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Perinatal Morbidity, Mortality, and Neurodevelopmental Outcomes of Neonates with Fetal Growth Restriction

Open Journal of Obstetrics and Gynecology 2024年第3期14卷 321-333页

作者： Natsuki Tamashiro Shuko Chinen Yoshino Kinjyo Yukiko Chinen tadatsugu kinjo Keiko Mekaru Department of Obstetrics and Gynecology Graduate School of Medicine University of the Ryukyus Nishihara Japan

Objective: This study aimed to assess perinatal morbidity, mortality rates, and neurodevelopmental outcomes in the management of fetal growth restriction (FGR) at a single tertiary institute. Methods: Among 2465 deliveries between 2013 and 2019, 109 cases of FGR were reviewed retrospectively for causes, indications for pregnancy termination, perinatal death, overall neonatal outcomes, and long-term prognosis. Results: Excluding FGR due to congenital anomalies (n = 17), the mortality rate was 3.3% (3/92). One neonate delivered at 23 weeks developed cerebral palsy (1.1%). Retinopathy of prematurity occurred in four neonates (4.3%). Neurodevelopmental disorders were present in six neonates (6.5%), all of whom were delivered at 32 - 38 weeks. Significantly lower gestational age at delivery, lower birth weight, and higher umbilical artery resistance indices were observed in neonates with neurodevelopmental disorders. Conclusions: Intact survival before 27 weeks of gestation at delivery with FGR is uncommon. Neurodevelopmental disorders may still develop after delivery at 32 - 38 weeks;consideration should be given to the timing of delivery usingfetal ductus venosus Doppler waveforms measurements to reduce neurodevelopmental disorders.

关键词： Fetal Death Fetal Growth Retardation Neurodevelopmental Disorders Perinatal Mortality Umbilical Artery Doppler Velocimetry

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The Effect of Insulin Resistance on In-Vitro Fertilization-Embryo Transfer in Women without Polycystic Ovary Syndrome

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Open Journal of Obstetrics and Gynecology 2016年第3期6卷 157-166页

作者： Keiko Mekaru Sugiko Oishi Kozue Akamine tadatsugu kinjo Chiaki Heshiki Hitoshi Masamoto Yoichi Aoki Department of Obstetrics and Gynecology Graduate School of Medicine University of the Ryukyus Nishihara Okinawa Japan

Purpose: Insulin resistance (IR) plays an important role in the pathogenesis of polycystic ovary syndrome (PCOS);therefore, insulin-sensitizing agents are widely used to improve IR in women with PCOS. However, whether IR in patients without PCOS should be treated remains uncertain. This study aims to clarify whether IR in patients without PCOS affects the outcomes of in-vitro fertilization-embryo transfer (IVF-ET) and pregnancy. Methods: Between January 2011 and December 2013, we retrospectively reviewed the medical records of 116 non-PCOS patients who underwent the first IVF–ET cycle. IR was calculated using the homeostasis model assessment (HOMA) index [HOMA-IR = (insulin × glucose)/405]. A HOMA index of >2.5 was used to indicate IR. Based on the HOMA index calculation, 28 patients were IR(+) and 88 patients had normal insulin sensitivity. We retrospectively compared the response with controlled ovarian hyperstimulation, retrieved oocytes number, fertilization rates, pregnancy rate, live birth rates, and gestational diabetes mellitus (GDM) incidence. Results: There were no significant differences in human menopausal gonadotropin administration, peak estradiol, retrieved oocyte number, fertilized embryo number, good quality embryo number, implantation rate, clinical pregnancy rate, miscarriage rate, delivery rate, or ovarian hyperstimulation syndrome and GDM incidences between the groups. Conclusion: IR in non-PCOS patients has no effect on IVF-ET outcomes or perinatal prognosis.

