Language：English   Publishing type：Research paper (scientific journal)  

AIM: Cervical ripening is commonly performed before oxytocin administration during labor induction in pregnant women with an unfavorable cervix. In Japan, a controlled-release Dinoprostone vaginal insert (CR-DVI) was approved in 2020. Although many studies have compared the mechanical methods of ripening and prostaglandins, few have examined the impact of additional options for labor induction. This study aimed to assess the impact of CR-DVI as an additional option for labor induction in women with an unfavorable cervix. METHODS: In this single-center retrospective study conducted in Japan, 265 participants were divided into two groups: before (January 2018 to May 2020) and after (June 2020 to November 2022) CR-DVI introduction. Before CR-DVI was introduced, hygroscopic dilators were used for all cases instead. On the other hand, after the introduction of CR-DVI, the first choice for cervical ripening was CR-DVI. The CR-DVI was retained vaginally for up to 12 hours after insertion. However, if hyper-stimulation or non-reassuring fetal status was suspected, or if a new membrane rupture occurred, it was removed immediately according to the removal criteria. Oxytocin infusions were used during both periods if needed. We compared delivery and neonatal outcomes between the groups. RESULTS: The 265 participants were divided into two groups: before (n=116) and after (n=149) CR-DVI introduction. There were no significant differences in maternal characteristics except for the primiparous proportion. CR-DVI was used in 93% of cases after introduction. Hygroscopic dilators also continued to be used; however, their use decreased to about 34%. The vaginal delivery rate was significantly higher after the introduction of CR-DVI than before its introduction (50.9% vs. 66.4%; p=0.01). Multivariable analysis revealed a significantly higher rate of vaginal delivery after CR-DVI introduction. Of the 149 cases in which a CR-DVI was used, 111 (79.9%) were removed before 12 hours. There were no significant differences in neonatal outcomes. CONCLUSION: The rate of vaginal delivery was higher after CR-DVI introduction than before its introduction, and adverse pregnancy outcomes did not increase. Therefore, introducing CR-DVI as an option for labor induction may increase the probability of vaginal delivery. Safety can also be ensured by adhering to the removal criteria.

DOI： 10.7759/cureus.53180

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Language：English  

Vitamin K deficiency can cause coagulopathy; therefore, supplementation is recommended to prevent intracranial hemorrhage in newborns. Some reports have shown that maternal vitamin K deficiency is associated with intracranial hemorrhage in the fetus. However, no clear guidelines exist for the diagnosis and treatment of maternal vitamin K deficiency to prevent fetal intracranial hemorrhage. We report a case of intrauterine fetal death due to intracranial hemorrhage associated with maternal vitamin K deficiency resulting from hyperemesis gravidarum. In this case, maternal protein induced by vitamin K absence II (PIVKA-II) was high at the time of intrauterine fetal death. Therefore, measuring maternal PIVKA-II levels in high-risk cases may help determine the timing of therapeutic interventions for vitamin K deficiency during pregnancy.

DOI： 10.1016/j.crwh.2023.e00566

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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In a cervico-isthmic pregnancy, the risk of placenta accreta increases with advancing gestational age. Previous reports have detailed cases that required hysterectomy at delivery or artificial abortion at an early gestational age. However, to the best of our knowledge, there have been no previous reports on the management of a cervico-isthmic pregnancy with fetal death during the second trimester. A 33-year-old primigravid woman was diagnosed with a cervico-isthmic pregnancy and fetal death at 15 weeks of gestation. Placenta accreta was suspected; hence, we chose expectant management and to observe the patient for placental tissue regression. After 5 weeks of expectant management, the ultrasonographic findings suggested remission of placenta accreta. Therefore, we performed a cesarean delivery and terminated the pregnancy. All uterine contents were removed, and the uterus was preserved. In cervico-isthmic pregnancy cases with fetal death, as in the current case, the possibility of fertility preservation could be increased by observing for placental tissue regression through expectant management.

DOI： 10.1016/j.crwh.2023.e00501

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Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: To verify the effectiveness of intervention in early pregnancy for women with early-onset gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: This study included women with a singleton pregnancy who were diagnosed with early-onset GDM by 20 weeks of gestation according to the International Association of Diabetes and Pregnancy Study Group (IADPSG) threshold. We retrospectively evaluated the pregnancy outcomes in pregnant women with early-onset GDM. In the treatment from early pregnancy group (n=286), patients were diagnosed with early-onset GDM at the Yokohama City University Medical Center (YCU-MC) in 2015-2017 and were treated for GDM from early pregnancy. Concerning the treatment from mid-pregnancy group (n=248), participants were diagnosed with early-onset GDM at five sites, including the YCU-MC in 2018-2019, and were followed up without treatment until the second 75 g oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. Treatment for GDM was given only if the GDM pattern was still present in the second OGTT. RESULTS: There were no significant differences in maternal backgrounds, including GDM risk factors and gestational weight gain, between the groups. Among the treatment from mid-pregnancy group, the false-positive early GDM was 124/248 (50%). Regarding pregnancy outcome, the rate of large for gestational age (LGA) was 8.8% in the treatment from early pregnancy group and 10% in the treatment from mid-pregnancy group, with no significant difference, whereas small for gestational age (SGA) was significantly higher in the treatment from early pregnancy group (9.4%) than in the treatment from mid-pregnancy group (4.8%) (p=0.046). There were no significant differences in maternal adverse events and neonatal outcomes between the groups. In a subanalysis limited to body mass index >25 kg/m2, LGA was significantly lower in the treatment from early pregnancy group than in the treatment from mid-pregnancy group. CONCLUSIONS: The strategy for diagnosing GDM by IADPSG thresholds in early pregnancy and providing treatment to all patients from early pregnancy did not improve the pregnancy outcomes, but rather increased the SGA rate.

DOI： 10.1136/bmjdrc-2022-003230

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Lobular endocervical glandular hyperplasia (LEGH) is characterized by clinically profuse and watery vaginal discharge. In pregnancy with LEGH, with watery fluid leakage persisting throughout pregnancy, it is often difficult to visually diagnose PROM. Adding to this difficulty, auxiliary diagnostic tests might also show positive results, complicating treatment and management.

