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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.)

Placenta accreta spectrum (PAS) disorders, comprising placenta accreta, increta and percreta, are associated with serious maternal morbidity and mortality. The incidence of PAS has increased in the recent years due the rising numbers of caesarean section births, but it is linked also to uterine surgeries like myomectomy, history of placenta accreta in previous pregnancy, and endometrial curettages. At the University Emergency Hospital Bucharest, due to access to transcatheter arterial embolization, we treat first-trimester caesarean scar pregnancy either diagnosed in our department or referred from different centers by the following algorithm: uterine artery embolization followed by safe aspiration. For cases of advanced pregnancies with PAS that come to our setting, we start to complete, preferably as early as the second trimester, the checklist required for a programmed caesarean section performed by a multidisciplinary team, including oncological gynecological surgeons in our department, urology specialist, and with a thorough intensive care preparation. The psychological support and the continuous counseling are performed as needed due to the continuous requirements of reassurance of the patient. We present a series of cases of caesarean scar pregnancies in order to underline the various ultrasonographic aspects of the early first trimester. We consider of utmost importance the early diagnosis and management of these cases that should not be missed in order to avoid future morbidity and mortality. We also present the ultrasonographic aspects of advanced pregnancies where PAS was identified and the management algorithms that we use in the treatment of these life-threatening obstetrical emergencies. [ABSTRACT FROM AUTHOR]

The genesis of neural tube defects (NTD) is poorly understood. The most prevalent types of NTDs are anencephaly, encephalocele and spina bifida. Craniorachischisis totalis (anencephaly with total open spina bifida) is the most severe form of neural tube defects. The concomitant presence of omphalocele was rarely described in the literature. We report a case of a secundigravida, 38 years old, who had a history of premature birth due to cervical incompetence, BMI=30, with hypothyroidism, revealing an embryo with craniorachischisis totalis together with omphalocele, diagnosed during a first-trimester ultrasound at 11 weeks of gestation. We discussed the implications of the diagnosis with the family and proceeded to pregnancy termination. Karyotyping was performed on the aborted product of conception, revealing trisomy 18. The folate level in the mother’s blood showed an above the normal level, thus the lack of folic acid could not be linked to NTD. This case highlights the importance of the first-trimester ultrasound in the diagnosis of severe malformations, together with the genetic diagnostic testing of the fetus. The right diagnosis is crucial for future prenatal investigation and counseling. [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 Farmacia is the property of Societatea de Stiinte Farmaceutice Romania 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.)

The incidence of adherent placenta has known a continuous ascendant incidence in the last decades. A correct management implies prenatal care and a careful planning of birth. We present the case of a 31-year-old G4P3, 37 weeks and 3 days' gravida which presented herself at the emergency room, accusing unsteady painful low-intensity uterine contractions and asking for a cardiologic consult. The anamnesis revealed that this pregnancy was not properly monitored by a specialist and her medical history included two deliveries by caesarean section, a known untreated familial hypertrophic cardiomyopathy and a 36 weeks ultrasound scan describing a single fetus with a suspected cardiac hypertrophy and a praevia, anterior inserted placenta. In this context, the suspicion of an adherent placenta was confirmed by emergency ultrasound where a mild bladder invasion was observed. Due to the possibilities offered by an emergency medical hospital complete preparation for delivery was possible during one hour. A successful cesarean hysterectomy was performed, with the extraction of the fetus from transverse presentation trough vertical hysterotomy and rapid closing of the uterine incision after cutting the cord. The vezicotomy for uterine catheterization and excision of invaded submucosal area and subsequent hysterectomy were uncomplicated. Both mother and fetus presented a favorable prognosis. We present this case in the context of its complexity and the successful applied approach. [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.)

The aim of this study is to establish morphological, histological and ultrasonographic (US) correlations in the placenta of type 2 diabetes. This is a multicenter case-control study conducted on a lot of 21 selected cases diagnosed with type 2 diabetes, analyzed over a two year period. The clinical characteristics of the patients in the study group are represented by the average age of 34 years and diabetes associated with preeclampsia, hypertension, diabetic neuropathy, urinary infections, obesity or history of infertility. All the patients in the study group are Caucasian. US assessment of placental characteristics in our series revealed increased placental thickness from the second trimester and placentomegaly at the end of the third trimester. Immature appearance of placenta has been observed. Gross analysis of maternal and fetal surfaces of the placentas revealed basal plate and subchorionic fibrin depositions, placental infarction or intervillous thrombosis. Preconceptional glycemic control and its support during gestation are essential for pregnancy outcome. US findings have as a background the morphological changes. From morphological perspective there is about a combination of anomalies, otherwise unspecific which, in terms of association with various comorbidities could define a placental diabetic pattern. [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.)

