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Objective: Placental abruption is associated with adverse perinatal outcomes including intrauterine fetal demise, which subsequently results in stillbirth. However, few studies have demonstrated the preventability of stillbirth due to placental abruption. Therefore, we evaluated the possibility of preventing stillbirth caused by placental abruption by reviewing all stillbirths in our region., Methods: This study reviewed all stillbirths after 22 weeks of gestation in Shiga Prefecture, Japan from 2010 to 2019, excluding lethal disorders. We evaluated 350 stillbirth cases, with and without placental abruption., Results: There were 32 stillbirths with PA and 318 without placental abruption. The probability of preventing stillbirth was significantly higher in patients with placental abruption than in those without (30% vs. 8%, p  < 0.001). We also determined the recommendations for preventing stillbirths with placental abruption., Conclusion: Some stillbirths caused by placental abruption can be prevented. We recommend improvements to perinatal maternal-fetal care and perinatal emergency transport systems.

Objective: We aimed to examine amniotic fluid neutrophil gelatinase-associated lipocalin (NGAL) and L-type fatty acid-binding protein (L-FABP) levels during pregnancy., Study Design: This study included singleton pregnancies. Amniotic fluid samples were collected at the time of vaginal delivery, cesarean section, amniocentesis, amnioreduction, and amnioinfusion. We analyzed changes of the NGAL and L-FABP levels during pregnancy and the factors affecting these values and their association with clinical outcomes., Results: Three hundred and one pregnancies were analyzed. Respective Pearson correlation coefficients for the NGAL and L-FABP levels and gestational age at inspection were - 0.351 and - 0.819 (p <0.001 and p < 0.001, respectively); weak and strong negative correlation were observed. The NGAL level was significantly higher in the intra-amniotic infection group than in the control group (p < 0.001). The L-FABP level was significantly higher in the fetal blood flow abnormalities group than in the control group (p < 0.001). The NGAL and L-FABP levels were significantly higher in the adverse outcomes group than in the control group (p = 0.019 and p < 0.001, respectively), and the respective areas under the concentration-time curve, with optimal cutoff values, for the NGAL and L-FABP levels were 0.693 (14,800 µg/gCr) and 0.864 (378 µg/gCr)., Conclusions: Amniotic fluid NGAL and L-FABP levels reflect fetal and neonatal immaturity. Additionally, the NGAL level is a useful predictive factor of intra-amniotic infection, and the L-FABP level is a useful predictive factor of fetal condition and short- and long-term prognoses., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Objective: Fetal growth restriction (FGR) is associated with perinatal adverse outcomes including intrauterine fetal death. Antenatally unidentified FGR has a higher risk of intrauterine fetal death than that identified antenatally. We, therefore, investigated the antenatal identification of FGR among intrauterine fetal deaths, and assessed the perinatal factors associated with the identification of FGR., Methods: This retrospective and population-based study reviewed all stillbirths in Shiga Prefecture, Japan, from 2007 to 2016 with exclusion criteria of multiple births, births at unidentified gestational weeks or < 22 gestational weeks, and lethal disorders. We analyzed cases of FGR, using the Japanese clinical definition: Z -score of estimated fetal weight for gestational age <-1.5 standard deviations ( SD )., Results: We identified 94 stillbirths with FGR among 429 stillbirths. Thirty-seven cases were antenatally identified during pregnancy management (39%). Dividing cases by a Z -score of -2.5 SD , 51 cases were classified as ≤-2.5 SD . Twenty-eight of the 51 cases (55%) with a Z -score <-2.5 SD were antenatally identified as having FGR, whereas 9 of the 43 cases (21%) with a Z -score ≥-2.5 SD were antenatally identified as having FGR ( p  = .002). Among cases with a Z -Score <-2.5 SD , 16 of 21 (76%) beyond 28 weeks' gestation and 12 of 30 (40%) before 28weeks' gestation were antenatally identified as having FGR ( p  = .023)., Conclusion: Fetal growth restriction leading to intrauterine fetal death in Japan was antenatally identified in less than half of cases. Antenatal identification of FGR was associated with the severity of growth restriction.

Objective: We aimed to analyze the predictive efficacy of amniotic fluid interleukin-6 (IL-6) and neutrophil gelatinase-associated lipocalin (NGAL) for fetal inflammatory response syndrome (FIRS)-related infection., Materials and Methods: We included singleton pregnancies classified into FIRS and non-FIRS groups. FIRS was defined as histologic chorioamnionitis and funisitis. Amniotic fluid samples were collected during vaginal delivery (VD) or cesarean section (CS). We compared amniotic fluid IL-6 and NGAL levels between the groups., Results: Forty-six pregnancies were analyzed and classified into 20 (43.5%) FIRS and 26 (56.5%) non-FIRS pregnancies. We observed significant differences in amniotic fluid IL-6 and NGAL. Amniotic fluid collection significantly influenced NGAL levels (p < 0.001). The area under the concentration-time curve (AUC), with optimal cutoff values, for amniotic fluid IL-6 and NGAL (VD and CS) levels was 0.948 (11,344 pg/mL), 0.800 (1180 ng/mL), and 0.946 (708 ng/mL), respectively., Conclusion: Amniotic fluid IL-6 and NGAL levels showed equivalent predictive ability for FIRS-related infection., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article., (Copyright © 2023. Published by Elsevier B.V.)

Gallbladder torsion is a rare disease that requires immediate surgical intervention to avoid maternal and/or foetal sepsis and death. However, preoperative diagnosis is challenging because the disease has no specific symptoms. A 37-year-old pregnant woman at 34 weeks of gestation presented with severe epigastric pain. Ultrasonography and computed tomography scan findings showed a distended gallbladder without stones, floating from the hepatic bed, and laboratory examination demonstrated normal liver function; therefore, we made a diagnosis of gallbladder torsion and performed a caesarean section and an open cholecystectomy under general anaesthesia. This is the first report wherein gallbladder torsion in pregnancy was diagnosed preoperatively. Gallbladder torsion should be considered as a differential diagnosis in case of such imaging findings.

