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Objectives. This study aimed to assess the impact of socio-economic factors on prenatal care accessibility and outcomes and to evaluate the effectiveness of specialized integrative prenatal care in mitigating these disparities. Materials and Methods. A prospective cohort study was conducted between 2020 and 2023 in Bucharest, Romania, involving 100 pregnant women. Participants were equally divided into two groups that received standard and specialized prenatal care. Data were collected through structured interviews, medical record reviews, and standardized questionnaires at multiple time points during pregnancy and postpartum. Results. Women receiving integrative care had longer gestation periods (37.8 vs. 37.6 weeks), higher average birth weights (3.3 kg vs. 3.14 kg), and fewer complications during labor (10% vs. 12.5%) compared to the standard care group. Socio-economic status significantly influenced outcomes, with lower income and education levels associated with shorter gestation periods and lower birth weights. Stronger support systems correlated with better mental health and improved pregnancy outcomes. Conclusions. Integrative prenatal care, which addresses both medical and psychosocial needs, significantly improves pregnancy outcomes, particularly for women of lower socio-economic status. Targeted interventions are essential to ensure equitable maternal and neonatal health outcomes. [ABSTRACT FROM AUTHOR]

Today, women’s health is a separate issue for doctors of many specialties, including obstetricians and gynecologists, family doctors, etc. There is a wide range of treatment options for managing diseases of the reproductive system in women. But despite this, many of these strategies do not work for our patients. Therefore, we need the latest personalized approaches to therapy. One of the newest trends in women’s health is the correction or restoration of the vaginal microbiome. In our previous publications, we have covered the issue of the normal composition of the vaginal microbiome and its changes in various pathological conditions. Modification of the vaginal microbiome can be a useful strategy in the treatment of sexually transmitted infections, bacterial vaginosis, candidiasis, benign, precancerous and even malignant diseases of the female reproductive system, miscarriage, preterm birth and other pregnancy complications. The concept of using exogenous microorganisms as a treatment has been known for centuries. Possible mechanisms by which exogenous strains of lactobacilli can affect vaginal microbiome include vaginal recolonization, increased production or release of lactic acid and other antimicrobial compounds, and modulation of the local mucosal immune response. From a microbiome perspective, “prebiotics” are nutraceutical compounds that induce bacterial growth or the activity of probiotics or beneficial endogenous microorganisms. One of the limitations of prebiotics is their dependence on the presence of lactobacilli, which are absent or almost absent in dysbiosis. Symbiotics are combinations of prebiotics and probiotics based on the concept that the first nutraceutical can improve the bacterial growth and function of the other. This review highlights the latest views on correction and/or restoration of the vaginal microbiome using not only probiotics, prebiotics, and symbiotic, but also phage-altering agents, phage therapy, vaginal microbiome transplantation, etc. Such methods of correction and/or restoration are currently relevant in the reproductive medicine, gynecology and obstetrics all over the world. Despite the fact that these are the newest methods of correction and/or restoration, they are developing every day and require more detailed coverage of this issue. [ABSTRACT FROM AUTHOR]

Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening condition that develops in the third trimester of pregnancy. AFLP shares similar clinical features with other more common pregnancy-associated conditions. However, early correct diagnosis is important for maternal and fetal survival. Once the diagnosis has been established, immediate delivery and maternal intensive support should be undertaken. Both parents and the infant should be tested for deficiencies of the mitochondrial fatty acid oxidation, especially for long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency, as many cases of AFLP are related to disruption of this physiological enzymatic pathway.

Tuberculosis (TB) in pregnancy is not only a matter of the past; it is also a current problem. These days, TB appears through mass migration and tourism in countries where it was believed that this condition is eradicated. Adequate knowledge about the medical history of patients, risk factors, diagnosis and treatment of tuberculosis should be part of the armamentarium of each physician involved in clinical practice. TB is mainly found in urban and socially deprived areas. Due to the length of the treatment, there is an increased risk of drug resistance in partially treated patients. Strong knowledge about the history, risk factors, diagnosis and treatment of TB should be part of the armamentarium of each physician. Many practitioners are reluctant to request a chest X-ray in pregnancy due to the fear of harming the fetus. Bypassing a diagnosis can have a devastating effect on the mother and fetus, as well as their family and medical staff. This article discusses the matters of diagnosis and treatment of asymptomatic infection and active TB in pregnancy. [ABSTRACT FROM AUTHOR]

