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A pregnant woman with severe aplastic anemia was managed using biweekly red blood cell transfusion and oral eltrombopag olamine administration during pregnancy. She was diagnosed with preeclampsia at 35 weeks of gestation. The severity of aplastic anemia is very important for predicting the course of pregnancy. The frequency of preeclampsia in pregnant women with aplastic anemia may be higher than that in general pregnancies. Attention is paid to severe anemia in the early trimesters. Eltrombopag can be used in pregnancy. [ABSTRACT FROM AUTHOR]

Pregnancy and childbirth have various effects on the physical as well as mental aspects of women. Therefore, appropriate considerations must be given to the mental health of pregnant women. The Guideline Review Committee of the Japanese Society of Psychiatry and Neurology launched a liaison meeting for the Japanese Society of Psychiatry and Neurology and the Japan Society of Obstetrics and Gynecology, with a view to creating a "Clinical guide for women with mental health problems during the perinatal period" by cooperation of these two fields. After repeated discussions with input from both academic societies, they jointly formulated the "Clinical guide for women with mental health problems during the perinatal period: Overview" in May 2020, and reported its "Detailed Contents" in April 2021. We hope that this guide, which is the English overview of the detailed guide, will contribute to the mental health of pregnant women, facilitating healthy pregnancies and childbirth. [ABSTRACT FROM AUTHOR]

Background: Few reports have presented an overall view of pregnant women with coronavirus disease 2019 (COVID-19) across an entire country and throughout the entire gestation period. Furthermore, no such reports are available for Japan. We examined the clinical characteristics and outcomes of pregnant women with COVID‑19 on a national scale in Japan.Methods: A nationwide questionnaire-based survey for all 2,185 maternity services in Japan was conducted between July and August 2020. Information regarding maternal characteristics and epidemiological, clinical, treatment, and perinatal outcomes of pregnant women diagnosed with COVID-19 between 16 January and 30 June 2020 were collected. Main outcome measures were incidence of pregnant women with COVID-19 and infant infection, positive rate of the universal screening test for asymptomatic pregnant women, identification of infection route and rates of maternal death, and severe cases.Results: Responses from 1,418 institutions were assessed (65% of all delivery institutions in Japan). Seventy-two pregnant women were reported to have been diagnosed with COVID-19. The positive rate of the universal screening test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among asymptomatic pregnant women was 0.03% (2/7428). The most common route of infection was familial (57%). Fifty-eight pregnant women with COVID-19 were symptomatic, of whom five (8.6%) had a severe infection and one died (a tourist). Severe respiratory symptoms, oxygen administration, and pneumonia were frequently reported in the third trimester and postpartum period compared with in early pregnancy (22.2% vs 2.5% [P = 0.03], 38.9% vs 7.5% [P = 0.01], and 50.0% vs 7.5% [P < 0.001], respectively). All pregnant women with COVID-19 underwent caesarean sections, regardless of symptoms. There were no SARS-CoV-2 transmissions to newborns.Conclusions: In Japan, the number of cases of COVID-19 infection in pregnant women is very low. Compared with early pregnancy, late pregnancy may be a risk factor for exacerbation of symptoms and familial transmission is the most common route of infection. The importance of infection prevention should be emphasised, especially in women in late pregnancy, their families, and any cohabitants. [ABSTRACT FROM AUTHOR]

