Yasumasa Ohno

Transcranial assessment of maternal cerebral blood flow velocity in patients with pre-eclampsia

Background. To clarify the cerebral hemodynamics in pre‐eclamptic pregnant women, we investigated the blood flow velocity of the cerebral arteries.

The value of Doppler ultrasound in the diagnosis and management of twin-to-twin transfusion syndrome

To evaluate the efficiency of the Doppler examination of umbilical arterial blood flow for the antenatal diagnosis and the monitoring of fetal condition during intrauterine treatment of twin-to-twin transfusion syndrome (TTTS), we studied 33 pairs of twins including 5 TTTS cases. In all cases umbilical arterial blood flow was examined by Doppler ultrasound and pulsatility index (PI) was calculated as umbilical arterial impedance. In twins with TTTS, PI of the recipient was outside the normal range and the difference of PI was greater than +0.5. In discordant twins without TTTS and concordant twins, the PI was within the normal range and the difference of PI ranged from −0.5 to +0.5. In 2 cases these findings were found before the appearance of fetal hydrops. In 2 TTTS cases transmaternal digitalization prevented the development of hydrops in the recipient. The difference of PI decreased with improvement in the fetal condition, and vice versa. Our data suggested that, in cases with TTTS, Doppler examination of umbilical arterial blood flow was effective in predicting fetal hydrops. Doppler was also very useful for monitoring the fetal condition during intrauterine treatment.

Tissue Distribution of Placental Leucine Aminopeptidase/Oxytocinase During Mouse Pregnancy

Placental leucine aminopeptidase (P-LAP), also called oxytocinase, is an enzyme responsible for hydrolyzing oxytocin. This enzyme is identical to cystine aminopeptidase. We examined the tissue distribution of P-LAP in normal adult mice and also in mothers and fetuses during mouse pregnancy using immunohistochemical (IHC) analysis. P-LAP-immunoreactive protein was expressed in various organs in a cell- and gestational stage-dependent manner. In the kidney, P-LAP was located in distal and collecting tubules but not in proximal tubules. The islet of Langerhans in the maternal pancreas stained positively for P-LAP in the periphery in early gestation. This staining pattern changed so that both the periphery and inner cells were positive during mid-gestation and finally only inner cells were positive in late gestation. Among the hematopoietic cells in the fetal liver, only megakaryocytes showed strong expression of P-LAP. The staining intensity increased with gestation on the apical surface of trophoblasts in the placental labyrinth. These data demonstrate that P-LAP is present in a variety of tissues, and its presence is affected by pregnancy and fetal development. Therefore, P-LAP may play a significant role in various physiological processes in non-pregnant, pregnant, and fetal mice.

Possible involvement of aminopeptidase A in hypertension in spontaneously hypertensive rats (shrs) and change of refractoriness in response to angiotensin Ii in pregnant Shrs

Background Hypertension complicated with pregnancy is a major cause of maternal and fetal mortality, but its pathophysiology is unclear. Objective To investigate the pressor response to angiotensin II (Ang II) and the involvement of the Ang II degrading protease, aminopeptidase A, in spontaneously hypertensive rats (SHRs). Design Pregnant SHRs and Wistar–Kyoto (WKY) rats were studied. Angiotensin II (200 ng/kg per min) or saline was infused by osmotic pump from day of 15 gestation, and caesarean section was performed at day 20 of gestation. Blood pressure during pregnancy, weight of placentas and pups at caesarean section, and aminopeptidase A activity in placenta and renal cortex were measured. Results Ang II treatment induced increases in blood pressure that were greater in non-pregnant WKY rats than those in pregnant WKY rats, pregnant SHRs, and non-pregnant SHRs. Renal aminopeptidase A activity in SHRs was significantly lower than that in WKY rats. Renal aminopeptidase A activity in pregnant SHRs was significantly greater than that in non-pregnant SHRs, but there was no significant increase in pregnant WKY rats. Placental aminopeptidase A activity in SHRs was greater than that in WKY rats. Placental aminopeptidase A activity in WKY rats was increased by Ang II, but was not increased in SHRs. Weights of placentas and pups were significantly lower in SHRs than in WKY rats. Conclusions Renal aminopeptidase A may be involved in the development of hypertension and the regulation of blood pressure in SHRs. Placental aminopeptidase A may be upregulated in response to fetal stress in pregnant SHRs.

