Search

Introduction. Placenta praevia (PP) is an obstetrical complication where the maturing placenta obstructs a part or all of the internal cervical os. Abnormal placenta invasion and development are associated with a spectrum of conditions rather than a single obstetric pathology. Objective. To review the ultrasound markers for placenta praevia in our experience and correlate the imagistic and histopathological findings. Methodology. This is a retrospective study including 259 patients admitted with the diagnosis of PP in the Obstetrics-Gynecology Clinic II of the County Emergency Clinical Hospital Craiova, Romania, between 2018 and 2023. Results. The most important ultrasound features associated with placenta praevia with accreta were loss of retroplacental hypoechoic area, presence of placental lacunae, presence of bladder wall discontinuity, placental bulge, exophytic mass, subplacental and/or uterovesical hypervascularity, placental lacunae feeder vessels, and bridging vessels. According to the degree of placental invasiveness, the histopathological evaluation showed disorganization of the uterine wall, myocytes anarchically distributed among the villi and decidual cells, neoformation vessels invading the myometrium, and these aspects were correlated with hyperadherence and significant antepartum and intrapartum bleeding. Conclusions. The aforementioned ultrasound features may put doctors on alert and, thus, dictate the appropriate therapeutic management to prevent complications that could endanger fetal or maternal life. [ABSTRACT FROM AUTHOR]

Objectives-To evaluate ultrasound markers during a first-trimester (FT) routine ultrasound examination for an early detection of open spina bifida (OSB) and to correlate the sonographic findings with the morpho-histological ones. Materials and Methods: This retrospective research was performed using data from foetuses that underwent FT anatomy scans (FTAS) with a gestational age between 11 weeks and 13 weeks and 6 days in the Prenatal Diagnostic Unit of the Clinical Emergency County Hospital Craiova from October 2022 until September 2023. Results: The study included 648 FT singleton pregnancies and 5 OSB cases were detected. In the OSB group, we found abnormal aspects of the fourth ventricle, also named intracranial translucency (IT) in 4 out of 5 cases of OSB (80%), a brain stem anteroposterior diameter, and brain stem to occipital bone ratio abnormal in all 5 cases (greater than 1) (100%), the crash sign was present in 80% (4 out of 5 cases) and the spinal defect was visualized in 4 out of 5 patients (80%). Medical termination of pregnancy (MTOP) was the preferred option in all cases of OSB. This allowed us to include an extended histological study to confirm the ultrasound diagnosis. Conclusions: A combined detailed FTAS that includes both cranial ultrasound markers of the posterior fossa and also a good visualization of the foetal spine offers an early optimal detection rate of spine abnormalities. [ABSTRACT FROM AUTHOR]

Objective. Evaluation of Intraplacental Villous Artery Doppler (IPVA) as a predictive factor compared to umbilical artery (UA) Doppler in placenta-mediated disease (PMD). Methods. This prospective study included a group of 106 pregnant women, of which 76 patients constituted the PMD group: preeclampsia (PE) and small for gestational age (SGA), and 30 pregnant women constituted the control group. IPVA and UA Doppler evaluation was performed in 2 pregnancy periods: 20.0-23.6 weeks, and 28.0-32.6 weeks of gestation. Results. From the study of maternal characteristics and risk factors for the presented pathology, we found that no studied risk factor was statistically involved in the evolution toward PMD during pregnancy. In the control group, we noticed a decrease in IPVA PI and RI, along with an increase in gestational age, while in the PMD group, these indices increased. Both in the 2nd and the 3rd trimester, we had a significant statistical difference between the two groups (p<0.001). Regarding the degree of prediction of the changes that occurred at this level, we found a good statistical correlation. A higher degree of positive predictability is noted, for IPVA-PI, but also for UA-PI, but with better sensitivity (72.27%) for UA PI in the 2nd trimester. Conclusions. We can conclude that both Doppler measurements, IPVA and UA can be used to evaluate and detect pregnancy complications that belong to PMD, preeclampsia, and/or fetal growth restriction. [ABSTRACT FROM AUTHOR]

