Cytogenetic Study for Reciprocal and Robertsonian Translocation / 대한주산의학회잡지

PURPOSE:This study was aimed to evaluate the incidence of translocation and types of translocations (reciprocal or Robertsonian) in cases of cytogenetic analysis. Method:The incidence of translocation was calculated and types of translocation were classified in 390 individuals who perfomed cytogenetic analysis in Hanyang University Hospital from January, 2005 to February, 2009. RESULTS:The overall incidence of translocation was 3.1% (12/390). Among these translocations, 8 cases were having reciprocal translocations showing karyotypes of 47,XXY,t(11;22)(q23;q11.2), 46,XY,t(4;8)(q31.1;q11.2), 46,X,inv(Y)(p11.3q11.23),t(8;9)(q24.3;q34.1), 46,XY,t(14;16)(q32;q22), 46,XX,t(6;7)(q27;p11.2), 46,XX,t(1;4)(q25;q33), 46,XX,t(3;5)(q25;q22) and 46,XX,t(1;2)(p36.1;p25.1) in each. Last 4 cases of translocations were Robertsonian translocations showing karyotypes of 45,XY,der (13; 15)(q10;q10), 45,XY,der(13;14)(q10;q10), 45,XY,der(13;14)(q10;q10)and 45,XX,der (22;22)(q10;q10) in each. CONCLUSION:Although patients are phenotypically normal, they might be balanced translocation carriers. In high risk patients, translocations are more frequent than normal population. Classification of translocation is necessary for further genetic counseling according to the types.

Incidence and Karyotypes According to Each Chromosome in 13 Cases with Inversion / 대한주산의학회잡지

PURPOSE: This study was aimed to evaluate the incidence and karyotypes according to chromosome in 13 cases with inversion detected by cytogenetic analysis. METHODS: The incidence of inversion was calculated and karyotypes of inversion were classified according to each chromosome in cases with inversion detected from 390 individuals who had undergone cytogenetic analysis in Hanyang University Hospital from January 2005 to February 2009. RESULTS: The overall incidence of inversions was 3.3% (13/390). All of 13 cases were heterozygotes for inversions. Among these 13 inversions, 12 cases (92.3%) were having pericentric inversions showing karyotypes of 46,XX,inv(9)(p11q13) in 7 cases, 46,XX,inv(9)(p11q12) in 2 cases, and one cases of 46,X, inv(Y)(p11.3q11.23), t(8;9)(q24.3;q34.1), 46,X, del(Y)(q12), inv(Y)(p10q11. 23) and 46,XY, inv(8)(p21q24.1) respectively. Last one case (7.7%) was having paracentric inversion showing a karyotype of 46,XX,inv(9)(q22.1q34.3). Classification according to each chromosome in 13 cases with inversion was that 10 of 13 cases (76.9%) were located in chromosome 9 (9 cases of pericentric inversions and a case of paracentric inversions), 2 of 13 cases (15.4%) in chromosome Y and 1 of 13 cases (7.7%) in chromosome 8. CONCLUSION: Although patients are phenotypically normal, they might be inversion carriers. In high risk patients, inversions are more frequent than normal population. Various types of inversion could be in different chromosomes. Classification of types of inversion are needed for further genetic counseling according to the types.

Chlamydia trachomatis Antibody in Fitz-Hugh-Curtis Syndrome / 대한진단검사의학회지

BACKGROUND: Fitz-Hugh-Curtis (FHC) syndrome is inflammation of the liver capsule associated with pelvic inflammatory disease. We measured Chlamydia trachomatis antibodies in 30 female patients with acute abdominal pain for diagnosis of FHC-syndrome, and the results were compared with other tests. METHODS: A dual-polymerase chain reaction was used for the detection of C. trachomatis in the cervix, and a micro-immunofluorescence test was performed to measure the antibody to C. trachomatis in serum. Cervical specimens were stained with Gram stain and cultured on chocolate agar for detection of Neisseria gonorrhoeae, and abdominal computed tomography (CT) and pelvic examinations were performed. RESULTS: Of the 30 patients examined, 19 were diagnosed as having FHC-syndromes and 11 abdominal pains without FHC-syndrome. C. trachomatis was detected from one of the five patients studied, and no N. gonorrhoeae was isolated from the patients with FHC-syndrome. High titers of IgG antibody (1:512-1:1,024) to C. trachomatis were demonstrated in all patients with FHC-syndrome. The CT scan revealed perihepatitis in 14 patients with FHC-syndrome. CONCLUSIONS: All patients with FHC-syndrome are associated with C. trachomatis infections, and a high titer of C. trachomatis antibody (IgG) is a very useful marker for FHC-syndrome.

