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Aim To investigate the utility of recombinant activated Factor VII (rFVIIa) for severe post-partum hemorrhage (PPH) in Japan. Methods We studied 69 patients treated with rFVIIa for severe PPH; 44 patients were from the registry of Japan Society of Obstetrical, Gynecological and Neonatal Hematology, and 25 were identified by a survey of the Japan Society of Obstetrics and Gynecology. Results Overall, the mean and median blood loss were 11 835 mL and 8639 mL, respectively. Treatment before rFVIIa included transarterial embolization in 23 patients and hysterectomy in 38. Forty-two patients had a single dose, 17 had two doses, and four had three doses. The mean (± SD) single dose was 81.60 ± 16.25 µg/kg. Sixty-five patients survived, and four died. The cause of PPH in patients who died was uterine rupture plus amniotic fluid embolism in two patients, uterine cervical laceration in one, and placental abruption in one. The amount of blood loss in cases of death was 6428-43 810 mL. This suggested that whether a patient survives or not was more dependent on her general condition before and after rFVIIa treatment than on the amount of blood loss. Four patients had thromboembolic events after rFVIIa treatment (deep vein thrombosis; deep vein thrombosis plus pulmonary embolism; acute myocardial infarction; and pulmonary embolism); all of these patients recovered. Conclusion The present promising results may support the utility of rFVIIa for severe PPH in Japan. [ABSTRACT FROM AUTHOR]

Aim To examine the associations between the pre-pregnancy body mass index ( BMI) and gestational weight gain ( GWG) with pregnancy outcomes in Japanese women. Methods The medical records of 1883 Japanese women who delivered singleton infants from January 2010 to January 2013 at Osaka- Minami Medical Center were retrospectively reviewed. We use the BMI classification which the World Health Organization defined for Asian populations and the GWG classified based on the current 2009 Institute of Medicine ( IOM) recommendations. The odds ratio ( OR) of each of the groups for the different pregnancy outcomes were compared to the recommended group using a logistic regression analysis adjusted by age, gestational weeks, parity, weight gain, mode of delivery, pregnancy induced hypertension ( PIH) and gestational diabetes mellitus. Results Women who were obese ( BMI, ≥25 kg/m2) and overweight ( BMI, 23-24.9 kg/m2) had a higher rate of developing PIH (adjusted OR, 6.68 and 3.21 [95% confidence interval [ CI], 3.31-13.3 and 1.29-7.24]). In contrast, GWG exhibited a correlation with the weight of the infant. The inadequate GWG group had a higher rate of small-for-gestational age ( SGA) infants (adjusted OR, 1.72 [95% CI, 1.22-2.46]). The rate of emergency cesarean section was not significantly different between the groups. Conclusion A pre-pregnancy BMI less than 23 kg/m2 is desirable to prevent Japanese women from developing PIH. GWG within the IOM recommendations also reduced the risk of PIH and SGA. [ABSTRACT FROM AUTHOR]

Aims Our objective was to evaluate the level of pregnant women's exposure to tobacco smoke by urinary cotinine testing at prenatal examinations, and to examine the effects of disclosing the results of urinary cotinine tests to pregnant women and their families on their smoking activities. Methods A prospective cohort study was conducted, enrolling 420 pregnant women who attended prenatal examinations at five private clinics in Japan. Urinary cotinine testing and a questionnaire survey regarding smoking status were conducted in early, middle, and late pregnancy. Urinary cotinine values were measured semiquantitatively using NicCheck I test strips. The results of each urinary cotinine test were handed to the pregnant woman and shared with her family. Results The percentages of urinary cotinine-positive subjects in middle and late pregnancy were significantly decreased compared with early pregnancy ( P < 0.001 each). Among the active smokers, there were no significant differences in the urinary cotinine-positive rates and the numbers of cigarettes among the three stages. In contrast, the urinary cotinine-positive rates in the passive smokers in late pregnancy were significantly lower than in early pregnancy ( P = 0.045) and those in non-smokers in middle and late pregnancy were also lower than in early pregnancy ( P = 0.001, P < 0.001). The numbers of cigarettes smoked by persons close to the passive smokers in middle and late pregnancy were significantly lower than in early pregnancy ( P < 0.001). Conclusions The feedback of the urinary cotinine test results at prenatal examinations decreased the level of exposure of pregnant passive smokers and non-smokers to tobacco smoke. [ABSTRACT FROM AUTHOR]

