Thrombotic thrombocytopenic purpura in three pregnancies / 대한산부인과학회지

Thromobotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS), characterized by microangiopathic hemolytic anemia, thrombocytopenia, fever, central nervous system abnormalities, and renal dysfunction, is severe multisystem disorder. TTP-HUS occurs predominantly in the reproductive aged-women, associated with poor prognosis. Although the morbidity and mortality have been significantly decreased by using plasma exchange therapy, refractory TTP-HUS remains a tremendous problem. It is crucial to differentiate other microangiopathic hemolytic anemia disease with a confusing presentation and to perform the immediate plasmapheresis. We have experienced three cases, which were initially diagnosed as HELLP syndrome or immune thrombocytopenic purpura. Despite of aggressive plasmapheresis, two women died. We present these cases with a review of the literature on pregnancy-associated thrombotic microangiopathy, including ADAMTS-13 activity assay as a new diagnostic test.

A Case Report of Acute Hepatitis A Infection in Pregnancy / 대한주산의학회잡지

Hepatitis A virus infection is the most common cause of acute hepatitis but is rarely reported during pregnancy. We report a case of acute hepatitis A in a 28-year old pregnant woman at 40 weeks of gestation. Her initial complaint was fever. Three days after, she developed spontaneous labor and delivered a healthy baby vaginally. Her laboratory examination showed thrombocytopenia, elevated D-dimer and decreased Fibrinogen level as well as markedly elevated liver enzymes. In addition, oliguria and pulmonary effusion were also noted. Hepatitis A infection during pregnancy may be associated with development of labor. And the differential diagnosis with preeclampsia and acute fatty liver of pregnancy is very important for the management.

Clinical analysis of ovarian pregnancy / 대한주산의학회잡지

OBJECTIVE: To evaluate the early diagnostic key of ovarian pregnancy. METHODS: A Retrospective case study of 31 cases of ovarian pregnancies treated between 1990 and 2007 at Kangnam St. Mary's hospital Catholic University of Korea was performed. The maternal age, obstetric history, clinical symptoms, sonographic findings, preceding factors, diagnostic modalities, and surgical treatment methods were investigated. RESULT: 31 ovarian pregnancies, diagnosed between 1990 and 2007, comprised (31/1176) 2.6% of all ectopic pregnancies. The most common sonographic finding was fluid collection surrounding the ovary and an ipsilateral enlarged ovary (83.9%). Presenting symptoms were similar to those of tubal pregnancies. Before 1997, wedge resection was done mostly by laparotomy (15/16 cases, 93.8 %) and from then on by laparoscopy (8/14 cases, 57.1%). CONCLUSION: Ovarian pregnancy should be suspected in young woman with symptom of lower abdominal pain, history of pelvic adhesion and sonographic finding of fluid collection around ovary or enlarged ovary for an early diagnosis. Early diagnosis and management can preserve fertility and ovarian function.

The comparison of beta-hCG levels according to treatment modalities in tubal pregnancy / 대한주산의학회잡지

OBJECTIVE: The aims of this study were to evaluate the effect of the methotrexate (MTX) method by comparing the change of the serum beta-hCG level between the MTX method and salpingectomy for treating tubal pregnancy, furthermore by analyzing differences between the MTX success group and the failure group, and to provide helps in establishing criteria for choosing the MTX method. METHODS: Medical records of the 118 patients who were diagnosed with tubal pregnancy were reviewed retrospectively for the period of January 2006 to December 2007 at Kangnam St. Marys Hospital. RESULTS: Between the MTX success group and the failure group, no difference was observed in pregnancy duration, but statistically significant differences were observed in the size of hematoma and the quantity of hemoperitoneum at the site of tubal pregnancy in ultrasonography and in the serum beta-hCG level (p<0.05). Compared with salpingectomy, the MTX method showed the patterns of a low decrease rate of serum beta-hCG level after treatment and even its increase during the early period of treatment, but the serum beta-hCG level decreased rapidly from Day 7 after treatment and became equal to that of salpingectomy on Day 28 after treatment. CONCLUSION: The size of hematoma and the quantity of hemoperitoneum at the site of tubal pregnancy and the serum beta-hCG level before treatment are important factors for success in the MTX method. The MTX method may be safe and effective relatively in hemodynamically stable tubal pregnancy patients, who need preserve the salpinx particularly.