Pregnancy causes changes in the uterus, such as increased cell volume and altered water content. However, the mechanisms that protect the structure and maintain the function of uterine smooth muscle cells against these changes during pregnancy have not been clarified. This study focused on the volume-regulated anion channel (VRAC), which opens with cell swelling under low osmotic pressure and releases Cl - ions and various organic osmolytes to resist cell swelling and regulates a wide range of biological processes such as cell death. In this study, myometrial smooth muscle (MSM) tissues and cells (MSMCs) were collected from non-pregnant and pregnant mice. Using western blotting and immunocytochemistry, leucine-rich repeat containing protein 8A (LRRC8A), an essential membrane protein that constitutes part of the VRAC, was determined to be diffused throughout MSMCs including in the cell membrane. Patch-clamp experiments were performed to investigate the electrophysiology of swelling-induced Cl - currents (I Cl, swell ) mediated by the VRAC. No significant changes between non-pregnancy and pregnancy groups were observed in either the expression density of LRRC8A or the current density of I Cl, swell , however the presence of LRRC8A on the cell membrane was significantly increased in the third trimester of pregnancy compared to the non-pregnancy. This study suggests that the VRAC may play a role, such as maintaining cellular homeostasis in the pregnant MSM.

Fetal growth restriction (FGR) is defined as fetuses who have failed to achieve a normal weight for gestational age. FGR is associated with adverse perinatal outcomes, including stillbirth. Pregnant women often perceive decreased fetal movements before intrauterine fetal death. Previous reports on the association between fetal movements and FGR have mainly targeted livebirths, with few focusing on stillbirths. Studying stillbirths, not livebirths, may help improve perinatal adverse outcomes. This study evaluated the association between FGR leading to stillbirth and maternal perception of decreased fetal movement. This was a population-based study reviewing all stillbirths in Shiga Prefecture, Japan for 10 years. We analyzed 219 stillbirth cases, those with versus without FGR. We then compared maternal visits to healthcare providers due to perception of decreased fetal movement between these two groups. There were 82 stillbirths with FGR, and the remaining 137 stillbirth were without FGR. Women with FGR, compared with those without, were significantly less often to visit the outpatient department due to decreased fetal movement (30%; 25/82 vs. 46%; 63/137: P = 0.034). Pregnant women have more difficulty perceiving decreased fetal movements in cases with severe FGR than in those without FGR. Healthcare providers, including midwives, may need to closely monitor FGR pregnancy in addition to instructing pregnant women to be aware of decreased fetal movement.

Poly(glycidyloxypropyl)silsesquioxane (PGPS) was successfully synthesized by hydrolysis and polycondensation using the nitrogen flow method. A poly(3-(2,3-dihydroxypropoxypropyl)silsesquioxane) (PSQ-OH) film was prepared via two routes. In route A, PSQ-OH was prepared by the hydrolysis of the epoxy group of PGPS in an aqueous hydrochloric acid (HCl)/tetrahydrofuran solution, affording a diol group; then, PSQ-OH was coated on a glass substrate and heated. The antifogging performance of the PSQ-OH film was evaluated in terms of water uptake (WU) and scratch resistance. The obtained PSQ-OH film exhibited a low WU of 5% and a scratch resistance of 1.6. In route B, PGPS was coated on a glass substrate and immersed in a 0.5 mol/L aqueous sulfuric acid solution for 1-15 h at room temperature, producing a diol group. The solid-state 13 C nuclear magnetic resonance spectrum indicated that the epoxy group was completely hydrolyzed after immersion for 15 h. The WU of the PSQ-OH film prepared via route B increased from 5 to 19% with the increase in the immersion time and was higher than that of the PSQ-OH film prepared via route A. The PSQ-OH film on a glass substrate retained transparency under water vapor exposure at 60 °C. The PSQ-OH film prepared via route B exhibited a high scratch resistance of 2.7-3.6, similar to that of a poly(3-(2-aminoethylaminopropyl)silsesquioxane) film. The scratch resistance of the PSQ-OH film was 5-7 times higher than that of the poly(vinyl alcohol) film. The PSQ-OH film was uniform with no pinholes and cracks. The PSQ-OH film was transparent and colorless and exhibited a high transmittance of >90% in the wavelength range of 400-800 nm. Overall, the prepared PSQ-OH film exhibits good antifogging, transparency, and mechanical properties.

New Findings: What is the central question of this study? The physiological response to sacral neuromodulation by pregnant women and foetuses has not been previously explored. What is the main finding and its importance? Sacral surface electrical stimulation had no adverse effect on pregnant women and foetuses at least 36 weeks of gestation. It may cause uterine relaxation resulting from decreased uterine artery pulsatility index and increased umbilical venous flow volume and thereby improve utero-placental perfusion and improve lower back pain., Abstract: This study aimed to examine the impact of sacral surface electrical stimulation on maternal and foetal physiology during pregnancy. Ten pregnant women at 36 weeks of gestation without multiple gestations, foetuses with malformations, foetal growth restriction, hypertensive disorders, polyhydramnios, or oligohydramnios were enrolled. This prospective study monitored maternal and foetal physiological responses before and after sacral surface electrical stimulation for single pregnancies. Sacral surface electrical stimulation was performed once per patient. Each parameter was measured directly before and then immediately after stimulation. Follow-up measurements were conducted at 12 h, 1 day, 2 days and 7 days after stimulation. Variables of interest were compared before and after the stimulation. Regarding the foetal Doppler measurements, significant differences were not found in the umbilical and middle cerebral artery pulsatility index. However, foetuses showed a significant increase in the umbilical venous flow volume. The uterine contraction frequency and the maternal uterine artery pulsatility index significantly decreased. Pregnancy outcomes, and rates of caesarean section, foetal distress, and neonatal asphyxia were not confirmed. In conclusion, sacral surface electrical stimulation had no adverse effects on pregnant women or foetuses at 36 weeks of gestation and might improve utero-placental perfusion and lower back pain., (© 2022 The Authors. Experimental Physiology © 2022 The Physiological Society.)

Background: Junctional ectopic tachycardia (JET) is caused by ectopic rhythms, originating in the atrioventricular node, typically with heart rate between 200 and 250 bpm. Herein, we present a case of fetal JET with normal fetal heart rate and a review of nine cases., Case Presentation: A 32-year-old, gravida 2, para 1, woman in whom fetal JET could not be diagnosed prenatally because the fetal heart rate was within the normal range. The fetus was diagnosed with premature restriction of the foramen ovale, and a cesarean section was performed, owing to the right heart overload that was characterized by fetal ascites and abnormal fetal Doppler velocity. Postnatally, the female neonate was diagnosed with JET on a 12-lead electrocardiogram, which revealed a neonatal heart rate of 158 bpm with narrow QRS and atrioventricular dissociation. After failure to respond to amiodarone therapy, she was treated with flecainide, which controlled the JET rate from 120 to 150 bpm. Fetal tachycardia with ventriculo-atrial (VA) dissociation or 1:1 VA conduction with a shorter VA interval than that of atrioventricular reentrant tachycardia confirmed the diagnosis of fetal JET., Conclusions: JET should be suspected even in the absence of tachycardia in patients with ductus venosus and pulmonary vein retrograde flow or tricuspid and mitral regurgitation without a cardiac anomaly, as tachycardia might sometimes be intermittent in cases of JET., (© 2022. The Author(s).)

