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Background. Women are commonly diagnosed with multiple sclerosis during reproductive age. There is need for disease control management during pregnancy, taking into consideration potential maternal and fetal risks. This review article aims to summarize what is acknowledged so far regarding treatment options of multiple sclerosis and outcomes in pregnancy, providing up-to-date information. Methods. In order to write this review a comprehensive literature electronic search for journal articles and guidelines regarding multiple sclerosis during pregnancy was undertaken. Results and conclusion. Multiple sclerosis management in pregnancy is a challenging issue. The use of disease-modifying drugs has improved both the course of the disease and the attitude towards pregnancy in patients living with multiple sclerosis. Pregnancy appears to have a protective effect on disease activity, particularly during the third trimester.

Background. Migraine is a frequent neurological disorder affecting mostly women in the childbearing age. It is influenced by fluctuation of female hormones, especially estrogen levels. Objectives. This review aims to describe the expression of migraine during the reproductive ages summarizing the diagnosis and effective, available treatment options. Materials and methods. We performed a systematic literature review searching information on the subject in PubMed and Medscape databases between 2000-2022. Outcomes. It reveals that during the first trimester due to symptoms of hyperemesis gravidarum, migraine attacks can exacerbate, while, through second and third trimester when estrogen levels rise, women report relief of symptoms. Therapy includes firstly behavioural approach and secondly pharmacological drugs along with non-invasive procedures, some still under investigation for pregnant state. For mild cases the first line is acetaminophen alone or together with antiemetics and in more severe cases or in women with past history of migraine triptans can used as the mainstay therapy. Conclusions. Despite recent discoveries on therapy and drugs, our understanding of the way medications may affect the fetus or new-born is incomplete and further evidence is needed, bringing potential for improved management of migraine during pregnancy.

Moyamoya disease (MMD) is a chronic vasculopathy characterized by progressive bilateral stenosis and occlusion of the terminal portion of the internal carotid artery (ICA) and the presence of an abnormal vascular network at the base of the brain, termed Moyamoya vessels (MMV). The main presentations of MMD are ischemia and hemorrhage, and diagnosis is done via angiography. Cerebral events were reported in 5.1% of pregnancies of MMD diagnosed mothers, in Japan. In the case of MMD diagnosis due to cerebrovascular events during gestation, 34.7% of patients presented with an ischemic event, while 69.5% suffered from hemorrhage. During gestation, hemorrhagic events were found to occur mostly antepartum, after 24 weeks of gestation, while cerebral infarction peaked 3-7 days after delivery. No treatment has been found to halt or reverse the progress of the disease. Interventions focus on reducing the risk of stroke and cognitive disfunction as a result of ischemia. In the case of pregnant women suffering hemorrhage due to MMD, conservative treatment, as well as ventricle puncture and drainage were to be efficient, and did not severely impact the child. When diagnosed before pregnancy occurs, MMD under treatment does not pose a significantly increased risk of complications, compared to pregnancies in unaffected women. No evidence suggests that MMD is a contraindication for pregnancy.

Aneurysms are sac-like dilatations of weakened wall areas within blood vessels. Cardiovascular related issues, such as hypertension, can put one at risk of developing such complications, with the possibility of rupturing. In the case of intracranial aneurysms, an outpouching forms where there is turbulent blood flow, often at the bifurcation of arteries. Depending on the morphology and location, different treatments need to be considered, but during pregnancy, further physiological changes also factor into decision making. In pregnant patients, intracranial hemorrhage cases are relatively low, yet they cause a high mortality rate amongst women, hence early detection and management of unruptured aneurysms is of significant importance.

