Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2011 edition

Abstract

Clinical guidelines for obstetrical practice were first published by the Japan Society of Obstetrics and Gynecology (JSOG) and the Japan Association of Obstetricians and Gynecologists (JAOG) in 2008, and a revised version was published in 2011. The aims of this publication include the determination of current standard care practices for pregnant women in Japan, the widespread use of standard care practices, the enhancement of safety in obstetrical practice, the reduction in burdens associated with medico-legal and medico-economical problems, and a better understanding between pregnant women and maternity-service providers. These guidelines include a total of 87 Clinical Questions followed by several Answers (CQ&A), a Discussion, a List of References, and some Tables and Figures covering common problems and questions encountered in obstetrical practice. Each answer with a recommendation level of A, B or C has been prepared based principally on 'evidence' or a consensus among Japanese obstetricians in situations where 'evidence' is weak or lacking. Answers with a recommendation level of A or B represent current standard care practices in Japan. All 87 CQ&A are presented herein to promote a better understanding of the current standard care practices for pregnant women in Japan.

Indicators of the need for insulin treatment and the effect of treatment for gestational diabetes on pregnancy outcomes in Japan

“…Overt diabetes in pregnancy was diagnosed if any of the following four criteria were fulfilled: (1) fasting plasma glucose ≥ 126 mg/dL; (2) HbA1c ≥ 6.5%; (3) definite diabetic retinopathy; and (4) random plasma glucose ≥ 200 mg/dL or 2-h plasma glucose levels in the OGTT of >200 mg/dL with either (1), (2), or (3) [2].…”

“…In this study, a two-step screening strategy with GCT between 24-28 weeks of pregnancy was used in accordance with the clinical recommendations of Japan Society of Obstetrics and Gynecology (JSOG) [2]. The universal initial screening for GDM assessed whether the pregnant women had the following clinical risk factors: (1) pre-gravid overweight (body mass index (BMI) ≥ 30); (2) past history of GDM; (3) past history of macrosomia (birth weight ≥ 4,000 g); (4) family history of type 2 diabetes in first-degree relatives; and (5) random plasma glucose ≥ 95 mg/dL [8].…”

Effects of nulliparity, maternal age, and pre-pregnancy body mass index on the development of gestational hypertension and preeclampsia

“…According to the "Guidelines for obstetrical practice in Japan 2011", 1) the conditions pregnant women must meet for a midwife-manage care system include a maternal age < 35 years and a pre-pregnancy body mass index (BMI, body weight [kg]/body height [m 2 ]) of 18.5 to 25.0. Both advanced maternal age ( > 35 years) and increased BMI are widely recognized risk factors for pregnancy induced hypertension (PIH), including preeclampsia (PE) and gestational hypertension (GH), in various ethnic groups.…”

Clinical impact of women with gestational diabetes mellitus by the new consensus criteria: two year experience in a single institution in Japan

“…Each woman underwent a two-step screening for GDM: universal early testing and a standard 1-h 50g oral glucose challenge test (GCT) in early and late pregnancy, respectively, based on the clinical recommendation by Japan Society of Obstetrics and Gynecology (JSOG) [4]. The universal early testing included the clinical risk factors, as follows: (1) pregravid overweight (BMI ≥ 25), (2) prior GDM, (3) past history of macrosomia (birth weight ≥ 4000g), (4) a family history of DM in the first-degree relatives, (5) random plasma glucose ≥ 95 mg/dL.…”

“…In Japan, the IADPSG recommendation was adopted in July 2010 [4], and is commonly used in the obstetric practice, although the screening strategy varies in hospitals. With this background, we have investigated perinatal outcomes of the IADPSG-defined GDM in our hospital.…”