Aim The associations among changes in dietary intake, maternal bodyweight, and fetal growth during the course of pregnancy were investigated in a prospective cohort study carried out on 135 Japanese women. Material and Methods Dietary intake was analyzed using digital photos of meals taken over 3 consecutive days, in the first, second and third trimester, and was compared with maternal bodyweight, estimated fetal bodyweight by ultrasound examination, and birthweight. Results Surprisingly, the mean total calorie intake remained below 1600 kcal/day during pregnancy, much lower than the value recommended in the 2010 edition of ' Dietary Reference Intakes for Japanese'. Dietary intake was similar throughout despite the recommendation of extra intake in late pregnancy. Maternal dietary intake did not correlate with fetal growth, although maternal bodyweight in the second trimester positively correlated with estimated fetal bodyweight in the third trimester. Maternal bodyweight before pregnancy positively correlated with birthweight. Conclusions Maternal bodyweight as well as eating habits established before pregnancy may have a considerable effect on fetal growth. There is an urgent need to improve the diet of Japanese women of child-bearing age, especially during pregnancy. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to investigate the associations among depression, anxiety and physical symptoms in peri- and postmenopausal women in a clinical setting. Material and Methods Two hundred and thirty-seven peri- and postmenopausal women enrolled in the Systematic Health and Nutrition Education Program at the Menopause Clinic of the Tokyo Medical and Dental University Hospital. Their responses to the Menopausal Health- Related Quality of Life ( MHR-QOL) and Hospital Anxiety and Depression Scale ( HADS) questionnaires were subjected to a cross-sectional analysis. The study focused on the relationship between the scores for HADS depression (HADS-D) and anxiety (HADS-A) subscales and those for somatic (nausea, dizziness, numbness, muscle and joint pains, tiredness, headaches), urinary (frequent urination), and vasomotor symptoms (hot flashes, night sweats) in the MHR-QOL questionnaire. Results The correlations among the scores for the six somatic symptoms and HADS-D and HADS-A were stronger than those for urinary or vasomotor symptoms. Multiple logistic regression analysis revealed that the score for headaches and that for HADS-A were significantly associated with severe depression after adjustment (odds ratio ( OR) [95% confidence interval ( CI)]: 1.49 [1.06-2.10] and 1.58 [1.37-1.83], respectively), whereas the scores for nausea and numbness, as well as HADS-D, were significantly associated with severe anxiety ( OR [95% CI]: 1.65 [1.15-2.39], 1.39 [1.05-1.84], and 1.36 [1.23-1.50], respectively). Conclusion Headaches were associated with depression, whereas nausea and numbness were associated with anxiety in peri- and postmenopausal women. The assessment of underlying mood disorders is required for the management of middle-aged women presenting with these somatic symptoms. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the correlation between non-reassuring fetal heart rate (NRFHR) patterns and poor neonatal outcome in placental abruption. Material and Methods: A retrospective study was performed involving 83 placental abruptions with a live fetus at one tertiary and one secondary hospital in Miyazaki prefecture, Japan. We examined the correlation among NRFHR, umbilical arterial blood gas status, and neonatal poor outcomes, including neonatal death (ND) and cerebral palsy (CP). Results: A total of 83 cases were divided into bradycardia ( n = 27), recurrent late deceleration (rLD, n = 29), severe variable deceleration or prolonged deceleration (sVD/PD, n = 8), and other cases ( n = 19). In the bradycardia group, the incidence of low umbilical artery (UA) pH (<7.0) was 59% and the average UA pH was 6.96 ± 0.22. Among these cases, 10 showed severe bradycardia (less than 80 b.p.m.) and an average UA pH of 6.85 ± 0.24, and four cases resulted in poor outcome (three CP and one ND). In the rLD group, the incidence of low UA pH (<7.0) was 7% and the average UA pH was 7.24 ± 0.12. In this group, a 40-week-old fetus with umbilical phlebitis had a lower UA pH (6.92) and developed CP. In the sVD/PD group, there were no cases of a low UA pH (<7.0) and the average UA pH was 7.30 ± 0.04. In this group, a 31-week-old boy with a UA pH of 7.36 developed CP (PVL). The remaining 19 cases had no CP. Conclusion: Poor neonatal outcome of placental abruption is closely related to NRFHR, especially the degree of bradycardia. In the rLD and sVD/PD groups, risk factors, such as prematurity and fetal inflammation, co-existed. [ABSTRACT FROM AUTHOR]

