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OBJECTIVE: Cesarean delivery at a preterm gestational age has been related to maternal complications such as bleeding and infection. However, previous reports are conflicting, and there is no consensus on the matter. We aimed to clarify the adverse effect of preterm cesarean delivery with an emphasis on maternal bleeding. STUDY DESIGN: We conducted a retrospective study comparing the frequency of maternal adverse outcome between preterm emergency cesarean delivery and term emergency cesarean delivery. Nine hundred and forty seven preterm cases and 1056 full-term cases were included in the study. We analyzed the frequency of abnormal bleeding defined as 1500 mL or more as primary outcome, blood transfusion rate, and rate of postoperative administration of antibiotics as secondary outcome. Logistic regression analysis was performed for confounding variables; age at delivery, primiparity, obesity, prior history of uterine surgery, abnormal placental position, abnormal glucose tolerance, hypertension during pregnancy, early rupture of membranes, and general anesthesia use during operation. As secondary analysis, to study the effects of method of incision, we compared adverse outcomes among classical cesarean delivery, inverted T incision, and upper segment incision within preterm emergency cesarean delivery. RESULTS: Preterm cesarean delivery had significantly higher rates of abnormal bleeding, transfusion and use of antibiotics than term cesarean delivery. Among the preterm delivery, classical incision was related to increased rate of blood transfusion and need for antibiotic treatment. CONCLUSION: Preterm cesarean delivery increases the risk of maternal bleeding. This should be considered especially in the setting of early preterm birth.

DOI： 10.1016/j.ejogrb.2018.12.033

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OBJECTIVES: To investigate the effect of chronic hypertension on expectant management for preeclampsia (PE). STUDY DESIGN: Pregnant women who were diagnosed with severe PE before 34 weeks of gestation between 2005 and 2016 and managed at a tertiary center were the subjects of the study. Mothers were classified into two groups: a severe superimposed PE (SSP) group and a severe PE (SP) group. We compared the groups in terms of perinatal outcomes. MAIN OUTCOME MEASURES: Pregnancy prolongation from the diagnosis of severe PE to delivery. RESULTS: The SSP group included 30 women whereas the SP group included 79 women. Expectant management could be performed in 24 subjects (80.0%) in the SSP group and 49 (62.0%) in the SP group (P = 0.110). Gestational age at diagnosis of PE (P = 0.016) and gestational age at delivery (P = 0.031) were significantly lower in the SSP group than in the SP group. There were no significant differences between the groups in terms of pregnancy prolongation (SSP, 8.5 days versus SP, 6.0 days; P = 0.25) or maternal and neonatal complications. CONCLUSIONS: Compared to severe PE, severe PE superimposed on chronic hypertension does not increase the prevalence of maternal complications, and an equivalent pregnancy prolongation was obtained. Expectant management was possible in severe superimposed PE on chronic hypertension, as it was in severe PE.

DOI： 10.1016/j.preghy.2019.01.007

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A 35-year-old primiparous woman was diagnosed with Turner syndrome at the age of 12 yr due to short stature. Her karyotype showed a mosaic pattern [45, X(19)/46, XX(11)]. She had been followed up by the pediatric service. GH was not prescribed because, although she was of relatively short stature, her growth trajectory was reasonable. She was started on estrogen replacement therapy at 15 yr of age and switched to Kaufmann therapy after 1 yr. After transitioning her care to the gynecology service at 20 yr of age, she was screened for complications and Kaufmann therapy was continued. No abnormalities were detected in the pre-pregnancy screening. She conceived by in vitro fertilization and embryo transplantation with oocyte donation. No severe complications occurred during gestation, and she gave birth to a female neonate vaginally at 41 wk and 6 d of gestation. The neonate's birthweight was 3166 g, and her Apgar scores were 8 and 9 at 1 and 5 min, respectively. No severe complications occurred during the postpartum period. Comprehensive medical treatment and appropriate transition from pediatric to adult services may improve the pregnancy outcomes of women with Turner syndrome.

