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This study aims to identify the clinical factors that can predict the requirement of massive transfusion among patients with postpartum hemorrhage (PPH). Methods: Consecutive anonymized patients with PPH who were treated at the emergency department of our perinatal medical center were examined. Patients who had received transfusions before admission, those who had cardiac arrest on arrival, and those without history of blood gas analysis were excluded. Our primary outcome was the requirement of massive transfusion defined as packed red blood cells of ≥10 units/24 h. Univariable logistic analysis was carried out to identify the odds ratio and 95% confidence interval (CI) of the explanatory variables for the outcome. Results: A total of 31 patients (massive transfusion, n = 19) were included in the main analysis. The crude odds ratio for fibrinogen per mg/dL and lactate per mmol/L were calculated as 0.98 (95% CI, 0.97-0.99) and 1.62 (95% CI, 1.08-3.02), respectively. The area under the curves for fibrinogen and lactate were 0.814 and 0.734, respectively, and optimal cutoff values for fibrinogen and lactate were 211 mg/dL and 4 mmol/L, respectively. Conclusion: These findings suggest that lactate and fibrinogen can be predictors for the requirement of massive transfusion in patients with PPH.

This study was conducted to examine the correlation between uterine vascularity and natural history of uterine leiomyoma. Seventy women with leiomyoma participated in this study. Measurements of uterine and leiomyoma volume, as well as blood flow characteristics of the main uterine artery and leiomyoma arteries, were made every 3 months for 1 year. Leiomyoma arteries could be detected in 52 (51.5%) of 101 leiomyomas. Leiomyoma volume increased in 24 (46.2%) of 52 leiomyomas with leiomyoma artery. However, the leiomyoma volume increased in only three (6.1%) of 49 leiomyomas without leiomyoma artery. No difference was found between the pulsatility index of the leiomyoma artery in the group with increased size and in the group with stable size. This study shows the vascularity of leiomyoma to be useful as a predictor of leiomyoma growth.

Key Clinical MessageResuscitative endovascular balloon occlusion of the aorta (REBOA) is a life‐saving procedure used to control bleeding and maintain blood pressure temporarily in traumatic hemorrhagic shock. Uterine rupture and placenta accreta provoke uncontrollable massive hemorrhaging. REBOA may be useful for hemodynamic stabilization to prevent cardiac arrest in high‐risk pregnancy.

We present a brief review of pregnancy induced hypertension (PIH) guidelines provided by the Japan Society for Study of Hypertension in Pregnancy (JSSHP) in 2009. This review aims to compare the Japanese standards of diagnosis, treatment, and management of hypertensive disorders in pregnancy with those of other countries, as well as to present a resource for Japanese clinical studies or case reports published internationally. Hypertension Research In Pregnancy

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Aim: Classification of pregnancy induced hypertension (PIH) according to the Japan Society of Obstetrics andGynecology defines early onset PIH as that which develops before 32 weeks of gestation, and late onset PIH as that which occurs thereafter. The present study aimed to validate this cut-off point. Methods: Clinical characteristics of the patients from 59 domestic tertiary settings of perinatal medicine were analyzed. Women with multiple pregnancies and /or any medical complications were excluded. Subgroups of mild and severe PIH were created according to the severity of hypertension. Results: Numbers of patients with preeclampsia (PE) and gestational hypertension (GH) were 619 and 194, respectively. Severe cases accounted for 379 (333 for PE and 46 for GH) and mild cases accounted for 434 (286 for PE and 148 for GH). The difference in patterns of distribution of onset time between severe and mild cases of PIH was more remarkable than those between PE and GH. Discriminate analysis showed 32.3 weeks of gestation to be the optimal cut-off point at which severe forms of PIH were distinguishable from mild forms. Receiver operating characteristic (ROC) curve analysis of assumptive diagnostic efficacy for predicting severe hypertension with time of disease onset was most predictive at 32 weeks of gestation. Statistical analyses revealed that the cases presenting before 32 weeks were not significantly different from the severely hypertensive cases in terms of maternal and offspring outcomes. Comparison of PIH cases occurring after 32 weeks with cases of mild hypertension were also very similar. Conclusions: It is considered appropriate to regard 32 weeks of gestation as an optimal cut-off point for subclassification of early and late onset types of PIH.