Ryu Matsuoka

Predisposing factors for massive hemorrhage during Cesarean section in patients with placenta previa

To investigate whether maternal history and ultrasound findings can be predictors for massive hemorrhage during Cesarean section in patients with placenta previa and adherence of the placenta.

Perinatal risk in singleton pregnancies after in vitro fertilization

OBJECTIVE To assess perinatal risks to singleton births after in vitro fertilization (IVF) versus spontaneous conception. DESIGN Cross-sectional. SETTING A 2006 registry database of the Japan Society of Obstetrics and Gynaecology (JSOG) capturing 5.8% of total births. PATIENT(S) 53,939 singleton births from spontaneous conceptions and 1,408 singletons after IVF. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Perinatal death, low-birth weight (LBW), small for gestational age (SGA), congenital malformation, and sex ratio assessment based on singleton birth cases versus singleton live-born cases. RESULT(S) In this study, IVF may include intracytoplasmic sperm injection (ICSI), gamete intrafallopian transfer, or IVF followed by zygote intrafallopian transfer. In crude and adjusted analysis, perinatal death, SGA, congenital malformation, and sex ratio were not statistically significantly associated with IVF. The LBW rates were statistically significantly higher in IVF pregnancies, but the association statistically significantly decreased after adjusting for confounding factors. Placental previa, a maternal outcome, was found to be statistically significantly higher in IVF pregnancies. CONCLUSION(S) No evidence was implicated IVF procedures as dramatically increasing the adjusted risk of perinatal death, LBW, SGA, congenital malformation, or sex ratio when compared with spontaneous conceptions. However, because of sample size limitations, the study cannot exclude small to moderate increases in perinatal deaths or congenital malformations.

Limitations of conservative treatment for repeat Cesarean scar pregnancy

delineate the level of fusion, connecting vessels and fetal contour (Figure 3). One week later, repeat scans by 3D transvaginal ultrasonography confirmed the diagnosis of conjoined twins. After counseling, the patient opted to terminate the pregnancy. After evacuation, two separate bodies and two separate upper and lower extremities were noted. The location of the conjoined site could not be identified on gross inspection of the abortus because the embryos had been destroyed during the evacuation procedure. Early diagnosis of conjoined twins is crucial for determining subsequent management and possibly decreasing maternal morbidity (evacuation vs. hysterotomy). Specific sonographic findings of conjoined twins examined during the first trimester include inseparable fetal bodies despite manipulation of the uterus with a transvaginal probe or prolonged continuous scanning, bifid appearance of the embryo, single yolk sac3, and a single umbilical cord with more than three vessels. Recently, some reports4–8 have described early diagnosis of conjoined twins by 3D ultrasound imaging combined with power Doppler, computed tomography and magnetic resonance imaging. In this case, prenatal diagnosis of conjoined twins was established by transvaginal 2D ultrasonography and power Doppler. However, 3D imaging with surfacerendering provided clearer images of the characteristic features of ischiopagus twins and helped the parents to understand the complex anomalies present in their fetuses. Furthermore, it improved our diagnostic confidence to provide adequate early intervention.

Velamentous cord insertion into the lower third of the uterus is associated with intrapartum fetal heart rate abnormalities

To evaluate the accuracy of sonographic identification of the site of umbilical cord insertion (CI) at 18–20 weeks of gestation, to compare the sensitivities for detection of a velamentous cord insertion (VCI) secondary to a CI into the anterior, posterior or fundal wall, and to compare the intrapartum complications secondary to VCI into the upper, middle or lower third of the uterus.

Attitudes toward non‐invasive prenatal diagnosis among pregnant women and health professionals in Japan

This study aims to assess the attitudes toward non‐invasive prenatal diagnosis (NIPD) and NIPD problems in clinical practice in Japan.

Velamentous cord insertion: significance of prenatal detection to predict perinatal complications.

