Prognostic Implication of Associated Cleft Palate in Patients with Cleft Lip / 대한주산의학회잡지

OBJECTIVE: The objective of this study is to compare the pregnancy outcomes and postnatal developmental problems according to the types of cleft lip and/or palate, and to evaluate the increase of the risk of the presence of cleft palate. METHODS: Retrospective analysis was performed in 96 cases of cleft lip and/or palate that were delivered, aborted, or terminated at Seoul National University Hospital from January 1990 to July 2004. The cases of cleft lip and/or palate were categorized based on the Nyberg's classification, and cleft palate alone was added to it. According to the types, the frequencies of associated anomaly and chromosomal anomaly were assessed, and the frequencies of termination, spontaneous abortion, fetal death in utero, and infant death were compared. When long-term follow-up was possible among the surviving infants, we compared the frequencies of ventilatory tube insertion into the middle ear, hearing problem, and speech-language problem. We evaluated the increase of the risk in the presence of cleft palate. RESULTS: Associated anomalies were present in 23.7% (9/38) of cases with cleft lip alone and in 55.1% (32/58) of those with cleft palate. The most common associated anomaly was cardiac anomaly. The surviving infants with cleft palate showed significantly higher rates of ventilatory tube insertion (70.0% [14/20] vs 3.1% [1/32]) and speech-language problem (42.1% [8/19] vs 10.7 % [3/28]) than those with cleft lip alone. The presence of cleft palate increased the risk of occurrence of associated anomaly (OR 3.97), termination (OR 5.20), infant death (OR 12.96), ventilatory tube insertion (OR 72.33), and speech-language problem (OR 6.06). CONCLUSION: Associated cleft palate in patients with cleft lip has a poor impact on pregnancy outcomes, middle ear disease, and speech-language problem. Therefore, during the prenatal screening ultraso-nography, the careful examination should be directed for the detection of cleft palate in cases with cleft lip.

Eisenmenger syndrome in pregnancy at second and third trimester / 대한산부인과학회지

OBJECTIVE: Because women with Eisenmenger syndrome are counseled strongly not to conceive, pregnancy cases with Eisenmenger syndrome are rare in clinical situation. We performed this study to analyze pregnancies at second and third trimester complicated by Eisenmenger syndrome and to evaluate changes during pregnancy and their outcomes. METHODS: Medical records were reviewed retrospectively for Eisenmenger syndrome patients who delivered at second and third trimester at Seoul National University Hospital from January 1989 to October 2005. RESULTS: Among the total of 6 pregnant women, 4 women delivered after 34 weeks and 2 women had therapeutic termination during second trimester. All 4 women who delivered after 34 weeks were categorized as class III by New York Heart Association classification. Maternal mortality rate was 33% (2 of 6 cases). All mortality cases were patients who delivered after 34 weeks. All neonates were small for gestational age with no neonatal death. There was no neonatal morbidity except one case of congenital atrial septal defect. CONCLUSION: Maternal mortality occurred in half of the women who continued their pregnancy beyond second trimester. We think that pregnancy should be still discouraged in patients with Eisenmenger syndrome and that therapeutic abortion should be offered in early pregnancy period.

A Case of Intracranial Cavernous Hemangioma Diagnosed in Pregnancy / 대한산부인과학회지

The cavernous hamangioma is a relatively rare intracranial vascular malformation and generally asymptomatic, Seizure is the most common clinical presentation and the hemorrhage is the second. Because reproductive females have the hormonal and hemodynamic changes, the first symptoms might develope in the gestational period. As we experienced a case of intracranial cavernous hemangioma initially diagnosed in pregnancy with new-onset seizures, we report this case with a brief review of literature.

Perinatal Outcomes of Triplet Pregnancies / 대한산부인과학회지

OBJECTIVE: To evaluate the perinatal outcomes and maternal complications associated with triplet pregnancies. METHODS: Medical records of consecutive triplet pregnancies delivered in ( )( )Hospital from 1997 to 2005 were reviewed for maternal and neonatal outcomes. Pregnancies associated with lethal congenital anomalies or the case that being delivered before 20 weeks of gestation were excluded. Neonatal outcomes included respiratory distress syndrome, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage and low Apgar scores, congenital anomaly and so on. Maternal outcomes included preeclampsia, preterm delivery, anemia and blood transfusion and so on. RESULTS: The mean gestational age at delivery was 31.5+/-4.1 weeks, and the mean birth weight for triplets was 1,654.4+/-578.1 g. 31 of total 39 neonates (79.5%) were admitted to the neonatal intensive care unit, and 9 neonates (23.1%) received mechanical ventilator care as well. Neonatal death occurred in 6 of 39 neonates (15.4%). Congenital anomaly was seen in 3 of 39 neonates (7.7%). Hyperbilirubinemia developed in 16 of 39 neonates (44.4%). Respiratory distress syndrome developed in 3 of 39 neonates (7.7%). The most common maternal complication was preterm labor (76.9%), followed by anemia (46.1%), preterm premature rupture of membrane (30.8%) and blood transfusion (7.7%). Five patients (5/13, 38.5%) received tocolytic therapy. CONCLUSION: The main cause of neonatal death in triplet pregnancies is the respiratory distress syndrome in extreme preterm delivery. The most common neonatal morbidities are hyperbilirubinemia and apnea of prematurity. There is no difference in neonatal outcomes according to birth order. The most common maternal complications are preterm delivery and anemia. The adverse outcomes of triplet pregnancies are mainly due to preterm delivery.

