The clinical practice pattern of postterm pregnancy in Korea / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to survey the clinical practice pattern of postterm pregnancy in Korea. METHODS: A questionnaire was mailed to 1114 physicians who are registered in Korean Society of Obstetrics and Gynecology (KSOG) and work in primary and secondary hospital as well as tertiary care center. The questions included information about the practice pattern implicating definition of postterm pregnancy, the time and the method of routine fetal surveillance and induction of labor as well as demographic information such as age, sex, location, professional part and the number of delivery. We got 23.2% (258/1114) of surveys returned and analyzed the data. RESULTS: Seventy-four percent (73.6%) of the respondents define 42 weeks gestation or greater to be postterm. However, 84.5% consider induction of labor at 41 weeks of gestation. Sixty-eight percent (68.3%) of the respondents start postterm pregnancy fetal testing at 40 weeks and 59.3% of them perform testing every week. For fetal surveillance testing, 85.7% of the respondents use NST and 39.5% of them use modified BPP. As for induction of labor, 65% of practitioners use oxytocin and 45% of them use prostaglandins (misoprostol and dinoprostone) when inducing both nulliparous and multiparous women with unfavorable cervix. CONCLUSION: Most of the respondents (84.5%) routinely induce low-risk singleton pregnancy at 41 weeks gestation, whereas the majority of them (73.6%) define postterm pregnancy beyond 42 weeks gestation.

Maternal and neonatal outcomes in pregnancies complicated with idiopathic thrombocytopenic purpura (ITP) / 대한산부인과학회지

OBJECTIVE: To investigate the maternal and neonatal outcomes in pregnancies complicated with idiopathic thrombocypenic purpura (ITP) and to identify antenatal factors to predict the neonatal thrombocytopenia. METHODS: We analyzed retrospectively maternal and neonatal outcomes of the32 pregnant women with ITP who were delivered over a 12-year period. RESULTS: The prevalence incidence of ITP in pregnancy was 0.87 per 1,000 live births in this study population. The diagnosis of ITP was made more before pregnancy than with afterduring during pregnancy (63% vs 37%). Maternal platelet transfusion was done in 62.5 % of pregnancies with ITP. Sixty nine percent of pregnancies with ITP received medical therapies; steroid only in 8 cases (25%), steroid + IVIG (intravenous immunoglobulin) in 6 cases (18.7%), IVIG only in 2 cases (6.2%), and steroid + IVIG + anti-Rh (anti-D) in 1 case (3.1%). Overall response rate (Plt > 50 x 10(9)/L) to medical treatment was 77%. Neonatal thrombocytopenia (Plt < 50 x 10(9)/Ll) was observed seen in 4 cases (14.2%) immunoglobulin. There was no correlation between the maternal and the neonatal platelet count. Moreover medical treatment during pregnancy did not make any difference in neonatal platelet count. There was one case of neonatal ICH (germinal matrix hemorrhage). CONCLUSION: Although neonatal thrombocytopenia occurred in 140% of pregnancies with ITP, no antenatal factor could predict neonatal thrombocytopenia.

Adnexal mass in Pregnancy: Correlation of Sonographic Findings and Pathology / 대한주산의학회잡지

OBJECTIVE:The purpose of this study was to investigate the role of sonographic findings and tumor markers in predicting malignancy of adnexal masses in pregnancy. METHODS:From January 1995 to September 2005, 190 cases of adnexal masses were operated during pregnancy. We reviewed their sonographic findings and medical records retrospectively. Sonographic features and tumor markers were correlated with malignant pathology. Pregnancy and neonatal outcomes were also studied after treatment of adnexal mass during pregnancy. RESULTS:From 190 cases, there were 10 cases (5.3%) of malignant tumor or tumors of borderline malignancy. In the 180 cases of benign adnexal mass, the most common type was mature cystic teratoma (36.7%). Preoperative sonographic findings were available in 110 cases. The median size was 6.3 cm for benign masses and 7.7 cm for malignant masses (p=0.05). Mixed echogenecity, septa and mural nodule were more frequently found in malignant masses (p=0.003, 0.029, 0.013, respectively). Tumor markers were available in 47 cases. In the 1st trimester, the level of serum CA-125 of the patients with benign masses were not different from those with malignant masses. However, in the 2nd and 3rd trimester, the difference was statistically significant (p=0.031). Forty- six patients underwent antepartum surgery and the overall pregnancy outcome was similar between the laparoscopic group and the laparotomy group. CONCLUSION:Mixed echogenecity, septa and mural nodule showed significant correlation with malignant adnexal mass in pregnancy.

