The Efficacy of Color Doppler Ultrasound in Diagnosis and Management of Placenta Previa with Accreta / 대한산부인과학회잡지

OBJECTIVE: To evaluate the efficacy of color Doppler ultrasound in diagnosis and management of placenta previa with accreta. METHODS: Hospital records were reviewed all cases of placenta previa from December 1999 to June 2002, and seventy-four patients with placenta previa underwent color Doppler ultrasound in their second and third trimester. Four diagnostic criteria of placenta accreta were diffuse lacunar flow pattern, exhibiting diffusely dilated vascular channels throughout the whole placenta: focal lacunar flow pattern showing irregular sonolucent vascular lakes, regionally or focally within the intraparenchymal placental area: absence of subplacental vascular signals in the areas lacking the peripheral subplacental hypoechoic zone: interphase hypervascularity with abnormal blood vessels linking the placenta to the bladder. RESULTS: Twenty-four of the seventy-four patients diagnosed placenta previa with accreta according to the above criteria and thirteen of these have proven to placenta accreta histopathologically. In ten cases hysterectomy were done under the group of suspicious placenta accreta. The sensitivity, specificity, positive predictive value and negative predictive value were 100%, 83%, 56% and 100%. CONCLUSION: The color Doppler ultrasound was effective method for the diagnosis of placenta previa with accreta, so proper diagnosis will be helpful to management of placenta previa with accreta patients.

A Case Patient None of Any Operation History Found Suture Needle in Uterus / 대한산부인과학회잡지

In past, there were some cases about foreign body, like gauze or metallic operative material, in abdominal cavity and they were associated with surgical procedure mostly. Recently we experienced a case of lost suture needle in uterus. She did not received any surgical procedures and just had 2 times of vaginal deliveries. The needle was found during pelvic surgery for hemoperitoneum. She was not known the fact that she had a foreign body in uterus. Although the patient complained chronic pelvic pain intermittently before visit hospital, she just thought of the nature of pain is like dysmenorrhea or nonspecific abdominal pain. The case considers about the moving of suture needle which was lost during vaginal delivery and fixed in the uterus and causing chronic pelvic pain. We report the case with a brief review of the literature.

A Clinical Study on the Recent Tendency of Pregnancy and Delivery in Women Aged 35 Years and Older / 대한산부인과학회잡지

OBJECTIVE: To access the pregnancy tendency and delivery in women aged 35 years and older. METHODS: From December 1999 to May 2001, 954 deliveries were in Ilsan Paik Hospital. Among them we compared 89 cases of pregnant women aged 35 years and older with under 30 year of age as control group 99 cases. The statistical analysis was performed using Chi-square tests, Mantel-Haenszel trend test, and statistical significance was defined as p value<0.05. RESULTS: The preterm delivery was higher in women aged 35 years and older (study group) (31.5%) than control group (8.1%) and cesarean birth (C/SEC) rate also higher in study group (61.8%) than control group (36.3%). In antenatal complications, there are no differences in both groups, but in postpartum complications, 4 cases hysterectomy were in study group compared with control group 1 case. In comparison of neonatal outcomes, neonatal intensive care unit (NICU) admission and congenital anomalies are higher in study group. Especially, in comparison of nulliparous women, study group (n=21) have higher C/SEC rate and preterm delivery than control group (n=63), but in pregnancy outcome there was no differences in both groups. CONCLUSION: There are no significant differences in pregnancy outcomes in both group, although preterm delivery and C/SEC rate are higher in elderly gravida. So elderly gravida is no more than high risk group, if appropriate management will be done.

Preterm delivery between 34-36weeks of gestation; Is it danger? / 대한산부인과학회잡지

OBJECTIVE: We performed this study to determine the safety and danger of preterm delivery at gestational age 34-36 weeks through antenatal profiles, neonatal conditions, neonatal morbidities. METHODS: We reviewed our antenatal and neonatal data between December 1999 and April 2001 to determine the morbidities of infants delivered at gestational age 34-36 weeks using x2test and Fisher's exact test. RESULTS: 1. Mean age was 30.8+/-4.58yrs and mean gravida was 2.68+/-1.56. Preterm premature rupture of membrane was higher in preterm delivery at gestational age 34 and 35weeks(respectively 58.6%, 50%). There was no difference in using tocolytics but, antenatal steroid treatment for prevention of respiratory distress syndrome(RDS) was most frequent in gestational age 34weeks.(20.68%). 2. There was no difference in the risk factor of preterm labor at each group. 3. 1-minute Apgar score<7 was significantly more frequent in neonates at gestational age 34weeks but neonatal weight and meconium staining were not different. 4. The rate of neonatal intensive care unit(NICU) admission was significantly higher in neonates delivered at gestational age 34weeks(93.1%), and RDS occurred in 3 cases delivered at gestational age 34weeks(10.34%). 2 cases delivered at gestational age 34 weeks needed the use of ventilator. CONCLUSION: Our study shows significant differences in neonatal morbidities between 34weeks and the others. In particular, all cases of Respiratory distress syndrome(n=3) occur in neonates delivered at 34weeks gestation not receiving antenatal steroid treatment and neonatal morbidities at 35 and 36weeks of gestation were not different with full term gestation.

Pregnancy Outcome of Natural and In-vitro Fertilization Twin Pregnancy / 대한주산의학회잡지

No abstract available.