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Background and Objectives: This research investigated the morphometric dimensions of the optic foramen (OF), superior orbital fissure (SOF) and inferior orbital fissure (IOF), using indirect measurement techniques such as laser scanning, making it likely the first study of its kind. This study aimed to identify the morphometric variability of the main orbit communications and to highlight the differences between genders. Materials and Methods: The anthropometric study was conducted on sixty dry skulls (120 orbits) of adults aged between 20 and 70 years. Measurements of orbital communications were made using the RS6 laser scanner. The orbital parameters that were investigated are as follows: length and width of the SOF and IOF, and height and width of the OF. Results: In males, the average height of the OF was 8.27 mm and 8.13 mm in females, while the average width of the OF was 6.34 mm in males and 5.83 mm in females. The SOF average length was 21.09 mm in males and 17.58 mm in females. The widths of the SOF in the three thirds (anterior, middle and posterior) in males were 5.14/4.77/7.11 mm and 2.28/3.48/5.80 mm in females. The average length of the IOF was 33.05 mm in males and 32.30 mm in females. The widths of the IOF in the three thirds (anterior, middle and posterior) were 5.61/3.92/4.70 mm in males and 7.24/4.68/4.08 mm in females. Conclusions: The OF height and width were higher in males compared to females. The SOF length and width were higher in males compared to females. The IOF length was higher in males for the right orbit and higher in females for the left orbit. The IOF width for both orbits was higher in females in the anterior and middle third, and higher for males in the posterior third. Evaluation of dry skulls using laser scanning is reliable and recommended for data accuracy. Laser scanning can become a usable method for all indented and hard-to-reach regions of the cranial skeleton. [ABSTRACT FROM AUTHOR]

Endometriosis is a benign chronic disease with a major impact on a woman's quality of life, mainly due to painful physical symptoms. Endometriosis is also a common cause of infertility caused by low ovarian reserve, distorted pelvic anatomy, and severe local inflammation with a direct negative impact on the quality of oocytes, embryos, and endometrium. We conducted a retrospective study between January 2019 and December 2023, including women with a history of surgery for endometriosis who underwent in vitro fertilization (IVF) to achieve pregnancy. Their reproductive outcome was compared with a group of patients with documented tubal obstruction. The aim of our study was to identify the factors associated with a positive impact on the pregnancy rate, specifically age, anti-Mullerian hormone (AMH), ovarian stimulation protocol, and types of gonadotropins used. We analyzed a group of 175 patients with endometriosis compared with 189 patients with tubal obstruction. The average age was similar between the two groups but with a difference in the average AMH value (1.63 ± 1.09 ng/mL vs. 2.55 ± 1.67 ng/mL). The most utilized ovarian stimulation protocol in both groups was the short gonadotropin-releasing hormone (GnRH) antagonist. The clinical pregnancy rate was 27.2% in the endometriosis group and 54.7% in the tubal obstruction group. Our study revealed that treatment with corifollitropin alfa in the endometriosis group was associated with a higher clinical pregnancy rate. AMH and age proved to be significant independent factors for the reproductive outcome. [ABSTRACT FROM AUTHOR]

Endometriosis is a common cause of infertility among reproductive-age women. A low ovarian reserve is associated with the presence of endometriotic cysts, and this is accentuated even more after surgery. Patients with a history of endometrioma are a special category of poor ovarian reserve requiring in vitro fertilization (IVF). The aim of this retrospective study was to evaluate the characteristics and outcome of ovarian stimulation and embryo transfer in women with a history of ovarian surgery for endometrioma compared with a control group with tubal factor infertility. A total of 146 patients had previous laparoscopic cystectomy for endometrioma (group A) and their IVF results were compared with 136 patients with documented tubal obstruction (group B). In both groups, the most frequently used ovarian stimulation protocol was the short antagonist in 84.24% versus 80.88%. The number of stimulation days was between 6 and 15 days in the two groups with a mean value of 12.76 days in group A and 9.47 days in group B. The clinical pregnancy rate was 26.77% in the endometrioma group and 39.68% in the tubal obstruction group. Patients with a history of endometrioma are less likely to conceive than those with tubal obstruction despite having similar ovarian reserve and stimulation results. [ABSTRACT FROM AUTHOR]

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Copyright of Obstetrică şi Ginecologie is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Obstetrică şi Ginecologie is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

THE IDENTIFICATION OF WOMEN HAVING OR BEING ABLE TO DEVELOP CERVICAL CANCER IS A MAJOR CONCERN WORLDWIDE EXPRESSED BY ENDEAVORS TO IMPLEMENT NEW METHODS OF SCREENING AND TRIAGE FOR PRECANCEROUS CERVICAL LESIONS (PCL). THE PRESENT WORK ENCOMPASSES RESULTS OF MANY TRIALS AND OBSERVATIONAL STUDIES PUBLISHED ON INTERNATIONAL DATABASES DURING LAST 10 YEARS. THE PURPOSE OF CURRENT STUDY IS TO HIGHLIGHT THE FEATURES OF ADVANCED BIOTECHNOLOGIES, CONCERNING THEIR CAPACITY OF LEADING TO AN EARLY RIGHT DIAGNOSIS SUPPORTING, TO COMPARE THE EFICACITY OF THESE TESTS SUCH SENSITIVITY AS SPECIFICITY, TO TRIAGE BETWEEN REGRESSIVE AND PROGRESSIVE PCL, TO HIGHLIGHT THE DIFFERENCE CONCERNING SCREENING METHODS ADOPTED BY THE NATIONAL PROGRAMMES WORLDWIDE. THE RESULTS SHOWED THAT PAP TEST IS AN EXPENSIVE METHOD, WITH HIGH LEVEL OF SUBJECTIVE ASSESSMENT AND WITHOUT POSSIBILITY OF DISCRIMINATION BETWEEN DIFERENT KINDS OF CYTOLOGIES. HUMAN PAPILLOMAVIRUS (HPV) GENOTYPE ALONE DOESN'T ALLOW TO DISTINGUISH TRANSIENT VERSUS PROGRESSIVE HPV INFECTION. IMMUNOSTAINING CYCLINE P16INK4A AND THE MORE PERFORMANT TEST, DUAL TEST P16INK4A/ KI 67 ALLOW THE TRIAGE OF CASES ABLE TO DEVELOP CANCER USED ALONE OR AS CO-TEST TO PRIMARY HPV SCREENING. PRIMARY CERVICAL SCREENING WITH HPV GENOTYPE ASSOCIATE WITH ONE OF CO-CIYTOLOGIC TEST IMPROVE THE ACCURACY OF AN EARLY DIAGNOSIS. [ABSTRACT FROM AUTHOR]

