Search

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

Over the last two decades, obesity and overweight have increased significantly, becoming public health problems worldwide. Data from literature show a continuous increase in the prevalence of the two entities, which results in an increasing number of overweight or obese patients who reach the reproductive age and become pregnant. Pregnancies in obese or overweight patient are the new challenges that obstetricians have to face. This review is based on publications that were found on PubMed, with a special attention to the review articles, cohort studies and randomized trials. Obesity and overweight can affect both getting and maintaining a pregnancy. The chances of obtaining a pregnancy decrease linearly by 4% for every 1 kg/m² gained, starting from a Body Mass Index (BMI) of 29 kg/m². The prevalence of fetal malformations is also increased in overweight or obese patients, the risk raising proportionally with the severity of obesity. These endemic diseases are also associated with certain maternal complications. A 10% increase in weight during pregnancy compared to pregestational BMI has been shown to be a factor that increases the risk by about 10% for the occurrence of hypertension and gestational diabetes, respectively. Newborns are also affected by these pathologies. Newborns in obese mothers have an increased percentage of adipose tissue, and studies have shown that there is an association between maternal adiposity and fetal weight at birth. The interventions in lifestyle and nutrition during pregnancy did not have an important effect on reducing the incidence of maternal and fetal complications. Therapeutic strategies are needed for normalizing body weight before pregnancy because reducing BMI has benefits for both mother and fetus. [ABSTRACT FROM AUTHOR]

Introduction. Cervical incompetence (cervical insufficiency) is the inability of the uterine cervix to retain a pregnancy in the absence of uterine contractions. It typically presents as acute, painless dilatation of the cervix, which can lead to a midtrimester pregnancy loss. Transvaginal ultrasound can be used as a diagnostic tool and to monitor cervical changes in cases of cervical incompetence. Materials and method. We have searched the literature on articles published on this aspect on PubMed, Google Scholar and Cochrane, by using the following keywords: “cervical incompetence”, “cervical shortening”, “ultrasound measurements”. We found that some of the ultrasound aspects used in the evaluation of cervical incompetence are: cervical length measurement, funneling assessment and bulging of the fetal membranes into a widened internal os. Conclusions. Cervical shortening is a prognostic indicator for the risk of preterm labor progressing into preterm delivery. [ABSTRACT FROM AUTHOR]

Introduction. The choroid plexus, or plica choroidea, is a plexus of cells that arise from tela choroidea in each of the ventricles of the brain. Regions of the choroid plexus produce and secrete most of the cerebrospinal fluid of the central nervous system. The prevalence of choroid plexus cyst (CPC) is 1:50 fetuses at 20 weeks of gestation and more than 90% resolve by 26 weeks, usually being asymptomatic, but large cysts can cause hydrocephalus. Ultrasound diagnosis is characterized by single or multiple cystic areas (>2 mm in diameter) in one or both choroid plexuses of the lateral cerebral ventricles in biparietal diameter section. The differential diagnosis should exclude an intraventricular hemorrhage penetrating into the choroid plexus and other rare types of cysts like colloid or ependymal cysts. Methodology. We compared two cases of fetuses with CPC, the first one being a fetus with aneuploidy and a series of anomalies detected at the ultrasound examination (intracardiac echogenic focus, increased nuchal fold and absent nasal bone), and the second one being a fetus with normal karyotype where CPC represented a transitory factor. Results. Choroid plexus cysts, also called “soft signs”, are associated with a risk for trisomy 18 and, possibly, trisomy 21. When they are isolated, the risk for aneuploidy is low. If they are present, a detailed ultrasound examination should be performed, with particular attention to the heart, brain and hands. If the ultrasound is abnormal, the next step should be a noninvasive prenatal test (NIPT) to determine the fetal karyotype. Conclusions. In the vast majority of cases, CPC are benign transient variants of normal intracranial anatomy. Chromosomal studies are strongly recommended whenever associated anatomic abnormalities are detected and when choroid plexus cysts are large, bilateral and persistent. [ABSTRACT FROM AUTHOR]

Introduction. Conjoined twins, also known as Siamese twins, represent one of the rarest anomalies of monozygotic pregnancies that have fascinated both medical world and the general public. The incidence of this anomaly varies between 1:50.000 and 1:100.000 births, and there is a higher predisposition toward female gender, with a ratio of 3:1. Conjoined twins appear from abnormal embryogenesis, the two main theories proposed for explaining the occurrence of this anomaly being fusion and fission. Conjoined twins were classified by Spencer (1996), and are named according to the most prominent site of fusion. The conjoined site may be in the ventral, dorsal or lateral groups. The extent of organ sharing, especially the heart, determines the possibility and prognosis of a separation procedure. Materials and method. The aim of this paper is to offer an overview of the literature regarding this rare anomaly of monoamniotic monochorionic twin pregnancy and to present the case of a 35-year-old multiparous patient (six previous pregnancies) who was referred to our hospital for the confirmation of the thoracopagus conjoined twins diagnosis and for management. Results. With the current findings, the diagnosis of thoracopagus twin pregnancy was established. The family was informed and counseled on the various management options. Due to the presence of a common heart, the termination option was offered and the family accepted. The termination of pregnancy was made through caesarean section, resulting two female twins of approximately 500 g in total which were sent to the pathologist. Conclusions. Conjoined twin pregnancy is a rare finding. Establishing a diagnosis using ultrasound examination early during pregnancy offers the possibility of assessing the prognosis of the pregnancy, based on the organs that are shared by the fetuses, to offer the patient and her family a prognostic and, if possible, the treatment options. [ABSTRACT FROM AUTHOR]

