Fetal therapy of severe symptomatic toxoplasmosis using azithromycin.

Severe symptomatic fetal toxoplasmosis rarely occurs after the maternal primary infection of Toxoplasma gondii. We herein report our experience of fetal therapy of symptomatic toxoplasmosis using azithromycin. Ultrasound assessment at 23 weeks' gestation revealed fetal ascites, cardiac effusion, cardiomegaly, enlarged lateral ventricles and thickened placenta. Serum Toxoplasma gondii antibody titer was ×81,920. Toxoplasma immunoglobulin M was 2.4 index (normal, <0.8 index), and immunoglobulin G was ≥240 IU/mL (normal, <6 IU/mL). Maternal oral administration of azithromycin in addition to sulfadoxine, pyrimethamine and acetylspiramycin was conducted. Spontaneous vaginal delivery occurred at 32 weeks and a male infant weighing 2036 g was born. Hepatosplenomegaly, chorioretinitis, hydrocephalus, intracranial calcifications, ascites, and meningitis were confirmed after birth. The infant underwent therapy with pyrimethamine and sulfadiazine. It seems imperative to establish a new drug choice for fetal therapy of severe symptomatic toxoplasmosis in order to reduce the maternal and fetal risks of drug side-effects.

Voronoi diagram description of the maternal surface of the placenta: preliminary report.

AIM: Voronoi diagram is defined as a diagram of a collection of geometric points that defines a partition of space into cells, each of which consists of the points closer to one particular point than to any other. The distinctive feature of a placentone is the fetomaternal circulatory unit which is composed of one villous tree with a corresponding, centrifugally perfused portion of the intervillous space. Based on this placental architecture, in this study we generated Voronoi diagram from the photographic images of the maternal surface of the placenta and compared them with the shapes of the actual placentones. MATERIAL AND METHODS: We simulated the placentones of 12 placentas based on Voronoi diagram using a computer program, and compared them with the photographic images of the actual maternal surface of the placentas. The point was carefully selected and adjusted so that the generated Voronoi diagram could represent the actual maternal surface of the placenta. RESULTS: Voronoi diagram simulated satisfactorily the borders of placentones in 10 placentas. However, we could not succeed in the simulation in two cases. CONCLUSION: It seems that development and formation of placentones are not only theoretically and physiologically explainable by Voronoi diagram, but also actually achieved by this mechanism. We believe that mathematical Voronoi diagram holds a promise for evaluating physiological and pathological development of the placenta.

Neurodevelopmental outcomes of very low birth weight and extremely low birth weight infants at 18 months of corrected age associated with prenatal risk factors.

BACKGROUND: Very premature infants occasionally have neurodevelopmental disabilities. However, there have been quite limited data on prenatal risk factors associated with their neurodevelopmental outcomes. AIM: To clarify the relationship between prenatal risk factors and neurodevelopmental outcomes of very premature infants. STUDY DESIGN: The study design is a retrospective review. SUBJECTS: One hundred seventy Japanese women with a singleton pregnancy and their infants whose birth weight being less than 1500 g were included. We classified those infants into 118 appropriate for gestational age (AGA) and 52 small for gestational age (SGA) infants. OUTCOME MEASURES: Infants' neurodevelopmental outcomes at 18 months of corrected age were evaluated by the Kyoto Scale of Psychological Development 2001 (KSPD). We analyzed and compared the infants' outcomes and prenatal risk factors between two groups. RESULTS: Mortality and rate of infants unevaluable by KSPD because of severe impairment were not significantly different between those groups. However, the developmental quotient score of the cognitive-adaptive area in SGA infants born between 25 and 31 weeks of gestation was significantly lower than that in AGA infants randomly selected as gestation-matched controls. More advanced gestational age and heavier birth weight protected against adverse neurodevelopmental outcomes in both groups. Moreover, male infants were related to the excess risk of adverse neurodevelopmental outcomes in the SGA group. CONCLUSION: In view of the neurodevelopment of the infants, it seems that the most efficient obstetric strategy for improving prognosis of premature infants should be targeted to prolong the pregnancy period as long as the reassuring fetal status and maternal stable health condition are being confirmed.