Our obstetricians and gynecologists manage pregnant women with conditions defined as high-risk pregnancies/deliveries by the Ministry of Health, Labour and Welfare of Japan. In some cases, these conditions become severe, resulting in premature delivery and subsequent admission of the neonates to the neonatal intensive care unit (NICU). However, it is unclear if high-risk pregnancies/deliveries also lead to a risk of NICU admission for term neonates. Here, we investigated whether high-risk pregnancies/deliveries that result in term deliveries increase the NICU admission rate for each factor that is considered high risk. We also focused on elderly primiparas at age 40 or greater as one high-risk factor and investigated whether it increases the NICU admission rate. Subjects were 2275 babies born after 37 weeks of gestation between January 2014 and December 2015. The NICU admission rate was significantly higher in the high-risk pregnancy (HR) group than in the low-risk pregnancy (LR) group (16.28% vs 3.79%, respectively; P <0.0001). The NICU admission rate was significantly higher for the elderly primipara group than for the control group (41.86% vs 4.50%, respectively; P <0.0001). Careful management is necessary for high-risk pregnancies as well as neonates at risk.

In this study, we classified twin pregnancy cases over the past 7 years at our hospital into a trial of labor (TOL) group and a planned cesarean section group, and retrospectively investigated complications in the mothers and neonates at delivery. We also compared safety between the two groups. Subjects included 74 of 159 cases of twin pregnancy who underwent delivery at our hospital over the 7-year period from January 2009 to December 2015. In total, 45 cases of diamniotic-monochorionic twins and 40 cases of emergent caesarean section due to maternal or fetal complications were excluded. The planned cesarean section group included 56 cases (76%), while the vaginal delivery group included 18 cases (24%). Eleven cases of TOL were successful, while 7 cases failed. There were no significant between-group differences in the backgrounds of the mothers such as age, height, body mass index, and gestational age, excluding the number of multiparous cases. No significant differences in neonatal prognosis were noted between firstborn and second-born in terms of birth weight, umbilical arterial blood pH, Apgar score, number of tracheal intubation cases, and the number of neonatal deaths.The success rate of vaginal delivery was higher in multiparous women than primiparas. All vaginal deliveries were successful among multiparous women, regardless of whether delivery was cephalic. There were no significant differences in the neonatal prognosis between successful/failed cases of vaginal delivery. The success/failure of vaginal delivery for twin pregnancy did not result in an increase in the incidence of neonatal complications. The success rate of vaginal delivery for twin pregnancy was higher among multiparous women.

Trousseau's syndrome is a condition in which thromboembolic events are triggered by hypercoagulation caused by a malignancy. Here, we report two cases in which gynecologic cancer was detected after cerebral infarction. Patient 1 was a 66-year-old gravida 0, para 0 who presented with left-sided arm and leg weakness. Head magnetic resonance imaging (MRI) facilitated a diagnosis of cerebral infarction. Subsequent contrast computed tomography (CT) revealed an ovarian tumor, and she underwent surgery on day 8 after admission. The tumor was diagnosed as ovarian clear cell carcinoma on pathological examination. She received adjuvant chemotherapy and the cancer has not progressed in more than 2 years after the surgery. Patient 2 was a 41-year-old gravida 1, para 1 who presented with impairment of consciousness, right hemiplegia, and aphasia. Head MRI facilitated a diagnosis of cerebral infarction. Contrast MRI and contrast CT findings were suggestive of endometrial cancer, and she underwent surgery on day 19 after admission. The cancer was diagnosed as grade 3 endometrial cancer on pathological analysis. She received adjuvant chemotherapy and the cancer has not progressed in more than 4 years after the surgery. Although treatment of the primary disease is considered to affect prognosis in Trousseau’s syndrome, many patients have poor survival prospects because, when detected, their cancer is too advanced to be treated surgically. These cases illustrate the need for close cooperation with other departments such as neurology and cerebrovascular surgery to ensure that these cancers are diagnosed quickly and the opportunity to start multimodality treatment is not missed.

In Japan, there are no predetermined guidelines on the management of pregnant women at 41 weeks of pregnancy. In our hospital, pregnant women at 41 weeks of pregnancy are candidates for induction, but induction may result in emergency caesarean section, atonic bleeding postpartum hemorrhage, and neonatal emergencies with admission to the Neonatal Intensive Care Unit (NICU). Therefore, we conducted a retrospective investigation to determine which cases are likely to end in such events. Our hospital recorded a total of 3,492 deliveries during the period 2013-2015. Of these, 382 pregnancies were delivered at 41 weeks. We compared the labor induction group and the spontaneous delivery group. The rate of emergency caesarean section for multiparas was 1％ and was as high as 21％ for primiparas, so we focused on primiparas in this study. The 258 primiparas from among all 382 cases were divided into the induction group (n＝122) and the spontaneous group (n＝136). Compared with the spontaneous group, the induction group had older primiparas, more body weight gain during pregnancy, and a high risk of emergency caesarean section. There was no significant difference in the proportion of neonates admitted to the NICU. In the analysis focused on the induction group, the rate of emergency cesarean section increased as the number of cases requiring induction and the number of elderly primiparas increased. With the recent increasing age of primiparas, it is necessary to educate women on the risks of weight gain during pregnancy.