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Endometrial polyps (EPs) are a frequent gynecological condition. EPs often arise in the common womanly patients and are appraised to be about 25%. Advancing age, hyperestrogenism, hypertension, and Tamoxifen use are acknowledged as ordinary risk elements for the development of EP. The etiopathogenesis of EP is not accurately elucidated, but certain considerations such as diabetes mellitus, hormonal factors or arterial hypertension are considered to perform a significant contribution. The diagnosis of EPs is essentially by imaging. Transvaginal ultrasound is the primary investigation in EPs. Hysteroscopic resection is now the "gold standard" to treat to treat this disease. Hysterectomy is the definitive treatment for EPs, but it requires a judicious indication and an adequate counseling of the patient. Currently, a certain histological pattern is found in different sequences in EPs. Even if the vast majority EPs are benign, they may reach hyperplastic, with malignant alteration. The purpose of this pictorial review is the integrated approach to this type of abnormal endometrial proliferation from the perspective of natural history, diagnosis, management, morphological aspects, risk of malignancy, recurrence and last but not least, clinical outcome.

Obiectiv. Identificarea modificărilor calitative şi cantitative ale mutaţiile factorilor de coagulare implicate în complicaţii materne şi fetale, determinarea nivelului de corelaţie dintre acestea şi gradul de implicare al trombofiliei ereditare în rândul femeilor însărcinate. Material şi metodă. Articolul se bazează pe 92 de publicaţii din 1995 până în 2017, incluzând 49.127 de paciente cu trombofilie, dintre care 1.272 au fost martori, având drept criterii de includere în studiu prezenţa preeclampsiei, retardul de creştere intrauterină sau pierderea timpurie sau tardivă a sarcinii. Rezultate. 31 studii bazate pe preeclampsie demonstrează implicarea mutaţiei genei G1691A factor V Leiden, a mutaţiei genei G20210A a protrombinei şi a mutaţiei genei C677T şi A1298C MTHFR ca factori principali în dezvoltarea acestei complicaţii. 10 studii se concentrează asupra gradului de restricţie de creştere intrauterine, iar mutaţia genei G20210A a factorului V Leiden, mutaţia genei G20210A a protrombinei, mutaţia genei C677T şi A1298C MTHFR, deficitul de proteina C şi proteină S fiind principalii factori implicaţi. Alte 32 de studii citează implicarea mutaţiei factorului V Leiden, a mutaţiei protrombinei şi a mutaţiei MTHFR în dezvoltarea pierderilor de sarcină precoce sau tardive. Concluzii. Pe baza a 92 de publicaţii riguros selectate, am putut demonstra relaţia dintre trombofilia cu risc mediu/crescut şi rezultatul sarcinii, în special din cauza prezenţei mutaţiei genei factor V Leiden, a mutaţiei genei protrombinei, dar şi a statusului homozigot al mutaţiei genei MTHFR.

To assess the ultrasound (US) impact in diagnosing placenta accreta (PA) in patients with anterior placenta praevia localization, overlying a Caesarean scar.This is a prospective study between January 2016 and December 2017 that included patients with Caesarean scar and placenta praevia in the third trimester of pregnancy. By means of two-dimensional (2D) grayscale and color Doppler, we investigated the presence of the following US markers for placental invasion: intraplacental lacunae, abnormal blood vessels at the myometrium-bladder interface, thinning of the hyperechogenic uterine serosa-bladder wall interface, loss of normal hypoechoic retroplacental myometrial space. Definitive diagnosis was made at delivery. The US findings were correlated with intraoperative and histopathological (HP) evaluations.We found 46 cases with anterior placenta praevia overlying a Caesarean scar. Twelve patients presented US criteria for PA. The confirmation was obtained (by means of intraoperative and/or HP features) in 11 of them. The US evaluation with all markers yields a sensitivity of 100% for PA detection. Among the US markers, the association of abnormal blood vessels at the myometrium-bladder interface and the intraplacental lacunae had the highest statistical correlation in the antenatal diagnosis of PA.Our study suggests that the antenatal US is a useful tool in predicting PA in high-risk patients. Special attention should be given to the presence of intraplacental lacunae and abnormal myometrial vessels in cases where the placental insertion overlaps a uterine scar for best identification of PA high-risk cases.