DOI： 10.1297/cpe.28.37

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Genital ulcer is one of the main clinical symptoms of Behçet disease; ulcers mostly occur in the vulva and are usually quite painful. We present an unusual case of Behçet disease wherein a painless genital ulcer was localized in the vagina. Our case is of a 43-year-old woman diagnosed with Behçet disease that was controlled with prednisolone. She became pregnant and developed fever, oral ulcers, and arthralgia at 16 weeks of gestation. Although a relapse of Behçet disease was suspected, ulceration and pain of the vulva were not observed. At 18 and 28 weeks of gestation, a vaginal ulcer was observed during regular prenatal examination, but the patient had no pain or other symptoms in the vulva. The vaginal ulcer healed at 29 weeks of gestation. No recurrence of the vaginal ulcer and other symptoms of Behçet disease were seen on subsequent follow-up examination at 1 month after delivery. Although genital ulcers of Behçet disease are common in the vulva and are generally painful, if they are located in the vagina, they can be painless. If Behçet disease is suspected based on other symptoms, a vaginal examination should be conducted as necessary for accurate evaluation of Behçet disease.

DOI： 10.1155/2019/2953676

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DOI： 10.1371/journal.pone.0206160

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DOI： 10.1016/j.diabres.2018.03.048

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We aimed to determine the optimal gestational weight gain (GWG) in Japanese women with a Body Mass Index (BMI) ≥25 kg/m2. The present retrospective study investigated singleton pregnancies in 6,781 Japanese women registered in the Japan Society of Obstetrics and Gynecology system in 2013. We divided overweight and obese women into four GWG categories based on the Institute of Medicine (IOM) recommended: weight loss, small weight gain, within IOM criteria, and above IOM criteria. The adjusted odds ratios and predicted probabilities of maternal and neonatal outcomes of interest with weight change were calculated. In overweight women, GWG was associated with neonatal birth weight. In the loss and small gain subgroups, there was a significant increase in small for gestational age (SGA) and low birth weight neonates (LBW). Predicted probabilities showed the lowest risk was observed in a weight gain of 0 kg; the risk sharply increased at a gain of 11.5 kg. In obese women, weight gain increased the prevalence of large for gestational age (LGA) neonates; however; SGA was not associated with GWG. Predicted probabilities showed an increase in the risk with weight gain. The observed optimal GWG was 0 to 11.5 kg in overweight, and weight loss in obese, pregnant Japanese women.

DOI： 10.1507/endocrj.EJ18-0027

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DOI： 10.1080/14767058.2017.1371130

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ObjectiveTo compare the efficacy and safety of hygroscopic dilators and balloon catheters for ripening of the cervix in induction of labor.Study designThis retrospective, observational study used data from the Successive Pregnancy Birth Registry System of the Japan Society of Obstetrics and Gynecology from 2012 to 2014. Nulliparous women in whom labor was induced by mechanical methods of cervical ripening at term were enrolled. The eligible women were divided into dilator, balloon <40 mL, balloon. 40 mL, and overlapping groups.ResultsThe groups included 4645, 4100, 6615, and 1992 women, respectively. In the overlapping group, which included the women in whom delivery was most difficult, the vaginal delivery rate was lower and the intrauterine infection and neonatal mortality rates were higher than those in the dilator group. No difference in the vaginal delivery rate was observed among the dilator, balloon <40 mL, and balloon. 40 mL groups (74.6%, 72.3%, and 73.8%, respectively; p>0.05). The vaginal instrumental delivery rate was higher in the two-balloon groups than in the dilator group. The volume of intrapartum hemorrhage was lowest in the dilator group. No significant difference in the frequencies of uterine rupture and intrauterine infection were observed among the dilator and two-balloon groups. With regard to neonatal outcomes, the frequency of a low Apgar score was statistically significantly lower in the dilator group than in the two-balloon groups. Moreover, the frequency of neonatal death tended to be lower in the dilator group than in the two-balloon groups.ConclusionWith regard to cervical ripening for labor induction in nulliparous women at term, the vaginal delivery rate on using a dilator and on using a balloon seems to be equivalent. Concerning maternal complications and neonatal outcomes, cervical ripening with hygroscopic dilators in labor induction might be safer.

DOI： 10.1371/journal.pone.0189665

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Expectant management of fetal death complicated by placenta previa occurring during midtrimester trimester may induce fetal/placental atrophy and decrease uterine blood flow to facilitate vaginal delivery. Our experience with these cases suggests that about 4 weeks of expectant management should be considered as a management strategy.

