Faculty Profiles - MAKI Jota

Papers - MAKI Jota

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Partner relationships, hopelessness, and health status strongly predict maternal well-being: an approach using light gradient boosting machine. Reviewed International journal

Hikaru Ooba, Jota Maki, Takahiro Tabuchi, Hisashi Masuyama

Scientific reports 13 ( 1 ) 17032 - 17032 2023.10

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

No recent study has explicitly focused on predicting the well-being of pregnant women. This study used data from an extensive online survey in Japan to examine the predictors of the subjective well-being of pregnant women. We developed and validated a light Gradient Boosting Machine (lightGBM) model using data from 400 pregnant women in 2020 to identify three factors that predict subjective well-being. The results confirmed that the model could predict subjective well-being in pregnant women with 84% accuracy. New variables that contributed significantly to this prediction were "partner help", "hopelessness," and "health status". A new lightGBM model was built with these three factors, trained and validated using data from 400 pregnant women in 2020, and predicted using data from 1791 pregnant women in 2021, with an accuracy of 88%. These factors were also significant risk factors for subjective well-being in the regression analysis adjusted for maternal age, region, parity, education level, and the presence of mental illness. Mediation analysis, with "hopelessness" as the mediator, showed that both "partner help" and "health status" directly and indirectly affected the outcome.

DOI： 10.1038/s41598-023-44410-1

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Relationship Between Heated Tobacco Products and Placental Abruption: A Prospective Cohort Study Using Online Questionnaire. Reviewed International journal

Hikaru Ooba, Jota Maki, Takahiro Tabuchi, Hisashi Masuyama

Journal of epidemiology and global health 15 ( 1 ) 30 - 30 2025.2

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Placental abruption (PA) is a critical obstetric complication, with maternal smoking recognized as a key risk factor. Despite the increased use of heated tobacco products (HTPs), the impact of HTPs remains unclear. This study investigated whether pregnant women using HTPs are at a higher risk of PA than non-users. METHODS: We analyzed data from "the Japan COVID-19 and Society Internet Survey," a prospective, self-reported online survey cohort. Questionnaires were randomly distributed between July 28, 2021, and August 30, 2021. Pregnant respondents in 2021 were invited to complete an additional survey from February 14, 2022, to February 28, 2022. We set the outcome as the absolute risk difference (aRD) and relative risk ratio (rRR) of PA incidence due to smoking HTPs in the first trimester of pregnancy. The sample size included 12 836 participants. We calculated outcomes using a generalized linear model (GLM) and inverse probability of treatment weighting (IPTW). We also performed a Bayesian approach and multiple-bias analysis for sensitivity analysis. RESULTS: We found the robust aRD of 0.07 (95% confidence interval (CI): 0.06, 0.09) and the rRR of 11.3 (95% CI: 7.5, 17.0). Multiple bias analyses showed that unmeasurable confounders would need to have at least an rRR = 14 relationship with both exposure and outcome to disprove the observed association. There has not been post hoc analysis or secondary use of data. CONCLUSION: Early pregnancy use of HTPs is associated with an increased risk of PA.

DOI： 10.1007/s44197-025-00373-2

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Voice analysis and deep learning for detecting mental disorders in pregnant women: a cross-sectional study. Reviewed International journal

