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Background: Pseudoexfoliation syndrome (PEX) is a common age-related ocular condition characterized by the accumulation of a fibrillar, pseudoexfoliative material on the anterior segment of the eye. This study aims to investigate the histopathological characteristics of pseudoexfoliative material within different ocular structures, including the eyelid, conjunctiva, and anterior lens capsule. Methods: A total of 32 anterior lens capsules, 3 eyelid fragments, and 12 conjunctival specimens were obtained from patients clinically diagnosed with PEX during ocular surgeries at the Onioptic Hospital of Ophthalmology. The tissue specimens were subsequently processed using the classical histological technique of paraffin embedding. This process enabled the production of serial sections with a thickness of 4 microns, facilitating the microscopic examination of fine details. The sections were stained with the hematoxylin-eosin (HE) method for the observation of microscopic structures. Results: This study's findings reveal that PEX material, characterized by its fibrillar and amorphous components, is consistently present across multiple ocular structures, including the anterior lens capsule, eyelid, and conjunctiva. When stained with H&E, the PEX material typically appears as amorphous, eosinophilic deposits. Under higher magnification, these deposits exhibit a fibrillar structure, often appearing as irregular, granular, or filamentous aggregates. Conclusions: The deposit of fibrillar material in the eyelid and conjunctiva, though less commonly emphasized compared to other structures, is a significant finding that sheds light on the systemic nature of the syndrome. The consistent identification of fibrillar eosinophilic deposits across these structures highlights the systemic distribution of PEX material, reinforcing the notion that PEX syndrome is not confined to the anterior segment of the eye. [ABSTRACT FROM AUTHOR]

Background: During the Covid-19 pandemic there have been a drastic decrease in hospitalizations for non-Covid conditions. The aim of this study was to evaluate the trend in hospitalizations for obstetrical conditions during and after the Covid-19 pandemic. Methods: For this study there we used electronical data base in order to search for all the obstetrical patients that were hospitalized in a tertiary maternity, Clinical Emergency County Hospital Craiova, during the pre-pandemic period (between March - December 2019), during pandemics (2020 March - December, 2021 March - December) and post pandemics (2022 March - December). Results: The total number of hospitalizations during 2020 dropped by 28% compared to the pre-pandemic year - 2019, and further by 30% in 2021, and by 26% in 2022. In terms of day admissions, a decreasing trend can be observed, with a total of 3230 admissions, from which, 208 in 2020 showing a decrease of 93%, 695 in 2021 with a decrease of 78% and 941 in 2022 with a decrease of 70% compared to 2019. We experienced a significant increase of vaginal birth rate during the pandemic (2020-2021) of 24% that can be attributed to the unavailability of many surrounding low-risk birth units during the pandemic. Conclusion: The obstetrical conditions hospitalizations dramatically dropped during the COVID-19 pandemic and have not yet recovered to the pre-pandemic level. [ABSTRACT FROM AUTHOR]

Due to rapid technology advancement and increasing diagnostic expertise, fetal medicine is rapidly improving. Prenatal diagnostic advancements made it possible to identify structural abnormalities in fetuses as early as the first trimester of pregnancy. However, to validate the echocardiographic diagnosis that led to the pregnancy termination, the termination of pregnancy owing to severe fetal deformities should be audited in accordance with a correct anatomic diagnosis. Following the PRISMA declaration, a systematic literature search was done to find articles on post-mortem first trimester human fetal heart evaluation. Thirteen suitable studies were found using the search method. It is theoretically possible to examine the human fetal heart after death in early pregnancy however these methods are not widely available due the costs associated with the procedure and the equipment, the effects of tissue coloration and distortion brought on by the fixation and contrasting processes (for micro-CT), the current requirement for a skilled operator to acquire, reconstruct, and process the images, and data storage requirements greater than those of conventional clinical scans. [ABSTRACT FROM AUTHOR]

Uterine dehiscence is a separation of the uterine musculature with intact uterine serosa. Uterine dehiscence can be encountered at the time of caesarean delivery, can be suspected on obstetric ultrasound, or can be diagnosed between pregnancies. Uterine scar dehiscence and rupture are serious complications of pregnancy that can lead to catastrophic outcome. We present the case of a 37-year-old patient with a history of a caesarean delivery five years ago, who came for a routine follow-up scan, at seven weeks of gestation. The transvaginal ultrasound assessment revealed, inside the uterine cavity, a gestational sac with a single embryo whose crown rump lenght coressponded to seven weeks of pregnancy, and the absence of the uterine muscle layer on the previous caesarean section scar with an anechoic area protruding through the lower segment of the caesarean section scar, with an intact serosal layer with a thickness of 1.8 mm. The patient was informed about the prognosis of the pregnancy and the associated risks of uterine rupture and miscarriage. The laparoscopic repair of the uterine dehiscence was offered. The patient refused the surgery. Therefore, the pregnancy was carefully monitored, with a thorough evaluation of the lower uterine segment thickness. The elective caesarean section delivery was planned prior to the onset of labor, at 38 weeks of pregnancy. A large uterine caesarean section scar dehiscence was noted during the procedure. The expectant management of uterine dehiscence detected by ultrasound during the first trimester is possible. Although the outcome was good in this case, we cannot advocate for expectant management in all cases of uterine dehiscence, because of the increased risk of uterine rupture that can lead to life-threatening complications. [ABSTRACT FROM AUTHOR]

