Abstracts of The 12th Congress of the Romanian Society of Ultrasonography in Obstetrics and Gynecology & the 9th National Conference of the Romanian HPV Society 12-14 September 2024, Târgu-Mureș, Romania

Abstracts of The 12^th Congress of the Romanian Society
of Ultrasonography in Obstetrics and Gynecology

 

12-14 September 2024, Târgu-Mureș, Romania

The role of ultrasound in the risk management of genetic abnormalities after in vitro fertilization

 

Dragoş Albu¹, Alice Albu²

1. “Carol Davila” University of Medicine and Pharmacy, Bucharest; Department of Maternofetal and Reproductive Medicine, Life Memorial Hospital, Bucharest, Romania

2. Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, Bucharest; “Elias” University Emergency Hospital, Bucharest, Romania

Introduction. The risk for genetic abnormalities in in vitro fertilization (IVF) pregnancies could be higher in some situations, such as advanced maternal age, recurrent abortions, implantation failure, twin pregnancies, and poor sperm parameters. IVF cases can be divided into preimplantation genetic tested (PGT) cases and non-PGT cases. In genetic abnormalities, ultrasound is used as a screening tool in the first and second trimesters of pregnancy and as a diagnostic tool when invasive procedures such as chorionic villus biopsy and amniocentesis are performed. Methodology. This is a retrospective analysis. The cases were evaluated with both transabdominal and transvaginal ultrasonography early in the first trimester, at 6-9 weeks of pregnancy, at 12-13 weeks, and in the second trimester at 16-18 weeks. Invasive guided ultrasound procedures (chorionic villus biopsy) were performed in the first trimester for four cases which involved potential monogenic disease: cystic fibrosis, von Hippel Lindau syndrome, primary torsion dystonia DYT1, and pontocerebellar hypoplasia. Amniocentesis was performed in the second trimester of pregnancy, mainly when mosaic embryos were transferred or in cases in which translocations were found in one of the parents. Results. Ultrasound signs of early pregnancy losses are empty sac, yolk sac only, small gestational sac, small embryonic pole, and early symmetrical arrested growth; these are characteristics of embryo chromosomal abnormalities. Holoprosencephaly and increased nuchal translucency were the most common signs found at first-trimester screening and were associated with trisomy 13 and trisomy 21. Chorionic villus biopsy confirmed the initial diagnosis in all cases when embryo selection was performed using PGT-M (preimplantation genetic testing for monogenic disease). In the second trimester, amniocentesis revealed normal pregnancies. Conclusions. Ultrasound is vital in the risk management strategies in PGT and non-PGT IVF cases.

Keywords: chromosomal abnormalities, in vitro fertilization, PGT

 

Endometrial waves: are they an ultrasound marker for adenomyosis?

 

Shadia Ateia, Carmen Cheleș

Victoria Medical Center, Bucharest, Romania

Introduction. Adenomyosis remains a challenging diagnosis from an ultrasound perspective. The application of the MUSA criteria for diagnosing this pathology partially standardizes the possibility of an accurate diagnosis, but there are cases where this is not an option. However, transvaginal ultrasound remains the first-line diagnostic tool in cases of adenomyosis. The aim of this paper is to evaluate the potential of uterine peristalsis, represented by “endometrial waves”, to be an ultrasound marker for the diagnosis of adenomyosis. Materials and method. In cases with clinical suspicion of adenomyosis, the first investigative indication is represented by transvaginal ultrasound, with the application of the MUSA criteria for the diagnosis of adenomyosis. To monitor uterine peristaltic activity, this ultrasound is performed during the periovulatory “window”. The presence and increased intensity of endometrial waves are frequently associated with the fulfillment of positive MUSA criteria for the diagnosis of adenomyosis. Results and conclusions. Performing transvaginal ultrasound in suspected cases of adenomyosis and monitoring uterine peristaltic activity can reveal an increased intensity of endometrial waves in patients meeting positive MUSA criteria for adenomyosis.

Keywords: adenomyosis, ultrasound, waves

 

The role of follicular volume in predicting oocyte maturity

 

Shadia Ateia, Carmen Cheleș

Victoria Medical Center, Bucharest, Romania

Introduction. Oocyte maturity is usually not considered outside the context of assisted human reproduction. However, in routine practice and outpatient settings, patients’ reproductive desires may necessitate a better evaluation and monitoring of their fertility parameters, even in the absence of an infertility context. The aim of this paper is to evaluate the predictive potential of one of the most important factors involved in the reproductive process, the mature oocyte, by correlating it with follicular volume. Materials and method. Performing transvaginal ultrasound to monitor ovulation involves conducting it during the periovulatory window and measuring follicular progression. Excluding estradiol measurement, the options for assessing follicular maturity are relatively limited or intuitive/collaborative, taking into account other clinical or paraclinical elements. Relating follicular volume to oocyte maturity, considering a natural progression rate of the dominant follicle of 1.5-2 mm/day, can estimate the timing of ovulation. Furthermore, the literature estimates an optimal follicular volume that can be correlated with oocyte maturity. The optimal clinical applicability of this information is certainly within ovarian stimulation cycles for mono-ovulation. Results and conclusions. The role of follicular volume in the predictive assessment of oocyte maturity is not to be overlooked, especially outside the context of assisted human reproduction/in vitro fertilization. The ultrasonographic information obtained is particularly applicable for optimizing the fulfillment of patients’ reproductive desires in routine outpatient practice.

Keywords: ultrasound, follicle, in vitro fertilization

 

 

Conservative management in cervical pregnancy: ultrasound-guided aspiration curettage

 

Fernanda-Ecaterina Augustin^1,2, Marius Augustin¹, Ionuț Vâlcea¹, Bianca Dinulescu¹, Romina-Marina Sima^1,2, Liana Pleș^1,2

1. Department of Obstetrics and Gynecology, “Sf. Ioan” Hospital, “Bucur” Maternity, Bucharest, Romania

2. Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Introduction. Cervical pregnancies are rare, occurring in about 1 in 8600 to 1 in 12,400 pregnancies, and they involve the implantation of the fertilized egg in the cervix. Sonographic findings in cervical pregnancy may include an hourglass-shaped uterus, a ballooned cervical canal, gestational tissue at the cervix, absence of intrauterine gestational tissue, and a portion of the endocervical canal between the gestation and the endometrial canal. Case report. This case presentation is of a 43-year-old woman, nulligravida, with no medical history, who presented to our clinic with 7 weeks of amenorrhea and abdominal pain. Transvaginal ultrasound examination revealed a single gestational sac, located in the middle third of the cervical canal, with a yolk sac measuring 4.2 mm in diameter and a ballooned appearance. An embryo without cardiac activity and a trophoblast with reduced vascularization were observed. The uterine cavity showed a hyperplastic endometrium. Following clinical and paraclinical examinations, the diagnosis of 7-week missed miscarriage cervical pregnancy was established. The patient was informed about the therapeutic management options, and in this case ultrasound-guided cervical aspiration was chosen. The patient signed the informed consent form, assuming all associated risks of the procedure, including the risk of hemostatic hysterectomy. The procedure was performed under spinal anesthesia. After dilatation of the cervical canal, an 8-size aspiration cannula was inserted and, under ultrasound guidance, the cervical pregnancy was evacuated. Afterwards, a curettage was systematically performed in the cervical canal and uterine cavity. The bleeding was minimal, and the patient’s recovery was favorable, allowing for discharge after three days. Conclusions. Cervical pregnancy can be managed conservatively, using transabdominal ultrasound to guide aspiration curettage. This approach preserves fertility and avoids the hepatotoxic effects of methotrexate. Future studies are needed to establish positive prognostic factors for selecting this method in the management of cervical pregnancy.

Keywords: cervical pregnancy, ultrasound-guided aspiration curettage, conservative management

 

Evaluation of fetal cardiac function in maternal gestational diabetes and dyslipidemia using conventional and speckle-tracking echocardiography

Biliana Belovan, Adrian Rațiu, Maria Ciupici-Cladovan, Ioan Sas

Department of Obstetrics and Gynecology, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania

Introduction. Due to metabolic changes in women of reproductive age and the increasing number of pregnant women with dyslipidemia and advanced maternal age, the incidence of gestational diabetes mellitus (GDM) remains high. The most commonly known cardiac effect of gestational diabetes mellitus in the fetus is hypertrophic cardiomyopathy, but recent studies have shown that it is preceded by subclinical cardiac dysfunction. This study aimed to assess the effect of GDM on fetal cardiac geometry and contractility by two-dimensional speckle-tracking technology. Materials and method. A prospective observational study, including 41 pregnant patients with GDM and dyslipidemia and 45 pregnant patients with no obstetrical pathology, was performed. For all fetuses, a four-chamber 3-second cine loop was recorded and analyzed with Fetal Heart Quantification (FetalHQ®). The following cardiac indicators were evaluated: global sphericity index (GSI), global longitudinal strain (GLS), fractional area change (FAC), and 24-segment end-diastolic diameter (EDD), fractional shortening (FS), and sphericity index (SI) for both ventricles. Differences between the two groups were analyzed. Results. The fetal left ventricular global longitudinal function was similar between the GDM and control groups. However, compared to the controls, right ventricular function in the GDM group was lower, only at 33 to 38 weeks. In the GDM group, the global spherical index (GSI) was lower than in the control group, at 33 to 38 weeks (1.175 versus 1.22; p=0.001). There were significant changes in right ventricular FAC and FS for segments 4-24 in fetuses exposed to GD (−1 SD; p<0.05). No significant differences were detected for GSI, GLS, EDD, or SI for either ventricle. Conclusions. Fetuses exposed to gestational diabetes mellitus present impaired right ventricular contractility, especially in the mid and apical segments, particularly during the later stages of pregnancy (33 to 38 weeks), compared to fetuses from healthy pregnancies. The Fetal HQ technique represents a valuable tool for evaluating the structure and function of fetal hearts affected by gestational diabetes mellitus during the advanced stages of pregnancy.

Keywords: gestational diabetes mellitus, dyslipidemia, echocardiography

 

Indications for endometrial ultrasound screening

 

Roxana-Elena Bohîlțea^1,2, Cristiana-Elena Durdu¹

1. Department of Obstetrics and Gynecology, “Filantropia” Clinical Hospital of Obstetrics and Gynecology, Bucharest, Romania

2. Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Lynch syndrome, one of the most common genetic syndromes predisposing to cancer, is associated with a wide range of malignant conditions, among which endometrial and colorectal cancers are the most frequent. Despite significant progress in understanding this condition over time, there are still aspects of its management that have not demonstrated clear benefits. Advances in genetic testing and discoveries related to the frequency of oncological pathology and the affected pathogenic variant are likely to lead to personalized medicine focused on the individual patient in the coming years. Although various screening methods for gynecological cancers have been used over time, they have not shown significant benefits in improving survival. This highlights the need to study and implement new screening and diagnostic methods, which have been investigated in recent years and are discussed in this paper. This study aims to highlight the role of ultrasound in screening for Lynch syndrome by evaluating the effectiveness of this method in the early detection of endometrial cancer among patients affected by this syndrome.

Keywords: Lynch syndrome, ultrasound screening, endometrial cancer, prevention

 

Malpractice in obstetric ultrasound. Loss of chance as a kind of prejudice

 

Dan Boitor-Borza

“Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

Introduction. Loss of chance is a concept taken from the French law. Our country’s courts are increasingly employing it in medical malpractice lawsuits. This study aims to identify medical malpractice trials including the loss of chance and to determine the type of trial (civil or criminal), the circumstances leading to acquittal, or the amount of monetary compensation for the patient. Materials and method. For this study, we used the Ministry of Justice database (https://www.portal.just.ro) and the High Court of Cassation and Justice database (https://www.iccj.ro/biblioteca-digitala/publicatii-iccj/bulletinul-jurisprudentei). They were last consulted on July 25, 2024. To select the cases, we employed the keywords “medical malpractice” and “loss of chance”. The inclusion criteria were: criminal or civil lawsuits involving medical malpractice that resulted in a loss of chance, and the availability of the judge’s reasoning on the websites. The criteria for exclusion were: malpractice in fields other than medicine, and unavailability of the reasoning on the websites. Results. The research yielded 164 cases based on Ministry of Justice data and six more based on the High Court of Cassation and Justice data. After removing duplicates and verifying the inclusion criteria, 58 records were retained. A source of bias is that the cases reported in the databases are not exhaustive; rather, they are based on prior selection by the institutions involved. In 52 of the 58 cases, healthcare providers were acquitted. The remaining six cases resulted in compensations of up to 10,000 euros for the harm caused by the loss of chance. The study provides an overview of these cases and synthetizes their key characteristics and outcomes. Conclusions. Raising awareness about loss of chance and its application in Romania is appropriate. Acceptance by the judge of the prejudice in this form may result in additional com­pen­sation for patients.

Keywords: loss of chance, malpractice, obstetric ultrasound

 

Essential follow-up in the first-trimester screening: case report on spontaneous regression of enlarged nuchal translucency and genetic testing, highlighting clinical uncertainty
 and guiding decision-making

 

Victor-Bogdan Buciu^1,2, Șerban Denis^1,2, Lăcrămioara Corhan¹, Ioan Sas^1,2

1. “Pius Brânzeu” County Emergency Clinical Hospital, Timişoara, Romania

2. Department of Obstetrics and Gynecology, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania

Introduction. First-trimester screening is essential for monitoring pregnancy progression, with nuchal translucency (NT) measurement serving as a critical marker for detecting chromosomal abnormalities and structural anomalies. This study aims to present a case of spontaneous regression of NT following first-trimester screening, emphasizing the importance of timely assessment and comprehensive screening methods, including advanced genetic testing. Materials and method. We describe a case involving a patient with grossly enlarged NT observed during routine screening at approximately 13 weeks of gestation. Due to a lack of cooperation, the associated screening bloodwork was not conducted. A follow-up ultrasound was performed three weeks later. Subsequently, the patient opted for amniocentesis, which included preliminary QF-PCR screening and detailed karyotyping. Results. The follow-up ultrasound revealed a significant spontaneous reduction in nuchal translucency. Despite this, amniocentesis was conducted. Preliminary QF-PCR results indicated normal chromosomal findings, and karyotyping confirmed chromosomal euploidy. Further array testing was not pursued due to technical and financial constraints. Subsequent ultrasound examinations, including second-trimester morphology, showed normal fetal development. Comparable secondary studies of the literature emphasize the high specificity of genetic evaluation in cases of cystic hygroma. Conclusions. This case underscores the critical importance of proper timing in the first-trimester screening. The absence of timely bloodwork and delayed detection of NT abnormalities could have resulted in a missed diagnosis, potentially impacting the clinical management. The discrepancy between the normal results from QF-PCR and karyotyping and the initial ultrasound suspicion of aneuploidy highlight the necessity of comprehensive genetic evaluation in cases with abnormal nuchal translucency. These findings advocate for adherence to recommended screening protocols and the implementation of thorough genetic testing to ensure accurate diagnosis and appropriate clinical intervention.

Keywords: nuchal translucency, genetic testing, first-trimester screening

 

Disseminated peritoneal leiomyomatosis: ultrasonographic diagnosis of masked benignity or hidden malignancy?

