The use of various Balloon tamponade technologies has steadily increased over the last five years in the management of postpartum haemorrhage. New methodologies and applications have been included beyond the original descriptions. Furthermore, novel approaches and mechanisms of action have also been suggested.No comparative trials involving “uterine/fertility sparing” approaches such as Balloon Tamponade Technology have been performed comparing the safety, efficiency and long term effects on endometrial and myometrial functions. However, balloon tamponade technology is rapidly becoming accepted as a preferred second line approach following failed first line uterotonics in many obstetric units.This paper reviews the current use of various balloon tamponade technologies in the management of postpartum haemorrhage.

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Aim: It has been reported that eclampsia might be caused by vasogenic edema from impaired autoregulation of cerebral blood flow, potentially due to elevated systemic blood pressure (BP). This study retrospectively investigated changes in systemic BP around eclampsia onset.
Methods: Eight women with eclampsia were enrolled. Three received antihypertensive drugs. Four had labor pains. Systolic and diastolic BP and heart rate were evaluated. Mean arterial pressure (MAP) and changes in BP (ΔBP) just before and after eclampsia onset were calculated.
Results: Systemic BP markedly increased just before eclampsia onset, then decreased to lower than before onset. The ΔBP1 (each BP just before eclampsia onset−mean BP) was 21±9 mmHg (21±11%), and the ΔBP2 (each BP just after eclampsia onset−BP just before eclampsia onset) was −40±18 mmHg (−31±12%) in MAP. The heart rate rapidly increased just after onset (75±8 vs. 128±6 bpm). Fetal cardiac monitoring showed prolonged deceleration in all pregnant patients.
Conclusions: It was suggested that both marked increase and decrease in BP around the onset of eclampsia might cause strong damage in not only maternal but also fetal blood circulation.

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Aim: Our aim was to establish a therapeutic strategy for eclampsia, stroke, and hypertension during pregnancy in Japan.
Methods: A questionnaire survey was sent to all obstetric institutions in Aichi Prefecture in order to collect information on characteristics of eclampsia and stroke during pregnancy as well as management of hypertension during labor and puerperium from 2005 to 2012.
Results: Of 518,024 deliveries, 203 cases of eclampsia (0.04%) and 51 cases of stroke (0.01%) were reported. Roughly 40% of eclampsia and stroke occurred at primary medical institutions, while 26% of strokes occurred at home. Most were managed at intensive medical institutions and 7 stroke patients died. Strokes occurred antepartum (41%), during labor (18%), and postpartum (41%). Most medical institutions measured blood pressure (BP) during labor and puerperium. During labor and puerperium, 15% of institutions allowed the supporting medical staff to decide whether or not the BP values should be reported.
Conclusions: This unique, long-term survey to address eclampsia and pregnancy-associated stroke enabled us to obtain detailed information and assess several issues regarding the maternal transport system, collaboration with neurosurgeons and ambulance services, and BP management during labor and puerperium in Japan.

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Aim: Various methods to reduce postpartum hemorrhage due to placenta previa have been suggested. The aim of this study is to evaluate the usefulness of vertical compression sutures (VCS) for controlling bleeding in patients with a placenta previa.
Methods: We analyzed 115 patents with placenta previa and compared 38 patients before the introduction of VCS and 77 patients after its introduction. The 77 patients were divided into 2 groups, 63 women in whom VCS were not used (Non-VCS Group) and 14 women who received VCS (VCS Group); the groups were compared.
Results: The average blood loss during surgery was 1,910±1,536 ml before the introduction of VCS and 1,530±699.0 ml after its introduction. The rate of patients with hemorrhage > 2,000 ml was 37% (14/38) before VCS were introduced and 19% (15/77) after their introduction (P<0.05). VCS were used in 14 cases and were effective in all cases. The average intraoperative blood loss was 1,443±655.8 ml in the Non-VCS group and 1,919±778.1 ml in the VCS Group (P<0.05). The rate of patients with hemorrhage > 2,000 ml was 13% (8/63) in the Non-VCS group and 50% (7/14) in the VCS Group (P<0.05).
Conclusions: VCS is effective for controlling bleeding with a placenta previa.

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Aim: To identify important factors that can be used to predict the presence of venous thromboembolism (VTE) or pulmonary embolism (PE) after cesarean section.
Methods: This retrospective study was conducted at Juntendo University Hospital from January to December in 2012. A total of 313 patients who underwent cesarean section were included. Complete blood count, biochemistry parameters, and parameters of coagulation-fibrinolysis, such as D-dimer levels, were examined on the day before cesarean section and on postoperative days 1, 3, and 5.
Results: Six cases of VTE and/or PE were identified. We designed an equation that incorporates changes in D-dimer levels for predicting the presence of thrombosis, as follows: y=(D1 D-dimer)×1.263−(D3 D-dimer)×1.741+(D3/D1 D-dimer)×6.42+(D5 D-dimer)×4.029−53.248. When the resulting value is > 20, the patient is considered likely to have thrombosis.
Conclusions: This study showed that rate of change in D-dimer levels from postoperative day 1 to day 3, and D-dimer level itself on postoperative day 5, are important factors for predicting the presence of VTE or PE.

