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A successfully implemented screening program for cervical cancer is essential for detecting cervical intraepithelial lesions which offer the possibility of appropriate management and monitoring, implicitly the limitation of the progression to an invasive form of cancer. For different grades of squamous intraepithelial lesions, the use of vaginal tablets or applicators based on various natural substances as hyaluronic acid, beta-glucan and Coriolus Versicolor is possible with the purpose of expectative management or prior and post excisional intervention. We present the incidence trend of abnormal Pap smear results for the last five years in the University Emergency Hospital of Bucharest, with a summary of the literature regarding the biochemical mechanism of the main natural components from vaginal tablets used in the management of precancerous cervical lesions HPV induced and we share our personal experience with three clinical cases that benefited from this therapy. As there is a therapeutic window between the Pap-smear result, colposcopy and preparing for intervention, local treatment with natural components is a suitable choice as it is easy to use, inexpensive and efficient. The conclusion we reached is that the vaginal treatment with natural substances can be useful in terms of improving the local inflammatory process on the one hand and lubricating and regenerating tissues with the improvement of subsequent procedural performance on the other. [ABSTRACT FROM AUTHOR]

Cord blood collection for stem cell storage remains a popular procedure due to the advantages associated to it. In the last ten years, the therapeutic potential of umbilical cord stem cells was demonstrated in the treatment of bone pathologies, neuropsychiatry, metabolic and genetic diseases. There are several factors with direct influence on the quality and quantity of cord blood collection for stem cell storage. The collection principles should be individualized according to the maternal and fetal characteristics. Furthermore, in the context of COVID-19 pandemic, additional information can be obtained through this procedure. We present a specific case-adapted strategy for the collection of umbilical cord blood and its application in analyzing the transplacental transfer of maternal COVID-19 antibodies after vaccination. We suggest that the informed consent offered to the future parents prior to the procedure should include the history of COVID-19 during pregnancy, the vaccination status of the mother and the gestational age at the time when this event occurred. [ABSTRACT FROM AUTHOR]

Preterm and premature rupture of fetal membranes (PPROM) refers to membrane rupture before 37 weeks of gestation in the absence of labor. The frequency of association with premature birth is about 1/3 and the incidence in pregnant women is 3%. Under the conditions of lack of infection and under continuous antibiotic prophylaxis, the expectant management can prolong the pregnancy by about one week, the duration of prolongation being inversely proportional to the gestational age. For 14% of pregnancies at the viability limit, less than 24 weeks of gestation, complicated by membrane rupture, fluid loss will be self-limiting due to “restoring membrane integrity” by changes of the decidua and of the myometrium. A number of associated factors significantly affect the prognosis of these cases, namely: gestational age, presence or absence of fetal or maternal infection, presence of uterine contractions, fetal presentation, fetal status, fetal lung maturity, cervical status and maternity status. The reference decision in order to obtain the most favorable prognosis in the short and long term is the expectant approach or labor induction/ caesarean delivery. Expectant management implies an increased risk of intrauterine infection, abruptio placentae and umbilical cord prolapse. The administration of corticosteroids in pregnancies between 24 and 34 weeks with PPROM aims to reduce neonatal death by respiratory distress syndrome, intraventricular hemorrhage, ulceronecrotic enterocolitis, and the need for ventilator support. Birth within the first 48 hours of presentation without being required by emergency obstetric conditions may be considered after counseling the future parents about the prognosis of premature delivery and after corticosteroid cure was applied for pulmonary maturation corresponding to pregnancy smaller than 34 weeks. The preferential approach of these cases, applied by the authors, is the expectant management respecting the above mentioned principles, which, observationally, provide a superior prognosis. The comparative retrospective analysis of both neonatal and maternal characteristics of pregnancies with PPROM supports the maximal possible prolongation of the evolution of pregnancies complicated with PPROM. [ABSTRACT FROM AUTHOR]

