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Struma ovarii is a rare type of ovarian teratoma primarily composed of over 50% thyroid tissue. Its occurrence is reported in 2–5% of all ovarian teratomas, with approximately 0.5% to 10% showing malignant transformation. Managing it during pregnancy poses significant challenges as pregnancy can promote the growth of malignant struma ovarii due to elevated levels of ovarian and pregnancy-related hormones, including estrogen, progesterone, and human chorionic gonadotrophin (hCG). Most ovarian tumors, including struma ovarii, are detected during routine ultrasonography in the first and second trimesters, often as acute emergencies. Diagnosis during pregnancy is rare, with some cases incidentally discovered during cesarean section when inspecting the adnexa for ovarian cysts. This review explores the diagnostic, management, and therapeutic approaches to struma ovarii during pregnancy. [ABSTRACT FROM AUTHOR]

Postpartum hemorrhage is a leading cause of maternal mortality. Various methods can be used to evaluate the postpartum uterine cavity volume. This work aims to introduce a simple method for uterine postpartum cavity volume evaluation, called Postpartum Uterine Ultrasonographic Scale (PUUS), which could be used routinely. In this prospective study, 131 consecutive Caucasian patients were evaluated by using the PUUS method. The mean age was 27.72 years (ranging from 15 to 42). Patients were examined in the same time intervals: within the first 24-48 hours after delivery in case of vaginal delivery, and within the first 48-72 hours, in case of cesarean delivery. Patients with PUUS grades 2, 3, or 4 were reexamined daily until the PUUS grade declined to 1 or 0. The PUUS method evaluated the length of the endometrium of the uterine cavity occupied by blood or debris, from grade 0 (no blood) to grade 4 (over three-quarters of the endometrial length occupied by blood/debris). The PUUS grade of uterine involution varied with the day of examination, gestation, and parity. In this article, a novel method of evaluating uterine postpartum involution titled PUUS is introduced. This method standardized uterine cavity involution in a numerical fashion. We hope that the PUUS scale could further be used to decrease the morbidity and mortality of women due to postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

The impact of an intensive educational program regarding candidiasis in pregnancyon health professionals knowledge at Clinical Hospital of Obstetrics and Gynecology "Elena Doamna" in Iași, Romania. The study was designed in three phases: Assessment phase, Implementation phase and Evaluation phase. The study was conducted from early January to the end of December 2019. The result of the study shows that its most frequent location is in the mouth and the vagina. The symptoms are reduced and the diagnosis is based on the clinical examination, the confirmation being performed by microscopic examination. Prophylactic treatment of candidiasis involves maintaining a rigorous hygiene, avoiding excessive and unprotected use of antibiotics and increasing the body's immunity through a balanced diet and through the intake of mineral salts and vitamins. [ABSTRACT FROM AUTHOR]

Introduction. Polycystic ovary syndrome (PCOS) represents one of the most frequent reproductive pathologies leading to infertility due to anovulation. According to the Rotterdam’s criteria, a patient must have at least two out of the next three criteria: high testosterone levels, menstrual irregularities, and typical polycystic ovarian aspect of the ovaries during ultrasound examination. Lately, the administration of inositol and vitex has proven positive effects on patients with PCOS and infertility. Materials and method. Between 4 January 2021 and 1 March 2022, we conducted a prospective study at the “Elena Doamna” Clinical Hospital of Obstetrics and Gynecology, Iași. We enrolled 33 patients with PCOS and primary or secondary infertility who accepted to take part in our study and signed the informed agreement. All patients had an ultrasound performed during their follicular phase. A sample of blood was obtained in order to obtain serum values for kisspeptin, LH, FSH, estradiol, testosterone, insulin and glycemic levels. All 33 patients agreed to a treatment with inositol and vitex for a period of three months, and to be clinically and paraclinically reevaluated afterwards. Results and conclusions. The post-therapeutic serum values showed a decrease in kisspeptin values with approximately 7.8%, a decrease in LH values with approximately 33%, and a decrease in prolactin with 22.16%. A difference has also been noticed during ultrasound examination. The ovarian volume for the right and left ovary decreased after the treatment with inositol and vitex in patients with PCOS. Considering our results, we can confirm that our study showed positive changes in patients with PCOS, and these must be taken in consideration when treating this pathology. [ABSTRACT FROM AUTHOR]

