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Introduction. One of the most significant factors contributing to major obstetric hemorrhage is placenta accreta spectrum (PAS). The incidence of PAS is increasing, being now approximately 3 per 1000 deliveries, due to the epidemic rise of caesarean section (CS) rate and to pregnancies resulting from assisted reproductive technology. This pathologic adherence of the placenta to the uterine myometrium can be associated with significant maternal-fetal risks. The antenatal diagnosis includes ultrasonographic (US) assessment and magnetic resonance imaging (MRI) spectrum, but still remains imperfect. This paper aims to offer a short review regarding the proper evaluation and management of PAS. In addition, we present our clinic experience with placenta accreta in the last year. Methodology. We conducted a PubMed search including reviews, case reports and original papers regarding PAS in the last 10 years. We also performed a 12-month retrospective study that included 42 pregnant women, aged between 18 and 46 years old. The inclusion criteria were: bleeding during the third trimester of pregnancy and history of caesarean section delivery. Results and discussion. All patients benefited from a transvaginal and transabdominal US. All suspected PAS cases were evaluated using the new International Federation of Gynecology and Obstetrics (FIGO) classification. Two patients also benefited from an MRI examination and cystoscopy due to high suspicion of PAS. In two cases, the delivery was followed by a hysterectomy. In three cases, the caesarean section was complicated by postpartum hemorrhage, yet controlled with ligation of the uterine artery unilateral or bilateral. Conclusions. Placenta accreta spectrum is impacting maternal health outcomes globally and should be managed by experienced multidisciplinary teams. The correct antenatal diagnosis of PAS includes a combination of ultrasound, MRI examination and cystoscopy. Hysterectomy is the accepted management of PAS, and the conservative or expectant management of placenta accreta spectrum should be considered investigational. [ABSTRACT FROM AUTHOR]

Introduction. Adnexal masses (AM) detected during pregnancy require a prompt and accurate diagnosis to ensure fetal safety and good outcomes. Adnexal masses in pregnant women are most commonly detected during ultrasonographic (US) examination, routinely performed early in pregnancy. The incidence of adnexal masses in pregnancy has a rate of 0.01-15%. Obstetricians should decide between expectant management with a risk of rupture, torsion, need for emergent surgery, labor obstruction and progression of malignancy, or surgical removal during pregnancy. We present a case report of unilateral adnexal mass diagnosed early in pregnancy. Materials and method. A 24-year-old female patient addressed an obstetrics-gynecology private practice for dating a first pregnancy. A single intrauterine sevenweek viable pregnancy was confirmed with a corpus luteum present in the right ovary. The examination of the left adnexa found an unilocular tumor of 18-20 cm, with no papillary structures, no solid components or acoustic shadows. There was no ascites, nor increased blood flow to the tumor. The imagistic criteria pleaded for a benign huge ovarian cyst. Results. In the second trimester, about 20 weeks of gestation, after proper counselling, we decided to perform open surgery to remove the adnexal mass. Intraoperatively, we were not able to find any normal ovarian tissue. We performed a unilateral adnexectomy. The patient was discharged 48 hours later, with no complications and no symptoms at all. Conclusions. The complex diagnosis of adnexal masses in pregnancy is now accessible due to clear and specific US guidelines that help differentiate between benign and malignant masses. The management of adnexal masses during pregnancy is still a subject of debate, with no consensus regarding the best management plan. Tumor size, nature, location, symptomatology and the first trimestre mass detection are all crucial aspects for a proper care. [ABSTRACT FROM AUTHOR]

Introduction. Caesarean scar pregnancy (CSP) is a life-threatening condition and an iatrogenic disease due to the rising number of caesarean sections (CS) in the last decades. CSP can be of type I (endogenic), with development towards the cervico-isthmic space or uterine cavity, or of type II (exogenic), with development towards the bladder and abdominal cavity. The most practical and effective technique to early diagnosis CSP is transvaginal ultrasound (TVUS), adding a color Doppler assessment. Magnetic Resonance Imaging is not necessary for making an accurate diagnosis. The optimal approach is yet to be established and standardized. We aimed to collect and condense published literature on CSP treatment, in this systematic review. We also present our center experience on the conservative treatment of caesarean scar pregnancy. Methodology. We performed extensive research on MEDLINE, Embase and Cochrane Library to find studies that included the treatment modality and efficacy and complications for CSP. Results and discussion. The wide literature on this issue offers solid data about five treatment modalities that include the resection of CSP through a transvaginal approach, laparoscopy, uterine artery embolization plus dilatation and curettage and hysteroscopy, uterine artery embolization combined with dilatation and curettage without methotrexate and repeated high-intensity focused ultrasound. The expectant management of CSP is to be avoided. We also present our experience with three cases of CSP that beneficiated from local methotrexate, with a good outcome. Conclusions. Caesarean scar pregnancy is an increasing challenge worldwide. Due to a high risk of serious complications, we encourage medical practitioners to screen for CSP by early TVUS in all patients with previous caesarean delivery. The proper treatment is challenging, and guidelines are still lacking. With this paper, we try to offer different approaches to caesarean scar pregnancy, yet the management should be individualized and assessed by a multidisciplinary team, for the safest clinical option. [ABSTRACT FROM AUTHOR]

