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Micronutrients are indispensable substances for ensuring proper metabolism, which, in the case of pregnant women, has an indirect influence on perinatal outcomes. Hypovitaminosis K is a rare condition in adults. However, vitamin K deficiency can pose a significant risk to the health of both mother and fetus, which can cause bleeding, especially in newborns. Newborns have a low natural level of vitamin K because they do not receive the necessary amounts in the antenatal period, which is caused by the slower transfer of this vitamin through the placenta. The use of drugs that affect the metabolism of vitamin K by pregnant women can increase the rate of various complications in newborns, related to hypovitaminosis K. Micronutrients, especially vitamin K, are essential for the body of pregnant women, being crucial in fetal development. [ABSTRACT FROM AUTHOR]

Background. Abnormal uterine bleeding in adolescence (AUBA) is a common gynecological issue. AUBA has a higher prevalence compared to adulthood (37% versus 10-20%), being determined by the menstrual disorders and influenced by hypothalamic-pituitary immaturity. Objective of the study. To assess the management of AUBA. Materials and method. The study included 60 adolescents, between 10 and 18 years old, admitted to Infant Gynecology Unit in the period 2021-2022. Gynecological and somatic anamnesis were determined. Clinical, ultrasound and laboratory examinations were performed. Pregnancy, iatrogenic causes, systemic and genital tract abnormalities were excluded from the study. The patients were informed, counseled and treated according to the national clinical guideline. Statistical data processing was performed using SPSS Statistics. Results. Sixty percent of the patients came from the rural area and 35% came from the urban area; 5% were refugees. The average age was 14.4 years old, menarche occurred at 11.8 years old, lasting in average 5.8 days. They had abnormal uterine bleeding for an average of 11.6 days. Coagulopathies, chromosomal abnormalities, and sexually transmitted diseases, including HIV infection, were determined in 11.5% of cases. Somatic diseases prevailed: anemia in 58.3% of cases, endocrine disorders in 10% of cases. The hormonal profile was performed in 81.6% of patients. The average admission was 8.6 days, and 35% patients were admitted for several times, 5% being treated in the intensive care unit. Patients received hemostatic (85%), anti-anemic (58.3%), hormonal (40%) and analgesic (11.7%) treatments. At the same time, the prolonged hormonal therapy (in 68% of cases) and anti-anemic treatment (in 50% of cases) were indicated after discharge. Conclusions. Abnormal uterine bleeding is one of the most important issues in adolescents’ health, requiring careful diagnosis, long-term treatment and follow-up. [ABSTRACT FROM AUTHOR]

Background. Intrahepatic pregnancy cholestasis (ICP) is a condition characterized by an increase in serum bile acid (BA) and liver function tests in the presence of skin pruritis. Given that high BA values cause the release of proinflammatory mediators, the authors propose that hematological inflammatory markers in the ICP, such as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), erythrocyte distribution index, standard deviation of the erythrocyte distribution index (RDW-SV) and coefficient of variation of the index (RDW-CV), undergo some changes. Materials and method. The prospective study was carried out by assessing 120 cases, divided into two groups: Group A – 60 women, whose pregnancy was complicated by ICP; and Group B – 60 cases without ICP. The χ² test without Yates’ correction for continuity was applied to compare the categorical variables. Results. The assessment of the BA level revealed the following mean values: 37±5.1 μmol/l in Group A (ranging between 10 and 211 μmol/l) and 3.47±0.2 μmol/l in Group B. Protein C-reactive was assessed in both groups, and elevated values were detected in seven cases in Group A and in 10 cases in Group B (χ² =0.617, p=0.4322). The mean values of hematological inflammatory markers were: NLR – 5±0.4 in Group A, compared with 4.7±0.3 in group B; PLR – 151.5±7.8 in Group A and 124.8±5.8 in Group B; MPV – 11.5±0.1 fl in Group A and 11.4±0.1 fl in Group B; RDW-SV – 46.5±0.8% in Group A and 48.6±0.8% in Group B; RDW-CV – 14.2±0.3 fl in Group A and 14.6±0.2 fl in Group B. Conclusions. The study revealed an increase in PLR values in the group of women whose pregnancy was complicated by ICP, compared to the control group. However, further studies with a larger number of participants are required in order to draw conclusions about the role of hematological inflammatory markers in intrahepatic cholestasis during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction. The number of pregnant women living with HIV has remained constant during the last years in the Republic of Moldova. It is known that HIV infection, associated with other pathologies, complicates the evolution of pregnancy, requiring a complex approach. HIV infection is often associated with premature birth, fetal growth restriction (FGR), increased perinatal mortality and morbidity rate. Materials and method. A 19-yearold pregnant, G2P1, was admitted to the third-level perinatal center of the Institute of Mother and Child, at 37-38 weeks of amenorrhea. High viral load for HIV and multiple fetal abnormalities were detected in a previous pregnancy (2018), presenting an indication for pregnancy interruption. Currently, the patient is receiving antiretroviral therapy (ARVT), with HIV RNA PCR 40rd percentile) and oligoamnios (amniotic fluid index ≤3 cm); reverse flow and velocimetry pathological Doppler flow on the fetal middle cerebral artery. In fetal interest, an emergency caesarean section was performed. A 2100 g fetus, Apgar 7/8 score, was extracted. The patient continued the administration of ARVT, along with antibiotic therapy. The newborn received ARVT, being artificially fed. Conclusions. The complex approach and the adequate management of the perinatal period in a patient with HIV infection require the assessment of the viral load for HIV, ARVT associated conditions and their influence on the fetal state. An important aspect consists in the decision about the modality and the time of delivery, according to maternal/fetal indications, and the artificial feeding of the newborn, in order to reduce the possible complications. [ABSTRACT FROM AUTHOR]

