Mihai Dimitriu

Invasive Molar Pregnancy in a Woman Aged 54 Years A Case Report

We reported a 54-year-old patient with a complete hydatidiform mole invasive in myometrium. This diagnostic was suggested by irregular vaginal haemorrhage, amenorrhea and reduced nausea. Our paraclinical investigation was: pelvic ultrasound and level of serum beta-human chorionic gonadotropin (β-hCG). Endovaginal ultrasound reveal enlarged uterus volume, with dimensions 12/15/8 cm, with the presence of multiple nodular formations located intramural and subserosal and a mass with Doppler rich blood supply through myometrium and endometrium. The level of β-hCG was 28099.00 mIU/L. Therapeutic method applied was abdominal hysterectomy and bilateral salpingo-oophorectomy. Anatomopathological report revealed a complete invasive mole and endometrial polyp. After the surgical intervention the patient was treated with Methotrexate as prophylactic chemotherapy recommended by oncologists because of the invasive character of mole and age of patient. The complete invasive mole is a benign tumor that is characterized by abnormal proliferation of trophoblast and is locally invasive and possible metastatic. Developing pregnancy rate in perimenopause period is very rare and most of the pregnancies that occur at this age are abnormal, spontaneous abortion occurring most often. We choose to report this case to emphasize that this condition can occur in a relatively advanced age, especially during perimenopause period.

EP06.21: Amniotic bands, anorectal and bladder agenesis: a unique association in a twin pregnancy with fetus papyraceus: Electronic Poster Abstracts

viscera into the chest, causing serious pulmonary and cardiac complications. The congenital diaphragmatic hernia (CDH) is classified according to the location of the protrusion, including in hiatal hernia, Morgagni-Larrey hernia, and Bochdaleck hernia as results of inadequate obliteration of the lumbar elements in the pleuroperitoneal area, during the eighth and tenth week of intrauterine development. We investigating a full-term pregnant woman complained about water broke and being diagnosed as congenital diaphragmatic hernia from fetomaternal ultrasound. Later, patient was underwent Caesarean section due to PROM, low pelvic score, and oligohydramnios with amniotic fluid index 1. A baby boy was born: weight 3200 gram with AS 1/3/4, then was directly intubated by the perinatologist as early neonatal resuscitation for congenital diaphragmatic hernia neonates. Due to limited facility of oxygen supply, the baby’s breathing was connected to HFO between 10 minutes. Later, the baby did not survive the early 2 days due to fail of breathing in stabilisation and preparation for diaphragm correction. We also investigated that there was decrease of vitamin A in mother’s serum as risk factor on diaphragm’s development in utero.

EP17.03: Echographic aspects of Caesarean scars in non-pregnant uterus after single or multiple Caesarean sections: Electronic Poster Abstracts

We developed a study during 2009 and 2016 in two tertiary care units in Bucharest: ‘St. Pantelimon’ Emergency Hospital and ‘Bucur’ Maternity. The study group included 110 nonpregnant women with history of low transverse CS with single or double layer uterine closure. Transvaginal ultrasound was performed to establish the parameters of the Caesarean scar: • the thickness of the tissue scar segment • the triangular shaped anechoic scar defect. We identified the basis of the triangle (P) and the height of the triangle (W) and we made the index thickness/basis and thickness/height of triangle.

The problems associated with adolescent pregnancy in Romania: A cross-sectional study

RATIONALEnThe extent of pregnancy in adolescents and young adults, especially in low and middle-income countries, is a source of increasing concern given its social and economic impact.nnnAIMS AND OBJECTIVEnWe hypothesized that there would be correlations between female patients becoming pregnant at a young age and practices such as harmful alcohol misuse, cigarette smoking, and drug use, the use of toxic substances, low educational attainment, and an essential absence of health care seeking about the outcome of adolescent pregnancies.nnnMETHODSnWe performed a prospective cross-sectional study of patients who gave birth between August and November 2017 at St. Pantelimon Emergency Hospital in Bucharest, Romania. Seventy-four patients aged 14 to 20xa0years, with a mean maternal age of 18.07xa0years, were enrolled in the study and answered a 15-item questionnaire about their social, educational, and medical background.nnnRESULTSnFifty-three patients (71.6%) gave birth by caesarean section and 21 (28.3%) by vaginal delivery. Notably, patients aged 14 to 16xa0years had a lower rate of caesarean delivery compared with those aged 17 to 20xa0years. Moreover, 83.0% of the caesarean sections and 76.1% of the vaginal deliveries were at term. With reference to age and type of delivery, women are more likely to give birth by caesarean section at any age group (the association is not statistically significant at Pxa0<xa0.05), except for the age of 15xa0years (five out of six patients in our sample had a spontaneous birth). Smoking was the most common risk behavior in the sample (45.9%, nxa0=xa034), followed by alcohol consumption (17.5%, nxa0=xa013) and drug use (5.40%, nxa0=xa04).nnnCONCLUSIONSnA high percentage of caesarean delivery was reported, particularly in patients aged >17xa0years. The percentage of female participants who underwent a caesarean delivery for their second pregnancy was significantly higher than compared with primipara participants. Patients receiving consistent antenatal care visits compared with those who did not monitor their pregnancy did not differ in the likelihood of undergoing a caesarean section.

