Modified laparoscopic cerclage was developed as an easy laparoscopic approach during pregnancy, with sutures placed lateral to the uterine vessels. To the best of our knowledge, its successful use in the first trimester has not been reported in Japan. Additionally, there are no published data on chronological assessment of feto-placental circulation using Doppler. Here, we present the case of a 31-year-old Japanese woman (gravida 2, para 1) with refractory cervical incompetence who had a history of preterm birth at 32 weeks of gestation and cervical conization. Modified laparoscopic cervicoisthmic cerclage was performed. Doppler findings showed normal feto-placental circulation before and after the procedure. Her pregnancy progressed uneventfully with no significant feto-placental circulation or obstetric complications, and the baby showed normal growth. Elective cesarean section was performed at 37 + 0 weeks' gestation. Modified laparoscopic cervicoisthmic cerclage is suggested as one of the treatment methods for pregnant women with refractory cervical incompetence.
The aim of this study was to clinically evaluate the efficacy of high-intensity focused ultrasound (HIFU) for fetal therapy of twin-reversed arterial perfusion (TRAP) sequence. Six patients underwent HIFU therapy: five patients during the first trimester and one patient during the second trimester. In this study, two types of HIFU systems were used. The first-generation HIFU system comprised a biaxial transducer and continuous exposure pattern. The second-generation HIFU system comprised a coaxial transducer and sequential exposure pattern. The first-generation apparatus was used in four cases, and the second-generation apparatus was used in two cases. For three patients, blood vessels to the acardiac twin had been occluded. Two patients had intrauterine fetal demise despite vessel occlusion. The total fetal survival rate was 67%, and the efficiency rate was 83% after HIFU therapy. After more than 2 years of follow-up, the surviving infants had no severe clinical complications and no postnatal development problems. There was no significant difference in survival rates. However, owing to its efficiency rate, HIFU therapy is beneficial and can reduce the cardiac load of the pump fetus. Given that complete occlusion of the blood vessels was not achieved in almost half of these cases, we could not show that HIFU therapy is superior to other treatments. However, HIFU does not require uterine puncture for fetal therapy. Hence, there were no fatal complications, such as bleeding, rupture of membranes, and infection. Thus, HIFU therapy might be one of the less invasive treatment methods for TRAP sequence in early pregnancy. This article is protected by copyright. All rights reserved.
Background
Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare lung disease that manifests as parenchymal fibrosis of the upper lung lobe and pleura. There have been no reports of IPPFE complicating pregnancy. Here, we report a case of IPPFE that deteriorated rapidly during pregnancy.
Case presentation
A 29-year-old woman presented with dyspnea and dry cough at 19 weeks of gestation. IPPFE with acute exacerbation was suspected on chest computed tomography (CT). Despite steroid treatment, her condition progressed. A cesarean section was performed at 28 weeks of gestation. On postoperative day 26, she underwent living-donor lung transplantation. She was discharged a year after transplantation.
Conclusion
Our experience suggested that when pregnancy is complicated by PPFE, the disease may deteriorate rapidly. In this case, even though IPPFE with acute exacerbation was diagnosed during pregnancy, live birth was achieved, and the mother survived after lung transplantation. Lung transplantation should be considered in these patients because, once advanced, pulmonary lesions may be irreversible.
: In this report, the second-generation high-intensity focused ultrasound HIFU systems were clinically evaluated for human fetal therapy in two cases of twin reversed arterial perfusion sequence. The HIFU systems comprised an improved lead zirconate-titanate transducer with an imaging phase array sector probe, a Sonachill cooling system, and three phases of HIFU exposure : a trigger pulse, a continuous heating wave, and an idle period to obtain images with the imaging probe set on the transducer. To evaluate skin surface temperature, a thermal camera was used. To evaluate vessel occlusions, blood ow was measured at xed timings after exposures. Target vessel occlusion was achieved with HIFU in only one of the cases, but recanalization occurred the following day. Both cases were nally treated with radiofrequency ablation and one infant was successfully delivered without any complications. This case highlighted three advantages with the change to second-generation HIFU systems in human fetal therapy : the simplicity of maneuvers by reduced range of motion disturbance ; the ability to observe in real time during the exposure ; and a decrease in total ultrasonic output. Treatment interruption due to burns or complaints of heat sensation represented an obstruction to treatment completion. This remains an issue to be addressed in the future.
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