Preeclampsia and systemic lupus erythematosus are medical conditions with established elevated risks of pregnancy complications and fetal compromise. Active lupus during pregnancy can trigger the appearance of preeclampsia. Research has demonstrated an increase in lupus disease flares during pregnancy, secondary to hormonal shifts required in order to maintain pregnancy. Hemolytic anemia, leucopenia, thrombocytopenia, sudden onset of hypertension after 20 weeks of gestation and decreasing complement components such as C3, C4 and CH50 are hallmarks of lupus flares during pregnancy. Timely and accurate prediction of preeclampsia is now feasible through estimation of novel placental and endothelial biomarkers, chiefly sFlt-1 and PIGF. A sFlt-1 to PIGF ratio under 38, in patients under 34 weeks of gestation suspected of disease, boasts the highest negative predictive value for preeclampsia and can successfully rule out preeclampsia development in the following 4 weeks in patients with normal values. Moreover, the sFlt-1 to PIGF ratio has proven its utility in the differential diagnosis of preeclampsia and active lupus nephritis, with normal ratio values noted in cases of lupus flares during pregnancy. Further research is required in order to identify other novel potential biomarkers.

Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the result of maternal alloantibodies interaction with human platelets antigen. Maternal alloantibodies are generated following the contact of maternal immune system with paternally acquired antigens on the fetal human platelets (PLTs). HPA-1a alloantibodies are responsible for more than 80% of cases of FNAIT. Low prevalence of FNAIT that occurs in less than 1 case out of 1000 births, and even a lower risk for intracranial hemorrhage makes a controversial discussion whether a screening in pregnant patients would bring benefits. Concerning pathogenesis of FNAIT, it has been shown that fetal platelets caring HPA-1a antigen enters maternal circulation and produce an immune response, that leads to production of HPA-1a maternal antibodies that afterwards can pass the placenta causing fetal thrombocytopenia. The majority of mothers who gave birth to a newborn with FNAIT usually are asymptomatic, although they might have a previous affected pregnancy. Although management of pregnancies complicated by FNAIT is still in discuss and controversial, a systemic review studies in 2017 showed that best guidance and delivery for pregnancies that are at risk for FNAIT is a weekly maternal administration of intravenous immunoglobulin, adding glucocorticoids depending on severity of FNAIT.

Background. Cytomegalovirus infection represents the most frequent congenital viral infection, with serious consequences on newborns. Neurosensorial hearing loss is the principal outcome, but also, the infection can cause other central nervous system’s anomalies. Although CMV infection can have a major impact on fetal development, there are not clear directions to follow yet, to prevent or treat this condition. Therefore, our purpose with this paper is to update the knowledge regarding the treatment options in order to prevent fetal transmission of maternal CMV infection, based on the latest data from the specialized literature in this field. Methods. Electronic research and analysis of the relevant articles published mainly in the last 5 years were performed, consulting the web platforms PubMed, ScienceDirect, Mendeley and ClinicalTrials.gov. Results and conclusions. To date, there is not enough evidence to reach a consensus on therapeutic methods to prevent or to treat fetal CMV infections and, as a consequence, antenatal screening is not justified. Many pharmaceutical companies work on vaccines to prevent CMV infection, but the results are only from studies’ second phase. Information on efficiency of hyperimmunoglobulin is mixt and it is necessary to clarify the dosage. Among antiviral agents, valaciclovir, which was studied in recent clinical trials, seems to have the best efficiency to prevent fetal transmission of maternal CMV infection and the best safety profile. Valganciclovir has possible embryotoxic effects, but higher potency and information on it are available only from case reports. The interest of scientific community on this topic is high, thus many studies are underway to bring new clarifications.

Behçet’s disease is a multisystemic inflammatory chronic vasculitis of unknown etiology characterized by recurrent oral ulcers, genital ulcers, eye lesions, and dermatological manifestations that is usually diagnosed during the reproductive years. There is limited information about the effects of Behçet’s disease on pregnancy and vice versa, but in most women, it appears to improve during this period. However, cases of activation or exacerbation of the disease in pregnancy are not uncommon and they are mainly manifested by oral ulcers, genital ulcers, and skin lesions. Corticosteroids and topical sucralfate are safe to use in pregnancy and while breastfeeding to treat oral ulcerations. The purpose of this study is to synthesize available information about Behçet’s disease oral manifestations in pregnancy, diagnosis, and treatment.

