Tomonobu Kanasugi

Assessment of Fetal Autonomic Nervous System Activity by Fetal Magnetocardiography: Comparison of Normal Pregnancy and Intrauterine Growth Restriction

Objective. To clarify the developmental activity of the autonomic nervous system (ANS) of the normal fetus and intrauterine growth restriction (IUGR) cases using fetal magnetocardiography (FMCG). Subjects and Methods. Normal pregnancy (n = 35) and IUGR (n = 12) cases at 28–39 and 32–37 weeks of gestation, respectively, were included in this study. The R-R interval variability was used to calculate the coefficient of variance (CVRR) and low frequency/high frequency (LF/HF) ratio. Results. The value of CVRR in the normal pregnancy group displayed a slight increasing trend with gestational age. However, no such trend was observed in the IUGR group. In contrast, the LF/HF ratio in both the normal pregnancy group and the IUGR group clearly increased over the gestational period; the normal group showing statistical significance. Conclusion. The development of fetal ANS activity in IUGR cases might differ from that observed in the normal pregnancy group, and this may facilitate early detection of IUGR.

Monochorionic twin fetus with VACTERL association after intracytoplasmic sperm injection

We report a rare case of a monochorionic twin gestation after intracytoplasmic sperm injection (ICSI) in which one of the fetuses had VACTERL association. A 27‐year‐old woman became pregnant by ICSI and was found to have monochorionic twin fetuses. One fetus was noted to have the following anomalies: a multicystic, dysplastic left kidney with a hydroureter, and a dilated colon. A normal‐sized stomach and normal amount of amniotic fluid were observed during the prenatal period with no other anomalies. The postnatal examination revealed hypospadias, and anal, esophageal, and duodenal atresia; thus, a diagnosis of VACTERL association was established. Although the prenatal diagnosis of this disorder is a challenge, even in a singleton, some of the characteristic features observed during antepartum ultrasonography may be a clue to the diagnosis, especially in a twin pregnancy after ICSI.

Expression of human telomerase reverse transcriptase and correlation with telomerase activity in placentas with and without intrauterine growth retardation

Background. Human telomerase reverse transcriptase has been found in telomerase‐positive tumor tissues, but not in telomerase‐negative nonmalignant somatic cells. Methods. Thirty‐two first‐trimester chorionic villi specimens (Group A), 33 second‐ and third‐trimester placenta specimens without asymmetric intrauterine growth retardation (Group B) and 13 specimens of placenta tissue from cases with intrauterine growth retardation (Group C) were examined for telomerase activity and expression of human telomerase reverse transcriptase by reverse transcription polymerase chain reaction and quantitative reverse transcription polymerase chain reaction. Results. Telomerase activity was detected in 29 of the 32 specimens (90.6%) in Group A, in 20 of the 33 specimens (60.6%) in Group B and none of the 13 specimens (0.0%) in Group C. Human telomerase reverse transcriptase was identified in all 32 specimens of Group A (100%), all 33 specimens of Group B (100%) and 2 of the 13 specimens in Group C (15.4%) by nested reverse transcription polymerase chain reaction. Copy numbers of human telomerase reverse transcriptase were 202.3±73.0 (n=32), 8.8±2.9 (n=33) and 0 (n=13) in Groups A, B, and C, respectively. Significant differences were observed between Groups A and B, Groups A and C, and Groups B and C (p<0.01, p<0.01, and p<0.01, respectively). Conclusions. Our findings indicate that human telomerase reverse transcriptase expression is the rate‐limiting determinant of telomerase activity in chorionic villi during the first trimester. Telomerase activity was not detected in placentas with intrauterine growth retardation, whereas human telomerase reverse transcriptase was expressed in some placentas with intrauterine growth retardation.

Acute abdomen due to ovarian congestion: a fallopian tube accompanied by a paratubal cyst, coiling tightly round the ovary.