DOI： 10.1002/ccr3.1012

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Background and AimLiver dysfunction with decreased antithrombin (AT) activity and/or thrombocytopenia is life threatening in pregnant women. Whether AT is clinically useful for prediction of liver dysfunction remains unclear.
MethodsA total of 541 women were registered prospectively at gestational week 34.7 (20.0-41.4) with available data on antenatal AT and platelet count (PLC).
ResultsLiver dysfunction defined as serum aspartate aminotransferase&gt;45IU/L concomitant with lactate dehydrogenase&gt;400IU/L occurred in five women antenatally (2weeks before delivery) and in 17 women post-partum (within 1week post-partum). Median (5th-95th) antenatal value was 85 (62-110)% for AT and 202 (118-315)x10(9)/L for PLC in the 541 women and was significantly lower in women with than without perinatal liver dysfunction; 75 (51-108) versus 86 (62-110)% and 179 (56-244) versus 203 (121-316)x10(9)/L, respectively. Nineteen (86%) women with liver dysfunction showed AT62% or thrombocytopenia (PLC118x10(9)/L) perinatally, but five lacked thrombocytopenia throughout the perinatal period. The best cut-off (AT, 77%; PLC, 139x10(9)/L) suggested by receiver operating characteristic curve gave antenatal AT and PLC sensitivity of 59% and 41% with positive predictive value of 8.6% and 14%, respectively, and combined use of AT and PLC improved sensitivity to 73% (16/22) with positive predictive value of 9.2% for prediction of perinatal liver dysfunction.
ConclusionsReduced AT not accompanied by thrombocytopenia can precede liver dysfunction. Clinical introduction of AT may enhance the safety of pregnant women.

DOI： 10.1111/jgh.13714

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Objective: To investigate the incidence and pregnancy outcomes of superimposed preeclampsia (PE) with or without proteinuria among women with chronic hypertension.
Methods: This retrospective study included 142 women with essential hypertension diagnosed at 620 weeks of gestation, managed at a tertiary center. They were divided into three groups (non-PE, PE with proteinuria, and PE without proteinuria) to compare pregnancy outcomes. The non-PE group was further divided into two subgroups (controlled and uncontrolled hypertension).
Results: There were 87 women in the non-PE group, 47 in the PE with proteinuria group, and 8 in the PE without proteinuria group. Median gestational age at delivery was 38.7 weeks in the non-PE group, 30.4 in the PE with proteinuria group, and 28.4 in the PE without proteinuria group. In three of the women in the PE without proteinuria group, the diagnostic criteria were fulfilled by liver involvement (complicated by thrombocytopenia in one woman). The remaining five women had uteroplacental dysfunction. The 87 women in the non- PE group were divided into a controlled hypertension subgroup of 75 women and uncontrolled hypertension subgroup of 12. The median gestational age at delivery was 39.1 weeks in the controlled HT subgroup and 34.1 weeks in the uncontrolled hypertension subgroup. The pregnancy outcomes were significantly poorer in the latter group.
Conclusion: Pregnancy outcomes were unfavorable in both the PE without proteinuria and PE with proteinuria groups. Women with non-PE uncontrolled hypertension also had poor pregnancy outcomes, although their outcomes were better than those of women with PE. (C) 2017 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.

DOI： 10.1016/j.preghy.2017.01.001

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Although it is widely accepted that uterine artery embolization (UAE) is an effective therapeutic strategy for postpartum hemorrhage (PPH), no consensus has been reached regarding the efficacy of UAE in patients with PPH with disseminated intravascular coagulation (DIC). This single-center retrospective cohort study included patients treated with UAE using NBCA for PPH between 2010 and 2015. The patients were divided into DIC and non-DIC groups, according to the obstetrical DIC score and the overt DIC diagnostic criteria issued by the International Society of Thrombosis and Haemostasis (ISTH), and their clinical outcomes were compared. There were 28 patients treated with UAE using NBCA. Complete hemostasis was achieved by UAE in 19 of 28 patients. In eight of nine patients with unsuccessful hemostasis, surgical hemostatic interventions were performed after UAE, and hemostasis was achieved in seven patients. UAE using NBCA showed no significant intergroup differences in complete hemostasis according to the presence or absence of DIC based on obstetrical DIC score (70% versus 62.5%, P = 1.000) or ISTH DIC score (54.5% versus 76.5%, P = 0.409). UAE using NBCA may be a useful first-choice treatment for PPH with DIC.

DOI： 10.1155/2017/1562432

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Expectant management leads to successful vaginal delivery following intrauterine fetal death in a woman with an incarcerated uterus. Management of intrauterine fetal death in the second or third trimester of pregnancy in women with an incarcerated uterus is challenging. We report a case of successful vaginal delivery following intrauterine fetal death by expectant management in a woman with an incarcerated uterus. In cases of intrauterine fetal death in women with an incarcerated uterus, vaginal delivery may be possible if the incarceration is successfully reduced. If the reduction is impossible, expectant management can reduce uterine retroversion, thereby leading to spontaneous reduction of the incarcerated uterus. Thereafter, vaginal delivery may be possible.

