Controversies and certainties in obstetrics and gynecology

The obstetrics section opens up this edition of our journal with a major obstetrical emergency – postpartum hemorrhage, causes and treatment, by presenting a retrospective study in which there were analyzed cases of postpartum hemorrhage, between April 2019 and April 2021, from the “Bucur” Maternity, Bucharest, concluding that the most common cause of postpartum hemorrhage was uterine atony, being more frequent after caesarean section.

Screening for cardiac anomalies represents a critical component of contemporary prenatal care, embodying a proactive approach to identifying congenital heart defects in developing fetuses. Cardiac anomalies represent a diverse spectrum of structural and functional abnormalites that may affect the heart and the great vessels. In the following paper, there were analyzed certain cases that proved challenging in the first instance or needed a second opinion or an expert examination. There were also reviewed cases that were missed in the first trimester and diagnosed later, to establish what was missing from the initial examination to make the diagnosis at that time.

Moving on, the next paper presents the rare case of complete hydatidiform mole, also known as molar pregnancy, which represents a gestational trophoblastic disease that originates in the placental tissue and has the capacity of producing metastases with prolonged evolution.

Adenomyosis is a benign gynecological pathology, commonly found in women aged 40-50 years old. The nonspecific clinical presentation and the lack of standardized diagnostic criteria make this pathology a challenge for clinicians. Thus, the case presented in the next paper aims to highlight the diagnostic and therapeutic management for persistent uterine bleeding at an advanced age, discussing the paraclinical evidence guiding the diagnosis.

The neonatology section presents the fetal and neonatal diagnosis and ma­nage­ment in a case of a neonate with con­ge­­ni­tal heart disease – the interesting case of a large-for-gestational-age male neo­­nate, born at 39 weeks of gestational age, who had the first fetal diagnosis of con­ge­ni­tal heart disease made by the pe­dia­­tric cardio­logist specialized in fetal and neonatal congenital heart disease, at 32 weeks of gestational age. The final fe­tal diagnosis was coarctation of the aor­ta (CoA) with hypoplastic arch, and hypo­plas­tic left ventricle, with the recommendations of immediate postnatal reas­sessment and postnatal prostaglandin E1 (PGE1) infusion.

The following paper brings to the front a challenging pathology, clear cell carcinoma of the ovary, a rare and aggressive subtype of ovarian cancer which is often associated with endometriosis, a chronic condition characterized by the presence of endometrial-like tissue outside the uterus. Clear cell carcinoma arising within the context of endometriosis presents unique diagnostic challenges for pathologists. The coexistence of benign endometriotic tissue and malignant clear cell carcinoma in the same specimen can be confounding.