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Objective@#Isotretinoin should not be used during pregnancy because of the risk of birth defects. Most pregnant women exposed to isotretinoin choose voluntary pregnancy termination due to concerns about birth defects. However, birth outcome data supporting the termination of pregnancy are lacking. This study aimed to evaluate pregnancy and neonatal outcomes after periconception exposure to isotretinoin. @*Methods@#This was a prospective cohort study. We evaluated pregnancy and neonatal outcomes after exposure to isotretinoin in 151 pregnant women. Among 1,026 callers at the Korean Teratology Information Service from 2001 to 2017 exposed to isotretinoin during the periconception period, 151 pregnant women who received counseling on teratogenic risk after visiting the clinic were included. @*Results@#Among the 151 participants who visited the clinic, only 42 were evaluated using ultrasonography until approximately 20 weeks of gestation. Ultimately, 23 patients were included in the study. The average gestation period during the last exposure to the drug was 2 weeks, and the average daily exposure dose was 12 mg. There were two cases of major birth defects in the exposure group. Spontaneous abortion rates were 17.7% and 8.7% in the exposure and nonexposure groups, respectively (P=0.035). There was no significant difference between the exposure and non-exposure groups in terms of pregnancy and neonatal outcomes. @*Conclusion@#There was no significant difference in pregnancy and neonatal outcomes, including birth defects, between the exposure and non-exposure groups. Further studies with larger sample sizes are required to validate our findings.
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Objective@#Isotretinoin is among the most notorious human teratogens, documented originally as causing up to 30% of malformations. This systematic review and meta-analysis aimed to evaluate the rates of major malformation (MM) among isotretinoin-exposed pregnant women over the years through a systematic review and meta-analysis. @*Methods@#Eligible studies were searched and identified using various databases. Single-arm meta-analysis and meta-analysis of odd ratios among controlled studies were performed using Review Manager version 5.3. @*Results@#Ten eligible studies that combined 2,783 isotretinoin-exposed women were included in our study. The rate of MM weighted for the sample size was 15%. Three studies that included an unexposed comparison group were eligible for the meta-analysis. The pooled odds ratio of MM for isotretinoin-exposed women was 3.76. After 2006, the pooled odds ratio of MM for isotretinoin exposure was significantly lower at 1.04. @*Conclusion@#The current rate of MM in isotretinoin-exposed women was substantially lower after 2006.
ABSTRACT
Objective@#Isotretinoin is among the most notorious human teratogens, documented originally as causing up to 30% of malformations. This systematic review and meta-analysis aimed to evaluate the rates of major malformation (MM) among isotretinoin-exposed pregnant women over the years through a systematic review and meta-analysis. @*Methods@#Eligible studies were searched and identified using various databases. Single-arm meta-analysis and meta-analysis of odd ratios among controlled studies were performed using Review Manager version 5.3. @*Results@#Ten eligible studies that combined 2,783 isotretinoin-exposed women were included in our study. The rate of MM weighted for the sample size was 15%. Three studies that included an unexposed comparison group were eligible for the meta-analysis. The pooled odds ratio of MM for isotretinoin-exposed women was 3.76. After 2006, the pooled odds ratio of MM for isotretinoin exposure was significantly lower at 1.04. @*Conclusion@#The current rate of MM in isotretinoin-exposed women was substantially lower after 2006.
ABSTRACT
Community-based preconception care for men and women of childbearing age has been introduced in Seoul. The program aims to focus on problem areas such as low birth rate, fertility issues potentially due to late marriages, preterm or premature births, and low-birthweight in newborn babies. The district administration officials of Seoul, as well as, academics from the Korean Society of Maternal and Child Health, developed a protocol by using a questionnaire and laboratory test for screening risk factors in pregnancy. The protocol was tested on a trial basis in four local districts in Seoul from July 2017 to 2018, extended to 12 local districts in 2019, and all 25 districts in Seoul in 2020. The protocol includes AntiMullerian Hormone tests to assess women’s ovarian reserve and male health checkups that include semen analysis and physical examinations of genitalia. These tests are conducted for early detection and treatment of infertility, especially in cases of late marriages. In order to prevent women being abandoned during pregnancy (leading them to single-parenting), the protocol also emphasizes building a gender-sen sitive environment by encouraging more male participation. A monitoring group comprised of Seoul city district officials and academics from the Korean Society of Maternal and Child Health, regularly visited the local districts to observe improvements and keep the program officials up to date. In addition, the group also conducted a mobile phone survey for feedback on the program. The interest and support of the resi dents in Seoul city, and positive results and development in pregnancy care and childbirth, are needed to stabilize and extend this protocol.
