Tetsuro Hoshiai

Efficacy of Recombinant Human Soluble Thrombomodulin in Severe Postpartum Hemorrhage With Disseminated Intravascular Coagulation

Objective: To investigate the efficacy of recombinant human soluble thrombomodulin (rTM) in disseminated intravascular coagulation (DIC) associated with severe postpartum hemorrhage (PPH). Patients and Methods: We conducted a retrospective review of 36 patients with severe PPH complicated by DIC admitted to a single tertiary center. The first 26 patients were treated without rTM (control group), and the next 10 consecutive patients were treated with rTM. Clinical parameters including bleeding symptoms and coagulation indices were evaluated. Results: Baseline characteristics, total blood loss, and transfusion requirements were similar between the 2 groups. On day 2, there was a significant difference between the 2 groups in the decrease in d-dimer level from baseline. The incidence of bleeding symptoms was decreased in the rTM group compared with the control group. No adverse events were observed in the rTM group. Conclusion: Recombinant human thrombomodulin may be an effective adjunctive therapy in the management of DIC related to PPH.

Impact of the Great East Japan Earthquake on Regional Obstetrical Care in Miyagi Prefecture

OBJECTIVES The authors report the results of surveys on the emergency transport or evacuation status of obstetric patients conducted in Miyagi prefecture, one of the major disaster areas of the Great East Japan Earthquake and tsunami. METHODS The surveys examined the damages to maternity institutions, evacuation status and transport of pregnant women, and prehospital childbirths and were conducted in 50 maternity institutions and 12 fire departments in Miyagi. RESULTS Two coastal institutions were destroyed completely, and four institutions were destroyed partially by the tsunami, forcing them to stop medical services. In the two-month period after the disaster, 217 pregnant women received hospital transport or gave birth after evacuation. Satisfactory perinatal outcomes were maintained. Emergency obstetric transport increased to approximately 1.4 fold the number before the disaster. Twenty-three women had prehospital childbirths, indicating a marked increase to approximately three times the number of the previous year. CONCLUSION In the acute phase of the tsunami disaster, maternity institutions were damaged severely and perinatal transport was not possible; as a result, pregnant women inevitably gave birth in unplanned institutions, and the number of prehospital births was increased extremely. To obtain satisfactory obstetric outcomes, it is necessary to construct a future disaster management system and to re-recognize pregnant women as people with special needs in disaster situations. Sugawara J , Hoshiai T , Sato K , Tokunaga H , Nishigori H , Arai T , Okamura K , Yaegashi N . Impact of the Great East Japan Earthquake on regional obstetrical care in Miyagi Prefecture. Prehosp Disaster Med. 2016;31(3):255- 258.

Development of algorithms to determine the onset of pregnancy and delivery date using health care administrative data in a university hospital in Japan

To develop and assess algorithms to determine the onset of pregnancy and delivery date using health administrative data from a university hospital in Japan.

Selective serotonin reuptake inhibitors and risk of major congenital anomalies for pregnancies in Japan. A nationwide birth cohort study of the Japan Environment and Children's Study.

We analyzed data from the Japan Environment and Childrens Study (JECS), on the association between selective serotonin reuptake inhibitors (SSRI) use during pregnancy and the risk of developing of major congenital anomalies in Japan. JECS is an ongoing nationwide birth cohort study. The study includes 95 994 single pregnant women and their offspring. Among them, 172 used any SSRI up to the 12th gestational week. Crude analyses show a significantly increased incidence of upper limb, abdominal, and urogenital abnormalities. In particular, the incidence of microcephaly, hydrencephalus, esophageal atresia, small intestinal atresia, and achondroplasia was significantly higher with than without exposure to these substances. On multivariate analyses, urogenital abnormality was significant (odds ratio 3.227; 95% confidence interval: 1.460–7.134). This Japanese nationwide birth cohort survey clarified that the use of any SSRI until the 12th gestational week was associated with urogenital abnormality in children. The survey for association with minor classification abnormality needs further examination in Japan.

