記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(一社)日本遺伝カウンセリング学会  

Nuchal translucency(NT)肥厚は胎児染色体異常や先天異常と関連し,出生前遺伝学的検査の一つとなっているが,通常の妊婦健診で指摘されることもあり,その情報提供に難渋する症例も少なくない。そこで当院の出生前診断外来を受診した妊婦のうち胎児NT肥厚が認められた児の転機をまとめ,その対応のあり方を考察した。単胎154例のうちNT値は2.5～16mmであった。染色体異常・形態異常のない症例は61.7%,染色体異常は26%,形態異常は7.1%であった。NT3mm未満(43例)では1例を除き,生児を得ていた。またNT肥厚6.5mm以上(26例)では1例であるが染色体異常も形態異常も認めず生児を得ていた。NT肥厚症例に対しては,正しい情報に基づいた出生前遺伝カウンセリングが行われる必要があり,その遺伝カウンセリングは慎重に対応する必要がある。(著者抄録)

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掲載種別：研究論文（学術雑誌）   出版者・発行元：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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その他リンク： https://link.springer.com/article/10.1186/s12902-022-01124-1/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: In Japan, the criteria of the latent and active phases of the first stage of labor have not been decided. The Japan Society of Obstetrics and Gynecology (JSOG) Perinatal Committee conducted a study to construct a spontaneous labor curve in order to determine the point of onset of the active phase. METHODS: The participants were women who had spontaneous deliveries at four health facilities in Japan between September 1, 2011, and September 31, 2019. Spontaneous delivery was defined as the spontaneous onset of labor at term (37 weeks, 0 days to 41 weeks, 6 days) with vaginal delivery of a mature fetus in a cephalic position without uterotonic agents or epidural analgesia. The time points for each "cm" of dilation were collected starting from the time of full dilation retrogradely. The relationship between time since labor onset and cervical dilation was expressed as a curve using a smoothing B-spline. RESULTS: A total of 4215 primiparous and 5266 multiparous women were included in this study. The spontaneous labor curve showed that in both primiparous and multiparous women, labor progress was slow until 5 cm cervical dilation, accelerating between 5 and 6 cm dilation, and steadily progressed after 6 cm dilation. CONCLUSION: We propose that the active phase of the first stage of labor be defined as starting at 5 cm dilation of the cervix, and that it be divided into an acceleration phase (5-6 cm dilation) and a maximal phase (>6 cm dilation).

DOI： 10.1111/jog.15053

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記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：日本語   出版者・発行元：(一社)日本遺伝カウンセリング学会  

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記述言語：日本語   出版者・発行元：(一社)日本遺伝カウンセリング学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: In 2010, the Japan Society of Obstetrics and Gynecology (JSOG) changed the diagnostic criteria for gestational diabetes mellitus (GDM) to follow the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. As a result, many pregnant women with mildly impaired glucose tolerance (IGT) were newly diagnosed with GDM. This study aimed to verify the effects of interventions in pregnant women with mild IGT who were newly diagnosed with GDM based on the present JSOG criteria. METHODS: We defined mild IGT as a degree of IGT that would be diagnosed as GDM according to the present but not the previous JSOG criteria. We compared pregnancy and delivery outcomes in women with mild IGT who delivered a singleton at 22 weeks of gestation or later, between 2000 and 2009 (untreated group, n = 503) versus between 2011 and 2017 (treated group, n = 781). RESULTS: The incidence of GDM-related composite complications such as macrosomia, shoulder dystocia, neonatal hypoglycemia, neonatal hyperbilirubinemia, and neonatal respiratory distress syndrome was comparable in the untreated and treated groups (10.1% vs. 11.9%, p = 0.11). The pregnancy outcomes were also comparable, except for infant birth weights, which were lower in the treated group than in the untreated group (3014 g vs. 3094 g; p = 0.02). CONCLUSIONS: Pregnancy outcomes were not affected by the interventions in pregnant women with mild IGT.