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PURPOSE@#The purpose of this report is to organize the history of Korean Mothersafe, a professional teratology information center. Throughout its domestic and international activities, Mothersafe has firm role to write journals and books, to provide counseling, to run educational courses on maternal and fetal toxicology, and so on. This paper delineates the achievements in last ten years and discusses the vision of Mothersafe.@*METHODS@#In order to formulate the accomplishments of Korean Mothersafe, the volume of counseling calls are carefully reviewed by their contents, counselees, and the consultation results, etc. Textbooks and journals based on the data from Mothersafe are evaluated. Other roles of the Mothersafe, such as hosting symposium and running public programs are also noted.@*RESULTS@#Korean Mothersafe provided 76,555 counseling to 45,933 expectant women and 30,622 breast-feeding women. The database has total 52,130 enrollments from 2010 to 2019. A total of 33 papers are published regarding medication, alcohol, smoking, radiation, etc. A specialized book on maternal-fetal toxicology was published and teratology part of obstetrics textbook was updated. Education programs and symposiums were held and primary care programs for expectant parents are run by Mothersafe.@*CONCLUSION@#Korean Mothersafe has contributed to safe environments for numerous pregnant and breast-feeding women regarding medication, drinking, smoking, and other hazardous substances. The huge database provided evidence for researches, textbooks and seminars, etc. Korean Mothersafe is now facing a new challenge to go forward through social dynamics with many issues regarding prevention and continuance of pregnancy, abortion, and so on.
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PURPOSE: The purpose of this study is to clarify the relevance of breastfeeding and its preventive effect on maternal hypertension as well as to evaluate the theoretical mechanism behind of it through systematic evaluation of existing articles. METHODS: For systematic evaluation of literatures in recent 5 years, 5 most suitable articles were selected with the key words, (breastfeeding or breastfeed or lactation) AND (hypertension or high blood pressure or hypertensive disorders) from PubMed, EMBASE, and Cochran Library, and carefully reviewed by 2 researchers. RESULTS: Breastfeeding women have less frequently developed hypertension in their later life. Depending on the duration of breastfeeding, compared to nonbreastfeeding women, breastfeeding women's odds ratio for developing hypertension are 0.87 (95% confidence interval [CI], 0.76–0.99), 0.83 (95% CI, 0.68–1.00), and 0.79 (95% CI, 0.65–0.97) each for 0–6 months, 6–12 months, and greater than 12 months of breastfeeding. As the number of breastfeeding children increases, the incidence of maternal hypertension decreases. In addition, both partial and exclusive breastfeeding lower the risk of developing maternal hypertension. Though the mechanism of prophylactic effect of breastfeeding on hypertension is not conclusive, reset hypothesis, oxytocin release, the increase of ghrelin and protein peptide YY, as well as epigenetic programming are considered to be relevant to the etiology of the condition. CONCLUSION: Breastfeeding prevents maternal hypertension later in life. Studies show dose-response relationship of breastfeeding as the duration matters. In addition, both partial and exclusive breastfeeding have preventive effect on maternal hypertension. Numerous mechanisms are continuously being reported and further studies are needed for clarification.
Subject(s)
Child , Female , Humans , Breast Feeding , Epigenomics , Ghrelin , Hypertension , Incidence , Odds Ratio , Oxytocin , Peptide YYABSTRACT
OBJECTIVE: The purpose of this study was to determine the efficacy of the AMPLICOR HPV test in comparison with the Hybrid Capture 2 (HC2) test in detecting HR HPV. METHODS: One hundred and fifty-three consecutive women attending the Colposcopy Clinic were included and cervical scrape specimens were tested for the presence of 13 HR HPV genotypes by both AMPLICOR HPV test and HC2 assay. RESULTS: The prevalence of HR HPV was 53/153 (34.6%) and 52/153 (34.0%) by AMPLICOR HPV test and HC2 assay, respectively. When discordant results were observed between AMPLICOR HPV test and HC2 assay, we used the HPV genotyping DNA chip and DNA sequence analysis, as reference standards. Concordant results were obtained for 128 (83.7%) of the 153 samples (Cohen's kappa=0.63, p<0.001). The genotyping showed that no HR HPV was detected in the 10 AMPLICOR negative HC2 positive samples, while HR HPV genotype was found in 3/13 (23.1%) AMPLICOR positive HC2 negative samples. The detection rates of HR HPV with AMPLICOR HPV test and HC2 assay were 38.7% and 48.4%, respectively, in CIN1; 95.0% and 100%, respectively, in CIN3/cancer. HPV positivity of AMPLICOR HPV test and HC2 assay increased linearly with the increasing grade of cytology or histology (p<0.001). In detecting high grade (CIN2+) lesions, sensitivities were 90.9% (CI, 75.9~97.0%), 95.5% (CI, 81.9~99.0%), respectively, for AMPLICOR HPV test and HC2 assay (p=1.00). The specificities of AMPLICOR HPV test and HC2 assay were 72.7% (CI, 64.3~79.8%) and 69.3% (CI, 60.7~76.7%), respectively (p=0.75). CONCLUSIONS: AMPLICOR HPV test is comparable to HC2 assay for detection of HR HPV, with similar sensitivity and specificity in detecting CIN2+ lesions. AMPLICOR HPV test can be considered clinically useful for detection of HR HPV. However, more data are clearly needed on the performance of AMPLICOR HPV test as a screening tool.
