Background: To evaluate maternal and neonatal outcomes of assisted reproductive technology (ART). Materials and Methods: Pregnant women registered from 2015 through 2017 (n = 6994) at five perinatal centers that managed high-risk pregnancies in Mie, Japan, retrospectively. Rates of preterm birth (<37 gestational weeks), early onset preeclampsia (<34 gestational weeks), late onset preeclampsia (≥34 gestational weeks), low-lying placenta, placenta previa, placenta accreta, placental abruption, atonic bleeding, uterine rupture, and amniotic fluid embolism after ART were evaluated. ART was defined as in vitro fertilization and micro-fertilization. Fisher’s exact test, Mann–Whitney’s U test, and logistic regression analysis were used to analyze the data. Results: Rates of obstetrical complications including low-lying placenta, placenta previa, placenta accreta, and atonic bleeding were increased with ART compared to those with the control. Particularly, ART was associated with a significantly increased rate of placenta accreta (adjusted odds ratio: 7.35, 95% confidence interval (CI): 3.20–16.6) and significantly decreased rate of placental abruption (adjusted odds ratio: 0.24, 95% CI: 0.07–0.61). Conclusions: This study showed that ART may reduce placental abruption and increase placenta previa. There is a possibility that the placenta attaches deeper in the myometrium because of ART.

We present a patient with a low-grade appendiceal mucinous neoplasm, resulting in disseminated peritoneal adenomucinosis (pseudomyxoma peritonei) with uterine involvement, and mimicking primary mucinous endometrial adenocarcinoma. On immunohistochemistry, neoplastic glands were cytokeratin 7-negative and cytokeratin 20-positive, indicating a gastrointestinal origin rather than a primary ovarian mucinous neoplasm. A diagnosis of uterine metastasis of appendiceal origin was made, based on the constellation of clinicopathological findings, that is, preceding appendiceal neoplasm, peritoneal involvement, absence of coexisting prototypical endometrioid adenocarcinoma or endometrial hyperplasia. The patient underwent hysterectomy and there was no evidence of disease progression at the 12-month follow up. This suggested the indolent nature of this particular neoplasm, despite its advanced stage.

Nonbacterial thrombotic endocarditis (NBTE) commonly occurs in advanced malignancies associated with a cancer-related hypercoagulable state, but the prevalence of NBTE in patients with less advanced malignancies is unknown. A 46-year-old woman had multiple thromboembolic events and disseminated intravascular coagulation on admission. Transthoracic echocardiography showed several growths on the mitral valve. Pelvic magnetic resonance imaging revealed a rapidly enlarging large tumor. In spite of anticoagulation therapy, she died 1.5 months after admission. At autopsy, NBTE with stage Ia ovarian cancer was diagnosed. In cases of higher-growth rate tumors with abundant necrosis, NBTE may occur in early-stage (even in stage Ia) ovarian cancer. In the majority of stage Ia ovarian cancers, curative surgical resection can be done. Prognostic improvement may be gained by such positive intervention, although this depends on the patient's general condition when NBTE occurs. With tumor resection, there is a possibility that the patient will recover from the hypercoagulable state and a poor outcome will be avoided.

A cotyledonoid dissecting leiomyoma is categorized as a leiomyoma with an unusual growth pattern, which is characterized by remarkable extrauterine bulbous growth in continuity with a dissecting myometrial component. A 36-year-old patient was preoperatively diagnosed with a mature cystic teratoma of the left ovary, and according to MRI, the tumor protruded from the uterus into the right broad ligament and was 10 cm in diameter. She underwent laparoscopic surgery to resect ovarian teratoma and the tumor under the right broad ligament. The tumor was almost completely resected and diagnosed as a cotyledonoid dissecting leiomyoma based on intraoperative and pathological findings. Recurrence was not seen for 26 months postoperatively in our case. Gross specimens are often mistaken for malignant lesions, but this was a benign disease. Even if some remnants of the leiomyoma remained postoperatively, recurrence has never been reported. When a cotyledonoid dissecting leiomyoma is resected laparoscopically, intrapelvic structures around it, such as the ureter, uterine artery, bladder, rectum and external iliac vessels, must be given careful attention.

Carcinomas other than adenocarcinomas are extremely rare in the fallopian tube. A 42-year-old woman with watery, intermittent vaginal discharge was found to have a left adnexal tumor. This case was diagnosed as primary carcinoma of the fallopian tube, FIGO Stage Ia. She underwent a total abdominal hysterectomy, a bilateral salpingo-oophorectomy, a pelvic and periaortic lymphoadenectomy, and an omentectomy, followed by cisplatin-based chemotherapy. Four years after the initial diagnosis of the disease, she remains in a disease-free state. Histologically, the tumor revealed a primary transitional cell carcinoma of the left fallopian tube. The findings on an immunohistochemical test for an epithelial membrane antigen, the CA125 antigen, were positive, whereas findings on a test for CEA were negative. We report a case of a malignant neoplasm of the fallopian tube with histological features of transitional cell carcinoma that arose from the tubal epithelium.