INTRODUCTION: CONTROLLED OVARIAN HYPERSTIMULATION (COH) MAY HAVE A NEGATIVE IMPACT UPON THE ENDOMETRIAL ENVIRONMENT, THUS, A "FREEZE-ALL" (FET) STRATEGY WAS CONSIDERED. METHODS: REVIEW INCLUDING 44 STUDIES EVALUATING 278.000 NEWBORNS AFTER ART, COMPARING THE RESULTS OF THE CLASSIC VERSUS FREEZE-ALL STRATEGY. RESULTS: THE CUMULATIVE LIVE BIRTH RATE (LBR) AND PREGNANCY RATE (PR) WERE SIGNIFICANTLY HIGHER IN THE "FREEZE-ALL" (FET) VERSUS ET (LBR: 60.55% VS. 45%, PR: RR 1.30 [CI 95%]). FET IS ASSOCIATED WITH A LOWER OBSTETRIC RISK [CI 95%]: THE FETUS HAS A LOWER RISK OF BEING SMALL FOR GESTATIONAL AGE RR: 0.59, LOW GESTATIONAL WEIGHT RR: 0.74, PREMATURE BIRTH RR: 0.74 BUT MORE INCREASED RISK OF CESAREAN RR: 1.10 AND LARGE FOR GESTATIONAL AGE RR: 1.49. WITH REGARD TO THE RISKS OF ANTEPARTUM HAEMORRHAGE, PLACENTA PRAEVIA, PERINATAL MORTALITY, CONGENITAL ANOMALIES AND SPONTANEOUS ABORTION RATE, THERE ARE NO CONSISTENT FINDINGS: SOME STUDIES CONCLUDED THAT THE RISK IS LOWER IN FET (0.67, 0.68, 0.8 AND, RESPECTIVELY 0,83), BUT MOST CONSIDER THAT THERE IS NO SIGNIFICANT STATISTICAL DIFFERENCE. GESTATIONAL HYPERTENSION IS CONTROVERSIAL, SOME STUDIES HAVE FOUND THAT IT IS MORE COMMONLY LINKED TO FET (RR: 1.29), BUT THE RESULTS ARE INSIGNIFICANTLY STATISTICALLY DIFFERENT. HOWEVER, FET IS AN INDEPENDENT RISK FACTOR FOR PLACENTA ACCRETA, 3 TIMES HIGHER THAN ET. MONOZYGOTIC MONOCHORIONIC PREGNANCY AFTER SINGLE-EMBRYO IS LOWER IN FET IN GENERAL (0.8%), BUT MATERNAL AGE BELOW 35 YEARS IS A RISK FACTOR IN FET CYCLES. CONCLUSIONS: "FREEZE-ALL" IS AN ELIGIBLE PROTOCOL. [ABSTRACT FROM AUTHOR]

INTRODUCTION: ENDOMETRIOSIS IS ONE OF THE MOST IMPORTANT CAUSES OF INFERTILITY IN REPRODUCTIVE AGE PATIENTS, BUT WHAT ARE THE MECHANISMS INVOLVED? THIS ARTICLE DESCRIBES STEP BY STEP THE PSYSIOPATHOLOGY BACKGROUND THAT LEADS TO PREGNANCY ACHIEVING IMPAIRMENT. METHODS: WE PERFORMED A REVIEW OF THE INTERNATIONAL SPECIALTY LITERATURE. RESULTS: ENDOMETRIOSIS DETERMINES MODIFICATION OF NEOANGIOGENESIS AND CELLULAR MEDIATED RESPONSE BY HIGH CONCENTRATIONS OF INFLAMMATORY CYTOKINES (IL1, IL6, TNF ALPHA, PROSTAGLANDIN, PROTEASES) AND ANGIOGENIC FACTORS (IL8 AND VEGF). THESE CAUSE ALTERATION OF THE PELVIC ANATOMY AND, IN ADDITION TO LOWERING AVB3 INTEGRIN ADHESION MOLECULE AND THE L-SELECTIN LIGAND, CONTRIBUTES TO ASSOCIATED IMPLANTATION FAILURE. NEVERTHELESS, OVULATION IMPAIRMENT BY MECHANICAL DISTRUCTION OR ALTERATION OF GRANULLAR CELLS FUNCTION WITH ESTROGEN AND PROGESTERONE SECRETION DEFICIENCY AND LUTEAL PHASE MODIFICATIONS HAVE A FERTILITY NEGATIVE IMPACT. THE EMBRYOTOXICITY EFFECT COMES IN ADDITION TO THIS WITH AN INCREASED ABORTION RATE. ALTERATION OF SPERMATOZOA MOBILITY AND ENDOMETRIAL RECEPTIVITY, INCREASED UTERINE CONTRACTILITY AND FALLOPIAN TUBES OBSTRUCTION COMPLETE THE PICTURE OF INFERTILITY IN THE ENDOMETRIOSIS PATIENT. CONCLUSIONS: ENDOMETRIOSIS AFFECTS FERTILITY THROUGH MULTIPLE MECHANISMS, AND IN ORDER TO TREAT AND GET PREGNANCY IN THESE PATIENTS, IT IS NECESSARY TO UNDERSTAND THEM. [ABSTRACT FROM AUTHOR]

Introduction. Premature birth is the leading cause of perinatal morbidity and mortality and its prevention is a priority for maternal-fetal medicine. Our paper presents an analysis of the pregnancy outcome in patients diagnosed with a sonographic short cervix after treatment by three different methods: progesterone, cervical cerclage and vaginal pessary. Methods. We selected representative articles from literature and analyzed the pregnancy outcome in women diagnosed with a short cervix by ultrasound in the second trimester and treated with progesterone, cerclage cervical and vaginal pessary. Results. Ultrasound diagnosis of a short cervix is the most important sign that predicts premature birth. Progesterone administered by vaginal route (in the form of200 mg tablets or 90 mg gel) was associated with a statistically significant reduction in the incidence of preterm birth and perinatal morbidity and mortality. Cervical cerclage and vaginal pessary reduce the rate of premature births only in certain cases and there is no significant difference between the treatment with progesterone and cerclage/pessary to prevent prematurity. Conclusions. In singleton pregnancy with a short cervix, without obstetrical history of premature births, progesterone reduces the incidence of preterm birth and neonatal morbidity and mortality. In twin pregnancy with a short cervix, cerclage is inefficient for preventing preterm birth and progesterone may be effective to improve neonatal outcome. Vaginal pessary is inefficient in reducing premature birth rates both for singleton and twin pregnancies. [ABSTRACT FROM AUTHOR]