Subject(s)
Female , Humans , Chimera , Colposcopy , Genotype , Mass Screening , Oligonucleotide Array Sequence Analysis , Prevalence , Sensitivity and Specificity , Sequence Analysis, DNAABSTRACT
Liposarcoma is one of the most common soft tissue sarcoma of adults and accounts for 1% in all malignant neoplasm. A liposarcoma of perineal origin is excessively rare, and preoperative diagnosis is difficult. Perineal liposarcoma was diagnosed in a 38-year-old woman. She presented with a large soft lump in the both perineal region of 4 months duration. We report a case of a liposarcoma on perineum which was treated with complete surgical resection without adjuvant radiation therapy. The patient has survived 2 years with no evidence of a recurrence.
Subject(s)
Adult , Female , Humans , Diagnosis , Liposarcoma , Perineum , Recurrence , SarcomaABSTRACT
OBJECTIVE: This study is designed to help pregnancy and delivery of mid-teenager mothers by analyzing the clinical features of pregnancy and delivery of mid-teenager mothers ranging from 13 to 16 years old. METHODS: This study includes 77 mothers aged 16 years and younger among the 3,863 mothers who delivered in our hospital from January 1998 to December 2005. We selected 100 mothers who aged between 17 and 19 years, 100 mothers who aged between 20 and 29 years as control groups respectively during the same period and statistical analysis is applied to compare the results. RESULTS: In this study, mid-teenagers constitutes 1.99% of all pregnant women. The number of antenatal care, the number of women experienced abortion, and age of menarche were significantly low in the mid-teenager mothers. Especially, the risks of anemia and meconium staining were significantly higher and the rate of cesarean section was significantly lower than those of the mothers in twenties. The risks of prematurity, low birth weight infant, preterm labor, and birth canal injury were higher than those of control groups, but there were no significant differences in three groups. CONCLUSION: Mid-teenager mothers were known to be high risk mothers in obstetrics due to immaturity in physics and low socioeconomic status. However, the risks can be decreased by adequate prenatal care, sufficient nourishment and maintenance of good habits based on medical and socioeconomic supports.
Subject(s)
Adolescent , Female , Humans , Infant, Newborn , Pregnancy , Anemia , Cesarean Section , Infant, Low Birth Weight , Meconium , Menarche , Mothers , Obstetric Labor, Premature , Obstetrics , Parturition , Pregnant Women , Prenatal Care , Social Class , Statistics as TopicABSTRACT
OBJECTIVE: To find out general characteristics, common problems, outcomes of delivery of unmarried mothers and related social factors, and to provide basic information based on the results in order to change social systems and to have a correct understanding of unmarried mothers. METHODS: We studied 196 unmarried mothers who delivered from Jan. 2003 to Aug. 2004. All data were collected by survey whose groups were divided into three by ages, and they were analyzed by Fisher's exact test obstetrically and socially. It verified 95% significant level. RESULTS: Cesarean section rate was 14.3% which is remarkably lower than married mothers. However, it is getting higher (p=0.003) as they are older, and the rate of group of 30s is similar to that of married mothers. Also, the average birth weight of unmarried mothers' babies is 3,056 gm and it is similar to that of married mothers. They took prenatal care only 3.27 times and 22% of them did not commence it until the 3rd trimester. Fifty seven percent drank alcohols, 51% smoked, and 49% used drugs during pregnancy. Most unmarried mothers who took this survey had a lower level and economic status. After delivery, 16.3% of them raise their babies and 83.7% of them had their babies adopted through welfare facilities. CONCLUSION: We conclude that it is necessary to have a social system, welfare facilities, and financial supports that educate contraceptive measures to potential unmarried mothers, let them recognize their situations, and protect them.
