Prevalence of Low Bone Mineral Density and Associated Risk Factors in Korean Puerperal Women

Although pregnancy is a medical condition that contributes to bone loss, little information is available regarding bone mineral density (BMD) in puerperal women. This cross sectional study aimed to evaluate the prevalence of low BMD in puerperal women and to identify associated risk factors. We surveyed all puerperal women who had BMD measurements taken 4–6 weeks after delivery in a tertiary university hospital, and did not have any bone loss-related comorbidities. Among the 1,561 Korean puerperal women, 566 (36.3%) had low BMD at the lumbar spine, total hip, femoral neck, and/or trochanter. Multivariate analysis revealed that underweight women had a significantly higher risk of low BMD compared with obese women at pre-pregnancy (adjusted odds ratio [aOR], 3.21; 95% confidence interval [CI], 1.83–5.63). Also, women with inadequate gestational weight gain (GWG) were 1.4 times more likely to have low BMD than women with excessive GWG (aOR, 1.42; 95% CI, 1.04–1.94). One-way ANOVA showed that BMDs at the lumbar spine and total hip were significantly different between the 4 BMI groups (both P < 0.001) and also between the 3 GWG groups (both P < 0.001). In conclusion, this study identifies a high prevalence of low BMD in puerperal women and thus suggests the need for further evaluation about the change of BMD in pregnancy and postpartum period.

Pathologic Differences between Placentas from Intrauterine Growth Restriction Pregnancies with and without Absent or Reversed End Diastolic Velocity of Umbilical Arteries

BACKGROUND: Abnormal umbilical artery Doppler velocimetry is one of the important findings of intrauterine growth restriction (IUGR) and IUGR is associated with high perinatal morbidity and mortality. In addition, this abnormal Doppler velocimetry is correlated with placental insufficiency. The aim of this study was to determine the pathologic differences in the placentas from IUGR pregnancies with and without the absent or reversed end diastolic velocity (AREDV). METHODS: Among the cases that had undergone prenatal follow-up in our institute, a retrospective slide review was conducted for 18 cases of IUGR with AREDV and 17 cases with IUGR that had normal end-diastolic flow of the umbilical artery. RESULTS: The birth weight and the other clinical parameters were not different among the two groups. Grossly, the placental weight percentiles were significantly smaller in AREDV group when they were adjusted according to gestational age. Histologically, chronic deciduitis, mural hypertrophy of the decidual arteries, an intimal fibrin cushion of the large fetal vessels, increased syncytial knots, villous agglutinations, avascular villi, villous stromal-vascular karyorrhexis, and acute atherosis were more frequently found in the AREDV group and their presence showed statistical significance. CONCLUSIONS: These findings suggest that pathologic abnormalities due to fetal and maternal vasculopathies in the placenta may be the cornerstone for inducing AREDV in the umbilical artery.

Current Status of Transurethral Prostatectomy: A Korean Multicenter Study

PURPOSE: We aimed to verify the current status of transurethral resection of the prostate (TURP) in Korea. MATERIALS AND METHODS: The medical records of 1,341 men who underwent TURP in 9 Korean medical centers between 2004 and 2008 were reviewed. The patients were divided into two groups according to time periods: 2004-2005 (group 1) and 2006-2008 (group 2). To verify differences in the two patient groups, age, prostate volume, indications for TURP, preoperative International Prostate Symptom Score (IPSS), and resected tissue weight were evaluated. RESULTS: The mean age of the patients was 71.2 years and the mean IPSS was 22.7. The patients' characteristics were not significantly different between the two groups. The annual cases of TURP increased over the study period. The proportion of lower urinary tract symptoms (LUTS) as an indication for TURP increased up to 58.3% in group 2 compared with 51.6% in group 1 (p=0.019). However, the proportion of patients who presented with acute urinary retention decreased from 35.5% to 30.3% with marginal statistical significance (p=0.051). Other indications such as hematuria, bladder stone, recurrent urinary tract infection, and hydronephrosis were not significantly different between the groups. The mean resected weights of the prostate were similar (17.5 g in group 1 and 18.3 g in group 2, respectively; p>0.05). CONCLUSIONS: TURP has been steadily performed in patients with benign prostatic hyperplasia and it is expected to remain constant. LUTS was the most common indication for TURP in recent years.

