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Holoprosencephaly is a brain abnormality resulting from an incomplete cleavage of the prosencephalon during early embryogenesis. Uncontrolled maternal diabetes mellitus is one of the strongest human teratogens and the most well-known cause of holoprosencephaly. We report a rare case of holoprosencephaly in a male fetus in a preexisting diabetic pregnancy. The diagnosis of the holoprosencephaly was established by ultrasound scan and MRI data. [ABSTRACT FROM AUTHOR]

Objectives. The prevention of preterm birth is one of the highest priorities for international obstetric research. This study aimed to evaluate the maternal factors that may influence the pregnancy outcomes in order to assess the fetal outcomes. The main parameters analyzed were the variables newborn’s Apgar score at 1 minute and Apgar score at 5 minutes. Materials and method. This is designed to be a retrospective, observational and non-randomized study on a sample of 30 pregnant women with ruptured membranes, diagnosed and treated in the Department of Obstetrics and Gynecology of the Bucharest University Emergency Hospital, Romania, between May 2021 and October 2021. We used two simple and multiple univariate linear regressions to achieve the main objective. The dependent variable used the APGAR score at 1 minute and the APGAR score at 5 minutes. Results. We obtained significant results regarding the impact of CRP, leukocytes count at admission, mode of delivery, presence of chorioamnionitis, funisitis, and male sex of the newborn on neonatal outcome. Conclusions. These results support further research in developing feasible multivariable prediction models in women with preterm rupture of membranes below 34 weeks of gestation. These models can help clinicians manage low- or high-risk pregnant women efficiently. [ABSTRACT FROM AUTHOR]

Background: Breast carcinoma is the most important cause of death in women's oncologic pathology worldwide. Due to its high frequency, important advances in diagnostic and management of this entity were made. Because of its rarity (only 0.5-1% in all breast cancers), little is known about male breast cancer, and no specific male standardised protocol was made, treatment and follow-up being adopted from women breast cancer guidelines. We consider that this entity, with its hormone specific profile, is worth being considered for further studies, taking into account that male breast cancer has afar worse prognostic than female breast cancer. Methods: We present our four-year experience with male breast lesions in a retrospective review study, including gynecomastia and breast carcinoma cases. Results: We identified 17 male breast lesions, 11 of them with a diagnosis of gynaecomastia, the rest being breast carcinomas. Four malignant lesions were encountered in the 5th, 6th and 7th decade, with two of them in young adults (35 and 40 years old). In a single case, two different histotypes of breast carcinoma were found. All of them were G2, with tumoral stages varying between IB to IV. Androgen receptors were expressed in each case, in different percentages. Conclusions: Male breast carcinoma is a rare entity with a poor prognosis, a diffuse and profound invasion of adjacent structures, and a high expression of hormone receptors, and with no histologic relation to gynaecomastia, considering that no associated benign lesions were found. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study is a retrospective analysis of the spectrum of ovarian tumors: statistics, epidemiology and pathological features, based on one-year experience in our hospital. Materials and method. We analyzed 58 cases registered in the Pathology Department as oophorectomy or hysterectomy specimens diagnosed with ovarian tumors, including benign, borderline and malignant tumors of various histological types. Results. Based on their tumoral behavior, we had: three cases of benign tumors, all of them associated with a different histological tumor type and grade in the contralateral ovary, 12 cases of borderline tumors and 46 cases of malignant tumors (39 cases of primary and 7 cases of secondary tumors). The most frequent histologic type was represented by highgrade serous carcinoma (37.9%). 85.7% of the secondary tumors were endometrial carcinomas extensions. Rare primary ovarian tumors were represented by: adult granulosa cell tumor, clear cell carcinoma, mixed serous-mucinous carcinoma and undifferentiated pleomorphic sarcoma (1.72% for each type). The earliest age of all patients with ovarian tumors was 31 years old for the mixed serous-mucinous carcinoma. Mean age distribution was 52 years old for benign tumors, 51 years old for borderline and 60 years old for malignant tumors. Conclusions. Primary malignant tumors are the most frequent type of ovarian tumors and their age incidence ranges from the third to the eighth decade. The majority of secondary ovarian tumors are of endometrial origin. [ABSTRACT FROM AUTHOR]

Objective. Ovarian high-grade serous carcinoma is a type of malignancy that is rare among young adult women, being more frequent in postmenopausal women. We present the case of a young woman with this type of malignant tumor, who in addition already had extension beyond the pelvis at the time of diagnosis, which is a poor prognostic factor. Case report. We repot the case of a 36-year-old woman who was admitted in our hospital with pelvic pain and ascites and also with suspicion of peritoneal carcinomatosis. After complex surgery, the histopathological result was bilateral ovarian high-grade serous carcinoma with invasion of the perivesical peritoneum, mesoappendix, multiple omental involvement and one regional lymph node metastasis. Afterwards, she was submitted for oncologic treatment. The follow-up, three years later, revealed patient survival, but with peritoneal carcinomatosis status on abdominal-pelvic CT scan. Discussions. Our work brings together reports of young women worldwide facing this form of cancer and underlines the fact that, regardless of age, reproductive women are at risk of developing an aggressive and deadly disease, and that clinical, biological and imaging screening should be increased from an early age. [ABSTRACT FROM AUTHOR]

