http://repository.usmf.md:80/handle/20.500.12710/10713 2026-06-10T01:44:39Z http://repository.usmf.md:80/handle/20.500.12710/29004 Title: Assessment of the cases of postpartum hemorrhage in multiparous women Authors: Cemortan, Maria; Bubulici, Cristina; Vicol, Maria-Magdalena; Grajdean, Elena; Scripnic, Gabriela; Manic, Milena Abstract: Introduction. Postpartum hemorrhage (PPH) is one of the leading obstetric complications, affecting 5-15% births. Being a major factor in maternal mortality and morbidity, PPH causes about 25% of maternal deaths worldwide. Aim of study. The aim of the study was to assess the cases of PPH in multiparous women, admitted to the Tertiary Perinatal Center. Methods and materials. The retrospective study was performed by assessing 81 clinical cases of PPH in multiparous women. Total blood loss in labor or C-section was performed by using graduated vessels, and all the sterile material used was weighted. For continuous variables, the mean values and standard deviation of the mean were calculated; the median (Me) as well as the interquartile range (Q1;Q3) in the case of a distribution of characteristics that differs from the normal. Results. The average age of women was 31.6±5.5 years (Me 32 (28;35.5)), varying in the limits of 20-42 years. The majority of participants delivered for the second time - 38 cases (46.9% (95% CI 33.3-59.9)), however, 30 women (37.0% (95% CI 25.9-48.2)) gave birth for the third time, and 13 women (16.1% (95% CI 8.5-27.4)) had 4th – 9th delivery. In 41 cases (50.6% (95% CI 40.7- 61.7)) a c-section was performed. The mean blood loss in vaginal delivery was 850±308 (Me 800 (600;1050)) mL, varying in the limits of 500– 1600 mL. Compared to the mean blood loss in Csection – 1752±1093 (Me 1500 (1100;1850)) mL, varying in the limits of 1000 – 5250 mL. In the structure of PPH there were assessed 26 cases (32.1% (95% CI 20.9-47.0)) of the placental defect or placenta adherens, 15 cases (18.5% (95% CI 10.3-30.5)) of lacerations of the birth canal, 11 cases (13.6% (95% CI 7.4-23.4)) of uterine atonia, and 2 cases (2.5% (95% CI 0-7.3)) of uterine rupture. Hence, in 46 women (56.8% (95% CI 44.6-69.1)) it was applied conservative management of the cases. However, in 20 cases (24.6% (95% CI 15.0-38.1)) an operative management was applied, from which 7 cases (8.6% (95% CI 3.7-14.7)) hemostatic sutures were applied. In 13 cases (16.0% (95% CI 8.5-27.4)) hysterectomy was performed, from which 9 cases (69.2% (95% CI 31.6-100)) subtotal hysterectomy without annexes was the elective method for definitive hemostasis. Conclusion. PPH is a major obstetric complication, which occurs more frequently in multiparous women, in association with placental pathology and birth canal trauma, explained by overextension of the uterus and coagulation disorders, requiring extensive surgical management. 2024-01-01T00:00:00Z http://repository.usmf.md:80/handle/20.500.12710/28438 Title: Anatomical variants of the median sacral artery Authors: Rotaraș, Alina Abstract: Introduction. Knowing the anatomical variants of the median sacral artery has the applied significance, since it is necessary for the surgeons when choosing the operational techniques, in order to ensure the safe access to the presacral space structures. The median sacral artery (hereinafter referred to as the ‘MSA’) is an azygos blood vessel, which is located in the midline, is of small calibre, begins at the dorsal semi-circumference of the abdominal aorta, at the level of the bifurcation thereof, and ends in glomus coccygeum. The MSA is a continuation of the abdominal aorta and a source of vascularisation for the coccyx region of the human organism. Aim of study. Assessing the anatomical variants of the median sacral artery, based on the morphological and topographical criteria, which were found in different reference sources. Methods and materials. The information on this topic was selected from 15 reference sources, and the specified data were analyzed, from the point of view of morphological and topographical variations of the median sacral artery. Results. It has been stated, based on the information as provided in the specialized references, that median sacral artery arises, in the majority of cases, in the dorsal part of the aorta, over the bifurcation thereof, at a distance of 5 to 18 mm, and more seldom directly at the bifurcation level. In reference to the posterior midline, the MSA is more frequently located on the left side of the midline, in case – right on the midline, and in the remaining cases, on the right side of the midline. It has been also stated that in those cases when the abdominal aorta bifurcation is over the level of inferior vena cava formation, then the median sacral artery has a descending rectilinear