 

Carmen-Elena Bucuri, Răzvan Ciortea, Maria-Patricia Roman, Cristina Ormindean, Ionel Nati, Viorela Suciu, Andrei Măluțan, Dan Mihu

“Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

Introduction. Disseminated peritoneal leiomyomatosis (DPL) is a rare condition characterized by multiple leiomyomas in the peritoneal cavity, primarily affecting women of reproductive age. While typically benign and treatable, DPL can pose significant challenges in diagnosis and, in rare cases, it may undergo malignant transformation. Hormonal influences – particularly sex hormones – play a crucial role in DPL pathogenesis, alongside iatrogenic factors such as morcellation during myomectomy. Materials and method. A comprehensive search of the PubMed and Scopus databases was performed to identify all relevant literature published between January 2010 and June 2024. In PubMed and Scopus, the search query used was “disseminated peritoneal leiomyomatosis” in any field. Only English language articles were included, based on the eligibility criteria. The initial search yielded a total of 104 records across the two databases. After removing duplicate articles, the remaining 65 titles and abstracts were screened to determine the relevance to the objectives of the review. This process led to the final inclusion of 21 studies that met the criteria of reporting complete case descriptions diagnosed as disseminated peritoneal leiomyomatosis. Data were then extracted from these 21 articles that comprehensively described the cases. Results. The diagnostic methods include computed tomography, ultrasound, magnetic resonance imaging and histopathological evaluation, essential for assessing disease extent and for guiding therapeutic decisions. Specifically, ultrasound plays a pivotal role in detecting and characterizing peritoneal lesions, providing detailed insights into their location, size and structure, which facilitate optimal treatment planning. The management options range from surgical interventions, which carry risks such as morcellation-induced dissemination, to conservative approaches for asymptomatic patients. Advanced surgical techniques and hormonal therapies show promise in reducing recurrence rates and in improving outcomes. Despite its low prevalence, with fewer than two hundred cases reported worldwide, the complexity of DPL underscores the need for a comprehensive understanding of its clinical presentation and management to ensure optimal patient outcomes. Conclusions. Early diagnosis, personalized treatment plans, and ongoing research to address challenges associated with disseminated peritoneal leiomyomatosis, with a particular emphasis on ultrasound evaluation for efficient disease management, are considered essential elements.

Keywords: disseminated peritoneal leiomyomatosis, ultrasound, hormonal therapy

 

Intrapartum ultrasound – an important instrument in contemporary obstetrics

 

Irina Burdeniuc, Liliana Fuior-Bulhac

“Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chișinău, Republic of Moldova

Introduction. The assessment of labor progress by intrapartum ultrasound may play an important role in the management of labor and delivery. During labor, we scan transabdominally for the anatomy, fetal position, fetal condition, fluid levels and placental position, and transperineally for fetal head station, thereby preventing numerous maternal and fetal complications. Materials and method. This is a review study that compares the most recent international guidelines on ultrasound in labor by different organizations, including the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the American College of Obstetricians and Gynecologists (ACOG), the World Association of Perinatal Medicine (WAPM), and the Society of Obstetricians and Gynecologists of Canada (SOGC). Results. Sonographic analysis of labor progress is a conceptually simple way of monitoring the key parameters of labor by ultrasound: cervical dilatation, fetal head descent, and fetal head position. The incorrect assessment of these parameters can increase the risk of maternal and perinatal complications. The indications for ultrasound evaluation in labor are slow progress or arrest of labor in the first stage, slow progress or arrest of labor in the second stage, ascertainment of fetal head position and station before considering or performing instrumental vaginal delivery, and the objective assessment of fetal head malpresentation. Knowing the position of the fetal head is a prerequisite for operative vaginal birth, enabling the accoucheur to predict the likelihood of success, identifying the need for rotation, and correctly placing the instrument. The induction of labor is increasingly common in modern obstetrics, associated with risks such as emergency caesarean deliveries, particularly high among nulliparous women. Ultrasound aids in selecting candidates likely to succeed with induction, thereby mitigating these risks. World Health Organization recommends limiting the number of digital examinations. Therefore, introducing less invasive methods like ultrasound examinations is proposed to assess labor progression more safely and comfortably. Conclusions. The widespread use of ultrasound during labor can reduce the risks and complications for both maternal and fetal health. Equipping maternity wards with ultrasound machines and training medical personnel in ultrasound diagnostic methods can significantly improve perinatal outcomes.

Keywords: intrapartum ultrasound, cephalic malpresentations, sonopartogram

 

The role of ultrasound markers for premature birth risk prediction

 

Ioana-Victoria Camen¹, Anda-Lorena Dijmărescu^1,2, Sidonia-Cătălina Vrabie^1,2, Sidonia-Maria Săndulescu^1,2, Maria-Magdalena Manolea^1,2

1. “Filantropia” County Clinical Hospital Craiova, Romania

2. University of Medicine and Pharmacy of Craiova, Romania

Introduction. Preterm birth is one of the most important causes of perinatal mortality, inducing long-term neonatal morbidity, as well as increased healthcare costs. The purpose of this research is to reveal the importance of ultrasound examination in the sense of evaluating some ultrasound markers, noninvasive, easy to perform, which can be used for the early detection of premature birth, either individually or combined. Materials and method. In our study, there were included 116 patients, and the following ultrasound parameters were evaluated: cervical length, utero-cervical angle, funneling, sludge, and cervical consistency index. The patients were evaluated in three periods of pregnancy: 18-22.6 weeks, 28-31.6 weeks, and 32-35.6 weeks. Results and conclusions. The sensitivity, specificity, the positive and negative predictive value, as well as the positive and negative predictive values for premature birth prediction showed us that a cervical length below 25 mm, which is a commonly used cutoff in clinical practice, is highly significant in predicting premature birth, with a sensitivity of 99% and a specificity of 61%. A pronounced funneling before 25 weeks is associated with an approximately 80% risk of preterm delivery. According to studies, it is considered that below 65% degree of deformation and below 20 percent of the normal consistency of the cervix, we have an increased risk of premature birth, in the category of 18-22.6 gestational weeks. Cervical length measurement remains the standard of preterm birth risk prediction. The use of the other described ultrasound markers can increase the quality of risk prediction, especially when at least two markers are used.

Keywords: premature birth, funneling, cervix

 

Adenomyosis – before and after menopause

 

Carmen Cheleș, Shadia Ateia

Victoria Medical Center, Bucharest, Romania

Introduction. Adenomyosis is a complex chronic condition that requires precise diagnosis and a personalized treatment approach. Materials and method. Although it is frequently diagnosed in women of reproductive age due to menstrual symptoms, adenomyosis can also have significant clinical implications in the postmenopausal period. Even though symptoms may improve due to decreased estrogen levels, some women may continue to experience symptoms or even develop adenomyosis after menopause. In postmenopausal women, the diagnosis is usually incidental, established during imaging investigations for other pathologies or following surgical interventions. Conclusions. Advances in imaging techniques and a better understanding of the pathogenesis have significantly improved the management of this condition. However, challenges remain in standardizing diagnosis and treatment, and ongoing research is essential to improve outcomes for affected patients.

Keywords: adenomyosis, menopause, diagnosis

 

Cystic adenomatoid malformation – clinical case

 

Carmen Cheleș^1,2, Alin Burlacu²

1. Victoria Medical Center, Bucharest, Romania

2. Wellborn Medical Network, Bucharest, Romania

Cystic adenomatoid malformation of the lung (CCAM) or congenital pulmonary airway malformation (CPAM) is a rare lung development anomaly that occurs during the fetal period. It involves the formation of cysts and abnormal masses in the lungs, which can vary in size and number. Prenatal ultrasound plays a crucial role in the diagnosis and management of this condition, allowing for the early identification of lung lesions and detailed evaluation. Early detection of CPAM allows for timely consultation with specialists (such as pediatric surgeons and neonatologists) and appropriate planning for management after birth. It also provides an opportunity for parental counseling regarding the condition, potential complications and treatment options. We present the case of a 41-year-old patient, IGIP, whose pregnancy was diagnosed with cystic adenomatoid malformation of the lung at 20 weeks of gestation.

Keywords: cystic adenomatoid malformation of the lung, prenatal ultrasound

 

Ultrasound diagnosis of T-shaped uterus

 

Carmen Cheleș, Shadia Ateia

Victoria Medical Center, Bucharest, Romania

Introduction. Congenital uterine malformations are increasingly diagnosed thanks to advances in ultrasound technology. The widespread accessibility of three-dimensional reconstruction in gynecological transvaginal ultrasound has facilitated the diagnosis of congenital uterine malformations. The T-shaped uterus, classified as U1.a according to the ESHRE classification, appears easy to identify ultrasonographically, but it presents a wide variety of forms, making a definitive diagnosis problematic in certain circumstances. The aim of this paper is to identify all accurate ultrasound diagnostic methods for the T-shaped uterus. Materials and method. Two-dimensional transvaginal ultrasound must include visualization of the uterus in both the sagittal and transverse planes. A careful examination of the uterine fundus in the transverse plane will reliably reveal a variety of uterine cavity shapes. However, three-dimensional reconstruction is necessary for the correct identification of the suspected cavity malformation type seen in 2D. For three-dimensional reconstructions of uterine cavities that seem to fall into the U1.a category, the application of the CUME criteria is necessary for the accurate diagnosis of a T-shaped uterus and for differentiating it from a borderline T-shaped uterus and a normal or arcuate uterine cavity. Additionally, there are other proposed identification methods that appear useful for the clear diagnosis of a T-shaped uterus. Results and conclusions. The correct application of the criteria for diagnosing a T-shaped uterus will lead to an accurate diagnosis and better subsequent therapeutic management, optimizing the patient’s fertility prognosis.

Keywords: ultrasound diagnosis, T-shaped uterus, fertility

 

Antepartum evaluation of uterine scars

 

Radu Chicea

Faculty of Medicine, “Lucian Blaga” University of Sibiu, Romania

Introduction. Uterine scars, primarily resulting from previous caesarean sections, pose significant clinical concerns during subsequent pregnancies. Antepartum evaluation of these scars is crucial for predicting potential complications such as uterine rupture and abnormal placentation. This study aims to assess the effectiveness of various imaging techniques in evaluating uterine scars. Materials and method. A prospective study was conducted on 30 pregnant women with a history of caesarean delivery, recruited from a tertiary care hospital between January 2022 and June 2023. The participants underwent comprehensive antepartum evaluations using transabdominal and transvaginal ultrasound (US), as well as magnetic resonance imaging (MRI) when indicated. Scar characteristics, including thickness, echogenicity and continuity, were documented. Data on maternal demographics, obstetric history and pregnancy outcomes were collected. The primary outcomes measured were the incidence of uterine rupture and placenta accreta spectrum (PAS) disorders. The statistical analysis was performed using the SPSS software, with significance set at p<0.05. Results. Of the 30 participants, the average gestational age at the time of evaluation was 28 weeks. Ultrasound was effective in identifying scar thickness, with a mean thickness of 3.5 mm ± 0.8 mm. MRI provided superior detail in cases with ambiguous US results, particularly in detecting PAS disorders. Two cases of PAS were confirmed, with MRI correctly identifying all cases. No case of uterine rupture occurred in the participants. There was a significant correlation between scar thickness below 2.5 mm and the adverse outcomes (p<0.01). Conclusions. Antepartum evaluation of uterine scars is essential for managing pregnancies with previous caesarean sections. Ultrasound, supplemented by MRI when necessary, effectively assesses scar integrity and helps predict complications such as uterine rupture and PAS disorders. Scar thickness below 2.5 mm on ultrasound is a critical threshold for an increased risk, necessitating closer monitoring and potential intervention. Future research should focus on refining the imaging techniques and for establishing standardized protocols for clinical practice.

Keywords: uterine scar, evaluation, caesarean section

 

Complete invasive mole or choriocarcinoma? Diagnostic pitfalls

 

Răzvan Ciortea, Dan Mihu, Carmen-Elena Bucuri, Cristina Ormindean, Alexandru Haprean

“Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

Introduction. An invasive mole is a hydatidiform mole characterized by the presence of enlarged hydropic villi invading into myometrium and vascular spaces. This entity can be regarded as the phenotypic cross between molar pregnancy and placenta increta, but the pathobiological mechanism is not well understood. Both invasive moles and choriocarcinoma may show invasion of the uterine vasculature and have secondary metastatic lesions, particularly involving the vagina and lungs. Materials and method. In this poster, we present a case of complete invasive mole that was diagnosed and treated in the 2^nd Obstetrics-Gynecology Clinic, Cluj-Napoca, Romania. Additionally, for creating this poster, we searched the scientific literature and synthetized the data regarding complete invasive mole published in the last 10 years, using Google Scholar and PubMed. Keywords used to filter the data were: “molar pregnancy”, “invasive molar pregnancy”, “ultrasound”, “gestational trophoblastic disease”. Results. We present the case of a 36-year-old patient diagnosed with molar pregnancy for which uterine dilation and curettage were practiced. The pathology confirmed the diagnosis of complete molar pregnancy. Subsequently, the patient presented a relapse. Pelvic ultrasound revealed a heterogeneous intrauterine mass measuring 6 cm in diameter. MRI examination described a complete hydatidiform mole. The differential diagnosis that came into question was between complete invasive mole and choriocarcinoma. Hysterectomy and bilateral adnexectomy were performed to treat the patient. The pathology confirmed the diagnosis of complete invasive mole. Conclusions. Invasive mole can be difficult to diagnose through ultrasound and curettage, because myometrial invasion cannot be fully evaluated. Also, there is a higher chance of persistent gestational trophoblastic disease with this diagnosis, following curettage.  Thus, definitive diagnosis and treatment often require hysterectomy.

Keywords: molar pregnancy, invasive molar pregnancy, ultrasound, gestational trophoblastic disease

 

Evaluation of ultrasonographic and morphopathologic findings in spina bifida

 

Ana-Maria Cocorăscu¹, Anca-Maria Istrate-Ofițeru^1,2,3, George-Lucian Zorilă^1,3, Iuliana-Alina Enache⁴, Cătălina Iovoaica-Rămescu⁴, Ștefan-Gabriel Ciobanu¹, Elena-Iuliana-Anamaria Berbecaru^1,4, Andreea Vochin¹, Roxana-Cristina Drăgușin^1,3, Ileana Drocaș¹,
Dominic-Gabriel Iliescu^1,3

1. Department of Obstetrics and Gynecology, Emergency County Hospital Craiova, Romania

2. Department of Histology, University of Medicine and Pharmacy of Craiova, Romania

3. Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania

4. Doctoral School, University of Medicine and Pharmacy of Craiova, Romania

Introduction. Spina bifida is the most common and complex central nervous system malformation in humans. There are several types of spina bifida: spina bifida aperta (SBA) – myeloschisis or myelomeningocele; spina bifida occulta (SBO). Objectives. Ultrasound marker assessment during routine first-trimester (FT) ultrasound examination for early detection of overt spina bifida (OSB) and the correlation of ultrasound findings with morphohistological findings. Materials and method. This retrospective research was performed using data from fetuses who underwent FT anatomy scans (FTAS), with a gestational age between 11 weeks and 13 weeks and 6 days, in the Prenatal Diagnostic Unit of the Clinical Emergency County Hospital Craiova, Romania, from October 2022 until September 2023. Results. The study included 150 singleton FT pregnancies, and five cases of OSB were found. In the OSB group, we observed abnormal aspects of the fourth ventricle, also called intracranial translucency (IT), in four out of five OSB cases (80%), a brain stem anteroposterior diameter, and brain stem to occipital bone ratio abnormal in all five cases (greater than 1). The crash sign was present in 80% (four out of five cases), and spinal defect was visualized in four out of five patients (80%). Medical termination of pregnancy (MTOP) was the preferred option in all OSB cases. This allowed us to include an expanded histological study to confirm the ultrasound diagnosis. Conclusions. A detailed combined FTAS that includes both cranial posterior fossa ultrasound markers and good visualization of the fetal spine provides an optimal rate of early detection of spinal abnormalities, and histopathological evaluation confirms the diagnostic imaging findings.