A De Novo Centric Fission of Chromosome 11 in a Patient with Recurrent Miscarriages

We report on a de novo centric fission of chromosome 11 in a healthy female referred for chromosome analysis due to recurrent miscarriages. Both fission products were mitotically stable. This centric fission of chromosome 11 appears to have no clinical significance for this patient other than recurrent miscarriages.

The Effect of Vitamin-C Vaginal Tablets (Vagi-C(R)) in Patients with Each Vaginitis in Pregnancy and in Normal Pregnant Women / 대한주산의학회잡지

OBJECTIVE: The purpose of this study is to evaluate the effect of Vitamin-C vaginal tablets on vaginal pH and vaginitis symptoms of pregnant women. METHODS: Ninety pregnant women who visited the antenatal clinic were included in this study after giving their informed consent. The treatment regimen of the vitamin-C vaginal tablets (250 mg, Vagi-C(R), Taurus Pharma GmbH, Germany) was one tablet given once a day for 6 consecutive days. Vaginal pH was measured the day before and the day after the Vit-C vaginal treatment. Ninety women of initial, ten failed to follow-up (participate). After routine screening using microscopic analysis of the vaginal smears, 31 of the 80 participating women fell into one of 3 pathologic groups (15 monilial infection, 10 bacterial vaginosis, 6 trichomonial infection) and leaving 49 pathogen-free pregnant women. 10 of the pathogen-free pregnant women were excluded during the study because they did not complete the treatment period due to vaginal irritation such as itching or burning sensations. The diagnosis of each vaginal infection was made by specific pathologic findings. RESULT: Mean vaginal pH values for the pathology group decreased significantly from 4.9 to 4.2. Pathologic findings of each infection were also improved without specific treatment. Bacterial vaginosis disappeared in 80.0% (8/10) of patients. The specific pathogens of the remained two vaginitis types were not detected in 33.3% (5/15) of monilial infection and 33.3% (2/6) trichomonial infection 1 week after discontinuation of Vitamin-C vaginal tablets. Although it is not significant, mean vaginal pH values decreased from 4.4 to 4.2 in the pathogen-free pregnant women. CONCLUSION: Vitamin-C, when vaginally applied, is effective in lowering vaginal pH and in the treatment of vaginitis in pregnant women.

Meta Analysis of Clinical Studies of Pregnancy and Delivery in Elderly Gravida / 대한산부인과학회지

OBJECTIVE: Our purpose was to identify the age-related inceased risks of the elderly gravida over 35 or 40 years at delivery by clarifying the effects of age and parity, their combination, and their interaction and the relationships of other complications. METHODS: We have made meta analysis about general and clinical characteristics of elderly gravida over the aged 35 or 40 years, based on the 7 domestic theses since 1996 year at the department of Obstetrics and Gynecology. RESULTS: The results were obtained as follows; In elderly gravida over the aged 35 or 40 years at delivery, maternal and neonatal outcomes were generally good, but in study group, there were a high incidence of gestational (preterm delivery, fetal presentation, pregnancy-induced hypertension, gestational diadetes, placenta previa, premature rupture of membranes) complications, uterine myoma during pregnancy and low birth weight in neonate after delivery. CONCLUSION: The increased risks of the elderly gravida over the aged 35 or 40 years at delivery may have been overshadowed by the previous focus on the elderly nullipara. In spite of high incidence of maternal morbidity, the overall maternal and neonatal outcomes were generally good. It is important to recognize what is more important in age-related pregnant-risks of the elderly gravida over the aged 35 or 40 years at delivery to appropriate counsel and manage this group of patients. This informations may be helpful for counsel in elderly gravida over the aged 35 or 40 years who are considering pregnancy.

