Introduction. Micronutrient deficiencies during pregnancy remain a major global public health concern, with implications for maternal health, fetal development, and long-term child outcomes. International organizations such as the WHO and FIGO have issued evidence-based guidelines on micronutrient supplementation, which are increasingly being adapted into national protocols. Material and methods. This narrative review was based on literature searches in PubMed, Scopus, Web of Science, and Google Scholar, covering January 2000 to May 2025. Peer-reviewed studies, systematic reviews, and clinical guidelines from WHO, FIGO, and the Moldovan Ministry of Health were included. The review focused on iron, folic acid, iodine, calcium, vitamin D, and selected trace elements. Results. Iron and folic acid emerged as the most consistently recommended supplements across guidelines, with proven efficacy in reducing maternal anemia and neural tube defects. Iodine and calcium are also emphasized, particularly in regions with documented dietary insufficiency. Moldova's antenatal care protocol largely aligns with WHO and FIGO recommendations, prioritizing targeted over universal supplementation for nutrients beyond iron and folate. Evidence on routine supplementation with multivitamin complexes remains inconclusive. Conclusions. Evidence-based micronutrient supplementation is essential to optimizing pregnancy outcomes. Universal iron and folic acid supplementation remain the cornerstone of antenatal nutrition strategies. Context-specific approaches, as exemplified by the Moldovan model, can enhance implementation in resource-limited settings.

The traditional World Health Organization (WHO) partograph has been used globally for decades as a standard tool for intrapartum labor monitoring. However, accumulating evidence has challenged its underlying assumptions, particularly the use of rigid cervical dilatation thresholds, and highlighted the need for a more individualized and woman-centered approach to childbirth care. In response, the WHO introduced the Labor Care Guide (LCG) in 2020, aligned with the 2018 WHO recommendations on intrapartum care for a positive childbirth experience. This narrative review aims to examine the scientific rationale, global implementation experience, and policy implications of the WHO LCG, with a particular focus on its relevance and application in the Republic of Moldova. A narrative review of peer-reviewed literature, WHO normative documents, International Federation of Gynecology and Obstetrics position statements, and international implementation studies was conducted. National policy documents and clinical guidelines from the Republic of Moldova were analyzed to contextualize local adoption. International evidence demonstrates that the WHO LCG supports individualized labor monitoring, reduces unnecessary obstetric interventions, and promotes respectful, woman-centered care without compromising maternal or neonatal safety. In 2025, the Republic of Moldova approved a new national guideline on intrapartum care, aligned with WHO principles and the conceptual framework of the LCG. This policy shift reflects a strategic effort to improve the quality of intrapartum care and address ongoing challenges in maternal health outcomes.The transition from the classical WHO partograph to the principles underpinning the WHO LCG represents a significant evolution in intrapartum care. The Republic of Moldova’s experience illustrates how countries with a long tradition of structured labor monitoring can adopt WHO-aligned, woman-centered approaches through national policy reform. Ongoing evaluation of implementation, including assessment of healthcare providers’ preparedness and perceptions, will be essential to ensure sustainable integration and to maximize potential benefits for maternal and neonatal health.

Intrahepatic cholestasis of pregnancy (ICP) is a liver condition that may impact both mother and fetus, including preterm birth and hemorrhage. Vitamin K, a fat-soluble vitamin essential for coagulation, may be deficient in ICP due to impaired bile flow, raising hemorrhage risk. The study aimed to analyze Vitamin K1, K2 MK4, and K2 MK7 levels in pregnant women with ICP and determine associations between Vitamin K deficiency and postpartum hemorrhage. This prospective cohort study included 44 pregnant women with ICP (L1) and 44 controls (L0). Serum Vitamin K levels, using high-performance liquid chromatography, and blood loss during delivery were assessed. Statistical analyses included t-tests and chi-square tests, with significance at p < 0.05. Study registration number ISRCTN21187408 https://www.isrctn.com/ISRCTN21187408 Registration date 03/06/2020. Women with ICP exhibited significantly lower mean levels of Vitamin K1 (0.15 ± 0.17 µg/L in L1 vs. 0.29 ± 0.30 µg/L in L0, p = 0.0085) and Vitamin K2 MK7 (0.17 ± 0.13 µg/L in L1 vs. 0.26 ± 0.14 µg/L in L0, p = 0.0024) compared to controls. Vitamin K1 deficiency was observed in 52.3

