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Vesicouterine fistula is a rare complication occurring mainly after cesarean sections. We present here a particular case of vesicouterine fistula (VUF) whose only symptom was urinary incontinence. We describe the diagnostic methods used and the surgical treatment used to resolve the case. A 30-year-old woman presented to the gynecology clinic with urinary incontinence that occurred 5 days postoperatively after a cesarean section. The diagnosis was made on the basis of computed tomography and cystoscopy. Treatment was surgical and consisted of excision of the fistula and suturing of the bladder and uterine wall, without interposition of the omentum. Postoperative evolution was uneventful. When the urethral catheter was removed on the 14th postoperative day, the patient presented spontaneous micturition without vaginal urine leakage. In the context of urinary incontinence after cesarean section, although it is a rare complication, we must consider the occurrence of a VUF.

Abstract Background Cervical cancer is a major public health problem worldwide. While Romania has the highest incidence of cervical cancer in Europe, the prevalence of HPV has not been evaluated. We report the first data on HPV prevalence and type distribution in Northeast Romania. Methods HPV prevalence and genotype distribution was investigated in 514 consecutively women with or without cervical lesions in Northeast Romania. Genotyping was performed with Linear Array Genotyping/Roche kit. Results In our study group, 192/514 (37.4%) patients were positive for HPV (infected with single and with multiple HPV types). Most frequent types were: 16 (10.5%), 53 (5.44%), 51 (5.05%), 52 (4.08%) 18 (2.91%) and 31 (2.73%). Conclusions Infection with high risk types of HPV is common in Northeast Romania. Enhanced and systematic screening for cervical cancer is needed. Our results call for the implementation of a National HPV vaccine program in Romania.

It is known that the cervical length is a predictive factor for pregnancy evolution to term, but there have not been conducted any trials yet to correlate it with myometrial electrical activity on long term. Nowadays, we don't dispose of a simple, widely available technique to objectively monitor uterine contractility during pregnancy, in order to assess the risk of preterm birth. Our aim was to evaluate the relation between clinical elements, the cervical length and the uterine contractility as recorded by antepartum electromyography. In this study were included 113 women with singleton pregnancies, with gestational age 20-29 weeks divided in two groups: 44 women with short cervical length and 69 with cervical length >25mm. The cervical length is indirectly correlated to the mean contraction frequency, and the contraction percentage was significantly lower in the normal cervix group when compared to the short cervix group. The mean number of contractions was slight increase in the short cervix group (11.27±9.59 vs 9.80±7.05 contractions/hour). 58% of the short cervix patients present a significantly high number of contractions/hour, of low amplitude, and more than 55% present great amplitude and duration of contractions. About 67% of the short cervix patients present high contraction areas. Maternal activity between 10 am-11pm was more pronounced for both study groups. Electromiography has proven its efficacy and utility in obstetrical practice for identify a short cervix, which is a risk factor for premature birth, and recommend the proper treatment. [ABSTRACT FROM AUTHOR]

Introduction/aim. Stillbirth represents a devastating experience for both family and care providers. The proportion of unexplained fetal deaths can be reduced following a rigorous and systematic evaluation and identifying a cause of death helps emotional healing and closure for parents, reducing the recurrence risk for future pregnancies. The objective of this study is to establish the fetal death causes, comparing with other data from the literature, and to propose a protocol for earlier assessment. Methodology. The retrospective, descriptive study included 300 cases of stillbirths hospitalized between 2015 and 2022 in the Department of Obstetrics of the “Cuza Vodă” Clinical Hospital of Obstetrics and Gynecology, Iaşi, a Romanian tertiary care maternity. The main inclusion criteria were all stillbirths ≥24 gestational age or ≥500 g weight birth. According to these criteria, the selected cases were subgrouped into four categories: extremely preterm birth (less than 28 weeks), very preterm (28-32 weeks), moderate to late preterm birth (32-36 weeks), and post-term pregnancies. A clinical, laboratory, ultrasonography and histopathological assessment was performed in all cases. Results and discussion. Possible causes of fetal death in more than 60% of stillbirth cases were identified, thus obtaining similar results to the scientific international literature. The most common causes of stillbirth were: infectious, hypertensive disorders, preexisting diabetes and gestational diabetes, umbilical cord abnormalities (excluding nuchal loop), and placental insufficiency, fetal structural and genetic abnormalities. Moreover, a checklist was designed in order to evaluate parental and current pregnancy history together with blood test parameters, trying to investigate other possible factors that can contribute to stillbirth. Conclusions. A systematic assessment including infectious medical history, placental examination, perinatal autopsy, and chromosomal microarrays represent important tools for determining the cause of stillbirth, and further investigations should be recommended when clinical findings are suggestive for a specific death cause. [ABSTRACT FROM AUTHOR]

