30 Jun 2013 • 2m read • View Author
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Our previous study demonstrated the safety and effectiveness of abdominal radical trachelectomy during pregnancy but did not focus on the fetus
This study aimed to clarify the influence of abdominal radical trachelectomy performed during pregnancy on the fetus
Eight cervical cancer patients who underwent abdominal radical trachelectomy at our hospital between February 2013 and August 2020 were enrolled in this study
To assess the peri- and postoperative influence on the fetus
we performed fetal heart monitoring at 30-min intervals during abdominal radical trachelectomy and calculated the estimated fetal body weight and resistance indexes of the middle cerebral artery and umbilical artery from postsurgery until delivery
Four out of eight patients had preterm birth due to chorioamnionitis in one case and consideration of the recurrent risk of cervical cancer in three cases
Fetal heart monitoring during abdominal radical trachelectomy revealed deceleration just once in one case but no abnormal findings in the other cases
the fetal growth after abdominal radical trachelectomy was normal until delivery
No abnormal Doppler findings were detected in the middle cerebral artery or umbilical artery
Our findings clarified that abdominal radical trachelectomy performed for the treatment of early-stage cervical cancer during pregnancy has no obvious influence on fetal growth
it is necessary to evaluate the growth and development of children delivered from mothers who have undergone abdominal radical trachelectomy during pregnancy
patients who are diagnosed with invasive cervical cancer during their pregnancies are not as rare in Japan as they are elsewhere
support the effectiveness of RT even during pregnancy
RT shortens the uterine cervix length and may make pregnant women more susceptible to intrauterine infection
pregnancy after RT occurs with apparent high-risk for preterm labor
Several studies have discussed the timing of delivery in post-RT pregnancy but have not focused on the fetus during such pregnancies
there is no evidence regarding intrauterine fetal growth or newborn long-term outcomes in post-RT pregnancy
The changes in blood flow to the uterus after RT may affect intrauterine fetal growth and well-being
anesthesia and direct surgical manipulation of the uterus containing the fetus during RT may affect intrauterine fetal growth and well-being
our aim in this study was to clarify the influence of abdominal radical trachelectomy during pregnancy (ART-DP) on the fetus
This is the first retrospective large cohort study to assess the safety and effectiveness of ART-DP with a focus on the fetus and newborn
a progesterone (250 mg) intramuscular injection was given routinely per week until delivery if there were no adverse effects
All patients were hospitalized after ART-DP until their deliveries
Vaginal washings and cervical canal length measurements were performed regularly
The timing of termination was selected based on an overall assessment of the gestational age
Child development was investigated by interviewing the patient at the periodic checkup
All management was conducted by experienced gynecological oncologists and perinatal professionals
Complications related to ascending infection were not observed in the aforementioned cases after the addition of this procedure
Changes in middle cerebral artery resistance index (MCA-RI) during pregnancy. MCA-RI measurement was performed every week. Each plot represents each value of MCA-RI. The solid line shows the average MCA-RI in each gestational week and the two dotted lines indicate the 10th percentile to 90th percentile. Each plot number corresponds to our case number
Changes in umbilical artery resistance index (UA-RI). Each plot represents each value of UA-RI. The solid line shows the average UA-RI in each gestational week and the two dotted lines indicate the 10th percentile to 90th percentile. Each plot number corresponds to our case number
Changes of estimated fetal body weight (EFBW)
Each dot represents EFBW for each gestational date
The solid line shows the average EFBW of the Japanese population in each gestational week
The zone between the two dotted lines is − 1.5 to 1.5 standard deviations
Each plot number corresponds to our case number
this study focused on the influences of ART-DP on subsequent fetal growth and development
A suspected reason for these miscarriages was insufficient blood flow because of the ligation of both uterine arteries
as only hypoxic changes of the placenta were observed during autopsy
patients may lose the chance to undergo surgery despite the presence of a resectable lesion at the time of diagnosis
ART-DP is one of the important treatment options for pregnancy-associated cervical cancer because some patients were successfully treated only by ART-DP
