Congenital hydronephrosis is a congenital dilatation of the urinary tract, including the renal pelvis, renal calix, and ureter, due to developmental abnormalities of the urinary tract；in recent years, many asymptomatic cases have been detected by fetal and neonatal ultrasound screening tests. Congenital hydronephrosis has a broad spectrum, ranging from spontaneous resolution to conversely progressive renal damage, and it is necessary to provide the medical management according to pathophysiology of the diseases.

 First, a general overview is given of the pathology, symptoms, diagnostic imaging and key points of treatment from the fetal period to infancy, in accordance with the treatment algorithm in the medical management guide of Congenital Hydronephrosis in Children published by the Japanese Society of Pediatric Urology. It then describes the etiology, definition, classification, diagnosis, medical and surgical treatment, long-term course, and management of congenital hydronephrosis, including ureteropelvic junction obstruction, vesicoureteral reflux, ureterovesical junction obstruction, ureterocele, ectopic ureter, and lower urethral tract obstruction.

 We conducted a risk factor analysis for retinopathy of prematurity（ROP）requiring treatment in 381 extremely low birth weight infants who were born in our hospital between January 2004 and December 2019. Among the subjects, 94 infants（181 eyes）required treatment（photocoagulation, anti-vascular endothelial growth factor［anti-VEGF］therapy, or surgery）for ROP. We introduced intravitreal injection of an anti-VEGF agent in 2012, and included the era of anti-VEGF therapy as an independent factor. The treatment rate for ROP decreased significantly from 30%（62/204）before to 18%（32/177）after introduction of anti-VEGF therapy. There were no significant differences in the maximum stage, retinal detachment rate, or retreatment rate before and after introduction of anti-VEGF therapy. The ROP treatment rates in international classification stage 2 and stage 3 before and after anti-VEGF therapy introduction were 21%（7/33）vs. 0%（0/43）（p < 0.01）and 90%（35/39）vs. 65%（30/46）（p = 0.01）, respectively. There were significant decreases in the ROP treatment rates in the era of anti-VEGF therapy. Multivariate logistic analysis with ROP treatment as the dependent variable, and perinatal factor, clinical course, and treatment factor as the independent variables identified the introduction of anti-VEGF therapy as the factor that tends to reduce the rate of ROP requiring treatment（adjusted odds ratio 0.42; 95% confidence interval 0.15–1.10; p = 0.08）. It is worth conducting a multicenter study on the introduction of anti-VEGF therapy and the ROP treatment rate.

 There is no effective treatment for coronavirus disease（COVID-19）; hence, mRNA vaccination, as a preventive measure, is the most effective protection. However, there are concerned regarding this vaccination because of the lack of experience with mRNA vaccines. Moreover, limited studies have evaluated COVID-19 vaccination status among pregnant and postpartum women in Japan. Therefore, we conducted a questionnaire survey to clarify the COVID-19 vaccination status, occurrence of adverse reactions, and reasons for vaccination hesitancy among pregnant and postpartum women. Questionnaires were collected from 637 women（response rate: 87.5%）. The vaccination coverage was 76%. Moreover, 40% and 60% women were vaccinated before and during pregnancy, respectively. The emergency cesarean section rate among vaccinated women was 7.9%. Non-local adverse reactions occurred in 37% and 54% women at the time of the first and second vaccination, respectively. There was one case of convulsive seizure after the first vaccination. The most common reason for vaccination hesitancy was “concern regarding its effect on the fetus.” It is necessary to disseminate appropriate information regarding COVID-19 vaccination among pregnant women and their families to help them make an informed decision.

 Meconium-related ileus（MRI）is functional bowel obstruction characterized by impaired meconium excretion and abdominal distension, which occurs in very low birth weight infants.

 Severe fetal growth restriction（FGR）, cesarian section delivery, maternal hypertension, maternal diabetes, and maternal MgSO₄ therapy were considered to be the risk factors of MRI. We retrospectively investigated the risk factors for MRI in patients born between 2010 and 2020 in our hospital who were admitted to the NICU at less than 32 weeks’ gestation and less than 1,500 g birth weight. The diagnostic criteria for MRI were decreased frequency of meconium defecation, presence of vomiting and other symptoms suggestive of intestinal obstruction; increased intestinal gas or dilated and tortuous intestine in an abdominal x-ray study; no evidence of necrotizing enterocolitis or spontaneous intestinal perforation in this study.