DOI： 10.1111/jog.14783

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In 2010, the International Association of Diabetes and Pregnancy Study Group (IADPSG) proposed new criteria indicating that gestational diabetes mellitus (GDM) can be diagnosed if the fasting threshold of ≤92 mg/dL, 1-h threshold of ≤180 mg/dL, or 2-h threshold of ≤153 mg/dL are exceeded during the 75-g 2-h oral glucose tolerance test (OGTT) performed at 24-28 weeks of gestation. The World Health Organization (WHO) recommends using the proposed diagnostic threshold values of the IADPSG to diagnose GDM; however, it does not limit the timing of the 75-g OGTT. Since 2010 in Japan, GDM has been diagnosed using the same criteria as that proposed by the WHO. However, neither the JSOG nor the WHO has provided any evidence that it is appropriate to use a threshold beyond the range recommended by the IADPSG. METHODS: This was a single-centre retrospective study based on the medical records and delivery registry database of our centre. We included women who underwent a 50-g glucose challenge test (GCT) with results < 140 mg/dL at 24-28 weeks of gestation and subsequently underwent a 75-g OGTT after 29 weeks of gestation with abnormal glucose tolerance suspected based on clinical findings. The reference values for the 75-g OGTT followed the IADPSG criteria. Subjects were classified into the normal glucose tolerance (NGT) group and the GDM group. The type of delivery and neonatal outcomes of the two groups were compared. A multivariable analysis was performed to match the backgrounds of both groups. RESULTS: In total, the NGT and GDM group comprised 189 and 49 women, respectively. Emergency caesarean delivery rates were similar in the GDM and NGT groups (10.6 and 12.2%, respectively; adjusted odds ratio [OR], 1.25; 95% confidence interval [CI], 0.43-3.64; p = 0.74); however, the elective caesarean delivery rate was higher in the GDM group than in the NGT group (16.3 and 5.3%, respectively, adjusted OR, 3.60; 95% CI, 1.27-10.19; p = 0.01). No significant differences were observed in other maternal and neonatal outcomes between both groups. CONCLUSION: Although a diagnosis of GDM during the third trimester does not improve pregnancy outcomes, it increases the elective caesarean delivery rate.

DOI： 10.1186/s12884-021-03730-8

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記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

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記述言語：日本語   出版者・発行元：神奈川県医師会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: Reports on pregnancy and delivery in women with Turner syndrome (TS) in Japan are limited to case reports, and the current situation remains unclear. Therefore, this study aimed to clarify the current situation of pregnancy and delivery in women with TS in Japan. METHODS: Our study comprised primary and secondary surveys and we included perinatal centers approved by the Ministry of Health, Labor and Welfare. RESULTS: A total of 24 cases from 19 facilities were reported, and we obtained individual information for 20 cases from 16 facilities. Of these 20 patients, 13 (65%) had become pregnant via oocyte donation. Three of these patients had received oocyte donation in Japan, while the other 10 had received donations in foreign countries. The other seven patients became pregnant with their own oocyte, with spontaneous menarche. Live babies were delivered by 18 patients, while an induced abortion was required at 18 weeks of gestation in one patient and an intrauterine fetal death from an unknown cause was detected at 38 weeks of gestation in another patient. Cesarean section was performed in 14 patients, with the most frequent indication being cephalopelvic disproportion. The rate of implementation of screening for complications related to TS was low, suggesting insufficient cooperation between facilities responsible for TS treatment, infertility and pregnancy and delivery management. CONCLUSION: To improve pregnancy outcomes in women with TS, improved cooperation between facilities and laws regarding oocyte donation in Japan are needed.

DOI： 10.1111/jog.14352

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記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

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記述言語：日本語   出版者・発行元：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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記述言語：日本語   出版者・発行元：神奈川県医師会  

