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Objective. The etiology of embryonic demise is multifactorial, with chromosomal abnormalities being the most common (40%). The purpose of this study is to evaluate the correlation between a serum biomarker, inhibine A, and an ultrasonographic parameter, the distance between yolk sac (YS) and embryo (DYSE), in assessing the prognosis of pregnancy evolutivity in the first trimester. Method. The study is a case-control prospective analysis that includes two groups of patients: 81 patients with first-trimester pregnancy in evolution, and 89 patients with embryonic demise, all of the patients having amenorrhea between 6 and 11 weeks. The endovaginal ultrasonographic exploration was performed to evaluate the distance between the lower pole of the embryo and the yolk sac. From each subject enrolled in the study, 20 ml of blood was collected for inhibin A dosing. Results. Regarding the DYSE in the case group, lower values were observed compared to the control group, the difference being statistically significant. In the statistical analysis of serum inhibin A values, statistically significant differences were observed between the two groups (p<0.05). Conclusions. DYSE has a high positive predictive value in identifying pregnancies with potentially reserved evolutivity, this study demonstrating that a DYSE<3 mm may lead to an unfavorable evolution of pregnancy. The low serum level of inhibine A is associated with an increased rate of non-viable embryos. [ABSTRACT FROM AUTHOR]

Aims: Embryonic demise is a frequent complication of the first trimester pregnancy. The purpose of this study was to evaluate the correlation between a serum biomarker, the soluble form of the vasculo-endothelial growth factor (sFlt-1) and the distance between the yolk sac (YS) and embryo (DYSE), determined by ultrasonography.Material and Methods: The study was a prospective case-control study that included 2 groups of patients - the control group with 81 first-trimester pregnancies in evolution and the case group with 89 first-trimester pregnancies with a potentially reserved evolutivity.Results: A correlation between the serum level of sFlt-1 and DYSE in embryos with crown-rump length (CRL) greater than 5 mm was identified, showing that a DYSE ≤3 mm correlates with a low level of sFlt-1 (p<0.05) and a DYSE> 4 mm correlates with an increased level of sFlt-1 (p<0.05).Conclusions: A low level of sFlt-1 associated with a distance between the embryo and yolk sac of small dimensions, respectively <3 mm, correlates with an increased rate of non-viable embryos. This correlation between an ultrasound and a serum parameter is of great value and brings important information about the viability of firsttrimester pregnancies. [ABSTRACT FROM AUTHOR]

Abdominal cystic masses are diagnosed during the intrauterine period and have a relatively low incidence. Fetal ovarian cysts are the most common form diagnosed prenatally or immediately after birth. The pathophysiology of the development of these types of tumors is not fully elucidated, with ovarian hyperstimulation caused by maternal and placental hormones being the most accepted hypotheses. We conducted a scoping review with the aim to map the current knowledge regarding the treatment of fetal ovarian cysts diagnosed in the intrauterine period. Focusing on the articles published in the last 10 years in the specialized literature, we tried to identify a conceptualization regarding the surveillance and treatment of these anomalies. We describe the case of a 38-year-old patient, in her second pregnancy, with a physiological course of pregnancy until 29 weeks of gestation, when a cystic mass of 52/48 mm was detected in the abdomen during the routine ultrasound examination. The most likely origin was established to be the right ovary. Applying the diagnostic criteria described by Nussbaum, the detected cystic mass was of a simple type, with a thin wall, transonic content, without the presence of septa, vegetations or the appearance of intracystic hemorrhage. We observed a linear growth trend from the time of diagnosis when the diameter measured 52 mm, until 38 weeks of gestation when it reached 76 mm. A female fetus was born, weighing 3570 g, with an Apgar score of 10, with a good postnatal adaptation. On the eighth day of life, the newborn was transferred to the pediatric surgery unit where ovarian cystectomy was performed. Intraoperatively, a cystic mass was found belonging to the right ovary, with a size of 80/70/70 mm. Ovarian cystectomy was performed, with the successful preservation of ovarian tissue. The postoperative recovery had a favorable outcome. [ABSTRACT FROM AUTHOR]

Embryonic demise is the most common event in the lives of women during theirs reproductive time with a rate of about 25%. The aim of this review is to outline the most important paraclinic and biological prognostic parameters. English language articles containing keywords like "embryonic demise", "predictive factors" which were searched using Medline and Pubmed. Systematic reviews, retrospective and prospective studies, clinical trials focused on this subject were selected. Informative value of the references of selected articles was used as base for further relevant headlines. Among the most significant reported predictive factors are the distance between the yolk sac (YS) and embryo, also known as the yalk stalk sign, the progesterone and β human chorionic gonadotropine levels. Low levels of biomarkers and abnormal appearance of gestational sac, crown-rump length and YS are considered worst prognostic factors and may lead to a poor outcome. [ABSTRACT FROM AUTHOR]

Introduction. The etiology of embryonic demise is multifactorial, with chromosomal abnormalities being the most common (60%). The purpose of this study is to evaluate the correlation between a serum biomarker, placental growth factor (PlGF), and an ultrasonographic parameter, the distance between yolk sac (YS) and embryo (DYSE), in assessing the prognosis of pregnancy evolutivity in the first trimester. Method. The study is a case-control prospective analysis that includes two groups of patients: 81 patients with first-trimester pregnancy in evolution, and 89 patients with embryonic demise, all of the patients having amenorrhea between 6 and 11 weeks. The endovaginal ultrasonographic exploration was performed to evaluate the distance between the lower pole of the embryo and the yolk sac. From each subject enrolled in the study, 20 ml of blood was collected for PlGF dosing. Results. Regarding the DYSE in the case group, lower values were observed compared to the control group, the difference being statistically significant. In the statistical analysis of serum PlGF values, statistically significant differences were observed between the two groups (p<0.0001). Conclusions. DYSE has a high positive predictive value in identifying pregnancies with potentially reserved evolutivity, this study demonstrating that a DYSE<3 mm may lead to an unfavorable evolution of pregnancy. The low serum level of PlGF is associated with an increased rate of nonviable embryos. [ABSTRACT FROM AUTHOR]

