Mode of Delivery and Neonatal Outcome in Adolescent Pregnancy (13-16 Years Old) Associated with Anemia.

Background: Adolescent pregnancy represents an important public-health problem due to its maternal and fetal outcomes. Adolescent patients are predisposed to multiple obstetrical complications, including anemia and preterm birth which has a higher incidence among this population; withal, in the specialty literature, anemia is considered to be a risk factor for preterm delivery; furthermore, multiple studies have demonstrated that a very young age is an independent risk factor for preterm birth. Objectives: The study aims to reveal if anemia during adolescent pregnancy has a negative impact on the time and mode of delivery and newborns' outcomes. Patients and methods: We performed a retrospective multicentric study on adolescent pregnancy. We analyzed 172 patients aged between 13 and 16 years who delivered in two large tertiary hospitals between 1 October 2018 and 15 April 2022. We divided the patients into two groups­a study group (n = 64) with anemia and a control group (n = 108) without anemia. We evaluated the modes of delivery, the times of birth, and the neonatal outcomes by 1-min newborn's Apgar score, neonatal intensive-care unit (NICU) admission, and the newborns' weights. Results: The rate of cesarean section was higher in patients with anemia than in the control group (45.31% vs. 38.88%, p < 0.001). We found that patients between 13 and 16 years diagnosed with anemia have a higher risk of preterm birth than those without anemia (35.93% vs. 21.29%, p < 0.001); however, an increased rate of LBW neonates was observed in the anemic adolescent group ≤14 years (p < 0.001). Regarding the newborns' 1-min Apgar score, NICU admission, no statistically significant differences were recorded between the two groups according to the severity of anemia. In the anemic patients' group, prenatal screening was identified in 9.37% of cases, while in the control group, in 16.67% (p = 0.034), which represents negative predictive factors, along with a low socio-economic status for the presence of anemia in young adolescent patients. Conclusions: Anemia is a risk factor for preterm birth, LBW, and cesarean section in young adolescent pregnancy. The association of lack of prenatal care and low socio-economic status worsens maternal and neonatal outcomes.

Neonatal Outcome Associated With Maternal COVID-19 Infection in Adolescent Patients.

Background Coronavirus disease 2019 (COVID-19) infection during pregnancy has been associated with high rates of preeclampsia, stillbirth, and preterm birth. Adolescent pregnancy has also been associated with various adverse maternal and neonatal outcomes, including preeclampsia, stillbirth, preterm birth, congenital anomalies, and low birth weight. Therefore, this study aimed to determine whether COVID-19 infection associated with adolescent pregnancy represents an additional risk factor. Methods We performed a study that included 17 adolescent COVID-19- positive patients, who delivered in the Department of Obstetrics and Gynecology of University Emergency Hospital, Bucharest, between 01.04.2020 and 15.04.2022, and a control group of 17 patients who were COVID-19-negative and delivered in the same period in the same unit. In the control group, additional risk factors that could affect neonatal outcomes were excluded. The COVID-19 infection was confirmed using a polymerase chain reaction (PCR) test. The analysis of neonatal outcomes included preterm birth, low birth weight, stillbirth, congenital anomalies, and Apgar score calculated at one minute. Results The data from this study showed that COVID-19 infection does not influence the newborn's weight or Apgar score in adolescent patients. Also, in our study, COVID-19 infection was not statistically significant according to preterm delivery in adolescents. Conclusion Adolescent pregnancy represents an important health problem associated with a high risk of maternal and neonatal complications. However, COVID-19 infection does not influence neonatal outcomes in this population.

Our Experience in Using the Endovascular Therapy in the Management of Hemorrhages in Obstetrics and Gynecology.

