Non-communicable diseases (NCDs) are chronic diseases that are non-infectious and non-transmissible. The World Health Organization (WHO) classifies cardiovascular disorders (myocardial infarction or stroke), diabetes, chronic respiratory diseases, and malignancy as the four major disease types of NCDs. Evidence supporting the influence of various environmental factors in the early developmental period on the risk of developing NCDs in adults has increased recently, leading to the proposal of the developmental origins of health and disease (DOHaD) theory. We reviewed the background of the paradoxical circumstances in which the morbidity of NCDs has rapidly increased in both developing and developed countries in view of distinct prenatal nutritional environments in the context of the DOHaD theory. We also discuss candidates for early interventions and biological samples for identifying biological markers in individuals at high risk of NCDs from the perspective of preemptive medicine in perinatal care.

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Preeclampsia (PE) is a significant obstetric risk factor and multi-organ complication of pregnancy characterized by high blood pressure and proteinuria, occurring in 2% of all pregnancies and resulting in maternal and fetal morbidities. Although the etiology of PE remains unclear, impaired trophoblastic invasion into the inner myometrial portion of spiral arteries causes these vessels to retain their musculoelastic properties, thereby inducing hypoperfusion, hypoxia and the subsequent systemic release of inflammatory cytokines that promote the excess production of soluble fms-like tyrosine kinase 1 (sFLT1). These pro-inflammatory cytokines may also enhance maternal inflammatory responses and systemic endothelial dysfunction, leading to maternal syndrome. Furthermore, the produced inflammatory cytokines induce tissue factor (TF), a receptor for coagulation factor VIIa/VII that subsequently initiates the TF-dependent coagulation pathway. Furthermore, hypoperfusion and hypoxia are responsive to vasoactive substances, which consequently results in vasospasms and vasoconstriction of the uterine artery. These vascular responses may activate the coagulation system in the intervillous space and induce further ischemic damage to trophoblastic cells in a hypercoagulable state, in which the serine protease thrombin plays various important roles. In this review, the pathogenesis of PE is discussed in the context of thrombin as a potential “toxin” by focusing on its role in the activation of coagulation.

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Placenta accreta is the leading cause of peripartum hysterectomy. While hysterectomy has long been the mainstay of treatment for placenta accreta, there has been a gradual shift over the last decade toward conservative management, both to avoid serious maternal morbidity and to preserve fertility. Nevertheless, there is no consensus regarding optimal strategies for the management of placenta accreta. The aim of this paper is to provide a comprehensive literature review regarding management of placenta accreta, especially from the point of view of its conservative treatment and strategies pursued in our practice.

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Aim: The aim was to retrospectively investigate whether intravenous administration of nicardipine might be useful for managing blood pressure (BP) after cesarean section in women with severe pregnancy induced hypertension (PIH).
Methods: Fifty-one postpartum women after cesarean section with severe hypertension (systolic BP [SBP] ≥160 mmHg) (28 preeclampsia [PE] and 23 gestational hypertension [GH]) were enrolled. According to the modified nicardipine sliding scale procedure, a continuous intravenous infusion of nicardipine at 1 to 6 mg/h was given to goal (SBP 120–140 mmHg) by evaluation every 30 min.
Results: Initial SBPs were 172±10 mmHg in PE and 175±11 mmHg in GH. The stable dose of nicardipine was 1.9±0.8 mg/h in PE and 1.4±0.6 mg/h in GH. The stable dose was greater in PE than in GH. Stable SBPs were 133±11 mmHg in PE and 136±11 mmHg in GH. SBP decrease rates were 23±6% in PE and 23±6% in GH.
Conclusion: In this retrospective study, intravenous administration of nicardipine using a sliding scale appeared useful for decreasing BP in both PE and GH.

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Aim: In order to establish more effective therapeutic strategies and for preventing maternal death (MD), this study investigated the causes of MD in Aichi Prefecture, Japan.
Methods: Questionnaire surveys were sent to all obstetric institutions in Aichi Prefecture to collect information on all cases of MD occurring between 2006 and 2012. Follow-up questionnaires were sent to institutions in which cases of MD had been reported.
Results: We found a total of 42 cases of MD. The annual maternal mortality rate (MMR) in Aichi Prefecture, which has been decreasing since 2010 was higher than that of all of Japan.. Among the 42 cases of MD, causes included the following: stroke (11 cases); severe obstetric hemorrhage (8 cases); and obstetric pulmonary embolism (PE; 10 cases). In addition, severe hypertension was observed in 5 of the 11 stroke patients. Amniotic fluid embolism was present in 5 of the 8 severe obstetric hemorrhage cases and in 6 of the 10 obstetric PE cases.
Conclusions: The MMR was higher in Aichi Prefecture than that in Japan. The leading causes of maternal death in Aichi Prefecture were stroke, severe obstetric hemorrhage and PE.

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We report two cases of placenta accreta identified during pregnancy after laparoscopic surgery. The first case involved a 39-year-old woman with a history of miscarriage. Ultrasonography and MRI revealed multiple uterine myomas and adenomyosis. One year after laparoscopic myomectomy and adenomyosis resection, ultrasonography at 33 weeks of gestation revealed a thin uterine posterior wall and placental invagination, indicating placenta accreta. During cesarean section, the muscular layer required repair after removal of the placenta. The second case involved a 37-year-old woman with excessive menstruation. Ultrasonography revealed a large uterine myoma adjacent to the endometrial cavity. Four years after laparoscopic myomectomy, ultrasonography revealed placenta accreta at 35 weeks of gestation. During cesarean section, the muscular layer needed to be partially resected together with the placenta. A thorough placental evaluation with ultrasonography is recommended in pregnancies achieved after myomectomy and adenomyosis resection.

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A 34-year-old pregnant woman was diagnosed with mixed connective tissue disease (MCTD), complicated with postpartum pulmonary hypertension (PH). She was taking 10 mg oral prednisolone during pregnancy. At 29 weeks’ gestation, systolic blood pressure increased and proteinuria developed, and she was admitted for preeclampsia. However, at 32 and 3/7 weeks’ gestation, her blood pressure elevated to 195/117 mmHg, and her platelet count decreased to 96×10³/μl. Thus, she was diagnosed as severe preeclampsia, and an emergency cesarean section was performed. At postpartum 1 day, she complained of dyspnea and palpitation. Pericardial effusion and right ventricle enlargement were detected on cardiac ultrasound. Her tricuspid regurgitation peak gradient was elevated (40 mmHg), indicating the presence of PH. Accordingly, prednisolone 30 mg/day was administered, and her dyspnea improved. Her blood pressure decreased and her proteinuria disappeared on day 10 postpartum. She was discharged on day 14 with oral prednisolone. Evaluation of cardiac and pulmonary functions before pregnancy in MCTD-complicated patients and careful observation for PH during and after pregnancy is recommended.

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