To determine the usefulness of transvaginal ultrasonographic cervical assessment for the prediction of preterm delivery in an apparently normal population, 729 pregnant women (between 15 and 34 weeks' gestation) were randomly enrolled in the study in ten tertiary perinatal centers in Japan. Cervical parameters, including cervical length, internal os dilatation, and funneling depth, were measured by transvaginal ultrasound. The predictive values of these measurements for preterm delivery were investigated in a prospective fashion. Among various cervical parameters, cervical length showed the best correlation with pregnancy outcome. Cervical length (mm) was gradually decreased as the gestational age progressed, the regression line being y = 41.21-0.22x. When the mean cervical length minus 1 standard deviation at each gestational age was chosen as a cut-off value, the group with a shortened cervix showed a significantly high preterm delivery rate exclusively in the primigravidae (odds ratio: 4.86, 95% CI: 1.85-12.72). Internal os dilatation, in contrast, was a useful predictor in multiparous women (odds ratio: 6.00, 95% CI: 1.65-21.71). It was concluded that tranvaginal ultrasonographic cervical assessment, especially the measurement of cervical length, was effective for the prediction of preterm delivery in the primigravidae.

Cervix Uteri↗

PubMedDate not supplied

High incidence of respiratory distress syndrome (RDS) in infants born to mothers with placenta previa.

OBJECTIVE: To evaluate the incidence of respiratory distress syndrome (RDS) in infants born to mothers with placenta previa and to assess the risk factors for RDS. METHODS: Ninety-nine pregnant women with placenta previa who delivered by cesarean section at 30-35 weeks of gestation were compared retrospectively with 102 pregnant women matched for week of gestation and birth year, who underwent elective cesarean section. Maternal characteristics, neonatal outcome, and incidence of RDS were analyzed. Umbilical cord blood samples were collected at delivery and were used to determine cortisol, epinephrine, and norepinephrine levels. Student's t-test, the chi-square test, and Fisher's exact test were used for statistical comparisons. P < 0.05 was considered significant. The Mann-Whitney U test was used for comparison of continuous variables. RESULTS: Preeclampsia, histological chorioamnionitis, and premature rupture of membranes were significantly lower in the placenta previa group (placenta previa: 2.0% vs. control: 14.7%, P < 0.01; 14.1% vs. 30.1%, P < 0.01; 7.1% vs. 17.6%, P < 0.05, respectively). The incidence of RDS was significantly higher in the placenta previa group than in the control group (29.3% vs. 6.9%, P < 0.0001). The cortisol level in umbilical cord blood in the placenta previa group was lower than in the control group (median 7.3, range 4.4-14.9 microg/dl vs. median 10.6, range 4.9-30.3 microg/dl, P < 0.05). There were no significant differences in epinephrine or norepinephrine levels between the two groups. CONCLUSIONS: The incidence of RDS in infants delivered at 30-35 weeks' gestation by cesarean section was significantly higher in mothers with placenta previa than in women without placenta previa. This may reflect decreased fetal stress since the cord blood cortisol levels were found to be lower in women with placenta previa.

Cesarean Section↗

PubMedDate not supplied

Successful embolization of a large superior gluteal artery pseudoaneurysm emerging during anticoagulant therapy.

Gross hemorrhage is the most serious complication of anticoagulant therapy. We report the discovery and treatment of a large pseudoaneurysm of the superior gluteal artery in one patient who had been receiving oral anticoagulant therapy. We diagnosed the pseudoaneurysm by contrast-enhanced computed tomography, and embolized the artery with stainless steel coils. The exact cause of the pseudoaneurysm remains unclear, however, minor trauma appears most likely.

Aneurysm, False↗

PubMedDate not supplied

Significance of chorioamnionitis.

In preterm deliveries, we have reported a high incidence (30-50%) of histologic chorioamnionitis (CAM) in the placenta. There is little evidence about the effects of CAM on preterm infants. We investigated the levels of complements and cytokines in the cord blood, the pathological nature of the placenta, the L/S ratio of gastric and tracheal aspirate of each preterm infant at birth, and assessed the biological effects of CAM on them. CAM stimulates the immunological system by cytokine production (IL6 and IL8) and complement activation in the fetus. It has been suggested that CAM may be one of the factor accelerating fetal maturation of the immunological system such as complement activation and immunoglobulin production, and of surfactant synthesis in the lung. On the contrary, CAM may damage the structures along the lining cells in the airway by accumulating polymorphonuclear cells of the infants with Wilson-Mikity syndrome.

Chorioamnionitis↗

PubMedDate not supplied

Readiness of Japan to participate in international collaborative studies.

A significant improvement has been achieved in perinatal mortality figures during the last decade in Japan with a neonatal mortality rate of 2.6 and a stillbirth rate of 4.1 for 1989. With its unique obstetric and neonatal services, there are advantages and also disadvantages in respect of clinical and basic research. The outlook for Japanese neonatal medicine is shown and the prospects for international collaborative studies in the future are given.

Clinical Trials as Topic↗

PubMedDate not supplied

MR and CT in the evaluation of sarcoid myopathy.

Sarcoid myopathy is a relatively rare extrapulmonary complication of sarcoidosis. We evaluated the diagnostic utility of MR at 1.5 T in four patients with sarcoid myopathy of the lower extremities established by biopsy. Two of the patients were of the "atrophic type" and two of the "nodular type." The findings on MR were compared with the findings on CT, gallium scanning, and electromyography. Only MR was positive in all cases. The T2-weighted scans (spin echo 2,000/80) revealed two distinctly different patterns of abnormality (i.e., discrete foci of high signal intensity lesions in the patients with the nodular type of sarcoid myopathy and atrophic muscle of high signal intensity in the patients with the atrophic type). Due to its ability to provide objective findings of the extent and distribution of muscle involvement, MR should prove useful in the detection, diagnosis, and monitoring of sarcoid myopathy.

Adult↗