Introduction. The evaluation of fetal long bone measurements, particularly femur length, is essential in assessing fetal biometry, gestational age, size, growth, and in identifying various abnormalities. This study explores the diagnostic value of long bones length in detecting conditions such as Down syndrome and skeletal dysplasia. A femur length below the 10th percentile for gestational age is consistently associated with Down syndrome, while an extremely short femur length often indicates skeletal dysplasia. Humeral length, particularly when small compared to the biparietal diameter, serves as an additional marker for Down syndrome risk. The accurate diagnosis requires measuring all long bone segments, while the femur/abdominal circumference ratio serves as a discriminator for lethal skeletal dysplasia. Complete fetal anatomic evaluation is crucial in the presence of a short femur. This poster presents the current state of the art in the ultrasonography of fetal long bone evaluation. Materials and method. The present paper was realized by synthesizing the data published in the last 30 years regarding fetal long bones ultrasound assessment found on Google Scholar and PubMed, using for filtering the keywords: “femur length”, “humerus length”, “ultrasound”, “trisomy”, and “skeletal dysplasia”. Results. Femur length is a standard parameter measured during fetal biometry assessment. A shortened femur for gestational age may raise the suspicion for fetal growth restriction, trisomy 21 or skeletal dysplasia. In certain cases, it may be the first hint for aneuploidies or skeletal dysplasia. Femur and humerus length can be used to adjust the risk for trisomy 21. When facing a shortened femur, a complete survey of all fetal long bones is mandatory, as it may unveil a potentially severe skeletal anomaly. Conclusions. Ultrasound measurement of fetal long bones and the ratio between different skeletal measurements can be the key for the prenatal diagnosis of fetal skeletal dysplasia or can rise the suspicion of a fetal aneuploidy that can determine further investigations for establishing or excluding such a condition of the fetus. [ABSTRACT FROM AUTHOR]

Introduction. Cervical incompetence (cervical insufficiency) is the inability of the uterine cervix to retain a pregnancy in the absence of uterine contractions. It typically presents as acute, painless dilatation of the cervix, which can lead to a midtrimester pregnancy loss. Transvaginal ultrasound can be used as a diagnostic tool and to monitor cervical changes in cases of cervical in competence. Materials and method. We have searched the literature on articles published on this aspect on PubMed, Google Scholar and Cochrane, by using the following keywords: “cervical incompetence”, “cervical shortening”, “ultrasound measurements”. We found that some of the ultrasound aspects used in the evaluation of cervical incompetence are: cervical length measurement, funneling assessment and bulging of the fetal membranes into a widened internalos. Conclusions. Cervical shortening is a prognostic indicator for the risk of preterm labor progressing into preterm delivery. [ABSTRACT FROM AUTHOR]

Introduction. The choroid plexus, or plica choroidea, is a plexus of cells that arise from tela choroidea in each of the ventricles of the brain. Regions of the choroid plexus produce and secrete most of the cerebrospinal fluid of the central nervous system. The prevalence of choroid plexus cyst (CPC) is 1:50 fetuses at 20 weeks of gestation and more than 90% resolve by 26 weeks, usually being asymptomatic, but large cysts can cause hydrocephalus. Ultrasound diagnosis is characterized by single or multiple cystic areas (>2 mm in diameter) in one or both choroid plexuses of the lateral cerebral ventricles in biparietal diameter section. The differential diagnosis should exclude an intraventricular hemorrhage penetrating into the choroid plexus and other rare types of cysts like colloid or ependymal cysts. Methodology. We compared two cases of fetuses with CPC, the first one being a fetus with aneuploidy and a series of anomalies detected at the ultrasound examination (intracardiac echogenic focus, increased nuchal fold and absent nasal bone), and the second one being a fetus with normal karyotype where CPC represented a transitory factor. Results. Choroid plexus cysts, also called “soft signs”, are associated with a risk for trisomy 18 and, possibly, trisomy 21. When they are isolated, the risk for aneuploidy is low. If they are present, a de tailed ultrasound examination should be performed, with particular attention to the heart, brain and hands. If the ultrasound is abnormal, the next step should be a noninvasive prenatal test (NIPT) to determine the fetal karyotype. Conclusions. In the vast majority of cases, CPC are benign transient variants of normal intracranial anatomy. Chromosomal studies are strongly recom mended whenever associated anatomic abnormalities are detected and when choroid plexus cysts are large, bilateral and persistent. [ABSTRACT FROM AUTHOR]

Introduction. Conjoined twins, also known as Siamese twins, represent one of the rarest anomalies of monozygotic pregnancies that have fascinated both medical world and the general public. The incidence of this anomaly varies between 1:50.000 and 1:100.000 births, and there is a higher predisposition toward female gender, with a ratio of 3:1. Conjoined twins appear from abnormal embryogenesis, the two main theories proposed for explaining the occurrence of this anomaly being fusion and fission. Conjoined twins were classified by Spencer (1996), and are named according to the most prominent site of fusion. The conjoined site may be in the ventral, dorsal or lateral groups. The extent of organ sharing, especially the heart, determines the possibility and prognosis of a separation procedure. Materials and method. The aim of this paper is to offer an overview of the literature regarding this rare anomaly of monoamniotic monochorionic twin pregnancy and to present the case of a 35 year old multiparous patient (six previous pregnancies) who was referred to our hospital for the confirmation of the thoracopagus conjoined twins diagnosis and for management. Results. With the current findings, the diagnosis of thoracopagus twin pregnancy was established. The family was informed and counseled on the various management options. Due to the presence of a common heart, the termination option was offered and the family accepted. The termination of pregnancy was made through caesarean section, resulting two female twins of approximately 500 g in total which were sent to the pathologist. Conclusions. Conjoined twin pregnancy is a rare finding. Establishing a diagnosis using ultrasound examination early during pregnancy offers the possibility of assessing the prognosis of the pregnancy, based on the organs that are shared by the fetuses, to offer the patient and her family a prognostic and, if possible, the treatment options. [ABSTRACT FROM AUTHOR]

