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Congenital hearing loss is a significant global health concern that affects millions of newborns and infants worldwide, posing substantial challenges for affected individuals, their families, and healthcare systems. This condition, present at birth, can stem from genetic factors, in utero exposures, infections, or complications during pregnancy or childbirth. The spectrum of congenital hearing loss ranges from mild to profound, impacting the development of speech, language, and cognitive skills, thereby influencing educational achievements, social integration, and future employment opportunities. Early detection and intervention strategies, such as newborn hearing screenings, genetic counseling, and the use of hearing aids or cochlear implants, are crucial for mitigating these impacts. This review article aims to explore the diagnostic approaches and management strategies for congenital cytomegalovirus-related hearing loss, emphasizing the importance of interdisciplinary care and the potential for technological advances to improve outcomes for affected individuals.

The reactivity of an electroencephalogram (EEG) to external stimuli is impaired in comatose patients showing burst-suppression (BS) patterns following hypoxic–ischemic brain injury (HIBI). We explored the reactivity of BS induced by isoflurane in rat models of HIBI and controls using intermittent photic stimulation (IPS) delivered to one eye. The relative time spent in suppression referred to as the suppression ratio (SR) was measured on the contralateral fronto-occipital cortical EEG channel. The BS reactivity (BSR) was defined as the decrease in the SR during IPS from the baseline before stimulation (SRPRE). We found that BSR increased with SRPRE. To standardize by anesthetic depth, we derived the BSR index (BSRi) as BSR divided by SRPRE. We found that the BSRi was decreased at 3 days after transient global cerebral ischemia in rats, which is a model of brain injury after cardiac arrest. The BSRi was also reduced 2 months after experimental perinatal asphyxia in rats, a model of birth asphyxia, which is a frequent neonatal complication in humans. Furthermore, Oxytocin attenuated BSRi impairment, consistent with a neuroprotective effect in this model. Our data suggest that the BSRi is a promising translational marker in HIBI which should be considered in future neuroprotection studies.

The increasing prevalence of bariatric surgery among women of childbearing age raises critical questions about the correct management of pregnancy following these procedures. This literature review delves into the multifaceted considerations surrounding pregnancy after bariatric surgery, with a particular focus on the importance of preconception counselling, appropriate nutrition assessment, and the necessity of correct folic acid supplementation. Key areas of investigation include nutrient absorption challenges, weight gain during pregnancy, and potential micronutrient deficiencies. Examining the relationship between bariatric surgery and birth defects, particularly heart and musculoskeletal issues, uncovers a twofold increase in risk for women who underwent surgery before pregnancy, with the risk emphasized before folic acid fortification. In contrast, a nationwide study suggests that infants born to mothers with bariatric surgery exhibit a reduced risk of major birth defects, potentially associated with improved glucose metabolism. In addition, this review outlines strategies for managing gestational diabetes and other pregnancy-related complications in individuals with a history of bariatric surgery. By synthesizing existing literature, this paper aims to provide healthcare providers with a comprehensive framework for the correct management of pregnancy in this unique patient population, promoting the health and well-being of both mother and child.

The amnion rupture sequence is a rare condition occurring early in pregnancy, resulting in complex fetal anomalies by disrupting normal embryonic development. The prevalence of amnion rupture sequence is reported to be 1.16 in 10,000 live births. This article explores the uncommon case of early amnion rupture leading to fetal encephalocele, suspected in the first trimester. Despite the variable and intricate nature of anomalies associated with this condition, cranio-facial and abdominal defects are frequently observed. Genetic testing was conducted, with normal results supporting our theory of amnion rupture. The patient decided to terminate the pregnancy, and the anatomopathological results confirmed the findings. This article discusses the diagnostic challenges, emphasizing the importance of timely identification through advanced imaging techniques.

