Comparison of Perinatal Outcomes According to the Majority of Physicians: Obstetrics Versus Endocrinology

Purpose@#To compare the perinatal outcomes among the majority of physicians who manage pregnancies complicated by gestational diabetes mellitus (GDM), particularly those who require insulin treatment. @*Methods@#We conducted a retrospective study involving 206 singleton pregnant women diagnosed with GDM between January 2017 and September 2022. The study participants were divided into 2 groups according to the majority of physicians (obstetrics vs. endocrinology). We compared the maternal characteristics and perinatal outcomes between the 2 groups and performed a subgroup analysis of preterm birth cases. @*Results@#During the study period, 206 pregnant women were diagnosed with GDM and 36.9% (76 of 206) required insulin treatment. Among the GDM A2 pregnancies, 26 patients visited or consulted endocrinologists, and 50 patients were managed by obstetricians. There were no significant differences in maternal characteristics and perinatal outcomes between the two groups. Eighteen infants were delivered before 37 weeks of gestation (12 in the obstetrician group and 6 in the endocrinologist group). In preterm-delivered patients, the birth weight was heavier in the endocrinology group (median [range], 2.66 [1.98–3.77] vs. 3.71 [2.48–4.17], p=0.025) despite similar gestational age at delivery (median [range], 35.5 [33.1–36.5] vs. 36.0 [34.2–36.6], p=0.511). However, there were no significant differences in perinatal outcomes, including the rate of neonatal hypoglycemia, oxygen treatment and the duration of neonatal intensive care unit admission. @*Conclusion@#Our data show that GDM can be managed by obstetricians even in cases requiring insulin treatment.

Summary of clinically diagnosed amniotic fluid embolism cases in Korea and disagreement with 4 criteria proposed for research purpose

Objective@#This study aimed 1) to investigate the clinical characteristics of amniotic fluid embolism (AFE) cases clinically diagnosed by maternal fetal medicine (MFM) specialists in Korea, 2) to check the disagreement with 4 recently proposed criteria by the Society for Maternal-Fetal Medicine (SMFM) for research purpose, and 3) to compare maternal outcomes between cases satisfying all 4 criteria and cases with at least 1 missing criterion. @*Methods@#This study included 12 patients clinically diagnosed with AFE from 7 referral hospitals in Korea. We collected information, including maternal age, symptoms of AFE, the amount of transfusion, and maternal mortality. @*Results@#The median maternal age was 33 years (range, 28–40 years). Regarding symptoms, cardiovascular arrest, hypotension, respiratory compromise, clinical coagulopathy, and neurologic signs were observed in 41.7%, 83.3%, 83.3%, 100%, and 66.7% of the cases, respectively. Among the 12 cases, 5 women died and 2 suffered severe neurologic disability, showing an intact survival rate of 41.7%. Disagreement with all 4 criteria proposed by the SMFM was found in 66.7% of the cases, due to the lack of criteria for disseminated intravascular coagulation or strict onset time (<30 minutes after delivery). There was no difference in maternal mortality and the amount of transfusion between cases satisfying all 4 criteria and cases with at least 1 missing criterion. @*Conclusion@#Two-thirds of clinically confirmed AFE cases did not satisfy all 4 criteria proposed by the SMFM, despite similar rates of maternal mortality with cases satisfying all 4 criteria. Our study suggests that there may be some discrepancy between the clinical diagnosis of AFE and the recent diagnostic criteria proposed by the SMFM for research purpose.

Summary of clinically diagnosed amniotic fluid embolism cases in Korea and disagreement with 4 criteria proposed for research purpose

Objective@#This study aimed 1) to investigate the clinical characteristics of amniotic fluid embolism (AFE) cases clinically diagnosed by maternal fetal medicine (MFM) specialists in Korea, 2) to check the disagreement with 4 recently proposed criteria by the Society for Maternal-Fetal Medicine (SMFM) for research purpose, and 3) to compare maternal outcomes between cases satisfying all 4 criteria and cases with at least 1 missing criterion. @*Methods@#This study included 12 patients clinically diagnosed with AFE from 7 referral hospitals in Korea. We collected information, including maternal age, symptoms of AFE, the amount of transfusion, and maternal mortality. @*Results@#The median maternal age was 33 years (range, 28–40 years). Regarding symptoms, cardiovascular arrest, hypotension, respiratory compromise, clinical coagulopathy, and neurologic signs were observed in 41.7%, 83.3%, 83.3%, 100%, and 66.7% of the cases, respectively. Among the 12 cases, 5 women died and 2 suffered severe neurologic disability, showing an intact survival rate of 41.7%. Disagreement with all 4 criteria proposed by the SMFM was found in 66.7% of the cases, due to the lack of criteria for disseminated intravascular coagulation or strict onset time (<30 minutes after delivery). There was no difference in maternal mortality and the amount of transfusion between cases satisfying all 4 criteria and cases with at least 1 missing criterion. @*Conclusion@#Two-thirds of clinically confirmed AFE cases did not satisfy all 4 criteria proposed by the SMFM, despite similar rates of maternal mortality with cases satisfying all 4 criteria. Our study suggests that there may be some discrepancy between the clinical diagnosis of AFE and the recent diagnostic criteria proposed by the SMFM for research purpose.

