Romina-Marina Sima

Low dose aspirin for preventing fetal growth restriction: a randomised trial

Abstract The purpose of this study was to investigate when in pregnancy to stop the administration of low dose aspirin (150 mg/daily) so as to prevent fetal growth restriction (FGR) A randomised, placebo-controlled study was designed. The patients were all screened positive using the Fetal Medicine Foundation (FMF) early pregnancy screening test for preeclampsia (PE) and FGR prediction. One hundred and fifty patients were enrolled and divided equally into three groups: A – the controls who received placebo treatment; B – those who received aspirin till 32 weeks of gestation and C – those who received aspirin till 36 weeks of gestation. The mean gestational age at enrollment was similar for all the groups (12.4 weeks). The growth curves, fetal and maternal Doppler measurements and amniotic fluid index (AFI) were monitored every 4 weeks. Also, the outcome of the pregnancy was noted and all the results were compared between the groups. FGR was defined as a fetal weight below the 10th centile for gestational age. In group C, there were less cases of FGR compared with the other groups: 6% vs. 10% in group B vs. 24% in controls. Also, there was a significant birth weight improvement in this group with a median of 3180 g compared with 2950 g in group B and 2760 g in group A (P=0.01). The gestational age at delivery was similar in all the groups (39 weeks in group C/39.2 weeks in group B/38.6 weeks in group A). In conclusion, low dose aspirin improves the outcome in the selected population and should be offered for prevention of FGR from 12 to 36 weeks.

Four years of experience in our clinic regarding hysteroscopies for abnormal uterine hemorrhages

Introduction. Abnormal uterine hemorrhages (AUH) are the most common symptom for presentation to gynecologist. Any uterine bleeding other than menstrual bleeding, which concerns the duration, frequency, quality or quantity of the bleeding is considered abnormal. Material and Methods. We realized a retrospective study based on medical records of the patients admitted for abnormal uterine hemorrhage at “Saint John” Emergency Clinical Hospital, “Bucur” Maternity between 2013 and 2016. From the patients with AUH, we focused on those who underwent hysteroscopies. Results. Our study included 146 patients. The age of patients varied from 22 to 71 years. Abnormal uterine bleeding was most prevalent among women of 40-50 years (20%), and the mean age was 42.65%. 82.88% from our patients had obstetrical history and only 17.12% didn’t give birth either as an option, or from primary or secondary infertility. 7.53% of the patients were hypertensive and 5.48% had endocrine pathology. All patients underwent diagnostic hysteroscopy and 4.79% patients therapeutic hysteroscopy. The therapeutic measures that were made are: hysteroscopic resection of the endometrium (47.3%), excision of polyps (36.99%), sinechiolysis (8.22%) and myomectomy (2.71%). The diagnoses were 46.48% endometrial polyp, 13.7% intramural leiomyoma, 13.7% IUD (intrauterine device) and 9.59% intrauterine synechiae, while 15.06% cumulated for uterine septum, endometrial hyperplasia, cervical polyp, foreign intrauterine bodies, secondary infertility, dysfunctional metrorrhagia. Conclusion. In patients with abnormal uterine hemorrhages, hysteroscopy provides the most accurate diagnosis and can reduce the burden of hysterectomy in many cases.

The role of laparoscopic myomectomy in the modern management of uterine fibroids – a literature review

Uterine fibroids are the most common benign tumors of the genital female tract and the leading indication for hysterectomies in the USA. The prevalence rates quoted in literature range from 20-50%, based on postmortem studies. The prevalence varies with age, with an increase in the late reproductive period. Since the beginning of 1990s laparoscopic myomectomy (LM) has provided an alternative to laparotomy when intramural and subserous myomata are to be managed surgically. However, this technique is still the subject of debate. Based on their own experience together with data from literature, the authors report on the situation today regarding the operative technique for LM and the risks and benefits of the technique as compared with myomectomy by laparotomy. The operative technique include four main stage: hysterotomy; enucleation; suture of the myomectomy site and extraction of the myoma. A consensus gradually emerges that the maximal size of myoma must be 8-10 cm and the total number of fibroids should not exceed four. When conducted by experienced surgeons, the risk of perioperative complications is no higher using this technique. The use of laparoscopic approach could reduce the haemorrhagic risk associated with myomectomy. LM could reduce also the risk of postoperative adhesions as compared with laparotomy. Spontaneous uterine rupture seems to be rare after LM but further studies are needed before it can be said whether the strength of the hysterotomy scars after LM is equivalent to that obtained after laparotomy. Some studies showed that the risk of recurrence seems to be higher after LM than after myomectomy performed by laparotomy. Laparoscopic myomectomy cases may become difficult if bleeding problems occur. Extended operative times may be necessary for morcellation and extensive laparoscopic suturing. Gynecologists need to improve their laparoscopic skills, as minimally invasive surgery is becoming the sine qua non condition of a modern surgeon.