Introduction/aim. The health of children born after assisted reproduction is of major interest, since already up to 6% of children born in European countries are the result of assisted reproductive techniques (ARTs). Frozen embryo transfers (FETs) are on a steep rise and comprise 32.6% of all ART treatment cycles in Europe. Although most in vitro fertilization (IVF) pregnancies are uncomplicated, there is an association with increased risks of maternal, fetal and perinatal outcomes. Methodology. The retrospective, descriptive study included 300 cases of in vitro fertilization pregnancies hospitalized in our department between 2016 and 2022. We recommend genetic counseling to all patients who have undergone IVF with or without intracytoplasmic sperm injection (ICSI). Results and discussion. The accuracy of firsttrimester genetic screening tests for aneuploidies may be affected by IVF, with a potential increased risk of false positive results for aneuploidies in patients who undergo first-trimester combined screening. We did not find associations between IVF (with and without ICSI) and congenital malformations. Several placental implantation disorders are more common with IVF (higher risk for abnormal placental structure: bilobed placenta, accessory placental lobes, placenta praevia, vasa praevia). We found a higher risk for preterm birth, low birth weight, very low birth weight and preeclampsia. Risks are more than doubled in IVF twin gestations. The assessment of fetal growth should be performed in the third trimester, with weekly antenatal fetal surveillance beginning by 36 weeks. Conclusions. IVF is associated with an increased risk of adverse maternal and perinatal outcomes. However, evidence is limited regarding whether specific screening, diagnostic or preventative interventions during pregnancy obviate or reduce such risks. Specific technical characteristics of IVF and the presence of underlying infertility affect the risks of adverse clinical outcomes. Therefore, individualization of care may be ideal for optimizing outcomes. [ABSTRACT FROM AUTHOR]

Introduction/aim. Postpartum hemorrhage (PPH) represents one the main causes of maternal death all over the world, among infections, preeclampsia, eclampsia, unsafe abortion and complications of delivery. In cases with severe hemorrhage (≥1500 ml), the blood product transfusion will significantly contribute to maternal morbidity. Thus, only by understanding the complex changes in the coagulation cascade we will be able to intervene optimally, without having harmful side effects. Materials and method. The increasing number of caesarean sections (C-section) determined a high incidence of the placenta accreta spectrum disorders, contributing significantly to PPH cases. A retrospective, descriptive study was carried out between 2018 and 2022, which included patients who underwent hysterectomy for severe postpartum hemorrhage after C-section (e.g., accreta, atony, uterine rupture, leiomyomas). Maternal characteristics that include parity, gestational age, number of fetuses, presence of placenta praevia and previous C-section were documented. The preoperative coagulation tests were performed in all cases, and a multimodal management regimen was used for the majority of severe PPH cases, before resorting to a hysterectomy, including the administration of tranexamic acid and recombinant activated factor VII. Also, the transfusions of blood products (e.g., packed red blood cells, fresh frozen plasma, thrombocyte concentrate), characteristics of the hysterectomy and intraoperative complications, has been recorded too. Results and conclusions. This retrospective, hospitalbased study made a considerable share to available knowledge about peripartum hysterectomies. One of the worst scenarios in postpartum hemorrhage represents the coagulopathy. The iatrogenic factors such as hypothermia, massive transfusion, quantity and type of replacement solutions can increase the intraoperative morbidity. The major indication for PPH was abnormal placentation (placenta accreta), reason why it should be utilized thromboelastography (TEG) and rotational thromboelastometry (ROTEM) as methods to individualize the treatment for coagulopathy, and to initiate it immediately. [ABSTRACT FROM AUTHOR]

