Awareness of Infectious Disease Screening During Early Pregnancy and Knowledge About its Vertical Transmission in Japan: A Report from the Pregnant Women Health Initiative.

OBJECTIVES: We aimed to clarify the accuracy of pregnant women's knowledge and understanding regarding infectious disease screening in early pregnancy and clarify the roles that should be played by health care providers in promoting the health of pregnant women and their children. METHODS: A cross-sectional questionnaire survey was conducted in 25 hospitals across Japan from May 2018 to September 2019. We compared the agreement rates regarding screening results for hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, human T-cell leukemia virus-1 (HTLV-1), and cervical cytology in the medical records and understanding of their results by pregnant women. We then investigated whether participants had knowledge regarding the risk of mother-to child transmission in these diseases and factors associated with their knowledge. RESULTS: We enrolled 2,838 respondents in this study. The rates of agreement for HBV and cervical cancer screening related to human papillomavirus infection were "substantial," those for syphilis was "moderate," and those for HCV and HTLV-1 were "fair," according to the Kappa coefficient. The rate of knowledge regarding mother-to-child transmission of syphilis was highest (37.0%); this rate for the other items was approximately 30%. Increased knowledge was associated with higher educational level and higher annual income. CONCLUSIONS FOR PRACTICE: Pregnant women in Japan had generally good levels of understanding regarding their results in early-pregnancy infectious disease screening. However, they had insufficient knowledge regarding mother-to-child transmission of these diseases. Health care providers should raise awareness in infectious disease prevention among pregnant women and the general public, providing appropriate measures and implementing effective perinatal checkups and follow-ups for infectious diseases.

Factors Predicting Rubella Vaccination and Antibody in Pregnant Women in Japan: A Report from Pregnant Women Health Initiative.

This study aimed to identify the factors predicting rubella vaccination status based on self-reported data and the presence of sufficient rubella antibody titers in pregnant women in Japan. We used the results of the nationwide questionnaire survey conducted at obstetric facilities in the Pregnant Women Health Initiative Project (PWHI), with 23 participating hospitals recruiting pregnant women from June 2018-November 2019. We extracted age, the number of deliveries, educational level, household income, pre-pregnancy smoking, and knowledge of rubella from questionnaires and medical records. We analyzed the association of rubella vaccination status and antibodies with each of these factors. We found that the number of previous deliveries, educational level, annual household income, smoking before pregnancy, and knowledge of rubella were factors predicting self-reported rubella vaccination status, while age and the number of previous deliveries were identified as factors predicting the presence of sufficient rubella antibody titers (32 folds or higher). Women considering pregnancy should be immunized against rubella to prevent congenital rubella syndrome in the future. Furthermore, social policies are needed to strongly encourage vaccination, especially for all citizens who were not given the opportunity or missed the chance to be vaccinated against rubella.

Factors Predicting Rubella Vaccination among Pregnant Women in Japan: an Interim Report from the Pregnant Women Health Initiative.

Following the 2018 rubella outbreak in Japan, this study aimed to assess rubella prevention measures based on the vaccination and immunization status of pregnant women in Japan. Our cohort study involved 3 local core hospitals in Yokohama City, and a total of 666 pregnant women were recruited between June 2018 and September 2019 and answered an online questionnaire. In total, 67.5% of the pregnant women had received rubella vaccination. The rate of rubella vaccination among pregnant women in the present survey was lower than that among age-matched female participants in a nationwide survey conducted in 2018. Overall, the study results showed that pregnant women in their 20s had a higher vaccination rate than those in their 40s, women who were nonsmokers before pregnancy had a higher vaccination rate than those who were smokers, and pregnant women who were aware that rubella may affect their fetuses had a higher vaccination rate than those who were unaware of this. This survey elucidated multiple predictive factors for rubella vaccination among pregnant women in Japan. Our results confirm the recommendation that women considering pregnancy should be vaccinated against rubella.

Spontaneous rupture of a degenerated leiomyoma causing peritonitis and ileus during pregnancy: A case report.

Degenerated leiomyomas can rupture during pregnancy, and leakage of the fluid causes peritonitis in rare cases. If peritonitis associated with a degenerated leiomyoma is observed, the occurrence of rupture of the leiomyoma should be considered.

Prenatal diagnosis of vasa previa and the course of the cord vessels contribute to the safety of cesarean sections: A case report.

Vasa previa can occur even in cases without placental malposition and the precise diagnosis of vasa previa, and the course of the cord vessels contributes to a safe delivery. The color Doppler is a useful and easy-to-use device to confirm the presence of vasa previa.

Massive subchorionic hematoma (Breus' mole) presents a variety of ultrasonic appearances: A case report and literature review.

Massive subchorionic hematoma (MSH) presents a variety of ultrasonic appearances. Placentomegaly with fetal growth restriction should be included as one of the differential diagnoses for intraplacental MSH. Care management of MSH requires to be tailored to each individual's responses while taking the NICU's capabilities and the patient's wishes into consideration.

Predicting the intrauterine fetal death of fetuses with cystic hygroma in early pregnancy.

We investigated whether it was possible to predict the prognosis of fetuses with cystic hygroma in early pregnancy based on the degree of neck thickening. We retrospectively analyzed 57 singleton pregnancies with fetuses with cystic hygroma who were examined before the 22nd week of pregnancy. The fetuses were categorized according to the outcome, structural abnormalities at birth, and chromosomal abnormalities. Here, we proposed a new sonographic predictor with which we assessed neck thickening by dividing the width of the neck thickening by the biparietal diameter, which is expressed as the cystic hygroma width/biparietal diameter ratio. The median cystic hygroma width/biparietal diameter ratio in the intrauterine fetal death group (0.51) was significantly higher than that in the live birth group (0.27). No significant difference in the median cystic hygroma width/biparietal diameter ratio was found between the structural abnormalities group at birth and the no structural abnormalities group, and no significant difference in the median cystic hygroma width/biparietal diameter ratio was found between the chromosomal abnormality group and the no chromosomal abnormality group. We used receiver operating characteristic analysis to evaluate the cystic hygroma width/biparietal diameter ratio to predict intrauterine fetal death. When the cystic hygroma width/biparietal diameter ratio cut-off value was 0.5, intrauterine fetal death could be predicted with a sensitivity of 52.9% and a specificity of 100%. It is possible to predict intrauterine fetal death in fetuses with cystic hygroma in early pregnancy if cystic hygroma width/biparietal diameter ratio is measured. However, even if cystic hygroma width/biparietal diameter ratio is measured, predicting the presence or absence of a structural abnormality at birth or a chromosomal abnormality is difficult.