Identification of marker chromosomes by reverse painting fluorescence in situ hybridization and comparative genomic hybridization / 대한산부인과학회지

OBJECTIVE: Although marker chromosome is defined as an abnormal chromosome in which no part can be identified, derivative chromosomes with structural abnormalities of unknown origin are also called as marker chromosomes conventionally. The clinical significance of a marker chromosome is determined according to the origin of marker chromosome. In this study reverse painting fluorescence in situ hybridization (FISH), and comparative genomic hybridization (CGH) methods were employed to elucidate the origin of marker chromosomes in 5 clinical cases. METHODS: Reverse painting probes were generated from five copies of each marker chromosomes microdissected with micromanipulator, amplified with DOP-PCR, and labeled with fluorochromes. The probes were hybridized to normal metaphases. For CGH, normal control and patients' DNA were directly labeled with spectrum-red-dUTP and spectrum-green-dUTP by CGH nick translation kit, and hybridized to normal reference metaphases. The CGH images were captured with a computer controlled fluorescence microscope equipped with a CCD camera and analyzed by Cytovision workstation. RESULTS: Five marker chromosomes were identified as follows (1) derivative chromosome 15 inducing partial trisomy of 15pter->q21, (2) isochromosome of 18p causing 18p tetrasomy, (3) short arm of chromosome 5 causing 5p trisomy (4) small accessory chromosome originated from centromeric region of chromosome Xq11->q12 (5) der(17) with inverted duplication of the short arm of chromosome 17. In all cases the origin of each marker chromosomes were identified successfully with reverse painting FISH, and these results were concordant with the CGH profiles. CONCLUSION: Our results indicate that combined reverse painting FISH and CGH is a rapid, convinient and powerful tool to identify the origin of marker chromosomes and derivative chromosomes caused by various chromosome abnormalities such as translocation, duplication, deletion.

Comparison of Outcomes of Incompetent Cervix Patients Treated with the Transvaginal Cerclage and the Modified Transvaginal Cerclage using Fibrin Sealant / 대한주산의학회잡지

OBJECTIVE: The purpose of our study is to compare the outcome of the modified transvaginal cerclage (MTVC) in patients who had not undergone a previous TVC with the outcome of patients treated with the transvagianl cerclage (TVC). METHOD: Incompetent cervix patients in the Obstetric/Gynecology department of Hanyang University Hospital post January, 1996 were selected as subjects for this study. 94 patients who received the TVC and 44 patients who received the MTVC using fibrin sealant were compared. The success of the operation was determined in the 34th week of pregnancy, and duration of pregnancy. RESULTS: Clinical characteristics of the TVC group and the MTVC group are showing no significant statistical difference between the two groups. The average gestational age of delivery was 36.0 and 37.0 week and the average weight was 2,797 g and 2,828 g respectively, also showing no significant (p=0.06) statistical difference. However, the duration of pregnancy between surgery and birth was 19.5 and 21.5 weeks showing significant (p=0.013) statistical difference, when the success rates of the treatments of incompetent cervix were observed according to the 34th week standard, TVC showed a 74% (71/96) rate of success and MTVC with fibrin sealant showed a 90.9% (40/44) rate of success, showing a significant statistical difference (Chi(2)=4.503, p<0.05). CONCLUSION:The success rate of MTVC using fibrin sealant showed to be significantly higher than the success rate of TVC. The reason for the difference in success rates is suspected to be because the fibrin sealant injected between the two TVC bands blocked the possibility of infection originating in the vagina. In the future, further research should focus on cultures of vaginal and amniotic fluids.

