A mixed Müllerian cystadenoma presenting as a paraurethral tumor.

•We report the first case of a paraurethral mixed Müllerian cystadenoma.•The cystic lesion was lined by a mixture of three different types of epithelium.•All epithelial cells were positive for estrogen receptor and PAX8.

Chromosome analysis of blastocysts derived from single pronuclear zygotes by array CGH and clinical outcomes by the transfer of single pronuclear zygotes.

PURPOSE: This study aimed to explore the aneuploidy of blastocysts derived from single pronuclear (1PN) zygotes, almost 75% of which were regarded as diploid, using array CGH and examine the pregnancy outcomes. METHODS: Embryonic aneuploidy screening of sixteen embryos from 1PN zygotes and sixteen embryos from 2PN zygotes was performed using array CGH in study 1. In addition, the reproductive outcome of 1761 single blastocysts, after untested frozen-thawed blastocyst transfer in IVF/ICSI patients, was retrospectively analyzed and compared between the 1PN and 2PN groups in study 2. RESULTS: The aneuploidy rates were 30.8% (4/13) in 1PN IVF, 33.3% (1/3) in 1PN ICSI, 46.2% (6/13) in 2PN IVF, and 100% (3/3) in 2PN ICSI. The 1PN group achieved clinical pregnancy in 25.0% (7/28) of IVF and 30.0% (3/10) of ICSI, whereas these rates in the 2PN control group were 44.6% (557/1250) of IVF and 37.4% (177/473) of ICSI. No miscarriage occurred in the pregnancies from 1PN zygotes, whereas the rates of miscarriage in the 2PN control group were 22.6% (126/557) in IVF and 22.2% (39/176) in ICSI. The delivery rate was similar in all groups. Ten deliveries in the 1PN group showed no newborn malformation. CONCLUSION: Within the limits of the small sample size, our results suggest that the aneuploidy and delivery rates of the blastocysts derived from 1PN zygotes are the same as those derived from 2PN zygotes. Blastocysts derived from 1PN zygotes may be used clinically and could increase the chance of pregnancy.

Chest compression of a pregnant woman by a seatbelt might affect fetal outcome, even in minor to moderate frontal vehicle collisions.

INTRODUCTION: Pregnant women often suffer from negative fetal outcomes, despite wearing a seatbelt correctly. When restrained vehicle passengers are involved in a frontal collision without suffering from any injuries, the forces they experience are particularly concentrated in the chest because of the seatbelt. We analyzed the biomechanics of chest injuries sustained by restrained pregnant drivers and possible effects of these injuries on the fetus. MATERIAL AND METHODS: The Maternal Anthropometric Measurement Apparatus dummy, version 2B, representing a pregnant woman at 30 weeks of gestation, was used. Sled tests were performed for recreating frontal impact situations with vector velocity changes at impact speeds of 13, 26, and 40km/h. Overall kinematics of the dummy were examined using high-speed video imaging. Quantitative dummy responses, such as time course of acceleration of the sled and chest, pressure of the belt, and deflection of the chest (right and left) during impact were also measured. RESULTS: Although collision velocities were different, the distances of forward movement of the dummy were similar (121-129mm) owing to the safety devices. However, maximum deflection of the chest (35.4mm to the left and 15.7mm to the right) was obtained at a 26-km/h collision. Additionally, maximum deflection of 28.7mm to the left and 10.9mm to the right of the chest were obtained at 40km/h. CONCLUSIONS: Because the uterus enlarges and the fundus reaches the lower part of the rib cage during late pregnancy, we consider that the reason for negative fetal outcomes is partly owing to chest compression and subsequent applied forces on the uterus, even in minor to moderate frontal collisions. This knowledge may be useful for forensic scientists who determine the causes and mechanisms of a fetal death or the offenders' responsibilities for both maternal and fetal outcomes when the mother is involved in a frontal vehicle collision.

Effects of high-dose dexamethasone in postpartum women with class 1 haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome.

This study was performed to investigate the effectiveness of dexamethasone in the management of postpartum women with class 1 haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. This retrospective study was conducted on 18 women with class 1 HELLP syndrome at the Shiga University of Medical Science. They were divided into two groups: Group A comprised participants who did not receive dexamethasone, and Group B comprised participants that intravenously received dexamethasone. The main outcomes were the serum laboratory values, mortality and morbidity. The only significant difference between the two groups in baseline characteristics was the aspartate aminotransferase levels. The linear regression analysis showed a significant difference between the two groups in the recovery of platelet counts (p = .046) and aspartate aminotransferase (p = .009). These findings support the use of high-dose dexamethasone to promote recovery of the platelet counts and aspartate aminotransferase levels in postpartum women with class 1 HELLP syndrome. Impact statement What is already known on this subject? Haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is one of the most dangerous complications that can occur during pregnancy and is considered a particularly serious variant of severe preeclampsia. Several clinical trials have been performed since 1994 because it was expected that corticosteroid therapy, primarily with dexamethasone, accelerates recovery after delivery. However, the effect of dexamethasone therapy on class 1 HELLP syndrome is unclear. What do the results of this study add? In this retrospective study, we demonstrated that dexamethasone administration significantly improved the recovery of the platelet count in postpartum women with class 1 HELLP syndrome, and did not increase the rate of maternal postpartum complications. What are the implications of these findings for clinical practice and/or further research? The use of high-dose dexamethasone in postpartum women with class 1 HELLP syndrome might be effective to promote recovery of the platelet count, and contributes a shorter duration of hospitalisation. Because the number of patients with class 1 HELLP syndrome is small, it is important to confirm these findings with well-designed multicentre prospective studies.

