Early-onset sepsis (EOS) remains a major cause of neonatal morbidity and mortality worldwide, with significant differences in the incidence and outcome of the disease in Europe. Eastern European countries face particular challenges due to differences in access to healthcare, diagnostic facilities, and prevention strategies. This review summarizes the results of recent research to provide insights into maternal risk factors, regional inequalities in access to healthcare, diagnostic biomarkers, pathogen patterns, and treatment protocols for EOS. This review also examines how healthcare infrastructure and socioeconomic factors influence EOS outcomes in Eastern Europe. Introduction: Early-onset sepsis (EOS) presents a significant health challenge for newborns, characterized by sepsis occurring within the first 72 h of life, primarily caused by the vertical transmission of pathogens from mother to child. Despite advancements in medical care, EOS remains particularly burdensome in resource-poor settings, especially in Eastern Europe, where disparities in healthcare access and maternal health are pronounced. This systematic review aims to provide insights into maternal risk factors, regional inequalities in healthcare access, diagnostic biomarkers, pathogen patterns, and treatment protocols for EOS. Background/Objectives: EOS is increasingly recognized as a public health issue, with outcomes significantly influenced by maternal health, socioeconomic status, and healthcare infrastructure. The review seeks to summarize the existing literature on EOS, particularly focusing on differences between high-income Western and low-resource Eastern European countries. The influence of maternal access to antenatal care, pathogen prevalence, and antibiotic resistance on EOS outcomes across regions will also be examined. Methods: To achieve the review’s objectives, a comprehensive search was conducted across multiple databases including PubMed, Google Scholar, ScienceDirect, and Scopus, adhering to PRISMA guidelines for systematic reviews. The inclusion criteria encompassed studies published within the last 20 years (January 2004–August 2024) that addressed EOS in late preterm or term infants, emphasizing maternal health, risk factors, diagnostic approaches, and treatment protocols pertinent to European populations. Exclusion criteria included non-English publications and studies lacking a focus on maternal and neonatal health. A total of 29 peer-reviewed articles meeting the specified criteria were ultimately included in the analysis. Results: The findings highlight significant regional disparities in EOS management between Western and Eastern Europe. Key issues include maternal risk factors, socioeconomic barriers to healthcare, diagnostic biomarkers, and pathogen resistance trends. Limited access to prenatal screenings and healthcare infrastructure in Eastern European countries, especially in rural regions in Romania, exacerbate the challenges faced by expectant mothers. Financial burdens, such as high out-of-pocket expenses, were shown to further restrict access to necessary maternal care. Conclusions: This systematic review emphasizes the urgent need for targeted investments in maternal healthcare infrastructure in Eastern Europe to mitigate the impacts of EOS. Enhanced screening programs, standardized surveillance systems, and ensuring equitable health policies are essential to improving neonatal outcomes. Additionally, tailored education and awareness campaigns for disadvantaged groups and comprehensive health policy reforms, including universal antenatal care and Group B Streptococcus (GBS), are essential to bridging healthcare gaps.

Thrombophilia is a disorder that makes patients susceptible to intravascular thrombosis that may increase the risk of developing a pregnancy on a known pathology. The female patient diagnosed with hypoplastic uterus and hereditary thrombophilia had a favorable evolution under properly administered anticoagulant treatment. The homozygous status for the C677T mutation may lead to an increase in plasma homocysteine levels, especially in pregnant women, being an associated risk factor for thrombosis. The risk of developing intravascular thrombosis requires primary prevention measures by adding D-dimers in the early diagnostic algorithm, being the most accurate marker of hypercoagulability and endogenous fibrinolysis. The corroboration of the hypercoagulability status with the results of genotyping, the frequencies of the minor/major alleles studied, single mononucleotide polymorphisms (SNPs) and the establishment of preventive therapy, aims to prevent intravascular thrombosis and thromboembolic phenomena.

Neonatal mortality, particularly due to early-onset sepsis (EOS), remains a pressing issue in Eastern Europe, with Romania experiencing one of the highest neonatal mortality rates in the European Union. EOS, caused by bacterial infections within the first 72 h of life, significantly contributes to neonatal deaths, particularly in rural and underserved areas where healthcare resources are limited. Disparities in prenatal care access, maternal demographics, and systemic healthcare gaps worsen this issue, highlighting the need for comprehensive interventions. Objectives: This review aims to examine the prevalence of neonatal mortality due to EOS in Romania and the broader Eastern European context, focusing on current prenatal care monitoring protocols and maternal demographics, and comparing the available literature with new data. By evaluating disparities in healthcare access, costs, and outcomes, this study identifies systemic barriers to maternal and neonatal care. Methods: A systematic review of 100 articles was conducted using PRISMA guidelines. Key sources included PubMed, Google Scholar, and open-access journals, with 25 articles meeting the inclusion criteria. The analysis encompassed maternal age, parity, literacy levels, marital status, and their impact on neonatal outcomes, alongside the financial burden of prenatal care. Results: The findings underscore stark inequalities in healthcare delivery between rural and urban regions, where limited prenatal visits, out-of-pocket costs, and cultural barriers hinder prompt EOS prevention and management. Advanced maternal age, low literacy, and socioeconomic disparities were identified as critical risk factors. Conclusions: To reduce neonatal mortality due to EOS, targeted efforts must address healthcare accessibility, improve prenatal care protocols, and integrate culturally sensitive practices. These interventions can bridge systemic gaps and promote equitable health outcomes for mothers and newborns across Eastern Europe.

