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We herein report the case of a 28-year-old pregnant woman with an acute presentation of remarkable petechiae on her lower extremities and severe thrombocytopenia (16 000/mm3 ) at the 35th week of gestation. Although idiopathic thrombocytopenic purpura was initially suspected, subsequent examinations revealed that her ADAMTS13 (a Disintegrin And Metalloprotease, with ThromboSpondin type 1 repeats, member 13) titer was extremely decreased, while she was negative for antibodies against ADAMTS13. Infusion of fresh frozen plasma was immediately performed, and the platelet count was observed to increase. However, severe pregnancy-induced hypertension and proteinuria emerged at 36 weeks and 2 days of gestation, and a male infant was delivered by emergency cesarean section on the 37th week of gestation. The postnatal development was uncomplicated. After delivery, although the mother's platelet count and ADAMTS13 activity decreased temporarily, both values increased following fresh frozen plasma transfusion. This case showed interesting aspects of congenital thrombocytopenic purpura (Upshaw-Schulman syndrome) in pregnancy. Moreover, the rapid measurement of the patient's ADAMTS13 activity and the subsequent accurate diagnosis of congenital thrombocytopenic purpura made it possible to treat the patient with fresh frozen plasma infusion and avoid contraindicated platelet infusion. Close cooperation between obstetricians, hematologists and pediatricians is necessary to achieve successful outcomes in cases of thrombocytopenic purpura during pregnancy.

The vernix caseosa is a complex membranous structure comprising 80% water, 10% protein, and 10% lipids including barrier lipids such as ceramides, free fatty acids, phospholipids and cholesterol, synthesized partly by fetal sebaceous glands during the last trimester of pregnancy in an antero-posterior and dorsoventral manner. Because of its lipid content, vernix is hydrophobic and protects the skin from excessive water exposure during the development of the stratum corneum. The vernix caseosa has various functions during fetal transition from an intrauterine to an extrauterine environment, including lubrication of the birth canal during parturition, barrier function to prevent water loss, temperature regulation, for innate immunity and for intestinal development. This review discusses the evidence supporting the prenatal and postnatal functions of vernix caseosa, along with its structure, composition, and physical and biological characteristics. Understanding the biology of the vernix may facilitate improved care of preterm infants immediately post-partum.

Purpose Inversion of chromosome 9 (inv[9]) is considered to be a normal variant, and the inv(9) in patients or husbands with recurrent pregnancy loss (RPL) is believed to be harmless. However, there are few reports concerning the outcomes of pregnancy in patients with RPL when the patient or their partner has inv(9). In this study, we analyzed the outcomes of pregnancy in this patient population. Methods Chromosomal karyotyping was performed for 2006 couples with RPL (two or more consecutive early pregnancy losses including non‐visualized cases) with their informed consent. The frequency of various chromosomal abnormalities in the patient population was then analyzed, and the outcomes of pregnancy in patients with inv(9) were investigated. Results The frequency of inv(9) in the overall population was 2.6% (52/2006). Thus far, 32 patients have conceived repetitively, resulting in live births in 23 cases and early pregnancy losses in nine cases. Four of the nine cases obtained a good outcome in the subsequent pregnancy. Thus, a successful outcome was obtained in 27 of the 32 (84.4%) cases. Conclusions This study suggests that inv(9) has no adverse influence on subsequent pregnancy.

Aim Recently, it is widely recognized that positivity for anti-phospholipid antibodies is a causative factor for a range of reproductive failures. Anti-cardiolipin beta2 glycoprotein I antibody (anti-CL-beta2-GPI) is a representative anti-phospholipid antibody, which strongly correlates with the development of thrombotic events and diversity of adverse pregnancies. In this series, we aimed to elucidate effective treatment for patients with recurrent fetal losses positive for anti-CL-beta2-GPI using Japanese-modified Chinese herbal medicine. Methods Twenty-one patients with recurrent fetal losses who were positive for anti-CL-beta2-GPI were treated with the Japanese-modified Chinese herbal medicine, Sairei-to (Chai-ling-tang), and low-dose aspirin with or without adrenal corticosteroid hormone. Of the 21 patients, the value of anti-CL-beta2-GPI ranged from 1.9 to 3.4 in 10 patients, and it was over 3.5 in 11 patients. Results Of the 21 patients treated with the current protocol, the pregnancy successfully continued in 17 patients (success rate: 81.0%). Of the four patients who showed repeated abortion, chromosome abnormality of chorionic villi was observed in two; thus, the success rate would be 89.5% (17 of 19 cases) on excluding these cases from the evaluation. Conclusion The efficacy of the current treatment adopting the modified Japanese version of the Chinese herbal medicine Sairei-to for patients with recurrent fetal losses positive for anti-CL-beta2-GPI was indicated.

