Immune tolerance at the feto-maternal interface is crucial for the growth of the semi-allograft fetus in the womb. The outcome of pregnancy is dependent on a fine balance between various immunological forces. For a long time, the potential role of the immune system in pregnancy disorders has remained enigmatic. Current evidence has revealed that natural killer (NK) cells are the predominant immune cell population in the uterine decidua. NK cells cooperate with T-cells to provide an optimal microenvironment for the growth of the developing fetus by producing cytokines, chemokines, and angiogenic factors. These factors support trophoblast migration and angiogenesis which regulates the process of placentation. NK cells differentiate between “self” and “non-self” through their surface receptors known as killer-cell immunoglobulin-like receptors (KIRs). They induce immune tolerance through communication via their KIR and fetal human leucocyte antigens (HLA). KIRs are surface receptors of NKs that comprise both activating and inhibiting receptors. Due to the wide diversity manifested by its genes, the KIR repertoire is different in each individual. Significant evidence has implicated KIRs in recurrent spontaneous abortion (RSA); however, maternal KIR gene diversity in RSA is still unclear. Research has shown that immunological aberrancies including activating KIRs, NK abnormalities, and T cell downregulation are risk factors for RSA. In this review, we discuss relevant data from experimental studies on NK cell abnormalities, KIR, and T-cells in the incidence of recurrent spontaneous abortion.

Polycystic ovary syndrome (PCOS) is a disorder with an unknown etiology that features a wide range of endocrine and metabolic abnormalities that hamper fertility. PCOS women experience difficulties getting pregnant, and if pregnant, they are prone to miscarriage, gestational diabetes, pregnancy-induced hypertension and preeclampsia, high fetal morbidity, and perinatal mortality. Insulin, the pancreatic hormone best known for its important role in glucose metabolism, has an underrated position in reproduction. PCOS women who have associated insulin resistance (with consequent hyperinsulinemia) have fertility issues and adverse pregnancy outcomes. Lowering the endogen insulin levels and insulin resistance appears to be a target to improve fertility and pregnancy outcomes in those women. Berberine is an alkaloid with a high concentration in various medicinal herbs that exhibits a hypoglycaemic effect alongside a broad range of other therapeutic activities. Its medical benefits may stand up for treating different conditions, including diabetes mellitus. So far, a small number of pharmacological/clinical trials available in the English language draw attention towards the good results of berberine’s use in PCOS women with insulin resistance for improving fertility and pregnancy outcomes. Our study aims to uncover how berberine can counteract the negative effect of insulin resistance in PCOS women and improve fertility and pregnancy outcomes.

SARS-CoV-2 infection in pregnant women is of growing interest due to controversy over the use of antiplatelet and/or anticoagulant drugs during pregnancy and postpartum. Pregnant women are susceptible to develop severe forms of viral infections due to pregnancy-related immune alterations, changes in lung functions, and hypercoagulability. The association of pregnancy with SARS-CoV-2 infection can cause an increased incidence of thrombotic complications, especially in the case of patients with some genetic variants that favor inflammation and thrombosis. Compared to the general population, pregnant women may be at increased risk of thrombotic complications related to COVID-19. The lack of extensive clinical trials on thromboprophylaxis and extrapolating data from non-pregnant patients lead to major discrepancies in treating pregnant women with COVID-19. Currently, a multidisciplinary team should determine the dose and duration of prophylactic anticoagulant therapy for these patients, depending on the disease severity, the course of pregnancy, and the estimated due date. This narrative review aims to evaluate the protective effect of thromboprophylaxis in pregnant women with COVID-19. It is unknown at this time whether antiplatelet or anticoagulant therapy initiated at the beginning of pregnancy for various diseases (preeclampsia, intrauterine growth restriction, thrombophilia) offers a degree of protection. The optimal scheme for thromboprophylaxis in pregnant women with COVID-19 must be carefully established through an individualized decision concerning gestational age and the severity of the infection.

The objective of this review was to bring to attention cytomegalovirus (CMV) infection during pregnancy, taking into consideration all relevant aspects, such as maternal diagnosis, fetal infection and prevention, prenatal diagnosis, and postnatal prognosis. A literature review was performed regarding adult and congenital infection. General information regarding this viral infection and potential related medical conditions was provided, considering the issues of maternal infection during pregnancy, transmission to the fetus, and associated congenital infection management. Prenatal diagnosis includes maternal serum testing and the confirmation of the infection in amniotic fluid or fetal blood. Additionally, prenatal diagnosis requires imaging techniques, ultrasound, and complementary magnetic resonance to assess cortical and extracortical anomalies. Imaging findings can predict both fetal involvement and the postnatal prognosis of the newborn, but they are difficult to assess, even for highly trained physicians. In regard to fetal sequelae, the early diagnosis of a potential fetal infection is crucial, and methods to decrease fetal involvement should be considered. Postnatal evaluation is also important, because many newborns may be asymptomatic and clinical anomalies can be diagnosed when sequelae are permanent.