Fetal pericardial effusion represents the accumulation of fluid higher than 2 mm surrounding the heart. It can be associated with hydrops fetalis, heart structural anomalies, arrythmia, viral infection, metabolic disorders, chromosomal anomalies, or it can be isolated (IFPE). We present the case of a 30-year-old healthy secundipara woman referred in our center at 22 weeks of gestation for the assessment of pericardial effusion. The patient had normal results at the noninvasive prenatal test (NIPT) for fetal aneuploidies. A detailed secondtrimester anomaly scan revealed significant pericardial effusion (12 mm) and with both lungs compressed inside the fetal thorax, without other signs of fetal structural abnormalities, hydrops, structural or functional cardiac defects. No signs of an active infection were found at the specific investigations, including extended TORCH complex. For additional genetic tests (fetal karyotype and Array-CGH), an amniocentesis was performed, with normal results. Due to the presence of a significant pericardial effusion over the previous three weeks that could result in pulmonary hypoplasia, a pericardiocentesis was performed and 10 ml of serocitrine liquid were aspirated and the lungs reexpanded. Fetal blood was referred for toxoplasmosis, cytomegalovirus and Ebstein-Barr virus testing which were negative. Cytology of the pericardial fluid identified lymphocytes and erythrocytes. The protein content of the pericardial fluid was consistent with a transudate. The pericardial effusion returned gradually during the next weeks, following pericardiocentesis, up until 8 mm at 29 weeks of gestation. Another pericardiocentesis is still on debate, depending on the pericardial effusion progress and its effects on the lung development and the heart hemodynamics. Almost half of the cases of IFPE resolve spontaneously, with a good neonatal outcome. Given the potential for pulmonary hypoplasia and the progression to hydrops, prenatal pericardiocentesis should be considered in similar cases, as it may allow the fetal lungs to develop, improving the fetal prognosis after birth. [ABSTRACT FROM AUTHOR]

Introduction. One of the most prevalent abdominal wall defects is omphalocele (exomphalos). This congenital anomaly can be diagnosed early in pregnancy at the time of the first-trimester scan, with a direct impact on prenatal and postnatal fetal prognosis and in management decisions. Other structural or chromosomal anomalies should be excluded. A multidisciplinary approach is necessary for an efficient prenatal counseling and an optimal perinatal care. We present a case of omphalocele detected in the second trimester of pregnancy, with a favorable outcome after postpartum surgery. Methodology. A 24-year-old female patient was diagnosed with an abdominal wall defect (omphalocele) at 21 weeks of gestation. Unfortunately, the patient had no first-trimester obstetrical care. She addressed to the Prenatal Diagnosis Unit of the Emergency County Clinical Hospital of Craiova for invasive genetic testing (amniocentesis). The ultrasound evaluation confirmed the omphalocele, yet the fetal sex was declared ambiguous. Results. The genetics confirmed a normal male fetal karyotype. The pregnancy got complicated with early growth restriction as the fetus measured under the 10th percentile. A caesarean section delivery was performed at 35 weeks and 3 days of gestation, due to chronic fetal distress. Postpartum diagnosis showed the omphalocele, yet the ambiguous genitalia were confirmed as micropenis. The 1700-gram neonate had a surgical repair of the abdominal wall defect, with excellent prognosis and normal development at the nine-month follow-up. Conclusions. An accurate prenatal diagnosis includes combining US evaluation with invasive testing. The termination of pregnancy can be recommended after proper counseling, especially in cases of a large defect and severe associated anomalies. However, unfortunately, in utero surgery, in these cases, has not been yet successful. Postnatal early interventions are usually required in specialized pediatric centers with excellent results, demonstrating a rapid development in this field. [ABSTRACT FROM AUTHOR]

Introduction. Caesarean scar pregnancy (CSP) is a life-threatening condition and an iatrogenic disease due to the rising number of caesarean sections (CS) in the last decades. CSP can be of type I (endogenic), with development towards the cervico-isthmic space or uterine cavity, or of type II (exogenic), with development towards the bladder and abdominal cavity. The most practical and effective technique to early diagnosis CSP is transvaginal ultrasound (TVUS), adding a color Doppler assessment. Magnetic Resonance Imaging is not necessary for making an accurate diagnosis. The optimal approach is yet to be established and standardized. We aimed to collect and condense published literature on CSP treatment, in this systematic review. We also present our center experience on the conservative treatment of caesarean scar pregnancy. Methodology. We performed extensive research on MEDLINE, Embase and Cochrane Library to find studies that included the treatment modality and efficacy and complications for CSP. Results and discussion. The wide literature on this issue offers solid data about five treatment modalities that include the resection of CSP through a transvaginal approach, laparoscopy, uterine artery embolization plus dilatation and curettage and hysteroscopy, uterine artery embolization combined with dilatation and curettage without methotrexate and repeated high-intensity focused ultrasound. The expectant management of CSP is to be avoided. We also present our experience with three cases of CSP that beneficiated from local methotrexate, with a good outcome. Conclusions. Caesarean scar pregnancy is an increasing challenge worldwide. Due to a high risk of serious complications, we encourage medical practitioners to screen for CSP by early TVUS in all patients with previous caesarean delivery. The proper treatment is challenging, and guidelines are still lacking. With this paper, we try to offer different approaches to caesarean scar pregnancy, yet the management should be individualized and assessed by a multidisciplinary team, for the safest clinical option. [ABSTRACT FROM AUTHOR]