Introduction. The evaluation of fetal long bone measurements, particularly femur length, is essential in assessing fetal biometry, gestational age, size, growth, and in identifying various abnormalities. This study explores the diagnostic value of long bones length in detecting conditions such as Down syndrome and skeletal dysplasia. A femur length below the 10th percentile for gestational age is consistently associated with Down syndrome, while an extremely short femur length often indicates skeletal dysplasia. Humeral length, particularly when small compared to the biparietal diameter, serves as an additional marker for Down syndrome risk. The accurate diagnosis requires measuring all long bone segments, while the femur/abdominal circumference ratio serves as a discriminator for lethal skeletal dysplasia. Complete fetal anatomic evaluation is crucial in the presence of a short femur. This poster presents the current state of the art in the ultrasonography of fetal long bone evaluation. Materials and method. The present paper was realized by synthesizing the data published in the last 30 years regarding fetal long bones ultrasound assessment found on Google Scholar and PubMed, using for filtering the keywords: “femur length”, “humerus length”, “ultrasound”, “trisomy”, and “skeletal dysplasia”. Results. Femur length is a standard parameter measured during fetal biometry assessment. A shortened femur for gestational age may raise the suspicion for fetal growth restriction, trisomy 21 or skeletal dysplasia. In certain cases, it may be the first hint for aneuploidies or skeletal dysplasia. Femur and humerus length can be used to adjust the risk for trisomy 21. When facing a shortened femur, a complete survey of all fetal long bones is mandatory, as it may unveil a potentially severe skeletal anomaly. Conclusions. Ultrasound measurement of fetal long bones and the ratio between different skeletal measurements can be the key for the prenatal diagnosis of fetal skeletal dysplasia or can rise the suspicion of a fetal aneuploidy that can determine further investigations for establishing or excluding such a condition of the fetus. [ABSTRACT FROM AUTHOR]

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

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

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

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

Late first-stage or second-stage caesarean section is commonly associated with fetal head impaction, leading to maternal and neonatal complications. This situation requires safe delivery techniques, but the optimal management remains controversial. The aim of this meta-synthesis was to compare maternal and neonatal outcomes associated with delivery techniques via caesarean section. Methodology. An electronic search of three databases, from inception to June 2021, was conducted. Cohort and randomized comparative studies on maternal and neonatal outcomes associated with techniques to deliver an impacted fetal head during caesarean section were included. The methodological quality of the primary studies was assessed. Review Manager 5.4 was used for statistical analyses. Nineteen articles, including 2345 women, were analyzed. Results. Three fetal extraction techniques were identified. Meta-analyses showed that the “pull” technique carries lower risks as compared to the “push” technique, and that the Patwardhan technique is safer compared to the “push” or the “push and pull” technique. Nine out of 11 quality criteria of the included studies were fully met. The “push” and the “pull” techniques were investigated by most included studies. The “pull” technique showed lower risks of blood transfusion (p=0.03), extension of uterine incision (p<0.00001), infection (p=0.003) and pyrexia (p<0.00001) compared to the “push” method. Conclusions. In the absence of robust evidence to support the use of a specific technique, the choice of the obstetrician should be based on best available evidence. Our study suggests that the “pull”, as well as the Patwardhan technique represent safe options to deliver an impacted fetal head. [ABSTRACT FROM AUTHOR]

Introduction. Late first-stage or second-stage caesarean section is commonly associated with fetal head impaction, leading to maternal and neonatal complications. This situation requires safe delivery techniques, but the optimal management remains controversial. The aim of this meta-synthesis was to compare maternal and neonatal outcomes associated with delivery techniques via caesarean section. Methodology. An electronic search of three databases, from inception to June 2021, was conducted. Cohort and randomized comparative studies on maternal and neonatal outcomes associated with techniques to deliver an impacted fetal head during caesarean section were included. The methodological quality of the primary studies was assessed. Review Manager 5.4 was used for statistical analyses. Nineteen articles, including 2345 women, were analyzed. Results. Three fetal extraction techniques were identified. Meta-analyses showed that the “pull” technique carries lower risks as compared to the “push” technique, and that the Patwardhan technique is safer compared to the “push” or the “push and pull” technique. Nine out of 11 quality criteria of the included studies were fully met. The “push” and the “pull” techniques were investigated by most included studies. The “pull” technique showed lower risks of blood transfusion (p=0.03), extension of uterine incision (p<0.00001), infection (p=0.003) and pyrexia (p<0.00001) compared to the “push” method. Conclusions. In the absence of robust evidence to support the use of a specific technique, the choice of the obstetrician should be based on best available evidence. Our study suggests that the “pull”, as well as the Patwardhan technique represent safe options to deliver an impacted fetal head. [ABSTRACT FROM AUTHOR]

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

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

Ovarian pregnancy is a rare entity. Making a definitive preoperative or even intraoperative diagnosis of ovarian pregnancy is difficult and the diagnosis is usually established by the pathologist. Rupture in the first trimester is the usual rule in ovarian ectopy. Thus, it continues to challenge practicing clinicians. The literature shows an association between intrauterine device usage and ovarian gestation. We present a case of ovarian pregnancy in a secundipara complaining of abdominal pain that also has pelvic adhesions. This case meets the four criteria of Spiegelberg and is interesting because of its rarity and association with adhesions, which makes diagnosis more difficult. [ABSTRACT FROM AUTHOR]

Introduction: In the context of endometrial cancer, visceral obesity as a risk factor is associated with a chronic inflammatory process, confirmed by the increase in inflammatory marker levels. Material and Method: The study is a case-control analysis including 2 groups of patients: group I - 50 patients diagnosed with endometrial cancer, group II - 70 patients without gynecological pathology or inflammatory disorders (control group). The diagnosis of endometrial cancer was made following histopathological examination that evaluated the tissue material obtained following endometrial biopsy. After clinical examination and anthropometric measurements, these patients underwent ultrasound and computer tomography examination by which intraperitoneal fat was determined. All parameters were included in the study database. Results: A significant correlation coefficient was also found between visceral fat evaluated by CT and visceral fat assessed by US (r =0.96, p<0.0001). In the case of the control group, the mean visceral fat area was 159.14±42.5 cm2), while in the group of patients with endometrial cancer, the mean visceral fat area was 251.37±59.78 cm2. Thus, there is a statistically significant difference in intraperitoneal fat between the two groups (p<0.0001). Conclusions: A visceral fat area larger than 250 cm2 is a risk factor for endometrial cancer. The measurement of visceral fat by US can be a screening method for endometrial cancer in obese patients. [ABSTRACT FROM AUTHOR]

