Uterine artery pulsatility index in hypertensive pregnancies: When does the index normalize in the puerperium?

OBJECTIVE: To investigate whether the uterine artery pulsatility index (UtA PI) of hypertensive pregnancies is higher than that of normal pregnancies in the puerperium, as well as in the antepartum period. METHODS: The UtA PI was measured in hypertensive (group 1) and normal pregnancies (group 2) during antepartum, immediate postpartum or late postpartum periods. Using the transvaginal approach, the bilateral uterine artery indices were measured. RESULTS: One hundred twenty-two women were enrolled: group 1, hypertensive disease in pregnancy (11 cases in antepartum, 13 cases in immediate postpartum and 10 cases in late postpartum period); group 2, normal pregnancies (32 cases in antepartum, 29 cases in immediate postpartum and 27 cases in late postpartum). In antepartum and immediate postpartum periods, the mean UtA PI and the proportion of cases with an early diastolic notch were higher in group 1 than in group 2 (antepartum mean UtA PI, 1.14 in group 1 vs. 0.68 in group 2, P<0.001; early diastolic notch, 46% vs. 9%, P<0.05; immediate postpartum mean UtA PI, 1.30 vs. 1.08, P<0.05; early diastolic notch, 85% vs. 48%, P<0.05). In late postpartum period, the mean value of UtA PI of group 1 was still higher than that of group 2, although the proportion of cases with an early diastolic notch was not different (mean UtA PI, 1.43 vs. 1.20, P<0.05; early diastolic notch, 60% vs. 52%, P=0.73). CONCLUSION: The UtA PI in hypertensive pregnancies was still higher than normal pregnancies in puerperal periods, suggesting that more than several weeks are required to resolve increased uterine artery vascular impedance.

Self-reported Smoking and Urinary Cotinine Levels among Pregnant Women in Korea and Factors Associated with Smoking during Pregnancy

This study examined urinary cotinine levels and self-reported smoking among pregnant women in Korea and the factors associated with smoking during pregnancy. The subjects were selected from pregnant women who visited 30 randomly sampled obstetric clinics and prenatal care hospitals in Korea in 2006. Smoking status was determined by self-reporting and urinary cotinine measurement. A total of 1,090 self-administered questionnaires and 1,057 urine samples were analyzed. The percentage of smoking revealed by self-reporting was 0.55% (95% confidence interval [CI], 0.11-0.99) and that revealed by urinary cotinine measurement (>100 ng/mL) was 3.03% (95% CI, 1.99-4.06). The kappa coefficient of agreement between self-reported smoking status and urinary cotinine measurement was 0.20 (95% CI, 0.03-0.37). Multiple logistic regression analysis revealed that early gestational period, low educational level, and being married to a smoker were significant risk factors for smoking during pregnancy. Smoking among pregnant women in Korea is not negligible, and those who are concerned to maternal and child health should be aware of this possibility among pregnant women in countries with similar cultural background.

Second trimester listeriosis followed by fetal death in utero (FDIU): A case report / 대한산부인과학회지

Listeriosis is an infectious disease caused by Listeria monocytogenes, a gram positive, facultatively anaerobic bacterium. Listeriosis occurs primarily in newborn infants, elderly patients, immunocompromised patients and pregnant women. One third of the patients are pregnant women, and complications of this disease include miscarriage, stillbirth and preterm labor. We experienced a case of listeriosis in a singleton pregnancy at 23rd week of gestation that presented with fever, chill, lower abdominal pain, backache, and eventually resulted in fetal death in utero. Autopsy results of the stillborn baby, as well as blood and amniotic fluid culture of the mother confirmed Listeria monocytogenes infection. Proper antibiotics therapy thereafter led to clear recovery of the infected mother. We report this case with a brief review of literature.

Successful Vaginal Delivery of a Pregnant Woman with Cantrell's Pentalogy

Cantrell's Pentalogy is a rare condition that consists of defects involving the abdominal wall, lower sternum, anterior diaphragm, pericardium, and heart. In the literature to date, pregnant women with Cantrell's Pentalogy have not been discussed. We performed successful vaginal delivery of a 23-yr-old nulliparous, primigravid woman who had been diagnosed with this condition. Diagnosis was based on cardiac catheterization, angiography, and echocardiogram, and abdominopelvic CT. Vaginal delivery may be an option for women with Cantrell's Pentalogy and may be attempted with caution.