Background Although uterine fibroids are a common gynecologic neoplasm, uterine diverticulum accompanied by a uterine fibroid is unique. In addition, pregnancy complicated with uterine diverticulum is extremely rare. We experienced a case of a uterine fibroid that was associated with a uterine diverticulum that enlarged during pregnancy and puerperium. Case presentation A 25-year-old nulligravida woman had an abnormal uterine cavity surrounded by myomatous mass. After natural conception, the mass and pouch had enlarged during pregnancy. Six months after elective cesarean delivery, she underwent laparotomy because of abdominal pain caused by the myomatous mass and the fluid inside. The tumor was connected to the midline of the posterior wall of the normal uterus. The resected tumor was pathologically diagnosed as leiomyoma and diverticulum. Conclusions Pregnancy can stimulate uterine fibroids to form uterine diverticula. Resection of the diverticulum and fibroid is a useful option for symptomatic patients with desired future fertility.

Supplemental digital content is available in the text., Objectives Cervical cancer is one of the most frequently diagnosed cancers in pregnancy. Our aim was to evaluate the safety and efficacy of abdominal radical trachelectomy (ART) for pregnant women with early-stage cervical cancer who strongly desire to preserve their pregnancies. Methods/Materials A retrospective observational study was performed for stage IB1 cervical cancer patients who underwent ART or radical hysterectomy (RH) at our hospital between February 2013 and June 2017. We compared differences in perioperative findings and oncologic outcomes among ART during pregnancy (ART-DP), ART, and RH groups. Results A total of 38 patients were included in this analysis. Six, 10, and 22 patients were assigned to the ART-DP, ART, and RH groups, respectively. There were no significant differences in the distribution of pathological TNM classifications, histology, tumor size, stromal invasion, and lymph-vascular space invasion among the 3 groups. The patients in the ART-DP group were younger than those in the RH group (P = 0.014). The ART-DP group was associated with more blood loss and prolonged surgery compared with the RH group (P = 0.017 and P = 0.014). The number of total lymph nodes in the ART-DP group was lower than that in the RH group (P = 0.036). However, there were no significant differences in age, surgical time, blood loss, or lymph node count between the ART-DP and ART groups. There were no significant differences in progression-free and overall survival times among the 3 groups, and no recurrence was observed in the ART-DP group. Conclusions Abdominal radical trachelectomy may be a tolerable treatment option for pregnant women with early-stage cervical cancer who strongly desire a baby.

Aim We aimed to assess the accuracy and effectiveness of fetal cardiac screening for congenital heart disease (CHD) during the second trimester by general obstetricians in a non-selected population. Methods In this multicenter, prospective cohort study of fetal cardiac screening, four-chamber and three-vessel views were recorded by obstetricians at 18–21 gestational weeks (GW). A total of 3005 fetuses that were scheduled for delivery at our institution were included. Results Thirty-seven newborns were born with CHD (1.2%). On excluding 23 cases of ventricular septal defects, the prenatal detection rate of CHD was 42.8%. Although six cases (75.0%) of severe structural abnormality were diagnosed prenatally, the prenatal detection rate of valvular abnormalities was 0%. Conclusion One-point ultrasound screening of the fetal heart using a combination of four-chamber and three-vessel views at 18–21 GW by general obstetricians in a non-selected population may be useful for detecting severe structural abnormalities but not valvular abnormalities. However, this limitation may be improved by conducting another fetal cardiac screening at approximately 30 GW along with the routine use of color Doppler.

A 39-year-old woman underwent emergency cesarean section (CS) due to placenta previa totalis with massive bleeding. Two major problems emerged in this patient after CS was carried out. One was partial retention of the placenta due to placenta accreta. Another major and more serious problem was pyoderma gangrenosum (PG) widely appearing at the skin of the abdomen around the CS wound. Conservative treatment was performed for the retained placenta, and it had completely disappeared by 76 days after the CS. The diagnosis of PG was promptly made in consultation with a plastic surgeon and a dermatologist when a wide ulcer emerged around the CS wound, and high-dose prednisolone was administered as treatment. At 90 days following the CS, near-complete epithelialization was achieved. This extremely rare case reflects the importance of rapid diagnosis and treatment of PG.

Recently, it is widely recognized that positivity for anti-phospholipid antibodies is a causative factor for a range of reproductive failures. Anti-cardiolipin beta2 glycoprotein I antibody (anti-CL-beta2-GPI) is a representative anti-phospholipid antibody, which strongly correlates with the development of thrombotic events and diversity of adverse pregnancies. In this series, we aimed to elucidate effective treatment for patients with recurrent fetal losses positive for anti-CL-beta2-GPI using Japanese-modified Chinese herbal medicine.Twenty-one patients with recurrent fetal losses who were positive for anti-CL-beta2-GPI were treated with the Japanese-modified Chinese herbal medicine, Sairei-to (Chai-ling-tang), and low-dose aspirin with or without adrenal corticosteroid hormone. Of the 21 patients, the value of anti-CL-beta2-GPI ranged from 1.9 to 3.4 in 10 patients, and it was over 3.5 in 11 patients.Of the 21 patients treated with the current protocol, the pregnancy successfully continued in 17 patients (success rate: 81.0%). Of the four patients who showed repeated abortion, chromosome abnormality of chorionic villi was observed in two; thus, the success rate would be 89.5% (17 of 19 cases) on excluding these cases from the evaluation.The efficacy of the current treatment adopting the modified Japanese version of the Chinese herbal medicine Sairei-to for patients with recurrent fetal losses positive for anti-CL-beta2-GPI was indicated.

