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A letter to the editor is presented in response to the medical case of conjoined twins after in-vitro fertilization-embryo transfer at blastocyst stage.

Purpose: Clinical investigation into the correlation between AIWA's score and premature labor. Patients: Eight hundred and twenty-nine (829) mothers delivered single baby at AIWA Maternity Hospital in 2000. The number of primipara (P) was 394, while that of multipara (M) was 435. We eventually analyzed 587 deliveries in 829, because the resting 238 deliveries were not fully followed up before delivery and the resting four were undertaken therapeutic premature termination. These 587 mothers had at least one time of AIWA's scoring in both 14–24 weeks of gestation and 25–32 weeks of gestation. Methods: We have been using the AIWA's score to detect and prevent premature labor for 4 years, which consists of findings of transvaginal ultrasonography (cervical length and funneling of internal os of the uterus), and internal examination (looseness of external os of the uterus and consistency of the cervix). The full score is 12, which means extremely high risk of premature labor. On the other hand, the score zero means no risk of premature labor. The patients, whose score over 8, should go into hospital to have cervical cerclage. and if multipara has histories of premature deliveries and/or threatened premature labor, P-score (1–3) is added to AIWA's score according to the degree of the risk. Five hundred and eighty-seven (587) deliveries were divided in four groups, including (1) over 1 week hospitalization (2) having cervical cerclage (3) premature deliveries (4) normal range deliveries (including OPD therapy and <1 week hospitalization). The distribution of AIWA's score was analyzed separately between nullipara and multipara in 14–19, 20–24, 25–28, and 29–32 weeks of gestation, respectively. In hospitalized patients, the most previous scores before hospitalization was analyzed. And, indications for prophylactic cervical cerclage before 27 weeks of gestation were: (1) nullipara and #8807; 8 (AIWA's score alone),... [ABSTRACT FROM AUTHOR]

Purpose: To elucidate the availability of ‘AIWA’s scoring' in prevention of preterm labor. Patients: We retrospectively studied the 6434 deliveries after 22 weeks of gestation, managed at AIWA-Maternity Hospital from 1986 to 1990, and from 1995 to 2000. • C-stage: deliveries from 1986 to 1990: 1786 (control stage without AIWA's scoring); • P-stage: deliveries from 1995 to 1997: 2190 (prototype stage without AIWA's scoring); • A-stage: deliveries from 1998 to 2000: 2458 (applied stage with AIWA's scoring). Nine twins and seven cases of pregnant mother transportation (MT) in (C) 1786, 25 twins and 3 MT in (P) 2190, and 17 twins, 2 triplets, 6 MT in (A) 2458, were involved, respectively. Methods: The ‘AIWA’s score' of risk assessment for premature delivery consists of cervical consistency, insertion resistance to external os of uterus by internal examination, and cervical length and funneling of internal os of uterus measured by transvaginal ultrasonography. The full AIWA's score is 12 point, which means extremely high risk of premature labor. On the other hand, 0 point means no risk of it. Then, P-score (0–3) consists of the history of early delivery, abortion after 18 weeks of gestation, present multiplicity and so forth. AIWA's score + P-score = AP-score. (A) From 1998 to 2000, in case with AP-score >8, before 26 weeks of gestation, patients had cervical cerclage if they wanted after severely informed consent. We compared some parameters between C- and A-stage. Results: The rate of premature delivery declined (from 4.5 to 3.2% <37 weeks [P < 0.05]; from 2.5 to 1.3%, <36 weeks [P < 0.01]) in A-stage using the risk assessment system. In all premature deliveries, those before 32 weeks of gestation declined from 15.2 to 2.6% (P < 0.01) in A-stage. The rate of preterm PROM <34 weeks in all deliveries declined from 0.56 to 0.12% (P < 0.05), while the rate of preterm PROM in premature labor decreased from 12.7 to... [ABSTRACT FROM AUTHOR]