The incidence of adherent placenta has known a continuous ascendant incidence in the last decades. A correct management implies prenatal care and a careful planning of birth. We present the case of a 31-year-old G4P3, 37 weeks and 3 days' gravida which presented herself at the emergency room, accusing unsteady painful low-intensity uterine contractions and asking for a cardiologic consult. The anamnesis revealed that this pregnancy was not properly monitored by a specialist and her medical history included two deliveries by caesarean section, a known untreated familial hypertrophic cardiomyopathy and a 36 weeks ultrasound scan describing a single fetus with a suspected cardiac hypertrophy and a praevia, anterior inserted placenta. In this context, the suspicion of an adherent placenta was confirmed by emergency ultrasound where a mild bladder invasion was observed. Due to the possibilities offered by an emergency medical hospital complete preparation for delivery was possible during one hour. A successful cesarean hysterectomy was performed, with the extraction of the fetus from transverse presentation trough vertical hysterotomy and rapid closing of the uterine incision after cutting the cord. The vezicotomy for uterine catheterization and excision of invaded submucosal area and subsequent hysterectomy were uncomplicated. Both mother and fetus presented a favorable prognosis. We present this case in the context of its complexity and the successful applied approach. [ABSTRACT FROM AUTHOR]

Introduction: Being associated with a systemic infection, SARS-CoV-2 affects multiple organs, including the placenta. SARS-CoV-2 placentitis is a new condition that shows the destructive effects of fibrin deposition in the perivillous area, chronic histiocytic intervillositis and trophoblast necrosis after the placenta is infected with SARS-CoV-2. Until now, there have been no published reports regarding the ultrasound signs of massive perivillous fibrin deposition and the recommended monitoring for these cases. Aim: Our aim was to analyze the sonographic appearance of the placenta in a series of SARS-CoV-2 infected pregnant women during their third trimester. Material and method: In all cases included in the present study, we performed serial obstetrical ultrasounds every seven days until delivery, followed by histopathological examination of the placenta postpartum. Results: In women with intrauterine growth restriction (IUGR), sonographic images of the placentas revealed that they matured faster within three weeks of receiving a COVID-19 diagnosis and reached a more rapid senescence. In all cases, there was a gradual increase in placental calcification from week to week, but only in pregnant women with a grade 3 placenta at the moment of inclusion in the study the deterioration was severe, leading to placental insufficiency and subsequently to IUGR. Conclusion: The cases who had an increased placental degree at the time of infection were associated with abnormally rapid placental aging. These aspects can be evaluated sonographically. [ABSTRACT FROM AUTHOR]

Preeclampsia is and remains an actual subject of obstetrics regarding the associated immediate high risk of morbidity and mortality for both mother and future risk for cardiovascular disease. Many different strategies to prevent preeclampsia have been studied, but none of the reported results presented a widely effectiveness, until now. Possibility of predicting preeclampsia would have a significant impact in decreasing the incidence of cases with tragic outcome related to this condition. For late-onset preeclampsia there is no prediction method at this time, in this context, the suitable approach is the diagnosis as early as possible in order of a better outcome. Lowdose aspirin (LDA) administrated in the first trimester to patients who are at increased risk for pre-eclampsia is the only drug that has proven benefits for reducing the frequency of this condition and associated adverse outcomes. In terms of prophylaxis with low molecular weight heparin in combination with LDA or as a single treatment, results are controversial, additional studies being required. We intend to summarize the latest proposals regarding the measures that can be taken to prevent maternal and fetal complications that may occur as a result of the development of preeclampsia, methods of early diagnosis and characteristics of atypical forms of preeclampsia. [ABSTRACT FROM AUTHOR]

The incidence of intrahepatic cholestasis of pregnancy is estimated to be 0.5% of all deliveries, with great geographic variations. Clinical onset of this condition is represented by intolerable pruritus dominant on the palms and soles of the feet with the emphasizing of symptoms during the night. Regarding the risks for the fetus, the main complications are prematurity, intrauterine demise, meconium-stained amniotic fluid and a greater incidence of neonatal respiratory distress syndrome. Our retrospective study aimed to analyze the incidence of intrahepatic cholestasis of pregnancy for a period of five years in Bucharest Emergency University Hospital, fluctuations of the incidence depending on maternal age and parity, also, related neonatal risks. Secondly, we present a literature review regarding maternal and fetal follow-up and the possibilities for preventing the potential related complications. During the studied period, the incidence of intrahepatic cholestasis of pregnancy was 0.3%. Fetal status at birth was influenced by this condition, being reflected by an Apgar score lower than 8 in 34% of cases. Also, meconium stained fluid was associated in a higher proportion (14%) comparing to uncomplicated pregnancies in which fetal demise was showed not to be a direct consequence of intrahepatic cholestasis of pregnancy. The major purpose of management of these pregnancies consists in a rigorous fetal surveillance and early delivery guided by the comparison of the risk of fetal death and potential risks of prematurity. There is no ideal method for fetal surveillance in intrahepatic cholestasis of pregnancy yet. [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.)

