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This article discusses the current status of paternal mental health care in obstetric institutes in Japan. Perinatal depression, which affects up to 15% of women, has been recognized as a common problem that can have adverse impacts on child development. In recent years, there has been a growing belief in Japan that the mental health of the whole family, including fathers, should be supported. However, the actual status of awareness and support for paternal depression in obstetric institutes has not been well analyzed. The article highlights the need to incorporate fathers into perinatal mental health care programs to support healthy families. [Extracted from the article]

Purpose: In Japan, the lack of obstetricians has made it impossible for a strict 24-h delivery monitoring system for high risk deliveries such as vaginal breech delivery at many obstetric facilities. The outcomes in the trial of vaginal breech delivery of singleton pregnancy limited one day at 37-38 weeks' gestation were examined.Materials and Methods: A planned induction of vaginal breech delivery at 37-38 weeks' gestation was performed in 72 women who got consent form April 2006 to March 2016 as follows: (1) insertion of a balloon catheter into the uterine cervix filled with a sterile saline fluid of 400-500 mL, (2) intravenous administration of oxytocin after confirming of the natural falling out by itself of the balloon catheter, and (3) selection of cesarean delivery when vaginal delivery cannot be expected by evening. The perinatal outcomes of them were examined from patient charts.Results: The completion rate of vaginal delivery in total was 67% (48/72). There were no cases of neonatal asphyxia or respiratory disorders. The severe perineal lacerations occurred in one case (2%).Conclusion: Planned vaginal breech delivery limited one day at 37-38 weeks' gestation seemed to be valid and safe and it can be one of the options for breech delivery in Japan. [ABSTRACT FROM AUTHOR]

The letter discusses a study comparing the labor curves between spontaneous and induced labor. The author expresses concern about the potential bias caused by the presence or absence of epidural anesthesia in the comparison. They suggest that a labor curve should be developed for both scenarios to provide a more accurate analysis. The letter is written by Shunji Suzuki and reported by the author. [Extracted from the article]

We examined the relation between smoking habits and maternal mental status such as depression and anxiety during the first trimester of pregnancy. Between July 2016 and June 2018, we examined the increased odds of depressive and anxiety symptoms in the women with smoking habits during prepregnancy with and without smoking cessation during the first trimester of pregnancy in comparison with those without smoking habits using self-administered questionnaires. The rate of depressive and anxiety symptom in the women with smoking habits during prepregnancy (46.4 and 47.3%, respectively) was higher than those in the women without smoking habits during the first trimester of pregnancy irrespective of smoking cessation. The rate of depressive or anxiety symptom during the first trimester of pregnancy did not change significantly by smoking cessation in the women with smoking habits during prepregnancy (depressive symptom: 44.6 versus 53.7%, p =.13; anxiety symptom: 45.3 versus 55.2%, p =.17). Smoking habits during prepregnancy seemed to be associated with the increased perinatal mental disorders irrespective of smoking cessation. [ABSTRACT FROM AUTHOR]

Objective: We examined factors associated with the development of spontaneous intertwin membrane separation in dichorionic twin pregnancy.Methods: Medical charts of 618 dichorionic twin pregnancies without the history of amniocentesis managed after 22 weeks' gestation at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2017 were reviewed.Results: Twenty-four cases (3.9%) were diagnosed with spontaneous intertwine membrane separation. The presence of different fetal sex and separated placentae were associated with the development of spontaneous intertwin membrane separation in dichorionic twin pregnancy (different fetal sex: crude odds ratio 2.44, 95% confidence interval, 1.1-5.5, p = .03; separated placentae: crude odds ratio 4.14, 95% confidence interval, 1.3-13, p = .01).Conclusion: The development of spontaneous intertwin membrane separation in dichorionic twin pregnancies seemed to be associated with dizygotic. [ABSTRACT FROM AUTHOR]

Under the COVID-19 (Coronavirus Disease 2019) pandemic, limitations are known to cause some psychosocial problems. We compared the results of mental screening of the postpartum women conducted during the COVID-19 epidemic with those at the same period last year. Based on the results, the worse mother-infant bonding was suspected at 1 month after birth under the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: In April 2008, the guidelines for obstetric practice in Japan have made the following recommendations: (1) do not use vacuum extraction (VE) for more than 20 min, and consider forceps delivery (FD) or an emergency cesarean section (CS) if necessary (20-minute VE trial rule), and (2) do not try VE more than five times, even if VE has been used for less than 20 min (5-time VE trial rule). The aims of the present study were to compare the obstetric policies related to failed VE before and after 2008.Methods: We reviewed the obstetric records of all cases of VE in cases of singleton pregnancy with a neonatal birth weight ≥ 2500 g beyond 37 weeks' gestation at our hospital from April 2002 to March 2014.Results: The success rate of VE decreased significantly (96.8 versus 94.1%, p = .02), while the rate of CS increased significantly (2.2 versus 5.0%, p < .01); however, there were no significant differences in these values between the two periods.Conclusions: We could not find the effects of the recommendation limiting the practice of VE. [ABSTRACT FROM AUTHOR]