DOI： 10.1002/ccr3.6630

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Language：Japanese   Publisher：(一社)日本糖尿病・妊娠学会  

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Language：Japanese   Publisher：(一社)日本糖尿病・妊娠学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

維持透析中女性の妊娠出産は羊水量の異常や妊娠高血圧症候群の合併などが多く、ハイリスク妊娠である。今回、内科と連携して妊娠中にドライウエイトを慎重に管理しながら頻回透析管理を行ったことにより、正期産に経腟分娩できた症例を経験した。症例は31歳、2妊0産。小児期から巣状分節性糸球体硬化症と診断され、慢性腎不全に対して29歳で週3回の血液維持透析を導入された。妊娠前に高血圧は指摘されていなかった。タイミング妊娠が成立し、妊娠4週で当科を受診した。妊娠高血圧症候群予防のため、妊娠28週まで低用量アスピリン療法を行った。また、妊娠7週からは透析頻度を週5回に増やし、妊娠23週からは入院管理とし、週6回の頻回透析を行った。羊水過多及び血圧上昇傾向に対して妊娠29週よりドライウエイトの増量を中止としたところ、血圧及び羊水量は正常に復した。妊娠37週0日にオキシトシンによる分娩誘発により正常経腟分娩に至った。児は2,740g、Apgar scoreは1分値8点、5分値9点で母児ともに経過良好であった。透析患者の妊娠症例では、内科と連携して厳重に管理し頻回に透析を行うことで、早産リスクを低減できる可能性があり、産科管理のみならず慎重で専門的な内科的管理が必要であるため、維持透析導入妊婦は、他科との連携を綿密にとることのできる医療施設での分娩が望ましい。(著者抄録)

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To investigate the relationships between communicative and critical health literacy (CCHL) and anxiety and depressive symptoms (ADs) in pregnant women during the coronavirus disease 2019 (COVID-19) pandemic. A cross-sectional study was conducted and 5466 pregnant women responded in Japan in September 2020. A Kessler 6 scale (K6) score ≥ 10, an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 13, and four CCHL groups were analyzed using a logistic regression model and trend test. The proportions of pregnant women with a K6 score ≥ 10 and EPDS score ≥ 13 were 13.5 and 15.4%, respectively. In comparisons with the low CCHL group, the adjusted odds ratio (95% CI) for anxiety symptoms was 0.770 (0.604-0.982) in the high CCHL group, while those for depressive symptoms were 0.777 (0.639-0.946), 0.665 (0.537-0.824), and 0.666 (0.529-0.838) in the lower, higher, and high CCHL groups (all p < 0.05), respectively, after adjustments for potential confounding factors, such as age, weeks of gestation, complications, history, number of children, marital status, education, employment, and income. Higher CCHL was associated with significantly lower adjusted odds ratios for anxiety (p for trend = 0.019) and depressive symptoms (p for trend < 0.001). These results suggest a relationship between CCHL and ADs in pregnant women during the COVID-19 pandemic.

DOI： 10.1038/s41598-022-18405-3

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Abstract

Background

To investigate whether false-positive early gestational diabetes mellitus (GDM) women can be managed similarly as normal glucose tolerance (NGT) women.

Methods

This retrospective study was conducted at a tertiary care center in Japan. Pregnancy and neonatal outcomes of 67 singleton pregnancies with false-positive early GDM and 1774 singleton pregnancies with NGT who delivered after 22 weeks of gestation were compared. GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria (patients having one or more of the following: fasting plasma glucose ≥ 92 mg/dL and a 75 g oral glucose tolerance test (OGTT) value ≥ 180 mg/dL at 1 h, or ≥ 153 mg/dL at 2 h). Pregnant women diagnosed with GDM in early pregnancy who did not meet the diagnostic criteria on the second OGTT were defined as having false-positive early GDM. Women with false-positive early GDM did not receive any therapeutic intervention during gestation.

Results

Maternal age, pre-pregnancy body mass index, and gestational weight gain were significantly higher in the false-positive GDM group than in the NGT group. No significant differences were found in pregnancy outcomes, including gestational age, birth weight, large for gestational age rate, and cesarean delivery rate. Except for a higher neonatal hypoglycemia rate in the false-positive early GDM group, no significant differences were found in neonatal outcomes.

Conclusions

There were no clinically significant differences between early GDM false-positive women exhibiting GDM patterns only during early pregnancy and NGT women. False-positive early GDM women can be managed similarly as NGT women, suggesting that World Health Organization diagnostic guidelines, applying the IADPSG criteria during early pregnancy, need revision.

DOI： 10.1186/s12902-022-01124-1

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Other Link： https://link.springer.com/article/10.1186/s12902-022-01124-1/fulltext.html

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: To investigate whether false-positive early gestational diabetes mellitus (GDM) women can be managed similarly as normal glucose tolerance (NGT) women. METHODS: This retrospective study was conducted at a tertiary care center in Japan. Pregnancy and neonatal outcomes of 67 singleton pregnancies with false-positive early GDM and 1774 singleton pregnancies with NGT who delivered after 22 weeks of gestation were compared. GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria (patients having one or more of the following: fasting plasma glucose ≥ 92 mg/dL and a 75 g oral glucose tolerance test (OGTT) value ≥ 180 mg/dL at 1 h, or ≥ 153 mg/dL at 2 h). Pregnant women diagnosed with GDM in early pregnancy who did not meet the diagnostic criteria on the second OGTT were defined as having false-positive early GDM. Women with false-positive early GDM did not receive any therapeutic intervention during gestation. RESULTS: Maternal age, pre-pregnancy body mass index, and gestational weight gain were significantly higher in the false-positive GDM group than in the NGT group. No significant differences were found in pregnancy outcomes, including gestational age, birth weight, large for gestational age rate, and cesarean delivery rate. Except for a higher neonatal hypoglycemia rate in the false-positive early GDM group, no significant differences were found in neonatal outcomes. CONCLUSIONS: There were no clinically significant differences between early GDM false-positive women exhibiting GDM patterns only during early pregnancy and NGT women. False-positive early GDM women can be managed similarly as NGT women, suggesting that World Health Organization diagnostic guidelines, applying the IADPSG criteria during early pregnancy, need revision.

DOI： 10.1186/s12902-022-01124-1

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本遺伝カウンセリング学会  

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AIM: To investigate how an extremely prolonged second stage of labor of 12 h or more affects maternal and neonatal outcomes. MATERIAL AND METHODS: This retrospective cohort study included nulliparous, pregnant women with 37 + 0 to 41 + 6 weeks of gestation whom vaginal delivery was attempted at the Yokohama City University Medical Center between 2014 and 2018. RESULTS: In 446 cases of the prolonged second stage of labor, there were 296 women (66%) in the 2- to 6-h second stage of labor group, 112 women (25%) in the 6- to 12-h group, and 38 women (8.5%) in the 12-h or longer group. The longer the second stage of labor, the more significant was the increase in the rates of augmentation of the delivery, emergency cesarean delivery, and operative vaginal delivery. Even in the 12 h or longer group, 82% were able to have vaginal delivery. The 6- to 12-h group had a significant increase in third- or fourth-degree perineal lacerations compared to the 2- to 6-h group (aOR 8.12 [95% CI 1.55-42.6]). Clinical chorioamnionitis was significantly increased in the 12 h or longer group (aOR 4.88 [95% CI 1.62-14.8]). In terms of neonatal outcomes, comparison between the three groups showed no significant difference. CONCLUSION: With an extremely prolonged second stage of labor, maternal complications involved a significant increase in severe perineal lacerations and chorioamnionitis; however, there was no increase in adverse outcomes for neonates. It was not possible to conclusively determine if the duration of the second stage is acceptable.

