Hydropic leiomyoma-like ovarian tumor: a case report.

Uterine leiomyomas, benign tumors common in reproductive-aged women, can display rare variants such as hydropic leiomyoma (HL), which exhibit unique histological features like zonal edema and increased vascularity. However, due to its rarity, comprehensive clinical knowledge about HL is limited. We report a case of a 49-year-old Japanese woman who was premenopausal and nulliparous, presenting with a two-year history of abdominal distension. An MRI scan revealed a 20 cm mass in the posterior part of the uterus, exhibiting characteristics suggestive of an ovarian tumor. During laparotomy, a cystic tumor connected with a swollen fibroid was found, and pathology confirmed HL. This case emphasizes that hydropic leiomyomas can mimic malignant tumors on ultrasonography due to their atypical features, necessitating additional evaluations using alternative imaging techniques or histopathological examinations for accurate diagnosis and appropriate management. The patient recovered uneventfully, broadening our understanding of HL's clinical presentation.

Prophylactic resuscitative endovascular balloon occlusion of the aorta use during cesarean hysterectomy for placenta accreta spectrum: a retrospective cohort study.

OBJECTIVE: Resuscitative endovascular balloon occlusion of the aorta for placenta accreta spectrum is used to control maternal hemorrhage during cesarean hysterectomy. This study aimed to assess the efficacy of resuscitative endovascular balloon occlusion of the aorta for placenta accreta spectrum by examines the change in the quantitative blood loss after applying resuscitative endovascular balloon occlusion of the aorta. METHODS: This retrospective cohort study included patients with placenta accreta spectrum who required cesarean hysterectomy (n = 37) between 2003 and 2022 at a tertiary care center. Patients were divided into two groups (with resuscitative endovascular balloon occlusion of the aorta, n = 13; without resuscitative endovascular balloon occlusion of the aorta, n = 24). The quantitative blood loss was compared between the groups. Generalized linear mixed models were used to examine changes in quantitative blood loss during cesarean hysterectomy after resuscitative endovascular balloon occlusion of the aorta was applied. The operating surgeon was set as the random effect. RESULTS: Operation time did not differ significantly between the groups (p = .09). The quantitative blood loss was significantly higher in patients who did not undergo resuscitative endovascular balloon occlusion of the aorta (2160 g) than in patients who did (1110 g; p < .01). Resuscitative endovascular balloon occlusion of the aorta significantly decreased the quantitative blood loss during cesarean hysterectomy (partial regression coefficient, 2312; 95% confidence interval, 49-4577; p < .05). CONCLUSION: Resuscitative endovascular balloon occlusion of the aorta decreased the quantitative blood loss during cesarean hysterectomy in patients with placenta accreta spectrum without significantly increasing the operation time. This suggests that resuscitative endovascular balloon occlusion of the aorta is effective in patients with placenta accreta spectrum.

Association between Gestational Weight Gain and Risk of Hypertensive Disorders of Pregnancy among Women with Obesity: A Multicenter Retrospective Cohort Study in Japan.

The relationship between weight gain during pregnancy and the onset of hypertensive disorders of pregnancy in women with pre-pregnancy obesity remains unclear. We examined the effects of weight gain during pregnancy on hypertensive disorders of pregnancy among women with pre-pregnancy body mass index (BMI) ≥ 25.0 kg/m2. This multicenter retrospective cohort study included nullipara women who delivered at two units in Japan between 1 January 2013, and 31 December 2020. Singleton primipara (n = 3040) were categorized into two pre-pregnancy BMI groups: 25.0-<30.0, and ≥30.0 kg/m2. Using multiple logistic regression analyses (reported as adjusted odds ratio and 95% confidence interval), gestational weight gain effects on overall hypertensive disorders of pregnancy, gestational hypertension, and pre-eclampsia were determined. Gestational weight gain increased hypertensive disorders of pregnancy (1.09, 1.03-1.16, p < 0.05) and pre-eclampsia risk (1.10, 1.01-1.20, p < 0.05) among the BMI 25.0-<30.0 kg/m2 group and hypertensive disorders of pregnancy risk among the ≥30.0 kg/m2 group (1.07, 1.00-1.05, p < 0.05). Using receiver operating characteristic curve analyses, among the BMI 25.0-<30.0 kg/m2 group, for hypertensive disorders of pregnancy (area under the curve [AUC], 0.63, p < 0.05) and pre-eclampsia (AUC, 0.62; p < 0.05), the weight gain cut-off was 10.5 and 10.6 kg, with sensitivity/specificity of 0.47/0.73 and 0.50/0.73, respectively. For the BMI ≥30.0 kg/m2 group (AUC, 0.63, p < 0.05), the cut-off was 3.5 kg (sensitivity/specificity, 0.75/0.49). The optimal gestational weight gain for reducing hypertensive disorders of pregnancy among women with a pre-pregnancy BMI > 25 kg/m2 may facilitate personalized pre-conception counseling among women with obesity.