Hikaru Ooba, Jota Maki, Hisashi Masuyama

Discover mental health 5 ( 1 ) 12 - 12 2025.2

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Perinatal mental disorders are prevalent, affecting 10-20% of pregnant women, and can negatively impact both maternal and neonatal outcomes. Traditional screening tools, such as the Edinburgh Postnatal Depression Scale (EPDS), present limitations due to subjectivity and time constraints in clinical settings. Recent advances in voice analysis and machine learning have shown potential for providing more objective screening methods. This study aimed to develop a deep learning model that analyzes the voices of pregnant women to screen for mental disorders, thereby offering an alternative to the traditional tools. METHODS: A cross-sectional study was conducted among 204 pregnant women, from whom voice samples were collected during their one-month postpartum checkup. The audio data were preprocessed into 5000 ms intervals, converted into mel-spectrograms, and augmented using TrivialAugment and context-rich minority oversampling. The EfficientFormer V2-L model, pretrained on ImageNet, was employed with transfer learning for classification. The hyperparameters were optimized using Optuna, and an ensemble learning approach was used for the final predictions. The model's performance was compared to that of the EPDS in terms of sensitivity, specificity, and other diagnostic metrics. RESULTS: Of the 172 participants analyzed (149 without mental disorders and 23 with mental disorders), the voice-based model demonstrated a sensitivity of 1.00 and a recall of 0.82, outperforming the EPDS in these areas. However, the EPDS exhibited higher specificity (0.97) and precision (0.84). No significant difference was observed in the area under the receiver operating characteristic curve between the two methods (p = 0.759). DISCUSSION: The voice-based model showed higher sensitivity and recall, suggesting that it may be more effective in identifying at-risk individuals than the EPDS. Machine learning and voice analysis are promising objective screening methods for mental disorders during pregnancy, potentially improving early detection. CONCLUSION: We developed a lightweight machine learning model to analyze pregnant women's voices for screening various mental disorders, achieving high sensitivity and demonstrating the potential of voice analysis as an effective and objective tool in perinatal mental health care.

DOI： 10.1007/s44192-025-00138-0

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Effectiveness of Exercise Therapy on Chemotherapy-induced Peripheral Neuropathy in Patients with Ovarian Cancer: A Scoping Review Reviewed

Masanori Konuma, Tomohiro Ikeda, Tomohiro Mitoma, Shinsuke Shirakawa, Jota Maki, Yoshimi Katayama, Masanori Hamada, Shoji Nagao, Toshifumi Ozaki

Gynecologic Oncology 192 155 - 162 2024.12

自然妊娠後に発症した正所異所同時妊娠の1例 Reviewed

高谷優, 大平安希子, 栗山千晶, 坂田周治郎, 大石恵一, 末森彩乃, 中藤光里, 大羽輝, 三苫智裕, 加藤正和, 三島桜子, 桐野智江, 牧尉太, 衛藤英理子, 増山寿

現代産婦人科 73 ( 1 ) 97 - 101 2024.12

Language：Japanese Publisher：中国四国産科婦人科学会

正所異所同時妊娠(HP;Heterotopic Pregnancy)は,子宮内妊娠と異所性妊娠が共存している状態である。生殖補助医療(ART)が要因の1つと考えられているが,自然妊娠後に発生したHPの1例を経験したので報告する。症例は30歳,4妊1産。自然妊娠にて妊娠成立し前医で妊娠管理していた。妊娠8週2日に急激な右下腹部痛が出現し前医に救急搬送された。子宮内に週数相当の胎芽と,ダグラス窩に液体貯留,右卵巣周囲に血腫像が疑われ,一時的に血圧低下を認めたため当院へ転院。卵巣出血に対して保存的加療を開始した。しかし翌日に血圧低下と腹腔内出血の増悪を認め,循環血液量減少性ショックと診断し緊急手術となった。術中所見より右卵管膨大部妊娠破裂と診断,右卵管切除術が施行された。術後経過良好で術後5日目に退院となった。その後の妊娠経過は良好であり,妊娠40週6日に経腟分娩にて男児を出産した。正所異所同時妊娠は子宮内妊娠の存在により子宮外の嚢胞を黄体嚢胞と間違えやすく,診断が困難である。ART後妊娠の他に骨盤内炎症性疾患,卵管手術歴,卵巣刺激などが正所異所同時妊娠のリスク因子と考えられているが,本症例は該当せず診断に苦慮した1例であった。妊娠初期に子宮内妊娠を確認した後の急性腹症,循環血液量減少性ショックの原因として,正所異所同時妊娠の可能性を考慮する必要があると考えられた。(著者抄録)

