The actual obstetric conditions in the middle scale National Hospitals of 15 that had 150-450 beds were investigated by the method of enquét.
Their results are shown as follow:
The obstetric wards were mostly consisted of obstetrics and gynecology sections. They had 12-49 beds. Full time doctors of 1-5 persons (mean 3) and midwives of 2-13 persons (mean 8.6) were working there. In most of deliveries, a obstetrician assisted a midwife in average 70.5 cases per month in a hospital, 23.5 cases per a doctor, and 8.2 cases per a midwife.
The positive deliveries, for example schedule deliveries or painless deliveries, were tended in hospitals that had relatively more obstetricians. 74 patients came, per day, in each out patient clinic in the National Hospital and they were examined by a obstetrician or by a gynecologist. The second coming patients had been organized in most of hospitals. The prenatal lessons for pregnant women and the specialized clinics, for example sterility or cancer clinic etc. were carried out in only half of hospitals. The examines for iron deficient anemia during pregnancy were done more than twice and the sedimentation rate, the coagu-lation time, the bleeding time, the chest film, E₃, the amnion water analysis etc, were done regularly in half of hospitals.
The observations of new born had been conf ered with pediatricians in most of hospitals. The system of the infants occupied with mother in the same room were adopted in the hospital of a few nursery.
The rate of cesarian section was operated in 5.1%, of total deliveries and they were managed by lumbar anesthesia in the hospitals that had no anesthesist. Regards with being on duty in obstetrics, the portal to portal system was predominant over the on duty system in the National Hospital. Some doctors who majored on duty were employed in some hospitals.
About the services towards the local medical treatments as a mission of the National Hospital, the co-operations with the local medical facilities had been scarecely but played as the role of central hospital

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In recent years, there is a growing tendency in the number of working women, reaching 11.2 million in 1972, and they amounts to 1/3 (32.4%) of all the employees, moreover, the married working women are in majority namely 56.5% of them. As for the pregnancy and delivery of the working women, however, some specialists are pointing out the higher incidence of the diseases during pregnancy and the abnormalities of babies at the delivery than those of the general women at homes, so far. Therefore, recently, we have surveyed working women's pregnancy and delivery in comparing with those of non-working women, thus we have obtained some findings on the health-care of working women, and the outline of the result is reported hereinafter. The present survey is a part of the investigations on working women's pregnancy and delivery performed by the Women and Minors Bureau, Ministry of Labor, Japan. According to the survey, the continuously working women after their delivery were 62.1% on the rate, and 37.9% of those women (nearly 40%) have retired. In classification by age, the most women of less than 29 years of age have retired, while those more than 30 years old are less likely to retire. Also, in classification by occupations, the working women have retired in the following order with the percentage, namely, hair-dressers and beauty-culturists 66.7%, general businesswomen (office-ladies) 52.6%, shop-girls (women) 51.0%, on the one hand, the less likely retired women are teachers 7.8%, nursery governesses 16.7%, assistant nurses 18.0%. As for the classification by diseases, working women's rate of signs on pregnancy-toxemia amounted to 31.2% that of abortion and premature-delivery reached 29.4%, and that of anemia was 44.3%, these rates are higher than those of non-working women, namely, each rate was 19.4%, 19.4% and 41.6%. Moreover, working women's rates of diseases such as premature-delivery 10.5%, pre-early rupture of the membrane 15.1%, minor labor pains 9.8%, prolonged delivery 14.4%, abnormal hemorrhage 9.4%, delivery of lower body weight babies 7.8%, and these rates are all higher than those of non-working women, namely, each, 9.5%, 5.6%, 1.7%, 8.9%, 3.3% and 5.6%. As for the adverse conditions classified by diseases, higher incidence was observed on pregnancy-toxemia in hair-dressers, beauty-culturists, night-workers, half-sitting works and the works under high temperatures of those more than 35 years old, followed by the sighs of abortion and premature delivery in hair-dressers, beauty-culturists, works in ascending and descending the stairway, night-works, half-sitting works, and the works under high or cool temperatures, also, the following working women are liable to deliver the lower body weight babies, namely, hair-dressers, beauty-culturists, nursery governesses, shop-ladies, over-time workers, night-workers, half-sitting working women, commuters in rush hours, workers in descending and ascending the stairway, and commuters of owner-drivers.
From the above results, it is necessary to take proper measures and to give the instructions on health-care in accordance with the individual situation of the working women

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In the present survey the urinary hormonal and vaginal cytologic tests are described, which are this days of great importance for the antenatal diagnostics. In this connection methodical problems are elucidated. The research of this field not yet arrived at a definitive conclusion, although some methods proved true in the practical medicine. This particularly concerns the urinary estriol test and vaginal navicular cell index in the evaluation of prolonged pregnancies. The author points out a correlation between lowered levels of estriol excretion and navicular cell index

