Pub Date : 2020-11-30DOI: 10.14390/jsshp.hrp2020-010
K. Papadakis, S. Myriknas, L. Kidd, Natasha Singh
Aim: External cephalic version (ECV) is the main intervention for facilitating vaginal birth without increasing intrapartum mortality and neonatal morbidity in term breech pregnancies. We appraise the hypothesis that the introduction of a specialised ECV clinic reduces preventable caesareans without compromising neonatal well-being. Methods: This is a prospective cohort study over a period of 3 years. Data were collected via attendance in the ECV clinic and women were followed up until the delivery and the postnatal period. Obstetric and neonatal notes were reviewed in order to assess obstetric data and fetal outcomes. Results: 181 suitable women with singleton pregnancy were included in our sample, from which 28 opted for elective caesarean delivery. 81% of the eligible women underwent an ECV. From the 120 ECVs performed, 78 women were nulliparous and 42 multiparous. The ECV was successful in a total of 64 cases (54%), 49% in nulliparous and 62% in multiparous women. Following that, 78% delivered vaginally of which 25% needed instrumental delivery. There were not any adverse events during the ECVs and no woman underwent emergency caesarean section for fetal distress due to the procedure. Conclusion: Our experience favours the ECV clinic, as it improves vaginal delivery rates with no obvious maternal and neonatal compromise. Cost-effectiveness and maternal satisfaction levels remain unknown. There is still room for improvement in detection, uptake and success ECV rates.
{"title":"Obstetric outcomes after instituting a dedicated External Cephalic Version clinic in a large tertiary centre: a 3-year prospective cohort study","authors":"K. Papadakis, S. Myriknas, L. Kidd, Natasha Singh","doi":"10.14390/jsshp.hrp2020-010","DOIUrl":"https://doi.org/10.14390/jsshp.hrp2020-010","url":null,"abstract":"Aim: External cephalic version (ECV) is the main intervention for facilitating vaginal birth without increasing intrapartum mortality and neonatal morbidity in term breech pregnancies. We appraise the hypothesis that the introduction of a specialised ECV clinic reduces preventable caesareans without compromising neonatal well-being. Methods: This is a prospective cohort study over a period of 3 years. Data were collected via attendance in the ECV clinic and women were followed up until the delivery and the postnatal period. Obstetric and neonatal notes were reviewed in order to assess obstetric data and fetal outcomes. Results: 181 suitable women with singleton pregnancy were included in our sample, from which 28 opted for elective caesarean delivery. 81% of the eligible women underwent an ECV. From the 120 ECVs performed, 78 women were nulliparous and 42 multiparous. The ECV was successful in a total of 64 cases (54%), 49% in nulliparous and 62% in multiparous women. Following that, 78% delivered vaginally of which 25% needed instrumental delivery. There were not any adverse events during the ECVs and no woman underwent emergency caesarean section for fetal distress due to the procedure. Conclusion: Our experience favours the ECV clinic, as it improves vaginal delivery rates with no obvious maternal and neonatal compromise. Cost-effectiveness and maternal satisfaction levels remain unknown. There is still room for improvement in detection, uptake and success ECV rates.","PeriodicalId":42505,"journal":{"name":"Hypertension Research in Pregnancy","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44597837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-30DOI: 10.14390/jsshp.hrp2020-009
A. Ohkuchi, E. Kondoh, Tatsuo Yamamoto, H. Seki, S. Saito, S. Makino, Miwa Nishida, T. Kikuchi
ratio of tyrosine to placental growth factor (sFlt-1/PlGF ratio), a flow diagram for the short-term prediction of preeclampsia (PE) using the sFlt-1/PlGF ratio in women at imminent/basal risk of preeclampsia. sFlt-1/PlGF flow for PE using ratio in at risk of PE at of consensus of at Web Meeting” held on expert consensus, appropriate perinatal care under close observation is recommended for women at imminent/basal risk of PE who have an sFlt-1/PlGF ratio > 38 at recruitment. For women at imminent risk of PE who have an sFlt-1/PlGF ratio ≤ 38 at recruitment, shortening the interval between maternal check-ups is recommended, along with re-evaluation of the sFlt-1/PlGF ratio 1–4 weeks after initial blood sampling, based on patient/fetal condition. using the sFlt-1/PlGF ratio under insurance in at of and