We experienced an unreported rare case with an adnexal mass causing severe acute abdomen during pregnancy. A 30‐year‐old Japanese pregnant woman was transported to our hospital for her right lower abdominal pain at 30 weeks of gestation. Magnetic resonance imaging and ultrasound demonstrated a cyst measuring 3–4 cm in diameter adjacent to the right ovary, and a parovarian cyst was considered to be the most probable diagnosis. We strongly suspected torsion of the ovarian pedicle or fallopian tube in conjunction with her clinical symptoms. Laparotomy revealed that the elongated right fallopian tube accompanied by a paratubal cyst was coiling tightly 2.5 times round the right ovary, causing apparent congestion and enlargement of the right ovary. Soon after we released the congested right ovary from the coiling of the fallopian tube, the congestion subsided. The postoperative course was favorable, and pregnancy and delivery were uneventful.

Association of blue rubber bleb nevus syndrome and placenta previa: Report of a case

Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by multiple recurrent vascular malformations. Herein we report the case of a patient with BRBNS and placenta previa. Sonography and MRI clearly identified several hemangiomas located adjacent to the uterus with none adjacent to the anterior lower uterine segment. This preoperative information helped us perform the uterine wall incision safely during the cesarean delivery. The presence and location of hemangiomas adjacent to the uterus should be carefully examined in a pregnant woman with BRBNS prior to elective or emergency cesarean delivery.

Fetal goiter associated with preconception hysterosalpingography using an oil‐soluble iodinated contrast medium

Fetal goitrous hypothyroidism is rare in pregnancies of euthyroid women. It is reported to be caused by excessive maternal iodine exposure, such as from oral intake. There has however been one case that occurred after hysterosalpingography (HSG) with an oil-soluble iodinated contrast medium. Here we report our own experience of fetal goiter after preconception HSG using this contrast medium. A 27-year-old woman was referred to our hospital at 29 weeks’ gestation with polyhydramnios. Her history was negative for thyroid disease and her iodine intake was normal. She had undergone treatment for infertility and, on the 11th day of her last menstrual cycle, she had undergone HSG with an oil-soluble iodinated contrast medium. Basal body temperature indicated that she was pregnant 5 days after the procedure. Following detailed ultrasound examination, a large homogeneous goiter, measuring 35 × 19 mm, was identified in the anterior aspect of the fetal neck (Figure 1), which was also visualized with fetal magnetic resonance imaging (MRI) (Figure S1). Maternal thyroid function was low, confirmed by a high level of serum thyroid-stimulating hormone (TSH) and low levels of free thyroxine (T4) and free triiodothyronine (T3). At 35 week’s gestation, levels had returned to normal without medical treatment and the polyhydramnios

Appendiceal mucocele and peritoneal inclusion cyst mimicking right adnexal masses: a diagnostic challenge in gynecologic practice

Mucocele of the appendix (MA) is an uncommon disease. Preoperative differential diagnosis of MA and a peritoneal inclusion cyst (PIC) from gynecologic diseases is still a challenge. We herein report a very rare case with MA and PIC. As far as we know, this is the first report of a case having MA and PIC found simultaneously at surgery. A 31-year-old woman complained of lower abdominal pain and high fever. Based on her symptoms and laboratory tests, pelvic inflammatory disease (PID) was considered to be the most probable diagnosis. She underwent antibiotics therapy and her conditions subsided. However, ascites reappeared in a month, and ultrasound and MRI demonstrated a right ovarian cyst and a suspected right hydrosalpinx. Laparotomy revealed large PIC and MA with normal bilateral adnexa. Patients with an adnexal mass or symptoms suggesting PID should be examined carefully considering such conditions in a daily gynecologic practice.

OP18.08: FGR fetuses have less facial expressions than AGA counterparts with the assessment by four-dimensional high-definition live (4D HDlive) ultrasound

only moderate decrease until 38 GW (108.2ml), but considerable variation of the absolute dimensions. The best fitting equation for SAS growth was a third-degree polynomial function (y = 433 – 59.6 * x + 2610 * x2 -33.36*x3; R2= 0.829). The relative SAS volume was high initially (40% in GW 16) and decreased until 23 GW (34%), peaked again at GW 27 (38%) and got reduced to 25% in GW 38. The best-fitting equation was a cubic function (y = 112-8.96*x+0.36*x2-0.00489*x3; R2 = 0.631). Conclusions: The SAS represents an important part of fetal intracranial anatomy, on average making up one third of the EV. Its reduction with advancing gestation may be considered a means to allow for further increase of brain volume until term, without concomitant increase in head size.

