Dear Colleagues,

On behalf of the Editorial Team of Hypertension Research in Pregnancy, I am pleased to announce the Journal Awards for the Year 2022.

The aim of these Awards is to recognize papers published in 2022, both clinical and experimental studies, that were highly appreciated by the Editorial Team.

In the year of 2022, following paper has been selected for the Hypertension Research in Pregnancy Awards.

Gestational diabetes mellitus offsets the birth rate of small-for-gestational-age infants induced by hypertensive disorders of pregnancy: a single-center retrospective cohort study

Mamoru Morikawa, Hidemichi Watari

Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

2022 Volume 10 Issue 4 Pages 108–116

Aim: To clarify the relationship between the incidence of gestational diabetes mellitus (GDM) with or without hypertensive disorders of pregnancy (HDP) and the incidence of small-for-gestational-age (SGA) infants.

Methods: We conducted a 75-g oral glucose tolerance test between 24 and 28 weeks of gestation in 455 pregnant women who were classified into four groups according to their GDM and HDP status retrospectively.

Results: The number of SGA infants born to women with GDM+HDP was similar to that born to women with HDP alone. In the GDM group, the SGA rate in women with GDM+HDP was similar to that in women with GDM alone. However, in the non-GDM group, significantly more SGA infants were born to women with HDP alone than to women with no pathology. The mean birthweight SD in women with GDM+HDP was comparable to that in women with GDM alone. However, the birthweight SD in women with HDP alone was significantly lower than that in women with no pathology. By multivariate analysis, birthweight SD<−0.564 was a predictor of HDP in the non-GDM group, but not in the GDM group.

Conclusions: This study showed that GDM might offset the number of SGA infants induced by HDP.

Preeclampsia is a pregnancy-related complication caused by impaired remodeling of the spiral artery in association with inappropriate implantation. A maladaptive immune response in early- to mid-pregnancy is thought to allow impaired angiogenesis that leads to poor placentation. Furthermore, poor placentation can lead to maternal systemic organ damage via increased placenta-derived humoral factors including anti-angiogenic factors and proinflammatory cytokines. Exosomes are cell-derived vesicles with a diameter of 50–100 nm. They contain micro-RNAs, DNA, and proteins that can affect both local and distant tissues. Exosomes derived from syncytiotrophoblasts might promote the pathogenesis of preeclampsia, and conversely, exosomes derived from mesenchymal stem cells might ameliorate the condition. Further studies focusing on exosomes are expected to clarify the pathogenesis of preeclampsia and lead to the development of new predictive tools and treatments for preeclampsia.

The shoulder width (width of the parascapular cross-section) is the greatest among various body widths and thus, it may complicate the passage of the fetus through the pelvis. The shoulder width is at its greatest when the arms are elevated in the breech presentation. It is important to understand three principles to deform or reduce the shoulder width, deliver a trapped shoulder, or align the shoulder axis with the wider diameter of the pelvis.: (1) elevation or descent of the unilateral shoulder joint (avoiding simultaneous entry of both shoulders into the pelvis); (2) internal rotation of the shoulder joint (reduction of the shoulder width and contact of the forearm with the chest wall); and (3) matching the shoulder axis to the pelvic oblique diameter or transverse diameter.

In cases of shoulder dystocia, (1) the anterior shoulder is first guided into the pelvis to prevent the simultaneous entry of both shoulders (suprapubic pressure), however, advancement of the posterior (opposite) shoulder, is also possible (Schwartz method). (2) Pushing the shoulder forward (internal rotation of the shoulder joint: [Rubin method, Woods corkscrew method]) reduces the shoulder width. Internal rotation of the shoulder is induced by a forward-pushing maneuver from the fetal back. (3) As the oblique and transverse diameters are greater than the anteroposterior diameter in the plane of the pelvic inlet, the fetus should be guided for the shoulder axis to match the oblique or transverse diameter, rather than the anteroposterior diameter (Woods corkscrew method, reverse corkscrew method).

The classical method of freeing the shoulders and arms in the breech presentation is performed as follows: (2) the posterior shoulder is first pushed forward and downward from the fetal back (internal rotation of the shoulder joint), with the fetal forearm closely contacting the chest wall. Then, (1) the shoulder is extracted downward by pulling the elbow joint of the posterior shoulder to deliver the arm. (3) The shoulder axis should match the oblique diameter. Freeing the arm leads to the advancement of the posterior shoulder, because this maneuver is performed while the fetal trunk is pulled upward. Freeing the shoulder and arm should always be performed from the fetal back with the same-side hand. In cases of arm elevation or a nuchal arm, internal rotation of the shoulder joint is particularly important. The upper arm and forearm should be made to descend in such a manner that they contact the face and head.