DOI： 10.1155/2017/2635275

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Although pregnancy after transarterial embolization (TAE) has occasionally been reported, gelatin sponge was used as the embolic agent in most of these cases. Reports on the effect of TAE with permanent embolic agents such as N-butyl cyanoacrylate or coil on subsequent pregnancies are rare. We describe placenta accreta associated with difficult hemostasis in two patients who became pregnant after TAE with permanent embolic agents. In pregnancy after TAE with permanent embolic agents, placenta accreta occurs frequently and well-developed collateral vessels are highly likely, resulting in difficult hemostasis. Although the acceptability of pregnancy after TAE with permanent embolic agents is controversial, patients should be informed that pregnancy is extremely high risk.

DOI： 10.1111/jog.13029

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Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with a high prevalence in females of childbearing age. Thus, reproduction in SLE patients is a major concern for clinicians. In the past, SLE patients were advised to defer pregnancy because of poor pregnancy outcomes and fear of SLE flares during pregnancy. Investigations to date show that maternal and fetal risks are higher in females with SLE than in the general population. However, with appropriate management of the disease, sufferers may have a relatively uncomplicated pregnancy course. Factors such as appropriate preconception counseling and medication adjustment, strict disease control prior to pregnancy, intensive surveillance during and after pregnancy by both the obstetrician and rheumatologist, and appropriate interventions when necessary play a key role. This review describes the strategies to improve pregnancy outcomes in SLE patients at different time points in the reproduction cycle (preconception, during pregnancy, and postpartum period) and also details the neonatal concerns.

DOI： 10.2147/IJWH.S90157

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DOI： 10.1002/ccr3.577

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DOI： 10.1002/ccr3.503

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DOI： 10.1002/ccr3.517

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DOI： 10.1002/ccr3.494

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DOI： 10.1002/ccr3.514

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To investigate how umbilical cord length relates to pregnancy outcomes, we retrospectively analyzed data from 89,042 deliveries recorded in the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System. We included term deliveries in which vaginal birth was attempted. Umbilical cord length was categorized into four groups: less than the first percentile, from the first percentile to less than the 10th percentile, from the 10th percentile to less than 25th percentile, and from the 25th percentile to less than the 75th percentile, which constituted the control group. Cord lengths of 33, 43, 48, 63cm corresponded to the first, 10th, 25th, and 75th percentile values of the cord length distribution, respectively. Statistically significant differences were observed in the rate of unplanned cesarean delivery for all three short cord groups compared to control. There was a higher odds ratio for unplanned cesarean delivery as the umbilical cord became shorter.

DOI： 10.3109/15513815.2015.1122126

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OBJECTIVE: To verify whether body mass index (BMI) classification proposed by the Institute of Medicine (IOM) is valid in Japanese women. METHOD: A study was conducted in 97,157 women with singleton pregnancies registered in the Japan Society of Obstetrics and Gynecology (JSOG) Successive Pregnancy Birth Registry System between January 2013 and December 2013, to examine pregnancy outcomes in four groups stratified by pre-pregnancy BMI category according to the 2009 criteria recommended by the Institute of Medicine (IOM). The groups comprised 17,724 underweight women with BMI <18.5, 69,126 normal weight women with BMI 18.5-24.9, 7,502 overweight women with BMI 25-29.9, and 2,805 obese women with BMI ≥30. The pregnancy outcomes were also compared among subgroups stratified by a gestational weight gain below, within, and above the optimal weight gain. RESULTS: The higher the pre-pregnancy BMI, the higher the incidences of pregnancy-induced hypertension, gestational diabetes mellitus, macrosomia, cesarean delivery, postpartum hemorrhage, and post-term birth, but the lower the incidence of small for gestational age (SGA). In all pre-pregnancy BMI category groups, excess gestational weight gain was associated with a higher frequency of large for gestational age and macrosomia; poor weight gain correlated with a higher frequency of SGA, preterm birth, preterm premature rupture of membranes, and spontaneous preterm birth; and optimal weight gain within the recommended range was associated with a better outcome. CONCLUSION: The BMI classification by the IOM was demonstrated to be valid in Japanese women.