Introduction. Acute pancreatitis (AP) is an indication for hospital admission, with an increasing incidence, still rare during pregnancy. The most common causes of AP are gallstones (65-100%), especially in pregnancy, alcohol abuse and hypertriglyceridemia. There are limited data available about maternal-fetal outcomes in cases of third-trimester pancreatitis. In cases of acute biliary pancreatitis during pregnancy, the adopted medical approach depends on the gestational age and, also, considering the high risk of recurrence of AP (70%) and the specific risks of each treatment. We present a case report of AP in late third trimester, managed with conservative treatment and elective caesarean section delivery. Methodology and results. A 24-year-old primigravida presented to the emergency room accusing upper abdominal pain, nausea and vomiting. A 38week viable pregnancy was confirmed, with no uterine contractions on cardiotocography. Blood tests revealed amylase/lipase three times above the upper limit of normal. The abdominal ultrasound showed multiple gallstones. Other conditions, such as gastric ulcer and duodenal ulcer, acute appendicitis, acute mesenteric ischemia, HELLP syndrome, placental detachment or uterine rupture, were excluded. In order to care for both mother and the fetus, a multidisciplinary team decided on a conservative management including hydration, administration of antispasmodics, analgesics, antibiotics and correction of electrolyte disturbances. Caesarean section delivery was scheduled, as the fetal calculated growth was over the 90th percentile (4700 g). The immediate postpartum period was uneventful for both mother and neonate. Laparoscopic cholecystectomy was planned six weeks after delivery. Conclusions. The impact of acute pancreatitis can be devastating, causing substantial maternal-fetal morbidity and mortality. This case report underlines the importance of early diagnosis and correct management of AP, especially in pregnancy. A multidisciplinary approach, including gastroenterologists, general surgeons and obstetricians, seems to be the key in making the best choice of management in acute pancreatitis during pregnancy. [ABSTRACT FROM AUTHOR]

Uterine myomas affects 2-10 % of pregnant women. They are hormone dependent tumors, and 30% of them will increase in response to hormonal changes of pregnancy, therefore a significant growth in the first trimester is expected. Usually, they are asymptomatic, but they may be associated with severe abdominal pain and adverse pregnancy outcomes. Conservative management is the first option. If the conservative treatment fails and the symptoms are severe, a myomectomy can be performed, with serious risks such as severe hemorrhage, uterine rupture, miscarriage and preterm labor. We present the case of a 31-year-old primigravida, presenting in our service for severe abdominal pain, pollakiuria and constipation. The ultrasound examination revealed a 14-week pregnancy, with no signs of fetal structural abnormalities and two large fibroids, one developed intramural and subserous, in the lower uterine segment and on the left parametrium, with a diameter of 100/95/87 mm, and the other one developed also intramural, into the right parametrium, with a diameter of 50/25/27 mm, in contact with the previous one. The placenta was developed on the anterior uterine wall and no signs of placental insufficiency were noted. The severe symptoms maintained during the following weeks, and the fibroids volume increased. At 17 weeks of pregnancy, due to severe abdominal pain, we decided to perform a myomectomy. The surgery was uneventful. The patient was monitored weekly. A detailed second-trimester anomaly scan was performed at 22 weeks and confirmed no signs of fetal structural abnormalities, an estimated fetal weight at percentile 30, and a pulsatility index within normal ranges for both uterine arteries and umbilical artery. One of the characteristics that contributed to the absence of fetal complications in our case was the fact that fibroids predominantly had a significant subserous and intramural component, without being in contact with the uterine cavity or placenta. Myomectomy during pregnancy in cases of symptomatic uterine fibroids not responding to conservative management may be considered, following appropriate counseling regarding the associated risks. [ABSTRACT FROM AUTHOR]

The aim of this study is to establish morphological, histological and ultrasonographic (US) correlations in the placenta of type 2 diabetes. This is a multicenter case-control study conducted on a lot of 21 selected cases diagnosed with type 2 diabetes, analyzed over a two year period. The clinical characteristics of the patients in the study group are represented by the average age of 34 years and diabetes associated with preeclampsia, hypertension, diabetic neuropathy, urinary infections, obesity or history of infertility. All the patients in the study group are Caucasian. US assessment of placental characteristics in our series revealed increased placental thickness from the second trimester and placentomegaly at the end of the third trimester. Immature appearance of placenta has been observed. Gross analysis of maternal and fetal surfaces of the placentas revealed basal plate and subchorionic fibrin depositions, placental infarction or intervillous thrombosis. Preconceptional glycemic control and its support during gestation are essential for pregnancy outcome. US findings have as a background the morphological changes. From morphological perspective there is about a combination of anomalies, otherwise unspecific which, in terms of association with various comorbidities could define a placental diabetic pattern. [ABSTRACT FROM AUTHOR]

During first-trimester ultrasound examination, the fetal bladder is described as an anechoic structure in the fetal pelvis. It can be observed from 10 weeks of pregnancy when the fetus starts producing urine. Fetal megacystis (FM) is defined, in the first trimester, as longitudinal bladder diameter of more than 7 mm. It can occur in 0.06% of the pregnancies. The management of FM is complex due to the various etiology and uncertain evolution. The leading cause of FM is lower urinary tract obstruction (LUTO). This pathology leads to hydronephrosis, renal dysplasia and severe oligohydramnios, with a poor prognosis. The FM management should search for chromosomal or genetic defects and associated fetal abnormalities. The broad spectrum of etiologies and prognosis makes the counseling challenging. We present the case of a 28-year-old pregnant woman referred for first-trimester investigations. The patient had an obstetrical history of a pregnancy with complex body stalk anomaly (BSA) – with termination of pregnancy at 12 weeks of gestation. Both maternal and paternal karyotype were normal. At 9 weeks of gestation, the ultrasound examination revealed an enlarged bladder, with 5 mm longitudinal diameter. Later on, at 12 weeks of gestation, a cystic appearance at the level of the umbilical cord insertion that communicated widely with the urinary bladder and abnormal aspects of the genitals for the gestational age were detected. These aspects maintained in the second trimester of pregnancy and progressive oligohydramnios was described. At 17 weeks of gestation, after proper counseling, the patient decided to terminate the pregnancy. The fetal necropsy confirmed the presence of FM, bladder exstrophy and the abnormal external genital organs. The genetic testing revealed a normal fetal karyotype. In conclusion, FM and bladder exstrophy occur most frequently due to LUTO. Fetal megacystis can be suspected even from 9 weeks of gestation. Although found in the same patient, BSA and FM syndromes did not seem to have a genetic cause. [ABSTRACT FROM AUTHOR]

