記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

This study aimed to elucidate the etiologies of and risk factors for recurrent pregnancy loss (RPL) according to fertile ability, focusing on the differences between superfertile and subfertile patients. This retrospective observational study included 828 women with RPL between July 2017 and February 2020. Patients were divided into three groups based on time to pregnancy (TTP): superfertile (SUP) (TTP ≤3 months for all previous pregnancies), subfertile (SUB) (previous TTP ≥12 months and use of assisted reproductive technology [ART]), and Normal (N) (TTP >3 or <12 months without ART). All patients were assessed for uterine anatomy, antiphospholipid antibodies (APAs), thyroid function, and thrombophilia. Of the 828 patients, 22%, 44%, and 34% were assigned to the SUP, SUB, and N groups, respectively. The mean ages were 33.9, 38.2, and 35.9 years in the SUP, SUB, and N groups, respectively, revealing a significant difference (P < 0.001). The anti-CL β2GPI antibody positivity rate was significantly higher in the SUP group (4.6%) than in the N group (0.8%; P = 0.016). The prevalence of APA positivity was lowest in the N group. Overall, the clinical characteristics and etiologies of RPL associated with superfertility and subfertility were strikingly similar, with comparable positivity rates after adjusting for maternal age. Further investigation including chromosomal analysis of products of conception is needed to elucidate the clinical impact of differences in fertility on patients with RPL.

DOI： 10.1016/j.jri.2023.104129

PubMed

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記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

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記述言語：日本語   出版者・発行元：日本エンドメトリオーシス学会  

Accessory cavitated uterine mass(ACUM)はまれな子宮嚢胞性疾患で,30歳未満の若年女性に好発し,重症の月経困難症や慢性的な下腹部痛を症状とする.ACUMの多くは,ホルモン療法に抵抗するといわれている.今回,低用量エストロゲン・プロゲスチン配合剤(LEP)投与により疼痛が軽快し保存療法を継続できているACUMを強く疑う1症例を経験したので報告する.症例は23歳,未妊の女性で,1年前から月経痛と持続下腹部痛を認め,経腟超音波断層像では子宮は正常大を示し,子宮左側壁に内腔を有する約3cm大の腫瘤を認めた.骨盤部MRIでは子宮筋腫や子宮腺筋症は検出されず,左子宮円索起始部付近にT1強調画像で高信号,T2強調画像でshadingを示す内腔を有する嚢胞を認めACUMを強く疑った.治療方針として手術を提案したが希望されず,保存的治療としてLEPを投与した.投与開始2ヵ月後には,疼痛は減少した.ACUMが疑われるが手術を希望されない症例にLEP投与が有効となりうると考えられた.(著者抄録)

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記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本婦人科腫瘍学会  

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記述言語：日本語   出版者・発行元：(公社)日本婦人科腫瘍学会  

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記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Breech presentation is observed in 3-4% at term of pregnancy and is one of the leading causes of cesarean section. There is no established treatment for breech presentation before 36 weeks. A retrospective cohort study was conducted to demonstrate that the lateral position is effective for breech presentation. However, there are no randomized controlled trials evaluating lateral position management for breech presentation. Here, we described the methodology of a randomized controlled trial of a cephalic version for breech presentation in the third trimester by lateral postural management (BRLT study). METHODS: The BRLT study is an open-label, randomized controlled trial with two parallel groups allocated in a 1:1 ratio to examine the lateral position management for breech presentation, as compared with expectant management care. An academic hospital in Japan will enroll 200 patients diagnosed with a breech presentation by ultrasonography between 28 + 0 weeks and 30 + 0 weeks. Participants in the intervention group will be instructed to lie on their right sides for 15 min three times per day if the fetal back was on the left side or lie on their left sides if the fetal back was on the right side. The instruction will be given every 2 weeks after confirmation of fetal position, and the lateral position will be instructed until the cephalic version, and after the cephalic version, the reverse lateral position will be instructed until delivery. The primary outcome is cephalic presentation at term. The secondary outcomes are cesarean delivery, cephalic presentation 2, 4, and 6 weeks after the instruction, and at delivery, recurrent breech presentation after cephalic version, and adverse effects. DISCUSSION: This trial will answer whether the lateral positioning technique is effective in treating breech presentation and, depending on the results, may provide a very simple, less painful, and safe option for treating breech presentation before 36 weeks, and it may impact breech presentation treatment. TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000043613. Registered on 15 March 2021 https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000049800 .

DOI： 10.1186/s13063-023-07395-w

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The use of angiogenesis inhibitors and poly ADP-ribose polymerase inhibitors following multi-agent chemotherapy, including platinum-based agents, has become the standard treatment for platinum-sensitive recurrent ovarian cancer (PSROC). However, the optimal maintenance therapy and selection criteria for these patients remain unclear. Thus, this study aimed to optimize the treatment options and selection criteria for patients with PSROC. The clinical data of 51 patients with PSROC admitted to Nippon Medical School Chiba Hokusoh Hospital and Nippon Medical School Hospital were retrospectively collected. The log-rank test was used for the survival analysis, and Cox proportional hazard regression analysis was used for the multivariate survival analysis. Of the 51 patients, 17 received maintenance therapy with bevacizumab (Bev), and 34 received olaparib (Ola). Recurrence-free survival (RFS) was significantly prolonged in the Ola group (27 months; 95% confidence interval (CI), 19-NA months) compared with that in the Bev group (9 months; 95% CI, 5-22 months; p = 0.000103). The efficacy of Ola was independent of background factors, including response to previous chemotherapy, homologous recombination status, histological type, or laboratory data. Ola is superior to Bev as PSROC maintenance therapy, especially in Japanese and Asian populations.

DOI： 10.3390/cancers15102869

PubMed

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：東京母性衛生学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(NPO)小切開・鏡視外科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：東京母性衛生学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Pelvic ultrasonography and measurement of serum cancer antigen 125 (CA-125) are recommended for preoperative evaluation before performing risk-reducing salpingo-oophorectomy (RRSO). We report our experience with two patients in whom an incidental gynaecological malignancy was found using endometrial cytology as a preoperative screening test for RRSO. Patient 1 was an early 50s woman with a pathologic variant of BRCA1 Transvaginal ultrasonography showed no endometrial abnormalities, but preoperative endometrial cytology revealed high-grade serous carcinoma. The patient underwent total hysterectomy, bilateral adnexectomy, pelvic and para-aortic lymph node dissection, and omentectomy. Patient 2 was a late 40s woman with a pathological variant of BRCA1 Transvaginal ultrasonography showed mild enlargement of the left ovary, and her CA-125 level was elevated. Preoperative endometrial cytology revealed high-grade serous cancer. She underwent total hysterectomy, bilateral adnexectomy and omentectomy. These case reports illustrate the importance of preoperative screening-including endometrial cytology-before performing RRSO.

DOI： 10.1136/bcr-2022-254484

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective We compared the recent obstetric outcomes of women aged 40 and over as advanced maternal age (AMA) to those with AMA more than 10 years ago. Methods This was a retrospective study of primiparous singleton pregnancies who delivered at ≥22 weeks of gestation managed at Japanese Red Cross Katsushika Maternity Hospital between 2003-2007 and 2013-2017. Results The percentage of primiparous women aged with AMA who delivered at ≥22 weeks of gestation increased from 1.5 to 4.8% (p<0.01) due to the increase in the pregnancy conceived by in vitro fertilization (IVF). In the pregnancies with AMA, the percentage of cesarean delivery decreased from 51.7 to 41.0% (p=0.01), while the prevalence of postpartum hemorrhage increased from 7.5 to 14.9% (p=0.01). The latter was associated with an increased rate of in vitro fertilization (IVF) use. Conclusions The percentage of AMA pregnancies significantly increased with the development of assisted reproductive technology, and the prevalence of postpartum hemorrhage also increased in AMA pregnancies.

DOI： 10.7759/cureus.35875

PubMed

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：日本子宮鏡研究会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J04260&link_issn=&doc_id=20230309470002&doc_link_id=10.1272%2Fmanms.19.10&url=https%3A%2F%2Fdoi.org%2F10.1272%2Fmanms.19.10&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：英語  

Retained products of conception can cause massive bleeding that can be prevented by uterine artery embolization before resection; however, uterine artery balloon occlusion is less invasive. While scattered reports of its use for postpartum hemorrhage exist, no indications have been described. We report a case of hysteroscopic resection of retained products of conception using uterine artery balloon occlusion instead of uterine artery embolization. A 29-year-old woman, gravida 2 para 0, noted an intrauterine mass after an abortion at 7 weeks' gestation. Follow-up visits showed insufficient lowering of human chorionic gonadotropin levels, necessitating surgical treatment. Considering the patient's desire to conceive, we performed uterine artery balloon occlusion to reduce the risk of perinatal complications associated with uterine artery embolization. The operation was completed without complications. The patient conceived spontaneously and had a live baby 7 months after surgery, thus proving the benefits of uterine artery balloon occlusion before hysteroscopic resection.

DOI： 10.1111/jog.15561

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記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: The objective of this study was to assess the potential risk factors for abscess development in patients with endometrioma who present with an acute abdomen. MATERIALS AND METHODS: We retrospectively reviewed the records of 51 patients who underwent emergency surgery for acute abdomen involving an endometrioma at our hospital between April 2011 and August 2021. The patients were divided into an infected group (n = 22) and a control group (n = 29). We analyzed patient characteristics; imaging findings; clinical data, including bacterial cultures; and perioperative outcomes to assess for differences between groups. RESULTS: Patients in the infected group were significantly older than those in the control group (P = 0.03). They were more likely to have a history of endometriosis surgery (P = 0.04) and more likely to have undergone transvaginal manipulation within 3 months of presentation (P = 0.01). Body temperature on the day of admission was significantly higher in the infected group (P = 0.007), as were C-reactive protein levels on the day of admission and before surgery (P < 0.001; P = 0.018) and the white blood cell count on the day of admission (P = 0.016). Preoperative imaging showed significant thickening of the tumor wall (P < 0.001) and an enhanced contrast effect (P < 0.001) in the infected group. CONCLUSION: We identified several factors that suggest abscess in patients with an acute abdomen who have a complication of pathologically confirmed endometriosis. A recent vaginal procedure is a particular risk factor for abscess development in patients with endometriomas.

DOI： 10.4103/gmit.gmit_36_22

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記述言語：英語  

Heavy menstrual bleeding is a type of abnormal uterine bleeding. Abnormal uterine bleeding includes the poorly characterized "not otherwise classified" category. Here, we report three abnormal uterine bleeding-not otherwise classified cases with uniform thickening of the junctional zone endometrium. Case 1: A 33-year-old nullipara with heavy menstrual bleeding presented with severe anemia (hemoglobin: 4.7 g/dL) and an 8.4-mm junctional zone endometrium on magnetic resonance imaging. Her condition improved with iron and low-dose estradiol-progestins. Case 2: A 36-year-old nulligravida had heavy menstrual bleeding, anemia (hemoglobin: 9.5 g/dL), and a 9.4-mm junctional zone endometrium; her anemia improved with iron supplementation. Case 3: A 39-year-old multipara had heavy menstrual bleeding, anemia (hemoglobin: 9.6 g/dL), and a 12.3-mm junctional zone endometrium, and was managed with a levonorgestrel-releasing intrauterine system. Pelvic examination, transvaginal sonography, and uterine size on magnetic resonance imaging were normal in all cases. In those without uterine abnormalities, uniform thickening of the junctional zone endometrium (⩾8 mm) may trigger heavy menstrual bleeding; hence, magnetic resonance imaging may be warranted in abnormal uterine bleeding-not otherwise classified cases.

DOI： 10.1177/2050313X231182803

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Malignant ovarian steroid cell tumours are a rare subgroup of sex cord-stromal tumours. There are no systematic reviews on the associated treatments, and little is known about their genomic profile. We describe a case of a pelvic malignant ovarian steroid cell tumour in a premenopausal woman in her 40s. She received cytoreductive surgery and six cycles of paclitaxel+carboplatin+bevacizumab. After recurrence, the tumour was surgically removed again, followed by radiation and hormone blockade therapy. Complete remission was achieved after treatment with bleomycin, etoposide and cisplatin. She remained in a platinum-sensitive relapse state and subsequently received maintenance therapy with olaparib. Since the tumour was initially refractory to treatment, tissue specimens were screened for gene mutations using a next-generation sequencing oncology panel and a somatic variant detection system, which revealed somatic gene mutations in ARID1A, PIK3CA, TERT and ATM, some of which are involved in DNA repair.

DOI： 10.1136/bcr-2021-248486

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記述言語：英語  

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.

DOI： 10.1002/ccr3.6789

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Preterm birth (PB) is the most-frequent complication occurring during pregnancy, with a significant impact on neonatal morbidity and mortality. Chorioamnionitis (CAM), the neutrophil infiltration into chorioamniotic membranes, is a major cause of PB. However, several cases of PB have also been reported without apparent pathogenic infection or CAM. Such cases are now attributed to "sterile inflammation." The concept of sterile inflammation has already attracted attention in various diseases, like cardiovascular diseases, diabetes, and autoimmune diseases; recently been discussed for obstetric complications such as miscarriage, PB, gestational hypertension, and gestational diabetes. Sterile inflammation is induced by alarmins, such as high-mobility group box 1 (HMGB1), interleukins (IL-33 and IL-1α), and S100 proteins, that are released by cellular damage without apparent pathogenic infection. These antigens are recognized by pattern-recognition receptors, expressed mainly on antigen-presenting cells of decidua, placenta, amnion, and myometrium, which consequently trigger inflammation. In reproduction, these alarmins are associated with the development of various pregnancy complications, including PB. In this review, we have summarized the development of PB related to acute CAM, chronic CAM, and sterile inflammation as well as proposed a new mechanism for PB that involves innate immunity, acquired immunity, and sterile inflammation.

DOI： 10.1016/j.jri.2022.103748

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Noninvasive prenatal testing (NIPT) is used to screen for fetal chromosomal abnormalities, such as fetal aneuploidy, and has been offered at our hospital since 2013. We analyzed data from our center to determine if NIPT screenees could be given more-accurate information on NIPT outcomes. METHODS: This retrospective observational study included 819 pregnant women who requested NIPT at Nippon Medical School Hospital from November 2013 to October 2021. We examined medical records for data on NIPT results and clinical outcomes. RESULTS: Of the 819 women, 764 (93.2%) underwent NIPT, and 55 (6.7%) did not. Of the 764 women who underwent NIPT, 17 received a positive result (2.2%), of whom 2 (11.8%), 4 (23.5%), and 11 (64.7%) received a positive result for trisomy 13, 18, and 21, respectively. The true-positive rates after definitive diagnoses of trisomy 13, 18, and 21 were 1 (50%), 3 (75%), and 11 (100%), respectively. Of the 17 positive results, there were two false-positive results (11.8%) (for trisomy 13 and trisomy 18). Eleven women with fetal aneuploidy terminated their pregnancies, and four cases resulted in intrauterine fetal death. Five neonates with negative NIPT results had congenital disease without chromosomal abnormality. Two patients had indeterminate results from the first blood sampling, possibly because of treatment with unfractionated heparin. The results of repeat testing after heparin cessation were negative. CONCLUSIONS: Our results were generally similar to nationwide data for Japan. NIPT providers can provide more detailed and individualized genetic counseling for each situation by understanding their own medical facility's data in detail.

DOI： 10.1272/jnms.JNMS.2022_89-512

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記述言語：日本語   出版者・発行元：日本生殖免疫学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: It is suggested that antenatal corticosteroid administration (ACS) to women at risk for late preterm birth reduces neonatal respiratory complications. However, ACS to pregnant women at risk in late preterm is still not recommended in Japan due to concerns about the long-term prognosis of their children. We aimed to assess the late preterm neonatal respiratory morbidity risk from singleton cesarean delivery before labor without ACS in pregnancy. METHODS: We retrospectively reviewed and analyzed data from the records of singleton cesarean deliveries of late preterm infants. The prevalence of neonatal respiratory morbidities necessitating ventilatory support such as continuous positive airway pressure or mechanical ventilation was compared with gestational age in late preterm. Respiratory distress syndrome (RDS) in the neonates was also compared. RESULTS: One hundred singleton cesarean deliveries in the late preterm period were eligible for inclusion: 22 neonates were delivered at 34 weeks, 34 at 35 weeks, and 44 at 36 weeks. There was a significant difference in respiratory morbidity that decreased significantly with gestational age (p < 0.001). Similarly, there was a significant difference in RDS, and the most frequent was at 34 weeks (18.2 %, p = 0.017). There were no cases of RDS at 36 weeks. CONCLUSION: Late preterm birth via cesarean delivery before labor without ACS, especially at 34 and 35 weeks, was associated with the need for ventilation. Treatment with ACS in elective cesarean section with the risk of preterm delivery before 35 weeks and 6 days might be allowed.

DOI： 10.1272/jnms.JNMS.2022_89-612

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The 2017 clinical guidelines for obstetrical practice by the Japan Society of Obstetrics and Gynecology and the Japan Association of Obstetricians and Gynecologists were revised and published as the 2020 edition (in Japanese). The aim of these guidelines is to present appropriate standard obstetric diagnosis and management procedures that have reached consensus among Japanese obstetricians. The 2020 guidelines include 113 clinical questions and an appendix, followed by answers (CQ&A; originally 112 in the 2017 edition), a discussion, list of references, and some tables and figures presenting common problems and questions encountered in obstetrical practice. Each answer comes with a recommendation level of A, B, or C and 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 113 CQ&As and the appendix are presented here to promote a better understanding of the current standard care practices for pregnant and lactating women in Japan.

