Obstetrics

Please find the following information on this page.

Our hospital is a key hospital of the Eco & Child Study in Sapporo.

Pregnancy and Drug Consultation Clinic (119.9KB)

Genetic Prenatal Diagnosis Clinic (127.9KB)

Greetings

The period of pregnancy and delivery is a starting point of life for babies and the beginning of the parental role for parents.
It is a great pleasure for us to spend this precious time with pregnant women, babies and their families, and to provide our specialist knowledge and skills while supporting the safety of mothers and babies.
We also provide specialist consultations on the management of high-risk pregnancies, such as complications of pregnancy and premature birth, or babies with congenital abnormalities, and provide the best possible care to achieve positive results.

Treatment policy

As an advanced medical facility, the Obstetrics/Maternity and Perinatal Care Center at Hokkaido University Hospital provides continuous health care and support for women during pregnancy and delivery and their newborn babies. Thus, we have set the following objectives:

To propose methods to maintain pregnancy, the delivery period and a delivery method that are appropriate for each patient
To respect the wishes of patients and ensure a safe delivery
To offer effective and maximum support for babies to grow up healthy

The department is divided into two clinical groups: an obstetric group and a neonatal group. Since the target diseases and circumstances are different between the groups, the details of medical care vary. However, both groups share the latest knowledge and strive to improve their medical skills and provide the best medical treatment in their individual specialties.

Areas of medical care

General obstetrics clinics (obstetrics prenatal clinic, obstetrics special checkup clinic)
Genetic/prenatal diagnosis clinic
Fetal heart echo clinic
Postpartum/contraception clinic
One-month newborn checkup clinic

Consultation hours

First-visit consultations are provided on Monday through Friday mornings (8:30 a.m. – noon).
However, first-visit patients can see obstetricians only on Tuesdays and Fridays.
Patients who visit the department for the first time on other days of the week may have to wait much longer. It is advisable to visit on Tuesday or Friday if possible.

For your next visit, you have to make an appointment for a general clinic or specialist clinic after the first-visit consultation.
Regarding the genetic/prenatal diagnosis clinic and the fetal heart echo clinic, you can only make a first visit on appointment. Please call the obstetrics clinic (011-706-5678) in advance.

Outline

Medical care system

The Maternity and Perinatal Care Center attached to the Obstetrics ward consists of a general ward, a nursery and a neonatal intensive care unit.
A total of 18 doctors – 12 obstetricians in charge of pregnant women (obstetric group) and six pediatricians in charge of newborn babies (neonatal group) – are engaged in pregnancy and delivery management in cooperation with several junior residents.
In addition to the care of high-risk pregnant women, premature babies and babies needing special treatment, we are also actively taking care of normal pregnancies and delivery.
Many pregnant women and women wishing to become pregnant are referred from other obstetrics and gynecology facilities in Hokkaido.
Many women are not referred, but come because they wish to deliver their babies at Hokkaido University Hospital.
Husbands can attend vaginal delivery in a private room.
A midwife, an obstetrician and a pediatrician attend all deliveries to ensure the safety of both mother and baby.
Various efforts are made for more comfortable pregnancy and delivery, even in a university hospital.
We discuss treatment policies for individual patients in detail at an obstetric meeting every morning and at a perinatal conference with the NICU every Monday.
For cases that need treatment in the neonatal period, a joint conference of the Department of Obstetrics and the NICU, as well as Pediatric Surgery, Cardiovascular Surgery and other clinical departments may be held.
Regarding cases of high-risk mothers, such as placenta previa accreta, we cooperate with Urology, Gynecology, Radiology and Anesthesiology to prepare for these cases.
In this way, the Department of Obstetrics at Hokkaido University Hospital employs a group care system rather than an attending doctor system to secure a safety net, and supports a medical care system of cooperation with other clinical departments to ensure the safety of pregnant women and their babies.

General obstetrics (obstetrics prenatal clinic; Mondays, Wednesdays and Thursdays; obstetrics special checkup clinic: Mondays, Wednesdays and Thursdays)

In addition to high-risk pregnancy/delivery we handle as an advanced medical facility, we also actively work on risk-free normal childbearing.