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Introduction. Isthmocele is a a defect of the anterior wall of the uterine isthmus located at the site of a previous cesarean delivery scar. Although in the last two decades the number of caesareans is globally on an ascending trend and the incidence of isthmocele is directly proportional increasing, the effects of this condition are insufficiently known and debated. Material and method. This paper presents an analysis of the isthmocele consequences based on literature review. Results. Isthmocele represents a vicious scarring of the uterine wall that leads to anatomical distortion of the uterus. Isthmocele can cause abnormal uterine bleeding, chronic pelvic pain and secondary infertility. The obstetrical consequences are abnormal insertion of the placenta and uterine scar pregnancy. Conclusion. Isthmocele incidence is increasing and frequently underdiagnosed. Isthmocele causes uterine distortion, thereby affecting the quality of life of the patients and serious complications in future pregnancies. Minimally invasive surgery is recommended for preventing and improving complications determined by isthmocele. [ABSTRACT FROM AUTHOR]

Copyright of Ginecologia.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

Copyright of Ginecologia.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ginecologia.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives. Assessment of key endometriosis diagnostic ultrasound techniques, highlighting technique, advantages and limitations of each method. Method. We reviewed the literature for different methods of ultrasound diagnosis of endometriosis and selected representative articles. In each study, final diagnosis of endometriosis was established on laparoscopy and/or histopathological examination. Results. We included 16 studies that investigated the use of ultrasonographyin the endometriosis diagnosis. Of these, 13 were prospective studies, a prospective studybased on personal cases, a presentation of a ultrasound technique (sonorectovaginography) and a review study that researched the accuracy of rectosigmoid deep infiltrative endometriosis diagnosis by transvaginal ultrasound (TVS). Data was analyzed by comparing statistical indicators for every sonographic investigation: prevalence, sensitivity, specificity, positive and negative predictive value. Conclusion. TVS stands as the first choice investigation for non-invasive diagnosis of endometriosis. TVS has an increased accuracy in detecting lesions of the ovaries, bladder and rectosigmoid. TVS with water contrastin the rectum (RWC- TVS) and sonovaginography prove to be more useful in detecting recto-vaginal lesions and are recommended to be used in cases where TVS can not exclude rectum infiltration. Transrectal ultrasound indications are limited to cases with a significant discrepancy between the results of clinical examination and TVS and is considered to be the best technique for evaluating the craniocaudal extension of rectal endometriosis. Gel sonovaginography and sonorectovaginography are effective diagnostic methods of endometriosis of the recto-sigmoid and posterior compartment. [ABSTRACT FROM AUTHOR]

A lot of methods have been used to evaluate the lower uterine segment after cesarean section: hysterography of the uterine scar, pelvic examination, amniography, x-ray pelvimetry and ultrasonography. The present study consisted of 275 secondiparous with the gestational age between 36 and 38 weeks. All recruited patient were evaluated by transvaginal ultrasound in order to characterize the lower uterine segment (LUS). LUS thickness was measured as the distance between the two calipers placed at the urinary bladder - myometrium interface and at the myometrium - chorioamniotic membrane interface. The appearance of the LUS where classified into three categories, where class I and II are considered non-dehiscent and class III was considered dehiscent. Therefore, the intraoperative assessment results included 19.6% patients in class III (dehiscent LUS, uterine content visible) and 80.4% patients in class I and II (non-dehiscent LUS). In the intraoperative non-dehiscent group 25.8% patients were included in class I (normal, well-developed LUS) and 54.6% were included in class II (thin LUS, uterine content not visible). The results showed that at a LUS thickness less than 2 mm carries a higher risk for dehiscence (incomplete uterine rupture) than those with a thickness more than 2 mm. [ABSTRACT FROM AUTHOR]

Cystic hygroma represents a fluid accumulation in different structures, often cephalic, on the left side, with an incidence of 1/6000-1/16,000. Karyotype anomalies are found in 20-75% of cases, most frequently Turner, Down, Klinefelter, Edwards and Patau syndromes. Subchromosomal abnormalities include Noonan syndrome, Fryns syndrome, multiple pterygium syndrome and achondroplasia, and also maternal alcohol consumption. We report a series of cases diagnosed in the first trimester with cystic hygroma and their genetic determinacy. The first patient was diagnosed at 11.6 weeks of gestation with a large cystic lesion sheltering the entire fetus, with omphalocele, AVSD and arthrogryposis. The patient decided the termination of pregnancy and the karyotype confirmed the Down syndrome. The second patient, having a term birth by caesarean section followed by five first-trimester miscarriages, presented at 8.5 weeks of gestation, with an ultrasound image of large cystic hygroma causing double contour suggestive for fetal hydrops and no fetal heartbeat. The abortion product karyotype revealed Turner syndrome. Couple karyotyping and genetic counseling were recommended, showing a 46,XX/47,XXX mosaicism in the mother, respectively an addition in the 9th pair of chromosomes in the father – 46,XY,add(9)(p12), for which arrayCGH was recommended in order to detect a possible chromosomal balanced translocation, which was ruled out. The third patient, with history of two early pregnancy miscarriages and two failed IVF procedures, presented with a spontaneous 11.6-week pregnancy showing cystic hygroma, medium size omphalocele, micrognathia and hypoplastic nasal bone. The parents decided the termination of pregnancy and the karyotype revealed trisomy 18. The fourth patient was diagnosed in the first trimester with a large left laterocervical cystic mass, consistent with lymphangioma. The follow-up showed normal development and amniocentesis revealed a normal karyotype. An appropriate weight neonate was born at 38 weeks by caesarean section, with a good postnatal transition, expecting removal surgery of the cervical lymphatic cyst sized 12 cm. We suggest a significant association between cystic hygroma and karyotype anomalies, stronger in patients with obstetrical failure history, validated by invasive genetic testing. [ABSTRACT FROM AUTHOR]