A fetus identified to be at risk for chromosomal abnormalities may benefit from identification of genetic defects through amniocentesis. Although the risks associated with amniocentesis are considered to be minimal, being an invasive procedure it is not completely without complications. Background and Objectives: The current study aims to identify correlations between blood contamination of samples collected during amniocentesis and certain factors dependent on the instruments used (thickness of the needle used to aspirate the fluid), the location of the placenta, and uterine vascularity (more pronounced in multiparous patients). Materials and Methods: The study included 190 patients in the second trimester of pregnancy who met one of the criteria for invasive prenatal diagnosis (age over 35 years, high risk in first trimester screening, history of pregnancies with genetic abnormalities, etc.). The amniotic fluid samples collected from these patients were analyzed in terms of blood contamination of the amniotic fluid aspirated with maternal cells Results: Of the patients in whom the procedure was performed using 21 G size needles, 16 samples (13.33% of the total) were contaminated. None of the samples collected from patients where a 20 G needle was used were contaminated. There was a statistically significant association between the lack of contamination and the use of Doppler ultrasound in multiparous patients with anterior placenta in whom a 21-gauge needle was used for amniocentesis. Conclusions: There is an increased rate of sample contamination (statistically significant) when using 21 G needle sizes and a significant difference in contamination between primiparous and multiparous patients, with contamination being more frequent in multiparous patients. The use of Doppler ultrasonography may benefit the procedure, as the contamination rate was significantly reduced when used during amniocentesis. [ABSTRACT FROM AUTHOR]

The umbilical cord and placenta may be the site of tumor development, sometimes jeopardizing the physiological development of the fetus. The umbilical cord becomes detectable on ultrasound from 7-9 weeks of gestation, initially as a thickened and straight structure, which increases in length and acquires a spiral shape. Umbilical cord cysts are rare abnormalities detected incidentally during routine ultrasounds. These can be classified as true cysts or pseudocysts, the final diagnosis being represented by the histopathological examination, which describes an epithelial layer in the case of true cysts. Pseudocysts are more frequently associated with trisomy 18 and 13, the risk of malformations being higher if the lesion is multiple, persists after 12 weeks of amenorrhea if the localization is paraxial; at the fetal or placental insertion of the cord. The placenta may also present various tumors. Subchorionic cysts have a 5-7% incidence, arising on the fetal placental face as anechoic images without Doppler signal. It is considered that their localization near the placental cord insertion site (PCIS) can result in intrauterine growth restriction. Other placental tumors include echogenic cystic lesions, placental lakes, chorioangiomas, hydatiform moles. The antenatal diagnosis should include investigations aimed at detecting the possible association with chromosomal abnormalities. Thus, we present the case of a 29-yearold primiparous, which, at 12 weeks of amenorrhea, it was detected a 2.5-cm diameter cyst located near the PCIS, increasing in dimensions up to 5 cm diameter at 16 weeks of amenorrhea, then having a steady evolution. The fetal development has not been affected, the histopathological examination describing the lesion as a subchorionic cyst. [ABSTRACT FROM AUTHOR]

Incidenţa sarcinii oprite în evoluţie este de 25%. Complicaţiile sarcinii de prim trimestru reprezintă o problemă actuală de sănătate. Etiologia opririi în evoluţie a sarcinilor este plurifactorială, anomaliile cromozomiale fiind cele mai frecvente (40%). Alte cauze pot fi reprezentate de: defecte de fază luteală, anomalii tiroidiene materne, diabet zaharat matern, infecţii, trombofilii ereditare sau dobândite, precum şi agenţi exogeni. În cadrul monitorizării prenatale se doreşte creşterea eficienţei metodelor de screening şi îmbunătăţirea metodelor de diagnostic în cazul sarcinilor de prim trimestru al căror potenţial evolutiv poate fi rezervat. Iniţial, embrionul este detectat imediat adiacent veziculei ombilicale (VO). Dacă embrionul este separat de aceasta, separarea se datorează dezvoltării sale. Pe măsură ce creşte lungimea cranio-caudală (LCC), creşte şi distanţa dintre embrion şi VO. Pentru embrionii cu un LCC de 5 mm sau mai mic, nu ar trebui să fie nicio separare a embrionului de VO sau una foarte mică (<2 mm). O distanţă mică (evaluată în literatura de specialitate de 2 mm) între un embrion cu LCC mai mare de 5 mm şi VO este un marker ecografic de prognostic nefavorabil. Astfel, s-a studiat distanţa dintre embrion şi VO (apreciată prin ecografie endovaginală) pentru embrionii cu LCC mai mare de 5 mm şi s-a identificat o corelaţie între aceasta şi nivelul seric al β-Human Chorionic Gonadotropin (beta-HCG), progesteron, forma solubilă a factorului de creştere endotelial (sFlt1), Human Inhibin A, Human Placental-Like Growth Factor şi Human Pregnancy Specific Beta 1 Glycoprotein, evidenţiindu-se corelaţii importante între aceşti factori serologici şi cel ultrasonografic în cazul pacientelor cu sarcină cu evoluţie nefavorabilă. [ABSTRACT FROM AUTHOR]

