Comparison of Outcomes of Incompetent Cervix Patients Treated with the Transvaginal Cerclage and the Modified Transvaginal Cerclage using Fibrin Sealant / 대한주산의학회잡지

OBJECTIVE: The purpose of our study is to compare the outcome of the modified transvaginal cerclage (MTVC) in patients who had not undergone a previous TVC with the outcome of patients treated with the transvagianl cerclage (TVC). METHOD: Incompetent cervix patients in the Obstetric/Gynecology department of Hanyang University Hospital post January, 1996 were selected as subjects for this study. 94 patients who received the TVC and 44 patients who received the MTVC using fibrin sealant were compared. The success of the operation was determined in the 34th week of pregnancy, and duration of pregnancy. RESULTS: Clinical characteristics of the TVC group and the MTVC group are showing no significant statistical difference between the two groups. The average gestational age of delivery was 36.0 and 37.0 week and the average weight was 2,797 g and 2,828 g respectively, also showing no significant (p=0.06) statistical difference. However, the duration of pregnancy between surgery and birth was 19.5 and 21.5 weeks showing significant (p=0.013) statistical difference, when the success rates of the treatments of incompetent cervix were observed according to the 34th week standard, TVC showed a 74% (71/96) rate of success and MTVC with fibrin sealant showed a 90.9% (40/44) rate of success, showing a significant statistical difference (Chi(2)=4.503, p<0.05). CONCLUSION:The success rate of MTVC using fibrin sealant showed to be significantly higher than the success rate of TVC. The reason for the difference in success rates is suspected to be because the fibrin sealant injected between the two TVC bands blocked the possibility of infection originating in the vagina. In the future, further research should focus on cultures of vaginal and amniotic fluids.

Outcome of 2nd Pregnancy after Transabdominal Cervicoisthmic Cerclage in Patient with Incompetent os of the Cervix / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to investigate the effectiveness of further successful pregnancies and prognosis after delivery where the band was not removed from a transabdominal cervicoisthmic cerclage (TCIC) after a first successful pregnancy. The candidates of TCIC were those who were diagnosed with incompetent internal os of cervix (IIOC) and either had failed to maintain pregnancy after undergoing transvaginal cerclage (TVC) or could not undergo TVC due to cervical abnormalities. METHODS: During the period from May of 1991 until November of 2002, there were total 20 cases in which the band was not removed after previous TCIC, followed by a first successful pregnancy. RESULTS: In the 20 patients who had undergone TCIC, the average age, average gestational age at the time of operation, average number of previous pregnancy, average number of surviving fetus, average number of preterm delivery, and average number of fetal death were 32 years old, 12.8 weeks, 5.4, 0.2, 2 and 2.2, respectively. Cesarean section was performed at an average gestational age of 37.1 weeks in which the average birth weight was 2903 g in the first born child among 19 patients. In the following pregnancies, the average age of the patients were 34 years old in which there were 17 successful deliveries out of 20 cases where the average gestational period was 35.4 weeks and an average weight of 2661 g. There was an average of 22.5 months between the time of the first and second delivery. CONCLUSION: When the location and tension of the band had been confirmed after the first delivery in a total of 20 patients, there was a high successful delivery rate of 85% (17/20) in the next pregnancy. In this study, there was no evidence to support the complications reported in previous studies of difficulty in removal of trophoblastic tissue after abortion, dysmenorrhea, and increase in infertility associated with non removal of bands.

Correlation analysis of Each Variable of Fetal Heart rate in Pregnancy induced hypertension and Intrauterine fetal growth restriction / 대한산부인과학회잡지

OBJECTIVE: We aim to analyze each variable of FHR in high risk pregnancies, namely intrauterine growth restriction (IUGR) and pregnancy-induced hypertension (PIH) including chronic hypertensive vascular disease (CHVD), mild and severe preeclampsia to build an objective decision basis using correlation analysis. METHODS: The patients were divided into two groups (500 normal pregnancies and 500 high risk pregnancies related to IUGR, CHVD, mild and severe preeclampsia), and then subdivided into intrauterine pregnancy before 24 weeks, 25-39 weeks, and after 40 weeks. We compared the canonical correlation between each group using variables of FHR after nonstress test (NST). RESULTS: In high risk pregnancies, the linearity was 0.6-0.8 in intrauterine pregnancy before 24 weeks, 0.53-0.68 in 25-29 weeks, 0.50-0.60 in 30-34 weeks, 0.38-0.45 in 35-39 weeks and 0.42-0.55 in after 40 weeks. In normal pregnancies, the linearity was 0.44-0.52 in intrauterine pregnancy before 24 weeks, 0.38-0.45 in 25- 39 weeks which was stable, and there was no specific change in after 40 weeks. Before 32 weeks, canonical variates of FHR_D and FHR_I revealed highest (0.36, 0.47 respectively) in high risk pregnancy and fetal movement and signal loss was the most valuable factors in normal pregnancy. In between 33 to 37 weeks, fetal movement (0.40) and signal loss (0.48) were related most closely in high risk pregnancies and 0.34 and 0.49 respectively in normal pregnancies which show similar pattern. In contrast, FHR_D was most highly related to the duration of pregnancy and FHR_I to fetal movement (0.38) in high risk pregnancy. In normal pregnancies, fetal movement (0.40) and signal loss (0.52) showed the highest linearity. CONCLUSION: The pregnancy with intrauterine growth restriction and pregnancy induced hypertension has more linear relation and less complexity in each variable of FHR than the normal pregnancy group. The formal, functional underdevelopment of fetus may results in the increasement of the linear depedent relation in each variable of FHR in these type of high risk pregnancies.

