Clinical Factors Predicting Disseminated Intravascular Coagulation (DIC) in Women With Placental Abruption and a Live Fetus.

OBJECTIVE: We examined predicting factors other than blood test results for disseminated intravascular coagulation (DIC) in patients with placental abruption and a live fetus who were transported by ambulance to our institute. METHODS: We reviewed the obstetric records of 60 singleton deliveries between January 2006 and December 2018. In this study, we excluded four cases with fetal demise at the time of transportation. In the other 56 cases, therefore, emergency cesarean section was performed at the time of diagnosis of placental abruption. Of the 56 cases, 12 cases were complicated by DIC (21.4%). Therefore, clinical risk factors leading to DIC other than intrauterine fetal demise (IUFD) were retrospectively examined with the remaining 44 cases set as control (78.6%). RESULTS: In evaluation with multivariate analysis, severe neonatal asphyxia (neonatal Apgar score <4 at 1 minute: adjusted odds ratio 2.89, p <0.01 and umbilical artery pH <7: adjusted odds ratio 4.01, p <0.01) was an independent risk factor for DIC, while short time interval from the onset to delivery (<1 hour; adjusted odds ratio 0.195, p = 0.04) was an independent negative risk factor for DIC. CONCLUSION: Severe neonatal asphyxia was a risk factor for DIC in cases of placental abruption in those transported by ambulance with surviving singleton fetuses, while a short time interval from the onset to delivery was a negative risk factor for DIC.

Influence of smoking habits on mental status in Japanese women during the first trimester of pregnancy.

PURPOSE: We examined the relation between smoking habits and maternal mental status such as depression and anxiety during the first trimester of pregnancy. MATERIAL AND METHODS: Between July 2016 and June 2018, we examined the increased odds of depressive and anxiety symptoms in the women with smoking habits during prepregnancy with and without smoking cessation during the first trimester of pregnancy in comparison with those without smoking habits using self-administered questionnaires. RESULTS: The rate of depressive and anxiety symptom in the women with smoking habits during prepregnancy (46.4 and 47.3%, respectively) was higher than those in the women without smoking habits during the first trimester of pregnancy irrespective of smoking cessation. The rate of depressive or anxiety symptom during the first trimester of pregnancy did not change significantly by smoking cessation in the women with smoking habits during prepregnancy (depressive symptom: 44.6 versus 53.7%, p = .13; anxiety symptom: 45.3 versus 55.2%, p = .17). CONCLUSIONS: Smoking habits during prepregnancy seemed to be associated with the increased perinatal mental disorders irrespective of smoking cessation.

Spontaneous disruption of the dividing membrane in monochorionic diamniotic twin pregnancy.

Spontaneous disruption of the dividing membrane in MD twins is rare and be associated with a higher incidence of prematurity and neonatal morbidity. In the present case, a spontaneous disrupted dividing membrane could be noted by ultrasonography.

Influence of perinatal low-dose acetylsalicylic acid therapy on fetal hemodynamics evaluated by determining the acceleration-time/ejection-time ratio in the ductus arteriosus.

AIM: Acceleration-time/ejection-time ratio (At/Et ratio) of Doppler waveform is an established hemodynamic parameters that reflect proximal stenosis. Using this parameter, we evaluated whether perinatal low-dose acetylsalicylic acid (ASA) therapy could alter hemodynamics in the ductus arteriosus. METHODS: Pulse Doppler measurements of the fetal ductus arteriosus were performed longitudinally from 20 to 37 gestational weeks in 106 healthy pregnant women (controls) and 65 pregnant women taking daily low-dose ASA (80 or 100 mg/day) because of a history of recurrent pregnancy loss. The At/Et ratio, pulsatility index (PI), and peak systolic velocity were evaluated and statistically analyzed. RESULTS: The At/Et ratio significantly increased with gestational age in both the ASA group (r = 0.54) and the control group (r = 0.35), while the PI did not. Median peak systolic velocities also increased with gestational age in both the ASA group (r = 0.39) and the control group (r = 0.31). No significant differences in At/Et ratio, PI, or peak systolic velocity were observed between the ASA group and the control group. CONCLUSION: Administration of low-dose ASA during pregnancy did not appear to alter hemodynamics in the fetal ductus arteriosus.

