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Human papillomaviruses (HPVs) are responsible for approximately 5% of all cancers, with high-risk types causing nearly all cervical cancer cases. While cervical cancer is the most recognized outcome of HPV infection, the virus also contributes to vulvar, vaginal, penile, anal, and head and neck cancers. HPV types 16 and 18 are the primary culprits in these malignancies. HPVs exhibit strict host specificity and encompass over 100 types, some linked to benign conditions like genital warts. The viral oncoproteins E6 and E7 play a crucial role in cancer development by inhibiting tumor suppressor genes. HPV-related diseases manifest in various ways, from common conditions like anogenital and plantar warts to rare presentations such as recurrent respiratory papillomatosis, conjunctival papillomas, and middle ear carcinomas. The clinicians must recognize this diversity to ensure the accurate diagnosis and management. Preventive measures, particularly large-scale vaccination, are essential to reduce the incidence and complications of HPV-related diseases. [ABSTRACT FROM AUTHOR]

Bartholin gland cysts account for 2% of all gynecologic visits per year. Although the treatments for Bartholin gland cysts seem apparently simple, recurrent cysts as well as the differential diagnosis between simple cyst, abscess or malignant pathology can complicate the management for this apparent common problem. Bartholin gland disorders, such as cysts and abscesses, can significantly impact a woman’s quality of life, necessitating effective and lasting interventions. Starting from the standard conduct of authors in Bartholin gland cyst, the article aims to review the current therapeutic techniques and to present a case report of an approach based on the excision of the gland. [ABSTRACT FROM AUTHOR]

Preeclampsia, affecting 5-10% of pregnancies, is a major cause of maternal and fetal morbidity and mortality, characterized by elevated blood pressure and proteinuria after 20 weeks of gestation. The complications include intrauterine growth restriction, eclampsia, placental abruption, and HELLP syndrome. Effective first-trimester screening, recommended by international societies, considers maternal risk factors such as the PlGF (placental growth factor) value, the pulsatility index of the uterine arteries, and the mean blood pressure. Advances in soluble biomarkers, especially the sFlt-1/PlGF ratio, offer improved early diagnosis and management by predicting preeclampsia weeks before the symptoms appear. Preventive measures – notably, low-dose aspirin – have been validated by the ASPRE study, showing a 62% reduction in preterm preeclampsia risk when administered from 11-14 weeks of gestation. Implementing these screening and prevention strategies nationwide, especially in resource-limited areas, is essential to reduce the incidence and to improve the outcomes for mothers and babies. [ABSTRACT FROM AUTHOR]

Umbilical cord cysts are rare anomalies, being associated in the first trimester most often with chromosomal defects or structural anomalies, while in the second and third trimesters, they are associated with urachal abnormalities. Umbilical cord cysts remain a pathology that could endanger the fetus by a rapid growth that could cause umbilical cord compression followed by fetal distress, torsion or thrombosis, with unfavorable consequences. We present the case of a pregnant patient diagnosed in the second trimester with umbilical cord cyst localized at the placental site of the umbilical cord, with a low-risk noninvasive prenatal test performed in the first trimester, with no other structural anomalies, who delivered a healthy baby at term. The intraoperative findings included the presence of an abnormally adherent placenta, respectively placenta accreta, in a patient with no surgical or obstetrical risk factors. The pathology report revealed an umbilical cord hematoma. The aim of this article is to debate whether an umbilical cord hematoma could be a marker for placental abnormalities. [ABSTRACT FROM AUTHOR]

Human T-cell leukemia virus-1 (HTLV-1) is the first infectious agent proven to cause cancer, and it is considered among the most potent carcinogens for humans. HTLV-1 is estimated to have infected 5-10 million individuals, with only about 5% of people that contract the virus expected to de)velop any associated disease. Within Europe, Romania appears to be the only region endemic to HTLV-1. There are two primary diseases associated with HTLV-1, T-cell leukemia/ lymphoma (ATL) and HTLV-1-associated myelopathy (HAM), or tropical spastic paraparesis (TSP). Each is linked to a distinct mode of transmission: ATL with breastfeeding, and HAM/TSP with blood transfusion. The main ways of viral transmission are from mother to child by breastfeeding, via blood transfusions, or through sexual intercourse. Vertical infection rate has been found to be 14.2%. In Romania, HTLV is included in the screening for blood donors, but not in prenatal screenings. Vertically transmitted infections can be reduced with up to 87% by avoiding breastfeeding. New research supports the effectiveness of prenatal screening followed by avoiding breastfeeding in reducing new cases of HTLV in endemic areas, and such measures must be taken in Romania as well. [ABSTRACT FROM AUTHOR]

