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Objective: Although prior attempts have failed to identify the beneficial effects of intensive fetal monitoring on cerebral palsy, the association between nonreassuring fetal status (NRFS) during labor and the incidence of long‐term neurodevelopmental delays in offspring remains unclear. This study aimed to evaluate this association using a nationwide birth cohort. Methods: Data from 72 869 women with singleton deliveries at and after 37 weeks of gestation from the Japan Environment and Children's Study (2011–2014) were analyzed. Multivariable logistic regression models were used to analyze the odds ratios (ORs) for neurodevelopmental delays using the Ages & Stages Questionnaire (Third Edition) in offspring aged 3 years. Results: The adjusted ORs for personal–social problems were 1.52 (95% confidence interval [CI], 1.06–2.16) for offspring delivered vaginally by nulliparous mothers and 1.51 (95% CI, 1.05–2.18) (for males, 1.70 [95% CI, 1.15–2.50]) for those delivered via cesarean section. No significant changes in adjusted ORs for neurodevelopmental delays were observed among participants without neonatal Apgar scores (ASs) <7 and without umbilical arterial pH (UmA‐pH) <7.20. Conclusion: NRFS during labor was associated with an increased incidence of personal–social problems in offspring aged 3 years. However, this association was not confirmed after excluding participants with neonatal ASs <7 and UmA‐pH <7.20. The association between NRFS and offspring's neurodevelopmental delays might vary based on delivery settings, offspring sex, and short‐term neonatal outcomes. Synopsis: Nonreassuring fetal status during labor in certain delivery settings is associated with an increased incidence of personal–social problems in offspring aged 3 years. [ABSTRACT FROM AUTHOR]

Aim: This retrospective study was performed to investigate whether certain fetal heart rate patterns were associated with subsequent cerebral palsy (CP) in infants with chorioamnionitis at or near term. Methods: We used cases registered by the Japan Obstetric Compensation System for CP, which is a nationwide population‐based database. Among them, 133 infants with chorioamnionitis who were born at ≥34 weeks of gestation were enrolled. All infants underwent magnetic resonance imaging (MRI), and all fetal heart rate charts had been interpreted according to the National Institute of Child Health and Human Development criteria, focusing on antepartum and immediately before delivery. Results: The incidence of CP after chorioamnionitis at ≥34 weeks of gestation was 0.3 per 10 000 in Japan. Between the clinical (24%) and subclinical groups (76%), the incidence of abnormal fetal heart rate patterns did not differ. According to the MRI classification, 88% of the infants with CP showed hypoxic–ischemic encephalopathy. Half of the infants with CP experienced terminal bradycardia, leading to severe acidosis and exclusively to hypoxic–ischemic encephalopathy. In another half, who did not experience bradycardia, 80% had moderate acidosis (pH 7.00–7.20) resulting in hypoxic–ischemic encephalopathy, and the remaining 20% showed non‐acidosis resulting in brain damage other than hypoxic–ischemic encephalopathy. The fetal heart rate patterns before the terminal bradycardia showed that the incidence rates of late deceleration or decreased variability were high (>60%). Conclusion: Fifty percent of pregnant women with chorioamnionitis‐related CP had terminal bradycardia that exclusively resulted in hypoxic–ischemic encephalopathy. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to clarify the feasibility of a mobile cardiotocogram (CTG) device for self‐monitoring fetal heart rate (FHR) in low‐risk singleton pregnant women. Methods: This study was conducted at six university hospitals and seven maternity clinics in Japan. Using a mobile cardiotocogram device (iCTG, Melody International Ltd., Kagawa, Japan), participants of more than 34 gestational weeks measured the FHR by themselves at least once a week until hospitalization for delivery. We evaluated the acquisition rate of evaluable FHR recordings and the frequency of abnormal FHR patterns according to the CTG classification system of the Japan Society of Obstetrics and Gynecology (JSOG). The participants also underwent a questionnaire survey after delivery to evaluate their satisfaction level of self‐monitoring FHR using the mobile CTG device. Results: A total of 1278 FHR recordings from 101 women were analyzed. Among them, 1276 (99.8%) were readable for more than 10 min continuously, and the median percentage of the total readable period in each recording was 98.9% (range, 51.4–100). According to the JSOG classification system, 1245 (97.6%), 9 (0.7%), 18 (1.4%), and four (0.3%) FHR patterns were classified as levels 1, 2, 3, and 4, respectively. The questionnaire survey revealed high participant satisfaction with FHR self‐monitoring using the iCTG. Conclusion: The mobile CTG device is a feasible tool for self‐monitoring FHR, with a high participant satisfaction level. [ABSTRACT FROM AUTHOR]