Primary myelofibrosis and pregnancy outcomes after low molecular-weight heparin administration: A case report and literature review

Rationale: Primary myelofibrosis is encountered with the myeloproliferative diseases and is the least prevalent among women of childbearing age. The prognosis is guided by pancytopenia, leukemic transformation and thrombosis which are the dominant complications. Patient concerns: Data regarding protocol management during pregnancy in the context of myelofibrosis are insufficient. Fewer than ten cases have been described until now and half of this cases have resulted in fetal death due to placental infarction during the second and third trimesters. Diagnoses: We present the case of a 34-year-old pregnant woman diagnosed with Jak 2- negative primary myelofibrosis. Personal history did not include miscarriage or stillbirth. Interventions: The patient was previously treated with anagrelide hydrochloride, which was interrupted at 6 weeks of gestation when the pregnancy was confirmed. It was replaced with Interferon-a 3u200aMU/day. Because of severe thrombocytosis, administration of aspirin 150u200amg/day was recommended. Outcomes: The pregnancy was uneventful. The patient was hospitalized at 33 weeks of gestation because of moderate vaginal bleeding and high risk of preterm birth. After a specialized hematological investigation, the treatment with aspirin was replaced with low-molecular-weight heparin 0.6u200aml per day. This combined treatment assisted in the natural tendency to lower platelet counts during pregnancy and resulted in stabilization of the hematological status. At 38 weeks of gestation the patient delivered a healthy baby boy via cesarean. He weight 2850 grams and his Apgar score was 9. Anticoagulant and interferon treatments were continued post-partum under hematologist surveillance. Lessons: This case was rare and complex. Because it was related to pregnancy it required continuos collaboration and supervision between obstetrician and hematologist.

Controversies in the role of vitamin D in infertility

The study that implicates vitamin D in playing a role in fertility is compelling, and it is backed up by sound hypothesis. Nevertheless, further research needs to be assess for the health benefits and reaching appropriate levels. This could represent a starting point of a new domain which could find simple approaches to improve health. Notwithstanding fertility benefits, patients should have vitamin D supplementation for health benefits, including pregnancy health, bone health and chronic disease risk reduction. This review is based on the results of clinical trials and studies published in medical journals and database from the moment it was first acknowledged until nowadays. We aim to present the evolution of the perspective on the subject and the new findings surrounding it. Vitamin D has its well-known function in calcium and phosphorus hemostasis, and its deficiency is predominant in high-risk populations, but the prevalence among healthy or asymptomatic adults is not well defined. Several theories and hypothesis have been launched over the last years regarding the etiology of vitamin D deficiency, none of them being flawless or able to explain the entire panel of symptoms. Taken into consideration the insufficiency of vitamin D which could have implications also in infertility, especially in young fertile women, the newest research could lead to new supplementation of vitamin D in the treatment of both women and male infertility management.

Progesterone and neuroprotection at menopause

The neuroprotective effect of progesterone has been demonstrated in numerous experimental cell and animal studies, in traumatic brain/spinal injury, neurodegenerative diseases, storke, demyelinating diseases. Thus progesterone has emerged as a promising candidate for preventing and treating neuronal related disorders leading to a few promising clinical studies.The effects of progesterone in the nervous system involve a variety of signaling actions, therefore we review the evidence that supports the neuroprotective effects of progesterone and recall the mechanisms that mediate these effects. We also discuss the biology of progesterone and the effects of this hormone on myelination and remyelination of the central and peripheral nervous system. Progesterone in the brain is derived from the steroidogenic endocrine glands or from local synthesis by neural cells. Stimulating the formation of endogenous progesterone is currently explored as an alternative strategy for neuroprotection, axonal regeneration, and myelin repair.

