Jun Kakogawa

Noninvasive monitoring of placental oxygenation by near-infrared spectroscopy.

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

Transabdominal Measurement of Placental Oxygenation by Near-infrared Spectroscopy

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

Prolonged Fetal Bradycardia as the Presenting Clinical Sign in Congenital Syphilis Complicated by Necrotizing Funisitis: A Case Report

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

Chronic hepatitis B infection in pregnancy illustrated by a case of successful treatment with entecavir.

Chronic hepatitis B virus (HBV) infection affects more than 350 million people worldwide [1]. The pregnancy courses of women with chronic HBV infection are generally favorable. However, severe complications of chronic HBV infection can occur during pregnancy. Optimal antiviral treatment of HBV infection during pregnancy is unclear. Keeffe et al. [2] have recommended individualization of therapy for pregnant HBV patients. chronic hepatitis B (CHB) with acute exacerbation has a high fatality rate up to 20–30% [3]. There are few reports on the management of CHB with acute exacerbation during pregnancy [4–7]. We present a successful pregnancy outcome of a woman treated with entecavir for CHB with acute exacerbation during pregnancy. A 36-year-old para-2 woman with CHB attended antenatal care visits our hospital from 6 weeks of gestation. She was diagnosed with CHB for the first time as a result of antenatal HBV screening on her first pregnancy. Since diagnosis, she has been followed by a gastroenterologist at our hospital and has been asymptomatic with the HBV DNA levels of approximately 7 log10 copies/mL and a normal alanine aminotransferase (ALT) level prior to the pregnancy described herein. Her previous pregnancies were uneventful and all resulted in full-term spontaneous deliveries. At 13-week gestation, she complained of fatigue and jaundice. Laboratory findings revealed a total bilirubin level of 3.6 mg/dL, a serum ALT level of 1,309 IU/L, a serum aspartate aminotransferase level of 2,386 IU/L and a lactate dehydrogenase level of 1,252 U/l. She was positive for hepatitis B surface antigen (HbsAg), hepatitis B e antigen (HbeAg) and HBV DNA in her serum. The HBV DNA level was greater than 7.6 log10 copies/mL. Hepatitis B e antibody (HbeAb) was not detected in her serum. Treatment with oral entecavir (0.5 mg/day) was initiated immediately for CHB with acute exacerbation. After initiation of treatment, she showed rapid clinical improvement; her ALT level decreased to 46 IU/L, and her HBV DNA level decreased to 4.6 log10 copies/mL at 2 weeks after initiation of treatment. Entecavir therapy was withdrawn after 32 days of therapy. She underwent hepatitis B e seroconversion during the course of treatment. After cessation of treatment, the patient showed no signs of a hepatitis flare-up. The HBV DNA level reached a plateau of approximately 3 log10 copies/mL with ALT normalization at 6 weeks after initiation of treatment. The spontaneous delivery of a male baby weighing 2,950 g occurred at 39 weeks gestation. The baby had Apgar scores of 8 and 9 at 1 and 5 min. The patient did not experience any adverse effects as the result of the treatment throughout the whole course of the pregnancy. The neonatal physical check-up revealed no congenital anomalies. The patient and the baby did not experience any complications during the postpartum period. Decisions about initiating treatment for HBV infection during pregnancy must include consideration of the risks and benefits for the mother and the fetus. Data on the safety of antiviral treatment of HBV during pregnancy remain limited. The US Food and Drug Administration lists telbivudine and tenofovir as pregnancy category B drugs and lamivudine, entecavir and adefovir as pregnancy category C drugs. Lamivudine is considered safe for use during J. Kakogawa (&) A. Sakurabashi M. Sadatsuki H. Gomibuchi S. Minoura Department of Obstetrics and Gynecology, National Center for Global Health and Medicine, 1-21-1, Shinjuku-ku, Tokyo, Toyama 162-8655, Japan e-mail: jkakogaw@hosp.ncgm.go.jp

Postpartum maternal pneumococcal meningitis complicated by endocarditis

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

Application of Near-Infrared Spectroscopy for the Evaluation of Placental Oxygenation

Aims: As the utero-placental circulation have major impact on the fetus, and the placental function can be criti- cal for determining fetal conditions, the placental oxygenation status was investigated. Methods: Near-infrared spectroscopy (NIRS) is a non-invasive technique used for the evaluation of regional tissue oxy- genation in a number of organs. The trans-abdominal NIRS was developed as a non-invasive technique for monitoring placental oxygenation, which was evaluated by the ratio of oxygenated hemoglobin to total hemoglobin (%) (tissue oxy- genation index ,TOI) values. The near-infrared light was confirmed to reach the placenta using the NIRS probe with an in- ter-optode distance of 4.5 cm and the NIRO apparatus (Hamamatsu Photonics, Hamamatsu, Japan). Results: Placental TOI values in pregnant women with pregnancy-induced hypertension and intrauterine fetal growth re- striction were significantly higher than those of pregnant women without complications, although there were no differ- ences of TOI values between the women with threatened preterm delivery and those without complications. Conclusion: Non-invasive monitoring of placental tissue oxygenation assessed by NIRS for the study of utero-placental function may have a high potential for clinical application, particularly in prenatal management.

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

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

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

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