Relationship between Twin-to-twin Delivery Interval and Umbilical Artery Acid-base Status in the Second Twin

The purpose of this study was to determine the effect of twin-to-twin delivery interval on umbilical artery acid-base status of the second twin at birth. This was a retrospective cohort study of all live-born twins with measured acid-base status in umbilical arterial blood who were delivered after 34 weeks' gestation from June 2003 to February 2006. Twins with any maternal or fetal complications were excluded. Subjects were divided into two groups based on the mode of delivery of the first twin: normal cephalic vaginal deliveries (n=40) or cesarean deliveries (n=67). The inter-twin differences in umbilical arterial blood pH, PCO2, PO2, and base excess in twin newborns born vaginally were significantly greater than the corresponding differences in those born by cesarean section. A significant positive correlation was found between twin-to-twin delivery interval and inter-twin difference in umbilical arterial blood pH in twin newborns born vaginally. The umbilical arterial blood pH of the second twin was less than 7.0 in 14% (2/14) in cases delivered more than 20 min after the first twin. The umbilical arterial blood gas status of the second twin worsened with increasing twin-to-twin delivery interval, and pathologic fetal acidemia (pH<7.0) might develop in the second twin when the twin-to-twin delivery interval was greater than 20 min.

Cervical Length and the Risk of Microbial Invasion of the Amniotic Cavity in Women with Preterm Premature Rupture of Membranes

The aims of this study were to determine whether sonographically measured cervical length is of value in the identification of microbial invasion of the amniotic cavity in women with preterm premature rupture of membranes (PPROM) and to compare its performance with maternal blood C-reactive protein (CRP), white blood cell count (WBC), and amniotic fluid (AF) WBC. This prospective observational study enrolled 50 singleton pregnancies with PPROM. Transvaginal ultrasound for measurement of cervical length was performed and maternal blood was collected for the determination of CRP and WBC at the time of amniocentesis. AF obtained by amniocentesis was cultured and WBC determined. The prevalence of a positive amniotic fluid culture was 26% (13/50). Patients with positive amniotic fluid cultures had a significantly shorter median cervical length and higher median CRP, WBC, and AF WBC than did those with negative cultures. Multiple logistic regression indicated that only cervical length had a significant relationship with the log odds of a positive AF culture. Transvaginal sonographic measurement of cervical length is valuable in the identification of microbial invasion of amniotic cavity in women with PPROM. Cervical length performs better than AF WBC, maternal blood CRP, and WBC in the identification of a positive amniotic fluid culture.

Prediction of Prolonged Pregnancy in Nulliparous Women by Transvaginal Ultrasonographic Measurement of Cervical Length at 20-24 Weeks and 37 Weeks

This study was done to evaluate transvaginal ultrasonographic measurement of cervical length at 20 to 24 weeks and 37 weeks as a predictor of prolonged pregnancy (defined as a pregnancy that extended beyond 41+2 weeks of gestation [289 days]) in nulliparous women. This prospective observational study enrolled 149 consecutive nulliparous women with singleton gestation at 37 weeks. Cervical length was measured by transvaginal ultrasonography at 20 to 24 weeks and 37 weeks. Cervical length at 37 weeks, but not at 20 to 24 weeks, was significantly longer in women delivered at >41+2 weeks than in those delivered at < or =41+2 weeks (p<0.005). There was a significant correlation between cervical length at 37 weeks and gestational age at delivery (Pearson correlation coefficient, r=0.387, p<0.0001). In the receiver operating curve, the best cut-off value of cervical length at 37 weeks for the prediction of prolonged pregnancy was 30 mm, with a sensitivity of 78% and a specificity of 62%. Cervical length assessed by transvaginal ultrasonography at 37 weeks can predict the likelihood of prolonged pregnancy in nulliparous women. However, there is no association between cervical length at 20 to 24 weeks and the occurrence of prolonged pregnancy.

Reference range for fetal orbital parameters: A prospective longitudinal study / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to establish reference ranges for the fetal orbital diameters (OD) and outer orbital diameters at 16 to 38 weeks' gestation. METHODS: This prospective longitudinal study enrolled 41 consecutive women with uncomplicated singleton gestations during their first trimester of pregnancy. Serial measurements of the fetal orbits by ultrasound examination were performed at intervals of 4 weeks until 28 weeks, and then every 2 weeks until 36 weeks, and weekly thereafter. Linear regression was used for statistical analysis. RESULTS: A total of 331 fetal orbital diameters and 298 outer orbital diameters were measured. The reference ranges for orbital diameters and outer orbital diameters were presented as mean, 95% confidence interval of the mean and percentiles. A linear growth function was observed between gestational age (GA), orbital diameter (Y=0.654 x GA - 0.856; r2=0.948; p<0.0001) and outer orbital diameter (Y=1.679 x GA+0.510; r2=0.942; p<0.0001). Significant correlation was also found between orbital diameter and outer orbital diameter (Y=2.451 x OD+4.840; r2=0.906; p<0.0001). CONCLUSION: We have presented percentile tables and regression formulas for fetal orbital diameters and outer orbital diameters. These results provide normative data of the growth of the fetal orbit and may be useful in assessing fetal orbital architecture in patients at risk of ocular abnormalities.