Keywords: prenatal diagnosis, ultrasound, histopathological evaluation, spina bifida

 

What’s wrong with my baby’s heart? Debates upon a case

 

Adelina Cocoş, Oana Bafani, Coralia Ştefănescu

Euromaterna Hospital Constanța, Romania

Introduction. Fetal arrhythmias are detected in at least 2% of unselected pregnancies during routine obstetrical scans. Most commonly there are transient, brief episodes, but sometimes they could develop in something more serious. Objective. To analyze the aspects of a particular irregular fetal heart beats and the practical management of these cases. Methodology. A 23-year-old healthy, heavy smoking, anxious patient was referred for a fetal echocardiography because of a “weird” fetal heart beat seen on a routine obstetric scan at 33 weeks of gestation. Results. A thorough examination, including functional parameters, was performed. Despite concerning aspects of the beats, the final diagnosis was benign premature atrial contractions. The mother was strongly advised to immediately quit smoking (she denied any prior advice). At 37 weeks, the rhythm was normal, and a healthy baby boy was delivered at term. Conclusions. Fetal arrhythmias are always an issue of concern for future parents, therefore these cases should always be referred for a highly specialized fetal echocardiography. A proper counseling, including quitting smoking, should always be performed by any professionals involved in pregnancy care.

Keywords: fetal PACs, maternal smoking, fetal arrhythmia

 

DiGeorge syndrome as a cause of late FGR

 

Nadejda Coliban, Hristiana Caproș, Nadejda Codreanu

Department of Obstetrics and Gynecology, Discipline of Obstetrics, Gynecology and Human Reproduction, “Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chișinău, Republic of Moldova

Fetal growth restriction (FGR) is a common obstetrical condition with profound perinatologic impact. One of the major causes of FGR is represented by genetic syndromes, which involve chromosomal abnormalities and specific genetic mutations affecting fetal development, which can lead to antenatal or neonatal death. Objective. The objective of this study is to identify the genetic causes associated with FGR and emphasize the importance of early diagnosis and appropriate management of afflicted pregnancies through the perspective of one clinical case. Materials and method. A description of the clinical case, followed by a literature review, was conducted by searching scientific databases, including PubMed, National Library of Medicine, and Cochrane, using the keywords: “fetal growth restriction”, “genetic syndrome”, “prenatal diagnosis”. Articles in open access were also searched and studied in Romanian, Russian and English languages. Results. During ultrasound at 32 weeks gestation, a fetus with estimated weight on the 7^th centile and abdominal circumference on the 4^th centile was found to have a cardiac anomaly, a pulmonary valve stenosis with atrial septal defect. Given the severity of this finding, further genetic testing was recommended. Amniocentesis was performed to obtain amniotic fluid for genetic analysis. The results of fluorescent in situ hybridization tests confirmed a deletion in the 22q11.2 region, leading to the diagnosis of DiGeorge syndrome. Discussion. Chromosomal abnormalities and monogenic genetic mutations account for 5% of FGR cases. Chromosomal abnormalities associated with FGR mentioned in the literature include Down syndrome, Edwards syndrome, Patau syndrome, cri-du-chat syndrome, and Williams-Beuren syndrome. Monogenic mutations can also cause FGR, such as Cornelia de Lange syndrome, Smith-Lemli-Opitz syndrome, Meier-Gorlin syndrome, 3M syndrome, Noonan syndrome, and achondroplasia or hypochondroplasia. By applying prenatal diagnostic methods and CGH array technique, chromosomal abnormalities or genetic mutations were detected in fetuses with the absence of any structural anomalies (isolated FGR) in 9.3% of patients with late-onset FGR. Conclusions. Genetic testing in fetal growth restriction is recommended only in cases with early onset and/or in the presence of fetal structural anomalies, but new karyotyping techniques have demonstrated the presence of chromosomal abnormalities and genetic mutations in patients with late-onset isolated FGR.

Keywords: fetal growth restriction, genetic syndrome, prenatal diagnosis

 

Aneurysm of the foramen ovale – prenatal diagnosis, hemodynamic consequences
and prognosis

 

Diana Comandaşu, Elvira Brătilă

1. Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

2. “Prof. Dr. Panait Sârbu” Clinical Hospital of Obstetrics and Gynecology, Bucharest, Romania

Foramen ovale aneurysm, also known as interatrial septal aneurysm or septum primum aneurysm, is defined by an abnormal protrusion of the interatrial septum, which results in decreased left atrial volume. Color Doppler ultrasound identifies reduced left ventricular inflow. It is frequently diagnosed as an isolated finding in the third trimester of pregnancy, without associating cardiac or extracardiac abnormalities, but it may impact fetal hemodynamics both prenatally and postnatally. The hemodynamic consequences identified by ultrasonography are represented by ventricular disproportion in favor of the right ventricle, with functional tricuspid regurgitation, right atrial dilatation, and the foramen ovale flap covers more than half of the area of the left atrium, which leads to a decrease in left ventricular flow detectable by color Doppler. Fetal arrhythmias caused by right atrial dilatation have also been reported, and in severe cases with early onset, they can cause hypoplasia of the left ventricle and aortic arch with pseudo-coarctation appearance by altering ventricular filling leading to decreased ventricular ejection. Postnatally, cases with severe damage present hypoxemia with the need for ventilation and frequently develop pulmonary hypertension. This work aims to present a series of cases from our clinic in which foramen ovale aneurysm was diagnosed antenatally and then confirmed by postnatal echocardiography. The personal case report includes three fetuses diagnosed at the third-trimester screening evaluation with foramen ovale aneurysm. In all three cases, the second-trimester screening ultrasound did not reveal any abnormalities. Also, the first-trimester screening revealed a low risk of aneuploidies in all cases. Sonographic signs identified in our case series included significant right atrial dilatation, caused by the wide flap of the foramen ovale that occupied almost the entire surface of the left atrium, causing mitral valve obstruction and secondary ventricular disproportion in favor of the right ventricle. All cases had postnatal echocardiographic confirmation, with a favorable evolution in terms of postnatal hemodynamic changes and the discharge of newborns within a maximum interval of seven days. We note that the birth was carried out at term by elective caesarean section in all cases, which were evaluated cardiologically immediately after birth, not being identified any associated abnormalities. The present paper discusses a relatively rarely diagnosed fetal heart pathology, but with potential long-term consequences.

Keywords: foramen ovale aneurysm, fetal heart pathology, postnatal echocardiography

 

Ultrasound role in heterotopic pregnancies

 

Ileana-Maria Conea¹, Anca Lesnic², Bianca-Maria Vlădan², Delia-Maria Bogheanu², Mihai-George Loghin², Liana Pleş¹

1. Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

2. Department of Obstetrics and Gynecology, “Sf. Ioan” Hospital, “Bucur” Maternity, Bucharest, Romania

Introduction. Heterotopic pregnancy refers to the simultaneous presence of intrauterine pregnancy and ectopic pregnancy, which is very rare, but potentially life-threatening. The spontaneous incidence in the general population is 1:30,000 pregnancies. Aims and metho­do­logy. The aim of this report is to present a case of early recognized extrauterine pregnancy followed by the diagnosis of an intrauterine pregnancy. Results and conclusions. The case refers to a 23-year-old patient, with a caesarean section two years ago, presented for right iliac fossa pain and vaginal bleeding, with smoking as heterotopic pregnancy risk factor. With an unsatisfactory kinetics of beta-HCG and the transvaginal ultrasound that revealed right hematosalpinx, free fluid and no viable intrauterine pregnancy, the patient had her right oviduct removed by means of laparoscopy. The four-week follow-up confirmed an intrauterine pregnancy with an embryo corresponding to 8 weeks of gestation. Our patient was advised, and the pregnancy is still developing. The presented case indicates the significance of correctly and carefully performed ultrasound examination. Early diagnosis of this pathology, thanks to a precise ultrasound examination, decreases the risk of complication, as well as women morbidity and mortality in the first trimester of pregnancy.

Keywords: heterotopic pregnancy, ectopic pregnancy, beta-HCG, laparoscopy, salpingectomy

 

Management of a giant ovarian mucinous cystadenoma in the case of a second-trimester pregnancy

 

Ștefana-Maria Craiciu¹, Mona Ifrim¹, Mihaela Grigore^1,2

1. “Cuza Vodă” Clinical Hospital of Obstetrics and Gynecology, Iași, Romania

2. “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

Introduction. Ovarian cysts occur commonly in women of childbearing ages. They are usually benign and therefore tend to be asymptomatic in the majority of the population. These tumors arise from the ovarian surface epithelium and have smooth inner and outer thin walls. Specifically, benign mucinous cystadenomas comprise 80%, forming the majority of ovarian mucinous tumors; 10% of these tumors are found to be malignant and the remaining 10% are borderline. A striking feature for these benign mucinous cystadenomas is that they can become massive in size, ranging from 5 to 28 cm, with larger size increasing the risk of malignancy. Materials and method. This case follows a 19-year-old patient with 18 weeks anamnestic amenorrhea who was admitted for a left adnexal mass diagnosed a month prior. The symptoms presented by the patient included abdominal pain, lower back pain and bloating. The initial clinical assessment revealed an abdominal mass of a size inconsistent with the duration of the amenorrhea, not painful on palpation. The abdominal ultrasound revealed the abdominal mass and the pregnancy that was developing normally within the uterus at the point of the examination. Results and conclusions. Given the increased size of the tumor, surgical treatment was decided, consisting in a left adnexectomy after the complete excision of the mass, with a favorable evolution of the patient and of the pregnancy following the intervention. Diagnosing a giant abdominal-pelvic mass represents a challenge for the medical team, since the clinical examination is usually nonspecific. The surgical treatment of giant ovarian mucinous cystadenomas can also become challenging because of the risks associated with the leakage of cystic contents into the peritoneal cavity and, in this particular case, because of the pregnancy loss risk.

Keywords: cystadenoma, pregnancy, adnexectomy

 

Fetal ventriculomegaly – a diagnosis or a hint?

 

Bianca Dinulescu¹, Mihaela Amza¹, Ionuț Valcea¹, Elena Nistor¹, Liana Pleș^1,2

1. Department of Obstetrics and Gynecology, “Sf. Ioan” Clinical Hospital, “Bucur” Maternity, Bucharest, Romania

2. Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Introduction. Fetal cerebral ventriculomegaly is defined as atrial diameter of lateral ventricle greater than 10 mm in the second and third trimesters. It is one of the most frequent fetal brain anomalies, with a prevalence of 1 per 1000 live births. Although fetal ventriculomegaly is often incidental, it can also be associated with genetic, structural and neurocognitive disorders. The outcomes can range from normal development to severe neurological impairment. Materials and method. We present seven cases of fetal ventriculomegaly diagnosed among 2560 second- and third-trimester scans conducted in our clinic over the past three years. The atrium of the lateral ventricle was measured in the transventricular plane, according to ISUOG Guidelines. The calipers were placed on the internal margins of the medial and lateral walls of the atria, at the level of the parietal-occipital groove. In order to confirm the diagnosis and the subsequent cause, complete fetal ultrasound scan was performed, and in certain cases fetal MRI and genetic testing were recommended. Results. Among all cases of ventriculomegaly, one presented as an isolated finding, diagnosed at 20 weeks, with a borderline value of 10 mm. The other six cases were associated with other conditions. We presented a case of mild ventriculomegaly diagnosed at 23 weeks, which was confirmed as trisomy 21. In another case, ventriculomegaly (15.3 mm) was found following the ultrasound scan at 30 weeks of pregnancy, and the diagnosis of intracerebral hemorrhage during the second trimester was established retrospectively. Severe ventriculomegaly (20 mm) was found at 37 weeks of pregnancy as a result of aqueductal stenosis. Another case of severe ventriculomegaly (17 mm) was associated with Arnold-Chiari III malformation, in a 19-week pregnancy. In the last two similar cases, corpus callosum dysgenesis was the only structural anomaly associated with ventriculomegaly (12 mm and 10 mm, respectively) identified at 38 and 33 weeks of pregnancy. Conclusions. Fetal ventriculomegaly, while often occurring without significant consequences, can also indicate underlying conditions that require a complete ultrasound evaluation for associated intracerebral or extracerebral anomalies that are essential in order to counsel the couple and offer proper management.

Keywords: ventriculomegaly, fetal malformations, syndromic

 

Taussig-Bing anomaly

 

Artur Focșa

Gynelux Clinic, Zalău, Romania

Introduction. The right ventricle (RV) with a double outlet (double outlet right ventricle – DORV) is defined as “one and more than 50% of the second major vessel originates from the right ventricle”. The location of the ventricular septal defect (VSD), the absence or presence of obstruction of one of the ejection pathways, as well as the position of the major vessels make this anomaly a complex malformative group. Taussig-Bing anomaly (TBA) is a type of DORV with malposition (transposition) of the great vessels, with their parallel orientation and subpulmonary VSD. Materials and method. Antenatal diagnosis of TBA represents a difficult problem for prenatal ultrasound. The characteristic ultrasound criteria of TBA are: 1) the origin of the aorta (Ao) from the right ventricle; 2) VSD with variable size and location; 3) Ao to the right of the pulmonary artery; 4) pulmonary artery in approximately normal position; 5) the existence of an “ejection septum” that separates the origin of the two large vessels. The optimal time for the diagnosis of TBA is considered to be 16-22 weeks of pregnancy, to carry out genetic examinations and detect other associated anomalies. The success of surgical treatment in the postnatal period depends on the complexity of the anomaly. Conclusions. TBA is a rare congenital malformation, whose treatment continues to be a real problem. Timely diagnosis and appropriate treatment can greatly reduce mortality and provide a better quality of life to all children who are on the waiting list for heart surgery. This presentation could help many colleagues to correctly recognize this cardiac anomaly, which could reduce the mortality and morbidity from this congenital disease.

