Keita Hasegawa

Cesarean scar pregnancy (CSP) is a rare but potentially life-threatening form of ectopic pregnancy, and its diagnosis may be challenging in early pregnancy. We report a case of a 40-year-old woman with a history of one cesarean section who was referred with suspected cervical pregnancy. Transvaginal ultrasonography demonstrated a cystic lesion at the cesarean scar site without detectable blood flow, whereas magnetic resonance imaging (MRI) suggested right adnexal ectopic pregnancy. Laparoscopic surgery was initiated; however, no adnexal pregnancy was identified, and the procedure was converted to ultrasound-guided uterine evacuation without preoperative uterine artery embolization. Chorionic villi were confirmed pathologically, and the postoperative course was uneventful. This case highlights that MRI findings may be atypical in early CSP and that color Doppler ultrasonography of peritrophoblastic blood flow may be useful for treatment planning, including decisions on preoperative uterine artery embolization.

Background and Objectives: Preterm birth (PTB) imposes a substantial medical and economic burden on perinatal care. Recent advances in 16S rRNA gene sequencing help detailed microbiota analysis. Understanding microbiota’s contribution may help in understanding PTB pathogenesis. We aim to investigate the microbiota profiles of the oral, vaginal, and placental microbiota in pregnant Japanese women hospitalized for care of preterm labor and examine the association between them and perinatal outcomes. Materials and Methods: This cross-sectional study included 20 pregnant Japanese women admitted to a single perinatal center for preterm labor between 2022 and 2023. Oral, vaginal, and placental samples were collected aseptically during hospitalization. The patients were retrospectively categorized into: term birth (TB, n = 10), chronic abruption-oligohydramnios sequence (CAOS, n = 3), and PTB without CAOS (PTB, n = 7) perinatal outcomes. Microbiota profiles were analyzed using 16S rRNA gene sequencing, and group comparisons were performed using univariate statistical methods. Results: Alpha or beta diversity of the oral and vaginal microbiota among the three groups did not differ significantly. CAOS and PTB groups showed a trend toward altered vaginal microbial composition, but not the TB group. In the placental microbiota, beta diversity differed significantly among the TB, PTB, and CAOS groups. Ureaplasma urealyticum was more abundant in the PTB group, whereas Ureaplasma parvum was more abundant in the CAOS group. Conclusions: A potential shift in the vaginal microbiota and alterations in the placental microbiota, observed in PTB, including CAOS, suggested a possible microbial contribution.

Childhood obesity is a substantial health problem worldwide. The origin of obesity (increased adiposity) can be partly traced back to intrauterine life. However, the determinants of fetal fat deposition remain unclear. This study investigated the association between cord blood adipocytokines related to lipid metabolism (leptin, adiponectin, and insulin-like growth factor-1 [IGF-1]) and fetal adiposity during gestation. A prospective study was conducted in a cohort of 94 singleton pregnancies. Fetal ultrasonography was performed at 24, 30, and 36 weeks of gestation. Estimated fetal adiposity (EFA) was calculated by integrating measurements of cross-sectional arm and thigh fat area percentages and anterior abdominal wall thickness. Plasma cytokine levels and C-peptide immunoreactivity (as a proxy for fetal insulin resistance) were evaluated in cord blood samples obtained at delivery. The associations of cord blood leptin, adiponectin and IGF-1 levels with EFA at 24, 30, and 36 weeks were determined by multiple linear regression, adjusted for potential covariates. The multivariate analyses indicated that leptin was significantly correlated with EFA at 30 and 36 weeks. Leptin was also positively correlated with C-peptide immunoreactivity in the umbilical cord. Cord adiponectin levels were not associated with EFA across gestation. Cord IGF-1 levels were significantly correlated with EFA and estimated fetal body weight (EFW) at 36 weeks. In conclusion, cord leptin was associated with EFA at 30 and 36 weeks, and IGF-1 was associated with EFA at 36 and EFW at 36 weeks. In Conclusion, cord leptin was associated with EFA at 30 and 36 weeks, and IGF-1 was associated with EFA and EFW at 36 weeks. Considering the effects of leptin and IGF-1 on fetal insulin resistance and lipid metabolism, increased levels of leptin and IGF-1 are potential plasma biomarkers of increased fetal adiposity, which may predispose to infant obesity and metabolic dysfunction in later life.

Placental attachment spanning from the anterior to the posterior uterine wall, resulting in the formation of two uterine cavities, presents a diagnostic challenge in obstetrics. Differential diagnoses include placental abruption, multiple gestations, placental variations, and uterine anomalies. Accurate prenatal identification is often difficult, especially when anomalies are not detected during early pregnancy. We report a rare case of a 27-year-old primigravid Japanese woman with a placenta spanning from the anterior to the posterior uterine wall, creating two cavities. At 35 weeks of gestation, ultrasound suggested an unusual placental position, with fetal parts located in separate cavities. At 37 weeks and three days, a cesarean section was performed for breech presentation. Intraoperatively, a partial uterine septum was palpated postplacental removal, with a planar fundus and no retroplacental hematoma. Postoperative ultrasound confirmed the diagnosis of a partial septate uterus. Although septate uterus is the most common uterine anomaly, it often remains undiagnosed in women without infertility. This case highlights the importance of considering uterine anomalies when placental morphology is atypical, especially in the absence of a prior diagnosis, as early recognition is crucial for appropriate perinatal management.