{"title":"Expert consensus: Indication criteria and screening strategy for preeclampsia using the serum sFlt-1/PlGF ratio at 18–36 weeks of gestation in women at imminent/basal risk of preeclampsia under insurance coverage","authors":"A. Ohkuchi, E. Kondoh, Tatsuo Yamamoto, H. Seki, S. Saito, S. Makino, Miwa Nishida, T. Kikuchi","doi":"10.14390/jsshp.hrp2020-009","DOIUrl":"https://doi.org/10.14390/jsshp.hrp2020-009","url":null,"abstract":"ratio of tyrosine to placental growth factor (sFlt-1/PlGF ratio), a flow diagram for the short-term prediction of preeclampsia (PE) using the sFlt-1/PlGF ratio in women at imminent/basal risk of preeclampsia. sFlt-1/PlGF flow for PE using ratio in at risk of PE at of consensus of at Web Meeting” held on expert consensus, appropriate perinatal care under close observation is recommended for women at imminent/basal risk of PE who have an sFlt-1/PlGF ratio > 38 at recruitment. For women at imminent risk of PE who have an sFlt-1/PlGF ratio ≤ 38 at recruitment, shortening the interval between maternal check-ups is recommended, along with re-evaluation of the sFlt-1/PlGF ratio 1–4 weeks after initial blood sampling, based on patient/fetal condition. using the sFlt-1/PlGF ratio under insurance in at of and","PeriodicalId":42505,"journal":{"name":"Hypertension Research in Pregnancy","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49061075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-30DOI: 10.14390/jsshp.hrp2020-019
J. Takeda, M. Nakabayashi†
To the Editor: In recent years, Japan has faced a rapidly and continuously declining birth rate similar to or even worse than those of other developed countries. The global COVID-19 pandemic in 2020 has further exacerbated this. Our purpose for writing this letter is to raise awareness on the relationship between the COVID-19 pandemic and declining birth rate in Japan. The COVID-19 pandemic in Japan noticeably worsened at the end of March 2020, and with the government’s declaration of a state of emergency, people voluntarily refrained from going outside unless urgently needed until June. If women became pregnant during this period, their estimated due dates would be in the first three months of 2021. Thus, we investigated the number of delivery appointments for these three months. The number of births in 2019 was 865,239, which amounts to a 5.8% decrease compared to the year before.1) If this decreasing trend continues this year, then the number of delivery appointments at delivery facilities should decrease by about 5%. However, in reality, the decrease is even greater (Figure). The difference of approximately 10–25% is not the result of a spontaneous decrease in the number of births, but likely due to another factor. Part of this difference might be explained by the temporary postponing of assisted reproductive technology in view of the statement set forth by the Japan Society for Reproductive Medicine (April 1, 2020).2) However, the entire difference cannot be solely pinned on this. Hospitals which provided data for this study are tertiary hospitals, as well as perinatal medical centers that take on cases of maternal transport or fetal congenital anomalies, which might be included in delivery appointments. However, given the magnitude of the difference, we view the avoidance of becoming pregnant due to fears of COVID-19 to be a major contributing factor. We propose the following three measures. First, a national survey of birth appointments should be conducted. Second, trends of decreasing birth appointments should be closely and continuously monitored. Lastly, the public should be provided with accurate information regarding the relationship between maternal and neonatal COVID19 infection. For the first measure, the use of data limited to tertiary hospitals and urban areas paints the picture that the COVID-19 situation is worse compared to rural areas. Thus, data from rural areas and local clinics should also be examined to determine whether similar trends are observed. For the second measure, the postponement of assisted reproductive technology was temporary and has now returned to normal after another announcement from Ch an ge s o f b irt h ap po in tm en ts (% )