DOI： 10.1111/jog.15438

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.31662/jmaj.2022-0113

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: This study aims to examine the association between malignant peritoneal cytology and prognosis in women with endometrial cancer. METHODS: We retrospectively analyzed the records of patients with endometrial cancer who underwent surgery with intraoperative peritoneal cytology at our hospital between January 1988 and December 2012. All results were reclassified according to the 2009 International Federation of Gynecology and Obstetrics (FIGO) system, and the relation between intraoperative peritoneal cytology results and recurrence and prognosis was examined. RESULTS: Of the 908 patients analyzed, 205 (22.6%) had positive peritoneal cytology. Patients with positive peritoneal cytology had significantly lower rates of recurrence-free survival (RFS) and overall survival (OS) than those in the negative cytology group (both p < 0.001). Subgroup analysis of patients with FIGO stage I/II showed significantly lower RFS in the positive-cytology group (p = 0.005), but there was no significant difference in OS (p = 0.637). In the patients with FIGO stage III/IV or patients classified as "high risk," the RFS and OS were significantly lower in the positive-cytology group (both p < 0.001). Cox regression analysis identified positive peritoneal cytology as a significant predictor of recurrence in patients with FIGO stage I/II disease. CONCLUSIONS: Patients with positive peritoneal cytology for endometrial cancer have a high risk of recurrence, regardless of histopathologic type or FIGO stage. Peritoneal cytology has already been removed from the 2009 FIGO classification of endometrial cancer, but it may deserve reconsideration.

DOI： 10.1111/jog.15457

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本妊娠高血圧学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本妊娠高血圧学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床免疫学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.31662/jmaj.2022-0069

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記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：日本語   出版者・発行元：日本女性骨盤底医学会  

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記述言語：英語  

DOI： 10.1016/j.ajp.2022.103151

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記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A woman in her 30s with cervical cancer underwent postoperative chemotherapy and showed allergic reactions to multiple taxanes. As the patient had infusion reactions to both paclitaxel and docetaxel, a prick test with Cremophor was conducted. In the absence of an allergic reaction to etoposide, we determined that the patient was allergic to pure taxane compounds. Among infusion reactions caused by taxanes, Cremophor allergy is reported in 3% of cases. Therefore, a prick test with Cremophor performed on a taxane infusion reaction will be useful in diagnosing allergy. In addition, allergy due to docetaxel may be managed by adequate premedication and continuous intravenous chlorpheniramine administration.

DOI： 10.1136/bcr-2022-250960

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

High-grade endometrial stromal sarcoma (HG-ESS) is a malignant uterine tumour with a poor prognosis. This study aimed to demonstrate the usefulness of maintenance chemotherapy with paclitaxel (PTX) and carboplatin (CBDCA) for HG-ESS recurrence, by examining a case of HG-ESS tumour progression as a result of maintenance therapy interruption because of the COVID-19 pandemic. The patient was a woman in her 60s who presented with lower abdominal pain, nausea and a pelvic tumour, which was diagnosed as HG-ESS. Chemotherapy with PTX (175 mg/m2 day 1) + CBDCA (area under the concentration-time curve 5 day 1) every 21-28 days (TC therapy) was administered for long-term maintenance of HG-ESS. After 26 cycles, chemotherapy had to be postponed because of the COVID-19 pandemic, thus leading to disease progression and eventually death. In conclusion, TC therapy can prolong survival in patients with HG-ESS, and maintenance chemotherapy should not be postponed.

DOI： 10.1136/bcr-2022-248971

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本産婦人科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本産婦人科感染症学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Here, we present two cases of women with social problems whose delivery and hospitalization costs were fully subsidized by the revised Hospitalization Assistance Policy Program. The presence of the program is required to be enlightened and expanded in Japan.

DOI： 10.31662/jmaj.2021-0211

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記述言語：英語  

We present a case of vaginal wall perforation during cesarean section. The cause of the perforation remained unclear. Although such conditions are rare, it is necessary to carefully check the condition of the vagina after performing cesarean section.

DOI： 10.31662/jmaj.2021-0228

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Placental abruption is separation of the placenta from its normal implantation site of the uterine body before delivery of the fetus during pregnancy or labor. It is a major cause of cerebral palsy registered in the Japan Obstetric Compensation System for Cerebral Palsy (JOCSC). It is classified into revealed and concealed hemorrhage types by the presence or absence of external bleeding, and the latter is associated with a poorer prognosis for mothers and infants. If the survival of the fetus is confirmed in cases of placental abruption, the fetus should usually be delivered promptly. There is no evidence-based preventive methods for placental abruption. Therefore, an awareness of the early symptoms of placental abruption among pregnant Japanese women is important.

DOI： 10.1272/jnms.JNMS.2022_89-312

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: The fetal sample used for embryonic chromosome analysis is often contaminated with maternal cells, making it difficult to evaluate the fetal chromosomes. We examined on the rate of maternal cell contamination and its relationship with maternal information in the embryonic chromosome analysis of missed abortions using the Giemsabanding method. METHODS: Chromosome analysis was performed in 200 cases of delayed miscarriages in first trimester between July 1, 2000 and May 31, 2019. Chorionic villi were collected and were analyzed using the Giemsa banding method. Among the 20 cells for which chromosomal examination was performed, cells wherein 46,XX chromosomes were found together with normal male karyotype or abnormal chromosomes were defined as maternal cell contamination. RESULTS: Of the 200 cases analyzed, 136 had abnormal chromosomes. The normal female karyotype (n = 52) was four times more prevalent than the normal male karyotype (n = 12). Maternal cell contamination was seen in 15.4% of the abnormal chromosome cases and 8.3% of the normal male karyotype cases. There was no significant difference in the gestational age between the contaminated and noncontaminated groups at the time of miscarriage diagnosis. However, miscarriage before fetal heartbeat confirmation was significantly associated with higher maternal cell contamination. CONCLUSION: We found maternal cell contamination in 15% of all the cases. Moreover, in many cases of the normal female karyotype, it was suspected that only maternal chromosomes were cultured. When performing embryonic chromosome analysis in recurrent miscarriages, we should pay attention to maternal cell contamination and interpret the results accordingly.

DOI： 10.1111/jog.15249

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present a case of large uterine cervical edema following cerclage during pregnancy.

DOI： 10.1002/ccr3.5670

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Carboplatin, the key drug used in treating gynaecological cancer, has an approximately 12-16% risk of hypersensitivity reactions. We aimed to investigate the efficacy and adverse effects of carboplatin desensitisation therapy for gynaecological cancer. METHODS: The desensitisation protocol was standardised as a four-step, 4-h, carboplatin administration in the hospital. A retrospective medical record review was conducted on 15 patients who underwent carboplatin desensitisation for gynaecological malignancies at our hospital. Patients' data were analysed to evaluate the treatment success rate, therapeutic effect of desensitisation, adverse events, and treatment. RESULTS: Of 91 carboplatin desensitisation cycles scheduled; the completion rate was 93.4% (85/91). Adverse events occurred in 23 of these 91 (25.3%). In four (4.4%) of the 23 cycles, hypersensitivity reactions could be treated only by discontinuing the infusion and slowing the administration, while in the remaining 19 (20.9%), medication was administered intravenously after discontinuing the infusion to manage hypersensitivity reactions. No treatment-related deaths occurred. Overall, 23 series of anti-cancer agent regimens, including carboplatin desensitisation, were administered to the 15 patients. The therapeutic response rate was 82.6% and the disease control rate was 95.7%. CONCLUSIONS: Carboplatin desensitisation was beneficial in patients with a history of carboplatin-induced hypersensitivity reactions.

DOI： 10.3390/medicines9040026

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: This study aimed to determine the efficacy of postural management in the lateral position for primiparous breech presentation. METHODS: A retrospective cohort study was conducted at a single institution from January 2020 through December 2020. Participants were singleton primiparous pregnant women diagnosed with breech presentation between 28 + 0 and 29 + 6 weeks of gestation. The exclusion criteria were scheduled cesarean delivery, uterine malformation, transverse position, and scheduled delivery at another hospital. A doctor instructed the women in the intervention group to lie on their right sides several times a day if the fetal back was on the left side or lie on their left sides if the fetal back was on the right side. The knee-chest position and other methods were not recommended. The control group received expectant management care. The primary endpoint was the percentage of fetuses in a cephalic presentation 2 weeks later. RESULTS: Of the 56 women included in the study, 17 women were instructed to lie in the lateral position, and 39 women received expectant management care only. After 2 weeks, women who were instructed to lie in lateral position had a higher rate of fetal cephalic version than the control group (82.4% [14/17] vs. 43.6% [17/39], p = 0.017). No study participants experienced adverse effects. CONCLUSIONS: Two weeks of postural management in the lateral position without the knee-chest position significantly reduced the rate of primiparous breech presentation in the third trimester of pregnancy.

DOI： 10.1111/jog.15149

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The current study examined the antimicrobial resistance of Chlamydia trachomatis (CT) genital infection during pregnancy in Japan. We requested 2,146 obstetrical facilities that are members of Japan Association of Obstetricians and Gynecologists to provide information of CT screening tests and antimicrobial resistance in pregnant women between April 2020 and March 2021. The prevalence of CT genital infection in Japan was 2.1%. The antimicrobial resistance was recognized in 2.0 and 2.4% of the cases using azithromycin and clarithromycin, respectively. There were no significant differences in the antimicrobial resistance rate between the 2 analogues (P = 0.28). In Japan, azithromycin and clarithromycin have effectively treated genital CT infections during pregnancy.

DOI： 10.3947/ic.2022.0030

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present a case of twin anemia-polycythemia sequence diagnosed postnatally with suspected chronic stress on the heart in the donor twin.

DOI： 10.1002/ccr3.5665

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Smoking during pregnancy has been reported to increase the perinatal risk. We investigated the perinatal outcomes in Japanese pregnant women with habitual smoking at pre-pregnancy and during pregnancy who delivered at our institute in Japan. METHODS: We reviewed the obstetric records of 9280 Japanese women with singleton delivery at ≥22 weeks of gestation at our institute between 2014 and 2019. On admission for delivery, a routine face-to-face interview was conducted by our midwives to ask about smoking during pregnancy. RESULTS: Of the total 9280 pregnant Japanese women, 532 (5.7%) had smoked before pregnancy. Of these, 272 (51.5%) quitted smoking after being diagnosed with pregnancy, while 258 (49.5%) continued to smoke during pregnancy and were diagnosed with habitual smoking during pregnancy. There was no significant relation between habitual smoking at pre-pregnancy and the perinatal adverse outcomes. However, habitual smoking during pregnancy was associated with the adverse perinatal outcomes such as the increased incidence of placental abruption (adjusted odds ratio [OR] 2.38, p = 0.04) and light-for-gestational-age neonate (adjusted OR 1.72, p = 0.03) on multiple logistic regression analyses. CONCLUSION: In this study, smoking was found to be associated with the adverse perinatal outcomes. The current results support the importance of smoking cessation during pregnancy.

DOI： 10.7759/cureus.22426

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記述言語：日本語   出版者・発行元：神奈川産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

"Specified expectant mothers" are defined as pregnant women at high risk of needing extra support after birth. To provide them appropriate support, the methods for evaluating specified expectant mothers should be standardized. Thus, in this study, I reviewed the evaluation and multidisciplinary collaboration in some regions reported to be actively supporting specified expectant mothers in Japan. The main items related to "specified expectant mothers" were as follows: (1) mental disorders, (2) younger age, (3) no consultation/late first visit, (4) poverty, and (5) multiple pregnancy. It is important to proactively identify and confirm the problems faced by pregnant women through screening and interviews conducted by the medical staff.

DOI： 10.31662/jmaj.2021-0165

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Introduction: The COVID-19 pandemic has caused stress and anxiety for pregnant women worldwide. We examined the anxiety symptom in Japanese women during pregnancy using a self-administered questionnaire under the COVID-19 pandemic. Methods: Between April 2020 and March 2021 (2020, the COVID-19 pandemic), we asked 248 Japanese women without history of mental disorders who delivered singleton neonates at 37-41 weeks' gestation to answer the two-item generalized anxiety disorder scale (GAD-2) at first, second, and third trimesters of gestation. We also asked 311 women with the same situation between January 2019 and December 2019 (2019) as control. Results: The women with anxiety symptom were common during the first trimester of gestation irrespective of COVID-19 pandemic. In 2019, the proportion of the women with anxiety symptom decreased as the trimester of pregnancy progressed (p < 0.01); however, in 2020, the proportion of women with anxiety symptom did not decrease during pregnancy. During the late pregnancy, the proportions of women with anxiety symptom in 2020 were significantly higher than those in 2019 (p < 0.01) regardless of maternal parity or age in Japan. Conclusion: The COVID-19 pandemic seemed to prevent the decrease in anxiety symptom that should decrease as pregnancy progresses regardless of maternal parity or age in Japan.

DOI： 10.31662/jmaj.2021-0204

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

不妊治療中の悪性腫瘍発見例が増えている。今回、不妊治療中に診断された卵巣癌と子宮体癌の重複例を経験した。症例は40歳0妊0産。不妊治療の経過中に経腟超音波断層法で5cm大の左卵巣嚢腫を指摘され、精査加療目的に当院紹介となった。初診時、経腟超音波断層法で左卵巣に7cm大の子宮内膜症性嚢胞および子宮内膜ポリープを認め、内膜細胞診は陰性であった。骨盤造影MRI検査でも悪性所見はなく、腹腔鏡および子宮鏡手術の方針とした。当科初診の7ヵ月後、子宮内膜症性嚢胞の悪性転化があり、最終的に根治手術を行い、術後病理診断で卵巣癌および子宮体癌の重複癌と診断した。未妊および不妊症患者は疫学的に卵巣癌発生リスクが高く、また排卵誘発剤が卵巣癌のリスクを高めると示唆されている。結論として、今回は術後病理検査により重複癌と診断したが、分子生物学的検討により転移癌と診断された報告があり、今後は分子生物学的検討も有用となる可能性がある。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

PURPOSE: Granulysin is a cytotoxic protein that simultaneously activates innate and cellular immunity. The authors aimed to evaluate whether granulysin is associated with the antiphospholipid antibody syndrome and whether heparin changes the granulysin levels. METHODS: A cohort study was performed with women with antiphospholipid antibody-positive recurrent pregnancy loss (RPL). The authors examined granulysin levels under RPL and evaluated the changes in serum granulysin levels before and 1 week after the commencement of heparin treatment. RESULTS: Serum granulysin levels before heparin treatment were significantly higher in women who tested positive for one or more types of antiphospholipid antibodies (2.75 ± 1.03 vs. 2.44 ± 0.69, p = 0.0341 by Welch's t test), particularly anti-phosphatidylethanolamine antibodies (IgG: 2.98 ± 1.09 vs. 2.51 ± 0.86, p = 0.0013; IgM: 2.85 ± 1.09 vs. 2.47 ± 0.77, p = 0.0024 by Welch's t test). After heparin treatment for 1 week, serum granulysin levels were significantly reduced (p = 0.0017 by the paired t test). The miscarriage rate was significantly higher in women whose serum granulysin levels were not reduced by heparin treatment (p = 0.0086 by Fisher's exact probability test). CONCLUSION: The results suggest that heparin may reduce the incidence of miscarriage by suppressing serum granulysin levels.

DOI： 10.1002/rmb2.12460

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/rmb2.12460

記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：英語  

DOI： 10.1272/jnms.JNMS.2022_89-630

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Zinc deficiency can cause various symptoms, including hair loss, anemia, and taste disorders. Recently, the association between cancer and zinc deficiency has received much attention with respect to its antioxidant properties. However, only a few studies have investigated the association between gynecologic cancers and zinc; to date, no studies have evaluated serum zinc status at the onset of gynecologic cancer or the relationship between zinc and cancer recurrence. The objectives of the present study were to determine whether serum zinc concentrations are associated with the development of gynecologic cancer, to clarify serum zinc dynamics between the onset and recurrence of gynecologic cancer, and to identify the associated factors. Accordingly, we retrospectively determined serum zinc concentrations before treatment in gynecologic patients with benign disease or cancer at the Nippon Medical School Chiba Hokusoh Hospital. We investigated anemia and hypoalbuminemia-the most common causes of zinc deficiency-as indicators of hyponutrition to determine the causal relationship of this deficiency with chemotherapy, radiation therapy, and recurrence, which may affect zinc concentration during cancer recurrence. The results indicated that there was no difference in zinc concentration between preoperative cancer patients and noncancer patients and that serum zinc concentrations were not associated with developing gynecologic cancers. However, patients with gynecologic cancer exhibited significantly lower serum zinc concentrations following treatment, and patients with recurrent cancer were 4.8 times more likely to develop zinc deficiency than those with nonrecurrent cancer. A serum zinc concentration of <61 μg/dL was an independent predictor of recurrence. Once zinc deficiency occurred, the recurrence rate of zinc deficiency reached as high as 69%. Overall, our study indicates that zinc deficiency is associated with recurrence in gynecological cancers and physicians should monitor zinc levels during disease management.

DOI： 10.3389/fonc.2022.1025060

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Preterm birth (PTB) is one of the most important problems that pose dilemmas for both the obstetrician and neonatologist, placing a heavy burden psychologically and financially on the families involved, and triggering high socio-economic costs to the public healthcare. The rate of PTB in Asian countries has been ranked at top globally. To reduce the PTB rate, to promote the prevention and intervention for PTB, and to better understand the pathophysiology underlying PTB, the Preterm Birth International Collaborative Australia branch (PREBIC-AA) was launched in 2017. A series scientific activities including organizing annual research symposiums has been planned and organized among Australasian countries. Here we briefly updated the current progress in clinical management and translational research on PTB in Australasian countries that have been participated in PREBIC-AA.

