Effects of Combination Therapy of Alendronate and Hormonal Therapy on Bone Mineral Density in Postmenopausal Korean Women: Multicenter, Randomized Controlled Clinical Trial

This study evaluated the effects of combination treatment with alendronate (ALEN) and hormone therapy (HT) on bone mineral density (BMD) in postmenopausal Korean women. This multicenter, randomized, controlled clinical trial enrolled 344 postmenopausal women with low BMD. The women received HT (0.625 mg/day of conjugated equine estrogen and 2.5 mg/day of medroxyprogesterone acetate) alone or in combination with ALEN (10 mg/day) for 1 year. Changes in BMD and biochemical markers of bone turnover were evaluated. Data from 203 women (HT alone, 99; combination treatment, 104) who completed this study were analyzed. BMD at the lumbar spine and total hip increased significantly in both treatment groups after 1 year. There were no significant differences between HT alone vs. the combination of ALEN and HT in mean BMD increase at the lumbar spine (6.9% vs. 7.9%) and total hip (3.7% vs. 3.8%). Combined therapy suppressed serum osteocalcin and urinary deoxypyridinoline to a greater extent than HT alone. In conclusion, compared to HT alone, combination treatment with ALEN and HT for 1 year did not offer a benefit in BMD in postmenopausal Korean women with low BMD.

The effect of time interval between a single course of antenatal corticosteroids and delivery on outcomes in preterm neonates / 대한산부인과학회지

OBJECTIVE: To determine whether the beneficial effects of a single course of antenatal corticosteroids for neonatal morbidity change with time METHODS: A retrospective chart review was performed of women who received a single complete course of antenatal corticosteroid and delivered a viable singleton infant between 26 and 35 weeks of gestation. Patients were divided into 1 of 3 groups on the basis of the interval from first corticosteroid dose to delivery (48 hr~7 days, 8~14 days and > or =15 days). Neonatal morbidities were compared between each groups. RESULTS: Two hundred three pregnancies were included, of which 78 women delivered at 48 hr-7 days, 65 women delivered at 8~14 days and 60 women delivered at > or =15 days. The 3 groups were similar in clinical characteristics and indications for antenatal steroids and delivery. Neonates delivered within 7 days had a lower incidence of receiving ventilatory support for more than 24 hours than 8~14 days group (32.1% vs 50.8%, P=0.023) and > or =15 days group (32.1% vs 51.7%, P=0.02). But there were no significant differences between the groups in ventilator days, surfactant use, oxygen dependency at 36 weeks of gestation, oxygen dependency at 28 days after delivery, intraventricular hemorrhage, necrotizing enterocolitis, sepsis and length of hospital days. There were no periventricular leukomalacia and neonatal death in all groups. CONCLUSION: Neonates delivered more than 7 days after first corticosteroid dose needed more short-term ventilatory support, but there were no differences in other neonatal outcomes.

A case of fetal intracranial hemorrhage diagnosed by antenatal ultrasonographic examination / 대한주산의학회잡지

Fetal intracranial hemorrhage is quite rare. Antenatal fetal intracranial hemorrhage may occur spontaneously, or in association with various maternal or fetal conditions. Currently, antenatal fetal intracranial hemorrhage may be diagnosed by imaging techniques including ultrasonography and less frequently, magnetic resonance imaging (MRI). We report a case of spontaneous fetal intracranial hemorrhage that was diagnosed antenatally in the third trimester with a brief review of literatures.

Abdominal wall endometriosis in the absence of previous surgery: A case report / 대한산부인과학회지

Endometriosis is a common gynecological entity and characterized by the presence of endometrial glands and stroma outside the normal location in the uterine cavity. Endometriosis has been reported mostly in the pelvic cavity but anywhere in the body such as umbilicus, appendix, bladder, cervix, pleural cavity, lung, rectum, vagina, vulva and round ligaments. The abdominal wall is one of the most common sites of extrapelvic endometriosis and usually develops in association with a prior surgical scar. However, endometriosis involving the scarless abdomen is rare. We experienced an unusual presentation of a woman with abdominal wall endometriosis in the absence of previous surgery associated with recurrent pneumothorax in menstrual cycle. We report this case with brief review of the literature.

A case of CHARGE syndrome diagnosed after delivery: A case report / 대한산부인과학회지

The acronym CHARGE (Coloboma, Heart defects, Atresia choanae, Retarded growth and development, Genital hypoplasia, and Ear abnormalities) was coined by Pagon et al. in 1981. The prevalence of CHARGE syndrome was estimated to be approximately 1/10,000 - 1/15,000. The cause of the CHARGE syndrome remains unknown but several observations support the role of genetic factors and a significantly higher paternal age at conception and several chromosomal abnormalities. The clinical spectrum of this multiple congenital anomaly and mental retardation is broad and variable, therefore the treatment of the CHARGE syndrome was not definitive and conservative. We hereby report, with reviewing other literature, a case of CHARGE syndrome diagnosed after delivery.