Objective To determine the proportion of couples affected by recurrent spontaneous abortion in which one partner carries balanced translocations among three chromosomes. Methods In a retrospective study, G-banded chromosome complements were analyzed for couples affected by recurrent spontaneous abortion who were referred to Niigata University Hospital, Japan, between January 1, 1990, and December 31, 2011. The frequency of couples in whom one of the partners carried balanced translocations among three chromosomes was determined, and the clinical outcomes for affected couples who subsequently achieved term pregnancies were reviewed. Results Of 1415 couples with recurrent spontaneous abortion during the study period, there were two (0.1%) in which one of the partners (the woman in both cases) carried balanced translocations among three chromosomes. Both couples achieved a subsequent pregnancy that continued successfully and resulted in a phenotypically normal neonate. Conclusion The frequency of balanced translocations among three chromosomes was estimated to be approximately 0.1% in a population affected by recurrent spontaneous abortion. With appropriate treatment based on careful examinations, affected couples can go on to achieve a successful pregnancy outcome.

We report two cases of women positive for anticardiolipin antibodies who experienced recurrent abortion whose husbands had isodicentric chromosome 15 aberrations who eventually had successful pregnancies. Two women were referred to our hospital due to their medical history of recurrent abortion. Both were diagnosed as being positive for anticardiolipin antibodies and their husbands with isodicentric chromosome 15. After both patients were treated with a Japanese herbal medicine (Sairei-to) and low-dose aspirin for the positive anticardiolipin antibodies, they delivered appropriate-for-date infants at term gestation. Although both husbands were revealed to have isodicentric chromosome 15, and coincidentally both wives were positive for anticardiolipin antibodies, their next pregnancies continued uneventfully as a result of the treatment.

A 40-year-old woman with a history of cesarean section and 3 episodes of uterine curettage for spontaneous or induced abortion presented with massive genital hemorrhage in the ninth week of gestation; she was treated with red cell concentrate and fresh frozen plasma transfusion. She was admitted to our hospital at the 11th week of gestation for continuous genital hemorrhage and cervical shortening (20 mm). Ultrasonography revealed placenta previa totalis. A lowlying gestational sac in early pregnancy, vascular lacunae, and an obscured retroplacental sonolucent zone indicated placenta percreta; magnetic resonance imaging showed similar findings. Owing to placenta percreta, uterus preservation was considered impossible. Elective cesarean section followed by total hysterectomy was performed at the 37th week of gestation, with bilateral internal iliac artery balloon catheter occlusion for reducing blood loss. The perioperative blood loss was 2,835 mL, for which the patient received blood transfusion. The postoperative course was uncomplicated.

Uterine sacculation is rare complication affecting the pregnant uterus, and is difficult to diagnose. Sacculation consists of a transitory pouch or sac-like structure caused by inverted uterine polarity. Vaginal delivery is difficult, and even cesarean section can be difficult because of peculiar risks associated with uterine sacculation. We report a pregnant patient with posterior sacculation due to a huge myoma in the lower anterior uterine segment. Sacculation, especially that complicated by a huge myoma, is very difficult to accurately diagnose and makes cesarean section surgery challenging. Because of the myoma in our present case, opening the lower uterine segment was impossible with cesarean section. The uterus was instead opened by corporeal vertical cesarean section. Myomectomy was not performed and the giant myoma thus remained. Postoperative assessment revealed the uterus to still be retroverted. The giant myoma was the cause of sacculation in this case.

We report a successful case of a pregnant female positive for anti-cardiolipin antibodies who experienced two abnormal pregnancies with postpartum cerebral hemispheric infarctions. A 38-year-old female diagnosed as being positive for anti-cardiolipin antibodies was referred to our hospital due to her strong desire to have a baby. The administration of Japanese herbal medicine, Sairei-to, as immunosuppressive therapy, and low dose aspirin, as anti-coagulation therapy, were initiated prior to the patient’s pregnancy. Five months after beginning the treatment, the patient conceived spontaneously. At 34 weeks of gestation, emergency cesarean section was performed due to increasing genital bleeding resulting from coincidental placenta previa and the patient delivered an appropriate-for-date female infant (1970 g). Treatment with Japanese herbal medicine (Sairei-to) and low-dose aspirin is considered to be an effective treatment option for patients positive for anti-phospholipid antibodies with past histories of abnormal pregnancies.

