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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.)

Recurrent implantation failures have multiple causes. Microorganisms frequently invade the uterine cavity, and consecutive endometrial infection or inflammation can play a role in implantation failure during assisted human reproduction techniques. Pathological microorganisms and inflammatory mediators in the host can cause a cascade of events, leading to the implantation failure or expulsion of the embryo. This review addresses an important factor related to implantation failure, dysbiosis and chronic endometritis. Prolonged menstrual bleeding, previous abortions, uterine curettage, tubal pathology or a history of vaginal bacterial infections are common risk factors for endometritis. Chronic endometritis is often asymptomatic, but it plays an important role in implantation failures. The embryo implantation rates were significantly higher in patients receiving combined antibiotic therapy for chronic endometritis. It is therefore important that, in the case of infertile couples, this potential cause be sought and treated, because, if left untreated, it has the potential to determine recurrent implant failure. Oral antibiotic therapy, associated with oral and vaginal probiotics, plays an important role in regulating endometrial microbiome. [ABSTRACT FROM AUTHOR]

Mixed malignant mesoderm sarcomas (MLMS) are a rare subtype of malignant tumors with a myometrial origin. Usually, this pathology is diagnosed in menopausal women and has a fast evolution, with an unfavorable prognosis. This study analyzed data from the literature, which were subsequently correlated with a case of MLMS confirmed by classical histopathological examination and immunohistochemistry. It was performed total hysterectomy with bilateral adnexectomy. The clinical manifestations found in MLMS are the presence of a pelvic-abdominal tumor mass, accompanied by abdominal pressure, discomfort and vaginal bleeding. Imaging investigations such as pelvic ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) may suggest the diagnosis, but only the histopathological exam confirms it. From a macroscopic point of view, MLMS has a soft, gelatinous structure, compared to leiomyofibromas, with a hard and spiral structure. Another feature of MLMS is the infiltrative, irregular-looking tumor margin. The microscopic aspects of this malignant tumor are nuclear pleomorphism, necrosis of tumor cells, the presence of myxoid matrix, and variable mitotic activity. Due to the classic hematoxylin-eosin staining, the uterine smooth muscle has a leiomyomatosis structure, with the presence of multiple nodular formations suggestive for malignant tumor proliferation, probably of mesenchymal origin. We have shown that tumor cellularity is highly reactive to the anti-Vimentin antibody, an immunolabeled type III intermediate filament (IF) protein found in mesenchymal cells through special immunohistochemical techniques, demonstrating the mesenchymal origin of the tumor. The positivity of myocytes in the immunoreaction with the anti-alpha-actin antibody of smooth muscle (αSMA) shows that the tumor belongs to the myometrial structure. Tumor-transformed cells were genetically altered and mutated in the p53 tumor suppressor gene, thus escaping standard tissue control, aspects identified by immunolabeling with the anti-Ki67 antibody, which revealed cells in division. Tumor growth and development were supported by protein activation of cyclin-dependent kinase (CDK) and the presence of immunolabeled hematopoietic stem cells using the anti-cluster antibody of differentiation 117 (c-kit). The use of an anti-Desmin antibody in combination with anti- αSMA demonstrates the involvement of smooth muscle cells in tumor growth and development. The following microscopic features established the basis for the diagnosis of MLMS: irregular myometrial invasion the myxoid appearance that highlights rare cells dividing on sea fields. The following microscopic features laid the foundations for MLMS diagnosis: irregular myometrial invasion, rare mitosis on high power field (HPF: an average of 2.6 cells/×400 (±0.96 cells/×400) due to the presence of abundant myxoid matrix, rich in proteoglycans and glycosaminoglycans, especially hyaluronic acid, which offers a hypocellular appearance, but also through cell pleiomorphism. [ABSTRACT FROM AUTHOR]

Objective. To investigate the potential of combined sonographic and clinical determinations to predict the mode of delivery at term. Materials and method. This observational prospective cohort study was deployed in a tertiary maternity hospital (University County Emergency Hospital Craiova). Unselected low-risk primiparous pregnant women were weekly evaluated at term for ultrasound determinations (estimated fetal weight [EFW]), head descent parameters, occiput position [OP], cervical length), Bishop score and maternal characteristics (age, height, weight). A thorough statistical analysis determined which variables were significantly correlated with the delivery mode. Results. Data from 276 term primiparous were analyzed. Head descent parameters were strongly and significantly correlated with each other, but only progression distance (PD) was correlated with the delivery mode (weeks 37, 38, 41, and the week before delivery). The week before delivery (WBD) measurements of head to perineum distance (HPD) and angle of progression (AOP) reached a close to significance p level: 0.055 and 0.07, respectively. The following variables were significantly correlated with the delivery mode: BMI in all term evaluations, along with PD measured at 37 and 38 weeks, maternal age for week 39, Bishop, EFW and OP for week 40 and BMI, EFW, and PD evaluated during the WBD. We have also provided logistic regression equations for each week that correctly forecasted the delivery mode, except for week 38. Cut-off values have been established for each significant parameter per week. The cut-off values must be read in conjunction with the AUC, which ranges from 0.55 to 0.73, depending on the variable. Conclusions. There are strong and significant correlations between the “head descent” ultrasound measurements at term. BMI is predictive regarding labor outcome throughout term evaluations. PD and BMI measured at 37-38 weeks correlate with the delivery mode and apparently can be used to forecast the delivery mode when the pregnancy reaches term. WBD measurements of EFW and PD can be used to forecast the delivery mode, perhaps within a policy addressed to pregnant women with pre-labor clinical signs. Larger studies are needed, due to the need for more and better-balanced data. [ABSTRACT FROM AUTHOR]