 In univariate analysis, there were significant differences in perinatal factors such as birth weight and small-for-date infants（SFD）. Regarding maternal background, the incidence of MRI was significantly higher for maternal hypertension. On the other hand, the incidence of MRI was lower for maternal MgSO₄ therapy. Multivariate analysis was performed using the factors that showed significant differences in univariate analysis as independent variables. As a result, SFD was independent risk factors for MRI.

 Preterm infants with bilirubin encephalopathy（pBE）are still being reported, especially in those born extremely premature. Prolonged hyperbilirubinemia beyond the first week of life has been associated with pBE development. However, there is little evidence on managing the prolonged hyperbilirubinemia in extremely premature infants（EPIs）. This study retrospectively investigated EPIs born at our institution between April 2017 and March 2021. Among 76 EPIs who survived beyond the 28 days of life（DOL）, 26（34%）received phototherapy after 28 DOL based on unbound bilirubin（UB）reference values, but not on total bilirubin values, provided in the 2017 Kobe University treatment criteria. Among these 26 infants with prolonged hyperbilirubinemia, 7 demonstrated high UB values of more than 0.8 μg/dL, which is cut-off thresholds for predicting kernicterus, beyond the 28 DOL. To prevent pBE, prolonged unbound bilirubinemia beyond the neonatal period should be considered, especially when caring for EPIs.

 BACKGROUND: In child maltreatment prevention, it is important to identify child maltreatment risk from pregnancy. Using socially high-risk pregnancy screening checklist designed in our hospital, we examined their child maltreatment risk factors.

 METHODS: We defined socially high-risk children as those born at our hospital during the 5-year period from 2016 whose mothers scored 5 or higher on the socially high-risk pregnancy screening checklist and studied child maltreatment risk factors during pregnancy by dividing these children into child maltreatment and non-child maltreatment groups.

 RESULTS: Of the 5656 newborns born in our hospital during the study period, 439（7.8%）were born to socially high-risk pregnant women with a score of 5 or higher, of which 30（6.8%, 0.53% of all births）were in the child maltreatment group. Having a Council for Children Requiring Care during perinatal period was strongly associated with child maltreatment by OR 9.56（95% CI, 3.88-23.26）, and a socially high-risk pregnancy screening checklist total score of 12 or higher was strongly associated with child maltreatment by OR 4.93（95% CI, 2.10-12.59）. Risk factors predicting child maltreatment were detected as "pregnant women aged 22 years or younger", "pregnant women have been abused", and "pregnant women’s personal appearance is unhygienic”.

 CONCLUSION: Socially high-risk pregnancy screening checklist was useful in predicting child maltreatment and establishing child care support for socially high-risk families.

 Objective: While advances have been made in neonatal care in Japan, regional disparities exist in neonatal mortality. We investigated the actual situation of perinatal medical care at our hospital and clarified the issues for Iwate Prefecture.

 Methods: Subjects were newborns admitted to our neonatal intensive care unit from January 2008 to December 2017 who died in the hospital. Classifications of very low birth weight, chromosomal abnormalities, congenital heart diseases, other congenital anomalies, and other congenital anomalies with congenital heart diseases were applied. Clinical courses were retrospectively examined from the medical records.

 Result: No consistent trend was seen in the proportion of hospitalizations in each group. The mortality rate has declined since 2010. The proportion of very low birthweight infants among deaths decreased, but that of chromosomal and other congenital abnormalities increased. The mortality rate of very-low-birthweight infants after 2012 matched the national average, coinciding with an increase in the number of neonatologists.

 Discussion: In addition to advances in neonatal care, a relationship appears to exist between decreases in mortality rates and improvements in medical systems such as telemedicine. We consider that the main factors that contribute to improved mortality are stable medical resources. A smooth transition to home medical care for infants with medical care is an important problem to solve.

