Pain in labor assessed from two discomfort aspects: Physical pain intensity and psychological stress state.

AIM: To assess two discomfort aspects of pain in labor, physical pain intensity and psychological stress state, we analyzed the association between the two parameters. METHODS: Twenty-nine pregnant Japanese women with a singleton in 37-40 weeks of gestation were analyzed. Physical pain intensity was examined by the Numeric Rating Scale (NRS). Psychological stress state was measured by chromogranin A (CgA) in saliva. Data were collected thrice during labor (at 4-6 cm and 10 cm of cervical dilatation and immediately after delivery) and were accumulated from 4-6 cm and 10 cm of cervical dilatation. The study was approved by the Ethics Committees of Osaka University and Tokyo Women's Medical University. RESULTS: The median NRS score (10, IQR = 10-18) and the median CgA in saliva (8.0, IQR = 4.3-12.0) pmol/mg at 10 cm of cervical dilatation were significantly higher than those at the other two time points (P < 0.05). Although there were no correlations between NRS scores and concentrations of CgA in saliva at the three time points, there was a significant correlation between accumulated NRS and accumulated CgA in saliva (r = 0.68, P = 0.000). There was a significant difference in the accumulated NRS scores (P = 0.005) but not in the accumulated concentrations of CgA between primiparae and multiparae. CONCLUSION: Women in labor perceived severe pain and psychological stress with similar patterns during labor. However, these parameters were independent and need to be measured to evaluate these two discomfort aspects.

Use of fondaparinux for thromboprophylaxis in an unfractionated heparin-intolerant pregnant woman with thrombotic predisposition.

A 34-year-old primigravida who had undergone thrombectomy for deep venous thrombosis (DVT) in her leg and exhibited low protein S activity, indicating predisposition to thrombosis, developed DVT of the leg. No pulmonary embolism was detected. After anticoagulant therapy with unfractionated heparin was discontinued because of liver dysfunction, danaparoid treatment was administered in hospital. The patient had a normal delivery after 39 weeks' gestation with no recurrence of thrombosis. During her second pregnancy four years later, she gave herself fondaparinux injections. She delivered normally after 38 weeks' gestation without experiencing DVT. Fondaparinux may be a useful anticoagulant for heparin-intolerant pregnant women.

Study for the improvement of umbilical cord blood sampling using a new trial apparatus.

AIM: The aim of this study was to evaluate the usefulness of the trial umbilical cord blood sampling bag for unrelated cord blood transplantation. MATERIAL AND METHODS: Data were obtained from 100 vaginal deliveries. In 50 cases, umbilical cord blood (UCB) was taken with the traditional Kawasumi type UCB sampling bag. In another 50 cases, UCB were taken with trial UCB sampling bag offered by NIPRO Co. We compared the sampling volume between the two groups. Furthermore, 10 cases in each group were matched by sampling volume; we examined the quality of UCB on the number and concentration of nucleated cells, mononuclear cells, CD34+ cells and colony-forming unit granulocyte macrophage and the numbers tested positive for bacteria. RESULTS: Whereas there were no significant differences in gestational weeks at sampling, the ratio of primipara women to multipara women, maternal age, and neonatal weight between the two groups, the sampling UCB volumes with the trial sampling bag were significantly higher than those with traditional sampling bags (P < 0.05). In addition, this phenomenon was more significant in the latter part of the study period (P < 0.05). On the other hand, there were no significant differences in the quality of UCB between the two groups. CONCLUSION: Once clinicians have become accustomed to the trial UBC sampling bag, this method might be a useful method for collecting UCB for unrelated cord blood transplantation.

High-temperature operation of gallium oxide memristors up to 600 K.

Memristors have attracted much attention for application in neuromorphic devices and brain-inspired computing hardware. Their performance at high temperatures is required to be sufficiently reliable in neuromorphic computing, potential application to power electronics, and the aerospace industry. This work focuses on reduced gallium oxide (GaOx) as a wide bandgap memristive material that is reported to exhibit highly reliable resistive switching operation. We prepared amorphous GaOx films to fabricate Pt/GaOx/indium tin oxide memristors using pulsed laser deposition. Stable resistive switching phenomena were observed in current-voltage properties measured between 300 and 600 K. The conduction mechanism analysis revealed that the resistive switching is caused by the transition between ohmic and space charge limiting current conductions. We elucidated the importance of appropriate control of the density of oxygen vacancies to obtain a high on/off resistance ratio and distinct resistive switching at high temperatures. These results indicate that GaOx is a promising memristor material that can be stably operated even at the record-high temperature of 600 K.