Introduction. Symptomatic pelvic organ prolapse has a relatively high prevalence and women have a 13-20% lifetime risk of having a surgical procedure to repair vaginal support defects. Despite the anterior vaginal compartment being the most common site of pelvic organ prolapse, the loss of apical support is typically associated with defects that usually occur at the insertions of cardinal-uterosacral ligament complexes, pubocervical fascia, and rectovaginal fascia to the pericervical ring. In addition to the midline defects in the posterior vaginal wall, detachments of the rectovaginal fascia along the arcus tendineus fasciae rectovaginalis and breaks at the pericervical ring insertion are responsible for the lateral and transverse defects, respectively. All of these defects can form rectoceles. Minimally invasive pelvic surgery to correct apical prolapses and posterior defects primarily includes laparoscopic or robotic assisted hystero-/sacrocolpopexy for defects that are more than grad III (grade III and IV) and the native tissue alternative of uterosacral ligament culdoplasty and suspension for defects that are less than grad III (grade II or III). Materials and method. In this paper, we present several cases of pelvic organ prolapse through which we highlight the techniques and advantages of the minimally invasivepelvic reconstructive surgery. Results. The gold standard procedure for apical prolapse that are grade III or IV remains the sacral colpopexy that suspends the vaginal vault by reinforcing the anterior and posterior vaginal fibromuscularis with mesh secured to the anterior longitudinal sacral ligament. The laparoscopic or robotic repair techniques of a uterine or vaginal vault prolapse or a rectocele that are grade II or III must address the reconstruction of the pericervical ring and its attachments to the cardinal-uterosacral ligament complexes, pubocervical fascia, and rectovaginal fascia by approaching the uterosacral ligaments together and reattaching to these ligaments. Conclusions. Sacrocolpopexy is the gold standard repair for apical prolapse that are grad III or IV for those who desire to maintain their sexual function, and minimally-invasive approaches offer similar efficacy with fewer risks than open techniques. Laparoscopic or robotic uterosacral ligament culdoplasty and suspension with reinforcing of the pericervical ring is a safe and effective native tissue option for grade II or III defects. [ABSTRACT FROM AUTHOR]

Introduction. The use of minimally invasive surgery with robotic assistance has grown exponentially since its approval. Applications include benign afflictions and staging and management of gynecologic malignancies. The rapid adoption of robotic technology comes from the enhanced visualization, wristed instrumentation, and improved ergonomics inherent to such systems, enabling more surgeons to perform minimally invasive procedures previously restricted to surgeons with advanced laparoscopic skills. Such technology may also enable those with laparoscopic experience to perform more complex cases that would otherwise require open techniques. Compared with traditional laparoscopy, robotic platforms are promoted as resulting in less blood loss, less postoperative pain, shorter hospital stay, and higher lymph node retrieval, although perhaps at the expense of cost. Compared to robotic surgery, laparoscopic surgery has certain limitations, such as two-dimensional imaging, restricted range of motion of the instruments, and poor ergonomic positioning of the surgeon. Materials and method. In this paper, we present our personal experience of 1171 surgical interventions regarding laparotomy versus laparoscopy versus robotic surgery. Results. Although the available literature suggests that robotic and laparoscopic techniques seem to be no different for many outcomes, there is compelling evidence that robotics has advantages over open techniques. Of the three outcomes that we believed had the most critical effect on patient care (operative time, length of hospital stay, and days to return to normal activity), there was a consistent trend toward reduced length of stay for robotic surgery compared to laparotomy. A total of 1171 interventions have been performed either by laparotomy, vaginal, laparoscopic or robotic. Out of these, 491 (41.92%) were performed laparoscopically and 83 were performed robotically (7.08%). Regarding the indications of the interventions, 414 (84%) laparoscopical interventions were performed for benign afflictions and 77 (16%) for malignancies. From the 83 robotic surgeries, 56 (75.9%) were performed for benign diseases and 20 (24.1%) were performed for malignancies. The cases of complex comorbidities, such as severe adhesions, obesity or deep infiltrating endometriosis, are well suited for robot-assisted surgery. More extensive interventions in deep infiltrating endometriosis with partial resection of the bowel or bladder can also be performed with lower complication rates by this minimally invasive approach. The use of robotic surgery for malignant gynecological diseases is increasing in proportion to centralization and the availability of the robot. The use of the robot may be meaningful even in fertility-conserving operations like trachelectomy. Conclusions. Overall, there seems to be an advantage to robotic techniques over traditional open surgery in the management of gynecological afflictions. Therefore, the specific method of minimally invasive surgery, whether laparotomy, conventional laparoscopy or robotic surgery, should be tailored to patient selection, surgeon ability and equipment availability. [ABSTRACT FROM AUTHOR]

Introduction. Vulvar cancer is the fourth most common gynecological malignancy. According to predisposing factors, vulvar cancer can be categorized into two types: the first type is found in younger women and is correlated with HPV infection. The second type is independent of HPV and occurs in elderly women. Squamous cell carcinoma accounts for 90% of the vulvar cancer. Early-stage disease is defined as stage I or II. Locally advanced disease is defined as stage III or IVA. Stage IVB disease refers to women with distant metastases. Materials and method. We present a systematic review in which we included articles concerning the treatment of advanced vulvar cancer. We will also present several cases of advanced vulvar cancer in order to demonstrate the right management of such cases. Results. The treatment of vulvar cancer involves a combination of surgery, radiotherapy and, rarely, chemotherapy. If the disease is locally advanced and the lesion is ≥1 cm from the median line, a radical vulvectomy and ipsilateral dissection of the inguino-femoral lymph nodes are performed. If the lesion is in median line, a radical vulvectomy and bilateral dissection of the inguino-femoral lymph nodes are performed. If the lymph nodes are positive, it can be opted for external beam radiotherapy of the primary tumor, lymph node and pelvis. If the nodes are negative, external beam radiotherapy of the primary tumor is performed. In all cases, adjuvant treatment follows. In patients with large tumors (above 4 cm) and macroscopic nodal metastases or extended localized disease to adjacent organs, the treatment course consists of chemoradiation with external beam radiotherapy to the tumor, groin and pelvis, as well as chemotherapy and surgery with perineal reconstruction. Conclusions. The basic treatment for vulvar cancer is surgery, but the radical nature of the procedure and adjuvant chemoradiation depends on the affectation of the lymph nodes in the inguino-femoral region and on the size of the tumor. The treatment can be long lasting and have a major impact on the quality of life. Perineal reconstruction can be accomplished using vulvoplaty, musculocutaneos flap, gracilis muscle flap, local flaps (transposition flaps) and biological graft flaps, with good results. [ABSTRACT FROM AUTHOR]