Association between gestational age at delivery and lymphocyte-monocyte ratio in the routine second trimester complete blood cell count / 영남의대학술지

Background@#We aimed to determine whether routine second trimester complete blood cell (CBC) count parameters, including neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), and platelet-lymphocyte ratio (PLR), could predict obstetric outcomes. @*Methods@#We included singleton pregnancies for which the 50-g oral glucose tolerance test and CBC were routinely performed between 24 and 28 weeks of gestation in our outpatient clinic from January 2015 to December 2017. The subjects were divided into three groups according to their pregnancy outcomes as follows: group 1, spontaneous preterm births, including preterm labor and preterm premature rupture of membranes; group 2, indicated preterm birth due to maternal, fetal, or placental causes (hypertensive disorder, fetal growth restriction, or placental abruption); and group 3, term deliveries, regardless of the indication of delivery. We compared the CBC parameters using a bivariate correlation test. @*Results@#The study included 356 pregnancies. Twenty-eight subjects were in group 1, 20 in group 2, and 308 in group 3. There were no significant differences between the three groups in neutrophil, monocyte, lymphocyte, and platelet counts. Although there was no significant difference in NLR, LMR, and PLR between the three groups, LMR showed a negative correlation with gestational age at delivery (r=−0.126, p=0.016). @*Conclusion@#We found that a higher LMR in the second trimester was associated with decreased gestational age at delivery. CBC parameters in the second trimester of pregnancy could be used to predict adverse obstetric outcomes.

Coronavirus Disease 2019 and Pregnancy

With the continued fight against coronavirus disease 2019 (COVID-19), new guidelines on its management are emerging; however, information on COVID-19 and pregnancy remains limited. Therefore, this study aimed to review the guidelines of the American College of Obstetricians and Gynecologists, Society for Maternal Fetal Medicine, and Royal College Obstetrics and Gynecology and International Society of Ultrasound in Obstetrics and Gynecology.

Standardization of measurement of cervical elastography, its reproducibility, and analysis of baseline clinical factors affecting elastographic parameters

A case of delivery of a pregnant woman with COVID-19 infection in Daegu, Korea

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is affiliated with the β-coronavirus subgroup, which includes SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), but is far more infectious than the 2. Because it is potentially life-threatening to infants and pregnant women with weak immune systems, clinical manifestations and vertical transmission of COVID-19 are matters of interest. Staff of the obstetrics department of university hospitals in Daegu and of the Daegu metropolitan government designated Daegu Fatima Hospital for the delivery of pregnant women with suspected and confirmed SARS-CoV-2 infection. Thirteen pregnant women with laboratory-confirmed COVID-19 were identified. Among them was a 28-year-old pregnant woman who had recovered from COVID-19 and had given birth to a healthy girl at 38 weeks of gestational age. We present our uncommon experience with a brief review of literatures.

Postnatally diagnosed coexisting congenital diaphragmatic hernia with pulmonary sequestration: a report of two cases

While the associations between pulmonary sequestration (PS) and congenital diaphragmatic hernia (CDH) are known, CDH may be obscured by PS and thus, overlooked on prenatal ultrasonography when coexisting with PS. We present 2 cases of postnatally diagnosed CDH combined with PS. In both cases, PS was prenatally diagnosed as an isolated lung mass, while CDH was confirmed only after birth. Both newborns were sufficiently stable that management was not required immediately after birth. PS may function as an “anatomical barrier” to prevent herniation of the abdominal contents into the chest, thus acting as a “protector” providing normal lung maturation throughout pregnancy. If PS is suspected prenatally, coexisting CDH may be obscured; thus, close prenatal care and counseling of the parents regarding the possibility of CDH are essential. These infants should be delivered at a tertiary center, and imaging should be performed to exclude coexisting CDH.

A case of delivery of a pregnant woman with COVID-19 infection in Daegu, Korea

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is affiliated with the β-coronavirus subgroup, which includes SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), but is far more infectious than the 2. Because it is potentially life-threatening to infants and pregnant women with weak immune systems, clinical manifestations and vertical transmission of COVID-19 are matters of interest. Staff of the obstetrics department of university hospitals in Daegu and of the Daegu metropolitan government designated Daegu Fatima Hospital for the delivery of pregnant women with suspected and confirmed SARS-CoV-2 infection. Thirteen pregnant women with laboratory-confirmed COVID-19 were identified. Among them was a 28-year-old pregnant woman who had recovered from COVID-19 and had given birth to a healthy girl at 38 weeks of gestational age. We present our uncommon experience with a brief review of literatures.

