Search

The purpose of this review is to draw attention to the importance of early diagnosis in cases of clinically significant fetomaternal hemorrhage, which is a rare but important condition to consider in the diagnosis of fetal distress. Unfortunately, since the signs of fetomaternal hemorrhage are nonspecific and the majority of cases occur spontaneously, without prior trauma or other condition, a high degree of suspicion from the clinician is necessary to establish the early treatment. The use of paraclinical tests, such as Kleihauer-Betke test and flow cytometry, is necessary to identify the passage of fetal erythrocytes into the maternal circulation. The determination of the most efficient and accessible method of diagnosis is imperative. The proposed diagnostic algorithm presented in this article can help standardize the diagnostic process of fetomateral hemorrhage, making it more efficient and precise. [ABSTRACT FROM AUTHOR]

The management of prelabor rupture of membrane (PPROM) is one of the most discussed issues in perinatal medicine. The guidelines recommend to manage the pregnancy expectantly whenever this is possible, taking into account certain factors, such as gestational age, presence or absence of maternal/fetal infection, presence or absence of labor, fetal presentation, fetal well-being, and cervical status. Our objective is to demonstrate the benefits of expectantly management. We undertook a retrospective observational analytical study in which we included PPROM pregnancy between 2015 and 2020. We followed the evolution of premature newborn using several parameters (neonatal death, respiratory distress syndrome, hypoxia, intraventricular hemorrhage, hypoglycemia, necrotizing enterocolitis, neonatal sepsis), originated from both PPROM pregnancies that were managed expectantly and PPROM that were delivered short time after admission. In PPROM pregnancies managed expectantly we included the patients to whom there had been administrated tocolysis, corticosteroids and antibiotics, so the delivery was postponed. We observed a significant decrease in neonatal complication in pregnancies that were prolonged. We concluded that the expectantly management of pregnancies with preterm prelabor rupture of membrane leads to a statistical benefit, decreasing the incidence of fetal and maternal complications. [ABSTRACT FROM AUTHOR]

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

Prelabor preterm rupture of the membranes (PPROM) refers to the rupture of the membranes before 37 weeks, but also before the onset of labor. Approximately 3% of pregnancies are complicated by PPROM, which is an important cause of neonatal morbidity and mortality. The aim of the study is to demonstrate the benefit of expectant management in PPROM, compared to immediate birth, defined in our study as birth in the first 48 h. We analyzed 562 pregnancies with PPROM by gestational age groups and short-term morbidities. Material and methods: We conducted a retrospective observational analytical study, which included women with PPROM between 24 + 0 and 36 + 6 weeks. We divided the cohort into gestational age groups: group 1 gestational age (GA) between 24 and 27, group 2 GA between 28 and 31, group 3 GA between 32 and 34, group 4 GA > 35 weeks. In each group, we analyzed the benefit of the latency period (established in our study as delivery after 48 h of hospitalization) in terms of short-term neonatal complications. Result: The latency period brought a significant benefit starting with GA greater than 28 weeks; therefore, in the group with GA between 28–31, the complications were significantly statistically lower, mentioning respiratory distress syndrome (no latency 100% vs. latency 85.1%) and admission to the neonatal intensive care unit (no latency 89.7% vs. latency 70.2%). In group 3, with GA between 32–34, we reached statistical significance in terms of respiratory distress syndrome (no latency 61.8% vs. latency 39%), hypoxia (no latency 50% vs. latency 31.7%) and admission to the neonatal intensive care unit (no latency 70.2% vs. latency 47.4%). Conclusion: Expectant management of pregnancies with PPROM can bring a real benefit in terms of the incidence of complications in premature infants, but this benefit depends most on the gestational age at which the membranes ruptured and the medical conduct put into practice during the latency period. [ABSTRACT FROM AUTHOR]

