Effects of preeclampsia on labor induction with prostaglandin E2 and oxytocin / 대한산부인과학회잡지

OBJECTIVE: The purposes of this study were 1) to determine whether preeclampsia itself affects failure of labor induction with prostaglandin E2 and oxytocin and 2) to investigate risk factors for failed induction in women with preeclampsia. METHOD: Fifty preeclamptic women and 175 nonpreeclamptic women requiring labor induction were studied prospectively. Intravaginal prostaglandin (PG) E2 tablet (Dinoprostone, The Upjohn company, 3 mg) followed by a second dose if the cervix assessed 6 hours later was 5 or less of Bishop score, and oxytocin were used for labor induction. Women with rupture of membrane, spontaneous contraction resulting in cervical change or an initial cervical examination showing more than 2 cm dilatation and 50% effacement were excluded. Statistics were analyzed with 2 test, Student t test, and multiple logistic regression. RESULTS: 1) The women with preeclampsia had a significantly higher rate of failed induction than did those without preeclampsia [24% (2/50) versus 9% (16/175); p <0.05]. However, the women with preeclampsia had a higher rate of the use of magnesium sulfate, and were more likely to decrease gestational age at induction and increase maternal weight than those without preeclamp sia (p <0.0001, respectively). There were no significant differences in prevalence of nulliparity and low initial Bishop score (< or =3) between the women with and without preeclampsia. 2) Multiple logistic regression showed that preeclampsia itself was not associated with failed induction after correction of known confounding variables (odds ratio 0.22, 95% confidence interval 0.03-2). 3) In women with preeclampsia, the use of magnesium sulfate only was associated with increased risk of failed induction analyzed by multiple logistic regression(odds ratio 38.5, 95% confidence interval 1.6-897). Maternal weight with 70 kg or more was associated with increased risk of failed induction, but it is not statistically significant (p=0.055). CONCLUSIONS: 1) The risk of failed induction is increased in women with preeclampsia, but not by preeclampsia itself but by the use of magnesium sulfate, prematurity, and increased maternal weight secondary to preeclampsia. 2) The use of magnesium sulfate is independent risk factor for failed induction in women with preeclampsia.

Multiple dose methotrexate chemotherapy in suspected medical treament failure of ectopic pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to determine the efficacy of multiple dose methotrexate (MTX) chemotherapy approved as a primary treatment of ectopic pregnancy in suspected medical treatment failure of ectopic pregnancy. METHODS: This study included 77 hemodynamically stable high risk ectopic pregnants diagnosed from January 1995 to June 2000 at department of Obstetrics & Gynecology, Sanggye Paik hospital, Inje university. High risk criteria of our study were adnexal ectopic mass 3.5 cm or serum-hCG 4,000 mIU/ml or presence of fetal heart beat(FHB) or presence of peritoneal fluid and fresh blood on culdocentesis. Statistics were analyzed with 2-test, Student t-test and odds ratio of each risk factors. RESULTS: The response rate of multiple dose MTX chemotherapy was 85.7%(66/70). There was no statistically difference of risk factors between success and failure group except fetal heart beat. Among 11 failure patients, there were 3 patients with adnexal ectopic mass 3.5 cm (odds ratio=1.4, 0.3~5.7), 3 patients with presence of FHB, 7 patients with presence of peritoneal fluid(odds ratio=1.0, 0.3~3.8), 8 patients with serum-hCG 4,000 mIU/ml (odds ratio=2.8, 0.7~11.6). CONCLUSION: There results suggest that multiple dose MTX chemotherapy can be treated regardless of ectopic mass size, presence of pretoneal fluid, serum beta-hCG level. But we must pay attention to treat ectopic pregnancy with presence of fetal heart beat.

Prenatal diagnosis of fetal intussusception: A case report / 대한산부인과학회잡지

Fetal intussusception is not common and the underlying mechanism triggering the event is not known at present. There are few reports of successful diagnosis in fetus with prenatal ultrasongraphy. It may be detected by meconium peritonitis. Meconium peritonitis is a nonbacterial foreign body reaction or chemical inflammation by intestinal perforation result from intestianl atresia, intussusception and fetal bowel obstruction. Recently we experienced a 33+1 weeks of gestational fetus with fetal intussusception who had prenatal ultrasonographic detection with meconium peritonitis, and the infant was underwent postnatal laparotomy. We present this case with a brief review of literature.