Objective: Transabdominal amnioinfusion is beneficial in oligohydramnios, which has high fetal mortality and does not improve with observation alone. However, there are few reports on the maternal adverse events of transabdominal amnioinfusion. This study aimed to evaluate the adverse events of amniocentesis with transabdominal amnioinfusion., Study Design: This study is a retrospective cohort study at a single tertiary perinatal center in Japan. A total of 313 procedures in 126 patients who underwent amniocentesis for transabdominal amnioinfusion at our tertiary perinatal institution were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE). Adverse events were retrospectively examined using a 5-grade evaluation based on the CTCAE. Procedurally, a 21-23-G percutaneous transhepatic cholangiography drainage (PTCD) needle was advanced under ultrasound guidance into the amniotic fluid cavity with a gravity-fed infusion of warm saline solution., Results: No maternal deaths were recorded. Only two maternal/fetal adverse events occurred, and grade 4 fetal adverse events requiring pregnancy termination were observed in seven cases. Fetal death occurred in five cases, all with severe oligohydramnios and premature rupture of the membranes. No placental abruption or bleeding occurred before or after delivery., Conclusion: Adverse events during transabdominal amnioinfusion were successfully analyzed using CTCAE. We also provided new terminology for evaluating adverse events during amnioinfusion. Our results may encourage obstetricians to perform amnioinfusion in difficult situations, with less concern for severe maternal or fetal adverse events., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objectives: Although amnioinfusion (AI) for repetitive variable deceleration has been reported to reduce the frequency of variable deceleration and cesarean section (CS) rate, CS is sometimes unavoidable even after therapeutic AI. The purpose of this study was to investigate prenatal factors related to the efficacy of therapeutic AI during labor., Methods: This retrospective study investigated 80 singleton pregnancies that underwent transcervical therapeutic AI for repetitive variable deceleration during labor. AI was performed with 500 mL of warmed saline through an intrauterine pressure catheter by gravity infusion. Prenatal factors related to emergency CS for fetal distress even after therapeutic AI were investigated., Results: Emergency CS was performed for 12 of the 80 cases due to fetal distress. Z-score for umbilical cord length was significantly smaller in the CS group (-0.68 SD) than in the vaginal delivery group (0.15 SD, p  < .001). No CSs were performed in cases with Z-score for umbilical cord length >-0.05 SD. No significant differences between CS and vaginal delivery groups were seen in gestational age at delivery, cervical dilatation at AI, birth weight, Z-score of birth weight, incidence of the nuchal cord or incidence of abnormal umbilical cord insertion., Conclusions: Therapeutic AI for repetitive variable deceleration was considered useful, in many cases avoiding emergency CS. Short umbilical cord length (lower Z-score) was related to emergency CS after therapeutic AI for repetitive variable deceleration. Umbilical cord length may offer an important factor for assessing the risk of fetal distress that is difficult to avoid, if methods to accurately determine umbilical cord length can be developed.

Purpose: To explore the histopathological findings of cesarean scar defect (CSD) and the immunological component in women with cesarean scar syndrome (CSS)., Methods: This retrospective study was conducted in a university hospital and a public hospital. A total of 63 patients with secondary infertility due to CSS who underwent laparoscopic resection of the CSD lesion were enrolled (CSS group), and 21 patients who underwent hysterectomy with a history of cesarean section were enrolled as control (non-CSS group). We compared the differences in histopathological findings of CSD lesions by hematoxylin and eosin staining and immunohistochemistry for CD3, CD20, CD56, CD68, CD138, myeloperoxidase, and tryptase between the two groups., Results: The frequency of presence of endometrium on the CSD surface was significantly lower ( p  = 0.0023) and that of adenomyosis was significantly higher ( p  = 0.0195) in the CSS group than in the non-CSS group. The number of CD3-, CD20-, CD68-, and tryptase-positive cells was significantly lower in the CSS group than in the non-CSS group; however, the number of CD138-positive cells was significantly higher in the CSS group ( p  = 0.0042)., Conclusions: This study suggested that the absence of endometrium, presence of adenomyosis, and chronic inflammation in CSD contributes to secondary infertility due to CSS., Competing Interests: Asuka Higuchi, Shunichiro Tsuji, Yuri Nobuta, Akiko Nakamura, Daisuke Katsura, Tsukura Amano, Fuminori Kimura, Satoshi Tanimura, and Takashi Murakami declare that they have no conflict of interest., (© 2021 The Authors. Reproductive Medicine and Biology published by John Wiley & Sons Australia, Ltd on behalf of Japan Society for Reproductive Medicine.)

Objective: The aim of the article was to investigate the changes in intra-amniotic pressure following transabdominal amnioinfusion during pregnancy., Design: This retrospective study included 19 pregnant women who underwent transabdominal amnioinfusion during pregnancy to relieve umbilical cord compression and improve the intrauterine environment or to increase the accuracy of ultrasonography., Materials and Methods: We measured and analyzed the changes in intra-amniotic pressure, single deepest pocket, and the amniotic fluid index before and after amnioinfusion. We also determined the incidence of maternal or fetal adverse events, such as preterm premature rupture of membranes, preterm delivery, fetal death within 48 h, placental abruption, infection, hemorrhage, and peripheral organ injury., Results: A total of 41 amnioinfusion procedures were performed for 19 patients. The median gestational age during the procedure was 24.3 weeks. The median volume of the injected amniotic fluid was 250 mL. The median single deepest pocket and amniotic fluid index after amnioinfusion were significantly higher than those before amnioinfusion (4.0 cm vs. 2.65 cm; p < 0.001 and 13.4 cm vs. 6.0 cm; p < 0.001). However, the median (range) intra-amniotic pressure after amnioinfusion was not significantly different compared to that before amnioinfusion (11 mm Hg vs. 11 mm Hg; p = 0.134). Maternal or fetal adverse events were not observed following amnioinfusion., Conclusion: Intra-amniotic pressure remained unchanged following amnioinfusion. The complications associated with increased intra-amniotic pressure are not likely to develop if the amniotic fluid index and/or single deepest pocket remains within the normal range after amnioinfusion. Studies of groups with and without complications are warranted to clarify the relationship between the intra-amniotic pressure and incidence of complications., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2021 by S. Karger AG, Basel.)