A velamentous insertion of the umbilical cord is characterized by the atypical aspect of the placental end of the cord, consisting in divergent umbilical vessels surrounded by fetal membranes and with no Wharton's jelly present, resulting a cord that is inserted rather into membranes than the placental disk. By the divergence of the umbilical vessels as they travers the amnion and the chorion before reaching the placenta this condition associates important obstetrical complications and the diagnosis by ultrasonography as early is possible is important for the guidance of the subsequent management. In this retrospective study we aimed to evaluate the incidence of velamentous cord insertion in University Emergency Hospital of Bucharest for a period of five years and analyze the pregnancies outcome and the obstetrical impact of this condition. Using the statistics department of University Emergency Hospital Bucharest we determined an incidence of 0.23% of pregnancies complicated by velamentous cord insertion. The examined parameters included intrauterine fetal death, small for gestational age, preterm delivery (<37 weeks), single artery umbilical cord and low Apgar score at 1 minute. We chose to exemplify with a case of early diagnosis of this condition, respectively at 15 weeks of gestation. The attempt to visualize cord insertion in the mid-trimester as a routine part of obstetric sonography is recommended. The identification of velamentous cord insertion dictates the mode and timing of delivery and can improve fetal outcome. [ABSTRACT FROM AUTHOR]

Two main causes of arterial thrombosis are known: first - atherosclerosis, extensively studied, and the second - atrial fibrillation. The lack of any risk factors and the occurrence at young age of a thrombotic event requires us to investigate possible other conditions, including inherited thrombophilia that is represented by a series of genetic disorders that increase the risk of thromboembolic disease. The role of thrombophilia in the occurrence of arterial thrombosis is inconsequential; this disorder is characterized by the tendency of developing venous thrombosis. We present a rare case of a 29 year old woman that presents an arterial thrombotic event subsequent to the caesarean section. The patient had a positive familial history for thrombotic events and a cavernous sinus thrombosis in personal history. Prophylactic treatment with unfractionated heparin throughout pregnancy was applied. At 31 weeks gestation the patient underwent cesarean surgery for nonreassuring fetal status, 2 weeks fetal intrauterine growth restriction and absent diastolic fl ow of uterine arteries. Three days post operatory arterial thrombosis is suspected. The context that led to this suspicion was paresthesia, color modification of the right leg and abolished popliteal pulse. Angiographic-CT confirmed the presumptive diagnosis. A cardiovascular, conservatory treatment was successfully applied. Considering the particularities of the presented case we discuss the occurrence of arterial thrombosis postpartum in the context of confirmed thrombophilia by reviewing the specialized literature. [ABSTRACT FROM AUTHOR]

Ovarian cancer is the seventh most commonly diagnosed cancer in women, with the highest mortality rate among female genital cancers. Due to the nonspecific symptoms and the lack of effective screening strategies, ovarian cancer is often diagnosed in an advanced stage of the disease, with a 5-year survival rate of 25%. The efforts of specialists are aimed at identifying screening methods, with the lowest possible rates of false positive or false negative results in order to diagnose the disease at an early stage, when the 5-year survival rate is 92%. In this study we analyzed the incidence of ovarian cancer in the last five years in the Bucharest University Emergency Hospital, being registered 153 cases of ovarian cancer. The aim of this paper is to analyze the correlation between the early diagnosis of ovarian cancer and the long-term prognosis. [ABSTRACT FROM AUTHOR]

