RESUMO
OBJECTIVE: This study was aimed to study clinical characteristics of patients with intrauterine meconium peritonitis, differences of various factors in between those who required operation and those who did not, risk factors leading into operation, and prognosis in the era of high prenatal diagnosis. METHODS: A retrospective review of 53 patients was done. Various factors for operation group (n= 41) and non-operation group (control, n=12) were compared. The risk factors for operation were analyzed by logistic regression analysis. RESULTS: The mean gestational age and birth weight for 53 including 41 (77%) of prenatally diagnosed cases were 36+/-3.4 weeks and 2,819+/-755 g, respectively. The most frequent antenatal sonographic finding was calcification. The most common etiology was ileal atresia. The first and full feeding was at 1.4+/-1.5 and 4.2+/-1.9 day, respectively for control (11.3+/-10.9 and 32.3+/-24.7 day). Risk factors for operation included requirement of mechanical ventilation and cesarean delivery. Overall survival rate was 94%. Survivial rate of those who were antenatally diagnosed was 97.6% in comparison to 83.3% who were not. The growth at 12 months was satisfactory. CONCLUSION: Favorable outcome of intrauterine meconium peritonitis is reassuring and stems from multidisplinary team approach.
Assuntos
Humanos , Recém-Nascido , Peso ao Nascer , Idade Gestacional , Perfuração Intestinal , Modelos Logísticos , Mecônio , Peritonite , Diagnóstico Pré-Natal , Prognóstico , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , UltrassonografiaRESUMO
OBJECTIVE: This study was performed to evaluate changes in the preterm birth rate and risk factors of preterm birth in Korea. METHODS: A total number of 5,433,746 birth cases from the birth certificate data from 1995 to 2003 obtained from the National Statistical Office of Korea was reviewed and analyzed. We evaluated the annual preterm birth rate for 9 years, seasonal and regional variations, multiple birth rate, the preterm birth rate for women aged 35 years or older. The logistic regression analysis was used to examine the relationship between preterm birth and risk factors including maternal and paternal age, parity, infantile sex, season and region of birth. RESULTS: The preterm birth rate has increased from 4.25% in 1995 to 10.03% in 2003. Seasonal and regional variations were found. The preterm birth rate was 6.65% in spring, 7.75% in summer, 7.36 in autumn, and 7.38% in winter. The preterm birth rate was 5.06% in Jeollabuk-do, the lowest rate, and 9.17% in Ulsan, the highest rate in Korea. The multiple birth rate has increased from 1.32% in 1995 to 2.01% in 2003. The mean age at first birth was 26 years in 1995, 28 years in 2003, and first birth rate for women aged 35 years or older has increased from 2.4% in 1995 to 4.8% in 2003. The preterm birth rate for women aged 35 years or older also increased from 8.14% in 1995 to 14.74% in 2003. The risk for preterm birth was significantly higher in the women aged 35 years or older, compared with those under 35 years (OR: 1.572, p<0.001). The risk for preterm birth in father aged 40-70 years was higher than those under 30 years (OR: 1.316, p<0.001). In the order of birth, the risk was higher in second or more-born than first-born (OR: 1.122, p<0.001). The odds ratio of preterm birth by infantile sex was 0.84 in male (p<0.001). Risk was significantly higher in multiple birth than in singleton (OR: 20.078, p<0.001). CONCLUSION: Based on the birth certificate data from 1995 to 2003, the preterm birth rate in Korea has increased since 1995. Older maternal and paternal old age, multiparity, male infant, and multiple birth can be considered as risk factors for preterm birth.
