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Fetal heart rate monitoring by cardiotocography (CTG) detects heart rate abnormalities, which can reflect various degrees of hypoxia. The main purpose of intrapartum fetal monitoring is not so much to prevent brain involvement, which is rarely caused by intrapartum asphyxia and is strangely seen by many authors as the main reason for monitoring, as to prevent all types of early and late neonatal morbidity induced by hypoxia and acidemia. CTG during labor is associated with a reduction of neonatal seizures, but without significant differences for cerebral palsy, infant mortality or other standard neonatal well-being measures. CTG has been associated with an increase in the number of cesarean sections and instrumental vaginal deliveries. Thus, a second examination has become necessary, which is represented by new technologies such as measurement of fetal pH, fetal pulse oximetry, and ST analysis of the fetal electrocardiogram. Each of the fetal monitoring methods introduced so far into practice seems to correspond to certain clinical scenarios. However, the obtained information is limited and depends on the investigated pathophysiological mechanism. In the 21st century, CTG continues to be the main intrapartum fetal well-being assessment method. [ABSTRACT FROM AUTHOR]

Infertility is usually defined as “failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse”, but in couples with advanced female age (>35 years), most practitioners initiate diagnostic evaluation after failure to conceive within 6 months. The ovarian factor is a key element in the evaluation of infertile patients. Ovulatory defects are present in 40% of infertile women and in approximately 15% of couples with infertility. The World Health Organization (WHO) classifies ovulation disorders into three groups: Group I - hypothalamic pituitary failure (hypothalamic amenorrhea or hypogonadotrophic hypogonadism), Group II - hypothalamic-pituitary-ovarian dysfunction (predominately polycystic ovarian syndrome) and Group III - ovarian failure. At ovarian level, within the process of ovulation, there is a micro folicullar stage of development (the anomalies of this stage are divided into two groups - micropolycystic ovaries and multifolicullar ovaries) and a macro follicular stage (with three different types of anomalies: macropolicystic ovaries, functional ovarian cysts and LUF syndrome). All of these anomalies can be assessed today using ultrasound techniques, especially transvaginal ultrasound. The term “ovarian reserve” has been used to describe the capacity of ovaries to respond to stimulation with gonadotropins and therefore to predict the fertility potential. There are 4 morphological markers used to appreciate the ovarian reserve: ultrasound evaluation of antral follicles, measurements of ovarian volume, average ovarian diameter and the evaluation of blood flow al the level of the ovarian stroma. Ultrasound examination plays a key role within the evaluation of the ovarian structure by being able to asses the ovulation/dysovulation processes and other causes of ovarian infertility (endometrioma, tumors). [ABSTRACT FROM AUTHOR]

Introduction/objectives. Romania ranks first regarding the incidence and mortality of cervical cancer (CC) in the European Union. The persistent infection with high-risk HPV subtypes is a confirmed precursor in the development of almost all invasive cervical cancers, with HPV 16 and HPV 18 being classically considered the most common oncogenic subtypes. The prevalence of various HPV strains varies widely across the globe. The objectives of this study were to determine the presence of HPV infection and the infectious viral subtype in patients with normal cervix, CIN and with cervical cancer hospitalized in our institution, as well as to evaluate the particularities of this infection according to certain clinical parameters, in order to prioritize the screening services for patients with high-risk characteristics for HPVinduced disease in our geographic region. Materials and method. A total of 77 patients admitted to the “Dominic Stanca” Clinic of Obstetrics and Gynecology, Cluj-Napoca, were enrolled in the study, grouped in three categories: Group 1 – Control (n=38), Group 2 – CIN (n=30), Group 3 – CC (n=9). For all patients, the diagnosis of the cervical condition was confirmed by histopathological examination. A complex clinical database was developed, followed by the detection of high-risk HPV strains by the HPV Genotypes 14 Real-TM Quant kit. The number of previous cyto-tumoral examinations, as well as the macroscopic appearance of the cervix at the gynecologic examination were also recorded. The SPSS v. 24.0 program was used for data analysis, considering the statistical significance at the standard level of 5%. Results. HPV infection was detected in 88.3% of the subjects and a large number of patients were coinfected with several HPV strains. The most prevalent HR strains were HPV 16, 58, 56, 52, 33 and 31. Considering a single examination, 42% of patients in the control group had abnormal cytological results (PAP III, PAP IV), probably in association with the presence of the HPV infection; however, all patients (100%) in CIN and CC groups had abnormal cytology. At the clinical examination, 26.3% of patients without neoplastic cellular changes had a cervix presenting a macroscopic lesion. When analyzing the appearance of the cervix according to the HPV status, it was found that almost half (44.11%) of the patients with microscopically normal cervix had HPV infection, in 96.8% of cases the detected strain being HPV 16. Conclusions. This study highlighted HPV 16, 58, 56 and 52 as the most prevalent strains in the analyzed population. Given the wide variability in the prevalence of HPV-HR strains by geographical area, it is important to include the most common genotypes in the test kits for each region. The appearance of a cervical lesion is associated in half of the cases with HPV 16 infection, in case of normal cytology. HPV testing could bring additional benefits in guiding the subsequent management for these patients. [ABSTRACT FROM AUTHOR]

