Objective: To clarify the fetal heart rate (FHR) pattern evolution and estimate the timing of brain injury in infants with cerebral palsy (CP) according to each of the umbilical cord (UC) troubles. Design: Longitudinal cohort study using the nationwide registry. Setting: Children with CP who were approved for disability support by the Japan Obstetric Compensation System for CP. Population: 126 infants with severe CP caused by UC troubles with a birth weight of 2000 g and 33 weeks of gestational age. Methods: Observers classified the intrapartum FHR strips into five groups: (1) the persistent bradycardia (P-Brady); (2) the persistently non-reassuring (P-NR); (3) Hon’s pattern; (4) the reassuring-prolonged deceleration (R-PD); and (5) the persistently reassuring (P-R). Main outcome measures: Timing and type of evolution patterns of abnormal FHR stratified by various UC troubles. Results: Of 126 cases, 32 were associated with umbilical cord prolapse, and 94 were with other UC morphological abnormalities. Overall, nearly half of the eligible cases had intrapartum onset with R-PD (43%). Meanwhile, around half of those associated with UC morphological abnormalities had an antenatal onset. In the intrapartum setting, most of the FHR deteriorations occurred during the first stage of labor, and there was a high incidence of Hon’s pattern in the case with velamentous insertion and multiple entanglements. Conclusion: Infants with severe CP associated with the UC troubles were characterized as sudden onset during the first stage of labor. Around half of those due to the UC morphological abnormalities were presumed to have an antenatal onset.

Objectives: To clarify whether microvascular ultrasound Doppler (SMI: superb microvascular imaging) can detect antenatal histological findings in pathologic placentas. Methods: In this prospective diagnostic observational study (STROBE), pregnant women who were admitted to our perinatal center for perinatal management were enrolled. Ultrasound examinations to identify placental pathologies using SMI were performed before delivery. After delivery, the placental tissue was clipped for microscopic examination, as the location of the placenta obtained ultrasound findings. The accuracy of antenatal ultrasound detection of placental pathologies was compared between women who were admitted due to fetal growth restriction (FGR), pre-eclampsia, and other indications. Results: The highest accuracy was observed with placental infarction in FGR (positive predictive value [PPV], 100%; sensitivity, 89%; area under the curve [AUC], 0.945), whereas PPV, sensitivity, and AUC in cases of preeclampsia were relatively low (AUC 0.540). Additionally, PPV, sensitivity, and AUC for avascular villi were 100%, 57%, and 0.785 in cases with FGR, 67%, 67%, and 0.780 in cases with preeclampsia, and 80%, 80%, and 0.920, respectively. The diagnostic accuracies predictive of congestion of stem villi and chorangiosis were insufficient (AUC<0.700). Conclusions: SMI can accurately detect placental pathologic findings, such as placental infarction and avascular villi. This modality may improve the perinatal management in cases of placental abnormalities.

Abstract Objective: To describe the clinical characteristics and outcomes of pregnant women with coronavirus disease (COVID‑19) on a national scale in Japan. Design: A nationwide questionnaire-based survey forwarded to all 2185 maternity services in Japan. Setting: A total of 1418 obstetric units that responded (65% of all delivery institutions in Japan). Population: Pregnant women with COVID-19 diagnosed between January and June 2020. Methods: Data were extracted from the questionnaire results. Main outcome measures: Incidence of pregnant women with COVID-19 and infant infection, positive rate of the universal screening test for asymptomatic pregnant women, identification of infection route, and rates of maternal death, severe cases, and caesarean sections. Results: Seventy-two pregnant women were reported to be diagnosed with COVID-19. The positive rate of the universal screening test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for asymptomatic pregnant women was 0.03% (2/7428). The most common route of infection was familial (57%). Fifty-eight pregnant women with COVID-19 were symptomatic; of whom five (8.6%) had a severe infection and one patient died (a tourist). Severe respiratory symptoms, oxygen administration, and pneumonia were frequently reported in the third trimester and postpartum period compared to early pregnancy (22.2% vs. 2.5% [p=0.03], 38.9% vs. 7.5% [p=0.01], and 50.0% vs. 7.5% [p<0.01], respectively). All pregnant women with COVID-19 underwent caesarean section, regardless of symptoms. There was no SARS-CoV-2 transmission to the newborns. Conclusion: The importance of infection prevention should be emphasized, especially in pregnant women, their families, and their roommates during late pregnancy.

Objective: To identify the characteristics of and measures taken by Japanese medical facilities providing maternity services that have recorded cases of nosocomial infection with SARS-CoV-2, which causes coronavirus disease 2019 (COVID-19). Design: A nationwide questionnaire survey: case-control study. Setting: Medical facilities providing maternity service in Japan. Population: 1,418 medical facilities providing maternity service (65% of all delivery facilities in Japan). Methods: A nationwide questionnaire survey about nosocomial COVID-19 was conducted in July 2020. A case-control study was conducted by including medical facilities providing maternity service with (Cases) and without (Control) nosocomial COVID-19. Main outcome measures: Contributed characteristics and variables associated with nosocomial COVID-19. The number of treated pregnant women with COVID-19 until June 2020 and cases of nosocomial COVID-19 in Japan. Results: Seventy-five COVID-19-positive pregnant women were treated in 48 facilities. Responses from Nosocomial infection was reported in 4.1% of the facilities. Nine reports developed a nosocomial infection in the maternity ward or obstetric department. Variables that contributed to nosocomial COVID-19 were chest CT on admission (adjusted odds ratio [95% confidence interval], 4.76 [2.44–9.27]), PCR test for SARS-CoV-2 before delivery (2.27 [1.21–4.25]), transfer of pregnant women with fever to another hospital (0.21 [0.06–0.71]), and private clinics (0.17 [0.05–0.60]). Conclusion: Nosocomial infection is likely to occur in large hospitals that treat a higher number of patients than private clinics do. Nosocomial infection can occur even in medical facilities performing COVID-19 screening tests, such as chest CT and PCR test.