Sindromul vezicii urinare hiperactive (VUH) include imperiozitatea și incontinenţa urinară prin imperiozitate (IUI) și apare frecvent în urma corecţiei chirurgicale a incontinenţei urinare de efort (IUE). Identificarea factorilor de risc pentru apariţia simptomelor VUH este importantă pentru a putea informa pacienta în mod corespunzător înainte de intervenţia chirurgicală. Postoperator, incidenţa imperiozităţii persistente este de 15%, iar cea a IUI este de 30%. Femeile diagnosticate cu incontinenţă urinară mixtă, predominantă prin imperiozitate, prezintă persistenţa simptomatologiei după intervenţia chirurgicală, comparativ cu pacientele cu IUE. Vârsta înaintată constituie, de asemenea, un factor de risc pentru apariţia simptomelor de VUH. Parametrii urodinamici ai VUH (presiunea crescută a detrusorului, presiunea intraluminală uretrală, fluxul urinar) pot prezice apariţia imperiozităţii postoperator sau a IUI. Gestionarea simptomelor VUH după intervenţia chirurgicală efectuată pentru IUE este aceeași ca și în cazul VUH idiopatice. Cu toate acestea, înainte de începerea tratamentului, este esenţial să excludem alţi factori care pot determina imperiozitate: obstrucţiile tractului urinar, infecţia tractului urinar sau eroziunea bandeletei. Simptomele VUH sunt frecvent raportate după intervenţia chirurgicală. Severitatea simptomelor de imperiozitate, lipsa complicaţiilor intraoperatorii și cura chirurgicală concomitentă a prolapsului sunt predictori importanţi ai imperiozităţii persistente sau ai apariţiei IUI postoperator. [ABSTRACT FROM AUTHOR]

Introduction. The knowledge of medical staff on oral health status during pregnancy is particularly important. Issues related to periodontal disease and oral cavity diseases may influence the pregnancy and birth. The objective of the study was to assess the knowledge of qualified personnel (dentists, obstetricians / gynecologists) on the oral health during pregnancy. Material and method. A cross sectional study was conducted on a number of 105 dentists and 105 obstetricians / gynecologists from Cluj Napoca, Romania, in the interval 1.01.2016 - 28.02.2016. With a questionnaire containing 19 questions with multiple answers were gathered information on: personal data (gender, age, specialty and years in practice), opinion regarding dental treatments and medication in pregnancy, knowledge on the link between periodontal disease and pregnancy, (complications and side effects on birth), sources of information about oral health during pregnancy. Data were statistically analyzed descriptive and comparative using SPSS program. Results. Both dentists and obstetricians had demonstrated knowledge about the status of oral health during pregnancy. Even if most of the respondents were aware of the connection between oral health and pregnancy (95.2% dentists and 87.6% obstetricians) only a third of obstetricians and a quarter of dentists mentioned a possible association between oral health and pregnancy pathology: preterm birth (29.5% dentists and 35.2% obstetricians) and low birth weight (20% dentists and 33.3% obstetricians). There were statistically significant differences between the opinions of these two categories of specialists, concerning mainly the administration of pharmaceuticals during pregnancy with minimal risks. Conclusions. The possible association between oral diseases and pregnancy pathology was understood by the majority of dentists and obstetricians; moreover, there was consensus in the most frequent dental treatments and protocols. However, the information regarding the possible correlation between periodontal health and pregnancy was not enough acknowledged by neither dentists nor obstetricians. [ABSTRACT FROM AUTHOR]

The article discusses the study aimed at comparing maternal and neonatal outcomes associated with delivery techniques via cesarean section. The results suggest that in the absence of robust evidence to support the use of a specific technique, the choice of the obstetrician should be based on the best available evidence. The study indicates that the "pull" and "Patwardhan" techniques represent safe options for delivering an impacted fetal head.

Preterm delivery is strongly associated with neurological impairments, such as cerebral palsy (CP), motor dysfunction, blindness, developmental delay and intellectual impairment. Antenatal administration of magnesium sulfate (MgSO4) has become a valuable approach of the neuroprotective strategy for preterm births. MgSO4 can prevent excitotoxicity via N-methyl-D-aspartic acid (NMDA) receptor antagonistic action and has an anti-inflammatory effect. There is still no international consensus on the dosage, time of administration and the need to repeat MgSO4 treatment. However, most studies report benefits for ≤31+6 weeks of gestation (GW) and imminent preterm birth, defined as active labor with ≥4 cm cervical dilation with either failure or contraindication to tocolysis, ≥4 cm dilatation with documented progressive change in cervical dilation, preterm pre-labor rupture of membranes with active labor, and for planned delivery for fetal or maternal indications. MgSO4 is recommended in a loading dose of 4 g intravenously (i.v.) for 30 minutes, followed by a 1 g/hour i.v. maintenance infusion for maximum 24 hours. It has been shown a significantly reduced rate of moderate and severe CP for the premature receiving MgSO4, but also a lower rate of motor dysfunction and a lower systemic vascular resistance and higher myocardial function in preterm infants born before 29 WG. One the other hand, several side effects have been reported and should be closely monitored. Maternal side effects include hypotension, tachycardia, respiratory depression, drowsiness, headache and muscle weakness. One trial reported a higher incidence of spontaneous intestinal perforation among extremely low birth weight infants. In conclusion, antenatal MgSO4 administration is a first step in preventing neurological damage, but further studies are mandatory to standardize its use. [ABSTRACT FROM AUTHOR]

