Impact of Maternal Age of 40 Years or Older on Pregnancy Outcomes / 대한주산의학회잡지

OBJECTIVE: The aim of this study was to examine the effects of maternal age on perinatal and obstetric outcomes with respect to maternal age older than 40 years. METHODS: A retrospective review of maternal and newborn medical records of women who delivered their babies in the hospitals of the Catholic University of Korea between January 1, 2000 and July 1, 2005 was conducted to compare pregnancy complications and perinatal outcomes in three age groups; women aged 25~29 years (group A; n=214), those aged 35~39 years (group B; n=276), and those aged 40 years and older (group C; n=347). RESULTS: The incidences of GDM (gestational diabetes mellitus), preterm birth and cesarean section in group C were by far the greatest among the three groups. The incidence of postterm delivery in group A was the highest among the three groups. Previous cesarean section and elderly gravida were the most frequent causes of cesarean section in group C. The incidences of low birth weight (<2,500 g) and the NMICU(neonatal medical intensive care unit) admission rate in group C were higher than those in group B, but not significantly different from those in group A. CONCLUSION: Maternal ages of 35~39 years do not appear to be associated with adverse perinatal and obstetrical outcomes. Maternal ages of over 40 years influence the incidences of PIH (pregnancy induced hypertension), GDM, preterm birth, cesarean section, placenta previa, low birth weight and NMICU admission.

A Clinical Study of Maternal Heart Disease in Pregnancy / 대한주산의학회잡지

OBJECTIVE:To assess the pregnancy outcomes complicated by maternal heart diseases. METHODS:From 1995 to 2006, medical records of pregnant women who had received full antenatal care at Kangnam St. Marys Hospital and Our Lady of Mercy Hospital with maternal heart diseases were reviewed. RESULTS:Forty one deliveries from 39 women were enrolled for analysis. 11 (26.7%) cases of the heart diseases were of rheumatic origin, 22 (53.7%) cases had arrhythmic disease, 3 (7.3%) cases had congenital heart disease, and the remaining 5 (12.3%) cases were consisted of miscellaneous diseases such as ischemic heart disease and congestive heart failure. There were 4 (9.8%) cases of pulmonary edema which had occurred as maternal complication during pregnancy. One case was a twin pregnancy. All of them were in New York Heart Association (NYHA) functional classes I, II before, during, and after delivery. Mean gestational age at birth and birth weight were 38.6 weeks and 3,157 g respectively. Neonatal congenital heart disease was shown in only one case with tetralogy of Falot and the other fetal anomaly was multicystic dysplastic kidney. CONCLUSION:Our results indicate that successful pregnancy outcome in patients with maternal heart disease would be possible in NYHA functional classes of I and II without any increased risk of complications.

Clinical Effects of Continuous Transabdominal Amnioinfusion in Preterm Premature Rupture of Membranes : Retrospective Study / 대한주산의학회잡지

OBJECTIVE : To assess the clinical role of continuous transabdominal amnioinfusion in pregnancies with preterm premature rupture of membranes (PPROM) less than 34 weeks of gestation. METHODS : In this retrospective study between January 1999 and December 2003, 76 singleton pregnancies complicated with PPROM less than 34+0 weeks of gestation, were included. Thirty-eight patients consented to undergo the continuous transabdominal amnioinfusion. The control group, matched with the amnioinfusion group by parity and gestational age at rupture of membranes, was managed expectantly. RESULTS : The median intervals from PPROM and delivery (latency period) (8.0+/-7.3 days vs. 1.7+/-2.5 days, p<0.001), the gestational age at delivery (223+/-17.8 days vs. 211+/-18.0 days, p=0.003) and the birth weight (1,853+/-465 g vs. 1,556+/-459 g, p=0.006) were significantly increased in the amnioinfusion group compared to the control group, respectively. In maternal complications, the amnioinfusion group showed higher rate of placental abruption (5.2% vs. 2.6%, p=0.556) than the control group, but were comparable in the rates of cesarean section (44.7% vs. 42.1%, p=0.817) and clinical chorioamnionitis (18.4% vs. 18.4%). The rate of neonatal ventilator care of positive pressure ventilation was significantly decreased in the amnioinfusion group, compared to the control group (15.8% vs. 50.0%, p=0.002). In neonatal morbidity, respiratory distress syndrome was more frequent in the control group compared to the amnioinfusion group, although it did not show statistical significance (34.2% vs. 15.8%, p=0.06). There were no significant differences in rates of Intraventricular hemorrhage (IVH) grade III, IV, neonatal sepsis and neonatal mortality between two groups. CONCLUSION : Our results suggest that, in pregnancies complicated with preterm premature rupture of membranes less than 34 weeks of gestation, the continuous transabdominal amnioinfusion might have improved the neonatal outcome without increasing the perinatal infection rate.