DOI： 10.1371/journal.pone.0157081

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DOI： 10.1002/ccr3.422

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DOI： 10.3109/14767058.2015.1095880

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Objective: To investigate the association between neurodevelopmental complications and biparietal diameter (BPD) growth rate.
Materials and Methods: The patients were pregnant women with severe fetal growth restriction &lt;( 5th percentile) before 30 weeks who delivered after 24 gestational weeks. We defined poor BPD growth as being at least 50% below the mean growth rate for at least 1 week. We analyzed maternal characteristics, neonatal complication morbidities, perinatal mortality rate, and neurodevelopmental complications in the child at age 2 years (corrected).
Results: BPD growth was categorized as normal or poor. Out of 8254 infants, 26 met the above criteria. The poor BPD growth group included 17 infants and the normal BPD growth group included nine infants. The gestational age at delivery was 28.7 (24.7-31.7) weeks in the poor BPD growth group and 28.5 (26.1 32.4) weeks in the normal BPD growth group, showing no significant difference. However, death or neurodevelopmental complications occurred in eight of the 17 infants in the poor BPD growth group, whereas neither death nor neurodevelopmental complications were observed in the normal BPD growth group (p = 0.009). Moreover, in those with poor outcomes, BPD growth rates were consistently below 40% and birth weights were &lt; 700 g.
Conclusion: BPD growth was associated with neurodevelopmental outcomes, and growth delay as compared with the mean growth rate is a risk factor for poor neurodevelopment. Copyright (C) 2015, Taiwan Association of Obstetrics & Gynecology. Published by Elsevier Taiwan LLC. All rights reserved.

DOI： 10.1016/j.tjog.2014.04.031

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Maternal status epilepticus can cause fetal hypoxic ischemic encephalopathy that in turn results in acute polyhydramnios caused by fetal dysphagia; thus, acute polyhydramnios is a symptom that should lead to a suspicion of fetal dysphagia caused by hypoxic ischemic encephalopathy.

DOI： 10.1002/ccr3.315

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AimsPlacental abruption is an important cause of perinatal mortality and morbidity. Although there are many reports on the risk factors for placental abruption, there are few on its classification. Our aim is to evaluate the associations between primary symptoms and the outcomes of placental abruption.
Material and MethodsWe carried out a retrospective cohort study of 12474 births at the Perinatal Center for Maternity and Neonates of the Yokohama City University Medical Center between January 2000 and December 2012. There were 151 women with placental abruption, 136 of whom were included in this study. The subjects were classified into two groups according to their primary symptoms: those with bleeding (external bleeding group) and those with abdominal pain (abdominal pain group). Maternal and neonatal outcomes were compared between the two groups.
ResultsBoth fetal and maternal outcomes were significantly poorer in the abdominal pain group than in the external bleeding group in terms of intrauterine fetal death (6.5% vs 33.3%, P&lt;0.001), perinatal mortality (8.1% vs 33.3%, P=0.001), umbilical arterial pH&lt;7.1 (15.7% vs 57.1%, P&lt;0.001), bleeding volume, rate of blood transfusion, and disseminated intravascular coagulation incidence.
ConclusionsThis classification based on primary symptoms was found to be useful for predicting both maternal and neonatal outcomes of placental abruption.

DOI： 10.1111/jog.12637

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Objectives. Systemic lupus erythematosus (SLE) flare and preeclampsia are difficult to differentiate from each other and occasionally coexist; This study aimed to analyze cases requiring termination of pregnancy due to SLE flare or preeclampsia and to elucidate the association between these two conditions;
Methods. Out of 71 pregnancies in 60 women managed for SLE-complicated pregnancies who delivered at or after 22 weeks' gestation at a tertiary center, 7 pregnancies were terminated due to uncontrollable severe SLE flare or severe preeclampsia We retrospectively analyzed the clinical courses and laboratory findings of these 7 cases to determine whether their pathological conditions were attributable to SLE flare alone, preeclampsia alone, or the coexistence of these two conditions.
Results. One of the 7 cases had preeclampsia alone, two had SLE alone, and four had both conditions. The coexistence of preeclampsia and SLE was thus the most common condition. In cases with both conditions, SLE flare had preceded preeclampsia, thereby making treatment after delivery difficult.
Conclusion. Severe SLE flare often preceded severe preeclampsia and worsened after delivery. When differentiating severe SLE flare from severe preeclampsia is difficult during pregnancy, women should be regarded as having SLE flare rather than preeclampsia and aggressively treated.

