A nationwide survey of the opinions of paediatricians regarding the management of neonates born to women with group B Streptococcus in Japanese maternity homes.

OBJECTIVE: The Japanese Midwifery Association (JMA) guidelines allow midwives to manage group B Streptococcus (GBS)-positive women during pregnancy and labour at maternity homes. However, no guidelines exist to manage neonates born to GBS-positive women in Japan. We aimed to investigate the opinions of paediatricians regarding optimal management strategies for neonates born to GBS-positive women in maternity homes. A questionnaire was sent to paediatricians at 396 Japanese perinatal medical centres. We examined opinions regarding examinations and routine clinical tests for neonates born to GBS-positive women in maternity homes. RESULTS: Of 235 paediatricians, only 11.2% considered that paediatric examinations were unnecessary for neonates born to GBS-positive women in maternity homes. Moreover, 20.5%, 13.2%, and 11.1% of paediatricians considered culture test of the nasal cavity, serum C-reactive protein level analysis, and blood cell count analysis, respectively, necessary for neonates born to GBS-positive pregnant women with intrapartum antibiotic prophylaxis (IAP), whereas 36.3%, 56.2%, and 40.6% of paediatricians considered these tests necessary in cases without IAP. The JMA guidelines had low penetration rates among paediatricians in Japan. To manage neonates born to GBS-positive women in maternity homes, midwives should engage with commissioned paediatricians in more detail and develop appropriate strategies to increase awareness and cooperation.

Management of group b streptococcus-positive pregnant women at maternity homes in JAPAN: a questionnaire survey of compliance among midwives.

BACKGROUND: Per the 2014 Japanese Midwives Association (JMA) guidelines, midwives were allowed to manage the deliveries for group B streptococcus (GBS)-positive pregnant women in labour at maternity homes without the supervision of a medical doctor if they complied with the guidelines of the Japan Society of Obstetrics and Gynecology (JSOG), wherein midwives working for maternity homes are expected to cooperate with commissioned obstetricians and paediatricians in cooperative medical facilities. We examined the rate of compliance with these JMA and JSOG guidelines regarding the management of GBS-positive pregnant women among midwives at maternity homes in Japan. METHODS: Between October and December 2015, an anonymous questionnaire was distributed to 337 maternity homes registered with the JMA by mail. The questionnaire obtained information regarding the timing of GBS screening, specimen collection, transfer of GBS-positive pregnant women from a maternity home to a hospital, administration of intrapartum antibiotic prophylaxis, and collaboration between midwives and commissioned obstetricians. Data were analysed using descriptive statistics. We used frequency distribution as the statistical test. RESULTS: Responses were received from 246 (73.0%) maternity homes, of which complete responses from 204 maternity homes (valid response rate, 60.5%) were analysed. Of these 204 maternity homes, only 97 (47.5%) conducted a GBS screening test during 33-37 weeks of gestation as recommended by the JSOG guidelines. Although midwives alone managed GBS-positive pregnant women in labour at 135 maternity homes (66.2%), intrapartum antibiotic prophylaxis, as recommended by the JSOG guidelines, was conducted in only 111 (54.4%). Moreover, only 37.0% (50/135) and 82.2% (111/135) of maternity homes ensured that GBS-positive pregnant women in labour with an elapse of ≥18 h after PROM and a body temperature of ≥38.0 °C, respectively, were transferred to a hospital by ambulance. Only at 58.3% (119/204) of maternity homes did midwives discuss the management of labour for GBS-positive pregnant women with commissioned obstetricians. CONCLUSIONS: Some midwives working for maternity homes did not follow the JMA and JSOG guidelines of the management of GBS-positive pregnant women. For improving compliance rates, midwives at maternity homes should discuss the management of GBS-positive pregnant women with commissioned doctors more carefully and concretely per the existing guidelines.

One-step scalable preparation method for non-cationic liposomes with high siRNA content.

Cationic liposomes (LPs) have been utilized for short interfering RNA (siRNA) delivery in vitro and in vivo owing to their high affinity for siRNA via electrostatic binding. However, both cytotoxicity and non-specific adsorption of cationic LPs in the body have prevented clinical siRNA applications. These situations have led to siRNA encapsulation in non-cationic LPs. We found that the instillation of neutral phospholipids dissolved in ethanol into aqueous solutions containing siRNA and CaCl2 resulted in high siRNA encapsulation (siRNA encapsulation efficiency: ∼ 80%; siRNA weight ratio: ∼ 10 wt% of LPs). The products were monodispersed, ∼ 200 nm, and negatively charged. Furthermore, when phospholipids with a high-phase transition temperature or cholesterol were used, the encapsulation efficiency and siRNA content remained high. Although anionic LPs could not encapsulate siRNAs using this method, the use of cholesterol-conjugated siRNA helped achieve substantial siRNA encapsulation in anionic LPs. These non-cationic siRNA-containing LPs did not show cytotoxicity in vitro, and could be formed with polyethylene glycol-conjugated phospholipids. When conjugated with targeting ligand, the non-cationic siRNA-containing LPs could suppress the expression of target gene in vitro. These data demonstrate that our preparation method would be suitable for large-scale LP production for systemic siRNA delivery.

