We discussed the current state of the emergency care of pregnant women and better ways to solve the problems confronting obstetricians and hospitals in our country.The basis of this problem is that doctors specialized in obstetrics and gynecology are working hard at high risk of being sued, resulting in the rapid decrease in the number of obstetricians. It has become difficult for many hospitals to maintain the department of obstetrics and gynecology. In other arords, it boils down to how to increase, or at least not to decrease the number of obstetricians and how to use present working doctors efficiently. By so doing, we could take in more emergency patients. To incease the number of those who choose obstetrics and gynecology, we should emphasize attrctive aspects of obstetrics and gynecology to students in early grades of medical schools. To assist the women doctors' return after maternity leave in taking care of their child, 24-hour day nurseries are necessary. Construction of the systems of short time work to reduce their hard and long-time load is also needed.In addition, the effective regional hospital association and cooperation should be encouraged and prompt maternal transportation should be achieved as much as possible. Doctors of different clinics or hospitals are expected to join forces to replenish the work of a regional perinatal central hospital. There are many of the medical treatment lawsuit when the newborn baby with cerebral palsy is born. This is one reason why the doctors keep away from obstetrics. A new system of the nofault amends system may be established by which the load of medical providers and patients can be reduced. Increased salary for obstetrician may be effective to induce doctors to obstetrics. These points were discussed.
Discipline of obstetrics ; Gynecology ; Emergency Care ; Child coping with hospitalization ; Circumferential

We report on two cases of diamniotic dichorionic pregnancy with delayed delivery of the second twin. Case 1 was a 29-year-old woman with a twin pregnancy at 19 weeks and 0 day presenting with a preterm rupture of the membranes (PROM) of the first twin. The patient was treated with ritodrine and systemic broad-spectrum antibiotics. Six hours after admission, the first twin was delivered stillborn without complication. At 23 weeks and 5 days, preterm labor resulted in and the second twin being delivered stillborn at a weight of 564 g. The interval between the first and second delivery was 33 days. Case 2 was a 30-year-old woman with a twin pregnancy at 15 weeks and 4 days presenting with amniotic fluid leakage. PROM was found, and she was treated with ritodrine and systemic broad-spectrum antibiotics. The next day, the first twin was delivered stillborn. At 26 weeks, due to adverse effects, ritodrine was changed to isoxsuprine and magnesium sulfate to control uterine contractions. At 33 weeks and 5 days, onset of labor was observed, and 11 hours after the cessation of treatment with isoxsuprine and magnesium sulfate, a viable female fetus was delivered by spontaneous vaginal delivery, weighing 1,806 g. The mother developed atonic bleeding of the uterus immediately after delivery.;The interval between the first and second twin deliveries was 33 days in case 1 and 127 days in case 2. The longer interval resulted in better fetal outcome, but it also may have increased the risk to the mother.
Twin Multiple Birth ; Delivery ; week ; Ritodrine ; Pregnancy

We show two cases of embryonal carcinoma and discuss the results treatment in this paper. Although the progress of this malignant tumor after treatment was not related to the stadium of the progress of disease, it was found related to the amount of serum AFP and to the immaturity of this neoplasm. In view of the latent metastasis, the combination chemotherapy with Cisplatin was deemed necessary. The dose intensity must be kept 1. Also, we considered it necessary to prescribe the medicine to the patients more than 6 cycles.

　　A 32-year-old woman underwent the laparoscopic ovarian cystectomy. During the operation, adrenaline was injected into her right ovary, because the amount of bleeding decreased. Soon after the injection, ventricular tachycardia occurred and her blood pressure increased to 190/125. The use of lidocaine induced the electrocardiogram to return to normal and brought down the blood pressure to a normal range. The operation was finished without hitch.　　Vasopressin has both an excellent hemostatic effect and cardiovascular side effects, and is often used at many medical facilities in Japan. But the treatment with vasopressin is neither covered by health insurance nor the relief system for sufferers from adverse drug reactions.　　So we usually use adrenaline which is insurable at laparoscopic operations. Adrenaline has also a hemostatic property, and causes severe cardiovascular adverse events such as ventricular tachycardia when used together with halogenated inhalation anesthetic. The Japanese Society of Anesthesiologists concludes that no serious side effects will arise from using adrenalin and sevoflurane or isoflurane based on its own findings.　　We had a case with ventricular tachycardia which occurred after an adrenaline local injection. But we recommend a careful use of adrenaline for local injection during a laparoscopic operation.

　　We report a case of an epithelioid smooth muscle tumor of low grade malignancy, known as smooth muscle tumor of uncertain malignant potential (STUMP), in a 65-year-old woman. The patient was referred to our hospital because of an abnormal result on screening of the uterus. We initially suspected leiomyosarcoma based on the findings of preoperative medical examinations and tests, so she underwent a total abdominal hysterectomy with salpingo-oophorectomy. The final diagnosis was a tumor with a low malignant potential (STUMP).