The primary objective of this study was to correlate hereditary thrombophilia (high- or low-risk) with specific placental histopathological (HP) and∕or immunohistochemical (IHC) changes, for confirming∕ruling out a possible linkage between these two biological parameters.We present a 3-year prospective study conducted between 2016 and 2019 that enrolled 90 women registered in two Clinics of Obstetrics and Gynecology in Craiova, Romania, with personal thrombotic and/or pathological obstetrical history. The HP and IHC analysis of the placenta was performed using monoclonal anti-cluster of differentiation 34 (CD34) antibody, anti-hypoxia-inducible factor-1 alpha (HIF-1α) and anti-endothelial nitric oxide synthase (eNOS) antibody.There was a high incidence of all thrombophilia (TPh) mutations in Caucasian women with thrombotic and obstetrical complications. Among them, both HP and IHC examination revealed significant changes. These were more severe in the placentas of patients with homozygous Factor V Leiden (FVL) gene mutation and double heterozygous FVL∕PII gene mutation. Multiple placental infarctions with massive fibrinoid necrosis and an increase in syncytial knots are common findings. In the same group, we found by means of IHC examination - intense positive HIF-1α and eNOS immunoexpression, and low positive CD34 expression, especially in fibrinoid necrosis and thrombosis areas. We found no correlation between clinical, HP and IHC changes in patients with low-risk TPh or without TPh.Among patients with obstetric and thrombotic complications, there is a high prevalence of TPh. It appears that hypercoagulability reported in high-risk thrombophilia (HR-TPh) has major effects on placental tissue (fibrinoid necrosis, multiple thromboses, hypoxia and oxidative stress). Significant placental changes were found predominantly in women with HR-TPh. Strategies for TPh screening based on HP/IHC pattern would be, most probably, more cost-effective compared with the extended TPh testing offered in large populations. This way, a smaller number of patients will be tested and in this group a higher proportion of patients will be found as having HR-TPh mutations.

First-trimester (FT) ultrasound examination appears to have a very good sensitivity in the detection of fetal abnormalities, especially when an extended protocol that is achievable with reasonable resources of time, personnel and ultrasound equipment, is used. It has been shown that the efficiency of the routine anomaly scan varies widely between the studies performed both in early or mid-pregnancy. The analysis of technique and study designs reveals that in each gestational age, the extension of the investigational protocol is the most important factor in modulating the detection rate. Moreover, the use of similar basic checklists at the FT and second trimester (ST) examinations revealed comparable anomaly detection rates in large population groups. First trimester combined test have been demonstrated as a useful screening tool for genetic syndromes and consecutively the FT ultrasound scan became a routine examination in most prenatal diagnostic centers. Its performance in structural abnormalities detection has been communicated in high-, medium-risk populations or unselected low-risk variable number of patients and compared to the ST anomaly scan effectiveness. A detailed first-trimester anomaly scan using an extended protocol is an efficient screening method to detect major fetal structural abnormalities in low-risk pregnancies. It is a method that it is feasible at 12 to 13 + 6 weeks with ultrasound equipment and personnel already used for routine first-trimester screening. Rate of detection of severe malformations is greater in early- than in mid-pregnancy and on postnatal evaluation. Early heart investigation could be improved by an extended protocol involving use of color Doppler. How to cite this article Iliescu D, Cara M, Tudorache S, Antsaklis P, Ceausu I, Paulescu D, Novac L, Cernea N, Antsaklis A. Challenges in Sonographic Detection of Fetal Major Structural Abnormalities at the First Trimester Anomaly Scan. Donald School J Ultrasound Obstet Gynecol 2015;9(3):239-259.

Objective The goal of this study is to evaluate the potential of first trimester (FT) screening in the diagnosis of agenesis of the ductus venosus (ADV) and to study its prevalence in a low-risk population, the associated conditions, and pregnancy outcome. Method Prospective, sequential screening study at two tertiary units with morpho-functional evaluation of the ductus venosus during the first and second trimester screening. We quantified the FT detection rate, prevalence, and associated conditions: umbilical shunting type, concomitant anomalies, and outcome. Results In 6114 consecutive pregnancies, we identified 11 cases of ADV. Ten (91%) were identified during the FT examination. The prevalence was 1 in 556, similar for both centers (1/478 vs. 1/691). Major structural defects and fetal effusions were detected in 8 (73%). twenty two percent had a major chromosomal abnormality. In 3 cases, the anomaly was isolated and had normal outcome, independent of liver by-pass, caliber of the shunt, and NT thickness. Conclusions Agenesis of the ductus venosus can be detected during FT. The early detection of ADV is important given its high association with major abnormalities. © 2014 John Wiley & Sons, Ltd.