Introduction. One of the most significant factors contributing to major obstetric hemorrhage is placenta accreta spectrum (PAS). The incidence of PAS is increasing, being now approximately 3 per 1000 deliveries, due to the epidemic rise of caesarean section (CS) rate and to pregnancies resulting from assisted reproductive technology. This pathologic adherence of the placenta to the uterine myometrium can be associated with significant maternal-fetal risks. The antenatal diagnosis includes ultrasonographic (US) assessment and magnetic resonance imaging (MRI) spectrum, but still remains imperfect. This paper aims to offer a short review regarding the proper evaluation and management of PAS. In addition, we present our clinic experience with placenta accreta in the last year. Methodology. We conducted a PubMed search including reviews, case reports and original papers regarding PAS in the last 10 years. We also performed a 12-month retrospective study that included 42 pregnant women, aged between 18 and 46 years old. The inclusion criteria were: bleeding during the third trimester of pregnancy and history of caesarean section delivery. Results and discussion. All patients benefited from a transvaginal and transabdominal US. All suspected PAS cases were evaluated using the new International Federation of Gynecology and Obstetrics (FIGO) classification. Two patients also benefited from an MRI examination and cystoscopy due to high suspicion of PAS. In two cases, the delivery was followed by a hysterectomy. In three cases, the caesarean section was complicated by postpartum hemorrhage, yet controlled with ligation of the uterine artery unilateral or bilateral. Conclusions. Placenta accreta spectrum is impacting maternal health outcomes globally and should be managed by experienced multidisciplinary teams. The correct antenatal diagnosis of PAS includes a combination of ultrasound, MRI examination and cystoscopy. Hysterectomy is the accepted management of PAS, and the conservative or expectant management of placenta accreta spectrum should be considered investigational. [ABSTRACT FROM AUTHOR]

Introduction. Adnexal masses (AM) detected during pregnancy require a prompt and accurate diagnosis to ensure fetal safety and good outcomes. Adnexal masses in pregnant women are most commonly detected during ultrasonographic (US) examination, routinely performed early in pregnancy. The incidence of adnexal masses in pregnancy has a rate of 0.01-15%. Obstetricians should decide between expectant management with a risk of rupture, torsion, need for emergent surgery, labor obstruction and progression of malignancy, or surgical removal during pregnancy. We present a case report of unilateral adnexal mass diagnosed early in pregnancy. Materials and method. A 24-year-old female patient addressed an obstetrics-gynecology private practice for dating a first pregnancy. A single intrauterine sevenweek viable pregnancy was confirmed with a corpus luteum present in the right ovary. The examination of the left adnexa found an unilocular tumor of 18-20 cm, with no papillary structures, no solid components or acoustic shadows. There was no ascites, nor increased blood flow to the tumor. The imagistic criteria pleaded for a benign huge ovarian cyst. Results. In the second trimester, about 20 weeks of gestation, after proper counselling, we decided to perform open surgery to remove the adnexal mass. Intraoperatively, we were not able to find any normal ovarian tissue. We performed a unilateral adnexectomy. The patient was discharged 48 hours later, with no complications and no symptoms at all. Conclusions. The complex diagnosis of adnexal masses in pregnancy is now accessible due to clear and specific US guidelines that help differentiate between benign and malignant masses. The management of adnexal masses during pregnancy is still a subject of debate, with no consensus regarding the best management plan. Tumor size, nature, location, symptomatology and the first trimestre mass detection are all crucial aspects for a proper care. [ABSTRACT FROM AUTHOR]

Introduction. Adnexal masses (AM) detected during pregnancy require a prompt and accurate diagnosis to ensure fetal safety and good outcomes. Adnexal masses in pregnant women are most commonly detected during ultrasonographic (US) examination, routinely performed early in pregnancy. The incidence of adnexal masses in pregnancy has a rate of 0.01 15%. Obstetricians should decide between expectant management with a risk of rupture, torsion, need for emergent surgery, labor obstruction and progression of malignancy, or surgical removal during pregnancy. We present a case report of unilateral adnexal mass diagnosed early in pregnancy. Materials and method. A 24 year old female patient addressed an obstetrics gynecology private practice for dating a first pregnancy. A single intrauterine seven week viable pregnancy was confirmed with a corpusluteum present in the right ovary. The examination of the left adnexa found an unilocular tumor of 18 20 cm, with no papillary structures, no solid components or acoustic shadows. There was no ascites, nor increased blood flow to the tumor. The imagistic criteria pleaded for a benign huge ovarian cyst. Results. In the second trimester, about 20 weeks of gestation, after proper counselling, we decided to perform open surgery to re move the adnexal mass. Intraoperatively, we were not able to find any normal ovarian tissue. We performed a unilateral adnexectomy. The patient was discharged 48 hours later, with no complications and no symptoms at all. Conclusions. The complex diagnosis of adnexal masses in pregnancy is now accessible due to clear and specific US guidelines that help differentiate between benign and malignant masses. The management of adnexal masses during pregnancy is still a subject of de bate, with no consensus regarding the best management plan. Tumor size, nature, location, symptomatology and the first trimestre mass detection are all crucial aspects for a proper care. [ABSTRACT FROM AUTHOR]

