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Preeclampsia, affecting 5-10% of pregnancies, is a major cause of maternal and fetal morbidity and mortality, characterized by elevated blood pressure and proteinuria after 20 weeks of gestation. The complications include intrauterine growth restriction, eclampsia, placental abruption, and HELLP syndrome. Effective first-trimester screening, recommended by international societies, considers maternal risk factors such as the PlGF (placental growth factor) value, the pulsatility index of the uterine arteries, and the mean blood pressure. Advances in soluble biomarkers, especially the sFlt-1/PlGF ratio, offer improved early diagnosis and management by predicting preeclampsia weeks before the symptoms appear. Preventive measures – notably, low-dose aspirin – have been validated by the ASPRE study, showing a 62% reduction in preterm preeclampsia risk when administered from 11-14 weeks of gestation. Implementing these screening and prevention strategies nationwide, especially in resource-limited areas, is essential to reduce the incidence and to improve the outcomes for mothers and babies. [ABSTRACT FROM AUTHOR]

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]

Background: Hysterosalpingo-foam sonography (HyFoSy) has gained popularity in the last decades, as it represents a feasible, well-tolerated, and minimally invasive method of evaluation of tubal patency in cases of infertility. The purpose of this study was to communicate the technical tips and tricks based on our experience in performing HyFoSy, with the aim to improve the feasibility, to reduce the pain, and to evaluate pregnancy-obtaining rate after procedure. Methods: Our observational study includes 672 patients from infertile couples who underwent HyFoSy for tubal patency evaluation. During HyFoSy, tubal pathway and patency as well as the level of pain were evaluated. A telephonic questionnaire was conducted in order to assess the pregnancy obtaining rate in the first 3 months and more than 3 months after the procedure. Results: The median age in our group was 33.5 years. Most of our patients (61.16%) underwent HyFoSy in the 8–10 days of the menstrual cycle. Tubal patency was present bilaterally in 86% cases, unilaterally in 11% of patients, and was absent in 3% of cases; 75% of patients related absent or tolerable pain, 17% described HyFoSy as a painful procedure, and 8% experienced extreme pain. After HyFoSy, pregnancy was naturally obtained in 10.86% of cases within the first 3 months after HyFoSy. Conclusions: HyFoSy represents a useful, easy to use, and painless tool in female infertility evaluation and should be considered as a complementary method of the transvaginal ultrasonography, completing the genital tract imaging with information about the hidden part of the standard examination: tubal patency. HyFoSy provides information about patency, caliber regularity, pathway, and occlusion location of the fallopian tubes; therefore, it should be introduced along with transvaginal ultrasound as a first-line infertility exploration method. [ABSTRACT FROM AUTHOR]

Mycoplasma genitalium belongs to the Mollicute class, represented by the smallest microorganisms which can live independently without a cell wall. From the same class, also involved in urogenital system pathogenesis, we mention Mycoplasma hominis and ureaplasmas, like Urealiticum or Parvum. Mycoplasma genitalium infection is found in 1-3.3% of individuals amongst the general population, but there is a higher prevalence among patients with nongonococcal urethritis (10-35%) or in patients with chronic cervicitis and pelvic inflammatory disease (12-28%). The recurrence of the infection and its chronic evolution yield an important practical importance. The main risk factors associated with Mycoplasma genitalium are represented by: age under 20 years old, more than two past sexual partners, and smoking. Mycoplasma genitalium is sensible to tetracyclines, macrolides and fluoroquinolones. Nevertheless, it seems that the microorganism has a great capacity to quickly acquire antibiotic resistance. The risk of recurrence of the Mycoplasma genitalium infection is high, both in women and men. The repeated urinary symptoms in men and also the urinary or genital symptoms in women are suggestive. The treatment must be resumed by choosing the optimal antibiotic. It is imperative that the sexual partner be tested and treated. Finally, it is important to check the cure of the infection. The risks of recurrence and/or persistence consists in the chronic pelvic inflammatory disease (CPID) with endometritis and chronic salpingitis. CPID can thus lead to infertility, due to the endocervical, endometrial and tubal mucosa injury. [ABSTRACT FROM AUTHOR]

Spina bifida aperta is one of the most frequent open neural tube defects and consists in a closure defect in the fetal spine and the subsequent skin, leaving the spinal cord vulnerable. Since folic acid supplementation has been recommended periconceptionally, the incidence of neural tube defects, including spina bifida, has been reduced dramatically. Unfortunately, spina bifida is usually diagnosed in the second trimester, more frequently between 18 and 20 weeks of gestation, according to the American College of Obstetricians and Gynecologists (ACOG), by visualizing the spinal defect, as well as well-known intracranial signs. There have been attempts in finding the right intracranial sign or measurement that can predict a future positive diagnosis of spina bifida or at least alert the sonographer to further investigate. The early diagnosis of spina bifida represents the subject of interest of this paper, as this congenital neural tube defect carries the burden of a significant morbidity. The mothers should be counseled, informed about the fetal complications of this pathology and about the therapeutic possibilities, including intrauterine fetal surgery, and they should also be given the possibility of pregnancy termination, if the patient decides in this direction. [ABSTRACT FROM AUTHOR]

