One Case of Prenatal diagnosed 48, XXYY / 대한산부인과학회잡지

Despite the rarity of 48, XXYY, having an incidence rate of 1 in 50,000 persons, 1 in 300 persons are reported to have a mental disorder of criminal behavior. The clinical characterics of 48, XXYY are similar to Klinefelter's syndrome such as small testis, tall stature, gynecomastia and can show mental retardation and skeletal anomaly. When the cause of elevated maternal serum AFP is not explained by USG or measurement of amniotic fluid AFP, during the second trimester of pregnancy, it is defined as unexplained elevation of maternal serum AFP. We report a case of 48, XXYY with unexplained elevation of maternal serum AFP which has been experienced in our hospital with brief review of literature.

The Association between Unexplained Second-Trimester Human Chorionic Gonadotropin Elevations and Pregnancy Outcome / 대한산부인과학회잡지

We conducted this cohort analytic study to determine whether women with unexplained elevations of maternal serum hCG at 15-18 weeks' gestation are at increased risk for pregnancy complications and adverse perinatal outcomes. The inclusion criteria were a singleton gestation, a confirmed gestational age, and an hCG level greater than 2.0 multiples of the median (MoM). The exclusion criteria were fetal anomalies, an abnormal karyotype, molar pregnancy, and an MSAFP level greater than 2.5 multiples of the median (MoM). A group of randomly selected women with hCG levels under 2.0 MoM served as controls. Patients with elevated levels of hCG had a significantly higher risk for PIH (17.9% versus 4.5%; P <.05) and preterm delivery (17.9% versus 3.5%; P<, 05) than control. But no significant differences were observed in the incidence of intrauterine growth restriction and low birth weight and in the newborn weight. We suggested that pregnancies with unexplained elevated hCG levels should be regarded as high-risk pregnancies. And these patients require careful monitoring with adequate obstetric management.

Unexplained Elevated Maternal Serum Alpha-fetoprotein in Singleton Pregnancies as a Predictor of Fetal Risk / 대한산부인과학회잡지

The aim of the study was to evaluate the significance of unexplained elevated mater- nal serum alpha-fetoprotein in singleton pregnancies as a prediction of fetal risk. The inclusion criteria for patents with unexplained MSAFP elevations were a MSAFP level 2.0 or greater multiples of the median ( MoM ), a single gestation, a confirmed gestatio- nal age and no fetal malformation or death on ultrasonography. In this study, 991 woman who attended the antenatal clinic at Taejeon Eul Ji Hospital from March, 1996 to March, 1997 were reviewed and data from 79 women with elevated maternal serum alpha-fetoprotein levels were analysed. The 67 of 79 patients with elevated maternal serum alpha-fetoprotein levels had on unexplained elevated MSAFP level. 13 women could not follow up. 54 pregnant women with unexplained elevated MSAFP levels were classified as the index group of singleton pregn- ancy and were matched against a control group. 108 patients with MSAFP levels 0.5 to 2.0 MoM served as control group. The incidence of antepartum hemorrhage ( placental previa ), preterm labor, intrauterine growth retardation ( IUGR ), low birth weight and pregnancy induced hypertension ( PIH ) in two groups was analyzed and the results was subjected to Fisher's Exact Test. None of the patients in the index group had chromosomal abnormalites or birth defect. IUGR occurred in 7 ( 12.96% ) of the index group babies but in only 3 ( 2.78% ) in the control group ( p < 0.02 ). preterm labor occurred in 5 ( 9.26% ) in the index group compared with 2 ( 1.85% ) in the control group ( p < 0.05 ). low birth weight occurred in 3 ( 5.5% ) of the index group babies and in 1 ( 0.9% ) in the control group ( p < 0.1 ). This study suggests that patients with unexplained midtrimester elevations of MSAFP are increased risk for IUGR, preterm labor. But no significance differences were observed in the incidence of low birth weight, antepartum hemorrhage ( placental previa ), PIH.

The Association Between Unexplained Second-Trimester Maternal Serum Alpha-Fetoprotein or Human Chorionic Gonadotropin Elevations and Perinatal Complications / 대한산부인과학회잡지

Our purpose was to study the correlation between elevated maternal serum alpha-fetoprotein(MSAFP) or human chorionic gonadotropin(HCG) levels and pregnancy-induced hypertension (PIH), preeclampsia, preterm delivery. MSAFP and HCG levels were measured in stored second-trimester(14~22 weeks) serum obtained from 510 women. The criteria for patients with unexplained MSAFP elevations were a MSAFP level 2.5 or greater multiples of the median(MoM) and HCG elevations were a HCG level 2.0 or greater multiples of the median(MoM) excluding multiple pregnancy, fetal malformation or death on ultra-sonography and molar pregnancy. In contrast, patients with MSAFP levels 0.5 to < 2.5 MoM, HCG levels < 2.0 MoM were served as controls. Women with elevated HCG levels had more significant association with PIH than control group(22.2 % versus 3.4 % ; p < .005). Elevated MSAFP was significantly associated with preeclampsia(7.7 % versus 1.1 % ; p < .05). But no significant differences were observed in the incidence of preterm delivery. We suggested elevated second-trimester MSAFP or HCG levels appear to be correlated with high risk for PIH and preeclampsia. So, These patients require careful monitoring with adequate obstetric managements.