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Introduction: Endometriosis is defined by the presence of endometrial tissue outside the uterus, therefore leading to a chronic inflammatory reaction, adhesions development, scar tissue and a distorted pelvic female anatomy, most of the times leading to female infertility. Kisspeptin represents a neuropeptide thought to have an essential role in the reproductive functions of both female and male patients. Recently, positive correlations with kisspeptins were noticed in patients diagnosed with endometriosis. Materials and methods: Our study was performed between January 2021-March 2022 in “Elena Doamna” Clinical Hospital of Obstetrics and Gynecology Iasi, Romania. It was a prospective case-control study and included two groups of patients. Both groups consisted in female patients aged between 18 and 45 years, with a body mass index (BMI) between 18,5-30 kg/m2 and similar medical data. Patients in the study group had primary or secondary infertility and endometriosis, while the control group consisted of women with no reproductive issues who had healthy regular menstruations and at least one child. All patients agreed to participate in our study and signed the consent form. Clinical examination, pelvic ultrasound and hormonal dosages were performed. We tested the levels of LH, FSH, kisspeptin, estradiol, prolactin, testosterone, insulin and the glycemic levels in both groups during the follicular phase of their menstrual cycle. Results: We managed to enroll eight patients with endometriosis in the study group and an equal number of patients in the control group. There were significant differences between serum kisspeptin levels, but not also between other hormonal dosages. All patients in the study group had medical evidences of endometriomas but none of them had been subjected to laparoscopy. Conclusions: When considering our study, we regarded the first attribution given to kisspeptin, the one of a metastasis suppressor, and concluded that the high serum values of kisspeptin in patients with endometriosis represented a compensatory-adaptive mechanism needed to constrain future spread of endometriomas in early stages of this pathology.

Aim: The evolution of coagulation factors in pregnant patients infected with SARS-CoV-2 during the pandemic is still debated. However, few studies have been carried out to evaluate the silent alterations of blood values in mild forms of the disease. Methods:A total of 153 pregnant patients with an asymptomatic form of COVID-19 and 306 healthy pregnant patients, who were admitted for delivery in our hospital between April 1, 2020 and March 1, 2022, were studied. The blood values harvested closest to the time of delivery were considered. Results:There was a significant variability in values of fibrinogen, prothrombin time, though these were still within normal limits. Conclusions:Pregnant patients with mild forms of COVID-19 displayed some blood alterations, even if they were asymptomatic for COVID-19.

Introduction: Polycystic ovarian syndrome (PCOS) is a common and multifactorial pathology among young women of reproductive age and one of the main causes for female infertility. Most patients are referred to a gynecologist due to specific symptoms such as menstrual irregularities, hirsutism, facial or body acne and inability to obtain a pregnancy. Lately, kisspeptin, a neuropeptide produced in the anterior region of the hypothalamus that seems to modulate the GnRH secretion and therefore the hypothalamic-hypophyseal-ovarian axis (HHO-axis), has been considered responsible for PCOS occurrence. Objectives:The aim of our study was to observe the changes in hormonal balances and kisspeptin serum levels in patients with PCOS after treatment with myo-inositol and vitex. Materials and methods:A prospective clinical study was conducted by us, between 4 January 2021 and 1 March 2022, in “Elena Doamna” Clinical Hospital of Obstetrics and Gynecology, Iasi, Romania. After obtaining the subjects’ informed consent and agreement to participate, we identified 14 patients with PCOS and primary or secondary infertility, who underwent laboratory investigations during the follicular phase of their menstrual cycles, testing for kisspeptin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, testosterone, insulin, blood sugar levels and prolactin. An abdominal-pelvic scan and full body examination were also performed. Patients, in accordance with their gynecologists’ recommendation, preferred a medical therapy consisting of myo-inositol 750 mg/day and vitex 400 mg/day. After three months of treatment, patients agreed to have a second check up to see if any changes occurred. Results:We found significant positive differences when considering kisspeptin, estradiol, FSH and prolactin serum values. There was no significant difference in testosterone and insulin serum levels; on the other hand, we observed an increase in LH serum levels. The mean ovarian volume before treatment was 14.0 for the right ovaries and 13.8 for the left ovaries. After treatment and the recommended lifestyle changes, we noticed a decrease in the mean ovarian volume (13.5 for the right ovaries and 13.4 for the left ovaries). Discussions and conclusions: The etiology of PCOS, which is considered a multifactorial pathology, remains unclear. Multiple studies have been conducted and are still exploring the role of kisspeptin as an etiologic factor for PCOS associated with infertility. Our study showed a decrease in kisspeptin values after the use of myo-inositol and vitex in patients with PCOS, therefore supporting the long-standing theory that kisspeptin might have an essential role in the development of PCOS.

