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To develop a clinical device for monitoring FBM with a simplified mechanism, the multichannel pulsed Doppler device was achieved by modifying the ultrasonographic module and probe of a cardiotocograph. A new algorithm of signal processing with a high-accuracy displacement estimation technique produced real-time and continuous displacement calculations. In vivo measurements demonstrated that real-time output produced commendable quality in FBM tracking. The displacement of a few hundred micrometers because of FBM was measured successfully. The results suggest that quantitative assessments of FBM should be possible with this technique.

Cloacal dysgenesis is frequently associated with uterine anomalies. We report a case of pregnancy which resulted in an abortion in a woman with a persistent cloaca. Presumptive diagnosis before operation was ectopic pregnancy of the left tube. Postoperatively, the site of implantation of the conceptus was found to be the cavity of a unicornuate uterus in association with a rudimentary horn, the presence of which misled us to diagnose an ectopic pregnancy.

An ultrasound examination in a woman at 9 weeks' gestation demonstrated a gestational sac with a live fetus in the left uterine horn which was surrounded by an extremely thin outer lining. An interstitial pregnancy was suspected and laparoscopy was performed. During laparoscopy the purple bulge in the left horn gradually reduced in size and eventually disappeared following the external pressure by the tip of the forceps. We believe this pressure caused contraction of the superficial myometrial fibers resulting in a shift in the location of the gestational sac to the central area of the uterus. The pregnancy continued and on Cesarean section at 34 weeks' gestation, a membranous protrusion of the uterine wall in the left horn was noticed. A myometrial defect caused by an intrauterine intervention in the patient's previous pregnancy was suspected to be the cause of this "movable gestational sac" phenomenon.

Cephalopagus twinning, an extremely rare type of conjoined twins, is characterized by the anterior union of the upper half of the body, with two faces each situated on the opposite side of a conjoined head. The prognosis for cephalopagus twins is extremely poor because surgical separation is not an option. Thus early prenatal diagnosis of cephalopagus twins is important to provide an opportunity for pregnancy termination if desired. However, in many instances, cephalopagus twins are misdiagnosed as a singleton pregnancy because of the extreme degree of fusion which makes accurate demonstration of the abnormalities very difficult. This report presents a case of cephalopagus twins which was confirmed at 13 weeks of gestation using three-dimensional ultrasound.

We assessed the expression of natural killer (NK) receptors in recurrent aborters before and after immunotherapy using their husbands' peripheral blood mononuclear cells (PBMCs).Using stored PBMCs from recurrent aborters before and after the immunotherapy, the expression of NK receptors, CD158a, CD158b, CD159 and CD94, were analyzed using monoclonal antibodies for respective receptors. The diversity of killer activatory receptors (KARs) and killer inhibitory receptors (KIRs) was also examined using reverse transcriptase-polymerase chain reaction (RT-PCR)-single strand conformation polymorphism (SSCP) method.In recurrent aborters, no apparent changes in NK receptor expression and the balance between KARs and KIRs were found before and after the immunotherapy.The allo-human leukocyte antigen (HLA)-stimulation caused by the immunotherapy for recurrent aborters did not affect the expression of NK receptors and the ratio of KARs to KIRs regardless of the outcome of subsequent pregnancies, suggesting that recurrent aborters may benefit from the immunotherapy through mechanisms unrelated to alteration in NK receptor status.

To examine how preexisting tubal adhesions and endometriosis affect pregnancy outcome after laparoscopic treatment in infertile women with no apparent causes of infertility other than tubal factors.Pregnancy outcomes in 186 infertile women for a follow-up period of 18 months after laparoscopy were analyzed. Laparoscopic manipulations consisted of adhesiolysis of tubes and removal of endometriotic lesions.The patients were classified into three groups, those with no tubal adhesions (group A, n = 83), unilateral tubal adhesions (group B, n = 46) and bilateral tubal adhesions with at least one tube patent (group C, n = 57). The cumulative pregnancy rate in group C (13.2%) was lower than in groups A (41.8%) and B (45.7%) 18 months after laparoscopy. The average time to conception in group A (6.7 +/- 0.8 months) tended to be shorter than that in group B (10.6 +/- 1.2 months). In group A, pregnancy rates were essentially the same between minimal/mild endometriosis and moderate/severe endometriosis. Regarding group B, women with minimal/mild endometriosis exhibited significantly higher pregnancy rates than those with moderate/severe endometriosis, while pregnancy rates in women without endometriosis fell in between.Pregnancy rates after laparoscopic treatment are different in relation to tubal status and the presence of endometriosis.

