Clinical and sonographic predictors for successful labor induction in preterm women / 대한산부인과학회지

OBJECTIVE: To identify the clinical and sonographic parameters which predict the likelihood of successful labor induction in preterm women. METHODS: This prospective observational study enrolled 103 consecutive preterm women (<37 weeks gestation) with singleton gestations scheduled for induction of labor. Transvaginal ultrasound for measurement of the cervical length was performed and the Bishop score was determined by digital examination. The parameters studied were gestational age at induction, parity, maternal age, Bishop score, sonographic cervical length, and current body mass index (BMI). Univariate and multivariate statistical methods were used for data analysis. RESULTS: Successful induction of labor occurred in 45 (44%) of women. Multiple logistic regression analysis identified parity, maternal BMI, and gestational age at induction as the independent predictors of successful labor induction in preterm women, although gestational age did not reach statistical significance (P=0.056). However, maternal age, sonographic cervical length, and Bishop score did not provide independent contribution to success of induction. CONCLUSION: In preterm women undergoing induction of labor parity, maternal BMI, and gestational age at induction were independent parameters in predicting successful induction of labor. However, sonographic cervical length and Bishop score had poor predictive values for success of labor induction.

A case of uterine angioleiomyoma causing severe anemia / 대한산부인과학회지

Angioleiomyoma is a benign mesenchymal neoplasm composed of smooth muscle cells and thick-walled vessels. It usually originates in the extremities or the head. Thus angioleiomyoma of the uterus is a very rare so that there were only 10 cases in the available English literature. Angioleiomyoma cause no serious problems with regard to diagnosis and are simply recognized as benign leiomyomas. These tumors happen to be found only after the surgery through histologic findings. It is therefore extremely difficult to diagnose angioleiomyoma by its shape through preoperative sonography test. We experienced a case of angioleiomyoma with massive vaginal bleeding causing severe anemia which seemed as a benign leiomyoma before the surgery. Hence, we report this case with a brief review of literature.

Reference range for the sonographically estimated fetal weights in twin gestations / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to establish the reference range for the sonographically estimated fetal weights (EFW) in twin gestations at 26 to 38 weeks' gestation. METHODS: This is a retrospective study of EFW that were obtained from electronic medical records of live births of all twins delivered between June 2003 through August 2007 at Seoul National University Bundang hospital. EFW was calculated using the mathematical model of Hadlock and only one measurement from each twin was used. Linear regression and Kolmogorov-Smirnov test were used for statistical analysis. RESULTS: Three hundred and forty-three twin pregnancies (686 fetuses) were included in this study. Reference range for EFW in twin gestations was presented as mean, standard deviation and percentiles. Scatterplots of EFW against gestational age (GA) were created with regression line of best fit and a linear growth function was observed between GA and EFW between 26 and 38 weeks' gestation (EFW=161.807 X GA - 3349.735 (r2=0.861, p<0.001). CONCLUSIONS: We established the reference range for EFW in twin gestations at 26 to 38 weeks' gestation. These results can be used as reference guidelines in the assessment of fetal growth restriction in Korean twin pregnancies.

A prospective longitudinal study of normal reference ranges for the length of fetal limb bones by ultrasound examination / 대한산부인과학회지

OBJECTIVE: To establish the reference ranges for the length of fetal limb bones (femur, tibia, fibula, humerus, ulna, radius, foot) at 12 to 38 weeks' gestation. METHODS: The candidates of this prospective longitudinal study were 43 consecutive women with uncomplicated singleton gestations who initially had antenatal care from the first trimester of pregnancy and follow-up regularly. We performed serial measurements of each limb bone and foot bone length by ultrasound examination every 4 weeks until 28 weeks, and then by 2 weeks until 36 weeks, and weekly thereafter. RESULTS: A total of 2,633 and 321 of fetal limb and foot bone lengths were measured. The reference ranges for the length of limb bones and foot length were presented as mean, 95% confidence interval of the means and in percentile. CONCLUSIONS: Our study results are represented as percentile tables for each of the limb bone length. These results can be provided as standardized data of the fetal limb bone length to distinguish from skeletal dysplasia and may well be suggested as the reference guideline for normal fetal limb bone length in Korea.

Evaluation of NeonatalImmature Reticulocyte Fraction in Small-for-gestational Age Infant in Umbilical Cord Blood / 대한산부인과학회잡지

OBJECTIVE: To evaluate the immature reticulocyte fraction (IRF) by automated calculator that have played a role of predicting marker for hematopoiesis induced by perinatal asphyxia. METHODS: Hospital charts of 40 neonates with diagnosis of small for gestational age (SGA: birth weight <10 percentile) and 47 babies of appropriate for gestational age (AGA) who were delivered vaginally between May 8, 2000 and March 2, 2002 at department of Obstetric and Gynecology, Sanggye Paik Hospital, Inje university. About 5 cc in cord blood was collected immediately after delivery, the calculation of nucleated RBC (N-RBC)/100WBC by macroscopic exam and the evaluation of reticulocyte maturation by automated reticulocyte calculator (Sysmex SE 9000, TOA Medical Electronics Co., Ltd, Kobe, Japan) were performed, and made a comparative study of apgar score. RESULTS: The comparison between AGA and SGA infants, the mean values of cord blood sampling parameter N-RBC (3.53 +/- 4.89 vs 7.92 +/- 10.06, P=0.016), middle fluorescence ratio reticulocyte (MFR) (0.21 +/- 0.02 vs 0.23 +/- 0.03, P<0.001), high fluorescence ratio reticulocyte (HFR) (0.08 +/- 0.03 vs 0.12 +/- 0.03, P<0.001), IRF (0.28 +/- 0.03 vs 0.35 +/- 0.05, P<0.001) were obtained. All of the parameters were significantly different between SGA infants and normal infants and IRF was more valuable marker than N-RBC in evaluation of hematopoietic activity in SGA infants (multiple logistic regression analysis: P value 0.282 vs <0.001). CONCLUSION: Immature reticulocyte fraction by automated calculator is more accurate and confident marker better than N-RBC/100WBC by manual countingin evaluation of the fetal hypoxic induced hematopoiesis.

