研究者詳細 - 春日　義史

論文 - 春日　義史

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The association between placenta implantation at prior myomectomy locations and perinatal outcomes in pregnant women who previously underwent one-step hysteroscopic myomectomy

Kasuga Y., Lin B.L., Kim S.H., Higuchi T., Iwata S., Nakada S.

Gynecology and Minimally Invasive Therapy （Gynecology and Minimally Invasive Therapy） 9 （ 2 ） 54 - 58 2020年04月

査読有り, ISSN 22133070

© 2020 Gynecology and Minimally Invasive Therapy. Objectives: There are no data describing the correlation between placenta implantation at prior myomectomy locations and perinatal outcomes in pregnant women after transcervical resection myomectomy (TCR-M). The aim of the study is to investigate the correlations between placenta implantation at prior myomectomy locations and perinatal outcomes in pregnant women who had previously undergone TCR-M. Materials and Methods: This was a retrospective, single-center study. We reviewed the records of 34 pregnant women who had previously undergone TCR-M for submucosal myoma and perinatal care in our hospital between January 2012 and January 2019. We examined surgical and pregnancy outcomes and evaluated correlations between placenta implantation at prior myomectomy locations and perinatal outcomes in women who delivered after 22 gestational weeks (n = 24). Results: Median maternal age at conception was 38 years (range, 28-44) and median duration between TCR-M and conception was 1.4 years (range, 0.3-5.8). There were 24 deliveries after 22 gestational weeks and 10 pregnancy losses. Among these 24 deliveries, the median gestational age at delivery was 39 weeks (range, 34-41); median birthweight, 3025 g (range, 2092-4012); and median blood loss at delivery, 573 g (range, 100-3000). There were no cases of placenta accreta and uterine rupture. Placenta implantation at a prior myomectomy location was detected in 14/24 women using transabdominal ultrasonography. Median blood loss was significantly higher in the implantation than in the nonimplantation group (P < 0.01). Conclusion: Our one-step TCR-M is useful for women with submucosal myoma. However, we suggest that clinicians should review and check the association between prior myomectomy locations and placenta implantation.

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頭痛および視野欠損を契機に診断に至った脳動脈解離による脳梗塞合併妊娠の1例

秋田啓介, 春日義史, 玉川真澄, 上條慎太郎, 大石真希, 遠藤豊英, 大谷利光, 池ノ上学, 落合大吾, 宮越敬, 田中守, 青木大輔

東京産科婦人科学会会誌（(一社)東京産科婦人科学会） 69 （ 2 ） 212 - 217 2020年04月

査読有り, ISSN 2186-0599

緒言:脳動脈解離は若年発症脳梗塞の原因となり、リスク因子としては片頭痛や高血圧が挙げられるが、妊婦における初発例は稀である。今回我々は妊娠中に発症した脳動脈解離による脳梗塞の1例を経験したので報告する。症例:31歳、3妊1産。既往歴として片頭痛を認めた。妊娠26週0日に激しい頭痛が出現し、その1週間後に右側半盲を認めた。頭部MRI/MRA検査で左後大脳動脈の狭小化と左後頭葉の虚血性変化が認められ、脳動脈解離による脳梗塞の診断となった。神経学的症状の増悪や血圧の変動なく経過し、妊娠37週5日に経腟分娩に至った。児は2926gの女児でApgar score 8/10点(1/5分値)であった。分娩中や分娩後に血圧の変動や新規の神経学的異常所見の出現は認めなかった。結論:神経学的異常所見を伴う頭痛を認める際には脳動脈解離を含めた脳血管障害を念頭に頭蓋内病変精査を行う必要があると考えられた。(著者抄録)