Reversible Posterior Leukoencephalopathy Syndrome with Eclampsia A Case Report / 대한주산의학회잡지

No abstract available.

Uterine artery Doppler velocimetry in the prediction of adverse obstetric outcomes in unexplained MSAFP elevations

Unexplained maternal serum-fetoprotein (MSAFP) elevation has been known to be associated with adverse obstetric outcomes, however it is not sufficiently useful as a screening test. This study was undertaken to determine whether uterine artery Doppler velocimetry could define a subset of patients with an elevated MSAFP level in whom complications of pregnancy might develop. The subjects included 179 women between 26 and 28 weeks' gestation with MSAFP > or = 2.5 multiples of the median, in whom either the presence of an early diastolic notch or a resistance index 0.6 was considered as an abnormal Doppler velocimetry finding. Those subjects who displayed abnormal Doppler velocimetry findings showed an increased incidence of preeclampsia, preterm birth, IUGR, and IUFD compared to those subjects with only elevated MSAFP (p < 0.05). No differences were observed in the incidence of LBW. Positive predictive values of adverse obstetric outcomes were significantly higher in the group having both elevated MSAFP and abnormal Doppler velocimetry compared to the group with only elevated MSAFP (p < 0.05). Uterine artery Doppler velocimetry in the second trimester can improve the value of unexplained MSAFP elevation in the prediction of adverse obstetric outcomes.

Review of Prenatal Sonographic findings in Edward syndrome / 대한산부인과학회잡지

PURPOSE: The purpose is to aid in the diagnosis and obstetric management by analysing the ultrasonographic findings of prenatally diagnosed Edward syndrome. METHOD: The study population consisted of 15 cases prenatally diagnosed Edward syndrome from January 1993 to January 1999. The medical charts and ultrasonographic findings were reviewed retrospectively, and especially the ultrasonographic findings before prenatal genetic diagnosis were anlyzed. RESULTS: All of the 15 cases reviewed showed at least one ultrasonographic finding suggesting Edward syndrome. In the first trimester, 2 cases revealed cystic hygroma and increased nuchal translucency, and after the second trimester, major structural anomalies including congenital heart anomalies and minor ultrasonographic findings such as choroid plexus cyst were noted. All of cases after 21 weeks of gestation showed congenital heart anomaly, and as the pregnancy progressed there was an increased tendency of intrauterine growth restriction and polyhydramnios. CONCLUSION: Prenatal ultrasonography in the screening process of Edward syndrome can be placed as a very informative method, as all of the Edward syndrome cases revealed at least one abnormal ultrasonographic findings. As congenital heart anomalies were found in all of the cases after 21 weeks of gestation, fetal echocardiography should be considered in evaluating suspected cases of Edward syndrome.

Correlation of prenatal renal parenchymal thickness with postnatal outcome of fetal hydronephrosis / 대한산부인과학회잡지

PURPOSE: The aims of this research are to correlate prenatal renal parenchymal thickness with postnatal outcome of fetal hydronephrosis, to establish the predictability of prenatal renal parenchymal thickness for surgical treatment and to apply this parameter to the evaluation and the follow-up of prenatal hydronephrosis. Material and METHOD: Between Jun 1991 and Jun 1998 we retrospectively identified 59 cases of fetal hydronephrosis in which renal pelvic anteroposterior diameter(PAPD) was greater than 10mm. Renal parenchymal thickness(RPT), renal pelvis anteroposterior diameter and renal anteroposterior diameter(RAPD) were measured on midtransverse from prenatal sonograms. The ability of these parameters to predict who would require surgical treatment was examined. The difference of these parameters in groups were compared using Wilcoxon rank sums analysis. RESULTS: 66.7% of fetuses with a renal parenchymal thickness lesser than 8mm and 71.4% of fetuses with a renal parenchymal thickness lesser than 6mm required surgical treatment. 33.3% of fetuses with an PAPD greater than 12mm and 45% of fetuses with an PAPD greater than 15mm required surgical treatment. 60% of fetuses with an ratio of PAPD/RAPD greater than 0.4 and 70% of fetuses with an ratio of PAPD/RAPD greater than 0.5 required surgical treatment. CONCLUSION: The research shows that RPT could be used as an useful parameter in the prediction of requirement of postnatal surgical treatment of fetal hydronephrosis ,in addition to the size of PAPD and the ratio of PAPD/RAPD which have been assumed as one of the most important parameters.

