Fetal movement counting is associated with the reduction of delayed maternal reaction after perceiving decreased fetal movements: a prospective study.

Maternal perception of decreased fetal movement is associated with adverse perinatal outcomes. Although there have been several studies on interventions related to the fetal movements count, most focused on adverse perinatal outcomes, and little is known about the impact of the fetal movement count on maternal behavior after the perception of decreased fetal movement. We investigated the impact of the daily fetal movement count on maternal behavior after the perception of decreased fetal movement and on the stillbirth rate in this prospective population-based study. Pregnant women in Shiga prefecture of Japan were asked to count the time of 10 fetal movements from 34 weeks of gestation. We analyzed 101 stillbirths after the intervention compared to 121 stillbirths before the intervention. In multivariable analysis, maternal delayed visit to a health care provider after the perception of decreased fetal movement significantly reduced after the intervention (aOR 0.31, 95% CI 0.11-0.83). Our regional stillbirth rates in the pre-intervention and post-intervention periods were 3.06 and 2.70 per 1000 births, respectively. Informing pregnant women about the fetal movement count was associated with a reduction in delayed maternal reaction after the perception of decreased fetal movement, which might reduce stillbirths

Insufficient antenatal identification of fetal growth restriction leading to intrauterine fetal death: a regional population-based study in Japan.

Objective:Fetal growth restriction (FGR) is associated with perinatal adverse outcomes including intrauterine fetal death. Antenatally unidentified FGR has a higher risk of intrauterine fetal death than that identified antenatally. We, therefore, investigated the antenatal identification of FGR among intrauterine fetal deaths, and assessed the perinatal factors associated with the identification of FGR.Methods:This retrospective and population-based study reviewed all stillbirths in Shiga Prefecture, Japan, from 2007 to 2016 with exclusion criteria of multiple births, births at unidentified gestational weeks or < 22 gestational weeks, and lethal disorders. We analyzed cases of FGR, using the Japanese clinical definition: Z-score of estimated fetal weight for gestational age <-1.5 standard deviations (SD).Results:We identified 94 stillbirths with FGR among 429 stillbirths. Thirty-seven cases were antenatally identified during pregnancy management (39%). Dividing cases by a Z-score of -2.5 SD, 51 cases were classified as ≤-2.5 SD. Twenty-eight of the 51 cases (55%) with a Z-score <-2.5 SD were antenatally identified as having FGR, whereas 9 of the 43 cases (21%) with a Z-score ≥-2.5 SD were antenatally identified as having FGR (p = .002). Among cases with a Z-Score <-2.5 SD, 16 of 21 (76%) beyond 28 weeks\u27 gestation and 12 of 30 (40%) before 28weeks\u27 gestation were antenatally identified as having FGR (p = .023).Conclusion:Fetal growth restriction leading to intrauterine fetal death in Japan was antenatally identified in less than half of cases. Antenatal identification of FGR was associated with the severity of growth restriction

Gallbladder torsion in pregnancy: a case report and literature review.

Gallbladder torsion is a rare disease that requires immediate surgical intervention to avoid maternal and/or foetal sepsis and death. However, preoperative diagnosis is challenging because the disease has no specific symptoms. A 37-year-old pregnant woman at 34 weeks of gestation presented with severe epigastric pain. Ultrasonography and computed tomography scan findings showed a distended gallbladder without stones, floating from the hepatic bed, and laboratory examination demonstrated normal liver function; therefore, we made a diagnosis of gallbladder torsion and performed a caesarean section and an open cholecystectomy under general anaesthesia. This is the first report wherein gallbladder torsion in pregnancy was diagnosed preoperatively. Gallbladder torsion should be considered as a differential diagnosis in case of such imaging findings

当院の子宮下部筋腫合併妊娠における分娩転帰について

　子宮筋腫は年齢と共に有病率が増加する。それ故、近年における晩婚化や出産年齢の高齢化に伴い、子宮筋腫合併妊娠も増加傾向にある。比較的大きな子宮筋腫が子宮下部にある場合、経腟分娩困難と判断され帝王切開が選択される症例も少なくないと考えられる。　子宮筋腫の位置及び大きさと経腟分娩の可否について検討するため、当院の外来にて経腟分娩困難となる可能性があると判断された子宮筋腫合併妊娠で、妊娠後期に核磁気共鳴画像法(Magnetic Resonance Imaging:以下MRI)が撮影された6症例に対して後方視的に検討した。6症例中5症例で経腟分娩が可能であったが、子宮体下部後壁に長径90mmの子宮筋腫を認めた1例は、妊娠41週で予定日超過のため誘発を開始したが、分娩停止のため帝王切開による分娩となった。帝王切開の1例を他の5例と比較すると、年齢、妊娠週数、子宮筋腫の大きさに特記すべき差異を認めないが、子宮筋腫の位置がほぼ正中で、かつ子宮筋腫の下端が内子宮口よりも低位であるとの特徴を認めた。逆に、長径70〜120mmの子宮下部筋腫が存在してもその位置が正中から偏心している場合や、位置が正中でも下端が内子宮口よりも高位であれば、経腟分娩が可能であった