Aim: The purpose of this article is to show the use and utility of mersilene tape in medical procedures, such as transabdominal cerclage (TAC). Material and methods: Based on their biomechanical properties, we present our experience with mersilene tape used as treatment for cervical incompetence. Cervical insufficiency or cervical incompetence is defined as asymptomatic cervical shortening and dilatation with the absence of detectable uterine contractions. The mechanical properties of cervical tissue are derived from its extracellular matrix and its most important constituent the fibrillar collagen, alongside other constituents such as proteoglycans, hyaluronic acid, elastin, and water. In the absence of the uterine contractions, the cervix is loaded by intrauterine pressure (including the weight of the growing fetus and amniotic sac), the gravity as well as passive pressure from the uterine wall. These forces also depend on the support action of pelvic floor structures and abdominal wall. The static load resulting from the combination of uterine growth, hydrostatic pressure and gravity seems to be the dominant determinants that cause cervical shortening. The placement of the mersilene tape acts as a barrier between the intrauterine pressure and the cervix. The main advantage of the TAC procedure is the placement of the nonabsorbable suture (mersilene tape at the level of the internal os, avoiding the placement of a vaginal foreign body and subsequently increasing the risk of ascending lower genital tract infection, decreased incidence of slippage, and the ability to leave the stitch in place between pregnancies. Results: The follow-up was without complications regarding the pregnancies treated with transabdominal cerclage. None of the pregnancies terminated prematurely as related to the presence of the tape, but it necessitates to be performed a caesarean section for delivery. Conclusions: Mersilene tape is safe and useful in different medical procedures, including transabdominal cerclage during pregnancy.

Malignant hematological conditions have recognized an increased incidence and require aggressive treatments. Targeted chemotherapy, accompanied or not by radiotherapy, raises the chance of defeating the disease, yet cancer protocols often associate long-term gonadal consequences, for instance, diminished or damaged ovarian reserve. The negative effect is directly proportional to the types, doses, time of administration of chemotherapy, and irradiation. Additionally, follicle damage depends on characteristics of the disease and patient, such as age, concomitant diseases, previous gynecological conditions, and ovarian reserve. Patients should be adequately informed when proceeding to gonadotoxic therapies; hence, fertility preservation should be eventually regarded as a first-intention procedure. This procedure is most beneficial when performed before the onset of cancer treatment, with the recommendation for embryos or oocytes’ cryopreservation. If not feasible or acceptable, several options can be available during or after the cancer treatment. Although not approved by medical practice, promising results after in vitro studies increase the chances of future patients to protect their fertility. This review aims to emphasize the mechanism of action and impact of chemotherapy, especially the one proven to be gonadotoxic, upon ovarian reserve and future fertility. Reduced fertility or infertility, as long-term consequences of chemotherapy and, particularly, following bone marrow transplantation, is often associated with a negative impact of recovery, social and personal life, as well as highly decreased quality of life.

Many women spend a third of their lives in postmenopause, and it’s a given that sexual life must go on after menopause since its benefits were vastly proven. A number of factors influence sexuality in postmenopause: the age at which menopause sets in, how menopause sets in, physical and mental state, quality of sexual life in perimenopause and the quality and duration of the relationship with the partner. The hypoestrogenism that characterizes menopause leads to a decrease in libido, to changes in the genital apparatus (vaginal atrophy, dyspareunia) or other changes (hot flushes, impaired urination, depression), which negatively affect sexual health. Assessing sexual dysfunction is not easy. The interplay between the types of factors that predispose, precipitate and maintain sexual dysfunction requires preparation on the part of the clinician in identifying the elements of interest and indicating appropriate therapy. Research on the quantification of sexual dysfunction in women has led to the development of various scales or questionnaires to assess the impact of menopausal-related changes on sexual function and quality of intimate life. The ultimate goal of the clinician is to find an optimal method of treatment that will improve the condition and enhance the quality of sexual life. The available knowledge about menopausal sexuality may still be the tip of the iceberg in both medical practice and society and further research and information campaigns are greatly needed.

Peripheral nerve injuries in the mother and newborn during delivery represent two obstetrical challenges, for which we try to find the best results both from the point of view of diagnosis and therapeutic strategy. The mother’s lesions can be due to obstetric trauma and neuraxial anesthesia, while fetal injuries are mainly caused by obstetric trauma due to instrumental vaginal delivery but also secondary to abnormal presentations, macrosomia, and deficiencies regarding perinatal monitoring during spontaneous vaginal birth. In most cases, these lesions resolve spontaneously, or if they persist, conservative treatment or surgical correction is necessary. Peripheral nerve injuries in the mother and the newborn continue to remain a challenge addressed to obstetricians and neonatologists, as in-depth, randomized studies are needed to develop clinical guidelines that can be applied.