Fetal Clinical and Paraclinical Outcomes in HIV-Positive Pregnant Women.

Background Adverse pregnancy outcomes in women with human immunodeficiency virus (HIV) infection remain significantly increased. Untreated maternal infection primarily leads to fetal complications, such as intrauterine growth restriction, stillbirth, or preterm birth. Concerning both maternal and fetal complications that can appear in pregnancy associated with HIV infection, the purpose of the study was to determine fetal and maternal demographic characteristics and the correlation between blood count parameters and poor fetal prognosis. Methods We conducted a quantitative study utilizing document review as the data collection method. This study encompassed a cohort of nine HIV-positive pregnant women who delivered at the Obstetrics and Gynecology Department of the University Emergency Hospital in Bucharest from January 1, 2021, to December 31, 2023. A comparative cohort of nine healthy pregnant women who delivered during the same period in the same facility was selected using stratified random sampling. We examined maternal and fetal demographic parameters and neonatal outcomes, reporting them to paraclinical laboratory data. Results The incidence of pregnancy-related HIV infections was 0.16%. The mean age of patients in the selected group was 29.88 ± 5.53. There was no statistically significant correlation between maternal clinical and paraclinical parameters in the HIV-positive and HIV-negative groups. Although there was a slightly negative difference in the fetal weight at birth, the 1-min APGAR (appearance, pulse, grimace, activity, and respiration) score, and the intrauterine growth restriction between the two groups, there was a statistically significant association between admission to the neonatal intensive care unit (NICU) and the neonates from HIV-positive pregnancies. In our study, we observed preterm deliveries in 22.22% of cases, and we did not record any stillbirths. The 1-min APGAR score was correlated with the value of leukocytes in peripheral blood. Vertical transmission was established to be 11.11% independent of maternal blood count parameters. Conclusion HIV infection during pregnancy leads to a higher risk of admission to the NICU. Fetal leukocytosis is indicative of a lower 1-min APGAR score. The primary emphasis of therapeutic intervention during pregnancy should center on vigilant monitoring of maternal viral load and the timely administration of antiretroviral therapy to enhance fetal outcomes.

SARS-CoV-2 Infection in Pregnant Women With Hypothyroidism.

Background Severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2) infection has been linked to increased maternal and fetal morbidity and mortality, as evidenced by numerous studies. Given the potential exacerbation of autoimmune diseases during viral infections, maternal and fetal complications such as preterm birth, low birth weight, or preeclampsia, often observed in pregnancies involving autoimmune thyroiditis with hypothyroidism, may be further aggravated. This study seeks to ascertain whether the association between viral infection and hypothyroidism contributes to an increase in adverse pregnancy outcomes. Methods This study included a cohort of 145 pregnant women with SARS-CoV-2 infection, who delivered in the Department of Obstetrics and Gynecology of the University Emergency Hospital in Bucharest, Romania, between January 1, 2020, and December 31, 2022. The participants were divided into two groups depending on the presence of autoimmune thyroiditis with hypothyroidism. We examined the maternal and fetal demographic parameters, paraclinical laboratory parameters, and outcomes, aiming to identify disparities between the two groups. Results Among the 145 SARS-CoV-2-positive pregnant women, the prevalence of hypothyroidism was 8.96%, with 13 cases reported. In the hypothyroidism group, the mean age of coronavirus disease 2019 (COVID-19) patients was higher (34.07 ± 5.18 years vs. 29.25 ± 6.23 years), as was the number of cases of investigated pregnancies, 12 (92.31%) vs. 91 (68.94%). There was no statistically significant correlation observed between fetal weight at birth, one-minute Apgar score, neonatal intensive care unit (NICU) admission, or intrauterine growth restriction between the two groups. Nevertheless, a case of stillbirth was recorded in the hypothyroidism group. The presence of thyroid pathology did not exacerbate the progression of the viral infection, as evidenced by the absence of cases of preeclampsia, ICU admission, or SARS-CoV-2 pneumonia. Conversely, the presence of hypothyroidism in pregnant women with SARS-CoV-2 infection was associated with lower uric acid levels and a slight decrease in international normalised ratio (INR) values. Additionally, there was a significant negative association between uric acid levels and the one-minute Apgar score in the hypothyroidism group, while no such correlations were observed in the other group. Furthermore, there was a statistically significant correlation between intrauterine growth restriction and uric acid values, as well as between the one-minute Apgar score and INR parameters, in both groups. Conclusion The link between SARS-CoV-2 infection and hypothyroidism does not appear to increase the risk of preterm birth, intrauterine growth restriction, or low fetal weight at birth. However, it may be associated with a higher risk of stillbirth. The presence of hypothyroidism in pregnant women with COVID-19 correlates with lower maternal uric acid levels and a slight decrease in INR values. The one-minute Apgar score correlates with the level of uric acid in pregnant women with SARS-CoV-2 infection and hypothyroidism.

