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.

The lifetime incidence of cancer in women is about 50%, with some gynecological cancers increasing, and the prevalence of depression in patients is assumed to be about 12-25%1）. Depression is thought to affect not only suicide but also death from cancer2）, and it is important to provide psychological care to patients as survivors from the time they are diagnosed with cancer. Psychotropic drugs are often chosen for treatment, but side effects such as extrapyramidal symptoms, drowsiness, and constipation are observed, and the quality of life of cancer patients can be increasingly compromised.In this article, we report on seven cases of gynecological cancer survivors who experienced significant efficacy of kososan for the depression and anxiety resulting from stress they felt during various processes such as diagnosis, notification, treatment, recurrence, and best supportive care (BSC). Kososan is a qi-regulating formula, and its efficacy in improving depression has been described since ancient times. In particular, it can be widely used for qi problems of women with a deficiency pattern, and its application to gynecological cancer treatment is considered to be very useful.

Pregnant women with renal disease are at high risk of perinatal complications and renal impairment. Here, we report the outcomes of 4 pregnancies complicated by renal disease diagnosed during pregnancy and the puerperal period. Case 1: Urine test had been positive for protein from 8 weeks of pregnancy, and chronic kidney disease stage G4 was diagnosed at 25 weeks of pregnancy. Renal impairment worsened over time, and cesarean section was performed due to non-reassuring fetal status at 32 weeks of pregnancy. Case 2: Urine test had been positive for protein since before pregnancy, and chronic glomerulonephritis was diagnosed at 15 weeks of pregnancy. Gradual impairment of renal function started at 31 weeks of pregnancy, and the patient had a vaginal delivery at 37 weeks of pregnancy. Case 3: Urine test had been positive for protein since before pregnancy, and hypertension and urine protein were observed since around 26 weeks of pregnancy. Cesarean section was performed due to acute renal failure at 36 weeks of pregnancy. Chronic glomerulonephritis was suspected after childbirth. Case 4: Blood pressure became uncontrollable beginning around 28 weeks of pregnancy, and cesarean section was performed due to sudden worsening of hepatic and renal functions at 31 weeks of pregnancy. Autosomal dominant polycystic kidney disease was diagnosed after childbirth. Pregnancies complicated by renal disease need to be managed carefully with monitoring of blood pressure and renal function. Cooperation with a renal specialist is crucial throughout the perinatal and puerperal periods.

We report a case of ureteral endometriosis thought to have developed following relapse of pelvic peritoneal endometriosis after laparoscopic surgery. The patient was a woman in her late 40s who had undergone laparoscopic right adnexectomy for an endometrial cyst 5 years earlier. Electrocoagulation was performed for residual endometriosis of adherent cyst wall on the right sacrouterine ligament. The normal left ovary was preserved and she received no postoperative hormonal therapy. She developed right back pain during menstruation 5 years after the surgery. Pyeloureterography revealed stenosis of the ureter to the right of the uterus. Urinary cytology revealed endometrial cells with no atypia. Conservative management was opted for because malignant transformation of endometriosis was considered unlikely and she was expected to reach menopause within a few years. She is now doing well 24 months after initiation of progestin treatment with placement of a ureteral stent. Postoperative hormonal therapy is recommended for patients who are considered to have possible lesions of residual endometriosis and for whom ovarian function is preserved.

　　We report a case of subcutaneous port-site hematoma developed on day 6 after laparoscopic left-sided salpingooophorectomy. To start the procedure, three ports were placed in the umbilicus and in each lower quadrant using bladeless trocars. No bleeding was observed at the trocar sites after insertion or withdrawal. The patient was discharged on postoperative day (POD) 3, but returned to the emergency outpatient department with acute left lower abdominal pain on POD 6. Dynamic CT revealed a port-site hematoma with active bleeding from a subcutaneous artery. Hemostasis was achieved easily by opening the trocar wound. Dynamic CT was useful to locate the bleeding vessel and enabled use of a minimally invasive procedure to control bleeding.

　　We report a case of vaginal cuff dehiscence after total laparoscopic hysterectomy that was successfully managed by a newly developed vaginal double-layer circular incision-closure method through a transvaginal approach. The nulligravid postmenopausal patient with cervical cancer received a diagnosis of vaginal evisceration on postoperative day 24. The eviscerated small intestine was pushed back after vaginal douching with normal saline before the procedure. The vaginal mucosa was incised circularly in two layers at the levels of 10 mm and 15 mm from the vaginal stump, and the edges apposed with double-layer closures. She was discharged on postoperative day 3 and followed up for 5 years, with no recurrence of cancer or vaginal dehiscence. This operative method is especially useful for a nulligravida with a small vagina.

