Language：Japanese   Publisher：(一社)日本糖尿病・妊娠学会  

妊娠糖尿病(gestational diabetes mellitus:GDM)合併妊婦について、妊娠中のOGTTを含む指標から産後早期糖代謝異常のリスクが予測可能か検証した。当院で出産した単胎GDM妊婦を、産後OGTTの結果により正常型群と境界型以上群に分け、GDMの診断時期別(妊娠24週未満診断:E-GDM、妊娠24週以降診断:L-GDM)に、OGTTを含む妊娠中の各種指標を比較した。産後1年程度の間にGDMの約3割に耐糖能異常を生じ、境界型の割合はGDM診断時期による違いはなかった。E-GDMではGDM診断時OGTT120分値が高い場合、L-GDMでは妊娠中体重増加量が多い場合に産後の耐糖能異常を認めやすいことが判明した。(著者抄録)

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Language：Japanese   Publisher：(一社)日本糖尿病・妊娠学会  

2010～2020年に当院で周産期管理をした母児のデータベースを構築し、妊娠糖尿病(gestational diabetes mellitus:GDM)の転帰や予後を明らかにすることを目的とした。対象妊婦4385例とし、GDM群285例、対照群4100例で比較したところ対照群で周産期合併症が多かった。そこで併存疾患をもつ妊婦を除外した2240例で再解析を行い、GDM群では対照群と比較し妊娠高血圧症候群、羊水過多、heavy for dates(HFD)が有意に多い結果となった。再解析をしたことで、GDMによる周産期合併症のリスクは、併存疾患によるものより相対的に小さいことが示唆された。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10396-023-01404-w

PubMed

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Publishing type：Research paper (scientific journal)   Publisher：Frontiers Media SA  

Background

There is a rising interest in perinatal mental health studies, and proper psychometric tools to assess autistic traits among this population in Japan are vital.

Objective

This study aimed to clarify the optimal factor structure of the AQ as part of a perinatal mental health research project.

Methods

We used the Japanese version of the AQ (AQ-J) to measure autistic-like traits in pregnant women. Participants were 4,287 Japanese women who were pregnant or who had given birth within the last month. We performed exploratory factor analysis (EFA) using the first sample group (n = 2,154) to obtain factor structures for the final item selections. We performed confirmatory factor analysis (CFA) using the second sample group (n = 2,133) to obtain a model with good fit, then compared the model to all previously proposed models to determine the best-fitting model.

Results

The EFA analysis identified a model consisting of 25 items distributed across three factors. Cronbach’s alpha for the total 25-item AQ-J, 9-item “Social interaction” factor, 11-item “Non-verbal communication” factor, and 5-item “Restricted interest” factor was 0.829, 0.829, 0.755, and 0.576, respectively. McDonald’s omega and its 95% confidence interval were 0.826 (0.821–0.836), 0.835 (0.821–0.837), 0.755 (0.744–0.766), and 0.603 (0.556–0.596), respectively. CFA confirmed that the three-factor structure had an acceptable fit (goodness of fit index: 0.900, comparative fit index: 0.860, root mean square error of approximation: 0.066). These findings indicated that the three-factor model was better than the 13 existing models.

Conclusion

The findings are discussed in relation to the adequacy of the AQ-J for assessing autistic traits in perinatal women. We recommend the use of this 25-item, three-factor AQ-J model for this population owing to its superiority to all previous models.

DOI： 10.3389/fpsyt.2023.1275043

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: We aimed to quantify the incidence of recurrent uterine rupture in pregnant women. DATA SOURCES: A literature search of PubMed, Web of Science, Cochrane Central, and ClinicalTrials.gov for observational studies was performed from 2000 to 2023. METHODS OF STUDY SELECTION: Of the 7,440 articles screened, 13 studies were included in the final review. We included studies of previous uterine ruptures that were complete uterine ruptures , defined as destruction of all uterine layers, including the serosa. The primary outcome was the pooled incidence of recurrent uterine rupture. Between-study heterogeneity was assessed with the I2 value. Subgroup analyses were conducted in terms of the country development status, year of publication, and study size (single center vs national study). The secondary outcomes comprised the following: 1) mean gestational age at which recurrent rupture occurred, 2) mean gestational age at which delivery occurred without recurrent rupture, and 3) perinatal complications (blood loss, transfusion, maternal mortality, and neonatal mortality). TABULATION, INTEGRATION, AND RESULTS: A random-effects model was used to pool the incidence or mean value and the corresponding 95% CI with R software. The pooled incidence of recurrent uterine rupture was 10% (95% CI 6-17%). Developed countries had a significantly lower uterine rupture recurrence rate than less developed countries (6% vs 15%, P =.04). Year of publication and study size were not significantly associated with recurrent uterine rupture. The mean number of gestational weeks at the time of recurrent uterine rupture was 32.49 (95% CI 29.90-35.08). The mean number of gestational weeks at the time of delivery without recurrent uterine rupture was 35.77 (95% CI 34.95-36.60). The maternal mortality rate was 5% (95% CI 2-11%), and the neonatal mortality rate was 5% (95% CI 3-10%). Morbidity from hemorrhage, such as bleeding and transfusion, was not reported in any study and could not be evaluated. CONCLUSION: This systematic review estimated a 10% incidence of recurrent uterine rupture. This finding will enable appropriate risk counseling in patients with prior uterine rupture. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42023395010.

DOI： 10.1097/AOG.0000000000005418

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: To compare maternal outcomes of prenatally- and non-prenatally-diagnosed placenta accreta spectrum (PAS). DATA SOURCES: A systematic literature search was performed in PubMed, the Cochrane database, and Web of Science until 28 November 2022. STUDY ELIGIBILITY CRITERIA: Studies comparing the clinical presentation of prenatally- and non-prenatally-diagnosed PAS were included. Primary outcomes were emergent cesarean delivery, hysterectomy, blood loss volume, number of transfused blood product units, urological injury, coagulopathy, reoperation, intensive care unit admission, and maternal death. We also calculated the pooled mean values for blood loss volume and the number of transfused blood product units. Secondary outcomes comprised maternal age, gestational age at birth, nulliparity, prior cesarean delivery, prior uterine procedure, assisted reproductive technology, placenta increta/percreta, and placenta previa. STUDY APPRAISAL AND SYNTHESIS METHODS: Study screening was conducted after duplicates were identified and removed. The quality of each study and the publication bias were assessed. Forest plots and I2 statistics were calculated for each study outcome for each group. The main analysis was a random-effects analysis. RESULTS: 415 abstracts and 157 full-text studies were evaluated. Thirty-one studies were analyzed. Prenatally-diagnosed PAS was associated with a significantly lower rate of emergency cesarean delivery (odds ratio (OR), 0.37; 95% CI, 0.21-0.67), higher hysterectomy rate (OR, 1.98; 95% CI, 1.02-3.83), lower blood loss volume (mean difference, -0.65; 95% CI, -1.17 to -0.13), and lower number of transfused red blood cell units (mean difference, -1.96; 95% CI, -3.25 to -0.68) compared with non-prenatally-diagnosed PAS. Pooled mean values for blood loss volume and the number of transfused blood product units tended to be lower in the prenatally- vs non-prenatally-diagnosed PAS groups. Nulliparity (OR, 0.14; 95% CI, 0.10-0.20), prior cesarean delivery (OR, 6.81; 95% CI, 4.12-11.25), assisted reproductive technology (OR, 0.19; 95% CI, 0.06-0.61), placenta increta/percreta (OR, 3.97; 95% CI, 2.24- 7.03), and placenta previa (OR, 6.81; 95% CI, 4.12-11.25) showed statistical significance. No significance differences were found for the other outcomes. CONCLUSIONS: Despite its severity, the positive impact of prenatally-diagnosed PAS on outcomes underscores the necessity of a prenatal diagnosis. Additionally, the pooled mean values provide a preoperative preparation guideline.

DOI： 10.1016/j.ajogmf.2023.101197

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: We aimed to conduct a systematic review and meta-analysis to assess clinical characteristics related to pathologically proven placenta accreta spectrum (PAS) without placenta previa. DATA SOURCES: A literature search of PubMed, the Cochrane database, and Web of Science was performed from inception to September 7, 2022. STUDY ELIGIBILITY CRITERIA: The primary outcomes were invasive placenta (including increta or percreta), blood loss, hysterectomy, and antenatal diagnosis. Additionally, maternal age, assisted reproductive technology, previous cesarean section, and previous uterine procedures were investigated as potential risk factors. The inclusion criteria were studies evaluating the clinical presentation of pathologically diagnosed PAS without placenta previa. STUDY APPRAISAL AND SYNTHESIS METHODS: Study screening was conducted after duplicates were identified and removed. The quality of each study and the publication bias were assessed. Forest plots and I2 statistics were calculated for each study outcome for each group. The main analysis was a random-effects analysis. RESULTS: Among 2598 studies that were initially retrieved, five were included in the review. With the exception of one study, four studies could be included in the meta-analysis. This meta-analysis showed that PAS without placenta previa was associated with a less risk of invasive placenta (OR, 0.24; 95% CI, 0.16-0.37), blood loss (MD, -1.19; 95% CI, -2.09 to -0.28) and hysterectomy (OR, 0.11; 95% CI, 0.02-0.53), and more difficult to diagnose prenatally (OR, 0.13; 95% CI, 0.04-0.45) than PAS with placenta previa. Additionally, assisted reproductive technology and a previous uterine procedure were strong risk factors for PAS without placenta previa, while previous cesarean section was a strong risk factor for PAS with placenta previa. CONCLUSIONS: The differences in clinical aspects of PAS with and without placenta previa need to be understood.