Umbilical artery blood gas analysis and its relationship with the placenta to birth weight ratios at birth in preeclampsia and small for gestational age / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to compare the umbilical artery blood gas analysis and assess the relationship between fetal oxygenation and placenta to birth weight ratios in preeclampsia and small for gestational age. METHODS: We compared the results of umbilical artery blood gas analysis and placenta to birth weight ratio in group of preeclampsia (N=28), group of small for gestational age (N=15), group of large for gestational age (N=15), and controls (N=24). And we also divided all of them into 3 groups by placenta to birth weight ratio at birth, 0.25 (N=18). We compared umbilical artery gas analysis in each groups. RESULTS: The placenta to birth weight ratio in PE was significantly lower than control group (p<0.05). Umbilical artery pO2 and O2 saturations in each group of preeclampsia and small for gestational age were significantly lower than group of large for gestational age and controls (p<0.05). But we could not find any differences in other umbilical artery blood gas analysis (pH, pCO2, HCO3-). Umbilical artery pO2 and O2 saturations of higher placenta to birth weight ratio were stepwise lower than those of lower placenta to birth weight ratio but, pCO2 of higher placenta to birth weight ratio was stepwise lower than those of lower placenta to birth weight ratio. But there was no significant difference. CONCLUSION: Our data suggested that fetal oxygenation is significant determinant of fetal growth from small for gestational age and preeclampsia. And it may be related to placental implantaton and growth.

Systematic Evaluation in Hospitalization in Mildly Preeclamptic Women whose Placental Dysfunction was Exacerbated / 대한주산의학회잡지

OBJECTIVES: To compare the systematic evaluations in hospitalization of mildly preeclamptic women whose placental dysfunction was exacerbated with those whose placental dysfunction was not exacerbated. METHODS: There were seventy six mildly preeclamptic women after systematic evaluations in hospitalization, in which twenty eight women showed exacerbated placental dysfunction. Outcome markers considered suggestive of exacerbation of placental dysfunction included oligohydramnios (amniotic fluid index less than 5 cm), clinical diagnosis of intrapartum fetal distress and progression to severe preeclampsia. A clinical diagnosis of fetal distress was made when the monitoring revealed recurrent late, persistent tachycardia with loss of variability or prolonged decelerations. RESULTS: There were no significant differences in the amount of 24 hours urine protein, the concentrations in serum protein, creatinine, aspartate transaminase and alanine transaminase and hematocrit. But in exacerbated group, the concentrations of serum albumin and urine creatinine and creatinine clearance were significantly lower and the concentrations of serum uric acid and lactate dehydrogenase were significantly higher than not exacerbated group. CONCLUSION: In mildly preeclamptic women diagnosed after systematic evaluation in hospitalization, we must give attention to those whose concentrations of serum albumin and urine creatinine and creatinine clearance are low and concentrations of serum uric acid and lactate dehydrogenase are high.

A Case of Wernicke's Encephalopathy Associated with Hyperemesis Gravidarum / 대한주산의학회잡지

Wernicke's encephalopathy, characterized by ataxia, nystagmus, confusion, due to thiamine deficiency, can be a lethal disease without appropriate treatment such as thiamine supplement. The thiamine defect could be from poor oral intake because of hyperemesis gravidarum as well as alcoholic disease. Radiologically, Wernicke's encephalopathy presents the abnormality around the 3rd and the 4th ventricle and periaqueductal area. We now present the case of Wernicke's encephalopathy associated with hyperemesis gravidarum with the radiologic finding and reviewing other literature.

Tuberculosis in Pregnancy / 대한주산의학회잡지

No abstract available.

Associated anomalies and perinatal outcomes in the fetus with single umbilical artery / 대한산부인과학회지

OBJECTIVE: To evaluate the pattern of associated structural anomalies, perinatal outcomes and obstetrical complications in fetuses with single umbilical artery. METHODS: 27 fetuses with a single umbilical artery were detected between May 1995 and June 2005 at our hospital. All medical records were reviewed for maternal demographics, associated anomalies, karyotypic analysis, pregnancy complications and perinatal outcome. RESULTS: Of the 27 fetuses, 1 (3.7%) was terminated and 1 (3.7%) was expired. 13 fetuses (48.1%) had an associated structural anomalies. The structural anomalies found in association with single umbilical artery were in the cardiovascular system (6 cases, 46.2%), urogenital system (6 cases, 46.2%), central nervous system (3 cases, 23.1%), neuromuscular system (3 cases, 23.1%) and gastrointestinal system (1 case, 7.7%). 6 cases (46.2%) among these had multiple malformations. Karyotypic analyses were available only in 3 cases and one of these was chromosomally abnormal. CONCLUSION: Scanning the umbilical cord should be one of the essential parts of the second trimester ultrasonographic examination. When single umbilical artery is detected, a detailed ultrasonographic examination including fetal echocardiography and fetal karyotyping should be recommended for search of associated structural and chromosomal abnormalities.

