This review described survival and neurodevelopmental outcomes of very-low-birthweight（VLBW）infants born between 2003 and 2015 who were registered to the Neonatal Research Network of Japan（NRNJ）database as of January 2020. Neurodevelopmental impairment（NDI）at 3 years of age was defined as any of the following: cerebral palsy（CP）, visual impairment（VI）as no functional vision in one or both eyes, hearing impairment（HI） requiring hearing amplification, cognitive impairments with a developmental quotient（DQ）<70 by the Kyoto Scale of Psychological Development（KSPD）test, or developmental delay judges by physicians. Among a total of 55444 VLBW infants, 4512（8.1％）died and follow-up data were obtained from 22817（45％ of survivors）infants. Mortality rate in NICU was 7.5％ and death after discharge was 0.6％. Of the infants evaluated for each impairment, 6.8％ had CP, 2.1％ had VI, 1.0％ had HI and 16.9％ had developmental delay. Of the 10226 extremely low birth weight（ELBW）infants evaluated, the proportions of CP, VI, HI, and developmental delay were 9.2％, 3.6％, 1.6％, and 24.4％, respectively. Finally, the proportions of death or NDI were 16.1％ in all infants and 25.6％ in ELBW infants. The incidences of death or NDI were clearly related to BW and gestational weeks at birth. Because neurodevelopmental outcome of VLBW or extremely preterm infants is an important benchmark for improvement of obstetric and neonatal medical care, nationwide longitudinal follow-up studies should be continued incorporation with obstetricians, neonatologist and pediatricians.

 We report our experience on the use of barbed suture in the myometrial suture in the cesarean section. Previously, we sutured the myometrium by interrupted first-layer sutures with 0 VICRYL®, followed by a continuous Lembert second-layer suture with 0 VICRYL®. The new regimen involved a continuous first-layer suture with STRATAFIX︎® Spiral PDS Plus®, followed by the same second-layer suture as previously. The interrupted suture group and the STRATAFIX group showed no difference in the amount of bleeding and the number of hemostatic procedures. However, the STRATAFIX group, compaired with the interrupted suture group, showed significantly shortened operation time in patients with the first cesarean section, and also the more retained thickness at the one month checkup in patients with first and repeated cesarean section.

 Objectives: To elucidate whether the oral administration of probiotics（PRO）during pregnancy is associated with the Edinburgh postnatal depression scale（EPDS）at 1 month after delivery.

 Methods: The subjects were 916 cases who delivered in our hospital from March 2017 to December 2018, without psychological disorders and/or poor socioeconomic background. Survey using the EPDS was conducted at 1 month after delivery, on all subjects. There were 78 cases in which clostridium butyricum MIYAIRI 588 （CBM588）was administered for 2 weeks or longer during pregnancy for gastro-intestinal symptoms, including constipations, and such symptoms improved after initiation of administration. These cases were defined as a PRO administration group. The EPDS positive group which considered a high risk group for postnatal depression, were defined as those cases having high EPDS scores（≧ 9 points）and/or a score of #10 on the questionnaire of ≧ 1 point. The relationship between oral PRO admini-stration and clinical parameters was analyzed, and included the following 5 para-meters: EPDS positive, elderly pregnancy（≧ 35 years old）, maternal obesity（body mass index before pregnancy ≧ 28 kg/m²）, gestational diabetes mellitus and preterm birth（< 37 weeks）. The statistical analysis was conducted using multivariate logistic analysis with significance of P< 0.05.

 Results: The related factors for the EPDS positive group were PRO administration during pregnancy, elderly pregnancy and preterm birth（< 37 weeks）.

 Conclusion: There is a possibility that the oral PRO administration during pregnancy may have the positive effect of preventing postnatal depression.