Aim: To characterize patterns of insulin secretion in women with overt diabetes and gestational diabetes (GDM) defined by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Material and Methods: A total of 228 Japanese women were examined retrospectively. All 228 women had a positive 50-g glucose challenge test (GCT) result at 25.2 ± 1.2 weeks of gestation and underwent a 75-g glucose tolerance test (GTT) at 27.4 ± 1.8 weeks of gestation. The immunoreactive insulin levels were determined during the GTT in four groups of pregnant women: five with overt diabetes, 20 with GDM according to both the previous Japan Society of Gynecology and Obstetrics (JSOG) and current IADPSG criteria (traditional GDM group), 43 with GDM according to only the IADPSG criteria (new GDM group), and 160 with non- GDM, but with a positive GCT result. Results: Attenuated and slow rise in plasma insulin in concert with prolonged hyperglycemia were characteristic in women with overt diabetes, compared with women with GDM in whom excessive insulin secretion in the presence of hyperglycemia was characteristic. The new GDM group did not differ significantly from the traditional GDM group with respect to scores of such indices as the insulinogenic index, the homeostasis model assessment for insulin resistance, and the quantitative insulin sensitivity check index. Conclusion: Women with overt diabetes have both an impaired capacity for insulin secretion and elevated insulin resistance, while women with GDM exhibit a maintained insulin secretory capacity with an elevated insulin resistance. [ABSTRACT FROM AUTHOR]

Aim: To identify variables which are strongly associated with fetal growth. Material and Methods: The study subjects were 203 Japanese women who had a plasma glucose level ≥140 mg/dL (7.8 mmol/L) on a 50-g glucose challenge test but were normoglycemic when challenged with a 75-g oral glucose tolerance test (GTT) according to the criteria previously used in Japan. All the subjects subsequently gave birth to singleton infants. The correlations between the standard deviation for birthweight (birthweight SD) and 15 other variables, including the maternal body mass index (BMI), plasma levels of glucose and insulin on the GTT, and various indices calculated using data from the GTT, were then examined. Univariate and multivariate regression analyses were performed. Results: Univariate analyses revealed significant correlations between the birthweight SD and the fasting plasma glucose level ( P = 0.0063), the pre-pregnancy BMI ( P = 0.0001), and the BMI at delivery ( P < 0.0001). Only the BMI at delivery remained as a significant factor that was independently correlated with the birthweight SD after a multivariate regression analysis. Conclusion: The suppression of maternal weight gain, rather than the suppression of the plasma glucose level, may be effective for avoiding infants with overgrowth among Japanese women with mildly impaired glucose tolerance. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to show changes in salivary cortisol and chromogranin A/protein concentrations as stress markers during pregnancy and to clarify the effect of chronic stress on stress markers. Material and Methods: Salivary samples were collected from 69 pregnant women during pregnancy. Salivary cortisol levels and chromogranin A/protein titers were determined. We surveyed the women's chronic stress using the Zung self-rating depression scale and General Health Questionnaire-28. Results: Cortisol levels in the saliva of pregnant women showed biphasic change during pregnancy. Chromogranin A/protein levels in the saliva of pregnant women increased in the second and the early third trimesters and decreased to the puerperal period. Salivary cortisol concentrations of the chronic high stress group were significantly lower compared with those of the normal group. Salivary chromogranin A/protein concentrations of the chronic high stress group were also significantly lower than those of the normal group. Conclusion: The titration of salivary cortisol concentrations and chromogranin A/protein levels is a useful tool to determine maternal stress levels. The elevation of cortisol and chromogranin A/protein in the saliva was suppressed in the chronic high stress group during pregnancy. [ABSTRACT FROM AUTHOR]

