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Abstract: Aim: We analyzed the incidence and prognosis of thromboembolism associated with combined oral contraceptives (COCs) by age groups in Japan. Methods: A total of 581 events of venous thromboembolism (VTE) and arterial thromboembolism (ATE) associated with COCs were analyzed from the Pharmaceuticals and Medical Devices Agency database from 2004 to 2013. In a statistical analysis, a good‐prognosis group included recovery cases and a poor‐prognosis group involved unrecovered cases with some sequela and fatal cases. The significant difference between these two groups was calculated by Pearson's chi‐square test, and the age‐specific tendency and the trend of differences in prognosis according to different hormonal contraceptives were examined by Cochran–Armitage trend test. Results: A total of 543 events were analyzed except 38 events due to unknown age, in which DVT only was the most frequent, followed by cerebral infarction, PE with DVT, PE only, cerebral vein thromboses. ATE ratio for overall thromboembolism tended to increase with advancing age (P = 0.0041). Good‐prognosis group was common (291 cases in VTE and 83 cases in ATE), followed by poor‐prognosis group (46 cases in VTE and 34 cases in ATE). All ATE cases had a significantly poorer prognosis in comparison with all VTE cases (P < 0.0001). Types of progestin and age difference, however, showed no trend in the differences between good‐prognosis group and poor‐prognosis group (P = 0.3548 and P = 0.6097). Conclusion: Thromboembolic events were the most frequent in the 40s. The ATE ratio for overall thromboembolism tended to increase with advancing age. All ATE cases had a significantly poorer prognosis in comparison with all VTE cases. [ABSTRACT FROM AUTHOR]

Aim The purpose of this study was to compare prophylactic subcutaneous drainage plus subcuticular sutures versus staples for the risk of wound separation after skin closure following gynecologic malignancy surgery, and to investigate the risk factors of this procedure. Material and Methods Patients were divided into two groups: 120 patients who were treated with subcutaneous drainage plus subcuticular sutures ( Suture group) and 201 patients with staples plus subcutaneous sutures ( Staples group). In the Suture group, subcuticular tissue was approximated with interrupted 4-0 polydioxanone sutures, and adhesive closure strips were used on the skin surface. A 3.3-mm closed drainage was implicated in subcutaneous tissue. In the Staples group, subcutaneous tissue was approximated with interrupted polyglactin ( Vicryl, Ethicon) sutures. Results Baseline characteristics were not significantly different between the two groups. Mean operation times were compatible (201 vs 196 min, P = 0.16). The incidence of wound separation was less in the Suture group than in the Staples group (3/120 vs 17/201, P = 0.033). Multiple logistic regression analysis revealed that the Staples group was an independent risk factor for wound separation (odds ratio 7.34, 95% confidence interval: 1.59-33.91, P = 0.011), independent of obesity, International Federation of Gynecology and Obstetrics stages, and operation time. None of the 14 obese patients in the Suture group showed surgical wound separation. Conclusions The combination of a prophylactic subcutaneous drain and subcuticular sutures reduced wound separation after skin closure following gynecologic malignancy surgery. With the information regarding risk factors established in this study, the above method provides the best results to minimize the risk, particularly in obese patients. [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 We investigated the neonatal outcome in chronically hypertensive patients with controlled hypertension, uncontrollable hypertension, or superimposed pre-eclampsia. Material and Methods The study included 120 patients who had chronic hypertension and were divided into three groups for which the perinatal and neonatal outcomes were retrospectively compared: pre-eclampsia superimposed on chronic hypertension ( SP: n = 28), chronic hypertension with severe hypertension uncontrolled in spite of intravenous or multiple oral antihypertensive medications in the latter half of pregnancy ( uCH: n = 44), and chronic hypertension with controlled to mild hypertension with or without medication ( cCH: n = 48). Results Preterm birth rate incidence was significantly higher in the SP and uCH groups than in the cCH group ( P < 0.05 for both). The incidence rates of low birthweight, very low birthweight, and extremely low birthweight for the groups were as follows: SP > uCH > cCH. Admission to the neonatal intensive care unit was significantly higher in the uCH and SP groups than in the cCH group ( P < 0.05 for both). Conclusion Like superimposed pre-eclampsia, uncontrolled chronic severe hypertension during late pregnancy results in a poorer neonatal outcome than controlled chronic mild hypertension. We conclude that absolute blood pressure can be used as a predictor of clinical outcome in pregnant chronic hypertension patients. [ABSTRACT FROM AUTHOR]

Aim The purpose of this study was to compare the intraoperative and postoperative parameters among the three approaches used to treat large uterine myomas: laparoscopic assisted vaginal hysterectomy ( LAVH), total laparoscopic hysterectomy ( TLH) and abdominal hysterectomy, and to evaluate the selection criteria for laparoscopic hysterectomy as determined by magnetic resonance imaging. Material and Methods The medical records of 155 patients who underwent a hysterectomy between January 2007 and April 2010 were examined. We also compared the indications and outcomes of LAVH and TLH for myomas larger than 7 cm. Results Patients who underwent LAVH or TLH had a lower average intraoperative blood loss, less intense postoperative pain, and shorter hospital stays than patients in the TAH group, although the length of the operations in the laparoscopic groups were significantly longer. To evaluate the selection criteria for the large sized myomas, we compared the LAVH and TLH groups for the myomas larger than 7 cm. The greatest uterine transverse diameters and the weight of the uteri were not significantly different between the LAVH and TLH groups (94.7 ± 20.8 and 83.1 ± 17.6 mm, 371.6 ± 160.3 and 286.7 ± 158.0 g, respectively). The average intraoperative blood loss in the TLH group was significantly lower than that in the LAVH (121.3 ± 111.2 vs 379.3 ± 222.4 g, P < 0.001). Conclusion Our data suggest that TLH is a better procedure for treating a large uterus no larger than 10 cm in its greatest transverse diameter. The preoperative total length of myoma nodules determined by MRI is a useful preoperative indicator of the uterine weight. [ABSTRACT FROM AUTHOR]

Aim: To demonstrate the difference between risk factors for gestational hypertension (GH) and preeclampsia (PE). Material and Methods: Using data from women with no essential hypertension and with singleton births between 2001 and 2005 delivering after 22 weeks of gestation at 125 centers in Japan (Japan Perinatal Registry Network) ( n = 241 292), we compared risk factors for GH and PE. Odds ratios were calculated using multivariate logistic regression analyses. Results: Of 241 292 women, 2808 (1.2%) developed GH and 6423 (2.7%) developed PE. Thirty-five years or older, primiparity, diabetes mellitus, and renal disease increased the risk of both hypertensive conditions. Forty years or older was a risk factor only for GH, while primiparity, female baby, and renal disease were risk factors only for PE. Early-onset was a common risk factor for small-for-gestational-age (SGA) in GH and PE, but in late-onset only PE was a risk factor for SGA. The main population of SGA infants was composed of PE cases because PE accounted for 83.3% of early-onset type before 32 weeks. Girl preponderance in the PE women was observed (sex ratio: boys/girls = 0.904), while slight boy preponderance was seen in normotensive women (1.06) and GH (1.02). Conclusion: Preeclampsia is associated with lower fetal sex ratio (girl preponderance) compared to GH or normotensive. Presence of hypertension is a risk factor for SGA in early-onset GH and PE, and hypertension and proteinuria are risk factors for SGA in late-onset group. [ABSTRACT FROM AUTHOR]