Prevention of striae gravidarum and quality of life among pregnant Japanese women.

BACKGROUND: striae gravidarum affects the quality of life (QOL) of Japanese pregnant women. Many pregnant women use skin moisturisers to prevent striae gravidarum. However, the relationship between these preventive steps and QOL remains unclear. OBJECTIVE: to evaluate the moisturising effect and QOL of pregnant women in an urban prefecture in central Japan with preventive steps against striae gravidarum. DESIGN AND METHOD: cross-sectional study. Pregnant women at 36 weeks of gestation were recruited at antenatal examinations. SETTING: four private clinics in an urban prefecture in central Japan. PARTICIPANTS: 156 pregnant women consisting of 83 primiparae and 73 multiparae were analysed. MEASUREMENTS: a self-administered questionnaire, the severity of striae gravidarum assessed by Davey's score and the dermatology-specific QOL were assessed by Skindex29. The water content in the stratum corneum of each woman's abdomen was measured with a Moisture checker. The Ethical Committee of Osaka University Medical School approved the study. FINDINGS: the prevalence of striae gravidarum was 37.8% and 121 (77.6%), including 76 (91.6%) primiparae and 45 (61.6%) multiparae, said they used a cream and/or lotion in an attempt to prevent striae gravidarum. The water content in the stratum corneum of the abdominal wall increased significantly after using cream and/or lotion (p=0.001). The severity and presence of striae gravidarum were not correlated with the preventive steps or water content in the stratum corneum of the abdominal wall (p=0.330 and p=0.835). Pregnant women who took the preventive steps showed higher scores for emotion on Skindex29 than those who did not (p=0.002). Although pregnant women with striae gravidarum showed a lower QOL for emotion than those without striae gravidarum (p=0.045), those who took the preventive steps maintained a similar level of QOL for emotion regardless of striae gravidarum. There have been few trials evaluating the QOL of pregnant women with striae gravidarum so a comparison of results among studies and determination of an appropriate sample size could not be conducted. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: preventive steps increase the amount of water content in the stratum corneum but this does not prevent striae gravidarum. Although pregnant women with striae gravidarum showed a lower QOL for emotion, the preventive steps were correlated with the level of QOL for emotion in pregnant women with striae gravidarum. Midwives need to absorb such information and recommend moisturising skin care for pregnant women.

Quality of life evaluation in Japanese pregnant women with striae gravidarum: a cross-sectional study.

BACKGROUND: Striae gravidarum is a physiological skin change that many pregnant women experience during pregnancy. The striae are often accompanied by a reddish purple color during pregnancy, and then lose pigmentation and become atrophic in the long term after pregnancy. Striae gravidarum seems to be undesirable to many pregnant women. However, the impact of striae gravidarum on pregnant women who experience it has not been clarified. The aim of this study was to evaluate the impact of striae gravidarum on the generic and dermatology-specific quality of life (QOL) of pregnant women. METHODS: A cross-sectional study was conducted at three private clinics in a typical urban area in Japan. We recruited 447 pregnant women at 36 weeks of gestation; One hundred and ninety-nine pregnant women at 36 weeks of gestation participated in the study and 179, consisting of 94 primiparae and 85 multiparae, were analyzed.We used and assessed Davey's score for striae gravidarum, World Health Organization Quality of Life assessment questionnaire for generic QOL, and Skindex-29 for dermatology-specific QOL. RESULTS: The prevalence of striae gravidarum was 39.1% (27.7% in primiparae, and 51.8% in multiparae). Although there were no differences in generic QOL scores between the presence and absence of striae gravidarum and with their severity, the whole group of pregnant women and the multiparae group showed significant differences in scores on emotion of Skindex-29 between the presence and absence of striae gravidarum (p = 0.012 and p = 0.011). Pregnant women with severe striae gravidarum showed significantly higher scores on emotion of Skindex-29 compared with those with absent or mild striae gravidarum (p < 0.001 and p = 0.005). CONCLUSIONS: There was no difference in generic QOL of pregnant women between the presence and absence of striae gravidarum, although the occurrence and severity of striae gravidarum influenced their dermatology-specific QOL. Multiparae women were especially impaired by striae gravidarum and it is considered important to prevent or reduce the severity of striae gravidarum of the multiparae group.