In Japan, uterine cancer screening during pregnancy is subsidized by public funds. We examined the current status of the results of cervical cytology conducted during pregnancy in Japan. We requested 2,293 obstetrical facilities to provide information on cervical cytology in pregnant women who delivered between October 2018 and March 2019. A total of 1,292 obstetrical facilities responded, with valid information on a total of 238,743 women. The implementation rate of cervical cytology during pregnancy was 86.8% in Japan. The prevalence of abnormal cervical cytology during pregnancy was 3.3% in total and 4.9% using a spatula/brush with liquid-based cytology (LBC). The prevalence of positive high-risk human papillomavirus (HPV) in teenagers with atypical squamous cells of undetermined significance (ASC-US) was significantly higher than women of other ages (p < 0.01). Because HPV vaccine coverage has dropped to less than 1% in Japan, a further study with various conditions will be needed to improve the accuracy of cervical cancer screening during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: We examined the clinical significance of pregnancies with true umbilical cord knots related to umbilical cord length. Methods: The material reviewed consisted of the total population of Japanese women who gave birth to singleton babies at 34–41 weeks' gestation at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2017. Results: During the study period, there were 32,315 Japanese women who gave birth to singleton babies at 34–41 weeks' gestation. Of these, true umbilical cord knots were recognized in 209 cases (0.6%). In addition, excessively long umbilical cords were recognized in 98 of the 209 cases (46.9%). On multivariate analysis, true umbilical cord knots were associated with intrauterine fetal demise (adjusted OR 5.65, 95% confidence interval [CI] 1.9–17, p =.02) and excessively long umbilical cord (adjusted OR 8.26, 95% CI 6.0–11, p <.01). The incidence of intrauterine fetal demise in cases with the excessively long umbilical cord (0%) was significantly lower than that without excessively long umbilical cord (4.2%, p =.04), and it was not different measurably from that without true umbilical cord knots (0.3%, p = 1.00). Conclusions: Excessively long umbilical cords may contribute to the decreased risk of intrauterine fetal demise in singleton pregnancies delivered at ≥34 weeks' gestation. [ABSTRACT FROM AUTHOR]

Objective: We examined the clinical utility of the Whooley questions in comparison with that of the Edinburgh Postnatal Depression Scale (EPDS) in Japan.Methods: We carried out mental health screening of all postnatal mothers (n = 258) who gave birth to singleton babies at term attending our hospital using the EPDS and the Whooley questions. For the EPDS, scores were calculated, and a score of nine points or more was regarded as "positive screening" according to the results of previous observations in Japan. For the Whooley questions, if at least one question was answered "yes," we diagnosed it as "positive screen."Results: The positive rate of the Whooley questions was 16.7%, while that of the EPDS (≥ 9 points) was 14.8% (p = .55). The incidence of postpartum depression was 5.4%. The difference in the sensitivity and positive predictive value of the two tools did not reach significance (p = .09 and .45, respectively).Conclusions: There were no significant differences in accuracy on comparing the two screening tools. We should examine how to use the two tools according to the regional support systems. [ABSTRACT FROM AUTHOR]

Background: Screening of pregnant women carrying human T-lymphotropic virus type 1 (HTLV-1) has a crucial role in reducing the number of HTLV-1 carriers. A national HTLV-1 screening program for pregnant women was started in 2011 in Japan. The purpose of this study is to report on the implementation of this nationwide screening program. Methods: This was a retrospective repeated cross-sectional study. We used datasets from surveys of HTLV-1-antibody-positive pregnant women performed by the Japan Association of Obstetricians and Gynecologists in 2011, 2013, and 2016. Outcomes for evaluation included the number of persons (pregnant women) who conducted the screening test, the number of positive persons (women) identified by these tests, and the proportion of positive persons to the number of persons (women) who conducted the tests. Results: Numbers of target facilities changed yearly: 1857 in 2011, 2544 in 2013, and 2376 in 2016. The mean number of screening-test participants increased per facility, but the median increased or decreased. The mean number of positive individuals identified decreased. Multivariate analysis results revealed the number of screenings was slightly reduced yearly, although areas (Kanto and Kinki) and high volume in facility types increased. Regarding the positive rates, some areas (Hokkaido/Tohoku, Kanto, and Chugoku/Shikoku) exhibited decreases or increases by facility type. The number of western blotting (WB) implementations decreased in 2016, positive rates identified by WB decreased in 2016 in all areas, and the number of facility types increased. The number of PCR participants increased in 2016 in Kanto and Kinki, but a decrease in facility type was observed. Positive rates were decreased in all areas (except the central region) but facility types were increased. Conclusions: The nationwide screening program for HTLV-1 in Japan was almost fully implemented. However, regional variations in screening tests were observed during this implementation. Thus, some incentives are needed to encourage proper implementation across all regions. [ABSTRACT FROM AUTHOR]

