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Aim: We investigated cervical parameters predictive of vaginal delivery in elective labor induction among women at 40–41 gestational weeks. Methods: This Japanese prospective single‐center cohort study was conducted between July 2019 and June 2020. We enrolled women with an uncomplicated singleton pregnancy who underwent labor induction at 40–41 gestational weeks. We analyzed background characteristics and cervical parameters, including Bishop score, cervical length, posterior cervical angle, and changes in cervical parameters before and after cervical dilatation. The endpoint was the rate of vaginal delivery. Results: Of 142 eligible participants, all 24 multiparous women underwent vaginal delivery. Among the nulliparous women (n = 118), the following categories showed significantly higher rates of vaginal delivery: Bishop scores of ≥6 before and after dilatation, compared with Bishop score <6 (adjusted prevalence ratio (aPR) [95% confidence interval (CI)]; 1.58 [1.17–2.13] and 1.56 [1.13–2.14], respectively) and cervical length of <10 and 10–20 mm before dilation, compared with cervical length of >30 mm (aPR [95% CI]; 1.47 [1.00–2.15] and 2.13 [1.42–3.18], respectively). The posterior cervical angle and other background characteristics showed no significant associations. Furthermore, women with cervical lengths of ≥20 mm before and <20 mm after dilatation showed a higher rate of vaginal delivery, compared to cervical length of ≥20 mm even after dilatation (aPR [95% CI]; 1.95 [1.19–3.20]). Conclusions: High Bishop score, short cervical length, and changes in cervical length with dilatation are potential independent predictors of vaginal delivery following elective labor induction in nulliparous women at 40–41 gestational weeks. [ABSTRACT FROM AUTHOR]

Background: The etiology of Bednar's aphthae remains unclear. Our aim was to investigate the incidence of, and factors associated with, Bednar's aphthae in a Japanese newborn cohort. Methods: A retrospective cross‐sectional study was conducted on neonates discharged from the well‐baby nursery at Saitama City Hospital, Japan. The principal investigator carefully examined each neonate's oral cavity, up to and including the pharynx, with a light‐emitting diode (LED) headlight to determine the presence of Bednar's aphthae. Maternal and neonatal clinical characteristics were first compared between neonates with and those without Bednar's aphthae by univariate analysis. Variables with significant inter‐group differences upon univariate analysis were entered into a multivariable logistic‐regression model. Results: This study enrolled 1996 infants. We observed Bednar's aphthae in 9.3% of the Japanese newborn infants who were included. When restricted to infants who were born via vaginal delivery, 13.2% of them had aphthae. Multivariable logistic regression analysis identified vaginal delivery (odds ratio = 6.19, p < 0.0001) in Model 1, and vaginal delivery (odds ratio = 6.73, p < 0.0001) and birth weight (odds ratio = 0.9995, p = 0.034) in Model 2 as independent risk factors for the disease. Conclusion: This is the first report of the prevalence of Bednar's aphthae among Japanese neonates. Vaginal delivery was identified as the strongest risk factor. Although confounding between mode of delivery and mechanical stimuli associated with sucking was not found in this study, the findings pave the way for a better understanding of the etiology of Bednar's aphthae. [ABSTRACT FROM AUTHOR]

Background: During the coronavirus disease (COVID-19) pandemic, caesarean section (CS) has been the preferred deliver method for pregnant women with COVID-19 in order to limit the use of hospital beds and prevent morbidity among healthcare workers., Methods: To evaluate delivery methods used during the COVID-19 pandemic as well as the rates of adverse events and healthcare worker morbidity associated with caesarean deliveries., Methods: We investigated maternal and neonatal backgrounds, delivery methods, indications and complication rates among pregnant women with COVID-19 from December 2020 to August 2022 in Mie Prefecture, Japan. The predominant mutation period was classified as the pre-Delta, Delta and Omicron epoch., Results: Of the 1291 pregnant women with COVID-19, 59 delivered; 23 had a vaginal delivery and 36 underwent CS. Thirteen underwent CS with no medical indications other than mild COVID-19, all during the Omicron epoch. Neonatal complications occurred significantly more often in CS than in vaginal delivery. COVID-19 in healthcare workers was not attributable to the delivery process., Conclusion: The number of CS with no medical indications and neonatal complications related to CS increased during the COVID-19 pandemic. Although this study included centres that performed vaginal deliveries during COVID-19, there were no cases of COVID-19 in healthcare workers. It is possible that the number of CS and neonatal complications could have been reduced by establishing a system for vaginal delivery in pregnant women with recent-onset COVID-19, given that there were no cases of COVID-19 among the healthcare workers included in the study.

