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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.)

Introduction. In the general population, the risk of ovarian cancer is 1.31%, while in patients with ovarian endometriosis, the risk of ovarian cancer rises to 1.8%. Endometriosis shares common pathological mechanisms with cancer: abnormal tissue multiplication, the presence of local and distant implants, resistance to apoptosis and invasion of other tissues. Regarding the histopathological subtypes, it is known that the endometrioid and the clear cell carcinoma prevail among ovarian cancers. This association with malignancy of a condition otherwise considered benign should be acknowledged in order to properly advise the patients with endometriosis. Studies have shown that tumor volume is linked to the malignancy association risk and the advanced age (over 50 years old) is a significant risk factor also. Materials and method. We present two cases of ovarian endometriosis associated with ovarian cancer that were admitted to the Obstetrics and Gynecology Department of the Bucharest University Emergency Hospital in 2020 and 2022. The ages of our patients were 33, respectively 32 years old, with large tumors, first with a long history of chronic pain, and the second with acute complains, and both underwent surgery, the definitive histopathological report revealing the association of ovarian carcinoma. We present the cases’ evolution starting from the initial symptoms, imaging studies and laboratory results, treatment planning, surgical approach and findings, surgical and oncological follow-up. Furthermore, for endometriosis associated ovarian cancer, we discuss several favorable prognostic factors, such as early stage at diagnosis, low-grade disease, endometrioid or clear cell histology, resulting in low invasiveness and slow growth. Conclusions. We recommend that, despite being low, the malignancy risk in cases of ovarian endometriosis should be considered during patient counselling. [ABSTRACT FROM AUTHOR]

Total placenta praevia is used to describe a placenta that completely covers the internal os. Placenta increta is one of the most important complications of placenta praevia and requiring usually a hysterectomy. We report a case of central placenta praevia diagnosed by ultrasound in which we accomplished conservative management of postpartum period. [ABSTRACT FROM AUTHOR]

A pregnancy becomes at high-risk when the life of the mother or the fetus is becoming fragile. Nowadays, many health problems come to different women before pregnancy and then extended during and after pregnancy. Health problems can occur before a woman becomes pregnant or during pregnancy. We report the management of a 48-year-old female patient with pregnancy obtained via in vitro fertilization with the use of donor oocytes and prophylactic transabdominal cerclage for history of cervical amputation, diagnosed with gestational diabetes mellitus. During the 38 week of pregnancy she delivered by cesarean section, a healthy fetus. [ABSTRACT FROM AUTHOR]

The dual immunostaining of cervical cytology p16/Ki-67 which combines a high sensitivity with a high specificity is the solution that has been developed in recent years for cervical precancer detection optimization. The test is a double immunocytochemistry staining performed simultaneously in the same cell for p16 - transforming infection marker and Ki67, a proliferation marker. This immunocytochemistry test is intended to optimize the surveillance or screening of young patients with cytology results: atypical squamous cells of undetermined significance with high risk human papilloma virus or low-grade squamous intraepithelial lesions, thus avoiding colposcopies and any invasive gesture at nulliparous, reducing the anxiety of patients linked to the indication of colposcopy and ultimately reducing diagnosis costs. Each year there are 500.000 new cases of cervical cancer detected worldwide and the average of 5 years survival rate is only 50%, thus including the CINtec PLUS test in cervical cancer screening programs may be seen as an innovative strategy an can provide real benefit to clinicians and patients as it helps identifying underlying disease and establish who should proceed to further procedures. [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.)

Introduction. Neurofibromatosis is a multiorgan affecting genetic disorder with multiple implication in a pregnancy course. Most frequent pregnancy-related complications in this background are first-trimester spontaneous abortion, stillbirth, intrauterine growth restriction and a high rate of caesarean section. Becker nevus syndrome is typically characterized by the presence of circumscribed cutaneous hamartoma, hyperpigmented and hypertrichotic, along with unilateral breast hypoplasia, muscle, skin and/or skeletal abnormalities. The association between these two disorders is an extremely rare event. Moreover, pregnancy in the context of these two disorders overlapped is an exceptional entity. Case presentation. We present the case of a 24-year-old primiparous gravida, 25 weeks of gestation, who was admitted to our clinic for a multidisciplinary approach in the context of severe deformation of the cervical-thoracic-lumbar spine, in “C” shape, associated with multiple café-au-lait spots, suggestive for neurofibromatosis type 1, and an asymptomatic large hyperpigmented and hypertrichotic lesion in the lumbar region, clinically indicating Becker nevus syndrome. Conclusions. The course of this case was clearly a challenge, being a unique case in terms of reports in the specialized literature, both nationally and internationally. [ABSTRACT FROM AUTHOR]