Introduction. Ultrasonographic diagnosis of amniotic bands may be difficult due to the similar appearance between uterine malformations and amniotic band syndrome. Band-like structures within the gestational sac are frequently noted on obstetric sonograms during the first and second trimesters of pregnancy. Clinicians should have a high index of suspicion of uterine anomaly to make an early diagnosis of bicornuate uterus and for preventing complications, but when the pregnancy history is unknown, it is difficult to establish a diagnosis in the third trimester. Materials and method. A 22-yearold second gravida, with a previous history of caesarean section, with undispensed pregnancy, presented at the “Elena Doamna” Clinical Hospital of Obstetrics and Gynecology, Iaşi, for routine examination. No uterine abnormality was reported by abdominal ultrasound in the first pregnancy. The ultrasound (US) showed breech presentation of the fetus, with no gross fetal anomalies. The bidimensional US revealed a band of tissue crossing the amniotic cavity, but not sectioning any part of the fetal body. Color Doppler revealed no blood flow through this structure. Due to insufficient data regarding the pregnancy, it was not known any uterine malformation. The patient gave birth, by caesarean section for fetal distress indication, to a female newborn, weighing 3470 g, with an Apgar score at 1 minute and 5 minutes of 4 and 8, respectively, with no structural anomaly observed at the postpartum examination. After the fetal delivery, the uterine cavity was examined and the patient was diagnosed with a bicornuate uterus with a single common cervix. Discussion and conclusions. The importance of evaluating the pregnancy in this pathology is essential due to the complications that can appear in the fetus intrapartum development. True amniotic bands are relatively rare. When are detected, the prognosis of amniotic bands is usually very poor. The visualization of a band-like structure should not be confused with amniotic band syndrome, especially when a thorough fetal anatomy survey reveals no structural anomalies. [ABSTRACT FROM AUTHOR]

The multiple pregnancies associated with COVID-19 represent a new and difficult condition to manage. The prognosis for rapid deterioration after caesarean delivery is difficult to assess and needs close interdisciplinary follow-up due to pregnancy and postpartum-related changes. We report the case of a 37-year-old primigesta, primipara patient who was admitted to the “Elena Doamna” Clinical Hospital of Obstetrics and Gynecology, Iaşi, at 33 weeks and 3 days of gestation with high-grade multiple pregnancies (quadruplets) for threatened premature birth associated with COVID-19. The patient had a history of surgically corrected atrial septal defect during childhood and is currently known to have paroxysmal supraventricular tachycardia. Tocolysis was ineffective and the decision to perform a caesarean operation was made. The diagnosis was established: primigesta, primipara, at 34 weeks of gestation, high-grade multiple pregnancy with quadruplets, intact membranes, threatened premature birth, surgically corrected atrial septal defect, paroxysmal supraventricular tachycardia, infection with SARS-CoV-2. The patient underwent a caesarean intervention and treatment for COVID-19 pneumonia. The intervention took place at 33 weeks and 4 days of gestation, resulting in four newborns with weight between 1400 g and 1820 g and Apgar scores between 6 and 8. All newborns were transferred to a third-degree neonatology ICU service due to their prematurity. During the postpartum period, the patient had a fulminant evolution of COVID-19 pneumonia, with rapid deterioration, needing respiratory support and antiviral treatment with remdesivir. Managing high-risk obstetrical pregnancies associated with COVID-19 requires a multidisciplinary team consisting of obstetricians, anesthesiologists, neonatologists and infectious disease specialists. [ABSTRACT FROM AUTHOR]

