論文 - 桂木 真司
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Maternal Death Due to Pulmonary Arterial Hypertension ― A Nationwide Survey in Japan ― 査読あり
Aoki-Kamiya C., Katsuragi S., Shiina Y., Hasegawa J., Yoshimatsu J., Nakai A., Ishiwata I., Sekizawa A., Ikeda T.
Circulation Journal 89 ( 1 ) 77 - 82 2024年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Circulation Journal
Background: With advances in treatment, the prognosis for pregnancies complicated by pulmonary arterial hypertension (PAH) has been improving. However, PAH-related maternal mortality remains high compared with that due to other cardiovascular diseases. The specifics of PAH-related maternal deaths under advanced medical standards are not well understood. Methods and Results: We used the maternal death registration system established by the Japan Association of Obstetricians and Gynecologists and reviewed 6 PAH-related maternal deaths from 2010 to 2022. All women were initially diagnosed with PAH during pregnancy or immediately after childbirth. The diagnosis of PAH tended to be delayed because symptoms were not reported to healthcare providers and/or a different disease was diagnosed. Cardiogenic shock occurred antepartum in 1 woman and during delivery or within 7 days after delivery in the other 5 women. Four women were resuscitated and started on extracorporeal membrane oxygenation. Pulmonary vasodilators were initiated in 4 women, with a median duration of 8 days from PAH diagnosis to starting medication. Right heart failure was the most common cause of maternal death, with a median duration of 16 days from PAH diagnosis to maternal death. Conclusions: All PAH-related maternal deaths occurred in women who were diagnosed with PAH after pregnancy. Diagnosing PAH and initiating pulmonary vasodilators takes considerable time, highlighting the importance of early diagnosis and early treatment.
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Tachycardia-Induced Cardiomyopathy Following Prolonged Ritodrine Infusion During Pregnancy: A Case Report. 査読あり
Nakao M, Izawa M, Takamisawa I, Horiuchi C, Ohmori A, Katsuragi S
Cureus 16 ( 12 ) e76465 2024年12月
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Out-of-pocket fertility preservation expenses: data from a Japanese nationwide multicenter survey 査読あり
Ono M., Takai Y., Harada M., Horie A., Dai Y., Kikuchi E., Miyachi M., Yamamoto T., Fujii N., Kajiyama H., Manabe A., Yasuoka T., Katsuragi S., Mekaru K., Maezawa T., Horage Y., Kataoka S., Nakayama R., Nakajima T.E., Kimura F., Shimizu C., Sugimoto K., Takae S., Yumura Y., Nishi H., Furui T., Morishige K.I., Watanabe C., Osuga Y., Suzuki N.
International Journal of Clinical Oncology 29 ( 12 ) 1959 - 1966 2024年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：International Journal of Clinical Oncology
Background: The expenses related to fertility preservation or subsequent assisted reproductive treatments are significant for adolescents and young adult patients in Japan’s current healthcare system. With fertility preservation becoming more widespread in developed countries, it is expected that these costs will be covered by insurance or subsidies. It is critical for patients, healthcare providers, and the government to know the costs that patients will be responsible for. In Japan, the costs of fertility preservation and subsequent assisted reproductive technology are not covered by insurance, but patients can apply for subsidies from the local and central governments if certain conditions are met. Presently, the above-mentioned costs, as well as the amount paid by the patient, vary by facility. Therefore, it is essential to ensure patients’ continued access to necessary medical care despite the associated costs. Methods: In this study, questionnaires were mailed to 186 certified fertility preservation facilities in Japan to assess patients who had undergone fertility preservation or assisted reproduction. The questionnaires were sent between October 27, 2023 and March 31, 2024, with 140 of the 186 facilities responding (response rate: 75.3%). Results: Our findings show that approximately one-third of the costs was borne by the patients. Conclusion: Given these circumstances, sustainable pricing and insurance coverage are necessary for both patients and facilities.
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Hasegawa J., Sekizawa A., Tanaka H., Katsuragi S., Tanaka K., Nakata M., Hayata E., Murakoshi T., Ishiwata I., Ikeda T.