 【Objective】This study aimed to determine the appropriate volume of stored blood required for autologous transfusion in patients with postpartum hemorrhage. 【Method】We retrospectively collected data from mothers who stored autologous blood and delivered at our hospital from January 2015 to March 2019. We developed model protocols to determine the appropriate volume of stored autologous blood and estimated the volume required for autologous and allogenic transfusions based on each model protocol. 【Results】There were 55 cases, and the reasons for storing autologous blood were placenta previa（51%）, rare blood type（27%）, placenta accreta（11%）, low lying placenta（9%）, and leiomyoma（9%）. The average volume of stored blood was 757mL（300–1,400mL）, and the average volume for autologous transfusion was 486mL（0–1,200mL）. Six cases also used the stored blood for allogenic blood transfusion（average 1,440mL, 280－3,600mL）. According to the simulation by model protocols, the appropriate volume of stored autologous blood was 400mL at baseline and 800mL for cases with placental abnormalities（including placenta previa, accrete, and low-lying placenta）. For cases with placental lacunae in ultrasonographic findings, >400mL of stored blood was used. 【conclusion】The results of this study suggested that we can optimize the volume of stored autologous blood based on the reason for utilization and ultrasonographic placental findings in each case.

 Lamellar body is a surfactant-containing lamellar structure secreted from type II alveolar epithelial cells, and Lamellar body count（LBC）is used to estimate surfactant production in utero and to predict fetal lung maturity. We conducted this study to evaluate the neonatal respiratory status at 36-38 weeks of gestation using LBC. 127 Amniotic fluid were analyzed immediately with no centrifugation and the number of lamellar bodies was counted using a platelet channel on the Sysmex KX-21.12 neonates（9.4%）had respiratory disorders and 115（90.4%） did not. The LBC in respiratory disorders group was significantly lower than in control group（2.7×10⁴/μL vs. 6.0×10⁴/μL; p<0.001）. The optimal cut off value to predict neonatal respiratory disorders was 4.4×10⁴/μL（area under the curve 0.833, 95% confidence interval 0.702-0.963）, with a sensitivity of 91.7%, specificity 69.6%, positive predictive value 26.2% and negative predictive value 94.1%. The LBC in vaginal delivery cases was significantly higher than in caesarean section cases（8.0×10⁴/μL vs. 5.3×10⁴/μL; p=0.036）. LBC is a useful method that is very simple, rapid, objective, and accurate in detecting neonatal respiratory disorders cases.

 The clinical outcomes of dinoprostone vaginal insert and mechanical methods for cervical ripening were compared retrospectively. The duration of labor and the time taken for hospital discharge were significantly shorter in the vaginal group than in the mechanical group. Mothers in the vaginal group had a significantly higher percentage of deliveries within 24 hours of vaginal insertion of dinoprostone than those in the mechanical group. In cases in which labor was induced at 37 or 38 weeks’ gestation due to maternal complications, there were no cases in either group in which use was discontinued due to worsening complications. Moreover, the time taken for hospital discharge was significantly shorter in the vaginal group, indicating the usefulness of dinoprostone vaginal insert in patients with maternal complications. On the other hand, uterine tachysystole and fetal dysfunctions may occur while administering dinoprostone vaginal inserts; therefore, careful management and compliance with the directions for use is necessary.

 【Objective】Coronavirus disease 2019（COVID-19）has a negative impact on not only on the physical but also the mental health of pregnant women owing to its uncertain effects on pregnancy, self-blame for contacting disease, and the changes to the hospital environment caused by the need for isolation. This study investigated the psychological impact of COVID-19 on pregnant women, with the aim of developing a medical intervention method and a hospital environment that takes the psychological aspect into consideration. 【Method】A questionnaire survey was conducted among pregnant women affected by COVID-19 who were treated at our hospital between April 2020 and March 2021, The study used Whooley’s comprehensive two-item questionnaire, the Edinburgh Postpartum Depression Questionnaire with open-ended questions, and the NICE guideline two-item questionnaire. 【Result】Results were obtained from 18 of the 22 eligible patients during the study period: ten, five, and seven tested positive for the Whooley’s comprehensive two-item questionnaire, the Edinburgh Postnatal Depression Questionnaire, and the NICE guideline two-item questionnaire, respectively. The most common open-ended question was about the effects of COVID-19 on the fetus. 【Conclusion】Many pregnant women were concerned about the effects of COVID-19 on the fetus and needed accurate information regarding these effects. They felt lonely owing to isolation. Therefore, it is necessary to establish a support system to prevent isolation during daily treatment, such as visiting the room after taking infection control measures.

