Mikio Morine

Differences in insulin sensitivity in pregnant women with overweight and gestational diabetes mellitus

Aim. The purpose of the present study was to investigate changes in insulin sensitivity using homeostasis model assessment (HOMA) and the quantitative insulin sensitivity check index (QUICKI) in normal-weight and overweight women with normal glucose tolerance (NGT) and gestational diabetes mellitus (GDM) during pregnancy. Methods. Ninety-two pregnant women in the first trimester, 202 in the second trimester and 154 in the third trimester were enrolled in this study. Fasting plasma glucose and insulin concentrations were measured in all women in the first, second and third trimesters. HOMA indices (insulin resistance, HOMA-IR and β-cell function, HOMA-β) and QUICKI were calculated from fasting glucose and insulin concentrations. Results. HOMA-IR values in overweight women with NGT and in women with GDM were significantly (p < 0.01) higher than those in normal-weight women with NGT. HOMA-IR in women with GDM increased significantly (p < 0.05) during pregnancy, but HOMA-IR values in normal-weight and overweight women with NGT did not change significantly with advance of gestation. QUICKI values in overweight women with NGT and in women with GDM were also significantly (p < 0.01) lower than those in normal-weight women with NGT, and QUICKI in women with GDM decreased significantly (p < 0.05) during pregnancy. HOMA-β in normal-weight women with NGT increased significantly (p < 0.01) during pregnancy. Conclusion. We showed that insulin sensitivities determined by using HOMA-IR and QUICKI in overweight women with NGT and women with GDM were lower than those in normal-weight women with NGT, and that insulin sensitivity in women with GDM declined with advance of gestation.

Transient hydrops fetalis of the donor fetus in twin-twin transfusion syndrome after therapeutic amnioreduction.

We present a case of twin–twin transfusion syndrome associated with transient hydrops fetalis observed in the donor after therapeutic amnioreduction at 22 weeks of gestation. After the amnioreduction, the bladder of the donor could be visualized and the donor subsequently began to make amniotic fluid, with spontaneous regression of hydrops fetalis. It is suspected that after therapeutic amnioreduction, intrauterine hemodynamic changes occurred and the donor developed transient hydrops fetalis due to volume overload. Copyright

A case of pregnancy complicated with congenital dysprothrombinemia (prothrombin Tokushima).

We present the course of pregnancy and delivery in a patient with congenital dysprothrombinemia. The patient is a 29-year-old nulliparous woman. She was diagnosed with dysprothrombinemia at 10 years of ag. Her course of pregnancy was uneventful. She delivered after prophylactic lyophilized human blood coagulation factor IX complex 800 U was administered. The plasma prothrombin activity was at 24.0% of normal plasma clotting activity. Her postpartum course was uneventful. After 6 years, her course of pregnancy was the same as before. Prophylactic lyophilized human blood coagulation factor IX complex 800 U was administered. Her plasma prothrombin activity was at 26.7%, and she underwent an induced delivery. Her postpartum course was uneventful. It is beneficial to use prophylactic lyophilized human blood coagulation factor IX complex 800 U in pregnancies that are complicated by dysprothrombinemia. The goal of therapy is to maintain prothrombin levels at above 20%.

A unique TBX5 microdeletion with microinsertion detected in patient with Holt-Oram syndrome.

Holt–Oram syndrome (HOS) is an autosomal dominant condition characterized by upper limb and congenital heart defects and caused by numerous germline mutations of TBX5 producing preterminal stop codons. Here, we report on a novel and unusual heterozygous TBX5 microdeletion with microinsertion (microindel) mutation (c.627delinsGTGACTCAGGAAACGCTTTCCTGA), which is predicted to synthesize a truncated TBX5 protein, detected in a sporadic patient with clinical features of HOS prenatally diagnosed by ultrasonography. This uncommon and relatively large inserted sequence contains sequences derived from nearby but not adjacent templates on both sense and antisense strands, suggesting two possible models, which require no repeat sequences, causing this complex microindel through the bypass of large DNA adducts via an error‐prone DNA polymerase‐mediated translesion synthesis.

P02.83: Placental mesenchymal dysplasia concomitant with fetal abdominal lymphangioma

gestation. Postnatal evaluation confirmed: V lumbar hemivertebrae; A imperforate anus and rectovaginal fistula; C subaortic IVC; TE esophagic atresia with tracheo esophagic fistula; R Hydronephrosis L unilateral talus. Comment: Between Nov 1998 and March 2006 in our institution, this is the first case of VACTERL syndrome presented in 43 000 deliveries. The diagnosis was suspected when an association of anomalies was found in a comprehensive ultrasound; despite that the urological condition was different from the prenatal diagnosis. This case confirms the need of a thorough evaluation of the fetal anomaly as soon as one anomaly has been found.

P04.05: Atypical inferior vena cava and ductus venous blood flow velocity pattern in the fetus with Ebstein's anomaly: a case report

We present a case of Ebstein’s anomaly with tri-phasic inferior vena cava (IVC) and ductus venosus (DV) forward flow pattern. Pulsed tissue Doppler imaging (TDI) were performed to elucidate the relationship of the atypical venous flow and the ventricular wall motions. A 32 year-old nulliparous woman conceived a monochorionic-diamniotic twin pregnancy by IVF. On a routine fetal sonography at 14 weeks of gestation, Twin A showed cardiomegaly (cardio-thoracic ratio: 53%) and severe tricuspid regurgitation (TR). Another twin was sonographically unremarkable. With advance of gestation, fetal echocardiography on Twin A revealed right atrial enlargement, severe holosystolic TR (1.3m/sec), the enlarged sail-like anterior leaflet of tricuspid valve (TV), and retrograde pulmonary artery and ductal flow in the absence of pulmonary regurgitation. Posterior and septal leaflets of TV were not detected. For sonographic findings stated above, Ebstein’s anomaly and pulmonary atresia was prenatally diagnosed. Pulsed Doppler examination showed tri-phasic IVC and DV forward flow pattern. Pulsed TDI recording of the right atrioventricular valve ring showed abnormal shortening after S wave from late systolic phase to isovolumic relaxation phase of the cardiac cycle. This abnormal shortening synchronized with the second wave of IVC and DV forward flow, and the left ventricle showed the same shortening. There were no sign of fetal arrhythmia or hydrops fetalis. A Cesarean section was performed at 36 weeks of gestations. Twin A was a female infant weighing 2290g with Apgar scores of 2 and 6 at 1 and 5 minutes, respectively. Postnatal diagnosis was the same as prenatal assessment. Starnes operation was performed at 6th day after birth. But she died at the 7th day because of cardiac failure. In conclusion, we detected tri-phasic IVC and DV forward flow pattern in the fetus with Ebstein’s anomaly. We speculate that the abnormal ventricular motion caused the atypical venous flow pattern.