Introduction. The amount of fluid in the fetal stomach varies significantly in case of normal fetuses. Changes in fetal stomach volume may be associated with multiple malformations. In case of reduced fetal stomach size, the most frequent associated pathology is esophageal atresia. Although some studies have attempted to make nomograms regarding fetal stomach size, there is currently no consensus on this and many authors still describe a “small or absent” stomach bubble or an “absent or collapsed fetal stomach”, without quantification. The ultrasonographic evaluation of the size of the stomach bubble remains subjective, being operatordependent. This results in an increased number of false positive diagnoses, which leads to patient anxiety, an increase in the number of additional investigations, as well as to higher costs. The objective was to carry out a review of the literature regarding the lower limit of the normal size of the stomach bubble and the implications of this parameter in establishing the positive diagnosis. Methodology. We searched for articles from the last five years in the PubMed database using as keywords: small fetal stomach bubble, esophageal atresia, prenatal ultrasound, fetal anomaly scan. Results. Prenatal diagnosis of esophageal atresia remains a challenge for sonographers. The main signs identified at ultrasound examination are: small or absent fetal stomach, polyhydramnios and “pounch sign”. The prenatal detection rate of esophageal atresia using ultrasonography was reported to be between 24% and 32%. When analyzing the studies, most authors defined the small fetal stomach only as subjective, mentioning either only the “small stomach bubble” or “absent fetal stomach”. A quantitative measurement, according to the nomograms, is not used. Nine studies analyzed the detection rate of “absent fetal stomach” or “small stomach bubble” in identifying antenatal esophageal atresia. This ultrasound mark was identified in 50% of cases. The incidence of false positive diagnosis was about 70%. Conclusions. With the improvement of other diagnostic modalities in the case of esophageal atresia, the detection rate increases, but ultrasonography remains the easiest method of diagnosis, due to the increased availability. Certain diagnostic criteria, using nomograms of fetal structures, could increase the rate of detection of fetal abnormalities. [ABSTRACT FROM AUTHOR]

Introduction. Ovarian tumors include masses with a fluid or parenchymal cystic character, characterized by typical or abnormal epithelial proliferation. They present an extreme diversity, the classification being realized according to several criteria. Ovarian tumors may be benign or malignant, cystic or solid, uni- or bilateral, secretory or non-secretory, primary or secondary. Ultrasound examination remains the gold standard imaging procedure used in ovarian mass evaluation. Doppler examination evaluates arterial and venous blood flow. The most commonly used Doppler spectral wave parameters are the resistivity index and the pulsatility index. The most commonly encountered complications of ovarian tumors are torsion of the ovary or adnexa, intracystic hemorrhage, as well as their malignant transformation. Although the diagnosis of adnexal torsion is most commonly based on the clinical examination of the patient, color Doppler evaluation may be useful by demonstrating the absence of arterial and venous flow. In case of intracystic hemorrhage, the resorption of the blood within the ovarian cyst determines the distinct ultrasound features, ranging from hyperecogenic aspects identified at the onset of hemorrhage, to hypo-/anecogenic images later. The model of the internal echoes will undergo changes with the passage of time and resorption of the clot. Doppler examination in the presence of intracystic hemorrhage will not reveal internal vascularization. Suggestive criteria for malignant ovarian masses are thick, multiple septations, papillary projections, solid stuctures within the tumor mass and ascites. Doppler ultrasound in malignant tumors identifies vessels of neoformation, which have low pulsatility and resistivity index. Conclusions. Color Doppler ultrasound can provide additional information to 2D ultrasound examination regarding the nature of the lesions, their malignant potential, and the presence of the torsion of the adnexa or ovary. The specificity and the positive predictive value of the 2D ultrasound examination in the diagnosis of the ovarian tumor complications increase when an extra examination using color and spectral Doppler is performed. [ABSTRACT FROM AUTHOR]

Perinatal mood and anxiety disorders (PMADs) profoundly impact maternal and infant health, affecting women worldwide during pregnancy and postpartum. This review synthesizes current research on the neurobiological effects of PMADs, particularly their influence on brain structure, function, and corresponding cognitive, behavioral, and mental health outcomes in mothers. A literature search across PubMed, PsycINFO, and Google Scholar yielded studies utilizing neuroimaging (MRI, fMRI) and cognitive assessments to explore brain changes in PMADs. The key findings indicate significant neurobiological alterations in PMADs, such as glutamatergic dysfunction, neuronal damage, and altered neural connectivity, particularly in postpartum depression (PPD). Functional MRI studies reveal distinct patterns of brain function alteration, including amygdala non-responsivity in PPD, differing from traditional major depressive disorder (MDD). These neurobiological changes are connected with cognitive impairments and behavioral modifications, impacting maternal caregiving. Understanding these alterations is fundamental for developing effective treatments. The findings emphasize the importance of focusing on maternal mental health, advocating for early detection, and personalized treatment strategies to improve maternal and child outcomes. [ABSTRACT FROM AUTHOR]