Aim: Anxiety and depression are common in cancer patients, because diagnosis of cancer raises the fear of death. Although mental problems are often overlooked in cancer patients, it is important to control psychological distress, improve the quality of life, encourage patients to express requests about cancer therapy appropriately, and reduce the burden on family members. Material & Methods: There were 214 patients admitted to the Department of Obstetrics and Gynecology of St. Marianna University Hospital for treatment of cancer between January 2007 and December 2008. At 2 weeks after learning the diagnosis of cancer, these patients completed a Hospital Anxiety and Depression Scale (HADS) questionnaire, and their psychological characteristics were investigated in relation to age, tumor type and time after learning the diagnosis. The cut-off value for intervention to manage maladjustment and major depression was set at a HADS score of 11. Results: The HADS score was 11 in 118 of the 214 patients (55.1%). The HADS score for anxiety was higher in younger patients, while the HADS score for depression was higher in older patients. There were no significant correlations between the HADS score and the type of gynecologic cancer (cervical cancer, endometrial cancer and ovarian cancer) or the time after learning the diagnosis. Conclusion: Assessment based on the HADS score revealed a high prevalence of psychological problems after announcement of the diagnosis of gynecologic cancer. This emphasizes the importance of psychiatric intervention when patients are informed of their condition. [ABSTRACT FROM AUTHOR]

Aim: Since women with Turner Syndrome (TS) have various complications, they require comprehensive medical evaluation and multidisciplinary treatment. Although TS patients receive adequate care in childhood, many adults with TS do not. Since most TS adults attend gynecologists for hormone replacement therapy, we suggest gynecologists take primary responsibility for their management. In an attempt to provide TS patients with a comprehensive treatment regimen, we started multidisciplinary medical management in the Reproductive Health Clinic at Yokohama City University Hospital. To evaluate the efficacy of this medical care system, a retrospective analysis was conducted. Methods: The clinical profiles of 57 TS patients were examined. The past histories, complications and clinical data of these patients were extracted from their medical records and examined clinically. Bone mineral density measurements of lumbar vertebrae (L2–4), anti-thyroid antibody titer measurements, hearing tests and cardiovascular MRI were also performed. Results: Mean follow-up duration was 5.1 years (range, 1–8 years). At the time of transition, patients with complications developed in childhood, such as amenorrhea, osteopenia/osteoporosis, otitis media, thyroid dysfunction and cardiovascular disease were identified. All these complaints were successfully followed up in our adult care system. Several complications common to TS adults, such as glucose intolerance, liver dysfunction, hyperlypidemia and hypertension could be identified by our screening system. Patients were referred to specialists when necessary. Conclusion: Multidisciplinary health management in our Reproductive Health Clinic improved the status of medical care for TS adults. [ABSTRACT FROM AUTHOR]

