Simultaneous bilateral tubal pregnancy following in-vitro fertilization and embryo transfer / 대한산부인과학회지

A case of simultaneous bilateral tubal pregnancy following in-vitro fertilization and embryo transfer is presented. On the 22 days after ET, the patient complained of low abdominal pain and vaginal spotting for one day and was suspected of left tubal pregnancy by transvaginal ultrasonography. However, laparoscopy revealed the bilateral tubal pregnancy and laparoscopic bilateral salpingectomy was performed. This unusual type of ectopic pregnancy must be kept in mind when evaluating a patient suspected of a possible early abnormal gestation after assisted reproductive technologies. It is critical to perform a close inspection of the abdomen, pelvis, and contralateral tube during surgery.

A Study of Clinical efficacy of GnRH Antagonist (Cetrorelix(R)) and GnRH Agonist for Controlled Ovarian Hyperstimulation / 대한산부인과학회지

OBJECTIVE: To compare the clinical outcomes of GnRH antagonist (cetrorelix(R)) with those of conventional GnRH agonist for down-regulation in assisted reproductive cycle. Materials and Method: Ninety-nine women undergoing IVF or ICSI were treated with either GnRH antagonist (cetrorelix(R)) or GnRH agonist (Lucrin(R)) for pituitary down regulation. The patient characteristics, basal hormone profile and IVF outcome were compared. RESULTS: There were no significant differences in age and duration of infertility between two groups. E2 (pg/mL)/LH (mIU/mL)/FSH (mIU/ mL) on the 3 day of menstrual period as a baseline were also not significantly different between two groups. The number of hMG amples administered (30.5+/-11.2 versus 47.6+/-16.4 ample/cycle) and the duration of stimulation (11.0+/-1.7 versus 14.1+/-2.2 days) were significantly lower in the cetrorelix(R) group. There were no significant differences in the fertilization and pregnancy rates, the number of embryo transferred, the number of mature oocyte and the number of embryo obtained between two groups. CONCLUSION: The cycles using an antagonist protocol shows a shorter duration of stimulation with comparable outcomes with few injections than those with an agonist protocol. GnRH antagonist can be effectively used as GnRH agonist for pituitary down regulation in IVF-ET cycles.

The quantitative analysis the number of mitochondrial DNA copy using real-time PCR and mitochondrial tRNA mutation analysis at position 3243 in Korean gestational diabetes mellitus / 대한산부인과학회지

OBJECTIVE: Mitochondrial gene mutations may play a role in the development of gestational diabetes mellitus. This study has assisted to confirm the relationship between the mitochondrial DNA copy number and the GDM. METHODS: Peripheral blood samples were collected from 68 patients with GDM and from 79 controls. For the quantification of mtDNA content, a comparative analysis was performed by the amplification of endogenous control (nuclear DNA, 28S rRNA). The mitochondrial A3243G mutation analysis performed. RESULTS: The ratio of mtDNA/28S rRNA was 1.2053 +/- 0.8307 in GDM patients and 1.7975 +/- 1.1355 in control group (p=0.0004), respectively. Among 68 GDM patients, the mutation in tRNA nt 3243 was detected in only one subject. The A3243G mutation in tRNA- Leu gene, implicated in GDM was reported in 1 of 68 (1.47%) but not in controls. CONCLUSION: In this investigation, blood samples from GDM patients using the real-time polymerase chain reaction will be applied to confirm the relationship between the mitochondrial DNA copy number and the GDM. It is hypothesized that this method will help to predict GDM, and aid in developing early diagnostic methods and treatment modalities.

Clinical Outcomes of Frozen-thawed Embryo Transfer after Microsurgical Removal of Damaged Blastomere / 대한불임학회지

OBJECTIVE: Human infertility clinics have been faced the demand for improving clinical results. The purpose of this study was to evaluate the effect of microsurgical removal of damaged blastomeres (DB) in frozen-thawed embryos on the clinical outcomes. METHODS: From January 2003 to May 2004, out of 258 thawing ET cycles were divided into three groups: Group-1 (n=46): Intact cleavaged embryos after thawing. Remained cycles with embryos containing DB were randomly divided into two groups. Group-2 (n=102): Drilling zona pellucida (ZP) of frozen-thawed embryos by acidified Tyrode's solution. Group-3 (n=110): Drilling ZP and removal of DB. Embryos after microsurgical manipulation were transferred into the uterus of patients. RESULTS: Clinical profiles and the mean number of transferred embryos among three groups were not different. Pregnancy and implantation rates were similar in three groups. It were 30.4% and 9.3% in Group-1, 29.4% and 7.8% in Group-2, and 26.4% and 7.6% in group-3, respectively. Miscarriage rate in Group-3 (37.9%) was slightly higher than those in Group-1 and Group-2 (14.3% and 23.3%), but it was not statistically significant. CONCLUSION: Intact cleaving embryos after DB removal showed higher potent of pregnancy and implantation. We could not find any improvement of clinical outcome by removal of DB in frozen-thawed embryos.