Ovarian malignancy in pregnancy: Experience for 17 years / 대한주산의학회잡지

OBJECTIVE: The aim of this study was to evaluate the clinical course and pregnancy outcome in patients who had ovarian cancer diagnosed during pregnancy. METHODS: Review of medical records of 10 cases of patients who have ovarian cancer diagnosed during pregnancy at three affiliated hospitals in the Catholic Medical Center from January 1991 to December 2007 was done. RESULTS: Among 10 cases diagnosed as ovarian cancer during pregnancy, six cases were in the first trimester, one case in the second trimester, and 3 cases in the third trimester. Six cases did not show any specific symptoms at diagnosis and seven cases showed malignant characteristics on ultrasonography. Pathologic evaluation showed 2 clear cell tumors in stage IIIb and Ia, 1 germ cell tumor in Ic, 1 immature teratoma in Ic, and 2 serous adenocarcinoma in Ic and Ic, 2 borderline serous adenocarcinoma, and 2 borderline mucinous adenocarcinoma. Three cases with epithelial ovarian cancer in stage I did not receive chemotherapy. Two cases in non-epithelial ovarian malignancy and 1 stage IIIb epithelial ovarian cancer received chemotherapy. In one case, chemotherapy was performed during pregnancy and a healthy child was delivered. Five in 10 cases were lost in long term follow-up and 5 cases including stage IIIb case, remain without evidence of recurrent disease. CONCLUSION: If early diagnosis and treatment are performed, ovarian cancer diagnosed during pregnancy has favorable prognosis. So, delay the treatment of ovarian cancer due to pregnancy should not be permitted and proper chemotherapy during pregnancy should be considered if necessary.

Clinical course and obstetrical outcomes of 94 pregnancies in Korean patients with systemic lupus erythematosus (SLE) / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to assess the maternal and fetal outcomes in pregnant women with systemic lupus erythematosus (SLE) and to evaluate clinical and laboratory markers for preterm birth and lupus flares. METHODS: 94 pregnancies of 60 patients were retrospectively evaluated from Jan 1997 to Sep 2004. We used clinical and laboratory data from the medical records and statistics analysis by Chi-square test, using SPSS 15.0 V. RESULTS: Pregnancy resulted in 74 (78.7%) live births, 11 (11.7%) spontaneous abortions, 2 (2.1%) therapeutic abortion, and 4 (4.2%) stillbirths. Thirty-seven cases (47.4%) were delivered by cesarean section. Obstetric complications included 17.9% of preterm births, 26.9% of preeclampsia, and 20.5% of IUGR. There were 31 (39.7%) uncomplicated cases among the pregnancies over 20 gestational weeks. There were 12 of transient neonatal lupus, 2 of neonatal death due to prematurity, and 51 of normal births. Low C4, myocarditis, pleural effusion prior to pregnancy, activity at conception, antiphospholipid antibody syndrome were significantly associated with preterm birth. The maternal long-term effect of pregnancy was poor, because 44.7% were in deterioration of cardiovascular, hematologic or renal function after delivery. Lupus nephritis, proteinuria, hematuria, and activity at conception were significantly associated with lupus flare during pregnancy. CONCLUSION: Pregnant women with active SLE at conception should be intensively monitored with maternal and fetal surveillance. It is essential to control disease activity during pregnancy. However, adequate pregnancy follow-up and delivery care by multidisciplinary effort with experience in management of patients with SLE resulted in a better outcome of lupus pregnancy.

Differential gene expression of transglutaminase 2 in term pregnancy with and without labor / 대한산부인과학회지

OBJECTIVE: Our purpose was to investigate transglutaminase 2 (TGM2) mRNA and protein expressions in term placentas and fetal membranes delivered with labor compared to no labor. METHODS: Samples were obtained from five cases delivered with labor and five cases delivered without labor after 38 weeks of gestation. Each sample was collected from amnion, chorion, central and peripheral portion of the basal plate of placenta. Real time polymerase chain reaction (RT-PCR) was done to analyze mRNA expression of TGM2. Western blot was done and TGM2 protein level was detected. Mann-Whitney U test was used for statistic analysis. RESULTS: In labor group, TGM2 mRNA expressions were decreased compared to no labor group in 3 sampling sites except chorion (0.66+/-0.10 vs 1.29+/-0.12 in peripheral placenta, 0.67+/-0.23 vs 1.02+/-0.02 in central placenta, 0.70+/-0.16 vs 1.04+/-0.05 in amnion in contrast with 1.62+/-0.64 vs 1.56+/-0.21 in chorion). TGM2 protein expressions of four differential portions were decreased in all labor groups (1.05+/-0.35 vs 1.27+/-0.19 in peripheral placenta, 0.69+/-0.84 vs 0.84+/-0.31 in central placenta, 0.33+/-0.15 vs 0.39+/-0.33 in amnion, 0.96+/-0.18 vs 1.77+/-0.61 in chorion). CONCLUSIONS: This result suggests that TGM2 might involve in labor progress of term pregnancy.

