Effects of lactoferrin in six patients with refractory bacterial vaginosis

We have reported that there was a high possiblity that Lactoferrin (LF) could be an effective drug for preventing preterm delivery and preventing intrauterine infections from our data in mice and rabbits. We report six cases with a history of multiple pregnancy losses or preterm delivery, and refractory bacterial vaginosis, who received the prebiotic LF therapy and gave a normal birth. 5 cases were pregnant women and the other one was non-pregnant woman. The ethics committee of this institution approved this treatment. We herein report cases in which, vaginal tablets and oral agents of the prebiotic LF were used because no response was observed with conventional treatments for vaginitis for a patients with a history of late miscarriages and extremely preterm delivery believed to be caused by refractory vaginosis and chorioamnionitis and significant improvements were observed in the vaginal bacterial flora. In all cases, from one month after the start of the use of LF, we began to detect Lactobacillus in their vagina. Subsequently, Lactobacillus gradually became dominant. Although there were few cases, the results suggest that the clinical application of LF to humans may be effective for preventing refractory vaginitis and cervical inflammation as well as preterm delivery.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Reversible cerebral vasoconstriction syndrome shows different clinical pictures at different times during the perinatal period: Two case reports

Objective: With the development of diagnostic imaging, a new clinical entity called reversible cerebral vasoconstriction syndrome (RCVS), which is considered to be a cause of secondary headache, has emerged. We herein present two cases of RCVS with different patterns of clinical progression. Case report: Case 1 occurred during labor, whereas case 2 occurred after delivery. Neither case presnted thunderclap headache at the onset of symptoms. Hypertensive disorders of pregnancy did not occur during the pregnancy or the puerperium in either case. Neurological symptoms following mild headache (Case 1: coma; Case 2: paralysis of the right extremities) were observed. Conclusion: Even when a patient has no risk factors for RCVS and had no severe headache, it is important not to miss any of the neurological symptoms. Magnetic resonance imaging (MRI) strongly supports the diagnosis, even during pregnancy. In addition, the diagnosis should always be reviewed while excluding eclampsia

Cervical cerclage for short cervix at 24-26 weeks of gestation: systematic review and meta-analysis of randomized controlled trials using individual patient-level data.

OBJECTIVE: To determine whether cervical cerclage for a transvaginal ultrasound short cervical length detected after 24 weeks of gestation in singleton pregnancies reduces the risk of preterm birth. DATA SOURCES: Ovid MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials were searched for the following terms: cerclage, cervical , uterine cervical incompetence , obstetrical surgical procedures , cervix uteri , randomized controlled trial , and controlled clinical trial . STUDY ELIGIBILITY CRITERIA: All randomized controlled trials comparing cerclage placement with no cerclage in singleton gestations with a transvaginal ultrasound short cervical length ≤ 25mm between 24 0/7 and 29 6/7 weeks of gestation were eligible for inclusion. STUDY APPRAISAL AND SYNTHESIS METHODS: Individual patient-level data from each trial were collected. If an eligible trial included patients with both multiple and singleton gestations with a short cervical length detected either before or after 24 0/7 weeks of gestation, only singletons who presented at or after 24 0/7 weeks were included. The primary outcome was preterm birth \u3c 37 weeks. Secondary outcomes included preterm birth \u3c 34, \u3c 32, and \u3c 28 weeks, gestational age at delivery, latency, preterm prelabor rupture of membranes, chorioamnionitis, and adverse neonatal outcomes. Individual patient-level data from each trial were analyzed using a two-stage approach. Pooled relative risks (RR) or mean differences with 95% confidence intervals were calculated where appropriate. RESULTS: Data from the four eligible randomized controlled trials were included. One hundred and thirty one singletons presented at 24 0/7 - 26 6/7 weeks of gestation and were further analyzed; there were no data on patients with cerclage at 27 0/7 weeks or later. Of those included, 66 (50.4%) were in the cerclage group, and 65 (49.6%) in the no cerclage group. The rate of preterm birth \u3c 37 weeks was similar between patients who were randomized to cerclage compared with those who were randomized to no cerclage (27.3% vs. 38.5%; RR 0.78, 95% CI 0.37-1.28). Secondary outcomes including preterm birth \u3c 34, \u3c 32, and \u3c 28 weeks, gestational age at delivery, time interval from randomization to delivery, preterm prelabor rupture of membranes, and adverse neonatal outcomes such as low birthweight, very low birthweight, and perinatal death were similar between the two groups. Planned subgroup analyses revealed no statistically significant differences in rate of preterm birth \u3c 37 weeks compared between the two groups based on cervical length measurement (≤ 15mm or ≤ 10mm), gestational age at randomization (24 0/7 - 24 6/7 weeks or 25 0/7 - 26 6/7 weeks), or history of preterm birth. CONCLUSIONS: Cervical cerclage did not reduce or increase the rate of preterm birth in singletons with a short cervical length detected after 24 weeks of gestation. As there was a 22% non-significant decrease in preterm birth associated with cerclage, which is a similar amount of risk reduction often associated with ultrasound-indicated cerclage before 24 weeks, further randomized controlled trials in this patient population are warranted