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Letters to the Editor Amniocele after laparoscopic myomectomy: is expectant management acceptable? An amniocele is a herniation of the amniotic sac through a uterine myometrial defect, usually associated with a previous procedure of the uterus or other obstetric events. Although relatively asymptomatic, there is a potential risk for uterine rupture, which leads to acute life-threatening conditions for the mother and the fetus. Owing to the recent trend of pregnancy in women of more advanced age and the increase in the number of pregnant women

AimTo assess the accuracy of neonatal distress prediction using the five‐level classification of fetal heart rate (FHR) and management protocol of the Japan Society of Obstetrics and Gynecology (JSOG).MethodsA case–control study was conducted. Vertex singleton pregnant women who delivered after 37 weeks' gestation from 2013 to 2015 were enrolled. The participants were categorized into two groups; controls were levels 1–3 (n = 1184), whereas cases were levels 4–5 (n = 117) group. Neonatal distress was defined as Apgar score < 8 points at 5 min or umbilical cord artery pH < 7.1.ResultsThere were 117 cases (9.0%). The frequency of the neonatal distress was observed in 1.3% controls and 6.8% cases (P < 0.01). Diagnostic accuracy of neonatal distress for cases showed a 6.8% positive‐predictive value, 34.8% sensitivity, 91.5% specificity and 98.7% negative‐predictive value. Among various obstetrical conditions, high sensitivity (100%) for prediction of neonatal distress was observed in women with chromosome abnormalities, placental abruption, umbilical cord abnormalities and excessive labor pain. Conversely, relatively low specificity (<50%) was observed in cases with oligohydramnios and excessive labor pain.ConclusionThe five‐level classification scheme was efficient for neonatal distress prediction. However, depending on the obstetric condition, the FHR findings and neonatal condition might be independent.

We experienced a case with fetal hydrops, polyhydramnios, and a well‐defined oval anechoic lesion of approximately 9 cm in size, without blood flow at 26 weeks' gestation. As increased middle cerebral artery peak systolic velocity, the fetal hydrops was caused by a placental tumor such as a chorioangioma; however, the tumor was atypical. Fetal blood hemoglobin was 8.3 g/dl on percutaneous umbilical cord blood sampling. After erythrocytes transfusion to the fetus, the mother normally delivered at 38 weeks' gestation. The placental tumor was histologically diagnosed as a necrotic chorioangioma. Obstetricians should note such atypical chorioangiomas when differential diagnosis of placental tumors.