Hemolytic disease of the fetus and newborn is a consequence of maternal immune response to fetal red blood cells antigens inherited from the father, that the mother does not possess, stimulated by antepartum or intrapartum fetomaternal hemorrhage. As a result, fetal erythrocytes are destroyed, leading to various degrees of anemia and hyperbilirubinemia, with high perinatal morbidity and mortality rates. This review’s purpose is to reveal the importance of the alloantibodies beyond RhD and ABO system, the updated algorithms used in the diagnosis and management of the disease and the importance of RhD universal immune prophylaxis practice. For this purpose, the database from PubMed and UpToDate was searched for literature reviews, case studies, society guidelines and retrospective studies in English regarding hemolytic disease of the fetus and newborn from 2013 to March 2022. Anti D prophylaxis protocols, early diagnosis and proper intrauterine and postpartum treatment help significantly reduce the disease’s burden.

Coronavirus disease 2019 (COVID-19) has rapidly become a global pandemic with a devastating morbidity and mortality. Pregnant women seem to be at increased susceptibility to have a severe disease and suffer adverse pregnancy outcomes. The only solution to mitigate this pandemic is prophylaxis by mass vaccination. We report a review based on current literature about the evidence available on efficacy and safety of anti-COVID-19 vaccines in pregnancy to aid women decide whether to vaccinate or not, while being pregnant or lactating. Studies so far did not find concerning maternal or fetal outcomes and show a similar efficiency of mRNA vaccines as in non-pregnant population. Moreover, anti-SARS-CoV-2 antibodies resulted from the vaccination seem to be transferred to the newborn through the placenta or the breastmilk building up the neonatal immunity. However, the exclusion from clinical trials created a great deficiency of evidence regarding the vaccination in this high-risk population resulting in their reluctance.

Impaired fertility is an important public health concern, especially in patients with immune-mediated rheumatic condiHydroxychloroquine (HCQ) is an antimalarial drug containing a 4-aminoquinoline radical, with immunomodulatory, antioxidant, anti-inflammatory and vascular protective effects, which is widely used in the treatment of various rheumatological conditions and is also compatible with pregnancy. It is well known that hydroxychloroquine crosses the placental barrier and hence it can protect against adverse perinatal outcomes, such as congenital heart block in fetusesof anti-SSA/Ro positive mothers. When it is administered at daily doses inferior or equal to 400 mg, HCQ is not associated with augmented risk of perinatal morbidity and it has also been found to prevent disease flares among pregnant women with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA), improving maternal outcomes and being protective toward fetal health as well. However, the concerns about its safety in pregnancy are still present because studies on the risks of perinatal defects associated with HCQ administration arise sparse and have controversial results. The purpose of the current article is to make a review of the medical literature concerning the safety of HCQ in pregnancy. For this purpose, scientific research in online medical publications such as Elsevier, PubMed, and The Lancet, was conducted.

As more reports of menstrual cycle abnormalities after COVID-19 vaccine inoculation are emerging in media and in clinical practice as well, it was deemed necessary to investigate these claims. This review aims to gather current scientific evidence on COVID vaccination’s effect on menstrual cycle. Further and extensive research is undeniably needed to fully understand these phenomena, but current studies have demonstrated an undeniable link between some menstrual cycle abnormalities (especially heavy menstrual flow and variations in cycle length) and breakthrough bleeding in nonmenstruating population and vaccination against SARS-CoV-2. Up to this point, these disturbances seem to be temporary, not lasting for more than a few cycles. The reported menstrual changes have appeared after inoculations of all brands of vaccines, and no particular technology (mRNA or adenovirus-vectored) was particularly associated with them. The greatest concerns raised were those regarding fertility. However, until now, there is no evidence of any of the COVID vaccines affecting fertility when comparing vaccinated and unvaccinated populations.