 The aim of this study is to evaluate the safety and efficacy of fundoplication for gastroesophageal reflux in neonates and infants. Between January 2001 and December 2019, fundoplication was performed in 50 patients who were younger than 6 months old at our hospital. The median age and weight at operation were 3.5 months and 3.9kg. Primary diseases were esophageal atresia in 19 patients, neurological disorders in 19, esophageal hiatal hernia in 7, diaphragmatic hernia in 3, and laryngeal tracheoesophageal cleft in 2. Laparotomy and laparoscopy were performed in 18 and 32 patients, respectively. Nissen procedure was selected in 44 patients and the other procedures were selected for 6 patients, and GERD resolved after fundoploication in all the patients. Intraoperative complications were minor injuries of the liver, stomach, esophagus, and spleen in 9 patients. Twelve patients needed postoperative respiratory support for a few days. Postoperative complications were recurrence in 7 cases, dumping syndrome in 7, and gastric dysmotility in 4. Recurrence occurred only in patients with esophageal disorders. Fundoplication for neonates and infants younger than 6 months old was safe and effective.

We have been transporting neonates from another clinic using our hospital’s own ambulance. Unfortunately, our ambulance could not run anymore, so we changed the areal neonatal transport system as described herein. Transport incubators are placed in each of the related facilities. According to clinical information from the maternity clinic, severe cases are round-trip transported on fire department ambulance ride with pediatrician. The cases that are not severe cases are transported as follows. At weekday daytime, a pediatrician goes to the maternity clinic by a taxi and return to our hospital on a regional fire department ambulance. At night-time and holidays, the maternity clinic staff transports neonates on a regional ambulance without a pediatrician. After this operational change, slight increase was noted in the transport time, with no severity misjudgment or sudden exacerbation during the transport by the maternity clinic staff. One way transport by the maternity clinic staff reduces in the total transport time. Although it is necessary to consider regional circumstances, this system may be one of the solutions for institutions that do not have their own ambulance.

Objective: To verify the adequacy of a management method at perinatal centers where there is a planned cesarean section at 38 weeks of gestation for women with asymptomatic placenta previa at 36 weeks of gestation. Method: This retrospective observational study included 94 women with singleton placenta previa, excluding placental adhesion disorder. Mothers without symptoms such as antenatal bleeding and regular uterine contraction were managed with bed rest alone. In these mothers, mothers diagnosed with asymptomatic previa at 36 weeks of gestation defined as a low risk group were scheduled for cesarean section after 38 weeks of gestation. Adverse events of mothers and neonates were examined in the low risk group.

Results: In this study, 27 of the 94 women were extracted as the low risk group. Of these 27, 25（93％） underwent the planned cesarean section after 38 weeks of gestation. Among the 27, compared with other reports from Japan, there was a low rate（7％）of emergency cesarean sections and little hemorrhaging at delivery （mean: 1447 g）without blood transfusion. No other hemostasis treatment including transcatheter arterial embolization and hysterectomy was required. No neonatal asphyxia was observed. Two neonates（7％）were admitted to a neonatal intensive care unit.

Conclusion: This study found women with no symptomatic placenta previa at 36 weeks of gestation could be managed safely with a planned cesarean at 38 weeks of gestation without deterioration of short-term prognosis of neonates.

Background: There are few detailed reports on the association between histologic chorioamnionitis（hCAM）and short-term outcomes in very low birth weight infants（VLBWI）.

Methods: We enrolled 17,806 VLBWI registered with Neonatal Research Network Japan between 2003 and 2012. Multivariable logistic regression models were used to evaluate the association between hCAM and short-term outcomes. Stratified analyses by four gestational age groups, i.e., 22-24, 25-27, 28-30 and 31-33 weeks, were also conducted. Additionally, the effect across the Blanc classification were examined.

Results: We detected the significant association between hCAM and lower incidence of respiratory distress syndrome（RDS） （adjusted odds ratio［aOR］＝0.60, p<0.001）, patent ductus arteriosus（PDA） （aOR＝0.87, p<0.001）, and mortality（aOR＝0.72, p<0.001）, and between hCAM and increased incidence of persistent pulmonary hypertension of the newborn（aOR＝1.16, p＝0.045）, chronic lung disease（CLD） （aOR＝1.57, p<0.001）, severe CLD（aOR＝1.16, p＝0.007）, intraventricular hemorrhage（IVH） （aOR＝1.11, p＝0.042）, sepsis （aOR＝1.20, p＝0.004）, and home oxygen therapy（HOT） （aOR＝1.55, p<0.001）. Stratified analyses indicated that those results were mainly driven by the younger gestational age groups. We found that hCAM with stage 3 Blanc classification was associated with lower incidence of RDS（aOR＝0.39, p<0.001）, PDA（aOR＝0.65, p<0.001）and death（aOR＝0.69, p<0.001）, and increased incidence of CLD（aOR＝1.93, p<0.001）and HOT（aOR＝2.17, p<0.001）, and that hCAM with stage 1 Blanc classification was associated with higher incidence of PDA （aOR＝1.23, p＝0.001）, IVH（aOR＝1.37, p<0.001）and retinopathy of prematurity（aOR＝1.18, p＝0.035） compared to patients without hCAM.