Facial dysmorphism is a common diagnosis which represents a broad spectrum of aetiologies with different outcomes spreading from normal outcome to foetal demise or new-borns with multiple malformations. Prenatal diagnosis can be difficult, making counselling a challenging task even in experienced hands. This paper aims to present an unusual case of facial dysmorphism (Binder phenotype) which resulted in a normal pregnancy. However, throughout the pregnancy, future parents experienced excruciating anxiety, which required multiple prenatal counselling appointments. We believe that in case of a Binder phenotype, genetic testing, multiple scanning appointments and extensive discussion with future parents are vital in the prevention of an unneeded ending of a pregnancy. [ABSTRACT FROM AUTHOR]

The last decade has seen incredible advances in the genetic era, in next-generation sequencing of cell-free DNA in the maternal plasma, detecting abnormal fetal chromosomes. Non-invasive prenatal testing (NIPT) has showed increased sensitivity and specificity for Down syndrome superior to any other screening test. Technical advances have made possible the detection of other conditions which does not necessarily mean clinical benefit for the patient. Private laboratories have added multiple conditions in the panel of NIPT, but some of these abnormalities are so rare, that their prevalence is not even clear. Data regarding clinical performance of extended NIPT is lacking. Implementation of such a test has to be carefully weighed, and not only the benefits but also the harm should be taken into account. [ABSTRACT FROM AUTHOR]

A case of uterine rupture at 24 weeks in a pregnancy succeeding myomectomy and triple embryo transfer is described and literature is reviewed systematically to evaluate the importance of uterine rupture in pregnancies after myomectomy in general and some important sub-populations. Systematic search identified 179 papers and following a strategical selection process 45 studies were analyzed in detail, including 6 cohort and 19 observational studies, 3 case series and 17 case reports. Comparison of risk of uterine rupture after abdominal and laparoscopic myomectomy is made. In pregnancies after IVF number of embryos transferred are determined. Optimal contraceptive intervals and surgical techniques are discussed. The consequences of these observations are analyzed and conclusions are made which can assist individualizing treatment options and improve patient selection. [ABSTRACT FROM AUTHOR]

Patients with positive Her-2/neu breast cancer and a high risk of recurrence are known to benefit from the addition of the dual blockade of Her-2/neu with Trastuzumab and Pertuzumab to the neoadjuvant chemotherapy, a combination which has been demonstrated to give a higher rate of a complete pathologic response in the breast and in the axilla. The purpose of this review is to outline the efficacy of the dual blockade with Trastuzumab and Pertuzumab in the neoadjuvant treatment of high-risk Her-2 positive breast cancer. Electronic databases (Pubmed, Medline, and Cochrane Database of Systematic Reviews) were searched for English- and German- language studies, which were published in the last ten years. The search has been focused on neoadjuvant clinical trials as well as on the data presented in the abstracts published at the San Antonio Breast Cancer Symposium as well as at the annual meeting of the American Society of Clinical Oncology. The results reported in the published clinical trials demonstrated a higher pathologic complete response rate in breast and lymph nodes after using targeted therapy with two anti-Her-2/neu agents - Trastuzumab and Pertuzumab in combination with neoadjuvant chemotherapy for early-stage Her-2/neu positive breast cancers. The pathologic complete response rate is the most important prognostic marker in Her-2/neu positive tumors, a higher pathologic complete response rate being demonstrated to be associated with a better survival outcome in terms of higher overall survival and disease-free survival rates. [ABSTRACT FROM AUTHOR]

Celiac disease (CD) is characterized by an abnormal immune response in susceptible individuals to dietary gluten derived from wheat, rye and barley. The disease affects not only the small bowel mucosa, but also many other extraintestinal organs resulting bone, liver, neurologic, skin and reproductive system disorders. The details of the pathogenic mechanism are not perfectly clear yet, but it is now proved that both humoral and cellular immune responses are triggered and autoimmune mechanisms are implicated. Studies have shown association of different pregnancy outcomes with maternal celiac disease. In this review, the most frequent fetal and neonatal outcome related to CD are presented, with a special focus on intrautherine growth restriction (IUGR) and prematurity. The need of active case finding of CD is discussed. [ABSTRACT FROM AUTHOR]

