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Ueda Y, Mogami H, Chigusa Y, Kawamura Y, Inohaya A, Takakura M, Yasuda E, Matsuzaka Y, Shimada M, Ito S, Morita S, Mandai M, Kondoh E. Hyposecretion of cervical MUC5B is related to preterm birth in pregnant women after cervical excisional surgery. Am J Reprod Immunol 2024; 91:e13832. [PMID: 38462543 DOI: 10.1111/aji.13832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024] Open
Abstract
PROBLEM Excisional surgery for cervical intraepithelial neoplasia is a risk factor for preterm birth in subsequent pregnancies. However, the underlying mechanisms of this association remain unclear. We previously showed that cervical MUC5B, a mucin protein, may be a barrier to ascending pathogens during pregnancy. We thus hypothesized that hyposecretion of cervical MUC5B is associated with preterm birth after cervical excisional surgery. METHOD OF STUDY This prospective nested case-control study (Study 1) included pregnant women who had previously undergone cervical excisional surgery across 11 hospitals. We used proteomics to compare cervicovaginal fluid at 18-22 weeks of gestation between the preterm and term birth groups. In another case-control analysis (Study 2), we compared MUC5B expression in nonpregnant uterine tissues between 15 women with a history of cervical excisional surgery and 26 women without a history of cervical surgery. RESULTS The abundance of MUC5B in cervicovaginal fluid was significantly decreased in the preterm birth group (fold change = 0.41, p = .035). Among the 480 quantified proteins, MUC5B had the second highest positive correlation with gestational age at delivery in the combined preterm and term groups. The cervicovaginal microbiome composition was not significantly different between the two groups. Cervical length was not correlated with gestational age at delivery (r = 0.18, p = .079). Histologically, the MUC5B-positive area in the nonpregnant cervix was significantly decreased in women with a history of cervical excisional surgery (0.85-fold, p = .048). The distribution of MUC5B-positive areas in the cervical tissues of 26 women without a history of cervical excisional surgery differed across individuals. CONCLUSIONS This study suggests that the primary mechanism by which cervical excisional surgery causes preterm birth is the hyposecretion of MUC5B due to loss of the cervical glands.
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Affiliation(s)
- Yusuke Ueda
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yosuke Kawamura
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Asako Inohaya
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahito Takakura
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eriko Yasuda
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yu Matsuzaka
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Shinji Ito
- Medical Research Support Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Inohaya A, Chigusa Y, Takakura M, Io S, Kim MA, Matsuzaka Y, Yasuda E, Ueda Y, Kawamura Y, Takamatsu S, Mogami H, Takashima Y, Mandai M, Kondoh E. Shear stress in the intervillous space promotes syncytial formation of iPS cells-derived trophoblasts†. Biol Reprod 2024; 110:300-309. [PMID: 37930227 DOI: 10.1093/biolre/ioad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/01/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023] Open
Abstract
The intervillous space of human placenta is filled with maternal blood, and villous trophoblasts are constantly exposed to the shear stress generated by maternal blood pressure and flow throughout the entire gestation period. However, the effects of shear stress on villous trophoblasts and their biological significance remain unknown. Here, using our recently established naïve human pluripotent stem cells-derived cytotrophoblast stem cells (nCTs) and a device that can apply arbitrary shear stress to cells, we investigated the impact of shear stress on early-stage trophoblasts. After 72 h of exposure to 10 dyn/cm2 shear stress, nCTs became fused and multinuclear, and mRNA expression of the syncytiotrophoblast (ST) markers, such as glial cell missing 1, endogenous retrovirus group W member 1 envelope, chorionic gonadotropin subunit beta 3, syndecan 1, pregnancy specific beta-1-glycoprotein 3, placental growth factor, and solute carrier family 2 member 1 were significantly upregulated compared to static conditions. Immunohistochemistry showed that shear stress increased fusion index, human chorionic gonadotropin secretion, and human placental lactogen secretion. Increased microvilli formation on the surface of nCTs under flow conditions was detected using scanning electron microscopy. Intracellular cyclic adenosine monophosphate significantly increased under flow conditions. Moreover, transcriptome analysis of nCTs subjected to shear stress revealed that shear stress upregulated ST-specific genes and downregulated CT-specific genes. Collectively, these findings indicate that shear stress promotes the differentiation of nCTs into ST.
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Affiliation(s)
- Asako Inohaya
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahito Takakura
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shingo Io
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Min-A Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yu Matsuzaka
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eriko Yasuda
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Ueda
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Kawamura
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shiro Takamatsu
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuhiro Takashima
- Department of Life Science Frontiers, Center for iPS Cell Research and Application, Kyoto University, Kyoto Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eiji Kondoh
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Nishikawa S, Miki M, Chigusa Y, Furuta M, Kido A, Kawamura Y, Ueda Y, Mandai M, Mogami H. Obstetric pelvimetry by three-dimensional computed tomography in non-pregnant Japanese women: a retrospective single-center study. J Matern Fetal Neonatal Med 2023; 36:2190444. [PMID: 36927362 DOI: 10.1080/14767058.2023.2190444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE While a basic understanding of pelvic size and typology is still important for obstetricians, pelvic measurement data for Japanese women are very scarce. To our best knowledge, no large-scale pelvimetry studies of Japanese women have been made for the past 50 years. This study aimed to investigate the accurate size, particularly the obstetric conjugate (OC) and transverse diameter of the pelvic inlet (TD), of modern Japanese women, using three-dimensional (3D) computed tomography (CT), and to obtain their reference values. METHODS This retrospective, single-center observational study enrolled Japanese non-pregnant women aged between 20 and 40 years, who underwent pelvic CT examination from 2016 to 2021. CT was performed for various reasons, including acute abdomen, search for cancer metastases, and follow-up of existing disease. However, no cases were taken for pelvic measurements. Pelvimetry was performed retrospectively using a 3D workstation. The OC was measured on a strict lateral view and the TD was measured on an axial-oblique view. Other clinical data, such as age, height, and weight, were also extracted from the medical charts and analyzed. RESULTS A total of 1,263 patients were enrolled, with the mean age of 32.7 years (standard deviation [SD] 6.2). The mean height, weight, and body mass index were 158.8 cm (SD 5.8), 54.8 kg (SD 11.7), and 21.7 kg/m2 (SD 4.4), respectively. The mean OC length was 127.0 mm (SD 9.5, 95% confidence interval [CI] 126.5-127.5), while the mean TD length was 126.8 mm (SD 7.5, 95% CI 126.4-127.2). Both values were normally distributed. Height was significantly associated with OC (regression coefficient = 0.75 [95% CI 0.66-0.84], p < .001) and TD (regression coefficient = 0.63 [95% CI 0.56-0.70], p < .001). Age showed a weak but statistically significant positive association with TD (regression coefficient = 0.14 [95% CI 0.07-0.20], p < .001) and OC (regression coefficient = -0.10 [95% CI -0.18 to -0.01], p = .026). CONCLUSION The 3D CT pelvimetry in 1,263 non-pregnant Japanese women of childbearing age revealed the mean OC and TD of 127.0 mm, and 126.8 mm, which were 11.8 mm and 4.3 mm larger, respectively, than those in the survey in 1972. Our data will be referred to in clinical practice as the standard pelvic measurement values for the Japanese population.
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Affiliation(s)
- Shoko Nishikawa
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masayo Miki
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Marie Furuta
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Kawamura
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Ueda
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Nishikawa S, Taki M, Okamoto H, Kawamura Y, Chigusa Y, Tomotaki S, Mandai M, Mogami H. The prognosis of neonatal respiratory status within three years after birth in chronic abruption-oligohydramnios sequence. J Obstet Gynaecol Res 2023; 49:2649-2655. [PMID: 37534531 DOI: 10.1111/jog.15755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023]
Abstract
AIM Chronic abruption-oligohydramnios sequence (CAOS), which is characterized by vaginal bleeding and oligohydramnios, adversely affects the lungs of fetuses due to bloody amniotic fluid and oligohydramnios. The criteria for termination of pregnancy remain controversial. This study aimed to examine respiratory function in infants within 3 years after birth and risk factors for respiratory prognosis, and to clarify the management of CAOS. METHODS This study is a case series of patients with CAOS managed at our institution between 2010 and 2020. The clinical data of the patients and their infants within 3 years after birth were reviewed. The amniotic fluid volume was measured using the maximum vertical pocket (MVP). RESULTS Six of 17 neonates (35.3%) used inhaled nitric oxide (iNO) to improve oxygenation. Women with longer periods of MVP <1 cm delivered more neonates using iNO; however, periods of MVP <2 cm were not associated with iNO use. Almost half of the infants required home oxygen therapy when discharged, regardless of amniotic fluid volume. At 18 months corrected age, only one child needed respiratory support, and the others discontinued. Two neonates, both born at 23 weeks of gestational age, died within 1 month after birth because of extremely preterm birth. CONCLUSIONS The amniotic fluid volume could predict the use of iNO in neonates, but it did not affect the child's respiratory function after the newborn period. Almost all children born to women with CAOS can improve their respiratory function as they grow up.
