Yasuo Otsubo

Clinical Trial of Induction of Labor versus Expectant Management in Twin Pregnancy

Objective: The appropriate date of delivery in twin pregnancies is supposed to be earlier than that in singleton pregnancy. The aim of this study was to compare two strategies for managing twin pregnancies (i.e., immediate induction and expectant management). Methods: Seventeen patients underwent immediately induced labor by administration of oral prostaglandin E2 at 37 weeks, while 19 patients underwent expectant management. Results: The average gestational age at delivery in the induction group was 37.5 ± 0.4 weeks, significantly earlier than that in the expectant management group (39.0 ± 1.1 weeks). However, there were no significant differences in the average birth weight between the two groups (2,700 ± 330 g in the induction group vs. 2,672 ± 392 g in the expectant management group). The cesarean delivery rate in the induction group was 18%, not significantly different from that in the expectant management group (32%). The most common indication for cesarean section in the expectant management group was maternal infection, while there was no maternal infection in the induction group (p = 0.08). Conclusion: It may be acceptable do intervene in twin pregnancies earlier than in singleton pregnancies during term.

Serum adenosine deaminase activity and its isoenzyme pattern in women with normal pregnancies

Abstract. Adenosine deaminase (ADA) is a purine enzyme which is essential for the proliferation, maturation and function of lymphoid cells, and congenital deficiency of this enzyme is associated with severe combined immunodeficiency disease. The activity of ADA has changed in diseases characterized by the alteration of cell-mediated immunity such as rheumatoid arthritis, systemic lupus erythematosus and tuberculosis, so ADA has been considered as a nonspecific marker of cell-mediated immunity. In this study we examined changes in serum total ADA activity and the patterns of two ADA isoenzymes, ADA1 and ADA2 in normal pregnant women, and evaluated the possible role of the alteration of cell-mediated immunity during normal pregnancy as causes of changes in ADA activity. We measured serum activities of total ADA, ADA1 and ADA2 in normal pregnant women in the third trimester (n=24) and age-matched healthy nonpregnant women (n=24). Peripheral blood lymphocytes and monocytes were also measured. In normal pregnant women, serum total ADA activity averaged 10.5 ± 0.5 U/L, which was significantly lower than in nonpregnant women (14.0 ± 0.5 U/L ) (p<0.05), and mean serum ADA2 activity also significantly reduced that of nonpregnant women (p<0.05). There was no significant difference in ADA1 activity in normal pregnant and nonpregnant women. The decrease in total ADA activity was accompanied by the decrease in lymphocyte count. These results suggest that reduced serum total ADA activity reflects decrease in ADA2 activity, and which may be in part associated with depressed cell-mediated immunity during normal pregnancy.

Iatrogenic monoamniotic twin gestation with progressive twin-twin transfusion syndrome.

Objective: Intentional puncture of the membrane has been reported to be a promising new method for the management of twin-twin transfusion syndrome. Case Report: Treatment of twin-twin transfusion syndrome with serial amniocenteses resulted in unintentional puncture of the dividing membrane at 24 weeks of gestation. Fetal growth discordance increased, and twin-twin transfusion did not improve following the puncture. Intrauterine death of both fetuses at 27 weeks of gestation occurred. Conclusion: Amniotic septostomy for the treatment of twin-twin transfusion sydnrome should be performed with serious consideration.

Maternal basal metabolic rate in twin pregnancy.

Objective: This study examined the basal metabolic rate in patients with twin pregnancies and compared the results with those of singleton pregnancies and non-pregnant women. Methods: In 15 non-pregnant women, 14 patients with twin and 25 patients with singleton pregnancies, the resting energy expenditure was measured using an open-circuit ventilatory system during the third trimester of pregnancy. Results: The averaged resting energy expenditure in patients with twin pregnancy was 1,636 ± 174 kcal/day, significantly higher than that in patients with singleton pregnancy (1,456 ± 158 kcal/day; p < 0.05). Both of these levels are significantly higher than those in non-pregnant women (1,228 ± 132 kcal/day; p < 0.05). Conclusion: Our results indicate that the estimated increased metabolic demands in patients during the third trimester of twin pregnancy are about 10% higher than those in women with singleton pregnancy. A prospective clinical study concerning nutrition counseling is needed.

Serum adenosine deaminase activity in women with hyperemesis gravidarum.

