Posttraumatic stress symptom in women with termination of pregnancy for fetal anomalies and its correlation with big five personality traits / 中国实用护理杂志

Objective To know about the post-traumatic stress disorders (PTSD) of women with termination of pregnancy for fetal anomalies (TOPFA),and investigate the relationship of PTSD and the big five personality traits.Methods The general questionnaire,the Impact of Event Scale-Revised (IES-R) and the Big Five Questionnaire were administered to the women with TOPFA in hospital from February 2014 to February 2015.Results The total score of IES-R of 84 cases was 26.20 ± 16.38.The scores of 49 cases(58.3％) were more than 19 and that of 20 cases (23.8％) more than 35.Women who had the first pregnancy had higher level of arousal symptoms,12.84±7.41 vs.9.65±5.53 (t =2.25,P ＜ 0.05).Women whose scores were above 19 had lower adaptation,sociality,altruism and conscience compared with those scored ≤ 19,14.96±3.29,16.84±3.00,18.55±3.49,17.57±2.99 vs.13.57±2.82,18.31±2.65,20.03±2.32,18.86±2.21,t=2.02-2.33,P ＜ 0.05.The IES-R score had no linear correlation with that of the big five personalities,and intrusion subscale had linear correlation with the adaptation.Avoidance symptoms had low positive relationship with sociality in women whose IES-R were above 19,r =0.23,P ＜ 0.05.In populations whose IES-R scored above 19,avoidance subscale had positive weak correlation with sociality,r=0.31,P ＜0.05.Conclusions The women with TOPFA had high level of PTSD before termination.Women with sever posttraumatic stress symptoms had lower sociality and altruism.Moreover,of the women who had sever posttraumatic stress symptoms,one with higher sociality always had higher avoidance symptoms.

Assessment of Placental Stiffness Using Acoustic Radiation Force Impulse Elastography in Pregnant Women with Fetal Anomalies

OBJECTIVE: We aimed to evaluate placental stiffness measured by acoustic radiation force impulse (ARFI) elastography in pregnant women in the second trimester with a normal fetus versus those with structural anomalies and non-structural findings. MATERIALS AND METHODS: Forty pregnant women carrying a fetus with structural anomalies diagnosed sonographically at 18-28 weeks of gestation comprised the study group. The control group consisted of 34 healthy pregnant women with a sonographically normal fetus at a similar gestational age. Placental shear wave velocity (SWV) was measured by ARFI elastography and compared between the two groups. Structural anomalies and non-structural findings were scored based on sonographic markers. Placental stiffness measurements were compared among fetus anomaly categories. Doppler parameters of umbilical and uterine arteries were compared with placental SWV measurements. RESULTS: All placental SWV measurements, including minimum SWV, maximum SWV, and mean SWV were significantly higher in the study group than the control group ([0.86 ± 0.2, 0.74 ± 0.1; p < 0.001], [1.89 ± 0.7, 1.59 ± 0.5; p = 0.04], and [1.26 ± 0.4, 1.09 ± 0.2; p = 0.01]), respectively. CONCLUSION: Placental stiffness evaluated by ARFI elastography during the second trimester in pregnant women with fetuses with congenital structural anomalies is higher than that of pregnant women with normal fetuses.

Diagnostic value of prenatal B ultrasound scan for fetal abnormalities / 中国医学装备

Objective:To analyze diagnostic value of color Doppler ultrasound (B ultrasound) screening obstetric fetal abnormal condition. Methods:Using retrospective analysis, 1148 cases of pregnant women carried out prenatal B ultrasound examination were selected in our hospital from January, 2013 to June, 2013. B ultrasound examination data are complete, in order to postpartum, after induced labor or autopsy results as the standard, B ultrasound screening for fetal anomaly judgment before producing the accuracy, sensitivity and specificity. Results:Twelve cases of pregnant women were carried out abnormal fetal ultrasound examination, the detection rate was 1.05%(12/1148);after the induction of labor after multiparous, or autopsy results found that fetal abnormality were 13 cases, accounting for 1.13%;the sensitivity of ultrasound for fetal anomaly examination was 92.3%(12/13), the specificity was 100%(1135/1135), the accuracy was 99.9%(1147/1148), It had significant difference (x2=20.22, P<0.05). Conclusion:Prenatal ultrasonic examination system with safe, noninvasive, simple, good repeatability and high reliability,has an important value in the diagnosis of fetal abnormalities, and which has important clinical value to reduce the birth defect.