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Affiliation(s)
- Shoko Nishikawa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mana Taki
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Haruko Okamoto
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yosuke Kawamura
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Seiichi Tomotaki
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Koyama M, Taki M, Okamoto H, Kawamura Y, Ueda Y, Chigusa Y, Mandai M, Mogami H. Characteristics of pregnancy complicated with type 1 and type 2 diabetes. Taiwan J Obstet Gynecol 2023; 62:655-660. [PMID: 37678991 DOI: 10.1016/j.tjog.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE Diabetes in pregnancy is a major risk factor for adverse perinatal outcomes such as congenital anomalies, hypertensive disorders of pregnancy (HDP), and macrosomia. For the mechanism of onset of type 1 and type 2 diabetes are different, we focused on the difference in perinatal outcomes between the type 1 and type 2 diabetes groups. MATERIALS AND METHODS We retrospectively reviewed 22 pregnancies with type 1 diabetes and 15 pregnancies with type 2 diabetes, who were managed in our single center, with regard to maternal diabetes conditions during pregnancy and neonatal birthweight and blood glucose level. Furthermore, we checked the effect of continuous glucose monitoring and continuous subcutaneous insulin injection in pregnancies with type 1 diabetes. RESULTS Type 1 diabetes in pregnancy was less controllable and increased neonatal birth weight and neonatal hypoglycemia within 2 h after birth after neonatal care unit admission. Continuous glucose monitoring and continuous subcutaneous insulin injection that are convenient to use, had a similar effect in the management of type 1 diabetes during pregnancy, compared with conventional diabetes treatment. In contrast, maternal BMI and HDP were increased in women with type 2 diabetes. CONCLUSION In the management of pregnancy with diabetes, we should pay attention to the difference in pregnancy prognosis between type 1 and type 2 diabetes.
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Affiliation(s)
- Misaki Koyama
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Mana Taki
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Haruko Okamoto
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yosuke Kawamura
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yusuke Ueda
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Yu S, Tani H, Chigusa Y, Kawamura Y, Kondoh E, Mandai M, Mogami H. Residual amniotic fluid volume predicts the sealing of preterm prelabor rupture of fetal membranes in the pre- and periviable period. Taiwan J Obstet Gynecol 2023; 62:543-546. [PMID: 37407191 DOI: 10.1016/j.tjog.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE Preterm prelabor rupture of fetal membranes (pPROM) is a leading cause of preterm birth. When pPROM occurs around the pre- and periviable period, the perinatal outcome is unfavorable. However, there have been a few cases in which the leakage of amniotic fluid ceases and the ruptured fetal membranes are spontaneously sealed. MATERIALS AND METHODS The prognosis of 38 cases of pPROM at less than 27 weeks of gestation in Kyoto University Hospital were studied. The clinical factors related to the sealing of fetal membranes were investigated. RESULTS Spontaneous sealing was confirmed in five patients (13%), and sealing occurred within 14 days of pPROM. Women in the no sealing group delivered at 26.3 ± 0.5 weeks of gestation, whereas women in the sealing group delivered at term at 38.8 ± 0.4 weeks (p < 0.0001). The maximum vertical pocket (MVP) of amniotic fluid at the time of pPROM diagnosis was 2.2 ± 0.3 cm in the no sealing group and 3.8 ± 0.5 cm in the sealing group (p = 0.043). All cases of sealing occurred when the MVP at diagnosis was more than 2 cm, and there were no cases of sealing if the MVP at diagnosis was less than 2 cm. In addition, the value of C-reactive protein at ROM was less than 0.4 mg/dL in all cases in the sealing group. CONCLUSION The residual volume of sterile amniotic fluid at the onset of pPROM may predict the possibility of fetal membrane sealing.
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Affiliation(s)
- Sae Yu
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirohiko Tani
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Kawamura
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Akaguma A, Ishii T, Uchida Y, Chigusa Y, Ueda Y, Mandai M, Mogami H. Laparoscopic resection for pedunculated focal nodular hyperplasia of the liver during pregnancy. Oxf Med Case Reports 2023; 2023:omad054. [PMID: 37377714 PMCID: PMC10292637 DOI: 10.1093/omcr/omad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/14/2023] [Accepted: 05/04/2023] [Indexed: 06/29/2023] Open
Abstract
Focal nodular hyperplasia (FNH) is the second most common intrahepatic benign mass lesion; however, extremely rarely, FNH grows in an exophytic manner. It is unclear whether pedunculated FNH can be managed in the same way as intrahepatic FNH. A 35-year-old female presented with right upper quadrant pain, and dynamic enhanced computed tomography revealed an exophytic hyperdense mass lesion originating from the liver, suggesting a pedunculated FNH. Shortly thereafter, she conceived. Since there was a history of acute abdomen, as well as the possibility of torsion of the mass or sudden massive bleeding during pregnancy, laparoscopic resection was performed at 17 weeks of gestation. Her postoperative and pregnancy course was uneventful, and she delivered a baby by cesarean section at 41 weeks of gestation. Our case suggests that pedunculated FNH, unlike typical intrahepatic FNH, may be better managed by laparoscopic surgery during pregnancy, resulting in favorable maternal and fetal outcomes.
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Affiliation(s)
- Ai Akaguma
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takamichi Ishii
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoichiro Uchida
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshitsugu Chigusa
- Correspondence address. Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara cho, Sakyo ku, Kyoto 606-8507, Japan. Tel: 81-75-751-3269; Fax: 81-75-761-3967; E-mail:
| | - Yusuke Ueda
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Himoto Y, Fujimoto K, Kido A, Otani S, Matsumoto YK, Mogami H, Nakao KK, Kurata Y, Moribata Y, Chigusa Y, Minamiguchi S, Mandai M, Nakamoto Y. Risk Stratification for Pregnancies Diagnosed With Fetal Growth Restriction Based on Placental MRI. J Magn Reson Imaging 2022; 56:1650-1658. [PMID: 35713388 DOI: 10.1002/jmri.28298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diagnosis of fetal growth restriction (FGR) entails difficulties with differentiating fetuses not fulfilling their growth potential because of pathologic conditions, such as placental insufficiency, from constitutionally small fetuses. The feasibility of placental MRI for risk stratification among pregnancies diagnosed with FGR remains unexplored. PURPOSE To explore quantitative MRI features useful to identify pregnancies with unfavorable outcomes and to assess the diagnostic performance of visual analysis of MRI to detect pregnancies with unfavorable outcomes, among pregnancies diagnosed with FGR. STUDY TYPE Retrospective. POPULATION Thirteen pregnancies with unfavorable outcomes (preterm emergency cesarean section or intrauterine fetal death) and 11 pregnancies with favorable outcomes performed MRI at gestational weeks 21-36. FIELD STRENGTH/SEQUENCE A 5-T, half-Fourier-acquired single-shot turbo spin echo (HASTE), spin-echo echo-planar imaging (SE-EPI) and T2 map derived from SE-EPI. ASSESSMENT Placental size on HASTE sequences and T2 mapping-based histogram features were extracted. Three radiologists qualitatively evaluated the visibility of maternal cotyledon on HASTE and SE-EPI sequences with echo times (TEs) = 60, 90, and 120 msec using 3-point Likert scales: 0, absent; 1, equivocal; and 2, present. STATISTICAL TESTS Welch's t-test or Mann-Whitney U test for quantitative features between the favorable and unfavorable outcome groups. Areas under the receiver operating curves (AUCs) of the three readers' visual analyses to detect pregnancies with unfavorable outcomes. A P value of <0.05 was inferred as statistically significant. RESULTS Placental size (major and minor axis, estimated area of placental bed, and volume of placenta) and T2 mapping-based histogram features (mean, skewness, and kurtosis) were statistically significantly different between the two groups. Visual analysis of HASTE and SE-EPI with TE = 60 msec showed AUCs of 0.80-0.86 to detect pregnancies with unfavorable outcomes. DATA CONCLUSION Placental size, histogram features, and visual analysis of placental MRI may allow for risk stratification regarding outcomes among pregnancies diagnosed with FGR. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Yuki Himoto
- Department of Diagnostic Radiology and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Koji Fujimoto
- Department of Real World Data Research and Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Otani
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuka Kuriyama Matsumoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Kyoko Kameyama Nakao
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuhisa Kurata
- Department of Diagnostic Radiology and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yusaku Moribata
- Preemptive Medicine and Lifestyle-related Disease Research Center, Kyoto University Hospital, Kyoto, Japan
| | | | | | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Ueda Y, Mogami H, Kawamura Y, Takakura M, Inohaya A, Yasuda E, Matsuzaka Y, Chigusa Y, Ito S, Mandai M, Kondoh E. Cervical MUC5B and MUC5AC are Barriers to Ascending Pathogens During Pregnancy. J Clin Endocrinol Metab 2022; 107:3010-3021. [PMID: 36112402 DOI: 10.1210/clinem/dgac545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Indexed: 12/15/2022]
Abstract
CONTEXT Cervical excision is a risk factor for preterm birth. This suggests that the cervix plays an essential role in the maintenance of pregnancy. OBJECTIVE We investigated the role of the cervix through proteomic analysis of cervicovaginal fluid (CVF) from pregnant women after trachelectomy surgery, the natural model of a lack of cervix. METHODS The proteome compositions of CVF in pregnant women after trachelectomy were compared with those in control pregnant women by liquid chromatography-tandem mass spectrometry and label-free relative quantification. MUC5B/AC expression in the human and murine cervices was analyzed by immunohistochemistry. Regulation of MUC5B/AC expression by sex steroids was assessed in primary human cervical epithelial cells. In a pregnant mouse model of ascending infection, Escherichia coli or phosphate-buffered saline was inoculated into the vagina at 16.5 dpc, and the cervices were collected at 17.5 dpc. RESULTS The expression of MUC5B/5AC in cervicovaginal fluid was decreased in pregnant women after trachelectomy concomitant with the anatomical loss of cervical glands. Post-trachelectomy women delivered at term when MUC5B/AC abundance was greater than the mean normalized abundance of the control. MUC5B levels in the cervix were increased during pregnancy in both humans and mice. MUC5B mRNA was increased by addition of estradiol in human cervical epithelial cells, whereas MUC5AC was not. In a pregnant mouse model of ascending infection, E. coli was trapped in the MUC5B/AC-expressing mucin of the cervix, and neutrophils were colocalized there. CONCLUSION Endocervical MUC5B and MUC5AC may be barriers to ascending pathogens during pregnancy.