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胎児超音波検査にて臍帯ヘルニアと両大血管右室起始を認め,出生後にheteropagus twinsと診断した一例 Reviewed

杉原百芳, 谷和祐, 大羽輝, 三苫智裕, 三島桜子, 大平安希子, 桐野智江, 牧尉太, 衛藤英理子, 早田桂, 増山寿

現代産婦人科 73 ( 1 ) 91 - 95 2024.12

Language：Japanese Publisher：中国四国産科婦人科学会

【緒言】Heteropagus twinsは,双胎の一児(自生体)に不完全な個体である他の児(寄生体)が結合したもので,100万出生に1例の頻度とされている極めてまれな先天異常である。今回,胎児超音波検査にて臍帯ヘルニアと両大血管右室起始を認め,出生後にheteropagus twinsと診断した一例を経験したため報告する。【症例】33歳女性,2妊1産。超音波検査にて臍帯ヘルニア及び胎児心構築異常が疑われ妊娠26週に当院紹介となった。妊娠27週時の羊水検査は46,XY正常核型,妊娠34週にMRI施行,肝および腸管の一部が脱出した臍帯ヘルニア,両大血管右室起始,心室中隔欠損症の胎内診断となった。妊娠38週3日に選択的帝王切開を施行した。2764g,Apgar score6点/8点の男児で上腹部に寄生体を認めた。出生時MRI検査等の精査を行い,臍帯ヘルニアと両大血管右室起始,心室中隔欠損症,肺動脈弁狭窄症に加えheteropagus twinsの診断となった。寄生体は下肢,陰茎,陰嚢,精巣様の構造物を有し,日齢11に結合双胎切除術および臍帯ヘルニアに対して一期的閉鎖術を施行した。日齢78に術後経過良好で退院となった。【考案】結合双胎の出生前診断は非常に困難である。しかし多くの症例では臓器や主要な血管の共有は少ないため外科手術は一般的に容易であり,予後は良好である。本症例では出生前診断には至らなかったが,各科と連携していたことで出生後の慎重な管理や家族のサポートが可能であった。非常に稀な疾患ではあるが,臍帯ヘルニアや心構築異常を合併し,染色体異常を伴わない場合にはheteropagus twinsを含めた希少な疾患も念頭に置き,慎重な評価をすることが重要である。(著者抄録)

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ADAR1 could be a potential diagnostic target for intrauterine infection patients. Reviewed International journal

Keiichiro Nakamura, Kunitoshi Shigeyasu, Thuy Ha Vu, Jota Maki, Kazuhiro Okamoto, Hisashi Masuyama

Scientific reports 14 ( 1 ) 29419 - 29419 2024.11

Language：English Publishing type：Research paper (scientific journal)

Intrauterine infection (IUI) is mainly an ascending infection in which vaginal and cervical pathogens ascend to the uterus and can affect the fetus. Until now, there is still no effective diagnostic biomarker for IUI, such as chorioamnionitis (CAM) and funisitis (FUN). Deoxyribonucleic acid (DNA)/Ribonucleic acid (RNA) editing molecules such as apolipoprotein-B mRNA-editing complex (APOBEC) 3 families and Adenosine deaminase family acting on RNA (ADAR)1 were examined in chorioamniotic membranes and umbilical cord of 83 patient samples. Furthermore, Ureaplasma parvum induced ADAR1 was investigated in human HTR-8/SVneo EVT cell line. ADAR1 had a significantly higher area under the curve (AUC) (0.721 and 0.745) than other APOBEC3s or cytokines in CAM and FUN patients. In vitro, ureaplasma parvum was demonstrated to activate ADAR1 (p = 0.025) and reduce RIG-I, IRF3, IFN-[Formula: see text], and IFN-β expression in EVT cell line (p = 0.005, p = 0.010, p < 0.001, and p = 0.018, respectively). High expression of ADAR1 was strongly associated with CAM and FUN patients (multivariate analyses; p = 0.035 and p = 0.002). ADAR1 could be a potential diagnostic target for IUI, such as CAM and FUN patients.