May-Thurner syndrome resulting in acute iliofemoral deep vein thrombosis during the second trimester of pregnancy.

Described is a 27-year-old pregnant woman with May-Thurner syndrome who experienced extensive pelvic and lower extremity thromboses during the antepartum period. The patient was referred for a symptomatic deep venous thrombosis at 23 weeks of gestation. Ultrasonography demonstrated a massive thrombus in the left iliofemoral vein. Heparin was given intravenously. Due to the possibility of pulmonary embolism during or immediately after delivery, a temporary inferior vena cava filter was inserted at 36 weeks of gestation. Labor was induced at 37 + 5 weeks of gestation; labor proceeded uneventfully and a male infant was born. Postpartum computed tomography (CT) demonstrated compression of the left common iliac vein by the right common iliac artery and lumbar vertebra. CT venogram demonstrated poor flow through the common iliac vein and well-developed collateral vessels. Critical stenosis at the origin of the left common iliac vein was consistent with a diagnosis of May-Thurner syndrome.

Neonatal periventricular leukomalacia without evidence of twin-to-twin transfusion syndrome following discordance in nuchal translucency: a case report.

We describe a case of neonatal periventricular leukomalacia (PVL) without evidence of twin-to-twin transfusion syndrome (TTTS) following discordance in nuchal translucency (NT). A 34-year-old woman with monochorionic twins after in-vitro fertilization and embryo transfer was referred to our hospital. At gestational week 11, fetus A showed increased NT (7.0 mm) and normal crown-rump length (CRL) (34.3 mm). Fetus B had normal values, with a NT of 1.3 mm and a CRL of 32.3 mm. Both twins maintained growth throughout pregnancy, with no evidence of TTTS. During the antepartum period, daily fetal heart rate monitoring showed a reassuring pattern. Cesarean delivery was performed in gestational week 32. Neonates A and B weighed 2,071 and 1,617 g, respectively (discordancy rate 21.9%), each with an Apgar score of 8 at 1 min. Soon after birth, brain ultrasonography of neonate A revealed high-echoic periventricular lesions bilaterally, and brain magnetic resonance imaging on day 7 revealed PVL. Neonate B showed completely unremarkable results.

Uterine rupture in the third trimester of a pregnancy subsequent to a cesarean section by transverse uterine fundal incision: A case report and literature review.

Cesarean section via a transverse uterine fundal incision is performed in patients with placenta previa to reduce blood loss. We describe a case of uterine rupture in a pregnant woman who previously underwent a cesarean section and recovered from cardiac arrest by multidisciplinary management.

Obstetrical risk factors for focal intestinal perforation in very low birth weight infants.

OBJECTIVE: Our objective was to determine the obstetrical risk for spontaneous focal intestinal perforation (FIP) in very low birth weight (VLBW) infants. METHODS: Eight mothers delivered infants who underwent laparotomy for FIP between 2001 and 2006 in our hospital. A retrospective case-control study of the eight case mothers and 32 control mothers was conducted. Clinical findings were retrospectively analyzed. RESULTS: There were significant differences in the frequency of oligohydramnios (P<0.01) and velamentous cord insertion (P<0.05) between cases and controls. The 1-min Apgar score was significantly lower in the FIP group than in the control group (P<0.05). Moreover, primigravidity was significantly associated with a risk of FIP. CONCLUSIONS: The etiology of FIP may be related to changes in the blood circulation, such as fetal hypoxic-ischemic episodes or disturbance in the umbilical blood flow, during the antepartum and/or intrapartum periods.

Pheochromocytoma-related cardiomyopathy during the antepartum period in a preterm pregnant woman.

We report a rare case of pheochromocytoma-related cardiomyopathy during the preterm period. The patient was a 33-year-old woman who was referred to our hospital at 34 weeks' gestation. Her pulse was 130 beats/min, blood pressure of 186/90 mmHg and oxygen saturation was 30-40%. Fetal bradycardia prompted an emergency cesarean section and, nine minutes after admission, a boy weighing 2774 g was delivered with Apgar scores of 2 at 1 min and 5 at 5 min. A preoperative echocardiogram showed reduced fractional shortening of 19%. At 8 h after the operation, cardiac arrest developed. An intra-aortic balloon pump and percutaneous cardiopulmonary support were inserted, and continuous hemodiafiltration was also commenced, after which her cardiac function and respiratory function gradually improved. Urinary catecholamine levels were elevated and abdominal computerized tomography confirmed the presence of a right suprarenal mass. Four months after delivery, she underwent a laparoscopic adrenalectomy and the mass was found to be a pheochromocytoma.