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A 35-year-old patient (gravida 0, para 0) with a history of four previous laparotomies, including two previous episodes of postoperative intestinal obstruction, conceived by means of in vitro fertilization and embryo transfer (IVF-ET), but was temporarily admitted for hypertension at 19 weeks of pregnancy. One week after discharge, she was readmitted due to re-elevation of blood pressure. Although renal function improved temporarily after the placement of ureteric stents and nephrostomy to treat bilateral hydronephrosis and ureteric dilation, she developed intestinal obstruction at 32 weeks. An extraperitoneal cesarean section was performed at 33 weeks. The patient had intraperitoneal adhesions due to previous multiple laparotomies, and postrenal dysfunction due to the enlarged pregnant uterus, which was the likely cause of hypertension. In patients with similar conditions, it is important to sufficiently explain the risks of serious complications before commencing infertility treatment.

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We report a case of patients with placental abruption which certified fetomaternal hemorrhage (FMH) after traffic injury. A 21-year-old multipara was admitted to private clinic after traffic accident on 29th week gestation. Cardiotocogram (CTG) showed sinusoidal-like pattern with tachycardia and she was transferred to our hospital. Her injury was also not severe, but due to abnormal CTG suggesting massive FMH, immediate cesarean section was performed. The infant was saved with the umbilical cord artery blood pH=7.243, and a maternal good postoperative course was observed. FMH was proved by maternal serum concentrations of hemoglobin F and alpha fetoprotein.

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Renovascular hypertension due to renal artery stenosis associated with fibromuscular dysplasia during pregnancy can lead to maternal and fetal complications. Although conventional percutaneous angiography and angioplasty are recommended for patients with renal artery stenosis due to fibromuscular dysplasia, the influence of these procedures on women and fetuses is unknown. A 27-year-old primigravida was diagnosed with renovascular hypertension possibly due to fibromuscular dysplasia. Percutaneous transluminal angioplasty in conjunction with renal angiography was initially planned, but she became pregnant and was referred to our department at 9 weeks of gestation. At 22 weeks of gestation, she was administered intravenous nicardipine (24-120 mg/day) for blood pressure control until 32 weeks of gestation. At 33 weeks 2 days of gestation, her hypertension was uncontrollable, and she delivered a healthy infant by cesarean section. Intravenous administration of nicardipine may present an effective and safe method to control blood pressure in women with fibromuscular dysplasia.

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This article was retracted.

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The Society for the Study of Delivery Management (SSDM) was established over 30 years ago and recently held its annual symposium during the annual meeting of the Japan Society for the Study of Hypertension in Pregnancy (JSSHP). To engage both the SSDM and JSSHP, Secretary Generals of the JSSHP (K. Naruse and Dr. Shintaro Makino from Juntendo Univ., Tokyo) were requested by Dr. Katsuto Eguchi (President of the JSSHP, Okayama Central Hospital, Okayama) and Dr. Shigeru Saito (President of the Meeting and President-elect of the JSSHP, Toyama Univ., Toyama) to state the new aims of the SSDM symposium.
Recently, new research from studies involving topics such as uterine spiral artery remodeling and epigenetic changes has proposed the direct effects as well as the pathophysiological similarities of pregnancy induced hypertension (PIH) as compared to other emergent obstetric diseases such as placental abruption, fetal growth restriction and non-reassuring fetal status, thrombotic diseases, amniotic fluid embolism, or brain stroke. However, very few groups in Japan and elsewhere accept the viewpoints of researchers/clinicians who wish to discuss obstetric emergency diseases from a broader perspective which includes early placentation failure, genetic changes that link PIH and other issues, and failed cases of PIH leading to other organ failure. As such, we propose addressing “obstetric emergencies” as a new aim for our annual symposium over the next few years. This will comprise one portion of the JSSHP, but will not be strongly restricted to a discussion on hypertension.
This year, we invited five clinicians to the symposium on October 5, 2013 in Toyama, chaired by Dr. Jun Yoshimatsu (National Cerebral and Cardiovascular Center, Osaka) and Dr. Koichiro Shimoya (Kawasaki Univ., Okayama). The theme was “Infusion-and-output balance on PIH and other obstetric emergency (include blood transfusion and control of postpartum hemorrhage),” and a fruitful discussion developed among the attendees, who comprised many passionate and enthusiastic young doctors and residents. The aim of the future SSDM remained undecided and is currently under revision by the next President of the Meeting (Dr. Satoru Takeda, Juntendo Univ., Tokyo), but the general consensus was to invite active researchers and clinicians to give talks with empirical data as well as findings on useful, challenging, or innovative clinical techniques and outcomes. Further support for this symposium from any clinical or basic research fields is greatly appreciated.

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