Katsufumi Otsuki

Limitations of conservative treatment for repeat Cesarean scar pregnancy

delineate the level of fusion, connecting vessels and fetal contour (Figure 3). One week later, repeat scans by 3D transvaginal ultrasonography confirmed the diagnosis of conjoined twins. After counseling, the patient opted to terminate the pregnancy. After evacuation, two separate bodies and two separate upper and lower extremities were noted. The location of the conjoined site could not be identified on gross inspection of the abortus because the embryos had been destroyed during the evacuation procedure. Early diagnosis of conjoined twins is crucial for determining subsequent management and possibly decreasing maternal morbidity (evacuation vs. hysterotomy). Specific sonographic findings of conjoined twins examined during the first trimester include inseparable fetal bodies despite manipulation of the uterus with a transvaginal probe or prolonged continuous scanning, bifid appearance of the embryo, single yolk sac3, and a single umbilical cord with more than three vessels. Recently, some reports4–8 have described early diagnosis of conjoined twins by 3D ultrasound imaging combined with power Doppler, computed tomography and magnetic resonance imaging. In this case, prenatal diagnosis of conjoined twins was established by transvaginal 2D ultrasonography and power Doppler. However, 3D imaging with surfacerendering provided clearer images of the characteristic features of ischiopagus twins and helped the parents to understand the complex anomalies present in their fetuses. Furthermore, it improved our diagnostic confidence to provide adequate early intervention.

Cord insertion into the lower third of the uterus in the first trimester is associated with placental and umbilical cord abnormalities

To assess the feasibility of detecting the cord insertion site during the late first trimester, and to investigate the possible association between perinatal complications and a cord insertion in the lower third of the uterus in the first trimester.

Effect of lactoferrin on lipopolysaccharide (LPS) induced preterm delivery in mice

Background. The present study attempted to confirm the preventive effect of lactoferrin on lipopolysaccharide (LPS) induced preterm delivery in mice.

Preventive effect of recombinant human lactoferrin on lipopolysaccharide-induced preterm delivery in mice

Background.  In order to investigate whether recombinant human lactoferrin (rh‐LF) has the same effect as bovine LF (b‐LF) for the prevention of preterm delivery, we conducted the following animal studies.

Cervical inflammatory cytokines and other markers in the cervical mucus of pregnant women with lower genital tract infection

Objective: To evaluate concentrations of interleukin (IL)‐6, IL‐8, lactoferrin (LF), and alpha defencine (α‐DF) in the cervical mucus of pregnant women and analyze their relation to cervicitis and bacterial vaginosis (BV). Methods: Cervical mucus samples were obtained from August 2003 through May 2004 from 157 women who were between the 6th and 36th week of an uncomplicated singleton pregnancy. All women were delivered at term, 69 without BV or cervicitis, 9 with BV, and 79 with cervicitis. Results: Interleukin 8, LF, and μ‐DF concentrations were higher in women with cervicitis (0.81 ± 0.36 pg/mL, 14.8 ± 12.3 μg/mL, and 0.60 ± 0.49 μg/mL) than in women without BV or cervicitis (0.35 ± 0.34 pg/mL, 8.0 ± 11.0 μg/mL, and 0.15 ± 0.12 μg/mL). Interleukin 6 concentration was higher in women with BV (0.26 ± 0.32 pg/mL) than in women without BV or cervicitis (0.09 ± 0.15 pg/mL) or in women with cervicitis (0.12 ± 0.18 pg/mL). Conclusions: Higher levels of inflammatory cytokines in the cervical mucus of pregnant women may lead to early detection of lower genital tract infection.

Cerclage for sonographic short cervix in singleton gestations without prior spontaneous preterm birth: systematic review and meta‐analysis of randomized controlled trials using individual patient‐level data

The aim of this systematic review and meta‐analysis was to quantify the efficacy of cervical cerclage in preventing preterm birth (PTB) in asymptomatic singleton pregnancies with a short mid‐trimester cervical length (CL) on transvaginal sonography (TVS) and without prior spontaneous PTB.

Administration of oral and vaginal prebiotic lactoferrin for a woman with a refractory vaginitis recurring preterm delivery: Appearance of lactobacillus in vaginal flora followed by term delivery

Lactoferrin (LF) is one of the prebiotics present in the human body. A 38‐year‐old multiparous woman with poor obstetrical histories, three consecutive preterm premature rupture of membrane at the 19th, 23rd and 25th week of pregnancy, was referred to our hospital. She was diagnosed as having refractory vaginitis. Although estriol vaginal tablets were used for 4 months, the vaginitis was not cured. We administrated vaginal tablets and oral agents of prebiotic LF, resulting in a Lactobacillus predominant vaginal flora. When she was pregnant, she continued to use the LF, and the Lactobacillus in the vaginal flora was continuously observed during pregnancy. An elective cesarean section was performed at the 38th week of pregnancy. When the administration of LF was discontinued after the delivery, Lactobacillus in the vaginal flora was disappeared.

Recombinant human lactoferrin inhibits matrix metalloproteinase (MMP-2, MMP-3, and MMP-9) activity in a rabbit preterm delivery model

Aim:  To investigate the effect of recombinant human lactoferrin (rh‐LF) on the expression of matrix metalloproteinase as a marker of cervical maturation, using a rabbit preterm delivery model in which preterm labor was induced by bacteria.

Randomized trial of ultrasound-indicated cerclage in singleton women without lower genital tract inflammation

This is the first report of a randomized trial of cerclage on pure cervical shortening without vaginosis or cervicitis. The objective of our multicenter randomized controlled trial was to assess the benefits of ultrasound‐indicated cervical cerclage in the mid‐trimester to prevent preterm birth in women who have no signs of infection or inflammation of the lower genital tract.

Decidual polyps are associated with preterm delivery in cases of attempted uterine cervical polypectomy during the first and second trimester

Abstract Objective: To clarify which types of cervical polyp removed during the first and second trimester are associated with the risk of spontaneous abortion and preterm delivery. Methods: Pregnant females who underwent attempted polypectomy of cervical polyps during pregnancy and delivered singleton infants between 2005 and 2011 were evaluated. The clinical courses and outcomes of preterm delivery after polypectomy stratified according to the pathologic diagnosis of the polyps were retrospectively reviewed. The removed polyps were classified into decidual polyps and endocervical polyps. Results: The pathological diagnoses included 41 decidual polyps and 42 endocervical polyps. No malignant polyps were found. The removal of decidual polyps during pregnancy carried a higher risk of spontaneous abortion (12.2% versus 0%, p = 0.026) and preterm delivery (34.2% versus 4.8%, p = 0.001) than that of endocervical polyps. According to the multivariate logistic regression analysis, risk factors for preterm delivery before 37 weeks’ gestation were the presence of decidual polyps and a history of preterm delivery. Conclusions: The risk of abortion and preterm delivery associated with polypectomy during pregnancy is greater in patients with decidual polyps. It might be safer not to remove cervical polyps during pregnancy, except in cases in which the polyps are suspected to be malignant.