Takehiko Fukami

Detection of the Cervical Gland Area in Threatened Preterm Labor Using Transvaginal Sonography in the Assessment of Cervical Maturation and the Outcome of Pregnancy

Objectives: To detect the cervical gland area in threatened preterm labor, and to determine its detection rate and relationship with cervical maturation and outcome of pregnancy in preterm labor. Methods: This was a mixed longitudinal and cross-sectional study involving 615 transvaginal scans performed to detect the cervical gland area and measure cervical length in 101 singleton pregnancies with threatened preterm labor. The patients were treated with intravenous administration of ritodrine chloride for regular uterine contractions at 16–35 weeks of gestation. 260 normal singleton pregnancies served as controls. Simultaneously conventional digital examination was used to assess the cervical maturation index. The detection rates of the cervical gland area, measurements of cervical length by sonography, and assessment of the cervical maturation index by digital examination in threatened preterm labor were compared with those of normal singleton pregnancies. In the threatened labor group, the outcome of pregnancy was assessed according to the sonographic absence or presence of the cervical gland area. Results: In the normal pregnancy group, the detection rate of the cervical gland area remained practically constant until the 31st week of pregnancy (97%), but substantially decreased thereafter (70.2% in gestational weeks 32–35). In the threatened preterm labor group, the detection rate of the cervical gland area was constantly lower (44.5%) and the cervical maturation index was higher (4.65 score) than in the normal pregnancy group (83.1% and 1.80 score, respectively). The outcome of pregnancy in the threatened preterm labor group was poorer in the subgroup with the absence of a cervical gland area than in the subgroup with the presence of a cervical gland area (duration of pregnancy 257.0 vs. 271.0 days, birth weight 2,597.2 vs. 2,990.0 g, and admission to delivery interval 38.8 vs. 60.8 days). Highly significant correlations were noted among the detection rates of a cervical gland area and cervical length, cervical maturation index, and outcome of pregnancy. Conclusions: This study demonstrates for the first time that the sonographic absence of the cervical gland area reflects cervical maturation and could be considered as a predictor of threatened preterm labor and a sign of poor outcome of pregnancy in this condition.

Significance of cervical gland area in predicting preterm birth for patients with threatened preterm delivery: comparison with cervical length and fetal fibronectin.

Background/Aims: Absent cervical gland area (CGA) has been considered a predictor of preterm delivery (PTD) for women at low risk. Predictive efficacy was analyzed in women at high risk for PTD and compared with cervical length (CL) <20 mm and fetal fibronectin (fFN) in cervicovaginal secretions. Methods: Case notes were reviewed for 108 subjects with gestation of 22–33 weeks who had been admitted to hospital with threatened PTD. The uterine cervix was observed by vaginal sonography and fFN was sampled on admission. Relationships between findings and outcome of PTD at <34 weeks’ gestation were analyzed. Results: Delivery at <34 weeks’ gestation occurred in 14.8% of patients. Absent CGA (68.8%), short CL (75.0%), short CL without CGA (62.5%) and positive fFN (62.5%) were more frequent in these patients than in patients undelivered at <34 weeks’ gestation (p < 0.05). Logistic regression analysis identified positive fFN and short CL with absent CGA as independent predictors for PTD (p < 0.0001). The mean interval from admission to delivery was 2.9 weeks in cases with fFN and both sonographic findings, compared to 9.3 weeks in cases with fFN but both sonographic finding (p = 0.0005). Conclusion: Short CL with absent CGA represents an independent predictor for PTD, as does fFN.

Serious Influence of Yersinia Enterocolitis on Pregnancy in a Woman Complicated With Chronic Hypertension and Gestational Diabetes Mellitus: A Case Report

A 40-year-old pregnant woman admitted into hospital to treat hypertension (HT) and gestational diabetes at 19 weeks of gestation. She contracted enterocolitis due to the foodborne pathogen Yersinia enterocolitica (YE) at 22 weeks of gestation. Hypoalbuminemia and ascites developed due to prolonged intractable diarrhea and vomiting. Since 25 weeks of gestation, marked albuminuria appeared and blood pressure gradually elevated. Fetal growth was found to be retarded. Cesarean section for non-reassuring fetal status was performed at 27 weeks 2 days, delivering a 641 gr boy (-2.9 SD from averaged neonatal body weights compatible with the gestational weeks, Apgar score 3/8 at1/5min.). Gastrointestinal symptoms and ascites resolved within 1 week of delivery. This represents the first report of YE infection seriously affecting perinatal prognosis.