Background: Screening of pregnant women carrying human T-lymphotropic virus type 1 (HTLV-1) has a crucial role in reducing the number of HTLV-1 carriers. A national HTLV-1 screening program for pregnant women was started in 2011 in Japan. The purpose of this study is to report on the implementation of this nationwide screening program.Methods: This was a retrospective repeated cross-sectional study. We used datasets from surveys of HTLV-1-antibody-positive pregnant women performed by the Japan Association of Obstetricians and Gynecologists in 2011, 2013, and 2016. Outcomes for evaluation included the number of persons (pregnant women) who conducted the screening test, the number of positive persons (women) identified by these tests, and the proportion of positive persons to the number of persons (women) who conducted the tests.Results: Numbers of target facilities changed yearly: 1857 in 2011, 2544 in 2013, and 2376 in 2016. The mean number of screening-test participants increased per facility, but the median increased or decreased. The mean number of positive individuals identified decreased. Multivariate analysis results revealed the number of screenings was slightly reduced yearly, although areas (Kanto and Kinki) and high volume in facility types increased. Regarding the positive rates, some areas (Hokkaido/Tohoku, Kanto, and Chugoku/Shikoku) exhibited decreases or increases by facility type. The number of western blotting (WB) implementations decreased in 2016, positive rates identified by WB decreased in 2016 in all areas, and the number of facility types increased. The number of PCR participants increased in 2016 in Kanto and Kinki, but a decrease in facility type was observed. Positive rates were decreased in all areas (except the central region) but facility types were increased.Conclusions: The nationwide screening program for HTLV-1 in Japan was almost fully implemented. However, regional variations in screening tests were observed during this implementation. Thus, some incentives are needed to encourage proper implementation across all regions. [ABSTRACT FROM AUTHOR]

Global warming has caused such problems as the poor coloration of grape skin and the decreased production of high-quality berries. We investigated the effect of synephrine (Syn) on anthocyanin accumulation. Anthocyanin accumulation in cultured grape cells treated with Syn at concentrations of 1 mM or higher showed no significant difference, indicating that the accumulation was concentration-independent. On the other hand, anthocyanin accumulation was dependent on the compound used for treatment. The sugar/acid ratio of the juice from berries treated with Syn did not differ from the control. The expression of anthocyanin-biosynthesis-related genes, but not phytohormones, was increased by the treatment with Syn at 24 h or later. The Syn treatment of cultured cells increased SOD3 expression and hydrogen peroxide (H2O2) production from 3 to 24 h after treatment. Subsequently, the expression of CAT and APX6 encoding H2O2-scavenging enzymes was also increased. Treatment of cultured cells with Syn and H2O2 increased the expression of the H2O2-responsive gene Chit4 and the anthocyanin-biosynthesis-related genes mybA1 and UFGT 4 days after the treatment and increased anthocyanin accumulation 7 days after the treatment. On the other hand, the treatment of berries with Syn and H2O2 increased anthocyanin accumulation after 9 days. These results suggest that Syn increases anthocyanin accumulation through H2O2 production without changing phytohormone biosynthesis. Syn is expected to improve grape skin coloration and contribute to high-quality berry production. [ABSTRACT FROM AUTHOR]

Purpose: We examined the relation between smoking habits and maternal mental status such as depression and anxiety during the first trimester of pregnancy.Material and Methods: Between July 2016 and June 2018, we examined the increased odds of depressive and anxiety symptoms in the women with smoking habits during prepregnancy with and without smoking cessation during the first trimester of pregnancy in comparison with those without smoking habits using self-administered questionnaires.Results: The rate of depressive and anxiety symptom in the women with smoking habits during prepregnancy (46.4 and 47.3%, respectively) was higher than those in the women without smoking habits during the first trimester of pregnancy irrespective of smoking cessation. The rate of depressive or anxiety symptom during the first trimester of pregnancy did not change significantly by smoking cessation in the women with smoking habits during prepregnancy (depressive symptom: 44.6 versus 53.7%, p = .13; anxiety symptom: 45.3 versus 55.2%, p = .17).Conclusions: Smoking habits during prepregnancy seemed to be associated with the increased perinatal mental disorders irrespective of smoking cessation. [ABSTRACT FROM AUTHOR]

We compared the current prevalence of and obstetric outcomes in underweight Japanese women with data from 16 years ago. We reviewed the obstetric records of singleton pregnant Japanese women who delivered at our institute at ≥ 22 weeks’ gestation from 2000 through 2002 and those from 2016 through 2018. From 2000–2002 to 2016–2018, numbers of pregnant women in their twenties decreased and pregnant women in their forties increased significantly (p < 0.01). There were no significant changes in the prevalence of underweight pregnant women between the 2 periods. The prevalence of women whose weight gain during pregnancy was less than optimal increased (p = 0.049). There was no difference in obstetric outcomes between the 2 periods. Based on the current results, we cannot judge the necessity of further education to curb the increasing trend of Japanese women who desire slimness. Maternal weight may not have a high priority as an indicator of the gestational nutritional status associated with obstetric outcomes in Japan. [ABSTRACT FROM AUTHOR]

Objective: We examined the clinical characteristics and obstetric outcomes in adolescent pregnancies in Japanese women.Methods: The present study was a retrospective investigation of all primiparous Japanese women with singleton pregnancies who gave birth at ≥22 weeks' gestation aged ≤18 years old (adolescent pregnancy, n = 325) and aged 28-30 years old (n = 2029) at Japanese Red Cross, Katsushika Maternity Hospital between 2002 and 2016.Results: The frequencies of smoking, economic problems, an unmarried single status at delivery and the start of prenatal care in the first trimester in the adolescent pregnancy group were significantly higher than in the control group (p < .01). The incidences of Chlamydia trachomatis, Condyloma acuminatum, and mental disorders in the adolescent pregnancy group were significantly higher than in the control group (p < .01). Pregnancy in adolescence was not related to adverse obstetric outcomes except preterm delivery (p = .02).Conclusions: Adolescent pregnancy was not associated with adverse obstetric outcomes; however, adequate social, economic, and mental support is needed for adolescent pregnant women. [ABSTRACT FROM AUTHOR]