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

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

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

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]

Borreliosis is one of the most common diseases transmitted by ticks. Clinical diagnosis is difficult due to non-specific symptoms and the fact that usually the patient does not remember when he was bitten by a tick, especially since the skin lesion, erythema migrans, is inconstant. We report the case of a 33-year-old patient, secundigesta, secundiparous, who attended her obstetrician during the 22nd week of pregnancy for fatigue and the appearance of erythematous lesions on the posterior region of her left calf. Following clinical and para-clinical examination she was diagnosed with borreliosis. Rapid antibiotic treatment was indicated. The evolution of pregnancy was normal. No fetal malformations were detected. At 39 weeks of pregnancy she delivered by cesarean section due to uterine rupture imminence a healthy male, weighing 3450 g, IA = 9. The impact of Lyme disease on pregnant women is difficult to assess. Maternal and fetal prognosis seems to be favorable if the diagnosis is established rapidly and an appropriate antibiotic therapy is indicated. [ABSTRACT FROM AUTHOR]

All patients in whom gonadotoxic treatment or gonadal resection is recommended and also present future reproductive intentions should be referred to a specialist in infertility and endocrinology to be detailed fertility preservation options. The gold standard in these cases is the cryopreservation of embryos, being superior to the freezing of oocytes or other techniques. For the cases where freezing embryos it is not possible, cryopreservation of mature oocytes is reasonable. Maturation of oocytes in vitro is an experimental method, with implantation and pregnancy rates lower than if using oocytes matured in vivo. Ovarian tissue cryopreservation is an investigational technique not recommended in patients with ovarian cancer or at increased risk for this pathology, with still uncertain eficacy, but more and more increasingly used. If cryopreservation of embryos or oocytes is not feasible, alternative methods are needed to protect fertility. For cases which are to undergo pelvic radiotherapy, but not to chemotherapy, ovarian transposition outside the field of radiation may be an option. The use of GnRH agonists in women following chemotherapy is not recommended, having unproven benefits and theoretical risks. Alternative methods (ovarian tissue transplantation, donation of oocytes or embryos, the use of surrogate mothers, adoption) are the last choices for cases where the other methods are not available. [ABSTRACT FROM AUTHOR]

A velamentous insertion of the umbilical cord is characterized by the atypical aspect of the placental end of the cord, consisting in divergent umbilical vessels surrounded by fetal membranes and with no Wharton's jelly present, resulting a cord that is inserted rather into membranes than the placental disk. By the divergence of the umbilical vessels as they travers the amnion and the chorion before reaching the placenta this condition associates important obstetrical complications and the diagnosis by ultrasonography as early is possible is important for the guidance of the subsequent management. In this retrospective study we aimed to evaluate the incidence of velamentous cord insertion in University Emergency Hospital of Bucharest for a period of five years and analyze the pregnancies outcome and the obstetrical impact of this condition. Using the statistics department of University Emergency Hospital Bucharest we determined an incidence of 0.23% of pregnancies complicated by velamentous cord insertion. The examined parameters included intrauterine fetal death, small for gestational age, preterm delivery (<37 weeks), single artery umbilical cord and low Apgar score at 1 minute. We chose to exemplify with a case of early diagnosis of this condition, respectively at 15 weeks of gestation. The attempt to visualize cord insertion in the mid-trimester as a routine part of obstetric sonography is recommended. The identification of velamentous cord insertion dictates the mode and timing of delivery and can improve fetal outcome. [ABSTRACT FROM AUTHOR]

Receptors for human chorionic gonadotropin (hCG) are found in the gonads expressed by the theca cells, interstitial cells, differentiated granulosa and lutheal cells, in the endometrial epithelium, myometrium and tubal mucosa, in the breast tissue, in the endothelium and smooth muscle of the uterine artery, in the cervix, thyroid, retina and skin tissue, on lymphocytes, macrophages, neuroendocrine cells, Leydig cells, seminal vesicles and prostate cells, and are present in a series of fetal vital organs. In pregnancy, human chorionic gonadotropin, a glycoprotein which has almost the same structure as the pituitary luteinizing hormone (LH), is one of the earliest products of the cells forming the embryo and can be considered one of the first signals elaborated by the embryo; it is involved in maintaining the corpus luteum, in implantation process, in immunomodulation, placental morphogenesis and function, as well as fetal growth and differentiation. Initially, immature trophoblast cells secrete β-hCG units, than in later pregnancy, complete αβ hCG is secreted by the trophoblast cells of vSTB fenotype, hCG secretion having a predictible pattern during a successful pregnancy. The hormone is an ideal marker in the diagnosis and monitoring of early intrauterine pregnancy and ectopic pregnancy, gestational trophoblastic disease, fetal aneuploidy, and placental dysfunction. [ABSTRACT FROM AUTHOR]