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記述言語：日本語   出版者・発行元：神奈川県医師会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS/INTRODUCTION: This study aimed to investigate the effects of the introduction of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for diagnosing gestational diabetes mellitus (GDM) on maternal and neonatal outcomes in Japan. MATERIALS AND METHODS: This was a retrospective study carried out at a tertiary center in Japan. Previously in Japan, GDM was diagnosed if two or more of the following Japan Society of Obstetrics and Gynecology (JSOG) criteria were met: fasting plasma glucose ≥100 mg/dL, 1-h value ≥180 mg/dL or 2-h value ≥150 mg/dL on the 75-g oral glucose tolerance. Since 2010, GDM has been diagnosed if one or more of the following IADPSG criteria are met: fasting plasma glucose ≥92 mg/dL, 1-h value ≥180 mg/dL or 2-h value ≥153 mg/dL on the 75-g oral glucose tolerance. We compared the pregnancy outcomes of all pregnant women with singleton pregnancies after 22 weeks' gestation at our hospital before (JSOG period) and after (IADPSG period) the IADPSG criteria were adopted. RESULTS: There were 3,912 women in the JSOG period and 4,772 in the IADPSG period. GDM prevalence increased from 2.9% in the JSOG period to 13% in the IADPSG period (P < 0.001). No significant differences between the groups were found in rates of macrosomia, or large for gestational age, and no significant differences were found in birthweight. The neonatal hypoglycemia rate and neonatal intensive care unit admission rate were significantly lower in the IADPSG period (adjusted odds ratio 0.51 and 0.78, respectively). CONCLUSIONS: Introduction of the IADPSG criteria for diagnosing GDM increased GDM diagnosis frequency fourfold, but reduced neonatal intensive care unit admission and neonatal hypoglycemia rates significantly.

DOI： 10.1111/jdi.13223

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

本邦では梅毒感染者の増加が報告され、梅毒合併妊娠及び先天梅毒の報告も増加している。今回、妊娠初期に梅毒血清反応陰性であったが妊娠中に梅毒感染をきたした梅毒合併妊娠の一例を報告する。症例は34歳2妊1産、自然妊娠後、初期より妊婦健診を受診し、妊娠初期検査では梅毒血清反応陰性であった。妊娠32週に手掌及び足部に皮疹が出現し、梅毒血清抗体価が陽性であったため妊娠36週0日に当科紹介となった。胎児は超音波、胎児心拍モニターともに明らかな異常は認めず、ペニシリンGの点滴で治療を開始し分娩まで継続した。妊娠37週6日に陣痛発来し自然経腟分娩に至り、新生児に先天梅毒を疑わせる症状は認めなかったが、同日より予防的にペニシリンGの点滴を開始した。その後、血清反応と髄液抗体反応の陰性を確認し治療を終了した。母体は治療を計4週間継続し、皮疹、血清抗体価ともに改善した。梅毒合併妊娠は、流死産、早産などのリスクを上昇させるため、診断後に早急に治療を要する。治療未完遂の際は先天梅毒を考慮し、新生児の血液検査、髄液検査を行う必要があり、検査、治療のために高次医療施設での管理が必要とされる。梅毒の臨床症状は多岐にわたるが、手掌、足底の皮疹は特徴的な所見であり、妊娠初期検査が陰性であっても症状や問診から梅毒が疑わしい場合には、早急に検査し治療につなげ、新生児先天梅毒の予防に努めるべきである。(著者抄録)

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記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

To estimate pregnancy complications in women newly diagnosed with gestational diabetes mellitus (GDM) according to the new International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and verify the validity of introducing the IADPSG criteria in Japan. This retrospective study included data from women with singleton delivery at 22 weeks or later at a tertiary hospital during 2000-2009. We compared pregnancy outcomes between women who would now be diagnosed with GDM according to the IADPSG criteria but not by the old JSOG criteria (IGT group, n = 503) and women with normal glucose tolerance according to both the criteria (NGT group, n = 2,789). Multivariate analysis was performed and adjusted for background factors. Maternal age at delivery and pre-pregnancy BMI were significantly higher in the IGT group than in the NGT group, while gestational weeks at delivery did not differ between the groups. No difference was observed in the rates of GDM-related composite complications (defined as cases with at least one of the following: macrosomia, shoulder dystocia, neonatal hypoglycemia, neonatal hyperbilirubinemia, or neonatal respiratory distress syndrome) at 11.9% and 8.8% (adjusted odds ratio (OR) 1.30, 95% confidence interval (CI) 0.90-1.87, p = 0.16). Pregnancy outcomes did not differ significantly between the IGT and NGT groups, except for frequencies of total neonatal admissions at 10.5% and 7.1%, respectively (adjusted OR 1.55, 95% CI 1.12-2.13, p < 0.01).