Impact of the Great East Japan Earthquake on spontaneous abortion and induced abortion: A population-based cross-sectional and longitudinal study in the Fukushima Prefecture based on the census survey of the Fukushima maternity care facility and vital statistics.

AIM: The 2011 Great East Japan Earthquake (GEJE) was a disaster leading to radiation exposure and psychological distress, particularly among pregnant women. However, it is not known how this affected the seasonal changes of pregnancy and childbirth. Therefore, this study investigated the impact of the GEJE in the Fukushima Prefecture on spontaneous and induced abortions with regard to seasonal variability. METHODS: We used the data of vital statistics of live birth and stillbirth registry and the census survey of the Fukushima Maternity Care Facility. We calculated the spontaneous and induced abortion rate for 2011-2016 using two different methods (cross-sectional and longitudinal). We calculated the quartiles and outliers to determine the impact and duration of the GEJE. Periodicity was investigated using spectral density analysis. The data were analyzed for the entire Fukushima Prefecture and by region. RESULTS: The spontaneous abortion rate did not show specific changes after the GEJE. Contrarily, the monthly analysis in the cross-sectional method, revealed specific increases in induced abortion rate during the year after the GEJE; in the longitudinal method, induced abortions increased among women who became pregnant within 1 year after the GEJE. Spontaneous abortion showed no specific periodicity, while induced abortion showed cycles of 6 and 12 months, with a particular increase in May each year. CONCLUSIONS: The spontaneous abortion rate was not affected by the GEJE. The changes in the induced abortion rate after the disaster may have overlapped with the timing of the increased periodicity, and cannot be attributed solely to the GEJE.

Gestational weight gain as a risk factor for dystocia during first delivery: a multicenter retrospective cohort study in Japan.

BACKGROUND: Dystocia is a common obstetric complication among nulliparous women, which requires medical intervention and carries the risk of negative maternal and neonatal outcomes. Our aim was to examine the association between body mass index (BMI) and the occurrence of dystocia. We also identified cutoffs of gestational weight gain, based on pre-pregnancy BMI, associated with the risk of dystocia. METHODS: This was a multicenter, retrospective, cohort study conducted in two tertiary Maternal-Fetal medicine units in Fukushima, Japan. The study population included nullipara women who delivered at either of the two units between January 1, 2013, and December 31, 2020. Women (n = 2597) were categorized into six groups (G) based on their pre-pregnancy BMI: G1 (< 18.5 kg/m2), G2 (18.5 to < 20.0 kg/m2), G3 (20.0 to < 23.0 kg/m2), G4 (23.0 to < 25.0 kg/m2), G5 (25.0 to < 30.0 kg/m2), and G6 (≥ 30.0 kg/m2). Using G3 as a reference, multiple logistic regression analyses were performed to estimate the risk of dystocia for each BMI category. Receiver operating characteristic curve analyses were performed to determine the cutoff value of gestational weight gain for the risk of dystocia. RESULTS: The highest BMI category (G6) was an independent risk factor for dystocia (adjusted odds ratio, 3.0; 95% confidence interval, 1.5-5.8). The receiver operating characteristic curve analysis revealed no association between gestational weight gain and the occurrence of dystocia in G5 and G6 (P = 0.446 and P = 0.291, respectively). For G1 to G4, AUC and predictive cutoffs of gestational weight gain for dystocia were as follows: G1, AUC 0.64 and cutoff 11.5 kg (P < 0.05); G2, AUC 0.63 and cutoff 12.3 kg (P < 0.05); G3, AUC 0.67 and cutoff 14.3 kg (P < 0.01); and G4, AUC 0.63 and cutoff 11.5 kg (P < 0.05). CONCLUSION: A pre-pregnancy BMI > 30.0 kg/m2 was an independent risk factor for dystocia. For women with a pre-pregnancy BMI < 25.0 kg/m2, the risk of dystocia increases as a function of gestational weight gain. These findings could inform personalized preconception care for women to optimize maternal and neonatal health.

