Introduction New-onset systemic lupus erythematosus (SLE) during pregnancy is rare and difficult to diagnose, especially in cases that manifest as preeclampsia. We report a patient with new-onset SLE that manifested as preeclampsia during pregnancy and provide a review of the literature to identify factors for a rapid diagnosis. Case A 32-year-old primigravid Japanese woman was diagnosed with severe preeclampsia and underwent emergent cesarean section at 29 weeks of gestation. Her hypertension and renal disorder gradually improved after the operation, but her thrombocytopenia and anemia worsened. SLE was diagnosed on postoperative day 5 by a comprehensive autoimmune workup. She was discharged on postoperative day 34 with remission. Conclusion Our case and previous reports suggest that distinguishing underlying SLE from preeclampsia in the third trimester is particularly difficult. Helpful factors for diagnosis of suspected SLE in these cases were persistence of symptoms and new atypical symptoms for preeclampsia revealed after delivery (e.g., fever, renal disorder, and thrombocytopenia).

Maternal virilization during pregnancy is rare. This condition may be caused by P450 oxidoreductase (POR) deficiency [1][2][3][4], which is an autosomal recessive genetic disease classified as congenital adrenal hyperplasia. Maternal virilization is associated with skeletal malformations, disorders of adrenal steroid synthesis, abnormal sexual development, and maternal virilization during pregnancy [1,2]. The authors describe a case of POR deficiency with maternal virilization during pregnancy. Case ReportA 24-year-old primigravida with a spontaneous pregnancy was referred to the present hospital with a positive pregnancy test. Her personal and family histories were unremarkable. The expected delivery date was calculated from the fetal crown-rump length at ten weeks' gestation, based on transvaginal ultrasonography. The woman was followed up at our hospital. Deepening voice and hirsutism started to develop in the second trimester and were worse at 38 weeks' gestation. Maternal virilization is generally caused by POR deficiency, aromatase deficiency, luteoma, or Sertoli-stromal cell tumors. Female fetuses are more severely affected by maternal virilization than male fetuses. However, prenatal ultrasonography failed to detect any anomaly or determine the sex in the current case. The patient adopted a wait-and-see approach, but the present authors also consulted pediatricians in their hospital because of the possibility of the above-mentioned diseases. They explained the possibility of POR deficiency to the patient, but noted that it was difficult to make an accurate diagnosis based on diagnostic imag-ing alone. They suggested performing a genetic diagnosis by aspiration of umbilical blood and explained the potential risks of this procedure, but the patient declined and insisted that she wanted to deliver at the present hospital, even in the event of fetal anomalies. Measurement of serum androgen levels could aid diagnosis with no risk to the fetus. Although the current patient declined to undergo this blood test, it should be considered in future cases. The estimated fetal body weight was 2,795 g (+0.66 SD) at 36 weeks' gestation, which was within the normal range. No abnormalities were detected prior to birth. Delivery was induced at 41 weeks and one day of gestation because of prolonged pregnancy, but an emergency caesarean section was performed because of arrested delivery. The neonate weighed 3,245 g with Apgar scores of 8 and 9 after one and five minutes, respectively. The neonate was diagnosed as female by transabdominal ultrasonography, based on the presence of clitoromegaly and a uterus. Abnormalities including craniosynostosis, joint contractures, arachnodactyly, vesicoureteric reflux, rhinopharyngeal stenosis, an abnormal foot shape, and cephalic angioma were detected at the same time. POR deficiency was suspected from maternal virilization, as indicated by her deepening voice and hirsutism, and the physical findings of the neonate (Figure 1A, B).Mutational analysis of the POR gene demonstrated heterozygo...

In cases of fetal heartbeat- (FHB-) positive cesarean scar pregnancy (CSP), the embryo and placenta grow rapidly week by week. We experienced an FHB-positive CSP case at 6 weeks of gestation and assessed the CSP in detail with transvaginal ultrasound and transabdominal ultrasound (TAUS), preoperatively. We performed Laminaria cervical dilatation under TAUS guidance and performed hysteroscopic resection of the pregnancy conceptus and curettage under hysteroscopic and TAUS guidance. We identified the gestational sac attached to the cesarean scar pouch with small plane, decidua basalis, and chorionic villi and present the clinical history and other findings. We also reviewed the related literature and found 76 previous studies, with six cases of FHB-positive CSP that contained hysteroscopic color images of the CSP. We present a review of selected cases. The implantation site was the anterior wall in almost all cases. Cervical dilatation was mainly performed using a Hegar dilator; ours was the only case using Laminaria dilatation. Transcervical resections were performed mainly under ultrasound guidance, with only one case undergoing laparoscopy. Electrocoagulation was performed in three of the six cases.

Antiphospholipid antibody syndrome (APS) is an autoimmune disease caused by the persistence of antiphospholipid antibodies. Moreover, there is a significantly increased risk of pregnancy complications in women with APS. The treatment is antithrombotic therapy. However, heparin-induced thrombocytopenia (HIT) is known as a severe complication of heparin utilization. HIT is an autoimmune disease caused by anti-heparin antibodies. Nevertheless, patients with APS frequently receive heparin as treatment for thrombotic events. The authors report a case of a Japanese woman with Sjögren's syndrome (SjS) and deep vein thrombosis who became pregnant following assisted reproduction technology. However, she suffered an intrauterine fetal death associated with HIT.

Objectives: To evaluate the ultrasonic characteristic of Caesarean scar pregnancy in anterior wall of the lower segment of the uterus by transabdominal and transvaginal three dimensional ultrasound and its guiding value for clinical treatment. Methods:The clinical data of 28 CSP diagnosed by transabdominal and transvaginal three dimensional ultrasound were retrospectively analysed. Under transabdominal and transvaginal two-dimensional and three dimensional ultrasound, it can be clearly displayed that the boundary and the relation of spatial relation between gestation sac and Caesarean scar, the thickness of muscle layer and the continuation of the perimetrium in Caesarean scar, the blood distribution of the internal and peripheral gestation sac and the situation of uterine cavity, cervix uteri etc. Results: There were not gestation sacs in uterine cavities of 28 CSP, but it could be seen in Caesarean scares. In terms of ultrasonic characteristics, there were 14 CSP which had the gestation sac only in Caesarean scar, 4 CSP which only had clutter echoic mass in Caesarean scar, 7 CSP which had segmental gestation sac in both Caesarean scar and the other in tuterine cavity, which looked like water drop or eggplant and 3 CSP which had segmental gestation sac in Caesarean scar and the other in cervix uteri, which looked like water drop or eggplant. In all of 28 CSP, the anterior wall of the lower segment of the uterus had a ''wedge'' change. The boundary between gestation sac and Caesarean scar was not clear, while the thickness of muscle layer in Caesarean scar was very thin. The blood flow signals were all concentrated in Caesarean scar and mostly rich. Conclusions:The relationship between gestation sac and Caesarean scar can be more clearly found by transabdominal and transvaginal colour Doppler flow imaging and three dimensional ultrasound which also could make localised and qualitative diagnosis as soon as possible and provide a reliable basis for clinical treatment and judging curative effect.