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Aim: It is unknown whether weekly maternal weight gain differs between Japanese women with singleton, twin, and triplet pregnancies. Methods: Gestational weight gain defined as net weight gain during pregnancy was analyzed in 135,036 pregnant Japanese women, including 128,838 with singletons, 5573 with twins, and 132 with triplets, who gave birth at ≥22 weeks of gestation between 2007 and 2009. Weekly weight gain was defined as follows: gestational weight gain÷[gestational week (GW) at Delivery-2]. Results: Length of gestation (weeks, mean±SD) decreased significantly (38.2±2.6, 35.3±3.0, and 32.7±2.8) with increasing number of fetuses, while overall gestational weight gain (kg) was significantly smaller in women with singletons than in those with either twins or triplets (9.6±4.4 vs. 10.9±4.8 or 10.9±5.2, respectively). Thus, weekly maternal weight gain (kg/week) increased significantly with increasing number of fetuses (0.26±0.12, 0.33±0.13, and 0.35±0.16). Among women with delivery at or after GW 34, difference in gestational weight gain (kg) was prominent between the three groups (9.8±4.4, 11.4±4.7, and 13.0±5.1 for singleton, twin, and triplet pregnancies, respectively, P<0.001 between any two groups). Conclusions: Weekly maternal weight gain increases with increasing number of fetuses. Our figures may be useful for advising Japanese women with multifetal pregnancies regarding gestational weight gain. [ABSTRACT FROM AUTHOR]

Aim To determine whether macrosomic infants with a birthweight of 4.0 kg or more have increased risk of cerebral palsy associated with neonatal encephalopathy ( Enc- CP). Methods A retrospective review of 132 singleton infants with Enc- CP fulfilling all of the following criteria: born at gestational week ( GW) 37 or more ( n = 126) or weighing 2.5 kg or more at birth ( n = 116) in or after January 2009 in Japan; no identifiable causes of cerebral palsy other than antenatal or intrapartum hypoxia; and exhibition of neonatal encephalopathy. National statistics of Japan were used to determine the numbers of infants according to birthweight categories. Results Of the 116 infants with a birthweight of 2.5 kg or more, 46 (39.7%), 49 (42.2%), 17 (14.7%) and four (3.4%) infants had birthweights of 2.5-2.99, 3.0-3.49, 3.5-3.99 and 4.0 kg or more, respectively. Corresponding figures among Japanese infants born in 2009-2011 were 42.8%, 45.4%, 10.9% and 0.90%, respectively. Infants with a birthweight of 4.0 kg or more had a relative risk (95% confidence interval) of Enc- CP of 3.89 (1.52-9.95) compared to those with a birthweight of 2.5-2.99 kg. Conclusion Japanese infants with a birthweight of 4.0 kg or more have increased risk of Enc- CP. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to underscore problems associated with the dipstick test and determination of protein concentration alone in spot-urine ( P-test) compared with spot-urine protein-to-creatinine ratio ( P/ Cr test) and to determine whether urine collection for 24-h test was complete. Material and Methods Dipstick and P/ Cr tests were performed simultaneously in 357 random spot-urine specimens from 145 pregnant women, including 35 with pre-eclampsia. Positive results were defined as ≥1+ on dipstick test, protein concentration ≥30 mg/dL on P-test, and P/ Cr ratio ≥ 0.27 (mg/mg) on P/ Cr test. Sixty-four 24-h urine tests (quantification of protein in urine collected during 24 h) were performed in 27 of the 145 women. We assumed that P/ Cr ratio ≥ 0.27 predicted significant proteinuria (urinary protein ≥ 0.3 g/day). The 24-h urine collection was considered incomplete when urinary creatinine excretion was <11.0 mg/kg/day or >25.0 mg/kg/day. Results Forty-four percent (69/156) of specimens with a positive test result on dipstick test contained protein < 30 mg/dL. Dipstick test was positive for 25.7% (69/269) of specimens with protein < 30 mg/dL and for 28.8% (79/274) of specimens with P/ Cr ratio < 0.27. P-test results were positive for 7.3% (20/274) and negative for 18.1% (15/83) of specimens with P/ Cr ratio < 0.27 and ≥0.27, respectively. Incomplete 24-h urine collection occurred in 15.6% (10/64) of 24-h urine tests. Daily urinary creatinine excretion was 702-1397 mg, while creatinine concentration varied from 16 mg/dL to 475 mg/dL in spot-urine specimens. Conclusion Dipstick test and P-test were likely to over- and underestimate risks of significant proteinuria, respectively. The 24-h urine collection was often incomplete. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to determine whether the use of transcervical balloon catheter ( TCBC) for induction of labor ( IOL) is a risk factor for cerebral palsy ( CP) associated with umbilical cord prolapse ( UCP-CP) in singleton pregnancies with cephalic presentation. Material and Methods Among all 102 infants with CP who were preliminarily determined as caused by antenatal and/or intrapartum hypoxemia by the Japan Council for Quality Health Care until April 2012, all 56 infants who met all of the following criteria were studied: cephalic singleton pregnancy, reassuring fetal status on electronic cardiotocogram at time of admission to obstetric facilities for labor pains, ruptured fetal membranes, and/or IOL, and hypoxic-ischemic encephalopathy at birth. Clinical backgrounds were compared between six infants with UCP-CP and the remaining 50 infants with CP not associated with UCP (non- UCP-CP). Results Frequencies of IOL (83% [5/6] vs 32% [16/50], P = 0.0236), use of TCBC (67% [4/6] vs 10% [5/50], P = 0.0044), and amniotomy (67% [4/6] vs 24% [12/50], P = 0.0494) were significantly higher in the UCP-CP than the non- UCP-CP group. Only TCBC was a risk factor significantly associated with UCP-CP after logistic regression analysis, yielding an odds ratio of 18.0 (95% confidence interval, 2.6-124; P = 0.003). Saline volumes of 80-150 mL were used for TCBC inflation in the four UCP-CP patients. Conclusion Use of TCBC with a saline volume ≥ 80 mL was a significant risk factor for UCP-CP; however, the absolute risk of UCP-CP was estimated to be very low, approximately one in 7875 TCBC users. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine whether antenatal decline in antithrombin (AT) activity occurs frequently and precedes the development of perinatal liver dysfunction in women with triplet pregnancies. Material and Methods: A retrospective observational study was conducted on all women who gave birth to triplets at gestational week ⩾22 at a single centre during a study period from January 2001 to March 2013. The following eight blood parameters were monitored weekly during the last 5 weeks of pregnancy and postpartum: AT activity, platelet count, fibrinogen, D-dimer, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), uric acid and creatinine. Pregnancy-induced AT deficiency (PIATD) and gestational thrombocytopenia were defined as antenatal AT activity <70% of normal level and antenatal platelet count <150 × 109/L, respectively. Liver dysfunction was defined as AST > 40 IU/L. LDH elevation was defined as LDH > 450 IU/L. Results: Sixteen women were eligible for this study. All variables except LDH exhibited significant changes antenatally: AT activity, platelet count and fibrinogen decreased, while D-dimer, AST, urate and creatinine increased. LDH increased significantly postpartum. PIATD, gestational thrombocytopenia, perinatal liver dysfunction, and LDH elevation occurred in eight, seven, six, and eight women, respectively. Liver dysfunction was preceded by PIATD alone in three, by both PIATD and gestational thrombocytopenia in one and by gestational thrombocytopenia alone in none of the subjects. After delivery, laboratory abnormalities similar to HELLP syndrome were seen in three women exclusively in the presence of PIATD. Conclusions: Reduced AT activity was likely to precede perinatal liver dysfunction in women with triplets. [ABSTRACT FROM AUTHOR]

Objective: Which physical findings and blood parameters predict postpartum hypertension remain to be studied in women with twin pregnancies. Methods: The antenatal systolic and diastolic blood pressures (SBP and DBP, respectively), and 16 laboratory variables were investigated in 150 normotensive women who gave birth to twins. Results: When the median values of the 18 continuous variables were used as cut-off values, an SBP>120 mm Hg (relative risk [95% confidence interval], 2.81 [1.94-4.08]), a DBP>70 mm Hg (2.42 [1.68-3.49]), an aspartate aminotransferase level>18 U/L (2.22 [1.55-3.19]), and a uric acid level>5.3 mg/dL (1.68 [1.20-2.36]) were independent risk factors for postpartum hypertension. Conclusions: Antenatal blood pressure measurements and a laboratory work-up may be useful clinically for predicting postpartum hypertension in women with twin pregnancies. [ABSTRACT FROM AUTHOR]