Introduction. Intrahepatic cholestasis of pregnancy (ICP) is a liver pathology that has negative impact on progression of pregnancy and childbirth in affected women. This study aims to assess the clinical characteristics of pregnancy and delivery among women diagnosed with intrahepatic cholestasis of pregnancy. Material and methods. The study was conducted as a prospective cohort study involving 142 clinical cases, divided into two groups according to the complication of pregnancy with cholestasis gravidarum. Evaluation of pregnancy and childbirth clinical aspects was performed alongside an examination of medical records. Statistical data were processed using IBM Statistics SPSS 21, MedCalc and GraphPad software. Results. It was determined that every fourth pregnant woman diagnosed with intrahepatic cholestasis of pregnancy also presented with hyperemesis gravidarum during the current pregnancy. Additionally, an elevated prevalence of iron deficiency anemia and gestational diabetes mellitus was detected among pregnant women with this condition. Meconium staining of the amniotic fluid complicated approximately one in every four pregnancies in women with intrahepatic cholestasis gravidarum. Conclusions. The study findings indicate a notable increase in hepato-biliary conditions and nephrourinary pathology among women with ICP. Hence, a high incidence of hyperemesis gravidarum, along with an elevated frequency of iron deficiency anemia and gestational diabetes mellitus, was found in women with this condition.

BACKGROUND: Intrahepatic cholestasis of pregnancy is a pregnancy-related liver condition that is characterized by elevated liver function tests and/or bile acids in the presence of pruritis. OBJECTIVE: The study aimed to assess the aspartate aminotransferase to Platelet Ratio Index and Fibrosis-4 Index scores in intrahepatic cholestasis of pregnancy. STUDY DESIGN: The prospective study was carried out by assessing 142 women: 71 whose pregnancies were complicated by intrahepatic cholestasis of pregnancy and 71 without intrahepatic cholestasis of pregnancy. The Fibrosis-4 Index score and aspartate aminotransferase to Platelet Ratio Index were assessed. RESULTS: Our findings indicate that both aspartate aminotransferase to Platelet Ratio Index and Fibrosis-4 Index scores were reliable indicators of intrahepatic cholestasis of pregnancy, correlating with important complications of the condition. CONCLUSION: This study provides valuable information to help clinicians better diagnose and perform the management of intrahepatic cholestasis of pregnancy.

Background Induction of labor is performed for either maternal or fetal indications to reduce perinatal morbidity and mortality without increasing maternal morbidity. The aim of this study was to review the scientific literature regarding induction of labor in patients with full-term pregnancy and create a systematic review of the literature to answer the question: “In patients with full-term gestation - does combining the Foley balloon with dinoprostone for the artificial induction of labor - offer better perinatal results over time from the application of the labor induction method until birth?”. Methods A literature search was performed on 23/08/2023 in the PubMed database; only articles published within the past 5 years were considered. We included articles in which labor was triggered with a vaginal device with dinoprostone, oxytocin, and/or a Foley catheter in full-term patients who met the following criteria: monofetal pregnancy, cranial presentation, intact membranes, and no history of uterine scar. We used the keywords “induction,” “labour,” “term,” “Foley,” “dinoproston,” “oxytocin.” Results The Pubmed database currently has approximately 20,000 scientific papers about labor induction. Only two studies met the proposed criteria. Considering the small volume of eligible data for the proposed research, the main meta-analysis addressing the topic was also considered. Conclusions The use of dinoprostone and oxytocin infusion is effective for triggering labor under conditions of compliance with obstetrical indications and pharmacological characteristics. Studies that compare the success of artificial induction of labor with Foley balloon and Foley+dinoprostone in patients with full term gestation are limited, but nevertheless, the association of Foley balloon with artificial induction with dinoprostone seems to be a cost-effective method. The limited number of scientific studies on this topic determines a risk of bias, inconsistency and imprecision, and for the future, we propose to carry out a randomized prospective study to study the topic.

