Mucinous cystadenoma is a benign neoplasm frequently encountered in the ovaries, distinguished by its significantly larger growth potential compared to other adnexal mas­ses. These lesions are considered precursors to ovarian can­cer, with the potential to slowly progress to borderline tu­mors or even invasive ovarian cancer. Prompt and pre­cise therapeutic intervention is crucial, as these tumors can reach considerable sizes and pose a poor prognosis if not managed properly. A holistic approach to patient care, which incorporates the patient’s expectations and associated comorbidities, is essential. The case of a mu­ci­nous cystadenoma identified through imaging in a 20-year-old patient highlights the occurrence of such tumors in youn­ger individuals, necessitating optimal and timely ma­nage­ment.

The birth rate in Romania has significantly decreased in re­cent years, following the same downward trend recorded through­out Europe. The lowest number of births in the last 60-100 years was noted in 2024. In Romania, according to the National Institute of Statistics, in 2024 there were re­cor­ded only 150,000 births. Preterm birth (

The luteal phase, initiated after ovulation, is characterized by the secretion of progesterone by the corpus luteum, which is essential for preparing the endometrium for em­bryo implantation. Luteal phase stimulation (LPS) is a procedure used in assisted reproductive technologies (ART), including in vitro fertilization (IVF), oocyte donation and fertility treatments, to optimize the number of oocytes for poor responder patients. This method is useful for wo­men with reduced ovarian reserve, increasing the num­ber of oocytes retrieved, thus augmenting the chances of ob­tai­ning more embryos, improving the chances of suc­ces­sful em­bryo implantation. Studies comparing luteal phase sti­mu­la­tion to traditional follicular phase stimulation have shown that LPS may offer benefits for women with poor ova­rian reserve or those undergoing fertility preservation. Ad­di­tio­nally, dual ovarian stimulation (DuoStim), which com­bines follicular and luteal phase stimulation in the same cycle, has proven effective, improving pregnancy out­comes for poor responders as a result of increasing the number of oocytes and embryos obtained. Although LPS tends to require a longer duration and higher doses of go­na­do­tro­pins, it has been associated with higher mature oocyte yields, though its cost-effectiveness and long-term cli­ni­cal benefits, especially in poor responders, need further in­ves­ti­ga­tion.

Objective. The aim of this randomized controlled study was to examine the effectiveness of biofeedback-assisted pel­vic floor muscle training (PFMT) and hypopressive exer­cises (HE) in women with pelvic organ prolapse (POP). Metho­do­logy. Thirty-two women diagnosed with POP (stages 2 and 3) according to the POP Classification System were in­clu­ded in the study. The participants were randomly as­signed to three groups: the PFMT group (n=10), the HE group (n=12), and the control group (n=10). To ensure that the participants performed the exercises correctly, they re­ceived three sessions of biofeedback-assisted PFMT/HE trai­ning. The exercises were performed as a home program for 12 weeks. All participants were given recommendations re­gar­ding POP. The Pelvic Organ Prolapse Symptom Score, the Pelvic Floor Distress Inventory-20, pelvic floor muscle strength assessment (using a perineometer), and quality of life assessment (using a Visual Analog Scale [VAS]) were ap­plied. Compliance with the 12-week exercise program was also assessed using VAS. Results. Compared to baseline and the control group, both PFMT and HE groups showed a reduction in POP symptoms, an increase in pelvic floor mus­cle strength, and an improvement in the quality of life after 12 weeks of treatment (p<0.05). There was no sta­tis­ti­cally significant difference between the exercise groups in post-treatment assessments (p>0.05). Exercise ad­he­rence was similar between the PFMT and HE groups (p>0.05). Conclusions. Pelvic floor muscle training and hypo­pres­sive exercises, when taught with biofeedback, were found to be effective in reducing POP symptoms. Teaching the exercises with biofeedback may have contributed to the patients’ correct understanding and execution of the exer­cises, thereby improving adherence. Further studies are needed to investigate the long-term effectiveness of exercise ap­proaches and to develop patient-specific strategies to en­hance compliance.

