Ikuno Kawabata

Incidence and risk factors for severe perineal laceration after vaginal delivery in Japanese patients

Objective: The aim of this study was to assess the frequency of severe perineal lacerations defined as either third- or fourth-degree lacerations during normal spontaneous vaginal delivery and to evaluate potential risk factors in Japanese patients. Materials and methods: An electronic audit of the perinatal database at the Tama-Nagayama Hospital of Nippon Medical School and Yamaguchi Hospital from 1997 through 2004 was completed. Singleton vaginal vertex deliveries were analyzed for potential risk factors using univariate and multivariate logistic regression analysis. Results: From the database, 7,946 deliveries were identified, with 135 deliveries resulting in severe lacerations (1.7%). In the multivariate logistic regression analysis, severe lacerations were associated significantly with primiparous (odds ratio, 4.36; 95% CI, 2.17–9.57), oxytocin use (odds ratio, 2.19; 95% CI, 1.27–3.73), midline episiotomy (odds ratio, 4.68; 95% CI, 2.09–11.55), forceps-assisted delivery (odds ratio, 7.11; 95% CI, 1.95–20.59), vacuum-assisted delivery (odds ratio, 5.93; 95% CI, 3.38–10.36), and shorter attendant experience (odds ratio, 2.88; 95% CI, 1.12–9.81). Conclusions: The present study demonstrated that operator factors, such as midline episiotomy, oxytocin use, assisted delivery and attendant experience, are independent risk for severe perineal lacerations after vaginal delivery in Japanese patients. The results suggest that midline episiotomy and assisted vaginal delivery, especially forceps-assisted delivery should be avoided in patients who are being delivered of a first child whenever possible.

Type and Location of Placenta Previa Affect Preterm Delivery Risk Related to Antepartum Hemorrhage

Purpose: To evaluate whether type and location of placenta previa affect risk of antepartum hemorrhage-related preterm delivery. Methods: We retrospectively studied 162 women with singleton pregnancies presenting placenta previa. Through observation using transvaginal ultrasound the women were categorized into complete or incomplete placenta previa, and then assigned to anterior and posterior groups. Complete placenta previa was defined as a placenta that completely covered the internal cervical os, with the placental margin >2 cm from the os. Incomplete placenta previa comprised marginal placenta previa whose margin adjacent to the internal os and partial placenta previa which covered the os but the margin situated within 2 cm of the os. Maternal characteristics and perinatal outcomes in complete and incomplete placenta previa were compared, and the differences between the anterior and the posterior groups were evaluated. Results: Antepartum hemorrhage was more prevalent in women with complete placenta previa than in those with incomplete placenta previa (59.1% versus 17.6%), resulting in the higher incidence of preterm delivery in women with complete than in those with incomplete placenta previa [45.1% versus 8.8%; odds ratio (OR) 8.51; 95% confidence interval (CI) 3.59-20.18; p < 0.001]. In complete placenta previa, incidence of antepartum hemorrhage did not significantly differ between the anterior and the posterior groups. However, gestational age at bleeding onset was lower in the anterior group than in the posterior group, and the incidence of preterm delivery was higher in the anterior group than in the posterior group (76.2% versus 32.0%; OR 6.8; 95% CI 2.12-21.84; p = 0.002). In incomplete placenta previa, gestational age at delivery did not significantly differ between the anterior and posterior groups. Conclusion: Obstetricians should be aware of the increased risk of preterm delivery related to antepartum hemorrhage in women with complete placenta previa, particularly when the placenta is located on the anterior wall.

Randomized trial of ultrasound-indicated cerclage in singleton women without lower genital tract inflammation

This is the first report of a randomized trial of cerclage on pure cervical shortening without vaginosis or cervicitis. The objective of our multicenter randomized controlled trial was to assess the benefits of ultrasound‐indicated cervical cerclage in the mid‐trimester to prevent preterm birth in women who have no signs of infection or inflammation of the lower genital tract.

The presence of amniotic fluid sludge in pregnant women with a short cervix: an independent risk of preterm delivery

Abstract Objective: To examine whether the presence of amniotic fluid sludge (AFS) could increase the risk of preterm delivery in women with a cervical length (CL) of less than 25 mm. Materials and methods: This is a retrospective cohort study of 110 women who were 14–30 weeks pregnant with a singleton gestation and a CL of less than 25 mm. The primary outcomes were defined as preterm delivery before 34 weeks and preterm delivery before 37 weeks. The secondary outcome was defined as preterm premature rupture of membranes (PPROM) prior to preterm delivery. Risk factors for preterm delivery were defined as AFS, subchorionic hematoma (SCH), history of preterm delivery, CL of less than 20 mm, and CL of less than 15 mm. A univariate analysis was performed to assess the primary and secondary outcomes according to the presence or absence of each risk factor. A multiple logistic regression analysis was performed to evaluate the parameters, using a significance of p < .05 on the univariate analysis to examine whether they were independent risk factors. Results: A significantly increased risk of preterm delivery was found in the group of women with AFS who actually did deliver prior to 34 weeks (p < .001; odds ratio [OR] 6.44; 95% confidence interval [CI] 2.51–16.5), prior to 37 weeks (p = .001; OR 4.46; 95% CI 1.76–11.3), and who had PPROM (p < .001; OR 4.96; 95% CI 2.00–12.3). A multivariate logistic regression analysis was performed in the women with AFS who experienced preterm delivery before 34 weeks, in the women with a CL less than 20 mm, and in the women with a CL less than 15 mm. The results showed that AFS was an independent risk factor for preterm delivery before 34 weeks (p = .001; OR 5.86; 95% CI 2.11–16.3). Conclusion: The presence of AFS was an independent risk factor for preterm delivery before 34 weeks in women with a CL less than 25 mm.

Morphological changes observed via fetal ultrasound in prenatally diagnosed and isolated congenital lymphangiomas: three case reports

We illustrate three cases of isolated congenital lymphangioma (CL). Fetal ultrasound (US) demonstrated uniloculated cystic masses that changed to multiloculated, subcutaneous, hypoechoic, avascular cystic masses with thin septations without solid components. Case 1: CL of the right forearm; Case 2: CL of the right hypochondrium; and Case 3: CL of the left upper posterior back. Postnatal US detected multiloculated, subcutaneous, hypoechoic, avascular cystic masses with thin septations without solid components or invasive developments. We prenatally and postnatally diagnosed them as isolated CL cases due to focal, soft, bulging masses with unclear margins. Due to our correct diagnosis and precise evaluation of sizes and locations, no perinatal complications occurred. In this case series, uniloculated features changed to multiloculated features and the largest macrocyst size decreased, whereas the sizes of the smaller microcysts increased. These morphological changes observed via fetal US represent intermittent CL growing processes.