DOI： 10.1016/j.ajogmf.2023.101027

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

AIM: In this review, We compared clinical characteristics of pregnant women aged 50 and older with those aged 45-49. Pregnant women ≥45 years are strongly associated with pregnancy-related complications, such as cesarean section rate, gestational hypertension, gestational diabetes mellitus, and preterm birth. Although pregnant women ≥50 years are considered more high-risk, differences in pregnancy outcomes between those over 45 and 50 years of age are unclear. METHODS: Our source strategy included using PubMed, the Cochrane Central Register of Controlled Trials, and Web of Science databases to include studies published between January 1, 2010 and September 30, 2022. The study population was pregnant women 50 years and older; the control group was pregnant women aged 45-49 years. Primary outcomes were cesarean section, gestational hypertension, gestational diabetes mellitus, and preterm birth. The secondary outcomes were small-for-gestational age, 5-min Apgar score < 7, neonatal intensive care unit admission (as neonatal outcomes), nulliparity, assisted reproductive technology (ART), and multifetal pregnancy (as maternal backgrounds). RESULTS: The incidence of cesarean section, gestational hypertension, and preterm delivery was significantly higher in those 50 years and older; however, significant differences disappeared when pooled analyses were limited to singleton pregnancies. ART was significantly more likely to be used for conception of pregnant women ≥50 years. Infants of women ≥50 years were more likely to be admitted to NICUs. CONCLUSIONS: The differences in outcomes between the two groups are obviously influenced by multiple pregnancies, therefore, reproductive medicine specialists should aim for singleton pregnancies in ART.

DOI： 10.1111/jog.15662

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.ajogmf.2023.100885

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Language：Japanese   Publisher：新潟産科婦人科学会  

胎児骨系統疾患は新生児期早期に管理を要する疾患であるが,超音波検査での胎児診断の精度は高くはない。今回,Three-dimensional computed tomography(以下,3D-CT)が胎児診断に有用であった胎児骨系統疾患の3例を経験したため報告する。症例1は妊娠16週より胎児骨系統疾患が疑われ,超音波検査で極めて予後不良な疾患が想定されたが,妊娠継続を希望され胎児3D-CTを撮像した。画像所見から骨形成不全症II型を強く疑い,分娩時損傷を回避するために帝王切開で出生した。症例2,3は妊娠27週頃より顕著な四肢の短縮を認め,胎児3D-CTによりそれぞれ骨形成不全症,軟骨無形成症と胎児診断した。3症例とも出生後速やかに新生児集中治療室(Neonatal Intensive Care Unit;NICU)に入室し,呼吸管理や画像検査,遺伝子検索などの早期介入につながった。胎児3D-CTは鑑別診断や重症度の診断精度が上がり,予後や治療方針を両親に事前に情報提供でき,かつ周産期管理指針が明確になる点で有用な検査であると考えられた。(著者抄録)

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BACKGROUND: A subsequent pregnancy after uterine artery embolization (UAE) raises several concerns, one of which is placenta accreta spectrum (PAS). Placenta previa is the strongest risk factor for PAS, which is most likely to occur in the lower uterine segment. PAS without placenta previa (i.e., uterine body PAS) is considered relatively rare. CASE PRESENTATION: A 35-year-old woman, gravida 2 para 1, had undergone UAE for postpartum hemorrhage due to uterine atony after vaginal delivery in her previous pregnancy. She developed placenta previa during her subsequent pregnancy and was therefore evaluated for PAS in the lower uterine segment. On the basis of examination findings, we considered PAS to be unlikely. During cesarean section, we found that the placenta was not detached from the uterine body, and the patient was determined to have uterine body PAS. Ultimately, a hysterectomy was performed. CONCLUSIONS: PAS can occur in a subsequent pregnancy after UAE. When a subsequent pregnancy after UAE is accompanied by placenta previa, it is important to maintain a high index of suspicion of uterine body PAS without being misled by the presence of placenta previa.

DOI： 10.1186/s12884-022-05031-0

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Language：English  

DOI： 10.1016/j.ejogrb.2022.05.018

PubMed

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AIM: We aimed to grasp the actual working hours of Japanese obstetricians and gynecologists (OB/GYN doctors) as accurately as possible, using the same method of the Ministry of Health, Labour, and Welfare (MHLW). METHODS: The time study targeted OB/GYN doctors working at 10 universities nationwide including Niigata University and 21 institutions which take a role of perinatal care in Niigata prefecture. Working hours per week were calculated based on the following categories: regular and overtime work inside the hospital, work outside the hospital, self-improvement, education, research, and others. Data on weekly working hours were converted to yearly data for analyses. RESULTS: A time study of 10 universities nationwide revealed that 30% of doctors work overtime for more than 1860 h even if they do not include on-call shifts in their working hours. In 21 institutions in Niigata, physicians in Niigata University worked more overtime than other hospitals. It became clear that community health care was supported by dispatching physicians working at university. Furthermore, the results of simulations predicted the pessimistic situation of perinatal medical care in Niigata. CONCLUSIONS: Our study showed the possibility to exist much more OB/GYN doctors who work more than 1860 h of overtime work per year than the data presented by the MHLW based on nation-wide survey in 2019. The fact that the working hours at the side jobs had a great influence on the increase in overtime work of physicians in University was the same result as the report of MHLW published in 2021.

DOI： 10.1111/jog.15230

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMC  

Background Our previous study demonstrated the safety and effectiveness of abdominal radical trachelectomy during pregnancy but did not focus on the fetus. This study aimed to clarify the influence of abdominal radical trachelectomy performed during pregnancy on the fetus. Methods Eight cervical cancer patients who underwent abdominal radical trachelectomy at our hospital between February 2013 and August 2020 were enrolled in this study. To assess the peri- and postoperative influence on the fetus, we performed fetal heart monitoring at 30-min intervals during abdominal radical trachelectomy and calculated the estimated fetal body weight and resistance indexes of the middle cerebral artery and umbilical artery from postsurgery until delivery. Results Four out of eight patients had preterm birth due to chorioamnionitis in one case and consideration of the recurrent risk of cervical cancer in three cases. Fetal heart monitoring during abdominal radical trachelectomy revealed deceleration just once in one case but no abnormal findings in the other cases. In all cases, the fetal growth after abdominal radical trachelectomy was normal until delivery. No abnormal Doppler findings were detected in the middle cerebral artery or umbilical artery. Conclusion Our findings clarified that abdominal radical trachelectomy performed for the treatment of early-stage cervical cancer during pregnancy has no obvious influence on fetal growth. Next, it is necessary to evaluate the growth and development of children delivered from mothers who have undergone abdominal radical trachelectomy during pregnancy.

DOI： 10.1186/s12884-022-04671-6

Web of Science

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Language：English  

BACKGROUND: Patients with systemic lupus erythematosus (SLE) are associated with pre-eclampsia. Pre-eclampsia can have systemic manifestations, such as ascites. Lupus peritonitis, a rare condition in patients with SLE, can also cause ascites. CASE PRESENTATION: A 31-year-old woman, primigravida, with SLE had a blood pressure of 170/110 mmHg and proteinuria at 29 weeks of gestation. She was diagnosed with pre-eclampsia. Her blood pressure was stabilized by an antihypertensive drug. At 30 weeks of gestation, a cesarean section was performed for maternal safety because of decreased urine output and massive ascites. Postoperatively, re-accumulation of ascites was observed. On the fourth postoperative day, ascites (approximately 3 L) was discharged from the cesarean section wound. A decrease in serum complement concentrations was observed, and she was diagnosed as having lupus peritonitis. The steroid dose was increased and she recovered well thereafter. CONCLUSIONS: Ascites occurs in pre-eclampsia and SLE, but determining which of these conditions causes ascites can be difficult. However, careful observation is necessary because of the differences in treatment of these two conditions.

DOI： 10.1186/s12884-022-04550-0

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Language：Japanese   Publisher：金原出版(株)  

＜文献概要＞日本国内10大学に勤務する産婦人科医を対象に勤務実態調査(タイムスタディ)を行った結果,大学病院勤務医の30%が年間1,860時間以上の時間外労働を行っている実態が明らかになった。また,新潟県内で行ったタイムスタディでは,新潟大学産婦人科に勤務する医師の48%,関連病院に勤務する医師の29%が,年間1,860時間以上の時間外労働を行っていることが示された。「医師の働き方改革」が間近に迫った今,われわれが置かれている現状を広く公開し,国民に理解を求めることが必要である。安全な周産期医療体制の確立は,産婦人科単独で成し遂げられるものではない。行政とともにそれぞれの地域に見合った新たな体制作りが急務である。

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Language：Japanese   Publisher：Japan Society of Perinatal and Neonatal Medicine  

We conducted a retrospective analysis on the clinical backgrounds and patient outcomes of 52 cases of congenital gastrointestinal atresia encountered in our institution in the past 28 years. These cases were divided into three groups: esophageal, duodenal, and intestinal atresia. Our evaluation revealed that the rate of polyhydramnios was significantly lower in the intestinal atresia group, but there was no significant difference in the rate of threatened preterm labor or preterm birth among all groups. Esophageal atresia had the highest perinatal mortality rate and the poorest neonatal prognosis. Conversely, there were no reported cases of chromosomal abnormalities in the intestinal atresia group, which had a good prognosis. Collectively, the prenatal diagnosis rate was 77% for all cases. Polyhydramnios as observed on ultrasonography, along with the appearance of gastric bubbles and bowel dilatation, and the use of fetal MRI all contributed to the prenatal diagnosis. However, when compared among groups, prenatal diagnosis and the accuracy of diagnostic rates by fetal MRI were significantly lower for esophageal atresia. Our analysis showed that ultrasonography and fetal MRI are useful tools for prenatal diagnosis of congenital gastrointestinal atresia, even though diagnosis is challenging in some cases. Since prenatal or postnatal prognosis depends on the site of the gastrointestinal tract obstruction, prenatal diagnosis has the significance of providing appropriate information to expectant parents, managing pregnancy, and facilitating neonatal treatment.

DOI： 10.34456/jjspnm.58.3_510

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Language：Japanese   Publisher：Japan Society of Perinatal and Neonatal Medicine  

Lamellar body is a surfactant-containing lamellar structure secreted from type II alveolar epithelial cells, and Lamellar body count（LBC）is used to estimate surfactant production in utero and to predict fetal lung maturity. We conducted this study to evaluate the neonatal respiratory status at 36-38 weeks of gestation using LBC. 127 Amniotic fluid were analyzed immediately with no centrifugation and the number of lamellar bodies was counted using a platelet channel on the Sysmex KX-21.12 neonates（9.4%）had respiratory disorders and 115（90.4%） did not. The LBC in respiratory disorders group was significantly lower than in control group（2.7×10⁴/μL vs. 6.0×10⁴/μL; p<0.001）. The optimal cut off value to predict neonatal respiratory disorders was 4.4×10⁴/μL（area under the curve 0.833, 95% confidence interval 0.702-0.963）, with a sensitivity of 91.7%, specificity 69.6%, positive predictive value 26.2% and negative predictive value 94.1%. The LBC in vaginal delivery cases was significantly higher than in caesarean section cases（8.0×10⁴/μL vs. 5.3×10⁴/μL; p=0.036）. LBC is a useful method that is very simple, rapid, objective, and accurate in detecting neonatal respiratory disorders cases.