Aim. We present our experience in the prenatal diagnosis of umbilical-portal-systemic venous shunts (UPSVS) and their prognostic factors. Materials and method. A prospective study was conducted in our center between January 2017 and January 2022, regarding the detection of UPSVS during pregnancy. In all UPSVS diagnosed cases, a detailed evaluation of the fetal abdominal veins was performed. We analyzed the type of the shunt and the integrity of the portal venous system. We analyzed the incidence of the UPSVS types, their associations and outcome predictors. Results. Thirtyone UPSVS cases were diagnosed in 14,793 scanned fetuses, with a prevalence of 0.2%. The gestational age at diagnosis ranged from 13 to 30 weeks. UPSVS were diagnosed in all first-trimester presented cases, except one. We detected 19 type I umbilical-systemic shunts (USS; 61.2%) that associated major morphological and genetic anomalies which worsened the outcome for this group. Also, anomalies of the portal venous system (PVS) were found in 87.5% of the assessed cases. Type II, ductus venosus-systemic shunt (DVSS), was found in 12.9%. PVS was normal in all cases, but half of them associated other structural anomalies. Type IIIa (intrahepatic portal-systemic shunt) was detected in five cases (16.1%); three of them presented an intact PVS, and two associated partial portal venous system agenesis (PPVSA) and intrauterine growth restriction (IUGR). In three cases (9.6%) we diagnosed a new category of complex umbilical-portal-systemic venous anomalies, with multiple shunts Karyotyping was performed in 25 diagnosed cases, with abnormal results in ten (40%) of them. Conclusions. The prevalence of this pathology in a tertiary unit is higher than reported, 0.2%. The early detection of UPSVS is feasible. The postnatal outcome in cases with UPSVS mainly depends on the presence of major structural, genetic and portal abnormalities and on the complexity of the shunt. Care should be given in monitoring the fetal well-being, as intrahepatic portalsystemic shunts are associated with intrauterine growth restriction (IUGR). [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. The main objective of our study was to demonstrate the potential of the first-trimester anomaly scan to identify components of the portal venous system (PVS), and to describe the potential of microscopic evaluation of the PVS in the FT. Materials and method. We evaluate the appearance of PVS in 200 scan examinations performed in fetuses between 12 and 13.6 gestational weeks (GW). The scans were performed in half of the cases by two operators who had extensive experience in obstetric ultrasound (Group I) and in the other half of the cases by two sonographers with less experience (Group two). The examinations were performed via transabdominal and, in selected cases, via transvaginal approaches. We performed macroscopic and microscopic examination of the liver in one case of interrupted pregnancy. Results. Group I successfully assessed all PVS features by transabdominal approach in 27% of the cases. The assessment rate was lower for Group II (14%). The transvaginal approach or reschedule showed a better rate of detection for both groups (88% in Group I and 72% in Group II). Unfavorable fetal position, BMI greater than 24, abdominal scar, retroverted uterus, fibroids and combinations of the above were reasons for the reschedule or using the transvaginal approach. Following reevaluations, the rate of detection of the L-shaped UV confluence increased from 91% to 98% in Group I, and from 79% to 95% in Group II, on transabdominal approach. The visualization of a normal L-shaped UV confluence, that excludes major PVS abnormalities, is achievable in approximately 80% of cases, regardless the examiners experience. The microscopic examination confirmed the normal aspect of portal venous system. Conclusions. Early fetal PVS assessment is feasible. The experience of the sonographer, uterus anomalies or the Body Mass Index (BMI) may be factors that affect the rate of detection. Combining the abdominal and vaginal approach or rescanning, a higher rate can be achieved. The first-trimester pathology can be performed only microscopically. [ABSTRACT FROM AUTHOR]