妊娠中期に卵巣癌と診断し、手術療法と化学療法治療後に生児を得られた1例

田中邦生, 長谷川慶太, 吉村拓馬, 大石真希, 大谷利光, 池ノ上学, 春日義史, 落合大吾, 岩田卓, 宮越敬, 田中守, 青木大輔

東京産科婦人科学会会誌（(一社)東京産科婦人科学会） 69 （ 2 ） 387 - 391 2020年04月

査読有り, ISSN 2186-0599

緒言:卵巣癌合併妊娠は1万から5万例に1例と頻度が低く、対応に一定の見解はない。今回我々は妊娠中期に卵巣癌を診断され、手術療法と化学療法を行い生児を得られた症例を経験した。症例:44歳、1妊0産。妊娠16週時に卵巣癌を疑われ、妊娠18週時に右付属器摘出術、左卵巣腫瘍摘出術、大網生検を施行した。右卵巣原発の高異型度漿液性癌IIIC期の診断にて術後パクリタキセルとカルボプラチン(TC)併用療法を4サイクル施行し、妊娠35週5日時に選択的帝王切開術とinterval debulking surgeryを同時に施行した。2118gの女児を娩出し、術後TC療法を2サイクル施行した。術後母体は再発を認めず、児の発育も良好である。結論:卵巣癌合併妊娠に対して、予め分娩時期を想定した管理・治療を行ったことで母児ともに合併症なく手術療法と化学療法を行うことができた。(著者抄録)

Transvaginal ultrasound features of the residual cervix in pregnancy after radical trachelectomy

Kasuga Y., Miyakoshi K., Tanaka M.

Journal of Medical Ultrasonics （Journal of Medical Ultrasonics） 47 （ 2 ） 335 - 337 2020年

ISSN 13464523

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Differences in fetal fractional limb volume changes in normal and gestational diabetic pregnancies: an exploratory observational study

Akiba Y., Ikenoue S., Endo T., Kasuga Y., Ochiai D., Miyakoshi K., Ishii R., Yakubo K., Tanaka M.

BJOG: An International Journal of Obstetrics and Gynaecology （BJOG: An International Journal of Obstetrics and Gynaecology） 128 （ 2 ） 329 - 335 2020年

査読有り, ISSN 14700328

© 2020 Royal College of Obstetricians and Gynaecologists Objective: Fetal fractional limb volume has been proposed as a useful measure for quantifying fetal soft tissue development. The aim of this study was to investigate the growth of fractional arm volume (AVol) and fractional thigh volume (TVol) of fetuses with maternal gestational diabetes (GDM) compared with those of fetuses with normal glucose tolerance (NGT). We hypothesised fetal fractional limb volume would be larger in the GDM group than in the NGT group in late gestation. Design: Exploratory observational study. Setting: Saitama Municipal Hospital. Sample: A total of 165 (125 NGT and 40 GDM) singleton Japanese pregnant women. Methods: AVol and TVol were assessed between 20 and 37 weeks’ gestation as cylindrical limb volumes based on 50% of the fetal humeral or femoral diaphysis length. Women were diagnosed as GDM based on the criteria of the Japan Society of Obstetrics and Gynecology. Main outcome measures: AVol and TVol were compared between women with NGT and those with GDM at each gestational age period (2-week intervals from 20 to 37 weeks’ gestation). Results: Overall, 287 ultrasound scans were performed (NGT group, 205 scans; GDM group, 82 scans). There was no significant difference of AVol between the groups before 32 weeks’ gestation. AVol was significantly larger in the GDM group than in the NGT group after 32 weeks’ gestation (P < 0.05). TVol was not statistically different between the groups across gestation. Conclusions: Detection of variations in fetal AVol may provide greater insight into understanding the origins of altered fetal body proportion in GDM. Tweetable abstract: AVol, but not TVol, is significantly larger in fetuses with GDM than in those with NGT after 32 weeks’ gestation.

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Impaired early phase insulin secretion associated with gestational diabetes mellitus in underweight women

Kasuga Y., Miyakoshi K., Saisho Y., Ikenoue S., Ochiai D., Tanaka M.