Congenital infections are a well-known cause of intrauterine fetal death and also of peri- and postnatal morbidity. Also, the malformative potential is well documented. Trans-placental infection of viruses, even in a subclinical phase of the maternal infection, can determine sever congenital syndroms. Even non-specific echographic anomalies may indicate a congenital infection. However, some echographic anomalies are specific for congenital syndromes. This is why establishig a fast and correct diagnosis of congenital infection is a dezideratum of the modern obstetrician. Ultrasound assessment is a key element in establishing the diagnosis and in follow-up of patients with congenital infections. [ABSTRACT FROM AUTHOR]

The vulnerability of adolescent girls to contact HPV is caused by several factors. These include: greater exposure to HPV through the risky sexual behavior, lack of immune memory and high rates of squamous metaplasia. Detecting HPV in teenage girls is most commonly associated with normal cytology. The incidence varies between 12-56% in women under 21 years, while in those over 35 years old ranges between 2-7%. Environmental factors, such as sexually transmitted infections or semen itself, may induce inflammation, repair and metaplasia favoring HPV infection. HPV vaccination should respect the principles of bioethics as a first key element in the relationship with the patient and an accurate, complete and efficient counseling. The arrangements in the prevention of infection are quite clearly established and include: educating teenagers and young people about HPV, counseling on the benefits of abstinence, delay in initiation of sexual intercourse, limiting the number of sexual partners. Histology but not cytology is the basic criterion for decision on uterine cervix surgery in adolescents. The decision regarding the surgical intervention on uterine cervix in teenage girls is always the exception. It is essential that young girls should be vaccinated prior to onset of sexual activity, and as a result, many of high degree precancers could be prevented, maximizing the effect of vaccines. For teenagers who have already begun their sexual life, the vaccine can still be effective and it is recommended because they will not be infected with HPV types protected by the vaccine. [ABSTRACT FROM AUTHOR]

Introduction. Adenomyosis is a benign gynecologic disease affecting women of reproductive age. It is characterized by the ectopic presence of endometrial tissue (endometrial glands and stroma) in the myometrium. The incidence of adenomyosis is considered to be 1% in the female population, and is found mainly in patients aged between 35 and 50 years old. Although it may be asymptomatic, clinical presentation of adenomyosis is composed of pelvic pain, dysmenorrhea, menometrorrhagia and infertility. Materials and methods. This paper presents an analysis of adenomyosis surgical treatment options based on personal experience and a literature review. Results and discussions. Surgery in adenomyosis associated with infertility is reserved to symptomatic adenomyosis and in cases of failure of assisted human reproduction techniques. For patients with adenomyos and infertility, the “uterine sparing” principle is recommended, with the excision of the adenomiotic lesions. This surgical technique is preffered than hysterectomy, considering a future pregnancy in patients with infertility. Conclusions. Classical surgical treatment for symptomatic adenomyosis is hysterectomy. Considering that a high proportion of patients with adenomyosis wish to preserve the reproductive function for a future pregnancy, the optimal surgical treatment is conservative, represented by abdominal or laparoscopic adenomyomectomy. [ABSTRACT FROM AUTHOR]

Vesicoureteral reflux (VUR), the retrograde flow of urine from the bladder upward toward the kidney, is diagnosed commonly following an urinary tract (UTI). The VUR key to diagnosis is to maintain an adequate index of suspicion for a UTI. A voiding cystography (VCUG) is required to confirm the diagnosis. The goal of management is to prevent renal parenchimal injury, although many patients have renal scarring at the time of diagnosis. Many patients who have low - or moderate grade reflux experience spontaneous resolution whith continous antibiotic chemoprophilaxis. Surgery may be required in patients who have grade IV-V reflux, persistent high-grade reflux or febrile breakthrough infections or who are not compliant with medications. [ABSTRACT FROM AUTHOR]

Introduction. Spina bifida is a non-lethal foetal anomaly, but the prognostic, the evolution and life quality of the foeti born with this malformation implies limb paralyses, severe neuro-motor dysfunctions, urinary and fecal incontinence etc. The cranial and cerebral ultrasound signs in the spina bifida aperta have a sensibility of over 99%, being sometimes the first element which draws the attention on a possible defect of the neural tube. The study evaluates the indirect cerebral and cranial signs, for the spina bifida aperta diagnostic without as sociated genetic syndromes, during the second trimester of pregnancy. Material and method. The thesis analyses a number of 17 cases diagnosed with spina bifida aperta, in three prenatal diagnostic centres, in two years' time, 2013- 2014. The ultrasonographic examination was performed by ob serving the ISUOG guides for the foetal neurosonography. The ultrasonographic signs and the parameters included in the stu dy were: the biparietal diameter, the cranial circumference, the flattening of the frontal bones, the transverse cerebellar com pression, the ventriculomegaly, the obliteration of the cisterna magna. The foetal karyotype was performed in all ca ses. Results. Spina bifida aperta in the cases with normal foe tal karyotype. The sign of fruits: 94.11%. The CM obliteration: 88.23%. The ventriculomegaly: 70.58%. The decrease of BPD: 64.7%. Low cranial circumference: 41.17%. Cerebellar anomaly on the whole - 16 cases. The therapeutic interruption of the pregnancy was performed in 16 cases, 1 case evolved on term with the informed counselling of the parents. Conclusions. The secondary ultrasound markers represent indirect diagnostic elements, but many times very precise in spina bifida aperta. The sign of fruits or the ventriculomegaly are in many cases the first element which draws the attention on the ultrasound screening in the second trimester of pregnancy. The ultrasound 3D/4D be come almost indispensable for the foetal neurosonography. [ABSTRACT FROM AUTHOR]