Congenital Heart Disease and Extracardiac Anomalies / 대한산부인과학회잡지

Purpose: The diagnostic usefulness of fetal echocardiography in congenital heart disease is well known. One of the indications for fetal echocardiography is presence of extracardiac anomalies and such coexistent congenital heart disease may have important implications for obstetric and neonatal management. MATERIALS AND METHODS: 496 women with singleton pegnancies with amgenital anomalies that underwent penatal care and follow-up in Severance Hospital for 5 years from 1991 to 1995 were evaluated for the incidence of congenital heart disease. RESULTS: The incidence of congenital heart disease in fetuses with the associated extracardiac anomalies were as follows; central nervous system 6.9%(11/160), gastro-intestinal system 10.7%(8/75), genito-urinary sysem 4.7%(4/85), others 5.6%(4/72). Thirty-one of eighty-ane fetuses with congenital heart disease were found to have the associated extracardidac anomalies and ten of them chenoscenal abnormalities. CONCLUSION: We recommend that fetuses with congenital extracardiac anomalies sbould be checked for the presence of congenital heart disease and chmmosomal abnormalities, if needed.

Adverse Pregnancy Outcome in Epileptic Women with Antiepileptic Drugs Treatment during Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The aims of this study was to examine whether epileptic women with antiepileptic drugs(AEDs) treatment during pregnancy were associated with an increased risk of adversed pregnancy outcome. METHODS: The study design was a retrospective analysis of 91 epileptic pregnant women attending the Severance Hospital Yonsei Medical Center between January 1980 and June 1998. Of the 91 women, data from 84 were available for analysis. Adverse pregnancy outcome in 66 women who were exposed to AEDs during pregnancy were compared with those of 18 controls who were not. The main adverse pregnancy outcome included spontaneous abortions, perinatal deaths, preterm deliveries, fetal growth restriction and congenital anomalies. RESULTS: Epileptic women with AEDs treatment during pregnancy were not significantly different from their controls in the incidence of spontaneous abortions(1.5% vs, 5.5%), perinatal deaths(1.5% vs. 0%), preterm deliveries(3% vs. 5.5%), fetal growth restriction(3% vs. 0%), and congenital anomalies(3% vs 5.5%). An adverse outcome occurred in 8 of 66 women(l2%) in the study group and 3 of 18 control group(16.5%). This difference was not statisitically significant. CONCLUSION: Our study shows that epileptic women who were exposed to AEDs during pregnancy do not have an increased risk of adversed pregnancy outcome than the women who were not.

Cytogenetic study employing chorionic villi in ectopic pregnancy

Maternal factors such as salpingitis and peritubal adhesion are known to be associated with ectopic pregnancy; however, a few studies have considered the chromosomal complements of ectopic conceptuses. We studied 16 ectopic conceptuses obtained by surgical resection. The karyotyping of chorionic villi was performed using direct and culture technique. Among 16 studied cases, 14 cases showed normal karyotype (nine with 46, XY; five with 46, XX). One case showed trisomy 16(47, XY, + 16) and another showed variation from normal chromosomal complement (46, XY, 14s+), resulting in 6.3% incidence of the structural abnormalities of the chromosome. On the basis of our study, we determined the possibility of chorionic villi karyotyping in ectopic pregnancy. This ectopic conceptuses are no more likely to show chromosomal abnormalities than in utero conceptuses of comparable gestational age. Therefore, maternal factors such as salpingitis and peritubal adhesion are the most likely explanations for ectopic pregnancy.