Qualified obstetrics and gynecology specialists take charge of the prenatal clinic, and perform ultrasound scans at each prenatal checkup to check the development of the fetus and the possibility of threatened premature delivery.
In the 10th month of pregnancy, a fetal heart rate monitoring test is also performed every week to evaluate the fetal status more frequently.
These lead to the prevention of premature delivery and an early diagnosis of pregnancy-induced hypertension, gestational diabetes, fetal disorders, etc.
At the mothers’ class offered as part of the outpatient clinic, midwives give advice on pregnancy, delivery and childcare.
There two LDRs (private rooms where pregnant women can spend time from the start of labor to delivery) in the obstetrics ward. If possible, it is recommended that your husband is present at the delivery.
Obstetricians and doctors in charge of newborn babies attend all deliveries to support safe deliveries.

High-risk pregnancy (obstetrics prenatal clinic; Mondays, Wednesdays and Thursdays; obstetrics special checkup clinic: Mondays, Wednesdays and Thursdays)

Many patients who need advanced prenatal/neonatal medical care and those for whom cooperation with other clinical departments is necessary are referred from other local medical institutions for premature delivery, pregnancy-induced hypertension, multiple pregnancy, complicated pregnancy, habitual abortion, etc.
In case of high-risk pregnancy, joint conferences including obstetricians, doctors in charge of newborn babies and midwives, as well as doctors from related clinical departments, are held when an important treatment policy is determined to provide appropriate information to the patient and her family.
Approximately 10% of all deliveries are cases that have been referred from other hospitals due to multiple pregnancy and another 10% of cases have been referred for fetal disorders. Accordingly, many of these end in premature births and Caesarean section deliveries.
A total of 12 obstetricians, six doctors in charge of newborn babies, several junior residents and nursing staff work together to provide advanced perinatal care expected of a university hospital, including delivery of extremely low birth weight infants, Caesarean section for placenta previa accreta and delivery management for pregnancy with advanced reproductive techniques.
The Obstetrics/Maternity and Perinatal Care Center at Hokkaido University Hospital established a Maternal-Fetal Intensive Care Unit (MFICU) in July 2013.
MFICU is an intensive care facility that provides advanced medical care to pregnant women and their fetuses in case of a high risk of pregnancy complications (pregnancy-induced hypertension, multiple pregnancy, threatened premature delivery, etc.), or fetal disorders (extremely low birth weight infant, congenital fetal malformation, etc.).
In other words, it is a facility that provides advanced obstetric care to pregnant women and serves as a bridge with neonatal emergency medical care.
Thus, standards are set on machinery and equipment for providing advanced medical care, assignment of medical staff who handle high risk pregnancies and an emergency cooperative system in- and outside the hospital.

Ultrasound scans as part of obstetric consultations

At the time of a prenatal checkup, it is checked whether the pregnancy is proceeding favorably for both the pregnant women and their babies.
Ultrasound scans are widely used as a way to observe the development of babies and detect abnormalities early.
There are two types of ultrasound scans: a normal ultrasound scan and a fetal ultrasound scan.
A fetal ultrasound scan, which is a proactive measure to detect morphological congenital abnormalities, is different from a normal ultrasound scan.

1. Basic meaning and characteristics of a normal ultrasound scan

A normal ultrasound scan is a safe test for pregnant women and babies, and it is performed mainly to check the development and health condition of babies.
To this end, it is used to check whether a baby is alive or dead, whether there are multiple fetuses, the development condition, fetal presentation (whether the head is positioned downward or whether the fetus is in breech presentation), the position of the placenta, the amount of amniotic fluid, and abnormalities of the mother’s uterus and ovaries.
The weight estimate may be calculated. By checking the condition of babies, doctors can take early measures if there are any concerns.
A malformation of a baby is sometimes detected incidentally with a normal ultrasound scan. Most babies are born healthy without any abnormalities.
However, some babies are born with diseases. If such a disease is detected by echo, or an external abnormality is found at birth, it is called a congenital malformation (approx. 3 – 5%). There are various types of congenital malformations, and the severity also varies from severe ones to minor ones that are not a cause for concern medically (characteristics).
Some are difficult to cure with current medical standards. However, treatment can be provided smoothly after birth (or from the fetal stage) for some types of diseases if the disease is diagnosed at the fetal stage, and a better outcome for the baby can be expected.
The uterus and fetus change throughout the pregnancy period. Some abnormalities may be detected in the mid to late pregnancy although nothing is detected earlier. Thus, it is necessary to perform scans at appropriate times.

