Comparison of pregnancy outcomes based on chorionicity between spontaneous and in vitro fertilization twins / 대한산부인과학회지

OBJECTIVE: To compare the pregnancy outcomes of in vitro fertilization (IVF) twins with those of spontaneous twins based on their chorionicities. METHODS: We performed a retrospective analysis of 598 twin pregnancies beyond 24 weeks of gestation delivered from October 1994 to December 2003. Subjects were grouped into the spontaneous group (n=392) and the IVF group (n=206) and then subgrouped into dichorionic (n=193, spontaneous vs. n=156, IVF) and monochorionic (n=154, spontaneous vs. n=34, IVF) subgroups. First, the obstetric and perinatal outcomes were compared between the spontaneous group and the IVF group regardless of their chorionicity. Second, the same outcome variables were compared between the spontaneous and the IVF group with same chorionicity. RESULTS: There was a significant increase in the incidence of preterm deliveries before 37 weeks of gestation in IVF twins (74.5% spontaneous vs. 82.5% IVF, p=0.031). However, the gestational age at delivery was not significantly different (34.5+/-2.86 weeks vs. 34.2+/-0.28 weeks). Antepartum admission was also significantly increased in IVF group (4.6% vs. 9.2%, p<0.001). We were unable to observe any significant difference in perinatal outcomes between the two groups other than increased in utero fetal demise in utero in the IVF group (0.3% vs. 1.5%, p<0.05). When we reanalyzed pregnancy outcomes based on chorionicity, there were more frequent admission to neonatal intensive care unit (42.7% vs. 52.6%, p<0.05) and necrotizing enterocolitis (0.5% vs. 3.5%, p<0.05) in dichorionic twins of the IVF group. In monochorionic twins, the incidence of placenta previa was increased in the IVF twin group (0% vs. 11.8%, p<0.001). CONCLUSION: In the IVF twins, the incidence of placenta previa was increased in monochrionic twins and the incidence of neonatal intensive care unit admission and necrotizing enterocolitis were also increased in dichorionic twins.

Subcellular localization of nuclear factor kappa B in term human fetal membranes and myometrium during labor / 대한산부인과학회지

OBJECTIVE: To investigate the subcellular localization of nuclear factor kappa B (NF-kappa B) in term human fetal membranes and myometrium during labor. METHODS: Fetal membranes and myometrial tissue were collected from term pregnant women undergoing cesarean delivery after labor (n=4) and before labor (n=4). An immunostaining was done with NF-kappa B p65 antibody. The intensity and distribution of nuclear immunostaining of NF-kappa B p65 subunit were evaluated visually using a semiquantitative analysis. RESULTS: NF-kappa B p65 was present in all tissues studied, and it was localized principally in the cytoplasm of cells of amnion and chorion. But, NF-kappa B p65 was localized more abundant in the nucleus than in the cytoplasm in myometrial cells. In amnion, chorion and myometrium, the staining scores of nuclear NF-kappa B did not show any difference between the after-labor group and before-labor group. CONCLUSION: In human term gestational tissues, subcellular localization of NF-kappa B showed cytoplasmic predominance in amnion and chorion, and nuclear predominance in myometrium. But these subcellular localizations did not change during labor.

Clinical Applicability of Absorbable Synthetic Suture Materials (Safil(R)/Safil(R) Quick/Monosyn(R)) in Obstetrical Surgeries / 대한주산의학회잡지

OBJECTIVE: To evaluate the clinical applicability and safety of absorbable synthetic suture materials (Safil(R)/Safil(R)Quick/Monosyn(R)) in obstetrical surgeries. METHODS: This clinical trial includes 100 patients who delivered vaginally and 198 patients who were undergone cesarean section from April 2004 to September 2004. In cases of vaginal delivery, patients were divided with the same number into the study group in which Safil(R) Quick was used and the control group in which chromic catgut was used for episiotomy and perineal laceration repair. In case of cesarean delivery, patients were divided into two groups. The first group which included 100 patients was subdivided with the same number into the study group in which Monosyn(R) was used and the control group in which chromic catgut was used for uterine repair. The second group which included 98 patients was subdivided with the same number into the study group in which Safil(R) was used and the control group in which Vicryl was used for rectus fascia repair. Wound healing status and complications are assessed during postoperative stage, at hospital discharge, and at postpartum out-patients follow-up. RESULTS: Compared with chromic catgut groups, Safil(R) Quick group showed no difference in hospital stay from vaginal delivery, wound healing status and surgical complications and Monosyn(R) group showed no difference in operating time, decrease in hemoglobin at postoperative day 3 and surgical complications. Safil(R) group showed no difference in operating time, postoperative pain and surgical complications compared with Vicryl group. CONCLUSION: Safil(R)/Safil(R) Quick/Monosyn(R) were equivalent with regard to most aspects of their clinical suitability and may be useful alternative suture materials in obstetrical surgeries.

A Case of Cloacal Anomaly with Multiple Associated Anomalies / 대한산부인과학회잡지

Cloacal anomaly is an extremely rare congenital malformation results from a failure in the development of the urorectal fold that separates the rectum from uterovaginal tract. It is characterized by the presence of a single duct where the gastrointestinal, genital and urinary tracts join. It presents with highly variable forms, which make it difficult to be diagnosed antenatally. We report a case of cloacal anomaly confirmed with autopsy, which was initially detected by the presence of a huge cystic fetal abdominal mass by ultrasound at a 22 weeks of gestation.

A Case of Primary Endometrial Squamous Cell Carcinoma / 대한산부인과학회잡지

Primary squamous cell carcinoma of the endometrium is very rare. In 1928 Flumann suggested three criteria for diagnosis: (1) no coexisting endometrial adenocarcinoma, (2) no connection between the endometrial squamous cell carcinoma and squamous epithelium of the cervix, and (3) no cervical squamous cell carcinoma. In 1975, the World Health Organization (WHO) updated Flumann's criteria by adding that the tumor must contain clear evidence of squamous differentiation, such as the presence of intercellular bridges and/or keratin. Most patients with endometrial squmamous cell carcinoma have had poor prognosis regardless of their stages of disease or treatment. In this report we present the clinical and pathological findings of a case of a primary squamous cell carcinoma that developed in the endometrial cavity of a 65-year-old patient with a review of the concerned literatures.