3D volume for monitoring the efficacy of methotrexate on placenta accrete: A case report / 대한산부인과학회지

Placenta accreta is a rare condition in which the placenta abnormally attaches to myometrium. It is associated with a high maternal morbidity and mortality rate due to massive hemorrhage, perforation, and infection. It is very rare to have placenta accreta in first trimester. Traditionally, hysterectomy has been the most performed management in abnormal placentation. Because it cannot preserve fertility, the conservative management such as methotrexate usage, and uterine artery embolization are pursued, recently. For monitoring the efficacy of the conservative management, serum human chorionic gonadotrophin (hCG) level has been used, however, low hCG does not always reflect the success of the treatment. 3D-ultrasonography is a new method to pursue the effect of conservative care, by measuring the volume of placenta accreta left in situ. We present a case of a 23-year-old patient with retained placenta accreta following dilatation and curettage, under a successful methotrexate treatment. The effect of methotrexate usage was evaluated by 3D-volume.

Factors influencing on perinatal outcomes in pregnancy with IgA nephropathy / 대한산부인과학회지

OBJECTIVE: The aim of this study is to evaluate factors influencing on perinatal outcomes of pregnancy with IgA nephropathy and the effect of pregnancy on the prognosis of IgA nephropathy. METHODS: We retrospectively reviewed clinical and laboratory findings of 28 pregnancies in 25 pregnant women with biopsy-proven IgA nephropathy at six hospitals of Catholic Medical Center throughout the period of January 1999 to December 2009. They are divided into two groups by presence or absence of perinatal complications such as preeclampsia and preterm labor and then compared. The prognosis of IgA nephropathy was determined by serum creatinine level and diagnosis of end stage renal disease (ESRD) until 3 years after delivery. Fisher exact test and Mann-Witney U test were used for statistical analysis. RESULTS: The factors that related perinatal complications included high blood pressure (P=0.019), low glomerular filtration rate (less than 50 mL/min) (P=0.029), and high creatinine level (more than 2.0 mg/dL) (P=0.005). Especially, hypertension and high creatinine level (more than 2.0 mg/dL) increased risk of not only preterm birth (P=0.017, P=0.026, respectively) but also preeclampsia (P=0.008, P=0.001, respectively). The factors that increased risk of ESRD within 2 years after delivery included high creatinine level (more than 2.0 mg/dL) (P=0.018) and preeclampsia (P=0.018). CONCLUSION: Our results indicate that hypertension and poor renal function could be predictors of poor perinatal outcomes, and when pregnancies with IgA nephropathy are complicated by preeclampsia or high creatinine level (more than 2.0 mg/dL), the prognosis of IgA nephropathy might be poor.

Perinatal outcome of pregnancy with hyperthyroidism / 대한산부인과학회지

OBJECTIVE: To evaluate the maternal and neonatal outcomes of pregnancies complicated with hyperthyroidism, according to the maternal treatment and thyroid function status during pregnancy. METHODS: This retrospective study was conducted on women complicated by hyperthyroidism who delivered between January 2000 and March 2010, at Catholic University Medical Center. The baseline characteristics as well as maternal and fetal outcomes were analyzed and compared according to maternal antithyroid medication and thyroid function status. RESULTS: Among 163 pregnant women complicated with hyperthyroidism, 103 women received antithyroid medication and 109 women showed euthyroid status during pregnancy. The mean gestational age and fetal birth weight at delivery were 38.2+/-2.9 weeks and 2.99+/-0.64 kg. There was no statistical difference in maternal complications between the medication group (n=103) and the non-medication group (n=59), while neonatal thyroid dysfunction including transient hypothyroidism was significantly higher in the medication group than the non-medication group (58% vs 24.5%, P<0.0001). The incidence of admission due to hyperemesis and neonatal thyroid dysfunction were significantly higher in the thyroid dysfunction group than the euthyroid group (21.7% vs 4.6%, P=0.0146; 66.7% vs 39.4%, P=0.0223, respectively). CONCLUSION: Maternal antithyroid medication as well as thyroid dysfunction during pregnancy could indicate the careful fetal thyroid monitoring to prevent neonatal thyroid dysfunction.