The Comparison between Modified Transvaginal Cerclage and Transabdominal Cervicoisthmic Cerclage after a failure of Previous Transvaginal Cerclage in Incompetent Internal Os of Cervix Patients / 대한산부인과학회잡지

OBJECTIVE: Incompetent internal os of cervix is one of the most common causes of midtrimester abortion in which interventions such as, transvaginal cerglage and transabdominal cervicoisthmic cerclage (TCIC) have been performed to prolong pregnancy. Transabdominal cerclage is beneficial in treating patients with cervices that are either extremely short, congenitally deformed, deeply lacerated after operative delivery, or markedly scarred because of previously failed transvaginal cerclage procedures. Due to technical difficulties and the fact that a cesarean section is necessary for delivery, has not been a procedure easily adopted. The purpose of our study was to compare the effectiveness of selected Modified McDonald cerclage (MTVC) and TCIC was compared in patients who had history of a previously failed transvaginal cerclage in other hospital. MATERIALS AND METHODS: Pregnancy outcomes of 13 patients who underwent TCIC from November 1997 to January 2002 and those of 28 patients who underwent MTVC from January 2000 to January 2002 were compared. Statistical analysis was done using Chi-square test and Mann-Whitney. RESULTS: The fetal salvage rates for total 13 cases of TCIC and 28 cases of MTVC were 100% (13/13) and 85.7% (24/28), respectively. The fetal salvage rates between these two groups were not statistically different. The mean gestational age at the time of operation in TCIC group was 13.15 (+/-1.63) weeks, mean gestational weeks delayed until delivery was 23.85 (+/-3.24) weeks and mean fetal body weight was 2780.77 (+/-667.33) gm. Comparably, the mean gestational age at the time of operation in MTVC group was 15.00 (+/-2.05) week, mean gestational weeks delayed until delivery was 9.96 (+/-6.65) week and mean fetal body weight was 2530 (+/-1071.26) gm. CONCLUSION: In patients who had a history of failure of TVC, the effectiveness of TCIC and MTVC had no statistical significance. Treatment with MTVC should be considered since TCIC is technically difficult and requires cesarean section.

Variables of Fetal Heart Rate and Neonatal Outcome according to Fetal Sex / 대한산부인과학회잡지

OBJECTIVE: The differences between two fetal sexes have been a matter of great concern from ancient times to present day. This study was initiated to research the varying fetal behaviors which would differ according to the fetal sex. METHODS: With every 1,500 cases of each fetal sex selected, the patterns which the varying factors related to FHR and prognosis of neonates in normal pregnancy were compared by means of Factor Analysis (a linear method). Canonical Ensemble was performed to compare the relationship of intrauterine fetal behavioral developments, and neonatal prognosis of each fetal sex. And whether the different types of the fetal sex would have influence also on the chaotic behavior was analyzed by the methods of linear Power Spectrum of FHR and Approximate Enthropy. RESULTS: The consequences of Factor Analysis showed that it is Apgar score on the factor 1 axis, and signal loss on the factor 2 axis in the case of male babies. In the case of female babies it is Apgar score on the factor 1 axis, and fetal movement on the factor 2 axis. Speaking of the specific value regarding FHR, male babies displayed higher frequency only in terms of fetal movement sign than female babies (p=0.0394). No other differences between two fetal sexes in abnormal findings were indicated (p>0.05). Among the babies at 30~33 weeks' gestation female babies were more likely to reveal higher Canonical Ensemble (male=0.41+/-0.05, female=0.05+/-0.04; p=0.00411), whereas male babies have a higher Approximate Entropy (male=0.926+/-0.01, female=0.871+/-0.01; p=0.0037). However Power Spectrum Analysis indicated that there were no significant differences as I compared LF/HF (p>0.05), the ratio of LF and HF of two fetal sexes, and same result was also drawn by Power Low beta-slope (p>0.05). CONCLUSION: The linear patterns of the FHR signal from the fetus suggest that there is no variables resulting from the type of fetal sex, except for the fetal movement frequency and the height and weight of neonates. The sympathetic and parasympathetic balance of both fetal sexes also showed a similar development pattern. In the mean time the differences which could be visible were made among the male and female babies specifically at 30~33 weeks' gestation. This may correspond to the fact that the lung maturation of the female fetus is completed before the third trimester of pregnancy, and the male fetus after the period, and finally the differences between the fetal sexes generally become insignificant toward term.

Correlation Analysis of Each Variable of Fetal Heart Rate After Maternal Hearing of Alpha-Brain Wave Induced Sound and Natural Sounds / 대한주산의학회잡지

No abstract available.

A Case of Pregnancy Complicated with Korean Hemorrhagic Fever / 대한산부인과학회잡지

No abstract available.