Keywords: Taussig-Bing anomaly, DORV, malposition (transposition) of vessels

 

Omphalocele in prenatal diagnosis: a retrospective case series of 22 patients

 

Tudor-Cătălin Gîscă^1,2, Demetra-Gabriela Socolov^1,2, Ioana Scripcariu^1,2, Ingrid Vasilache^1,2, Gabriel-Ioan Anton¹, Corina Zamir¹,
Felicia Hărățu, Ioan Sârbu^2,3

1. “Cuza Vodă” Clinical Hospital of Obstetrics and Gynecology, Iași, Romania

2. “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania 

3. “Sf. Maria” Emergency Clinical Hospital for Children, Iaşi, Romania 

Introduction. Omphalocele is a rare congenital anomaly, occurring in approximately 3.38 out of every 10,000 pregnancies, characterized by the protrusion of abdominal organs through an opening in the abdominal wall, at the base of the umbilical cord. The severity varies, involving organs such as the small intestine, colon or stomach, and in rarer cases, the liver. Approximately 50% of cases are associated with genetic syndromes, including trisomy 13, 18 and Beckwith-Wiedemann syndrome. Materials and method. A retrospective study was conducted on 22 cases of omphalocele prenatally diagnosed by ultrasound between January 2021 and January 2023. Data were collected on prenatal diagnosis, type of birth, associated anomalies and clinical outcomes. Genetic testing was performed in 14 cases. Results. Out of 22 prenatally diagnosed cases of omphalocele, eight (36%) resulted in miscarriage. Among the remaining 14 cases, two (9%) were premature births at 27 and 33 weeks of gestation, and the remaining 12 (55%) were delivered at term. All 14 surviving neonates were subsequently transferred to a pediatric hospital for further management. The maternal age ranged from 15 to 40 years old. The median gestational age at delivery was 39 weeks, and most of the women were from rural areas. The majority of patients were delivered by caesarean section and were female. Genetic testing was conducted on 14 cases, revealing that 10 (71%) had a normal karyotype, although six (60%) of these were associated with additional morphological anomalies, primarily cardiovascular anomalies such as mitral and tricuspid regurgitation and ventricular septal defect. We identified two cases of trisomy 18 and two cases of trisomy 13. Neonatal adaptation issues were noted: two required mechanical ventilation, one needed continuous positive airway pressure, and one required oxygen therapy. The remaining neonates had good adaptation, with no significant respiratory issues. Conclusions. The study highlights the importance of prenatal diagnosis and of multidisciplinary approach in managing omphalocele. Early detection allows for birth planning and immediate postnatal care, which are essential for improving outcomes. While isolated omphaloceles have a favorable prognosis, the presence of associated anomalies significantly impacts the survival and long-term health.

Keywords: omphalocele, abdominal wall defects, chromosomal anomalies

 

Comparison of the Ovarian-Adnexal Reporting and Data System (O-RADS), International Ovarian Tumor Analysis Simple Rules (IOTA SR), and the Assessment of Different Neoplasias in the Adnexa (ADNEX) model for ovarian cancer diagnosis

 

Ion-Florin Gorun¹, Cosmin Cîtu², Ioan Sas², Adrian Rațiu², Zoran Popa², Marius Forga², Oana-Maria Gorun²

1. “Pius Brînzeu” County Emergency Clinical Hospital, Timișoara, Romania

2. Department of Obstetrics and Gynecology, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania

Ovarian cancer remains one of the most lethal gynecologic malignancies worldwide. Timely and accurate diagnosis is paramount for improving prognosis and survival rates. In recent years, various diagnostic models and systems have been developed to enhance the accuracy of ovarian cancer detection, among which the International Ovarian Tumor Analysis (IOTA) ADNEX model, the IOTA Simple Rules, and the Ovarian-Adnexal Reporting and Data System (O-RADS) have gained significant attention. The aim of this study is to establish a comprehensive comparison of the diagnostic accuracy of the O-RADS, ADNEX, and IOTA Simple Rules. A comprehensive analysis of the PubMed database was performed to identify relevant research up until June 2024. The I² statistic was employed to evaluate heterogeneity, and the sensitivity and specificity estimates were pooled using a random-effects model. The meta-analysis included data from 13 studies, comprising a total of 6526 patients. The pooled sensitivity and specificity for IOTA Simple Rules were 0.86 and 0.89, respectively. IOTA ADNEX demonstrated a pooled sensitivity of 0.92 and a specificity of 0.9. O-RADS showed a pooled sensitivity of 0.9 and a specificity of 0.88. The studies for all three guidelines exhibited substantial heterogeneity, suggesting variability in study designs and patient populations. In conclusion, the IOTA ADNEX, IOTA Simple Rules, and O-RADS models demonstrate high diagnostic accuracy for ovarian cancer, with the IOTA ADNEX model slightly outperforming the others in terms of sensitivity and specificity.

Keywords: ovarian cancer, diagnosis, gynecologic malignancies

 

Evaluation of myometrial invasion using transvaginal ultrasound in endometrial cancer

 

Ion-Florin Gorun¹, Cosmin Cîtu², Ioan Sas², Adrian Raţiu², Zoran Popa², Marius Forga², Oana-Maria Gorun²

1. “Pius Brînzeu” County Emergency Clinical Hospital, Timișoara, Romania

2. Department of Obstetrics and Gynecology, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania

Introduction. The appropriate surgical approach and prognosis in endometrial cancer are contingent upon an accurate preoperative assessment of myometrial invasion. Transvaginal ultrasound (TVUS) is a commonly used imaging modality for this purpose. This systematic review and meta-analysis are designed to assess the diagnostic efficacy of TVUS in the detection of myometrial invasion in patients with endometrial cancer. Materials and method. A thorough literature search was performed in the PubMed database to identify studies that evaluated the sensitivity and specificity of TVUS in detecting the invasion of the myometrium in endometrial cancer. Data extraction included study characteristics, sensitivity, specificity, and their 95% confidence intervals. A random-effects model was used to pool sensitivity and specificity estimates, and heterogeneity was assessed using the I² statistic. Results and conclusions. Fourteen studies’ data were used in the meta-analysis. The pooled sensitivity of TVUS for detecting myometrial invasion was 0.75, and the pooled specificity was 0.85. The I² statistic revealed high heterogeneity among studies, suggesting variability in study designs, patient populations, and ultrasound techniques. The sensitivity of TVUS in detecting myometrial invasion in patients with low-risk endometrial cancer was 0.72, while its specificity was 0.76. In conclusion, transvaginal ultrasound is reasonably accurate in diagnosing myometrial invasion in endometrial cancer, with good sensitivity and specificity. These findings confirm that TVUS is a dependable preoperative tool for the clinical management of endometrial cancer. Nevertheless, the high heterogeneity observed emphasizes the necessity for standardization in TVUS techniques and additional research to authenticate these results in various clinical settings.

Keywords: endometrial cancer, transvaginal ultrasound, miometrial invasion

 

Cardiac ventricular disproportion in the third trimester – a warning sign?

 

Cătălin-Gabriel Herghelegiu^1,2, Doru Herghelegiu¹, Alina-Mihaela Călin³, Nicolae Suciu^1,4

1. “Polizu” Hospital, “Alessandrescu-Rusescu” National Institute for Mother and Child Health, Bucharest, Romania

2. Sanador Hospital, Bucharest, Romania

3. Faculty of Medicine and Pharmacy, Dunărea de Jos University of Galați, Romania

4. Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Cardiac evaluation during pregnancy has always been a significant interest for obstetricians. The initial recommendations for cardiac assessment by pioneers of fetal ultrasound, G.R. DeVore and L.D. Allan, in the 1980s, suggested the visualization of the four-chamber view and the assessment of ventricular appearance. The four-chamber view remains, even after over 40 years, possibly the most important cardiac section used in all current cardiac evaluation guidelines. All these guidelines, including those proposed by SRUOG and ISUOG for cardiac evaluation in 2023, mandate obtaining the four-chamber view and evaluating the ventricles, stating they should be of relatively equal size. This phrasing allows for a very subjective assessment of ventricular disproportion as an abnormal aspect of fetal echocardiography. Thus, this ventricular disproportion, defined as an apparently larger right ventricle compared to the left, can encompass a range of pathologies from very severe, such as left heart hypoplasia where sometimes a left ventricle is hard to identify, to mild cases of aortic coarctation that do not require treatment. The assessment of ventricular disproportion becomes even more subjective in the third trimester of pregnancy, when the right ventricle is physiologically more dilated compared to the left (right ventricle diameter/left ventricle diameter below 1.5). Thus, during routine examinations, a significant ventricular disproportion is often observed, which represents an alarm signal. Fortunately, this ultrasound sign has a high rate of false-positive results, making it important how we define ventricular disproportion. On the other hand, a detailed cardiac evaluation is always necessary to exclude underlying cardiac malformations that could endanger the newborn’s life.

Keywords: ventricular disproportion, aortic coarctation, hypoplastic left heart

 

A rare case of cervical angioleiomyoma: a challenge of imaging diagnosis

 

Ciprian Ilea^1,2, Irina Stoian^1,2, Cristian Ciupercă³

1. “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

2. Department of Obstetrics and Gynecology, “Cuza Vodă” Clinical Hospital of Obstetrics and Gynecology, Iași, Romania

3. County Emergency Clinical Hospital Brăila, Romania

Introduction. Angioleiomyoma of the uterine cervix is an extremely rare type of benign tumor, and due to its complexity, it represents a challenge for imaging diagnosis. Materials and method. A 42-year-old patient presented with metrorrhagia, significant cyclic pains, low abdominal pain, and dysuria. A large protruding mass was seen on the left side wall of the uterine cervix. The combined imaging evaluation, carried out in stages, highlighted the presence of an important tumor mass developed on cervix. Result. After an adequate evaluation, the surgical intervention was performed which confirmed the diagnosis of angioleiomyoma of the uterine cervix, the subsequent evolution being favorable. Conclusions. The correct imaging diagnosis of the angioleiomyoma of the uterine cervix is nonspecific and involves a staged, multidisciplinary evaluation.

Keywords: angioleiomyoma, uterine cervix tumor, metrorrhagia

 

Obstructive malformations of the fetal digestive tract – the challenges of prenatal diagnosis

 

Gheorghe Iliev¹, Elena Hanganu², Ana-Maria Scurtu³

1. “Dr. Gheorghe Iliev” Medical Center, Iași, Romania

2. First Pediatric Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

3. “Sf. Maria” Emergency Clinical Hospital for Children, Iaşi, Romania 

Introduction. Prenatal diagnosis of obstructive digestive malformations (ODM), such as esophageal atresia (EA), duodenal atresia (DA) and small intestine atresia (SIA), is made on the basis of indirect ultrasound signs (absence of the stomach, digestive dilatations, digestive hyperechogenicity, polyhydramnios, ascites). These signs appear late, in the second half of pregnancy. Isolated ODMs have a good prognosis. Conversely, the association with other structural or chromosomal abnormalities worsens the perinatal prognosis. The prenatal diagnosis of obstructive digestive malformations shortens the time between birth and surgery and reduces the complications caused by late intervention. We present the role and limitations of fetal ultrasound in the diagnosis of ODM. Materials and method. The study is retrospective and includes the period between 1 January 2007 and 30 June 2024. Routine second- and third-trimester fetal ultrasound were performed. We used the ultrasound signs for ODM (absence of the stomach, “double-bubble”, small/large bowel dilatations, polyhydramnios). We recommended prenatal genetic and pediatric surgery counseling. Results. We diagnosed four cases with isolated EA, five cases with isolated DA, and 11 cases with SIA (two cases with associated abnormalities). Intrauterine fetal death occurred in three cases with small intestine atresia. The prenatal diagnosis was reconfirmed after surgery in 1/5 cases with EA, 5/5 cases with DA, and 6/8 cases with SIA. Two cases with small intestine atresia had favorable postnatal outcome and were interpreted as transient small bowel dilatation. Postoperative death was encountered in three cases with small intestine atresia. Conclusions. The prenatal diagnosis of obstructive digestive malformations is feasible. However, the prenatal diagnosis also presents challenges because the identification of malformations is based on indirect ultrasound signs. The appearance of these signs is late, and in some cases the signs may be absent. The prenatal diagnosis advantage of obstructive digestive malformations lies in the optimization of obstetric management, as well as in faster postnatal surgical diagnosis and treatment.

Keywords: congenital gastrointestinal obstruction, pregnancy outcomes, prenatal diagnosis

 

Prenatal diagnosis of the atrioventricular septa defect – associated anomalies
and obstetrical management

 

Gheorghe Iliev¹, Daniela Scripcaru², Vlad Gorduza³

1. “Dr. Gheorghe Iliev” Medical Center, Iași, Romania

2. Laboratory of Pathology, “Cuza Vodă” Clinical Hospital of Obstetrics and Gynecology, Iași, Romania

3. Department of Genetics, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania

Introduction. Atrioventricular septal defect (AVSD) covers a spectrum of congenital heart malformations characterized by a common atrioventricular junction coexisting with deficient atrioventricular septation. The prenatal diagnosis is possible from 13-14 weeks of gestation. We present the role of fetal ultrasound in establishing the prenatal diagnosis and in defining obstetric management. Materials and method. The study is retrospective, including the period between 1 January 2007 and 30 June 2024. We performed fetal morphology according to the existing protocols. We divided the cases into Group A, diagnosed in the first trimester, and Group B, diagnosed in the second and third trimesters. We recommended prenatal genetic and pediatric cardiology counseling. Indications for termination of pregnancy were established by the ethics committee. Results. We diagnosed 36 cases with AVSD. Group A included 11 cases: one case also presented hypoplastic left heart; seven cases presented extracardiac malformations. Genetic diagnosis was performed in six cases. Two cases with trisomy 21 (T21) and two cases with trisomy 18 (T18) were diagnosed. Termination of pregnancy was practiced in nine cases. Two children were born. Neonatal death occurred in one case. One newborn underwent surgical treatment (he had a favorable outcome). Group B included 25 cases: 10 cases had associated cardiac malformations (four cases with left isomerism); in 11 cases, extracardiac malformations were present. Genetic diagnosis was performed in 13 cases. Eight cases were diagnosed with T21 and two cases with T18. Intrauterine fetal death occurred in one case. Termination of pregnancy was practiced in five cases. Eleven children were born. Neonatal death occurred in six cases. Five newborns underwent surgical treatment (all had favorable outcome). Four cases were not followed-up. Conclusions. Atrioventricular septal defects can be diagnosed starting from 13-14 weeks of gestation. The association of cardiac and extracardiac malformations worsens the perinatal prognosis. Detailed prenatal diagnosis aids in effective parenting counseling, obstetric management, and postnatal surgical planning.

Keywords: atrioventricular septal defect, congenital heart disease, fetal echocardiography

 

Primary infertility caused by genital tuberculosis. Case presentation – clinical, sonographic and morphopathologic aspects

 

Anca-Maria Istrate-Ofițeru^1,2,3, George-Lucian Zorilă^1,3, Iuliana-Alina Enache^1,4, Cătălina Iovoaica-Rămescu^1,4, Ștefan-Gabriel Ciobanu^1,4, Elena-Iuliana-Anamaria Berbecaru^1,4, Ana-Maria Cocorăscu¹, Andreea Vochin¹, Rodica-Daniela Nagy¹, Cristina-Maria Comănescu^1,5, Dominic-Gabriel Iliescu^1,3

1. Department of Obstetrics and Gynecology, County Emergency Clinical Hospital Craiova, Romania

2. Department of Histology, University of Medicine and Pharmacy of Craiova, Romania

3. Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania

4. Doctoral School, University of Medicine and Pharmacy of Craiova, Romania

5. Department of Anatomy, University of Medicine and Pharmacy of Craiova, Romania

Introduction. Genital tuberculosis is a chronic disease that can manifest by pelvic inflammatory disease, infertility, or menstrual cycle abnormalities. Risk factors include low immunity, diabetes mellitus, autoimmune diseases, kidney disease, immunosuppressive treatment or the use of tobacco, drugs or prohibited substances. Symptoms associated with genital tuberculosis may include pelvic pain, menstrual disorders (reduced or increased menstruation, dysmenorrhea), or even infertility. Case presentation. A 23-year-old patient with no previous known health problems consulted a gynecologist for infertility. The clinical examination revealed pain on palpation of both adnexa. Ultrasound examination revealed an abnormal appearance of both fallopian tubes, with accumulation of fluid inside them. It was decided to perform a hysteronsonosalpingography to check the tubal patency, and their obstruction was revealed (“inflated” tubes). It was decided to perform laparoscopy for a direct evaluation of the obviously pathological tubes, where it was found that they were chronically severely inflamed, filled with purulent content (pyosalpinx) and adherent at the pelvic level. This stage of severe damage, similar to pelvic abscesses, did not allow their repair, but a salpingectomy was performed, and the extracted tubes were sent for histopathological examination. Histopathological examination revealed an intense inflammatory process in the tubal wall with rich inflammatory infiltrate and multiple multinucleated cells. Conclusions. For this case, a prompt diagnosis of genital tuberculosis, with excision of the severely afflicted fallopian tubes and specific antituberculosis treatment were absolutely necessary to reduce the risk of the often-serious complications of this pathology. Establishing the cause of infertility, its treatment and obtaining a pregnancy through in vitro fertilization are key steps in the successful resolution of this case. However, the histopathological result indicated the diagnosis of genital tuberculosis (tuberculous salpingitis), which requires initially antituberculous treatment and, later, after healing, assisted human reproduction techniques in order to obtain a pregnancy.