When it has been declared a global epidemic, HIV infection became a challenge for medical world. Even if there is only one healed case cited in literature, treatment for HIV-infection have evolved during time leading to very good results in disease control and limitation of virus transmission. When it comes for viral transmission, an essential research topic became the prevention of mother to fetal transmission. In the long run, many discovered antiretroviral drugs proved to be efficient in controlling HIV infection during pregnancy and thereby in reducing the risk of viral transmission to the fetus. But along with use of the HIV-treatment in pregnancy, many questions have appeared. Are the drugs safe for the fetus, or are there any adverse pregnancy outcomes? Should the treatment be adjusted for the desired results in pregnancy, or should the initial treatment be changed when the pregnancy is diagnosed? Many retrospective or prospective observational studies and comparative studies have been conducted in order to answer those questions and to analyze the efficacy and the safety of mostly used antiretroviral drugs in pregnancy. This article reviews the existing studies, guidelines and recommendations regarding the combined antiretroviral HIV treatment during pregnancy for fetal infection prevention.

Gestational diabetes mellitus (GDM) is one of the most frequent complications of pregnancy. Despite international efforts, there is no consensus regarding the optimal method of screening and diagnosis of GDM. Some organizations propose screening only for women with high risk of GDM, while others suggest testing all pregnant women. Furthermore, there are more types of screening and diagnostic tests (one vs. two-step approach) with different glycemic thresholds. The aim of this review is to present and compare the screening and diagnosis guidelines of the most influential organizations. Additionally, this study evaluates the differences between selective and universal screening. The necessity for a consensus and for a single acceptable guideline has been repeatedly highlighted by experts in order to allow uniform clinical practice and to improve perinatal and maternal outcomes.

Background. The parvovirus B19 (B19V) belongs to the Parvoviridae family, genus Erythrovirus, and is a virus that causes a common childhood disease called erythema infectiosum, also largely known as the fifth childhood disease. The clinical appearance is marked by the “slapped cheek” facies and an erythematous rash localized mainly on the extremities and on the trunk. Most people gain immunity during childhood, and when it occurs in pregnancy in non-immunized women, there are some serious complications for the fetus that can occur. B19V infection in pregnancy can conduct to fetal loss or severe hydrops fetalis, due to the risk of vertical transmission to the fetus and the virus tropism for the erythropoietic fetal stem cells with subsequent cell destruction and fetal anemia. Invasive treatment, as intrauterine fetal transfusion, is necessary for the cases of severe fetal anemia with good survival rates afterwards. The purpose of this review is to update the current knowledge regarding the best management of severe fetal anemia and other complications related to B19V infection in pregnancy, based on the latest data from literature and guidelines. Methods. Electronic research for relevant articles published in the last years was made, with the usage of PubMed, Medline, Cochrane Data Base, and the current international guidelines promoted by the Obstetrics and Gynecology Societies. Results and conclusions. The importance of prenatal detection of non-immunized women by serologic testing for parvovirus B19 should not be overlooked, and subsequent follow-up should be recommended in order to lower the incidence of fetal complications associated with developing the disease in pregnancy, especially during epidemics. In case of P19V infection in pregnancy, serial ultrasounds and lab tests should be performed in order to determine the impact on the fetus and the apparition of fetal hydrops. The future moms who are not immunized to B19V should be advised about the risk of vertical transmission and the associated fetal sequelae that can occur. Assessment for maternal disease and for fetal impairment has to become a priority when there are signs of primary infection in pregnancy.

Anti-Ro antibodies are detected frequently in the general population, but more so in patients with autoimmune conditions as Sjögren’s syndrome and systemic lupus erythematous (SLE). During pregnancy, anti-Ro antibodies can cross the placenta by hijacking physiological mechanisms and can have deleterious effects on the fetus. Administration of hydroxychloroquine (HCQ) to pregnant women with documented anti-Ro antibodies has been shown to prevent congenital heart block (CHB ). Serial fetal ultrasound scans and echocardiograms are controversial in pregnant women with anti-Ro antibodies. When complete CHB is diagnosed, this is irreversible and can lead to fetal heart failure, hydrops, and death. After delivery, babies with complete CHB require pacemaker. In the presence of maternal anti-Ro antibodies, there is a high risk of recurrence of CHB for future pregnancies, if there is a previously affected child. Adequate counselling and prophylactic treatment with HCQ should be encouraged.

