Comparison of Spatial Neurocognitive Function between Insomnia Disorder Patients and Normal Sleeping Control: Pilot Study / 수면정신생리

OBJECTIVES: Chronic insomnia disorder is a common and one of the most distressing sleep disorders. This pilot study was conducted to compare the spatial function between insomnia disorder patients and good sleeping control. METHODS: We enrolled the 22 patients with chronic insomnia during over one year who met the DSM-5 diagnostic criteria of insomnia disorder and 27 normal sleeping controls. The Cambridge Neuropsychological Test Automated Battery (CANTAB) has been performed to compare the spatial cognitive function between insomnia disorder patients and good sleeping controls. RESULTS: The CANTAB results showed significant differences in the problems solved in minimum moves of Stockings of Cambridge test (t = −2.499, p = 0.017). The significant difference between two groups remained after controlling age, sex, and Beck Depression Index non-sleep scores (F = 5.631, p = 0.022). CONCLUSION: This study suggests that the patients with insomnia disorder have poor spatial planning function.

Flexural strength and microstructure of two lithium disilicate glass ceramics for CAD/CAM restoration in the dental clinic

OBJECTIVES: There has been a growing interest in glass ceramic systems with good esthetics, high fracture resistance and bonding durability, and simplified fabrication techniques using CAD/CAM. The aim of this study is to compare flexural strength before and after heat treatment of two lithium disilicate CAD/CAM blocks, IPS e.max CAD (Ivoclar Vivadent) and Rosetta SM (Hass), and to observe their crystalline structures. MATERIALS AND METHODS: Biaxial flexural strength was tested according to ISO 6872 with 20 disc form specimens sliced from each block before and after heat treatment. Also, the crystalline structures were observed using field-emission scanning microscopy (FE-SEM, Hitachi) and x-ray diffraction (XRD, Rigaku) analysis. The mean values of the biaxial flexural strength were analyzed by the Mann-Whitney U test at a significance level of p = 0.05. RESULTS: There were no statistically significant differences in flexural strength between IPS e.max CAD and Rosetta SM either before heat treatment or after heat treatment. For both ceramics, the initial flexural strength greatly increased after heat treatment, with significant differences (p < 0.05). The FE-SEM images presented similar patterns of crystalline structure in the two ceramics. In the XRD analysis, they also had similar patterns, presenting high peak positions corresponding to the standard lithium metasilicate and lithium disilicate at each stage of heat treatment. CONCLUSIONS: IPS e.max CAD and Rosetta SM showed no significant differences in flexural strength. They had a similar crystalline pattern and molecular composition.

The Evaluation of Integrated Test as an Antenatal Screening Test for Down's Syndrome in Korea

BACKGROUND: Antenatal screening for Down's syndrome has been developed and improved over the past 20 yr. Recently, integrated test, which combines the first and second trimester markers has shown the highest detection rate (DR) and lowest false positive rate (FPR) among Down's syndrome screening tests currently in use. The purposes of this study were to evaluate the screening performance of integrated test and to compare the results with triple test studies in Korea. METHODS: The study population consisted of Korean pregnant women who underwent triple or integrated test between April 2005 and December 2008. Triple test was performed using measurements of alpha-fetoprotein (AFP), unconjugated estriol (uE3), and human chorionic gonadotropin (hCG) in the second trimester. Integrated test was performed using nuchal translucency (NT) by ultrasonography and pregnancy-associated plasma protein A (PAPP-A) from maternal serum in the first trimester, and AFP, uE3, hCG, and inhibin-A in the second trimester. The screening performance of each test was evaluated by DR and FPR. RESULTS: Twenty-seven Down's syndrome pregnancies were confirmed in women screened by triple (N=6,736) or integrated test (N=7,688). At 1:100, 1:270, and 1:300 of risk cutoff, triple test showed 45%, 73%, and 73% of DR and 4.7%, 11.2%, and 12.4% of FPR, respectively. At 1:100, 1:150, and 1:300 of risk cutoff, integrated test showed 63%, 69%, and 75% of DR and 1.5%, 1.9%, and 3.0% of FPR, respectively. CONCLUSIONS: Integrated test showed higher DR and lower FPR, demonstrating better screening performance than triple test.