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As a rule, we have adopted a policy of active artificial induction of labor for pregnancies carried over two weeks or more beyond the expected date of confinement, In the present communication, we have attempted to evaluate validity of this policy from statistical and clinical points of view.
The incidence of prolonged pregnancies during the past three years from 1971 through 1973 was 1.67% in terms of actual incidence and 0.89% in terms of corrected incidence out of 3, 121 deliveries in our clinic, Obstetrical complications such as excessive bleeding, cesarian section, prolonged delivery and fetal asphyxia were recognized to be significantly higher in prolonged pregnancies than in control cases, Obviously primiparous women with prolonged pregnancies have proven to have much more chance of association with such complications than multiparous women with prolonged pregnancies, probably due to the factor related to the soft parturient canal. It was concluded that special considerations on the soft canal together with artificial induction of labor have to be taken in account for the management of prolonged pregnancies of primiparous women to improve the prognosis of labor and newborn

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1) Objective
Recently there has been an increasing number of pregnant diabetics in Japan like many other developed countries. Pregnancy normally has marked endocrinologic and metabolic changes. Coexisting diabetes is therefore likely to have significant influence on both the maternal body and the fetus. While the fact that pregnancy is diabetogenic is of metabolic interest, the chronic fetal distress that may occur in pregnant diabetics is of obstetrical importance. The present study was undertaken to investigate the control of pregnant diabetics from the obstetric and diabetic standpoints.
2) Method
Glycosuria of pregnancy were examinated in 2, 875 pregnant women, and glucose tolerance tests were performed in 155 cases.
On the other hand, 15 normal non-pregnant women, 56 normal pregnant women and 12 pregnant diabetics (falling into class A or B according to White's classification) were used in this study. A glucose tolerance test (GTT) was performed and blood sugar, IRI response and ΔIRI/ΔBS were measured on all subjects. For the pregnant diabetics obstetrical findings were noted, plus, urinary estriol, serum HPL and serum HCG were determined serially during the terminal stage of pregnancy.
3) Results
Glycosuria of pregnancy was found in 6.6%. Pregnant diabetics were 11 cases (0.38%), including gestational diabetes 5 cases and overt diabetes 6 cases.
Blood glucose and IRI response curves varied during the GTT with different groups of subjects. In normal pregnancy the IRI response increased from the first to the second and on into the third trimester. In class A pregnant diabetics the IRI response was delayed in elevation, In class B diabetics the IRI response curve was low and the ΔIRI/ΔBS also was low. Serum HPL and serum HCG were elevated at times in the presence of diabetes, but in some cases they decreased after the 35th week of pregnancy. In well controlled diabetics the urine estriol level was stationary throughout pregnancy, but it began to decline from the 36th week in some cases and remained about mg/day in others. Infants of mothers with placental dysfunction were not viable due to various complications. From these results it was concluded that monitoring of endocrine function is essential for the successful control of pregnant diabetics

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Toxemia of pregnancy certainly remains a major determinant for the prognosis of the mother and child, even though it has recently tended to be markedly less common both with the spread of maternal and infantile hygiene and with innovated management of pregnant and nursing mothers. Studies were made of toxemia of pregnancy as an important component of the problems involved in the management of such women with respect to its diagnosis and treatment, the prognosis in the mother and child, and the associated variation in pertinent laboratory indices, particularly estriol and HPL levels. The results obtained are as follow:
1) Of a total of 145 cases of toxemia of pregnancy encountered recently, 17 had a severe form (11 pure type, 6 mixed type), 5 specific varieties (1 eclampsia, 1 pulmonary edema, 2 premature separation of the normally implanted placenta, 1 cerebral hemorrhage), and 20 sequela or sequelae.
2) Approximately one-half of the severe cases were admitted as emergency patients, suggesting inadequate management of pregnant women.
3) Sequela or sequelae were present in 4.9% of mild cases, 58.8% of severe cases, and 80% of cases of specific varieties. These figures indicate the importance of postpartum management.
4) Management of the infant at the Newborn Center was necessary in 15 cases: 7 mild and 8 severe or specific cases. Findings of note in these cases include an infant with low birth weight, SFD, hypoglycemia and hypocalcemia.
5) As regards the prognosis in the mother and child, there was no case of maternal death whereas 6 infants died, often due to unknown causes, the perinatal mortality being as high as 41.4%.
6) A detailed follow-up study was made of the course in 5 cases of specific types of toxemia of pregnancy. Of these cases, those of pulmonary edema and cerebral hemorrhage seemed to be full of suggestions clinically.
7) Determinations were made continuously of the urinary level of estriol in order to have an objective grip on fetoplacental function in toxemia of pregnancy. In the severe form of the disease, the estriol level was almost invariably 15mg/dl or below, tending to decline gradually, while it was correlated to a significant extent with SFD. Results of interest were also obtained with respect to HPL level, which is now under further estimation in a larger series of cases. In short, it must be stressed that a more thorough management of pregnant women is necessary along with pertinent data on and appropriate countermeasures against toxemia of pregnancy in individual cases

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The relations between high risk babies and their mothers with high risk pregnancy, who admitted in the 2nd Tokyo National Hospital during recent three years were discussed.
The most significant factors as the high risk pregnancy were the toxicosis, anemia and placenta previa during pregnant stage.
The most significant factors of the babies who were born from high risk mothers were twin, prematurity, asphyxia, etc.
Among the low birth weight infant group, the frequency of the high risk pregnancy of their mothers were higher in the cases with lower birth weight and lower gestational week.
For the purpose to gain good prognosis of the high risk babies, the control of the high risk pregnancy and the transitional care of the babies since immediately soon after birth by neonatologists may be valuable