DOI： 10.34456/jjspnm.58.3_492

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Language：Japanese   Publisher：Japan Society of Perinatal and Neonatal Medicine  

The clinical outcomes of dinoprostone vaginal insert and mechanical methods for cervical ripening were compared retrospectively. The duration of labor and the time taken for hospital discharge were significantly shorter in the vaginal group than in the mechanical group. Mothers in the vaginal group had a significantly higher percentage of deliveries within 24 hours of vaginal insertion of dinoprostone than those in the mechanical group. In cases in which labor was induced at 37 or 38 weeks’ gestation due to maternal complications, there were no cases in either group in which use was discontinued due to worsening complications. Moreover, the time taken for hospital discharge was significantly shorter in the vaginal group, indicating the usefulness of dinoprostone vaginal insert in patients with maternal complications. On the other hand, uterine tachysystole and fetal dysfunctions may occur while administering dinoprostone vaginal inserts; therefore, careful management and compliance with the directions for use is necessary.

DOI： 10.34456/jjspnm.58.3_498

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd  

Background: Postpartum hemorrhage (PPH) is a potentially fatal condition requiring urgent and appropriate intervention. Uterine artery embolization (UAE) has a high hemostatic capacity for PPH, but it may fail. Disseminated intravascular coagulation (DIC) has been reported as a risk factor associated with the failure of UAE. Case presentation: A 37-year-old primigravida with dichorionic diamniotic twins and placenta previa underwent cesarean section. The blood loss during surgery was 4950 mL. Hemostasis was achieved using an intrauterine balloon tamponade device. However, she lost a further 2400 mL of blood 5 h after surgery. We embolized both uterine arteries using gelatin sponges and confirmed hemostasis. She was suffering from DIC and received ample blood transfusions. However, a further 1300 mL of blood was lost 18 h after surgery and we performed repeated UAE, with complete recanalization of the uterine arteries on both sides and re-embolization with gelatin sponges. Her DIC was treated successfully by blood transfusions at this time, and she showed no further bleeding after the repeated UAE. Conclusions: DIC is a risk factor for the failure of UAE. Repeated UAE may be effective after sufficient improvement of the hematological status in patients with PPH and DIC.

DOI： 10.1186/s12884-021-04191-9

Scopus

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1111/jog.14737

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/jog.14737

Language：English   Publishing type：Research paper (scientific journal)  

AIM: The Ministry of Health, Labour, and Welfare of Japan proposed a regulation of overtime work as a reform in work style. However, the regulation may deteriorate the quality of medical services due to the reduction in training time. Thus, the study aimed to reveal perceptions in terms of generation gaps in views on self-training and overtime work, among members of the Japan Society of Obstetrics and Gynecology (JSOG). METHODS: A web-based, self-administered questionnaire survey was conducted among members of the JSOG. In total, 1256 respondents were included in the analysis. Data were collected on age, sex, experience as a medical doctor, location of workplace, work style, the type of main workplace, and number of full-time doctors in the main workplace. The study examined the attitudes of the respondents toward overtime work and self-training. The respondents were categorized based on experience as a medical doctor. RESULTS: According to years of experience, 112 (8.9%), 226 (18.0%), 383 (30.5%), 535 (42.6%) doctors have been working for ≤5, 6-10, 11-19, and ≥ 20 years, respectively. Although 54.5% of doctors with ≤5 years of experience expected the regulation on working hours to improve the quality of medical services, those with ≥20 years of experience expressed potential deterioration. After adjusting for covariates, more years of experience were significantly related with the expectation of deterioration in the quality of medical services. CONCLUSIONS: The study revealed a generation gap in the views about self-training and overtime work among obstetricians and gynecologists in Japan.

DOI： 10.1111/jog.14735

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Abstract

Background

We report a case of pulmonary edema induced by tocolytic agents that was successfully managed with noninvasive positive-pressure ventilation (NPPV) and resulted in extended gestation.

Case presentation

A 36-year-old Japanese pregnant woman received tocolytic therapy with ritodrine hydrochloride, magnesium sulfate, nifedipine, and betamethasone from 28 weeks of gestation. She developed respiratory failure. and her chest X-ray showed enlarged pulmonary vascular shadows. At 29 weeks and 1 day of gestation, she was diagnosed with pulmonary edema induced by tocolytic agents. Because respiratory failure worsened 2 days after ritodrine hydrochloride and magnesium sulfate were stopped, NPPV was initiated. Her respiratory status improved and she was weaned off of NPPV after 3 days. She underwent cesarean section because of breech presentation at 30 weeks and 0 days of gestation due to initiation of labor pains.

Conclusions

NPPV can be safely administered in cases of tocolytic agent-induced pulmonary edema during pregnancy.

DOI： 10.1186/s13256-021-02704-w

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Other Link： http://link.springer.com/article/10.1186/s13256-021-02704-w/fulltext.html

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Blackwell Publishing  

Aim: Transverse uterine fundal incision (TUFI) was developed to avoid catastrophic hemorrhage associated with cesarean section of the placenta previa–accreta. Abdominal incisions extend as far as the upper abdomen in patients in the third trimester of pregnancy and require general anesthesia. Instead, we tried to aspirate amniotic fluid (AF) to reduce the uterine size. Methods: TUFI was performed in 19 of our patients in the third trimester in whom placenta previa accreta could not be ruled out between June 2012 and August 2016. After the lower abdominal vertical incision, we attempted to exteriorize the uterine fundus. If this was impossible, we inserted an 18-gauge spinal needle into the amniotic space. We aspirated AF until the uterine fundus could be exteriorized. Results: We exteriorized the uterine fundus without extending the incision to the upper abdomen by aspirating 250–670 mL of AF in 12 patients who were between the 33rd and 37th week of pregnancy, and TUFI was performed under spinal anesthesia. AF aspiration was not required in four patients who were in the 30th or 31st week of pregnancy and in two patients with oligohydramnios in the 35th week of pregnancy. In one case, the trial was canceled due to hemorrhagic AF aspiration. No serious complications were observed in mothers or neonates. Conclusion: TUFI could be made by abdominal incision to the left of the umbilicus under spinal anesthesia without anesthesia by reducing the uterine size through AF aspiration, even for patients in the third trimester of pregnancy.

DOI： 10.1111/jog.14604

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Language：Japanese   Publisher：新潟産科婦人科学会  

妊娠中の子宮破裂は母児ともに重篤な状態を招きやすい病態であるが、特徴的な臨床所見や徴候について明確な知見がなく、早期診断が困難である。今回、当院で過去15年間に子宮破裂と診断された5症例について臨床所見と母児の転帰を中心に検討した。臨床的背景として、4例が高齢妊娠、うち1例は多産婦であった。特徴的な臨床所見として、陣痛とは異なる腹痛を3例、分娩前の異常出血を2例に認めた。子宮収縮の特徴的な所見として、陣痛減弱を1例に認め、他の1例に子宮頻収縮を認めた。母体の転帰として、輸血を要したものが3例あり、うち1例は出血コントロールが困難で子宮全摘術を施行された。児の転帰は、長期予後を調査しえた4例すべてが転帰良好であった。

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Language：Japanese   Publisher：新潟産科婦人科学会  

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Language：Japanese   Publisher：新潟産科婦人科学会  

症例は6妊3産の30歳で、自然妊娠成立し、妊娠18週に近医産婦人科クリニックを初診した。20週時に施行された妊娠初期検査でSTS定性(+)、TPHA定性(+)であり、梅毒合併妊娠として21週時に当科を紹介初診した。血液検査ではSTS定量64倍、TPHA価24.97S/COであった。2年前に第3子の周産期管理を行った病院へ問い合わせ、その際の妊娠初期検査ではSTS定性・TPHA定性とも陰性であったことを確認した。性風俗の従事歴・利用歴がないことや、夫婦での性交渉状況から潜伏梅毒と診断し、アモキシシリン内服による治療を開始した。超音波検査で胎児感染を示唆する所見は認めず経過したが、服薬コンプライアンス不良であり、妊娠30週時点でSTS定量64倍、TPHA価22.40S/COであった。分娩様式はTOLAC希望であったが、未陣発のため妊娠42週0日に帝王切開を行い、3684gの男児をアプガースコア8/9点で出産した。児に明らかな梅毒感染所見は認めず、日齢15日目に退院した。母は1ヵ月検診の血液検査でSTSの低下が不十分であったことから感染症内科へ紹介したが、その後の定期受診はされていない。

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Language：English   Publishing type：Research paper (scientific journal)  

Purpose: The Hospital Anxiety and Depression Scale (HADS) is a self-report questionnaire widely used to assess anxiety and depression. To the best of our knowledge, only four studies have examined the factor structure of the HADS for assessing pregnant women, with conflicting results. This study aimed to assess the factor structure and measurement invariance of the HADS for use with pregnant Japanese women. Participants and Methods: A total of 936 pregnant Japanese women completed the HADS questionnaire at three time points: the first and third trimester of pregnancy, and postpartum. We examined the factor structure of the HADS in Group 1 (n = 466) using exploratory factor analysis (EFA). We then compared the models identified in Group 1 with those from previous studies using confirmatory factor analysis (CFA) in Group 2 (n = 470). We performed multiple-group CFA for Group 2 to test the measurement invariance of the best-fit model across the three time points. Results: The EFA for the Group 1 data at the three time points revealed a two-factor model. In the CFA, the two-factor model from Group 1 showed the best fit with the data at the three time points. In the multiple-group CFA for Group 2, we confirmed the configural and metric invariance of the two-factor model across the three time points. Conclusion: Our findings provide evidence for a two-factor structure and weak measurement invariance of the HADS in pregnant Japanese women during the peripartum period.

