Yuka Yamamoto

Severe left heart obstruction with retrograde arch flow influences fetal cerebral and placental blood flow

Decreased middle cerebral artery (MCA) pulsatility index (PI) is a marker of fetal brain‐sparing in placental insufficiency and it is also found in fetuses with severe congenital heart disease. This study sought to explore the impact of anatomical subtypes in fetal heart disease on MCA‐PI and head growth.

Emerging tocolytics: challenges in designing and testing drugs to delay preterm delivery and prolong pregnancy

The global rate of preterm delivery (before 37 completed weeks of pregnancy) is increasing and there are no effective means available to prevent this rise. Prematurity is the principal cause of neonatal mortality and a major cause of pediatric morbidity and long-term disability. Current strategies to prolong pregnancy are based on inhibiting the mechanisms that effect uterine smooth muscle (myometrium) contractions in women who are in preterm labor. Most drugs in this group were developed for other purposes. Newer strategies are designed to maintain a state of uterine quiescence and pregnancy, preventing the myometrium from initiating contractions and entering preterm labor. Again, it may be possible to use existing drugs for pregnancy maintenance. Several financial and practical barriers exist for developing completely new drugs to delay labor. Designing clinical trials to test tocolytics is complicated, as the health of two patients must be considered and the nature of preterm birth and its outcomes are different at early preterm labor (< 28 weeks) and late preterm labor (34 – 36 weeks).

Increased Expression of Enzymes for Sphingosine 1-Phosphate Turnover and Signaling in Human Decidua During Late Pregnancy

Abstract An appropriate balance between uterine quiescence and activation during pregnancy is essential for a successful outcome. Sphingosine 1-phosphate (S1P), a bioactive lipid, increases cell survival, proliferation, and angiogenesis, all important to maintain the pregnancy. Indeed progesterone increases sphingosine kinase 1 (SPHK1) mRNA, which produces S1P. In contrast, induction of prostaglandin endoperoxide synthase 2 by S1P and stimulation of SPHK1 by estradiol and cytokines suggests a role for S1P in the termination of pregnancy. Human decidua is important for regulating the maintenance and termination of pregnancy with production of progesterone receptors, cytokines, and prostaglandins. We hypothesized that S1P is produced by and acts on the decidua to stimulate production of mediators that induce labor. Our objective was to investigate the metabolism of S1P and its receptors in human decidua during pregnancy. We found that SPHK1 protein and activity positively correlated with increasing gestational age in human decidua parietalis. This was accompanied at term by increased expression of the S1P lyase, which irreversibly degrades S1P. This implies increased S1P turnover in the decidua at term. Although the mRNA level of phosphatidic acid phosphatase type 2A and 2B (PPAP2A,B), which dephosphorylate extracellular S1P, were increased at term, PPAP2 activity did not change. Sphingosine 1-phosphate receptor 3 protein expression also increased at term, indicating increased signaling by S1P in the decidua. There were no differences in any parameter tested in decidua from women in labor compared to those who were not. This work provides the first evidence of increased S1P synthesis, degradation, and signaling in human decidua during gestation.

Changes in fetal cardiac axis between 8 and 15 weeks' gestation

To document changes in the normal embryonic/fetal cardiac axis in the late first and early second trimesters of pregnancy.

Progression of outflow tract obstruction in the fetus

Fetal ventricular outflow tract obstruction (OTO) is congenital heart disease with significant potential for progression before birth as a consequence of the unique nature of the fetal circulation. The pattern of evolution depends upon the timing of development, severity of obstruction and the influence of the OTO on the fetal atrioventricular valve and myocardial function. Critical aortic (AS) or pulmonary (PS) valve stenosis, the two most common forms of fetal OTO, may be associated with progressive ventricular and great artery hypoplasia if presenting early in gestation or with normal ventricular and great artery growth if evolving later in gestation. In some affected fetuses, AS or PS may lead to the evolution of fetal heart failure. This article will review our current understanding of the natural history of fetal AS and PS, experience with fetal intervention and future directions of research.

Time spatial labeling inversion pulse magnetic resonance angiography in pregnancy with adenomyosis.

Time spatial labeling inversion pulse (Time‐SLIP) is a non‐contrast magnetic resonance angiography (MRA) technique. No cases in which this technique was used during pregnancy have been reported. We report herein two cases with adenomyosis of the same size and location that underwent Time‐SLIP MRA during pregnancy. In case 1, the blood flow within the adenomyosis was poor, and the uterine blood flow toward the placenta was normal, resulting in no fetal growth restriction (FGR). In case 2, the blood flow within the adenomyosis was quite rich, and placental blood flow seemed decreased, resulting in severe FGR. As well as the Doppler ultrasonography, Time‐SLIP MRA was useful for evaluating uterine blood flow during pregnancy. This is the first report of the use of Time‐SLIP MRA during pregnancy.