Aim: Manual fundal pressure (MFP) is still used to assist vaginal deliveries during the second stage of labor in predominantly lower‐middle income countries; however, there is insufficient evidence on the risk factors in MFP‐assisted vaginal deliveries for adverse neonatal outcomes. The aim of the present study was to investigate the association between placental location and neonatal outcomes in MFP‐assisted vaginal deliveries. Methods: The present study was a single‐center retrospective cohort study in patients with all MFP‐assisted vaginal singleton deliveries from January 2016 to December 2020. Placental location was divided into two categories: posterior‐lateral and anterior‐fundal. The primary outcome was a neonatal adverse composite including umbilical artery blood pH <7.2, Apgar score <7 at 5 min, neonatal intensive care unit admission and neonatal resuscitation. We used multivariable logistic regression models to investigate the association between placental location and neonatal outcomes. Results: We extracted 522 MFP‐assisted deliveries among 5053 vaginal deliveries. The proportion of posterior‐lateral and anterior‐fundal placentation was 239 (45.8%) and 283 (54.2%), respectively. The crude prevalence of neonatal composite outcome in the anterior‐fundal group was significantly higher than that in the posterior‐lateral group (39.6% vs. 28.9%; p = 0.013). Multivariable logistic regression analysis found that the prevalence of neonatal adverse outcome in the anterior‐fundal group was significantly higher compared with the posterior‐lateral group (adjusted odds ratio, 1.52; 95% confidence interval, 1.04–2.23). Conclusion: Anterior‐fundal placentation was significantly associated with an increased risk of neonatal adverse outcomes compared to posterior‐lateral placentation in MFP‐assisted vaginal deliveries. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the contribution of the duration of skin-to-skin contact (SSC) on blood glucose levels at 2 hours after birth in healthy full-term infants. This observational study was done at one of the baby-friendly hospitals located in Aichi, Japan in 2009. Sixty newborn infants who were born vaginally from uncomplicated pregnancies were participated. All infants were held SSC within 5 minutes. All data regarding neonatal information, blood glucose levels at 2 hours of age, and maternal information were obtained from their medical history. Multiple linear regression analysis was performed to identify the independent contribution of the duration of SSC. The mean duration of SSC was 59.6 ± 13.6 minutes (range: 11.0-97.0 minutes) and the infant blood glucose level was 53.1 ± 9.5 (range: 30.0-80.0 mg/dL) mg/dL. The duration of SSC (β [95% confidence interval] = .282 [range: 0.037-0.357], standardized β = .282, P < .017) was significantly and positively associated with infant blood glucose levels independent of gestational age, birth weight, sex, length of second-stage labor, and mode of delivery. Thus, the longer early SSC was associated with higher blood glucose level at 2 hours of age in healthy full- term infants. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Previous studies have shown adverse obstetric outcomes of the laparoscopic resection of a rudimentary horn. Our study aimed to investigate the obstetric outcome in our institution and to review previous studies. Methods: Using a retrospective analysis, data were reviewed from singleton pregnancies with maternal uterine anomalies at a medical center in Osaka, Japan, between January 2011 and March 2016. The uterine anomaly cases were divided into a ‘postlaparoscopic resection of the rudimentary horn’ group (study group) and an ‘other uterine anomalies’ (bicornuate uterus, uterine didelphys and unicornuate uterus) group (control group). Primary outcomes of interest were differences in obstetric outcomes, such as spontaneous preterm birth rate, small for gestational age (SGA) infant rate and hypertensive disorders of pregnancy (HDP) rate between the study and the control group, and the secondary outcome of interest was mode of delivery in the study group. Results: Data from 40 deliveries were included in the study (7 deliveries: study group, 33 deliveries: control group). No significant difference was observed between the two groups in terms of either mean gestational weeks at delivery (36.4 weeks vs 37.1 weeks; P = .38), cesarean delivery rate (57.1% vs 57.5%; P = 1.0), SGA infant rate (<10th percentile) (0% vs 24.2%; P = .31) and HDP rate (0.0% vs 3.0%; P = 1.0). Three of seven cases with postlaparoscopic resection of the rudimentary horn were able to deliver vaginally without complications. Conclusion: Our study shows that the obstetric outcome observed in the study group was similar to that observed in the control group. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to re-evaluate the effectiveness of antenatal corticosteroids (ACS) and to analyze the association between ACS and the mode of delivery in the context of perinatal morbidity and mortality in very-low-birth-weight (VLBW) infants. Study Design: This retrospective cohort study involved 15,765 VLBW infants born between 2003 and 2008 at less than 34 weeks of gestation and weighing less than 1,500 g at birth. Data were obtained from the Japanese neonatal research network database. Univariate and multivariate logistic regression analyses were performed to evaluate the impact of ACS and mode of delivery on the risk of infant mortality and morbidity. Results: Administration of ACS was associated with decreases in mortality rate, intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP), and was not associated with the incidence of respiratory distress syndrome (RDS), periventricular leukomalacia or necrotizing enterocolitis (NEC). When the administration of ACS was analyzed in the context of different modes of delivery, the incidence of IVH and ROP tended to decrease with cesarean section deliveries, whereas the incidence of RDS tended to decrease and the incidence of NEC tended to increase for infants delivered vaginally. The incidence of chronic lung disease tended to increase in association with both delivery methods. Conclusions: This large cohort study reconfirms that ACS treatment is associated with decreases in infant mortality and severe morbidity. Furthermore, the delivery method may be associated with severe morbidity in VLBW infants exposed to ACS. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Purpose To epidemiologically investigate the relationship between a heavy for gestational age infant (HGA) and postpartum hemorrhage (PPH) resulting mainly from uterine atony. Methods This retrospective observational study included Japanese women at a single tertiary obstetric hospital in Tokyo metropolitan area. The inclusion criteria were as follows: 1) vaginal delivery between 2007 and 2010, 2) single delivery at term, 3) primipara, and 4) maternal age of ≥20 years. HGA is defined as an infant with a birth weight greater than the 90th percentile of the new intrauterine growth curves in Japan. The primary outcomes were PPH (blood loss, ≥500 ml) and severe PPH (SPPH; blood loss, ≥1,000 ml). Multiple logistic regression analysis was performed to calculate the odds ratio (OR) and 95% confidence interval (CI) of PPH and SPPH in association with HGA. Results Of the 2,340 women studied, PPH and SPPH were found to occur in 593 (25.3%) and 63 (2.7%) women, respectively. The results of the multivariate analyses indicated that HGA was significantly associated with PPH (adjusted OR 2.34, 95% CI 1.71-3.19) and SPPH (adjusted OR 2.43, 95% CI 1.21-4.86). Conclusion HGA was considered an independent risk factor for PPH that results mainly from uterine atony. Thus, physicians and midwives could identify women at risk for PPH from uterine atony before delivery. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify intrapartum factors that are associated with the prevalence of urinary incontinence in the early postpartum period (3-5 days after delivery) and 3 months after delivery and to compare the prevalence of urinary incontinence after spontaneous delivery with its prevalence after assisted delivery and clarify the difference.Subjects and Methods: A retrospective cohort study was conducted with 421 parturients who had given birth to a single full-term infant by vaginal delivery on obstetrics and gynecology units in metropolitan Tokyo as the subjects. After conducting a self-report questionnaire survey in regard to urinary incontinence in the early postpartum period, the responders were followed up for 3 months and requested to reply to the same questionnaire again. Intrapartum information was obtained from the medical records, and factors associated with urinary incontinence at the two points in time were assessed by means of a multivariate logistic regression analysis. Results: Replies to the early questionnaire were obtained from 403 of the 421 puerperants, and the prevalence was 30.8%. Replies to the questionnaire at 3 months after delivery were obtained from 286 patients (follow-up rate: 71.0%), and 44.7% of those who had early urinary incontinence had symptoms. Early urinary incontinence was more common inprimipara (p=0.013). The rate was higher among women who had urinary incontinence during pregnancy (p=0.004), and early urinary incontinence was more common in women who had undergone an episiotomy (p=0.006). By contrast, BMI when not pregnant and the presence or absence of urinary incontinence during pregnancy were associated with urinary incontinence 3 month after delivery (p=0.045 and p<0.001, respectively), and there were no significant associations with any of the intrapartum factors. The prevalence of early urinary incontinence was significantly lower in the spontaneous delivery group than in the assisted delivery group (p<0.001), but there was no difference between the two groups at 3 months after delivery.Conclusions: About half of the patients with early urinary incontinence also had symptoms at 3 months after delivery. Early urinary incontinence occurred in a high percentage of the primipara and it was more common in women who had undergone an episiotomy. The prevalence of early urinary incontinence was lower in the spontaneous delivery group than in the assisted delivery group, and spontaneous delivery was beneficial in maintaining pelvic floor function, but there was no difference at 3 months after delivery, and the influence of delivery had waned. [ABSTRACT FROM AUTHOR]