Introduction. The increasing incidence of abnormal insertion of placenta justifies the need to highlight which are the frequent factors involved in this pathology and to improve the methods able to sustain a prenatal diagnosis of abnormal placenta spectrum disorders, so useful to avoid a catastrophic postpartum hemorrhage. Material and method. The study was conceived by analysis of articles and clinical guidelines published online concerning the placenta accreta spectrum disorders (PAS) in the last five years. The study allows to clarify the terms that define PAS, the factors that frequently generate this pathology, and the ultrasonographic criteria able to support PAS diagnosis. Results. The most proper terminology remains the one launched by Luke (1966), because it includes all three significant criteria, such as the depth of the myometrial invasion of the villi, the lateral extension of the placenta accreta, and the variable degrees of myometrial invasion in the same placenta. Among the factors most frequently involved, there are repeated caesarean sections, uterine curettages and manual extraction of the placenta. The features of ultrasonographic criteria were the loss of hypoechogenic space, placental abnormal lacunae, loss or disruption of bladder wall continuity, thinning of the thickness of the myometrium, bulging of the placenta, focal placental exophytic, color Doppler changes such as uterovesical hypervascularization, subplacental hypervascularization, “bridging vessels” and Doppler intramiometrial vessels with high velocimetry oriented to the placental lacuna. The three-dimensional (3D) power Doppler sonography shows placental hypervascularization, vessels with a twisted path and different caliber. MRI is recommended to validate if a posterior placenta is accreta too. Conclusions. Women with risk factors for PAS should be screened by US at 11-14 weeks of pregnancy. The US criteria for antenatal diagnosis of SAP must be checked in the second trimester of pregnancy to avoid a catastrophic postpartum hemorrhage associated with disseminated intravascular coagulation syndrome. [ABSTRACT FROM AUTHOR]

Introduction. The standard treatment for earlystage cervical cancer is represented by radical hysterectomy with pelvic lymphadenectomy. Laparotomy has been the main choice of approach for a long period of time and, although effective, it is highly invasive and associated with increased morbidity, longer hospital stay and postoperative complications. Since the early 1990’s, radical hysterectomy with pelvic lymphadenectomy has been successfully performed laparoscopically. The use of minimally invasive techniques has led to better postoperative outcomes, lower intraoperative blood loss and shorter hospital stay. Although there is recent debate concerning the significant inferiority of the minimally invasive approach followed by the LACC (laparoscopic approach to cervical cancer) study in 2018, there are recent studies that question its findings and that sustain that there is still an important place for minimally invasive surgery in early cervical cancer. Materials and method. We present a systematic review in which we included articles regarding minimally invasive surgery in cervical cancer and the future perspective of this approach. Results. There are several meta-analyses that compared minimally invasive surgery with open surgery for early cervical cancer. Regarding intraoperative blood loss, hospital stay and postoperative complications, there are four meta-analyses which conclude that laparoscopic approach is superior to the abdominal one. The careful selection of patients can lead to excellent oncologic outcomes. The results from the studies incriminating minimally invasive surgery showed no significant differences in disease-free survival rate and overall survival rate for low-risk cervical cancer (tumors below 2 cm, no lymphovascular space invasion, depth of invasion below 10 mm and negative pelvic lymph nodes). So, at least for these patients, minimally invasive surgery is naturally a better solution. Fertility sparing surgery includes mainly patients with low-risk cervical cancer, a category for which minimally invasive surgery should be primarily used for. Conclusions. While there are still aspects that undoubtedly need to be improved concerning a standardized technique, minimally invasive surgery still has an important role in the treatment of early-stage cervical cancer. [ABSTRACT FROM AUTHOR]

Introduction. With nearly 570,000 new cases per year and 310,000 deaths per year, cervical cancer is the second most frequent cancer in women and the third leading cause of cancer-related deaths in females. Good oncologic outcomes after surgery have been reported for early-stage cervical cancer with a disease-free survival of 90.6% at three years and 96.5% at 4.5 years, respectively, and an overall survival of 96% and 99%, respectively. For this subset of patients, lymph node status is a major prognostic factor since five-year disease-free survival falls from 88% to 57% in case of lymph node metastasis. Materials and method. We present a systematic review in which we included articles regarding the sentinel lymph node mapping and the future perspective of this procedure. Results. According to the international guidelines for the treatment of early-stage cervical cancer, the gold standard treatment includes pelvic-lymph-node dissection (PLND) in order to adapt the treatment to a potential lymphatic metastasis. A lymph-node metastasis is present in 27% of early cervical cancers, leading to a high rate of overtreatment with unnecessary pelvic lymphadenectomy in three out of four patients. Moreover, this lymphatic surgery is known to induce significant morbidity and can lead to a decreased quality of life. The sentinel node detection rate is high in women with early-stage cervical cancer (96.3%, with 82% bilateral detection). Sentinel node mapping has a sensitivity of 96.3% and a negative predictive value of 98.7% in women with tumor size above 20 mm. This high sensitivity, with a low risk of complications after it, concludes that sentinel lymph node biopsy is a very promising technique but demands full adherence to the sentinel lymph node algorithm and experience with this method. Conclusions. The current trend in cervical cancer management is focused on less aggressive strategy without jeopardizing oncologic outcomes. The sentinel lymph node biopsy is a sturdy alternative to systematic full pelvic lymphadenectomy for lymph node staging in early-stage cervical cancer. According to the abundant literature, there is a trend in the acceptance of sentinel lymph node biopsy in current clinical practice and, in time, maybe will became the gold standard of node staging in early-stage cervical cancer. [ABSTRACT FROM AUTHOR]

Introduction. Endometriosis is an estrogen-dependent chronic inflammatory disease defined as the presence of endometrium-like tissue outside the uterus. Due to the steroid-dependent nature of the disease, it was considered that endometriosis lesions regress and most frequently disappear after the menopause, but more recent information showed that women with a history of endometriosis may experience the worsening of symptoms and the reactivation of residual disease. Materials and method. We present our clinic experience and a systematic review concerning endometriosis in menopause, manifestation, management and treatment. Results. The prevalence of postmenopausal endometriosis is estimated to be about 2-5% of all patients diagnosed with endometriosis. As it is well known, no existing theory can explain the development of all endometriosis lesions. It is believed that, in early menopause, endometriosis is due to an estrogen responsive tissue – for example, increased ovarian estrogen secretion during the first years of menopause or conversion of precursor steroids to estrogens in peripheral tissue. During the late menopause, endometriosis can be explained by genetic and/or epigenetic incident causing estrogen-independent progression, increased sensitivity to estrogens or increased local production of estrogens. Menopausal hormone therapy is believed to stimulate the growth of endometriosis. However, endometriosis has also been reported in postmenopausal women who do not use hormone therapy, which underlines the complex pathogenesis of this disease. Knowing the increased potential risk of underlying malignancy in this population, hormone therapy approaches are more limited and it is suggested that the first-line treatment for endometriosis in postmenopausal patients should be surgical. Conclusions. Although it is a rare disease, peri- and post-menopausal endometriosis should be taken into account due to the risk of disease recurrence and malignant transformation. Understanding the genetic or epigenetic incidents involved, the hereditary incidents and the environmental factors will be important for prevention, diagnosis and therapy. Postmenopausal endometriosis seems to expose the patient to a higher risk of malignant transformation. Due to the lack of high-quality studies, the therapeutic conduct in patients with a history of endometriosis during menopause is not clear. The surgical excision should be taken into consideration due to the risk of disease recurrence and malignant transformation. Multicenter randomized trials or large observational studies are needed to inform clinicians and patients alike. [ABSTRACT FROM AUTHOR]