DOI： 10.1111/jog.15212

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：English   Publishing type：Research paper (scientific journal)  

This study investigated the implementation status, attitudes, and practices regarding maternal pertussis vaccination in delivery facilities in Kanagawa, Japan. We conducted a questionnaire survey of pertussis vaccination during pregnancy at 125 delivery service facilities, excluding midwifery clinics, in Kanagawa Prefecture from June 18 to July 20, 2020. The questionnaire comprised multiple-choice items, with single or multiple answers depending on the question. Of the 125 facilities surveyed, valid responses were obtained from 72 facilities (58%). There were 41 primary clinics with birthing facilities (57%), 16 general hospitals (not designated perinatal centers) (22%), 10 regional perinatal centers (14%), and five tertiary perinatal centers (7%). None of the facilities administered pertussis vaccination during pregnancy. Forty facilities (56%) reported knowledge of the severity of neonatal and infant pertussis infections. Twenty-three facilities (32%) reported knowledge of the prevention of pertussis infection by vaccination during pregnancy. All facilities reported willingness to consider vaccination if included in the Japanese guidelines. In Japan, the pertussis vaccination during pregnancy is not highly practiced by obstetricians; thus, it is not as popular as in other countries. Further studies are needed to promote strategies to prevent pertussis infection in the neonatal and infant periods.

DOI： 10.1080/21645515.2021.1958609

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

AIM: The aim of this study was to clarify the physical and mental burden of the COIVD-19 pandemic on obstetricians and gynecologists in Japan and to identify factors that increase the burden of their psychological stress. METHODS: A web-based questionnaire was sent to obstetricians and gynecologists in Japan via email and social media to collect voluntary responses. This survey was conducted from September 1 to 30, 2020. RESULTS: A total of 852 valid responses were included in the analysis; 76% (644) of the physicians felt that the COVID-19 pandemic caused them physical and mental stress equal to or greater than the most severe disaster they had ever experienced. Physicians who reported high mental and physical stress were more likely to be in areas with high numbers of infected patients (odds ratio (OR) 1.571, p = 0.012). Physicians experienced great stress to the point of wearing heavy personal protective equipment during routine vaginal deliveries by mothers with no COVID-19 symptoms. This trend was markedly pronounced for physicians working in regions with fewer cases of COVID-19 infection. CONCLUSIONS: Obstetricians and gynecologists who reported high mental and physical stress were more likely to be in areas with high numbers of infected patients. One potential reason for this may be that they were required to wear more personal protective equipment than necessary. Infection control methods that ensure the safety of obstetricians and gynecologists while not causing unnecessary physical or psychological stress are needed.

DOI： 10.1111/jog.14878

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Language：English   Publishing type：Research paper (scientific journal)  

AIM: To evaluate psychological stress among pregnant and puerperal women in Japan during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: In this cross-sectional study, we recruited pregnant women and puerperal women who delivered between January and September 2020 in Japan, using an online questionnaire. Participants were divided into low, middle, and high groups according to the degree of the epidemic in their region of residence. Related factors were analyzed using the chi-squared test. The relationship between COVID-19 epidemic regions and depression risks and anxiety using the Edinburgh Postnatal Depression Scale (EPDS) and Kessler 6 scale (K6) was evaluated using a univariate and multivariable logistic regression model. RESULTS: Overall, 7775 cases, including 4798 pregnant and 2977 puerperal women, were analyzed. The prevalence of high EPDS and K6 scores was significantly increased in pregnant women in the high than those in the low epidemic regions (EPDS: adjusted odds ratio [aOR] 1.453, 95% confidence interval [CI] 1.205-1.753; K6: aOR 1.601, 95% CI 1.338-1.918). There was no difference in EPDS score, but the prevalence of high K6 scores was significantly increased in puerperal women in the high than those in the low epidemic regions (aOR 1.342, 95% CI 1.066-1.690). Further, restriction on going to their hometown for delivery increased the prevalence of high EPDS scores among pregnant (aOR 1.663, 95% CI 1.296-2.133) and puerperal women (aOR 1.604, 95% CI 1.006-2.557). CONCLUSIONS: Decreased support due to the COVID-19 pandemic affected the psychological status of pregnant and puerperal women; hence, investing medical resources in their healthcare essential.

DOI： 10.1111/jog.14877

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Publishing type：Research paper (scientific journal)   Publisher：Public Library of Science (PLoS)  

In 2009, the United States Institute of Medicine (IOM) reported the optimal gestational weight gain (GWG) during twin pregnancy based on the pre-pregnancy body mass index (BMI). However, there are ethnic variations in the relationship between GWG and pregnancy outcomes. We aimed to establish the criteria for optimal GWG during twin pregnancy in Japan. The study included cases of dichorionic diamniotic twin pregnancy registered in the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System between 2013 and 2017. We analyzed data for cases wherein both babies were appropriate for gestational age and delivered at term. Cases were classified into four groups based on the pre-pregnancy BMI: underweight (BMI &lt;18.5 kg/m²), normal weight (18.5 kg/m² ≤BMI&lt; 25.0 kg/m²), overweight (25.0 kg/m² ≤BMI&lt; 30.0 kg/m²), and obese (BMI ≥30.0 kg/m²) and we calculated the 25^th–75^th percentile range for GWG for the cases. The 3,936 cases were included. The GWG ranges were 11.5–16.5 kg, 10.3–16.0 kg, 6.9–14.7 kg, and 2.2–11.7 kg in the underweight, normal weight, overweight, and obese groups, respectively. Thus, in the current study, the optimal GWG during twin pregnancy was lower than that specified by the IOM criteria. Factoring this in maternal management may improve the outcomes of twin pregnancies in Japan.

DOI： 10.1371/journal.pone.0253596

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：English   Publishing type：Research paper (scientific journal)  

AIM: This study aimed to clarify how the COVID-19 pandemic impacts psychological stress levels in postpartum women in Yokohama, Japan. METHODS: We retrospectively compared the rates of positive screening tests for postpartum depression (Edinburgh Postnatal Depression Scale score of 9 or more or self-injury factors) and liaison/psychiatric intervention rates between pre-pandemic and pandemic groups of postpartum women who delivered a live birth at our tertiary perinatal center in Yokohama, Japan between January 2019 and May 2020. Those whose postpartum health screening was performed in 2019 (March-June 2019) were considered the pre-pandemic group, and those whose screening was performed between March and June 2020 were considered the pandemic group. Adjustments were made for maternal background, pregnancy, and delivery outcomes, including a history of psychiatric disorders, complications, preterm delivery, NICU admission, and maternal postpartum complications, and the data were analyzed using a logistic regression analysis. RESULTS: Postpartum health screenings were performed on 339 women before the pandemic and 279 women during the pandemic. Positive screening rates for postpartum depression did not change before and during the pandemic (adjusted odds ratio 1.48, 95% confidence interval 0.885-2.46). CONCLUSIONS: There was no apparent increase in maternal psychological stress due to the COVID-19 pandemic in Yokohama, Japan. Postpartum women responded differently in settings with varied levels of disease severity and social restrictions.

