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Congenital heart disease (CHD) is the most common birth defect and represents the leading cause for mortality and morbidity in infants and young adults. Early fetal echocardiography is usually considered a highly specialized scan. The goal of this study is to evaluate the impact of operator's experience in assessing still images of the 4-chamber view and 3-vessels view and to evaluate the feasibility and the performance of a first trimester screening protocol for CHD. An online questionnaire consisting of still images of the 4-camber view and 3-vessel view from 50 normal and abnormal cases was reviewed by an expert group made of seven obstetricians specialized in fetal medicine and a nonexpert group made of 13 obstetricians that are certified in ultrasound. After individually visualizing each image set made of the 4-chamber view and 3-vessel view, they had to conclude if the case was normal or abnormal and what images were abnormal. A total of 50 image sets of both normal and abnormal fetal hearts were examined by the 20 reviewers, resulting in 1000 evaluations. The expert group achieved a detection rate of 97.1% with a false positive rate of 5.7%. The nonexpert group achieved also a good detection rate of 91.3% but with a much higher false positive rate of 33.9%. The most frequently missed CHD involved the great arteries and had a normal 4-chamber view. In the majority of false positive cases the 3-vessel view was incorrectly interpreted as abnormal. A screening protocol for CHD, based on the 4-chamber view and 3-vessel view alone can offer a good detection rate for CHD with a small false positive rate, but only if it is implemented by highly specialized sonographers. [ABSTRACT FROM AUTHOR]

Recently, substantial progress has been made in diagnosis and treatment, complicated ectopic pregnancy is a not negligible cause of maternal mortality, being the leading cause of maternal death in the first trimester of pregnancy and responsible for 6% of maternal deaths. The aim of this study is to evaluate patients with ectopic pregnancy from a clinical, paraclinical and therapeutic point of view and to compare the influence of the management on hospitalization days and the preservation of patients fertility. This paper presents a prospective case-control study for 65 patients, who have been diagnosed serologically and ultrasonically. In the group of patients studied, 25% patients were treated with methotrexate, 65% were required surgical treatment, 4% required surgical and medical treatment, and 2% the management of expectation. Laparoscopy significantly reduces the hospitalization period, contributing decisively to the rapid reintegration into society, increasing patient comfort, an excellent mental tone that promotes earlier healing, the number of complications decreases. [ABSTRACT FROM AUTHOR]

Endometriosis is a common condition among women of reproductive age that can cause chronic pelvic pain and infertility. Rapid establishment of a positive diagnosis of endometriosis is essential for effective management. The positive diagnosis of endometriosis is difficult to establish and requires invasive methods. The "golden standard" for diagnosis is still laparoscopy. Current research has not yet established specific non-invasive diagnostic methods for endometriosis. Imaging techniques, endometrial or serum markers facilitate diagnosis and are useful in monitoring the patient's progress. A number of noninvasive investigations, such as imaging techniques, or biomarkers are currently being evaluated for use in routine practice. A combination of these noninvasive tests could be the standard for diagnosing endometriosis in the future. [ABSTRACT FROM AUTHOR]

Endometriosis is a benign, chronic, estrogen-dependent condition, present in 10% of women of reproductive age. The condition is associated with chronic pelvic pain and infertility that influence their quality of life, as well as married life and has important socio-economic consequences. Despite its high morbidity, its etiopathogenesis is incompletely known. A large number of studies suggest that the ability of endometrial implants to grow in ectopic locations may be correlated with the altered immune response towards the endometriotic tissue. There are enough data to show that immune system mediators, such as cytokines and chemokines, are playing key roles in the onset and olso on progression of endometriosis. There are studies that prove the association between endometriosis and autoimmune diseases. The present paper aims to investigate the implications of the immune response in the etiopathogenesis of endometriosis. The study of cellular or humoral immunity deficits, the presence of autoantibodies associated with this condition, can facilitate the understanding of the mechanisms that lead to the appearance and spread of endometriosis. We hope that this information will ultimately provide the basis for the development of new effective approaches in endometriosis management. [ABSTRACT FROM AUTHOR]