Turner syndrome (TS) is a genetic disease with a female phenotype and the most frequent 45,XO karyotype. Prenatal diagnosis is based on ultrasound examination, which can suggest structural abnormalities and genetic assessment. Fifty percent of the cases are detected by ultrasound examination with major anomalies. Case presentation. A 29-year-old patient, with a caesarean section delivery four years before, referred for routine screening of a first-trimester pregnancy. The ultrasound exam revealed a 12-weeks of gestation singleton pregnancy, with increased nuchal translucency (6 mm), left heart hypoplasia, septal interventricular defect, mitral regurgitation and mitral valve dysplasia, with the reversed aortic flow. After counseling, the couple decided the termination of pregnancy due to its unfavorable prognosis. The suspected ultrasound anomalies were confirmed by autopsy. Also, a new computed fetal heart reconstruction technique was used for confirming fetal heart defects, as for this gestational age is barely impossible to correctly assess the anatomical structures. Turner syndrome (45,XO) karyotype was confirmed. Conclusions. The first-trimester structural ultrasound screening is important, as severe structural anomalies can be identified. With an early diagnosis and proper counseling, the couple may decide the termination of pregnancy. The fetal autopsy evaluation confirms the data obtained through the ultrasound examination, and with a proper technique, the microscopic evaluation, with special software reconstruction, can confirm fetal heart disorders, in a proper manner. [ABSTRACT FROM AUTHOR]

Introduction. Twin-to-twin transfusion syndrome (TTTS) is a severe complication in monochorionic multiple pregnancies, with high mortality rates. Early TTTS represents 7-23% of all TTTS and is defined as debut before 18 weeks of pregnancy. The early diagnosis of TTTS is not standardized at this moment, but Quintero staging, based on two-dimensional ultrasound and Doppler study, can be helpful even in the first trimester, although those assessment are appropriate for the second trimester. Case presentation. We present the case of a 29-year-old woman with no medical history who was referred at 8 weeks and 2 days of amenorrhea. The transvaginal ultrasound assessment revealed two GS (gestational sacs) with two embryos. A marked discordance was noted between the CRLs (crown-rump length) of the two embryos. At 11 weeks and 4 days, the patient was examined, and we observed the appearance of the “lambda” sign which suggested a dichorionic diamniotic pregnancy. The discordance in the development of the two fetuses was maintained. After a thorough morphological examination, a fetal cystic hygroma and a ductus venosus agenesis were noticed in the smaller fetus. Noninvasive prenatal testing was recommended, with normal results. At 13 weeks and 4 days of amenorrhea, the patient was examined, and a 21% discordance was noted between the two fetuses. Also, inside the GS of one of the fetuses, we noticed a thick amniotic band that was probably misinterpreted before as a “lambda” sign. The pregnancy was considered monochorionic/diamniotic. At this point, we suspected an early TTTS. The ultrasound aspect of cystic hygroma and ductus venosus agenesis was persistent. The patient requested medical termination of pregnancy. The forensic exam of the fetuses revealed a severe growth discordance between the two fetuses, a unique placenta and an amniotic band. The genetic exam revealed two female fetuses with normal karyotypes. Conclusions. The early diagnosis of TTTS is rare, and most of them remain undiagnosed, waiting for the fusion of the chorioamniotic membrane after 16 weeks of pregnancy. One amniotic band can be misinterpreted as chorioamniotic membrane and the “lambda” sign can be described in early pregnancies. [ABSTRACT FROM AUTHOR]

Introduction. Spina bifida (SB) is a congenital anomaly caused by the incomplete development of neural tube. It can be further classified into SB occulta (closed) and aperta (open). The first type is the mildest form of the neural tube defects which involves a minimal neural involvement and a hidden vertebral defect. The second type defect allows the neural tissues to communicate with the external environment such as meningocele and myelomeningocele. A reliable prenatal diagnosis of open SB is feasible as early as the end of the first trimester, by means of direct or indirect signs. The severity of open spina bifida disease is associated with the size of the spinal defect. Case report. We present the case of a pregnant woman examined in our center from 18 gestational weeks with suspected encephalocele and recommendation for abortion. The ultrasound scan identified a tumoral formation in the cervical region with 15 mm in diameter and origin in the spinal cord central canal – suggestive for open spina bifida with cervical meningocele. Apart from the cervical spine malformation and the mild difference between lateral cerebral ventricles, the fetal development was normal and we didn’t identify indirect signs suggestive for Chiari type II malformation. During the pregnancy, the cervical meningocele has increased from 15 mm to 30 mm until the third-trimester, when the fetus was born. The evolution of the newborn was favorable. Meningocele repair was performed successfully in the first weeks of life, and at the age of 1 years old the child had a good neurological outcome. Conclusions. Cervical open SB is difficult to differentiate from occipital meningocele at the first-trimester anomaly scan, as the spine is not yet fully ossified and the ultrasound findings are subtler. Cervical open SB accompanied by cervical meningocele can associate a normal brain morphology, with no Chiari type II structural determinations. [ABSTRACT FROM AUTHOR]