Thoraco-omphalopagus conjoined twins diagnosed at 14 weeks of gestation / 대한산부인과학회지

Conjoined twins are very rare and the mortality rate of the fetus is extremely high. Early prenatal diagnosis is crucial, as it provides the opportunity for the mother and father to help in recognizing the conjunction of the twins and to help medical team in defining the prognosis of conjoined twins. We present a case of thoraco-omphalopagus conjoined twins diagnosed by two-dimensional and three-dimensional transabdominal sonography at 14(+2) weeks of gestation.

Congenital lymphangiomatosis of the right lower limb / 대한산부인과학회지

Lymphangiomatosis is a condition of lymphatic tissue malformation with multiple or diffuse involvement of soft tissues, visceral organs. Congenital abnormalities of the lymphatic system are very rare, and reports of congenital lymphangiomatosis are even fewer. We experienced a case of congenital lymphangiomatosis detected as edema of the right limb by prenatal ultrasonography and then diagnosed by magnetic resonance imaging. We describe this case with a brief review of the literature.

The perinatal outcome of monoamniotic twin pregnancies / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to determine the perinatal outcome in monoamniotic twin pregnancies and to review the recently published literature about the topic. METHODS: This retrospective study examined the records of prenatally diagnosed monoamniotic twin pregnancy casese in our institution between January 1997 and April 2010. RESULTS: Among 1,112 twin pregnancies, there were 15 (1.3%) monoamnionic twins, including 2 conjoined twin pregnancies. Twelve (80%), 9 (60%), 5 (33.3%), and 4 pregnancies (26.7%) delivered after 20, 30, 32, and 34 weeks, respectively. Among 12 pregnancies that continued after 20 weeks of gestation, three cases showed one-fetal death and one, both-fetal death. The perinatal mortality rate (from 20 weeks of gestation to 28 days after birth) was 37.5%. The incidence of lethal anomalies and congenital heart anomalies was 20% and 23.3%, respectively. The mean gestational age at delivery was 31.4+/-4.53 weeks; 16 of 18 neonates (84.2%) were admitted to the neonatal intensive care unit (NICU). Three neonates expired on the first day after birth. The mean duration of the NICU stays for 13 live neonates was 32.0+/-29.3 days (range, 3 to 114 days). The main causes of perinatal deaths were preterm birth, congenital anomalies, pregnancy loss before 20 weeks, and intrauterine fetal demise that might have resulted form cord entanglement. CONCLUSION: Perinatal mortality in monoamniotic twins was still very high and the survival rate after 32 weeks of gestation is approximately one-third. Further studies are needed to improve the perinatal mortality.

Analysis of placental pathological findings contributing to intrauterine fetal death / 대한산부인과학회지

OBJECTIVE: To evaluate placental causes of fetal death intrauterine (IUFD) bases on placental pathologic findings. METHODS: Retrospective review of 123 placental pathological reports of singleton fetal deaths from 20 weeks of gestation to 41 weeks of gestation. RESULTS: The incidences of maternal causes, fetal causes, inflammatory causes, miscellaneous and unremarkable findings were 45.5%, 28.4%, 16.2%, 23.5%, respectively. The incidence of fetal anomaly was 8.9%. Fetal anomalies were deeply related to fetal cause (P=0.000). Intrauterine growth restriction was significantly associated with maternal causes (P=0.038). CONCLUSION: No pathological guideline regarding placental examination of intrauterine fetal death exists. In future studies, a better definition of fetal death causes and associated placental pathological findings might aid clinicians in counseling, assessing the risk of recurrence and even preventing fetal death in subsequent pregnancies.

