Mayumi Tokunaka

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.

Antenatal ultrasound screening using check list before delivery for predicting a non-reassuring fetal status during labor.

Abstract Objective: To clarify the effectiveness of ultrasound screening at 36 weeks’ gestation for predicting a non-reassuring fetal status during labor (NRFS). Methods: A prospective cohort study was conducted between 2012 and 2013. Ultrasound evaluations of umbilical cord and placental abnormalities and fetal biometry were performed among pregnant females at 36 weeks’ gestation. Patients who underwent ultrasound screening were divided into three risk level groups according to their abnormalities. After delivery, NRFS and emergency Cesarean section (eCS) rate were compared between the risk groups. Results: A total of 790 subjects were analyzed. Elective Cesarean section was performed in 111 cases. Consequently, 34 cases in the high-risk group, 45 cases in the middle-risk group and 600 cases in the low-risk group were analyzed. NRFS was diagnosed in 17.6%* of the patients in the high-risk group, 11.1%* of the patients in the middle-risk group and 5.6% of the patient’s in the low-risk group. eCS was performed in 8.8%* of the high-risk subjects, 4.4%* of the middle-risk subjects and 0.8% of the low-risk subjects (*p < 0.05 compared to the low-risk group). Conclusions: The use of antenatal ultrasound screening and risk classification effectively identifies cases of NRFS during delivery.

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.

Outcomes in the absence of the ductus venosus diagnosed in the first trimester

Abstract Purpose: To clarify the outcomes of the absence of the ductus venosus (DV) diagnosed in fetuses suspected to have a structural abnormality during a morphological assessment in the first trimester. Methods: Infants in whom ultrasound fetal morphological assessments were attempted in the first trimester (11 to 13–6 weeks of gestation) and who were subsequently delivered between 2013 and 2015 at Showa University Hospital were enrolled. In cases in which the absence of the DV was diagnosed in the first trimester, the prognosis was assessed. Results: First-trimester ultrasound screening was performed in a total of 2610 cases between 2013 and 2015. Fetal edema (n = 38), hydrops (n = 16), abnormal four-chamber view findings (n = 2), and tricuspid regurgitation (n = 1) were observed in a total of 52 cases (2.0%). In 4 of the 52 cases with abnormal ultrasound findings, the absence of the DV was detected. Conclusion: If fetal edema or hydrops in early pregnancy is found without any other structural abnormalities, not only chromosomal abnormalities should be suspected but also an evaluation for the absence of the DV should be included. In addition, absence of the DV with fetal edema may be associated with the outcomes of cardiac dysfunction, chromosome abnormalities, and intrauterine sudden death. Severe fetal edema is associated with a poor prognosis, and the family must be carefully informed of the potential outcomes.