Preeclampsia is and remains an actual subject of obstetrics regarding the associated immediate high risk of morbidity and mortality for both mother and future risk for cardiovascular disease. Many different strategies to prevent preeclampsia have been studied, but none of the reported results presented a widely effectiveness, until now. Possibility of predicting preeclampsia would have a significant impact in decreasing the incidence of cases with tragic outcome related to this condition. For late-onset preeclampsia there is no prediction method at this time, in this context, the suitable approach is the diagnosis as early as possible in order of a better outcome. Lowdose aspirin (LDA) administrated in the first trimester to patients who are at increased risk for pre-eclampsia is the only drug that has proven benefits for reducing the frequency of this condition and associated adverse outcomes. In terms of prophylaxis with low molecular weight heparin in combination with LDA or as a single treatment, results are controversial, additional studies being required. We intend to summarize the latest proposals regarding the measures that can be taken to prevent maternal and fetal complications that may occur as a result of the development of preeclampsia, methods of early diagnosis and characteristics of atypical forms of preeclampsia. [ABSTRACT FROM AUTHOR]

The aim of the research was to assess the outcome of persistent (=two years) low-grade cervical intraepithelial neoplasia (CIN 1) medicated with loop electrosurgical excision procedure (LEEP). An analysis of 38 topics with persistent biopsy-confirmed CIN 1 diagnosed after low-grade squamous intraepithelial lesion (LSIL) or atypical squamous cells of undetermined significance (ASC-US) on Pap test and treated using LEEP was performed. Post-LEEP follow-up were scheduled in 6 months, 1 year, and yearly thereafter: cytology, colposcopy, and plasma diagnostic examinations. There were 38 LSIL patients treated with LEEP conization. About 6 patients were excluded from the study due to subsequent hysterectomy and 2 patients never attended the follow-up schedule in the rest. The remaining 30 patients were retrospective studied for the incidence of recurrent rate. The mean age of the patient was 44 years. About 50% of patients were multiparity and nearly one - third used oral contraceptive pill. The results of this study suggest that the incidence of CIN 2+ lesions during follow-up of persistent biopsy-confirmed CIN 1 after ASC-US/LSIL treated by LEEP is very low. [ABSTRACT FROM AUTHOR]

Total hip arthroplasty is a surgical procedure that address to people with severe hip disorder. The number of total hip replacement is growing year by year due to the good functional results obtained after this procedure, which include pain relief, improvement of walking and quality of life. With improvements in the techniques, materials and prostheses, hip arthroplasties are performed in the younger age patients, which leads to the demand for revision procedures. This procedure almost always come across with acetabular bone defect. The main challenge for the surgeon during the revision hip arthroplasty is to achieve good implant stability. The purpose of this study is to assess the early clinical and radiological results after revision acetabular components using trabecular metal shells and augments. It was performed on 26 patients classified as Paprosky IIC and IIIA. The functional evaluation was performed perioperatively, at three and then at six months after the surgery using radiographic evaluation and Harris Hip Score. No evidence of cup migration or periacetabular osteolysis was noted. With low rate of complications and with overall good level of satisfaction, we assume that modular TM acetabular components may provide good long-term solutions for reconstruction of acetabulum in revision hip arthroplasty. [ABSTRACT FROM AUTHOR]

The acromioclavicular joint dislocation represents a common shoulder injury that frequently occurs to young and active individuals. Most of these AC lesions can be treated conservatively but high-grade dislocation need surgical treatment. There are numerous surgical techniques described in literature for treating this injury. The surgeons must choose between open reduction with internal fixation and arthroscopic fixation, which is the latest technique developed. The aim of this study is to evaluate the functional results and the level of pain after an arthroscopic fixation using a TightRope system to treat AC dislocation. It is a less invasive technique, allowing a stable fixation of the joint. In our study we analyzed 48 patients with acute acromioclavicular dislocation, all of them surgically treated using an arthroscopic method with a single TightRope device. An important reduction in pain perception was achieved at six months after the surgery, comparing with the preoperative moment. No system failure was recorded. Arthroscopic treatment of AC dislocation with the use of TightRope system is an efficient technique which can correct deformity and restore full range of motion in a short period of time. [ABSTRACT FROM AUTHOR]

