Chorioamnionitis (CAM), an inflammation of the foetal membranes due to infection, is associated with preterm birth and poor perinatal prognosis. The present study aimed to determine whether CAM can be diagnosed prior to delivery based on the bacterial composition of the amniotic fluid (AF). AF samples from 79 patients were classified according to placental inflammation: Stage III (n = 32), CAM; Stage II (n = 27), chorionitis; Stage 0-I (n = 20), sub-chorionitis or no neutrophil infiltration; and normal AF in early pregnancy (n = 18). Absolute quantification and sequencing of 16S rDNA showed that in Stage III, the 16S rDNA copy number was significantly higher and the α-diversity index lower than those in the other groups. In principal coordinate analysis, Stage III formed a separate cluster from Stage 0-I, normal AF, and blank. Forty samples were classified as positive for microbiomic CAM (miCAM) defined by the presence of 11 bacterial species that were found to be significantly associated with CAM and some parameters of perinatal prognosis. The diagnostic accuracy for CAM according to miCAM was: sensitivity, approximately 94%, and specificity, 79–87%. Our findings indicate the possibility of predicting CAM prior to delivery based on the AF microbiome profile.

Aim We aimed to assess the outcomes of combined spinal–epidural (CSE) analgesia compared with no analgesia in spontaneous labor. Methods We performed a retrospective cohort study of deliveries between 2008 and 2014 comparing two groups based on the use of CSE analgesia in both nulliparous and multiparous women. Adjusted odds ratios (aOR) were calculated using logistic regression analysis. Results Among 5247 (3334 nulliparous, 1913 multiparous) singleton deliveries, 3041 (2045, 996, respectively) patients received CSE analgesia and 2206 (1289, 917, respectively) had no analgesia. CSE analgesia was associated with increased risk of oxytocin augmentation (P < 0.01), prolonged duration of labor (P < 0.01), instrumental delivery (aOR, 3.35; 95% confidence interval (CI), 2.69–4.19 for nulliparous and aOR, 2.13; 95% CI, 1.32–3.53 for multiparous women), blood loss volume during vaginal delivery (P < 0.01), meconium‐stained amniotic fluid (aOR, 1.23; 95% CI, 1.02–1.51 and aOR, 1.39; 95% CI, 1.01–1.93) and Apgar score less than 7 at 1 min (aOR, 1.85; 95% CI, 1.28–2.74 and aOR, 2.65; 95% CI, 1.35–5.61) in both nulliparous and multiparous women, respectively, and umbilical arterial blood gas pH less than 7.15 (aOR, 2.69; 95% CI, 1.35–5.75) and umbilical arterial blood gas pH less than 7.10 (aOR, 3.69; 95% CI, 1.11–16.69) in multiparous women. There was no significant difference in incidence of cesarean delivery or Apgar score less than 7 at 5 min. Conclusion We observed several increased risks in obstetric and neonatal outcomes among pregnant women who received CSE analgesia during labor. Preparations for these risks are needed when administering CSE analgesia during labor.

