Dear Colleagues,

On behalf of the Editorial Team of Hypertension Research in Pregnancy, I am pleased to announce the Journal Awards for the Year 2017.

The aim of these Awards is to recognize papers published in 2017, both clinical and experimental studies, that were highly appreciated by the Editorial Team.

In the year of 2017, following paper has been selected for the Hypertension Research in Pregnancy Awards.

A pilot study investigating the LOX index as a potential biomarker of endothelial function in pregnancy.

Kohei Fujita¹, Eiji Kondoh¹, Yoshitsugu Chigusa¹, Haruta Mogami¹, Kaoru Kawasaki¹, Mari Ujita¹, Masatoshi Fujita², Ikuo Konishi¹

¹Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan, ²Department of Cardiovascular Medicine, Uji Hospital, Uji, Kyoto, Japan

Aim: This study aimed to determine the normal range of the lectin-like oxidised LDL receptor (LOX) index during pregnancy and investigate whether the index can be used as a biomarker of maternal endothelial function.

Methods: We conducted a prospective pilot study consisting of 12 pregnant women without obstetric or medical complications and eight non-pregnant women at Kyoto University Hospital between March 2011 and March 2012. Endothelial function was evaluated by the reactive hyperaemia index (RHI) using Endo-PAT2000 in early, mid-, and late gestation. Plasma levels of soluble LOX-1 (sLOX-1) and LOX-1 ligand containing apolipoprotein B (LAB) in each gestation period were measured by ELISA. The LOX index was obtained by multiplying plasma levels of LAB with those of sLOX-1.

Results: The LOX index increased significantly as gestational age advanced. The LOX index, but not LAB or sLOX-1, was correlated with RHI in mid-gestation (R=0.3352, P=0.0486).

Conclusions: The LOX index during mid-gestation may be a useful biomarker of maternal endothelial function.

It is not known whether pregnant women with chronic hypertension (CH) develop preeclampsia (PE) more frequently than those with white coat hypertension (WCH). Therefore, we planned the following 2 studies: study 1 is a multicenter prospective observational study to distinguish WCH and CH, in (A) pregnant women with suspected hypertension with blood pressure measured in a clinical setting, and who had not been diagnosed with hypertension prior to the current pregnancy, and (B) pregnant women with a previous diagnosis of hypertension, but who have not received an accurate diagnosis specifying whether they have CH or WCH; study 2 is a multicenter retrospective cohort study, which will start after the recruitment of subjects in study 1, to compare the incidences of PE and gestational hypertension (GH) in women with WCH or CH. Here, we described a protocol for a prospective multicenter cohort study (JP-WCH study; UMIN study ID: UMIN000032790).

In Japan, perinatal mental disorders are recognized as significant complications of pregnancy and the postpartum period. Left untreated, maternal mental disorders can lead to serious social and physical problems in mothers, including suicide, child abuse, and child neglect. A number of steps in perinatal mental health care can be taken to help mothers remain emotionally balanced during pregnancy and after childbirth. Active interventions mediated by cooperation among professionals from multiple fields will decrease the incidence of serious problems associated with maternal mental disorders.

Maternal mortality rates in Japan declined steadily until around 2007, after which they plateaued, with current numbers residing at 2.7–4.8/100,000 total births. A more accurate grasp on the number of maternal deaths and suicide cases among pregnant women and those within 1 year postpartum is needed. These data must be analyzed in order to provide countermeasures and knowledge on emergency life-saving measures. To this end, the entire medical team should attend training so that the various problems may be resolved among multidisciplinary professionals and better treatment and management may be provided, facilitating a proper response to any situation. Establishing cooperative relationships with higher level medical institutions to which patients may need to be transferred is also important. Sharing case histories and courses in regular case conferences and debriefing sessions would also be beneficial.

Aim: This study aimed to identify risk factors for bleeding complications of postoperative prophylactic anticoagulation after cesarean section in preeclampsia cases.

Methods: A total of 68 cases of preeclampsia or superimposed preeclampsia at a tertiary perinatal center in Tokyo between 2012 and 2017 were recruited for this study. Bleeding complications were defined as subcutaneous, subfascial, or intraperitoneal hematoma detected by ultrasonography or computed tomography. Associations of clinical and laboratory data with bleeding complications were assessed by univariate and multivariate analyses.

Results: Bleeding complications were recorded in nine cases: subcutaneous hematoma in four cases, subfascial hematoma in four cases, and intraperitoneal hematoma in one case. Univariate analysis revealed preoperative platelet count and 24-h urine protein level to be associated with bleeding complications. Moreover, multivariate logistic regression analysis revealed preoperative platelet count (odds ratio, 0.867; 95% confidential interval, 0.756–0.994; P=0.04) and 24-h urine protein level (odds ratio, 1.498; 95% confidential interval, 1.031–2.176; P=0.03) to be independent risk factors for bleeding complications.

Conclusion: Preoperative platelet count and 24-h urine protein level may help to identify patients at increased risk for bleeding complications.

Aim: Several devices are used for balloon tamponade. In Japan, metreurynters are widely used for cervical ripening; however, there is little evidence for their use in hemostatic uterine balloon tamponade. This study aimed to assess the non-inferiority of metreurynters as the balloon device for obstetric hemorrhage.

Methods: Medical charts of all patients with obstetric hemorrhage of more than 1,000 ml who underwent balloon tamponade with metreurynters were retrospectively reviewed for five years at a tertiary referral university hospital.

Results: A total of 89 uterine balloon tamponade cases were identified from medical records. Of these, 66 cases involved term postpartum hemorrhage (PPH) within 24 h after delivery (PPH group) and 23 involved other types of cases (other group), including cesarean scar pregnancy, cervical pregnancy, retained placenta, and others. In the PPH group, the average hemostasis rate was 93.9%, whereas the rate was 91.3% in the other group. Seven cases failed to achieve hemostasis with balloon tamponade only and required additional treatment. There were no adverse events related to balloon tamponade using metreurynters.

Conclusions: Metreurynters used for balloon tamponade were non-inferior to Bakri balloons in hemostasis and complication rates, suggesting they are effective and appropriate for the management of obstetrical hemorrhage.