Significance of fetal heart rate by vaginal ultrasound in the early pregnancy / 대한산부인과학회잡지

OBJECTIVE: Fetal heart rate in embryos(6-8 gestational weeks) have been significantly related to fetal outcome, but have rarely been studied. We attempted to identify fetal heart rate during 6-8 gestational weeks. Our purpose was to determine the lower limit of the heart rate associated with a favorable outcome and to evaluate the prognosis for those embryos with slow heart rates in early period. METHODS: We prospectively studied 798 singleton pregnancies between Jul. 1997-Dec. 1999 visiting our hospital. Gestational age was calculated from the beginning of the last menstrual period in the case of regular cycle and was confirmed by the crown-rump length. Other cases were measured by crown-rump length or mean gestational sac diameter. Color doppler sonography was used to calculate the fetal heart rate in beats per minute as the mean of 3 waves. RESULTS: Mean fetal heart rate (+/-SD) were 114.08+/-15.40 bpm for group 1, 126.49+/-18.78 for group 2, 139.83+/-19.92 for group 3, and 149.58+/-23.34 for group 4(p<0.001). Prognosis in the first trimester improved as heart rate increased to 100 bpm in group 1 and 120 bpm in group 2. In group 3 and 4, most of fetus with heart rates below 110 bpm died. CONCLUSIONS: The fetal heart rate during 6-8 gestational weeks is associated with fetal outcome at the end of the first trimester and we can identify the fetuses that are in risk.

Diagnostic Efficacy of the Morphological Scoring System of Ultrasound, CA-125, Color Doppler Sonography(CDS), and Magnetic Resonance Imaging(MRI) in Detecting Ovarian Malignancy / 대한산부인과학회잡지

OBJECTIVE: Ovarian cancer is a silent disease with few symptoms. Because early detection of ovarian cancer is difficult, most cases are diagnosed at an advanced stage. To determine whether an ovarian tumor is malignant or not, various diagnostic procedures have been used including physical examination, ultrasound and tumor markers such as CA-125. We recently compared color Doppler sonography(CDS) with the morphological scoring system and CA-125 levels in establishing an accurate preoperative diagnosis of adnexal mass. As a result, we tried to compare the morphological scoring system with CA-125 and CDS in the diagnosis of adnexal mass. METHODS: The medical records of 47 patients referred with preexisting adnexal lesion were reviewed retrospectively by comparing ultrasonic data(morphological scoring system and color Doppler finding) with serum CA-125 and MRI findings. RESULTS: Forty-nine masses were removed surgically and confirmed as 25 malignancies and 22 benign tumors. In cases using the morphological scoring system and CA-125, the accuracy showed 95% sensitivity. In cases using the morphological scoring system and CDS, the sensitivity was 88%. In cases using the morphological scoring system and CDS, the sensitivity was 48%. CONCLUSIONS: The morphological scoring system and CA-125 are the basic methods for predicting ovarian malignancy. MRI and CDS may be also useful diagnosis methods in diagnosis of ovarian malignancy. But combination of these diagnositic modalities may not improve the accuracy of predicting ovarian malignancy, significantly.