 We conducted a retrospective analysis on the clinical backgrounds and patient outcomes of 52 cases of congenital gastrointestinal atresia encountered in our institution in the past 28 years. These cases were divided into three groups: esophageal, duodenal, and intestinal atresia. Our evaluation revealed that the rate of polyhydramnios was significantly lower in the intestinal atresia group, but there was no significant difference in the rate of threatened preterm labor or preterm birth among all groups. Esophageal atresia had the highest perinatal mortality rate and the poorest neonatal prognosis. Conversely, there were no reported cases of chromosomal abnormalities in the intestinal atresia group, which had a good prognosis. Collectively, the prenatal diagnosis rate was 77% for all cases. Polyhydramnios as observed on ultrasonography, along with the appearance of gastric bubbles and bowel dilatation, and the use of fetal MRI all contributed to the prenatal diagnosis. However, when compared among groups, prenatal diagnosis and the accuracy of diagnostic rates by fetal MRI were significantly lower for esophageal atresia. Our analysis showed that ultrasonography and fetal MRI are useful tools for prenatal diagnosis of congenital gastrointestinal atresia, even though diagnosis is challenging in some cases. Since prenatal or postnatal prognosis depends on the site of the gastrointestinal tract obstruction, prenatal diagnosis has the significance of providing appropriate information to expectant parents, managing pregnancy, and facilitating neonatal treatment.

 【Aim】To determine the perinatal factors, especially qualitative and quantitative evaluation of enteral feeding on subsequent occurrence of extrauterine growth restriction（EUGR）in very-low-birthweight infants（VLBWI）.

 【Subjects and Methods】305 VLBWI whose gestational age < 30 weeks and birthweight >10%ile were enrolled. EUGR was defined as the z-score of body weight, head circumference and body length at expected date of confinement（EDC）was < -1.28, which is identical with < 10%ile. The subjects were divided into two group with or without EUGR at EDC in each anthropometric parameter, respectively. In addition to perinatal factors, intake volume of breast milk and formula milk from birth to 35 weeks’ postmenstrual age（early phase; ml/kg/day）and intake volume of breast milk and formula milk from 36weeks after gestation to EDC（Late phase; ml/kg/day）were compared between two group in each parameter, respectively.

 【Results】The EUGR rate in body weight, head circumference and body length were 35.4%, 3.6% and 47.8%, respectively. Logistic regression analysis revealed fewer breast milk intake in early phase was significant risk factor for subsequent EUGR in all three parameter, and longer mechanical ventilator days was significant risk in EUGR in body weight and length.

 【Conclusion】Larger volume of breast milk feeding, especially in premature period and shortened mechanical ventilation days may prevent the subsequent EUGR occurrence.

 Objective: We retrospectively examined the evaluation of cord blood glucose levels in predicting postnatal hypoglycemia and differences in blood glucose levels according to risk factors for hypoglycemia and modes of delivery. Subjects and methods: The subjects were 230 in-born babies between April 2021 and March 2022 who had risk factor of hypoglycemia and were measured for blood glucose levels. We compared 1-hour after birth and cord blood glucose levels and determined the cut-off value of cord blood glucose levels for predicting hypoglycemia. We also examined whether there were differences in blood glucose levels by risk factor and mode of delivery. Result: Cord blood glucose levels were significantly lower in the hypoglycemia group and the cut-off value of cord blood for hypoglycemia was 71mg/dl in all cases. There were also differences in blood glucose levels in 1-hour after birth and in cord blood depending on risk factors and mode of delivery. Conclusion: Cord blood glucose levels are considered to be useful in predicting postnatal hypoglycemia, and may help with early intervention for hypoglycemia.

 Objective: The purpose of this study was to identify risk factors for Adherent placenta.

 Methods: A retrospective cohort study was conducted on 3,733 vaginal delivery of singleton pregnancies between October 2015 and May 2021 at Showa University Northern Yokohama Hospital. The case group included 34 pregnancies which required the manual removal of the placenta and was clinically diagnosed with Adherent placenta. These cases were then compared with a control group consisting of 68 cases randomly selected from pregnancies demonstrating a normal delivery of the placenta. We compared the maternal backgrounds and delivery processes between the two groups. The placental pathology in the case group was also examined.

