記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: In Japan, the diagnostic criteria for obstetric disseminated intravascular coagulation (DIC) were revised in 2024. This study aimed to evaluate the clinical utility of the revised obstetric DIC criteria, defined as the ability to identify patients at higher risk of severe maternal outcomes at presentation. METHODS: This single-center retrospective cohort study included women who delivered at ≥ 22 weeks of gestation and were transferred for primary postpartum hemorrhage (PPH) between April 2016 and March 2025. Women were compared according to obstetric DIC status and the presence of severe maternal outcomes to evaluate the ability of the revised criteria to identify patients with severe outcomes at presentation. RESULTS: Among women transferred for primary PPH, 18% were diagnosed with obstetric DIC. Severe maternal outcomes occurred more frequently in the obstetric DIC group than in the non-obstetric DIC group (55% vs. 24%; p = 0.002; relative risk, 2.27; 95% CI, 1.47-3.51). Fibrinogen levels were significantly lower in the severe group (163 mg/dL vs. 241 mg/dL, p < 0.001), whereas fibrin/fibrinogen degradation product (FDP) (85.6 μg/mL vs. 32.4 μg/mL, p = 0.61) and D-dimer (11.2 μg/mL vs. 9.5 μg/mL, p = 0.083) levels showed no significant differences. CONCLUSIONS: Although the revised obstetric DIC criteria better reflect the underlying pathophysiology by incorporating hyperfibrinolysis, severe maternal outcomes were still observed in women without obstetric DIC, likely reflecting dilutional coagulopathy. These findings suggest that fibrinogen may serve as an indicator of maternal severity, complementing markers of enhanced fibrinolysis.

DOI： 10.1111/jog.70388

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Primary small bowel carcinoma in pregnant women is extremely rare. Small bowel cancer is difficult to diagnose because of its rarity, lack of specific clinical symptoms, and particular anatomical features. We experienced a case of primary small bowel adenocarcinoma with ovarian metastasis during pregnancy. This is the first reported case of a patient with small bowel adenocarcinoma whose pregnancy continued to term and ended in delivery. CASE PRESENTATION: A 32-year-old pregnant woman developed abdominal pain, and imaging examination revealed an ovarian tumor at 29 weeks of gestation. We performed laparotomy and resected the ovarian tumor, which was initially suspected to be primary ovarian cancer. The patient continued the pregnancy to term. A detailed examination of the abdominal cavity during cesarean delivery at 37 weeks revealed that the primary lesion was located in the small bowel. CONCLUSION: It is important to recognize that the small bowel may be the primary site of metastatic ovarian cancer. Detailed and careful examination is necessary to diagnose small bowel cancer during pregnancy.

DOI： 10.1159/000540524

PubMed

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記述言語：日本語   出版者・発行元：横浜市立大学医学会  

子宮筋腫合併妊娠と分娩後異常出血の関連性については議論が分かれる．今回我々は，胎盤と隣接した粘膜下筋腫合併妊娠で経腟分娩後の産褥出血を経験した．症例は34歳， 3 妊2 産，自然妊娠し，前医で妊婦健診を行っていた．妊娠26週の経腹超音波検査で6 cm大の粘膜下筋腫が胎盤に隣接していた．妊娠35週に子宮筋腫は8 cmと増大し，分娩時の出血リスクを考慮され，当科へ紹介された．妊娠39週3 日で経腟分娩後に産褥出血を認めた．出血の原因を弛緩出血と考え，子宮収縮薬を投与したが出血は持続した．胎盤の辺縁約3．5cmが子宮筋腫表面を覆うように隣接しており，胎盤剥離時の子宮筋腫表面の血管損傷を疑い，子宮動脈塞栓術を施行し止血を得た．粘膜下筋腫合併妊娠において，胎盤形成後は子宮筋腫と胎盤の位置関係に留意した妊娠分娩管理が重要である．胎盤と子宮筋腫が隣接する場合，産褥出血のリスクを考慮し，子宮内バルーンタンポナーデや輸血の準備に加え，UAE施行可能な高次医療機関での管理を考慮すべきである．

CiNii Research

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その他リンク： https://search.jamas.or.jp/link/ui/2023286382