Introducere. Evaluarea ecografică transvaginală reprezintă standardul îngrijirii ginecologice de rutină atât la pacientele asimptomatice, cât şi la cele care prezintă fenomene dureroase, sângerare vaginală anormală sau mărirea de volum a abdomenului. Scopul acestui studiu este de a prezenta avantajele ultrasonografiei în detecţia şi caracterizarea cât mai corectă a tumorilor ovariene borderline la pacientele evaluate în Spitalul Clinic Judeţean de Urgenţă Craiova. Materiale şi metodă. Am realizat un studiu retrospectiv pe o perioadă de doi ani, care a inclus un număr de 49 de paciente cu tumori ovariene borderline. Fiecare caz a fost evaluat utilizând examinarea de rutină 2D, uneori şi reconstrucţiile 3D. Pentru fiecare formaţiune tumorală s-au notat mărimea, aspectele morfologice şi caracteristicile power Doppler. Rezultatele au fost comparate cu cele ale pacientelor cu tumori ovariene maligne sau cu tumori ovariene benigne. Scanările au fost realizate de doi examinatori cu experienţă, folosind un sistem Voluson E8 (General Electric Healthcare), în perioada mai 2017 - mai 2019. Rezultate. Din cele 49 de cazuri, 23 au fost tumori ovariene mucinoase, iar 26 au fost chistadenoame seroase borderline. Proiecţiile papilare intrachistice au fost semnificativ mai frecvent întâlnite în tumorile borderline (51%) decât în tumorile benigne (4%) sau în tumorile maligne (3%). În 45 de cazuri, diagnosticul histopatologic a confirmat suspiciunea imagistică (91%). Trei cazuri au fost subdiagnosticate, rezultatul histopatologic confirmând malignitatea invazivă. Concluzii. Cea mai frecventă descriere ecografică a tumorilor ovariene borderline este reprezentată de prezenţa proiecţiilor papilare intrachistice. Totuşi, acestea nu reprezintă un marker ecografic cu sensibilitate superioară pentru diagnosticul tumorilor ovariene borderline. [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.)

Introducere şi obiective. Unghiul de progresie (UdP), evaluat prin ecografie transperineală, a fost iniţial propus pentru evaluarea progresiei travaliului, fiind o măsurătoare angulară ce se pretează optim la traiectul curb al canalului de naştere. Numeroase studii au încercat stabilirea valorii predictive a UdP pentru calea de naştere. În acest studiu, am propus măsurarea ultrasonografică săptămânală a UdP la primiparele la termen înainte de debutul travaliului şi compararea datelor între cele două populaţii, respectiv primiparele care au născut pe cale vaginală spontană (NV) şi primiparele care au născut prin operaţie cezariană (OC). Metodă. În studiu au fost incluse toate primiparele la termen care s-au prezentat în cadrul Spitalului Clinic Judeţean de Urgenţă din Craiova, pe o perioadă de trei ani. Au fost excluse din studiu sarcinile cu indicaţie pentru naştere prin OC, sarcinile multiple, precum şi sarcinile cu feţi în prezentaţie noncefalică. Protocolul a presupus examinarea săptămânală în planul transperineal infrapubic sagital cu măsurarea UdP. După obţinerea datelor, acestea au fost prelucrate statistic şi comparate între cele două populaţii. Rezultate. În grupul NV, UdP a înregistrat valori semnificativ superioare faţă de grupul OC la 37, 40 şi 41 de săptămâni, dar acestea nu au fost semnificative la 38 şi 39 de săptămâni. Global, mediana cazurilor cu NV a crescut de la 90° la 101,5°, iar în cazul grupului de naşteri prin OC, mediana a avut un trend oscilant şi cu o creştere redusă, de la 84,45° la 89,7°. Concluzii. UdP a fost considerat un parametru ultrasonografic adecvat pentru că a prezentat un trend lent ascendent din săptămâna 37 către săptămâna 41 gestaţională, indiferent de calea de naştere. Totuşi, nu am reuşit să demonstrăm o acurateţe satisfăcătoare pentru estimarea prognosticului căii de naştere. Probabil, studii ulterioare ce includ corelaţii între diferiţi parametri ecografici pot stabili o combinaţie care să ofere o predicţie solidă asupra modului de naştere. [ABSTRACT FROM AUTHOR]

