Postpartum Spontaneous Intrahepatic Hemorrhage and Hepatic Rupture in the HELLP Syndrome / 대한산부인과학회잡지

The HELLP syndrome, which is characterized by hemolysis, elevated liver enzymes and low platelets, complicates 4 to 14% of preeclamptic or eclamptic pregnancy. Its course is usually benign except when spontaneous hepatic rupture, a rare catastrophic event, threatens life. The authors have experienced one case of spontaneous hepatic rupture in HELLP syndrome during immediate postpartum period, which was treated with surgical intervention on the first postpartum day. We report this case with a brief review of the literatures.

A Case of de Novo Interstitial Deletion 16(Q13q22) / 대한주산의학회잡지

Deletion of the long arm of chromosome 16 is uncommon. The causes of deletion are two: one is unbalanced translocation and the other is de novo deletion. In our case, a baby was born with characteristics of the deletion of the long arm of chromosome 16: distinct craniofacial dysmorphism, mild hydrocephalus, ventriculoseptal defect, coarctation of aorta, short neck, low set, small and posterially rotated ears and shortening of long bones. High resolution GTG and RBG banding analyses revealed a karyotype: 46, XY, del(16)(q13q22) de novo.

Two Cases of Complete Remission of Gestational Trophoblastic Disease in Oophorectomized Patients / 대한부인종양콜포스코피학회잡지

Although chemotherapy remains to be the mainstay of treatment of trophoblastic disease, hysterectomy has been performed as the primary management of nonmetastatic trophoblastic disease who desire sterilization and for uterine disease resistant to chemotherapy. Clinically, the documentation of disease regression is provided by serial quantitative serum beta-hCG assays and the persistent disease may be indicated when the serum beta-hCG values rise for 2 weeks or plateau for 3 weeks or more. Because of similarity in molecular structure, the confounding effect of an elevated LH on beta-hCG assessment in castrated women after treatment for trophoblastic disease has been documented. This LH cross-reactivity may be suspected in women with bilateral oophorectomy demonstrating persistent low levels of beta-hCG. It is particularly true when the assay is perfo-rmed by conventional polyclonal radioimmunoassay. We have experienced two cases of nonmetastatic trophoblastic disease whose serum beta-hCG assay plateaued at a low level after total abdominal hysterectomy with bilateral salpingo-oophorectomy and chemotherapy. Clinical and radiologic work-ups were done for metastatic lesion in dose patients, but the results were negative. The quantitative LH assays (Serono LH MAIAclone kit, Roma, Italy) were performed with the sera obtained from the patients; the results were 37 and 31 mIU/ml (1st IRP) with beta-hCG of 14 and 13 mIU/ml (1st IRP), respec-tively. With the initiation of oral estrogen replacement thrapy to those patients, the quantitative beta-hCG values fell below 5 mIU/ml (1st IRP) and they remained in complete chemical remission without any additional chemotherapy for one year. The persistant low titers of beta-hCG in those patients were considered to be result of LH cross-reactivity on beta-hCG assessment. It is concluded that whenever the assay of beta-hCG shows persistent low titers in the oophorectomized patient for treatment of trophoblastic disease, LH cross-reactivity should be suspected.

Two Cases of Complete Remission of Gestational Trophoblastic Disease in Oophorectomized Patients / 대한부인종양콜포스코피학회잡지

Although chemotherapy remains to be the mainstay of treatment of trophoblastic disease, hysterectomy has been performed as the primary management of nonmetastatic trophoblastic disease who desire sterilization and for uterine disease resistant to chemotherapy. Clinically, the documentation of disease regression is provided by serial quantitative serum beta-hCG assays and the persistent disease may be indicated when the serum beta-hCG values rise for 2 weeks or plateau for 3 weeks or more. Because of similarity in molecular structure, the confounding effect of an elevated LH on beta-hCG assessment in castrated women after treatment for trophoblastic disease has been documented. This LH cross-reactivity may be suspected in women with bilateral oophorectomy demonstrating persistent low levels of beta-hCG. It is particularly true when the assay is perfo-rmed by conventional polyclonal radioimmunoassay. We have experienced two cases of nonmetastatic trophoblastic disease whose serum beta-hCG assay plateaued at a low level after total abdominal hysterectomy with bilateral salpingo-oophorectomy and chemotherapy. Clinical and radiologic work-ups were done for metastatic lesion in dose patients, but the results were negative. The quantitative LH assays (Serono LH MAIAclone kit, Roma, Italy) were performed with the sera obtained from the patients; the results were 37 and 31 mIU/ml (1st IRP) with beta-hCG of 14 and 13 mIU/ml (1st IRP), respec-tively. With the initiation of oral estrogen replacement thrapy to those patients, the quantitative beta-hCG values fell below 5 mIU/ml (1st IRP) and they remained in complete chemical remission without any additional chemotherapy for one year. The persistant low titers of beta-hCG in those patients were considered to be result of LH cross-reactivity on beta-hCG assessment. It is concluded that whenever the assay of beta-hCG shows persistent low titers in the oophorectomized patient for treatment of trophoblastic disease, LH cross-reactivity should be suspected.