DOI： 10.3389/fped.2022.903546

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Nutcracker syndrome is a condition in which the left renal vein is pinched between the abdominal aorta and the superior mesenteric artery, resulting in an increase in renal vein pressure and certain symptoms. We report a very rare case of retroperitoneal hematoma caused by the rupture of varicose veins of the left ovary. CASE PRESENTATION: A 77-year-old Japanese woman, para 7, experienced sudden left lower abdominal pain. She had no history of trauma or treatment complications. Computed tomography revealed a left retroperitoneal hematoma, but her abdominal pain subsided quickly; thus, urgent treatment was not required. We then scheduled her for an assessment regarding the cause of her bleeding. However, 6 days after the pain onset, abdominal pain symptoms recurred, confirming hematoma regrowth. Magnetic resonance imaging and three-dimensional computed tomography revealed an abnormal vascular network from the left side of the uterus to the left adnexa. Subsequent angiography revealed that the retroperitoneal bleeding originated from rupture of the distended left ovarian vein, which caused blood reflux from the left renal vein to the left ovarian vein. Although angiography confirmed a passage between the left renal vein and inferior vena cava, computed tomography showed obvious stenosis in the left renal vein. In accordance with these findings, we diagnosed the cause of the distention and rupture of the left ovarian vein as nutcracker syndrome. She underwent embolization of the left ovarian vein as hemostasis treatment, and had a good course thereafter. CONCLUSIONS: This is the first report of a spontaneous rupture of the left ovarian vein caused by nutcracker syndrome. Nutcracker syndrome is not yet well known to clinicians and should be considered as part of the differential diagnosis when an abnormal vascular network in the pelvis is found.

DOI： 10.1186/s13256-021-03192-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present a case of dysgerminoma of the right adnexa with an infiltration to the right wall of the uterus and a metastasis of para-aortic lymph node.

DOI： 10.1002/ccr3.5227

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.14740/jocmr4624

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: In Japan, the lack of obstetricians has made it impossible for a strict 24-h delivery monitoring system for high risk deliveries such as vaginal breech delivery at many obstetric facilities. The outcomes in the trial of vaginal breech delivery of singleton pregnancy limited one day at 37-38 weeks' gestation were examined. MATERIALS AND METHODS: A planned induction of vaginal breech delivery at 37-38 weeks' gestation was performed in 72 women who got consent form April 2006 to March 2016 as follows: (1) insertion of a balloon catheter into the uterine cervix filled with a sterile saline fluid of 400-500 mL, (2) intravenous administration of oxytocin after confirming of the natural falling out by itself of the balloon catheter, and (3) selection of cesarean delivery when vaginal delivery cannot be expected by evening. The perinatal outcomes of them were examined from patient charts. RESULTS: The completion rate of vaginal delivery in total was 67% (48/72). There were no cases of neonatal asphyxia or respiratory disorders. The severe perineal lacerations occurred in one case (2%). CONCLUSION: Planned vaginal breech delivery limited one day at 37-38 weeks' gestation seemed to be valid and safe and it can be one of the options for breech delivery in Japan.

DOI： 10.1080/14767058.2019.1686471

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記述言語：日本語   出版者・発行元：日本生殖免疫学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

DOI： 10.1111/jog.15068

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION AND IMPORTANCE: Uterine leiomyoma is a common disease. The tumor gradually increases and becomes a target for treatment when accompanied by certain symptoms. It rarely grows into a giant uterine leiomyoma, which is defined as leiomyoma weighing >11.34 kg. CASE PRESENTATION: A 58-year-old Japanese woman had a history of putamen hemorrhage and deep vein thrombosis. A giant uterine leiomyoma prevented her from walking, and she scheduled surgery for its removal. The tumor was 46 × 35 × 27 cm, and the uterine arteries and veins were extremely dilated. A blocking balloon catheter was placed in the abdominal aorta to prevent massive bleeding, and a filter was placed in the inferior vena cava to prevent pulmonary thromboembolism. The surgery focused on careful vascular treatment, with selective ligation of the ovarian arteries and veins and the uterine arteries. The total amount of bleeding was 1130 g, and the uterus was removed without complications. The weight of the excised tissue was 22.6 kg. CLINICAL DISCUSSION: Surgical treatment of the largest giant uterine leiomyomas is rare and challenging. Previous reports addressed the risk of massive bleeding and perioperative death. Surgery is the best treatment for giant uterine leiomyomas, but perioperative management and surgical procedures require complex and elaborate planning. CONCLUSION: Very few gynecologists have experience treating giant uterine leiomyomas. Successful surgery requires careful surgical preparation, and the gynecological oncologist must have extensive experience with giant leiomyomas.

DOI： 10.1016/j.ijscr.2021.106416

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床免疫学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：英語  

DOI： 10.1080/07357907.2021.1982961

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

An appendectomy with a thorough examination of the gastrointestinal tract should be performed in women with a mucinous ovarian tumor.

DOI： 10.1002/ccr3.4784

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：英語  

DOI： 10.1186/s12889-021-11049-4

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記述言語：英語  

DOI： 10.1080/14767058.2019.1640677

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

In a twin pregnancy, it may be difficult to notice the decreased fetal movements, which is one of the main symptoms of fetomaternal hemorrhage, in one fetus due to the movements of the other fetus.

DOI： 10.1002/ccr3.4330

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The current study was conducted to examine the number of human T-cell leukemia virus type 1 (HTLV-1) carrier and how horizontal transmission affects the prevalence of HTLV-1 carrier in pregnant Japanese women in 2019. We requested 2,214 obstetrical facilities to provide information of HTLV-1 tests in pregnant women who delivered in 2019. The estimated number of HTLV-1 carrier in pregnant Japanese women was 952. At least 10% or more of the HTLV-1 carriers were those due to horizontal transmission.

DOI： 10.7883/yoken.JJID.2021.097

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.31662/jmaj.2020-0109

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.31662/jmaj.2021-0005

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: We examined the relation between smoking habits and maternal mental status such as depression and anxiety during the first trimester of pregnancy. MATERIAL AND METHODS: Between July 2016 and June 2018, we examined the increased odds of depressive and anxiety symptoms in the women with smoking habits during prepregnancy with and without smoking cessation during the first trimester of pregnancy in comparison with those without smoking habits using self-administered questionnaires. RESULTS: The rate of depressive and anxiety symptom in the women with smoking habits during prepregnancy (46.4 and 47.3%, respectively) was higher than those in the women without smoking habits during the first trimester of pregnancy irrespective of smoking cessation. The rate of depressive or anxiety symptom during the first trimester of pregnancy did not change significantly by smoking cessation in the women with smoking habits during prepregnancy (depressive symptom: 44.6 versus 53.7%, p = .13; anxiety symptom: 45.3 versus 55.2%, p = .17). CONCLUSIONS: Smoking habits during prepregnancy seemed to be associated with the increased perinatal mental disorders irrespective of smoking cessation.

DOI： 10.1080/14767058.2019.1635110

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記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We examined factors associated with the development of spontaneous intertwin membrane separation in dichorionic twin pregnancy. METHODS: Medical charts of 618 dichorionic twin pregnancies without the history of amniocentesis managed after 22 weeks' gestation at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2017 were reviewed. RESULTS: Twenty-four cases (3.9%) were diagnosed with spontaneous intertwine membrane separation. The presence of different fetal sex and separated placentae were associated with the development of spontaneous intertwin membrane separation in dichorionic twin pregnancy (different fetal sex: crude odds ratio 2.44, 95% confidence interval, 1.1-5.5, p = .03; separated placentae: crude odds ratio 4.14, 95% confidence interval, 1.3-13, p = .01). CONCLUSION: The development of spontaneous intertwin membrane separation in dichorionic twin pregnancies seemed to be associated with dizygotic.

DOI： 10.1080/14767058.2019.1618826

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記述言語：英語  

We present here a rare case of twin-twin transfusion syndrome with anemia-polycythemia developed at 34-35 weeks of gestation.

DOI： 10.1002/ccr3.3609

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: In April 2008, the guidelines for obstetric practice in Japan have made the following recommendations: (1) do not use vacuum extraction (VE) for more than 20 min, and consider forceps delivery (FD) or an emergency cesarean section (CS) if necessary (20-minute VE trial rule), and (2) do not try VE more than five times, even if VE has been used for less than 20 min (5-time VE trial rule). The aims of the present study were to compare the obstetric policies related to failed VE before and after 2008.Methods: We reviewed the obstetric records of all cases of VE in cases of singleton pregnancy with a neonatal birth weight ≥ 2500 g beyond 37 weeks' gestation at our hospital from April 2002 to March 2014.Results: The success rate of VE decreased significantly (96.8 versus 94.1%, p = .02), while the rate of CS increased significantly (2.2 versus 5.0%, p < .01); however, there were no significant differences in these values between the two periods.Conclusions: We could not find the effects of the recommendation limiting the practice of VE.

DOI： 10.1080/14767058.2019.1611767

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC STUDY HYPERTENSION PREGNANCY  

Aim: We examined the relationship between second stage of labor duration and umbilical artery lactate levels in uncomplicated multiparous women.Methods: This was a retrospective study of 789 healthy multiparous women with no history of caesarean section and singleton pregnancy, who had a vaginal delivery after 37 weeks' gestation at our institutes between August 2015 and March 2017. As controls, 1,082 uncomplicated nulliparous women who gave birth during the same period were also examined.Results: The average umbilical artery lactate level increased with increasing second stage of labor duration (p < 0.05) in multiparous women. Multiparous women with a second stage of labor duration of 0-60 min had a significantly lower average lactate level compared to nulliparous women (p < 0.05), while those with a second stage of labor duration of 121-180 min had a significantly higher average lactate level compared to nulliparous women (p < 0.05).Conclusion: A prolonged second stage of labor duration was associated with increased umbilical artery lactate levels.

DOI： 10.14390/jsshp.HRP2021-008

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The purpose of this study was to investigate the predictors of the effect of olaparib on platinum-sensitive recurrent ovarian cancer with unknown germline BRCA mutations. We retrospectively examined 20 patients with platinum-sensitive ovarian cancer who were treated at the Nippon Medical School Chiba Hokusoh Hospital, Japan, from 2018 to 2020. We found that the median progression-free survival was 11.4 months (95% Confidence interval (CI): 3.8-Not Available (NA)) in the group with NLPN score [recurrent neutrophil-lymphocyte ratio (rNLR) × number of previous regimens] >7.51, and median progression-free survival was not reached in the group with NLPN score <7.51 (95% CI: 21.8-NA) (p = 0.0185). There was a clear correlation between the degree of dose reduction of olaparib and recurrence (p = 0.00249). Our results show that NLPN scores lower than 7.51 are associated with a favorable outcome of olaparib treatment for platinum-sensitive recurrent ovarian cancer. In cases with a high rNLR, it may be necessary to start olaparib treatment as early as possible to obtain low NLPN scores. Our results imply that the effectiveness of olaparib can be determined after recurrence and before platinum treatment begins. As newer drugs for ovarian cancer are developed, the measurement of biomarker levels at the start of treatment for recurrent ovarian cancer, as shown in our study, may provide strong support for cancer treatment protocols.

DOI： 10.3389/fonc.2021.697952

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

DOI： 10.1371/journal.pone.0245282

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC STUDY HYPERTENSION PREGNANCY  

We examined the association between 'specified expectant mothers (SEMs; pregnant women with social problems)' at our institute and their mental status at one month after delivery. We examined 890 pregnant women who delivered at >= 37 weeks of gestation at our institute between January 2019 and October 2019. We excluded mothers with mental disorders requiring medication and whose children were hospitalized in the neonatal intensive care unit. During the study period, there were 148 SEMs with healthy babies (16.6%). The frequency of screening positive on the Japanese version of the Mother-to-Infant Bonding Scale and the Edinburgh Postnatal Depression Scale was higher in SEMs than in non-SEMs (P = 0.04 and 0.02). In addition, there was a strong positive correlation between scores on the two scales in SEMs (r(2) =0.41, P< 0.01). The present results indicate the quantitatively clarify of the mental vulnerabilities in SEMs.

DOI： 10.14390/jsshp.HRP2021-011

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Spontaneous disruption of the dividing membrane in MD twins is rare and be associated with a higher incidence of prematurity and neonatal morbidity. In the present case, a spontaneous disrupted dividing membrane could be noted by ultrasonography.

DOI： 10.1002/ccr3.3437

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Widespread rubella epidemics have sometimes occurred in Japan. We compared the prevalence of rubella antibodies in women who had conceived after infertility treatments and in those who had conceived spontaneously. We reviewed the obstetric records of nulliparous Japanese women who had conceived after infertility treatments and whose babies had been born at the Japanese Red Cross Katsushika Maternity Hospital from 2014 to 2018. No significant differences in the rates of women with rubella antibody titers < 8 or < 32 emerged between those who had been treated and those who had not (titer < 8: 4.1 vs. 3.4%, p = 0.58; titer < 32: 17.3 vs. 15.3%, p = 0.45, respectively). It is necessary to thoroughly implement pre-conception care concerning the risk of congenital rubella infection for women undergoing infertility treatments, especially in Japanese obstetric clinics.

DOI： 10.15167/2421-4248/jpmh2020.61.4.1208

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: We examined the clinical significance of pregnancies with true umbilical cord knots related to umbilical cord length.Methods: The material reviewed consisted of the total population of Japanese women who gave birth to singleton babies at 34-41 weeks' gestation at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2017.Results: During the study period, there were 32,315 Japanese women who gave birth to singleton babies at 34-41 weeks' gestation. Of these, true umbilical cord knots were recognized in 209 cases (0.6%). In addition, excessively long umbilical cords were recognized in 98 of the 209 cases (46.9%). On multivariate analysis, true umbilical cord knots were associated with intrauterine fetal demise (adjusted OR 5.65, 95% confidence interval [CI] 1.9-17, p = .02) and excessively long umbilical cord (adjusted OR 8.26, 95% CI 6.0-11, p < .01). The incidence of intrauterine fetal demise in cases with the excessively long umbilical cord (0%) was significantly lower than that without excessively long umbilical cord (4.2%, p = .04), and it was not different measurably from that without true umbilical cord knots (0.3%, p = 1.00).Conclusions: Excessively long umbilical cords may contribute to the decreased risk of intrauterine fetal demise in singleton pregnancies delivered at ≥34 weeks' gestation.

DOI： 10.1080/14767058.2019.1584177

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Introduction: To support pregnant women with serious social problems, we retrospectively examined the current status of social problems during pregnancy in Japan. Methods: We examined the frequency, associated factors, and outcomes of the pregnant women with social problems at our institute for each year from 2016 to 2019. Results: The frequency of pregnant women with social problems significantly increased year by year (p < 0.01). The breakdown of high-risk factors associated with the social problems has remained almost unchanged; however, the frequency of unmarried pregnant women, unplanned pregnancy, foreigners who cannot speak either Japanese or English, and pregnant women who are somehow anxious significantly increased (p < 0.05). Conclusions: We will endeavor to solve the various social problems of pregnant women through multidisciplinary collaboration.

DOI： 10.31662/jmaj.2020-0056

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記述言語：英語  

DOI： 10.1080/14767058.2020.1814250

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC  

An amendment to this paper has been published and can be accessed via the original article.

DOI： 10.1186/s12889-020-09314-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: We examined the clinical utility of the Whooley questions in comparison with that of the Edinburgh Postnatal Depression Scale (EPDS) in Japan.Methods: We carried out mental health screening of all postnatal mothers (n = 258) who gave birth to singleton babies at term attending our hospital using the EPDS and the Whooley questions. For the EPDS, scores were calculated, and a score of nine points or more was regarded as "positive screening" according to the results of previous observations in Japan. For the Whooley questions, if at least one question was answered "yes," we diagnosed it as "positive screen."Results: The positive rate of the Whooley questions was 16.7%, while that of the EPDS (≥ 9 points) was 14.8% (p = .55). The incidence of postpartum depression was 5.4%. The difference in the sensitivity and positive predictive value of the two tools did not reach significance (p = .09 and .45, respectively).Conclusions: There were no significant differences in accuracy on comparing the two screening tools. We should examine how to use the two tools according to the regional support systems.

DOI： 10.1080/14767058.2018.1560413

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記述言語：英語  

DOI： 10.1080/14767058.2020.1793942

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記述言語：英語  

DOI： 10.1080/14767058.2020.1793319

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC  

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.

DOI： 10.1186/s12889-020-09258-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Under the COVID-19 (Coronavirus Disease 2019) pandemic, limitations are known to cause some psychosocial problems. We compared the results of mental screening of the postpartum women conducted during the COVID-19 epidemic with those at the same period last year. Based on the results, the worse mother-infant bonding was suspected at 1 month after birth under the COVID-19 pandemic.

DOI： 10.1080/14767058.2020.1763949

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記述言語：英語  

DOI： 10.1080/14767058.2018.1526920

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Umbilical cord blood (UCB) has become an established alternative source of hematopoietic stem cells with marrow and postmobilization peripheral blood. The presence of a large amount of clots may lead to the deterioration of cord blood quality. To improve UCB quality as a source of hematopoietic stem cells in Japan, we examined factors associated with UCB collection methods from the viewpoint of eliminating the presence of clots. Methods: In August 2019, we requested the directors of 74 certified facilities to provide information on UCB collection methods in Japan. A total of 46 (62.2%) of them responded with valid information on a total of 2,892 UCB collections. In this study, collected UCB without clots macroscopically was evaluated as a high-quality UCB. Results: The 2,891 UCB collections described during the study period were divided to those with (n = 760, 26.3%) and without clots (high quality; n = 2,131, 73.7%). Multivariate analysis revealed single puncture as a factor determining high-quality UCB collection (adjusted odds ratio (ORs): 1.80, 95% confidence interval (CI): 1.3 - 5.4, P = 0.01). Conclusions: Single puncture is an independent effective factor determining high-quality manual UCB collection in Japan.

