Pregnancy-associated Deaths: 31-year Experience.

AIM: The aim of the present study was to elucidate the clinical characteristics of pregnancy-associated maternal deaths. METHODS: We performed a retrospective analysis with medical records and autopsy reports of cases of pregnancy-associated deaths. We collected information on all maternal deaths related to pregnancy that occurred in 3 hospitals affiliated with Nippon Medical School in Japan from January 1, 1984, to December 31, 2014. Data analyzed were maternal age, past medical history, parity, gestational age, clinical signs and symptoms, cause of death, and maternal autopsy findings. RESULTS: A total of 26 maternal deaths occurred during the 31-year study period. Autopsies were performed for 16 patients (61.5%). The 26 deaths included 19 (73.1%) classified as direct maternal deaths and 7 (26.9%) classified as indirect maternal deaths. The mean maternal age at death was 33.1±4.3 years (range, 26-41 years). The highest percentage of women was aged 35 to 39 years (38.5%). Of the 26 maternal deaths, 69% occurred at 32 to 41 weeks of gestation. In cases of direct maternal death, the leading causes were amniotic fluid embolism (7 cases, 27.0% of all deaths) and hemorrhage (6 cases, 23.1% of all deaths). In cases of indirect obstetric deaths, the causes included cardiovascular disorders, cerebrovascular disorders, sepsis due to group A streptococcal infection, and hepatic failure of unknown etiology. CONCLUSIONS: Amniotic fluid embolism was the leading cause of maternal deaths and was followed by obstetric hemorrhage. To prevent and reduce the number of maternal deaths in Japan, further basic and clinical research on amniotic fluid embolism is required.

Huge ovarian endometrioma that grew after menopause: Case report.

Endometriomas occur in women of reproductive age and are rare after menopause. A 56-year-old gravida 3 para 2 woman complained of abdominal fullness that had gradually worsened over approximately one year (i.e. 5 years postmenopause). Diagnostic imaging revealed a cystic lesion that extended to just below the diaphragm. An ovarian cystoma of low malignancy was suspected. The preoperative blood test indicated normal estradiol levels at 12.6 pg/mL. She underwent bilateral adnexectomy and total hysterectomy. The appendages on the affected (i.e. right) side weighed approximately 12 kg. An ovarian endometrioma with benign pathology was diagnosed. Postmenopausal endometrioma can occur even in patients with normal postmenopausal estradiol values who are not receiving exogenous hormones. These patients require careful follow-up.

Predicting onset of labor from echogenicity of the cervical gland area on vaginal ultrasonography at term.

BACKGROUND AND AIM: On vaginal ultrasonography, cervical gland area (CGA) gradually disappears with advancing gestation. This is attributed in part to the echogenicity of the CGA becoming equal to that of the cervical stroma. The present study aimed to assess the usefulness of echogenicity in the CGA at term for predicting the time of spontaneous onset of labor. METHODS: The ratio of mean grayscale level (MGL) in the CGA to that in the cervical stroma (CGA/stroma MGL ratio) was estimated as an index of echogenicity in the CGA in women after 36 weeks of gestation (n=190). Using this ratio, time until onset of labor was predicted among women between 37 and 38 weeks (n=104). RESULTS: CGA/stroma MGL ratio increased with advancing gestation, decreasing cervical length (CL), and increasing Bishop score. Univariate logistic analysis indicated that a combination of CL<20 mm and CGA/stroma MGL ratio ≥100% predicted onset of labor within a week [odds ratio (OR), 22.2; 95% confidence interval (CI), 2.4-202.0] was even better than short CL alone (OR, 6.8; 95%CI, 1.7-26.7; P=0.006). Stepwise logistic analysis identified that this combination was an only independent predictor (OR, 20.8; 95%CI, 2.3-188.5; P=0.007). CONCLUSION: The combination of CGA/stroma MGL ratio ≥100% and short CL may offer a useful predictor of onset of labor.