DOI： 10.1111/jog.14776

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Child abuse and postnatal depression are two public health problems that often co-occur, with rates of childhood maltreatment highest during the first year of life. Internet-based behavioural activation (iBA) therapy has demonstrated its efficacy for improving postnatal depression. No study has examined whether the iBA program is also effective at preventing child abuse. This study aims to investigate whether iBA improves depressive symptoms among mothers and prevents abusive behaviours towards children in postpartum mothers in a randomized controlled trial, stratifying on depressive mood status. The study also evaluates the implementation aspects of the program, including how users, medical providers, and managers perceive the program in terms of acceptability, appropriateness, feasibility, and harm done. METHODS: The study is a non-blinded, stratified randomized controlled trial. Based on cut-off scores validated on Japanese mothers, participants will be stratified to either a low Edinburgh Postnatal Depression Scale (EPDS) group, (EPDS 0-8 points) or a high EPDS group (EPDS ≥9 points). A total of 390 postnatal women, 20 years or older, who have given birth within 10 weeks and have regular internet-access will be recruited at two hospitals. Participants will be randomly assigned to either treatment, with treatment as usual (TAU) or through intervention groups. The TAU group receives 12 weekly iBA sessions with online assignments and feedback from trained therapists. Co-primary outcomes are maternal depressive symptoms (EPDS) and psychological aggression toward children (Conflict Tactic Scale 1) at the 24-week follow-up survey. Secondary outcomes include maternal depressive symptoms, parental stress, bonding relationship, quality of life, maternal health care use, and paediatric outcomes such as physical development, preventive care attendance, and health care use. The study will also investigate the implementation outcomes of the program. DISCUSSION: The study investigates the effectiveness of the iBA program for maternal depressive symptoms and psychological aggression toward children, as well as implementation outcomes, in a randomized-controlled trial. The iBA may be a potential strategy for improving maternal postnatal depression and preventing child abuse. TRIAL REGISTRATION: The study protocol (issue date: 2019-Mar-01, original version 2019005NI-00) was registered at the UMIN Clinical Trial Registry (UMIN-CTR: ID UMIN 000036864 ).

DOI： 10.1186/s12884-021-03767-9

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In pregnant patients with a divided uterine cavity, the decidual tissue on the nonpregnant side may be discharged prior to the delivery of the fetus. The pregnancy can continue if the uterine contractions and vaginal bleeding are controlled and the fetus is not in distress.

DOI： 10.1002/ccr3.4042

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1111/jog.14776

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/jog.14776

Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

AIMS: To investigate whether the Institute of Medicine (IOM) guidelines for optimal gestational weight gain (GWG) in twin pregnancies are applicable to Japanese women. METHODS: This was a retrospective study involving women who delivered full-term twins at our tertiary center diagnosed with a normal prepregnancy body mass index. The women were divided into two groups, according to the optimal GWG recommended by the IOM (16.8-24.5 kg): the adequate GWG (AGWG) group with GWG meeting the guidelines and the low GWG (LGWG) group with GWG below the guidelines. Next, the women were divided into two groups according to birthweight: a group with both twins born appropriate for gestational age (AGA group) and a group with one or both twins born small for gestational age (SGA group). Their GWG as well as their pregnancy outcomes were compared. RESULTS: A total of 265 women were included. The AGWG group had a significantly higher proportion of hypertensive disorders of pregnancy than the LGWG group. There was no significant difference in the proportion of women with both twins born AGA or the rate of admission to the neonatal intensive care unit. Meanwhile, the median GWG in the AGA group was 13.6 kg, which was significantly higher than 12.0 kg in the SGA group. And even the median GWG in the AGA group was below the lower limit of the IOM guidelines. CONCLUSION: The optimal GWG for Japanese women with twin pregnancies may be below the IOM guidelines.

DOI： 10.1111/jog.14529

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Language：English  

Because the anterior lower uterine segment is stretched, the incarcerated gravid uterus case with a history of cesarean section is a good candidate for manual reduction.

DOI： 10.1002/ccr3.3524

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Language：Japanese   Publisher：神奈川県医師会  

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1111/jog.14529

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/jog.14529

Language：English   Publishing type：Research paper (scientific journal)  

In 2009, the United States Institute of Medicine (IOM) reported the optimal gestational weight gain (GWG) during twin pregnancy based on the pre-pregnancy body mass index (BMI). However, there are ethnic variations in the relationship between GWG and pregnancy outcomes. We aimed to establish the criteria for optimal GWG during twin pregnancy in Japan. The study included cases of dichorionic diamniotic twin pregnancy registered in the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System between 2013 and 2017. We analyzed data for cases wherein both babies were appropriate for gestational age and delivered at term. Cases were classified into four groups based on the pre-pregnancy BMI: underweight (BMI <18.5 kg/m2), normal weight (18.5 kg/m2 ≤BMI< 25.0 kg/m2), overweight (25.0 kg/m2 ≤BMI< 30.0 kg/m2), and obese (BMI ≥30.0 kg/m2) and we calculated the 25th-75th percentile range for GWG for the cases. The 3,936 cases were included. The GWG ranges were 11.5-16.5 kg, 10.3-16.0 kg, 6.9-14.7 kg, and 2.2-11.7 kg in the underweight, normal weight, overweight, and obese groups, respectively. Thus, in the current study, the optimal GWG during twin pregnancy was lower than that specified by the IOM criteria. Factoring this in maternal management may improve the outcomes of twin pregnancies in Japan.

DOI： 10.1371/journal.pone.0253596

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

症例は35歳6妊1産、31歳時に子宮頸癌IB1期(組織型Glassy cell carcinoma)と診断され妊孕性温存を強く希望し、他院で広汎子宮頸部摘出術を施行した。その後のフォローアップでは再発の兆候はみられず、33歳時に体外受精-胚移植で妊娠し、妊娠36週に帝王切開術で分娩した。今回、自然妊娠し、妊娠・分娩の管理目的に妊娠15週2日に当院を紹介され受診した。当院初診時は性器出血や感染兆候を認めなかったため、外来管理の方針とし、出血や子宮収縮などの切迫早産の兆候がみられた場合には入院管理にする方針とした。妊娠の経過中には切迫早産の兆候を認めず、胎児発育は良好であり、帝王切開術施行前日まで外来で管理できた。妊娠37週6日に予定帝王切開術で2920gの女児を娩出した。術中腹腔内の癒着や血管叢の損傷はなく、特に問題なく終刀した。術後は母児ともに経過良好であり、術後1週間で退院した。広汎子宮頸部摘出術後妊娠は、残存頸管が短く自然の子宮頸管による感染の防御機構も破綻するため、早産のハイリスクであるが、子宮収縮や子宮内感染兆候など切迫兆候を認めなければ外来管理及び正期産での分娩が可能である。(著者抄録)