Peripartum hysterectomy refers to the hysterectomy performed during delivery or within 24 hours. This is a relatively rare procedure, that can be emergent or planed depending on the indication. In about 30-50% cases of emergency performed hysterectomies the cause is represented by severe uterine hemorrhage, which is impossible to control by the usual methods, as it happens in abnormal placentation or uterine atony. Conservative methods should always be attempted in order to avoid if possible the morbidity and sterilization implied by hysterectomy. Regarding the risk factors for peripartum hysterectomy, prior caesarean delivery increases the incidence of this procedure from 1 in 30.000 to 1 in 220. The associated mortality is declared to be <1 percent, and the most frequent complications are febrile morbidity, hemorrhage and urinary tract injury. We studied the incidence of peripartum hysterectomy and the most common associated condition of these cases in the Bucharest Emergency University Hospital for a period of six and a half years. Data were retrieved from the statistics department of the hospital. From January first, 2011 to June 26, 2017 in our hospital 21.746 deliveries were registered, of which 55 cases (0.25%) required peripartum hysterectomy. The associated pathologies analyzed were placental disorders (placenta accreta, increta, percreta), placenta previa, preeclampsia, uterine atony, uterine rupture, fibroids, cervical cancer and infection. Also, the rate of admission in the intensive care unit and mortality were analyzed. The obtained results matched with those declared in the literature. The anticipation of the need of peripartum hysterectomy with the proper preparation, counseling and timing is a key element for the future outcome of the case. Knowing the relation of various risk factors with the possible need of this procedure significantly increases the rate of success and decreases the incidence of complications. [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.)

Hysterectomy is the most common gynecologic procedure performed all over the world and various complications may appear depending on the surgical route. Delayed postoperative hemorrhage is a rare, life threatening complication. It requires timely management and recently the surgical reinterventions tend to be replaced by minimally invasive techniques. Transcatheter arterial embolization shows good results as a treatment strategy for massive vaginal bleeding post hysterectomy, when vaginal vault suturing fails to achieve hemostasis. We report a case of right uterine artery bleeding occurring 30 days after vaginal hysterectomy that was successfully treated by transcatheter arterial embolization. [ABSTRACT FROM AUTHOR]

Pregnancy is a risk factor for developing a severe, complicated form of COVID-19. Medical reports have revealed that pregnancy increases three times the risk of ICU admission and 1.7 times the risk of death in patients with COVID-19. The crossing of the placenta by the antibodies generated through vaccination offer a level of protection that should not be ignored. We aimed to comparatively analyze the levels of SARS-CoV-2 IgG and IgM antibodies in pregnant women who have had this infection during pregnancy or have undergone a complete vaccination cycle during pregnancy, as well as antibody levels in newborns. The inclusion criterion was history of SARS-CoV-2 infection during pregnancy or COVID-19 complete vaccination. For each case the peri-partum values of IgG and IgM SARSCoV- 2 antibodies were analyzed in the same laboratory along with those of their newborns. The vaccination rate in our study group was about 6%. All cases had a significant value of protective IgG SARS-CoV-2 antibodies and the level of protective antibodies of the newborns closely followed maternal values. From the cases with SARS-CoV-2 infection during pregnancy, only 16.6% had a protective level of antibodies and 75% of the newborns from these cases had protective levels of IgG SARS-CoV-2 antibodies. Our results clearly plead in favor of vaccination in pregnancy which provides significant benefits for both mothers and infants. [ABSTRACT FROM AUTHOR]

Placental site trophoblastic tumour (PSTT) is a very rare and unique form of gestational trophoblastic tumour, representing about 1-2% of all gestational trophoblastic tumours. Usually, the pattern is a slow growing nodule implicating the endometrium and myometrium, accompanied by abnormal uterine bleeding. Three ultrasound types of PSTT are described, but thereis no specific characteristic for diagnosis. We present the case of a patient with an atypical placental site trophoblastic tumour diagnosed two months after a caesarean scar pregnancy. In the presented case there are several particularities, such as the rapid growth and progression of the tumour, the limitation to the myometrium and the difficulty of the differential diagnosis and approach. [ABSTRACT FROM AUTHOR]

