Clinical review of midtrimester amniocentesis / 대한산부인과학회지

OBJECTIVE: To compare the usefulness of prenatal screening tests for chromosomal abnormalities by analyzing the cytogenetic results of midtrimester amniocentesis METHODS: We reviewed a total of 1264 cases of midtrimester prenatal genetic amniocentesis performed from February 1997 to September 2003, of which accorded to indications of cytogenetic studies. Cytogenetic results were analyzed with the distribution of maternal age, indications of amniocentesis. RESULTS: The most common age of total subjects was in between 35-39 years (37.1%). The indications of amniocentesis were abnormal maternal serum marker (60.0%), advanced maternal age (34.8%), abnormal ultrasonographic findings (3.2%), in order. The overall incidence of chromosomal aberration was 3.9% (49/1264). No significant difference was found between the mean maternal age with and without abnormal fetal karyotype. According to indications, there was 12.5% (5/49) of chromosomal abnormalities in abnormal sonographic finding group, 5.2% (36/688) in abnormal maternal serum screening group and 2.4% (12/498) in advanced maternal age group. There was statistical significance (P=0.004) only in abnormal ultrasonographic finding group. CONCLUSION: Ultrasonography was become to be more important due to development of high resolution ultrasonography, skillful technique and awareness of sonographic markers. Ultrasonographic abnormality could be the most predictive marker for abnormal fetal karyotypes.

Clinical and Pathologic Study of Abnormal Uterine Bleeding in Premenopausal Women-To Evaluate the Prognostic Variables of Endometrial Hyperplasia / 대한산부인과학회잡지

OBJECTIVE: We performed this study to understand correlation between clinical aspects and pathological findings of abnormal uterine bleeding (AUB) and to evaluate the prognostic variables of endometrial hyperplasia. METHODS: We reviewed 500 premenopausal women with abnormal uterine bleeding who underwent endometrial biopsy from January 1996 to February 2003, retrospectively. Pregnant women, or women who had hematologic disease, or who used iatrogenic hormones were excluded. The age of women with AUB was mostly in the 5th decade (41.3 +/- 6.8). Body mass index (BMI) in most of women (69.6%) was between 18.6 and 24.9 (22.7 +/- 3.5). RESULTS: Among AUB menorrhagea (51.0%) was the most common bleeding pattern, and the next one was intermenstrual bleeding (38.0%). Histologic findings of endometrium were proliferative phase (34.0%), hyperplasia (26.4%), and seceretory phase (22.6%), in order of frequency. 79.0% (104 cases) of endometrial hyperplasia were simple hyperplasia, 16.0% (21 case) were complex hyperplasia, and 5.0% (7 case) were atypical hyperplasia. The associated diseases were myoma uteri, hypertension, and diabetes mellitus, in order of frequency. The endometrial hyperplasia was diagnosed in 46.4% of patients whose BMI was between 27.0-29.9, in 40% of patients between 30.0-34.9 and in 100% of patients whose BMI was 35.0 or more. The endometrial hyperplasia was diagnosed in 40.6% of patients with an endometrial thickness measured 15.1 mm to 20.0 mm, in 57.1% of patients with 20.1 mm to 25.0 mm, and in 100% of patients with 25.1 mm or higher. CONCLUSION: In premenopausal woman with AUB, the endometrial hyperplasia was highly associated with women whose BMI was 27.0 or higher, or with endometrial thickness measured more than 15.0 mm. Therefore endometrial biopsy should be taken in women with AUB whose BMI is high, or endometrial thickness is thick to exclude the endometrial hyperplasia.

Maternal Morbidity and it's Risk Factors in Eclamptic Woman / 대한산부인과학회잡지

OBJECTIVE: To identify risk factors for maternal morbidity in eclamptic woman. METHODS: A retrospective analysis was performed on the record of eclamptic woman during from August 1989 to February 2002. Univariate analysis was used to determine which of the independent variables were significantly different between two groups (antepartum vs postpartum). RESULTS: The incidence of eclampsia was 1 in 1,795 deliveries and the maternal mortality rate was 4.3%. Maternal complications associated with eclampsia were abruptio placentae (13.0%), pulmonary edema (26.1%), acute renal failure (39.1%), HELLP syndrome (30.4%), disseminated intravascular coagulopathy (8.7%), neurologic sequelae (8.7%), maternal death (4.3%). One patient died from disseminated intra- vascular coagulopathy, sepsis, and multiorgan failure after postpartum eclampsia. Women with antepartum eclampsia had higher incidence of acute renal failure (44.4% vs 20%) and HELLP syndrome (33.3% vs 20%) than did in women with postpartum eclampsia. Conversely, women with postpartum eclampsia had higher incidence of disseminated intravascular coagulopathy (6.7% vs 20%) and neurologic sequelae (6.7% vs 20%). CONCLUSION: Early detection and management of preeclampsia can prevent the eclampsia and maternal mortality and morbidity.

