Publications by authors named "Shintaro Makino"

55 Publications

Up-regulation of cytosolic prostaglandin E synthase in fetal-membrane and amniotic prostaglandin E2 accumulation in labor.

PLoS One 2021 23;16(4):e0250638. Epub 2021 Apr 23.

Department of Biochemistry, Juntendo University School of Medicine, Tokyo, Japan.

Prostaglandin E2 (PGE2) is known to have important roles in labor, but the detailed mechanism underlying the spontaneous human labor remains unknown. Here, we examined the involvement of prostaglandin biosynthetic enzymes and transporter in the accumulation of PGE2 in amniotic fluid in human labor. PGE2 and its metabolites were abundant in amniotic fluid in deliveries at term in labor (TLB), but not at term not in labor (TNL). In fetal-membrane Transwell assays, levels of PGE2 production in both maternal and fetal compartments were significantly higher in the TLB group than the TNL group. In fetal-membrane, the mRNA level of PTGES3, which encodes cytosolic prostaglandin E synthase (cPGES), was significantly higher in TLB than in TNL, but the mRNA levels of the other PGE2-synthase genes were not affected by labor. Moreover, the mRNA level of PTGS2, which encodes cyclooxygenase-2 (COX-2) in the amnion was significantly higher in TLB than in TNL. Western blot analyses revealed that the levels of COX-1 and COX-2 were comparable between the two groups, however, the level of cPGES was relatively higher in TLB than in TNL. COXs, cPGES, and prostaglandin transporter (SLCO2A1) proteins were all expressed in both chorionic trophoblasts and amniotic epithelium. These findings suggest that COXs, cPGES and SLCO2A1 contribute to PGE2 production from fetal-membrane in labor.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250638PLOS
April 2021

Effect of hypofibrinogenemia on obstetrical disseminated intravascular coagulation in Japan in 2018: a multicenter retrospective cohort study.

Int J Hematol 2021 Mar 12. Epub 2021 Mar 12.

Department of Obstetrics and Gynecology, Hamamatsu Medical Center, Hamamatsu, Japan.

Japanese obstetrical hemorrhage recommendations state that not only pregnant women with an obstetrical disseminated intravascular coagulation (DIC) score ≥ 8 points but also those with fibrinogen levels ≤ 1.5 g/L have a high risk of maternal death and warrant blood transfusion. Our aim was to demonstrate the potential of fibrinogen levels ≤ 1.5 g/L as predictors of a Japanese obstetrical DIC score of ≥ 8. We included 595 participants with blood loss ≥ 1000 mL during vaginal delivery or ≥ 2000 mL during cesarean delivery. The frequency and volume of red blood cell (RBC), fresh-frozen plasma, platelet concentrate (PC), and fibrinogen administration in women with a DIC score of ≥ 8 and fibrinogen levels of ≤ 1.5 g/L were significantly higher than controls (P < 0.0001). Multivariate analysis demonstrated that a score of ≥ 3 was associated with RBC or fibrinogen administration and a score of ≥ 5 was associated with PC transfusion. Fibrinogen levels ≤ 1.89 g/L and ≤ 2.44 g/L were associated with PC transfusion and fibrinogen administration, respectively. Fibrinogen levels ≤ 1.5 g/L may have similar potential to a DIC score of ≥ 8 points for detecting obstetrical DIC in Japan.
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http://dx.doi.org/10.1007/s12185-021-03119-5DOI Listing
March 2021

A Retrospective Multicenter Study on the Usefulness of 50 g Glucose Challenge Test in Gestational Diabetes Mellitus Screening.

JMA J 2020 Apr 6;3(2):125-130. Epub 2020 Apr 6.

Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.

Introduction: To clarify the usefulness of glucose challenge test (GCT), the rate of gestational diabetes mellitus (GDM) detection and perinatal outcomes were compared between the groups of random blood glucose level (RBG) and 50 g GCT in this study.

Methods: The first survey was conducted at 255 institutions registered by the Kanto Society of Obstetrics and Gynecology and clinical training institutions in the Kanto Area, followed by a second survey. The included women were broadly classified into the RBG and GCT groups, according to the mid-trimester blood glucose screening method, and the perinatal outcomes of the two groups were retrospectively compared. The primary outcomes were the proportion of infants weighing 3,500 g or more and birth weight ≥90-percentile infants.

Results: The rate of GDM diagnosis was significantly higher in the GCT group (7.6%) than that in the RBG group (4.8%). However, no significant differences were observed in perinatal outcomes, i.e., the proportion of infants weighing 3,500 g or more or birth weight ≥90 percentile.

Conclusions: GCT is not superior for predicting infants weighing 3,500 g or more and birth weight ≥90 percentile, as compared with RBG.
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http://dx.doi.org/10.31662/jmaj.2019-0072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590393PMC
April 2020

Whole exome sequencing of fetal structural anomalies detected by ultrasonography.