No abstract available [ABSTRACT FROM AUTHOR]

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 1.4 –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. [ABSTRACT FROM AUTHOR]

Aim: Placental/umbilical cord blood (CB) has been used increasingly not only for transplantations, but also in the field of life science research. However, little information is available on the biological characteristics of CB units collected in rural areas because no medical facilities are affiliated with CB banks. Little attention has been paid to the collection of CB units in rural areas compared to CB collected in metropolitan areas. CB is a precious source for life science research due to the recent low birth rate in Japan. Therefore, to efficiently utilize CB units, the purpose of the present study was to investigate the optimum obstetric factors associated with a higher yield of mononuclear/CD34+ cells per CB unit. Methods: CB units were collected at a single hospital (Hirosaki National Hospital). A total of 126 CB units from 105 vaginal deliveries and 21 cesarean section deliveries were available for cell separation within 24 h. Mononuclear low-density (LD) cells were separated using Ficoll-Paque and then processed for CD34+ cell enrichment using magnetic cell sorting. Associations between the maternal/neonatal factors and the yield of LD/CD34+ cells were analyzed. Results: Despite the larger net weight of CB collected from cesarean section deliveries, the total number of LD cells collected from vaginal deliveries was significantly higher than that collected from cesarean section deliveries. The total number of LD cells per CB unit from primigravidae was significantly higher compared with that collected from from multigravidae. Conclusion: CB units from vaginal deliveries of primigravidae may be more favorable because they contain a higher yield of mononuclear cells. [ABSTRACT FROM AUTHOR]

