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Aim To evaluate whether the presence of amniotic components in the maternal uterine vasculature could be a specific pathological indicator for amniotic fluid embolism ( AFE). Methods Medical records of patients treated between January 2006 and March 2013 were retrospectively examined to identify patients who underwent post-partum hysterectomy or autopsy due to maternal death. Three subjects with AFE with disseminated intravascular coagulation ( DIC)-type post-partum hemorrhage ( PPH), and 13 non- AFE subjects were included in analysis. Histochemical staining using hematoxylin-eosin (HE) and alcian blue, and immunohistochemical staining for sialyl- Tn were conducted to detect amniotic components in the maternal uterine vasculature. Results Alcian blue was positive for amniotic components in the uterine vasculature of all subjects with AFE and of several subjects without AFE. Similarly, HE and sialyl- Tn were negative in some AFE subjects and positive in some non- AFE subjects. Conclusions The presence of maternal intravascular fetal material is not a specific indicator for AFE with DIC-type PPH. Therefore, the presence of fetal components in the uterine vasculature is unlikely to be a definitive indicator for AFE. [ABSTRACT FROM AUTHOR]

Aim: To assess the preventive effect on preterm birth of intravaginal ulinastatin (urinary trypsin inhibitor; UTI) administration during the mid‐trimester in women with singleton pregnancy and both cervical shortening and lower genital infections. Methods: Pregnant women with a short cervical length < 25 mm between 16 and 26 weeks of gestation and who had been diagnosed with a lower genital infection were randomly assigned for intravaginal UTI administration or placebo. All of the women were screened for infection or inflammation of the lower genital tract, and women with negative results were excluded. Results: Of the 92 patients with a short cervical length who were assessed for eligibility for this study, 86 singleton patients were enrolled. All patients were randomized to one of two treatment groups: patients administered UTI (n = 35) and placebo (n = 35). There were no differences between the two groups in the incidence of preterm delivery before 28, 30, 32, 34 and 37 weeks of gestation and in perinatal outcomes. Conclusion: For women diagnosed with a short cervical length < 25 mm) between 16 and 26 weeks of gestation and lower genital infection, who were at risk of preterm birth, administration of transvaginal UTI with vaginal irrigation showed no apparent benefit. Future research on the efficacy of UTI should evaluate modified modes of UTI application. [ABSTRACT FROM AUTHOR]

To investigate the frequency and type of abnormal karyotype in Japan by amniocentesis before 22 weeks of gestation. We performed a retrospective analysis of 28 983 amniotic fluid specimens in a local population collected before 22 weeks gestations for fetal karyotyping. The incidence of abnormal karyotype was 6.0%. The main indication was advanced maternal age (AMA) of 35 years and older, which represented over half of the clinical indications. Abnormal karyotype was most frequently reported among the referrals for abnormal ultrasound findings (21.8%), followed by positive maternal serum screen results (5.3%). Three-fourths of abnormal karyotype was either autosomal aneuploidy (64.0%) or sex chromosome aneuploidy (11.6%). Abnormal karyotype was detected in 2.8% of pregnant women referred for AMA. Clinically significant abnormal karyotype increased with advancing maternal age. The frequency and type of abnormal karyotype detected by amniocentesis for various indications were determined. Amniocentesis was mainly performed among the referrals for AMA, which is a characteristic distribution of indications of Japan. [ABSTRACT FROM AUTHOR]

The rudimentary horn is a rare developmental anomaly of the Müllerian duct. Ectopic pregnancy in the rudimentary horn is estimated to occur in one out of 76,000-150,000 pregnancies. A 30-year-old primigravida suddenly collapsed after 3 days of continuous abdominal pain. Emergency laparotomy revealed a massive intraperitoneal hemorrhage and fetal demise. The growth of the fetus after 19 weeks of gestation is believed to have caused the rudimentary horn rupture, thereby rapidly leading to hemorrhagic shock in the mother and ischemic death in the fetus. This is the first autopsy report on maternal death due to the rudimentary horn or other Müllerian duct anomalies, which emphasizes the need for forensic pathologists to consider this condition as a possible cause of unexpected death in fertile women. In addition, it is very important for clinicians to detect Müllerian duct anomalies by sonography during routine obstetric examinations, and promptly diagnose anomaly related ectopic pregnancies in women displaying symptoms of an acute abdomen, intraperitoneal hemorrhage, or shock in the emergency practice. [ABSTRACT FROM AUTHOR]