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Affiliation(s)
- Yusuke Ueda
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yosuke Kawamura
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masahito Takakura
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Asako Inohaya
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Eriko Yasuda
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yu Matsuzaka
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Shinji Ito
- Medical Research Support Center, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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10
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Kawamura Y, Mogami H, Yasuda E, Takakura M, Matsuzaka Y, Ueda Y, Inohaya A, Kawasaki K, Chigusa Y, Mandai M, Kondoh E. Fetal macrophages assist in the repair of ruptured amnion through the induction of epithelial-mesenchymal transition. Sci Signal 2022; 15:eabi5453. [PMID: 36099339 DOI: 10.1126/scisignal.abi5453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The premature rupture of the amniotic sac, a condition referred to as a preterm prelabor rupture of membranes (pPROM), is a leading cause of preterm birth. In some cases, these ruptured membranes heal spontaneously. Here, we investigated repair mechanisms of the amnion, a layer of epithelial cells in the amniotic sac closest to the embryo. Macrophages migrated to and resided at rupture sites in both human and mouse amnion. A process called epithelial-mesenchymal transition (EMT), in which epithelial cells acquire a mesenchymal phenotype and which is implicated in tissue repair, was observed at rupture sites. In dams bearing macrophage-depleted fetuses, the repair of amnion ruptures was compromised, and EMT was rarely detected at rupture sites. The migration of cultured amnion epithelial cells in wound healing assays was mediated by EMT through transforming growth factor-β (TGF-β)-Smad signaling. These findings suggest that fetal macrophages are crucial in amnion repair because of their ability to induce EMT in amnion epithelial cells.
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Affiliation(s)
- Yosuke Kawamura
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Eriko Yasuda
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Masahito Takakura
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Yu Matsuzaka
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Yusuke Ueda
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Asako Inohaya
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Kaoru Kawasaki
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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11
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Shiraga A, Ohsuga T, Kawasaki K, Mogami H, Minamiguchi S, Mandai M. A case of placental multiple giant chorangioma leading to neonatal death from fetal hydrops. Case Reports in Perinatal Medicine 2022. [DOI: 10.1515/crpm-2022-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Although placental chorangiomas are often asymptomatic, larger tumors (>4–5 cm) can cause various perinatal complications, including polyhydramnios, preterm birth, fetal anemia, fetal hydrops, and intrauterine fetal death. Symptomatic placental chorangiomas are often diagnosed prenatally on ultrasonography as a mass on the fetal side of the placenta.
Case presentation
A 37-year-old pregnant woman underwent emergency cesarean delivery at 34 weeks’ gestation due to rapidly progressive fetal hydrops leading to fetal dysfunction, resulting in neonatal death. Placental pathology indicated multiple placental giant chorangiomas that occupied 40% of the placenta. Because of the disk shape of the placenta, prenatal diagnosis by ultrasonography was difficult.
Conclusions
Some placental chorangiomas are difficult to diagnose and lead to fetal hydrops and poor prognosis, even if ultrasonography does not show an obvious mass in the placenta.
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Affiliation(s)
- Aoi Shiraga
- Department of Obstetrics and Gynecology , Kyoto University Hospital , Kyoto , Japan
| | - Takuma Ohsuga
- Department of Obstetrics and Gynecology , Kyoto University Hospital , Kyoto , Japan
| | - Kaoru Kawasaki
- Department of Obstetrics and Gynecology , Kyoto University Hospital , Kyoto , Japan
| | - Haruta Mogami
- Department of Obstetrics and Gynecology , Kyoto University Hospital , Kyoto , Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology , Kyoto University Hospital , Kyoto , Japan
| | - Masaki Mandai
- Department of Obstetrics and Gynecology , Kyoto University Hospital , Kyoto , Japan
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12
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Ohsuga T, Egawa M, Kii M, Ikeda Y, Ueda A, Chigusa Y, Mogami H, Mandai M. Association between nonanemic iron deficiency in early pregnancy and perinatal mental health: A retrospective pilot study. J Obstet Gynaecol Res 2022; 48:2730-2737. [DOI: 10.1111/jog.15397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/07/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Takuma Ohsuga
- Department of Gynecology and Obstetrics Kyoto University Graduate School of Medicine Kyoto Japan
| | - Miho Egawa
- Department of Gynecology and Obstetrics Kyoto University Graduate School of Medicine Kyoto Japan
| | - Misato Kii
- Faculty of Medicine Kyoto University Kyoto Japan
| | - Yumie Ikeda
- Department of Gynecology and Obstetrics Kyoto University Graduate School of Medicine Kyoto Japan
- Department of Health Informatics Kyoto University School of Public Health Kyoto Japan
| | - Akihiko Ueda
- Department of Gynecology and Obstetrics Kyoto University Graduate School of Medicine Kyoto Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics Kyoto University Graduate School of Medicine Kyoto Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics Kyoto University Graduate School of Medicine Kyoto Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics Kyoto University Graduate School of Medicine Kyoto Japan
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13
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Moriuchi K, Kawasaki K, Hayashi M, Ueda A, Yamanishi Y, Mogami H, Fujita K, Shiro R, Yo Y, Mandai M, Matsumura N. Plasma Antithrombin Activity during Long-Term Magnesium Sulfate Administration for Preeclampsia without Severe Hypertension. Healthcare (Basel) 2022; 10:healthcare10081581. [PMID: 36011238 PMCID: PMC9408047 DOI: 10.3390/healthcare10081581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022] Open
Abstract
In preeclampsia, plasma antithrombin activity is decreased, which leads to exacerbation of the disorder. We previously showed that long-term magnesium sulfate (MgSO4) administration prolonged the pregnancy period and may be able to improve pregnancy outcomes for patients with severe preeclampsia. The present study aimed to investigate the changes in plasma antithrombin activity during long-term MgSO4 administration for patients without severe hypertension. This multicenter retrospective study included patients with preeclampsia and superimposed preeclampsia without severe hypertension at diagnosis. The participants were divided into two groups: MgSO4 nontreatment group (three institutions) and MgSO4 treatment group (one institution). Antithrombin activity from time of diagnosis to delivery were compared between the two groups. In the MgSO4 nontreatment group (n = 16), antithrombin activity prior to delivery was significantly lower than at time of diagnosis (p = 0.015). In three cases, antithrombin activity was less than 60%. On the other hand, in the MgSO4 treatment group (n = 34), antithrombin activity did not change until just before delivery (p = 0.74). There were no cases in which antithrombin activity was decreased below 60%. Long-term MgSO4 administration for preeclampsia without severe hypertension may prevent a decrease in antithrombin activity and improve the disease state of preeclampsia.
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Affiliation(s)
- Kaori Moriuchi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka-Sayama 589-8511, Osaka, Japan
| | - Kaoru Kawasaki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka-Sayama 589-8511, Osaka, Japan
- Correspondence: ; Tel.: +81-72-366-0221
| | - Maako Hayashi
- Department of Obstetrics and Gynecology, Japanese Red Cross Otsu Hospital, Otsu 520-8511, Shiga, Japan
| | - Akihiko Ueda
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto 606-8507, Sakyo, Japan
| | - Yukio Yamanishi
- Department of Obstetrics and Gynecology, Japanese Red Cross Wakayama Medical Center, Wakayama 640-8558, Wakayama, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto 606-8507, Sakyo, Japan
| | - Kohei Fujita
- Department of Obstetrics and Gynecology, Japanese Red Cross Otsu Hospital, Otsu 520-8511, Shiga, Japan
| | - Reona Shiro
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka-Sayama 589-8511, Osaka, Japan
| | - Yoshie Yo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka-Sayama 589-8511, Osaka, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto 606-8507, Sakyo, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka-Sayama 589-8511, Osaka, Japan
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14
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Ueda A, Nakakita B, Chigusa Y, Mogami H, Ohtera S, Kato G, Mandai M, Kondoh E. Impact of efforts to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan: a nationwide retrospective study. BMC Pregnancy Childbirth 2022; 22:496. [PMID: 35715763 PMCID: PMC9205073 DOI: 10.1186/s12884-022-04824-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background The Japan Society of Obstetrics and Gynecology and the Japan Association of Obstetricians and Gynecologists have issued the guidelines and recommendations on postpartum hemorrhage since 2010 and have been conducted widespread educational activities from 2012. The aim of this study was to investigate the impact of these efforts by the Societies to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan. Methods A national retrospective cohort study was conducted using the national database of health insurance claims for the period 2012 and 2018. The subjects were all insured women who received a blood transfusion for postpartum hemorrhage. The primary endpoints of this study were hysterectomy and maternal mortality. The etiology of hemorrhage, treatment facility, type of procedure, and blood transfusion volume were tabulated. Results Women with postpartum hemorrhage that underwent transfusion increased from 3.5 to 5.5 per 1000 deliveries between 2012 and 2018. The most common cause of postpartum hemorrhage was atonic hemorrhage. After insurance coverage in 2013, the intrauterine balloon tamponade use increased to 20.3% of postpartum hemorrhages treated with transfusion in 2018, while the proportion of hysterectomy was decreased from 7.6% (2013–2015) to 6.4% (2016–2018) (p < 0.0001). The proportion of postpartum hemorrhage in maternal deaths decreased from 21.1% (2013–2015) to 14.1% (2016–2018) per all maternal deaths cases (p = 0.14). Cases with postpartum hemorrhage managed in large referral hospitals was increased (65.9% in 2012 to 70.4% in 2018) during the study period (p < 0.0001). Conclusions The efforts by the Societies to prevent maternal mortality due to obstetric hemorrhage resulted in a significant decrease in the frequency of hysterectomies and a downward trend in maternal mortality due to obstetric hemorrhage. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04824-7.
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Affiliation(s)
- Akihiko Ueda
- Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Baku Nakakita
- Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Shosuke Ohtera
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital/National Institute of Public Health, Kyoto, Japan
| | - Genta Kato
- Solutions Center for Health Insurance Claims, Kyoto University Hospital, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan.
