Search

Introduction: Pregnancy is a normal physiological state that predisposes to thrombosis, which is caused by the hormonal changes in the maternal body. These ones are represented by the change of the blood flow (venous stasis), by changes in the vessel wall (hypotonia, endothelial lesions), changes in the coagulation factors (increased levels of factor VII, factor VIII, factor X, von Willebrand factor), and by the decrease in the natural anticoagulants level (protein C, protein S). In this study, we aimed to establish a possible association between thrombosis and hereditary thrombophilia in pregnant women with this pregnancy - related pathology. Thrombosis during pregnancy is a serious complication that requires excellent cooperation between obstetrician and anesthetist. The second purpose of our study was to monitor the incidence of IUGR in these women. Intrauterine growth restriction is a major cause of fetal morbidity and mortality during pregnancy. At present, the role of the factor V Leiden mutation, of the prothrombin gene mutation, and of the MTHFR gene mutation as risk factors for IUGR is not clearly established. Material and methods: Retrospective study - 161 pregnant women with a history of thrombosis, intrauterine growth restriction, preeclampsia, recurrent miscarriages, who were admitted to the "Cuza Vodă" Maternity in Ia'i, between 2015 and 2017, and on whom genetic tests for thrombophilia were carried out. We monitored the risk of thrombosis and the prevalence of maternal thrombophilia in the group of pregnant women who had IUGR as well. Results: In comparison with a control group, the following were found: the risk of thrombosis in patients with factor V Leiden mutation is higher, pregnant women with a family medical history of thrombosis have a higher risk of thrombosis, the prevalence of hereditary thrombophilia is 3 times higher in the group of pregnant women who also have IUGR, the frequency of the MTHFR gene mutation and of protein S is higher in the IUGR group, and there is no significant connection between the factor V Leiden mutation and preeclampsia or IUGR. Conclusion: This study demonstrates that the protein S deficiency and the MTHFR gene mutation are more common in IUGR pregnancies. No significant association was found between the factor V Leiden mutation and preeclampsia or between factor V Leiden and IUGR. The risk of thrombosis in patients with mutation in the factor V gene was 2.52 times higher than in patients who didn't have this mutation. [ABSTRACT FROM AUTHOR]

Introduction. The prothrombin G20210A mutation is the second most common inherited thrombophilia after the factor V Leiden mutation. Challenging clinical issues include the decisions regarding when to test for the mutation and how to manage individuals with the mutation, either in the setting of venous thromboembolism (VTE), or as an incidental finding. Materials and method. In this study, there were included a total of 1,607 women with a history of recurrent pregnancy loss, between January 2010 and June 2018, who were admitted to the infertility clinic with desire to increase fertility. Results and conclusions. Since the homozygous forms of the FVL-prothrombin gene mutations have low incidence and MTHFR mutation is similar to the healthy population, preconceptional thrombogenic gene mutations screening seems to be controversial. [ABSTRACT FROM AUTHOR]

Introducere. După 20 de ani de la iniţierea vaccinării generalizate a tuturor nou-născuţilor pentru virusul hepatitei B (VHB), cazurile de hepatită B s-au diminuat considerabil, dar încă nu au dispărut. Este necesară cercetarea epidemiologică în dinamică asupra fenomenului. Materiale şi metodă. Lotul de studiu: 205 pacienţi diagnosticaţi cu hepatită cronică cu VHB (834 de internări). Criterii de includere: elemente clinice, biologice, serologice, virusologice de diagnostic pozitiv de hepatită cronică cu VHB. Intervalul de urmărire: 10 ani (ianuarie 2005 - decembrie 2014). Rezultate şi concluzii. Numărul de cazuri a scăzut semnificativ în comparaţie cu etapele anterioare, ceea ce demonstrează că vaccinarea nou-născuţilor a fost şi este o măsură preţioasă. Se remarcă schimbarea dinamicii incidenţei şi prevalenţei, dar menţinerea unui număr de cazuri în ciuda vaccinării, iar acestea se explică prin transmiterea de la mamă la copil. Deşi numărul total de naşteri este în scădere, numărul transmiterilor verticale ale VHB este în creştere. [ABSTRACT FROM AUTHOR]