Human T-lymphotropic virus (HTLV) is considered to be the most highly oncogenic existing virus, being the cause of several fatal diseases such as adult T cell leukemia-lymphoma (ATL) and HTLV-I-associated myelopathy (HAM). The main transmission methods are unprotected sexual intercourse, vertical transmission and breastfeeding and direct exposure to infected blood or tissue. The identification of infected mothers prior to delivery is a highly important step in preventing mother to child transmission. Universal antenatal screening for HTLV is not recommended in Romania, although there are sufficient data demonstrating the risk of vertical transmission. We present the case of an HTLV-1-infected pregnant woman, with an aim to highlight: i) points of strategy for the management of HTLV during pregnancy; ii) the particularities of the course of pregnancy; and iii) the aspects that show the importance of knowing the status regarding the HTLV infection antepartum. The case was particular due to the ascendant proviral load during the pregnancy period, which led to the initiation of antiretroviral therapy and the particular pregnancy outcome with preterm rupture of membranes and fetal growth restriction. According to current recommendations, pregnant women infected with HTLV-1 should be advised to refrain from donating blood, body organs, or other tissues. There is no evidence of the number of individuals infected with this virus in Romania at present, and the diagnosis can only occur by chance. A specific treatment or immunization for HTLV infection does not currently exist, thus preventive methods are the only tool to reduce the prevalence and mortality of this infection., (Copyright © 2020, Spandidos Publications.)

The latest decades are characterized by an enormous progression in the field of human genetics. In consequences, for various phenotypic manifestations, genetic testing could identify a specific underlying cause. An estimated incidence for all types of 18q deletions is one in 55 000 births predominant on females. About 94% of cases with 18q deletion syndrome appearance are de novo, and the remaining 6% are the inherited from a parent carrying a balanced chromosomal translocation. We present the case of a 35-year-old female who was admitted in our Unit for a second ultrasound opinion after being diagnosed at the second trimester scan at gestational age of 21 weeks of pregnancy with multiple brain and heart malformations, having the recommendation for fetal magnetic resonance imaging (MRI). Further investigations included genetic analysis and pathological examination. Major malformations diagnosed and confirmed were agenesis of the corpus callosum, ventriculomegaly with dilated fourth ventricle, partial agenesis of vermis, bilateral anophthalmia with wide nasal base and left cleft lip. Additional, cardiac malformation, with an important ventricular septal defect and overriding aorta were noted. The results of the microarray analysis showed an abnormal fetal karyotype with a loss of 30.5 basis identified in the long arm of chromosome 18. Although most of the cases of 18q deletion are sporadically or de novo, could be cases where the possible existing syndromes can be inherited from a healthy or mild affected parent. Therefore, in order to establish the recurrence risk, parental karyotypes are recommended.

Located under the cerebral hemispheres and draining the anterior and central regions of the brain into the sinus of the posterior cerebral fossa, the vein of Galen aneurysmal malformation is considered to be a rare cause of hydrocephaly. The presence of this condition in the neonatal period typically includes intractable heart failure and a poor prognosis. We report a case of aneurysm of the vein of Galen diagnosed prenatally at 28 weeks of gestation, with the delivery at term by caesarean section of a female infant. Sonographically, the vein of Galen appeared in the mid-sagittal plane, large, supratentorial, non-pulsatile; on color Doppler, the structure filled with bright color, reflecting a turbulent venous flow. A low grade of ventriculomegaly was present during the evolution of pregnancy; regarding the cardiovascular function, an intrauterine right cardiac insufficiency overlapped a tricuspid regurgitation and right atrial dilatation. A multidisciplinary committee decided a neonatal embolization of the aneurysm as an emergency requirement due to increased pulmonary hypertension developed in the next 24 hours after birth. After the embolization of the two main drainage vessels, the cardiac dysfunction persists. Two days later the evolution became unfavorable, leading to the necessity of the second embolization, which resulted in a 48 hours' coma and death, due to a cerebral hemorrhage secondary to thrombosis and fissure of the embolized aneurysm. The prognosis for the neonate with malformation of the Galen vein depends upon the severity of the cardiovascular status. Embolization represents actually the treatment of choice with the best results of these cases, but the mortality remains as high as 50 percent even in the most specialized centers of the world. As far as we know this is the only case of Galen aneurysmal malformation in Romania which beneficiated of embolization by interventional treatment in neonatal period.