Journal of Maternal-Fetal and Neonatal Medicine （Journal of Maternal-Fetal and Neonatal Medicine） 35 （ 12 ） 1 - 3 2020年

査読有り, ISSN 14767058

© 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group. Background: No reports have focused on the clinical and metabolic characteristics of gestational diabetes (GDM) in underweight women. The aim of this study is to investigate the clinical and metabolic features of underweight GDM (pregravid BMI, <18.5 kg/m2: U-GDM). Materials and methods: Women diagnosed with GDM were categorized based on their pre-pregnancy BMI as either underweight (n = 49) or normal weight (pregravid BMI, 18.5–25.0 kg/m2: n = 271: N-GDM). During the study period, GDM was diagnosed using the International Association of Diabetes in Pregnancy Study Group criteria. Women with multi-fetal pregnancies, fetal congenital anomalies, overt diabetes in pregnancy, and pre-gestational diabetes mellitus were excluded. Results: There were no notable differences in maternal age at delivery and the rate of nulliparous between the U-GDM and N-GDM groups. Regarding antepartum oral glucose tolerance test profiles, women with U-GDM exhibited significantly lower fasting plasma glucose (FPG) levels than those with N-GDM (p <.01). The Insulinogenic Index of women with U-GDM was significantly lower than that of women with N-GDM (p <.05). Conclusion: Impaired early phase insulin secretion was associated with GDM onset in underweight women.

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Changes in bone metabolic profile associated with pregnancy or lactation

Miyamoto T., Miyakoshi K., Sato Y., Kasuga Y., Ikenoue S., Miyamoto K., Nishiwaki Y., Tanaka M., Nakamura M., Matsumoto M.

Scientific Reports （Scientific Reports） 9 （ 1 ） 6787 2019年12月

査読有り

© 2019, The Author(s). Calcium and nutrients are transferred from mothers to fetuses or infants during pregnancy or lactation, respectively, promoting metabolic changes in the mother, many uncharacterized. To evaluate these changes, we undertook two parallel studies. In one we analyzed fourteen clinical cases of vertebral fragility fractures, at or before three months after partum, in mothers who breastfed their infants. In the other, we enrolled 79 additional pregnant subjects, some who chose to breastfeed and others who did not, and analyzed changes in bone metabolic status starting between 34 and 36 weeks of gestation and ending one month after partum. In the larger group, bone-resorbing and bone-forming parameters such as serum TRACP5b and osteocalcin, respectively, significantly increased after partum. Among parameters that changed after partum, serum PTH and the bone-resorbing markers serum TRACP5b and urine NTX were significantly higher in mothers who only breastfed infants compared to mothers who fed infants formula or a mix of both. However, bone-forming parameters were comparable between breastfeeding and non-breast-feeding groups after partum, suggesting that elevated bone-resorption occurs only in the breastfeeding group. Radiographic analysis after partum demonstrated that no subject among the 79 analyzed showed vertebral fractures, even those who breastfed exclusively. Among fracture cases analyzed, subjects exhibited significantly lower bone mineral density than did non-fracture cases in breastfeeding-only subjects. We conclude that bone metabolic status significantly changes over the period between pregnancy and post-partum lactation, and that low bone mineral density seen in a small subset of breastfeeding-only cases likely causes post-partum vertebral fragility fractures.

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再癒着に留意した子宮鏡下癒着剥離術施行後に良好な周産期経過をたどった重度アッシャーマン症候群の1例