{"title":"Expected reduction in the number of births due to the COVID-19 pandemic and proposal for countermeasures","authors":"J. Takeda, M. Nakabayashi†","doi":"10.14390/jsshp.hrp2020-019","DOIUrl":"https://doi.org/10.14390/jsshp.hrp2020-019","url":null,"abstract":"To the Editor: In recent years, Japan has faced a rapidly and continuously declining birth rate similar to or even worse than those of other developed countries. The global COVID-19 pandemic in 2020 has further exacerbated this. Our purpose for writing this letter is to raise awareness on the relationship between the COVID-19 pandemic and declining birth rate in Japan. The COVID-19 pandemic in Japan noticeably worsened at the end of March 2020, and with the government’s declaration of a state of emergency, people voluntarily refrained from going outside unless urgently needed until June. If women became pregnant during this period, their estimated due dates would be in the first three months of 2021. Thus, we investigated the number of delivery appointments for these three months. The number of births in 2019 was 865,239, which amounts to a 5.8% decrease compared to the year before.1) If this decreasing trend continues this year, then the number of delivery appointments at delivery facilities should decrease by about 5%. However, in reality, the decrease is even greater (Figure). The difference of approximately 10–25% is not the result of a spontaneous decrease in the number of births, but likely due to another factor. Part of this difference might be explained by the temporary postponing of assisted reproductive technology in view of the statement set forth by the Japan Society for Reproductive Medicine (April 1, 2020).2) However, the entire difference cannot be solely pinned on this. Hospitals which provided data for this study are tertiary hospitals, as well as perinatal medical centers that take on cases of maternal transport or fetal congenital anomalies, which might be included in delivery appointments. However, given the magnitude of the difference, we view the avoidance of becoming pregnant due to fears of COVID-19 to be a major contributing factor. We propose the following three measures. First, a national survey of birth appointments should be conducted. Second, trends of decreasing birth appointments should be closely and continuously monitored. Lastly, the public should be provided with accurate information regarding the relationship between maternal and neonatal COVID19 infection. For the first measure, the use of data limited to tertiary hospitals and urban areas paints the picture that the COVID-19 situation is worse compared to rural areas. Thus, data from rural areas and local clinics should also be examined to determine whether similar trends are observed. For the second measure, the postponement of assisted reproductive technology was temporary and has now returned to normal after another announcement from Ch an ge s o f b irt h ap po in tm en ts (% )","PeriodicalId":42505,"journal":{"name":"Hypertension Research in Pregnancy","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42075602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-30DOI: 10.14390/jsshp.hrp2020-005
S. Takeda
Rapid progress in perinatal care in recent decades has led to a dramatic decline in perinatal, neonatal, and maternal mortality (excluding suicides), and achieved remarkable improvements in obstetrical outcomes in Japan. However, while maternal mortality had been on a continuous and steady decline up until 2007 (3.1/100,000 total births), the rate has been fluctuating since then (e.g., 2.7/100,000 in 2014, 3.4/100,000 in 2016). This is likely attributed to a variety of factors that have emerged in the past 20 years due to changes in the environment and social situation surrounding women, such as later marriage and rise in maternal age. In Western countries, “late maternal deaths” occurring between 42 days and one year after delivery are considered to be just as important as “maternal deaths,” i.e., deaths during pregnancy or within 42 days of termination of pregnancy. In particular, suicides attributable to psychiatric disorders have become a serious issue among women less than one year postpartum. However, in Japan, the actual number of deaths by suicide is unknown, since neither death certificates nor postmortem certificates include information on pregnancy and delivery. Despite the fact that the total number of suicide deaths in Japan is known, whether such deaths are associated with perinatal mental issues or not is unclear, and thus, no measures have been taken. Untreated perinatal depression and psychiatric disorders not only cause issues such as suicide, but are also related to pediatric developmental and mental disorders, neglect, and/or child abuse due to impaired nurturing ability. Suicide rates among pregnant and parturient women in Osaka, Tokyo, and Mie are much higher than those of the UK, the US, and Sweden. There is an urgent need to establish a regional support system that facilitates interactions among the obstetrical, pediatric, psychiatric field, and local administrations for monitoring and supporting mothers and infants, as well as a system that allows families, schools, and society to support young people, in order to realize improved preconception health care.