Vaccination against human papillomavirus (HPV) was introduced into clinical practice as the most effective strategy for primary prevention of cervical cancer and HPV-induced benign or premalignant lesions. It has been demonstrated that not only adolescents but also adults respond positively to vaccine immune stimulation. A history of abnormal Pap test and genital warts or HPV infection may reduce the efficacy of vaccination, but does not contraindicate it. HPV vaccination increases the magnitude and quality of natural immunity. Radical treatments of cervical lesions do not ensure the elimination of HPV infection. Using the vaccine without the surgical removal of the HPV lesion is useless. However, combining surgical treatment and HPV vaccination can play a crucial role in reducing recurrences. Evidence supports the fact that universal vaccination, of both men and women, from adolescence to 45-50 years old, would represent the optimal modality to control HPV infection-related diseases. [ABSTRACT FROM AUTHOR]

Introduction. Herlyn-Werner-Wunderlich syndrome (HWW) is a rare congenital anomaly of the urogenital tract characterized by the triad: uterus didelphys, obstructed hemivagina and unilateral renal agenesis, which is two times more common on the right side than on the left side. The incidence of this syndrome is 0.1-3.8% and, so far, in less than 10 cases the association of this pathology with acute urinary retention has been reported. Materials and method. We present the case of a 13-year-old girl who came to our emergency room accusing pain of increased intensity in the lower abdominal floor, started insidiously a week before, accompanied by nausea, pallor, sweating, anxiety and moderate vaginal bleeding (menstrual status). The anamnesis revealed absent diuresis for about 6 hours, menarche at 12 years old, regular menstruation, oligomenorrhea and dysmenorrhea. The clinical examination revealed respiratory movements of the abdomen, distension caused by a pseudotumoral mass located subumbilically, reluctant, painful; normal external genitalia. The paraclinical examination (ultrasound and MRI) revealed: voluminous cystic mass of 155/100/100 mm located between the bladder and the rectum, suggestive of hematometrocolpos; lower it protruded into the vagina, the image being suggestive of the transverse vaginal septum; uterus didelphys; normal ovaries and fallopian tubes. Unseen left kidney – left renal agenesis. Results. Surgery was performed with urinary bladder catheterisation, incision of the septum and continuous aspiration – about 1000 ml of chocolate-like fluid, suggestive of old blood, followed by resection of the vaginal septum. Conclusions. A high rate of awareness and clinical suspicion of HWW syndrome among adolescents is necessary for both the diagnosis and the prompt surgical treatment, leading to remission of symptoms, prevention of complications and to preservation of fertility. [ABSTRACT FROM AUTHOR]

Managementul optim al endometriozei rămâne controversat, în special din cauza aspectului eterogen al endometriozei, de la forme asimptomatice cu caracter autolimitant până la forme severe, cu implicarea tuturor organelor pelviene. Introducerea tehnologiei laser, prin combinarea proprietăților de tăiere și hemostază, a revoluționat chirurgia laparoscopică. Intervențiile conservatoare cum ar fi coagularea sau vaporizarea leziunilor de suprafață, chistotomia cu evacuarea conținutului, chistotomia cu coagularea bazei endometriomului sau chistectomia sunt preferate intervențiilor radicale în cazul pacientelor care doresc prezervarea fertilității. Coagularea sau vaporizarea inadecvată creşte riscul de endometrioză reziduală, în timp ce coagularea sau vaporizarea exagerată poate determina distrugerea țesutului ovarian normal și instalarea secundară a insuficienței ovariene. Rezecția parțială a peretelui se practică din ce în ce mai rar, deoarece țesutul endometrial care căptușește chistul poate rămâne funcțional și poate determina reapariția simptomelor. Una dintre tehnicile care s-au dovedit promițătoare în tratamentul endometriozei, atât din punctul de vedere al țesutului ovarian restant, cât și al foliculogenezei, este terapia în trei pași. Tehnica aceasta combină tratamentul laparoscopic cu cel medical hormonal, totodată îmbinând două gesturi laparoscopice, și anume drenarea chistului endometriozic și mai apoi vaporizarea cu laser a peretelui intern al chistului. Chistectomia presupune incizia peretelui, care poate fi realizată într-o manieră liniară sau circulară. Avantajul unei deschideri ovalare sau circulare constă în identificarea demarcaţiei dintre ovarul sănătos şi endometriom. O incizie liniară direct peste endometriom poate prezenta doar ţesut anormal în aria de incizie. Pasul următor constă în efectuarea chistoscopiei necesare pentru a diferenția endometriomul de un chist hemoragic sau de o formațiune malignă. Obiectivele procedurilor conservatoare sunt: îndepărtarea tuturor focarelor endometriozice, rezecția aderențelor, tratarea durerii, reducerea riscului de recidivă și de aderențe postoperatorii și readucerea organelor afectate la o condiție normală anatomică și fiziologică. Pentru pacientele infertile, restabilirea relației tubo-ovariene normale este esențială pentru a spori fertilitatea. [ABSTRACT FROM AUTHOR]