The risk factors of emergency cesarean hysterectomy for placenta previa / 대한산부인과학회지

OBJECTIVES: The purpose of this study is to investigate the clinical risk factors of emergency cesarean hysterectomy in patients with pregnancies complicated by placenta previa and whether the third trimester transvaginal ultrasonographic findings of placenta previa would predict emergency cesarean hysterectomy. MATERIALS AND METHODS: Between January 1995 and March 2005, we retrospectively reviewed the records and compared between patients with pregnancies complicated by placenta previa who underwent cesarean hysterectomy and patients with pregnancies complicated by placenta previa who did not undergo cesarean hysterectomy. RESULTS: There were 314 had placenta previa and 34 patients were performed cesarean hysterectomy (10.83%). There were significant differences on the basis of maternal age (31.53+/-4.41 vs 34.06+/-4.12, p<0.05), parity (0.81+/-0.70 vs 1.29+/-0.63, p<0.05) , the number of cesarean section (0.36+/-0.56 vs 0.91+/-0.75, p<0.05), previous history of placenta previa and presence of placenta accreta, but not on the basis of gestational age, the number of antenatal vaginal bleeding, the number of abortions and emergency operation between two groups. On the basis of third trimester transvaginal ultrasonographic findings, significant differences were found on the distances from the internal os of cervix (1.18+/-3.66 vs 2.67+/-2.94, p<0.05) and thickness of lower placental edge. However, the presence of lacuna in the lower placenta was not associated with emergency hysterectomy. CONCLUSIONS: Patients with placenta previa are at a higher risk of undergoing cesarean hysterectomy when they are associated with placenta accreta, thick lower placenta edge, and positively longer distance to the internal os of cervix. The other clinical factors such as maternal age, parity, the number of cesarean section and previous history of placenta previa might be associated the risk of cesarean hysterectomy.

Minimally Invasive Neuroendoscopic Surgery for Pituitary Apoplexy Diagnosed During Pregnancy / 대한산부인과학회지

Pituitary apoplexy is a life-threatening condition resulting from hemorrhage or necrosis of a pituitary tumor with subsequent compression of the optic nerves and cavernous sinuses. This is the first case report of a patient who experienced pituitary apoplexy due to hemorrhage of pituitary adenoma, which was initially recognized during pregnancy, and submitted to minimally invasive neuroendoscopic transnasal transsphenoidal approach in the third trimester of pregnancy.

Clinical Outcome of Pregnancy-associated Aplastic Anemia Treated with Supportive Anagement / 대한주산의학회잡지