DOI： 10.14740/jh628

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Disruption of the dividing membrane in monochorionic diamniotic twins is associated with a higher incidence of prematurity and neonatal morbidity. In the present case, a cramped fragment of the dividing membrane could be noted following fetoscopic laser photocoagulation.

DOI： 10.1002/ccr3.2570

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

This study was performed to investigate whether the Japanese guidelines for gestational weight gain (GWG) can be used to determine the risks of multiple pregnancy outcomes and estimate optimal GWG in 101,336 women with singleton pregnancies in 2013. Multivariable logistic regression analyses indicated that the risks associated with low birth weight, small for gestational age, and preterm birth increased significantly with weight gain below the Japanese guidelines, and the risks of macrosomia and large for gestational age increased with weight gain above the guidelines regardless of Asian-specific pre-pregnancy body mass index (BMI). The GWG cutoff points estimated from the adjusted area under the receiver operating characteristics curve >0.6 corresponded to 10-13.8 kg in underweight women with pre-pregnancy BMI < 18.5 kg/m2; 10-13.7 kg in normal weight women with pre-pregnancy BMI 18.5-22.9 kg/m2; 8.5-11.4 kg in overweight women with pre-pregnancy BMI 23-24.9 kg/m2, 5-13.3 kg in obese women with pre-pregnancy BMI 25-29.9 kg/m2; and 4.7 kg in obese women with pre-pregnancy BMI ≥ 30 kg/m2. The optimal GWG ranges proposed by the present study are slightly higher than those recommended by the current Japanese guidelines.

DOI： 10.1038/s41598-019-53809-8

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記述言語：英語   出版者・発行元：(一社)日本妊娠高血圧学会  

2002〜2015年に当院にて妊娠22週以上で単児分娩した女性を対象とした後ろ向きコホート研究を実施し、胎児発育不全(FGR)または前置胎盤や低置胎盤(PPLLP)合併妊娠の臨床的特徴について検討した。評価項目は、母体年齢、経産回数、体外受精歴、高血圧性疾患、分娩様式、胎児超音波所見、分娩時在胎期間、新生児仮死、分娩後出血などとした。適格基準を満たした24118例中、PPLLP単独は284例、FGR単独が521例、FGRおよびPPLLP合併7例であった。FGR発症とPPLLPの存在との間に関連は認められなかった。多変量ロジスティック回帰分析の結果、FGRおよびPPLLP合併妊娠における大量出血による緊急帝王切開の発生率は、PPLLPまたはFGR単独妊娠よりも高いことが明らかになった。FGRおよびPPLLP合併妊娠では、分娩前大量出血に関連した早産のリスク上昇に注意すべきであることが示唆された。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J06353&link_issn=&doc_id=20201026260005&doc_link_id=130007762853&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007762853&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: The lack of obstetricians in Japan has prevented the implementation of a 24-hour delivery monitoring system for high-risk deliveries such as twin vaginal delivery at many obstetric facilities. To examine the outcomes of a 1-day trial of the vaginal delivery of twins at 36-37 weeks' gestation. Methods: We induced the vaginal delivery of twins at 36-37 weeks' gestation of 256 women who provided consent between January 2007 and December 2016 using the following protocol: 1) administration of 0.5 mg oral prostaglandin E2 every 1 hour (maximum: 1.5 mg) in the morning; 2) intravenous administration of oxytocin and amniotomy in the afternoon; and 3) selection of caesarean delivery when vaginal delivery was not expected by evening. We examined their perinatal outcomes in a chart review. Results: The completion rates of vaginal delivery in total, nulliparous, and multiparous women were 79%, 72%, and 84%, respectively. There were no cases of neonatal asphyxia. The total incidence of neonatal respiratory disorders was 2.1%, but there were no cases of persistent pulmonary hypertension. The total incidence of postpartum hemorrhage requiring transfusion was 2.7%. Conclusion: The 1-day planned vaginal delivery of twins at 36-37 weeks' gestation appears valid and safe, and our findings suggest that it can be an option for the delivery of twins.

DOI： 10.5468/ogs.2019.62.6.404

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: We performed a retrospective case-control study of vaginal delivery at term without epidural anesthesia to identify clinical predictions of postpartum urinary retention (PUR). Methods: We reviewed the obstetric records of all singleton vaginal deliveries at Japanese Red Cross, Katsushika Maternity Hospital form January 2016 through December 2017. Results: There were 58 women (2.4%) complicated by PUR and 2391 women without PUR. A multivariate analysis revealed nulliparity, instrumental delivery, and episiotomy as independent risk factors for PUR (nulliparity: adjusted OR 2.39, 95%CI 1.2-4.8, p = 0.01; instrumental delivery: 3.53, 95%CI 1.9-6.7, p < .01, episiotomy: adjusted OR 1.96, 95%CI 1.0-3.8, p = .04). While, urination (or urethral catheterization) within 1 hour before delivery revealed as independent prevention factor for PUR (adjusted OR 0.54, 95%CI 0.30-0.99, p = .048). Conclusions: The risk factors identified in our institute seemed to approximately similar to those observed in the institutes capable of performing epidural anesthesia. In addition, urination just before delivery seemed to be an independent prevention factor for PUR.

DOI： 10.1080/14767058.2018.1465559

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1080/01443615.2018.1555576

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We examined the clinical characteristics and obstetric outcomes in adolescent pregnancies in Japanese women. METHODS: The present study was a retrospective investigation of all primiparous Japanese women with singleton pregnancies who gave birth at ≥22 weeks' gestation aged ≤18 years old (adolescent pregnancy, n = 325) and aged 28-30 years old (n = 2029) at Japanese Red Cross, Katsushika Maternity Hospital between 2002 and 2016. RESULTS: The frequencies of smoking, economic problems, an unmarried single status at delivery and the start of prenatal care in the first trimester in the adolescent pregnancy group were significantly higher than in the control group (p < .01). The incidences of Chlamydia trachomatis, Condyloma acuminatum, and mental disorders in the adolescent pregnancy group were significantly higher than in the control group (p < .01). Pregnancy in adolescence was not related to adverse obstetric outcomes except preterm delivery (p = .02). CONCLUSIONS: Adolescent pregnancy was not associated with adverse obstetric outcomes; however, adequate social, economic, and mental support is needed for adolescent pregnant women.

DOI： 10.1080/14767058.2017.1421928

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記述言語：英語   出版者・発行元：(一社)日本妊娠高血圧学会  

症例は35歳女性1妊0産で、妊娠40週時に陣痛のため入院した。入院時の血圧は121/80mmHgであった。陣痛時、胎児の状態がnon-reassuring fetal statusとなったため、脊椎麻酔下で帝王切開を行い、体重3562gの女児を出産した。術中・術後と異常なく、出産後7日目まで順調であったが、8日目に頭痛とめまいを訴え、座位を保持することができず、血圧は170/110mmHgに上昇した。CTにより、右前頭皮質の出血性病変の近傍に浮腫性病変が認められた。MRIでは、直径2〜3cmの高信号強度領域と低信号強度領域がみられ、周産期無症候性脳出血の診断に至った。これらの所見から、脳出血が発生してから何日も何の症状もなく経過したことが示唆された。脳動脈瘤、動静脈奇形、もやもや病などの脳に異常があったことを示す異常な所見はなかった。抗浮腫薬、降圧薬、抗けいれん薬による治療を行い、17日目に左半身麻痺の状態で退院した。保存療法後、現在はリハビリテーションを受けている。

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記述言語：英語  

In the current case of fetomaternal hemorrhage with reduced fetal movements, the findings of cardiotocography (CTG) seemed to be indicating reassuring fetal status; however, a late deceleration and sinusoidal heart rate (SHR)-like findings were observed following a weak uterine contraction. Altogether, this case indicates that the presence of reduced fetal movements may precede the appearance of SHR patterns on CTG in cases of chronic fetomaternal hemorrhage.

DOI： 10.1002/ccr3.2057

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We evaluated the current prevalence of gonococcal cervicitis among pregnant women in institutes that either do or do not routinely screen for gonococcal infection in Japan. We requested 2,330 obstetrical facilities to provide information on Neisseria gonorrhoeae cervicitis in pregnant women. A total of 1,876 (80.5%) of them responded. The universal screening test for gonococcal cervicitis, involving nucleic acid amplification for all pregnant women, was performed in 281 institutes (13.9% of institutes across Japan). The total rate of pregnant women with gonococcal cervicitis was 1.3% in the institutes performing the screening test during pregnancy, while it was only 0.2% (p < 0.01) in those not performing it. This suggests that 84% of infected women may have been missed in the institutes that do not routinely perform the screening test for gonococcal cervicitis. It may be time to examine the cost-effectiveness of providing gonococcal screening for all pregnant women in Japan.

DOI： 10.1371/journal.pone.0211595

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background:  Some studies have demonstrated that breastfeeding can protect mothers from postpartum depression; therefore, we examined the association between postpartum depression and lactation status at one month after delivery at a Japanese perinatal center. Methods: We reviewed the obstetric records of all (total 809) nulliparous healthy women with vaginal singleton delivery at 37-41 weeks' gestation at our institute between July 2018 and June 2019. A face-to-face interview with the women was conducted on admission for delivery to ask whether or not they hoped to perform exclusive breastfeeding for their babies, and an additional interview was conducted one month after delivery to ask about their feeding methods currently. Maternal mental status was examined based on the scores using the Edinburgh Postnatal Depression Scale (EPDS), and women with EPDS scores of ≥9 points were regarded as 'positive screening'. Results: 592 women (73.1%) hoped to perform exclusive breastfeeding for their babies on admission. Of these, at one month, 442 (74.7%) performed exclusive breastfeeding, while 150 (25.3%) performed mixed or artificial feeding. The average EPDS scores and the incidence of EPDS scores ≥9 points in the women performing exclusive breastfeeding were 4.3 ± 3.6 and 14.3% (63/442), respectively. They did not differ from those in the women performing mixed or artificial breast feeding [4.2 ± 3.7, p = 0.60 and 13.3% (20/150), p = 0.78]. Conclusion: Development of postpartum depression does not seem to be associated with incomplete breastfeeding at our hospital, and therefore there are other risk factors indicated in the development of postpartum depression.

DOI： 10.12688/f1000research.20704.2

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記述言語：英語  

We present here 9 cases of intrauterine subamniotic hemorrhage to describe the pathological sequence. The definite diagnosis of subamniotic hemorrhage was mainly made macroscopically with the presence of hemorrhage or hematoma wrapped in the membrane on the fetal surface by postnatal examining of the placenta. In 7 of them (78%), the presence of gradual subamniotic hemorrhage in the second trimester of pregnancy was suspected. In the cases, severe fetal growth restriction and preterm delivery were recognized in 2 (29%) and 4 cases (57%), respectively. In the other 2 cases (22%), acute anemia associated with acute subamniotic hemorrhage was clinically suspected. This may be the first report examining the clinical characteristics of acute or gradual intrauterine subamniotic hemorrhage. Both patterns of subamniotic hemorrhage seemed to be associated with the adverse perinatal outcomes.

DOI： 10.1155/2019/1828457

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

DOI： 10.1371/journal.pone.0218573

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Maternal mental status has been thought to be affected by the delivery modes. We examined the relation between delivery modes and the mental status of women who delivered at our institute in Japan. Methods: Data were collected from the medical charts of 643 primiparous women without a history of mental disorders who delivered singleton babies and underwent a 1-month postpartum check-up at our institute from September 2018 to June 2019. The maternal mental status was examined based on the scores of the Edinburgh Postnatal Depression Scale (EPDS) and the Mother-Infant Bonding Scale (MIBS). Results: The rate of high scores of the EPDS and the MIBS in women choosing elective cesarean section were higher than in women with vaginal delivery and emergency cesarean section. Conclusion: Mental health care may be necessary for women choosing elective cesarean section.

DOI： 10.12688/f1000research.20677.3

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記述言語：英語   出版者・発行元：(一社)日本妊娠高血圧学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/ijgo.12639

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

DOI： 10.1080/14767058.2017.1336761

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We examined the relation between intimate partner violence (IVP) and maternal mental status such as depression and anxiety. METHODS: Between April 2016 and October 2016, we asked all Japanese women during the first trimester of pregnancy to answer the three self-administered questionnaires to screen IVP and depressive and anxiety symptoms. RESULTS: There were 19 women who had a high score in the modified Violence Against Women Screen (VAWS) (4.1%, IPV group) and 408 women who had a score 0 (86.8%, control group). Overall, the rate of the women with depressive, anxiety, and depressive plus anxiety symptoms were 21.3, 31.5, and 16.0%, respectively. The rate of depressive and/or anxiety symptoms in the IPV group were significantly higher than those in the control group (Odds ratio = 5.02 and 7.40, p < .01 by X2 test). CONCLUSIONS: The significant adverse effect of IPV on maternal mental status seemed to be observed in Japanese women during the first trimester of pregnancy.

DOI： 10.1080/14767058.2017.1317739

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.14740/jocmr3365w

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記述言語：英語  

DOI： 10.1111/1471-0528.14928

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記述言語：英語   出版者・発行元：(一社)日本妊娠高血圧学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J06353&link_issn=&doc_id=20181218200002&doc_link_id=%2Feo6hyrep%2F2018%2F000601%2F004%2F0011-0014%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Feo6hyrep%2F2018%2F000601%2F004%2F0011-0014%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.14740/jocmr3348w

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記述言語：英語  

DOI： 10.1080/14767058.2017.1285887

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We examined the optimal weight gain in the healthy Japanese women with favorable perinatal outcomes of (dichorionic) twin pregnancy. METHODS: We calculated the average weight gain in the women whose height was 150-164 cm with favorable perinatal outcomes of dichorionic twin pregnancy set for this study. The women were categorized to underweight, normal, overweight and obese based on the pre-pregnancy body mass index (BMI) categories according to the Institute of Medicine (IOM) and the World Health Organization (WHO) body mass index (BMI) cutoffs. RESULTS: The average GWG in the normal-weight women with the favorable perinatal outcomes was 13.9 ± 3.6 kg. It was significantly different from that in the underweight, overweight and obese women according to the both 2 BMI cutoffs by Student's t-test (p < 0.01). CONCLUSION: There are optimal ranges of weight gain during twin pregnancy based on the BMI classification.

DOI： 10.1080/14767058.2016.1272568

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記述言語：英語  

DOI： 10.1016/j.ajog.2017.09.006

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

DOI： 10.1080/14767058.2016.1266477

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1080/01443615.2017.1312311

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We examined the recent reasons for hindering antipsychotic medications during pregnancy in Japan. METHODS: We retrospectively analyzed the medical charts of all women who gave birth after 22 weeks' gestation at Japanese Red Cross Katsushika Maternity Hospital from August 2016 to July 2017. RESULTS: Four pregnant women with mental disorders (three schizophrenia and one adjustment disorder) kept the interruption of medications under their partners' compulsion. All of their partners had a history of mental disorders (two schizophrenia, one anxiety disorder and one adjustment disorder). CONCLUSION: In cases of pregnancy requiring mental health care, mental health care on partners seemed to be also needed.

DOI： 10.14740/jocmr3155w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The aim of this study was to compare the obstetric outcomes of twin pregnancies between Japanese women aged ≥ 40 years and their younger counterparts aged 25 - 29. METHODS: This was a retrospective study of twin pregnancies managed at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2016. Women aged 40 and older at delivery (n = 117) were compared with women aged 25 - 29 at delivery (n = 536). RESULTS: Although the women ≥ 40 years old were more likely to have increased risks of HELLP (hemolytic, elevated liver enzymes and low platelet) syndrome and very low birth weight neonates, there were no measurable differences in obstetric outcomes such as hypertensive disorders, premature delivery and neonatal asphyxia between the two groups. CONCLUSION: Advanced maternal age did not seem to affect obstetric outcomes in twin pregnancies seriously.

DOI： 10.14740/jocmr3148w

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記述言語：英語  

DOI： 10.1016/j.tjog.2017.05.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We examined the current status of depressive and anxiety symptoms in Japanese women during pregnancy and postpartum. METHODS: We asked 220 Japanese women who gave birth to singleton babies at term to answer the two self-administered questionnaires (Whooley's two questions and two-item generalized anxiety disorder scale) at first, second and third trimester of pregnancy and 1 month after delivery. RESULTS: The rates of women with depressive symptoms were common during the first trimester of pregnancy (25%) and the postpartum (17%), while the women with anxiety symptoms were common during the first trimester of pregnancy (36%). Eight percent women had histories of mental disorders, and 95% of them showed depressive and/or anxiety symptoms somewhere during pregnancy. Of the women who had depressive symptoms during postpartum, 86% showed depressive and/or anxiety symptoms somewhere during pregnancy. CONCLUSION: Screening for depressive and anxiety symptoms during pregnancy was suggested to be useful to detect high risk women of postpartum depression.

DOI： 10.14740/jocmr3035w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1097/AOG.0000000000002075

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In this preliminary study, we examined the effect of acupressure, acupuncture and moxibustion (oriental treatments) to prevent of the relapse/deterioration of perinatal depression in women with pregnancy-related anxiety and previous depression. METHODS AND RESULTS: Between 2014 and 2016, there were 48 women with pregnancy-related anxiety and previous depression who had delivery at ≥ 22 weeks' gestation in our institute. Of these, oriental treatments were performed in eight and two women (totally 10, 21%) during pregnancy and postpartum, respectively. One of the 10 (10%) who received oriental treatments admitted depressive symptoms during pregnancy or postpartum, while 18 of the rest 38 who did not receive oriental treatments admitted depressive symptoms (47%, P = 0.065). CONCLUSION: The oriental treatments may be useful for pregnant women who need perinatal mental health care.

