The Department of Obstetrics and Gynecology is divided into three main parts:

1. Gynecology
2. Obstetrics
3. Infertility treatment

We aim to deliver in all aspects of treatment, from primary care to the latest in advanced medical care.

In our outpatient section, we have respective sections for our non-pregnant and pregnant patients. From Monday to Friday, we have five consultation rooms in operation for first visits, two for follow-up visits, and the remainder for pregnancy check-ups and infertility. Other than the first visit, we operate on an appointment system. On Saturdays, we run three rooms, first visits, pregnancy check-ups and infertility.

Our inpatient ward is located on the fourth floor in Ward Building 1. Gynecology patients are located in the western section of the ward, obstetrics to the east and the Perinatal Centre is located to the south.

Gynecology

Cervical cancer As screening becomes more commonplace, the early detection of cervical cancer is increasing and cases of progressive cancer requiring total hysterectomy are decreasing. As a result, we are seeing an increasing polarization of cases, from premalignant or early stage cancer to progressive cancer which is inoperable. We perform conservative surgery for early-stage cervical cancer for those who wish to conceive again.

Endometrial cancer There is a clear upward trend of cases for this condition. As a result, we recommend hysteroscopy for any patients with metrorrhagia. For all patients, we conduct extensive testing and imaging to assess the stage of the cancer and determine the appropriate surgery. If the cancer is advanced then we prepare patients for surgery through pre-operative chemotherapy and the collection of autologous blood. Following surgery we conduct radiotherapy and supplemental chemotherapy according to pathology results.

Ovarian Cancer With the introduction of combination chemotherapy and secondary debulking surgery, we have seen a dramatic improvement in outcomes for patients. As a result, the five year survival rate for stage 1 cancer is 100% and for stage 3 cancer it is now over 40%. Care for terminal stage malignant tumors is significantly longer in duration than those in other areas of medicine. We administer terminal care in these cases with the patient’s quality of life in mind.

Uterine fibroid At one stage not available, pharmacotherapy is now a viable treatment option for this, resulting in a dramatic decrease in the number of cases requiring surgery to less than half. Diagnosis for this is increasing, with the patient demographic centered around women in their forties. In cases where surgery is required, transvaginal or laparoscopic-assisted transvaginal surgery are the preferred options. When this isn’t possible, we perform trans-abdominal surgery. For patients who wish to preserve their fertility, we conduct hysterosalpingography and MRI for possible myomectomy, a procedure which results in a high rate of fertility preservation postoperatively.

Laparoscopic surgery This surgery is performed either by introducing gas peritoneal cavity or by the wall-lift method. The surgical removal of benign ovarian cysts, adnexectomy and surgical intervention before rupture in an ectopic pregnancy are undertaken in most cases by laparoscopy. This lessens invasiveness and admission time.

Treatment is long-term for polycystic ovary syndrome, amenorrhea resulting from anorexia, hyperprolactinaemia, hormone imbalance and other disorders which affect patients from young womanhood onwards. For menopausal disorders resulting from age, there is hormone replacement therapy, which is undertaken whilst monitoring bone density.

Obstetrics

We delivered 1188 births in 2009, an annual increase, contrary to national trends. We perform deliveries with an emphasis on a needs priority basis as we cater to a diversifying patient demographic.

Our approach to birth prioritizes a natural birth and we avoid labor induction unless necessary. With each follow-up visit throughout pregnancy, examination is also accompanied by guidance from a midwife. Throughout the course of pregnancy, we hold mothers’ guidance classes and parents’ guidance classes. Following birth, we offer an outpatient clinic to assist with breastfeeding, follow-up phone calls to each patient and hold a mother and baby social event following pregnancy.

A midwife is available to assist with a birth plan, based on the mothers’ wishes. Kangaroo care is also an option in the birth plan, which is well accepted among patients. We encourage the mother and baby to stay in the same room from the first day after birth, in order for the baby to receive the nutrients available from breast milk.

We receive an increasing amount of admissions of abnormal births around the clock from neighboring institutions, including threatened premature delivery and premature membrane rupture, which can result in serious complications for the mother, and birth deformities.

Appointed by the prefectural government, our Perinatal Centre is equipped with a perinatal intensive care unit, with the delivery area equipped with six beds. The neonatal intensive care unit is located in close proximity, where low birth weight, very low birth weight, extremely low birth weight and infants with complications are treated. We work with a premature infant treatment team from the pediatrics department, where treatment plans are discussed and determined pre- and post-delivery.

Infertility Treatment

Our infertility clinic operates from Monday to Saturday, for those who are having trouble conceiving. Examinations start from the first visit.

The first step in treatment is extensive testing, which is used to determine the cause and the appropriate treatment. This includes hysteroscopy and laparoscopy. Awide-range of treatments are available, including ovulation induction, artificial insemination, in vitro fertilization, micro-insemination and embryo cryopreservation, with our results being some of the best in the country. We are also the first in the prefecture to introduce tubal canalization treatment by hysteroscopy for fallopian tube obstruction. We hold regular information sessions for assisted reproductive technology, where treatment methods, results, adverse effects and costs are discussed, allowing an informed decision from patients.

Close collaboration with our urologist infertility team is also essential for the treatment of male infertility. Successful conception leading to birth is now possible for conditions resulting in male infertility, such as Klinefelter syndrome, using a combination of testicular sperm extraction and IVF.

Emotional care in cases of infertility is also essential. We have a dedicated section in our ward for procedures including embryo transplantation and oocyte retrieval. We also hold sessions for patients to have open discussion and we hope to develop this further in the future.

We also provide extensive testing for cases of recurrent abortion, including chromosomal analysis of chorionic villi, according to the wishes of the patient. Appropriate treatment is the given based on these results, including surgical intervention for uterine anomalies and pharmacotherapy for antiphospholipid-antibody syndrome.

Prefectural Perinatal Centre

Accredited Specialist Training Facility: The Japan Society of Obstetrics and Gynecology
Provisional Accredited Specialist Training Facility: Japan Society of Perinatal and Neonatal Medicine
Accredited Prefectural Training Facility (Maternal Protection Law)