Naoko Iwanaga

Analysis of pregnancies in women with Takayasu arteritis: Complication of Takayasu arteritis involving obstetric or cardiovascular events

The incidence of Takayasu arteritis during child‐bearing years is relatively high. The management of pregnancies in patients with this disease is of great importance in clinical obstetrics. Here we analyzed pregnancies of women with Takayasu arteritis with and without complications.

Vaginal delivery in pregnancy with Moyamoya disease: Experience at a single institute

Cesarean section is commonly selected in pregnancy with Moyamoya disease. We consider vaginal delivery with epidural anesthesia a viable alternative in such cases.

Uterine artery flow velocity waveforms during uterine contractions: Differences between oxytocin‐induced contractions and spontaneous labor contractions

Aim:  To clarify the effects on uterine arterial flow velocity waveforms of uterine contractions following oxytocin infusion and during spontaneous labor.

Effect of eicosapentaenoic acid agent on aggravated hypertriglyceridemia during pregnancy

Aggravated hypertriglyceridemia with a serum triglyceride of more than 1000 mg/dL is a risk of acute pancreatitis during pregnancy. However, there have been few reports on the administration of an eicosapentaenoic acid (EPA) agent for aggravated hypertriglyceridemia during pregnancy. A 29‐year‐old multiparous Japanese woman was transferred to our hospital at 29 + 0 weeks of gestation due to hypertriglyceridemia of 898 mg/dL. Because diet control was not enough, we decided to use an EPA agent, resulting in a reduction in triglyceride levels to 550 mg/dL. A male infant, weighing 2667 g, was born at 37 + 2 weeks transabdominally, and was complicated with respiratory distress syndrome. The final diagnosis was type III hyperlipoproteinemia with the apolipoprotein E3/2 phenotype and a broad β‐migrating lipoprotein on polyacrylamide gel electrophoresis of serum lipoproteins. In conclusion, an EPA agent may be a possible therapeutic approach for aggravated hypertriglyceridemia during pregnancy, although it may increase a risk of respiratory distress syndrome.

Management of pulmonary vasodilator therapy in three pregnancies with pulmonary arterial hypertension

Pregnancy with pulmonary arterial hypertension (PAH) has a significantly high risk of maternal death and women with PAH are basically advised to avoid pregnancy. Recently, several reports have described pregnant women with PAH who were treated with pulmonary vasodilators during pregnancy and delivered safely. However, the efficacy of this treatment during pregnancy is still not clear. Here we report on the short‐term outcomes of three primiparous women with PAH who were prescribed pulmonary vasodilator therapy during their pregnancies. All women delivered preterm due to cardiac and/or obstetric reasons and were discharged without any complication. Pulmonary vasodilator therapy can be used safely during the pregnancies of PAH patients and may contribute to improved maternal and fetal prognoses.

Safety and efficacy of a 52‐mg levonorgestrel‐releasing intrauterine system in women with cardiovascular disease

We sought to examine the safety and efficacy of a 52‐mg levonorgestrel‐releasing intrauterine system (LNG‐IUS), and to evaluate the changes in biomarkers of infection, anemia and cardiovascular conditions after LNG‐IUS insertion in women with cardiovascular disease.

Utility of Fluid Assessment Based on the Intrathoracic Impedance Monitoring in a Peripartum Woman with Heart Disease

Recently, implantable cardioverter-defibrillators (ICD) have become capable of monitoring intrathoracic impedance to detect an increased fluid volume and heart failure. Pregnancy is a well-known cause of an increased body fluid volume; however, it is not clear whether the measurement of intrathoracic impedance by ICD is clinically useful for precisely detecting heart failure in pregnant women. We herein report the case of a 39-year-old woman with an ICD that had been implanted after an event of ventricular fibrillation due to severe aortic regurgitation with a bicuspid aortic valve. Elevated right ventricular pressure and brain natriuretic peptide levels were detected at 37 weeks of gestation and postpartum. At the same time, the ICDs stored fluid index gradually increased and exceeded the threshold on the 10th day after delivery. She was treated with diuretics and recovered from postpartum heart failure. The physiological volume changed in the perinatal period, but we were still able to detect heart failure by ICD. Intrathoracic impedance monitoring is effective in the perinatal field.