Aim: Women suffering from perinatal depression often have not noticed their mental condition, they often present with unspecified somatic complaints. Therefore, we examined the presence or absence of unspecified somatic complaints and the variability in complaints in women with perinatal depression who visited the Department of Oriental Medicine (DOM) at our Japanese perinatal center. Methods: The material reviewed consisted of the total population of Japanese women who visited our institute for a perinatal visit and underwent delivery at ≥37 weeks gestation at our institute between 2015 and 2018. We examined the DOM consultation rate, number and duration of visits to the DOM, presence or absence of unspecified somatic complaints (general malaise), and presence or absence of frequently changing complaints in the women with and without perinatal depression. Results: The DOM consultation rate in women with perinatal depression was significantly higher than in those without perinatal depression (odds ratio 5.02, 75% confidence interval 3.2–7.6, P < 0.01). The rate of unspecified somatic complaints and frequently changing complaints in women with perinatal depression were significantly higher than those without perinatal depression (unspecified somatic complaints: 44% vs. 10%, odds ratio 5.79, 75% confidence interval 2.6–13, P < 0.01; frequently changing complaints: 33% vs. 4%, odds ratio 12.7, 75% confidence interval 5.0–33, P < 0.01). Conclusion: To improve the recognition and management practices of perinatal depression, a standardized training will be needed on how to communicate in order to understand the mental problems in pregnant women concerning atypical symptoms of depression and unspecified somatic complaints. [ABSTRACT FROM AUTHOR]

In Japan, uterine cancer screening during pregnancy is subsidized by public funds. We examined the current status of the results of cervical cytology conducted during pregnancy in Japan. We requested 2,293 obstetrical facilities to provide information on cervical cytology in pregnant women who delivered between October 2018 and March 2019. A total of 1,292 obstetrical facilities responded, with valid information on a total of 238,743 women. The implementation rate of cervical cytology during pregnancy was 86.8% in Japan. The prevalence of abnormal cervical cytology during pregnancy was 3.3% in total and 4.9% using a spatula/brush with liquid-based cytology (LBC). The prevalence of positive high-risk human papillomavirus (HPV) in teenagers with atypical squamous cells of undetermined significance (ASC-US) was significantly higher than women of other ages (p < 0.01). Because HPV vaccine coverage has dropped to less than 1% in Japan, a further study with various conditions will be needed to improve the accuracy of cervical cancer screening during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Screening of pregnant women carrying human T-lymphotropic virus type 1 (HTLV-1) has a crucial role in reducing the number of HTLV-1 carriers. A national HTLV-1 screening program for pregnant women was started in 2011 in Japan. The purpose of this study is to report on the implementation of this nationwide screening program.Methods: This was a retrospective repeated cross-sectional study. We used datasets from surveys of HTLV-1-antibody-positive pregnant women performed by the Japan Association of Obstetricians and Gynecologists in 2011, 2013, and 2016. Outcomes for evaluation included the number of persons (pregnant women) who conducted the screening test, the number of positive persons (women) identified by these tests, and the proportion of positive persons to the number of persons (women) who conducted the tests.Results: Numbers of target facilities changed yearly: 1857 in 2011, 2544 in 2013, and 2376 in 2016. The mean number of screening-test participants increased per facility, but the median increased or decreased. The mean number of positive individuals identified decreased. Multivariate analysis results revealed the number of screenings was slightly reduced yearly, although areas (Kanto and Kinki) and high volume in facility types increased. Regarding the positive rates, some areas (Hokkaido/Tohoku, Kanto, and Chugoku/Shikoku) exhibited decreases or increases by facility type. The number of western blotting (WB) implementations decreased in 2016, positive rates identified by WB decreased in 2016 in all areas, and the number of facility types increased. The number of PCR participants increased in 2016 in Kanto and Kinki, but a decrease in facility type was observed. Positive rates were decreased in all areas (except the central region) but facility types were increased.Conclusions: The nationwide screening program for HTLV-1 in Japan was almost fully implemented. However, regional variations in screening tests were observed during this implementation. Thus, some incentives are needed to encourage proper implementation across all regions. [ABSTRACT FROM AUTHOR]

This letter to the editor discusses the issue of antimicrobial resistance (AMR) in Neisseria gonorrhoeae (NG) infections during pregnancy in Japan. The author refers to global surveillance data from the World Health Organization (WHO) that shows increasing resistance to azithromycin and decreased susceptibility or resistance to ceftriaxone and cefixime. The author conducted a study in Japan and found that AMR in NG was recognized in a small percentage of pregnant women using azithromycin, but there was no AMR to ceftriaxone or cefixime. The author suggests that the changes in AMR levels may be due to the relative increase in ceftriaxone use and the fluctuation in NG genotypes. The author emphasizes the need for further examination of the molecular epidemiology of the disease and continued AMR surveillance. [Extracted from the article]