Clinical study of Failure to Progress as an Indication for Cesarean Section / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate the appropriateness of diagnosis of the failure to progress (FTP) and accompanying emergency Cesarean section in university hospital and possibility of reducing emergency Cesarean section among these patients. METHODS: Chart review of 680 patients who had underwent emergency Cesarean section with diagnosis of FTP between January 1996 and December 2002 at Hanyang University Medical Center was carried out for this study. Among patients who underwent normal vaginal delivery during the same period, 300 patients were randomly chosen for control group. Comparison between these two groups on maternal physical properties, management during delivery, birth weight and sex of babies were made. Also, differences of labor management among obstetrical staff were compared RESULTS: Compared to the vaginal delivery group, FTP group patients showed older age (29.1 vs 27.7 yr) (p=0.000), shorter stature (158.4 vs 159.8 cm) (p=0.001), and heavier body weight (68.2 vs 65.7 kg) (p=0.000) suggesting unfavorable outcome Also, birth weight of the newborn infant was heavier compared to the normal delivery group (3350 vs 3181 g) (p=0.001). In addition, the frequency of PG E2 use was higher (45% vs 35%) (p=0.001) and hours of oxytocin use was longer (6.3 vs 4.2 hr) (p=0.000) in FTP group. The distribution of delivery time in FTP group was around four or more hours in comparison to the normal delivery group in which the judgement was made that there was as inclination for sufficient effort for the purpose of a normal delivery. On one side, cervical dilatation was less than 3 cm, there were 44 people in a group with less than 70% effacement of cervix in which 40 of these people (excluding 4) were capable for a normal delivery with additional effort. Moreover, in the case of the failure to progress group, active labor management can decrease the rate of cesarean section to about 5.8% (40/680). CONCLUSION: The results of this study suggests the possibility that frequency of cesarean section could be reduced through the efforts of active labor management. However, there are a variety of factors leading to cesarean section that must be analyzed along with social and national support.

The Clinical Significance of Abnormal 50 gm Oral Glucose Tolerance Test for Gestational Diabetes Screening / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the clinical significance of pregnant women who had abnormal 50 g oral glucose tolerance test (GTT) but normal 100 g oral GTT with those who had normal 50 g oral GTT. MATERIALS AND METHODS: Between March 1999 and Feb 2001, 812 pregnant women underwent 50 g oral GTT in the department of Ob/Gyn, Hanyang Univ. Hospital and these women were entered for this study. Among these women, those who showed abnormal 50 g oral GTT but normal 100 g oral GTT were entered for study group and those who showed normal 50 g oral GTT were entered for control group. For the perinatal outcome, average birth weight, frequency of macrosomia, intrauterine growth restriction (IUGR), premature birth, preeclampsia, cesarean section rate were compared for both groups. RESULTS: Of 812 patients, 93 patients were entered for study group and 703 patients were entered for control group. The average birth weight of the fetus in the study group at 3359.3 grams was higher than the control group at 3243.6 grams (p<0.05). The frequency of macrosomia was 11.8% in the study group and 3.3% in the control group (p=0.0001). Premature birth occurred more frequently in the study group at 10.8% as compared to the control group at 4.8% (p<0.05). Other factors did not show any significant differences. But, although a higher rate of a macrosomia was seen in the study group than in the control group, the abnormal 50 g oral GTT was not risk factor after controlling for confounding risk factors by logistic regression modeling (OR 1.53). On the other hand, the maternal BMI and the increase in body weight during pregnancy were the risk factors of macrosomnia after controlling for confounding risk factors by logistic regression modeling (OR 6.27 and 5.58). CONCLUSION: Abnormal 50 g oral GTT but normal 100 g oral GTT was not found to be a risk factor for macrosomia or pre-eclampsia. There needs to be personalized assessment of other risk factors in correlation with macrosomia, especially in obese women with a BMI greater than 26 before pregnancy, and in those with increase in body weight greater than 16 kg during pregnancy.