Introduction. Vaginal candidiasis is one of the most common genital infections during pregnancy. On average, three out of four pregnant women develop vaginal candidiasis. One of the most common types of fungus that live in and on the human body is called Candida (Candida albicans). Materials and method. The study was performed on a group of 200 pregnant women with pregnancies in the first, second and third trimesters; of these, 150 pregnant women (75%) were diagnosed with vaginal candidiasis. We took into account the medical history of pregnant women, the anamnesis, the general physical examination, the obstetrical clinical examination, and the paraclinical examinations (cytobacteriological examination, yeast culture on Sabourand medium, fungigram). Of the 150 pregnant women diagnosed with vaginal candidiasis, 30 pregnant women (20%) were in the first trimester of pregnancy, 30 pregnant women (20%) were in the second trimester of pregnancy, and 90 pregnant women (60%) were in the third trimester of pregnancy. Candida albicans is a fungus that is found in the normal flora of the vagina, and when it multiplies excessively and exceeds the protective flora, candidiasis occurs. Causes of vaginal candidiasis in pregnancy: changes of pH in pregnancy with reduced ability of the body’s defenses, hormonal changes (increased estrogen levels) in pregnancy lead to increased glycogen – the main food for the development of fungus, highly processed foods that have a high sugar content, low level of hygiene, consumption of antibiotics. Results. We note that three out of four pregnant women have vaginal candidiasis during pregnancy. Candida albicans normally exists in the mouth, intestines, skin and mucous membranes, usually in wet areas but without causing problems. When the conditions in the environment in which it lives change, this fungus multiplies uncontrollably, and the infection it causes is called candidiasis. Discussion and conclusions. Vaginal candidiasis can cause miscarriage, premature birth and chorioamnionitis with Candida. It is also one of the most common forms of fungal diseases reported in pregnant women that can cause systemic infections of newborns, especially in those who are underweight at birth and premature. Ideally, it is necessary to treat vaginal candidiasis before pregnancy, as well as early diagnosis during pregnancy with the administration of specific treatment – azol antifungals are recommended as therapy of choice during pregnancy and can be given as local creams or intravaginal suppositories (eggs) for seven days. Regarding the high incidence of vaginal candidiasis in pregnant women (3/4), it is very important for the future mother to remember that the safest treatment is the one prescribed by the doctor. This is the only way to get rid of recurrent candidiasis. [ABSTRACT FROM AUTHOR]

Background. The evolution of pregnant critical COVID-19 patients is unpredictable. Methodology. The patients admitted to the COVID-19 intensive care unit of the “Cuza Vodă” Clinical Hospital of Obstetrics and Gynecology in Iaşi between January 1st and December 1st, 2021, with critical forms of the disease (n=21) were included and retrospectively studied. Brixia scores (H – highest, L – lowest, A– upon admission, and E – when hospitalization ended) were calculated from their chest X-rays. The patients’ age range was 25-52 years old. Results. Both A score and E scores decreased throughout the year 2021, due to the progress in patient management. The highest scores were close to the admittance scores, while the lowest scores were not always the ones obtained when hospitalization ended. Conclusions. Most critically ill pregnant COVID-19 patients improved their respiratory function throughout hospitalization, but the evolution was not as linear as expected. [ABSTRACT FROM AUTHOR]

Background: During viral outbreaks, pregnancy poses an increased risk of infection for women. Methods: In a prospective study, all patients admitted for delivery at term to Elena Doamna Obstetrics and Gynecology University Hospital in Iasi, Romania, between 1 April 2020 and 31 December 2020 were included. There were 457 patients, divided into two groups: group 1, SARS-CoV-2-positive patients (n = 46) and group 2, SARS-CoV-2-negative patients (n = 411). Among other tests, complete blood count was determined upon admittance, and the following values were studied: white blood cell count, lymphocytes, neutrophils, red blood cell count, hemoglobin, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, mean corpuscular volume, red blood cell distribution width, hematocrit, platelet count, mean platelet volume, platelet distribution width, plateletcrit, and platelet large cell ratio. Results: in pregnant SARS-CoV-2-infected patients at term, there was a significant decrease in white blood cell, neutrophil, and lymphocyte count, and an increase in mean corpuscular hemoglobin concentration, compared to healthy pregnant women at term, although all still within normal limits. None of the other components of the complete blood count or fetal outcomes studied was significantly influenced by SARS-CoV-2 infection in pregnant patients at term. [ABSTRACT FROM AUTHOR]