A 35-year-old Japanese woman in the 24th week of gestation with bilateral breast enlargement was referred to hospital. She was diagnosed with Burkitt's lymphoma and admitted for detailed evaluation and treatment. Early delivery and subsequent chemotherapy was chosen after considering the gestational week, her general condition and the wishes of the patient and her husband. She gave birth to a male infant by cesarean section in the 25(th) week of gestation. It had been planned to begin high-dose chemotherapy, such as CODOX-M/IVAC, on day 7 of the puerperium; however, her general condition worsened and chemotherapy was therefore begun on day 2 after the birth. Eight hours after chemotherapy (cyclophosphamide, vincristine and doxorubicin), she developed cardiac arrest due to tumor lysis syndrome. Despite medical treatment, her bleeding tendency did not improve and she died of respiratory failure with alveolar bleeding five days after chemotherapy.

Objective: Our aim was to investigate the association between fetal growth and cerebrovascular resistance in fetuses with congenital heart disease (CHD). Methods: Fetal echocardiography was performed to measure the biparietal diameter, abdominal circumference, femur length, estimated fetal body weight, middle cerebral artery (MCA) resistance index (RI) and umbilical artery (UA) RI in 44 fetuses with CHD and 140 normal fetuses at a gestational age of 28–34 weeks. Results: Fetuses with CHD exhibited significantly lower values for femur length, estimated fetal body weight at the third trimester, body weight, length, and chest circumference at birth than normal controls. The percentages of fetuses showing MCA RI values 90th percentile were significantly higher in the CHD group than in the control group. However, there were no significant differences in any biometric parameters measured between cases with MCA RI values ≧10th percentile and values Conclusions: Growth restriction and blood flow changes were observed significantly more frequently in fetuses with CHD than in those without CHD. Further studies are necessary to clarify the association between fetal growth and dynamic changes in fetal circulation.

Aim: To determine the relationship between ultrasound findings during the first trimester and obstetrical outcomes. Methods: A retrospective cohort study was carried out on 516 women who underwent ultrasound examination between 12 and 14 gestational weeks. Results: The reduced crown-rump length, biparietal diameter, femur length (Z-score 90th and 95th percentile) were not associated with poor obstetrical outcomes. A ductus venosus pulsatility index greater than the 90th percentile was associated with aneuploidy, small for gestational age and low birth weight infants. Conclusion: Increased pulsatility in the ductus venosus is associated with increased risk for chromosomal abnormality in early pregnancy. Here we show that increased pulsatility is also linked to fetal growth restriction.

We report a case of a pregnant woman diagnosed as having vasa previa by magnetic resonance imaging (MRI). A parous woman was referred to our hospital at 31 weeks of gestation due to suspicion of placenta previa. Transvaginal ultrasound examination together with the Doppler techniques showed a fetal vessel on a lesion of low and high mixed echogenecities over the internal os, but could not confirm whether it was placental tissue or not. MRI demonstrated that it was not placenta but a hemorrhage between bilobed placentas and that the vessel was running over the internal os freely from the placenta. At 34 weeks of gestation, emergency cesarean section was performed due to increasing vaginal bleeding. MRI should be useful in the diagnosis of vasa previa when the relation between the position of the placenta and that of suspicious vessels cannot be adequately evaluated by ultrasound.

To establish reference ranges for ductus venosus waveform indices in the Japanese population. In this retrospective cross-sectional study, 791 singleton fetuses of healthy Japanese couples were examined from January 2004 to January 2008. Reference ranges for ductus venosus waveform indices were constructed from cross-sectional data obtained at between 18 and 41 weeks of gestation. With a success rate of 84%, a total of 667 measurements in 791 women were eligible for analysis. The median pulsatility index (PI) of fetal ductus venosus decreased from 0.54 at 18 weeks of gestation to 0.30 at 41 weeks of gestation. The median end-diastolic velocity/peak systolic velocity (a/S) of the ductus venosus increased from 0.56 at 18 weeks of gestation to 0.76 at 41 weeks of gestation. In this study, we established reference ranges for the PI and a/S of the ductus venosus in the Japanese population, which differed slightly from other published reference data. The results will be useful for further studies to determine the validity of the clinical importance of the ductus venosus for at-risk fetuses.

A pregnant woman at 32 weeks of gestation was emergently admitted to our hospital with symptoms of nausea, vomiting, and uterine contraction. Cardiotocogram demonstrated a loss of variability and late deceleration in fetal heart rate pattern. Emergency cesarean section was performed, and a male infant weighing 1750 g was born with Apgar scores of 1 at 1 min, and 3 at 5 min after delivery. After cesarean section, the patient developed an acetone breath odor, and blood examination demonstrated remarkable acidemia and an extremely high level of blood glucose. The patient was diagnosed with ketoacidosis with acute onset of fulminant type 1 diabetes mellitus. Intensive care was applied due to the severe diabetes mellitus conditions. The patient's general condition ameliorated during the postoperative period, although there was a possibility of neurological complications in the infant.

A 27-year-old female patient underwent cesarean section and a postoperative hematoma occurred at the site of the uterine incision. The patient underwent relaparotomy to remove the hematoma. Four days later she developed a fever of over 39 degrees C and an abscess had formed at the site. Despite therapy with several antimicrobial agents, her fever persisted. Consequently, she underwent transvaginal abscess drainage, after which she promptly became afebrile. Mycoplasma hominis was considered to be the primary causative organism. There are two reasons that could explain why the wound infection became serious: (i) M. hominis is resistant to several antimicrobial agents that are usually used to treat obstetric infections; and (ii) a long time is required to identify the pathogen. In conclusion, M. hominis should be considered as a causative organism if an antimicrobial-resistant infection occurs at the surgical site after a cesarean section.