Conclusion: The effects of hCAM could differ across the gestational age and the Blanc classification.

 We conducted a nationwide survey about the awareness and utilization by obstetricians and gynecologists of contents concerning pregnancy in clinical guidelines developed by other medical societies than Japan Society of Obstetrics and Gynecology. We sent a questionnaire to 599 clinical training facilities of obstetrics and gynecology in Japan. Out of the 316 responded facilities, the awareness of the contents concerning pregnancy in the clinical practice guidelines is low, and the utilization is low too. The utilization rate was high in perinatal medical centers. There was a tendency that doctors with more than 31 years’ occupational experience did not use them. 95％ and more reported that obstetricians and gynecologists need to participate in the preparation of the clinical practice guidelines by other medical societies. This questionnaire revealed that the awareness and utilization by obstetricians and gynecologists of contents concerning pregnancy in the clinical practice guidelines developed by other medical societies are generally low. It is possible that the involvement of obstetricians and gynecologists in the creation of guidelines and the development of younger doctors enhance the awareness and utilization.

 【Purpose】The purpose of this study is to identify the temporally change of parents’ anxiety and attachment for the babies hospitalized in neonatal intensive care unit（NICU）.

 【Method】The survey was conducted between May 1st and December 31st in 2016 at three NICUs in Kyoto and Osaka prefecture in Japan. Data were collected through the questionnaire from fifty-five parents whose babies were either premature or those with congenital disorders. Data of twenty four parents of twelve infants were analyzed. Parents were asked to answer questions at one week and one month after birth. The questionnaire includes anxiety, attachment and open questions. The study was approved by the Research Ethics Committees in each hospital.

 【Result】In the total score through the questionnaire, parental attachment did not change from a week after birth to one month. In addition, parents’ anxiety had decreased from a week after birth to one month. The anxiety scores negatively correlated with gestational age at birth. At one month, mothers were more eager to attend procedures and cares provided to their babies compared to fathers.

 【Conclusion】In this prospective study, the attachment of parents whose babies were hospitalized in NICU did not increase within one month while their anxiety decreased in one month. It is crucial for medical workers to be aware of this change and their need to provide best support for parents in NICU.

 Congenital hyperinsulinism（CHI）is a disease characterized by persistent hypoglycemia due to excessive secretion of insulin. Congenital portosystemic shunt（CPSS）is a rare vascular malformation and induces a direct bypass of the liver connecting the portal vein to the body’s circulatory system. We experienced two cases of CHI with coexisting CPSS which closed spontaneously.

 Total bile acid and ammonia were monitored until the complete closure. Because some CPSS have symptoms and do not close depending on the site, we should distinguish coexisting CPSS when we diagnosed CHI with elevated total bile acid and ammonia.

Most cases of paroxysmal supraventricular tachycardia（PSVT）that develop during the neonatal period are those of atrioventricular reciprocating tachycardia（AVRT）caused by Wolff-Parkinson-White（WPW）syndrome. In AVRT patients, there is a risk of heart failure if paroxysmal tachycardia persists. To our knowledge, there have been few reports of PSVT caused by WPW syndrome in preterm infants, and hence we here report our experience of treatment of such a patient. The patient was a female infant born at 32 weeks and 0 days of gestation, with a birth weight of 1,580 g. On day 6 after birth, her heart rate suddenly increased to 260 beats per minute. Her tachycardia recovered to sinus rhythm after vagal nerve stimulation by placing an ice bag on her face. We diagnosed the patient as having AVRT caused by evident WPW syndrome through detection of a short RP and delta waves on electrocardiography（ECG） . To treat the patient’s repeating tachycardia, we started administration of flecainide, which is a class Ic sodium channel blocker, at 2 mg/kg/day. After increasing the dose to 4 mg/kg/day, tachycardia disappeared completely and there were no adverse events. The patient was discharged from our hospital on day 54 without any central nervous system complications. For preterm infants born in the first half of the thirtieth week of gestation, development of periventricular leukomalacia should be considered, and they may require prompt treatment of tachycardia.