DOI： 10.14740/jocmr3009w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

DOI： 10.1080/14767058.2016.1205026

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: This study was performed to assess the differences in the birth canal lacerations following the lateral and fours posture deliveries compared with those following the supine posture deliveries. METHODS: We examined the birth canal lacerations of our "low risk" pregnant women under the midwife-led delivery care at Japanese Red Cross Katsushika Maternity Hospital between April 2006 and March 2015. RESULTS: There were 3826, 1754 and 719 women who delivered with supine, lateral and fours postures. The rate of no laceration in the women who delivered with lateral posture was significant lower than that in the women who delivered with supine posture (OR 0.630, 95% CI 0.56-0.71, p < 0.01); however, the incidence of perineal laceration in the women who delivered with lateral posture was significant lower than that in the women who delivered with supine posture (OR 0.856, 95% CI 0.76-0.90, p < 0.01). The incidence of perineal laceration of third- or fourth-degree in the women who delivered with fours posture was significant higher than that in the women who delivered with supine posture (OR 2.28, 95% CI 1.2-4.2, p < 0.01). CONCLUSION: The current results may be to help for self-determination of birthing postures in prenatal women.

DOI： 10.1080/14767058.2016.1209654

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記述言語：英語   出版者・発行元：(一社)日本妊娠高血圧学会  

子癇前症女性における当該疾患発症前の体重増加を評価し、体重増加に及ぼす浮腫の影響を調査した。子癇前症女性77例(妊娠時母体年齢32.8±5.3歳)を子癇前症群、妊娠時に同一の年齢、出産歴、身長、体重であった女性77例を対照群とし、子癇前症群ではその診断4週間前まで、診断2〜4週間前、診断2週間前からの体重増加を後ろ向きに評価した。また対照群では同一期間の体重増加を調査した。子癇前症診断4週間前までの平均体重増加は、対照群における同一妊娠期間の被験者の平均体重増加と差異はなかった。一方子癇前症診断4週間前からの平均体重増加は対照群の同一妊娠期間の被験者よりも有意に多く、また全身浮腫を有する割合も対照群より有意に高かった。さらに子癇前症群では、全身浮腫を有する患者の子癇前症診断2週間前の平均体重増加は、全身浮腫のない患者よりも有意に多かった。子癇前症を伴う母体の体重増加は、子癇前症発症前の浮腫に起因することが示唆された。

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記述言語：英語  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.14740/gr766w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.14740/jocmr2883w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We examined the optimal gestational weight gain (GWG) in the healthy Japanese women with favorable perinatal outcomes of singleton pregnancy. METHODS: We calculated the average GWG in the women whose height was 150 - 164 cm with favorable perinatal outcomes set for this study. The women were categorized to underweight, normal, overweight and obese based on the pre-pregnancy body mass index categories according to the Institute of Medicine guideline. RESULTS: The average GWG in the normal-weight women with the favorable perinatal outcomes was 11.4 ± 3.7 kg. It was not significantly different from that in the underweight and overweight women (12.0 ± 3.4 and 10.0 ± 4.8 kg) by Student's t-test. The average GWG in the obese women was significantly lower than that in the other three groups (3.2 ± 2.2 kg, P < 0.01). CONCLUSION: Based on the current results, the optimal GWG for the Japanese women without obesity was found to be 10 - 12 kg.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2147/IJWH.S129168

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記述言語：英語   出版者・発行元：(一社)日本妊娠高血圧学会  

正期産中に脳卒中または子癇を発症した妊婦を、血圧変化に着目して評価した。分娩のため入院した17例(年齢20〜43歳)を対象に、母体年齢、出産歴、蛋白尿、浮腫、ならびに分娩入院の3〜7日前、入院時、脳卒中または子癇発症0.1〜2時間前の収縮期血圧(SBP)/拡張期血圧を評価した。妊娠高血圧症候群に伴う子癇は14例、脳卒中は3例で発症した。7例は母体年齢が35歳以上で、9例は蛋白尿、3例は重篤な全身性浮腫を合併していた。16例は分娩のための入院3〜7日前のSBPは正常で、そのうち6例は入院時SBPも正常であった。さらに両疾患発症0.1〜2時間前では、子癇発症の2例と脳卒中発症の7例においてSBPが正常で、軽度高血圧症のみが明らかとなった。SBPが160mmHg以上の重篤な高血圧症は、子癇または脳卒中発症直後に全例で観察された。分娩中には血圧の定期的な測定が重要であることが示された。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J06353&link_issn=&doc_id=20171205180003&doc_link_id=10.14390%2Fjsshp.HRP2016-001&url=https%3A%2F%2Fdoi.org%2F10.14390%2Fjsshp.HRP2016-001&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In order to examine the optimal weight gain during pregnancy in Japanese women, we analyzed the perinatal outcomes in Japanese women with the optimal range of weight gain during pregnancy according to the Japanese (the Japanese Ministry of Health, Labour and Welfare: JMHLW and the Japan Society for the Study of Obesity: JASSO) guidelines compared with those according to the USA (the Institute of Medicine: IOM) guideline. METHODS: We compared the obstetric outcomes in two groups of gestational weight gain within the optimal range based on the IOM and Japanese guidelines in women of pre-pregnancy body mass index (BMI) categories of underweight, normal, overweight and obese. RESULTS: In the underweight and normal-weight women, the incidences of preterm delivery and low-birth-weight infant in the JMHLW group were significantly higher than those in the IOM group; however, the incidence of some other perinatal complications in the JMHLW group was significantly lower than that in the IOM group. In the overweight women, the incidences of preterm delivery and low-birth-weight infant in the JSSO group were significantly higher than those in the IOM group; however, there were no significant differences in the obstetric outcomes between the obese women in the JSSO and IOM groups. CONCLUSION: Based on the current results, we should be more tolerant for the weight gain during pregnancy in Japanese woman than ever, especially in overweight women.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3109/14767058.2015.1103731

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In 2012, the recommendation for immediate contact and visit to obstetric institutions by pregnant women was emphasized by The Japan Obstetric Compensation System for Cerebral Palsy (JOCSC). In this study, we examined whether or not the increased awareness has led to the improvement of perinatal outcomes of placental abruption managed at private clinics. METHODS: We reviewed the obstetric records of 38 singleton pregnant women complicated by placental abruption that developed at home, and were managed at private clinics from April 2008 through April 2016. RESULTS: The perinatal outcomes, specifically the rate of cases with ≥ 1 hour time interval between symptom onset and clinic visit, have not changed significantly after the intervention. CONCLUSION: The provision of information regarding the early clinical symptoms associated with placental abruption in pregnant women has not been well documented in Japan.

DOI： 10.14740/jocmr2662w

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記述言語：英語  

DOI： 10.1016/j.ajp.2016.05.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.7883/yoken.JJID.2015.561

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In this study, we examined the current status of psychosocial or psychological intervention for women during pregnancy and the postpartum period in Japan. METHODS: We estimated the number of women receiving perinatal psychosocial or psychological intervention in Japan. On December 2015, we requested 2,462 obstetrical facilities that are members of the Japan Association of Obstetricians and Gynecologists (JAOG) to provide information on women who received psychosocial or psychological intervention during pregnancy, the hospitalization period for childbirth and the puerperal 1 month in 2014. A total of 1,305 (53.0%) of the 2,462 obstetrical facilities responded with valid information on a total of 515,373 women, accounting for approximately 52% of all deliveries that occurred in Japan during the study period. RESULTS: The number of women who received psychosocial or psychological intervention during pregnancy, the hospitalization period for childbirth and the puerperal 1 month were 4,843 (0.94%), 4,791 (0.93%) and 3,015 (0.59%), respectively. In total, 8,743 women (1.70%) received psychosocial or psychological intervention in 2014. CONCLUSION: Considering the response rate, the number of women requiring perinatal psychosocial or psychological intervention was estimated to be 16,000 per year in Japan.

DOI： 10.14740/jocmr2568w

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記述言語：英語  

DOI： 10.1007/s00737-015-0587-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We examined the perinatal outcomes in cases of at least one fetal demise in monochorionic and diamniotic twin pregnancies. METHODS: We reviewed the obstetric records of all Japanese twin pregnancies managed beyond 9 weeks' gestation at Japanese Red Cross Katsushika Maternity Hospital between 2008 and 2014. RESULTS: The incidence in the monochorionic twin pregnancies was significantly higher than that in the dichorionic twin pregnancies (8.3% vs. 2.6%, odds ratio: 3.40, 95% confidence interval: 1.5 - 7.6, P < 0.01). Of these, 60.0% were diagnosed as fetal demise of both fetuses at the same time (vs. dichorionic twin pregnancy: odds ratio: 12.0, 95% confidence interval: 1.3 - 120, P = 0.04). The rate of "vanishing twin" in cases of at least one fetal demise at 10 - 14 weeks' gestation in the monochorionic twin pregnancies was significantly lower than that in the diamniotic twin pregnancies (30.0% vs. 88.9%, odds ratio: 0.05, 95% confidence interval: 0.01 - 0.53, P = 0.01). CONCLUSION: The incidence of fetal demise and the influence on the co-twin in monochorionic twin pregnancy is greater than those in dichorionic twin pregnancy.

DOI： 10.14740/jocmr2479w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND METHODS: To identify whether or not a history of assisted reproductive technology (ART) is associated with the low incidence of Chlamydia trachomatis (CT) infection in pregnant women, we reviewed the obstetric records of the Japanese women aged 35 - 42 years. RESULTS: The prevalence of CT in the pregnancies without ART was 1.1% (28/2,632) using nucleic acid amplification tests, while it was zero in the pregnancies conceived by ART (0/364, P = 0.049 by the X(2) test). CONCLUSIONS: A history of ART seemed to be a negative risk factor for CT infection in pregnant women.

DOI： 10.14740/jocmr2444w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.7883/yoken.JJID.2015.495

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We examined the prevalence of specific perinatal complications of monochorionic-diamniotic twin pregnancies in cases without any abnormal findings until the second trimester of pregnancy. This was a retrospective cohort study performed at a tertiary perinatal center in Tokyo, Japan. There were 88 cases of uncomplicated monochorionic-diamniotic twin pregnancies at 28 weeks of gestation. In five of them (5.7%), there were serious complications associated with placental circulatory imbalance between the twins during the third trimester of pregnancy. Two cases were complicated by twin-twin transfusion syndrome, two cases were complicated by twin anemia-polycythemia sequence, and one case was complicated by acute twin-twin transfusion syndrome. In the five cases, no abnormal ultrasonographic findings or symptoms were recognized one or two weeks prior to the diagnosis. Fifty-eight cases (65.9%) were delivered at term uneventfully. Serious complications due to placental circulatory imbalance between twins occurred in about 6% of cases during the third trimester of pregnancy.

DOI： 10.4137/JCM.S38895

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective. The objective of this study was to describe the recent clinical characteristics of labor using 3 systems of Japanese midwife-led primary delivery care, as follows: (1) those intending to give birth at home managed by midwives who do not belong to our hospital, (2) those planning to give birth in our hospital managed by the same midwives, and (3) those planning to give birth managed by midwives who belong to our hospital. Methods. A retrospective cohort study was performed. Results. There were no significant differences in the obstetric or neonatal outcomes among the 3 groups. The rate of transfers during labor with the system involving midwives belonging to our hospital was higher than those with the other 2 systems. In addition, the timing of transfers in the system with the midwives belonging to our hospital was earlier than with the other 2 systems. Among the 3 groups, there were no significant differences in the rate of the main 2 indications for transfers: fetal heart rate abnormality and failure to progress. Conclusion. There were no significant differences in perinatal outcomes among the 3 systems; however, there were some differences in the status of transfers to obstetric shared care.

DOI： 10.1155/2016/9101479

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.14740/jocmr2371w

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DOI： 10.1016/j.ajp.2015.10.013

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We examined the clinical significance of pregnancies complicated by velamentous cord insertion (VCI) associated with other umbilical cord/placental abnormalities. METHODS: Data were collected from 168 deliveries complicated by VCI and from 16,797 unaffected controls. All placentae were screened identically by trained staff. In this study, we examined the presence of excessively long umbilical cord (longer than 70 cm), vasa previa, single umbilical artery, circumvallate placenta, succenturiate placenta, lobed placenta, placenta previa, low lying placenta and placenta accrete as the other umbilical cord/placental abnormalities. RESULTS: Using a multivariate analysis, the pregnancies complicated by VCI were independently associated with in vitro fertilization use (P < 0.01), maternal smoking (P = 0.03), preterm delivery (P = 0.03), fetal asphyxia (P = 0.01) and small-for-gestational-age infants (P = 0.02). It was also independently associated with vasa previa (P < 0.01), single umbilical artery (P = 0.04), lobed placenta (P = 0.01) and placenta previa (P = 0.03). However, these umbilical cord/placental abnormalities were not associated with the further adverse outcomes of the pregnancies complicated by VCI. CONCLUSION: VCI is associated with an increased risk of adverse perinatal outcomes irrespective of the presence of other umbilical cord/placental abnormalities. Routine identification of the placental cord insertion site should be considered.

DOI： 10.14740/jocmr2310w

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記述言語：英語  

DOI： 10.1016/S0140-6736(15)00536-X

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We examined the risk of hypertensive disorders in relation to maternal depressive and anxiety disorders which were diagnosed before or during early pregnancy in Japanese women. METHODS: We reviewed the obstetric records of all Japanese singleton deliveries at ≥ 22 weeks' gestation managed at the Japanese Red Cross Katsushika Maternity Hospital between 2009 and 2014. Potential risk factors for hypertensive disorders with maternal depressive and anxiety disorders were selected as follows: maternal age, parity, medications, self-interruption of medications and economic problems. RESULTS: The incidence of hypertensive disorders did not increase in the pregnant women with depressive disorders compared with that in the normal control pregnant women (P = 0.96). However, the incidence of hypertensive disorders in the women with anxiety disorders was higher than that in the control women (odds ratio (OR): 2.61, 95% confidence interval (CI): 1.4 - 5.0, P < 0.01). In the women with anxiety disorders, 19% performed self-interruption of medications during pregnancy, and it was associated with the increased risk of hypertensive disorders (vs. no medication group, OR: 7.50, 95% CI: 1.5 - 38, P = 0.03; vs. medication group, OR: 16.0, 95% CI: 2.4 - 110, P < 0.01). CONCLUSIONS: Maternal uncontrolled anxiety disorders due to self-interruption of medications seemed to be associated with the increased risk of hypertensive disorders in Japanese pregnant women.

DOI： 10.14740/jocmr2284w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We examined the obstetric outcomes of singleton vaginal deliveries in women with cerclage at our institute to confirm the risk of intrapartum cervical lacerations in vaginal deliveries of women with cerclage. METHODS: Data on all Japanese singleton vaginal deliveries at ≥ 34 weeks' gestation managed at the Japanese Red Cross Katsushika Maternity Hospital between 2008 and 2014 were collected. RESULTS: During the study period, cervical cerclage was performed in 95 of 9,490 (1.0%) women with singleton pregnancy at 12 - 22 weeks of singleton pregnancy who delivered at ≥ 34 weeks' gestation. The incidence of intrapartum cervical lacerations and postpartum hemorrhage ≥ 1,000 mL in the women with cerclage were higher significantly than that in the women without cerclage (cervical lacerations: crude odds ratio (OR): 26.9, 95% confidence interval (CI): 14 - 51, P < 0.01; postpartum hemorrhage: crude OR: 2.86, 95% CI: 1.6 - 4.9, P < 0.01). Using a multivariate analysis, cerclage was independently associated with the increased incidence of intrapartum cervical lacerations (P < 0.01). CONCLUSIONS: Cervical cerclage is an independent risk factor of intrapartum cervical lacerations in vaginal deliveries.

DOI： 10.14740/jocmr2227w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We examined whether or not the Japanese pregnant women with a history of a cesarean section have the knowledge about the benefits and harms of trial of labor after cesarean (TOLAC) and elective repeat cesarean delivery (ERCD). METHODS: We reviewed the obstetric records of 121 Japanese women with a prior cesarean section who visited our hospital for reservation of their second delivery between January and December 2013. RESULTS: Forty-five (37%) of them wanted to perform TOLAC at the first interview. Of these, 14 women (31%) with a history of an urgent cesarean chose TOLAC because of the insufficient anesthetic effect during cesarean, while 11 women (24%) with a history of an elective cesarean did not have the knowledge of the risks of TOLAC and urgent cesarean. Nineteen of those (76%) selected ERCD following the counseling. CONCLUSIONS: Some Japanese pregnant women with TOLAC hope seemed to have insufficient knowledge about the benefits and harms of TOLAC and ERCD. Therefore, the improvement of the process of counseling and decision making may be needed for pregnant women with a history of a cesarean section in Japan.

DOI： 10.14740/jocmr2214w

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記述言語：英語  

This is the first case report of trisomy 13 complicated by massive fetomaternal hemorrhage (FMH). A pale male infant weighing 2,950 g was delivered with low Apgar scores by emergency cesarean section due to non-reassuring fetal status. The umbilical arterial pH and hemoglobin level were 6.815 and 6.9 g/dL (normal: 13 - 22 g/dL), respectively. The maternal hemoglobin-F and serum alpha-fetoprotein levels were 6.0% (normal: < 1.0%) and 1,150 ng/mL (4.1 multiple of median), respectively. The neonate was diagnosed as having trisomy 13 by a subsequent chromosome examination. In the placenta, massive intervillous thrombosis was observed microscopically. This placental finding has been reported to be associated with both preeclampsia and massive FMH. In addition, the incidence of preeclampsia in pregnancies complicated by trisomy 13 has been reported to be significantly higher than normal karyotype populations. Therefore, the current finding may support the association between trisomy 13 and the incidence of massive FMH.