Problem In this study, we investigated whether or not significant compatibility of human leukocyte antigen (HLA)-class II alleles exists between spouses with severe pre-eclampsia (PE) (including gestational hypertension, GH). Method of study The HLA-class II genotypes were determined using a polymerase chain reaction-restriction fragment length polymorphism method. The number of incompatible alleles in 57 patient couples with severe PE (including GH) were determined, and compared with that in 74 control couples. Results The number of patient couples and control couples with each number of mismatched alleles of the HLA-DR, -DQ, and -DP genotypes was as follows. The number of patient couples with zero, one, two, three, and four-allele mismatches was 41 (72.9%), and with five and six-allele mismatches was 16 (27.1%). On the other hand, the number of control couples with zero, one, two, three, and four-allele mismatches was 38 (51.4%), and with five and six-allele mismatches was 36 (48.6%). Thus, the number of patient couples with five and six-allele mismatches was significantly lower compared with that in control couples. The same result was obtained as regards the mismatched alleles of the HLA-DR, -DQ, and -DP phenotypes. Conclusion These findings suggest that significant compatibility of HLA-class II alleles between spouses is implicated in the genesis of PE (including GH).

Aim: To evaluate the usefulness of magnetic resonance imaging (MRI) in predicting the risk of lethal pulmonary hypoplasia in fetuses. Methods: The subjects consisted of 15 fetuses (29–40 weeks' gestation), including fetuses with major malformation diagnosed on prenatal ultrasonography. MRI using a 1.5 T magnet and half-Fourier acquisition single-shot fast spin-echo sequences were applied to all fetuses at 29–36 weeks. Fetal lung-to-liver signal intensity ratio (LLSIR) was calculated by medians of region-of-interest analysis; estimated fetal bodyweight (FBW), by ultrasonography; and estimated fetal lung volume (FLV), by planimetric measurement of total lung volume. FLV/FBW was also calculated. The presence of the pulmonary hypoplasia in neonates was identified based on clinical and anatomico-pathological findings. Differences in LLSIR and FLV/FBW were analyzed for surviving and non-surviving neonates. Results: Ten surviving neonates had a median LLSIR of 3.00, range: 1.60–4.40, while that in seven non-surviving neonates was 2.21, range: 0.70–3.72; no significant difference was found between the groups. Surviving neonates had a median FLV/FBW of 11.4, range: 7.1–15.7, while that in non-surviving neonates was 4.4, range: 3.1–5.7. FLV/FBW in non-surviving neonates was significantly lower than that of the FLV/FBW for surviving fetuses (P

Objective Our objective was to determine the clinical significance of fetal hypoechoic hepatomegaly and serial change of liver sizes. Methods The liver sizes of four fetuses with hypoechoic hepatomegaly were serially estimated by liver length, as measured from the dome of the right hemidiaphragm to the tip of the right lobe. Results All cases were associated with trisomy 21 or transient abnormal myelopoiesis (TAM). Two cases were trisomy 21 with TAM, one case was a phenotypically normal newborn, who had developed TAM during the fetal period, and the last case was trisomy 21 without TAM. In the last case, it is speculated that TAM had developed and regressed completely before birth. Two cases, whose hepatomegaly had improved before birth, showed good prognosis and the other two cases, in whom improvement had not been observed, resulted in death after birth by liver failure. Conclusion These experiences show that one of the differential diagnoses of hypoechoic hepatosplenomegaly is TAM and that the change of live size is a predictor of prognosis. Copyright © 2007 John Wiley & Sons, Ltd.

Problem To elucidate the efficacy of the treatment using a Japanese-modified Chinese herbal medicine, Sairei-to, and low-dose aspirin with or without a corticosteroid hormone for the patients with adverse pregnancy histories positive for anti-phospholipid antibodies. Methods of study Fifteen cases positive for anti-phospholipid antibodies, who had experienced preterm delivery in which an extremely low birthweight infant (

Objective To elucidate the possible mechanisms of immunotherapy for unexplained recurrent aborters using their husband's mononuclear cells. Design Prospective clinical study. Setting Institutional practice at the Outpatient Clinic for Infertility, Niigata University Medical Hospital. Patient(s) Fifty-two unexplained recurrent aborters were chosen as an experimental group. Intervention(s) Each patient was injected with her husband's mononuclear cells as immunotherapy. Peripheral blood was obtained from the patients. Main Outcome Measure(s) The percentage of CD4-positive cells, TH1 cells, TH2 cells, and the TH1/TH2 ratio were analyzed in the patients before and after immunotherapy. The same analyses were performed in the successful and the unsuccessful group. Result(s) To date, 42 of the 52 patients have become newly pregnant. Of the 42, 34 patients have already delivered (successful group) and 3 are now pregnant, while the remaining 8 cases experienced repeated abortion (unsuccessful group). The percentage of TH2 cells significantly increased in the total patient population, while the TH1/TH2 ratio significantly decreased in the total patient population and in the successful group. Conclusion(s) These findings suggest that immunotherapy with the husband's mononuclear cells for unexplained recurrent abortion induces a dominant state of TH2 cells in the patients.