Key Clinical Message: In the current case of fetomaternal hemorrhage with reduced fetal movements, the findings of cardiotocography (CTG) seemed to be indicating reassuring fetal status; however, a late deceleration and sinusoidal heart rate (SHR)‐like findings were observed following a weak uterine contraction. Altogether, this case indicates that the presence of reduced fetal movements may precede the appearance of SHR patterns on CTG in cases of chronic fetomaternal hemorrhage. In the current case of fetomaternal hemorrhage with reduced fetal movements, the findings of cardiotocography (CTG) seemed to be indicating reassuring fetal status; however, a late deceleration and sinusoidal heart rate (SHR)‐like findings were observed following a weak uterine contraction. Altogether, this case indicates that the presence of reduced fetal movements may precede the appearance of SHR patterns on CTG in cases of chronic fetomaternal hemorrhage. [ABSTRACT FROM AUTHOR]

Objective: We examined the clinical significance of pregnancies with true umbilical cord knots related to umbilical cord length.Methods: The material reviewed consisted of the total population of Japanese women who gave birth to singleton babies at 34-41 weeks' gestation at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2017.Results: During the study period, there were 32,315 Japanese women who gave birth to singleton babies at 34-41 weeks' gestation. Of these, true umbilical cord knots were recognized in 209 cases (0.6%). In addition, excessively long umbilical cords were recognized in 98 of the 209 cases (46.9%). On multivariate analysis, true umbilical cord knots were associated with intrauterine fetal demise (adjusted OR 5.65, 95% confidence interval [CI] 1.9-17, p = .02) and excessively long umbilical cord (adjusted OR 8.26, 95% CI 6.0-11, p < .01). The incidence of intrauterine fetal demise in cases with the excessively long umbilical cord (0%) was significantly lower than that without excessively long umbilical cord (4.2%, p = .04), and it was not different measurably from that without true umbilical cord knots (0.3%, p = 1.00).Conclusions: Excessively long umbilical cords may contribute to the decreased risk of intrauterine fetal demise in singleton pregnancies delivered at ≥34 weeks' gestation. [ABSTRACT FROM AUTHOR]

We evaluated the current prevalence of gonococcal cervicitis among pregnant women in institutes that either do or do not routinely screen for gonococcal infection in Japan. We requested 2,330 obstetrical facilities to provide information on Neisseria gonorrhoeae cervicitis in pregnant women. A total of 1,876 (80.5%) of them responded. The universal screening test for gonococcal cervicitis, involving nucleic acid amplification for all pregnant women, was performed in 281 institutes (13.9% of institutes across Japan). The total rate of pregnant women with gonococcal cervicitis was 1.3% in the institutes performing the screening test during pregnancy, while it was only 0.2% (p < 0.01) in those not performing it. This suggests that 84% of infected women may have been missed in the institutes that do not routinely perform the screening test for gonococcal cervicitis. It may be time to examine the cost-effectiveness of providing gonococcal screening for all pregnant women in Japan. [ABSTRACT FROM AUTHOR]

In this paper, approximately 2,326,000 published patent applications applied between 2010 and 2019 by Japanese applicants in Japan were collected. 5 prefectures where patent applications much increased between 2010 and 2019 were identified, and their characteristics were analyzed. It was observed that they could be classified according to the diversity of the applicants and the IPC sections that contributed to the increase in patent applications. Based on these findings, this paper proposes a new model to classify regional patent application capability maturity. This model is useful for national and prefectural policy-makers to know the recommended policy to improve the maturity level of the target region and to assess the effectiveness of the implemented policy from the viewpoint of increases in patent applications. [ABSTRACT FROM AUTHOR]

This letter to the editor discusses the issue of antimicrobial resistance (AMR) in Neisseria gonorrhoeae (NG) infections during pregnancy in Japan. The author refers to global surveillance data from the World Health Organization (WHO) that shows increasing resistance to azithromycin and decreased susceptibility or resistance to ceftriaxone and cefixime. The author conducted a study in Japan and found that AMR in NG was recognized in a small percentage of pregnant women using azithromycin, but there was no AMR to ceftriaxone or cefixime. The author suggests that the changes in AMR levels may be due to the relative increase in ceftriaxone use and the fluctuation in NG genotypes. The author emphasizes the need for further examination of the molecular epidemiology of the disease and continued AMR surveillance. [Extracted from the article]

Introduction: Recently, we have been providing comprehensive treatment for pregnant women with mental disorders involving specialists from multiple fields in cooperation with local administrative agencies. In this study, we examined the outcomes of treatment for women with perinatal mental disorders in our institute to evaluate the effect of our recent approach to improve perinatal mental health. Methods: We retrospectively compared the outcomes between pregnant women with mental disorders who delivered from April 2015 to March 2017 with those from April 2009 to March 2011. We examined the following: presence or absence of necessity of medication, self-interruption of medication, deterioration/relapse of mental disorders, and administrative support. Results: There was no significant difference in the rate of pregnant women with mental disorders between the two periods (3.2 versus 3.2%, respectively, p = .94). The rates of patients requiring medication and those with self-interruption of medication did not reach significance (p = .90 and.19, respectively) between the two periods; however, the rate of patients with deterioration/relapse of mental disorders decreased significantly during pregnancy and postpartum (20.3 versus 10.7 and 7.3 versus 1.7%, p = .04 and.03, respectively). On the other hand, the patients receiving administrative supports increased significantly over the total study period (p < .01). Conclusions: It was suggested that our recent active management of pregnant women with mental disorders might have contributed to prevent the deterioration/relapse of mental disorders during pregnancy and postpartum. [ABSTRACT FROM AUTHOR]