Clinical and Pathologic Study of Abnormal Uterine Bleeding in Premenopausal Women-To Evaluate the Prognostic Variables of Endometrial Hyperplasia / 대한산부인과학회잡지

OBJECTIVE: We performed this study to understand correlation between clinical aspects and pathological findings of abnormal uterine bleeding (AUB) and to evaluate the prognostic variables of endometrial hyperplasia. METHODS: We reviewed 500 premenopausal women with abnormal uterine bleeding who underwent endometrial biopsy from January 1996 to February 2003, retrospectively. Pregnant women, or women who had hematologic disease, or who used iatrogenic hormones were excluded. The age of women with AUB was mostly in the 5th decade (41.3 +/- 6.8). Body mass index (BMI) in most of women (69.6%) was between 18.6 and 24.9 (22.7 +/- 3.5). RESULTS: Among AUB menorrhagea (51.0%) was the most common bleeding pattern, and the next one was intermenstrual bleeding (38.0%). Histologic findings of endometrium were proliferative phase (34.0%), hyperplasia (26.4%), and seceretory phase (22.6%), in order of frequency. 79.0% (104 cases) of endometrial hyperplasia were simple hyperplasia, 16.0% (21 case) were complex hyperplasia, and 5.0% (7 case) were atypical hyperplasia. The associated diseases were myoma uteri, hypertension, and diabetes mellitus, in order of frequency. The endometrial hyperplasia was diagnosed in 46.4% of patients whose BMI was between 27.0-29.9, in 40% of patients between 30.0-34.9 and in 100% of patients whose BMI was 35.0 or more. The endometrial hyperplasia was diagnosed in 40.6% of patients with an endometrial thickness measured 15.1 mm to 20.0 mm, in 57.1% of patients with 20.1 mm to 25.0 mm, and in 100% of patients with 25.1 mm or higher. CONCLUSION: In premenopausal woman with AUB, the endometrial hyperplasia was highly associated with women whose BMI was 27.0 or higher, or with endometrial thickness measured more than 15.0 mm. Therefore endometrial biopsy should be taken in women with AUB whose BMI is high, or endometrial thickness is thick to exclude the endometrial hyperplasia.

Study on Umbilical Cord Plasma Leptin in Preeclamptic and Normal Pregnant Women / 대한산부인과학회잡지

OBJECTIVE: Leptin, the protein encoded by the Ob gene in the adipose cell, is produced by the placenta during pregnancy and materanal serum leptin is increased in preeclampsia. The objective of this study was to compare umbilical cord plasma leptin level between infants of mothers who experienced preeclampsia and infants of control subjects and to understand the physiology of leptin. METHODS: Leptin concentrations were measured in cord blood at birth using a specific radioimmunoassay employing human recombinant leptin (Human leptin RIA kit; Linco Research, Inc. U.S.A.). We compared cord plasma leptin between preeclamptic (n=17 women) and normal pregnancies (n=21 women). RESULTS: Gestational age is the only one significant variable among the demographic variables (P=0.011). There was no statistically significant difference in cord plasma leptin level between infants of mothers who experienced preeclampsia and infants of control subjects, but preeclampsia group had slightly lower leptin levels than control subjects (Control subjects: 4.8 [3.7-7.9] ng/ml, Preeclamptic women: 2.7 [2.3-6.8] ng/ml, P=0.142). There was also no difference in the leptin value adjusted for different gestational age, or ratio between cord plasma leptin level and gestational age (Control subjects: 0.017 [0.013-0.018], Preeclamptic women: 0.010 [0.008-0.025], P=0.131). CONCLUSION: We found no difference between umbilical cord plasma leptin in infants of mothers who had preeclampsia and umbilical cord plasma leptin in infants of control subjects, but insignificantly lower levels of umbilical cord plasma leptin in infants of mothers who had preeclampsia. It suggest that maternal serum concentration do not correlate with cord leptin concentration and dysregulation of leptin metabolism and/or function in the placenta may be implicated in the pathogenesis of preeclampsia.

A Case of Advanced Squamous Cell Carcinoma Arising in Mature Cystic Teratoma of the Ovary / 대한산부인과학회잡지

Mature cystic teratoma comprises approximately 10-20% of all ovarian neoplasms and malignant transformation from mature cystic teratoma is reported to be less than 2%. Squamous cell carcinoma is the most frequent malignancy (80%) arising in mature cystic teratoma followed by sarcoma (7-8%), adenocarcinoma (6-7%), carcinoid tumor, melanoma, choriocarcinoma (1-2%). Prognosis of squamous cell carcinoma in mature cystic teratoma is reported much poorer than that of epithelial ovarian cancer with the same stage. We experienced one case of squamous cell carcinoma arising in mature cystic teratoma.