Background: Use of antiretroviral drugs has reduced the mortality rate for HIV infection and many HIV-discordant couples wish to have children. It is possible for an HIV-infected man to father children without risk of HIV transmission if HIV-free spermatozoa can be obtained from his semen. Methods: An improved swim-up method was used to collect HIV-free spermatozoa from the semen of HIV-positive males. Diluted semen was layered over a Percoll solution with a continuous density gradient of 30–98%, and then centrifuged. The bottom layer was collected by cutting the end from the tube and the sperm suspension was collected using the swim-up method. Spermatozoa were tested by nested polymerase chain reaction (PCR) for HIV-1 RNA and DNA, with a detection limit of one copy. Spermatozoa were used for assisted reproduction in 43 couples. Results: HIV-1 RNA and proviral DNA were not detected by nested-PCR assay in all 73 of the collected spermatozoa samples from 52 patients. The HIV-1-negative sperm was used for in vitro fertilization in 12 couples and for intracytoplasmic sperm injection in 31 couples. No detection of HIV-1 RNA or proviral DNA in the culture medium of the fertilized eggs was confirmed again before embryo transfer. Of the 43 female partners, 20 conceived and 27 babies were born. HIV antibodies, HIV RNA and proviral DNA were negative in all of the females and babies. Conclusions: HIV-negative spermatozoa could be obtained from semen of HIV-positive men. The method involves no risk of HIV transmission to female partners and their children.

Feto-fetal transfusion syndrome (FFTS) in monochorionic triplets is a rare clinical entity which may share the principal adverse perinatal outcomes of twin-twin transfusion syndrome. Recently, favorable prognoses regarding morbidity and mortality in twins after selective laser photocoagulation of placental communicating vessels (SLPCV) have been described. But descriptions of this procedure in monochorionic triplet cases are limited. This is the case report of an experience of SLPCV applied to monochorionic triamniotic triplets with FFTS. Triplet A had polyhydramnios, while absent end-diastolic flow in the umbilical artery of triplet B, the triplet with anhydramnios, was persistent. Triplet C looked normal, vertical amniotic pocket and Doppler studies yielding normal results. At the beginning of the SLPCV procedure, feto-fetal hemorrhage, subsequent to the fetal death of the donor triplet, occurred. Both surviving cofetuses showed persistent bradycardia; and 1 fetus died while the other recovered from the fetal bradycardia. All vascular anastomoses between the 3 triplets could be identified and obliterated, requiring two trocars. Our fetoscopic observation revealed feto-fetal hemorrhage after demise of monochorionic triplet, which led to injury of other fetuses due to hypovolemia in an instant. In conclusion, SLPCV might be a valid option for FFTS in triplet cases, while further experience is required in order to evaluate the risks and benefits of this procedure in triplet cases.

Gastric cancer associated with pregnancy is extremely rare and the prognosis is generally grave. A 31-year-old Japanese women, 41 weeks pregnant, displayed disseminated intravascular coagulation (DIC), although clinical symptoms and diagnostic examinations did not indicate an obstetrical cause. She went into labor spontaneously and vaginally delivered a 3248-g normal female infant, after receiving a blood transfusion. On the day 5 postpartum, a gastroduodenal fiberscope examination indicated advanced gastric cancer. She was also diagnosed with bilateral chronic subdural hematoma and underwent an operation to allow drainage. It was not possible to treat her curatively, so she was treated conservatively for DIC. She died on day 13 postpartum. Necropsy of the iliac bone indicated bone marrow metastasis of adenocarcinoma. This is the first known case of a pregnant woman with DIC occurring as the first manifestation of advanced gastric cancer.

OBJECTIVE To elucidate the effect of multiple pregnancies on lumbar spine bone mineral density (BMD). METHODS The BMD of the lumbar spines (L2-L4) of 1,113 healthy women was measured within 7 days of childbirth. In addition 113 women had spine BMD measurements after their next delivery. RESULTS In the cross-sectional study, there was no apparent effect of parity on lumbar BMD. In the longitudinal study, the mean BMD after the next delivery was significantly higher than that after the initial delivery (1.019 +/- 0.115 g/cm(2) vs. 1.006 +/- 0.117 g/cm(2), P = 0.001, paired t test) with a percent change (DeltaBMD%) of 1.4 +/- 4.2%. Multiple regression analysis to identify independent predictors of DeltaBMD% showed a negative correlation with maternal age at the subsequent delivery (P = 0.033) but no correlation of DeltaBMD% with the length of lactation between the scans. CONCLUSION Multiple pregnancies may not reduce maternal lumbar BMD, although the percentage decrease in BMD was greater in older women at the subsequent delivery. The length of lactation between the scans had no effect on these results.