Rhabdomyolysis caused by tocolytic therapy with oral ritodrine hydrochloride in a pregnant woman with placenta previa.

Oral-ritodrine-hydrochloride-induced rhabdomyolysis is rare. We report a case of oral-ritodrine-hydrochloride-induced rhabdomyolysis in a pregnant woman with placenta previa without neuromuscular disorders. The patient was a 30-year-old, Japanese primigravida woman, who became pregnant spontaneously. At 23 gestational weeks, she was diagnosed as having placenta previa and prophylactic oral ritodrine hydrochloride (15 mg/day) was initiated. At 29 1/7 gestational weeks, she was referred to our hospital for perinatal management of placenta previa. Two days thereafter, vaginal bleeding accompanied by frequent uterine contractions occurred and she was admitted. On admission, laboratory tests revealed an abnormal increase of blood creatine kinase (CK) value of 7200 IU/L. CK-MB isoenzyme was 208 IU/L. Aspartate transaminase (163 IU/L), alanine transaminase (74 IU/L) and lactate dehydrogenase (536 IU/L) levels were also increased. The patient started to complain of extreme muscle pain in her upper and lower limbs and general weakness. The next day, laboratory tests revealed a tremendous increase of blood CK level of 87,300 IU/L, a blood myoglobin level of 11,200 ng/mL, and a urinary myoglobin level of 615 ng/mL. An emergency cesarean section was carried out. After delivery, the laboratory data improved gradually with the CK levels at 107 IU/L. If patients complain of muscular symptoms following oral ritodrine hydrochloride use, physicians should consider rhabdomyolysis.

Successful management of pregnancy and delivery in a woman with multiple coronary stenoses of unknown cause.

We describe the case of a 30-year-old primiparous woman who had multiple coronary stenoses of unknown cause, and discuss causes and risks in pregnancy in a patient with coronary stenoses and the management and outcome. At 13 years of age, the patient was diagnosed as having multiple coronary stenoses and percutaneous transluminal coronary angioplasty was performed. At the age of 30, coronary arteriography demonstrated multiple severe stenoses. Her previous physician had permitted her to become pregnant. At 32 weeks' gestation, due to uncontrollable uterine contractions, magnesium sulfate was administered. At 37 weeks' gestation, a cesarean section was performed because of breech presentation, and she delivered a healthy female infant. During cesarean section, oxytocin was given at a slower rate. There has been no recurrence of cardiac events during and after pregnancy. Multiple coronary stenoses during pregnancy need a multidisciplinary approach.

A large meconium pseudocyst that developed into the generalized type during the antepartum period.

A fetal intraabdominal cystic mass, measuring 6 cm, was detected at 30 weeks of gestation in a 27-year-old gravida 2 para 1 woman. At 33 weeks of gestation, the cyst disappeared. Ultrasonography showed fetal bowel dilatation, polyhydramnios, and intraabdominal calcifications. Fetal meconium peritonitis was diagnosed prenatally. Because the fetal ileus became worse, a cesarean section was performed at 35 weeks of gestation; a female infant weighing 2,131 g with an Apgar score of 8 was delivered. Six hours after birth, the neonate received an ileostomy. The bowel was reanastomosed 42 days after the initial operation. On postoperative pathology, a meconium pseudocyst was diagnosed. To our knowledge, this is the first report of a large fetal meconium pseudocyst that developed into the generalized type in the uterus during the preterm antepartum period.

MCI-186 administered to the maternal circulation inhibits fetal brain injury resulting from total umbilical cord occlusion in the chronically instrumented fetal lamb.

OBJECTIVE: To evaluate the transplacental effects of MCI-186 (edaravone), a potent hydroxyl radical scavenger, administered to the maternal circulation to inhibit fetal brain injury caused by umbilical cord occlusion. METHODS: Nine chronically instrumented lambs were prepared. In three cases, 10-min persistent total umbilical cord occlusion (group A) was performed. Another three cases underwent occlusion and were administered 60 mg of MCI-186 through the maternal femoral vein prior to the end of occlusion (group B). The remaining three cases underwent sham operation (group C). On day 3 after insult, fetal brains were extirpated. Paraffin-embedded brain tissue sections were stained with hematoxylin and eosin, Bodian, Kluver-Barrera, and TUNEL. Neuronal cellular damage was evaluated by two pathologists blinded to the experimental conditions. RESULTS: Group A displayed numerous cells with eosinophilic condensation of nuclear chromatin and proliferation of microglia in the hippocampus and basal ganglia. TUNEL-positive cells were observed in the periventricular area. Group B showed microglial proliferations, but no marked changes. No pathological changes were apparent in group C. CONCLUSIONS: MCI-186 administered to the maternal circulation could inhibit fetal brain injury resulting from hypoxia-reperfusion induced by umbilical cord occlusion.

