One case of prenatally diagnosed vasa previa accompanied by succenturiate placenta / 대한산부인과학회지

Vasa previa is said to occur when fetal vessels, unsupported by placenta or umbilical cord, transverse the menbranes over the cervix, below the presenting part. It is typically caused by velamentous insertion of the umbilical cord with fetal vessels between the cervix and presenting part. Bilobed or succenturiate placentas also can be associated with aberrant vasculature over the internal cervical os. Vasa previa has an incidence of approximately one per 2,000-5,000 deliveries. It has a high fetal mortality due to fetal exsanguination resulting from fetal vessels tearing when the menbranes rupture. So Prenatal detection of vasa previa is very important. We believe transvaginal ultrasound in combination with color Doppler is the most effective tool in the antenatal diagnosis of vasa previa. Recently, we experienced one case of vasa previa accompanied by succenturiate placenta diagnosed prenatally by color Doppler and transvaginal sonography. Here we report our experience with a literature review.

Interleukin-6, tumor necrosis factor-alpha, and antioxidant levels in the umbilical venous plasma of preeclampsia / 대한산부인과학회지

OBJECTIVE: Our purpose was to investigate Interleukin-6 (IL-6), tumor necrotic factor-alpha (TNF-alpha), lipid peroxide levels, oxygen-radical absorbance capacity (ORAC), and antioxidant levels in umbilical venous blood plasma and to evaluate the roles of them in the pathophysiology of preeclampsia. STUDY DESIGN: Samples of umbilical venous plasma were obtained from 20 normal and 20 preeclamptic women between 33 and 40 weeks gestation. IL-6 and TNF-alpha was assayed by an enzyme-linked immunoassay. Lipid peroxide levels were measured by thiobarbituric acid reaction. The ORAC values were measured by Cao's method. Ascorbic acid, retinol, alpha-tocopherol, and gamma-tocopherol were measured by high performance liquid chromatography. RESULTS: There was no significant differences of IL-6 levels in umbilical venous plasma between women with normal and preeclampsia (2.79+/-0.21 vs. 2.94+/-0.17 ng/ml). TNF-alpha levels in umbilical venous plasma of women with preeclampsia were significantly higher than that of women with preeclampsia (3.04+/-0.01 vs. 1.40+/-0.01 ng/ml, p<0.01). Lipid peroxide levels in umbilical venous plasma of women with preeclampsia were significantly higher than that of women with normal pregnancy (7.32+/-0.09 vs. 5.18+/-0.14, p<0.01). The ORAC values in umbilical venous plasma of women with preeclampsia were significantly lower than that of women with normal pregnancy (12,836.5+/-249.4 vs. 10,490.2+/-276.9 U/ml, p<0.05). Ascorbic acid levels in umbilical venous plasma of women with preeclampsia were significantly lower than those of women with normal pregnancy (320.2+/-48.5 vs. 538.5+/-68.2 nmol/ml, p<0.05). CONCLUSION: The above results in umbilical venous plasma suggest that the imbalance of lipid peroxidation and antioxidant activity in placenta is involved in the pathophysiology of preeclampsia. Increased TNF-alpha in the umbilical venous plasma showed inflammatory reaction in the placenta would be one of the cause of preclampsia. An antioxidant vitamin, ascorbic acid, may act an important antioxidant factor in preeclampsia.

Significance of morphologic score and vascular index in the diagnosis of ovarian malignancy using ultrasonography / 대한산부인과학회지

OBJECTIVE: The aim of this study was to know whether we can distinguish benign from malignant ovarian tumors according to morphologic scoring system (MS), blood flow characteristics (Resistance index (RI), Pulsatility index (PI)) using color doppler sonography and a combination of both in patients undergoing laparotomy or laparoscopy for a clinically diagnosed ovarian mass. METHODS: From January 2001 to December 2003, 99 patients with ovarian tumors scheduled for laparotomy or laparoscopy were studied at our institute. Ultrasound was carried out to study the ovarian morphology followed by color doppler sonography. A score of > or =9 on MS, a PI or =9 on MS as indicative of malignancy was associated with the following statistical parameters: sensitivity 69.6%, specificity 69.8%, positive predictive value (PPV) 75.0%, negative predictive value (NPV) 63.8%. A mean score of malignant tumor (9.8+/-2.64) is significantly higher than that of benign tumor (7.5+/-2.44). This was statistically significant (p[t]<0.05). A resistance index (RI) < or =0.4 was associated with sensitivity 19.6%, specificity 97.6%, PPV 91.6%, NPV 48.2%. A pulsatility index (PI) < or =1.0 was associated with sensitivity 44.6%, specificity 81.3%, PPV 75.7%, NPV 53.0%. A mean of RI in malignancy (0.64+/-0.277) is lower than that of RI in benign tumor (0.79+/-0.299). A mean of PI in malignancy (1.34+/-0.982) is lower than that of PI in benign tumor (2.06+/-1.310). These was statistically significant (p[t]<0.05). The addition of RI or PI to MS did not improve the accuracy in predicting ovarian malignancy. CONCLUSION: Although RI or PI achieved better specificity and PPV compared to MS, the addition of RI or PI to MS did not increase its accuracy in the discrimination between benign and malignant ovarian tumors.