Takashi Okai

First successful case of non‐invasive in‐utero treatment of twin reversed arterial perfusion sequence by high‐intensity focused ultrasound

High‐intensity focused ultrasound (HIFU) has excellent potential as a non‐invasive therapeutic tool in various fields of medicine. We present a case of twin reversed arterial perfusion sequence, in which non‐invasive blood flow occlusion in the acardiac fetus was successfully achieved by means of HIFU exposure from outside the maternal abdomen. HIFU was applied to blood vessels of the acardiac fetus at the point at which the umbilical cord entered the body in a series of four procedures at 3‐day intervals starting at 13 weeks gestation, and in a final procedure with higher power at 17 weeks. The HIFU intensity was set at approximately 2300u2009W/cm2 for the initial series of procedures and at 4600u2009W/cm2 for the final procedure, with exposure periods of 10u2009s. As color Doppler examination revealed absence of blood flow to the acardiac fetus after the second round of HIFU exposure, we concluded that complete occlusion of target vessels had been achieved. Delivery was by Cesarean section at 37 weeks gestation. A male neonate (the pump fetus) was born weighing 1903u2009g with Apgar scores of 8 and 9 at 1 and 5 min, respectively. At the time of writing, the baby was healthy and growing normally, with the exception of congenital pseudarthrosis. Copyright

Placental expression of microRNA-17 and -19b is down-regulated in early pregnancy loss.

OBJECTIVEnFirst, to determine if microRNA-17 and -19b are expressed in villous samples at early stages of pregnancy. Second, to determine whether placental expressions of these microRNAs along with their main targets (PTEN, CREB-1, TGFβ-1 and TGFβ-RII) are altered in early pregnancy loss.nnnSTUDY DESIGNnExpression levels of microRNAs and mRNA targets in villous samples from early pregnancy loss (n=11) and matched normal cases (n=20) by gestational age were determined by RT-PCR.nnnRESULTSnBoth microRNA-17 and -19b were expressed in all cases of normal pregnancy. They were significantly down-regulated (relative ratios: 0.35 and 0.34 respectively) in early pregnancy loss. Their main target, PTEN mRNA, was significantly up-regulated in early pregnancy loss (relative ratio: 2.6, 95%CI: 0.2-29.8). TGF-β1, CREB-1 and TGFβ-RII were not significantly different between the two groups.nnnCONCLUSIONnmicroRNA-17 and -19b are expressed in early stages of pregnancy. They are down-regulated in villous samples from early pregnancy loss. We suggest that these main members of the microRNA-17-92 cluster might be involved in placental invasion and its dysregulation might also be related to other conditions characterized by defective placentation.

Administration of oral and vaginal prebiotic lactoferrin for a woman with a refractory vaginitis recurring preterm delivery: Appearance of lactobacillus in vaginal flora followed by term delivery

Lactoferrin (LF) is one of the prebiotics present in the human body. A 38‐year‐old multiparous woman with poor obstetrical histories, three consecutive preterm premature rupture of membrane at the 19th, 23rd and 25th week of pregnancy, was referred to our hospital. She was diagnosed as having refractory vaginitis. Although estriol vaginal tablets were used for 4 months, the vaginitis was not cured. We administrated vaginal tablets and oral agents of prebiotic LF, resulting in a Lactobacillus predominant vaginal flora. When she was pregnant, she continued to use the LF, and the Lactobacillus in the vaginal flora was continuously observed during pregnancy. An elective cesarean section was performed at the 38th week of pregnancy. When the administration of LF was discontinued after the delivery, Lactobacillus in the vaginal flora was disappeared.

Physiological changes in the pattern of placental gene expression early in the first trimester.

Objective: To assess the physiological changes in the placental expression pattern of a panel of genes related to angiogenesis and oxidative stress during the early part of the first trimester of pregnancy. Methods and Results: The expression of a selected panel of genes was quantified by reverse transcriptase–polymerase chain reaction in samples of villous trophoblasts obtained from women between 6 and 11 weeks of gestation undergoing elective artificial abortion. We found that the levels of messenger RNA (mRNA) expression of placental growth factor (PlGF), heme oxygenase 1(HO-1), and superoxide dismutase (SOD) increased significantly with gestational age (r = .37, P = .001; r = .24, P =.04; and r = .52, P < .001, respectively). Conversely, the mRNA expression level of fms-like tyrosine kinase 1 (FLT-1) decreased significantly (r = −.30, P = .009). Conclusion: During the early part of the first trimester of pregnancy, the placental gene expression levels of PlGF, HO-1, and SOD increase with gestational age, whereas the expression of FLT-1 decreases. The alteration in this pattern of gene expression in early pregnancy may therefore play an important role in placenta-related disorders such as preeclampsia.

