Soichiro Nakayama

Perinatal outcome of monochorionic diamniotic twin pregnancies managed from early gestation at a single center.

Aim:  The aim of this study was to evaluate the perinatal outcome of monochorionic diamniotic (MD) twin gestations managed from early gestation onward at a single center.

Differences in bone metabolism between singleton pregnancy and twin pregnancy

OBJECTIVE The objective of this study was to examine the influence of twin pregnancy on calcium metabolism, including bone turnover markers and calcium-regulating factors, by comparison between singleton pregnancy and twin pregnancy in women during pregnancy and puerperium in cross-sectional and longitudinal studies. METHODS Women with singleton and twin pregnancies were recruited from the outpatient clinic of Tokushima University Hospital. In both cross-sectional and longitudinal studies, bone formation and resorption markers, mineral metabolism and calcium-regulating factors were measured at 10, 25, 30 and 36 weeks of pregnancy and at 4 days and 1 month postpartum in women with singleton and twin pregnancies. RESULTS Urinary levels of cross-linked type I collagen N-telopeptides and C-terminal telopeptides of type I collagen in women with twin pregnancy were significantly higher than those in women with singleton pregnancy and those high levels were observed earlier than those in women with singleton pregnancy. In the cross-sectional study, serum levels of bone-specific alkaline phosphatase, calcium and phosphate in women with twin pregnancy were higher and the levels of 1,25-(OH)2 vitamin D and 25-(OH) vitamin D in women with twin pregnancy were lower than those in women with singleton pregnancy. CONCLUSION Changes in bone metabolism in women with twin pregnancy are different from those in women with singleton pregnancy. Early and large increases in bone turnover markers allow women with twin pregnancy to meet high fetal demand for calcium during pregnancy.

Incidences of Feto-Fetal Transfusion Syndrome and Perinatal Outcomes in Triplet Gestations with Monochorionic Placentation.

Introduction: This study aimed to determine the incidences of feto-fetal transfusion syndrome (FFTS) and perinatal outcomes in triplet gestations with monochorionic placentation. Materials and Methods: In this retrospective cohort study, we evaluated the incidences of FFTS and perinatal outcomes at 28 days of age in cases of triplet gestations with monochorionic placentation who visited our centers before 16 weeks of gestation and delivered over a period of 11 years. Results: In 41 triplet gestations (17 monochorionic triamniotic, 22 dichorionic triamniotic, 1 dichorionic diamniotic, and 1 monochorionic monoamniotic), the incidence of FFTS was 17.1%, and the median gestational age at FFTS diagnosis was 19 weeks. In 123 triplets, the incidences of fetal death and neonatal death at 28 days of age were 8.1 and 0.9%, respectively. None of the surviving infants had grade 3 or 4 intraventricular hemorrhage, while cystic periventricular leukomalacia occurred in 6 of 113 infants (5.3%). The incidence of poor outcomes (death or any major neurological complication at 28 days of age) was 13.8%. Discussion: Seventeen percent of triplet pregnancies with monochorionic placentation developed FFTS, and 14% had a poor outcome. Therefore, triplet gestations with monochorionic placentation should be followed carefully.

Perinatal complications of monochorionic diamniotic twin gestations with discordant crown–rump length determined at mid-first trimester

The aim of this study was to investigate the value of discordance of crown–rump length (DCRL) at mid‐first trimester to predict adverse outcomes in monochorionic diamniotic twin gestations (MD).

Effect of prolonged hospitalization for threatened preterm labor on maternal and fetal vitamin D levels

We aimed to evaluate the effect of prolonged hospitalization for threatened preterm labor (TPL) on maternal and fetal vitamin D status.

