Explore the vast range of titles available.

In this study, we aimed to investigate the mechanisms underlying oligohydramnios in foetal growth restriction (FGR), focusing on the contribution of renal structural and functional abnormalities. A guinea pig model of maternal nutrient restriction (MNR) was established to induce FGR. Pregnant guinea pigs were divided into control and MNR groups. Foetuses were classified as appropriate for gestational age (AGA) or FGR based on body weight. Amniotic fluid and foetal kidneys were collected at gestational days 60–61. Amniotic fluid biomarkers were measured. Histopathology was performed to evaluate renal morphology. MNR resulted in a 25% reduction in foetal body and placental weights and a 50% reduction in amniotic fluid volume compared with AGA controls. Histological analyses revealed renal injury in FGR foetuses, characterised by podocyte foot process effacement, endothelial damage, and disruption of the tubular basement membrane. These structural abnormalities indicate impaired glomerular filtration and defective tubular reabsorption. Amniotic fluid concentrations of albumin, cystatin C, and liver-type fatty acid–binding protein were higher in FGR than in controls, reflecting glomerular leakage and tubular oxidative stress. These findings are consistent with reduced foetal urine production and development of oligohydramnios. They indicate that oligohydramnios in MNR-induced FGR is associated with compromised renal integrity.

Background Cesarean scar defects (CSD) are caused by cesarean sections and cause various symptoms. Although there has been no previous consensus on the name of this condition for a long time, it has been named cesarean scar disorder (CSDi). Methods This review summarizes the definition, prevalence, and etiology of CSD, as well as the pathophysiology and treatment of CSDi. We focused on surgical therapy and examined the effects and procedures of laparoscopy, hysteroscopy, and transvaginal surgery. Main findings The definition of CSD was proposed as an anechoic lesion with a depth of at least 2 mm because of the varied prevalence, owing to the lack of consensus. CSD incidence depends on the number of times, procedure, and situation of cesarean sections. Histopathological findings in CSD are fibrosis and adenomyosis, and chronic inflammation in the uterine and pelvic cavities decreases fertility in women with CSDi. Although the surgical procedures are not standardized, laparoscopic, hysteroscopic, and transvaginal surgeries are effective. Conclusion The cause and pathology of CSDi are becoming clear. However, there is variability in the prevalence and treatment strategies. Therefore, it is necessary to conduct further studies using the same definitions. The chronic inflammation that occurs in cesarean scar defect spreads into the uterine cavity and reduces fertility. Such secondary infertility has been termed cesarean scar disorder. This condition can be cured by endoscopic surgery.

Background Cesarean scar defects can lead to long-term complications, such as cesarean scar disorders, cesarean scar pregnancy, and the risk of uterine scar dehiscence and rupture in subsequent pregnancy. However, the optimal closure technique to prevent the development of cesarean scar defects (CSD) remains unclear. Therefore, this study aimed to explore whether two-layer interrupted versus two-layer continuous sutures could prevent the formation of CSD. Methods A randomized controlled trial was conducted in a single university hospital in Japan. We recruited pregnant women with ≥ 20 primary or previous cesarean sections. Participants were randomly assigned to either a two-layer interrupted or a two-layer continuous suture group. Residual myometrial thickness (RMT) and the depth of CSD were measured using sonohysterography, 6–8 months post-cesarean section. In addition, the rate of severe CSD, defined as a loss of over 50% of the myometrium, was examined. Results Of the 220 study participants, 43 dropped out; 89 in the interrupted group and 88 in the continuous group underwent sonohysterography. No significant difference in RMT was observed in the interrupted and continuous groups (median 8.1 [interquartile range, 6.2–9.9] mm and 7.9 [4.6–10.3] mm, respectively). However, the incidence of severe CSD in the interrupted group was significantly lower than that in the continuous group (2% versus 22%, p  < 0.0001). Multivariate logistic regression analysis revealed that the factors contributing to developing severe CSD were interrupted suture (odds ratio [OR]: 0.04, 95% confidence interval [95%CI]: 0.006–0.281, p  = 0.0011), the difference in myometrial thickness between the fundal and cervical sides at the center of the uterine wound before suturing (OR: 1.65, 95%CI: 1.144–2.367, p  = 0.0072), and retroversion of the uterus at 6–8 months after cesarean section (OR: 3.42, 95%CI: 1.074–10.946, p  = 0.0374). Conclusion This study suggested that two-layer interrupted sutures are superior to two-layer continuous sutures in preventing the development of severe CSD. Trial registration Clinical trial identification number: University Hospital Medical Information Network registration code, UMIN000040601. URL of the registration site: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046334 .

