ObjectiveTo verify whether body mass index (BMI) classification proposed by the Institute of Medicine (IOM) is valid in Japanese women.MethodA study was conducted in 97,157 women with singleton pregnancies registered in the Japan Society of Obstetrics and Gynecology (JSOG) Successive Pregnancy Birth Registry System between January 2013 and December 2013, to examine pregnancy outcomes in four groups stratified by pre-pregnancy BMI category according to the 2009 criteria recommended by the Institute of Medicine (IOM). The groups comprised 17,724 underweight women with BMI <18.5, 69,126 normal weight women with BMI 18.5–24.9, 7,502 overweight women with BMI 25–29.9, and 2,805 obese women with BMI ≥30. The pregnancy outcomes were also compared among subgroups stratified by a gestational weight gain below, within, and above the optimal weight gain.ResultsThe higher the pre-pregnancy BMI, the higher the incidences of pregnancy-induced hypertension, gestational diabetes mellitus, macrosomia, cesarean delivery, postpartum hemorrhage, and post-term birth, but the lower the incidence of small for gestational age (SGA). In all pre-pregnancy BMI category groups, excess gestational weight gain was associated with a higher frequency of large for gestational age and macrosomia; poor weight gain correlated with a higher frequency of SGA, preterm birth, preterm premature rupture of membranes, and spontaneous preterm birth; and optimal weight gain within the recommended range was associated with a better outcome.ConclusionThe BMI classification by the IOM was demonstrated to be valid in Japanese women.

Abstract. We aimed to determine the optimal gestational weight gain (GWG) in Japanese women with a Body Mass Index (BMI) ≥25 kg/m 2 . The present retrospective study investigated singleton pregnancies in 6,781 Japanese women registered in the Japan Society of Obstetrics and Gynecology system in 2013. We divided overweight and obese women into four GWG categories based on the Institute of Medicine (IOM) recommended: weight loss, small weight gain, within IOM criteria, and above IOM criteria. The adjusted odds ratios and predicted probabilities of maternal and neonatal outcomes of interest with weight change were calculated. In overweight women, GWG was associated with neonatal birth weight. In the loss and small gain subgroups, there was a significant increase in small for gestational age (SGA) and low birth weight neonates (LBW). Predicted probabilities showed the lowest risk was observed in a weight gain of 0 kg; the risk sharply increased at a gain of 11.5 kg. In obese women, weight gain increased the prevalence of large for gestational age (LGA) neonates; however; SGA was not associated with GWG. Predicted probabilities showed an increase in the risk with weight gain. The observed optimal GWG was 0 to 11.5 kg in overweight, and weight loss in obese, pregnant Japanese women. should gain between 5 and 9 kg to obtain the best maternal and perinatal outcomes [4]. However, a few studies from Europe and North America have suggested that a GWG below the IOM guidelines is associated with more favourable pregnancy outcomes in obese women [3,[7][8][9][10][11][12][13].Japanese women are more likely to be underweight than those in Europe and North America; therefore, the Submitted Jan. 22, 2018; Accepted Feb. 3, 2018 as EJ18-0027 Released online in J-STAGE as advance publication Mar. 20, 2018 Correspondence to: Shigeru Aoki, Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, 4-57 Urafunecyou, Minami-ku, Yokohama City, Kanagawa 232-0024, Japan. E-mail: smyyaoki@yahoo.co.jp obesity classification used in Japan differs from that developed by the IOM [14][15][16]. According to the criteria developed by the Japan Society of Obstetrics and Gynecology (JSOG), women with a BMI of ≥25 kg/m 2 are classified as obese without further subdivision [17]. Optimal weight gain for pregnant Japanese women with a BMI ≥25 kg/m 2 is assessed on a case-to-case basis [18,19]. In our previous study entitled, "Pregnancy outcomes based on pre-pregnancy body mass index in Japanese women: POBMIJ Study," we reported that the IOM classification is also applicable to pregnant Japanese women because overweight (25 kg/m 2 ≤ BMI <30 kg/m 2 ) and obese (BMI ≥30 kg/m 2 ) women have different pregnancy outcomes. In addition, when pregnancy outcomes were compared among three groups of pregnant Japanese women with GWG below, within, and above the IOMrecommended weight gain, pregnant women with GWG within the IOM criteria had the best pregnancy outcomes among those with a BMI <30 kg/m 2 , whereas no differences were observ...

Asherman's syndrome is defined as partial or complete obstruction of the uterine cavity primarily caused by intrauterine procedures and infections. Hysteroscopic adhesiolysis is commonly used to treat Asherman's syndrome. Although the frequency of placenta accreta is known to increase with pregnancy after hysteroscopic adhesiolysis, precise data remain unknown. We report a case of placenta accreta following hysteroscopic lysis of adhesions caused by Asherman's syndrome and IVF treatment and review the literature on placenta accreta following hysteroscopic adhesiolysis. It is necessary to consider placenta accreta as a complication of pregnancies after hysteroscopic adhesiolysis for Asherman's syndrome, particularly in those conceived using IVF.

To describe the transport time and timing of transfer of patients with postpartum hemorrhage to a tertiary care institution in an urban area. Methods:We included patients with postpartum hemorrhage transferred to our hospital from a perinatal care facility. We defined transfer time as the time between the referring physician's request for transfer and the patient's arrival at our hospital. We examined transfer time and its breakdown, the shock index before and after transfer, and the prognosis.Results: Overall, 79 patients with postpartum hemorrhage were transported to our hospital within a median (interquartile range) of 53 min (47-63 min). In 70 cases (89%), the request for transport was made before the shock index reached 1.5, and two cases had cardiac arrest during transport.Conclusions: Most patients who were transferred to our hospital were transferred according to the criteria recommended by the guideline. However, the occurrence of cardiac arrest during transport indicates the need to shorten the time from transfer requests to emergency calls by strengthening cooperation with regional perinatal care facilities.

Risk factors for Chlamydia trachomatis infection and preterm birth in pregnant Japanese women: Does chlamydial infection cause preterm birth?