Artera ombilicala unică (AOU) poate fi diagnosticată ecografic antenatal în până la 2% dintre sarcini, iar când este asociată cu alte defecte structurale fetale există un risc crescut de anomalii cromozomiale și eventuale complicații fetale perinatale. Diagnosticul AOU trebuie să alerteze medicul obstetrician pentru a căuta malformații asociate și markeri ai defectelor cromozomiale. Frecvența anomaliilor cromozomiale în artera ombilicală unică izolată (AOUI) este însă extrem de mică. Riscul pentru boală cardiacă congenitală după diagnosticul AOU la un făt aparent normal dintr-o populație neselectată pare să fie mic și nu justifică necesitatea consultării unui specialist în ecocardiografie fetală. AOUI poate fi însă un predictor independent pentru eventuale complicații fetale perinatale, cum ar fi: hipotrofie fetală, oligo- și polihidramnios, diabet zaharat gestațional și mortalitate perinatală crescută. Cu toate acestea, diagnosticarea AOUI nu scade rata nașterii vaginale pentru copiii la termen. În situația descoperirii incidentale a AOUI, cazurile diagnosticate necesită monitorizare atentă pe parcursul sarcinii, aspect crucial în depistarea și prevenirea unor eventuale complicații perinatale. Alături de examinarea ultrasonografică detaliată, se impun și teste de screening prenatale, cariotipare prin amniocenteză la cazurile cu alte anomalii asociate sau cu teste de screening pozitive. Cariotiparea nu este însă recomandată la cazurile cu AOUI. [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.

Background: Postpartum iron deficiency anemia (PPIDA) is highly prevalent in developing countries where it constitutes an important cause of maternal morbidity and mortality. Potential determinants of PPIDA are prepartum iron deficiency or iron deficiency anemia in association with severe blood loss during delivery. We investigated the efficacy of oral Sucrosomial® iron for recover from mild-to-moderate PPIDA., Methods: This pilot study was conducted in three medical centers in Romania. Adult women (≥ 18y) with mild (hemoglobin [Hb] 9-11 g/dL) or moderate (Hb 7-9 g/dL) PPIDA diagnosed at screening (2-24 h after delivery) were eligible. Women with mild PPIDA received oral Sucrosomial® iron (Pharmanutra, S.p.A, Italy) once daily (30 mg elemental iron per capsule) for 60 days. Those with moderate PPIDA received oral Sucrosomial® iron twice daily (60 mg elemental iron) for 10 days, followed by a 50-day course of oral Sucrosomial® iron once daily (30 mg elemental iron). Laboratory parameters, as well as subjective clinical symptoms using a 3-point Likert Scale, were assessed at baseline and on study days 10, 30 and 60., Results: Sixty anemic women entered the study, but three were missed during follow-up. At day 60, a Hb rise was observed in both groups (+ 3.6 ± 1.5 g/dL; p < 0.01), 81% experienced correction of anemia (Hb ≥ 12 g/dL), 36% achieved a ferritin concentration ≥ 30 ng/mL (p < 0.05), and 54% a transferrin saturation (TSAT) ≥ 20% (p < 0.01). For women still anemic at day 60, mean Hb was close to normality (11.3 ± 0.8 g/dL). Resolution of IDA-associated clinical symptoms was already observed just 10 days after treatment initiation. No patient discontinued treatment due to gastrointestinal adverse events., Conclusions: Sucrosomial® iron was shown to be potentially effective and well tolerated at treating mild and moderate PPIDA. These results encourage the use of oral Sucrosomial® iron as a treatment option for PPIDA, but larger studies with longer follow-up are warrant., (© 2023. The Author(s).)

