Omental Incarceration over Twenty Years Presenting as a Hyperechoic Endometrial Mass in a Postmenopausal Woman

Uterine perforation related with dilatation and curettage (D&C) is an uncommon event. Combined complications such as hemorrhage, adjacent organ injury, and omental incarceration may require an emergent surgical treatment. These are usually evident immediately or several days after the D&C, and a delayed presentation of uterine perforation are extremely rare. Herein, we report a rare case of omental incarceration presenting as a hyperechoic endometrial mass in a postmenopausal woman, diagnosed twenty-three years after the D&C. According to this case, when we encounter a hyperechoic endometrial lesion penetrating the uterine wall in women with a history of an intrauterine procedure such as D&C, we need to consider the possibility of an incarcerated omentum.

Omental Incarceration over Twenty Years Presenting as a Hyperechoic Endometrial Mass in a Postmenopausal Woman

Uterine perforation related with dilatation and curettage (D&C) is an uncommon event. Combined complications such as hemorrhage, adjacent organ injury, and omental incarceration may require an emergent surgical treatment. These are usually evident immediately or several days after the D&C, and a delayed presentation of uterine perforation are extremely rare. Herein, we report a rare case of omental incarceration presenting as a hyperechoic endometrial mass in a postmenopausal woman, diagnosed twenty-three years after the D&C. According to this case, when we encounter a hyperechoic endometrial lesion penetrating the uterine wall in women with a history of an intrauterine procedure such as D&C, we need to consider the possibility of an incarcerated omentum.

Alteration of Genomic Imprinting Status of Human Parthenogenetic Induced Pluripotent Stem Cells during Neural Lineage Differentiation

BACKGROUND AND OBJECTIVES: Genomic imprinting modulates growth and development in mammals and is associated with genetic disorders. Although uniparental embryonic stem cells have been used to study genomic imprinting, there is an ethical issue associated with the destruction of human embryos. In this study, to investigate the genomic imprinting status in human neurodevelopment, we used human uniparental induced pluripotent stem cells (iPSCs) that possessed only maternal alleles and differentiated into neural cell lineages. METHODS: Human somatic iPSCs (hSiPSCs) and human parthenogenetic iPSCs (hPgiPSCs) were differentiated into neural stem cells (NSCs) and named hSi-NSCs and hPgi-NSCs respectively. DNA methylation and gene expression of imprinted genes related neurodevelopment was analyzed during reprogramming and neural lineage differentiation. RESULTS: The DNA methylation and expression of imprinted genes were altered or maintained after differentiation into NSCs. The imprinting status in NSCs were maintained after terminal differentiation into neurons and astrocytes. In contrast, gene expression was differentially presented in a cell type-specific manner. CONCLUSIONS: This study suggests that genomic imprinting should be determined in each neural cell type because the genomic imprinting status can differ in a cell type-specific manner. In addition, the in vitro model established in this study would be useful for verifying the epigenetic alteration of imprinted genes which can be differentially changed during neurodevelopment in human and for screening novel imprinted genes related to neurodevelopment. Moreover, the confirmed genomic imprinting status could be used to find out an abnormal genomic imprinting status of imprinted genes related with neurogenetic disorders according to uniparental genotypes.

Reviving external cephalic version: a review of its efficacy, safety, and technical aspects

Currently, the rate of cesarean sections being performed in Korea is approximately 40%, with Korea ranking 4th among the Organization for Economic Co-operation and Development countries with respect to cesarean deliveries. Breech presentation at term is an important indication for cesarean section among other factors, including medicolegal concerns and pregnancies in women of advanced maternal age. Term breech presentation is associated with a higher fetal mortality rate than that associated with a cephalic presentation. Therefore, in Korea, most of these women deliver by cesarean section to avoid the complications of vaginal breech delivery. However, cesarean section is itself associated with considerable obstetric morbidity and sometimes, mortality. External cephalic version (ECV) is a useful method to reduce the cesarean section rate in women with breech presentation and therefore to reduce the incidence of breech presentation at delivery. Studies have shown that routine use of ECV reduces the cesarean section rate by approximately two-thirds in term pregnancies with breech presentation. ECV is accepted as a safe, efficacious, and cost-effective method and is recommended by both the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynecologists in all pregnancies with term breech presentation, if not contraindicated. In Korea, although most clinicians are aware of the option of ECV, their relative lack of experience in performing the procedure and fear of complications render them hesitant to perform ECV. This review is aimed at guiding obstetricians by describing the efficacy, safety concerns, and technical aspects of this procedure.

