Our hospital is the only medical institution in Ibaraki Prefecture designated as a Type I infectious disease center and a regional perinatal maternal and child health care center, and we have been actively accepting COVID-19-positive pregnant women. In this report, we describe the perinatal outcomes of 58 pregnant women who were polymerase chain reaction/antigen positive for COVID-19 and were managed at our hospital between July 2020 and September 2022. The severity of illness was mild in 49 patients (84.5%), moderate I in 5 (8.6%), moderate II in 2 (3.4%), and false positive in 2 (3.4%). Obstetric complications included 5 cases of impending preterm delivery, 3 cases of gestational diabetes mellitus, and 1 case of impending miscarriage. Among 22 of the women who gave birth while positive for COVID-19, the mode of delivery was vaginal delivery in 18 cases, cesarean section in 3 cases, and emergency cesarean section in 1 case after transfer to another hospital. Four cases were delivered on day 4 of illness, 3 on day 5, and 1 each on days 1, 3, 7, 8, 14, 16, 21, 25, and 29; 4 cases were asymptomatic at delivery but had tested positive on admission or screening at the time of family positive identification. The mean gestational age was 38 weeks 4 days (range, 34 weeks 2 days to 40 weeks 6 days; standard deviation [SD], 10.164 days), mean birth weight was 3042 g (range, 2000-3680 g; SD, 401.268 g), mean Apgar scores at 1 and 5 min were respectively 7.90 (range, 6-9; SD, 0.514) and 8.86 (8-9, SD, 0.343), and umbilical arterial pressure (UVC) was 7.90 mmHg (range, XX-XX; SD, X.343), and umbilical artery blood gas pH was 7.304 (range, 7.120-7.360; SD, 0.058). In the 44 COVID-19-positive pregnant women managed from the sixth wave onward, 43 (97.7%) had mild disease and 1 (2.3%) was a false positive. Since COVID-19-positive pregnant women are considered to be at high risk during the perinatal period and require careful management, many medical institutions initially performed elective Cesarean sections. However, the perinatal outcomes were good in the 18 patients who delivered vaginally at our hospital, and it is not essential to choose cesarean section because of COVID-19 positivity alone, unless the patient is severely ill. The reason for the significant decrease in the disease severity from the sixth wave onward may be the influence of widespread vaccination or changes in the disease caused by mutant strains. While continuing to recommend vaccination of pregnant women, it is necessary to flexibly change the response according to the disease status of COVID-19 in the future.

Placenta accreta spectrum (PAS) disorders may lead to massive postpartum hemorrhage but optimal treatment strategies have yet to be determined. This retrospective analysis involved 35 cases of PAS that occurred at our hospital between January 2014 and November 2021. Mean maternal age was 37 (21-43) years and 8 pregnancies were the result of assisted reproductive therapy. Fifteen patients had placenta previa, 12 had a history of cesarean delivery, and one had a history of PAS. Mean gestational age was 36 (26-41) weeks. Twenty deliveries were by cesarean section and 15 were vaginal deliveries. Mean blood loss was 2,970 (300-14,727) mL. Nine patients were treated by manual placenta removal, one of whom had a delayed hysterectomy because of bleeding. Eleven patients were treated by cesarean hysterectomy and 2 were treated by curettage. Thirteen patients were treated by conservative management, and in 3 of them, treatment was changed to curettage, abdominal placenta resection, or hysterectomy because of vaginal bleeding or intrauterine infection. Four patients thought to have PAS before delivery were treated by cesarean hysterectomy and the amount of bleeding was not severe. Conservative treatment for placenta accreta was successful in 10 patients (77%), and the uterus could be preserved in 12 women (92%). In cases thought to be PAS before delivery, if the placenta is not removed, cesarean hysterectomy should be selected. Conservative management tends to be selected in cases of PAS when the main part of the placenta can be removed. However, in cases of life-threatening hemorrhage or infection, clinicians might need to perform peripartum hysterectomy or uterine artery embolization when bleeding or infection occurs. Therefore, clinicians should obtain informed consent for such treatment in advance.