Brain cancer during pregnancy is an unusual event with a poor resolution due to its signs and symptoms that can be confounded with those of pregnancy. Complications like infections and hemorrhages can occur due to multiple tumoral surgeries and these may represent another risk factor and can increase the morbidity and mortality. One of the most important facts we noticed in our two cases we encountered is that both patients were very young (25 years old and, respectively, 26 years old) and both were pregnant when the diagnosis was established. The histopathological exam revealed different results, as one had glioblastoma and the other had anaplastic oligodendroglioma. The last one needed multiple intervention due to complications. In both cases, the newborns had a favorable evolution and the patients started radiotherapy after delivery. [ABSTRACT FROM AUTHOR]

Acute fatty liver of pregnancy is a potentially fatal condition, with an incidence of 1 in 15,000 pregnancies. The reported associated maternal and perinatal mortality exceeds 70%. With prompt and correct diagnosis and management, this percentage decreases to about 20%. The diagnosis may be challenging due to nonspecific clinical presentation, therefore the best approach remains the exclusion of the most common liver diseases in pregnancy. We report a case of acute fatty liver of pregnancy in a 38-year-old secundiparous patient, with 36 weeks of gestation, diagnosed with postpartum dilated cardiomyopathy after her first pregnancy, who presented with severe jaundice, nausea, vomiting, liver enzymes increased over a hundred times and severely increased direct and indirect bilirubin values. The prompt diagnosis and the multidisciplinary approach led to a successful outcome of this case. [ABSTRACT FROM AUTHOR]

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Nationally, the methods used for the diagnosis of preeclampsia have not significantly changed in the last 20 years. Diagnosis is based on monitoring maternal blood pressure and confirming proteinuria. However, these signs are nonspecific and are generally present when preeclampsia manifests clinically. Determination of serum levels of angiogenic placental factors and especially that of the PlGF/ sFlT-1 ratio (also known as index of angiogenesis) have an increased sensitivity and specificity in periodic assessment of the risk of preeclampsia, identifying the condition in early stages. Preeclampsia is a condition with severe consequences both maternal and fetal, and for that matter, a precocious diagnoses and an accurate evaluation of the severity of the disease are highly important in order to appoint an adequate treatment, thus decreasing the risk of complications. [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 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.)

Twenty percent of chromosomally abnormal first-trimester miscarriages are represented by triploidy. This chromosomal abnormality occurs in 1 of 3500 pregnancies at 12 weeks, 1 in 30,000 at 16 weeks, and in 1 in 250,000 at 20 weeks of gestation. There are just a few cases reported in the literature, because the vast majority of them are miscarried. We are presenting the case of a young female patient whose first-trimester screening echography didn’t reveal any risk for trisomy 13, 18 and 21, but a further evaluation at 19 weeks of gestation found a seriously deterioration of the growth curve, with severe intrauterine growth restriction (IUGR), which led us to the indication of an invasive diagnostic method. The amniocentesis revealed a triploidy and the decision of the abortion was the one the patient has chosen. In case of severe IUGR in the absence of frequent syndromes, triploidy could be one of the causes and the amniocentesis could set the diagnostic and impose the subsequent approach. [ABSTRACT FROM AUTHOR]

