Key Clinical MessageIn the presence of megacystis in the second half of pregnancy, with increased amniotic fluid, especially in a female fetus, the most likely diagnostic result is megacystis, microcolon, intestinal hypoperistalsis syndrome, MMIHS. In these cases, the diagnosis of MMIHS should be strongly considered instead of lower urinary tract obstruction.

Acute intestinal obstruction in pregnancy is a rare, unusual, and very challenging non obstetric surgical pathology linked with great fetal-maternal morbidity and mortality. It is estimated that a surgeon may encounter and resolve 1 to 2 cases in his career. Bowel obstruction is difficult to diagnose because signs and symptoms such as pain, vomiting, abdominal distention, and constipation are frequently attributed to normal pregnancy. On the other hand, gravidity requires immediately, in case of suspicion of grave abdominal pathology, such as bowel obstruction, that surgery should not be delayed.

Fetomaternal hemorrhage is defined as transfer of fetal blood into placental circulation and therefore into maternal circulation during pregnancy, and represents an important contributor to intrauterine fetal demise and neonatal death. The condition is rarely diagnosed prenatally because clinical findings are often nonspecific, and it is unpredictable. In this paper we present an illustrative case of massive spontaneous fetomaternal hemorrhage where the diagnosis was highly suspected antenatally based on maternal reported reduced fetal movements, abnormal suggestive cardiotocographic trace, and increased peak systolic velocity in the fetal middle cerebral artery. We discuss obstetrical and neonatal management and review the current knowledge in the literature. Maintaining a high index of suspicion for this condition allows the obstetrician to plan for adequate diagnostic tests, arrange intrauterine treatment or delivery, and prepare the neonatal team.

Obiective. În acest studiu, am investigat dacă măsurătorile NIRS înainte şi după transfuziile de concentrat eritrocitar pot răspunde la întrebarea: a reprezentat transfuzia un beneficiu? Pot fi utile măsurătorile derivate din NIRS în identificarea unor criterii mai obiective pentru ghidurile de transfuzie? Material şi metodă. Studiu prospectiv, observaţional ce s-a derulat în perioada iulie 2017 – martie 2018 într-un centru terţiar de terapie intensivă . A înrolat 44 de prematuri cu greutatea ≤1.250 g şi vârstă gestaţională ≤30 săptămâni, care au fost randomizaţi în funcţie de transfuzia de CE în grup transfuzat (n = 29) şi grup netransfuzat (n = 15). Prematurii care au necesitat transfuzie au fost monitorizaţi NIRS, pretransfuzional (monitorizare continuă 24 de ore), în timpul transfuziei, şi 24 de ore după transfuzie. Pacienţii netransfuzaţi au fost de asemenea monitorizaţi cu pulsoximetrie regională cerebrală la o vârstă postnatală şi în condiţii clinice asemănătoare grupului transfuzat. Rezultate. Valorile oximetriei cerebrale şi sistemice au avut valori comparabile la cele cele două grupuri atunci când s-au comparat rezultatele dinaintea transfuziei.Legat de efectul transfuzional se observă o creştere semnificativă a oxigenării tisulare cerebrale (CrSO2) chiar în timpul transfuziei, efect ce se menţine timp de 24 de ore: medie CrSO2 80±2, p value 0,019. De asemenea valorile fracţiei de extracţie a oxigenului tisular cerebral încep să scadă în timpul transfuziei, şi se menţin scăzute şi în următoarele 24 de ore 0,22±0,05 vs 0,15±0,02 – p value <0,013. Concluzii. Transfuzia de CE la prematurii cu greutate foarte mică stabili clinic are ca rezultat creşterea tranzitorie a CrSO2 şi scăderea tranzitorie a FTOE. Putem folosi fracţia de eliberare a oxigenului tisular - FTOE - ca indicator al nevoii de transfuzie alături de valoarea hematocritului şi semnele clinice.

Spontaneous hemoperitoneum in pregnancy (SHP) is an uncommon, but very critical complication when present in pregnancy, leading to important morbidity and mortality for both mother and fetus. The etiology includes a large spectrum of causes, not taking into consideration trauma or other pathologies not pregnancy related. One of the most frequent triggers is the rupture of the varicose veins around the uterus that can occur either spontaneously or during labor, that can be associated with the unfortunate event of delivery of a stillborn baby. Endometriosis has been suspected to be also implicated in the apparition of spontaneous hemoperitoneum in pregnant women due to the fragility of the tissues associated with endometriosis chronic inflammation (ruptured endometrioma, intraabdominal adhesions, decidualization at the site of endometriotic implants). Even the operative vaginal delivery can conduct to this complication, but the cases described in the literature were also associated with lesion of endometriosis at the bleeding site. Moreover, assisted reproductive procedures (IVF-ET) is incriminated as one of the possible etiologies. The improvements in the resuscitation, operative and anesthetic management of these cases have lowered the maternal mortality, but perinatal mortality still has a high value (31%). Symptoms as acute or subacute abdominal pain, that can be associated or not with hypovolemic shock and signs of fetal affliction, identified as heart decelerations, should raise a question mark regarding the possibility of a hemoperitoneum. Electronic research for subject related reviews and articles has been made, using PubMed, Medline, Cochrane Data Base and also the current international guidelines regarding the management of hemoperitoneum in pregnancy, recommended by Obstetrics and Gynecology Societies in United States and United Kingdom. Adequate case management as hematologic analysis, abdominal ultrasound, CT scan or MRI should reveal free intrabdominal fluid and estimate the blood loss, which can then be confirmed by paracentesis or by direct urgent laparotomy or laparoscopy. The aim of the current review is to raise awareness of this rare, but potentially fatal, complication in pregnancy and its most appropriate management, according to the current information presented in the medical literature.