Introducere. Struma ovarii este o tumoră benignă rară, cel mai frecvent unilaterală, care poate metastaza în cazuri rare. Este de obicei asimptomatică şi nu este diagnosticată preoperatoriu din cauza absenţei unor markeri imagistici sau biologici specifici pentru această entitate tumorală. Materiale şi metodă. Prezentăm un caz rar de struma ovarii bilateral, diagnosticat după efectuarea tratamentului chirurgical, pe baza examenului histopatologic, şi prezentăm totodată o revizuire a literaturii în ceea ce priveşte acest subiect. Rezultate şi concluzii. Caracteristicile ecografice ale struma ovarii sunt nespecifice, dar poate fi observată o masă heterogenă, predominant solidă. Este dificil să se facă diagnosticul diferenţial între struma ovarii şi chisturile dermoide pe baza aspectului lor ecografic. Cu toate acestea, fluxul Doppler poate ajuta la diagnosticarea preoperatorie a struma ovarii. Semnalele de flux sangvin detectate din centrul leziunii şi rezistenţa scăzută la curgere pot fi mai frecvente în struma ovarii. Tratamentul chirurgical este de elecţie în aceste cazuri, atât pentru stabilirea diagnosticului, cât şi din punct de vedere curativ. După efectuarea histerectomiei totale cu anexectomie bilaterală, s-a constatat o evoluţie favorabilă, cu normalizarea nivelului de CA125 la această pacientă şi obţinerea unui status normotiroidian postoperatoriu. [ABSTRACT FROM AUTHOR]

Introducere. Cariotipul 46 XY reprezintă o tulburare de dezvoltare sexuală în care persoana cu un cromozom X şi un cromozom Y în fiecare celulă - model care se găseşte în mod normal la bărbaţi - are organe genitale ambigue, nefiind în mod clar bărbat sau femeie. Unele persoane cu cariotip 46 XY, cu tulburare de dezvoltare sexuală, prezintă organe de reproducere feminine dezvoltate complet sau parţial, în timp ce alte persoane nu prezintă deloc dezvoltarea acestor structuri. Persoanele cu tulburare de dezvoltare sexuală cu cariotip 46 XY pot fi crescute ca bărbaţi sau femei. Tratamentul implică intervenţii chirurgicale şi terapie de substituţie hormonală. Aceste persoane prezintă un risc crescut de a dezvolta tumori gonadale şi beneficiază de supraveghere sau tratament chirurgical pentru a elimina gonadele anormal dezvoltate. Demonstrăm importanţa căutării atente a structurilor mülleriene, având în vedere vizualizarea dificilă uneori a acestora, şi importanţa laparoscopiei pentru diagnosticul corect şi complet al sindromului Swyer. Diagnosticul diferenţial între sindromul Swyer şi sindromul de insensibilitate completă la androgeni reprezintă o provocare. Materiale şi metodă. Prezentăm rezultatul unui caz particular de sindrom Swyer, cu agenezia unor structuri mülleriene (vagin), hipoplazia unor structuri mülleriene (uter hipoplazic) şi dezvoltarea normală şi completă a altor structuri mülleriene (trompe). Rezultate şi concluzii. Demonstrăm că analiza citogenetică nu este utilă pentru diagnosticul diferenţial între aceste două sindroame şi că vizualizarea structurilor mülleriene este dificilă şi arătăm importanţa efectuării laparoscopiei cu examenul histopatologic al ţesuturilor gonadale pentru diagnosticul diferenţial între aceste două sindroame. [ABSTRACT FROM AUTHOR]