The presence of amniotic fluid sludge in pregnant women with a short cervix: an independent risk of preterm delivery

Abstract Objective: To examine whether the presence of amniotic fluid sludge (AFS) could increase the risk of preterm delivery in women with a cervical length (CL) of less than 25 mm. Materials and methods: This is a retrospective cohort study of 110 women who were 14–30 weeks pregnant with a singleton gestation and a CL of less than 25 mm. The primary outcomes were defined as preterm delivery before 34 weeks and preterm delivery before 37 weeks. The secondary outcome was defined as preterm premature rupture of membranes (PPROM) prior to preterm delivery. Risk factors for preterm delivery were defined as AFS, subchorionic hematoma (SCH), history of preterm delivery, CL of less than 20 mm, and CL of less than 15 mm. A univariate analysis was performed to assess the primary and secondary outcomes according to the presence or absence of each risk factor. A multiple logistic regression analysis was performed to evaluate the parameters, using a significance of p < .05 on the univariate analysis to examine whether they were independent risk factors. Results: A significantly increased risk of preterm delivery was found in the group of women with AFS who actually did deliver prior to 34 weeks (p < .001; odds ratio [OR] 6.44; 95% confidence interval [CI] 2.51–16.5), prior to 37 weeks (p = .001; OR 4.46; 95% CI 1.76–11.3), and who had PPROM (p < .001; OR 4.96; 95% CI 2.00–12.3). A multivariate logistic regression analysis was performed in the women with AFS who experienced preterm delivery before 34 weeks, in the women with a CL less than 20 mm, and in the women with a CL less than 15 mm. The results showed that AFS was an independent risk factor for preterm delivery before 34 weeks (p = .001; OR 5.86; 95% CI 2.11–16.3). Conclusion: The presence of AFS was an independent risk factor for preterm delivery before 34 weeks in women with a CL less than 25 mm.

Rhabdomyosarcoma of the Uterus: A Case Report.

Rhabdomyosarcoma is a malignant, mesenchymal tumor showing evidence of skeletal muscle differentiation. Although rhabdomyosarcoma rarely arises from the uterus, uterine rhabdomyosarcoma has a poor prognosis. We describe a case of uterine rhabdomyosarcoma diagnosed with endometrial curettage. Case Report A 36-year-old nulliparous woman had received follow-up care for a uterine myoma for 2 years. Subsequently, the patient presented with abdominal distension and hypermenorrhea. Physical examination revealed an abdominal mass palpable to the level of the umbilicus. Pelvic examination showed the uterus to be the size of an infant’s head. The patient also experienced atypical vaginal bleeding once a year, which gradually became more frequent. Recently, it occurred twice a week. Therefore, she was admitted to our hospital. On admission, the hemoglobin level was 5.4 g dL. Hematological testing indicated iron deficiency anemia. Blood coagulation testing showed normal ranges. The cancer antigen 125 level was slightly elevated at 49 U mL. The serum levels of cancer antigen 19-9 and carcinoembryonic antigen were within normal limits. Endometrial samples were collected with endometrial curettage. On the basis of the histological findings from the collected samples, rhabdomyosarcoma was diagnosed. However, because of the small amount of curettage samples, the histological subtype of the rhabdomyosarcoma could not be determined. Computed tomography of the pelvis and abdomen showed a large pelvic mass with irregular density. Furthermore, computed tomography of the chest revealed multiple nodules in the lungs, which suggested pulmonary metastases. Magnetic resonance imaging of the pelvis demonstrated an enlarged nodular pelvic mass containing irregular intensities (Fig. 1A and B). After a multidisciplinary meeting, the patient was treated with multiagent chemotherapy. Vincristine, doxorubicin, and cyclophosphamide were administered intravenously but were not effective. The patient died 5 months after being admitted to our hospital. On the basis of the findings of this case, we emphasize the importance of correctly diagnosing pelvic masses in women. Histological Findings Figure 2 shows the histopathological features of the biopsy specimens obtained with endometrial curettage. Histopathological examination of the specimens revealed small circular or oval tumor cells (Fig. 2A). No carcinomatous elements were identified. The morphologic features were consistent with those of rhabdomyosarcoma. With immunohistochemical examination the tumor cells stained strongly positive for desmin (Fig. 2D) and vimentin (Fig. 2F) and negative for caldesmon (Fig. 2C). In addition, the tumor cells demonstrated positive nuclear expression for myogenin. These immunohistochemical findings supported the histological diagnosis of rhabdomyosarcoma. The MIB-1 index was 80% (Fig. 2E).

