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Abstract Background Cervical cancer is a major public health problem worldwide. While Romania has the highest incidence of cervical cancer in Europe, the prevalence of HPV has not been evaluated. We report the first data on HPV prevalence and type distribution in Northeast Romania. Methods HPV prevalence and genotype distribution was investigated in 514 consecutively women with or without cervical lesions in Northeast Romania. Genotyping was performed with Linear Array Genotyping/Roche kit. Results In our study group, 192/514 (37.4%) patients were positive for HPV (infected with single and with multiple HPV types). Most frequent types were: 16 (10.5%), 53 (5.44%), 51 (5.05%), 52 (4.08%) 18 (2.91%) and 31 (2.73%). Conclusions Infection with high risk types of HPV is common in Northeast Romania. Enhanced and systematic screening for cervical cancer is needed. Our results call for the implementation of a National HPV vaccine program in Romania.

It is known that the cervical length is a predictive factor for pregnancy evolution to term, but there have not been conducted any trials yet to correlate it with myometrial electrical activity on long term. Nowadays, we don't dispose of a simple, widely available technique to objectively monitor uterine contractility during pregnancy, in order to assess the risk of preterm birth. Our aim was to evaluate the relation between clinical elements, the cervical length and the uterine contractility as recorded by antepartum electromyography. In this study were included 113 women with singleton pregnancies, with gestational age 20-29 weeks divided in two groups: 44 women with short cervical length and 69 with cervical length >25mm. The cervical length is indirectly correlated to the mean contraction frequency, and the contraction percentage was significantly lower in the normal cervix group when compared to the short cervix group. The mean number of contractions was slight increase in the short cervix group (11.27±9.59 vs 9.80±7.05 contractions/hour). 58% of the short cervix patients present a significantly high number of contractions/hour, of low amplitude, and more than 55% present great amplitude and duration of contractions. About 67% of the short cervix patients present high contraction areas. Maternal activity between 10 am-11pm was more pronounced for both study groups. Electromiography has proven its efficacy and utility in obstetrical practice for identify a short cervix, which is a risk factor for premature birth, and recommend the proper treatment. [ABSTRACT FROM AUTHOR]

Traditional methods of fetal monitoring are used mainly during labor, leaving the only course of action - the caesarean intervention - in cases with high risk of fetal distress. We used another approach and set up a database that consists of cardiotocographic (CTG) recordings acquired ante partum during the 25th-28th week of pregnancy, by means of a Monica Healthcare AN24 fetal monitoring system. The analyzed signals are the maternal heart rate (MHR), the fetal heart rate (FHR) and the maternal uterine contractions (UC). The database is divided into two groups based on the risk of preterm labor: the control group that consists of 64 normal recordings and the study group that has 48 pathological or suspicious recordings. The analyzing method implemented is the Partial Directed Coherence (PDC) that determines the degree of correlation and the dynamic of couplings between corresponding signals. The purpose of the analysis is to identify the differences between the two groups and correlation degree for the specified signals in pathological or suspicious cases. [ABSTRACT FROM AUTHOR]

Endometriosis is a chronic disease characterized by the ectopic presence of endometrial-like tissue, which mainly affects women of reproductive age and generates symptoms that can have great impact on their physical, mental and social well-being. In Romania, more and more women are being diagnosed with endometriosis due to increased addressability to gynecologists for chronic pelvic pain and to increased possibilities of diagnosis by ultrasonography and laparoscopy. Therefore, gynecologists must be prepared to manage and counsel such patients. It is the doctor's duty to establish a diagnosis as early as possible and to inform the patient about the possibility of recurrence and the associated infertility. The chronic pelvic pain associated with endometriosis must not be considered a trifling symptom, because it is invalidating and it significantly affects the quality of life. A symptomatic treatment for strictly relieving the pelvic pain should not be recommended without considering the possibility of endometriosis and without further investigating the patient. After achieving the diagnosis, which most often occurs quite late, it is necessary to pursue a treatment protocol that sometimes raises difficult ethical dilemma due to the high risks and side effects on one hand and the limited benefit on the other hand. In some cases, pain is so invalidating that the last resort is total hysterectomy. Affected women are usually nulliparous, and recommending radical surgery to remove all endometriosic implants (thus abolishing the pain) would make it impossible for the patient to ever conceive a child. In this article the authors discuss the ethical challenges raised by endometriosis in terms of diagnosing and treating the disease and illustrate the gynecologists' dilemmas through clinical cases. [ABSTRACT FROM AUTHOR]

Introduction. Human immunodeficiency virus (HIV), that ultimately determines the development of AIDS, evolved in time in a pandemic disease. Objectives. Our study evaluated first-trimester markers for aneuploidy in HIV-positive pregnant women under HAART (highly active antiretroviral therapy). Materials and method. This was a prospective study that took place between January 2018 and December 2019 in the “Cuza Vodă” Clinical Hospital of Obstetrics and Gynecology, Iaşi, Romania. We analyzed first-trimester PAPP-A (pregnancy-associated plasma protein A) and βHCG (β human chorionic gonadotropin) levels in 25 HIV-positive pregnant women under HAART and compared them with the values of these markers in 31 seronegative pregnant women. Results. Both βHCG and PAPP-A were lower in HIV-positive women under HAART. Discussion. These alterations of first-trimester markers for aneuploidy might lead to an overestimation of the risk for Down syndrome. Conclusions. Obstetricians need to know the alterations of first-trimester markers for aneuploidy, so that they can correctly advise these women accordingly. [ABSTRACT FROM AUTHOR]