DOI： 10.14740/jocmr2169w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.14740/jocmr2137w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.14740/jocmr2097w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.14740/jocmr2049w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We examined the perinatal outcomes of twin deliveries following selective uterine fundal pressure maneuver (UFPM) during the second stage of the first twin delivery. METHODS: At our institute, if non-reassuring fetal heart rate and/or maternal exhaustion were observed during the second stage of the first twin, selective UFPM was performed following making sure of the position of the first twin's buttocks by ultrasonography. We reviewed the obstetric records of all cases of trial of vaginal delivery of twins between 2002 and 2012. RESULTS: A total of 64 cases were evaluated for the statistical analyses. Of these, selective UFPM for the first twin was performed in 15 cases (24%). Although the cases requiring selective UFPM for the first twin was associated with an increased postpartum hemorrhage, there were no significant differences in neonatal outcomes between the two groups. CONCLUSION: There was no evidence that the selective UFPM is unsafe for both mother and two babies during the second stage of the first twin delivery.

DOI： 10.3109/14767058.2014.921901

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Precipitous labor is defined as expulsion of the fetus within less than 3 hours of commencement of regular contractions. We retrospectively examined our cases of precipitous labor to identify the clinical significance and perinatal outcomes following precipitous labor in singleton vertex deliveries. METHODS: A retrospective population-based study was conducted comparing women with singleton precipitous labor and those with labor of normal duration. We examined the clinical characteristics and outcomes by comparing patients with precipitous labor and those with labor of normal duration in 0 and two-parous singleton pregnant women. RESULTS: Using a multivariate analysis, precipitous labor in nulliparous women was independently associated with teenagers (adjusted OR: 1.71, 95% CI: 0.99 - 2.95, P = 0.049), preterm delivery (adjusted OR: 1.77, 95% CI: 1.16 - 2.70, P < 0.01) and hypertensive disorders (adjusted OR: 1.77, 95% CI: 1.19 - 2.65, P < 0.01), while in two-parous women, it was independently associated with hypertensive disorders (adjusted OR: 2.64, 95% CI: 1.33 - 5.24, P < 0.01). No significant differences were noted between the two groups regarding maternal or neonatal complications on both nulliparous and two-parous women. CONCLUSION: Although precipitous labor was associated with hypertensive disorders in singleton vertex deliveries, it was not associated with maternal or neonatal outcomes.

DOI： 10.14740/jocmr2058w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We examined obstetric and fetal/neonatal outcomes in women with a history of recurrent miscarriage. METHODS: We reviewed the obstetric records of all 5,829 nulliparous pregnant women who delivered at #8805;14 weeks' gestation from 2008 through 2013 at our perinatal center. Of these women, 74 had a history of recurrent miscarriage (1.3%). The control population consisted of 4,176 nulliparous women without a history of miscarriage. Demographic information and characteristics of labor were extracted from patient charts. RESULTS: The rate of maternal age #8805;40 years (p<0.01) and the rate of in vitro fertilization use (p<0.01) were higher in women with recurrent miscarriage than in women without miscarriage. Eleven women with recurrent miscarriage (14.9%) were treated with low-dose aspirin with and without subcutaneous heparin. In addition, the rate of cesarean delivery was higher in women with recurrent miscarriage than in women without miscarriage (p=0.02). However, fetal/neonatal outcomes did not differ significantly between the populations. CONCLUSION: The pregnancy of women with a history of recurrent miscarriage is not associated with adverse outcomes at our perinatal center.

DOI： 10.1272/jnms.82.36

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We investigated perinatal outcomes in pregnant Japanese women who habitually consumed alcohol during pregnancies managed at our hospital. Of the 4,791 Japanese women with singleton deliveries at ≥22 weeks' gestation, 44 (0.9%) were found to have habitually consumed alcohol during pregnancy. Multiple logistic regression analyses suggested that habitual alcohol consumption during pregnancy was not associated with adverse perinatal outcomes. However, 64% of the women who habitually consumed alcohol during pregnancy also habitually smoked; smoking leads to increased risks of a low birth weight and placental abruption.

DOI： 10.1272/jnms.82.163

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Placental lesions, including placental infarction, are associated with fetal and neonatal mortality and morbidity. We present a case of fetal growth restriction associated with an old, diffuse placental infarction. Because the placenta had only a single viable cotyledon, the others being atrophic, the lesion appeared to be a placental tumor on prenatal ultrasonography. The patient did not have pregnancy-induced hypertension. At 31 weeks of gestation, a cesarean delivery was performed because of fetal growth arrest and breech presentation. A small-for-gestational age infant was delivered with Apgar scores of 8 at both 1 and 5 minutes, and the infant had cleft palate and cleft lips. Pathological examination of the placenta revealed an old, diffuse infarction without neoplastic change. In cases in which a placental tumor causing fetal growth restriction is strongly suspected, diffuse placental infarction should be considered as part of the differential diagnosis, because placental tumors are associated with poor maternal prognosis.

DOI： 10.1272/jnms.82.156

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Vitamin K deficiency is associated with malnutrition in some complications, such as hyperemesis gravidarum, active gastrointestinal diseases, and psychological disorders. Maternal vitamin K deficiency can cause fetal bleeding, in particular, fetal intracranial hemorrhage. Although fetal hemorrhage is uncommon, severe damage to the fetus may be inevitable. We describe a pregnant woman with vitamin K deficiency possibly due to hyperemesis gravidarum. The patient was treated for the deficiency, and no fetal or neonatal hemorrhagic diseases were manifested.

DOI： 10.1272/jnms.82.54

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: This study was to examine the clinical usefulness of expectant management of early-onset severe preeclampsia. METHODS: We reviewed the obstetric records of all Japanese singleton deliveries at ≥22 weeks' gestation managed at Japanese Red Cross Katsushika Maternity Hospital between 2007 and 2012. We compared the obstetric characteristics and perinatal outcomes between the cases of deliveries before (n = 19) and after completion of corticosteroids (n = 30) (immediate delivery versus expectant management). RESULTS: Although the gestational age at delivery in the patients expectantly managed was higher than that in the patients required immediate deliveries (31.0 versus 29.3 weeks), the difference in the incidence of neonatal respiratory distress syndrome between the two groups did not reach the statistical significance (74 versus 47%, p = 0.06). The incidence of pulmonary edema in the patients expectantly managed was significantly higher than that in the patients required immediate deliveries within the first 48 h (20 versus 0%, p = 0.04). CONCLUSION: The current results could not support the clinical usefulness of expectant management of early-onset severe preeclampsia.

DOI： 10.3109/14767058.2013.870548

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DOI： 10.3109/14767058.2013.852175

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We examined the clinical significance of difficult suture removal following the McDonald procedure. We examined 117 patients following the McDonald procedure with a singleton pregnancy who delivered at ≥34 weeks of gestation. Difficult suture removal was defined as when spinal anesthesia was required for suture removal. Seven patients (6.0%) were defined as involving difficult suture removal. The cervical length in the difficult-removal-group was significantly shorter than that in the easy-removal-group at suture removal (p = 0.04). If the cervical length was shorter than 20 mm, the odds ratio for difficult suture removal was 9.0 (95% CI 1.6-49, p = 0.01). The progression of cervical ripening following the McDonald suture may be associated with an increased risk of difficult suture removal.

DOI： 10.3109/14767058.2013.852179

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The 'Clinical Guidelines for Obstetrical Practice, 2011 edition' were revised and published as a 2014 edition (in Japanese) in April 2014 by the Japan Society of Obstetrics and Gynecology and the Japan Association of Obstetricians and Gynecologists. 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 of burdens associated with medico-legal and medico-economical problems, and a better understanding between pregnant women and maternity-service providers. The number of Clinical Questions and Answers items increased from 87 in the 2011 edition to 104 in the 2014 edition. The Japanese 2014 version included a Discussion, a List of References, and some Tables and Figures following the Answers to the 104 Clinical Questions; these additional sections covered common problems and questions encountered in obstetrical practice, helping Japanese readers to achieve a comprehensive understanding. Each answer with a recommendation level of A, B or C was prepared based principally on 'evidence' or a consensus among Japanese obstetricians in situations where 'evidence' was weak or lacking. Answers with a recommendation level of A or B represent current standard care practices in Japan. All 104 Clinical Questions and Answers items, with the omission of the Discussion, List of References, and Tables and Figures, are presented herein to promote a better understanding among English readers of the current standard care practices for pregnant women in Japan.

DOI： 10.1111/jog.12419

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DOI： 10.1089/bfm.2013.0100

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

DOI： 10.3109/14767058.2013.814631

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DOI： 10.3109/14767058.2013.804055

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Lactulose is a non-digestible disaccharide formed from fructose and galactose. The objective of this study was to assess the effect of lactulose on gastrointestinal function after cesarean section. One hundred patients who underwent cesarean section at the Japanese Red Cross Katsushika Maternity Hospital were enrolled in this study. They were divided into 2 groups by randomization: (1) an L group that was treated with gelatinous lactulose (N = 48) and (2) a control group (C group) that did not receive gelatinous lactulose (N = 52). The interval between cesarean section and first postoperative flatus, defecation, and walking; appearance of symptoms of ileus; use of other medicines for stimulating bowel movement; properties and state of feces; and duration of postoperative hospital stay were compared between the two groups. The two groups did not show a significant difference in postoperative outcomes, except for the incidence of loose or watery stools (50% in the L group and 26.9% in the C group, P = 0.03). This study could not demonstrate the apparent effectiveness of lactulose in improving bowel function after cesarean section. Therefore, a routine use of gelatinous lactulose after surgery may negatively impact the patients undergoing cesarean section.

DOI： 10.1155/2014/752862

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We examined differences in delivery modes between deliveries managed by female obstetricians and gynecologists (OB/GYNs) and those managed by male OB/GYNs at our hospital. The rate of vacuum extraction/forceps delivery was significantly lower when deliveries were managed by female OB/GYNs. Logistic regression analysis showed that the lower rate of vacuum extraction/forceps delivery was associated with a lower rate of diagnosis of nonreassuring fetal status during the second stage of labor by female OB/GYNs. The rate of cesarean delivery and obstetric outcomes did not differ with the gender of the managing OB/GYN. The increasing number of female OB/GYNs may help increase the rate of maternal satisfaction associated with the decreased rate of instrumental delivery.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The present study examined the relation between the timing of elective cesarean delivery at term and neonatal respiratory outcomes at our institution. From 2005 through 2013, 1,951 elective cesarean singleton deliveries were performed at term. Of the neonates, 141 (7%) had respiratory disorders requiring oxygen supplementation. In comparison to the incidence of respiratory disorders in neonates delivered at full term (39-40 weeks), the incidences in neonates delivered at ≤38+1/7 weeks' and at 41 weeks' gestation were significantly higher. Uncomplicated elective cesarean singleton delivery should be avoided at 38+1 weeks or earlier, and we also pay attention to the respiratory outcomes of neonates delivered by elective cesarean section at 41 weeks' gestation.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE AND METHODS: We examined the relationship between low fibrinogen levels (<200 mg/dL) and the severity of postpartum hemorrhage in singleton vaginal deliveries after 22 weeks' gestation complicated by postpartum hemorrhage requiring transfusion at our hospital. RESULTS: During a 10-year period, 61 women (0.38%) received transfusions owing to postpartum hemorrhage within the first 24 hours after delivery. Of these women, 13 (21%) had low fibrinogen levels (mean, 123 ± 68 mg/dL) when postpartum hemorrhage was diagnosed, and the other 48 (79%) had normal fibrinogen levels (mean, 305 ± 50 mg/dL). Neither total blood loss nor the incidence of additional therapies, such as hysterectomy, differed between the 2 groups of women. Women with low fibrinogen levels started to receive transfusions significantly earlier (98 ± 58 minutes after delivery) than did women with normal fibrinogen levels (142 ± 75 minutes after delivery, p=0.03) and received more units of fresh-frozen plasma (p=0.03). CONCLUSION: The early transfusion of fresh-frozen plasma in women with postpartum hemorrhage and low fibrinogen levels might help prevent adverse outcomes.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To perform trend analysis of primary midwife-led delivery care for 'low risk' pregnant women at our hospital. METHODS: A retrospective cohort study was performed to examine trends and outcomes of labor under primary midwife-led delivery care at the Japanese Red Cross Katsushika Maternity Hospital between 2008 and 2012. RESULTS: During the study period, the rate of deliveries initially considered 'low risk' decreased from 25 to 22% (p < 0.01). This change was associated with increased cases of previous Cesarean deliveries and preterm delivery. There were no significant changes in the neonatal outcomes; however, the rate of Cesarean delivery and incidence of severe perineal laceration in primary midwife-led delivery care were decreased from 2.1 and 3.3% to 0.3 (p = 0.02) and 1.1% (p = 0.04), respectively due to the close cooperation between midwives and obstetricians. CONCLUSION: The rate of deliveries initially considered 'low risk' decreased over the last 5-year period. Closer cooperation between midwives and obstetricians is important in primary midwife-led delivery care.

DOI： 10.7150/ijms.8204

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記述言語：英語  

DOI： 10.3109/14767058.2013.794216

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: It has not been extensively studied whether planned home and planned hospital births under primary midwife-led care increase risk of adverse events among low-risk women in Japan. METHODS: A retrospective cohort study was performed to compare perinatal outcome between 291 women who were given primary midwife-led care during labor and 217 women who were given standard obstetric shared care. Among 291 women with primary midwife-led care, 168 and 123 chose home deliver and hospital delivery, respectively. Perinatal outcomes included length of labor of 24 h or more, augmentation of labor pains, delivery mode, severe perineal laceration, postpartum hemorrhage of 1000 mL or more, maternal fever of 38°C or more and neonatal asphyxia (Apgar score, <7). Analysis was by intention to treat. RESULTS: The incidence of transfer from primary midwife-led care to obstetric shared care was 27% (77 women) mainly due to failure of labor progress (21%, 16 women), postpartum hemorrhage (19%, 15 women) and non-reassuring fetal status (19%, 15 women). Significantly higher incidence of transfer to obstetric shared care from primary midwife-led care was seen among women who chose hospital delivery compared with women who chose home delivery (34 vs 21%, P = 0.011). There were no significant differences in the incidence of adverse perinatal outcomes between women with obstetric shared care and women with primary midwife-led care (regardless of being hospital delivery or home delivery). CONCLUSION: Approximately one-quarter of low-risk women with primary midwife-led care required obstetric care during labor or postpartum. However, primary midwife-led care during labor at home and hospital for low-risk pregnant women was not associated with adverse perinatal outcomes in Japan.

DOI： 10.1111/jog.12094

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.pedneo.2013.03.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The aim of this study was to identify the clinical significance associated with ptyalism gravidarum in Japanese singleton pregnancies. METHODS: Data were collected from 22 patients complicated by ptyalism gravidarum whose symptoms continued until delivery and from 7,743 unaffected controls. RESULTS: The incidence of ptyalism gravidarum in the Japanese pregnant women was about 0.3 %. Using multiple logistic regressions, ptyalism gravidarum was associated with history of hyperemesis gravidarum (p < 0.01), neonatal male sex (p = 0.02) and small for gestational age infants (p = 0.04). CONCLUSIONS: Ptyalism gravidarum may be a distinctive condition leading to adverse perinatal outcomes.

DOI： 10.1007/s00404-012-2614-x

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記述言語：英語  

DOI： 10.1007/s00404-012-2537-6

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記述言語：英語  

DOI： 10.3109/14767058.2012.733745

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We retrospectively evaluated a series of 18 monoamniotic and 7 pseudomonoamniotic (secondary to rupture in the membrane dividing monochorionic diamniotic twins) twin gestations managed after 20 weeks' gestation. There were no significant differences in the incidence of neonatal death or umbilical cord entanglement between the monoamniotic and pseudomonoamniotic twin gestations (33 versus 21%, P = 0.94 and 72 versus 43%, P = 0.36). Therefore, the same serious management may be needed for pseudomonoamniotic twin gestations as for monoamniotic twin gestations.

DOI： 10.1155/2013/369419

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective. We examined which specific factors contributed to the increase in Cesarean delivery rate at our hospital over a 10-year period. Methods. From January 2002 to December 2012, data on the Japanese singleton deliveries at ≥22-week gestation managed at Japanese Red Cross Katsushika Maternity Hospital were collected. Potential factors associated with the increasing Cesarean delivery rate were selected according to previous studies. In this study, the incidences of intrauterine fetal demise, umbilical artery pH <7.1, and severe perineal laceration were calculated for each year. Results. The Cesarean delivery rate at our institution increased significantly during the study period (17.3% in 2002 versus 23.4% in 2012, P < 0.01). During the study period, the Cesarean delivery rates in the cases of nulliparity, preterm delivery, low birth weight (<2,500 g), previous Cesarean deliveries and breech presentation were increased significantly. The incidence of intrauterine fetal demise and low umbilical artery pH was significantly decreased, and a negative correlation was found between the Cesarean delivery rate and the incidence of low umbilical artery pH for each year (r = -0.92, P < 0.01). Conclusion. At our institute, the neonatal outcomes seemed to be improved associated with the increased Cesarean delivery rate between 2002 and 2012.

DOI： 10.1155/2013/863282

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The aim of this study was to identify the factors associated with the increased risk of postpartum hemorrhage requiring transfusion in Japanese twin pregnancies in comparison with those in Japanese singleton pregnancies. METHODS: We reviewed the obstetric records of all singleton and twin deliveries after 22 weeks' gestation at the Japanese Red Cross Katsushika Maternity Hospital from 2003 through 2011. Potential risk factors for transfusion due to hemorrhage after cesarean delivery were selected according to previous studies of postpartum hemorrhage or transfusion or both after delivery: maternal age, parity, previous cesarean deliveries, history of infertility therapies such as in vitro fertilization, gestational age at delivery, neonatal birth weight, placenta previa, uterine myoma≥6 cm, hypertensive disorders, placental abruption, emergency cesarean deliveries and general anesthesia. RESULTS: Using multiple logistic regression, the independent risk factors for postpartum hemorrhage requiring transfusion in singleton pregnancies were preterm delivery [odds ratio (OR) 2.40, 95% confidence interval (CI) 1.2-4.6, p<0.01], placenta previa (OR 8.08, 95% CI 3.9-16, p<0.01) and placental abruption (OR 12.8, 95% CI 2.3-76, p<0.01). In twin pregnancies, however, the independent risk factors for postpartum hemorrhage requiring transfusion were gestational age at ≥41 weeks (OR 8.20, 95% CI 1.3-40, p<0.01) and hypertensive disorders (OR 5.45, 95% CI 2.2-14, p<0.01). CONCLUSIONS: The factors associated with postpartum hemorrhage requiring transfusion in cesarean deliveries of twins seemed to be different from those in singleton cesarean deliveries.