Examinarea cu ultrasunete este metoda de elecție în diagnosticul sarcinii oprite în evoluție, precum și a sarcinii cu potențial evolutiv rezervat. Incidența evoluției nefavorabile a sarcinii este crescută în primul trimestru. Înainte ca embrionul să fie identificat prin ultrasonografie, caracteristicile ecografice ale sacului gestațional pot fi utilizate ca factori de prognostic. Odată vizualizat embrionul și vezicula vitelină, se pot utiliza de asemenea ca markeri ecografici de prognostic: dimensiunea sacului gestațional raportată la cea a embrionului, rata de creștere a embrionului din momentul identificării activității cardiace, aspectul și dimensiunea veziculei viteline, fluxul diastolic permanent sau semnalele vasculare anormale de la nivelul veziculei viteline. Un element explorat insuficient rămâne distanța dintre embrion și vezicula vitelină, din momentul în care aceste structuri devin vizibile. Distanța dintre embrion și vezicula vitelină ≤ 2 mm reprezintă un parametru ecografic cu rol predictiv important, care sugerează o posibilă evoluție nefavorabilă a sarcinii. Corelațiile dintre această distanță și alți parametrii ecografici (lungimea cranio- caudală a embrionului, aspectul, dimensiunea și vascularizația veziculei viteline) sau dintre această distanță și anumiți parametrii serologici (nivelul plasmatic al progesteronului și al β hCG-ului), pot constitui factori predictivi pentru evoluția nefavorabilă a sarcinii de prim trimestru. [ABSTRACT FROM AUTHOR]

Background and aims. Perimenopause is marked by clinical manifestations which disturb everyday life and which may also hide a pathomorphological, more precisely endometrial, substrate. An accurate early diagnosis established by accessible, non-invasive methods is very important for the therapeutic management. Method. The study included 103 patients aged between 41.5-55.11 years, divided into 3 age groups: 40-44 years (n=10), 45-49 years (n=54) and ≥50 years (n=39). Results. Certain risk factors of endometrial neoplasm or premalignant conditions were evidenced, their accurate identification being useful in limiting the number of patients with abnormal uterine bleeding (AUB) submitted to diagnostic screening. The most common cause of AUB in our study was fibroma, followed by functional causes. Conclusions. Transvaginal ultrasound (TVUS) represents a minimally invasive method for the screening of perimenopausal patients with AUB, especially to rule out endometrial adenocarcinoma (EAC). TVUS sensitivity was higher than clinical diagnosis in case of leiomioma, polypi and EAC. TVUS was more accurate in the diagnosis of EAC, polypi and leiomioma. [ABSTRACT FROM AUTHOR]

Introduction. The identification of biological markers that indicate an increased risk for the development or recurrence of endometrial cancer (EC) in obese women might be useful for decreasing EC mortality and morbidity. Glucose-regulated protein 78 (GRP78) is a major protein of the endoplasmic reticulum expressed in all normal cells. Overexpression of GRP78 has been reported to be a tumoral biomarker. Increased detection of GRP78 is positively correlated with the tumoral stage and prognosis. This study aimed to identify a correlation between intraperitoneal fat, plasma GRP78 levels, and EC. Materials and Methods. Two groups of patients were included in the study: group I, 44 patients diagnosed with EC, and group II, 44 patients without gynecological pathology or inflammatory disorders. Visceral fat was determined by ultrasound and plasma GRP78 levels were measured. Results. Plasma GRP78 levels were significantly higher in patients with EC compared to the control group. Intraperitoneal fat was in a positive linear correlation with the plasma GRP78 level (p<0.0001). Conclusion. The measurement of the GRP78 level associated with the determination of intraperitoneal fat can be a useful predictor for EC. [ABSTRACT FROM AUTHOR]

Aims. To characterize the vascularity of endometriotic cysts using color Doppler ultrasound and to differentiate more accurately between endometriotic cysts and other pelvic cyst masses. Methods. Two prospective studies were initiated: the first included 50 patients diagnosed with ovarian endometriotic cysts and 50 patients without gynecological pathology, in whom the resistance index (RI) of the uterine artery, ovarian artery and endometrial arcuate arteries in the early secretory phase was determined by endovaginal Doppler ultrasound; the second study included 50 patients diagnosed with ovarian endometriotic cysts, in whom the RI of the uterine artery, ovarian artery and cyst wall arteries in the late proliferative phase and in the late secretory phase was determined. Results. In the early secretory phase, the vascular flow through the uterine artery was significantly higher in patients with ovarian endometrioma. These patients had increased endometrial vascularity in the early secretory phase compared to the control group. In the late secretory phase, the vascular flow through the ovarian artery was higher compared to the late proliferative phase in patients with ovarian endometrioma. The vascularization of the ovarian endometrioma wall was significantly increased in the late secretory phase compared to the late proliferative phase. Conclusions. Vascularization, described through the arrangement of vessels, vascular density and vascular resistance, is an important factor in the evaluation of ovarian endometrioma. [ABSTRACT FROM AUTHOR]