Subject(s)
Female , Humans , Pregnancy , Alcohols , Birth Weight , Cesarean Section , Financial Support , Illegitimacy , Linear Energy Transfer , Mothers , Prenatal Care , Single Person , Smoke , Social WelfareABSTRACT
Granulosa cell tumor is a rare ovarian neoplasm. It's indolent growth leads to large tumor at time of diagnosis. It is characterized by variable and long interval to recurrence in pelvic and peritoneal cavities, but solitary retroperitoneal recurrence is very rare. At laparotomy, a 52-years-old woman was found to have an oval shaped cystic tumor near left renal hilar region. Ten years ago, she had total hysterectomy with bilateral salpingo-oophorectomy due to left ovarian granulosa cell tumor. Histological features of the retroperitoneal tumor were granulosa cell tumor. We report a rare case of solitary retroperitoneal recurrence of granulosa cell tumor with a review of relevant literatures.
Subject(s)
Female , Humans , Diagnosis , Granulosa Cell Tumor , Granulosa Cells , Hysterectomy , Laparotomy , Ovarian Neoplasms , RecurrenceABSTRACT
Complete testicular feminization syndrome (androgen insensitivity syndrome) is the most common form of male pseudohermaphroditism, transmitted by means of maternal X-linked recessive gene. This syndrome is marked by unique combination; Normal female phenotype, normal male karyotype, 46,XY, normal or slightly elevated male blood testosterone levels and a high LH. Clinically, the diagnosis should be considered in a female with inguinal hernias, a patient with primary amenorrhea and absent uterus. we present a case testicular feminization syndrome with blindly ended vagina and inguinal masses with a brief review of literatures.
Subject(s)
Female , Humans , Male , Disorder of Sex Development, 46,XY , Amenorrhea , Androgen-Insensitivity Syndrome , Diagnosis , Genes, Recessive , Hernia, Inguinal , Karyotype , Phenotype , Testosterone , Uterus , VaginaABSTRACT
Myelodysplastic syndrome (MDS) is a relatively uncommon hematological disorder, charactedzed by cytopenia in the peripheral blood and normo-or hypercellularity in the bone marrow with morphological dysplastic change. Ineffective hematopoiesis leads to hematological failures in this syndrome. MDS is largeIy affected in older individuaIs with a median age of 60-75. It's association with pregnancy is even rarer. Although the exact incidence of MDS in pregancy is unknown, it is likely to be less than 1 per 100,000 pregnancies annually. Recently, we experienced a case of MDS presented initially during pregnancy in a 34-year-old primipara and managed with intensive hematologic support. Uerine rupture occurred in pregnancy complicated with MDS at 34 gestation weeks and a healthy infant was successfully delivered by Cesarean section. We report this case with a brief review of the literature.
Subject(s)
Adult , Female , Humans , Infant , Pregnancy , Bone Marrow , Cesarean Section , Hematopoiesis , Incidence , Myelodysplastic Syndromes , Rupture , Uterine RuptureABSTRACT
Myelodysplastic syndrome (MDS) is a relatively uncommon hematological disorder, charactedzed by cytopenia in the peripheral blood and normo-or hypercellularity in the bone marrow with morphological dysplastic change. Ineffective hematopoiesis leads to hematological failures in this syndrome. MDS is largeIy affected in older individuaIs with a median age of 60-75. It's association with pregnancy is even rarer. Although the exact incidence of MDS in pregancy is unknown, it is likely to be less than 1 per 100,000 pregnancies annually. Recently, we experienced a case of MDS presented initially during pregnancy in a 34-year-old primipara and managed with intensive hematologic support. Uerine rupture occurred in pregnancy complicated with MDS at 34 gestation weeks and a healthy infant was successfully delivered by Cesarean section. We report this case with a brief review of the literature.
Subject(s)
Adult , Female , Humans , Infant , Pregnancy , Bone Marrow , Cesarean Section , Hematopoiesis , Incidence , Myelodysplastic Syndromes , Rupture , Uterine RuptureABSTRACT
Heterotopic pregnancy, simultaneous intrauterine and extrauterine pregnancy, is an extremely rare case. The incidence of heterotopic pregnancy was about 1 to 30,000 pregnancy, but it has been increased. Ectopic pregnancy is associated with significant mortality if not promptly diagnosed. Careful pelvic examination combined serial beta-hCG determinations and transvaginal sonography to evaluation the adnexal region are necessary prerequisites for early diagnosis. We report a case of discovery of heterotopic pregnancy after elective abortion with brief review of literature.