The impact of intrauterine infection on fetal brain damage assessed by S100B protein concentrations in umbilical cord arteries.

OBJECTIVE: To assess the impact of intrauterine infection on fetal brain damage by measuring S100B protein concentration in umbilical cord arteries. METHODS: In the intrauterine infection cases determined by pathology of 25 deliveries (Group I) and non-infection cases of 35 deliveries as control (Group C), we compared gestational age at delivery, birth weight, fetal heart rate monitoring during labor, Apgar score, umbilical cord artery pH and S100B protein concentrations in umbilical arteries measured by two-site immunoradiometric assay kit. RESULTS: (1) There was no significant correlation between pH and concentration of S100B protein. (2) Gestational age at delivery was found to be earlier in Group I, resulting in lower birth weights, when compared with Group C. (3) There was no significant difference between two groups concerning Apgar scores, pH. (4) S100B protein concentrations in Group I was significantly higher than those of Group C (3.9 7 ± 0.66 versus 1.8 9 ± 0.56 µg/L, p < 0.05). (5) The concentration of S100B protein in severe chorioamnionitis (CAM) cases were significantly higher than those of mild CAM and control cases. CONCLUSION: Higher concentration of S100B protein in Group I suggests that intrauterine infection itself has a serious risk factor on fetal brain damage.

Transplacental effects of allopurinol on suppression of oxygen free radical production in chronically instrumented fetal lamb brains during intermittent umbilical cord occlusion.

OBJECTIVE: To evaluate the transplacental effect of allopurinol, which acts as a xanthine oxidase inhibitor and free radical scavenger, on inhibiting the production of superoxides during intermittent partial umbilical cord occlusion. METHODS: Using four chronically instrumented fetal lambs, ewes received 400 mg allopurinol over a period of two hours. Concentrations of allopurinol and oxypurinol in blood samples from mothers and fetuses and fetal brain microdialysis perfusate were measured by HPLC. In another three cases the production of superoxide during intermittent umbilical cord occlusion was studied by measurement of chemiluminescence in perfusate before and after administration of Allopurinol. RESULTS: (i) Allopurinol concentration in mothers had reached equilibrium by 30 min after starting administration and maintained a concentration about 6 mug/ml. Allopurinol concentration in fetuses increased gradually and reached 2.25 +/- 0.54 microg/ml at 120 min; (ii) Oxypurinol concentration in both mothers and fetuses increased during administration of allopurinol; (iii) Concentrations of allopurinol and oxypurinol in the perfusates reached 0.32 +/- 0.12 microg/ml, 0.53 +/- 0.22 microg/ml at 120 min respectively; and (iv) Administration of allopurinol significantly suppressed superoxide production during intermittent partial umbilical cord occlusion. CONCLUSION: These results demonstrated a good transfer of allopurinol from mother to fetus and suggested the possibility of intrauterine treatment to inhibit fetal brain damage resulting from increased oxygen free radicals.

Evaluation of creatine kinase, lactate dehydrogenase, and amylase concentrations in umbilical blood of preterm infants after long-term tocolysis.

Creatine kinase (CK), lactate dehydrogenase (LDH), and amylase levels of preterm infants following long-term tocolysis in pregnant women are limited. The objective of this study was to determine if the tocolytic therapy affects CK, LDH, and amylase levels in the umbilical blood. This study included 215 preterm infants born to women treated with and without ritodrine hydrochloride. CK, LDH, and amylase levels in the umbilical blood at delivery were determined. Infants were divided according to the ritodrine tocolysis, as follows: Group A (n = 91), not exposed to ritodrine; Group B (n = 44), IV ritodrine for <1 week; Group C (n = 80), IV ritodrine for ≥1 week. The CK concentration in cord blood of Group C (198.8 ± 14.2 IU/L) was significantly higher in comparison with Group A (155.0 ± 7.3 IU/L, P < 0.05). There was no significant difference in LDH and amylase levels in the three groups. The CK significantly correlated with gestational age (r = 0.42, P < 0.01) and birth weight (r = 0.38, P < 0.01). LDH and amylase levels did not change with gestational age nor birth weight. In conclusion, long-term ritodrine tocolysis leads to increased umbilical blood CK level.