BACKGROUND: An increasing number of reports suggest that endometriosis is associated with abnormal immune function involving changes in both cell-mediated and humoral immunity, although the aetiology of the disease remains undefined. The human leukocyte antigen system (HLA) is known to play a role in the aetiology of a number of diseases. This study examines the possible association between the HLA-DR and endometriosis. METHODS: Eighty-three patients diagnosed with endometriosis by laparoscopic examination were typed for HLA-DR antigens using a PCR–restriction fragment length polymorphism analysis. The frequency of HLA-DR genotypes in this patient population was compared with that in a population of general controls. RESULTS: The incidence of HLA-DRB1*1403 in the patient group was 6.0% (10/166 alleles) compared with 1.4% in the control group (6/444 alleles), and the incidence of the HLA-DRB1*1403 allele was significantly greater in patients with endometriosis compared with the control population [odds ratio 4.68, 95% confidence interval 1.67–13.09, P 0.0013 (χ 2 analysis), (corrected P values: Pc 0.0494)]. No significant difference was found between the two groups with regards to the frequency of the other HLA-DR alleles. CONCLUSIONS: The results from this study may be helpful to implicate a role of HLA-DR antigens in the development of endometriosis, although further investigation is required.

Objective: The aim of this study was to clarify the appropriate timing for peripheral blood progenitor cells (PBPC) harvesting after platinum-based mobilization chemotherapy by measurement of the circulating CD34+ cell concentrations. Patients and Methods: PBPC were collected for autotransplantation via a total of 68 leukaphereses in 16 patients with gynecological cancer. Circulating CD34+ cell concentrations were measured by CD34-side scatter parameter analysis. Results: Data could be fitted into a linear regression line described by the equation y=0.33+4.14×x (R 2=0.256), where y=the number of harvested colony-forming unit granulocyte macrophage (CFU-GM (×105/kg) and x=the percentage of circulating CD34+ cells and y=1.747+44.53×x (R2= 0.475), where y=the number of harvested CD34+ cells (×106/kg) and x=the percentage of circulating CD34+ cells. Failure to mobilize sufficient CFU-GM numbers (>1×105/kg) occurred in 29 of 31 leukaphereses when the percentage of circulating CD34+ cells was less than 0.10%. Conclusions: Harvesting procedure may be avoided when circulating CD34+ cells showed less than 0.10% after platinum-based mobilization chemotherapy.

We present a case of a patient whose L1CAM gene in X-chromosome has a C924T transition. Her first son's ventriculomegaly was prenatally detected. A mature infant was born, his head circumference was large, and thumbs were bilaterally adducted. X-linked hydrocephalus (XLH) was suspected. The DNA examination revealed that both her and boy's LICAM gene had a C924T transition. She became pregnant 5 years later and amniocentesis was performed. The results of cytogenetic analysis revealed that the fetus was female. She continued her pregnancy and delivered a healthy girl. She again became pregnant 3 years later. The chromosomal analysis revealed that the fetus was male. Fetal DNA analysis determined that the fetus had the inherited mutation. She chose to terminate the pregnancy. A C924T mutation can be disease causing for XLH, and the detection of this mutation would aid in genetic counseling for the prenatal diagnosis of XLH.

We present a case of a patient whose L1CAM gene in X-chromosome has a C924T transition. Her first son's ventriculomegaly was prenatally detected. A mature infant was born, his head circumference was large, and thumbs were bilaterally adducted. X-linked hydrocephalus (XLH) was suspected. The DNA examination revealed that both her and boy's LICAM gene had a C924T transition. She became pregnant 5 years later and amniocentesis was performed. The results of cytogenetic analysis revealed that the fetus was female. She continued her pregnancy and delivered a healthy girl. She again became pregnant 3 years later. The chromosomal analysis revealed that the fetus was male. Fetal DNA analysis determined that the fetus had the inherited mutation. She chose to terminate the pregnancy. A C924T mutation can be disease causing for XLH, and the detection of this mutation would aid in genetic counseling for the prenatal diagnosis of XLH.

Morgagni hernia is an extremely rare form of congenital diaphragmatic hernia. Only 6 cases of this condition have been reported in the English literature, as diagnosed prenatally. The prognosis of the disease is determined by the severity of the pulmonary hypoplasia and associated anomalies. Here we report a case of Morgagni hernia with massive pericardial effusion diagnosed by ultrasonography and MRI during the second trimester, enabling planning of appropriate treatment in the pre- and perinatal periods.