DOI： 10.1007/s00404-012-2461-9

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記述言語：英語  

DOI： 10.3109/14767058.2012.684162

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.ijgo.2011.08.023

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The purpose of this paper was to examine the obstetric and neonatal outcomes of preterm singleton pregnancies complicated by placental abruption following preterm premature rupture of membranes (p-PROM) compared with those without p-PROM. We reviewed the obstetric records of 95 singleton deliveries complicated by placental abruption at 22-36 weeks' gestation. The incidence of placental abruption in singleton pregnancies with p-PROM was 4.7%, and the crude odds ratio of placental abruption for women following p-PROM was 6.50 (P < 0.01). Of the 95 cases of placental abruption in preterm singleton deliveries, 64 cases (67.4%) occurred without p-PROM and 31 cases (32.6%) occurred following p-PROM. The incidence of histological chorioamnionitis stage III in the patients following p-PROM was significantly higher than that in the patients without p-PROM (P = 0.02). The rate of emergency Cesarean deliveries associated with nonreassuring fetal status (NRFS) in the patients following p-PROM was significantly lower than that in the patients without p-PROM. However, there were no significant differences in the maternal and neonatal outcomes between the patients with and without p-PROM. Although p-PROM may be one of important risk factors for placental abruption associated with chorioamnionitis, it may not influence the perinatal outcomes in preterm placental abruption.

DOI： 10.5402/2012/856971

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The aim of this study was to determine the factors associated with intrapartum asphyxia in singleton deliveries beyond 37 weeks' gestation. We reviewed the obstetric records of Japanese singleton deliveries after 37 weeks' gestation managed at Japanese Red Cross Katsushika Maternity Hospital from 2005 through 2010. Forty-nine cases were diagnosed as intrapartum asphyxia on the basis of an Apgar score <4 at 5 minutes or umbilical arterial pH <7.0 or both. Cases with umbilical arterial pH ≥7.1 and 1-minute Apgar score ≥7 were examined as controls (n=10,484). Logistic multivariate regression analysis showed that intrapartum asphyxia was independently associated with cases of trial of labor after cesarean delivery (adjusted odds ratio, 3.24; 95% confidence intervals, 1.0-11; p=0.04). Our findings may be encouraging for the counseling of patients regarding a possible attempt at trial of labor after cesarean delivery.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present here a case of fore-lying of the umbilical cord. In this case, transvaginal sonography did not reveal the umbilical cord beyond the fetal head before maternal urination; however, 5 minute later, a fore-lying umbilical cord was revealed between the floating fetal head and the uterine cervix after urination. The present case indicates the importance of careful evaluation of preterm premature rupture of the membranes by means of transvaginal ultrasonography in predicting umbilical cord prolapse.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The aims of this study were to compare the perinatal outcomes of successful vacuum extraction (VE) or failed VE and to compare the perinatal outcomes of failed VE followed by forceps delivery (FD) or Cesarean section (CS) from 2000 through 2007. Compared with cases of successful VE, cases of failed VE followed by CS had a significantly higher incidence of neonatal complications, whereas cases of failed VE followed by FD had a significantly higher incidence of maternal injury. Both CS and FD remain important yet distinct treatments for emergency cases of failed VE. Therefore, the decision to use a second instrument (FD) or to proceed to CS should be made in each case on the basis of these differences.

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記述言語：英語  

DOI： 10.1515/jpm.2011.096

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記述言語：英語  

DOI： 10.1515/jpm.2011.080

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記述言語：英語  

DOI： 10.3109/14767058.2010.545926

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

DOI： 10.3109/14767058.2010.545912

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: In singletons, neonatal small-for-gestational age (SGA) status is an unfavorable postpartum outcome leading to cesarean section (CS) and increasing the possibility of maternal operative complications. Perinatal characteristics of SGA newborns in dichorionic (DC) twins were investigated for the prognostic impact on their mothers. METHODS: A retrospective study was performed from 2004 to 2009 on 329 DC twins with two live births. Neonates were classified as SGA if they weighed less than the 10th percentile at birth according to Japanese singleton norms. Statistical differences between DC twins delivering appropriate-for-gestational age (AGA)/AGA pairs (control group) and AGA/SGA, SGA/AGA or SGA/SGA pairs (the first/second twins) were analyzed. RESULTS: The median (range) of the gestational ages at delivery for AGA/AGA, AGA/SGA, SGA/AGA and SGA/SGA pairs were 37.1 (27.1-40.3), 37.2 (29.0-40.9), 37.1 (28.1-40.7) and 37.3 (33.3-40.4) weeks, and the complete vaginal delivery rates of both fetuses were 66.2% (43/65), 84.8% (28/33), 82.4% (14/17) and 70.0% (7/10), respectively. Compared with AGA/AGA pairs, AGA/SGA pairs showed a higher incidence of spontaneous vaginal births of both fetuses (31.3% [26/83] vs 19.9% [37/186], OR 1.84, 95% CI 1.45-4.73) and a lower incidence of emergent CS (25.3% [21/83] vs 38.7% [72/186], OR 0.53, 95% CI 0.30-0.95). CONCLUSION: The relatively small size of SGA fetuses allows both fetuses to remain inside the uterus for a longer time and to easily pass through the maternal parturient canal for complete vaginal delivery. Neonatal SGA status is a favorable factor for avoiding operative complications of CS and optimizing maternal perinatal outcomes.

DOI： 10.1111/j.1447-0756.2010.01450.x

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記述言語：英語  

DOI： 10.1097/AOG.0b013e3182172c6c

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: This study investigated the clinical significance of placental abruption occurred at preterm compared with those that occurred at term. METHODS: We reviewed the obstetric records of 102 singleton deliveries complicated by placental abruption after 22 weeks of gestation. The χ(2) test for categorical variables was used and differences with p < 0.05 were considered significant. Odds ratios (ORs) and 95% confidence intervals (CIs) were also calculated. RESULTS: Of 102 cases of placental abruption, 60 cases (59%) occurred at preterm and 42 (41%) at term. There were no significant differences in perinatal outcomes between the two groups with preterm and term gestations. The incidence of histological chorioamnionitis in the preterm group was significantly higher than that in the term group (crude OR 3.4, 95% CI 1.4-8.2, p < 0.01) while that of placental embolisms and/or infarctions in the preterm group was significantly lower than that in the term group (crude OR 0.35, 95% CI 0.16-0.80, p = 0.01). Using logistic regression, preterm placental abruption was significantly more likely in multiparous patients (adjusted OR 2.5, 95% CI 1.0-6.2, p = 0.046) and those demonstrating histological chorioamnionitis (adjusted OR 3.5, 95% CI 1.4-9.1, p < 0.01), while term placental abruption was significantly more likely in cases of placental embolisms and/or infarctions (adjusted OR 3.5, 95% CI 1.2-10, p = 0.02). CONCLUSION: The current results indicate that the possible processes leading to placental abruption at preterm are different from those at term.

DOI： 10.1007/s00404-010-1478-1

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記述言語：英語  

DOI： 10.1515/jpm.2010.117

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s10396-010-0275-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To investigate the maternal risk factors for small-for-gestational age (SGA) newborns in Japanese dichorionic (DC) twins. METHODS: A retrospective study was conducted from 2003 to 2008 on 340 DC twin pregnancies resulting in two live births. Newborns were classified as SGA if their birth weight was below the 10th percentile according to Japanese singleton norms. Statistical differences were evaluated between pregnancies resulting in appropriate-for-gestational age (AGA) pairs and those resulting in at least one SGA neonate. RESULTS: The study population consisted of AGA/AGA (50.8%), AGA/SGA (37.0%) and SGA/SGA pairs (12.0%). Logistic regression analysis identified significant interrelations for SGA with maternal nulliparity (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.30-0.91), smoking (OR 3.25, 95% CI 1.09-9.66), assisted reproductive technology (OR 0.52, 95% CI 0.30-0.89), pregnancy-induced hypertension (OR 2.00, 95% CI 1.01-4.31), pregravid weight (kg) (unitary OR 0.94, 95% CI 0.91-0.97) and monthly weight gain (kg/month) (unitary OR 0.25, 95% CI 0.14-0.44). Bivariable receiver operating characteristic curves were generated for monthly weight gain (area under the curve [AUC] 0.626, cutoff 1.41 kg/month, P<0.001) and total weight gain (AUC 0.615, cutoff 14.0 kg, P<0.001). CONCLUSION: Cigarette smoking and weight gain control are relatively modifiable factors for which interventional management is necessary to avoid perinatal problems arising from SGA pregnancy. Further studies are needed to investigate optimal nutrition, health guidance and subsequent weight gain control that lead to concrete improvement in maternal and infant prognoses.

DOI： 10.1111/j.1447-0756.2010.01301.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present here a case of isolated torsion of a left normal fallopian tube at 37 weeks' gestation. Although uncommon, especially on the left side, torsion of the fallopian tube should be included in the differential diagnosis of abdominal pain during pregnancy.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Delivery before arrival at a hospital did not cause major perinatal complications; however, it may reflect a serious problem of perinatal medicine in eastern Tokyo, Japan.

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記述言語：英語  

DOI： 10.1159/000332120

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

There have been several studies of adverse perinatal outcomes associated with the indiscriminate use of labor-inducing drugs. However, the present results indicate that the appropriate use of labor-inducing drugs is not unsafe and improves neonatal outcomes in abnormal deliveries.

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記述言語：英語  

DOI： 10.1159/000321684

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Postnatal examination of fetal appendages is important because this information may help predict perinatal outcome. We present a case of a red streak along the entire umbilical vein after a cesarean section due to non-reassuring fetal status. The pathological findings revealed an umbilical cord with dilated vascular changes and mild funisitis. Because the dilated change was intense in the umbilical vein, the red streak of the umbilical cord was caused by venous congestion. Moreover, we considered that the umbilical venous congestion was due to increased resistance in the fetal intra-abdominal umbilical vein, which was associated with the non-reassuring fetal status.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To evaluate clinical features of assisted reproductive technology (ART) patients with pregnancy-induced hypertension (PIH) compared to spontaneously conceived PIH patients. METHODS: We retrospectively compared PIH incidence, maternal outcomes, and neonatal outcomes among these patients. RESULTS: Preeclampsia, cesarean rate, and massive maternal bleeding were significantly more common in the ART group. Neonatal outcomes showed no significant difference between the groups. Multiple regression analysis revealed ART as an independent risk factor for preeclampsia. However, higher cesarean rate and massive bleeding were mainly associated with multiple pregnancy. CONCLUSION: ART patients with PIH had an increased incidence of preeclampsia, cesarean delivery, and massive maternal hemorrhage.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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&#x2009;=&#x2009;1029) and those without a history of abortion (n&#x2009;=&#x2009;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&#x2009;=&#x2009;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.

DOI： 10.3109/14767050903551517

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We examined the relationship between serum uric acid levels and changes in renal circulation in women with twin pregnancy compared with those in women with singleton pregnancy. METHODS: The Doppler waveforms of the bilateral maternal main renal arteries were obtained from 15 women at 37-38 weeks of nonpreeclamptic twin pregnancy and 16 healthy women at the same gestational age of singleton pregnancy. The resistance index (RI), pulsatility index (PI), and acceleration time were determined. RESULTS: The mean serum uric acid level in the twin pregnancy group was significantly higher than that in the singleton pregnancy group (5.0 ± 0.9 vs. 3.7 ± 0.6 mg/dl, P < 0.01). Although there were no significant differences in the RI or PI levels between the singleton and twin pregnancy groups, the acceleration time in the twin pregnancy group was significantly prolonged compared with that in the singleton pregnancy group (82.2 ± 29 vs. 59.9 ± 17 ms, P = 0.01). There was a significant correlation between serum uric acid levels and acceleration times (r(2) = 0.55, P < 0.01). CONCLUSION: The changes in renal circulation may be one of the possible mechanisms leading to hyperuricemia in women with twin pregnancies.

DOI： 10.1007/s10157-010-0306-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The purpose of this study was to examine the association between time of delivery and perinatal outcomes in singleton deliveries at Japanese Red Cross Katsushika Maternity Hospital. We performed a retrospective cohort study of all singleton deliveries at ≥ 22 weeks' gestation from 2002 through 2009 at our hospital. During the nighttime period (12 midnight to 8 am), although the rate of delivery of high-risk pregnancies was low, the rate of low umbilical artery pH (< 7) was higher than that during the daytime periods (8 am to 4 pm) (odds ratio 1.9, 95% confidence interval 1.1-3.4, p = 0.02). During the nighttime period, in addition, the rate of low umbilical artery pH in patients with emergent cesarean delivery was significantly higher than that during the daytime period (odds ratio 6.9; 95% confidence interval 2.5-19, p < 0.01). In our hospital, the rate of adverse neonatal outcomes associated with cesarean birth was increased at nighttime period.

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記述言語：英語  

DOI： 10.1097/AOG.0b013e3181f02ae2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The aim of this study was to determine the perinatal outcomes of placental abruption associated with the presence of histological chorioamnionitis. We reviewed the obstetric records of 96 singleton deliveries complicated by placental abruption after 22 weeks' gestation. Of these 96 cases, 37 cases (39%) were diagnosed as having histological chorioamnionitis in the placenta. The incidence of premature delivery, preterm rupture of the membranes and low birth weight in the cases of placental abruption with chorioamnionitis were higher than in cases without chorioamnionitis. However, there were no significant differences in the incidence of other outcomes, such as fetal demise, low Apgar score, or low umbilical artery pH, between the cases of placental abruption with and without histological chorioamnionitis. Although the incidence of prematurity in the cases of placental abruption with chorioamnionitis was higher than that in cases without chorioamnionitis, there were no significant differences in fetal and neonatal conditions between the abruption cases with and without chorioamnionitis.

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記述言語：英語  

DOI： 10.3109/14767050903449928

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We examined whether the incidence of neonatal respiratory disorders has increased with the increased rate of elective cesarean delivery in twin pregnancies. We reviewed the obstetric records of 292 twin deliveries with vertex presentation of the first twin after 37 weeks' gestation at our hospital from 2000 through 2008. The study period was divided into 3 parts as follows: period 1: 2000 through 2002 (n=76); period 2: 2003 through 2005 (n=104); and period 3: 2006 through 2008 (n=112). We compared the rate of elective cesarean delivery due to maternal request and the incidence of transient tachypnea of the newborn (TTN). There has been a significant increase in rate of elective cesarean delivery (period 1: 18%; period 2: 25%; period 3: 48%) over the past several years. This increase was observed to be due to an increase in maternal requests for elective cesarean delivery. However, there were no significant differences in the incidence of TTN in the 3 periods [period 1: 7.2%; period 2: 6.7%; period 3: 8.0%]. The recent increase in the rate of cesarean delivery did not cause the increase in the incidence of neonatal respiratory disorders in twin pregnancies.

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記述言語：英語  

DOI： 10.1016/j.ajog.2009.08.027

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We examined the incidence of abnormally shaped placentae such as circumvallate placenta and succenturiate lobes of placenta and their complications in twin compared with singleton pregnancies. METHODS: A retrospective cohort study was performed with 592 (174 monochorionic and 418 dichorionic) twin and 11,311 singleton pregnancies managed at our hospital between 2000 and 2007. RESULTS: There was no measurable difference in the incidence of circumvallate placenta between twin and singleton pregnancies (1.2% vs. 1.9%), while the incidence of succenturiate lobes of placenta in twin pregnancies was significantly higher than that in singleton pregnancies (1.5% vs. 0.73%, P = 0.033). In singleton pregnancies, the incidences of placental complications such as placental abruption, vasa previa and retained placenta were observed to be associated with the presence of abnormally shaped placentae. In the twin pregnancies, however, there were no relation between the incidences of placental complications and the presence of abnormally shaped placentae. CONCLUSIONS: Succenturiate lobes of placenta were more common in twin pregnancies compared with singleton pregnancies. However, the presence of abnormally shaped placentae does not seem to affect perinatal outcomes in twin pregnancies.

DOI： 10.1007/s00404-009-1064-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To examine the perinatal outcomes of elderly primiparous dichorionic twin pregnancies conceived by in vitro fertilization (IVF) compared with those conceived spontaneously. METHODS: Data were collected from primiparous women aged 35 and older with dichorionic twin pregnancy conceived by IVF (n = 64) and those conceived spontaneously (n = 87). Data included antenatal data, gestational age at delivery, obstetric complications such as preeclampsia, gestational diabetes, placental previa and placental abruption, mode of delivery, birth weight, birth weight discordance, fetal demise, Apgar score at 1 min and umbilical areterial pH. RESULTS: The rate of elective Cesarean sections in the group conceived by IVF was significantly higher than that conceived spontaneously. There were no significant differences in other variables between the two groups. CONCLUSIONS: The current results did not support the IVF-related risks of elderly primiparous dichorionic twin pregnancies.