Urinary incontinence (UI) represents a condition that, although not vital, has a significant impact that can interfere with the quality of life in a meaningful way for many women, its overall prevalence being of approximately 40%. Since 1920, urogynecologists showed an increasing interest in imaging techniques of the pelvic floor, ultrasound being the method of examination most frequently used with benefits that result from easy accessibility and reduced costs. At the beginning, B-mode ultrasound via transvaginal or transperineal route, was used to describe the urinary bladder and the anterior compartment and only later, the other pelvic compartments. Pelvic floor dysfunctions include several conditions among which UI. The main indications for transperineal ultrasound are: recurrent urinary tract infections, urgency-, frequency-, stress-UI, dysuria, prolapse of pelvic organs, dyspareunia, fecal incontinence, pelvic masses. This method proves its utility in assessing parameters like: residual urine, detrusor wall thickness, mobility of the bladder neck, anterior and posterior urethrovesical angle, urethral integrity. Stress UI may be highlighted by Color Doppler. Studying the pelvic floor during contractions or Valsalva maneuvre allows the assessment of the functional anatomy, keypoint for understanding the UI pathophysiology. The assessment of these specific objective and reproducible parameters is complementary to the diagnosis of UI and puts several therapeutic options in a different light. The progress in imaging permanently contributes to the improvement of therapeutic management either refining existing techniques or supporting the development of new procedures in urogynecology. [ABSTRACT FROM AUTHOR]

Introduction. Herlyn-Werner-Wunderlich syndrome (HWW) is a rare congenital anomaly of the urogenital tract characterized by the triad: uterus didelphys, obstructed hemivagina and unilateral renal agenesis, which is two times more common on the right side than on the left side. The incidence of this syndrome is 0.1-3.8% and, so far, in less than 10 cases the association of this pathology with acute urinary retention has been reported. Materials and method. We present the case of a 13-year-old girl who came to our emergency room accusing pain of increased intensity in the lower abdominal floor, started insidiously a week before, accompanied by nausea, pallor, sweating, anxiety and moderate vaginal bleeding (menstrual status). The anamnesis revealed absent diuresis for about 6 hours, menarche at 12 years old, regular menstruation, oligomenorrhea and dysmenorrhea. The clinical examination revealed respiratory movements of the abdomen, distension caused by a pseudotumoral mass located subumbilically, reluctant, painful; normal external genitalia. The paraclinical examination (ultrasound and MRI) revealed: voluminous cystic mass of 155/100/100 mm located between the bladder and the rectum, suggestive of hematometrocolpos; lower it protruded into the vagina, the image being suggestive of the transverse vaginal septum; uterus didelphys; normal ovaries and fallopian tubes. Unseen left kidney – left renal agenesis. Results. Surgery was performed with urinary bladder catheterisation, incision of the septum and continuous aspiration – about 1000 ml of chocolate-like fluid, suggestive of old blood, followed by resection of the vaginal septum. Conclusions. A high rate of awareness and clinical suspicion of HWW syndrome among adolescents is necessary for both the diagnosis and the prompt surgical treatment, leading to remission of symptoms, prevention of complications and to preservation of fertility. [ABSTRACT FROM AUTHOR]

Preeclampsia is a multisystemic disease, with a prevalence of 2-5%, that affects pregnant women. Every year, 76,000 women and 500,000 fetuses die due to the complications of this pathology. The prenatal screening for preeclampsia is constantly being updated. Globally, attempts are being made to identify easily reproducible, cost-effective screening markers that determine with great accuracy the patients prone to develop preeclampsia. Thus, there are differences between the described risk factors, the screening and prevention protocols recommended by world-recognized medical associations, such as the International Federation of Obstetrics-Gynecology (FIGO) and the American College of Obstetrics-Gynecology (ACOG). According to the latest FIGO recommendations, all pregnant patients should be screened in the first trimester for preeclampsia, including: maternal risk factors, mean blood pressure, placental growth factor and uterine artery pulsatility index. Patients at increased risk of developing preeclampsia will undergo preventive treatment with aspirin between 11- 14 weeks +/- 6 days and 36 weeks of pregnancy. ACOG presents patients with a history of preeclampsia, multiple pregnancy, chronic hypertension, type 1 or 2 diabetes, kidney disease or autoimmune diseases as having an increased risk of developing preeclampsia and a need for the prophylactic administration of aspirin. There is also a difference between the risk factors presented by the two associations. In conclusion, the determination of screening markers that provide an increased identification of patients at risk of developing preeclampsia, as well as the precise determination of risk factors for preeclampsia are imperative to anticipate and initiate the preventive treatment for women at risk, decreasing the prevalence of the disease, its complications and implicitly the costs. [ABSTRACT FROM AUTHOR]

The vitelline duct is the structure that can be visualized early inside the gestational sac, allowing the ultrasound diagnosis of intrauterine pregnancy. Embryological aspects. The vitelline duct begins to form at approximately 14 days post-conception. In the fourth week of embryological development, the vitelline duct wall consists of three thin cell layers: the outer layer (the ectoderm); the inner layer, lined by the endodermal epithelium; the mesodermal layer, consisting of island blood formations where hematopoietic stem cells can be identified. Aspects of 2D ultrasound. The ultrasound aspect of the vitelline duct initially appears as two parallel lines. Subsequently, from 5.5 weeks it appears as a round, transonic structure, with a diameter of 3-5 mm. Certain ultrasound parameters of the vitelline duct can be described, which can be used to evaluate the evolutionary prognosis of the pregnancy: early visualization, dimensions, number, form, persistence of visualization in the second trimester, calcification. Aspects of 3D ultrasound. Performing the volumetry of the vitelline duct allows a more accurate estimation of the relationship between the vitelline duct and the volume of the gestational sac, as well as the correlation between the volume of the vitelline duct and the cranial- caudal length of the embryo. The VOCAL method allows a detailed evaluation of the external surface of the vitelline duct. Aspects of Doppler ultrasound. The vascularization of the vitelline duct is related to the intervillous circulation and plays an essential role in the early maternal-embryonic exchange. Under normal conditions, the velocimetry profile of the vitelline duct is characterized by: low velocity, absence of diastolic flow, the average IP value of 3.24. In a pregnancy with reserved evolutionary potential, the vascular flow is characterized by: irregular vascular flow, permanent diastolic flow, signs of venous blood flow. The combination of 2D, 3D and Doppler ultrasound allows the identification of important moments in the development of pregnancy, allowing at the same time the thoroughgoing study of physiological and physiopathological mechanisms, characteristic of the first trimester pregnancy. [ABSTRACT FROM AUTHOR]

