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Pelvic abscesses located in the uterovesical space usually appear postpartum after cesarean delivery. Late presentation after months or years following surgery is rarely reported, especially in immunocompetent patients. We report the case of a young patient presenting an abscess of the uterovesical pouch, infiltrated in the myometrium, posterior wall of the bladder and parametrium. The case particularities include limited identifiable predisposing risk factors, acute onset of symptoms and belated diagnosis eight years after her second cesarean. The abscess removal by laparotomy required extensive debridement, total hysterectomy, bilateral salpingectomy and partial cystectomy, with good outcome after surgical treatment. We highlight the importance of a mixt urogynecology team for individualized case management and we discuss similitudes with other late cesarean complications. [ABSTRACT FROM AUTHOR]

Abdominal pregnancy is a very rare form of ectopic pregnancy and is associated with an increased mortality rate. The main lifethreating complication is intraperitoneal bleeding from placental site. The gestational age is important for the prediction of complications’ severity. While most cases are secondary to a tubal rupture and the subsequently implantation in the peritoneal cavity, a previous uterine perforation can also represent the leading cause. In the current paper, we report an extremely rare case of secondary abdominal pregnancy with a gestational age of 11 weeks in a 37year old patient having a history of unnoticed uterine perforation. This report raises awareness on a rare and severe obstetrical condition, discussing the case particularities, with the aim to highlight the urge for prompt diagnostic and treatment measures. [ABSTRACT FROM AUTHOR]

Vaginal bleeding in the first trimester is a common occurrence, but the majority of the pregnancies have a normal outcome. The careful assessment is yet important, given the possibility of complications. The patients with a threatened abortion should be monitored for progression to pregnancy failure. The most common type of spontaneous abortion is early pregnancy loss, defined as death of an embryo or fetus within the first 13 weeks of pregnancy. The clinical manifestations have low specificity, neither the duration of bleeding, nor the presence of lower abdominal cramping in the first trimester being reliable indicators of pregnancy outcome, thus the special attention has turned to ultrasonography for the evaluation of early pregnancy complications. The therapeutic approach (expectant management, medication or surgical interventions) should be tailored based on the gestational age, clinical and ultrasound findings. Severe hemorrhage requires urgent treatment, the surgical evacuation of the products of conception being often necessary. In this paper, we present the incidence and prevalence of early pregnancy loss and threat of abortion in the Department of Obstetrics and Gynecology of the Bucharest University Emergency Hospital, for a two-year period, discussing the impact of the advanced maternal age as a risk factor for spontaneous abortion. [ABSTRACT FROM AUTHOR]

Vertebral hemangioma is one of the most frequent benign tumors of the spine. About 1% of these tumors become aggressive and symptomatic. The aggressive vertebral hemangiomas associated with pregnancy represent an extremely rare condition, and obstetricians should be aware of this pathology in case of subacute onset of motor deficit and paraplegia, especially during the third trimester. The association with pregnancy favors the rapid onset of neurological symptomatology and raises particular issues in terms of prompt diagnosis and treatment, with the aim to prevent both maternal and fetal morbidity. We report a rare case of aggressive thoracic hemangioma during pregnancy. The severe and rapidly progressive neurological deficit caused by the vertebral tumor required complex postpartum interventional and neurosurgical treatment. [ABSTRACT FROM AUTHOR]

The genesis of neural tube defects (NTD) is poorly understood. The most prevalent types of NTDs are anencephaly, encephalocele and spina bifida. Craniorachischisis totalis (anencephaly with total open spina bifida) is the most severe form of neural tube defects. The concomitant presence of omphalocele was rarely described in the literature. We report a case of a secundigravida, 38 years old, who had a history of premature birth due to cervical incompetence, BMI=30, with hypothyroidism, revealing an embryo with craniorachischisis totalis together with omphalocele, diagnosed during a first-trimester ultrasound at 11 weeks of gestation. We discussed the implications of the diagnosis with the family and proceeded to pregnancy termination. Karyotyping was performed on the aborted product of conception, revealing trisomy 18. The folate level in the mother’s blood showed an above the normal level, thus the lack of folic acid could not be linked to NTD. This case highlights the importance of the first-trimester ultrasound in the diagnosis of severe malformations, together with the genetic diagnostic testing of the fetus. The right diagnosis is crucial for future prenatal investigation and counseling. [ABSTRACT FROM AUTHOR]

The genesis of neural tube defects (NTD) is poorly understood. The most prevalent types of NTDs are anence pha ly, encephalocele and spina bifida. Craniorachischisis totalis (anencephaly with total open spina bifida) is the most severe form of neural tube defects. The concomitant presence of omphalocele was rarely described in the literature. We report a case of a secundigravida, 38 years old, who had a history of premature birth due to cervical incompetence, BMI=30, with hypothyroidism, revealing an embryo with craniorachischisis totalis together with omphalocele, diagnosed during a first trimester ultra sound at 11 weeks of gestation. We discussed the implications of the diagnosis with the family and proceeded to pregnancy termination. Karyotyping was performed on the aborted product of conception, revealing trisomy 18. The folate level in the mother’s blood showed an above the normal level, thus the lack of folic acid could not be linked to NTD. This case highlights the importance of the first trimester ultrasound in the diagnosis of severe malformations, together with the genetic diagnostic testing of the fetus. The right diagnosis is crucial for future prenatal investigation and counseling. [ABSTRACT FROM AUTHOR]