The increase in the incidence of ectopic pregnancy in the last 20 years, with the serious compromise of the woman's obstetric future and the life-threatening complications caused by it, makes ectopic pregnancy a very current problem, frequently encountered in Obstetrics-Gynecology clinics The aim of this study is to compare how risk factors and management can influence the incidence and the risk of recurrence of ectopic pregnancy. This paper presents a prospective case-control study for 65 patients, who have been diagnosed serologically and ultrasonically. In the present study, the most common risk factors involved were: pelvic inflammatory disease (46%), ectopic pregnancy (20%), smoking (85%), abortions (55%), and abdominal surgery (43%). In the group of patients studied, patients required surgical and medical treatment, and also a management of expectation. The risk factors that influence recurrence were smoking (100%), pelvic inflammatory disease (84.6%), abortions (53.8%), abdominal surgery (46%). By the type of surgery (laparoscopy or laparotomy), the risk of recurrence varies between 6 and 10% and does not seem to be influenced by it. [ABSTRACT FROM AUTHOR]

Background and Objectives: Despite being largely preventable, cervical cancer mortality still remains an important public health problem globally, in Europe, and in Romania. The European Union member states are urged to implement systematic, population-based screenings for cervical cancer, but the programs developed by the countries remain very heterogeneous. This study aimed to investigate the differences in cervix cancer mortality between Romania and EU and within Romania over the last two decades and to reveal the major sources of inequalities and the policy implications. Materials and Methods: We analyzed the number of deaths and the mortality rates by cervical cancer, standardized using the direct method, over two decades (2001–2016 for the EU, and 2001–2019 for the national and sub-national analyses). Trends, mortality reduction over the years, and mortality differences at the beginning and end of the time interval have been calculated for the EU and Romania, at national and sub-national levels (rural–urban and regions). Results: Our results revealed differences in cervical cancer mortality between Romania and EU and within Romania (among regions and rural–urban areas). These differences used to be very high in the past and are still persisting. Conclusions: The country should revisit its national cervical cancer screening program, which has been implemented for many years, but with a very limited participation rate. Due to the similar problems existing in Central-Eastern Europe, targeted support from the EU for the members from this geographical area could contribute to the minimization of differences in cervical cancer mortality among the EU members. [ABSTRACT FROM AUTHOR]

Worldwide, cervical cancer ranks 4th in frequency in the female population, with about half of the cases being fatal. In Romania, it is the second type of cancer found in women, after breast cancer and the main cause of cancer mortality in patients aged between 15 and 44 years. The main cause of this type of cancer is human papilloma virus (HPV) infection. Although HPV is very widespread (> 85%), progression to cervical cancer is relatively rare. In countries that have implemented cervical screening programs, the incidence and mortality caused by this pathology have decreased by 50-75%. Also, the emergence of vaccines against the most common strains of oncogenic HPV and the implementation of vaccination programs will bring additional benefits in preventing cervical cancer. This paper presents the results of a retrospective study, performed on a number of 92 patients, which aimed to know the distribution of different HPV genotypes, their impact on the cervical epithelium, the degree of access to the national screening program, and openness to anti HPV vaccination. [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 infection, which originated from a market in Wuhan, China, spread rapidly, so on March 11, 2020, the WHO decreed that the outbreak became a pandemic. Over 90% of people infected with SARS-CoV-2 are either asymptomatic or have mild symptoms. However, there are cases that develop severe forms of the disease, from acute respiratory distress syndrome to septic shock with multiorgan failure and exitus. However, reports of pregnant women diagnosed with Covid-19 are low. Changes in the maternal organism in pregnancy, including immunity, respiratory system and hypercoagulability, but also various comorbidities, could be a risk factor for pregnant women to develop complications associated with COVID-19, with increased morbidity and mortality compared to the general population. The effects of SARS-CoV-2 infection on pregnancy are not sufficiently understood, nor are the effects of pregnancy on disease progression. Although the existence of the virus has been shown in biological samples such as the placenta, umbilical cord, or amniotic fluid, the maternal and fetal effects of the virus are not well known. Recent studies confirm the possibility of intrauterine maternal-fetal transmission of the virus, but also of specific antibodies. The possibility of infection by breastfeeding is not yet sufficiently investigated. We looked for data on the treatment and prophylaxis of SARS-CoV-2 infection during pregnancy, as well as on the choice of the optimal birth pathway in these women. The aim of this paper was to conduct a systematic review of the literature on pregnancy and birth management in patients infected with SARS-CoV-2 that could lead to an improvement in the quality of their medical care. [ABSTRACT FROM AUTHOR]