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

Introduction. Adenomyosis is a benign pathology defined by the presence of endometrial glands in the miometrium, accompanied by chronic pelvic pain, infertility and vaginal bleeding. It is a hormonal dependent condition and is common in reproductive age. Adenomyosis areas differ from the normal endometrium by increased local production of estrogen or prostaglandins and resistance to progesterone action. Materials and method. The study included 23 patients, aged 26-52 years old, diagnosed with adenomyosis. Postoperatively obtained specimens were included in paraffin and studied histologically and immunohistochemically. The blocks were cut by the microtome, the sections were applied on simple slides for histological staining of Hematoxylin-Eosin and on Poly-L-lysin slides for the immunohistochemical stains. The antibodies were: anti-estrogen receptors (ER), anti-progesterone receptors (PR), anticytokeratin 7 (CK7), anti-cytokeratin 20 (CK20). Results. Classical Hematoxylin-Eosin staining showed the presence of mono-layered, cylindrical glandular epithelial tissue in the structure of the myometrium, and with immunohistochemistry we showed that these glands were of endometrial origin, being CK7-positive and negative at CK20, making a differential diagnosis with an eventual metastasis from the digestive tract. The receptors for estrogen and progesterone are present in the structure of these glands. Conclusions. Adenomyosis is a benign pathology diagnosed with certainty by histopathological examination. Receptors for estrogen and progesterone are features for endometrial tissue, and cytokeratins make the differential diagnosis with digestive epithelium. [ABSTRACT FROM AUTHOR]

Diabetes is the most common medical complication associated with pregnancy. During pregnancy complicated with maternal diabetes (DM), the placenta suffers certain pathological, functional and structural changes. DM was correlated with a rapid progressive microangiopathy and this, in turn, may be associated with capillary hypertension and changes in capillary permeability. The objective of the study is to identify the clinical correlations with influence on gestation in general, and on the placental structure in particular, in pregnancy associated with type 1 (T1DM), type 2 (T2DM) and gestational diabetes mellitus (GDM). The impact of the clinical conditions associated with DM on placenta has been analyzed and correlated with the ultrasound (US), morphological, histological and immunohistochemical study of the placental structure. Preexisting maternal hypertension, preeclampsia and obesity were the main associated conditions. The US examination of placental characteristics revealed an increase in placental thickness in the second trimester. The macroscopic analysis showed that the placentas of women with diabetes are heavier. Gross pathological analysis of maternal and fetal surfaces of placentas revealed subcortical or basal plaque fibrin deposition, and placental infarction or intervillous thrombosis. From the microscopic point of view, the findings include fibrinoid necrosis, intervillous fibrosis, focal hyaline degeneration, villous immaturity, chorangiosis, placental calcifications, placental infarction or decidual vasculopathy. Maternal hypertensive disorders amplify the spectrum of morphological changes in the placenta. Placental immaturity and villous capillary dysfunction are characterized by increased angiogenesis and enhanced vascular permeability. The diabetic placenta does not show specific changes, but different associations may be a diabetic pathological pattern influenced by associated conditions, especially preeclampsia, obesity, dyslipidemias and the lack of euglycemia during pregnancy. [ABSTRACT FROM AUTHOR]

Kaposi's sarcoma (KS) represents a type of cancer that usually arises on the skin and very rarely in other organs. KS-associated herpesvirus (KSHV), also known as human herpesvirus-8 (HHV-8) commonly arises in patients with acquired immunodeficiency syndrome (AIDS). Laryngeal involvement of KS is very rare. Our study comprised of three cases with laryngeal KS. All cases were solved through surgical excision of the tumor. Histopathological and immunohistochemistry examinations revealed laryngeal KS. Laryngeal KS should be managed through surgical resection, followed by oncological treatment.

Background: The effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy remain relatively unknown., Aim: We present this original paper where we analyzed 60 parturients, at term, 30 without associated infection (C-) and 30 with associated infection (C+), present at birth., Methods: We analyzed the blood count and placental microscopic structure through classical and immunohistochemical staining and observed the placental areas affected by the presence of SARS-CoV-2., Results: SARS-CoV-2 infection was accompanied by a decrease in the number of lymphocytes, the number of platelets and the presence of placental structural changes, identifying extensive areas of amyloid deposits, placental infarcts, vascular thrombosis, syncytial knots, with a decrease in placental vascular density and the presence of infection in the cells located at decidual level, at syncytiotrophoblast level and at the level of the cells of the chorionic plate, still without overcoming this barrier and without causing any fetal infection in the analyzed cases., Conclusions: This study shows that the invasion of SARS-CoV-2 in the placenta can produce significant structural changes, with a decrease in placental vascular density that can have significant implications on proper fetal perfusion. Also, the presence of immunoreactivity at the level of decidua, the placental villi, as well as the chorionic plate proves that the virus can overcome the maternal-fetal barrier. However, in the analyzed cases there were no fetal infections at birth, which may show that local placental factors can be a protective filter for the fetus.