Aim: To assess the accuracy of neonatal distress prediction using the five‐level classification of fetal heart rate (FHR) and management protocol of the Japan Society of Obstetrics and Gynecology (JSOG). Methods: A case–control study was conducted. Vertex singleton pregnant women who delivered after 37 weeks' gestation from 2013 to 2015 were enrolled. The participants were categorized into two groups; controls were levels 1–3 (n = 1184), whereas cases were levels 4–5 (n = 117) group. Neonatal distress was defined as Apgar score < 8 points at 5 min or umbilical cord artery pH < 7.1. Results: There were 117 cases (9.0%). The frequency of the neonatal distress was observed in 1.3% controls and 6.8% cases (P < 0.01). Diagnostic accuracy of neonatal distress for cases showed a 6.8% positive‐predictive value, 34.8% sensitivity, 91.5% specificity and 98.7% negative‐predictive value. Among various obstetrical conditions, high sensitivity (100%) for prediction of neonatal distress was observed in women with chromosome abnormalities, placental abruption, umbilical cord abnormalities and excessive labor pain. Conversely, relatively low specificity (<50%) was observed in cases with oligohydramnios and excessive labor pain. Conclusion: The five‐level classification scheme was efficient for neonatal distress prediction. However, depending on the obstetric condition, the FHR findings and neonatal condition might be independent. [ABSTRACT FROM AUTHOR]

Aim: In Hokkaido, Japan, the number of people suffering from coronavirus disease 2019 (COVID‐19) is rapidly increased, and by the end of February 2020, there were already 70 confirmed cases of the disease. We investigated the safety of urgently initiated maternal telemedicine in preventing the spread of the coronavirus infection. Methods: This retrospective, single‐institution study examined maternal telemedicine at the department of obstetrics of the Hokkaido University Hospital from March 4 to April 2, 2020. The physicians remotely examined the pregnant women from their homes using a visual communication system which kept communication confidential, performed prenatal checkup and administered medical care according to their various blood pressures, weights and cardiotocograms. Results: Forty‐four pregnant women received a total of 67 telemedicine interventions. Thirty‐two pregnant women (73%) had complications, and 22 were primiparas (50%). Telemedicine interventions were provided 19 times at less than 26 weeks of gestation, 43 times between 26 and 36 weeks of gestation and 5 times after 37 weeks of gestation. There was one case with an abnormality diagnosed during the remote prenatal checkups, and the patient was hospitalized on the same day. However, there were no abnormal findings observed in mothers and children during the other 66 remote prenatal checkups and medical care. Conclusion: Maternal telemedicine can be safely conducted in pregnant women who are at risk of having an underlying disorder or fetal abnormality 1 month following the start of the attempt. It should be considered as a form of maternal medical care to prevent the spread of COVID‐19. [ABSTRACT FROM AUTHOR]