Although premature constriction or closure of the ductus arteriosus (PCDA) is associated with poor prognosis and early delivery is considered before deterioration occurs, some cases may improve and have a good prognosis, but the changes in fetal Doppler during the reopening of the ductus arteriosus are unclear, as are the factors related to its reopening. We encountered two cases of PCDA. In the first case, right cardiac function and ductus venosus flow normalized in a few days and the ductus arteriosus reopened spontaneously, and became vaginal delivery at 37 weeks of gestation. In the second case, labor induction was performed due to confirmed fetal cardiac stress associated with the closure of the ductus arteriosus at 38 weeks of gestation, and cesarean section was performed due to non-reassuring fetal status. The improvement in the right ventricular myocardial performance index, ductus venosus pulsatility index, the tendency for ductus arteriosus diastolic velocity to decrease, and confirmation of prograde flow into the pulmonary artery within a few days could serve as predictive indicators for the reopening of the ductus arteriosus.

This case report describes a rare instance of a 33-year-old woman with systemic lupus erythematosus (SLE) who experienced a pregnancy complicated by preeclampsia, eclampsia, and postpartum atypical hemolytic uremic syndrome (aHUS). At 28 weeks and four days of gestation, the patient presented with severe hypertension, proteinuria, and a loss of consciousness, leading to an emergency cesarean section. Postoperatively, the patient developed acute kidney injury, respiratory failure, and thrombotic microangiopathy (TMA). Although she exhibited the classic triad of hemolytic anemia, thrombocytopenia, and renal dysfunction, normal complement levels ruled out postpartum exacerbation of SLE, and aHUS was not diagnosed during hospitalization. Differential diagnoses, including HELLP (Hemolysis, Elevated Liver Enzyme levels, and Low Platelet levels) syndrome, thrombotic thrombocytopenic purpura, and Shiga toxin-producing Escherichia coli (STEC)-HUS, were excluded. Schistocytes appeared on postoperative day 5, leading to the cessation of tacrolimus and the initiation of prednisolone. Continuous hemodiafiltration and mechanical ventilation facilitated gradual recovery, and the patient was discharged on postoperative day 26. Post-discharge genetic testing revealed no pathogenic mutations; however, the clinical presentation supported a diagnosis of aHUS. aHUS driven by excessive complement activation requires prompt recognition and treatment with plasma exchange or anti-complement monoclonal antibodies (e.g., eculizumab). In this case, delayed recognition of aHUS precluded the use of such therapies. This case highlights the importance for clinicians to consider the possibility of aHUS in postpartum patients with severe renal dysfunction and TMA symptoms, even if the patient has an underlying SLE, as early diagnosis and treatment of aHUS is necessary to improve maternal outcomes.

Although the influence of continuous-flow left ventricular assist device (CF-LVAD) support on peripheral circulation has been widely discussed, its monitoring modalities are limited. The aim of this study was to assess the peripheral circulation using the laser speckle flowgraph (LSFG) which can quantitatively measure the ocular blood flow. We implanted a centrifugal CF-LVAD (EVAHEART®; Sun Medical Technology Research Corporation, Nagano, Japan) in five adult goats (body weight 44.5 ± 2.9 kg) under general anesthesia. The waveform of the central retinal artery using the mean blur rate (MBR) for ocular blood velocity and fluctuations as a parameter of pulsatility were obtained before LVAD implantation and after LVAD full-bypass support. The MBR waveform and LSFG fluctuation data were compared with the waveform and pulsatility index of the external carotid artery using an ultrasonic flow meter to evaluate circulatory patterns at different levels. The MBR waveform pattern of the central retinal artery was pulsatile before LVAD implantation and less pulsatile under LVAD full bypass. The fluctuation was 14.7 ± 1.86 before LVAD implantation and 3.85 ± 0.61 under LVAD full bypass (p < 0.01), respectively. The fluctuations of LSFG showed a strong correlation with the pulsatility index of the external carotid artery meaning that similar changes in circulatory pattern were observed at two different levels. Measuring the ocular blood flow using LSFG has potential utility for the assessment of the status of the peripheral circulation and its pulsatility during CF-LVAD.

Pemphigoid gestationis (PG) is a rare autoimmune blistering disorder that typically manifests during the second or third trimester of pregnancy. It is characterized by intensely pruritic urticarial plaques and blister formation, driven by an autoimmune response against the BP180 protein in the basement membrane. In this report, three cases of PG are presented, each illustrating distinct clinical courses and management strategies. The first case involves a 32-year-old primigravida at 31 weeks of gestation who presented with abdominal blisters that were unresponsive to topical steroids. Oral prednisone at a dosage of 15 mg was initiated at 33 weeks, leading to the resolution of the rash by 37 weeks. She subsequently delivered vaginally at 40 weeks. The second case concerns a 37-year-old multigravida who developed blisters on her limbs and abdomen at 27 weeks, which improved with the application of topical steroids. Due to a history of a previous cesarean section, she delivered via elective cesarean section at 38 weeks. The third case involves a 35-year-old multigravida who experienced fetal growth restriction starting from 29 weeks. She developed a mild erythematous, pruritic rash, and blisters at 33 weeks and required an emergency cesarean section at 33 weeks due to non-reassuring fetal status. The diagnosis of PG was confirmed postpartum. These cases underscore the clinical variability and potential complications associated with PG. They also suggest that the severity of PG's cutaneous manifestations may not directly correlate with pregnancy outcomes. Early detection and individualized management are crucial to optimizing both maternal and neonatal outcomes.

