Amniotic fluid α-fetoprotein (AFP) values were measured in 241 patients who underwent amniocentesis at the hospital of Hyogo College of Medicine from January, 1980 to January, 1988. The normal range of amniotic fluid AFP values at 16 to 20 weeks of gestation was defined in 118 pregnant women who subsequently delivered normal infants. The mean±standard deviation values were as follows : 1.7±0.4 mg/dl at 16 weeks (26 pregnancies), 1.5±0.4 mg/dl at 17 weeks (34 pregnancies), 1.3±0.3 mg/dl at 18 weeks (33 pregnancies), 1.2±0.2 mg/dl at 19 weeks (19 pregnancies) and 1.1± 0.4 mg/dl at 20 weeks (4 pregnancies).
The values in two cases of anencephalus were markedly elevated above the normal range, 30 mg/ dl and 50, 000 mg/dl. However, in patients with toxemia, premature labor or deliveries of immature infants or abnormal infants with omphalocele, arthogryposis or chromosomal anomalies, the amniotic fluid AFP values were within the normal range.
These results suggest that the assessment of amniotic fluid AFP in the 2 nd trimester of pregnancy is of predictive value the prenatal diagnosis of neural tube defect but is less predictive of other fetal abnormalities.

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Undrstanding the hemoglobin switching regulation mechanism in extremely premature infants is particularly important understanding the extrauterine adaptation of the infants. In this study, we sought to identify factors influencing oxygen affinity in fetal bood and neonatal blood and obtained these results.
(1) Developmental aging is required for hemoglobin switching. The Hb F level was 91.3 % until the 26 th gestational week, but it gradully dropped to 72.8 % by the 38 th week.
(2) Switching in premature infants (27 to 32 weeks) is delayed at least two weeks in comparison with full-term infants. In premature infants, 2, 3-DPG rises rapidly immediately after birth, changing oxygen affinity and adapting Hb F to a high oxygen environment.
(3) A delay in the switching of fetal hemoglobin to adult hemoglobin was confirmed in IUGR (intrauterine growth retardation) intants. However, there is a compensatory increase in 2, 3-DPG for adaptation after birth.
(4) A delay in 2, 3-DPG increase was observed in RDS (respiratory distress syndrome) infants, and oxygen affinity remained high.

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The influence of neonatal and fetal asphyxia on the energy metabolism in the brain was studied by analyzing NADH (nicotinamide adenine dinucleotide hydroxine) fluorescence evoked by ultraviolet light in cross sections of frozen rabbit brains.
In the cortex, hypocampus, thalamus, pons, and medulla, very bright fluorescence was seen in stable newborns with heart rates>140bpm. This phenomenon suggested abundant NADH accumulation in these areas.
With the exception of the cortex and hypocampus, the same tendency was seen on in stable fetuses (HR>140 bpm).
However, in newborns with asphyxia induced by N₂O inhalation (HR<70 bpm), the brightness of the fluorescence increased more and more in all areas of cross sections of the brain as the duration of asphyxia or of bradycardia was prolonged, especially in the cortex, hypocampus, thalamus, pons, and medulla.
In fetuses with asphyxia (HR<70 bpm) caused by maternal hypoxia (inhalation by pregnant rabbits of N₂O with 5-12% O₂), the pattern of fluorescence was similar to that in asphyxiated newborns, but it was not so bright.

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A clinicopathologic study was carried out on three cases of primary ovarian malignant tumors, probably arising from the cells of external endometriosis. Every tumor had components of benign endometriosis beside the malignant tumors.
Case 1 : Endometrioid carcinoma with other components originating from the Mülerian duct; endometriosis, adenoacanthoma, clear cell carcinoma and adenocarcinoma whichmimics cervical adenocarcinoma of the uterus.
Case 2 : Endometrioid carcinoma with endometriosis and clear cell carcinoma.
Case 3 : Endometrioid stromal sarcoma with endometriosis.
These tumors of the ovary are probably arising from malignant transformation of the external endometriosis. But the admixture of many components originating from the Müllerian duct is suspect that external endometriosis and the accompanying malignant tumors are originating from the metaplasia of Müllerian-oriented celom-associated cells.