Aim: We aimed to evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of noninvasive prenatal testing (NIPT) in high-risk pregnant women., Methods: Pregnant women who underwent GeneTech NIPT, the most commonly used NIPT in Japan, between January 2015 and March 2019, at Japan NIPT Consortium medical sites were recruited for this study. The exclusion criteria were as follows: pregnant women with missing survey items, multiple pregnancy/vanishing twins, chromosomal abnormalities in the fetus other than the NIPT target disease, and nonreportable NIPT results. Sensitivity and specificity were calculated from the obtained data, and maternal age-specific PPV and NPV were estimated., Results: Of the 45 504 cases, 44 263 cases fulfilling the study criteria were included. The mean maternal age and gestational weeks at the time of procedure were 38.5 years and 13.1 weeks, respectively. Sensitivities were 99.78% (95% confidence interval [95% CI]: 98.78-99.96), 99.12% (95% CI: 96.83-99.76), and 100% (95% CI: 88.30-100) for trisomies 21, 18, and 13, respectively. Specificities were more than 99.9% for trisomies 21, 18, and 13, respectively. Maternal age-specific PPVs were more than 93%, 77%, and 43% at the age of 35 years for trisomies 21, 18, and 13, respectively., Conclusion: The GeneTech NIPT data showed high sensitivity and specificity in the detection of fetal trisomies 21, 18, and 13 in high-risk pregnant women, and maternal age-specific PPVs were obtained. These results could provide more accurate and improved information regarding NIPT for genetic counseling in Japan., (© 2021 Japan Society of Obstetrics and Gynecology.)

Ultrasonography and fetal heart rate monitoring are subjective assessments of fetal condition, which warrants the need for objective markers to predict fetal condition. Urinary L-type fatty acid-binding protein (L-FABP) levels correlate with hypoperfusion. Elevated amniotic fluid L-FABP levels may represent fetal tissue hypoperfusion since the amniotic fluid contains fetal urine. In this study, we aimed to analyze the effectiveness of amniotic fluid L-FABP as a predictor of fetal condition. We classified singleton pregnancies into groups based on fetal growth restriction (FGR) with and without fetal blood flow abnormalities (FGR and healthy-FGR groups, respectively) and the non-FGR group (control group). We collected amniotic fluid at the time of vaginal delivery, cesarean section and amniocentesis, and compared the patient characteristics, clinical outcomes and amniotic fluid levels of L-FABP between the groups. We analyzed 153 singleton pregnancies and 186 amniotic fluid samples (FGR group, 6 (3.9%) pregnancies and 23 (12.4%) samples; healthy-FGR group, 15 (9.8%) pregnancies and 20 (10.7%) samples; control group, 132 (86.3%) pregnancies and 143 (76.9%) samples). The amniotic fluid L-FABP level was significantly higher in the FGR group compared to that in the healthy-FGR and control groups. Multivariate analysis revealed that the amniotic fluid L-FABP level was not affected by fetal body weight. Additionally, the amniotic fluid L-FABP levels increased significantly in cases with fetal blood flow abnormalities or early gestational age. Therefore, amniotic fluid L-FABP level may be an objective and accurate predictive marker of fetal condition.

Aim: To analyze the effectiveness of amniotic fluid neutrophil gelatinase-associated lipocalin and L-type fatty acid-binding protein as predictive factors for fetal inflammatory response syndrome., Methods: We classified single pregnancy cases into the fetal inflammatory response syndrome and nonfetal inflammatory response syndrome groups. We collected amniotic fluid at vaginal delivery and cesarean section and compared the patient characteristics, maternal white blood cell count, C-reactive protein level, and amniotic fluid interleukin-6; neutrophil gelatinase-associated lipocalin; and L-type fatty acid-binding protein levels between the groups. We further analyzed the relationship between L-type fatty acid-binding protein levels and neonatal clinical outcomes., Results: We analyzed 129 pregnancies, of which 36 and 93 (27.9% and 72.1%, respectively) were classified into the fetal inflammatory response syndrome and nonfetal inflammatory response syndrome groups, respectively. We observed significant differences in the maternal white blood cell counts and amniotic fluid interleukin-6 and neutrophil gelatinase-associated lipocalin levels. On the multivariate analysis, the useful predictive factors were maternal white blood cell count and amniotic fluid interleukin-6 and neutrophil gelatinase-associated lipocalin levels. Furthermore, the level of L-type fatty acid-binding protein was significantly higher in the transient tachypnea of the newborn and postnatal respiratory support group than in the control group., Conclusions: The maternal white blood cell count and amniotic interleukin-6 and neutrophil gelatinase-associated lipocalin levels were effective predictors of fetal inflammatory response syndrome. Amniotic fluid L-type fatty acid-binding protein level was an effective predictor of neonatal respiratory support., (© 2021 Japan Society of Obstetrics and Gynecology.)

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.Impact statement 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.

Background: There is no established treatment for fetal growth restriction during pregnancy. We report two cases that represent an example of an amnioinfusion-based management strategy for severe fetal growth restriction with umbilical cord complications., Case Presentation: We encountered two cases of fetal growth restriction with abnormal fetal Doppler velocity. In one case, fetal ultrasound revealed a hypercoiled umbilical cord with a single umbilical artery and oligohydramnios, while fetal Doppler revealed a reversed end-diastolic flow in the umbilical artery and reversed a-waves of the ductus venosus. Umbilical cord compression was confirmed at 22 weeks and 2 days of gestation, and nine amnioinfusions were performed to relieve the umbilical cord compression. A cesarean section was performed at 31 weeks and 2 days of gestation because of severe preeclampsia. The Asian infant is now a normally developed 6-month-old. In another Asian case, fetal ultrasound revealed a hypercoiled cord, while fetal Doppler revealed a reversed end-diastolic flow in the umbilical artery and intermittent reversed a-waves of the ductus venosus. Umbilical cord compression was confirmed at 24 weeks and 5 days of gestation, and seven amnioinfusions were performed. A cesarean section was performed at 31 weeks and 1 day of gestation because of nonreassuring fetal status. At the age of 1 month, the Asian infant was stable on respiratory circulation. In both cases, fetal Doppler findings improved significantly following amnioinfusions., Conclusions: Amnioinfusion is a symptomatic treatment for umbilical cord compression. However, to determine the therapeutic effect of amnioinfusion, complete resolution of the umbilical cord compression should be ascertained by ultrasonography., (© 2021. The Author(s).)

