Search

This study aimed to determine the efficacy of postural management in the lateral position for primiparous breech presentation.A retrospective cohort study was conducted at a single institution from January 2020 through December 2020. Participants were singleton primiparous pregnant women diagnosed with breech presentation between 28 + 0 and 29 + 6 weeks of gestation. The exclusion criteria were scheduled cesarean delivery, uterine malformation, transverse position, and scheduled delivery at another hospital. A doctor instructed the women in the intervention group to lie on their right sides several times a day if the fetal back was on the left side or lie on their left sides if the fetal back was on the right side. The knee-chest position and other methods were not recommended. The control group received expectant management care. The primary endpoint was the percentage of fetuses in a cephalic presentation 2 weeks later.Of the 56 women included in the study, 17 women were instructed to lie in the lateral position, and 39 women received expectant management care only. After 2 weeks, women who were instructed to lie in lateral position had a higher rate of fetal cephalic version than the control group (82.4% [14/17] vs. 43.6% [17/39], p = 0.017). No study participants experienced adverse effects.Two weeks of postural management in the lateral position without the knee-chest position significantly reduced the rate of primiparous breech presentation in the third trimester of pregnancy.

A 34-year-old, gravida 0 para 0 Japanese woman visited a regional hospital complaining of dysmenorrhea, hematuria during menstruation, and right inguinal pain. She had a history of dysmenorrhea and three prior rounds of in vitro fertilization with embryo transfer, which were all with transfers of cryopreserved-thawed single embryos in natural cycles, resulting in no pregnancy. An ultrasound revealed a large 2 × 1-cm nodule between the bladder and the anterior wall of the uterus and a 3-cm cystic lesion in the right adnexal area. A combined cystoscopic and laparoscopic resection of the bladder endometriosis and cystectomy of the right endometrioma were carried out. A single ultrasound-guided transfer of a cryopreserved-thawed embryo in the cleavage stage was performed 4 months postoperatively, which resulted in an uncomplicated pregnancy. The combined, single procedure was minimally invasive and eradicated the lesions that may have caused the infertility.

A 33-year-old, gravida 3, para 2, woman was transferred to our hospital, with acute abdominal pain. Abdominal computed tomography (CT) revealed a cystic lesion accompanied by ring-enhancement between the liver and right kidney with fluid collection in the pelvic cavity. Serum hCG value was 3100 mIU/mL. Transvaginal sonography revealed a pseudo-gestational sac in a thickened endometrium. With a preoperative diagnosis of ectopic pregnancy at 7 weeks of gestation, laparotomy was performed. Following careful removal of clots between the liver and right kidney that contained a gestational sac, continuous bleeding from a defect in the Gerota's fascia of the right kidney was noted. The postoperative course was uneventful and the serum hCG concentration decreased markedly. This case demonstrates that the Gerota's fascia is a possible site of ectopic pregnancy, and that CT can identify a pregnancy in the Gerota's fascia as well as in the liver and spleen.

Aim: Anti-β2-glycoprotein I (anti-β2-GPI) antibody has been detected in cases of recurrent abortion and intrauterine death. Placenta growth factor (PlGF) and vascular endothelial growth factor (VEGF) are growth factors that accelerate villous proliferation. Soluble VEGF receptor-1 (sVEGFR1) is a soluble receptor for PlGF and suppresses the function of PlGF. In order to study the pathological mechanism of anti-β2-GPI antibody, we evaluated the effects of anti-β2-GPI antibody on PlGF, VEGF and sVEGFR1 production from cultured choriocarcinoma cells. Methods: The sera were taken from six anti-β2-GPI antibody-positive and six anti-β2-GPI antibody-negative patients with recurrent miscarriages. Choriocarcinoma cells (JEG-3) were cultured in 24-well plates. After each serum and isolated immunoglobulin G (IgG) were added to the culture medium, the PlGF, VEGF and sVEGFR1 in the culture medium were measured by ELISA 24 h later. When the isolated IgG was added to culture medium, only the levels of PlGF were measured. Results: The anti-β2-GPI antibody-positive sera and isolated IgG significantly suppressed the production of PlGF from JEG-3 cells more strongly than the anti-β2-GPI antibody-negative sera. The suppressive effects were not changed by serum inactivation. There was no significant difference in the values of the XTT assay and the production of VEGF and sVEGFR1 between the antibody-positive and antibody-negative sera. Conclusions: Anti-β2-GPI antibody-positive sera and IgG suppress the production of PlGF from JEG-3 cells. We suggest that the anti-β2-GPI antibodies may suppress PlGF production from trophoblasts and cause the failure of placenta formation and function.