Effects of Transplanted Human Cord Blood-Mononuclear Cells on Pulmonary Hypertension in Immunodeficient Mice and Their Distribution

OBJECTIVES To investigate the effects of human umbilical cord blood-derived mononuclear cell (hUCB-MNC) transplantation on pulmonary hypertension (PH) induced by monocrotaline (MCT) in immunodeficient mice and their distribution. METHODS MCT was administered to BALB/c Slc-nu/nu mice, and PH was induced in mice 4 weeks later. Fresh hUCB-MNCs harvested from a human donor after her delivery were injected intravenously into those PH mice. The medial thickness of pulmonary arterioles, ratio of right ventricular to septum plus left ventricular weight (RV/S+LV), and ratio of acceleration time to ejection time of pulmonary blood flow waveform (AT/ET) were determined 4 weeks after hUCB-MNC transplantation. To reveal the incorporation into the lung, CMTMR-labeled hUCB-MNCs were observed in the lung by fluorescent microscopy. DiR-labeled hUCB-MNCs were detected in the lung and other organs by bioluminescence images. RESULTS Medial thickness, RV/S+LV and AT/ET were significantly improved 4 weeks after hUCB-MNC transplantation compared with those in mice without hUCB-MNC transplantation. CMTMR-positive hUCB-MNCs were observed in the lung 3 hours after transplantation. Bioluminescence signals were detected more strongly in the lung than in other organs for 24 hours after transplantation. CONCLUSIONS The results indicate that hUCB-MNCs are incorporated into the lung early after hUCB-MNC transplantation and improve MCT-induced PH. J. Med. Invest. 64: 43-49, February, 2017.

Prenatal assessment of coronary artery anatomy using color Doppler in cases of D‐transposition of the great arteries: Case reports

Abnormal coronary artery (CA) anatomy is common in cases of D‐transposition of the great arteries (TGA) and can be a significant risk factor during the arterial switch operation. Here, we report three cases of TGA in which CA anatomy was assessed prenatally using color Doppler imaging. All CA, except the left circumflex CA in one case, were identified. CA anatomy was completely correctly diagnosed in one of our three cases. In the two remaining cases, the left circumflex CA could not be visualized in one patient, and the origin of the left anterior descending CA was not correctly diagnosed in the other. We found that prenatal assessment of CA anatomy using color Doppler in TGA was feasible, but the diagnostic accuracy was limited. We anticipate that more experience with the advancing technology will improve accuracy.

Prenatal three-dimensional color Doppler imaging showing crossover of the inflow streams of two ventricles in a case of criss-cross heart

A 23-year-old woman was referred to us at 33 weeks of gestation because of an abnormal fetal four-chamber view. Fetal echocardiography showed that the right atrium, tricuspid valve, right ventricle (RV), pulmonary valve and pulmonary artery were on the same axial plane of the chest (Fig. 1a, Video 1a). The left atrium (LA) seemed normal, but the left ventricle (LV) was not depicted. The ventriculoarterial connection was suspected to be a double outlet right ventricle (DORV) with coarctation of the aorta (CoA). At 34 weeks, a small LV was depicted more inferiorly to the RV on the sagittal plane of the chest (Fig. 1b, Video 1b). A detailed observation of the LV revealed that the LA was connected to the inferior small LV on the right side through a restricted mitral valve (Fig. 1c, Video 1c). A ventricular septal defect (VSD) was also detected. Threedimensional (3D) color Doppler tomographic ultrasound imaging (TUI) (Voluson E8; GE Healthcare Japan, Tokyo, Japan) revealed that the inflow of the LV, which ran from left to right, was inferior to the inflow of the RV, which ran from right to left (Fig. 1d, Video 1d). Furthermore, 3D color Doppler rendering imaging clearly showed the crossing of the inflow streams of the RV and LV up and down (Fig. 1e, Video 1e). These findings suggested a prenatal diagnosis of criss-cross heart with mitral stenosis, hypoplasia of the LV, VSD, DORV, and CoA. The prenatal diagnosis was confirmed by neonatal echocardiography that revealed the perimembranous VSD (10.8 mm) as well as the presence of a secundum atrial septal defect (8.2 mm). Criss-cross heart is a rare complex congenital cardiac malformation characterized by crossing of the inflow streams of the ventricles due to twisting of the heart along its long axis [1]. Only a few prenatally diagnosed cases have been reported previously [2–4]. 3D color Doppler TUI displayed the inflow streams of the LV and RV simultaneously and separately, which assisted us in understanding the spatial relationship of the atrioventricular connections. Moreover, 3D color Doppler rendering imaging clearly delineated the characteristic crossing of the inflow streams; these are difficult to see with 2D color Doppler because the two AV valves are not visualized on the same plane due to the twisting of the heart [1]. Although 3D echocardiography has been implemented, 2D echocardiography is the principal tool for evaluating fetal heart defects [5]. One of the main reasons for this is that the image resolution obtained with a 3D dataset is not as good as that of 2D real-time ultrasound. In this case, 2D echocardiography visualized each atrioventricular inflow tract clearly, but the 2D images required us to create a mental 3D reconstruction of the complexed atrioventricular connections for the diagnosis of criss-cross heart. Electronic supplementary material The online version of this article (doi:10.1007/s12574-017-0339-3) contains supplementary material, which is available to authorized users.

