Applying the Ecology Model to Perinatal Medicine: From a Regional Population-Based Study

Objective. Ecology model is useful to provide a framework for organizing medical care. We aimed to see if the ecology model is applicable to perinatal care in Japan. Methods. On a population-based approach, we had 53,461 deliveries in Miyazaki from 2001 to 2005. In comparison, we used all of the 106,613 deliveries in Tokyo in 2009. Women were divided into 4 grades by risk-allocation criteria and their proportion was expressed per 1,000 women to apply to the model and to delineate the ecology curve. The perinatal mortality was compared by Chi-square test. Results. We found remarkable similarity in ecology curves between the original ecology models and that representing Miyazaki perinatal data. However, the curve representing Tokyo was different from the original one. Besides, the perinatal mortality was significantly lower in Miyazaki (4.40/1,000) than in Tokyo (5.06/1,000). Conclusion. Applying the ecology model to perinatal care is useful with improvement of perinatal outcome and it would provide an appropriate framework for organizing perinatal care

Is the Perinatal Outcome of Placental Abruption Modified by Clinical Presentation?

Objective. The purpose of this study was to elucidate the impact of the clinical presentation on perinatal outcome in placental abruption. Study Design. A retrospective study was performed in 97 placental abruptions. Placental abruptions were classified according to clinical presentation: pregnancy-induced hypertension (HT, n = 22), threatened premature labor and/or premature rupture of membranes (TPL/ROM, n = 35), clinically low risk (LR, n = 27), and others (n = 13). Perinatal outcomes were compared among the HT, TPL/ROM, and LR groups. Results. The HT had significantly higher incidence of IUGR, IFUD, and low fibrinogen. The TPL/ROM had less severe disease. However, the LR had significantly higher incidence of IUFD, low UA pH < 7.1, low Apgar score of <7 at 5 min, and low fibrinogen. Conclusion. Disease severity in placental abruption is likely to depend on the clinical presentation

Magnesium Sulfate as a Second-Line Tocolytic Agent for Preterm Labor: A Randomized Controlled Trial in Kyushu Island

Objectives. We evaluated the efficacy of magnesium sulfate as a second-line tocolysis for 48 hours. Materials and Methods. A multi-institutional, simple 2-arm randomized controlled trial was performed. Forty-five women at 22 to 34 weeks of gestation were eligible, whose ritodrine did not sufficiently inhibit uterine contractions. After excluding 12 women, 33 were randomly assigned to either magnesium alone or combination (ritodrine and magnesium). The treatment was determined as effective if the frequency of uterine contraction was reduced by 30% at 48 hours of the treatment. Results. After magnesium sulfate infusion, 90% prolonged their pregnancy for >48 hours. Combination therapy was effective in 95% (18/19), which was significantly higher than 50% (7/14) for magnesium alone. Conclusion. This randomized trial revealed that combination therapy significantly reduced uterine contractions, suggesting that adjuvant magnesium with ritodrine is recommended, rather than changing into magnesium alone, when uterine contractions are intractable with ritodrine infusion

Daño Cerebral Hipóxico-Isquémico en Ratas de 7 Días de Edad: Alteraciones Neurológicas Tempranas y Lesiones Permanentes

