Objective: To assess and compare the clinical aspects of uterine rupture by dividing the gestational age at uterine rupture occurrence into <37-week (preterm) and ≥37-week (term) groups. Design: Retrospective cohort study. Setting: 187 acute-care hospitals in Japan. Population: Pregnant women diagnosed with uterine rupture. Methods: We conducted a large nationwide study using a national inpatient database from July 2010 to March 2022. The patients’ characteristics, in-hospital procedures, and outcomes were investigated and compared between those who developed uterine rupture at preterm and term groups. Main Outcome Measures: Hysterectomy, complications, proportion of blood transfusions, and postoperative length of stay. Results: In total, 298 eligible patients were identified (161 in preterm group and 137 in term group). The incidence of placenta accreta spectrum was significantly higher in the preterm than term group (18.0% vs. 6.6%, respectively; P = 0.003). Vacuum delivery (19.0% vs. 0.6%, P < 0.001) and uterine fundal pressure (2.9% vs. 0.0%, P = 0.004) were more likely to be applied in the term than preterm group. The maternal need for mechanical ventilation (26.3% vs. 12.4%, P = 0.003), the incidence of disseminated intravascular coagulation (40.1% vs. 25.5%, P = 0.009), and the requirement for platelet transfusions (32.8% vs. 15.5%, P < 0.001) were greater in the term than preterm group. Additionally, the duration of the postoperative hospital stay was longer in the term group. Conclusions: This study shows that individual characteristics vary with the gestational age at uterine rupture and that the maternal morbidity rate is notably higher in term than preterm uterine ruptures.

Purpose: Mirogabalin has a mechanism similar to that of pregabalin in the treatment of neuropathic pain. However, it remains unclear whether these drugs differ in terms of serious side effects, such as fall-related fractures, in older patients. This study aimed to investigate whether mirogabalin is associated with a decrease in fractures compared with pregabalin. Methods: We performed a retrospective cohort study using the DeSC database, a large administrative claims database in Japan. This study involved 49,393 patients ≥ 65 years taking mirogabalin or pregabalin between April 2019 and March 2020.The cumulative incidence of fractures was compared between those receiving mirogabalin and those receiving pregabalin using Kaplan-Meier curves and multivariable Cox proportional hazards models. A sensitivity analysis was performed for patients who received mirogabalin or pregabalin without other analgesic medications at the initial dose. Results: During a median follow-up of 20 months, 8,152 (16.5%) and 41,241(83.5%) received pregabalin, respectively. The proportions of fractures in the mirogabalin and pregabalin groups were 24.2% and 25.5%, respectively. Cox regression analysis showed that mirogabalin was associated with a lower risk of fractures (hazard ratio, 0.88; 95% confidence interval, 0.84–0.93). Sensitivity analysis also demonstrated a significant difference in fracture events between the mirogabalin and pregabalin groups without other analgesic medications (hazard ratio, 0.88; 95% confidence interval, 0.82–0.96). Conclusions: Our analyses suggest that the administration of MGB was associated with a decreased probability of fracture compared with PGB, although further studies are warranted to confirm these findings.

Background: The effectiveness of glucocorticoids in preventing biphasic reactions in patients with anaphylaxis is still controversial. We evaluated the effects of glucocorticoids on rates of biphasic reactions in patients with anaphylaxis treated with adrenaline. Methods: In this retrospective observational study using a national inpatient database in Japan, we identified 31,570 patients with anaphylaxis treated with adrenaline on the day of admission. We divided them into two groups: those who were treated with adrenaline plus glucocorticoids and those who received adrenaline only on the day of admission. We performed a one-to-four propensity score matching analysis between the two groups. The primary outcome was occurrence of a biphasic reaction and the secondary outcome was 7-day all-cause mortality. Results: Of the 31,570 eligible patients, 28,145 (89.2%) were treated with glucocorticoids. After propensity score matching, there were no significant differences in rates of biphasic reactions (odds ratio, 1.03; 95% confidence interval, 0.86–1.24; p=0.14) or 7-day all-cause mortality (odds ratio, 0.68; 95% confidence interval, 0.40–1.17; p=0.16) between patients with anaphylaxis treated with and without glucocorticoids. Conclusion: Our findings do not support the use of glucocorticoids to prevent biphasic reactions in patients with severe anaphylaxis requiring adrenaline.