Optimal gestational weight gain to reduce the risk of hypertension disorders of pregnancy among women with obesity: A single tertiary referral center study in Japan.

AIM: To examine the effect of weight gain during pregnancy on hypertension disorders of pregnancy among women with a prepregnancy body mass index ≥30.0 kg/m2 . METHODS: This retrospective cohort study included 257 Japanese women (116 primipara; 141 multipara) with singleton pregnancies with a prepregnancy body mass index ≥ 30.0 kg/m2 , who gave birth during 2013 to 2020 at Ohta Nishinouchi Hospital. Multiple logistic regression analyses were performed to identify the effect of gestational weight gain on early-onset (<34 weeks), late-onset (≥34 weeks), and overall hypertension disorders of pregnancy. RESULTS: The prevalence of hypertension disorders of pregnancy in primiparas and multiparas was 28.4% and 11.3%, respectively. By multiple logistic regression analysis, gestational weight gain during pregnancy increased the risk of early-onset (adjusted odds ratio: 1.20, 95% confidence interval: 1.03-1.39, p < 0.05) and overall hypertension disorders of pregnancy (adjusted odds ratio: 1.12, 95% confidence interval: 1.03-1.22, p < 0.05) among primiparas. Based on receiver operating characteristic curve analyses for early-onset (area under the curve 0.67, 95% confidence interval: 0.56-0.78; p < 0.05) and overall hypertension disorders of pregnancy (area under the curve 0.76, 95% confidence interval: 0.61-0.91; p < 0.05) among primiparas, we determined the cut-off weight gain during pregnancy for early-onset and overall hypertension disorders of pregnancy as 3.85 kg, with sensitivity/specificity of 0.76/0.59 and 0.91/0.53, respectively. CONCLUSION: We recommend that the optimal gestational weight gain for reducing HDP be under 3.85 kg. This information may facilitate personalized pre-conception counseling among women with obesity.

A case of spontaneous parasitic myoma in a patient without a history of myomectomy treated laparoscopically.

Parasitic myoma (PM) is a rare disease in which multiple leiomyomas are intraperitoneally formed. Recently, an increasing number of cases due to specimen morcellation during minimally invasive surgery has been reported. We present the first case of a PM identified intraoperatively during laparoscopic hysterectomy. A 40-year-old Japanese multiparous woman presented to our hospital with heavy menstrual bleeding. She had no history of previous surgery. Magnetic resonance imaging showed uterine myomas. As the patient did not wish for further pregnancy, she underwent oral gonadotropin-releasing hormone antagonist therapy followed by a total laparoscopic hysterectomy. Intraoperatively, we identified a thumb-sized tumor on the left side of the peritoneum. Histopathological examination showed evidence of benign leiomyoma.

Introduction and utility of resuscitative endovascular balloon occlusion of the aorta for cases with a potential high risk of postpartum hemorrhage: A single tertiary care center experience of two cases.

Postpartum hemorrhage is an important obstetric complication and the leading cause of maternal mortality worldwide. Occasionally, we encounter unexpected massive postpartum hemorrhage diagnosed for the first time after delivery. Therefore, it is essential to pay attention to patients with a high risk of postpartum hemorrhage. The authors report two cases of patients at high risk of postpartum hemorrhage that were successfully managed by resuscitative endovascular balloon occlusion of the aorta before cesarean section. Case 1: A 32-year-old woman with a history of cesarean section and who conceived using assisted reproductive technology was diagnosed with partial placenta previa at 25 weeks of gestation. Because of tocolysis failure, emergent cesarean section with resuscitative endovascular balloon occlusion of the aorta was performed at 36 weeks of gestation. Natural placental resorption was observed. She was discharged at 5 days after delivery without significant hemorrhage. Case 2: A 41-year-old woman with suspected placenta accreta spectrum due to a cesarean scar pregnancy was referred to our hospital at 33 weeks of gestation. A planned cesarean section with resuscitative endovascular balloon occlusion of the aorta was conducted at 37 weeks of gestation. There was no visual evidence of abnormal placental invasion of the myometrium, and natural placental resorption was observed. She was discharged at 5 days after delivery without significant hemorrhage.