J Hum Genet 2021 May 3;66(5):499-507. Epub 2020 Nov 3.

Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan.

The objective of this study was to evaluate the efficacy of whole exome sequencing (WES) for the genetic diagnosis of cases presenting with fetal structural anomalies detected by ultrasonography. WES was performed on 19 cases with prenatal structural anomalies. Genomic DNA was extracted from umbilical cords or umbilical blood obtained shortly after birth. WES data were analyzed on prenatal phenotypes alone, and the data were re-analyzed after information regarding the postnatal phenotype was obtained. Based solely on the fetal phenotype, pathogenic, or likely pathogenic, single nucleotide variants were identified in 5 of 19 (26.3%) cases. Moreover, we detected trisomy 21 in two cases by WES-based copy number variation analysis. The overall diagnostic rate was 36.8% (7/19). They were all compatible with respective fetal structural anomalies. By referring to postnatal phenotype information, another candidate variant was identified by a postnatal clinical feature that was not detected in prenatal screening. As detailed phenotyping is desirable for better diagnostic rates in WES analysis, we should be aware that fetal phenotype is a useful, but sometimes limited source of information for comprehensive genetic analysis. It is important to amass more data of genotype-phenotype correlations, especially to appropriately assess the validity of WES in prenatal settings.
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http://dx.doi.org/10.1038/s10038-020-00869-8DOI Listing
May 2021

Comparison of the labor curves with and without combined spinal-epidural analgesia in nulliparous women- a retrospective study.

BMC Pregnancy Childbirth 2020 Aug 15;20(1):467. Epub 2020 Aug 15.

Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.

Background: Neuraxial labor analgesia is known to increase the rate of instrumental delivery and prolong the second stage of labor; however, there is no standard method to evaluate the progress of labor under analgesia. Friedman curve is considered the gold standard for evaluating the progress of labor. However, it included not only neuraxial labor analgesia but also labor without analgesia. Thus we compared the labor curves of primiparous women undergoing labor with and without neuraxial labor analgesia, to understand the progress of labor in both groups and to arrive at a standard curve to monitor the progress of labor under neuraxial analgesia.

Methods: Primiparous women with cephalic singleton pregnancies who delivered at term from 2016 to 2017 were included. Two hundred patients who opted for combined spinal-epidural (CSE) labor analgesia were included in the CSE group and 200 patients who did not undergo CSE were included in the non-CSE group. In all, 400 cases were examined retrospectively. The evaluation parameters were cervical dilation and fetal station, and we calculated the average value per hour to plot the labor curves.

Results: The labor curve of the non-CSE group was significantly different from the Friedman curve. In the CSE group, the time from 4 cm dilation of the cervix to full dilation was 15 h; in addition, the speed of cervical dilation was different from that in the non-CSE group. The progress of labor in the CSE group was faster than that in the non-CSE group during the latent phase; however, the progress in the CSE group was slower than that in the non-CSE group during the active phase.

Conclusions: Neuraxial labor analgesia results in early cervical dilation and descent of the fetal head; thus, appropriate advance planning to manage the delivery may be essential.
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http://dx.doi.org/10.1186/s12884-020-03161-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429797PMC
August 2020

Antepartum eclampsia with reversible cerebral vasoconstriction and posterior reversible encephalopathy syndromes.

J Obstet Gynaecol Res 2020 Oct 10;46(10):2147-2152. Epub 2020 Aug 10.

Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.

A 39-year-old pregnant woman was experienced thunderclap headache due to reversible cerebral vasoconstriction syndrome (RCVS) as a prodromal symptom. Two days after, she was brought to our hospital after an eclamptic seizure at 35 weeks of gestation. After management with magnesium sulphate, a cesarean delivery was performed, and passed without eclamptic seizure recurrence with calcium channel blocker (CCB) administration for hypertension and prophylaxis of another seizure. Antepartum eclampsia is sometimes complicated by headache as a prodromal symptom. Cerebrovascular diseases in the perinatal period include eclampsia, RCVS and posterior reversible encephalopathy syndrome, which have potentially overlapping pathologies. Here, we first report a case of overlapping those three diseases in the antepartum period. Our best literature review showed that antepartum RCVS is severe and has complications besides thunderclap headache, and there is a case report which CCB administration was shown to be effective in the treatment of antepartum RCVS. If thunderclap headache is recognized, prediction of eclampsia and getting better course of RCVS with CCB administration may be possible.
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http://dx.doi.org/10.1111/jog.14410DOI Listing
October 2020

Cesarean Section for Placenta Previa and Placenta Previa Accreta Spectrum.

Surg J (N Y) 2020 Jul 9;6(Suppl 2):S110-S121. Epub 2020 Mar 9.

Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan.

