http://repository.usmf.md:80/xmlui/handle/20.500.12710/27983 The 10th International Medical Congress for Students and Young Doctors, 24-27 April, 2024 2026-10-27T09:07:07Z http://repository.usmf.md:80/xmlui/handle/20.500.12710/29004 Assessment of the cases of postpartum hemorrhage in multiparous women Cemortan, Maria; Bubulici, Cristina; Vicol, Maria-Magdalena; Grajdean, Elena; Scripnic, Gabriela; Manic, Milena 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/xmlui/handle/20.500.12710/28438 Anatomical variants of the median sacral artery Rotaraș, Alina 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. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z http://repository.usmf.md:80/xmlui/handle/20.500.12710/28441 Corpus callosum agenesis in morphoclinical aspect Rotaraș, Arina 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. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z http://repository.usmf.md:80/xmlui/handle/20.500.12710/28506 Molecular-genetic and environmental mechanisms of myopia Moldovanu, Mirela Introduction. Myopia is a multifactorial pathology that causes the decrease or loss of vision, in most cases the elongation of the longitudinal axis of the eyeball is involved. From an etiological point of view, numerous factors are involved in the appearance and development of myopia: genetic, constitutional, environmental, lifestyle, external factors. Pathogenetically, different molecules are involved that participate in the formation of structures that ensure the normal anatomy and proper functioning of the organ of vision. Aim of study. Myopia is an important global public health and socioeconomic problem. According to a number of more than 100 studies on the prevalence of myopia, in 2020 there were 28% of registered cases of myopia globally and 4% of cases of high myopia. These numbers continue to grow annually, including the cases of myopia detected at a young age, and definitive treatments for this pathology do not exist, even surgical interventions have different recurrence rates. Methods and materials. This work was created based on the review of specialized literature, using books and articles published in electronic sources recognized by the international medical community, such as: NCBI, PubMed, GeneCards, OMIM. Results. According to studies, there are more than 200 genes involved in the occurrence and development of myopia. In some cases, the pathology appears isolated, in other cases it has a syndromic component. For example, the PAX-6 protein, encoded by the homonymous gene, is a regulator of gene transcription and is indispensable for the development of neural tissues, especially of the eye, and mutations in this gene are involved in the development of non-syndromic myopia, according to some studies. At the same time, in recent years, the topic of epigenetic changes is brought up more and more frequently. These can be significantly influenced by environmental factors, are time-dependent and have tissue specificity, all of which complicate the study of epigenetic characteristics, since myopia often appears in childhood and adolescence and it is practically impossible to obtain eye tissues at these ages. Conclusion. Myopia is a pathology known for a long time and by many people, but most often it does not have a single and concrete cause. If in the case of syndromic myopia, it can be assumed antenatally due to the detection of certain syndromes during genetic testing, then in the case of epigenetic changes, determined by environmental factors and lifestyle, it cannot be precociously predicted. However, in the case of an emmetropic child in childhood and early adolescence and without myopic parents, reducing the time spent on activities that require close visual work, including the use of gadgets, as well as increasing the duration of outdoor activities, could be the first and simplest advice to delay the onset of myopia as much as possible and to minimize the risk of its rapid worsening and its complications in case of detection. most cases the elongation of the longitudinal axis of t he eyeball is involved. From an etiological point of view, numerous factors are involved in the appearanc e and development of myopia: genetic, constitutional, environmental, lifestyle, extern al factors. Pathogenetically, different molecules are involved that participate in the formatio n of structures that ensure the normal anatomy and proper functioning of the organ of vision. Aim of study. Myopia is an important global public health and socioeco nomic problem. According to a number of more than 100 studies on the prevalence of m yopia, in 2020 there were 28% of registered cases of myopia globally and 4% of cases of high myopia. These numbers continue to grow annually, including the cases of myopia detected at a young age, and definitive treatments for this pathology do not exist, even surgical interventi ons have different recurrence rates. Methods and materials. This work was created based on the review of specialized lite rature, using books and articles published in electronic sources rec ognized by the international medical community, such as: NCBI, PubMed, GeneCards, OMIM. Results. According to studies, there are more than 200 genes involved in the occurrence and development of myopia. In some cases, the pathology a ppears isolated, in other cases it has a syndromic component. For example, the PAX-6 protein, enc oded by the homonymous gene, is a regulator of gene transcription and is indispensable for t he development of neural tissues, especially of the eye, and mutations in this gene are invo lved in the development of non-syndromic myopia, according to some studies. At the same time, in recent years, the topic of epigenetic changes is brought up more and more frequently. These can be significantly influenced by environmental factors, are time-dependent and have tissue spe cificity, all of which complicate the study of epigenetic characteristics, since myopia often a ppears in childhood and adolescence and it is practically impossible to obtain eye tissues at the se ages. Conclusion. Myopia is a pathology known for a long time and by many p eople, but most often it does not have a single and concrete cause. If in the cas e of syndromic myopia, it can be assumed antenatally due to the detection of certain syndromes during ge netic testing, then in the case of epigenetic changes, determined by environmental factors and lifestyle, it cannot be precociously predicted. However, in the case of an emmetropic child in childhood and early adolescence and without myopic parents, reducing the time spent on activiti es that require close visual work, including the use of gadgets, as well as increasing the duratio n of outdoor activities, could be the first and simplest advice to delay the onset of myopia as much as possible and to minimize the risk of its rapid worsening and its complications in case of det ection. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z