Effect on clinical work practice of establishing a neonatal intensive care unit at a medical school-affiliated teaching hospital.

OBJECTIVE: The aim of this study was to examine the effects of a newly established neonatal intensive care unit (NICU) on clinical work practice and educational activity at Nippon Medical School Musashikosugi Hospital. METHODS: This retrospective study analyzed the clinical records of all neonates admitted to the NICU from December 2010 through November 2013. Anthropometric data, clinical status, problems, and outcomes of patients and the related obstetrical history were extracted and analyzed. RESULTS: Of the 568 neonatal admissions, about half were related to preterm birth (49%) and low birth weight (55%). Forty-eight percent of patients were born via caesarean delivery. Maternal hypertension, diabetes, and thyroid disease were found in 8%, 5%, and 2% of cases, respectively. Mechanical ventilatory support was provided for 20% of patients. Neonates from multiple pregnancy and with significant congenital anomalies accounted for 17% and 10% of all patients, respectively. Five patients died during hospitalization. In addition training was provided in the NICU for an average of 10 residents and 20 medical students per year. CONCLUSION: Since the NICU was established, closer cooperation beyond the framework of a single department has come to be needed. In addition, NICUs in teaching hospitals are expected to provide opportunities for medical students and residents to observe and participate in multidisciplinary medical care.

Clinical characteristics of amniotic fluid embolism: an experience of 29 years.

AIM: The aim of this study was to elucidate the clinical characteristics and risk factors for amniotic fluid embolism (AFE). METHODS: We performed a retrospective case study analysis of patients using medical records and autopsy records. The diagnosis of AFE was based on the presence of clinical symptoms using Clark's criteria and autopsy results. We analyzed patient records from a 29-year period in three hospitals affiliated with the Nippon Medical School in Japan. RESULTS: Ten diagnoses of AFE were found in the records. First, we classified AFE patients into two types based on the initial presenting symptoms: post-partum hemorrhage and cardiopulmonary collapse. Fifty percent of the patients initially presented with post-partum hemorrhage and disseminated intravascular coagulation. Most were diagnosed with post-partum hemorrhage or uterine atony at AFE onset. Similarly, 50% presented with cardiopulmonary arrest or pulmonary arrest as initial symptoms, and most were diagnosed with eclampsia. Second, risk factors for AFE included advanced maternal age, multiparity, increased intrauterine pressure and disruptions of the uterine vasculature. Third, the case fatality rate was 70%. Fourth, squamous cells were observed in maternal central venous blood of five patients. CONCLUSION: AFE patients were classified into two types based on presenting signs and symptoms. Knowledge of the various initial symptoms of AFE enables a correct diagnosis.

A phase II study of paclitaxel and carboplatin with a biweekly schedule in patients with epithelial ovarian cancer: Gynecologic Cancer Network trial.

AIM: The objective of this multicenter phase II study was to evaluate the effects of biweekly paclitaxel and carboplatin combination chemotherapy on response rate and toxicities in patients with epithelial ovarian cancer. PATIENTS AND METHODS: Patients with International Federation of Gynecology and Obstetrics stage II to IV ovarian cancer received paclitaxel at a dose of 120 mg/m(2) and carboplatin at an area under the curve of 3 mg/mL per minute every 2 weeks for 8 or more cycles. Inclusion criteria included an Eastern Cooperative Oncology Group performance status of 0 to 2 and no previous chemotherapy. Informed consent was obtained from each patient before the start of treatment. RESULTS: From March 2003 through July 2009, 42 patients from 5 institutions were eligible to be evaluated for response and toxicity. The median age was 60.5 years (age range, 34-81 years). The International Federation of Gynecology and Obstetrics stage was stage II in 3 patients, stage III in 31 patients, and stage IV in 8 patients. The response rate was 66.7% (95% confidence interval: 50.5%-80.4%). Sixty-nine percent (29 of 42) of patients received 8 or more cycles of chemotherapy. The median progression-free survival was 18.5 months, and overall survival was 59.1 months. The most common grade 3 or 4 hematological toxicity was neutropenia (61.0%). No patients had grade 3 or 4 thrombocytopenia. The most common grade 3 nonhematological toxicities were neuropathy (4.9%) and nausea (2.4%). CONCLUSION: Paclitaxel combined with carboplatin using a biweekly schedule is a safe and effective chemotherapy regimen for patients with epithelial ovarian cancer. Our results suggest that a biweekly schedule is well tolerated and is less toxic than a triweekly schedule.

