Clinical factors associated with birth weight of infants born to pregnant women with diabetes.

We aimed to examine the clinical factors associated with the birth weight of infants born to Japanese pregnant women with diabetes. This retrospective observational study enrolled 204 Japanese women with singleton pregnancies with type 1 diabetes (n = 135) or type 2 diabetes (n = 69). We used multiple regression analyses to examine factors associated with birth weight standard deviation (SD) scores. In addition, we compared the clinical findings among the groups of mothers who gave birth to appropriate for gestational age infants (AGA group), large for gestational age infants (LGA group), and small for gestational age infants (SGA group). Multiple regression analyses showed that the birth weight SD score was positively associated with type 2 diabetes. In women with type 1 diabetes, the birth weight SD score was positively associated with glycated albumin levels and gestational weight gain and negatively associated with pre-pregnancy underweight. Only gestational weight gain was positively associated with birth weight SD scores in women with type 2 diabetes. Glycated hemoglobin levels, gestational weight gain, and triglyceride levels were significantly higher in the LGA group than in the AGA group. The SGA group showed significantly lower gestational weight gain and triglyceride levels than the AGA group. These results suggest that it is important to manage not only blood glucose levels but also pre-pregnancy body weight and gestational weight gain for appropriate fetal growth. The effects of clinical factors on infant birth weight may differ between patients with type 1 and those with type 2 diabetes.

Pregnancy Complications and Impact on Kidney Allograft After Kidney Transplantation in IgA Nephropathy.

Pregnancy in kidney transplantation (KT) recipients has been challenging because of the high risk of maternal, fetal, and renal complications. Although patients with immunoglobulin A nephropathy (IgAN)-chronic kidney disease (CKD) are at a high risk for hypertension in pregnancy (HIP), the maternal risk in KT recipients with IgAN as the etiology remains unclear. We retrospectively reviewed the medical records of pregnant KT recipients who delivered at our hospital. The incidence of maternal and fetal complications and the impact on kidney allografts between the group with IgAN as the primary kidney disease and the group with other primary diseases were compared. The analysis included 73 pregnancies in 64 KT recipients. The IgAN group had a higher incidence of HIP than the non-IgAN group (69% vs. 40%, p = 0.02). IgAN as primary kidney disease and interval from transplantation to conception were associated with HIP (OR 3.33 [1.11-9.92], p = 0.03, OR 0.83 [0.72-0.96], p < 0.01, respectively). The 20-year graft survival or prevention of CKD stage 5 in group with IgAN was lower than that in the group with other primary disease (p < 0.01). KT recipients should be informed of the risk of HIP and possibility of long-term worsening of postpartum renal function.

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.

Successful pregnancy after limb-sparing hemipelvectomy for Ewing sarcoma: Case report and literature review.

OBJECTIVE: We present a case of successful pregnancy in a patient who underwent limb-sparing hemipelvectomy combined with multi-agent chemotherapy and radiotherapy for Ewing sarcoma. CASE REPORT: A 17-year-old girl was diagnosed with Ewing sarcoma of the left pelvis at the age of 17 and received limb-sparing hemipelvectomy combined with multi-agent chemotherapy and radiotherapy. The patient received oral contraceptives as hormone replacement therapy after completion of treatment. A normal menstruation cycle restored after the withdrawal of oral contraceptives. The patient spontaneously conceived at the age of 25. The patient complained of difficulty walking due to pelvic distortion during pregnancy and delivered a healthy neonate at term by cesarean section. CONCLUSION: Successful pregnancy and delivery can be achieved after limb-sparing hemipelvectomy combined with chemotherapy and radiotherapy for Ewing sarcoma. Our report provides important information on perinatal management, given the low incidence of pregnancy following treatment of Ewing sarcoma in the pelvis.

Successful Pregnancy After Sacrectomy Combined With Chemotherapy and Radiation for Ewing Sarcoma: Case Report and Literature Review.