Maternal perception of decreased fetal movement is associated with adverse perinatal outcomes. Although there have been several studies on interventions related to the fetal movements count, most focused on adverse perinatal outcomes, and little is known about the impact of the fetal movement count on maternal behavior after the perception of decreased fetal movement. We investigated the impact of the daily fetal movement count on maternal behavior after the perception of decreased fetal movement and on the stillbirth rate in this prospective population-based study. Pregnant women in Shiga prefecture of Japan were asked to count the time of 10 fetal movements from 34 weeks of gestation. We analyzed 101 stillbirths after the intervention compared to 121 stillbirths before the intervention. In multivariable analysis, maternal delayed visit to a health care provider after the perception of decreased fetal movement significantly reduced after the intervention (aOR 0.31, 95% CI 0.11-0.83). Our regional stillbirth rates in the pre-intervention and post-intervention periods were 3.06 and 2.70 per 1000 births, respectively. Informing pregnant women about the fetal movement count was associated with a reduction in delayed maternal reaction after the perception of decreased fetal movement, which might reduce stillbirths.

Osteogenesis imperfecta (OI), or brittle bone disease, is a heterogeneous disorder characterised by bone fragility, multiple fractures, bone deformity, and short stature. OI is a heterogeneous disorder primarily caused by mutations in the genes involved in the production of type 1 collagen. Severe OI is perinatally lethal, while mild OI can sometimes not be recognised until adulthood. Severe or lethal OI can usually be diagnosed using antenatal ultrasound and confirmed by various imaging modalities and genetic testing. The combination of imaging parameters obtained by ultrasound, computed tomography (CT), and magnetic resource imaging (MRI) can not only detect OI accurately but also predict lethality before birth. Moreover, genetic testing, either noninvasive or invasive, can further confirm the diagnosis prenatally. Early and precise diagnoses provide parents with more time to decide on reproductive options. The currently available postnatal treatments for OI are not curative, and individuals with severe OI suffer multiple fractures and bone deformities throughout their lives. In utero mesenchymal stem cell transplantation has been drawing attention as a promising therapy for severe OI, and a clinical trial to assess the safety and efficacy of cell therapy is currently ongoing. In the future, early diagnosis followed by in utero stem cell transplantation should be adopted as a new therapeutic option for severe OI.

A number of scholarly reports have shown the importance of mental health care during pregnancy, especially for women with mental disorders. Nevertheless, the postpartum mortality rate due to mental disorders has been a serious issue in Japan. Therefore, since January 2015, our hospital has implemented a liaison system in which one psychiatric nurse specialist contributes to perinatal care. The aim of this study is to explore the impacts of a psychiatric nurse specialist as a liaison for pregnant women with mental disorders. More specifically, the investigation was retrospectively performed from January 2011 to December 2019 using medical records from a single university medical hospital in Japan. Participants comprised pregnant women with mental disorders. Of the 4,066 total deliveries completed during the study period, 152 women were detected as being exposed to the liaison system (2015-2019), while 92 were recognized as controls (2011-2014). We then conducted a comparative analysis between those who were exposed to the liaison system and the control group. Except for Apgar scores taken five minutes after birth, there were no intergroup differences in the patient characteristics or perinatal psychiatric outcomes. We found that the liaison system was associated with an increased rate of referral to the local public health center (p = 0.003). The system also significantly delayed the time at which patients first visited a psychiatrist because a psychiatric nurse could determine the urgency through interviews with the patients. Overall, our results suggest that the liaison system is helpful for pregnant women with mental disorders.

Background: Uterine inversion may cause massive hemorrhage, resulting in maternal deterioration and death. Replacement of the inverted uterus must be performed as soon as possible. As time passes, the inverted uterus becomes atonic and necrotic, and a surgical approach may be required., Case Presentation: A 27-year-old Japanese woman was admitted to our hospital 4 hours postpartum with increased hemorrhage after the replacement of an inverted uterus. Recurrent inversion was diagnosed, and though the atonic uterus was replaced again by the Johnson maneuver, hemorrhage persisted. Balloon tamponade was not successful in stopping the hemorrhage, and uterine artery embolization was performed. Bleeding resumed the next day on removal of the balloon, and hysterectomy was performed. Massive hemorrhage, coagulopathy, and uterine necrosis caused uterine atony, and the reperfused blood flow on replacement of the ischemic uterus increased hemorrhage., Conclusions: Cases of uterine inversion with coagulopathy lasting for more than 4 hours may require a surgical intervention, and uterine replacement may have to be delayed until the maternal hemodynamic condition is stabilized. Uterine replacement under laparotomy may be also be considered due to the risk of increased hemorrhage.

Aim: Our study aimed to clarify the prognosis of bilateral and unilateral umbilical artery end-diastolic blood flow abnormalities (BFAs) in monochorionic diamniotic twin pregnancies. Methods: Monochorionic diamniotic twin pregnancies were classified into bilateral (group 1), unilateral (group 2), and no (group 3) umbilical artery end-diastolic BFAs. After the usual obstetric management, short- and long-term prognoses were analyzed. Results: A total of 171 monochorionic diamniotic twins were analyzed and classified into group 1 (13 twins, 7.6%), 2 (12 twins, 7.0%), and 3 (146 twins, 85.4%). Gestational age at delivery was significantly lower in group 1 than in groups 2 and 3 (median, 29.3, 35.6, and 35.6 weeks, respectively; p  < .01 and p  < .001). The survival rate of fetuses with BFAs was significantly lower in group 1 than in group 2 (23.0% [3/13] versus 100% [12/12]; p  < .001). However, the survival rate of the co-twin was not significantly different between groups 1 and 2 (84.6% [11/13] versus 100% [12/12]; p  = .48). The survival rate of both fetuses was significantly lower in group 1 than in groups 2 and 3 (53.8% [14/26], 100% [24/24], and 98.6% [288/292], respectively; both p  < .001). In cases with fetal therapy, the survival rate of both fetuses tended to be lower in group 1 than in group 2 (44.4% [8/18] versus 83.3% [10/12]; p  = .05). In cases without fetal therapy, the gestational age at delivery tended to lower in group 1 than in group 2 and was significantly lower than in group 3 (median, 29.1, 35.6, 35.6 weeks, respectively; p  = .05 and p  < .05). The survival rate of fetuses with BFA tended to be lower in group 1 than in group 2 (50.0% [2/4] versus 100% [12/12]; p  = .05). The survival rate of the co-twin was not significantly different between groups 1 and 2 (100% [4/4] versus 100% [12/12]; p  = 1). The survival rate of both fetuses tended to be lower in group 1 than in group 2 and was significantly lower than in group 3 (75% [6/8], 100% [24/24], and 99.2% [278/280], respectively; p = .05 and p  < .01). Conclusions: In monochorionic diamniotic twin pregnancies, bilateral umbilical artery end-diastolic BFAs demonstrated a poor prognosis. However, unilateral abnormalities exhibited a good prognosis similar to that in twins with normal umbilical artery blood flow. If such abnormalities are detected during a routine checkup, the umbilical artery pulse wave on the other side should be examined.