Isthmocele, also known as uterine niche, refers to a myometrial defect of the anterior wall of the uterine isthmus, specifically at the site of the previous C-section scar. The prevalence of isthmocele has increased in tandem with the rise in deliveries by caesarean section. Risk factors include aspects related to the surgical procedure. The present study aimed to assess the relationship between various suture types and the development of a niche. The analysis of the present study is based on data collected from the evaluation of 52 patients, 6 weeks post C-section performed in 'Saint Pantelimon' Hospital in Bucharest, Romania. The parameters examined included patient age, the number of previous births by C-section, the type of suture used and uterine anatomy. Out of all the 52 patients, 42.3% developed an isthmocele. The results confirm a significant association between the presence of the niche and the type of suture of the first layer, proving that when non-locking continuous suture was used, the absence of niche was observed in most cases, while using the locking continuous suture was associated with more niches. Using the continuous locking suture for the first layer was associated with severe niches, while no severe niches were observed in patients with the other two types of sutures. There is a statistically significant association between the use of continuous locking sutures for uterine closure in the first layer and the development of a uterine niche. Furthermore, all instances of severe niches were linked to this type of suture, compared with continuous non-locking suture or interrupted suture. Given the escalating rate of C-sections, further research is crucial to identify the suture type that minimizes the risk of isthmocele formation. The present study's limitations revolve around its exclusive focus on a single institution and the relatively small sample size., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2024 Zampieri et al.)

Despite advances in fetal monitoring during labor, one of the most critical causes of neonatal death and neurologic injuries remains intrapartum asphyxia. Umbilical cord gases can be used to detect acidosis and fetal distress. We conducted a retrospective, multicenter study to evaluate umbilical cord blood pH and lactate as a mean of evaluating the degree of intrapartum hypoxia and also to establish which of the two is more reliable in predicting morbidity in term neonates. The present study utilized a total of 124 cases that met the criteria for intrapartum asphyxia and 150 normal term newborns that were randomly selected as case control. Both umbilical cord lactate and pH proved to be accurate predictors of neonatal morbidity caused by intrapartum hypoxia. Lactate proved to be superior to pH in predicting adverse neonatal outcome. The greatest sensibility and specificity in predicting intrapartum asphyxia were achieved in our study by using a cutoff value of 3.75 mmol/l for lactate and 7.24 for pH., (Copyright © 2020, Spandidos Publications.)

Human T-lymphotropic virus (HTLV) is considered to be the most highly oncogenic existing virus, being the cause of several fatal diseases such as adult T cell leukemia-lymphoma (ATL) and HTLV-I-associated myelopathy (HAM). The main transmission methods are unprotected sexual intercourse, vertical transmission and breastfeeding and direct exposure to infected blood or tissue. The identification of infected mothers prior to delivery is a highly important step in preventing mother to child transmission. Universal antenatal screening for HTLV is not recommended in Romania, although there are sufficient data demonstrating the risk of vertical transmission. We present the case of an HTLV-1-infected pregnant woman, with an aim to highlight: i) points of strategy for the management of HTLV during pregnancy; ii) the particularities of the course of pregnancy; and iii) the aspects that show the importance of knowing the status regarding the HTLV infection antepartum. The case was particular due to the ascendant proviral load during the pregnancy period, which led to the initiation of antiretroviral therapy and the particular pregnancy outcome with preterm rupture of membranes and fetal growth restriction. According to current recommendations, pregnant women infected with HTLV-1 should be advised to refrain from donating blood, body organs, or other tissues. There is no evidence of the number of individuals infected with this virus in Romania at present, and the diagnosis can only occur by chance. A specific treatment or immunization for HTLV infection does not currently exist, thus preventive methods are the only tool to reduce the prevalence and mortality of this infection., (Copyright © 2020, Spandidos Publications.)

The development of granulomatous lesions in distant organs is an uncommon complication of the immunotherapy with BCG vaccine. We report a case of granulomatous hepatitis after the 12th BCG intravesical instillation (6 weekly followed by 6 monthly) in a 58-year-old man with superficial bladder cancer. The patient was admitted because of fever and jaundice. Disseminated BCG infection was suspected on the basis of history, clinical examination and a liver biopsy that showed noncaseating granulomatous hepatitis. PCR for M. bovis was positive in the liver tissue, confirming the mycobacterial dissemination. Our patient improved clinically with a regimen including both corticosteroids and antituberculosis agents.