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Introduction. Preexistent maternal hypertension requires usually treatment from the beginning of pregnancy. If the causes remain unknown, they can lead to a poor outcome of the fetus and can have a strong psychological impact on the mother. Case presentation. A 27-year-old patient, known for 10 years with severe arterial hypertension, presented for an investigation with angio-MRI following a second-term intrauterine fetal death at 18 weeks of pregnancy. The angio-MRI objectivated a 90% occlusion on the right renal artery. A double-stent was placed, leading to a significative reducing of the occlusion to only 10%. Normal values of the blood pressure were achieved and no medication was further acquired for this pathology. Currently, a second pregnancy was achieved, now the patient being followedup, at 37 weeks of gestation, with no complications until now, and she will be giving birth the following weeks. Discussion. The management of severe arterial hypertension was difficult to achieve for this patient, in her first pregnancy. She was treated with alpha-methyldopa 250 mg per day and nifedipine, without success, unfortunately. The importance and success of this case were given by the resilience of doctors who discovered the stenosis after her fourth MRI. Conclusions. Although rare, we can say that there are cases with congenital renal artery stenosis that can be treated in young women, helping them conceive spontaneously healthy babies. The multidisciplinary follow-up was important in this case, as the patient was first refused for angio-MRI because of allergic reaction to intravenous substance. [ABSTRACT FROM AUTHOR]

Introduction. Pregnancy and fibroma can occur simultaneously, although depending on the localization of the fibroma, it can pe associated with female infertility. We present a case successfully resolved last year in our clinic: a 44-year-old patient who obtained spontaneously a pregnancy after 10 years of fertility treatments and managed to follow to term the pregnancy simultaneously with a gigantic polyfibromatous uterus. Case presentation. The patient D.M. was given small chances to conceive naturally, in her thirties, because of her polyfibromatous uterus (more than 10 uterine fibromas that continued to grow as years followed). She tried in vitro fertilization, without success, and in 2021 she managed to conceive naturally. Her doctor was naturally reserved and managed her pregnancy monthly, the patient being diagnosed at 28 weeks of gestation with gestational diabetes. At that moment, we could measure with difficulty the fetus, because there were at least six fibromas of 8 cm each, most of them intramurally. She was programed at 37 weeks of gestation for caesarean section following transverse presentation. A baby boy, weighing 2640 g, with Apgar scores of 5 (at 1 minute) and 7 (at 5 minutes), was born, due to the difficult extraction. Discussion. The obstetrics and gynecology team, after the consent of the mother, decided to do simultaneously total interanexial hysterectomy for this patient, because the uterus was globally enlarged up to her diaphragm, even after delivery. We also performed bilateral hypogastric artery ligation. Preoperatively, blood tests were taken, and isogroup and isoRh were prepared. The patient received intravenous ferrum postoperatively and left the hospital after a week of triple antibiotic association and anticoagulant prophylactic therapy, with a hemoglobin level of 9.7 g/dl and a hematocrit level of 27%. Conclusions. We successfully present the unique case of a primiparous 44-year-old patient who managed to conceive and to give birth at term to a healthy baby, but also the disciplinary approach to the polyfibromatous uterus, as it further endangered the patient’s life. [ABSTRACT FROM AUTHOR]

Introduction. As Romanian caesarean delivery rates rise, there is a need to evaluate the success of vaginal birth after caesarean delivery (VBAC) in public hospitals. Results. A total of 63 cases were analyzed, and relevant information on maternal and fetal parameters, including outcome of the present pregnancy, were retrieved. A total of 63 cases of VBAC were included in our study. The mean age of the patients was 30.52 years old. In our selected cases, 40 patients (63%) received prenatal care, 21 (33%) patients did not receive any prenatal care, and two patients (4%) were partially followed-up. The mean admission to delivery time interval expressed in days was 0.97. A total of 27 patients (42.8%) had ruptured membranes before VBAC. Prophylactic episiotomy was performed in 38 cases (60.3%), and instrumental delivery was indicated in eight cases (12.6%): seven vacuum extractions and one forceps application. The mean gestational age at birth was 37.25 weeks of gestation. The smallest gestational age was 27 weeks, while the maximum gestational age at birth in our cases was 42 weeks. A total of 15 preterm births were identified: three cases of extreme preterm births, five cases of very preterm births, and seven cases of late‐term births. Only one case of post-term birth at 42 gestational weeks and four other cases of late‐term births at 41 weeks were recorded. The male:female ratio for newborns was 1.73, with a mean birth weight of 2,956.03 g, respectively a mean Apgar score at 1 minute of 7.63. The main complications that followed VBAC were postpartum hemorrhage (10 cases) and uterine atony (five cases), which required manual removal of the placenta and instrumental and manual control of the uterine cavity. Postpartum transfusion of two units of blood were required in two cases. Discussion. The first objective of the present study was to retrospectively assess the VBAC cases that were admitted to a tertiary maternity hospital in Romania, between January 2014 and August 2020. An increasing trend in the number of VBACs was observed, from four births in 2014 to 17 births in 2019, but in this tertiary center, approximately 6000 births take place annually, so the VBAC rate is less than 1%. [ABSTRACT FROM AUTHOR]