According to the increase in the rate of cesarean section and the increase of high-aged pregnancy, we seem to more often encounter cases with placenta previa and placenta previa accrete spectrum. There are concerns about these cases, such as difficulty in controlling bleeding from the separation surface of placenta previa, the need for hysterectomy as a life-saving procedure, systemic management and hemostasis during massive hemorrhage, and treatment of disseminated intravascular coagulation (DIC). These cases are most frequently associated with cesarean hysterectomy.
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http://dx.doi.org/10.1055/s-0039-3402036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396465PMC
July 2020

Pure 9p duplication syndrome with aplasia of the middle phalanges of the fifth fingers.

Eur J Med Genet 2020 Oct 18;63(10):104005. Epub 2020 Jul 18.

Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.

9p duplication syndrome is a common congenital anomaly syndrome with specific facial features, mental and developmental retardations, and characteristic fingers. Pure 9p duplication without other chromosomal structural variations is very rare. It has recently been reported that cases with partial 9p duplication including SMARCA2 have phenotypes overlapping with Coffin-Siris syndrome (CSS). Herein, we present a family with pure 9p duplication syndrome in which phenotypes partially characteristic of CSS were identified. In one of two siblings, X-ray examination revealed hypoplasia of the distal phalanges of the fifth fingers, aplasia of the middle phalanges of the fifth fingers, and aplasia of the distal phalanges of the second to fifth toes. In pure 9p duplication together with our one affected case, 9 out of 14 cases (64.3%), excluding cases whose clinical data were unavailable, presented the absence or hypoplasia of the middle phalanges of fingers or toes. Interestingly, there are no reports on CSS with aplasia or hypoplasia of the middle phalanx. Therefore, this family might suggest that the aplasia or hypoplasia of the middle phalanges of the fifth fingers or toes is a distinct finding that can distinguish between pure 9p duplication and CSS.
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http://dx.doi.org/10.1016/j.ejmg.2020.104005DOI Listing
October 2020

Laparoscopic Removal of Modified Vertical Uterine Compression Sutures due to Postoperative Focal Pain.

Surg J (N Y) 2020 Apr 31;6(2):e67-e70. Epub 2020 Mar 31.

Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.

Previously we reported laparoscopic removal of compression sutures due to uterine ischemia and related pain, which has two of the difficult aspects: (1) maneuvering the curved needle to perform compression suturing in the narrow surgical field, and (2) distinguishing between the threads of the cesarean section wound sutures versus the vertical compression sutures during removal, as the threads are the same white color. We performed vertical compression sutures for intrapartum hemorrhage with total placental previa, and modified both the needle type and the color of the thread used for uterine compression sutures during cesarean section. After the operation, we performed successful laparoscopic removal of compression sutures for postoperative focal pain. Changing the needle type and color helped to perform operations. The present case supports the concept that the laparoscopic removal of uterine compression suturing is useful for controlling pain in cases where general analgesics are ineffective.
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http://dx.doi.org/10.1055/s-0040-1708865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108947PMC
April 2020

Retrospective study of the recurrence risk of preterm birth in Japan.

J Matern Fetal Neonatal Med 2020 Feb 18:1-5. Epub 2020 Feb 18.

Department of Obstetrics and Gynecology, Juntendo University, Tokyo, Japan.

A history of preterm birth is a risk factor for preterm birth in a future pregnancy, and there are some reports of prevention methods, such as the administration of progesterone. However, the rate of recurrence of preterm birth in Japan has not been clarified, and there is no data for judging whether these preventive methods are effective. To clarify the risk of recurrence of preterm birth and preterm prelabor rupture of membranes (pPROM) in Japan. A retrospective study was conducted using the perinatal registration database of the Japan Obstetrics and Gynecology Society for the Perinatal Center from 2014 to 2016. There were 704,418 subjects, of which 190,990 were excluded those with unknown maternal information, those under the age of 20 years, those with perinatal disease related to preterm birth, and first-time mothers. Logistic model unavailable and multivariate analysis were performed. An analysis of the preterm birth history indicated the risk of preterm birth in the current pregnancy, and the odds ratio for preterm birth recurrence once, twice, and three times or more was 3.3, 6.6, and 7.8, respectively. As a secondary analysis, we analyzed whether the history of pPROM is a risk factor of recurrence of pPROM and found a significant association with an odds ratio of 3.4. Having a preterm birth history increases the risk of recurrence of preterm birth, and the risk of recurrent preterm birth increases as the number of preterm births increases. Although this report is intended for high-risk pregnancies wherein the rate of preterm birth is high, as previously reported, our data indicate that in Japan, preterm birth is a risk factor of recurrent preterm birth.
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http://dx.doi.org/10.1080/14767058.2020.1727435DOI Listing
February 2020

Assessment of extravasation on ruptured uterine artery pseudoaneurysm using contrast-enhanced ultrasonography during uterine balloon tamponade.

J Int Med Res 2020 Apr 20;48(4):300060519893166. Epub 2019 Dec 20.

Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.