Introduction. Endometriosis is a common gynecological condition among women of childbearing age, associated with chronic pelvic pain, dysmenorrhea, infertility and impaired quality of life. Although the internationally accepted gold standard is the diagnostic laparoscopy, the preoperative noninvasive diagnosis methods – clinical examination, transvaginal ultrasound and magnetic resonance imaging (MRI) – are an important step in the correct preoperative diagnosis of endometriosis. The aim of this paper is to determine the ideal method of preoperative noninvasive diagnosis depending on the symptoms and location of endometriosis lesions, whether clinical examination and transvaginal ultrasound are sufficient or when MRI examination is necessary. Methodology. We performed, on a group of 96 patients diagnosed with endometriosis, imaging examination by transvaginal ultrasound and MRI before the surgical treatment of the lesions, with the collection of biological samples for histopathological examination. The results obtained after the intervention were observed, comparing the lesions identified preoperatively with those excised during surgery. Results. MRI provides accurate information for the staging of deep endometriosis, especially when the case does not allow a transvaginal ultrasound examination – it is limited by chronic pelvic pain, virgo intacta or obese patient. MRI is used when the clinical examination and ultrasound do not identify lesions in symptomatic patients (parametric lesions, uterosacral ligaments). The association of MRI increases the sensitivity of transvaginal ultrasound in the diagnosis of endometriosis in these cases (70.3% compared to 11.3%). Large endometriosis lesions that can be easily identified on clinical examination and ultrasound do not require MRI (rectal nodules d≥2 cm, endometriomas d≥4 cm). For intestinal endometriosis, MRI and ultrasound have similar efficiency (83.78% and 87.75%). Discussion and conclusions. Although it is not a routine investigation in all patients suspected of having endometriosis, MRI is effective in identifying the lesions. It is necessary for the gynecologist to request an MRI investigation when the transvaginal ultrasound is insufficient or cannot be performed. The methods depend on the experience of the gynecologist and radiologist in making a preoperative assessment of the lesions, so that the surgical treatment is performed in the most complete way possible. [ABSTRACT FROM AUTHOR]

Objectives. Platelet-rich plasma (PRP) is gaining more and more popularity as a minimally invasive option for a series of disease, therefore it is important to be informed about the potential use and indications of this therapy. Platelets stimulate the natural healing process of tissue, having 5- to10-fold higher concentration of growth factors than the whole blood, and in the same time no side effects. Methodology. This is a literature review highlighting the results of the use of PRP in different gynecological pathologies. Results. Platelets promote healing and attract stem cells to the site of the injury, thus they stimulate the natural healing process. PRP can be successfully used for faster re-epithelialization in the treatment of cervical ectopy or vulvar dystrophy (lichen sclerosus, kraurosis vulvae), for obtaining lower rates of wound infection, necrosis and wound dehiscence, and shorter recovery time in breast and vulvar reconstructive surgery and in fistulae treatment. In addition to these, it has been shown that PRP addition with absorbable and nonabsorbable vaginal meshes used in pelvic floor reconstructive procedures is associated with a better functional outcome. Nevertheless, PRP plays an important role in reproductive medicine, when used in premature ovarian failure for “ovarian rejuvenation”, in ovarian torsion for a better reperfusion, in intrauterine infusion for a better endometrial growth and receptivity. In vitro, it is demonstrated to seal amion tears and enhance membrane healing, preventing the premature rupture of membranes. Last but not least, PRP is used in aesthetic gynecology, including female sexual dysfunction (O-Shot, G-Shot therapy, vaginal rejuvenation). Conclusions. PRP is a simple but effective therapeutic modality to treat numerous noninvasive or minimally invasively gyneologic conditions, it has no side effects, and it is worth to be studied on a large scale and clinically used. [ABSTRACT FROM AUTHOR]

Objectives. This is a review of literature, highlighting the results of the use of pulsed CO2 laser for the treatment of vulvovaginal atrophy (VVA) in postmenopausal women. Methodology. We included 11 clinical studies and 3 histopatological studies, involving more than 1500 participants. All patients received three laser sessions, one at every 4-6 weeks. All studies included an examination before the procedure, then one after each session. Some studies included evaluation at follow-ups at 3, 6, 12, 18 and 24 months. We selected the studies based on the same evaluation scales: Visual Analog Scales (VAS), Vaginal Health Index Scores (VHIS), Female Sexual Function Index (FSFI) and Short Form 12 questionnaires (SF-12), and the participants’ satisfaction was measured on a 5-point Likert scale (1 = very dissatisfied; 5 = very satisfied). These scales were used to assess pain, vaginal burning, vaginal itching, vaginal dryness, dyspareunia and dysuria. Results. The data indicated in all available publications a significant improvement in VVA symptoms (vaginal dryness, burning, itching and dyspareunia; p<0.001) and overall, after 3 sessions, 92.58% of thepatients were satisfied or very satisfied. In the long-term studies, the satisfaction of the patients at 6 months was 92%, at 12 months it was 82.66%, at 18 months it was 63%, and at 24 months it was 25%. The objective histological measurements of the effect of laser therapy improved significantly as well. Conclusions. Histological and clinical evidence supports the use of CO2 lasers in the treatment of VVA. The long-term data showed that the improvement of vaginal health continues up to 12 months after fractional CO2 laser treatment, and progressively decreses up to 24 months. [ABSTRACT FROM AUTHOR]

