Prophylactic cervical cerclage for the prevention of early premature delivery in nulliparous women with twin pregnancies.
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Female↗
Biomedical subjects
K Kuromaki
Publications and source records attributed to K Kuromaki.
Trial of prophylactic administration of TXA2 synthetase inhibitor, ozagrel hydrochloride, for preeclampsia.
OBJECTIVE: In an attempt to investigate the prophylactic effect of a thromboxane A2 (TXA2) synthetase inhibitor on pregnant women with a high risk of preeclampsia, the following clinical study was undertaken. METHODS: Forty pregnant women were randomly allocated to control or treatment groups. Ozagrel Hydrochloride (400 mg/day, orally) and placebo were started at 20 weeks of gestation and continued until delivery. RESULTS: Seventeen of 20 (85%) women in the control group developed preeclampsia, whereas 9 of 20 (45%) in the treatment group developed preeclampsia. Ozagrel Hydrochloride significantly (p < 0.01) reduced the occurrence of preeclampsia, and the incidence of both hypertension (p < 0.05) and proteinuria (p < 0.01) was significantly less in the treatment group compared with the control group. One month after administration, the mean plasma concentration of TXB2, a metabolite of TXA2, was significantly decreased (p < 0.01) to 62.4 +/- 13.6%, whereas that of 6-keto prostaglandin F1 alpha, a metabolite of PGI2, was significantly increased (p < 0.01) to 206.7 +/- 52.8%. There were no maternal or fetal side effects observed. CONCLUSIONS: It seems likely that Ozagrel Hydrochloride could be used for the prevention of preeclampsia in high-risk pregnant women.
Administration, Oral↗
Persistent subchorionic hematoma with clinical symptoms until delivery.
OBJECTIVE: This study was performed retrospectively to clarify the clinical features of persistent subchorionic hematoma with clinical symptoms until delivery. METHODS: We studied all the 22 cases of persistent subchorionic hematoma with symptoms until delivery from 4763 singleton pregnant women delivered in our hospital from 1985 to 1996 inclusive to investigate their clinical course and pregnancy outcome. RESULTS: The initial symptom of subchorionic hematoma was vaginal bleeding and/or uterine contractions. The onset of the symptoms showed two peaks at 9-11 and 30-31 weeks of gestation. The pregnancy outcome was spontaneous abortion in three cases (13.6%), premature labor in 17 cases (77.3%) or full-term delivery in two cases (9.1%). Tocolysis was needed in 17 of the 22 cases (77.3%), of which 16 cases failed to prevent premature delivery. CONCLUSION: Persistent subchorionic hematoma with clinical symptoms until delivery is likely to result in abortion or premature labor, because that may be thought to be a severe type.
Abortion, Spontaneous↗
The management of cervical incompetence with protruded membranes into the vagina by vaginal irrigation with granulocyte elastase inhibitor: ulinastatin and PVP-iodine solution.
In an attempt to prevent preterm premature rupture of the membranes (PPROM) and to prolong the duration of pregnancy in patients with a dilated cervix and with the membranes protruding into the vagina, the combination therapy of irrigation with a solution containing granulocyte elastase inhibitor (ulinastatin) and PVP-iodine onto the membranes, as well as the use of antibiotics and tocolytic agents, was tested. Ten patients with protruding membranes were treated by this combination therapy and five patients were instructed to have strict bedrest without any medication. In the non-treated group, all patients were delivered within 2 days of admission and all babies had a poor prognosis. In the treated group, the pregnancy was prolonged by between 3 and 108 days (mean values 33.6 days). Only two out of 10 patients had PPROM. In cases with protruding membranes, this combination therapy seemed to be useful in preventing rupture and so prolonging the pregnancy and increasing the survival rate of the infants.
Journal Article↗
Ovarian pregnancy diagnosed in the third trimester: a case report.