We compared the current prevalence of and obstetric outcomes in underweight Japanese women with data from 16 years ago. We reviewed the obstetric records of singleton pregnant Japanese women who delivered at our institute at ≥ 22 weeks’ gestation from 2000 through 2002 and those from 2016 through 2018. From 2000–2002 to 2016–2018, numbers of pregnant women in their twenties decreased and pregnant women in their forties increased significantly (p < 0.01). There were no significant changes in the prevalence of underweight pregnant women between the 2 periods. The prevalence of women whose weight gain during pregnancy was less than optimal increased (p = 0.049). There was no difference in obstetric outcomes between the 2 periods. Based on the current results, we cannot judge the necessity of further education to curb the increasing trend of Japanese women who desire slimness. Maternal weight may not have a high priority as an indicator of the gestational nutritional status associated with obstetric outcomes in Japan. [ABSTRACT FROM AUTHOR]

Introduction: Recently, we have been providing comprehensive treatment for pregnant women with mental disorders involving specialists from multiple fields in cooperation with local administrative agencies. In this study, we examined the outcomes of treatment for women with perinatal mental disorders in our institute to evaluate the effect of our recent approach to improve perinatal mental health. Methods: We retrospectively compared the outcomes between pregnant women with mental disorders who delivered from April 2015 to March 2017 with those from April 2009 to March 2011. We examined the following: presence or absence of necessity of medication, self-interruption of medication, deterioration/relapse of mental disorders, and administrative support. Results: There was no significant difference in the rate of pregnant women with mental disorders between the two periods (3.2 versus 3.2%, respectively, p = .94). The rates of patients requiring medication and those with self-interruption of medication did not reach significance (p = .90 and.19, respectively) between the two periods; however, the rate of patients with deterioration/relapse of mental disorders decreased significantly during pregnancy and postpartum (20.3 versus 10.7 and 7.3 versus 1.7%, p = .04 and.03, respectively). On the other hand, the patients receiving administrative supports increased significantly over the total study period (p < .01). Conclusions: It was suggested that our recent active management of pregnant women with mental disorders might have contributed to prevent the deterioration/relapse of mental disorders during pregnancy and postpartum. [ABSTRACT FROM AUTHOR]

This study examined the risk of deterioration/relapse in pregnant women who discontinued their antidepressant medications based on the discretion of the psychiatric specialists compared with those who performed self-interruption. We reviewed the obstetric records of all singleton deliveries beyond 22 weeks of gestation at Japanese Red Cross Katsushika Maternity Hospital from January 2009 through December 2015. Compared with the women continuing antidepressant medications throughout pregnancy, the incidence of deterioration/relapse was higher in the women who discontinued their antidepressant medications regardless of who made the decision (interruption based on the discretion of the psychiatric specialists: 61%, odds ratio (OR), 8.05; 95% confidence interval (CI), 2.4–27;p < 0.01; self-interruption: 63%, odds ratio (OR), 8.79; 95% confidence interval (CI), 2.6–29;p < 0.01 versus 16%). The continuation of medications and careful observation are required for pregnant women complicated by depressive disorders. [ABSTRACT FROM PUBLISHER]

We examined the current status of syphilis-infected pregnant Japanese women, according to the results of syphilis screening and confirmation tests of women who gave birth in Japan between October, 2015 and March, 2016. We requested 2458 obstetrical facilities to provide information of syphilis screening tests and 78.1% of them responded. Considering the response rate and the rate of implementation of confirmation tests, the number of syphilis-infected pregnant Japanese women was estimated to be 250 (1/4022) per year. [ABSTRACT FROM AUTHOR]