Use of ultrasound shear-wave elastography to evaluate change in cervical stiffness during pregnancy.

AIM: The aim of this study was to evaluate the usefulness of shear-wave elastography (SWE) for measuring change in cervical stiffness during pregnancy, with regions of interest (ROI) designed for easy identification. METHODS: A total of 280 women were enrolled in this study. SWE was performed at a routine prenatal visit. A measurement area was chosen at the anterior part of the cervix, and a circular ROI 5 mm in diameter was set at two points, 5-10 mm (lower point) and 15-20 mm (upper point) from the external cervical os. The generalized estimating equation was used to estimate the correlation between stiffness and gestational age, using generalized linear models. RESULTS: There were significant negative correlations between stiffness and gestational age. The estimated regression equations of the lower and upper points were Y = -0.049X + 3.675 (P < 0.05) and Y = -0.060X + 4.170 (P < 0.05), respectively. The stiffness at the upper point behaved statistically significantly differently to that at the lower point. Softening of the cervix at the upper point was significantly different between single pregnancies and twin pregnancies (P < 0.05), but no marked difference was noted between primiparous and multiparous women. CONCLUSION: Cervical elastography using SWE was useful for measuring change in cervical stiffness during pregnancy, and the upper area of the cervix may be a more relevant assessment point for cervical softening than the lower area.

Fetal Right Ventricular Diverticulum Detected by Prenatal Ultrasound Screening.

Prenatal ultrasound screening has allowed for the detection of in utero cardiac abnormalities. Specifically, distinction is possible between ventricular diverticula and aneurysms, which is important because each condition has a different clinical outcome. We report the case of a 35-year-old, gravida 1, para 1 woman, with no significant past medical history, who underwent routine prenatal ultrasound screening at 32 weeks' gestation. A four-chamber ultrasound of the fetal heart combined with M-mode echocardiography showed abnormal dilatation of the right ventricular chamber measuring 2.2 cm × 1.0 cm but with normal contractility. Delivery was performed at full term by cesarean section, and a right ventricular diverticulum was confirmed by postnatal cardiac computed tomography. The baby developed normally with no cardiac sequelae during followup. This case demonstrates the importance of making a correct diagnosis of ventricular diverticula by prenatal ultrasound when abnormal dilatation of the fetal ventricle is identified during routine screening. Because evaluating the wall contractility by M-mode ultrasound leads to evaluating whether it has the myocardium, we conclude that M-mode echocardiography is effective for the purpose of prenatal cardiac diagnosis and can distinguish between ventricular aneurysms and functioning ventricular diverticula.

Prenatal diagnosis of sirenomelia in the late second trimester with three-dimensional helical computed tomography.

Sirenomelia is a rare congenital syndrome that is characterized by the anomalous development of the caudal region of the body. The anomalies include bilateral renal agenesis or dysgenesis and the absence of the sacrum and other vertebral defects. Sirenomelia is also known as "mermaid syndrome," because of the one lower extremity. It is usually associated with severe oligohydramnios, and its prognosis is very poor due to pulmonary hypoplasia that is caused by severe oligohydramnios. The patient referred to our hospital at the gestational age of 27 weeks with fetal growth restriction and oligohydramnios. The estimated fetal body weight was 970 g (-4.9 S.D.). We could identify only one-side extremities, and could not identify kidneys by ultrasound examination. Because a single lower extremity and severe oligohydramnios are characteristics of the sirenomelia, we suspected sirenomelia. However, it could not be confirmed by ultrasound examination because of oligohydramnios. Therefore, we performed three-dimensional helical computed tomography (3D-CT), which is more accurate than ultrasound examinations for prenatal diagnosis of skeletal abnormalities. 3D-CT revealed an only one lower extremity. At 36 weeks and 5 days of gestation, the woman went into spontaneous labor and delivered an infant weighing 870 g. The infant has a single upper extremity and a single lower extremity. We provided supportive care for the neonate, who however died 1 hour 36 minutes after birth from severe respiratory distress. In summary, we report the correct diagnosis of sirenomelia with 3D-CT in the late second trimester.