BACKGROUND Serum adenosine deaminase (ADA) activity increases in diseases where cellular immunity is stimulated. Since hyperemesis gravidarum is characterized by enhanced cell-mediated immunity, serum ADA activity may be altered. The present study evaluated the relation between serum ADA activity and changes in cell-mediated immunity as causes of changes in ADA activity in hyperemesis gravidarum. METHODS Serum activities of total ADA and its isoenzymes, ADA1 and ADA2, were measured in women with hyperemesis gravidarum (n = 24) and normal pregnancies (n = 24). Peripheral blood lymphocyte and monocyte counts were also measured. RESULTS In hyperemesis gravidarum, serum total ADA and ADA2 activities averaged 16.8 +/- 0.5 and 13.3 +/- 0.7 U/l, respectively, which were significantly higher than those in normal pregnancies (10.2 +/- 0.5 and 7.8 +/- 0.5 U/l, respectively) (p < 0.05). The mean values for ADA1 activity in women with hyperemesis gravidarum and normal pregnancies were similar. The increase in total ADA activity was accompanied by the increase in lymphocyte and monocyte counts. CONCLUSIONS These results suggest that increased serum total ADA activity reflects increases in ADA2 activity, which may be at least in part attributed to enhanced cell-mediated immunity in hyperemesis gravidarum.

Serum Adenosine Deaminase Activity in Women with Pre-Eclampsia

The present study investigated serum adenosine deaminase (ADA) activity and the patterns of two ADA isoenzymes, ADA1 and ADA2, and to evaluate the possible role of cell-mediated immunity as causes of the changes in ADA activity in pre-eclampsia. We measured serum activities of total ADA, ADA1 and ADA2 in pre-eclampsia (n = 22) and normal pregnancy (n = 22). Peripheral blood monocyte counts and neopterin levels, reflecting the activation of the monocyte-macrophage cell system, were also measured. In pre-eclampsia, serum total ADA and ADA2 activities were significantly increased compared with normal pregnancy (p < 0.05), which were accompanied by increases in serum neopterin levels. These results suggest that increased total ADA activity reflects increases in ADA2 activity, which may be in part related to enhanced cell-mediated immunity during pre-eclampsia.

Sonographic evaluation of umbilical cord insertion with umbilical coiling index.

The aim of this study was to investigate the association between umbilical cord hypocoiling and abnormal placental insertion of the umbilical cord.

Regulation of plasma adenosine levels in normal pregnancy.

The aim of this study was to investigate the possible mechanism of the regulation of plasma adenosine concentration [ADO] in normal pregnancy. We measured the activities of circulating enzymes that are involved in the production and metabolism of adenosine, and plasma [ADO] in nonpregnant (n = 14) and normal pregnant women (n = 14) in the third trimester. In pregnant women, the activity of plasma 5′-nucleotidase and plasma [ADO] were significantly elevated and plasma adenosine deaminase activity was significantly reduced. Enzymatic activities of both plasma enzymes appear to be changed in a way that would favor increased adenosine concentrations.

Intrauterine therapy for the acutely enlarging fetal cystic hygroma.

Enlarged fetal cystic hygroma is known to cause life-threatening complications such as fetal hydrops and neonatal respiratory difficulty. A 28-year-old Japanese woman, gravida 0, presented with fetal cystic hygroma at 23 weeks of gestation. There were no other structural malformations or hydrops detected by ultrasonographic examination. In addition, the karyotype was diagnosed as normal through amniotic fluid analysis. The cystic lesion showed acute enlargement and intrauterine sclerotherapy using OK-432 was performed at 26 weeks. The size of the cyst initially decreased, which was followed by a gradual increase. A viable 3,098 g male infant was delivered by cesarean section at 37 weeks without any other complications. The infant had no clinical difficulty during the neonatal period and later underwent a surgical removal of the remaining cystic lesion. Cases of fetal cystic hygroma showing acute enlargement without other complications are considered good candidates for intrauterine therapy to prevent subsequent complications.

Relation between Serum Uric Acid and Plasma Adenosine Levels in Women with Preeclampsia

The aim of this study was to examine the relationship between plasma adenosine and serum uric acid levels in women with preeclampsia. Maternal arterial blood sampling was performed to measure serum uric acid and plasma adenosine levels in 20 pregnant women complicated by preeclampsia and 22 normal pregnant women at 33–38 weeks of gestation. The average plasma adenosine levels were 0.31 ± 0.12 µmol/l in the normal pregnant group and 0.45 ± 0.11 µmol/l in the preeclampsia group. The mean serum uric acid level in women with preeclampsia was 5.9 ± 0.60 mg/dl, significantly higher than in the normal pregnant women (4.4 ± 0.69 mg/dl). Positive correlations were found between serum uric acid and plasma adenosine levels in both the group with (r2 = 0.38, p < 0.05) and the group without (r2 = 0.54, p < 0.05) preeclampsia. There was also a significant correlation between serum uric acid and plasma adenosine levels on the whole (r2 = 0.59, p < 0.05). Our results suggest that increased adenosine is a contributing source of preeclamptic hyperuricemia.