Objectives. To examine the obstetric outcomes of our ''low risk'' pregnant women under the midwife-led delivery care compared with those under the obstetric shared care. Methods. A retrospective cohort study compared outcomes of labor under midwife ''primary'' care with those under obstetric shared care. The factors examined were: maternal age, parity, gestational age at delivery, length of labor, augmentation of labor pains, delivery mode, episiotomy, perineal laceration, postpartum hemorrhage, neonatal birth weight, Apgar score, and umbilical artery pH. In this study, pregnant women were initially considered ''low risk'' at admission when they had no history of medical, gynecological, or obstetric problems and no complications during the present pregnancy. Results. There were 1031 pregnant women initially considered ''low risk'' at admission. At admission, 878 of them (85%%) requested to give birth under midwife care; however 364 of these women (42%%) were transferred to obstetric shared care during labor. The average length of labor under the midwife ''primary'' care was significantly longer than that under the obstetric shared care. However, there were no significant differences in the rate of prolonged labor (≥≥24 h). There were no significant differences in other obstetric or neonatal outcomes between the two groups. Conclusions. There was no evidence indicating that midwife ''primary'' care is unsafe for ''low risk'' pregnant women. Therefore, midwifery care is recommended for ''low risk'' pregnant women. [ABSTRACT FROM AUTHOR]

Aim: We examined whether the Doppler waveforms of the maternal renal main arteries are altered in women with twin pregnancy compared with those in singleton pregnancy. Methods: The indices of vascular resistance and acceleration time of the maternal main renal arteries were obtained from 19 healthy women at 37-38 weeks of singleton gestation and 17 women at the same gestational age with non-preeclamptic twin gestation. Results: There were no significant differences in the indices of vascular resistance between the singleton and twin groups. However, the acceleration time was significantly prolonged in the twin pregnancy group compared with that in the singleton pregnancy group (83.7 +/- 24 vs. 59.8 +/- 12 ms, p < 0.01). Conclusion: The current results imply that maternal renal arteries are more significantly affected by hemodynamic changes in twin pregnancy than in singleton pregnancy. [ABSTRACT FROM AUTHOR]

Aim: This study examined the clinical significance of patients complicated by circumvallate placenta in comparison with patients with a normal placenta. Methods: Data were collected from 139 singleton deliveries complicated by circumvallate placenta and from 7666 unaffected controls managed at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2005. Results: The incidence of premature delivery, oligohydramnios, non-reassuring fetal status on cardiotocogram, placental abruption and intrauterine fetal death in patients complicated by circumvallate placenta were significantly higher than those in control patients. The odds ratio of placental abruption in patients complicated by circumvallate placenta was 13.1 (95% confidence limits: 5.65–30.2). Conclusion: A circumvallate placenta is associated with a higher incidence of serious perinatal complications such as placental abruption. [ABSTRACT FROM AUTHOR]

Introduction: This study investigated the relation between adenosine and thyroid function associated with hyperemesis gravidarum. Methods: We examined 84 Japanese singleton pregnant women with an average age of 33.0±5.8 years at 9–12 weeks gestation being managed at our hospital. The patients were divided into three groups according to the severity of emesis: (1) those with hyperemesis gravidarum (nausea and vomiting with weight loss >5%, n=13), (2) those with emesis (nausea and vomiting with weight loss <5%, n=31), and (3) those with no symptoms as a control ( n=40). Results: The average serum TSH levels in the emesis and hyperemesis groups were significantly higher than that in the control group ( P<0.05). The average plasma adenosine level in the hyperemesis group was significantly higher than those in the control pregnant and emesis groups ( P<0.05). There were no significant differences in plasma adenosine levels between the control pregnant and emesis groups. The serum TSH level showed significant correlations with weight loss (%) and plasma adenosine levels ( P<0.05). Conclusions: Our findings support the possible role of adenosine in counteracting the further progression of hyperemesis gravidarum associated with gestational thyrotoxicosis. [ABSTRACT FROM AUTHOR]