*Report on the results of a normal ultrasound scan

Results excluding congenital fetal malformations
Unless specifically asked, part of the results of ultrasound (amount of amniotic fluid, the position of the placenta, fetal presentation, the degree of fetal development, etc.) is reported to patients only if abnormalities are detected.
Baby’s condition incidentally detected by ultrasound
When checking a baby in early pregnancy by a normal ultrasound scan, we sometimes detect a clear malformation, and also incidentally find a condition that is not a clear abnormality but gives cause for some of concern about the baby and a potential abnormality.
This condition means that the baby has a higher possibility of a chromosomal abnormality or other diseases (heart and kidney diseases).
Since it is not a clear abnormality, the baby is usually born healthy.
In such cases, a pregnant woman can undergo further tests for an accurate diagnosis, but she may feel that it is a burden and her fear may cause anxiety in the baby, although it is not a clear abnormality.
Patients have the rights not to undergo tests and not to know the results of the tests if they wish. Please let us know in advance whether you wish to know the results if a condition that has not been clarified by ultrasound scan, but may lead to an abnormality of your baby or a condition that gives the doctor cause for concern is incidentally detected at a normal prenatal checkup.
If you are not interested in checking the condition of the baby, please let us know accordingly (you will be asked early in the pregnancy at the obstetrics special checkup clinic).

2. Basic meaning and characteristics of a fetal ultrasound scan

If you would like to check whether your baby has a morphological congenital abnormality at a prenatal checkup, there are two ways.
One is to spend a long time looking into all the details of the condition at a specialty outpatient clinic as described below, and the other is to gradually check at prenatal checkups.
The former allows us to look into numerous check points at one or two visits, because we can take enough time (this approach is taken in the fetal ultrasound scan at the genetic prenatal diagnosis clinic that is described below).
In the latter way, we can look into check points little by little at prenatal checkups, but the accuracy is lower, because time is limited and the purpose of the ultrasound at prenatal checkups is the above-mentioned normal ultrasound scan.
This includes STIC-based fetal heart screening (fetal heart screening using 3D moving images) conducted at 22 to 30 weeks of pregnancy.

Diagnosis of fetal congenital diseases (fetal heart echo clinic: Thursdays)

If you wish to undergo a detailed ultrasound scan dedicated to the fetal heart at or after 22 weeks of pregnancy, please visit the fetal heart echo clinic on Thursdays.
We conduct detailed tests here on heart diseases of babies to let parents know about diseases and treatments before birth and prepare for safe and better treatment after birth for babies with severe heart disease.
Patients in whom something has been found with a normal ultrasound scan and those who are diagnosed with heart disease at other hospitals are encouraged to visit this clinic for detailed tests (health insurance treatment). A visit to the clinic may also be recommended based on the results of an ultrasound scan conducted at the genetic prenatal diagnosis clinic (health insurance treatment). If strongly desired, you can visit the clinic at your own expense. Please ask your doctor.
We respect your wishes about the provision of information.
You can visit the fetal heart echo clinic only on appointment. Please call the obstetrics clinic (011-706-5678).

As a critical care medical center, the Department of Obstetrics at Hokkaido University Hospital often sees cases with suspected fetal disorders that have been referred from other hospitals.
In such cases, we perform detailed ultrasound examination as well as MRI and CT as necessary.
We diagnose, manage and treat various diseases including congenital heart, digestive and kidney/urologic diseases, nervous diseases and systemic bone diseases.
Advanced specialist knowledge and skills are often required, and we take advantage of the expertise unique to university hospitals to collect information on each disease.
Regarding systemic bone diseases and intractable brain malformations, we have a system of collecting the latest information using a network with external institutions and a system of consultations for a remote diagnosis, allowing us to make preparations based on the latest information.
We cooperate with clinical departments specializing in individual diseases (Pediatrics, Pediatric Surgery, Urology, Neurosurgery, Plastic Surgery and other departments) to perform continuous diagnosis and treatment from before birth to neonatal treatment after birth.