The corpus callosum serves as a link between the two hemispheres, with an important role in cognitive mechanisms, also integrating motor and sensitive information and processing stimuli. Evaluation of the morphologic structure of the corpus callosum in order to diagnose structural anomalies such as hyperplasia, hypoplasia, as well as indirect signs of corpus callosum agenesia can be realised using ultrasonography during the mid-trimester screening. At present, it is recommended to perform a targeted evaluation only in high-risk cases of central nervous system abnormalities; the International Society of Ultrasound in Obstetrics and Gynaecology has not included the corpus callosum evaluation in the routine secondtrimester screening. Callosal anomalies present uncertainty in the fetal prognosis: 75% of cases of isolated corpus callosum agenesis develop normally; on the other hand, they could develop various degrees of neurological impairment from language or social deficiency to autism or schizophrenia. We, therefore, highlight the importance of corpus callosum evaluation, as the agenesis of the corpus callosum can be an isolated defect, but it can also be associated with other extracerebral anomalies or it could be a part of a syndrome. Completing the diagnosis often requires magnetic resonance imaging and genetic tests. [ABSTRACT FROM AUTHOR]

Objectives. Currently, there is no established gold standard for the treatment of caesarean scar pregnancy (CSP). This study aims to propose a new standard of care for managing CSP. Caesarean scar pregnancy is classified into two types: type 1 (on the scar) and type 2 (in the niche). There is currently no international standard for predicting invasion extent or for determining the most effective management approach for CSP. Materials and method. Our protocol involved intramuscular methotrexate injection, followed by uterine artery embolization and suction evacuation as part of a conservative approach. This protocol was applied to seven patients diagnosed with CSP. Only patients with caesarean scar pregnancy at an early gestational age (≤9 weeks) who provided written consent for the combined treatment method were included. Results. All cases had positive outcomes, without any complications such as uterine perforation, emergency hysterectomy, severe hemorrhage or endometritis. Early diagnosis of CSP and the location of invasive trophoblast opposite the uterine scar were significant predictors for a favorable outcome. Conclusions. This series of CSP cases demonstrates that the combination of systemic methotrexate and uterine artery embolization ensures effective and minimally invasive management of caesarean scar pregnancy. This treatment protocol is suitable for both types of CSP. The early identification of pregnancy location, particularly after caesarean delivery, should be mandatory to prevent CSP-related complications. [ABSTRACT FROM AUTHOR]

Advancements in ultrasound technology and the integration of cell-free DNA testing into standard prenatal screening services have made it feasible to identify fetal sex at an early stage. Fetal sex determination through sonography relies on different factors depending on the gestational stage. In the late second trimester, it is determined by directly visualizing the external genitalia. However, in the late first and early second trimester, it primarily relies on the direction of the genital tubercle, known as the “sagittal sign”. Other sonographic landmarks, like the fetal scrotum, midline raphe of the penis, labial lines, uterus, descended testis and the direction/ origin of the fetal micturition jet in males, can aid in the accurate fetal sex determination. However, malformed external genitalia can lead to inaccurate results. This article focuses on the sonographic determination of fetal sex during the late first trimester, early second trimester and late second trimester, using both transvaginal and transabdominal ultrasound techniques. Additionally, we explore various elements that have contributed to the accuracy of fetal sex determination. While ultrasound examination of the external genitalia is typically sufficient, there are certain situations where it becomes crucial to identify the internal genitalia for precise prenatal diagnosis and thorough counseling. This paper aims to review these situations in which the evaluation of the internal genital organs is necessary, as well as the ways in which ultrasound can be used in the diagnosis of genital malformations. [ABSTRACT FROM AUTHOR]

Objectives. Currently, there is no established gold standard for the treatment of caesarean scar pregnancy (CSP). This study aims to propose a new standard of care for managing CSP. Caesarean scar pregnancy is classified into two types: type 1 (on the scar) and type 2 (in the niche). There is currently no international standard for predicting invasion extent or for determining the most effective management approach for CSP. Materials and method. Our protocol involved intramuscular methotrexate injection, followed by uterine artery embolization and suction evacuation as part of a conservative approach. This protocol was applied to seven patients diagnosed with CSP. Only patients with caesarean scar pregnancy at an early gestational age (≤9 weeks) who provided writ ten consent for the combined treatment method were included. Results. All cases had positive outcomes, without any complications such as uterine perforation, emergency hysterectomy, severe hemorrhage or endometritis. Early diagnosis of CSP and the location of invasive trophoblast opposite the uterine scar were significant predictors for a favorable outcome. Conclusions. This series of CSP cases demonstrates that the combination of systemic methotrexate and uterine artery embolization ensures effective and minimally invasive management of caesarean scar pregnancy. This treatment protocol is suitable for both types of CSP. The early identification of pregnancy location, particularly after caesarean delivery, should be mandatory to prevent CSP related complications. [ABSTRACT FROM AUTHOR]