Diabetes is the most common medical complication associated with pregnancy. During pregnancy complicated with maternal diabetes (DM), the placenta suffers certain pathological, functional and structural changes. DM was correlated with a rapid progressive microangiopathy and this, in turn, may be associated with capillary hypertension and changes in capillary permeability. The objective of the study is to identify the clinical correlations with influence on gestation in general, and on the placental structure in particular, in pregnancy associated with type 1 (T1DM), type 2 (T2DM) and gestational diabetes mellitus (GDM). The impact of the clinical conditions associated with DM on placenta has been analyzed and correlated with the ultrasound (US), morphological, histological and immunohistochemical study of the placental structure. Preexisting maternal hypertension, preeclampsia and obesity were the main associated conditions. The US examination of placental characteristics revealed an increase in placental thickness in the second trimester. The macroscopic analysis showed that the placentas of women with diabetes are heavier. Gross pathological analysis of maternal and fetal surfaces of placentas revealed subcortical or basal plaque fibrin deposition, and placental infarction or intervillous thrombosis. From the microscopic point of view, the findings include fibrinoid necrosis, intervillous fibrosis, focal hyaline degeneration, villous immaturity, chorangiosis, placental calcifications, placental infarction or decidual vasculopathy. Maternal hypertensive disorders amplify the spectrum of morphological changes in the placenta. Placental immaturity and villous capillary dysfunction are characterized by increased angiogenesis and enhanced vascular permeability. The diabetic placenta does not show specific changes, but different associations may be a diabetic pathological pattern influenced by associated conditions, especially preeclampsia, obesity, dyslipidemias and the lack of euglycemia during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction. Cervico-isthmic pregnancies represent a rare entity easily discovered and mostly associated from a diagnostic point of view with reduced spotting and typical ultrasound appearance. Materials and method. Herein we present the case of a young female patient presenting at the emergency ward for intense bleeding ceased after uterotonic treatment, with an initial suspicion of a failed normal uterine cavity pregnancy - secondary cervico- isthmic located gestational sac. Uterine curettage or medical abortion was postponed for sequel beta human chorionic gonadotropin (beta-HCG) results, which in association with serial ultrasound showed a primary cervicoisthmic pregnancy. Methotrexate therapy in association with following uterine artery embolization and immediate curettage were done successfully. Conclusions. In conclusion, a high degree of suspicion is needed whenever a failed normal pregnancy is suspected in association with intense bleeding and cervico-isthmic gestational sac. The aspects leading to a correct diagnosis in this particular case are made out of an association of ultrasound signs corroborated with beta-HCG values. [ABSTRACT FROM AUTHOR]

A uterine scar throughout pregnancy is a potentially omnious aspect, as there can be a great deal of evolution variation from normal pregnancy outcome to major feto-maternal loss. Uterine scars and niches with and without any pregnancy have been widely evaluated ranging normal, 3D ultrasound to magnetic resonance imaging. Herein we present the case of a normal pregnancy outcome involving a uterine niche evaluated before and throughout gestation. Despite the normal uterine appearance with a normal caesarean scar ultrasound before pregnancy, in the late first-trimester frontal middle caesarean scar buldging was observed, showing a typical appearance enhanced until the late second to early third trimester. In the third trimester, no evident ultrasound caesarean scar dehiscence was observed, despite the operative room aspect. In conclusion, we emphasise the simple ultrasound signs relevant for early diagnosis which can contribute to pathology prevention. [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 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 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.)

Introduction. Adenomyosis is a benign pathology defined by the presence of endometrial glands in the miometrium, accompanied by chronic pelvic pain, infertility and vaginal bleeding. It is a hormonal dependent condition and is common in reproductive age. Adenomyosis areas differ from the normal endometrium by increased local production of estrogen or prostaglandins and resistance to progesterone action. Materials and method. The study included 23 patients, aged 26-52 years old, diagnosed with adenomyosis. Postoperatively obtained specimens were included in paraffin and studied histologically and immunohistochemically. The blocks were cut by the microtome, the sections were applied on simple slides for histological staining of Hematoxylin-Eosin and on Poly-L-lysin slides for the immunohistochemical stains. The antibodies were: anti-estrogen receptors (ER), anti-progesterone receptors (PR), anticytokeratin 7 (CK7), anti-cytokeratin 20 (CK20). Results. Classical Hematoxylin-Eosin staining showed the presence of mono-layered, cylindrical glandular epithelial tissue in the structure of the myometrium, and with immunohistochemistry we showed that these glands were of endometrial origin, being CK7-positive and negative at CK20, making a differential diagnosis with an eventual metastasis from the digestive tract. The receptors for estrogen and progesterone are present in the structure of these glands. Conclusions. Adenomyosis is a benign pathology diagnosed with certainty by histopathological examination. Receptors for estrogen and progesterone are features for endometrial tissue, and cytokeratins make the differential diagnosis with digestive epithelium. [ABSTRACT FROM AUTHOR]