Ultrasound assessment of fetal colon development during the third trimester of pregnancy: A prospective longitudinal study / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to establish a normal range for the outer diameter of the fetal transverse colon from 28 to 40 weeks' gestation. METHODS: This prospective longitudinal study enrolled 38 consecutive women with uncomplicated singleton gestations during their first trimester of pregnancy. Ultrasound for serial measurements of the fetal transverse colon diameter were performed at intervals of 2 weeks from 28 weeks to 36 weeks and then weekly until delivery. Linear regression was used for statistical analysis. RESULTS: A total of 201 transverse colon diameters were measured in all 38 fetuses. The normal range for the outer diameter of the transverse colon from 28 to 40 weeks' gestation was presented as mean, 95% confidence interval of the mean and range. A linear growth function was observed between gestational age (GA) and transverse colon diameter (TCD) (TCD=0.499 x GA - 0.5504, r2=0.65; p<0.0001). CONCLUSION: We have presented a table of normal range and a regression formula for outer diameter of the fetal transverse colon from 28 to 40 weeks' gestation. These data may serve as reference values in the detection of abnormalities of the fetal colon.

A Case of Heterotopic Pregnancy / 대한산부인과학회잡지

Heterotopic pregnancy, simultaneous intrauterine and extrauterine gestations, is a relatively rare condition with an estimated incidence of 1 in 30,000 pregnancies. The incidence of heterotopic pregnancies have increased in recent years because of rising incidence of pelvic inflammatory disease, pelvic surgery, expanding use of assisted reproductive technology. Common sites of extrauterine gestation are salpinx, cornus and cervix of uterus, ovary, and abdomen in order of incidence. Early detection of heterotopic pregnancy is very difficult and is often more difficult in the case of abdominal pregnancy. However, to avoid high maternal morbidity, mortality, and loss of pregnancy, one should always take this into consideration and should conduct careful and thorough gynecologic evaluations. We have experienced a case of abdominal pregnancy following termination of intrauterine pregnancy in a 23-year-old unmarried woman and report it with brief review of literatures.

Clinical Efficacy of Cervicography in Patients with Atypical Squamous Cells of Undetermined Significance (ASCUS) on Cervical Cytology / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to investigate the correlation between the cervicographic diagnoses and histologic diagnoses in patients with ASCUS cytologic diagnosis according to The Bethesda System. METHODS: This study was performed in outpatient clinic of Department of Obstetrics and Gynecology at Dankook University Medical Center from January 1, 2000 to July 31, 2000. Of the 120 patients who underwent both conventional Papanicolaou cervical cytologic test and cervicographic examination, 30 cases with ASCUS cytologic diagnosis were analyzed. Cervicographic diagnoses were compared with histologic diagnoses as a reference standard. RESULTS: Followings are the results summarized. 1. Age distribution was between 26 and 62. The mean age was 43.1 years. 2. The mean gravidity was 4.5 and the mean parity was 2.5. 3. There were 19 (63.3%) cervicographic diagnoses of Negative, 6 (20.0%) of Atypical, and 5 (16.7%) of Positive. Of the 5 Positive diagnoses, there were 3 cases of P0 and 2 cases of P1. 4. There were 1 (3.3%) histologic diagnosis of WNL, 23 (76.7%) diagnoses of cervicitis, 3 (10.0%) of LSIL, and 3 (10.0%) of HSIL. 5. Of the 19 cervicographic diagnoses of Negative, there were 17 histologic diagnoses of cervicitis, and 2 of LSIL. Of 6 cases of Atypical, there were 4 histologic diagnoses of cervicitis and 2 of HSIL. Of 5 cases of Positive, there were 3 histologic diagnoses of cervicitis, 1 of LSIL, and 1 of HSIL. 6. Cervicography for detecting LSIL or worse yielded sensitivity of 33.3%, specificity of 87.5%, positive predictive value of 40.0%, and negative predictive value of 84.0%. CONCLUSION: There was no statistical significance because of small data. Cervicography does not seem to replace conventional Papanicolaou cervical cytologic screening test or play an adjunctive role for detection of LSIL or worse in patients with ASCUS on cervical cytology. But a multicenter study with large data will be required to get the proper conclusion.

