ABSTRACT
OBJECTIVE: The aim of this study was to analyze the perinatal mortality rate (PMR) and to evaluate the risk factors of perinatal deaths such as birth weight, gestational age, maternal age, fetal sex, number of antenatal visits, and cause of deaths. METHODS: Review of electronic medical records of 4,910 cases of singleton deliveries from 1998 to 2003 at Yongdong Severance Hospital was done. The perinatal period was defined according to the WHO definition and the cause of mortality was determined according to Aberdeen Classification. RESULTS: Crude (corrected) PMR was 22.8 (13.4). Among 4862 deliveries excluding termination of pregnancy and severe congenital anomalies, (1) stillbirths accounted for 78% (51/65) of perinatal deaths. (2) Distribution of neonatal birth weights less than 1,000 g, 1,000~1,499 g, 1,500 g~2,499 g were 0.3%, 0.7%, 5.6% with survival rates of 73.7%, 86.1%, and 99.6% respectively. (3) Deaths of preterm births accounted for 86% (12/14) of total neonatal deaths. (4) PMR of 494 cases of advanced maternal age was higher (20.2) than those of other age groups without statistical significance (p=0.273). (5) PMR of male-to-female ratio was 173:100 with statistical significance (p= 0.031). (6) PMR of infants with less than 2 antenatal visits was 152.0, in comparison with the rate (7.3) of infants with more than 2 antenatal visits (p<0.001). Among 112 cases of crude perinatal deaths, the leading causes were congenital anomalies (31.3%), prematurity cause unknown (28.6%), and maternal disease (10.7%). CONCLUSIONS: The number of births is decreasing, but no significant decrease of PMR was observed. Therefore, intensive care of preterm infants and congenital anomalous babies should be improved.
Subject(s)
Humans , Infant , Infant, Newborn , Pregnancy , Birth Weight , Cause of Death , Electronic Health Records , Gestational Age , Infant, Premature , Critical Care , Maternal Age , Parturition , Perinatal Mortality , Premature Birth , Risk Factors , Stillbirth , Survival RateABSTRACT
Primary adrenal insufficiency is a rare disease which can lead to fatal outcomes when complicated in pregnancy. The vague symptoms such as nausea, fatigue and abdominal pain may interfere with its diagnosis. But once the diagnosis is made after a simple ACTH stimulation test, a successful pregnancy and delivery can be accomplished by replacement of steroids. It is to be noted that proper management in crises such as labor, delivery, operation and postpartum is very important. We report a case of successful delivery of a woman with primary adrenal insufficiency with a brief review of literature.
Subject(s)
Female , Humans , Pregnancy , Abdominal Pain , Addison Disease , Adrenocorticotropic Hormone , Diagnosis , Fatal Outcome , Fatigue , Nausea , Postpartum Period , Rare Diseases , SteroidsABSTRACT
We report our experience with the diagnostic, clinical and biochemical findings, complications and maternal-perinatal outcome in a case of acute fatty liver of pregnancy. A 31-year-old multipara presented herself at 35 weeks' gestation with general malaise, gastroesophageal reflux, jaundice, hepatorenal dysfunction and disseminated intravascular coagulation. An abdominal ultrasound revealed a mild fatty liver. A tentative diagnosis of acute fatty liver of pregnancy was made, and immediately a healthy male infant weighing 2330 gm was delivered by emergency cesarean section. On 1, 2 and 6 days after delivery, oliguria, acute respiratory distress syndrome and pancreatitis developed, respectively. Abnormal levels of AST/ALT, creatinine, fibrinogen, PT/PTT and platelet recovered to normal ranges 7-10 days after delivery. Serum amylase and lipase became normal 24 days after delivery with conservative treatment. Ventilator care for acute respiratory distress syndrome continued up to 49 days after delivery, when total bilirubin, ammonia, alkaline phosphatase, r-GT, and AST/ALT began to normalize. The discharge was recommended on the 88th postpartum day. Our result suggests that acute fatty liver of pregnancy can be diagnosed on the basis of clinical and laboratory findings. Prompt delivery, intensive supportive care and awareness of its complications can markedly improve maternal and perinatal outcome.
Subject(s)
Adult , Child , Female , Humans , Infant , Male , Pregnancy , Alkaline Phosphatase , Ammonia , Amylases , Bilirubin , Blood Platelets , Cesarean Section , Creatinine , Diagnosis , Disseminated Intravascular Coagulation , Emergencies , Fatty Liver , Fibrinogen , Gastroesophageal Reflux , Jaundice , Lipase , Mothers , Oliguria , Pancreatitis , Postpartum Period , Reference Values , Respiratory Distress Syndrome , Ultrasonography , Ventilators, MechanicalABSTRACT
OBJECTIVE: Many countries including U.S. have established their own Antenatal Screening Guideline suitable for their actual state to help Obstetricians detect pregnancy-related problems in clinical conditions. However, even investigations on the actual condition of Antenatal Screening in clinical conditions are not thoroughgoing enough in Korea. Therefore, this study was to survey the actual condition of Antenatal Screening in Obstetric Clinics in Korea. METHODS: Among 868 Obstetric Clinics, in which 100 or more cases of delivery were performed per annum according to an aggregate summary of the National Health Insurance Corporation in 2001, 848 clinics representing their correct address were selected to carry out a cross-sectional descriptive survey and understand the actual state of Antenatal Screening with literature review. RESULTS: Antenatal Screening Tests have been carried out in a diverse forms in Obstetric Clinics; some items (CBC, Urine analysis, VDRL test, ABO and Rh typing, HBs Ag and HBs Ab test, Triple test, Ultrasound, Rubella Ig M and Ig G test, Oral Glucose Tolerance test) of the test were performed as a basic test in 80% or higher of Obstetric Clinics; some items (Chlamydia test, PAPP-A, Chest X-ray, BUN, Creatinine, EKG, Cervix culture for Gonococcus) of the test were performed routinely in 10% or less of Obstetric Clinics or selectively in high-risk pregnant women; and some items (PAP smear, Blood chemistry, Nuchal translucency) of the test were performed on the basis of physician's experience or given conditions. CONCLUSION: According to the findings of this study, the role of Antenatal Tests as a screening test in clinical conditions is not evaluated properly under the current state. Thus, clinical assessment should be performed for each item of Antenatal Tests with respect to a screening test and systematic and efficient Antenatal Screening Guideline suitable for Korean conditions should be established in future studies.