Keywords: genital tuberculosis, infertility, hys­te­ro­so­no­sal­pin­go­graphy

 

Updates on the ultrasound semiology of cytomegalovirus infection in pregnancy

 

Victor Juncu^1,3, Edvin Vaso³, Liliana Fuior-Bulhac⁴, Mihai-Emil Căpîlna^1,2

1. Obstetrics and Gynecology Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu-Mureș, Romania

2. Obstetrics and Gynecology Department, County Emergency Clinical Hospital Târgu-Mureș, Romania

3. Obstetrics and Gynecology Department, Mediaș County Hospital, Romania

4. “Nicolae Testemițanu” State University of Medicine and Pharmacy, Chișinău, Republic of Moldova

Introduction. Cytomegalovirus (CMV) is the most common cause of congenital infection, with a frequency between 0.2% and 2.2% of all live births. In fact, more children suffer serious disabilities caused by congenital CMV than by several better-known childhood maladies such as Down syndrome or fetal alcohol syndrome. The clinical manifestations of congenital CMV infection include hearing loss, visual impairment and developmental disabilities. Materials and method. The present scientific work represents the synthesis of the specialty literature regarding the particularities of CMV infection in pregnancy and the main elements of ultrasound semiology. Discussion. The most common characteristics for cytomegalovirus infection in pregnancy are represented by age under 30, high socioeconomic level, working, CMV-negative during anterior pregnancy, employed person, first child in nursery, and an interval between pregnancies under two years. In the presence of evocative clinical data or predictive serological tests, the ultrasound identification of the main ultrasound markers characterizing CMV infection in pregnancy is required: fetal growth restriction, hyperechogenic bowel, ventriculomegaly, oligohydramnios, and ascites. Ultrasound semiology will involve the careful study, evolving over time, of cerebral and extracerebral signs, severe predictive and non-severe predictive signs that will determine the particularities of pregnancy monitoring, the proposed time for birth and postnatal management. Conclusions. The consequences of congenital CMV infection can vary, from mild symptoms to more serious complications, including neurosensory disorders such as deafness, vision problems, developmental delays, and other disabilities. Therefore, it is important to take preventive measures to prevent CMV infection in pregnant women, but also to prevent the infection of the fetus when a pregnant woman is infected. Finally, it is important to carry out appropriate medical monitoring in the event of infection of the fetus and of the child born with congenital cytomegalovirus infection.

Keywords: cytomegalovirus, ultrasound, semiology

 

Ectopic pregnancies of unusual location: management and therapeutic dilemmas

 

Maria-Magdalena Manolea, Maria-Sidonia Săndulescu, Sidonia-Cătălina Vrabie, Ioana-Victoria Camen, Anda-Lorena Dijmărescu

University of Medicine and Pharmacy of Craiova; “Filantropia” Clinical Hospital, Craiova, Romania

Introduction. Despite ongoing advancements in ul­trasound technology and medical practice, ectopic preg­nancy continues to be an important diagnostic and ma­nage­ment challenge. Although the fallopian tube is the most common site for an ectopic pregnancy, cases have also been documented in other locations such as the cervix, ovary, abdomen, and caesarean scar. Materials and method. Caesarean scar pregnancy (CSP), a type of ectopic pregnancy occurring at the site of a previous caesarean section, is becoming more prevalent due to the increasing number of caesarean deliveries. Cervical pregnancy, a rare form of ectopic pregnancy, involves the implantation of the embryo in the cervical canal. Abdominal pregnancy, another rare variant, occurs when the embryo implants either initially or secondarily within the abdominal cavity, outside the uterus and fallopian tubes. This paper’s aim is to present three cases with these rare pathological types of pregnancies diagnosed and successfully treated in our clinic: cervical ectopic pregnancy, caesarean scar ectopic pregnancy, and abdominal ectopic pregnancy. After diagnosis, the three cases were monitored biochemically through repeated determination of chorionic chondrotrophin and through imaging examinations: ultrasounds and MRI for abdominal ectopic pregnancy, in order to locate as precisely as possible and to see the evolution after the administration of medical treatment with methotrexate. Results and conclusions. While for the abdominal pregnancy the medical treatment was sufficient, for the pregnancies with cervical or cicatricial localization, aspiration evacuation was needed after the administration of methotrexate. The significance of these rare atypical ectopic pregnancies that we present in our work lies in their potential to cause increased maternal morbidity and mortality due to serious complications such as uterine rupture and severe hemorrhage.

Keywords: ectopic pregnancy, caesarean scar pregnancy, abdominal pregnancy, cervical pregnancy

 

Diagnosis, management and prognosis of non-immune hydrops fetalis

 

Marius Moga^1,2, Simona Duță³, Andreea Nadoleanu¹, Iulia Candidu¹, Costin Anastasiu^1,2

1. Faculty of Medicine, Transylvania University of Brașov, Romania

2. Department of Obstetrics and Gynecology, Clinical Hospital of Obstetrics and Gynecology Brașov, Romania

3. Department of Obstetrics and Gynecology, “Filantropia” Clinical Hospital of Obstetrics and Gynecology, Bucharest, Romania

Introduction. Hydrops fetalis is a serious fetal condition characterized by the accumulation of abnormal amounts of fluid in at least two different fetal compartments, mainly pleural effusion, ascites, pericardial effusion, and skin edema. Depending on the underlying pathophysiology, it is divided into two categories: immune and non-immune. Although having a poor prognosis, we aim to provide up-to-date insights into the diagnostic tools and management strategies available. Materials and method. We systematically searched the databases (PubMed, Scopus, Google Scholar), focusing on articles published in the last five years that offered the latest information on the management and outcome of non-immune hydrops fetalis cases, depending on the underlying cause, gestational age at the time of the diagnosis, and intrauterine interventions. Results. After the diagnosis of hydrops fetalis is established through ultrasound imaging, it is crucial to identify the underlying cause, as it affects both the progression of symptoms and the overall prognosis. Thus, a series of investigations are performed: maternal TORCH and parvovirus B19 screening, detailed fetal imaging for fetal anemia and anatomical defects, and genetic testing for chromosomal abnormalities. Further, the management focuses on treating the likely cause with the aid of medications and in utero interventions (fetal blood transfusion and fetal surgery). In order to improve the outcomes, delivery planning and postnatal care are also essential. Conclusions. Hydrops fetalis is a complex and challenging clinical scenario, given by the variety of etiologies, the associated complications, the overall poor prognosis, and the multidisciplinary approach required. Even with early accurate diagnosis, the treatment options remain limited, and ongoing research is needed to refine the therapeutic approaches and enhance the long-term outcomes for afflicted pregnancies.

Keywords: non-immune hydrops fetalis, ultrasound diagnosis, in utero interventions

 

Neural tube defects – ultrasonographic diagnosis in the first trimester of pregnancy

 

Dragoș Popescu^1,2, Radu Chicea^1,2, Răzvan Stănescu²

1. “Lucian Blaga” University of Sibiu, Romania

2. County Emergency Clinical Hospital Sibiu, Romania

The estimated average global prevalence of neural tube defects (NTDs) is two cases per 1000 births, amounting to approximately 214,000-322,000 afflicted pregnancies worldwide annually. Neural tube defects have multiple risk factors, including genetic and non-genetic factors (i.e., maternal nutritional status, pre-pregnancy diabetes, early pregnancy exposure to valproic acid – anti-epileptic medication, and a previous pregnancy affected by a NTD). Ultrasound imaging in the first trimester is an essential method for the early detection of neural tube defects in the fetus. This period allows for a detailed evaluation of embryonic structures, being crucial for the diagnosis and management of these conditions. Importance of early diagnosis. Neural tube defects, such as spina bifida and anencephaly, are severe and can have devastating consequences on fetal development. The use of ultrasound in the first trimester allows for the early identification of these anomalies, enabling appropriate interventions and medical management planning. Diagnostic techniques and methods. Transvaginal ultrasound and high-frequency abdominal ultrasound probes are used for detailed visualization of embryonic structures and the developing brain. Also, 3D and 4D imaging can provide a three-dimensional and dynamic perspective on the observed malformations. Management and patients’ counseling. Early diagnosis allows for the rapid initiation of appropriate therapies and genetic counseling for parents. A multidisciplinary team, including obstetricians, pediatric neurologists and pediatric surgeons, is essential for planning corrective surgical interventions and supportive treatment. Conclusions. Early detection of neural tube defects in the first trimester through ultrasound is crucial for improving prognosis and patients’ quality of life. Continuous advancements in ultrasound technology and the integration of artificial intelligence in image analysis promise to further support the accurate diagnosis and the efficient management of these conditions.

Keywords: neural tube defects, congenital malformations, prenatal ultrasound, early diagnosis, genetic counseling, surgical interventions.

 

Current ultrasound features for the diagnostic and management of placental abruption

 

Răzvan Socolov¹, Andreea Pruteanu², Diana Popovici¹, Ioana Păvăleanu¹

1. “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

2. “Elena Doamna” Clinical Hospital of Obstetrics and Gynecology, Iași, Romania

Ultrasound is a critical tool in diagnosing and managing placental abruption. The objectives of ultrasonographic evaluation include confirming the diagnosis by identifying the presence of placental abruption, assessing the severity by evaluating the extent of detachment and the size of hematomas, monitoring fetal well-being, and guiding management decisions regarding the timing and method of delivery. The common ultrasound findings in placental abruption are: the presence of a retroplacental hematoma, increased placental thickness, marginal hematoma, subchorionic hematoma, variations in the placenta’s echogenicity (suggesting bleeding), and myometrial contractions near the site of abruption. There are various limitations regarding the ultrasonographical evaluation in abruptio placentae: sensitivity – ultrasound may not detect all cases, especially smaller or more recent abruptions; operator dependency – accuracy can vary based on the operator’s skill and experience; gestational age – the visualization can be more challenging in early pregnancy. In conclusion, ultrasound is indispensable for diagnosing placental abruption, evaluating its severity, and guiding the clinical management to optimize maternal and fetal outcomes.

Keywords: placental abruption, ultrasound, diagnostic

 

Fetal growth restriction monitoring strategies

 

Mihaela Steriu

Life Memorial Hospital, Bucharest, Romania

The aim of this study is to establish standard rules for predicting the evolution and severity of fetal growth restriction, in order to obtain the best neurobehavioral prognosis after birth. Management suggestions keys will balance fetal and neonatal morbidity over the threshold of labor induction. Thus, iatrogenic prematurity and the risk of fetal death will be avoided. We have many possibilities for an active fetal status surveillance, with a reassurance rhythm for the physiopathology of fetal well-being. The cardiotocography nonstress test measures the fetal acid-base status. Umbilical Doppler flow offers information about impairment placental perfusion. Middle cerebral artery Doppler is sensitive to fetal hypoxia. Doppler of ductus venosus shows the fetal cardiac function and predicts the progression towards fetal compromise. The biophysical score measures the acid-base balance at the time of examination. Finally, the recommendation for a safe delivery will be given by integrating all the aforementioned parameters.

Keywords: fetal growth restriction, fetal monitoring, umbilical doppler

 

Junctional zone

 

Mihaela Steriu

Life Memorial Hospital, Bucharest, Romania

Histological, the myometrium is subdivided into three layers: stratum supravasculare, or the outer myometrium, located between the vascular arcade and the serosa of the uterus, the middle myometrium or stratum vasculare, and the inner myometrium or stratum subvasculare. The subendometrial area, known as junctional zone, drew our clinical attention when we started to detect differences in signal intensity at magnetic resonance exams, or the appearance of echogenicity by transvaginal ultrasound. The magnetic resonance images are dissimilar by the ultrasound captures. At magnetic resonance, the signal intensity changes abruptly, thus the junctional zone is thickened than the same measured by tridimensional ultrasound. At bidimensional ultrasound, the boundaries cannot be fenced. Histologically, the details are gradual; in the studied cases, the junctional zone is distinguished from the middle and inner myometrium by shrinking in smooth muscle cells density, larger extracellular spaces between connective tissue, water imbibition and vascular properties. The endometrial and subendometrial zones as making up a functional unit, contributing to peristalsis, and are involved in spermatozoa and blastocyst dynamic, thus explaining the failure of implantation or menorrhagia, as adenomyosis pathognomonic sign. The aim of this study is to standardise the setting of imagistic features, to establish the accordance between magnetic resonance and ultrasound aspects, correlated with histological and histopathological description of junctional zone. In such way, accompanied by clinical signs and symptoms, it is obtained allows an accurate and well documented diagnosis.

Keywords: endometrium, junctional zone, adenomyosis

 

Beyond the image: assessing ultrasound’s sufficiency in adenomyosis management

 

Mihai Surcel, Georgiana Nemeti, Iulian Goidescu, Adelina Staicu, Ioana Rotar, Dan Boitor, Daniel Mureşan

Department of Obstetrics and Gynecology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

Adenomyosis stands out as a particularly capricious uterine pathology, characterized by a broad spectrum of clinical manifestations.  Frequently, patients with adenomyosis report symptoms like dysmenorrhea and menorrhagia or even reduced fertility. However, for some, these challenges can escalate into obstetrical complications such as preterm birth, small for gestational age, pregnancy-induced hypertension or postpartum hemorrhage and, in rare cases, catastrophic uterine rupture. Despite the huge clinical interest, adenomyosis is still a histopathologic condition defined solely by its morphological elements: the distinct presence of ectopic endometrial glands and stroma embedded within hyperplastic smooth muscle in the myometrium. In terms of diagnosis, imaging tools like ultrasound and MRI offer impressive accuracy in diagnosing adenomyosis, closely aligning with histological findings. Still, when considering the management, adenomyosis is recognized for having one of the poorest standardized treatment strategies within the field of gynecology. This alarming situation requires a comprehensive reassessment of all the components involved in this process, including morphological variants and the biological characteristics of both ectopic and eutopic endometrial tissue, all of which are crucial determinants for the resulting clinical form of adenomyosis. Equally significant – yet often overlooked – are the primary uterine functions that may be compromised to some extent during the various phases of adenomyotic development. This study will investigate adenomyosis phenotypes by examining the three primary mechanistic theories (invasion of endometrial basalis into the myometrium, de novo metaplasia, and the outside to inside invasion), while also considering their impact on uterine functions. We will also explore specific biological characteristics linked to endometrial invasiveness, including angiogenesis, proliferation, cell survival events, steroid receptor expression, immune alterations, dysregulation of the extracellular matrix, as well as other factors related to inflammation, neurogenesis and fibrosis. Ultimately, the study will revolve around the central question: what contributions can ultrasound offer in this approach?

