Herniated Nucleus Pulposus during Pregnancy / 대한주산의학회잡지

A herniated nucleus pulposus (HNP) during pregnancy has been a rare occurrence with a reported incidence of 1:10,000 case. It is hard to diagnose because of the potentially hazardous effect of ionizing radiation to the fetus when complaining back pain during pregnancy. In this case, magnetic resonance imaging (MRI) provide safe and useful modality and in general, back pain usually respond readily to conservative treatment. Cauda equina syndrome or severe and/or progressive neurologic deficit is a medical emergency that necessitates prompt surgery during pregnancy. She admitted at 31 weeks gestation for sudden development of right leg paresthesia and ankle motor weakness, an MRI showing compression on right nerve root at the level of L5~S1. After 4 weeks treated with bed rest and analgesics, we delivered by cesarean section and laminectomy at the same time. We have experienced a pregnancy with HNP, so report of this case with brief review of literature.

The perinatal outcome of vaginal delivery in twin pregnancy / 대한산부인과학회지

OBJECTIVE: To evaluate the perinatal outcome of vaginal delivery in twin pregnancy according to the presentation of the fetus. METHODS: A total of 274 cases suitable to this objective were selected from the 301 cases of twin pregnancy delivered between March 2000 and February 2005. They were categorized into 3 groups according to the presentation of the fetus; vertex/vertex as the group A (133 cases), vertex/nonvertex as the group B (80 cases), nonvertex in the first twin as the group C (61 cases). And then each group also was divided into 2 subgroups according to the mode of delivery; vaginal delivery and cesarean delivery. The difference between the subgroups in each group as to perinatal outcome was retrospectively compared and analyzed for statistical significance. RESULTS: The incidence of vaginal delivery in group A (46/133, 34.6%) was significantly higher than in group B (5/80, 6.3%) and C (5/61, 8.2%). A total of 218 (79.6%) cases were underwent the cesarean delivery and the most common indication of cesarean delivery was elective twin cesarean delivery in all 3 groups (65.4%, 93.8%, 91.8% respectively). The incidence of neonatal admission to the neonatal intensive care unit was, however, higher in vaginal delivery (40.2%) than in cesarean delivery (32.8%) in group A. The most common cause for neonatal intensive care unit admission was low birth weight for simple observation, and average admission dates of vaginal delivery was 17.0 days and cesarean delivery was 16.8 days. CONCLUSION: Vaginal delivery of twins depends on the presentation of the fetus, but no significant difference in perinatal outcome of group A were observed between the mode of delivery. Therefore attempt to decrease the incidence of elective twin cesarean delivery in group A is demanded.

Perinatal Outcomes of Twin-Twin Transfusion Syndrome according to Clinical Stage based on Sonographic findings / 대한산부인과학회지

OBJECTIVE: After classifing the twin-twin transfusion syndrome (TTTS) according to clinical stage by Quintero, we reviewed effectiveness and usefulness of clinical stage by Quintero in diagnosis and treatment of TTTS. METHODS: Twelve cases (16%) were diagnosed as TTTS among 75 examples (31.3%) of monochorionic twin pregnancy out of 240 cases of twin pregnancy born in our hospital between Mach 2000 and June 2004. For TTTS, the clinical stage was decided at the time of initial diagnosis, and any changes of it were observed according to the developments of pregnancy. Neonate was regarded as alive when 5 minutes Apgar score was above 7 after birth. Also we observed the vascular anastomosis of placenta, and classified the method of treatments and its results according to each clinical stage. RESULTS: Two cases were classified into the clinical stage 1 through 4 each, and 4 cases in the clinical stage 5. The higher the clinical stage, the shorter the duration between diagnosis and delivery (p<0.05). In cases of both survivors, compared to no survivors, the interval between diagnosis and delivery were long (p<0.05). In the clinical stage 4 and 5, we found many cases that didn't have placental vascular anastomosis between artery and artery, and in this case, there revealed poor perinatal outcomes. For 4 cases that fell in the clinical stage 1 and 2 and 4, we performed amnioreduction and for one case in the clinical stage 2, we did amnioseptostomy at the same time. In 4 cases with amnioreduction or amnioseptostomy, survival rate was 38%. CONCLUSION: The clinical classification system of TTTS by ultrasound would be helpful for planning treatments and also for predicting the outcomes.