Discrepancy in cytogenetic results between amniotic fluid cells and other fetal tissues: A case report / 대한산부인과학회지

We present two fetuses who were prenatally diagnosed by amniocentesis as having chromosomal mosaicism but who had a normal karyotype in the fetal blood by cordocentesis. One of the both fetuses had Turner and the other had trisomy 20 mosaicism. The prognosis for Turner mosaicism and trisomy 20 mosaicism diagnosed prenatally has yet to be established. The pregnancy with 45,X/46,XX mosaicism was terminated at 23+3 weeks' gestation. Autopsy findings showed no features of Turner's syndrome. Postnatal cytogenetic analysis revealed 45,X[4]/46,XX[52] mosaicism in skin and 46,XX in the lung tissue. The other fetus had amniocytes with trisomy 20 mosaicism and fetal cord blood cells with a normal karyotype. The baby was delivered at 38+2 weeks' gestation. At birth and 3 months after birth, no apparent abnormal findings were found. These cases with chromosomal discrepancy among various fetal tissues are rare. Two cases were discussed with the review of literature.

Spontaneous uterine rupture during second trimester / 대한산부인과학회지

Spontaneous uterine rupture during pregnancy is a very uncommon but catastrophic event resulting in even maternal and newborn mortality. Clinicians should make a prompt diagnosis and management in patients presenting with acute abdominal pain, hypovolemic shock and fetal compromise. We present a case of spontaneous uterine rupture during second trimester.

Pregnancy outcomes of antenatally diagnosed congenital cystic adenomatoid malformation of lung / 대한산부인과학회지

OBJECTIVE: To determine the accuracy of antenatal diagnosis, pregnancy outcome and the predictors for adverse outcome in antenatally diagnosed congenital cystic adenomatoid malformation (CCAM). METHODS: A retrospective review was performed on a total of 32 patients with antenatally diagnosed CCAM between January, 1999 and June, 2008. RESULTS: Of 32 cases with antenatally diagnosed CCAM, 8 patients were lost to follow-up. In remaining 24 patients, postnatal histologic examination and/or radiologic study showed definitive diagnostic features of CCAM (n=20), pulmonary sequestration (n=3) and congenital lobar emphysema (n=1). The accuracy of antenatal diagnosis was 83.3% (20/24). The rate of presence of hydrops and/or ascites was 10% (2/20) in those with CCAM confirmed postnatally. Of the 2 patients with ascites and/or hydrops, thoraco-amniotic (TA) shunt was performed in one case with hydrops and termination was done in the other case. All of the 15 cases with ongoing pregnancy were delivered at term, except one with TA-shunt who was born at 33(+3) weeks of gestation (mean gestational age at birth+/-standard deviation; 39.6+/-2.2 weeks, mean birth weight; 3,200+/-500 gram). All 15 neonates were discharged alive without any complication. Antenatal sonographic microcystic lesion was associated with postnatal histologic type III lesion [5 type III lesions in 7 microcystitc cases (71.4%) vs. no type III lesion in 13 macrocystic cases (0%), P<0.01]. CONCLUSION: The incidence of ascites and/or hydrops was 10% (2/20) in fetuses with CCAM. Antenatally diagnosed CCAM has an excellent prognosis in the absence of signs of ascites and/or hydrops.

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.

Small bowel obstruction in midtrimester of pregnancy: A case report / 대한산부인과학회지

Small bowel obstruction in pregnancy is a rare critical condition with high morbidity and mortality. The diagnosis of small bowel obstruction in pregnancy is often delayed because the symptoms such as nausea, vomiting, and abdominal pain mimic typical pregnancy-associated complaints. So, a high level of suspicion especially in patients with a history of previous abdominal surgery is essential for early diagnosis. Once the diagnosis is made, surgery should be performed immediately. We present the first case of small bowel obstruction during pregnancy in Korea with a brief review of the literature.

Neonatal outcome of vertex-vertex and vertex-nonvertex second twin according to the mode of delivery / 대한산부인과학회지

OBJECTIVE: The purposes of this study were to estimate the success rate of vaginal delivery after trial of labor (TOL) and to analyze the neonatal outcome of vertex-vertex (V-V) and vertex-nonvertex (V-NV) second twin according to the mode of delivery. METHODS: We reviewed retrospectively the medical records of V-V and V-NV twin delivered between December 1996 and February 2006. The patients were classified as TOL group and elective cesarean delivery (ECD) group to compare of the neonatal morbidity and mortality in second twin. Neonatal morbidity included intraventricular hemorrhage, respiratory distress syndrome, disseminated intravascular coagulopathy, sepsis, necrotizing enterocolitis, and birth trauma. Student t-test, Mann-Whtiney U test, Pearson's chi-square, and Fisher's exact were performed for the comparison of the neonatal outcome in second twin according to the groups. RESULTS: There are 349 eligible cases within given period. The proportions of TOL and ECD were 49% (n=170) and 51% (n=179), respectively. The success rates of vaginal delivery after TOL were 75% (n=93) in V-V twin and 70% (n=32) in V-NV twin. There were no significant differences in the neonatal outcome between TOL and ECD group. Additionally there were no significant differences in the neonatal outcome between cesarean delivery after the failure of TOL (n=45) and ECD group. CONCLUSION: Our results suggest that TOL in V-V and V-NV twin may be a safe method and can reduce the rate of ECD without adverse effect on neonatal outcome of second twin unless there are other obstetrical indications for cesarean delivery.