OBJECTIVE: Pregnancy-associated aplastic anemia remains a rare occurrence. The aim of this study was to examine the maternal and fetal outcomes of pregnancy-associated aplastic anemia treated with supportive care. METHODS: From January 1995 to December 2004, a total of 14 women newly diagnosed with pregnancy-associated aplastic anemia were recruited for the study. RESULTS: Eleven (78%) of the 14 women were diagnosed with pregnancy-associated aplastic anemia during the second or third trimester. There were eight severe cases; three of which were diagnosed at the initial presentation. All 14 women had conservative management with transfusions but not specific immunological or hormonal therapies during pregnancy. Blood transfusions were performed prenatally in seven mothers and perinatally in 13. Of the 12 patients eligible for follow-up, one achieved complete remission and another eight showed partial remission after delivery. During the follow up period, there was no case of maternal-fetal death in our series. The pregnancies were continued uneventfully in most cases. CONCLUSIONS: This study demonstrated favorable maternal and neonatal outcomes with transfusion support alone for pregnancy-associated aplastic anemia. Therefore, pregnancy continuation with meticulous blood support should be considered, rather than therapeutic termination, for women with pregnancy-associated aplastic anemia.

Differential diagnosis of Thrombocytopenia newly developed during pregnancy / 대한산부인과학회지

OBJECTIVE: Gestational thrombocytopenia has a mild course as a common problem during pregnancy, whereas idiopathic thrombocytopenic purpura (ITP) presents with a chronic or moderate to severe course. Very few studies have been conducted so far to discriminate between the two diseases. This study was aimed to identify factors predictive of the subsequent development of ITP among pregnant women presenting with thrombocytopenia. METHODS: From January 1999 to June 2005, a total of 58 pregnant women newly diagnosed with thrombocytopenia were recruited for the study. Among them, 33 were finally diagnosed with gestational thrombocytopenia and the other 25 with ITP. The clinical factors for each of ITP and neonatal thrombocytopenia were evaluated, and final outcomes were also described. RESULTS: On multivariate analysis, thrombocytopenia diagnosed before 28 completed weeks and platelet count of less then 50 x 10(9)/L at the time of its presentation were found to be independently predictive of ITP (p<0.001 and p=0.004 respectively). In addition, platelet count of less then 20 x 10(9)/L at nadir during pregnancy was a significant risk factor for neonatal thrombocytopenia (p=0.013). CONCLUSION: The onset time of thrombocytopenia and platelet count at its presentation remain useful parameters to discriminate ITP from gestational thrombocytopenia. These findings may help in allowing an appropriate antenatal care and postpartum follow up.

The Outcome of Pregnancy Combined with Idiopathic Thrombocytopenia Purpura and the Effect of Pregnancy on the Severity of This Disease / 대한주산의학회잡지

OBJECTIVE: The incidence of idiopathic thrombocytopenic purpura (ITP) is greatest in female during their childbearing years, so the concurrence of pregnancy and ITP is not unusual. Numerous studies have examined the outcomes of newborns, whereas fewer studies have been conducted with regard to the morbidity of obstetric patients with ITP. This study was aimed to find the outcome of pregnancy combined with ITP and the influence of the pregnancy on the severity of this disease. METHODS: From January 1996 to December 2005, a total of 62 pregnant women with ITP and their 73 deliveries were recruited for the study. Among them, 38 were diagnosed with ITP during pregnancy and the other 24 had pre-existing ITP before pregnancy. RESULTS: The severity of thrombocytopenia was exacerbated during pregnancy, but recovered to a level of non-pregnant period after delivery in most cases. The outcome of pregnancy of all the patients was uneventful except each one case of fetal demise at 35 gestational weeks and preterm delivery at 30 gestational weeks. One patient suffered from multiple subdural hemorrhage during pregnancy, which was spontaneouly recovered. Twenty newborns (27.8%) had transient congenital thrombocytopenia and 18 of them required treatment for hemostatic impairment. CONCLUSION: For women with ITP, Pregnancy can affect the severity of ITP, but life-threatening complication was almost lacking. Although, in not a few cases, there may need to treat both mothers and infants to raise their platelet counts, most mothers with ITP can proceed with their pregnancies and delivery healthy infant without complication.

