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To clarify the clinical risk factors associated with poor neonatal outcomes due to umbilical cord prolapse (UCP).A postal questionnaire survey was attempted in Japan. The clinical risk factors and managements associated with poor neonatal outcomes were analyzed in cases of UCP treated in Japan.A total of 267 cases of UCP (out of 2 037 460 total deliveries) were analyzed. The rates of intrauterine death, neonatal death and survival with disability were 3.4%, 5.6% and 7.1%, respectively. The multivariate regression analysis for these poor neonatal outcomes revealed that the significant risk factors included a prolapsed amniotic sac (adjusted odds ratio (aOR), 4.49), preterm labor (aOR, 2.99) and replacement of the prolapsed umbilical cord into the uterus (aOR, 2.87). However, UCP that occurred during labor (aOR, 0.28) and emergency cesarean section (aOR, 0.11) were associated with a reduction in the rates of poor outcomes. The interval between the diagnosis of UCP and delivery was significantly longer in the infants with a poor outcome than intact survival (median 30 versus 24 min, p = 0.048).An emergency cesarean section should be carried out immediately to ensure a better outcome for the infant.

Large cell neuroendocrine carcinoma (LCNEC) is well-reported to result in unfavorable prognoses in many organ cancers while being rarely reported in gynecologic cancer, especially ovarian and endometrial cancers. Here we report a case of ovarian cancer with LCNEC which spread to distant organs within 1 year of primary surgery despite the fact that the post-surgical stage was Ia. The case received platinum-based chemotherapy as an adjuvant therapy after her curative surgery. However, LCNEC in the case was resistant to the chemotherapy. In our review of published works, ovarian cancer cases with LCNEC show poor prognoses regardless of adjuvant chemotherapy following complete resection. Median overall survival was 10 months in stage I cases. Development of chemotherapy sensitive for LCNEC is needed.

Objective To test the concept of taxane sequencing, this feasibility trial evaluated maintenance of docetaxel after paclitaxel and carboplatin combination chemotherapy in patients with stage IC-IV ovarian cancer. Methods All patients received debulking surgery followed by paclitaxel and carboplatin chemotherapy. Attainment of clinically defined complete or partial response was confirmed by image scanning. Maintenance of docetaxel started at an initial dose of 70 mg/m2 every 4 weeks for 6 cycles and was extended to 10 cycles unless disease progression and/or recurrence during the protocol therapy or unacceptable toxicities were seen. Results Stage subsets in 20 eligible patients were as follows: IIIB, 2 patients (10%); IIIC, 13 patients (65%); IV, 5 patients (25%). Neutropenia was common (40% with grade 3 or 4) and was most frequent during first or second cycle although the disabling peripheral neuropathy was not observed. Twelve patients completed protocol therapy (6≤cycles), while 8 patients failed to complete 6-cycle chemotherapy, because of progressive disease (5 patients) or grade 4 toxicities (3 patients). Median PFS was 20 months and 3-year PFS rate was 12%. Median overall survival was 39 months and 3-year OS rate was 69%. Conclusion Six cycles of single-agent docetaxel maintenance chemotherapy is feasible and generally tolerable to women with advanced ovarian cancer who attained a clinically defined response to initial paclitaxel and carboplatin based chemotherapy.

Clinical guidelines for obstetrical practice were first published by the Japan Society of Obstetrics and Gynecology (JSOG) and the Japan Association of Obstetricians and Gynecologists (JAOG) in 2008, and a revised version was published in 2011. The aims of this publication include the determination of current standard care practices for pregnant women in Japan, the widespread use of standard care practices, the enhancement of safety in obstetrical practice, the reduction in burdens associated with medico-legal and medico-economical problems, and a better understanding between pregnant women and maternity-service providers. These guidelines include a total of 87 Clinical Questions followed by several Answers (CQ&A), a Discussion, a List of References, and some Tables and Figures covering common problems and questions encountered in obstetrical practice. Each answer with a recommendation level of A, B or C has been prepared based principally on 'evidence' or a consensus among Japanese obstetricians in situations where 'evidence' is weak or lacking. Answers with a recommendation level of A or B represent current standard care practices in Japan. All 87 CQ&A are presented herein to promote a better understanding of the current standard care practices for pregnant women in Japan.

Objectives: The incidence of poor neurologic outcomes was studied in term newborns who had suffered severe asphyxia at birth. Methods: Subjects were 152 newborns admitted to the NICU with a low Apgar score at 1 or 5 minutes. A 1-year prospective follow-up of neurological outcomes was carried out by a questionnaire survey concluded between April 1, 1996 and March 31, 1998. Results: 1) The incidence of a poor neurologic outcome, including 15 neurologic sequelae and 6 deaths, was 13.8% among the subjects. 2) The risk of a poor outcome was increased by 13-fold in neonates with adverse neurological signs and 31-fold in those with hypoxic ischemic encephalopathy. Conclusion: The incidence of poor neurologic outcome was very high among term infants with low Apgar scores. These infants were 10 times to 20 times more likely to die, or to survive with permanent disabilities, than were infants without low Apgar scores.

Background To clarify whether the use of balloons for cervical ripening is associated with the incidence of umbilical cord prolapse. Methods A postal questionnaire survey was distributed in Japan. Cases of umbilical cord prolapse occurring during labor in association with the use of balloons for cervical ripening between 2007 and 2011 in Japan were analyzed. Results Answers from 942 institutions were obtained. The subjects included 369 patients with fore-lying or prolapse of the umbilical cord among a total of 2,037,460 deliveries. Among the singleton vertex cases, fore-lying or prolapse of the umbilical cord during labor were observed in 88 (0.005%) of 1,891,189 deliveries not associated with the use of balloons for cervical ripening and in 93 (0.064%) of 146,271 deliveries associated with the use of balloons for cervical ripening (Odds ratio 13.67, 95% confidence interval 10.21, 18.30). All types of balloons were significantly associated with the occurrence of fore-lying or prolapse of the umbilical cord. A total of 39% of cases of umbilical cord prolapse occurred during manual or spontaneous balloon removal, while 53% of cases occurred after a while not directly associated with balloon removal. Conclusion The risk of umbilical cord prolapse was significantly increased during the use of balloons for cervical ripening, especially in cases involving the use of disk-type and ball-type balloons filled with large amounts of water.