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

Acute abdomen during pregnancy is a plurietiological, pathological entity that evolves rapidly, with increased morbidity and mortality of both mother and foetus. We report the management of two cases, with history of hysteroscopic procedures: a patient aged 35 years diagnosed with advanced abdominal pregnancy and a pregnant I gesta, I para, 29 weeks of gestation, with uterine rupture of a apparent intact uterus. The uterine scar caused by hysteroscopic procedures is a potential risk factor for the occurrence of advanced abdominal pregnancy and uterine rupture, two entities of acute abdomen during pregnancy. Unfortunately, the diagnosis and treatment of these conditions are not standardized. Therefore the management of a patient with ectopic abdominal pregnancy and uterine rupture patients with abdominal or uterine rupture is a real challenge for the obstetrician. [ABSTRACT FROM AUTHOR]

The vanishing twin syndrome is part of the much more complex notion of death of a foetus in utero, but it expressly refers to the succumbing and disappearance of one or more embryos or foeti, in the environment of a multiple pregnancy, during the first trimester of pregnancy. The embryo-foetal disappearance can be due to some genetic causes, anatomic anomalies, placenta insufficiency, anomalies of the umbilical cord, infections or related maternal pathological situations such as high blood pressure and diabetes. The article proposes the presentation of this particular situation of the multi-foetal pregnancy, in terms of the diagnostic, the conduct and the obstetrical prognostic, presenting the experience of its own cases and the existing data in the specialty literature. [ABSTRACT FROM AUTHOR]

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

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

Adolescent pregnancy represents a major health problem worldwide, because it is associated with multiple maternal and fetal complications, the most important one being maternal death. According to the specialty literature, the leading cause of death among adolescents is represented by adverse outcomes associated with pregnancy. Also, in this group of patients there is a high risk of sexually transmitted diseases. The most common obstetrical complications in pregnant adolescents are preeclampsia and eclampsia, which increase the risk of maternal and fetal mortality. Regarding the neonatal outcomes, it has been demonstrated that newborns from adolescent patients have a higher risk of preterm birth, low birth weight and stillbirth. All these complications may be due to the physical and biological immaturity, but also may be the result of the lack of antenatal care. We performed a retrospective study in the Department of Obstetrics and Gynecology of the University Emergency Hospital Bucharest between 30 September 2020 and 30 September 2022. The study included three adolescents who gave birth and were declared dead in our unit, and a control group of five adult patients with the same characteristics. The aim of the study was to establish the incidence and the risk factors of mortality among adolescents compared to adult women. The neonatal status was established by neonatology team. The results showed that the incidence of maternal mortality is higher in adolescent patients compared to the adult ones as reported to all patients who gave birth. The patients aged between 35 and 40 years old had the highest rate of mortality, followed by the group of patients aged between 18 and 19 years. The lack of antenatal care had an important significance in both groups. Fetal mortality was similar in both adolescent and adult groups. [ABSTRACT FROM AUTHOR]

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

Abdominal pregnancy is a very rare form of ectopic pregnancy and is associated with an increased mortality rate. The main lifethreating complication is intraperitoneal bleeding from placental site. The gestational age is important for the prediction of complications’ severity. While most cases are secondary to a tubal rupture and the subsequently implantation in the peritoneal cavity, a previous uterine perforation can also represent the leading cause. In the current paper, we report an extremely rare case of secondary abdominal pregnancy with a gestational age of 11 weeks in a 37year old patient having a history of unnoticed uterine perforation. This report raises awareness on a rare and severe obstetrical condition, discussing the case particularities, with the aim to highlight the urge for prompt diagnostic and treatment measures. [ABSTRACT FROM AUTHOR]

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

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

Systemic lupus erythematosus (SLE), a chronic autoimmune disease predominantly affecting women during their reproductive years, presents unique challenges during pregnancy. This retrospective study, conducted at the Obstetrics and Gynecology Department of the Emergency University Hospital Bucharest, between 2021 and 2023, analyzes three cases of SLE in pregnancy to elucidate maternal and neonatal outcomes. Through the analysis of three compelling cases, the study navigates the complexities of severe preeclampsia, SLE flares, thrombocytopenia, intrauterine growth restriction and preterm delivery, each demanding a nuanced approach. The findings underscore the critical role of interdisciplinary collaboration and meticulous medication management, with a specific focus on the compatibility and efficacy of hydroxychloroquine. By unraveling the diverse clinical presentations and outcomes, the study contributes with valuable insights into optimizing pregnancy care for women grappling with systemic lupus erythematosus. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

