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The human immunodeficiency virus (HIV) infection is a real public health problem in both developing and developed countries. HIV infection has not been treated efficiently for a long time, with HIV-positive women at increased risk of transmitting the infection to their newborns. Without the appropriate treatment, the evolution of the infection is relatively fast. Due to the antiretroviral treatment, the progression of the disease is blocked during the period of asymptomatic infection, and the risk of neonatal transmission is very low. HIV-positive patients undergoing antiretroviral therapy develop undetectable viremia and, in such situations, patients no longer have a risk of transmitting the infection. The antiretroviral medication is a combination of several classes of drugs (protease inhibitors, nucleoside and non-nucleoside reverse transcriptase inhibitors, integrase inhibitors and CCR5 inhibitors) whose aim is to stop the viral replication at different stages. The infection is most often transmitted in the perinatal period, so it is very important that we know the maternal viremia and choose the type of birth with the lowest risk of transmitting the infection to the fetus. For this reason, any HIV-positive patient with detectable viremia at childbirth should receive treatment during labor and delivery, with a nucleoside or non-nucleoside reverse transcriptase inhibitor that crosses the fetal-placental barrier. [ABSTRACT FROM AUTHOR]

Introduction. Corpus callosum is the largest fiber structure of the white matter, designed to connect the two cerebral hemispheres. Its role is to integrate motor functions, sensory and cognitive processes. The ultrasound evaluation of the corpus callosum is visible from 18 weeks, although at 20 weeks all components of corpus callosum are visible. Its growth development continues until three years of life, when it reaches the final form. Agenesis of the corpus callosum is an easy diagnostic, but other diagnoses concerning length, width and structure of short corpus callosum can be a challenge. Length anomaly can be appreciated using growth diagrams of the gestational age. It can be formulated using growth diagram. That is the reason why we consider it very important to have growth nomograms for the population in Romania, since the dimensions of corpus callosum vary according to sex, race and geographical area. Evaluating the length and comparing to nomograms is not always correct, because it can be different from the values in other populations, without being pathological. In order to avoid this issue, a ratio was proposed that was shown to be constant thorough the pregnancy. The ratio is defined by dividing the internal occipitofrontal diameter to the corpus callosum maximal length. It is stated that this is constant, despite the gestational age, and it is around 2.24-2.46. Materials and method. We included in this study all the patients examined in our unit between 30.05.2023 and 14.07.2023 for second-trimester and third-trimester anomaly scans. This is a pilot study for a larger one included in the PhD thesis of Mihai-George Loghin. We evaluated 96 patients, two patients with agenesis of corpus callosum, and for six patients could not be measured due to technical difficulties. Seventynine pregnant patients in the second trimester and nine patients in the third trimester were analyzed. The length of the corpus callosum and the internal occipitofrontal diameter were measured either by transvaginal or transabdominal approach, then the ratio between the two structures was calculated. Results and conclusions. Currently, pregnant women with a gestational age between 20 and 32 weeks were included in the study. Based on the measurements performed in our clinic, we want to create nomograms for this ratio (occipitofrontal diameter and corpus callosum length) distributed by gestational age for the local population. We found that most patients fall within the range of 2.4-2.6 for the local population. The highest value obtained was 3.6, and the lowest 2.02. Of the 79 patients analyzed, two cases were excluded, because the fetus presented agenesis of the corpus callosum. For the patients followed-up over time, it was observed that the value ratio remained relatively constant along with the fetal growth. [ABSTRACT FROM AUTHOR]

Introduction. Isoimmunization in the Rhesus (Rh) system was a health system issue until methods of diagnosis and especially prevention by immunoglobulin administration were introduced at the beginning of the 21st century. Fetal disease is caused by antibodies against the fetal red cells when there is an Rh incompatibility (Rh negative mother and Rh-positive fetus). Since antibodies are produced by fetal maternal hemorrhage, the immune response starts with a false pregnancy event and is enhanced by subsequent pregnancies, unless prophylaxis is performed. The disease has many degrees, the more severe being fetal hydrops caused by hemolytic anemia, cardiac failure and hepatomegaly. After birth, the most obvious condition is determined by the high values of bilirubinemia that can cause jaundice and neurological damage, with long-term consequences. Materials and method. We present the case of a 24-year-old pregnant woman admitted in our unit, reporting the lack of fetal movement. Results and conclusions. The 24-year-old patient, with one previous caesarian section and three abortions on request, now being 34-week pregnant, diagnosed with RH incompatibility at 24 weeks, was monitored by ultrasound, and antibody anti-D determination that did not reveal isoimmunization. At 32 weeks, she was admitted in the hospital for uterine contractility, and the blood test performed revealing antibody anti-D titer of 1:8. Ultrasound scan was normal, without signs of fetal anemia (normal PSV on MCA). At 34 weeks, the patient was admitted in our unit, reporting absent fetal movement for 24 hours. Ultrasound examination identified: mild polyhydramnios (AFI=25 cm), fetal ascites, cardiomegaly and high PSV and IP on MCA, pulsatility index (IP) on the middle cerebral artery (MCA) of 3.35, and PSV of 120 cm/s. The biological test identified: maternal mild anemic syndrome, normocytic normochromic form, without signs of iron deficiency (hemoglobin=8.8 g/dl). Repeated CTG and biophysical profile (BP) revealed a non-assuring fetal pattern with absent variability and lack of reactivity, with BP five. Emergency delivery was decided, and caesarean section was performed, considering the previous birth with a uterine scar. A 2600-gram female fetus was extracted, with an Apgar score of 4. The fetal blood count revealed severe anemia (Hb=3 g/dl), and the fetus showed sign of hydrops, ascites, cardiomegaly and hepatomegaly requiring neonatal intensive care and exsanguino transfusion. The outcome was favorable, and the baby was discharged after 14 days. The case identifies the necessity of correct screening and prophylaxis of isoimmunization whenever Rh incompatibility is present, even in pregnancies that are terminated in an early stage. This problem should be questioned and addressed in the facilities that perform abortion on request. [ABSTRACT FROM AUTHOR]