With a relatively frequent incidence of 1-2%, fetal heart arrhythmias may represent a sign of compromised fetal status. Most arrhythmias are isolated, but in some cases they are associated with structural or functional cardiac abnormalities. A series of specific investigations, such as the detection of anti-Ro/SSA and La/SSB autoantibodies in lupus patients, may indicate the etiology. Detailed echocardiography, specialized echocardiography and cardiotocographic monitoring can direct the management towards expectative or further fetal cardiology consult. Fetal arrhythmias with irregular rhythm, translating intermittently blocked beats, have good prognosis, are well tolerated and can rarely progress to significant cardiac pathology. Thus, the presence of 3-5 extrasystoles per minute with normal heart rate requires high-level fetal heart echocardiography and weekly monitoring of heart rate. Tachycardia or bradycardia associated with fetal cardiac extrasystoles have indication for specialized fetal cardiac evaluation based on detailed echocardiography and weekly cardiotocographic monitoring, along with rigorous fetal movement monitoring by the mother. Fetal sinus tachycardia can be considered normal if it occurs sporadically during fetal movements. The indication of transplacental treatment occurs in case of fetal hydrops or persistent tachycardia (>220 beats/min), digoxin being the reference drug. Fetal bradycardia frequently associates a background cardiac pathology, heterotaxia or long QT syndrome. The presence of fetal heart arrhythmias is not an absolute indication of birth by caesarean section if there is the possibility of continuous fetal monitoring, otherwise it is the best option. [ABSTRACT FROM AUTHOR]

Restless legs syndrome (Willis-Ekbom disease), characterized by the urgent need for leg movement during rest periods, has a significantly increased incidence during gestational period, being three times more frequent in pregnancy compared to the general population. Approximately one in five women will experience symptoms typical for this syndrome during pregnancy, especially during the last trimester. In terms of pregnancy prognosis, restless legs syndrome has been associated with an increased incidence of gestational hypertension, preeclampsia, depressive disorder, chronic fetal distress, intrauterine growth restriction, prematurity, and caesarean delivery. Poor nighttime sleep quality associated with marked sleepiness, physical and psychic inefficiency throughout the day are the main factors leading to therapeutic behavior requirement. The main etiological factors involved are genetic predisposition, iron and folate deficiency, elevated estrogen levels and nerve compression. Although treatment differs depending on symptoms severity and associated conditions, the first line of therapeutic approach includes iron supplementation, physiotherapy and psychotherapy. In case of severe, refractory symptomatology significantly impacting the quality of life, the allowed treatment includes the minimum effective dose of clonazepam (0.25 mg/day) and carbidopa-levodopa (25/100 mg). For extreme cases, refractory to the aforementioned medication, oxycodone therapy may be considered also at the lowest dose. In spite of the transient appearance of the restless legs syndrome during pregnancy, these cases require specific monitoring due to possible associated conditions. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse has become a common pathology among women, and due to the increased incidence of this disorder, multiple surgical techniques have been developed as a means of treatment. There are multiple causes for pelvic prolapse. One of the main causes is increased intraabdominal pressure that can be caused by pregnancy, labor, birth or obesity. Other causes include hysterectomy, pelvic trauma and connective tissue disorders. Many hypotheses claim that the uterus itself is a healthy organ, and the pathophysiology of prolapse is a congenital or acquired connective tissue disorder (during vaginal delivery) and that uterine prolapse is just a symptom, not a disease. Vaginal hysterectomy fails to address the pathology in connective tissue disease, which causes recurrence in 10-40% of cases. Laparoscopic lateral suspension is a surgical technique which has the following key surgical steps: vesicovaginal dissection, mesh insertion and fixation, and the lateral suspension itself. The main advantages of this technique are uterine preservation and low recurrence rate. Other advantages include the low risk of intraoperative nerve and vascular system injury, the reduction of hospitalisation, as well as the simplicity of the technique. The complications of the technique are mesh-related, that can cause erosion, infection, pain and perforation of neighboring organs. The laparoscopic lateral suspension is an alternative treatment in vaginal prolapse, with few complications and with the advantage of uterine preservation. [ABSTRACT FROM AUTHOR]

Objectives. The aim of this case report is to present a single patient case superimposed on the literature knowl-edge in regard to mophometric mandibular variations observed on dental panoramic radiography and used to identify patients with low bone mass density (BMD). Case presentation. A 62 years old female patient reported to the Blident Help Dental Clinic, for specific visits and treatments, 3 years apart. Based on the digital panoramic radiography and DXA measurement, an osteoporosis evaluation with radiomorphometric indices was performed. Values for maximum condylar height, maximum coronoid height, projective height of the mandibular ramus, mini-mum ramus breadth and antegonial angle are higher on both sides. the values decreased for gonial angle, gonial index, mandible cortical width (MCW), superior and inferior mental height and panoramic mandibular indices on both sides. Bigonial distance also dicreased and the mandibular cortical index (MCI) changed from C2 category in 2017 to C3 category in 2020. Discussions. This postmenopausal pacient had a decline in MCW values which were lower than 3 mm (threshold to differentiate normal) on panoramic radiographs of women with low BMD. Antegonial Index had a decreased val- ue and could be used as a prediction index for osteoporosis. MCI index changed from C2 to C3 in correlation with the changes of bone mass density in lumbar spine. Conclusions. MCI, MCW, antegonial index and bone density played an important role in determining significance of effects of lower BMD at postmenopausal on the mandibular ramus region. [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.)