DOI： 10.3109/14397595.2014.979522

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AimThe aim of this study was to elucidate the risk of poor pregnancy outcomes in women with adenomyosis by comparing their outcomes to those of women without uterine abnormalities.
Material and MethodsThe subjects were 36 women diagnosed with adenomyosis before pregnancy who were managed at a tertiary care center between January 2002 and December 2012. Our hospital database was retrospectively reviewed to identify pregnancy outcomes associated with adenomyosis. The control group consisted of 144 women without uterine abnormalities who gave birth during the same period and whose age at delivery was adjusted by applying propensity scores. Pregnancy outcomes were compared between the adenomyosis and control groups. The main outcomes were gestational age at delivery, preterm delivery, preterm premature rupture of membranes, fetal malpresentation, cesarean delivery, small-for-gestational age, 5-min Apgar score&lt;7, umbilical arterial pH&lt;7.1, and neonatal intensive care unit admission. The data are presented as medians (range) or frequencies (percentage).
ResultsThe adenomyosis group had significantly higher rates of preterm delivery (41.7% vs 12.5%), preterm premature rupture of membranes (19.4% vs 4.2%), small-for-gestational age (33.3% vs 10.4%), fetal malpresentation (27.8% vs 8.3%), and cesarean delivery (58.3% vs 24.3%), as compared with the control group. No significant differences were observed in 5-min Apgar score&lt;7 or umbilical arterial pH&lt;7.1 between the two groups.
ConclusionsPregnancies in women with adenomyosis were associated with a higher preterm delivery rate and more frequent occurrences of fetal growth restriction and fetal malpresentation, such that both pregnancy and delivery outcomes were poor.

DOI： 10.1111/jog.12604

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AimTo investigate the clinical features of gestational thrombocytopenia (GT) difficult to differentiate from immune thrombocytopenia (ITP) during pregnancy.
MethodsThe January 2000-December 2012 hospital database was analyzed to identify women with ITP or GT (after excluding other possible causes of thrombocytopenia) among those first noted to have platelet counts of less than 100000/L during pregnancy. The maternal characteristics, platelet count fluctuations and pregnancy outcomes were compared between women with ITP and GT.
ResultsThere were 23 pregnancies (22 women) with thrombocytopenia (GT, 13; ITP, 10). The GT group included five twin pregnancies (38.5%), whereas all pregnancies of the ITP group were singleton pregnancies, with significantly more twin pregnancies in the GT group (P=0.046). Thrombocytopenia in the first trimester occurred in 70% (7/10) of ITP cases and 23.1% (3/13) of even GT cases. The nadir platelet count was less than 70000/L in 100% (10/10) of ITP cases and 30.8% (4/13) of GT cases (P&lt;0.001). Maternal treatment was required in 80% (8/10) of ITP cases, but in none of the GT cases. The pregnancy outcomes were favorable in both groups, and no case required fetal treatment.
ConclusionGestational thrombocytopenia with platelet counts of less than 100000/L occurred more frequently in twin pregnancies. Although onset of thrombocytopenia in the first trimester and a platelet count of less than 70000/L is more common in ITP, these findings were not uncommon in GT. Differentiation between ITP and GT may be feasible only with post-partum changes in the platelet count.

DOI： 10.1111/jog.12496

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DOI： 10.1155/2015/342065

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Objective. To evaluate pregnancy outcomes in women with uterine anomalies by applying a method for diagnosing and classifying congenital uterine malformations. Design. Retrospective study. Setting. Tertiary care center. Population. Ninety-four women with uterine anomalies who delivered after 22 gestational weeks. Methods. Excluding the 14 women with a history of surgery and seven with one endometrial cavity, 73 women with two endometrial cavities were subdivided into those with two external uterine orifices (2-OS subgroup) and those with one external uterine orifice (1-OS subgroup). Main outcome measures. Pregnancy outcomes, such as preterm birth, abnormal fetal presentation, cesarean delivery and placental abruption. Results. The 2-OS subgroup comprised women with a didelphic or complete septate uterus who had a significantly higher rate of cesarean delivery (91% vs. 18%, p &lt; 0.001) than the control group (normal uterine morphology; n = 5763). The 1-OS subgroup comprised women with a bicornuate or incomplete septate uterus who had significantly higher rates of preterm birth (27% vs. 5%, p &lt; 0.001) and placental abruption (14% vs. 0.7%, p &lt; 0.001) than the control group. Conclusions. Classification of uterine anomalies by the number of uterine endometrial cavities and external uterine orifices is an easy and reliable means of predicting pregnancy outcomes.

DOI： 10.1111/aogs.12400

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KEY CLINICAL MESSAGE: We present a case in which to of fetal subdural hematoma developing despite that the maternal the prothrombin time by international normalized ratio (PT/INR) during pregnancy was within the normal range.