Endometriosis is a gynecological estrogen-dependent disease, characterized by the presence of active endometrial tissue, represented by glandular epithelial and stromal cells, outside the uterine cavity. There have been described three types of endometriosis: peritoneal superficial endometriosis, ovarian endometriomas, and deep infiltrating endometriosis (DIE). DIE is deffined from a histologically perspective as a lesion that extends more than 5 mm into the peritoneal space or which affects the wall of the pelvic organs. Endometriosis of the bladder is considered to be a form of deeply infiltrating endometriosis. The relation with infertility involves multiple and complex mechanisms. It is estimated that over half of the patients affected by this condition are subfertile. Many women with either minimal, mild or severe endometriosis experience difficulties in conceiving or maintaining a pregnancy. We report the case of a women diagnosed with a severe form of infiltrating endometriosis, with endometrioma in the bladder, who obtained a pregnancy and delivered in the 39 week of gestation by caesarean section and had a good evolution. [ABSTRACT FROM AUTHOR]

The various types of patient positioning during gynecological surgical interventions produce numerous hemodynamic and mechanical changes, optimal positioning requiring a compromise between the position required for surgical access and that which the patient can tolerate. The objective of this article is to describe the main types of positioning of patients in gynecological interventions, while analyzing the precautions necessary for the prophylaxis of the related complications. The main types of positioning discussed in this article are the supine position (dorsal decubitus), the Trendelenburg position, and the lithotomy (or gynecological) position. Patient placement for a surgical procedure is the responsibility of the surgeon, anesthetist, and nurse in the operating room. Whenever possible, the position should be rehearsed with the patient before the anesthesia, to verify that the patient can tolerate this positioning. The chosen position may cause physiological changes, that may be exacerbated by anesthesia and may result in soft tissue injuries. We have presented all these types of changes: cardiovascular, pulmonary, nerve destruction, skin lesions caused by pressure, ulcerations, compartment syndrome, increased intracranial pressure, drawing attention to the available prevention methods. [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.)

The incidence of intrahepatic cholestasis of pregnancy is estimated to be 0.5% of all deliveries, with great geographic variations. Clinical onset of this condition is represented by intolerable pruritus dominant on the palms and soles of the feet with the emphasizing of symptoms during the night. Regarding the risks for the fetus, the main complications are prematurity, intrauterine demise, meconium-stained amniotic fluid and a greater incidence of neonatal respiratory distress syndrome. Our retrospective study aimed to analyze the incidence of intrahepatic cholestasis of pregnancy for a period of five years in Bucharest Emergency University Hospital, fluctuations of the incidence depending on maternal age and parity, also, related neonatal risks. Secondly, we present a literature review regarding maternal and fetal follow-up and the possibilities for preventing the potential related complications. During the studied period, the incidence of intrahepatic cholestasis of pregnancy was 0.3%. Fetal status at birth was influenced by this condition, being reflected by an Apgar score lower than 8 in 34% of cases. Also, meconium stained fluid was associated in a higher proportion (14%) comparing to uncomplicated pregnancies in which fetal demise was showed not to be a direct consequence of intrahepatic cholestasis of pregnancy. The major purpose of management of these pregnancies consists in a rigorous fetal surveillance and early delivery guided by the comparison of the risk of fetal death and potential risks of prematurity. There is no ideal method for fetal surveillance in intrahepatic cholestasis of pregnancy yet. [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.)

Zika fever is a viral infection caused by an arthropod-borne RNA flavivirus. Zika virus may be transmitted to humans via a bite of an infected Aedes mosquito, blood product transfusion, unprotected sexual contact and by maternal-fetal vertical path. Clinical manifestations typically include maculopapular pruritic rush, low-grade fever, arthralgia and conjunctivitis. Recently demonstrated, there is a strong relationship between Zika virus infection and Guillain-Barré syndrome. Zika congenital syndrome includes severe destruction of the brain parenchyma, ocular abnormalities, neurologic abnormalities and positional arthrogryposis type abnormalities. The major fetal damage justifies pregnancy termination. Diagnosis is based on immunologic and molecular tests. There is no specific prevention and treatment methods for Zika virus infection, but a vaccine is under development. Avoiding traveling to areas with mosquito transmission of Zika virus of fertile women, protection from mosquitoes and protected sexual contact are currently the only measures available to reduce the spread of the virus at this time. [ABSTRACT FROM AUTHOR]