Assuntos
Feminino , Humanos , Lactente , Masculino , Declaração de Nascimento , Ordem de Nascimento , Pai , Coreia (Geográfico) , Modelos Logísticos , Prole de Múltiplos Nascimentos , Razão de Chances , Paridade , Parto , Idade Paterna , Nascimento Prematuro , Fatores de Risco , Estações do AnoRESUMO
OBJECTIVE: To evaluate the clinical outcomes of In-utero fetal shunt operations at Asan Medical Center. METHODS: We reviewed the medical records of 33 occasions in 28 pregnancies that underwent intrauterine shunt operations between December, 1998 and April, 2004. Fetal shunt operations were considered for cases of hydrothorax (N=10), congenital cystic adenomatoid malformation type I (CCAM Type I)(N=5), lower urinary tract obstruction (N=6), severe hydronephrosis (N=7) and severe fetal ascites (N=5). Selection criteria of fetus for the shunt operation required normal karyotype and negative infection. Basket-shaped catheter was used for the procedure. Kruskal-Wallis test, Mann-Whitney U test, and Chi-Square test were used for statistical analysis. P<0.05 was considered statistically significant. RESULTS: In CCAM Type I, the mean gestational age was 25.6+/-4.0 weeks at diagnosis, 26.0+/-4.4 weeks at shunt operation and 36.6+/-3.9 weeks at delivery. Perinatal survival rate was 66.7% (2/3). In hydrothorax, the mean gestational age was 26.7+/-3.3 weeks at diagnosis, 27.3+/-3.3 weeks at shunt operation and 34.9+/-3.0 weeks at delivery. Perinatal survival rate was 80.0% (4/5). In lower urinary tract obstruction, the mean gestational age was 18.5+/-3.7 weeks at diagnosis, 19.6+/-3.5 weeks at shunt operation and 34.5+/-2.9 weeks at delivery. Perinatal survival rate was 80.0% (2/3). In hydronephrosis, the mean gestational age was 25.3+/-5.3 weeks at diagnosis, 27.4+/-5.3 weeks at shunt operation and 36.9+/-2.2 weeks at delivery. Perinatal survival rate was 83.3% (5/6). In ascites, the mean gestational age was 29.6+/-3.9 weeks at diagnosis, 29.9+/-3.8 weeks at shunt operation and 34.1+/-3.0 weeks at delivery. Perinatal survival rate was 100.0% (5/5). Complications occurred in 48.5% (16/33) of the cases. The most common complication was shunt dislodgement (N=7). CONCLUSION: In-utero fetal shunt operation should be considered as a treatment option for hydrothorax, CCAM type I, lower urinary tract obstruction, severe hydronephrosis and severe ascites with a significant risk for pulmonary hypoplasia.
Assuntos
Gravidez , Ascite , Catéteres , Malformação Adenomatoide Cística Congênita do Pulmão , Diagnóstico , Feto , Idade Gestacional , Hidronefrose , Hidrotórax , Cariótipo , Prontuários Médicos , Seleção de Pacientes , Taxa de Sobrevida , Ultrassonografia , Sistema UrinárioRESUMO
BACKGROUND: Retention of gestational weight can be a significant contributor to obesity related complications. Few studies have assessed the impact of behavioral factors in Korea. This study was performed to identify the impact of factors on weight change at 1 year postpartum. METHODS: A questionnaire was sent twice by mail to 635 women who delivered singleton infant without complications in Seoul Asan Hospital from January 2002 to March 2002 and 97 available responses were received. Parity, pre-pregnancy weight, fullterm weight and postpartum behaviors were collected from routine medical records and questionnaire. RESULTS: Mean age was 30.5 years and mean pre-pregnancy BMI was 20.9 kg/m2. Mean total weight gain during pregnancy was 13.6+/-4.3 kg/m2 weight change at 1 year postpartum was 1.9+/-3.8 kg. Nearly 17.5% of women experienced a major weight gain of 4.5 kg at 1 year postpartum. Women who had higher pre-pregnancy BMI (> or =23 kg/m2) were at high risk for major weight gained at 1 year postpartum (OR: 4.14). Women who gained 13.6 kg or more during pregnancy and with lower income were at high risk for major weight gain at 1year postpartum (OR: 5.28, 4.13 respectively). CONCLUSION: Pre-pregnancy BMI, gestational weight gain and household monthly income are significantly associated with weight change at 1year postpartum. These findings support the need of the guidelines for preventing major weight retention associated with pregnancy.
Assuntos
Feminino , Humanos , Lactente , Gravidez , Características da Família , Coreia (Geográfico) , Prontuários Médicos , Obesidade , Paridade , Serviços Postais , Período Pós-Parto , Seul , Aumento de PesoRESUMO
About half of all cases of hypertrophic cardiomyopathy(HCMP) have a positive family history. All first-degree relatives of patients with HCMP should be screened with echocardiography. The prenatal diagnosis of abnormal septal hypertrophy in fetuses of mothers with HCMP has not yet been documented. We report a prenatal diagnosis in a case of familial HCMP by ultrasonography which was confirmed by autopsy. Fetal echocardiography provides a valuable aid in diagnosis of familial HCMP.