Role of Resource Circularity in Carbon Neutrality

With the help of circular strategies, products can be used longer (i.e., reuse, repair, and refurbish). Products that are difficult to use will be recycled efficiently. The present paper provides actionable guidelines for reducing environmental impact at all stages of a product’s life cycle, including the manufacture and assembly of the materials that make up the product, environmental impacts during use, and environmental impacts at final disposal, as well as specific actions and evaluation mechanisms. The circular economy is a concept that encompasses specific actions and their evaluations. To clarify the contribution of this circular economy to carbon neutrality, the present paper highlights how it is important to recognize the role of carbon as both an energy carrier and a material. CO2 is a waste product from burning and powering carbon. CO2 must be disposed of like any other waste product, but carbon itself is also an energy carrier. Thus, when promoting the carbon cycle, it is important to harmonize carbon’s function as a material with its role as an energy carrier. The further introduction of renewable energy and societal shift towards circular economy would contribute to carbon neutrality and more resource efficient use in a mutually complementary manner

Amniotic fluid interleukin-6 and neutrophil gelatinase-associated lipocalin for predicting fetal inflammatory response syndrome based on histological chorioamnionitis and funisitis

Objective: We aimed to analyze the predictive efficacy of amniotic fluid interleukin-6 (IL-6) and neutrophil gelatinase-associated lipocalin (NGAL) for fetal inflammatory response syndrome (FIRS)-related infection. Materials and methods: We included singleton pregnancies classified into FIRS and non-FIRS groups. FIRS was defined as histologic chorioamnionitis and funisitis. Amniotic fluid samples were collected during vaginal delivery (VD) or cesarean section (CS). We compared amniotic fluid IL-6 and NGAL levels between the groups. Results: Forty-six pregnancies were analyzed and classified into 20 (43.5%) FIRS and 26 (56.5%) non-FIRS pregnancies. We observed significant differences in amniotic fluid IL-6 and NGAL. Amniotic fluid collection significantly influenced NGAL levels (p < 0.001). The area under the concentration–time curve (AUC), with optimal cutoff values, for amniotic fluid IL-6 and NGAL (VD and CS) levels was 0.948 (11,344 pg/mL), 0.800 (1180 ng/mL), and 0.946 (708 ng/mL), respectively. Conclusion: Amniotic fluid IL-6 and NGAL levels showed equivalent predictive ability for FIRS-related infection

Predictive factors of labour onset using ultrasonography

We analysed the effectiveness of transvaginal ultrasonographic and foetal/maternal pulse Doppler findings as predictors of labour onset within 1 week. We included 22 single normal pregnancies and evaluated the one-point and short- and long-term differences in uterine artery pulsatility index (PI), umbilical artery PI, middle cerebral artery PI (MCA-PI), peak systolic velocity, and cervical length (CL). Presence of funnelling and membrane separation over the internal cervical os was evaluated. Significant changes were observed in the one-point measurement of and short-term and long-term differences in CL, the one-point measurement of and long-term difference in MCA-PI, and the presence of membrane separation (Grade 2). In multivariate analysis, the significant predictors were short-term differences in CL (odds ratio [OR]: 5.27), long-term differences in MCA-PI (OR: 13.3), and presence of membrane separation (Grade 2) (OR: 5.38). Transvaginal ultrasonographic and foetal pulse Doppler findings were effective predictors of labour onset within 1 week.Impact statement What is already known on this subject? Parameters reported to predict labour onset include the Bishop score, cervical length, decreased long-term cervical length, funnelling of the internal cervical os, and adrenal gland volume. What do the results of this study add? Short-term changes in cervical length, long-term changes in middle cerebral artery pulsatility index, and the presence of membrane separation Grade 2 were found to be useful predictive factors of labour onset in this study. What are the implications of these findings for clinical practice and/or further research? The prediction of labour onset enables clinicians to properly manage pregnancy and delivery considering maternal and foetal conditions