Isolated gestational proteinuria preceding the diagnosis of preeclampsia : an observational study

Introduction. Some pregnant women develop significant proteinuria in the absence of hypertension. However, clinical significance of isolated gestational proteinuria (IGP) is not well understood. This study aimed to determine the prevalence of IGP in singleton pregnancies and the proportion of women with IGP who subsequently developed preeclampsia (IGP-PE) among all PE cases. Material and methods. This was an observational study of 6819 women with singleton pregnancies at 12 centers, including 938 women with at least once determination of protein-to-creatinine ratio (P/Cr). Significant proteinuria in pregnancy (SPIP) was defined as P/Cr (mg/mg) level >0.27. IGP was defined as SPIP in the absence of hypertension. Gestational hypertension (GH) preceding preeclampsia (GH-PE) was defined as preeclampsia (PE) in which GH preceded SPIP. Simultaneous PE (S-PE) was defined as PE in which both SPIP and hypertension occurred simultaneously. Results. IGP and PE were diagnosed in 130 (1.9%) and 158 (2.3%) of 6819 women, respectively. Of 130 women with IGP, 32 (25%) progressed to PE and accounted for 20% of all women with PE. Hence, women with IGP had a relative risk of 13.1 (95% CI; 9.2-18.5) for developing PE compared with those without IGP [25% (32/130) vs. 1.9% (126/6689)]. At diagnosis of SPIP, P/Cr levels already exceeded 1.0 more often in women with S-PE than in those with IGP-PE [67% (33/49) vs. 44% (14/32), respectively, p = 0.031]. Conclusions. IGP is a risk factor for PE, and IGP-PE accounts for a considerable proportion (20%) of all PE

Annual report of Subcommittee for Examination of Causes of Maternal Death and their Prevention in Perinatology Committee, Japan Society of Obstetrics and Gynecology, 2013

As the fibrinogen level decreases early in atonic bleeding, early administration of FFP may be important as an initial approach to treat atonic bleeding.Amniotic fluid embolism is classified into 2 types, conventional type and uterus-type

Association between Lactobacillus species and bacterial vaginosis-related bacteria, and bacterial vaginosis scores in pregnant Japanese women

<p>Abstract</p> <p>Background</p> <p>Bacterial vaginosis (BV), the etiology of which is still uncertain, increases the risk of preterm birth. Recent PCR-based studies suggested that BV is associated with complex vaginal bacterial communities, including many newly recognized bacterial species in non-pregnant women.</p> <p>Methods</p> <p>To examine whether these bacteria are also involved in BV in pregnant Japanese women, vaginal fluid samples were taken from 132 women, classified as normal (n = 98), intermediate (n = 21), or BV (n = 13) using the Nugent gram stain criteria, and studied. DNA extracted from these samples was analyzed for bacterial sequences of any <it>Lactobacillus</it>, four <it>Lactobacillus </it>species, and four BV-related bacteria by PCR with primers for 16S ribosomal DNA including a universal <it>Lactobacillus </it>primer, <it>Lactobacillus </it>species-specific primers for <it>L. crispatus</it>, <it>L. jensenii</it>, <it>L. gasseri</it>, and <it>L. iners</it>, and BV-related bacterium-specific primers for BVAB2, <it>Megasphaera</it>, <it>Leptotrichia</it>, and <it>Eggerthella</it>-like bacterium.</p> <p>Results</p> <p>The prevalences of <it>L. crispatus</it>, <it>L. jensenii</it>, and <it>L. gasseri </it>were significantly higher, while those of BVAB2, <it>Megasphaera</it>, <it>Leptotrichia</it>, and <it>Eggerthella</it>-like bacterium were significantly lower in the normal group than in the BV group. Unlike other <it>Lactobacillus </it>species, the prevalence of <it>L. iners </it>did not differ between the three groups and women with <it>L. iners </it>were significantly more likely to have BVAB2, <it>Megasphaera, Leptotrichia</it>, and <it>Eggerthella</it>-like bacterium. Linear regression analysis revealed associations of BVAB2 and <it>Megasphaera </it>with Nugent score, and multivariate regression analyses suggested a close relationship between <it>Eggerthella</it>-like bacterium and BV.</p> <p>Conclusion</p> <p>The BV-related bacteria, including BVAB2, <it>Megasphaera</it>, <it>Leptotrichia</it>, and <it>Eggerthella</it>-like bacterium, are common in the vagina of pregnant Japanese women with BV. The presence of <it>L. iners </it>may be correlated with vaginal colonization by these BV-related bacteria.</p

