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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.)

Rationale, aims, and objectives: The aim of this study was to focus attention on episiotomy practice in Romanian maternity units in order to identify factors associated with the very high rate of the procedure in Romania and to consider strategies to reduce it. Methods: In this clustered cross‐sectional study, a total of 11 863 patients were recorded in eight Romanian maternity units to assess the prevalence of episiotomy. A random effects Poisson model was used to estimate the prevalence rate in univariate and multivariate models. Results: Among the 11 863 patients included for analysis, 8475 (71.4%) had an episiotomy. The prevalence of episiotomy was 92.7% for the first vaginal birth, 73.2% for the second vaginal birth, and 35% for the third vaginal birth. The overall rate of suturing was higher than the episiotomy rate for all patients (total rate 79.2%). The likelihood of exiting the maternity ward with an intact perineum after the first vaginal birth was less than 5% at the first vaginal birth. Conclusions: In conclusion, routine episiotomy is the norm in Romanian maternity units, with episiotomy rates among the highest in Europe. Episiotomy use is mainly driven by local professional norms, experiences, previous training, and practitioners' decisions rather than evidence, guidelines, or variations in patient needs at the time of vaginal birth. [ABSTRACT FROM AUTHOR]

It is widely accepted that uterine contractions are generated by the electrical activity of myometrial cells. Early in gestation, this electrical activity is low and becomes more intense and synchronized later in pregnancy, peaking at term. Actual technology allows recording and characterizing electromyographic signals, using electrodes placed on the abdominal surface. This is a noninvasive technique, electrohysterograpy (EMG), which can be used to monitor human uterine electrical events. In clinical settings, it could help the clinician to differentiate uterine contractions that will lead to delivery, premature or at term, from physiological uterine activity. As the key of preterm labor is prevention and treatment, EMG could be an important tool to use for this purpose. We are describing the available techniques and their applications. [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. The development of ultrasonography allows the early identification of major fetal anomalies, as early as from 11-13 gestational weeks. Recent studies have described a new ultrasound mark associated with open spina bifida in the first trimester. "Crash sign" represents the posterior-caudal displacement and pathological deformation of the mesencephaly impacted in the occipital bone in these cases. In order to understand this phenomenon, this study evaluated the dimensions of the mesencephal-occipital space in normal pregnancies. Materials and method. The prospective study was conducted in a single center, between January 2017 and January 2020. During this period, 305 patients were evaluated with first-trimester screening. Ultrasounds were performed by a single specialist in maternal-fetal medicine. The maximum distance, in the anteroposterior axis, between the mesencephaly and the anterior occipital bone, in an axial section, was measured at the level of the fetal head. Results. The age of the patients included in the study ranged from 19 to 43 years old, with an average of 32.4 years of age. The average gestational age at which the examination was performed was 12.72 weeks, with a minimum of 10.9 and a maximum of 14.3. The cranial-caudal length was between 46 mm and 84 mm. The intracranial mesencephalic-occipital distance had an average of 1.85 mm, its variation depending on the gestational age (average values): 10 weeks - 1.39 mm, 11 weeks - 2.27 mm, 12 weeks - 2.49 mm, at 13 weeks - 3.21 mm, and at 14 weeks - 4.02 mm. Conclusions. The mesencephalic-posterior intracranial distance increases with gestational age, in the first trimester of pregnancy. Knowing the normal limits of variation allows the improvement of the detection rate of open spina bifida at 11-13 weeks. [ABSTRACT FROM AUTHOR]

Introduction. With the development of technology, prenatal ultrasound identifies relatively frequent echogenic lesions in the fetal abdomen. Fetal abdominal calcifications occur in several situations, such as meconial peritonitis, chromosomal anomalies, intrauterine infections with cytomegalovirus, rubella and parvovirus B19, cystic fibrosis, primary liver tumors, but may also have an unspecified etiology. Although most of them are associated with a low risk for the newborn, they are difficult to counsel and cause significant anxiety for parents. Methodology. We present the case of a 28-year-old pregnant woman, a former smoker, in which the 22-week ultrasound identified several intraabdominal perihepatic calcifications, especially around the stomach and the umbilical hepatic vein. The TORCH complex did not detect acute infections and the patient had noninvasive testing of fetal DNA at 19 weeks, with a low risk for aneuploids and microdeletions. Results. The calcifications persisted at 29 weeks as well, being visible at the periphery of the liver, at both lobes and around the umbilical vein, with no signs of intestinal obstruction or ascites fluid. Fetal MRI, performed at 34 weeks, excluded fetal bowel obstruction or atresia. The pregnancy evolved without any further complications, reaching full-term development. The patient gave birth to a 38-week-old male fetus, 2990 g, Apgar score 9, with good postnatal adaptation, balanced from a cardiopulmonary and neurological point of view, with supple, depressible abdomen, with stools and urination. The fetus had no acute infections with Toxoplasma, rubeola or cytomegalovirus. The abdominal radiography and the abdominal ultrasound confirmed the intraabdominal calcifications, apparently without clinical impact on the newborn. Their cause remains unknown, and the symptomatology given by them is insignificant, which supports their idiopathic character. Conclusions. Fetal liver calcifications are relatively common. If isolated, they have a good prognosis, when aneuploidy and fetal infections are excluded. However, in the case of major fetal defects, there is the risk of various chromosomal abnormalities. [ABSTRACT FROM AUTHOR]

