Michiya Natori

Experimental growth retardation produced by transient period of uteroplacental ischemia in pregnant Sprague-Dawley rats.

OBJECTIVE Introduction of experimental growth retardation, which was based on the hypothesis of uteroplacental postischemic hypoperfusion, was attempted by a transient period of uteroplacental ischemia in dated-pregnant Sprague-Dawley rats. STUDY DESIGN On day 17 of gestation right uterine horn circulation was occluded for 5 to 60 minutes in 35 dams. The fetuses were delivered by cesarean section and studied on day 21 of gestation. For each experiment the fetuses in the right horn served as the ischemia group and those in the left horn were used as the control group. RESULTS Statistical analysis by Wilcoxon signed-rank test demonstrated a significant decrease in the fetal weights and in the liver-to-body weight ratios, in contrast to an increase in the brain-to-body weight ratios in the 60-minute ischemia group, compared with those in the control group. This ischemia resulted in a 14% incidence of fetal deaths. CONCLUSION Ischemia of a single uterine horn circulation in pregnant rat for 60 minutes should readily serve as a suitable model for asymmetric intrauterine growth retardation.

Herpes simplex virus 2-associated hemophagocytic lymphohistiocytosis in a pregnant patient.

BACKGROUND: Uncontrolled phagocytosis of normal hemopoietic cells by activated histiocytes in bone marrow is collectively referred to as hemophagocytic lymphohistiocytosis. CASE: We present a case of hemophagocytic lymphohistiocytosis associated with herpes simplex virus-2 infection in the second trimester. Cytopenia, elevated C-reactive protein, ferritin, soluble interleukin-2 receptor, and interleukin-6 with high-grade fever were observed following genital herpes infection, and the existence of hemophagocytes in bone marrow confirmed the diagnosis of hemophagocytic lymphohistiocytosis. Corticosteroid therapy failed to arrest the hemophagocytic process, whereas cyclosporin A was effective. The patient delivered a healthy infant after remission and has not experienced exacerbation. CONCLUSION: It is often important to take into consideration hemophagocytic lymphohistiocytosis when encountering cytopenia with high-grade fever. Cyclosporin A was a safe and available strategy for this corticosteroid-resistant case.

A retrospective evaluation of maternal serum screening for the detection of fetal aneuploidy

A retrospective evaluation of alpha‐fetoprotein (AFP), human chorionic gonadotropin (hCG), and unconjugated oestriol (uE3) levels in maternal blood in the second trimester was conducted for cases of aneuploid pregnancies identified from a series of women who underwent amniocentesis. Blood samples were collected from 1078 women just before genetic amniocentesis was performed, mainly for individuals of advanced maternal age (greater than 35 years). Twenty‐five maternal serum samples from pregnant women with an aneuploid fetus, including 14 with Downs syndrome, were available for analysis of all three parameters. An algorithm to detect Downs syndrome was used for this analysis with a risk of ≥1:299 classified as screen‐positive, this being found for 20.4 per cent of the cases (220/1078). The actual Downs syndrome detection rate was 85.7 per cent (12/14), whereas the detection rate for all aneuploidies was 72.0 per cent (18/25). Those that were not detected were two cases of trisomy 21, one trisomy 18, two trisomy 13, three sex chromosome abnormalities, and one case of an additional marker chromosome. The data indicate that this tri‐analyte test should be provided after thorough genetic counselling and informed decision‐making regarding maternal serum screening for women who wish for a prenatal diagnosis.

Manifestation of Mirror Syndrome after Fetoscopic Laser Photocoagulation in Severe Twin-Twin Transfusion Syndrome

Mirror syndrome is a preeclampsia-like disease first described in a case of severe hydrops fetalis caused by rhesus isoimmunization, later reported in some cases of nonimmunological fetal hydrops. Twin-twin transfusion syndrome (TTTS) is a severe complication associated with monochorionic pregnancies, in particular, severe TTTS with one hydropic fetus leading to a poor prognosis. We report here a case of mirror syndrome that occurred after selective fetoscopic laser photocoagulation in severe TTTS at 24 weeks’ gestation.

Evaluation of the radiologic findings on hysterosalpingography by selective hydrotubation with flexible hysterofiberscope.

PurposeThe objective of this study was to assess further the significance and accuracy of hysterosalpingography (HSG) by comparing the radiologic findings on HSG to selective hydrotubation (SHT) using a hysterofiberscope in 106 women with tubal occlusion.ResultsPatency was successfully observed by SHT in 72 of 134 tubes and 62 of 106 patients. Proximal obstruction was divided into three groups according to the shape of cornual obstruction (sharp, dull, defect) on HSG. The success rate for SHT in unilateral obstruction (64%) were significantly higher than those in bilateral obstruction (39%). In the three groups of proximal obstruction, the success rates for SHT were 24, 75, and 30% in sharp, dull, and defect, respectively. The group of dull had significantly higher success rate than the groups of sharp and defect. Thirteen of 62 patients who successfully recanalized became pregnant at 9-month follow-up interval.ConclusionCareful evaluation of the cornual obstruction in radiologic findings on HSG may be important for the decision on further treatment. Furthermore, SHT using a hysterofiberscope is an effective method for evaluating tubal obstruction and for managing it in a selected group of patients with tubal obstruction.

Androstenedione and progesterone concentrations in preovulatory follicular fluid correlate with successful fertilization and cleavage of human oocytes in vitro**Presented at the 7th Annual Meeting of the Society of Japan Fertilization and Implantation, Fukui, Japan, July 15 to 16, 1989.

OBJECTIVE To determine if androstenedione (A) and progesterone (P) concentrations in preovulatory follicular fluid (FF) correlate with successful fertilization and cleavage of human oocytes in vitro. DESIGN A retrospective randomized trial. SETTING Hospital department of obstetrics and gynecology. PATIENTS Fifty-five patients, ages 24 to 39 years, with normal menstrual cycles undergoing in vitro fertilization (IVF) for tubal infertility. INTERVENTIONS Multiple follicular development was induced with clomiphene citrate and human menopausal gonadotropin. MAIN OUTCOME MEASURES Relationships among FF steroid hormone, morphological maturity of oocyte-corona-cumulus complexes, and fertilization and cleavage of oocytes. RESULTS Follicles with mature oocyte-corona-cumulus complexes and unfertilized oocytes contained significantly greater amounts of A (P less than 0.05) than those with mature oocyte-corona-cumulus complexes and fertilized ova, indicating the occurrence of atretic changes. Follicles yielding successfully fertilized and cleaved ova had significantly greater amounts of P (P less than 0.05) and A (P less than 0.01) but similar levels of 17 beta-estradiol compared with follicles yielding fertilized ova that failed to cleave. CONCLUSIONS Follicles yielding oocytes that cleaved as a result of IVF have both a shift in steroidogenesis from estrogen to progestin accumulation and declining aromatase activity, thus reflecting progressive luteinization of the follicles.