Pregnancy Outcome in Renal Transplant Recipients: A Retrospective Study / 대한주산의학회잡지

OBJECTIVE: The aim of our study was to identify graft, obstetric and maternal outcomes of pregnancies in renal transplant recipients at our center. METHODS: A 14-year retrospective study between January 1990 and December 2003, 224 women 15 to 45 years of age had transplantation and were analyzed the outcomes of pregnancies, obstetric complications and graft function. RESULTS: Thirty-four pregnancies occurred in 21 of 224 patients. The mean age at the time of conception was 29.5 years (21 to 36 years) with a mean interval of 61.9 months (one to 162 months). In the pregnancy outcome, there were the 23 live births (67.6%) included 13 preterm and 10 term deliveries, 3 spontaneous abortions (8.8%), 7 artificial abortions (20.5%) and one case of ectopic pregnancy (2.9%). Obstetric complications were; preeclampsia (39.1%), preterm labor (43.4%), urinary tract infections (38.2%) and gestational diabetes (8.6%). Nine pregnancies within 2 years of transplantation had the permissible obstetric outcomes comparing with the others after 2 years (spontaneous abortion: p=0.77, artificial abortion: p=0.88, live birth: p=0.36). In twelve pregnancies appearing renal dysfunction associated with pregnancy, the abortion rate was increased comparing the others with stable renal function (p=0.006). Pre-pregnancy serum creatinine > or =1.4 mg/dl was associated with increased preterm delivery, but not significant (50.0% vs 28.5%, p=0.30). In graft function, serum creatinine 3~6 postpartum was significantly increased comparing pre-pregnancy levels (p=0.04). Five cases of 7 patients with acute rejection episode associated with pregnancy conceived after 4 years of transplantation. Two-year graft survival after delivery was 95.2% (20/21) and chronic rejection and graft failure was diagnosed in one case at postpartum 14 months. CONCLUSION: These findings suggest that, if the graft function is stable, pregnancy within 2 years after renal transplantation might be safe. Pregnancy does not appear to have adverse effects on long term graft survival.

Comparison of diagnostic methods used for detection of preterm premature rupture of membrane / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to compare the detection rate among diagnostic methods used for preterm premature rupture of membrane (PPROM). METHODS: The study population was composed of pregnant women who visited delivery room at our hospital due to vaginal watery discharge from 1 March 2002 to 28 February 2003. The gestational age was between 15 and 36+6/7 weeks of gestation. The study group was composed of 74 pregnant women. The rupture of membrane was tested by nitrazine test, ROM-check test and actim PROM test. It was regarded true positive that normal spontaneous preterm delivery was occurred within 72 hrs. The detection rates of each test were analyzed. RESULTS: There were positive results in 65 cases of nitrazine test, 23 cases of ROM-check test and 53 cases of actim PROM test. Of these positive cases, cases that delivered within 72 hours were in 33 cases of nitrazine test, 13 cases of ROM-check test and 30 cases of actim PROM test. Among three diagnostic methods, the sensitivity is highest for nitrazine test (86.8%) and the specificity is highest for ROM- check test (72.2%). The positive predictive value shows no significant difference among three methods and the negative predictive value is highest for actim PROM test (61.9%). The combination of ROM-check test and actim PROM test shows most accurate detection rates for diagnosis of preterm premature rupture of the membranes (sensitivity 84.2%, specificity 42.3%, positive predictive value 56.1%, negative predictive value 64.7%). CONCLUSION: Our data shows that combination of diagnostic methods might improve detection rate for PPROM. Future studies remain to improve detection rate of PPROM.

A case of Vascular Anastomoses in Dichorionic Diamniotic-Fused Placentas Resulting in "Pseudo" Twin-to-Twin Transfusion Syndrome / 대한산부인과학회지

Virtually all monochorionic twin placentas contain vascular connections between the circulatory domains of each twin. In contrast, vascular anastomoses are generally thought not to occur in fused, dichorionic placentation. In the twin-to-twin transfusion syndrome (TTTS) one twin is preferentially perfused by blood from the cotwin via unbalanced placental vascular anastomoses. This vascular shunting results in twins born with discrepant weights, colors and hemoglobins. When one of the TTTS criteria was not present, the pregnancy was defined as "pseudo" TTTS. In pregnancies complicated by "pseudo" TTTS indicate that small twins have abnormal cord insertion more frequently than large twins. We present a case of vascular anastomoses in dichorionic diamniotic-fused placentas resulting in "pseudo" TTTS with a brief review of the literatures concerned.