Statistical Analysis of Twin Pregnancy for 10 Years (1993~2002) / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to evaluate the clinical aspects of twin pregnancy and its outcome. METHODS: From January 1993 to December 2002, we reviewed the medical records of 249 cases of twin birth at least weighed 500 g or more and over 20 weeks of gestation among 14,273 deliveries at Hanyang University Hospital. Paired sample t test and linear regression test were used for statistical analysis. p<0.05 was defined significantly. RESULTS: The incidence of twin births was one in 59.6 birth, and the annual rate of twin births has increased since last 10 years (p<0.05). The predominant age group was 25-29 (47.0%) and mean age was 29.8 +/- 3.9 years old. According to parity, primipara (63.9%) was the most frequent. The predominant gestational age of twin births was 37-38 weeks (42.2%) and mean gestational weeks of twin births was 36.3 +/- 2.9 weeks. The ratio of spontaneous and iatrogenic twinning were 73.1% vs 26.9%. The cephalic-cephalic combination (49.8%) was the predominant presentation. The most common mode of twin delivery was cesarean section (76.5%) and its main indication was "elective" (33.5%). The mean interval between 1st and 2nd baby deliveries among normal spontaneous vaginal delivery was 6 minute 28 seconds. Both male group (43.0%) was predominant. The mean birth weights of 1st and 2nd baby were 2341 +/- 592 grams and 2200 +/- 594 grams respectively. No significant differences were seen in one minute and five minute Apgar scores between 1st and 2nd baby. The most common type of placental membrane was single placenta, two chorion, two amnion (40.6%). The most frequent maternal complication during pregnancy was anemia (41.8%), followed by preterm labor (39.0%) and preeclampsia (20.9%). The perinatal mortality rate was 50 per 1000 newborns and 2 cases (0.8%) of maternal death were encountered. The risk of intrauterine fetal death and abortion was 2.4% and 0.8% respectively. CONCLUSION: Recently, although the incidence of twin pregnancy has been increased, it has greater risks of obstetrical complications and higher perinatal mortality than singleton pregnancy. Therefore, further prospective studies of twin pregnancy are needed for counselling and effective management about perinatal prognosis.

The Approximate Entropy in Maternal Anemia during Pregnancy according to Gestational Age / 대한주산의학회잡지

OBJECTIVES: Maternal anemia is common hematologic disorders during pregnancy. Although mild maternal anemia is not associated with fetal anemia, neonatal morbidity including fetal anemia are common with severe maternal anemia during pregnancies. We aim to analyze each variable of FHR using linear and nonlinear methods to detect maternal anemia during pregnancies. METHODS: Seventy antepartal anemic pregnant women(Hb<10.0g/dL) and the contrast group, 70 normal pregnant women were selected among the women who underwent nonstress test(NST) during 3rd trimester in Hanyang University Hospital. The calculated FHR parameters(NST time=20 min) from collected FHR data(40-50min) were made by HYFM II data file. To assess the difference between the anemic and normal pregnancy group, the parameters such as baseline FHR, variability (AMP, MMR), acceleration and deceleration(15bpm-15seconds), gestational age at the time of NST, loss of record, the number of fetal movement, FHR were evaluated. We compared the canonical correlation between each groups using variables of NST. The overall complexity of each FHR time series was quantified by its approximate entropy(ApEn), measure of regularity derived from nonlinear dynamics, "chaos theory". Finally we extract the value of ApEn and were compared between two groups, normal and anemic pregnant women. RESULTS: There were significant decrease of FHR variability(amplitude and mean minute interval) in anemic group. Canonical correlation ensemble was significantly high in 36th-37th and 38th-39th gestational weeks in anemic group(p-value=0.03048 and 0.03421). The value of ApEn was significantly low(0.68+0.26) in anemic group comparing with normal pregnant group(0.95+0.08), respectively. CONCLUSIONS: This study shows that FHR of maternal anemia is different from that of normal pregnant women, and that subtle behavioral differences could be demonstrated in uterus using computerized FHR analysis. The anemic women during pregnancy have more linear and less complicated FHR than the normal pregnancy group. ApEn, which is bound to be used as an index of fetal well-being would be used as an evaluating tool of intrauterine fetal function in the near future.

A Case of Heterotopic Pregnancy after in Vitro Fertilization and Embryo Transfer / 대한주산의학회잡지

Heterotopic pregnancy is a rare event, occurring less than 1 : 30,000 pregnancies in natural conception cycles. With assisted reproduction techniques, however, this incidence increase to between 1 : 100 and 1 : 500. It is known to present with a variety of symptoms and signs after leading to a delay in establishing the correct diagnosis. Delay in diagnosing and surgery can jeopardize both maternal well-being and survival of the intrauterine fetus. Prompt diagnosis and appropriate surgery contribute to the favorable outcome for the mother and surviving infant. We experienced a case of heterotopic pregnancy after in vitro fertilization and embryo transfer, which carried the intrauterine pregnancy to term delivery following rupture of the tubal pregnancy, with hypovolemic shock. So we report this case with review of literatures.