OBJECTIVES: To study the changes after hypoxia-ischemia (HI), and to observe both, the vulnerability of the different regions of the brain to HI and the heat shock protein-72 kDa (HSP72) induction and its efects on the neuronal cell. MATERIAL AND METHODS: 7-days-old rats were exposed to left carotid artery ligation followed by 2 h of HI and then they were sacrificed at different time points. Brains extracted at 1-72 h were immunohistochemically study using the HSP-72 and the microtubule associated protein-2 (MAP2) stainings. Brains extracted at 1-4 weeks underwent histopathological study. RESULTS: Loss of MAP2 immunostaining was detected since the 1st hour post-insult, being highest at 24 h. MAP2 reappeared at 72 h in almost all the brain regions of the ligated hemisphere, except the hippocampal CA3 region. At 1-2 weeks post HI, we observed atrophic and cystic lesions. 15-20% of rats did not show any anatomical lesion up to 4 weeks post HI. The HSP72 synthesis was early in the dentate gyrus of the hippocampus, but a delayed induction was observed in the CA3 region; this region showed an increased vulnerability to HI. CONCLUSIONS: Absence of anatomical lesion was observed in 15-20% of rats exposed to HI. Atrophic or cystic lesions are observed since 1-2 weeks after the insult, despite an apparent immunohistochemical recovery at 72 h.OBJETIVOS: Observar las diferencias de vulnerabilidad de las diferentes regiones cerebrales frente a la hipoxia isquemia (HI), y la inducción de la síntesis de marcadores de injuria neuronal y su efecto posterior en la neurona. MATERIALES Y MÉTODOS: Se ligó la arteria carótida izquierda a ratas de 7 días de edad, seguido de 2 h de hipoxia, sacrificándolas a diferentes intervalos de tiempo. Se realizó un estudio inmunohistoquímico con la proteína del golpe del calor de 72 kDa (HSP72) y la proteína asociada al microtúbulo tipo 2 (MAP2) durante las primeras 72 h. RESULTADOS: La pérdida de inmunotinción del MAP2 se observó desde la 1 h, siendo máxima a las 24 h, pero a las 72 h se observó una reaparición en la mayoría de regiones del hemisferio izquierdo, excepto la región CA3 del hipocampo. Entre 1 y 2 semanas después se observó lesiones de tipo atrófico y cístico. 15-20% de ratas no sufrió daño anatómico hasta las 4 semanas. Hubo síntesis temprana de HSP72 en el giro dentado del hipocampo, mientras que en la región CA3 su inducción fue tardía, observándose aquí mayor vulnerabilidad a la HI. CONCLUSIONES: En 15 a 20% de ratas sometidas a HI no se observa daño anatómico hasta las 4 semanas. La lesión atrófica o cística se consolida entre 1 y 2 semanas después del insulto, a pesar de una aparente recuperación inmunohistoquímica a las 72 h

Daño Cerebral Hipóxico-Isquémico en Ratas de 7 Días de Edad: Alteraciones Neurológicas Tempranas y Lesiones Permanentes

OBJECTIVES: To study the changes after hypoxia-ischemia (HI), and to observe both, the vulnerability of the different regions of the brain to HI and the heat shock protein-72 kDa (HSP72) induction and its efects on the neuronal cell. MATERIAL AND METHODS: 7-days-old rats were exposed to left carotid artery ligation followed by 2 h of HI and then they were sacrificed at different time points. Brains extracted at 1-72 h were immunohistochemically study using the HSP-72 and the microtubule associated protein-2 (MAP2) stainings. Brains extracted at 1-4 weeks underwent histopathological study. RESULTS: Loss of MAP2 immunostaining was detected since the 1st hour post-insult, being highest at 24 h. MAP2 reappeared at 72 h in almost all the brain regions of the ligated hemisphere, except the hippocampal CA3 region. At 1-2 weeks post HI, we observed atrophic and cystic lesions. 15-20% of rats did not show any anatomical lesion up to 4 weeks post HI. The HSP72 synthesis was early in the dentate gyrus of the hippocampus, but a delayed induction was observed in the CA3 region; this region showed an increased vulnerability to HI. CONCLUSIONS: Absence of anatomical lesion was observed in 15-20% of rats exposed to HI. Atrophic or cystic lesions are observed since 1-2 weeks after the insult, despite an apparent immunohistochemical recovery at 72 h.OBJETIVOS: Observar las diferencias de vulnerabilidad de las diferentes regiones cerebrales frente a la hipoxia isquemia (HI), y la inducción de la síntesis de marcadores de injuria neuronal y su efecto posterior en la neurona. MATERIALES Y MÉTODOS: Se ligó la arteria carótida izquierda a ratas de 7 días de edad, seguido de 2 h de hipoxia, sacrificándolas a diferentes intervalos de tiempo. Se realizó un estudio inmunohistoquímico con la proteína del golpe del calor de 72 kDa (HSP72) y la proteína asociada al microtúbulo tipo 2 (MAP2) durante las primeras 72 h. RESULTADOS: La pérdida de inmunotinción del MAP2 se observó desde la 1 h, siendo máxima a las 24 h, pero a las 72 h se observó una reaparición en la mayoría de regiones del hemisferio izquierdo, excepto la región CA3 del hipocampo. Entre 1 y 2 semanas después se observó lesiones de tipo atrófico y cístico. 15-20% de ratas no sufrió daño anatómico hasta las 4 semanas. Hubo síntesis temprana de HSP72 en el giro dentado del hipocampo, mientras que en la región CA3 su inducción fue tardía, observándose aquí mayor vulnerabilidad a la HI. CONCLUSIONES: En 15 a 20% de ratas sometidas a HI no se observa daño anatómico hasta las 4 semanas. La lesión atrófica o cística se consolida entre 1 y 2 semanas después del insulto, a pesar de una aparente recuperación inmunohistoquímica a las 72 h