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

Introduction. The incidence of embryonic demise is 25%. Complications of the first trimester pregnancy are a current health problem. The etiology of the embryonic demise is multifactorial, with chromosomal abnormalities being the most common (40%). In prenatal monitoring, it is desirable to increase the effectiveness of screening methods and improve diagnostic methods for first-trimester pregnancies whose outcome can be reserved. Materials and method. The paper is a prospective case-control analysis that took place at the "Dominic Stanca" Clinic of Obstetrics and Gynecology in Cluj-Napoca between 2015 and 2017, and comprised two groups of patients: 81 patients with first-trimester pregnany in evolution and 89 of patients with a potentially reserved outcome pregnancy, both groups having amenorrhea between 6 and 11 weeks. Endovaginal ultrasounds were performed to assess the distance between the yolk sac and the embryo (DYSE), and venous blood was harvested for serum dosing of the soluble vasculo-endothelial growth factor (sFlt-1). Results. Significant statistical differences were observed between the serum level of the serological follow-up observed in the two groups, respectively a significantly lower serum level in the reserved outcome pregnancies compared to the favorable ones (p<0.001). Conclusions. The identification of low serum levels of sFlt-1 followed in this study can be considered as a screening prediction test of potentially reserved outcome pregnancies. [ABSTRACT FROM AUTHOR]

Introducere. Puţine tehnici de investigaţie paraclinică au avut în medicină impactul pe care l-a avut ecografia. Aprecierea unei dezvoltări normale a embrionului şi ulterior a fătului este completată de tehnici 3D care au deschis noi posibilităţi de cercetare a diferenţierii şi creşterii embrionare şi fetale, oferind perspectiva unei vizualizări mai detaliate a produsului de concepţie in utero. 3D HD Live este o tehnică de obţinere a unor imagini „realiste” printr-o postprocesare a imaginilor care se bazează pe recunoaşterea automată a componentelor structurale analizate cu augmentarea elementelor de suprafaţă şi utilizarea unui spectru de culori asemănător cu cel al ţesuturilor examinate. Silhouette este un algoritm de dată relativ recentă care permite vizualizarea interfeţelor tisulare cu densităţi diferite, permiţând obţinerea unor imagini tridimensionale în care sunt conturate cavităţile care apar sub forma unui conţinut transparent. Materiale şi metodă. Au fost evaluate săptămânal, între 6 şi 12 săptămâni, 31 de cazuri în 2D şi concomitent, prin diferite tehnici tridimensionale, pentru aprecierea corectă a aportului ecografiei 3D. De asemenea, au fost analizate informaţiile din literatură pe această temă pentru compararea datelor. Rezultate şi concluzii. 3D HD Live şi 3D HD Live Silhouette permit constant evidenţierea primelor structuri cerebrale la embrioni măsurând lungimi craniopodale de la 9,3-23,9 mm. Numeroasele tehnici tridimensionale au permis îmbunătăţirea evaluării 2D, cu apariţia progresivă a unor algoritmi care permit evidenţierea unor aspecte inaccesibile vizualizării până nu de mult. Trebuie însă menţionat că aportul ecografiei 3D este aditiv, existând în literatură un impresionant număr de articole care dezbat utilitatea reală a ecografiei 3D în primele 12 săptămâni de sarcină. Totuşi, progresul constant al tehnologiei, cu îmbunătăţirea periodică a imaginilor obţinute, vor impune cu siguranţă tot mai mult utilizarea 3D în prima parte a sarcinii. [ABSTRACT FROM AUTHOR]

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

Pe măsură ce structurile fetale şi cele placentare se dezvoltă, reţeaua lor vasculară devine mai pronunţată. Prin urmare, pe timpul sarcinii este posibilă observarea a trei unităţi separate şi totuşi unite: circulaţia maternă, placentară şi fetală. Partea maternă a circulaţiei placentare este reprezentată de arterele uterine şi de ramurile acestora, care se ramifică până la placa deciduală a placentei. Cu ajutorul ecografiei Doppler se poate identifica şi caracteriza, chiar din trimestrul I de sarcină, fluxul vascular de la nivelul arterei uterine, arterelor arcuate, radiale, precum şi de la nivelul arterelor spiralate. Placenta este organul unde se întâlnesc două sisteme circulatorii perfect distincte: unul deschis - matern şi altul închis - fetal. În nicio parte a placentei nu există o comunicare directă între sângele matern şi cel fetal. Aceste evenimente pot fi studiate cu acurateţe prin ecografia 2D, 3D color sau power Doppler. Analiza Doppler pulsat arată două tipuri de unde obţinute din spaţiul intervilos: unda pulsatilă arterială şi flux venos continuu. Trimestrul I de sarcină permite evaluarea circulaţiei fetale la diferite niveluri: circulaţia ombilicală, vasele arteriale periferice (aorta descendentă, vasele intracerebrale), cordul, structuri venoase (vena cavă inferioară, ductul venos). Circulaţia ombilicală este prezentă începând de la şase săptămâni de amenoree, când vascularizaţia viloasă confluează cu tubul cardiac primitiv. Spectrul Doppler obţinut din circulaţia centrală venoasă a embrionului aduce informaţii referitoare la aspectul fiziologic al ventriculului drept. Astfel, informaţii specifice legate de presarcină, complianţa miocardului şi de presiunea la sfârşitul diastolei pot fi obţinute prin urmărirea Doppler a DV, precum şi a venei cave inferioare (VCI). După şase săptămâni de gestaţie, pot fi detectate semnale spectrale şi de culoare Doppler de flux pulsatoric de sânge în inima fetală şi vasele mari. În ultima parte a primului trimestru de sarcină, ultrasonografia şi înregistrarea Doppler pot fi realizate transabdominal. [ABSTRACT FROM AUTHOR]