Introduction. Intrahepatic cholestasis of pregnancy is a liver disease, the diagnosis of which is based on the assessment of serum bile acid levels and liver function tests. The study aimed to assess liver function test values in women with intrahepatic cholestasis of pregnancy. Materials and methods. The study was based on a prospective cohort study of 142 clinical cases, divided into two groups according to the complication of pregnancy with cholestasis gravidarum. The research was carried out by assessing the level of liver function tests as well as by studying medical documentation. Statistical data were processed using IBM Statistics SPSS 21, MedCalc and GraphPad software. To assess sensitivity and specificity in examining model efficiency, the ROC curve was used. Results. Increased ALT and AST values were found in women with intrahepatic cholestasis of pregnancy. Alkaline phosphatase and γ-glutamyltransferase values were increased in an insignificant number of pregnant women with cholestasis gravidarum. Based on ROC curves, the sensitivity of ALT indicator in diagnosis of intrahepatic cholestasis of pregnancy was 81.7%, specificity - 81.7%; for AST the sensitivity of the indicator was 80.3%, specificity - 81.7%. Conclusions. In the study it was demonstrated significant increase of ALT and AST values in women with cholestasis gravidarum, as well as high sensitivity and specificity of these indicators in the diagnosis of intrahepatic cholestasis of pregnancy.

Introduction. Hematological inflammatory markers may be promising diagnostic markers for assessing the severity of intrahepatic cholestasis of pregnancy. The aim of the study was to evaluate and compare the levels of hematological inflammatory markers in intrahepatic cholestasis of pregnancy. Material and methods. A prospective cohort study of 142 clinical cases, divided into two groups depending on the presence of cholestasis gravidarum, was carried out. The research was conducted by assessing the level of bile acids and hematological inflammatory markers in the mother’s blood, as well as by studying medical records. The IBM Statistics SPSS 21 program was used to process the statistical data. To compare categorical variables, the χ² without the Yates’ continuity correction test was applied. Results. There was an increase in platelet-to-lymphocyte ratio in pregnant women with intrahepatic cholestasis of pregnancy compared to the control group (146.0±6.8 versus 135.2±7.3, respectively). The values of neutrophil-to-lymphocyte ratio and the average volume of platelets were similar in both groups. At the same time, the study found a decrease in the values of erythrocyte distribution among women whose pregnancy was complicated by cholestasis gravidarum. Conclusions. The study showed a significant increase in platelet-to-lymphocyte ratio in women whose pregnancy was complicated by cholestasis gravidarum, as well as an increase in this indicator with increasing levels of bile acids. Thus, this ratio may be a promising diagnostic marker in assessing the severity of intrahepatic cholestasis of pregnancy.

Introduction. Abnormal placentation is a challenge of diagnostic and treatment for all perinatal health professionals. The most important risk factors for the development of pathological placental invasion have been identified as birth by previous cesarean section, placenta praevia and advanced maternal age. Antenatal diagnosis can reduce morbidity and mortality; it is usually determined by grayscale ultrasound and confirmed by nuclear magnetic resonance, which can better delimit the degree of placental invasion. The management of pathological placental invasion is one complex and multidisciplinary, because abnormal placentation is associated with significant maternal morbidity and mortality. Objective: to present a literature review on the topic of abnormal placentation based on international studies. Methods and materials: research in international databases by applying in the MedLine search systems, Web of Science keywords – abnormal placentation, cesarean section, placenta accreta, placenta previa, hysterectomy. Results. With the identification of risk factors and the possibilities of obstetric ultrasonography, many cases of placenta accreta are diagnosed prenatally. However, not all patients have access to ultrasound, skilled ultrasound or experienced radiologists or obstetricians who can make these prenatal diagnoses. Due to these limitations, cases of abnormal placenta can only be encountered at birth. Therefore, it is important for all obstetricians to be familiar with the epidemiology, risk factors, diagnosis and management of these potentially very morbid and fatal pathologies of abnormal placentation.

Neonatal hemorrhagic syndrome, which affects several principal organs during the early neonatal period, denotes a deficiency of vitamin K and coagulation factors.