Mycoplasma genitalium belongs to the Mollicute class, represented by the smallest microorganisms which can live independently without a cell wall. From the same class, also involved in urogenital system pathogenesis, we mention Mycoplasma hominis and ureaplasmas, like Urealiticum or Parvum. Mycoplasma genitalium infection is found in 1-3.3% of individuals amongst the general population, but there is a higher prevalence among patients with nongonococcal urethritis (10-35%) or in patients with chronic cervicitis and pelvic inflammatory disease (12-28%). The recurrence of the infection and its chronic evolution yield an important practical importance. The main risk factors associated with Mycoplasma genitalium are represented by: age under 20 years old, more than two past sexual partners, and smoking. Mycoplasma genitalium is sensible to tetracyclines, macrolides and fluoroquinolones. Nevertheless, it seems that the microorganism has a great capacity to quickly acquire antibiotic resistance. The risk of recurrence of the Mycoplasma genitalium infection is high, both in women and men. The repeated urinary symptoms in men and also the urinary or genital symptoms in women are suggestive. The treatment must be resumed by choosing the optimal antibiotic. It is imperative that the sexual partner be tested and treated. Finally, it is important to check the cure of the infection. The risks of recurrence and/or persistence consists in the chronic pelvic inflammatory disease (CPID) with endometritis and chronic salpingitis. CPID can thus lead to infertility, due to the endocervical, endometrial and tubal mucosa injury. [ABSTRACT FROM AUTHOR]

Spina bifida aperta is one of the most frequent open neural tube defects and consists in a closure defect in the fetal spine and the subsequent skin, leaving the spinal cord vulnerable. Since folic acid supplementation has been recommended periconceptionally, the incidence of neural tube defects, including spina bifida, has been reduced dramatically. Unfortunately, spina bifida is usually diagnosed in the second trimester, more frequently between 18 and 20 weeks of gestation, according to the American College of Obstetricians and Gynecologists (ACOG), by visualizing the spinal defect, as well as well-known intracranial signs. There have been attempts in finding the right intracranial sign or measurement that can predict a future positive diagnosis of spina bifida or at least alert the sonographer to further investigate. The early diagnosis of spina bifida represents the subject of interest of this paper, as this congenital neural tube defect carries the burden of a significant morbidity. The mothers should be counseled, informed about the fetal complications of this pathology and about the therapeutic possibilities, including intrauterine fetal surgery, and they should also be given the possibility of pregnancy termination, if the patient decides in this direction. [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]

First-trimester screening is focused on both markers of aneuploidies and structural abnormalities detection. In the past ten years, clinicians have been increasingly interested in using Doppler ultrasound in the first trimester of pregnancy. Doppler examination can help estimate the risk of aneuploidy and early diagnose severe fetal malformations. The purpose of this article is to highlight the importance of color Doppler ultrasound examination of the fetus in the first trimester. Color Doppler examination also has a great significance in studying maternal-fetal circulation. According to the ISUOG guidelines, several vascular territories should be covered: uterine arteries, umbilical artery, and ductus venosus. The nowadays first trimester Doppler examination not only identifies specific ultrasonographic markers for aneuploidy but also aids in the identification and analysis of many anatomical structures. [ABSTRACT FROM AUTHOR]

Stem cells are precursor cells capable of self-renew and of generating numerous mature cell types. As the field of human embryonic stem cells harvesting has been put under questionable ethic issues, other sources are under investigation and present tremendous potential: tissue specific progenitor stem cells, mesenchymal stem cells, umbilical cord cells, bone marrow stem cells, and induced pluripotent stem cells. Stem cells interest different departments of regenerative medicine as well as conservative wildlife. Stem cells might be a viable option for the treatment of pathologies such as spinal injuries, cardiovascular disease, diabetes, liver injuries or even osteoarthritis. Scientists are looking forward to developing molecules that can activate tissue specific stem cells, promote stem cells to migrate to the side of tissue injury, and promote their differentiation to tissue specific cells, so that many health issues could have an alternative and efficient treatment and or even be cured. [ABSTRACT FROM AUTHOR]