Abnormal uterine bleeding (AUB) is a common gynecologic complaint that accounts for one-third of outpatient visits to gynecologists and for more than 70% of all gynecologic consults in the perimenopausal and postmenopausal years, leading to increased healthcare costs and to decreased quality of life. AUB describes any variation from normal bleeding patterns in non-pregnant, reproductive-aged women beyond menarche lasting for at least 6 months. Transvaginal ultrasound is the firstline imaging test for the evaluation of AUB in both premenopausal and postmenopausal women. Transvaginal ultrasound can be used to diagnose structural causes of abnormal bleeding such as polyps, adenomyosis, leiomyomas, hyperplasia and malignancy, and can also be beneficial in making the diagnosis of ovulatory dysfunction. Traditional 2-dimensional imaging is often enhanced by the addition of 3-dimension imaging with coronal reconstruction and saline infusion sonohysterography. The availability of newer diagnostic tools has made it possible to promptly diagnose and treat an increasing number of such AUBs in an office setting. Once a proper diagnosis has been established, appropriate management must be implemented. Therefore, AUB should not be under-/overestimated, and diagnosis, investigations and treatment should be proposed as early as possible, taking into account the scientific data available in the current state of medical knowledge. [ABSTRACT FROM AUTHOR]

With the development of ultrasonography, many placental lesions have become detectable since the first trimester of pregnancy. Some of the most common placental lesions diagnosed by ultrasound are hypoechoic images, causing controversy over differential diagnosis and possible damage to the fetus. Placental lakes are anechoic lesions with a diameter ≥1 cm surrounded by placental tissue with normal echogenicity, being frequently diagnosed in the second trimester of pregnancy. Their incidence varies between 2.2% and 17.8%, usually without impact on fetal development. Subchorionic cysts are anechoic lesions, without Doppler signal, that can be detected from the first trimester. Their content differs from amniotic fluid and histologically there are detected perivillous fibrin desposits and X cells. The association with intrauterine growth restriction (IUGR) assumes: cyst count >3, diameter >4.5 cm or their location near the placental cord insertion site (PCIS). Echogenic cystic lesions (ECL) are hypoechoic lesions ≥1 cm in diameter, characterized by an echogenic crown and an irregular border. They may be correlated with IUGR and preeclampsia, histologically identifying predominantly as inter-villous thrombi. Other possible differential diagnoses should be considered: chorioangiomas, hydatiform moles, placenta accreta, and "vanishing twin". In conclusion, a wide range of placental lesions can be detected by ultrasound, with a variable echo over the development of the fetus. The antenatal diagnosis of these entities is of particular importance. [ABSTRACT FROM AUTHOR]

Introducere. La nivelul compartimentului pelvian anterior există trei grupe de ligamente care au rol suportiv pentru uretră: ligamentele periuretrale, parauretrale şi pubouretrale. Acestea împreună cu peretele vaginal anterior asigură continenţa urinară. O leziune a structurilor menţionate poate determina apariţia cistocelului, a hipermobilităţii uretrale sau a incontinenţei urinare de efort (IUE). Cuantificarea leziunilor se poate realiza prin examinarea clinică, în asociere cu ultrasonografia transperineală. Materiale şi metodă. A fost realizat un studiu transversal în care au fost incluse 70 de paciente cu disfuncţii ale compartimentului pelvian anterior şi paciente de control. Pacientele au fost evaluate clinic, utilizând sistemul de cuantificare a prolapsului organelor pelviene (POP-Q), şi ultrasonografic, prin abord transperineal. Parametrii prin care s-a definit mobilitatea colului vezical au fost diferenţa dintre distanţa simfiză pubiană (SP) - col vezical (CV) în repaus şi în timpul manevrei Valsalva şi deplasarea înspre posterior a colului vezical (DPCV). În aceleaşi condiţii s-a evaluat şi modificarea unghiului uretro-vezical posterior (UVP). Rezultate. Din totalul pacientelor, 52% au prezentat stadiul POP-Q ≥2. Cel mai frecvent simptom asociat a fost pierderea involuntară de urină. La pacientele cu POP-Q≥2 care au prezentat IUE, distanţa SP-CV s-a redus în medie cu 13,8 mm, PCV a crescut în medie cu 5,59 mm, iar media diferenţelor UVP (repaus versus Valsalva) a crescut cu 27,69°. La pacientele cu POP-Q≥2 fără IUE, distanţa SP-CV s-a redus în medie cu 19,5 mm, PCV a crescut în medie cu 14 mm, iar media diferenţelor UVP (repaus versus Valsalva) a crescut cu 7°. Concluzii. În grupul pacientelor cu IUE s-a înregistrat o creştere semnificativ mai mare a unghiului UVP, comparativ cu grupul fără IUE. În grupurile studiate comparativ, reducerea distanţei SP-CV şi, respectiv, creşterea DPCV nu au fost semnificative statistic. [ABSTRACT FROM AUTHOR]