Intra‐ and post‐partum acute aortic dissection (Stanford type B): Report of two cases

Pregnancy with Marfan syndrome (MFS) presents challenges to the clinician because of the increased incidence of maternal cardiovascular complications, including acute aortic dissection (ADD) and the involvement of the fetus owing to the urgency of the need for surgery and the low likelihood of survival with premature delivery. Patient 1 was a 36‐year‐old pregnant Japanese woman with MFS who was referred at 16 gestational weeks with aortic root diameter 35.1 mm. Stanford type B AAD occurred on delivery without evident blood pressure changes. Patient 2 was a 31‐year‐old pregnant Japanese woman with MFS with aortic root diameter 28.3 mm at 20 gestational weeks after David procedure. Ultimately fatal Stanford type B AAD occurred on post‐partum day 15. Both patients were treated with beta‐blockers when AAD occurred. Although these two patients were initially considered to have relatively low risk according to previous reports and guidelines, AAD occurred. It is very important to provide information about these high pregnancy risks to women with MFS before conception, and to follow MFS pregnancies with great caution.

Impact of pregnancy on the size of small cerebral aneurysm

Abstract Objective: Because the management of cerebral aneurysms during pregnancy remains controversial, the objective of this study was to perform a retrospective review of pregnant women with cerebral aneurysms to determine whether pregnancy is a risk factor for aneurysm rupture. Methods: The change in size of aneurysms during pregnancy was examined by performing repeat magnetic resonance angiography in five pregnant women with cerebral aneurysms between 2005 and 2013. The outcome examined was development of subarachnoid hemorrhage. Results: Among the five pregnancies, there were eight cerebral aneurysms. Subarachnoid hemorrhage did not developed during any pregnancy. In four of the pregnancies, the cerebral aneurysms did not change in size during pregnancy, remaining 2–5 mm. Although in one pregnancy, the aneurysm increased from 6 to 7 mm during the third trimester, it returned to its original size in the postpartum period. Conclusions: We suggest that if the cerebral aneurysm is small (≤ 5 mm), it is likely to remain unchanged despite the increase in circulating blood volume during pregnancy. Cerebral aneurysms greater than 5 mm but without blebs, irregular shape, high-risk location, or increased aspect ratio are also at low risk of rupture and are not likely to change during pregnancy.

Plasma Levels of Neopterin and Biopterin in the Umbilical Vessels and the Maternal Vein

Abstract Tetrahydrobiopterin (BH4) is a highly bioactive pterin required for nitric oxide synthase and monooxygenases of aromatic amino acids, and is involved in the synthesis of nitric oxide, catecholamines and Serotonin. Although these functions imply that pterin metabolism plays critical roles in human development, the intrauterine metabolism is unclear. To elucidate the pterin metabolism in the human feto-placental unit, blood was obtained from the umbilical artery and vein, and the maternal vein, and plasma biopterin and neopterin concentrations were analyzed by the high-performance liquid chromatography method. To clarify the effect of labor, data was also compared between the transvaginal delivery (TV) and the caesarean delivery (CS). The levels of biopterin and the neopterin, and neopterin/biopterin ratio were higher in the fetal plasma than in the maternal plasma. Biopterin levels in the umbilical artery were higher than those in the umbilical vein. There were significant correlations in either biopterin or neopterin between the fetal plasma and the maternal plasma. There was no significant difference in the fetal pterin levels between TV and CS. The results suggest the stimulated BH4 synthesis in the fetoplacental unit, the independent homeostasis of the fetal pterin metabolism, and the possibility of dynamic movements of pterins among the fetus, the placenta and the mother.