Keywords: adenomyosis, ultrasound, infertility

 

Management of pregnant women with complex cardiovascular disease – case report

 

Miruna-Florina Ștefan¹, Lucia-Ștefania Magda^1,2, Cătălin-Gabriel Herghelegiu³, Doru Herghelegiu³

1. University Emergency Hospital Bucharest, Romania

2. Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

3. Sanador Hospital, Bucharest, Romania

Prevalence and impact of cardiac diseases in pregnant women. The prevalence of heart diseases in pregnant women is 0.1-4%, with congenital heart defects being the most common pathology. The incidence of severe aortic stenosis during pregnancy is rare, as aortic stenosis is more frequent in men, and severe stenosis is uncommon in women of childbearing age. Physiological changes and risks during pregnancy. Pregnancy induces a decrease in systemic vascular resistance and blood pressure, an increase in heart rate and stroke volume and, consequently, a rise in cardiac output. These changes can decompensate previously asymptomatic significant aortic stenosis. Pregnant women with severe aortic stenosis may develop heart failure and atrial arrhythmias. After delivery, hemodynamic changes caused by the autotransfusion of uterine blood volume and reduction of intraabdominal pressure occur. The sudden increase in preload can also lead to maternal cardiac decompensation. Maternal and fetal risks. The maternal risk in pregnant women with aortic stenosis depends on the severity of the stenosis, the presence of symptoms, and the diameter of the aortic root. The consequences for the fetus include chronic fetal distress, intrauterine growth retardation and premature birth. Case management. As advancements in medical care enable more women with heart disease to enter their childbearing years, a multidisciplinary approach becomes imperative. The coordination of care is often facilitated by a pregnancy heart team, comprising cardiologists, obstetricians and anesthesiologists, ensuring comprehensive and specialized management tailored to individual patient needs.

Keywords: pregnancy, cardiovascular disease, aortic stenosis

 

Telemedicine in obstetrical echography: transforming maternal healthcare

 

Vlad-Iustin Tica, Dragoș Brezeanu, Ana-Maria Brezeanu

Faculty of Medicine, “Ovidius” University of Constanța; “Sf. Apostol Andrei” County Emergency Clinical Hospital, Constanţa, Romania

Introduction. The field of obstetrics and gynecology has significantly benefited from the revolutionary impact of telemedicine in healthcare. By harnessing technological advancements to enable remote consultations and healthcare delivery, telemedicine has notably improved the accessibility, efficiency and quality of maternal and women’s health services. Telemedicine in obstetrical echography – also known as tele-obstetric ultrasound – is an emerging practice that integrates telecommunications technology with prenatal ultrasound diagnostics to provide remote healthcare services. This paper examines the benefits, challenges, implementation strategies and prospects of telemedicine in obstetrical echography, with a focus on its potential to improve access to prenatal care, especially in underserved and rural areas. The advent of telemedicine has transformed various medical fields, including obstetrics, by enabling remote diagnosis and consultation. Obstetrical echography plays a crucial role in monitoring fetal development and maternal health. Integrating telemedicine into this field can bridge the gap between patients and specialists, ensuring comprehensive prenatal care regardless of geographical constraints. Tele-obstetric ultrasound significantly enhances access to prenatal care. It ensures that patients in rural and underserved areas receive essential prenatal care, where specialist services are often lacking. Additionally, tele-obstetric ultrasound offers early detection of complications through timely ultrasound examinations, which can lead to better maternal and fetal outcomes. Specialists can interpret ultrasound images in real-time, enabling immediate and accurate diagnoses. Telemedicine enables multidisciplinary collaboration and integrated specialist consultations, reducing travel expenses and time as it negates the need for physical visits to urban healthcare centers. Centralizing expert reviews of ultrasound images improves resource allocation and overall efficiency within healthcare systems. The future of telemedicine in obstetrical echography is promising, with anticipated technological advancements, including artificial intelligence for image interpretation and enhanced telecommunication systems. These innovations are expected to improve the accuracy, accessibility and efficiency of prenatal care services globally. Conclusions. Telemedicine in obstetrical echography is a significant advancement in ensuring comprehensive prenatal care for all expectant mothers, regardless of location. Continued investment in technology, training and regulatory frameworks is essential to realize the full potential of this innovative healthcare delivery model. As technology evolves, telemedicine will continue to play a vital role in enhancing maternal and women’s health, making quality care accessible to all. The integration of telemedicine into obstetrics and gynecology practice represents a significant advancement in improving health outcomes for women and their families.

Keywords: telemedicine, healthcare, obstetrical echography

 

Adnexal torsion – series of cases

 

Mihaela-Camelia Tîrnovanu¹, Bogdan-Florin Toma¹, Cristian Păvăloiu², Viaceslav Pavalatii², Mădălina Ciuhodaru¹, Loredana Toma¹

1. “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

2. “Cuza Vodă” Clinical Hospital of Obstetrics and Gynecology, Iași, Romania

Background. Ovarian torsion represents the fifth most common gynecological emergency, with a prevalence of 3%. Aim. To evaluate the ultrasound aspect of ovarian masses with torsion. Methodology. We present 11 cases of ovarian torsion confirmed by surgery. Results. The mean age of patients was 44.18±5 years old (limits: 20-68 years old), with only three cases in post-menopause. The most frequent location was on the right side 7/11 cases. The average size of the ovarian mass was 10 cm (limits: 6-15 cm). Usually, the diagnosis was suspected due to noisy symptoms. An unusual ovarian location anterior or posterior to the uterus or a change in position is suggestive of adnexal torsion. The absence of ovarian Doppler flow is highly specific and was found in almost all patients during the Doppler examination. Whirlpool sign of twisted vascular pedicle is pathognomonic, but we found it only in half of cases. Ovary tenderness to transducer pressure was present in the majority of women. Free pelvic fluid was seen only in four cases. The fallopian tube twists with the ovary and can be increased in volume with liquid inside. Regarding pathological exam of the ovarian mass, we had two rare situations. In one case with ovarian fibroma, we detected a non-homogenous mass (82/36 mm) without vessels, located on the left ovary, behind the uterus and we had to make a differential diagnosis with a malignant tumor. In the second case, we found a homogenous hypoechoic ovarian mass with a smooth internal wall, but it was a mucinous borderline ovarian tumor. Conclusions. Ultrasonography is the primary imaging modality for the evaluation of ovarian torsion. Understanding the imaging appearance of ovarian torsion will lead to conservative, ovary-sparing treatment for young women. The treatment of choice is always the surgical removal, with an intraoperative frozen section, if possible.

Keywords: ovarian mass, torsion, ultrasound

 

Ultrasonographic evaluation of women of reproductive age after hysterectomy

 

Elena Vataman¹, Aliona Serbulenco¹, Eduard Izbaş², Liudmila Vangheli²

1. “Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chișinău, Republic of Moldova

2. Excellence Medical Center, Chişinău, Republic of Moldova

Introduction. Hysterectomy remains one of the most common types of gynecologic interventions in most countries and represents the treatment of choice for benign pathologies. Although it is performed to increase the quality of life of these patients, a series of early and late complications may occur following this procedure, and the ultrasonographic evaluation plays an important role in their diagnosis and management. The purpose of the study was to highlight the ultrasonographic features in women of reproductive age after hysterectomy and to identify the most frequent postoperative complications. Materials and method. An exhaustive review of the relevant scientific literature was performed. The articles were selected by critical analysis, comparing the results of the studies and highlighting the key ideas on this topic. Results. Hysterectomy significantly reduces the possibility of genital pathology, but it does not completely exclude it. A series of studies estimated the major role of pelvic ultrasonography in postoperative monitoring, and the presence of adhesions, abnormal location of the ovaries and displaced intestine make it difficult to interpret the result in this category of patients. Some of the most common complications after hysterectomy highlighted by ultrasonography are pelvic fluid collections and peritoneal inclusion cysts. Failure of the abnormal peritoneum to absorb fluid from the functioning ovaries results in a collection of serous or hemorrhagic fluid. Abnormal collection of lymphatic fluid, called lymphocele, is another possible complication after hysterectomy, visualized on ultrasound as multiloculated cystic masses with thin septa. At the same time, the development of residual ovary syndrome, characterized by the formation of benign ovarian cysts, was reported as a possible complication after hysterectomy, with an incidence of 0.89% to 3.38%. Conclusions. The data of the specialized literature show that hysterectomy is associated with multiple early and late complications, and the ultrasonographic evaluation can contribute to the early diagnosis and to the establishment of their management tactics.

Keywords: hysterectomy, ultrasonographic evaluation, reproductive age

 

Impact of SARS-CoV-2 on placental structure – a morphopathologic study

 

Andreea Vochin¹, Anca-Maria Istrate-Ofițeru^1,2,3, George-Lucian Zorilă^1,3, Iuliana-Alina Enache⁴, Cătălina Iovoaica-Rămescu⁴,
Rodica-Daniela Nagy¹, Cristina-Maria Comănescu⁵, Dominic-Gabriel Iliescu^1,3

1. Department of Obstetrics and Gynecology, County Emergency Clinical Hospital Craiova, Romania

2. Department of Histology, University of Medicine and Pharmacy of Craiova, Romania

3. Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania

4. Doctoral School, University of Medicine and Pharmacy of Craiova, Romania

5. Department of Anatomy, University of Medicine and Pharmacy of Craiova, Romania

Introduction. The effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy remain poorly understood. Aim. We present this paper in which we analyzed 60 term parturients, 30 without associated infection (C-) and 30 with associated infection (C+) at birth. Methodology. We analyzed the complete blood count (CBC) and microscopic structure of the placenta by classical and immunohistochemical immunostaining, and we observed the placental sites damaged by the presence of SARS-CoV-2. Results. SARS-CoV-2 infection was associated with a reduction in lymphocyte count, platelet count and the presence of structural placental changes, with extensive areas of amyloid deposits, placental infarcts, vascular thromboses, syncytial nodules, with a reduced placental vascular density and the presence of the infection in decidual cells, syncytiotrophoblasts and chorionic plate cells, but without passing through this barrier and without causing fetal infection in the cases analyzed. Conclusions. This study indicates that the invasion of SARS-CoV-2 in the placenta can induce significant structural changes, with a reduction in placental vascular density that may have significant implications for fetal perfusion adequacy. Also, the presence of immunoreactivity in the decidua, placental villi and chorionic plate demonstrates that the virus can penetrate the maternal-fetal barrier. However, in the cases analyzed, there were no fetal infections at birth, which may indicate that local placental factors may be a filter of protection for the fetus.

Keywords: SARS-CoV-2, placental structure, morphopathology

 

 

Abstracts of the 9^th Conference of the Romanian HPV Society,
12-14 September 2024, Târgu-Mureș, Romania

 

 

The lesser-known consequences of HPV infection

 

Roxana-Elena Bohîlțea^1,2, Cristiana-Elena Durdu¹, Alina-Irina Anghel¹

1. Department of Obstetrics and Gynecology, “Filantropia” Clinical Hospital of Obstetrics and Gynecology, Bucharest, Romania

2. Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Human papillomavirus (HPV) infection is responsible for approximately 5% of all cancers, with cervical cancer being the most well-known outcome of this infection. However, HPV-associated conditions manifest in a wide range of locations and clinical presentations. Beyond cervical cancer, HPV infection can lead to lesser-known conditions such as recurrent respiratory papillomatosis, conjunctival papilloma, epidermodysplasia verruciformis, Bowen’s disease, and middle ear carcinomas. It is essential for clinicians to be aware of this diversity of manifestations to ensure an accurate diagnosis and an appropriate management of patients. The implementation of preventive measures – particularly, widespread vaccination – is crucial in reducing the incidence and complications of HPV-related diseases. This paper aims to highlight these lesser-known consequences of HPV infection and to underscore the importance of prevention and public health education.

Keywords: HPV infection, HPV-associated conditions, conjunctival papillomatosis, vaccination, prevention

 

The Romanian Society of Preventive Medicine (SRPM) project for integrated
screening centers

 

Roxana-Elena Bohîlțea^1,2, Cristiana-Elena Durdu¹

1. Department of Obstetrics and Gynecology, “Filantropia” Clinical Hospital of Obstetrics and Gynecology, Bucharest, Romania

2. Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Cancer remains a major cause of mortality globally and in Europe, with a significant incidence also in Romania. Cancers such as cervical, breast, colorectal, prostate and lung are among the most common and have a major impact on public health. Despite the importance of early detection, data on participation in screening programs are limited in Romania, particularly among socioeconomically vulnerable groups. In this context, this paper proposes a project by the Romanian Society of Preventive Medicine (SRPM) for the establishment of integrated screening centers. These centers will provide specialized services for screening cervical, breast, colorectal, prostate and lung cancers. Activities will include cervical sample collection, mammograms, colonoscopies, PSA tests and pulmonary imaging, ensuring a multidisciplinary and comprehensive approach. A key element of these centers will be offering HPV vaccination, which is crucial for preventing infections that can lead to cervical cancer. Additionally, the centers will provide colposcopy services and treatment for preneoplastic lesions, contributing to the reduction of incidence and mortality through early detection of lesions. This presentation will cover the methodology for implementing these centers, anticipated challenges and potential benefits to public health. It will also discuss the impact of expanding screening to other types of cancer, such as colorectal, prostate and lung cancers. The SRPM project aims to improve access to screening services, raise awareness and align Romania’s public health practices with European standards.

Keywords: screening centers, prevention, screening, vaccination, cancer

 

HPV-negative cervical cancer: distinguishing characteristics compared
to HPV-positive cases

 

Iulia Canditu, Andreea Nadoleanu, Claudia Cristescu, Marius Moga

Department of Obstetrics and Gynecology, “Dr. I.A. Sbârcea” Clinical Hospital of Obstetrics and Gynecology, Brașov, Romania

Introduction. Human papillomavirus (HPV) is well established as a major cause of cancers in the female genital area, with nearly all cervical cancers attributed to HPV. Nonetheless, about 7% of cervical carcinomas are classified as HPV-negative. The primary differences between HPV-negative and HPV-positive cervical cancers encompass etiology, prevalence, prognosis and molecular characteristics. Materials and method. We present the case of an 80-year-old woman, suffering from type 2 diabetes mellitus, hypertension and obesity, who was admitted to our unit due to moderate metrorrhagia. The transvaginal ultrasound assessment revealed cervical tumor extending to the body of the uterus with parametrial involvement. The complete blood count showed anemia (Hg=10.3 g/dl). Results. To determine the appropriate management for the patient, additional investigations were conducted. The results of cytological test and the HPV DNA test were negative. A cervical biopsy was done, showing gastric-type adenocarcinoma of the uterine cervix. Consequently, the magnetic resonance imaging revealed pelvic lymph node involvement, which resulted in her classification as FIGO stage IIIC. Given the comorbidities and the age, the patient refused the initiation of radiotherapy and chemotherapy. Conclusions. Despite being less common, HPV-independent cervical cancers require close attention due to their increased aggressiveness (higher prevalence of lymph nodes metastases), older age at diagnosis, and poorer prognosis compared to HPV-positive cases.