The Clinical Significance of Absence of Umbilical Artery End-Diastolic Flow in Severe Pre-Eclampsia and Eclampsia / 대한산부인과학회잡지

To determine the perinatal mortality and morbidity of fetuses with absent end-diastolic velocities (AEDV) of the umbilical artery in severe pre-eclampsia and eclampsia, the outcome of 5 fetuses with AEDV was compared with that of 35 fetuses with positive end-diastolic velocities (PEDV). The study population comprised 38 cases of severe pre-eclampsia and 2 cases of eclampsia with structurally normal singletons, who had had umbilical artery Doppler velocimetry weekly from admission to delivery. The Doppler velocimetry result was not used for the clinical management. Perinatal death and neonatal morbidity from both groups were further examined in gestational age category to control the influence of preterm births. The incidence of AEDV of the umbilical artery Doppler velocimetry in severe pre-eclampsia and eclampsia was 12.5% (5/40). The AEDV group had a significantly higher incidence than the PEDV group in terms of ceasarean section due to fetal distress (60% : 17%), Apgar score < 7 at 5 minutes (60% : 14%), perinatal death (25% : 0%) and assisted mechanical ventilation (67% : 9%) both at 32-36 weeks. Time intervals from the detection of AEDV to delivery of live neonates varied from the day to 15 days. In conclusion, AEDV in the umbilical artery might be of clinical value in routine surveillance of pregnancies complicated by severe pre-eclampsia and eclampsia, and predict hypoxic fetal condition which needs operative interventions before or during labor and mechanical ventilation after birth.

A Study of Group B Streptococcal Infection in Korean Pregnant Women / 대한산부인과학회잡지

OBJECTIVE: To evaluate the degree of streptococcal colonization in Korean pregnant women. METHODS: The study comprised of 153 singleton pregnant women who visited Severance Hospital for delivery, and their neonates. Specimens for GBS culture were collected by a sterile cotton swab from lower vagina and cervix of pregnant women, and from ear canal and throat of neonates. They were first cultured for 48 hours in Todd-Hewitt broth and then subcultured onto Tryptose blood agar plates(Difco). Group B streptococci were confirmed by the presence of beta-hemolysis and a positive reaction with Phadebact group B Streptococci reagent(Karo Biodiagnostics AB, Huddinge, Sweden). RESULTS: The prevalence of positive cultures in pregnant women and neonates were 2.61%(4/153) and 0%(0/4), respectively. In the study population there was a case of suspicious group B streptococcual sepsis in an infant whose mother was colonized. CONCLUSIONS: In our study the GBS colonization rate in Korean pregnant women was significantly lower than that of other countries. The reason for this difference may be associated with a racial differences, or social factors such as socio-economic status or a life style.

Prenatal Sonographic Detection and Perinatal Outcome of Fetal Gastrointestinal Anomalies / 대한산부인과학회잡지

OBJECTIVE: Our aim was to evaluate the accuracy of prenatal sonographic detection of fetal gastrointestinal(GI) anomalies and to present perinatal outcome of fetal GI anomalies, incidence of polyhydramnios, other malformations and chromosomal abnormalities associated with fetal GI anomalies. MATERIALS AND METHODS: Prenatal sonographic results were compared with GI anomalies found in 32 neonates during recent 8 years. 32 cases of fetal GI anomalies were divided into three groups based on the level of obstruction and complication; group 1: upper GI obstruction(4 esophageal, 5 duodenal and 8 ileojejunal atresia); group 2: lower GI obstruction(1 colonal, 9 anorectal atresia); group 3: GI obstruction with secondary complication(1 ascites, 2 meconium peritonitis, 2 meconium pseudocyst). RESULTS: The accurate prenatal sonographic detection rate of fetal GI anomalies was 70.6% in group 1 and 100% in group 3 and there was no detection in group 2. False positive diagnosis was made in 5 cases(2: esophageal atresia, 3:ileojejunal atresia), but none of them except one case of multiple cardiac anomalies confirmed by autopsy, was followed by termination of pregnancy. Polyhydramnios was significantly associated with group 1 and associated malformations with group 2. An abnormal karyotype existed in three out of 32(1 case of trisomy 18 in esophageal atresia, 2 cases of trisomy 21, each one in duodenal and anorectal atresia). Survival rate of group 1, 2, 3 were 76%, 25%, and 40% respectively. CONCLUSIONS: The upper GI anomalies were easily detected by prenatal sonographic examination and had a good prognosis. But, the lower GI anomalies were difficult to diagnose prenatally and had a poor prognosis. Therefore, further efforts to diagnose for lower GI anomalies should be performed.