Three Cases of Endodermal Sinus Tumor of the Ovary / 대한산부인과학회잡지

The endodermal sinus tumor (EST) is the second most common form of malignant germ cell tumor of the ovary. It accounts for 22% of germ cell lesions and the median age of the patients is 19 years. Three fourths of the patients are initially seen with a combination of abdominal pain and abdominal or pelvic mass. Acute pain is caused by torsion of the tumor and the symptoms are acute and may lead to the diagnosis of acute appendicitis or a ruptured ectopic pregnancy. The tumor is usually large with most tumors measuring between 10 and 30 cm diameter. These neoplasms are highly malignant. In the past, these tumors were once almost uniformly fatal within 2 years of diagnosis, but recent advances in treating the EST of the ovary with the combination chemotherapy result in improvement of the prognosis. Management of younger patients with early stage ovarian EST who desire to preserve fertility can be a challenging problem, and treatment strategies which can save ovarian function must be considered. We have experienced three cases of endodermal sinus tumor in three women (Ic, 18 years; IIc, 20 years; Ic and right proximal femur metastasis, 21 years) and report them with eager review of literatures.

A Clinical Study of Placental Adhesions: Placenta Accreta, Placenta Increta, and Placenta Percreta / 대한산부인과학회잡지

OBJECTIVE: The objective of this study is to investigate the clinical characteristics of placental adhesions in order to improve maternal and fetal well-beings. METHODS: We reviewed the medical records of twenty cases of placental adhesions from January 1, 1995 to December 31, 1999 in Dankook University Medical Center. RESULTS: The incidence of placental adhesions is 0.267%. Of them, the percentage of placenta accreta was 35%, placenta increta, 60% and placenta percreta, 5%. Placental adhesions were observed more often in multipara (80%) than nullipara (20%). Co-existing placenta previa (50%), previous cesarean delivery (40%), multigravidity (5 or more; 40%) and previous artificial abortion (70%) were associated with placental adhesions. 85% of placental adhesions were treated by hysterectomy in order to manage postpartal uterine bleeding. Packed red cell transfusions were necessary in 18 cases of placental adhesions (90%). Maternal complications were wound infection (10%), disseminated intravascular coagulation, throm- boembolism, stress ulcer, postoperative fever, bladder perforation, pulmonary edema, and pleural effusion etc. Fetal complications were preterm birth (30%), neonatal death (5%), and fetal death in utero (10%). CONCLUSION: This study revealed that placental adhesions show grave maternal and fetal complications. Obstetricians should examine carefully to confirm placental adhesions and prepare thoroughly the postpartal emergency-care, especially in the high-risk gravida.

A Case Of Pelvic Actinomycosis Complicated By Tuboovarian Abscess / 대한산부인과학회잡지

Pelvic actinomycosis is a chronic suppurative and granulomatous disease with multiple abscess and draining sinus tracts caused by Actinomyces, a Gram-positive, anaerobic, non-acid-fast bacterium. Pelvic actinomycosis is a rare disease, but it is more common with intrauterine device users than others. The symptoms and signs of pelvic actinomycosis are variable, from asymptomatic to mimicking the symptoms and signs of pelvic mass or acute peritonitis, and sometimes it is difficult to discriminate pelvic malignancy from actinomycosis. Identifying the typical "sulfur granule" with hematoxylin-eosin stain and detecting the actinomycotic colony in Gram stain may suggest the diagnosis. We have experienced a case of pelvic actinomycosis complicated by right tuboovarian abscess in a 39-year-old woman using intrauterine device and report it with brief review of literatures.

A Case Of Pelvic Actinomycosis Complicated By Tuboovarian Abscess / 대한산부인과학회잡지

Pelvic actinomycosis is a chronic suppurative and granulomatous disease with multiple abscess and draining sinus tracts caused by Actinomyces, a Gram-positive, anaerobic, non-acid-fast bacterium. Pelvic actinomycosis is a rare disease, but it is more common with intrauterine device users than others. The symptoms and signs of pelvic actinomycosis are variable, from asymptomatic to mimicking the symptoms and signs of pelvic mass or acute peritonitis, and sometimes it is difficult to discriminate pelvic malignancy from actinomycosis. Identifying the typical "sulfur granule" with hematoxylin-eosin stain and detecting the actinomycotic colony in Gram stain may suggest the diagnosis. We have experienced a case of pelvic actinomycosis complicated by right tuboovarian abscess in a 39-year-old woman using intrauterine device and report it with brief review of literatures.