Pregnancy in adolescents has a major impact all over the world due to its maternal, fetal and social complications. Establishing a good way to prevent adolescent pregnancy could decrease its incidence. In Romania, the incidence is one of the highest in Europe. Although the adolescents represent a special social category because of their immature physical and mental status, we should treat them in the most serious medical way. Also, fetal and maternal morbidity and mortality are high in this category of patients. This is why an appropriate management during pregnancy and peripartum plays an essential role in decreasing these complications. We present the experience of the Department of Obstetrics and Gynecology of the Bucharest University Emergency Hospital in the management of pregnancy in adolescents. [ABSTRACT FROM AUTHOR]

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

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

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

Uterine polyfibromatosis is one of the most common solid tumours of the uterus. Regarding the therapeutic options, especially for young female patients, the embolization of the uterus arteries is a minimally invasive, efficient procedure with a reduced rate of secondary reactions. The embolization of the uterus arteries is an interventional technique, with increased efficiency in reducing and even in stopping the haemorrhage in female patients with FIGO IIIB or IV staged cervical neoplasm, playing an important part in increasing the quality of life. We present our experience in the interventional treatment of solid uterine tumours, taking into account that during the period 1.01.2013 - 31.12.2016, at the Obstetrics- Gynaecology Clinic of the Bucharest Emergency University Hospital, the embolization of uterine arteries for haemostatic purposes was performed in 23 female patients diagnosed with cervical neoplasm staged IIIB or IV and in 882 female patients with uterine polyfibromatosis. [ABSTRACT FROM AUTHOR]

Simptomul cardinal al cancerului de endometru este sângerarea uterină anormală; pe baza lui, 35% dintre cazuri sunt diagnosticate în stadii avansate, cu speranță de viață semnificativ redusă. Diagnosticul precoce al cancerului endometrial trebuie bazat pe 4 elemente: investigarea sângerării uterine anormale apărută în pre-/postmenopauză, investigarea particularităților/anomaliilor examenului de citologie cervicală, diagnosticarea, tratarea și monitorizarea adecvată a leziunilor endometriale precursoare/asociate cancerului endometrial și screeningul populației cu risc crescut (sindrom Lynch, sindrom Cowden). Ecografia transvaginală reprezintă metoda principală de selectare a sângerărilor uterine anormale în postmenopauză care trebuie supuse biopsiei endometriale, reducând pe criterii certe numărul manevrelor invazive inutile cu 40%, dirijează modalitatea optimă de investigare ulterioară și exclude celelalte cauze structurale de sângerare uterină anormală și patologia anexială. Prima linie de explorare biopsică ar trebui să fie biopsia prin aspirație. Screeningul cancerului de endometru nu este recomandat populației generale, cu excepția sindromului Lynch; metoda de screening este biopsia endometrială. Standardizarea etapelor de diagnostic trebuie să se realizeze în scopul scăderii timpului și costurilor necesare obținerii unui diagnostic în stadiul incipient al bolii și în scopul începerii cât mai precoce a tratamentului. Diagnosticul precoce al cancerului de endometru depinde esențial de îmbunătățirea adresabilității femeilor în stadii incipiente de boală, prin creșterea nivelului de educație sanitară al populației. [ABSTRACT FROM AUTHOR]

Adolescentele reprezintă un grup vulnerabil pentru bolile cu transmitere sexuală, inclusiv HPV, atât din cauza comportamentului mai liber, dar şi a imaturităţii tractului genital. Managementul infecţiei cu HPV în cadrul acestui grup de paciente trebuie individualizat în funcţie de severitatea leziunilor induse, însă având în vedere că majoritatea sunt tranzitorii. Totuşi, persistenţa infecţiei poate duce la morbiditate şi mortalitate semnificative. La femeile la menopauză, infecţia cu HPV este rezultatul persistenţei factorilor de risc şi al consecinţelor acestora. La pacientele cu citologie cervico- vaginală persistent modificată şi istoric de infecţie cu HPV, s-a observat o incidenţă crescută a leziunilor cervicale preinvazive. În vederea unui management adecvat trebuie avut în vedere că reactivarea la menopauză a unei infecţii latente este mai frecventă decât apariţia unei noi infecţii. [ABSTRACT FROM AUTHOR]