王洪欣, 春日義史, 吉村拓馬, 大橋千恵, 石垣順子, 鈴木毅, 金善惠, 樋口隆幸, 染谷健一, 林保良, 中田さくら

神奈川産科婦人科学会誌（神奈川産科婦人科学会） 56 （ 1 ） 29 - 32 2019年10月

査読有り, ISSN 0910-2485

緒言:アッシャーマン症候群は子宮内膜損傷により子宮内腔が癒着した状態であり、子宮性不妊の原因となる。今回我々は再癒着に留意した子宮鏡下癒着剥離術(trans-cervical resection of Asherman syndrome:(TCR-A)施行後に良好な周産期経過をたどった重度アッシャーマン症候群の1例を経験した。症例:29歳、3妊0産(人工妊娠中絶1回、稽留流産2回)、いずれも子宮内容除去術を施行されている。過少月経ならびに既往よりアッシャーマン症候群を疑われ、精査加療目的に当院を紹介受診した。子宮鏡検査では子宮内腔の2/3以上が結合織性癒着し、重度アッシャーマン症候群と診断し、TCR-Aの方針とした。子宮内腔の白色で内膜が存在しない癒着部分をはさみ鉗子で鋭的に切断解放し、術後癒着予防のために子宮内避妊器具を挿入した。術後1ヵ月の子宮鏡検査では子宮内腔の再癒着を認めなかった。術後5ヵ月で自然妊娠成立し、癒着胎盤の発生に留意して管理したが、妊娠経過に異常は認めなかった。妊娠37週3日に経腟分娩に至り、児は2265gの女児、Apgar score8/9点(1/5分値)であった。分娩時出血量は200g、胎盤剥離はスムーズであり、癒着胎盤を認めなかった。結語:再癒着に留意したTCR-Aを行ったことで自然妊娠成立し、良好な妊娠分娩予後をたどった可能性が示唆された。(著者抄録)

腰背部痛を主訴に来院した結核性胸膜炎合併妊娠の1例

松井友哉, 春日義史, 石垣順子, 鈴木毅, 金善惠, 樋口隆幸, 染谷健一, 中田さくら

神奈川産科婦人科学会誌（神奈川産科婦人科学会） 56 （ 1 ） 46 - 49 2019年10月

査読有り, ISSN 0910-2485

目的:本邦における結核発生数は減少傾向にあるものの、他の先進国と比較して多く、特に発展途上国出身者に多い。今回我々は腰背部痛を主訴に来院した結核性胸膜炎合併妊娠の1例を経験したので報告する。症例:42歳、8妊5産、フィリピン国籍。妊娠20週に約2週間継続した咳を認めたが、鎮咳薬で軽快していた。妊娠23週2日、左腰背部痛と呼吸苦を主訴に外来を受診したところ、左季肋部圧痛と左肋骨脊柱角叩打痛を認めた。腎盂腎炎の診断で入院管理とし、抗菌薬投与を開始したところ、第6病日に吸気時に増悪する背部痛が顕在化した。画像検査や採血検査上、結核が疑われたが、喀痰培養検査などは陰性であったために経皮的胸膜生検を行った。臨床経過ならびに病理組織学的検査結果より結核性胸膜炎及び肺結核と診断したため、多剤併用療法を開始した。その後の経過は順調であり、既往帝王切開術後妊娠のために妊娠37週5日に選択的帝王切開術を施行した。児は男児で3380g、Apgar score8/9点(1/5分値)であった。児に先天性結核は認めず、母児ともに術後7日目に退院した。結論:今回我々は腰背部痛を主訴に来院した結核性胸膜炎合併妊娠の1例を経験した。結核性胸膜炎発症時には腰背部痛を主訴に来院する可能性があり、特に発展途上国出身者では腰背部痛の鑑別疾患として結核性胸膜炎を念頭に入れることも必要であると考えられた。(著者抄録)

