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Background: Kidney function impairment in pregnancy is challenging, with incidence and prognosis only partially known. Studies concerning maternal and fetal outcomes in pregnancies occurring in patients with renal injury and the therapeutic strategies for improving the prognosis of these patients are scarce due to the limited number of cases reported. Objectives: We aimed to establish correlations between the main maternal and fetal outcomes in patients with severe CKD or AKI in pregnancy to improve the prognosis, referring to a control group of patients with mild kidney impairment. Methods: For this purpose, we conducted a retrospective study, at University Emergency Hospital in Bucharest, Romania, from January 2019 until December 2021, selecting 38 patients with AKI and 12 patients diagnosed with advanced CKD, compared to 42 patients displaying borderline values of serum creatinine (0.8–1 mg/dL), reflecting the presence of milder kidney impairment. Results: The probability of having a child that is premature and small for gestational age, with a lower Apgar score and more frequent neonatal intensive care unit admissions, delivered by cesarean section, is higher in patients with highly reduced kidney function. Conclusion: Severe kidney function impairment is associated with a grim fetal prognosis and obstetrical complications. [ABSTRACT FROM AUTHOR]

Gangliogliomas are extremely rare central nervous tumors composed of an admixture of glial and neuroepithelial elements. Gangliogliomas mainly affect the temporal lobe and occur in the pediatric population. There are several controversies in the scientific literature regarding these tumors, which debuted with the exclusion of grade II gangliogliomas in the 2006 edition of the current World Health Organization (WHO) classification. The upcoming edition due in the last months of 2021 is not expected to include changes regarding the current classification of glio-neuronal tumors. This vision has led to a number of articles that have pushed for the reintroduction of this category. However, these articles support the reintroduction of this degree in terms of prognosis and evolution, without providing clear criteria for the inclusion of certain gangliogliomas in this category. On the other hand, there are uncertainties about the relationship of gangliogliomas with focal cortical dysplasia. The coexistence of the two entities, as well as their succession are occasionally encountered in practice and have led to numerous studies that have tried to clarify the relationship between them. The most common and most accessible element in routine practice is the immunoreactivity for CD34. Both entities express this marker, and dual lesions express the highest percentage of immunoreactivity for CD34. In this article, we study the expression of CD34 on a series of cases including both grade I gangliogliomas and anaplastic gangliogliomas diagnosed between 2011 and 2020 in a Neuropathology Unit in Bucharest Romania. [ABSTRACT FROM AUTHOR]

Induction of labor (IOL) is an event that occurs in up to 25% of pregnancies. In Europe, the misoprostol vaginal insert (MVI—Misodel®) was approved for labor induction in 2013. Studies on the outcomes and safety of IOL in obese pregnant women are scarce; no data are available on MVI IOL in high-risk pregnancy obese women (HRPO—late-term, hypertension, diabetes). As the obesity rates are growing steadily in pregnant women, we aimed to evaluate the failure rate for induction and the safety of a 200 μg MVI in obese (body mass index (BMI) >30 kg/m2) HRPO compared to that for obese non-high-risk pregnancies (non-HRPO). For this purpose, we conducted a cross-sectional study in "Filantropia" Clinical Hospital, Bucharest, Romania, from June 2017—the date of the initiation of the MVI IOL protocol in our clinic—to September 2019. The primary outcomes were the failure rate, measured by cesarean section (CS) ratio, and secondarily, the safety profile of MVI, analyzed by one-way ANOVA. Out of a total of 11,096 registered live births, IOL was performed on 206 obese patients. Of these, 74 obese pregnant women had their labor induced with MVI (HRPO, n = 57, and non-HRPO, n = 17). The average maternal age was 29.9 ± 4.8 years (19–44 years). Across the groups, the rate of CS was 29.8% (n = 17) in the HRPO group compared to 23.5% (n = 4) in the non-HRPO group (p = non significant). In the vaginally birth subgroups, the median time from drug administration to delivery was shorter in the HRPO group compared to the non-HRPO group (16.9 ± 6.0 h 95% confidence interval (CI) 15.0–18.8 vs. 19.4 ± 9.2 h 95% CI 13.8–25.0, p = 0.03). No significant differences were found regarding the maternal outcomes among the studied groups; in terms of perinatal outcomes of safety, 5.4% (n = 4) of the cases of vaginal delivery for HRPO were associated with neonatal intensive care unit (NICU) admissions. The MVI seems to be an efficient labor induction agent in high-risk pregnancy obese women with good maternal outcomes and low perinatologic complications. [ABSTRACT FROM AUTHOR]

