Japan Association Of Obstetricians And Gynecologists Research Articles

Expansion of Mental Health Care in Japanese Obstetric Institutes.

The Japan Association of Obstetricians and Gynecologists (JAOG) has raised awareness of the usefulness of identifying pregnant women with mental health problems and supporting them through multi-professional collaboration. We evaluated the results of questionnaire surveys on mental health care conducted in all obstetric institutes that are members of the JAOG annually. Between 2017 and 2023, we requested all obstetric institutes (n = 2,073-2,427) that are members of the JAOG to provide information concerning mental health care for pregnant and postpartum women about the situation in December every year from 2017. Here, we evaluated the results of the questionnaire surveys. During the study periods, 56.9-74.8% of the 2,073-2,427 institutes responded with valid information. The percentage of obstetric institutes screening for mental health problems during pregnancy and the postpartum period increased from 54.3% and 53.7% to 87.1% and 83.8%, respectively (p < 0.01). However, the proportion of obstetric institutes able to manage pregnant women with mental disorders did not change significantly during the study period. There has been progress in the active identification of women with mental health problems during pregnancy and the postpartum period. However, the proportion of institutes managing mental disorders has not changed.

Activities of the Japan Council for Implementation of the Maternal Emergency Life Support System reduced direct causes of maternal deaths in Japan.

Here, we aimed to provide an overview of Japan Council for the Implementation of the Maternal Emergency Life-Saving System (J-CIMELS) and its simulation program, which has reduced maternal mortality due to direct causes in Japan. The Japan Association of Obstetricians and Gynecologists (JAOG), Japan Association of Obstetricians and Gynecologists, and Maternal Death Exploratory Committee (JMDEC) launched the Maternal Death Reporting Project in 2010. The project analyzed obstetricians' tendency to delay their initial response to sudden maternal deterioration. Obstetricians can predict small changes before deterioration by monitoring vital signs. In 2015, the J-CIMELS was established to provide practical education. J-CIMELS developed a simulation program (J-MELS; Japan Maternal Emergency Life Support) to ensure that the obstetricians acquire the latest knowledge of emergency physicians, anesthesiologists, and other general practitioners and apply it in clinical situations. In the last 7 years, the J-MELS basic course has been conducted 1000 times with a total attendance of 19 890 people. As a result, the incidence of obstetric hemorrhage progressively decreased from 29% in 2010 to 7% in 2020. We believe that the activities of J-CIMELS are improving obstetric care providers' medical practices in Japan.

Development and application of a large-scale disaster preparedness system in the perinatal field.

To introduce the Perinatal Early Assessment and Communication system for Emergencies (PEACE), a dedicated internet-based system for sharing maternal and newborn health information during large-scale disaster. PEACE was developed by the Japan Society of Obstetrics and Gynecology (JSOG) to enable internet-based sharing of maternal and newborn support information between facilities and rescue teams in disaster areas. PEACE input rates during prefecture-scale disasters and in disaster drills were surveyed for two facility categories: centers for perinatal medical care (CPMs) and combined clinics + regional general hospitals. The PEACE input rate was 60%-100% (mean 86%) for CPMs and 5%-86% (mean 47%) among clinics + regional general hospitals. After encouraging PEACE input from JSOG, the Japan Association of Obstetricians and Gynecologists (JAOG), and the disaster response departments of prefectural governments, input rates increased significantly from 74% to 98% in CPMs (P= 0.018) and from 14% to 80% in clinics + regional general hospitals (P= 0.020). JSOG has established the first national system for sharing health information of pregnant women and newborns for use during disasters. The cooperation of prefectures and experience during disaster drills were critical to improving PEACE input rates.

Maternal Death Related to Sudden Unexpected Death in Epilepsy: A Nationwide Survey in Japan.

Sudden unexpected death in epilepsy (SUDEP) is defined as the sudden death of a patient with epilepsy in the absence of an anatomic or toxicologic cause. Whether pregnancy is a risk factor for SUDEP is unclear. Using data submitted to the Japan Association of Obstetricians and Gynecologists (JAOG), which has been collating information regarding all maternal deaths in Japan since 2000, this study evaluated maternal mortality data from 2010 to 2019 to evaluate the current circumstances of maternal death related to SUDEP in Japan. Six women died due to SUDEP during this period; the maternal mortality rate related to SUDEP was 0.066/100,000 individuals. Two women each died during the second trimester, third trimester, and postpartum period. Four and two women were receiving monotherapy and no therapy with anti-epileptic drugs, respectively. The duration of epilepsy was ≤15 years in three women, >15 years in one woman, and unknown in two women. This study furthers our understanding of the prevalence of maternal deaths due to SUDEP in Japan. Further studies are needed to confirm whether pregnancy is a risk factor for SUDEP.

