Prenatal Biochemical and Ultrasound Markers in Chromosomal Anomalies

The unbalanced chromosomal anomalies generate an abnormal pattern of development and usually determine miscarriage. The most frequent prenatal chromosomal anomalies are X monosomy, trisomies of chromosomes 21, 18, 13, 16, 8, triploidy and tetraploidy. Identification of chromosomal anomalies can be done by prenatal screening and diagnosis. Prenatal screening is biochemical, sonographic or molecular (detection of fetal DNA in maternal blood). Biochemical screening can be done in the first or second trimester. First-trimester screening is based on the detection in maternal serum of beta-hCG (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A). Biochemical screening in the second trimester requires the detection of alpha-fetoprotein (aFP) hGC, unconjugated estriol (μE) and inhibin A. The sonographic examination can be used in the first or second trimesters. In the first trimester, an ultrasound can identify soft markers like nuchal translucency, nasal bone and ductus venous flow. In the second trimester the sonographic examination can identify congenital anomalies or different soft markers. Prenatal chromosomal diagnosis requires an invasive procedure to obtain embryonic or fetal material. Such procedures are represented by chorionic villus sampling amniocentesis or cordocentesis. The fetal cells are used for cell cultures (in cytogenetic methods) or for molecular analyses (FISH, QF-PCR, MLPA, array-CGH)

Maternal and fetal outcome in HELLP syndrome in a tertiary care hospital in north east Romania