{"title":"The current status of and measures against maternal suicide in Japan","authors":"S. Takeda","doi":"10.14390/jsshp.hrp2020-005","DOIUrl":"https://doi.org/10.14390/jsshp.hrp2020-005","url":null,"abstract":"Rapid progress in perinatal care in recent decades has led to a dramatic decline in perinatal, neonatal, and maternal mortality (excluding suicides), and achieved remarkable improvements in obstetrical outcomes in Japan. However, while maternal mortality had been on a continuous and steady decline up until 2007 (3.1/100,000 total births), the rate has been fluctuating since then (e.g., 2.7/100,000 in 2014, 3.4/100,000 in 2016). This is likely attributed to a variety of factors that have emerged in the past 20 years due to changes in the environment and social situation surrounding women, such as later marriage and rise in maternal age. In Western countries, “late maternal deaths” occurring between 42 days and one year after delivery are considered to be just as important as “maternal deaths,” i.e., deaths during pregnancy or within 42 days of termination of pregnancy. In particular, suicides attributable to psychiatric disorders have become a serious issue among women less than one year postpartum. However, in Japan, the actual number of deaths by suicide is unknown, since neither death certificates nor postmortem certificates include information on pregnancy and delivery. Despite the fact that the total number of suicide deaths in Japan is known, whether such deaths are associated with perinatal mental issues or not is unclear, and thus, no measures have been taken. Untreated perinatal depression and psychiatric disorders not only cause issues such as suicide, but are also related to pediatric developmental and mental disorders, neglect, and/or child abuse due to impaired nurturing ability. Suicide rates among pregnant and parturient women in Osaka, Tokyo, and Mie are much higher than those of the UK, the US, and Sweden. There is an urgent need to establish a regional support system that facilitates interactions among the obstetrical, pediatric, psychiatric field, and local administrations for monitoring and supporting mothers and infants, as well as a system that allows families, schools, and society to support young people, in order to realize improved preconception health care.","PeriodicalId":42505,"journal":{"name":"Hypertension Research in Pregnancy","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49540733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.14390/jsshp.hrp2020-012
Tomomi Yamazaki, A. Cerdeira, S. Agrawal, I. Koh, J. Sugimoto, M. Vatish, Y. Kudo
Preeclampsia is a major complication of pregnancy and is associated with significant fetal and maternal morbidity and mortality. Timely prediction of preeclampsia facilitates referral of potential patients to an adequate tertiary center, which helps reduce adverse outcomes associated with the disease. Moreover, by accurately ruling out preeclampsia, patients can be discharged safely and relieved of anxiety. Numerous candidate biomarkers have been proposed for the diagnosis and prediction of preeclampsia. Among these, maternal circulating factors such as soluble FMS-like tyrosine kinase-1 (sFlt-1), an anti-angiogenic factor, and placental growth factor (PlGF), an angiogenic factor, are considered the most promising. Measuring these factors as a ratio allows assessment of the angiogenic imbalance that characterizes incipient or overt preeclampsia. The sFlt-1/PlGF ratio increases before the onset of preeclampsia and thus may help predict the disease. The test is used as a predictive tool in several countries but not yet routinely performed in Japanese hospitals. We performed a systematic review of studies that assessed the performance of the sFlt-1/PlGF ratio in predicting preeclampsia in Japanese patients. Three studies were included in the systematic review. All studies reported high negative predictive values of the sFlt-1/PlGF ratio (i.e., for ruling out PE), in agreement with the current evidence of the test performance worldwide. The sFlt-1/PlGF ratio could be of significant relevance in the Japanese population.