The effects of sivelestat sodium hydrate on uterine contraction and the concentration of maternal and fetal blood cytokines in a sheep model of intra-amniotic infection induced by lipopolysaccharide.

OBJECTIVE: To evaluate the effects of a neutrophil elastase inhibitor, sivelestat sodium hydrate, in a sheep model of intra-amniotic infection(IAI) induced by lipopolysaccharide (LPS) injected into the intra-amniotic compartment. METHODS: We examined 15 chronically instrumented ewes, the ewes were assigned randomly as group A (five ewes) administered an antibiotic after LPS administration, group B (five ewes) administered a neutrophil elastase inhibitor (0.2 mg/kg/h) with an antibiotic after LPS administration, and group C (five ewes) a sham operation group. Uterine contraction was evaluated by fetal tracheal pressure and concentrations of PGE2, IL-6, IL-8, TNF-α in maternal and fetal blood before and after LPS administration were measured chronologically. RESULTS: (1) All ewes of group A delivered within 72 h, but only one ewe of group B delivered. Uterine contraction of group B was suppressed about 60% in comparison with group A. (2) Maternal blood concentrations of PGE2, IL-6, IL-8, and TNF-α level of group A increased chronologically and when compared with groups B and C the increase was significantly higher. (3) There were no significant changes in the fetal blood cytokines in any of the three groups. CONCLUSION: Administration of neutrophil elastase inhibitor might suggest a useful strategy to prevent premature delivery resulting from intrauterine infection.

Changes of expression of glucose transporters in the fetal lamb brain after MCI-186 administration to the maternal circulation with 10-min persistent umbilical cord occlusion.

OBJECTIVE: To evaluate the effect of MCI-186 (3-methyl-1-phenyl-2-pyrazoline-5-one), a potent hydroxyl radical scavenger, administered to the maternal circulation following umbilical cord occlusion in regard to glucose transporter (GLUT) expression. MATERIALS AND METHODS: Fourteen instrumented lambs were prepared. In three cases, a 10-min persistent umbilical cord occlusion was performed; 30 min after the insult, fetal brains were extirpated (Group A). Four cases had a 10-min occlusion(Group B) and four cases had 10-min occlusion and were administered MCI-186 to the maternal circulation (Group C).Three days following the insult, the fetal brains were extirpated. The remaining three cases had a sham operation (Group D).Brain tissue sections were stained at the locations of GLUT-1, -3 and -5 and were evaluated by two pathologists. RESULTS: The expression of GLUT-1 and -3 significantly increased in the basal ganglia, hippocampi and periventricular region of Group B when compared with that of Group A. The expression of GLUT-1 and -3 in three regions of Group B were significantly higher than that of Group C and D. GLUT-5 was recognised only in Group B. CONCLUSION: On the basis of expression of GLUT, the protective effect of MCI-186 on brain injury resulting from hypoxia/ ischemia-reperfusion is documented.

Very low-density lipoprotein in the cord blood of preterm neonates.

Human fetuses have markedly low levels of serum lipids and a unique lipoprotein profile with respect to quality, with low-density lipoprotein (LDL)-like particle as the dominant cholesterol carrier. However, little is known about triglyceride (TG) distribution. In addition, lipid metabolism is important in lung development, with indications that TG from very low-density lipoprotein (VLDL) is essential for surfactant synthesis. We investigated TG distribution in preterm neonate cord blood and the relationship of VLDL-TG levels with respiratory distress syndrome (RDS). The study included 103 appropriate-for-gestational-age neonates (61 males). We performed serum lipoprotein analyses in cord blood by high-performance liquid chromatography with gel permeation columns. Term neonates had low cord blood TG concentrations distributed equally to the LDL and VLDL fractions. However, preterm neonates had even lower TG concentrations, with VLDL as the dominant carrier. The LDL-TG and high-density lipoprotein-TG concentrations in cord blood increased gradually with gestational age, but cord blood VLDL-TG concentrations increased dramatically from 32 to 34 weeks of gestational age. Neonates with RDS exhibited no RDS-specific lipoprotein profile; however, most were born before the timing of the dramatic VLDL-TG increase. Our results suggest that 34 weeks of gestation is a critical period for TG metabolism, indicating the need for evaluation of the lipid nutritional state in preterm neonates.