We report a 32-year-old woman (1-gravid, 1-para) with a vesicular lesion in her uterus that was pointed out on ultrasound at 8 weeks' gestation. Amniocentesis at 15 weeks' gestation showed a normal female karyotype, 46XX. As the pregnancy advanced, the mole-like lesion became relatively reduced. Throughout gestation, the maternal human chorionic gonadotropin level was normal, but the serum alpha fetoprotein level rose as her pregnancy progressed. Her fetus did not exhibit any remarkable anomalies. The patient visited our hospital complaining of a diminished feeling of fetal movements at 36 weeks 5 days' gestation, and intrauterine fetal death (IUFD) was confirmed. She delivered a 2336-g female without any definite anomalies. A pathological examination led to a diagnosis of placental mesenchymal dysplasia, and androgenetic/biparental mosaicism in the placenta was identified using p57^kip2 immunohistochemical staining. And it also revealed that the rupture of the cirsoid chorionic vessels had led to IUFD. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1030203924510721.

Introduction: Some pregnant women develop significant proteinuria in the absence of hypertension. However, clinical significance of isolated gestational proteinuria (IGP) is not well understood. This study aimed to determine the prevalence of IGP in singleton pregnancies and the proportion of women with IGP who subsequently developed preeclampsia (IGP‐PE) among all PE cases.Material and methods: This was an observational study of 6819 women with singleton pregnancies at 12 centers, including 938 women with at least once determination of protein‐to‐creatinine ratio (P/Cr). Significant proteinuria in pregnancy (SPIP) was defined as P/Cr (mg/mg) level >0.27. IGP was defined as SPIP in the absence of hypertension. Gestational hypertension (GH) preceding preeclampsia (GH‐PE) was defined as preeclampsia (PE) in which GH preceded SPIP. Simultaneous PE (S‐PE) was defined as PE in which both SPIP and hypertension occurred simultaneously.Results: IGP and PE were diagnosed in 130 (1.9%) and 158 (2.3%) of 6819 women, respectively. Of 130 women with IGP, 32 (25%) progressed to PE and accounted for 20% of all women with PE. Hence, women with IGP had a relative risk of 13.1 (95% CI; 9.2–18.5) for developing PE compared with those without IGP [25% (32/130) vs. 1.9% (126/6689)]. At diagnosis of SPIP, P/Cr levels already exceeded 1.0 more often in women with S‐PE than in those with IGP‐PE [67% (33/49) vs. 44% (14/32), respectively, p = 0.031].Conclusions: IGP is a risk factor for PE, and IGP‐PE accounts for a considerable proportion (20%) of all PE.

It is undetermined which blood variables related to iron storage during the first trimester of pregnancy could efficiently predict anemia occurring during the third trimester. Red blood cell count (RBC), hemoglobin concentration, hematocrit, ferritin, iron, and total iron binding capacity (TIBC) were assessed longitudinally during the first, second, and third trimesters of 231 healthy Japanese women. None of the patients had anemia in the first trimester and none used iron supplementation before the second trimester blood test. Anemia was defined as hemoglobin (Hb) < 11 g/dL for the first trimester and Hb < 10.0 g/dL for the third trimester. Forty-seven (20%) women developed anemia in the third trimester. The first trimester RBC, Hb, hematocrit, and ferritin levels were significantly lower in women with third-trimester anemia than those without anemia. The first trimester hemoglobin level exhibited a greater area under the curve of the receiver operating characteristic curve for prediction of the third trimester anemia than other blood variables; the optimal cut-off (12.6 g/dL) of hemoglobin yielded a sensitivity of 83% (39/47). First trimester hemoglobin levels were significantly better predictors of anemia during the third trimester than the indices of iron storage, including serum iron, ferritin, and TIBC levels.

Problem: Enhanced secretion of type-2 T-helper (Th2) cytokine is a characteristic feature in normal physiological pregnancy. A study has demonstrated defective production of interleukine-4 (IL-4) and other Th2 cytokine in women with recurrent pregnancy loss (RPL). Several studies have suggested that IL-4 variable number of tandem repeat (VNTR) gene polymorphism is probably associated with different IL-4 production. Methods of study: The IL-4 VNTR genotypes were assessed in 109 Japanese women with RPL and 210 ethnically matched women experiencing at least one live birth and no spontaneous abortion. Results: No significant differences in IL-4 VNTR genotype frequencies were found between the RPL and the control [B1B1 genotype (reference); B1/B2 and B2/B2 genotypes, odds ratio, 0.91; 95% confidence interval, 0.58–1.45]. Conclusion: The present study suggests that the IL-4 VNTR allele is not a major genetic regulator in RPL.