Article Current Status of Nosocomial COVID-19 Cases in Delivery Facilities in Japan

Background: In Japan, there are more than 2000 maternity facilities that provide delivery services for approximately 860 thousand deliveries per year. More than half of all deliveries are managed in private clinics which medical resources are limited and maternal transport is often required. In such condition, we aimed to identify the characteristics of and measures taken by Japanese medical facilities providing maternity services that have recorded cases of nosocomial infection with SARS-CoV-2, which causes (COVID-19).Methods: A nationwide questionnaire survey about nosocomial COVID-19 was conducted in July 2020. A case-control study was conducted by including medical facilities with (Cases) and without (Control) nosocomial COVID-19.Findings: Responses from 1,418 medical facilities were assessed (65% of all delivery facilities in Japan). Seventy-five COVID-19-positive pregnant women were treated in 48 facilities. Nosocomial infection was reported in 4.1% of the facilities. Nine patients developed a nosocomial infection in the maternity ward or obstetric department. Variables that contributed to nosocomial COVID-19 were chest CT on admission (adjusted odds ratio [95% confidence interval], 4.76 [2.44–9.27]), PCR test for SARS-CoV-2 before delivery (2.27 [1.21–4.25]), transfer of pregnant women with fever to another hospital (0.21 [0.06–0.71]), and private clinics (0.17 [0.05–0.60]).Interpretation: Nosocomial infection is likely to occur in large hospitals that treat a higher number of patients than private clinics do. Nosocomial infection can occur even in medical facilities performing COVID-19 screening tests, such as chest CT and PCR test.Funding Statement: Nationwide survey associated with COVID-19 infection, The Japan Association of Obstetricians and Gynecologists (JAOG).Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This study was approved by the JAOG (No. 80, July 1st, 2020). This investigation was conducted according to the principles of the Declaration of Helsinki. Informed consent was not obtained from patients or their families because this study was based on the analysis of facility forms, and the patient records/information was anonymized prior to the analysis.

Guidelines for office gynecology in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2017 edition.

Six years after the first edition of The Guideline for Gynecological Practice, which was jointly edited by The Japan Society of Obstetrics and Gynecology and The Japan Association of Obstetricians and Gynecologists, the third revised edition was published in 2017. The 2017 Guidelines includes 10 additional clinical questions (CQ), which brings the total to 95 CQ (12 on infectious disease, 28 on oncology and benign tumors, 27 on endocrinology and infertility and 28 on healthcare for women). Currently a consensus has been reached on the Guidelines and therefore the objective of this report is to present the general policies regarding diagnostic and treatment methods used in standard gynecological outpatient care that are considered appropriate. At the end of each answer, the corresponding recommendation level (A, B, C) is indicated.

Neural tube defects and folic acid in Japan: Prologue introduction ‐ Understanding of the current status of Japan and the proposal from Japanese Teratology Society

Neural tube defects and folic acid in Japan: Prologue introduction ‐ Understanding of the current status of Japan and the proposal from Japanese Teratology Society

Naproxen Sodium for Pain Control With Intrauterine Device Insertion: A Randomized Controlled Trial.

Naproxen Sodium for Pain Control With Intrauterine Device Insertion: A Randomized Controlled Trial.

Efficacy of transfusion with fresh-frozen plasma:red blood cell concentrate ratio of 1 or more for amniotic fluid embolism with coagulopathy: a case-control study.

The Japan Association of Obstetricians and Gynecologists (JAOG) recommends transfusion with a fresh-frozen plasma (FFP):red blood cell (RBC) ratio of 1 or more in postpartum hemorrhage. However, no global consensus exists concerning this, and little is known regarding the impact of FFP:RBC ratio on maternal mortality. This study evaluates the efficacy of transfusion with FFP:RBC ratio of 1 or more for amniotic fluid embolism (AFE) with coagulopathy. The Maternal Death Exploratory Committee, established by the JAOG, conducted this retrospective nationwide case-control study in Japan. Women with AFE and coagulopathy were included in the study and were stratified into survival and death groups. Obstetric variables and therapy methods (hysterectomy, uterine artery embolism, and transfusion with FFP:RBC ratio ≥ 1) were compared between the survival and death groups. A total of 54 women had AFE and coagulopathy (death group, n=22; survival group, n=32). Only nine (40.9%) women in the death group were transfused with FFP:RBC ratio of 1 or more, whereas 29 (90.6%) women in the survival group were transfused with FFP:RBC ratio of 1 or more. FFP:RBC ratio of 1 or more was found to be associated with better survival rate (adjusted odds ratio, 28.32; 95% confidence interval, 4.26-188.37). No difference was found in obstetric variables, hysterectomy, and uterine artery embolism between survival and death groups. Transfusion with FFP:RBC ratio of 1 or more is associated with higher survival rate in women with AFE with coagulopathy.