În prezent, ecografia este utilizată extrem de precoce în sarcină, începând cu evaluarea dezvoltării embrionare în primele 5-8 săptămâni, până la screeningul aneuploidiilor și al anomaliilor fetale majore de la 11-13+6 săptămâni gestaționale. Ultrasunetele sunt o formă de energie și astfel ele interacționează cu țesuturile vii pe care le traversează (bioefecte), fiind parțial transformate în căldură (efect termic) sau producând variații locale ale presiunii (efect mecanic sau non-termic). Ecografele actuale afișează pe monitor permanent doi indici (termic și mecanic), furnizând clinicianului o indicație asupra posibilelor riscuri de modificări termice sau mecanice. După recomandările actuale, în cazul ecografiei în modul B, indicii termic și cel mecanic trebuie menținuți sub valoarea 1. Evaluarea Doppler implică niveluri de energie superioare unei ecografii în modul B, bidimensională sau tridimensională, astfel că în aceste situații sunt recomandate precauții suplimentare. Nu există informații asupra unui efect cumulativ sau al influenței expunerilor repetate. Ecografia trebuie utilizată în primul trimestru de sarcină numai în cadrul unei indicații medicale, pentru cel mai scurt timp posibil și la cea mai joasă intensitate care permite un diagnostic precis, în special în cazul examinărilor Doppler. Suplimentar, ca urmare a absenței unor informații complete asupra bioefectelor și siguranței clinice, informarea clinicienilor este necesară. [ABSTRACT FROM AUTHOR]

Evaluarea ductului venos (DV) este utilizată în detecția anomaliilor cardiace majore și a aneuploidiilor în cursul ecografiei de prim trimestru. Obiective. Dezvoltarea unei metode obiective de identificare a formelor de undă anormale la nivelul DV, prin analiza sa semicantitativă. Material și metodă. Funcție de aspectul undei a, de umplere activă ventriculară în cursul sistolei atriale, undele DV au fost clasificate în normale, cu unda a fals negativă și respectiv real negativă. Au fost incluse în studiu sarcinile cu făt unic, cu CRL de 45-84 mm. Au fost determinate rapoartele vitezelor S/v, S/D și v/D, unde S - sistola ventriculară (unda s), V - relaxarea ventriculară telediastolică (depresiunea v), D - umplerea pasivă diastolică ventriculară (unda D). Cazurile identificate retrospectiv, în perioada 2009-2016, cu unda a posibil sau real negativă la nivelul DV, au fost reclasificate, constituind grupul de studiu. Grupu-control, cu unda a pozitivă, a fost format prin evaluarea prospectivă a 439 de sarcini normale, în perioada 2015-2016. Rezultate. Au fost disponibile pentru analiză 436 de cazuri cu unda a pozitivă, 37 cu unda a fals negativă și 24 de cazuri cu unda a negativă. Valorile medii ale S/v și S/D au fost semnificativ diferite pentru cele trei grupuri de studiu, având o creștere progresivă de la normal spre forma real negativă, respectiv 1,48±0,15, 1,67±0,17 și 2,08±0,75 pentru S/v și 1,19±0,06, 1,23±0,06 și 1,33±0,15 pentru S/D. Valorile medii ale v/D au fost mai mari la fluxurile cu unda a pozitivă, dar nu au existat diferențe semnificative între grupurile cu unda a fals și respectiv real negativă, 0,81±0,06, 0,74±0,08 și 0,68±0,14. Concluzii. Evaluarea semicantitativă a undei fluxului sangvin la nivelul DV poate facilita recunoașterea undelor a real negative. [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.)