Umbilical plasma concentration of endothelin-1 in intrapartum fetal stress: effect of fetal heart rate abnormalities

Objective To measure the umbilical plasma concentration of endothelin (ET)-1 in the presence of labor, fetal heart rate (FHR) abnormalities, and fetal hypoxia. Methods Umbilical and maternal plasma concentrations of ET-1 were measured in 100 pregnant women at full-term deliveries (60 with vaginal delivery without induction and 40 with elective cesarean delivery without labor). We assessed the FHR pattern, measured umbilical blood gases and plasma concentration of vasopressin, and investigated the relationships between the umbilical vein-artery ET-1 concentration difference and these variables. Results The concentration of ET-1 in the umbilical vein was higher than in the umbilical artery and the maternal vein in all cases. The umbilical vein-artery ET-1 concentration difference (mean ± standard error of the mean) was significantly greater in the vaginal delivery group (4.5 ± 2.0 pmol/L) than in those delivered by elective cesarean (1.7 ± 1.5 pmol/L) (P < .05). The umbilical vein-artery ET-1 concentration difference was significantly greater when more than three episodes of severe variable decelerations occurred during the 30-minute period before delivery (7.0 ± 2.0 pmol/L) than in the absence of any decelerations (1.6 ± 1.5 pmol/L) (P < .05). The umbilical vein-artery ET-1 concentration difference correlated positively with the umbilical arterial concentration of vasopressin (r = 0.45, P < .05) and negatively with the umbilical arterial oxygen pressure (r = −0.47, P < .05). Conclusion In cases of vaginal delivery with FHR abnormalities and with fetal hypoxia, the fetoplacental concentration of ET-1 was increased.

Effect of Prostaglandin E1 on Ophthalmic Artery Velocimetry in a Pre-Eclamptic Woman with Visual Disturbance Caused by Retinal Arterial Narrowing

We reported the ophthalmic arterial velocimetry and the effect of prostaglandin E1 on that using color Doppler ultrasonography in a 29-year-old pre-eclamptic woman with postpartum weakness of vision due to retinal arterial narrowing. In this case, we found higher pulsatility index and lower mean velocity than that in normal pregnancy. The 30.8% reduction of ophthalmic artery pulsatility index and 53.9% acceleration of mean velocity were observed at 25 min after intravenous administration of prostaglandin E1. Normalization of these values preceded the recovery of vision. These findings suggest a vasodilated effect of prostaglandin E1 on orbital circulation in a pre-eclamptic woman with weakness of vision due to retinal arterial narrowing.

Isolated gestational proteinuria preceding the diagnosis of preeclampsia – an observational study

Some pregnant women develop significant proteinuria in the absence of hypertension. However, clinical significance of isolated gestational proteinuria (IGP) is not well understood. This study aimed to determine the prevalence of IGP in singleton pregnancies and the proportion of women with IGP who subsequently developed preeclampsia (IGP‐PE) among all PE cases.

Pure Red Cell Aplasia and Acute Hepatitis during Pregnancy

Pure red cell aplasia during pregnancy is rare. We present a case in a 26-year-old pregnant woman, referred to our hospital at 31 weeks’ gestation because of severe anemia caused by acute hepatitis. She was treated with repeated blood transfusions and the pure red cell aplasia gradually remitted during the pregnancy. A live infant was delivered by cesarean section at 34 weeks’ gestation. Postpartum, the pure red cell aplasia and hemolytic anemia remitted completely. Our case illustrates that pure red cell aplasia may occur late in pregnancy associated with acute viral hepatitis and is reversible during pregnancy without any necessity for steroid therapy.

Serial fetal heart rate monitoring in monozygotic twin, one of which was anencephalic

This report describes FHR patterns of monozygotic twins, one of whom was anencephalic. The recording were made from 20 to 36 weeks of gestation. Differences were observed in the FHR patterns after week 28.

Primary chemotherapy in strongly suspected yolk sac tumor of the ovary

Abstract We report a case of a right ovarian tumor measuring 10.8 × 10 × 8.5 cm (diagnosed as a yolk sac tumor) in a 31-year-old nulligravid woman with serum α-fetoprotein (AFP) level of 25 000 ng/ml and pleural effusion. Seven courses of primary chemotherapy (PVB; cisplatin, vinblastine, bleomycin) were given from May 16 to November 11, 1994. No surgical procedures were conducted. After the second course of PVB, the pleural effusion resolved; after the third course, the tumor disappeared, and after the fourth course, serum AFP decreased to the normal range. At the true of writing (May 11, 1998), the patient is in good health without recurrence, with an AFP level below 20 ng/ml. This paper reports, for the first time, a patient with yolk sac tumor in whom remission was achieved by primary chemotherapy alone.