MIRAGE syndrome is a recently described congenital condition characterized genetically by heterozygous gain-of-function missense mutations in the growth repressor sterile alpha domain containing 9 (SAMD9) located on the arm of chromosome 7 (7q21.2). The syndrome is rare and is usually diagnosed in newborns and children with myelodysplasia, infection, restriction of growth, adrenal hypoplasia, genital phenotypes, and enteropathy, hence the acronym MIRAGE. The aims of this paper are (1) to present fetal ultrasound features in a case where MIRAGE syndrome was diagnosed prenatally and (2) to review the existing literature records on prenatal manifestations of MIRAGE syndrome. In our case, the fetus had severe early fetal growth restriction (FGR) with normal Doppler studies, atypical genitalia, oligohydramnios, and hyperechogenic bowel at the routine mid-gestation anomaly scan. Amniocentesis excluded infections and numeric or structural chromosomal abnormalities while whole exome sequencing (WES) of the fetal genetic material identified the specific mutation. Targeted testing in parents was negative, suggesting the “de novo” mutation in the fetus. We could not identify other specific case reports in the literature on the prenatal diagnosis of MIRAGE syndrome. In cases reported in the literature where the diagnosis of MIRAGE syndrome was achieved postnatally, there are mentions related to the marked FGR on prenatal ultrasound. Severe early-onset FGR with no other apparent cause seems to be a central prenatal feature in these babies, and WES should be offered, especially if there are other structural abnormalities. Prenatal diagnosis of MIRAGE syndrome is possible, allowing for reproductive choices, improved counseling of parents, and better preparation of neonatal care.

This report explores the diverse spectrum of congenital anomalies of the kidney and urinary tract (CAKUT), ranging from asymptomatic presentations to the most severe form characterized by bilateral renal agenesis. Genitourinary anomalies, a prevalent subset within this domain, account for a significant proportion, constituting 15–20% of anomalies identified during prenatal screening. An ectopic kidney is defined by the presence of an empty renal fossa and the displacement of the kidney from the lumbar region to alternative locations, with the pelvic region emerging as the most prevalent site. The reported case involves bilateral renal ectopia with unilateral duplex kidney. Initial suspicions of a renal anomaly arose during the first trimester, leading to a definitive diagnosis in the second trimester. The patient underwent regular monitoring every four weeks, ultimately delivering a healthy baby at term. This case underscores the frequency of renal anomalies, emphasizing that a considerable proportion remains asymptomatic. These findings contribute to a broader understanding of congenital renal anomalies, their varied manifestations, and the importance of vigilant prenatal screening for early detection and management.

Abdominal wall defects encompass three primary classifications: gastroschisis, omphalocele and anomalies resembling body stalk. Potential causative factors include early amnion rupture, amniotic bands, vascular disruptions or abnormal folding of the embryo. The prevalence of these defects stands at 1 in 14,000 live births. Body stalk anomaly is characterized by a substantial abdominal defect coupled with spine and limb anomalies, along with a very short or absent umbilical cord. We present a case of a rare abdominal defect known as body stalk anomaly, the most severe form of this spectrum of diseases. The diagnosis of this anomaly was established during the first trimester of pregnancy. Subsequently, the patient opted for pregnancy termination and chose not to undergo genetic testing. The anatomo-pathological results confirmed the findings. Body stalk anomaly is not compatible with life; therefore, early identification and understanding the clinical implications of this rare anomaly for informed decision-making in prenatal care are very important.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Preconception evaluation of couples wishing to conceive is an important step toward a healthy pregnancy and it is especially important in people with a chronic condition or at genetic risk. The most common endocrine disorders in women at reproductive age are those involving the thyroid gland and it is well recognized that hyperthyroidism (HT), over-function of the thyroid gland, is associated with risks of maternal, fetal, and neonatal complications. The aim of this paper is to review the latest evidence regarding the components of preconception counseling in women with HT that contemplate a pregnancy. We also want to raise awareness among healthcare professionals about the importance of periconceptional counseling in improving pregnancy outcomes and avoid maternal and fetal complications related to thyroid dysfunction. In women with Graves’ disease seeking pregnancy, it is essential to discuss all the treatment options along with the associated risks and benefits. Extensive prospective studies are still needed to understand the implications of current recommended strategies for the management of HT in preconception and during pregnancy.