Current status of pregnancy-related maternal mortality in Japan: a report from the Maternal Death Exploratory Committee in Japan

ObjectiveTo clarify the problems related to maternal deaths in Japan, including the diseases themselves, causes, treatments and the hospital or regional systems.DesignDescriptive study.SettingMaternal death registration system established by the Japan...

Current Proportion of Women Receiving Perinatal Psychosocial or Psychological Intervention in Japan.

BackgroundIn this study, we examined the current status of psychosocial or psychological intervention for women during pregnancy and the postpartum period in Japan.MethodsWe estimated the number of women receiving perinatal psychosocial or psychological intervention in Japan. On December 2015, we requested 2,462 obstetrical facilities that are members of the Japan Association of Obstetricians and Gynecologists (JAOG) to provide information on women who received psychosocial or psychological intervention during pregnancy, the hospitalization period for childbirth and the puerperal 1 month in 2014. A total of 1,305 (53.0%) of the 2,462 obstetrical facilities responded with valid information on a total of 515,373 women, accounting for approximately 52% of all deliveries that occurred in Japan during the study period.ResultsThe number of women who received psychosocial or psychological intervention during pregnancy, the hospitalization period for childbirth and the puerperal 1 month were 4,843 (0.94%), 4,791 (0.93%) and 3,015 (0.59%), respectively. In total, 8,743 women (1.70%) received psychosocial or psychological intervention in 2014.ConclusionConsidering the response rate, the number of women requiring perinatal psychosocial or psychological intervention was estimated to be 16,000 per year in Japan.

Current Status of the Nutritional Guidance of Baby to Human T-Cell Leukemia/Lymphoma Virus Type I Carriers by Japanese Obstetricians

In humans, breast-feeding is the major route for mother-tochild transmission of human T-cell leukemia/lymphoma virus type I (HTLV-I). HTLV-I transmission by breast milk is associated with ingestion of infected cells and can be prevented by formula-feeding [1]. Therefore, in most of the developed world, mothers with a proven HTLV-I infection should be advised not to breast-feed their babies. In our recent observation in Japan, the number of HTLV-1 carrier in Japanese pregnant women has been estimated to be 1,620 (0.16% of all pregnant women) per year [2]. Based on the guidelines for obstetrical practice in Japan, the HTLV-1 carrier should be recommended to be instructed in the following methods as alternatives to breast-feeding for the prevention of HTLV-1 vertical transmission: 1) formula feeding, 2) frozen-thawed breast milk and 3) short-term breast-feeding within the first 3 months after birth [3]. However, the current status of the nutritional guidance of baby to HTLV-1 carriers by Japanese obstetricians has not been well examined. To examine the current status of mother-to-child transmission of HTLV-I preventing in Japan, on December 2014, we requested 2,544 obstetricians that are members of Japan Association of Obstetricians and Gynecologists (JAOG) and directors of each obstetric facility to provide information of the strategies. Of the 2,544 obstetricians, 1,345 (52.9%) responded. In cases of pregnant woman with positive western blot (WB) test, 953 (70.9%) of the Japanese obstetricians perform the informed choice of the three methods described above, 337 (25.1%) recommend formula feeding, and six (0.4%) recommend long-term breast milk, respectively. In Japan, because the mother-to-child transmission rates under the above three methods have been reported to be both about 3% [4, 5], about 70% of Japanese obstetricians perform the informed choice of the three methods as alternatives to breast-feeding. Breastfeeding is beneficial to the health of both the infant and mother, and mothers generally believe this. Therefore, it is possible that many of the HTLV-I-carrier mothers want to choose breastfeeding as the method of feeding their infants. However, the ground studies for the transmission rates with frozen-thawed breast milk and short-term breast-feeding have not been large (n = 64 and 162 in cases of frozen-thawed breast milk and short-term breast-feeding, respectively) [4]. Therefore, we have not yet evaluated the utility of these methods precisely. It is necessary to clarify the issues by follow-up of all cases prospectively. On the other hand, it has been described that the diagnosis of HTLV-1 carriers in their children is possible at the age of ≥ 3. However, only 698 obstetricians (55.4%) of them recommend the HTLV-1 screening tests for the children of women with positive WB test when they become ≥ 3 years old. The HTLV-1 screening tests might fraught with problems of announcements and personal information; however, the results are possible to facilitate the future diagnosis of adult T-cell leukemia and HTLV-1 associated myelopathy. Therefore, it seems to be necessary to convey to the mothers about the diagnostic methods of the HTLV-1 carriers of their children. These problems will be expected to be elucidated by a nationwide prospective cohort study.

