Placental elasticity evaluation using virtual touch tissue quantification during pregnancy.

INTRODUCTION: Virtual touch tissue quantification (VTTQ) has been developed to evaluate tissue elasticity. Our previous study using delivered placentas showed increased elasticity in fetal growth restriction (FGR). Therefore, we investigated changes in placental elasticity during pregnancy, including complicated pregnancies. METHODS: Based on complications, 199 women were divided into 5 groups (normal, FGR, pregnancy induced hypertension (PIH), diabetes mellitus and collagen disease), and shear wave velocity (SWV) of the placenta, measured using VTTQ, was compared. A cross-sectional study was performed with the 143 normal cases to construct the reference range. The association between placental SWV and the expression ratio of collagen fibers in the placenta stained with Masson's trichrome was determined. RESULTS: The SWV was safely measured for all participants. The correlation between SWV and gestational weeks was not significant. The mean ± SD SWVs in the normal, FGR, and PIH groups were 0.98 ± 0.21, 1.28 ± 0.39, and 1.60 ± 0.45 m/sec, respectively. The FGR and PIH groups had significantly higher SWVs than that of the normal group. SWV and the expression ratio of collagen fibers were significantly correlated. DISCUSSION: Based on the present findings, changes in SWV during pregnancy were associated with placental fibrosis, and increased SWV in PIH and/or FGR cases might be influenced by infarction, ischemic changes, and inflammation, as well as fibrosis. In conclusion, the measurement of placental SWV is potentially useful to evaluate the condition of the placenta during pregnancy.

Increased antiangiogenetic factors in severe proteinuria without hypertension in pregnancy: is kidney biopsy necessary?

Acute onset of severe proteinuria during pregnancy obliges physicians to clinically discriminate between gestational proteinuria (GP) and new onset of nephritis. A multiparous woman developed severe proteinuria (5.8 g/day) without hypertension at 32 weeks of gestation. We measured the maternal level of soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sEng), which were extremely high (41.3 and 54.8 ng/ml, respectively), leading us to consider this condition as GP rather than acute onset of nephritis. Thus, we did not perform a kidney biopsy and did not administer a steroid agent. Non-reassuring fetal status required emergency Cesarean section at 33 weeks. Proteinuria decreased to 0.36 g/day at 12 weeks after delivery, and finally disappeared 26 weeks postpartum. Measurement of sFlt-1 and sEng in a pregnant woman with severe proteinuria without hypertension may assist in differential diagnosis of GP from acute onset of nephritis, and thus help to decide whether to perform kidney biopsy during pregnancy.

Gestational hypertension as a subclinical preeclampsia in view of serum levels of angiogenesis-related factors.

It is controversial whether gestational hypertension (GH) and preeclampsia (PE) have the same pathophysiology. Our aim was to clarify whether the serum soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio and levels of soluble endoglin (sEng) are different in women with GH and with PE. In women with GH (15 cases), hypertension preceding PE (h-PE, 10 cases) and PE in which hypertension and proteinuria occurred simultaneously (si-PE, 36 cases), blood samples were collected after disease onset. The levels of log(10)(sFlt-1/PlGF) in women with GH were significantly lower than in women with h-PE and si-PE (1.65±0.39 vs. 2.22±0.35 and 2.15±0.46). The levels of log(10)sEng in women with GH were also significantly lower than in women with h-PE and si-PE (1.51±0.43 vs. 1.87±0.21 and 1.85±0.32). The incidence rates of the sFlt-1/PlGF ratio 95th percentile of the reference value were 73, 100 and 92%, respectively, (P=0.080), and those of sEng 95th percentile were 67, 100 and 89%, respectively, (P=0.053). In conclusion, the levels of sFlt-1/PlGF ratio and sEng in women with GH were lower than in those with h-PE and with si-PE; however, the majority of women with GH showed abnormal increases of both sFlt-1/PlGF ratio and sEng, suggesting that GH may be a subclinical PE in view of serum levels of angiogenesis-related factors.

Manual separation followed by local cleanliness for pediatric labial adhesion.

AIM: Although labial adhesion is usually a benign disorder in childhood, it may occasionally be misdiagnosed as a severe disorder, causing parental anxiety. The present study was undertaken to analyze the clinical features, treatments employed and their effectiveness in pediatric patients with labial adhesion, with special emphasis on manual separation. METHODS: We reviewed the medical charts of pediatric patients with labial adhesion who were treated in our Pediatric Gynecology Division of the university hospital over 3.5 years. RESULTS: Eight pediatric patients received manual separation followed by local gentamicin ointment and washing. In all eight, manual separation remedied the condition at one visit without recurrence. CONCLUSION: Manual separation followed by local cleanliness not only remedied pediatric labial adhesion but also prevented its recurrence. Thus, it is an effective treatment for pediatric labial adhesion.

Placental site trophoblastic tumor (PSTT) with multiple metastases and extremely poor prognosis.

Placental site trophoblastic tumor (PSTT) is a rare type of gestational trophoblastic disease. There is a wide clinical spectrum of presentation and behavior ranging from a benign condition to an aggressive disease with a fatal outcome. PSTT limited to the uterus is in a good prognosis group, but PSTT with metastasis is a lethal disease. We document a case of PSTT with multiple metastases and extremely poor prognosis. A 36-year-old woman had abnormal irregular vaginal bleeding 14 months after her third pregnancy and delivery. The mitotic count of the tumor cells was quite high (23/10 high-power fields). It would have been difficult to remove the tumor by surgery because of the tumor size and its invasion, so we suggested chemotherapy. We treated her with EMA/CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) as a first-line regimen. During the sixth cycle of EMA/CO, the disease became drug-resistant and she died 8 months after the first symptom. This was a rare case among documented patients with PSTT with metastasis, with the patient having short-term survival (<1 year). We conclude that a high mitotic count and atypical undifferentiated pathological features are significant poor prognostic factors for survival in PSTT.

Mirror syndrome associated with hydropic acardius in triplet pregnancy.

UNLABELLED: Mirror syndrome is the association of triple edema, i.e. fetal, placental and maternal edema, with maternal preeclampsia. We here report the first case of mirror syndrome resulting from hydropic acardius in triplet pregnancy. METHODS/RESULTS: A 26-year-old nulliparous woman spontaneously conceived two living fetuses and one acardius, and suffered preterm rupture of the membranes at 23 2/7 weeks of gestation. We observed triple edema, hydropic acardius, placental edema, and maternal edema, together with maternal high blood pressure, proteinuria and low hematocrit, and therefore suspected the presence of mirror syndrome. Due to the prematurity of the fetuses, we closely observed her, awaiting fetal maturity. Three days later (23 5/7 weeks), cord prolapse occurred, leading to emergent cesarean section. Female infants, weighing 492 and 554 g, respectively, were born alive; the former died on the 13th postnatal day and the latter was healthy with no sequelae. An acardius weighing 860 g had vascular communication with the 492-gram fetus. Histological examination confirmed a monochorionic, triamniotic single placenta. The mother suffered from pulmonary edema and was treated in the intensive care unit under respiratory support, but soon improved. CONCLUSIONS: When dealing with multifetal pregnancy, especially when complicated by an acardius, obstetricians must have the highest level of concern for the occurrence of mirror syndrome, a life-threatening condition both to the mother and the fetus.