Gestational psittacosis is a rare disease that is associated with significant maternal and fetal morbidity and mortality. Currently, there is no examination method which allows for a quick diagnosis. We report a case of gestational psittacosis that could not be diagnosed as psittacosis during treatment and resulted in maternal and fetal death despite intensive treatment. We also reviewed 23 cases of gestational psittacosis. Fetal and maternal mortality was 82.6% (19/23) and 8.7% (2/23), respectively. In pregnant women with high fever and flu-like symptoms, we should suspect Chlamydia psittaci infection if at least one of the following is present; contact with sheep, parrots, parakeets or goats; normal or moderately decreased leucocyte count, thrombocytopenia and hepatic and/or renal dysfunction; cough and/or lobe consolidation or infiltration on chest X-ray. Antibiotic therapy with macrolide prenatally, macrolide or tetracycline postnatally and termination of pregnancy should be considered., (© 2020 Japan Society of Obstetrics and Gynecology.)

Eating disorders are common psychiatric disorders among women of reproductive age, and the prevalence of eating disorders has been increasing over time in Japan and other countries. The aim of the present study was to assess perinatal outcomes in maternal anorexia nervosa in Japan and to explore methods to improve perinatal outcomes. This study consists of a case series describing 13 single pregnancies of 11 women with a history of anorexia nervosa, and a cross-sectional study comparing 13 cases with 240 healthy controls. In the case group, nine cases conceived while underweight, including three who had fertility treatment. Anorexia symptoms during pregnancy were quite common, and pregnant smokers presented with extremely disturbed eating behaviors. In a cross-sectional study, premature birth and the standard deviations from the mean birth weight and mean head circumference at birth were evaluated as outcome measures. The adjusted odds ratios or the adjusted differences between two means for the above outcomes were estimated by two approaches: multivariate models and matching analysis. Statistical analysis showed that maternal anorexia nervosa was associated with an increased risk of premature birth and symmetric growth restriction mediated by low pre-pregnancy body mass index and poor gestational weight gain which were adjusted as confounders. Smoking during pregnancy was a potential indicator of abnormal eating behavior and could be predictive of poor perinatal outcomes. We therefore conclude that remission of anorexia nervosa before pregnancy could improve perinatal outcomes through both normal nutrition and smoking cessation. Fertility treatment while underweight is not recommended.

Background: Adenomyosis is a benign gynecological condition in which endometrial tissue or endometrial-like tissue develops within the uterine myometrium. Few cases of disseminated intravascular coagulation has been reported in the patients with adenomyosis. Although hysterectomy is indicated for refractory massive uterine bleeding in the patients with advanced uterine adenomyosis, conservative treatment is often desired in women in the late reproductive age. Recently such cases are increasing due to the social trend of late marriage., Case Presentation: A 37-year-old woman with huge adenomyosis, gravida 2 para 0, was referred to our hospital to terminate her pregnancy. Acute, non-septic, disseminated intravascular coagulation (DIC) developed after early pregnancy was terminated in a woman with huge adenomyosis. Massive bleeding and DIC occurred 3 days after the dilatation and curettage. There was no evidence of infection as the cause of the DIC, because neither bacteria nor endotoxin could be detected in her blood, and antithrombin 3 (AT3), which would be expected to decrease in septic patients, was not decreased. Hemorrhage in the adenomyotic tissue after the termination presumably developed inflammation, with numerous microthrombi and necrosis in the adenomyotic tissue, which subsequently promoted coagulation and fibrinolysis, leading to the onset of massive uterine bleeding and DIC. Although severe hyperfibrinolysis is observed in peripheral blood, the fibrinolysis state in the uterine myometrium is considered to be even more severe. The newly formed clots for hemostasis under the uterine mucosa could be removed due to the excessive activation of fibrinolytic system happened in the adjacent myometrium, leading to the onset of massive uterine bleeding. Massive bleeding and DIC resolved quickly after the patient was treated with nafamostat mesilate, which is effective for both excessive coagulation and fibrinolysis., Conclusions: Adenomyosis could cause massive bleeding and DIC when pregnancy is terminated. Massive bleeding was considered to occur because the excessive fibrinolysis system inside adenomyosis affected the adjacent endometrium. Before considering hysterectomy to control refractory uterine bleeding, nafamostat mesilate should be considered as one option, thinking the pathophysiology of the massive bleeding due to uterine adenomyosis.

Background: There have been no previous reports on the postnatal course, especially long-term outcomes, of fetal hydrothorax patients, including those treated with thoracoamniotic shunting (TAS) using a double-basket catheter.The outcomes of cases from a single center are reported., Methods: Cases of fetal hydrothorax managed at our center between 2005 and 2015 were enrolled retrospectively. TAS was performed if indicated. Long-term outcomes such as cerebral palsy, developmental disabilities, and others were analyzed., Results: Ninety-two cases of fetal hydrothorax were included. The causes were primary chylothorax, transient abnormal myelopoiesis, cardiac disease, pulmonary sequestration, mediastinal neoplasm, and infection. TAS was performed in 36 cases. Early neonatal death occurred in 19 cases. The 28-day survival rates for all cases and for TAS cases were 70% (48/69) and 72% (26/36), respectively. Of the cases that underwent TAS, one was treated with home oxygen therapy, one was diagnosed with cerebral palsy and severe intellectual disability, and five were diagnosed with mild or moderate developmental disabilities., Conclusions: The results showed that the survival rate and long-term outcomes of cases with hydrothorax have improved as TAS has become more prevalent. The reasons for these results need to be elucidated, and efforts are needed to further improve outcomes., (© 2019 S. Karger AG, Basel.)