International Journal of Infectious Diseases 146 2024年9月
掲載種別：研究論文（学術雑誌） 出版者・発行元：International Journal of Infectious Diseases
Objectives: To clarify the infection route in maternal death due to invasive group A streptococcal (GAS) infection and toxic shock syndrome (TSS). Methods: A retrospective study was conducted on maternal deaths due to GAS-TSS in Japan between January 2010 and March 2024. The final causal diagnosis of maternal death and the infection routes of GAS were analysed using medical records, laboratory data and autopsy findings. Results: Among the 616 maternal deaths during the study period, 48 (8%) involved infectious diseases. The most common infection was invasive GAS (56%, n = 27), 21 (78%) and six cases occurred during the antepartum and puerperium periods, respectively. In the GAS-TSS group, 71% (15/21) infections were originated the upper respiratory tract. However, in the puerperium cases, 67% (4/6) were infected from the genital tract. In addition, no maternal deaths due to GAS-TSS were reported during the COVID-19 pandemic period in Japan from 2020 to 2023. Conclusion: Most antepartum GAS infections were from the upper respiratory tract. They may be reduced by preventive measures, including frequent disinfection, wearing masks and isolation from persons at high risk of carrying GAS, such as symptomatic children. On the other hand, GAS-TSS during puerperium infection via the genital tract.
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Relationship between maternal mortality and ritodrine hydrochloride as a tocolytic agent in Japan 査読あり
Nakamura M., Sekizawa A., Hasegawa J., Nakata M., Katsuragi S., Tanaka H., Murakoshi T., Kanayama N., Ishiwata I., Ikeda T.
The journal of obstetrics and gynaecology research 50 ( 7 ) 1111 - 1117 2024年7月
掲載種別：研究論文（学術雑誌） 出版者・発行元：The journal of obstetrics and gynaecology research
AIM: In Japan, unlike Western countries, tocolytic agents are administered in long-term protocols to treat threatened preterm labor. Evaluating the side effects of this practice is crucial. We examined whether ritodrine hydrochloride had been administered in cases of maternal death, aiming to investigate any relationship between ritodrine administration and maternal death. METHODS: This retrospective cohort study used reports of maternal deaths from multiple institutions in Japan between 2010 and 2020. Data on the reported cases were retrospectively analyzed, and data on the route of administration, administered dose, and clinical findings, including causes of maternal death, were extracted. The amount of tocolytic agents was compared between maternal deaths with ritodrine administration and those without. RESULTS: A total of 390 maternal deaths were reported to the Maternal Death Exploratory Committee in Japan during the study period. Ritodrine hydrochloride was administered in 32 of these cases. The frequencies (n) and median doses (range) of oral or intravenous ritodrine hydrochloride were 34.4% (11) and 945 (5-2100) mg and 84.4% (27) and 4032 (50-18 680) mg, respectively. Frequencies of perinatal cardiomyopathy, cerebral hemorrhage, diabetic ketoacidosis, and pulmonary edema as causes of maternal death were significantly higher with ritodrine administration than without it. CONCLUSIONS: Our results suggest a relationship between long-term administration of ritodrine hydrochloride and an increased risk of maternal death due to perinatal cardiomyopathy, cerebral hemorrhage, diabetic ketoacidosis, and pulmonary edema. In cases where ritodrine should be administered to prevent preterm labor, careful management and monitoring of maternal symptoms are required.
DOI： 10.1111/jog.15951
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看護学生における月経随伴症状に関する検討 査読あり
桂木真司
宮崎県医師会医学会誌 48 ( 1 ) 94 - 100 2024年3月
掲載種別：研究論文（学術雑誌）
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過去15年間の宮崎県の分娩数および分娩施設数に関する検討 査読あり
桂木真司
宮崎県医師会医学会誌 48 ( 1 ) 88 - 93 2024年3月
掲載種別：研究論文（学術雑誌）
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骨髄異型性症候群合併妊娠の管理 査読あり
桂木真司
宮崎県医師会医学会誌 48 ( 1 ) 113 - 116 2024年3月
担当区分：責任著者 掲載種別：症例報告
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Enomoto N., Maki S., Nii M., Yamaguchi M., Tamaishi Y., Takakura S., Magawa S., Tanaka K., Tanaka H., Kondo E., Katsuragi S., Ikeda T.