Adolescența este o perioadă de tranziție de la copilărie la viața de adult. Începe odată cu instalarea pubertății - proces de dezvoltare fizică, psihică și emoțională cauzat de o serie de modificări, în special endocrine. Numărul sarcinilor în rândul adolescentelor este în continuă creștere, ca urmare a schimbărilor sociale. Din păcate, multe sarcini la vârsta adolescenței sunt de multe ori cauza abuzului și violenței sexuale, riscul fiind mai mare pentru tinerele crescute într-un mediu social vulnerabil. Ratele ridicate ale sarcinii la vârsta adolescenței sunt determinate de gradul scăzut de informare a tinerelor cu privire la sexualitate și planificarea familială și de un nivel redus de implementare a programelor de educație sexuală. Sarcinile la adolescente sunt însoțite de o incidență crescută a preeclampsiei, nașterii premature sau restricției de creștere intrauterină. În acest context, consultația prenatală și dispensarizarea gravidei adolescente reprezintă o provocare pentru obstetricieni. [ABSTRACT FROM AUTHOR]

Umbilical cord abnormalities have an increased incidence and are often associated with structural or chromosomal abnormalities or deficient placentation. The persistent right umbilical vein is frequently associated with other life-threatening malformations. A four-vessel cord has been noted in normal neonates, but also in neonates with multiple congenital anomalies, and it is a common finding in conjoined twins. Single umbilical artery is associated with other fetal malformations and with growth restriction or abnormal karyotype. Excessive spiraling of a very long umbilical cord is often present in cases of unexplained fetal demise. Umbilical artery aneurysm is highly associated with trisomy 18, single umbilical artery, cardiac anomalies and intrauterine fetal death. Fetal intraabdominal umbilical vein varix has been associated with a high incidence of fetal anomalies and obstetric complications. More than 20% of umbilical cord cysts are associated with fetal chromosomal or structural defects. Velamentous umbilical cord insertion occurs in approximately 1% of singleton gestations, but it is more common in monochorionic twin gestations, in placenta praevia and in stillbirth cases, particularly from multiple pregnancies. True knot of the umbilical cord is a rare occurrence, which is difficult to diagnose antenatally; the constriction of the umbilical cord may lead to obstruction of the fetal circulation and subsequent intrauterine death. This paper reviews the most important aspects of the structural abnormalities of the umbilical cord, as determined by prenatal ultrasound, highlighting the experience of a very important obstetrics and gynecology department of Romania over the past five years. [ABSTRACT FROM AUTHOR]

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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.)

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.)

Objectives Pregnancy is considered a real metabolic challenge and a key moment for the development of subsequent maternal overweight or obesity-related complications such as gestational diabetes mellitus (GDM). Literature studies constantly report certain risk factors for GDM: family history of diabetes, previous GDM, advanced maternal age, being overweight or obese, fetal macrosomia, smoking. Among these factors, diet and regular physical exercise are modifiable, therefore educating patients could help prevent GDM and its related maternal and fetal complications. The aim of this study is to present our experience in the prevention of GDM in a group of 204 pregnant patients with detected risk factors. Methods A group of 204 pregnant patients with detected risk factors for GDM was enrolled in the study between April 2016 and April 2017. All patients were admitted in the Emergency University Hospital in Bucharest and followed-up at regular visits during pregnancy. A questionnaire was given to record patients' family history of cardiovascular disease, obesity and diabetes, lifestyle, diet, smoking and self-medication. Data about patients' pre-pregnancy BMI and gestational weight-gain was also recorded. At 24-28 weeks of gestation, all patients performed a 75g oral glucose tolerance test and pregnant patients with impaired glucose tolerance (IGT) were selected. These patients were put on a prudent diet, with a high intake of vegetables and white meat and were advised to quit smoking. Results The prudent diet had a positive impact on the gestational weight gain in the third trimester of the pregnant woman found to have an IGT, lowering the risk for obesity. Interestingly, the patients who had an active life before pregnancy and a moderate physical activity during pregnancy, gained less weight. Those who quit smoking and who supplemented their diet with vitamin D, C and iron also had better pregnancy outcomes. Conclusions Changes in modifiable risk factors (healthy diet, exercise) among pregnant women, especially overweight or obese, may reduce the risk of GDM and subsequent complications for both mother and fetus. Moreover, action upon these risk factors should be taken earlier than second or third trimester for better results. [ABSTRACT FROM AUTHOR]

