Difference in reproductive performance between two subtypes of bicornuate uterus.

PURPOSE: We compared reproductive outcome in patients with two subtypes of bicornuate uterus who underwent a Strassmann metroplasty procedure. METHODS: Eleven patients diagnosed using the R-AFS definition were divided into partial and complete type, then reproductive outcome following a Strassmann metroplasty was evaluated. RESULTS: All four patients with the partial type anomaly conceived and achieved a live birth, while none of the seven with the complete type anomaly were able to conceive. CONCLUSION: Patients with the partial type of bicornuate uterus showed a favorable prognosis after a Strassmann metroplasty. Conversely, those with the complete type should be treated as uterus didelphis, and not undergo a metroplasty.

Association of uterine wall thickness with pregnancy outcome following uterine-sparing surgery for diffuse uterine adenomyosis.

BACKGROUND: The risk of uterine rupture is a major concern for women who become pregnant after undergoing an adenomyomectomy. AIMS: The aim of this study was to investigate the association of uterine wall thickness with pregnancy outcome. MATERIALS AND METHODS: Uterine wall thickness was measured using sonography and/or magnetic resonance imaging in 23 pregnant women who underwent uterine-sparing surgery for diffuse uterine adenomyosis prior to conception. RESULTS: Of the 23 women, 10 (43.5%) had an early miscarriage and 13 (56.5%) proceeded to delivery. Of the ten early miscarriage cases, two had a uterine rupture caused by excision of the uterine wall to within 7 mm. CONCLUSIONS: Wall thickness of the excised uterus was highly associated with uterine rupture. We concluded that optimum wall thickness for conception and preventing uterine rupture during pregnancy may range from 9 to 15 mm.

New myomectomy technique for diffuse uterine leiomyomatosis.

AIM: The aim of this study was to determine the effects of a new myomectomy technique for diffuse uterine leiomyomatosis. MATERIAL AND METHODS: To enucleate multiple myomas, we developed a novel myomectomy technique involving longitudinal dissection of the uterus in the midline. On each side of the anterior and posterior walls, the uterine wall was further divided into two pieces from the incision site. Myomas were separated into serosal and mucosal sides, and then enucleated for removal from the thinned myometrium. RESULTS: This procedure was applied for seven patients with diffuse leiomyomatosis. The mean number of myomas enucleated from each patient was 117 (range, 74-226). Mean total weight of enucleated myomas was 147.6 g (range, 59-360 g). Mean operative time was 284 min (range, 212-407 min). Mean blood loss was 1614 g (range, 428-4421 g), with three patients requiring blood transfusion. Anemia due to menorrhagia improved in all women. Three patients became pregnant, with two undergoing cesarean section after a normal course of pregnancy and giving birth to healthy babies. The third pregnancy ended in miscarriage. We noticed intraoperatively that myoma nodules were connected to each other in every case. CONCLUSIONS: This procedure should be considered as a therapeutic option in women suffering from symptoms of diffuse uterine leiomyomatosis who wish to avoid hysterectomy.

Diffuse uterine leiomyomatosis in patient with successful pregnancy following new surgical management.

Diffuse uterine leiomyomatosis is associated with significant infertility and miscarriage complications. Appropriate diagnosis and therapy is essential. A 33-year-old woman was referred to our hospital because of GnRH analogue treatment-resistant multiple myomas and infertility. Following new technical myomectomy, she conceived spontaneously and delivered a 2,470 g healthy baby by cesarean section. New technical myomectomy may become an important conservative treatment option for patients with diffuse uterine leiomyomatosis.

Longitudinal follow up of delayed eclampsia using cerebroangiography.

A 33-year-old primigravida experienced a delayed eclamptic convulsion. Following the convulsion, an i.v. administration of magnesium sulfate was utilized in response to cerebroarterial vasospasms, which were seen before and 1 week after the convulsion. Our findings confirm that the appropriate use of magnesium sulfate is necessary in such cases.

Effect of insulin resistance improvement due to lifestyle intervention on overweight perimenopausal Japanese women: a preliminary study.