DOI： 10.1507/endocrj.EJ19-0279

PubMed

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記述言語：日本語   出版者・発行元：神奈川県医師会  

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記述言語：日本語   出版者・発行元：神奈川県医師会  

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記述言語：日本語   出版者・発行元：神奈川県医師会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We aimed to investigate the optimal range of gestational weight gain (GWG) for Japanese underweight (body mass index <18.5 kg/m2) women using the Japanese Birth Registry System. The study subjects included underweight women who were divided into groups according to the GWG recommendations of the Ministry of Health, Labour and Welfare (MHLW) (9-12 kg): <9.0 kg, group A; 9-12 kg, group B; and >12 kg, group C. The subjects were then classified according to the recommendations of the Institute of Medicine (IOM) (12.7-18.1 kg): <12.7 kg, group D; 12.7-18.1 kg, group E; and >18.1 kg, group F. In total, 148,135 cases were analysed. The frequencies of small for gestational age, preterm delivery, and caesarean delivery were as follows: 19.3%, 22.7%, and 28.5% for group A; 11.7%, 8.7%, and 22.8% for group B; 8.0%, 4.9%, and 21.5% for group C; 15.0%, 14.7%, and 25.2% for group D; 8.0%, 5.3%, and 21.5% for group E; and 7.0%, 5.5%, and 25.0% for group F, respectively. These results indicated that groups C and E had the best outcomes. Therefore, the IOM guidelines seem more appropriate than the MHLW guidelines. Therefore, the MHLW recommended GWG guidelines require revision.

DOI： 10.1038/s41598-019-54550-y

PubMed

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記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

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記述言語：日本語   出版者・発行元：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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Introduction: The purpose of this study was to classify patients with placental abruption (PA) into those with a history of PA (recurrence group) and those without a history (first-occurrence group), and compare the two groups to investigate whether perinatal outcomes differ between first-time PA and recurrent PA. Materials and methods: Subjects include 6475 patients diagnosed with PA from the Pregnancy Birth Registry System of the Japan Society of Obstetrics and Gynecology. Patients were classified into recurrence group and first-occurrence group. Perinatal outcomes were compared between 141 patients in the recurrence group and 705 patients in the first-occurrence group with 1:5 propensity score matching, adjusting for maternal age, history of smoking, pregnancy-induced hypertension, and premature rupture of membranes as covariates. Results: There were no cases of maternal mortality in either groups, and the perinatal mortality rate did not exhibit a significant difference. Gestational age at delivery was significantly earlier in the recurrence group than in the first-occurrence group (35.3 vs 37.9 weeks, p < .001). The rate of preterm delivery at less than both 32 and 37 weeks of gestation was significantly higher in the recurrence group. The rate of UmApH < 7.1 and 5 min Apgar score < 7 were significantly higher in the recurrence group (21 vs 13%, p = .020, 20% vs 10%, p = .003, respectively). Conclusions: The results suggest that recurrent PA occurs at an earlier gestational age and follows a more severe course than the first occurrence of PA.

DOI： 10.1080/14767058.2019.1660766

PubMed

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

PubMed

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記述言語：日本語   出版者・発行元：神奈川県医師会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：神奈川県医師会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(一社)日本妊娠高血圧学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：神奈川県医師会  

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記述言語：英語  

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

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PUBLIC LIBRARY SCIENCE  

OBJECTIVE: To compare the efficacy and safety of hygroscopic dilators and balloon catheters for ripening of the cervix in induction of labor. STUDY DESIGN: This 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. RESULTS: The 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. CONCLUSION: With 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