Coxsackievirus B Infection Is Highly Related with Missed Abortion in Korea

PURPOSE: This study investigated the possible relationship between viral infection and first trimester pregnancy loss. MATERIALS AND METHODS: A prospective study was performed on 51 gravidas with missed abortion, fetal anomaly, pre-term delivery, and full-tem delivery at Hanyang University Hospital. Enteroviruses were detected by semi-nested reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry in abortive tissues and placentas. Enterovirus serotypes were confirmed by genome sequencing. Herpesviruses were detected by PCR. RESULTS: Coxsackievirus B3 (CVB3) was detected in 8 of 14 missed abortion cases, 1 of 27 full-term cases, and none of the 9 pre-term cases. Coxsackievirus B1 (CVB1) was detected in an encephalocele case. Herpes simplex virus type 1 was found in 4 full-term cases, 3 pre-term cases, and none of the missed abortion cases. CONCLUSION: The prevalence of CVB3 was significantly higher in missed abortion cases compared to full-term or pre-term delivery cases. CVB infection may therefore be an important etiological agent of missed abortion.

Comparison of fetal magnetic resonance imaging and ultrasonography for the diagnosis of fetal anomalies / 대한주산의학회잡지

PURPOSE: To compare the accuracy of fetal magnetic resonance imaging (MRI) and prenatal ultrasonography (USG) with postnatal diagnosis for the diagnosis of fetal anomalies. METHODS: Retrospective analysis of 41 fetuses who underwent fetal MRI with prenatal USG from 2005 to 2008 was performed. In 28 cases of the total population, the final neonatal diagnosis was also analyzed for the consistency of pre- and postnatal diagnoses for each diagnostic tool. Postnatal diagnosis was confirmed by physical examination, radiographic studies (USG, MRI and/or computed tomography), surgery, and/or autopsy. RESULTS: Mean gestational age at the fetal MRI performed was 26.1+/-4.7 weeks. The most common indication of the fetal MRI was central nervous system (CNS) anomalies (n=12), followed by thoracic anomalies (n=5), abdominal anomalies (n=2), genitourinary anomalies (n=3), head and neck anomalies (n=4), and others (n=2). When compared with postnatal diagnosis, the accuracy of prental MRI was superior to prenatal USG (89% vs. 71%). The cases with additional accurate diagnosis with using fetal MRI were 4 CNS, 1 genitourinary, and 1 craniofacial anomaly. Of notes, there was a case of enlarged cisterna magna in which prenatal MRI missed the diagnosis. In 2 cases (7.1%), both imaging studies made an incorrect prenatal diagnoses. CONCLUSION: Fetal MRI could confirm the USG diagnosis in most cases and provided more accurate diagnosis in some cases of CNS and thoracic, genitourinary system abnormalities. MRI is expected to be a good adjunctive for USG to improve prenatal diagnosis of fetal anomalies.