Objective: Contrast-enhanced ultrasonography (CEU) has been used in critical trauma situations to visualize extravasation; however, its use is limited in the field of obstetrics. Cases of ruptured uterine artery pseudoaneurysm (UAP) were analyzed to clarify the efficacy to CEU during uterine balloon tamponade.

Methods: Cases of ruptured UAP diagnosed at a teaching university hospital from January 2015 to December 2017 were retrospectively analyzed. UAP was diagnosed using color Doppler ultrasonography. Extravasation was identified using computed tomography and double checked using CEU with an intravenously administered contrast agent (Sonazoid; Daiichi Sankyo Company, Ltd., Tokyo, Japan) and an ultrasound instrument (HI VISION Preirus; Hitachi Aloka Medical, Ltd., Tokyo, Japan). A balloon was then inserted into the uterine cavity and inflated at the point of bleeding until extravasation ceased.

Results: Three patients exhibited ruptured UAP during the study period. Bleeding points were successfully identified using CEU in all cases, and hemostasis was achieved using uterine balloon tamponade. Obliteration of UAP was confirmed using magnetic resonance imaging, and no patients developed recurrent UAP or any complications.

Conclusion: CEU can be used at the bedside to promptly diagnose ruptured UAP. Moreover, it precisely facilitates balloon compression at the point of bleeding.
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http://dx.doi.org/10.1177/0300060519893166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645375PMC
April 2020

Hereditary angioedema with deep vein thrombosis and pulmonary thromboembolism during pregnancy.

Taiwan J Obstet Gynecol 2019 Nov;58(6):895-896

Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan.

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http://dx.doi.org/10.1016/j.tjog.2019.04.003DOI Listing
November 2019

Fetal umbilical cord cyst may evolve to omphalocele during pregnancy.

J Clin Ultrasound 2020 Mar 14;48(3):181-183. Epub 2019 Nov 14.

Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.

Omphalocele is rarely complicated by umbilical cord cysts. In our case, an umbilical cord cyst and fetal ascites were detected at 26 weeks' gestation in a fetus with trisomy 13. This changed to omphalocele with subsequently absorbed fetal ascites at 35 weeks' gestation. We propose two hypotheses. The abdominal wall may have been physically pierced or an omphalocele might have preexisted, and the intestinal tract in the hernia sac was pushed by fetal ascites.
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http://dx.doi.org/10.1002/jcu.22786DOI Listing
March 2020

Characteristics of labor-onset hypertension persist after neuraxial labor analgesia.

J Obstet Gynaecol Res 2020 Jan 16;46(1):104-109. Epub 2019 Oct 16.

Department of Obstetrics and Gynecology, Juntendo University, Tokyo, Japan.

Aim: This study aimed to investigate the rate of labor-onset hypertension (LOH) under neuraxial labor analgesia and the effect of neuraxial labor analgesia on LOH.

Methods: A retrospective study was conducted in a tertiary university hospital from 2015 to 2016. Patients who were admitted to the hospital for vaginal delivery under combined spinal and epidural anesthesia were selected. LOH was defined as the elevation of systolic blood pressure (BP) to ≥140 mmHg or diastolic BP to ≥90 mmHg for the first time after the onset of labor. Cases of LOH that persisted after neuraxial labor analgesia (prolonged LOH) were further analyzed to determine the hypertension severity and therapeutic intervention rate.

Results: Among 775 patients, 213 (28.4%) developed LOH. Prolonged LOH was observed in 30 patients (3.9%). LOH severity and the likelihood of prolonged LOH were positively correlated. Therapeutic intervention was administered only to the patients with prolonged LOH, that is, to 100% of those with emergent hypertension, to 21.1% of those with severe hypertension during labor, and to 36.8% of those with severe hypertension, to 55.6% of those with mild hypertension in the post-partum period.

Conclusion: The rate of LOH was reduced significantly after neuraxial labor analgesia. Patients with prolonged LOH should be carefully followed up during labor and in the post-partum period because such patients often require antihypertensive therapy.
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http://dx.doi.org/10.1111/jog.14140DOI Listing
January 2020

Pre-conception status, obstetric outcome and use of medications during pregnancy of systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) in Japan: Multi-center retrospective descriptive study.

Mod Rheumatol 2020 Sep 24;30(5):852-861. Epub 2019 Sep 24.

Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan.