A Case of congenital hydrocephalus associated with fetal intraventricular hemorrhage / 대한주산의학회잡지

Intraventricular hemorrhage is common in premature infants, and post-hemorrhagic hydrocephalus may follow. Rarely, intraventricular hemorrhage can occur in utero and may lead to congenital hydrocephalus. In most cases no underlying disease is identified. The fetus may be compromised by intrauterine hypoxia leading to hemorrhage. Fetal hydrocephalus can be identified by ultrasonography, but the hemorrhagic lesion can be identified with high sensitivity by magnetic resonance imaging. There are neurologic deficit in neonate with fetal hydrocephalus. Early surgical treatment is recommended for neurodevelopmental outcome. We experienced a case of congenital hydrocephalus associated with fetal intraventricular hemorrhage in our hospital. We report the case with a brief review of the literature.

Gestational trophoblastic disease in a patient with twin pregnancy consisting of complete hydatidiform mole and co-existing live fetus after in vitro fertilization / 대한산부인과학회지

A 45-year-old, multigravida woman who had been pregnant with dichorionic twins after in vitro fertilization (IVF) was referred due to early onset of severe preeclampsia. Ultrasonographic findings were multicystic tumor and normal placenta with a live fetus appropriate for 14 weeks of gestation. After therapeutic abortion, the multicystic tumor showed hydropic feature. The fetus had no anomalous finding. Histopathologic analysis revealed complete hydatidiform mole and normal placental tissue attaching three vesseled umbilical cord. Gestational trophoblastic disease (GTD) was diagnosed due to rising levels of serial beta-hCG values and abnormal sonographic findings. The patient treated with combined chemotherapy. We report a case of a complete hydatidiform mole and coexisting normal live fetus after IVF, which was complicated with early onset severe preeclampsia and persistent GTD.

Significance of prenatal radiologic diagnosis of the central nervous system anomalies / 대한주산의학회잡지

OBJECTIVE: The present study compared the findings of ultrasonography and MRI in the prenatal diagnosis of congenital central nervous system anomalies and identified the merits of MRI. METHODS: We retrospectively analyzed the medical records of neonates diagnosed with congenital central nervous system anomaly after birth born at the Department of Obstetrics and Gynecology in Kangnam St. Marys Hospital during the period from January 1997 to April 2008, and compared the findings of prenatal ultrasonography and MRI with the results of postnatal diagnosis. RESULTS: There were a total of 13 neonates postnatally diagnosed with congenital central nervous system anomaly, and 6 of them had prenatal MRI. Among them, ventriculomegaly and hydrocephalus were observed in 3 cases, arachnoid cyst in 2 cases, and megacisterna magna in 1 case. Supplementary information was available for all the 6 cases, and diagnosis based on the supplementary information was closer to postnatal diagnosis. CONCLUSION: In fetuses in which congenital central nervous system anomaly is observed in ultrasonography, prenatal MRI can provide supplementary information and enable more accurate diagnosis. This can be helpful in counseling the guardians and deciding treatment modality.

Comparative study between pregnancies with and without hypertensive disorders in placental abruption / 대한주산의학회잡지

OBJECTIVE: The aim of this study was to compare the clinical characteristics of placental abruption according to the presence or absence of hypertensive disorders in pregnancy. METHODS: The retrospective analysis was performed in total 363 cases of placental abruption among 25,895 deliveries during 5 years from January, 2003 to December, 2007 in 8 hospitals of Catholic university in Korea. Maternal characteristics and neonatal outcomes were compared with parametric test. RESULTS: The incidence of placental abruption was 1.40% during the study period. The proportion of patients complicated with hypertensive disorders was 33.1%. There was no difference in maternal age and the number of previous pregnancy between two groups with or without hypertensive disorders. As expected, mean gestational age at delivery was lower in placental abruption with hypertensive disorders compared to those without the diseases (237.1 days vs 239.1 days). The incidence of abnormal fetal presentation, multiple gestation, PPROM, and polyhydramnios were more common in patients with placental abruption without hypertensive disorders. On the other hand, the incidence of maternal thrombophilia was significantly higher in patients with placental abruption with hypertensive disorders. The patients with placental abruption with hypertensive disorders had higher incidence of abdominal pain, fetal distress, uterine contraction, and uterine hypertonus (p<0.05). In terms of maternal complication, the patients with placental abruption with hypertensive disorders had more severe complications including shock, coagulopathy and renal failure (p<0.05) and had worse perinatal outcome including FDIU (fetal death in uterus) and neonatal death (10.8% vs 10.3%). CONCLUSION: In patients with placental abruption with hypertensive disorders in pregnancy, maternal complications were more common and prenatal outcome was worse compared to patients with placental abruption without hypertensive disorders.