Background : Cervical cancer is one of the most common malignancies in women in terms of prevalence and mortality. Cervical cancer has some particularities that distinguish it from any other oncologic pathology: first, it is completely preventable by prompt detection of its precursor, cervical intraepithelial neoplasia (CIN); second, the Human Papillomavirus (HPV) infection is a known etiological agent; third, the mean age at diagnosis is much lower than in other oncologic conditions, as a consequence of the sexually-transmitted HPV. Methods : We evaluated the expression level of several long noncoding RNAs and a microRNA in samples from 30 patients with CIN, 9 with cervical cancer and 38 normal samples using qRT-PCR technology. Results : We observed higher expression levels for MEG3, DAPK1 , MLH1 and MALAT1 in CIN samples than in normal samples, whereas TIMP3 and SOX1 had lower expression levels. For cancer samples, DAPK1 , MLH1 and MALAT1 had higher expression, and MEG3 , TIMP3 and SOX1 had lower expression when compared to normal samples. In the case of CIN versus cancer samples, only MEG3 gene showed a statistically significant difference. The expression of miR-205-5p was lower in both CIN and cancer samples compared to normal samples. Conclusion: Decreased MEG3 expression could be considered an alarm signal in the transition from a premalignant cervical lesion to invasive cancer, while altered expression levels of TIMP3 , SOX1 , MLH1 , MALAT1 and miR-205-5p could serve as early biomarkers in the diagnosis of premalignant cervical lesions. Future studies, including a larger number of patients with CIN, will be of particular importance in validating these observations.

Background and objective : Spontaneous heterotopic pregnancy (SHP) is a rare condition represented by the synchronous coexistence of an intrauterine and an ectopic pregnancy. It rarely occurs with natural conception and is usually a consequence of assisted reproductive techniques. Diagnosis of SHP can be a challenge for the clinician. The evolution of the intrauterine pregnancy is dependent on many factors, such as the location of the heterotopic pregnancy, gestational age at the time of diagnosis, the surgical procedure, the presence of other risk factors, early or delayed management. The aim of this systematic review of the literature was to extract existing evidence on spontaneous heterotopic pregnancy with otherwise unaffected intrauterine pregnancy. Materials and Methods : From a total of 1907 database entries identified in PubMed, EMBASE and Cochrane reviews, we selected 18 papers for narrative synthesis, for which we explored the diagnostic options, treatment, and outcome of these extremely rare epidemiologic occurrences. Manuscripts were assessed using the CARE guidelines for reporting case reports. Results : The main symptom was abdominal pain, and the preferred treatment approach was surgical, more precisely, using a laparoscopic approach. Most cases presented no risk factors, and the diagnosis was mostly made in the first semester. Conclusions : Normal follow-up and evolution of intrauterine pregnancy have been observed regardless of surgical approach (open or laparoscopic). Early diagnosis and treatment are advised, as they impact maternal and fetal outcomes. Evidence on this topic is scarce, predominantly comprised of case reports with variable degrees of adherence to dissemination guidelines. More studies on this topic are required to optimize care protocols for this type of pregnancy.

Background and objectives: The objective of this study was to evaluate the potential of first trimester uterine artery Doppler ultrasonography for the early prediction of preeclampsia (PE), in at-risk pregnant women. Materials and Methods: This was a prospective longitudinal study, including 120 Caucasian pregnant women with risk factors for PE. The potential of pulsatility indexes (PI) and notch was assessed as a tool for preeclampsia screening. Results: Doppler examination of the uterine artery performed early at 11-14 WA allows the detection of pregnancies that will develop PE with a sensitivity of 61.5% and a specificity of 63.8% based on PI analysis. Predictive power increases slightly by adding bilateral notch (sensitivity = 65.4%; specificity = 66%). Conclusions: Uterine artery Doppler examination is an effective non-invasive screening test for the development of PE in pregnancies at risk, particularly appropriate in health systems with limited means of evaluating other biomarkers.