{"title":"Predictive Accuracy of Soluble FMS-Like Tyrosine Kinase-1/Placental Growth Factor Ratio for Preeclampsia in Japan: A Systematic Review","authors":"Tomomi Yamazaki, A. Cerdeira, S. Agrawal, I. Koh, J. Sugimoto, M. Vatish, Y. Kudo","doi":"10.14390/jsshp.hrp2020-012","DOIUrl":"https://doi.org/10.14390/jsshp.hrp2020-012","url":null,"abstract":"Preeclampsia is a major complication of pregnancy and is associated with significant fetal and maternal morbidity and mortality. Timely prediction of preeclampsia facilitates referral of potential patients to an adequate tertiary center, which helps reduce adverse outcomes associated with the disease. Moreover, by accurately ruling out preeclampsia, patients can be discharged safely and relieved of anxiety. Numerous candidate biomarkers have been proposed for the diagnosis and prediction of preeclampsia. Among these, maternal circulating factors such as soluble FMS-like tyrosine kinase-1 (sFlt-1), an anti-angiogenic factor, and placental growth factor (PlGF), an angiogenic factor, are considered the most promising. Measuring these factors as a ratio allows assessment of the angiogenic imbalance that characterizes incipient or overt preeclampsia. The sFlt-1/PlGF ratio increases before the onset of preeclampsia and thus may help predict the disease. The test is used as a predictive tool in several countries but not yet routinely performed in Japanese hospitals. We performed a systematic review of studies that assessed the performance of the sFlt-1/PlGF ratio in predicting preeclampsia in Japanese patients. Three studies were included in the systematic review. All studies reported high negative predictive values of the sFlt-1/PlGF ratio (i.e., for ruling out PE), in agreement with the current evidence of the test performance worldwide. The sFlt-1/PlGF ratio could be of significant relevance in the Japanese population.","PeriodicalId":42505,"journal":{"name":"Hypertension Research in Pregnancy","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43340211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.14390/jsshp.hrp2020-014
T. Nagao, Midori Funakura, M. Saito, H. Hyodo
Pulmonary arteriovenous malformation (PAVMs) is a rare condition characterized by abnormal vascular connections between pulmonary arteries and veins. Increased pulmonary blood flow during pregnancy can exacerbate intrapulmonary shunt, which can cause stroke or pulmonary hemorrhage and lead to maternal death, miscarriage, and fetal growth restriction. PAVMs may be misdiagnosed, as their prominent symptoms are similar to those of pulmonary embolism (PE). We report herein a case of a 20-year-old woman diagnosed with PAVMs, who was initially suspected to have PE. She developed hypoxemia and deep vein thrombosis immediately after delivery that resulted in fetal growth restriction and asymptomatic acute cerebral infarction. Undiagnosed chronic hypoxemia was considered as a differential diagnosis of PE, since the patient showed signs of chronic hypoxia such as clubbing and cyanosis. Our findings underscore the importance of thorough systemic assessment during the first visit of patients with suspected PE.