 For the case of ovarian cancer during pregnancy, it is necessary to select examinations and treatments in consideration of both maternal prognosis and effects on the fetus. Here, we report two cases of ovarian cancer diagnosed during pregnancy. The first case was 37-year-old and was diagnosed with low grade left serous carcinoma at 5 weeks of gestation. At 8 weeks of gestation, a left salpingo-oophorectomy, omentectomy, right ovarian biopsy, and ascites cytology were performed and was diagnosed as stageIC2. She continued pregnancy without additional treatment, and vaginal delivery at 41 weeks in gestation. No recurrence have occurred in the first 6 years after initial treatment. The second case was 33-year-old and was diagnosed with left mucinous carcinoma stage IC2（Grade 2）at 13 weeks gestation. After 3 courses of chemotherapy using paclitaxel and carboplatin at 16, 19 and 22 weeks of gestation, cesarean section and staging laparotomy was performed at 37 weeks of gestation. Three courses of postoperative chemotherapy using paclitaxel and carboplatin was also performed, and no recurrence or complications have occurred in the 2 years after the treatment.

 There were no notable abnormalities in pregnancy in either case, and both children had a good short-term prognosis.

 There are few a decade reports of stage IC epithelial ovarian during pregnancy. We report the clinical characteristics of these patients and provide a literature review.

 Currently, opioid use for chronic pain during pregnancy has been increasing. Opioid abuse in pregnancy is associated with neonatal abstinence syndrome（NAS）. However, there is no long-term follow-up study on the newborns.

 The mother was 29 years old with a history of Gravida 2, Para 1. She used a massive dose of opioid for chronic pain that induced by fibromyalgia. She delivered her first baby without decreasing the dose of opioid （460 mg morphine equivalent per day）during pregnancy. The newborn was diagnosed as NAS with the maximum Finnegan score of 7.

 Although he did not need any specific treatment for withdrawal, he was suspected of Autism Spectrum Disorders at age of 18 months. When she became pregnant with the second child, we determined to decrease the dose of her opioid. She successfully underwent reduction of opioid（up to 75 mg morphine equivalent per day）without relapse or severe pain. The newborn was also diagnosed as NAS, but the maximum Finnegan score was 4. After the delivery, she quitted all opioids and her pain is now controlled only by acetaminophen.

 The use of opioid during pregnancy will possibly increase in the future. However, this case report suggests that it is important to consider appropriate dose of opioids for each patient.

 Spondyloepiphyseal dysplasia congenital is caused by mutation in the type 2 collagen gene（COL2A1）, characterized by short stature and skeletal anomalies. Children with SEDC often have retinal degeneration, hearing issue and cleft palate. We report two cases of neonates who have short stature, cleft palate and hearing issue. Both of them have mutation in the COL2A1（case1: c.3589G>A, p.Gly1197Ser, case2: c.3400 G>A, p.Gly1134Ser）Skeletal anomalies are difficult to diagnose before birth. Severity is different individual. Comprehensive diagnosis involving clinical features, radiologic signs and genetic testing, appropriate treatment, and cooperation with other departments are necessary.

 Amniotic fluid embolism（AFE）has been one of the major causes of maternal death in Japan. Here we report a case who survive an AFE by prompt evaluation and treatments. A 39-year-old G1P0 female gave birth vaginally at 41 week’s gestation. She unexpectedly became breathless 70 minutes after the delivery and a heavy uterine bleeding was continued. Though she once went into cardiac arrest, prompt intensive treatments maintained her life, and the uterine hemorrhage was controlled by the administration of recombinant factor VIIa following permanent embolization of uterine arteries（UAE）. Total amount of hemorrhage was 9,309mL. We diagnosed that she had disseminated intravascular coagulopathy-type amniotic fluid embolism with her clinical course and the results of blood examination. She discharged with her baby on postpartum day 30 without any sequelae. It was speculated that the factors that saved her life were prompt start of blood transfusion and the administration of recombinant factor VIIa following permanent UAE by an intramural review meeting.