DOI： 10.1038/s41598-024-81097-4

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地域産婦人科医療における統合的医療DXの推進 Invited Reviewed

牧尉太

Rad Fan(ラドファン) 22 ( 13 ) 68 - 72 2024.11

健康・医療情報のデータ共有基盤構築/デジタル田園健康特区での取組みデジタル田園健康特区での健康医療系サービス実装に関する現状と課題 Reviewed

牧尉太, 那須保友, 櫻井淳, 前田嘉信

医療情報学連合大会論文集 44回 337 - 340 2024.11

Decline in and recovery of fertility rates after COVID-19-related state of emergency in Japan. Reviewed International journal

Tomohiro Mitoma, Jota Maki, Hikaru Ooba, Hisashi Masuyama

BMJ open 14 ( 10 ) e087657 2024.10

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: The COVID-19 pandemic led to a decline in fertility rates worldwide. Although many regions have experienced a temporary drop in fertility rates with the spread of the infection, subsequent recovery has varied across countries. This study aimed to evaluate the impact of COVID-19 infection rates and regional sociodemographic factors on the recovery of fertility rates in Japan following the state of emergency. METHODS: This study examined prefectural fertility data from before the COVID-19 pandemic to forecast fertility rates up to 2022 using a seasonal autoregressive integrated moving average model. A regression analysis was conducted on fertility rates during the first state of emergency and the subsequent recovery rate with respect to the number of new COVID-19 cases and sociodemographic factors specific to each prefecture. RESULTS: During the first state of emergency, the monthly fertility rate decreased by an average of -13.8% (SD: 6.26, min: -28.78, max: 0.15) compared with the previous year. Over the following 22 months, the average fertility recovery rate was +2.31% (SD: 3.57; min: -8.55, max: 19.54). Multivariate analysis of the impact of the pandemic on fertility changes during the first emergency indicated a negative correlation between new COVID-19 cases per capita and the proportion of nuclear households. No significant correlation was found between fertility recovery rate and new COVID-19 cases or emergency duration. When classifying fertility rate fluctuation patterns before and after the emergency into four clusters, variations were noted in the proportion of the elderly population, marriage divorce rate and the number of internet searches related to pregnancy intentions across the clusters. CONCLUSIONS: No association was found between pregnancy intentions related to the spread of infection, such as the number of new cases and the fertility recovery rate following the first state of emergency. Differences in the patterns of decline and recovery during the pandemic were observed based on population composition and internet searches for infection and pregnancy across different prefectures.

DOI： 10.1136/bmjopen-2024-087657

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Evaluating the impact of a trial of labor after cesarean section on labor duration: a retrospective cohort study. Reviewed International journal