DOI： 10.2147/NDT.S294918

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

Purpose: Postpartum depression is a well-known risk factor, and postpartum anxiety and parity are potential risk factors, for mother-infant bonding disorder. However, few studies have focused on the relationships among these factors and mother-infant bonding. This cross-sectional study explored the associations between depression, anxiety and parity, and mother-infant bonding. Materials and Methods: Japanese mothers, both primiparas and multiparas, completed the Mother-to-Infant Bonding Scale (MIBS) and the Hospital Anxiety and Depression Scale (HADS) one month after childbirth. We performed a stepwise multiple regression analysis with the forward selection method to assess the effects of HADS anxiety and depression scores and parity as independent variables on mother-infant bonding as the dependent variable. Results: A total of 2379 Japanese mothers (1116 primiparas and 1263 multiparas) took part in the study. MIBS score (2.89 ± 2.68 vs 1.60 ± 2.11; p < 0.0001) was significantly higher in primiparas than in multiparas. HADS anxiety (6.55 ± 4.06 vs 4.63 ± 3.41; p < 0.0001) and depression (6.56 ± 3.43 vs 5.98 ± 3.20; p < 0.0001) scores were also significantly higher in primiparas than in multiparas. A stepwise multiple regression analysis with the forward selection method revealed that HADS depression and anxiety scores and parity were significantly associated with MIBS score (p = 0.003, 0.015 and 0.023). Conclusion: Depression, anxiety and primiparity were negatively associated with mother-infant bonding one month after childbirth.

DOI： 10.2147/NDT.S287036

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1080/01443615.2019.1600480

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Language：English   Publishing type：Research paper (scientific journal)  

The vernix caseosa is a complex membranous structure comprising 80% water, 10% protein, and 10% lipids including barrier lipids such as ceramides, free fatty acids, phospholipids and cholesterol, synthesized partly by fetal sebaceous glands during the last trimester of pregnancy in an antero-posterior and dorsoventral manner. Because of its lipid content, vernix is hydrophobic and protects the skin from excessive water exposure during the development of the stratum corneum. The vernix caseosa has various functions during fetal transition from an intrauterine to an extrauterine environment, including lubrication of the birth canal during parturition, barrier function to prevent water loss, temperature regulation, for innate immunity and for intestinal development. This review discusses the evidence supporting the prenatal and postnatal functions of vernix caseosa, along with its structure, composition, and physical and biological characteristics. Understanding the biology of the vernix may facilitate improved care of preterm infants immediately post-partum.

DOI： 10.1111/jog.14103

PubMed

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Language：Japanese   Publisher：金原出版(株)  

＜文献概要＞妊娠35週に著明な絨毛間腔の拡張を伴う胎盤肥厚が出現し母体搬送され,その後の周産期転帰に異常を認めなかった症例を経験した。胎盤肥厚は児の周産期予後を悪化させると報告されている。そこでPubMedを用いて,常位胎盤早期剥離に関連しない胎盤肥厚の報告例(7論文:28症例+自験例)について系統的レビューを行った。その結果,妊娠第2三半期以前に胎盤肥厚が出現した症例は,第3三半期以降に発症した症例と比較してsmall-for-gestational ageの発症率が有意に高いことが示された。胎盤肥厚の出現時期は高次施設への搬送の必要性を判断する一助になると思われた。

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

帝王切開後の術後創部感染(SSI)、特に子宮筋切開部SSIや子宮創部膿瘍を予防するため感染性滲出液の貯留を防ぐことの重要性に着目し、効果的な排液法としてドレーン挿入の有効性の有無と適切なドレーンの挿入法について検討した。まず、感染性滲出液の効果的な排液法を、in vitroの帝王切開術後モデルを作成して検討した。帝王切開術後モデルの作成には鶏肉とヨーグルトを用い、鶏肉を子宮下節の筋層縫合後の子宮筋層のモデル、感染性滲出液の代用にヨーグルトを使用した。膀胱子宮窩腹膜を縫合し、閉鎖式吸引ドレーンを挿入した「膀胱子宮窩腹膜縫合モデル」が最も効率よく滲出液を排液した。「無縫合モデル」ではヨーグルトは少しずつ吸引されるが、「縫合モデル」と比べ効率が悪く、ヨーグルトの注入量が多くなると周囲に漏出した。そのため、適切に滲出液を排除するためには、ダグラス窩にもドレーンの挿入を要すると考えられた。開放式ドレナージ法では少量の排液を認めたが、滲出液を十分に排除することは困難であった。この結果を受け、2013年8月から絨毛膜羊膜炎等の感染を背景に有する症例(胎胞形成や前期破水など)のうち、緊急手術となった症例を対象とし、帝王切開時に、膀胱子宮窩腹膜を縫合し閉鎖式吸引ドレーンを挿入するドレナージ法を導入した。その結果、子宮筋層切開創の創部感染の発生率は0.32%に有意に低下し、腹壁の創部感染もドレナージ法導入前後で9例から1例に減少した。

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.tjog.2018.11.009

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Language：Japanese   Publisher：金原出版(株)  

＜文献概要＞オウム病はChlamydia(Chlamydophila)psittaciによる動物由来感染症であり,主に鳥類から感染する。インフルエンザ様症状をきたす軽症例から,播種性血管内凝固症候群(DIC)や多臓器不全などをきたす重症例まで臨床像は多様であり,死亡例の報告もある。妊娠中に発症したオウム病は海外から15例報告されており,母体死亡1例を含めいずれも重症例で,生児が得られたのは4例のみであった。今回国内初の妊娠オウム病症例を経験した。当初は病原菌を特定できないまま,子宮内胎児死亡,妊産婦死亡に至った。妊婦はオウム病のハイリスクであると認識し,妊娠中は鳥類や家畜との不必要な接触を避けるように,啓蒙,指導することが重要である。

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Language：Japanese   Publisher：(公社)日本超音波医学会  

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Introduction: Primary spinal cord tumours can lead to severe neurological complications and even death. Pregnant women often complain of discomfort of the lower limbs, which is usually caused by sciatica. Here we present the case of a pregnant woman, who was initially considered to have sciatica, but was finally diagnosed with a primary intramedullary spinal cord tumour. Case presentation: A 28-year-old pregnant woman presented to our hospital with inexplicable numbness in her lower limbs. She was initially considered to have sciatica, but acute deterioration of neurological symptoms and plain magnetic resonance imaging (MRI) findings suggested malignancy. The patient was finally diagnosed with a primary intramedullary spinal cord tumour at the C3-Th5 region. An emergency caesarean section was performed, after which the spinal cord lesion was evaluated using contrast-enhanced MRI, positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-d-glucose integrated with computed tomography, and spinal angiography, and further treatment was initiated. However, while the patient's spinal cord tumour surgery was performed in early postpartum, her paraplegia and bladder and rectal disturbances remained unchanged even 1 year after surgery. Discussion: Because of the low incidence of spinal cord tumours during pregnancy, no definite reports have been published on the treatment of pregnant patients with spinal cord tumours. Although safe imaging tests during pregnancy are limited, intervention in such patients should be performed as early as possible to avoid irreversible neurological deterioration.

DOI： 10.1038/s41394-018-0059-6

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Language：English   Publisher：Blackwell Publishing Ltd  

DOI： 10.1111/1471-0528.14899

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER TAIWAN  

Objective: Severe motor vehicle accidents involving pregnant women can result in fetal and neonatal death. We describe a case in which fetal death occurred due to relatively mild seatbelt injuries and present the characteristic magnetic resonance imaging (MRI) findings of the placenta.
Case Report: A 26-year-old primigravid woman at 20 weeks gestation was involved in an automobile accident. Although she suffered only a seatbelt injury, fetal death subsequently occurred. Contrast enhanced MRI showed the region compressed by the seatbelt as a low-intensity band without enhancement, and serum alpha-fetoprotein and hemoglobin F levels were elevated.
Conclusion: Careful monitoring, including blood and abdominal examinations, should be performed when pregnant women suffer seatbelt injuries. (C) 2017 Taiwan Association of Obstetrics & Gynecology. Publishing services by Elsevier B.V.

DOI： 10.1016/j.tjog.2016.08.009

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Language：Japanese   Publisher：金原出版(株)  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00535&link_issn=&doc_id=20161222120015&doc_link_id=10.18888%2FJ00535.2017065776&url=https%3A%2F%2Fdoi.org%2F10.18888%2FJ00535.2017065776&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(株)メジカルビュー社  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(株)診断と治療社  

原因不明の羊水過多を呈した妊婦に対して積極的な問診を行い、筋強直性ジストロフィーと診断した2症例を経験した。疾患の重篤度に鑑みて、羊水過多の原因に先天性筋強直性ジストロフィーを想定することは重要である。先天性筋強直性ジストロフィーは出生直後に適切な管理が行われなければ死亡に至ることもある。出生前に確実に診断し、高次施設において妊娠・分娩管理を行うことが望ましい。(著者抄録)

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Language：Japanese   Publisher：金原出版(株)  

妊娠中に急性白血病(AL)を発症することは稀であるが、著者等は偶然にも1年間に3例のAL合併妊娠を経験したので、各例の概要を提示した。また、3例の経験をもとに、ALの診断から治療に至るプロセスで産婦人科医が担うべき役割について考察し、以下の結論を得た。1)妊娠中は様々な愁訴があり、感冒症状や倦怠感を訴えた場合には、これらの症状にALなどの血液疾患がマスクされている可能性を常に念頭におく必要がある。2)血液検査を行う際には、特に目視による血液像の確認が重要である。3)ALは診断後早急に治療を開始しなければならないため、産婦人科医は母児の状態を速やかに把握し、血液内科や小児科と協議しながら児娩出や化学療法のタイミングを判断することが必要である。

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Language：Japanese   Publisher：(株)東京医学社  

26歳。自然妊娠し、経過順調であった。妊娠20週5日、軽自動車を時速50kmで運転中、対向車と正面衝突し車が横転するという事故を起こした。この時、3点式シートベルトを着用しており、エアバッグが作動した。1時間後に当院に救急搬送された。来院時、右肩と両側上前腸棘部にシートベルト痕を認めた以外は体表面に目立った外傷はなく、腹痛や性器出血、破水も認めなかった。超音波検査でも母体の心タンポナーデや血胸、腹腔内出血などのいわゆるFAST(focused assessment with sonography for trauma)は陰性であった。一方、胎児心拍は50〜60/分と徐脈を呈しており、事故から1時間半後に消失し、子宮内胎児死亡が確認された。その原因検索目的で施行したMRIの所見などから、原因として、1)交通事故に起因する物理的な圧迫に伴う常位胎盤早期剥離、2)胎盤実質の損傷と胎盤内の血管破綻に伴う急激な胎盤機能不全、3)胎児母体間輸血などが考えられた。また、胎盤尾側の損傷がシートベルトに沿うように帯状を呈していたことから、シートベルトによる胎盤への強い衝撃が一連の誘因であったと推測された。