 Results: According to a multivariate analysis, ART pregnancy and a premature rupture of the membrane were independently associated factors. In the case group, chorioamnionitis was also found in 50% of the cases.

 Conclusion: In addition to ART pregnancies, our findings indicated that a premature rupture of the membrane may be a risk factor for Adherent placenta.

 Hereditary hemorrhagic peripheral telangiectasia（HHT）is an autosomal dominant progressive disorder characterized by multiple peripheral telangiectasia of the skin, mucous membrane and arteriovenous malformations（AVMs）of multiple organs and repeated bleeding as the three main symptoms. Reports of pregnancy cases complicated with HHT are rare. A 28-year-old G2P0 woman with AVM was referred to our department at 8 weeks’ gestation for perinatal care. Urinary protein was detected from 31 weeks’ gestation, but her blood pressure was not elevated. On day 3 of week 37 of pregnancy, she had a headache and repeated vomiting, so she visited our hospital. Because magnetic resonance imaging revealed cerebral hemorrhaging and she had an impaired consciousness, she underwent emergency Caesarean section and ventricular drainage. Computed tomography after the operation showed that the bleeding had been caused by rupture of a new cerebral aneurysm. Coil embolization was performed. She was diagnosed with hereditary hemorrhagic peripheral telangiectasia after surgery. She had no residual effects. There are few reports of HHT-complicated pregnancy that developed cerebral hemorrhaging during the course of pregnancy and underwent emergency Caesarean section. Since cerebral hemorrhaging during pregnancy has a high mortality rate, it is important to respond promptly and collaborate with other departments, including neurosurgery.

 Malformations of cortical development（MCD）are rare diseases. Patients with MCD are associated with severe clinical outcomes due to intractable epilepsy, hypotonia, and psychomotor developmental delay. Antenatal diagnosis is sometimes difficult because typical morphological features are usually observed after 30 weeks of gestational age. We herein report two cases of MCD diagnosed after birth.

 Case1

 A 38-year-old pregnant woman was referred to our institution at 29 weeks of gestation for evaluation of fetal ventriculomegaly and small cerebellum. At 35 weeks of gestation and the postnatal age of 4 days, Magnetic resonance imaging（MRI）showed the enlarged posterior fossa, but otherwise was unremarkable. At the postnatal age of 2 months, he had feeding difficulty and MRI revealed pachygyria, resulting in the diagnosis of MCD.

 Case2

 A 30-year-old pregnant woman visited our hospital at 27weeks of gestation because of polyhydramnios. Ultrasound examination demonstrated an AFI of 34 cm and large bladder of the fetus, showing no evidence of cranial nerve disease or intestinal atresia. Postnatal ultrasonography and MRI revealed pachygyria, reaching a diagnosis of MCD.

 Although antenatal diagnosis of MCD is challenging, ultrasonography focusing on the gyri and sulci contributes to prenatal diagnosis, and careful follow-up with pediatricians should be given to the newborn who has the possibility of neurological abnormalities.

 The novel coronavirus infections（COVID-19）during pregnancy are more likely to get severity and are high risk for premature delivery. Although the causality is unclear, some cases of acute pancreatitis with COVID-19 are also reported. We herein report the case of severe acute pancreatitis after COVID-19 pneumonia in pregnancy women, who resulted in delivery by cesarean section at 31 weeks gestation. A 37-year-old nulligravida women was admitted to referral hospital at 29 weeks gestation for COVID-19 pneumonia. Nine days after the diagnosis of COVID-19, she experienced epigastric pain with elevated amylase level, and was diagnosed as severe acute pancreatitis. While being treated for pancreatitis, the labor started at 31 weeks gestation, where she was transported to our hospital and delivered by cesarean section for indication of low-lying placenta and COVID-19. She had no risk factors of acute pancreatitis: including alcohol and gall stones. Pregnant women with COVID-19 should be managed considering not only respiratory disease and obstetrics complication, but various complications including acute pancreatitis.