Introducere. Boala Lyme (borelioza) este o patologie infecţioasă multisistemică produsă de spirochete din genul Borrelia spp., care sunt transmise de la animal la om prin înţepătura de căpuşe. România se regăseşte în aria de răspândire a acestei boli, existând zone cu caracter endemic, infecţia apărând în anumite perioade de vârf pe parcursul anului. Borelioza nu se manifestă imediat şi nu apare la toţi cei înţepaţi de căpuşe, astfel încât foarte multe cazuri rămân nedescoperite sau, din cauza faptului că aceasta poate mima simptomatologia altor boli, diagnosticul este dificil de efectuat. La gravide, boala Lyme este destul de rară, dar transmiterea transplacentară, deşi controversată şi nedemonstrată pe deplin, se pare că este posibilă în cazul în care pacienta nu este tratată. Complicaţiile fetale sunt redutabile, de la malformaţii cardiace complexe până la avort sau moarte intrauterină. Cu toate acestea, sunt puţine cazuri descrise în lume de boală Lyme în sarcină şi lucrări despre consecinţele ei asupra fătului. De aceea, considerăm utile prezentarea unui astfel de caz şi atenta urmărire a sarcinilor cu borelioză. Material şi metodă. Raportăm cazul unei gravide, IIG, IIP, care se prezintă la medicul ginecolog în săptămâna a 22-a de sarcină, având o leziune eritematoasă suspectă în context epidemiologic sugestiv pentru borelioză. În continuare, se efectuează consulturi de specialitate (dermatologie şi boli infecţioase) pentru realizarea unor diagnostice de excludere. Ulterior, testele serologice relevă rezultat echivoc al Ac IgM anti-Borrelia spp., ceea ce complică şi mai mult diagnosticul. Gravida este tratată în acelaşi timp pentru infecţie de tract urinar, sarcina fiind atent monitorizată atât ecografic, cât şi clinic şi paraclinic, pentru depistarea posibilelor complicaţii materno-fetale. Rezultate. Contextul clinic şi epidemiologic sugestiv pentru borelioză, rezultatele serologice controversate ale testelor ELISA şi confirmate prin PCR, asociate cu prezenţa concomitentă a unor infecţii de tract urinar, au determinat specialiştii să recomande gravidei tratament antibiotic. În aceste condiţii, evoluţia sarcinii este favorabilă, cu atenta supraveghere a mamei şi a fătului. Pacienta naşte prin operaţie cezariană, la termen, un făt viu, normoponderal, sănătos. Lăuza şi nou-născutul au fost testaţi imediat după naştere pentru borelioză, fătul neprezentând răspuns imun. Placenta a fost atent analizată prin examen histopatologic, fără a se decela modificări, excluzându-se astfel transmiterea transplacentară a spirochetelor. Concluzii. Diagnosticul diferenţial al bolii Lyme la gravidă trebuie făcut cu mare atenţie, ţinând cont de particularităţile imunologice şi de reacţiile fals-negative şi fals-pozitive datorate altor patologii. În general, pacientele primesc antibioterapie pentru alte infecţii genitourinare, care de cele mai multe ori tratează şi infecţia transmisă de căpuşă. Cu toate acestea, anamneza corectă, identificarea eritemului migrator şi informarea pacientelor asupra riscurilor bolii Lyme sunt esenţiale pentru identificarea şi tratarea la timp a unei infecţii cu potenţial malformativ şi consecinţe nefaste în sarcină. [ABSTRACT FROM AUTHOR]

Introducere. Rutina practicii clinice obstetricale și materno-fetale presupune evaluarea ultrasonografică a structurii placentare pe toată durata gestației, prin tehnica standard 2D, dar și prin tehnici 3D şi Doppler avansate. Scopul studiului este de a realiza corelații sistematice între placentația anormală evaluată ultrasonografic și diagnosticul morfopatologic al acestei structuri gestaționale. Material și metodă. Cercetare multicentrică terțiară ce include un număr de 734 de sarcini neselectate, diagnosticate ultrasonografic cu anomalii placentare sau ale membranelor fetale, în intervalul 2012-2017. Evaluarea ultrasonografică a fost urmată de studiul morfopatologic al acestor structuri. Intervalul de examinare a variat între 11 (+4) şi 38 (+5) săptămâni gestaționale. Studiul include 722 de sarcini unice și 12 sarcini multiple. Diagnosticul ultrasonografic a inclus evaluare transabdominală, transvaginală sau mixtă. Rezultate. Corelații ultrasonografice şi morfopatologice au fost observate pentru: infarcte placentare - 75 de cazuri (10,21%), anecogenități placentare - 17 (2,31%), placenta circummarginata - 42 (5,72%), tumori placentare - 7 (0,95%), placenta praevia - 24 (3,26%), hematom retroplacentar - 51 (6,94%), benzi amniotice - 31 (4,22%), placentă hiperaderentă (accreta, increta, percreta) - 28 (3,81%), placentă molară - 27 (3,67%), lobulație anormală - 42 (5,72%), abruptio placentae - 9 (1,22%). Concluzii. Un număr semnificativ de anomalii placentare pot fi detectate ultrasonografic chiar din primul trimestru de sarcină. Examinarea 2D standard este esențială pentru diagnostic, dar tehnicile 3D şi Doppler avansat completează și susțin evaluarea ultrasonografică. Anumite structuri anatomice macroscopice ale placentei au expresie ultrasonografică evidentă și bine definită, aducând detalii pentru prognosticul materno-fetal. Există un număr semnificativ de anomalii fetale, structurale sau funcționale, unele cu implicare sindromică, a căror identificare ultrasonografică trebuie să conducă spre examinarea morfopatologică a structurii placentare. Anumite anomalii de placentație detectate ultrasonografic pot atrage atenția asupra necesității diagnosticului prenatal invaziv. [ABSTRACT FROM AUTHOR]

