We are reporting a case of a 36 year-old Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) positive hypertensive primigravida with postpartum uterine atony that required emergency subtotal hysterectomy at Saint John Hospital Bucur Maternity Bucharest. The maternity was designated as the Coronavirus Disease 2019 (COVID-19) Maternity for Bucharest and Ilfov County since March 2020. The patient was mildly symptomatic for SARS-CoV-2, infection confirmed with reverse transcription polymerase chain reaction (RT-PCR). The caesarean section was performed and a live male fetus was born, 2630 g and Apgar Score of 9 (the male fetus was negative for SARS-CoV-2). Postpartum hysterectomy with adnexal preservation was performed because of uterine atony. The postoperative evolution was favorable. The patient was discharged with her baby 10 days after birth. Given the limited resources, the placenta, the umbilical cord and the uterus were not tested for SARS-CoV-2. The pathology exam revealed that on the maternal side there were specific uterine atony lesions as well as endometrial and miometrial ischaemia. The placenta had nonspecific findings: chronic ischemic lesions with small villi, fibrin deposits in the materno-fetal interface. The peculiarity of the case is that we report the morphological findings of the placenta and uterus resulted from intrapartum uterine atonia in a patient with gestational arterial hypertension, premature birth and COVID-19. Further studies are required to characterize the pattern of such intricate conditions.

Progesterone is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. Its main functions are playing a key role in the development, differentiation, and normal functioning of female reproduction-related target tissues including the uterus (endometrium and myometrium), the ovary, and the mammary gland, as well as regulating the hypothalamic�pituitary�gonadal axis. Soon after the discovery of the progesterone receptor (PR) it was appreciated that the development of a PR antagonist would have a major therapeutic potential. Numerous related compounds have been synthesized exhibiting a spectrum of activity ranging from pure progesterone receptor antagonists (PA), to mixed agonists/antagonists. These latter compounds are also known as selective progesterone receptor modulators (SPRM), progesterone receptor modulators (PRM), mesoprogestins or partial agonist�antagonists. Ulipristal acetate is a SPRM used in Europe for preoperative treatment of moderate-to-severe symptoms of uterine leiomyomas in adult women of reproductive age. This is a retrospective cohort study conducted in two medical units, Saint John Hospital and Egometacs Clinic, between january 2017-december 2018, on women treated with UPA (ulipristal acetate) for symptomatic uterine fibroids, in order to evaluate if there were any liver function changes after the treatment. In the mentioned period, 74 women were treated with UPA for symptomatic uterine myomas in the two units. After checking the records, 6 women were lost on follow up (only the first visit was recorded), 4 didn�t complete the treatment course and 7 had incomplete laboratory evaluation, either at the beginning or at the end of treatment. Finally, our cohort was comprised of 57 women, aged between 20 and 50 years old, treated with UPA for various conditions (myomas, abnormal bleeding, pelvic pain etc.) during a period of 3 month�, and adherence to treatment was 100%. We performed a paired T-test on the before and after values of the AST, ALT, GGT enzymes and total bilirubin levels, for our statistical analysis we used SPPS 20, and the charts were built using Microsoft Excel. There were no significant statistical differences between the before and after values of the variables measured in our study. In our study the paired T-test determined that there were no statistical significant differences between the liver function after Esmya administration. Altough there was no evidence of hepatic impairment in the 3 months course of treatment, precautions as the one recomended by EMA, should be respected. Still, more studies are needed in order to rule out the potential harmful effect of UPA on the liver, taking into account detailed liver function evaluation and extended laboratory tests. Until then, the temporary safety measures issued by the European Medicines Agency, are to be respected. The measures include: no use of UPA for women with known liver conditions, careful monitoring of liver function monthly for the patients under treatment and at four weeks after, and immediate discontinuation and report of any adverse complaints.

Introduction: Abdominal anomalies that appear during intrauterine life are complex due to many organs that are affected. In cases, the ultrasound appearance is a cystic image with different content and the differential diagnosis is often difficult. Body-research methods: the organs affected by abdominal congenital anomalies involve the gastroin testinal tract (stomach, duodenum, small bowel or colon, and gall bladder), the kidney and urinary tract, the peritoneal cavity (ascites), suprarenal glands, and tumors of the reproductive system (especially the ovaries). In order to identify the affected structures, it is mandatory to know the normal aspect of the abdominal content at different gesta tional ages. The diagnosis may be very difficult, but its accuracy is important, considering the need of further counseling the couple. In minor conditions, without chromosomal anomalies or associations, the outcome is usually good, and there are even possibilities of in utero treatment. In severe conditions, with poor outcome, the couple can choose to terminate the pregnancy, after counseling is provided. Conclusion: abdominal congenital anomalies are common findings in ultrasound screenings for anomalies in all the trimes ters of pregnancy and their recognition is important for subsequent management.

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