Clinical and Paraclinical Features in Pregnancies Associated With Renal Impairment Due to Hypertensive Complications.

Background An association between renal impairment and hypertensive complications occurring during pregnancy has been shown in a limited number of studies. As a consequence of a lack of clear criteria for diagnostic certainty, acute renal failure during pregnancy is a challenging pathology to diagnose, mainly due to the physiological reduction of nitrogen retention parameters. In light of the fact that renal injury is associated with a poor maternal and fetal prognosis, this study aims to determine the maternal demographic features and the cut-off of serum creatinine that can lead to a heightened risk of prematurity, stillbirth, intrauterine growth restriction, or the necessity of neonatal intensive care. Methods We performed a study that included a cohort of 45 pregnant women with acute renal injury who delivered in the Department of Obstetrics and Gynecology of the University Emergency Hospital in Bucharest between January 1, 2017, and December 31, 2022, a cohort of 45 pregnant women with a value of serum creatinine between 0.8 and 1 mg/dL, and a cohort of 45 pregnant women, selected at random, with a value of serum creatinine under 0.8 mg/dL, who delivered in the same period in the aforementioned unit. The analysis included neonatal outcomes (preterm birth, intrauterine growth restriction, stillbirth, Apgar score calculated at one minute, the need for neonatal intensive care), maternal demographic features, medical and obstetrical history, and paraclinical parameters. Results The incidence of acute renal injury was 0.33% for the entire cohort of patients who gave birth in our hospital. Out of that lot, 65.21% of the cases of acute renal impairment associated with pregnancy were caused by hypertensive complications. The mean age of patients with acute kidney injury (AKI) was 29.4 ± 6.66, preponderantly primiparous. The majority of the neonates from patients with AKI (62.22%) were born with a birth weight under 2.500 grams. Preterm deliveries were preponderant (66.66%) in patients with AKI, while in the control group, the incidence of preterm deliveries was 48.88%. Stillbirth in the AKI group had an incidence of 13.33%, while in the control group, there were none. Due to these neonatal complications, most of the newborns in the AKI group needed neonatal intensive care. An important percentage of the patients who developed AKI (40%) did not benefit from proper medical care during pregnancy or before admission to our unit. The cutoff of 1.09 mg/dL of serum creatinine level was established following receiver operating characteristic curve analysis. Conclusion AKI during pregnancy is associated with hypertensive disorders, low birth weight, and preterm deliveries.

An Extensive Study Regarding the Microscopic Anatomy of the Early Fetal Human Optic Nerve.

The development of the optic nerve and its surrounding tissues during the early fetal period is a convoluted period because it spans both the organogenesis period and the fetal period. This study details the microscopic anatomy and histoembryology of the optic nerve in embryos during the early fetal period, including the second half of the first trimester of pregnancy. Serial sections through the orbit of variously aged embryos allowed us to analyze the nerve in both longitudinal and transverse aspects. A histological assessment and description of the structures surrounding and inside the nerve were performed, highlighting the cellular subtypes involved. By employing immunohistochemical techniques, we could characterize the presence and distribution of astrocytes within the optic nerve. Our findings suggest that by the 8th gestational week (WG) the structures are homologs to all the adult ones but with an early appearance so that maturation processes take place afterward. By this age, the axons forming the nerve are definitive adult axons. The glial cells do not yet exhibit adult phenotype, but their aspect becomes adult toward the 13th week. During its development the optic nerve increases in size then, at 14 weeks, it shrinks considerably, possibly through its neural maturation process. The morphological primordium of the blood-nerve barrier can be first noted at 10 WG and at 13 WG the morphological blood-nerve barrier is definitive. The meningeal primordium can be first noted as a layer of agglomerated fibroblasts, later toward 13 WG splitting in pachymeninx and leptomeninges and leaving space for intrinsic blood vessels.

