Uterine contraction may not be an independent risk factor for spontaneous preterm birth before 35 weeks in women with cervical shortening.

OBJECTIVE: To compare the risk of spontaneous preterm birth (SPTB) before 35 weeks in symptomatic and asymptomatic women with cervical shortening at 16-34 weeks under mid-trimester universal screening of cervical length (CL). METHOD: Multicenter retrospective cohort study involving six secondary/tertiary perinatal centers was planned in 2016. Primary outcomes were SPTB before 35 weeks. In all, 407 women were analyzed using multivariable logistic regression analysis for predicting SPTB before 35 weeks while adjusting for presence/absence of uterine contraction, gestational weeks, vaginal bleeding, and CL classification (1-9, 10-14, 15-19, and 20-24 mm) at admission, the execution of cervical cerclage, and the presence/absence of past history of preterm delivery. RESULTS: SPTB before 35 weeks of pregnancy occurred in 14.5%. Presence of uterine contraction was not an independent risk factor for SPTB before 35 weeks (adjusted odds ratio [aOR] 1.22, 95% confidence interval [CI] 0.67-2.20). CL of 1-9 mm, CL of 10-14 mm, and vaginal bleeding at admission were independent risk factors for SPTB before 35 weeks (aOR 5.35, 95% CI 2.11-13.6; aOR 2.79, 95% CI 1.12-6.98; and aOR 2.37, 95% CI 1.12-5.10, respectively). CONCLUSION: In women with a cervical shortening at 16-34 weeks, presence of uterine contractions at admission may not be an independent risk factor for the occurrence of SPTB before 35 weeks.

Clinical characteristics of pregnancies with a history of recurrent miscarriage at a Japanese perinatal center.

OBJECTIVE: We examined obstetric and fetal/neonatal outcomes in women with a history of recurrent miscarriage. METHODS: We reviewed the obstetric records of all 5,829 nulliparous pregnant women who delivered at #8805;14 weeks' gestation from 2008 through 2013 at our perinatal center. Of these women, 74 had a history of recurrent miscarriage (1.3%). The control population consisted of 4,176 nulliparous women without a history of miscarriage. Demographic information and characteristics of labor were extracted from patient charts. RESULTS: The rate of maternal age #8805;40 years (p<0.01) and the rate of in vitro fertilization use (p<0.01) were higher in women with recurrent miscarriage than in women without miscarriage. Eleven women with recurrent miscarriage (14.9%) were treated with low-dose aspirin with and without subcutaneous heparin. In addition, the rate of cesarean delivery was higher in women with recurrent miscarriage than in women without miscarriage (p=0.02). However, fetal/neonatal outcomes did not differ significantly between the populations. CONCLUSION: The pregnancy of women with a history of recurrent miscarriage is not associated with adverse outcomes at our perinatal center.

Timing of elective cesarean singleton delivery and neonatal respiratory outcomes at a Japanese perinatal center.

The present study examined the relation between the timing of elective cesarean delivery at term and neonatal respiratory outcomes at our institution. From 2005 through 2013, 1,951 elective cesarean singleton deliveries were performed at term. Of the neonates, 141 (7%) had respiratory disorders requiring oxygen supplementation. In comparison to the incidence of respiratory disorders in neonates delivered at full term (39-40 weeks), the incidences in neonates delivered at ≤38+1/7 weeks' and at 41 weeks' gestation were significantly higher. Uncomplicated elective cesarean singleton delivery should be avoided at 38+1 weeks or earlier, and we also pay attention to the respiratory outcomes of neonates delivered by elective cesarean section at 41 weeks' gestation.

Obstetrician gender and delivery mode at a Japanese perinatal center.

We examined differences in delivery modes between deliveries managed by female obstetricians and gynecologists (OB/GYNs) and those managed by male OB/GYNs at our hospital. The rate of vacuum extraction/forceps delivery was significantly lower when deliveries were managed by female OB/GYNs. Logistic regression analysis showed that the lower rate of vacuum extraction/forceps delivery was associated with a lower rate of diagnosis of nonreassuring fetal status during the second stage of labor by female OB/GYNs. The rate of cesarean delivery and obstetric outcomes did not differ with the gender of the managing OB/GYN. The increasing number of female OB/GYNs may help increase the rate of maternal satisfaction associated with the decreased rate of instrumental delivery.

Association between fibrinogen levels and severity of postpartum hemorrhage in singleton vaginal deliveries at a Japanese perinatal center.

OBJECTIVE AND METHODS: We examined the relationship between low fibrinogen levels (<200 mg/dL) and the severity of postpartum hemorrhage in singleton vaginal deliveries after 22 weeks' gestation complicated by postpartum hemorrhage requiring transfusion at our hospital. RESULTS: During a 10-year period, 61 women (0.38%) received transfusions owing to postpartum hemorrhage within the first 24 hours after delivery. Of these women, 13 (21%) had low fibrinogen levels (mean, 123 ± 68 mg/dL) when postpartum hemorrhage was diagnosed, and the other 48 (79%) had normal fibrinogen levels (mean, 305 ± 50 mg/dL). Neither total blood loss nor the incidence of additional therapies, such as hysterectomy, differed between the 2 groups of women. Women with low fibrinogen levels started to receive transfusions significantly earlier (98 ± 58 minutes after delivery) than did women with normal fibrinogen levels (142 ± 75 minutes after delivery, p=0.03) and received more units of fresh-frozen plasma (p=0.03). CONCLUSION: The early transfusion of fresh-frozen plasma in women with postpartum hemorrhage and low fibrinogen levels might help prevent adverse outcomes.

Single-cell chemical lysis method for analyses of intracellular molecules using an array of picoliter-scale microwells.

Analyzing the intracellular contents and enzymatic activities of single cells is important for studying the physiological and pathological activities at the cellular level. For this purpose, we developed a simple single-cell lysis method by using a dense array of microwells of 10-30-pL volume fabricated by poly(dimethylsiloxane) (PDMS) and a commercially available cell lysis reagent. To demonstrate the performance of this single-cell lysis method, we carried out two different assays at the single-cell level: detection of proteins by antibody conjugated microbeads and measurement of protease activity by fluorescent substrates. The results indicated that this method readily enabled us to monitor protein levels and enzymatic activities in a single cell. Because this method required only an array of PDMS microwells and a fluorescence microscope, the simplicity of this platform opens a way to explore the biochemical characteristics of single cells even by those who are not familiar with microfluidic technology.