DOI： 10.1002/ccr3.75

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AimTo determine associations of maternal pre-pregnancy underweight with poor outcomes and evaluate how gestational weight gain affects risks for such outcomes in pre-pregnancy underweight Japanese women.
MethodsBy analyzing the January 2001-December 2012 hospital database, we retrospectively identified 6954 women with pre-pregnancy normal weights (body mass index, 18.5-24.9kg/m(2)) and 1057 pre-pregnancy underweight women (body mass index, &lt;18.5kg/m(2)) who delivered at the Perinatal Maternity and Neonatal Center of Yokohama City University. These women were stratified by weekly weight gain during the second/third trimesters to investigate associations of gestational weight gain with spontaneous preterm birth and small for gestational age (SGA). Spontaneous preterm birth and SGA incidences were compared with those of women meeting Institute of Medicine (IOM) guidelines to determine optimal weight gain in Japanese women.
ResultsPreterm birth and SGA incidences were significantly higher in pre-pregnancy underweight than in pre-pregnancy normal weight women (4.6% vs 2.4% [P=0.005] and 13.9% vs 9.7% [P=0.003], respectively). For pre-pregnancy normal weight women, preterm birth incidence was significantly higher in those with weight gain of less than 0.2kg/week than in those IOM guidelines. For pre-pregnancy underweight women, preterm birth and SGA incidences were significantly higher in those with weight gain of less than 0.3kg/week than in those meeting IOM guidelines.
ConclusionPreterm birth and SGA incidences did not differ significantly between pre-pregnancy normal weight women with weight gain of 0.2kg/week or more and pre-pregnancy underweight women with weight gain of 0.3kg/week or more, as compared to women meeting IOM guidelines. These results suggest that IOM guidelines for gestational weight gain may lack external validity in Japanese women.

DOI： 10.1111/jog.12283

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To examine the clinicopathological characteristics of pregnant women who presented with intermittent hemorrhage occurring throughout pregnancy until delivery.
A total of 24 women with intermittent hemorrhage occurring throughout pregnancy were categorized into two groups, a group with persistent subchorionic hematoma (PSH) and another with chronic abruption (CA), and the pregnancy outcomes were compared between the two groups. The data were expressed as medians (range).
There were 18 women in the PSH group and 6 women in the CA group. The median gestational age at delivery was 27.9 (22.1-33.4) weeks in the PSH group and 32.9 (24.3-33.1) weeks in the CA group, revealing a significantly earlier gestational age at delivery in the former group (p = 0.014). The percentage of the women developing acute abruption tended to be higher in the CA group [66.7 % (4/6)] than in the PSH group [26.3 % (5/18)]. Small for gestational age (SGA) infants and neonatal chronic lung disease were seen at high incidences, but only in the PSH group [21.1 % (4/18) and 42.1 % (8/18), respectively].
PSH was associated with earlier gestational age at delivery, a higher incidence of SGA infants, and poorer pregnancy outcomes than CA.

DOI： 10.1007/s00404-013-2972-z

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

AimTo compare outcomes after emergency cerclage versus expectant management for prolapsed fetal membranes in women with cervical incompetency.
MethodsThe January 2000-December 2012 hospital database was analyzed to identify women managed for prolapsed fetal membranes who did not have premature rupture of membranes, clinically discernible chorioamnionitis, or treatment-resistant uterine contractions from 15 to 26weeks of gestation retrospectively. Durations of pregnancy prolongation and numbers of deliveries after 32 and 28weeks were compared between women undergoing emergency cervical cerclage and those receiving expectant management.
ResultsFifteen of the 35 women underwent emergency cervical cerclage (cerclage group'), while the other 20 were managed expectantly (bedrest group'). In the cerclage group, median gestational ages at procedure and delivery times were 22.6 (15.9-26.1) and 32.4 (19.4-41.6) weeks, respectively. Median gestational ages on admission and at delivery in the bedrest group were 23.4 (21.1-26.4) and 26.0 (23.1-36.4) weeks, respectively. The median duration of pregnancy prolongation was 44days (4-165) in the cerclage group and 12.5days (2-93) in the bedrest group (P&lt;0.01). Numbers of deliveries after 28 and 32weeks were both significantly higher in the cerclage than in the bedrest group (P&lt;0.05).
ConclusionIn women with prolapsed fetal membranes but no signs of infection or painful uterine contractions, emergency cervical cerclage prolonged pregnancy duration as compared with expectant management.