OBJECTIVE: We hypothesized that body composition and biomarkers of menopausal obesity would be affected by administration of a nutrition and exercise regimen. To test this hypothesis, an interventional study was performed in which perimenopausal subjects increased their daily level of physical activity and decreased their daily caloric intake for a period of 12 weeks. METHOD: Nine patients with a chief complaint of obesity and menopausal disorders were enrolled in this study. We prescribed that the subjects engage in the daily physical activity of walking more than 10,000 steps, which is equivalent to 150 to 400 kcal per day, and reduce their daily nutritional intake by 200 kcal. Daily physical activity was measured with a computerized accelerometer, and nutrition intake was measured using food frequency questionnaires. Body composition was measured via biophysical impedance analysis. Biochemical examinations were performed before and after the study. As an assessment of glucose tolerance, homeostasis model assessment-insulin resistance (HOMA-IR) values were measured. RESULTS: There were no significant changes in weight, body mass index, or body composition after 12 weeks. However, daily physical activity related to energy consumption was slightly but not significantly increased. Six of the nine subjects (66.7%) had abnormal baseline HOMA-IR values (mean 7.0 +/- 2.6; normal upper limit = 1.5) and demonstrated decreases in HOMA-IR values, with an average of 5.2 +/- 2.3 (P <0.05), after 12 weeks of study. CONCLUSION: Our mild intervention on daily physical activity and nutrition changed HOMA-IR values, an assessment of impaired glucose tolerance. These results suggest that longitudinal mild intervention on daily physical activity and nutrition could change insulin sensitivity even without weight reduction.

Maternal basal metabolic rate in twin pregnancy.

OBJECTIVE: This study examined the basal metabolic rate in patients with twin pregnancies and compared the results with those of singleton pregnancies and non-pregnant women. METHODS: In 15 non-pregnant women, 14 patients with twin and 25 patients with singleton pregnancies, the resting energy expenditure was measured using an open-circuit ventilatory system during the third trimester of pregnancy. RESULTS: The averaged resting energy expenditure in patients with twin pregnancy was 1,636 +/- 174 kcal/day, significantly higher than that in patients with singleton pregnancy (1,456 +/- 158 kcal/day; p < 0.05). Both of these levels are significantly higher than those in non-pregnant women (1,228 +/- 132 kcal/day; p < 0.05). CONCLUSION: Our results indicate that the estimated increased metabolic demands in patients during the third trimester of twin pregnancy are about 10% higher than those in women with singleton pregnancy. A prospective clinical study concerning nutrition counseling is needed.

Resting oxygen consumption in patients with twin pregnancy.

OBJECTIVE: This study examined the resting oxygen consumption in patients with a twin pregnancy and compared the results with those of singleton pregnancies. METHODS: In 15 patients with a twin and 26 patients with a singleton pregnancy, the resting oxygen consumption was measured using an open-circuit ventilatory system during the third trimester of pregnancy. RESULTS: The average resting oxygen consumption in patients with a twin pregnancy was 231+/-25 ml/min, significantly higher than that in patients with a singleton pregnancy (209+/-24 ml/min, P<0.05). CONCLUSION: Our results indicate an estimated increase in metabolic rate in patients during the third trimester of a twin pregnancy compared with those with a singleton pregnancy.

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.

Basal metabolic rate in hyperemesis gravidarum: comparison to normal pregnancy and response to treatment.

OBJECTIVE: The aim of the study was to measure resting minute ventilation and oxygen consumption in patients with hyperemesis gravidarum before and after treatment and to compare the results with those of normal pregnant women. STUDY DESIGN: Baseline evaluation was performed with the use of an open-circuit ventilatory system in 17 hospitalized patients with hyperemesis gravidarum and was repeated 1 week after treatment. Thirty-seven normal pregnant women served as control subjects. RESULTS: Resting minute ventilation and oxygen consumption were decreased by 20% and 15% (P <.001), respectively, in patients with hyperemesis compared with control subjects. The decrease occurred despite a measurable increase of free thyroxine compared with normal pregnancy. Treatment resulted in a 10% increase in oxygen consumption in those patients with increased thyroid stimulation, but not otherwise. CONCLUSION: Resting oxygen consumption is reduced significantly in patients with hyperemesis gravidarum that is consistent with a state of partial starvation rather than increased in parallel with increases of thyroid axis activity.

The T-helper 1/T-helper 2 balance in peripheral blood of women with hyperemesis gravidarum.

OBJECTIVE: The purpose of this study was to evaluate the T-helper 1/T-helper 2 balance and its relation with pregnancy-related hormones in hyperemesis gravidarum. STUDY DESIGN: The T-helper 1/T-helper 2 ratio and plasma progesterone and estrogen levels were examined in the peripheral blood of 22 women with hyperemesis gravidarum and normal pregnancies. The proportion of CD4-positive cells that expressed intracellular cytokines (interferon gamma and interleukin-4) were analyzed by blood flow cytometry. The ratio of interferon gamma-secreting cells to interleukin-4-secreting cells was taken as the T-helper 1/T-helper 2 ratio. RESULTS: In hyperemesis gravidarum, the proportions of interleukin-4-secreting cells increased, and the T-helper 1/T-helper 2 ratio averaged 8.4 +/- 0.9, which was significantly lower than in normal pregnancy (11.6 +/- 1.1, P <.05). The changes in the T-helper 1/T-helper 2 ratio in hyperemesis gravidarum were accompanied by the elevation of progesterone and estrogen levels. CONCLUSION: A further shift of the T-helper 1/T-helper 2 balance to the T-helper 2 dominance in hyperemesis gravidarum may be related to the increase of progesterone and estrogen levels.

