Motoharu Imanaka

Transcervical amnioinfusion of antibiotics: A basic study for managing premature rupture of membranes☆

To determine the best method of preventing ascending infection in the management of premature rupture of membranes, antibiotics such as latamoxef sodium, cefoperazone sodium, and cefotaxime sodium were infused directly into the amniotic cavity in 64 patients undergoing induction of labor at term. A single infusion of 100 or 500 mg of each drug resulted in a concentration of 200 to 1000 micrograms/ml immediately after infusion, and the concentration remained above 10 micrograms/ml for about 24 hours without significant increase in fetal or maternal blood levels. Consequently, a daily single dose of 100 mg or more is probably effective prophylaxis in cases of premature rupture of membranes. When intrauterine infection is suspected, the dose can be increased to 500 mg or more, and transplacental administration may be added to achieve a higher concentration in fetal blood. The present study simulates well premature rupture of membranes, and an amnioinfusion of antibiotics will be reliable and effective in managing premature rupture of membranes.

Saline solution amnioinfusion for oligohydramnios after premature rupture of the membranes

In the conservative management of premature rupture of the membranes, most patients have oligohydramnios caused by continuous leakage of amniotic fluid. To avoid unfavorable effects of oligohydramnios on fetal development and well-being, we infused physiologic saline solution continuously into the amniotic cavity at a flow rate of 10 to 20 ml/hr with a new cervical indwelling catheter (PROM-fence). As a result the average pocket size of amniotic cavity was 2.7 cm before amnioinfusion, 5.9 cm 1 day after, 5.8 cm 5 days after, and 5.0 cm 10 days after amnioinfusion. The saline solution amnioinfusion made it possible to keep the amniotic cavity fluid level adequate. Variable deceleration disappeared in one case. No side effects such as uterine contractions were observed. We recommend the method of saline solution amnioinfusion for its favorable effects on fetal environment during management of premature rupture of membranes.

Prenatal diagnosis of succinyl-coenzyme A:3-ketoacid coenzyme A transferase deficiency.

Succinyl‐CoA:3‐ketoacid CoA transferase (SCOT) deficiency is a rare disorder of ketone body catabolism. In the present study, we prenatally diagnosed SCOT deficiency in a fetus in a family of which the proband was the first patient with SCOT deficiency identified in Japan, by analysis of enzyme activity levels in samples of chorionic villi and cultured amniocytes. In the fetus of the family, SCOT activity was not detected in either chorionic villi or cultured amniocytes. Since the levels of SCOT activity in control chorionic villi were close to our minimal detectable level and were much lower than those in control cultured amniocytes, enzyme assay in cultured amniocytes was more feasible than that in chorionic villi for prenatal diagnosis of SCOT deficiency. No elevated accumulation of 3‐hydroxybutyrate or acetoacetate was detected in the amniotic fluid of the fetus. To our knowledge, this report is the first of prenatal diagnosis of SCOT deficiency.

Uterine blood flow velocity waveforms during early postpartum course following Caesarean section

OBJECTIVE To assess the change of uterine blood flow after Caesarean section. STUDY DESIGN Doppler flow velocity waveforms were acquired from the uterine arteries and small arteries near the myometrial wound detected by transvaginal power Doppler ultrasonography in 23 patients on the 3rd, 6th and 9th postoperative days. RESULTS The resistance index for the uterine artery did not show any change during the study period, while that for the small arteries slightly decreased. CONCLUSION Uterine blood flow resistance after Caesarean section did not show any change during the early postpartum period.

Umbilical cord venous pulsation in normal fetuses and its incidence after 13 weeks of gestation

A total of 1175 umbilical venous Doppler flow velocity waveforms were acquired from 449 normal pregnant women whose fetuses were delivered at term without neonatal asphyxia or anomalies. Arterial and venous flow velocity waveforms were acquired from a free loop of the umbilical cord. The incidence of umbilical venous pulsation decreased from 30.4% at 13-14 weeks of gestation to 14.8% at 21-22 weeks of gestation. After 23 weeks, this incidence was settled within 5.0-7.8%. There was no difference between the umbilical arterial resistance index of the fetuses with venous pulsation and without pulsation before 22 weeks. But the resistance index was lower in the pulsatile fetuses than in the nonpulsatile fetuses after 23 weeks of gestation. The origin of venous pulsations before early second trimester was suspected to be different from that after late second trimester.

UMBILICAL VENOUS PULSATION AND REGIONAL CIRCULATORY DISTURBANCE

The umbilical cord conditions at the point where regional umbilical venous pulsation occurred were examined in 15 patients between the 28th and 40th gestational week. The patients delivered appropriate-for-date infants without anomalies. Regional venous pulsation was observed in cases of large-angle cord winding (especially more than 60 degrees). It was also observed where the umbilical cord was compressed by the fetus, uterine wall or placenta, even if the umbilical cord was straight. From these findings, we concluded that regional umbilical venous pulsation is the result of regional circulatory disturbance of the umbilical cord.

Effects of umbilical arterial resistance on its arterial blood flow velocity waveforms

Background. We propose to clarify the effect of umbilical arterial resistance on umbilical arterial blood flow patterns in normal pregnant women.

Massive fetomaternal hemorrhage

We evaluated the potential prognostic factors for fetomaternal hemorrhage (FMH). Sinusoidal heart rate pattern and decrease in fetal movement are considered important signs of FMH. However these findings were detected in only two of six cases of FMH and were thought to be late signs of FMH. Fetal hemoglobin levels in the maternal circulation for infants born alive following FMH were less than 5%. Our findings suggest that this amount of blood loss could cause fetal death.

Cyclic changes in the umbilical arterial flow in mono-chorionic, di-amniotic twin pregnancy

OBJECTIVE To determine the effect of arterio-arterial anastomosis on the umbilical arterial flow in mono-chorionic, di-amniotic twin pregnancy. SUBJECTS Thirty-three women with mono-chorionic, di-amniotic twin pregnancy. METHODS Pulsed Doppler ultrasonographic examination was performed every 4 weeks to obtain umbilical arterial flow velocity waveforms in both two fetuses. RESULTS In five of the women, cyclic flow changes in the umbilical arterial flow were detected in the smaller fetus. All of these twins had arterio-arterial anastomosis on the surface of the placenta. CONCLUSION The fetuses in mono-chorionic and di-amniotic twin gestation who showed cyclic changes in umbilical arterial flow had arterio-arterial anastomosis. But, this characteristic flow was not observed every time.

Antepartum detection of cord presentation by transvaginal ultrasonography for term breech presentation: Potential prediction and prevention of cord prolapse

Aim:  We evaluated the efficacy of antepartum screening for cord presentation by trans‐vaginal ultrasonography (TVS) on predicting and preventing umbilical cord prolapse (UCP) in term breech delivery.