The overall risk of methicillin-resistant Staphylococcus aureus (MRSA) in obstetric populations is unknown. MRSA infection incidence has increased in pregnant women and neonates even if prevention techniques of MRSA have improved. MRSA infections affect both mothers and their infants. MRSA is the most common pathogen responsible for postpartum mastitis. There are also other postpartum infections with MRSA such as cellulitis, pelvic thrombophlebitis, pneumonia, septicemia, cesarean wound infections, episiotomy infections and urinary tract infections. The objectives of this review were to identify the most frequent risk factors for postpartum MRSA infection and to determine the frequency of antibiotic-resistant Staphylococcus aureus infections after delivery. A literature review was conducted using PubMed and we used the following key words “MRSA infection in postpartum”, “risk factors for postpartum MRSA infection”. We are included in our review 27 articles from the last 20 years which presented rare cases of MRSA infection in postpartum and those which identified the risk factors of this infection after delivery. Infections with MRSA appear to be more frequent among pregnant women colonized with MRSA. Early identification of MRSA, early diagnosis and appropriate treatment of infection is mandatory for a good prognosis. By now, vigilance and effective MRSA prevention strategies are considered essential to limit the spread and infection.

Systemic lupus erythematosus (SLE) is common in women of reproductive age and can have serious consequences on pregnancy outcomes. Recent updates in the clinical management of this condition have brought improvements for mothers affected and their babies. The aim of this general review is to offer the perspective of the maternal-fetal medicine specialist on the recent updates in clinical management of SLE in pregnancy and to bring into the attention of the rheumatology specialists the tools that obstetricians have nowadays in monitoring high-risk pregnancies.

Promoting and supporting breastfeeding is a global priority and an important intervention for the survival of children. The World Health Organization and the American Academy of Pediatrics recommend exclusive breastfeeding in the first six months of life. This article propose a review of the most important medical and psychological aspects regarding psychological counseling and breastfeeding. We highlighted the results of studies that reflect the importance of breastfeeding and its effects on the baby and mother. This paper is a review based on information from the literature. The analysis was limited to articles and guides in English published between January 1, 2007 - June 1, 2021 on PubMed, ScienceDirect and Google Scholar using the following keywords: breastfeeding, mother-child relationship, psychological counseling, breastfeeding counseling, breastfeeding factors, exclusive breastfeeding. In this review we discuss the medical and psychological characteristics of breastfeeding, factors that determine exclusive breastfeeding and its effects, prenatal breastfeeding counseling and the role of psychological counseling in initiating and maintaining breastfeeding. Psychological counseling and care practices influence the achievement and duration of breastfeeding.

The problem of infertility is complex and very delicate, medicine and psychology being concerned with better understanding the causes and consequences of infertility, as well as the symptoms of psychopathology in correlation with it. The aim of this review is to clarify how fertilization treatment impacts the couple and to present therapeutic interventions in assisting couples facing infertility. This paper is a review based on information from the literature. The analysis was limited to articles and guidelines in English published between January 1, 2000 and November 1, 2021 on PubMed, ScienceDirect and Google Scholar using the following keywords: infertility, support, couple, treatment, mental health, psychological interventions. In this review, we discussed the treatment methods and emotional symptoms of couples diagnosed with infertility and the psychological interventions needed to optimize the well-being of infertile people. According to the literature, the role of psychoeducation for couples undergoing assisted human reproduction treatment is important in the optimal management of the difficulties they go through and can also add value to the medical process. Also, psychological interventions relieve the emotional symptoms that are felt by infertile couples, optimize well-being and increase success rates in the treatment of infertility.

Nowadays, women diagnosed with multiple sclerosis and belonging to the reproductive age group have high pregnancy rates, thus increasing the need of a careful pregnancy management in order to avoid maternal and fetal complications. The challenge of the chosen subject consists in identifying the available treatment that can be used during pregnancy time, emphasizing the need of a rigorous care during the preconceptional and postpartum period. The aim of the current review is to describe the management of a pregnant woman diagnosed with multiple sclerosis, in regards of treatment, anesthesia, mode of delivery and management and prevention of relapses during the postpartum period.