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

産科危機的出血は母体の循環動態によって治療方法が異なる。一般的には循環動態が不安定な場合は開腹術が優先される。今回、我々は産科危機的出血に対して大動脈内遮断バルーンを用いて循環動態を安定させ動脈塞栓術で止血を得た症例を経験したため報告する。症例は28歳、1妊0産、自然妊娠され経過順調だったが、妊娠40週3日に続発性微弱陣痛の診断でオキシトシンの点滴による陣痛促進を行った。子宮口全開大、St+1まで進行したが基線細変動小減少及び持続する胎児徐脈を認めたため、吸引分娩で児を娩出した。新生児は男児、2946g、Apgar scoreは1分値1点、5分値6点、9分値10点、臍帯動脈血pHは7.221であった。産後、子宮収縮薬や多量輸血を行っても止血を得られず当院に産褥搬送され分娩後3時間で当院へ到着した。多量輸血を行ったが循環動態が短期間で増悪したため、大動脈内遮断バルーンを胸部下行大動脈内でインフレートしたところ循環動態が改善した。不全子宮破裂が疑われ、止血治療として経カテーテル動脈塞栓術を選択した。止血術開始30分後に両側子宮動脈を塞栓し、90分で完全に止血し得た。止血後の経過は良好で、搬送後8日目に退院した。循環動態が不安定な産科危機的出血に対し、大動脈内遮断バルーンの使用により治療の選択肢が広がり、より安全に止血処置を行うことができる。(著者抄録)

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Language：Japanese   Publisher：神奈川産科婦人科学会  

子宮摘出を要する産褥出血の症例は循環動態が不安定であり、リスクの高い手術となる場合が多い。今回我々は大動脈内バルーン遮断(Intra-aortic balloon occlusion;IABO)を行い、子宮摘出術で救命できた産科危機的出血の一例を経験した。症例は31歳、3妊2産で妊娠経過は特に問題はなかった。妊娠37週2日に陣痛発来し前医へ入院した。子宮口開大8cmの時点から陣痛促進剤を使用し、30分後に正常経腟分娩に至った。分娩1時間後にShock Index(SI)1.54のため子宮収縮薬の使用及び多量輸液をしたが改善なく、分娩2時間半後に非凝固性の出血が出現し、SI1.84となったため当院へ搬送となった。来院時、意識障害と持続する非凝固性の性器出血を認めた。子宮腔内バルーンタンポナーデによる止血を試み、挿入するも固定できず滑脱し、さらに大量輸血を行うも循環動態が不安定な状態が継続したため、子宮全摘術の方針とした。救急救命医によりIABOを行い、輸血を継続したところ循環動態が安定したため手術を開始した。開腹すると不全子宮破裂の所見であり、子宮摘出術により止血が得られた。術後は経過良好であり、合併症なく、術後8日目に退院した。産後出血に対する子宮摘出術はIABOを行うことでより安全に行うことができ、産褥搬送に関わる診療科等との連携も重要である。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: This study aimed to assess the validity of applying the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for the diagnosis of gestational diabetes mellitus (GDM) at any time during pregnancy. RESEARCH DESIGN AND METHODS: This multicenter cohort study was conducted at five Japanese facilities from January 2018 to April 2019. The study cohort included women at a high risk of GDM who met one or more of the following IADPSG criteria during early pregnancy: fasting plasma glucose (FPG) ≥92 mg/dL and 75 g oral glucose tolerance test (OGTT) value of ≥180 mg/dL at 1 hour, or ≥153 mg/dL at 2 hour (hereafter early-onset GDM). Women diagnosed with early-onset GDM were followed up without therapeutic intervention and underwent the 75 g OGTT again during 24-28 weeks of gestation. Those exhibiting the GDM patterns on the second 75 g OGTT were diagnosed with true GDM and treated, whereas those exhibiting the normal patterns were diagnosed with false positive early GDM and received no therapeutic intervention. RESULTS: Of the 146 women diagnosed with early-onset GDM, 69 (47%) had normal 75 g OGTT values at 24-28 weeks of gestation, indicating a false-positive result. FPG levels were significantly higher in the first 75 g-OGTT test than in the second 75 g-OGTT test (93 mg/dL and 87.5 mg/dL, respectively; p<0.001). FPG levels were high in 86 (59%) women with early-onset GDM during early pregnancy but in only 39 (27%) women during mid-pregnancy. Compared with false positive early GDM, true GDM was more frequently associated with adverse pregnancy outcomes. CONCLUSIONS: Although women with early-onset GDM were followed up without treatment, the results of repeated 75 g OGTT during mid-pregnancy were normal in about 50%. Our data did not support the adoption of IADPSG thresholds for the diagnosis of GDM prior to 20 weeks of gestation.

DOI： 10.1136/bmjdrc-2020-001234

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

The aim of this study was to clarify the risk factors for chlamydial infection and determine whether infection during pregnancy is associated with preterm birth in Japanese women. The subjects were women who underwent Chlamydia trachomatis polymerase chain reaction testing during a singleton pregnancy and delivered after the 22nd week of gestation at a tertiary care center between January 1, 2000 and December 31, 2016. We compared Chlamydia-positive (n = 259) and Chlamydianegative (n = 1,974) groups and evaluated the pregnancy outcomes. The Chlamydia-positive group had a higher rate of public assistance coverage, smoking during pregnancy, nulliparity, lack of a partner, presence of other sexually transmitted infections, high-risk social status, and younger age (P < 0.01). The incidence of preterm births was not different between the groups, with an odds ratio of 0.95 (95% confidence interval: 0.62-1.46). The incidences of low birth weight deliveries, premature rupture of membranes, and preterm premature rupture of membranes prior to the 37th week were also comparable between the groups. Chlamydial infection during pregnancy had no effect on preterm birth, even after adjustment for confounding factors.

DOI： 10.7883/yoken.JJID.2019.116

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：English  

Vasa previa can occur even in cases without placental malposition and the precise diagnosis of vasa previa, and the course of the cord vessels contributes to a safe delivery. The color Doppler is a useful and easy-to-use device to confirm the presence of vasa previa.

