New Hysteroscopic Approaches to Uterine Fibroids

The hysteroscopic myomectomy is a very important application of the gynecologic endoscopy, as it allows minimal invasive removal of the type 0, 1, and 2 fibroids with minimal damage to the uterine wall. In the last decade, new developments of this method allowed an even less invasive approach, with possibility of ambulatory procedure. We discuss the importance of these new developments, based very much on the pseudocapsule of the myoma, and analyze the literature data regarding the outcome. The cold loop resection is a technique that could be used in type 1 and type 2 myomas, with less complications and limitations than the classical electrical resectoscope. Another development, more useful for type 0 and 1 myoma, is the hysteroscopic morcellator, similar to the laparoscopic one, but providing a faster and safer procedure. We also update the complications of hysteroscopic myomectomy and their management, including long-term and obstetrical complications related to hysteroscopic myomectomy. In conclusion, new developments and studies show that hysteroscopic myomectomy has become a valid endoscopic technique ready to be used by many specialists

The Influence of Climate on Critically Ill Pregnant COVID-19 Patients, as Revealed by the Inflammation Indexes, in Spring versus Autumn 2021 Infection

(1) Background: Seasonality is an important environmental factor that influences immune re-sponses (2) Methods: In a retrospective study, we included all pregnant patients admitted to the Elena Doamna Obstetrics and Gynecology Hospital with a critical form of COVID-19 infection between 1 January and 1 December 2021. The blood counts collected on the specific A, H and E Brixia score- collection days, or the ones collected closest to those days, were considered in our study. We also studied the differences between the two groups regarding the inflammation in-dexes exhibited on those specific days: A (admittance), H (highest Brixia score), and E (end of hospitalization). (3) Results: The values of NLR, dNLR, SII, and AISI are significantly higher and IIC is significantly lower for the spring group versus the autumn group, especially on the H and E Brixia score-collection days. (4) Conclusions: These results suggest that severe-COVID-19 in-flammation was significantly higher in the spring of 2021 in Romania than in autumn 2021, in regard to pregnant patients

Self-oocyte activation and parthenogenesis: An unusual outcome of a misconducted IVF cycle

A rare cause of infertility is the lack of fertilisation with the spontaneous activation of oocytes, leading to parthenogenesis. We present such a case. The patient was a G1P0 38-year-old woman of African ethnicity, who requested an in vitro fertilisation (IVF) with donor sperm. She received a stimulation protocol of 75 IU of FSH/LH from day 3 of the cycle, which she interrupted after 2 d, and restarted with the same dosage for another 3 d from day 7, plus one administration of GnRH antagonist in day 10 of the cycle. With a follicle reaching 19 mm on day 11, estradiol of 325 ng/ml, ovulation was induced with hMG 5000 UI, and oocyte pick-up performed at 30 h. One oocyte was retrieved, and good-quality sperms were added to the insemination procedure. No fecundation occurred at 20 h, with the extruded oocyte separated from the granulosa wall. At 40 h and 64 h the aspect was of three cells, one cell with one nucleus, the others with high granulation and no visible nuclei. This case shows an unusual self-activation oocyte in a poorly managed IVF cycle. The patient will be further evaluated, to decide if a better managed stimulation protocol would prevent recurrence

SARS-CoV-2 Infection Susceptibility of Pregnant Patients at Term Regarding ABO and Rh Blood Groups: A Cohort Study

Background and Objectives: The susceptibility of pregnant patients at term to SARS-CoV-2 infection regarding the ABO and Rh blood group polymorphism was analyzed in this study. Materials and Methods: In this prospective study, 457 patients admitted for delivery at term in our hospital, between 1 April 2020 and 31 December 2020 were studied. There were 46 positive and 411 SARS-CoV-2 negative patients. Their values for RT-PCR, ABO, and Rh blood group analyses, which were determined upon admittance, were studied. Results: A slightly higher percentage of infected pregnant patients at term belonged to the A blood group compared with the percentage belonging to the other blood groups; this was also true for the healthy control group. For the Rh-negative pregnant patients at term, the odds of being infected with SARS-CoV-2 was OR = 1.22 compared with Rh-positive patients where OR = 1. In our study, the highest risk was found among BIII Rh-negative pregnant patients at term (OR = 3). None of the above differences were statistically significant. Conclusions: No significant difference was found between the percentage of ABO or Rh blood groups in SARS-CoV-2 positive patients when compared with SARS-CoV-2 negative patients (p = 0.562)

Retained Placenta Percreta with Acquired Uterine Arteriovenous Malformation—Case Report and Short Review of the Literature

Placenta accreta spectrum disorder (PAS) has an increased frequency due to the high number of cesarean sections. The abnormal placentation associated with a retained placenta can cause persistent uterine bleeding, with ultrasound Doppler examination being the main choice to assess the uterine hemorrhage. An acquired uterine arteriovenous malformation (AVM) may occur because of uterine trauma, spontaneous abortion, dilation and curettage, endometrial carcinoma or gestational trophoblastic disease. The treatment for abnormal placentation associated with AVM can be conservative, represented by methotrexate therapy, arterial embolization, uterine curettage, hysteroscopic loop resection or radical, which takes into consideration total hysterectomy. Therapeutic management always considers the degree of placental invasion, the patient hemodynamic state and fertility preservation. Considering the aspects described, we present a case of retained placenta percreta associated with acquired uterine AVM, with imagistic and clinical features suggestive of a gestational trophoblastic disease, successfully treated by hysterectomy, along with a small review of the literature, as only a few publications have reported a similar association of diagnostics and therapy