Introducere. Diagnosticul prin RMN al endometriozei are la bază trei semne înalt sugestive: T2 shading (scăderea intensității semnalului pe secvența T2 comparativ cu secvența T1), T2 dark spots (indicator de hemoragie cronică) și, mai nou, secvența de difuzie cu harta ADC (apparent diffusion coefficient), care măsoară gradul de restricție al mișcării browniene a moleculelor de apă libere. Studiile recente sugerează însă posibilitatea apariției acestor semne frecvent și în cazul chisturilor hemoragice. Metodologie. S-a analizat baza de date a Departamentului de radiologie și imagistică din cadrul Spitalului Clinic Judeţean de Urgenţă Cluj-Napoca și s-au luat în studiu șase paciente cu endometrioză confirmată și trei paciente cu chisturi hemoragice. Protocoalele de examinare utilizate sunt: Axial T1 FSE, TR 470.0, TE 12.5; Axial T1 FSE FS, TR 593, TE 12.5; Sagital T2 PROPELLER (TR 6374, TE 107); Axial T2 focus, spaceing 0, TR 6823, TE 100; Difuzie (DWI axial) contrast LAVA-FLEX (TR 6.3, TE 4.2). S-au efectuat măsurători cantitative bazate pe hărțile ADC calculate la 10-6 mm2/sec a leziunilor folosind un ROI (region of interest) de 10 mm2 centrat pe zona cu hiposemnal franc. Rezultate. Valorile ADC în cazul endometriozei (1100) au fost mai mici decât în cazul chisturilor hemoragice (1800). T2 shading a fost prezent la trei din şase paciente cu endometrioză, respectiv la una din trei paciente cu chist hemoragic. T2 dark spot s-a regăsit la cinci din şase paciente cu endometrioză, versus una din trei paciente cu chist hemoragic. Concluzii. Cele trei semne RMN aduc argumente valoroase în favoarea diagnosticului endometriozei fără a putea însă stabili diagnosticul de certitudine, care trebuie confirmat prin EHP. [ABSTRACT FROM AUTHOR]

În chirurgia vaginală reconstructivă, rezultatele funcţionale nu se corelează liniar cu rezultatele anatomice. Prolapsul genital și incontinenţa urinară se asociază cu reducerea excitării sexuale, cu raritatea orgasmelor și dispareunie. Dispareunia și disfuncţia sexuală după chirurgia vaginală sunt raportate diferit de către diferiţi autori. Dimensiunile fizice ale vaginului nu influenţează semnificativ funcţia sexuală. Locul chirurgiei vaginale are un impact mai semnificativ asupra ratelor dispareuniei postoperatorii. Repararea peretelui vaginal posterior a fost asociată cu o rată mai mare a dispareuniei postoperatorii, mai ales atunci când se efectuează o plicaturare a mușchilor ridicători anali. Din cauza datelor contradictorii în ceea ce privește repararea cu meșă, trebuie cântărite cu atenţie beneficiile rezultatelor durabile comparativ cu impactul posibil negativ asupra funcţiei sexuale. Activitatea sexuală, cât și satisfacţia sexuală trebuie să constituie criterii de măsurat după tratamentul chirurgical reconstructiv vaginal. [ABSTRACT FROM AUTHOR]

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

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

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

Preeclampsia (PE) rămâne o problemă majoră a obstetricii, reprezentând una dintre principalele cauze de mortalitate și morbiditate materno-fetală. Obiectivele acestei cercetări au fost evaluarea parametrilor Doppler la nivelul arterei uterine (IP, notch-ul și combinațiile acestora) la gravidele cu risc, în trimestrul I și al II-lea de sarcină, cu scopul de a realiza o predicție cât mai precoce a PE. S-au considerat aspecte anormale ale Dopplerului arterei uterine prezența notch-ului bilateral și/sau a mediei IP >percentila a 95-a. Din lotul total de 120 de gravide luate în studiu, 26 au dezvoltat PE, reprezentand lotul I, iar 94 de paciente cu evoluție fiziologică a sarcinii au consituit lotul al II-lea. Examinarea Doppler a arterei uterine în trimestrul I de sarcină a evidențiat IP patologic la 26,9% gravide din lotului I și la 13,8% din lotul al II-lea. Prezenta notchului bilateral la nivelul arterei uterine în trimestrul I de sarcina a fost evidenţiata la 61,5% gravide din lotul I, și 41,5% din lotul al II-lea. Modificările globale ale parametrilor Doppler studiați în trimestrul I, au fost prezente la 65,4% gravide din lotul I și 48,9% din lotul al II-lea. Examinarea Doppler a arterei uterine în trimestrul al II-lea de sarcină a evidențiat IP patologic la 53,8% gravide din lotul I și 13.8% din lotul al II-lea. Analiza globală a parametrilor Doppler modificați în trimestrul al II-lea a evidenţiat IP patologic, notch sau asocierea acestora la 73,1% gravide din lotul I și la 23,4 % din lotul al II-lea. Examinarea Doppler a arterei uterine constituie un test de screening non-invaziv eficient pentru apariția PE la sarcinile cu risc. Persistența notch-ului bilateral și constatarea unei valori anormale a IP din primul în al doilea trimestru au identificat grupul de paciente cu riscul cel mai mare de a dezvolta PE. [ABSTRACT FROM AUTHOR]

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

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

Recurența crescută a prolapsului genital după chirurgia reconstructivă pelviană atrage după sine necesitatea abordării unei tehnici chirurgicale de mare finețe, coroborată cu posibilitatea utilizării protezelor biologice sau sintetice pentru a asigura un suport adecvat. Corectarea simultană a tulburărilor de statică pelviană și a incontinenței urinare poate fi realizată cu ajutorul materialelor protetice care facilitează consolidarea tisulară și au rol suportiv local. O atenție sporită trebuie acordată potențialelor complicații care derivă din utilizarea acestor materiale: eroziuni, durere, infecții, dispareunie, perforația organelor adiacente. Selectarea pacientelor în vederea utilizării materialelor protetice în tulburările de statică pelviană este unul din elementele care pot contribui la reușita intervenției. Prezența factorilor de risc constituie elemente de prognostic nefavorabil pentru acest tip de intervenții. Este indicată adaptarea utilizării materialelor protetice la particularitățile anatomoclinice în vederea corecțiilor primare, secundare sau în cazul recidivelor și se impune ca avantajele protezării chirurgicale pelviene să depășească net riscurile de apariție a complicațiilor. Una dintre preocupările actuale este reprezentată de eroziunile cauzate de meșe. Rata apariției acestei complicații este variabilă în funcție de abordul chirurgical și de materialele utilizate. Dintre materialele protetice nonresorbabile, meșele fabricate din polipropilenă cu macropori au cea mai mică incidență a infecțiilor și a eroziunilor. În vederea minimizării ratei de apariție a complicațiilor, rigurozitatea tehnicii chirurgicale, experiența vastă a operatorului, calitatea materialelor protetice și terenul favorabil al pacientei sunt elemente care vizează reușita intervenției. [ABSTRACT FROM AUTHOR]