Current Status of the Screening of Chlamydia trachomatis Infection Among Japanese Pregnant Women.

Chlamydia trachomatis (CT) infection in pregnancy can cause maternal disease, adverse pregnancy outcomes, and neonatal disease [1-6]. In general, approximately 80% of CT infected women are asymptomatic or minimally symptomatic. There-fore, screening is the only means to effectively identify infec-tions [2]. In Japan, pregnant women are routinely tested for CT with the Japanese public funds. According to the guide-lines for obstetrical practice in Japan [7], Japanese obstetri-cians must provide a test for the detection of CT for the pre-vention of neonatal CT infection and diagnose urogenital CT infection when CT is detected using polymerase chain reac-tion (PCR), strand displacement amplification, transcription mediated amplification, an enzyme immunoassay, or culture methods in specimens obtained from the uterine cervix (CT nucleic acid detection tests). However, CT antibody detection by IgA tests has been substituted for these methods by some of obstetricians.On October 2014, we requested 2,544 obstetrical facilities that are members of Japan Association of Obstetricians and Gynecologists (JAOG) to provide information of CT screen-ing tests in pregnant women between October 2013 and March 2014. A total of 1,644 (64.6%) of 2,544 obstetrical facilities responded with possible statistical analysis information on a total of 328,788 women, accounting for approximately 65% of all deliveries that occurred in Japan during the study period. Of the 1,644 obstetrical facilities, CT nucleic acid detection PCR tests, CT nucleic acid detection tests except PCR and CT antibody detection tests were performed in 1,221 (74.3%), 408 (24.8%) and 15 (0.9%) facilities, respectively.Table 1 shows the maternal age distribution under the three CT screening tests (CT nucleic acid detection tests with and without PCR and CT antibody detection tests). There were no significant differences in the maternal age distribution among the three CT screening tests groups.Table 2 shows the results of CT screening tests (CT nucle-ic acid detection tests with and without PCR and CT antibody detection tests) of the study population by age. There were no significant differences in the rate of positive CT between the two groups of CT nucleic acid detection screening tests with and without PCR. However, the positive rate by the CT anti-body detection tests was significantly higher than those by the two CT nucleic acid detection tests with and without PCR (P < 0.01 by X

Prevalence of human T-cell leukemia virus type 1 carrier in Japanese pregnant women in 2013.

Since September 2010, in Japan serological screening for the detection of human T-cell leukemia virus type 1 (HTLV-1) antibodies can be performed for all women during pregnancy with the Japanese public funds for strategies for prevention of HTLV-1 vertical transmission, because Japan, especially Kyushu area, has been reported to be one of the areas of highest prevalence of HTLV-1 in the world [1, 2]. In our previous study [3], we examined the prevalence of HTLV-1 carrier in Japanese pregnant women according to the implement rate and results of HTLV-1 screening and confirmation tests of women who gave births in Japan in 2011. The total rates of positive HTLV-1 screening tests and positive western blot (WB) test in positive screening tests were 0.32% and 49.8%, respectively in 2011. Considering the response rate and the rate of implementation of WB test, the number of HTLV-1 carrier in Japanese pregnant women in 2011 was estimated to be 1,560 (0.15%). In addition, although the number of delivery in Kyushu area was only 14% of Japanese deliveries, 53% of HTLV-1 carrier of Japanese pregnant women was present in Kyushu area. Recently, the migration of Japanese people from Kyushu area to the metropolitan areas has been thought to contribute to a significant decrease of HTLV-1 carriers in Kyushu area and an increase in Kanto (including Tokyo) area in Japan [1, 4]. To confirm this migration in Japanese pregnant women, on December 2014, we requested again 2,544 obstetrical facilities that are members of Japan Association of Obstetricians and Gynecologists (JAOG) to provide information of HTLV-1 tests in pregnant women who delivered at ≥ 22 weeks’ gestation in 2013. A total of 1,356 (53.3%) of 2,544 obstetrical facilities responded and information on a total of 538,167 women, accounting for approximately 54% of all deliveries that occurred in Japan during the study period (approximately 1,001,800 births) was provided. In 2013, the total rates of positive HTLV-1 screening tests and positive WB test in positive screening tests were 0.35% and 50.8%, respectively. Considering the response rate and the rate of implementation of WB test, the number of HTLV-1 carrier in Japanese pregnant women in 2013 was estimated to be 1,780 (0.18%). Table 1 shows the difference in the estimated number of HTLV-1 carrier based on positive WB test by area in Japan between 2011 and 2013. The estimated number of HTLV-1 carrier in 2013 seemed to be more than that in 2011, especially in the northeast and southwest (Kyushu) areas. In addition, 51% of HTLV-1 carrier of Japanese pregnant women was present in Kyushu area, although the number of delivery in Kyushu area was only 13% of Japanese deliveries in 2013. Although the migration of Japanese people from Kyushu area to the metropolitan areas has been supposed to contribute to a significant decrease of HTLV-1 carriers in Kyushu area, the estimated number of HTLV-1 carrier of pregnant women seemed to be increased in Kyushu area. In addition, the estimated rate of HTLV-1 carrier in pregnant women in Kyushu area was still significantly higher than that in the other areas (P < 0.01 by the Chi-square test). Therefore, there are still remaining problems concerning the locality for strategies for prevention of HTLV-1 vertical transmission in Japan.