BACKGROUND: Ewing sarcoma is considered to have a poor prognosis. Recent advances in multidisciplinary management have resulted in a marked improvement in long-term survival. CASE: We describe a case of successful pregnancy in a patient who underwent sacrectomy combined with multi-agent chemotherapy and radiotherapy for Ewing sarcoma. The patient was diagnosed with Ewing sarcoma of the sacrum at the age of 16. The ovaries were transposed, the uterus was shielded, and a gonadotropin-releasing hormone agonist was used during treatment to protect ovarian function. The patient spontaneously conceived at the age of 27. After an uneventful pregnancy, the patient delivered a healthy neonate at term by cesarean section. SUMMARY AND CONCLUSIONS: Successful pregnancy and delivery can be achieved after multi-modality treatment with pretreatment intervention for fertility preservation.

Prenatal diagnosis of pyriform sinus fistula: case report and literature review.

We describe a case of prenatal diagnosis of a pharyngeal cyst as a pyriform sinus fistula on the findings of ultrasonography and magnetic resonance imaging.

Peripartum heart failure caused by left ventricular diastolic dysfunction: a case report.

Peripartum cardiomyopathy is a rare but potentially life-threatening condition. The current definition of peripartum cardiomyopathy only includes patients with systolic dysfunction. We describe a 25-year-old nulligravid patient with heart failure, i.e. left ventricular diastolic dysfunction with preserved systolic dysfunction during the third trimester of pregnancy. She complained of dyspnea and was referred to our hospital at 31 weeks of gestation. The patient met the clinical criteria for peripartum cardiomyopathy with the exception of systolic dysfunction. Brain-type natriuretic peptide levels peaked at 1447 pg/dL. The patient responded to therapy for heart failure and showed resolution of her diastolic dysfunction by 1 month postpartum. The case demonstrated the important role of diastolic dysfunction in peripartum heart failure and the possibility of clarifying the pathophysiology of peripartum cardiomyopathy by evaluating diastolic function. Further investigations are needed to provide evidence regarding the clinical role of diastolic dysfunction in peripartum heart failure.

Predisposing individual characteristics and perinatal outcomes of women in the Tokyo metropolitan area who initiate prenatal care late in their pregnancy: a case-control study.

Purpose. The purpose of this study was to investigate the individual characteristics and perinatal outcomes of women who initiate prenatal care late in their pregnancy in the Tokyo metropolitan area. Methods. Retrospective study. The study enrolled all women at our hospital who initiated prenatal care after 22 weeks of gestation (late attenders) and control women who initiated prenatal care prior to 11 weeks of gestation participated in the study at the National Center for Global Health and Medicine between January 1, 2007 and June 30, 2011. We compared the maternal characteristics and perinatal outcomes of late attenders with those of the control group. Results. A total of 121 late attenders and 1,787 controls were enrolled. Late attenders had a higher incidence of unmarried compared with the control group (P < 0.01). There were no differences in the incidence of preterm delivery and low birth weight; however, babies of the late attenders had a higher incidence of admission to the neonatal intensive care unit compared with the control group (P < 0.01). Conclusions. Our results indicate that there is a pressing need for further steps to promote the importance of receiving prenatal care during pregnancy.

Effect of Social Service Prenatal Care Utilization on Perinatal Outcomes among Women with Socioeconomic Problems in the Tokyo Metropolitan Area.

Background. To investigate the effect of social service prenatal care (PNC) utilization on perinatal outcomes among women with socioeconomic problems in the Tokyo metropolitan area. Methods. Retrospective study. The study enrolled all women at our hospital who either attended PNC utilizing social services (attenders) or who did not attend PNC (nonattenders) between January 1, 2007, and December 31, 2010. We compared the maternal characteristics and perinatal outcome of attenders with those of nonattenders. Results. A total of 83 attenders and 45 nonattenders were enrolled. The mean gestational age at the first PNC visit was 31.1 weeks in the attenders. Attenders were found to have a lower incidence of preterm delivery, pregnancy-induced hypertension, emergency cesarean section, low birth weight, and the NICU admission than nonattenders (P < 0.05). Conclusions. The utilization of social service PNC greatly improved perinatal outcomes among women with socioeconomic problems problems in the Tokyo metropolitan area.