 Pregnancy-associated aHUS is one of the conditions of thrombotic microangiopathy characterized by microangiopathic hemolytic anemia, consumptive thrombocytopenia, and organ damage due to intravascular platelet thrombus. We report a case of pregnancy-related aHUS with prolonged renal dysfunction after the onset of postpartum HELLP syndrome, with a review of the literature. The patient was 36 years old, had 3 pregnancies and 2 deliveries, and had no abnormalities of note. She was admitted to the hospital at 39 weeks and 0 day of pregnancy due to onset of labor pains, and vaginal delivery was performed 32 minutes after admission. After delivery, hypertension persisted, pericardial pain appeared, and blood tests revealed markedly elevated liver enzymes and LDH, and thrombocytopenia, leading to a diagnosis of HELLP syndrome. Renal function worsened from the second day postpartum, and pulmonary edema was observed from the fifth day. The patient was clinically diagnosed as having aHUS, and plasma exchange therapy was performed on the 7th and 8th postpartum days, and hemodialysis therapy was performed on the 10th postpartum day. Thereafter, her renal function improved steadily, and her general condition improved accordingly, and she was discharged from the hospital on the 17th postpartum day. At present, 12 months postpartum, there has been no recurrence of renal function decline.

 Neonatal Ductus arteriosus aneurysm（DAA）is considered as an innocent disease, and actually most of DAA disappear spontaneously. On the other hand, fatal complications of DAA have been reported. The characters of fatal DAA on the screen of ultrasound cardiography（UCG）and the necessity of the examinations for finding fatal DAA, how to follow DAA are unclear. We diagnosed DAA in 14 patients out of 204 neonates hospitalized to the department of neonatology in 7 months. We examined 14 cases of DAA and observed and recorded clinical characters. We could follow 13 of 14 patients with DAA by UCG until DAA disappeared. There were 3 patterns of the closing process:1）without thrombus formation in DAA, 2）with partial thrombus in DAA, 3）with fully filling thrombus in DAA. We performed contrast-enhanced computed tomography（CT）scan in 7 patients without symptoms because DAA appeared to press the left pulmonary artery on the UCG screen. In all the 7 cases, CT scan showed that DAA did not contact with LPA. In all cases, ductus arteriosus closed without symptoms. In 13 cases with the follow-up by UCG, DAA disappeared spontaneously without complications, irrespective of the closing processes. We suggest that asymptomatic DAA do not need invasive imaging techniques in addition to UCG, and we recommend the follow-up of DAA by UCG until it disappears completely, considering fatal complications and developing adult DAA.

 Congenital syphilis can be prevented by penicillin treatment of pregnant women with syphilis. Benzathine penicillin G is used worldwide, but it is difficult to use in Japan, because of following a fatal case of intramuscular penicillin injection in the 1950s, so, amoxicillin, an oral penicillin drug, is commonly used for the treatment of pregnant women with syphilis. There are few reports on infants born to pregnant women treated with amoxicillin.

 In this study, we examined six pregnant women with syphilis and their newborns who were treated with amoxicillin during antenatal care at our hospital from 2016.1. to 2020.12. Five patients were started on amoxicillin by 15 weeks of gestation, and one patient was first diagnosed at 21 weeks of gestation, so amoxicillin was started at 22 weeks of gestation. All of them received treatment of amoxicillin 1,500mg/day and the median duration of administration was 7.5 weeks（6-12 weeks）, and all cases were completed the administration 1 month before the delivery. In five pregnant women, the rapid plasma regain（RPR）titer, as nontreponemal antibodies, after amoxicillin treatment decreased more than a quarter compared with the pre-treatment RPR, but only one case did not show a quarter decrease. In all cases, the newborn’s RPR titer at birth was reduced to more than a quarter of the mother’s RPR titer at delivery. However, penicillin G treatment was administered to newborn whose RPR titer did not decrease by more than a quarter before and after the mother’s treatment. There were no cases of congenital syphilis diagnosed in all patients. Amoxicillin treatment of pregnant women with syphilis may be expected to prevent congenital syphilis.

 Body-stalk anomaly（BSA）is an extremely rare fatal disease which causes organ prolapse into the extra-embryonic body cavity. When BSA is associated with multiple pregnancies, it is difficult to make a policy decision. We report here a case of dichorionic-diamniotic twin（DD twin）with BSA in one of the twins.

 The patient was 33 years old. She presented to our hospital and was diagnosed as a DD twin. Ultrasound examination at 13 weeks gestation revealed that one child had an organ prolapse into the extra-embryonic body cavity and was diagnosed with BSA. Parents and multiple occupations discussed "what is best" for the fetuses and decided to continue the pregnancy. After managing complications, a cesarean section was performed on the 6th day of 36th week of pregnancy of gestation. The child with BSA weighed 1,656g and died at delivery. The healthy baby was a male weighing 2,096g and was discharged alive on the 10th day.