Postnatally diagnosed coexisting congenital diaphragmatic hernia with pulmonary sequestration: a report of two cases

While the associations between pulmonary sequestration (PS) and congenital diaphragmatic hernia (CDH) are known, CDH may be obscured by PS and thus, overlooked on prenatal ultrasonography when coexisting with PS. We present 2 cases of postnatally diagnosed CDH combined with PS. In both cases, PS was prenatally diagnosed as an isolated lung mass, while CDH was confirmed only after birth. Both newborns were sufficiently stable that management was not required immediately after birth. PS may function as an “anatomical barrier” to prevent herniation of the abdominal contents into the chest, thus acting as a “protector” providing normal lung maturation throughout pregnancy. If PS is suspected prenatally, coexisting CDH may be obscured; thus, close prenatal care and counseling of the parents regarding the possibility of CDH are essential. These infants should be delivered at a tertiary center, and imaging should be performed to exclude coexisting CDH.

Gestational Diabetes Mellitus and Long-Term Prognosis of the Offsprings / 임상당뇨병

The hyperglycemia and adverse pregnancy outcomes (HAPO) study demonstrated a linear increase in the risk of adverse pregnancy outcomes with increasing maternal glycemia that can be less severe than overt diabetes and is often untreated. Recently, HAPO follow-up studies were published on longterm consequences on children of gestational diabetes mellitus (GDM) gravidas. Two articles examined the association of untreated maternal glycemia with markers of glucose metabolism in a total of 4,160 ethnically diverse children 10~14 years of age. Children of mothers with GDM had higher prevalence of impaired glucose tolerance (IGT). Moreover, there were strong positive associations between maternal continuous and categorical glycemia status and child’s 75-g glucose tolerance test, A1C, IGT, and impaired fasting glucose. Another two articles evaluated the risk of childhood adiposity of 4,832 children born from mothers with GDM. GDM was associated with childhood adiposity as evaluated by multiple methods. Additionally, maternal glucose level across a continuum was associated with childhood obesity, percentage body fat, and sum of skinfolds > 85th percentile after adjustment for maternal body mass index. These findings could have implications for glucose targets in mothers with GDM and indicate that even mild hyperglycemia can affect adversely glucose metabolism and obesity in the children of mothers with GDM.

Comparison of perinatal outcomes in late preterm birth between singleton and twin pregnancies

OBJECTIVE: To determine whether late preterm twin neonates have a more favorable perinatal outcome than singleton late preterm neonates. METHODS: We studied 401 late preterm births between 34+0 and 36+6 weeks of gestation, from January 2011 to December 2014 in our institution. We compared the maternal and neonatal characteristics and perinatal outcomes between singleton and twin pregnancies. Perinatal outcomes included Apgar score, admission to the neonatal intensive care unit (NICU) or special care nursery, duration of NICU stay, and the rate of composite morbidity (antibiotic use, hypoglycemia, hypocalcemia, hyperbilirubinemia requiring phototherapy, respiratory support, and respiratory distress syndrome). RESULTS: A total of 289 neonates were in the singleton group and 112 in the twin group. The twin group showed smaller mean birth weight despite of longer gestational age at delivery. In addition, there were significant differences in the indication of delivery and cesarean section rate between the 2 groups. Overall, the risk of composite morbidity was similar between 2 groups (odds ratio, 1.4; 95% confidence interval, 0.8 to 2.4). CONCLUSION: Our findings suggest that late preterm twins do not show a more favorable outcome than singleton late preterm births.

Incarceration of a pedunculated uterine fibroid in an umbilical hernia

Uterine fibroids are common benign tumors that may cause an umbilical hernia in patients with increased intra-abdominal pressure due to pregnancy, obesity, ascites, and intra-abdominal tumors. However, the simultaneous occurrence of uterine fibroids and umbilical hernias, or fibroids and an associated umbilical hernia, during pregnancy has rarely been reported. Here, we present the case of a fibroid presenting as an incarcerated umbilical hernia in a menopausal patient.

Heterotopic pregnancy after a single embryo transfer

Heterotopic pregnancy is a rare and life-threatening condition which is defined as coexistent intrauterine and ectopic gestation. The risk of ectopic and heterotopic pregnancy is increasing due to the increased risk of multiple pregnancies with the aid of assisted reproductive technologies. However, it hardly happens in the setting of single embryo transfer, since single embryo transfer significantly reduces the incidence of multiple pregnancies. Surprisingly, we experienced a case of heterotopic pregnancy after a single embryo transfer caused by coincidental natural pregnancy during assisted reproductive technologies. An infertile woman who underwent, during her natural cycle, transfer of a single embryo that had been cryopreserved for 3 years was found to be heterotopically pregnant. After an early and successful management with laparoscopic right salpingectomy, she finally reached at full-term vaginal delivery.