pathway, and only sometimes – a descending sinuous pathway. In reference to the left/right common iliac veins, there have been identified the following locations of the MSA: its location in the midline, as correlated to both veins, has been stated in 40.9% of cases; its deviation to the left, next to the left common iliac vein has been stated in 31.2% of cases; its direction to the right common iliac vein has been stated in 27.3% of cases. Several authors mention the cases of rare occurrence, when the median sacral artery priorly intersects the left common iliac vein, on its pathway. Conclusion. The point of origin of the median sacral artery varies, and it may have different pathways, both rectilinear and sinuous ones. Topographically, the MSA is located differently, in reference to blood vessels and adjacent formations. Knowing the anatomical variants of the median sacral artery, as pertaining to its morphological and topographical peculiarities, will be a great benefit for the practical medicine and it has a major importance when carrying on surgical interventions at the presacral space level, or various gynecological procedures. significance, since it is necessary for the surgeons when choosing the operational techniques, in order to ensure the safe access to the presacral space structures. The median sacral artery (hereinafter referred to as the ‘MSA’) is an azygos blood vessel, which is located in the midline, is of small calibre, begins at the dorsal semi-circumfe rence of the abdominal aorta, at the level of the bifurcation thereof, and ends in glomus coccygeum. The MSA is a continuation of the abdominal aorta and a source of vascularisation for the coccyx region of the human organism. Aim of study. Assessing the anatomical variants of the median sacral artery, based on the morphological and topographical criteria, which were found in different reference sources. Methods and materials. The information on this topic was selected from 15 reference sources, and the specified data were analyzed, from the point of view of morphological and topographical variations of the median sacral artery. Results. It has been stated, based on the information as provided in the specialized references, that median sacral artery arises, in the majority of cases, in the dorsal part of the aorta, over the bifurcation thereof, at a distance of 5 to 18 mm, and more seldom directly at the bifurcation level. In reference to the posterior midline, the MSA is more frequently located on the left side of the midline, in case – right on the midline, and in the remain ing cases, on the right side of the midline. It has been also stated that in those cases when the abdominal aorta bifurcation is over the level of inferior vena cava formation, then the median sacral artery has a descending rectilinear pathway, and only sometimes – a descending sinuous pathway. In referenc e to the left/right common iliac veins, there have been identified the following locatio ns of the MSA: its location in the midline, as correlated to both veins, has been stated in 40.9% of c ases; its deviation to the left, next to the left common iliac vein has been stated in 31.2% of cases; its direction to the right common iliac vein has been stated in 27.3% of cases. Several authors m ention the cases of rare occurrence, when the median sacral artery priorly intersects the left common iliac vein, on its pathway. Conclusion. The point of origin of the median sacral artery varies, and it may have different pathways, both rectilinear and sinuous ones. Topographically, the MSA is located differently, in reference to blood vessels and adjacent formations. Know ing the anatomical variants of the median sacral artery, as pertaining to its morphological and top ographical peculiarities, will be a great benefit for the practical medicine and it has a major importance when carrying on surgical interventions at the presacral space level, or various gynecological procedures. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z http://repository.usmf.md:80/handle/20.500.12710/28441 Title: Corpus callosum agenesis in morphoclinical aspect Authors: Rotaraș, Arina Abstract: Introduction. Agenesis of the corpus callosum (ACC) is a congenital brain anomaly, characterized by the absence of commissural fibers connecting the two large hemispheres of the brain. This can be partial or total and can appear in isolation or in association with genetic abnormalities/syndromes, having a reserved evolution and prognosis. The ACC presents the most cerebral malformation, associated with over 250 genetic syndromes, the incidence being 1:300 newborns, in about 80% of cases the neurological manifestations, being quite severe, which leads to a high morbidity, mortality and neuropsychological invalidation of these children. Aim of study. Studying the morphoclinical aspects of corpus callosum agenesis according to the data elucidated in the bibliographic sources. Methods and materials. 