Effect of gestational weight gain on preeclampsia among underweight women: A single tertiary referral center study in Japanese women.

AIM: To examine the effect of weight gain during pregnancy on preeclampsia among women with a prepregnancy body mass index < 18.5 kg/m2 . METHODS: This retrospective cohort study included 479 Japanese women with singleton pregnancies and a prepregnancy body mass index < 18.5 kg/m2 , who gave birth between 2013 and 2019 at Ohta Nishinouchi Hospital. The study included 22 (18 with preeclampsia and four with gestational hypertension) and 457 patients with and without hypertensive disorders of pregnancy, respectively. RESULTS: The prevalence of hypertensive disorders of pregnancy and preeclampsia was 4.6% and 3.8%, respectively. With weight gain during pregnancy (continuous variable) set as a reference, multiple logistic regression revealed that excessive weight gain during pregnancy increased the risk of preeclampsia (adjusted odds ratio: 1.13, 95% confidence interval: 1.00-1.28, p < 0.05) and hypertensive disorders of pregnancy (adjusted odds ratio: 1.15, 95% confidence interval: 1.03-1.29, p < 0.05). Based on receiver operating characteristic curve analyses (area under the curve 0.65, 95% confidence interval: 0.50-0.80; p < 0.05), we determined the cutoff value of weight gain during pregnancy for the occurrence of preeclampsia among women with body mass index < 18.5 kg/m2 to be 13.0 kg, with sensitivity and specificity of 0.50 and 0.78, respectively. CONCLUSION: This study indicates that excessive weight gain during pregnancy increases preeclampsia risk among underweight women and provides new recommendations for weight gain during pregnancy for such women. Further research regarding the pathogenesis of preeclampsia for underweight women is warranted.

Tubo-ovarian abscess in a patient with cri du chat syndrome: A case report.

A tubo-ovarian abscess is an infection that occurs as a sequela of pelvic inflammatory disease. There is no reported association between a tubo-ovarian abscess and cri du chat syndrome in the medical literature. Herein, we report the case of a 44-year-old woman with cri du chat syndrome who was subsequently diagnosed with a tubo-ovarian abscess. After emergent laparotomy, simple total hysterectomy, and bilateral adnexectomy, the patient was discharged 13 days postoperatively without complications.

Maternal disease activity and serological activity as predictors of adverse pregnancy outcomes in women with systemic lupus erythematosus: a retrospective chart review.

PURPOSE: To evaluate the association between disease activity, serological activity, and adverse pregnancy outcomes (APOs) in women with systemic lupus erythematosus (SLE) and determine the cut-off values of complements to predict APOs in live birth cases. METHODS: This retrospective chart review included pregnant women with SLE who had singleton live births after 22 weeks between 2006 and 2020. First trimester maternal disease activity was assessed for SLE onset during pregnancy, antiphospholipid syndrome, SLE pregnancy disease activity index (SLEPDAI), disease flare-ups, lupus nephritis, pancytopenia, and daily prednisolone dosage. Serological activity was assessed for autoantibodies and complements. APOs included preterm birth (PTB), low birth weight infants, small-for-gestational age infants, preterm premature rupture of membranes, and preeclampsia (PE). Chi-square and Fisher's exact tests were used to compare categorical variables; a receiver-operating characteristic analysis was performed to calculate the cut-off values of complements to predict APOs. RESULTS: Fifty-two participants met the inclusion criteria. The incidence of PTB and PE was associated with a high SLEPDAI (p < 0.001, p = 0.001), disease flare-ups (p = 0.007, p < 0.001), lupus nephritis (p = 0.020, p = 0.012), anti-dsDNA antibodies (p = 0.047, p = 0.016), anti-SSA antibodies (p = 0.003, p = 0.004), low CH 50 (p < 0.001, p < 0.001), low C3 (p < 0.001, p < 0.001), and low C4 (p < 0.001, p = 0.001), respectively. The cut-off values of C4 to predict PTB and PE were 13.0 mg/dL (higher than the normal lowest limit). CONCLUSION: High maternal disease activity and high serological activity in the first trimester in women with SLE are significantly associated with APOs. Proper disease control and close management for hypocomplementemia are required for better perinatal outcomes.