Введение. Патологическая плацентация – это проблема диагностики и лечения для специалистов в области перинатального здравоохранения. Наиболее важными факторами риска развития патологической инвазии плаценты являются роды после предыдущего кесарева сечения, предложение плаценты и возраст матери. Антенатальная диагностика может снизить заболеваемость и смертность; патология выявляется с помощью ультразвука в оттенках серого и подтверждается ядерным магнитным резонансом, который может лучше определить степень проникновения плаценты. Лечение патологической инвазии плаценты является многопрофильным комплексом, поскольку патология плаценты связана со значительной материнской заболеваемостью и смертностью. Цель: представить обзор литературы по теме патологической плацентации на основе международных публикаций. Методы и материалы: исследования в международных базах данных с использованием поисковых систем Medline, PubMed. Результаты. Благодаря выявлению факторов риска и возможности акушерского ультразвукового исследования многие случаи приросшей плаценты диагностируются пренатально. Однако не все пациенты имеют доступ к УЗИ, квалифицированным ультразвуковым сканерам или опытным радиологам или акушерам, которые могут поставить этот пренатальный диагноз. Из-за этих ограничений случаи аномальной плаценты могут встречаться только при рождении ребенка. Поэтому важно, чтобы все акушеры были ознакомлены с эпидемиологией, факторами риска, диагностикой и лечением этих потенциально очень морбидных и фатальных патологий аномальной плацентации.

Intrahepatic cholestasis of pregnancy is pregnancy-specific liver disorder, characterized by pruritus as the main clinical symptom, and fasting liver function tests. The term thrombophilia is used to describe a group of conditions characterized by blood coagulation disorder with increased risk of blood clot formation, which may be congenital or acquired. In general, population the incidence of thrombophilia and intrahepatic cholestasis of pregnancy varies widely, depending on the type of disorder (in case of congenital thrombophilia) and geographical distribution (in case of intrahepatic cholestasis of pregnancy). A high incidence of pregnancy complications makes both congenital thrombophilia and intrahepatic cholestasis of pregnancy very important in clinical practice. At the same time, association between these two disorders is extremely complicated in management, due to perinatal risks. The key-point for the management is cooperation among obstetricians, hematologists, and hepatologists, being crucial for better outcomes.

Intrahepatic cholestasis of pregnancy is a disorder characterized by pruritus and elevated liver function tests and bile acids. Poor vitamin absorption and, as a result, hypovitaminosis K can occur as a result of the pathology. Given the known effects of vitamin K, the authors considered that hypovitaminosis K could increase the risk of coagulopathic hemorrhage in pregnant women. The study revealed that 59.2% of women with intrahepatic cholestasis of pregnancy were diagnosed with hypovitaminosis K; however, 98.6% of women had normal coagulogram indices. Thus, coagulogram markers are more likely to indicate vitamin K activity than its actual level.

Introduction. Intrahepatic cholestasis of pregnancy (ICP) is a disorder characterized by pruritus and elevated liver function tests and is associated with a high incidence of adverse perinatal outcomes. Multi-disciplinary cooperation is critical for managing the condition and ensuring better pregnancy outcomes. The objective of the study was to assess the clinical symptoms and intensity of cutaneous pruritus in women with intrahepatic cholestasis of pregnancy. Material and methods. The study group included 71 women with ICP. The patients were asked about their symptoms and intensity of itching. The intensity of cutaneous pruritus was assessed according to two scales. SPSS 21 software was used to conduct the statistical analysis. Results. On the onset of symptoms women had indicate the intensity of itching at 5.1±2.3 points on average, according to visual analog scale. 53.5% women indicated the symptom to be occasional or discontinuous. By the moment of the survey, 66.2% women indicated the intensity of the pruritus more or equal to 8 points, being continuous in 52.1% of cases. In the post-partum period, the intensity of the pruritus decreased, being assessed on the third day after delivery as less or equal with 5 points in 93.1% of cases, being occasional or discontinuous in 90.1% of cases. Conclusions. Pruritus is the most prevalent clinical sign of ICP and it should not be ignored, being considered as a call for follow-up.

Intrahepatic cholestasis of pregnancy is a disorder, characterized by pruritus and elevated liver function tests. Associated with a high incidence of adverse perinatal outcomes, intrahepatic cholestasis of pregnancy (ICP) requires thorough attention in clinical practice. In addition, there is a high rate of stillbirth in cases of ICP. Women with ICP should be informed of the inability to predict stillbirth. Multi-disciplinary cooperation is critical for managing the condition and ensuring better pregnancy outcomes.

Micronutrients are indispensable substances for ensuring proper metabolism, which, in the case of pregnant women, has an indirect influence on perinatal outcomes. Hypovitaminosis K is a rare condition in adults. However, vitamin K deficiency can pose a significant risk to the health of both mother and fetus, which can cause bleeding, especially in newborns. Newborns have a low natural level of vitamin K because they do not receive the necessary amounts in the antenatal period, which is caused by the slower transfer of this vitamin through the placenta. The use of drugs that affect the metabolism of vitamin K by pregnant women can increase the rate of various complications in newborns, related to hypovitaminosis K. Micronutrients, especially vitamin K, are essential for the body of pregnant women, being crucial in fetal development.