Background: In this exploratory study, we aimed to evaluate the dynamics of angiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), soluble Endoglin (sEng), and sFlt-1/PlGF, PlGF/sFlt-1, and sEng/PlGF ratios] and oxidative stress [8-epi-prostaglandin F2 alpha (8-epi-PGF2α) and 8-epi-PGF2α/PlGF ratio] mediator levels in women with suspected or confirmed pre-eclampsia (PE) at least two times during pregnancy. We also wanted to identify the possible correlations between 8-epi-PGF2α and angiogenic mediator levels at the time of inclusion of pregnant women. Methods: We included 40 pregnant women with suspected or confirmed PE, with a mean age of 29 years (range between 18 and 41 years) and gestational age between 18 and 28 weeks at inclusion in this study. The Enzyme-Linked Immunosorbent Assay (ELISA) method to measure the levels of serum angiogenic and oxidative stress mediators was used. Results: The evaluation of baseline sFlt-1/PlGF ratios using a cut-off of 38 suggested that 25 pregnant women had a sFlt-1/PlGF ratio of >38 (sFlt-1/PlGF ratio of >38 group) and 15 had a sFlt-1/PlGF ratio of ≤38 (sFlt-1/PlGF ratio of ≤38 group). The increases in sFlt-1/PlGF ratio in the sFlt-1/PlGF ratio of >38 group were caused by both an increase in sFlt-1 (2.04-fold) and a decrease in PlGF levels (2.55-fold). The 8-epi-PGF2α median levels were higher in the sFlt-1/PlGF ratio of >38 group (1.62-fold). During follow-up after pregnancy, we observed that the mean values of sFlt-1 and sEng and the median values of 8-epi-PGF2α and sFlt-1/PlGF, sEng/PlGF, and 8-epi-PGF2α/PlGF ratios increased directly proportional to gestational age for each measurement time until delivery in both groups. For five women who had a sFlt-1/PlGF ratio ≤38 at inclusion, sFlt-1/PlGF ratio was observed to increase to >38 later in pregnancy. We observed that, in the sFlt-1/PlGF ratio >38 group, baseline 8-epi-PGF2α levels better correlated with angiogenic mediator levels. Conclusions: Our study shows that 33.33% of pregnant women evaluated for suspected or confirmed PE with a sFlt-1/PlGF ratio of ≤38 displayed a rise in sFlt-1/PlGF ratio in subsequent weeks. In addition, together with angiogenic mediators, 8-epi-PGF2 α can be utilized as an independent predictor factor to help clinicians identify or predict which pregnant women will develop PE.

Background/Objectives: Heterotopic cesarean scar pregnancy (HCSP) is an exceptionally rare and potentially life-threatening form of ectopic pregnancy, characterized by the coexistence of a viable intrauterine pregnancy and an ectopic implantation within a previous cesarean section scar. Its incidence has risen in recent years, primarily due to the increased rate of cesarean deliveries and the widespread use of assisted reproductive technologies (ART). This systematic review aims to provide a comprehensive synthesis of published evidence on HCSP, with a focus on epidemiology, diagnostic challenges, therapeutic strategies, complications, and maternal-fetal outcomes. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science up to May 2025, in accordance with PRISMA guidelines. Included studies comprised case reports, case series and retrospective reviews documenting confirmed HCSP cases. Data were extracted on clinical presentation, imaging, treatment approaches, outcomes, and complications. Results: Thirty studies reporting 40 confirmed HCSP cases were included. Transvaginal ultrasonography was the primary diagnostic tool, although diagnosis was often delayed by the presence of a viable intrauterine pregnancy. Management strategies included surgical intervention, local medical therapy and conservative approaches or expectant management. Maternal complications included hemorrhage and uterine rupture, while fetal outcomes were variable. In selected cases, intrauterine pregnancy continued to term. Conclusions: HCSP is a rare but high-risk obstetric entity requiring early recognition and multidisciplinary management. Prompt ultrasound-based diagnosis and individualized treatment can significantly reduce maternal morbidity and improve fetal outcomes. Further multicenter studies are warranted to establish standardized diagnostic and management protocols.