On the 2nd of December 2003, in the Official Journal of the European Union it was published the “Council Recommendation on cancer screening” which had issued recommendations, setting out principles of best practice in the early detection of cancer. The recommendations called on all EU countries to take a common action to implement national, population-based screening pro-grams for breast, cervical and colorectal cancer, as an in te gral part of the Community Agreement duties in or der to complete the national policies, with the aim to im prove the public health. A first report, published in 2008, showed that, despite the documented progress, the mem ber states had fallen short of the established target set for the minimum number of examinations by more than 50%. The second report, consisting in the European Coun cil’s recommendations implementation concerning can cer screening, was elaborated and published in 2017, with the attendance of 28 member states. In a subsequent re port regarding the European Council’s recommendations im-ple men ta tion status, Romania appears in the minority of EU member states that do not have yet organized po pu la-tion-screening programs for breast cancer and colorectal can cer. In 2020, Romania declared a 0.2% coverage rate of breast examination, an inviting rate of 0.2%, and an 82% participation rate for breast cancer screening. Re gar ding cervical cancer screening, the coverage rate is 9.2%, the inviting rate is 65% and the participation rate is 14.2%. The general intent of European Union’s plan to com bat can cer subsides in the prevention, detection and treat-ment improvement, as well as cancer management in the EU, reducing health inequalities between and inside the member states. The technical support offered to the mem ber states could contribute to the increase of screening rates, while guides and structural support could contribute to assuring a comparably high health system quality in all Europe. [ABSTRACT FROM AUTHOR]

Human papillomaviruses (HPVs) are responsible for approximately 5% of all cancers, with high-risk types causing nearly all cervical cancer cases. While cervical cancer is the most recognized outcome of HPV infection, the virus also contributes to vulvar, vaginal, penile, anal, and head and neck cancers. HPV types 16 and 18 are the primary culprits in these malignancies. HPVs exhibit strict host specificity and encompass over 100 types, some linked to benign conditions like genital warts. The viral oncoproteins E6 and E7 play a crucial role in cancer development by inhibiting tumor suppressor genes. HPV-related diseases manifest in various ways, from common conditions like anogenital and plantar warts to rare presentations such as recurrent respiratory papillomatosis, conjunctival papillomas, and middle ear carcinomas. The clinicians must recognize this diversity to ensure the accurate diagnosis and management. Preventive measures, particularly large-scale vaccination, are essential to reduce the incidence and complications of HPV-related diseases. [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]

During pregnancy, gestational diabetes is the most common metabolic disorder, characterized by altered glucose tolerance. The prevalence of gestational diabetes is increasing, which is linked to the rise in maternal obesity rates in recent years. Despite numerous large-scale studies on the topic, there is still ongoing debate about the screening and treatment of gestational diabetes. The fetal and neonatal complications associated with gestational diabetes include fetal macrosomia, hyperinsulinemia, hypoglycemia, hypocalcemia, neonatal hyperbilirubinemia, increased risk of respiratory distress, and shoulder dystocia, especially in macrosomic babies. Additionally, children born to diabetic mothers are at a higher risk of developing obesity and diabetes in adolescence and adulthood. Maternal complications of gestational diabetes include an increased risk of developing hypertensive syndromes and the likelihood of requiring a caesarean section. Screening and treatment of gestational diabetes are crucial in ensuring healthy outcomes for both mother and child. In this article, we will explore the importance of early detection and effective management of gestational diabetes, highlighting the benefits of timely intervention, and the potential risks of untreated gestational diabetes. Furthermore, we will present the latest international guidelines and recommendations for the screening and management of gestational diabetes. [ABSTRACT FROM AUTHOR]

Human T-cell leukemia virus-1 (HTLV-1) is the first infectious agent proven to cause cancer, and it is considered among the most potent carcinogens for humans. HTLV-1 is estimated to have infected 5-10 million individuals, with only about 5% of people that contract the virus expected to de)velop any associated disease. Within Europe, Romania appears to be the only region endemic to HTLV-1. There are two primary diseases associated with HTLV-1, T-cell leukemia/ lymphoma (ATL) and HTLV-1-associated myelopathy (HAM), or tropical spastic paraparesis (TSP). Each is linked to a distinct mode of transmission: ATL with breastfeeding, and HAM/TSP with blood transfusion. The main ways of viral transmission are from mother to child by breastfeeding, via blood transfusions, or through sexual intercourse. Vertical infection rate has been found to be 14.2%. In Romania, HTLV is included in the screening for blood donors, but not in prenatal screenings. Vertically transmitted infections can be reduced with up to 87% by avoiding breastfeeding. New research supports the effectiveness of prenatal screening followed by avoiding breastfeeding in reducing new cases of HTLV in endemic areas, and such measures must be taken in Romania as well. [ABSTRACT FROM AUTHOR]

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]

Intrauterine growth restriction is defined as the fetal failure of achieving the endorsed growth potential and the diagnosis is made on the basis of ultrasound estimated fetal weight below the 10th centile in the absence of a gold standard for defining this condition. Fetuses with growth restriction are at risk for perinatal morbidity and mortality and for poor long-term health outcomes. In the last 10 years many algorithms have been developed aiming to prevent these consequences. This year new consensus-based definitions for early and late fetal growth restriction, including cut-off values for parameters, have been agreed. An update in diagnosis and management of intrauterine growth restriction, through a review of the latest publications in the field, presents the arguments for decisions necessary to produce national guidelines and recommendations of clinical practice in order to reduce the perinatal morbidity and mortality due to this condition, whose prevalence is estimated at 6-7% of total births in Romania. [ABSTRACT FROM AUTHOR]