Objective To evaluate intra- and interobserver agreement for first-trimester fetal cardiac structural assessment, using two-dimensional (2D) ultrasound (2D-US) and 4D-US (4D spatiotemporal image correlation (STIC) technology), to compare the methods and to assess the advantages of adding color Doppler to each technique. Methods Digital videoclips (B-mode and color Doppler) and 4D-STIC volumes (gray-scale and color Doppler) from 632 pregnancies with normal fetal hearts were acquired and stored at the time of detailed first-trimester ultrasound examination. Later analysis on a randomized sample of 100 cases was performed, targeting 11 cardiac structures and features. We compared visualization of fetal heart parameters using 2D-US vs 4D-US and gray-scale vs color Doppler imaging. Results STIC volumes were considered satisfactory (adequate visualization of at least 8/11 parameters) in 78% of cases and 2D-US acquisitions in 89% of cases. The intra- and interobserver agreement was good for both 2D and 4D methods (kappa > 0.6), and the percentage overall agreement was very high using both methods (95%). 2D- and 4D-US identification of the fetal cardiac parameters did not differ significantly. The differences between gray-scale and color Doppler imaging were statistically significant in identifying similar key cardiac parameters, for both 2D- and 4D-US (P

Objective To assess the potential of first-trimester sonography in the detection of fetal abnormalities using an extended protocol that is achievable with reasonable resources of time, personnel and ultrasound equipment. Methods This was a prospective two-center 2-year study of 5472 consecutive unselected pregnant women examined at 12 to 13 + 6 gestational weeks. Women were examined using an extended morphogenetic ultrasound protocol that, in addition to the basic evaluation, involved a color Doppler cardiac sweep and identification of early contingent markers for major abnormalities. Results The prevalence of lethal and severe malformations was 1.39%. The first-trimester scan identified 40.6% of the cases detected overall and 76.3% of major structural defects. The first-trimester detection rate (DR) for major congenital heart disease (either isolated or associated with extracardiac abnormalities) was 90% and that for major central nervous system anomalies was 69.5%. In fetuses with increased nuchal translucency (NT), the first-trimester DR for major anomalies was 96%, and in fetuses with normal NT it was 66.7%. Most (67.1%) cases with major abnormalities presented with normal NT. Conclusions A detailed first-trimester anomaly scan using an extended protocol is an efficient screening method to detect major fetal structural abnormalities in low-risk pregnancies. It is feasible at 12 to 13 + 6 weeks with ultrasound equipment and personnel already used for routine first-trimester screening. Rate of detection of severe malformations is greater in early- than in mid-pregnancy and on postnatal evaluation. Early heart investigation could be improved by an extended protocol involving use of color Doppler. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

The present study aimed to observe and compare the values of microvessel density (MVD), mast cell microdensity (McMD) and macrophage microdensity (MphMD) in intratu- moral areas compared with the advancing edges, and to assess any correlations between these values and the degree and stage of the neoplasia. The cases of 52 patients who were diagnosed with endometrial carcinoma between 2003 and 2011 were analyzed, the majority of which were in the first stage of the disease (44 cases). Double sequential immunohistochemistry and the hot-spot counting method were used to assess the MVD (CD105 + MVD), McMD (tryptase + (Try + ) McMD) and MphMD (CD68 + MphMD) densities. The χ 2 test, paired Student's t-test and the Pearson correlation index were used to assess the significance of the results . A weak correlation was observed at the advancing edge only, between CD105 + MVD and Try + McMD (P=0.039). No significant differences were identified in the analysis of CD105 + MVD, Try + McMD and CD68 + MphMD, but wide variations in their distribution were observed. Depending on the tumor stage, CD105 + MVD exhib- ited an intratumoral, indirect correlation with Try + McMD for stage IA (P=0.026) and II (P=0.013) tumors. CD105 + MVD presented an indirect correlation with CD68 + MphMD in stage IB tumors (P=0.016) and at the advancing edge for well-differentiated tumors (P=0.027). An analysis of the corre- lation between CD68 + MphMD and Try + McMD indicated that the intratumoral levels of CD68 + MphMD were directly proportional with the Try + McMD values in well-differentiated (P=0.005) and stage II (P=0.012) tumors, while at the front of the invasion, this correlation was indirect (P=0.010) in stage II tumors. In endometrioid endometrial carcinoma (EEC), angio- genesis is at its most active at the advancing edge of the tumor, where mast cells play a pro-angiogenic role.