{"title":"Pulmonary arteriovenous malformations with deep vein thrombosis and hypoxemia after delivery as a differential diagnosis of pulmonary embolism: A case report","authors":"T. Nagao, Midori Funakura, M. Saito, H. Hyodo","doi":"10.14390/jsshp.hrp2020-014","DOIUrl":"https://doi.org/10.14390/jsshp.hrp2020-014","url":null,"abstract":"Pulmonary arteriovenous malformation (PAVMs) is a rare condition characterized by abnormal vascular connections between pulmonary arteries and veins. Increased pulmonary blood flow during pregnancy can exacerbate intrapulmonary shunt, which can cause stroke or pulmonary hemorrhage and lead to maternal death, miscarriage, and fetal growth restriction. PAVMs may be misdiagnosed, as their prominent symptoms are similar to those of pulmonary embolism (PE). We report herein a case of a 20-year-old woman diagnosed with PAVMs, who was initially suspected to have PE. She developed hypoxemia and deep vein thrombosis immediately after delivery that resulted in fetal growth restriction and asymptomatic acute cerebral infarction. Undiagnosed chronic hypoxemia was considered as a differential diagnosis of PE, since the patient showed signs of chronic hypoxia such as clubbing and cyanosis. Our findings underscore the importance of thorough systemic assessment during the first visit of patients with suspected PE.","PeriodicalId":42505,"journal":{"name":"Hypertension Research in Pregnancy","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44408197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-27DOI: 10.14390/jsshp.hrp2020-004
Rie Seyama, S. Makino, M. Shinohara, Masaya Takahashi, Anna Sato, J. Takeda, S. Takeda, A. Itakura
Aim: Retained products of conception (RPOC) can cause postpartum hemorrhage. However, if intrauterine evacuation is performed for RPOC without adhesion, it can lead to massive hemorrhage due to an inability to identify bleeding points during the operation. Here, we describe the advantages of intrauterine evacuation of RPOC using contrast-enhanced ultrasonography (CE-US), which can identify bleeding points and contribute to successful hemostasis, and uterine balloon tamponade (UBT) in four clinical cases. Methods: We encountered four cases of RPOC and performed intrauterine evacuation combined with CE-US and UBT from 2018 to 2019. The ultrasound contrast agent, perfluorobutane, was infused immediately before the operation. After intrauterine evacuation, the uterine balloon was retained. Results: In all cases, CE-US identified bleeding points immediately, enabling retention of the uterine balloon on the bleeding points and subsequent hemostasis. None of the cases experienced complications the day after the operation.
{"title":"Advantages of contrast-enhanced ultrasonography and uterine balloon tamponade during intrauterine evacuation of retained products of conception","authors":"Rie Seyama, S. Makino, M. Shinohara, Masaya Takahashi, Anna Sato, J. Takeda, S. Takeda, A. Itakura","doi":"10.14390/jsshp.hrp2020-004","DOIUrl":"https://doi.org/10.14390/jsshp.hrp2020-004","url":null,"abstract":"Aim: Retained products of conception (RPOC) can cause postpartum hemorrhage. However, if intrauterine evacuation is performed for RPOC without adhesion, it can lead to massive hemorrhage due to an inability to identify bleeding points during the operation. Here, we describe the advantages of intrauterine evacuation of RPOC using contrast-enhanced ultrasonography (CE-US), which can identify bleeding points and contribute to successful hemostasis, and uterine balloon tamponade (UBT) in four clinical cases. Methods: We encountered four cases of RPOC and performed intrauterine evacuation combined with CE-US and UBT from 2018 to 2019. The ultrasound contrast agent, perfluorobutane, was infused immediately before the operation. After intrauterine evacuation, the uterine balloon was retained. Results: In all cases, CE-US identified bleeding points immediately, enabling retention of the uterine balloon on the bleeding points and subsequent hemostasis. None of the cases experienced complications the day after the operation.","PeriodicalId":42505,"journal":{"name":"Hypertension Research in Pregnancy","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44665783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-07DOI: 10.14390/jsshp.hrp2020-002
Hiroto Hirashima, K. Kaminaga, Y. Koyashiki, K. Tabata, R. Usui, A. Ohkuchi
Uterine necrosis after uterine artery embolization (UAE) for postpartum hemorrhage (PPH) is relatively rare. A 29-year-old primiparous woman had a diamniotic dichorionic twin pregnancy following frozen blastocyst transfer. She developed preeclampsia at 34 +3 weeks, and cesarean section was performed due to lung edema at 35 +2 weeks. UAE was performed using a gelatin sponge 3 hours after the operation due to PPH; however, the hemorrhage continued, and we performed a second UAE using n-butyl-2-cyanoacrylate. Uterine subinvolution continued after the second UAE, and her fever recurred 11 days after the operation. Magnetic resonance imaging suggested uterine necrosis 14 days after the operation, resulting in hysterectomy. The present study reviewed 17 cases of uterine necrosis following UAE in women with PPH, fever, abdominal/pelvic pain and found that delayed appearance of various symptoms was common. A long-lasting subinvolution may be a novel specific feature of uterine necrosis in women with UAE due to PPH.