Background: Pelvic floor muscles support the pelvic organs and control voiding. The first choice in the repair of pelvic floor function that is damaged during pregnancy and delivery is pelvic floor muscle training, which involves repeated muscle relaxation and contraction. However, as muscle contractions cannot be visualised, it is difficult to assess whether patients understand how to contract them. Therefore, we assessed patients' comprehension of pelvic floor muscle contraction by comparing two teaching methods, vaginal palpation and transabdominal ultrasound, following vaginal delivery. We hypothesised that vaginal palpation is better than transabdominal ultrasound in this regard., Methods: This randomised controlled trial conducted in facilities in Tokyo, Japan between July 2018 and January 2019 included women aged ≥ 20 years at 4-6 weeks after vaginal delivery. The randomisation involved website-based centralised allocation. The primary outcome was a change in bladder base displacement during pelvic floor muscle contraction before and after training, which was measured using transabdominal ultrasound. Participants performed three contractions for 3 s, and the mean value was used for statistical analysis. The secondary outcome was a change in understanding the contraction before and after training, which was measured using a five-point Likert scale questionnaire. Outcomes were analysed using Welch's t-test., Results: Sixty-five participants were randomly allocated to the vaginal palpation group (n = 32) and transabdominal ultrasound group (n = 33). Baseline characteristics were similar between the groups. Changes in bladder base displacement were not significantly different between the groups (p = 0.181). Within-group analyses showed that bladder base displacement was large in both groups after the respective intervention. There were no significant differences in any of the outcomes between the two groups before and after the intervention., Conclusions: Vaginal palpation and transabdominal ultrasound might be useful for comprehending pelvic floor muscle contraction after vaginal delivery., Trial Registration: UMIN 000032304. Registered 18 April 2018, https://upload.umin.ac.jp/cgi-open-bin/icdr&#95;e/ctr&#95;view.cgi?recptno=R000036820 .

Aim: To evaluate the efficacy and safety of dinoprostone vaginal insert (PROPESS) in pregnant post-term Japanese women requiring cervical ripening., Methods: This randomized, double-blind, placebo-controlled study included 114 pregnant Japanese women at term (41 weeks of gestation) requiring cervical ripening (baseline Bishop score (BS) ≤ 4). The primary end-point was the proportion of subjects with successful cervical ripening defined as BS ≥ 7 or vaginal delivery in 12 h. The secondary end-points were changes in BS, proportion of women with vaginal delivery, proportion of women receiving mechanical cervical ripening procedure and use of oxytocic drugs., Results: PROPESS administration for a maximum of 12 h showed significantly higher successful cervical ripening rate (47.4% vs 14.3%, respectively; treatment contrast [TC]: 33.1%; P = 0.0002). The median time from administration to vaginal delivery was significantly shorter in the PROPESS group than in the placebo group (26.18 h vs 33.02 h; OR 2.51; 95% CI [1.60-3.92]; P < 0.0001). In the PROPESS group, the dosage of uterotonic drugs, such as oxytocin, decreased, and the number of patients who used these drugs also decreased., Conclusion: PROPESS administration for a maximum of 12 h was an effective and well-tolerated treatment for pregnant Japanese women post-term requiring cervical ripening., (© 2020 The Authors. Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology.)

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.

Our gut microbiome plays a fundamental role in our health and disease. The microbial colonization of human gut begins immediately at birth and is an indispensable natural process that modulates our physiology and immunity. Recent studies are elegantly revealing how and when these microbes colonize the gut and what elements could potentially influence this natural phenomenon. The vertical mother-to-baby transmission of microbes is a crucial factor for normal development and maturation of newborn's immune, metabolic as well as neurological health. This important and delicate process of gut microbiota development may be impacted by various factors such as birth mode, type of feeding, gestational age at birth, antibiotics exposure in early life, surrounding environment and hygiene settings, and so on. Perturbations in early life gut microbial colonization have been associated with the development of several diseases such as diabetes, obesity, asthma, allergies, celiac disease, neurodevelopmental disorders, and so on. However, it remains unclear whether predisposition to these diseases is due to the lack of acquisition of the mother's (vaginal and perianal) microbes during birth or because of abnormal exposure to unsolicited bacteria. Hence, studies are required to scrutinize the colonization pattern of infant gut microbiome in context to birth mode and also to elucidate how long these differences could persist. In these contexts, we review and discuss some of the findings obtained from recent investigation of the gut microbiota composition in healthy Japanese infants and young adults born vaginally or by C-section., (© 2018 S. Karger AG, Basel.)