Hideki Tomizawa

Intimate Partner Violence and Unintended Pregnancy Among Bangladeshi Women

This study examined the relationship between intimate partner violence (IPV) and unintended pregnancy using data from women reporting IPV in the 2007 Bangladesh Demographic Health Survey. The analysis included 4,695 married women, aged 15 to 40 years, who had at least one birth in the last 5 years. Bivariate and multiple logistic regression analyses were performed to assess the relationship between IPV and pregnancy. About one third (30.4%) of women were abused physically and/or sexually and about one third (30.9%) of their births in the last 5 years were unintended. Compared with women who suffered no IPV, women who were abused sexually had a 1.64-fold increased risk of unintended pregnancy, which is higher than those who suffered physical abuse only (odds ratio: 1.35). The prevalence of unintended pregnancy among those who experienced severe physical violence was 1.60 times higher than those who reported no abuse. The findings indicate a significant relationship between IPV and unintended pregnancy among Bangladeshi women.

Analysis of Renal Artery Hemodynamics in Normal Fetuses Using the Color Doppler Method

Objective: From analysis of fetal renal artery hemodynamics, we attempted to reveal renal glomerular and tubular function in normal fetuses during pregnancy. Design: The study included 36 cases of normal fetuses from the 20th to the 40th week of gestation; Vmax (the systolic peak velocity of main renal artery), Vmean (time averages of trace of peak velocity) blood flow were initially measured between 20 and 24 weeks of gestation and every 4 weeks thereafter. The measurement was performed a total of five times in a longitudinal study. In addition, the blood flow waveform was concurrently examined. Results: The Vmax was 22.02 ± 0.50 cm/s at 20–24 weeks of gestation. This standard value (100%) was found to increase for each group as follows: 125.2, 149.1, 156.1, and 181.5%. Furthermore, using 20–24weeks of gestation as the standard, the Vmean increased after the 37th week of gestation: 186.7%, respectively. At 20–24 weeks of gestation, the blood flow wave forms consisted of 43.2% type I (only systolic waveforms), and 56.8% type II (both systolic and diastolic waveforms). Type III waveforms (waveforms that extended beyond the diastolic to the next systolic component) were not recognized. In the 33- to 36-week group, 82.6% of the waveforms were type II, and in the 37- to 40-week group, 76.2% of the waveforms were type III. Conclusions: The Vmax and Vmean of the renal artery in normal fetuses exhibit a similar rate increase when 20–24 weeks of gestation is compared to 37–40 weeks of gestation. The blood flow waveforms changed as pregnancy progresses; thus, it was inferred that this finding was related to the development of the renal glomerular and renal tubular function.

Hemodynamics of the renal artery and descending aorta in fetuses with renal disease using color Doppler ultrasound--longitudinal comparison to normal fetuses.

Abstract Objective: To examine the hemodynamic values of the renal artery (RA) and descending aorta (DA) in normal fetuses, and to compare these values to those of fetuses with renal disease, thus evaluating the usefulness of hemodynamic analysis for the diagnosis of fetal renal disease. Materials and methods: We examined 46 normal fetuses and 15 fetuses with renal disease (six cases of polycystic kidney (PCK) and nine cases of hydronephrosis). We measured the maximum systolic velocity (Vmax) of the RA and DA using color Doppler. Measurements were made five times, from the 20th to the 40th week, in both the control and the renal disease group. Results: In the fetuses with PCK (Potters syndrome) that died postpartum from non-functional kidneys, the Vmax of the RA and DA in the 35th week were 13 cm/s and 25.4 cm/s, respectively. In the fetus with PCK (Trisomy 9) that died due to non-functional kidneys in the 34th week, the values were 13.3 cm/s and 29.6 cm/s, respectively. These values were well below those of the normal group: more than 1.5 SD below the mean. In two fetuses from the nine with hydronephrosis that had a unilateral non-functional kidney, the RA did not clearly show identifiable blood flow. Conclusions: The Vmax of the RA and DA in fetuses with renal disease correlates with fetal kidney function, particularly the RA Vmax. Vmax of 1.5 SD below the mean should be the lower normal limit.

