Difficulty in Serologic Screening for Subclinical Rubella during Pregnancy.

In Japan, rubella antibodies are tested in all pregnant women to detect subclinical infections. This study aimed to assess the validity of measuring rubella antibodies for detecting subclinical rubella among pregnant women in Japan. This single-center retrospective study measured rubella hemagglutination inhibition (HI) titers and rubella-specific IgM antibody index (IgM) values. IgM values were measured by conducting enzyme immunoassay, and IgM-values >1.2 were considered positive. Of 14,965 included pregnant women, 186 (1.2%) were IgM-positive. Only one patient was clinically diagnosed with rubella (HI titer, 1:2,048; IgM value, 10) and developed fever and skin rash. She decided to terminate her pregnancy without undergoing repeated blood tests. Of the IgM-positive patients, 136 (73.1%) had rubella HI titers of < 1:256. The correlation coefficient between rubella HI and IgM titers was weakly positive (0.2527; P < 0.0001). This study showed that a single combination of rubella HI and rubella-specific IgM measurements alone could not detect subclinical rubella. Creating awareness among pregnant women by informing them that almost all rubella-specific IgM-positive individuals without symptoms are not acutely infected could decrease their anxiety and prevent unnecessary pregnancy termination.

Comparison of quality of life after robotic-transvaginal natural orifice transluminal endoscopic surgery and robot-assisted laparoscopic hysterectomy.

OBJECTIVES: We investigated quality of life (QOL) of patients who underwent total hysterectomy for benign uterine diseases using two surgical approaches: robotic-transvaginal natural orifice transluminal endoscopic surgery (R-vNOTES) and robot-assisted laparoscopic hysterectomy (RALH). STUDY DESIGN: This single-center retrospective study was conducted in a tertiary academic setting and included 65 patients who underwent robotic-assisted hysterectomy for benign uterine diseases. Total hysterectomy was performed using R-vNOTES or RALH by the same gynecologist between December 2021 and June 2022. The primary outcome was a comparison of QOL over time and complete QOL recovery (postoperative QOL score/preoperative QOL score ≥ 1) by postoperative day 28 (POD28) in the R-vNOTES and RALH groups. QOL was examined using EQ-5D-5L in this study. The secondary outcome was a comparison of the surgical outcomes in the R-vNOTES and RALH groups. RESULTS: Complete QOL recovery was achieved by 62.7% in the R-vNOTES group and 7.3% in the RALH group at POD7 (p <.001) and by 100% in the R-vNOTES group and 56.1％ in the RALH group at POD28 (p <.001). In a multivariable model, patients who underwent R-vNOTES achieved higher complete QOL recovery at POD 28 [adjusted hazard ratio: 4.03, 95% confidence interval: 2.03-8.04]. There was no significant difference between the R-vNOTES and RALH groups in terms of operating time (p =.07), intraoperative blood loss (p =.35), uterus weight (p =.76), or postoperative complications (p =.71). CONCLUSION: The R-vNOTES approach for total hysterectomy for benign uterine diseases provided better complete QOL recovery by POD28 compared to the RALH approach. The surgical outcomes for R-vNOTES were equivalent to those for RALH, suggesting that R-vNOTES may provide a safe approach for robot-assisted hysterectomy.

Case of suspected lobular endocervical glandular hyperplasia in a cervical cystic lesion during pregnancy.

Lobular endocervical glandular hyperplasia (LEGH) is characterized by clinically profuse and watery vaginal discharge. In pregnancy with LEGH, with watery fluid leakage persisting throughout pregnancy, it is often difficult to visually diagnose PROM. Adding to this difficulty, auxiliary diagnostic tests might also show positive results, complicating treatment and management.

Psychological stress associated with the COVID-19 pandemic in postpartum women in Yokohama, Japan.

AIM: This study aimed to clarify how the COVID-19 pandemic impacts psychological stress levels in postpartum women in Yokohama, Japan. METHODS: We retrospectively compared the rates of positive screening tests for postpartum depression (Edinburgh Postnatal Depression Scale score of 9 or more or self-injury factors) and liaison/psychiatric intervention rates between pre-pandemic and pandemic groups of postpartum women who delivered a live birth at our tertiary perinatal center in Yokohama, Japan between January 2019 and May 2020. Those whose postpartum health screening was performed in 2019 (March-June 2019) were considered the pre-pandemic group, and those whose screening was performed between March and June 2020 were considered the pandemic group. Adjustments were made for maternal background, pregnancy, and delivery outcomes, including a history of psychiatric disorders, complications, preterm delivery, NICU admission, and maternal postpartum complications, and the data were analyzed using a logistic regression analysis. RESULTS: Postpartum health screenings were performed on 339 women before the pandemic and 279 women during the pandemic. Positive screening rates for postpartum depression did not change before and during the pandemic (adjusted odds ratio 1.48, 95% confidence interval 0.885-2.46). CONCLUSIONS: There was no apparent increase in maternal psychological stress due to the COVID-19 pandemic in Yokohama, Japan. Postpartum women responded differently in settings with varied levels of disease severity and social restrictions.

The current status, attitudes, and practices concerning maternal pertussis vaccination in obstetric delivery facilities in Kanagawa Prefecture, Japan: a questionnaire survey.

This study investigated the implementation status, attitudes, and practices regarding maternal pertussis vaccination in delivery facilities in Kanagawa, Japan. We conducted a questionnaire survey of pertussis vaccination during pregnancy at 125 delivery service facilities, excluding midwifery clinics, in Kanagawa Prefecture from June 18 to July 20, 2020. The questionnaire comprised multiple-choice items, with single or multiple answers depending on the question. Of the 125 facilities surveyed, valid responses were obtained from 72 facilities (58%). There were 41 primary clinics with birthing facilities (57%), 16 general hospitals (not designated perinatal centers) (22%), 10 regional perinatal centers (14%), and five tertiary perinatal centers (7%). None of the facilities administered pertussis vaccination during pregnancy. Forty facilities (56%) reported knowledge of the severity of neonatal and infant pertussis infections. Twenty-three facilities (32%) reported knowledge of the prevention of pertussis infection by vaccination during pregnancy. All facilities reported willingness to consider vaccination if included in the Japanese guidelines. In Japan, the pertussis vaccination during pregnancy is not highly practiced by obstetricians; thus, it is not as popular as in other countries. Further studies are needed to promote strategies to prevent pertussis infection in the neonatal and infant periods.

Novel COL4A1 mutation in a fetus with early prenatal onset of schizencephaly.

Porencephaly and schizencephaly are congenital brain disorders that can be caused by COL4A1 mutations, though the underlying mechanism and developmental processes are poorly understood. Here, we report a patient with schizencephaly, detected by fetal ultrasonography and fetal magnetic resonance imaging, with a de novo novel mutation in COL4A1 (c.2645_2646delinsAA, p.Gly882Glu). Our results suggest that the onset of damage that potentially results in schizencephaly occurs mid-pregnancy.