UMF “Gr.T.Popa”, Iaşi, Spitalul “Cuza Vodă”, IaşiObjective: Hepatic vascular injury in preeclampsia is responsible for HELLP syndrome (Haemolisis, Elevated Liver enzymes, Low Platelet count), sometimes without hypertension or proteinuria. The aim of the study was to evaluate maternal and fetal outcome in pregnant women with HELLP syndrome hospitalized in a third level maternal-fetal unit. Methods: Data concerning the clinical evolution of patients and laboratory analyzes were recuperated from the electronic archive of “Cuza Voda” Hospital. Statistical processing was performed with Microsoft Office Excel 2007 TM. Results: Between 01.01.2009-31.12.2013, in “Cuza Voda” Hospital, Iasi, a number of 29 352 births were recorded, 55 (0.187 %) being diagnosed with HELLP syndrome. Among them, only for 25 cases we could recover complete data for statistical processing. The 25 patients had a mean age of 29.2 years (range 19-39). The mean gestational age when HELLP syndrome was diagnosed, was 31.8 weeks of amenorrhea (range 27-38 ) and the mean biometric age at the preoperative ultrasound was 30.3 weeks of amenorrhea (range 24-37). Caesarean section was completed in 22/25 cases (88 %), the remaining 3 cases delivered vaginally, at a mean of 56.2 hours after admission (range 0.5 – 384 h). Maternal prognosis was burdened with the following complications: severe preeclampsia (10/25 cases), eclampsia (3/25 cases), uteroplacental apoplexy (4/25 cases), pulmonary edema (3/25 cases), acute renal failure (9/25 cases), disseminated intravascular coagulation syndrome (2/25 cases), maternal death (1/25 cases). Fetal evolution presented the following complications: antepartum fetal death (4/25 cases), RCIU (11/25 cases), prematurity (22/25 cases) with a premature birth between 27-34 weeks (17/25 cases) and between 34 -37 weeks (5 cases). One minute Apgar score was 0 in 4 cases, the remaining cases showing an average of 6.3 (range 1-9) at 1 minute and of 7.1 (range 1-9) at 5 minutes. Conclusions: Management and delivery of patients with HELLP syndrome should take place in a tertiary level unit with a trained multidisciplinary team (obstetrician, anesthetist, neonatologist, medical laboratory doctor, operating theater nurses, intensive care nurses, midwives) and technical facilities available. A rapid and accurate diagnosis and a prompt intervention can reduce the risk of maternal and fetal mortality and morbidity.Obiectiv: Atingerea hepatică vasculară în preeclampsie este responsabilă de sindromul HELLP (haemolisis, elevated liver enzymes, low platelet count), uneori fără HTA şi nici proteinurie. Scopul studiului a fost de a evalua prognosticul matern şi fetal la gravidele internate cu HELLP sindrom într-o unitate materno-fetală de nivel trei. Material şi metodă: Datele despre evoluţia clinică a pacientelor şi analizele de laborator au fost preluate din arhiva electronică a Spitalului “Cuza Vodă” cât şi din foile de observaţie. Prelucrarea statistică s-a efectuat utilizând programul Microsoft Office Excel 2007 TM. Rezultate: În perioada 01.01.2009-31.12.2013, în Spitalul Clinic de Obstetrică-Ginecologie Cuza Vodă, Iaşi au fost asistate un număr de 29352 naşteri, dintre care 55 (0.187%) au fost diagnosticate cu HELLP sindrom. Dintre acestea, doar pentru 25 cazuri s-au putut recupera datelele complete pentru prelucrarea statistică. Cele 25 paciente au avut o vârstă medie de 29.2 ani (interval 19-39). Vârsta gestaţională medie la care s-a instalat HELLP sindromul a fost de 31.8 săptămâni amenoree (interval 27-38) iar vârsta medie biometrică conform ecografiei preoperatorii a fost de 30.3 săptămâni amenoree (interval 24-37). Naşterea s-a finalizat prin cezariană în 22/25 cazuri (88%), restul de 3 cazuri care au născut natural internându-se cu naştere declanşată, la o distanţă medie de 56.2 ore de la internare (interval 0,5-384h). Prognosticul matern a fost grevat de următoarele complicaţii: preeclampsie severă (10/25 cazuri), eclampsie (3/25 cazuri), apoplexie utero-placentară (4/25 cazuri), edem pulmonar acut (3/25 cazuri), insuficienţa renală acută (9/25 cazuri), sindrom de coagulare intravasculară diseminată (2/25 cazuri), deces matern (1/25 cazuri). Evoluţia fetală a prezentat următoarele complicaţii: moarte fetală antepartum (4/25 cazuri), RCIU (11/25 cazuri), prematuritate (22/25 cazuri) din care naştere prematură între 27-34 săptămâni (17/25 cazuri), iar între 34-37 săptămâni (5 cazuri). Scorul APGAR la 1 minut a fost 0 în 4 cazuri, restul cazurilor prezentând o medie de 6.3 (interval 1-9) la 1 minut şi de 7.1 (interval 1-9) la 5 minute. Concluzii: Managementul şi naşterea pacientelor cu sindrom HELLP trebuie să aibă loc într-o unitate de nivel trei, cu o echipă multidisciplinară antrenată (obstetrician, anestezist, neonatolog, medic de laborator, asistente de bloc operator, reanimare, moaşe) şi facilităţi tehnice disponibile. Un diagnostic rapid şi corect şi o intervenţie promptă, pot reduce riscul de mortalitate şi morbiditate maternă şi fetală

CANDIDIASIS IN PREGNANCY- PERSONAL STUDY

The impact of an intensive educational program regarding candidiasis in pregnancyon health professionals knowledge at Clinical Hospital of Obstetrics and Gynecology ”Elena Doamna” in Iași, Romania. The study was designed in three phases: Assessment phase, Implementation phase and Evaluation phase. The study was conducted from early January to the end of December 2019. The result of the study shows that its most frequent location is in the mouth and the vagina. The symptoms are reduced and the diagnosis is based on the clinical examination, the confirmation being performed by microscopic examination. Prophylactic treatment of candidiasis involves maintaining a rigorous hygiene, avoiding excessive and unprotected use of antibiotics and increasing the body's immunity through a balanced diet and through the intake of mineral salts and vitamins

How the SARS-CoV-2 Pandemic Period Influenced the Health Status and Determined Changes in Professional Practice among Obstetrics and Gynecology Doctors in Romania