Granulocyte colony-stimulating factor as a potential inducer of ovulation in infertile women with luteinized unruptured follicle syndrome

Luteinized unruptured follicle (LUF) syndrome is one of the intractable ovulation disorders that are commonly observed during cycles of treatment with ovulation inducers, for which no effective therapy other than assisted reproductive technology is available. Here, we investigated whether granulocyte colony-stimulating factor (G-CSF) could prevent the onset of LUF syndrome. We analyzed the effects of G-CSF in 68 infertile women with LUF syndrome who received ovulation induction (clomiphene + human chorionic gonadotropin [hCG] therapy or follicle-stimulating hormone + hCG therapy). G-CSF (lenograstim, 100 μg) was administered subcutaneously. Onsets of LUF syndrome were compared between the cycle during which G-CSF was given in combination with the ovulation inducer (ie, the G-CSF treatment cycle) and the subsequent cycle during which only the ovulation inducer was given (ie, the G-CSF nontreatment control cycle). The results showed that LUF syndrome recurred in only 3 cycles during the G-CSF treatment cycle (4.4% [3/68 cycles]), whereas LUF syndrome recurred in 13 cycles during the subsequent G-CSF nontreatment control cycle (19.1% [13/68 cycles]). The additional use of G-CSF significantly prevented the onset of LUF syndrome during ovulation induction (P = 0.013, McNemar test). No serious adverse reactions because of the administration of G-CSF were observed. In conclusion, our findings indicate that G-CSF may become a useful therapy for LUF syndrome.

P30.08: The usefulness of MRI in the diagnosis of fetal lung maturity

Results: TFLV correlated best with FBV, according to the following cubic fit: TFLV = 2E − 09 × FBV3 − 1E − 05 × FBV2 + 0.0508 × FBV − 1.7934 (r2 = 0.85, P < 0.001). The normal median O/E TFLV based on gestational age in eutrophic fetuses (n = 174) was 99.1% (range, 31.2–158.0%) being higher than that in fetuses ≤ 5th percentile (n = 11; 46.2%; range, 15.7–87.3%, P < 0.01) and lower than in fetuses ≥ 95th percentile (n = 15; 146.8%; range, 87.2–204.2%, P < 0.01). However, the normal median O/E TFLV based on FBV was independent of biometric indices irrespective of the percentile of fetal weight. Conclusion: FBV correlated best with TFLV, irrespective of its biometry. In fetuses suspected of pulmonary hypoplasia, the benefit of FBV in prediction of postnatal survival remains to be determined.

P04.36: Analysis of the hemodynamics of the renal artery and descending aorta in fetuses with renal disease using color Doppler ultrasound—longitudinal comparison to normal fetuses

Objective: To determine the accuracy of ultrasound (US) estimation of fetal weight (EFW) in gastroschisis. Methods: The reliability of US EFW in gastroschisis has been questioned, mainly due to the presumed decrease in abdominal circumference resulting from bowel evisceration. In order to answer this question, we performed a retrospective review of all infants delivered at Thomas Jefferson University Hospital between 1991–2003 with gastroschisis. EFW was determined from the most recent US prior to delivery combined with a correction for normal anticipated interval growth (Williams RL, Obstet Gynecol 1982). Adjusted EFW was then compared with actual birth weight (BW). The primary outcome was the difference between adjusted EFW and BW. Mann-Whitney test was used for comparison of nonevenly distributed continuous variables. Type 1 error was set at 0.05 (two-sided). Results: Overall, US accurately predicted weight in 26 cases of gastroschisis with a mean difference of 2% ± 15% SD. However, there was a trend for US < 36 w GA to overestimate BW, compared to US ≥ 36 w GA: 45% vs. 0%, p 0.09. Similarly, when anticipated normal growth was factored in, US performed ≥ 2 w from delivery was more likely to overestimate BW than US < 2 w from delivery: 90% vs. 0%, p < 0.001. Infants born < 36 w (N = 10) had a mean BW at the 52% for GA compared to 37% for infants born ≥ 36 w (N = 16), p 0.14. No infants born < 36 w were < 10% for GA, compared to 12.5% born ≥ 36 w, p 0.51. Conclusions: Overall, US is an accurate predictor of fetal weight in gastroschisis. When compared to the expected growth rate of normal fetuses, the rate of fetal growth appears to be slower in fetuses with gastroschisis, particularly after 36 w GA.