Objectives: Some monochorionic twin pregnancies need intensive cardiac management even in the absence of twin-to-twin transfusion syndrome after birth. The purpose of this study was to investigate risk factors related to persistent hypotension requiring cardiotonic agent use among monochorionic twin pregnancies without twin-to-twin transfusion syndrome., Study Design: This was a retrospective study of 316 monochorionic twin pregnancies without twin-to-twin transfusion syndrome (632 babies). All cases were treated in the neonatal intensive care unit. Hypotension was defined as mean arterial blood pressure below the norm for gestational age. Decreased left ventricular ejection fraction was defined as a value <60%. Dopamine, dobutamine and phosphodiesterase III inhibitor were used as cardiotonic agents for hypotension persisting even after adequate infusion., Results: Among the 632 cases, 33 (5.2%) needed cardiotonic agents for persistent hypotension. The frequency of persistent hypotension with decreased left ventricular ejection fraction was significantly higher among larger twins (4.4%) than among smaller twins (0.6%, p = 0.0038). In larger twins, multivariate analysis showed that Z-score for cardiothoracic area ratio (odds ratio, 2.31; p < 0.001), tricuspid regurgitation (odds ratio, 6.34; p = 0.015) and gestational age at delivery (odds ratio, 0.66; p < 0.001) correlated with persistent hypotension. In smaller twins, univariate analysis showed gestational age at delivery, birth weight, Z-score for birth weight and Z-score for cardiothoracic area ratio of the larger twin were related to persistent hypotension. Concentration of brain natriuretic peptide in the umbilical vein in larger and smaller twins were significantly correlated (coefficient of correlation = 0.792, p < 0.001)., Conclusions: In monochorionic twin pregnancies, attention needs to be given to cardiac size along with amniotic fluid and fetal growth. Both larger and smaller twins carry risks of persistent hypotension after birth. Close observation is needed, especially in cases where the larger twin displays cardiomegaly despite absence of twin-to-twin transfusion syndrome., (Copyright © 2019. Published by Elsevier B.V.)

Objectives: Our study aimed to analyze the differences in intra-amniotic pressures in patients with polyhydramnios with and without symptoms., Study Design: We recruited patients with pregnancies in which amnioreduction was performed for polyhydramnios in the Department of Fetal-Maternal Medicine at Nagara Medical Center between April 2017 and August 2018. Amnioreduction was performed for severe polyhydramnios with maternal symptoms [symptomatic group] or polyhydramnios without maternal symptoms [asymptomatic group] such as abdominal distension, dyspnea, or threatened premature labor. We measured the intra-amniotic pressure after every 200 ml volume reduction during the amnioreduction., Results: A total of 27 patients who underwent amnioreduction were classified into symptomatic (66.7%, 18/27) and asymptomatic (33.3%, 9/27) groups. Gestational age, amniotic fluid index at the time of amnioreduction, and the volume of amniotic fluid removed were not significantly different between the symptomatic and asymptomatic groups [median 32.4 weeks vs. 33.1 weeks, median 38.0 cm vs. 39.0 cm, and median 1500 ml vs. 2500 ml, respectively]. However; the intra-amniotic pressure before amnioreduction was significantly higher in the symptomatic group than in the asymptomatic group [median 15.0 mmHg (range, 10-27) vs. 10.0 mmHg (range, 6.0-13); p < 0.005]. After amnioreduction, these pressures decreased significantly to median 9.0 mmHg (range, 5.0-13) (p < 0.001) in the symptomatic and 7.0 mmHg (range, 4.0-11) (p < 0.05) in the asymptomatic group. The median intra-amniotic pressure gradually decreased and reached a plateau during the amnioreductions in both groups., Conclusions: With polyhydramnios, the intra-amniotic pressure was significantly higher in the symptomatic group than in the asymptomatic group. Therefore, uterine pressure tolerance might vary according to the individual. In addition, intra-amniotic pressure monitoring might enhance the safety during amnioreduction procedures to avoid drastic and potentially harmful pressure changes., (Copyright © 2019 Elsevier B.V. All rights reserved.)

We report prophylactic amnioinfusion (AI) for variable decelerations in umbilical cord compression without oligohydramnios as an early sign of deterioration. We performed a transabdominal AI in cases without oligohydramnios using the ultrasonography findings of umbilical cord compression (i.e. sandwich sign [SWS]) and variable decelerations (VD) in a foetal heart rate. Thirteen cases and 21 AIs were analysed. Nine (69%) cases were of a foetal growth restriction and 4 (31%) had umbilical hyper-coiled cords. VD frequency (p < .0001), umbilical artery pulsatility index (PI) (p < .01) and ductus venous PI (0.66 vs. 0.48; p < .05) significantly decreased, and an umbilical venous (UV) flow volume (121 vs. 197 ml/min/kg; p < .05) significantly increased after AI. The umbilical artery diastolic blood flow abnormalities and UV pulsation improved. In conclusion, AI improves the umbilical cord compression even without oligohydramnios. The SWS is an important marker of deterioration to severe oligohydramnios and latent foetal damage. IMPACT STATEMENT What is already known on this subject? Antepartum variable decelerations due to umbilical cord compression are significantly associated with the deceleration in labour. In particular, foetal hypoxia leads to other adverse events such as foetal distress, hypoxic-ischemic encephalopathy, and pulmonary arterial hypertension after birth. Amnioinfusion has been shown to be effective in patients who also have oligohydramnios. What do the results of this study add? Amnioinfusion may be effective in the cases with ultrasonography findings of umbilical cord compression (i.e. sandwich sign) and in cases with variable decelerations in foetal heart rate, but without oligohydramnios. What are the implications of these findings for clinical practice and/or further research? Amnioinfusion may be helpful to prevent adverse events including oligohydramnios and anhydroamnios.

