severe hemorrhage or endometritis. Early diagnosis of CSP and the location of invasive trophoblast opposite the uterine scar were significant predictors for a favorable outcome. Conclusions. This series of CSP cases demonstrates that the combination of systemic methotrexate and uterine artery embolization ensures effective and minimally invasive management of caesarean scar pregnancy. This treatment protocol is suitable for both types of CSP. The early identification of pregnancy location, particularly after caesarean delivery, should be mandatory to prevent CSP related complications. [ABSTRACT FROM AUTHOR]

Advancements in ultrasound technology and the integration of cell free DNA testing into standard prenatal screening services have made it feasible to identify fetal sex at an early stage. Fetal sex determination through sonography relies on different factors depending on the gestational stage. In the late second trimester, it is determined by directly visualizing the external genitalia. However, in the late first and early second trimester, it primarily relies on the direction of the genital tubercle, known as the “sagittal sign”. Other sonographic land marks, like the fetal scrotum, midlineraphe of the penis, labial lines, uterus, descended testis and the direction/ origin of the fetal micturitionjet in males, can aid in the accurate fetal sex determination. However, malformed external genitalia can lead to inaccurate results. This article focuses on the sonographic determination of fetal sex during the late first trimester, early second trimester and late second trimester, using both transvaginal and transabdominal ultrasound techniques. Additionally, we explore various elements that have contributed to the accuracy of fetal sex determination. While ultrasound examination of the external genitalia is typically sufficient, there are certain situations where it becomes crucial to identify the internal genitalia for precise prenatal diagnosis and thorough counseling. This paper aims to review these situations in which the evaluation of the internal genital organs is necessary, as well as the ways in which ultrasound can be used in the diagnosis of genital malformations. [ABSTRACT FROM AUTHOR]

Intrauterine growth restriction or fetal growth restriction represents a fetal incapacity of achieving its entire growth potential in intrauterine life, as a result of maternal, fetal and/or placental causes, from hypertension, autoimmune diseases, drug consumption, hereditary thrombophilia to genetic syndromes, intrauterine infections, umbilical cord anomalies or placental insufficiency. The ultrasonographic evaluation of the fetus with intrauterine growth restriction identifies an estimated fetal weight or a fetal abdominal circumference below the 10 th percentile for gestational age; a severe fetal growth restriction is defined as an estimated fetal weight below the 3rd percentile. The Delphi consensus managed to classify fetal growth restriction as early, being diagnosed under 32 weeks of gestation, respectively late, after 32 weeks of gestation. Up to 10% of pregnancies are complicated by fetal growth restriction, which are then considered high-risk pregnancies for the morbidity and mortality risk carried for the fetus, requiring an accurate diagnosis of the cause, intensifying the fetal monitoring and timing the birth, in order to deliver the fetus in safe conditions. This paper proposes an algorithm for an initial evaluation of fetal growth restriction, with the aim of simplifying the medical approach when encountering a fetus with intrauterine growth restriction, in order to improve morbidity and mortality rates among pregnancies complicated by fetal growth restriction. [ABSTRACT FROM AUTHOR]

Transvaginal ultrasound and serum concentration of human chorionic gonadotropin are the main methods of prognostic evaluation of early pregnancies. Although these pregnancy investigation methods have proven their benefits, the interpretation is fundamental for a correct diagnosis, in order to avoid interventions that may affect pregnancies that would normally have had a physiologic course, as well as to apply an appropriate management in the case of nonviable pregnancies. Recent studies have shown the need to adopt rigorous criteria that minimize false positive results and thus decrease the frequency of diagnostic errors. Over time, a series of ultrasound features have been described which have proven effective in predicting nonviable pregnancies in the first trimester (cranio-caudal length in relation to the presence or absence of cardiac activity, yolk sac diameter, gestational sac diameter in relation to presence or absence of embryo with cardiac activity, embryonic heart rate, subchorionic hematoma etc.). In the context of the new prospects for the development of artificial intelligence softwares, the present work focuses on the description of the precise ultrasonographic aspects aboded by the latest studies that propose certain cut-off values dependent on the gestational age of the ultrasound parameters in the first trimester, increasing the sensitivity and the specificity of ultrasound in the diagnosis of nonviable early pregnancies, thus aiming to improve the reproductive prognosis of couples with recurrent abortions. [ABSTRACT FROM AUTHOR]

Advancements in ultrasound technology and the integration of cell-free DNA testing into standard prenatal screening services have made it more feasible to identify fetal sex at an early stage. Fetal sex determination through sonography relies on different factors, depending on the gestational stage. In the late second trimester, it is determined by directly visualizing the external genitalia. However, in the late first and early second trimesters, it primarily relies on the direction of the genital tubercle, known as the sagittal sign. Other sonographic landmarks, like the fetal scrotum, midline raphe of the penis, labial lines, uterus, descended testis, and the direction or origin of the fetal micturition jet in males, can aid in the fetal sex determination accuracy. However, malformed external genitalia can lead to inaccurate results. This article focuses on the sonographic determination of fetal sex during the late first trimester, early second trimester and late second trimester, utilizing both transvaginal and transabdominal ultrasound techniques. Additionally, we explore various elements that have contributed to the precision of fetal sex determination. While ultrasound examination of the external genitalia is typically sufficient, there are certain situations where it becomes crucial to identify the internal genitalia for precise prenatal diagnosis and thorough counseling. This paper aims at reviewing these situations in which the evaluation of the external genital organs is necessary, as well as the ways in which ultrasound can be used in the diagnosis of genital malformations. [ABSTRACT FROM AUTHOR]