Introduction. The “freeze-all” (FET) strategy was considered by the international reproductive societies, as it was observed that the controlled ovarian hyperstimulation (COH) may have a negative impact upon the endometrial environment, affecting the implantation process or the development of the pregnancy. Methodology. We performed a systematic review, including 44 studies evaluating 278,000 newborns after ART, comparing the results of the classic ET versus “freeze-all” strategy. Results. The cumulative live birth rate (LBR) and pregnancy rate (PR) were significantly higher in the “freeze-all” strategy versus ET (LBR: 60.55% versus 45%; PR:RR 1.30 [CI 95%]). FET is associated with a lower obstetrical risk (CI 95%): the fetus has a lower risk of being small for gestational age (RR: 0.59), low gestational weight (RR: 0.74), premature birth (RR: 0.74), but a more increased risk for caesarean section (RR: 1.10) and large for gestational age (RR: 1.49). With regard to the risks of antepartum haemorrhage, placenta praevia, perinatal mortality, congenital anomalies and spontaneous abortion rate, there are no consistent findings: some studies concluded that the risk is lower in FET (0.67, 0.68, 0.8 and, respectively, 0,83), but most studies consider that there is no significant statistical difference. Gestational hypertension is controversial, some studies finding that it is more commonly linked to FET (RR: 1.29), but the results were insignificantly statistically different. However, FET is an independent risk factor for placenta accreta, three times higher than ET. Monozygotic monochorionic pregnancy after single embryo is lower in FET in general (0.8%), but maternal age below 35 years old is a risk factor in FET cycles. Conclusions. All this information makes the “freezeall” strategy an eligible protocol in the future. [ABSTRACT FROM AUTHOR]

Cystic hygroma or lymphangioma was first described in 1843 and represents a lesion that can occur in any anatomical structure of the fetus, but is most frequently found in the cephalic region (75%), especially on the left side of the body. The incidence of the condition is reported as ranging from 1/6000 to 1/16,000 cases. Karyotype abnormalities are found in 20-75% of cases, the most frequently involved conditions being Turner, Down, Klinefelter, Edwards and Patau syndomes. Other nonchromosomal abnormalities associated with cystic hygroma are Noonan, Fryns, multiple pterygium syndomes and achondroplasia. Also, an important association between maternal alcohol consumption and this condition has been observed. We present a series of four cases diagnosed in the first trimester with cystic hygroma and their genetic determinance. The first patient, aged 42, IG, IP, was diagnosed at 11.6 weeks of gestation with a large cystic hygroma covering the entire fetus, omphalocele, atrio-ventricular septal defect, and arthrogriposis. The patient decided to terminate the pregnancy and the karyotype of the abortion product revealed Down syndrome. The second patient, aged 33, VIIG, IIP, with a personal history of a term birth by caesarean section followed by five misscariages in the first trimester, presented at 8.5 weeks of gestation an ultrasound aspect of large cystic hygroma causing double contour suggestive for fetal hydrops and no fetal heartbeat. The karyotype of the abortion product revealed Turner syndrome. Couple karyotyping and genetic counselling were recommended, showing a 46,XX/47,XXX mosaicism in the mother, respectively an addition in the 9th pair of chormosomes in the father – 46,XY,add(9)(p12), for which arrayCGH was recommended in order to detect a possibile chromosomal balanced translocation. The third patient, aged 38, IIIG, IP, with a personal history of two first-trimester misscariages and two failed IVF procedures, presented with a spontaneous pregnancy. At 11.6 weeks of gestation, the ultrasound revealed cystic hygroma, medium size omphalocele, microgratia and small nasal bone. The parents decided pregnancy termination and kayrotyping, which is still in progress. The fourth patient, aged 32, IG, IP, was diagnosed in the first trimester with a large latero-cervical cystic mass, consistant with a lymphatic cyst. The periodic follow-up showed no other abnormalities, and amniocentesis revealed a normal fetal karyotype. The neonate was born at 38 weeks of gestation by caesarean section and presented a normal weight and good adaptation to neonatal life, being programmed for surgery in order to remove the left sided cervical lympahtic cyst sized 12 cm. In conclusion, our small number of cases of fetuses with cystic hygoma suggests a relatively high association with genetic defects, especially in patients with personal history of obstetrical failure, which justifies us to recommend in these cases the genetic testing. [ABSTRACT FROM AUTHOR]

Introducere şi obiectiv. Endometrul uman este un țesut dinamic, care suferă cicluri de creștere și regresie cu fiecare ciclu menstrual. Celulele stem progenitoare adulte sunt probabil responsabile pentru această capacitate remarcabilă de regenerare. Aceleași celule stem progenitoare pot avea, de asemenea, o capacitate sporită de a genera endometrioză atunci când are loc o menstruație retrogradă. Celulele stem progenitoare se află în uter și, cu toate acestea, pot călători și din alte țesuturi, cum ar fi măduva osoasă, pentru a repopula populația progenitoare. Celulele stem mezenchimale sunt, de asemenea, implicate în patogeneza endometriozei și pot fi sursa principală de endometrioză în afara cavității peritoneale atunci când se diferențiază în locații ectopice. Toate aceste date pot avea implicații clinice și pot oferi o bază pentru noi aplicații terapeutice potențiale. Metodologie. Prezența celulelor progenitoare în endometru și în sângele menstrual a condus la ipoteza că aceste celule ar putea fi cel puțin parțial responsabile pentru dezvoltarea endometriozei. Numeroase studii din ultimul deceniu au contribuit la consolidarea acestei ipoteze, prin abordări diferite. Într-un studiu, s-a sugerat că stratul bazal al endometrului a fost semnificativ eliminat în fluxul menstrual la femeile cu endometrioză, comparativ cu femeile sănătoase. Interesant este faptul că celulele stem endometriale sunt deosebit de frecvente în țesutul endometrial în timpul menstruației. S-a speculat că celulele stem endometriale pot juca un rol important în dezvoltarea implanturilor endometriale. Rezultate. Celulele epiteliale în unele leziuni ale endometriozelor sunt monoclonale, sugerând o singură origine celulară. Alte leziuni endometriale sunt policlonale, sugerând contaminarea cu celule stromale policlonale şi colonizarea repetată a leziunii cu celule din alte surse, cum ar fi măduva osoasă. S-au furnizat noi dovezi ale regenerării endometriale la pacienții cu transplant de măduvă osoasă care au primit măduvă dintr-un transplant de măduvă osoasă care nu corespunde cu antigenul unic HLA. Celulele epiteliale endometriale derivate de la donatori și celulele stromale au fost detectate în probele endometriale ale primitorilor de măduvă osoasă prin RT-PCR și imunohistochimie. Mobilizarea ciclică a celulelor stem derivate din măduva osoasă poate fi un proces fiziologic normal. Aceste constatări definesc o nouă teorie pentru etiologia transdiferențierii ectopice a endometriozelor de celule stem. Am arătat că celulele stem derivate din măduva osoasă pot contribui la endometrioză, explicând probabil apariția bolii în afara cavității peritoneale. S-a arătat că stratul bazal a fost eliminat semnificativ mai mult în fluxul menstrual, sugerând un număr crescut de celule stem din acest strat care pot duce la o tendință de endometrioză. Discuţie şi concluzii. Toate aceste abordări reprezintă exemple concrete ale noilor strategii terapeutice potențiale care ar putea duce la identificarea populațiilor de celule stem care contribuie la dezvoltarea leziunilor endometriale. Mai mult, celulele stem derivate din endometru s-au dovedit a fi utile în tratamentul mai multor boli cronice și adesea debilitante, inclusiv boala Parkinson și diabetul. Ele demonstrează că uterul este un organ dinamic permeabil la celule stem fetale capabile de transdiferențiere, precum și o sursă regenerabilă de celule stem multipotente. În timp ce avem încă multe de înțeles despre celulele stem, aplicațiile lor potențiale în biologia reproducerii și în medicină sunt nenumărate. [ABSTRACT FROM AUTHOR]