 While the cause of neonatal gastric rupture is unclear, it is attributed to hypoxic episodes and the gastrointestinal asphyxia defense mechanism. Fetomaternal transfusion syndrome（FMT）is the transfusion of fetal blood into the maternal circulation, which can cause severe neonatal anemia. We experienced a rare case of these two diseases being complicated in a single patient. A 33-year-old woman was administered magnesium sulfate due to preterm labor at 27 weeks’ gestation. At 29 weeks and 1 day of gestation, a cardiotocogram indicated a sinusoidal-pattern, so emergency caesarean section was performed. Soon after birth, the patient（birth weight 1,192g, Apgar scores 1/5/7, female）presented with extremely pale skin and low muscle tone. Her hemoglobin level was 2g/dL, and the HbF and α-fetoprotein levels in the maternal blood were elevated, and we diagnosed the patient with anemia caused by FMT. After performing a blood transfusion, her condition improved. However, the patient developed a gastric rupture at 6 days of age, and therefore an emergency operation was performed. In the present case, it is possible that the gastric rupture was caused by an association of factors such as severe anemia due to FMT, prematurity, the use of indomethacin for patent ductus arteriosus, and tube feeding.

 When a disaster strikes, it becomes difficult to secure clothing, food, and shelter as well as medical resources. In this report, we discuss about our experience of an assisted childbirth over a videophone in a nursing hospital during a disaster. A 29-year-old woman（gravida: 2, para: 1）who was 40 weeks pregnant had labor pain, but was unable to come to our hospital because of a landslide. She headed to a nursing hospital close to her home; however, it did not have a perinatal department. Because it was impossible to transport her to our hospital, we consulted with the on-duty doctor at the nursing hospital and decided to provide childbirth assistance over the videophone. We confirmed the delivery status by videophone and provided instructions that, led to a normal vaginal delivery. The baby weighed 2,900 g, and the Apgar score was 9/10. The mother and baby were healthy after giving birth and were discharged on the 4th day after giving birth. Although it is difficult to secure medical resources at the time of a disaster, it may be secured in the future by using various devices and promoting perinatal education.

We report a case of a preterm infant presenting with breast milk-acquired cytomegalovirus（CMV）infection. The male infant was born at 24 weeks and 6 days of gestation with a birth weight of 807 g. He received enteral nutrition primarily consisting of frozen breast milk from day 3, which was switched to medium chain triglyceride milk formula on day 34 as part of treatment for chylothorax. White stools were observed from day 80 and blood tests showed increased direct bilirubin and hepatic enzyme levels. A diagnosis of breast milk-acquired CMV infection was made based on the following: i）the preterm infant tested negative for urinary CMV deoxyribonucleic acid（CMV-DNA）multiple times from day 0 to day 44, and ii）base sequence in the hypervariable domain of CMV between the urinary sample of the infant and breast milk were identical. Valganciclovir was administered for four weeks from day 113, and was discontinued upon obtaining a negative blood CMV-DNA result.

Acquired CMV infection typically occurs from one to two months after birth. Our case is significant because the infection occurred later than usual and urinary CMV-DNA levels were measured over time from an early stage after birth. We discuss this case with reference to relevant literature.

 Hypothermia causes neonatal cold injury, which presents with a variety of symptoms, including facial flushing and edema, bradycardia, apnea, hypoglycemia, and even hemorrhagic tendencies. Approximately 80 cases have been described in the Japanese literature; however, only a few cases have described infants abandoned soon after birth. This report describes a low-birth-weight infant who presented with severe hypothermia and neonatal cold injury following abandonment. On admission, we observed significant bradycardia, hypoglycemia, reduced platelet count, and metabolic acidosis in addition to hypothermia（rectal temperature 26.7℃）. Rapid rewarming saved the infant’s life without apparent sequelae. Rapid rewarming is the main method of rewarming; however, clinicians must carefully monitor infants during recovery.