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When myomectomy is indicated and blood loss is expected to be large because of enuclation of large and multiple intramural myomatas and repairing the enuclated muscular cavities, we have performed hemostasis by bilaterally clamping the uterine artery and the infundibulopelvic ligament with arterial or vascular clamps. As the hemostatic method, the broad ligament between the round ligament and the infundibulopelvic ligament was cut 3-4 cm in length and the retroperitoneal space was opened to visualize the uterine artery. The uterine artery was separated from the interstitial tissues at the proximal portion of branching part from the internal iliac artery and held with teflon tape. The same technique was carried out on the contralateral side. The uterine artery and the infundibulopelvic ligament were clamped with Diefenbach's arterial clamps and Satinskey's vascular clamps, respectively.
Five patients with primary and secondary sterility underwent myomectomy with the hemostaic method. The weight of the enuclated myomatas ranged from 200 g to 655 g (mean, 364 g). The mean blood loss was 216 ml. The mean duration of operation was 1hr and 56 min with the mean period of 28.8 min for hemostasis.
This hemostatic method is safe and may be useful for extensive myomectomy as well as uteroplastic surgery for congenital anomalies of the uterus.

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A retrospective analysis of abruptio placentae in the Hospital of Hyogo College of Medicine was performed. There were 45 cases of abruprio placentae in 7141 deliveries, an incidence of 0.63 % over the past 15 years from January 1, 1974 through April 31, 1989. The average age of the patients was 31.2±9.6 years (21 to 41 years). In 25 of these patients (55.6 %) abruptio placentae occurred at 33 to 38 week of gestation. Risk factors were recognized in 28 cases (62.2 %) : hypertension of pregnancy (20 cases), uterus bicornis (5 cases), polyhydramnios (2 cases) and external trauma (1 case). The most common clinical symptom was abdominal pain, which was present in 43 (95.6 %) of the patients. Vaginal bleeding was noted in 31 (68.9 %), fetal distress in 23 (51.1 %), tonic uterine contraction in 22 (48.9 %) and intrauterine fetal death in 14 (31.1 %) at the time of admission. Bloody amniotic fluid was noted in 22 (48.9 %) of the 45 patients and bloody ascitic fluid in 18 (60 %) of the 30 patients who were delivered by caesarean section. The diagnosis of abruptio placentae was made antenatally in 28 (62.2 %) of the 45 patients and confirmed at delivery in the other 17 of the 30 (66.7 %) delivered by caesarean section : the diagnosis was abruptio placentae in 27 and fetal distress in three. The other 15 patients were delivered vaginally.
The perinatal mortality of abruptio placentae was 55.6 % (25/45) which represents 15 % of the 168 perinatal deaths during the period. There were 14 intrauterine fetal deaths before admission, eight stillbirths after admission, and three neonatal deaths.
The risk factors responsible for perinatal mortality due to abruptio placentae were analyzed. Perinatal death was significantly associated with tonic uterine contraction, bloody amniotic fluid, bloody ascitic fluid, more than 1000 ml of external hemorrhage, retroplacental echo-free space in real-time sonography, abruption of more than 50 % of placenta confirmed after delivery, posible ABO incompatibility and prenatal care in another hospital before the occurrence of abruptio placentae.
Maternal complications appeared in 35 (77.8 %) of the 45 patients : anemia in 35, uteroplacental apoplexy in 16, DIC in 13, shock in five, thrombophlebitis in there, acute renal falure in two and endomyometritis in one. One patient who had severe hypertension during pregnancy before abruptio placentae and who was admitted to our hospital with the diagnosis of abruptio placentae complicated by DIC died of cerewbral hemorrhage. Early treatment for hypertension in pregnancy is very important to prevent maternal death due to abruptio placentae.

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Placental alkaline phospatese (P-ALP) is a glycoprotein hormone expressed mainly in term placenta. However, it has been recently reported that this hormone can also be detected in the serum of patients with gynecologic malignancies.
Here, we have utilize a P-ALP cDNA specific probe to detect P-ALP mRNA exprssion in an ovarian cancer case where serum P-ALP level was elevated. The result of this experiment showed that P-ALP mRNA species roughly equivalent in size to that of P-ALP mRNA in term placenta was produced by this ovarian cancer tissue. This finding suggests that ectopic P-ALP found in the serum of patients with gynecologic malignancies are produced locally by these tissue.

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