DOI： 10.1002/ccr3.2432

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Language：Japanese   Publisher：神奈川産科婦人科学会  

肝被膜下血腫はHELLP症候群の0.9-2.0%に合併し、肝破裂に進行すれば母体の死亡率は高い。しかしながらその臨床所見は非特異的で発見が遅れやすい。HELLP症候群に合併し、輸血療法のみで管理し得た肝被膜下血腫を経験したので報告する。症例は30歳1回経妊0回経産。他院で健診中異常はなく経過し、妊娠33週5日分娩先のA病院を健診として受診した。その際に心窩部痛・呼吸困難の訴えがあり、レバミピドを処方され経過観察されていた。妊娠35週3日朝から呼吸困難が増悪しA病院を予約外で受診した。血圧150/91mmHg、脈拍68回/分、SpO2 100%、血小板5.6万/μL、AST326U/L、ALT 362U/L、LDH537U/Lであり、HELLP症候群を疑い当院へ母体搬送された。当院受診時さらに肝酵素が上昇しており、また、CTGでsevere prolonged decelerationがあり、母体HELLP症候群、NRFSに対し、血小板輸血を行いつつ緊急帝王切開術を施行した。淡血性腹水が少量貯留しており、肝右側に腫瘤があったが、活動性出血はなかったため閉腹し術後に造影CT撮影の方針とした。術後の造影CTで肝周囲に境界明瞭な血腫像があったがExtravasationなく、活動性の出血はないと判断し、再出血・感染に注意し慎重に経過観察とした。肝機能は術後11日で改善したため退院し、術後95日のCTで血腫は消失していた。肝被膜下血腫は保存的に管理し得るが、介入の時期を逸することがないよう、血液検査、画像検査で慎重に経過観察することが必要である。また、早期に診断するために、HELLP症候群に肝被膜下血腫が合併することを念頭において診療にあたるべきである。(著者抄録)

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

AIMS: The Japanese Society for the Study of Hypertension in Pregnancy revised the diagnostic criteria for pre-eclampsia (PE) to conform to those of the International Society for the Study of Hypertension in Pregnancy (ISSHP) in 2018. This study aimed to investigate whether pregnancy outcomes differ based on the presence of proteinuria and validate the adoption of the ISSHP criteria in Japan. METHODS: This is a retrospective study involving 308 women diagnosed with hypertensive disorders of pregnancy at a tertiary center. They were divided into the following groups: PE with proteinuria (n = 218), PE without proteinuria (n = 45) and gestational hypertension (n = 45) according to the ISSHP criteria for comparison of pregnancy outcomes. RESULTS: Applying the ISSHP criteria increased the number of pregnant women diagnosed as having PE by 14.6% (45 women). The difference in the rate of composite maternal complications between the two groups was unremarkable, with 33 cases (15.1%) in the PE with proteinuria group and 9 cases (20%) in the PE without proteinuria group. Moreover, composite neonatal complications occurred in 37 cases (17%) of PE with proteinuria group and 6 cases (13.3%) of PE without proteinuria group, showing remarkably similar incidence rate in the two groups. Women with PE with and without proteinuria had significantly earlier deliveries and lower neonatal birth weight than those with gestational hypertension. CONCLUSION: Pregnancy outcomes of PE with and without proteinuria were almost similar although their incidence increased, confirming its validity for adaptation of the ISSHP criteria in Japan.

DOI： 10.1111/jog.14017

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Language：English  

A 30-year-old woman with a bicorporeal uterus complained of abdominal pain and vaginal hemorrhage at 28 weeks and 5 days of gestation. There were no signs of placenta previa with echography in the second trimester; however, the echography showed a highly echoic area (91 × 85 mm), indicating placenta previa. Thereafter, abdominal pain and vaginal bleeding increased. Thus, we suspected placental abruption and performed cesarean section. After cesarean section, discharge of placenta-like tissue into the vagina was confirmed and pathological examination of the tissue showed only the decidua. In cases of uterine malformations, in which the uterine cavity is divided into pregnant and nonpregnant sides, the decidua on the nonpregnant side can be discharged before the onset of delivery. In addition, at the time of decidual discharge, echography findings are similar to those of placenta previa and the clinical symptoms are similar to those of placental abruption.

DOI： 10.1111/jog.13971

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

妊産婦の脳血管障害の頻度は稀であるが、妊産婦死亡原因の上位に位置する。しかし脳血管障害を発症した早産期妊婦の妊娠分娩管理に関して明確な基準はない。今回、我々は妊娠33週で脳動静脈奇形(arteriovenous malformation:AVM)破裂により急性硬膜下血腫をきたし重篤な意識障害を発症したが緊急帝王切開ののちに開頭血腫除去術を実施し、母児を救命しえた症例を経験した。高血圧を伴わない妊婦の意識障害の原因としてAVMを背景とした脳血管障害を念頭に置く必要があることが示唆された。また、妊娠中の脳血管障害を疑った際には脳神経外科を含めた集学的治療可能施設かつ早産児の管理可能な施設で母体を評価し、児の娩出時期を検討すべきである。(著者抄録)

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Language：Japanese   Publisher：神奈川産科婦人科学会  

子宮筋腫合併妊娠の頻度は3.2〜10.7%とされ、産後過多出血など妊娠時・分娩時合併症の頻度とリスクは増加する。今回我々は、粘膜下筋腫合併妊娠で産後過多出血をきたし子宮摘出を要した1例を経験したので報告する。症例は39歳2妊1産。自然妊娠し前医で健診を受けていた。妊娠初期に粘膜下筋腫(7.0×5.8cm)を指摘された。妊娠経過は順調で、妊娠38週5日、正常経腟分娩に至った。分娩後も持続的な出血があり、前医で子宮収縮薬の投与、大量輸液、輸血、子宮腔内バルーンタンポナーデを行ったが止血できず、出血量が4500gを超えたため分娩後19時間30分で当院へ搬送された。来院時、超音波で子宮内に7cm大の腫瘤影を認めた。Shock Index 1.1、Hb5.6g/dlであり、非凝固性の出血が持続し、DIC徴候を認めたため子宮摘出術を施行した。摘出検体では子宮内腔に7cm大の粘膜下筋腫を認め、総出血量は7304g、総輸血量は赤血球液製剤34単位、新鮮凍結血漿34単位であった。術後経過良好で、術後7日目に退院した。子宮筋腫合併妊娠では厳重な管理を行い、特に筋腫の位置や筋腫径によってはハイリスクとなるため、高次医療施設での管理が望まれる。また産後過多出血では、止血に難渋し抗DIC治療、外科的止血法が必要となりうるため、早期から高次医療施設への搬送を考慮することが重要である。(著者抄録)