Perinatal Outcomes of Triplet Pregnancies / 대한산부인과학회지

OBJECTIVE: To evaluate the perinatal outcomes and maternal complications associated with triplet pregnancies. METHODS: Medical records of consecutive triplet pregnancies delivered in ( )( )Hospital from 1997 to 2005 were reviewed for maternal and neonatal outcomes. Pregnancies associated with lethal congenital anomalies or the case that being delivered before 20 weeks of gestation were excluded. Neonatal outcomes included respiratory distress syndrome, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage and low Apgar scores, congenital anomaly and so on. Maternal outcomes included preeclampsia, preterm delivery, anemia and blood transfusion and so on. RESULTS: The mean gestational age at delivery was 31.5+/-4.1 weeks, and the mean birth weight for triplets was 1,654.4+/-578.1 g. 31 of total 39 neonates (79.5%) were admitted to the neonatal intensive care unit, and 9 neonates (23.1%) received mechanical ventilator care as well. Neonatal death occurred in 6 of 39 neonates (15.4%). Congenital anomaly was seen in 3 of 39 neonates (7.7%). Hyperbilirubinemia developed in 16 of 39 neonates (44.4%). Respiratory distress syndrome developed in 3 of 39 neonates (7.7%). The most common maternal complication was preterm labor (76.9%), followed by anemia (46.1%), preterm premature rupture of membrane (30.8%) and blood transfusion (7.7%). Five patients (5/13, 38.5%) received tocolytic therapy. CONCLUSION: The main cause of neonatal death in triplet pregnancies is the respiratory distress syndrome in extreme preterm delivery. The most common neonatal morbidities are hyperbilirubinemia and apnea of prematurity. There is no difference in neonatal outcomes according to birth order. The most common maternal complications are preterm delivery and anemia. The adverse outcomes of triplet pregnancies are mainly due to preterm delivery.

Ultrasonographic indicators in predicting postnatal outcomes of antenatally detected ventriculomegaly / 대한산부인과학회지

OBJECTIVE: The aim of this study was to find out the prognostic indicators of antenatally detected ventriculomegaly. METHODS: During the study period (Nov. 1995 through Jan. 2003), we identified 96 cases of fetal ventriculomegaly and reviewed their antenatal and postnatal follow-up records retrospectively. Excluding cases of termination before viable stage and incomplete follow-up, 68 cases were evaluated. Severe ventriculomegaly (fetal hydrocephalus; n=30) was defined as lateral ventricular atrial width (LVAW) greater than 15 mm, and mild ventriculomegaly (n=38) was defined as LVAW between 10 and 15 mm. Subgroup of LVAW <12 mm (n=23) was also analyzed. Antenatal workup included detailed ultrasonography, TORCH test and karyotyping. Outcome parameters were the presence of progressive lesion, NICU admission, shunt operation and critical damage that included delayed development, cerebral palsy and death after live birth. RESULTS: Overall survival rate was 89.7% (61/68) and the median postnatal follow-up duration was 17.0 (0.0-69.3) months. Severe ventriculomegaly group showed higher incidence of progressive lesion, NICU admission and shunt operation than did mild group. Within mild ventriculomegaly group, critical damage was more common in cases with associated anomalies, and this difference was present even in the subgroup of LVAW <12 mm (2/16 vs. 4/7, p<0.05). CONCLUSION: In mild ventriculomegaly group, comprehensive antenatal workup including detailed ultrasonography is important because associated anomaly is a poor prognostic factor, even in cases of LVAW <12 mm. In terms of critical damage such as developmental delay, cerebral palsy and postnatal death, the prognosis of cases with mild ventriculomegaly is also guarded.