Hikaru Ooba, Jota Maki, Hisashi Masuyama

BMC pregnancy and childbirth 24 ( 1 ) 542 - 542 2024.8

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Cesarean section (C-section) rates are increasing globally, and repeated C-sections are associated with increased maternal morbidity. Trial of labor after C-section (TOLAC) is an approach to reduce the recurrence of C-sections. However, limited research exists on the impact of cesarean scars on labor duration in TOLAC, considering the termination of labor through C-section and selection bias. This study aimed to investigate the impact of cesarean scars on labor duration in TOLAC participants, accounting for potential confounding factors and biases. METHODS: This retrospective cohort study included 2,964 women who attempted vaginal birth at a single center in Japan from 2012 to 2021. The study categorized participants into TOLAC (n = 187) and non-TOLAC (n = 2,777) groups. Propensity scores were calculated based on 14 factors that could influence labor duration, and inverse probability of treatment weighting (IPTW) was applied. Cox proportional hazards regression analysis estimated hazard ratios (HRs) for labor duration, with and without IPTW adjustment. Sensitivity analyses used propensity score matching, bootstrapping, and interval censoring to address potential biases, including recall bias in the reported onset of labor. RESULTS: The unadjusted HR for labor duration in the TOLAC group compared to the non-TOLAC group was 0.83 (95% CI: 0.70-0.98, P = 0.027), indicating a longer labor duration in the TOLAC group. After adjusting for confounding factors using IPTW, the HR was 0.98 (95% CI: 0.74-1.30, P = 0.91), suggesting no significant difference in labor duration between the groups. Sensitivity analyses using propensity score matching, bootstrapping, and interval censoring yielded consistent results. These findings suggested that the apparent association between TOLAC and longer labor duration was because of confounding factors rather than TOLAC itself. CONCLUSIONS: After adjusting for confounding factors and addressing potential biases, cesarean scars had a limited impact on labor duration in TOLAC participants. Maternal and fetal characteristics may have a more substantial influence on labor duration.

DOI： 10.1186/s12884-024-06744-0

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The adenosine deaminase family acting on RNA 1 can be a useful diagnostic biomarker in chorioamnionitis. Reviewed International journal

Keiichiro Nakamura, Kunitoshi Shigeyasu, Jota Maki, Eriko Eto, Hisashi Masuyama

Placenta 153 53 - 58 2024.8

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Chorioamnionitis (CAM) involves infection and inflammation of the chorion and amniotic membrane, but there are still no effective diagnostic biomarkers for CAM. METHODS: We investigated the correlation between RNA editing enzyme Adenosine deaminase family acting on RNA 1 (ADAR1) and CAM in chorion and amniotic membrane specimens derived from premature rupture of the membrane (PROM), CAM (pathologically diagnosed), and clinical CAM (clinically diagnosed) patients using reverse transcription polymerase chain reaction (RT-PCR). RESULTS: ADAR1 was upregulated in the chorion and amniotic membrane specimens of CAM and clinical CAM patients (p < 0.001 and p = 0.005). ADAR1 had a significantly higher area under the curve (AUC) (0.735 and 0.828) than markers of inflammation characteristics in diagnosing CAM and clinical CAM patients. ADAR1 also had significantly higher AUC (0.701 and 0.837) than clinical characteristics for CAM and clinical CAM patients. DISCUSSION: ADAR1 can be a useful diagnostic biomarker in CAM patients.

DOI： 10.1016/j.placenta.2024.05.133

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Multicenter Remote-Access Simulation of Vaginal Delivery for High-Flexibility Medical Education during the Coronavirus Pandemic. Reviewed

Eriko Eto, Jota Maki, Noriyuki Yamashita, Toru Hasegawa, Ayano Suemori, Hikari Nakato, Hikaru Oba, Tomohiro Mitoma, Sakurako Mishima, Satoe Kirino, Akiko Ohira, Hisashi Masuyama

Acta medica Okayama 78 ( 4 ) 313 - 322 2024.8

Language：English Publishing type：Research paper (scientific journal)

During the coronavirus pandemic, face-to-face simulation education became impossible. Therefore, we aimed to develop remote-access simulation education with a sense of realism through Information and Communication Technology (ICT) using a perinatal whole-body management and delivery simulator. In September 2021, we administered a multi-center simultaneous remote simulation based on our developed model. Ten universities in the Chugoku-Shikoku region were connected via a web-conferencing system to a live broadcast of a virtual vaginal birth in which a fictional hospitalized pregnant woman experienced accelerated labor and gave birth through vacuum delivery for fetal distress. A Video on Demand (VOD) was made beforehand using a new simulator that allowed for a visual understanding of the process of the inter-vaginal examination. We provided a participatory program that enhanced the sense of realism by combining VOD and real-time lectures on each scenario, with two-way communication between participants and trainee doctors using a chat function. Most participants answered "satisfied" or "very satisfied" with the content, level of difficulty, and level of understanding. From November 2021, we have used the videos of all processes in face-to-face classes. Our construction of a high-flexibility education system using remote simulation in the field of obstetrics and gynecology, especially in the vaginal delivery module, is unique, creative, and sustainable.