A Case of Acute Monoblastic Leukemia developed during Pregnancy / 대한주산의학회잡지

Acute leukemias are among the most common malignant neoplasms of young woman, but paradoxically, their incidence complicating pregnancy is cited to be very low. In most situations, the course of the pregnancy does not seem to be affected by the presence of the leukemia. So early diagnosis and treatment of acute leukemia might be very important., since acute leukemia in a pregnant young woman poses an immediate threat to life and any treatment delay would significantly worsen the patient's prognosis. We report a 37-year-old female who had symptoms and signs of acute leukemia such as vaginal spotting and leukemia cutis and was diagnosed as acute monoblastic leukemia M5(FAB) in January 2002 with 25 weeks' pregnancy. This case represents the use of combination chemotherapy successfully resulted in complete remission in the second trimester without any adverse impact on the fetus in uterus.

Outcome of 2nd Pregnancy after Transabdominal Cervicoisthmic Cerclage in Patient with Incompetent os of the Cervix / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to investigate the effectiveness of further successful pregnancies and prognosis after delivery where the band was not removed from a transabdominal cervicoisthmic cerclage (TCIC) after a first successful pregnancy. The candidates of TCIC were those who were diagnosed with incompetent internal os of cervix (IIOC) and either had failed to maintain pregnancy after undergoing transvaginal cerclage (TVC) or could not undergo TVC due to cervical abnormalities. METHODS: During the period from May of 1991 until November of 2002, there were total 20 cases in which the band was not removed after previous TCIC, followed by a first successful pregnancy. RESULTS: In the 20 patients who had undergone TCIC, the average age, average gestational age at the time of operation, average number of previous pregnancy, average number of surviving fetus, average number of preterm delivery, and average number of fetal death were 32 years old, 12.8 weeks, 5.4, 0.2, 2 and 2.2, respectively. Cesarean section was performed at an average gestational age of 37.1 weeks in which the average birth weight was 2903 g in the first born child among 19 patients. In the following pregnancies, the average age of the patients were 34 years old in which there were 17 successful deliveries out of 20 cases where the average gestational period was 35.4 weeks and an average weight of 2661 g. There was an average of 22.5 months between the time of the first and second delivery. CONCLUSION: When the location and tension of the band had been confirmed after the first delivery in a total of 20 patients, there was a high successful delivery rate of 85% (17/20) in the next pregnancy. In this study, there was no evidence to support the complications reported in previous studies of difficulty in removal of trophoblastic tissue after abortion, dysmenorrhea, and increase in infertility associated with non removal of bands.

Correlation analysis of Each Variable of Fetal Heart rate in Pregnancy induced hypertension and Intrauterine fetal growth restriction / 대한산부인과학회잡지

OBJECTIVE: We aim to analyze each variable of FHR in high risk pregnancies, namely intrauterine growth restriction (IUGR) and pregnancy-induced hypertension (PIH) including chronic hypertensive vascular disease (CHVD), mild and severe preeclampsia to build an objective decision basis using correlation analysis. METHODS: The patients were divided into two groups (500 normal pregnancies and 500 high risk pregnancies related to IUGR, CHVD, mild and severe preeclampsia), and then subdivided into intrauterine pregnancy before 24 weeks, 25-39 weeks, and after 40 weeks. We compared the canonical correlation between each group using variables of FHR after nonstress test (NST). RESULTS: In high risk pregnancies, the linearity was 0.6-0.8 in intrauterine pregnancy before 24 weeks, 0.53-0.68 in 25-29 weeks, 0.50-0.60 in 30-34 weeks, 0.38-0.45 in 35-39 weeks and 0.42-0.55 in after 40 weeks. In normal pregnancies, the linearity was 0.44-0.52 in intrauterine pregnancy before 24 weeks, 0.38-0.45 in 25- 39 weeks which was stable, and there was no specific change in after 40 weeks. Before 32 weeks, canonical variates of FHR_D and FHR_I revealed highest (0.36, 0.47 respectively) in high risk pregnancy and fetal movement and signal loss was the most valuable factors in normal pregnancy. In between 33 to 37 weeks, fetal movement (0.40) and signal loss (0.48) were related most closely in high risk pregnancies and 0.34 and 0.49 respectively in normal pregnancies which show similar pattern. In contrast, FHR_D was most highly related to the duration of pregnancy and FHR_I to fetal movement (0.38) in high risk pregnancy. In normal pregnancies, fetal movement (0.40) and signal loss (0.52) showed the highest linearity. CONCLUSION: The pregnancy with intrauterine growth restriction and pregnancy induced hypertension has more linear relation and less complexity in each variable of FHR than the normal pregnancy group. The formal, functional underdevelopment of fetus may results in the increasement of the linear depedent relation in each variable of FHR in these type of high risk pregnancies.