Reversible posterior leukoencephalopathy syndrome due to eclampsia in a woman with a twin pregnancy produced with donated oocytes.

A 35-year-old primigravida with severe ovarian dysfunction underwent in vitro fertilization with oocytes donated by her sister. A twin pregnancy ensued, and she received prenatal care at our hospital. She underwent a cesarean section at 35 weeks' gestation because of pregnancy-induced hypertension (PIH) and breech presentation at the onset of labor. Eclampsia with a generalized seizure occurred 5 hours after the cesarean section, while the patient was receiving medical treatment for disseminated intravascular coagulation secondary to an atonic uterus. Reversible posterior leukoencephalopathy syndrome (RPLS) was diagnosed with magnetic resonance imaging the following day. With control of the hypertension and seizures, the condition of the patient was stabilized, and the RPLS resolved several days later. Eclampsia and RPLS associated with pregnancy can be life-threatening and are typically closely related to PIH. Thus, this case illustrates that the risk of PIH is increased in pregnancies produced with donated oocytes.

Correlation between an absence of cervical gland area on transvaginal sonography and cervical mucus hyaluronic acid levels in women with threatened preterm delivery.

PURPOSE: Transvaginal sonographic findings of an absent cervical gland area (CGA) and a short cervical length (CL) are frequently observed in patients with threatened preterm delivery. The present study aimed to clarify whether sonographic findings are due to active production of hyaluronic acid (HA)in the cervix. METHODS: Possible relationships between sonographic findings of the presence or absence of the CGA and/or a short CL and cervical mucus HA concentration were investigated in 68 women with threatened preterm delivery at 22 ­ 31 weeks' gestation and 136 women without threatened preterm delivery as controls. RESULTS: HA levels were higher in women with threatened preterm delivery (68.0 ng/mL) than in controls (39.0 ng/mL; P = 0.001). Similarly, HA levels were higher in women with preterm labor showing an absent CGA and a short CL than in women with threatened preterm delivery without such findings (P < 0.01). Stepwise multivariate logistic regression identified an absent CGA and threatened preterm delivery as independent predictors of high HA levels (P = 0.04). HA concentration was not predictive for preterm delivery. CONCLUSION: A sonographic finding of an absent CGA reflects high HA levels in the cervix with threatened preterm delivery.

Expression and role of nestin in human cervical intraepithelial neoplasia and cervical cancer.

Nestin expression reportedly correlates with aggressive growth, metastasis, poor prognosis and presence of cancer stem cells (CSCs) in various tumors. In this study, we determined the expression and role of nestin in cervical intraepithelial neoplasia (CIN) and cervical cancer. We performed immunohistochemical and in situ hybridization analyses of nestin in 26 cases for each stage of CIN and 55 cervical cancer tissue samples. To examine the role of nestin in cervical cancer cells, we stably transfected expression vectors containing nestin cDNA into ME-180 cells. We studied the effects of increased nestin expression on cell proliferation, cell motility, invasion as well as sphere and soft agar formation. Nestin was not localized in the squamous epithelium in normal cervical tissues, but it was weakly expressed in the basal squamous epithelium of CIN 1. In CIN 2, nestin was localized to the basal to lower 2/3 of the squamous epithelium, whereas in CIN 3, it was localized to the majority of the squamous epithelium. Nestin was detected in all cases of invasive cervical cancer. Nestin mRNA was expressed in both ME-180 and CaSki cells. Growth rate, cell motility and invasion ability of stably nestin-transfected ME-180 cells were not different from empty vector-transfected ME-180 (mock cells). However, the nestin-transfected ME-180 cells formed more colonies and spheres compared to the mock cells. These findings suggest that nestin plays important roles in carcinogenesis and tumor formation of cervical cancer cells. Nestin may closely correlate with regulation of CSCs.