In recent years, fetal treatments for diseases diagnosed before birth have gradually become common.
Such treatments include fetoscopic laser photocoagulation of the placental communicating vessels for twin-to-twin transfusion syndrome, ultrasound-guided radiofrequency ablation for acardiac twin pregnancies, shunts for fetal pleural effusion, congenital cystic adenomatoid malformation of the lung and fetal megacystis, fetal transfusion therapy for fetal anemia, prevention of heart failure in case of fetal cardiac block, and transplacental antiarrhythmic therapy for fetal tachyarrhythmia.

Genetic counseling and prenatal diagnosis (Genetic Prenatal Diagnosis Clinic : Tuesdays)

The Department of Obstetrics at Hokkaido University Hospital provides genetic counseling in cooperation with the Division of Clinical Genetics.
Medical geneticists and genetic counselors certified by the Japan Society of Human Genetics and the Japanese Society for Genetic Counseling take much time to provide professional counseling on appointment for people who not only seek advice on obstetrics and the perinatal period, but also on various genetic problems as well as those who consider prenatal chromosome analysis or genetic diagnosis.
Regarding prenatal diagnosis, we comply with the

Guidelines for Genetic Test/Diagnosis in Medical Science (255.4KB) set by the Japanese Association of Medical Sciences and View on Prenatal Genetic Test and Diagnosis by the Japan Society of Obstetrics and Gynecology.
Prenatal chromosome diagnosis is performed using non-definitive as well as definitive tests. Requirements for definitive tests, such as amniotic diagnosis and chorionic villus sampling, are as follows:

Cases in which either partner of a couple has a chromosomal aberration
Cases in which a woman had previously given birth to a child with a chromosomal abnormality
Cases of pregnancy at an older age
Cases of a pregnant woman who is heterozygous for a serious X-linked genetic disease that becomes manifest in the neonatal period or childhood
Cases in which both partners of a couple are heterozygous for a serious autosomal recessive inherited disease that becomes manifest in the neonatal period or childhood
Cases in which either or both partners of a couple are heterozygous for a serious autosomal recessive inherited disease that becomes manifest in the neonatal period or childhood
Cases in which a fetus may be affected with a serious disease (cases in which a non-definitive test shows a high risk.

A variety of choices are presented at genetic counseling on prenatal diagnosis. Since the choices decrease as the pregnancy progresses, it is recommended to visit our hospital at 12 or 13 weeks of pregnancy.
Non-definitive tests (tests to evaluate probability) include early pregnancy ultrasound screening (start of the 11th week – the 6th day of the 13th week of pregnancy), maternal serum screening test (at and after the start of the 15th week of pregnancy), a combination of ultrasound and maternal serum screening test (start of the 11th week to the 6th day of the 13th week of pregnancy), and noninvasive prenatal genetic testing using fetal DNA in maternal blood (at and after the start of the 10th week of pregnancy).
There are multiple options for definitive tests. Chorionic villus sampling is performed at about 12 weeks of pregnancy and amniotic diagnosis is performed at about 16 weeks of pregnancy. The chromosome karyotype is available two or three weeks later.
If an abnormality in a fetus is detected by an ultrasound scan during pregnancy, chorionic villus sampling and amniotic diagnosis may produce normal results contrary to expectations.
A structural abnormality that is not clarified by ordinary chromosome analysis is sometimes suspected. In such cases, SNP microarray testing may be proposed at the genetic counseling.
This is also known as high resolution chromosome analysis. Highly accurate genetic information obtained from the testing may make it possible to clarify the precise condition of the fetus.
Actually, this testing is said to detect a genetic abnormality in 15% to 25% of fetuses showing an abnormality by diagnostic imaging, but no abnormality by chromosome analysis. However, it sometimes detects genetic changes of which the meaning is unknown. More advanced genetic counseling is necessary.
We also use such cutting-edge techniques to perform prenatal diagnosis.
Regarding prenatal genetic diagnosis for specific diseases, we fully provide genetic counseling, discuss it with the Division of Clinical Genetics and obtain approval from the ethical committee.
The targets include the following of the above requirements for definitive tests:

Cases in which a pregnant woman is heterozygous for a serious X-linked genetic disease that becomes manifest in the neonatal period or childhood
Cases in which both partners of a couple are heterozygous for a serious autosomal recessive inherited disease that becomes manifest in the neonatal period or childhood
Cases in which either or both partners of a couple are heterozygous for a serious autosomal recessive inherited disease that becomes manifest in the neonatal period or childhood

We have successfully performed prenatal diagnosis of numerous diseases.
The procedure often takes time. It is recommended to undergo genetic counseling before pregnancy.
Many people just talk with us at genetic counseling and do not undergo testing.
It is advisable to visit us with your spouse before making a decision based on limited information. We will help you find the best solution during continued genetic counseling.
We also provide genetic counseling for patients who have given birth to a baby with a congenital disease and those who experienced miscarriage.
After a baby is born, we cooperate with various clinical departments (Pediatrics, Pediatric Surgery, Urology, Neurosurgery, Plastic Surgery and other departments) to accurately diagnose the baby and provide genetic counseling for following pregnancies.
You can only have counseling on appointment. Please check the appointment procedure in

Genetic Prenatal Diagnosis Clinic (127.9KB), and contact us directly (genetic prenatal diagnosis clinic: 011-706-7022).
For consultations on matters not related to obstetrics and the perinatal period, please call the Division of Clinical Genetics.

Postpartum management (postpartum/contraception clinic: Fridays)

At the postpartum clinic, we not only check the involution of the uterus but also provide health management and care for the future.
We provide follow-up for hypertension, gestational diabetes, etc., and perform uterine cancer screening (at the one-month postnatal checkup). If it is found that treatment is necessary at other departments, we refer patients to the relevant departments in our hospital or neighboring hospitals.
For family planning, we provide consultations for the following pregnancy and birth control (low-dose pills or intrauterine device).
If you have received infertility therapy (especially in-vitro fertilization) at the infertility group of the Department of Gynecology in our hospital and hope to receive the same therapy at the following pregnancy, please revisit the infertility group.

Neonatal care (one-month newborn checkup clinic: Fridays, neonatal clinic at the Department of Pediatrics)

The ward for the neonatal section was expanded and reorganized in May 2009, and the total number of beds is 23: nine for the neonatal intensive care unit (NICU), 11 for the growing care unit (GCU) and three for the nursery (four from April 2013).
In the NICU, we take care of babies who need intensive care, include very low birth weight infants with a birthweight of less than 1,500 g and newborn babies who need surgery immediately after birth.
After completing intensive care at the NICU, babies who still need time before discharge are taken care of at GCU.
NICU and GCU not only save the lives of babies who need intensive care, but also actively introduce developmental care such as kangaroo care.
At the nursery, we take care of babies who were born healthy and give advice on bathing the baby to the family.
Neonatologists provide consultations and perform ultrasound scans (brain, heart, kidney, etc.) before or after rooming-in.
Kangaroo care: care whereby even a small baby is removed from the incubator to have skin-to-skin contact with his/her mother

Medical care results

Deliveries: January – December 2011 (number of fetuses)

All deliveries: 329
Normal deliveries: 27
Abnormal deliveries: 302
Premature deliveries: 62 (22 – 27 weeks: 10, 28 – 35 weeks: 35, 36 weeks: 17)
Caesarean sections: 141
Complicated pregnancy/high-risk pregnancy: 179 in total (mothers)

Outpatient clinics: January – December 2011 (total number of patients seen)

Obstetrics prenatal checkup clinic: 2,554
Obstetrics special checkup clinic: 721
Postpartum/contraception clinic: 852
Infertility clinic: 1,314
Genetic/prenatal diagnosis clinic: 299
Prenatal ultrasound clinic: 22

Others

Prenatal chromosome diagnosis: 47 (amniocentesis: 21 cases, chorionic villus sampling: 26 cases)
Fetal treatments: 5 cases, 8 times

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