Introduction. Preexistent maternal hypertension requires usually treatment from the beginning of pregnancy. If the causes remain unknown, they can lead to a poor outcome of the fetus and can have a strong psychological impact on the mother. Case presentation. A 27-year-old patient, known for 10 years with severe arterial hypertension, presented for an investigation with angio-MRI following a second-term intrauterine fetal death at 18 weeks of pregnancy. The angio-MRI objectivated a 90% occlusion on the right renal artery. A double-stent was placed, leading to a significative reducing of the occlusion to only 10%. Normal values of the blood pressure were achieved and no medication was further acquired for this pathology. Currently, a second pregnancy was achieved, now the patient being followedup, at 37 weeks of gestation, with no complications until now, and she will be giving birth the following weeks. Discussion. The management of severe arterial hypertension was difficult to achieve for this patient, in her first pregnancy. She was treated with alpha-methyldopa 250 mg per day and nifedipine, without success, unfortunately. The importance and success of this case were given by the resilience of doctors who discovered the stenosis after her fourth MRI. Conclusions. Although rare, we can say that there are cases with congenital renal artery stenosis that can be treated in young women, helping them conceive spontaneously healthy babies. The multidisciplinary follow-up was important in this case, as the patient was first refused for angio-MRI because of allergic reaction to intravenous substance. [ABSTRACT FROM AUTHOR]

Introduction. Peripartum cardiomyopathy (PPCM) is a relatively rare cardiac disease that manifests in the final stage of pregnancy and in the first months after delivery in women with no preexisting heart disease. Many etiological processes have been suggested: viral myocarditis, abnormal immune response to pregnancy, excessive prolactin excretion, prolonged tocolysis and a familiar predisposition to PPCM. Its diagnosis is often delayed because its symptoms, which include fatigue, dyspnea and palpitations, are nonspecific. For this reason, the diagnosis of PPCM is still made by exclusion of other etiologies. Methodology. We conducted a multidisciplinary assessment of the case of a 28-year-old patient who presented with suggestive cardiovascular symptoms shortly after caesarean section delivery. Under the guidance of our cardiology department, the patient was diagnosed and treated promptly. Given the complexity of the case, we reviewed multiple literature data and we hereby present a summary of our findings. Results. The overall prognosis of PCM is good in the majority of the cases, although some patients may progress to irreversible heart failure. Progression of the condition requiring heart transplantation is described in 4% of cases, and death appears in 9% of cases at a two-year follow-up. Complete recovery of systolic function occurs usually in the first six months after delivery, although the recovery phase need not be limited to the first 12 months. Continuing improvement was observed in the second and third year after diagnosis. Persistence of the disease after six months portends worse survival. Conclusions. PCM is a relatively rare disease which can have devasting consequences and should be promptly identified and correctly treated. Early diagnosis is important and, therefore, women who develop symptoms of heart failure during pregnancy or shortly after that should be investigated for this condition. The effective treatment reduces the mortality rates and increases the chance of complete recovery of the ventricular systolic function. [ABSTRACT FROM AUTHOR]