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Language：English   Publisher：WILEY-BLACKWELL  

DOI： 10.1111/1471-0528.13610

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Language：Japanese   Publisher：(株)東京医学社  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00621&link_issn=&doc_id=20140822220002&doc_link_id=%2Faq9syuse%2F2014%2F004408%2F002%2F1003-1006%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faq9syuse%2F2014%2F004408%2F002%2F1003-1006%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publisher：WILEY  

DOI： 10.1111/1471-0528.12550

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Language：Japanese   Publisher：(株)診断と治療社  

非瘢痕子宮破裂の4症例を提示した。症例1(35歳)、症例3(32歳)、症例4(31歳)は3回以上の分娩を経験しており、症例1、症例2(35歳)、症例4では促進剤を使用していたことから、全ての症例でリスクファクターを有していたことになる。また、4症例において、幸いにも母体死亡は認めなかったが、2例で輸血を要し、3例で子宮摘出を余儀なくされた。症例1、2は分娩中に突然の児心音低下と強い腹痛が認められたため、常位胎盤早期剥離を疑い緊急帝王切開術を施行した。症例3、4はともに分娩中に明らかな異常は認められず、分娩後に症状が出現した。症例3は後腹膜血腫の疑い、症例4は弛緩出血を疑い、止血目的で開腹術を施行した。妊娠および分娩時の非瘢痕子宮破裂の診断は決して容易ではないが、今回経験した全4例において、その裂創はいずれも子宮体下部〜峡部の側壁の縦走が認められた。非瘢痕趾球破裂が疑われる場合、子宮体下部〜峡部の側壁に出血あるいは血腫を疑わせる低エコー領域が存在しないかを確認することにより、早期診断が可能となり、開腹の時機を逸しないものと考えられた。

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Language：English  

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Language：English   Publisher：Blackwell Publishing Ltd  

DOI： 10.1111/1471-0528.12555

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Language：English   Publishing type：Research paper (scientific journal)  

In patients with fructose-1,6-bisphosphatase (FBPase) deficiency, maternal and fetal neurodevelopmental abnormalities can be induced by severe hypoglycemia and lactic acidosis, which is triggered by pregnancy. The patient was a 24-year-old and primipara. Via pre-pregnancy education and management including self-monitoring of blood glucose and prompt medical intervention with glucose infusions, she never experienced hypoglycemia with impaired consciousness. She delivered a 2,406 g male infant at 38 weeks of gestation by cesarean section. No neurological abnormalities in either the mother or the child appeared during the following 2 years. This is the first report with detailed descriptions of the management of a pregnant woman with FDPase deficiency. This report suggests that for a patient with FBPase deficiency, the maternal and fetal complications can be reduced by pre-pregnancy education and self-monitoring of blood glucose to prevent hypoglycemia.

DOI： 10.1007/8904_2013_290

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

Objective To determine the feasibility and safety of transverse fundal incision with manual placental removal in women with placenta praevia and possible placenta accreta.
Design Case series.
Setting Four level-three Japanese obstetric centres.
Population Thirty-four women with prior caesarean section and placenta praevia that widely covers the anterior uterine wall, in whom placenta accreta cannot be ruled out.
Methods A transverse fundal incision was performed at the time of caesarean section and manual placental removal was attempted under direct observation.
Main outcome measure Operative fluid loss.
Results The total volume of fluid lost during our operative procedure compares favourably with the volume lost during our routine transverse lower-segment caesarean sections performed in patients without placenta praevia or accreta. The average fluid loss was 1370g. No patients required transfer to intensive care, and there were no cases of fetal anaemia.
Conclusions This procedure has the potential to reduce the heavy bleeding that arises from caesarean deliveries in women with placenta praevia and placenta accreta.

DOI： 10.1111/1471-0528.12252

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Language：Japanese   Publisher：(株)東京医学社  

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No reports have described effects on the fetus of maternal jaundice caused by drug-induced hepatotoxicity during pregnancy, particularly in the first trimester. We report on two pregnant women who developed severe drug-induced hepatic failure and hyperbilirubinaemia during the period of fetal organogenesis. Both were diagnosed and treated promptly, and neither of the newborns had organic abnormalities. Prompt discontinuation of the drug suspected to be causing the condition is the optimal management, immediately decreasing the maternal bilirubin level and improving the perinatal prognosis. It appears that brief exposure of the fetus to maternal hyperbilirubinaemia during the first trimester may not affect fetal development, even if the mother's bilirubin level temporarily exceeds 171.0 μmol/l.

DOI： 10.7196/SAJOG.580

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Nishijima K, Shukunami K, Yoshinari H, Takahashi J, Maeda H, Takagi H, Kotsuji F. Interactions among pulmonary surfactant, vernix caseosa, and intestinal enterocytes: intra-amniotic administration of fluorescently liposomes to pregnant rabbits. Am J Physiol Lung Cell Mol Physiol 303: L208-L214, 2012. First published May 25, 2012; doi: 10.1152/ajplung.00081.2011.-Although vernix caseosa is known to be a natural biofilm at birth, human pulmonary surfactant commences to remove the vernix from fetal skin into the amniotic fluid at gestational week 34, i.e., well before delivery. To explain this paradox, we first produced two types of fluorescently labeled liposomes displaying morphology similar to that of pulmonary surfactant and vernix caseosa complexes. We then continuously administered these liposomes into the amniotic fluid space of pregnant rabbits. In addition, we produced pulmonary surfactant and vernix caseosa complexes and administered them into the amniotic fluid space of pregnant rabbits. The intra-amniotic infused fluorescently labeled liposomes were absorbed into the fetal intestinal epithelium. However, the liposomes were not transported to the livers of fetal rabbits. We also revealed that continuous administration of micelles derived from pulmonary surfactants and vernix caseosa protected the small intestine of the rabbit fetus from damage due to surgical intervention. Our results indicate that pulmonary surfactant and vernix caseosa complexes in swallowed amniotic fluid might locally influence fetal intestinal enterocytes. Although the present studies are primarily observational and further studies are needed, our findings elucidate the physiological interactions among pulmonary, dermal-epidermal, and gastrointestinal developmental processes.

DOI： 10.1152/ajplung.00081.2011

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

A Japanese girl with neonatal-onset chronic hepatitis and systemic inflammation was diagnosed with hyper-immunoglobulinemia D and periodic fever syndrome (HIDS). However, she lacked the typical HIDS features until the age of 32 months. She had compound heterozygous MVK mutations, H380R and A262P, the latter of which was novel. These findings suggest that HIDS patients could lack typical episodes of recurrent fever at the onset and that HIDS should be considered as a possible cause of neonatal-onset chronic hepatitis.

DOI： 10.1007/s10165-011-0442-7

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Language：English   Publisher：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.jen.2011.06.018

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Language：Japanese   Publisher：(株)メジカルビュー社  

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38歳(5回経妊2回経産婦)。患者は2回の帝王切開の既往と3回の流産手術の既往があった。今回、前置胎盤の妊娠管理を目的として、妊娠29週5日目に著者らの施設へ紹介入院となった。妊娠30週時のカラードプラ検査では、胎盤から子宮筋層、そして膀胱へ向かう、激しい血流が描出された。また、妊娠34週時のMRIでは膀胱と接する部分の子宮筋層が明らかではなく、胎盤の辺縁は不整で、膀胱への広範な絨毛浸潤が疑われた。以上より、妊娠35週5日目に選択的帝王切開術を行ったところ、子宮下部の腫大をはじめ膀胱子宮窩腹膜付近の血管怒張、漿膜下の胎盤透見が観察された。更に膀胱と子宮は強固に癒着し、1期的手術は困難と判断され、子宮底部横切開法にて2894gの女児が娩出された。以後、子宮筋切開創を縫合閉腹し、帝王切開術から27日目に子宮全摘出術と膀胱の処理が行われたが、膀胱の処理に際しては病的筋層を残したまま膀胱を縫合したため、術後一時的な縫合不全を生じた。だが、バルーンカテーテルを留置することで自然修復が得られ、目下は経過良好である。

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Language：English   Publisher：Mosby Inc.  

DOI： 10.1016/j.annemergmed.2009.06.506

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Language：Japanese   Publisher：(株)日本小児医事出版社  

動脈管早期閉鎖は胎児水腫や新生児遷延性肺高血圧症をきたし、以前はきわめて重篤な病態とされていた。しかし、近年では出生前診断も可能になり、出生後の早期対応によっては必ずしも予後不良でないことや軽症例が存在することが明らかになってきた。今回われわれは、動脈管早期閉鎖により新生児遷延性肺高血圧症をきたした1例を経験した。本症例では出生前に胸水貯留を認めており、胎内で右心不全がかなり進行していたと推測された。出生後、鎮静、経鼻的持続陽圧呼吸管理を併用した酸素投与、利尿剤、PDE III阻害剤投与を行った。日齢14の退院時には三尖弁逆流が軽度残存していたが、生後1ヵ月の時点ではそれも消失していた。本症例は出生前診断例ではなかったが、生後早期のうちに診断し適切な治療を施したことで重症化を抑止できたケースであると思われた。(著者抄録)

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Other Link： http://search.jamas.or.jp/link/ui/2008344602

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Other Link： http://search.jamas.or.jp/link/ui/2008255671

Language：Japanese   Publisher：(株)日本小児医事出版社  

母体に投与された子宮収縮抑制剤が新生児の骨代謝に及ぼす影響を検討するため、在胎30〜41週で出生した児の臍帯血を採取し、Ca,Mg,P、骨型ALP,25(OH)vitamin D,intact PTH,1型プロコラゲンC末端プロペプチド(P1CP)、1型コラゲンC末端テロペプチド(1CTP)濃度を計測した。母体が子宮収縮抑制剤の投与を受けていない児では、在胎週数が短いほどP1CP、1CTPが有意に高かった。母体が硫酸マグネシウムの投与を受けた児では、非投与群に比べて臍帯血中のCaが低く、Mgが高かった。母体が塩酸リトドリンの投与を受けた児ではintact PTHが有意に高かった。母体が両剤の投与を受けた児ではMg,1CTPが高く、P1CP/1CTPが低かった。出生前の子宮収縮抑制剤の投与は児の骨代謝に影響し、代謝性骨疾患を発生させる可能性があることが示唆された。(著者抄録)