Background/aim: The aim of the study was to evaluate the serum concentration of main chemokines and interferons in patients with diagnosed endometriosis. Materials and methods: A total of 160 women were divided in two study groups (group 1 - endometriosis; group 2 - healthy women). Serum levels of IFN-α, IFN-γ, MCP-1, MIP-1α, MIP-1β, RANTES, eotaxin, IL-8, MIG, IP-10, and IL-17A were measured with Human Multiplex Cytokine Panels. Results. Serum levels of IFN-γ, MCP-1, and IL-8 were significantly higher (mean 14.03, 57.24, and 534.24, respectively, compared to 0.58, 20.51, and 259.82, respectively), and serum levels of IP-10 and eotaxin were significantly lower in women with endometriosis compared to the controls (mean 1.15 and 1.01, respectively, compared to 3.90 and 3.22, respectively). Conclusions. According to our results women with endometriosis have elevated levels IFN-γ, MCP-1, and IL-8, and lower serum levels of IP-10 and eotaxin, indicating unbalanced immune activity in endometriosis. [ABSTRACT FROM AUTHOR]

Background: Endometriosis is a frequent gynecologic disease with a severe impact on the quality of life in the affected women; its pathogenesis is yet to be fully understood, with an altered immunity as a possible key factor. The present study aimed to investigate the serum anti-inflammatory cytokine profile in the patients with endometriosis compared with the healthy controls. Materials and Methods: One hundred and sixty women were included, divided into two study groups (Group I -- endometriosis; Group 2 -- healthy women). We evaluated the serum levels of interleukin-1 receptor antagonist (IL-1Ra), IL-2, IL-2R, IL-4, IL-10, IL-13, and IL-15 with the use of Human multiplex cytokine panels. Statistical analyses (normality distribution analysis, independent t-test, Mann--Whitney U-test) were performed using IBM SPSS software (version 22.0) and GraphPad Prism (version 5.00); receiver operating characteristic curve were used to demonstrate the diagnostic performance of the studied markers. Results: The mean serum level of IL-1Ra, IL-4, and IL-10 were significantly higher in women with endometriosis compared to women free of disease from the control group (30.155, 138.459, and 1.489, respectively, compared to 14.109, 84.710, and 0.688, respectively; P < 0.001, P < 0.001, and P = 0.002, respectively.). No significant differences in the mean serum levels of IL-2, IL-13, and IL-15 were observed between the studied groups and IL-2R had a very low detection rate. Conclusion: Endometriosis is associated with elevated levels of anti-inflammatory cytokines, IL-1Ra, IL-4, and IL-10, markers that have a potential role as a prognostic factor for endometriosis. [ABSTRACT FROM AUTHOR]

Obesity is currently an important public health issue, registering a rapid increase in recent decades and affecting young people more and more frequently. The result is an increasing number of overweight or obese patients who reach reproductive age and become pregnant. Obesity is considered as an increased volume of adipose tissue which has well-known negative effects on multiple systems, but also on reproductive function. This piece of information led to the search for the existence of a connection between an increased Body Mass Index and the dysfunction of uterine contractility. Most cases of post-term pregnancy which usually require the induction of childbirth are observed in patients with increased Body Mass Index. The most important adipokines are represented by adiponectin, leptin, ghrelin, visfatin and apelin. Leptin has been demonstrated to act at smooth muscle fiber level in the vascular wall where it produces a decrease in calcium release from the sarcoplasmic reticulum, thus reducing the uterine contractile force. Leptin has an inhibitory effect on the frequency and amplitude of uterine contractions. Increased serum levels of leptin in obese women are involved in the inhibition of the apoptotic phenomenon involved in uterine involution. Visfatin exerts a more potent inhibitory effect compared to leptin upon uterine contractions. The inhibitory effect of ghrelin on uterine contractility involves a possible role in the regulation of myometrial activity. Apelin exerts a potent inhibitory effect on myometrial cells, causing a reduction in both the amplitude and the frequency of uterine contractions. Adipose tissue is currently regarded as a real endocrine organ, responsible for the production of bioactive polypeptides, adipocytokins. Adipokines exert modulating effects during pregnancy and there is evidence of their involvement in the pathophysiology of pregnancy-related complications. [ABSTRACT FROM AUTHOR]

Preeclampsia (PE), a multisystem pregnancy-associated disease, has a major contribution to maternal morbidity and mortality worldwide, affecting approximately 10 million women worldwide. PE is thought to occur as a consequence of several factors, including defective spiral artery remodeling, placental oxidative stress, endothelial dysfunction and systemic inflammation. Recently, microRNAs (miRNAs) have been associated with the pathogenesis of PE and could play an important role in the development of PE. MicroRNAs are intensely expressed in the placenta during a normal pregnancy. Thus, analyzing miRNAs in the sera of PE patients could enrich knowledge about the pathophysiological mechanisms of this disease. Recent articles highlight the relationship between the aberrant expressions of several miRNAs and negative pregnancy outcomes. A number of miRNAs, including miR-16, miR-29b, miR-34a, miR- 155, miR-210 and miR-675, have been shown to decrease the proliferation and migration of trophoblasts. At the same time, recent studies have shown that miR-210 and miR-155 are constantly aberrantly expressed in women with PE. Thus, by elucidating the functional role of these modified miRNAs, important pathways involved in PE could be identified and potential predictive/diagnostic biomarkers could be brought to light, which could be used in PE. Moreover, enriching our knowledge about the role of miRNAs in pregnancy-associated diseases is necessary in order to develop therapeutic strategies in the future. [ABSTRACT FROM AUTHOR]

