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Aim: Single‐arm, open‐label, phase 3 study to evaluate the efficacy and safety of ferric derisomaltose (FDI) for iron deficiency anemia (IDA) in Japanese women with postpartum hemorrhage (PPH). Methods: Postpartum women aged 20–39 years with serum ferritin <25.0 ng/ml, hemoglobin (Hb) <10.0 g/dl, and blood loss ≥500 ml within 24 h post‐delivery were eligible to receive high‐dose intravenous FDI. The primary endpoint was the maximum change in Hb concentration by Week 8. Key secondary endpoints included change in iron parameters and percentage of patients with a total Edinburgh Postnatal Depression Score (EPDS) ≥9. Safety assessments included treatment‐emergent adverse events (TEAEs) and iron concentrations in maternal milk. Results: All (n = 21 [100.0%]) patients received the predetermined total iron dose by Day 8. Hb concentrations increased rapidly and significantly (p < 0.001) following FDI. Serum ferritin levels also increased rapidly and were maintained near or above the upper limit of normal reference value (250 ng/ml). Following FDI, two (9.5%) patients had a total EPDS score of ≥9. TEAEs occurred in 23 of 42 (54.8%) patients and neonates overall, including 18 of 21 (85.7%) patients and 5 of 21 (23.8%) neonates. TEAEs were mild in all adult patients and four neonates, and moderate in one neonate. Iron concentrations in maternal milk remained within normal reference values. Appropriate patient selection and patient‐adjusted dosage selection facilitated safe and effective administration of high‐dose (≥1000 mg) FDI. Conclusions: Rapid and sustained improvements in Hb and iron stores occurred following FDI for IDA with PPH, with no new safety signals identified. Clinical trial identifier: JapicCTI‐194888. [ABSTRACT FROM AUTHOR]

Aim Pelvic shape affects the progression of labor. The gynecoid-type pelvis has been the most common in women, but a previous study reported that the anthropoid type has increased in Japan. The purpose of this study was to examine: (i) the current prevalence of different pelvic shapes in Japanese pregnant women; and (ii) the changes in the prevalence of the pelvic shapes over the past 50 years. Material and Methods We conducted a cross-sectional study using descriptive analysis for the prevalence of the pelvic shape and a historical comparison to assess the changes in the proportions of pelvic shapes with Japanese data from the 1960s to the 1980s. We reviewed a total of 517 delivery records from May 2010 to August 2012 at a rural Japanese hospital where prenatal X-ray pelvimetry had been routinely performed as local practice. We analyzed the readings of the digital imaging data in pregnant women who underwent X-ray pelvimetry. Results We identified the X-ray data in 326 Japanese pregnant women. The prevalence of the anthropoid, gynecoid and flat types was 151 (46.3%), 142 (43.6%), and 33 (10.1%), respectively. There were no differences in the maternal characteristics according to the pelvic shapes. The prevalence of the anthropoid-type pelvis has increased by approximately 40% and that of the gynecoid type has decreased by 20% since the 1960s. Conclusion The prevalence of the anthropoid-type pelvis have significantly increased in Japan. Identifying a determinant of this phenomenon requires further research. [ABSTRACT FROM AUTHOR]

Aim To examine the relationship between preterm birth and socioeconomic factors, past history, cervical length, cervical interleukin-8, bacterial vaginosis, underlying diseases, use of medication, employment status, sex of the fetus and multiple pregnancy. Methods In a multicenter, prospective, observational study, 1810 Japanese women registering their future delivery were enrolled at 8+0 to 12+6 weeks of gestation. Data on cervical length and delivery were obtained from 1365 pregnant women. Multivariate logistic regression analysis was performed. Results Short cervical length, steroid use, multiple pregnancy and male fetus were risk factors for preterm birth before 34 weeks of gestation. Multiple pregnancy, low educational level, short cervical length and part-timer were risk factors for preterm birth before 37 weeks of gestation. Conclusion Multiple pregnancy and cervical shortening at 20-24 weeks of gestation was a stronger risk factor for preterm birth. Any pregnant woman being part-time employee or low educational level, having a male fetus and requiring steroid treatment should be watched for the development of preterm birth. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Placental lakes are sonolucent or hypoechoic areas in images of the placenta, usually considered a physiological dilation of intervillous space with a rather good obstetrical outcome. However, diagnostic criteria for and the clinical significance of placental lakes are yet to be completely established, because of a wide variety of ultrasound findings, especially on color Doppler examination. We experienced a case of a huge placental lake, larger than the total placental area, located in an entire retroplacental space, concomitant with several penetrations of artery type blood flow. The antenatal differential diagnosis and course of clinical management are reported. [ABSTRACT FROM AUTHOR]