(1) Background: A quarter of maternal deaths are caused by post-partum hemorrhage; hence obstetric bleeding is a significant cause of morbidity and mortality among women. Pelvic artery embolization (PAE) represents a minimally invasive interventional procedure which plays an important role in conservative management of significant bleeding in Obstetrics and Gynecology. The aim of this study was to evaluate the effect and the complications of PAE in patients with significant vaginal bleeding with different obstetrical and gynecological pathologies. (2) Methods: We conducted an observational, retrospective study on 1135 patients who presented to the University Emergency Hospital of Bucharest with vaginal bleeding of various etiology treated with endovascular therapy. All the patients included in the study presented vaginal hemorrhage that was caused by: uterine leiomyomas, genital tract malignancies, ectopic pregnancy, arterio-venous mal-formations and other obstetrical causes. We excluded patients with uncontrolled high blood pressure, severe hepatic impairment, congestive heart failure, renal failure or ventricular arrhythmias. (3) Results: Bleeding was caused in 88.19% of cases by uterine leiomyomas (n = 1001), 7.84% (n = 89) by cervical cancer, 2.29% by ectopic pregnancy (n = 26), 1.23% by arteriovenous malformation (n = 14) and 0.52% by major hemorrhage of obstetrical causes. Endovascular procedures were used in all the cases. In patients with uterine leiomyomas, supra-selective uterine arteries embolization was used. In 97% (n = 1101) of patients, bleeding was stopped after the first attempt of PAE. 3% (n = 34) needed a second embolization. In 12 of 14 cases of AVM, PAE was successful, two other cases needed reintervention; (4) Conclusions: Endovascular procedures represent a major therapy method for both acute and chronic hemorrhage in Obstetrics and Gynecology. It can be used in post-partum or post-traumatic causes of vaginal bleeding, but also in patients with chronic hemorrhage from uterine leiomyomas or inoperable genital malignancies or even as a preoperative adjuvant in cases of voluminous uterine fibroids or invasive malignant tumors, aiming to reduce intraoperative hemorrhage.

Difference between Preterm Birth in Adolescent and Adult Patients.

Background: Preterm delivery represents an important public health problem due to its neonatal outcomes. There are numerous complications that occur due to prematurity, but the most significant one is represented by neonatal death. Even if the certain mechanism of prematurity is elusive, there are various risk factors known to be involved in the etiology of preterm birth, among which one is young age. Objectives: The present study aims to find whether preterm delivery has a higher rate in adolescent patients and if neonatal outcomes are different in adolescent and adult patients. Patients and methods:We performed an observational retrospective study about preterm infants from adolescent and adult patients. Thus, we analyzed 96 patients aged between 13 and 38 years who delivered in our unit between October 1st 2018 and December 31st 2021. Patients were divided into two groups: a study group (n=59), which included adolescents who delivered preterm, and a control group (n=37), which comprised adult patients who delivered preterm. We evaluated the rate of prematurity of all births and among patients enrolled in the present study and the neonatal outcome by newborn's weight, one-minute newborn's Apgar score and Neonatal Intensive Care Unit (NICU) admission. Results:In our study, the rate of prematurity was higher in adolescent patients, with a rate of 61.46%. The newborns' outcomes, analyzed by newborn's weight and one-minute Apgar score, were better in adolescent patients compared to adult ones. Therefore, newborns from adult patients needed neonatal intensive care more often, with a rate of 62.16%, while in the study group the percentage was 38.98%. The rate of antenatal care was higher in adult patients compared to adolescent ones (32.43% versus 27.12%). Conclusion:Adolescents have a higher risk of preterm delivery; however, their newborns have better outcomes than those of adult patients. The lack of antenatal care represents a risk factor for preterm delivery.

Preeclampsia and neonatal outcomes in adolescent and adult patients.

Preeclampsia is an important health problem with a higher prevalence in the adolescent population. Furthermore, preeclampsia causes adverse maternal and neonatal outcomes. Newborns can be affected by preeclampsia, resulting in lower birth weight or Apgar score, the need for neonatal intensive care, or prematurity. All these complications are also associated with adolescent pregnancies, and together with preeclampsia, it can determine poorer neonatal outcomes. The aim of the study was to compare the neonatal outcomes of adolescents and adults with preeclampsia. We analyzed data on all the newborns of adolescents with preeclampsia (n=12) who delivered at the Department of Obstetrics and Gynecology of University Emergency Hospital in Bucharest between January 1st, 2019, and December 31st, 2019 and compared it with data from 12 aleatory newborns of adults diagnosed with preeclampsia. The prevalence of preeclampsia was higher in the adolescent population compared with the adult one. The weight of newborns was lower among adolescents with preeclampsia. There were no significant differences in Apgar scores between the two groups. Preterm delivery was more frequent in adolescent patients with preeclampsia. Preeclampsia is an additional risk factor for adolescent pregnancy, but it is also a severe materno-fetal complication for this population.

