Hiroyuki Nobeyama

Reference ranges for time-related analysis of ductus venosus flow velocity waveforms in singleton pregnancies

To investigate time intervals of ductus venosus (DV) flow velocity waveforms (FVW) in correlation to fetal heart rate and gestational age and to construct reference ranges for the second and third trimester. Furthermore, we investigate time intervals of FVW through the tricuspid valve.

Uterine artery flow velocity waveforms during uterine contractions: Differences between oxytocin‐induced contractions and spontaneous labor contractions

Aim:  To clarify the effects on uterine arterial flow velocity waveforms of uterine contractions following oxytocin infusion and during spontaneous labor.

Protein S deposition at placenta: a possible role of protein S other than anticoagulation.

Protein S is an antithrombotic cofactor for protein C that also has multifunctional anti-inflammatory, cellular protective, apoptotic and mitogenic properties. Protein S levels are thought to decrease during pregnancy, but the underlying mechanism remains unknown. We compared protein S concentrations throughout normal pregnancy with those of nonpregnant women and measured plasma C4b-binding protein levels in nonpregnant women and in pregnant women at the 40th gestational week. We also examined protein S and C4b-binding protein in the placenta by immunohistochemical staining at early (20th gestational week) and late (40th gestational week) stages of pregnancy. Plasma protein S activity and free protein S-antigen levels significantly decreased from the 10th gestational week and total protein S antigen decreased from the 20th. C4b-binding protein levels between pregnant and nonpregnant women did not significantly differ. The stainable portion of protein S was located at the fetomaternal interface, particularly at degenerative villi. C4b-binding protein was weakly stained at the same areas as protein S. Neither protein S nor C4b-binding protein were stained at normal villi. These results indicated that protein S can protect or restore damaged villi via a physiological effect in addition to its anticoagulation properties.

P20.04: Pregnancy complicated with cervical varix and low‐lying placenta: a case report

Objectives: Uterine myomas are benign disease observed in 2 to 3% of all normal pregnancies. The aim of this study is to assess the influence of large uterine myomas on obstetric outcome. Methods: Sixty nine pregnant women with large uterine myoma (8 cm or greater) identified by second trimester ultrasound scans (Accuvix XQ, Medison Co., Seoul, Korea) who delivered at Yonsei University Health System between January 2005 and March 2011 were enrolled. If more than one myoma was detected, the largest one was considered to be representative. The number, size, position, and location of the uterine myomas and the perinatal complications were analyzed. Results: The women were 33.1 ± 3.9 years of age and delivered infants, weighing 3098 ± 600 g at 36.6 ± 5.6 weeks of gestation. Intrauterine fetal deaths at second trimester were noted in two cases. Three pregnancies terminated between 16 and 20 weeks due to preterm premature rupture of membranes, incompetent cervix, and intrauterine fetal death resulted in postpartum hemorrhage caused by retaind placenta. Acute pain localized at myoma site requiring analgesics occurred in 9 (13%) of the women at 17–22 weeks. The fibroids located at uterine fundus were highly associated with the pain symptom (P < 0.05). Preterm labor showed in 12 (17.4%) cases, 50% of which led to preterm delivery. A Cesarean section was performed in 65% of the pregnancies with vertical uterine incision in 11% thereof. Intraoperative bleeding amount was 726 ± 289 ml. The size of the fibroids remained unchanged during pregnancy in most cases. Conclusions: Large uterine myoma may cause abdominal pain, preterm delivery, high rate of cesarean section, intrauterine fetal death and postpartum hemorrhage. However, the neonatal outcome was not adversely affected by large myoma during pregnancy.

P21.03: Assessment of atrio-ventricular valve opening and closure time intervals in normal fetuses

Objectives: To analyze the duration of the atrio-ventricular valve (AVV) opening time and closure time in normal fetal hearts. Methods: This cross-sectional study included 67 normal fetuses aged 18 to 38 weeks’ gestation. The following time intervals were taken: Rt-AVV-O; from the opening of right AVV to its closure, Rt-AVVC; from the closure of right AVV to its opening, Lt-AVV-O; from the opening of left AVV to its closure, Lt-AVV-C; from the closure of left AVV to its opening. These variables were correlated with gestational age and fetal heart rate in normal fetuses. Results: All of the variables except Lt-AVV-C showed positive correlation with gestational age (Spearman’s rank correlation coefficient: Rt-AVV-O; 0.423, Lt-AVV-O; 0.674 and Rt-AVV-C; 0.389). In regard of fetal heart rate, negative correlation were found in all of the variables (Rt-AVV-O: −0.689, Lt-AVV-O: −0.789, Rt-AVV-C: −0.425 and Lt-AVV-C: −0.259). Conclusions: This study firstly showed gestational changes of time interval of AVV-O and AVV-C in uncomplicated fetuses. In addition, different evolution in right and left heart was suggested in fetal life.