Expression of Tissue Tissue-transglutaminase-2 (TGM2) and Cyclo-oxygenase (COX) in the Fetal Membrane of Preterm Birth / 대한주산의학회잡지

BACKGROUND: Preterm labor accounts for one third of preterm deliveries. However, the causes and the mechanism of preterm labor are still under investigation. The purpose of this study was to investigate the changes of tissue transglutaminase 2 (TGM2) and cyclo-oxigenase I,II in the fetal membrane of patients with preterm birth compared with patients with term delivery. METHODS: Fetal membrane were obtained from women with preterm birth due to preterm labor (n=3) and from the women with term delivery (n=3) after each vaginal birth. The expression of TGM2, COX I & II were assessed by RT-PCR and immunoblotting analysis of the amnion and chorion. Nonparametric statistics were used for analysis. RESULTS: In the amnion in patients with preterm delivery, the expression of TGM2, COX I and COX II mRNA were increased by 2.3-fold, 2.7-fold, 1.3-fold, respectively, compared to term delivery with labor. The protein expression of TGM2 and COX I in these patients was increased in 1.9-fold and 2.1-fold but COX II protein expression showed no significant change, compared to term delivery with labor. In the chorion in patients with preterm delivery, the expression of TGM2, COX I and COX II mRNA showed no significant change, compared to term delivery with labor, but the protein concentration was significantly increased in 14.6-fold, 1.4-fold and 1.3-fold respectively, compared to term delivery with labor. CONCLUSION: This study shows that TMG2 and COX I are expressed more in the fetal membrane at preterm delivery caused by preterm labor, compared to term delivery with labor. These data suggests that the mechanism of preterm labor might be different form term labor.

Restrictive Dermopathy In Two Siblings

Restrictive dermopathy (RD) is a rare and lethal autosomal recessive skin disorder that presents with rigid and tense skin, multiple joint contractures and fixed facial expression. We report herein two siblings from consecutive pregnancies affected with RD. Both siblings died of respiratory insufficiency at a day after birth. An autopsy for the first baby and a skin necropsy for the second baby were performed. The gross findings of both were characterized by thin, translucent skin with prominent vessels, multiple joint contractures resulting in hyperflexed position, and a typical facial appearance with a fixed open mouth in the O-position. Such manifestations are typical features of RD. At the autopsy of the first baby, no internal organ abnormality was found. The histologic findings of the skin of the second baby revealed a thin dermis consisting of a flat dermal-epidermal junction, hypoplastic skin appendages and compactly arranged collagen bundles. Elastic tissue stain showed markedly decreased elastic fibers.

The effect of oligohydramnios on the adverse perinatal outcome and clinical characteristics in uncomplicated term pregnancies / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to assess the effect of the isolated oligohydramnios on the perinatal outcome in uncomplicated term pregnancies. METHODS: We used data from Jan 2002 to Dec 2005 in all uncomplicated pregnancies between 37 and 41weeks and 6 days of gestation with a singleton fetus, underwent monitoring with serial determination of AFI. Oligohydramnios was defined by ultrasonographic determination of AFI < or =5 cm. Exclusion criteria were PROM, maternal medical complications and fetal anomalies detected by prenatal ultrasound. We investigated the mode of delivery, birth weight, birth weight <10th percentile, 1 and 5 min Apgar score, umbilical cord pH and base excess, and meconium stained amniotic fluid (MSAF). We also assessed the predictive value of obstetric factors associated with adverse perinatal outcome. We used statistics analysis by Chi-square test, independent-samples T test using SPSS 14.0 V. RESULTS: 2,491 patients met our inclusion criteria. Oligohydramnios was diagnosed in 8.63% (215/2,491). There was significantly difference in cesarean section for fetal distress between those with oligohydramnios vs. normal AFI (43.8% vs.4.1%). Patients with oligohydramnios had significantly lower SGA (15.3% vs. 5.7%), lower Apgar score at 1 min<7 (7.9% vs. 3.3%), and higher rate of MSAF (31.2% vs. 18.4%) than those with normal AFI. There were musculoskeletal abnormalities in 10/215 (4.6%) and urogenital abnomralites in 53/215 (24.6%). CONCLUSION: Isolated oligohydramnios in uncomplicated term pregnancies is associated with an increased adverse perinatal outcome. Nulliparity, advanced maternal age, MSAF, SGA, and lower BPP were significantly associated with the adverse perinatal outcomes.