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15
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Aki M, Katsumata M, Yamanoi K, Ueda A, Nakakita B, Tani H, Kawasaki K, Chigusa Y, Mogami H, Mandai M, Kondoh E. The significance of clinical symptoms of subchorionic hematomas, “bleeding first”, to stratify the high-risk subgroup of very early preterm delivery. Taiwan J Obstet Gynecol 2022; 61:243-248. [DOI: 10.1016/j.tjog.2022.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/28/2022] Open
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16
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Affiliation(s)
- Haruta Mogami
- Department of Gynecology and Obstetrics Kyoto University Graduate School of Medicine Kyoto Japan
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17
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Motoki T, Chigusa Y, Tomotaki S, Kawamura Y, Taki M, Yamaguchi K, Mandai M, Mogami H. Clinical Features of Neurodevelopmental Outcomes in Children with Preterm Severe Fetal Growth Restriction: A Retrospective Observational Study. JMA J 2022; 5:341-348. [PMID: 35992293 PMCID: PMC9358274 DOI: 10.31662/jmaj.2022-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/26/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction: Fetal growth restriction (FGR) is a clinical condition wherein a fetus fails to achieve the expected growth potential. Although FGR is the leading cause of perinatal morbidity and mortality, there is a lack of knowledge about the long-term developmental outcomes of children who had FGR in Japan. Here, we sought to clarify the features of neurodevelopmental outcomes in preterm-born children with severe FGR (sFGR) and identify associated clinical factors. Methods: The clinical data of 26 preterm sFGR cases and 26 preterm appropriate for gestational age (AGA) cases with a similar gestational age distribution were reviewed retrospectively. Developmental quotient (DQ) scores assessed during the 1- and 2-year corrected ages using the Kyoto Scale of Psychological Development were analyzed. Results: sFGR was diagnosed at 26 (18-34) weeks of gestation, and the gestational age at delivery was 31 (25-36) weeks. The overall DQ scores of children in the sFGR group were significantly lower than those in the AGA group (80 vs. 90.5, P = 0.0127). Of the three areas that comprise the DQ (Postural-Motor, Cognitive-Adaptive, and Language-Social), the sFGR group only showed significantly lower DQ scores (72.5 vs. 88, P = 0.0255) in the Language-Social area. Both fetal body weight and fetal body weight Z score at birth significantly correlated with the DQ scores (r = 0.4912, P = 0.0108, and r = 0.5621, P = 0.0028), whereas neither the duration of fetal growth arrest nor the gestational age at birth correlated with the DQ scores (r = 0.3598, P = 0.0842, and r = 0.3522, P = 0.0776). Conclusions: Our results indicate that preterm-born children with sFGR have greater neurodevelopmental impairment than preterm-born children without FGR, specifically in terms of the DQ scores for the Language-Social area. It is imperative to encourage continuous long-term follow-up and appropriate interventions after birth.
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Affiliation(s)
- Takahiro Motoki
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | | | | | - Yosuke Kawamura
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Mana Taki
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Ken Yamaguchi
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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18
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Yasuda E, Mogami H, Matsuzaka Y, Inohaya A, Takakura M, Ueda Y, Kawamura Y, Chigusa Y, Kondoh E, Mandai M. Subchorionic hematoma promotes epithelial-mesenchymal transition of amniotic epithelial cells. Placenta 2021. [DOI: 10.1016/j.placenta.2021.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Inohaya A, Chigusa Y, Matsuzaka Y, Yasuda E, Takakura M, Ueda Y, Kawamura Y, Io S, Mogami H, Kondoh E, Mandai M. Shear stress in the intervillous space promotes trophoblast syncytium formation. Placenta 2021. [DOI: 10.1016/j.placenta.2021.08.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Ueda A, Chigusa Y, Mogami H, Nakita B, Ohtera S, Kato G, Horie A, Mandai M, Kondoh E. Maternal near-miss attributable to haemorrhagic stroke in patients with hypertensive disorders of pregnancy in Japan: A national cohort study. Pregnancy Hypertens 2021; 25:240-243. [PMID: 34315129 DOI: 10.1016/j.preghy.2021.07.244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the epidemiologic and clinical characteristics of maternal near-misses attributable to haemorrhagic stroke (HS) occurring in patients with hypertensive disorders of pregnancy (HDP), with a focus on severe neurological morbidity. METHODS A national retrospective cohort study was conducted using the national database of health insurance claims for the period 2010 to 2017. The subjects were all insured women with a diagnosis of both HDP and HS. Severe neurological morbidity requiring rehabilitation, types of HDP, types of HS, and magnesium sulphate use were tabulated. RESULTS The number of women with HDP who were diagnosed with HS was 3.4 per 100,000 deliveries between 2010 and 2017. Forty percent of HDP-related HS cases had neurological morbidities requiring rehabilitation (1.4 per 100,000 deliveries), and 4.4% were in a persistent vegetative state after HS. Of the HDP cases who developed HS, 69.2% were severe HDP, of which 55.6% were without eclampsia. The most common type of HS was intracerebral haemorrhage (2.5 per 100,000 deliveries), followed by subarachnoid haemorrhage due to cerebral aneurysm (1.2 per 100,000 deliveries). The frequency of magnesium sulphate use increased in all patients with HDP-related HS in the second half of the study period (2014-2017) compared with the first half (2010-2013) (p < 0.0001). This was more evident in cases of HDP-related HS with eclampsia (31.9% to 83.8%) compared to those without eclampsia (25.0% to 42.9%). CONCLUSION Of the maternal near-miss cases due to HDP-related HS, 40.0% were rehabilitated and 69.2% were HDP without either eclampsia or severe hypertension.
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Affiliation(s)
- Akihiko Ueda
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Yoshitsugu Chigusa
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Baku Nakita
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Shosuke Ohtera
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital/National Institute of Public Health, Japan
| | - Genta Kato
- Solutions Centre for Health Insurance Claims, Kyoto University Hospital, Kyoto, Japan
| | - Akihito Horie
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan.
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21
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Sato M, Inohaya A, Yasuda E, Mogami H, Chigusa Y, Kawasaki K, Kawamura Y, Ueda Y, Takai H, Mandai M, Kondoh E. Three-dimensional human placenta-like bud synthesized from induced pluripotent stem cells. Sci Rep 2021; 11:14167. [PMID: 34239021 PMCID: PMC8266876 DOI: 10.1038/s41598-021-93766-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 06/22/2021] [Indexed: 11/08/2022] Open
Abstract
Placental dysfunction is related to the pathogenesis of preeclampsia and fetal growth restriction, but there is no effective treatment for it. Recently, various functional three-dimensional organs have been generated from human induced-pluripotent cells (iPSCs), and the transplantation of these iPSCs-derived organs has alleviated liver failure or diabetes mellitus in mouse models. Here we successfully generated a three-dimensional placental organ bud from human iPSCs. The iPSCs differentiated into various lineages of trophoblasts such as cytotrophoblast-like, syncytiotrophoblast-like, and extravillous trophoblast-like cells, forming organized layers in the bud. Placental buds were transplanted to the murine uterus, where 22% of the buds were successfully engrafted. These iPSC-derived placental organ buds could serve as a new model for the study of placental function and pathology.
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Affiliation(s)
- Mai Sato
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Asako Inohaya
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Eriko Yasuda
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Kaoru Kawasaki
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Yosuke Kawamura
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Yusuke Ueda
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Hiroshi Takai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan.
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22
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Chigusa Y, Mogami H, Minamiguchi S, Kido A, Ishida A, Kurata Y, Yasuda E, Kawasaki K, Horie A, Yamaguchi K, Mandai M, Kondoh E. Chronic abruption-oligohydramnios sequence (CAOS) revisited: possible implication of premature rupture of membranes. J Matern Fetal Neonatal Med 2021; 35:6894-6900. [PMID: 34016009 DOI: 10.1080/14767058.2021.1929159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM The pathogenic mechanism of chronic abruption-oligohydramnios sequence (CAOS) remains unknown, and there are no objective standards for diagnosis on imaging or using pathological evidence. We aimed to reconsider and clarify the true pathology of CAOS by integrating clinical, magnetic resonance imaging (MRI) and histopathological findings of the placenta. MATERIAL AND METHODS This is a case series of patients with CAOS managed at our hospital between 2010 and 2020. The clinical data of the patients, including MRI findings and placental pathology, were reviewed retrospectively. RESULTS A total of 18 patients were eligible. Preterm birth occurred in 17 (94%) cases; the median gestational age at delivery was 25. Three neonates (17%) died within two years, and 10 neonates (56%) developed chronic lung disease. MRI was performed in 13 cases and clearly showed intrauterine hematoma and hemorrhagic amniotic fluid. Pathologically, in all cases, retroplacental hematoma was not detected, and fetal membranes were extremely fragile and ragged. Shedding and necrosis of the amniotic epithelium was a characteristic finding, which was confirmed in 17 cases (94%). Diffuse chorionic hemosiderosis (DCH) was detected in all cases. CONCLUSIONS The fundamental cause of CAOS is repeated intrauterine hemorrhage and subsequent subchorionic hematoma, which induces hemorrhagic amniotic fluid and DCH. Consequently, these factors result in the necrosis and weakening of the amnion. Therefore, the true pathology of CAOS is believed to be premature rupture of membranes rather than chronic abruption.