Assuntos
Humanos , Autopsia , Cardiomiopatia Hipertrófica Familiar , Diagnóstico , Ecocardiografia , Feto , Hipertrofia , Mães , Diagnóstico Pré-Natal , Ultrassonografia , Ultrassonografia Pré-NatalRESUMO
OBJECTIVES: To determine the effectiveness and clinical utility of antenatal corticosteroids in the reduction of neonatal morbidity and mortality on preterm birth Material and method: Neonatal outcomes of 312 preterm babies were evaluated retrospectively. One hundred and two preterm babies(study group) were given dexamethasone more than 1 dose antenatally and 210 preterm babies(control group) were not given dexamethasone antenatally. Antenatal steroids were administered in the form of four 5mg intramuscular doses of dexamethasone 12 hours apart. Maternal and neonatal outcomes of study group were compared with those of control group. Student t- test, x2 test, Fisher's exact test, and logistic regression analysis were used where appropriate. p-value< 0.05 was considered significant. RESULTS: Antentenatal corticosteroid significantly decreased the incidence of RDS(OR:0.47, 95% CI:0.25-0.86), IVH/PVL(OR : 0.32, 95% CI : 0.12-0.86), necrotizing enterocolitis(OR : 0.49, 95% CI : 0.25-0.98), and neonatal death(OR: 0.30, 95% CI: 0.10 - 0.89) in preterm delivery. In the presence of PROM, antenatal corticosteoid seemed to have no protective effect on the neonatal complications such as RDS, IVH/PVL, NEC, PDA, and neonatal death. CONCLUSIONS: Antenatal administration of corticosteroids was effective to decrease the incidence of neonatal morbidity and neonatal mortality in the preterm neonates with no apparent maternal complications.
Assuntos
Humanos , Lactente , Recém-Nascido , Corticosteroides , Dexametasona , Incidência , Mortalidade Infantil , Modelos Logísticos , Mortalidade , Nascimento Prematuro , Estudos Retrospectivos , EsteroidesRESUMO
Fetal bilateral renal agenesis is a lethal congenital anomaly. An early and reliable prenatal diagnosis is extremely important as it may offer options for pregnancy termination as early as possible. The criteria for the ultrasonographic diagnosis of bilateral renal agenesis are severe oligohydramnios, nonvisualization of the bladder, and the empty renal fossae. However, severe oligohydramnios makes it difficult to diagnose the disease because of poor sonographic resolution. We present a case of fetal bilateral renal agenesis diagnosed by ultrasonography after amnioinfusion at 19 weeks gestation.
Assuntos
Feminino , Gravidez , Diagnóstico , Oligo-Hidrâmnio , Diagnóstico Pré-Natal , Ultrassonografia , Ultrassonografia Pré-Natal , Bexiga UrináriaRESUMO
Werniche's encephalopathy is clinically characterized by the acute onset of global confusion, ataxia, gaze paresis, and nystagmus. It result from a deficiency in thiamine, an essential coenzyme in intermediate carbohydrate metabolism. The prompt use of thiamine prevents progression of the disease and reverses those lesions that have not yet progressed to the point of fixed structural change. We experienced a case of Wemiches encephalopathy associated with hyperemesis gravidarum, which happens to the patient who are injected only dextrose without thiamine. Therefore, we emphasize the need of thiamine replacement in hyperemesis gravidarum.
Assuntos
Feminino , Humanos , Gravidez , Ataxia , Metabolismo dos Carboidratos , Glucose , Hiperêmese Gravídica , Paresia , TiaminaRESUMO
OBJECTIVE: To determine the dincal significance of placenta previa totalis. METHODS: Maternal and neonatal medical rerords were reviewed retrospectively. Between March 1990 and June 1997, sixty-nine pregnant women with placenta previa totalis delivered at Asan Medical Center. Diagnosis of placenta previa totalis was confirmed during cesarean section. RESULTS: Mean maternal age at diagnosis was 31.7+ 3.9 years and 3 patients(4.3%) were nullipara. Fifty two patients(75%) had the history of vaginal bleeding during their index pregnancy and seventeen of 52 patients were admitted more than once. Median gestational age at the time of initial bleeding episode was 33.2 weeks(range 23.5-41. 1) and median interval from the first admission to delivery was 11 days(range 1-63), Major placental implantation site was posterior uterine wall(64%, 44/69). Six cases(8%) were complicated with placenta accreta or increta and no case was combined with abruptio placentae. Estimated blood loss at the time of cesarean section was 1,510+/-952ml(mean+/-SD) and 43 patients(62%) were transfused. No case was complicated with disseminated intravascular coagulation. Eight patients(11.6%, 8/69) underwent cesarean hysterectomy because of uncontrollable bleeding. Thirty four patients(49.3%) delivered their babies before 37 weeks of gestation. The mean gestational age at delivery was 36.4+/-3.0 weeks(mean+/-SD). Major neonatal morbidity was respiratory distress syndrome(20.3%, 14/69). Perinatal death rate was 4.3%(3/70). CONCLUSION: Because pregnant women complicated with placenta previa totalis have high probability for transfusion and cesarean hysterectomy, these patients should be managed cautiously and thoroughly. The most frequent neonatal morbidity was respiratory distress syndrome due to preterm delivery.