Introducere şi obiectiv. Endometrioza este o boală cronică având costuri mari, care provoacă durere pelviană și subfertilitate ca simptome principale, iar în funcție de localizare asociază alte simptome, precum durere pelviană ciclică, dismenoree, dispareunie, disurie şi dischezie. În prezent, testele neinvazive nu pot fi utilizate pentru diagnosticarea corectă a tuturor implanturilor de endometrioză în practica clinică, dar combinația optimă de imagistică preoperatorie poate crește rata de succes. Imagistica preoperatorie cu stabilirea unui diagnostic precis permite un plan optim pentru managementul chirurgical al endometriozei profunde infiltrate (DIE): planificarea abordării terapeutice optime și consilierea pacientei. Din cauza simptomatologiei nespecifice, diagnosticul de endometrioză rămâne o provocare - în prezent nu există un standard acceptat în unanimitate cu privire la algoritmul de diagnosticare. Metodologie. Am căutat în literatura de specialitate metaanalize, studii randomizate controlate și studii prospective cu privire la sensibilitatea ultrasonografiei transvaginale (TVUS) și a imagisticii prin rezonanță magnetică (IRM) pelviană în diagnosticarea DIE. Am comparat și am confirmat rezultatele cu statisticile noastre. Rezultate. Niciun examen imagistic folosit singular nu este suficient de performant pentru a identifica extensia DIE. TVUS este o procedură de cabinet, ieftină și repetabilă, care poate fi utilizată cu succes în diagnosticarea anumitor localizări ale DIE. TVUS reprezintă examenul de primă linie utilizat atunci când endometrioza este suspectată clinic. TVUS poate fi folosită pentru a identifica localizări anatomice suplimentare DIE, comparativ cu IRM, atunci când este efectuată de un expert. Precizia diferitelor tehnici ale TVUS în diagnosticul DIE a fost raportată diferit în funcție de localizarea leziunii. TVUS are o sensibilitate ridicată în detectarea DIE de la nivelul ligamentelor uterosacrate, septului rectovaginal, peretelui vaginal, spațiului Douglas și rectosigmoidului. Discuţie şi concluzii. Investigațiile imagistice suplimentare, cum ar fi TVUS-BP, RWC-TVUS, 3TMRI, MDCT-e etc., măresc sensibilitatea diagnosticului DIE. Suspiciunea ridicată de DIE preoperatorie permite o planificare optimă a intervenției chirurgicale, cu posibilitatea unei echipe multidisciplinare și consilierea corectă a pacientei. Cel mai important aspect în diagnosticarea DIE este reprezentat de experiența examinatorului. Specialiștii cu experiență în diagnosticarea și tratarea endometriozei au o rată ridicată de detecție a DIE preoperatoriu ultrasonografic. [ABSTRACT FROM AUTHOR]

We present a rare case of postpartum umbilical cord hematoma with unknown cause in a term newborn. The neonate was born by caesarean section indicated for failure of medical induction of labour in a 28-year-old primipara with a 41-week pregnancy. The mother did not suffer from any pathology throughout gestation, presenting a morphologically normal foetus and negative urine and cervical cultures. She delivered a 3690-gram male newborn, with an Apgar score of 9 at one minute and 10 at five minutes, following an uncomplicated caesarean section. The newborn presented good postnatal adaptation, and breast alimentation was initiated in the first day of life. The C-reactive protein (CRP) of the newborn was negative and his evolution was favourable in the first two days of life. In the third day of life, the neonate presented swelling of the umbilical cord stump, with a dark-red coloration, suggestive for hematoma. Antibiotic prophylaxis and local antiseptic therapy were initiated, CRP was repeated and bacteriological samples were collected, the results being negative. After two days of local antiseptic treatment, the umbilical stump fell and the umbilicus presented normal appearance. The evolution of the neonate was good, and he was discharged in the fifth day of life. The mother did not present any sign of infection or thrombosis, with a physiological recovery. The particularity of the case is represented by the rarity of the pathology, until present only a few cases of umbilical cord haematoma being described in the specialty literature. The etiology in this case is idiopathic, the infectious, malformative, thromboembolic and mechanical causes being ruled out. The only risk factor in our case could be represented by the advanced gestational age (41 weeks of pregnancy), which could explain partially the frailty of the umbilical cord vessels. [ABSTRACT FROM AUTHOR]

The abdominal cerclage is a therapeutic procedure that performs a reliable cervical canal obliteration in specific selected cases. The abdominal cerclage is indicated for cervico-isthmic incompetence in patients who had repeatedly failed transvaginal cerclage, and also in those with anatomical abnormalities represented by a very short or absent cervix due to congenital or surgical conditions. The paper aims to present a series of eight cases in which abdominal cerclage was performed. The abdominal cerclage can be performed through open abdominal route or laparoscopic. The procedure can be practiced prophylactically before conception or during pregnancy, in the first trimester of gestation either prophylactically, or as an emergency solution for imminent abortion. The abdominal cerclage is a safe procedure, with an excellent fetal outcome, and is an alternative treatment for cervico-isthmic incompetence. The advantages of the abdominal cerclage are represented by the placement of the cerclage tape in close proximity of the internal os, the absence of a foreign body in the vagina (that could cause infection), decreased risk of suture migration, and the ability to keep the suture in place for future pregnancies. The abdominal cerclage is the only therapeutic solution in patients with a history of recurrent abortions resulting from failed transvaginal cerclages, as well as in patients with very short or absent cervix. [ABSTRACT FROM AUTHOR]

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