Mitsuhiko Koresawa

Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2011 edition

Clinical guidelines for obstetrical practice were first published by the Japan Society of Obstetrics and Gynecology (JSOG) and the Japan Association of Obstetricians and Gynecologists (JAOG) in 2008, and a revised version was published in 2011. 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 in burdens associated with medico‐legal and medico‐economical problems, and a better understanding between pregnant women and maternity‐service providers. These guidelines include a total of 87 Clinical Questions followed by several Answers (CQ&A), a Discussion, a List of References, and some Tables and Figures covering common problems and questions encountered in obstetrical practice. Each answer with a recommendation level of A, B or C 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 87 CQ&A are presented herein to promote a better understanding of the current standard care practices for pregnant women in Japan.

The use of balloons for uterine cervical ripening is associated with an increased risk of umbilical cord prolapse: population based questionnaire survey in Japan

BackgroundTo clarify whether the use of balloons for cervical ripening is associated with the incidence of umbilical cord prolapse.MethodsA postal questionnaire survey was distributed in Japan. Cases of umbilical cord prolapse occurring during labor in association with the use of balloons for cervical ripening between 2007 and 2011 in Japan were analyzed.ResultsAnswers from 942 institutions were obtained. The subjects included 369 patients with fore-lying or prolapse of the umbilical cord among a total of 2,037,460 deliveries. Among the singleton vertex cases, fore-lying or prolapse of the umbilical cord during labor were observed in 88 (0.005%) of 1,891,189 deliveries not associated with the use of balloons for cervical ripening and in 93 (0.064%) of 146,271 deliveries associated with the use of balloons for cervical ripening (Odds ratio 13.67, 95% confidence interval 10.21, 18.30). All types of balloons were significantly associated with the occurrence of fore-lying or prolapse of the umbilical cord. A total of 39% of cases of umbilical cord prolapse occurred during manual or spontaneous balloon removal, while 53% of cases occurred after a while not directly associated with balloon removal.ConclusionThe risk of umbilical cord prolapse was significantly increased during the use of balloons for cervical ripening, especially in cases involving the use of disk-type and ball-type balloons filled with large amounts of water.

Clinical risk factors for poor neonatal outcomes in umbilical cord prolapse.

Abstract Objectives: To clarify the clinical risk factors associated with poor neonatal outcomes due to umbilical cord prolapse (UCP). Methods: A postal questionnaire survey was attempted in Japan. The clinical risk factors and managements associated with poor neonatal outcomes were analyzed in cases of UCP treated in Japan. Results: A total of 267 cases of UCP (out of 2 037 460 total deliveries) were analyzed. The rates of intrauterine death, neonatal death and survival with disability were 3.4%, 5.6% and 7.1%, respectively. The multivariate regression analysis for these poor neonatal outcomes revealed that the significant risk factors included a prolapsed amniotic sac (adjusted odds ratio (aOR), 4.49), preterm labor (aOR, 2.99) and replacement of the prolapsed umbilical cord into the uterus (aOR, 2.87). However, UCP that occurred during labor (aOR, 0.28) and emergency cesarean section (aOR, 0.11) were associated with a reduction in the rates of poor outcomes. The interval between the diagnosis of UCP and delivery was significantly longer in the infants with a poor outcome than intact survival (median 30 versus 24 min, p = 0.048). Conclusion: An emergency cesarean section should be carried out immediately to ensure a better outcome for the infant.

A case of trisomy 21 with holoprosencephaly: The fifth case

SummaryA case of trisomy 21 with holoprosencephaly, the fifth case in the literature, is described. The patient also had extracephalic malformations frequently associated with Down syndrome. The possibility of a causal relationship between trisomy 21 and holoprosencephaly is discussed.

Prenatal diagnosis of haemophilia BM

SummaryAccurate mid-trimester prenatal diagnosis was achieved in a Japanese haemophilia BM family. At 21 weeks of gestation, liver blood from the male fetus at 50% risk was sampled using a needle guided by ultrasound. F.IX (F.IX:C and F.IX:Ag) and ox-brain PT in the fetal plasma were low and prolonged, but within the normal range of controls at mid-trimester. Pregnancy went to term and woman gave birth to an unaffected male. Haemophilia BM can be diagnosed in the mid-trimester of pregnancy by determination of F.IX:C, F.IX:Ag and ox-brain PT in pure fetal plasma.

Prenatal Diagnosis and Fetal Therapy Utilizing Fetoscope

Abstract Fetoscopy has not been familiar in Japan, probably due to the low frequency of its major indicated disorders. Recently this technique is drawing the interest by its unique ability to approach to the fetus directly. In this circumstance, fetoscopy itself, the indications, the usage in fetal therapy, and fetal electrocardiogram as an expanded apprication of fetoscopy are presented.