Aim Intrapartum fetal bradycardia necessitates immediate operative delivery. Our aim was to investigate the hypothesis that some non-reassuring fetal heart rate (FHR) patterns were present before the onset of terminal bradycardia in infants who developed subsequent brain damage. Material and Methods From a population-based study of 65 197 deliveries, 190 stillbirths, 115 neonatal deaths, and 136 neurologically high-risk infants were registered by the Miyazaki Perinatal Conference. There were 15 cases of neurologically high-risk infants born at >34 weeks of gestation exhibiting intrapartum terminal bradycardia. Focusing on the brain-damaged infants, we retrospectively analyzed FHR patterns for at least 1 h prior to the bradycardia. Results Brain damage (cerebral palsy [ n = 11] and mental retardation [ n = 2]) was diagnosed at 2 years old in 13 out of 15 neurologically high-risk infants. Two infants had bradycardia on admission. In the remaining 11 infants, FHR patterns were reassuring in six (55%) and non-reassuring in five (45%), including late decelerations ( n = 4) and variable decelerations ( n = 2). Clinically relevant factors in the non-reassuring group included intrauterine infection ( n = 3), malpresentation with umbilical cord coiling ( n = 1), and unknown causes ( n = 1). Clinically relevant features in the reassuring group included cord prolapse ( n = 1), vaginal breech delivery ( n = 1), shoulder dystocia ( n = 1), rupture of membranes ( n = 1), and unknown causes ( n = 2). Conclusion More than half of the brain-damaged infants born at >34 weeks of gestation who exhibited intrapartum terminal bradycardia had unremarkable FHR patterns before abrupt-onset bradycardia. For those with non-reassuring patterns preceding bradycardia, intrauterine infection was the major sentinel event. [ABSTRACT FROM AUTHOR]

Objectives. The Japan Academy of Midwifery developed and disseminated the "2012 Evidence-based Guidelines for Midwifery Care" in order to achieve a more uniform standard of care during childbirth. The aim of this study was to describe the implementation of the Guideline among hospitals, clinics and midwifery birth centers. The focus was on care during the first stage of labor. Data was collected through October 2010 to July 2011. Methods. Participants were managers who were in charge of hospitals, clinics and midwifery birth centers handling childbirth in Tokyo, Kanagawa, Chiba, and Saitama. Questions about the Guideline's implementation during the first stage of labor comprised 18 items. The Ethics Committee of St. Luke's College of Nursing, Tokyo, Japan (No. 10-1002) provided ethical approval. Results. Agreeing to participate were 255 institutions (total response rate, 37.2%): 18 hospitals (response rate, 50.2%), 66 clinics (20.8%), and 71 midwifery birth centers (54.2%). Responses to continuity of caregivers for care during pregnancy and childbirth indicated Guideline adoption in midwifery birth centers (92.9%) and clinics (54.7%), but not in hospitals (15.3%). Two interventions for inducing labor were minimally adopted: (1) membrane sweeping for induction of labor was not common (hospitals .8%, clinics 3.1%, midwifery birth centers 1.4%), and (2) nipple and breast stimulation (hospitals 0%, clinics 1.5%, midwifery birth centers 5.6%). It was a policy for 38% of midwifery birth centers to provide continuous electronic monitoring on admission. Epidural analgesia was used if necessary as a policy in 31.6% of hospitals and 31.3% of clinics. Possibility for immersion in water around 40 centigrade for labor pain management as a practice in midwifery birth centers was higher (92.7%) than in hospitals (48.3%) and clinics (26.7%). Examples of adoption of methods for labor pain management with higher rates were: position change (95%), back massage (88%), warm pack (74%), and walking (61%). A routine enema to accelerate contractions was not common (hospitals 1.7%, clinics 9.1%, midwifery birth centers 1.4%). No institution had a policy for amniotomy as routine care. Conclusion. There were considerable gaps between the Guideline and practice in hospitals, clinics, and midwifery birth centers. Based on the results of this study, evaluation of the Guideline should be conducted in a few years. Limitation of this study was the low reply rate of respondents. It is necessary to elucidate the actual conditions throughout Japan. [ABSTRACT FROM AUTHOR]

The Japan Academy of Midwifery has developed the Evidence-Based Care During Childbirth Guideline for Midwives (2012 edition) containing care policies for healthy low risk women and newborns. In order to disseminate the guideline, contents of the guideline are introduced for midwives through the current paper. A total of twenty nine clinical questions were included in the guideline. For each clinical question, evidence statement, its explanations and references were prepared. Evidence-based and women-centered care would be promoted if midwives adopt care policy in the guideline at hospitals, clinics and independent midwives. [ABSTRACT FROM AUTHOR]