　　This retrospective study was carried out to clarify the preventive effect of neutral positioning of both arms on upper extremity neuropathy after gynecological laparoscopic surgery compared with right arm abduction positioning. In 93 cases of right arm abduction positioning >90°, with the left arm tucked in at the side, postoperative right hand numbness occurred in 6 cases (6.5%). In these 6 cases, symptoms disappeared in 4 cases after postoperative day (POD) 1, in 1 case after POD 21, and in the remaining case after POD 41. In 81 cases where both arms were in the neutral position tucked in at the sides with shoulder braces applied, upper extremity numbness was not experienced in any cases; however, shoulder pain developed in 4 cases (4.9%) and was thought to be related to using the shoulder braces. The pain disappeared in 2 cases after POD 1, in 1 case after POD 2, and in the remaining case after POD 3. In right arm abduction positioning without the use of shoulder braces, shoulder pain was not experienced in any cases. Neutral positioning of both arms in gynecological laparoscopic surgical patients was effective for the prevention of upper extremity neuropathy, but measures to alleviate the onset of shoulder pain after change in positioning need to be addressed in the future.

　　We have developed a new surgical procedure for uterine prolapse of round ligament suspension to the psoas minor tendon by the use of a laparoscope. Here, we describe the new technique and report the outcome of surgery in three cases.　　Operative procedure: The fundus of the uterus is lifted back up to its natural position by fixing the round ligament of the uterus to the psoas minor tendon after incising the peritoneum covering psoas. It is important to use the tendon as a stronger reattachment site in addition to the psoas major muscle. The round ligament is tacked to the tendon by a 2-0 nonabsorbable suture on bilateral sides. The second suture may be added if the uterus is not appropriately lifted up by the first suture. The retroperioneum is closed by a continuous 3-0 absorbable suture after fixation.　　Cases: Two patients with severe uterine prolapse and one patient with a mild condition went through the operation safely and have experienced no recurrence for 10 to 24 months. One severely ill patient complained about post -operative right inguinal pain early and another with the severe condition complained that something felt wrong with the right thigh.　　We propose the operation of laparoscopic round ligament psoas minor tendon-hitching as a safe and effective surgical treatment for uterine prolapse.

　　A 59-year-old woman, para 2, attended our hospital for an abdominal mass and atypical genital bleeding. Magnetic resonance imaging revealed a 30×25cm uterine myoma. A preoperative blood examination showed the following results: hemoglobin, 21g/dl; hematocrit, 71.5%; erythropoietin, 38.5mIU/ml; and estradiol, 29.9pg/ml. Abdominal total hysterectomy and bilateral salpingo-oophorectomy were performed, with an estimated blood loss of 1650ml. The weight of the uterus, including the myoma nodule, was 4740g, and the results of histology confirmed the diagnosis of leiomyoma. By postoperative day 28, her hemoglobin, erythropoietin, and estradiol levels had fallen to levels of 15.1g/dl, 6.0mIU/ml, and 5.8pg/ml, respectively, which are normal for a postmenopausal woman. The findings suggest that the leiomyoma secreted erythropoietin and induced erythrocytosis. Estradiol stimulates erythropoietin secretion and enlargement of the leiomyoma. Some studies have shown that erythropoietin is also a growth factor for leiomyoma. More than half of the erythropoietin-producing leiomyomas are detected after menopause. It was discovered that leiomyoma cells can produce aromatase, which transforms androstenedione into estradiol. Although estradiol secretion from the ovaries decreases in the postmenopausal period, the estradiol and erythropoietin autocrine/paracrine system in leiomyoma might promote its own growth after menopause.

　　We researched intrauterine fetal death (IUFD) after 22 weeks of gestation from 2009 to 2014 in our departments. During this period, there were 6236 childbirths and 35 cases (0.56%) resulted in IUFD. We researched the background and causes of IUFD in these 35 cases. The median age was 34 years and advanced maternal age accounted for 48.6% of cases, while elderly primipara accounted for 20%. There were 5 cases (14.3%) of pregnancy after fertility treatment. The median gestational age when IUFD was recognized was 30 weeks, but the gestational age in 4 cases was unclear because of lack of antenatal check-ups. The main risk factors for IUFD were maternal age over 35 (0.95% to 0.40%) and lack of antenatal check-ups (3.7% to 0.5%). The major causes of IUFD were umbilical cord abnormalities (n=10) and placental abruption (n=8), but IUFD of unknown etiology accounted for about 30% of cases. We should better inform mothers about the importance of antenatal check-ups and manage pregnancies carefully for those who have risk factors for IUFD. Furthermore, we should increase research into the causes of stillbirths.