A 37-year-old multiparous woman complained of uterine prolapse at 14 weeks of gestation. A silicone ringshaped middle-size vaginal pessary (# 62 mm) was placed into the vagina to reduce prolapsed uterus. Because the cervical length became shortened at 25 weeks of gestation, we decided to start intramuscular administration of progesterone (250 mg) weekly. At 33 weeks of gestation, she complained of the vaginal pessary spontaneous falling out, so we inserted a vaginal pessary of the same size again. The uterocervical angle became acute, going from 100 to 60 after placing the vaginal pessary into the vagina. We took the vaginal pessary out at 37 weeks of gestation. The patient gave birth at 39 weeks by spontaneous vaginal delivery to a healthy baby. A vaginal pessary may help continue a pregnancy via the same mechanism as a cervical pessary, which sharpens the uterocervical angle.
BackgroundThe umbilical arterial pH (UApH) in cases of clinically apparent chorioamnionitis (CAM) in which the infant later develop severe cerebral palsy (CP) has not yet been fully investigated. The objective of this study was to determine the UApH in CAM cases in which the infant later develop severe CP.MethodsA review was conducted unti1 April 2014 among 324 infants with CP diagnosed to be caused by antenatal and/or intrapartum conditions, as determined by the Japan Council for Quality Health Care. Eighty-six infants born at over 34 weeks of gestation with an abnormal FHR pattern during labor were selected. The subjects were divided into the following two groups: cases with (Group I, n = 19) and those without (Group II, n = 67) clinical CAM. Severe fetal acidemia was defined as a pH of less than 7.0.ResultsThe frequency of severe acidemia in Groups 1 and II was 26.3 and 74.6 %, respectively. In addition, the frequency of severe acidemia was significantly less in Group I (odds ratio (OR) 0.12, 95 % confidence interval (CI) 0.03–0.53) than in Group II, while the frequency of fetal tachycardia was greater in Group I (OR 7.61, 95 % CI 1.82–31.7) than in Group II, after adjusting for confounding effects.ConclusionsThe frequency of severe acidemia was lower in the cases of clinical CAM in which the infant later developed severe cerebral palsy than in the cases without clinical CAM. The relation of fetal tachycardia to CP with clinical CAM, but not to acidemia, should be reevaluated in such cases.
Aim: A cohort study was performed to clarify the influence of risk factors on perinatal events (obstetric complications and/or perinatal deaths). Methods: This cohort study reviewed 395 785 births from 2011 to 2013. Women with singleton pregnancies delivered after 22 weeks of gestation were included. The OR were determined on multivariate analysis. The perinatal event score (PES) for risk factors, which is the product of the OR of risk factors for obstetric complications, OR of risk factors for perinatal death, and OR of obstetric complications for perinatal death, was introduced to clarify the impact of each risk combination.Results: There were 20 risk factors such as maternal age and medical complications relating to the 11 obstetric complications, including pregnancy-induced hypertension and preterm labor. As a result, 77 combinations of risk factors and obstetric complications were found to be significant. Six obstetric complications such as preterm labor and cervical insufficiency were found to be related to perinatal death. Two factors were found to be directly related to perinatal death: age >40 years old (OR, 1.24; 95%CI: 1.11-1.39) and essential hypertension (OR, 1.56; 95%CI: 1.19-2.05). As a result, PES ranged from 1.07 (primipara for premature rupture of membrane) to 40.1 (essential hypertension for placental abruption), and high PES (≥8) was identified in 21 combinations of risk factors and obstetric complications. Conclusion: This newly created score for perinatal events, PES, can be used as an indicator of the impact of risk factors on perinatal events.
The text mining method was useful for exploratory analysis of the textual data obtained from pregnant women, and the monthly change in the words used in the mothers' comments as pregnancy progressed differed according to their degree of unease.
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