Perinatal mortality at Yongdong Severance Hospital, 1998~2003 / 대한주산의학회잡지

OBJECTIVE: The aim of this study was to analyze the perinatal mortality rate (PMR) and to evaluate the risk factors of perinatal deaths such as birth weight, gestational age, maternal age, fetal sex, number of antenatal visits, and cause of deaths. METHODS: Review of electronic medical records of 4,910 cases of singleton deliveries from 1998 to 2003 at Yongdong Severance Hospital was done. The perinatal period was defined according to the WHO definition and the cause of mortality was determined according to Aberdeen Classification. RESULTS: Crude (corrected) PMR was 22.8 (13.4). Among 4862 deliveries excluding termination of pregnancy and severe congenital anomalies, (1) stillbirths accounted for 78% (51/65) of perinatal deaths. (2) Distribution of neonatal birth weights less than 1,000 g, 1,000~1,499 g, 1,500 g~2,499 g were 0.3%, 0.7%, 5.6% with survival rates of 73.7%, 86.1%, and 99.6% respectively. (3) Deaths of preterm births accounted for 86% (12/14) of total neonatal deaths. (4) PMR of 494 cases of advanced maternal age was higher (20.2) than those of other age groups without statistical significance (p=0.273). (5) PMR of male-to-female ratio was 173:100 with statistical significance (p= 0.031). (6) PMR of infants with less than 2 antenatal visits was 152.0, in comparison with the rate (7.3) of infants with more than 2 antenatal visits (p<0.001). Among 112 cases of crude perinatal deaths, the leading causes were congenital anomalies (31.3%), prematurity cause unknown (28.6%), and maternal disease (10.7%). CONCLUSIONS: The number of births is decreasing, but no significant decrease of PMR was observed. Therefore, intensive care of preterm infants and congenital anomalous babies should be improved.

Black Cohosh and St. John's Wort (GYNO-Plus(R)) for Climacteric Symptoms

PURPOSE: This study was conducted to investigate the efficacy of black cohosh (Cimicifuga racemosa) and St. John's wort (Hypericum perforatum) in women with climacteric symptoms, and to assess their effects on vaginal atrophy, hormone levels, and lipid profiles. MATERIALS AND METHODS: In this double-blind randomized, placebo-controlled, multicenter study, 89 peri- or postmenopausal women experiencing climacteric symptoms were treated with St. John's wort and black cohosh extract (Gynoplus

Polycystic Ovary Syndrome and Insulin Resistance / 대한산부인과학회지

Polycysytic Ovary Syndrome (PCOS) is a common endocrine disorder characterized by chronic anovulation and hyperandrogenism. The etiology of PCOS is complex and incompletely understood. Accumulating data conclude that hyperinsulinemia and hyperandrogenemia may cause hormonal abnormalities that lead to disturbance of ovarian function. Although insulin resistance is not a part of the diagnostic criteria for PCOS, its importance in its pathogenesis can not be ignored. Excess insulin is capable of stimulating steroidogenesis and therefore excessive androgen production occurs from the theca cell system. Recently, the effects of insulin sensitizer in PCOS patients are being reported and they include the improvement of menstrual pattern, improvement in hyperandrogenism, increased response in ovulation induction and prevention of cardiovascular diseases. Understanding the relation of PCOS and insulin resistance will offer an improvement in treatment of PCOS in the future.

Transabdominal Embryofetoscopy for the Detection of Short Rib-polydactyly Syndrome, Type II(Majewski), in the First Trimester

Our aim was to demonstrate the potential of first-trimester embryofetoscopy for prenatal diagnosis in a continuing pregnancy. A patient at risk for giving birth to an infant with short rib-polydactyly syndrome, type II (Majewski), presented for prenatal diagnosis at 9 weeks of gestation. A 1 mm semirigid fiberoptic endoscope with an 18 gauge examination sheath and a single-chip digital camera were used for transabdominal embryofetoscopy. Transabdominal embryofetoscopy was performed at 13 weeks of gestation. Direct visualization of the fetus was achieved and no gross limb or facial abnormalities were seen. This case shows that embryofetoscopy is a useful tool for early diagnosis in high-risk patients in the first trimester for continuing pregnancies.