Placenta accreta spectrum (PAS) disorders, comprising placenta accreta, increta and percreta, are associated with serious maternal morbidity and mortality. The incidence of PAS has increased in the recent years due the rising numbers of caesarean section births, but it is linked also to uterine surgeries like myomectomy, history of placenta accreta in previous pregnancy, and endometrial curettages. At the University Emergency Hospital Bucharest, due to access to transcatheter arterial embolization, we treat first-trimester caesarean scar pregnancy either diagnosed in our department or referred from different centers by the following algorithm: uterine artery embolization followed by safe aspiration. For cases of advanced pregnancies with PAS that come to our setting, we start to complete, preferably as early as the second trimester, the checklist required for a programmed caesarean section performed by a multidisciplinary team, including oncological gynecological surgeons in our department, urology specialist, and with a thorough intensive care preparation. The psychological support and the continuous counseling are performed as needed due to the continuous requirements of reassurance of the patient. We present a series of cases of caesarean scar pregnancies in order to underline the various ultrasonographic aspects of the early first trimester. We consider of utmost importance the early diagnosis and management of these cases that should not be missed in order to avoid future morbidity and mortality. We also present the ultrasonographic aspects of advanced pregnancies where PAS was identified and the management algorithms that we use in the treatment of these life-threatening obstetrical emergencies. [ABSTRACT FROM AUTHOR]

Placenta accreta spectrum (PAS) disorders, comprising placenta accreta, increta and percreta, are associated with serious maternal morbidity and mortality. The incidence of PAS has increased in the recent years due the rising numbers of caesarean section births, but it is linked also to uterine surgeries like myomectomy, history of placenta accreta in previous pregnancy, and endometrial curettages. At the University Emergency Hospital Bucharest, due to access to transcatheter arterial embolization, we treat first trimester caesarean scar pregnancy either diagnosed in our department or referred from different centers by the following algorithm: uterine artery embolization followed by safe aspiration. For cases of advanced pregnancies with PAS that come to our setting, we start to complete, preferably as early as the second trimester, the checklist required for a programmed caesarean section performed by a multidisciplinary team, including oncological gynecological surgeons in our department, urology specialist, and with a thorough intensive care preparation. The psychological support and the continuous counseling are performed as needed due to the continuous requirements of reassurance of the patient. We present a series of cases of caesarean scar pregnancies in order to underline the various ultrasonographic aspects of the early first trimester. We consider of utmost importance the early diagnosis and management of these cases that should not be missed in order to avoid future morbidity and mortality. We also present the ultrasonographic aspects of advanced pregnancies where PAS was identified and the management algorithms that we use in the treatment of these life threatening obstetrical emergencies. [ABSTRACT FROM AUTHOR]

During pregnancy, maternal diet is a modifiable factor that impacts the birth outcome. Since the nutritional needs of a pregnant women vary during preconception, gestational and breastfeeding period, it is necessary to adapt the diet and lifestyle, optimally under the personalized nutrition guidance of a specialist. High quality research regarding diet during pregnancy remains challenging as nutritional concerns also vary according to religion, financial income, age and education of the pregnant woman, as well as specific traditions of each country, limited number of dietitians with special training in maternal nutrition. The obstetrician usually plays a major role in dietary counselling and the use of nutritional monitoring tools can help identify pregnant women who may be at risk due to an inappropriate diet. The age of the pregnant women can be important when it comes to dietary and lifestyle changes. In this context, we addressed a questionnaire to 100 pregnant women in third trimester of pregnancy in order to evaluate a possible correlation between the age and the dietary behavior and lifestyle of a pregnant woman. Furthermore, the maternal compliance with dietary recommendations in pregnancy and the exposure to various risks due to unhealthy nutrition were also analysed in the study. [ABSTRACT FROM AUTHOR]

Transvaginal ultrasound and serum concentration of human chorionic gonadotropin are the main methods of prognostic evaluation of early pregnancies. Although these pregnancy investigation methods have proven their benefits, the interpretation is fundamental for a correct diagnosis, in order to avoid interventions that may affect pregnancies that would normally have had a physiologic course, as well as to apply an appropriate management in the case of nonviable pregnancies. Recent studies have shown the need to adopt rigorous criteria that minimize false positive results and thus decrease the frequency of diagnostic errors. Over time, a series of ultrasound features have been described which have proven effective in predicting nonviable pregnancies in the first trimester (cranio-caudal length in relation to the presence or absence of cardiac activity, yolk sac diameter, gestational sac diameter in relation to presence or absence of embryo with cardiac activity, embryonic heart rate, subchorionic hematoma etc.). In the context of the new prospects for the development of artificial intelligence softwares, the present work focuses on the description of the precise ultrasonographic aspects aboded by the latest studies that propose certain cut-off values dependent on the gestational age of the ultrasound parameters in the first trimester, increasing the sensitivity and the specificity of ultrasound in the diagnosis of nonviable early pregnancies, thus aiming to improve the reproductive prognosis of couples with recurrent abortions. [ABSTRACT FROM AUTHOR]