A pilot study and case reports on endometrial microbiota and pregnancy outcome: An analysis using 16S rRNA gene sequencing among IVF patients, and trial therapeutic intervention for dysbiotic endometrium.

PURPOSE: The present study aimed to analyze the pregnancy outcomes of IVF patients presenting Lactobacillus-dominated microbiota (LDM) or non-Lactobacillus-dominated microbiota (NLDM) of their endometrium and to report cases who were treated for NLDM concurrently with antibiotics and prebiotic/probiotic supplements in a Japanese infertile population. METHODS: Ninety-two IVF patients were recruited from August 2017 to March 2018. Endometrial fluid samples for sequencing were collected using an IUI catheter. The bacterial status of the endometrium and the pregnancy outcomes were analyzed. For cases with NLDM, antibiotics and prebiotics/probiotics were administered according to their individual microbial conditions. RESULTS: Forty-seven cases (51.1%) presented LDM and 45 cases (48.9%) presented NLDM at initial analysis. Nine Patients with NLDM were treated by antibiotics and prebiotics/probiotics, and successfully became Lactobacillus-dominant. Pregnancy rates by single vitrified-warmed blastocyst transfers were higher in the LDM group (58.9% per patient and 36.3% per FBT) than in the NLDM group (47.2% per patient and 34.7% per FBT) but not significantly different. CONCLUSION: The results of this study could not necessarily prove the clear benefit of establishing Lactobacillus-dominated endometrium in terms of pregnancy outcome, but there is significance in searching for endometrial microbial status of infertile patients and recovering Lactobacillus-dominated endometrium might benefit implantation.

[Anesthetic Management of Massive Postpartum Haemorrhage in Which Uterine Compression Sutures Were Used].

BACKGROUND: Uteline compression sutures which preserve portion of placenta tends to cause disseminated intravascular coagulation (DIC). But there have been no reports of anesthetic management of massive postpartum haemorrhage in which uterine compression sutures were used. METHODS: We reviewed the anesthetic management of 9 cases of massive postpartum haemorrhage in which uterine compression sutures were used in our hospital from May 2010 until Sep 2012. RESULTS: Seven cases were complicated by DIC (or the possibility of DIC) and required early infusion of blood products. Six cases required the use of ventilators. All cases recovered and were ultimately discharged. CONCLUSIONS: In the cases of massive postpartum haemorrhage in which uterine compression sutures were used, serious blood loss occurred during the operation, leading to a high probability of the development of DIC. Thus, it is necessary to manage DIC immediately.

Correlations between stress hormone levels in umbilical cord blood and duration of delivery.

Correlations between umbilical cord blood concentration of stress response hormone cortisol and prolactin, and delivery duration were examined. Thirty-three cases were selected in which both mothers and neonates were healthy, and the neonates were delivered at full term. The umbilical cord blood was collected at the time of delivery and concentrations of cortisol and prolactin were measured. The cortisol level was significantly higher after vacuum-assisted delivery than after spontaneous delivery (p=0.044). Significant positive correlations (p=0.0289) were observed between cortisol level and delivery duration. In particular, the duration of the second stage of delivery showed stronger positive correlation (p=0.0304) with the cortisol level. The prolactin level showed weak correlation with the duration of full delivery and the second stage of delivery. The findings suggest that foetuses may respond to stress by uterine contraction during delivery.

Successful living donor liver transplantation for fulminant hepatic failure that manifested immediately after cesarean delivery.

A 31-year-old pregnant woman was diagnosed as having acute hepatitis of unknown etiology and conservatively treated. An emergency cesarean delivery was performed 5 days later at 33 weeks and 3 days of gestation because of a gradual deterioration in liver function. Two days after the cesarean delivery, she lost consciousness in the evening (Glasgow coma scale [GCS] = 9) because of hepatic encephalopathy and was diagnosed as having fulminant hepatic failure (FHF). Five days after the cesarean delivery, the patient (blood type B) underwent a successful left lobe with caudate lobe (S1+2+3+4) liver transplantation from her father (blood type AB), an ABO-incompatible donor. At 1 year follow-up, she and her baby are in good medical condition. The drastic deterioration in hepatic function, despite intensive plasmapheresis and continuous hemodiafiltration, during the early postpartum period suggested a possible causative association between the termination of pregnancy and progression of FHF from acute hepatitis of unknown etiology.