Association of placenta previa with placental size in Japanese women: A study from a single tertiary referral center.

AIM: The effect of placenta previa on age-specific placental size has not yet been elucidated. This study aimed to examine the effect of placenta previa on the Japanese standardized z-scores of placental size. METHODS: This retrospective cohort study included Japanese participants from Ohta Nishinouchi Hospital with single pregnancies who gave birth during 2013-2019. The participants were categorized into two groups based on the presence or absence of placenta previa. Multiple linear regression analyses were used to identify the association of placenta previa with the z-score of placental size, after adjusting for factors, such as maternal smoking status, maternal age, assisted reproductive technology, myoma uteri, uterine anomaly, maternal hypertension at the time of pregnancy, and body mass index before pregnancy. RESULTS: A total of 4071 Japanese women (76 with placenta previa and 3995 without placenta previa) were identified. Placenta previa significantly increased the placental weight z-score (partial regression coefficient: 0.44, 95% confidence interval 0.10-0.70, p < 0.001). CONCLUSION: Placenta previa increased the age-specific placental size. Further studies are required to examine whether placenta previa is associated with the risk of obstetrics complications related to the placental size.

Effect of gestational weight gain on placental weight: A single tertiary referral center study of Japanese women.

AIM: The effect of gestational weight gain on placental weight has not been elucidated. We aimed to examine the effect of body weight gain during pregnancy on the Japanese standardized z-score of placental weight, based on the pre-pregnancy body mass index. METHODS: This retrospective cohort study included Japanese women with singleton pregnancies who gave birth during 2013-2019 at Ohta Nishinouchi Hospital. Participants (n = 3610) were categorized by their pre-pregnancy body mass index: G1 (<18.5 kg/m2 ), G2 (18.5 to <20.0 kg/m2 ), G3 (20.0 to <23.0 kg/m2 ), G4 (23.0 to <25.0 kg/m2 ), and G5 (≥25.0 kg/m2 ). Multiple linear regression analysis was used to identify associations between insufficient or excessive gestational weight gain in each body mass index category and z-score of placental weight, with adjustments for maternal age, assisted reproductive technology, and maternal pre-pregnancy conditions, such as hypertension, diabetes mellitus, myoma uteri, and uterine anomalies. RESULTS: Among the 3610 women assessed, 479, 692, 1292, 435, and 711 were in G1-G5, respectively. In G1, G3, and G4, excessive weight gain increased the placental weight z-score ([B: 0.50, 95% confidence interval [CI]: 0.23-0.76], [B: 0.19, 95% CI: 0.19-0.33], and [B: 0.18, 95% CI: 0.10-0.26]). Insufficient weight gain decreased the placental weight z-score in G3 (B: -0.19, 95% CI: -0.33 to -0.06) and G4 (B: -0.21, 95% CI: -0.29 to -0.13) women. CONCLUSION: The effect of weight gain during pregnancy on placental size varies by pre-pregnancy body mass index. This result may guide personalized pre-conception counseling to improve the outcomes of offspring.

First trimester heterotopic pregnancy with shock treated laparoscopically, followed by uneventful term pregnancy and normal birth.

Heterotopic pregnancy (HP), a coexistence of intrauterine and ectopic pregnancies, is extremely rare. Although there have been many reports of maternal outcomes in pregnant women with HP, they have not described fetal neurodevelopmental outcomes and survival. A 30-year-old Japanese woman in early gestation who had undergone two previous cesarean deliveries was transferred to our hospital with vital signs of shock. HP was confirmed by ultrasonography and laparoscopic surgery, and right salpingectomy was performed. At term, a 2,875 g neonate was delivered via cesarean section without any complications.

Unexpected placenta accreta spectrum after the use of assisted reproductive technology in women with adenomyomectomy.