12 bibliographic sources were studied in which the morphological appearance and clinical manifestations of corpus callosum agenesis were mentioned. Results. In no. 12 of sources was indicated that agenesis of the corpus callosum from a morphological point of view is divided into total and partial agenesis, in which usually the splenium (posterior part) is absent. The clinical aspect of this anomaly is based on the neurological disorders, as well as the symptoms related to the anomalies with which ACC is associated, all of which are mentioned in no. 12 of sources. Most of the bibliographic sources mention the methods of investigation of this malformation, the main one being the ultrasound of pregnant women which needs to be performed no later than on the 20th -22nd weeks of gestation. Conclusion. Total corpus callosum agenesis is much more common than partial agenesis. Agenesis of the corpus callosum is most commonly associated with other intracranial anomalies, including Interhemispheric Cyst with Hydrocephalus, Dandy-Walker Malformation, Neuronal Migration Disorder, Inferior Vermis Agenesis, Encephalocele, Interhemispheric Fissure Lipoma. The method of choice in establishing agenesis of the corpus callosum is the ultrasound examination. characterized by the absence of commissural fibers conne cting the two large hemispheres of the brain. This can be partial or total and can appear in isol ation or in association with genetic abnormalities/syndromes, having a reserved evolution and prognos is. The ACC presents the most cerebral malformation, associated with over 250 genetic syndromes, the incidence being 1:300 newborns, in about 80% of cases the neurological manifestat ions, being quite severe, which leads to a high morbidity, mortality and neuropsychological invalida tion of these children. Aim of study. Studying the morphoclinical aspects of corpus callosum agen esis according to the data elucidated in the bibliographic sources. Methods and materials. 12 bibliographic sources were studied in which the morphological appearance and clinical manifestations of corpus callosum a genesis were mentioned. Results. In no. 12 of sources was indicated that agenesis of the corpus callosum from a morphological point of view is divided into total and partia l agenesis, in which usually the splenium (posterior part) is absent. The clinical aspect of this anomaly is based on the neurological disorders, as well as the symptoms related to the anomalie s with which ACC is associated, all of which are mentioned in no. 12 of sources. Most of the bibli ographic sources mention the methods of investigation of this malformation, the main one being the ultrasound of pregnant women which needs to be performed no later than on the 20th -22nd weeks of gestation. Conclusion. Total corpus callosum agenesis is much more common than partial agenesis. Agenesis of the corpus callosum is most commonly associa ted with other intracranial anomalies, including Interhemispheric Cyst with Hydrocephalus, Dandy-Wa lker Malformation, Neuronal Migration Disorder, Inferior Vermis Agenesis, Encephalocele, Interhemispheric Fissure Lipoma. The method of choice in establishing agenesis of the corpus c allosum is the ultrasound examination. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z http://repository.usmf.md:80/handle/20.500.12710/28454 Title: Gluten intolerance. Celiac disease Authors: Volc, Renata Abstract: Introduction. Celiac disease (CD) is an immune-mediated inflammatory condition of the small intestine that occurs in genetically predisposed individuals when they are exposed to gluten (a plant-based protein component found in grains). The disease has a variable incidence, with a worldwide prevalence of approximately 1:100; Statistics have shown that 70% of patients reported with celiac disease are female. Distribution of population groups, reported that HLA DR3 Phenotype occurs in 70-90% of patients. Aim of study. Celiac disease is an autoimmune disorder and an inflammatory disease that manifests itself upon ingestion of gluten in the upper small intestine and is characterized by the gradual deterioration of the intestinal mucosa. Biochemically, it highlights an immune reaction, which is mediated by certain cells of the immune system, which attack the cells of the small intestine. Methods and materials. It has been scientifically proven that the prevalence of celiac disease in the majority of the population ranges from 0.5% to 1%. Medical science researchers have determined that the incidence is higher among people with autoimmune