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

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.

[Clinical study and treatment of uterine sarcoma at Niigata City General Hospital].

We report a retrospective study of 16 patients with uterine sarcoma from 1986 to 2001 in Niigata City General Hospital. Five-year survival rates in stage I, II, III and IV (FIGO) were 68% (n = 4), 50% (n = 2), 0% (n = 3), and 0% (n = 7), respectively. Overall survival for the patients with incomplete resection of tumor at primary laparotomy (n = 7) was significantly poorer than that with complete resection (n = 8). Patients with a high-LDH (lactic acid dehydrogenase) value tended to have poorer prognoses, but there was no significant difference of overall survival between the high-LDH group (n = 8) and the normal-LDH group (n = 8). Fifteen patients had postsurgical adjuvant chemotherapy. Out of 5 evaluable patients undergoing first-line chemotherapy, there were only 2 partial responders with IAP (ifosfamide, adriamycin, cisplatin) chemotherapy, and out of 11 evaluable patients undergoing second-line chemotherapy, there was only 1 partial responder with IAP. Out of 10 patients who had no evidence of disease after prior therapy, 6 patients had recurrences. Five patients underwent secondary surgery for recurrence and residual tumor. Of them, 3 patients did not have complete resection of residual tumor and died within 1 year after secondary surgery. Although prognosis of advanced uterine sarcoma and recurrence is poor, it is suggested that aggressive resection for recurrence and residual tumor improves prognosis.