Conservative Medical Treatment of Intramural Pregnancies Diagnosed by MRI: Two Case Reports / 대한주산의학회잡지

Intramural pregnancy is one of the rare forms of ectopic pregnancy and the optimal treatment is unknown. We describe two cases of intramural pregnancy treated with systemic methotrexate, which were diagnosed by pelvic MRI. Medical treatment with methotrexate may be a conservative treatment alternative for intramural pregnancies.

Fetal Macrosomia (> or = 4,500 g): A Clinical Study of 271 Cases according to the Mode of Delivery / 대한주산의학회잡지

OBJECTIVE: To determine obstetric outcome in infants > or =4,500 g according to delivery mode. METHODS: Records of 271 mothers and infants weighing > or =4,500 g over a 11-year period (1993~2003) were retrospectively reviewed. Maternal and perinatal outcomes were compared in relation to delivery mode. RESULTS: The frequency of macrosomia ranged 0.38% in 4,500 g or more. Vaginal delivery was achievable in 78/271 (28.8%) of women allowed to labor, of which 71.2% were operative. In macrosomia frequency correlations to parity showed 33.9% (92 cases) in primiparous women, 66.9% (179 cases) in multiparous women. According to the type of delivery, cesarean section has proven to be the most popular mode. The cesarean section group had a higher incidence of maternal BMI (> 25 kg/m2). The frequency of diabetes, hypertension, low Apgar score at 5 and 10 minutes was similar in both groups. CONCLUSION: It would be appropriate to have definite diagnostic schemes and adequate choice of delivery method for macrosomia. Maternal height, weight, BMI (body mass index) may associated with fetal body weight and delivery mode.

Search for Differentially Expressed Genes in Preterm Human Placentae and Their Membranes by Annealing Control Primer System / 대한주산의학회잡지

OBJECTIVE: The aim of this study was to investigate the gene expression profiles using GeneFishingTM kit in human placentae and their membranes delivered at preterm caused by preterm labor. METHODS: Specimens were obtained from placenta, chorion, and amnion delivered at preterm and term, respectively. Total RNAs were isolated from each specimen. Thereafter, the profiles of expression genes between preterm and term specimens were compared using a new and accurate reverse transcription-polymerase chain reaction (RT-PCR) that involves annealing control primers (ACPs) to identify the genes expressed differentially and screened by basic local alignment search tool (BLAST) search. RESULTS: Using 20 ACPs, 13 differentially expressed genes (DEGs) were identified and sequenced. 7 of them were expressed up-regulation, while 6 were expressed down-regulation in preterm deliveries. A BLAST searches revealed that 11 were known genes and 2 were unknown genes. Among known genes, up-regulated genes were insulin-like growth factor II associated protein, vigilin, acyl-Coenzyme A dehydrogenase, tissue inhibitor of metalloproteinase 1 (TIMP1), ribosomal protein S26 (RPS26), follistatin-like 1 (FSTL1) and down-regulated genes were two mitochondrial DNAs, ribosomal protein S28 (RPS28), transglutaminase 2 (TGM2), heparin sulfate proteoglycan (HSPG, perlecan). CONCLUSION: This study shows that the ACP system is a good method for the identification of preterm-related genes. Furthermore, this study suggests that further analysis of the differentially expressed genes in preterm we have identified should provide insights into the molecular basis of preterm delivery caused by preterm labor.

