Yui Yamasaki

The factors associated with the failure of transcatheter pelvic arterial embolization for intractable postpartum hemorrhage

Abstract Objective: The transcatheter pelvic arterial embolization (TAE) is effective for postpartum hemorrhage (PPH). There has been a little information about the factors for ineffectiveness of TAE. The aim of this study was to determine factors associated with TAE failure for PPH. Study design: Fifty-five women who underwent TAE for intractable PPH were included. Clinical factors involving age, history of pregnancy, gestational weeks of delivery, mode of delivery, causes of PPH, complete blood count, blood loss volume, transfusion amount, shock index and disseminated intravascular coagulation (DIC) score were compared between TAE success group (n=48) and TAE failure group (n=7). Results: The uni- and multi-variate analyses revealed that advanced maternal age (OR 1.46, 95% CI 1.12–2.18) and retained placenta as a cause of PPH (15.48, 2.04–198.12) were found to be significant factors for TAE failure. Conclusion: The advanced age and retained placenta were independent factors associated with TAE failure for intractable PPH.

Prediction of adherent placenta in pregnancy with placenta previa using ultrasonography and magnetic resonance imaging.

OBJECTIVE Adherent placenta is a life-threatening condition in pregnancy, and is often complicated by placenta previa. The aim of this prospective study was to determine prenatal imaging findings that predict the presence of adherent placenta in pregnancies with placenta previa. STUDY DESIGN The study included 58 consecutive pregnant women with placenta previa who underwent both ultrasonography and magnetic resonance imaging prenatally. Ultrasonographic findings of anterior placental location, grade 2 or higher placental lacunae (PL≥G2), loss of retroplacental hypoechoic clear zone (LCZ) and the presence of turbulent blood flow in the arteries were evaluated, in addition to MRI findings. Forty-three women underwent cesarean section alone; 15 women with adherent placenta underwent cesarean section followed by hysterectomy with pathological examination. To determine imaging findings that predict adherent placenta, univariate and multivariate logistic regression analyses were performed. RESULTS Univariate logistic regression analyses demonstrated that anterior placental location, PL≥G2, LCZ, and MRI were associated with the presence of adherent placenta. Multivariate analyses revealed that LCZ (p<0.01, odds ratio 15.6, 95%CI 2.1-114.6) was a single significant predictor of adherent placenta in women with placenta previa. CONCLUSION This prospective study demonstrated for the first time that US findings, especially LCZ, might be useful for identifying patients at high risk for adherent placenta among pregnant women with placenta previa.

In vitro fertilization-embryo transfer pregnancy was a risk factor for hemorrhagic shock in women with placental polyp

Abstract Objective: The aim of this study was to determine the risk factors for hemorrhagic shock in women with placental polyp. Materials and methods: Twelve women (group A) developed hemorrhagic shock (shock index < 1.5) and received uterine artery embolization (UAE). The other 25 women (group B) had shock index < 1.5 and did not receive UAE. All women underwent transcervical resection (TCR). The risk factors for the development of hemorrhagic shock, including the age, conception mode, numbers of previous abortion, gestational weeks at termination of pregnancy (TOP), blood loss weights at TOP and at TCR, were analyzed. Results: When compared with group B, group A had higher in vitro fertilization-embryo transfer (IVF-ET) pregnancy rate (58.3 versus 12.0%, p < 0.01), number of previous abortion (median 1.58 versus 0.68, p < 0.05), gestational weeks at TOP (median 36.5 versus 17.0 weeks, p < 0.05), and blood loss weight at TOP (median 2151 versus 40 g, p < 0.05). A logistic regression analysis reveled that IVF-ET (OR 41, 95% CI 1.3–1264) and blood loss weight at TOP (1.0025, 1.0006–1.0044) were independent risk factors for hemorrhagic shock. Conclusions: For the first time, IVF-ET pregnancy was found to be a risk factor for the development of hemorrhagic shock in women with placental polyp.

Long-Acting Luteinizing Hormone-Releasing Hormone Agonist for Ovarian Hyperstimulation Induced by Tamoxifen for Breast Cancer

Tamoxifen treatment for breast cancer may induce ovarian cysts and supraphysiological levels of serum estrogen. We report successful management with luteinizing hormone-releasing hormone (LHRH) agonist of ovarian hyperstimulation induced by tamoxifen. A 49-year-old woman was operated on for invasive ductal carcinoma of the right breast. She received breast irradiation and adjuvant tamoxifen therapy. After 2 years, she had a cystic ovarian mass, and her serum concentration of estradiol was 1280 pg/mL. She was treated with an injection of 11.25 mg leuprolide acetate, a long-acting LHRH agonist, without abandoning tamoxifen therapy. The levels of estradiol decreased to <10 pg/mL and the cystic mass disappeared 2 months later. Three-month depot treatment with LHRH agonists can be useful for patients receiving tamoxifen for breast cancer who have ovarian cysts and supraphysiological levels of estrogen.

Two cases of massive subchorionic thrombosis

Abstract Massive subchorionic thrombosis (MST) is defined as a massive thrombosis under the chorionic plate, and is responsible for obstetric complications. We encountered two cases of MST. Placental abruption was misdiagnosed by ultrasound examination in Case 1, and a cesarean section was performed at 33 weeks of gestation. Magnetic resonance imaging (MRI) at 21 weeks of gestation suggested MST in Case 2. A cesarean section was performed at 26 weeks’ gestation because of pregnancy-induced hypertension, fetal growth restriction and non-reassuring fetal status.

Prenatal diagnosis of holoprosencephaly with proboscis and cyclopia caused by monosomy 18p resulting from unbalanced whole-arm translocation of 18;21

Abstract A case of holoprosencephaly (HPE) with proboscis, fused eyes in one orbit, and cyclopia was diagnosed by fetal ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). Ultrasonographic examination at 28 weeks of gestation showed fusion of the frontal part of the brain and ventricular dilation. Subsequent CT and MRI examinations confirmed this anomaly as alobar HPE. Amniocentesis followed by chromosome analysis demonstrated karyotype as de novo 45,XY, der (18;21)(q10;q10), with deletion of a short arm of chromosome 18. The pregnancy ended in a premature delivery of a male neonate weighing 1716 g at 34 weeks. Macroscopically, there were mid-frontal proboscis and single orbit with two eyes without normal nasal structures. He died 1 h after birth.

A case of congenital brain teratoma extending into the orbit

Abstract Congenital tumors arising from the central nervous system are uncommon. A 31-year-old pregnant woman had an uneventful course until 33 weeks of gestation (GW). An ultrasonographic examination at 35 GW first demonstrated an increase in fetal head size. The brain midline shifted to the left side due to the intracranial tumor extending into the orbit in the right hemisphere at 36 GW. The brain teratoma in the fetus was suspected by magnetic resonance imaging of the heterogeneous enhancement and calcification. The male baby was delivered by cesarean section at 36 GW and he had facial dimorphism with right exophthalmos. The tumor volume continued to increase after surgery and the baby died at 123 days of life.