For pregnant women with invasive cervical cancer
the advantages and disadvantages of each treatment modality are essential to make the decision
our findings clarified that there was no obvious influence of ART-DP for pregnancy-associated cervical cancer on fetal growth and newborn development
all fetuses were able to avoid exposure to anticancer agents
To establish the safety and effectiveness of ART-DP for pregnancy-associated cervical cancer
we need to continue investigating perinatal outcomes and children’s growth and development after ART-DP
All data analysed during this study are included in this published article
Abdominal radical trachelectomy during pregnancy
International Federation of Gynecology and Obstetrics
Cancer incidence and mortality worldwide: sources
methods and major patterns in GLOBOCAN 2012
Impact of HPV vaccine hesitancy on cervical cancer in Japan: a modelling study
Radical Trachelectomy for the treatment of early-stage cervical Cancer: a systematic review
Reproductive and oncologic outcomes after fertility-sparing surgery for early stage cervical cancer: a systematic review
Pregnancies after vaginal radical trachelectomy (RT) in patients with early invasive uterine cervical cancer: results from a single institute
Management of pregnancy after radical trachelectomy
The safety and effectiveness of preserving the ascending uterine artery in a modified fertility-sparing abdominal radical trachelectomy
Fetal and umbilical Doppler ultrasound in normal pregnancy
Immediate radical trachelectomy versus neoadjuvant chemotherapy followed by conservative surgery for patients with stage IB1 cervical cancer with tumors 2cm or larger: a literature review and analysis of oncological and obstetrical outcomes
Abdominal radical trachelectomy versus chemotherapy followed by vaginal radical trachelectomy in stage 1B2 (FIGO 2018) cervical cancer
A systematic review on fertility and recurrence rates
The safety and effectiveness of abdominal radical Trachelectomy for early-stage cervical Cancer during pregnancy
Is long-term tocolysis effective for threatened premature labour
In which preterm labor-patients is intravenous maintenance tocolysis effective
Inappropriate use of ritodrine hydrochloride for threatened preterm birth in Japan: a retrospective cohort study using a national inpatient database
New Japanese neonatal anthropometric charts for gestational age at birth
Mid-trimester preterm premature rupture of membranes (PPROM): etiology
international recommendations of treatment options and outcome
Abdominal radical trachelectomy during pregnancy: a systematic review of the literature
Laparoscopic treatment for appendicitis during pregnancy: retrospective cohort study
Adnexal torsion during pregnancy: outcomes after surgical intervention-a retrospective case-control study
Non-obstetric surgery during pregnancy - an eleven-year retrospective analysis
Anesthesia for nonobstetric surgery in pregnancy
Oncologic and obstetrical outcomes with fertility-sparing treatment of cervical cancer: a systematic review and meta-analysis
First trimester placental volume is reduced in hypertensive disorders of pregnancy associated with small for gestational age fetus
The placental basis of fetal growth restriction
The double life-saving approach of abdominal radical Trachelectomy during pregnancy for early-stage cervical Cancer-an overview of the literature and our institutional experience
Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero
Cancer during pregnancy: a review of preclinical and clinical Transplacental transfer of anticancer agents
Cancer and pregnancy: a comprehensive review
Neoadjuvant chemotherapy in cervical cancer in pregnancy
Efficacy of neoadjuvant platinum-based chemotherapy during the second and third trimester of pregnancy in women with cervical cancer: an updated systematic review and meta-analysis
International incidence of childhood cancer
2001-10: a population-based registry study
Clinical efficacy of modified preoperative neoadjuvant chemotherapy in the treatment of locally advanced (stage IB2 to IIB) cervical cancer: randomized study
Phase II clinical study of neoadjuvant chemotherapy with CDDP/CPT-11 regimen in combination with radical hysterectomy for cervical cancer with a bulky mass
Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting
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There is no source of financial support or funding
Mina Itsukaichi and Kosuke Yoshihara contributed equally to this work
Niigata University Graduate School of Medical and Dental Sciences
All authors were responsible for project development and read and approved the final manuscript
This study was approved by the institutional ethics review board at Niigata University (No
Written informed consent was obtained from all patients
All methods were performed in accordance with the relevant guidelines and regulations including Declaration of Helsinki