The Association of Fetal Heart Rate Pattern following Cordocentesis with Pregnancy outcome / 대한산부인과학회잡지

OBJECTIVE: The cordocentesis is regarded as an useful procedure for the prenatal evaluation of fetal disease, but it's complications are fetal loss, umbilical cord bleeding, umbilical cord hematoma, fetal bradycardia, fetomaternal hemorrhage, abruptio placentae, and chorioamnionitis due to it's invasiveness. The fetal bradycardia following cordocentesis is transient and self-limited in most cases, and the prevalence rate of fetal bradycardia following cordocentesis was reported to be between 1.5 and 13 per cent. The purpose of this study was to evaluate the association of fetal heart rate pattern following cordocentesis with adverse pregnancy outcome. METHODS: We investigated retrospectively the fetal heart rate following cordocentesis, the Apgar score of neonate, the birth weight of neonate, gestational age at delivery, preterm delivery, intrauterine growth retardation, stillbirth, and chromosome analysis in 64 codocenteses between 1 February 2000 and 28 February 2001. Normal fetal heart rate was defined as 100 up to 170 bpm, fetal bradycardia as less than 100 bpm lasting one more minute, and fetal tachycardia as more than 170 bpm lasting one more minute. RESULTS: 1. Fetal heart rate pattern following the cordocentesis was normal in 53 cases (82.8%), bradycardia in 6 cases (9.4%) and tachycardia in 5 cases (7.8%). 2. The pregnancy outcome was well-being fetus at birth in 51 cases, terminated pregnancy in 5 cases, intrauterine growth restricted fetus in 5 cases, preterm birth in 1 case and intrauterine death in 2 cases. 3. Mean Apgar-1minute/-5minute scores in neonates were 8.4 +/- 0.2/9.3 +/- 0.2 in the normal fetal heart rate group, 6.8 +/- 1.7/7.6 +/- 1.9 in fetal bradycardia group and 8.4 +/- 0.2/9.4 +/- 0.2 in fetal tachycardia group, that showed no statistically significant difference between groups. 4. The gestational weeks at birth/birth weight were 38.9 +/- 0.4 weeks/3193 +/- 90 g in normal fetal heart rate group, 36.8 +/- 3.2 weeks/2733 +/- 340 g in bradycardia group and 40.0 +/- 0.2/3465 +/- 21 g in tachycardia group, that showed no statistically significant difference between groups. 5. The number of puncture at the same time of cordocentesis was one in 45 cases, two in 15 cases and three in 4 cases. 6. There was no difference in fetal heart rate pattern following cordocentesis between 60 cases of normal and 4 cases of abnormal cardiovascular findings sonographycally. 7. The karyotyping was normal in 60 cases and abnormal in 4 cases, each of which was 46,XY,inv(9),46,X,i(Xq)/45,X,47,XY,+mar, and 46,XX,t(7;15)(q10;q10) respectively. CONCLUSION: Fetal bradycardia or tachycardia following cordocentesis was not associated with adverse pregnancy outcomes.

Pregnancy Outcome after Exposure of Suspected Teratogens in Early Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To compare the risk of congenital anomaly after exposure to suspected teratogens in early pregnancy with the known baseline risk to the geneneral population. METHODS: From September 1999 to August 2001, we counseled about the teratogenic risk of the fetus by relevant medical literatures after assessment of type, amount, and time of exposure for 302 pregnant women exposed to suspected teratogens such as drugs, radiation, alcohol, and cigarette smoking. We followed up on the pregnancy outcome with the rate of termination of pregnancy and incidence of congenital anomaly. RESULTS: Among a total of 302 cases, 253 pregnant women (83.8%) delivered, 15 (5%) were aborted spontaneously, 34 (11.3%) were terminated. 297 pregnant women (98.3%) were lastly exposed to drugs in mean 5.3 +/- 0.2 gestational weeks. Medicines taken were gastrointestinal drugs (23%), NSAIDs (18.3%), antibiotics (16.2%), antihistamines (10.8%) in the order of frequency. 74 pregnant women (24.5%) were exposed to radiation in mean 5.1 +/- 0.5 gestational weeks. The mean dose was 234.60 mrem. 113 pregnant women (37.3%) lastly drank alcohol in mean 4.5 +/- 0.4 gestational weeks and the mean amount was 1.55 oz. 36 pregnant women (11.9%) lastly smoked in mean 4.4 +/- 0.3 gestational weeks and the mean amount was 7.3 cigarettes/day. We found structural anomalies in 5 cases (Polydactylyl, Ileal agenesis, Both ear mass, Left ectopic kidney, Meningomyelocele) and 1 chromosomal abnormality case (Trisomy18). CONCLUSION: The rate of fetal structural anomaly was 2% in this study and is not more than baseline risk of general population. Therefore, evidence-based teratogenic risk counseling may prevent unnecessary pregnancy termination.