 Thrombotic microangiopathy（TMA）is a syndrome characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ failure caused by small vessel thrombosis. TMAs are life threatening and pose medical emergencies as they worsen suddenly. This report presents the case of a 29-year-old woman, gravida 1, para 0, who was at 12 weeks’ gestation. She had been diagnosed with systemic lupus erythematosus（SLE）; however, the disease condition was stable when she became pregnant. She was diagnosed with TMA at 9 weeks’ gestation in the previous hospital after she presented with thrombocytopenia and renal failure. Plasma exchange did not show any effect; hence, she was transferred to our hospital. Based on the view that pregnancy caused TMA, we performed artificial abortion; however, her condition showed no improvement. As TMA develops secondary to SLE, we continued immunosuppressive therapy. However, she developed multiple complications, including bacteremia of Candida and multiple-drug-resistant Pseudomonas aeruginosa and hemophagocytic syndrome which led to her death. TMA is rare in pregnant or postpartum women; however, its occurrence increases among women with SLE. When we encounter TMA, early diagnosis and appropriate therapy could help us to prevent patients’ death.

 We report a case of 34-year-old pregnant woman who was diagnosed with poorly differentiated, advanced gastric adenocarcinoma at 23 weeks of gestation, she was initiated on a course of SOX（S-1/L-OHP）. At 32 weeks and 5 days of gestation, she delivery a girl（weight: 1572g; Apgar score of 8 points〔1 minute value〕and 9 points〔5 minute value〕 ）via selective caesarean section. She underwent chemotherapy at the postpartum outpatient clinic, but died 9 months after the caesarean section. At the time of discharge（54 days after birth）, the baby did not show any growth and development abnormalities. The effects of chemotherapy during pregnancy on mothers and infants are still unknown. Previously, SP therapy was recommended as chemotherapy for advanced gastric cancer; however, in the recent years, SOX therapy has been recommended. Thus far, the guidelines pertaining to chemotherapy for gastric cancer during pregnancy have been unclear. Hence, cases need to be treated individually. This case provides insights into the impact of SOX on pregnant mothers and their infants.

 Enterobacter cloacae, a gram-negative bacillus, is a member of the normal gut microbiota; however, it is often highly virulent in neonates. Notably, neurological sequelae of meningitis may occur despite the administration of systemic antibiotics. We describe a female neonate weighing 2,309 g born at 33 weeks and 4 days of gestation who developed E. cloacae meningitis and ventriculitis after undergoing surgery for jejunal atresia. She developed severe cerebral necrosis despite treatment with high-dose carbapenem. We speculated that bacterial translocation of E. cloacae secondary to surgical injury caused meningitis and ventriculitis. E. cloacae can rapidly colonize the gut in neonates soon after birth; therefore, early identification of this highly pathogenic organism is important to initiate prompt and optimal infection control measures, particularly in neonates undergoing gastrointestinal surgery.

We experienced 6 fetuses in pregnant women infected with PB19. There were 3 infected pregnant women in 2015 and 2 in 2019, and we found that the number of pregnant women infected with parvovirus B19 increased at the same time as the epidemic of parvovirus B19 infection.

All of the infected pregnant women were raising their children, and infectious erythema was prevalent at the preschool children’s destination. Therefore, in order to prevent parvovirus B19 infection in pregnant women, wearing a mask and encouraging hand-washing should be emphasized at the screening of pregnant women.

The outcomes of their fetuses included two cases of intrauterine fetal demise, one case of stillbirth due to abortion, and two cases of normal neonates, one case of heart failure.

The severity of the symptoms ranged from severe to mild cases.

Among severe cases, there was a case of term infant with anemia, heart failure, and persistent pulmonary hypertension of the newborn. In another case, of the dichorionic diamniotic twin, there were cases in which the first fetus died in utero and the second fetus died due to abortion due to Potter syndrome.