Conservative Management With a Multimodal Approach of a 12-Week Cervical Ectopic Pregnancy With Fetal Megacystis.

Cervical ectopic pregnancy is the rarest kind of ectopic pregnancy, and it is known as the implantation of an embryo into the cervical mucosa. It is commonly associated with complications such as hemorrhage from the cervix and can lead to severe consequences if it is not treated early. For this reason, the treatment for a cervical pregnancy often requires an abdominal hysterectomy. To avoid such radical management, several conservative methods of termination have been used. In this paper, we report a complex management of one of our ectopic cervical cases, which includes embolization of the uterine arteries, treatment with methotrexate and mifepristone, evacuation of the pregnancy followed by local hemostatic sutures and application of a balloon in the cervix. The post-operative period was uneventful. After a three-day postoperative stay, the patient was discharged. The management options employed in the presented case achieved the goal of preserving fertility for our patient. There are no specific guidelines for the treatment of cervical pregnancies in advanced gestational age.

Unraveling the Intricate Link: Deciphering the Role of the Golgi Apparatus in Breast Cancer Progression.

Breast cancer represents a paramount global health challenge, warranting intensified exploration of the molecular underpinnings influencing its progression to facilitate the development of precise diagnostic instruments and customized therapeutic regimens. Historically, the Golgi apparatus has been acknowledged for its primary role in protein sorting and trafficking within cellular contexts. However, recent findings suggest a potential link between modifications in Golgi apparatus function and organization and the pathogenesis of breast cancer. This review delivers an exhaustive analysis of this correlation. Specifically, we examine the consequences of disrupted protein glycosylation, compromised protein transport, and inappropriate oncoprotein processing on breast cancer cell dynamics. Furthermore, we delve into the impacts of Golgi-mediated secretory routes on the release of pro-tumorigenic factors during the course of breast cancer evolution. Elucidating the nuanced interplay between the Golgi apparatus and breast cancer can pave the way for innovative therapeutic interventions and the discovery of biomarkers, potentially enhancing the diagnostic, prognostic, and therapeutic paradigms for afflicted patients. The advancement of such research could substantially expedite the realization of these objectives.

Gossypiboma, the Hidden Enemy of an Emergency Cesarean Hysterectomy-Case Report and Review of the Literature.

Gossypiboma or textiloma is a rare medical situation that can complicate the favorable evolution of a surgical case, with repercussions for the patient's prognosis. The diagnosis can be difficult due to various clinical symptoms, the time elapsed since the surgical intervention, and the imaging often not being precise in detecting textilomas. Due to the medicolegal implications, the reporting of this event is inconsistent. We present a rare case of a 28-year-old woman who presented with vague pain in the left iliac fossa 11 months after an emergency cesarean hysterectomy was performed. The preoperative imaging examination identified the presence of a subhepatic mass with dimensions of 10 × 8 cm2 and another formation in the right iliac fossa with dimensions of 11 × 9 cm2. Exploratory laparotomy found the presence of a large subhepatic gossypiboma, intimately adherent to the hepatic angle of the colon and omentum and a second one adherent to the sigmoid colon, small intestine, and parietal peritoneum. The particularity of this case is given by the simultaneous presence of two textilomas with inconclusive evolution, which can make the differential diagnosis difficult to achieve. For a better assessment of the risk of occurrence of this pathology and the identification of a correct prevention strategy, we performed an extensive search and a review of all the articles published in the PubMed database, identifying 57 articles. In conclusion, emergency surgery increases the risk of this complication, and, as a result, prevention can be achieved by following existing protocols in the operating room.

SARS-CoV-2 Infection during Pregnancy Followed by Thalamic Neonatal Stroke-Case Report.