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Other Link： http://search.jamas.or.jp/link/ui/2008196133

Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Endothelial cells produce nitric oxide (NO), a potent vasodilator. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NO synthase. Little is known about the potential physiological roles of ADMA in a perinatal setting. This study measures concentrations of ADMA in umbilical blood using enzyme-linked immunosorbent assay and those of NO as nitrite/nitrate (NOx(-)) using the Griess assay. Their relationship to the degree of prematurity and maternal clinical condition is examined. Results show that ADMA concentrations in umbilical blood from control newborns were about twice as high as those of lactating women, healthy children, and healthy adults. Umbilical blood NOx(-) concentrations from control newborns were about half of those of lactating women, healthy children, and healthy adults. Consequently, the levels of ADMA relative to NOx(-) were about 4-fold higher in umbilical blood from control newborns than in blood from lactating women, healthy children, and healthy adults. Furthermore, the umbilical blood ADMA concentrations and the ratios of ADMA to NOx(-) in newborns were higher according to their birth prematurity and lower birth weight. The umbilical ADMA concentrations were independent of the delivery mode and maternal preeclampsia. We infer that the high ADMA levels play physiological roles in maintaining vascular tone and blood redistribution to vital organs during birth, thereby favoring the circulatory transition from fetal to neonatal life. (C) 2008 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.metabol.2007.09.003

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DOI： 10.1016/j.ajog.2005.12.060

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DOI： 10.1080/01443610600636152

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DOI： 10.1016/j.ejogrb.2005.09.022

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：INT PEDIATRIC RESEARCH FOUNDATION, INC  

Studies using in vitro analysis have shown that the interaction between pulmonary surfactant and vernix caseosa could explain the appearance of amniotic fluid turbidity. That phenomenon is interpreted based on the "roll-up" hypothesis. We tested the roll-up hypothesis by examining the presence of micelles of pulmonary surfactant in human amniotic fluid at term. Amniotic fluid samples were collected from each of six healthy pregnant women at term and at 16 wk of gestation. These samples were stained negatively and analyzed using an electron microscope. Ultrastructures present in amniotic fluid were compared with the structure of micelles derived from suspended surfactant TA isolated from bovine lung. Surfactant TA formed spheroidal and rod-shaped micelles 10-70 nm in diameter above the critical micelle concentration. Identical micelle particles were described in human amniotic fluid at term. In addition, surfactant protein B was identified in the micelle fraction of amniotic fluid. However, no micelles were found in human amniotic fluid taken at 16 wk of gestation. Our results support the view that pulmonary surfactant could induce the detachment of vernix caseosa and increase the turbidity of the amniotic fluid.

DOI： 10.1203/01.pdr.0000228329.90502.3a

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DOI： 10.1007/s00404-006-0144-0

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Language：English   Publisher：ELSEVIER IRELAND LTD  

DOI： 10.1016/j.ejogrb.2005.09.021

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DOI： 10.1016/j.ejogrb.2005.11.022

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Language：Japanese   Publisher：金原出版(株)  

妊娠初期に胎盤が内子宮口を覆う場合に,胎盤辺縁部の形態が妊娠後期の前置胎盤発生予測の指標となり得るかを検討した.妊娠12週0日から15週6日においての単胎妊娠2543例を対象に経腟超音波による胎盤の形態観察を行ったところ,168例で胎盤が内子宮口を覆っていた.Previa群は9例で,他はnon-previa群であった.両群の胎盤辺縁部の形態を胎盤辺縁角を測定することで数値化した.両群の比較検定試験では,スチューデント t試験およびマンホイットニーのU テストにおいて,前置胎盤群の平均角度(60.8度)は,非前置胎盤群(103.4度)に比べて有意に低値であった.Receiver operating characteristic曲線のunity lineから最も離れている点(74度)をカットオフ値とすると,感度・特異度・陽性予測・陰性予測はそれぞれ77%・100%・20%・100%であった.信頼度テストBland-Altman plot法では,本測定法は高信頼性を示していた.以上,これらのことからも胎盤辺縁角の測定は,妊娠後期の前置胎盤発生を予測する有用な手段と考えられた

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30歳女.妊娠10週6日に突然,左下肢の腫脹と疼痛が出現した.超音波検査で左下肢の深部静脈血栓症(DVT)と診断した.凝固系検査では,プロテインS活性とプロテインS抗原量の低下を認めた.直ちにヘパリンを静注し,続いて持続投与を開始した.左下肢の疼痛は消失した.入院28日目からカプロシンの皮下注に変更し,活動範囲を病棟内に拡大した.入院42日目には下肢の腫脹も下腿レベルでのみ1cmの周径差と著明な改善を認め,入院55日目に退院した.カプロシンの皮下注を継続し,妊娠38週1日に女児を経腟分娩した.子宮復古不全のために貧血が進行したが保存的治療で改善した.分娩後19日目に退院した

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Other Link： http://hdl.handle.net/10098/1912

Language：English   Publisher：ELSEVIER IRELAND LTD  

DOI： 10.1016/j.maturitas.2006.02.003

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Language：Japanese   Publisher：(株)メディカルレビュー社  

生後0日女児.在胎37週2日,頭位自然分娩で出生した.自発呼吸はあったが微弱で,チアノーゼも遷延し,気管内挿管され,新生児集中管理室に搬送した.胸郭はベル型で低形成であった.多発性嚢胞腎と診断した.肺サーファクタント製剤を気管内投与し,その後は人工換気療法を施行した.生後3日には経鼻持続陽圧呼吸管理に移行できた.生後6日以後は経鼻酸素投与のみで酸素化は良好となり,生後25日には酸素投与も中止した.生後5日に血清CRP値が上昇し,検尿で細菌尿,膿尿も認めたため尿路感染症と診断した.セフォタキシムの静脈内投与を開始した.また,DICの検査所見を示し,濃厚血小板血漿,メシル酸ナファモスタットも投与した.経鼻胃管より血性,胆汁性の胃液が吸引され,カンジダ腸炎,壊死性腸炎を併発したと考えられ,アムホテリシンBの静脈内投与も併用した.生後80日に退院した

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DOI： 10.1016/j.ejogrb.2005.10.026

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DOI： 10.1093/humrep/dei339

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DOI： 10.2337/diacare.29.02.06.dc05-1932

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DOI： 10.1093/aje/kwj042

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DOI： 10.1111/j.1479-828X.2006.00526.x

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DOI： 10.1016/j.ejogrb.2005.06.026

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DOI： 10.1159/000092474

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DOI： 10.1080/00016340600589438

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DOI： 10.7863/jum.2005.24.12.1738

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Language：English   Publisher：MASSACHUSETTS MEDICAL SOC  

DOI： 10.1056/NEJM200512013532216

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Language：English   Publisher：ROYAL COLLEGE OF PSYCHIATRISTS  

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DOI： 10.1016/j.ejogrb.2005.06.036

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DOI： 10.1016/j.ejogrb.2005.01.019

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Language：Japanese   Publisher：金原出版(株)  

福井大学医学部で考案した開腹下癒着胎盤子宮温存手術を,帝王切開時に併施した症例を提示して紹介した.本術式のポイントは,1)子宮筋層に加える縦切開,2)子宮の翻転,3)オキシトシン製剤を投与しながらの胎盤剥離である.本法では子宮翻転により胎盤付着面を直視下に置くことができ,出血部位を直接確認できるため止血操作も容易である.癒着の弱い部位から順次剥離を進められるという利点もある.経腟分娩後に判明した癒着胎盤例も,開腹下に本法を行うことで安全に子宮温存が可能である.本術式は癒着胎盤のスタンダードを目指すものではないが,強度な癒着胎盤であっても子宮温存が可能な例もある.適応は限られるが,子宮摘出術を考慮しながら,その一歩手前で試みる価値がある方法と思われる

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DOI： 10.1016/j.ejogrb.2004.12.012

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

BACKGROUND: Control of bleeding is the goal of management for placenta accreta, which usually necessitates hysterectomy. A Committee Opinion of The American College of Obstetricians and Gynecologists (ACOG) has addressed the difficulties of conservative treatments.
CASES: Placentas of 2 primiparous women with placenta accreta were removed operatively from their uteri. One woman underwent a low transverse cesarean delivery, and the other had delivered vaginally. In each case, the anterior uterine wall was incised vertically between the lower segment and fundus before manual removal. After eversion of the uterus, the placenta was successfully detached from the wall after intramyometrial administration of oxytocin.
CONCLUSION: A vertical incision in die anterior uterine wall and subsequent eversion of the uterus may aid in avoiding with placenta accreta. (c) 2005 by The American College of Obstetricians and Gynecologists.