Background and Objectives: The beginning of the SARS-Cov-2 pandemic period has had a strong impact on patients’ life, but also on doctors. The main goal of this research is to identify the difficulties related to the professional activity and personal life of obstetrics and gynecology doctors. Material and Methods: In total, 94 physicians from a single university center answered to an online questionnaire. Socio-demographic, health, family, and job-related data were collected. Data were processed using SPSS (v.25). Results: 7.4% of the doctors were confirmed infected with SARS-Cov-2 during the first 6 months of the pandemic, and 48.94% treated infected patients. Due to the large number of patients, 10.64% of the doctors have had no days-off during the last 6 months, and 22.34% of them have had new medical problems that led them to see a specialist. Seventeen to nineteen percent mentioned an increasing number of working hours and shifts per month due to the pandemic period, more than 10% used pills to cope with work-stress, and 25% of them had sleep disorders along with appetite loss. Extra-protection rules and negative consequences of wearing special equipment were identified: thermal discomfort that caused decreasing resistance and concentration during the surgery (52%), reduced mobility and accuracy of surgical or medical gestures (40%), and intraoperative visibility (47%). Doctors who were working with confirmed pregnant women preferred caesarean section. Conclusions: Working under the stress of an infection with SARS-Cov-2 is causing a lot of pressure and determines changes in personal, familial, social, and professional life. Understanding the challenges that ob-gyn doctors are facing will help institutions to better provide support

Fetal Atrial Septal Aneurysm: Follow-Up from Second to Third Trimester

Atrial septal aneurysm (ASA) is a rarely reported fetal finding. Its definition is variable, but the diagnosis is usually made when the foramen ovale flap extends at least halfway across the left atrium. It is considered a transient, self-limiting condition, but on occasion, it can be complicated by fetal arrhythmia or left ventricular (LV) inflow obstruction—if longstanding, this can lead to left heart hypoplasia. We present two cases of ASA diagnosed at the second trimester scan, one of which was subsequently complicated by LV inflow obstruction and prenatal suspicion of hypoplastic aortic arch. This report is a good illustration of how structure follows function: a small LV preload can lead to a decreased LV output, which in turn will end up in a hypoplastic LV and outflow tract—all this is reversible after birth, due to the physiological circulatory modifications that occur in the newborn

Digitization of Gynecology Using Artificial Intelligence: Cervical Mapping Corroborated With Clinical Data for Conization Necessity

Cervical cancer is the fourth most common female malignancy worldwide. In developing countries, it is the most common subtype of cancer and the third leading cause of cancer mortality among women. Artificial intelligence has the potential to be of real use in the prevention and prompt diagnosis of cervical cancer. The aim of our study was to develop a medical platform consisting of an automated observation sheet containing colposcopy data, a software that would use a machine learning module based on clinical and image data for diagnosis and treatment, and a telemedicine module to enable collaboration between gynecologists

The Additional Role of the 3-Vessels and Trachea View in Screening for Congenital Heart Disease

Background and Objectives: Although frequent and associated with high mortality and morbidity rate, congenital heart disease (CHD) has a suboptimal prenatal detection rate, with significant variation according to the scanning protocol. The aim of this study was to evaluate the role of the 3-vessels and trachea view (3VT) in detecting CHD, with or without the use of Color Doppler, with an emphasis on major CHD. Materials and Methods: We performed a retrospective study on 1596 unselected pregnant patients presenting at 11–37 weeks of gestation for a routine anomaly scan. We selected all CHD cases, and we analyzed the performance of the 4-chamber (4C) and 3VT view in detecting CHD. Results: A total of 46 fetuses with CHD were identified, yielding a 2.86% overall incidence, and 0.87% for major CHD. Grayscale 4C detected 47.8% of all CHD, going up to 71.7% by adding grayscale 3VT, with no major CHD remaining undetected by combining grayscale 4C and 3VT. Conclusions: Grayscale 4C and 3VT views are effective in detecting major CHD, thus proving their utility even in a low resource setting