Peripartum hysterectomy refers to the hysterectomy performed during delivery or within 24 hours. This is a relatively rare procedure, that can be emergent or planed depending on the indication. In about 30-50% cases of emergency performed hysterectomies the cause is represented by severe uterine hemorrhage, which is impossible to control by the usual methods, as it happens in abnormal placentation or uterine atony. Conservative methods should always be attempted in order to avoid if possible the morbidity and sterilization implied by hysterectomy. Regarding the risk factors for peripartum hysterectomy, prior caesarean delivery increases the incidence of this procedure from 1 in 30.000 to 1 in 220. The associated mortality is declared to be <1 percent, and the most frequent complications are febrile morbidity, hemorrhage and urinary tract injury. We studied the incidence of peripartum hysterectomy and the most common associated condition of these cases in the Bucharest Emergency University Hospital for a period of six and a half years. Data were retrieved from the statistics department of the hospital. From January first, 2011 to June 26, 2017 in our hospital 21.746 deliveries were registered, of which 55 cases (0.25%) required peripartum hysterectomy. The associated pathologies analyzed were placental disorders (placenta accreta, increta, percreta), placenta previa, preeclampsia, uterine atony, uterine rupture, fibroids, cervical cancer and infection. Also, the rate of admission in the intensive care unit and mortality were analyzed. The obtained results matched with those declared in the literature. The anticipation of the need of peripartum hysterectomy with the proper preparation, counseling and timing is a key element for the future outcome of the case. Knowing the relation of various risk factors with the possible need of this procedure significantly increases the rate of success and decreases the incidence of complications. [ABSTRACT FROM AUTHOR]

Scop. Sintetizarea informaţiilor privind urmărirea post-excizie a leziunilor cervicale HPV pozitive, prin testare HPV și terapie antivirală, pentru o mai bună înţelegere și un management adecvat al patologiei. Materiale și metodă. S-a analizat literatura de specialitate recentă, internaţională, asupra subiectului, urmărindu-se cu precădere factorii de risc asociaţi persistenţei infecţiei HPV. Rezultate. Principalii factori incriminaţi în persistenţa infecţiei HPV, în cadrul leziunilor CIN I - CIN III, au fost reprezentaţi de marginile pozitive post-excizie, încărcătura virală mare și coexistenţa mai multor tulpini HPV. 10% din pacientele la care s-a practicat trachelectomie radicală au prezentat la un an postoperator un tipaj HPV pozitiv pentru tulpini cu risc crescut. Concluzii. Principalul tratament la pacientele HPV pozitive cu leziuni cervicale este reprezentat de excizia leziunii, dar trebuie subliniată existenţa cazurilor de persistenţă a infecţiei, ce poate determina apariţia de noi leziuni locoregionale. Monitorizarea pacientelor prin tipaj HPV și instituirea în cazurile necesare a terapiei antivirale ca tratament adjuvant îmbunătăţesc prognosticul pacientelor. [ABSTRACT FROM AUTHOR]