A neonatal stroke is a cerebrovascular process caused by interruption of cerebral blood flow that occurs with an incidence between 1 per 1600 and 1 per 2660 live births. Relative higher incidence in the neonatal period compared to later childhood is favored by the hypercoagulability state of the mother, mechanical stress during delivery, transient right to left intracardiac shunt, high hematocrit, blood viscosity, and risk of dehydration during the first few days of life. The exact cause of a neonatal stroke remains unclear in many cases. About 80% of neonatal strokes are due to arterial ischemic events involving the middle cerebral artery. Typical clinical manifestations in a neonatal stroke are usually seizures that appear immediately after birth or after several days of life, but many of the cases may remain asymptomatic. We present the case of a late preterm infant diagnosed with a thalamic stroke on the fifth day of life with no clinical signs except for repeated episodes of apnea. The anamnesis and clinical context, in this case, revealed a SARS-CoV-2 infection in late pregnancy and early bacterial neonatal sepsis. Early identification of a perinatal stroke and increasing awareness of physicians about this condition in the neonatal period have paramount importance to reduce developmental postischemic damage.

Correlations between Maternal and Fetal Outcomes in Pregnant Women with Kidney Failure.

BACKGROUND: Kidney function impairment in pregnancy is challenging, with incidence and prognosis only partially known. Studies concerning maternal and fetal outcomes in pregnancies occurring in patients with renal injury and the therapeutic strategies for improving the prognosis of these patients are scarce due to the limited number of cases reported. OBJECTIVES: We aimed to establish correlations between the main maternal and fetal outcomes in patients with severe CKD or AKI in pregnancy to improve the prognosis, referring to a control group of patients with mild kidney impairment. METHODS: For this purpose, we conducted a retrospective study, at University Emergency Hospital in Bucharest, Romania, from January 2019 until December 2021, selecting 38 patients with AKI and 12 patients diagnosed with advanced CKD, compared to 42 patients displaying borderline values of serum creatinine (0.8-1 mg/dL), reflecting the presence of milder kidney impairment. RESULTS: The probability of having a child that is premature and small for gestational age, with a lower Apgar score and more frequent neonatal intensive care unit admissions, delivered by cesarean section, is higher in patients with highly reduced kidney function. CONCLUSION: Severe kidney function impairment is associated with a grim fetal prognosis and obstetrical complications.

Thromboprophylaxis in Pregnant Women with COVID-19: An Unsolved Issue.

SARS-CoV-2 infection in pregnant women is of growing interest due to controversy over the use of antiplatelet and/or anticoagulant drugs during pregnancy and postpartum. Pregnant women are susceptible to develop severe forms of viral infections due to pregnancy-related immune alterations, changes in lung functions, and hypercoagulability. The association of pregnancy with SARS-CoV-2 infection can cause an increased incidence of thrombotic complications, especially in the case of patients with some genetic variants that favor inflammation and thrombosis. Compared to the general population, pregnant women may be at increased risk of thrombotic complications related to COVID-19. The lack of extensive clinical trials on thromboprophylaxis and extrapolating data from non-pregnant patients lead to major discrepancies in treating pregnant women with COVID-19. Currently, a multidisciplinary team should determine the dose and duration of prophylactic anticoagulant therapy for these patients, depending on the disease severity, the course of pregnancy, and the estimated due date. This narrative review aims to evaluate the protective effect of thromboprophylaxis in pregnant women with COVID-19. It is unknown at this time whether antiplatelet or anticoagulant therapy initiated at the beginning of pregnancy for various diseases (preeclampsia, intrauterine growth restriction, thrombophilia) offers a degree of protection. The optimal scheme for thromboprophylaxis in pregnant women with COVID-19 must be carefully established through an individualized decision concerning gestational age and the severity of the infection.

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.

Diagnostic Pitfall in Atypical Febrile Presentation in a Patient with a Pregnancy-Specific Dermatosis-Case Report and Literature Review.