Introduction. Intrauterine growth restriction (IUGR) affects 5-10% of pregnancies and represents the second cause of perinatal mortality. Early-onset IUGR is usu- ally caused by placental dysfunction, but many other causes may be involved. Case report. We present the case of a 42-year-old woman, IIP, referred for amniocen- tesis for high genetic risk (trisomy 18) revealed by the noninvasive prenatal test (NIPT) for fetal aneuploidies. The amniocentesis performed at 16 weeks and 6 days showed a normal karyotype. A detailed second-trimester anomaly scan was repeated at 22 weeks and confirmed no signs of fetal structural abnormalities, an estimated fetal weight (EFW) at percentile (p) 16, and a pulsatility index (PI) within normal ranges for both uterine arteries and umbilical artery (UA). No signs of an active infec- tion were found at the specific investigations, including extended TORCH complex, and thrombophilia was ruled out. During the following weeks, the fetus developed symmetric IUGR<8th percentile, with normal UA, MCA (middle cerebral artery), and ductus venous (DV) flows. At 30 weeks, the EFW was at percentile 5.2. At 32 weeks, we noticed a deterioration of the fetal well-being with a non- reactive nonstress test, absent end-diastolic flow in UA, but with normal DV Doppler. The patient was admitted for closer surveillance, corticotherapy and magnesium sulfate therapy. The CPR (cerebral-placental ratio) was <5th percentile, and PI-UA was above percentile 95. Two days later, the CPR reversed, the short-term variations on cardiotocography decreased at 3.1 ms, and an 1130 g fetus was delivered by caesarean section, with an Apgar score of 7. Overall, the outcome was favorable, with the newborn discharged after one month. Conclusions. In early-onset IUGR, optimal monitoring and delivery timing are crucial. Doppler scanning (uterine arteries, UA and MCA) and biophysical monitoring help prevent acidemia and stillbirth. Placental mosaicism must be considered in cases where NIPT results are not con- firmed by invasive genetics. [ABSTRACT FROM AUTHOR]

Introduction. Vertical transmission of hepatitis C virus (HCV) occurs in rare cases (5-8%), more often during birth and, seldom, transplacental, before birth. Hepatitis C virus can cause acute or chronic hepatitis. Materials and method. We present the case of a 42-year-old woman, gravida 2, para 2, with 32 weeks of gestation. The ultrasound exam noticed fetal ascites, polyhydramnios and echogenic fetal bowel. The mother was tested for the TORCH panel, including HCV. Anti-HCV antibodies were present. We decided to perform fetal cordocentesis, paracentesis and amniocentesis. From cordocentesis we obtained approximately 8 ml of fetal blood, analyzed for: albumin, direct bilirubin, indirect bilirubin, total bilirubin, blood count, blood glucose, direct Coombs test, HCV RNA, IgM antibodies for cytomegalovirus/toxoplasmosis/Rubella/herpes simplex type 1 and 2. Also, 160 ml of fetal ascites fluid were sent for cytological and biochemical analysis, and 40 ml of clear amniotic fluid were used to detect infection with herpes simplex, Epstein-Barr or parvovirus. Results. The biochemical tests and blood count performed from the fetal blood were within normal range. The direct Coombs test was negative. HCV RNA was detected. Antibodies for cytomegalovirus/toxoplasmosis/Rubella/herpes simplex type 1 and 2, Epstein-Barr and parvovirus B19 were absent. The biochemical tests performed from the fetal ascites fluid showed: red blood cells 3000/mm³, leukocytes 835/mm³, glucose 57 mg/dL, albumin 1.90 g/dL, creatinine 0.53 mg/dL, urea 19 mg/dL, proteins 3.4 g/dL, positive Rivalta test. HCV RNA was detected. IgM antibodies for cytomegalovirus/toxoplasmosis/Rubella/herpes simplex type 1 and 2 were all absent. Fetal ascites markedly decreased and normal echogenicity of the bowel was noted. Conclusions. In rare cases, HCV can be transmitted vertically from the mother to the unborn baby. Cordocentesis and paracentesis helped us diagnose the fetus before birth and improve his prognosis after birth. [ABSTRACT FROM AUTHOR]

Introduction. Hepatitis C virus (HCV) can cause acute or chronic hepatitis. HCV can be spread through inadequate sterilization or reuse of syringes and needles, blood transfusion, injecting drug use, sexual intercourse, and vertical transmission from the mother to the fetus, although the last two are very rare. Vertical transmission of HCV occurs in rare cases (5-8%), more often during birth, and seldom transplacental, before birth. Women infected with HCV are more predisposed to give birth to preterm babies or low birth weight babies, or babies with congenital anomalies. Materials and method. We present the case of a 42-year-old woman, gravida 2, para 2, with a 32-33-week pregnancy, with not investigated deaf-mutism, who came in the emergency room for preterm labor contractions. At the ultrasound exam, we noticed fetal ascites, polyhydramnios and echogenic fetal bowel. The patient was admitted to our clinic for further investigations. We recommended an amniocentesis and a genetic consultation. The mother was tested for the TORCH panel, including HCV. The anti-HCV antibodies were present. In our service, the mother was also diagnosed with gestational diabetes. Following the clinical and paraclinical investigations performed, we decided to perform fetal cordocentesis, paracentesis and amniocentesis. Under ultrasound guidance, we performed cordocentesis and obtained approximately 8 ml of fetal blood and sent it for the following biological tests: albumin, direct bilirubin, indirect bilirubin, total bilirubin, blood count, blood glucose, direct Coombs test, HCV RNA, IgM antibodies for cytomegalovirus/ toxoplasmosis/rubella/herpes simplex type 1 and 2. For the second puncture, the catheter was introduced at the level of the fetal peritoneal cavities under ultrasound guidance. We extracted 160 ml of fetal ascites fluid and sent it for cytological and biochemical analysis (leukocytes, red blood cells, glucose, albumin, creatinine, urea, proteins, Rivalta test, cytological examination). We also performed amniocentesis and collected 40 ml of clear amniotic fluid. We used it to detect an infection with herpes simplex virus, Epstein-Barr virus, or parvovirus. Results. The biochemical tests and blood count performed from the fetal blood were within normal range. The direct Coombs test was negative. HCV RNA was detected (251 UI/mL). IgM antibodies for cytomegalovirus/ toxoplasmosis/rubella/herpes simplex type 1 and 2 were all absent, and antibodies for Epstein-Barr virus and parvovirus B19 were also absent. The cytological exam of the ascites fluid showed smears with hypercellularity: very frequently lymphocytes, rare isolated mesothelial cells within normal cytological limits, rare polymorphonuclear leukocytes, and rare red blood cells. The biochemical tests performed from the fetal ascites fluid showed: red blood cells (3000/mm3), leukocytes 835/mm3, glucose 57 mg/dL, albumin 1.90 g/dL, creatinine 0.53 mg/dL, urea 19 mg/dL, proteins 3.4 g/dL, positive Rivalta test. HCV RNA was detected. IgM antibodies for cytomegalovirus/toxoplasmosis/rubella/ herpes simplex type 1 and 2 were all absent. After fetal diagnosis, our colleagues from the infectious disease department recommended parenteral/oral hepatoprotective treatment for the mother; there was no possibility of antiviral treatment of the fetus. After performing the paracentesis of the fetus, the amniotic fluid was in the normal range, the fetal ascites were in small quantity with ultrasonographic hepatosplenomegaly aspect and normal echogenicity of the bowel. Almost seven weeks after the paracentesis, the patient gave birth to a baby, gender male, weight 2880 g, with an Apgar score of 7, which was handed over to the neonatology service, for further investigations. Conclusions. In rare cases, HCV can be transmitted vertically from the mother to the unborn baby. Cordocentesis and paracentesis helped us diagnose the fetus before birth and improve his prognosis after birth. [ABSTRACT FROM AUTHOR]

