Herniated Nucleus Pulposus during Pregnancy / 대한주산의학회잡지

A herniated nucleus pulposus (HNP) during pregnancy has been a rare occurrence with a reported incidence of 1:10,000 case. It is hard to diagnose because of the potentially hazardous effect of ionizing radiation to the fetus when complaining back pain during pregnancy. In this case, magnetic resonance imaging (MRI) provide safe and useful modality and in general, back pain usually respond readily to conservative treatment. Cauda equina syndrome or severe and/or progressive neurologic deficit is a medical emergency that necessitates prompt surgery during pregnancy. She admitted at 31 weeks gestation for sudden development of right leg paresthesia and ankle motor weakness, an MRI showing compression on right nerve root at the level of L5~S1. After 4 weeks treated with bed rest and analgesics, we delivered by cesarean section and laminectomy at the same time. We have experienced a pregnancy with HNP, so report of this case with brief review of literature.

Perinatal Outcomes of Twin-Twin Transfusion Syndrome according to Clinical Stage based on Sonographic findings / 대한산부인과학회지

OBJECTIVE: After classifing the twin-twin transfusion syndrome (TTTS) according to clinical stage by Quintero, we reviewed effectiveness and usefulness of clinical stage by Quintero in diagnosis and treatment of TTTS. METHODS: Twelve cases (16%) were diagnosed as TTTS among 75 examples (31.3%) of monochorionic twin pregnancy out of 240 cases of twin pregnancy born in our hospital between Mach 2000 and June 2004. For TTTS, the clinical stage was decided at the time of initial diagnosis, and any changes of it were observed according to the developments of pregnancy. Neonate was regarded as alive when 5 minutes Apgar score was above 7 after birth. Also we observed the vascular anastomosis of placenta, and classified the method of treatments and its results according to each clinical stage. RESULTS: Two cases were classified into the clinical stage 1 through 4 each, and 4 cases in the clinical stage 5. The higher the clinical stage, the shorter the duration between diagnosis and delivery (p<0.05). In cases of both survivors, compared to no survivors, the interval between diagnosis and delivery were long (p<0.05). In the clinical stage 4 and 5, we found many cases that didn't have placental vascular anastomosis between artery and artery, and in this case, there revealed poor perinatal outcomes. For 4 cases that fell in the clinical stage 1 and 2 and 4, we performed amnioreduction and for one case in the clinical stage 2, we did amnioseptostomy at the same time. In 4 cases with amnioreduction or amnioseptostomy, survival rate was 38%. CONCLUSION: The clinical classification system of TTTS by ultrasound would be helpful for planning treatments and also for predicting the outcomes.