Chapters authored
Management of Placenta Accreta in Pregnancy with Placenta Previa
Placenta accreta is a life-threatening obstetrical condition. Prenatal prediction of placenta accreta helps to minimize clinical complications. Placenta previa is one of the most important factors associated with placenta accreta. In our prospective cohort study, ultrasound finding of loss of the retroplacental hypoechoic clear zone was found to be a single predictor of placenta accreta in women with placenta previa (odds ratio, 15.6; 95% confidence interval, 2.1–114.6; p < 0.01). In addition, we have devised a novel scoring system for predicting placenta accreta in pregnancy with placenta previa, yielding 91.3% sensitivity, 98.0% specificity, 87.5% positive predictive value, and 98.7% negative predictive value. Planned preterm cesarean hysterectomy with the placenta left in situ is generally recommended for women with suspicion of placenta accreta. If the women have a desire for future fertility, conservative approach may be considered.
Part of the book: Placenta
A Novel Autoantibody against β2-Glycoprotein I/HLA Class II Complexes in Antiphospholipid Syndrome
We have found that a novel autoantibody against β2-glycoprotein I (β2GPI)/human leukocyte antigen (HLA) class II complexes (anti-β2GPI/HLA-DR) is involved in the pathogenesis of antiphospholipid syndrome (APS). It was also found that many APS patients who were negative for conventional antiphospholipid antibodies (aPLs) possessed anti-β2GPI/HLA-DR. These results suggested that anti-β2GPI/HLA-DR measurements may be more sensitive for diagnosing APS than conventional aPLs tests. Recurrent pregnancy loss (RPL) is one of the clinical manifestations of APS. Therefore, a prospective, multicenter, cross-sectional study were conducted to assess whether anti-β2GPI/HLA-DR is also associated with RPL. This study of 227 couples with RPL revealed that 22.9% (52/227) of RPL women tested positive for anti-β2GPI/HLA-DR, and 24 (19.8%) of the 121 couples with unexplained RPL tested positive for anti-β2GPI/HLA-DR. Interestingly, thirty-five of the 52 (67.3%) RPL patients who were positive for anti-β2GPI/HLA-DR possessed no conventional aPLs of criteria. This novel autoantibody against β2GPI/HLA class II complexes may be a major risk factor for RPL, and it may be a promising biomarker for diagnosing APS.
Part of the book: Antiphospholipid Syndrome