In the maternal and child health statistics of Japan for 2003, perinatal deaths were most frequent in pregnant women with abnormalities of the placenta, umbilical cord, and fetal membrane. Despite advances in perinatal medicine, approximately 2% of low-risk pregnant women still require an emergency cesarean section after the onset of labor. Because it is likely that half of these cases are associated with placental and umbilical cord abnormalities, it is thought that prenatal detection of such abnormalities would reduce the number of emergency cesarean sections in low-risk women. In our previous studies, some abnormalities of the placenta and umbilical cord were associated with abnormalities of cord insertion. Furthermore, we reported that prenatal detection of velamentous cord insertion (VCI) reduced the number of emergency cesarean sections in low-risk women. In this review, we describe the prenatal detection of abnormalities of umbilical cord insertion and the management of VCI based on our current clinical data.

Recent advances in non-invasive prenatal DNA diagnosis through analysis of maternal blood.

Prenatal diagnosis of aneuploidy and single‐gene disorders is usually performed by collecting fetal samples through amniocentesis or chorionic villus sampling. However, these invasive procedures are associated with some degree of risk to the fetus and/or mother. Therefore, in recent years, considerable effort has been made to develop non‐invasive prenatal diagnostic procedures. One potential non‐invasive approach involves analysis of cell‐free fetal DNA in maternal plasma or serum. Another approach utilizes fetal cells within the maternal circulation as a source of fetal DNA. At the present time, fetal gender and fetal RhD blood type within RhD‐negative pregnant women can be reliably determined through analysis of maternal plasma. Furthermore, genetic alterations can be diagnosed in the maternal plasma when the mother does not have the alterations. However, the diagnosis of maternally inherited genetic disease and aneuploidy is limited using this approach. Non‐invasive prenatal diagnosis through examination of intact fetal cells circulating within maternal blood can be used to diagnose a full range of genetic disorders. Since only a limited number of fetal cells circulate within maternal blood, procedures to enrich the cells and enable single cell analysis with high sensitivity are required. Recently, separation methods, including a lectin‐based method and autoimage analyzing, have been developed, which have improved the sensitivity of genetic analysis. This progress has supported the possibility of non‐invasive prenatal diagnosis of genetic disorders. In the present article, we discuss recent advances in the field of non‐invasive prenatal diagnosis.

Placenta Increta: Postpartum Monitoring of Plasma Cell-free Fetal DNA

Antenatal prediction of abnormal adherence of the placenta to the uterine wall is very important in clinical practice because it is associated with high maternal morbidity and a high risk of mortality. We previously reported that the concentration of fetal DNA in maternal plasma is increased in cases of placenta previa, especially in patients with placenta increta and placenta accreta (1). It has been suggested that invasion of trophoblasts into the uterine muscle of these patients produces increased plasma concentrations of cell-free fetal DNA because of the destruction of trophoblasts by the maternal immune system on invasion of the uterine muscle. We earlier proposed that antenatal prediction of abnormal conditions, such as placenta increta, might be achieved by an analysis of fetal DNA in the plasma of high-risk pregnant women, including those with placenta previa and/or a previous history of uterine surgery (1). In the present report, we describe a case of placenta increta in which a small part of the placenta remained adherent despite manual removal of the placenta at the time of delivery. The patient was followed by monitoring the concentrations of plasma human chorionic gonadotropin human chorionic gonadotropin β (hCGβ) and fetal DNA (DYS14) after delivery. A 37-year-old Japanese woman, gravida 0, para 0, was admitted to Showa University Hospital …

Cord insertion into the lower third of the uterus in the first trimester is associated with placental and umbilical cord abnormalities

To assess the feasibility of detecting the cord insertion site during the late first trimester, and to investigate the possible association between perinatal complications and a cord insertion in the lower third of the uterus in the first trimester.

Analysis of placental weight centiles is useful to estimate cause of fetal growth restriction

Aim:  To establish a nomogram of placental weight at delivery and to clarify the associations among standardized placental weights and known risk factors of fetal growth restriction (FGR).