Progressive Fetal Subdural Hematoma Associated With Maternal Vitamin K Deficiency: Prenatal Diagnosis and Neurologically Favorable Prognosis

A 31-year-old woman, gravida 2, para 0, was referred to our hospital at 28 weeks’ gestation for an enlarged biparietal diameter in the fetus. Her first pregnancy had ended in artificial abortion at 11 weeks’ gestation for social reasons. She did not have any histories including anorexia or coagulation abnormality. She began to vomit frequently at 7 weeks’ gestation and was treated for hyperemesis gravidarum with infusion of nutrients. The nutritional solution contained multiple vitamins but not vitamin K. Because severe vomiting persisted, detailed examinations were performed. Upper gastrointestinal endoscopy at 25 weeks’ gestation revealed reflux esophagitis. She also had a diagnosis of mental disorders (attention deficit/hyperactivity disorder and anxiety disorder), and on-demand use of a major tranquilizer (risperidone) was started. At 28 weeks’ gestation, an enlarged biparietal diameter was noticed, and she was referred and admitted to our hospital. Fetal sonography revealed an enlarged biparietal diameter of 85.5 mm (14.0 standard deviation [SD]) caused by bilateral subdural hematoma (Figure 1A). As maternal serum protein induced by vitamin K absence or antagonist II (PIVKA-II) concentration, which was induced in the liver as a result of vitamin K absence, turned out to be 1.391 mAU/m (normal,< 40 mAU/mL), we highly suspected vitamin K deficiency and started its replacement therapy. There were not any other abnormal findings such as thrombopenia and coagulopathy (eg, low fibrinogen levels) in the maternal

Facial Expressions of Fetal Growth Restriction and Appropriate-for-Gestational Age Fetuses Assessed by Four-Dimensional High-Definition Live Ultrasound

Objective: To determine whether fetal growth restriction (FGR) fetuses have less facial expressions than appropriate-for-gestational age (AGA) counterparts with the assessment by four-dimensional high-definition live (4D HDlive) ultrasound. Methods: 4D HDlive ultrasound examinations of fetal facial expressions were performed on singleton pregnant women between 26 and 39 weeks of gestation. The duration of the 4D HDlive recordings was 15 minutes in all cases. The frequency of seven types of previously-reported facial expressions, or blinking, mouthing, yawning, tongue expulsion, sucking, smiling and scowling, were assessed. Two observers counted the frequencies, and inter-and intra-observer reproducibility was examined. Wilcoxon rank-sum test was used for comparison of FGR and AGA group. Kruskal-Wallis test was used for intra-group significance of frequencies of seven types of fetal facial expressions. P<0.05 was considered significant. Results: In this study, good intra- and inter-class correlation coefficients and intra- and inter-observer agreements were obtained. Thus, measurement values by only one examiner were used for further analysis. The facial expressions of 16 fetuses (FGR: n=8, AGA: n=8) were assessed. We noted a tendency for FGR fetuses to have less facial expressions than AGA counterparts. Although statistically significant inter-group difference was not detected in frequency of any facial expressions, this propensity is conspicuous in smiling (p=0.065) and mouthing (p=0.279). In AGA fetuses, the commonest facial expression was mouthing and was significantly more frequent than blinking (p=0.007), tongue expulsion (p=0.007) and sucking (p=0.002). We also noted a tendency that the frequency of facial expressions declines with fetal maturation. Although no statistically significant difference was shown, this propensity is prominent in mouthing of FGR (p=0.071). Conclusion: 4D HDlive ultrasound provides promising modalities in novel evaluative imaging of fetal various facial expressions, and may help to elucidate functional development of central nervous system (CNS) and facial expressions both in normal and compromised fetuses.