The purpose of this study was to determine the efficacy of paclitaxel in combination with cisplatin and granulocyte-colony stimulating factor (G-CSF) for mobilization of peripheral blood progenitor cells (PBPC). Twenty-seven patients with gynecological cancer received paclitaxel and cisplatin (TP, n = 9) or other platinum-based chemotherapy (n = 18) (etoposide and cisplatin [n = 5]; cyclophosphamide, adriamycin, and cisplatin [n = 8]; or pepleomycin, etoposide, and cysplatin [n = 5]). Each combination was followed by G-CSF. The mean number of colony-forming unit granulocyte macrophage (CFU-GM)/kg and CD34+ cells/kg collected per cycle was 1.2 x 105 and 0.8 x 106 after the TP regimen, compared with 2.6 x 105 (P0.05) and 2.0 x 106 for patients who received other platinum-based chemotherapy. The CFU-GM target yield (/=1.0 x 105/kg) was achieved in 56% and 83% patients in the TP and comparison group, respectively. With the TP regimen, a younger age (/=50 years of age) and fewer prior chemotherapy cycles (/=2) were associated with the CFU-GM targeted yield (0.05). In conclusion, TP mobilized PBPC less effectively than other platinum-based chemotherapy. Therefore, the TP regimen may need to be changed to another appropriate regimen when PBPC mobilization is planned for high-dose chemotherapy in gynecological cancer patients.

Changes in the structure and metabolism of trabecular bone and marrow adipocytes in rats during pregnancy and the early stage of postpartum were evaluated by investigating bone mineral density (BMD) and bone and fat histomorphometry. Forty-nine female virgin Sprague-Dawley rats aged 200 days were mated and divided into seven groups: (1) beginning controls; (2) antepartum-on-day-7; (3) antepartum-on-day-21; (4) nonlactating on the fourth postpartum day; (5) nonlactating on the sixth postpartum day; (6) nonlactating on the eighth postpartum day; (7) lactating on the eight postpartum day. The significant decreases occurred in the trabecular bone at the end of pregnancy and lactation, and the bone formation increases and the bone structure is almost recovered in nonlactating rats within 6 days of postpartum. The percent adipocyte volume, adipocyte number, and unit adipocyte volume significantly decreased during postpartum whether lactating or nonlactating, and they significantly showed negative correlation with the osteoid volume values. The serum triglyceride value and body weight of the seven groups correlated significantly with the unit adipocyte volume value (r = 0.49, P = 0.004; r = 0.58, P = 0.0005, respectively). We concluded that bone resorption and formation are regulated separately during late pregnancy and lactation and that the recovery of BMD from lactation appears to rely on an acceleration of bone formation. Furthermore, the metabolism of the marrow adipocyte may be correlated with bone formation rates, serum triglyceride value, and body weight during pregnancy and early stage of puerperium.

Objective: To clarify whether there are susceptible HLA-DQB1 or HLA-DPB1 alleles in women with preeclampsia. Methods: The frequency of HLA-DQB1 and HLA-DPB1 alleles was analyzed in 47 women with previous severe preeclampsia and compared with that in 85 normal fertile women. The types of HLA-DQB1 and HLA-DPB1 alleles were assessed using a polymerase chain reaction–restriction fragment length polymorphism method. Results: The frequency of HLA-DQB1∗04 allele in previously preeclamptic women was 21.3% (20 of 94 loci) and in the controls was 11.2% (19 of 170 loci). Thus, the HLA-DQB1∗04 allele frequency was significantly higher in preeclamptic women compared with controls ( P 2 test, OR 2.15, 95% confidence interval 1.08, 4.27). The frequency of other HLA-DQB1 alleles and all HLA-DPB1 alleles was not significantly different between groups. The incidence of homozygosity of HLA-DQB1 or HLA-DPB1 alleles in preeclamptic women was not significantly different compared with that of normal fertile women. Conclusion: These data suggest that women who have the HLA-DQB1∗04 allele might be susceptible to preeclampsia.

We examined the subcellular localization of BRCA1 proteins using immunohistochemical staining with C‐terminal (GLK‐2 antibody) and N‐terminal (Ab‐2 antibody) monoclonal antibodies in 44 familial ovarian cancers. Among these, 24 cases were associated with 13 independent germ‐line mutations of BRCA1, and loss of heterozygosity (LOH) at one or more BRCA1 microsatellite markers was found in all 21 informative tumors tested. With GLK‐2 antibody, cytoplasmic staining was observed in 15 of 16 tumors (93.8%) with mutation in exon 11, and BRCA1 staining was absent in 8 of 8 tumors (100%) with mutation in exons other than exon 11. When immunohistochemical staining was performed with Ab‐2 antibody, both nuclear and cytoplasmic staining were observed in 14 of 16 tumors (87.5%) with mutation in exon 11. Interestingly, nuclear staining was observed in 3 of 3 tumors (100%) with mutation downstream of exon 11, even though no staining was detected in 5 of 5 tumors (100%) with mutation upstream of exon 11. On the other hand, in familial ovarian cancers without BRCA1 mutations, nuclear staining or both nuclear and cytoplasmic staining was observed in 18 of 20 specimens (90%) and 20 of 20 specimens (100%) with GLK‐2 antibody and with Ab‐2 antibody, respectively. These results suggest that an immunohistochemical assay in combination with employing the C‐terminal and the N‐terminal antibodies appears to have potential as a reliable and useful technique for the screening of BRCA1 mutations, at least to predict the status of mutation, upstream or downstream of exon 11.