Feasibility of Automated Quantification of Regional Disease Patterns Depicted on High-Resolution Computed Tomography in Patients with Various Diffuse Lung Diseases

OBJECTIVE: This study was designed to develop an automated system for quantification of various regional disease patterns of diffuse lung diseases as depicted on high-resolution computed tomography (HRCT) and to compare the performance of the automated system with human readers. MATERIALS AND METHODS: A total of 600 circular regions-of-interest (ROIs), 10 pixels in diameter, were utilized. The 600 ROIs comprised 100 ROIs that represented six typical regional patterns (normal, ground-glass opacity, reticular opacity, honeycombing, emphysema, and consolidation). The ROIs were used to train the automated classification system based on the use of a Support Vector Machine classifier and 37 features of texture and shape. The performance of the classification system was tested with a 5-fold cross-validation method. An automated quantification system was developed with a moving ROI in the lung area, which helped classify each pixel into six categories. A total of 92 HRCT images obtained from patients with different diseases were used to validate the quantification system. Two radiologists independently classified lung areas of the same CT images into six patterns using the manual drawing function of dedicated software. Agreement between the automated system and the readers and between the two individual readers was assessed. RESULTS: The overall accuracy of the system to classify each disease pattern based on the typical ROIs was 89%. When the quantification results were examined, the average agreement between the system and each radiologist was 52% and 49%, respectively. The agreement between the two radiologists was 67%. CONCLUSION: An automated quantification system for various regional patterns of diffuse interstitial lung diseases can be used for objective and reproducible assessment of disease severity.

Ultrasound-guided local injection of potassium chloride (KCl) and methotrexate (MTX) in the treatment of cornual pregnancy / 대한산부인과학회지

OBJECTIVE: To evaluate efficacy and safety of local injection of potassium chloride (KCl) and methotrexate (MTX) in the treatment of cornual pregnancy. METHODS: We retrospectively reviewed all cases of cornual pregnancy treated conservatively from 2005 through August 2007. Eight cases were identified and two cases were heterotopic interstitial pregnancy. All cases were managed with local injection of KCl or methotrexate under ultrasound guidance and 2 cases were treated with intra-muscular injection of MTX in combination. After the procedure all cases with cardiac activity was confirmed to be aborted by ultrasound. Also serial follow-up sonographic examination and serum beta-hCG measurement were performed. RESULTS: The mean initial beta-hCG level was 53,331.6 mIU/mL and ranged from 14,332 mIU/mL to 125,721 mIU/mL. Mean gestational age was 48.3 days from 40 to 65 days. All cases were aborted successfully and follow up beta-hCG were declined abruptly. Two cases of heterotopic pregnancy resulted in successful deliveries at full term. CONCLUSION: Cornual resection or hysterectomy should no longer be the first line of treatment for hemodynamically stable patients with cornual pregnancy. They can be successfully treated through local injection of MTX or KCl by ultrasound guidance.

Semi-Automatic Measurement of the Airway Dimension by Computed Tomography Using the Full-Width-Half-Maximum Method: a Study on the Measurement Accuracy according to the CT Parameters and Size of the Airway

OBJECTIVE: To assess the influence of variable factors such as the size of the airway and the CT imaging parameters such as the reconstruction kernel, field-of-view (FOV), and slice thickness on the automatic measurement of airway dimension. MATERIALS AND METHODS: An airway phantom was fabricated that contained eleven poly-acryl tubes of various lumen diameters and wall thicknesses. The measured density of the poly-acryl wall was 150 HU, and the measured density of the airspace filled with polyurethane foam was -900 HU. CT images were obtained using a 16-MDCT (multidetector CT) scanner and were reconstructed with various reconstruction kernels, thicknesses and FOV. The luminal radius and wall thickness were measured using in-house software based on the full-width-half-maximum method. The measured values as determined by CT and the actual dimensions of the tubes were compared. RESULTS: Measurements were most accurate on images reconstructed with use of a standard kernel (mean error: -0.03 +/- 0.21 mm for wall thickness and -0.12 +/- 0.11 mm for the luminal radius). There was no significant difference in accuracy among images with the use of variable slice thicknesses or a variable FOV. Below a 1-mm threshold, the measurement failed to represent the change of the real dimensions. CONCLUSION: Measurement accuracy was strongly influenced by the specific reconstruction kernel utilized. For accurate measurement, standardization of the imaging protocol and selection of the appropriate anatomic level are essential.