A type of familial cleft of the soft palate maps to 2p24.2–p24.1 or 2p21–p12

Cleft of the soft palate (CSP) and the hard palate are subtypes of cleft palate. Patients with either condition often have difficulty with speech and swallowing. Nonsyndromic, cleft palate isolated has been reported to be associated with several genes, but to our knowledge, there have been no detailed genetic investigations of CSP. We performed a genome-wide linkage analysis using a single-nucleotide polymorphism-based microarray platform and successively using microsatellite markers in a family in which six members, across three successive generations, had CSP. A maximum LOD score of 2.408 was obtained at 2p24.2-24.1 and 2p21-p12, assuming autosomal dominant inheritance. Our results suggest that either of these regions is responsible for this type of CSP

Clinical features of abruptio placentae as a prominent cause of cerebral palsy

Background: Although abruptio placentae causes hypoxia in the infant and thus leading to cerebral palsy (CP), its incidence and clinical features at a nation wide level have not been demonstrated. Aims: To determine the proportion of abruptio placentae among antenatal and intrapartum causative factors leading to cerebral palsy (CP) and clinical features of such abruptio placentae. Study design: A review was conducted in 107 infants with CP in whom CP was determined to be due to antenatal and or intrapartum hypoxic conditions by the Japan Council for Quality Health Care until April 2012. Results: Abruptio placenta was responsible for 28 (26%) of the 107 CP infants, and was the single leading causative factor of CP. Of these 28 women, 22 (79%) exhibited non-reassuring fetal status on admission to obstetric facilities at 36.2 ± 2.6 weeks of gestation and had neonates with umbilical cord arterial blood pH (base excess) of 6.728 ± 0.164 (-25 ± 5.4 mmol/L). In these 22 women, strong abdominal pain and/or profuse vaginal bleeding occurred 159 ± 99 min prior to admission to an obstetric facility, and the interval until delivery after admission was 47 ± 31 min. Hypertension or isolated proteinuria preceded clinical events in one (4.5%) and five (23%) of these 22 women, respectively. Conclusions: Abruptio placentae was responsible for CP in one quarter of all cases determined to be due to antenatal and/or intrapartum hypoxic conditions in Japan. New strategies to shorten the interval until admission to an obstetric facility after onset of symptoms are urgently needed

Pregnancy outcomes of women exposed to laninamivir during pregnancy

Purpose The purpose of this study is to assess pregnancy outcomes of women treated with a novel neuraminidase inhibitor, laninamivir, during pregnancy. Methods A retrospective review of pregnancy outcomes of 112 pregnant women who were given laninamivir for treatment of influenza was performed. Possible adverse events, including miscarriages, preterm birth, foetal malformation and any neonatal morbidity requiring treatment, were assessed. Results Seventeen, 39, 46 and 10 women were administered a single inhaled dose of 20 or 40 mg of laninamivir at gestational week (GW) 3-11, 12-21, 22-36 and 37 or more, respectively. One (1.8%) of 56 women with laninamivir at GW <22 experienced miscarriage at GW <12. The remaining 111 women gave birth to 111 viable infants but at preterm (GW <37) in nine (8.8%) of 102 women with laninamivir at GW <37. Three (2.7%) of the 111 newborns had malformations: forefoot varus deformity, foot polydactyly and cleft lip in one each born to a mother taking laninamivir atGW6, 17 and 21, respectively. Five neonates (4.5%) were small for gestational age. Eleven (9.9%), five (4.5%) and no neonates required phototherapy for jaundice, transient respiratory supports for respiratory distress syndrome (n = 2) or transient tachypnoea of the newborn (n = 3), and glucose administration for hypoglycaemia, respectively. Conclusions Although this study included a small number of study women and no control women, the results suggested that maternal exposure to laninamivir did not increase the rate of adverse pregnancy and foetal outcomes. (C) 2014 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons, Ltd