DOI： 10.18926/AMO/67547

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【周産期(産科)の手術の工夫-筆者はこうしている】帝王切開術筋層縫合法新しい縫合糸による筋層縫合 Invited Reviewed

牧尉太, 増山寿

周産期医学 54 ( 8 ) 1084 - 1088 2024.8

Authorship：Lead author,　Corresponding author Language：Japanese Publisher：(株)東京医学社

＜文献概要＞はじめに帝王切開は,女性の開腹手術のなかで最も施行される基本的な手術の一つである。WHOは,帝王切開による出産を10～15%以内とすることを求めているが,近年,医学的そして社会的な状況の変化に伴い,その頻度は増加している。出産という女性特有のイベントは,女性の社会進出と人生設計の最も重要な節目の時期に訪れる。その時期にわが国では4人に1人の女性が余儀なくされる帝王切開術により生じる子宮筋層の癒合不全や瘢痕部の菲薄化(cesarean scar defect:CSD)に注目が集まっている。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J00621&link_issn=&doc_id=20240829020007&doc_link_id=10.24479%2Fperi.0000001677&url=https%3A%2F%2Fdoi.org%2F10.24479%2Fperi.0000001677&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Barbed versus conventional sutures for cesarean uterine scar defects: A randomized clinical trial. Reviewed International journal

Jota Maki, Tomohiro Mitoma, Hikaru Ooba, Hikari Nakato, Sakurako Mishima, Kazumasa Tani, Eriko Eto, Dan Yamamoto, Risa Yamamoto, Kenji Kai, Takashi Tamada, Kazuyo Akamatsu, Kunihiro Kawanishi, Hisashi Masuyama

American journal of obstetrics & gynecology MFM 6 ( 9 ) 101431 - 101431 2024.7

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The role of barbed sutures in preventing myometrial defects and enhancing postpartum outcomes after cesarean section is uncertain. OBJECTIVE: This study compared clinical and ultrasonographic outcomes of uterine scar defects after C-section with barbed and conventional smooth thread sutures. STUDY DESIGN: This was a multicenter, parallel-group, randomized, controlled clinical trial. Four obstetrics and gynecology departments across three Japanese healthcare regions were included. The participants were women requiring their first cesarean delivery between May 2020 and March 2023. Of the 1211 participants enrolled, 298 underwent cesarean section and 253 were followed-up until July 2023. Participants with singleton pregnancies were randomly assigned (1:1 ratio) to receive either conventional or spiral thread sutures with a double-layer continuous suture. The study period comprised the time of consent to the 6- to 7-month examination. The primary endpoint was the rate of scar niches >2 mm evaluated using transvaginal ultrasonography at 6 to 7 months after surgery. Additional metrics included the total operative time, suture application time, operative blood loss, number of additional sutures required for hemostasis, maternal surgical complications, postoperative infections, surgeon's years of experience, and individual subscale scores. RESULTS: All data of the 220 participants (barbed suture group: 110; conventional suture group: 110) were available, thus enabling a full analysis set. A comparison of the barbed and conventional suture groups, respectively, revealed the following: niche length, 2.45±1.65 mm (range: 1.0-6.7) versus 3.79±1.84 mm (range: 1.0-11.0) (P<0.001); niche depth, 1.78±1.07 mm (range: 1.0-5.7) versus 2.70±1.34 mm (range: 1.0-7.3) (P<0.001); residual myometrial thickness, 8.46±1.74 mm (range: 4.8-13.0) versus 7.07±2.186 mm (range: 2.2-16.2) (P<0.001); and niche width, 1.58±2.73 mm (range: 0.0-14.0) versus 2.88±2.36 mm (range: 0.0-11.0) (P<0.001), respectively. The barbed suture group exhibited no defects and a residual myometrial thickness <3 mm. Furthermore, the barbed suture group had a lower rate of uterine niches (29.1%; n=32/110) than the conventional suture group (68.2%; n=75/110). Secondary outcomes showed no significant differences in operative times, maternal surgical complications, or postoperative complications. CONCLUSIONS: Double-layer barbed sutures during cesarean delivery may prevent cesarean section scar defects and postoperative complications.