The Comparison between Modified Transvaginal Cerclage and Transabdominal Cervicoisthmic Cerclage after a failure of Previous Transvaginal Cerclage in Incompetent Internal Os of Cervix Patients / 대한산부인과학회잡지

OBJECTIVE: Incompetent internal os of cervix is one of the most common causes of midtrimester abortion in which interventions such as, transvaginal cerglage and transabdominal cervicoisthmic cerclage (TCIC) have been performed to prolong pregnancy. Transabdominal cerclage is beneficial in treating patients with cervices that are either extremely short, congenitally deformed, deeply lacerated after operative delivery, or markedly scarred because of previously failed transvaginal cerclage procedures. Due to technical difficulties and the fact that a cesarean section is necessary for delivery, has not been a procedure easily adopted. The purpose of our study was to compare the effectiveness of selected Modified McDonald cerclage (MTVC) and TCIC was compared in patients who had history of a previously failed transvaginal cerclage in other hospital. MATERIALS AND METHODS: Pregnancy outcomes of 13 patients who underwent TCIC from November 1997 to January 2002 and those of 28 patients who underwent MTVC from January 2000 to January 2002 were compared. Statistical analysis was done using Chi-square test and Mann-Whitney. RESULTS: The fetal salvage rates for total 13 cases of TCIC and 28 cases of MTVC were 100% (13/13) and 85.7% (24/28), respectively. The fetal salvage rates between these two groups were not statistically different. The mean gestational age at the time of operation in TCIC group was 13.15 (+/-1.63) weeks, mean gestational weeks delayed until delivery was 23.85 (+/-3.24) weeks and mean fetal body weight was 2780.77 (+/-667.33) gm. Comparably, the mean gestational age at the time of operation in MTVC group was 15.00 (+/-2.05) week, mean gestational weeks delayed until delivery was 9.96 (+/-6.65) week and mean fetal body weight was 2530 (+/-1071.26) gm. CONCLUSION: In patients who had a history of failure of TVC, the effectiveness of TCIC and MTVC had no statistical significance. Treatment with MTVC should be considered since TCIC is technically difficult and requires cesarean section.

The Sex Ratio of Offspring in Pregnancies Complicated with Hyperemesis Gravidarum / 대한주산의학회잡지

OBJECTIVES: There are a few studies reporting difference in sex ratio at birth in pregnancies complicated with hyperemesis gravidarum but it has not been reported in domestic journals yet. The purpose of this study is to evaluate difference of sex ratio in hyperemesis gravidarum patients compared to normal pregnant women. MATERIALS AND METHODS: We identified 111 women who were diagnosed as hyperemesis gravidarum and had delivered babies in Hanyang University Hospital between Jan. 1995 to Dec. 2000. The control group was 1995 women who had no obstetric problems including hyperemesis gravidarum during the pregnancy and had delivered baby at term. We compared the sex ratio of infant and the characteristics of these two groups. The study group was divided into two subgroups depending on the severity of disease, mild group and severe group, and difference of sex ratio in these group were also compared. We analyzed the data using student T-test and chi-square test and p-value < 0.05 was considered as statistically significant. RESULTS: Compared to sex ratio(female:male) of control group(44.8:55.2), hyperemesis gravidarum showed the sex ratio of 58.6:41.4(p=0.005). There was no further difference of sex ratio between two subgroups of hyperemesis gravidarum according to severity of disease. CONCLUSION: In pregnancies complicated with hyperemesis gravidarum the sex ratio of female was significantly high. The studies based on more variables and larger population would produce more accurate results.