Scientific Reports 13 ( 1 ) 20945 2023年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Scientific Reports
Although digital examination of the cervix is the standard method used worldwide for evaluating the progress of delivery, it is subjective. Transperineal ultrasound (TPU) is combined with digital evaluation for accurate assessment of fetal descent and rotation of the advanced part of the fetus. This retrospective study aimed to clarify the impact of introducing TPU on perinatal outcomes at Mie University Hospital. We analyzed singleton pregnant women who underwent delivery management at our hospital between April 2020 and March 2021. Perinatal outcomes were compared between patients who used TPU (TPU+ group) and those who did not (TPU− group). The angle of progression and head direction were measured. The rate of vaginal delivery was significantly increased (90.9% vs. 71.6%; P = 0.0017), and the second stage of labor was significantly prolonged in the TPU+ group (148.1 vs. 75.8 min; P < 0.0001). A significant difference was observed in termination in the latent phase between the TPU+ group [3/8 (37.5%) cases] and TPU− group [20/25 (80.0%) cases] (P = 0.036). The rate of vaginal delivery can be increased through accurate evaluation of the progress of delivery with TPU.
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High maternal mortality rate associated with advanced maternal age in Japan
Tanaka H., Hasegawa J., Katsuragi S., Tanaka K., Arakaki T., Nakamura M., Hayata E., Nakata M., Murakoshi T., Sekizawa A., Ishiwata I., Ikeda T.
Scientific Reports 13 ( 1 ) 2023年12月
掲載種別：研究論文（学術雑誌） 出版者・発行元：Scientific Reports
This study aimed to clarify the relationship between maternal mortality and advanced maternal age in Japan and to provide useful information for future perinatal management. Maternal death rates by age group were investigated for all maternal deaths in Japan for an 11-year period, from 2010 to 2021. Maternal deaths among those aged ≥ 40 years were examined in detail to determine the cause, and the number of deaths by cause was calculated. The causes of onset of the most common causes of death were also investigated. The maternal mortality rates were 0.8 (95% confidence interval [CI] 0.3–4.7) for < 20 years, 2.6 (95% CI 1.7–3.8) for 20–24 years, 2.9 (95% CI 2.3–3.6) for 25–29 years, 3.9 (95% CI 3.3–4.5) for 30–34 years, 6.8 (95% CI 5.9–7.9) for 35–39 years, and 11.2 (95% CI 8.8–14.3) for ≥ 40 years of age. Patients who were ≥ 40 years of age had a significantly higher mortality rate compared to that in other age groups. Hemorrhagic stroke was the most common cause of death in patients aged ≥ 40 years (15/65 [23%]), and preeclampsia (8/15 [54%]) was the most common cause of hemorrhagic stroke. Maternal mortality is significantly higher in older than in younger pregnant women in Japan, with hemorrhagic stroke being the most common cause of maternal death among women > 40 years of age. More than half of hemorrhagic strokes are associated with hypertension disorder of pregnancy. These facts should be considered by women who become pregnant at an advanced age and by healthcare providers involved in their perinatal care.
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子宮頸癌放射線治療後の照射野内リンパ節再発に対して手術療法を選択した5例
藤﨑 碧, 大西 淳仁, 佐藤 謙成, 大澤 綾子, 圓﨑 夏美, 吉本 望, 川越 靖之, 永井 公洋, 桂木 真司
日本婦人科腫瘍学会雑誌 42 ( 3 ) 285 - 291 2023年10月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：公益社団法人 日本婦人科腫瘍学会
概要：子宮頸癌において初回治療で放射線照射歴のある症例では，再発した場合その場所が照射野内か照射野外かが治療法の選択ならびに予後に重要である．照射野内の再発部位への再照射は，合併症等から限定的であり，その他の有効な治療法が限られるため生存期間が短い．選択される治療法は化学療法が中心であり，近年では免疫チェックポイント阻害薬が有効な薬剤として注目されている．手術療法はあくまでも限定的であり，骨盤除臓術，salvage hysterectomy＋lymphadenectomyやsalvage lymphadenectomyなどが報告されている．骨盤除臓術はある程度の根治性は担保されるものの，患者への侵襲，機能損失が大きい術式であり，限られた症例にのみ適応となる．一方でsalvage hysterectomy＋lymphadenectomy，lymphadenectomyは報告例も少なく，根治性よりもQOLを重視した治療法といえる．今回われわれは，子宮頸癌の照射野内リンパ節再発に対して，腫瘍の摘出のみを目的とする外科的介入を行い，患者への侵襲を軽減しなおかつ良好な結果を得られた5症例を経験したので報告する．
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生後9ヶ月まで生存したThanatophoric dysplasiaの一例 査読あり
桂木真司
宮崎県医師会医学会誌 47 ( 2 ) 186 - 190 2023年9月
担当区分：責任著者 掲載種別：症例報告
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Effects of sturgeon fillet intake on top-ranked Japanese female long-distance runners
Haraguchi N., Nakao H., Sakakibara Y., Tamura H., Nagahama K., Sakurai K., Sameshima H., Schauerte M., Ikenoue T., Katsuragi S.
