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Factor XIII deficiency is an extremely rare autosomal recessive genetic disorder, occurring in 1 of 3–5 million people, and is associated with perinatal complications, such as habitual abortion and prolonged bleeding. Although plasma‐derived factor XIII (Fibrogamin®) carries a risk of infection and contains very low concentrated forms of factor XIII (FXIII) used for a pregnant woman with congenital coagulation factor XIII deficiency, recombinant factor XIII (rFXIII, Novo Thirteen®; Tretten®, Novo Nordisk, Bagsværd, Denmark), which has no risk of infection and is highly concentrated, has emerged as a novel formulation. Herein, we report the first case of a Japanese pregnant woman with congenital coagulation factor XIII deficiency successfully managed by rFXIII. She had a good perinatal course without pregnancy‐related complications and transfusion through the perinatal period. [ABSTRACT FROM AUTHOR]

We analysed the effectiveness of transvaginal ultrasonographic and foetal/maternal pulse Doppler findings as predictors of labour onset within 1 week. We included 22 single normal pregnancies and evaluated the one-point and short- and long-term differences in uterine artery pulsatility index (PI), umbilical artery PI, middle cerebral artery PI (MCA-PI), peak systolic velocity, and cervical length (CL). Presence of funnelling and membrane separation over the internal cervical os was evaluated. Significant changes were observed in the one-point measurement of and short-term and long-term differences in CL, the one-point measurement of and long-term difference in MCA-PI, and the presence of membrane separation (Grade 2). In multivariate analysis, the significant predictors were short-term differences in CL (odds ratio [OR]: 5.27), long-term differences in MCA-PI (OR: 13.3), and presence of membrane separation (Grade 2) (OR: 5.38). Transvaginal ultrasonographic and foetal pulse Doppler findings were effective predictors of labour onset within 1 week. What is already known on this subject? Parameters reported to predict labour onset include the Bishop score, cervical length, decreased long-term cervical length, funnelling of the internal cervical os, and adrenal gland volume. What do the results of this study add? Short-term changes in cervical length, long-term changes in middle cerebral artery pulsatility index, and the presence of membrane separation Grade 2 were found to be useful predictive factors of labour onset in this study. What are the implications of these findings for clinical practice and/or further research? The prediction of labour onset enables clinicians to properly manage pregnancy and delivery considering maternal and foetal conditions. [ABSTRACT FROM AUTHOR]

Background: Uterine artery pseudoaneurysm (UAP) normally presents genital bleeding in the puerperal period, and severe hydronephrosis rarely presents during pregnancy. We report a rare case of severe ureteral obstruction accompanied by uterine artery pseudoaneurysm in the early second trimester of pregnancy, which was successfully treated by surgical intervention.Case Presentation: A 42-year-old nulligravid woman who had undergone myomectomy 3 years earlier was referred to our hospital for acute left abdominal pain at the 17th week of gestation. Ultrasonography showed severe left hydronephrosis and a 6-cm mass in the parauterine space. Color Doppler ultrasonography revealed a spinning turbulent flow pattern inside the mass lesion. Contrast-enhanced computed tomography revealed the left uterine artery feeding blood flow to the mass and left ureteral obstruction by the mass. These results indicated left hydronephrosis secondary to left uterine artery pseudoaneurysm. To resolve the problem, laparotomy was performed. As uterine artery isolation was impossible, ligation of the left internal iliac artery and releasing of the ureteral obstruction were carried out. The hydronephrosis and abdominal pain promptly resolved after the surgery. Thereafter, fetal development proceeded normally in the remaining months of the pregnancy. A healthy baby was delivered through cesarean section at 36 weeks gestational age. At the cesarean section, the left lower uterine segment where the UAP had been present was not visible because of the firm adhesion in around it.Conclusions: Uterine artery pseudoaneurysm can cause hydronephrosis in the early second trimester of pregnancy. Ligation of the unilateral internal iliac artery is a safe and effective intervention to block the blood flow to the uterine artery pseudoaneurysm during pregnancy, when uterine artery ligation seems not possible. In the pregnancy after previous surgical procedures to the uterus, uterine artery pseudoaneurysm should be considered in the differential diagnosis of symptomatic hydronephrosis. [ABSTRACT FROM AUTHOR]