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The results of 114 pregnancies are reported, which had a cerclage of the uterine cervix in Nagoya National Hospital from July, 1963 to June, 1973.
During the same period there were 13, 556 deliveries at this hospital, the cerclage rate was 0.84%. 114 women had 35 living children (20.3%) from 174 previous pregnancies after 17 weeks without cerclage. In the same cases following cerclage, 103 children (91.2%) survived. We divided the cerclage into therapeutic and prophylactic, depending whether the cervical incompetence is confirmed from progressive effacement and dilatation of the cervix occuring over serial examinations during pregnancy or the cervical incompetence is inferred from presumptive evidence, namely a history of repeated relatively painless and bloodless second trimester abortions, typical finding of the hysterography and admission of the No.8 Hegar dilator effortlessly through the internal os etc. 11 cases were therapeutic and 103 cases were prophylactic. There is no difference in the results between therapeutic and prophylactic cerclage. So we favor the prophylactic cerclage rather than awaiting the establishment of the cervical incompetence

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The prevention of premature birth is important. In many instances, however, there is no recognizable cause of premature labor, although the most common complications were toxemia, multiple pregnancy, placenta praevia, congenital uterine anomalies, early rupture of membrances and cervical incompetence.
The prevention of these conditions would aid materially in decreasing the number of deaths from prematurity.
We try prevention of premature birth by surgical measures (Shirodkar operation and McDonald operation). Frequency of premature infant could be reduced to 7.3% from 11.8%

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The placenta previa was determined using _99mTc. H. S. A. by isosensitive colour scintillation scanning in 2 patients in the third trimester of pregnancy.
The measurements of the count per minute (c. p. m. ) were carried out by isosensitive scanning using two collimated detectors as two pens method. The technique of application of the isosensitive scana is fully described and its superiority in accuracy, simplicity and danger of radiation discussed.
Of the 2 patients with recurrent vaginal bleeding who were performed by cesarean section, one patient was found to be in the right lower posterior marginal placenta previa indicated on the colour isosensitive scanning and the other was also found to be in the right lower posterior lying placenta indicated on the same scanning.
No failure in the diagnosis of placental site was noted. Because of the precise localization of the placenta, this colour placentography and the measurement of the count per minute of γ emission shows promise of improving the diagnosis of placental previa and management of third trimester bleeding

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Abdominal pregnancy is classified among the rare cases of ectopic pregnancy. There are a few cases in which this kind of pregnancy continues for a considerably long period, shows specific progress and exerts important influences on mother and infant. The authors recently encountered two cases of abdominal pregnancy in succession.
Case I: A nulliparous thirty-one-years-old woman was found to have an abdominal pregnancy through cesarean section. She delivered a mature baby 2, 800gm, in weight, who died three days after birth as a result of respiratory distress. Placenta remained in the abdominal cavity, but no particular subjective or objective impairment was recognized during the course of observation.
Case II: An emergency operation on a nulliparous twenty-six-years-old woman inter-rupted an early-stage abdominal pregnancy, which was confirmed by histo-pathological studies.
Considering the symptoms, progress of pregnancy and clinical observation during and after surgery, both cases were assumed to be secondary abdominal pregnancies.
This report summarized the pathogenesis, progress and medical treatment of these two rare cases and includes a discussion of references

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We report the following clinical statistics of the patients mostly suffering from post-partum mental disorders, and also those suffering from mental disorders during a period of pregnancy or after abortion. These observation were made over a period of nine years from October 1, 1965 through September 30. 1974.
1) Total number of female cases in our hospital's psychiatric department during this period was 1, 744 excluding those who came only for medical examination. Of these, 52 patients sufferd a disease during the 6 months period after either childbirth or still-birth. This results in a rate of 2.98%.
2) These 52 patients' disorders can be subdivided into the following groups:
a. Confused, delirious state-6
b. Schizophrenia-6
c. Depression-14
d. Suspected Sheehan's syndrome-1
e. Persecution delusion-1 (This patient also suffered from hearing difficulty)
f. Neurosis-24
3) Our patients' age at the onset of their disease tended to be somewhat older than the national average for childbirth given in statistics gathered in 1969.
4) Number of delivery per patient were less than the national average of the statistics. Neurotic and depressed patients tended to have had more than two deliveries while confused, delirious state, and schizophrenic patients tended to have had less.
5) The interval between childbirth and onset of illness were:
a. Confused, delirious state-mostly within 1 week
b. Schizophrenia-mostly 1 to 3 months
c. Depression-all cases 8 days to 3 months
d. Neuroses-various interval
6) The onset of illness during period of pregnancy was:
a. Confused, delirious state-1
b. Depression-1
c. Neuroses-2
The onset of illness after abortion was:
a. Depression-1
b. Neuroses-5
Both of these groups were much less in number than those suffering from onset after the childbirth

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