 In cases of multiple pregnancies with BSA, it is possible to have a live baby by strict management of obstetric complications, and it is important to discuss "what is best" for the fetuses with the multidisciplinary team and the parents.

 Introduction: While developments in cosmetic medicine have made breast augmentation more easily performed, little is known about the impact of breast augmentation on lactation. AQUAlift®, a nonabsorbable filler, should not be used in breast augmentation because of reported postoperative complications such as internal migration and infection. A patient delivered 3 years after AQUAlift® was injected into the bilateral breasts and developed mastitis. The patient was treated with drainage and analgesics, but the treatment was difficult, and she had difficulty continuing breastfeeding.

 Case: A 41-year-old woman, first delivery, had bilateral AQUAlift® injections into the breasts for breast augmentation at the age of 38. There was no report of breast augmentation during pregnancy. On postpartum day 10, fever and pain, redness, and induration of the left breast appeared, and the patient was monitored by a midwife with breast care and frequent milking, but there was no improvement. She was admitted to the hospital on postpartum day 17 with a diagnosis of mastitis. She was treated with drainage and analgesics, but her symptoms did not improve, and on the 25th and 31st postpartum she was weaned with cabergoline.

 Discussion: Due to advances in breast augmentation, breastfeeding assistants are often unaware of a history of surgery based on visual examination and palpation alone, and few patients voluntarily report their history. If a history of breast augmentation could be obtained during pregnancy, it would provide an opportunity for more careful observation of postpartum breast changes, including continued frequent breast care after discharge from the hospital. It is important to provide opportunities to discuss breastfeeding while checking the condition of the breasts during pregnancy, and when a history of breast augmentation is obtained, it is important to support the patient so that advice can be given on possible symptoms and countermeasures during lactation.

 Obstructive hemivagina and ipsilateral renal anomaly（OHVIRA）syndrome results from congenital anomalies of Wolff’s and Müller’s canals, which presents with a duplicated uterus, unilateral vaginal closure, and ipsilateral renal dysplasia.

 Case: Right multiple renal cysts and dilated lower intestines were suspected in a female fetus on ultrasonography. After birth, a 1cm cystic mass with a smooth surface, which increased in size with crying, was found below the urethral orifice.

 The right kidney and urinary tract had a polycystic appearance with dilated ureter on ultrasonography and no function by 99mTc- dimercaptosuccinic acid renal scintigraphy.

 Magnetic resonance urography revealed a dilated right ureter connected with the vulvar mass.

 The right ureteral orifice was not detected in the urethra and bladder by cystoscopy, and the right kidney and dilated ureter were removed by laparoscopy.

 Postoperatively, the vulvar mass disappeared, and uterus didelphys were found on ultrasonography, which could be diagnosed as OHVIRA syndrome.

 Discussion: Females with congenital unilateral kidney and urinary tract anomalies can have uterine and vaginal abnormalities, so careful examination is important.

 Incontinentia pigmenti, an X-linked dominant genetic disorder caused by NEMO gene mutations, may include complications not only in the skin but also in the central nervous system and eyes at the ectoderm. However, intestinal atresia as a complication of incontinentia pigmenti is rare. We encountered a female infant with incontinentia pigmenti and intestinal atresia. She was delivered vaginally at 38 weeks and 4 days of gestation: height 48.0 cm, weight 2,436 g, Apgar scores of 7 and 8 at 1 and 5 min, respectively. At her birth, she remained hospitalized based on the observation of erosions and warty lesions on the skin, suggesting congenital skin disease. A skin biopsy suggested incontinentia pigmenti. Enteral nutrition did not pass, and intestinal atresia was observed at exploratory laparotomy.

 An end-to-end anastomosis was performed, but the dilated intestinal tract remained after the operation, a dilated intestinal resection and an intestinal anastomosis was then performed. The patient was discharged from the hospital at the age of 80 days. Genetic testing revealed a NEMO gene exon 4–10 deletion type.

 The simultaneous presentation of incontinentia pigmenti and intestinal atresia has not been reported before, and we considered the possibility that the intestinal atresia was an accidental complication.