Plasma 5'-nucleotidase activities increase in women with hyperemesis gravidarum.

OBJECTIVES: To investigate plasma activities of 5'-nucleotidase, a key enzyme in the production of adenosine and evaluate the relationship between changes in 5'-nucleotidase activities and pregnancy-related hormones, estrogen, progesterone and human chorionic gonadotropin (hCG) in women with hyperemesis gravidarum. DESIGN AND METHODS: Plasma 5'-nucleotidase activities and estradiol, progesterone and hCG levels were measured in 21 women with hyperemesis gravidarum and normal pregnancies, matched for age, parity and gestational week. RESULTS: In women with hyperemesis gravidarum, plasma 5'-nucleotidase activities averaged 8.1 +/- 0.6 IU/L, which were significantly increased compared to those in normal pregnant women (5.5 +/- 0.5 IU/L)(p < 0.05). The increases in plasma 5'-nucleotidase activities were accompanied by elevations of plasma estradiol, progesterone and hCG levels. CONCLUSIONS: The increase of plasma 5'-nucleotidase activities may be at least partly attributed to elevations of pregnancy-related hormones, suggesting changes in purine metabolism in women with hyperemesis gravidarum.

Plasma nitric oxide levels and the expression of P-selectin on platelets in preeclampsia.

OBJECTIVE: The purpose of this study was to investigate the correlation of plasma nitric oxide levels with the expression of P-selectin on platelets in preeclampsia. STUDY DESIGN: Plasma levels of nitrite and nitrate (the stable nitric oxide metabolites) and the expression of P-selectin on platelets (a platelet activation marker) were measured in 25 normal pregnant women and 25 women with preeclampsia. The effects of the inhibition of nitric oxide synthesis on the expression of P-selectin also was measured in vitro. RESULTS: Plasma nitrate levels and the expression of P-selectin averaged 30.5 +/- 2.2 micromol/L and 8.9% +/- 1.1% (SEM), respectively, in preeclampsia, which was significantly higher than in normal pregnancy (P <.05). Nitric oxide synthesis inhibition in vitro significantly increased the expression of P-selectin in normal pregnancy by 284% (P <.05), which was significantly higher than in preeclampsia (156%, P <.05). CONCLUSION: The inhibitory effects of increased nitric oxide on the expression of P-selectin is attenuated in preeclampsia, which may contribute partly to the pathogenesis of preeclampsia.

Serum adenosine deaminase activity in women with hyperemesis gravidarum.

BACKGROUND: Serum adenosine deaminase (ADA) activity increases in diseases where cellular immunity is stimulated. Since hyperemesis gravidarum is characterized by enhanced cell-mediated immunity, serum ADA activity may be altered. The present study evaluated the relation between serum ADA activity and changes in cell-mediated immunity as causes of changes in ADA activity in hyperemesis gravidarum. METHODS: Serum activities of total ADA and its isoenzymes, ADA1 and ADA2, were measured in women with hyperemesis gravidarum (n = 24) and normal pregnancies (n = 24). Peripheral blood lymphocyte and monocyte counts were also measured. RESULTS: In hyperemesis gravidarum, serum total ADA and ADA2 activities averaged 16.8 +/- 0.5 and 13.3 +/- 0.7 U/l, respectively, which were significantly higher than those in normal pregnancies (10.2 +/- 0.5 and 7.8 +/- 0.5 U/l, respectively) (p < 0.05). The mean values for ADA1 activity in women with hyperemesis gravidarum and normal pregnancies were similar. The increase in total ADA activity was accompanied by the increase in lymphocyte and monocyte counts. CONCLUSIONS: These results suggest that increased serum total ADA activity reflects increases in ADA2 activity, which may be at least in part attributed to enhanced cell-mediated immunity in hyperemesis gravidarum.

The current perception thresholds in normal pregnancy.

