Prophylactic Hypogastric Artery Ballooning in a Patient with Complete Placenta Previa and Increta

Abnormal attachment of the placenta (Placenta accreta, increta, and percreta) is an uncommon but potentially lethal cause of maternal mortality from massive postpartum hemorrhage. A 33-yr-old woman, who had been diagnosed with a placenta previa, was referred at 30 weeks gestation. On ultrasound, a complete type of placenta previa and multiple intraplacental lacunae, suggestive of placenta accreta, were noted. For further evaluation of the placenta, pelvis MRI was performed and revealed findings suspicious of a placenta increta. An elective cesarean delivery and subsequent hysterectomy were planned for the patient at 38 weeks gestation. On the day of delivery, endovascular catheters for balloon occlusion were placed within the hypogastric arteries, prior to the cesarean section. In the operating room, immediately after the delivery of the baby, bilateral hypogastric arteries were occluded by inflation of the balloons in the catheters previously placed within. With the placenta retained within the uterus, a total hysterectomy was performed in the usual fashion. The occluding balloons were deflated after closure of the vaginal cuff with hemostasis. The patient had stable vital signs and normal laboratory findings during the recovery period; she was discharged six days after delivery without complications. The final pathology confirmed a placenta increta.

Update in management of gestational diabetes mellitus / 대한주산의학회잡지

Women with gestational diabetes mellitus (GDM) are at increased risk for adverse outcome during pregnancy and the development of type 2 diabetes, cardiovascular disease, metabolic syndrome after pregnancy. Offspring of women with GDM are at increased risk of obesity, glucose intolerance, and diabetes in late adolescence and young adulthood. For preventing complication, patients diagnosed with GDM should monitor their blood glucose level, physical activity, and undergo nutritional counseling for the purpose of maintaining normoglycemia, but not meeting glycemic goals with dietary changes alone should begin insulin therapy. After delivery, patients with prior gestational diabetes mellitus, especially history of obesity, hyperglycemia, insulin treatment during pregnancy, should be tested for diabetes annually. Offspring of women with GDM should be followed closely for the developing of obesity and impaired glucose tolerance.

Prenatal Diagnosis of Cystic Hygroma at Axillar / 대한주산의학회잡지

Fetal cystic hygroma is a congenital malformation of the lymphatic system resulting from the jugular-lymphatic obstruction sequence. This is characterized by single or multiple cysts within the soft tissues, usually involving the neck and is easily diagnosed by prenatal ultrasonography. We report a case of axillary cystic hygroma which was diagnosed by ultrasonography at 25 weeks of gestation with a brief review of related literatures.

A Fetus with Persistent Hyperextended Neck Complicated with Ventriculomegaly and Pulmonary Immaturity in Third Trimester / 대한주산의학회잡지

Hyperextended neck of the fetal head is among the various fetal attitudes detected by prenatal sonography. Various etiologies may lead to hyperextension of the fetal head, including fetal anomalies such as structural abnormalities, conjoined twins and fetal neck masses, nuchal cord and uterine factors such as leiomyoma and uterine malformations. The importance of the precise prenatal diagnosis of this condition relates not only to the delivery mode, but also to the detection of associated conditions, as noted above. We report a case of a fetus whose persistent hyperextended neck was detected by midtrimester sonography, and who later demonstrated ventriculomegaly and lung immaturity in the 3rd trimester.