Objective: We performed a retrospective case-control study of vaginal delivery at term without epidural anesthesia to identify clinical predictions of postpartum urinary retention (PUR). Methods: We reviewed the obstetric records of all singleton vaginal deliveries at Japanese Red Cross, Katsushika Maternity Hospital form January 2016 through December 2017. Results: There were 58 women (2.4%) complicated by PUR and 2391 women without PUR. A multivariate analysis revealed nulliparity, instrumental delivery, and episiotomy as independent risk factors for PUR (nulliparity: adjusted OR 2.39, 95%CI 1.2-4.8, p = 0.01; instrumental delivery: 3.53, 95%CI 1.9-6.7, p < .01, episiotomy: adjusted OR 1.96, 95%CI 1.0-3.8, p = .04). While, urination (or urethral catheterization) within 1 hour before delivery revealed as independent prevention factor for PUR (adjusted OR 0.54, 95%CI 0.30-0.99, p = .048). Conclusions: The risk factors identified in our institute seemed to approximately similar to those observed in the institutes capable of performing epidural anesthesia. In addition, urination just before delivery seemed to be an independent prevention factor for PUR. [ABSTRACT FROM AUTHOR]

Objective:We examined the optimal weight gain in the healthy Japanese women with favorable perinatal outcomes of (dichorionic) twin pregnancy. Methods:We calculated the average weight gain in the women whose height was 150–164 cm with favorable perinatal outcomes of dichorionic twin pregnancy set for this study. The women were categorized to underweight, normal, overweight and obese based on the pre-pregnancy body mass index (BMI) categories according to the Institute of Medicine (IOM) and the World Health Organization (WHO) body mass index (BMI) cutoffs. Results:The average GWG in the normal-weight women with the favorable perinatal outcomes was 13.9 ± 3.6 kg. It was significantly different from that in the underweight, overweight and obese women according to the both 2 BMI cutoffs by Student’st-test (p < 0.01). Conclusion:There are optimal ranges of weight gain during twin pregnancy based on the BMI classification. [ABSTRACT FROM AUTHOR]

Introduction: Recently, we have been providing comprehensive treatment for pregnant women with mental disorders involving specialists from multiple fields in cooperation with local administrative agencies. In this study, we examined the outcomes of treatment for women with perinatal mental disorders in our institute to evaluate the effect of our recent approach to improve perinatal mental health.Methods: We retrospectively compared the outcomes between pregnant women with mental disorders who delivered from April 2015 to March 2017 with those from April 2009 to March 2011. We examined the following: presence or absence of necessity of medication, self-interruption of medication, deterioration/relapse of mental disorders, and administrative support.Results: There was no significant difference in the rate of pregnant women with mental disorders between the two periods (3.2 versus 3.2%, respectively, p = .94). The rates of patients requiring medication and those with self-interruption of medication did not reach significance (p = .90 and .19, respectively) between the two periods; however, the rate of patients with deterioration/relapse of mental disorders decreased significantly during pregnancy and postpartum (20.3 versus 10.7 and 7.3 versus 1.7%, p = .04 and .03, respectively). On the other hand, the patients receiving administrative supports increased significantly over the total study period (p < .01).Conclusions: It was suggested that our recent active management of pregnant women with mental disorders might have contributed to prevent the deterioration/relapse of mental disorders during pregnancy and postpartum. [ABSTRACT FROM AUTHOR]

Objective: This study was performed to assess the differences in the birth canal lacerations following the lateral and fours posture deliveries compared with those following the supine posture deliveries.Methods: We examined the birth canal lacerations of our "low risk" pregnant women under the midwife-led delivery care at Japanese Red Cross Katsushika Maternity Hospital between April 2006 and March 2015.Results: There were 3826, 1754 and 719 women who delivered with supine, lateral and fours postures. The rate of no laceration in the women who delivered with lateral posture was significant lower than that in the women who delivered with supine posture (OR 0.630, 95% CI 0.56-0.71, p < 0.01); however, the incidence of perineal laceration in the women who delivered with lateral posture was significant lower than that in the women who delivered with supine posture (OR 0.856, 95% CI 0.76-0.90, p < 0.01). The incidence of perineal laceration of third- or fourth-degree in the women who delivered with fours posture was significant higher than that in the women who delivered with supine posture (OR 2.28, 95% CI 1.2-4.2, p < 0.01).Conclusion: The current results may be to help for self-determination of birthing postures in prenatal women. [ABSTRACT FROM AUTHOR]