{"title":"Uterine necrosis following uterine artery embolism due to postpartum hemorrhage: A case report and review","authors":"Hiroto Hirashima, K. Kaminaga, Y. Koyashiki, K. Tabata, R. Usui, A. Ohkuchi","doi":"10.14390/jsshp.hrp2020-002","DOIUrl":"https://doi.org/10.14390/jsshp.hrp2020-002","url":null,"abstract":"Uterine necrosis after uterine artery embolization (UAE) for postpartum hemorrhage (PPH) is relatively rare. A 29-year-old primiparous woman had a diamniotic dichorionic twin pregnancy following frozen blastocyst transfer. She developed preeclampsia at 34 +3 weeks, and cesarean section was performed due to lung edema at 35 +2 weeks. UAE was performed using a gelatin sponge 3 hours after the operation due to PPH; however, the hemorrhage continued, and we performed a second UAE using n-butyl-2-cyanoacrylate. Uterine subinvolution continued after the second UAE, and her fever recurred 11 days after the operation. Magnetic resonance imaging suggested uterine necrosis 14 days after the operation, resulting in hysterectomy. The present study reviewed 17 cases of uterine necrosis following UAE in women with PPH, fever, abdominal/pelvic pain and found that delayed appearance of various symptoms was common. A long-lasting subinvolution may be a novel specific feature of uterine necrosis in women with UAE due to PPH.","PeriodicalId":42505,"journal":{"name":"Hypertension Research in Pregnancy","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48165591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-10DOI: 10.14390/jsshp.hrp2020-001
Liangcheng Wang, Kohei Hamamoto, Azusa Kimura, Aya Ishiguro, Isao Horiuchi, K. Takagi
Intrauterine balloon tamponade (IBT) is widely used for treating obstetric hemorrhage. However, only a few reports on IBT failure exist. We report a case of IBT failure caused by an over-expanded lower uterine segment (LUS). A 30-year-old woman with twin pregnancy presented with bleeding after cesarean section. During surgery, uterine atony was observed; however, intravenous administration of oxytocin and ergometrine resolved the condition. Continuous hemorrhage was observed postoperatively, despite the administration of uterotonics and uterine massage. Although IBT was performed, the bleeding persisted, as recognized from the drainage fluid. Enhanced computed tomography revealed that the bleeding spot could not be compressed by the inflated balloon due to the over-expanded LUS. The balloon was removed; uterine artery embolization was required to achieve hemostasis. Our experience indicated that over-expanded LUS could cause IBT failure. If bleeding continues post-IBT replacement and an over-expanded LUS is observed, alternative treatments should be promptly
{"title":"Over-expanded lower uterine segment: a cause of intrauterine balloon tamponade failure","authors":"Liangcheng Wang, Kohei Hamamoto, Azusa Kimura, Aya Ishiguro, Isao Horiuchi, K. Takagi","doi":"10.14390/jsshp.hrp2020-001","DOIUrl":"https://doi.org/10.14390/jsshp.hrp2020-001","url":null,"abstract":"Intrauterine balloon tamponade (IBT) is widely used for treating obstetric hemorrhage. However, only a few reports on IBT failure exist. We report a case of IBT failure caused by an over-expanded lower uterine segment (LUS). A 30-year-old woman with twin pregnancy presented with bleeding after cesarean section. During surgery, uterine atony was observed; however, intravenous administration of oxytocin and ergometrine resolved the condition. Continuous hemorrhage was observed postoperatively, despite the administration of uterotonics and uterine massage. Although IBT was performed, the bleeding persisted, as recognized from the drainage fluid. Enhanced computed tomography revealed that the bleeding spot could not be compressed by the inflated balloon due to the over-expanded LUS. The balloon was removed; uterine artery embolization was required to achieve hemostasis. Our experience indicated that over-expanded LUS could cause IBT failure. If bleeding continues post-IBT replacement and an over-expanded LUS is observed, alternative treatments should be promptly","PeriodicalId":42505,"journal":{"name":"Hypertension Research in Pregnancy","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43870681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-30DOI: 10.14390/jsshp.hrp2019-016