Journal of Obstetrics and Gynaecology Research 49 ( 8 ) 2164 - 2174 2023年8月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Obstetrics and Gynaecology Research
Aims: The aim of this study is to investigate whether consumption of sturgeon fillets reduces the oxidative stress marker urinary 8-hydroxy-2′-deoxyguanosine (8OHdG) in top-ranked Japanese female long-distance runners. Methods: In a before-and-after study, nine professional long-distance female athletes ate 100 g/day of sturgeon fillets for 2 weeks. Urinalysis (8OHdG, an oxidative stress marker, and creatinine), blood tests (fatty acids and 25-hydroxyvitamin D [25OHD]), exercise intensity, subjective fatigue, muscle elasticity, muscle mass, body fat mass, and nutritional intake using image-based dietary assessment (IBDA) were compared before, immediately after, and 1 month after the intervention. Results: Consumption of sturgeon fillets suppressed 8OHdG (p < 0.05) in the increased exercise intensity female athletes. Eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and 25OHD levels in blood increased from before to immediately after and 1 month after the intervention (p < 0.05). IBDA showed that intake of n-3 fatty acid increased after and one month after the intervention, whereas DHA, imidazole dipeptide and vitamin D intake increased after the intervention (p < 0.05) and then decreased after 1 month (p < 0.05). There were no significant changes in subjective fatigue, muscle elasticity, muscle mass, and body fat. Conclusions: The results suggest that eating sturgeon fillets during intense training may increase blood levels of EPA, DHA, and 25OHD, which may suppress urinary oxidative stress (8OHdG) in top-ranked Japanese long-distance runners.
DOI： 10.1111/jog.15711
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Tanaka H., Hasegawa J., Katsuragi S., Tanaka K., Arakaki T., Nakamura M., Hayata E., Nakata M., Sekizawa A., Ishiwata I., Ikeda T.
Journal of Clinical Medicine 12 ( 8 ) 2023年4月
掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Clinical Medicine
Background: Unlike Europe and the United States, Japan has seen numerous maternal deaths from hemorrhagic strokes related to hypertensive disorders of pregnancy (HDP). This study retrospectively analyzed deaths associated with HDP-related hemorrhagic stroke in Japan to determine the number of deaths that may have been prevented with blood pressure control during pregnancy. Methods: This study included maternal deaths related to hemorrhagic stroke cases. The proportion of patients without proteinuria whose blood pressure exceeded 140/90 mmHg between 14+0 and 33+6 weeks of gestation were determined. Lastly, the application of tight antihypertensive management was evaluated. Results: Among 34 HDP-related maternal deaths, 4 cases involved patients without proteinuria whose blood pressures exceeded 140/90 mmHg between 14+0 and 33+6 weeks of gestation. These included two chronic hypertension and two gestational hypertension cases. None of the patients received antihypertensive agents, and their blood pressures were managed leniently. Conclusion: Among HDP-related hemorrhagic stroke deaths in Japan, only a few cases of maternal death could have been prevented with tight blood pressure management, as described in the CHIPS randomized controlled trial. Therefore, to prevent HDP-related hemorrhagic stroke in Japan, new preventive strategies during pregnancy should be established.