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

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

Intrauterine growth restriction or fetal growth restriction represents a fetal incapacity of achieving its entire growth potential in intrauterine life, as a result of maternal, fetal and/or placental causes, from hypertension, autoimmune diseases, drug consumption, hereditary thrombophilia to genetic syndromes, intrauterine infections, umbilical cord anomalies or placental insufficiency. The ultrasonographic evaluation of the fetus with intrauterine growth restriction identifies an estimated fetal weight or a fetal abdominal circumference below the 10 th percentile for gestational age; a severe fetal growth restriction is defined as an estimated fetal weight below the 3rd percentile. The Delphi consensus managed to classify fetal growth restriction as early, being diagnosed under 32 weeks of gestation, respectively late, after 32 weeks of gestation. Up to 10% of pregnancies are complicated by fetal growth restriction, which are then considered high-risk pregnancies for the morbidity and mortality risk carried for the fetus, requiring an accurate diagnosis of the cause, intensifying the fetal monitoring and timing the birth, in order to deliver the fetus in safe conditions. This paper proposes an algorithm for an initial evaluation of fetal growth restriction, with the aim of simplifying the medical approach when encountering a fetus with intrauterine growth restriction, in order to improve morbidity and mortality rates among pregnancies complicated by fetal growth restriction. [ABSTRACT FROM AUTHOR]

Transvaginal ultrasound and serum concentration of human chorionic gonadotropin are the main methods of prognostic evaluation of early pregnancies. Although these pregnancy investigation methods have proven their benefits, the interpretation is fundamental for a correct diagnosis, in order to avoid interventions that may affect pregnancies that would normally have had a physiologic course, as well as to apply an appropriate management in the case of nonviable pregnancies. Recent studies have shown the need to adopt rigorous criteria that minimize false positive results and thus decrease the frequency of diagnostic errors. Over time, a series of ultrasound features have been described which have proven effective in predicting nonviable pregnancies in the first trimester (cranio-caudal length in relation to the presence or absence of cardiac activity, yolk sac diameter, gestational sac diameter in relation to presence or absence of embryo with cardiac activity, embryonic heart rate, subchorionic hematoma etc.). In the context of the new prospects for the development of artificial intelligence softwares, the present work focuses on the description of the precise ultrasonographic aspects aboded by the latest studies that propose certain cut-off values dependent on the gestational age of the ultrasound parameters in the first trimester, increasing the sensitivity and the specificity of ultrasound in the diagnosis of nonviable early pregnancies, thus aiming to improve the reproductive prognosis of couples with recurrent abortions. [ABSTRACT FROM AUTHOR]

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

In this study, we explore the "why?", and "how?", monitoring the pH of the fetal scalp is used, and show its limitations. In addition, we review the development of new devices based on the modern physics and nanomaterials serving this topic. Most of the works we found in our search have focused on improving the prognostic of fetal heart rate monitoring, because it is the "golden standard" in determining fetal distress. Although the best-known screening method, it can only provide limited information about the actual status of the fetus. The best predictive assessment, with the highest reproducibility, states that a normal fetal heart rate is indicative of a healthy baby. However, its excellent sensitivity is much reduced when identifying the actual "distress". This is when second-line monitoring methods come into play to guide the diagnostics and direct the obstetrician towards an action plan. Although a historic method, fetal scalp pH sampling is still under review as to its efficiency and place in the current obstetrics. Continuous surveillance of the fetal parameters is important, especially for the fetuses undergoing intrauterine growth restricted (IUGR). Since fetal scalp blood sampling is still under research and is a randomized controlled trial, which compares the relevance of pH and lactates to the obstetrical situation, the maternal-fetal medicine could greatly benefit from the introduction of engineered nanomedicines to the field. [ABSTRACT FROM AUTHOR]

The corpus callosum serves as a link between the two hemispheres, with an important role in cognitive mechanisms, also integrating motor and sensitive information and processing stimuli. Evaluation of the morphologic structure of the corpus callosum in order to diagnose structural anomalies such as hyperplasia, hypoplasia, as well as indirect signs of corpus callosum agenesia can be realised using ultrasonography during the mid-trimester screening. At present, it is recommended to perform a targeted evaluation only in high-risk cases of central nervous system abnormalities; the International Society of Ultrasound in Obstetrics and Gynaecology has not included the corpus callosum evaluation in the routine secondtrimester screening. Callosal anomalies present uncertainty in the fetal prognosis: 75% of cases of isolated corpus callosum agenesis develop normally; on the other hand, they could develop various degrees of neurological impairment from language or social deficiency to autism or schizophrenia. We, therefore, highlight the importance of corpus callosum evaluation, as the agenesis of the corpus callosum can be an isolated defect, but it can also be associated with other extracerebral anomalies or it could be a part of a syndrome. Completing the diagnosis often requires magnetic resonance imaging and genetic tests. [ABSTRACT FROM AUTHOR]