Este permisă stimularea ovariană în endometrioză? Prevalența endometriozei este de 50% la femeile infertile, o cifră alarmantă, care generează probleme legate de managementul infertilității asociate, stimularea ovariană devenind o alegere optimă, urmată sau nu de inseminare intrauterină (IIU) ori fertilizare in vitro (FIV)(1). Când este permisă stimularea ovariană în endometrioză? Endometrioza este o boală care afectează femeile aflate la vârstă reproductivă. Vârsta este un factor important în decizia de stimulare ovariană, rezultatele stimulării fiind superioare la vârsta sub 35 de ani. De asemenea, decizia de stimulare ovariană trebuie să țină cont de: stadiul endometriozei, durata infertilității, rezerva ovariană și numărul de foliculi antrali(2). Ce tipuri de stimulări ovariene există? Stimularea poate fi clasificată ca simplă, în cazul rapoartelor sexuale programate și în IIU pe ciclu spontan, sau controlată în cazul IIU și al FIV. Cu ce se face o stimulare eficientă? Stimularea ovariană este de obicei asociată cu IIU sau FIV. În caz de endometrioză asociată cu FIV sunt urmate protocoalele standard de fertilizare. Tratamentul cu analogi de GnRH pentru 3-6 luni înaintea unei tehnici de reproducere asistată (TRA) în endometrioză crește de patru ori șansa de obținere a unei sarcini. Există efecte adverse ale stimulării ovariene în endometrioză? Hiperstimularea ovariană, trombembolismul venos sau reducerea rezervei ovariene sunt principalele efecte adverse. Intervenția chirurgicală poate preceda sau nu stimularea ovariană, existând dovezi contradictorii privind eficacitatea acesteia(1). Inducția ovulatorie în endometrioză este o alternativă realistă? Stimularea ovariană, precedată sau nu de intervenție chirurgicală, urmată sau nu de TRA, s-a dovedit a fi o opțiune bună în tratamentul infertilității asociate endometriozei. [ABSTRACT FROM AUTHOR]

Managementul optim al endometriozei rămâne controversat, în special din cauza aspectului eterogen al endometriozei, de la forme asimptomatice cu caracter autolimitant până la forme severe, cu implicarea tuturor organelor pelviene. Introducerea tehnologiei laser, prin combinarea proprietăților de tăiere și hemostază, a revoluționat chirurgia laparoscopică. Intervențiile conservatoare cum ar fi coagularea sau vaporizarea leziunilor de suprafață, chistotomia cu evacuarea conținutului, chistotomia cu coagularea bazei endometriomului sau chistectomia sunt preferate intervențiilor radicale în cazul pacientelor care doresc prezervarea fertilității. Coagularea sau vaporizarea inadecvată creşte riscul de endometrioză reziduală, în timp ce coagularea sau vaporizarea exagerată poate determina distrugerea țesutului ovarian normal și instalarea secundară a insuficienței ovariene. Rezecția parțială a peretelui se practică din ce în ce mai rar, deoarece țesutul endometrial care căptușește chistul poate rămâne funcțional și poate determina reapariția simptomelor. Una dintre tehnicile care s-au dovedit promițătoare în tratamentul endometriozei, atât din punctul de vedere al țesutului ovarian restant, cât și al foliculogenezei, este terapia în trei pași. Tehnica aceasta combină tratamentul laparoscopic cu cel medical hormonal, totodată îmbinând două gesturi laparoscopice, și anume drenarea chistului endometriozic și mai apoi vaporizarea cu laser a peretelui intern al chistului. Chistectomia presupune incizia peretelui, care poate fi realizată într-o manieră liniară sau circulară. Avantajul unei deschideri ovalare sau circulare constă în identificarea demarcaţiei dintre ovarul sănătos şi endometriom. O incizie liniară direct peste endometriom poate prezenta doar ţesut anormal în aria de incizie. Pasul următor constă în efectuarea chistoscopiei necesare pentru a diferenția endometriomul de un chist hemoragic sau de o formațiune malignă. Obiectivele procedurilor conservatoare sunt: îndepărtarea tuturor focarelor endometriozice, rezecția aderențelor, tratarea durerii, reducerea riscului de recidivă și de aderențe postoperatorii și readucerea organelor afectate la o condiție normală anatomică și fiziologică. Pentru pacientele infertile, restabilirea relației tubo-ovariene normale este esențială pentru a spori fertilitatea. [ABSTRACT FROM AUTHOR]

Amniocentesis is the most commonly performed invasive prenatal diagnostic procedure. The relative simplicity of the method has made amniocentesis available in a large number of centres. Amniocentesis may increase the risk of fetomaternal hemorrhage (FMH) due to needle transfixation of the maternal abdomen skin to the amniotic membrane and sometimes the placenta. There is an increase in FMH after performing amniocentesis, but there is no consensus regarding the best method to monitor the safety of these procedure. Flow cytometry immunophenotyping, using a monoclonal antibody against fetal hemoglobin, has become an interesting alternative to classical Kleihauer test to measuring FMH. Blood contamination of amniotic fluid (AF) during amniocentesis correlates directly with: needle thickness, physician experience, number of puncture points taken for sample acquisition, placental location. The puncture needle is recommended to have a thickness between 20-23 gauge (G).. Maternal cell contamination is prevented by discharging the first 2 ml of each sample. Another factor affecting safety of amniocentesis is the volume of procedures performed by the operator. High volume experience is reported to have decisive impact on rates of procedure-related adverse outcomes The impossibility of AF extraction at the first puncture requires its repetition, which increases the risk of AF contamination. From this point of view, it is extremely important to identify before the procedure the most voluminous AF bags, but also to choose a tract that avoids the transplacental passage. Placement of the placenta on the anterior wall increases the risk of AF contamination compared to the back or posterior wall location. Regarding the isoimunisation risc after amniocentesis, when a FMH occurs with less than 0.1 ml, isoimmunization at six months after delivery is 3%. Amniocentesis is safe to be carried out in fetal medicine when is followed by standard methods and conducted by trained professionals. [ABSTRACT FROM AUTHOR]

