Hidehiko Miyake

Increased Level of Granulocyte Elastase in Cervical Secretion Is an Independent Predictive Factor for Preterm Delivery

Objective: The objective of this study was to explore whether increased levels of granulocyte elastase in cervical secretion is an independent predictive factor for preterm delivery before 34 weeks of gestation in the patient with preterm labor. Methods: One hundred and sixty-one women with preterm labor at 22–28 weeks of gestation were enrolled prospectively. The level of granulocyte elastase in cervical secretions was measured by immunoassay, vaginal secretions were collected for the microscopic evaluation of Gram-stained smears, and the uterine cervix was assessed by transvaginal ultrasonography. Results: Nineteen of 161 patients (12%) delivered before 34 weeks of gestation. Granulocyte elastase assessment had a sensitivity, specificity, positive predictive value, and negative predictive value for preterm delivery of 53, 75, 22 and 92%, respectively. A positive elastase assessment was associated with a relative risk for preterm delivery of 2.9 (95% CI 1.3–6.6), whereas a positive bacterial vaginosis assessment and shorter cervical length less than 25 mm demonstrated a relative risk of 1.9 (95% CI 0.8–4.6) and 1.5 (95% CI 0.6–5.0), respectively. Conclusion: The present study demonstrates that the risk of spontaneous preterm delivery before 34 weeks of gestation is increased in the women with preterm labor who are found to have an increased level of granulocyte elastase in cervical secretions.

Midwife-led care unit for 'low risk' pregnant women in a Japanese hospital

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.

Umbilical Cord Ulceration after Prenatal Diagnosis of Duodenal Atresia with Interstitial Deletion of Chromosome 13q: A Case Report

Umbilical cord ulceration complicated by massive local hemorrhage may be a lethal event in the fetus, and this ulceration has been reported to be associated with upper intestinal atresia. The diagnosis of umbilical cord bleeding is difficult. We present a case of umbilical cord ulceration, hemorrhage, and duodenal atresia which had, in addition, an interstitial deletion of chromosome 13q. A female infant weighing 1,691 g was delivered by cesarean section at 34 weeks of gestation and had resuscitation and laparotomy. Just before the cesarean section, ultrasonography showed a ‘double bubble’ sign and a linear shadow, suggesting fibrin in the amniotic cavity. This finding may help in the diagnosis of bleeding from the cord.

Maternal risk factors for small-for-gestational age newborns in Japanese dichorionic twins.

Aim:  To investigate the maternal risk factors for small‐for‐gestational age (SGA) newborns in Japanese dichorionic (DC) twins.

Obstetric outcomes of elderly primiparous singleton pregnancies conceived by in vitro fertilization compared with those conceived spontaneously

AimTo examine the obstetric outcomes of elderly primiparous singleton pregnancies conceived by in vitro fertilization (IVF) compared with those conceived spontaneously.MethodsData 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.ResultsThe 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.ConclusionsThe current results did not support the IVF-related risks of elderly primiparous singleton pregnancies.

Factors associated with delayed delivery of infant in Cesarean section

transverse incision, the rectus fascia was also incised transversely. During this period, we rarely have used barrier agents for preventing adhesions during Cesarean section. Data are presented as number (%) or mean ± SD. For statistical analysis, the χ 2 test with Yates’ correction for categorical variables was used while the Student’s t-test for continuous variables was used. Differences with p < 0.05 were considered significant. Table I shows maternal height and weight at delivery, neonatal birth weight and incision-to-delivery time of the first or second non-urgent Cesarean deliveries between 2008 and 2010. There were no significant differences in the average maternal height and weight at delivery and neonatal birth weight in the 6 groups in Table I. The average incision-to-delivery intervals by transverse incision at non-urgent repeat Cesarean deliveries were longer significantly than those by vertical incision irrespective of number of Cesarean delivery or adhesion in the abdominal cavity. In addition, the average incision-to-delivery intervals with severe adhesions were longer significantly than those without severe

Influence of umbilical cord abnormalities (velamentous/marginal cord insertion and nuchal cord) on the perinatal outcomes of the second twin after vaginal delivery of the first twin

No abstract available

Neonatal small‐for‐gestational age status as a favorable factor for the complete vaginal delivery of both fetuses in Japanese dichorionic twins

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.

Hemodynamic Changes in Maternal Renal Arteries in Twin Pregnancy

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 nonpreeclamptic 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.

In vitro fertilization as a risk factor for transfusion after vaginal singleton delivery

Despite the great studies made in the reduction of pregnancy-related maternal mortality, hemorrhage remains a leading cause of maternal death. To further reduce the maternal mortality rate, the risk factors related to hemorrhage must be identified. Some previous studies have identified prolonged labor, preeclampsia, macrosomia, induction and/or augmentation of labor, forceps delivery, retained placenta and soft-tissue lacerations as major risk factors for severe postpartum hemorrhage [1,2]. However, these previous studies may have some limitations such as a bias of including multiple pregnancies. In deliveries of multiple pregnancies, overdistention of the uterus may weaken the contraction and retraction of the uterine muscles and increase the risk of postpartum hemorrhage [3]. In this study, therefore, we examined vaginal singleton deliveries to identify factors most strongly associated with the increased risk of severe postpartum hemorrhage needing transfusion. We reviewed the obstetric records of 8874 singleton vaginal deliveries at Japanese Red Cross Katsushika Maternity Hospital from 2002 through 2007. Blood loss during vaginal delivery was calculated by collecting and measuring the blood in collection devices used specifically for vaginal birth and then weighing sheets, drapes, and sponges after delivery. Transfusion was considered if estimated volume of hemorrhage reached 30–40% of the blood volume (1500–2000 ml) and/or shock index (pulse/ systolic blood pressure) of the patient reached 1.0– 1.5. The decision for transfusion was made by attending obstetrician with consideration of the patient’s health status, the duration of hemorrhage and the influence of hemorrhage on vital signs. Demographic information and the characteristics of labor were extracted from patient charts. Cases and controls were compared by x or Fisher’s exact test for categorical variables. Odds ratios (ORs) and 95% confidence intervals (CIs) were also calculated. Differences with p5 0.05 were considered significant. Variables used in the multivariate model were those that on univariate analysis had shown statistically significance (p5 0.05) toward association with increased risk of transfusion (Table I). Logistic regression was then performed to identify the factors most strongly associated with transfusion in a multivariate model. Of these deliveries, 26 (0.29%) received transfusions after delivery. The causes for these hemorrhage were uterine atony (15 cases; 58%), genital tract laceration (5; 19%), retention of the placenta (4; 15%) and others (2; 8%). Table II shows the adjusted ORs ratios and 95% CIs for the incidence of transfusion using logistic multivariable regression analysis. As shown in Table II, receiving transfusion was significantly more likely in cases with history of in vitro fertilization (adjusted OR, 6.8), low set placenta (43), placental abruption (15), or retained placenta (24). The current results may support some previous studies concerning the risk factors related to severe postpartum hemorrhage [1,2]. Based on this study, on the other hand, a pregnancy conceived by in vitro fertilization may be an additional main risk factor for severe postpartum hemorrhage needing transfusion. The reason leading to this consequence is not clear. One possible explanation may be that endometrial hyperstimulation caused by the high estrogen and progesterone levels, coupled with multiple embryo