This study evaluated the effects of double-layer interrupted sutures (DIS) and double-layer continuous sutures (DCS) on uterine blood flow and residual myometrial thickness (RMT) in cynomolgus monkeys after cesarean section (CS). In DIS (  = 8) and DCS (  = 8) groups, uterine blood flow was assessed at 6 months post-CS using MRI by Ktrans. RMT was measured by T2-weighted magnetic resonance imaging (MRI) at 6 months. Laparoscopic evaluations were performed at 2 and 6 months. At 6 months, Ktrans was significantly higher in the DIS group 6. RMT at the suture site did not differ significantly between groups. Adhesions were observed in three DIS and two DCS animals. Nonadhesive DIS animals had significantly higher Ktrans and greater RMT at 6 months compared with adhesive DIS animals. Nonadhesive DIS exhibited significantly higher Ktrans and greater RMT at 6 months than nonadhesive DCS. While overall differences were limited, exploratory findings indicate that DIS demonstrated superior uterine blood flow compared with DCS. Nonadhesive DIS animals exhibited greater RMT than adhesive DIS animals, suggesting a potential benefit of adhesion prevention.

This study aimed to identify predictors of pelvic lymph node metastasis in low-risk endometrial cancer, defined as cases with no more than half myometrial invasion, preoperative endometrial biopsy results indicating endometrioid carcinoma Grade 1 (G1) or Grade 2 (G2), and no extrauterine spread. Among the factors examined, we focused on the tumor volume index derived from MRI, calculated by multiplying the maximum longitudinal diameter along the uterine axis, the maximum anteroposterior diameter on the sagittal plane, and the maximum transverse diameter on the horizontal plane. A retrospective analysis was conducted on 117 patients who underwent the standard treatment protocol (total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection) at our institution from July 1, 2014, to December 31, 2023. Pelvic lymph node metastasis was observed in seven cases (5.9%). Univariate analysis showed a significant association with serum cancer antigen-125 (CA-125) level (p=0.035) and tumor volume index (p=0.003). A receiver operating characteristic (ROC) analysis revealed that a tumor volume index cutoff of 38 cm³ yielded an area under the curve (AUC) of 0.83, with a true positive fraction (TPF) of 0.86 and a false positive fraction (FPF) of 0.15. Multivariate analysis also identified a tumor volume index (≥38 cm³) as an independent predictive factor (odds ratio 26.3, 95% confidence interval 2.6-272, p=0.006). Cases with a tumor volume index ≥38 cm³ accounted for 23 cases (20% of all) of the cohort; among these, six cases (25%) had pelvic lymph node metastases. In contrast, the metastasis rate was only one case (1%) in 94 cases (80% of all) with a tumor volume index <38 cm³. These findings suggest that the tumor volume index is useful for evaluating the risk of pelvic lymph node metastasis in low-risk endometrial cancer, contributing to decision-making on whether to perform pelvic lymph node dissection and risk stratification for sentinel lymph node navigation surgery.

We developed a new artificial placenta (AP) system consisting of a loop circuit configuration extracorporeal membrane oxygenation (ECMO) with a bridge circuit designed to be applied to the fetus in the form of an umbilical arterial–venous connection. We aimed to evaluate the feasibility of the AP system by performing a hydrodynamic simulation using a mechanical mock circulation system and fetal animal experiment. The effect of the working condition of the AP system on the fetal hemodynamics was evaluated by hydrodynamic simulation using a mechanical mock circulation system, assuming the weight of the fetus to be 2 kg. The AP system was introduced to two fetal goats at a gestational age of 135 days. The general conditions of the experimental animals were evaluated. The mock simulation showed that in an AP system with ECMO in the form of an umbilical arterial–venous connection in series, it could be difficult to maintain fetal hemodynamics when high ECMO flow was applied. The developed AP system could have high ECMO flow with less umbilical blood flow; however, the possibility of excessive load on the fetal right-sided heart should be noted. In the animal experiment, kid 1 (1.9 kg) was maintained on the AP system for 12 days and allowed to grow to term. In kid 2 (1.6 kg), the AP system could not be established because of the occlusion of the system by a thrombus. The developed AP system was feasible under both in vitro and in vivo conditions. Improvements in the AP system and management of the general fetal conditions are essential.