Introduction. Pregnancy and fibroma can occur simultaneously, although depending on the localization of the fibroma, it can pe associated with female infertility. We present a case successfully resolved last year in our clinic: a 44-year-old patient who obtained spontaneously a pregnancy after 10 years of fertility treatments and managed to follow to term the pregnancy simultaneously with a gigantic polyfibromatous uterus. Case presentation. The patient D.M. was given small chances to conceive naturally, in her thirties, because of her polyfibromatous uterus (more than 10 uterine fibromas that continued to grow as years followed). She tried in vitro fertilization, without success, and in 2021 she managed to conceive naturally. Her doctor was naturally reserved and managed her pregnancy monthly, the patient being diagnosed at 28 weeks of gestation with gestational diabetes. At that moment, we could measure with difficulty the fetus, because there were at least six fibromas of 8 cm each, most of them intramurally. She was programed at 37 weeks of gestation for caesarean section following transverse presentation. A baby boy, weighing 2640 g, with Apgar scores of 5 (at 1 minute) and 7 (at 5 minutes), was born, due to the difficult extraction. Discussion. The obstetrics and gynecology team, after the consent of the mother, decided to do simultaneously total interanexial hysterectomy for this patient, because the uterus was globally enlarged up to her diaphragm, even after delivery. We also performed bilateral hypogastric artery ligation. Preoperatively, blood tests were taken, and isogroup and isoRh were prepared. The patient received intravenous ferrum postoperatively and left the hospital after a week of triple antibiotic association and anticoagulant prophylactic therapy, with a hemoglobin level of 9.7 g/dl and a hematocrit level of 27%. Conclusions. We successfully present the unique case of a primiparous 44-year-old patient who managed to conceive and to give birth at term to a healthy baby, but also the disciplinary approach to the polyfibromatous uterus, as it further endangered the patient’s life. [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.)

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.)

Assisted Reproductive Technology techniques (ART) have been raising psychological controversies since the beginning, from contesting the procedure itself to challenging the various situations and ways in which ART could be performed. For many of those issues the verdict is mainly influenced by cultural, religious and political differences amongst countries. It is unlikely to reach a consensus on these matters in the near future. At the same time, there are several ethical challenges concerning the individual medical management of the very heterogeneous population of patients referred to in vitro fertilization (IVF)/ART which could be easier brought to a common point of view of the specialists involved in ART. Practically, about one in 5-6 child-seeking couples confronts primary or secondary fertility issues. Comparing the level of secondary infertility (frequently reproductive ageing and gynecological disorders related) in Romania (and Eastern European countries) versus high income countries we might associate the important difference observed with the socio-economic and medical access differences between those groups of countries. Our study analyzed the social issues regarding optimal access to ART and the medical and ethical challenges involved in providing optimal individualized ART treatments to infertile patients /couples. [ABSTRACT FROM AUTHOR]

Urinary incontinence is a major cause of morbidity and invalidism which influences the quality of life and affects women of all ages. Therefore, this represents a social or hygiene problem and can be objectively demonstrated. In this context, urinary incontinence can be considered a public health problem, as it causes a significant decrease in the quality of life and affects the patient's life socially, psychologically, occupationally, physically and sexually. The study addressed these women's quality of life, so that the result of the analysis would be an optimal collaboration with the patients in order to find the best possible diagnosis and treatment methods. As it is not a life-threatening condition, but rather a personal and social hygiene problem, the necessity of a treatment was perceived differently depending not only on the level of education, but on the degree of social and professional integration, too. [ABSTRACT FROM AUTHOR]

Endometriosis is a chronic disease characterized by the ectopic presence of endometrial-like tissue, which mainly affects women of reproductive age and generates symptoms that can have great impact on their physical, mental and social well-being. In Romania, more and more women are being diagnosed with endometriosis due to increased addressability to gynecologists for chronic pelvic pain and to increased possibilities of diagnosis by ultrasonography and laparoscopy. Therefore, gynecologists must be prepared to manage and counsel such patients. It is the doctor's duty to establish a diagnosis as early as possible and to inform the patient about the possibility of recurrence and the associated infertility. The chronic pelvic pain associated with endometriosis must not be considered a trifling symptom, because it is invalidating and it significantly affects the quality of life. A symptomatic treatment for strictly relieving the pelvic pain should not be recommended without considering the possibility of endometriosis and without further investigating the patient. After achieving the diagnosis, which most often occurs quite late, it is necessary to pursue a treatment protocol that sometimes raises difficult ethical dilemma due to the high risks and side effects on one hand and the limited benefit on the other hand. In some cases, pain is so invalidating that the last resort is total hysterectomy. Affected women are usually nulliparous, and recommending radical surgery to remove all endometriosic implants (thus abolishing the pain) would make it impossible for the patient to ever conceive a child. In this article the authors discuss the ethical challenges raised by endometriosis in terms of diagnosing and treating the disease and illustrate the gynecologists' dilemmas through clinical cases. [ABSTRACT FROM AUTHOR]