Malignant mixed mesodermal sarcomas (myxoid leiomyosarcomas - MLMS) are a rare form of uterine cancer developed from the smooth muscles of the uterus. It usually affects women in the postmenopausal period and has an aggressive character with an unfavorable evolution and prognosis. This paper presents a case where MLMS was postoperatively confirmed with the aid of the histopathological (HP) examination coupled with specific immunolabeling techniques. In addition, we reviewed modern literature to compare our results. Clinically, patients may present with a pelvic tumor, vaginal bleeding, or abdominal pressure. Imagistic investigations, such as pelvic ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT may support the diagnosis. Nevertheless, solely the HP examination establishes it. Macroscopically, MLMS is soft and gelatinous, unlike the conventional rigid and spiral leiomyoma appearance. Furthermore, the infiltrative, irregular tumor margin is characteristic of MLMS. From a microscopic point of view, the following are present: tumor cell necrosis, nuclear pleomorphism, and variable mitotic activity. With classical Hematoxylin-Eosin (HE) staining, myometrium presents a leiomyomatous structure and multiple nodular formations with the aspect of malignant tumor proliferation, most likely mesenchymal. We used multiple special immunolabeling techniques. Thus, we observed the intense reactivity of the cells to the anti-vimentin antibody, which immunolabeled type III intermediate filament (IF) protein expressed in mesenchymal cells, thus demonstrating tumor mesenchymal affiliation. Smooth cell positivity for alpha-smooth muscle actin (α-SMA) demonstrates that the tumor is present in its whole myometrial structure. Tumor cells also underwent mutations involving the p53 tumor suppressor gene demonstrated by the number of tumoral cells in division immunolabeled with anti-Ki67 proliferation antibody. Tumor development was demonstrated by protein activation of cyclin-dependent kinase (CDK) and the presence of c-Kit-bound hematopoietic stem cells, immunolabeled with the anti-cluster of differentiation 117 (anti-CD117) antibodies. The anti-desmin antibody demonstrates, along with α-SMA, the involvement of myocytes in the tumoral process. The following microscopic characteristics laid the foundation for the diagnosis of MLMS: irregular myometrial invasion, rare mitosis on high-power fields (HPFs), cell pleomorphism, predominant myxoid component that gave a hypocellular appearance, the matrix rich in proteoglycans and glycosaminoglycans, especially hyaluronic acid.

The Bishop score serves as an evaluation system performed by digital vaginal examination (DVE) to determine cervical ripening. The scoring system includes cervical dilatation, position, effacement and consistency of the cervix and fetal head station1. Nowadays, the Bishop score is frequently used as an important parameter for the prediction of successful induction of labor., Objective: Our objective was to demonstrate the role of the Bishop scoring system in prediction of the mode of delivery in primiparous women at term before the onset of labor., Method: We included in this study unselected primiparous women at term, after 37 weeks of gestation, who presented to the Prenatal Diagnostic Unit (PDU) of the University Emergency County Hospital of Craiova. We excluded from the study multiparous patients, pregnancies with a planned Caesarean section delivery (CD), non-cephalic presentations and multiple pregnancies, twin pregnancies and those with detected fetal anomalies. The protocol included weekly DVEs until delivery for all patients, to determine the evolution of the Bishop score at term and in the week before delivery, and potential correlations with delivery outcome. To reduce clinical bias, the DVEs were performed by three experienced obstetricians involved in the research., Results: Statistical analysis yielded a 4 to 6 Bishop score in all weekly examinations. At 37 weeks of gestation, the majority of primiparous women had a Bishop score of 4, with no significant differences between the primiparous who delivered vaginally and the ones where Caesarean section was necessary. During the following weekly evaluations, we noted a slight turn to a Bishop score of 6 for most of them, without any significant differences between the two groups. However, at 41 weeks of gestation, there was a significant higher Bishop score in the group of primiparous women who delivered vaginally., Conclusion: In our study, the use of the Bishop score failed as a prediction tool for the mode of delivery in primiparous women at term before the onset of labor, at a gestational age less than 40 weeks. Therefore, Bishop score should not be used to counsel regarding the probability of an uncomplicated vaginal delivery (VD) before the onset of labor., Competing Interests: Authors declare no conflicts of interest. They do not have interests which may be perceived as posing a conflict or bias. They have no financial interests in any company or organization that might benefit from the publication., (Copyright © 2014, Medical University Publishing House Craiova.)