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Affiliation(s)
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | | | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Ayami Ishida
- Department of Diagnostic Pathology, Kyoto University, Kyoto, Japan
| | - Yasuhisa Kurata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Eriko Yasuda
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Kaoru Kawasaki
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Akihito Horie
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Ken Yamaguchi
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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23
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Kondoh E, Chigusa Y, Ueda A, Mogami H, Yamaguchi K, Mandai M. CT scan assessment of intrauterine balloon tamponade failure for the treatment of atonic postpartum haemorrhage: implications for treatment. BJOG 2021; 128:1726-1731. [PMID: 33938132 DOI: 10.1111/1471-0528.16724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 11/28/2022]
Affiliation(s)
- E Kondoh
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Y Chigusa
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - A Ueda
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - H Mogami
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - K Yamaguchi
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - M Mandai
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
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24
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Takahashi S, Horie A, Yamamura S, Kawamura A, Yamaguchi A, Sunada M, Tani H, Mogami H, Hamanishi J, Kondoh E, Mandai M. Oncofertility care in young women and the outcomes of pregnancy over the last 5 years. Future Sci OA 2021; 7:FSO680. [PMID: 33815825 PMCID: PMC8015666 DOI: 10.2144/fsoa-2020-0169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: To ascertain the actual outcomes of oncofertility care in young women to provide more appropriate care. Materials & methods: We analyzed the data of 67 female patients under 43 years of age who underwent oncofertility care between January 2015 and September 2019. Results: There were 28 patients with breast cancer, 19 patients with hematologic cancer and 20 patients with other cancer diagnoses. Breast cancer patients tended to take longer than hematologic cancer patients to initiate oncofertility treatment. Despite undergoing oncofertility care, seven of nine pregnant patients did not choose assisted reproductive technology (ART). Conclusion: As spontaneous pregnancies were more common than ART pregnancies in our study, pregnancy by not only ART but also non-ART method is a viable option for young cancer survivors. We conducted a study about oncofertility care and pregnancy outcomes in female cancer survivors under 43 years old. Even after chemotherapy, pregnancy by not only assisted reproductive technology (ART) but also non-ART method is a viable option for young cancer survivors. Social support as well as ART advancement is important for young cancer survivors and the low marriage rate may contribute to the low pregnancy rate.
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Affiliation(s)
- Sayuri Takahashi
- Department of Gynecology & Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan
| | - Akihito Horie
- Department of Gynecology & Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan
| | - Sachi Yamamura
- Department of Gynecology & Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan
| | - Akeo Kawamura
- Department of Gynecology & Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan
| | - Ayaka Yamaguchi
- Department of Gynecology & Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan
| | - Masumi Sunada
- Department of Gynecology & Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan
| | - Hirohiko Tani
- Department of Gynecology & Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan
| | - Haruta Mogami
- Department of Gynecology & Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan
| | - Junzo Hamanishi
- Department of Gynecology & Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan
| | - Eiji Kondoh
- Department of Gynecology & Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan
| | - Masaki Mandai
- Department of Gynecology & Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan
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25
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Kondoh E, Ueda A, Mogami H. Rethinking uterine compression suture for atonic postpartum hemorrhage. Acta Obstet Gynecol Scand 2021; 100:5-6. [PMID: 33314064 DOI: 10.1111/aogs.14035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/20/2020] [Accepted: 10/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Akihiko Ueda
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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26
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Sato M, Kondoh E, Takai H, Kawasaki K, Kawamura Y, Chigusa Y, Mogami H, Mandai M. Three-dimensional vascularized human placenta from an iPSC-derived organ bud transplant. Placenta 2021. [DOI: 10.1016/j.placenta.2020.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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27
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Io S, Kondoh E, Iemura Y, Minamiguchi S, Chigusa Y, Mogami H, Mandai M. Severe fetal anemia as a consequence of extra-abdominal umbilical vein varix: A case report and review of the literature. Congenit Anom (Kyoto) 2021; 61:4-8. [PMID: 33099808 DOI: 10.1111/cga.12397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/01/2022]
Abstract
Umbilical vein varix is associated with a high incidence of fetal anomalies and perinatal complications. There are two types of umbilical vein varix: fetal intra-abdominal and extra-abdominal. Herein, a case is reported of severe fetal anemia with extra-abdominal umbilical vein varix. A 33-year-old primigravida was referred to our hospital for fetal growth restriction, fetal cardiomegaly, and decreased fetal movements at 26 weeks' gestation. A Doppler assessment showed an elevated middle cerebral artery peak systolic velocity at 2.2 MoM, suggesting fetal anemia. Umbilical vein varix had caused intermittent turbulent flow, provoking hemolytic anemia. Intrauterine transfusion improved fetal circulatory failure and anemia and prolonged gestational period. At 33 weeks' gestation, the patient underwent cesarean delivery due to nonreassuring fetal status. Pathological analysis revealed focal loss of vascular smooth muscle of the umbilical vein. Extra-abdominal umbilical vein varix has been reported in 14 cases including this case. The antenatal diagnosis rate is reported to be 79%; fetal heartbeat abnormalities and fetal deaths were reported as 50% and 14%, respectively. Eighty-six percent of patients had intra-umbilical cord thrombosis, but currently this is the only case of hemolytic anemia. Furthermore, extra-abdominal umbilical vein varix may present as fetal hydrops with anemia. During ultrasound examination of fetal anemia, umbilical cord screening should be performed with caution.
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Affiliation(s)
- Shingo Io
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshiki Iemura
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
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28
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Kawamura Y, Mogami H, Inohaya A, Ueda Y, Kawasaki K, Chigusa Y, Kondoh E, Mandai M. Fetal macrophages in amnion promote the healing of ruptured membranes through TGF-β1-induced epithelial-mesenchymal transition. Placenta 2021. [DOI: 10.1016/j.placenta.2020.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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29
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Ueda A, Chigusa Y, Mogami H, Kawasaki K, Horie A, Mandai M, Kondoh E. Predictive factors for flares of established stable systemic lupus erythematosus without anti-phospholipid antibodies during pregnancy. J Matern Fetal Neonatal Med 2020; 35:3909-3914. [PMID: 33143489 DOI: 10.1080/14767058.2020.1843626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To identify predictors of systemic lupus erythematosus (SLE) flares during pregnancy in patients previously considered to be at low risk. MATERIALS AND METHODS The retrospective cohort study included 54 singleton pregnancies, managed between 2005 and 2019, involving maternal diagnosed SLE at a low disease activity (SLE Disease Activity Index ≤4) for ≥12 months before conception and without anti-phospholipid antibodies. Pregnancy outcomes were compared between patients who had SLE exacerbations during pregnancy (flare group, n = 21) and patients that did not have a flare (non-flare group, n = 33). RESULTS The flare group had shorter gestational durations (p = .01), lower birth weights (p = .02), and a higher risk of emergent cesarean section (p = .002) compared with the non-flare group. The flare group demonstrated higher doses of prednisone (p = .04) at the time of conception as well as an increased rate of low 50% hemolytic complement (CH50) activity (p = .03) in the first trimester compared to the non-flare group. A decision tree drawn using a prednisone dose ≥10.5 mg/day and a low CH50 predicted SLE flares with a net accuracy of 78%. CONCLUSIONS A prednisone dose ≥10.5 mg daily and CH50 hypocomplementemia in early pregnancy are useful in the early detection of patients at a high risk of SLE exacerbation.
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Affiliation(s)
- Akihiko Ueda
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | | | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Kaoru Kawasaki
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Akihito Horie
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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30
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Shitanaka S, Chigusa Y, Kawahara S, Kawasaki K, Mogami H, Mandai M, Kondoh E. Conservative management for retained products of conception after less than 22 weeks of gestation. J Obstet Gynaecol Res 2020; 46:1982-1987. [PMID: 32761752 DOI: 10.1111/jog.14405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/14/2020] [Accepted: 07/05/2020] [Indexed: 11/28/2022]
Abstract
AIM The aim of the study was to investigate the efficacy of conservative treatment in cases of retained products of conception (RPOC) with a preceding pregnancy of less than 22 weeks and to assess whether serum beta-human chorionic gonadotropin (hCG) levels could be a useful index to monitor the progress of treatment. METHODS This is a case series of patients with RPOC developed after less than 22 weeks of gestation and managed expectantly with serial serum hCG measurement between 2011 and 2017. The clinical data of subjects were reviewed retrospectively. Cases that did not require invasive treatment such as surgery were designated as conservative management success. RESULTS A total of 19 cases were eligible: 14 miscarriages and 5 induced abortions. Eleven patients underwent dilatation and curettage. The diagnosis of RPOC was made 35 (8-80) days after abortion. All patients were successfully treated with conservative management. Serum hCG levels at diagnosis were 29.6 (3.2-1585) mIU/mL. Serial measurement of serum hCG was continued until the levels became lower than the cutoff value, and the mean duration to hCG disappearance was 67.5 (6-183) days. In all cases, RPOC vanished spontaneously 77 (27-184) days after diagnosis. The disappearance of RPOC in the uterine cavity was subsequent to a significant decrease in serum hCG. Once serum hCG levels reached the cutoff value, no bleeding episodes were observed. CONCLUSION Conservative management for RPOC might be acceptable and effective. Furthermore, serial serum hCG levels reflect the activity of RPOC, and hCG may be a reliable index to monitor the progress of treatment.
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Affiliation(s)
- Shimpei Shitanaka
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan.,Department of Obstetrics and Gynecology, Toyooka Public Hospital, Toyooka, Hyogo, Japan
| | | | - Shunsuke Kawahara
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Kaoru Kawasaki
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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Abstract
Preterm premature rupture of membranes (pPROM) typically leads to spontaneous preterm birth within several days. In a few rare cases, however, amniotic fluid leakage ceases, amniotic fluid volume is restored, and pregnancy continues until term. Amnion, the collagen-rich layer that forms the load-bearing structure of the fetal membrane, has regenerative capacity and has been used clinically to aid in the healing of various wounds including burns, diabetic ulcers, and corneal injuries. In the healing process of ruptured fetal membranes, amnion epithelial cells seem to play a major role with assistance from innate immunity. In a mouse model of sterile pPROM, macrophages are recruited to the injured site. Well-organized and localized inflammatory responses cause epithelial mesenchymal transition of amnion epithelial cells which accelerates cell migration and healing of the amnion. Research on amnion regeneration is expected to provide insight into potential treatment strategies for pPROM.
