Masayo Takata

Differential Blood Flow in Uterine, Ophthalmic, and Brachial Arteries of Preeclamptic Women

OBJECTIVE To develop a method that employs noninvasive, pulsed Doppler ultrasonography combined with measurement of flow‐mediated vasodilation to evaluate characteristic endothelial dysfunction in various degrees of preeclampsia. METHODS Uterine, ophthalmic, and brachial arterial blood flow of 99 pregnant women (control group [n = 32], non‐preeclamptic intrauterine growth restriction group (n = 15), mild preeclampsia group [n = 25], and severe preeclampsia group [n = 27]) were evaluated by pulsed Doppler ultrasound or flow‐mediated vasodilation. RESULTS Uterine, orbital, and brachial circulation were altered in preeclampsia, whereas no significant differences were observed between the non‐preeclamptic intrauterine growth restriction and control groups. Pulsatility index in the uterine arteries of preeclamptic women with intrauterine growth restriction was approximately three‐fold higher than that of normotensive women with or without intrauterine growth restriction. The peak ratio (defined to quantify characteristic flow velocity waveform) of the ophthalmic artery of hypertensive women was significantly higher than that of normotensive women. Flow‐mediated vasodilation in the brachial artery of preeclamptic women with intrauterine growth restriction was significantly lower than that in preeclamptic women without intrauterine growth restriction. Among preeclamptic women, elevation of the resistance in the uterine artery and reduced flow‐mediated vasodilation were closely correlated to intrauterine growth restriction, whereas the elevated peak ratio of the ophthalmic artery was dependent on hypertension, irrespective of the presence of intrauterine growth restriction. CONCLUSION Ultrasound evaluation of uterine and orbital circulation and flow‐mediated vasodilation of the brachial artery helps differentiate the degree and severity of preeclampsia.

Clinical Experience of Long-Term Transdermal Treatment with Nitric Oxide Donor for Women with Preeclampsia

Isosorbide dinitrate (ISDN), a nitric oxide donor, was applied transdermally for 4–16 days to 4 preeclamptic women with oligohydramnios, intrauterine fetal growth retardation (IUGR), and elevated resistance of blood flow in the uterine arteries. Pulsed Doppler ultrasonography revealed immediate and drastic improvement of pulsatility index (PI) of uterine arteries following treatment with ISDN. The average PI in uterine arteries of the 4 patients was reduced to approximately 67% of that of the untreated state. In 2 patients the amniotic fluid gradually increased over a few days which suggested improvement of fetoplacental circulation during administration of ISDN. This study suggests that long-term transdermal ISDN is an effective therapy, at least in a portion of preeclamptic women, to avoid maternal hypertension, fetal distress, oligohydramnios, and IUGR, and consequentially to prolong the gestational period.

A long-term transdermal nitric oxide donor improves uteroplacental circulation in women with preeclampsia.

Objective. To determine the effects of long‐term transdermal administration (range, 4–30 days; mean ± SD, 11.1 ± 7.2 days) of isosorbide dinitrate, a nitric oxide donor, in preeclamptic women. Methods. We studied uterine and fetoplacental circulation of 12 preeclamptic women with oligohydramnios and an elevated pulsatility index in the uterine arteries. Results. Transdermal isosorbide dinitrate significantly suppressed the blood pressure of patients. Pulsed Doppler ultrasonography revealed that the average pulsatility index in the uterine arteries was significantly reduced by treatment with isosorbide dinitrate (P < .003). The average pulsatility index in the umbilical artery was also significantly reduced (P < .004). Furthermore, the size of the amniotic fluid pocket increased approximately 4‐fold by treatment with isosorbide dinitrate. Conclusions. Long‐term transdermal administration of isosorbide dinitrate improves fetoplacental circulation and may be effective therapy for avoiding maternal hypertension and oligohydramnios in some preeclamptic women.

Bisphenol A stimulates NO synthesis through a non-genomic estrogen receptor-mediated mechanism in mouse endothelial cells

Biological actions of bisphenol A (BPA), an environmental chemical, have not been fully elucidated. We studied effect of BPA on nitric oxide (NO) synthesis in the murine endothelial cell line, MSS31. BPA (1-100 microM) increased nitrite/nitrate, a stable metabolites of NO, levels in culture medium of MSS31. However, Western blotting showed that the level of endothelial NO synthase protein was not increased by 16 h of treatment with BPA (10 microM). ICI 182,780 (10 microM), an estrogen receptor (ER) antagonist, suppressed BPA-induced NO synthesis while actinomycin D (1 microg/ml), a transcription inhibitor, or cycloheximide (40 microM), a protein synthesis inhibitor, exhibited no effect on BPA-induced NO synthesis. These results indicate that BPA stimulates NO synthesis through a non-genomic ER-mediated mechanism. Short-term effects of BPA on NO synthesis were weak but similar to 17beta-estradiol.

Effect of a Nitric Oxide Donor on the Ophthalmic Artery Flow Velocity Waveform in Preeclamptic Women

To evaluate the effects of an antihypertensive agent on the orbital circulation of preeclamptic women.

Fetal hydrocephalus secondary to intraventricular hemorrhage diagnosed by ultrasonography and in utero fast magnetic resonance imaging. A case report.