DOI： 10.1097/01.AOG.0000154005.24631.ec

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.mcg.0000159269.58480.4b

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DOI： 10.1016/j.ejogrb.2004.07.018

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Language：English   Publisher：AMER INST ULTRASOUND MEDICINE  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER INST ULTRASOUND MEDICINE  

Objective. This study was intended to determine the relationship between the angle of the lower placental edge in early pregnancy and the previa/low-lying placenta at delivery.
Methods. We used transvaginal sonography to consecutively screen 2543 singleton pregnancies. All subjects were scanned during the period of gestation between 12 weeks 0 days and 15 weeks 6 days. The angle of the lower placental edge was measured when the placenta covered the internal cervical os. These cases were followed sonographically until term.
Results. Of 168 cases in which the internal cervical os was covered at screening, 9 showed previa/low-lying placenta at delivery (previa/low-lying group). The remaining 159 showed no abnormal placentation (nonprevia group). There were significantly fewer degrees of angle in the previa/low-lying group than in the nonprevia group (P &lt;.05). For the previa/low-lying group, the arithmetic mean, median, and SD values of the angles were 60.8degrees, 5.0degrees, and 9.8degrees, respectively. For the nonprevia group, those values were 103.4degrees, 103.0degrees, and 31.8degrees, respectively. Data based on the cutoff number of the angle of 74degrees indicated the following: sensitivity of placenta previa or low-lying placenta at term, 100% (9 of 9), false-positive rate, 23% (36 of 159), positive predictive value, 20% (9 of 45), and negative predictive value, 100% (123 of 123).
Conclusions. The angle between the placental-uterine interface and fetal placental surface can be evaluated during early pregnancy. It appears to accurately precict placenta previa or low-lying placenta at term gestation with a sensitivity of 100%, a false-positive ate of 23%, and a high negative predictive value of 100%, which would allow for elimination of some of the multiple scans.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：TAYLOR & FRANCIS LTD  

Growing evidence indicates that oxidative stress occurs during the fetal-to-neonatal transition. Such stress plays an important role in the pathogenesis of many neonatal diseases. Thioredoxin (TRX), a redox-regulating protein with antioxidant activity, is induced in various cells against oxidative stress and is secreted extracellularly. This study was undertaken to examine the clinical and biological importance of TRX in the perinatal setting. We measured concentrations of TRX in umbilical cord blood and breast milk using a sandwich ELISA. Our study demonstrated that concentrations of TRX in umbilical cord blood were six to seven times higher than those in blood of healthy adults. This study also showed that umbilical concentrations of TRX were correlated significantly with the extent of prematurity of the newborn, and that they were elevated significantly in newborns of mothers with preeclampsia compared to those of mothers without preeclampsia. In contrast, concentrations of coenzyme Q(10) and vitamin E in umbilical blood were lower than adult blood levels. Breast milk concentrations of TRX during the early postpartum period were seven to eight times higher than those in blood of lactating women. Those of the coenzyme Q(10) were lower than adult blood levels, while those of vitamin E were comparable to adult blood levels. Our findings suggest that the systemic release of TRX is enhanced at birth, and that early breast milk is a rich source of this protein. Consequent high levels of TRX in newborns may provide a unique protective mechanism that allows the maintenance of redox balance during the fetal-to-neonatal transition.

DOI： 10.1080/10715760500053578

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.AOG.0000149842.31312.e4

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.AOG.0000153259.48553.96

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Language：English   Publisher：W B SAUNDERS CO-ELSEVIER INC  

DOI： 10.1016/j.ajem.2004.01.006

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：KARGER  

Objective: To clarify resuscitation methods against the lethal vernix caseosa aspiration syndrome. Method: A single case report with a literature review. Results: Our case report was associated with aspiration syndrome caused by an airway obstruction of vernix caseosa: a proteolipid biofilm synthesized by the fetus. A 23-year-old woman normally delivered a mature infant at term. The infantile oral cavity was filled with numerous aggregates of vernix caseosa. Two hours after his birth, the infant died from respiratory insufficiency. We discuss the difference between management of our case and the previously reported case. Conclusion: Pregnant women with a diffuse pattern of high-level echoes in prenatal ultrasonography, suggesting the presence of massive vernix caseosa, should be transferred to a well-equipped institution that can administer inhaled nitric oxide and extracorporeal membrane oxygenation. Copyright (C) 2005 S. Karger AG, Basel.

DOI： 10.1159/000083904

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：KARGER  

Massive subchorionic hematoma is a localized collection of blood or hematoma in the placenta, and can result in serious obstetrical complications. The condition can be diagnosed antenatally by ultrasound. However, no reports have previously described the same condition featuring an intraplacental fluid-fluid level on imaging studies. We report a case of massive subchorionic hematoma diagnosed prenatally, and propose an additional peculiar finding detectable on both the ultrasound and magnetic resonance images: the intraplacental fluid-fluid level. We also review previously reported cases that were detected by ultrasonography. Copyright (C) 2005 S. Karger AG, Basel.

DOI： 10.1159/000081364

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Language：English   Publishing type：Research paper (scientific journal)  

In cases with placenta accreta occurring on the previous cesarean scar, a longitudinal incision is generally appropriate. However, the placenta may prevent both a longitudinal and lower transverse incision. We report a case of placenta increta on the previous cesarean scar, and discuss the role of transverse fundal uterine incision.

DOI： 10.1080/14767050400018189

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：J REPROD MED INC  

BACKGROUND: Detorsion and cystectomy of twisted adnexa have been performed in young women. However, identification was incomplete, and the function of the affected tube was not investigated.
CASE: A 23-year-old, nulligravid woman with an acute abdomen was diagnosed with adnexal torsion. An emergency laparotomy revealed that both ovaries were 12 x 9 x 9 cm. The right adnexa were twisted and bluish black. Detorsion of the twisted lesion and ipsilateral fallopian tube was performed, with subsequent cystectomy of both lesions. Hysterosalpingography on the 14th postoperative day showed right tubal obstruction; 6 months postoperatively, repeat hysterosalpingography revealed patency of the right tube.
CONCLUSION: At least several months may be required for functional recovery of an untwisted tube. For that reason, postoperative repeat hysterosalpingography is a useful method for follow-tip of function in an untwisted tube.

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1080/01443610410001696897

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Language：English   Publisher：W B SAUNDERS CO  

DOI： 10.1016/j.ajem.2004.02.026

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.cursur.2003.11.005

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Taylor and Francis Ltd.  

Subamniotic hematoma is a placental pathological lesion resulting from the rupture of allntochorionic vessels. Some of them decrease in size during pregnancy. However, the relation between the reduction of the lesions during pregnancy and the structure of the placenta at delivery has not been previously reported. We report a case of subamniotic hematoma detected prenatally, which decreased in size during the third trimester, and presented with a cystic structure resembling a deflated balloon at delivery, and also review the literature of the placental surface cysts detected by prenatal ultrasound.

DOI： 10.1080/jmf.16.6.373.375

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W.B. Saunders  

DOI： 10.1016/j.ajem.2004.02.026

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Language：Japanese   Publisher：(株)協和企画  

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Language：Japanese   Publisher：(株)永井書店  

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Other Link： http://search.jamas.or.jp/link/ui/2002093375

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Language：Japanese   Publisher：新潟県医師会  

妊産婦自身の被養育体験、パートナーとの関係性、対人コミュニケーション能力などの妊産婦自身の発達特性、周産期の不安や抑うつ、アタッチメントやボンディング、以上の項目の相互の関連について検討した。さらに、本研究で同定された関連性に対して、産科学的情報も加味しながら産婦人科および小児科と連携し、精神医学的立場から妊産婦を対象とした適切な介入システムを構築した。妊娠初期(妊娠12週〜15週前後)、後期(妊娠30〜34週)、産後(1ヵ月)の妊産婦を対象にアンケート調査を実施する。周産期のメンタルヘルスや子どもとのアタッチメント形成を予測する因子を同定することで、精神科医の早期からの適切な介入が可能となり、妊産婦の自殺予防に大きく貢献可能であると同時に、子どもとの良好なアタッチメント形成に寄与できる点において、大きな意義があると考えられた。

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Language：Japanese   Publisher：(一社)日本新生児成育医学会  

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Language：Japanese   Publisher：(公社)日本母性衛生学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：福井県産婦人科医会  

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Language：Japanese   Publisher：北海道産科婦人科学会  

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Language：Japanese   Publisher：北海道産科婦人科学会  

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Language：Japanese   Publisher：福井県産婦人科医会  

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Language：Japanese   Publisher：福井県産婦人科医会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：滋賀医科大学産科学婦人科学講座  

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Language：Japanese   Publisher：東北連合産科婦人科学会・北日本産科婦人科学会  

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Language：Japanese   Publisher：日本肺サーファクタント・界面医学会  

羊水中に存在する肺サーファクタントの動態を検討するため、SIB法を用いて125I標識サーファクテン(STA)を合成し、妊娠27日目のウサギ羊水腔内に投与した。健常成熟児から無菌的に採取した胎脂にSTAを加えて、37℃で24時間インキュベートしたものをSTAミセル溶液とした。STAミセル溶液を妊娠23日目のウサギ羊水腔内に投与し、7日目に胎仔の小腸絨毛に生ずる形態学的変化と機能的変化を観察した。対側には生理食塩水を投与し、対照とした。ウサギ胎仔から小腸を摘出した。125I標識STAは、投与30分後には母体血中に移行し、大部分は尿から排出された。125I標識STAは、胎仔の全臓器に移行し、胃液と胎仔腸管に強い集積を認めた。対照群では、絨毛は疎で、その配列に乱れが生じた。STAミセル投与群では絨毛が密に存在し、その構造も保たれていた。STAミセル溶液は、下部小腸に有意な機能変化をもたらした。STAミセル溶液の予防投与により、肉眼的・組織学的重症度スコア、apoptosis指数の全ての項目において有意な改善を認めた。

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：福井県産婦人科医会  

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Language：Japanese   Publisher：福井県産婦人科医会  

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Language：Japanese   Publisher：福井県産婦人科医会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(一社)電子情報通信学会  

胎児の健康診断に対して、医療現場で広く用いられている分娩監視装置は、超音波ドプラ信号を用いて胎児心拍の変動状態を監視している。胎児の健康状態をさらに詳細に調べるためには、瞬時心拍数の細変動解析が必要であるが、分娩監視装置では3〜4拍分のドプラ信号心拍周期値(RR時間と呼ぶ)を平均化して、BPM(一分間あたりの心拍数に換算して)で心拍数の値を表示している。そのため、細変動解析が難しいと言われているが、分娩監視装置のドプラ信号を用いた細変動解析能力を評価するために、平均的なドプラ信号のBPMをRR間隔時間を換算し、また、平均化される前の各々の瞬時ドプラ信号の心拍RR間隔時間データを直接用いて評価実験を行う。本研究では、これらのドプラ信号を用いた細変動解析能力を、心電図信号によるRR間隔時間(基準値とみなす)を用いて行った細変動解析値と対比して比較評価する。(著者抄録)

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Language：Japanese   Publisher：東北連合産科婦人科学会・北日本産科婦人科学会  

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Language：Japanese   Publisher：東北連合産科婦人科学会・北日本産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(株)メジカルビュー社  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)電子情報通信学会  