To describe the pre-conception status, pregnancy outcomes, and medication prevalence in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Crohn's disease (CD), and ulcerative colitis (UC). E-mail-based questionnaire survey for the Japan Maternal Fetal Intensive Care Unit Network hospitals inquiring prevalence and clinical features of SLE, RA, CD and UC complicated pregnancies for 2 years. The number of SLE, RA, CD and UC among 69,810 deliveries was 184, 139, 27 and 178, respectively. Less than half of pregnancies were planned. Assisted reproductive technology (ART) pregnancy rates were higher in SLE, RA and UC than in the general population (11.4, 23.0 and 7.4 vs 5.1%,  < .001 each). Preterm delivery, preeclampsia, and fetal growth restriction (FGR) were more frequent in SLE than in the general population (39.4 vs. 5.6%  < .001, 15.0 vs. 6.0%  < .001, 12.9 vs 4.2%  < .001). Prevalence of preterm delivery in RA and UC (27.5 vs. 5.6%  < .001, 11.3 vs. 5.6%  < .05) and FGR in CD (28.6 vs. 4.2%  < .001) was also higher than that in the general population. SLE, RA, CD, and UC complicated pregnancies were at high risks of obstetric adverse outcome. High ART rates necessitate pre-conception counseling in SLE, RA, and UC pregnancies.
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http://dx.doi.org/10.1080/14397595.2019.1661592DOI Listing
September 2020

National survey of uterine rupture in Japan: Annual report of Perinatology Committee, Japan Society of Obstetrics and Gynecology, 2018.

J Obstet Gynaecol Res 2019 Apr 10;45(4):763-765. Epub 2019 Mar 10.

Perinatology Committee, Japan Society of Obstetrics and Gynecology, Tokyo, Japan.

Aim: To clarify the frequency of occurrence of uterine rupture and its prognosis, a nationwide survey was performed.

Methods: Cases of uterine rupture recorded for a period of 5 years were included.

Results: There were 152 cases of uterine rupture with an incidence rate of 0.015%. The scarred uterine rupture cases were found to have a significantly earlier occurrence of uterine ruptures in comparison to the unscarred cases: unscarred 39.0 weeks, cesarean section 37.0 weeks, myomectomy 32 weeks and adenomyomectomy 30-32 weeks. And it became apparent that the frequency of hysterectomy, cerebral palsy and neonatal death were higher in the cases of uterine rupture during labor than before delivery. Among the cases of scarred uterine rupture, neonatal prognosis was poorer in cases of pregnancy after myomectomy or adenomyomectomy in comparison with postcesarean section cases.

Conclusion: This survey revealed the current incidence of uterine rupture in Japan.
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http://dx.doi.org/10.1111/jog.13924DOI Listing
April 2019

Prenatal sonographic findings and prognosis of craniosynostosis diagnosed during the fetal and neonatal periods.

Congenit Anom (Kyoto) 2019 Jul 5;59(4):132-141. Epub 2018 Sep 5.

Department of Maternal and Fetal Medicine, Miyagi Children's Hospital, Sendai, Japan.

The aim of the study was to explore the sonographic findings of fetuses with craniosynostosis and investigate their prognosis. We conducted a 5-year, multicenter retrospective study and collected data on patients with craniosynostosis diagnosed in the perinatal period. Of 41 cases, 30 cases (73%) were syndromic craniosynostosis, eight cases (20%) were non-syndromic craniosynostosis and the other three cases (7%) were secondary craniosynostosis of chromosomal deletion syndromes. The prenatal ultrasound detection rate was 61%. Half of the cases of syndromic craniosynostosis detected during the perinatal period were Pfeiffer syndrome; there were also six cases of Apert syndrome, three cases of Crouzon syndrome and other rare form of syndromic craniosynostosis (Beare-Stevenson syndrome, Saethre-Chotzen syndrome, cranioectodermal dysplasia, and thanatophoric dysplasia). Abnormal shape of the skull was the most common finding leading to prenatal diagnosis of craniosynostosis. Abnormal head biometry, which was the second most frequent finding, was closely correlated with deformation of the cranial shape. Three cases presented with ventriculomegaly and exophthalmos but normal cranial shape and size. The overall survival rate of infants with syndromic craniosynostosis was 79%, while all of the infants with non-syndromic craniosynostosis survived. In conclusion, prenatal diagnosis of craniosynostosis is difficult, especially when dysmorphic change of the fetal cranium is not evident. Abnormal head biometry and ventriculomegaly could potentially be additional markers of fetal craniosynostosis and consequently increase the prenatal detection rate.
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http://dx.doi.org/10.1111/cga.12308DOI Listing
July 2019

Multiple Placental Infarcts in a Pregnant Woman with Essential Thrombocythemia.

Intern Med 2018 Dec 10;57(24):3647-3650. Epub 2018 Aug 10.

Department of Hematology, Juntendo University School of Medicine, Japan.

Myeloproliferative neoplasms (MPNs), including polycythemia vera, essential thrombocythemia (ET), and primary myelofibrosis, mainly occur in older patients, but have also been reported in younger patients. A "second peak" occurs in female patients in their thirties, particularly in ET; thus, the management of pregnancy is often discussed. We herein present the case of a 33-year-old woman with a high platelet count and multiple placental infarcts during delivery who was subsequently diagnosed with ET. Although there are no worldwide guidelines for the management of MPNs in pregnancy, the risk of thrombosis is markedly increased in these patients, and antithrombotic therapy should be considered.
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http://dx.doi.org/10.2169/internalmedicine.1311-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355404PMC
December 2018

Enclosing sutures technique for control of local bleeding in a case of placenta increta.