Pruritic urticarial papules and plaques of pregnancy (PUPPP) usually occurs in the third trimester of pregnancy in primiparous women. It is a self-limiting inflammatory disorder with a still unknown pathogenic mechanism. The abdominal wall overdistension, with a subsequent inflammatory response due to damage to the connective tissue, represents a pathogenesis explanation. Clinical features involve intensely pruritic urticarial rash with edematous, erythematous papules and plaques. The clinical picture and dermal biopsy establish the diagnosis. Topical corticosteroids and oral antihistamines are usually sufficient, but sometimes systemic corticosteroids are necessary. Maternal and fetal prognosis is excellent, and the lesions resolve after birth with no scarring or pigmentary change. We present a case of a 36-year-old patient with a 32-week pregnancy who was admitted with a generalized pruritic rash accompanied by fever. The final diagnosis was decided after multiple pathology exclusions. Treatment consisted of systemic corticoid therapy. The patient gave birth by cesarean section to a healthy newborn without dermatological lesions or other conditions. Adding more PUPPP cases to the literature portfolio will bring more awareness to this under-recognized and under-reported skin disorder. We trust this case will encourage other physicians to publish more cases of pregnancy-specific dermatoses.

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.

A Systematic Approach of the Intrauterine Morphogenesis of the Human Palpebral Apparatus.

The human eyelid embodies a vast diversity of functions. Acting as a protective shield for the ocular apparatus and as a light regulator in the sight process, eyelids stand a fascinating - yet omitted - role in facial aesthetics, serving as a racial trait by which humankind succeeded to manifest heterogeneity as a species. These assumptions are precisely forecasted right from in-utero life through intricate processes of growth and cell differentiation. In the Department of Anatomy of "Carol Davila" University of Medicine and Pharmacy, we performed morphological assessments on 41 embryos and fetuses with gestational ages ranging from 6 to 29 weeks. This study aims to illustrate the morphogenesis of eyelids in human embryos and fetuses and highlight macroscopic features which could potentially have significant clinical implications in ophthalmic pathology.

A Challenging Diagnosis: Placental Mesenchymal Dysplasia-Literature Review and Case Report.

We describe a 22-year-old woman (2-gravid) case who was referred to our clinic at 18 weeks of gestation for a placenta with vesicular lesions discovered on prenatal examination routine. An ultrasound exam at 31 weeks of gestation showed numerous vesicular lesions, which gradually augmented as the pregnancy advanced. A live normal-appearing fetus was confirmed by intrauterine growth restriction (IUGR). The maternal serum ß-human chorionic gonadotropin level remained in normal ranges. At some point, a multidisciplinary medical consensus considered the termination of the pregnancy, but the patient refused to comply. At 33 weeks of gestation, preterm premature rupture of membranes (pPROM) occurred, and she spontaneously delivered a 1600 g healthy female baby with a good long-term outcome. Placental mesenchymal dysplasia (PMD) was retrospectively diagnosed after confronting the data from ultrasound, chorionic villus sampling (CVS), amniocentesis, pathological examination, and immunohistochemical stain. The lack of sufficient reports of PMD determines doctors to be cautious and reserved, approaching these cases more radically than necessary. We reviewed this disease and searched for all cases of PMD associated with healthy, live newborns.

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.

The role of the ultrasound examination in atypical placental site trophoblastic tumour differential diagnosis and management. A case report.

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.

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.

COVID-19 Pandemic Impact on Cord Blood Collection for Stem Cell Use and Actual Perspectives.

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.

Current Evidence about Developmental Dysplasia of the Hip in Pregnancy.

In adults, developmental dysplasia of the hip (DDH) represents a spectrum of disorders. It is commonly found in women in routine orthopedic practice. Hip dysplasia is a leading precursor of joint laxity; when untreated, it can contribute to chronic modifications, such as thickening of the pulvinar and ligamentum teres (which can also elongate), hypertrophy of the transverse acetabular ligament, and osteoarthritis. DDH is presumed to be associated with alterations in pelvic morphology that may affect vaginal birth by the reduction in the transverse diameter of the pelvic inlet or outlet. Here, we provide an overview of the current knowledge of pregnancy-associated DDH. We primarily focused on how a surgical DDH treatment might influence the pelvic shape and size and the effects on the mechanism of birth. We presented the female pelvis from the standpoint of bone and ligament morphology relative to a pelvic osteotomy. Then, we described whether the pregnancy was impacted by previous surgical DDH treatments, performed from infancy to adulthood. In conclusion, hip dysplasia is not associated with high-risk complications during pregnancy or with increased difficulty in vaginal delivery.