Malignant melanoma is one of the most frequent cancers diagnosed during pregnancy. Any pigmented skin lesions that change the color should be examined by an experienced dermatologist and if suspected, should be biopsied. Recent studies showed that malignant melanoma in pregnancy has not a worse outcome compared with non-pregnant state. Diagnosis of melanoma does not require an early delivery excepted pregnant patients with poor prognosis that need more aggressive treatment. Diagnosis and treatment need to be established in specialized centers with a multidisciplinary team. Pregnancy monitoring should be performed by team consisting of an obstetrician, a neonatologist and a specialist in fetal medicine.

Pregnancy affects women's sleep in many ways. Physical and emotional difficulties, especially towards the end of pregnancy, can lead to sleep disorders. Several studies suggest associations between sleep quality and high blood pressure, diabetes and depression. Sleep deprivation affect both mother and fetus. Sleep disorders are associated with low birth weight, intrauterine growth restriction, premature birth and cesarean births. This paper is a review based on information from the literature. The analysis was limited to articles and guidelines in English published between January 1, 2000 and May 1, 2020 on PubMed, ScienceDirect and Google Scholar using the following keywords: sleep, pregnancy, depression, anxiety, mental health, sleep disorders, pregnant women, interventions, treatment. In this review, we discuss the characteristics of prenatal maternal sleep, hormonal changes during pregnancy and their effects on sleep, the effects of changing sleep patterns on the pregnant woman, and the interventions needed to optimize sleep quality. According to the literature, sleep disorders are significant risk factors for mood disorders. Knowing sleep changes and their effects is useful for informing mothers. Consideration of non-pharmacological treatments and interventions such as cognitive-behavioral therapy, mindfulness therapy and relaxation exercises can be effective in optimizing the quality of sleep in pregnant women.

Pregnancy and birth in adolescence involve certain risks for both mother and fetus. Psychologically, adolescent mothers have a higher risk of developing emotional disorders. This paper is a review based on information from the literature. The analysis was limited to articles in English published between January 1, 2000 and September 1, 2021 on PubMed, ScienceDirect and Google Scholar using the following keywords: pregnancy, adolescents, adolescence, risk factors, support factors, psychological interventions. In the context of pregnancy in this challenging stage of adolescence girls should be referred to pre- and postnatal counseling programs or support groups so that they develop healthy relationships and support networks.

The fear of childbirth is a mental health problem that involves a severe, excessive fear of pregnancy and the time of birth. This condition is also called "tocophobia" or, better said, birth phobia. This review is based on information from articles in the literature published between January 1, 2001 and November 1, 2021 in PubMed, ScienceDirect and Google Scholar using the following keywords: fear of childbirth, symptoms, causes, tools, psychological interventions. In this review, we discussed the types of fears women have about pregnancy and childbirth, the instruments that is used for assessing the fear of childbirth, and how to cope with and overcome this fear. According to the literature, the role of psychological counseling for women facing fear of childbirth is important in the optimal management of emotional symptoms associated with pregnancy.

This article propose a review of the most important medical and psychological aspects regarding pregnancy after miscarriage. We highlighted the results of studies that reflect the importance of psychological implications and emotional care. This paper is a review based on information from the literature. The analysis was limited to articles and guides in English published between January 1, 2010 and June 1, 2021 on PubMed, ScienceDirect and Google Scholar using the following keywords: miscarriage, pregnancy after miscarriage, psychological counseling, psychological interventions. In this review we discuss the medical and psychological characteristics of this research area. We focus on the emotional aspects involved, the emotional and mental states that appear and the ways to deal with this difficulty in life. Psychotherapy, psychological counseling and care practices influences the wellbeing of women and represents a real support in mental recovery after miscarriange.

Diabetes mellitus is a metabolic disease with life-threatening morbidity and with epidemic spread. This metabolic disorder affects an increasing number of pregnant women. General practitioners and obstetricians need to know how some occult maternal metabolic disorders could be revealed by pregnancy and how pregnancy could influence the fetal health and the long-term progression of maternal disease. Pregnancy is considered a stress test for life and diabetes mellitus is a good example to illustrate this correlation.