Hydroxysteroid (17-ß) dehydrogenase 1 is dysregulated by miR-210 and miR-518c that are aberrantly expressed in preeclamptic placentas: a novel marker for predicting preeclampsia.

In this study, to search for novel preeclampsia (PE) biomarkers, we focused on microRNA expression and function in the human placenta complicated with PE. By comprehensive analyses of microRNA expression, we identified 22 microRNAs significantly upregulated in preeclamptic placentas, 5 of which were predicted in silico to commonly target the mRNA encoding hydroxysteroid (17-ß) dehydrogenase 1 (HSD17B1), a steroidogenetic enzyme expressed predominantly in the placenta. In vivo HSD17B1 expression, at both the mRNA and protein levels, was significantly decreased in preeclamptic placentas. Of these microRNAs, miR-210 and miR-518c were experimentally validated to target HSD17B1 by luciferase assay, real-time PCR, and ELISA. Furthermore, we found that plasma HSD17B1 protein levels in preeclamptic pregnant women reflected the decrease of its placental expression. Moreover, a prospective cohort study of plasma HSD17B1 revealed a significant reduction of plasma HSD17B1 levels in pregnant women at 20 to 23 and 27 to 30 weeks of gestation before PE onset compared with those with normal pregnancies. The sensitivities/specificities for predicting PE at 20 to 23 and 27 to 30 weeks of gestation were 0.75/0.67 (cutoff value=21.9 ng/mL) and 0.88/0.51 (cutoff value=30.5 ng/mL), and the odds ratios were 6.09 (95% CI: 2.35-15.77) and 7.83 (95% CI: 1.70-36.14), respectively. We conclude that HSD17B1 is dysregulated by miR-210 and miR-518c that are aberrantly expressed in preeclamptic placenta and that reducing plasma level of HSD17B1 precedes the onset of PE and is a potential prognostic factor for PE.

Spontaneous uterine perforation due to clostridial gas gangrene associated with endometrial carcinoma.

Few cases of clostridial gas gangrene associated with uterine malignancy have been reported. We report on a 46-year-old woman with clostridial sepsis. On the day of admission due to severe abdominal pain, peritonitis was diagnosed, and computed tomography showed free air in the abdomen. At emergency laparotomy, perforation of the necrotic uterine wall was observed. During hysterectomy, septic shock developed, and life-saving therapy was performed in the intensive care unit after surgery. Pathological examination of the necrotic uterine wall showed grade III endometrial adenocarcinoma of the uterine endometrium (International Federation of Gynecology and Obstetrics stage IIIa) with gas gangrene due to Clostridium perfringens. This report aims to alert gynecologists to the possibility that clostridial gas gangrene of the uterus can occur in patients with peritonitis and intra-abdominal free air. Early recognition and aggressive therapy can save patients' lives.

Significance of cervical gland area in predicting preterm birth for patients with threatened preterm delivery: comparison with cervical length and fetal fibronectin.