Fetal abnormalities in the fetal anomaly clinic at Siriraj Hospital.

In order to reduce perinatal morbidity and mortality rates, a Fetal Anomaly Clinic has been set up at Siriraj Hospital. The aims are to identify abnormal fetuses and manage them in an appropriate way before delivery. From 1st May, 2000 to 30th April, 2002, 142 pregnancies with fetal abnormalities out of 10,386 pregnant women examined were found at the Fetal Anomaly Clinic, Siriraj Hospital. There were 32 fetuses (22.5%) with CNS abnormalities and neural tube defects with a mean gestational age at diagnosis of 18.6 weeks, 12 fetuses (8.5%) with gastrointestinal abnormalities with a mean gestational age at diagnosis of 17.1 weeks, 12 cases (8.5%) with cardiovascular and pulmonary abnormalities with a mean gestational age at diagnosis of 24.8 weeks, 10 cases (7%) with skeletal abnormalities with mean gestational age at diagnosis of 26.7 weeks,15 cases (10.6%) with chromosome abnormalities with a mean gestational age at diagnosis of 21.7 weeks, 18 cases (12.6%) of KUB abnormalities with a mean gestational age at diagnosis of 25.6 weeks and 43 cases (30.3%) of other abnormalities with a mean gestational age at diagnosis of 24.5 weeks. Counsellings was given before making a decision and all abnormalities were confirmed by autopsy, amniocentesis, paediatric neonatologists or paediatric surgeons.

Transvaginal ultrasonographic detection of fetal abnormalities in the first trimester / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate the efficiency of transvaginal ultrasonography for detection of fetal anomalies in first trimester. METHODS: This cohort included pregnant women between 9~14 weeks of gestation from April 2000 to April 2002 at department of Obstetrics and Gynecology, Sanggye Paik hospital, Inje university. Besides ACOG (1993) criteria, we scan nuchal translucency, FHR, cranium, abdominal wall and nuchal lesion using transvaginal sonography. If the anatomical survey was normal, the women underwent routine 18~24 weeks anomaly scans. RESULTS: 20 fetuses were identified as having 21 anomalies. Central nervous system anomaly (38%: 8/21) was the most frequent type of malformation. The other detected anomalies were isolated disorders of the lymphatic system 28% (6/21: two cystic hygromas and four nuchal edema), cystic hygroma associated with hydrops 14% (3/21), abdominal wall defects 14% (3/21), skeletal dysplasia 5% (1/21). Of the 20 fetuses that was diagnosed, 14 patients had elective first-trimester abortion, two had spontaneous fetal deaths, four were delivered at term. CONCLUSION: Besides offering the possibility of early termination, first trimester sonography has the advantage of identifying a transient sonographic sign, nuchal edema, which can be used as a marker in screening for fetal chromosomal abnormalities.

The Clinical Study on the Incidence Rate and Cause of the Preterm Births / 대한주산의학회잡지

