This study aims to assess medication adherence levels and identify the factors associated with it, among pregnant women in the city of Varna, Bulgaria. A pilot, observational, cross-sectional study was conducted among pregnant women at the Ambulatory Medical Centre for Specialised Care “Prof. Dr. Dimitar Stamatov”, Varna, Bulgaria. Medication adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8). The study period was from 15 ^th July 2025 until 15 ^th October 2025. Overall, medication adherence was moderate, with a mean score of 5.92 (SD = 1.62), among the 50 pregnant women who participated in the study (mean age = 31.96; SD = 6.48). No significant associations were observed between adherence and age (r = 0.044, p = 0.760), educational level (t(48)= 0.445, p = 0.658), or trimester of pregnancy (t(48)= 0.901, p = 0.372). Adherence levels did not vary significantly across parity, although a slight, non-significant trend toward higher adherence was observed among multiparous women. Research on medication adherence during pregnancy is still limited, emphasizing the importance of further investigation to better understand adherence behaviours and their determinants in this vulnerable population.

BACKGROUND: Cervical gestations are rare potentially life-threatening conditions. Although these can cause massive hemorrhage, most of them abort during the first trimester without having been diagnosed. However, cervico-isthmic pregnancies are more likely to persist to an advanced gestation in the second and third trimester owing the need for hysterectomy due to defect placentation. CASE PRESENTATION: We presented a rare case of cervical pregnancy after donor egg in vitro fertilization procedure, with no previous pregnancies, medical, and surgical history. Our patient rejected early termination of pregnancy at 5 gestational weeks. Pregnancy continued until 16 weeks when she was hospitalized and terminated due to medical grounds with curettage. Post-operative period was uneventful until day 20, when she was admitted with suspicion of retained placental tissue and endometritis. A hysterectomy was done with blood transfusion due to excessive blood loss. Histologic examination confirmed placenta accreta spectrum disorder. CONCLUSION: Cervical pregnancy can be treated conservative if timely diagnosed by early ultrasound, which can reduce the chances of severe life-threatening hemorrhage necessitating hysterectomy or blood transfusion.

INTRODUCTION Cytomegalovirus (CMV) is the most frequent cause of congenital viral infection, associated with developmental delay, sensorineural hearing loss (SNHL) and fetal death. Primary infection during first trimester is associated with poor prognosis and a higher risk for neurological damage such as mental retardation, cerebral palsy or behavior spectrum disorders. Short interval between infection and ultrasound manifestations is a poor prognostic marker. CASE PRESENTATION The authors present a case of an acute cytomegalovirus infection with isolated ventriculomegaly, diagnosed at 16 gestational weeks. A review of the literature about screening and diagnostic challenges for CMV infection during pregnancy was done, emphasizing the bad prognosis in cases with early primary infection and the need for regular screening programs and prevention. CONCLUSION Screening for anti CMV IgM / IgG and IgG avidity in all pregnant women could be recommended to identify risk groups and improve diagnostic capabilities.

Background: Prader-Willi syndrome (PWS) is a multisystemic complex imprinting disorder. Prenatal diagnosis of PWS is still a challenge with non-specific ultrasound markers and limitations for diagnosis with non-invasive screening methods. Prenatal suspicion and early postnatal diagnosis are mandatory for promoting healthy growth and development, preventing complications, and providing health care professionals and families with the necessary support and resources for effective management. Presentation: We report two PWS cases caused by maternal uniparental disomy, who presented with IUGR, specifically reduced fetal abdominal circumference (AC) during the second and early third trimesters against the background of reduced fetal move-ments, normal Doppler indicators and oligohydramnios. They were diagnosed in the early neonatal period with no prenatal suspicion but with similar ultrasound markers of the developing pregnancies, analyzed retrospectively. Aim: The aim of this study is to emphasise the need to raise awareness among specialists about genetic syndromes such as Prader–Willi syndrome, in order to improve the information provided to couples regarding the limitations of current prenatal screening methods, as well as to ensure that, in cases of prenatal suspicion, appropriate genetic testing can be initiated. A confirmed diagnosis would allow timely and adequate measures to be taken, given the complications of the postnatal period in these patients and their need for specialised care and management Conclusions: The presence of the aforementioned prenatal characteristics may raise suspicion for PWS. In such cases, invasive diagnostic procedures and methylation testing may be indicated, enabling earlier diagnosis and timely management, which can ultimately improve the quality of life of affected individuals and their families.

Background: Endometriosis is a chronic gynecological disorder associated with infertility, diminished ovarian reserve, and variable outcomes after assisted reproductive technology (ART). However, its effects on oocyte competence, embryo quality, implantation, and live birth remain controversial. Objective: To critically synthesize current evidence regarding the impact of endometriosis on ovarian reserve, oocyte and embryo competence, and ART outcomes, with emphasis on ovarian endometrioma (OMA), disease stage, adenomyosis, surgery, and pretreatment strategies before IVF/ICSI. Methods: We conducted a targeted narrative literature review using PubMed, Embase, and Scopus for studies published between 2014 and 2025. We prioritized systematic reviews, meta-analyses, randomized trials, large cohort studies, guidelines, and clinically relevant recent publications on endometriosis-associated infertility and ART outcomes. This article is a critical narrative review rather than a systematic review; therefore, we did not report PRISMA flow or conduct a formal risk-of-bias assessment. Results: Endometriosis is consistently associated with reduced ovarian reserve and lower oocyte yield, particularly in women with OMA or previous ovarian surgery. Evidence on oocyte and embryo competence remains heterogeneous, although recent studies suggest that embryo euploidy and per-transfer live birth are often preserved when good-quality embryos are available. In contrast, cumulative live birth rate may decline because repeated ART cycles yield fewer oocytes and embryos. Adenomyosis appears to impair implantation and cumulative outcomes independently. Conclusions: Endometriosis predominantly affects oocyte quantity rather than uniformly impairing embryo competence. Routine surgery or prolonged medical pretreatment before IVF is not supported for all patients and should be individualized.