DOI： 10.1007/s00404-009-1083-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

DOI： 10.1159/000260331

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記述言語：英語  

DOI： 10.3109/14767050903029626

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記述言語：英語  

CONTEXT: Ptyalism gravidarum is of unknown origin and is usually defined as an excessive secretion of saliva, common in women with nausea and vomiting who might have difficulty in swallowing their saliva. CASE REPORT: We present here 2 cases complicated by ptyalism gravidarum during all trimesters of pregnancy. In one case, ptyalism recovered spontaneously at 35-36 weeks' gestation, and in the other case, it recovered after delivery. CONCLUSION: Ptyalism gravidarum may not be a serious condition leading to adverse perinatal outcomes, however there may not be any satisfactory treatment.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To identify the factors associated with the increased risk of developing preeclampsia in twin pregnancies compared with those in singleton pregnancies. METHODS: We reviewed the obstetric records of all deliveries at > or =22 weeks' gestation managed at the Japanese Red Cross Katsushika Maternity Hospital between 2001 and 2007. RESULTS: The incidence of preeclampsia in the twin pregnancies (7.6%: 45 in 593) was significantly higher than that in the singleton pregnancies (1.7%: 196 in 11,311; P < 0.01). In singleton pregnancies, the developing preeclampsia was associated with maternal age at > or =35 years, primiparity, maternal BMI > or =25 before pregnancy, history of infertility therapies such as IVF and having a history of previous preeclampsia. In twin pregnancies, however, the developing preeclampsia was not associated with these variables. CONCLUSIONS: In Japanese women, the factors reported to be associated with the increased risk of preeclampsia in singleton pregnancies may not alter the increased risk of preeclampsia in twin pregnancies.

DOI： 10.1007/s00404-009-0932-4

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記述言語：英語  

DOI： 10.1007/s10396-009-0225-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

In 2008, 84% (459) of 548 women with pregnancies initially considered "low risk" requested to give birth under midwifery care at Japanese Red Cross Katsushika Maternity Hospital. Of these, 42% (191) were referred to obstetric care during labor at term; however, we found no evidence that midwifery primary obstetric care is less safe for women with "low-risk" pregnancy than is standard obstetric care. Therefore, we recommend that midwifery care be promoted with an international collaborative effort.

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記述言語：英語  

BACKGROUND: Although urinary retention caused by the retroverted gravid uterus is uncommon, acute urinary retention is an emergency condition. CASES: We present here two cases of acute urinary retention at 12 weeks' gestation secondary to retroverted gravid uterus. Although some preventive measures were suggested to the patients, recurrences of urinary retention occurred during the following 2-3 weeks and in their next pregnancies. CONCLUSION: In cases that urinary retention due to retroverted gravid uterus once occurred, we have to pay attention to the recurrence of urinary retention during the next pregnancies.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: A case-control study of twins was performed to identify clinical predictions of emergency cesarean delivery in the second-born twin after vaginal delivery of the first twin. METHODS: The obstetric records were reviewed of all twin vaginal deliveries at the Japanese Red Cross Katsushika Maternity Hospital from 2002 through 2007. RESULTS: There were 206 vaginal deliveries of first twins at >or=33 weeks of gestation. Of these deliveries, nine women (4.4%) underwent an emergency cesarean for the delivery of the second twin. The incidence of cesarean delivery for the second twin was significantly greater in cases with a history of infertility therapy (odds ratio: 5.0, 95% confidence intervals: 1.2-22), gestational age at >or=39 weeks (24, 4.7-120), nonvertex presentation (6.2, 1.5-26), operative delivery of the first twin (6.1, 1.5-24) and intertwin delivery time interval >30 min (7.2, 1.7-30). CONCLUSION: The most important risk factor of emergency cesarean delivery in the second twin was a gestational age of >or=39 weeks.

DOI： 10.1111/j.1447-0756.2008.00976.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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 22.2 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.

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記述言語：英語  

Background. We present here 2 cases of acute twin-twin transfusion occurred during vaginal labor in monochorionic-diamniotic twin pregnancies. Case. Fetal heart rate tracings showed tachycardia in the donor twin in the first case, while they showed reassuring patterns in both twins in the second case. Conclusion. These differences in changes of fetal heart rate in the donor twins following acute twin-twin transfusion may be resulted from the differences in amount of transfusion and elapsed time.

DOI： 10.1155/2009/498530

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The aim of this study was to investigate the influence of fusion of the placentas on various obstetric and neonatal findings in dichorionic twin pregnancies. METHODS: Medical charts of the total population of women who gave birth to dichorionic twin babies at the Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2007 were reviewed. Data were collected from 158 deliveries with dichorionic fused placentas and from 261 deliveries with separate placentas. RESULTS: There were no significant differences in various obstetric and neonatal findings between dichorionic twin pregnancies with fused placentas and those with separate placentas. CONCLUSION: The current findings indicate that there is no significant influence of fusion of placentas in dichorionic twin pregnancies.

DOI： 10.1159/000238112

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We examined the obstetric outcomes of low-risk labors at the 'Japanese tatami' mat compared with Western-style delivery room. METHODS: A retrospective cohort study was performed on 201 deliveries at the 'Japanese tatami' delivery room and 360 deliveries at the standard Western-style delivery room. RESULTS: There were no measurable differences in the duration of labor, the incidence of perineal laceration, total maternal blood loss and the incidence of low Apgar score and umbilical artery pH between the two groups. CONCLUSIONS: We found no evidence that the Japanese room is unsafe for low-risk infants and mothers in comparison with the standard Western-style delivery room.

DOI： 10.1515/JPM.2009.102

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記述言語：英語  

DOI： 10.1515/JPM.2009.055

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

In this case-control study, we examined infants delivered vaginally at 37 weeks or later to identify factors associated with transient tachypnea of the newborn (TTN). We reviewed the obstetric records of all vaginal deliveries at the Japanese Red Cross Katsushika Maternity Hospital from 2005 through 2007. Demographic information and the characteristics of labor were extracted from patient charts. Multivariate analysis identified that the incidence of TTN was significantly associated with nulliparity; a history of infertility therapy, such as in vitro fertilization; augmentation of labor; nonreassuring fetal status; vacuum/forceps delivery; and low Apgar score (<7) at 1 and 5 minutes. In addition, a low Apgar score at 1 minute was the factor most strongly associated with the incidence of TTN (adjusted odds ratio, 20; 95% confidence intervals, 12-34; p<0.001). The present results indicate that the improvement of obstetric surveillance to diminish the frequency of low Apgar scores is important for preventing TTN in infants delivered vaginally at 37 weeks or later.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We examined deliveries of twins to identify factors most strongly associated with an increased risk of transfusion. We reviewed the obstetric records of 511 twin deliveries at the Japanese Red Cross Katsushika Maternity Hospital from 2003 through 2007. After 18 (3.5%) of these deliveries, transfusions were required. Transfusion was significantly more likely after elective cesarean delivery at a gestational aged of 37 weeks or more (odds ratio, 4.85; 95% confidence interval, 1.87-12.61). Emergency cesarean delivery (at > or =37 weeks' gestation) was not associated with an increased risk of transfusion. The delivery mode of twins should be carefully considered because of the increased risk of transfusion after elective cesarean delivery at a gestational age of 37 weeks or more.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Prenatal recognition of circumvallate placenta is important because the condition may lead to some serious perinatal complications. METHODS: The possibility of antenatal ultrasonographic screening for circumvallate placenta was examined by measuring the thickness of the placenta at the thickest point. The study group consisted of 722 unselected patients with uncomplicated singleton pregnancies seen for routine ultrasonographic examination between 18 and 21 weeks' gestation. Data were collected from 11 deliveries complicated by completely circumvallate placenta and from 711 unaffected controls. RESULTS: The average thickness of the placenta was 2.22 ± 0.36 cm in the control subjects, whereas it was 2.74 ± 0.53 cm (P = 0.01 versus control) for circumvallate placentas. When a placental thickness greater than 3.0 cm was demonstrated, 19.4% (6/31) had a circumvallate placenta at delivery (P < 0.01). CONCLUSION: The current results suggest that measurement of placental thickness is useful for screening for circumvallate placenta.

DOI： 10.1007/s10396-007-0168-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: This study examined the clinical significance of patients complicated by succenturiate lobes of placenta in comparison with patients with normal placenta. METHODS: Data were collected from 47 patients complicated by succenturiate lobes of placenta and from 7,666 unaffected controls. RESULTS: The frequency of maternal age > or =35 years and history of using in vitro fertilization in patients complicated by succenturiate lobes of placenta were significantly higher than those in control patients (P < 0.01). In addition, the incidence of non-reassuring fetal status, vasa previa, postpartum hemorrhage and retained placenta in the study group were significantly higher than those in control (P < 0.01). CONCLUSION: These results support the adverse obstetric outcomes in pregnancies with succenturiate lobes of placenta and may suggest the pathogenesis of these placental shape aberrations associated with assisted reproductive technology.

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記述言語：英語  

DOI： 10.1080/14767050801924159

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記述言語：英語  

DOI： 10.1080/14767050801927905

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To investigate obstetric outcomes in singleton pregnancies conceived by in vitro fertilization (IVF) to nulliparous women older than 35 compared to those of their younger counterparts. METHODS: Nulliparous women 35 years and older at delivery conceived by IVF (n = 89) were compared with nulliparous women 34 years and younger at delivery conceived by IVF (n = 48). Data included antenatal data, gestational age at delivery, maternal and neonatal complications and mode of delivery. RESULTS: The incidence of pregnancy-induced hypertension in the younger group was significantly higher than that in the elderly group (13 vs. 3.4%, P = 0.043). There were no measurable differences in other obstetric outcomes such as placental abnormality, premature delivery or neonatal asphyxia between the two groups. CONCLUSION: The current results suggest that obstetric complications in pregnancies conceived IVF are attributed to mechanisms other than those depend on advanced maternal age.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

DOI： 10.1111/j.1447-0756.2007.00682.x

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記述言語：英語  

DOI： 10.1515/JPM.2008.085

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Usually, fetal asphyxia/demise because of umbilical cord entanglement and secondary cord occlusion is a unique characteristic of monoamniotic twin pregnancies. We present here a rare case of fetal asphyxia due to cord entanglement in a monochorionic diamniotic twin pregnancy complicated by 2nd-trimester single intrauterine demise. In this case, there was no amniocentesis or any other invasive intrauterine procedure performed during pregnancy.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present here a case of transient anhydramnios due to premature rupture of the membranes observed from 19 weeks' gestation. At 27 weeks' gestation, the amniotic fluid had increased due to spontaneous membrane sealing. At 32 weeks' gestation, premature rupture of the membranes occurred again. A male fetus was delivered with birth weight 1,706 g. Although the infant was diagnosed as having dry lung syndrome, he is now a healthy 1-year-old boy.

DOI： 10.1159/000151673

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The aim of this study is to investigate maternal and neonatal outcomes in dichorionic twins to nulliparous women older than 35 compared to those of their younger counterparts. This was a retrospective study of dichorionic twin pregnancies managed at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2006. Nulliparous women 35 years and older at delivery (n = 60) were compared with nulliparous women between the ages of 20 and 29 at delivery (n = 71). The women > or = 35 year old were more likely to have used assisted reproductive technology. There were no measurable differences in obstetric outcomes such as preeclampsia, premature delivery, low birth weight and neonatal asphyxia between the two pregnancies. Advanced maternal age does not seem to affect obstetric outcomes in nulliparous dichorionic twin pregnancies.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Preeclampsia has been classified into two types on the basis of the T helper (Th)1/Th2 balance: Th1-predominant type and Th2 predominant type. In this study, we examined the Th1/Th2 ratio in peripheral Th cells in 11 patients with preeclamptic twin pregnancies, 11 normal (nonpreeclamptic) twin pregnancies, 11 preeclamptic singleton pregnancies, and 11 normal singleton pregnancies. The average Th1/Th2 ratio in the patients with preeclamptic twin pregnancy was 8.3 +/- 3.4 (mean +/- SD), which was similar to those in patients with normal singleton and twin pregnancies and significant lower than that in patients with preeclamptic singleton pregnancies (p = 0.003). The present results suggest that the mechanisms of preeclampsia differ between singleton and twin pregnancies.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We examined vaginal deliveries of twins to identify factors most strongly associated with the increased risk of postpartum hemorrhage (estimated blood loss > or = 1,000 mL). We reviewed the obstetric records of all 171 twin vaginal deliveries at Japanese Red Cross Katsushika Maternity Hospital from January 2002 through August 2006. Of these deliveries, 41 (24%) were complicated by postopartum hemorrhage. Postpartum hemorrhage was significantly more likely in cases with gestational age > or = 39 weeks (odds ratio [OR], 3.47; 95% confidence interval [CI], 1.65-7.28), a combined birth weight of more than 5,500 g (OR, 2.53; 95% CI, 1.00-6.45), induction of labor (OR, 2.87; 95% CI, 1.38-5.98), oxytocin administration during labor (OR, 2.86; 95% CI, 1.27-6.48), or a duration of labor > or = 24 hours (OR, 2.55; 95% CI, 1.15-5.62). Postpartum hemorrhage is a frequent complication in twin pregnancies. Therefore, special attention should be given after birth to patients with induction of labor or intervened delivery especially at > or = 39 weeks gestation.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Aim:  To examine the obstetric outcomes of elderly primiparous singleton pregnancies conceived by in vitro fertilization (IVF) compared with those conceived spontaneously. Methods:  Data were collected from primiparous women aged 35 years and older with a singleton pregnancy conceived by IVF (n = 89) or spontaneously (n = 849). Data included antenatal data, gestational age at delivery, obstetric complications, such as pregnancy-induced hypertension, gestational diabetes, placental previa and placental abruption, mode of delivery, birth weight, fetal demise and the Apgar score at 1 min. Results:  The elective Cesarean rate in pregnancies following IVF was significantly higher than that in the control group (P = 0.014). However, there were no significant differences in obstetric outcomes between the two groups. Conclusions:  The current results did not support the IVF-related risks of elderly primiparous singleton pregnancies. (Reprod Med Biol 2007; 6: 219-222).

DOI： 10.1111/j.1447-0578.2007.00188.x

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記述言語：英語  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We examined the relation between first-trimester crown-rump length (CRL) discordance and birth weight discordance in dichorionic twin pregnancies conceived by assisted reproductive technology (ART). METHODS: We examined 101 nulliparous dichorionic twin pregnancies producing male-male or female-female infants conceived spontaneously (n = 38) or following in vitro fertilization and embryo transfer (n = 63). RESULTS: There were no significant differences in CRL disparity or birth weight discordance between spontaneous and ART-conceived dichorionic twin pregnancies. There was a positive correlation between CRL disparity and birth weight discordance in ART-conceived twin pregnancies (r(2) = 0.22, p = 0.02), while there was no such correlation in spontaneous pregnancies (r(2) = 0.02, p = 0.40). CONCLUSION: In ART-conceived dichorionic twin pregnancies, CRL disparity may be associated with birth weight discordance.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We retrospectively analyzed the clinical significance of placental position in patients with placental abruption by comparing cases in which the placenta was implanted on the anterior wall of the uterus (n=17) and those in which the placenta was on the posterior wall (n=12). There were no significant differences in clinical features of patients or pregnancy outcomes between the two groups. In this study, all patients with an anterior-wall placenta received a diagnosis of placental abruption prenatally, whereas only 8 patients (67%, p=0.01) with posterior-wall placenta received a diagnosis of placental abruption prenatally. Serious consideration should be given to the diagnosis of placental abruption in patients with a posterior-wall placenta.

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記述言語：英語  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We performed uterine artery Doppler velocimetry in 16 nulliparous and 16 parous women with non-preeclamptic singleton gestations and 16 nulliparous and 16 parous women with dichorionic twin gestations at 17-18 and 26-27 weeks of gestation. In both singleton and twin pregnancies, the average pulsatility index (PI) in nulliparous women was significantly higher than that in parous women at 17-18 weeks of gestation. At 26-27 weeks of gestation, however, there were no significant differences in PI between nulliparous and parous women with either singleton or twin pregnancies. During the early second-trimester of non-preeclamptic singleton and twin pregnancies, parity has a significant effect on uterine artery blood flow.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: The maternal glycosylated hemoglobin (HbA1C) level in early pregnancy has been observed to be lower than the prepregnant value. In Japan, the average body mass index (BMI) shows a very slight change during early pregnancy, which has been thought to be associated with the incidence of hyperemesis gravidarum. METHODS: We examined the relation between HbA1C and changes in BMI levels of 274 pregnant Japanese women managed at our hospital during early pregnancy. RESULTS: The average HbA1C in early pregnancy was 5.1 +/- 0.4%, which did not differ markedly from that of nonpregnancy (5.0 +/- 0.5%). The HbA1C level showed a negative correlation with the increasing value of BMI during early pregnancy (r2 = 0.26, p < 0.05). CONCLUSIONS: In this study, we could not identify a significant decrease in HbA1C in Japanese women during early pregnancy. This finding may be associated with the incidence of hyperemesis gravidarum in Japanese women.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The effect of hormone replacement therapy (HRT) on plasma adenosine levels was investigated in climacteric women experiencing hot flushes. METHODS AND RESULTS: Plasma adenosine levels were measured in 13 peri-menopausal women with frequent hot flushes (>5 per day) before and 3-4 months after initiating HRT. Thirteen healthy pre-menopausal, 9 peri-menopausal women with few hot flushes (<1 or 2 per day) and 10 healthy postmenopausal women were enrolled as controls. The average plasma adenosine level in the peri-menopausal women was 0.20+/-0.09 micromol/L, which was significantly higher than in the pre-menopausal (0.12+/-0.07 micromol/L, p<0.05), peri-menopausal with few hot flushes (0.10+/-0.09 micromol/L, p<0.05) and postmenopausal women (0.13+/-0.06 micromol/L, p<0.05). Both the increased adenosine level and the hot flushes were decreased by HRT (plasma adenosine: 0.13+/-0.06 micromol/L). CONCLUSIONS: Increased plasma adenosine in peri-menopausal women may be associated with frequent hot flushes.

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