The authors declare that they have no competing interests
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
Image of fetal heart monitoring during surgery
the fetal heart rate was measured every 30 min to check for bradycardia
Images of cervical cerclage of neo cervix and closure of neo external os
Left panel shows the image after trachelectomy
Right panel demonstrated cervical cerclage and os closure
unless otherwise stated in a credit line to the data
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DOI: https://doi.org/10.1186/s12884-022-04671-6
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To get to Minamizawa Ajisai Mountain from central Tokyo involves a 75-minute train trip
starting with the Chūō line from the JR Shinjuku Station
with transfers to the Ōme and Itsukaichi lines
and then a 40-minute walk from Musashi Itsukaichi Station at the end of the Itsukaichi line
An impish elf welcomes visitors to the entrance of Minamizawa Ajisai Mountain
The wood carving is the work of local sculptor Tomonaga Akimitsu
The pathway up the mountain winds its way through a breathtaking expanse of hydrangea blossoms extending along the path and down the steep slopes bordering a stream below
More than 10,000 tourists come to enjoy the sight during the peak of the hydrangea season from mid-June to early July
Minamizawa Ajisai Mountain is owned by Minamizawa Chūichi
known affectionately by the nickname “Chūitchan,” a remarkable 92-year-old who tends to this life-long project as the seventeenth-generation head of the local Minamizawa family
he has worked alone to transform what was once a cedar forest into lush hydrangea shrubbery
Any journey of a thousand miles must begin with a first step
“My ancestors’ graves are on the mountain
I just thought it would be nice if we could walk up a flower-lined path on our visits to the family graveyard.”
Chūichi was the second son of a family with six boys and three girls
In the postwar era of reconstruction Chūichi started his own Minamizawa Lumber Company at the age of 27
“In this region, Obon
when the spirits of the departed are believed to visit the homes of the living
and so I took some saplings from two hydrangea bushes in my garden and planted them on the mountain path.”
The replanted hydrangeas bloomed beautifully
Chūichi and his daughter
Since turning in his driver’s license when he turned 90
Chūichi depends on Kazue to drive him up to the mountain every day in her little truck
Chūichi began cultivating hydrangea shoots in the family vegetable garden
I learned everything directly from the flowers.”
Chūichi was able to extend his hydrangea-lined path to the family graveyard
his magnificent creation had become well-known
and more and more people came to walk the mountain path and enjoy the blossoms
when people tell you how pretty your flowers are
reaching the mountain top and beyond to include the paths leading to Mount Konpira and the Seoto hot springs
and spreading out along the slopes in between
Blue and white hydrangea blossoms line the mountain path
Hydrangeas cover the ground in a cedar forest at roughly 360 meters of elevation
To ensure that his hydrangeas would get enough sunlight
Chūichi had to thin out the cedar forests and climb trees to prune their branches
while at the same time managing his lumber company
“You can’t ask someone to do something that is not going to make any money
I got up at four every morning to work on the mountain before going to my office
Back then the company was only closed on the first and third Sundays of the month
On those days I worked on the mountain all day
getting so dirty I had to change my clothes completely three or four times
I gave my dirty clothes to the wife to launder
but I’ve been told when I wasn’t around she spoke with pride of our Ajisai Mountain.”
The hydrangeas of Minamizawa Ajisai Mountain
Chūichi tended to Ajisai Mountain by himself
Another person to step up was Miyazaki Shōsaku
a retired teacher from an elementary school in central Tokyo who moved to the area to live in a house his father had purchased
Calling on local residents and his former pupils
Miyazaki formed a group of supporters called the Hana no Kai (Flower Association) and currently acts as a liaison with the local administration
Still another person moved by Chūichi’s dedication is Tomonaga Akimitsu
who act as guideposts on the route to Minamizawa Ajisai Mountain from Musashi Itsukaichi Station
Tomonaga created the puppets for Purinpurin Monogatari
a series broadcast by NHK from 1979 to 1982
he moved to the area and built a studio and home near Ajisai Mountain
He has since created his own museum out of a 150-year-old farmhouse
which opened in 2002 as the Fukasawa Tiny Museum
“I got to know Chūichi when I was thinking about digging a pond and putting in koi carp
He has his own koi pond and gives me a lot of advice.”