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Affiliation(s)
- Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - R Ann Word
- Department of Obstetrics and Gynecology, Cecil H. and Ida Green Center for Reproductive Biology Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
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32
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Nakakita B, Ueda A, Chigusa Y, Mogami H, Mandai M, Kondoh E. Modified Mississippi protocol for HELLP/partial HELLP syndrome occurring in the periviable period: A report of three cases. Hypertens Res Pregnancy 2020. [DOI: 10.14390/jsshp.hrp2019-017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Baku Nakakita
- Department of Gynecology and Obstetrics, Kyoto University
| | - Akihiko Ueda
- Department of Gynecology and Obstetrics, Kyoto University
| | | | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University
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33
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Kondoh E, Chigusa Y, Ueda A, Mogami H, Mandai M. Novel intrauterine balloon tamponade systems for postpartum hemorrhage. Acta Obstet Gynecol Scand 2019; 98:1612-1617. [DOI: 10.1111/aogs.13692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/23/2019] [Accepted: 07/07/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Eiji Kondoh
- Department of Gynecology and Obstetrics Kyoto University Kyoto Japan
| | | | - Akihiko Ueda
- Department of Gynecology and Obstetrics Kyoto University Kyoto Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics Kyoto University Kyoto Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics Kyoto University Kyoto Japan
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34
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Ueda A, Nakakita B, Chigusa Y, Mogami H, Inohaya A, Yamaguchi K, Horie A, Hamanishi J, Mandai M, Kondoh E. Tight systolic blood pressure control early in pregnancy improves pregnancy outcomes in women with chronic hypertension. Hypertens Res Pregnancy 2019. [DOI: 10.14390/jsshp.hrp2019-014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Akihiko Ueda
- Department of Gynecology and Obstetrics, Kyoto University
| | - Baku Nakakita
- Department of Gynecology and Obstetrics, Kyoto University
| | | | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University
| | - Asako Inohaya
- Department of Gynecology and Obstetrics, Kyoto University
| | - Ken Yamaguchi
- Department of Gynecology and Obstetrics, Kyoto University
| | - Akihito Horie
- Department of Gynecology and Obstetrics, Kyoto University
| | | | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University
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35
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Kiyokawa H, Mogami H, Ueda Y, Kawamura Y, Sato M, Chigusa Y, Kondoh E, Mandai M. Glucocorticoid Weakens Fetal Membranes via IL-1B Production by Amniotic Fluid Macrophage. Placenta 2019. [DOI: 10.1016/j.placenta.2019.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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36
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Abstract
BACKGROUND Premature rupture of membranes occurring in previable midtrimester patients is associated with perinatal mortality, and optimal therapeutic methods are yet to be established. OBJECTIVE This study's objective was to investigate whether an elastomeric sealant, which has been used as a hemostatic agent for arterial anastomosis, could plug the uterine endocervical canal to prevent leakage of intrauterine fluid in an ex vivo model. METHODS The elastomeric sealant or fibrin glue was applied to the cervix of uteri removed for benign gynecological disease (n = 4). Normal saline was administered into the ex vivo uterine cavity through a catheter using a pressure infusion bag. Intrauterine pressure was measured using a digital pressure gauge, and the pressure at which normal saline started leaking out of the uterine cervix was compared between both the sealants. RESULTS No fluid leakage was observed with the elastomeric sealant until the pressure exceeded 20 kPa (150 mmHg), while the leakage onset pressure with fibrin sealant was 6.6 ± 1.8 kPa (50 ± 14 mmHg). The threshold leak pressure where the onset of liquid flow was initiated was significantly different between both the sealants (p < .0001). CONCLUSIONS Intracervical elastomeric sealant exhibited powerful fluid leakage prevention in an ex vivo model. The sealant would have potential to prevent the leakage of amniotic fluid in pregnancies with previable premature rupture of membranes.
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Affiliation(s)
- Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Yosuke Kawamura
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | | | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Akihiko Ueda
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Junzo Hamanishi
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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37
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Takai H, Kondoh E, Mogami H, Kawasaki K, Chigusa Y, Sato M, Kawamura Y, Murakami R, Matsumura N, Konishi I, Mandai M. Placental sonic hedgehog pathway regulates foetal growth via insulin-like growth factor axis in preeclampsia. J Clin Endocrinol Metab 2019; 104:4239-4252. [PMID: 31120491 DOI: 10.1210/jc.2019-00335] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 05/17/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Placental dysfunction is the underlying cause of common major disorders of pregnancy, such as foetal growth restriction (FGR) and preeclampsia. However, the mechanisms of placental dysfunction are not entirely elucidated. We previously reported 10 reliable preeclampsia pathways based on multiple microarray data sets, among which was the sonic hedgehog (SHH) pathway. Here we describe the significant role of SHH signalling involved in placental development and foetal growth. METHODS The placental expression levels of surrogate markers of the SHH pathway, patched homolog 1 (PTCH1) and glioma-associated oncogene homolog 2 (GLI2), were evaluated using quantitative real-time polymerase chain reaction (qPCR), western blot analysis and immunohistochemistry. We investigated the underlying mechanisms of the SHH pathway in trophoblast syncytialization, a critical process for placental development and maturation, using primary cytotrophoblasts. Moreover, the potential roles of placental SHH signalling in the regulation of the insulin-like growth factor (IGF) axis were explored by pathway analysis of microarray data. Finally, the influence of SHH signalling on foetal growth was examined by placental administration of cyclopamine, an SHH pathway inhibitor, to pregnant mice. RESULTS The SHH pathway was downregulated in preeclampsia placentas and its activation was highly correlated with birth weight. Trophoblast syncytialization was modulated by non-canonical SHH-adenylate cyclase (ADCY) signalling rather than canonical SHH-GLI signalling. The IGF1R pathway was regulated by both non-canonical SHH-ADCY signalling and canonical SHH-GLI signalling. Inhibition of placental SHH signalling significantly reduced foetal weight in mice. CONCLUSION Placental development and foetal growth were regulated through the SHH pathway via the IGF axis.
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Affiliation(s)
- Hiroshi Takai
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
| | - Eiji Kondoh
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
| | - Haruta Mogami
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
| | - Kaoru Kawasaki
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
| | | | - Mai Sato
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
| | - Yosuke Kawamura
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
| | - Ryusuke Murakami
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
| | - Ikuo Konishi
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masaki Mandai
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
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Kiyokawa H, Mogami H, Ueda Y, Kawamura Y, Sato M, Chigusa Y, Mandai M, Kondoh E. Maternal Glucocorticoids Make the Fetal Membrane Thinner: Involvement of Amniotic Macrophages. Endocrinology 2019; 160:925-937. [PMID: 30776301 DOI: 10.1210/en.2018-01039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/13/2019] [Indexed: 01/10/2023]
Abstract
Glucocorticoid use during pregnancy is known to increase the risk of preterm birth and preterm premature rupture of membranes (pPROM). Here, we investigated the mechanism of how glucocorticoids weaken the fetal membranes. The amnion mesenchymal layer was significantly thinner in pregnant women treated with prednisolone and in corticosterone-injected mice than in control groups. Matrix metalloproteinase (MMP)-9 mRNA and its activity, COX2 mRNA levels, and prostaglandin E2 synthesis were increased, whereas type 1 collagen (COL1A1) mRNA levels were decreased in the fetal membranes of corticosterone-injected mice. Unexpectedly, the proliferation and migration of macrophages were observed around the corticosterone-injected amnion, and IL-1β was released from these macrophages. In human amnion mesenchymal cells, cortisol did not change MMP mRNA expression, whereas IL-1β treatment robustly increased MMP and COX2 mRNA expression. COL1A1 mRNA level was decreased by both cortisol and IL-1β. These data suggest that the recruitment of amniotic macrophages by glucocorticoids plays a pivotal role in weakening of the fetal membranes, leading to the pathogenesis of pPROM.
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Affiliation(s)
- Hikaru Kiyokawa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Ueda
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yosuke Kawamura
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mai Sato
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kondoh E, Chigusa Y, Ueda A, Nakakita B, Mogami H, Mandai M. Video image: Ultrasound findings of a novel subtype of atonic postpartum hemorrhage: is it still a diagnosis of exclusion? Hypertens Res Pregnancy 2019. [DOI: 10.14390/jsshp.hrp2019-001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University
| | | | - Akihiko Ueda
- Department of Gynecology and Obstetrics, Kyoto University
| | - Baku Nakakita
- Department of Gynecology and Obstetrics, Kyoto University
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University
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Kawasaki K, Kondoh E, Chigusa Y, Kawamura Y, Mogami H, Takeda S, Horie A, Baba T, Matsumura N, Mandai M, Konishi I. Metabolomic Profiles of Placenta in Preeclampsia. Hypertension 2019; 73:671-679. [DOI: 10.1161/hypertensionaha.118.12389] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kaoru Kawasaki
- From the Department of Gynaecology and Obstetrics, Kyoto University, Japan (K.K., E.K., Y.C., Y.K., H.M., A.H., T.B., N.M., M.M.)
- Department of Obstetrics and Gynaecology, National Hospital Organization Kyoto Medical Center, Japan (K.K., I.K.)
| | - Eiji Kondoh
- From the Department of Gynaecology and Obstetrics, Kyoto University, Japan (K.K., E.K., Y.C., Y.K., H.M., A.H., T.B., N.M., M.M.)
| | - Yoshitsugu Chigusa
- From the Department of Gynaecology and Obstetrics, Kyoto University, Japan (K.K., E.K., Y.C., Y.K., H.M., A.H., T.B., N.M., M.M.)
| | - Yosuke Kawamura
- From the Department of Gynaecology and Obstetrics, Kyoto University, Japan (K.K., E.K., Y.C., Y.K., H.M., A.H., T.B., N.M., M.M.)
| | - Haruta Mogami
- From the Department of Gynaecology and Obstetrics, Kyoto University, Japan (K.K., E.K., Y.C., Y.K., H.M., A.H., T.B., N.M., M.M.)
| | - Satoru Takeda
- Department of Obstetrics and Gynaecology, Juntendo University, Tokyo, Japan (S.T.)
| | - Akihito Horie
- From the Department of Gynaecology and Obstetrics, Kyoto University, Japan (K.K., E.K., Y.C., Y.K., H.M., A.H., T.B., N.M., M.M.)
| | - Tsukasa Baba
- From the Department of Gynaecology and Obstetrics, Kyoto University, Japan (K.K., E.K., Y.C., Y.K., H.M., A.H., T.B., N.M., M.M.)
| | - Noriomi Matsumura
- From the Department of Gynaecology and Obstetrics, Kyoto University, Japan (K.K., E.K., Y.C., Y.K., H.M., A.H., T.B., N.M., M.M.)
| | - Masaki Mandai
- From the Department of Gynaecology and Obstetrics, Kyoto University, Japan (K.K., E.K., Y.C., Y.K., H.M., A.H., T.B., N.M., M.M.)
| | - Ikuo Konishi
- Department of Obstetrics and Gynaecology, National Hospital Organization Kyoto Medical Center, Japan (K.K., I.K.)
