Preterm birth (PTB) and threatened preterm labor (TPL), an important pre-PTB state, are major obstetric complications during pregnancy. However, their triggers have not been fully elucidated. The vagina is dominated by Lactobacillus species (categorized as community state types; CSTs I, II, III, and V) or by mixed anaerobes (CST IV). An abundance of the latter is associated with bacterial vaginosis (BV) and BV-triggered PTB/TPL. To identify factors that influence the diversity of vaginal microbiota associated with BV and CST IV (BV-type) bacterial profile, we performed a bioinformatic analysis of the microbial taxa using 16S rRNA amplicon sequencing data of bacterial genome in oral, vaginal, and rectal samples collected from 58 pregnant Japanese women. Interestingly, common residence of BV-associated bacteria in the vagina and rectum was individually detected in the CST IV (non-Lactobacillus dominated) group by species-level Spearman correlation coefficient analysis, suggesting that the rectum acts as a reservoir of BV-associated bacterial species in the CST IV group. The current study provides evidence of bacterial co-residence in vagina and rectum in the non-Lactobacillus dominated group, which could be targeted to reduce the risk of preterm incidence in pregnancy.

Excessive fibrinolysis detected with thromboelastography in a case of amniotic fluid embolism: fibrinolysis may precede coagulopathy.

The aim of this study was to elucidate the nature of decidual polyp (DP) and to compare DP outcomes treated with cervical cerclage for a shortened cervix with the outcomes of cases treated with cervical cerclage without DP. The medical records of pregnant women who were complicated with cervical polyps were retrospectively reviewed. Cervical cerclage was considered for those cases with a shortened cervical length of under 25 mm and before 25 gestational weeks. We also reviewed pregnant women who had no cervical polyps, and who underwent cervical cerclage during the same study period, and defined them as the control group. A total of 56 pregnant women with cervical polyps were identified. All of the polyps in the 14 cases that had undergone cervical cerclage migrated into the cervical canal. Of the thirty seven cases with cervical polyps that did not necessitate cervical cerclage, eight women delivered preterm and six of these cases were diagnosed as DP. In all of the women studied, polyp migration was observed in 68.6 %. Cervical cerclage was performed significantly earlier in the DP group than in the control group of 46 cases (p < 0.001; 18.4 weeks vs. 21.4 weeks, respectively). Cervical cerclage is effective in DP cases with a shortened cervical length and polypectomy should not be performed during pregnancy because of the risk of miscarriage.

Objective: In the present study, we aimed to examine whether the TSH/FT4 ratio after the second trimester can predict the prevalence of preeclampsia (PE) or gestational hypertension (GH). Study design:Retrospective case-control study. Methods:We collected TSH and FT4 serum levels after the second trimester in 133 pregnant women with suspected PE or GH. Participants were divided into 2 groups, the PE+GH group and the non-PE+GH group and conducted the retrospective study for the two groups to evaluate the background and the prevalence of PE or GH were retrospectively evaluated.Results: Among the participants in the PE+GH group, mean age, body mass index (BMI) at no pregnancy and BMI at delivery were 34.5 ± 6.7 years, 22.3 ± 3.9 kg/m 2 and 26.0 ± 4.0 kg/m 2 , respectively. Among the participants in the non-PE+GH group, mean age, BMI at no pregnancy and BMI at delivery were 32.9 ± 5.5 years, 22.5 ± 4.8 kg/m 2 and 26.1 ± 4.4 kg/m 2 , respectively. There were no significant differences observed between the two groups. The cutoff point of the TSH/FT4 ratio was 1.9 (sensitivity 0.45, specificity 0.81), which was derived from the receiver operating characteristic curve. The adjusted odds ratio of PE or GH prevalence was 3.60 (95% CI: 1.62-8.02). Conclusion:The TSH/FT4 ratio after the second trimester may aid in the prediction of PE or GH prevalence.ratio, may be associated with the prevalence of PE or gestational hypertension (GH) and examined whether TSH/FT4 ratio could be measured more easily than the sFlt-1/PlGF ratio. MethodsThis matched case-control study was conducted between April 2014 and March 2016 at the Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka City, Japan.Our hospital is located in the Miyakojima Ward of Osaka City. The population of Miyakojima Ward is approximately 104,000, with the birth of approximately 870 infants each year. Our hospital has 1063 beds and fulfills the role of a perinatal medical center. The maternal-fetal intensive care unit (MFICU) consists of 6 beds, the neonatal intensive care unit (NICU) 12 beds and the growing care unit (GCU) 18 beds.A total of 1810 singleton pregnancies delivered at our hospital were enrolled: 270 of them had suspected PE or GH or were diagnosed with PE at the last pregnancy. The analysis included 133 eligible pregnancies in which TSH and FT4 could be measured after the second trimester ( Figure 1).We divided the participants into 2 groups: 1 group with PE or GH (PE+GH group) and 1 group without PE or GH (non-PE+GH group). IntroductionPreeclampsia (PE) is considered to be caused by a vascular endothelial cell disorder and has recently been associated with soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF).The disorder results from abnormal maternal spiral artery remodeling [1].In normal pregnancy, trophoblastic cells penetrate the decidua as well as the alternate vascular endothelial cells or vascular muscles of the maternal spiral arteries, resulting in maternal spiral artery remodelling [2]. In...

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