Botulinum toxins (BoNTs) are produced by several anaerobic species of the genus Clostridium and, although they were originally considered lethal toxins, today they find their usefulness in the treatment of a wide range of pathologies in various medical specialties. Botulinum neurotoxin has been identified in seven different isoforms (BoNT-A, BoNT-B, BoNT-C, BoNT-D, BoNT-E, BoNT-F, and BoNT-G). Neurotoxigenic Clostridia can produce more than 40 different BoNT subtypes and, recently, a new BoNT serotype (BoNT-X) has been reported in some studies. BoNT-X has not been shown to actually be an active neurotoxin despite its catalytically active LC, so it should be described as a putative eighth serotype. The mechanism of action of the serotypes is similar: they inhibit the release of acetylcholine from the nerve endings but their therapeutically potency varies. Botulinum toxin type A (BoNT-A) is the most studied serotype for therapeutic purposes. Regarding the gynecological pathology, a series of studies based on the efficiency of its use in the treatment of refractory myofascial pelvic pain, vaginism, dyspareunia, vulvodynia and overactive bladder or urinary incontinence have been reported. The current study is a review of the literature regarding the efficiency of BoNT-A in the gynecological pathology and on the long and short-term effects of its administration.

The cesarean section rate in Romania is among the top three in Europe and that it is among the top ranked in the world. Robson classification is a particularly useful tool for all factors involved in obstetrics. In our study, 840 cesarean births from 2018 were classified according to Robson Classification. Thus, the patients analyzed in the present study have in common an almost obvious trait: the indication for caesarean is, in mostly analyzed cases, not very clear. In fact, much of the cesareans studied are nothing but cesarean performed at the request of the patient. We believe that the urgent implementation of Robson Classification in maternity hospitals in Romania is not only necessary, but also extremely urgent, being a practical tool in determining the causes of certain obstetrical practices and customs.

Despite being rare, the incidence of pregnancy-related cancer is expected to rise as women continue to delay childbearing and give birth later in their reproductive years. In this broad category, tumors like breast cancer, dermatological neoplasia and cervical cancer are most common and tend to arise in women of childbearing age. All pregnant women with clinical and cytologic suspicion of cervical cancer, except for squamous atypia or low-grade squamous intraepithelial lesions, should undergo colposcopy, with or without biopsy, the latter being avoided if possible due to possible complications which, although rare, may involve preterm labor initiation.Some studies have attempted to assimilate comparable results of USG with MRI during the gestational period by determining the sensitivity, specificity, and accuracy of trans-rectal ultrasound (TRUS) in comparison to magnetic resonance imaging (MRI). In order to identify the proper way to diagnose and treat the disease, because of the complexity due to pregnancy, a multidisciplinary team consisting of a gynecologist, medical and surgical oncologist, and radiologist should be assembled. Both maternal and fetal wellbeing should be taken into consideration when the medical team must choose among termination of pregnancy, delay of maternal treatment, and iatrogenic preterm delivery. Psychological counseling also plays an important role and due to the sensitivity of the issue, should continue through gestation and the postpartum.In order to develop optimal guidelines for diagnosis, treatment, and outcome issues, large scale prospective studies are needed, but feasibility may be limited due to the scarcity of cervical cancer cases associated with pregnancy. Bălălău OD. et al. 25

We are constantly concerned about improving the diagnostic and treatment conditions we offer to our patients, and starting from the observation that the widespread use of Mepivastesin 30 mg / mL(Mepivacaine Hydrochloride) anesthesia in dental and even buccal-facial interventions has a real success and increased safety profile, inspired and encouraged by its use for the local anesthesia during diagnostic hysteroscopy, we started to use this anesthetic substance in gynecology, for the local anesthesia necessary for the electroresection of the benign and premalignant lesions of the cervix. Thus, data was collected, regarding 527 patients who received such local anesthesia between 2007 and 2017 (10 years) and worked out a study that demonstrated that the method can be used with relief and safety for this type of minimally invasive gynecological interventions.

A woman goes through many biological (hormonal, physical), psychological (emotional), and socio-cultural changes during pregnancy. Furthermore, changes also occur in the mother's familial and interpersonal world after childbirth. While some mothers have positive emotions at birth, such as joy and pleasure, others complain of negative experiences varying from sadness and depression to psychosis. Thus, the risk of depression is higher for women during the postpartum period, having a tendency to decrease in most cases over the first 2 weeks after delivery. Unfortunately, this favorable evolution does not happen in about 1 in 4-7 women, who develops postpartum depression. Postpartum depression has generally the same features as any common depressive episode encountered at any other time in life. However, assessment of depressive symptoms in the parental period implies not only general tools (such as the Depression Scale of the Center for Epidemiological Studies or the Beck Depression Inventory), but also a specific evaluation using the Edinburgh Postnatal Depression Scale. Taking into account all changes that occur during the peripartum period, a multimodal approach for postpartum depression would be recommended, including an appropriate lifestyle (walks, ambient environments), counseling, cognitive-behavioral therapy, and finally antidepressant medication when required. As a conclusion, postpartum depression may range from a mild and reversible episode to a severe and persistent form. Antepartum and postpartum screening, an early diagnosis, and a tailored approach to depression are essential for better results and prognosis related to both mother and child.