Kisspeptin Variations in Patients with Polycystic Ovary Syndrome—A Prospective Case Control Study

Background and objectives: Kisspeptin, also named metastin, showed important roles in initiating the secretion of gonadotropin-releasing hormone (GnRH) and is an essential factor in the development of polycystic ovaries syndrome (PCOS). Several research studies noticed associations between kisspeptin levels and patients with anovulatory cycles due to PCOS with an increased LH/FSH ratio. The aim of our study was to bring scientific evidence regarding the correlation between high kisspeptin and luteinizing hormone values in subfertile women due to PCOS. Materials and Methods: A prospective case-control study was conducted in “Elena Doamna” Hospital of Obstetrics and Gynecology between 4 January 2021 and 1 March 2022. All patients agreed to participate in our study, had ages between 18 and 45 years old, and had a body mass index between 18.5 and 30 kg/m2. The study group consisted of subfertile patients with PCOS and menstrual disturbances, including amenorrhea or oligomenorrhea. The control group consisted of healthy patients with ovulatory cycles and no other reproductive or endocrinology pathologies. During the follicular phase of their menstrual cycle, patients had blood samples taken with the dosage of kisspeptin, LH, FSH, estradiol, insulin, glycemic levels, testosterone, and prolactin. Pelvic ultrasounds and clinical examinations were performed as well. Results: Significant differences were observed in kisspeptin, LH, FSH, and estradiol levels between patients with PCOS and the control group. After the univariate analysis, PCOS was significantly associated with increased kisspeptin, increased LH, and decreased FSH. There was no significant association between PCOS, estradiol, prolactin, and insulin. Conclusions: kisspeptin serum values are higher in subfertile PCOS patients, supporting the hypothesis that an over-stimulation of the KISS1 system might cause the hyper-stimulation of the HPG-axis

The Rare Case of a COVID-19 Pregnant Patient with Quadruplets and Postpartum Severe Pneumonia. Case Report and Review of the Literature

Background and Objectives: The multiple pregnancies associated with COVID-19 is a new and difficult condition to manage. The prognosis for rapid deterioration after the cesarean delivery is difficult to assess and needs close interdisciplinary follow-up due to pregnancy and postpartum-related changes. Materials and Methods: We report the case of a 37-year-old primigesta primipara patient who was admitted to “Elena Doamna” Clinical Hospital of Obstetrics and Gynecology at 33 weeks and 3 days of gestation with high-grade multiple pregnancies (triplets) for threatened premature birth associated with COVID-19. The patient had a history of surgically corrected atrial septal defect during childhood and currently is known to have paroxysmal supraventricular tachycardia. Tocolysis was ineffective and the decision to perform a cesarean operation was made. The diagnosis was established: primigesta, primipara, at 34 weeks of gestation, high-grade multiple pregnancy with triplets, intact membranes, threatened premature birth, surgically corrected atrial septal defect, paroxysmal supraventricular tachycardia, infection with COVID-19. The patient underwent a cesarean intervention and treatment for COVID-19 pneumonia. The intervention took place at 33 weeks and 4 days of gestation resulting in four newborns with weights between 1400 g and 1820 g and Apgar scores between 6–8. All newborns were transferred to a third-degree Neonatology ICU service due to their prematurity. The fourth newborn was not identified in any of the ultrasounds performed during pregnancy. During the postpartum period, the patient had a fulminant evolution of COVID-19 pneumonia, with rapid deterioration, needing respiratory support and antiviral treatment. Discussions: Managing high-risk obstetrical pregnancies associated with COVID-19 requires a multidisciplinary team consisting of obstetricians, anesthesiologists, neonatologists, and infectious disease doctors. Conclusion: Our case is the first to our knowledge in Romania to present an association of high-grade multiple pregancy with COVID19 moderate form, rapidly evolving postpartum, needing rapid intensive care admission, and specific treatment with Remdesivir, with good post-treatment evolution