Obiective. Analiza procedeelor de refacere a anatomiei compartimentului perineal posterior în cazurile de prolaps genital de gradele 2-3 și 4. Materiale și metodă. Studiul retrospectiv a analizat cazurile de prolaps genital de grad 2-3 sau 4 operate în Clinica de Obstetrică-Ginecologie a Spitalului „Dr. Ion Cantacuzino”. Analiza a fost efectuată asupra datelor demografice, a tipului de intervenţie chirurgicală, a complicaţiilor și evoluţiei postoperatorii. Rezultate. Au fost identificate 44 de cazuri de prolaps genital de gradele 2-3 și 4, la care au fost efectuate procedurile specifice adresate compartimentului posterior perineal, dintre care 7 cazuri de colposacrosuspensie și 37 de cazuri de colpo-/cervicosuspensie la ligamentele sacrospinoase, cu sau fără proceduri asociate. Colposacrosuspensia s-a asociat cu patologie uterină în 42,86% din cazuri, versus 5,41% în fixările la ligamentele sacrospinoase (p=0,0140). Numărul de zile de spitalizare a fost semnificativ statistic mai mic în cazul fixării la ligamentele sacrospinoase, comparativ cu colposacrosuspensia (4,64 versus 7 zile; p=0,0052). Concluzii. Colpo-/cervicosuspensia la ligamentele sacrospinoase reprezintă o intervenţie de elecţie la pacientele cu prolaps genital de grad 2-3 sau 4, cu patologie sistemică asociată severă sau cu antecedente chirurgicale abdominale importante. Colposacrosuspensia reprezintă o alternativă de tratament al prolapsului genital de grad 2-3 sau 4, la paciente nulipare, cu patologie uterină asociată, la care eventual se impune histerectomia. [ABSTRACT FROM AUTHOR]

Obiective. Prezentarea unui procedeu de refacere a anatomiei în cazurile de prolaps genital de gradul 3 sau 4, asociat cu cistocel și/sau rectocel per magna. Materiale și metodă. Prolapsul genital de gradul 3 sau 4, asociat cu cistocel și/sau rectocel per magna, pune probleme deosebite de reducere a excesului de mucoasă vaginală, precum și de întărire a aparatului fascial subvezical și intervaginorectal. Propunem un procedeu care asociază, simultan cu întărirea compartimentului posterior prin fixarea apexului vaginal (cu/fără cervix) cu meșă la ligamentele sacrospinoase, plasarea unei meșe suburetrale prin procedeul TOT și întărirea aparatului fascial subvezical și intervaginorectal prin plasarea sub mucoasa vaginală a excesului de mucoasă vaginală dezepitalizat. Rezultate. Procedeul a fost executat în 7 cazuri, fără incidente intraoperatorii sau complicaţii postoperatorii. În urmărirea pacientelor, la 3 luni postoperator, nu s-au decelat semne și simptome de complicaţii sau recidivă. Concluzii. Excesul de mucoasă vaginală reprezintă o sursă valoroasă de material autolog pentru utilizarea în scopul întăririi aparatului fascial subvezical și intervaginorectal, în cazurile de prolaps genital asociate cu cistocel și/sau rectocel per magna. [ABSTRACT FROM AUTHOR]

Leiomiomul uterin este una dintre cele mai frecvente afecţiuni ginecologice, ale cărui diagnostic și opţiuni terapeutice sunt foarte bine documentate. Totuși, leiomiomul vezicii urinare este o tumoră benignă rară (mai puţin de 1% din toate tumorile vezicii urinare). Raportăm cazul unei paciente de 48 de ani, fără antecedente personale patologice semnificative, internată în Secţia de Obstetrică și Ginecologie III a Spitalului Universitar de Urgenţă București pentru dureri pelviene, metroragii și polakiurie. În urma unui bilanţ imagistic minuţios (ecografie transvaginală convenţională, ecografie 3D și CT pelvian), la nivelul uterului au fost detectate multiple mase hipoecogene, bine delimitate, cu vascularizaţie circumferenţială, localizate intramiometrial, cu dimensiuni variabile. O tumoră cu aceleași caracteristici și cu diametrul de 4 cm a fost decelată în peretele posterior al vezicii urinare. Pacienta prezenta anemie ușoară (Hgb 8,8 mg/dl). S-a intervenit chirugical și s-a practicat histerectomie totală, cu anexectomie bilaterală. Tumora vezicală a fost de asemenea extirpată, cu limite de rezecţie oncologică. Tumora din vezica biliară a fost, de asemenea, eliminată. În urma unei analize microscopice riguroase, a fost stabilit diagnosticul de polifibromatoză uterină și leiomiom de vezică urinară. Leiomioamele vezicii urinare sunt foarte rare, cu doar 250 de cazuri raportate în întreaga lume. Rezecţia chirurgicală completă are o rată foarte scăzută a recidivelor, cu un prognostic excelent. [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 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.)