Although there has been various pandemics throughout the history of humankind, modern age was thought to be ready to face such a challenge by implementing an advanced health care system. However, epidemic outbreaks are ubiquitous, and they have a substantial potential to evolve into pandemics, hence this being the actual context of SARS-CoV-2 pandemics from 2019. The difficulty of the addressed subject consists in the fact that the majority of pharmacological clinical studies omited pregnant patients. Acknowledging the physiological changes, pregnant women represent an unique group of patients as pregnancy could embody a particular substrate for this contemporary type of infection.

Thrombophilias are a group of coagulation disorders associated with a predisposition to thrombotic events. They could be inherited (genetic) or acquired. The most encountered inherited thrombophilias are factor V Leiden (FVL), prothrombin gene mutation (G20210A) (PGM), protein S deficiency, protein C deficiency and antithrombin (AT) deficiency. Based upon the risk of thrombosis, there are two types of inherited thrombophilias, high risk and low risk. The high risk inherited thrombophilia includes antithrombin III deficiency, factor V Leiden homozygotes, prothrombin gene mutation and compound heterozygotes FVL and PGM. The low risk thrombophilia includes factor V Leiden heterozygote, PGM heterozygote, protein C deficiency and protein S deficiency. The incidence of all thromboembolic events is estimated to approximately 1-2 per 1000 pregnancies and about an equal number are identified antepartum and in the puerperium. Screening for thrombophilia in pregnancy is not universally recommended because of the low incidence of the condition and because it is not cost-effective. Some adverse pregnancy outcomes could be associated with some types of thrombophilia, but this association is weak and there is no reason to initiate extensive investigations or therapeutic measures. Both obstetricians and hematologists and women need to be correctly informed and avoid emotional decisions and unnecessary invasive treatments.

Infections acquired during pregnancy add up to the overall perinatal rate of mortality and morbidity. Because it has the potential to be screened in all pregnant women, infection with cytomegalovirus continues to raise awareness among obstetricians and healthcare providers, given the perinatal complications involved, but also because not all parturient women are equally informed about the impact of the disease. A significant possibility of vertical transmission is attainable if primary infection is acquired in pregnancy, especially in the first trimester, when the risk of developing a congenital neonatal disease is higher. Even so, there are many more steps to be taken into consideration in order to fully understand the consequences of the infection, given the fact that the leading consequence of the congenital disease is the sensorineural hearing loss in the neonates, thus raising an important question: why a generalized serological screening in early pregnancy for CMV is just not justifiable?

Posterior reversible encephalopathy syndrome (PRES) is a clinical radiologic syndrome characterized by visual deficits, altered consciousness, headache, confusion, seizures and focal neurological signs. Its pathophysiology is still uncertain, with vasogenic edema being the most frequent incriminated mechanism. It was described in correlation with hypertensive encephalopathy, eclampsia, use of cytotoxic and immunosuppressive drugs and renal diseases. Regarding its association with pregnancy, it is important to deliver the baby as soon as possible, to administer proper medication for hypertension, with labetalol being first choice and combat seizures or any signs of status epilepticus. A clear diagnosis can be established by combining clinical presentation with imaging techniques, especially T2 images of MRI. It has a rapid progression and good prognosis is obtained by early recognition and prompt treatment of associate condition.

Parvovirus B19 infection is the most common cause of non-immune hydrops in fetuses. The risk of congenital infection is highest in the 1st and 2nd trimester and there are no current recommendations regarding screening of low-risk pregnancies. Recent exposure of the mother and ultrasound findings of fetal anemia or hydrops should include parvovirus B19 infection investigation. Adequate monitoring through ultrasound and Doppler determine the fetal and perinatal outcome as interventions as intrauterine blood transfusions are the main treatment.