关键词： Insulin Resistance Polycystic Ovary Syndrome In-Vitro Fertilization-Embryo Transfer Gestational Diabetes Mellitus

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Measurements of the Lower Uterine Segment at Term in Women with Previous Cesarean Delivery

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Open Journal of Obstetrics and Gynecology 2016年第1期6卷 1-7页

作者： tadatsugu kinjo Hitoshi Masamoto Keiko Mekaru Yusuke Taira Yukiko Chinen Hayase Nitta Yoichi Aoki Department of Obstetrics and Gynecology Graduate School of Medicine University of the Ryukyus Nishihara Okinawa Japan

Purpose: To evaluate the accuracy of sonographic measurements of the lower uterine segment (LUS) thickness at term in predicting uterine scar defects in women with previous Cesarean delivery (CD). Methods: Eighty-nine pregnant women who underwent CD between 37 and 41 weeks of gestation from 2013 to 2015 were enrolled in this study and divided into two groups. Group A consisted of women with previous CD, and Group B consisted of women with previous vaginal deliveries. We performed an ultrasound evaluation of the myometrial and full thickness of LUS (mLUS and fLUS) transvaginally before a CD and evaluated the appearance of LUS during surgery, which was defined as follows: grade I, well-developed;grade II, thin without visible content;grade III, translucent with visible content;and grade IV, either dehiscence or rupture. Results: The median mLUS and fLUS were 1.50 and 4.07 mm in the group A, and 2.75 and 5.37 mm in the group B. We observed significant differences in the median mLUS and fLUS between grades I/II (2.07 and 4.37 mm) and grades III/IV (0.67 and 2.52 mm). Both mLUS and fLUS were predictive factors for grades III/IV and cutoff values were 0.97 mm of mLUS and 3.13 mm of fLUS, having a sensitivity of 87.5% and 75.0%, and a specificity of 87.7% and 91.4% in mLUS and fLUS measurement, respectively. Conclusion: Sonographic measurements of LUS at term may be a feasible and reliable method to predict uterine rupture or uterine dehiscence in women with prior CD.

关键词： Lower Uterine Segment Sonographic Measurement Previous Cesarean Uterine Rupture Uterine Dehiscence

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Cesarean Scar Pregnancy: A Report of 11 Cases and Review of the Literature Regarding Subsequent Pregnancy

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Open Journal of Obstetrics and Gynecology 2016年第1期6卷 8-15页

作者： Chiaki Heshiki Keiko Mekaru Maho Miyagi Sugiko Oishi Kozue Akamine Hitoshi Sugiyama tadatsugu kinjo Hitoshi Masamoto Yoichi Aoki Department of Obstetrics and Gynecology Graduate School of Medical Science University of the Ryukyus Nishihara Okinawa Japan Science and Technology Group Okinawa Institute of Science and Technology Graduate University Onna Okinawa Japan

Background: There is no consensus regarding the optimal treatment for cesarean scar pregnancy (CSP) because treatment efficacy, safety, and the influence on subsequent pregnancy must be taken into consideration. Here we report our experience with 11 cases of CSP and review the literature regarding subsequent pregnancy. Methods: Records of 11 CSP cases that were treated at our hospital were retrospectively reviewed. CSP was treated by local methotrexate (MTX) injection or laparotomic or laparoscopic removal of the gestational mass and myometrial repair. Outcome of subsequent pregnancy after treatment was followed-up until delivery. Results: Local MTX injection was performed for six cases, laparotomic removal of the gestational mass and myometrial repair was performed for two, and laparoscopic removal of the gestational mass and myometrial repair was performed for three. The uterus was preserved in all cases. After CSP treatment, eight pregnancies occurred in five cases, resulting in six live births and two miscarriages. Conclusion: Advantages and disadvantages of various treatment methods for CSP continue to be elucidated. Serum hCG level, location of the gestational mass, thickness of the lower uterine segment at the time of diagnosis, and whether the patient wishes for fertility preservation should be considered when choosing a treatment plan.

关键词： Cesarean Scar Pregnancy Methotrexate Fertility Preservation

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