Prolonged fetal bradycardia as the presenting clinical sign in congenital syphilis complicated by necrotizing funisitis: a case report.

Syphilis remains a serious cause of neonatal morbidity and mortality worldwide. In this paper, we describe a case of congenital syphilis that was fully supported by abnormal fetal heart rate patterns and placental histopathological evidence. A 24-year-old para 4 woman, who did not attend antenatal care, was admitted to our hospital with a complaint of abdominal discomfort at an estimated 31-week gestation. Fetal heart rate monitoring showed prolonged bradycardia. A neonate weighting 1,423 g with severe birth asphyxia was immediately delivered by cesarean section. Following delivery, the mother and the neonate were diagnosed with syphilis. Histopathological examination confirmed severe chorioamnionitis and necrotizing funisitis with numerous Treponema pallidum. Conclusions. Challenges in establishing the diagnosis of necrotizing funisitis are essential for optimal management of a fetus with a systemic inflammatory response in utero.

Postpartum maternal pneumococcal meningitis complicated by endocarditis.

Bacterial meningitis is associated with high morbidity and mortality. Few cases of pneumococcal meningitis during pregnancy and the postpartum period have been reported. We describe a case of postpartum pneumococcal meningitis complicated by endocarditis. A 26-year-old para-2 woman who had had a normal vaginal delivery at 38 weeks at a maternity home was transported to our hospital with a 39.5°C fever 11 days postpartum. Eight hours after her arrival, her state of consciousness deteriorated rapidly. Lumbar puncture revealed Gram-positive cocci consistent with Streptococcus pneumoniae. She was immediately treated with antibiotics and subsequently diagnosed with endocarditis. Final culture results from the blood and cerebrospinal fluid confirmed the presence of S. pneumoniae. She recovered completely with no evidence of neurological damage. Maintaining a high clinical suspicion and initiating appropriate diagnostic testing and therapeutic interventions promptly are essential to reducing the morbidity and mortality associated with bacterial meningitis.

Antepartum intracranial hemorrhage due to unrecognized unilateral moyamoya disease: a case report.

PURPOSE: Moyamoya (meaning a "hazy puff of smoke" in Japanese) disease is a rare cerebrovascular occlusive disease. Moyamoya disease may become symptomatic for the first time during pregnancy. We report a case of antepartum intracranial hemorrhage due to unrecognized unilateral moyamoya disease, which was subsequently diagnosed as HELLP syndrome during the postpartum period. STUDY DESIGN: A case report of a 29-year-old Japanese primigravida who was transported to our hospital at 39 weeks of gestation because of sudden loss of consciousness and left hemiplegia. On arrival, her blood pressure was 143/94 mmHg with 1+ proteinuria by dipstick. Brain computed tomography revealed a right putaminal hemorrhage with intraventricular hemorrhage. The patient delivered a neonate by emergency cesarean section, and an intracranial hematoma was subsequently evacuated. Approximately 3 h postoperatively, she was diagnosed with HELLP syndrome and the following were initiated: IV magnesium sulfate, antihypertensive agents, and transfusion of 10 units of platelets. Angiographic findings were consistent with unilateral moyamoya disease. CONCLUSIONS: Moyamoya disease is a rare entity that must be considered in the differential diagnosis of hemorrhagic stroke during pregnancy. It is important to perform careful monitoring and adequate management with cooperation between obstetricians and other specialists when serious complications arise.

Noninvasive monitoring of placental oxygenation by near-infrared spectroscopy.