The pregnancy outcome of women with congenital uterine anomaly exceeding 20 weeks of gestation / 대한산부인과학회지

OBJECTIVE: To evaluate the pregnancy outcomes of women with congenital uterine anomaly exceeding 20 weeks of gestation. METHODS: We reviewed retrospectively the birth records of the Seoul National University Hospital between January 1, 1990, and December 31, 2005. We grouped congenital uterine anomalies into five classes, namely bicornuate, didelphys, septate, arcuate, and unicornuate uterus. We compared the pregnancy outcomes with each anomaly. RESULTS: We found 106 cases of congenital uterine anomaly within a given period of time. There were 63 cases of bicornuate uterus, 19 cases of didelphys, 16 cases of septate uterus, 5 cases of arcuate uterus, and 3 cases of unicornuate uterus. The overall preterm delivery rate was 22.6% (24/106) and cesarean section rate was 74.5% (79/106). A high cesarean section rate was due to metroplasty, abnormal fetal presentation, and uterine anomaly itself. The preterm delivery rate and cesarean section rate of each uterine anomaly did not differ statistically from one another. Five fetuses were stillborn, and one fetus died after birth because of a placenta abruption. The overall take-home baby rate was 94.3% (100/106). There was no maternal mortality and only one case was suffered from postpartum bleeding. CONCLUSION: Our results suggest that the most of women with uterine anomaly exceeding 20 weeks of gestation may take their baby home.

The Clinical Study of Fetal Death in Utero / 대한주산의학회잡지

OBJECTIVE: To investigate the clinical characteristics and etiologic factors of pregnancies with fetal death in utero (FDIU). METHODS: Retrospective review of medical records of 184 pregnancies with FDIU between March 1996 and March 2006 was conducted and descriptive analysis was done. Medical records were unavailable in 14 cases which were excluded in the analysis of etiology and diagnostic evaluation. RESULTS: The overall incidence was 1.31%. There was no significant difference in the yearly incidence during the study period. Age distribution of FDIU was between 18 and 44 and the incidence was highest in 25~29 year-old age group. The risk analysis showed statistically significant risk in the age group under 25 (OR, 2.455) and 25~29 (OR, 1.590) compared to 30~34 year-old age group. The risk of age group beyond 35 has a tendency to increase but was not statistically significant. FDIU was the most prevalent (38.58%) among pregnancies less than 29 weeks of gestation. Most of cases were delivered vaginally (86.5%). Etiologic factors included unexplained causes (37.1%), fetal factors (29.4%), placental and cord factors (18.2%) and maternal factors (15.3%). Autopsy was done in 128 cases (75.3%) and placental pathology was examined in 148 cases (87.1%). Among the workups done, autopsy and placental pathology were the most informative. CONCLUSION: Despite the advance of prenatal care, the incidence of FDIU was steady throughout the study period. The etiology of the largest proportion was unexplained. Once FDIU is diagnosed, prompt delivery should be done and appropriate diagnostic tests should be offered to aid in next pregnancy.

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.

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 chorioangioma of placenta complicated by fetal anemia and fetal hydrops / 대한산부인과학회지

Benign chorioangioma of the placenta is the most common primary tumor of the placenta similar to hamartoma. Most small-sized tumors do not make any clinical problem, but uncommon large tumors (>5 cm in diameter) may produce both maternal and fetal complications, such as polyhydramnios, preterm labor, fetal hydrops, microangiopathic hemolytic anemia, disseminated intravascular coagulation, intrauterine growth restriction, preeclampsia and placental abruption. In this respect, the diagnosis and management of chorioangioma and its complication should be done appropriately. We report a case of chorioangioma presenting with polyhydramnios, preterm labor, fetal anemia and fetal hydrops, diagnosed by antenatal ultrasonography and postnatal placental histologic examination, and live born baby with the brief review of the literature related to this type of tumor.

Two Cases of Pregnancies Complicated with Central Diabetes Insipidus / 대한산부인과학회지

Diabetes insipidus is an unusual cause of urinary frequency during pregnancy. It occurs in 2 to 6 per 100,000 pregnancies. It is a disorder in which the abnormal secretion, degradation, or activity of vasopressin cause hypotonic polyuria, polydipsia, and dehydration. And this syndrome appears to be associated with multiple gestations, preeclampsia, and abnormal liver function. We report two cases of pregnancies complicated with diabetes insipidus. One patient was diagnosed during pregnancy and DDAVP (L-deamino-8-d-arginine vasopressin) was used to manage diabetes insipidus. The other patient was diagnosed before pregnancy and DDAVP was not used.

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.

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.