Aim: Vaginal environment is an important factor in predicting threatened abortion and premature rupture of membranes (PROM) in early pregnancy. Vaginal human β-defensin-2 (HBD-2), a main antimicrobial peptide associated with innate immunity, plays multiple roles to protect the lower genital tract from microbes. This study aimed to assess the usefulness of vaginal HBD-2 as a biochemical marker for monitoring the vaginal environment in pregnant women.
Methods: Twenty-eight pregnant women were enrolled in this study. Vaginal secretion samples were collected to determine Nugent scores, and vaginal washing fluid (4 ml saline) was used to measure HBD-2 levels by ELISA.
Results: In the first trimester, vaginal HBD-2 levels were significantly lower in patients with bacterial vaginosis (BV) (42.1±19.8 pg/ml) compared to those without BV (350.1±68.7 pg/ml, P<0.05), and in patients with PROM (57.2±31.9 pg/ml) compared to those without PROM (375.9±69.4 pg/ml, P<0.05).
Conclusions: Low vaginal HBD-2 levels during early pregnancy suggest a poor vaginal environment and the possibility of developing PROM.
Neuraxial anesthesia is a gold standard anesthetic technique employed for labor analgesia and cesarean section. Spinal cord injury can occur if the needle insertion is performed above the recommended lumbar spine level. Pre-procedural lumbar spine ultrasound scanning can provide several benefits, such as increasing first attempt success rate, reducing the number of attempts, and reducing redirection of the needle.
Pulmonary aspiration during general anesthesia is a fatal complication which remains a cause of maternal mortality. Gastric content volume (GCV) is an important component related to the risk of regurgitation followed by aspiration. There is growing interest in the utility of bedside gastric ultrasound to assess GCV in non-obstetric and obstetric populations.
This review discusses trends in mode of breech delivery in Japan. Recently, primary elective cesarean delivery rates for singleton breech pregnancies have markedly increased due to medical counseling and maternal requests. However, breech extraction skills should be preserved and passed on to future generations of obstetricians. Vaginal breech delivery may be considered if well-trained and full-time medical staff with experience performing breech deliveries are available and comprehensive informed consent is obtained. As specialists of obstetrics and gynecology, it may be necessary to acquire rudimentary techniques for vaginal breech delivery in order to perform fair and objective informed consent procedures regarding the mode of breech delivery.