Effects of Oligohydramnios on Perinatal Outcome and Latency Period in Patients with Preterm Premature Rupture of Membranes / 대한주산의학회잡지

OBJECTIVES: To examine the effects of the oligohydramnios on perinatal outcome and latency period in patients with preterm premature rupture of membranes. METHODS: We performed a retrospective analysis of 98 singleton pregnancies complicated by preterm premature rupture of membranes, with delivery between 26 and 35 weeks' gestation. Amniotic fluid index was determined using transabdominal ultrasound at admission. All medical records of mothers and neonates were reviewed. Oligohydramnios was defined as amniotic fluid index less or equal to 5.0 cm and latency period was defined as time interval from membrane rupture to delivery. Chi-spuare test, Fisher's exact test, Student-t test, Mann-Whitney U test were used for statistical analysis. RESULTS: 1) Of the 98 patients, 59 patients(60%) were oligohydramnios group(AFI5.0). Both groups were similar with respect to selected dermographics, gestational age at rupture of the membranes, chorioamnionitis, 1 min Apgar score and 5 min Apgar score. Patients with oligohydramnios demonstrated a lower gestatoinal age at birth and lower birth weight. There were no statistically significant correlations in neonatal morbidity and perinatal mortality between both groups. 2) For comparing latency period, we excluded deliveries of Cesarean section or induction. Comparing the remained group(25 patients), median of latency period in oligohydramnios group were 41.5 hours and median of latency period in non-oligohydramnios group were 44 hours. There were no statistically significant correlations in oligohydramnios and latency period. CONCLUSION: There were no significant effects of the oligohydramnios on poor perinatal outcome and latency period in patients with preterm premature rupture of membranes

Multiple dose methotrexate chemotherapy in suspected medical treament failure of ectopic pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to determine the efficacy of multiple dose methotrexate (MTX) chemotherapy approved as a primary treatment of ectopic pregnancy in suspected medical treatment failure of ectopic pregnancy. METHODS: This study included 77 hemodynamically stable high risk ectopic pregnants diagnosed from January 1995 to June 2000 at department of Obstetrics & Gynecology, Sanggye Paik hospital, Inje university. High risk criteria of our study were adnexal ectopic mass 3.5 cm or serum-hCG 4,000 mIU/ml or presence of fetal heart beat(FHB) or presence of peritoneal fluid and fresh blood on culdocentesis. Statistics were analyzed with 2-test, Student t-test and odds ratio of each risk factors. RESULTS: The response rate of multiple dose MTX chemotherapy was 85.7%(66/70). There was no statistically difference of risk factors between success and failure group except fetal heart beat. Among 11 failure patients, there were 3 patients with adnexal ectopic mass 3.5 cm (odds ratio=1.4, 0.3~5.7), 3 patients with presence of FHB, 7 patients with presence of peritoneal fluid(odds ratio=1.0, 0.3~3.8), 8 patients with serum-hCG 4,000 mIU/ml (odds ratio=2.8, 0.7~11.6). CONCLUSION: There results suggest that multiple dose MTX chemotherapy can be treated regardless of ectopic mass size, presence of pretoneal fluid, serum beta-hCG level. But we must pay attention to treat ectopic pregnancy with presence of fetal heart beat.

Prenatal diagnosis of fetal intussusception: A case report / 대한산부인과학회잡지

Fetal intussusception is not common and the underlying mechanism triggering the event is not known at present. There are few reports of successful diagnosis in fetus with prenatal ultrasongraphy. It may be detected by meconium peritonitis. Meconium peritonitis is a nonbacterial foreign body reaction or chemical inflammation by intestinal perforation result from intestianl atresia, intussusception and fetal bowel obstruction. Recently we experienced a 33+1 weeks of gestational fetus with fetal intussusception who had prenatal ultrasonographic detection with meconium peritonitis, and the infant was underwent postnatal laparotomy. We present this case with a brief review of literature.

Reversible Posterior Leukoencephalopathy Syndrome with Eclampsia A Case Report / 대한주산의학회잡지

No abstract available.