This study examined the risk of deterioration/relapse in pregnant women who discontinued their antidepressant medications based on the discretion of the psychiatric specialists compared with those who performed self-interruption. We reviewed the obstetric records of all singleton deliveries beyond 22 weeks of gestation at Japanese Red Cross Katsushika Maternity Hospital from January 2009 through December 2015. Compared with the women continuing antidepressant medications throughout pregnancy, the incidence of deterioration/relapse was higher in the women who discontinued their antidepressant medications regardless of who made the decision (interruption based on the discretion of the psychiatric specialists: 61%, odds ratio (OR), 8.05; 95% confidence interval (CI), 2.4–27;p < 0.01; self-interruption: 63%, odds ratio (OR), 8.79; 95% confidence interval (CI), 2.6–29;p < 0.01 versus 16%). The continuation of medications and careful observation are required for pregnant women complicated by depressive disorders. [ABSTRACT FROM PUBLISHER]

Objective: We examined the optimal weight gain in the healthy Japanese women with favorable perinatal outcomes of (dichorionic) twin pregnancy.Methods: We calculated the average weight gain in the women whose height was 150-164 cm with favorable perinatal outcomes of dichorionic twin pregnancy set for this study. The women were categorized to underweight, normal, overweight and obese based on the pre-pregnancy body mass index (BMI) categories according to the Institute of Medicine (IOM) and the World Health Organization (WHO) body mass index (BMI) cutoffs.Results: The average GWG in the normal-weight women with the favorable perinatal outcomes was 13.9 ± 3.6 kg. It was significantly different from that in the underweight, overweight and obese women according to the both 2 BMI cutoffs by Student's t-test (p < 0.01).Conclusion: There are optimal ranges of weight gain during twin pregnancy based on the BMI classification. [ABSTRACT FROM AUTHOR]

Objective: We performed a retrospective case-control study of vaginal delivery at term without epidural anesthesia to identify clinical predictions of postpartum urinary retention (PUR). Methods: We reviewed the obstetric records of all singleton vaginal deliveries at Japanese Red Cross, Katsushika Maternity Hospital form January 2016 through December 2017. Results: There were 58 women (2.4%) complicated by PUR and 2391 women without PUR. A multivariate analysis revealed nulliparity, instrumental delivery, and episiotomy as independent risk factors for PUR (nulliparity: adjusted OR 2.39, 95%CI 1.2–4.8, p = 0.01; instrumental delivery: 3.53, 95%CI 1.9–6.7, p <.01, episiotomy: adjusted OR 1.96, 95%CI 1.0–3.8, p =.04). While, urination (or urethral catheterization) within 1 hour before delivery revealed as independent prevention factor for PUR (adjusted OR 0.54, 95%CI 0.30–0.99, p =.048). Conclusions: The risk factors identified in our institute seemed to approximately similar to those observed in the institutes capable of performing epidural anesthesia. In addition, urination just before delivery seemed to be an independent prevention factor for PUR. [ABSTRACT FROM AUTHOR]

Focuses on a study which examined the magnetic properties and crystal structures of Sm[sub2](Fe,V)[sub17]N[suby] coarse powder. Background on the compounds; Methods used; Results and discussion.

We present a case of twin anemia‐polycythemia sequence diagnosed postnatally with suspected chronic stress on the heart in the donor twin. [ABSTRACT FROM AUTHOR]

Objective. The objective of this study was to describe the recent clinical characteristics of labor using 3 systems of Japanese midwife-led primary delivery care, as follows: (1) those intending to give birth at home managed by midwives who do not belong to our hospital, (2) those planning to give birth in our hospital managed by the same midwives, and (3) those planning to give birth managed by midwives who belong to our hospital. Methods. A retrospective cohort study was performed. Results. There were no significant differences in the obstetric or neonatal outcomes among the 3 groups. The rate of transfers during labor with the system involving midwives belonging to our hospital was higher than those with the other 2 systems. In addition, the timing of transfers in the system with the midwives belonging to our hospital was earlier than with the other 2 systems. Among the 3 groups, there were no significant differences in the rate of the main 2 indications for transfers: fetal heart rate abnormality and failure to progress. Conclusion. There were no significant differences in perinatal outcomes among the 3 systems; however, there were some differences in the status of transfers to obstetric shared care. [ABSTRACT FROM AUTHOR]

We present a case of dysgerminoma of the right adnexa with an infiltration to the right wall of the uterus and a metastasis of para‐aortic lymph node. [ABSTRACT FROM AUTHOR]

Objective: We examined the relation between intimate partner violence (IVP) and maternal mental status such as depression and anxiety.Methods: Between April 2016 and October 2016, we asked all Japanese women during the first trimester of pregnancy to answer the three self-administered questionnaires to screen IVP and depressive and anxiety symptoms.Results: There were 19 women who had a high score in the modified Violence Against Women Screen (VAWS) (4.1%, IPV group) and 408 women who had a score 0 (86.8%, control group). Overall, the rate of the women with depressive, anxiety, and depressive plus anxiety symptoms were 21.3, 31.5, and 16.0%, respectively. The rate of depressive and/or anxiety symptoms in the IPV group were significantly higher than those in the control group (Odds ratio = 5.02 and 7.40, p < .01 by X2 test).Conclusions: The significant adverse effect of IPV on maternal mental status seemed to be observed in Japanese women during the first trimester of pregnancy. [ABSTRACT FROM AUTHOR]

