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

Sphingosine 1-Phosphate (S1P) in the Peritoneal Fluid Skews M2 Macrophage and Contributes to the Development of Endometriosis

Sphingosine 1-phosphate (S1P), an inflammatory mediator, is abundantly contained in red blood cells and platelets. We hypothesized that the S1P concentration in the peritoneal cavity would increase especially during the menstrual phase due to the reflux of menstrual blood, and investigated the S1P concentration in the human peritoneal fluid (PF) from 14 non-endometriosis and 19 endometriosis patients. Although the relatively small number of samples requires caution in interpreting the results, S1P concentration in the PF during the menstrual phase was predominantly increased compared to the non-menstrual phase, regardless of the presence or absence of endometriosis. During the non-menstrual phase, patients with endometriosis showed a significant increase in S1P concentration compared to controls. In vitro experiments using human intra-peritoneal macrophages (MΦ) showed that S1P stimulation biased them toward an M2MΦ-dominant condition and increased the expression of IL-6 and COX-2. An in vivo study showed that administration of S1P increased the size of the endometriotic-like lesion in a mouse model of endometriosis

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

Effect of the Fukushima nuclear power plant accident on radioiodine (131I) content in human breast milk

Background: Environmental pollution with radioiodine occurred after an accident at the Fukushima nuclear power plant (FNP) on March 11, 2011, in Japan. Whether environmental pollution with 131I can contaminate human breast milk has not been documented. Methods: 131I content was determined in 126 breast milk samples from 119 volunteer lactating women residing within 250 km of the FNP, between April 24 and May 31, 2011. The degree of environmental pollution was determined based on the data released by the Japanese government. Results: An 131I content (becquerels per kilogram, Bq/kg) of 210 in the tap water in Tokyo, which is located 230 km south of the FNP, on March 22 and of 3,500 in spinach sampled in a city located 140 km southwest of the FNP on March 19 decreased over time to < 21 on March 27 and 12 on April 26, respectively. Seven of 23 women who were tested in April secreted a detectable level of 131I in their breast milk. The concentrations of 131I (Bq/kg) in the breast milk of the 7 women were 2.3 (on month/day, 4/24), and 2.2, 2.3, 2.3, 3.0, 3.5 and 8.0 (4/25); the concentrations of 131I in the tap water available for these 7 women at the same time points were estimated to be <1.3. None of the remaining 96 women tested in May exhibited a detectable 131I in their breast milk samples. Conclusions: The contamination of breast milk with 131I can occur even when only mild environmental 131I pollution is present

Effects of campaign for postpartum vaccination on seronegative rate against rubella among Japanese women

Background: Japan experienced two rubella outbreaks in the past decade (2004 and 2012 - 2013), resulting in 10 and 20 infants with congenital rubella syndrome (CRS), respectively. This study was performed to determine whether the seronegative rate was lower in multiparous women than in primiparous women in Japan. Methods: Hemagglutination inhibition (HI) test results during pregnancy were analyzed retrospectively in 11048 primiparous and 9315 multiparous women who gave birth at six hospitals in northern Japan in the 5-year study period (January 2008 through December 2012). Women with HI titer < 1: 8 were defined as susceptible to rubella. Results: The seronegative rate was significantly lower in multiparous than primiparous women aged 30 - 31 years (2.3% [22/967] vs. 4.5% [66/1454], P = 0.0036), 36 - 37 years (3.4% [55/1601] vs. 5.7% [79/1389], P = 0.0030), and overall women (3.8% [350/9315] aged 34.7 +/- 5.2 vs. 5.4% [597/11048] for 33.2 +/- 5.9, P < 0.001). The susceptible fraction size did not differ largely according to hospital, ranging from 3.5% to 6.3%. Those for each year did not change markedly; 4.5% [150/3369], 5.2% [221/4268], 4.4% [195/4412], 4.6% [186/4056], and 4.6% [195/4258] for 2008, 2009, 2010, 2011, and 2012, respectively. Those for teenagers were consistently high: 22.7% [5/22], 20.7% [6/29], 20.6% [7/34], 13.0% [3/23], and 23.5% [4/17] for 2008, 2009, 2010, 2011, and 2012, respectively. Conclusions: The seronegative rate was significantly lower in multiparous than primiparous women. However, Japanese rubella vaccination programs were insufficient to eliminate CRS