disorders. Patients with type 1 diabetes are prone to celiac disease, and in the last 20 years there has been a considerable increase in cases. Results. Inflammation and nutrient malabsorption, in addition to diarrhea, distention and abdominal pain, lead to damage to many organs and systems such as: iron deficiency leading to anemia, vitamin deficiencies, osteoporosis, dermatitis herpetiformis, tooth enamel defects, chronic fatigue, joint pain, poor growth, delayed puberty, infertility or repeated miscarriages, and other autoimmune disorders. A number of neurological problems have also been associated with celiac disease; these include migraines, depression, attention deficit/hyperactivity disorder and epilepsy. The diagnosis of celiac disease is established: a) upon the histological finding of an increased number of intraepithelial T lymphocytes; of crypt hyperplasia; of the expansion of regenerative epithelial crypts until the total disappearance of villi; b) positive serological testing (IgA tissue transglutaminase, anti-deamidated gliadin-related peptides IgA and Ig G, IgA antibodies); c) by molecular genetic testing of HLA-DQA1 and HLA-DQB1 which can be determinant or of HLADQ2 and HLA-DQ8) which can be used to exclude celiac disease. Conclusion. Celiac disease (CD) is a very common disorder but in most cases it starts silently. Many of the patients are identified through screening of at-risk groups or after the onset of symptoms of malabsorption, rarely for complications associated with the disease. The diagnosis of CD and its differential diagnosis is made from integrations between typical histological findings and clinical, serological and immunological features. The Corazza-Villanacci system is a useful method to assess mucosal damage and response to gluten-free diet in patient follow-up. intestine that occurs in genetically predisposed individuals when they are exposed to gluten (a plant-based protein component found in grains). The disease has a variable incidence, with a worldwide prevalence of approximately 1:100; Statistics have shown that 70% of patients reported with celiac disease are female. Distribution of populati on groups, reported that HLA DR3 Phenotype occurs in 70-90% of patients. Aim of study. Celiac disease is an autoimmune disorder and an inflammat ory disease that manifests itself upon ingestion of gluten in the upper small i ntestine and is characterized by the gradual deterioration of the intestinal mucosa. Biochemi cally, it highlights an immune reaction, which is mediated by certain cells of the immune system, whi ch attack the cells of the small intestine. Methods and materials. It has been scientifically proven that the prevalence o f celiac disease in the majority of the population ranges from 0.5% to 1%. Medi cal science researchers have determined that the incidence is higher among people with aut oimmune disorders. Patients with type 1 diabetes are prone to celiac disease, and in the l ast 20 years there has been a considerable increase in cases. Results. Inflammation and nutrient malabsorption, in addition to di arrhea, distention and abdominal pain, lead to damage to many organs and systems such as: iron deficiency leading to anemia, vitamin deficiencies, osteoporosis, dermatitis he rpetiformis, tooth enamel defects, chronic fatigue, joint pain, poor growth, delayed puberty, infertility or repeated miscarriages, and other autoimmune disorders. A number of neurological problems ha ve also been associated with celiac disease; these include migraines, depression, attention defi cit/hyperactivity disorder and epilepsy. The diagnosis of celiac disease is established: a) upon the histological finding of an increased number of intraepithelial T lymphocytes; of crypt hyperp lasia; of the expansion of regenerative epithelial crypts until the total disappearance of villi; b) positive serological testing (IgA tissue transglutaminase, anti-deamidated gliadin-related peptides IgA and Ig G, IgA antibodies); c) by molecular genetic testing of HLA-DQA1 and HLA-DQB1 which can be determinant or of HLADQ2 and HLA-DQ8) which can be used to exclude celiac disease. Conclusion. Celiac disease (CD) is a very common disorder but in mos t cases it starts silently. Many of the patients are identified through screening of at- risk groups or after the onset of symptoms of malabsorption, rarely for complications as sociated with the disease. The diagnosis of CD and its differential diagnosis is made from integr ations between typical histological findings and clinical, serological and immunological features. Th e Corazza-Villanacci system is a useful method to assess mucosal damage and response to gluten-free diet in patient follow-up. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z