Web of Science

PubMed

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記述言語：英語  

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

PubMed

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記述言語：英語  

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

PubMed

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

mitotically active cellular fibroma(MACF)は,卵巣線維芽細胞性腫瘍の中で,細胞密度が高く,核分裂像も多くみられるが,核異型は軽度なものを呼ぶ.その多くは予後良好で再発例も少ない.今回我々は,再発を繰り返したMACFの一例を経験したので報告する.症例は64歳,5回経妊5回経産.閉経50歳.X年1月,腹部膨満感を主訴に近医を受診した.骨盤内腫瘤及び腹水貯留を認め,精査加療目的に当科を紹介され受診した.卵巣腫瘍の診断で骨盤内腫瘍摘出術及び両側付属器摘出術を施行した.腫瘍は手拳大,表面平滑で左卵巣との連続性を認めたが卵巣には異常所見は認めなかった.病理組織診断の結果は過剰卵巣から発生したMACFであった.その後約5年間に2度の再発を繰り返し,それぞれ摘出術を要した.現在慎重に経過観察中であるが再発の兆候は見られていない.MACFは基本的には予後良好で再発することは稀であるとされている.しかし,癒着や腫瘍の被膜破綻を認める場合,再発のリスクが高いと考えられ,慎重な経過観察が必要である.また,再発予防について腫瘍の完全切除以外の有効な治療法は報告が無く,今後の検討が必要と考えられる.(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J05804&link_issn=&doc_id=20140410180012&doc_link_id=20504&url=http%3A%2F%2Fjsog-k.jp%2Fjournal%2Flfx-journal_detail-id-20504.htm&type=%8A%D6%93%8C%98A%8D%87%8EY%89%C8%95w%90l%89%C8%8Aw%89%EF%8E%8F%28~%91%E651%8A%AA3%8D%86%29&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00020_3.gif

記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

8歳女児。腹痛と腹部膨満を主訴に近医を受診、卵巣腫瘍が疑われたため著者らの施設へ紹介となった。腹部造影CTおよび骨盤MRI所見より腹膜播種を伴う卵巣未熟奇形の疑いで左付属器摘出術、大網切除術ほか、ダグラス窩病変の生検が行われた。その結果、病理組織学的に腹膜神経膠腫を伴った未熟奇形腫で、術後は化学療法としてJEB療法を4コース施行後、横隔膜下とダグラス窩の結節摘出、残存大網切除が追加された。

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：日本語   出版者・発行元：横浜市立大学医学会  

背景:近年,遺伝性乳がん卵巣がん症候群(HBOC)を含めた各種遺伝学的検査の保険診療が拡充している中で,2020年4月から当院に遺伝子診療科が新設された.これまで各診療科で対応していたBRCA遺伝学的検査に対し,2021年4月から検査前から遺伝カウセリングを行う体制とした.遺伝子診療科開設前後のBRCA遺伝学的検査実施体制についてまとめ,問題点や今後の課題について考察した.対象と方法:2018年8月～2022年2月に当院でBRCA遺伝学的検査実施検討症例について,診療録をもとに後方視的に検討した.結果:BRCA遺伝学的検査実施症例は173例,BRCA変異陽性は18例(10.4%),陰性153例(88.4%),variant of uncertain significance(VUS) 2例(1.2%)であった.遺伝子診療科開設後は全例自施設で検査後カウンセリングが実施できていたが,サーベイランスに結びついている症例は5例,家系員の検査実施は2例のみであった.また多遺伝子パネル検査を推奨する症例25例(80.6%)にも,適切な遺伝カウンセリングが実施できていた.結語:検査前遺伝カウンセリングは重要であるが,HBOCと診断された家系員の検査の受検率の向上や,他の遺伝性腫瘍が疑われる患者への介入,遺伝カウンセリングの継続のタイミングなど,今後も検討が必要である.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01499&link_issn=&doc_id=20230111330001&doc_link_id=https%3A%2F%2Fycu.repo.nii.ac.jp%2Frecords%2F2600&url=https%3A%2F%2Fycu.repo.nii.ac.jp%2Frecords%2F2600&type=%E6%A8%AA%E6%B5%9C%E5%B8%82%E7%AB%8B%E5%A4%A7%E5%AD%A6%EF%BC%9A%E6%A8%AA%E6%B5%9C%E5%B8%82%E7%AB%8B%E5%A4%A7%E5%AD%A6%E5%AD%A6%E8%A1%93%E6%A9%9F%E9%96%A2%E3%83%AA%E3%83%9D%E3%82%B8%E3%83%88%E3%83%AA&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80205_3.gif

記述言語：日本語   出版者・発行元：(一社)日本糖尿病・妊娠学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病・妊娠学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

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記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

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記述言語：日本語   出版者・発行元：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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記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本遺伝カウンセリング学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

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記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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