J Obstet Gynaecol Res 2018 Aug 22;44(8):1472-1475. Epub 2018 Jun 22.

Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.

Antepartum diagnosis of uterine placenta increta is difficult, thus considering a counterplan during placental delivery is obliged. Uterine compression suture is one of the choices of hemostatic surgical techniques for postpartum hemorrhage. However, uterine synechiae/ischemia are known for the complications. To avoid these complications, we performed a novel hemostatic suture with a contrivance for a case of uterine posterior placenta increta. A nullipara with a history of multiple intrauterine operation underwent cesarean delivery. She was diagnosed as placental increta, and most of the placenta was removed manually. Because continuous bleeding from attachment site was observed even with a balloon tamponade test, four single sutures pierced only the uterine posterior wall with deliberate gaps to each knot were placed to enclose bleeding area. Hemostasis was accomplished without blood transfusion or hysterectomy. This novel hemostatic technique has the potential to control local bleeding without excessively reducing uterine blood flow.
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http://dx.doi.org/10.1111/jog.13670DOI Listing
August 2018

Long-term uterine balloon tamponade for treatment and obliteration of ruptured uterine pseudoaneurysm.

Taiwan J Obstet Gynecol 2018 Jun;57(3):329-331

Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.

Objective: Rupture of uterine artery pseudoaneurysm (UAP) is a life-threatening event after childbirth. Hysterectomy or uterine arterial embolization was often needed for hemostasis. However, such procedures may cause severe morbidities for these women. To estimate the efficacy of uterine balloon tamponade (UBT) for controlling ruptured UAP bleeding, a retrospective analysis in a single teaching hospital was performed.

Materials And Methods: We reviewed the medical record of Juntendo University Hospital in 2015. All the women diagnosed with UAP were recruited to this study and management for UAP was investigated.

Results: Three women were treated with UBT for ruptured UAP. All cases achieved hemostasis. One case had recurrent UAP after 24 h of UBT, and was retreated with UBT for a longer duration. The UAP was obliterated after more than 2 days of UBT in all cases.

Conclusion: UBT has potential as a therapeutic technique not only for treatment of a ruptured UAP but also for obliteration of a UAP.
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http://dx.doi.org/10.1016/j.tjog.2018.04.001DOI Listing
June 2018

The use of medial, wider vertical compression sutures to reduce uterine blood flow for effaced uterine isthmus: a case report.

J Obstet Gynaecol 2018 Aug 12;38(6):871-873. Epub 2018 Feb 12.

a Department of Obstetrics and Gynecology , Juntendo University Faculty of Medicine , Tokyo , Japan.

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http://dx.doi.org/10.1080/01443615.2017.1387522DOI Listing
August 2018

Successful management of obstetric disseminated intravascular coagulation using a portable fibrinogen-measuring device.

J Obstet Gynaecol Res 2018 Apr 23;44(4):788-791. Epub 2018 Jan 23.

Department of Obstetrics and Gynecology, Juntendo University, Tokyo, Japan.

The importance of fibrinogen replacement therapy in obstetric disseminated intravascular coagulation is well recognized. However, fibrinogen measurement in conventional laboratories has been a time-consuming task. Recently, a Japanese manufacturer developed a portable device that enables immediate fibrinogen measurement at the point of care. This report describes a case in which this device was used for the successful management of obstetric disseminated intravascular coagulation.
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http://dx.doi.org/10.1111/jog.13583DOI Listing
April 2018

Incidence and risk factors of severe lacerations during forceps delivery in a single teaching hospital where simulation training is held annually.

J Obstet Gynaecol Res 2018 Apr 5;44(4):708-716. Epub 2018 Jan 5.

Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.

Aim: This study was conducted to evaluate the incidence of severe lacerations during forceps delivery and the risk factors associated with such delivery in a hospital where simulation training is held annually.

Methods: The medical records of 857 women who underwent forceps delivery at term with singleton cephalic presentation from 2010 to 2015 were reviewed. The relationship between clinical characteristics and birth canal trauma was analyzed. Birth canal trauma included third and fourth degree perineal lacerations. Univariable and multivariable models of logistic regression were employed to estimate the raw odds ratio and were adjusted for cofactors with 95% confidence intervals. Statistical significance was defined as P < 0.05.

Results: The incidence of severe lacerations was 10.1%. Birth weight, fetal head station, the rate of malrotation and the number of extractions were higher in women with severe lacerations (P < 0.01), whereas the use of obstetric anesthesia was lower in women with such lacerations (P < 0.01). Neither the indication for forceps delivery nor the qualifications of the operator had any influence on the incidence of severe lacerations.

Conclusion: The incidence of severe lacerations was relatively low. Risk factors for severe lacerations with forceps delivery were identified as birth weight, fetal head station, malrotation and the number of extractions. Obstetric anesthesia may protect against severe lacerations.
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http://dx.doi.org/10.1111/jog.13558DOI Listing
April 2018

Relationship between fetal heart rate patterns and a time course for evaluation of fetal well-being: "the 30 minutes rule" for decision of mechanical delivery.