Uterine cervical varices are rare complications of pregnancy that can cause massive bleeding when ruptured. However, there is a lack of sufficient research on its management strategies. We herein present a case of hemorrhage from cervical varix in which the bleeding site was sutured at 17 weeks of gestation and the pregnancy continued until 36 weeks. The patient was a 31-year-old woman, gravida 1 para 0. She visited her previous hospital at 17 weeks of gestation because of massive genital bleeding. A varicose vein was found in the uterine cervix, and the bleeding site was sutured to stop bleeding. However, the bleeding recurred at 28 weeks of gestation, and the patient was transferred to our hospital. There was no massive bleeding after transfer. We decided to perform a scheduled cesarean section because of the possibility of massive hemorrhage from varicose vein. However, we had to perform an emergency cesarean section due to premature rupture of the membranes at 36+3 weeks of gestation. The intraoperative blood loss was 1166 g. Both the mother and the child were doing well, and the varicose vein disappeared after the operation. Many studies have reported that bleeding from cervical varices can be managed via gauze compression or suturing of the cervix. However, suture hemostasis may be effective for bleeding in relatively early pregnancy, as in this case. In addition, there are many cases of excessive bleeding at the time of parturition, and thus, it is important to prepare for such cases.

 We report a case in which the neonate died of sepsis only five hours after the delivery by cesarean section. A 36 years old nulliparous woman was transferred to our hospital at 28 weeks of gestation due to premature labor, and premature rupture of membranes. Due to nonreassuring fetal status, emergent cesarean section was performed four and half hours after rupture of membranes. The heart beat and respiration were absent right after the birth, and neonatal resuscitation was performed. Despite the treatment in NICU, the neonate died of sepsis five hours after birth. Both the neonates’ blood culture and oropharyngeal swab were positive for GBS. GBS was confirmed positive for maternal vaginal and anal swab. The histological examination of the placenta and autopsy results revealed intrauterine GBS infection. It was suspected that the fetus was already infected with GBS before rupture of membranes, and GBS sepsis was completed at the time of delivery. The onset of GBS EOD precedes rupture of membranes in some cases. Therefore, further accumulation of data may be crucial for the standardization of care before rupture of membranes or labor onset.

 Incarcerated pregnant uterus is an obstetric condition in which a pregnant uterus grows with the retroversion of the uterus into the pelvic cavity, occasionally even up to the third trimester.

 Incarcerated pregnant uterus is extremely rare; however, the termination of an undiagnosed case during pregnancy may lead various complications. Therefore, we need an early diagnose and appropriate management.

 Here, we report a case of incarcerated pregnant uterus with a myoma of the uterus fundus. The patient was 37-years-old female（gravida 1, para 0）.

 She was referred to our hospital due to a high-risk pregnancy, with a 10cm diameter-myoma. Upon our first examination, we could not detect the portio by a vaginal speculum, but we found a mass at the Douglas pouch. We suspected the abnormal position of the uterus was a result of the myoma; therefore, we planned MRI at 20weeks of gestational age for evaluation. The MRI findings showed an incarcerated pregnant uterus and placenta previa with the myoma at the fundus. Therefore, we selected a caesarean section for delivery and started the preparation for that. After identifying an appropriate position of the uterine incision by ultrasound, we were able to safely do the elective caesarean section at 36 weeks of gestational age.

 Tuberous sclerosis（TSC）is a neurocutaneous syndrome that causes hamartomatous lesions and tumorigenesis in systemic organs due to cellular proliferation. We report a case involving an extremely low birth weight infant at a gestational age of 25 weeks and 5 days; the infant weighed 759 g at birth who complicated with tuberous sclerosis complex（TSC）. The ultrasonography after birth demonstrated intracardiac tumor. The tumor was suspected to be a rhabdomyoma because the tumor regressed spontaneously after a temporary increase in size after birth. Moreover, he presented with seizures and subsequently was diagnosed with West syndrome（WS）. The seizures due to WS improved with adrenocorticotropic hormone（ACTH）therapy. Although early diagnosis of TSC is important for postnatal systemic management and detection of complications associated with TSC, diagnosis of TSC can be difficult because of premature birth. We hope to accumulate more reports on TSC in preterm infants and data on the efficacy or side effects of new therapeutic agents for complications associated with TSC.