Clinical Characteristics and Outcome of Isolated Fetal Hydronephrosis / 대한산부인과학회지

OBJECTIVE: Routine maternal ultrasonography has revealed a very high incidence of fetal hydronephrosis. However, there is little data available, in Korea, on the natural progress of prenatal hydronephrosis. Therefore, to help in the management of patients, the antenatal course and neonatal follow-up data of isolated fetal hydronephrosis were analyzed. METHODS: Prenatal diagnosis, etiologies, clinical characteristics, and outcome were studied retrospectively in 77 cases of unilateral and bilateral prenatal hydronephrosis from January 2000 to March 2004. Cases were classified as mild (7 mm > or =, , ) prenatal hydronephrosis as depending on the renal pelvis anteroposterior diameter. Fisher's exact test and Chi-square test were used for statistical analysis. RESULTS: The etiologies of prenatal hydronephrosis were ureteropelvic junction obstruction 45 (58.4%), vesicoureteral reflux 2 (2.6%), ureterocele 1 (1.3%), and urethra obstruction 1 (1.3%). At delivery, 18 cases were normal kidneys, and during the follow-up periods, 10 cases resolved spontaneously. Mild, moderate, and severe hydronephrosis were present in 30 (38.9%), 38 (49.4%), and 9 (11.7%) respectively. Operations were performed in 2/38 (5.3%) of moderate cases, and 7/9 (77.8%) of severe cases. CONCLUSION: Most of prenatal hydronephrosis diagnosed by ultrasonography disappeared postnatally and the needs for postnatal operations were rare. It is suggested that hydronephrosis in the fetus or neonate dose not necessarily imply the presence of an obstructive uropathy or a significant functional abnormality and the reassurance of parents and follow up evaluation of the neonate during perinatal period may be needed.

Normal Variation and Predictive Value for Pregnancy Outcome of Fetal Heart Rate in the Early First Trimester / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to define the normal variation of fetal heart rate (FHR) and to analyze whether first-trimester fetal heart rate (FHR) are useful in predicting pregnancy outcome. METHODS: We prospectively studied 162 singleton pregnancies with gestational ages ranging from 5 to 10 weeks between Mar. 1999 and Jan. 2003 visting our hospital. Color doppler sonography was used to calculate the fetal heart rate in beats per minute as the mean of 3 waves. RESULTS: The following results were obtained. 1. Overall, 149 pregnancies reached viability and 13 resulted in fetal loss before 13 weeks' gestation. 2. A significantly higher number of viable pregnancies, compared with fetal losses, had FHR within one (73.1% compared with 38.5%, p<0.001) and two (94.6% compared with 69.2%, p<0.001) standard deviations of the mean for viable pregnancies at corresponding gestational ages. 3. A significant correlation was seen between gestational age and fetal heart rate (p<0.001). The regressing equation for heart rate was as follows: heart rate = 3.40 X gestational age (days)-30.15 (r = 0.87). 4. There was no significant difference in the fetal heart rates between male and female embryos during this early stage of pregnancy. CONCLUSION: First-trimester FHR can be helpful to predict pregnancy outcome. Women with FHR outside the reference range from the mean for viable pregnancies at corresponding gestational ages may be at risk for eventual pregnancy loss.

A Study of Successful Prognostic Factors in Vaginal Birth after Cesarean Sections / 대한산부인과학회잡지

OBJECTIVE: Recently, with rising rates of repeat cesarean sections, enormous amount of the studies about trial of labor after cesarean section have been reported to decrease the rate of cesarean section. The purpose of this study is to provide data regarding the safety and the successful prognostic factors of VBAC (vaginal birth after cesarean section). METHODS: This retrospective study was performed based on 194 pregnant women who tried vaginal delivery after cesarean section at Eulji University Hospital from March 1997 to February 2002. The age of mother, gestational age, estimated fetal body weight by ultrasonography, neonatal body weight, cervical effacement, cervical dilatation, Bishop score, the number of previous vaginal delivery, and spontaneous labor were analyzed between successful group (177 patients) and failure group (17 patients) with trial of labor. Student T-test and Chi-square test were used for statistical analysis. RESULTS: 177 cases (91.24%) in 194 cases succeeded in VBAC and 17 cases (8.76%) failed. There was no maternal death or uterine rupture in the cases of trial of labor. The gestational age, estimated fetal body weight by ultrasonography, neonatal body weight, cervical effacement, cervical dilatation, Bishop score, the number of previous vaginal delivery, spontaneous labor had notable differences between the successful group and the failure group. But, There was no significant difference in maternal age. CONCLUSION: The trial of labor after cesarean section is relatively safe method of delivery if it is performed under strict indication. Above findings can be used as possible prognostic factors for the success of VBAC and may reduce the risk and complication of VBAC. The following studies with large populations and performed by multi-centers will be needed for the evaluation of safety and successful prognostic factors of VBAC.