When it was decided to set up guideposts for visitors to Ajisai Mountain
Chūichi cut down some of his own trees and gave them to Tomonaga to carve
Located about a 15-minute walk from Ajisai Mountain
the whimsical museum opens onto a cobblestone approach
Tomonaga was born in 1944 the town of Shimanto
On display in his museum are the puppets from the NHK series Purinpurin Monogatari
Chūichi has remained the mainstay of the Ajisai Mountain project
With the approach of his ninetieth birthday
“I need to find someone to take over while I am still in good health.”
And that was when two young Akiruno entrepreneurs spoke up
saying they would like to carry on in his footsteps
Takamizu Ken and Minamishima Yūki were both born in 1990 and had been teammates on their university’s baseball team
a company to develop and sell local Itsukaichi products as part of a town renewal project
One of their specialty products was Amacha
“Amacha is a mutated species of mountain hydrangea
So we thought it would flourish on Ajisai Mountain
We asked Chūichi if we could cultivate the plant at the summit of his mountain,” says Takamizu
Chūitchan’s Ajisai Tea was first sold in 2019
about 500 ajisai tea (Amacha) shrubs are cultivated at the top of Ajisai Mountain in a field at 460-meter elevation
The two were deeply moved by their encounter with Chūichi and his life story
“Ajisai Mountain is a local treasure and an essential tourism resource for the city of Akiruno
We didn’t know a thing about hydrangeas
but we asked him if we could get involved somehow
And so Takamizu and Minamishima apprenticed themselves to Chūichi
Chūichi had opened up the mountain to the public for free for 30 years
he placed a box at the entry to the mountain and asked for a voluntary donation of ¥300 per person
Takamizu and his people stepped in and set up a reception counter during the hydrangea season
charging ¥500 to enter and ¥500 for parking
Their next step was to launch a crowdfunding campaign
In 2021
Chūichi’s daughter Kazue opened her own dried flower studio Cazue above the family garage
There she makes and sells wreaths and other products out of dried hydrangea cuttings from the summer
Maintaining Ajisai Mountain as Chūichi’s successor is no easy task
“The most back-breaking job is pruning
It’s really difficult to decide which branches to cut and which to leave alone,” says Minamishima
who works a dizzying schedule as he also manages his company’s café outside Musashi Itsukaichi Station and its campground
Seeing his successors’ frantic efforts annoys Chūichi somewhat
“How can it take so long to learn which branches to cut and which to leave
There is always something that has to be done on the mountain
The flowers and weather aren’t going to wait for you!”
The two young men listen to Chūichi’s complaints in silence
“If it were just a matter of tending to the hydrangeas
I’m sure a professional gardener could do much better
But that’s not enough to carry on the spirit with which Chūichi started this project
We don’t know anything about hydrangeas
but I’m confident we are more determined than anyone else when it comes to valuing his feelings and making sure this place gets handed on intact to future generations,” says Minamishima
Chūichi smiles like a grandfather watching over his grandchildren
I’ll keep going up the mountain to teach them
But only the Buddha knows how long I can do that
They are going to have to figure things out on their own.”