OBJECTIVE: The aim of study was to compare incidence rate and causes of the preterm birth that are the major factor of newborn mortality and morbidity. METHODS: Respectively there were 428 preterm deliveries out of 5,309 deliveries, from January to August 1995, and there were 319 preterm deliveries out of 2,028 deliveries, from January to August 2000 at Gill hospital, a hospital in affiliation with Gachon Medical School. The data were collected by review of the hospital record and the statistical analysis was performed using paired T-tests, Oneway ANOVA, Fisher's exact test, and statistics significance was defined as p<0.05. RESULTS: The incidence rate of the preterm birth increased from 8.1%(428/5,309) in 1995 to 15.7%(319/2,028) in 2000. Unknown causes of preterm birth decreased from 25.5%(109) to 20.2%(66). PPROM(Preterm premature rupture of the membranes) decreased from 26.9%(115) to 22.9%(73). IIOC(Incompetent internal os of cervix) decreased from 9.7%(41) to 6.9%(22). Uterine anomaly decreased from 1.6%(7) to 1.0%(3). And other causes deceased from 8.9%(38) to 5.1%(16). Multiple pregnancy increased from 10.1%(44) to 17.6%(56). Fetal anomaly increased from 2.1%(9) to 6.3%(20). Pregnancy induced hypertension increased from 7.9%(34) to 13.3%(42). There was not much change for the placental disorder or for placental abruption which decreased from 7.3%(31) to 6.7%(21). According to the analysis, there is a noticeable decrement in IIOC but noticeable increase in multiple pregnancy, fetal anomaly and PIH. CONCLUSION: Comparing the data from the preterm birth of 1995 and 2000, the unknown cause of the preterm birth is understood more accordingly to the decrement of known cause. The increase of multiple pregnancy seems to be caused by better in vitro fertilization. The increase of fetal anomaly is most likely caused by drug abuse, environmental pollution, and prenatal diagnosis. Differ from the decrease of previous research, the increase of PIH is caused by the increase of incidence of the preterm birth and also patients moving from private hospital to 3rd party hospital. We hope that we can continuously research the cause of the preterm birth and use that basic information to decrease the death and disease rates of newborn infants

Frequency of fetal anomaly and perinatal outcome in polyhydramnios / 대한산부인과학회잡지

OBJECTIVE: To determine the frequency of fetal anomaly and perinatal outcome in pregnant women with polyhydramnios. METHODS: Ultrasound examinations from January 1998 to August 2001 were reviewed to identify 170 patients with singleton pregnancy which diagnosed polyhydramnios. Frequency of fetal anomaly and perinatal outcomes were compared with amniotic fluid index (AFI) 20.0-25.0 cm as group 1 and AFI >25.0 cm as group 2. RESULTS: The prevalence of polyhydramnios was 0.54% (170/31,358). The types of structural anomalies were gastrointestinal system (10/34, 29.4%), genitourinary system (9/34, 26.5%), central nervous system (CNS, 6/34, 17.7%), cardiovascular system (CVS, 3/34, 8.8%), neuromuscular system (2/34, 5.9%), respiratory system (1/34, 2.9%) and others (3/34, 8.8%). The structural anomaies between two groups were significantly different. The rate of cesarean section, low 5-min Apgar score (25.0 cm) and genitourinary system anomaly was dominant in group 1 (AFI 20.0-25.0 cm). Polyhydramnios (AFI>25.0 cm) indicated an increased risk of severe fetal anomaly.

