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Disseminated peritoneal leiomyomatosis (DPL) is a rare condition marked by multiple leiomyomas in the peritoneal cavity, predominantly affecting women of reproductive age. Although typically benign, DPL can present significant diagnostic challenges and, in rare cases, may progress to malignancy. A primary contributing factor to DPL is iatrogenic, particularly due to surgical interventions such as morcellation during myomectomy. This scoping review explores the pathogenesis, epidemiology, diagnosis, and management of DPL, highlighting the crucial role of hormonal influences and iatrogenic factors. Diagnostic methods include computed tomography, ultrasound, magnetic resonance imaging, and histopathological evaluation, which are essential for assessing disease extent and guiding treatment. Management strategies encompass surgical intervention—with a focus on minimizing iatrogenic risks—conservative approaches for asymptomatic patients, and advancements in hormonal treatments. Emphasis is placed on preventing iatrogenic dissemination through refined surgical techniques and patient education. Despite its rarity, with fewer than 200 cases reported globally, understanding DPL's clinical presentation and iatrogenic origins is vital for optimal patient outcomes. This review underscores the importance of early diagnosis, personalized treatment plans, and ongoing research to address the challenges associated with DPL. [ABSTRACT FROM AUTHOR]

Introduction. The knowledge of medical staff on oral health status during pregnancy is particularly important. Issues related to periodontal disease and oral cavity diseases may influence the pregnancy and birth. The objective of the study was to assess the knowledge of qualified personnel (dentists, obstetricians / gynecologists) on the oral health during pregnancy. Material and method. A cross sectional study was conducted on a number of 105 dentists and 105 obstetricians / gynecologists from Cluj Napoca, Romania, in the interval 1.01.2016 - 28.02.2016. With a questionnaire containing 19 questions with multiple answers were gathered information on: personal data (gender, age, specialty and years in practice), opinion regarding dental treatments and medication in pregnancy, knowledge on the link between periodontal disease and pregnancy, (complications and side effects on birth), sources of information about oral health during pregnancy. Data were statistically analyzed descriptive and comparative using SPSS program. Results. Both dentists and obstetricians had demonstrated knowledge about the status of oral health during pregnancy. Even if most of the respondents were aware of the connection between oral health and pregnancy (95.2% dentists and 87.6% obstetricians) only a third of obstetricians and a quarter of dentists mentioned a possible association between oral health and pregnancy pathology: preterm birth (29.5% dentists and 35.2% obstetricians) and low birth weight (20% dentists and 33.3% obstetricians). There were statistically significant differences between the opinions of these two categories of specialists, concerning mainly the administration of pharmaceuticals during pregnancy with minimal risks. Conclusions. The possible association between oral diseases and pregnancy pathology was understood by the majority of dentists and obstetricians; moreover, there was consensus in the most frequent dental treatments and protocols. However, the information regarding the possible correlation between periodontal health and pregnancy was not enough acknowledged by neither dentists nor obstetricians. [ABSTRACT FROM AUTHOR]

Aims. To characterize the vascularity of endometriotic cysts using color Doppler ultrasound and to differentiate more accurately between endometriotic cysts and other pelvic cyst masses. Methods. Two prospective studies were initiated: the first included 50 patients diagnosed with ovarian endometriotic cysts and 50 patients without gynecological pathology, in whom the resistance index (RI) of the uterine artery, ovarian artery and endometrial arcuate arteries in the early secretory phase was determined by endovaginal Doppler ultrasound; the second study included 50 patients diagnosed with ovarian endometriotic cysts, in whom the RI of the uterine artery, ovarian artery and cyst wall arteries in the late proliferative phase and in the late secretory phase was determined. Results. In the early secretory phase, the vascular flow through the uterine artery was significantly higher in patients with ovarian endometrioma. These patients had increased endometrial vascularity in the early secretory phase compared to the control group. In the late secretory phase, the vascular flow through the ovarian artery was higher compared to the late proliferative phase in patients with ovarian endometrioma. The vascularization of the ovarian endometrioma wall was significantly increased in the late secretory phase compared to the late proliferative phase. Conclusions. Vascularization, described through the arrangement of vessels, vascular density and vascular resistance, is an important factor in the evaluation of ovarian endometrioma. [ABSTRACT FROM AUTHOR]

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

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

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]