Toxoplasmosis is the most common cause of congenital infection, causing long term ocular and neurological lesions with relapses during childhood and adolescence. The risk of congenital infection is highest after primary maternal infection with advancing maternal gestation. Only a few european countries recommend a routine prenatal screening although therapeutic options are the same. Primary prevention measures regarding food hygiene and secondary prevention through serological testing are the most important ways to prevent and detect toxoplasmosis during pregnancy. Counselling is challenging since there is a need for reference centers of diagnosis. In Romania there is a routine clinical practice to offer screening through the TORCH panel in the first trimester of pregnancy. This review summarizes the current methods of diagnosis and management of toxoplasmosis in pregnancy.

Pregnancy-associated breast cancer is one of the leading pregnancy-related types of cancer with an increasing incidence. It represents a special situation which requires careful attention for the medical team in fulfilling the goals of the treatment: the cure of the disease and the well-being of the pregnancy. The decisions regarding the most appropriate therapeutic methods should be made by a multidisciplinary team after offering counseling to the patient. The diagnosis of breast cancer during pregnancy or breastfeeding is a challenging situation considering the physiological changes. The first line of treatment is considered to be surgery indicated in any trimester of pregnancy, with mastectomy being often used. Chemotherapy can be offered, except for the first trimester, taking into account the risk of malformations. Radiotherapy, hormonal and biological treatment are contraindicated during pregnancy. The fetus must be evaluated regularly during treatment and the decision of delivery should be made on obstetrical and oncological indications.

Background. Oral anti-diabetics in the treatment of gestational diabetes mellitus have had different approaches among time in medical guidelines. The interest in this pregnancy-associated disease is due to the dramatic increase of rates of gestational diabetes but also to the significantly higher short-term and longterm implications for mother and off-spring. This article aims to review the literature and guidelines on current recommendations regarding oral therapy in gestational diabetes mellitus. Methods. A systematic literature electronic search for reviews and guidelines was undertaken using Pub Med and the official websites of Diabetes and Obstetrics and Gynecology associations. Conclusions. Whereas oral anti-diabetics are an attractive alternative approach to insulin, in the last guidelines published by the societies of Obstetrics and Gynecology and Diabetes a new trend is noticeable subtracting oral anti-diabetics as the first option because of the lack in high-quality data on long-term safety, higher rate of treatment failure and pharmacokinetics.

Planning a pregnancy for a woman diagnosed with epilepsy might be a challenge, but nowadays it is no more a contraindication. By offering careful education to this population, maternal and neonatal normal outcome is expected. It is important to have a multidisciplinary team of professionals that include a neurologist, a maternal fetal medicine specialist, an obstetrician and an anesthesiologist that manage the case and inform the women about potential risks for them and for fetuses, evolution of their scheme of treatment and particular adjustments that they need to do, as well as advices and strategies for postpartum period. The goal should always be optimal seizure control and minimal exposure to antiepileptic drugs for fetus. Preconception counseling should accomplish the four most important steps for the benefits of both mother and fetus: particular choice of antiepileptic drugs and the lowest effective dose, valproate avoidance, folate supplementation and birth control with contraceptives until baseline is achieved. Finally, although there is an increased risk for congenital malformations and neurodevelopment disorders, a good managed pregnancy can maintain to a minimum the fetal exposure to side effects of antiepileptic drugs and maternal risk for seizure.

Myasthenia gravis (MG) is an autoimmune disorder defined by weakness and rapid fatigue of skeletal muscles due to deterioration of neuromuscular junction by autoantibodies targeting either acetylcholine receptors (AchRs) or other molecules such as muscle specific kinase receptors (MuSK). It affects predominantly women in the third decade of life and the effects of pregnancy on the evolution of the disease is variable, usually the aggravation of symptoms occurs during the first trimester or first month postpartum. The aim of this review is to discuss the clinical management of MG in pregnancy and to highlight the implications of MG on pregnancy and vice-versa, as well as reviewing the available treatment by using documentary analysis. The findings of this review show a variable clinical course of the disease with remission, worsening or preserving the status quo. MG does not influence the course of pregnancy to a large degree and by careful antenatal care and a multidisciplinary team approach a normal pregnancy and delivery can be achieved.