Comparative Study of Perinatal Outcome and the Incidene of Congenital Anomalies of Babies Born after Intracytoplasmic Sperm Injection (ICSI) and Conventional In-vitro Fertilization (IVF) / 대한불임학회지

The safety of ICSl as a novel procedure of assisted fertilization may be assessed by the health of the baby born. In order to evaluate the safety of ICSI, perinatal outcome and congenital anomaly of the babies born after ICSI were compared with those of babies born after IVF (control group). We analysed the clinical data from the obstetric and pediatric records, including the information obtained through telephone. The results are as follows; Mean gestaional age (+/-SEM) and birth weight in singleton pregnancy were 38.8+/-1.9 weeks and 3209.7+/-501.9gm in IVF group, 39.0+/-2.2 weeks and 3289.9+/-479.5gm in ICSI group, respectively. Mean gestational age and birth weight in twins were 36.8+/-2.1 weeks and 2512.8+/-468.0gm in IVF group, 36.5+/-2.8 weeks and 2492.7+/-537.1gm in ICSI group. In IVF group, perinatal mortality rates were 8.5 in singletons and 56.6 in twinst for the ICSI singletons and ICSI twins, the perinatal mortality rates were 11.6 and 49.0, respectively. The incidence of congenital malformations was 3.6% (8/224) in IVF group and 2.1% (4/188) in ICSI group, there was no statistical difference (p>0.05, Fisher's exact test). The incidence of major congenital anomalies was 0.9% (2/224; pulmonary artery hypoplasia, renal cystic dysplasia) in IVF group and 1.1% (2/188; holoprosencephaly, Cri du chat syndrome) in ICSI groups (p>0.05, Fisher's exact test). Similarly, there was no significant difference in incidence of minor congenital anormalies 2.7% (6/224) in IVF group and 1.1% (2/188) in ICSI group respectively (p>0.05, Fisher's exact test). In conclusion, there was no difference in the perinatal outcome and the incidence of congenital anomalies between the babies born after ICSI and those after conventional IVF.

The Affects of the Initial Fetal Number on Pregnancy Outcomes before Multifetal Pregnancy Reduction / 대한산부인과학회잡지

Multifetal pregnancy reduction(MFPR) appears to be an efficacious method for impro-ving the perinatal outcome of high order multifetal pregnancies(three or more fetuses). But it is controversial that larger initial fetal number before MFPR affects pregnancy outcomes adversely. The purpose of this study is to determine the affects of the initial fetal numbers on pregnancy outcomes and to compare the obstetrical outcomes according to the initial fe-tal numbers. Eighty four patients who conceived triplet or more by assisted reproductive technology(ART) in our infertility clinics and underwent MFPR to twins between January 1993 and December 1995. Sixteen patients were lost follow-up. Among the remaining 68 patients, four pateints were excluded from this study because of the pregnancy loss before 20 weeks gestation. The patients(n=64) were divided into three groups by the initial fetal number before reduction. 33 patients with triplet gestations(group 1), 18 patients with qua-druplets gestations(group 2), and 13 patients with quintuplet or more gestations(group 3) were retrospectively enrolled. Gestational age at delivery and birthweights were compared according to the initial fetal numbers. The mean maternal age was similar in each three groups. The results were as follows : 1) Although there was a trend of decreasing gestati-onal weeks at delivery and decreased birthweight in each groups(mean+/-SEM : 36.9+/-0.3, 34.7+/-1.3, 32.7+/-1.9 and 2,600+/-58, 2,161+/-215, 1,855+/-249 respectively), there were no stati-stical difference between group 1 and group 2, but there were significantly lower in group 3, compared with group1(p < 0.05). 2) The incidence of birth before 36 weeks gestation in each group 1, group 2, and group 3 were 12.1%, 38.9%, and 53.8% respectively(p < 0.05). 3) The incidence of low birthweight( < 2,500gm) in each group 1, group 2, and group 3 were 30.3%, 55.6%, and 69.2% respectively(p < 0.05). In conclusion, although MFPR reduced the high order multifetal pregnancy into twin pregnancy, the duration of gestation and the birth weight of newborn were still had a tendency of shortening and low respectively in high order multifetal pregnancy. Therefore strict control of the number of dominant follicles during superovulation and the number of transfered embryo in in vitro fertilization(IVF) is required for improving the pregnancy outcomes in ART.