Development of a Framework for On-Demand Caesarean Section in Romania.

BACKGROUND: Caesarean section rates have continued to trend upward in most countries, including Romania, creating a number of economic challenges. In the public health system, there is no regulation for performing Caesarean sections on demand; it is often done unlawfully, and in private hospitals, it is a real business. Thus, this study aims to investigate the budgetary impact at a hospital level and the profit per procedure by introducing on-demand caesarean sections for a fee. METHODS: This study was conducted in one of the largest maternity units in Western Romania-the "Bega" Maternity Clinic of the Timisoara County Emergency Hospital. For the analysis, the difference between a proposed occupancy rate (between 50 and 85%, increasing every 5 percent) and the actual occupancy rate was calculated. Considering that this difference can be used to admit patients to receive Caesarean sections on demand for a fee, the profit that could be obtained during the study period was calculated. RESULTS: It is reported that between 238 (proposed occupancy rate of 50%) and 4683 patients (a proposed occupancy rate of 85%) could have benefited from on-demand caesarean section surgery in 2017-2019. Between RON 419,999 and RON 8,551,636 could be obtained in the 3 years of study by implementing caesarean section against payment. CONCLUSION: The implementation of a system of on-demand payment for caesarean sections in Romania would bring significant profits to the hospital budget.

Evaluation of the Obstetric Patient: Pregnancy Outcomes during COVID-19 Pandemic—A Single-Center Retrospective Study in Romania

Acute respiratory-syndrome-related coronavirus 2, or SARS-CoV-2, has become a public health issue in our country. It mainly affects the vulnerable population, especially those with comorbidities. In this retrospective study, we set out to explore the effects of COVID-19 on pregnancy, with the vulnerability of pregnant women to SARS-CoV-2 infection also representing a main focus. We included 39 patients who tested positive for SARS-CoV-2 and 39 control subjects recruited from the Emergency County Hospital of Hunedoara, Romania. Our aim was to explore the indirect impact of the COVID-19 pandemic on pregnancy, as our patient group was included in the "high-risk" category. As a result, cesarean section prevailed, the main reason being fetal hypoxia. Newborns were evaluated by real-time postnatal polymerase chain reaction (RT-PCR) viral testing: none exhibited SARS-CoV-2 infection, with no vertical transmission of the virus being detected. Moreover, we observed no maternal or neonatal deaths resulting from COVID-19. SARS-CoV-2 has been found to cause a heterogeneity of manifestations with damage to multiple organs, and its evolution remains unknown. In our study, the need for antiviral treatment was limited, but anticoagulants proved effective in terms of improving the outcome. [ FROM AUTHOR] Copyright of Reports (MDPI AG) is the property of MDPI 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 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 . (Copyright applies to all s.)

A Race against the Clock: A Case Report and Literature Review Concerning the Importance of ADAMTS13 Testing in Diagnosis and Management of Thrombotic Thrombocytopenic Purpura during Pregnancy.

Thrombocytopenic purpura (TTP) is a rare, potentially fatal pathology characterized by microangiopathic thrombotic syndrome and caused by an acute protease deficiency of von Willebrand factor, ADAMTS13. Moreover, ADAMTS13 deficiency promotes microthrombosis led by the persistence of ultra-large VWF multimers in the blood circulation. According to the few studies involving pregnant participants, the heterogeneity of manifestations has made this pathology difficult to diagnose, with an unexpected occurrence and increased risk of maternal and fetal morbidity and mortality. We reported on the case of a 28-year-old pregnant woman with an obstetric score of G2P0 who presented to the obstetrics and gynecology department of our clinic with the complaint of minimal vaginal bleeding. The evolution of our case was severe and life-threatening, a "race against the clock", with our goal being to emphasize the importance and difficulty of diagnosing TTP in the absence of specific symptomatology. We faced a lack of technological support for a correct and complete diagnosis, and the first manifestation of this disease was the intrauterine death of the fetus. After completing all the necessary procedures, the placental tissue was sent for further histopathological evaluation. We highlighted the importance of monitoring ADAMTS13 for relapses monthly, with prophylaxis being essential for maternal and fetal mortality and morbidity.

First neonates with severe acute respiratory syndrome coronavirus 2 infection in Romania: Three case reports.

RATIONALE: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which quickly spread throughout the world, has been putting medical workers all over the world in difficulty because of the high number of cases combined with the lack of information about the disease. Although pediatric cases are rare, the group age under 12 months has been in general more susceptible to develop severe forms of the disease compared with the patients in the age interval of 1 to 18 years. PATIENT CONCERNS: Three newborns have been tested positive for SARS-CoV-2 infection. One of them presented bilateral decreased air entry, while the other 2 had no respiratory symptomatology. All 3 developed diaper erythema and oral candidiasis. DIAGNOSIS: For building up the report, newborns that were positive for coronavirus disease 2019 (COVID-19) infection were included in the case series. The chest X-ray of the symptomatic patient revealed a medium degree of hilar parenchymal infiltration and a slight infiltration of the visceral pleura. INTERVENTIONS: The patients were admitted in our isolated neonatology ward. All of them received antifungal treatment for the oral candidiasis and topic cream for diaper erythema. The symptomatic patient also received prophylactic antibiotherapy, human immunoglobulins, aminophylline, and parenteral nutrition. OUTCOMES: All 3 neonates were discharged after 2 consecutive negative tests for SARS-CoV-2. Patients 1 and 2 fully recovered, whereas the condition of patient 3 improved. LESSONS: Even if there are only a few reported cases of neonates infected with COVID-19 and most of them present mild manifestations, newborns need a more careful insight because of the nonspecific symptomatology.