Semi-Automatic Measurement of the Airway Dimension by Computed Tomography Using the Full-With-Half-Maximum Method: a Study of the Measurement Accuracy according to the Orientation of an Artificial Airway

OBJECTIVE: To develop an algorithm to measure the dimensions of an airway oriented obliquely on a volumetric CT, as well as assess the effect of the imaging parameters on the correct measurement of the airway dimension. MATERIALS AND METHODS: An airway phantom with 11 poly-acryl tubes of various lumen diameters and wall thicknesses was scanned using a 16-MDCT (multidetector CT) at various tilt angles (0, 30, 45, and 60degree). The CT images were reconstructed at various reconstruction kernels and thicknesses. The axis of each airway was determined using the 3D thinning algorithm, with images perpendicular to the axis being reconstructed. The luminal radius and wall thickness was measured by the full-width-half-maximum method. The influence of the CT parameters (the size of the airways, obliquity on the radius and wall thickness) was assessed by comparing the actual dimension of each tube with the estimated values. RESULTS: The 3D thinning algorithm correctly determined the axis of the oblique airway in all tubes (mean error: 0.91 +/- 0.82degree). A sharper reconstruction kernel, thicker image thickness and larger tilt angle of the airway axis resulted in a significant decrease of the measured wall thickness and an increase of the measured luminal radius. Use of a standard kernel and a 0.75-mm slice thickness resulted in the most accurate measurement of airway dimension, which was independent of obliquity. CONCLUSION: The airway obliquity and imaging parameters have a strong influence on the accuracy of the airway wall measurement. For the accurate measurement of airway thickness, the CT images should be reconstructed with a standard kernel and a 0.75 mm slice thickness.

The nanoleakage patterns of experimental hydrophobic adhesives after load cycling / 대한치과보존학회지

The purpose of this study was: (1) to compare nanoleakage patterns of a conventional 3-step etch and rinse adhesive system and two experimental hydrophobic adhesive systems and (2) to investigate the change of the nanoleakage patterns after load cycling. Two kinds of hydrophobic experimental adhesives, ethanol containing adhesive (EA) and methanol containing adhesive (MA), were prepared. Thirty extracted human molars were embedded in resin blocks and occlusal thirds of the crowns were removed. The polished dentin surfaces were etched with a 35% phosphoric acid etching gel and rinsed with water. Scotchbond Multi-Purpose (MP), EA and MA were used for bonding procedure. Z-250 composite resin was built-up on the adhesive-treated surfaces. Five teeth of each dentin adhesive group were subjected to mechanical load cycling. The teeth were sectioned into 2 mm thick slabs and then stained with 50% ammoniacal silver nitrate. Ten specimens for each group were examined under scanning electron microscope in backscattering electron mode. All photographs were analyzed using image analysis software. Three regions of each specimen were used for evaluation of the silver uptake within the hybrid layer. The area of silver deposition was calculated and expressed in gray value. Data were statistically analyzed by two-way ANOVA and post-hoc testing of multiple comparisons was done with the Scheffe's test. Silver particles were observed in all the groups. However, silver particles were more sparsely distributed in the EA group and the MA group than in the MP group (p < .0001). There were no changes in nanoleakage patterns after load cycling.

One case of monoamniotic twin pregnancy with cord entanglement and fetus survival at 32+4 weeks after successful medical amnioreduction and intensive ultrasound surveillance / 대한산부인과학회지

Monoamniotic twin pregnancies are relatively rare, but perinatal mortality is high about 30-70%. The major cause of fetal death is cord accident, congenital anomalies, twin-twin transfusion syndrome, and intrauterine growth restriction. Especially cord entanglement occurs; perinatal mortality is about 50%. So the active management of monoamniotic twins to reduce the complication of cord entanglement is important. This is a case of monoamniotic twin pregnancy with cord entanglement and both fetuses survival by elective cesarean section at 32+4 weeks after medical amnioreduction and intensive fetal surveillance.