Advancements in ultrasound technology and the integration of cell free DNA testing into standard prenatal screening services have made it feasible to identify fetal sex at an early stage. Fetal sex determination through sonography relies on different factors depending on the gestational stage. In the late second trimester, it is determined by directly visualizing the external genitalia. However, in the late first and early second trimester, it primarily relies on the direction of the genital tubercle, known as the “sagittal sign”. Other sonographic land marks, like the fetal scrotum, midlineraphe of the penis, labial lines, uterus, descended testis and the direction/ origin of the fetal micturitionjet in males, can aid in the accurate fetal sex determination. However, malformed external genitalia can lead to inaccurate results. This article focuses on the sonographic determination of fetal sex during the late first trimester, early second trimester and late second trimester, using both transvaginal and transabdominal ultrasound techniques. Additionally, we explore various elements that have contributed to the accuracy of fetal sex determination. While ultrasound examination of the external genitalia is typically sufficient, there are certain situations where it becomes crucial to identify the internal genitalia for precise prenatal diagnosis and thorough counseling. This paper aims to review these situations in which the evaluation of the internal genital organs is necessary, as well as the ways in which ultrasound can be used in the diagnosis of genital malformations. [ABSTRACT FROM AUTHOR]

Intrauterine growth restriction or fetal growth restriction represents a fetal incapacity of achieving its entire growth potential in intrauterine life, as a result of maternal, fetal and/or placental causes, from hypertension, autoimmune diseases, drug consumption, hereditary thrombophilia to genetic syndromes, intrauterine infections, umbilical cord anomalies or placental insufficiency. The ultrasonographic evaluation of the fetus with intrauterine growth restriction identifies an estimated fetal weight or a fetal abdominal circumference below the 10 th percentile for gestational age; a severe fetal growth restriction is defined as an estimated fetal weight below the 3rd percentile. The Delphi consensus managed to classify fetal growth restriction as early, being diagnosed under 32 weeks of gestation, respectively late, after 32 weeks of gestation. Up to 10% of pregnancies are complicated by fetal growth restriction, which are then considered high-risk pregnancies for the morbidity and mortality risk carried for the fetus, requiring an accurate diagnosis of the cause, intensifying the fetal monitoring and timing the birth, in order to deliver the fetus in safe conditions. This paper proposes an algorithm for an initial evaluation of fetal growth restriction, with the aim of simplifying the medical approach when encountering a fetus with intrauterine growth restriction, in order to improve morbidity and mortality rates among pregnancies complicated by fetal growth restriction. [ABSTRACT FROM AUTHOR]

Transvaginal ultrasound and serum concentration of human chorionic gonadotropin are the main methods of prognostic evaluation of early pregnancies. Although these pregnancy investigation methods have proven their benefits, the interpretation is fundamental for a correct diagnosis, in order to avoid interventions that may affect pregnancies that would normally have had a physiologic course, as well as to apply an appropriate management in the case of nonviable pregnancies. Recent studies have shown the need to adopt rigorous criteria that minimize false positive results and thus decrease the frequency of diagnostic errors. Over time, a series of ultrasound features have been described which have proven effective in predicting nonviable pregnancies in the first trimester (cranio-caudal length in relation to the presence or absence of cardiac activity, yolk sac diameter, gestational sac diameter in relation to presence or absence of embryo with cardiac activity, embryonic heart rate, subchorionic hematoma etc.). In the context of the new prospects for the development of artificial intelligence softwares, the present work focuses on the description of the precise ultrasonographic aspects aboded by the latest studies that propose certain cut-off values dependent on the gestational age of the ultrasound parameters in the first trimester, increasing the sensitivity and the specificity of ultrasound in the diagnosis of nonviable early pregnancies, thus aiming to improve the reproductive prognosis of couples with recurrent abortions. [ABSTRACT FROM AUTHOR]