Objective. Ulcerative colitis is a chronic inflammatory bowel disease, with multifactorial etiology, mainly determined by immunological and environmental factors. The purpose of this article is to describe an acute episode of ulcerative colitis, its management, and also the negative effects upon the fetus. Case. A 28-yearold secundiparous, at 34 weeks of gestation, presented to our clinic with acute mucous and bloody diarheea, cramping abdominal pain, being admitted with a diagnosis of preterm labour. Following sigmoidoscopy with biopsy and histopathological examination, a diagnosis of acute episode of ulcerative colitis was established, and a treatment with hydrocortisone, double antibiotic therapy and hydroelectrolytic repletion was administered, with initial favourable evolution. At 36 hours after admission, the patient's general status suddenly altered, and a magnetic resonance examination revealed toxic megacolon and acute fetal decompensation. The patient delivered through emergency caesarean section a live, hemodynamically and respiratory stable newborn. Conclusions. A multidisciplinary intervention is required in order to proper manage similar cases. The mother's and newborn's evolution was favourable under specific treatment. [ABSTRACT FROM AUTHOR]

Introduction. The management of pregnant women with cardiac mechanical valves represents a real medical challenge, since the anticoagulant used must not cross the fetal-placental barrier, in order to avoid its teratogenic effect or the appearance of hemorrhages at the fetal level. Anticoagulants available for management include: vitamin K antagonists, unfractionated heparin (UFH) and low molecular weight heparin (LMWH). Case presentation. A IIIG IIIP, at 37 weeks of gestation, with twin bichorial pregnancy, the first fetus - pelvic presentation, the second fetus - transverse presentation, with intact membranes, pregnancy cholestasis, double scar uterus, heart valve prosthesis, DSA, chronic venous insufficiency, under chronic anticoagulant treatment with Clexane® 80 mg x 2/day, was admitted for non-systemic uterine contractions. With 36 hours before the intervention, the Clexane® is replaced by HNF with aPTT taken at five hours, and stopped with five hours before the intervention, resuming it five hours postoperatively. Favorable evolution after caesarean intervention, but on the fifth day after birth, the presence of a subperitoneal subaponevrotic hematoma is established. After the reintervention, Clexane® 0.6 ml x 2/day is decided, with a favorable evolution, without the need for a surgical reintervention. Conclusions. Until the 38th week, LMWH is administered. This can be replaced with warfarin from S13-S36. At birth, warfarin should be replaced with LMWH or UFH due to the severe risk of bleeding. LMWH (atiXa) and UFH (aPTT) should be stopped 24 hours before birth is scheduled. The normalization of fetal INR takes longer than the maternal one. Postpartum rapid reintroduction of maternal anticoagulant therapy may lead to a major risk of bleeding. [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]

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]

Objective. Lymphomas are a heterogenous group on neoplastic diseases, divided into two categories: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Considering the small incidence of these diseases in pregnancy, the purpose of this article is to enhance the clinical management and postpartum evolution of both mother and newborn. Case. A 37-year-old patient, III GII P, with a six-week pregnancy, presents to our clinic with a sore throat and a palpable laterocervical tumor. Following biopsy and hystopathological examination, a diagnosis of non-Hodgkin lymphoma is validated. At 28 weeks of gestation, the patient starts chemotherapy with CHOP scheme (cyclophosphamide, doxorubicine, vincristine and prednisone), and at 39 weeks of gestation she delivers through caesarean section a live newborn, female gender, with a 3120 g weight, and Apgar score 8. At one week postpartum, the newborn is diagnosed with mild ventricular dysfunction based on the echocardiographic examination. Following a haemato-oncological consult, the patient adds monoclonal antibody anti-CD20 rituximab to her previous chemotherapy scheme, with a favourable evolution. Conclusions. Laterocervical and submandibular tumors are important clinical clues that lead to a presumptive clinical diagnosis of lymphoproliferative malignancies. A multidisciplinary team is required in order to proper asses and to quickly manage the case with an individualised treatment. [ABSTRACT FROM AUTHOR]