Efficacy of Methotrexate in Management of Cervical Pregnancy / 대한주산의학회잡지

OBJECTIVES: This retrospective study was performed to evaluate the overall efficacy of methotrexate chemotherapy and to determine its proper management protocol in cervical pregnancy. METHOD: From January 1999 to May 2004, 44 patients of cervical pregnancy admitted in hospitals attached to Catholic University Medical Center. Among those, data of 35 cases received methotrexate therapy were analyzed. Clinical characteristics, route of methotrexate administration, concomitant invasive procedures, complications, and outcomes were analyzed. Analysis was performed by unpaired t-test, Fisher's exact test and Wilcoxon's rank sum test. RESULTS: The overall success rate of methotrexate was 82.9% and there was no significant difference according to viability, although initial beta hCG was significantly increased in viable pregnancy (p=0.0085). Major route of methotrexate was systemic in nonviable pregnancy and combined in viable pregnancy (p=0.035). In all patients who had a combination of systemic and local injection with methotrexate, treatment outcome was successful. Most common complication of methotrexate was liver toxicity, but not serious. CONCLUSION: Our results suggest that methotrexate treatment is effective as a therapeutic modality for early cervical pregnancy, but its administration route might be not related with efficacy. Furthermore, the combination of systemic and local intra-amniotic injection seems to be more effective.

Polymorphisms of matrix metalloproteinase-1 and -2 genes in the pregnant women with preterm premature rupture of membranes / 대한산부인과학회지

OBJECTIVE: To elucidate whether polymorphisms of matrix metalloproteinase (MMP)-1 and -2 promotor genes are associated with preterm delivery caused by preterm premature rupture of membranes (PPROM) in Korean pregnant women. METHODS: We conducted a case-control study of korean pregnant women admitted to our labor and delivery unit. PPROM group (n=31) was defined as women whom delivered before 37 weeks of gestation due to PPROM. Control group (n=291) included women who were delivered after 37 weeks of gestation and had no history of preterm delivery. Genomic DNA was extracted from maternal peripheral blood. Polymerase chain reaction (PCR) and direct sequencing were done to determine the genotype of MMP-1 promotor -1607 and MMP-2 promotor -1306 of each participant. Data was analyzed by 2-tailed unpaired t test, x2 test, odds ratio with 95% confidence interval (CI) using SPSS 10.0. RESULTS: The carrier rate of MMP-1*1G was significantly higher in the PPROM group than that in the control group (p=0.020; odds ratio 3.09, 95% CIl 1.14-8.35). The frequency of 1G allele of MMP-1 was also significantly higher in the PPROM group than that in the control group (p=0.011, odds ratio 1.97, 95% CI 1.16-3.36). There was, however, no significant difference in the carrier rate of genotype as well as in the allelic frequencies of MMP-2*T in PPROM group compared with the control group (p=0.430, odds ratio 1.48, 95% CIl 0.56-3.96; p=0.377, odds ratio 1.58, 95% CI 0.57-4.40). CONCLUSION: Our data suggest that polymorphism of MMP-1 promotor -1607 might be associated with PPROM in Korean pregnant women.

Prenatal Diagnosis of Congenital Diaphragmatic Hernia in a Fetus with 46,XY/46,X,-Y,+der(Y)t(Y;1)(q12;q12) Mosaicism: A Case Report

Congenital diaphragmatic hernia (CDH) is often associated with major anomalies and chromosomal abnormalities. Chromosomal abnormalities are usually detected in 9.5% to 34% of fetuses with CDH prenatally diagnosed and the defect has also been reported in association with multiple syndromes such as Pallister-Killian syndrome, Fryns syndrome, Di George syndrome and Apert syndrome. Among the chromosomal abnormalities associated with CDH, trisomy 21, 18, and 13 are most common. Association with complex chromosomal aberrations such as mosaicism has also been reported. However, CDH presented in a fetus with Y-autosome translocation is extremely rare. Herein, we reported a case of fetus with 46,XY/46,X,-Y, +der(Y)t(Y;1)(q12;q12) mosaicism who presented with CDH diagnosed by ultrasonography at 19 weeks' gestation.