Evaluation of Myocardial Function According to Early Diastolic Intraventricular Pressure Difference in Fetuses

Background Intraventricular pressure difference (IVPD), the diastolic suction during early diastole, is known as a useful marker of myocardial diastolic function in adults with different heart diseases, but there are no studies of fetal IVPD. The aim of this study was to determine whether IVPD exists and changes prenatally and whether IVPD correlates with preexisting parameters to evaluate fetal cardiac diastolic function and ventricular dominance. Methods Cross‐sectional study data (stroke volume, fetal cardiac output, E/A ratio, and myocardial performance index) from 117 healthy fetuses at 17 to 36 weeks of gestation were retrospectively evaluated. The total IVPD was calculated using Eulers equation with color M‐mode data. Segmental IVPD was evaluated as apical, mid, and basal IVPDs. Results The total IVPD in the right ventricle and left ventricle significantly increased in late gestation compared with that in different fetuses studied at midgestation (right and left ventricles, &rgr; = 0.813 and &rgr; = 0.895, respectively; P < .001). In both ventricles, the apical IVPD percentage, but not basal or mid IVPD, significantly increased at late gestation compared with that in different fetuses studied at midgestation. Both stroke volumes were correlated with IVPD (right and left ventricles, &rgr; = 0.796 and &rgr; = 0.784, respectively; P < .001). Although myocardial performance index in the left ventricle did not show a significant correlation with IVPD, the E/A ratio had a very weak correlation with IVPD (right ventricle, &rgr; = 0.576, P < .001; left ventricle, &rgr; = 0.338, P < .01). Conclusions IVPD has been proved to exist in both ventricles during the fetal stage. The total IVPD increased in late gestation, and the ventricular length increased because of increased apical IVPD in both ventricles. Furthermore, the increase of IVPD in both ventricles was correlated with stroke volume and, accordingly, cardiac output. Left ventricular dominance in IVPD from the fetal stage may offer interesting insight into fetal cardiac development. HighlightsIVPD, which is ventricular suction, exists beginning in the fetal stage.The total IVPD increases during late gestation, along with an increase in apical IVPD.In the fetal stage, left ventricular IVPD was dominant compared to right ventricular IVPD.

OC23.05: Relationship between Doppler parameters and postnatal outcomes in fetuses with congenital diaphragmatic hernia

to demonstrate this sign prompted further 3D evaluation and the palate was examined in stored volumes of the fetal face. Results: Based on this observation the superimposed line was absent in 17 fetuses with cleft of secondary palate which was confirmed by 3D evaluation and also postnatally. Out of 17, thirteen had defects involving the premaxilla and four had isolated median cleft of the secondary palate. The appearance of the superimposed line was useful in ruling out median cleft palate in 32 high risk cases with a previous history of cleft palate. None of the cases with the normal appearance of the superimposed line had median palatine cleft when evaluated postnatally. Conclusions: The superimposed line sign is a new sonographic marker in evaluation of midline defects of secondary palate and documentation of this sign proves the presence of both palate and vomer in midline. This marker can be better demonstrated in the late first trimester leading to early diagnosis of palatine clefts and this sign could also increase the detection rate of isolated cleft palate. Early diagnosis of median cleft palate can lead to better counselling options at the time of first trimester aneuploidy screening.

Predictive markers and prenatal management of isolated fetal complete atrioventricular block: A retrospective review at a single institution

The study was conducted to determine an effective method for identifying patients at high risk of developing isolated complete atrioventricular block (CAVB) and to review the efficacy of prenatal anti‐inflammatory treatment.

Parameters of fetal pulmonary vascular health: baseline trends and response to maternal hyperoxia in the second and third trimesters

Several parameters, including branch pulmonary artery (PA) diameter and Doppler‐derived PA acceleration‐to‐ejection time ratio (AT/ET), peak late‐systolic/early‐diastolic reversed flow (PEDRF) and pulsatility index (PI) response to maternal hyperoxia, have been used to investigate fetal pulmonary health. Lower AT/ET, increased PEDRF and lack of PI response to hyperoxia have been observed in fetuses with severe lung hypoplasia and are considered markers of pulmonary vascular resistance. We sought to further define the evolution of PA diameter and Doppler parameters and their response to maternal hyperoxia in healthy fetuses.