Keywords: HPV-negative, cervical cancer, gastric-type adenocarcinoma

 

Epidemiology of cervical dysplasia in an obstetrics and gynecology clinic from Sibiu

 

Radu Chicea¹, Dragoș Popescu¹, Amina Grindeanu¹, Eugen Chicea², Răzvan Stănescu², Andrei Neagu²

1. Faculty of Medicine, “Lucian Blaga” University of Sibiu, Romania

2. Emergency County Clinical Hospital Sibiu, Romania

Introduction. Cervical dysplasia is a significant public health issue. Understanding its epidemiology in clinical settings is vital for effective prevention and management strategies. This study aims to evaluate the prevalence, risk factors and demographic characteristics associated with cervical dysplasia in an obstetrics and gynecology clinic from Sibiu, Romania. Materials and method. A retrospective cohort study was conducted at a tertiary obstetrics and gynecology clinic from January 2021 to December 2023. Medical records of 200 women, aged 21-65 years old, who underwent routine Pap smears and HPV testing were reviewed. Data collected included patient demographics, smoking status, sexual history, contraceptive use and the results of cytological examinations. Cervical dysplasia was classified according to the Bethesda system. Statistical analyses, including Chi-Squared tests and logistic regression, were performed to identify significant associations between risk factors and the presence of cervical dysplasia, with the significance set at p<0.05. Results. Out of 120 women, 20 (16.7%) were diagnosed with cervical dysplasia. The breakdown of dysplasia cases was as follows: 12 (10%) with low-grade squamous intraepithelial lesions (LSIL), seven (5.8%) with high-grade squamous intraepithelial lesions (HSIL), and one (0.8%) with atypical glandular cells (AGC). The mean age of women with dysplasia was 35.7 years old. Significant risk factors identified included smoking (OR 2.1; 95% CI; 1.4-3), early onset of sexual activity (OR 1.8; 95% CI; 1.2-2.6), and multiple sexual partners (OR 2.5; 95% CI; 1.7-3.7). The contraceptive use showed a complex association, with long-term oral contraceptive users having a higher prevalence of HSIL (p<0.01). Conclusions. Cervical dysplasia is prevalent in the studied population, with notable associations with smoking, early sexual activity and multiple sexual partners. Regular screening and targeted interventions for high-risk groups are essential for the early detection and management. These findings underscore the importance of comprehensive sexual health education and smoking cessation programs in reducing the incidence of cervical dysplasia. Future research should focus on longitudinal studies to further elucidate causal relationships and the effectiveness of preventive measures.

Keywords: epidemiology, cervical dysplasia, health issue

 

Mass-media role in HPV vaccination in adolescents

Mădălina Ciuhodaru¹, Mihaela Târnovanu¹, Petra Acostăchioaiei²

1. “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

2. “Elena Doamna” Clinical Hospital of Obstetrics and Gynecology, Iași, Romania

Objectives. Our aim is to establish the influence of mass-media, and especially of technology, in the increasingly provided human papillomavirus (HPV) vaccination in teenagers, as HPV represents a primary high-risk factor for cervical cancer worldwide. Materials and method. We used an anonymous enquiry to 28 high schoolers about how they perceived the prevention for HPV infection through different media – television, internet, social media (Tik-Tok, Instagram etc.) – versus the same approach from parents or doctors. Results and conclusions. Eighty-one percent found out about HPV vaccination from the internet (by scrolling), mostly on Tik-Tok or Instagram. Not surprisingly, the majority were females (78.1%). Definitely, the third age group (15-16 years old) was more informed compared with the first (11-12 years old) and second (13-14 years old) age groups. Another difference regarded the parental background – those from educated families knew about the vaccination in a quite large proportion (67.3%) compared to teenagers whose families had a medium or low education. There was a huge misconception about vaccination in young boys, deeply contrasting to girls, about the doses, risks or places to get vaccinated. In medium or highly educated families, the person who gave some information about HPV infection/vaccination was mostly a parent, rarely the family doctor, and only 3-4 teenagers reached the gynecologist to talk about it. Conclusions. In this new e-heath era, we need new strategies to talk and inform about the possible prevention of an endemic disease such as cervical cancer to both sexes and applying the new technologies.

Keywords: HPV, cervical cancer, prevention, media, e-health

 

A study of HPV genotypes and abnormal Pap smears in women from Western Romania – a retrospective analysis

 

Sebastian Ciurescu^1,2, Ioan Sas¹, Larisa Tomescu^1,2, Nicoleta Nicolae¹

1. Department of Obstetrics and Gynecology, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania

2. Doctoral School, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania

Introduction. The rising cervical cancer rates, linked to the human papillomavirus (HPV), necessitate proactive measures. HPV genotyping identifies high-risk strains, enabling targeted screening and risk stratification. This informs treatment decisions with the potential to reduce cervical cancer cases. Western Romania’s newly implemented screening program warrants a retrospective analysis of Pap cytology and HPV genotypes. Materials and method. Our retrospective study on Pap cytology and HPV genotypes in Western Romania examined Pap smears from 195 sexually active women from the Gynecology Ambulatory of the Municipal Emergency Clinical Hospital Timișoara, over a two-year period. HPV genotyping was performed on a subset of 67 patients. Data analysis utilized JASP, employing descriptive statistics, frequency tables, contingency tables, Chi-Squared test, odds ratio, and Fisher’s exact test. Results. Among 195 patients undergoing Pap smears, the most common finding was negative (77.95%), indicating no abnormal cells. A smaller proportion showed low-grade squamous intraepithelial lesions (LSIL; 11.28%) or atypical (ASC-US; 8.72%) results. High-grade lesions (HSIL, ASC-H) were infrequent. Category II (CII) was the most prevalent cytology grade (75.90%), followed by category III (CIII, 24.10%). HPV genotyping was conducted on a subgroup of 67 patients. Type 16 was the most frequent (28.36%), followed by “other high-risk types” (20.89%), and types 16 and 18 (13.43%). No HPV testing was performed for 65.64% of the patients. These findings emphasize the value of Pap smear screening for the early detection of cervical abnormalities. Conclusions. Our Western Romania study underscores the critical role of HPV testing alongside Pap cytology in cervical cancer prevention. We observed that HPV testing is a powerful tool for identifying high-risk women, offering a more comprehensive screening strategy when combined with Pap cytology. The study also revealed a diverse HPV genotype distribution, suggesting the need for broader-spectrum vaccines, like the nonavalent vaccine. Despite limitations, our findings advocate for incorporating HPV testing into national screening guidelines. Future research should explore larger studies and the cost-effectiveness of broader-spectrum vaccines. Implementing these insights could lead to more effective cervical cancer prevention strategies in Western Romania.

Keywords: cytology, Pap smear, human papillomavirus

 

Cervical dysplasia in immunocompromised pregnant women – case report

 

Diana-Elena Comandaşu^1,2, Astia Axenti², Lavinia-Mădălina Sichim², Maria Olinca^1,2, Elvira Brătilă^1,2

1. Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

2. “Prof. Dr. Panait Sîrbu” Clinical Hospital of Obstetrics and Gynecology, Bucharest, Romania

It has been demonstrated so far that immunosuppressed patients as a result of HIV viral infections, post-organ transplant immunosuppressive therapy or autoimmune diseases have a significantly increased risk of cervical cancer. The purpose of this paper is to highlight the association between the damage to the immune system and the risk of cervical cancer, especially during pregnancy. Among the behavioral factors that alter the immune system, smoking appears to significantly increase the risk of cervical cancer, while a nutrient-deficient diet moderately increases the risk. It is difficult to determine whether sexually transmitted infections other than human papillomavirus (HPV) infection are independent risk factors. Identifying those groups of women who may fail to clear persistent human papillomavirus infections would help individualize screening guidelines and target immune-associated factors in the etiology of cervical cancer. We present the case of a 31-year-old patient, diagnosed with chronic HIV infection stage C1, on antiretroviral treatment and co-infection with the hepatitis C virus, with undetectable viremia and CD4 status over 250. The pregnant woman presented to the clinic for pregnancy monitoring, in the first trimester. At the paraclinical evaluation of the first trimester, a cervical cytology high-grade dysplasia (HSIL) was established. Colposcopic evaluation was performed at approximately 10 weeks of gestation, revealing high-grade colposcopic abnormalities with suspicion of invasion. We note that, at the previous cervical cytological evaluation, performed, respectively, in the first trimester of her first pregnancy, the cytological result was negative for intraepithelial or malignant lesion. As associated risk factors in this case, we mention chronic smoking and malnutrition. After counseling the patient, who associated a high degree of anxiety as a result of knowing the immunosuppressed status, it was decided to perform a conization. This excised a large fragment of the cervix, measuring 5/4.5/2 cm, with the histopathological diagnosis of HSIL/CIN3/CIS, with extension to the level of numerous metaplastic endocervical glands. The identified lesion was described as being present in the endocervical margin of some fragments. Counseling was resumed, taking into account the histopathological result, and as a result of the high level of anxiety, the patient opted for hysterectomy, considering the rapid evolution of cervical dysplasia to cervical cancer in the context of immunosuppression in a short period of less than three years. All therapeutic options were offered to the patient, who gave her informed consent for hysterectomy. A total hysterectomy was performed, with lymph node sampling, which revealed low-grade cervical dysplasia on the operating piece. Also, intraoperatively, the upper third of the vaginal mucosa was excised because of its pathological friable appearance, identifying VAIN2 on the specimen. The postoperative evolution was uneventful. The postoperative consultation at one month revealed a cicatrized vaginal stump, with a normal macroscopic appearance, the patient resuming her current activities. This case report emphasizes the importance of customizing the screening for the category of immunosuppressed patients, considered those at high risk of developing cervical dysplasia with a rapid evolution to cancer.

Keywords: immunosuppressed patients, cervical dysplasia, pregnancy

 

HPV infection and pregnancy

 

Mihaela Grigore^1,2, Ioana Grasu², Alexandra Catrinescu², Anda Pristavu^1,2, Ștefania Iamandi², Ana-Maria Grigore²

1. Department of Obstetrics and Gynecology, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

2. “Cuza Vodă” Clinical Hospital of Obstetrics and Gynecology, Iaşi, Romania

Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections, with significant implications for reproductive health. During pregnancy, managing HPV infection presents challenges related to the progression of cervical lesions, the risk of vertical transmission, and the available therapeutic options. This paper aims to analyze the impact of HPV infection on pregnancy, discuss monitoring strategies for pregnant patients with cervical lesions, and assess the risk of neonatal transmission. Most HPV infections remain asymptomatic during pregnancy; however, hormonal and immunological changes may influence the progression of cervical lesions. In general, high-grade lesions require careful surveillance, and the treatment indications are limited to selected cases. The most important role of management is to diagnose microinvasive lesions. Vertical transmission of HPV is possible, but its clinical impact on the newborn remains controversial. Rigorous colposcopic and cytological monitoring of pregnant patients with HPV infection is essential to prevent complications. Postpartum screening strategies and HPV vaccination remain key aspects of long-term prevention.

Keywords: HPV infection, pregnancy, cervical intraepithelial lesion, colposcopy, management

 

Actual challenges of colposcopy

 

Mihaela Grigore^1,2, Ioana Grasu², Alexandra Catrinescu², Ștefania Iamandi², Anda Pristavu1,2, Gabriel Costachescu¹

1. Department of Obstetrics and Gynecology, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

2. “Cuza Vodă” Clinical Hospital of Obstetrics and Gynecology, Iaşi, Romania

Colposcopy is a subjective examination method of the inferior genital tract disease. Despite its utility, there are several challenges associated with the procedure, from the clinician’s perspectives. Difficulties can arise in obtaining a clear view of the cervix, especially in patients with anatomical variations, excessive bleeding, during pregnancy or in patients with other complicating factors. The interpretation of colposcopic findings is somewhat subjective, and can vary between clinicians. Differentiating between normal variations and pathological changes can be difficult, leading to potential diagnostic inconsistencies. It is necessary to ensure that clinicians receive thorough training in colposcopy techniques and interpretation of findings. Also, the update training need to reflect current best practices. And utilizing digital imaging, new technologies and documentation in order to enhance accuracy and allow for review by colleagues can be useful.

Keywords: colposcopy, cervical screening, cervical intraepithelial neoplasia

 

Vulvar disease – from HPV infection to autoimmune disorder

 

Corina Grigoriu

Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Introduction. Vulvar disease is a common burden at different ages. In young females, HPV-induced lesions are common, as well as common infections. In older patients, lichen sclerosus may develop, and overlapping of premalignancy or vulvar cancer is not rare. Methodology. An overview of recent literature was performed, searching for predisposing factors that lead to the appearance of complicated lichen sclerosus. Results. Lichen sclerosus has not yet a clear cause. Frequent local trauma, changing of hormonal status, chronic inflammation and autoimmunity have been studied. Changes of vulvar microbiome, as well as skin and anal microbiome may be important in disease development, in a larger picture of immune-mediated Th1-IFN gamma induced phenotype (as a genetic predisposition). Local oxidative stress, with lipid and DNA peroxidation, favors an autoimmune response and carcinogenesis. HPV appears to be more frequent in the microbiome of patients with lichen sclerosus and vulvar high-grade intraepithelial lesions, and Prevotella and Bacterioidales appear less frequent in patients with lichen sclerosus compared to healthy patients. Conclusions. The changing of vulvar microbiome and the active presence of HPV may be the missing puzzle piece in understanding vulvar disease.

Keywords: vulvar disease, HPV, autoimmune disorders

 

HPV genotyping implications in precancerous cervical lesions treatment

 

Dominic Iliescu

Department of Obstetrics and Gynecology, County Emergency Clinical Hospital Craiova; Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania

HPV testing is recommended for primary screening, triage of equivocal cervical cytology, and post-treatment surveillance after conization or trachelectomy. Cone excision and LEEP are considered both diagnostic and therapeutic, and they can effectively eradicate CIN. However, despite the removal of the entire lesion with negative margins, the HPV infection can persist. Early detection of treatment failure is important, as post-treatment CIN rates are reported between 5% and 15%. LEEP treatment for CIN 2/3 affects the subsequent acquisition of HPV infection, with a reduction in the acquisition of new carcinogenic HPV infections. HPV persistence varies among studies. The main factors include: HPV type (16), pre-conization high viral load, glandular involvement, positive surgical margin status, and positive cytology at follow-up. Almost all recurrent diseases after conization occur in patients with persistent HR-HPV infections, in about one-third of the patients at 24 months. Pre-conization viral load appears to be more important than the lesion grade. Clearances have been shown to be slower in patients with CIN 1 and 2 versus CIN 3 and CIS, and justified by higher HPV DNA loads. This is why the treatment should be very careful regarding residual lesions and include immunostimulants, local or general antivirals, and vaccination.

