Outcomes of "one-day trial of vaginal breech delivery of singleton pregnancy" at 37-38 weeks' gestation at a Japanese perinatal center.

PURPOSE: In Japan, the lack of obstetricians has made it impossible for a strict 24-h delivery monitoring system for high risk deliveries such as vaginal breech delivery at many obstetric facilities. The outcomes in the trial of vaginal breech delivery of singleton pregnancy limited one day at 37-38 weeks' gestation were examined. MATERIALS AND METHODS: A planned induction of vaginal breech delivery at 37-38 weeks' gestation was performed in 72 women who got consent form April 2006 to March 2016 as follows: (1) insertion of a balloon catheter into the uterine cervix filled with a sterile saline fluid of 400-500 mL, (2) intravenous administration of oxytocin after confirming of the natural falling out by itself of the balloon catheter, and (3) selection of cesarean delivery when vaginal delivery cannot be expected by evening. The perinatal outcomes of them were examined from patient charts. RESULTS: The completion rate of vaginal delivery in total was 67% (48/72). There were no cases of neonatal asphyxia or respiratory disorders. The severe perineal lacerations occurred in one case (2%). CONCLUSION: Planned vaginal breech delivery limited one day at 37-38 weeks' gestation seemed to be valid and safe and it can be one of the options for breech delivery in Japan.

Disruption of the dividing membrane in monochorionic diamniotic twin pregnancy.

Disruption of the dividing membrane in monochorionic diamniotic twins is associated with a higher incidence of prematurity and neonatal morbidity. In the present case, a cramped fragment of the dividing membrane could be noted following fetoscopic laser photocoagulation.

Case Series of Intrauterine Subamniotic Hemorrhage.

We present here 9 cases of intrauterine subamniotic hemorrhage to describe the pathological sequence. The definite diagnosis of subamniotic hemorrhage was mainly made macroscopically with the presence of hemorrhage or hematoma wrapped in the membrane on the fetal surface by postnatal examining of the placenta. In 7 of them (78%), the presence of gradual subamniotic hemorrhage in the second trimester of pregnancy was suspected. In the cases, severe fetal growth restriction and preterm delivery were recognized in 2 (29%) and 4 cases (57%), respectively. In the other 2 cases (22%), acute anemia associated with acute subamniotic hemorrhage was clinically suspected. This may be the first report examining the clinical characteristics of acute or gradual intrauterine subamniotic hemorrhage. Both patterns of subamniotic hemorrhage seemed to be associated with the adverse perinatal outcomes.