This is a case of a fetus affected by an amniotic band detected at 20 weeks of gestation. A presumptive diagnosis was made based on the ultrasound features. The ultrasound showed an abnormally developed right lower limb and no other associated fetal abnormalities. The unilaterality of the defect decreases the chances of genetic abnormality or an early vascular insult. The postnatal examination of the newborn concluded that the prenatal diagnosis was right.

Klippel–Trenaunay syndrome (KTS) is a very rare vascular malformation syndrome also referred to as a capillary–lymphatic–venous malformation with unknown aetiology. The aim of our paper is to highlight interesting images, regarding a rare case of foetal Klippel–Trenaunay syndrome diagnosed prenatally in our department and confirmed postnatally with a favourable evolution during the gestation and neonatal periods. This case was diagnosed at 26 weeks gestation and characterised through ultrasound by the presence of superficial multiple cystic structures of different sizes spreading over the left leg with hemihypertrophy and reduced mobility. The cystic lesions were spreading to the left buttock and the pelvic area. The right leg and upper limbs had normal appearance with good mobility. There were no signs of hyperdynamic circulation or foetal anaemia, but mild polyhydramnios was associated. The ultrasound findings were confirmed postnatally, the left leg presented multiple cystic lesions and port wine stains, and there was hypertrophy and fixed position, with favourable evolution at 6 months of life, when the size of the lesions began to decrease and the mobility of the leg improved.

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.

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.

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.

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.

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.

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.

Autoimmune Congenital Heart Block (CHB) is an immune-mediated disease caused by transplacental passage of maternal circulating anti-Ro/SSA and anti-La/SSB antibodies which can bind to fetal cardiac tissue, damaging conduction tissues by inflammation and fibrosis. Approximately 2% of pregnancies with positive anti-Ro antibodies will be complicated by fetal atrioventricular block and the risk of recurrence in subsequent pregnancies is 10 times higher. We report a case of a clinically asymptomatic patient diagnosed with anti-Ro antibodies who had two pregnancies complicated by CHB with different outcomes. Despite preventive treatment with hydroxychloroquine (HCQ) from 6 weeks of pregnancy onward, the fetus developed second to third degree CHB. Dexamethasone was added. The pregnancy evolved to near-term with persistent intermittent CHB. It is not clear how pregnancies with recurrent fetal CHB despite prophylaxis with HCQ should be managed and there is a need for controlled studies to answer the remaining questions in relation to this subject.

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.

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.

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.

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.

Fetal biliary lithiasis is a benign condition characterized by the presence of gallstones in the gallbladder of a developing fetus. It is typically detected incidentally during a routine obstetric echography. The incidence of this condition varies from 0.03% to 2.3%. In most cases, fetal cholelithiasis resolves spontaneously and has an excellent prognosis. However, there are certain risk factors that may contribute to its development. Maternal factors that increase the risk of fetal cholelithiasis include placental abruption, elevated estrogen levels, narcotic use, diabetes, enteral nutrition, and specific medications, such as ceftriaxone, furosemide, and prostaglandin E2. Fetal factors that can contribute to the condition include Rhesus or ABO blood group incompatibility, congenital anomalies affecting the cardiovascular, gastrointestinal, or urinary systems, twin pregnancies with the fetal demise of one twin, genetic anomalies such as trisomy 21, chromosomal aberrations, cystic fibrosis, growth restriction, oligohydramnios, hepatitis, or idiopathic causes. Usually, the gallstones spontaneously resolve before or after birth without requiring specific treatment. However, in rare instances, complications can arise, such as the formation of biliary sludge, inflammation of the gallbladder (cholecystitis), or obstruction of the bile ducts. If complications occur or if the gallstones persist after birth, further evaluation and management may be necessary. Treatment options can include medication, minimally invasive procedures, or, in severe cases, surgical removal of the gallbladder.