Acute fatty liver of pregnancy complicating acute respiratory distress syndrome: A case report with survival of mother and child / 대한산부인과학회지

We report our experience with the diagnostic, clinical and biochemical findings, complications and maternal-perinatal outcome in a case of acute fatty liver of pregnancy. A 31-year-old multipara presented herself at 35 weeks' gestation with general malaise, gastroesophageal reflux, jaundice, hepatorenal dysfunction and disseminated intravascular coagulation. An abdominal ultrasound revealed a mild fatty liver. A tentative diagnosis of acute fatty liver of pregnancy was made, and immediately a healthy male infant weighing 2330 gm was delivered by emergency cesarean section. On 1, 2 and 6 days after delivery, oliguria, acute respiratory distress syndrome and pancreatitis developed, respectively. Abnormal levels of AST/ALT, creatinine, fibrinogen, PT/PTT and platelet recovered to normal ranges 7-10 days after delivery. Serum amylase and lipase became normal 24 days after delivery with conservative treatment. Ventilator care for acute respiratory distress syndrome continued up to 49 days after delivery, when total bilirubin, ammonia, alkaline phosphatase, r-GT, and AST/ALT began to normalize. The discharge was recommended on the 88th postpartum day. Our result suggests that acute fatty liver of pregnancy can be diagnosed on the basis of clinical and laboratory findings. Prompt delivery, intensive supportive care and awareness of its complications can markedly improve maternal and perinatal outcome.

A case of successful pregnancy in Addison's disease / 대한산부인과학회지

Primary adrenal insufficiency is a rare disease which can lead to fatal outcomes when complicated in pregnancy. The vague symptoms such as nausea, fatigue and abdominal pain may interfere with its diagnosis. But once the diagnosis is made after a simple ACTH stimulation test, a successful pregnancy and delivery can be accomplished by replacement of steroids. It is to be noted that proper management in crises such as labor, delivery, operation and postpartum is very important. We report a case of successful delivery of a woman with primary adrenal insufficiency with a brief review of literature.

HBsAg screening test of Korean pregnant women during antenatal period / 대한산부인과학회지

OBJECTIVE: To evaluate and improve the method in management of HBsAg positive mothers in Korea by the screening time and method. METHODS: From January 2003 to March 2003, questionnaires were obtained using mail or telephone from total 848 hospitals or clinics handling more than 100 deliveries in year 2001 and 341 of them (40.2%) returned their answers. 279,734 out of 507,151 (55.2%) were investigated in number of delivery cases. The screening time and method for HBsAg in antenatal period were analyzed. RESULTS: Most of hospitals tested for HBV infectivity more than once during antenatal period. 99.1% of hospitals tested for HBsAg and 96.1% of hospitals tested for HBsAb. 87.1% of pregnant women were tested for HBsAg on the first visit. HBsAb was tested at the same time with HBsAg in 96.2%. 41% of hospitals repeated test in third trimester for those with negative HBsAg and 54% of HBsAg positive mothers were retested in third trimester. For those who admitted only for delivery, 45.9% of hospitals tested for HBsAg irrespective of their history. Clinics used RPHA for test method in 38.1% which was higher in proportion compare to hospitals. CONCLUSION: HBV infectivity must be screened in all pregnant women. Repeating test in third trimester may be unnecessary and a policy should be made for those who admit for delivery alone. EIA method is recommended instead of RPHA method.

A Case of Spina Bifida Diagnosed by Prenatal Ultrasonography / 대한산부인과학회잡지

In prenatal diagnosis of neural tube defects, maternal serum alpha-fetoprotein (MSAFP) level in second trimester is used as a screening test. However, it shows low sensitivity with high false positive rate. Also, alpha-fetoprotein and acetylcholinesterase in amniotic fluid through amniocentesis is used, but it is an invasive technique with low sensitivity. Recently, due to improved prenatal sonography, typical sonographic findings of spina bifina are reported and contributed to early diagnosis and detection of possible co-existing abnormalities. We report a case of spina bifida detected at 21 weeks of pregnancy by prenatal sonograph at our institution with a brief review of literature.

Two Cases of Ectopic Pregnancy Implanted in the Previous Cesarean Section Scar Treated with Dilatation and Evacuation after Vaginal Misoprostol / 대한산부인과학회잡지

Implantation of a pregnancy within the scar of previous cesarean section is the rarest form of ectopic pregnancy. If diagnosed early, treatment options are capable of preserving the uterus and subsequent fertility. However, delayed diagnosis and treatment can lead to uterine rupture, hemorrhage and maternal morbidity. We present two cases of ectopic pregnancy developing in the previous cesarean section scar in which successfully treated with dilatation and evacuation after vaginal misoprostol.