Introduction. Monochorionic diamniotic twin pregnancies represent a rare event associated with an extremely rare com­pli­ca­tion of the spontaneous rupture of the di­vi­ding mem­brane between the amniotic sacs. Once this rup­ture ap­pears, the pregnancy becomes functionally a mo­no­am­nio­tic pregnancy, with a high risk of developing umbilical cord entanglement (up to 50%) and a supplementary rise in the perinatal mortality (up to 70%). Materials and method. This literature review included 10 highly selected cases of spontaneous septostomy – respectively, patients with diamniotic pregnancy who didn’t have any invasive procedures, included between 2012 and 2024. Results. In 80% of the identified cases, the diagnosis was established an­te­na­tally, during the ultrasound examination from the se­cond trimester, between 24 and 28 weeks of gestation. One of the most important and severe complications is re­pre­sen­ted by the umbilical cord entanglement (60%). The age of gestation at the moment of delivery varied between 24 and 37 weeks, with the majority being over 32 weeks. The chosen method of delivery, in the majority of cases, was by caesarean section. There are established risk factors for the eventuality of a septostomy; also, the ultrasound elements that can facilitate the diagnostic, maintaining the necessity of an anatomopathological confirmation. Conclusions. Du­ring the monochorionic diamniotic pregnancy, the spon­ta­neous rupture of the dividing membrane is an extremely rare event, with a high difficulty of diagnosis antenatally. Once the diagnostic was established, the pregnancy should be­ne­fit from a management similar to that of mo­no­cho­rio­nic pregnancy.

Introduction. Ovarian endometrioma is a common ma­ni­fes­ta­tion of endometriosis, and it is associated with infertility. Two main surgical treatments have been de­scribed: complete laparoscopic excision and conservative tech­niques. These methods are substantially different re­gar­ding their efficacy and the risk of afflicting the ovarian re­serve, therefore their impact on fertility requires a critical as­ses­sment. Objective. The aim of the study was to com­pare the effects of major surgical methods on fertility in wo­men diagnosed with ovarian endometrioma. Materials and method. A systematic literature review, from 2019 to 2024, was performed, using PubMed, MEDLINE, Scopus, Coch­rane, and Google Scholar databases, using keywords such as “ovarian endometrioma”, “surgical treatment”, “fertility” and “ovarian reserve”. Thirty-eight original studies, twelve meta-analyses and seven review articles were in­clu­ded. The parameters evaluated were the recurrence rate, the anti-Müllerian hormone level and the spontaneous preg­nancy rate. Chi-square test and Cox proportional ha­zard analysis were the statistical tests applied. Results. The com­plete laparoscopic excision significantly reduced the re­cur­rence rates compared to drainage or cyst wall ablation (12% versus 33%; p<0.01). However, this procedure caused a more pronounced decrease of ovarian reserve, measured by anti-Müllerian hormone (AMH), with a mean reduction of 35% compared to 12% after conservative methods (p<0.05). The spontaneous pregnancy rate after excision was approximately 50%, higher than the 27% rate observed with conservative techniques (p<0.05). Conclusions. The com­plete laparoscopic excision of ovarian endometrioma pro­vi­ded a superior disease control and higher spontaneous preg­nancy rates compared to conservative methods. How­ever, the fertility benefit must be balanced against the risk of re­duced ovarian reserve. The choice of the surgical method should be individualized, considering age, cyst size and the re­pro­duc­tive desire.

A hemostatic condition known as Von Willebrand disease (VWD) is defined by a quantitative or qualitative deficit of the Von Willebrand factor (VWF). Both men and women are equally impacted. With a mean diagnostic age of 19 years old, this illness presents with more severe clinical signs in females of reproductive age. Von Willebrand disease in­crea­ses the chance of postpartum hemorrhage and its as­so­cia­ted complications from transfusion support and mul­ti­organ injury from tissue hypoperfusion in pregnant pa­tients. These factors increase the risk of complications du­ring labor or the postpartum period. We describe the case of a 35-year-old primigravida woman who had Von Wille­brand disease diagnosed before she became pregnant. While not administered, the institutional procedure for ad­dres­sing this condition included obtaining and being ready for the administration of Von Willebrand factor and fac­tor VIII (FVIII) throughout the postpartum period and cae­sa­rean birth. With an increase in Von Willebrand factor levels, this led to the successful management of prenatal and postpartum hemorrhage, preventing the need for blood trans­fu­sions and the subsequent hypoperfusion symp­toms. The importance of specialist therapy for Von Wille­brand disease during pregnancy and childbirth is shown by this instance, which also highlights the need of following in­sti­tu­tio­nal procedures, including certain he­mo­sta­tic agents. For the thorough care of females with this illness through­out the perinatal period, the cooperative ef­forts of a mul­ti­dis­ci­pli­nary team, comprising obstetricians, he­ma­to­lo­gists and other medical specialists, are essential.