DOI： 10.3390/jcm12082908
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特集 妊産婦死亡の現状と削減に向けた対策 総論 妊娠高血圧症候群に関連した死亡の削減に向けて
桂木 真司
周産期医学 53 ( 3 ) 287 - 293 2023年3月
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Miyoshi T., Maeno Y., Matsuda T., Ito Y., Inamura N., Kim K.S., Shiraishi I., Kurosaki K., Ikeda T., Sago H., Horigome H., Yoda H., Tsukahara S., Teramachi Y., Takahashi K., Toyoshima K., Nakai M., Katsuragi S.
Ultrasound in Obstetrics and Gynecology 61 ( 1 ) 49 - 58 2023年1月
掲載種別：研究論文（学術雑誌） 出版者・発行元：Ultrasound in Obstetrics and Gynecology
Objectives: Although many studies have supported the efficacy of transplacental treatment for fetal supraventricular tachyarrhythmia, the long-term neurodevelopmental outcome after antenatal antiarrhythmic treatment is not well understood. The aim of this study was to investigate the prognosis and neurodevelopmental outcome at 36 months of corrected age and the incidence of tachyarrhythmia after birth, following protocol-defined antenatal therapy for fetal supraventricular tachyarrhythmia. Methods: This was a 3-year follow-up study of a multicenter trial that evaluated the efficacy and safety of protocol-defined transplacental treatment for fetal supraventricular tachycardia (SVT) and atrial flutter (AFL). The primary endpoints were mortality and neurodevelopmental impairment (NDI) at 36 months of corrected age. NDI was defined as any of the following outcomes: cerebral palsy, bilateral blindness, bilateral deafness or neurodevelopmental delay. Neurodevelopmental delay was evaluated using appropriate developmental quotient scales, mainly the Kyoto Scale of Psychological Development, or examination by pediatric neurologists. The detection rate of tachyarrhythmia at birth and at 18 and 36 months of corrected age was also evaluated as the secondary endpoint. In addition, the association of NDI at 36 months with perinatal and postnatal factors was analyzed. Results: Of 50 patients enrolled in the original trial, one withdrew consent and in two there was fetal death, leaving 47 patients available for enrollment in this follow-up study. Of these, 45 cases were available for analysis after two infants were lost to follow-up. The mortality rate was 2.2% (1/45) during a median follow-up of 3.2 (range, 2.1–9.4) years. The infant died at the age of 2.1 years. Another infant had missing neurodevelopmental assessment data. In the remaining 43 infants, at 36 months of corrected age, NDI was detected in 9.3% (4/43) overall and in two of three (66.7%) cases with fetal hydrops with subcutaneous edema. Cerebral palsy was noted in two infants with severe subcutaneous edema or ascites at an early gestational age. Neurodevelopmental delay was found in two infants with severe congenital abnormalities (one with tuberous sclerosis and the other with heterotaxy syndrome). Tachyarrhythmia was present in 31.9% (15/47) cases in the neonatal period and decreased to 8.9% (4/45) and 4.5% (2/44) at 18 and 36 months of corrected age, respectively. The median ventricular rate at diagnosis was significantly higher in infants with NDI compared to those without (265 vs 229 bpm; P = 0.003). In infants with NDI, compared to those without, fetal hydrops with subcutaneous edema at diagnosis was more common (50.0% vs 2.6%; P = 0.019) and the duration of fetal effusion was longer (median, 10.5 vs 0 days; P = 0.013). Postnatal arrhythmia and physical development abnormalities were not associated with NDI. Conclusions: This multicenter 3-year follow-up study is the first to demonstrate the long-term mortality and morbidity of infants born following protocol-defined transplacental treatment for fetal SVT and AFL. NDI was associated with the presence of fetal hydrops with subcutaneous edema at diagnosis and longer duration of fetal effusion. Neurodevelopmental delay was detected only in infants with severe congenital abnormalities. Therefore, in infants that have undergone antenatal treatment for fetal tachyarrhythmia and in which there are no comorbidities, the risk of NDI is low. However, in those with fetal hydrops with subcutaneous edema and/or associated severe congenital abnormalities, the risk for long-term neurologic morbidity might be considered somewhat increased. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