A. Nakanishi, C. Kamiya, M. Sawada, T. Shionoiri, T. Konishi, C. Horiuchi, M. Tsuritani, N. Iwanaga, J. Yoshimatsu
Aim: The influence of cardiovascular changes resulting from hypertension on the course of pregnancy is unclear. The purpose of this study was to evaluate the influence of cardiovascular changes as detected by echocardiography on the course of pregnancy with chronic hypertension. Methods: This retrospective cohort study targeted women with a singleton pregnancy and chronic hypertension during the period between January 1, 2010 and December 31, 2018. We compared echocardiographic values between subjects with blood pressure (BP) elevation (BP elevation group) and normotensive subjects (control group) during pregnancy. Results: Twenty-nine hypertensive pregnant women were eligible for this study (14 subjects in the BP elevation group and 15 subjects in the control group). Left ventricular posterior wall thickness (PWT) and left ventricular mass index (LVMI) tended to be greater in the BP elevation group compared to the control group, but the differences were not significant. In the sub-cohort of subjects aged ≥ 35 years, PWT and LVMI were significantly greater in the BP elevation group compared to the control group. Conclusions: Left ventricular hypertrophy (LVH) in pregnant women with chronic hypertension may be a predictor of BP elevation during pregnancy.
{"title":"Left ventricular hypertrophy in Japanese pregnant women with chronic hypertension predicts blood pressure elevation during pregnancy","authors":"A. Nakanishi, C. Kamiya, M. Sawada, T. Shionoiri, T. Konishi, C. Horiuchi, M. Tsuritani, N. Iwanaga, J. Yoshimatsu","doi":"10.14390/jsshp.hrp2019-016","DOIUrl":"https://doi.org/10.14390/jsshp.hrp2019-016","url":null,"abstract":"Aim: The influence of cardiovascular changes resulting from hypertension on the course of pregnancy is unclear. The purpose of this study was to evaluate the influence of cardiovascular changes as detected by echocardiography on the course of pregnancy with chronic hypertension. Methods: This retrospective cohort study targeted women with a singleton pregnancy and chronic hypertension during the period between January 1, 2010 and December 31, 2018. We compared echocardiographic values between subjects with blood pressure (BP) elevation (BP elevation group) and normotensive subjects (control group) during pregnancy. Results: Twenty-nine hypertensive pregnant women were eligible for this study (14 subjects in the BP elevation group and 15 subjects in the control group). Left ventricular posterior wall thickness (PWT) and left ventricular mass index (LVMI) tended to be greater in the BP elevation group compared to the control group, but the differences were not significant. In the sub-cohort of subjects aged ≥ 35 years, PWT and LVMI were significantly greater in the BP elevation group compared to the control group. Conclusions: Left ventricular hypertrophy (LVH) in pregnant women with chronic hypertension may be a predictor of BP elevation during pregnancy.","PeriodicalId":42505,"journal":{"name":"Hypertension Research in Pregnancy","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48273903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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