Peripartum hysterectomy remains a rare but critical sur­gi­cal procedure, typically performed in the context of se­vere obstetric hemorrhage unresponsive to conservative ma­nage­ment. This retrospective case series analyzes 15 pe­ri­par­tum hysterectomies performed over a 17-month pe­riod (January 2024 – May 2025) in a high-volume ter­tiary referral center. The overall incidence was 0.68%, with the most frequent indication being placenta praevia with or without abnormal placental adherence, followed by uterine atony, placental abruption, and one case of se­vere sepsis. The median maternal age was 32 years old, and caesarean delivery was the mode of birth in 14 out of 15 cases. Blood loss ranged from 2000 to 3800 mL, with variable transfusion requirements. Intensive care unit (ICU) admission was required in over 70% of patients, and hospital stays ranged between five and 28 days, with a median of 10 days. Despite the severity of the clinical scenarios, maternal sur­vi­val was 100%. These findings emphasize the need for early diagnosis, coordinated multidisciplinary care and in­sti­tu­tio­nal preparedness in managing patients at high risk for pe­ri­partum hysterectomy.

Uterine torsion is a rare and difficult condition that is most commonly encountered in pregnant women, but it can also affect non-pregnant patients. We report a case of ute­rine torsion accompanied by bilateral ovarian torsion, as­so­cia­ted with a large pedunculated subserosal fibroid, in a non-gravid patient who had previously undergone caesarean section following an in vitro fertilization (IVF) procedure. The patient complained of acute pelvic-ab­do­mi­nal pain, vomiting and lower back pain, which worsened over the course of one week. Diagnostic imaging, including contrast-en­hanced CT and ultrasound, revealed a giant cystic pelvic mass with vascularization, which initially suggested an ovarian origin. However, urgent laparotomy revealed a 25-cm fibroid with extensive necrosis and torsion. A total hysterectomy with bilateral adnexectomy was performed. The histopathological analysis confirmed a pedunculated subserosal uterine leiomyoma with ischemic necrosis and cystic transformation. Postoperatively, the patient recovered well, and she was discharged after four days. This case high­lights the importance of considering uterine torsion in the differential diagnosis of pelvic masses, particularly when associated with large fibroids.

Background. Preeclampsia, whether de novo or super­im­posed on chronic hypertension, is a major contributor to ma­ter­nal and perinatal morbidity and mortality world­wide. It affects approximately 5% of pregnancies, being closely as­so­cia­ted with fetal growth restriction (FGR), par­ti­cu­larly in early-onset cases. Early identification of high-risk fac­tors and timely intervention remain essential to improve out­comes. Case presentation. We report the case of a preg­nant patient with a history of severe pre­eclamp­sia and FGR in a previous pregnancy, requiring pre­term de­li­very at 27 weeks. In the current pregnancy, early-on­set FGR was diag­nosed at 26 weeks, despite ade­quate an­ti­hyper­ten­sive therapy. The patient was enrolled in a tele­mo­ni­to­­ring pro­gram (Heart4Mom®) from the first tri­mes­ter, ena­bling con­ti­nuous remote blood pressure sur­veil­lance. A hyper­ten­sive crisis (systolic BP ≥ 200 mmHg) was promptly detected through the app, prompting emergency re­fer­ral. Subsequent fetal Doppler evaluation revealed re­versed a-wave in the duc­tus venosus and reduced fetal move­ments, leading to ur­gent delivery. Management and outcomes. The case was managed in accordance with the Romanian Society of Obstetrics and Gynecology and the NICE guidelines. The integration of digital health tools facilitated real-time data collection, early diagnosis, multidisciplinary care, and post­par­tum psychological follow-up. This case is notable for de­mon­stra­ting the successful clinical management of early-on­set preeclampsia without maternal or fetal mortality – an out­come rarely reported in literature, especially in ca­ses diag­nosed prior to 26 weeks. Conclusions. This case high­lights the critical role of telemonitoring platforms, such as Heart4Mom®, in managing high-risk pregnancies. Re­mote sur­veil­lance enables the early detection of clinical de­te­rio­ra­tion, timely therapeutic intervention, and personalized care plan­ning. Future prospective studies are needed to validate these findings and to further integrate digital tools into stan­dard obstetric protocols for hypertensive disorders.