Preeclampsia is an important problem of public health, leads among the main causes of mortality and morbidity worldwide. There are many patho-psychological abnormalities of preeclampsia, but its etiology is poorly known. Aim. The study intends to find out the possibilities and limitations in diagnosing and treating this disease. The objective of this study was to establish that the C reactive protein is an efficient marker of preeclampsia and it correlates significantly with the severity of this disease. Material and method. The patients were selected from the pregnant women who were hospitalized in "Cuza Vodă" Iaşi Clinical Hospital of Obstetrics and Gynecology (n=82), in the period of time between 2003 and 2012, with a gestational age of over 20 weeks, and who came here for a speciality consult. The study was retrospective and case-control type; it was focused on the clinical-progressive aspects of preeclampsia, by checking the correlation of inflammatory parameters with blood pressure for a lot of pregnant women with preeclampsia, in comparison with a lot of normal pregnant women. Results. The severe forms of preeclampsia can be found in older age (25-43 years old), with an average around 37 years old (p=0.02). According to the cases studied, the severity of preeclampsia was noticed for average values of blood pressure of about 155 mmHg (p<0.001). The average values of C reactive protein were significantly higher for women with severe preeclampsia (89.14 ± 51.31 mg/l) (p<0.001). Conclusions. The severe forms of preeclampsia represent a major cause for maternal morbidity and mortality, especially in the complicated cases with HELLP syndrome and acute pulmonary edema, cerebral hemorrhage, acute respiratory infections, cuoagulopathy. [ABSTRACT FROM AUTHOR]

Preeclampsia is an obstetric complication that is characterized through hypertension and proteinuria which appear after week 20 of pregnancy, more frequent in the last week before labour. The pregnancy can induce or worsen hypertension; the increase in systolic blood pressure with 30 mmHg and/or the diastolic blood pressure with 15 mmHg represents a risk factor in preeclampsia. The prediction of preeclampsia has a prognostic of over 75% if the data is correlated with the pulsatility index obtained by uterine artery Doppler procedure and is also correlated with the craniocaudal length of the fetus. [ABSTRACT FROM AUTHOR]

Introduction/objective. Zika virus (ZIKV) is a dangerous infectious agent, due to its potential to cause severe teratogenic results, especially an abnormal brain development – microcephaly. It is also well known that the most common geographical areas for the transmission of this disease are South and Central America, South Asia, the Pacific region and, in particular, the United Kingdom, which is contracted by mosquito bites. Methodology. For this paper, we consulted studies in the literature and selected the essential information on the complications of this infection. Results. Pregnant women are advised to avoid traveling to these areas or contraception for three months after returning from one of these regions. Like other agents, ZIKV can be transmitted vertically through the placenta during pregnancy, with potentially harmful consequences for the fetus. The easy clinical presentation made it difficult to establish a case definition for ZIKV infection in pregnant women. Zika virus infections during pregnancy are mainly identified using nucleic acid amplification and serological tests. Discussion and conclusions. While highly sensitive and specific laboratory diagnostic tests will improve the identification of maternal ZIKV infection before severe fetal abnormalities occur, there are currently no antivirals available to prevent the vertical transmission of Zika virus to humans. [ABSTRACT FROM AUTHOR]