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

妊娠30週で陣痛発来前に子宮破裂をきたし胎児死亡に至った。前回の帝王切開術時の筋層切開が逆T字切開であった1例を経験した。症例は32歳、4妊2産。前回の分娩は妊娠37週に陣痛発来し、骨盤位のため緊急帝王切開術を行ったが児娩出困難のため逆T字切開で児を娩出した。帝王切開術後7ヵ月で自然妊娠し、初期より前医で妊婦健診を受診していた。妊娠30週、夜間に突然の腹痛を訴えて救急要請し、前医を受診した。持続する胎児徐脈を認めたため、常位胎盤早期剥離を疑い当院へ母体搬送となった。来院時、腹痛の訴えあり、経腹超音波では児心拍認めず、子宮内胎児死亡、常位胎盤早期剥離の疑い、帝王切開術後妊娠のため、全身麻酔下で帝王切開術を施行した。腹腔内には凝塊血とDouglas窩に幸帽児で娩出された児を認め、子宮は腹側に圧排されていた。子宮体部前面に前回の逆T字切開創に一致する完全子宮破裂の所見を認めた。出血コントロールが得られていたため、子宮を温存して終刀した。帝王切開術をはじめとする子宮手術既往の有る妊婦は、その頻度は低いものの陣痛発来前の子宮破裂の可能性がある。帝王切開術後妊娠については、本症例のように切開方法が子宮体下部横切開以外であること、次回妊娠までの期間が短いことは子宮破裂のハイリスクであり、陣痛発来前に子宮破裂を起こす可能性もあるため、破裂の可能性を念頭に置いて管理すべきである。(著者抄録)

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：English   Publishing type：Research paper (scientific journal)  

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

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: The objective of this study is to examine the effect of low-glucose value on the 1-h 50-g glucose challenge test (GCT) on neonatal body weight in low-risk Asian singleton pregnant women. METHOD: We retrospectively analyzed women who delivered a singleton neonate at term at a tertiary center and underwent GCT at 24-28 weeks of gestation between June 2001 and June 2015. The low GCT group was defined as <75 mg/dL and 75-139 mg/dL were control. We compared these two groups of maternal characteristics, small for gestational age neonate (SGA), large for gestational age neonate (LGA), low-birth weight, and macrosomia. The χ2 test, Fisher's exact test, and Student's t test were used. RESULTS: There were 313 low GCT groups and 4611 control. The low GCT group were younger, had lower prepregnancy body weight, higher stature, and lower prepregnancy body mass index (BMI). After adjusting these variables, the low GCT group had a lower rate of LGA and a higher rate of SGA. Neonatal body weight is more influenced by maternal physique than by low GCT result (standardized coefficient (β); GCT 0.071, height 0.188, prepregnancy BMI 0.143). CONCLUSIONS: Neonatal body weight was only slightly influenced by low GCT result, but markedly influenced by maternal physique, such as height and prepregnancy BMI.

DOI： 10.1080/14767058.2017.1371130

PubMed

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：神奈川県医師会  

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Publishing type：Research paper (scientific journal)  

© 2019 S.O.G. CANADA Inc.. All rights reserved. Purpose of investigation: The purpose of the present study is to evaluate the perinatal outcome of expectant management for prolonged preterm premature rupture of membranes (PPROM) near the limit of fetal viability. Materials and Methods: Pregnant women who delivered babies between January 2000 and March 2015 and had a history of PPROM at 22–23 weeks of gestation with a latency of one week or longer were included in the PPROM cohort. The control cohort included women who delivered babies within 24 hours after PPROM during the same period. Perinatal outcomes were compared between the two cohorts. Results: No differences were observed between the two cohorts in terms of survival to discharge from the NICU (p = 0.43) and respiratory complication at one year of corrected age (p = 1.00). Conclusions: Prolonged PPROM did not affect the rate of survival discharge from NICU and respiratory complication at one year of corrected age.

DOI： 10.12891/ceog4196.2019

Scopus

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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

PubMed

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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

PubMed

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Language：Japanese   Publisher：(一社)日本妊娠高血圧学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：English   Publisher：Wiley  

As labor may mask a symptom of the rupture of ovarian cyst and delivery is a risk factor of its rupture, the possibility of rupture of ovarian cyst should always be considered during delivery.

DOI： 10.1002/ccr3.1554

PubMed

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

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Language：Japanese   Publisher：ライフサイエンス出版(株)  

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J-GLOBAL

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

腸間膜嚢腫とは,腸間膜に発生する嚢胞性腫瘍の総称で稀な疾患である.今回我々は,卵巣腫瘍疑いで経過観察中に合併した腸閉塞のため緊急開腹術を実施し,腸間膜嚢腫と判明した症例を経験したので報告する.症例は67歳.2回経妊0回経産.腹痛の主訴で近医内科を受診し,腹部CT検査で卵巣腫瘍を疑われ,当科紹介受診となった.腫瘤は経腟超音波検査にて径25cmであった.腫瘤の内部に腸管が蠕動運動しているような所見があり,同部位に血流を伴っていたが,MRI検査では卵巣腫瘍が疑われた.画像診断では悪性を示唆する所見はなく,腫瘍マーカーも陰性であったため,患者の希望により経過観察の方針とした.初診より7ヵ月後に下腹部痛と嘔吐を主訴として当院救急外来を受診し,腹部Xpと腹部CT検査で腸閉塞と診断した.腸閉塞の原因として,骨盤内腫瘍性病変の関与を疑い緊急開腹術を行ったところ,腸間膜嚢腫と判明した.術後経過は良好で,術後13日目で退院となった.腸間膜嚢腫は一般に特異的な症状に乏しく,画像所見上も特徴的な所見に乏しいため,その診断は困難であるが,卵巣腫瘍の鑑別診断の一つとして考慮する必要があると思われた.(著者抄録)

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

2005年1月から2010年12月の分娩総数5029例のうち、炎症性腸疾患(IBD)合併妊娠33例について報告した。内訳は潰瘍性大腸炎(UC)25例、Crohn病(CD)8例であった。妊娠中IBD治療薬を要さなかったのはUC群9例、CD群2例であった。UC群で臨床症状の悪化を認めたのは5例で、うち3例はIBD治療薬を自己中断していた。CD群では妊娠前よりCDコントロール不良であった1例を除くと、症状悪化を認めた症例はなかった。帝王切開術を選択したのはUC群3例、CD群4例で、UC群はいずれも産科的適応、CD群は産科的適応2例、CDの肛門近傍病変のためが2例であった。UC群の在胎週数は平均39.1週、CD群は38.6週で、早産はそれぞれ3例、2例であった。新生児体重はUC群2985g、CD群2785gで、胎児発育遅延を認めた症例もあったが、CDコントロール不良例以外にはIBDとの関連は示唆されなかった。新生児の奇形はUC群の1例にtrisomy 21が認められた。

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

1998年4月から13年間に管理したHIV感染妊娠症例31例(のべ21人)を対象とし、分娩例を中心に患者背景、妊娠経過、治療内容、転帰について後方視的に検討した。転帰は分娩16例(51.6%)、人工妊娠中絶12例、部分胞状奇胎1例、妊娠継続中2例であり、分娩例全例に抗ウイルス療法を行い、妊娠中に全例で貧血を認めたが、分娩時にHIV-RNA量が1000copies/mL以上であったのは1例のみで、他の15例は良好にコントロールされていた。分娩法は選択的帝王切開術15例、緊急帝王切開術1例であり、産後は全例人工栄養とし、新生児に対して生後6週間まで抗ウイルス療法を継続した。現在まで母子感染例は認めておらず、HIV感染例においても妊娠中に適切な対応を行うことで、通常の妊娠例とほぼ同等のリスクでの分娩管理が可能になると考えられた。