Incontinenţa urinară (IU) reprezintă o afecţiune cu un impact negativ semnificativ asupra pacientelor, reflectat atât în plan fizic și psihic, cât și social, prevalenţa globală a acestei patologii fiind de 40%. În prezent, nicio metodă imagistică nu este considerată gold standard în diagnosticul și conduita impusă de IU. Ecografia transperineală este o metodă ușor accesibilă în vederea evaluării IU. Conform recomandărilor elaborate în urma întrunirii forurilor specializate în IU, ecografia transperineală nu este recomandată în cadrul evaluării primare la paciente cu IU (nivel de evidenţă 3/grad de recomandare C), fiind considerată un test opţional în cazul pacientelor cu IU recurentă sau mixtă. Pentru efectuarea ecografiei transperineale se utilizează un transductor convex de 3,5-6 MHZ. Printre elementele care pot fi cuantificate prin această tehnică în cazul IU se evidenţiază: mobilitatea colului vezical, unghiul uretro-vezical posterior/anterior, joncţiunea vezico-uretrală, grosimea peretelui vezical, evaluarea fiind efectuată comparativ, în condiţii de repaus și în timpul manevrei Valsalva. De asemenea, pot fi decelate aspecte incidentale, precum prezenţa unor diverticuli uretrali, care pot fi cauze ale IU. Standardizarea determinărilor efectuate poate contribui la evaluarea exhaustivă a cazurilor cu IU și la alegerea algoritmului ideal în conduita impusă de această entitate patologică. [ABSTRACT FROM AUTHOR]

Incontinenţa urinară de efort (IUE) este o afecţiune frecventă care afectează global una din trei femei. În urmă cu mai mult de trei decenii, colposuspensiile retropubiene și bandeletele pubovaginale cu fascie autologă au fost principalele metode chirurgicale utilizate pentru tratarea IUE. Pe măsură ce tehnologia a avansat, tratamentul chirurgical al IUE s-a îmbunătăţit, prin implementarea materialului sintetic. În ultimii zece ani, tehnica standard acceptată a fost operaţia de suspensie suburetrală. În prezent, majoritatea femeilor cu IUE optează pentru bandeleta suburetrală, existând peste 3,6 milioane de astfel de bandelete montate în întreaga lume. În ceea ce privește tipul de bandeletă care trebuie folosit pentru femeia incontinentă, se consideră că atât bandeletele sintetice, cât și cele nesintetice au rezultate bune pentru majoritatea pacientelor. Obezitatea și vârsta înaintată nu influenţează rezultatul intervenţiei. Montarea unei bandelete sintetice pentru IUE trebuie evitată în caz de eroziune uretrală sau vaginală în antecedente, diverticul uretral, fistulă uretro-vaginală sau leziuni uretrale anterioare. În aceste cazuri, pentru a scădea morbiditatea, bandeleta pubovaginală fascială ar trebui să fie alegerea optimă. Pentru a elimina unele dintre efectele secundare, a fost dezvoltată o nouă generaţie de bandelete, numite „mini-slinguri”. Acestea sunt de dimensiuni mai reduse și nu penetrează ţesuturile la fel de profund comparativ cu cele standard. Materialul sintetic, alături de dimensiunea porilor reprezintă alte caracteristici care trebuie luate în considerare la alegerea bandeletei. Rezultatele pe termen lung ale utilizării bandeletelor în cura IUE sunt corelate cu experienţa chirurgului, particularităţile biologice ale pacientelor, dar și cu caracteristicile bandeletei. [ABSTRACT FROM AUTHOR]

Malformațiile cardiace sunt cele mai frecvente anomalii congenitale, acestea putând fi întâlnite atât izolat, cât și în asociere cu anomalii cromozomiale. Prima examinare a cordului fetal este recomandată în timpul screeningului pentru anomalii cromozomiale de trimestrul I și aceasta trebuie să fie urmată de o reevaluare între 20 și 23 de săptămâni de sarcină. Astfel, pacientelor care nu prezintă factori de risc pentru malformații cardiace li se va efectua o evaluare de bază a cordului fetal. Pacientele care prezintă oricare dintre următorii factori de risc: translucența nucală >= 3,5 mm, suspiciunea absenței ductului venos, suspiciunea unei malformații cardiace la evaluarea de bază a cordului fetal, antecedente de defecte cardiace severe la făt/copil, beneficiază de evaluarea în detaliu a cordului fetal. Principiile de bază ale examinării cordului în primul trimestru de sarcină sunt similare cu cele utilizate la vârste gestaționale avansate, fiind recomandată examinarea în dinamică a secțiunilor transverse, pornind de la nivelul abdomenului superior până la nivelul toracelui. Examenul Doppler color facilitează evidențierea anatomiei cordului fetal, a conexiunilor vasculare, precum și a direcției fluxului sangvin. Asocierea ecografie 2D - ecografie Doppler color îmbunătățește calitatea examinării cordului fetal. Evaluarea situsului cardiac, a imaginii de 4 camere, a ductului venos, a căilor de ejecție a ventriculului stâng și drept, a imaginii de 3 vase, a arcului aortic, a arterei subclavivulare drepte, a septului interventricular și a încrucișării arterei aorte cu artera pulmonară permit aprecierea normalității structurilor examinate sau identificarea unor elemente patologice. Aceste aspecte sunt sugestive pentru prognosticul antepartum și permit decizia informată privitoare la opțiunile terapeutice. [ABSTRACT FROM AUTHOR]