Introduction. The increased social and economic burden caused by the novel COVID-19 outbreak is gradually becoming a worrisome issue for the health sector. The novel coronavirus invades the target cell by binding to ACE2, which is widely expressed in the ovaries, uterus, vagina and placenta. Significantly, the SARS-CoV-2 is said to interrupt female fertility through regulating ACE2. Thus, it is essential to investigate if SARS-CoV-2 infection hampers female fertility, given that there is no systematic and comprehensive evidence on the association of COVID-19 with fertility. Materials and method. We performed a web research regarding male and female fertility and COVID-19. The eligibility criteria included: population aged 13-49 years old; exposure (infection with SARS-CoV-2); comparison (population without SARS-CoV-2 infections or latent SARS-CoV-2 infections); and outcome (female fertility, such as ovarian reserve function, uterine receptivity, oviducts status and menstruation status, male fertility and parameters). Results. Some studies showed that COVID-19 vaccines don’t impair fertility in men or women, but SARS-CoV-2 infection could potentially affect a man’s fertility for up to 60 days; for example, being 18% less likely to conceive during the next cycle of their female partner, compared with men who had not tested positive. Conclusions. Further data need to be acquired to synthetize the new effects on the population. Any infection – particularly an infection that involves fever – can affect sperm production and can affect ovulation, factors that apply in COVID-19. [ABSTRACT FROM AUTHOR]

Introduction. Meeting the contraceptive needs of women living with HIV (WLHIV) has primary health benefits for them, in addition to being a key element to prevent mother-to-child HIV transmission. This analysis will estimate the current number of infant HIV infections prevented by contraception. Methodology. We performed a literature search of PubMed to identify reports of drug interactions between hormonal contraceptives (HCs) and antiretroviral drugs (ARVs). We also reviewed the guideline of contraceptive hormone preparations and antiretrovirals for additional data and recommendations. Results. Several studies of combined oral contraceptive pills (COCs) identified decreased serum estrogen and progestin levels when co-administered with certain ARVs. The contraceptive efficacy of injectable depot medroxyprogesterone acetate (DMPA) and the levonorgestrel intrauterine system (LNG-IUS) were largely unaffected by ARVs, while data on the contraceptive patch, ring and implant were not significant information to mention. Conclusions. Contraception continues to play an integral role in global HIV prevention efforts in the era of increasing HIV treatment coverage, especially in poor-income countries. Broad contraceptive availability, increased contraceptive voluntarism and method mix are key components to preventing unintended births and ending new infant HIV infections worldwide. [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]

Introduction. Fetal aortic coarctation still represents a challenge even for the best sonographers, especially in the early forms of appearence. Case presentation. A secundipara, with a previous healthy child, presents for the first assesement with a 32-week pregnancy. The ecography showed: IUGR of minus 3 weeks, a significant discrepancy between the right and left ventricule, fibroelastosis of the wall in right ventricule, and a suspicion of aortic coarctation. The aortic isthmal diameter was measured immediately proximal to the insertion of the arterial duct in the transverse (three vessel and trachea) and sagittal view, and the ductal diameter was measured immediately before it entered the descending aorta in the same view. Conclusions. The Z-scores for the fetal aortic isthmus and arterial duct are measured in the three vessels and trachea view and for the isthmus in the sagittal plane. In suspected coarctation, these Z-scores and the isthmal to ductal ratio may help in longitudinal assessment of the aortic arch and help at the prenatal diagnosis of coarctation. [ABSTRACT FROM AUTHOR]

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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.)

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.)

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.)

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.)

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.)

Pacienta R.S., în vârstă de 37, aflată la a 2-a sarcină, în prezent 20 de săptămâni de amenoree, se internează pentru monitorizarea sarcinii cu risc obstetrical crescut. Prima ecografie a fost efectuată în primul trimestrul de sarcină, stabilindu-se o sarcină monocorială, monoamniotică. A fost trimisă în vederea morfologiei fetale, la 20 de săptămâni de sarcină, cu diagnosticul: IIG Sarcina 20 de săptămâni, gemelară, monocorială, monoamniotică, ambii feți vii, polihidramnios. Uter cicatriceal. Examen ecografic - polihidramnios acut AFI=43 cm, făt I - vezică urinară prezentă, stomac prezent, cord aspect normal CA=137 mm - 19 săptămâni, Doppler AO PI = 1,36 duct venos cu undă atrială pozitivă, făt II - vezica urinară de dimensiuni foarte reduse, stomac prezent, cord aspect normal, CA =124 mm - 18 săptămâni, Doppler AO PI = 0,93, duct venos aspect normal, undă atrială pozitivă. Se practică amniocenteza diagnostică, amnioreducție cu extragere a 300 ml de lichid amniotic. Ulterior se administrează tratament antispastic și antibiotic doză unică. Rezultat analiză FISH: normal, feți de sex feminin. După o săptămână se reevaluează cazul, fără modificarea semnificativă a parametrilor ecografici, și se practică amnioreducție, extrăgându-se 2 l de lichid amniotic. AFI preamnioreducție = 43 cm, AFI postintervenţie = 27 cm. La 32 de săptămâni AFI - 30 cm, se instituie tratament cu Indometacin oral 1 cp/12 ore - 5 zile, AFI posttratamet ameliorându-se semnificativ. La 34 de săptămâni, se decide terminarea sarcinii prin operaţie cezariană, pentru diagnosticul: Ssarcina gemelară monocorială monoamniotică 34 săptămâni, sindrom transfuzat-transfuzor stadiul Quintero 3. Se extrag doi feți de sex feminin G = 1100 g, respectiv G = 1700 g, cu adaptare bună neonatală. [ABSTRACT FROM AUTHOR]

