Anesthetic Considerations and Outcomes in Amniotic Fluid Embolism: A Retrospective Study over a 15-Year Period.

(1) Background: A rare and unexpected consequence of childbirth, labor, or the immediate postpartum period is amniotic fluid embolism (AFE). This study aims to identify AFE cases during or immediately after birth from anesthetic management perspectives. Secondary goals include assessing patient clinical features, obstetric care techniques, birth outcomes, and case survival. (2) Methods: A retrospective observational study assessed AFE patients hospitalized in three Romanian clinical institutions from October 2007 to April 2023. Based on the Society of Maternal-Fetal Medicine (SMFM) criteria, we diagnosed 11 AFE patients. (3) Results: AFE occurred in eight cases (73%) during peripartum, two (18%) within 30 min after placental delivery, and 1 (9%) during a scheduled cesarean surgery. Only one of six cardiorespiratory arrest patients responded to external cardiac massage, while the other five (83%) needed defibrillation. The patients received, on average, five units of red blood cells, six of fresh frozen plasma, and two of activated platelets. Six patients (55%) received factor VIIa infusions. Maternal mortality was 36.3%. Six neonates (75%) needed neonatal resuscitation, and two (25%) died on the second and third days. (4) Conclusions: AFE management necessitates a multidisciplinary approach and the incorporation of advanced life support techniques to optimize outcomes for both the mother and newborn.

Impact of Exogenous Factors and Anesthetic Risk in Premature Birth during the Pandemic Period.

BACKGROUND: Premature birth remains a public health problem worldwide, involving a broader context and a multidisciplinary team aimed at combating this phenomenon as much as possible. The consumption of addictive substances by women who are pregnant can occur in different social contexts and at different stages of their lives, which modulate its extent. Obstetricians and anesthetists should consider the anesthetic maternal risks that may arise due to these addictive behaviors. The maternal anesthetic risk is higher in women who are pregnant with a medium-level of education, imbalanced nutrition, stress associated with physical or mental activity, affected sleep hygiene, and failed marriages. OBJECTIVES: The objectives of the study refer to analyzing the impact of exogenous factors and the anesthetic risk on premature birth for women who were pregnant during the pandemic period and in women who were pregnant without COVID-19 infection. The authors studied a significant sample of 3588 women who were pregnant without COVID-19 infection, among whom 3291 gave birth at term and 297 gave birth prematurely. METHODS: The methods analyzed consist of studying the specialized literature regarding the impact of exogenous factors and parturient's anesthetic risk on premature birth and identifying the regional risk profile of women who are pregnant in the southeast region of Romania compared to that identified in the specialized literature. In the analytical methods, we used a linear regression to study the incidence of exogenous risk factors on anesthetic risk in women who were pregnant with premature births compared to those with full-term births. RESULTS: The results confirm the significant impact of exogenous factors on anesthetic risk and the significant impact of anesthetic risk on premature births. The novelty of the study lies in highlighting the modification of the regional exogenous risk profile during the pandemic period in southeast Romania due to unfavorable socio-economic causes and the translation of grade I and II prematurity events to higher frequencies with an increased level of maternal anesthetic risk. CONCLUSIONS: The study findings show that the anesthetic risk is maximized in parturients with a middle school education. Additionally, the anesthetic risk of patients who are pregnant increases with the intensification of smoking adherence and its maintenance throughout the pregnancy at the same intensity. Our study aims to provide a basis for the diversification and development of community intervention programs in the post-COVID-19 era, considering the reshaping of social models and the repositioning of social principles and values. Obstetricians and anesthetists must know and promote family values to harmonize the lives of family members and provide a better life for the mother and child.

Hyperglycosylated-hCG: Its Role in Trophoblast Invasion and Intrauterine Growth Restriction.

Human chorionic gonadotropin (hCG) is produced by the placenta and its roles have been studied for over a century, being the first known pregnancy-related protein. Although its main role is to stimulate the production of progesterone by corpus luteal cells, hCG does not represent just one biologically active molecule, but a group of at least five variants, produced by different cells and each with different functions. The hyperglycosylated variant of hCG (H-hCG) plays a key role in trophoblast invasion, placental development and fetal growth. During trophoblast invasion, H-hCG promotes extravillous cytotrophoblast cells to infiltrate the decidua, and also to colonize and remodel the spiral arteries in to low resistance, larger-diameter vessels. As fetal growth is heavily reliant on nutrient availability, impaired trophoblast invasion and remodeling of the uterine arteries, leads to a defective perfusion of the placenta and fetal growth restriction. Understanding the function of H-hCG in the evolution of the placenta might unveil new ways to manage and treat fetal growth restriction.

A Real-Life Action toward the End of HIV Pandemic: Surveillance of Mother-to-Child HIV Transmission in a Center from Southeast Romania.

Preventing mother-to-child HIV transmission is a strategy to eliminate new infections to move toward a world free of HIV/AIDS. The aim of this study is to assess the effectiveness of the perinatal infection prevention program in a single center from southeast Romania. Newborns of HIV-positive mothers from 2005 to 2020 were followed-up until the age of two in a retrospective study. The transmission rate from HIV-positive mothers to living children was zero, but neonatal mortality, preterm birth and birth defects were still high. The peculiarity of our study is the high proportion of mothers with a nosocomial pattern of HIV transmission. Intensifying the efforts for accurate implementing the interventions for the prevention of mother-to-child HIV transmission, a long time follow-up for HIV-exposed uninfected children and new research on related HIV pregnancies are necessary to reach the objective of a new generation free of HIV.

Synchronous bilateral primary ovarian carcinoma - case presentation.

Bilateral synchronous primary ovarian carcinoma, histopathologically identical or different is a rare entity encountered in clinical practice. We present the case of a 38-year-old patient who is admitted with the presence of a massive pelvic abdominal tumor formation of 45÷35÷25 cm occupying the lower pelvic and upper abdominal floor, reaching halfway distance between the umbilicus and sternum and lateral bilaterally in the two abdominal flanks until iliac wing. The mixed transabdominal÷transvaginal ultrasound and computed tomography (CT), establish the diagnosis of bilateral ovarian tumor. The CA-125 level is 1822 IU÷mL. The exploratory laparotomy identifies two distinct bilateral ovarian tumors, ascites liquid and pelvic and lumbo-aortic lymphadenopathy, thus the surgery involves hysterectomy with bilateral ovariectomy, pelvic and paraaortic lymphadenectomy and omentectomy. Histopathological and immunohistochemistry (IHC) diagnosis highlights a well-differentiated serous carcinoma on the left ovary and right ovary. The six-month check after surgery as well as the one-year check showed the efficiency of postsurgery chemotherapy and did not signal the presence of relapses. The particularity of this case lies in the presence of bilateral synchronous primary ovarian carcinoma, histopathologically and IHC indicated serous carcinoma present with a difficult differential diagnosis including clear cell carcinoma at a young patient.