Cesarean delivery and perinatal mortality rates in Japan, 2007–2011

Objective: Cesarean delivery (CD) rates are increasing dramatically in developed countries. In this study, we examined the relationship between CD rates and perinatal mortality (PM) rates in all 47 prefectures in Japan.Methods: The CD rates were derived from a national obstetrics facility survey conducted by the Japan Association of Obstetricians and Gynecologists (JAOG), which included 94.1% of all childbirths in Japan during the 5-year period from 2007 to 2011. The PM rates were based on vital statistics during the same period.Results: During the 5-year period from 2007 to 2011, the CD rates compiled for the 47 prefectures in Japan increased significantly in each successive year, whereas PM rates decreased significantly in each successive year. However, no statistically significant correlation between CD and PM rates was detected.Conclusion: There is a lack of evidence for a significant correlation between recently increasing CD rates and decreasing PM rates in Japan.

WS15-3 - New Cervical Cancer Screening Strategy with Contesting of Cytology and HPV Testing

ABSTRACT The Japan Association of Obstetricians and Gynecologists (JAOG) recommended screening for cervical cancer in women age 20 to 65 years with a combination of cytology and human papillomavirus (HPV) testing every 3 years in 2011. The US Preventive Services Task Force (USPSTF) and a multidisciplinary partnership among the American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathology (ACS/ASCCP/ASCP) recommendations are published in 15 March 2012. The recommendations are based on a systematic evidence review. The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing. Although the two sets of guidelines were developed independently, they are generally consistent. Screening with cytology and HPV testing every 5 years or cytology alone every 3 years in women age 21 to 65 years is recommended. On the other hand, HPV testing alone as a primary screening approach will be planed in Europe. Recommended screening practices should not change on the basis of HPV vaccination status. Specifically, co-testing has increased sensitivity for detecting cervical intraepithelial neoplasia grade 3 or greater (CIN3+), and women who have undergone co-testing have a lower risk of CIN3+ and invasive cancer. Because of this improved performance, co-testing can be used for screening at less frequent intervals than cytology alone. In addition, co-testing offers greater risk reduction than cytology alone for adenocarcinoma of the cervix and its precursors. However, Guideline of Japanese Ministry of Health, Labor and Welfare (MHLW) still shows a screening with cytology every 2 years. Now, we are keen to change the guideline of cervical cancer screening based on the latest evidences in Japan. Our new recommendation will be shown with data based on the medico-economic analysis in this work shop.

Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2011 edition

Clinical guidelines for obstetrical practice were first published by the Japan Society of Obstetrics and Gynecology (JSOG) and the Japan Association of Obstetricians and Gynecologists (JAOG) in 2008, and a revised version was published in 2011. The aims of this publication include the determination of current standard care practices for pregnant women in Japan, the widespread use of standard care practices, the enhancement of safety in obstetrical practice, the reduction in burdens associated with medico-legal and medico-economical problems, and a better understanding between pregnant women and maternity-service providers. These guidelines include a total of 87 Clinical Questions followed by several Answers (CQ&A), a Discussion, a List of References, and some Tables and Figures covering common problems and questions encountered in obstetrical practice. Each answer with a recommendation level of A, B or C has been prepared based principally on 'evidence' or a consensus among Japanese obstetricians in situations where 'evidence' is weak or lacking. Answers with a recommendation level of A or B represent current standard care practices in Japan. All 87 CQ&A are presented herein to promote a better understanding of the current standard care practices for pregnant women in Japan.