Analysis of prenatal screening results in 3 595 middle pregnant women / 国际检验医学杂志

Objective To explore the clinical value of prenatal screening by detecting α-fetoprotein(AFP),β-human chorionic gonadotrophin(β-HCG)and free estriol(u-E3)levels in the second trimester of pregnancy.Methods AFP,β-HCG and u-E3 were de-tected in 3 595 second trimester pregnant women by chemiluminescence.The risk value was calculated by combining with the factors of age,pregnant weeks,body weight,etc.Then the high-risk pregnant women were carried out the amniotic fluid cells chromosome karyotype analysis and B-ultrasonic examination.Results Among 3 595 pregnant women,the screening positive rates of Down′s syndrome(DS),Edward′s syndrome(ES)and neural tube defects(NTD)were 3.70%(133/3 595),0.11%(4/3 595)and 1.44%(52/3 595)respectively.In the prenatal screening,there were 189 cases of high risk pregnant women,among them 87 cases were per-formed the prenatal diagnosis of amniotic fluid cells chromosome karyotype analysis and B-ultrasonic examination,6 cases were defi-nitely diagnosed,in which 3 cases were DS,2 cases were NTD and 1 case was ES.Conclusion Prenatal screening is a non-invasive detection method and has the important clinical application value for avoiding the birth of DS,ES and NTD neonates.

The rate and etiologies of second trimester fetal loss in twin pregnancies / 대한산부인과학회지

OBJECTIVE: To evaluate and compare the rate and etiologies of second trimester pregnancy loss in monochorionic (MC) or dichorionic (DC) twins, and natural or assisted reproductive technology (ART) twins. METHODS: Between January 1997 and December 2008, there were 146 cases of second trimester twin pregnancy losses (between 12 and 24 weeks gestation) from 2,467 twin pregnancies. They were divided into four groups according to chorionicity and fertilization. Chorionicity was established by ultrasound at early gestation and confirmed by histologic examination after delivery. From a total of 2,467 twin deliveries, 392 MC, 2058 DC, and 17 unknown chorionicity were observed. Fertilization methods were classified as 736 natural, 1,590 ART, and 141 unknown conceptions. The pregnancy loss rate and possible mechanisms were compared in each group. RESULTS: During the study period, there were 43 MC, 86 DC, and 17 unknown chorionicities and 45 natural, 78 ART, and 23 unknown fertilizations. Total twin pregnancy loss rate was 5.9% (146/2,467), with 11.0% (43/392) and 4.2% (86/2,058) for MC twin group and DC twin group, respectively. Likewise, it was 6.1% (45/736) and 4.9% (78/1,590) for natural twin group and ART twin group. The most common cause was intrauterine fetal death (IUFD) in 22 (51.2%) in MC twin group and preterm premature rupture of membranes (PPROM) in 40 (46.5%) in DC twin group, followed by preterm labor (PTL) in 37 (43%). In natural pregnancy, IUFD was the most common etiology in 20 (44.5%) and for ART twin group, it was PTL in 35 (44.9%). CONCLUSION: Twin pregnancy loss rate was higher in MC twin group compared with DC twin group in the second trimester. MC twin group had a higher incidence of IUFD as a cause of second trimester pregnancy loss. The etiologies in DC twin group were PPROM and PTL. It is suggested that antenatal care in twin pregnancy should be explored for preventing fetal loss and promoting neonatal well-being.

A case of cornual pregnancy ruptured at 24 week's gestation / 대한산부인과학회지

A cornual pregnancy occurs when the conceptus implants at the cornus of the uterus which is the junction between the fallopian tube and uterine cavity. It accounts for 2 to 4% of tubal pregnancy and rupture usually occurs between 8 weeks and 16 weeks of gestation. The rich vascularity in this location makes the rupture particularly dangerous, resulting in higher maternal mortality. The presented case was unique in that the pregnancy was believed to be a normal intrauterine pregnancy till 24 week's of gestation, when it ruptured and presented as the pregnant patient with hypovolemic shock of unknown cause. We present this case with a brief review of the literature.

The Clinical Significance of Uterine Artery Doppler Flow Velocity Waveforms as a Screening Test in the Second Trimester Pregnancies / 대한주산의학회잡지

OBJECTIVE: We performed uterine artery doppler flow velocity waveforms between 20~24 weeks of gestation to access the screening properties for predicting pregnancy-induced hypertension or intrauterine growth retardation in general population. METHODS: Total 458 normal pregnant women were enrolled in this study. The abnormal uterine artery doppler flow velocity waveforms was defined that systolic/diastolic ratio is greater than 2.6 or diastolic notch waveforms are seen. RESULTS: The incidence of PIH and IUGR among study population was 3.5% and 3.5%, respectively. The incidence of PIH in normal and abnormal uterine artery Doppler flow velocity waveforms group were 2.0% and 11.4%, and those of IUGR were 3.4% and 4.2%, respectively. The incidence PIH or IUGR among abnormal doppler group was 14.2%, which was higher than in normal group of 5.4%. This method had a sensitivity of 34.3%, a specificity of 86.1% and positive predictive value of 15.7% for the prediction of PIH and IUGR. CONCLUSION: Although abnormal uterine artery doppler flow velocity waveforms is associated with an increased risk of PIH or IUGR, the lowered positive predictability lead to apply the follow-up examination or standardization of doppler ultrasonography.