Morbidities in pregnancy associated with systemic lupus erythematous

The association between systemic lupus erythematosus (SLE) and pregnancy is not a rare event, but these pregnacy are associated with an increased risk of preeclampsia, fetal growth restriction, fetal stillbirth, prematurity and neonatal death. Nephritis is an important complication of SLE xa0and a factor for maternal and fetal morbidity. Studies of the impact of SLE and pregnancy morbidities generate conflicting results. The aim of these study was to realize a systematic analysis in the literature concerning the pregnancy outcome in women with SLE and SLE associated with lupus nephritis. We searched the electronic database in literature and random effects of analytycal methods were used to evaluate pregnancy complications rates. Also the association between pregnancy and nephritis it is not very often encountered in different articles. Active SLE and the presence of antiphospholipid antibodies (APA) are considered the most powerful predictors of perinatal morbidity. We found that a significant number of pregnancies occur during periods of active nephritis (19%), and have positive APAs (26.2%). Up to 75% of patients with SLE have clinically evident renal disease. Lupus flare in pregnancy is one of the major issues associated with SLE. However, studies report variable flare rates in pregnancy between 25-65%. Other important perinatal complications associated with SLE in pregnancy are: gestational hypertension (16.3%), fetal growth restriction (12,7%), preeclampsia (7,6%), preterm delivery (39,4%), stillbirth (3,6%), neonatal death (2,5%). Neonatal lupus syndromes is a form of passively acquired fetal autoimmunity from maternal antibodies, anti-Ro and anti-La antibodies with important cardiac involvement, most commonly congenital heart block. Previous and actual lupus nephritis is associated with negative effects on preganancy and with a deterioration of renal function. Despite considerable improvement in success rates, suboptimal obstetrical outcomes still remain a cause for concern. Best pregnancy results can be obtained if appropriately managed by a multidisciplinary team of physicians.

OP19.05: Three dimensional echographic evaluation of septate uterus after hysteroscopic septum resection and correlation with pregnancy outcome

Methods: 25 premenopausal women (mean age: 31 years old) diagnosed as having PCOS according to Rotterdam criteria and 44 healthy regularly menstruating premenopausal women (mean age: 30 years old) used as controls were assessed in the follicular part of the menstrual cycle by 4D STIC-HDF transvaginal ultrasound. Using 1cc spherical sampling we calculated Vascularization index (VI) from the most vascularized part of the ovarian stroma at two different moments of the cardiac cycle (systole and diastole. System settings were kept constant for all the patients (PRF = 0.6 kHz, gain = 0.8) and depth at 40 mm. The ratio of VI between systole and diastole (S/D VI) was also calculated. Analysis was performed off-line using the 4D View software (version 10.2) in a personal computer. VI and S/D VI were compared using U MannWhitney test. A P value < 0.005 was considered as statistically significant Results: Median VI during systole and diastole were significantly higher in PCOS as compared with controls. S/D VI ratio was significantly lower in PCOS women (Table 1). Conclusions: Assessment of ovarian stromal vascularization using STIC-HDF spherical sampling is feasible. Our data show that ovarian stromal vascularization is higher in PCOS women. Increased vascularization is maintained throughout cardiac cycle.

P25.07: Corpus calosum abnormalities: 2D versus 3D multiplanar versus 3D-VCI

volumetry by VOCAL 30o was performed in an ACCUVIX XQ device (Medison, Seoul, Korea) and MRI in Sonata Maestro Class system in a Leonardo workstation using ARGUS VA60C software. (Siemens, Erlangen, Germany). Reliability and agreement of the two techniques were evaluated with intraclass correlation coefficients (ICCs), and proportionate Bland-Altman plots were constructed. Results: A high degree of reliability was observed between VOCAL and MRI (ICC 0.879 [95% CI: 0.794; 0.929]). Bland-Altman tests showed no clinically significant mean percent differences between measurements (MD: 21.92 [95% LA: ±29.32; SD: ±14.96]). Conclusions: Three-dimensional volumetry of fetal lateral ventricles by VOCAL method has good agreement with fetal MRI in fetuses with ventriculomegaly.