Brixia Score in Outcomes of Alpha versus Delta Variant of Infection in Pregnant Critical COVID-19 Patients

Background: Critical COVID-19 patients account for 1.7 to 13% of all pregnant COVID-19 patients. Methods: Patients admitted to the COVID-19 intensive care unit of Elena Doamna Obstetrics and Gynecology University Hospital in Iasi between 1 January and 1 December 2021, with critical forms of the disease, were included and retrospectively studied. The patients’ age range was 25–44 years in the Alpha group (n = 12) and 27–52 years in the Delta group (n = 9). Results: Most critically ill pregnant COVID-19 patients in the Alpha group delivered when admitted to the intensive care unit, while less than half of those in the Delta group delivered when admitted; the rest were released home and continued their pregnancy normally. There was a significant difference regarding the number of patients released to home care and the number of days after admission when delivery occurred (p = 0.02 and 0.022, respectively). Conclusions: There was no significant difference in maternal and fetal outcomes between the two groups, except for the number of patients released to home care and the number of days after admission when delivery occurred. There was no correlation between any Brixia scores (H, L, A, E) and any maternal or fetal outcomes in both groups

The Importance of the Novel Postpartum Uterine Ultrasonographic Scale in Numerical Assessments of Uterine Involution Regarding Perinatal Maternal and Fetal Outcomes

Background: Uterine involution assessments are critical for the prevention of postpartum hemorrhage. Various methods have been used worldwide. Methods: The PUUS (Postpartum Uterine Ultrasonographic Scale) method evaluates, by transabdominal ultrasonography, the length of the endometrium of the uterine cavity occupied by blood or debris, from grade 0 (no blood) to grade 4 (over three-quarters of the endometrial length occupied by blood/debris). A total of 131 consecutive patients admitted for delivery in the Elena Doamna Obstetrics and Gynecology University Hospital in Iasi, Romania, were prospectively evaluated using the PUUS method. The mean age was 27.72 years old, and they were examined during the first 24–48 h after vaginal delivery, or in the first 48–72 h after cesarean delivery. For patients with a PUUS grade greater than 1, re-examination was preformed daily in the following days, until the PUUS grade decreased to 1 or 0. Results: By standardizing uterine involution in a numerical fashion, we precisely demonstrate that uterine involution varied with the method of delivery (vaginal/cesarean) and with the number of vials of oxytocin received intrapartum, but not with the number of vials of ergometrine maleate received, and not with the origin of the parturient (rural/urban)

Pregnancy during Adolescence and Associated Risks: An 8-Year Hospital-Based Cohort Study (2007–2014) in Romania, the Country with the Highest Rate of Teenage Pregnancy in Europe

Aim. To determine pregnancy and delivery outcomes among teenagers. Materials and Methods. An 8-year retrospective comparative hospital-based cohort study is analysing singleton pregnancy comorbidities and delivery parameters of a teenage group under the age of 20 compared with a young adult group 20–24 years of age in a university hospital. Results. Teenage is a risk factor for preterm birth <37 weeks (1.21 [1.08–1.35]), foetal growth restriction (1.34 [1.21–1.48]), episiotomy (1.27 [1.21–1.34]), uterine revision (1.15 [1.06–1.25]), APGAR <7 at 1 min (2.42 [1.21–1.67]), cephalopelvic disproportion (1.26 [1.07–1.48]), and postpartum haemorrhage (1.42 [1.25–1.62]); however, caesarean delivery occurs less frequently in teenagers than in adults (0.75 [0.70–0.80]). The following comorbidities are risk factors for teenage pregnancy (risk ratio [CI 95%]): anaemia (1.13 [1.10–1.17]), low urinary tract infection (1.10 [1.03–1.18]), pediculosis (2.42 [1.90–3.00]), anogenital condyloma (1.50 [1.04–2.17]), and trichomoniasis (1.74 [1.12–2.68]). The risks for hepatitis B and hepatitis C, premature rupture of membranes, and placenta praevia were lower compared with those in the young adult group, respectively, 0.43 (0.26–0.71), 0.90 (0.85–0.96), and 0.29 (0.20–0.41), while the risk for gestational diabetes and preeclampsia were the same in both groups. Conclusion. Considering the high risks for teenage pregnancy, this information should be provided to pregnant adolescent women and their caregivers

Complete Blood Count Peculiarities in Pregnant SARS-CoV-2-Infected Patients at Term: A Cohort Study

Background: During viral outbreaks, pregnancy poses an increased risk of infection for women. Methods: In a prospective study, all patients admitted for delivery at term to Elena Doamna Obstetrics and Gynecology University Hospital in Iasi, Romania, between 1 April 2020 and 31 December 2020 were included. There were 457 patients, divided into two groups: group 1, SARS-CoV-2-positive patients (n = 46) and group 2, SARS-CoV-2-negative patients (n = 411). Among other tests, complete blood count was determined upon admittance, and the following values were studied: white blood cell count, lymphocytes, neutrophils, red blood cell count, hemoglobin, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, mean corpuscular volume, red blood cell distribution width, hematocrit, platelet count, mean platelet volume, platelet distribution width, plateletcrit, and platelet large cell ratio. Results: in pregnant SARS-CoV-2-infected patients at term, there was a significant decrease in white blood cell, neutrophil, and lymphocyte count, and an increase in mean corpuscular hemoglobin concentration, compared to healthy pregnant women at term, although all still within normal limits. None of the other components of the complete blood count or fetal outcomes studied was significantly influenced by SARS-CoV-2 infection in pregnant patients at term