Vascular anomalies can be identified during ultrasound screening for fetal malformations. Fetal vascular anomalies are classified into vascular tumors and vascular malformations. Both vascular tumors and vascular malformations can cause heart failure due to increased blood flow to the heart. The diagnosis of fetal vascular lesions in certain cases offers the opportunity to intervene antenatally, allowing the determination of the optimal time and place for birth, so as to improve access to specialised postnatal care. In this study, we analyzed a group of pregnant women who were evaluated at the "Filantropia" Cinical Hospital in Bucharest during the past three years for second-trimester screening for fetal malformations. We selected patients with fetal vascular anomalies and vascular anomalies of the placenta and umbilical cord, and classified them according to the pregnancy complications, mode and time of birth, as well as short-term prognosis. Considering the results of the study, it is still controversial whether the analysis of vascular anomalies should be included in the routine screening of pregnant women or there should be a pathology identified in isolation during the examination for other anomalies. [ABSTRACT FROM AUTHOR]

Small-for-gestational-age fetuses are defined as fetuses with an estimated weight under the 10th percentile for the gestational age. Fetal growth restriction (FGR) is one of the most difficult and frequent situations in clinical practice. A true FGR is associated with abnormal Doppler and poorer perinatal outcome, instead of small-for-gestational-age fetuses who do not present abnormal feto-placental function, Doppler and have a normal perinatal outcome. Unfortunately, gestational age is not always easy to establish due to the lack of ultrasound examinations during the first trimester. On the other hand, in some cases, a small-forgestational- age fetus develops also intrauterine growth restriction and the differentiation between the two entities becomes more difficult. We analyzed a group of pregnant women who delivered in the "Filantropia" Hospital, Bucharest, in the last two years and divided them in four groups (small for gestational age, intrauterine growth restriction, mixed features, control group) and we separated a group of pregnant women without a proper pregnancy dating. This study evaluated the fetal and neonatal complications, the moment of onset, the degree of severity and the moment of delivery. We tried to identify the correct protocol in order to make a right decision of the optimal delivery of the fetus. The final step of this algorithm is to establish the way of delivery in order to reduce fetal injury and the risk of an iatrogenic preterm delivery. [ABSTRACT FROM AUTHOR]

Background. Alkaline phosphatase is an enzyme that catalyzes the hydrolysis of esters in an alkaline environment. Four isoenzymes have been identified in the human body: placental alkaline phosphatase (PLALP isoenzyme), intestinal alkaline phosphatase (IAP), hepatic/bone/renal alkaline phosphatase (L/B/K ALP) and germ cell alkaline phosphatase (GCALP). The uses of ALP in neonatology have been intensively studied, and associations have been demonstrated between elevated alkaline phosphatase levels and hypocalcemia and hypophosphatemia in premature infants, the onset of early osteopenia and the occurrence of necrotizing enterocolitis. Objective. The current study aimed to demonstrate the correlation between elevated alkaline phosphatase levels in blood from the umbilical cord and elevated transcutaneous bilirubin levels that indicated phototherapy. Material and methods. The study included 250 term newborns within 01-06.2018 and 31 had indication for phototherapy, and 219 without indication for phototherapy, in a tertiary maternity hospital in Bucharest, Romania. Alkaline phosphatase was determined in the umbilical cord serum. Results. The values of the alkaline phosphatase were from 145 to 417 U/l for the newborns without phototherapy and the treated group was beetween 320 and 602 U/l. The values of the alkaline phosphatase were not influenced by the birth weight, Apgar score, and gender. Conclusions. Alkaline phosphatase may represent a predictive marker for the need for phototherapy in term neonates, but further extended studies are required on larger groups of patients. [ABSTRACT FROM AUTHOR]

Background/Aim: Since March 2020 when the number of COVID-19 positive patients reported a fulminant increase in Romania, reorganisation of the medical services took place in order to provide the possibility of treating increasing number of cases with this pathology and to diminish as much as possible the number of COVID-19 related deaths. The aim of the current paper is to analyse the outcomes of 273 patients with gynaecological cancers who could not be treated in the service were they were initially addressed. Material and Method: a total number of 343 patients with gynecologic oncology disorders were addressed to “Dr. Ion Cantacuzino” hospital in Bucharest Romania and could not be treated in this unit due to the fact that it became an auxiliary service for obstetrical COVID positive patients. Results: complete follow up was possible in 273 cases 87 patients were redistributed to other services of gynecologic oncology and received their surgical treatment as planned, 141 patients received their surgical treatment in other clinics after a mean delay of six months while 45 cases were further submitted to oncological treatment, four of them being dead at the end of the study. Conclusions: modification of hospital structure and diminishing the oncological patients’ access to oncologic surgery during COVID pandemic significantly impacted on gynecologic cancer care. [ABSTRACT FROM AUTHOR]