A successful pregnancy in patient with pulmonary hypertension associated with systemic lupus erythematosus / 대한산부인과학회지

Pulmonary hypertension is a rare and potentially life-threatening complication of Systemic lupus erythematosus (SLE), and 5 cases has been previously documented in pregnancy. Four cases died after delivery and only one case was alive. We describe the case of a 28-year-old pregnant woman with pulmonary hypertension related to SLE with no previous history of immunologic disease including SLE. Diagnosis was made at 22 weeks of gestation. Medication including prednisolone and hydroxychloroquinone was commenced immediately and continued throughout the pregnancy. On fetal sonogram, the fetal growth was 3~10 percentile and diastolic notch of uterine arteries was noted. However, a healthy baby girl weighing 2,400 g was born in planned vaginal delivery at gestation week 38. There were no postpartum complications.

A clinical study of depressive symptoms during pregnancy / 대한산부인과학회지

OBJECTIVE: To examine the incidence of the depressive symptoms during pregnancy and the socio-demographic and obstetric factors associated with depression. METHODS: Two hundred five women who had received antenatal care at Kangnam St. Mary's Hospital from March 2008 to May 2008 completed the questionnaire related to socio-demographic characteristics and Edinburgh Postnatal Depression Scale (EPDS). Statistics were performed using chi-square test and Fisher's extract test (SPSS 12.0). Results were considered statistically significant for P-values<0.05. RESULTS: Of 205 pregnant women, the mean score of EPDS was 7.3+/-4.2.54 of 205 women (26.5%) scored more than 10 point which is the cutoff value to define depressive symptoms. The incidences of depressive symptoms were not significantly different by the trimester (25.7% vs. 29.0% vs. 25.0%, P<0.844). There were no significant socio-geographic factors associated with depressive symptoms. In cases of unexpected pregnancies, the incidence of depressive symptoms was significantly high (34.6% vs. 21.0%, P=0.036), and the women who have problems of previous pregnancies scored significantly higher EPDS (56.3% vs. 23.8%, P=0.014). CONCLUSION: This study was the first report about the depression symptoms during pregnancy. Based on this study, we have to focus on and manage depression symptoms related to pregnancy.

Laparoscopic finding of Acute Pelvic Inflammatory Disease / 대한산부인과학회지

OBJECTIVE: To analyze physical, laboratory and laparoscopic findings of suspicious cases of pelvic inflammatory disease (PID) and compare the group shown positive findings during laparoscopic surgery with that shown negative findings. METHODS: We selected 42 doubtful cases of PID that were treated by diagnostic laparoscopic surgery in St. Paul hospital of Catholic Medical Center from Jan. 2001 to Jun. 2003 and evaluated symptoms, duration of pain, and physical, laboratory, laparoscopic and histological findings. RESULTS: Of the 42 patients, we classified 22 patients shown pelvic inflammatory findings at laparoscopic surgery into the positive group and 20 patients shown non-specific or free-inflammatory findings into negative group. Between two groups, there were no significant differences in ages, parities and histories of PID. Number of intrauterine device (IUD) users was 5 and all of the five patients were positive group though none was belonged to negative group. Mean duration for developing acute pain was much shorter in positive group (3.1 days) than negative group (22.3 days). There were no meaningful differences in rise of body temperature and CRP level, but the degree of leukocytosis was greater in positive group (10,581/mm3) than negative group (7,720/mm3). Ratio of polymorphonuclear (PMN) leukocytes was higher in positive group (73.3%) than in negative group (59.7%) and number of cases those erythrocyte sedimentation rate (ESR) above 30 mm/Hr was larger in positive group (n=17) than in negative group (n=10). CONCLUSION: Of the suspicious cases of PID based on patient's symptoms and physical findings, the rate of the cases shown positive findings in laparoscopic surgery was 52.3%. Distinctive factors between two groups were usage of IUD, urgency of symptom, degree of leukocytosis, increase in ratio of PMN leukocytes and ESR. We suggest the exploration of more sensitive and specific diagnostic tools.