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Prenatal sonographic assessment of the posterior fossa in the mid-sagittal plane at 11-14 weeks’ gestation has been highlighted as an essential diagnostic step by the current literature. This approach is used for the early detection of open spina bifida during the first trimester by analyzing the three spaces of the posterior fossa: brain stem, the fourth ventricle and cisterna magna. Abnormal size of fetal posterior fossa spaces is an important sign in the diagnosis of fetuses with central nervous system malformation and needs to be submitted for differential diagnosis when any alterations are observed. Among them, Dandy-Walker malformation is one of the major causes of congenital hydrocephalus, being a rare condition, with poor-prognosis, manifested by enlarged posterior fossa. On the basis of available evidence, the assessment of the fetal posterior cranial fossa is feasible from 11 to 14 weeks gestational age and it is believed that abnormal appearance of the posterior fossa at this stage of pregnancy could improve early detection of Dandy-Walker malformation by prompting an early second trimester ultrasound evaluation.

Endometriosis is a frequent gynecological disease among women of reproductive age, a benign condition with an uncertain etiology, but with multiple theories being proposed as main mechanisms of development. Perineal endometriosis is an uncommon condition, with various theories about its pathogenesis including the contiguous propagation of endometrial tissue over the episiotomy perineal scar. A 36-year-old woman, G2 P2, presented with cyclic inflammation and pain in the episiotomy area, with significant impairment of her daily quality of life. Clinical examination revealed a palpable mass in the episiotomy area and a probable clinical diagnosis of perineal scar endometriosis was considered, with further investigation being recommended. The patient was surgically treated by local excision of the perineal mass and the histopathologic examination of the mass confirmed the diagnosis of perineal endometriosis in the episiotomy scar. Although perineal endometriosis remains a rare condition, it should be considered in all patients with an anterior vaginal delivery and a painful perineal mass during menstrual cycle, a wide excision of the affected tissue remaining the best option for a permanent cure.

Binder syndrome and Nager syndrome are part of the spectrum of skeletal dysplasias. Although exceedingly rare, both syndromes are amenable to prenatal diagnosis because they present with features that can be detected by prenatal ultrasound. Genetic prenatal diagnosis is sometimes possible but remains difficult if the etiology of the disease is not homogenous. In cases of severe skeletal dysplasias, the prognosis is unfavorable irrespectively of the genetic defect. In cases with only mild structural anomalies, prenatal counselling is especially difficult. We present cases of Binder syndrome and Nager syndrome diagnosed by us prenatally. We elaborate on the etiology of Binder syndrome and discuss the current classification of facial dysostoses.

Cytomegalovirus (CMV) is the most common cause of perinatal viral infection, affecting 0.2-2.2% of all neonates, with variation among different study populations. It can cause serious long-term neurological sequelae, being the leading cause of non-genetic congenital hearing loss. The risk of congenital infection is highest after primary maternal infection, varying between 30-70% and depending on the gestational age at the time of infection. Although CMV can have serious neurodevelopmental consequences, in most developed countries current guidelines do not recommend routine screening for CMV in pregnancy, since current tests have a low predictive value for cases with serious adverse outcome and efficient therapeutic options are not standardized yet. In Romania there is a routine clinical practice to offer screening for most common causes of infections, including CMV, in the first trimester of pregnancy In these settings, this review summarizes the current methods of diagnosis and management of CMV infection in pregnancy.

Polyhydramnios is frequently seen in patients with diabetes in pregnancy, as well as in cases of fetal malformations. The aim of our paper is to present a rare case of a fetus with anomalies of the precordial veins (absent ductus venosus, intracardiac drainage of the umbilical vein, persistent left superior vena cava) and upper intestinal tract obstruction. The mother developed gestational diabetes and polyhydramnios, in this case. The 29-year-old patient was admitted to our hospital at 35 weeks of gestation with ruptured membranes. Cesarean section was performed. A live baby boy, 2400 g, with multiple congenital abnormalities (including esophageal atresia) was delivered. Our case illustrates the diagnostic approach to polyhydramnios and the difficulty to prenatally diagnose esophageal atresia, in the context of a fetus with multiple malformations.

The antiphospholipid syndrome (APS or Hughes Syndrome) is a systemic autoimmune disease characterised by the presence of specific and persistent circulating antiphospholipid antibodies (APL) and the subsequent morbidities they cause, including pregnancy complications and thrombosis. The three main antiphospholipid antibodies are: lupus anticoagulant (LA); anticardiolipin antibodies (aCL) IgG and IgM; and anti-â2-glycoprotein 1 IgG and IgM antibodies. Antiphospholipid syndrome is associated with pregnancy complications such as recurrent early fetal loss, fetal death, preeclampsia (PE), and fetal growth restriction (FGR). Although autoimmune disorders may have serious implication during pregnancy important advancements in pregnancy outcome have been reported in women with APL. The challenge arises in case of women refractory to conventional treatment (heparine/aspirin combination), which occurs in about 20-30% of cases. The management of pregnant women with non-criteria APS manifestations and that of APL carriers during their first pregnancy is also discussed. This paper aims to discuss the risk stratification, clinical and pregnancy implications and current treatment strategies for pregnant women.

Crohn’s disease (CD) is a chronic infl ammatory bowel disease with onset during reproductive age. Advancement in medical therapies and treatment strategies have made pregnancy following a diagnosis of CD a viable and safe option for more women with this disease. In this review we discuss the evidence based management of Crohn’s disease during pregnancy.

Thrombocytopenia, defined as blood platelet count below 150,000/ìL is the second leading cause of blood disorders in pregnancy after anemia. Gestational thrombocytopenia explains 70-80% of all cases of thrombocytopenia in pregnancy. Hypertensive disorders account for approximately 20% and immune thrombocytopenic purpura for about 3-4%. Other etiologies are considered rare in pregnancy. The aim of this study is to review the specific causes of thrombocytopenia in pregnancy, their obstetrical implications and management.