Variables of Fetal Heart Rate and Neonatal Outcome according to Fetal Sex / 대한산부인과학회잡지

OBJECTIVE: The differences between two fetal sexes have been a matter of great concern from ancient times to present day. This study was initiated to research the varying fetal behaviors which would differ according to the fetal sex. METHODS: With every 1,500 cases of each fetal sex selected, the patterns which the varying factors related to FHR and prognosis of neonates in normal pregnancy were compared by means of Factor Analysis (a linear method). Canonical Ensemble was performed to compare the relationship of intrauterine fetal behavioral developments, and neonatal prognosis of each fetal sex. And whether the different types of the fetal sex would have influence also on the chaotic behavior was analyzed by the methods of linear Power Spectrum of FHR and Approximate Enthropy. RESULTS: The consequences of Factor Analysis showed that it is Apgar score on the factor 1 axis, and signal loss on the factor 2 axis in the case of male babies. In the case of female babies it is Apgar score on the factor 1 axis, and fetal movement on the factor 2 axis. Speaking of the specific value regarding FHR, male babies displayed higher frequency only in terms of fetal movement sign than female babies (p=0.0394). No other differences between two fetal sexes in abnormal findings were indicated (p>0.05). Among the babies at 30~33 weeks' gestation female babies were more likely to reveal higher Canonical Ensemble (male=0.41+/-0.05, female=0.05+/-0.04; p=0.00411), whereas male babies have a higher Approximate Entropy (male=0.926+/-0.01, female=0.871+/-0.01; p=0.0037). However Power Spectrum Analysis indicated that there were no significant differences as I compared LF/HF (p>0.05), the ratio of LF and HF of two fetal sexes, and same result was also drawn by Power Low beta-slope (p>0.05). CONCLUSION: The linear patterns of the FHR signal from the fetus suggest that there is no variables resulting from the type of fetal sex, except for the fetal movement frequency and the height and weight of neonates. The sympathetic and parasympathetic balance of both fetal sexes also showed a similar development pattern. In the mean time the differences which could be visible were made among the male and female babies specifically at 30~33 weeks' gestation. This may correspond to the fact that the lung maturation of the female fetus is completed before the third trimester of pregnancy, and the male fetus after the period, and finally the differences between the fetal sexes generally become insignificant toward term.

Vaginal birth after cesarean section: A 10-years study / 대한산부인과학회잡지

OBJECTIVE: Recently, enormous amount of the studies about trial of labor after cesarean section has been reported to decrease the rate of cesarean section. This study focused on analyzing multiple variables and results to acknowledge the safety and complications of VBAC (vaginal birth after cesarean section). METHODS AND MATERIALS: This study was performed based on 97 pregnant women who were tried vaginal delivery after cesarean section at Hanyang University Hospital from January 1990 to December 1999. The age of mother, gestational age, estimated fetal body weight by ultrasonography, neonatal body weight, cervical dilatation, cervical effacement, Bishop score, the number of previous vaginal delivery, complications of mother, and complications of fetus were analyzed between successful group (82 patients) and failure group (15 patients) with trial of labor. Student T-test and Chi-square test were used for statistical analysis. RESULTS: In the 97 cases with trial of labor after cesarean, the success rate was 84.5% and failure rate was 15.5%. The estimated fetal body weight by ultrasonography, cervical dilatation and effacement, Bishop score, Apgar score had notable differences between successful group and failure group, while the other factors had not. There was no maternal death or uterine rupture in the cases of trial of labor. CONCLUSION: Trial of labor after cesarean section is relatively safe method of delivery if it is performed under strict indication. It could be suggested that VBAC has relatively little complication in both mother and fetus. The studies with large populations and performed by multi-centers will be needed for the evaluating safety of VBAC and developing safe protocols to decrease the risk of complications.