Umbilical cord abnormalities are not rare, and are often associated with structural or chromosomal abnormalities, fetal intrauterine growth restriction, and poor pregnancy outcomes; the latter can be a result of prematurity, placentation deficiency or, implicitly, an increased index of cesarean delivery due to the presence of fetal distress, higher admission to neonatal intensive care, and increased prenatal mortality rates. Even if the incidence of velamentous insertion, vasa praevia and umbilical knots is low, these pathologies increase the fetal morbidity and mortality prenatally and intrapartum. There is a vast heterogeneity among societies' guidelines regarding the umbilical cord examination. We consider the mandatory introduction of placental cord insertion examination in the first and second trimester to practice guidelines for fetal ultrasound scans. Moreover, during the mid-trimester scan, we recommend a transvaginal ultrasound and color Doppler assessment of the internal cervical os for low-lying placentas, marginal or velamentous cord insertion, and the evaluation of umbilical cord entanglement between the insertion sites whenever it is incidentally found. Based on the pathological description and the neonatal outcome reported for each entity, we conclude our descriptive review by establishing a new, clinically relevant classification of these umbilical cord anomalies. [ABSTRACT FROM AUTHOR]

Cardiac and cardiovascular malformations are of real interest in terms of definition, epidemiology, and means of early diagnosis by imaging. Although ultrasound examination reaches exceptional performance nowadays, unusual pathologies are still exposed to the risk of either incorrect acquired image or misinterpretation by the specialist in a routine scan. Herein, we present a case of a 20-week-old fetus (from an apparently low-risk pregnancy) with complex cardiac and vascular abnormalities, including an arteriovenous malformation along with ventricular septal defect, ductal coarctation of the aorta, aneurysm of a brachiocephalic vein, and dilation of the entire neck and upper mediastinum venous system, and the limitations that were encountered in the process of diagnosis and management of the case. [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]

Caesarean section is one of the most common abdominal surgeries that do not benefit from a standard technique. The short­-term and long-­term consequences of the intervention depend on the technique used at each stage of the procedure, the choice of method being essentially influenced by the knowledge of anatomical landmarks and scientific evidence. The objective of our review is to pro vide updated evidence-­based guidance for surgical decisions during caesarean delivery. We focused on the requirements of the uterine closure at the time of caesarean section, with emphasis on the woman’s reproductive desires. The conventional double-­layer and single-layer suturing are discussed in this paper, with regard to full thickness healing of the cut margins. The quality of the cut margins of the uterus due to the process of labor on a prior scared uterus may lead to the poor healing of the uterine wall and results in thinned out scars. [ABSTRACT FROM AUTHOR]

Incidenţa placentei aderente a crescut în ultimii 60 de ani, datorită creşterii indicelui de cezariană. Deși diagnosticul ecografic are o sensibilitate considerată a fi de 90% și o specificitate de 97%, iar rezonanța magnetică este larg disponibilă și are acuratețe diagnostică înaltă, experiența clinică analizată în cadrul Spitalului Universitar de Urgență pe o perioadă de doi ani, în concordanță cu datele din literatură, susține faptul că există o discrepanță nejustificată între diagnosticul prenatal și cel intraoperator. Lucrarea prezintă o largă revizie a literaturii de specialitate, în scopul formulării unei abordări coerenete și standardizate a pacientelor cu factori de risc, precum și a metodelor actuale optime de abordare terapeutică. European Working Group on Abnormally Invasive Placenta propune, în scopul facilitării diagnosticului imagistic al placentei invazive, un consens al criteriilor ecografice, rezultat prin analiza a 23 de studii referitoare la diagnosticul antenatal ecografic al acestei patologii: pierderea omogenității placentare, cu multiple spații transonice, lacune adiacente miometrului periplacentar; pierderea sau iregularitatea spațiului transonic retroplancetar; miometrul retroplacentar subțire <1 mm; absența liniei delimitante a vezicii urinare; masă exofitică ce depășește seroasa uterină și invadează vezica urinară; protruzia placentei în spațiul vezical. Hemoragia incontrolabilă datorată placentaţiei invazive reprezintă una dintre principalele indicații ale histerectomiei peripartum și o cauză majoră de coagulopatie intravasculară diseminată, detresă respiratorie a adultului, insuficiență renală și mortalitate maternă. Morbiditatea și mortalitatea maternă datorate placentei aderente sunt semnificativ reduse de diagnosticul prenatal care condiționează nașterea într-un centru specializat, cu o echipă multidisciplinară, experimentată, beneficiind de o pregătire preoperatorie adecvată. [ABSTRACT FROM AUTHOR]