Background/Aim: Initial treatment of endometrial cancer with surgery and platinum and taxane-based chemotherapy is often successful, but it remains unclear as to whether certain types of the disease relapse. The aim of this study was to identify the clinical features of recurrence in patients without residual tumour in endometrial cancer. Patients and Methods: Clinical features, histological type, and time to recurrence were analyzed in 640 endometrial cancer patients without residual tumours. Results: Of 640 patients, 517 were type I and 123 were type II. For type I, early recurrent (ER) disease and late recurrent (LR) disease were noted in 80 and 8 patients, respectively, and 97.5% of ER occurred within 2 years. After recurrence, 76.2% of ER and 50% of LR patients died. In type II, ER and LR were noted in 41 and 1 patients, respectively, and 97.6% of ER occurred within 2 years, of which 75.6% died after recurrence. One LR case died of disease. Conclusion: Most patients recurred within 2 years irrespective of clinical stage or type.The incidence of endometrial cancer is increasing year upon year. Endometrial cancer (EC) occurs at a higher rate than cervical cancer, ovarian cancer, and vaginal cancer, and is the most common malignancy of the female reproductive tract in Japan and other high-income countries. In 2012, 76,000 deaths worldwide were due to EC (1). Thus, improvement in EC prognosis is required on a global scale. Treatment for EC mainly consists of cytoreductive surgery and adjuvant chemotherapy. In the early stages of EC, cytoreductive surgery is the standard of care, while cytoreductive surgery and adjuvant chemotherapy including platinum and taxanes are used for advanced EC. In general, EC is successfully treated by the first round of treatment. However, the majority for patients with advanced EC recur within a median period of 3 years and 15-20% of recurrence is observed even in patients without residual disease (2-4). Many recurrence sites are observed; local recurrence to the vaginal cuff, or distant metastasis to lungs. However, late recurrence at more than 3 years is not well understood in patients with EC.EC is pathologically classified into type I and type II. Type I EC, which is an oestrogen-related tumour, accounts for approximately 80% of EC cases. In addition, the histology of type I EC is regarded as grade 1 or grade 2 endometrioid adenocarcinoma and mucinous adenocarcinoma, according to the Japan Society of Gynaecologic Oncology (JSGO) guidelines. Type II EC, which is thought to be an oestrogennon-related tumour, accounts for the remaining 15%-20% of EC cases. The histology of type II EC, which contributes to its heterogeneity, includes serous, clear cell adenocarcinoma, grade 3 endometrioid adenocarcinoma and other types of adenocarcinoma. Patients with type I EC, generally, have a more favourable prognosis compared with patients with type II EC (5). In the 2015 JSGO Annual Report, 48.7%, 20.3%, 8.5%, 5.4%, 2.2%, and 14.9% of diagnosed patients had endometrioid adenocarcinoma grade 1 (...

Intra-amniotic infection (IAI) is a major cause of preterm birth with a poor perinatal prognosis. We aimed to determine whether analyzing vaginal microbiota can evaluate the risk of chorioamnionitis (CAM) in preterm labor cases. Vaginal discharge samples were collected from 83 pregnant women admitted for preterm labor. Based on Blanc’s classification, the participants were divided into CAM (stage ≥ II; n = 46) and non-CAM (stage ≤ I; n = 37) groups. The 16S rDNA amplicons (V1–V2) from vaginal samples were sequenced and analyzed. Using a random forest algorithm, the bacterial species associated with CAM were identified, and a predictive CAM (PCAM) scoring method was developed. The α diversity was significantly higher in the CAM than in the non-CAM group (P < 0.001). The area under the curve was 0.849 (95% confidence interval 0.765–0.934) using the PCAM score. Among patients at < 35 weeks of gestation, the PCAM group (n = 22) had a significantly shorter extended gestational period than the non-PCAM group (n = 25; P = 0.022). Multivariate analysis revealed a significant difference in the frequency of developmental disorders in 3-year-old infants (PCAM, 28%, non-PCAM, 4%; P = 0.022). Analyzing vaginal microbiota can evaluate the risk of IAI. Future studies should establish appropriate interventions for IAI high-risk patients to improve perinatal prognosis.

Ovarian cancer is the most lethal malignancy among gynaecological cancers. Although many anticancer agents have been developed for the treatment of ovarian cancer, it continues to have an extremely poor prognosis. Heparin-binding epidermal growth factor-like grown factor (HB-EGF) has been reported to be a rational therapeutic target for ovarian cancer. Here, we evaluated the clinical significance of serum HB-EGF by examining the association between prognosis and serum HB-EGF levels in patients with primary ovarian cancer. We found that high serum HB-EGF concentrations were significantly associated with poor prognosis in a combined cohort of patients with all stages of ovarian cancer, as well as in a subset of patients with advanced disease. In addition, serum HB-EGF levels increased as the cancer advanced. These data suggest that serum HB-EGF may be a target for the design of novel therapies for ovarian cancer.