日本人妊娠糖尿病既往女性における産後糖代謝異常発症予測因子に関する後方視的検討

春日義史, 宮越敬, 税所芳史, 池ノ上学, 荒田尚子, 田中守

糖尿病と妊娠（(一社)日本糖尿病・妊娠学会） 19 （ 2 ） S - 67 2019年08月

査読有り, ISSN 1347-9172

日本人妊娠糖尿病(Gestational Diabetes Mellitus:GDM)既往女性における産後糖代謝異常(Postpartum Abnormal Glucose Tolerance:pAGT)発症予測因子を検討した。対象は日本人GDM合併単胎妊婦のうち、分娩後1年以内に75gOGTTを受けた女性である(pAGT[n=59]、正常耐糖能型[n=154])。GDM診断時OGTT血糖値ならびに遺伝因子とpAGTとの関連解析を行ったところ、OGTT2時間値のpAGT発症予測能が高かった(AUC=0.72)。遺伝因子では4遺伝子がpAGT群においてリスクアレルを多く持つ傾向にあり、検出された4遺伝子中、3遺伝子はインスリン分泌関連遺伝子であった。日本人GDM既往女性において、GDM診断時OGTT 2時間値がpAGT発症予測に有用であり、遺伝学的にインスリン分泌不全の関与が示唆された。(著者抄録)

Ultrasound Findings of Varices at the Site of Uterovaginal Anastomosis in a Pregnant Woman After Radical Trachelectomy.

Kasuga Y, Miyakoshi K, Tanaka M

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine （Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine） 38 （ 12 ） 3363 - 3364 2019年05月

査読有り, ISSN 0278-4297

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Twelve-year experience of office-setting removal of lost intrauterine devices in place for more than 10 years

Kasuga Y., Lin B., Maki J., Wang H., Yoshimura T., Nagai Y., Nakada S.

European Journal of Contraception and Reproductive Health Care （European Journal of Contraception and Reproductive Health Care） 24 （ 3 ） 206 - 208 2019年05月

査読有り, ISSN 13625187

© 2019, © 2019 The European Society of Contraception and Reproductive Health. Objective: We investigated the effectiveness of removing lost intrauterine devices (IUDs) that had been in place for over 10 years, using Lin's biopsy grasper in an office setting. Methods:This single-centre, retrospective study conducted between March 2006 and June 2018 included 49 women who had had an IUD in place for contraception for more than 10 years and who underwent removal of the lost IUD using Lin's biopsy grasper under transabdominal sonography without use of a tenaculum, anaesthesia and analgesia, after dilation of the cervical os and hysteroscopy. Results: The women's median age was 52 years (range 34–80 years) and the median duration of insertion was 17 years (range 10–43 years). Forty-eight (98%) women had their lost IUD removed using Lin's biopsy grasper. Among the removed IUDs, there were eight FD-1 IUDs with a string, 13 FD-1 IUDs without a string, 13 Chinese IUDs, seven Ota ring IUDs, three KS ring IUDs, two Saf-T-Coil IUDs, two Lippe loop IUDs and one Wing IUD. All women tolerated the procedure and there were no major operative complications. Conclusions: Lin's biopsy grasper was effective in removing IUDs that had been in place for a long time.

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Clinical and genetic characteristics of abnormal glucose tolerance in Japanese women in the first year after gestational diabetes mellitus

Kasuga Y., Miyakoshi K., Tajima A., Saisho Y., Ikenoue S., Ochiai D., Matsumoto T., Arata N., Hata K., Tanaka M.

Journal of Diabetes Investigation （Journal of Diabetes Investigation） 10 （ 3 ） 817 - 826 2019年05月

査読有り, ISSN 20401116

© 2018 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd Aims/Introduction: Risk factors of type 2 diabetes mellitus in Japanese women with recent gestational diabetes mellitus are unknown. The objective of the present study was to investigate the clinical and genetic characteristics associated with postpartum abnormal glucose tolerance in Japanese women with gestational diabetes mellitus. Materials and Methods: A total of 213 Japanese women with recent gestational diabetes mellitus who underwent a postpartum 2-h oral glucose tolerance test were investigated. The association between antepartum clinical characteristics and postpartum abnormal glucose tolerance (diabetes or prediabetes based on the Japan Diabetes Society criteria) was examined. Frequencies of 45 known type 2 diabetes mellitus-associated genetic variants were also compared between women with and without postpartum abnormal glucose tolerance. Results: A total of 59 women showed postpartum abnormal glucose tolerance (prediabetes, n = 51; diabetes, n = 8). Plasma glucose levels at 1 or 2 h, the insulinogenic index and the insulin secretion-sensitivity index-2 of the antepartum oral glucose tolerance test were independent of postpartum abnormal glucose tolerance risk factors (P = 0.006, P = 0.00002, P = 0.01 and P = 0.006, respectively). Four genetic variants (rs266729 [ADIPOQ], rs6017317 [HNF4A], rs5215 [KCNJ11] and rs7177055 [HMG20A]) showed a nominally significant association with postpartum abnormal glucose tolerance (P < 0.05, respectively). Among these, three were related to insulin secretion. Postpartum abnormal glucose tolerance risk significantly increased with increasing risk-allele number (P = 0.0005; odds ratio 1.91). Conclusions: Clinical features and genetic variants related to impaired insulin secretion are risk factors of postpartum abnormal glucose tolerance in Japanese women with recent gestational diabetes mellitus.