Intrauterine devices (IUD) are one of the most commonly used methods of contraception worldwide. The long term effect makes it desirable by most patients. The insertion of an IUD is not difficult as a technique but it involves multiple complications such as uterine perforation and migration into the abdominal cavity, urinary bladder perforation, fistula formation, bowel perforation and intra-abdominal adhesions. We present the case of a 31-year-old female patient (para=4) with a medical history of an IUD insertion during her postpartum period in February 2018. In April 2019, during her normal follow up consultation, the speculum examination did not detect any IUD strings and the abdominopelvic ultrasound showed no signs of the device inside the uterine cavity. A subsequent X-ray identified the device in a horizontal position in the pelvic region. The patient was scheduled for surgical intervention, but in the meantime she became pregnant. Decision to continue with the pregnancy was taken and surgery was delayed until the postpartum period. In August 2020, a laparoscopic surgical procedure was performed; during the intervention, the IUD was identified in the anterior rectal wall with only the strings exiting the wall. Therefore, a visceral surgeon advice was required. The device was removed by continuing the laparoscopic intervention. The patient was given antibiotic treatment and had a favorable evolution. Although IUD is thought to be an easy and accessible method of contraception, complications such as uterine perforation must always be taken in consideration and well explained to all patients.

Objective To develop a core outcome set for endometriosis. Design Consensus development study. Setting International. Population One hundred and sixteen healthcare professionals, 31 researchers and 206 patient representatives. Methods Modified Delphi method and modified nominal group technique. Results The final core outcome set includes three core outcomes for trials evaluating potential treatments for pain and other symptoms associated with endometriosis: overall pain; improvement in the most troublesome symptom; and quality of life. In addition, eight core outcomes for trials evaluating potential treatments for infertility associated with endometriosis were identified: viable intrauterine pregnancy confirmed by ultrasound; pregnancy loss, including ectopic pregnancy, miscarriage, stillbirth and termination of pregnancy; live birth; time to pregnancy leading to live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital abnormalities. Two core outcomes applicable to all trials were also identified: adverse events and patient satisfaction with treatment. Conclusions Using robust consensus science methods, healthcare professionals, researchers and women with endometriosis have developed a core outcome set to standardise outcome selection, collection and reporting across future randomised controlled trials and systematic reviews evaluating potential treatments for endometriosis. TWEETABLE ABSTRACT: @coreoutcomes for future #endometriosis research have been developed @jamesmnduffy.

The hysteroscopic myomectomy is a very important application of the gynecologic endoscopy, as it allows minimal invasive removal of the type 0, 1, and 2 fibroids with minimal damage to the uterine wall. In the last decade, new developments of this method allowed an even less invasive approach, with possibility of ambulatory procedure. We discuss the importance of these new developments, based very much on the pseudocapsule of the myoma, and analyze the literature data regarding the outcome. The cold loop resection is a technique that could be used in type 1 and type 2 myomas, with less complications and limitations than the classical electrical resectoscope. Another development, more useful for type 0 and 1 myoma, is the hysteroscopic morcellator, similar to the laparoscopic one, but providing a faster and safer procedure. We also update the complications of hysteroscopic myomectomy and their management, including long-term and obstetrical complications related to hysteroscopic myomectomy. In conclusion, new developments and studies show that hysteroscopic myomectomy has become a valid endoscopic technique ready to be used by many specialists.

The use of nuchal translucency (NT) in 1992 by Nicolaides et al was a major breakthrough in screening for chromosomal aneuploidies at the end of the first trimester. However, pathological conditions other than chromosomal aneuploidies are also associated with increased NT, which can also be detected in normal fetuses. This study sought to evaluate the causes of this ultrasound sign in a group of patients from Iasi, Romania. During the decade-long study period, there were 71 certified cases involving increased NT; the patients in these cases underwent diagnostic amniocentesis and karyotyping. In most of the examined cases (55 cases, 78%), there was no aneuploidy. The remaining cases involved trisomy 21 (T21) (18%), trisomy 18 (T18) (2%), or triploidy (2%). In most cases, the indication for amniocentesis was increased NT alone (81%), whereas the remaining cases also involved advanced maternal age (5.5%), abnormal serologic markers (10%), or other ultrasound signs (3.5%) (2 cases—cardiac anomalies and fetal hydrops). A favorable pregnancy outcome at term was achieved in 40 cases (56% from total, 72% from euploid pregnancies); kidney anomalies or nonlethal cardiac conditions were observed in 12 cases (17%), 6 of which involved complications associated with premature onset of labor, and miscarriages occurred in 6 cases. Three cases were lost at follow-up. Although it is common practice to assume that increased NT is an indication for amniocentesis, both literature results and our study findings indicate that the majority of cases with increased NT involve no aneuploidy and result in a favorable outcome if no other anomaly is present. Better evidence-based management of such cases could be promoted by conducting larger, multicenter studies, and following cases for longer periods.