Malformațiile arteriovenoase Galen se dezvoltă in utero prin persistența fistulelor între arterele primitive pia-arahnoidiene și venele piale care se intersectează în unghi drept. Dimensiunea șuntului se corelează cu severitatea și precocitatea efectelor hemodinamice și ale afectării neurologice progresive datorată efectului de masă. Prezentăm un caz de malformație anevrismală a venei Galen diagnosticat prenatal la 28 de săptămâni de gestație pe baza detectării în centrul secțiunii talamice a unei formațiunii chistice anecogene nepulsatile cu semnal Doppler intens, mixt, însoțită de un aspect atipic al poligonului Willis, ventriculomegalie unilaterală borderline și dilatație de cord drept dezvoltată progresiv în cursul evoluției sarcinii. Insuficiența cardiacă severă neonatală a impus abordarea terapeutică de urgență. Embolizarea vaselor aberante a fost realizată în două etape, prin cateterizarea arterei femurale, sub anestezie generală, în cadrul Compartimentului de angiografie și terapie endovasculară a SUUB; în ziua a treia de viață neonatală s-a reușit obstrucția unui șunt din artera cerebrală superioară dreaptă și a altuia din artera cerebrală posterioară stângă, cu reducerea a 45-50% din fluxul total al șuntului. A doua intervenție impusă de lipsa de ameliorare a parametrilor cardiaci a avut loc la 7 zile post-partum şi a constat în microcateterizarea și ocluzia unui șunt din artera carotidă dreaptă și a altui șunt din circulația posterioară, sistându-se 80% din fluxul anevrismului. Tromboza acută a venei Galen a fost urmată de ruptura peretelui anevismal și de hemoragie periventriculară și intraventriculară, care au necesitat drenaj extern. După cunștințele noastre, acesta este singurul caz de anevrism Galen care a beneficiat de terapie prin embolizare supraselectivă în perioada neonatală în România, până la acest moment. [ABSTRACT FROM AUTHOR]

Pe baza consensurilor grupurilor internaționale de studiu al tumorilor (IOTA, IETA, MUSA, FIGO) privind termenii, definițiile și măsurătorile standard necesare descrierii ultrasonografice a endometrului și leziunilor intrauterine, a tumorilor ovariene, a miometrului, formațiunilor tumorale miometriale și joncțiunii endomiometriale, în scopul îmbunătățirii predictibilității riscului pe baza aspectului lor sonografic modul B, Doppler color și sonohisterografic, precum și a uniformizării limbajului utilizat în studii clinice, în 2016 a fost realizat un software capabil să genereze un raport complet, detaliat, actual și reproductibil al examinării ultrasonografice ginecologice. Datorită înaltei valori predictive a algoritmului ultrasonografic de identificare a cancerului endometrial realizat de Dueholm și colab., acesta a fost, de asemenea, inclus în rândul câmpurilor de examinare. Comunicăm rezultatele incipiente ale implementării acestui program în cadrul practicii medicale ultrasonografice curente a unora dintre centrele de referință ale țării. Programul se dovedește a fi facil în utilizare, util ghidării terapeutice, elaborează rapoarte reproductibile, fiind desigur perfectibil pe măsura acumulării experienței în derulare. Crearea acestui software a avut drept scop îmbunătățirea sensibilității și specificității diagnostice a ecografiei ginecologice, uniformizarea, actualizarea și detalierea rapoartelor medicale de specialitate, sperând a se constitui într-un reper pentru formularea ghidurilor de practică medicală vizând patologia ginecologică. [ABSTRACT FROM AUTHOR]

The incidence of endometrial cancer reported in Romania for 2015 was 8.7/100000 women, holding the third position in the genital area, following cervical and ovarian cancer. The current national statistical studies and the ones performed within the Bucharest Emergency University Hospital certify that 35% of the endometrial cancers diagnosed based on the abnormal uterine bleeding are in advanced stages, with a significantly reduced life expectancy. The identification of endometrial cancer should be based on the following items: correct investigation of abnormal uterine bleeding occurring in premenopause or postmenopause, investigation of abnormalities of the cervical cytology examination, diagnosis, treatment and appropriate monitoring of the precursor endometrial lesions or associated with endometrial cancer and the screening of the increased risk population (Lynch syndrome, Cowden syndrome). The assessment of the risk population and of the cases confirmed in a histopathological manner should be performed in a standardised manner, the medical practice guidelines of the Ministry of Health should be updated and implemented in hospitals and in specialised practices and family physicians' practices; medical practice should focus on early detection, the addressability of women in the early stages of the disease should be improved and the informational system necessary for controlling the route of the cases should also become functional together with the national register of cancer and of rare diseases. The purpose of the performed program is the reduction of mortality owed to cervical cancer, the extension and increase in the quality of life of the female patients through the early identification of this illness. [ABSTRACT FROM AUTHOR]