Due to rapid technology advancement and increasing diagnostic expertise, fetal medicine is rapidly improving. Prenatal diagnostic advancements made it possible to identify structural abnormalities in fetuses as early as the first trimester of pregnancy. However, to validate the echocardiographic diagnosis that led to the pregnancy termination, the termination of pregnancy owing to severe fetal deformities should be audited in accordance with a correct anatomic diagnosis. Following the PRISMA declaration, a systematic literature search was done to find articles on post-mortem first trimester human fetal heart evaluation. Thirteen suitable studies were found using the search method. It is theoretically possible to examine the human fetal heart after death in early pregnancy however these methods are not widely available due the costs associated with the procedure and the equipment, the effects of tissue coloration and distortion brought on by the fixation and contrasting processes (for micro-CT), the current requirement for a skilled operator to acquire, reconstruct, and process the images, and data storage requirements greater than those of conventional clinical scans., Competing Interests: The authors have no conflict of interest to declare., (Copyright © 2022, Medical University Publishing House Craiova.)

Objectives: This study aims to establish a correlation between placental histopathological and immunohistochemical (IHC) changes and preterm birth with fetal growth restriction (FGR, formerly called intrauterine growth restriction - IUGR)., Patients, Materials, and Methods: This prospective study was performed on a group of 30 parturients, with singleton gestation, of which 15 patients gave birth at term, and the other 15 patients gave birth prematurely. After the statistical correlation of the clinical and demographic data with premature birth (PB) and term birth (TB), we performed histological and IHC research on the respective placentae. To observe normal and pathological microscopic placental structures, we used the Hematoxylin-Eosin (HE) and Periodic Acid Schiff-Hematoxylin (PAS-H) classical stainings, but also special immunostaining with anti-cluster of differentiation 34 (CD34) and anti-vascular endothelial growth factor (VEGF) antibodies., Results: We found a statistically significant difference between the TB∕PB categories and the age of the patients, their antepartum weight, the weight of the newborns, and the placenta according to the sex of the newborn. Histological analysis revealed in the case of TB, small areas of perivillous amyloid deposition, with the significant extension of these areas both intravillous and perivillous in the case of PB. Massive intravillous calcifications, syncytial knots, and intravillous vascular thrombosis were also frequently present in PB. With PAS-H staining were highlighted the intra∕extravillous vascular basement membranes, but especially the massive fibrin deposits rich in glycosaminoglycans. By the IHC technique with the anti-CD34 antibody, we noticed the numerical vascular density, higher in the case of TB, but in the case of PB, there were large areas of placental infarction, with a lack of immunostaining in these areas. Through the anti-VEGF antibody, we observed the presence of signal proteins that determined and stimulated the formation of neoformation vessels in the areas affected by the lack of post-infarction placental vascularization. We observed a highly significant difference between placental vascular density between TB∕PB and newborn weight, sex, or placental weight., Conclusions: Any direct proportional link between the clinical maternal-fetal and histological elements yet studied must be considered. Thus, establishing an antepartum risk group can prevent a poor pregnancy outcome.

Introduction: Gastric cancer represents a real public health problem as far as incidence, aggressiveness and unfavorable prognosis are concerned. The autonomous nervous system might be one of the major factors involved in the onset, progression, and metastasis, both sympathetically and parasympathetically. The increased activation of the M3 muscarinic acetylcholine receptors (mAChRs) triggers pro-oncogenic mechanisms, especially at a gastric level, through the activation of the Hippo signaling pathway and the increase of the nerve growth factor., Patients, Materials and Methods: In this study, biopsy or postoperative gastric resection pieces have been evaluated by histopathological (HP) and immunohistochemical (IHC) examination in a group of 77 gastric patients and 23 patients without an oncological diagnosis. To quantify the IHC signal, also considering the HP aspect, light microscopy images were obtained., Results: The M3 mAChR expression analysis has been correlated with the different gastric adenocarcinoma differentiation degrees (G1-G3). M3 mAChR presence has been observed also in the non-malignant gastric tissue, but it was significantly increased in the tumor tissue. The highest receptor expression was recorded in patients with a poorly-differentiated (G3) adenocarcinoma, these expressions decreasing with the increase of the differentiation degree towards moderately-differentiated (G2) and well-differentiated (G1)., Conclusions: Surgical or pharmacological parasympathetic activity inhibition could decrease the development and progression of gastric tumors and could improve the gastric cancer patient's prognosis.