Introduction. Human immunodeficiency virus is a virus that causes AIDS (acquired immunodeficiency syndrome), a disease that has a major socioeconomic impact. Materials and method. In our study, we tried to assess both fetal heart structure and function in HIVpositive pregnant women under antiretroviral therapy (HAART – highly active antiretroviral therapy). It was a prospective study that took place between January 2018 and December 2019. The hearts of 14 fetuses from HIV-positive pregnant women on antiretroviral therapy were assessed. Results. We found some statistically significant sex-related cardiac changes in HIV-exposed uninfected fetuses. We detected a narrowing of the aorta in female fetuses and also smaller left ventricular transverse diameter in male fetuses. The myocardial performance index remained unaltered. Discussion. Because the majority of the patients included in this study had undetected viral loads, the effects on cardiac structure and function seems to be due to antiretroviral therapy. The effects of antiretroviral therapy on fetal heart seem to be sex-related. Conclusions. A more complete image about the risks and benefits of antiretroviral treatment, and also adopting management strategies to improve fetal outcomes, may also ensure better compliance of mothers to this vital treatment, that succeeded in turning a high mortality disease in a chronic one, with rates of survival similar to those of unaffected people. [ABSTRACT FROM AUTHOR]

Introduction/aim. Placental protein-13 (PP-13) is a member of the galectin group, involved in placental implantation, maternal artery remodeling and placental inflammatory processes. Its levels are lower in the first trimester for pregnancies later affected by ischemic placental disease and slowly increase during the second and third trimesters of pregnancy. The aim of the present meta-analysis is to assess the predictive performance of PP-13 in first-trimester preeclampsia (PE) screening. Methodology. PubMed, Web of Science, Scopus, Embase, BIOSIS and Cochrane databases were used to find relevant studies. All prospective and retrospective observational studies that evaluated the accuracy of PP-13 in predicting preeclampsia were assessed. The investigation revealed that the quantitative synthesis was based on 14 studies. Results. In studies that analyzed women with PE without subclassifying the population into early-onset PE (EO-PE) and late-onset PE (LO-PE), the pooled sensitivity of PP-13 was 0.53 (95% CI; 0.08-0.99; ² 0.0%) and the pooled specificity of PP-13 was 0.83 (95% CI; 0.38-1.29; ² 0.0%). The summary receiver operating characteristic curve (SROC) was 0.88 (95% CI; 0.80-0.94). In the group of studies that categorized EO-PE separately, the pooled sensitivity of PP-13 was 0.51 (95% CI; -0.04–1.05; ² 0.0%), with a specificity of 0.88 (95% CI; 0.33-1.42; ² 0.0%). The area under the SROC was 0.69 (95% CI; 0.54-0.81). In the LO-PE group, the pooled sensitivity of PP-13 was 0.58 (95% CI; -0.17–1.33, I² 0.0%), with a specificity of 0.85 (95% CI, 0.10-1.60, ² 0.0%). The area under the SROC was 0.77 (95% CI, 0.63-0.87). Discussion and conclusions. The sensitivity analysis revealed a higher accuracy of PP-13 for the LO-PE screening compared to EO-PE. The incorporation of this biomarker in the first-trimester screening algorithms that combine maternal characteristics, sonographic parameters and serum biomarkers could be a viable option. [ABSTRACT FROM AUTHOR]

Introduction. Anencephaly is one of the most severe fetal pathologies, resulting from failure to close the neural tube at the base of the skull on the 26th- 28th day of conception. Once diagnosed in one of the twins, the management options are: abortion of both twins, expectation management or selective feticide. The continuation of pregnancy results in an increased risk of preterm birth for the apparently normal twin due to polyhydramniosis developed by the anencephalic twin. Materials and method. Presentation of a case with complicated twins with anencephaly. Results. A 38-year-old pregnant woman, gesta III, para II, with a history of caesarean section and a spontaneous abortion, diagnosed in the territory with dichorionic diamniotic twin pregnancy, suspected of having an anencephal fetus, addresses our service at 20 weeks of gestation for further investigations and conduct. The second-trimester morphology shows a normal structural fetus and an anencephalic fetus. Pregnancy develops normally until week 27, when the polyhydramnios is installed at the anencephal fetus for which four amniotic reductions are performed. The patient gives birth prematurely at 36 weeks by caesarean section, a normal fetus of 3200 g, and an anencephaly fetus of 1030 g. Conclusions. The risk of preterm birth of an apparently normal fetus increases with the earlier diagnosis of anencephaly. To reduce this risk, selective feticide, especially in diamniotic twin, can be considered an efficient behavior. [ABSTRACT FROM AUTHOR]