A case of maternal vitamin K deficiency associated with hyperemesis gravidarum: its potential impact on fetal blood coagulability.

Vitamin K deficiency is associated with malnutrition in some complications, such as hyperemesis gravidarum, active gastrointestinal diseases, and psychological disorders. Maternal vitamin K deficiency can cause fetal bleeding, in particular, fetal intracranial hemorrhage. Although fetal hemorrhage is uncommon, severe damage to the fetus may be inevitable. We describe a pregnant woman with vitamin K deficiency possibly due to hyperemesis gravidarum. The patient was treated for the deficiency, and no fetal or neonatal hemorrhagic diseases were manifested.

The Effect of the Gelatinous Lactulose for Postoperative Bowel Movement in the Patients Undergoing Cesarean Section.

Lactulose is a non-digestible disaccharide formed from fructose and galactose. The objective of this study was to assess the effect of lactulose on gastrointestinal function after cesarean section. One hundred patients who underwent cesarean section at the Japanese Red Cross Katsushika Maternity Hospital were enrolled in this study. They were divided into 2 groups by randomization: (1) an L group that was treated with gelatinous lactulose (N = 48) and (2) a control group (C group) that did not receive gelatinous lactulose (N = 52). The interval between cesarean section and first postoperative flatus, defecation, and walking; appearance of symptoms of ileus; use of other medicines for stimulating bowel movement; properties and state of feces; and duration of postoperative hospital stay were compared between the two groups. The two groups did not show a significant difference in postoperative outcomes, except for the incidence of loose or watery stools (50% in the L group and 26.9% in the C group, P = 0.03). This study could not demonstrate the apparent effectiveness of lactulose in improving bowel function after cesarean section. Therefore, a routine use of gelatinous lactulose after surgery may negatively impact the patients undergoing cesarean section.

Design and assessment of the new APS dialyzer (APS-SA series).

Dialyzer performance seems to greatly depend on the hollow-fiber membrane performance, the morphology of the hollow-fiber membrane bundles (e.g., wave-shaped hollow-fiber membrane bundles), and the design of the dialyzer housing. Consequently, we developed the APS dialyzer APS-SA series, equipped with wave-shaped hollow-fiber membrane bundles as an optimal three-dimensional morphology along with new housings, to realize enhanced dialysis performance. Incorporation of a new type of housing, including a full baffle structure and a short taper section, and a new type of morphology for the hollow-fiber membrane bundles have been verified to allow the dialysate to diffuse uniformly along the full baffle panel around the circumference and to fully permeate into the core of the hollow-fiber bundle. As a result, the APS-SA series has been proved to have achieved enhanced diffusion performance and increased clearance of small molecule solutes such as urea and creatinine, compared with conventional dialyzers. This series is expected to provide increased Kt/V values and dialysate-saving performance in future clinical use.

Development of a dialyzer with enhanced internal filtration to increase the clearance of low molecular weight proteins.

Accumulated low molecular weight proteins in hemodialysis patients require a high-flux dialyzer. There have been several methods proposed for enhancing internal filtration, including narrowing the inside diameter of the hollow fibers, lengthening the fibers, and increasing the fiber density ratio. We tried to enhance the internal filtration by increasing the pressure drop in the dialysate compartment through increasing the fiber density ratio. If the fiber density ratio is too high, however, an irregular dialysate path may result, thus decreasing dialysis performance. Therefore, we took note of the shape of the inner housing and added a short taper structure, which improved the dialysate path dramatically. Consequently, we developed an internal filtration-enhanced dialyzer (APS-Prototype) to improve dialysis performance. The internal filtration rate in water (measured by Doppler ultrasound) was 13.2 l/session for the APS-Prototype and 5.3 l/session for the APS-15E. The amount of alpha1-microglobulin (alpha1-MG) in bovine plasma was 0.34 g for the APS-Prototype and 0.11 g for the APS-15E. In addition, the amount of alpha1-MG in vivo was 29.0% +/- 5.8% for the APS-Prototype, significantly higher than that for the APS-15E (13.6% +/- 1.9%). The desirable loss of albumin is 2-4 g in hemodiafiltration, and it was 3.92 +/- 1.03 g for the APS-Prototype. The prototype showed excellent solute removal performance with no clinical or engineering problems.