Ultrasound-guided local injection of potassium chloride (KCl) and methotrexate (MTX) in the treatment of cornual pregnancy / 대한산부인과학회지

OBJECTIVE: To evaluate efficacy and safety of local injection of potassium chloride (KCl) and methotrexate (MTX) in the treatment of cornual pregnancy. METHODS: We retrospectively reviewed all cases of cornual pregnancy treated conservatively from 2005 through August 2007. Eight cases were identified and two cases were heterotopic interstitial pregnancy. All cases were managed with local injection of KCl or methotrexate under ultrasound guidance and 2 cases were treated with intra-muscular injection of MTX in combination. After the procedure all cases with cardiac activity was confirmed to be aborted by ultrasound. Also serial follow-up sonographic examination and serum beta-hCG measurement were performed. RESULTS: The mean initial beta-hCG level was 53,331.6 mIU/mL and ranged from 14,332 mIU/mL to 125,721 mIU/mL. Mean gestational age was 48.3 days from 40 to 65 days. All cases were aborted successfully and follow up beta-hCG were declined abruptly. Two cases of heterotopic pregnancy resulted in successful deliveries at full term. CONCLUSION: Cornual resection or hysterectomy should no longer be the first line of treatment for hemodynamically stable patients with cornual pregnancy. They can be successfully treated through local injection of MTX or KCl by ultrasound guidance.

One case of monoamniotic twin pregnancy with cord entanglement and fetus survival at 32+4 weeks after successful medical amnioreduction and intensive ultrasound surveillance / 대한산부인과학회지

Monoamniotic twin pregnancies are relatively rare, but perinatal mortality is high about 30-70%. The major cause of fetal death is cord accident, congenital anomalies, twin-twin transfusion syndrome, and intrauterine growth restriction. Especially cord entanglement occurs; perinatal mortality is about 50%. So the active management of monoamniotic twins to reduce the complication of cord entanglement is important. This is a case of monoamniotic twin pregnancy with cord entanglement and both fetuses survival by elective cesarean section at 32+4 weeks after medical amnioreduction and intensive fetal surveillance.

A Case of Fetal Bilateral Renal Agenesis Diagnosed by Transvaginal Ultrasonography / 대한산부인과학회지

Fetal bilateral renal agenesis is a lethal congenital anomaly characterized by bilateral pulmonary hypoplasia, deformities and death due to severe oligohydramnios. This syndrome is associated with malformations of genitourinary tract, cardiovascular system, vertebral bodies or imperforated anus in more than half of the affected individuals. An early and reliable prenatal diagnosis is extremely important because 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, empty renal fossae. But poor sonographic resolution of severe oligohydramnios makes it difficult to diagnose the disease. We present a case of bilateral renal agenesis diagnosed at the 18th weeks gestation by using Transvaginal Ultrasonography and Color Doppler.

A Case of Amniotic Band Syndrome: Craniofacial Deformity and Amputation of Lower Leg / 대한산부인과학회잡지

The amniotic band syndrome is rare congenital deformity, presumably due to rupture of amniotic sac during the early pregnancy and appears to cause fetal injury through deformation, malformation, or disruption. This syndrome is given many names yet follows a clearly defined clinical pattern. The diagnosis was based on sonographic visualization of either amniotic bands or bands associated with fetal deformation or deformities in nonembryologic distribution. Recently, we experienced a case of amniotic band syndrome, in which partial absence of cranial bone, asymmetric facial dysmorphism and amputation of right lower leg were detected. At our best knowledge, this is one of few case describing prenatal ultrasound diagnosis of amniotic band syndrome in Korea. So, we present this case with a brief review of the literatures.

Fetal Ovarian Cysts: Sonographic Findings and Natural Courses / 대한산부인과학회잡지

OBJECTIVE: To evaluate sonographic findings and natural courses of fetal ovarian cysts. METHODS: Seven pregnant women (mean, 26 years old; 33 weeks of gestation) diagnosed with having fetal ovarian cysts were evaluated. All were followed-up more than once in utero. We analyzed the location, size, and characteristics (number of locules, thickness of wall/septa, internal echogenecity) of cysts. Internal echogenecity was categorized into 4 types (A=anechoic, B=fluid-fluid level, C=isoechoic portion, D=lace-like). Amount of amniotic fluid, fetal biometry, and other abnormalities were evaluated. RESULTS: In all cases, fetal ovarian cysts were located in lateral or anterior lower abdomen. At time of diagnosis, cysts were 4.2 cm in mean size, round and unilocular. Six cases were type A and the other was type B. On follow-up examination, type A cysts were disappeared (n=1), not changed (n=2), increased in size (n=1), or changed in internal echogenecity (n=2; type B and D). The case categorized into type B at the time of diagnosis was changed to type C later. The case categorized into type A at the time of diagnosis was changed to type B on the first follow-up, but changed to type C on the next examination. Finally, all fetal ovarian cysts were disappeared in utero (n=2) or postnatally (n=5). Fetal biometry and amniotic fluid amount were normal. In all cases, no other abnormalities were detected and full-termed healthy female babies were delivered. CONCLUSION: Fetal ovarian cysts may have various patterns of internal echogenecity although the most common pattern is unilocular anechoic. The size and pattern of internal echogenecity of the fetal ovarian cysts is changeable in utero, however all of them disappear spontaneously in utero or postnatally.