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Language：Japanese   Publisher：(一社)日本周産期・新生児医学会  

25歳(1経妊0経産)。自然妊娠による2絨毛膜2羊膜性双胎であり、妊娠32週2日に切迫早産の診断で塩酸リトドリン内服を開始したが、妊娠33週3日より呼吸困難が出現した。受診時には高血圧、体重の著明な増加を伴う全身浮腫、蛋白尿、経皮的動脈血酸素飽和度の低下、肺水腫を認めたため、母体適応にて緊急帝王切開術を行った。術後の心エコー検査、Swan-Ganzカテーテル検査にて左室駆出率と肺動脈楔入圧の低値を認め、肺水腫は非心原性の可能性が考えられた。しかし、肺水腫改善後も左室駆出率低値が持続し、心筋生検組織像で周産期心筋症以外の器質的疾患を疑わせる所見がなかったことから、肺水腫に合併した周産期心筋症と診断した。

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：(公社)日本産科婦人科学会  

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Language：Japanese   Publisher：神奈川産科婦人科学会  

66歳女。3日前から不正出血があり、経腟超音波で子宮内腔に液体貯留と内腔に突出する26×14mm大の扁平な充実性腫瘤を認めた。細胞診では子宮頸部、子宮内膜ともに異常細胞は認めず、子宮内膜組織診では異型のない萎縮状の子宮内膜に接して充実性に増殖する異型上皮細胞を認めた。異型細胞は核クロマチンが粗造でN/C比が高く、流れるような配列で充実性に増殖しており、管腔形成はみられず、非角化型扁平上皮癌と診断された。頸癌の可能性も否定できず、準広汎子宮全摘術および両側付属器摘出術を施行した。摘出子宮の大きさは80mm×50mmで、超音波で観察された子宮内腔の腫瘤は明らかではなく、右壁のやや頸部よりに20mm×10mmの陥凹した部分を認めた。陥凹部分には内膜上皮の欠損がみられるのみで残存腫瘍はなく、頸部には異形成を含め上皮性病変は認めなかった。FDG-PETでは他臓器原発を疑わせる異常集積像はなく、子宮原発と判断した。術後1年半以上経過し、再発所見は認めていない。

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

子宮筋層内妊娠の頻度は低く、帝王切開術後の子宮切開瘢痕部への妊娠が多い。妊娠のフォロー中に疑われる場合の他、不正性器出血や急性腹症を契機として診断される場合もある。今回我々は、敗血症を呈し、その治療の過程で子宮筋層内妊娠と診断した症例を経験したので報告する。症例は45歳、7回経妊3回経産(3回経腟分娩、2回人工流産、2回自然流産)。悪寒、発熱を主訴に当院救急外来に受診した。41.4℃の高熱で、WBC21,300μl、CRP20.1mg/dlと炎症所見が強く、全身状態不良であった。敗血症を疑い、入院の上、抗生剤の投与を開始した。CT検査で骨盤内に低吸収領域を認め、経腟エコーでは、子宮底部に径3cmの腫瘤影を認めたが、同部位に圧痛なく、子宮の可動性も良好であったため、抗生剤治療を継続した。しかし、症状が遷延したため、MRI検査を行い、子宮底部に内部不均一、T2強調画像で高輝度に映る腫瘤影を確認した。変性子宮筋腫および周囲の炎症を疑い、保存的治療ではこれ以上の改善は困難と判断し、腹式単純子宮全摘術を施行した。子宮は鵞卵大で両側付属器、腹腔内に癒着を認めなかった。摘出した子宮の底部筋層内に径3.5cmの腫瘤を認め、内部は壊死していた。病理学的検査で子宮筋層内部の膿瘍内に絨毛、脱落膜を認め、子宮筋層内妊娠の診断に至った。術後経過は良好で、術後8日で退院となった。子宮筋層内妊娠は、頻度は低いが、本例のように敗血症に至る場合もあり、特に子宮内操作の既往のある女性において、子宮筋層内に腫瘤を認める場合には鑑別診断の一つとして考慮する必要があると考えられた。(著者抄録)

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CiNii Books

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CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2017199608

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CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2017086071

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CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2017033879

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CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2017017728

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CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2017017734

Language：Japanese   Publisher：金原出版  

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Other Link： http://search.jamas.or.jp/link/ui/2016351349

Language：Japanese   Publisher：東京医学社  

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Other Link： http://search.jamas.or.jp/link/ui/2016151172

Language：Japanese   Publisher：日本産科婦人科学会  

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Other Link： https://projects.repo.nii.ac.jp/?action=repository_uri&item_id=456712

Language：Japanese   Publisher：日本産科婦人科学会  

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CiNii Books

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Language：Japanese   Publisher：日本産科婦人科学会  

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Language：Japanese   Publisher：日本産科婦人科学会  

CiNii Books

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Other Link： https://projects.repo.nii.ac.jp/?action=repository_uri&item_id=457305

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CiNii Books

J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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CiNii Books

J-GLOBAL

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CiNii Books

J-GLOBAL

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Language：Japanese   Publisher：日本産科婦人科学会  

CiNii Books

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Other Link： https://projects.repo.nii.ac.jp/?action=repository_uri&item_id=454451

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CiNii Books

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Other Link： https://projects.repo.nii.ac.jp/?action=repository_uri&item_id=453425

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Other Link： http://search.jamas.or.jp/link/ui/2013355337

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Other Link： http://search.jamas.or.jp/link/ui/2013179270

Language：Japanese   Publisher：日本遺伝カウンセリング学会  

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Language：Japanese   Publisher：社団法人日本産科婦人科学会  

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Language：Japanese   Publisher：日本産科婦人科学会  

CiNii Books

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Other Link： https://projects.repo.nii.ac.jp/?action=repository_uri&item_id=449278

Language：Japanese   Publisher：日本産科婦人科学会  

CiNii Books

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Other Link： https://projects.repo.nii.ac.jp/?action=repository_uri&item_id=448742

Language：Japanese   Publisher：日本産科婦人科学会  

CiNii Books

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Other Link： https://projects.repo.nii.ac.jp/?action=repository_uri&item_id=448889

Language：Japanese   Publisher：日本産科婦人科学会  

CiNii Books

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Other Link： https://projects.repo.nii.ac.jp/?action=repository_uri&item_id=448891

Language：Japanese   Publisher：日本産科婦人科学会  

CiNii Books

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Other Link： https://projects.repo.nii.ac.jp/?action=repository_uri&item_id=448798

Language：Japanese   Publisher：(公社)日本婦人科腫瘍学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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Language：Japanese   Publisher：医学書院  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2010270515