Multiple pregnancy, short cervix, part-time worker, steroid use, low educational level and male fetus are risk factors for preterm birth in Japan: a multicenter, prospective study.

AIM: To examine the relationship between preterm birth and socioeconomic factors, past history, cervical length, cervical interleukin-8, bacterial vaginosis, underlying diseases, use of medication, employment status, sex of the fetus and multiple pregnancy. METHODS: In a multicenter, prospective, observational study, 1810 Japanese women registering their future delivery were enrolled at 8⁺° to 12⁺6 weeks of gestation. Data on cervical length and delivery were obtained from 1365 pregnant women. Multivariate logistic regression analysis was performed. RESULTS: Short cervical length, steroid use, multiple pregnancy and male fetus were risk factors for preterm birth before 34 weeks of gestation. Multiple pregnancy, low educational level, short cervical length and part-timer were risk factors for preterm birth before 37 weeks of gestation. CONCLUSION: Multiple pregnancy and cervical shortening at 20-24 weeks of gestation was a stronger risk factor for preterm birth. Any pregnant woman being part-time employee or low educational level, having a male fetus and requiring steroid treatment should be watched for the development of preterm birth.

Habitual use of warm-water cleaning toilets is related to the aggravation of vaginal microflora.

AIM: Warm-water cleaning toilets, or 'bidet toilets', are one of the most popular household goods in Japan. However, a recent large-scale survey raised questions about the relationship between bidet toilet use and bacterial vaginitis as reflecting bacterial vaginosis with inflammation. Recently, gynecologists have expressed concerns about the increase in aggravated vaginal microflora in habitual bidet users. Therefore, the present study was designed to clarify the possible relevancy of bidet usage to changes in vaginal microflora. METHODS: Two hundred and sixty-eight non-pregnant women of reproductive age, with an increase in vaginal discharge, consented to enter the study. On outpatient visit, an aliquot of cervicovaginal secretion was obtained by a sterilized cotton swab and cultured using standard culture systems. RESULTS: Normal microflora (Lactobacillus species) was not present in 42.86% of bidet toilet users, compared to 8.77% of non-users. Fecal bacteria were detected in 50 of the 268 cases (18.66%), 46 cases in users (92%) and only 4 cases in non-users (8%). Contamination by other pathogens was 4 to 6 times higher in users than in non-users. CONCLUSION: Habitual use of bidet toilets aggravates vaginal microflora, either by depriving normal microflora or facilitating opportunistic infection of fecal bacteria and other microorganisms.

Establishment of a prediction method for premature rupture of membranes in term pregnancy using active ceruloplasmin in cervicovaginal secretion as a clinical marker.

AIM: Term pregnancy complicated by premature rupture of membranes (PROM) is thought to be associated in part with subclinical infection, and places mothers and neonates at an increased risk for several complications. Therefore, perinatal care would be greatly helped if a reliable clinical measure were available for predicting the incidence of PROM. METHODS: One hundred and ninety-six pregnant women who consented to enter this study were screened using a method developed to assess active ceruloplasmin in cervicovaginal secretion as a clinical marker for predicting the incidence of PROM. Cervicovaginal secretions were obtained from the cervical canal at about 36 weeks of pregnancy. The active ceruloplasmin level in the cervicovaginal secretion was measured using an original enzyme-linked immunoabsorbent assay. RESULTS: Of 196 women, 27 women (13.8%) developed PROM and 169 women (86.2%) did not develop PROM. Active ceruloplasmin in the cervicovaginal secretion was significantly higher in the PROM group than in the non-PROM group (P < 0.001). Analysis using receiver-operating characteristic curves showed that the active ceruloplasmin level (1420.0 ng/mL) proved to be the proper cut-off value to best predict the incidence of PROM. CONCLUSION: Active ceruloplasmin in the cervicovaginal secretion might be a reliable clinical marker for term PROM.