Prolactin is known to inhibit the production of prostaglandins, key substances in the initiation of labour. To explore a possible role of prolactin in human parturition, prolactin levels were therefore measured in amniotic fluid and decidua at full-term pregnancy. Prolactin levels in amniotic fluid before labour were about three times higher than those at labour and they tended to decrease with time during labour. Prolactin levels in decidua before labour were about twice as high as those at labour. These findings suggest a possible involvement of prolactin in human parturition. Journal of Endocrinology (1991) 130, 151–153

We investigated the physiological role of epidermal growth factor (EGF) in fetal growth in mice in which midgestational sialoadenectomy induced maternal EGF deficiency. Sialoadenectomy decreased the fetal weight significantly, indicating that maternal EGF deficiency caused intrauterine growth retardation. The weight of the fetal liver in the sialoadenectomized mice was reduced in proportion to the decrease in body weight (82.7+/-10.2 vs. 70.9+/-10.9 mg), whereas the brain weight was not reduced. Sialoadenectomy significantly decreased the glucose concentration in fetal plasma (86.0+/-13.0 vs. 63.0+/-11.8 mg/dl) without affecting the maternal plasma level of glucose. Transplacental transfer of 3H-2-deoxyglucose was significantly decreased by sialoadenectomy (5.17+/-1.25 vs. 2.94+/-1.02%), but transfer of 14C-aminoisobutyric acid was not affected. Northern blot analysis and in situ hybridization of glucose transporter isoform GLUT1 and GLUT3 messenger RNAs (mRNAs) in placenta revealed that sialoadenectomy significantly reduced the expression of GLUT3 mRNA without affecting GLUT1 mRNA levels. Administration of anti-EGF antiserum enhanced the effects of EGF deficiency, which were almost completely corrected by EGF supplementation. These results indicate that EGF plays an important role in fetal growth by regulating the transplacental supply of glucose via GLUT3 expression in the placenta.

The aim of this study was to compare the predictive value of umbilical artery Doppler velocimetry in women in the supine position with that in women in the complete left lateral position as a screening test for abnormal obstetric outcomes. Umbilical artery resistance index (RI) was measured at 27-29 weeks and 35-37 weeks in 202 pregnant women. The measurements were performed with the mother in the supine position in 100 cases (supine group), and in the complete left lateral position in 102 cases (lateral group). Predictive values of the tests for abnormal outcomes (small for gestational age, fetal distress, pregnancy-induced hypertension) were compared between both groups. When abnormal RIs were defined as being greater than the 90th centile in the supine group, the sensitivities for any of the abnormal outcomes at 27-29 weeks were 18% in the supine group and 6% in the lateral group; the positive predictive values were 30% and 25%, respectively. For measurement at 35-37 weeks, the sensitivity and positive predictive value were 29% and 45%, respectively in the supine group, and 0% in both cases in the lateral group. When abnormal RIs were defined as being greater than the 90th centile in the lateral group, the sensitivities at 27-29 weeks were 41% in the supine group and 6% in the lateral group; the positive predictive values were 44% and 8%, respectively. At 35-37 weeks, the sensitivity and positive predictive value were 53% and 43% in the supine group, and 6% and 8% in the lateral group. Umbilical artery Doppler velocimetry when the mother was in the complete left lateral position was of little value as a screening test. However, when the mother is in the supine position, it may serve as a kind of stress test and disclose latent obstetric abnormalities in certain cases.

A complete hydatidiform mole coexisting with a fetus is a rare condition. The diagnosis is often difficult because of the morphological similarity to a partial mole, but is crucial to management in the postmolar course. We present a case of molar pregnancy coexisting with a fetus in which DNA polymorphism analysis revealed a different genetic origin for the fetal and molar parts. This is the only known case of a complete mole in a twin pregnancy complicated by pre-eclampsia followed by maternal pulmonary oedema. During follow-up, the patient developed a clinically invasive mole which was successfully treated with chemotherapy. In this case, genetic analysis unequivocally diagnosed a twin pregnancy consisting of a complete hydatidiform mole and a fetus.

We describe a case of congenital cystic adenomatoid malformation treated by thoracoamniotic shunting using a double-flower catheter. An ultrasound examination at 25 weeks' gestation revealed a cystic mass within the fetal thoracic cavity, hydrops and polyhydramnios. Thoracoamniotic shunting under ultrasound guidance using a double-flower catheter was performed at 27 weeks. The procedure not only decompressed the lung cyst but also improved the secondary physiological changes, i.e. mediastinal shift, hydrops and polyhydramnios. A 2438-g male neonate was delivered at 37 weeks with no respiratory problems and resection of the right lower pulmonary lobe was successfully performed 24 h after birth.

Overall, approximately 1% of ectopic pregnancies are abdominal pregnancies, which can be life-threatening even when surgical intervention with laparotomy is performed. We present a case in which abdominal pregnancy was successfully managed by operative laparoscopy. A 25 year old Japanese woman presented 6 weeks after her last menstruation with elevated basal body temperature, lower abdominal pain, and light vaginal bleeding. The urinary human chorionic gonadotrophin (HCG) concentration was 2137 IU/I, and laparoscopic findings (i.e. the implantation site was the posterior serosa of the uterus with normal adnexae) established a diagnosis of primary abdominal pregnancy. The gestational product was completely removed by laparoscopic surgery with no uncontrollable loss of blood. The urinary concentration of HCG declined rapidly and the patient made an uneventful recovery. Operative laparoscopy is a safe alternative for the management of appropriately selected patients with early abdominal pregnancy.