An analysis of various factors affecting postpartum umbilical cord blood volume for hematopoietic stem cell transplantation / 대한산부인과학회지

OBJECTIVE: Umbilical cord blood is an effective alternative to bone marrow as a source of hematopoietic stem cells for transplantation. But the amount of collected umbilical cord blood and its contents are limited and obtaining an adequate volume of umbilical cord blood is essential for successful transplantation. The aim of this study was to identify factors that influence the volume of umbilical cord blood. METHODS: A retrospective analysis of the maternal, neonatal and placental factors that were obtained by medical record review was conducted. The variables that were evaluated for this study were mother's age, parity, gestational age, presence of maternal diabetes mellitus, route of delivery, multiple births, neonatal sex and birth weight, and placental weight. Total 484 deliveries were evaluated from March 2003 to April 2004. The statistical significance of observed differences was calculated using t-test and multiple regression analysis; p-value<0.05 was considered significant. RESULTS: Gestational age, neonatal birth weight, placental weight, parity, number of fetus and maternal diabetes mellitus were significantly associated with a greater volume of collected umbilical cord blood. Obstetric factors that influenced the total nucleated cell concentration were gestational age, neonatal birth weight, placental weight, number of fetus, and route of delivery. CONCLUSION: To prolong a gestational age as far as possible, at least beyond the 37 completed weeks of gestation, and modifying a method of vaginal delivery or cesarean section rather than conventional vaginal delivery method can increase significantly the volume of collected cord blood and the yield of the concentration of total nucleated cell.

A Case of Fetal Bilateral Renal Agenesis Diagnosed by Transvaginal Ultrasonography / 대한산부인과학회지

Fetal bilateral renal agenesis is a lethal congenital anomaly characterized by bilateral pulmonary hypoplasia, deformities and death due to severe oligohydramnios. This syndrome is associated with malformations of genitourinary tract, cardiovascular system, vertebral bodies or imperforated anus in more than half of the affected individuals. An early and reliable prenatal diagnosis is extremely important because it may offer options for pregnancy termination as early as possible. The criteria for the ultrasonographic diagnosis of bilateral renal agenesis are severe oligohydramnios, nonvisualization of the bladder, empty renal fossae. But poor sonographic resolution of severe oligohydramnios makes it difficult to diagnose the disease. We present a case of bilateral renal agenesis diagnosed at the 18th weeks gestation by using Transvaginal Ultrasonography and Color Doppler.

Evaluation for Patterns of the Maternal Weight changes and the Twin Weight Discordance Changes during whole Pregnant Periods / 대한주산의학회잡지

OBJECTIVES: To evaluate the patterns of changes in maternal weight and fetal weight discordance in twin pregnancies during consecutive gestational periods. METHODS: A retrospective chart review was done for a total of 148 twin pregnancies taken care of throughout pregnancies between February 2002 and May 2004. They were divided into two groups; group A consisting of 109 cases without postnatal complications and with no more than 25% twin weight discordance at birth, and group B consisting of 39 cases with more than 25% twin weight discordance. Both ultrasound examination and maternal weight measurement were conducted in the three gestational intervals; between prepregnant times to gestational age 18 weeks, between gestational ages 18 to 28 weeks, and from gestational age 28 weeks to delivery. RESULTS: Except for maternal weights, none of the pregnancy factors such as maternal age, parity, gravity, height, prepregnant weight, duration of pregnancy, natural or artificial pregnant status, gender and chorionicity showed any significant difference by means between the two groups. The maternal BMI of the group A vs. the group B at the first, the second, and the third period were 0.53+/-0.10% and 2.01+/-1.28%, 2.97+/-0.11% and 4.84+/-1.23%, and 3.29+/-0.16% and 2.15+/-0.63% respectively. Inter-twin weight discordances between the two groups were 8.29+/-0.67% vs. 11.26+/-1.25 %, 7.79+/-0.05% vs. 11.03+/-1.36%, and 9.07+/-0.55% vs. 32.79+/-1.13%, respectively. CONCLUSIONS: Although several factors that affect twin weight discordance may be considered, we showed that the pattern of maternal weight gain during the gestational period is associated with the estimated values of twin weight discordances in the first gestational period.

Cases of Transarterial embolization in Arteriovenous Malformation of Uterus / 대한산부인과학회지

Uterine arteriovenous malformations are very rare but potentially life-threatening lesions. These lesions may be congenital or acquired, but especially in patients with a history of infection, curettage, abortion, pelvic surgery or cancer. Ultimate treatment depends on the patients desire for fertility. Embolization therapy is effective method in reproductive age patients of. We have experienced two clinical cases of arteriovenous malformation of uterus, which is presented with a brief review of literature.