Placenta accreta spectrum (PAS) is a rare complication that can lead to life-threatening postpartum hemorrhage. PAS can sometimes occur unexpectedly, without placenta previa;such cases can lead to higher maternal mortality and morbidity than expected cases. Here, the authors report a case of unexpected PAS caused by assisted reproductive technology (ART) in a woman with adenomyosis. The patient was a 37-year-old Japanese primipara woman who presented to our hospital at 11 weeks gestation, later returning to her parents' house to give birth. The woman had adenomyosis and underwent adenomyomectomy, which was followed by an ART pregnancy. The patient was admitted to our hospital because of a life-threatening preterm birth, with a short cervix and no evidence of placenta previa. Despite strict perinatal management, preterm rupture of the membrane (PROM) occurred. During laparotomy, the small intestine, rectum, and both right and left ovaries were clumped together and severely adhered to the surface of the uterus. After delivery, manual partial removal of the placenta was performed, resulting in heavy bleeding from the implantation site, which was diagnosed as an unexpected PAS. Following several uterine compression efforts, we successfully preserved the uterus.

Effect of magnesium sulfate on baroreflex during acute hypoxemia in chronically instrumented fetal sheep.

AIM: To investigate the effects of magnesium sulfate on fetal baroreflex in normoxemia or acute fetal hypoxemia. METHODS: Fetal baroreflex response was elicited using phenylephrine (30 µg) in saline and magnesium sulfate in 8 chronically treated and instrumented fetal sheep. Hypoxemia was induced using nitrogen gas inflow for 30 min. Baroreflex, calculated as the ratio of the fetal heart rate change to the mean arterial pressure, was monitored after magnesium sulfate administration and in rapid and nonrapid eye movement (NREM) sleep states. Baroreflex was assessed in response to hypoxemia in control groups in both the rapid and NREM sleep states. RESULTS: Baroreflex was not significantly affected by saline, magnesium sulfate and rapid or NREM sleep states in normoxemic sheep. Hypoxemia increased the baroreflex in the saline-treated group (hypoxemic vs normoxemic rapid eye movement sleep: 4.37 ± 2.48 vs 2.72 ± 0.83; P < 0.05; hypoxemic vs normoxemic NREM sleep: 4.30 ± 1.47 vs 3.15 ± 0.83; P < 0.001). Magnesium sulfate decreased the baroreflex in the hypoxemic fetuses (magnesium sulfate hypoxemic vs. control normoxemic fetuses: 1.42 ± 0.92 vs 3.15 ± 0.83, P < 0.05). CONCLUSION: The hypoxemic fetal sheep, from the ewes that were receiving magnesium sulfate, showed a significantly reduced in the baroreflex response. In clinical practice, baroreflex-related decelerations in hypoxemic fetuses of mothers receiving magnesium sulfate should be carefully interpreted.

Successful management of preoperatively diagnosed torsion of a subserosal uterine fibroid by pneumoperitoneum laparoscopic single-port surgery.

OBJECTIVE: Preoperative diagnosis and successful management of acute torsion of a subserosal fibroid by using appropriate imaging modalities and single-port laparoscopic surgery. CASE REPORT: A 44-year-old nulliparous woman presented with lower abdominal pain. Computed tomography and magnetic resonance imaging with contrast enhancement revealed a tumor in the pouch of Douglas with a low contrast at the center and thin-rim enhancement. Torsion of a uterine subserosal fibroid was diagnosed preoperatively. Laparoscopic single-port surgery by pneumoperitoneum was performed. Torsion of the pedicle attached to the uterine wall was excised by bipolar coagulation and cut with scissors. The extirpated fibroid was extracted from the umbilical wound. The pneumoperitoneum single-port laparoscopic surgery was completed as a gynecologic emergency operation. CONCLUSION: Torsional uterine fibroids are difficult to diagnose preoperatively as symptoms are nonspecific and need emergent surgical management as an acute abdomen. Preoperative diagnosis using appropriate imaging modalities is important to perform single-port laparoscopic surgery.

Association of amniotic fluid sludge with preterm labor and histologic chorioamnionitis in pregnant Japanese women with intact membranes: A retrospective study.