DOI： 10.1111/jog.12207

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Objective: We investigated whether women with severe fetal growth restriction (FGR &lt; 5th percentile) associated with severe preeclampsia (PE) occurring in the second trimester are candidates for expectant management.
Study design: This is a retrospective study involving 33 women who developed severe PE or superimposed PE in the second trimester and were expectantly managed at a tertiary center. They were divided into groups with and without severe FGR on admission (severe FGR (+) group: 17 women; severe FGR (-) group: 16 women) for comparison of the duration of pregnancy prolongation, major maternal complications, and perinatal outcomes. The data are presented as medians (range) or frequencies (percentage).
Results: The duration of pregnancy prolongation was 10 days in both groups. Major maternal complications occurred in 5 of 17 women (29.4%) in the severe FGR (+) and 5 of 16 (31.3%) in the severe FGR (-) group, showing very similar incidence rates in the 2 groups. The perinatal survival rates were favorable at 82.4% (14/17) in the severe FGR (+) and 100% (16/16) in the severe FGR (-) group.
Conclusion: Regarding expectant management of severe preeclampsia occurring in the second trimester, there was no difference in the duration of pregnancy prolongation between the groups with and without severe FGR on admission. Because favorable perinatal outcomes can be expected without compromising maternal safety by prolonging pregnancy as expectant management for severe FGR, it was suggested that women with severe FGR are suitable candidates for expectant management. (C) 2013 International Society for the Study of Hypertension in Pregnancy Published by Elsevier B.V. All rights reserved.

DOI： 10.1016/j.preghy.2013.11.006

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AimThis study aimed to determine whether mechanical cervical dilatation with a laminaria tent in women with premature rupture of membranes (PROM) at term may influence the maternal/neonatal outcomes.
MethodsWe reviewed the medical records and histopathologic results of the placenta in 782 women with PROM at term. Of the 486 women seen prior to 2010 (group 1), 85 had Bishop scores of 5 or less and underwent insertion of laminaria tents (group A). In the 296 women admitted after 2010 (group 2), 27 had Bishop scores of 5 or less and underwent labor management without insertion of laminaria tents (group B). The patient characteristics, delivery course and neonatal outcomes were compared between the groups.
ResultsThere were no significant differences in the maternal age, percentage of nulliparas, body mass index, gestational age at delivery or Bishop score between the groups. The Bishop score improved from 2.5 to 6.1 after laminaria tent insertion in group A. However, there were no significant intergroup differences in the frequency of use of labor-inducing agents or the time interval from PROM to delivery. The incidence of clinical/pathological chorioamnionitis was not higher in group A than in group B. No significant differences were found in the Apgar scores, umbilical artery pH or frequency of asphyxia neonatorum between the groups. Mechanical cervical dilatation by laminaria tent insertion neither increased the incidence of infection nor contributed to improvement of the perinatal prognosis.
ConclusionMechanical cervical dilatation does not provide any benefit for women with PROM at term.

DOI： 10.1111/jog.12116

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Aims. To analyze the pregnancy outcomes of circumvallate placenta retrospectively and to predict circumvallate placenta during pregnancy based on its clinical features. Methods. The pregnancy outcomes of 92 women with circumvallate placenta who delivered live singletons at a tertiary care center between January 2000 and September 2012 were compared with those of 9057 controls. Results. Women with circumvallate placenta were associated with higher incidences of preterm delivery (64.1%), placental abruption (10.9%), emergency cesarean section (45.6%), small-for-gestational age (36.9%), neonatal death (8.9%), neonatal intensive care unit admission (55.4%), and chronic lung disease (33.9%). When vaginal bleeding during the second trimester and premature chemical rupture of membranes (PCROM) were both used as predictive factors for circumvallate placenta, the sensitivity was 28.8% and specificity was 99.9%. Conclusion. With circumvallate placenta, pregnancy outcomes were poor and had characteristic clinical manifestations. In women with both vaginal bleeding and PCROM during pregnancy, circumvallate placenta should be strongly suspected.

DOI： 10.1155/2014/986230

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We report our experience with a case of presumptive cesarean scar pregnancy, based on detection of a gestational sac (GS) in early pregnancy at the site of a previous cesarean scar. The GS grew into the uterine cavity as the pregnancy progressed, showing an ultrasound image similar to that of a normal pregnancy. Thus, the pregnancy continued, resulting in a viable birth at 28 weeks of gestation. Cesarean scar pregnancy is classified as myometrial implantation or implantation growth into the uterine cavity. In the latter type, the gestational sac moves upward with increasing gestational weeks and it shows the same ultrasound image as a normal pregnancy. Therefore, the diagnosis must be made in the early pregnancy.

DOI： 10.1155/2014/375685

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