Relationship between fetal biophysical profile and fetal cord blood acid-base status obtained by cordocentesis / 대한산부인과학회잡지

OBJECTIVE: Fetal biophysical profile is widely used antenatal test for fetal wellbeing, but its biochemical background is not well known. The purpose of this study is to examine the relationship of fetal biophysical profile and cord blood acid base status including gas analysis using cord blood obtained by cordocentesis, by which the biochemical background of fetal biophysical profile can be understood. STUDY DESIGN: 121 pregnant women received cordocentesis for various indication, of whom the fetuses were evaluated with fetal biophysical profile just before the cordocentesis. Cord blood obtained by cordocentesis was analyzed for acid-base and gas status. The results of both tests were compared by appropriate statistical method. RESULTS: Fetal biophysical profile showed definite correlation with the results of cord blood acid-base and gas analysis (p<0.001). Fetal biophysical profile was not a sensitive study for the diagnosis of fetal acidemia, but the test could be used for the diagnosis of severe fetal acidemia. Variables of fetal biophysical profile responded to acidemia differently and there were gradual changes among the variables according to the degree of acidemia. Gestational age was important factor for the normality of nonstress test, even after adjustment of pH level. Anomaly did not affect the fetal biophysical profile and fetal biophysical profile was determined mainly by fetal metabolic status. CONCLUSION: Fetal biophysical profile score is a useful noninvasive antenatal test reflecting fetal acid base status, effective for the diagnosis of severe acidemia, probably affected by fetal gestational age, but not by fetal anomaly.

Angiographic embolization in the management of obstetrical hemorrhage / 대한산부인과학회잡지

OBJECTIVE: To investigate whether emergency selective arterial embolization may serve as a safe and effective alternative treatment in the management of intractable pregnancy-associated hemorrhage. METHODS: Between February 1992 and March 1999, 20 patients at Seoul National University Hospital underwent angiographic embolization to control obstetrical hemorrhage. In all cases, hemostatic embolization was performed because of intractable hemorrhage unresponsive to conservative management. All available hospital records were reviewed and detailed to collect adequate clinical data such as specific leading complication, clinical status, estimated blood loss and blood replacement requirements, length of procedure, used emboli, complications associated with the procedure, and its results. RESULTS: We have experienced the successful embolization in 18 of 20 patients of pregnancy-related hemorrhage from the different causes. One of these successful cases required two embolization attempts. Two of these patients needed surgical treatment because of rebleeding after the embolization. The mean length of the time for the procedure was 96.4+/-50.1 minutes (range; 50-260 min.). The average length of hospitalization was 10.4+/-7.7 days (range; 1-36 days). No major complication related to the embolization was found. Two women became pregnant after embolization. CONCLUSIONS: This study indicates that angiographic embolization is a safe and effective method for the control of pregnancy-related hemorrhagic complications unresponsive to conservative management and that it allows maintenance of reproductive ability.

Normal Range of Amniotic Fluid Alpha-Fetoprotein in Midtrimester Korean Pregnant Women / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to determine normal amniotic fluid alpha-fetoprotein level in midtrimester Korean pregnant women whose neonatal outcomes were normal. METHODS: Amniotic fluid alpha-fetoprotein(AFAFP) levels were measured by specific radioimmunoassay (RIA) in midtrimester pregnant women for various indications of amniocentesis from May 1992 to July 1999 at Seoul National University Hospital. Normal ranges were obtained from 640 singleton pregnancies in which neonatal outcomes were normal. RESULTS: Median values of AFAFP in Korean pregnant women were 13,250ng/mL, 12,900ng/mL, 11,150ng/mL, 9,430ng/mL, 8,019ng/mL, 6,800ng/mL, 5,850ng/mL, 5,750ng/mL, 5,210ng/mL, 3,420ng/mL at 15 week, 16 week, 17 week, 18 week, 19 week, 20 week, 21 week, 22 week, 23 week, 24 week, respectively. CONCLUSION: This determination of the median values and the normal range of AFAFP level by each gestational week in uncomplicated Korean women could be used reference values for prenatal diagnosis of various disorders like open neural tube defect.

A Case of Prenatal Diagnosis of Congenital Nephrotic Syndrome / 대한산부인과학회잡지

No abstract available.

Clinical Feature and Prognosis of Pregnancies in Patients with Takayasu's Arteritis / 대한산부인과학회잡지

No abstract available.

3 Cases of Pregnancies in Patients with Liver Cirrhosis / 대한산부인과학회잡지

Far Eastern countries including Korea show the high prevalence of hepatitis B virus carriers, so that the incidence of liver cirrhosis is higher than in western countries. But pregnancies with liver cirrhosis are rarely encountered in clinical settings, since liver cirrhosis usually develops after childbearing ages and often causes the disturbance of estrogen metabolism, resulting in severe menstrual irregularity and infertility. Therefore, little is known about the interactions between liver cirrhosis and pregnancy. Liver cirrhosis and portal hypertension are not contraindications to pregnancy but necessitate intensive monitoring throughout pregnancy because the complications of liver cirrhosis, which pose additional risks during pregnancy, are numerous and unpredictable. We report 3 cases of pregnancies in patients with liver cirrhosis with brief review of the literature.

Unexplained Elevated Levels Of Midtrimester Maternal Serum alpha-fetoprotein Are Associated With Spontaneous Preterm Birth / 대한산부인과학회잡지

OBJECTIVES: Our purpose was 1) to determine whether elevated maternal serum alpha- fetoprotein(MSAFP) predict increased risk of spontaneous preterm delivery and indicated preterm delivery; 2) to determine whether elevated maternal serum human chorionic gonadotropin(MSHCG) predict increased risk of preterm delivery. Methods: Between September 1995 and April 1998, 945 of 2105 pregnant women who received midtrimester MSAFP screening were identified and evaluated. 81 women with MSAFP levels of 2.0 MoM or more were included in the study group while 864 women with levels less than 2.0 MoM served as controls. Pregnancy outcome were obtained from hospital records and statistical analysis were performed. RESULTS: Women with elevated MSAFP levels showed an increased risk for preterm delivery(p<0.05), fetal growth restriction(p<0.05) and hypertensive disorders(p<0.05), but not for preterm premature rupture of membrane, fetal death in utero. There was a strong association between unexplained elevated MSAFP levels and spontaneous preterm delivery(p<0.05) but our study does not support an association between unexplained elevated MSAFP levels and indicated preterm delivery. There was no association between elevated MSHCG levels and preterm delivery regardless of MSAFP levels. CONCLUSION: We concluded that unexplained elevated levels of midtrimester MSAFP were associated with an elevated risk of spontaneous preterm delivery but not with a risk of indicated preterm delivery. Elevated MSHCG levels were not associated with a risk of preterm delivery and spontaneous preterm birth.