We evaluated the clinical usefulness of near-infrared spectroscopic quantitative measurement of placental oxygenation for the noninvasive estimation of uteroplacental function in pregnant women. We performed a prospective, observational clinical study. Women without complications (N = 15), women with threatened preterm delivery (TPD; N = 6), and women with intrauterine fetal growth restriction (IUGR; N = 6) were enrolled. Measurements of placental tissue oxygenation index (TOI) using the NIRO-300 (Hamamatsu Photonics, Hamamatsu City, Japan) were recorded. Mean TOI was 72.3 +/- 5.3% in women without complications, 72.9 +/- 5.6% in pregnant women with TPD, and 78.7 +/- 3.0% in pregnant women with IUGR. Mean TOI in pregnant women with IUGR was significantly higher than that of the other two groups (P < 0.05). In the IUGR group, although gestational age at measurement on admission was less than that made during hospitalization (P < 0.05), there were no differences in the TOI in relation to gestational age at measurement. Higher TOIs in pregnant women suggest decreased placental function. Monitoring the TOI by near-infrared spectroscopic quantitative measurement may have a high potential for clinical application, particularly in prenatal management.

Transabdominal measurement of placental oxygenation by near-infrared spectroscopy.

We evaluated the clinical usefulness of near-infrared spectroscopic quantitative measurement of placental tissue oxygenation for noninvasive estimation of uteroplacental function in pregnant women. We performed a prospective observational clinical study. Women without complications (N = 15) and women with pregnancy-induced hypertension (PIH; N = 6) were enrolled. Measurements of placental tissue oxygenation index (TOI) using NIRO-300 (Hamamatsu Photonics, Hamamatsu City, Japan) were recorded. The mean TOI in women without complications was 72.36 +/- 5.36% and 80.28 +/- 2.78% in pregnant women with PIH. The mean TOI in pregnant women with PIH was higher than that of pregnant women without complications. There were no differences in the TOI in relation to gestational age at onset of PIH, forms of PIH, or severity of hypertension. Higher TOIs in pregnant women suggest the reduced ability of the placental function. Monitoring the TOI by near-infrared spectroscopic quantitative measurement may have a high potential for clinical application, particularly in prenatal management.

Measurement of placental oxygenation by transabdominal near-infrared spectroscopy.

The uteroplacental circulation in the placenta can have a major impact on the fetus. Near infrared spectroscopy (NIRS) is the noninvasive method of measuring changes in blood volumes and oxygen concentrations in living tissue. The purpose of this study is to monitor changes in placental tissue oxygen index (TOI) levels, in patients with intrauterine fetal growth restriction during pregnancy, using NIRS. We measured placental TOI values of 15 normal pregnant woman and 15 patients with intrauterine growth restriction admitted to our hospital. The placenta was assessed by ultrasound examination and NIRS was performed on all patients. The TOI values of the IUGR group when hospitalized was 78.6 +/- 1.6 (SD). This value was significantly higher than that of the controls (78.6 +/- 1.6 [SD] versus 70.2 +/- 0.4 [SD]). And the TOI values of the IUGR group, when measured before delivery, were 77.8 +/- 1.6 (SD). The TOI values of the IUGR group before delivery were significantly higher than those of the control group (77.8 +/- 1.6 [SD] versus 70.3 +/- 0.4 [SD]). We propose that NIRS is a candidate, noninvasive method for assessing placental oxygen dynamics on a real-time basis. In the near future it may contribute to perinatal medical practice.

Transabdominal measurement of oxygenation of the placenta by near-infrared spectroscopy.

Near-infrared spectroscopy (NIRS) has been used as a noninvasive method for monitoring the real-time oxygenation status in areas such as the brain and striated muscle. Because the oxygenation status of the placenta is closely related to the fetal condition, monitoring placental oxygenation through the maternal abdomen is desirable. We performed transabdominal monitoring of oxygenation of the placenta by NIRS in 11 women. We improved the conventional probe of the NIRO 300 system (Hamamatsu Photonics KK, Hamamatsu, Japan) to obtain placental oxygenation data. With this probe, we succeeded in obtaining oxyhemoglobin and deoxyhemoglobin data through the maternal abdomen. We believe NIRS will prove to be useful for intrapartum monitoring.