DOI： 10.1016/j.ajogmf.2024.101431

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The problems with information transmission for people with hearing loss during disasters and emergencies and the solution for them Reviewed

Kataoka Y., Kobayashi Y., Noda Y., Ohmori I., Maki J., Hiyoshi K., Honda T.

Japanese Journal of Disaster Medicine 29 ( 2 ) 124 - 130 2024.5

Total laparoscopic wedge resection for an intramural ectopic pregnancy using an intraoperative ultrasound system: A case report. Reviewed

Kotaro Kubo, Atsushi Fujikawa, Tomohiro Mitoma, Sakurako Mishima, Akiko Ohira, Satoe Kirino, Jota Maki, Eriko Eto, Hisashi Masuyama

Asian journal of endoscopic surgery 17 ( 2 ) e13303 2024.4

Language：English

Intramural pregnancy is a rare form of ectopic pregnancy, and the optimal treatment remains uncertain. We describe a 33-year-old woman (gravida 2, para 0) who visited our hospital with suspected ectopic pregnancy. The patient was asymptomatic and hemodynamically stable. Transvaginal ultrasonography revealed pregnancy at 6 weeks of gestation and a gestational sac and fetal heartbeat in the anterior muscular layer of the uterus, away from the endometrium. The fetal sac measured 26 mm. The serum human chorionic gonadotropin (hCG) level had increased to 27 655 mIU/mL. Accordingly, the patient was diagnosed with an intramural ectopic pregnancy and underwent total laparoscopic wedge resection using intraoperative ultrasonography. The postoperative course was uneventful, and she was discharged after 4 days. Her serum hCG level normalized at 26 days postoperatively. This case indicates that intraoperative laparoscopic ultrasonography seems viable for treating intramural pregnancies.

DOI： 10.1111/ases.13303

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【産婦人科医のための緊急対応サバイバルブック】産科編妊産褥婦の合併疾患への対応法糖尿病性ケトアシドーシス Reviewed

牧尉太

臨床婦人科産科 78 ( 4 ) 308 - 312 2024.4

帝王切開-疾患構造の変化に対応する新たな取り組み- 子宮創部菲薄化低減を目指す糸の役割 Barbed Sutureによる無結紮子宮再建 Reviewed

牧尉太, 増山寿

日本周産期・新生児医学会雑誌 59 ( 4 ) 479 - 481 2024.4

【帝王切開のネガティブ・インパクトの克服と新たな取り組み】ネガティブ・インパクトの回避に向けた取り組み有棘糸を用いた子宮筋層縫合法 Reviewed

牧尉太

産婦人科の実際 73 ( 3 ) 243 - 248 2024.3

Authorship：Lead author,　Last author,　Corresponding author Language：Japanese Publisher：金原出版(株)

＜文献概要＞帝王切開は,われわれ産婦人科医が最も日常的に行う基本的な手術の1つであるが,難手術ケースも散在するため,術前のシミュレーションや熟達者との修練・指導が重要である。Barbed Sutureを子宮筋層縫合に使用することで,二層連続縫合の手術手順の運針操作を従来どおり行うことができ,かつ術者の習熟度を問わず子宮創部菲薄化予防を達成できる可能性が示唆される。ただし,帝王切開はあくまで手術であり,分娩時期のリスク評価・内診所見・分娩進行・胎児心拍陣痛図の正確な判読を行い,安易な手術選択を避け,帝王切開自体のリスクに鑑みることは言うまでもない。

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