Aim The aim of this study was to assess the incidence and risk factors for recurrent spontaneous preterm birth (PTB) in Japan. Material and Methods A retrospective cohort study was conducted at five tertiary perinatal centers in Osaka, Japan from 2008 through 2012. Perinatal data were collected from medical records of women with a singleton gestation and a previous spontaneous PTB. Exclusion criteria were first‐trimester spontaneous abortion, first antenatal visit beyond 14 weeks of gestation, and previous PTB with medical indications, placenta previa, abruptio placenta, multiple pregnancy, fetal anomaly, and antepartum fetal demise. The associations between recurrent spontaneous PTB and perinatal factors were evaluated by logistic regression analysis. Results Of 547 women with a previous spontaneous PTB, 89 (16.3%) suffered a recurrent spontaneous PTB. The risk factors for recurrence included multiple previous spontaneous PTB (adjusted odds ratio [aOR]: 2.26; 95% confidence interval [CI]: 1.19–4.30; P = 0.013), no previous term birth (aOR: 2.08; 95%CI: 1.24–3.49; P = 0.005), and interpregnancy interval < 12 months (aOR: 2.13; 95%CI: 1.17–3.85; P = 0.013). Conclusion Approximately one in six women with a previous spontaneous PTB suffered a recurrent spontaneous PTB. Multiple previous spontaneous PTB, no previous term birth, and short interpregnancy interval were independent risk factors for recurrence.

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We investigated the changes of low-density lipoprotein (LDL) size and serum lipids during pregnancy and postpartum not only in normal pregnant women but also in preeclampsia. Serum triglyceride (TG) and total cholesterol levels as well as serum high-density lipoprotein (HDL)-cholesterol, apolipoprotein (Apo) A1, B, E and remnant-like particle (RLP)-cholesterol levels were increased in normal pregnant women. The LDL peak particle diameter (PPD) in normal pregnant women was decreased during pregnancy and that at 37 weeks of gestation showed significant decrease compared with the women at 4 weeks after delivery (25.8 +/- 1.0 vs.26.8 +/- 0.7 nm, p < 0.05). The LDL-PPD in the preeclamptic women at admission (mean gestational age: 36 +/- 2.4 weeks) was significantly lower than that in normal pregnancy at 37 weeks of gestation (24.7 +/- 1.2 vs. 25.8 +/- 1.0 nm, p < 0.05). Moreover, the LDL-PPD in the preeclamptic women was significantly higher after delivery compared with the level at admission (27. +/- 0.7 vs. 24.7 +/- 1.2 nm, p < 0.05) accompanied by an improvement in plasma lipids profile. These findings suggest that the predominance of small, dense LDL, a potential contributor to endothelial dysfunction, may be a possible predictor of preeclampsia.

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A correlation between H. pylori infection and thrombocytopenia during pregnancy was not found in this study.

Three-dimensional (3D) power Doppler sonographic imaging provides a 3D view of the blood vessels. This technique reportedly has advantages over other forms of sonography in visualizing normal and abnormal fetal vascular anatomy. We report the case of a 36-year-old pregnant woman in whom 3D power Doppler sonography with simultaneous gray-scale imaging was performed at 32 weeks' gestational age to investigate an intestinal obstruction in the fetus that was suspected on the basis of 2-dimensional sonographic findings. The 3D sonograms revealed that the superior mesenteric artery and vein of the fetus were wound counterclockwise, forming the "barber-pole" sign. At 38 weeks' menstrual age, the female infant was delivered vaginally. Only duodenal atresia and annular pancreas, but not intestinal malrotation, were found postnatally. Surgical reconstruction of the duodenum was performed, with no major complications. Previous research suggests that the counterclockwise barber-pole sign is a normal finding. On the basis of our case, we believe that this "negative finding" might be used to exclude the diagnosis of midgut volvulus, a condition that would be expected to cause these vessels to wrap around in a clockwise direction.

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In April 2008, the specialization in departments of obstetrics and gynecology was conducted in Sennan area of Osaka prefecture in Japan, which aims at solving the problems of regional provision of obstetrical service. Under this specialization, the departments of obstetrics and gynecology in two city hospitals were combined as one medical center, whilst one hospital is in charge of the department of gynecology and the other one operates the department of obstetrics. In this paper, we implement a cost-benefit analysis to evaluate the validity of this specialization. The benefit-cost ratio is estimated at 1.367 under a basic scenario, indicating that the specialization can generate a net benefit. In addition, with a consideration of different kinds of uncertainty in the future, a number of sensitivity analyses are conducted. The results of these sensitivity analyses suggest that the specialization is valid in the sense that all the estimated benefit-cost ratios are above 1.0 in any case.