P07.12: Hemodynamic analysis of the fetal renal artery of oligohydroamnion using color Doppler ultrasound—comparison with normal fetuses by a longitudinal study

a fetal blood sampling was realized with fetal transfusion in case of fetal anemia. Results: 18 fetuses have been evaluated, the first MCA measures were realized at a mean age of 22 weeks’ gestation (16–33 weeks) and the last one for those cases not transfused at 34 weeks (32–36), the number of MCA measures for each fetus was 6.6 (1–13). 2 fetuses were referred in an hydropic state and their first MCA value was > 1.5 MoM, 2 fetuses had MCA value > 1.5 MoM at the first exam, 7 fetuses had < 1.5 MoM at the first exam and developed > 1.5 MoM after a mean delay of 7 weeks (4–13 w) that is after a mean of 2.5 exams (1–6), and 7 fetuses had MCA value < 1.5 MoM during all the pregnancy. 10 fetuses had fetal blood sampling and 9 required in utero transfusion (39 in utero transfusions have been done with a mean of 4.33 for each fetus), 7 did not have any invasive procedures (41%) and one had an amniotic fluid optical density and this fetus was the only one anemic at birth. One fetus with hydrops died in utero at 23 weeks. The sensitivity of MCA Doppler was 90%, the specificity was100%, the PPV was 100% and the NPP was 89%. Conclusion: MCA peak systolic velocity is a highly sensitive noninvasive method for determining the fetuses with moderate to severe anemia. It allowed to reduce in 41% fetal invasive procedures.The fetal invasive procedures are best indicated and the morbidity of such procedure is reduced.

P081: Color Doppler analysis of renal arterial hemodynamics in fetuses with renal disease-confirmation of blood flow changes specific to the renal artery and its diagnostic significance

Objectives: We have compared the hemodynamics of the renal artery (RA), between normal fetuses and those with renal diseases by color Doppler method and we have evaluated the efficacy of blood flow measurement for the diagnosis of fetal renal diseases. Methods: The study group consisted of 36 normal fetuses and 10 fetuses with renal diseases (six cases of polycystic kidney disease and four cases of hydronephrosis). After obtaining informed consent, the maximum systolic velocity (Vmax) of the RA was measured with color Doppler equipment, and it was analyzed at five gestational intervals: 20–24 weeks; 25–28 weeks; 29–32 weeks; 33–36 weeks; and 37–40 weeks. Results: Two cases of renal fatal insufficiency secondary to polycystic kidneys (PCK) were detected postpartum. In one case, which delivered at 35 weeks, the Vmax of RA was 13 cm/sec. In the other case, which delivered at 34 weeks, the Vmax of RA was 13.3 cm/sec. These values were below the mean − 1.5SD of the normal group. In the eight other cases, which exhibited normal renal function postpartum, the Vmax of RA were almost above mean − 1.5SD. Conclusion: Only the Vmax of RA in fatal cases of fetal renal disease was found to be lower than 1.5SD below the mean. Fetuses with renal disease who were found to have a normal life expectancy showed above mean − 1.5SD. Therefore, the Vmax of RA is indicative of fetal renal function, and is useful for establishing the diagnosis of fetal diseases.