Introduction. The placenta accreta spectrum (PAS) refers to the abnormal invasion of the trophoblast into the uterine wall. When the placental villi penetrate the entire myometrium and reach the uterine serosa or the pelvic organs, it is called placenta percreta. The greatest risk for developing PAS is represented by uterine scars which is increasing due to high rate of caesarean sections. Materials and method. We present a case of hemoperitoneum and hemorrhagic shock in a twelve-week pregnancy. The patient was admitted for abdominal pain and syncope. The pregnancy was diagnosed at seven weeks without finding a caesarean scar implantation. The ultrasound was not followed by any other scans, depside the fact that she had two previous caesarean sections. Results. A 33-yearold woman reported uneventful pregnancy until couple of hours prior to admission, when she accused lower abdominal pain accompanied by syncope. The clinical evaluation revealed hypotensive confused patient with signs of peritoneal irritation and no vaginal bleeding. The transvaginal ultrasound scan revealed closed cervix with normal length with the internal ostium covered by placental tissue that ascended on the anterior wall without myometrium or serosa to delimit the placenta for the peritoneal cavity. In the vesicouterine space, there was an inhomogeneous area suggestive for blood accumulation. The gestational sac contained the single embryo corresponding to twelve weeks of pregnancy with cardiac activity. The abdominal scan indicated the presence of fluid in retrouterine space and in hepatorenal space. Emergency laparotomy was performed which revealed the pregnant uterus with ruptured vessels and active bleeding at the level of caesarean scar and, also, a uterine rupture through which placental tissue was externalized. Considering the higher risk of bleeding and that there were no other methods for achieving hemostasis (uterine artery embolization), we preformed hysterectomy. The evolution of the patient was surgically uneventful, requiring transfusion with two units of blood and one unit of plasma. She was discharged after five days. The pathological examination confirmed the diagnosis of placenta percreta and uterine rupture at the caesarean scar level, interesting also the vessels on the uterine surface. Conclusions. The incidence of placenta with abnormal adhesion is increasing due to the high rate of caesarean sections, and it requires close monitoring of the subsequent pregnancy from the early stages. Considering the potentially although rare hemorrhagic accident, PAS is a life-threatening condition, even in the first trimester. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is continuously affecting many pregnant women around the world. Due to the immunosuppression associated with pregnancy, pregnant women infected with SARS-CoV-2 are at an increased risk of developing severe forms compared to non-pregnant women. Analyzing international studies that reported COVID-19 cases among pregnant women, most infections occurred in the second trimester of pregnancy, with 15% of them requiring hospitalization. Of the total number of pregnant women, 64% gave birth by caesarean section. Evidence has shown that maternal oxygenation can be restored quickly after giving birth. In parallel, new scientific papers have reported placental infection during COVID-19, leading to placental vascular disease, preeclampsia-like syndrome, fetal growth restriction and increased risk of perinatal death. Avoiding these adverse events could justify the increased birth rate by caesarean section. Also, some women in labor end up giving birth by caesarean section due to the prophylactic use of anticoagulants or antiplatelet agents against thromboembolism related to COVID-19, thus preventing the administration of epidural anesthesia and therefore increasing the incidence of bleeding during labor. Most caesareans are performed to reduce excessive ventilation and stress during labor, as these may worsen the respiratory and proinflammatory conditions due to COVID-19. This justifies caesarean section surgery in the case of mild forms of the disease. Experts believe that premature birth can bring considerable benefits to the treatment and subsequent outcome of COVID-19. [ABSTRACT FROM AUTHOR]