Introduction. Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-related condition characterized by the presence of cutaneous pruritus and modifications in liver function tests (LFTs). Materials and method. The retrospective study was performed by assessing 35 clinical cases of ICP in women admitted to the “Mother and Child” Institute, Chişinău, Republic of Moldova. Results. The mean age of women with ICP was 31.1±0.9 years old. Assessing the LFTs indicated the following mean values: alanine aminotransferase 71.8±13.8 U/l, aspartate aminotransferase 95.7±16.4 U/l, alkaline phosphatase 512±65.4 U/l. Relative leukocytosis was detected in four cases, the erythrocyte sedimentation rate was estimated in 25 women, in all cases the values were increased, the C-reactive protein was assessed in 12 cases, from which in three cases the values were increased up to 48 µ/ml. The total serum cholesterol level was assessed in 14 pregnant women, being increased in all cases; in 17 pregnant women with ICP (48.6%), hypoproteinemia was diagnosed. The birth occurred at less than 37 weeks in 45.7% of pregnant women. Delivery ended with a caesarean section in 45.7% of cases, of which in 62.5% emergency interventions were performed. Conclusions. Women with ICP present significant changes in LFTs during pregnancy, requiring numerous readmissions to specialized hospital units. The incidence of caesarean section among pregnant women with ICP was about 45.7% and a significant number of them were carried out urgently. [ABSTRACT FROM AUTHOR]

Introduction: Hypertensive disorders in pregnancy are a relevant medical and social problem that can have consequences for both, the mother and the fetus. According to the World Health Organization (WHO), preeclampsia is one of the most serious complications, affecting approximately 2-8% of pregnancies worldwide. Case Report: Patient X., 26 years old, second ongoing pregnancy, 37-38 weeks of gestational (w.g.), presented herself at the Emergency Unit of Tertiary Perinatal Center, Chisinau, Republic of Moldova (RM) with the complains: fatigue, persisting occipital headache for 2-3 days, along with high blood pressure (BP) 165/100 mmHg. Information gathered via clinical case monitoring, through diligent examination of the medical record, and by a comprehensive review of the literature. Discussions : Patient X., 26 years old, admitted with complaints: fatigue, persisting occipital headache for 2-3 days, along with high BP 165/100 mmHg. Obstetric history revealed the history of cesarian section (C-section), due to preeclampsia, associated with premature rupture of the amniotic sac at 39 w.g. Ultrasound exam revealed a placentomegaly at 36 w.g. in the current pregnancy. The patient, hemodynamically stable, with a respiratory rate of 17 breaths per minute, a pulse rate of 88 beats per minute, and BP initially measured at 170/110 mmHg, which subsequently decreased to 150/100 mmHg over 2 hours, without changes in the pulse rate. Palpation of the uterus revealed an ovoid shape and normal tone. The fetus was in the cephalic presentation. Fetal heart rate was ~146 beats/min, clear, rhythmic. The pelvic exam revealed the biologically unprepared birth canal. Traces of protein in urine. The diagnosis was established: Pregnancy 37-38 w.g. Rh negative without isoimmunization. History of C-section. Pregnancy induced hypertension. Antihypertensive treatment was administered according to the guidelines (methyldopa, nifedipine, metoprolol). Despite the treatment, BP values remain elevated (165-150 /100-90 mmHg) for the next 2 days with periodic occipital headaches. Ultrasound of the fetus showed blood flow centralization, also cardiotocographic changes were determined. In support of the preeclampsia diagnosis update, the C-section was recommended along with magnesium therapy. A female fetus was delivered, 3000 grams, Apgar score 7/8. The post-operative period was uncomplicated. Conclusions: Comprehensive understanding and management of hypertensive disorders in pregnancy is crucial for preventive measures to minimize maternal and/or fetal risks. Therefore, handling the appropriate medication, deciding a delivery method, and timing, along with optimal postpartum management are essential. [ABSTRACT FROM AUTHOR]