Este unanim recunoscut la ora actuală faptul că studiile epidemiologice, clinice și moleculare converg spre ideea clasificării adenocarcinoamelor endometriale în cel puțin două subclase: tipul I - în care tumorile sunt adenocarcinoame endometroide și probabil mucinoase, în timp ce tipul II include formele de carcinoame seroase sau cu celule clare. Patologia malignă a endometrului reprezintă cea mai frecventă neoplazie invazivă a tractului genital feminin. Majoritatea acestor cazuri sunt reprezentate de adenocarcinomul endometrioid (sau de tip I), care este cel mai comun tip histologic. În cazul tipului I de carcinoame, gradingul histopatologic este de mare importanță în stabilirea prognosticului și, în multe cazuri, a conduitei terapeutice. Majoritatea pacientelor solicită consultul de specialitate în momentul apariției hemoragiei pe cale vaginală, cel mai important simptom al acestei palologii, iar tumoarea este de obicei limitată la corpul uterin la momentul diagnosticului. Factorii de risc ai cancerului endometrial includ, în mare, obezitatea și vârsta avansată. Alți factori care influențează riscul sunt: sindromul ovarelor polichistice, terapia estrogenică, în special la menopauză, menarha devreme, menopauza precoce, istoric de infertilitate, nuliparitatea, neregularitățile menstruale, rasa albă, tratamentul cu tamoxifen, diabetul, hipertensiunea arterială, boli ale vezicii urinare, contracepție orală combinată pe termen lung și fumatul. Există numeroase studii, în ultimele două decenii, cu privire la carcinomul endometrial, însă la fel de adevărat este și faptul că s-au înregistrat modificări semnificative în modelele de distribuție a caracteristicilor patologice, în cadrul acestor entități cu variabilitate destul de amplă. Carcinomul endometroid de tip mucinos reprezintă 1-2% dintre cancerele endometriale, având un aspect mucinos ce cuprinde mai mult de jumătate din tumoare și fiind denumit generic aspect focal. Scopul acestui studiu este de a stabili corelații imagistice, morfologice și de patologie chirurgicală privind diagnosticul, conduita terapeutică și prognosticul tumorilor uterine din categoria adenocarcinomului endometrial endometroid. [ABSTRACT FROM AUTHOR]

Ultrasonografia (US) poate aduce informații utile în diagnosticul incontinenței urinare de efort (IUE) prin evaluarea morfologică a vezicii urinare, uretrei, dar și a statusului și mobilității uretro-vezicale. Din punct de vedere morfologic, uterul și pereții vaginali prolabați reprezintă mesagerii defectelor anatomice. Examenul clinic evaluează defectul herniar și gradul de prolabare. Important pentru un tratament corect este conținutul sacului herniar și mecanismul de apariție al prolapsului. US poate aduce date cu privire la conținutul sacului herniar, poate explica simptomele - dificultăți de evacuare vezicală, rectală, IUE - și orientează asupra defectelor anatomice. Soluțiile de diagnostic US în IUE sunt reprezentate de ecografie transperineală (translabială)- TPUS, ecografie transvaginală - TVUS sau ecografie endoanală - EAUS. Evaluarea US în IUE urmărește: măsurarea volumului urinar rezidual, grosimea detrusorului, dinamica colului vezical, prezența cistocelului, integritatea uretrei, mase tumorale sau diverticuli. US introitală (sondă de 5 MHz) poate diagnostica elongația de col sau colpocelul - corpul uterin retroversat ce ocupă sacul herniar posterior. EAUS și 2D/3D TPUS sunt complementare în evaluarea compartimentului posterior. Reperele US ale compartimentului posterior sunt: centrul tendinos perineal - formă triunghiulară, ușor hiperecogen, situat anterior de sfincterul anal; septul rectovaginal - aspect hiperecogen între peretele vaginal (hipoecogen) și musculara rectală și unghiul ano-rectal - între axul longitudinal al canalului anal și peretele rectal posterior. Concluzii. US este neinvazivă versus cistouretrografie/defecografie, cost-eficientă comparativ cu RMN în dinamică, permite evaluarea în timp real a planșeului pelvic, oferind date de anatomie funcțională sau evaluarea poziției și dinamicii meșelor de polipropilenă. US este utilă în evaluarea preoperatorie prin posibilitatea aprecierii conținutului sacului herniar și a corelației defect anatomic - simptome. US contribuie la evaluarea rezultatelor postterapeutice, a poziției meșelor sintetice și la verificarea efectului lor funcțional. US devine un element important atât în diagnosticul IUE, permițând aprecierea morfologică și dinamică a tractului urinar inferior, cât și în evaluarea preoperatorie pentru stabilirea conduitei chirurgicale. [ABSTRACT FROM AUTHOR]