Banner photo: Ajisai Mountain’s creator Minamizawa Chūichi
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Some say fall is Japan’s greatest season. And don’t you feel like you’re missing most of it holed up in the city? Although nature can feel far away, spectacular displays of koyo (autumn viewing) foliage and Japan’s native fall flowers
are only an hour or two away by public transit
Make the most of your weekends with day trips out of the city this autumn that won’t break your budget or require you to rent a car to get there
From photogenic bridges to fields of scarlet kochia (summer cypress) bushes, read on for your next-day trip getaway
Akigawa Valley is the perfect place for a hike
fantastic views and a relaxing soak in a hot spring
the tourism center has plenty of maps and brochures detailing local attractions
If you’re looking to take a trek through mountainous terrain or trace a path along the Akigawa River
with the longest ones taking up to six hours to complete
One of the highlights of the area is Ishibunebashi Bridge which is accessible via the Jyurigi Bus Stop just outside of the station
this suspension bridge fully immerses you in the Akigawa River’s natural serenity and provides numerous vantage points to enjoy the valley’s autumn colors
Looking to soothe your body after a day of hiking
Continue onto the other side of the bridge and find the popular Seoto-no-yu Spa
Whether you only have time for a free foot bath or a full-on dip in the onsen
this hot spring is a lovely way to end your day trip before heading back into Tokyo’s hustle and bustle
1420 Tokura, Akiruno, Tokyo - Map
Nearest station: JR Itsukaichi Musashi-Itsukaichi
Kamakura has its fair share of attractions for day trippers from Tokyo
Autumn travelers should make time for Hasedera Temple
a site renowned for its seasonal flora which includes plum blossoms in the winter
hydrangeas in the summer and Japanese maples in the fall
the spiritual sibling of a temple by the same name in Nara
houses a Kannon statue measuring over nine meters tall
hundreds of jizo (small guardian statues protecting children)
If you’re looking to take a break during your exploration of the temple complex
check out Kaikoan Restaurant and enjoy the fantastic view alongside curries and pastas or opt for a snack at Teraya Cafe
head to Hasedera between the end of November and the middle of December when the temple and its foliage are illuminated after sunset
Take a walk around the temple grounds and marvel at the orange and red trees seemingly glowing against the night sky and reflected in the waters below
Peak season: Late November to mid-December
3-11-2 Hase, Kamakura, Kanagawa - Map
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Join the leading Asian tourist attraction to assist our diverse range of customers
The riverside in the Akiruno area has lots of spots to camp and relax on a day trip
Really scenic spaces that aren't all concreted up
Can't go wrong ever with Kamakura and I never get tired of cycling thru or walking around that area
Driving and finding parking can be a nightmare though
I meant the second photo for Akiruno but Okutama looks great too
Myself and Mrs Elvis have had a many a good holiday there
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one evening in late August and a small group of hikers gathers outside the ticket gates at Musashi-Itsukaichi
the final station on the Itsukaichi Line connecting the rural suburbs of western Tokyo
The sun went down around 30 minutes earlier
but there’s still a faint afterglow in the sky
There’s not much wind and the humidity is high
as is typical of summer in Japan.googletag.cmd.push(function() { googletag.display('div-gpt-ad-1499653692894-0'); });
Donning a dark gray polo shirt and a light backpack
Jun Nakano beckons the party toward a large map in the station to explain where they will be going tonight
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Lush green mountains and crystal-clear waters greet visitors to Akigawa Valley
a mere hour by train or car from central Tokyo
Accessible from Musashi-Itsukaichi Station in the western Tokyo city of Akiruno
the valley is a relaxing retreat where people can enjoy such outdoor activities as hiking
local groups run nature schools for children
After spending a day in the great outdoors
soaking in the onsen hot springs at Akigawa Keikoku Seoto-no-yu Spa can be refreshing and relaxing
boasts indoor and open-air baths and saunas that offer fantastic views of the valley
Ishibunebashi Bridge — a pedestrian suspension bridge close to the spa — also affords spectacular views of the valley
which is transformed into a sea of vivid reds and golden yellows when the leaves change color in the fall
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Japan’s 47 prefectures were established in the years after the Meiji Restoration to replace the former provinces
Divisions similar to those currently in place have existed since 1888
The provinces had been around for many centuries
and even today their names appear in the names of places
Here we introduce the old names for the Kantō region
where Tokyo and six other prefectures can now be found
which runs from Kawasaki Station to Tachikawa Station
there are four stations that use the kanji 武蔵 (Musashi): Musashi-Kosugi
there are 21 stations that use the name Musashi across the prefectures of Kanagawa