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Ikeda A, Kondoh E, Chigusa Y, Mogami H, Kameyama Nakao K, Kido A, Horie A, Baba T, Hamanishi J, Mandai M. Novel subtype of atonic postpartum hemorrhage: dynamic computed tomography evaluation of bleeding characteristics and the uterine cavity. J Matern Fetal Neonatal Med 2019; 33:3286-3292. [PMID: 30651015 DOI: 10.1080/14767058.2019.1571033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Uterine atony is the leading cause of severe postpartum hemorrhage (PPH); however, the underlying cause of intractable atonic PPH unresponsive to conventional treatments (such as uterotonics and intrauterine balloon tamponade) remains unclear.Objectives: The aim of this study was to investigate whether intractable atonic PPH is associated with the type of bleeding (arterial or nonarterial) and its location, along with variations in the size and shape of the uterine cavity after delivery.Study design: This retrospective study included women who had undergone a dynamic computed tomography (CT) scan for the management of severe PPH at Kyoto University Hospital between April 2011 and March 2017. Patients' electronic medical records were reviewed, and relevant clinical information was collected. The presence of contrast extravasation (CE) on CT images in the early phase (40 s) was regarded as active arterial bleeding. Bleeding sites and size of the uterine cavity were evaluated using an xyz coordinate system. The size of the uterine cavity was compared between groups with CE into the upper and lower parts of the uterine body.Results: Of the 60 women assessed for eligibility, 30 were included in the current analysis. Contrast extravasation was detected in 19 women, with 14 showing CE in the early phase. The presence of CE in the early phase was significantly associated with the need for transarterial embolization (Fisher's exact test, p = .0017). The upper and lower parts of the uterine cavity were 97.4 ± 2.7 mm (mean ± standard error of the mean) and 87.2 ± 3.5 mm in length, respectively. The maximum anteroposterior diameters of the upper and lower parts of the uterine cavity were 23.1 ± 2.6 and 76.0 ± 3.0 mm, respectively, and the largest transverse diameters were 67.3 ± 1.9 and 81.1 ± 2.3 mm, respectively. The group that showed CE into the upper uterine cavity had significantly larger qualitative parameters of the upper uterine cavity compared to the group with CE into the lower uterine cavity. The gate from the lower uterine cavity toward the upper uterine cavity was narrow (anteroposterior diameter of 22.6 ± 2.0 mm, transverse diameter of 40.7 ± 3.3 mm), and the intrauterine balloon was always found in the lower uterine cavity on the CT scan. The upper uterine body was characterized by a flat oval-shaped cavity (xy plane), thick uterine wall, and lack of uniformity among bleeding sites (z = 62.4 ± 14.8 mm). In contrast, the lower uterine cavity was a circular shape (xy plane) with thin walls, and bleeding sites were located at lateral sides around the level of the internal os (z = -18.8 ± 4.9 mm).Conclusions: Atonic PPH has a significant subtype, named "PRACE," which is characterized by PPH, resistance to treatment, and arterial CE. The need for embolization can be predicted by the presence of arterial bleeding and its location, along with the shape of the uterine cavity.
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Affiliation(s)
- Asami Ikeda
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | | | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Kyoko Kameyama Nakao
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Akihito Horie
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Tsukasa Baba
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Junzo Hamanishi
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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Watanabe K, Chigusa Y, Kondoh E, Mogami H, Horie A, Baba T, Mandai M. Human chorionic gonadotropin value and its change prior to methotrexate treatment can predict the prognosis in ectopic tubal pregnancies. Reprod Med Biol 2019; 18:51-56. [PMID: 30655721 PMCID: PMC6332740 DOI: 10.1002/rmb2.12247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/20/2018] [Accepted: 09/19/2018] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate the role of beta-human chorionic gonadotropin (HCG) level and its change prior to methotrexate (MTX) treatment as predictors of treatment success and to access the posttreatment observation period for ectopic tubal pregnancy. METHODS Clinical data of 41 females treated with MTX for tubal pregnancies were reviewed and analyzed retrospectively. RESULTS Among 41 patients, 34 achieved complete resolution without surgery. No statistically significant difference was observed in the presence of hemorrhagic ascites, serum progesterone levels, or diameters of adnexal mass between the MTX success and failure groups. Serum HCG levels on the day of MTX administration (day 1) were significantly lower in the MTX success group. Moreover, % HCG change per day, which represents the increment ratio of HCG prior to MTX treatment, was significantly lower in the MTX success group. Receiver operating characteristic (ROC) curves demonstrated that the treatment success was predicted by % HCG change per day less than +12.6% per day with a sensitivity of 87% and a specificity of 71%. The duration from treatment to complete recovery was strongly correlated with day 1 HCG levels. CONCLUSIONS Pretreatment HCG change is a significant predictor of therapeutic success of MTX treatment, and the treatment period may be predicted from initial HCG levels.
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Affiliation(s)
- Koichi Watanabe
- Department of Gynecology and ObstetricsKyoto UniversityKyotoJapan
| | | | - Eiji Kondoh
- Department of Gynecology and ObstetricsKyoto UniversityKyotoJapan
| | - Haruta Mogami
- Department of Gynecology and ObstetricsKyoto UniversityKyotoJapan
| | - Akihito Horie
- Department of Gynecology and ObstetricsKyoto UniversityKyotoJapan
| | - Tsukasa Baba
- Department of Gynecology and ObstetricsKyoto UniversityKyotoJapan
| | - Masaki Mandai
- Department of Gynecology and ObstetricsKyoto UniversityKyotoJapan
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Moriuchi K, Chigusa Y, Kondoh E, Murakami R, Ueda Y, Mogami H, Mandai M. Enoxaparin administration within 24 hours of caesarean section: a 6-year single-centre experience and patient outcomes. J OBSTET GYNAECOL 2018; 39:451-454. [DOI: 10.1080/01443615.2018.1527300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kaori Moriuchi
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Yoshitsugu Chigusa
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Ryusuke Murakami
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Yusuke Ueda
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
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Ueda A, Nakakita B, Chigusa Y, Tani H, Mogami H, Mandai M, Kondoh E. Committee for Academic Affairs JSSHP Research Award 2018 Clinical Research Introducing tight systolic blood pressure control before 16 weeks’ gestation is associated with good pregnancy outcomes in patients with chronic hypertension. Hypertens Res Pregnancy 2018. [DOI: 10.14390/jsshp.6.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Akihiko Ueda
- Department of Gynecology and Obstetrics, Kyoto University Hospital
| | - Baku Nakakita
- Department of Gynecology and Obstetrics, Kyoto University Hospital
| | | | - Hirohiko Tani
- Department of Gynecology and Obstetrics, Kyoto University Hospital
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University Hospital
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Hospital
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University Hospital
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Hamada K, Chigusa Y, Kondoh E, Ueda Y, Kawahara S, Mogami H, Horie A, Baba T, Mandai M. Noninvasive Positive-Pressure Ventilation for Preeclampsia-Induced Pulmonary Edema: 3 Case Reports and a Literature Review. Case Rep Obstet Gynecol 2018; 2018:7274597. [PMID: 30186649 PMCID: PMC6114237 DOI: 10.1155/2018/7274597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/07/2018] [Indexed: 11/17/2022] Open
Abstract
Pulmonary edema caused by severe preeclampsia can be an indication for pregnancy termination. We aimed to investigate whether noninvasive positive-pressure ventilation (NPPV) was useful for preeclampsia-induced pulmonary edema. Three cases of preeclampsia-induced pulmonary edema managed with NPPV in our institute were reviewed retrospectively. A literature review was conducted regarding NPPV usage during pregnancy. NPPV was initiated at 30, 20, and 24 weeks of gestation in the 3 cases. In all cases, NPPV slowed the progression of pulmonary edema and succeeded in delaying pregnancy termination by 17 days on average. Maternal outcomes were positive, and no intubation was required. Between 1994 and 2017, there were 11 articles describing 12 cases in which NPPV was applied for pulmonary edema during pregnancy. However, there has been no case of NPPV management of preeclampsia-induced pulmonary edema thus far. Maternal and fetal outcomes were positive in these 12 cases. NPPV may contribute to prolonging pregnancy in patients with poor oxygenation due to preeclampsia-induced pulmonary edema. However, patients should be closely monitored, and the decision to intubate or terminate the pregnancy should be made without delay when the maternal or fetal condition worsens.