OP36.03: Time-related analysis of ductus venosus flow velocity waveforms in normal fetuses and intrauterine growth restriction

Objectives: To evaluate the correlation between fetal cerebral blood perfusion by fractional moving blood volume and the degree of fetal anemia in maternal red-cell alloimmunization fetuses selected by elevated middle cerebral artery Doppler (MCA). Methods: Cerebral blood perfusion measured by fractional moving blood volume (FMBV) was assessed in 16 consecutive fetuses with increased peak systolic velocity (PSV, > 1.5 MoM) in the MCA Doppler, and correlated with the presence (defined as hemoglobin levels < 0.84 MoM for gestational age) and degree of anemia at the time of cordocentesis. Results: Fetuses with confirmed anemia at cordocentesis showed significantly higher FMBV values than those with normal hemoglobin (39.9% vs. 22.9%, P = 0.01). Cerebral FMBV showed a significant negative correlation with the concentration of fetal hemoglobin (−0.62, P = 0.01) and a non-significant positive correlation with the PSV in the MCA Doppler (0.11, P = 0.69). The false positive rate of increased FMBV (above 2.0 MoM) and MCA-PSV was 8.0% and 31.3% for the diagnosis of fetal anemia, while it was 10% and 43.8%, for the diagnosis of severe fetal anemia, respectively. Conclusions: Increased cerebral tissue perfusion might decrease the false positive rate of the middle cerebral artery Doppler for the diagnosis of fetal anemia in maternal red cell alloimmunization.

OP24.04: Time‐related analysis of ductus venosus flow velocity waveforms in normal singleton pregnancies

the inferior vena cava was 87.1o (range 52–130o). Both angles were constant during pregnancy. The size of the angle between the rt. hepatic and ductus is 45% of that between the angle of rt, hepatic and IVC. Two groups were defined according to gestational age: 13–19 weeks gestation (99 women) and 20–30 weeks of gestation (84 women). The angles between the rt. hepatic to the ductus venosus and IVC were 37.6o and 85.7o, respectively, in the first group; 40.9o and 87.8o at second trimester. There were no significant differences in the angles between the 2 groups Conclusions: The geometrical arrangement of the abdominal venous return to the atrium is constant throughout pregnancy. We believe that knowledge of this arrangement can assist in evaluation of abnormal venous return to the rt. atrium.

P34.12: Persistent placental maternal blood flow visualized with LevovistTM in a case of dead fetus syndrome

rate has been reported. Therefore, it is important that obstetricians recognize risk factors for vasa previa and diagnosis of this condition should be made before rupture of the membrane. The risk factors include velamentous insertion of the cord, a bilobed, succenturiate, or low-lying placenta, multifetal pregnancy, or pregnancy resulting from in vitro fertilization. Evaluation of high-risk patients with transvaginal color flow Doppler ultrasound has been recommended. We experienced 9 cases of vasa previa without placenta previa out of 5,000 women over a 5-year period. Prenatal detection was made in 8 patients because low-lying placenta and velamentous insertion of the umbilical cord were identified during the 2nd trimester screening. Vasa previa was confirmed by 3D color flow ultrasound in these cases and Cesarean section was performed after pulmonary maturation was confirmed, or in some cases after betamethasone administration. In one case, however, vasa previa could not be identified because the cord insertion was not velamentous. Although the placenta was low-lying, vaginal color flow Doppler ultrasound was not performed. This case resulted in a rupture of vasa previa at 40 weeks’ gestation and required emergency Cesarean section. Apgar scores of the neonate at 1 and 5 minutes were 2 and 5. The neonate required blood transfusion. Advances in ultrasound have led to improved ability to diagnose this condition. Transvaginal color flow Doppler ultrasound in high-risk groups is mandatory even if a velamentous insertion of the cord is not identified.