Extra-adrenal paraganglioma masquerading as severe preeclampsia

Paraganglioma in pregnancy is an extremely rare condition and its diagnosis is often delayed because the clinical symptoms can mimic those of preeclampsia or gestational hypertension. Here, we report the case of a 32-year-old, gravida 2, para 1 woman who presented with severe headache, palpitation, and sweating at 37 weeks' gestation. Although emergent cesarean section was performed on the assumption of severe preeclampsia, blood pressure fluctuated and heart rate remained tachycardiac. We suspected that she might have thromboembolic lesion in the chest or pheochromocytoma. Chest and abdominal computed tomography revealed a 4 cm mass in the left para-aortic space. Serum and urinary catecholamine levels were found to be significantly increased. She underwent laparoscopic mass removal and the pathology confirmed paraganglioma. When typical paroxysmal hypertension is accompanied by headache, palpitation, and sweating during pregnancy, adrenal tumors should be considered.

External cephalic version experiences in Korea

OBJECTIVE: The aim of this study was to evaluate obstetric outcomes of external cephalic version (ECV) performed at or near term. METHODS: Single pregnant woman with breech presentation at or near term (n=145), who experienced ECV by one obstetrician from November 2009 to July 2014 in our institution were included in the study. Maternal baseline characteristic and fetal ultrasonographic variables were checked before the procedure. After ECV, the delivery outcomes of the women were gathered. Variables affecting the success or failure of ECV were evaluated. RESULTS: Success rate of ECV was 71.0% (n=103). Four variables (parity, amniotic fluid index, fetal spine position and rotational direction) were observed to be in correlation with success or failure of ECV. In contactable 83 individuals experienced successful ECV, cesarean delivery rates were 18.1%, 28.9%, and 5.3% in total, nulliparas, and multiparas, respectively. CONCLUSION: Based on the results, ECV is proposed to be safe for both mother and her fetus. In addition, it is a valuable procedure that increases probability of vaginal delivery for women with breech presentation.

The Correlation between Maternal Adult Attachment Style and Postpartum Depression and Parenting Stress / 신경정신의학

OBJECTIVES: We aimed to determine whether the adult attachment styles of pregnant women could predict development of postpartum depression. METHODS: Korean version of Revised Adult Attachment Scale, State Trait Anxiety Inventory-State/Trait (STAI-S/T), and Center for Epidemiologic Studies-Depression Scale (CES-D) were administered at baseline. Edinburgh Postnatal Depression Scale (EPDS), Parenthood Stress Questionnaire (PSQ), STAI-S, and CES-D were assessed at week 2 and 6 postpartum. Participants were categorized into the secure-mom (SM ; n=48) or insecure-mom (IM ; n=9) group. RESULTS: While STAI-S scores in SM showed a continuous decrease during the entire observation period, STAI-S scores in IM decreased during the first two weeks but increased during the next four weeks. While SM showed decreased CES-D scores from week 2 to 6, IM showed increased CES-D scores from week 2 to 6. Although SM showed decreased EPDS scores from week 2 to 6, IM showed increased EPDS scores from week 2 to 6. In SM, the change in EDPS score from week 2 to week 6 showed positive correlation with PSQ-ability and PSQ-social subscale scores. CONCLUSION: Assessing the maternal adult attachment style before giving birth appears to be helpful for screening the high-risk group who are vulnerable to development of postpartum depression.

Congenital Epidermoid Cyst of the Oral Cavity: Prenatal Diagnosis by Sonography

Epidermoid cysts are benign developmental anomalies that are rarely observed in the oral cavity of neonate. If large in size, especially in the developing fetus or newborn infant, they can cause swallowing difficulty and occasionally respiratory difficulty. We report a case of epidermoid cyst in the oral cavity detected prenatal sonography. The sonographic finding was large cystic mass, measuring 30x25 mm. In this case, supplies and equipment for an emergency tracheostomy were made available prior to the delivery. However, the infant did not require intervention to secure the airway. The lesion was surgically excised, and histologic diagnosis was epidermoid cyst. After 6 months of follow up, the cyst had not recurred. This case illustrates the value of accurate prenatal diagnosis and planned perinatal management using a team approach.