Fragile X syndrome is an important cause of premature ovarian insufficiency and the most common inherited cause of intellectual disability. Objectives. Prenatal diagnosis of fragile X syndrome by detecting expansion from premutation (PM) carrier and full mutation (FM) fetus, in young pregnant women with a family history of premature ovarian insufficiency (menopause before age 40), having before pregnancy an ultrasound appearance of severe impaired ovarian reserve and a positive genetic diagnostic for carrier of fragile X syndrome. PCR was used to compare the FMR1 alleles in chorionic villi and amniocytes. Material and methods. We tested all eligible women referred for reproductive counseling, which were genetically tested, conceived during a five years period and expressed their concern about the risk of having an affected fetus. Results. Invasive prenatal diagnosis was carried out in 12 pregnancies and we detected 1 FM and 6 PM fetuses; 4 couples decided to terminate the pregnancy. Conclusions. We sustain offering prenatal screening for fragile X syndrome to individuals at increased risk of carrying a premutation or full mutation. [ABSTRACT FROM AUTHOR]

Background. Obesity and excessive weight gain during pregnancy are related to increased fetal size and perinatal complications. Pregnancy induces several physiological metabolic alterations to ensure an optimal supply to the fetus. Gestational diabetes (GDM) is mainly responsible for the development of LGA fetuses, but an increasing number of these fetuses are born from non-diabetic mothers with underlying metabolic alterations. Maternal fat mass, throughout serum adipokines (Adpk), such as adiponectin (AD) and visfatin (VIS), is related to fetal growth via insulin resistance. The exact mechanisms are yet to be elucidated. Fetal size and weight are established by ultrasound biometry. Objective. We hypothesize that serum concentrations of AD and VIS are related to fetal growth via fat mass and insulin resistance. We investigated the relationship between Adpk, maternal lipid metabolism and fetal size estimated by ultrasound in mid gestation. Study design: 70 pregnant women were investigated during pregnancy, evaluating their blood levels of glucose, cholesterol and triglycerides. A glucose tolerance test was performed at 24-28 weeks of pregnancy, serums levels of Adpk and biometry were measured in the 2nd trimester. Results. Maternal serum AD inversely correlated with pre-pregnancy BMI, overweight and obese women showing lower levels. Fetal weight inversely correlated with serum AD. We found disparity in circulating maternal VIS between normal and overweight women and neonatal weight. Conclusion. The connection between maternal serum adiponectin and visfatin and the presence of lipid and glucose metabolic alterations support the hypothesis that perturbation of adipokine homeostasis plays a role in GDM and abnormal fetal growth. [ABSTRACT FROM AUTHOR]

Moartea fetală in utero este mult mai frecventă în sarcina multiplă, comparativ cu sarcina unică. Mai mult, moartea in utero a unuia dintre feți ridică probleme legate de etiologie, interrelație maternofetală și feto-fetală. La fel ca și în multe alte circumstanțe ale sarcinii multiple, corionicitatea are un rol decisiv. Datorită anastomozelor vasculare și a circulației interfetale partajate specifice placentației monocorionice, moartea in utero a unuia dintre feți, prin fluctuațiile hemodinamice interfetale subsecvente, este responsabilă pentru aproximativ 20-40% dintre anomaliile care apar la fătul supraviețuitor. Moartea fetală unică prezintă un risc de 20% pentru encefalomalacia multichistică și naștere prematură a supraviețuitorilor în sarcina monocorionică. Anomaliile cerebrale ale fătului supraviețuitor sunt atribuite mai multor mecanisme, cel mai important fiind cel hipoxic-ischemic, conducând în final la hemoragii intraventriculare și leucomalacie periventriculară. Șocul hipovolemic pe care îl resimte fătul supraviețuitor reprezintă un mecanism important, de asemenea. Conform acestei teorii, fătul decedat acționează printr-un efect de robinet asupra supraviețuitorului, care practic sângerează spre fătul decedat, lipsit de rezistență vasculară. Acest sindrom transfuzional rapid se realizează prin intermediul anastomozelor superficiale arterio-arteriale și veno-venoase. Managementul morții in utero a unuia dintre feți în sarcina multiplă este net diferențiat prin problematica legată de corionicitate. Dacă în sarcina multiplă bicorionică atitudinea este în principiu mai limpede și se bazează în special pe managementul expectativ conservator și evaluarea fetală sistematică, fiind evident supusă riscului de avort sau naștere prematură, în sarcina monocorionică această atitudine este mult mai complexă. Dacă evenimentul fatal al unuia dintre feți survine în cel de-al doilea trimestru de sarcină, supravegherea ultrasonografică a fătului supraviețuitor este esențială, decizia intervenției elective este sensibilă, iar prognosticul este inevitabil supus hazardului. [ABSTRACT FROM AUTHOR]