AIM: The presence of amniotic fluid sludge has been identified as a risk factor for preterm birth. We sought to validate the clinical characteristics of amniotic fluid sludge in Japanese pregnant women with preterm labor and intact membranes. METHODS: This was a retrospective study of 54 patients. The presence of amniotic fluid sludge was confirmed using transvaginal ultrasonography data during pregnancy. The following data were collected: gestational age, the presence of histologic chorioamnionitis, time from the diagnosis of threatened premature labor to delivery, oncofetal fibronectin (onfFN) levels, C-reactive protein peak value levels, cervical length at the time of onset of threatened premature labor and types of neonatal complications. RESULTS: Significant differences (P = 0.03) were observed in the age at delivery in relation to the presence of amniotic sludge: delivery occurred at 28.3 ± 4.5 weeks and 31.7 ± 4.3 weeks in sludge positive patients and sludge-negative patients, respectively. Presence of sludge in patients diagnosed with histological chorioamnionitis at <37 weeks of gestation differed significantly (P = 0.01): sludge-positive, 81.8%; sludge-negative, 20.9%. Among the sludge-positive patients, 100% were positive for serum onfFN (≥50 ng/mL), whereas only 54% of sludge-negative patients were positive for serum onfFN (P = 0.03). Presence of amniotic fluid sludge did not significantly affect neonatal complications. CONCLUSION: Our results confirmed previous findings that amniotic fluid sludge is a self-determining risk factor for preterm birth and chorioamnionitis in pregnant Japanese women.

Establishing a Treatment Algorithm for Puerperal Genital Hematoma Based on the Clinical Findings.

Postpartum hemorrhage within 24 hours after delivery remains the leading cause of maternal mortality worldwide. Puerperal genital hematoma (PGHA) is a rare complication of postpartum hemorrhage, and PGHA can be life-threatening if hemostasis is not properly achieved. However, a reliable management algorithm for PGHA based on the clinical findings has not been developed. The objectives were to evaluate the management strategies for PGHA and identify the clinical findings that help select the treatment for PGHA. The medical records of women who were treated for PGHA in our department were reviewed, and data regarding the clinical findings and the treatment strategy for PGHA were analyzed. Thirty-four women who underwent treatment for PGHA were identified and divided into three groups according to the final procedure that achieved hemostasis: conservative management (CM) (n = 9), surgical management (SURG) (n = 15), and arterial embolization management (AEM) (n = 10). Regarding the clinical findings on initial evaluation, the shock index was significantly higher in the AEM group than in the CM or SURG group; and initial platelet count and fibrinogen level were significantly lower in the AEM group than in the CM group. There was no significant difference in any computed tomography (CT) finding among the three groups. In conclusion, this study clearly shows the difference in clinical findings among treatment strategies for PGHA. We suggest that the clinical findings of shock index, platelet count, and fibrinogen level together with CT findings are helpful and valuable for selecting the treatment strategy for PGHA.

The change of fetal heart rate short-term variability during the course of histological chorioamnionitis in fetal sheep.

OBJECTIVE: Histological chorioamnionitis (CAM) is related to neonatal mortality and morbidity. However, identifying intrauterine inflammation before delivery is challenging. The aim of this study was to investigate the changes in fetal heart rate (FHR) short-term variability (STV) during the course of histological CAM. STUDY DESIGN: Changes in STV were measured in 7 chronically instrumented fetal sheep at 111-120 days of gestation. Lipopolysaccharide (LPS) was infused into the amniotic cavity for 2 days following the 4th postoperative day to develop histological CAM. STV was determined based on the R to R interval of the fetal electrocardiogram. We continued to observe the changes in STV until the time of intrauterine fetal death (IUFD). The umbilical cord and fetal membranes were evaluated histologically after IUFD. The experiment was divided into two phases: 1) the acute phase, defined as the 24-hour period between the first and second injections of LPS and 2) the perimortem phase, defined as the period between the second injection of LPS and IUFD. Changes in STV in both the acute and perimortem phases were evaluated using Friedman's test. A probability of <0.05 was accepted as statistically significant. RESULTS: The fetuses died, on average, at 23.7 ±â€¯4.9 h after the second injection of LPS. Both the umbilical cord and fetal membranes showed histological evidence of severe inflammation. During the perimortem phase, there were statistically significant differences in STV at each time point. STV increased significantly at 6, 4, and 3 h before intrauterine fetal death compared to the baseline. CONCLUSION: Our study suggests that STV increased as the fetal condition deteriorated during the course of histological CAM.