Pregnancy and particularly postpartum period associate a high risk of thromboembolic disease, especially when another procoagulant condition is present. Besides the hypercoagulable state characteristic to pregnancy, the factors that increase this risk are venous stasis of the lower extremities, endothelial injury, and the presence of an inherited thrombophilia. The thromboembolic risk grows exponentially during pregnancy and persists 12 weeks postpartum. Regarding the localization, there is a predisposition for developing deep vein thrombosis in left inferior limb, characteristic for 70% to 90% of cases, this predisposition being augmented by the hospitalization status. A history of venous thromboembolism associates a recurrence risk in pregnancy 20-30 times higher than the incidence of this pathology in pregnant and postpartum population. About 50% of venous thromboembolism in pregnancy associates hereditary or acquired thrombophilias; in this context, the screening for thrombophilic disorders should be recommended to all pregnant women who associate a history of venous thromboembolism or manifested venous thrombosis during the current pregnancy. For all cases of pregnancies and postpartum women, avoidance of dehydration, active live and, respectively, early mobilization are recommended. For the cases of pregnancies with confirmed antiphospholipid syndrome (APS), low doses of aspirin are recommended to be added to the prophylactic therapy with LMWH/UFH, as early as possible in pregnancy, up to 36 weeks of gestation, this treatment schedule having the highest efficiency in early pregnancy loss prevention and favorable pregnancy outcome. The cases of thromboembolism during pregnancy and puerperium are complex, with high mortality and morbidity risk, and require team collaboration between cardiologist, gynecologist, hematologist and intensive care specialists. The key to success for a good prognosis is the compliance with a clear, standardized, adapted protocol. [ABSTRACT FROM AUTHOR]

Introducere. Sindromul de dilatare a tractului urinar fetal (SDTU) cuprinde dilatarea limitată la pelvisul renal, calice și/sau uretere. Vezica urinară poate fi dilatată, de asemenea. SDTU are o incidență de 1-5%, fiind mai frecvent la sexul masculin (2:1). Studiul are ca scop evidențierea aspectelor de diagnostic ultrasonografic (US), evaluarea prognosticului și managementul pre- și postnatal al SDTU. Material și metodă. Studiu multicentric pe o perioadă de doi ani. Sarcini unice cu SDTU diagnosticat ultrasonografic (US). SDTU a fost evaluat atât prin US 2D, dar și prin tehnici de reconstrucție 3D, TUI și Doppler. Rezultate. Diagnosticul US - distensia pelvisului renal cu sau fără dilatație caliceală. Pelvisul renal este măsurat anteo-posterior în planul transversal. Criteriile de diagnostic pentru SDTU în trimestrul al doilea - ușor (4-7 mm), moderat (7-10 mm), sever (>10 mm); în trimestrul al treilea - ușor (7-9 mm), moderat (9- 15 mm), sever (>15 mm). În cele mai multe cazuri, SDTU este o constatare izolată. AFI este de obicei normal. Concluzii. SDTU este o constatare comună, de obicei tranzitorie, dar există un risc semnificativ de patologie renală, în special prin dilatarea progresivă sau severă, caliectazii sau dilatare ureterală. Dacă SDTU este diagnosticat în al doilea trimestru, se recomandă reevaluare în ultimul trimestru pentru a identifica hidronefroza persistentă sau agravarea acesteia. Cele mai comune etiologii sunt: hidronefroza, obstrucția joncțiunii uretero-pelvice și refluxul vezicoureteral. Toate acestea sunt de obicei tranzitorii. Este recomandată US renală postnatal. Profilaxia infecției urinare neonatale poate fi necesară. 25% dintre cazuri necesită intervenții chirurgicale. [ABSTRACT FROM AUTHOR]

Infecția cu virusul HPV este cea mai frecventă boală cu transmitere sexuală. HPV este o infecție predominant a tinerelor, având o rată de 6-8 ori mai mare de apariție la adolescente decât la adulte. Transmiterea virusului în cadrul acestui grup vulnerabil este influențată de comportamentul specific vârstei. Din nefericire, 75% din adolescentele HPV pozitive prezintă citologii cervico-vaginale normale, persistența infecției cu HPV făcând diferența în progresiunea spre apariția de leziuni preinvazive. În grupul adolescentelor, progresia spre leziuni de grad scăzut este rară, rata de remisiune fiind crescută. Leziunile de grad înalt reprezintă o provocare pentru medicul curant care optează pentru o metodă de diagnostic și tratament ce are ca scop prezervarea fertilității. [ABSTRACT FROM AUTHOR]

Fertility preservation in cancer patients is currently based on either assisted reproductive technology or fertility-sparing surgery. Loss of fertility may be caused by excisional surgery associated with an adnexal or uterine pathology or secondary to gonadal insufficiency caused by chemotherapy or radiation. The counseling of these patients is very important, being carried out jointly by the oncologist, gynecologist, and reproductive medicine specialist. Reproductive surgery usually requires avoiding laparotomy to significantly reduce the formation of adhesions and trauma or tissue damage. This is done using standard laparoscopic surgery or robotic surgery (computer-assisted laparoscopy), a method increasingly used and accessible to all specialists who want to maintain the fertility of their patients with various oncological diseases. [ABSTRACT FROM AUTHOR]