Prune-belly syndrome detected by ultrasound in the first trimester and the usefulness of vesicocentesis as a modality of treatment

Prune-belly syndrome may be related to lower urinary tract obstruction (LUTO). LUTO in the early gestational age exacerbates fetal renal function and may require intrauterine intervention. If early developed LUTO causes bladder distension and abdominal musculature deficiency, it will result in prune belly syndrome. Therefore, early detection of the disease and proper treatment before the renal impairment is important. However, there are few literatures concerning the treatment of prune belly syndrome in the first trimester. We report a case of prune belly syndrome diagnosed at 11+6 weeks of gestation and the value of vesicocentesis as a modality of treatment. Ultrasound showed dilated fetal bladder and vesicocentesis was successful in reducing the volume of the bladder. However, the pregnancy was terminated upon request.

Congenital Chloride Diarrhea in Dizygotic Twins / 대한소아소화기영양학회지

Congenital chloride diarrhea (CLD) is a rare inherited autosomal recessive disorder. Mutations of the solute carrier family 26 member 3 gene cause profuse, chloride ion rich diarrhea, which results in hypochloremia, hyponatremia and metabolic alkalosis with dehydration. If a fetal ultrasound shows bowel dilatation suggestive of bowel obstruction, or if a neonate shows persistent diarrhea and metabolic alkalosis, CLD should be considered in the differential diagnosis. The severity of CLD varies, but early detection and early therapy can prevent complications including growth failure. We report a case of dizygotic twins affected by CLD who had been born to non-consanguineous parents. Both of them showed growth failure, but one of the twins experienced worse clinical course. He showed developmental delay, along with dehydration and severe electrolyte imbalance. He was diagnosed with CLD first at 6-month age, and then the other one was also diagnosed with CLD.

Prenatally diagnosed agenesis of corpus callosum / 대한산부인과학회지

OBJECTIVE: To report the clinical characteristics of the fetuses with agenesis of corpus callosum (ACC) diagnosed by prenatal ultrasonography. METHODS: Between 1998 and 2007, total twenty-two cases of ACC were identified. All cases were diagnosed by the direct evaluation of the corpus callosum using the ultrasonograpy with or without 3D multi-slice technique and color Doppler. Postnatal work-up was done by MRI or autopsy. RESULTS: The median gestational week was 26 weeks (19 to 34 weeks). The most common abnormal ultrasonographic finding was ventriculomegaly, shown in 19 (86.3%) of 22 cases. Absent cavum septum pellucidum and dilated upward displacement of third ventricle were also shown in 18 (81.8%) and 15 (68.2%) of 22 cases, respectively. Postnatal work-up performed in 9 cases (4 live-born babies and 5 still births) additionally confirmed the associated anomalies in three cases including a heart defect, an Aicardi syndrome, and trisomy 18. CONCLUSION: The analysis of 22 cases presented in this report provides the precise materials to understand ACC. Targeted ultrasonographic evaluation may be helpful for prenatal diagnosis of ACC but has the limitation in differentiation of an isolated ACC from complex defect. To solve this limitation, therefore, the meticulous prenatal work-up and counseling would be needed.

Prenatal Diagnosis of Transient Abnormal Myelopoiesis in a Down Syndrome Fetus

We report a case of transient abnormal myelopoiesis in a Down syndrome fetus diagnosed at 28(+3) weeks of gestation that rapidly progressed to intrauterine death 10 days later. Fetal hepatosplenomegaly with cerebral ventriculomegaly, although not specific, may be a suggestive finding of Down syndrome with transient abnormal myelopoiesis. Prompt fetal blood sampling for liver function test and chromosomal analysis are mandatory for early detection and management.