Objective: This study aimed to evaluate the feasibility of prenatal measurement of umbilical cord length using magnetic resonance imaging (MRI) in comparison with that of postnatal visual measurement., Study Design: Patients who underwent MRI pelvimetry to rule out cephalopelvic disproportion were recruited. We compared the umbilical cord length measured prenatally using the three-dimensional image of the umbilical cord constructed by AZE virtual place system (AZE ® , Japan) on MRI (M-length) and measured postnatally using the actual length (R-length). The time interval between MRI scan and birth was set within 4 weeks. Patients were divided into normal, long (>90th centile), and short (<10th centile) groups based on the umbilical cord length., Results: A total of 106 pregnancies were analyzed. MRI was performed at a mean gestational age of 37.4 (34.1-41.7) weeks; the mean gestational age at delivery was 39.4 (36.0-41.8) weeks. M-length and R-length were 67.9 ± 13.6 [mean ± standard deviation] and 57.2 ± 12.7 cm, respectively. The correlation coefficient was larger in the long and short groups than in the normal group. The intraclass correlation coefficient showed high agreement, and Pearson's correlation coefficient revealed correlation inspection as r = 0.702. Bland-Altman analysis indicated non-agreement, and the bias and upper and lower limits of agreement were 10.6 cm and -6.0 and 27.3 cm, respectively., Conclusions: Short and long umbilical cord lengths are associated with perinatal mortality and morbidity. Prenatal measurement of umbilical cord length using MRI is feasible for daily clinical use to distinguish short or long umbilical cords. Further research is needed for more precise clinical application and technical reduction of overestimation errors., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Acute funisitis is characterized by the infiltration of fetal neutrophils from the umbilical vessels into Wharton's jelly and presents as fetal inflammation. However, no reports about its prenatal diagnosis using ultrasonography have been published. We encountered one case of oligohydramnios at 26 weeks and another case of threatened premature delivery at 27 weeks of gestation with ultrasonographic findings of non-uniform thickening of Wharton's jelly, a heterogeneous internal echo, and a high echoic line of the umbilical vessel wall. Acute funisitis was diagnosed, and the postpartum histopathological examination revealed severe funisitis in both cases. To our knowledge, this is the first case report of prenatal diagnosis of funisitis determined using ultrasonography. When we find such ultrasonographic features under the circumstances of intrauterine infection, severe funisitis should be included in the differential diagnosis.

Aim: The aim of this study was to evaluate the usefulness of shear-wave elastography (SWE) for measuring change in cervical stiffness during pregnancy, with regions of interest (ROI) designed for easy identification., Methods: A total of 280 women were enrolled in this study. SWE was performed at a routine prenatal visit. A measurement area was chosen at the anterior part of the cervix, and a circular ROI 5 mm in diameter was set at two points, 5-10 mm (lower point) and 15-20 mm (upper point) from the external cervical os. The generalized estimating equation was used to estimate the correlation between stiffness and gestational age, using generalized linear models., Results: There were significant negative correlations between stiffness and gestational age. The estimated regression equations of the lower and upper points were Y = -0.049X + 3.675 (P < 0.05) and Y = -0.060X + 4.170 (P < 0.05), respectively. The stiffness at the upper point behaved statistically significantly differently to that at the lower point. Softening of the cervix at the upper point was significantly different between single pregnancies and twin pregnancies (P < 0.05), but no marked difference was noted between primiparous and multiparous women., Conclusion: Cervical elastography using SWE was useful for measuring change in cervical stiffness during pregnancy, and the upper area of the cervix may be a more relevant assessment point for cervical softening than the lower area., (© 2017 Japan Society of Obstetrics and Gynecology.)

We encountered a 62-year-old woman who experienced frequent episodes of hypoglycemia. She was diagnosed with postprandial reactive hypoglycemia according to the results of oral glucose and sucrose tolerance tests, having undergone an endocrinological examination and image inspection. The administration of low-dose voglibose, an alpha-glucosidase inhibitor (α-GI), improved the glucose fluctuations and inhibited hypoglycemic symptoms. Voglibose is also known to diminish oxidative stress and maintain endothelial function after hyperglycemia. An α-GI might effectively prevent hypoglycemic symptoms and endothelial dysfunction by suppressing oxidative stress in such cases.

Prenatal ultrasound screening has allowed for the detection of in utero cardiac abnormalities. Specifically, distinction is possible between ventricular diverticula and aneurysms, which is important because each condition has a different clinical outcome. We report the case of a 35-year-old, gravida 1, para 1 woman, with no significant past medical history, who underwent routine prenatal ultrasound screening at 32 weeks' gestation. A four-chamber ultrasound of the fetal heart combined with M-mode echocardiography showed abnormal dilatation of the right ventricular chamber measuring 2.2 cm × 1.0 cm but with normal contractility. Delivery was performed at full term by cesarean section, and a right ventricular diverticulum was confirmed by postnatal cardiac computed tomography. The baby developed normally with no cardiac sequelae during followup. This case demonstrates the importance of making a correct diagnosis of ventricular diverticula by prenatal ultrasound when abnormal dilatation of the fetal ventricle is identified during routine screening. Because evaluating the wall contractility by M-mode ultrasound leads to evaluating whether it has the myocardium, we conclude that M-mode echocardiography is effective for the purpose of prenatal cardiac diagnosis and can distinguish between ventricular aneurysms and functioning ventricular diverticula.

Sirenomelia is a rare congenital syndrome that is characterized by the anomalous development of the caudal region of the body. The anomalies include bilateral renal agenesis or dysgenesis and the absence of the sacrum and other vertebral defects. Sirenomelia is also known as "mermaid syndrome," because of the one lower extremity. It is usually associated with severe oligohydramnios, and its prognosis is very poor due to pulmonary hypoplasia that is caused by severe oligohydramnios. The patient referred to our hospital at the gestational age of 27 weeks with fetal growth restriction and oligohydramnios. The estimated fetal body weight was 970 g (-4.9 S.D.). We could identify only one-side extremities, and could not identify kidneys by ultrasound examination. Because a single lower extremity and severe oligohydramnios are characteristics of the sirenomelia, we suspected sirenomelia. However, it could not be confirmed by ultrasound examination because of oligohydramnios. Therefore, we performed three-dimensional helical computed tomography (3D-CT), which is more accurate than ultrasound examinations for prenatal diagnosis of skeletal abnormalities. 3D-CT revealed an only one lower extremity. At 36 weeks and 5 days of gestation, the woman went into spontaneous labor and delivered an infant weighing 870 g. The infant has a single upper extremity and a single lower extremity. We provided supportive care for the neonate, who however died 1 hour 36 minutes after birth from severe respiratory distress. In summary, we report the correct diagnosis of sirenomelia with 3D-CT in the late second trimester.

We presented the case of a 46-year-old man with no medical or family history but with a history of smoking 3 packs of cigarettes per day for the past 25 years. He was admitted to our hospital due to hemoptysis. Chest computed tomography revealed a tumor of right upper lung and interstitial pneumonia in the surrounding lung parenchyma. He was operated upon and diagnosed with stage IIB pleomorphic carcinoma of the lung with invasion of the chest wall. He underwent three courses of postoperative carboplatin (CBDCA) (area under the curve 5 on day 1, every 3 weeks and paclitaxel(PTX) (200 mg/m(2); day 1, every 3 weeks) combination chemotherapy. No recurrence was observed for a period of 760 days after the operation. According to previous reports, lung pleomorphic carcinoma is aggressive and has a poor prognosis. Further, the significance of chemotherapy in the management of this disease has not been established. Postoperative combination chemotherapy of CBDCA and PTX may result in a good prognosis for this disease.