Background and objectives : As pelvic floor disorders are often difficult to assess thoroughly based on clinical examination alone, the use of imaging as a complementary technique is helpful. This study's aim was to investigate by transperineal ultrasound (US) if there was any significant difference in the mobility of the bladder neck in women with stress urinary incontinence (SUI) without a cystocele and in those with SUI and an associated cystocele. The study also investigated whether the number of vaginal births and/or the heaviest newborn's birth weight was correlated with the bladder neck mobility. Materials and Methods : A total of 71 women suffering from SUI were included in the study and divided into two groups based on the presence of a cystocele. Their bladder neck mobility was evaluated by transperineal US, calculating the distance from the inferior margin of the symphysis pubis to the bladder neck (SPBN), and the dorsocaudal linear movement (DLM), term used to illustrate the displacement of the bladder neck by subtracting rest and Valsalva values. GraphPad Prism 8 was used for statistical analysis. Results : Within both study groups, the SPBN values were significantly higher and the DLM values were significantly lower at rest as compared to Valsalva maneuver ( p < 0.05). No significant difference between the groups regarding SPBN and DLM values at rest, Valsalva, or subtraction was demonstrated. A significant positive correlation was found between the bladder neck mobility and the heaviest newborn's birth weight, regardless of the presence of a cystocele ( p = 0.042). Conclusions : The presence of a cystocele had no significant impact on the bladder neck mobility measurements in patients with SUI. The heaviest newborn's birth weight positively correlated with bladder neck hypermobility, as quantified by SPBN.

Aims: Embryonic demise is a frequent complication of the first trimester pregnancy. The purpose of this study was to evaluate the correlation between a serum biomarker, the soluble form of the vasculo-endothelial growth factor (sFlt-1) and the distance between the yolk sac (YS) and embryo (DYSE), determined by ultrasonography., Material and Methods: The study was a prospective case-control study that included 2 groups of patients - the control group with 81 first-trimester pregnancies in evolution and the case group with 89 first-trimester pregnancies with a potentially reserved evolutivity., Results: A correlation between the serum level of sFlt-1 and DYSE in embryos with crown-rump length (CRL) greater than 5 mm was identified, showing that a DYSE ≤3 mm correlates with a low level of sFlt-1 (p<0.05) and a DYSE> 4 mm correlates with an increased level of sFlt-1 (p<0.05)., Conclusions: A low level of sFlt-1 associated with a distance between the embryo and yolk sac of small dimensions, respectively <3 mm, correlates with an increased rate of non-viable embryos. This correlation between an ultrasound and a serum parameter is of great value and brings important information about the viability of firsttrimester pregnancies.

Background and Aims: Perimenopause is marked by clinical manifestations which disturb everyday life and which may also hide a pathomorphological, more precisely endometrial, substrate. An accurate early diagnosis established by accessible, non-invasive methods is very important for the therapeutic management., Method: The study included 103 patients aged between 41.5-55.11 years, divided into 3 age groups: 40-44 years (n=10), 45-49 years (n=54) and ≥50 years (n=39)., Results: Certain risk factors of endometrial neoplasm or premalignant conditions were evidenced, their accurate identification being useful in limiting the number of patients with abnormal uterine bleeding (AUB) submitted to diagnostic screening. The most common cause of AUB in our study was fibroma, followed by functional causes., Conclusions: Transvaginal ultrasound (TVUS) represents a minimally invasive method for the screening of perimenopausal patients with AUB, especially to rule out endometrial adenocarcinoma (EAC). TVUS sensitivity was higher than clinical diagnosis in case of leiomioma, polypi and EAC. TVUS was more accurate in the diagnosis of EAC, polypi and leiomioma.

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.

Background: Loss of genomic stability appears as a key step in colorectal carcinogenesis. Micronucleus (MN) designates a chromosome fragment or an entire chromosme which lags behind mitosis. MN may be noticed as an additional nucleus within the cytoplasm cell during the intermediate mitosis phases. We tested the hypothesis that MN and its related anomalies may be associated with the presence of neoplastic colorectal lesions., Method: Peripheral blood lymphocytes were cultured and microscopically examined. The frequency of micronuclei (FMN) and the presence of nucleoplasmic bridges (NPB) in binucleated cells were compared in patients with of without colorectal neoplastic lesions., Results: We included 45 patients undergoing colonoscopy, 23 males and 22 females, with a median age of 59. 17 patients had polyps, 11 colorectal cancer (CRC) and 17 had a normal colonoscopy. The FMN was significantly higher in women than in men (8.14 vs 4.17, p=0.008); NPB were significantly less frequent in patients with advanced adenomas (>10mm or vilous) or CRC (p=0.044) when compared with patients with normal colonoscopy, hiperplastic polyps or non-advanced adenomas., Conclusion: Micronuclei are more frequent in women, but its frequency was not significantly different in patients with advanced adenomas or CRC. Null or low frequency values for nucleoplasmic bridges presence in peripheral lymphocyte may be predictive for advanced adenomas and colorectal cancer.