胎児の健康状態の検診には、分娩監視装置の超音波ドプラ信号を用いた胎児の平均心拍数の時系列が広く用いられている。胎児の健康状態をさらに詳細に検診するには、正確な胎児の瞬時心拍数の細変動解析が必要になる。そのためにはノイズが高い環境下でも、胎児心音の瞬時心拍数(RR時間間隔に相当)を正確に検出するための技術が確立することが重要である。本研究では、そのための第一歩として、従来音声のピッチ周期抽出に用いられて来た手法、短時間自己相関関数、短時間フーリエ変換を用いてパワースペクトルを求める方法を、分娩監視装置から出力される超音波ドプラ心音に適用する実験を行った結果を示す。(著者抄録)

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本女性医学学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本外科感染症学会  

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Language：Japanese   Publisher：(一社)日本女性医学学会  

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Language：Japanese   Publisher：東北連合産科婦人科学会・北日本産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：北海道産科婦人科学会  

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Language：Japanese   Publisher：北海道産科婦人科学会  

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Language：Japanese   Publisher：北海道産科婦人科学会  

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Language：Japanese   Publisher：北海道産科婦人科学会  

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：Blackwell Publishing Ltd  

DOI： 10.1111/1471-0528.13259

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：WILEY-BLACKWELL  

DOI： 10.1111/1471-0528.13259

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：日本肺サーファクタント・界面医学会  

超低出生体重児の消化管機能の成熟に向けた治療戦略について肺サーファクタントと胎脂を用いた動物実験により検討した。新生仔ラットの壊死性腸炎モデルを確立後、サーファクテン(STA)と胎脂を用いて作成したSTAミセル溶液による壊死性腸炎予防効果を検討した。STAの臨界ミセル濃度は80μg/mLであった。STAは水溶液中で直径10ないし70nmの球状、環状のミセル分子を形成した。新生仔ラットが壊死性腸炎を発症すると、体重は、出生時よりも平均で0.64g減少したが、STAミセル溶液を予防的に投与することにより、僅かではあるが体重が増え個体も出現した。STAミセル溶液を投与する事により、新生仔ラットの生存率は33.3%から69.0%へ改善した。STAミセル溶液投与群では、肉眼的重症度スコア、組織学的重症度スコア、アポトーシスインデックスの全ての項目において有意に改善した。

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Language：Japanese   Publisher：東北連合産科婦人科学会・北日本産科婦人科学会  

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Language：Japanese   Publisher：東北連合産科婦人科学会・北日本産科婦人科学会  

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Language：Japanese   Publisher：The Institute of Electronics, Information and Communication Engineers  

It is pointed out that the importance of fetal-heart-rate baseline variability on fetal-heart-rate monitoring used for diagnosis of embryonic health condition. However, the instantaneous RR Time Interval is hardly obtained on conventional method using ultrasonic Doppler reflected signal. In this paper, an experimental system to measure RR interval of fetal heart using heart sound is proposed.

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：WILEY-BLACKWELL  

DOI： 10.1111/1471-0528.12556

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：WILEY-BLACKWELL  

DOI： 10.1111/1471-0528.12555

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：福井大学医学部  

症例は38歳1経産婦で、妊娠23週0日に頭痛と全身倦怠感を自覚し、前医にて重症妊娠高血圧腎症と診断され、当院救急搬送となった。可能な限り妊娠を継続する方針とし、直ちに塩酸ヒドララジンと硫酸マグネシウムの併用療法を開始した。母体血圧が150/88mmHgに低下した時点では胎児臍帯動脈血流速度波形に異常所見は認めず、胎動も良好であった。血圧がさらに下降し120/80mmHgになると、臍帯動脈血流に拡張期の途絶の所見が出現し、胎動も減少した。塩酸ヒドララジン投与を中止し、血圧が140/90mmHgに回復すると、拡張期途絶の所見は消失し、胎動も活発となった。妊娠23週6日に再び高血圧症が出現し、臍帯動脈拡張期の血流は終始途絶した状態となり、塩酸ヒドララジン投与も無効であったため、緊急帝王切開術を施行し、563gの男児を娩出した。母体の産褥経過は良好で、血圧と蛋白尿は速やかに改善し、術後14日目に軽快退院した。また、出生児の経過も良好で、生後5ヵ月で退院となり、生後24ヵ月の幼児検診では正常な神経発達を認めている。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J04807&link_issn=&doc_id=20140220360001&doc_link_id=%2Fef2fukui%2F2014%2F001401%2F001%2F0001-0004%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fef2fukui%2F2014%2F001401%2F001%2F0001-0004%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

DOI： 10.1111/1471-0528.12555

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：Blackwell Publishing Ltd  

DOI： 10.1111/1471-0528.12556

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Language：Japanese   Publisher：日本肺サーファクタント・界面医学会  

超低出生体重児の消化管成熟に向けた治療戦略について肺サーファクタントと胎児を用いた動物実験により検討した。サーファクテンは、80μg/mLの濃度に達すると水溶液中で環状ミセルを形成した。妊娠38週の羊水からは6検体中15検体にミセルの存在を確認したが、妊娠16週の羊水6検体からはミセルを検出できなかった。ウサギ羊水腔内に投与した二種類の蛍光標識リポソームは、ウサギ胎仔に嚥下されて胎仔小腸に到達した。肝臓には蛍光リポソームは到達しなかった。STAミセル溶液投与群では絨毛は密に存在し、絨毛構造にも漏れは生じなかった。サーファクテン・ミセル溶液の持続投与は、ウサギ胎仔の小腸全長及び出生時体重に影響を与えなかった。

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Language：Japanese   Publisher：東北連合産科婦人科学会・北日本産科婦人科学会  

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Language：Japanese   Publisher：東北連合産科婦人科学会・北日本産科婦人科学会  

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Language：Japanese   Publisher：東北連合産科婦人科学会・北日本産科婦人科学会  

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Language：Japanese   Publisher：東北連合産科婦人科学会・北日本産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：日本産科婦人科学会  

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Other Link： https://projects.repo.nii.ac.jp/?action=repository_uri&item_id=450800

Language：Japanese   Publisher：東北連合産科婦人科学会・北日本産科婦人科学会  

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Language：Japanese   Publisher：東北連合産科婦人科学会・北日本産科婦人科学会  

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Language：Japanese   Publisher：東北連合産科婦人科学会・北日本産科婦人科学会  

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Language：Japanese   Publisher：北海道産科婦人科学会  

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Language：Japanese   Publisher：北海道産科婦人科学会  

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Language：Japanese   Publisher：北海道産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：泌尿器科紀要刊行会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：English   Publisher：MOSBY-ELSEVIER  

DOI： 10.1016/j.annemergmed.2009.06.506

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本小児科学会  

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Language：Japanese   Publisher：(公社)日本婦人科腫瘍学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Other Link： https://projects.repo.nii.ac.jp/?action=repository_uri&item_id=442540

Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

妊娠後期には羊水の濁りが急激に生じることが知られている。著者等は、この濁りは胎児の肺成熟に伴って産生された肺サーファクタントが胎脂を取り込んで&quot;分子集合体ミセル&quot;を形成し羊水に分散するための現象であることを明らかにした。本来生体の保護フィルムとして働く胎脂が妊娠後期に皮膚から剥がれ落ちる事実は、胎脂がそれ以外の役割を担っている可能性を示唆する。一方、乳汁中の主要なエネルギー源である長鎖脂肪酸は、腸管内で胆汁酸と反応し、ミセル構造をとることで消化管から吸収される。今回、胎児が嚥下する羊水と新生児が摂取する母乳の両者に&quot;分子集合体ミセル&quot;が存在するという点に着目し、超低出生体重児の初期管理に有効な経腸栄養剤の開発に向けた基礎的検討を行った。ウサギを用いて、独自に作製したサーファクテン・ミセル溶液を羊水腔内に持続投与し、胎仔の腸管成熟に及ぼす影響について検討した。その結果、本溶液は胎仔の小腸上皮に局所的に作用して腸管成熟を促すことが示唆された。

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Language：Japanese   Publisher：(一社)日本内分泌学会  

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Language：Japanese   Publisher：発達腎研究会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：日本産婦人科・新生児血液学会  

前置胎盤では、多くの場合、帝王切開が必要となる。しかしながら、前置胎盤に対する標準術式は確立されていないのが現状である。前置癒着胎盤及び広範な前壁付着を伴う前置胎盤に対し、出血をコントロールしながら、目視下での胎盤剥離が可能な『子宮底部横切開法』を確立した。この手技の有用性と安全性を報告する。(著者抄録)

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：発達腎研究会  

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Language：Japanese   Publisher：日本産婦人科・新生児血液学会  

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Language：Japanese   Publisher：(一社)日本産科婦人科内視鏡学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Other Link： https://projects.repo.nii.ac.jp/?action=repository_uri&item_id=439339

Language：English   Publisher：発達腎研究会  

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Language：Japanese   Publisher：北海道産科婦人科学会  

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Language：Japanese   Publisher：北海道産科婦人科学会  

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Language：Japanese   Publisher：北海道産科婦人科学会  

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：AMER INST ULTRASOUND MEDICINE  

Web of Science

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Language：Japanese   Publisher：日本産科婦人科学会-東北連合地方部会  

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Language：Japanese   Publisher：日本産科婦人科学会-東北連合地方部会  

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Language：Japanese   Publisher：日本産科婦人科学会-東北連合地方部会  

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：AMER INST ULTRASOUND MEDICINE  

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：MOSBY-ELSEVIER  

DOI： 10.1016/j.ajog.2005.02.124

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)  

DOI： 10.1097/01.AOG.0000149842.31312.e4

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PubMed

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.AOG.0000152005.80380.48

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Other Link： https://projects.repo.nii.ac.jp/?action=repository_uri&item_id=436181

Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)  

DOI： 10.1097/01.AOG.0000150443.23143.fc

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PubMed

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.AOG.0000149162.89941.83

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.AOG.0000145332.52142.d3

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Language：Japanese   Publisher：日本産科婦人科学会-東北連合地方部会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：日本産科婦人科学会  

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Other Link： https://projects.repo.nii.ac.jp/?action=repository_uri&item_id=434090

Language：Japanese   Publisher：(公社)日本母性衛生学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：日本妊娠高血圧学会  

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Other Link： http://id.nii.ac.jp/1141/00139789/

Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：日本産科婦人科学会-東北連合地方部会  

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Language：Japanese   Publisher：日本産科婦人科学会-東北連合地方部会  

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