Osamu Nakamoto

Clinical Predictors in the Natural History of Uterine Leiomyoma: Preliminary Study

This study was conducted to examine the correlation between uterine vascularity and natural history of uterine leiomyoma. Seventy women with leiomyoma participated in this study. Measurements of uterine and leiomyoma volume, as well as blood flow characteristics of the main uterine artery and leiomyoma arteries, were made every 3 months for 1 year. Leiomyoma arteries could be detected in 52 (51.5%) of 101 leiomyomas. Leiomyoma volume increased in 24 (46.2%) of 52 leiomyomas with leiomyoma artery. However, the leiomyoma volume increased in only three (6.1%) of 49 leiomyomas without leiomyoma artery. No difference was found between the pulsatility index of the leiomyoma artery in the group with increased size and in the group with stable size. This study shows the vascularity of leiomyoma to be useful as a predictor of leiomyoma growth.

Resuscitative endovascular balloon occlusion of the aorta as an adjunct for hemorrhagic shock due to uterine rupture: a case report

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a life‐saving procedure used to control bleeding and maintain blood pressure temporarily in traumatic hemorrhagic shock. Uterine rupture and placenta accreta provoke uncontrollable massive hemorrhaging. REBOA may be useful for hemodynamic stabilization to prevent cardiac arrest in high‐risk pregnancy.

183. Severe hypertension and maternal organ involvements were closely related in the disease of hypertensive disorders of pregnancy

Purpose Severe hypertension (sevHT, over 160/110 mmHg) is supposed to be pathogenesis of maternal organ involvements in the disease of hypertensive disorders of pregnancy. It remains that to what extent each target organ is to be damaged in sevHT. Methods 2746 pregnant women managed in our tertial perinatal center from 2013 to 2016 were entered in this study retrospectively. All cases with sevHT were managed expectantly in the same antihypertensive protocol. Disease type was defined by restrictive criteria in irrespective of organ involvements. Result 192 cases of 2746 found sevHT and 91 cases was in antepartum (AP), 90 in intrapartum (IP) and 21 in postpartum (PP). 9 cases (11%) of 91 cases in AP showed gestational hypertension (GH), 47 (58%) preeclampsia and 22 (27%) preeclampsia superimposed on chronic hypertension (PES). 11% of GH in AP, 58% of PE in AP, 41% of PES in AP, 11% in IP and 29% in PP complicated with organ involvements. HELLP related involvements such as elevated liver enzymes, low platelets count or renal impairment were observed in 34% of PE in AP, 27% of PES in AP and 14% in PP. Hyperpermeability involvements such as pleural edema or massive ascites were diagnosed in 9% of PE or PES in AP. About CNS involvements, eclampsia were observed in 4% of PE in AP, cerebral vascular spasms 6% of PE in AP, 5% of PES in AP, 1% in IP and 14% in PP. Conclusions SevHT found in 7% (192 of 2746). CNS involvements found 9% of preeclamptic disease. HELLP related involvements related to the preeclamptic disease. Hyperpermeability involvements had even 11% in GH in preeclamptic disease. We showed maternal organ involvements were closely related with preeclamptic disease with sevHT. Also hyperpermeability involvements related with GH with sevHT. In discussing non-proteinuric preeclampsia, hyperpermeability disorders play important role.

Predictive Value of the TSH/FT4 Ratio in Women with Suspected PE or GH

Objective: In the present study, we aimed to examine whether the TSH/FT4 ratio after the second trimester can predict the prevalence of preeclampsia (PE) or gestational hypertension (GH). Study design: Retrospective case-control study. Methods: We collected TSH and FT4 serum levels after the second trimester in 133 pregnant women with suspected PE or GH. Participants were divided into 2 groups, the PE+GH group and the non-PE+GH group and conducted the retrospective study for the two groups to evaluate the background and the prevalence of PE or GH were retrospectively evaluated. Results: Among the participants in the PE+GH group, mean age, body mass index (BMI) at no pregnancy and BMI at delivery were 34.5 ± 6.7 years, 22.3 ± 3.9 kg/m2 and 26.0 ± 4.0 kg/m2, respectively. Among the participants in the non-PE+GH group, mean age, BMI at no pregnancy and BMI at delivery were 32.9 ± 5.5 years, 22.5 ± 4.8 kg/m2 and 26.1 ± 4.4 kg/m2, respectively. There were no significant differences observed between the two groups. The cutoff point of the TSH/FT4 ratio was 1.9 (sensitivity 0.45, specificity 0.81), which was derived from the receiver operating characteristic curve. The adjusted odds ratio of PE or GH prevalence was 3.60 (95% CI: 1.62-8.02). Conclusion: The TSH/FT4 ratio after the second trimester may aid in the prediction of PE or GH prevalence.

OS012. Eclampsia with progressing disease correlates to severe diastolicblood pressure.

INTRODUCTION Eclampsia is MRI-radiologically defined as posterior reversible encephalopathy syndrome (PRES), which indicate cases with eclampsia might improve spontaneously and reversibly. On the other hand the central nervous system is the main target organ affected by the disease of severe preeclampsia. Eclampsia is thought to be one of the severe states of this disease. We should recognise some eclamptic cases to grow worse resulting in disastrous stroke or poor prognosis. Especially the symptoms of long lasting unconsciousness or repeating seizures, or the sings with cerebrovascular vasospasms or brain stem lesion are considered as the progressing disease among the disease of eclampsia. We studied what factors among obstetrics features are related to this progressing disease of eclampsia. OBJECTIVES Thirty six cases with eclampsia were entered in this study. All cases were managed in our hospital from 1995 to 2011. All cases had hypertensive disorders and 23 cases complicated with preeclampsia or superimposed preeclampsia. Four cases were antepartum eclampsia, 12 cases intrapartum and 10 cases postpartum. 20 cases were diagnosed as progressing disease of eclampsia, and 16 cases were no progressing disease. METHODS As obstetric features, the peak values of hypertension at the onset of eclampsia, the proteinuria severity, the organ involvements such as HELLP syndrome or renal failure, parity and maternal age were studied. The values of systolic blood pressure (sBP) and diastolic blood pressure (dBP) were considered as independent parameters each other in this study. Statistical analysis was performed how these obstetric confounding features were to be correlated with progressing disease of eclampsia by logistic regression analysis (LRA). Univaiate and multivariate LRA were performed using with peak sBP, peak dBP, peak proteinuria, or other features as covariates, and progressive disease as dependent variable. RESULTS Univariate analysis showed that ⩾210mmHg of sBP, ⩾105mmHg of dBP and ⩾10g/day of proteinuria were related to the progressing disease of eclampsia compared with the no progressing disease. And multivariate analysis showed that ⩾105mg of dBP had significantly the highest adjusted odds ratio of 10.0 (95%CI 0.96-103, p=0.05). CONCLUSION We had shown previously CNS disorders such as eclampsia had the strongest correlation with severe sBP ⩾200mmHg among 108 cases of preeclampsia with severe hypertension and severe proteinuria, whereas other organ involvements such as HELLP syndrome had the strongest correlation with severe dBP ⩾110mmHg (now not in published, presented in ISSHP 2010). Other studies also strengthen the significance of high sBP in the management of eclampsia [1,2]. Controversially we noticed in this study that the progressing disease of eclampsia significantly related to severe dBP ⩾105mmHg. This indicates that severe dBP are the important marker as for predicting serious organ involvements either in central nervous system or in other organs in the disease of preeclampsia/eclampsia.