Introduction. Human reproduction is a vast field, in continuous research. Reproductive immunology represents the medical area that deals with the interactions between the immune response and the reproductive system and the adaptation of the mother’s body to pregnancy and abortive disease regarding the response to embryonic “stimulus” may influence the new treatments and the understanding of pregnancy in the immune context. Among the problems that can cause infertility, there are the immune dysfunctions of the human reproductive system. Methodology. This presentation is a literature review with interest in information on reproductive immunology. Discussion. Human reproduction has many influencing factors, but adaptive immunological mechanisms are an area to consider given the pathology associated with reproduction. Conclusions. Normal reproductive function is given by the interaction, not the competition of the immune and reproductive systems from the formation of gametes to fertilization, implantation and the balance of the mother-fetus interface. [ABSTRACT FROM AUTHOR]

Objectives. Literature analysis of the influence of HPV genital infection on the pregnancy outcome. Methodology. A series of studies and literature data were evaluated regarding the risk of human papillomavirus infection in pregnancy and the implication in premature birth. Results. Six studies were included in the paper. HPV alone or surgical interventions due to HPV infection were analyzed as a risk factor in the outcome of the pregnancy. The results of the studies varied. The three studies that analyzed HPV-related disease of the cervix concluded that HPV is incriminated in poor pregnancy outcome. Three studies of the PPROM and HPV had different results. One study showed that HPV is not involved in pregnancy outcome, while the other two studies offered data, concluding that HPV is involved in premature birth. Conclusions. Research on the HPV involvement in premature birth offer precious data that may lead to new research area in the near future, with valuable results and influence in the pregnancy outcome. [ABSTRACT FROM AUTHOR]

The ideal screening test for cervical cancer is the one that has the ability to correctly and effectively identify all patients with premalignant changes, while at the same time exclude those without changes. Unfortunately, no test is perfect. Cervicovaginal cytology is the traditional screening method, independently described by Aurel Babeș and George Papanicolaou in 1927 and 1928, respectively. Data from the scientific literature report a relatively low sensitivity for conventional cytology, ranging from 20% to 50%, and a specificity in the identification of HSIL lesions that can reach up to 90%, based on the experience of the examiner. Given the mechanism of cervical carcinogenesis, the detection of human papillomavirus (HPV) infection is currently one of the main screening alternatives, especially in the context of the dramatic cost reductions which occurred in the recent years. HPV testing may have a sensitivity of up to 17% higher compared to classical cytology, but the latter is known for a slightly increased specificity compared to HPV testing. Although HPV testing is more effective in identifying high­grade lesions, it generates more indications for colposcopy. However, a negative HPV result is more encouraging than a negative cytological result, because the cytological examination is more likely to be false negative, which would lead to delays in the application of appropriate treatment. Regardless of age group stratification, cytological and HPV co­testing have a much higher sensitivity (>92%) in the identification of premalignant lesions compared to isolated testing. [ABSTRACT FROM AUTHOR]

This study provides a conceptual exploration of an innovative telemedicine-enhanced team-based care (TETC) model, tailored to prenatal care, integrating a multidisciplinary team approach with advanced telemedicine technologies. The algorithm developed for TETC aims to optimize communication and coordination among healthcare professionals, including obstetricians, midwives, nutritionists, and mental health experts. This cohesive team structure ensures a comprehensive care plan encompassing all facets of maternal and fetal health. Leveraging telemedicine tools like video conferencing and digital health records, the model supports remote consultations and coordinated care, proving particularly advantageous during pandemics or in regions with limited healthcare access. Central to the TETC model is patient-centered care, focusing on personalized care plans attuned to the individual needs, health status, and socioeconomic backgrounds of pregnant women. This approach not only enhances accessibility and convenience by diminishing the necessity for physical consultations but also ensures continuity of care throughout pregnancy. This continuity is crucial for consistent health parameter tracking and early risk identification. The paper discusses the model's design, operational workflow, and ethical and legal considerations, providing implementation guidelines and potential applications. The TETC model, rooted in current technological capabilities and healthcare frameworks, underscores the need for close collaboration with healthcare professionals to adhere to medical standards and address real-world requirements effectively., Competing Interests: The authors declare no conflict of interest., (© 2024 by the authors.)