Lucrarea abordează o perioadă de 10 ani din punct de vedere al evoluției numărului și procentului de operații cezariene din totalul nașterilor și a impactului acestora asupra rezultatelor perinatale. Rezultatele studiului au demonstrat cu certitudine că lărgirea indicațiilor către nașteri abdominale cu sporirea incidenței acestora contribuie la îmbunătățirea indicatorilor mortalității perinatale

The paper addresses a period of 10 years in terms of the evolution of the number and percentage of cesarean operations in total births and their impact on perinatal outcomes. The results of the study showed with certainty that the widening of indications for abdominal births with increasing their incidence contributes to improving indicators of perinatal mortality.

Background: The results of the MICS study in the Republic of Moldova show that 7% of 15–19 year-old women have already started their sexual life, of which 5% have already given birth. Since the number of women using modern methods of contraception is suboptimal, unintended pregnancies remain a persistent problem in Moldova.Methods: We have conducted a hospital based study in the largest maternity in Moldova. Women who gave birth 24–72 hours before were included as study participants and were divided into two groups - group # 1, in which the pregnancy was unplanned but was accepted psychologically and women gave birth and group # 2 which covered the women who consciously did not use contraception because they were planning a pregnancy.Results: The results of the study showed that 50.6% of the respondents started their sexual life at the age of ≤ 18 but only 34.2% of the total number of these women started using a contraceptive method along with the onset of sexual life. The results of the study showed that only 54.4% of the pregnancies were planned. Besides the fact that 54.0 ± 2.9% of the women in the postpartum period were not planning a pregnancy, 10.4% of women would not use any contraceptive method after discharge from maternity. Thus, in the event of an unwanted pregnancy in the future − 17% of women will have an abortion done, and 82.6% of women will accept unwanted pregnancy and will give birth. The most frequently cited reasons for women not to use a contraceptive method when not planning pregnancy were: fear of side effects − 14.6%, insufficient knowledge of different methods of contraception − 5.8%, increased cost of contraception − 8.8%.Conclusions: The results of the study showed that only half of the pregnancies that ended up with delivery were planned, the other half occurring spontaneously, following the unuse of a contraceptive method.Trial registration number ISRCTN10397992Plain English summaryThe article presents data on the analysis about awareness, attitudes and use of contraception methods among 600 women who were admitted in the hospital where they gave birth 24-72 hours before. Women answered a list of questions about the contraception methods they know and used before this pregnancy, whether the pregnancy was intended or not, and perspective of using modern contraception methods after the current birth.Respondents started their sexual life at the age of ≤18 in a half of cases but only 1/3 of the total number of these women started using a contraceptive method along with the onset of sexual life. The results of the study showed that only 54.4% of the pregnancies were planned. Besides the fact that 54% of the women in the postpartum period were not planning a pregnancy in future, 10.4% of women responded that they would not use any contraceptive method after discharge from maternity. Thus, in the event of an unwanted pregnancy in the future - 17% of women will do an abortion, and 82.6% of women will accept unwanted pregnancy and will give birth. The most common contraceptive method used by the women before current pregnancy is the male condom, and 1/3 of the women will use it after giving birth, at the same time, some women plan to change the contraceptive method.Providing information for all ages groups: adolescents, young nuliparous women, and women that already have delivered is crucial for their sexual and reproductive health.

Maternal outcome of intrahepatic cholestasis of pregnancy (ICP) is usually benign, with postpartum pruritus resolving, but with a major predisposition to ante-, intra- and post-partum haemorrhage, as a main cause of maternal morbidity and mortality. Besides that, ICP is associated with increased fetal morbidity and mortality, especially preterm birth, respiratory distress and stillbirth. The main option of the management of intrahepatic cholestasis of pregnancy is to improve maternal symptoms, to normalize the biochemical markers and to reduce risks for the fetus. Ursodeoxycholic acid is the best therapeutic agent available, with proven efficacy in decrease skin pruritus and restoring abnormal levels of serum bile acids and functional tests of liver.