We examined the current status of syphilis-infected pregnant Japanese women, according to the results of syphilis screening and confirmation tests of women who gave birth in Japan between October, 2015 and March, 2016. We requested 2458 obstetrical facilities to provide information of syphilis screening tests and 78.1% of them responded. Considering the response rate and the rate of implementation of confirmation tests, the number of syphilis-infected pregnant Japanese women was estimated to be 250 (1/4022) per year. [ABSTRACT FROM AUTHOR]

An appendectomy with a thorough examination of the gastrointestinal tract should be performed in women with a mucinous ovarian tumor. [ABSTRACT FROM AUTHOR]

Objective: This study was to examine the clinical usefulness of expectant management of early-onset severe preeclampsia. Methods: We reviewed the obstetric records of all Japanese singleton deliveries at ≥22 weeks' gestation managed at Japanese Red Cross Katsushika Maternity Hospital between 2007 and 2012. We compared the obstetric characteristics and perinatal outcomes between the cases of deliveries before ( n = 19) and after completion of corticosteroids ( n = 30) (immediate delivery versus expectant management). Results: Although the gestational age at delivery in the patients expectantly managed was higher than that in the patients required immediate deliveries (31.0 versus 29.3 weeks), the difference in the incidence of neonatal respiratory distress syndrome between the two groups did not reach the statistical significance (74 versus 47%, p = 0.06). The incidence of pulmonary edema in the patients expectantly managed was significantly higher than that in the patients required immediate deliveries within the first 48 h (20 versus 0%, p = 0.04). Conclusion: The current results could not support the clinical usefulness of expectant management of early-onset severe preeclampsia. [ABSTRACT FROM AUTHOR]

Key Clinical Message: In a twin pregnancy, it may be difficult to notice the decreased fetal movements, which is one of the main symptoms of fetomaternal hemorrhage, in one fetus due to the movements of the other fetus. [ABSTRACT FROM AUTHOR]

Aim It has not been extensively studied whether planned home and planned hospital births under primary midwife-led care increase risk of adverse events among low-risk women in Japan. Methods A retrospective cohort study was performed to compare perinatal outcome between 291 women who were given primary midwife-led care during labor and 217 women who were given standard obstetric shared care. Among 291 women with primary midwife-led care, 168 and 123 chose home deliver and hospital delivery, respectively. Perinatal outcomes included length of labor of 24 h or more, augmentation of labor pains, delivery mode, severe perineal laceration, postpartum hemorrhage of 1000 m L or more, maternal fever of 38° C or more and neonatal asphyxia (Apgar score, <7). Analysis was by intention to treat. Results The incidence of transfer from primary midwife-led care to obstetric shared care was 27% (77 women) mainly due to failure of labor progress (21%, 16 women), postpartum hemorrhage (19%, 15 women) and non-reassuring fetal status (19%, 15 women). Significantly higher incidence of transfer to obstetric shared care from primary midwife-led care was seen among women who chose hospital delivery compared with women who chose home delivery (34 vs 21%, P = 0.011). There were no significant differences in the incidence of adverse perinatal outcomes between women with obstetric shared care and women with primary midwife-led care (regardless of being hospital delivery or home delivery). Conclusion Approximately one-quarter of low-risk women with primary midwife-led care required obstetric care during labor or postpartum. However, primary midwife-led care during labor at home and hospital for low-risk pregnant women was not associated with adverse perinatal outcomes in Japan. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify the factors associated with the increased risk of postpartum hemorrhage requiring transfusion in Japanese twin pregnancies in comparison with those in Japanese singleton pregnancies. Methods: We reviewed the obstetric records of all singleton and twin deliveries after 22 weeks' gestation at the Japanese Red Cross Katsushika Maternity Hospital from 2003 through 2011. Potential risk factors for transfusion due to hemorrhage after cesarean delivery were selected according to previous studies of postpartum hemorrhage or transfusion or both after delivery: maternal age, parity, previous cesarean deliveries, history of infertility therapies such as in vitro fertilization, gestational age at delivery, neonatal birth weight, placenta previa, uterine myoma ≥6 cm, hypertensive disorders, placental abruption, emergency cesarean deliveries and general anesthesia. Results: Using multiple logistic regression, the independent risk factors for postpartum hemorrhage requiring transfusion in singleton pregnancies were preterm delivery [odds ratio (OR) 2.40, 95 % confidence interval (CI) 1.2-4.6, p < 0.01], placenta previa (OR 8.08, 95 % CI 3.9-16, p < 0.01) and placental abruption (OR 12.8, 95 % CI 2.3-76, p < 0.01). In twin pregnancies, however, the independent risk factors for postpartum hemorrhage requiring transfusion were gestational age at ≥41 weeks (OR 8.20, 95 % CI 1.3-40, p < 0.01) and hypertensive disorders (OR 5.45, 95 % CI 2.2-14, p < 0.01). Conclusions: The factors associated with postpartum hemorrhage requiring transfusion in cesarean deliveries of twins seemed to be different from those in singleton cesarean deliveries. [ABSTRACT FROM AUTHOR]