Three‐dimensional HDlive rendering of fetal perineum in anorectal atresia

Anorectal atresia (ARA) is a relatively common congenital malformation that is usually diagnosed by perineal inspection after birth1. HDlive is a new surface-rendering mode in ultrasound imaging which uses an adjustable light source to increase depth perception2,3. We present our experience of HDlive imaging for prenatal perineal inspection in a fetus with ARA. A 32-year-old Japanese woman, gravida 2, para 1, was referred to our institution at 31 + 1 weeks’ gestation because she wished to deliver in our hospital. Her pregnancy course was uneventful and firstand second-trimester sonographic examinations performed at another institution were reportedly unremarkable. An initial ultrasound examination of the fetus revealed moderate polyhydramnios, a small stomach, left renal dysplasia, mild lumbar kyphosis and a single umbilical artery. A tangential two-dimensional (2D) ultrasound scan of the fetal perineum revealed the absence of a perianal muscular complex (PAMC; Figure 1a). Three-dimensional (3D) HDlive imaging revealed a normal perineum but no anal dimple (Figure 1b). Thus, ARA was strongly suspected. Fetal echocardiography revealed pulmonary atresia with ventricular septal defect (VSD). Follow-up ultrasound at 33 weeks revealed an esophageal pouch in the neck, suggestive of esophageal atresia. These findings pointed towards a diagnosis of VATER association. A 2110-g female was delivered at 38 + 1 weeks’ gestation, with 1-min and 5-min Apgar scores of 7 and 8, respectively. Postnatal perineal inspection revealed ARA with a rectovestibular fistula (Figure 1c). Postnatal radiography

Case of non-mosaic trisomy 20 in amniotic fluid cultures without anomalies in the fetus: Cytogenetic discrepancy between amniocytes and fetal blood

We report a case of non‐mosaic trisomy 20 detected prenatally by amniocentesis during the 16th week of pregnancy. Fetal blood sampling showed a normal karyotype and no fetal, neonatal or infant abnormalities were observed. Amniotic fluid cell karyotyping revealed a trisomy 20 (47,XY,+20) with 100% trisomic cells (38/38); however, a subsequent cordocentesis revealed a normal male karyotype. Moreover, a follow‐up ultrasonographic examination did not reveal any major congenital malformations, and a healthy male infant was delivered subsequently at an appropriate gestational age without obvious anomalies. Cytogenetic analysis of blood lymphocytes from the infant revealed a normal karyotype, but cultured cells from the term placenta showed a mosaic karyotype 47,XY,+20/46,XY with 88% trisomic cells (44 of 50). Furthermore, no anomalies or developmental delays were observed in the neonatal period, thus suggesting two possibilities: confined placental mosaicism with the presence of normal and abnormal cell lineages, or generalized mosaicism affecting a limited number of tissues in both the placenta and fetus.