Comparative Study of Tension-free Vaginal Tape and Burch Colposuspension in the Surgical Management of Female Stress Urinary Incontinence / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the effectiveness, easiness, postoperative complications between tension-free vaginal tape (TVT) and Burch colposuspension (BC) in the surgical management of female genuine stress urinary incontinence. METHODS: A retrospective study of 77 cases with stress urinary incontinence at Department of Obstetrics and Gynecology and Urology, Pochon CHA University Medical College from January 2000 to December 2002, followed up more than 6 months. All of 77 cases were above grade 2 genuine stress urinary incontinence, 37 cases were performed tension-free vaginal tape, 40 cases were performed Burch colposuspension. RESULTS: Cure rate was 91.4% in the tension-free vaginal tape (TVT) group, 90% in the Burch colposuspension group. The mean operative time for TVT was 23.4 minutes and for Burch colposuspension was 47.2 minutes. The mean hospital stay in TVT was 1.8 days and in Burch colposuspension was 5.2 days. The incidence and severity of postoperative complication is similar in both groups. CONCLUSION: The cure rates of TVT were comparable with Burch colposuspension in the surgical management of female genuine stress urinary incontinence. And the incidence and severity of postoperative complication is similar in both groups. Moreover TVT is simple procedure more than Burch colposuspension.

Comparative Study of Tension-free Vaginal Tape and Burch Colposuspension in the Surgical Management of Female Stress Urinary Incontinence / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the effectiveness, easiness, postoperative complications between tension-free vaginal tape (TVT) and Burch colposuspension (BC) in the surgical management of female genuine stress urinary incontinence. METHODS: A retrospective study of 77 cases with stress urinary incontinence at Department of Obstetrics and Gynecology and Urology, Pochon CHA University Medical College from January 2000 to December 2002, followed up more than 6 months. All of 77 cases were above grade 2 genuine stress urinary incontinence, 37 cases were performed tension-free vaginal tape, 40 cases were performed Burch colposuspension. RESULTS: Cure rate was 91.4% in the tension-free vaginal tape (TVT) group, 90% in the Burch colposuspension group. The mean operative time for TVT was 23.4 minutes and for Burch colposuspension was 47.2 minutes. The mean hospital stay in TVT was 1.8 days and in Burch colposuspension was 5.2 days. The incidence and severity of postoperative complication is similar in both groups. CONCLUSION: The cure rates of TVT were comparable with Burch colposuspension in the surgical management of female genuine stress urinary incontinence. And the incidence and severity of postoperative complication is similar in both groups. Moreover TVT is simple procedure more than Burch colposuspension.

The Effect of Pelvic Organ Prolapse on Lower Urinary Tract Function

Pelvic organ prolapse (POP) is a process in which the pelvic contents, including the reproductive organ, bladder, rectum, and/or small intestines become herniated through defects in the vaginal wall. The pelvic organs are closely related to the urinary tract and thus various urinary functions can be affected. The purpose of this study was to evaluate the relationship between pelvic organ prolapse and lower urinary tract function by urodynamic studies. From March 1999 to May 2000, 40 patients with pelvic organ prolapse who underwent urodynamic studies (uroflowmetry, filling cystometry, urethral pressure profile) without barrier reduction of prolapse were analyzed. The majority of the cases of low grade POP involved patients with anterior wall prolapse, whereas the higher POP stages were more frequent in women with cervical cuff prolapse. Symptoms of stress urinary incontinence and hesitancy were more frequent in the patients with anterior wall prolapse. The urodynamic study showed a statistically significant increase in MUCP in patients with POP stage IV and the leading point of POP was cervical cuff. The subjective urinary symptoms of patients with POP appear to be less reliable as a diagnostic tool. POP had no adverse effect on the bladder storage function. However, POP affected the voiding function through an increase in MUCP, especially in patients with stage IV prolapse and when the leading point of POP was cervical cuff. Following the surgical correction of POP, an evaluation of the preoperative changes in the urodynamic study parameters should be performed.

Tuberculous Epididymo-orchitis in Acquired Immune Deficiency Syndrome Patients / 대한비뇨기과학회지

The urogenital tract manifestations of acquired immune deficiency syndrome (AIDS) include the entire array of voiding symptoms; infections, neurogenic bladder problems, impotence, infertility, neoplasma and AIDS associated renal syndromes. Tuberculosis occurs in approximately 4% of patients with AIDS, and involves at least one extrapulmonary site in nearly 50% of cases. However, tuberculous infection of the testicle in AIDS is rarely seen. Herein, we report a case of tuberculosis epididymoorchitis, which developed as a result of reactivation in an AIDS patient. To the best of our knowledge, this is the first reported case of AIDS presenting as tuberculous epididymoorchitis in Korea.