The purpose of this paper was to examine the obstetric and neonatal outcomes of preterm singleton pregnancies complicated by placental abruption following preterm premature rupture of membranes (p-PROM) compared with those without p-PROM. We reviewed the obstetric records of 95 singleton deliveries complicated by placental abruption at 22-36 weeks' gestation. The incidence of placental abruption in singleton pregnancies with p-PROMwas 4.7%, and the crude odds ratio of placental abruption for women following p-PROM was 6.50 (P < 0.01). Of the 95 cases of placental abruption in preterm singleton deliveries, 64 cases (67.4%) occurred without p-PROM and 31 cases (32.6%) occurred following p-PROM. The incidence of histological chorioamnionitis stage III in the patients following p-PROM was significantly higher than that in the patients without p-PROM(P = 0.02). The rate of emergency Cesarean deliveries associated with nonreassuring fetal status (NRFS) in the patients following p-PROMwas significantly lower than that in the patients without p-PROM. However, there were no significant differences in the maternal and neonatal outcomes between the patients with and without p-PROM. Although p-PROM may be one of important risk factors for placental abruption associated with chorioamnionitis, itmay not influence the perinatal outcomes in pretermplacental abruption. [ABSTRACT FROM AUTHOR]

No abstract available [ABSTRACT FROM AUTHOR]

Objectives. To examine the obstetric outcomes of our ''low risk'' pregnant women under the midwife-led delivery care compared with those under the obstetric shared care. Methods. A retrospective cohort study compared outcomes of labor under midwife ''primary'' care with those under obstetric shared care. The factors examined were: maternal age, parity, gestational age at delivery, length of labor, augmentation of labor pains, delivery mode, episiotomy, perineal laceration, postpartum hemorrhage, neonatal birth weight, Apgar score, and umbilical artery pH. In this study, pregnant women were initially considered ''low risk'' at admission when they had no history of medical, gynecological, or obstetric problems and no complications during the present pregnancy. Results. There were 1031 pregnant women initially considered ''low risk'' at admission. At admission, 878 of them (85%%) requested to give birth under midwife care; however 364 of these women (42%%) were transferred to obstetric shared care during labor. The average length of labor under the midwife ''primary'' care was significantly longer than that under the obstetric shared care. However, there were no significant differences in the rate of prolonged labor (≥≥24 h). There were no significant differences in other obstetric or neonatal outcomes between the two groups. Conclusions. There was no evidence indicating that midwife ''primary'' care is unsafe for ''low risk'' pregnant women. Therefore, midwifery care is recommended for ''low risk'' pregnant women. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the clinical significance of placental abruption occurred at preterm compared with those that occurred at term. Methods: We reviewed the obstetric records of 102 singleton deliveries complicated by placental abruption after 22 weeks of gestation. The χ test for categorical variables was used and differences with p < 0.05 were considered significant. Odds ratios (ORs) and 95% confidence intervals (CIs) were also calculated. Results: Of 102 cases of placental abruption, 60 cases (59%) occurred at preterm and 42 (41%) at term. There were no significant differences in perinatal outcomes between the two groups with preterm and term gestations. The incidence of histological chorioamnionitis in the preterm group was significantly higher than that in the term group (crude OR 3.4, 95% CI 1.4-8.2, p < 0.01) while that of placental embolisms and/or infarctions in the preterm group was significantly lower than that in the term group (crude OR 0.35, 95% CI 0.16-0.80, p = 0.01). Using logistic regression, preterm placental abruption was significantly more likely in multiparous patients (adjusted OR 2.5, 95% CI 1.0-6.2, p = 0.046) and those demonstrating histological chorioamnionitis (adjusted OR 3.5, 95% CI 1.4-9.1, p < 0.01), while term placental abruption was significantly more likely in cases of placental embolisms and/or infarctions (adjusted OR 3.5, 95% CI 1.2-10, p = 0.02). Conclusion: The current results indicate that the possible processes leading to placental abruption at preterm are different from those at term. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the association between time of delivery and perinatal outcomes in singleton deliveries at Japanese Red Cross Katsushika Maternity Hospital. We performed a retrospective cohort study of all singleton deliveries at ⩾22 weeks' gestation from 2002 through 2009 at our hospital. During the nighttime period (12 midnight to 8 am), although the rate of delivery of high-risk pregnancies was low, the rate of low umbilical artery pH (<7) was higher than that during the daytime periods (8 am to 4 pm) (odds ratio 1.9, 95% confidence interval 1.1-3.4, p=0.02). During the nighttime period, in addition, the rate of low umbilical artery pH in patients with emergent cesarean delivery was significantly higher than that during the daytime period (odds ratio 6.9; 95% confidence interval 2.5-19, p<0.01). In our hospital, the rate of adverse neonatal outcomes associated with cesarean birth was increased at nighttime period. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the perinatal outcomes of placental abruption associated with the presence of histological chorioamnionitis. We reviewed the obstetric records of 96 singleton deliveries complicated by placental abruption after 22 weeks' gestation. Of these 96 cases, 37 cases (39%) were diagnosed as having histological chorioamnionitis in the placenta. The incidence of premature delivery, preterm rupture of the membranes and low birth weight in the cases of placental abruption with chorioamnionitis were higher than in cases without chorioamnionitis. However, there were no significant differences in the incidence of other outcomes, such as fetal demise, low Apgar score, or low umbilical artery pH, between the cases of placental abruption with and without histological chorioamnionitis. Although the incidence of prematurity in the cases of placental abruption with chorioamnionitis was higher than that in cases without chorioamnionitis, there were no significant differences in fetal and neonatal conditions between the abruption cases with and without chorioamnionitis. [ABSTRACT FROM AUTHOR]