Prenatal diagnosis of congenital heart disease: trends in pregnancy termination rate, and perinatal and 1-year infant mortalities in Korea between 1994 and 2005.

AIM: To determine the pregnancy termination rate, and perinatal and 1-year infant mortality rates following prenatally-detected congenital heart disease (CHD) and trends over an 11-year period. METHODS: Between 1994 and 2005, 1603 gravidas underwent fetal echocardiography in our institution, in which 378 fetuses were diagnosed with CHD. The study period was divided into the following three groups for time-trend analysis: 1994-1997, 1998-2001, and 2002-2005. Data regarding gestational age at diagnosis and delivery, the presence of extracardiac or chromosomal abnormalities, pregnancy termination rate, and perinatal and 1-year mortalities were collected by review of medical records and telephone interviews. RESULTS: Among 378 fetuses with a prenatally-detected CHD, complete perinatal and infant outcomes were available for 336 fetuses (88.9%). There was a gradual increase in prenatally-detected CHD by fetal echocardiography during the study period (1994-1997, 10.3%; 1998-2001, 17.3%; and 2002-2005, 24.3%). The mean gestational ages at diagnosis and delivery were 27.2 +/- 5.6 and 37.8 +/- 2.9 weeks, respectively. Overall, the pregnancy termination rate in this study population was 20.2% and the perinatal and 1-year infant mortality rates were 6.3% and 9.7%, respectively. Among the fetuses who underwent cardiac surgery, surgical mortality occurred in two (3.8%); both died more than 1 month after surgery. Although the pregnancy termination rates remained unchanged, there was a significant decrease in perinatal and 1-year infant mortality rates over the study period. CONCLUSION: Although the perinatal and 1-year infant mortalities following prenatally-detected CHD have continued to decrease significantly during the past 11 years, pregnancy termination rates have remained unchanged.

Cervicovaginal matrix metalloproteinase-9 and cervical ripening in human term parturition.

OBJECTIVE: To investigate the changes of matrix metalloproteinase-9 (MMP-9) in cervicovaginal fluid during pregnancy and its association with parturition. STUDY DESIGN: A prospective study was conducted on nulliparous women between 16 and 42 weeks with normal singleton pregnancies in the following categories: (1) preterm control (n=39); (2) term labor induction without labor or rupture of membranes (n=68); (3) term spontaneous labor with intact membranes (n=42); (4) term premature rupture of membranes (n=24). The MMP-9 concentration in the cervicovaginal fluid was measured by immunoassay. RESULTS: (1) Cervicovaginal MMP-9 did not change significantly with advancing gestation until 37 weeks, and significantly increased after 37 weeks. (2) Cervicovaginal MMP-9 levels were similar in women with no labor, spontaneous labor, and premature rupture of membranes at term. (3) For the induced labor group, a high Bishop score (>or=4) was significantly correlated with cervicovaginal MMP-9. However, an elevated cervicovaginal MMP-9 did not predict achieving active phase of labor or vaginal delivery after labor induction. CONCLUSION: Cervicovaginal MMP-9 correlated with cervical ripening before labor at term. However, cervicovaginal MMP-9 did not change with spontaneous labor or rupture of membranes at term and did not predict success of labor induction.

Antepartum risk factors associated with peripartum cesarean hysterectomy in women with placenta previa.

The objective of this study was to identify antepartum risk factors for peripartum hysterectomy in women with placenta previa. The medical records of women with placenta previa who underwent cesarean section (C/S) were reviewed retrospectively. Data regarding the reproductive history and peripartum outcomes were analyzed. Multivariable analysis was used to identify factors independently associated with hysterectomy. During an 8.5-year period, 346 cases of placenta previa were identified in 24,987 deliveries (1.4%). An emergent hysterectomy was performed in 31 patients (9.0%). Multiparity, total previa, history of abortion, C/S, and placenta previa was more common in the hysterectomy group. An increasing number of abortions and C/S were associated with a higher frequency of hysterectomy. By the multivariable analysis, previous abortion, previous C/S, and total previa were significant risk factors for hysterectomy. We concluded that in women with placenta previa, history of abortion as well as prior C/S, and a total previa are strong antepartum risk factors for peripartum hysterectomy.