They are spread over a wide area with Musashi-Itsukaichi in Akiruno
the furthest west and Musashi-Ranzan in Ranzan
Musashi was the name of the province that covered almost all of Tokyo and Saitama and also Kawasaki and Yokohama (excluding some western wards). The name was used up until the current administrative divisions were formed. Incidentally, it is no coincidence that the height of Tokyo Skytree is 634 meters. Based on goroawase number wordplay
the structure provides a perfect view over the former Musashi Province
Sagami Province was located in Kanagawa Prefecture
it may seem that Musashi appropriated all the big cities
Yokohama was a small fishing village until it rose to prominence as a base for foreign trade with the opening of its port in 1859
Sagami was the location for the shogunate in Kamakura
and during the Warring States period (1467–1568)
the province’s Odawara flourished as the castle town of the powerful Later Hōjō clan
Chiba Prefecture is also known as 房総半島 (the Bōsō Peninsula)
which is based on kanji from the old province names 安房 (Awa)
The kanji 総 (fusa) is an old word for “hemp,” which was cultivated by the Shikoku clan said to have traveled to the area on the Kuroshio Current
The ancient province of Fusa later split into three parts
it may seem strange that although 上 means up and 下 means down
This naming is actually related to the distance they are from the capital
as people crossed to the Bōsō Peninsula by sea from Sagami Province
it meant the southern side of the peninsula
This principle of distance also applies to 上野 (Kōzuke) and 下野 (Shimotsuke)
Originally known as 毛野国 (referred to as both Keno and Kenu Province)
the area was then divided into 上毛野国 (Kamitsuke Province) and 下毛野国 (Shimotsuke Province)
although the kanji 毛 (ke) stopped being used in the province name
it can still be found in a number of other names like 上毛三山 (Jōmō-Sanzan)
the three famous mountains of Gunma Prefecture: Mount Akagi
It also appears in 両毛線 (the JR Ryōmō Line)
which runs between Takasaki in Gunma Prefecture and Oyama in Tochigi Prefecture
an ancient chronicle compiled in the early eighth century
Hitachi is described as a paradise blessed by fertile mountains and the sea
kanji from 常陸 (Hitachi) and 磐城 (Iwaki
now Fukushima Prefecture) were combined to indicate the Jōban (常磐) area
which became known as a coal-producing region near the capital
The JR Jōban Line today links this area to Tokyo
As one of the leading electronics makers in Japan
has a history of more than 107 years promoting the international standardization of the electro-technology
served as a member of the preparatory meeting
and attended the official inauguration of the International Electrotechnical Commission (IEC) in London
Japan was the only Asian country present at the inauguration meeting and Fujioka made progressive comments there
As a multi-tiered maker involved in the production of everything from heavy electric machinery such as power generators through to household appliances
each division has developed its products with international standardization in mind
This trend became especially strong after World War II as Japan's economy developed tremendously
and the company reacted by becoming more business-oriented.googletag.cmd.push(function() { googletag.display('div-gpt-ad-1499653692894-0'); });
the World Trade Organization was established
settling on the mission of promoting international trade on a global scale
"This became the turning point for the IEC to become more strategic
and under the guidance of the Ministry of Trade
Toshiba employees have actively attended IEC's Technical Committees (TC)
in whichever fields we are involved in," explained Atsushi Itsukaichi
Chief Specialist of the Technology Planning Office
Technology and Innovation Division of Toshiba Corporation
While many have cursed the early arrival of rainy season this year
the moisture-loving insects such as the firefly are likely to be in heaven
must be hoping that the rain stays off this Saturday evening for the annual Firefly Festival
Large numbers of visitors from the surrounding areas are expected to swarm to the city's Hotaru Park to watch the riverbanks light up
The best viewing time is said to be from around 7 p.m
there will also be a whole host of traditional food stalls and other festivities taking place along the town's streets throughout the day.googletag.cmd.push(function() { googletag.display('div-gpt-ad-1499653692894-0'); });
The appropriately named Hotaru Park ("hotaru" is the Japanese word for "firefly") is situated next to the city's meandering Tsuri River
Local hearsay has it that the lightening bugs are secretly released for the festival by a small group of locals that breed them during the year
Both the river and the park have since become notable for their abundant amount of fireflies
with local authorities having even invested in a special hotaru no yakata (firefly house) to watch the seasonal display from
While the celebrations are just a one-day event
the fireflies will be around for a few weeks longer
A stroll along the riverside toward the mountains could make for a pleasant summer evening
The Firefly Festival takes place at Hotaru Park in Fussa
The park is a five-minute walk from Ushihama Station on the Ome Line and Kumagawa Station on the JR Itsukaichi Line
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