The information provided by Doppler ultrasound examination during labor permits the understanding of the mechanisms regarding the physiology and pathophysiology of feto-placental exchange and the fetal adaptive systems. There are certain technical difficulties related to intrapartum Doppler ultrasound examination. The investigated sites are the uterine arteries, umbilical arteries, fetal circulation. In diastole, when intrauterine pressure exceeds maternal diastolic pressure, the perfusion pressure of the uterine artery blood flow is no longer present. A progressive decrease in the diastolic component is seen along with an increase in intrauterine pressure from 10 to 60 mmHg. During premature birth or preeclampsia, there are particular changes in the uterine blood flow. A remarkable stability of the umbilical resistance index is found during labor, which shows the permanent presence of feto-placental exchange. Certain correlations can be established between fetal heart rate changes in labor and Doppler ultrasound aspects at the level of umbilical arteries. Doppler examination confirms the concept of reduced cerebral blood flow by the compression of the fetal skull as a cause of decelerations occurring during labor. The decision regarding the extraction of the fetus can only be made by correlating the results of Doppler ultrasound with the other paraclinical methods for the monitoring of the intrapartum fetal status. [ABSTRACT FROM AUTHOR]

Aims: To analyse the intra- and interobserver variability of two elastographic methods of quantification available on the same machine, the technical factors that may influence variability as well as the intra- and interobserver variability for the same indices between two different ultrasound machines in an in vitro experimental setting.Material and Methods: Three different types of silicone experimental devices (ED) were conceived for the purpose of this study. Two observers performed repeated measurements on two ultrasound machines. Strain elastography, with strain ratio determination between the ED was performed on both machines. Shear wave ratio was also assessed. The data obtained were used to calculate intra- and interobservervariability. Reproducibility was assessed in relation to the size of the elastographic region of interest (ROI) and to the difference in stiffness between the ED, through the value of the ICCs (Intraclass Correlation Coefficient).Results: Strain ratio had high inter- and intraobserver reproducibility, regardless of the machine used, on a large number of determinations.The choice of a small ROI diameter (5 mm) over a large ROI diameter (15mm) increased reproducibility (ICC = 0.87 vs 0.78, p=0.000). It is observed that, by Shear Wave Elastography, only when analysing structures with a large difference in hardness, significance is obtained in terms of interobserver reproducibility (ICC = 0.75, p=0.000).Conclusions: On a large number of determinations, both techniques are inter- and intraobserver reproducible. It is preferable to opt for a smaller ROI diameter in order to increase interobserver reproducibility. SWE Ratio provides significant reproducibility only when analysing structureswith large difference in hardness. [ABSTRACT FROM AUTHOR]

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

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

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

Se consideră că 1-25% dintre femeile însărcinate necesită terapie cu levotiroxină pentru hipotiroidism. Principalele mecanisme adaptative tiroidiene în sarcină sunt: creşterea titrului seric al globulinei de legare a tiroxinei; scăderea disponibilităţii pentru iod; HCG-ul placentar, care are un efect tireostimulant; placenta secretă desiodază de tip 3, care antrenează o creştere a unui T3 inactiv. Valorile TSH-ului peste 2,5 mUi/e confirmă diagnosticul; T4 liber poate finormal sau scăzut. În contextul hipotiroidismului, se constată o creştere a incidenţei preeclampsiei, a naşterii premature, a DPPNI şi a hemoragiilor în post-partum. În caz de hipotiroidism matern, dezvoltarea fătului poate finormală. S-a evidenţiat că deficitul hormonilor tiroidieni în primul trimestru de sarcină poate induce întârziere de creştere fetală, deficit intelectual sau deficit motor spastic. Carenţa de iod reprezintă una dintre principalele cauze ale hipotiroidismului în cursul sarcinii. Decelarea hipotiroidismului în sarcină impune instituirea unui tratament precoce. În cazul pacientelor cu hipotiroidism anterior sarcinii, tratamentul trebuie adaptat. Strategiile de depistare a hipotiroidismului în sarcină trebuie să răspundă în principal la două întrebări: 1. Este necesar un bilanţ al funcţiei tiroidiene la toate femeile însărcinate? 2. Trebuie prevenită carenţa de iod? Evaluarea funcţiei tiroidiene ar trebui recomandată tuturor femeilor cu antecedente tiroidiene, în context familial de boli tiroidiene sau afecţiuni autoimune. Studiile recente insistă asupra interesului în ceea ce priveşte depistarea sistematică a tuturor disfuncţiilor tiroidiene în cursul sarcinii. Hipotiroidismul matern şi hipotiroidismul fetal exercită efecte adverse importante asupra fătului. Din aceste motive, hipotiroidismul matern ar trebui evitat. [ABSTRACT FROM AUTHOR]

The role of cervical cerclage in prolonging the gestational age constitutes a controversial topic in modern obstetrics, especially due to the increased morbidity and mortality associated with premature birth. The cervical cerclage represents an obstetrical manoeuver that strengthens the cervix, prevents amniotic membrane prolabation and preterm premature rupture of membranes, and extends the gestational age in singleton pregnancies. There are three distinct situations in which cerclage can be beneficial: prophylactic cerclage for cervical insufficiency; therapeutic cerclage, when ultrasound transvaginal evaluation of the cervix identifies modifications of length and/or shape, and emergency cerclage, in situations when we have dilatation of the cervix. The aim of our study was to asses retrospectively the circumstances of cervical cerclage in our clinic and to evaluate the benefits of this obstetrical manoeuver in prolonging the gestational age. [ABSTRACT FROM AUTHOR]

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