Clinical Significance of Conventional Papanicolaou Cervical Cytology Test: A Cytohistologic Comparison / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to obtain an important basic data which would be useful not only in clinical practice but also in clinical trial of ThinPrep Pap Test and Computerized Screening Test as the new trends of cervical cancer detection, by analyzing the conventional Papanicolaou cervical cytologic test according to The Bethesda System (TBS) and investigating the correlation between abnormal cytologic diagnoses and histologic diagnoses. METHODS: This study was performed in Obstetrics and Gynecology outpatient clinic (OG group: high risk and screening population) and in Health Check-up Center/Industrial Medicine clinic (HC group: screening population) at Dankook University Medical Center from January 1, 1999 to December 31, 2000. Ten thousand and seven hundred eighty seven cases (5,019 cases in OG group and 5,768 cases in HC group) who underwent conventional Papanicolaou cervical cytologic test were analyzed. Abnormal cytologic diagnoses ([Atypical Squamous Cells of Undetermined Significance (ASCUS) or worse]) were compared with histologic diagnoses as a reference standard. RESULTS: Followings are the results summarized. 1. Of the 10,807 patients, 20 (0.19%) were diagnosed as unsatisfactory for evaluation. Of 10,787 cases, there were 5,501 (51.00%) cytologic diagnoses of Within Normal Limit (WNL), 4,911 (45.53%) of Benign Cellular Change (BCC), 168 (1.56%) of ASCUS, 67 (0.62%) of Low-grade Squamous Intraepithelial Lesion (LSIL), 89 (0.83%) of High-grade Squamous Intraepithelial Lesion (HSIL), 34 (0.32%) of Squamous Cell Carcinoma (SCC), 16 (0.15%) of Atypical Glandular Cells of Undetermined Significance (AGUS) and 1 (0.01%) of Adenocarcinoma (ACC), respectively in conventional Papanicolaou smear series. The ASCUS/SIL ratio was 1.08. Statistically, there were more cytologic diagnoses of WNL, ASCUS, LSIL, HSIL, and SCC in OG group but BCC in HC group. 2. The age distribution of patients were as follows: 9 cases under 19 years, 1,011 in the 20's, 3,244 in the 30's, 3,110 in the 40's, 2,218 in the 50's, 1,035 in the 60's, 148 in the 70's, and 12 over 80 years. The mean age was 44.03 years. The mean age of HC group was significantly higher than that of OG group. The mean ages of BCC and ASCUS in HC group were significantly higher than those in OG group. 3. Of 10,787 cases, there were 375 abnoraml cytologic diagnoses (ASCUS/AGUS or worse): 245 in OG group and 130 in HC group. Statistically, there were more high-grade cytologic diagnoses (HSIL, SCC, and ACC) both in older age and in OG group. 4. Of 375 cases with abnormal cytologic diagnoses, 176 patients had histologic diagnoses. Of the 56 ASCUS, 21 (37.5%) showed positive histologic LSIL or worse diagnoses. Of the 112 cytologic LSIL or worse cases, 91 (81.25%) showed positive histologic LSIL or worse diagnoses. Of 176 cases, 105 (59.66%) showed high-grade histologic diagnoses (HSIL or worse). Of the 7 AGUS, 5 (71.43%) showed HSIL or worse diagnoses. There was a statistically significant relation between cytologic diagnoses and high-grade histologic diagnoses in squamous abnormalities. CONCLUSION: This study showed that our data according to TBS criteria were similar to other reports in the literatures. There were statistically significant difference between OG group and HC group in age and some diagnoses. And there was a statistically significant relation between cytologic diagnoses and high-grade histologic diagnoses in squamous cell abnormalities. This study will play a relevant role in clinical trial of ThinPrep Pap Test and Computerized Screening Test as well as in clinical practice.

A Case of Low-Grade Endometrial Stromal Sarcoma of the Uterus (So-Called "Endolymphatic Stromal Myosis") / 대한산부인과학회잡지

Uterine sarcomas are relatively rare tumors of mesodermal origin that constitute 2-6% of uterine malignancies. Uterine sarcomas include endometrial stromal sarcoma (ESS), leiomyosarcoma (LMS), malignant mixed m llerian tumor (MMMT) of both homologous and heterologous type, pure heterologous sarcomas, blood vessel sarcomas, and lymphoma. Endometrial stromal tumors are divided into three types: 1) endometrial stromal nodule, 2) low-grade stromal sarcoma or endolymphatic stromal myosis, and 3) endometrial stromal sarcoma. The low grade endometrial stromal sarcoma is very rare. It shows occasional local recurrence, which might arise from endometrial stroma, from adenomyosis, and rarely from endometriosis. We have experienced a case of low grade endometrial stromal sarcoma of the uterus in a 54-year-old woman, which is presented with a review of literatures.