First prenatal diagnosis of a Niemann–Pick Disease Type C2 Revealed by a Cystic Hygroma: A Case Report and Review of the Literature

Background The importance of fetal nuchal translucency was highlighted in the early 1990s as a useful first-trimester marker to identify fetal chromosomal abnormalities. Here, we report the prenatal diagnosis of a fetus with Niemann–Pick disease type C initially identified by first-trimester ultrasonographic markers and eventually confirmed by extensive genetic evaluation. Case presentation The fetus of a 30-year-old woman exhibited a cystic hygroma in the first trimester of pregnancy. The woman underwent chorionic villus sampling with extensive genetic investigations to identify the genetic cause of the ultrasonographic findings. Owing to normal karyotype results, further evaluation of 1,024 genes underlying structural abnormalities was performed. This test identified a homozygous mutation of the NPC2 gene (OMIM 601015), which has been reported to be pathogenic and responsible for Niemann–Pick disease type C2 (NPD-C2). Genetic evaluation of the parents found them to be carriers. Considering the poor prognosis, the parents decided to terminate the pregnancy. Ultrasonographic screening during the subsequent pregnancy showed normal findings; however, molecular testing for the previous familial mutation c.441 + 1G>A identified the fetus as homozygous for this mutation. Therefore, the parent chose to terminate the subsequent pregnancy as well. Conclusion We report the first prenatal diagnosis of NPD-C2 based on a cystic hygroma found during the first trimester of pregnancy as the sole indicator.

P10.08: Accuracy of ultrasound findings in fetal cardiac disease correlated with neonatal diagnosis

Objectives: In severe anomalies requiring early intervention in utero, ultrasound diagnosis may be beneficial facilitating neonatal care. The aim of this study is to determine the correlation of ultrasound findings in congenital fetal heart disease and neonatal diagnosis. Methods: A retrospective study of all patients with singleton pregnancy between 2010–2011 was performed. The data collected included patient age, gestational age, cardiac diagnosis, extracardiac anomalies, prenatal and postnatal management and outcome. Results: Out of 4749 patients admitted in our hospital 23 were CHDs (congenital heart defects), 18 living newborns, 3 stillbirths and 2 misscariages. Mean age was 24 (range 16–40) and mean gestational age 31 weeks (range 24–40). Ultrasound was the most relevant diagnosis tool in all CHDs cases for both in utero and postpartum diagnosis. We recorded VSD (ventricular septal defect) in 10 cases, ASD (atrial septal defect) in 8 cases, TGA (transposition of great arteries) 4 cases, common arterial trunk 1 case, coarctation of aortic artery 1 case, TOF (tetralogy of Fallot) 1 case and HLHS (hypoplastic left heart syndrome) 1 case. In utero ultrasound findings were VSD (10 cases), ASD (8 cases), TGA (4 cases), common arterial trunk 1 case, coarctation of aortic artery 1 case, TOF 1 case and HLHS 1 case. We recorded 8 cases of extracardiac anomalies (hydrocephalia, keiloskisis, esophagus athresia, abdominal situs inversus and encephalocele). We had 3 stillbirth cases with mean gestational age 35 weeks and 2 misscariages at 24 and 22 weeks with complex CHDs associated with extracardiac anomalies. Conclusions: In our study the most common CHDs was VSD. The correlation rate between prenatal and postnatal ultrasound findings was more than 90%. Although the sensitivity of routine ultrasound remains low there is no doubt that an increasing number of fetal diagnosis are being made and sonografic diagnosis of CHDs is feasible from early gestation.