Introduction. Reverse arterial perfusion syndrome, known as acardiac twins, complicates approximately 1% of monocorionic twins, 75% occurring in pairs of diamniotic twins and 25% in pairs of monoamniotic twins. If TRAP is not treated properly, the mortality rate of the twin pump is greater than 55%. Materials and method. Presentation of a case with complicated twin pregnancy with TRAP syndrome. Results. A 23-yearold pregnant woman, gesta I, para I, is diagnosed at 14 weeks with a monochorionic diamniotic twin pregnancy from which an acardiac twin. The patient is investigated according to the protocol and followed-up by ultrasound every 2 weeks. The development of the twin pump was normal during pregnancy, the acardiac twin developing oligoamnios at 28 weeks, which prevented the practice of intrauterine intervention. It is decided the conservative management with the monitoring of the normal twin. At 34 weeks, the birth is triggered, the result being a live newborn, of female sex, G=2380 g, and an acardiac twin, with G=1660 g. Conclusions. The premature birth of a living, healthy baby, applying conservative management, is the best possible result in this case. To improve the survival rate for donor twins up to 80%, surgery is recommended. [ABSTRACT FROM AUTHOR]

Objective. Lymphomas are a heterogenous group on neoplastic diseases, divided into two categories: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Considering the small incidence of these diseases in pregnancy, the purpose of this article is to enhance the clinical management and postpartum evolution of both mother and newborn. Case. A 37-year-old patient, III GII P, with a six-week pregnancy, presents to our clinic with a sore throat and a palpable laterocervical tumor. Following biopsy and hystopathological examination, a diagnosis of non-Hodgkin lymphoma is validated. At 28 weeks of gestation, the patient starts chemotherapy with CHOP scheme (cyclophosphamide, doxorubicine, vincristine and prednisone), and at 39 weeks of gestation she delivers through caesarean section a live newborn, female gender, with a 3120 g weight, and Apgar score 8. At one week postpartum, the newborn is diagnosed with mild ventricular dysfunction based on the echocardiographic examination. Following a haemato-oncological consult, the patient adds monoclonal antibody anti-CD20 rituximab to her previous chemotherapy scheme, with a favourable evolution. Conclusions. Laterocervical and submandibular tumors are important clinical clues that lead to a presumptive clinical diagnosis of lymphoproliferative malignancies. A multidisciplinary team is required in order to proper asses and to quickly manage the case with an individualised treatment. [ABSTRACT FROM AUTHOR]

Introduction. The incidence of pregnancy on the uterine scar is 1/1800-1/2500 pregnancies, increasing in the last 20 years, with the increase of the caesarean section. Case presentation. A 34-year-old patient, at her fifth pregnancy, with four births by caesarean section in the past (the last one seven months ago), presented at the emergency room with reduced genital bleeding and hypogastric pain. Transvaginal ultrasound established the diagnosis of pregnancy on uterine scar, and a 5-week embryo with present cardiac activity. Methotrexate 1 mg/kg intramuscular was administered, the patient being reviewed after five days, when the cardiac activity was absent, with the persistence of peripheral vascularization at the level of the uterine scar. Uterine dilatation and curettage were performed, and the trophoblastic fragments were extracted under ultrasound control. Two days later there were confirmed the HCG regression and the ultrasound evacuation of the pregnancy from the level of the uterine scar. The risk factors for pregnancy on the uterine scar are: thin uterine segment below 5 mm, the ultrasound visualization of a gestational sac that protrudes into the bladder-vaginal space, and a history of irregular vaginal bleeding. Discussion. The early diagnosis allows for conservative treatment with better results, and the subsequent follow-up by early ultrasound on a new pregnancy is important. There is no consensus on the most effective treatment, the options including: administration of methotrexate, either locally, in the sac, or by systemic intramuscular treatment, uterine artery embolization, uterine and hemostatic uterine bleeding, or hysteroscopic excision that offers minimal complication rates. Conclusions. Pregnancies on the uterine scar are rare, but with increasing incidence, having a major impact on the woman's subsequent fertility. [ABSTRACT FROM AUTHOR]

Objective. Ulcerative colitis is a chronic inflammatory bowel disease, with multifactorial etiology, mainly determined by immunological and environmental factors. The purpose of this article is to describe an acute episode of ulcerative colitis, its management, and also the negative effects upon the fetus. Case. A 28-yearold secundiparous, at 34 weeks of gestation, presented to our clinic with acute mucous and bloody diarheea, cramping abdominal pain, being admitted with a diagnosis of preterm labour. Following sigmoidoscopy with biopsy and histopathological examination, a diagnosis of acute episode of ulcerative colitis was established, and a treatment with hydrocortisone, double antibiotic therapy and hydroelectrolytic repletion was administered, with initial favourable evolution. At 36 hours after admission, the patient's general status suddenly altered, and a magnetic resonance examination revealed toxic megacolon and acute fetal decompensation. The patient delivered through emergency caesarean section a live, hemodynamically and respiratory stable newborn. Conclusions. A multidisciplinary intervention is required in order to proper manage similar cases. The mother's and newborn's evolution was favourable under specific treatment. [ABSTRACT FROM AUTHOR]

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