Tomonori Segawa

Different profiles of circulating angiogenic factors and adipocytokines between early- and late-onset pre-eclampsia.

Please cite this paper as: Masuyama H, Segawa T, Sumida Y, Masumoto A, Inoue S, Akahori Y, Hiramatsu Y. Different profiles of circulating angiogenic factors and adipocytokines between early‐ and late‐onset pre‐eclampsia. BJOG 2010;117:314–320.

Superimposed Preeclampsia in Women with Chronic Kidney Disease

Aim: To evaluate whether pregnant women with chronic kidney disease (CKD) adapt poorly to increases in renal blood flow. This can exacerbate renal function and impair perinatal outcome, as there is a major interplay between CKD and preeclampsia (PE). Methods: We analyzed the outcomes of 90 pregnant women with preexisting CKD. The estimated glomerular filtration rate (eGFR) was measured along with the levels of angiogenic factors, soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor, which might act in the pathophysiology of PE. Results: In pregnancies with CKD, PE and preterm delivery were increased and the increased blood pressure worsened the perinatal outcomes much more than the increased proteinuria. All pregnancies with severe renal insufficiency were delivered preterm because of impaired renal function. The eGFR was correlated significantly with 24-hour creatinine clearance (r = 0.830). Significant differences in sFlt-1 and placental growth factor levels were found between severe PE without any complications and severe superimposed PE (p < 0.05), and between women with and without declining renal function in superimposed PE (p < 0.01). Conclusion: Pregnancies with CKD have a high risk of obstetrical complications. The eGFR might serve for evaluating renal function during pregnancy. Angiogenic factors might be potential markers for a differential diagnosis between PE and worsening renal function.

Successful management of anti-Jra alloimmunization in pregnancy: A case report

Background: Hemolytic disease of the fetus/newborn due to Jra immunization is very rare and considered to be mild, and only routine obstetrical care is recommended for pregnant women sensitized to the Jra antigen. Case Report: A 20-year-old nulliparous woman was referred to our hospital for perinatal management. Her indirect Coombs test was positive for anti-Jra antibody (1:64). At 33 weeks’ gestational age, we observed that fetal growth was mildly restricted and the peak systolic velocity of the fetal middle cerebral artery (PSV-MCA) was above the upper limit of the reference range (1.55 multiples of the median). Amniocentesis was also carried out and the ΔOD450 value was in the lower mid-zone of the Liley curve. We continued to carefully observe the patient because we observed PSV-MCA values within 1.50–1.60 multiples of the median and no other findings of fetal anemia. She vaginally delivered a female infant weighing 2,136 g at 37 weeks’ gestational age. The infant received treatment with both iron and recombinant erythropoietin without developing hyperbilirubinemia and blood transfusion. Conclusion: PSV-MCA should be monitored for the detection of fetal anemia, even in pregnant women sensitized to some antigens for which only routine obstetrical care is recommended.

Acknowledgment to the Reviewers

The editors greatly appreciate the support of all reviewers whose comments and scientific evaluation of submitted manuscripts are invaluable for ensuring the scientific quality of this journal. In addition to the listed permanent members of the Editorial Board, the following distinguished clinicians and scientists listed below acted as reviewers for Gynecologic and Obstetric Investigation from the beginning of November 2011 to the end of October 2012. The Editors hereby express their sincere gratitude for and their appreciation of the work done as well as the support given to this journal.