Introduction. In obstetric practice, every physician is aiming to shun from any difficult vaginal delivery, as it can lead to serious fetal and maternal complications. Both doctor and pregnant patients at term who are admitted in the labor ward want to know the chance for a successful vaginal delivery and the risks for an operative delivery (instrumental delivery or caesarean section). Clinical evaluation remains the gold standard for managing labor. However, the use of intrapartum ultrasound (IPU) has been proposed to help physicians in managing labor as a noninvasive method to predict obstructed labor in low-risk patients and to identify high-risk patients even before the onset of the partum. Method. We reviewed all studies demonstrating that ultrasound examination is more accurate and reproducible than the clinical examination for evaluating cervical dilatation, fetal head station, and fetal head position. Results. Discovering and using a risk tool may be useful for reassuring most women regarding their likelihood success at achieving an uncomplicated vaginal delivery, as well as selecting those patients with such a high risk for caesarean delivery that they should avoid a trial of labor. Such a risk tool has the potential to highly improve planning hospital service needs and minimizing the patients’ risk. Conclusions. In the last decade, IPU assessment has become a need, as it proved to be a reliable and objective method for obstetricians in decision making and preventing unnecessary intervention. IPU should be used as a complementary tool in labor and not undermine the clinician’s skills. [ABSTRACT FROM AUTHOR]

Spontaneous preterm birth (SPTB), defined as delivery before 37 weeks of gestation, remains a significant obstetric dilemma even after decades of research in this field and the leading cause of neonatal mortality and morbidity in developed countries. A short cervix is an important predictor of SPTB and several treatment strategies have been proposed. The cervical pessary has been tested as a possible intervention to prevent SPTB in singleton pregnancies. There is still conflicting evidence regarding the efficacy of it. The prevailing thought is that the pessary works similar to a mechanical device that keeps the cervix closed during pregnancy and also alleviates the amount of pressure on the cervix by shifting the angle of the cervix. The purpose of this case series is to provide preliminary proof on the utility of cervical pessary application in women with short cervix, especially during the COVID-19 pandemic. Between March 2020 and March 2022, 42 pregnant women were followed-up with Arabin pessaries in our clinic. Cervical pessary proved to be an inexpensive and less invasive option to cervical cerclage in pregnant women with shortened cervix. Pessary application and removal did not require anesthesia. Almost all the pessary users complained of increased vaginal discharge due to foreign body irritation after the use of a cervical pessary. No vaginal infections were demonstrated. Forty patients delivered after 34 weeks of gestation and only two patients delivered before 34 weeks of gestation. During the pandemic, the pessary use, instead of cervical suturing, has decreased hospital stays and reduced healthcare costs and proved to be a feasible alternative for the prevention of preterm delivery. Regarding the compliance and the tolerance, most women reported having a positive experience and that they were motivated to continue the treatment when they were continuously followed-up by an experienced clinic. This limited case series underlines that cervical pessary can be a trustworthy option for the prolongation of pregnancy and may represent special importance to health services in low-resource countries. [ABSTRACT FROM AUTHOR]

Introduction. Condyloma acuminatum is a clinical manifestation of human papillomavirus infection. This pathology is characterized by the presence of fleshy, pigmented papules, located in the anogenital region. The most common types of HPV which cause these anogenital warts are HPV 6 and HPV 11. Case report. A 31-year-old patient, with a caesarean birth in the obstetrical history, came to the hospital’s ambulatory service with several giant tumors/warts in the anorectal region. The tumors started to develop four years ago and have grown ever since. It was decided to apply the surgical treatment with the excision of these formations and to send the excised pieces to the pathological anatomy department. The histopathological result proved the presence of HPV infection (positive immunostaining with anti-p16 antibody), an increased degree of cell proliferation (intensive immunostaining with anti-Ki67 antibody), an abundant vascularization of warts, and cauliflower-like formations (intense immunostaining with anti-cluster of differentiation 34 antibody). All of this proves the ability of the condylomatous tumors to grow and develop very fast. The negative reaction on the immunostaining with the antip53 antibody demonstrated the benign character of the tumors. Conclusions. The surgical treatment does not cure the HPV infection, but it does help improving the patients’ quality of life. Histopathological and immunohistochemical examination helped us prove that the clinical development of the tumors was determined by the presence of HPV, and the accelerated development of warts was achieved from a large number of dividing cells, supported by an intense vascularization. The absence of oncoprotein p53 confirmed the benignity of cauliflower formations. [ABSTRACT FROM AUTHOR]