Prediction of delivery within 7 days after ultrasonographic measurement of the cervical angle and cervical length in term pregnancies / 대한산부인과학회지

OBJECTIVE: The study was to assess the value of the cervical angle (CA) and cervical length (CL) measurement by transvaginal ultrasonography (USG) in predicting delivery within 7 days after USG in low risk singleton term pregnancies. METHODS: This prospective study included 85 singleton low risk term pregnancies. The CA and the CL were measured at 36 weeks' gestation and each week thereafter. Seven cases were lost to follow-up and finally a total of 78 cases were analyzed. The number of days to delivery was recorded. The odds ratios of the CA and CL for predicting delivery within 7 days after USG at different weeks' gestation were calculated using the Cox proportional hazard model. Receiver-operation characteristic curves were drawn to determine the cutoff values of the CA and CL. RESULTS: CA measurement did not predict delivery within 7 days after USG. However, there was a significant relationship between the CL and the days to delivery at 37 weeks' gestation. The optimal cutoff value in predicting the delivery within 7 days was 10 mm at 37 weeks' gestation. We could not obtain proper cutoff points at other weeks' gestation. CONCLUSION: CA measurement by transvaginal USG may not have a significant clinical impact on predicting delivery within 7 days after USG. However, CL measurement USG at 37 weeks' gestation can help predict the delivery within 7 days after USG.

Fetal Choledochal Cyst Diagnosed at 22 Weeks of Gestation by Three-Dimensional Ultrasonography: A Case Report

Choledochal cyst is a cystic or fusiform dilatation of the extra- or intrahepatic bile duct that has rarely been reported in prenatal cases. Here we report a fetus with choledochal cyst diagnosed prenatally by three-dimensional (3-D) ultrasonography at 22 weeks of gestation. We demonstrated an image of choledochal cyst by using a new ultrasound technique, a 3-D multislice view. After close intrauterine followup, surgery was successfully performed and postoperative course was uneventful.

A case of prenatally diagnosed thanatophoric dysplasia type I using 3D multislice view / 대한산부인과학회지

Lethal skeletal dysplasia can be suspected at relatively early pregnancy by ultrasonography, but the final diagnosis is difficult to make. Genetic, histopathologic and radiologic examinations are needed for the diagnosis. The most common lethal skeletal dysplasia is thanatophoric dysplasia (TD) and which can be subdivided into two types according to its clinical features. Advances in prenatal ultrasound techniques, especially 3D multislice scan technique enable to get adequate plans to diagnose TD. We report one case of thanatophoric dysplasia type I diagnosed by new 3D multislice view technique and confirmed by histopathologic, genetic, radiologic examination after termination at 20 weeks of gestation.

Preschool infant sexual assault: Experiences at sexual assault clinic / 대한산부인과학회지

OBJECTIVE: Life cycles and social environments are different among sexual assault victims according to ages, a study of sexual assault should be individualized by specific age groups. The aim of this study was to make basic data for proper management or prevention of infant sexual assaults by evaluating experiences at sexual assault clinic. METHODS: Two hundreds and ten sexual assault victims referred to specialized sexual assault clinic in teaching hospital. There were 25 infant victims aged 2 to 6 years, then retrospective chart reviews were done. Collecting evidences and managements processes were carried out by the female obstetric doctors who were specially trained to manage sexual assault patients. Analysis was done to determine the frequency, location and severity of genital and non genital physical trauma and the site and time of the assault, the nature of the physical contacts, use of weapons were recorded. RESULTS: Infant sexual assaults occupies 11.9% of all sexual assault cases. Those occurred frequently between 14:00 to 18:00 (44%). Play-grounds or rooftop of apartments were the most frequent place (52%) for assault. Genital fondling with finger was the most frequent type of assaults. Vaginal intercourses tried in 6 cases (24%). No severe genital or body wounds observed. Specific psychologic treatments were needed in 6 infants (24%). CONCLUSION: Infant sexual assaults were different from other age groups of victims in place, type, time, assailant characteristics.

Prediction of an actual birth within one week by ultrasonographic examination at 38 weeks' of gestation / 대한산부인과학회지