The purpose of this study was to evaluate a quantitative analysis of the nociceptive threshold, using the current perception threshold (CPT), in women with normal pregnancies and to assess the relationship between nociceptive thresholds and ovarian sex steroids. The subjects consisted of 10 women with singleton pregnancies and 14 age-matched healthy female volunteers. The CPTs (5,250, and 2,000 Hz) of the dominant ankle section were determined with a Neurometer CPT/C (Neurotron, Baltimore, MD). Blood samples were collected after these examinations, and the total 17beta-estradiol (E(2)) and progesterone concentrations in sera were measured. The present findings clearly indicated that the CPTs at 2,000 Hz in women at term in normal pregnancies were significantly higher than those in nonpregnant women (p<0.05). At 5 and 250 Hz, there was no significant difference between pregnant and nonpregnant women. While there was also no significant correlation between CPT and E(2), and progesterone, there was significant correlation between CPT and the ratio of 17 beta-estradiol/progesterone (E(2)/P) at 2,000 Hz (p<0.05, r=0.67). We suggest from these data that changes in pressure sensitivity occur at term in pregnancy, and that other factors, possibly stimulated by both E(2) and progesterone, may play an important role in this change.

Resting energy expenditure in pregnant Japanese women.

The subjects were 160 pregnant women with no complications who were examined with indirect calorimetry by a single observer; 20 healthy age-matched non-pregnant women were used as controls. Assessment was performed 12 hours after oral intake of food. Each measurement of resting energy expenditure divided by the body surface area was analyzed and compared with that of the controls. In pregnant women, the mean resting energy expenditure divided by the body surface area did not significantly increase until 32 weeks' gestation. Energy expenditure increased significantly by about 300 approximately 600 kJ/m(2) between before 31 weeks' gestation and the end of pregnancy. Significant changes occurred in the 32 approximately 35 and 36 approximately 40 weeks' gestational stages (3,790+/-370,4,110+/-385 kJ/m(2)) (p<0.05). Resting energy expenditure increases at conception, and does not increase until 32 weeks' gestation, but increases gradually from 32 weeks' gestation to term in normal pregnant women as assessed by indirect calorimetry.

Relationship between plasma malondialdehyde levels and adenosine deaminase activities in preeclampsia.

BACKGROUND: Preeclampsia is characterized by endothelial cell dysfunction, and lipid peroxidation and alterations of immune responses may be involved in the pathogenesis of this disease. The aim of the present study was to examine changes in plasma malondialdehyde (MDA) level, an indicator of lipid peroxidation, and adenosine deaminase (ADA) activity, as a marker of T-cell activation in preeclampsia, and evaluated the possible relationship between those parameters in the pathogenesis of preeclampsia. METHODS: Plasma levels of MDA, an end product of lipid peroxidation induced by reactive oxygen species, and ADA activities were measured in 26 women with preeclampsia and 26 normal pregnancies. RESULTS: In preeclampsia, plasma MDA level and ADA activity averaged 0.43 +/- 0.03 micromol/l and 15.8 +/- 0.8 U/l, respectively, which were significantly higher than those of normal pregnancy (0.31 +/- 0.02 micromol/l and 9.5 +/ -0.6 U/l, respectively) (P<0.05). In addition, plasma MDA level was positively correlated to ADA activity in preeclampsia (r=0.52, P<0.05). CONCLUSIONS: These results suggest that enhanced lipid peroxidation and T-cell activation, and the presence of possible interrelationship and cross talk between those parameters may be related at least partly to the pathogenesis of preeclampsia.

Regulation of plasma adenosine levels in normal pregnancy.

The aim of this study was to investigate the possible mechanism of the regulation of plasma adenosine concentration [ADO] in normal pregnancy. We measured the activities of circulating enzymes that are involved in the production and metabolism of adenosine, and plasma [ADO] in nonpregnant (n = 14) and normal pregnant women (n = 14) in the third trimester. In pregnant women, the activity of plasma 5'-nucleotidase and plasma [ADO] were significantly elevated and plasma adenosine deaminase activity was significantly reduced. Enzymatic activities of both plasma enzymes appear to be changed in a way that would favor increased adenosine concentrations.

Serum adenosine deaminase activity in women with pre-eclampsia.

The present study investigated serum adenosine deaminase (ADA) activity and the patterns of two ADA isoenzymes, ADA1 and ADA2, and to evaluate the possible role of cell-mediated immunity as causes of the changes in ADA activity in pre-eclampsia. We measured serum activities of total ADA, ADA1 and ADA2 in pre-eclampsia (n = 22) and normal pregnancy (n = 22). Peripheral blood monocyte counts and neopterin levels, reflecting the activation of the monocyte-macrophage cell system, were also measured. In pre-eclampsia, serum total ADA and ADA2 activities were significantly increased compared with normal pregnancy (p < 0.05), which were accompanied by increases in serum neopterin levels. These results suggest that increased total ADA activity reflects increases in ADA2 activity, which may be in part related to enhanced cell-mediated immunity during pre-eclampsia.