Gravidă T.M, dispensarizată de medic specialist OG, depistată la 23 de săptămâni vârstă gestațională, la morfologia fetală, cu formațiune retroperitoneală cu diametru de 17/17/22 cm, pentru care s-a solicitat consult urologic, care a stabilit diagnosticul de chist renal polar superior, pentru care s-a montat o nefrostomă, cu drenajul formațiunii chistice aproximativ 2000 ml, conținut lichidian limpede. Se internează pentru monitorizarea sarcinii cu risc crescut. Pe parcursul internării se instituie tratament cu Ranitidină f ½/12 ore, Dexametazonă f I/12 h (plachete 117000/mm3 la internare - 4 cure preoperator), Dopegyt 1 cp/zi, Utrogestan 2 cp/zi, Magnerot 2 cp/zi, monitorizare cardio-tocografică zilnică în limite normale. Pe data de 13.07.2014, ora 09:40, naşte prin operaţie cezariană segmento-transversală un nou-născut viu, sex masculin G = 3400 g, A = 9. Evoluţie favorabilă postintervenție, externându-se în ziua a 3-a de lehuzie cu stare generală bună, fără acuze subiective. Conduita terapeutică a chisturilor renale în sarcină este una controversată. Atenție deosebită trebuie acordată riscului de infecție și sepsis. Literatura descrie apariția infecțiilor în jurul a 24-28 de săptămâni, odată cu creșterea uterului și comprimarea tractului urinar, făcând posibilă creșterea în dimensiuni și, ulterior, infectarea chistului. Particularităţile cazului au constat din dimensiunea mare a chistului, 17/17/22 cm anterior puncționării, și 14/17 cm, ulterior; diagnosticarea cu chist renal la 20 de săptămâni de sarcină, pacienta neavând nicio acuză subiectivă anterior diagnosticării. La trei luni de la naştere, pacienta a fost redirecţionată către Clinica de Urologie Cluj-Napoca, unde s-a intervenit chirurgical, practicându-se nefrectomie totală laparoscopică. [ABSTRACT FROM AUTHOR]

Operaţia cezariană este una dintre cele mai frecvente proceduri obstetricale, cu o rată de creştere a numărului de cezariene în întreaga lume, în cele mai recente studii. Mortalitatea și morbiditatea maternă și fetală asociate cu operaţia cezariană sunt o problemă importantă de sănătate publică. Se impune, aşadar, evaluarea efectelor operaţiilor cezariene repetate asupra morbidităţii materne și fetale. Obiectivele studiului: Evidenţierea cazuisticii pentru surprinderea evoluţiei incidentei complicaţiilor post CST; aprecierea dinamicii grupelor de vârstă afectate; identificarea factorilor de risc, a diagnosticelor asociate; aprecierea reală a intervenţiilor chirurgicale asociate CST și a complicaţiilor postoperatorii; evidenţierea patologiei asociate a nou-născutului. Lotul de studiu: 293 de paciente, urmărite în Maternitatea „Cuza Voda”, la care s-a practicat operaţie cezariană în perioada 1 ianuarie 2008-1 ianuarie 2016. Pacientele au fost împărţite în patru grupe de vârstă, cu un procentaj crescut de complicaţii pentru fiecare categorie de vârstă: sub 20 de ani - 4 paciente (75%), 21-30 de ani - 104 paciente (88,46%), 31-40 de ani - 166 de paciente (83,13%), peste 40 de ani - 19 paciente (84,21%). Intervalul de urmărire: 8 ani (1 ianuarie 2008-1 ianuarie 2016). Studiul a avut o componentă retrospectivă- consultarea foilor de observaţie - 1 ianuarie 2008-1 ianuarie 2016. Concluzii. Creşterea numărului de operaţii cezariene este asociată cu multiple complicaţii materne și fetale. Scăderea numărului de operaţii cezariene la pacientele primipare este necesară, pentru a reduce riscul acestor complicaţii. Naşterea vaginală după operaţia cezariană ar putea fi o opţiune care trebuie evaluată și recomandată la gravidele la care acest lucru este posibil. [ABSTRACT FROM AUTHOR]