Thoracoamniotic shunting (TAS) is an effective treatment for fetal pleural effusion. We report a case of bilateral fetal pleural effusion in which catheter displacement into the amniotic cavity occurred due to fetal movement after TAS. Initially, left TAS was performed twice using a 60-mm catheter, resulting in displacement and the catheter being pinched between the fetal fingers. Subsequently, a 50-mm catheter was employed for left TAS, which successfully prevented further displacement. Labor was induced at 35 weeks and three days of gestation due to an increase in right fetal pleural effusion. Following delivery, the infant was managed with directional positive airway pressure and drainage of the pleural effusion and remained stable on respiratory support. This case highlights the importance of tailoring catheter length and placement based on the thickness of the fetal chest wall to minimize displacement risks associated with fetal movement., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Katsura et al.)

Umbilical cord rupture, though rare, is a severe obstetric complication with significant implications for neonatal morbidity and mortality. We present the case of a 38-year-old primiparous female diagnosed with a single umbilical artery (SUA) and velamentous cord insertion (VCI) in late pregnancy. At 40 weeks of gestation, during labor induction, the patient suddenly experienced massive vaginal bleeding and fetal bradycardia, necessitating an emergency cesarean section. Postoperatively, it was confirmed that the umbilical cord had ruptured. The neonate required immediate and intensive resuscitation, including blood transfusion and therapeutic hypothermia. Remarkably, despite the critical initial condition, the neonate exhibited no neurological deficits and was discharged in stable condition on the 27th day. The presence of SUA and VCI likely increased the vulnerability of the umbilical cord, predisposing it to rupture. This case emphasizes the importance of prenatal ultrasound in detecting umbilical cord abnormalities such as SUA and VCI. The early detection of these abnormalities allows for proactive management, including closer monitoring and timely surgical intervention, which are crucial for optimizing neonatal outcomes. This report provides valuable insights into the pathophysiology and management of umbilical cord rupture., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Shiga University of Medical Science Research Ethics Committee issued approval R2022-116. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Inatomi et al.)

Pemphigoid gestationis (PG) is a rare autoimmune blistering disorder that typically manifests during the second or third trimester of pregnancy. It is characterized by intensely pruritic urticarial plaques and blister formation, driven by an autoimmune response against the BP180 protein in the basement membrane. In this report, three cases of PG are presented, each illustrating distinct clinical courses and management strategies. The first case involves a 32-year-old primigravida at 31 weeks of gestation who presented with abdominal blisters that were unresponsive to topical steroids. Oral prednisone at a dosage of 15 mg was initiated at 33 weeks, leading to the resolution of the rash by 37 weeks. She subsequently delivered vaginally at 40 weeks. The second case concerns a 37-year-old multigravida who developed blisters on her limbs and abdomen at 27 weeks, which improved with the application of topical steroids. Due to a history of a previous cesarean section, she delivered via elective cesarean section at 38 weeks. The third case involves a 35-year-old multigravida who experienced fetal growth restriction starting from 29 weeks. She developed a mild erythematous, pruritic rash, and blisters at 33 weeks and required an emergency cesarean section at 33 weeks due to non-reassuring fetal status. The diagnosis of PG was confirmed postpartum. These cases underscore the clinical variability and potential complications associated with PG. They also suggest that the severity of PG's cutaneous manifestations may not directly correlate with pregnancy outcomes. Early detection and individualized management are crucial to optimizing both maternal and neonatal outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Shiga University of Medical Science Research Ethics Committee issued approval R2022-116. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Inatomi et al.)