BACKGROUND Epilepsy still remains a serious challenge for any obstetrician due to the potential teratogenicity of all antiepileptics. However, without appropriate maternal therapy the seizures can reappear, with direct negative impact on fetus. Currently, sirenomelia is the most severe caudal pole dysgenesis, consequent to an abnormal vascular supply development in the fetal lower body. CASE REPORT We report a stillborn, GA/LMP = 37weeks, delivered by an epileptic woman, who received in the first four months of pregnancy phenobarbital (PH) 0.1 g/day and carbamazepine (CMZ) 0.4 g/day, followed only by PH 0.1 g/day, until delivery. The stillborn, weighing 2200 g, presented sirenomelia type II, with some of its “classic” features: oligohydramnios, absence of kidneys, bladder, rectum, uterus, and a single umbilical artery. Some other “particularities” included: no Potter's facies and no significant cardio-pulmonary abnormalities. DISCUSSION Since PH and CMZ alone are responsible, commonly, for mild abnormalities, we hypothesized that combined therapy with PH and CMZ (both strong enzyme-inductors, especially PH) potentiated their teratogenicity, by producing supplementary quantities of epoxides and/or other oxides, which accumulated in the fetal tissues. Except for sirenomelia, all other mild abnormalities, theoretically associated with “fetal CMZ and/or PH syndrome,” are rarely observed, fact which demonstrates the drug–drug interactions between the two antiepileptics. CONCLUSION This report highlights the possibility that PH/CBZ therapy during fetal organogenesis can induce sirenomelia, by a synergistic teratogenic effect and support the recommendation to use only one drug in pregnant epileptic women. A careful ultrasound monitoring of these patients is mandatory due to the teratogenic risk of both seizures and therapy. Birth Defects Research (Part A) 97:425–428, 2013. © 2013 Wiley Periodicals, Inc.

MANAGEMENT OF HSIL (CIN II) IN NULLIPAROUS PATIENTS (Abstract): Cervical carcinogenesis evolves in several stages over a relatively long period of time (7-20 years) and it can be diagnosed by multiple non-invasive screening methods (PAP smear, HPV genotyping, colposcopy) and consecutively treated. It is known that 50% of CIN II cases regress spontaneous and 30% progress to CIN III or cervical cancer. Management of HSIL (CIN II) has a major importance for clinicians because many patients are young and it is important to preserve the obstetrical outcome. Therefore, in this study, 3 types of management for CIN II were proposed in nulliparous patients: 1. conservative management; 2. LOOP / LLETZ; 3. conization. The main goal of the study was to evaluate if, in very carefully selected cases, conservative and minimally invasive management may be a viable therapeutical option, in order to preserve obstetrical outcome of the patients, knowing that conization determine a moderate to severe shortening of the cervix and increases the risk of second trimester abortion or preterm delivery, especially by premature rupture of membranes; conization can determine infertility by cervical stenosis. In our limited study a less aggressive management of cervical lesions provided better obstetrical outcomes both in terms of getting pregnant and in duration of pregnancy. Although current management of CIN II is considered to be similar to CIN III, in carefully selected nulliparous patients (high social status, high education, compliant patients), with satisfactory colposcopy (squamous-cylinder junction visible in colposcopy, lesions at a distance from the cervical os and endocervical cytology without pathological changes) and the CL less than 30-32 mm, we can opt for conservative management (by follow-up) or loop diathermy (single or multiple) or LLETZ, with a rigorous follow-up, thus preserving the obstetrical outcome.

Ultrasound is a crucial part of everyday obstetrical practice and becomes more and more important in the management of traditionally clinical aspects of obstetrics, such as management of labor and delivery, offering a possibly more objective method of examination. The rate of labor induction has doubled in the last two decades and more objective methods are needed to assess the possible outcome of an induction and help clinicians in order to counsel women appropriately. Regarding the management of labor there is extensive evidence that clinical assessment during labor is not accurate, with potential consecutive major implications in the decision-making and the prognosis of the delivery mode. Several studies have shown that ultrasound is an objective method of assessing labor and its progress and is very helpful in decision-making for instrumental deliveries. The purpose of this article is to review the evidence available in literature regarding the benefits and the role in general of ultrasonography in prelabor and labor. How to cite this article Iliescu D, Antsaklis P, Paulescu D, Comanescu A, Tudorache S, Antsaklis A, Ceausu I, Novac L, Cernea N, Kurjak A. Applications of Ultrasound in Prelabor and Labor. Donald School J Ultrasound Obstet Gynecol 2012;6(3):257-269.

Interstitial deletion of the proximal short arm of chromosome 10 represents a rare genetic alteration. Literature review revealed that only 10 postnatal diagnosed clinical cases with deletions overlapping 10p12p11 were published until present. We report the first prenatal diagnosis and postnatal findings in a male fetus with a 10.6 Mb interstitial deletion of the short arm of chromosome 10 (10p11.22-p12.31).