This paper presents a rare case of fetal hydrops detected at just 23 weeks of gestation in a 22-year-old woman’s first pregnancy. The fetal ultrasound revealed severe skeletal anomalies, craniofacial deformities, and thoracic abnormalities, suggesting a complex and severe skeletal dysplasia, potentially type IA Achondrogenesis—a lethal autosomal recessive condition marked by ossification delay. This case highlights the significance of advanced genetic testing, such as next-generation sequencing (NGS) and whole-genome sequencing (WGS), in diagnosing and understanding skeletal dysplasias. Skeletal dysplasias represent a group of genetic disorders that affect osteogenesis. The prevalence of this condition is 1 in 4000 births. Sadly, 25% of affected infants are stillborn, and around 30% do not survive the neonatal period. There is a wide range of rare skeletal dysplasias, each with its own specific recurrence risk, dysmorphic expression, and implications for neonatal survival and quality of life. When skeletal dysplasia is incidentally discovered during routine ultrasound screening in a pregnancy not known to be at risk of a specific syndrome, a systematic examination of the limbs, head, thorax, and spine is necessary to reach the correct diagnosis. Prenatal diagnosis of skeletal dysplasia is crucial for providing accurate counselling to future parents and facilitating the proper management of affected pregnancies. An accurate diagnosis can be a real challenge due to the wide spectrum of clinical presentations of skeletal dysplasia but advances in imaging technologies and molecular genetics have improved accuracy. Additionally, some of these skeletal dysplasias may present clinical overlap, making it especially difficult to distinguish. After the 11th revision of genetic skeletal disorder nosology, there are 771 entities associated with 552 gene mutations. The most common types of skeletal dysplasia are thanatophoric dysplasia, osteogenesis imperfect, achondroplasia, achondrogenesis, and asphyxiating thoracic dystrophy.

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.

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.

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.

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.

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.

Pregnancy is a particular period of time for a woman, so that it is important to accurately determine the impact of adjacent pathologies on the natural evolution of the nine months of pregnancy. Although there is still much to debate on the association between periodontal disease and pregnancy, the conclusion seems to remain the same: untreated periodontal pathology in pregnancy could have adverse consequences such as premature birth or low birth weight fetuses. Periodontopathies are introduced as risk factors, the novelty of the subject being the association between untreated periodontal pathology and the evolution of pregnancy. The affected periodontal tissue has the potential of releasing microorganisms that could colonize the placenta, ultimately having adverse consequences on the evolution of pregnancy, consequences such as premature birth or inadequate birth weight. The purpose of this review is to assess the association between periodontal disease and the negative consequences on pregnancy. Using databases such as PubMed, more than 1,500 articles were screened, including systematic reviews, case-control studies and prospective cohort studies assessing the association between periodontitis and pregnancy. Only 54 from the abovementioned papers were included in the final review.

Objectives. Our study assesses the social and psychological impact of the symptoms of endometriosis. Materials and methods. This crosssectional study was conducted from January 2014 to January 2016. The research involved two groups. The study instrument, the EHP-5 questionnaire, was completed by the respondents on the admission date or on the routine gynecological visit day. Results. Endometriosis has a negative social and psychological impact on women’s life, the most affected areas being work, fertility and sexual activity. Moreover, pain and the negative perception of self-image are major sources of distress. Conclusion. The symptoms and effects of endometriosis, especially chronic pelvic pain, mood changes and infertility, are significant negative factors in women’s life. The authors further conclude that the EHP-5 questionnaire can be more widely used to help select women who may need special attention in terms of their quality of life, thus helping gynecologists refer affected women to a health care professional.

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.

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.

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?

Objective: To describe the incidence and the characteristics of pregnancies complicated by hypertensive disorders of pregnancy (HDP) in one of the largest maternity hospitals in Romania. Methods: A retrospective cohort study including all deliveries at ≥24 weeks’ gestation was performed. Results: The incidence of preeclampsia was 1.2%, of gestational hypertension 2.2% and of chronic hypertension 0.4%. Pregnancies with HDP had higher rates of stillbirth, birthweight

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.

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.