Fetal growth restriction is an important part of monitoring a pregnancy. Because guidelines or diagnostic criteria for either minor or major thrombophilia are scarce, this systematic review aims to summarize the present knowledge in the field. We performed the CRD42022376006 protocol in Prospero with a systematic literature search in PubMed and Web of Science databases and included original full-text articles (randomized control trials and clinical trials) from the last 10 years, published in English, and with the "thrombophilia AND (pregnancy OR diagnostic criteria) AND fetal growth restriction" criteria. After two researchers extracted the articles of interest, they were assessed using the Newcastle–Ottawa Scale and eight articles were included. The elements from the thrombophilia diagnostic predict IUGR, factor V Leiden mutation, MTHFR C667T mutation, protein S deficiency, antithrombin deficiency, factor VII polymorphism, and antiphospholipid antibodies, while the association of protein C, PAI-1 and certain combinations of mutations are still under debate and require the collection of more data. The present systematic review provides an extensive picture of the actual knowledge about thrombophilia diagnosis and its links with pregnancy complications, such as intrauterine growth restriction, despite its limitation in the inclusion of other actually debated disorders such as PAI-1 mutation, protein C deficiency and other thrombophilia types. [ABSTRACT FROM AUTHOR]

Brest cancer represents the most common cancer worldwide, being the second deadliest cancer in women. There is no doubt regarding the importance of breast cancer screening. Mammography represents the primary imaging technique used to detect suspicious lesion for breast cancer. This imagistic method has been found to decrease the mortality related to breast cancer. Mammography may detect evidence of cancer one and a half to four years before cancer becomes clinically obvious. Patients with breast tissue augmentation need a routine screening mammography in order to evaluate the native breast tissue. The indications for breast cancer screening are the same as in women without implants, the only difference being that women with breast implants should be approached differently from a clinical point of view. Standard imaging technique for this type of patients involves four sections in alternative of the usual two sections per breast. In conclusion, women with breast augmentation should not be neglected and should undergo breast cancer screening alongside the targeted population, even though the required technique is more laborious and requires a more experienced eye. [ABSTRACT FROM AUTHOR]

VACTERL represents an acronym for a broad spectrum of congenital anomalies such as vertebral anomalies, anorectal anomalies (anal atresia), cardiac anomalies, tracheoesophageal fistula or atresia, renal anomalies, and limb anomalies. We present the case of a male fetus with multiple anomalies consistent with VACTERL association such as scoliosis, imperforate anus, common truncus arteriosus, tracheoesophageal fistula associated with inferior esophagus atresia, polycystic kidneys, with short right ureter, lower limb hypoplasia micrognathia, hygroma, duodenal atresia, and cloacal malformation, with an aberrant omphalomesenteric duct. The presented case highlights the crucial importance of pathologists specialized in the dissection and confirmation of fetal abnormalities as an essential part of the multidisciplinary team that establishes the management of complicated pregnancies with this type of pathology. [ABSTRACT FROM AUTHOR]

The wide access to varied, attractive, and aggressively promoted information can induce pregnant women to think that any form of complementary therapy can be a saving solution for a medical problem because these therapies are natural, therefore, harmless. Updated information from literature about indications, benefits, limits, and risks of phytotherapy in pregnancy was presented. Valuable therapeutic resources with proven clinical efficacy (evidence-based medicine) were presented for each trimester of pregnancy, during labor, postpartum, but also during breastfeeding. For some phytotherapeutics, there are scientific studies. There is also a detailed presentation about some possibilities for therapeutic errors, which should be avoided during pregnancy. Positive results of phytotherapy deserve to be known and applied by the obstetrician for the certain benefit of future mothers. [ABSTRACT FROM AUTHOR]

The increase in the number of microorganisms that cause maternal-fetal infections has led to the need to update the acronym TORCH (Toxoplasma, Others, Rubella, Cytomegalovirus, Herpes) to SCRATVHEZ (Syphilis, Cytomegalovirus, Rubella, AIDS, Tuberculosis, Varicella, Herpes, Enterovirus, Zika). The multiple routes of transmission (transplacental, intrapartum, breast milk or posttransfusion), the multitude of microorganisms generating various and complex complications – from quasi-asymptomatic diseases to intrauterine growth restriction, neurological sequelae and to fetal death, the treatment that varies from case to case, between symptomatic and etiological and the possibility of preventing infections, outline their complexity and importance. A complete and correct early diagnosis involves clinical, biological and serological evaluation from the prenatal period, in order to prevent the evolution of infections, especially in the case of those in which there is an etiological treatment. The importance of knowing these infections and the effort to prevent their transmission, in order to limit the development of the consequences they can cause, are key elements in the optimal management of a pregnancy. [ABSTRACT FROM AUTHOR]

