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Copyright of Obstetrică şi Ginecologie 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 Obstetrică şi Ginecologie 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.)

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]

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]

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]

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 second trimester 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 pericardio centesis, 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]

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]

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 per formed, 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 my omectomy. 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]

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. 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]