Maternal-neonatal outcome in HELLP syndrome and severe preeclampsia / 대한산부인과학회지

OBJECTIVE: To assess the clinical characteristics, laboratory findings, the maternal and neonatal complications between HELLP syndrome and severe preeclampsia. METHODS: We reviewed the material and neonatal charts of 34 pregnancies complicated by HELLP syndrome and 40 pregnancies complicated by severe preeclampsia managed at our hospital between January, 2001 and December, 2005. We compared the clinical characteristics, laboratory findings, the maternal and neonatal complications between two groups. Results were compared by student T test, chi-square test. RESULTS: Our study showed that in HELLP syndrome patients had the less gestational age at admission, gestational age at delivery, the lower platelet counts, the higher AST, ALT, LDH, and the longer hospitalization period than in severe preeclampsia. Steroid (dexamethasone) use, cesarean delivery rate and MgSO4 use were more frequent in HELLP syndrome than severe preeclampsia. Neonatal birth weight was lower with HELLP syndrome. There was no significant difference in maternal and neonatal complications. CONCLUSION: HELLP syndrome need to be recognized a unique form of severe preeclampsia. It was associated with serious maternal and fetal mortality, the appropriate management would be done by early diagnosis using laboratory tests.

The significance of maternal serum and umbilical cord blood leptin concentration with intrauterine fetal growth restriction and/or preeclampsia / 대한산부인과학회지

OBJECTIVE: To ascertain whether fetal growth restriction with or without preeclampsia is associated with alteration of leptin concentration in maternal and umbilical cord serum. METHODS: Maternal serum and umbilical cord blood leptin concentrations were determined by ELISA assay in 25 women with singletone pregnancies complicated by fetal growth restriction without preeclampsia (IUGR), in 11 women with singletone pregnancies complicated by fetal growth restriction with preeclampsia (IUGR+PE), in 9 women with singletone pregnancies complicated by preeclampsia without fetal growth restriction (PE), and in 13 women with uncomplicated singletone pregnancies (Control). RESULTS: Maternal weight and BMI before pregnancy and in delivery were significantly different among groups. The lowest weight and BMI before pregnancy and in delivery was group IUGR. Neonatal birth weight was significantly different among groups. The lowest birth weight was group IUGR+PE. Maternal serum leptin concentration and umbilical cord leptin concentration were not significantly different among groups. Maternal serum leptin levels were not significantly correlated with maternal BMI or with neonatal birth weight. Umbilical cord blood leptin levels were significantly correlated with neonatal birth weight. CONCLUSION: Maternal serum leptin concentration and umbilical cord blood leptin levels were independent of presence of preeclampsia and/or IUGR. Umbilical cord blood leptin reflects neonatal birth weight.

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

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

Differential Gene Expression in Placenta of Term Pregnant Women with and without Labor using cDNA Microarray / 대한주산의학회잡지

OBJECTIVE:cDNA microarray technology was used to comprehensively analyze the gene expression in the placenta of term women with labor compared to without labor. METHODS:Placental tissue was obtained from patients in spontaneous labor (n=5) and those not in labor (n=5) during Cesarean section of full term pregnancy. mRNA levels were examined through cDNA microarray using Agilent GeneSpringGX 7.3 (Agilent technology, USA). SPSS 11.0 was used for statistical analysis. RESULTS:Among total 38,467 genes, 2,374 genes were detected to be up-regulated in labor samples, while 12 genes were down-regulated. 40 genes of them were identified as significantly up-regulated in levels of expression (up-regulated > or =5.0 fold, p<0.05). According to gene ontology analysis, they are associated with variable cell biologic functions including apoptosis, signal transduction, metabolic process, immune response, and transcription, etc. CONCLUSION:This study suggests that our results could provide interesting clues to understanding the initiation and the process of normal labor and might lead to further studies in a more targeted fashion.

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

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

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

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