Introduction/objective. Group B Streptococcus (GBS) is normally found in the body. This is one of the important factors that should be investigated during pregnancy. In women, group B Streptococcus is most often found in the vagina and rectum, which is why there is a risk of transmission from a pregnant woman to the fetus during labor, the chances of which decrease when the mother receives treatment. Methodology. For this paper, we consulted studies in the literature and selected the essential information on the complications of this infection. Results. Pregnant women are tested for GBS as part of routine prenatal care between 36 and 38 weeks of pregnancy. If the results show that GBS is present, most women will receive intravenous antibiotics once the labor has begun. This is done to help protect the fetus from being infected. The best time for treatment is during labor. Penicillin is the most commonly used antibiotic to prevent early-onset disease in newborns. Discussion and conclusions. Pregnant women should be tested for GBS, and if the test is positive, the baby can be monitored for GBS after birth. [ABSTRACT FROM AUTHOR]

Introduction. Human immunodeficiency virus (HIV), that ultimately determines the development of AIDS, evolved in time in a pandemic disease. Objectives. Our study evaluated first-trimester markers for aneuploidy in HIV-positive pregnant women under HAART (highly active antiretroviral therapy). Materials and method. This was a prospective study that took place between January 2018 and December 2019 in the “Cuza Vodă” Clinical Hospital of Obstetrics and Gynecology, Iaşi, Romania. We analyzed first-trimester PAPP-A (pregnancy-associated plasma protein A) and βHCG (β human chorionic gonadotropin) levels in 25 HIV-positive pregnant women under HAART and compared them with the values of these markers in 31 seronegative pregnant women. Results. Both βHCG and PAPP-A were lower in HIV-positive women under HAART. Discussion. These alterations of first-trimester markers for aneuploidy might lead to an overestimation of the risk for Down syndrome. Conclusions. Obstetricians need to know the alterations of first-trimester markers for aneuploidy, so that they can correctly advise these women accordingly. [ABSTRACT FROM AUTHOR]

Introduction. Human immunodeficiency virus is a virus that causes AIDS (acquired immunodeficiency syndrome), a disease that has a major socioeconomic impact. Materials and method. In our study, we tried to assess both fetal heart structure and function in HIVpositive pregnant women under antiretroviral therapy (HAART – highly active antiretroviral therapy). It was a prospective study that took place between January 2018 and December 2019. The hearts of 14 fetuses from HIV-positive pregnant women on antiretroviral therapy were assessed. Results. We found some statistically significant sex-related cardiac changes in HIV-exposed uninfected fetuses. We detected a narrowing of the aorta in female fetuses and also smaller left ventricular transverse diameter in male fetuses. The myocardial performance index remained unaltered. Discussion. Because the majority of the patients included in this study had undetected viral loads, the effects on cardiac structure and function seems to be due to antiretroviral therapy. The effects of antiretroviral therapy on fetal heart seem to be sex-related. Conclusions. A more complete image about the risks and benefits of antiretroviral treatment, and also adopting management strategies to improve fetal outcomes, may also ensure better compliance of mothers to this vital treatment, that succeeded in turning a high mortality disease in a chronic one, with rates of survival similar to those of unaffected people. [ABSTRACT FROM AUTHOR]

Introduction. Meeting the contraceptive needs of women living with HIV (WLHIV) has primary health benefits for them, in addition to being a key element to prevent mother-to-child HIV transmission. This analysis will estimate the current number of infant HIV infections prevented by contraception. Methodology. We performed a literature search of PubMed to identify reports of drug interactions between hormonal contraceptives (HCs) and antiretroviral drugs (ARVs). We also reviewed the guideline of contraceptive hormone preparations and antiretrovirals for additional data and recommendations. Results. Several studies of combined oral contraceptive pills (COCs) identified decreased serum estrogen and progestin levels when co-administered with certain ARVs. The contraceptive efficacy of injectable depot medroxyprogesterone acetate (DMPA) and the levonorgestrel intrauterine system (LNG-IUS) were largely unaffected by ARVs, while data on the contraceptive patch, ring and implant were not significant information to mention. Conclusions. Contraception continues to play an integral role in global HIV prevention efforts in the era of increasing HIV treatment coverage, especially in poor-income countries. Broad contraceptive availability, increased contraceptive voluntarism and method mix are key components to preventing unintended births and ending new infant HIV infections worldwide. [ABSTRACT FROM AUTHOR]