Self-concept, Anxiety, Depression Scales and Behavior Estimation in Primary Nocturnal Enuresis / 대한비뇨기과학회지

Purpose: Nocturnal enuresis has been regarded as one of the most prevalent problems of childhood. Nocturnal enuresis may lead to a distressing and perplexing problem for children, resulting in social withdrawal, guilty feelings, and a sense of loneliness. In this study, we investigated changes in self-awareness, anxiety, depression, and behavior estimation before and after treatment in children with primary nocturnal enuresis. MATERIALS AND METHODS: Psychologic inventories were evaluated in 48 primary nocturnal enuretic patients who had been successfully treated for their nocturnal enuresis from April 2001 to March 2002. Before and after treatment, self-administered questionnaires, such as Kovac's Children's Depression Inventory, Piers-Harris Children Self-Concept scale, and State-Trait Anxiety Inventory for Children, were evaluated by the enuretics. Their parents were also evaluated by the Child Behavior Check list. RESULTS: In Kovac's Children's Depression Inventory and Piers-Harris Children Self-Concept scale, there were no signs of psychologic abnormality before and after treatment of nocturnal enuresis in terms of self-awareness and depression. Compared with the pre-treatment scores, there was significant improvement in trait anxiety after treatment of nocturnal enuresis (p<0.05). In the Child Behavior Check list, the parents thought that enuresis did not lead to abnormal behavior in their children. CONCLUSIONS: These results suggest no serious psychopathologic abnormalities before and after treatment of primary nocturnal enuresis. The enuretic patients may suffer from trait anxiety. Consequently, the successful treatment of nocturnal enuresis may alleviate a child's anxiety and prevent secondary psychopathologic abnormalities.

A Case of False Positive Amniotic Fluid Acetylcholinestserase in One Fetus of Twin Pregnancy conceived by Intracytoplasmic Sperm Injection and Zygote Intrafallopian Tube Transfer / 대한주산의학회잡지

Maternal serum alpha-fetoprotein(MSAFP) has been a world wide screening test for open neural the tube defect. But elevation of MSAFP is related to not only neural tube defect, but also incorrect gestational age, congenital anomalies such as congenital nephrosis, esophageal and intestinal obstruction, low birth weight, oligohydroamnios, fetal death and chromosomal anomalies. If MSAFP is elevated, gestational age, congenital anomalies such as neural tube defect, multiple pregnancy and fetal death must be evaluated by ultrasound. When the ultrasound is nondiagnostic, amniotic fluid AFP(AFAFP) levels are measured and if AFAFP is elevated, presence or absence of aetylchoineststarase(AChE) is determined to rule out the false positive of amniotic AFP. Amniotic AChE test yielded detection rate of open spina bifida of 99%, 98% for anecephaly and a false-positive rate of 0.34%. We report a case with elevated AFAFP and positive amniotic AChE result in one fetus of the twin pregnancy conceived by ICSI and ZIFT, but in which targeted ultrasound findings were normal, maintained the pregnancy to term and normal twin was delivered by elective cesarean section.

Acute Leukemia and Myelodysplasitc Syndrome During Pregnancy A Single Institutional Experience of 4 Cases / 대한산부인과학회잡지

We have reviewed the medical records of 4 pregnant patients with concomitant acute leukemia at our institution in conjunction with determining the delivery process in order to reduce complications associated with the delivery. Of the 4 patients, three cases were diagnosed as acute leukemia and the other as myelodysplastic syndrome. One experienced an incomplete abortion at gestational age of 10 weeks, after remission induction chemotherapy. The remaining three patients made delivery at full term by Cesarean section. Our observation indicated that Cesarean delivery was advisable for these three patients. Most of the patients had thrombocytopenia or anemia. Before the Cesarean section or dilatation or evacuation, transfusion was undertaken to prevent hemorrhage or severe anemia. In the cases of refractoriness to blood transfusion, a greater amount was transfused. After Cesarean section, some complications were reported such as fever, delayed wound repair, and vaginal bleeding. Based on the our observations, we are of the opinion that pregnant women with acute leukemia or myelodysplastic syndrome can be managed even in those cases where the state of leukemia is not in complete remission or chemotherapy-induced cytopenia is. And the proper measures are timely undertaken to prevent complications associated with delivery.