Taiwan J Obstet Gynecol 2017 Dec;56(6):788-792

Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Japan.

Objective: To predict acidosis in fetus showing deceleration associated with non-reassuring fetal status during delivery, we examined the relationship between duration of the deceleration and umbilical arterial pH.

Materials And Methods: A total of 19,907 deliveries in eight facilities of the Juntendo Perinatal Care Group, 895 cases of vaginal deliveries with level 3 decelerations were selected for the subjects of this study. The cut-off point of time when the umbilical arterial pH fell below 7.20 in all cases of level 3 and for each deceleration type were examined. The explanatory variables were the pH and pO of umbilical arterial gas and the time from onset of the level 3 pattern to delivery. From receiver operating characteristic (ROC) analysis using these variables, the critical point indicating low Apgar score was set at an umbilical arterial pH < 7.20.

Results: The cut-off point of time when the umbilical arterial pH fell below 7.2 was 33.5 min for all cases of level 3, and 604 cases of severe variable decelerations with normal baseline variability and normal baseline heart rates, the cut-off point was 33.5 min as well. For 108 cases of late decelerations, there was no significant cut-off point for either the mild or severe cases. Mild prolonged deceleration showed the cut-off point of 34.5 min.

Conclusions: We confirmed the time indices for predicting and preventing acidosis in fetuses showing decelerations. To prevent fetal acidosis, the decision related to proper timing for performing assisted delivery by considering the time course is important.
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http://dx.doi.org/10.1016/j.tjog.2017.10.015DOI Listing
December 2017

Predictive markers and prenatal management of isolated fetal complete atrioventricular block: A retrospective review at a single institution.

J Obstet Gynaecol Res 2018 Feb 21;44(2):228-233. Epub 2017 Nov 21.

Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.

Aim: The study was conducted to determine an effective method for identifying patients at high risk of developing isolated complete atrioventricular block (CAVB) and to review the efficacy of prenatal anti-inflammatory treatment.

Methods: Fourteen CAVB cases and 76 anti-Ro-positive cases without CAVB were included in the study. Anti-Ro/La titers by double immunodiffusion and the prevalence of anti-52 kDa/60 kDa-Ro/48 kDa-La by Western blotting were compared between anti-Ro-positive women with and without CAVB. Outcomes of anti-Ro-positive CAVB cases were compared based on active prenatal anti-inflammatory treatment (plasma exchange or transplacental betamethasone). We evaluated the outcomes of five pregnancies from three women who had an affected child and underwent prophylactic plasma exchange (PEX) during subsequent pregnancy.

Results: Ten out of 14 patients with CAVB were positive for anti-Ro. Anti-Ro titers were significantly higher in patients with CAVB (CAVB median 64; without CAVB median 16; P < 0.01). All cases with CAVB showed high titers of anti-Ro (≥ 32×), whereas only 42% of cases without CAVB showed high titers (≥ 32×) (P < 0.001). The survival rate at one year was 80% in anti-Ro-positive CAVB cases with active prenatal anti-inflammatory treatment, but only 40% in cases that did not receive treatment. Recurrence was not observed in cases treated with prophylactic PEX.

Conclusions: An anti-Ro level of 32× could be the threshold value for CAVB development. Prenatal anti-inflammatory treatment in patients with CAVB and prophylactic PEX in patients who had an affected child may have the potential to improve pregnancy outcomes.
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http://dx.doi.org/10.1111/jog.13511DOI Listing
February 2018

Retrospective multicenter study of leaving the placenta in situ for patients with placenta previa on a cesarean scar.

Int J Gynaecol Obstet 2018 Mar 15;140(3):345-351. Epub 2017 Dec 15.

The Perinatology Committee of the Japan Society of Obstetrics and Gynecology, Tokyo, Japan.

Objective: To investigate maternal outcomes after leaving the placenta in situ for placenta accreta spectrum (PAS) disorders in patients with placenta previa on a cesarean delivery scar.

Methods: The present retrospective study reviewed medical records from women with placenta previa on a cesarean scar underwent perinatal care at secondary- or tertiary-level perinatal centers in Japan between January 1, 2010, and December 31, 2014. Perinatal management was conducted based on each leading obstetrician's discretion. The primary outcome was success of the leaving the placenta in situ approach for PAS disorders (defined as preserving the uterus without hysterectomy).

Results: Of 178 eligible centers, 126 (71%) participated in this study; data from 613 patients were included. Of these, 41 had the placenta left in situ owing to PAS disorders and follow-up data were available for 36 women. Leaving the placenta in situ was successful in 25 (69%) patients, with placental resorption occurring postpartum (median 89 days; range 6-510). Hysterectomy was performed for 11 patients, primarily owing to hemorrhage and/or infection (median 30 days; range 0-95 days, postpartum).