Objective. To investigate if the unilateral ventricular dilatation detected by fetal and neonatal ultrasound is associated with neurological abnormalities during the first two years of life. Materials and method. A number of 1319 neonates were examined by head ultrasound on the first and third days of life. Prenatal histories and ultrasound were collected in all cases. There were selected the cases with unilateral ventricular dilatation that were examined by head ultrasound at one, two, four and six months and by clinical and neurologic examination and, if needed, using specific imaging and neurologic investigations at one, two, four, six, twelve months and at two years. Results. There were detected the dilatation of the left ventricle (18 cases), posterior horn of the left ventricle (88 cases), and posterior horn of the right ventricle (12 cases). All these cases were asymptomatic during the neonatal period and only six out 88 cases with left posterior horn dilatation and one of the 12 the cases with right posterior horn dilatation developed neurologic abnormalities. All these cases were identified before delivery by fetal ultrasound. The abnormalities identified were: tonus abnormalities – hypotonic at 4 and 6 months with normalization at 12 months in three out of 88 cases with left posterior horn dilatation and one out of 12 cases with dilatation of the posterior horn of the right ventricle. There were delays in the fine motor skills in all the six symptomatic cases with left ventricular dilation and in one out of 12 cases with right ventricular dilation. Conclusions. Unilateral ventricular dilatation detected by neonatal ultrasound is usually asymptomatic. The symptomatic cases are characterized by transient tonus abnormalities and abnormalities in the fine motor skills. [ABSTRACT FROM AUTHOR]

The increase in the number of microorganisms that cause maternal-fetal infections has led to the need to update the acronym TORCH (Toxoplasma, Others, Rubella, Cytomegalovirus, Herpes) to SCRATVHEZ (Syphilis, Cytomegalovirus, Rubella, AIDS, Tuberculosis, Varicella, Herpes, Enterovirus, Zika). The multiple routes of transmission (transplacental, intrapartum, breast milk or posttransfusion), the multitude of microorganisms generating various and complex complications – from quasi-asymptomatic diseases to intrauterine growth restriction, neurological sequelae and to fetal death, the treatment that varies from case to case, between symptomatic and etiological and the possibility of preventing infections, outline their complexity and importance. A complete and correct early diagnosis involves clinical, biological and serological evaluation from the prenatal period, in order to prevent the evolution of infections, especially in the case of those in which there is an etiological treatment. The importance of knowing these infections and the effort to prevent their transmission, in order to limit the development of the consequences they can cause, are key elements in the optimal management of a pregnancy [ABSTRACT FROM AUTHOR]

Objective. To investigate if the unilateral ventricular dilatation detected by fetal and neonatal ultrasound is associated with neurological abnormalities during the first two years of life. Materials and method. A number of 1319 neonates were examined by head ultrasound on the first and third days of life. Prenatal histories and ultrasound were collected in all cases. There were selected the cases with unilateral ventricular dilatation that were examined by head ultrasound at one, two, four and six months and by clinical and neurologic examination and, if needed, using specific imaging and neurologic investigations at one, two, four, six, twelve months and at two years. Results. There were detected the dilatation of the left ventricle (18 cases), posterior horn of the left ventricle (88 cases), and posterior horn of the right ventricle (12 cases). All these cases were asymptomatic during the neonatal period and only six out 88 cases with left posterior horn dilatation and one of the 12 the cases with right posterior horn dilatation developed neurologic abnormalities. All these cases were identified before delivery by fetal ultrasound. The abnormalities identified were: tonus abnormalities – hypotonic at 4 and 6 months with normalization at 12 months in three out of 88 cases with left posterior horn dilatation and one out of 12 cases with dilatation of the posterior horn of the right ventricle. There were delays in the fine motor skills in all the six symptomatic cases with left ventricular dilation and in one out of 12 cases with right ventricular dilation. Conclusions. Unilateral ventricular dilatation detected by neonatal ultrasound is usually asymptomatic. The symptomatic cases are characterized by transient tonus abnormalities and abnormalities in the fine motor skills. [ABSTRACT FROM AUTHOR]

The most frequent eating disorders are anorexia nervosa, binge eating and bulimia nervosa. They are frequently aggravated during pregnancy or postpartum and because they impair the general health and psychosocial functioning of the patients, it is fundamental to be carefully managing these pathologies in a multidisciplinary team. The common association with menstrual irregularities, even with secondary amenorrhea, lead to unplanned pregnancy following the patients’ belief that they are infertile, and this represents a risk factor for both mother and fetus. Carefully attention should be paid in the patients’ assessment due to the concealment behaviors adopted in order to hide the maladaptive patterns or the eventual use of certain potential drugs that are thought to prevent weight gain or an excessive appetite and, moreover, in the postpartum period patient should be carefully investigated for an eventual anxiety or depression syndrome that may arise as a result of the postpartum body shape or weight gain from the pregnancy period [ABSTRACT FROM AUTHOR]

The route of delivery influences the gut microbiota and the development of the immune system. At the moment of birth, cesarean section infants have a lower diversity of bacteria when compared to naturally born infants. The delivery mode does influence the oral cavity colonization of infants, but there is no relevant association with dental caries. [ABSTRACT FROM AUTHOR]