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Glycemic and metabolic features in gestational diabetes: singleton versus twin pregnancies.

Akiba Y, Miyakoshi K, Ikenoue S, Saisho Y, Kasuga Y, Ochiai D, Matsumoto T, Tanaka M

Endocrine journal 66 （ 7 ） 647 - 651 2019年04月

ISSN 0918-8959

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筋腫分娩様に腟内に突出した巨大子宮頸部筋腫合併妊娠の1例

田中邦生, 春日義史, 王洪欣, 吉村拓馬, 大橋千恵, 眞木順子, 鈴木毅, 金善惠, 樋口隆幸, 染谷健一, 林保良, 中田さくら

関東連合産科婦人科学会誌（(一社)関東連合産科婦人科学会） 56 （ 1 ） 73 - 77 2019年03月

査読有り, ISSN 2186-0610

【緒言】子宮筋腫は妊娠適齢期女性において頻度の高い疾患であり,筋腫合併妊娠は比較的よく遭遇する病態である.今回我々は筋腫分娩様に腟内に突出した巨大子宮頸部筋腫合併妊娠の1例を経験したので報告する.【症例】32歳,3妊1産(経腟分娩1回,自然流産1回).自然妊娠成立後,無月経11週に当院を受診した.初診時には腟内を占拠する7cm大の子宮筋腫を認め筋腫分娩が疑われた.MRI検査(妊娠15週)にて,子宮頸管後壁との境界が不明瞭な9cm×6cm×9cmの腫瘤が腟内に突出しており,筋腫は子宮頸部後壁発生の頸部筋腫であると診断した.妊娠中は経過観察の方針とし,特に有害事象の発症はなかった.筋腫が腟内を占拠していたため,経腟分娩は困難と判断し,帝王切開術の方針とした.妊娠36週4日に選択的帝王切開術を施行し,出血リスクを考慮して筋腫切除は行わなかった.児は1,915gの女児で,Apgar score 8/9点(1/5分値)であり,構造異常は認めなかった.また,術中出血量は818gで診察でも有茎性筋腫ではなく,子宮頸部後壁発生の頸部筋腫であることを確認し,悪露流出可能を確認後に手術を終了とした.術後経過良好にて術後7日目に退院した.【結語】頸部筋腫と有茎性筋腫分娩との鑑別にMRI検査は有用であり,頸部筋腫と筋腫分娩の鑑別を行えたことで経過観察を行い,良好な予後を得られた.(著者抄録)