Introduction. There are many types of human papillomavirus, and 14 of these types are commonly associated with cervical cancer. Approximately 70% of the cervical cancers and preneoplastic lesions are caused by types 16 and 18. Preneoplastic cervical lesions can be treated, and HPV infection can disappear under the action of the immune system. Persistent infections can progress to neoplastic lesions. Materials, method and results. This is a retrospective study, conducted in the period 2018-2019. This study included a group of 30 young patients, aged 17-29 years old. All the patients included in this study had cytological and colposcopic changes of the cervix and HPV HR+ genotyping. Some of the patients complained of vaginal bleeding after sexual intercourse, leukorrhea and vaginal discomfort, but most of them were asymptomatic and were diagnosed with HPV during a screening exam. For the patients with low-grade lesions on the cytological exam or colposcopy, it was decided to apply local treatments and a follow-up after six months. For the patients with highgrade lesions, we performed an excision of the cervical lesions. The excised fragments were sent to the anatomic pathology department for microscopic study. Using the immunohistochemical study, we proved the presence of HPV in the excised tissue (positive anti-p16 antibody) and an increased degree of intraepithelial cell proliferation (CIN1-positive reaction to anti-Ki67 antibody in the basal layer, CIN2-positive reaction in the basal and intermediate layers, CIN3-positive reaction in the basal, intermediate and superficial layer). Seventeen patients presented high-grade lesions on the microscopic examination for the excised tissue. Conclusions. Untreated HPV infection leads to the transformation of normal cervical cells into premalignant and later malignant cells. These lesions were identified by histological and immunohistochemical studies that proved the degree of the intraepithelial lesions, by the presence of cells in the proliferation phase. The influence of HPV infection, demonstrated immunohistochemically, highlighted the prognosis and the evolution of the patients. [ABSTRACT FROM AUTHOR]

Introduction. Adenomyosis is a benign uterine disease. It is represented by the presence of endometrial glands in the structure of the myometrium. It has become a common pathology. The symptoms are intense and usually affect the patient’s daily life. Adenomyosis can be suspected based on the clinical and ultrasound aspects, and diagnosed by histopathological exam. It has multiple morphofunctional aspects, and sometimes it has important consequences on the patient’s life. Methodology. This is a retrospective study, conducted between 2018 and 2021 in the Obstetrics-Gynecology Clinic II of the Craiova County Emergency Clinical Hospital, on a group of 40 patients, aged between 21 and 58 years old. The patients presented menometrorrhagia and pelvic-abdominal pain. The usual blood tests frequently revealed a certain degree of anemia, and the ultrasound examination showed suggestive aspects of adenomyosis. For some patients, a symptomatic treatment was necessary and in other patients, the surgical treatment. The samples were sent to the pathological anatomy department for the histopathological examination. The diagnosis of adenomyosis was confirmed by histopathological examination. In the classic hematoxylin-eosin staining, we observed areas with fibrocollagen tissue in full myometrium, groups of dilated cystic glands and endometrial stroma, with acute periglandular inflammation. The differential diagnosis with a possible metastasis with a digestive starting point was made using the immunohistochemical study with anti-estrogen receptor (ER) antibodies – positive reaction, anti-progesterone receptors (PR) – positive reaction, anti-cytokeratin 7 (CK7) – positive reaction, and anti-cytokeratin 20 (CK20) – negative reaction. Conclusions. The histopathological examination confirmed the existence of endometrial glands, positive for hormonal markers, and cytokeratins that are specific for the endometrial epithelium. The ultrasound examination proved to be a useful tool in the diagnosis of adenomyosis. It also helped us to guide the treatment and follow up the results. [ABSTRACT FROM AUTHOR]

Abdominal wall endometriosis is a frequent pathology, more and more common due to the increase in the percentage of births through caesarean section. The endometrial tissue can suffer certain structural and functional changes which can be detected by the immunohistochemical examination. These changes may lead to normal cell transformation in some patients with preneoplastic alterations (hyperplasia, dysplasia) and then evolving to neoplasia. Objective. The evaluation of how the inflammatory system is involved in cellular alteration and the observation of the preneoplastic (hyperplastic) transformation of areas of interest. Experimental part. This is a retrospective study of 20 patients admitted in the Obstetrics-Gynecology II Clinic, Emergency County Hospital of Craiova, between 2016 and 2021, which presented a history of caesarean section. The diagnosis of abdominal wall endometriosis was presumed due to the accentuated symptoms and the presence of a mass at the caesarean section scar level detected by ultrasound investigation. The patients were then biopsied and the excision of the endometriotic nodules was performed. The histopathological examination established the final diagnosis. Results and discussion. The patients included in the study were between 17 and 56 years old. We noticed that preneoplastic cellular changes (endometrial hyperplasia) occur more frequent in older aged patients. Cytokeratin 7 (CK7) is found in both normal and neoplastic endometrial cells and can be used as a differential diagnosis marker, as it is negative in ovarian or digestive carcinomas. Anti-B-cell lymphoma-2 (Bcl-2)/phosphatase and tensin homolog (PTEN) antibody reveal immunolabeled ectopic endometrial cells, which may have suffered preneoplastic alterations. Anti-tryptase/Cluster of Differentiation 68 antibody demonstrates the presence of many mast cells/macrophages involved in the immune reaction around the endometriosis foci. Conclusions. A multitude of inflammatory, hormonal and mechanical factors are involved in the development of endometriosis. The presence of cellular apoptosis inhibiting genes increases the cell division rate, and the strong immune response can influence the malignant transformation of endometriosis. [ABSTRACT FROM AUTHOR]