Introduction. The increased social and economic burden caused by the novel COVID-19 outbreak is gradually becoming a worrisome issue for the health sector. The novel coronavirus invades the target cell by binding to ACE2, which is widely expressed in the ovaries, uterus, vagina and placenta. Significantly, the SARS-CoV-2 is said to interrupt female fertility through regulating ACE2. Thus, it is essential to investigate if SARS-CoV-2 infection hampers female fertility, given that there is no systematic and comprehensive evidence on the association of COVID-19 with fertility. Materials and method. We performed a web research regarding male and female fertility and COVID-19. The eligibility criteria included: population aged 13-49 years old; exposure (infection with SARS-CoV-2); comparison (population without SARS-CoV-2 infections or latent SARS-CoV-2 infections); and outcome (female fertility, such as ovarian reserve function, uterine receptivity, oviducts status and menstruation status, male fertility and parameters). Results. Some studies showed that COVID-19 vaccines don’t impair fertility in men or women, but SARS-CoV-2 infection could potentially affect a man’s fertility for up to 60 days; for example, being 18% less likely to conceive during the next cycle of their female partner, compared with men who had not tested positive. Conclusions. Further data need to be acquired to synthetize the new effects on the population. Any infection – particularly an infection that involves fever – can affect sperm production and can affect ovulation, factors that apply in COVID-19. [ABSTRACT FROM AUTHOR]

Introduction. An isthmocele, a caesarean scar defect or uterine niche, is any indentation representing myometrial discontinuity or a triangular anechoic defect in the anterior uterine wall, with the base communicating to the uterine cavity, at the site of a previous caesarean section scar. Methodology. We studied the literature and we analyzed international standards of treatment regarding this defect and the criteria which are important for the treatment algorithm. Results. The hysteroscopic resection of isthmocele is a minimally invasive, non-time-consuming and low-morbidity procedure, allowing visualization and repair of the defect. A laparoscopic approach has been advocated for large defects (RM<3mm), in the presence of symptoms and desire to maintain fertility. Conclusions. The increasing prevalence of isthmocele, through its gynecological and obstetric complications, caused by the increasing number of caesarean sections (CS) deliveries performed worldwide, is alarming, therefore isthmocele should figure as a differential diagnosis in women with previous CS deliveries, especially in those with risk factors of multiple previous caesarean sections and retroflexed uterus. [ABSTRACT FROM AUTHOR]

Introduction. Parvovirus B19 (B19V) is the causative agent of the relatively benign childhood disease erythema infectiosum (fifth disease). Maternal B19V infection can lead to serious fetal complications during pregnancy. Up to 50% of women are nonimmune and susceptible to B19V infection. Methodology. We studied the literature and we search for the most frequent complications that were reported in the European Union regarding the parvovirus B19 infection. Results. Infection may result in anemia, spontaneous abortion and/or hydrops fetalis. The early diagnosis of B19V infection will identify those at risk and may allow for early intervention therapy, thereby improving fetal survival. The virus is spread via aerosol droplets through the respiratory route. It can be spread transplacentally to the fetus during active maternal infection (33% transmission rate across the placenta). Conclusions. Most pregnant women are asymptomatic but, for an appropriate patient management, there is a need for an accurate B19V diagnosis. [ABSTRACT FROM AUTHOR]

The paper describes a research–development which had the objective to implement and manage the Electronic Patient Record in a multifunctional pilot platform named PROMED. The Electronic Patient Record implemented by PROMED platform is mainly aimed to facilitate both patient and health providers access to the health records and to provide an optimization of diagnostic and decision in healthcare services based on patients' medical history and medical statistics. The project promotes modern information and communication technologies for increasing quality and efficiency of healthcare services in an information based society. The PROMED platform is expected to contribute specifically to the improvement of the healthcare services in Romania by offering a solution for the integration of the main stakeholders involved in national healthcare system: patients, health service providers and public health authorities. The pilot system is first implemented in the “Cuza Voda” Obstetrics and Gynecology Hospital in Iassy, an important universitary and cultural city in the North East of Romania. [ABSTRACT FROM AUTHOR]