Background: When a tumor of the umbilical cord is prenatally visualized, it is possible to propose the diagnosis depending on the sonographic appearance of the tumor. Angiomyxoma of the umbilical cord appears as a complex solid-cystic mass that is made of angiomatous component and myxoid stroma. When the tumor is diagnosed, serial ultrasound and doppler examinations are used to monitor the tumor’s size and the overall fetal well-being including doppler investigations and fetal growth. Angiomyxomas are not associated with fetal chromosomal pathologies. The cases of intrauterine rupture and fetal death was described in the literature. Case presentation: A 28 years-old pregnant woman was referred to our clinic for second opinion because of visualized umbilical cord tumor during second trimester ultrasound screening. The tumor gradually increased in size until 34th week of gestation, when the rupture of the cystic component was observed. The fetal doppler studies was normal during the course of pregnancy, we observed decreased AC and decreased estimated fetal weight. At the gestational age of the 37 weeks the labor was induced and heathy male infant was born. Conclusions: For the first time to our knowledge, we demonstrate the case of uncomplicated rupture of the cystic component of the angiomyxoma that lead to the possibility to manage the pregnancy conservatively without any compromise of the fetus.

A Caesarean scar pregnancy is challenging and difficult diagnosis that can cause such complications as uterine rupture, profuse haemorrhage and maternal death. There are many single reports in literature but only few case series. Nowadays, caesarean scar pregnancy is becoming more frequent, it is caused by an increasing number of operative deliveries. In this paper, 10 cases of caesarean scar pregnancy treated in the Gynecology Clinic of the Riga Eastern Clinical University Hospital over 6 years are analysed. One of 10 patients had no symptoms on the day of presentation, 4 patients had pain in their lower abdomen, 3 had spotting, 6 had vaginal bleeding, and 2 of them had bleeding after legal abortion. All patients had 1 or 2 caesarean section in their history. Gestational age of the pregnancy was estimated from 3 to 12 weeks by the last menstrual period. All 10 patients were treated surgically. One patient was treated with 75 mg Methotrexate p.o., 2 days course, but the therapy was unsuccessful. Nine of 10 patients had total or subtotal hysterectomy. In one case, excision of scar pregnancy was performed and uterus was preserved. The most common symptoms of caesarean scar pregnancy are pain in the lower abdomen, spotting and vaginal bleeding. The treatment depends on severity of symptoms, gestational age and surgical experience.

Background. Simulation as a proxy tool for conditional clinical training became a powerful technique for introducing trainees to the ultrasound imaging world, allowing them to become a trained sonographer taking into consideration different rates of progress completing a specific task against the time and ensuring the long-lasting maintenance of the obtaining practical skills. Adding a costly, but effective high-fidelity simulator to the residency program justified the expense, demonstrating efficiency of training for improving the clinical performance and confidence of trainees. Materials and methods. A pilot study in Riga Maternity Hospital within the framework of the study “Role of metabolome, biomarkers and ultrasound parameters in successful labour induction” (Fundamental and Applied Research Programme lzp-2021/1-0300) was performed between March 1st 2022 and 31st April 2022. A virtual-reality simulator (Scantrainer, MedaphorTM, Cardiff, UK) was used with the teaching module for assessment of the uterine cervix. Five trainees in obstetrics and two young specialists included in the study. None of them had Fetal Medicine Foundation certificate of competence in the assessment of the uterine cervical lenght before. The time used on the simulator, the number of simulations and a mean confidence in cervical length assessment before and after simulation were recorded. Results. The study on assesment of uterine cervical lenght demonstrated statistically significant increase in confidence (p=0.008) and statistically significant decrease in time needed to complete correctly the same tasks for the trainees (p=0.008) that shows a positive learning curve over the time of training on ScanTrainer, Medaphor. Conclusions. The simple task allows to become a certified specialist in uterine cervical assessment in the short period of time. That support the productiveness of the simulation-based education. The training program should be updated taking into consideration simulation curriculum.

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Objective: To compile existing knowledge on the level of cervical regeneration (detected by ultrasound) after loop electrosurgical excision procedure (LEEP) and to suggest research protocol for further studies. Methods: We conducted a literature search of Medline, Web of Science, Scopus, and Cochrane databases using the keywords “cervix” and “regeneration” without year restrictions. Our eligibility criteria included studies that analysed cervical volume and length regeneration using ultrasound. A literature review was conducted following PRISMA guidelines and registered in PROSPERO (reg. no. CRD42021264062). Information about the studies was extracted from each analysed study on an Excel datasheet and the average regeneration with standard deviation was calculated. All included studies’ possible biases were assessed by the National Institutes of Health’s (NIH) quality assessment tool. Results: The literature search identified 802 papers and four trials (n = 309) that met our criteria. They investigated cervical length and volume regeneration after LEEP using ultrasound, concluding that there is a profound regeneration deficit. Average cervical length regeneration after 6 months was 83.4% (±10.8%) and volume regeneration was 87.4% (±6.1%). All analysed studies had their biases; therefore, based on the conducted studies’ protocols, we present a CeVaLEP research protocol to guide high-quality studies. Conclusion: After LEEP, there is a cervical regeneration deficit. There is a lack of high-quality studies that assess cervical volume regeneration and its relation to obstetrical outcomes. There is a gap in the field and more research is needed to define the prenatal risks related to cervical regeneration.