OC104: Significance of absent cervical gland area (CGA) in prediction for preterm birth in patients suffered from threatened preterm delivery: Comparison of predictive efficacy with short cervical length (CL) and positive fetal fibronectin (fFN)

performed according to FMF recommendations, at 21–23 weeks of gestation. The patients were afterwards followed-up until the time of delivery. The value of the measurement was then assessed as a predictor of PD. Results: Among singleton pregnancies the mean CL at the time of the scan was 37.37 ± 7.7 mm. The incidence of PD < 34 and < 37 weeks of gestation was 5.4% and 13.5%, respectively. Mean CL in the above groups equaled 30.5 ± 4.9 mm and 30.25 ± 6.4 mm, respectively (P = ns). Patients who delivered ≥ 34 and ≥ 37 weeks of gestation had significantly longer cervical canal at the time of the scan (37.77 ± 7.6 mm and 38.81 ± 6.8 mm, respectively; P = 0.02 and P = 0.0003 when compared with the groups < 34 and < 37 weeks of gestation). 8.1% of women in singleton pregnancies had CL ≤ 25 mm (22.33 ± 2.1 mm) and their average time of delivery was 36.6 ± 3.8 weeks of gestation. In 91.9% of women with cervical canal > 25 mm (38.7 ± 6.4 mm; P < 0.0001) the average time of delivery was 38.14 ± 2.0 weeks of gestation. Among twin pregnancies the mean CL was 32.68 ± 7.7 mm. The incidence of PD < 34 and < 37 weeks of gestation was 22.7% and 45.45% and mean CL 29.4 ± 3.8 mm and 32.65 ± 6.5 mm, respectively (P = ns). No significant differences in delivery times were found upon analyzing groups with CL of ≤ 25 and > 25 mm in twin pregnancies. Conclusions: Mid-pregnancy CL measurement can be of predictive value for earlier delivery in singleton pregnancy after IVF, but seems less important in twin pregnancies. Further studies on larger groups of IVF patients are required to evaluate its accurate predictive value.

P35.06: Intramural Pregnancy with a past history of artificial abortion - A case report

Background: Along with two-dimensional measurements, threedimensional measurements of embryonic structures may have prognostic value for embryonic development. Objective: The aim of this study was to compare three-dimensional ultrasound volumetry of intrauterine contents in cases of normal and missed IVF pregnancies. Material and Methods: Three-dimensional volumetric data were collected from a total of 54 patients with first-trimester singleton pregnancies after IVF and measured by VOCAL software. Results: Among 54 patients, 33 women had an ongoing IVF pregnancy and 21 had a missed miscarriage. There were no significant differences in age or gestational age between groups. Both gestational sac volume (GSV) and embryo volume (EV) proved to be statistically different in both groups (P < 0.05). The mean GSV, as measured by three-dimensional sonography, was 17.27 + / − 2.11 ml in normal IVF pregnancies and 2.48 + / − 0.43 ml in missed IVF pregnancies. The mean EV was 1.43 + / − 0.18 ml in normal IVF pregnancies versus 0.08 + / − 0.05 ml in missed miscarriages. No statistically significant difference was found when yolk sac volumes (YSV) of normal and abnormal pregnancies were compared (0.10 + / − 0.04 versus 0.13 + / − 0.03 (P > 0.05)), though as a rule enlarged YSV was found to be a marker of poor prognosis. However EV/GSV, YSV/GSV and YSV/EV ratios turned out to be statistically different in those groups of patients (EV/GSV = 0.084 + / − 0.007 versus 0.031 + / − 0.015, YSV/GSV = 0.016 + / − 0.009 versus 0.071 + / − 0.022, YSV/EV = 0.260 + / − 0.134 versus 27.721 + / − 13.632 (P < 0.05)). Conclusion: Three-dimensional ultrasound volumetry of intrauterine contents in IVF pregnancies does not seem to improve the diagnosis of miscarriage, however, its potential to predict pregnancies that will fail and determine the appropriate management regime for individual patients merits further research.

P14Sonographic features of the cervix in the midtrimester as a predictor of preterm delivery

Background