Introduction. Kisseptin is a hypothalamic peptide that plays an essential role in the upstream of gonadotropin-releasing hormones by mediating sex steroid feedback and metabolic regulation of the reproductive axis. Recent studies have shown its role in puberty onset, in the maintenance of normal reproductive function and in metabolic and hormonal disturbances leading to polycystic ovarian syndrome (PCOS). Encoded by the KISS1 gene, it was first isolated from human placental tissue, but later on, its presence has been discovered in other numerous organs. PCOS is a common disorder characterized by polycystic ovaries, chronic anovulation and hyperandrogenism. Considering the existing evidence of kisspeptin regulating the hypothalamo-pituitarygonadal axis, it is only a matter of time until this neuropeptide will play an important role in the diagnosis and management in PCOS. Materials and method. During January 2021 and May 2021, in the “Elena Doamna” Clinical Hospital of Obstetrics and Gynecology, Iaşi, a prospective study, showing the implications of kisspeptin in patients diagnosed with PCOS, was initiated. Sixty female patients were included in our study. They were divided into two groups, the control group consisting in 30 healthy patients with no evidence of PCOS or other endocrinological disorders, and a test group consisting in patients with PCOS. All patients were rigorously selected by respecting inclusion and exclusion criteria, and all of them gave their consent in participating in this study. Eight hormonal parameters were taken into consideration: kisspeptin, luteinizant hormone, follicular stimulant hormone, testosterone, estradiol, prolactin, insulin, and glycemic index. All laboratory tests were performed during follicular period. All patients benefited from clinical examination and pelvic echography. Results. When observing the results in our PCOS group, we encountered higher levels of kisspeptin, up to 200 pg/ml, and LH/FSH modified reports. The control group showed overall lower levels of kisspeptin, with values beneath 100 pg/ml. Discussion. Recent studies have clearly shown the involvement of kisspeptin and its receptors in the reproductive axis and in PCOS complicated by infertility. Further studies are needed in order to identify new and better therapeutic schemes for patients suffering from PCOS infertility. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this paper is to highlight the extent of changes caused by the COVID-19 pandemic on the addressability and pathology of infertility patients. Methodology. In a retrospective study, we evaluated all consecutive patients who were referred to our hospital for hysterosalpingography between April 1, 2020 and March 31, 2021 (study group, n=12), compared to patients from the previous period, April 1, 2019 – March 31, 2020 (control group, n=116). Results. Variations between the two groups were highlighted, in terms of age, urban background, living in other counties, referring doctor outside the hospital (31.83 years old; 50%; 16.66%; 0% in the study group versus 32.5 years old; 68.1%; 26.72%; 26.72% in the control group). Significant variations were observed in terms of uterine pathology: bicornuate uterus and endometriosis (8.33% in the study group versus 2.58% in the control group). The proportion of right hydrosalpinx (25% versus 7.78%) and left hydrosalpinx (16.66% versus 10.34%) also increased significantly. Conclusions. The coronavirus pandemic reduced the addressability of patients with infertility to 10.3% compared to the previous year, and significantly increased the proportion of patients discovered with bicornuate uterus, endometriosis and hydrosalpinx. [ABSTRACT FROM AUTHOR]