Expression of TADG-15 in Squamous Cell Carcinoma of the Uterine Cervix / 대한산부인과학회잡지

OBJECTIVE: Tumor-associated differentially expressed gene-15 (TADG-15/Matriptase/MT-SP1) is an epithelial-derived, integral serine protease which has been implicated in the progression of epithelial tumors. The aims of this study were to evaluate the expression pattern of TADG-15 in cervical squamous cell carcinoma and investigate the different expressions according to presence of lymph node metastasis. METHODS: Tumor specimens were obtained from each 20 patients with invasive squamous cell carcinoma (ISCC) with and without lymph node (LN) metastasis. Normal cervical tissues as control were obtained from 10 patients with myoma uteri. Immunohistochemical analysis was performed with antibody to TADG-15. RESULTS: The immunohistochemical staining showed that the expression of TADG-15 was undetectable in all normal squamous epithelia, but had variable staining in the basal layer of normal endocervical glands. The expression of TADG-15, exhibiting cytoplasmic and membranous staining, were significantly up-regulated in almost all (95%) of the ISCC in comparison to the normal control (P<0.001). But the expression of TADG-15 was not significantly different between ISCC with and ISCC without LN metastasis (P=0.56). However there was increasing tendency of expression in ISCC with LN metastasis in comparison to ISCC without LN metastasis. CONCLUSION: These results suggest that TADG-15 may play a significant role in carcinogenesis of squamous cell carcinoma of the uterine cervix and may represent novel markers for this disease. Further studies of serine protease and TADG-15 gene will likely result in the development of novel approaches for early detection and therapy of this disease.

A Pilot Study of Platinum-based Three Cycle-Consolidation Chemotherapy in Epithelial Ovarian Cancer / 대한산부인과학회잡지

OBJECTIVE: The aim of this study is to evaluate the efficacy of additional three cycles of platinum- based chemotherapy in epithelial ovarian cancer patients with clinical complete response (CR). METHODS: Patients with histologically confirmed epithelial ovarian cancer stage II-IV and showing clinical CR after primary surgery and six cycles of chemotherapy with platinum-based chemotherapy entered into the study. Three cycles of platinum/paclitaxel (cisplatin/paclitaxel or carboplatin/paclitaxel) or cyclophosphamide/cisplatin, cyclophosphamide/adriamycin/cisplatin were administered as a consolidation chemotherapy only in patients with an agreement to informed consent. RESULTS: A total of 96 patients entered into the study. According to informed consent, 47 patients were treated by consolidation chemotherapy and 49 patients were followed up without further treatment. The median follow-up period was 30.5 months in total patients. The mean number of chemotherapy courses administered on the consolidation arm was 2.7. The median actuarial disease-free survival for the patients without consolidation chemotherapy arm was 26.0 months and consolidation arm, 27.0 months. No difference was detected in disease-free survival (p=0.89). Median overall survival is not reached, but there was no significant difference between the two arms of the trial (p=0.76). WHO grade 3-4 toxicity criteria were emesis (4.1% vs. 2.1%), anemia and/or neutropenia (10.2% vs. 19.1%), and others (4.1% vs. 21.3%). CONCLUSION: Although sample size is small and not randomized, these results suggest that platinum- based consolidation chemotherapy do not provide a favorable outcome in terms of disease-free survival in patients with a clinical CR after debulking surgery and six cycles of same regimen.

Perinatal Outcome in Relation to the Latency of Delivery in Severe Preeclampsia before 32 Weeks of Gestation / 대한주산의학회잡지

OBJECTIVE: To study the differences in the pregnancy outcomes of severe preeclampsia before 32 weeks of gestation in relation to the latency between admission and delivery. METHODS: We reviewed medical records of 89 pregnant women who were managed in Samsung Medical Center because of severe preeclampsia before 32 weeks of gestation between January 1996 and February 2004. We studied the differences in the management and the neonatal outcomes between the immediate delivery group (admission to delivery 2 days). We excluded maternal renal disease, chronic hypertension, multiple pregnancies, diabetes and placenta previa from this study. RESULTS: 40 women were included in the immediate delivery group and 49 women in the expectant management group. Antenatal corticosteroid was given pregnant women in the expectant management group (89.8% vs. 52.5%, p<0.0001). There was no significant difference in the occurrence of small for gestational age- and prematurity-related complications including neonatal mortality. There was significantly less respiratory distress syndrome in the expectant management group (46.9% vs. 62.5%, p=0.0315). However this difference disappeared when the adjustment was made to the gestational age at delivery (p=0.223). CONCLUSION: The latency period does not seem to alter the neonatal prognosis in severe preeclampsia before 32 weeks of gestation but the gestational age at the delivery, a reflection of the severity of the preeclampsia, seems to be the single most important factor for the occurrence of neonatal respiratory distress syndrome.