Aim: To assess the effects of estrogen and hypnotics on Japanese peri- and postmenopausal women with sleep disturbance. Methods: Among the records of 1451 participants enrolled in the Systematic Health and Nutrition Education Program conducted at the Menopause Clinic of the Tokyo Medical and Dental University Hospital between 1995 and 2009, those of 202 peri- and postmenopausal women were retrospectively analyzed. These women, who had moderate to severe sleep disturbances, had either received only health and nutrition education (control; n = 119), or had received education with either conjugated estrogen (estrogen [0.625 mg/day]; n = 55) or nightly hypnotics (hypnotics; n = 28), and were followed up for a median interval of six months. Results: Both oral estrogen and hypnotics improved the subjective sleep disturbance scores, while administration of hypnotics decreased the percentage of women reporting difficulty in initiating sleep or nonrestorative sleep. Oral estrogen was also effective in alleviating various menopausal symptoms, while hypnotics were not. The health-related quality of life of these patients was significantly promoted by health and nutrition education alone, and neither estrogen nor hypnotics had an additive effect on it. Administration of hypnotics substantially lowered the blood pressure of the subjects (systolic pressure, -10.2%; diastolic pressure, -8.3%) and significantly reduced body weight (-2.1%), body mass index (-2.2%) and body fat (-7.8%), without affecting lean body mass. Conclusions: Oral estrogen and hypnotics are effective for sleep disturbance in Japanese peri- and postmenopausal women. They can be admininstered either singly or in combination, according to the patient’s characteristics. [ABSTRACT FROM AUTHOR]

To investigate the maternal risk factors for small-for-gestational age (SGA) newborns in Japanese dichorionic (DC) twins. A retrospective study was conducted from 2003 to 2008 on 340 DC twin pregnancies resulting in two live births. Newborns were classified as SGA if their birth weight was below the 10th percentile according to Japanese singleton norms. Statistical differences were evaluated between pregnancies resulting in appropriate-for-gestational age (AGA) pairs and those resulting in at least one SGA neonate. The study population consisted of AGA/AGA (50.8%), AGA/SGA (37.0%) and SGA/SGA pairs (12.0%). Logistic regression analysis identified significant interrelations for SGA with maternal nulliparity (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.30-0.91), smoking (OR 3.25, 95% CI 1.09-9.66), assisted reproductive technology (OR 0.52, 95% CI 0.30-0.89), pregnancy-induced hypertension (OR 2.00, 95% CI 1.01-4.31), pregravid weight (kg) (unitary OR 0.94, 95% CI 0.91-0.97) and monthly weight gain (kg/month) (unitary OR 0.25, 95% CI 0.14-0.44). Bivariable receiver operating characteristic curves were generated for monthly weight gain (area under the curve [AUC] 0.626, cutoff 1.41 kg/month, P < 0.001) and total weight gain (AUC 0.615, cutoff 14.0 kg, P < 0.001). Cigarette smoking and weight gain control are relatively modifiable factors for which interventional management is necessary to avoid perinatal problems arising from SGA pregnancy. Further studies are needed to investigate optimal nutrition, health guidance and subsequent weight gain control that lead to concrete improvement in maternal and infant prognoses. [ABSTRACT FROM AUTHOR]

Aim: To examine if we could predict periventricular leukomalacia (PVL) from the area of the lateral ventricle (LV). Methods: Six neonates in whom cystic PVL could be detected by magnetic resonance imaging (MRI) but not by ultrasound (US) were termed the 'invisible group'. Six neonates in whom cystic PVL could be detected by MRI and US were termed the 'visible group'. Eleven neonates in whom cystic PVL could not be detected by MRI or US were termed the 'control group'. The ratio of LV to head circumference (HC) was calculated as the area of LV (cm [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to clarify the risk of rubella infection for pregnant women in the outbreak area. Material & Methods: We performed a retrospective, population-based study on all 232 pregnant women during the rubella outbreak period in Tokunoshima Island. All women had a rubella hemagglutination inhibition (HI) titer drawn during their current pregnancy. In 61 women, HI titers were compared between the current and past pregnancies. Rubella IgG antibody titers were measured and IgG avidity index (AI) was calculated for 92 non-infected pregnant women. Results: Of the 232 candidates, 22 pregnant women contracted rubella infection (congenitally infected infants: 2). Seventeen of 61 pregnant women showed a four-fold or greater elevation in HI titer when compared with previous titers. Their previous HI titers were all ≤64. Low IgG AIs (<30%) were only observed in women with a HI titer of ≤64 (92 non-infected women). Conclusions: The risk of maternal rubella infection in the outbreak was as follows: non-immunized pregnant woman and pregnant woman with a rubella HI antibody titer ≤64 and low IgG AI. [ABSTRACT FROM AUTHOR]