Clinical Analysis of Fetal Congenital Anomalies / 대한산부인과학회잡지

The term congenital anomalies here refers to structural defect (congenital malformations, deformations, disruptions and dysplasias), chromosomal abnormalities, inborn errors of metabolism and hereditary disease. The prevalence of major congenital malformation (i.e., defects either incompatible with life or severe enough to interfere with normal living) is about 2% to 3%. In the past, infection was one of the major cause of perinatal morbidity and mortality, but owing to the development of antibiotics and intensive care, congenital anomalies are becoming a major cause of perinatal morbidity and mortality. Perinatal diagnosis of congenital anomalies is becoming more important because appropriate perinatal care may minimize the effect of congenital anomalies. This report was based on the 234 cases of the congenital anomalies among 8,099 newborns delivered at Dankook University Hospital from Mar. 1st, 1995 to Feb. 28th, 2000. The analyzed results were as follows: 1. The overall incidence of the congenital anomalies was 2.9%. The incidence of congenital anomalies in male newborns (141, 60.2%) was statistically significantly higher than that of female (90, 38.5%) and ambiguous (3, 1.3%). 2. The incidence of the congenital anomalies of 21-25 year old maternal age was the lowest among each other age group. The incidence of this group was 1.6%, of less than 20 year old group was 2.7%, of over 35 year old group was 2.9%. But there was no statistically significant difference among each maternal age groups. 3. There was no statistically significant difference in the incidences of congenital anomalies between parity. 4. The incidence of low-birth weight less than 2,500 g in congenital anomalies was 9.2%, which was 5.1 times higher than that of the more than 2,500 g. 5. The incidence of vertex presentation in congenital anomalies (192, 82.1%) was very high compared to breech presentation (42, 17.9%). 6. In the method of deliveries, vaginal deliveries was 131 cases (56.0%) and cesarean section was 103 cases (44.0%). 7. The incidence of the congenital anomalies in stillbirth was 28.4%, which was 13 times higher than that of the live birth. 8. The perinatal mortality rate in congenital anomalies were 93 cases (39.7%) and stillbirths were 62 cases (28.4%). 9. When classified according to the type of congenital anomalies, the rate of the incidence was 13.3% (31 cases) in central nervous system, 9.4% (22 cases) in neck and face anomaly, 6.8% (16 cases) in cardiac anomaly, 1.3% (3 cases)in pulmonary anomaly, 5.5% (13 cases) in gastrointestinal anomaly, 13.7% (32 cases) in genitourinary anomaly, 18.4% (43 cases) in musculoskeletal anomaly, 9.0% (21 cases) in skin and soft tissue anomaly, 14.1% (33 cases) in multiple anomaly and 5.5% (13 cases) in chromosomal anomaly. The most common major congenital anomalies was hydrocephalus (14 cases, 5.9%) and polycystic kidney (14 cases, 5.9%). The rate of perinatal mortality of the congenital anomalies was 38.5%, particularly it was the highest in the CNS anomalies which were 89.7%, the next 50.0% in cardiopulmonary anomalies.

Efficacy of Prenatal Ultrasonographic Diagnosis of Congenital Anomalies

During a 6-year period, from January 1990 to December 1995, 101 neonates with congenital anomalies were admitted to the division of pediatric surgery of Youngdong Severance Hospital. Fifty eight of them had prenatally detectable anomalies by ultrasonography and all of them had prenatal screening more than once with ultrasound. The abnormalities were prenatally detected in 24 neonates (41%). The detection rate was 70% in patients who had the prenatal screening at our hospital, whereas, the rate was 24% when it was performed at other medical facilities. Duodenal and jejunoileal atresias showed the highest detection rate (86%) and the next was the abdominal mass. The esophageal atresia was suggested by maternal polyhydramnios in 3 patients (25%). The only one patient with diaphragmatic hernia (17%) and no patients with gastroschisis were prenatally detected. The mean interval from birth to operation was 32 hours in the prenatally detected patients and 50 hours in the nondetected. The complication rate and the mortality after emergency operation were 20% and 7% in the detected group and 58% and 23% in the nondetected, respectively. The average period of the hospitalization was 20 days in the detected group and 39 days in the nondetected. We conclude that the prenatal detection of anomalies was necessary in order to give adequate care to the mothers and the babies, including early transfer to the tertiary care hospital, the decision of the optimal timing of delivery and of the timing of operation for babies. The prenatal diagnosis was also helpful to reduce the operative complication and the mortality.

Ethical lssues of Prenatal Diagnosis and lntervention of Fetal Anomalies / 中国医学伦理学

This article suggests that doctors should keep the principle that patients’interest should be the first and respect the autonomy of pregnant woman during the prenatal diagnosis and intervention,and brings the ethical concept of fetus as a patient.Before prenatal diagnosis and intervention,doctors should tell the pregnant woman about the advantages and disadvantages of the project for her to make decision.For the fetus born with deformity but still having survival ability,fetal ethical principle prohibits against termination unless pregnant woman has diseases not permitting to continue pregnancy,although there is an increasing risk of morbidity and mortality.