The practice patterns of second trimester fetal ultrasonography: A questionnaire survey and an analysis of checklists

OBJECTIVE: To analyze practice patterns and checklists of second trimester ultrasonography, and to investigate management plans when soft markers are detected among Korean Society of Ultrasound in Obstetrics and Gynecology (KSUOG) members. METHODS: An internet-based self-administered questionnaire survey was designed. KSUOG members were invited to the survey. Checklists of the second trimester ultrasonography were also requested. In the questionnaire survey, general practice patterns of the second trimester ultrasonography and management schemes of soft markers were asked. In the checklists analysis, the number of items were counted and also compared with those recommended by other medical societies. RESULTS: A total of 101 members responded. Eighty-seven percent routinely recommended second trimester fetal anatomic surveillance. Most (91.1%) performed it between 20+0 and 23+6 weeks of gestation. Written informed consents were given by 15.8% of respondents. Nearly 60% recommended genetic counseling when multiple soft markers and/or advanced maternal age were found. Similar tendencies were found in the managements of individual soft markers. However, practice patterns were very diverse and sometimes conflicting. Forty-eight checklists were analyzed in context with the number and content of the items. The median item number was 46.5 (range, 17 to 109). Of 49 items of checklists recommended by International Society of Ultrasound in Obstetrics and Gynecology and/or American Congress of Obstetricians and Gynecologists, 14 items (28.6%) were found in less than 50% of the checklists analyzed in this study. CONCLUSION: Although general practice patterns were similar among KSUOG members, some of which were conflicting, and there is a need for standardization of the practice patterns and checklists of second trimester ultrasonography, which also have very wide range of spectrum.

Spontaneous Restoration of Unrecognized Uterine Inversion / 대한주산의학회잡지

We report a case of unrecognized uterine inversion was restored spontaneously without surgical intervention. Initially, the case was diagnosed as uterine atony and not uterine inversion and was managed successfully with uterine artery embolization. However, a partial uterine inversion was detected on a subsequent scheduled pelvic examination. Fortunately, her uterus was completely restored without any surgical intervention on eighth week after delivery.

Successful pregnancy outcome in a Korean patient with symptomatic Wilson's disease

Wilson's disease is an inherited disease of copper metabolism leading to the toxic accumulation of copper, primarily in the liver and brain. Although the literature shows successful outcomes after proper treatment, pregnant patients with Wilson's disease still need close monitoring and management. Here, we report the case of a successful pregnancy in a Korean woman with Wilson's disease. A 33-year-old primigravid patient with Wilson's disease visited our antenatal clinic. Of her own volition, she had stopped her medication 2 years earlier. Oral zinc oxide therapy was started, and she was closely monitored throughout her pregnancy. She delivered a healthy female infant weighing 3.13 kg through a cesarean section. After delivery, the clinical course of both the mother and the baby were uneventful. We review crucial points in the treatment and the management dilemmas raised by the patient.

Erratum: Author's name correction

The Editorial Office of Obstet Gynecol Sci would like to correct the author's name. The Editorial Office apologizes for any inconvenience that it may have caused.

Vaginal adhesions in a woman with the history of dystocia

Postpartum genital tract adhesions are unusual, and their cause has not been evaluated. However, severe dystocia and numerous pelvic examinations have been suggested as possible causes. Here, we report a case of vaginal adhesions following a difficult labor that presented as dyspareunia for 5 months. Pelvic examination and ultrasonography revealed a transverse vaginal septum that obstructed the vaginal cavity, and fluid collection proximal to this septum. The patient was successfully treated with surgical resection and administration of antibiotics.

Pregnancy outcomes of IgA nephropathy / 대한산부인과학회지

OBJECTIVE: We performed this study to evaluate maternal and fetal outcomes of pregnancies with IgA nephropathy. METHODS: We reviewed 20 pregnancies occurred in 14 women who were diagnosed as IgA nephropathy with the method of renal biopsy between 1997 and 2006. We used clinical and laboratory data from medical records and statistic analysis using SPSS 15.0. RESULTS: Of 20 prenancies, there were 17 live births and 3 spontaneous abortions. There was no stillbirth and congenital anomaly. We found severe preeclampsia in 47%, low birth weight in 53% and preterm birth (comprising medical indications) in 59%. But most were late preterm birth and all were alive. Blood pressure was elevated after delivery compared with pre-pregnancy. CONCLUSION: Although pregnancy is not contraindicated in IgA nephropathy, it is associated with significant complications comprising preeclampsia, preterm birth and low birth weight.