子宮鏡手術を契機にKaufmann療法を中止したところ自然妊娠し生児を得た早発卵巣不全の1例

眞木順子, 林保良, 王洪欣, 吉村拓馬, 大橋千恵, 鈴木毅, 春日義史, 金善惠, 樋口隆幸, 染谷健一, 中田さくら

神奈川産科婦人科学会誌（神奈川産科婦人科学会） 55 （ 2 ） 145 - 147 2019年02月

査読有り, ISSN 0910-2485

今回我々は、急性骨髄性白血病治療後の早発卵巣不全に対して長年Kaufmann治療を行い、子宮粘膜下筋腫に対する子宮鏡手術を契機にKaufmann療法を中止したところ自然妊娠に至った一例を経験したので報告する。症例は30歳 0妊0産であり、9歳で急性骨髄性白血病を発症し、12歳の再発時に骨髄移植、放射線治療の既往がある。自然周期での月経はなく、16歳から14年間Kaufmann療法にて消退出血を起こしてきた。不正出血の症状を認めたため、外来にて精査したところ14.8×13.0×13.5mmの突出率70〜80%程度の粘膜下筋腫を認め、Kaufmann療法中止の上、子宮鏡下子宮筋腫核出術の方針となった。手術当日経腹超音波にて子宮内に胎嚢及び胎児心拍を認め、妊娠7週相当であったため、手術は中止とし、周産期管理を行い、生児を得た。Kaufmann療法は以前リバウンド作用による排卵誘発法として用いられており、数周期施行後にKaufmann療法を中止すると、卵巣機能が活性化され、排卵が回復する可能性があるとされている。原発性無月経であってもKaufmann療法を中止し、月経周期や排卵が自然回復する可能性があることを念頭に置く必要がある。(著者抄録)

腹腔鏡下子宮筋腫核出術中の内膜穿破時に摘出した内膜腫瘤から診断し得た、子宮内膜異型増殖症の1例

染谷健一, 竹田貴, 吉村拓馬, 王洪欣, 大橋千恵, 眞木順子, 鈴木毅, 春日義史, 金善惠, 樋口隆幸, 林保良, 中田さくら

神奈川産科婦人科学会誌（神奈川産科婦人科学会） 55 （ 2 ） 159 - 163 2019年02月

査読有り, ISSN 0910-2485

子宮や付属器の良性疾患に対する手術の前に、一般的に悪性疾患の除外のために子宮頸部細胞診や子宮内膜細胞診などを行うことが多いが、特に内膜細胞診はその精度に留意が必要である。今回我々は、術前の画像診断、細胞診ともに悪性所見を認めなかった症例において、子宮筋腫に対して腹腔鏡下子宮筋腫核出術を行い、術中の内膜破綻を機に内膜のポリープ状病変を発見し、子宮内膜異型増殖症の診断に至った症例を経験したので、報告する。症例は37歳女性、0妊0産、過多月経を主訴に、粘膜下筋腫を含む多発筋腫を指摘され、紹介受診。画像上、40mm大の粘膜下筋腫及び左内膜症性嚢胞を認め、スクリーニングの子宮頸部及び内膜細胞診に異常なきことを確認し、腹腔鏡下子宮筋腫核出術、左卵巣嚢腫摘出術を施行した。術中の筋腫核出の際に内膜が破綻し、内腔にポリープ状病変があることを偶発的に発見し、切除した。病理診断にて、同病変は子宮内膜異型増殖症であった。術後に再度、子宮内膜細胞診、組織診、子宮鏡観察にて内腔病変の残存や癌の併存を疑う所見のなきことを確認し、全腹腔鏡下腟式子宮全摘出術を行った。本症例のように、子宮筋腫による内腔変形がある場合、子宮内膜細胞診によるスクリーニングには限界があることを十分に理解し、筋腫核出などの妊孕性温存手術を行う際は、術前に子宮鏡による内腔観察を考慮することが重要であると考えられた。(著者抄録)

Size for gestational age at birth according to offspring sex and gestational weight gain in underweight women

Kasuga Y., Shigemi D., Tamagawa M., Suzuki T., Kim S., Higuchi T., Yasunaga H., Nakada S.