The legality of the abortion procedure has been a controversial issue over time in all states of the world. These specific controversies have existed, exist and will continue to exist because we do not have a solution that is unanimously accepted by the international community that is generally valid. The abortion procedure involves aspects of legal, medical, religious, moral, democratic and criminal law specific to each regime, some countries not incriminating the acts by which abortion is performed, while others incriminate the same acts, performed in different forms. In our legislation, abortion has been incriminated since the appearance of the Penal Code of Romania, in 1864, continued in the Penal Code in 1936, followed by that of 1969, starting, for a period (from December 1989 to 1996), to no longer be incriminated under any circumstances. In this paper, the focus is on the most relevant modalities of regulation for this procedure, namely the criminal law rules into force in the second half of the communist regime and those currently into force, highlighting the positive aspects brought by the new Penal Code. [ABSTRACT FROM AUTHOR]

The legality of the abortion procedure has been a controversial issue over time in all states of the world. These specific controversies have existed, exist and will continue to exist because we do not have a solution that is unanimously accepted by the international community that is generally valid. The abortion procedure involves aspects of legal, medical, religious, moral, democratic and criminal law specific to each regime, some countries not incriminating the acts by which abortion is performed, while others incriminate the same acts, performed in different forms. In our legislation, abortion has been incriminated since the appearance of the Penal Code of Romania, in 1864, continued in the Penal Code in 1936, followed by that of 1969, starting, for a period (from December 1989 to 1996), to no longer be incriminated under any circumstances. In this paper, the focus is on the most relevant modalities of regulation for this procedure, namely the criminal law rules into force in the second half of the communist regime and those currently into force, highlighting the positive aspects brought by the new Penal Code. [ABSTRACT FROM AUTHOR]

Myasthenia gravis is an autoimmune neuromuscular disorder characterized by the presence of nicotinicreceptor auto-antibodies which reduce the number of these receptors within the muscular junction. It is twice as common among women at a young age than men, so it may occur during pregnancy. We report the case of a 20-year-old pacient, with a pregnancy of 34 weeks, known with a generalized form of myasthenia gravis for 4 years who is admitted to our clinic for pregnancy monitoring. She also requires treatement for a urinary infection with Klebsiella which led to ureterohydronephrosis on the right kidney. This infection caused a myasthenic crisis before presentation. The pregnancy was carried to term and the pacient gave birth to a male baby with a weight of 2650 grams. In conclusion, the evolution of a pregnant pacient with myasthenia gravis is unpredictable and it requires careful monitoring from a multidisciplinary team. [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]

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]

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]

The progress of biologic and ultrasound assessments in pregnancy has a favorable impact, demonstrated in the case we are presenting, in terms of monitoring the pregnancy reaching the term, in a patient diagnosed with obstetrical antiphospholipid syndrome and septated uterus diagnosed after a previous spontaneous abortion at 6 weeks of gestation, when ultrasonographic evaluation and uterine cavity control have been performed. We pay attention to this case from the point of view of placental abnormalities that can occur if the uterine malformation leads to an anatomical perturbation of the insertion and development of the placenta, but also to the placental abnormalities from the antiphospholipid syndrome in which thrombosis can lead to placental dysfunction. These aspects are supported by laboratory tests that highlight the antiphospholipid antibodies and ultrasound findings obtained from pregnancy monitoring (placental anomalies, fetal growth curve, uterine artery, umbilical artery and middle cerebral artery Doppler flows, amniotic fluid index). From the category of anti-phospholipid antibodies, anti-annexin V antibodies are directly involved in the disruption of placenta as early as 7 weeks of gestation. [ABSTRACT FROM AUTHOR]

The dual p16/Ki67 immunocytochemical coloration, which combines a high sensitivity with high specificity, is the solution which has been developed lately for the optimization of the identification of the precancer of the cervix. The test is a double immunocytochemical marking simultaneously in the same cell for p16 (marker of the transforming infection) and Ki67 (marker for proliferation). Through this immunocytochemical test, the optimization is taken into consideration for the surveillance or sorting of the young female patients with the ASC-US cytological results with high risk of HPV or LCIL, thus avoiding the colposcopies and the eventual invasive gestures in nulliparous women, reducing the anxiety of the female patients related to the colposcopy indication and finally the reduction of the diagnosis costs. At a worldwide level, each year, more than 500,000 new cases of cervical cancer are diagnosed and the average rate of survival at 5 years of patients is only 50%, and thus the introduction of the CINtec PLUS test in the screening programs for cervical cancer may be considered an innovative strategy in the prevention of the cervical cancer and may bring a real benefit to the clinicians and patients through the fact that it helps in identifying the basic illness, establishing that category which implies additional procedures (colposcopy). [ABSTRACT FROM AUTHOR]