Aim: The induction of labor before due date has recently been proved to reduce the rate of cesarean sections and is not associated with increased risk of adverse perinatal outcomes as compared to expectant management. Controlled‐release dinoprostone (PGE₂) vaginal insert has recently been approved for use in Japan. However, evidence regarding its efficacy in cervical ripening and labor induction before due date remains limited. We aimed to compare the efficacy of PGE₂ vaginal inserts and mechanical dilation for labor induction before due date.Methods: This retrospective cohort study included 206 mothers at 37, 38, and 39 weeks' gestation delivered at our institution between January 2021 and October 2022. Perinatal outcomes, including the success rate of vaginal delivery, were compared between the PGE₂ (n = 46) and metreurynter/laminaria tent (non‐PGE₂) (n = 160) groups. The success rate of vaginal delivery was defined as the proportion of women who delivered vaginally within 48 h of initiating oxytocin augmentation.Results: The success rate of vaginal delivery was significantly higher in the PGE₂ group (37/49, 80.4%) than in the non‐PGE₂ group (106/177, 66.2%). Emergency cesarean section related to non‐reassuring fetal status was performed with none in the PGE₂ group and with eight (5.0%) in the non‐PGE₂ group.Conclusions: The rate of vaginal delivery was significantly higher in the PGE₂ group for elective labor induction between 37 and 39 weeks. The PGE₂ vaginal insert could increase the success rate of vaginal delivery for elective induction of labor at 39 weeks.

Although ovarian cancer is generally unilateral, a few cases of bilateral ovarian cancer have been reported, most of which originate from metastases of unilateral ovarian cancer. However, synchronous primary bilateral ovarian cancer (SBOC), comprising two different histological types of ovarian cancer, is extremely rare, with limited reports on its clinical course and prognosis. Herein, we report the case of a 56-year-old postmenopausal Japanese woman with stage IVB SBOC with combined left ovarian clear cell and right ovarian mucinous carcinomas. The patient underwent surgery and received postoperative taxane/platinum-based chemotherapy, which temporarily reduced the tumor size. However, an increase in tumor size and brain metastases were subsequently identified. Treatment was accordingly discontinued, and the patient died of the disease 12 months after diagnosis. In this case report, we detail the clinical course of a case of SBOC. To the best of our knowledge, this is the first report of SBOC with combined histological types of clear cell and mucinous carcinomas, and it is also the first report of SBOC with the eventual discovery of brain metastases.

Objective: The authors aimed to investigate the prevalence of pregnancy and obstetric outcomes in patients who underwent radical trachelectomy (RT) for early‐stage cervical cancer in the Kanto area, Japan.Method: A survey among 113 perinatal centers affiliated with the Kanto Society of Obstetrics and Gynecology was conducted to investigate their experience in managing pregnancies following RT, between 2010 and 2020. The association between preterm delivery (before 34 gestational weeks) and a midtrimester short cervix (n = 10), and 103 were delivered after 22 gestational weeks. The incidences of preterm delivery before 28 and 34 gestational weeks were 8.7% and 30.1%, respectively. A midtrimester short residual cervix was associated with preterm delivery (P = 0.046).Conclusion: Since more than 100 pregnancies were recorded after RT in the Kanto area, many physicians had more opportunities to manage pregnancy after RT. Pregnancy following RT is associated with increased risk of preterm delivery, and midtrimester short residual cervix is a good predictor of preterm delivery.

Preterm birth (PTB), defined as the birth of a baby at p value < 10^–6). This data report aims to provide summary statistics of current GWASs on PTB in a Japanese population for future meta-analyses of genetics and PTB with larger sample sizes.

This study aimed to investigate the diagnostic accuracy of the placenta accreta index (PAI) for predicting placenta accreta spectrum (PAS) in women with placenta previa. We analyzed 33 pregnancies with placenta previa at Keio University Hospital. The PAI was assessed in the early third trimester, and PAS was diagnosed histologically or clinically defined as retained placenta after manual removal attempts. The PAI and incidence of PAS were analyzed. Ten women (30%) were diagnosed with PAS and had higher volumes of perioperative bleeding (p = 0.016), higher rate of requiring uterine artery embolization (p = 0.005), and peripartum hysterectomy (p = 0.0002) than women without PAS. A PAI > 2 was the most useful cut-off point for predicting PAS and was more sensitive than prediction values using traditional evaluation (history of cesarean section and placental location). Post-hoc analysis revealed a higher rate of previous history of cesarean delivery (30% vs. 4.4%, p = 0.038), severe placental lacunae (≥grade2) (70% vs. 8.7%, p = 0.0003), thin myometrial thickness (90% vs. 22%, p = 0.0003), anterior placenta (100% vs. 30%, p = 0.0002), and presence of bridging vessels (30% vs. 0%, p = 0.0059) in PAS women. PAI could help predict the outcomes of women with placenta previa with and without a history of cesarean delivery to reduce PAS-induced perinatal complications.