Journal of Developmental Origins of Health and Disease （Journal of Developmental Origins of Health and Disease） 10 （ 5 ） 536 - 541 2019年

査読有り, ISSN 20401744

© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2019. Although maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are related to fetal growth, there is a paucity of data regarding how offspring sex affects the relationship between maternal BMI in underweight mothers (pre-pregnancy BMI <18.5 kg/m 2 ) and size for gestational age at birth. The aim of this study was to investigate the effect of offspring sex on the relationships among maternal pre-pregnancy BMI, GWG and size for gestational age at birth in Japanese underweight mothers. Records of women with full-term pregnancies who underwent perinatal care at Kawasaki Municipal Hospital (Kawasaki, Japan) between January 2013 and December 2017 were retrospectively reviewed. The study cohort included underweight (n=566) and normal-weight women (18.5 kg/m 2 1/2pre-pregnancy BMI<25 kg/m 2 ; n=2671). The incidence of small for gestational age (SGA) births in the underweight group was significantly higher than that in the normal-weight group (P<0.01). Additionally, SGA incidence in the underweight group was significantly higher than that in the normal-weight group (P<0.01) in female, but not male (P=0.30) neonates. In the women with female neonates, pre-pregnancy underweight was associated with a significantly increased probability of SGA (odds ratio [OR]: 1.80; P<0.01), but inadequate GWG was not (OR: 1.38; P=0.11). In contrast, in women with male neonates, inadequate GWG was associated with a significantly increased probability of SGA (OR: 1.53; P=0.03), but not with pre-pregnancy underweight (OR: 1.30; P=0.10). In conclusion, the present results suggest that pre-pregnancy underweight is associated with SGA in female offspring but not in male offspring.

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Intrauterine Protrusion of Metal Coils: A Rare Complication of Uterine Artery Embolization

Yoshimura T., Kasuga Y., Higuchi T., Lin B.

Journal of Minimally Invasive Gynecology （Journal of Minimally Invasive Gynecology） 26 （ 7 ） 1215 - 1216 2019年

ISSN 15534650

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Impaired fetal growth in mothers with inadequate gestational weight gain: a retrospective study in Japanese uncomplicated pregnancy.

Ikenoue S, Miyakoshi K, Kasuga Y, Ochiai D, Matsumoto T, Tanaka M

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians （Journal of Maternal-Fetal and Neonatal Medicine） 33 （ 13 ） 1 - 5 2018年12月

査読有り, ISSN 1476-7058

Introduction: The average birth weight in Japan has gradually decreased and the number of low birth weight infant has increased over the last 30 years. Japanese pregnant women are characterized with lower prevalence of obesity than those in other developed countries, and maternal underweight before pregnancy is independently associated with low birth weight. However, the association between maternal inadequate gestational weight gain (GWG) and the risk of small for gestational age (SGA) in Japanese uncomplicated pregnant women has not been fully understood. This study aimed to examine the effect of maternal inadequate GWG on the risk of SGA in Japanese uncomplicated pregnancies. Methods: We retrospectively analyzed uncomplicated Japanese singleton pregnancies that delivered at term gestation in our institution from 2006 to 2016. The association between GWG and birth weight was analyzed by multiple linear regression. Potential confounding factors included maternal age, parity, prepregnancy BMI, and neonatal sex. The association between inadequate GWG and SGA was also examined by logistic regression. Results: A total of 3837 mother–neonate dyads were analyzed. Maternal GWG was 10.1 ± 3.7 kg (mean ± SD), and 2529 (66%) had inadequate GWG. After adjusting for confounding factors, GWG significantly correlated with birth weight (standardized β = 0.199, p <.001). Inadequate GWG increased the risk of delivering SGA neonate (adjusted odds ratio (aOR) = 1.97 [1.45–2.68], p <.001). This association was particularly pronounced in underweight (aOR = 2.95 [1.38–6.29], p =.005) and normal weight mothers (aOR = 1.79 [1.27–2.52], p =.001), and not in overweight/obese mothers (p =.115). Conclusion: Maternal GWG is associated with birth weight in Japanese women with uncomplicated singleton pregnancies. Inadequate GWG is an important risk factor of SGA, particularly in non-obese women. The present finding would potentially provide further evidence that promoting adequate gestational weight gain in Japanese underweight and normal weight mothers would reduce SGA, as well as metabolic dysfunction in later life.

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