BACKGROUND/AIMS: Absent cervical gland area (CGA) has been considered a predictor of preterm delivery (PTD) for women at low risk. Predictive efficacy was analyzed in women at high risk for PTD and compared with cervical length (CL) <20 mm and fetal fibronectin (fFN) in cervicovaginal secretions. METHODS: Case notes were reviewed for 108 subjects with gestation of 22-33 weeks who had been admitted to hospital with threatened PTD. The uterine cervix was observed by vaginal sonography and fFN was sampled on admission. Relationships between findings and outcome of PTD at <34 weeks' gestation were analyzed. RESULTS: Delivery at <34 weeks' gestation occurred in 14.8% of patients. Absent CGA (68.8%), short CL (75.0%), short CL without CGA (62.5%) and positive fFN (62.5%) were more frequent in these patients than in patients undelivered at <34 weeks' gestation (p < 0.05). Logistic regression analysis identified positive fFN and short CL with absent CGA as independent predictors for PTD (p < 0.0001). The mean interval from admission to delivery was 2.9 weeks in cases with fFN and both sonographic findings, compared to 9.3 weeks in cases with fFN but both sonographic finding (p = 0.0005). CONCLUSION: Short CL with absent CGA represents an independent predictor for PTD, as does fFN.

Combined chemotherapy with paclitaxel and carboplatin for mucinous cystadenocarcinoma of the ovary during pregnancy.

Combined chemotherapy using carboplatin and paclitaxel has been established as a standard regimen for epithelial ovarian carcinoma. We present the case of a 36-year-old woman with ovarian mucinous cystadenocarcinoma who underwent exploratory laparotomy during pregnancy, revealing Stage 1c at gestational week 15. Afterwards, five courses of paclitaxel and carboplatin chemotherapy were administered biweekly from gestational week 24. Cesarean section was performed at gestational week 36. No recurrent or metastatic lesions were found and outcomes for both mother and neonate have been satisfactory for 40 months since diagnosis of ovarian carcinoma.

Atypical case of reversible posterior leucoencephalopathy syndrome associated with puerperal HELLP syndrome.

Reversible posterior lekoencephalopathy syndrome (RPLS) is usually reversible. However, permanent cerebral damage may result if diagnosis is delayed. White matter edema in the posterior cerebral hemispheres is typical on neuroimaging. A 36-year-old primigravid woman underwent induction of labor due to mild pregnancy-induced hypertension. At 5 h after delivery, she developed eclampsia seizures complicated by hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. Magnetic resonance imaging showed high-density lesions in anterior regions without any abnormalities in posterior cerebral regions. Cases of postpartum RPLS without involvement of posterior brain regions after eclampsia complicated by HELLP syndrome are very rare. Patients with RPLS do not always show typical manifestations.

Effect of sera on the adhesion of natural killer cells to the endothelium in severe pre-eclampsia.

OBJECTIVE: To investigate the effect of serum on the interaction between natural killer (NK) cells and endothelial cells in pre-eclampsia. METHODS: Seven severely pre-eclamptic patients, five normal pregnant women, and four normal non-pregnant women were included in this study. Freshly isolated NK cells labeled with Chromium-51 were incubated on an endothelial cell monolayer in the presence of patient serum. In regard to the characteristics of adhesive molecules, the endothelial cells were blocked by monoclonal antibodies (mAbs) to intracellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1); the NK cells were blocked by mAbs to leukocyte function-associated antigen (LFA-1) and very late antigen-4 (VLA-4) before co-incubation. After incubation, the adherent cells were solubilized with 1% Triton X. The lysates were collected and counted in a gamma counter. RESULTS: The adhesion of NK cells to the endothelium in the normal pregnancy group decreased significantly in comparison to the non-pregnant group (7%vs 72%; P < 0.01). Adhesion in the severe pre-eclamptic group was significantly higher in comparison to the normal pregnant group (44%vs 7%; P < 0.01). The blocking percentages of mAbs on NK adhesion in the severe pre-eclampsia group were 49 +/- 4% to LFA-1, 61 +/- 48%, 67 +/- 39% to VLA-4, ICAM-1, and 68 +/- 7% to VCAM-1. CONCLUSION: Sera from normal pregnant women suppress the adhesion between NK cells and endothelial cells, whereas the suppressive effect of sera from pre-eclamptic patients has a diminished affect.

A case report: change in fetal heart rate pattern on spontaneous uterine rupture at 35 weeks gestation after laparoscopically assisted myomectomy.