We observed a patient with a primary ovarian pregnancy complicated by severe preeclampsia and a presumed fetal anomaly. Diagnosis was made at cesarean section at 30 weeks of gestation. Etoposide, given intravenously at a dose of 100 mg daily for 5 days, prevented massive bleeding during the procedure that was subsequently performed to separate the placenta.
Adult↗
The possibility of clinical application of the thromboxane A2 synthase inhibitor, ozagrel, for the treatment and prevention of preeclampsia: a preliminary report.
OBJECTIVES: This study was performed to investigate whether the TXA2 synthase inhibitor, ozagrel, was effective in the treatment and prevention of pre-eclampsia. STUDY DESIGN: Ozagrel was administrated therapeutically to 4 severely pre-eclamptic women, and prophylactically to 5 pregnant women with histories of severe preeclampsia and complications. RESULTS: The therapeutic administration (TA) of ozagrel improved hypertension and proteinuria. Two patients delivered appropriate-for-date (AFD) infants, whereas the other 2 patients delivered light-for-date (LFD) infants. Mean plasma concentrations of TXB2 (plasma TXB2) decreased, whereas plasma 6-keto PGF1 alpha were almost unchanged. The prophylactic administration (PA) of ozagrel prevented the occurrence of preeclampsia in 3 of the 5 patients. All delivered AFD infants. The duration of pregnancy was prolonged more than that of previous pregnancies in all patients. Plasma TXB2 decreased, whereas plasma 6-keto PGF1 alpha increased. CONCLUSIONS: PA prevented preeclampsia and intrauterine growth retardation, whereas TA improved only maternal symptoms. These results might justify a large prospective study to determine whether ozagrel is an effective prophylactic.
Adult↗
Autologous blood transfusion for the patient with placenta previa complicated by placenta increta: a case report.
The patient, who was 34 years of age, had previously had a transverse incision of the lower uterine segment cesarean section because of placenta previa. She was admitted to the hospital due to placenta previa again at 27 weeks of gestation in the current pregnancy. Ultrasound examination revealed placenta increta as well as placenta previa. In an attempt to avoid homologous blood transfusion at the time of profuse hemorrhage anticipated to occur during cesarean section, an autologous blood transfusion was planned. Fifteen hundred ml of autologous blood was collected by a leap-frog method during the 8 weeks prior to cesarean section. A cesarean hysterectomy was performed at 37 weeks of gestation because of placenta increta. Blood loss was estimated at 1,830 ml, and 1,500 ml of autologous blood was transfused. A leap-frog method of autologous blood collection for this pregnant woman with risk of massive hemorrhage was simple and beneficial, resulting in the preservation of more than 1,500 ml of autologous blood for transfusion.
Adult↗
[Clinical study of autologous blood transfusion in pregnant women].
The effect of autologous blood donation during the third trimester of pregnancy on the maternal circulation, the properties of blood collected in a phosplatebuffered citrate anticoagulant solution, and the clinical outcome of autologous blood donation and transfusion for pregnant women were investigated in this study. Thirty-four pregnant women with placenta previa or previous cesarean delivery underwent phlebotomies in an autologous transfusion program. Three hundred ml of blood was collected under the observation of fetal heart rate patterns and uterine contractions from 3 weeks prior to the planned date of cesarean section and a total of 900 ml of blood was stored. Electronic fetal monitoring tracings were all normal and changes in blood pressure and pulse rates were minimal during the blood donation. The decrease in hemoglobin after the removal of 900 ml of blood was only 0.6g/dl on average during the 3 weeks, since the concentration of erythropoietin in serum and the counts of reticlocyte increased in a few days after blood removal. But there were no significant changes in TAT levels in serum. Twelve out of 34 pregnant women received the autologous blood transfusion during or after cesarean delivery and the homologous transfusions were avoided. The results of this study suggested that autologous blood transfusion for pregnant women with a high incidence of blood loss at delivery, such as placenta previa or previous cesarean delivery was safe and advantageous in avoiding homologous blood transfusion.
Adult↗