Although fetal hydrocephalus is commonly detected by prenatal ultrasonographic examination, posthemorrhagic hydrocephalus has rarely been observed in the fetus. We report a case of hydrocephalus secondary to intraventricular hemorrhage (IVH) diagnosed by in utero magnetic resonance imaging (MRI) at 37 + 1 weeks of gestation. Ultrasonography revealed enlargement of the bilateral ventricles and an irregular mass measuring 20 × 12 × 10 mm in the right lateral ventricle. T1-weighted images with two-dimensional fast low-angle shot (2D-FLASH) and T2-weighted images with half-Fourier single-shot turbo spin echo (HASTE) demonstrated that an old hemorrhagic clot existed in the right lateral ventricle of the fetus. Hydrocephalus secondary to IVH was confirmed by postnatal MRI and ventriculoscopy. Fast MRI is especially useful for prenatal diagnosis of fetal brain abnormalities because it minimizes the artifact of fetal movement.

Involvement of peroxynitrite in LPS‐induced apoptosis of trophoblasts

Objective:  To examine whether or not peroxynitrite was involved in trophoblastic apoptosis induced by a bacterial endotoxin, lipopolysaccharide (LPS).

Evaluation of normal fetal branch pulmonary artery diameters measured by ultrasonography: a comparison with congenital diaphragmatic hernia.

Objective: The aim of this study was to examine the size of fetal branch pulmonary artery (PA) diameters in normal growth fetuses. Method: Fetal PA diameters were measured in 175 normal fetuses between 18 and 40 weeks of gestation from 2005 to 2006. In addition, 4 fetuses with left-sided congenital diaphragmatic hernia (CDH) from 2001 to 2006 were retrospectively reviewed. Branch PA diameters were measured from a cross-sectional image at the level of the three-vessel view (main PA, ascending aorta and superior vena cava) to demonstrate the long axis of both branch PAs whenever possible. Results: Both the left and right PA diameters were found to correlate strongly with the advancing gestational age (r = 0.78, p < 0.01, respectively). Left pulmonary artery to main pulmonary artery (LPA/MPA) ratio and right pulmonary artery to main pulmonary artery (RPA/MPA) ratio were calculated. These two parameters were almost constant throughout gestation. LPA in fetal left CDH was smaller than control. Both LPA/MPA and RPA/MPA were within the normal range in most cases. Conclusions: It is important to establish the normal range of branch PA diameters and it appears to be useful to compare the branch PA diameters in normal fetuses with that in cases of pulmonary hypoplasia.

Contents Vol. 23, 2008

R. Achiron, Tel Hashomer N.S. Adzick, Philadelphia, Pa. L. Allan, London K.J. Blakemore, Baltimore, Md. T.-H. Bui, Stockholm F.A. Chervenak, New York, N.Y. T. Chiba, Tokyo Y. Chiba, Osaka W.H. Clewell, Phoenix, Ariz. J.E. De Lia, Milwaukee, Wisc. Y.M.D. Lo, Hong Kong J.A. Deprest, Leuven G.C. Di Renzo, Perugia M. Dommergues, Paris J.W. Dudenhausen, Berlin Y. Dumez, Paris N.M. Fisk, Herston, Brisbane A.W. Flake, Philadelphia, Pa. W.D.A. Ford, North Adelaide U. Gembruch, Bonn P.D. Gluckman, Auckland M. Hansmann, Bonn M.R. Harrison, San Francisco, Calif. J.C. Hobbins, Denver, Colo. L.K. Hornberger, San Francisco, Calif. E.R.M. Jauniaux, London M.P. Johnson, Philadelphia, Pa. C. Jorgensen, Copenhagen J.-M. Jouannic, Paris H.H.H. Kanhai, Leiden A. Kurjak, Zagreb P.M. Kyle, London S. Lipitz, Tel-Hashomer S. Mancuso, Roma G. Mari, Detroit, Mich. M. Martinez-Ferro, Buenos Aires P. Miny, Basel K.J. Moise, Houston, Tex. K.H. Nicolaides, London U. Nicolini, Milan L. Otaño, Buenos Aires Z. Papp, Budapest R. Quintero, Tampa, Fla. G. Ryan, Toronto J. Rychik, Philadelphia, Pa. G.R. Saade, Galveston, Tex. H. Sago, Tokyo W. Sepulveda, Santiago P. Stone, Auckland D.V. Surbek, Bern M. Tanemura, Nagoya S. Tercanli, Basel J.-L. Touraine, Lyon B.J. Trudinger, Westmead J.M.G. van Vugt, Amsterdam S.L. Warsof, Virginia Beach, Va. C.P. Weiner, Kansas City, Kans. R.D. Wilson, Philadelphia, Pa. R. Zimmermann, Zürich Clinical Advances and Basic Research

Changes in the Aortic and Pulmonary Diameters in a Fetus with Hypoplastic Left Heart Syndrome

We diagnosed hypoplastic left heart syndrome in a 26-week-old fetus using fetal echocardiography. Color Doppler ultrasonography was helpful for evaluating the structural abnormalities. The diameters of the aorta and the pulmonary artery were measured periodically from 26 to 38 weeks of gestation. Aortic diameter was below the normal range throughout gestation. The diameter of the pulmonary artery was normal at 26 weeks of gestation but gradually dilated and was abnormally dilated after the 36th week of gestation. Here we discuss the cause of enlarged pulmonary artery in fetal hypoplastic left heart syndrome.