Objective: This study examined the basal metabolic rate in patients with twin pregnancies and compared the results with those of singleton pregnancies and non-pregnant women. Methods: In 15 non-pregnant women, 14 patients with twin and 25 patients with singleton pregnancies, the resting energy expenditure was measured using an open-circuit ventilatory system during the third trimester of pregnancy. Results: The averaged resting energy expenditure in patients with twin pregnancy was 1,636 ± 174 kcal/day, significantly higher than that in patients with singleton pregnancy (1,456 ± 158 kcal/day; p < 0.05). Both of these levels are significantly higher than those in non-pregnant women (1,228 ± 132 kcal/day; p < 0.05). Conclusion: Our results indicate that the estimated increased metabolic demands in patients during the third trimester of twin pregnancy are about 10% higher than those in women with singleton pregnancy. A prospective clinical study concerning nutrition counseling is needed. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Adenosine is an important metabolic modulator and adenosine concentrations are affected by sympathetic nerve stimulation and cytokine production. Since hyperemesis gravidarum is characterized by overactivation of sympathetic nerves and enhanced production of tumor necrosis factor (TNF)-α, plasma adenosine concentrations may be altered. The present study evaluated plasma adenosine concentrations and their relation with norepinephrine and TNF-α concentrations in hyperemesis gravidarum. Methods: Plasma concentrations of adenosine, norepinephrine, and TNF-α were measured in 34 healthy nonpregnant women, and 34 women with hyperemesis gravidarum and normal pregnancies, matched for age, parity and gestational week. The relationships between plasma adenosine, and norepinephrine and TNF-α concentrations in hyperemesis gravidarum were evaluated. Results: Mean plasma adenosine, norepinephrine, and TNF-α concentrations were significantly increased in women with hyperemesis gravidarum compared to those in nonpregnant and normal pregnant women (p<0.05). The increase in plasma adenosine concentrations correlated with the increase of norepinephrine and TNF-α in hyperemesis gravidarum (r=0.50, p<0.05 and r=0.43, p<0.05, respectively). Conclusions: Adenosine is an established suppressor of excessive sympathetic nerves activation and cytokine production, so the increase in plasma adenosine in hyperemesis gravidarum might serve to counteract further progression of hyperemesis gravidarum. [Copyright &y& Elsevier]

OBJECTIVE: The aim of the study was to measure resting minute ventilation and oxygen consumption in patients with hyperemesis gravidarum before and after treatment and to compare the results with those of normal pregnant women. STUDY DESIGN: Baseline evaluation was performed with the use of an open-circuit ventilatory system in 17 hospitalized patients with hyperemesis gravidarum and was repeated 1 week after treatment. Thirty-seven normal pregnant women served as control subjects. RESULTS: Resting minute ventilation and oxygen consumption were decreased by 20% and 15% (P < .001), respectively, in patients with hyperemesis compared with control subjects. The decrease occurred despite a measurable increase of free thyroxine compared with normal pregnancy. Treatment resulted in a 10% increase in oxygen consumption in those patients with increased thyroid stimulation, but not otherwise. CONCLUSION: Resting oxygen consumption is reduced significantly in patients with hyperemesis gravidarum that is consistent with a state of partial starvation rather than increased in parallel with increases of thyroid axis activity. [ABSTRACT FROM AUTHOR]