Assuntos
Feminino , Humanos , Gravidez , Descolamento Prematuro da Placenta , Cesárea , Diagnóstico , Coagulação Intravascular Disseminada , Idade Gestacional , Hemorragia , Histerectomia , Idade Materna , Mortalidade , Placenta Acreta , Placenta Prévia , Placenta , Gestantes , Estudos Retrospectivos , Hemorragia UterinaRESUMO
The purpose of this study was to evaluate the relationship between umbilical coiling index and Doppler velocimetry in umbilical artery. The umbilical coiling index was calculated by dividing the total number of helices by the entire cord length(in centimeter) postnatally between December 1995 and March 1996. Doppler flow velocities were obtained from the umbilical artery bifore delivery( within 3 days). The mean umbilical coiling index was 0.17 +/- 0.09 )n=186). The subjects with umbilical coiling indices below the tenth percentile(0.08), above the 90th percentile(0.3), and between the tenth and 90th percentile were defined as hypocoiled, hypercoiled, and normocoiled. The subjects with hypocoiled and hypercoiled cords did not differ from those with normocoiled cords in perinatal outcomes. The correlations between umbilical coiling index and umnilical artery systolic-diastolic ratio were not significang(r=0.015, p < 0.05). The subjects with umbilical artery systolic-diastolic ratio above 90th percentile(3.0) differed from those with below 90th percentile in several ways : fetal heart rate disturbances, birth weight, intrauterine growth retardation and admission to intensive care unit were higher in high S-D ratio group. This study suggest that the umbilical coiling level dose not interfere umbilical aretery flow.
Assuntos
Feminino , Gravidez , Artérias , Peso ao Nascer , Retardo do Crescimento Fetal , Frequência Cardíaca Fetal , Unidades de Terapia Intensiva , Reologia , Artérias UmbilicaisRESUMO
The amniotic band syndrome is a collection of fetal malformations caused by fibrous bands that appear to entangle or entrap various parts of fetus in utero, leading to deformation, malformation, or disruption involving the limbs, craniofacial region and trunk. The incidence of this syndrome is relatively rare. This syndrome often shows irreversible serious outcome. So, early diagnosis of amniotic band syndrome is important. Ultrasonography enables us to detect the amniotic band syndrome prenatally. In the second and third trimester of the pregnancy, it is relatively easy to detect major anomalies of amniotic band syndrome by its characteristic features, including amputation and/or constriction of the extremities, facial clefts, asymmetric encephaloceles and gastroschisis. Five cases of amniotic band syndrome which have been diagnosed prenatally by ultrasonography are discussed. The diagnosis was based on sonographic visualization of amniotic band and associated fetal deformation, malformations or disruption known to characterize the amniotic band syndrome.
Assuntos
Feminino , Humanos , Recém-Nascido , Gravidez , Síndrome de Bandas Amnióticas , Amputação Cirúrgica , Constrição , Diagnóstico , Diagnóstico Precoce , Encefalocele , Extremidades , Feto , Gastrosquise , Incidência , Terceiro Trimestre da Gravidez , UltrassonografiaRESUMO
Pure, nongestational ovarian choriocarcinomas is extremely rare. Most ovarian choriocarcinoma are combined with other malignant germ cell tumors or can arise as a metastaais from a primnry gestational choriocarcinoma. We experienced a case of primary ovarian choriocarcinoma that probably was associated with a past history of the mixture of germ cell tumor and present it with a review of literature.
Assuntos
Feminino , Gravidez , Coriocarcinoma , Neoplasias Embrionárias de Células GerminativasRESUMO
No abstract available.