Increased Levels of Cell-Free Human Placental Lactogen mRNA at 28-32 Gestational Weeks in Plasma of Pregnant Women With Placenta Previa and Invasive Placenta:

We compared the levels of cell-free human placental lactogen (hPL) messenger RNA (mRNA) in maternal plasma at 28 to 32 weeks of gestation between women with diagnosis of placenta previa or invasive placenta and women with an uneventful pregnancy. Sensitivity and specificity of hPL mRNA for the prediction of invasive placenta were further explored. Plasma hPL mRNA were quantified by real-time reverse-transcriptase polymerase chain reaction in women with placenta previa (n = 13), invasive placenta (n = 5), and normal pregnancies (n = 92). Median (range) hPL mRNA was significantly higher in women with placenta previa, 782 (10-2301) copies/mL of plasma, and in those with invasive placenta, 615 (522-2102) copies/mL of plasma, when compared to normal pregnancies, 90 (4-4407) copies/mL of plasma, P < .01 and P < .05, respectively. We found a sensitivity of 100% and a specificity of 61.5% for the prediction of invasive placenta among women with placenta previa. In conclusion, expression of hPL mRNA is increased in plasma of women with placenta previa and invasive placenta at 28 to 32 weeks of gestation.

Distribution of nuchal translucency thickness in Japanese fetuses

To establish reference values for the nuchal translucency (NT) thickness in Japanese fetuses.

Defect in the uterine wall with prolapse of amniotic sac into it at 32 weeks' gestation in a primigravida woman without any previous uterine surgery

We experienced a case of uterine wall defect with amniocele in a primigravida woman without any history of uterine surgery. On admission due to acute abdominal pain at 32 weeks gestation, an ultrasound examination showed a 9u2009×u20097‐cm sized echogenic cystic area in the Morrison pouch. Color Doppler revealed a flow from the uterus into the cystic area through a myometrial defect. During the operation, a 1‐cm defect in the uterine myometrium was found on the right fundus. An intact amniotic sac was prolapsed into the abdominal cavity through the myometrial defect. This was an extremely rare case of unexplained uterine wall defect.

Relationship between the umbilical cord coiling index and the umbilical blood flow at 11–13 weeks of gestation

The aim of this study was to clarify the effects of umbilical cord coiling on the umbilical blood flow at 11–13u2009weeks of gestation.

The volume of the chorion villosum is associated with the location of the umbilical cord in the first trimester

To clarify whether villous placental volumes in cases with low cord insertion (CI) are smaller than those with normal cord insertion.

Opening of the uterine isthmus at 11-13 weeks' gestation is not related to developmental abnormalities of the placenta.

OBJECTIVESnTo clarify whether openning of the uterine isthmus between 11 and 13weeks gestation adversely affects the placental development.nnnMETHODSnThe uterine cervix and isthmus lengths were measured prospectively using transabdominal ultrasound at 11 to 13+6 weeks gestation. Following delivery, the pregnancy and delivery course were reviewed. The associations between the conditions of the uterine isthmus during the first trimester and the perinatal complications associated with placental abnormalities were analyzed.nnnRESULTSnA total of 653 cases were analyzed. The isthmus had been completely opened (isthmus length = 0mm) in 15.9%, 21.6% and 24.1% of the cases at 11, 12 and 13 weeks gestation. The frequencies of perinatal complications in the cases whose isthmus had been opened (cases) and the other cases (controls) were as follows; 1.4% and 1.0% (ns) for placenta previa, 1.4% and 1.2% (ns) for abnormal cord insertion, 3.5% and 4.3% (ns) for pre-eclampsia, 9.9% and 9.0% (ns) for small for gestational age, and 12.0% and 7.6% (ns) for preterm delivery, respectively.nnnCONCLUSIONnEarly opening of the uterine isthmus at 11 to 13 weeks gestation does not appear to adversely affect either the placental development or the course of pregnancy.