Introduction. The fetal cardiac function is affected both in cardiac malformations and in the adaptation to various pathologies, such as twin-to-twin transfusion syndrome (TTTS), intrauterine growth restriction (RCIU) and diabetes. Knowing the pathophysiological mechanisms helps to optimize the perinatal management. Therefore, the development of early and viable diagnostic techniques for fetal cardiac dysfunction is being attempted. The objective of the study is to identify the ultrasound markers of fetal cardiac dysfunction that influence the fetal prognosis. Methodology. The literature regarding fetal cardiac function and prognostic ultrasound parameters has been systematically reviewed, searching the PubMed website for articles published in English in the past 10 years following the algorithm (fetus OR fetal) AND echocardiography AND (cardiac function OR cardiac dysfunction) AND (prognosis OR prognostic OR outcome). Results. A total of 141 relevant articles were identified, published with a constant annual frequency and distributed as follows: review/ opinion articles (14); heart malformations (65); normal structural cord (62): IUGR (16), diabetes (12), TTTS (8), arrhythmias (7), others (19). In the case of cardiac malformations, ultrasound parameters specific to each pathology were described. For the normal structural heart, diastolic dysfunction and abnormal myocardial deformation are the earliest signs, but they are still at the experimental level, so that abnormal flow through the venous duct continues to be the best predictor of fetal mortality. Conclusions. In the past 10 years, there has been a constant interest in characterizing fetal cardiac dysfunction. Currently, there is no valid universal protocol, each pathology requiring a punctual evaluation in order to establish the prognosis. Thus, the knowledge of several ultrasound parameters helps the clinician in more detailed characterization of the fetal cardiac function. [ABSTRACT FROM AUTHOR]

Introducere. Restricţia de creştere fetală este definită ca fiind greutatea fetală estimativă sub percentila 10. Dezvoltarea fetală poate fi afectată de un mediu intrauterin neadecvat, asociat cu o reducere cronică a aportului de oxigen şi nutrienţi. Detectarea cât mai rapidă a acestor anomalii de aport este esenţială pentru o intervenţie eficientă a obstetricianului. Între elementele propuse pentru depistarea sa, indicii Doppler - şi mai ales cel uterin - par a fi corelaţi cu greutatea fetală. Indicele de pulsatilitate medie pe arterele uterine (IPAUt) mai mare de percentila 95, măsurat în trimestrul al doilea şi în trimestrul al treilea, se asociază cu restricţia de creştere intrauterină, dar şi cu dezlipirea de placentă, preeclampsie şi cu decesul fetal intrauterin. Utilizarea IP-AUt poate constitui o metodă de screening pentru evaluarea riscului obstetrical şi ajută la o selecţie a pacientelor care necesită o monitorizare atentă. Materiale şi metodă. S-a efectuat un studiu prospectiv observaţional la paciente care s-au adresat pentru ecografia morfologică de trimestrul al doilea şi la cea de evaluare a creşterii în trimestrul al treilea. S-au identificat 28 de gravide cu sarcini unice, cu vârsta gestaţională între 19 şi 26 de săptămâni, cu feţi având greutatea estimată mai mică decât percentila 10, şi un grup de 17 gravide, cu vârsta gestaţională între 32 şi 38 de săptămâni, cu feţi având greutate estimată mai mică decât percentila 10. S-a efectuat examenul ecografic, cu măsurarea indicilor Doppler şi a biometriei fetale. Au fost luaţi în considerare şi factorii de risc materni, precum hipertensiunea arterială gestaţională, diabetul zaharat, obezitatea şi consumul de tutun. Rezultate şi concluzii. În urma efectuării studiului, s-a observat o corelaţie între feţii cu greutatea estimativă mică pentru vârsta gestaţională şi IP-AUt crescut. În cadrul efectuării indicilor Doppler, s-a remarcat că, în grupul de trimestrul al doilea, trei dintre paciente aveau IP-AUt peste valorile normale (10,7%), iar în grupul gravidelor de trimestrul al treilea, cinci paciente aveau IP-AUt crescut (29,5%). În niciun caz cu IP-AUt crescut nu s-a detectat vreo altă patologie obstetricală semnificativă (preeclampsie, hematom retroplacentar), dar un caz din cele de trimestru trei s-a soldat cu moarte fetală in utero. În concluzie, măsurarea IP-AUt s-a corelat mai bine cu restricţia de creştere fetală în trimestrul al treilea, iar studiile viitoare pe loturi mai mari pot confirma importanţa evaluării acestui indice inclusiv la ecografia de trimestru trei. [ABSTRACT FROM AUTHOR]

