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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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

Surgery during pregnancy post additional concerns an represent a major stress factor for both anesthesiologist and gynecologists. Approximately 0.5-2% of all pregnant women undergo a least one nonobstetric surgery during their pregnancy, and the number is growing in recent years. Until present days, no anesthetic drug has been shown to be clearly dangerous to human fetus. Thus, a pregnant woman should never be delayed from surgery regardless of teratogenic effects at any gestational age. The choice of anesthetic technique, drugs and surgical procedure should be guided by mother safety and continuation of adequate uteroplacental perfusion. Regarding Cesarean Section, it is now the most common surgery performed in the United States, with over 1 million women delivered by cesarean every year. Due to medical and legal implication, anesthesia must be safe in order to improve maternal and fetal outcome. Ultimately, success of each case is granted by multidisciplinary team approach and adherence to the latest clinical practice guidelines. [ABSTRACT FROM AUTHOR]

Trauma is complicating 1 in 12 pregnancy and is considered to be the first cause of non-obstetrical maternal death. Frequently encountered complications are preterm delivery, placental abruption or spontaneous abortion. Presence of the gravid uterus is a major contributor that increases the risk of the occurrence of possible wounds, and as the pregnancy progresses, multiple changes that occur can make the management of the pregnant patient harder. Studies have shown that domestic abuse should not be overlooked. First evaluation needed for pregnant trauma woman comprise complete blood count, coagulation profile, Rh factor determination, urine analysis, electrolytes and glucose, toxicology screening and the Kleinhauer-Betke (KB) test. Also, diagnostic imaging is not discouraged, and may raise and also confirm the suspicion for placental abruption or uterine rupture. In case of cardiac arrest and unsuccessful resuscitation of the mother within 4 minutes, literature recommends a perimortem cesarean delivery, if gestational age is above 23 weeks and the fetus is potentially viable. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

With scarcely any reports published on the association of fetal endocardial fibroelastosis and Ro antibodies maternal transfer during pregnancy, this subject continues to raise concern among health care providers around the world, especially when neonatal lupus syndrome is taken into consideration as the main diagnosis. Fetuses with congenital atrioventricular block have a risk of intrauterine fetal demise and the concern comes from a variety of factors that show significant association between the presence of maternal antibodies to SS-A/Ro during pregnancy and their children serum level of these antibodies. Nevertheless, fetal endocardial fibroelastosis plays an important role in altering ventricular diastolic function and ventricular development in children and neonates. Methods. Medical literature was searched on PubMed and Medline using key words such as fetal endocardial fibroelastosis, anti-Ro antibodies in pregnancy and neonatal lupus syndrome and over 200 articles were taken into consideration, with 17 of them included in the final review. The clinical case included in this paper was referred to the Department of Maternal Fetal Medicine, Filantropia Clinical Hospital in Bucharest, during the second pregnancy after a first pregnancy that resulted in stillbirth with congenital heart block and fibroelastosis as a result of the maternal diagnosis of Sjogren’s syndrome with transplacental transfer of SS-A/Ro antibodies. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]