During pregnancy, gestational diabetes is the most common metabolic disorder, characterized by altered glucose tolerance. The prevalence of gestational diabetes is increasing, which is linked to the rise in maternal obesity rates in recent years. Despite numerous large-scale studies on the topic, there is still ongoing debate about the screening and treatment of gestational diabetes. The fetal and neonatal complications associated with gestational diabetes include fetal macrosomia, hyperinsulinemia, hypoglycemia, hypocalcemia, neonatal hyperbilirubinemia, increased risk of respiratory distress, and shoulder dystocia, especially in macrosomic babies. Additionally, children born to diabetic mothers are at a higher risk of developing obesity and diabetes in adolescence and adulthood. Maternal complications of gestational diabetes include an increased risk of developing hypertensive syndromes and the likelihood of requiring a caesarean section. Screening and treatment of gestational diabetes are crucial in ensuring healthy outcomes for both mother and child. In this article, we will explore the importance of early detection and effective management of gestational diabetes, highlighting the benefits of timely intervention, and the potential risks of untreated gestational diabetes. Furthermore, we will present the latest international guidelines and recommendations for the screening and management of gestational diabetes. [ABSTRACT FROM AUTHOR]

Advancements in ultrasound technology and the integration of cell-free DNA testing into standard prenatal screening services have made it more feasible to identify fetal sex at an early stage. Fetal sex determination through sonography relies on different factors, depending on the gestational stage. In the late second trimester, it is determined by directly visualizing the external genitalia. However, in the late first and early second trimesters, it primarily relies on the direction of the genital tubercle, known as the sagittal sign. Other sonographic landmarks, like the fetal scrotum, midline raphe of the penis, labial lines, uterus, descended testis, and the direction or origin of the fetal micturition jet in males, can aid in the fetal sex determination accuracy. However, malformed external genitalia can lead to inaccurate results. This article focuses on the sonographic determination of fetal sex during the late first trimester, early second trimester and late second trimester, utilizing both transvaginal and transabdominal ultrasound techniques. Additionally, we explore various elements that have contributed to the precision of fetal sex determination. While ultrasound examination of the external genitalia is typically sufficient, there are certain situations where it becomes crucial to identify the internal genitalia for precise prenatal diagnosis and thorough counseling. This paper aims at reviewing these situations in which the evaluation of the external genital organs is necessary, as well as the ways in which ultrasound can be used in the diagnosis of genital malformations. [ABSTRACT FROM AUTHOR]

Simple Summary: Gynecological cancers affect many women of reproductive age, necessitating the development of fertility preservation methods to fulfill family planning. Consequently, providing treatment options that preserve fertility in women diagnosed with gynecological cancers has become a crucial component of care for survivors. This leads to improved quality of life, allowing survivors to become mothers even in the seemingly adverse circumstances posed by cancers. However, although there are guidelines on fertility preservation in the context of neoplasms, physicians do not routinely consider it and do not discuss these options with their patients. It is important for patients to be informed about the available options for fertility preservation and to be encouraged to make informed decisions in collaboration with their medical team. Standardized guideline recommendations for onco-fertility should be considered in the future. We explore possible methods that can be employed for obtaining a pregnancy after gynecologic cancer treatment, including more exotic ones like uterine transplant. (1) Background: Currently, an increasing number of women postpone pregnancy beyond the age of 35. Gynecological cancers affect a significant proportion of women of reproductive age, necessitating the development of fertility preservation methods to fulfill family planning. Consequently, providing treatment options that preserve fertility in women diagnosed with gynecological cancers has become a crucial component of care for survivors. (2) Methods: We conducted an extensive search of relevant scientific publications in PubMed and Embase databases and performed a narrative review, including high-quality peer-reviewed research on fertility after being treated for gynecologic cancers, reporting pregnancy rates, birth rates, and pregnancy outcomes in cancer survivors as well as therapeutic options which partially preserve fertility and methods for obtaining a pregnancy in survivors. (3) Discussion: The medicine practiced today is focused on both treating the neoplasm and preserving the quality of life of the patients, with fertility preservation being an important element of this quality. This leads to an improved quality of life, allowing these women to become mothers even in the seemingly adverse circumstances posed by such a pathology. However, although there are guidelines on female fertility preservation in the context of neoplasms, an analysis shows that physicians do not routinely consider it and do not discuss these options with their patients. (4) Conclusions: Advancements in medicine have led to a better understanding and management of gynecological neoplasms, resulting in increased survival rates. Once the battle against these neoplasms is won, the issue of preserving the quality of life for these women arises, with fertility preservation being an important aspect for women who have not yet fulfilled their family planning desires at the time of diagnosis. It is important for patients to be informed about the available options for fertility preservation and to be encouraged to make informed decisions in collaboration with their medical team. Standardized recommendations for onco-fertility into guidelines should be taken into consideration in the future. [ABSTRACT FROM AUTHOR]