Ecografia şi-a câştigat deja un rol fundamental în obstetrică. Dacă explorarea în timpul sarcinii oferă informaţii esenţiale despre făt, anexe şi patologia asociată sarcinii, după naştere rolul ecografiei nu este la fel de clar. Prezentăm un studiu al sensibilităţii ecografiei în monitorizarea uterului în post-partum şi analizăm alte elemente important de urmărit la examenul ultrasonografic post-partum. Materiale şi metodă. Acesta este un studiu prospectiv, realizat în Spitalul „Elena Doamna” din Iaşi, constând în măsurarea IFU (înălţimea fundului uterin) clinic şi ecografic şi încadrarea într-un scor în funcţie de dimensiuni şi imagini ecografice, între 0 (uter fără conţinut) şi 4 (conţinut endocavitar ocupând peste ¾ din cavitate). Examinarea s-a făcut în primele 48 de ore la paciente cu naştere cezariană şi în primele 72 de ore la cele cu cezariană. În cazul în care scorul era diferit de 0 sau 1, s-a făcut urmărirea în dinamică până la atingerea acestui scor. Am analizat evoluţia post-partum în funcţie de mediul de provenienţă, de modul de naştere, de gestaţie, paritate şi de tratamentul cu uterotonice. Rezultate. Au fost incluse 131 de cazuri, cu vârsta medie de 27 de ani, iar factorii de risc ai persistenţei unui scor mai mare decât 1 la trei zile au fost: multiparitatea, naşterea naturală şi tratamentul cu oxitocin. Nu au fost obţinute diferenţe semnificative pentru mediul de provenienţă, utilizarea ergometului post-partum sau controlul cavităţii (instrumental/manual) versus fără control. Cu cât diminuarea scorului a fost mai rapidă, cu atât evoluţia a fost favorabilă, fără a necesita controlul ulterior al cavităţii. Discuţii şi concluzii. Ecografia poate fi utilă în post-partum pentru mai multe elemente: evaluarea cicatricei post-cezariană, modificarea poziţiei uterului post-cezariană, inserţia corectă a steriletului post-partum, modificările Dopplerului uterin post-partum şi evoluţia conţinutului uterin. Privind acest din urmă element, studiul nostru confirmă rolul fundamental al evaluării ecografice, eventual seriate, în a decide un eventual gest chirurgical post-partum, care poate determina complicaţii la distanţă. [ABSTRACT FROM AUTHOR]

Copyright of Ginecologia.ro 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.)

Cervico-vaginal anomalies resulting from abnormal uro-genital sinus development could be difficult not only for diagnostic and treatment, but also involving neighboring structures, including the bladder and kidneys. We present a case treated by a combined hystero-laparoscopy procedure. Case presentation. A 17-year old patient, G0P0, presented for primary amenorrhea. The clinical and imagistic diagnostic (including MRI) confirmed a partial agenesis of the cervix and upper vaginal third. A complex treatment procedure was carried on: laparoscopy, also treating additional endometriosis of the left ovary; hysteroscopy through laparoscopic approach with transuterine passage through the cervix to the vaginal fornix; vaginal placement of anintrauterine Foley catheter. The 6-week postoperative removal of the catheter showed a vesico-vaginal fistula confirmed by cystoscopy and fluoroscopic evaluation. In conclusion, this rare case underlines the difficult management of cervico-vaginal anomalies, that requires a uro-gynecological competent approach. [ABSTRACT FROM AUTHOR]