Introduction: The purpose of the paper is to present the safety and outcomes of uterine artery embolization (UAE) performed in patients at high risk or with active haemorrhage. Methods: A review of the literature was performed regarding the outcome of the procedure considering the main indications and current recommendations. Also, the experience of our centre from September 2014 to September 2016 is presented. Results: We performed a thorough search of the published literature and realized a descriptive review. The current indications are uterine fibroids, cervical neoplasia, adenomyosis, ectopic pregnancies (uterine and abdominal locations) and arterio-venous malformations. In our University Hospital, a retrospective study showed that we used the method in controlling the bleeding due to uterine fibroids, uterine ectopic pregnancies, cervical cancers and surgical high-risk dysfunctional uterine haemorrhage. All procedures were technically successful. The results of the technique were beneficial in all cases, except one case of cervical pregnancy complicated with choriocarcinoma and another case with recurrent perimenopause dysfunctional uterine bleeding in a case with multiple severe comorbid illness. Conclusions: The availability of the procedure in settings with experienced staff in gynaecology and radiology is beneficial in selected cases.

Prenatal development of the human brain from undifferentiated neuroepithelium, crosses numerous steps towards primordial organization and subsequent cytoarchitectural layering, ascending and progressive from the lower cortical layers to the superior ones. Our study represents a systematic, comparative assessment of imaging studies and the histological evaluation of the prenatal development of the human brain. We evaluated 232 cases using 3D ultrasound. Histological study was performed on 17 cases aged between 8 and 32 weeks pregnancy and compared with imaging results. For the ultrasound study, we chose five anatomical landmarks: the choroid plexus, thalamus, cerebellum, hippocampus and island (Sylvian fissure). The histological study was performed on dissected brain specimens preserved in formaldehyde and was followed by immunohistochemical determination in order to complete the picture of the morphological evolution of the structures evaluated. We analyzed the accuracy of the description of marker elements (choroid plexus, thalamus, cerebellum, hippocampus and Sylvian fissure) in three-dimensional ultrasound evaluation. This showed a good correlation with the morphological evaluation as well as with the dimensional descriptions from the literature. Histological and immunohistochemical assessment helped complete the picture of the central nervous system development. Highlighting fetal cerebral structures by three-dimensional ultrasound, together with morphological examination helped us create a dynamic array of the central nervous system development.

Background Congenital heart disease (CHD) is the most common birth defect usually not associated with known risk factors and the leading cause of infant mortality. Early and accurate prenatal diagnosis of CHDs allows termination of pregnancy (TOP) in severe CHD and reduces the neonatal morbidity and mortality rates by selecting of the appropriate institution for delivery. Fetal heart should be screened in the first trimester (FT) because at this gestational age the heart has almost completed its …

Epilepsy still remains a serious challenge for any obstetrician due to the potential teratogenicity of all antiepileptics. However, without appropriate maternal therapy the seizures can reappear, with direct negative impact on fetus. Currently, sirenomelia is the most severe caudal pole dysgenesis, consequent to an abnormal vascular supply development in the fetal lower body.We report a stillborn, GA/LMP = 37 weeks, delivered by an epileptic woman, who received in the first four months of pregnancy phenobarbital (PH) 0.1 g/day and carbamazepine (CMZ) 0.4 g/day, followed only by PH 0.1 g/day, until delivery. The stillborn, weighing 2200 g, presented sirenomelia type II, with some of its "classic" features: oligohydramnios, absence of kidneys, bladder, rectum, uterus, and a single umbilical artery. Some other "particularities" included: no Potter's facies and no significant cardio-pulmonary abnormalities.Since PH and CMZ alone are responsible, commonly, for mild abnormalities, we hypothesized that combined therapy with PH and CMZ (both strong enzyme-inductors, especially PH) potentiated their teratogenicity, by producing supplementary quantities of epoxides and/or other oxides, which accumulated in the fetal tissues. Except for sirenomelia, all other mild abnormalities, theoretically associated with "fetal CMZ and/or PH syndrome," are rarely observed, fact which demonstrates the drug-drug interactions between the two antiepileptics.This report highlights the possibility that PH/CBZ therapy during fetal organogenesis can induce sirenomelia, by a synergistic teratogenic effect and support the recommendation to use only one drug in pregnant epileptic women. A careful ultrasound monitoring of these patients is mandatory due to the teratogenic risk of both seizures and therapy.