Chorangiosis is a vascular hyperplasia in the terminal chorionic villi, usually diagnosed histologically using the criteria of Altshuler. Its true etiology has not been fully identified, but chorangiosis has been proposed to result from a longstanding, rather low-grade hypoxia in the placental tissue. To clarify a possible association of placental oxygenation status with the development of chorangiosis, we measured placental tissue oxygen index (TOI) values using near-infrared spectroscopy (NIRS) before delivery and retrospectively compared them to the detection of placental chorangiosis, in a total of 47 (46 singleton and one set of dichorionic diamniotic twins) pregnant women. Small for gestational age (SGA) and/or maternal complications were observed in all cases of placental chorangiosis. Placental TOI values were significantly elevated in cases of chorangiosis. This indicates high oxygen saturation in the intervillous spaces because placental TOI values are expected to represent the oxygenation of maternal blood in the placental tissue. A possible preceding low efficiency of oxygen transfer to the fetal circulation in the villi might not only augment the oxygen saturation of maternal blood in intervillous spaces, but also cause rather low oxygenation in the capillaries of the villi and result in chorangiosis. [ABSTRACT FROM AUTHOR]

Background. The purpose of this study was to examine whether EP4 as prostaglandin (PG) E2 receptor is involved in lipopolysaccharide (LPS)-induced cervical ripening. Methods. New Zealand White non-pregnant rabbits were randomly allocated to 4 equal groups and treated with vaginal suppositories containing LPS with various concentrations of EP4-selective antagonist once daily for 3 days, and then sacrificed for analysis. Analysis was performed in order to examine the inhibitory effect of EP4 antagonist on LPS-induced cervical ripening. The expression of EP4 in a cervix treated with LPS was examined immunohistochemically. The percent of cervical extensibility in the segment of cervix as the tensile strength was determined with 5.8 g of constant perpendicular stretching. The ripening area of the cervix with edematous changes in H&E sections was calculated by a microscopic system with a computer-assisted digital analyser. Type-1 collagenase activity was determined in cervical tissue using FITC-labelled type-1 collagen. Results. Immunohistochemical study shows the positive staining of EP4 at the interstitial cells in the cervix treated with LPS. The extensibility, cervical edematous area and type-1 collagenase activity are significantly reduced in the cervix treated with LPS in the presence of EP4 antagonist compared with that treated with LPS alone. Conclusions. These data implicates the EP4 as the PGE2 receptor involved in LPS-induced cervical ripening. [ABSTRACT FROM AUTHOR]

Compression has been regarded as the main haemostatic mechanism of compression sutures; however, we suggest that reduced uterine blood flow may be another important action. We suggest that our 'double vertical compression sutures' may have dual actions: haemostatic compression of the bleeding surface and reduced uterine blood flow. [ABSTRACT FROM AUTHOR]

Background. In this study, we used an endogenous thrombin potential (ETP)-based assay to examine the response to activated protein C (APC) during early puerperium of 6 Japanese patients of deep vein thrombosis (DVT) and pulmonary embolism (PE) without a history of familial thrombophilia or antiphospholipid syndrome. Methods. The patient group comprised 6 Japanese women diagnosed for DVT or PE at Hamamatsu University School of Medicine, between July 1997 and April 2000. The control group comprised 30 healthy Japanese women in early puerperium. APC-sensitivity ratio (APC-sr), complete blood count (CBC), and other coagulant variables (thrombin- antithrombin-complex (TAT) and fibrin/fibrinogen-degration product (FDP)-D-dimer levels) were determined. Results. Mean APC-sr was 2.0 ± 0.3 in the control group and significantly higher (3.3 ± 1.0) in the patient group (P < 0.05). The FDP-D-dimer level was significantly higher in the patient group than in the control group, but there was no significant difference in the TAT complex level. Conclusions. We conclude that sensitivity to APC is reduced in patients with DVT or PE during early puerperium. Although further clinical studies are needed to confirm, it appears that sensitivity to APC detected by ETP-based assay could become a useful marker to estimate the occurrence of DVT or PE. [ABSTRACT FROM AUTHOR]

The article presents a study which investigated the mechanisms by which intrauterine balloons achieve the balloon tamponade effect of inducing uterine contraction. It relates how balloon tamponade was performed in six women with atonic bleeding after normal vaginal delivery. Using radiation force impulse elastography, the stiffness of the uterine corpus and cervix was estimated before and after balloon tamponade in one patient.