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Affiliation(s)
- Kohei Hamada
- Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yusuke Ueda
- Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Shunsuke Kawahara
- Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Akihito Horie
- Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tsukasa Baba
- Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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Sato M, Kondoh E, Iwao T, Hiragi S, Okamoto K, Tamura H, Mogami H, Chigusa Y, Kuroda T, Mandai M, Konishi I, Kato G. Nationwide survey of severe postpartum hemorrhage in Japan: an exploratory study using the national database of health insurance claims. J Matern Fetal Neonatal Med 2018; 32:3537-3542. [PMID: 29656684 DOI: 10.1080/14767058.2018.1465921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Aim: The aim of this study was to investigate epidemiological and clinical aspects of severe postpartum hemorrhage (PPH) in Japan. Methods: We used national health insurance claims from 2011 to 2014 provided by the Ministry of Health, Labour and Welfare. The data included randomly selected claims that covered 10% of all inpatients in October, a so-called sampling dataset (covering 1/120 inpatients per year). We extracted claims for transfused blood, and further narrowed down the claims by names of diseases linked to PPH. As most referral obstetric facilities have adopted the diagnosis procedure combination (DPC)-based payment system while small-scale obstetric facilities have not (non-DPC facilities), the claims were also analyzed separately for DPC and non-DPC facilities. We assessed the incidence and causes of PPH, transfusion volume of red blood cells (RBC) and fresh frozen plasma (FFP), and surgical hemostatic management. Results: The number of PPH cases that required blood transfusion in the sampling dataset was 29, 29, 32, and 36 in 2011, 2012, 2013, and 2014, respectively. The leading cause of PPH was uterine atony followed by placental abruption. Although no specific trends were observed for the volume of transfused RBC (1467 ± 234 ml in 2014), there was a steady increase in the rate of FFP utilization in non-DPC facilities from 37% to 79% over the 4-year sampling period. Intrauterine balloon tamponade emerged in 2014. Conclusion: This nationwide survey indicates that the annual incidence of severe PPH is increasing. Furthermore, FFP has become more prevalent in small-scale obstetric facilities.
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Affiliation(s)
- Mai Sato
- a Department of Gynaecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Eiji Kondoh
- a Department of Gynaecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Tomohide Iwao
- b Department of Medical Informatics , Kyoto University , Kyoto , Japan
| | - Shusuke Hiragi
- b Department of Medical Informatics , Kyoto University , Kyoto , Japan
| | - Kazuya Okamoto
- b Department of Medical Informatics , Kyoto University , Kyoto , Japan
| | - Hiroshi Tamura
- b Department of Medical Informatics , Kyoto University , Kyoto , Japan
| | - Haruta Mogami
- a Department of Gynaecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Yoshitsugu Chigusa
- a Department of Gynaecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Tomohiro Kuroda
- b Department of Medical Informatics , Kyoto University , Kyoto , Japan
| | - Masaki Mandai
- a Department of Gynaecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Ikuo Konishi
- a Department of Gynaecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Genta Kato
- c Solutions Center for Health Insurance Claims, Kyoto University Hospita , Kyoto , Japan
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Itoh H, Mogami H, Bou Nemer L, Word L, Rogers D, Miller R, Word RA. Endometrial stromal cell attachment and matrix homeostasis in abdominal wall endometriomas. Hum Reprod 2018; 33:280-291. [PMID: 29300932 PMCID: PMC5850606 DOI: 10.1093/humrep/dex371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/26/2017] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION How does progesterone alter matrix remodeling in abdominal wall endometriomas compared with normal endometrium? SUMMARY ANSWER Progesterone may prevent attachment of endometrial cells to the abdominal wall, but does not ameliorate abnormal stromal cell responses of abdominal wall endometriomas. WHAT IS KNOWN ALREADY Menstruation is a tightly orchestrated physiologic event in which steroid hormones and inflammatory cells cooperatively initiate shedding of the endometrium. Abdominal wall endometriomas represent a unique form of endometriosis in which endometrial cells inoculate fascia or dermis at the time of obstetrical or gynecologic surgery. Invasion of endometrium into ectopic sites requires matrix metalloproteinases (MMPs) for tissue remodeling but endometrium is not shed externally. STUDY DESIGN SIZE, DURATION Observational study in 14 cases and 19 controls. PARTICIPANTS /MATERIALS, SETTING, METHODS Tissues and stromal cells isolated from 14 abdominal wall endometriomas were compared with 19 normal cycling endometrium using immunohistochemistry, quantitative PCR, gelatin zymography and cell attachment assays. P values < 0.05 were considered significant and experiments were repeated in at least three different cell preps to provide scientific rigor to the conclusions. MAIN RESULTS AND THE ROLE OF CHANCE The results indicate that MMP2 and MMP9 are not increased by TGFβ1 in endometrioma stromal cells. Although progesterone prevents attachment of endometrioma cells to matrix components of the abdominal wall, it does not ameliorate these abnormal stromal cell responses to TGFβ1. LARGE SCALE DATA N/A. LIMITATIONS REASONS FOR CAUTION Endometriomas were collected from women identified pre-operatively. Not all endometriomas were collected. Stromal cells from normal endometrium were from different patients, not women undergoing endometrioma resection. WIDER IMPLICATIONS OF THE FINDINGS This work provides insight into the mechanisms by which progesterone may prevent abdominal wall endometriomas but, once established, are refractory to progesterone treatment. STUDY FUNDING/COMPETING INTEREST(S) Tissue acquisition was supported by NIH P01HD087150. Authors have no competing interests.
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Affiliation(s)
- Hiroko Itoh
- Cecil H and Ida Green Center for Reproductive Biological Sciences, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Haruta Mogami
- Cecil H and Ida Green Center for Reproductive Biological Sciences, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Laurice Bou Nemer
- Cecil H and Ida Green Center for Reproductive Biological Sciences, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Larry Word
- Cecil H and Ida Green Center for Reproductive Biological Sciences, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David Rogers
- Cecil H and Ida Green Center for Reproductive Biological Sciences, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rodney Miller
- ProPath Laboratory, Immunohistochemistry Division, Dallas, TX
| | - R Ann Word
- Cecil H and Ida Green Center for Reproductive Biological Sciences, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Uchino E, Takada D, Mogami H, Matsubara T, Tsukamoto T, Yanagita M. Membranous nephropathy associated with pregnancy: an anti-phospholipase A2 receptor antibody-positive case report. CEN Case Rep 2018; 7:101-106. [PMID: 29349731 DOI: 10.1007/s13730-018-0304-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/10/2018] [Indexed: 11/29/2022] Open
Abstract
Pregnancy and membranous nephropathy (MN) can occur concurrently with nephrotic syndrome. However, the pathophysiology of MN associated with pregnancy remains unclear, including the involvement of anti-M-type phospholipase A2 receptor (PLA2R) antibody, the major antigen of idiopathic MN (iMN). A treatment for the condition is also not established. We present the case of a 43-year-old pregnant female with incidental proteinuria and hypoalbuminemia. We made a diagnosis of nephrotic syndrome at 11 week gestation. Renal biopsy revealed iMN using predominant granular staining of IgG4 along the glomerular basement membrane. No secondary cause was identified. Oral glucocorticoid therapy was started from 17 week gestation and induced complete remission at 28 week gestation. A healthy infant was born at 38 week gestation. Glucocorticoid therapy was stopped postpartum without MN relapse. Anti-PLA2R antibody was later found to be positive using serum reserved from before treatment. In conclusion, we presented the case of a pregnant woman with iMN and anti-PLA2R antibodies, whose nephrotic syndrome was successfully controlled with oral glucocorticoids to reach complete remission, even after tapering off the medication. Pregnancy per se might be associated with iMN onset.
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Affiliation(s)
- Eiichiro Uchino
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Daisuke Takada
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takeshi Matsubara
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tatsuo Tsukamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.,Division of Nephrology and Dialysis, Department of Medicine, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ougi-machi, Kita-ku, Osaka, 530-8480, Japan
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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49
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Abstract
Preterm premature rupture of membranes (pPROM) is a major cause of preterm birth. Recently, extracellular matrix-directed treatment is applied for wound healing. Here, we used a pregnant mouse model to test the efficacy of collagen type 1 gel for healing of the prematurely ruptured fetal membranes. Although injection of PBS into the ruptured fetal membranes resulted in 40% closure, injection of collagen type 1 improved closure rates to 90% within 72 h. Macrophages of the M2 wound healing phenotype were entrapped in the collagen layer. In primary human amnion mesenchymal cells, collagen type 1 gels activated collagen receptor discoidin domain receptor 2 (DDR2) to induce myosin light chain phosphorylation and migration of injured amnion mesenchymal cells. These findings define the mechanisms for matrix-directed therapeutics for pPROM.
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Affiliation(s)
- Haruta Mogami
- Department of Obstetrics and Gynecology, Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Annavarapu Hari Kishore
- Department of Obstetrics and Gynecology, Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - R Ann Word
- Department of Obstetrics and Gynecology, Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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50
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Abstract
Preterm premature rupture of membrane (pPROM) is associated with 30–40% of preterm births. Infection is considered a leading cause of pPROM due to increased levels of proinflammatory cytokines in amniotic fluid. Only 30%, however, are positive for microbial organisms by amniotic fluid culture. Interestingly, in some pregnancies complicated by preterm premature rupture of membranes (pPROM), membranes heal spontaneously and pregnancy continues until term. Here, we investigated mechanisms of amnion healing. Using a preclinical mouse model, we found that small ruptures of the fetal membrane closed within 72 h whereas healing of large ruptures was only 40%. Small rupture induced transient upregulation of cytokines whereas large ruptures elicited sustained upregulation of proinflammatory cytokines in the fetal membranes. Fetal macrophages from amniotic fluid were recruited to the wounded amnion where macrophage adhesion molecules were highly expressed. Recruited macrophages released limited and well-localized amounts of IL-1β and TNF which facilitated epithelial-mesenchymal transition (EMT) and epithelial cell migration. Arg1 + macrophages dominated within 24 h. Migration and healing of the amnion mesenchymal compartment, however, remained compromised. These findings provide novel insights regarding unique healing mechanisms of amnion.
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Affiliation(s)
- Haruta Mogami
- The Cecil H. and Ida Green Center for Reproductive Biological Sciences, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Annavarapu Hari Kishore
- The Cecil H. and Ida Green Center for Reproductive Biological Sciences, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yucel Akgul
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - R Ann Word
- The Cecil H. and Ida Green Center for Reproductive Biological Sciences, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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