A 35-year-old woman (gravida 1, para 0) underwent termination of pregnancy (ToP) at 12 weeks of gestation. One month after ToP, she experienced significant vaginal bleeding and the mass with blood flow was identified on imaging. The presence of a placental polyp with arteriovenous malformation (AVM) was suspected on transvaginal sonography and MRI. Since the bleeding had ceased when she visited our hospital, we decided to treat the placental polyp with AVM with gonadotropin-releasing hormone (GnRH) antagonist therapy instead of surgery. Two months after GnRH antagonist treatment, the mass and blood flow in the uterus disappeared. Menstruation resumed 1 month after the completion of treatment. In our case, we were able to successfully treat placental polyps with AVM using GnRH antagonist therapy.
Abstract Purpose: To clarify whether maternal oxygen administration during vaginal delivery improves umbilical artery (UA) gas measurements and neonatal outcomes. Methods: Singleton pregnancies requiring operative vaginal delivery or emergency cesarean section (CS) due to non-reassuring fetal status (NRFS) during vaginal delivery at our hospital from 2018 to 2021 were retrospectively investigated. Intrapartum fetal wellbeing was evaluated based on the 5-tier fetal heart rate (FHR) pattern which is a delivery management method widely used in Japan. Operative vaginal deliveries or emergency CS were performed under integrated judgment in NRFS. Patients were divided into the oxygen group in which oxygen (10 L/min) was supplied by a facemask and the room air group. The umbilical artery (UA) gas measurements and neonatal outcomes were compared retrospectively. The oxygen administration was classified by conditions before and after the Coronavirus Disease 2019 pandemic. As a secondary evaluation, stratification of FHR pattern levels was also examined. Results: A total of 250 patients required obstetric surgical delivery due to NRFS, including 140 (56%) and 110 (44%) in the oxygen and room air groups, respectively. No differences in maternal background factors were found between the oxygen and room air groups, except for maternal age. UA gas measurements and neonatal outcomes also showed no significant differences. Conclusions: Transmaternal oxygen administration for intrapartum NRFS did not affect neonatal cord blood gases and neonatal outcomes. Thus, routine oxygen administration for intrapartum NRFS may not always be necessary.
ABSTRACT Co‐infections with human papillomavirus (HPV) of multiple genotypes mainly occur due to increased sexual activity. To address the prevalence and trend of HPV co‐infections in Japan, HPV‐type‐specific data from Japanese women ( n = 8128) aged < 40 years and newly diagnosed with cervical abnormalities at 24 hospitals between 2012 and 2023 were analyzed. These included cervical intraepithelial neoplasia grade 1/2 (CIN1/2, n = 2745), CIN3/adenocarcinoma in situ (AIS) ( n = 3953), and invasive cervical cancer (ICC, n = 1430). For women enrolled in this study since 2019, information on sexual behaviors was collected via a self‐administered questionnaire. Time‐trend analyses by disease category showed significant declines in the prevalence of multiple HPV infections in CIN1/2 (49.1%−38.3%, p trend = 0.0004), CIN3/AIS (44.7%–31.5%, p trend = 0.0002), and ICC (26.7%–10.5%, p trend < 0.0001) during the last decade. When these data were analyzed separately for women aged 20–29 and 30–39 years, similar declining trends were observed in each disease category. Using data from 2111 women for whom information on sexual history was available, the number of sexual partners was strongly associated with increased multiple HPV infections ( p < 0.0001). In conclusion, the declining prevalence of HPV co‐infections in cervical cancer and its precursors may reflect a decrease in sexual activity among Japanese women of reproductive age.