Conclusion: Leaving the placenta in situ, with close postpartum follow-up for at least several months, could be a uterus-preserving option for patient with PAS disorders.
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http://dx.doi.org/10.1002/ijgo.12397DOI Listing
March 2018

Annual Report of the Perinatology Committee, Japan Society of Obstetrics and Gynecology, 2016: Overall report on a comprehensive retrospective study of obstetric management of preterm labor and preterm premature rupture of the membranes.

J Obstet Gynaecol Res 2018 Jan 8;44(1):5-12. Epub 2017 Nov 8.

Perinatology Committee, Japan Society of Obstetrics & Gynecology, Tokyo, Japan.

We conducted a questionnaire survey on the current obstetric management of preterm labor (PL) and preterm premature rupture of the membranes (pPROM). The questionnaire covered approximately a third of all preterm deliveries and nearly half of the preterm deliveries before 32 gestational weeks. The diagnostic criterion for PL was either painful uterine contractions or cervical dilatation. Tocolytic agents were primarily used as long-term maintenance therapy. Intrauterine infection was clinically diagnosed at most responding institutions. Amniocentesis was performed for PL or pPROM at only a small number (10%) of institutions. Prenatal steroids were administered for PL or pPROM, if indicated, at approximately 40-60% of responding institutions. Prophylactic antibiotics to maintain pregnancy were administered for pPROM at approximately 90% and for PL at approximately 20% of institutions. Maintenance therapy with a tocolytic agent was used for pPROM at approximately 90% of institutions.
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http://dx.doi.org/10.1111/jog.13515DOI Listing
January 2018

Factors associated with adverse pregnancy outcomes in women with antiphospholipid syndrome: A multicenter study.

J Reprod Immunol 2017 08 4;122:21-27. Epub 2017 Aug 4.

Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.

The aim of this study was to understand the clinical features of antiphospholipid syndrome (APS)-complicated pregnancies and evaluate risk factors for the adverse pregnancy outcomes. This multicenter study evaluated live-birth rates according to therapy modality for APS and risk factors of pregnancy loss in 81 pregnancies. Risk factors for pregnancy complications, including premature delivery before 34 gestational weeks, hypertensive disorders of pregnancy, thrombocytopenia, and light-for-date neonate, were evaluated in 51 women who received low dose aspirin (LDA) plus unfractionated heparin (UFH) and delivered after 24 GW. The live-birth rate in APS pregnancies with LDA+UFH therapy was 92.6%. A multiple logistic regression analysis demonstrated that LDA+UFH therapy decreased the risk of pregnancy loss (OR 0.13, 95%CI 0.03-0.62), and that a history of pregnancy loss despite LDA+UFH therapy increased the risk of pregnancy loss (OR 8.74, 95%CI 1.69-45.2). LDA therapy prior to pregnancy decreased the risk of premature delivery (OR 0.14, 95%CI 0.03-0.69). Positive tests for two or more anti-phospholipid antibodies increased the risks of premature delivery (OR 9.61, 95%CI 1.78-51.8) and thrombocytopenia (OR 4.90, 95%CI 1.11-21.7). Laboratory findings of low complements increased the risk of hypertensive disorders of pregnancy (OR 12.1, 95%CI 1.61-91.0). Standard therapy yielded high live-birth rates. Positive tests for two or more anti-phospholipid antibodies and low complements were associated with adverse pregnancy outcomes. These results have important implications for clinicians.
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http://dx.doi.org/10.1016/j.jri.2017.08.001DOI Listing
August 2017

Japanese Clinical Practice Guide for Critical Obstetrical Hemorrhage (2017 revision).

J Obstet Gynaecol Res 2017 Oct 24;43(10):1517-1521. Epub 2017 Jul 24.

Japan Society of Transfusion Medicine and Cell Therapy, Tokyo, Japan.

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http://dx.doi.org/10.1111/jog.13417DOI Listing
October 2017

Laparoscopic removal of uterine vertical compression sutures.

Gynecol Minim Invasive Ther 2017 Apr-Jun;6(2):73-75. Epub 2016 May 15.

Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.

Uterine compression suturing is a relatively easy and effective way of hemostasis during cesarean section and is becoming widely accepted. However, complications such as necrosis or synechiae have been reported. We firstly report a case of laparoscopic removal of vertical compression sutures and discuss its benefits and improvements to be made. This case report is of a 32-year-oId woman with placenta previa who received uterine vertical compression sutures for controlling massive bleeding during cesarean section. Because she complained of unbearable pelvic pain, laparoscopic compression suture removal was performed. Her pain was relieved after the threads were removed, suggesting that the compression sutures were the cause of her pelvic pain due to uterine ischemia. Although the risks of reoperation during the early postpartum period still exist, compression suture thread removal should be considered in cases of suspected uterine ischemia.
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http://dx.doi.org/10.1016/j.gmit.2016.03.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6113968PMC
May 2016