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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]

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]

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: 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]

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]

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]

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]

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]

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]

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 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]

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 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]

To the Editors, After delivery, early ambulation has been recommended to promote involution of uterus and natural urination, prevent thrombus, and feel a sense of well-being for delivery [[1]]. Because women perform urination by sitting, there may be the possibility of developing micturition syncope associated with orthostatic hypotension. For example, cases of micturition syncope following the first urination after delivery are sometimes experienced. [Extracted from the article]

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: We examined the perinatal outcomes of twin deliveries following selective uterine fundal pressure maneuver (UFPM) during the second stage of the first twin delivery. Methods: At our institute, if non-reassuring fetal heart rate and/or maternal exhaustion were observed during the second stage of the first twin, selective UFPM was performed following making sure of the position of the first twin's buttocks by ultrasonography. We reviewed the obstetric records of all cases of trial of vaginal delivery of twins between 2002 and 2012. Results: A total of 64 cases were evaluated for the statistical analyses. Of these, selective UFPM for the first twin was performed in 15 cases (24%). Although the cases requiring selective UFPM for the first twin was associated with an increased postpartum hemorrhage, there were no significant differences in neonatal outcomes between the two groups. Conclusion: There was no evidence that the selective UFPM is unsafe for both mother and two babies during the second stage of the first twin delivery. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the influence of chorionicity on umbilical arterial blood gas discordance in twin pairs after an elective cesarean delivery that was published in a previous issue.

Since January 2009, the Japanese Government Offices has launched a new medical insurance system [[3]], the Japan Obstetric Compensation System for Cerebral Palsy, to compensate for cerebral palsy (CP) derived in principle from intrapartum hypoxia and to improve perinatal care and requested the Japan Council for Quality health care (JCQHC) to organize this system. To date, the JCQHC has provided 13 reports of CP in the second twin following vaginal delivery of the first twin at near term. [Extracted from the article]

A letter to the editor is presented regarding a study which explores the prevalence of domestic violence (DV) against pregnant women in Japan.

A letter to the editor in response to the article "Umbilical artery blood flows among pregnancies with single umbilical artery: a prospective case-controlled study," by J. Baron et al, published in a previous issue is presented.

A letter to the editor is presented which discusses a study of the actual strategies of feeding for pregnant women who cannot be confirmed as human T-cell leukemia virus type 1 (HTLV-1) carrier by western blot (WB) test.

We examined the clinical significance of difficult suture removal following the McDonald procedure. We examined 117 patients following the McDonald procedure with a singleton pregnancy who delivered at ⩾34 weeks of gestation. Difficult suture removal was defined as when spinal anesthesia was required for suture removal. Seven patients (6.0%) were defined as involving difficult suture removal. The cervical length in the difficult-removal-group was significantly shorter than that in the easy-removal-group at suture removal (p = 0.04). If the cervical length was shorter than 20 mm, the odds ratio for difficult suture removal was 9.0 (95% Cl 1.6-49, p = 0.01). The progression of cervical ripening following the McDonald suture may be associated with an increased risk of difficult suture removal. [ABSTRACT FROM AUTHOR]

We examined the current status of human T-cell leukemia virus type 1 (HTLV-1) carrier in Japanese pregnant women, according to the results of HTLV-1 screening and confirmation tests of women who gave birth in Japan in 2011. We requested 2642 obstetrical facilities to provide information of HTLV-1 tests and 71.3% of them responded. Considering the response rate and the rate of implementation of confirmation tests, the number of HTLV-1 carrier in Japanese pregnant women was estimated to be 1620 (0.16%) per year. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article regarding the cesarean delivery which is a factor that promotes decreased prevalence of exclusive breastfeeding in Japan.

A letter to the editor is presented regarding a retrospective cohort analysis on the association between pelvic adhesions and incision-to-delivery intervals of infant among Cesarean women in Japan.

A letter to the editor is presented regarding a study which examines the necessity of midwife-led care during pregnancy in Japan.

A letter to the editor in presented which discusses a study of extrachorial placenta in pregnancy.

The purpose of the present study was to examine the influence of history of abortion on the next pregnancy outcomes associated with preeclampsia. This investigation involved 5206 nulliparous Japanese women with singleton pregnancies who delivered after 22 weeks of gestation. The patients were divided into two groups: those with a history of spontaneous and/or artificial abortion during the previous pregnancies after the marriage with the same partner ( n = 1029) and those without a history of abortion ( n = 4173). There was no significant difference in the incidence of preeclampsia between the 2 groups with and without previous abortions (4.0% vs. 3.9%, p = 0.91). In addition, there were no significant differences in the incidence of perinatal complications associated with preeclampsia between the 2 groups. Although further studies may be needed, based on the current results history of abortion does not seem to affect perinatal outcomes associated with preeclampsia. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to the article "History of intrauterine curettage and placental complications" by S. Suzuki published in the previous issue of the journal is presented.

A letter to the editor is presented in response to an article on in vitro fertilization as a risk factor for transfusion after vaginal singleton delivery that was published in a previous issue.

A letter to the editor is presented about the duration of the active phase of labor between singleton and twin pregnancies.

A letter to the editor is presented concerning lateral axillary nerve palsy as a complication of labor.

A letter to the editor related to intrauterine curettage and placental complications is presented.

We performed uterine artery Doppler velocimetry in 16 nulliparous and 16 parous women with non-preeclamptic singleton gestations and 16 nulliparous and 16 parous women with dichorionic twin gestations at 17–18 and 26–27 weeks of gestation. In both singleton and twin pregnancies, the average pulsatility index (PI) in nulliparous women was significantly higher than that in parous women at 17–18 weeks of gestation. At 26–27 weeks of gestation, however, there were no significant differences in PI between nulliparous and parous women with either singleton or twin pregnancies. During the early second-trimester of non-preeclamptic singleton and twin pregnancies, parity has a significant effect on uterine artery blood flow. [ABSTRACT FROM AUTHOR]

The article discusses the impacts of grandmultiparity on adverse pregnancy outcomes on the pregnancy planning in Japan. It examines the pregnancy outcomes of 41 Japanese women and observe an increased in incidence of perinatal complications in grandmultiparous women. Two tables are presented which shows the research result on the pregnancy outcomes of Japanese women and of the age-matched Japanese women.

A letter to the editor is presented in response to the article "The Benefit of Labor Induction for Preeclampsia Beyond 37 Weeks' Gestation," by Shunji Suzuki that was published in a previous issue.