Fraser Syndrome - a Case Report and Review of Literature.

Fraser syndrome is a rare autosomal recessive genetic disorder characterized by major features such as cryptophthalmos, syndactyly, malformations of the larynx and genitourinary tract, craniofacial dysmorphism, orofacial clefting, mental retardation and musculoskeletal anomalies. In total, about 150 affected patients have been described in the literature. The diagnosis of this syndrome can be established after clinical examination. We present the clinical findings of a rare case of Fraser syndrome with lethal phenotype due to bilateral renal agenesis in a female stillborn.

Giant ovarian mucinous cystadenoma with borderline areas: a case report.

Nowadays, giant ovarian mucinous cystadenomas are a rare condition, due to early diagnose and treatment. We report the case of a 44-year-old patient, who was diagnosed and admitted in our department with a giant pelvi-abdominal mass. The patient was operated with very high-risk consent, thus an enormous ovarian cyst of approximately 30 kg was extirpated. Afterwards, an extensive histopathological analysis was performed in order to determine the exact clinicopathological entity of the giant tumor-enteric type of multilocular mucinous ovarian cyst adenoma with borderline areas, with benign proliferation. Although giant ovarian mucinous cyst adenoma with borderline areas is an extremely rare condition, when encountered it is a real challenge for both surgeon and pathologist.

Inherited thrombophilia in pregnant women with intrauterine growth restriction.

BACKGROUND: Intrauterine growth restriction (IUGR) is a major cause of fetal morbidity and mortality during pregnancy. The role of mutation in the factor V gene, prothrombin gene, MTHFR gene, as risk factors for intrauterine growth restriction during pregnancy, is not very well known so far. MATERIALS AND METHODS: This is a retrospective study of 151 pregnant women with a history of complicated pregnancy: intrauterine growth restriction, preeclampsia, recurrent pregnancy loss or maternal venous thromboembolism, who were admitted in Bucharest Emergency University Hospital, during the period January 2010 to July 2014. Genetic testing was performed for all the cases to detect: factor V Leiden mutation, G20210A mutation in the prothrombin gene, C677T mutation and A1298C mutation in methylenetetrahydrofolate reductase (MTHFR) gene. Blood samples were obtained as soon as the diagnosis of intrauterine growth restriction was established with ultrasonography. RESULTS: The following gene mutations were associated with increased risk of IUGR: G20210A prothrombin gene mutation (OR 4.81, 95% CI 1.05 - 2.22, p= 0.043), G1691A factor V gene mutation (factor V Leiden) (OR 1.58, 95% CI 0.61 - 4.080, p= 0.347), C677T MTHFR gene mutation (OR 1.61, 95% CI 0.79 to 3.26, p= 0.186), compound heterozygous MTHFR C677T and A1298C (OR 1.66, 95% CI 0.81- 3.42, p= 0.169). Particularly, for G20210A prothrombin gene mutation we found statistically significant risk (p≤0.05) of IUGR.

Past experience of SUUB's Pathology Department in classic based cervico-vaginal cytology.

The importance of screening to detect early lesions that may soon turn into cervical carcinoma is well known. The Romanian contribution to the diagnosis of these lesions dates back over a century ago and is due to A. Babes (1926 and later in the standardization of the Papanikolaou 1928). The experience of the Cytology Compartment of the University Emergency Hospital in Bucharest increased permanently regarding smears made conventionally and those in liquid medium. We believe that this experience should be statistically analyzed and compared with the histological results, especially for the cases of high-grade intraepithelial neoplastic lesions. The article scholastically presents the activity of SUUB's Cytology Compartment, our cases arising mostly from Departments of Gynecology and from medical or surgical emergency cases that were considered at risk by SUUB's clinicians. Our study is based on conventional based Pap test cervico-vaginal cytology activity reports of SUUB's Pathology Department from the past 23 months - 9730 cases -, using Bethesda 2001 system, including descriptive statistics parameters by age, year period, and diagnostic categories. The authors make a detailed description of the pool, enumerating its epidemiological attributes for a future comparative analysis CBP versus LBP - the current technical procedure in SUUB's Cytology Compartment.