A 31-year-old nulligravid woman who underwent laparoscopically assisted myomectomy 5 months before becoming pregnant suffered uterine rupture at 35 weeks gestation. A 50 g intramuscular myomatous node had been removed laparoscopically. Early signs of rupture included sudden onset of severe abdominal tenderness and frequent uterine contractions despite reassuring FHR tracing. Variable deceleration was observed as late as 7.5 hours after onset. Emergency cesarean section was performed due to increasing severity of tenderness, revealing complete uterine rupture at the fundus site without extrusion of the fetus or placenta. A male neonate (2,860 g) was delivered without asphyxia and an Apgar score of 8. Total volume of hemorrhage was approximately 50 ml. The ruptured uterine wall was repaired by suturing in 2 layers. The present case indicates that sudden onset of abdominal tenderness in pregnant women with a history of laparoscopic myomectomy may suggest uterine rupture even in the presence of reassuring FHR. This is a rare case, as non-reassuring FHR patterns generally appear in the late stages of uterine rupture.

Intrauterine therapy for the acutely enlarging fetal cystic hygroma.

Enlarged fetal cystic hygroma is known to cause life-threatening complications such as fetal hydrops and neonatal respiratory difficulty. A 28-year-old Japanese woman, gravida 0, presented with fetal cystic hygroma at 23 weeks of gestation. There were no other structural malformations or hydrops detected by ultrasonographic examination. In addition, the karyotype was diagnosed as normal through amniotic fluid analysis. The cystic lesion showed acute enlargement and intrauterine sclerotherapy using OK-432 was performed at 26 weeks. The size of the cyst initially decreased, which was followed by a gradual increase. A viable 3,098 g male infant was delivered by cesarean section at 37 weeks without any other complications. The infant had no clinical difficulty during the neonatal period and later underwent a surgical removal of the remaining cystic lesion. Cases of fetal cystic hygroma showing acute enlargement without other complications are considered good candidates for intrauterine therapy to prevent subsequent complications.

Fetal and neonatal thermoregulation.

The metabolic rate of the fetus per tissue weight is relatively high when compared to that of an adult. Moreover, heat is transferred to the fetus via the placenta and the uterus, resulting in a 0.3 degrees C to 0.5 degrees C higher temperature than that of the mother. Therefore, fetal temperature is maternally dependent until birth. At birth, the neonate rapidly cools in response to the relatively cold extrauterine environment. Thus, the neonatal temperature rapidly drops soon after birth. In order to survive, the neonate must accelerate heat production via nonshivering thermogenesis (NST), which is coupled to lypolysis in brown adipose tissue. Heat is produced by uncoupling ATP synthesis via the oxidation of fatty acids in the mitochondria, utilizing uncoupled protein. Thermogenesis must begin shortly after birth and continue for several hours. Since thermogenesis requires adequate oxygenation, a distressed neonate with hypoxemia cannot produce an adequate amount of heat to increase its temperature. In contrast to the neonate, the fetus cannot produce extra heat production. This is because the fetus is exposed to inhibitors to NST, which are produced in the placenta and then enter the fetal circulation. The important inhibitors include adenosine and prostaglandin E2, both of which have strong anti-lypolytic actions. The inhibitors play an important role in the metabolic adaptation of a physiological hypoxic fetus because NST requires adequate oxygenation. Furthermore, the presence of NST inhibitors allows the fetus to accumulate an adequate amount of brown adipose tissue before birth. The umbilical circulation transfers 85% of the heat produced by the fetus to the maternal circulation. The remaining 15% is dissipated through the fetal skin to the amnion, and is then transferred through the uterine wall to the maternal abdomen. As long as fetal heat production and loss are appropriately balanced, the temperature differential between the fetus and the mother remains constant (heat clump). However, when the umbilical circulation is occluded for any reason, the fetal temperature will rise in relation to the extent of the occlusion. The fetal temperature may elevate to the hyperthermic range in cases of acute cord occlusion; if this occurs, fetal growth, including brain development, may be impacted. Experimentally induced cord occlusion, which is recognized as a significant cause of brain damage, results in a rapid elevation of body temperature; however, the brain temperature tends to remain constant. This is considered to be a cerebral thermoregulatory adaptation to hypoxemia, which has the physiologic advantage of protecting the fetus from hyperthermia, a condition that predisposes the fetus to hypoxic injury (cerebral hypometabolism). A number of thermoregularatory mechanisms are in place to maintain normal fetal and neonatal growth. Data has primarily been collected from animal studies; aside from the strict thermal control provided in the newborn nursery, little information exists concerning these mechanisms in the human fetus and neonate. Probably further information on thermoregulation is necessary specially to improve perinatal management for hypoxic fetuses.