OBJECTIVE: The aim of this study is to predict spontaneous labor onset delivery within 7 days in low risk pregnant women at 38 weeks' of gestation by ultrasonographic examination of cervical changes. MATERIAL AND METHODS: This prospective study included 110 singleton low risk pregnancies between 37(+0) and 37(+6) weeks of gestation. Fifteen cases were lost during follow-up and finally 95 pregnant women (58 nulliparous, 37 multiparous) were analysed. The study period was from Oct/2005 to May/2007. Four cervical changes (length, gland thickness, funneling and canal formation) were evaluated. Main outcome was remaining day to delivery after the examination. Remaining days to actual delivery with spontaneous labor onset were recorded and the pregnancies were divided into two groups according to remaining days (within 7 days, over 7 days) to compare predicting power of delivery within 7 days. ROC curves were drawn to find out cut-off values of cervical length and gland thickness. Sensitivity, specificity, positive predictive value and negative predictive value were extracted from four cervical changes. RESULTS: Mean cervical length of pregnant women at 38 weeks' of gestation was 25.8 (+/-10.0) mm and mean cervical gland thickness was 4.3 (+/-1.2) mm. Funnelings of uterine cervix were detected in 13 cases (13.7%), canal formations in 6 cases (6.3%). All four cervical changes were statistically valuable to predict delivery within 7 days and the cervical length showed highest sensitivity. When the cervical length was measured under 20 mm, the possibility of delivery within 7 days was 78.6% (p<0.001). The cervical gland thickness less than 4 mm could predict the delivery within 7 days with sensitivity of 57.1% (p<0.01). Sensitivities of funneling and canal formation for delivery within 7 days were 54.5%, 36.4% each. CONCLUSION: Ultrasonographic examination of the cervical changes in low risk singleton pregnancy at 38 weeks' of gestation are valuable for predicting spontaneous labor onset delivery within 7 days. Among four cervical changes, cervical length is most sensitive ultrasonographic marker.

Ultrasonographic factors related with prediction of delivery day in term singleton pregnancy / 대한산부인과학회지

OBJECTIVE: The aim of this study was to find out the relating factors with the actual delivery day in term singleton pregnancy. METHODS: The 52 patients with singleton gestation were visited weekly and measured for their lower uterine segment (LUS) thickness, cervical length and cervical gland thickness by transvaginal ultrasonography and for amnionic fluid index (AFI) by transabdominal ultrasonography from 36 weeks of gestation until birth. Regression analysis was used to find out the relevance between these factors and remaining days to birth. RESULTS: There was a significant relationship between cervical length and remaining days to birth in term pregnancy, which could be described as a mathematical equation (remaining days for delivery = 6.12 + 0.24 x cervical length (mm) r=0.29, p<0.01). However, no relationship was found between factors such as LUS, AFI, and cervical gland thickness and remaining days to birth. CONCLUSION: Our results suggest that the actual delivery day in term singleton pregnancy might be predicted with cervical length.

Clinical Significance of Lower Uterine Segment Thickness in Term Pregnancy / 대한산부인과학회지

OBJECTIVE: The aim of this study was to evaluate the role of lower uterine segment thickness in predicting an actual delivery date and to determine the factors affecting the depth of lower uterine segment. METHODS: Sixty patients with singleton gestation were weekly measured for their lower uterine segment (LUS), cervical length, cervical gland thickness and AFI by ultrasonography from 36 weeks. The regression analysis was carried to find out the relevance between LUS and the remaining days to birth and Pearson correlation analysis was performed for relevance between LUS and other factors such as maternal age, parity, cervical length, cervical gland thickness, and AFI. RESULTS: LUS became thin as cervical length decreasing. However, the relevance between LUS and other factors such as age, parity, cervical gland thickness, and AFI was not found. While individual LUS thickness is decreasing as delivery date becomes closer, LUS thickness as a group is found not to be related with the delivery date. CONCLUSION: In term pregnancy, LUS thickness decreases with cervical change but it cannot predict the delivery date.

The Characteristics of Fetus with Neural Tube Defect Accompanied by Club Foot in Prenatal Ultrasonography / 대한산부인과학회지

OBJECTIVE: The objective of this study is to determine whether the club foot of the affected fetus is related to the location, size, and rupture state of the spinal neural tube defect lesion. METHODS: Ultrasound and medical records of 21 fetuses with spinal neural tube defect were reviewed. At the time of diagnosis 7 fetuses had clubfoot and 14 fetuses didn't have. All the fetuses with spinal neural tube defect were divided into two groups, one with clubfoot fetuses, and the others without clubfoot. RESULTS: The mean lesion size of the clubfoot group was significantly larger than normal foot group (4.1+/-1.22 cm vs 2.1+/-1.59 cm). And the level of lesion is significantly higher in club foot group. But the rate of sac rupture is lower in club foot group. CONCLUSION: The fetuses with clubfoot detected at the time of diagnosis had larger size and higher level of lesion.