Fetal interventions – experience of fetal medicine center

Universitatea de Medicină şi Farmacie “Gr.T.Popa” Iaşi, Spitalul Clinic de Obstetrică şi Ginecologie ”Cuza Vodă” IaşiThe development of the prenatal diagnosis improved our capacity to diagnose fetal anomalies and other problems, before birth. Therefore, the fetus has become more and more an independent subject of investigation and treatment. Fetal surgical interventions are the top of surgical innovation. They are performed for diagnosis purposes: chorionic villus biopsy, amniocentesis, cordocentesis, but also for treatment. Intrauterine fetal interventions have been developed for various severe fetal anomalies in order to increase the chance of survival and/or improve the postnatal prognosis: Laser coagulation (twin-twin transfusion syndrome), bladder or thoracic shunt, draining of cystic structures, endotracheal balloon (diaphragmatic hernia). Embryo-reduction is a particular form of intrauterine intervention addressing to high-order multiple pregnancies. We present aspects of fetal interventions made during 2010-2014 period. Data were obtained from Astraia database (over 3500 patients). We performed 56 chorionic villous biopsies, 214 amniocentesis, 2 cordocentesis and 6 selective embryo-reductions (over 11 gestational weeks). Two thoraco-amniotic shunts were placed; one fetal bladder shunt and we performed a coagulation of umbilical cord (TRAP syndrome). We performed also 17 intrauterine transfusions, on 5 patients with isoimmunisation. At the moment of the fi rst fetal transfusion, the gestational ages were between 21-32 weeks, fetal haemoglobin was 3.7-8.5 g/dl and in two cases the fetuses presented hydrops. Intrauterine fetal treatments are extremely effective if they comply with the indication and also they enables continuation of pregnancy to gestational age at which risks of prematurity are greatly reduced.O dată cu dezvoltarea diagnosticului prenatal s-a îmbunătăţit şi capacitatea noastră de a diagnostica problemele fetale, înainte de naştere. Prin urmare, fătul a devenit din ce în ce mai mult un subiect independent de investigaţie, dar şi de tratament. Intervenţiile fetale reprezintă vârful inovaţiei chirurgicale. Ele sunt realizate în scop diagnostic: biopsia de vilozităţi coriale, amniocenteza şi cordocenteza, dar şi în scop terapeutic. Intervenţiile fetale intrauterine au fost dezvoltate pentru diferite anomalii fetale severe în scopul de a creşte şansa de supravieţuire şi/sau de a îmbunătăţi prognosticul postnatal: coagulare Laser (sindrom transfuzat-transfuzor), plasare de şunt vezical sau toracic, drenaj (structuri chistice), balonaş endotraheal (hernie diafragmatică). Embrioreducţia reprezintă o formă particulară de intervenţie intrauterină care se adresează sarcinilor multiple. Prezentăm aspecte ale intervenţiilor fetale realizate în perioada 2010-2014. Datele au fost extrase din baza de date Astraia (peste 3500 paciente). Au fost realizate 56 biopsii de vilozităţi coriale, 214 amniocenteze, 2 cordocenteze şi 6 embrioreducţii selective (după 11-12 săptămâni). Au fost plasate 2 şunturi toraco-amniotice, 1 şunt vezical fetal şi s-a realizat o electrocoagulare intrauterină a cordonului ombilical (sindrom TRAP). Au fost realizate 17 transfuzii intrauterine la 5 sarcini cu izoimunizare materno-fetală. La momentul primei transfuzii vârsta gestaţională a fost între 21-32 săptămâni, hemoglobina fetală de 3.7-8.5 g/dl şi în doua cazuri fetuşii prezentau semne de hidrops. Tratamentele fetale intrauterine sunt extrem de eficace dacă se respectă cu indicaţia şi permit continuarea sarcinii până la o vârstă gestaţională la care riscurile prematurităţii sunt mult reduse

HPV prevalence and type distribution in women with or without cervical lesions in the Northeast region of Romania

Abstract Background Cervical cancer is a major public health problem worldwide. While Romania has the highest incidence of cervical cancer in Europe, the prevalence of HPV has not been evaluated. We report the first data on HPV prevalence and type distribution in Northeast Romania. Methods HPV prevalence and genotype distribution was investigated in 514 consecutively women with or without cervical lesions in Northeast Romania. Genotyping was performed with Linear Array Genotyping/Roche kit. Results In our study group, 192/514 (37.4%) patients were positive for HPV (infected with single and with multiple HPV types). Most frequent types were: 16 (10.5%), 53 (5.44%), 51 (5.05%), 52 (4.08%) 18 (2.91%) and 31 (2.73%). Conclusions Infection with high risk types of HPV is common in Northeast Romania. Enhanced and systematic screening for cervical cancer is needed. Our results call for the implementation of a National HPV vaccine program in Romania.</p

The Need for Cervical Cancer Control in HIV-Positive and HIV-Negative Women from Romania by Primary Prevention and by Early Detection Using Clinically Validated HPV/DNA Tests

<div><p>Background</p><p>In Romania, a country with no organized national surveillance program regarding cervical cancer, the early diagnosis of HPV (Human Papilloma Virus) infections is a major requirement, especially in HIV-infected women. The objective of this study was to determine the HPV prevalence and type distribution in young HIV-positive women and to assess the difference in the risk factors for developing cervical cancer compared to those of HIV-negative women.</p><p>Method</p><p>We conducted one cross-sectional cohort study from June 2013–September 2014, including 1,032 women: 992 HIV- women who were 36.5 years old (limits: 17 ÷ 84) and 40 HIV + women who were 22.9 years old (limits: 17 ÷ 30) with iatrogenic HIV infected. We detected HPV types with the <i>Linear Array HPV Genotyping</i> test (Roche, Romania).</p><p>Results</p><p>DNA/HPV was detected in 18/40 (45%) of the HIV+ patients and in 350/992 (35.2%) of the HIV- patients (OR = 1.5, 95%CI 0.76÷2.96). After age adjustment, the overall HPV prevalence was 51.6% in HIV+ versus 63.2% in HIV- women aged under 25, and 22.2% in HPV+ versus 47.2% in HIV- women aged 25–34. We detect HIV being a risk factor for acquiring multiple HPV type infections (OR = 2.30, 95% CI 0.88÷5.97). The eight most common HPV types (high-risk, and low-risk) for women below age 30, HIV+ / - were: HPV 16, 18, 31, 51, 58, 68, and 6 and 82 respectively. To assess the risk factors of HIV-positive women for acquiring HPV infection, we analyzed the CD4/μL, ARN/HIV copies/μL, the age group, the number of sexual partners, smoking, and the type of HPV infection (single versus multiple infections). We found that the number of sexual partners and smoking are statistically significant risk factors.</p><p>Conclusion</p><p>Even though there are no significant differences regarding the prevalence of HPV infection in HIV + <i>versus</i> HIV – patients, multiple infections were more frequent in the first group. In our study group young HIV-infected patients under HAART therapy, high number of sexual partners (more than 3) and smoking were detected to be risk factors. Future organized screening for HPV infection using sensitive and specific methods are necessary at the national level in Romania.</p></div

The HPV prevalence in HIV-positive women and HIV-negative women, compared by age group.

<p>The HPV prevalence in HIV-positive women and HIV-negative women, compared by age group.</p

The demographic characteristics of the two study groups.

<p>The demographic characteristics of the two study groups.</p

The eight most common HPV types (high-risk or low-risk) for women below age 30, HIV+ /-.

<p>The eight most common HPV types (high-risk or low-risk) for women below age 30, HIV+ /-.</p