Prenatal diagnosis of spondylothoracic dysplasia (Jarcho-Levin syndrome) by ultrasound / 대한산부인과학회잡지

The Jarcho-Levin syndrome (spondylothoracic dysplasia) is a rare autosomal recessive disorder characterized by a short neck, short trunk and a constricted thorax due to multiple rib and vertebral defects. The small size of thorax in newborns frequently leads to respiratory insufficiency and death in neonates or infancy. We reports the prenatal diagnosis using ultrasonography of a fetus affected with spondylothoracic dysplasia, or Jarcho-Levin syndrome, in patient without a positive family history for this condition.

Prenatal diagnosis of spondylothoracic dysplasia (Jarcho-Levin syndrome) by ultrasound / 대한산부인과학회잡지

The Jarcho-Levin syndrome (spondylothoracic dysplasia) is a rare autosomal recessive disorder characterized by a short neck, short trunk and a constricted thorax due to multiple rib and vertebral defects. The small size of thorax in newborns frequently leads to respiratory insufficiency and death in neonates or infancy. We reports the prenatal diagnosis using ultrasonography of a fetus affected with spondylothoracic dysplasia, or Jarcho-Levin syndrome, in patient without a positive family history for this condition.

Effects of Oral administration of Iron Supplements During Pregnancy on Maternal Hemoglobin Levels and Birth Weights / 대한산부인과학회잡지

OBJECTIVE: This study was performed to evaluate the effects of oral administration of iron supplements during pregnancy on maternal hemoglobin concentrations and birth weights. METHOD: Data from clinical records of 141 pregnant women and their babies were analysed. Studied mothers were classified to 3 groups such as non iron supplement group (groupI), 2-3 months supplement group (group II), and over 4 months supplement group (group III) by the duration (months) of oral supplement prescribed. RESULTS: There was positive correlation between hemoglobin levels and iron supplement duration. Proportions of anemia showed decreasing basis with the increasing iron supplement duration. The maternal hemoglobin levels showed decreasing basis with the increasing birth weight. There was positive correlation between iron supplement duration and maternal hemoglobin levels, but there was no significant correlation between iron supplement duration and birth weight. For the groupI(non-supplement group), maternal hemoglobin levels were decreased with the increasing birth weight but there was no significant correlations between hemoglobin levels and birth weights with increased iron supplement duration. CONCLUSION: There was a significant inverse correlation between maternal hemoglobin levels and birth weight in non-iron supplement group but there was no significant correlations between hemoglobin levels and birth weights with increased iron supplement duration.

The Change of Fetal Liver Length and Liver Volume by Ultra-sonography according to Gestational Age in Normal Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The measurement of liver size can be used for the diagnosis of the fetal growth abnormality (FGR, macrosomia etc.). The purpose of this study was to evaluate a mathematical relationship between the fetal liver size(liver length or volume) and the gestational age in the normal pregnancies. Brief comparisons were also tried on the base of the degree of the correlation between liver length and its volume. METHODS: We collected 54 singleton pregnancies of 20 to 36weeks of gestation for measuring fetal liver length and 57 singleton pregnancies for measuring fetal liver volume. We used Combison 530 utrasonic machine(Kreztechnik AG, Zipf, Austria). RESULTS: There was significant correlation between liver size( length and volume) and gestation age. And the liver volume better correlated with gestational age than liver length(r=0.93 : r=0.78, p<0.0001, p<0.0001). CONCLUSION: Ultrasonic measurement of fetal liver size is a reliable indicator of fetal growth, especially liver volume. Therefore these data may have a potential value for the prediction of abnormal fetal growth(FGR, macrosomia).

The Outcomes of 17,744 Cervicovaginal Smears in Ihha University Hospital / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to investigate the distribution of the result of 17,744 cervicovaginal smears and their pathologic results in Inha University Hospital to make a reference data. METHODS: During 28 months, May 1996 to August 1998, we performed 17,774 cervicovaginal smears and arranged them by the Bethesda system and compared them with their pathologic results. RESULTS: Among 17,744 smears, there were 93.2% of benign results, 2.9% of ASCUS, 0.9% of LSIL, 1.4% of HSIL, and 0.8% of SCC. The ASCUS/SIL ratio was 1.28. Among ASCUS, the high grade histologic outcome was composed 4.0%. Among LSIL, there were 15.7%, and HSIL 48.0%, SCC 56.1%, AGUS 9.3%, and Adenocarcinoma, the results was 69.2%. CONCLUSION: Among 17,744 smears, there were 93.2% of benign results, 2.9% of ASCUS, 0.9% of LSIL, 1.4% of HSIL, and 0.8% of SCC. The ASCUS/SIL ratio was 1.28. These results were very similar to other data and we would like to add our data to them as a reference. And the worse the smear results were, the worse the pathologic results were.

Ultrasound-directed paracentesis of idiopathic massive fetal ascites / 대한산부인과학회잡지

Isolated fetal ascites may be different from general category of nonimmune hydrops in both prenatal course and prognosis. We experienced one case of isolated fetal ascites of unknown origin treated by in utero ultrasound-directed paracentesis and so present it with brief review of literature.