Aim: This study aimed to examine whether blood pressure ≥130/80 mmHg is an appropriate reference value for hypertension in pregnant women by conducting a meta-analysis of studies reporting maternal/perinatal outcomes according to blood pressure levels at <20 weeks of gestation.

Methods: The meta-analysis of studies identified through PubMed/MEDLINE and Ichushi-Web searches was conducted to evaluate the incidence of preeclampsia, gestational hypertension, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age birth.

Results: The meta-analysis of 12 prospective and retrospective cohort studies revealed that the risks of preeclampsia, gestational hypertension, and hypertensive disorders in pregnancy were higher in women with blood pressure ≥120/80 mmHg, particularly ≥130/80 mmHg, relative to <120/80 mmHg. The risk of preterm birth was higher in women with blood pressure ≥120/80 mmHg, and significantly higher in those with blood pressure ≥140/90 mmHg, relative to <120/80 mmHg. The risk of small-for-gestational-age birth did not differ significantly by blood pressure status.

Conclusions: Blood pressure ≥120/80 mmHg, particularly ≥130/80 mmHg, is associated with increased maternal and perinatal risks. We propose new blood pressure categories as normal (<120/80), high normal (120–129/<80), and elevated (130–139/80–89), although further studies will be needed to set ≥130/80 mmHg as a new reference for hypertension in pregnant women.

Uterine balloon tamponade is the first-line treatment for postpartum hemorrhage (PPH). However, as cases accumulate, the disadvantages of conventional balloons, such as difficulties with insertion, displacement, dislodgement, slipping outside, and occlusion of the drainage tube with blood clots, have become evident. The newly developed Atom uterine hemostatic balloon has a stylet designed as an insertion guide for smooth insertion. The end of the insufflation portion can be housed in the handle tip of the stylet inserted into the other drainage tube to facilitate retrograde insertion of the balloon and prevent damage to the cervical canal during cesarean section. This balloon was designed in the shape of an apple to prevent it from slipping off. A drainage port without projections was used to improve adhesion to the uterine luminal wall.

The Atom balloon was inserted transabdominally during cesarean section in 13 patients, transvaginally after completing cesarean section in two patients, and transvaginally after vaginal delivery in two patients. Use of the new balloon had a hemostatic effect in all cases, including a case with coagulopathy. Neither occlusion of the drainage tube nor dislodgement of the balloon was observed. There were no cases of abnormal placement, displacement, or dislodgement at the time of balloon insertion. No complications, such as cervical laceration during insertion or intrauterine infection, were observed.

The patient was a 38-year-old woman, gravida 2, para 1. Labor started at 40 weeks of gestation. Labor induction was initiated due to uterine inertia, and as fetal distress was observed, vacuum extraction was performed along with the Kristeller maneuver. Just after delivery, decreased blood pressure and hematuria were observed, and the patient was urgently transported to our hospital. Upon arrival, hematoma formation was noted in the bladder. Ultrasound on postpartum day 4 confirmed the formation of a vesicouterine fistula. The patient was diagnosed with unscarred uterine rupture and bladder rupture and underwent surgery. In this case, the external force applied to the uterus during delivery was presumed to be the cause of unscarred uterine rupture and bladder rupture. If hypotension or hematuria is observed during delivery, it is important to consider the possibility of unscarred uterine rupture and bladder rupture when managing the condition.

A 36-year-old female (gravida 1, para 0) had persistent anemia since early pregnancy in an otherwise normal course of pregnancy. She visited our department with a complaint of abdominal pain at 37 weeks 2 days of gestation. Her pain was initially accompanied by uterine contractions but later appeared independently. Fever and fetal tachycardia with decelerations were also observed. Abdominal ultrasound revealed fluid accumulation in the abdominal cavity, and an emergency cesarean section was performed with suspicion of placental abruption and imminent uterine rupture. A small amount of intestinal fluid was found in the abdominal cavity, leading to a diagnosis of peritonitis due to small intestinal perforation. A female infant weighing 2,560 g was delivered (Apgar score: 9; umbilical artery pH: 7.278). The patient underwent resection of the perforated portion of the small intestine and ileostomy. Postoperative pathological examination revealed Crohn’s disease. The patient was discharged after surgery and is undergoing remission induction therapy and nutritional therapy for Crohn’s disease.