The Clinical Study on the Incidence Rate and Cause of the Preterm Births / 대한주산의학회잡지

OBJECTIVE: The aim of study was to compare incidence rate and causes of the preterm birth that are the major factor of newborn mortality and morbidity. METHODS: Respectively there were 428 preterm deliveries out of 5,309 deliveries, from January to August 1995, and there were 319 preterm deliveries out of 2,028 deliveries, from January to August 2000 at Gill hospital, a hospital in affiliation with Gachon Medical School. The data were collected by review of the hospital record and the statistical analysis was performed using paired T-tests, Oneway ANOVA, Fisher's exact test, and statistics significance was defined as p<0.05. RESULTS: The incidence rate of the preterm birth increased from 8.1%(428/5,309) in 1995 to 15.7%(319/2,028) in 2000. Unknown causes of preterm birth decreased from 25.5%(109) to 20.2%(66). PPROM(Preterm premature rupture of the membranes) decreased from 26.9%(115) to 22.9%(73). IIOC(Incompetent internal os of cervix) decreased from 9.7%(41) to 6.9%(22). Uterine anomaly decreased from 1.6%(7) to 1.0%(3). And other causes deceased from 8.9%(38) to 5.1%(16). Multiple pregnancy increased from 10.1%(44) to 17.6%(56). Fetal anomaly increased from 2.1%(9) to 6.3%(20). Pregnancy induced hypertension increased from 7.9%(34) to 13.3%(42). There was not much change for the placental disorder or for placental abruption which decreased from 7.3%(31) to 6.7%(21). According to the analysis, there is a noticeable decrement in IIOC but noticeable increase in multiple pregnancy, fetal anomaly and PIH. CONCLUSION: Comparing the data from the preterm birth of 1995 and 2000, the unknown cause of the preterm birth is understood more accordingly to the decrement of known cause. The increase of multiple pregnancy seems to be caused by better in vitro fertilization. The increase of fetal anomaly is most likely caused by drug abuse, environmental pollution, and prenatal diagnosis. Differ from the decrease of previous research, the increase of PIH is caused by the increase of incidence of the preterm birth and also patients moving from private hospital to 3rd party hospital. We hope that we can continuously research the cause of the preterm birth and use that basic information to decrease the death and disease rates of newborn infants

A Case of Congenital Neuroblastoma Detected by Prenatal Ultrasonography / 대한주산의학회잡지

The increasingly common use of obstetrical sonography has led to a growing number of prenatally diagnosed neuroblastomas. The two most important factors in the prognosis of clinical neuroblastoma are the age of the patient at diagnosis and the stage of the disease. Patients with disease at an earlier stage and well-differentiated tumors have a better prognosis than those with disease at a more advanced stage and poorly differentiated tumors. We have experienced a case of congenital neuroblastoma that was recognized prenatally by ultrasonography and identified as stage IV disease postnatally. We report the case with brief review of related literatures.

Birthweight and growth discordancy in twin pregnancies according to the type of placenta and the portion of umbilical cord insertion / 대한산부인과학회잡지

OBJECTIVE: To investigate the effect of the type of placenta and the portion of umbilical cord insertion on birthweight and growth discordancy in twin pregnancies. METHODS: We selected 120 twins of 146 multiple pregnancies between March, 2000 and March, 2002, and one fetus of all cases at least weighed 500 g or more and over 24 weeks of gestation. The fetuses were included that 44 twins (88 fetuses) had monochorionic placentas and the 76 twins (152 fetuses) had dichorionic placentas. The dichorionic twins were divided into two groups; one (38 twins, 76 fetuses) showed the fused type of placenta and the other (38 twins, 76 fetuses) showed the separate type of placenta. The types of umbilical cord insertion were also divided into the central portion and the peripheral portion, the peripheral portion was defined within 2 cm of margin of placenta, and included marginal and velamentous insertion of umbilical cord. Stastical analysis were performed with Student t-test and runs test. p<0.05 was defined significantly. RESULTS: 1. The central type of umbilical cord insertion in dichorionic placenta was more frequent than that of monochorionic placenta (p<0.01). 2. The dichorionic infants, regardless the number of placenta, who weighed more than monochorionic infants at birth (p<0.01). 3. Twin pairs with over 25% of growth discordancy were 16 cases (13.3%), which included 9 cases (9/76, 11.8%) of dichorionic placenta and 7 cases (7/44, 15.9%) of monochorionic placenta. The severe growth discordancy was more commonly developed in monochorionic twins than dichorionic twins (p<0.01). 4. Perinatal deaths in twin pairs with over 25% of GD were 12 cases, which included 3 cases (3/18, 16.7%) of dichorions, and 9 cases (9/14, 64.3%) of monochorions. Therefore, perinatal death was showed more commonly in monochorinic twin infants (p<0.01). CONCLUSION: The type of umbilical cord insertion affected the birthweight of dichorionic separated infants. Monochorionic placenta attributed to more severe growth discordancy and increased perinatal death rate than the dichorionic placenta. Antenatal detection of chorionicity and the portion of umbilical cord insertion may improve the perinatal outcome.