Introduction. Ovarian tumor formations represent a common pathology in gynecology. They are divided into malignant, benign, secondary and borderline ovarian tumors. The benign tumors develop locally, starting with the ovarian follicles, the luteal body etc. Malignant tumors are formations that can invade locally and disseminate at distance. Premalignant tumors are tumor formations that present a high risk for malignant transformation, without having to invade other organs. Materials and method. The study included 30 patients, 10 patients with benign ovarian cysts, 10 with borderline ovarian tumors and 10 with malignant ovarian tumors. The patients were between 19 and 72 years old, diagnosed and treated in the Clinic of Obstetrics-Gynecology II of the County Clinical Emergency Hospital of Craiova, between 2015 and 2019. The pieces obtained postoperatively were introduced in paraffin and studied from the histological and immunohistochemical point of view. The blocks resulted were sectioned using the microtome, the sections were applied on simple smears for the classical histological stains Hematoxylin-Eosin (HE)/Trichromic Masson (TM) and on smears with Poly-L-lysine for immunohistochemical stains. The antibodies used were as follows: anti-estrogen receptor (ER), anti-progesterone receptor (PR), anti-Cytokeratin 7 (CK7), anti-Cytokeratin 20 (CK20), anti-Ki67, anti-B Cell Lymphoma (BCL2), anti-Cluster of differentiation (CD34), and anti-cancer antigen 125 (CA125). Results. The classic HE and TM stains demonstrated the presence of cystic structures, while by means of immunohistochemistry we showed that these tumors are of ovarian epithelial type, being positive for CK7 and negative for CK20, making the differential diagnosis with a possible metastasis from the level of the digestive tube. Estrogen and progesterone receptors are present in the structure of these glands, influencing the therapeutic conduct. Cellular antiapoptotic genes were positive in the hyperplastically/neoplastically transformed areas, while cell proliferation was intensely positive in the malignant areas. Vascularization was intense especially in cases diagnosed with borderline tumors. Conclusions. The surgical intervention and the subsequent histopathological examination provide actual data regarding the diagnosis of tumor certainty, helping to establish the long-term prognosis and the application of other types of treatment. [ABSTRACT FROM AUTHOR]

Introduction. There are several strains of human papillomavirus (HPV) and 14 of them have been associated with cervix cancer. High-risk strains cause most cervix cancer and preneoplastic lesions. Preneoplastic cervical lesions can be treated, and HPV infection may disappear under the action of the inflammatory system in a few months or up to two years. Persistent infections can turn the normal cervix into a pathological one. Materials, method and results. The 32-year-old patient presented to the ambulatory service for vaginal dyspareunia and minimal vaginal bleeding after sexual contact. The speculum examination revealed an exocervix increased in volume, presenting lesions, slightly bleeding upon touch. Samples were collected for the Pap smear in liquid environment. The result of the Pap smear revealed the presence of abnormal squamous cells (ASC-H) and HPV genotyping detected strains 42 and 59. The product was also sampled for the CIN Tech 2++ test, which was positive in rare epithelial cells. Colposcopy with biopsy was performed. Following the colposcopy and the histopathology results, the existence of cervical changes (cervical intraepithelial neoplasia CIN 1, 2) was demonstrated in an area of pavementous transformation, and electroresection with diathermy snare was decided. The excised fragments were subjected to microscopic study. By using immunohistochemistry, we demonstrated that 2/3 of the thickness of the epithelium was positive in the reaction with anti-Ki67 and anti-p16 antibodies, (CIN 1 – positive reaction with anti-Ki67 antibody in the basal layer; CIN 2 – positive reaction in the basal layer and in the intermediate layers). Also, in the classical stains we noticed the asynchronism between the nucleus and the cytoplasm in the dysplasically transformed areas. The patient was periodically monitored to avoid relapse. Conclusions. HPV infection may influence the transformation of normal cervical cells into preneoplastic or malignant transformation cells. The early detection and treatment of these modifications can cease pathological evolution and save lives. [ABSTRACT FROM AUTHOR]

Introducere. Există numeroase tulpini de virus papiloma uman (HPV), iar 14 dintre acestea au fost asociate cu cancerul cervical. Două tulpini - 16 şi 18 - cauzează 70% din cancerele cervicale şi leziunile preneoplazice. Leziunile cervicale preneoplazice pot fi tratate, iar infecţia cu HPV poate dispărea sub acţiunea sistemului inflamator în câteva luni sau până la doi ani. Infecţiile persistente pot transforma colul normal într-unul patologic. Materiale, metodă şi rezultate. O pacientă în vârstă de 28 de ani s-a prezentat în serviciul ambulatoriu pentru sângerări vaginale în cantitate minimă după contactul sexual. La examenul cu valve s-a constatat exocol mărit de volum, lezional, sângerând uşor la atingere. S-au recoltat probe pentru examenul Babeş-Papanicolau în mediul lichid. Rezultatul testului Papanicolau a evidenţiat prezenţa celulelor scuamoase anormale (ASCUS), iar la genotiparea HPV s-au detectat tulpinile 16 şi 18. S-a practicat colposcopie cu biopsie. În urma rezultatelor colposcopice şi histopatologice s-a demonstrat existenţa modificărilor cervicale (neoplazie intraepitelială cervicală CIN 1, 2, 3) şi s-a decis practicarea conizaţiei. Fragmentul sub formă de con, excizat, a fost supus studiului microscopic. Cu ajutorul imunohistochimiei am demonstrat prezenţa HPV în ţesut (reacţie pozitivă la anticorpii anti-HPV, anti-p16) şi gradul crescut de proliferare celulară intraepitelială (CIN 1 - reacţie pozitivă la anticorpul anti-Ki67 în stratul bazal; CIN 2 - reacţie pozitivă în stratul bazal şi în straturile intermediare; CIN 3 - reacţie pozitivă în stratul bazal, în straturile intermediare şi în stratul superficial). Cu anticorpul anti-proteină tumorală 53 (p53) s-au pozitivat câteva celule af late în diviziune. Concluzii. Infecţia cu HPV poate inflenţa transformarea celulelor normale cervicale în unele cu transformări preneoplazice sau maligne. Detectarea prococe şi tratarea acestor modificări pot stopa evoluţia patologică şi salva vieţi. [ABSTRACT FROM AUTHOR]