Clinical features and prognosis in pregnant women with thyroid cancer / 대한산부인과학회지

OBJECTIVE: The aim of the present study is to evaluate pregnancy outcomes and whether to change disease progress of thyroid cancer during peripartum period in pregnant women diagnosed as thyroid cancer. to examine the effect of pregnancy on the prognosis of concomitant thyroid cancer. METHODS: The retrospective study was made by the review of medical records of 37 pregnancies of pregnant women with thyroid cancer, who had delivered in our hospital between Jan. 1990 and Jun. 2004. Pregnancy outcomes and treatment process were described. RESULTS: There were 37 deliveries of 34 women diagnosed as thyroid cancer among 23,303 deliveries of women who had delivered at our hospital during the study period. The mean age at operation for thyroid cancer and delivery was 26.7 +/- 3.6 years old and 30.1 +/- 3.8 years old, respectively. Regarding to the mode of delivery, there were 26 cases of vaginal delivery, 10 cases of cesarean section including emergency and one termination in 26-week gestational age because of severe fetal anomaly. Another women got a therapeutic abortion in 18-week gestational age because of subsequent unexpected pregnancy during postoperative radioiodine therapy. All of them undertook thyroid operation; thyroidecomy (9 cases of total thyroidectomy, 9 cases of subtotal thyroidectomy and 19 cases of lobectomy) and then got synthyroid and postoperative radioiodine therapy, if necessary. There were 11 women with relapse evidence of thyroid cancer during follow-up periods. And there was no difference of recurrence rate and clinical outcomes (e.g, lymph node metastasis or tumor size) between the group diagnosed as thyroid cancer during pregnancy and those with thyroid cancer who were not pregnant at the time of diagnosis. CONCLUSION: There was no difference in the relapse of thyroid cancer during the peripartum period. It is attributed that thyroid cancer has an excellent long-term prognosis and initial aggressive surgery and postoperative adjuvant management has developed. The women with thyroid cancer could be pregnant and deliver without a fear of relapse unless she is under radioiodine therapy or in aggravated disease state. We observed no increased risk in obstetric outcomes such as preterm delivery or small for gestational age.

A Case of Pregnancy in Patient with Pulmonary Lymphangioleiomyomatosis / 대한산부인과학회잡지

Pulmonary lymphangioleiomyomatosis is a rare disorder of unknown cause and characterised by hamartomatous proliferation of smooth muscle occurring in women of reproductive age exclusively. It causes dyspnea, recurrent pneumothorax, chylothorax, hemoptysis and respiratory failure eventually. Chest radiographs show diffuse interstitial infiltrates and cysts of uniform size, and pulmonary function tests often show airflow limitation with increase in residual volume. Hormonal factors are thought to play a role because it generally affects premenopausal women, but there is no definite treatment yet. We present an unusual case of pulmonary lymphangioleiomyomatosis during normal pregnancy with a review of literature.

Serum CA 19-9 levels in patients with endometriosis / 대한산부인과학회잡지

OBJECTIVE: To explore the efficacy of serum CA19-9 determination for the detection of endometriosis. DESIGNS: A retrospective analysis. MATERIALS AND METHODS: Preoperative serum CA19-9 and CA125 concentrations were measured in 53 patients with surgically and/or histologically diagnosed endometriosis. The extent of disease was staged according to the revised American Fertility Society (1985) classification system. RESULTS: Serum CA19-9 levels were elevated (>or=37 U/ml) in 13 (24.5%) out of 53 patients with endometriosis and serum CA125 levels were elevated (>or=35 U/ml) in 13 (24.5%). Either CA19-9 or CA125 levels in serum were elevated in 18 (34.0%) patients. In patients with stage III or IV endometriosis, elevated CA19-9 levels were noted in 11 (31.4%) of 35 patients, while CA125 in 12 (34.3%). Either CA19-9 or CA125 levels in serum were elevated in 15 (42.9%) of 35 patients with stage III or IV. CONCLUSION: These results suggest that serum CA19-9, in addition to CA125, measurement could help in identifying patients with moderate to severe endometriosis.

A Case of Postpartum Ovarian Vein Thrombosis After Vaginal Delivery / 대한산부인과학회잡지

When patients revisit hospital after delivery because of fever and lower abdominal pain, the diagnosis of ovarian vein thrombosis should be considered. If fever dose not fall promptly even with aggressive intravenous antibiotics therapy, a ultrasound or a CT scan should be obtained for prompt diagnosis and therapy. We report a case of postpartum ovarian vein thrombosis that detected by a CT scan and treated successfully with anticoagulation therapy.

Nonimmune hydrops fetalis: clinical characteristics and prognostic factors of neonatal survival / 대한산부인과학회잡지

OBJECTIVE: We undertook this study to find out clinical characteristics and prognostic factors of neonatal survival in nonimmune hydrops fetalis (NIHF). METHODS: From Oct. 1988 to Feb. 2001, 54 cases of nonimmune hydrops fetalis diagnosed at Seoul National University Hospital (SNUH) were included in our study. The incidence and perinatal mortality were investigated. The diagnostic work-up for associated conditions (or etiology) included detailed ultrasonography, karyotyping, fetal echocardiography, infection work-up (TORCH, parvovirus), and autopsy (if fetus was dead). Among 54 cases, 20 cases of liveborns were divided into two groups. Group I survived beyond neonatal period (survived>28 days) and group II did not (expired3 (OR=21, CI 1.77, 248.1; p3 (p<0.01). CONCLUSION: Over 3 of 1-min and 5-min AS were meaningful factors for neonatal survival in NIHF.