Keywords: HPV, conization, CIN, viral load

 

Optimization of cervical screening through co-testing with HPV and Pap smear: analysis
of guideline compliance and clinical correlations

 

Maral Madadi, Alina Marin, Radu Vlădăreanu

Department of Obstetrics-Gynecology and Neonatology, “Elias” University Emergency Hospital, Bucharest, Romania

Introduction. Cervical cancer screening is a critical preventive health measure, with current guidelines advocating for the use of both Pap smear and HPV co-testing to enhance early detection of cervical abnormalities. This study aims to assess the effectiveness of this combined approach in the Obstetrics and Gynecology Department of the “Elias” University Emergency Hospital, Bucharest, from December 2023 to the present. Materials and method. We conducted a retrospective analysis of cervical screening data collected from patients who underwent both Pap smear and HPV co-testing during the specified period. Screening outcomes were evaluated for compliance with the established clinical guidelines. The results were further correlated with patients’ demographics, clinical history and follow-up interventions to determine the real-world applicability and benefits of co-testing in a clinical setting. Results. Our preliminary findings indicate a substantial adherence to screening guidelines among the evaluated patients. Co-testing yielded a higher detection rate of high-risk HPV infections and cervical cytological abnormalities compared to Pap smear alone. The integration of HPV testing provided additional diagnostic clarity, particularly in cases with ambiguous Pap smear results, facilitating timely and appropriate clinical management. Conclusions. The implementation of HPV and Pap smear co-testing in our department has demonstrated significant improvements in the early detection of cervical abnormalities. Adherence to screening guidelines and the correlation of co-testing results with clinical outcomes underscore the importance of this approach in optimizing cervical cancer prevention strategies. Future directions will focus on continuous monitoring of screening practices, patients’ education, and the long-term impact of co-testing on patients’ outcomes.

Keywords: cervical cancer screening, Pap smear, HPV genotyping, guideline compliance, co-testing, clinical correlations

 

New recommendations on HPV vaccination

 

Roxana Mătăsariu^1,2, Radu Pintilie^1,2, Ioan-Tudor Lazăr^1,2, Iuliana Bujor^1,2, Elena Niță¹, Mihaela Grigore^1,2

1. Department of Obstetrics and Gynecology, “Cuza Vodă” Clinical Hospital of Obstetrics and Gynecology, Iaşi, Romania

2. Department of Obstetrics and Gynecology, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

Human papillomavirus (HPV) is one of the most common sexually transmitted viral infections worldwide, detectable in 5-20% of sexually active women of reproductive age. The increased incidence of cervical cancer is partly due to the fact that the infection is more frequently associated with oncogenic types 16 and 18. Persistent HPV infection in adult women is associated with an increased risk of developing cervical dysplasia and cervical cancer. In Romania, HPV infection represents a major public health issue due to patients’ reluctance towards HPV vaccination. HPV vaccination in adult patients, especially in those aged 26-45 years old, can reduce the risk of progression to precancerous lesions, even after initial exposure to the virus. Recent studies show that vaccination can prevent the recurrence of cervical dysplasia in women who have already been treated for such lesions. The vaccine is effective not only in adolescents but also in adult women, reducing the risk of recurrent infections with oncogenic HPV strains. The global impact of vaccination demonstrates a significant reduction in infections with oncogenic strains and precancerous lesions, confirming the vaccine’s efficacy for public health. Vaccination prevents reinfection, viral reactivation (if it is the vaccine serotype), and subsequent infections with other serotypes included in the vaccine. Antibodies generated after natural infection are not always protective, but when an adequate titer is achieved, they provide delayed protection (after one year). Studies conducted since the launch of the HPV vaccine (2006) have shown that post-vaccination immunity does not decline over time, which is why, to date, the need for a booster dose after the primary vaccination has not been established. The future of HPV vaccination focuses on expanding global coverage and on eradicating cervical cancer in the coming decades.

Keywords: human papillomavirus, HPV infection, HPV vaccine

 

Management of discordant cytology-colposcopy in HPV-positive patients

 

Mihai Mitran¹, Maria Olinca¹, Roberta Deaconescu², Anca Potecă¹, Elvira Brătilă¹

1. “Prof. Dr. Panait Sîrbu” Clinical Hospital of Obstetrics and Gynecology, “Bucharest; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

2. University of Medicine and Pharmacy of Craiova, Romania

Cervical cancer is one of the most common malignant tumors affecting the female genital organs worldwide. Human papillomavirus (HPV) is the major etiological agent involved in the pathogenesis of cervical dysplasia and cervical cancer. Babeş-Papanicolaou cytology is an exfoliative cytology through which the cells from the superficial layers of the epithelium are detached, exposed on a glass slide and stained. The current American Congress of Obstetricians and Gynecologists (ACOG) recommendations for cervical cancer screening in women depend on age, HIV infection/immunodeficiency, and pregnancy status. Screening should begin at the age of 21 years old. Women aged 21 to 29 should be screened by cytology every three years. Women aged 30 to 65 should be screened with cytology and HPV co-testing every five years or cytology only every three years. The risk of high-grade squamous intraepithelial lesion (HSIL) in a patient with a positive HPV test and an abnormal Pap smear is approximately 20%, and it increases to 33% if the patients is HPV positive at more than one visit. Conclusions. Educating patients about the risk factors for HPV exposure, as well as safe sex practices can reduce the risk of HPV infection. Vaccines have been developed against high-risk HPV types 16 and 18, as well as against low-risk HPV types 6 and 11. Because most high-grade lesions are associated with HPV16, vaccination is predicted to reduce the incidence of HSIL/CIN2/CIN3 by up to 87%.

Keywords: HSIL, cervical cancer, cytology

 

Current value of different cervical tests in predicting cervical pathology
in the “Dr. Ion Cantacuzino” Clinical Hospital

 

Şerban Nastasia, Adelina Achim, Cătălina Savu, Anca Popa, Manuela-Cristina Russu

Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Introduction. CIN1 is the expression of benign HPV viral replication, for which no further surgical treatment is necessary. On the opposite, CIN2 and CIN3 represent the expression of persistent HPV viral infection, with the potential to progress to cervical cancer. CIN2, CIN3 and cervical cancer are grouped in CIN2+ lesions, for which further surgical treatment is required. Materials and method. A retrospective study was performed, investigating the performance of HPV status, Pap smear, CIN-Tec Plus immunochemistry and colposcopy for detecting cervical preinvasive lesions. All patients had gold-standard pathology-proven diagnosis. P16 immunochemistry on pathological specimens for discriminating CIN2+ lesions was not performed. Results. Between 2019 and 2024, seventy-six consecutive patients with at least one cervical abnormal test (cytology, HPV, CIN-Tec Plus, colposcopy) were included in the study. Out of these, in 71 patients either a cone biopsy (52.1%) or an LETTZ procedure (47.8%) was performed. The pathological diagnosis was available in 68 patients: negative – three cases (4.4%), CIN1 – 31 cases (45.5%), CIN2 – 12 cases (17.6%), CIN3 – 19 cases (27.9%) and cervical carcinoma – three cases (4.4%). The sensitivity, specificity, positive and negative predictive values for cytology predicting CIN2+ were, respectively, 87.87%, 15,15%, 50.87% and 55.56%; for CIN-Tec Plus – 50%, 21.4%, 38.89% and 30%; for HPV –100%, 11.54%, 54.90% and 100%; for colposcopy – 96.30%, 13.64%, 57.78% and 75%. The sensitivity and negative predictive values for CIN-Tec Plus predicting CIN3+ were, respectively, 27.77% and 71.42%. Depending on the pathological result, a second cervical intervention was performed in 0% cases of negative pathology, in 3.23% of CIN1 cases, in 8.33% of CIN2 cases, in 36.84% of CIN3 cases, and in 100% of cervical cancers (p=0.0007). Discussion. Cytology and HPV status perform as reported in the literature. CIN-Tec Plus shows a weak sensitivity and negative predictive value for CIN2+, and a usable negative predictive value for CIN3 positive.

Keywords: cervical tests, cytology and HPV status, CIN-Tec Plus

 

Trends in the evolution of HPV testing – is methylation the new holy grail?

 

Maria Olinca, Mihai Mitran, Anca Potecă, Elvira Brătilă

“Prof. Dr. Panait Sîrbu” Clinical Hospital of Obstetrics and Gynecology, “Bucharest; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

The increasing global burden of HPV-associated cancers necessitates more precise diagnostic approaches beyond traditional HPV DNA testing. Although current HPV testing provides high sensitivity, its limited specificity leads to unnecessary follow-ups and overtreatment. Emerging evidence suggests that DNA methylation analysis of host and viral genes may offer enhanced diagnostic accuracy by identifying high-grade lesions with malignant potential. This review evaluates current trends in HPV testing, focusing on the molecular mechanisms underpinning DNA methylation and its clinical relevance in cervical cancer screening. We highlight critical biomarkers, including hypermethylation of host genes such as CADM1, MAL and HPV viral regions like L1 and L2, linked to persistent infections and progressive lesions. Clinical studies demonstrate that methylation markers improve specificity when integrated into HPV testing protocols, reducing false-positive rates. We further discuss technological advancements in methylation detection methods, including next-generation sequencing and methylation-specific PCR. These assays enable precise risk stratification, paving the way for individualized screening strategies. As research advances, methylation profiling holds potential as a primary or adjunctive test in cervical cancer screening programs. The clinical implications of incorporating methylation-based diagnostics into routine screening could redefine the management of HPV-associated lesions and reduce the burden of cervical cancer worldwide.

Keywords: HPV test, DNA methylation, diagnosis

 

Current insight – screening, monitoring and epidemiology of HPV-associated cancers

 

Maria Olinca, Anca Potecă, Mihai Mitran

“Prof. Dr. Panait Sîrbu” Clinical Hospital of Obstetrics and Gynecology, “Bucharest; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

HPV-associated cancers, including cervical, anogenital and oropharyngeal malignancies, represent a significant global health challenge, despite advances in screening and vaccination programs. The effective control strategies depend on understanding the epidemiological trends and on optimizing screening and monitoring protocols through evidence-based approaches. This presentation synthesizes current research on HPV-associated cancer screening methods, including cytology, HPV DNA testing, and novel molecular assays such as DNA methylation and RNA transcriptomic profiling. We review epidemiological data reflecting changes in HPV prevalence and cancer incidence following widespread vaccine introduction, highlighting reductions in cervical cancer but emerging concerns about rising oropharyngeal cancer rates. Key focus areas include risk-based screening models, personalized follow-up protocols, and real-world implementation of integrated HPV testing platforms. We also explore how advances in molecular diagnostics and artificial intelligence-driven screening tools improve the surveillance accuracy. By connecting epidemiological insights with clinical practice, this review underscores the need for adaptive screening strategies that reflect shifting disease patterns and evolving patient risk profiles.

Keywords: HPV, cancer, epidemiology

 

Easier access to HPV vaccination – is the target group informed?

 

Aida Petca^1,2, Ruxandra Ivan², Tiberiu Nedelcu¹

1. Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

2. Department of Obstetrics-Gynecology and Neonatology, “Elias” University Emergency Hospital, Bucharest

Introduction. Human papillomavirus (HPV) is a major public health concern due to its association with various types of cancer, particularly cervical cancer. Despite the availability of effective vaccines, vaccination rates among young people remain suboptimal. This study aims to assess the level of awareness among adolescents about HPV infection and protective measures against it. Methodology. As part of a course on HPV infection and protective measures conducted for a group of young people aged 15 to 19 years old, included in the Summer School for high school students organized by the “Carol Davila” University of Medicine and Pharmacy, Bucharest, two questionnaires were administered before and after the course. The questionnaire focused on awareness levels, protective measures, and vaccination status. Results. Almost all study participants reported having prior knowledge about HPV infection and the possibility of vaccination against it. The main source of their information was their parents. Ninety percent of the study respondents were aware of the virus’ involvement in the development of cervical cancer, but less than half were aware of the possibility of developing other types of cancer. Although 40% of the young people are not vaccinated against HPV, following the course, all of them expressed the desire to obtain the protection offered by vaccination. In conclusion, this study demonstrates an increase in awareness of HPV infection and the need for protective measures following educational interventions.

Keywords: HPV infection, HPV vaccine, adolescents

 

HPV-positive ENT neoplasms – etiopathogenic update, diagnosis and treatment

 

Ana-Maria Popa¹, Loredana Mitran², Cornelia Nițipir¹

1. Oncology Department, “Elias” University Emergency Hospital, Bucharest, Romania

2. ENT Department, “Elias” University Emergency Hospital, Bucharest, Romania

ENT neoplasms are staged according to the presence of p16 on immunohistochemistry (IHC). Thus, the therapeutic protocol as well as the prognosis are greatly influenced by this. Our paper presents a five-year retrospective study carried out by the ENT and oncology departments of the “Elias” University Emergency Hospital, Bucharest, Romania.

Keywords: ENT neoplasia, HPV, oncologic management

 

The psychosocial factor in the persistence of HPV infection and cervical screening –
a study on women from Northeast Romania

 

Irina-Liviana Stoian¹, Maria Marchiş¹, Demetra Socolov^1,2, Samar Nassouh^1,2, Ciprian Ilea^1,2

1. “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

2. “Cuza Vodă” Clinical Hospital of Obstetrics and Gynecology, Iași, Romania

Introduction. Cervical cancer is still a substantial global public health issue among women. In the prevention and early diagnosis, cervical cancer screening plays a crucial role. However, acceptance of and participation in this screening are influenced by various factors. The women’s psychological status, including stress, anxiety, depression or individual perception of health, can influence the decision to participate in cervical cancer screening. The current study aimed to investigate the psychological impact of Papanicolaou (Pap) testing in women from Northeast Romania. Materials and method. We used a questionnaire specifically developed for this study, which included structured questions aimed to assess various aspects of the psychological impact of cervical cancer screening. The statistical analysis for this study was performed using IBM SPSS Statistics version 26. Results. The study indicated a significant positive association between the perception that the Pap test was painful and anxiety related to unfavorable results and fertility concerns fertility. Younger women tend to have their Pap test more often than older women. Women with previous negative Pap test results tend to have lower levels of anxiety related to unfavorable results compared to women previously experiencing positive Pap test results. The results indicated that the regression model (i.e., age, perceptions about the Pap test – cost, pain and embarrassment) did not significantly predict the anxiety related to the unfavorable results. Conclusions. Our study highlights important psychosocial aspects related to cervical cancer screening and provides a foundation for improving health promotion services and risk awareness programs.

Keywords: anxiety, Pap test, cervical screening

 

Methylation tests as triage marker in cancer screening HPV-based cervix

 

Călin Todoran

Regina Maria Hospital, Cluj-Napoca, Romania

Screening plays a key role in the secondary prevention of cervical cancer. High-risk human papillomavirus (hrHPV) testing, a highly sensitive test with limited specificity, has become the gold standard for screening programs. Thus, the importance of effective screening strategies, including DNA methylation markers, was emphasized. Despite the potential reported in individual studies, methylation markers still require validation before being recommended.

Keywords: cancer screening, HPV, methylation

 

Assessment of patients’ knowledge of human papillomavirus – a detailed analysis

 

Octavia Velicu¹, Mihai Mitran², Cristina Popescu¹, Silviu Predoi¹, Alin Burlacu¹

1. Wellborn Hospital, Bucharest, Romania

2. “Prof. Dr. Panait Sîrbu” Clinical Hospital of Obstetrics and Gynecology, Bucharest; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Human papillomavirus (HPV) infection remains a major public health issue due to the high number of newly diagnosed cases of cervical cancer and the large number of deaths caused by this pathology. A better understanding from specialized medical professionals about the degree of patients’ awareness of this pathology and the possibilities of prophylaxis should lead to better results in the communication with patients. The present study, conducted by questionnaire method, revealed the importance of social platforms as a means of collecting information from patients, but, unfortunately, we faced with a poor management of this research, especially in patients with low socioeconomic factors. We thus emphasize the importance of patients’ education by health professionals with each opportunity.

Keywords: HPV, cervical cancer, questionnaire