Use of three-dimensional ultrasonograms in daily clinical medicine requires the development of data accumulation techniques and image reconstruction techniques . We describe an image position and orientation detection technique using small piezoelectric vibratory gyroscopes. Such gyroscopes, of the same type that is used in an automobile navigation system, produce angular velocity by Coriolis force. After attaching three gyroscopes to an ordinary transvaginal probe, we attempted to detect image orientation to assist transvaginal scanning and to reconstruct three-dimensional projection images. Three-dimensional images were reconstructed by simple white and black inversion thresholding technique. Using free hand transvaginal scanning, the direction of the transvaginal ultrasound beam was displayed with B-mode ultrasonography. Using a personal computer, three-dimensional images of follicles and fetuses were successfully reconstructed within a few minutes. Our system provides easy understanding of transvaginal sonographic images and potentially might allow ordinary ultrasound machines to handle three-dimensional images in a day-to-day clinical practice.

This study was undertaken to investigate the influence of past pregnancy and delivery on the perimenopausal status in 144 women (48-52 years of age). Individual interviews to ascertain the personal profile, medical history, events at pregnancy, delivery and puerperium, and the kind and severity of climacteric symptoms were held. The subjects were divided into two groups by means of a simplified menopausal index (SMI): group A had climacteric symptoms (SMI50) and those in group B had mild symptoms (SMIor = 50). The analysis of the principal components, and the correlation among the variables revealed that three factors--the impression and events at past pregnancies and deliveries, reproductive functions, and the psycho-character properties--had a significant influence on the status at the perimenopause, but the social-environmental factors appeared to have no significant influence on the severity of climacteric symptoms.

Cellular proliferation and differentiation in mammary gland are known to be significantly altered during pregnancy and subsequent lactation. To characterize the different stages of mammary gland during pregnancy and lactation, we analyzed the glycosphingolipid compositions in the mammary gland of DDD and ICR mice at several periods of pregnancy and lactation, and found that the ganglioside composition, but not neutral glycosphingolipids, was characteristically altered during the pregnancy and lactation periods. The concentrations of acidic glycosphingolipids, I3SO3-GalCer 1, GM3, GM1a, GM1b and GD1a, were reduced during the course of pregnancy and lactation. GD1 alpha (III6NeuAc alpha,IV3NeuAc alpha-Gg4Cer) was first detected at the mid-period of pregnancy (12 days of pregnancy for ICR mice), increased in concentration at the late-period of pregnancy (GD1 alpha concentration was 100 times higher at 18 days than that at 12 days of pregnancy), and was a major ganglioside comprising 60-70% of the total lipid-bound sialic acid in the mammary gland of ICR and DDD mice at the lactation period, indicating that expression of GD1 alpha is associated with the lactating mammary gland of mice. In fact, GD1 alpha was highly concentrated in the milk fat globule, in which it was a major component.

Decidualized tissues are characterized by the intensive outgrowth of the microvasculature. Several angiogenic factors are assumed to be involved during the drastic change in the vasculature occurring in the process of decidualization. We examined the possible role of platelet-derived endothelial cell growth factor (PD-ECGF), a known angiogenic factor, during the process of early decidualization in humans. The expression of PD-ECGF in human endometrium was demonstrated by Western blot analysis, a marked increase being found in decidualized endometrium. Immunohistochemical staining showed that PD-ECGF immunoreactivity was present mainly in decidualized endometrial stromal cells. We established a primary cell culture of human endometrial stromal cells which were differentiated into decidualized cells in vitro by the addition of progesterone. In this cell culture system, progesterone augmented the expression of PD-ECGF in a dose-dependent fashion. The addition of progesterone also resulted in an increased release of prolactin, a well-known marker for decidualization. These findings suggest that PD-ECGF may play a physiological role as a possible angiogenic factor in the process of decidualization of human endometrium.

Much evidence indicates that human tissues produce prolactin. However, little is known as to which agents regulate its production in decidual tissues. Therefore, it is of interest to examine the effect of arachidonic acid on the production of prolactin, since it is present in considerably large amounts in decidual tissues. The addition of arachidonic acid to culture media resulted in a significant reduction in the amount of prolactin secreted from incubated decidual tissues in a dose-related fashion. Other poly-unsaturated fatty acids, i.e. linoleic and gamma-linolenic acid also inhibited its secretion, whereas saturated fatty acid and mono-unsaturated fatty acids, such as oleic acid, were without effect. The addition of phospholipase A2 and phospholipase C, enzymes to liberate arachidonic acid from phospholipids, also suppressed the secretion of prolactin. Indomethacin and BW-755C, inhibitors of cyclooxygenase and lipoxygenase, respectively, had essentially no effect on the secretion of prolactin. Translatable mRNA for prolactin was detected in decidual tissues. Arachidonic did not alter either the amount of mRNA in prolactin of the amount of its mRNA as a percentage of total mRNA. Thus, it appears that arachidonic acid possibly plays a role as a physiological regulator of prolactin secretion in human decidual tissues. The action of arachidonic acid is not mediated by cyclooxygenase or lipoxygenase products, suggesting that arachidonic acid itself, or its metabolites other than prostaglandin and leukotriene, may be involved in the regulation of prolactin secretion.