Introduction. Acute pancreatitis (AP) is an indication for hospital admission, with an increasing incidence, still rare during pregnancy. The most common causes of AP are gallstones (65-100%), especially in pregnancy, alcohol abuse and hypertriglyceridemia. There are limited data available about maternal-fetal outcomes in cases of third-trimester pancreatitis. In cases of acute biliary pancreatitis during pregnancy, the adopted medical approach depends on the gestational age and, also, considering the high risk of recurrence of AP (70%) and the specific risks of each treatment. We present a case report of AP in late third trimester, managed with conservative treatment and elective caesarean section delivery. Methodology and results. A 24-year-old primigravida presented to the emergency room accusing upper abdominal pain, nausea and vomiting. A 38week viable pregnancy was confirmed, with no uterine contractions on cardiotocography. Blood tests revealed amylase/lipase three times above the upper limit of normal. The abdominal ultrasound showed multiple gallstones. Other conditions, such as gastric ulcer and duodenal ulcer, acute appendicitis, acute mesenteric ischemia, HELLP syndrome, placental detachment or uterine rupture, were excluded. In order to care for both mother and the fetus, a multidisciplinary team decided on a conservative management including hydration, administration of antispasmodics, analgesics, antibiotics and correction of electrolyte disturbances. Caesarean section delivery was scheduled, as the fetal calculated growth was over the 90th percentile (4700 g). The immediate postpartum period was uneventful for both mother and neonate. Laparoscopic cholecystectomy was planned six weeks after delivery. Conclusions. The impact of acute pancreatitis can be devastating, causing substantial maternal-fetal morbidity and mortality. This case report underlines the importance of early diagnosis and correct management of AP, especially in pregnancy. A multidisciplinary approach, including gastroenterologists, general surgeons and obstetricians, seems to be the key in making the best choice of management in acute pancreatitis during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction. Adnexal masses (AM) detected during pregnancy require a prompt and accurate diagnosis to ensure fetal safety and good outcomes. Adnexal masses in pregnant women are most commonly detected during ultrasonographic (US) examination, routinely performed early in pregnancy. The incidence of adnexal masses in pregnancy has a rate of 0.01 15%. Obstetricians should decide between expectant management with a risk of rupture, torsion, need for emergent surgery, labor obstruction and progression of malignancy, or surgical removal during pregnancy. We present a case report of unilateral adnexal mass diagnosed early in pregnancy. Materials and method. A 24 year old female patient addressed an obstetrics gynecology private practice for dating a first pregnancy. A single intrauterine seven week viable pregnancy was confirmed with a corpusluteum present in the right ovary. The examination of the left adnexa found an unilocular tumor of 18 20 cm, with no papillary structures, no solid components or acoustic shadows. There was no ascites, nor increased blood flow to the tumor. The imagistic criteria pleaded for a benign huge ovarian cyst. Results. In the second trimester, about 20 weeks of gestation, after proper counselling, we decided to perform open surgery to re move the adnexal mass. Intraoperatively, we were not able to find any normal ovarian tissue. We performed a unilateral adnexectomy. The patient was discharged 48 hours later, with no complications and no symptoms at all. Conclusions. The complex diagnosis of adnexal masses in pregnancy is now accessible due to clear and specific US guidelines that help differentiate between benign and malignant masses. The management of adnexal masses during pregnancy is still a subject of de bate, with no consensus regarding the best management plan. Tumor size, nature, location, symptomatology and the first trimestre mass detection are all crucial aspects for a proper care. [ABSTRACT FROM AUTHOR]