Clinical significance of Urinary protein fractional analysis in Severe preeclampsia / 대한산부인과학회지

OBJECTIVE: To determine whether severity of proteinuria or urinary protein fractional analysis correlates with adverse maternal and fetal outcomes in women with severe preeclampsia. METHODS: Thirty-six women diagnosed of severe preeclampsia from January, 2002 to April, 2003 were studied. The correlation between proteinuria or urinary albumin fraction, and maternal mean arterial pressure, neonatal birth weight, 1 minute apgar score were analyzed statistically. Thirty-six patients were divided into two groups according to the pattern of urinary protein fraction. One group was a selective proteinuria group if the albumin fraction was over 70%, and another was a non-selective proteinuria group if the fraction was below 70%. The maternal and neonatal outcomes were compared between the two groups. RESULTS: Significant positive correlation was observed between proteinuria and mean arterial pressure, between urinary albumin fraction and neonatal birth weight. Negative correlation was significantly present between proteinuria and neonatal birth weight, 1 minunte apgar score, between proteinuria and albunin fraction. Increased proteinuria, higher mean arterial pressure, higher serum uric acid level, lower creatinine clearance, lower neonatal birth weight, and lower 1 minunte Apgar score were observed in the non-selective proteinuria group than those in the selective proteinuria, although there was no statistical significance. CONCLUSION: With increasing proteinuria and decreasing albumin fraction, there is increased risk of adverse maternal and fetal outcome. Proteinuria fractional analysis by electrophresis might provide useful information regarding the prediction of pregnancy outcomes.

Fetal Well-being Evaluation by Determination of High Frequency Measurement Noise for Fetal Heart Rate Signal / 대한산부인과학회지

OBJECTIVE: This study was done to propose a new method of determining the cutoff frequency against measurement noise in fetal heart rate signal and to analyze the discriminating value for normal fetus (pH>7.15) and abnormal fetus (pH< or =7.15) by nonlinear method. METHODS: The patients were classified by umbilical artery pH (7.15) or base excess (-10 mEq/L). After removing the high frequency noise components at the cutoff frequency determined in this study, we calculated correlation dimension as a discriminating value for the normal and abnormal fetuses. RESULTS: After low pass filtering of fetal heart rate signal at the cutoff frequency, the numerical result of embedding dimension was 5.47+/-0.67 (normal), 4.43+/-0.60 (abnormal) (p<0.001), and correlation dimension was 2.51+/-0.43 (normal), 1.79+/-0.15 (abnormal). CONCLUSION: We could determine the cutoff frequency from the different fluctuation level between high frequency noise and principal signal according the cutoff frequency function. The detection of fetal distress was done objectively by this method. We could discriminate between normal fetus and abnormal fetus by correlation dimension as indicator for the nonlinear complexity.

The length of active labor in women with vaginal birth after cesarean section compared with nulliparas and multiparas / 대한산부인과학회지

OBJECTIVE: Despite the general information of vaginal birth after cesarean section (VBAC), little is known about the duration of active labor in women attempting VBAC. The aim of this study was to compare the time length of active labor in women attempting VBAC compared with nulliparas or multiparas, and then, provide further insight for better management of labor. METHODS: From January 1999 to December 2003, a total of 444 patients with VBAC were entered into the study. Women with two or more history of caesarean section or previous vaginal delivery were all excluded from the study. Time length of active labor in these patients was compared with 335 nulliparas and 218 multiparas consecutively visiting our unit for delivery in 2003. RESULTS: For patients with VBAC, the duration of active and second phase were 184.8+/-115.7, and 25.1+/-15.2 minutes, which was significantly shorter than nulliparas (p<0.05), but longer than multiparas (p<0.05). To eliminate confounding factors affecting the duration, 374 women without use of vacuum, oxytocin, or epidural anesthesia were selected for analysis. Consistently, the time length of active and second phase in women with VBAC was significantly shorter than in nulliparas, but longer than in multiparas (p<0.001) except for active phase compared with nulliparas (p=0.295). CONCLUSION: With regard to the time length of active labor, women attempting VBAC were in the intermediate group when compared with nulliparas or multiparas. Understanding of this unique time interval in women attempting VBAC may help in allowing an appropriate management for labor process.