Changes in plasma endothelin-1 after elective cesarean section in women with preeclampsia and the relationship to thrombocytopenia.

OBJECTIVE: The aim of this study was to clarify the time course of plasma endothelin-1 levels and platelet counts after elective cesarean section in women with preeclampsia, and to investigate the relationship between them postoperatively. METHODS: We studied 20 patients with preeclampsia and 25 healthy pregnant women without preeclampsia who underwent cesarean section and 20 women without preeclampsia who had vaginal deliveries. The plasma endothelin-1 and platelet counts were measured serially after cesarean section. RESULTS: 1) In patients with preeclampsia, plasma endothelin-1 levels peaked on postoperative day 0 (p<0.05), and remained high, then fell to the preoperative level from day 5. The concentration was lower in healthy pregnant women undergoing cesarean section than in patients with preeclampsia before surgery, but showed a gradual significant increase from postoperative day 0 to postoperative day 3 (p<0.05) before falling. The women who underwent vaginal delivery showed a peak level of endothelin-1 on the day of delivery but this fell rapidly between day 3. 2) Women with preeclampsia showed a negative correlation between plasma endothelin-1 levels and platelet counts after cesarean section (r=0.46, p<0.01), while women without preeclampsia undergoing cesarean and vaginal deliveries did not. CONCLUSION: Endothelin-1 production is stimulated after cesarean section, which is paralleled with postpartal thrombocytopenia only in patients with preeclampsia.

Correlations between interscapular deep temperature and plasma free fatty acid levels in pregnant women with hyperemesis gravidarum.

OBJECTIVES: The aim of the present study was to investigate whether deep temperature directly reflects underlying pathology in pregnant women with hyperemesis gravidarum. SUBJECTS. We studied 24 women at first trimester hospitalized for hyperemesis gravidarum who had lost a mean of 4.3 kg since becoming pregnant and 20 pregnant controls who did not experience hyperemesis gravidarum and were matched for weeks of gestation and pre-conception weight and height. METHODS: Serum free T(3), T(4), and plasma free fatty acid levels were determined, and deep temperatures of the interscapular tissues were measured. Measurements were compared at admission and after symptoms improved. RESULTS: Free fatty acid, free T(3), and T(4) levels at admission were appreciably higher in the hyperemesis gravidarum group than in the control group (p<0.05). After symptoms improved, free fatty acid levels in patients had decreased by 29% and free T(4) levels by 28% (p<0.05). A significant relationship was observed between reductions in free fatty acid level accompanying improvement in patient status and decreases in both free T(3) and free T(4) levels (p<0.05). Interscapular deep temperatures at admission (36.4 +/- 0.5 C degrees ) significantly decreased to 35.8 +/- 0.9 C degrees after symptoms improved (p<0.05). Reductions in interscapular temperature as a result of improvements in patient status were significantly correlated with reductions in free fatty acid level (p<0.001). CONCLUSIONS: Deep temperatures of the interscapular region in hyperemesis gravidarum change in association with lipolysis as a result of transient hyperthyroidism. This phenomenon can be used as an indicator for evaluating improvements in the pathologic features of hyperemesis gravidarum.