Preconception folic acid supplementation use and the occurrence of neural tube defects in Japan: A nationwide birth cohort study of the Japan Environment and Children's Study

We evaluated the relationship between preconception folic acid supplementation and the occurrence of neural tube defects (NTDs) in offspring, using data from the Japan Environment and Childrens Study (a nationwide prospective birth cohort study) database. Of 92 269 participants with single pregnancies, 74 cases (offspring or fetuses) had NTDs, including 32 cases of spina bifida, 24 cases of anencephaly, and 19 cases of encephalocele. A total of 7634 participants (8.27%) used preconception folic acid supplementation, and of these, 621 (0.67%) also took in dietary folic acid at ≥480 μg/day. Multivariate logistic regression analyses demonstrated no association between preconception folic acid supplementation and NTDs in offspring or fetuses (odds ratio [OR] 0.622; 95% confidence interval [CI]: 0.226‐1.713). Moreover, the participants who combined preconception folic acid supplement use with dietary folic acid intake ≥480 μg/day demonstrated no incidence of NTDs in offspring or fetuses. Our analysis is limited by the absence of the data on the daily amount of supplementary folic acid intake, requiring careful attention to the interpretation. Additional surveys are required in Japan to resolve those limitations for further comprehensive assessment.

Management of Pregnancy Achieved by Oocyte Donation to a Woman with 47,XXX and POF

Abstract: [Objective] To present a case of pregnancy achieved by oocyte donation abroad to a woman with 47,XXX and premature ovarian failure (POF). [Patient(s)] A 39-year-old woman, gravida 0, para 0, with 47,XXX, POF and hypertension, achieved pregnancy by donation of oocytes abroad, and consulted us for pregnancy management. Dichorionic diamniotic twin fetuses were observed by ultrasonography, and gestational diabetes mellitus (GDM) occurred at 12 weeks of gestation. One of the twins was diagnosed with intrauterine growth restriction (IUGR) at 24 weeks of gestation. Uterine contraction was frequently observed at 28 weeks of gestation. Brain sparing effect was seen in the IUGR fetus at 30 weeks of gestation. The IUGR fetus presented a non-reassuring fetal status (NRFS) at 32 weeks of gestation, therefore twins were delivered by Caesarean section. [Results] Neonate 1 weighed 1,754 g with an Apgar score of 9/10 (1/5 minutes). Neonate 2 weighed 950 g with an Apgar score of 7/8. Both did well. While GDM improved in three weeks, the patients hypertension persisted after delivery. [Conclusion] This kind of case will increase in Japan due to the emergence of middlemen for oocyte donations. To prepare for them, it is necessary to further investigate mechanisms of complications in pregnancies achieved with donated oocytes.

Decrease and senescence of endothelial progenitor cells in patients with preeclampsia

BACKGROUND In preeclampsia, the precise mechanism of impaired vascular function is still unclear. We hypothesized that cellular function of circulating endothelial progenitor cells (EPCs) might be impaired in patients with preeclampsia. OBJECTIVE The objective of this study was to investigate the number and status of cellular senescence of EPCs in the circulation of women with preeclampsia. METHODS Circulating EPCs were cultured from patients with preeclampsia (n = 8) and normotensive pregnant women (n = 7). EPC numbers were assessed by colony-forming unit (CFU) methodology as previously reported. In addition, to assess cellular senescence, we measured endogenous beta-galactosidase activity. Moreover, we assessed whether the serum level of C-reactive protein (CRP), a marker for systemic inflammation, was associated with cellular impairment of EPCs. RESULTS The number of circulating EPCs was decreased in women with preeclampsia controls (median, 10.0 vs. 34.0 CFU; P < 0.01). The rate of cellular senescence was significantly increased in patients with preeclampsia (33.9%) compared with that in controls (22.9%; P < 0.05). Patients with preeclampsia were divided into two subgroups: the CRP-negative group (CRP, <0.1 mg/dl; n = 4) and the CRP-positive group (CRP, > or =0.1 mg/dl; n = 4). Interestingly, EPC CFU counts were markedly decreased in CRP-positive patients compared with those in CRP-negative patients (5.0 and 25.0 CFU, respectively; P < 0.05). Median values for cellular senescence were greater in the CRP-positive group than in the CRP-negative group, although this did not achieve statistical significance (43.5% and 33.3%, respectively; P = 0.12). CONCLUSION Depletion and cellular aging of EPCs in patients with preeclampsia might be associated with endothelial dysfunction and could be affected by systemic inflammation.