DOI： 10.1002/uog.26113
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ウレアプラズマ肺炎を契機に顕在化した超早産児肺リンパ管拡張症の一例 査読あり
榊原 康平, 山田 直史, 児玉 由紀, 小畑 静, 都築 康恵, 村岡 純輔, 青木 良則, 山下 理絵, 中目 和彦, 金子 政時, 桂木 真司, 都築 諒, 佐藤 勇一郎
日本周産期・新生児医学会雑誌 59 ( 1 ) 116 - 121 2023年
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：一般社団法人 日本周産期・新生児医学会
肺リンパ管拡張症（Pulmonary lymphangiectasia；PL）は肺リンパ管拡張を特徴とし，肺胞拡張障害をきたして重篤な呼吸不全を起こす疾患である．今回，ウレアプラズマ肺炎を契機に呼吸状態が増悪し，剖検でPLと診断された症例を報告する． 症例は超低出生体重児（在胎23週2日，610g，男児）．母体は，妊娠23週1日に胎胞形成，23週2日に経腟分娩となった．児はサーファクタント投与後，安定化した状態で人工呼吸管理を行っていた．日齢15にCRP上昇と肺野の透過性低下が認められた．各種抗菌薬治療では改善なく，日齢30の気管内分泌物ウレアプラズマ培養陽性により，アジスロマイシン水和物を開始した．CRPは著減したが，呼吸不全は悪化して日齢44に死亡した．病理解剖では，肺リンパ管がびまん性に拡張したPLと診断した．臨床的にはウレアプラズマ肺炎を契機に顕在化したPLと考えられた．
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Kawano T., Kawagoe Y., Fujisaki M., Osawa A., Ueno N., Enzaki N., Kawaguchi T., Onishi J., Katsuragi S., Sameshima H.
Internal Medicine 62 ( 4 ) 629 - 632 2023年
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Internal Medicine
We herein report a case of ovarian cancer recurrence detected every time with symptoms of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. A 46-year-old woman who had a history of ovarian cancer 9 months earlier developed joint pain along with pitting edema in both hands and was diagnosed with RS3PE syndrome. Two and four years after initial surgery for ovarian cancer, symptoms of RS3PE syndrome appeared, and a recurrent site was detected. With resection of the relapsed sites and increased maintenance dose of methylprednisolone, these symptoms improved within a month.
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Matsushita T., Arakaki T., Sekizawa A., Hasegawa J., Tanaka H., Katsuragi S., Nakata M., Murakoshi T., Ikeda T., Ishiwata I.
Journal of Maternal-Fetal and Neonatal Medicine 36 ( 1 ) 2175207 2023年
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Maternal-Fetal and Neonatal Medicine
Objective: Cardiovascular disease (CVD) is the leading cause of maternal deaths in high-income countries. This study aimed to assess the characteristics of maternal deaths due to CVDs and the quality of care provided to patients, and to identify elements to improve maternal care in Japan. Methods: This descriptive study used the maternal death registration data of the Maternal Deaths Exploratory Committee of Japan between 2010 and 2019. Results: Of 445 eligible pregnancy-related maternal deaths, 44 (9.9%) were attributed to CVD. The most frequent cause was aortic dissection (18 patients, 40.9%), followed by peripartum cardiomyopathy (8 patients, 18.2%), and pulmonary hypertension (5 patients, 11.4%). In 31.8% of cases, cardiopulmonary arrest occurred within 30 min after initial symptoms. Frequent symptoms included pain (27.3%) and respiratory symptoms (27.3%), with 61.4% having initial symptoms during the prenatal period. 63.6% of the patients had known risk factors, with age ≥35 years (38.6％), hypertensive disorder (15.9%), and obesity (15.9%) being the most common. Quality of care was assessed as suboptimal in 16 (36.4%) patients. Cardiac risk assessment was insufficient in three patients with preexisting cardiac disease, while 13 patients had symptoms and risk factors warranting intensive monitoring and evaluation. Conclusion: Aortic dissection was the leading cause of maternal death due to CVDs. Obstetrics care providers need to be familiar with cardiac risk factors and clinical warning signs that may lead to impending fatal cardiac events. Timely risk assessment, patient awareness, and a multidisciplinary team approach are key to improving maternal care in Japan.
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特集 Controversies in perinatology 2023 産科編 妊娠中の巨大子宮筋腫合併-核出術を行わない
中山 徹男, 桂木 真司
周産期医学 52 ( 12 ) 1689 - 1691 2022年12月