In Japan, the hospitalization assistance policy (HAP) system helps pregnant women who, for financial reasons, cannot give birth at medical institutions. The HAP system allows these women to deliver at specified midwifery institutions. We compared women with singleton pregnancies who gave birth with the HAP system (n=150) or without (control; n=2,869). Although the percentage of women younger than 20 years was significantly greater in the HAP system group than in the control group, the parity number in the HAP system group was significantly greater than that in the control group. The percentage of non-Japanese was significantly higher in the HAP system group than in the control. The rates of preterm delivery and of low birth weight (<2,000 g) were significantly greater in the HAP system group than in the control group. From the perspective of perinatal medicine, social risks, such as poverty, present some perinatal problems, even in Japan. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the relationship between plasma ET-1 levels and T helper-1 (Th1):Th2 immunity in women with twin pregnancies. The percentage of Th1 and Th2 cells and the Th1:Th2 cell ratios in peripheral blood from 13 normal singleton pregnant women and 13 patients with twin pregnancies at 29–34 weeks' gestation were calculated using flow cytometry. The plasma ET-1 was also determined using a modified radioimmunoassay. The plasma ET-1 concentrations and the cell ratios of Th1:Th2 in twin pregnancies were significantly lower than those in singleton pregnancies. A positive correlation was found between plasma ET-1 levels and the ratios of Th1:Th2 cells in the whole subjects. Our results indicate that decreased ET-1 levels are associated with Th1:Th2 immunity in twin pregnancies. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses a study of the actual strategies of feeding for pregnant women who cannot be confirmed as human T-cell leukemia virus type 1 (HTLV-1) carrier by western blot (WB) test.

We examined the current status of human T-cell leukemia virus type 1 (HTLV-1) carrier in Japanese pregnant women, according to the results of HTLV-1 screening and confirmation tests of women who gave birth in Japan in 2011. We requested 2642 obstetrical facilities to provide information of HTLV-1 tests and 71.3% of them responded. Considering the response rate and the rate of implementation of confirmation tests, the number of HTLV-1 carrier in Japanese pregnant women was estimated to be 1620 (0.16%) per year. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to examine the influence of history of abortion on the next pregnancy outcomes associated with preeclampsia. This investigation involved 5206 nulliparous Japanese women with singleton pregnancies who delivered after 22 weeks of gestation. The patients were divided into two groups: those with a history of spontaneous and/or artificial abortion during the previous pregnancies after the marriage with the same partner ( n = 1029) and those without a history of abortion ( n = 4173). There was no significant difference in the incidence of preeclampsia between the 2 groups with and without previous abortions (4.0% vs. 3.9%, p = 0.91). In addition, there were no significant differences in the incidence of perinatal complications associated with preeclampsia between the 2 groups. Although further studies may be needed, based on the current results history of abortion does not seem to affect perinatal outcomes associated with preeclampsia. [ABSTRACT FROM AUTHOR]

Objective This study examined the resting oxygen consumption in patients with a twin pregnancy and compared the results with those of singleton pregnancies. Methods In 15 patients with a twin and 26 patients with a singleton pregnancy, the resting oxygen consumption was measured using an open-circuit ventilatory system during the third trimester of pregnancy. Results The average resting oxygen consumption in patients with a twin pregnancy was 231 ±25 ml/min, significantly higher than that in patients with a singleton pregnancy (209±24 ml/min, P < 0.05). Conclusion Our results indicate an estimated increase in metabolic rate in patients during the third trimester of a twin pregnancy compared with those with a singleton pregnancy. [ABSTRACT FROM AUTHOR]

We present a case of monochorionic-diamniotic (MD) twin pregnancy with polyhydramnios-polyhydramnios sequence. A 20-year-old woman, gravida 1, para 0, was referred to our hospital at 31 weeks and 6 days' gestation for consultation about a high-risk pregnancy due to the presence of discordant fetal growth pattern (26% of fetal growth discordance) with polyhydramnios in MD twin pregnancy. Ultrasound examination at admission showed a maximal vertical pocket (MVP) of 11.4 cm in twin A and an MVP of 4.7 cm in twin B. At 33 weeks' gestation, the MVPs had increased to 222 cm and 10.2 cm, respectively. At 33 weeks and 2 days' gestation, Cesarean section was performed because of uncontrolled uterine contractions associated with polyhydramnios. Twin A was a female weighing 2,280 g, and twin B was a female weighing 1,782 g (22% growth discordance). The estimated amniotic fluid volumes of twins A and B were 5,000 and 1,000 mL, respectively. [ABSTRACT FROM AUTHOR]