Preeclampsia is a multisystemic disease, with a prevalence of 2-5%, that affects pregnant women. Every year, 76,000 women and 500,000 fetuses die due to the complications of this pathology. The prenatal screening for preeclampsia is constantly being updated. Globally, attempts are being made to identify easily reproducible, cost-effective screening markers that determine with great accuracy the patients prone to develop preeclampsia. Thus, there are differences between the described risk factors, the screening and prevention protocols recommended by world-recognized medical associations, such as the International Federation of Obstetrics-Gynecology (FIGO) and the American College of Obstetrics-Gynecology (ACOG). According to the latest FIGO recommendations, all pregnant patients should be screened in the first trimester for preeclampsia, including: maternal risk factors, mean blood pressure, placental growth factor and uterine artery pulsatility index. Patients at increased risk of developing preeclampsia will undergo preventive treatment with aspirin between 11- 14 weeks +/- 6 days and 36 weeks of pregnancy. ACOG presents patients with a history of preeclampsia, multiple pregnancy, chronic hypertension, type 1 or 2 diabetes, kidney disease or autoimmune diseases as having an increased risk of developing preeclampsia and a need for the prophylactic administration of aspirin. There is also a difference between the risk factors presented by the two associations. In conclusion, the determination of screening markers that provide an increased identification of patients at risk of developing preeclampsia, as well as the precise determination of risk factors for preeclampsia are imperative to anticipate and initiate the preventive treatment for women at risk, decreasing the prevalence of the disease, its complications and implicitly the costs. [ABSTRACT FROM AUTHOR]

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

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

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

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

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.)

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.)

Twin reversed arterial perfusion (TRAP) sequence is a rare (1/35.000 pregnancies) and severe complication specific to monochorionic twin pregnancies, involving the presence of an acardiac twin and a structurally normal co-twin (pump twin). The normal twin has a high mortality rate (50- 70%), especially due to congestive heart failure. We report on the case of a IIG IIIP 33 year-old patient who was referred to our institution form another service with the initial diagnosis of multiple pregnancy with one dead twin. Ultrasound revealed 24 gestational weeks intrauterine biamniotic monochorionic twin pregnancy with TRAP sequence and polyhydramnios. Therapeutic amniocentesis was performed for polyhydramnios, evacuating 500 ml of amniotic fluid. A fetoscopic intervention was decided, with the occlusion of the umbilical cord of the acardiac twin, followed by the evacuation of another 700 ml amniotic fluid. The patient was readmitted to our institution at 34 gestational weeks for preterm premature rupture of membranes and vaginal bleeding. Ultrasound revealed intrauterine growth restriction of the living twin, corresponding to 30 gestational weeks and retroplacentar hematoma, reaching 8,5/5 cm. The patient gave birth through cesarean section to a living female fetus, weighing 1480 g, Apgar score 6, 7, 8 at 1, 2 and respectively 5 minutes. In conclusion, TRAP sequence is a rare entity, requiring early diagnosis and careful ultrasound monitoring, in order to select the best management option for the pump twin. To the best of our knowledge, this is the first case reporting a twin pregnancy with TRAP sequence complicated with retroplacentar hematoma. [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.)

Background and aims. Endometriosis is a commonly encountered disorder in women of reproductive age, consisting of the presence of active ectopic endometrial tissue outside the endometrial cavity. Surgical scar endometriosis is a rare condition representing about 2% of all endometriosis cases. The purpose of this study was to assess the main characteristics, diagnostic tools and therapeutic options in abdominal wall endometriosis (AWE). Methods. We have reviewed a series of fourteen cases with histopathological confirmation of AWE that were managed in our institution. Results. The main characteristic of AWE were emphasized, showing that 78.57% of the patients had at least one previous caesarian section and that in only 57.14% of all cases an accurate diagnosis of AWE was established preoperatively. Conclusion. A direct relationship between gynecological and obstetrical surgery and AWE is well established and as the caesarian section rates increase constantly, the awareness regarding AWE should also be increased. [ABSTRACT FROM AUTHOR]

Aims: The objective of the study was to compare the efficiency of 20 MHz skin ultrasonography and 40 MHz conventional ultrasonography in the assessment of plaque psoriasis and to assess the efficiency of 40 MHz real-time sonoelastography in the early detection of steroid-induced skin atrophy in psoriatic plaques. Patients and methods: Ultrasonographic blinded evaluation was performed on 16 plaques in three consecutive patients, at baseline and after hydrocortisone acetate 1% ointment six-week application. The parameters were epidermal and dermal thicknesses for gray-scale ultrasonography and strain ratio for sonoelastography. Strain ratio was computed between the dermis and the adjacent hypodermis. Student's t-test for paired samples was performed. A confidence level of p<.05 was considered significant. Results: At follow-up, epidermal thickness was significantly reduced with 20 MHz (p = .002) and 40 MHz sonography (p = .032), while dermal thickness varied insignifcantly with 20 MHz (p = .35) and 40 MHz sonography (p = .33). Measurements at 40 MHz were significantly higher than their 20 MHz counterparts at baseline (epidermis: p < .001; dermis: p = .003) and at follow-up (epidermis: p < .001; dermis: p = .001). Strain ratio revealed no significant change of dermal elasticity (p = .96). Conclusions: Although epidermal and dermal measurements varied significantly with 20 MHz and 40 MHz ultrasonography, both techniques efficiently quantified treatment response by measuring the reduction of epidermal thickness. Sonoelastographic findings were consistent with the expected outcome of short-term use of low-potency corticosteroid. Further studies are recommended. [ABSTRACT FROM AUTHOR]