Aim: Intrapartum management guidelines based on fetal heart rate classification comprising a 5-tier system (Levels 1-5) was proposed by the Perinatology Committee of the Japan Society of Obstetrics and Gynecology (JSOG). This study aimed to assess the reproducibility and clinical usefulness of this classification. Methods: For assessing intraobserver and interobserver reproducibility in the interpretation of fetal heart rate tracing, 2 obstetricians reviewed 247 fetal heart rate tracings using the JSOG classification (Level 1, normal; Level 2, benign variant; Level 3, mild variant; Level 4, moderate variant; and Level 5, severe variant) and a subjective 3-tier classification (normal, equivocal, and ominous). In a separate series, we investigated whether the JSOG classification is related to early neonatal outcome and the delivery mode in 96 deliveries. Results: Weighted kappa coefficients of intraobserver and interobserver reproducibility in the interpretation of fetal heart rate tracings based on the JSOG classification were 0.73 to 0.77 and 0.70, respectively. In the subjective classification, these values were 0.69 to 0.72 and 0.59. There was a progressive increase in the rate of instrumental or cesarean deliveries across the 5 levels of the JSOG classification (P<0.001). Although, level 5 of the JSOG classification had a lower Apgar score and umbilical artery pH than did the other 4 levels (p<0.05), there were no significant differences among the other levels in regard to early neonatal outcome. Conclusions: This study demonstrated that both intraobserver reproducibility and interobserver reproducibility of the JSOG classification for interpreting FHR tracings were clinically acceptable. The results also suggest that the intervention according to the JSOG classification is useful for avoiding worsening early neonatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the five-tier classification of fetal heart rate (FHR) tracings recently proposed by Japan Society of Obstetricians and Gynecologists (JSOG). Methods: The database between January and June 2009 was reviewed for women in active labor at ≥36 ++ 0 gestational weeks, with singleton fetuses in cephalic presentation and with umbilical artery blood gas analyses. Continuous FHR tracings were assessed according to the five-tier classification proposed by JSOG, where level 1 is normal, level 2 is subnormal and levels 3-5 are abnormal patterns. Results: A total of 341 parturient women were eligible for this study protocol. The median (range) of the levels in the first and the second stage of labor were 1 (1-4) and 2 (1-4), respectively ( p < 0.001). Both pH and base excess of umbilical artery decreased with higher levels of FHR tracings interpretation ( p < 0.01). Interventions resulting in delivery were more necessary in the first stage of labor than in the second stage of labor in cases of levels 3 and more. Conclusions: Five-tier system for FHR tracing interpretation proposed by JSOG intercorrelates with the fetal acid-base balance well. Categorization of FHR tracings by uniform diagnostic criteria will be useful to standardize therapeutic strategy by sharing common perception among obstetrical staff. [ABSTRACT FROM AUTHOR]

Background: The human NOTCH4 gene is a candidate gene for schizophrenia due to its chromosomal location and neurobiological roles. In a British linkage study, NOTCH4 gene polymorphisms were highly associated with schizophrenia. In a Japanese case-control association study, however, these polymorphisms did not show significant associations with schizophrenia. We conducted a case-control study with Japanese subjects to explore an association between the triplet repeat polymorphism in the NOTCH4 gene and schizophrenia, including subtypes of schizophrenia, longitudinal disease course characteristics, and a positive family history for psychoses. Methods: We examined the (CTG)n repeat polymorphism in the NOTCH4 gene among 100 healthy Japanese individuals and 102 patients with schizophrenia (22 paranoid, 38 disorganized, 29 residual, 64 episodic, 31 continuous, 42 with prominent negative symptoms, and 46 with positive family histories) using a polymerase chain reaction-based, single-strand conformational polymorphism analysis. Results: Five different alleles consisting of 6, 9, 10, 11, and 13 repeats of CTG (Leu) in patients with schizophrenia, and 4 alleles consisting of 6, 9, 10, and 11 repeats in controls were found. No significant differences in genotype or allele frequencies of repeat numbers were found between controls and patients. In addition, there were no associations between the polymorphism and schizophrenia subtypes, longitudinal disease course characteristics, or positive family history of the patients. Conclusions: Our data suggest a lack of association between the NOTCH4 gene triplet repeat polymorphism and schizophrenia in Japanese individuals. [ABSTRACT FROM AUTHOR]