The effect of pregnancy induced hypertensive disorders on perinatal death in placental abruption / 대한산부인과학회지

OBJECTIVE: To evaluate the clinical profiles and outcomes of patients with placental abruption and the effect of hypertensive disorders on perinatal death. METHODS: It was a retrospective study over 9 years from 1 January 1995 to 31 December 2003. We reviewed the data of women (N=104) presenting placental abruption among 10,940 women who were delivered at this hospital. RESULTS: The incidence of placental abruption was 0.95% or one in 104 deliveries. Only 47.6% of these could be diagnosed before delivery. The most common symptom was vaginal bleeding (71.1%) and intrauterine fetal death had already occurred in 26.9%. Perinatal mortality rate was 32.6% including still birth (26.9%) and neonatal death (5.7%). There was no maternal death. 28.8% of placental abruption were associated with preeclampsia and other hypertensive disorders but in most cases (68.3%), the contributing factors could not be found. When the hypertensive disorders were associated, perinatal mortality rate was 33%, which was not significantly different when compared with perinatal mortality (32%) without hypertensive disorder (p>0.05). But the neonates from the hypertensive women were more growthly impaired than those from normotensive women (p<0.05). CONCLUSION: Hypertensive disorders was an important factor in women with placental abruption but in most cases the contributing factors could not be found. The hypertensive disorders did not aggravate the perinatal mortality but increased the rate of intrauterine growth retardation in placental abruption.

A Case of Chronic Placental Abruption-Oligohydramnios Sequence at 19 Weeks' Gestation / 대한산부인과학회지

Placental abruption is defined as the early separation of a normal placenta from the wall of the uterus before delivery of the fetus. The incidence of it has been reported to be approximately 1% of all pregnancies and perinatal mortality rates from abruption ranged from 20% to 40% in recent studies. Catastrophic placental abruption occurs infrequently, and 20% of patients will deliver seven days later or longer after abruption. These patients have a diagnosis of chronic abruption. 60% of patients with chronic abruption develop oligohydramnios. Chronic abruption-oligohydramnios sequence (CAOS) is defined by the following criteria: (1) clinically significant vaginal bleeding in the absence of placenta previa or other identifiable source of bleeding, (2) amniotic fluid volume initially documented as normal, and (3) oligohydramnios (amniotic fluid index < or =5) eventually developing without concurrent evidence of ruptured membranes. Recently we have experienced a case of chronic abruption with newly developed oligohydramnios at 19 weeks' gestation and report our case with brief review of the literature.

A Case of Thanatophoric Dysplasia Type II Prenatally Diagnosed at 20 Gestational Weeks / 대한산부인과학회지

Thanatophoric dysplasia is a lethal skeletal dysplasia due to the dysfunction of endochondral ossification characterized by short limbs, narrow chest, micromelia, cranial dysplasia. Tavormina described in 1995 that the dysfunction of endochondral ossification is due to the missence mutation of the gene presenting the Fibrblast Growth Factor Receptor 3. Thanatophoric dysplasia is classified as two types. The type I is characterized by the curved short limbs and severe platyspondyly, and the type II by the kleeblattschadel (cloverleaf deformity) and straight short limbs. Both are destined to the death a few days after the delivery due to the pulmonary hypoplasia from the hypoplastic thorax. We experienced a case of thanatophoric dysplasia on antenatal ultrasound examination and then pregnancy was terminated by vaginal delivery. Now, with the review of literature, we report the case of thanatophoric dysplasia confirmed by clinical features and radiological finding.

A Case of Large Cystic Myxoid Leiomyoma in Uterine Round Ligament / 대한산부인과학회지

Uterine leiomyomas are the most common benign uterine tumor. They may be subserosal, intramural, or submucosal in location within the uterus or located in the cervix, in the broad ligament, or on a pedicle. But leiomyoma of the round ligament of the uterus is a rare condition occurring predominantly in premenopausal middle-age women, which is usually single and unilateral. In 50% of patients, they are associated with similar lesion of the uterus. Recently we have experienced a case of large cystic myxoid leiomyoma of the round ligament of the uterus misdiagnosed as an ovarian tumor in 32 year-old multiparous woman. We report this case with a brief review of literatures.

The maternal change of malondialdehye levels in plasma and superoxide dismutase levels in plasma and erythrocyte as biologic markers of oxidative stress in pregnancy with preeclampsia / 대한산부인과학회지

OBJECTIVES: To evaluate lipid peroxidation status and antioxidative systems in preeclamptic pregnancies by measuring plasma malondialdehyde (MDA) and plasma and erythrocyte superoxide dismutase (SOD) activities in women with or without preeclampsia METHODS: I measured lipid peroxidation end product, malondialdehyde in plasma and free radical scavenging enzyme, superoxide dismutase in plasma and erythrocyte as biologic markers of oxidative stress. The comparison was made between the sixteen preeclamptic women and the fourteen normal pregnant controls. Data were analyzed statistically using Student's t-test. RESULTS: Maternal plasma concentration of MDA was not significantly different in preeclampsia (46.95+/-12.26 nmole/mL) as compared with normotensive pregnancy (54.01+/-29.91 nmole/mL). And preeclamptic women had similar antioxidant enzyme SOD activity in plasma (0.083+/-0.043 U/mg protein) as compared with normotensive pregnancy (0.081+/-0.012 U/mg protein). But, preeclamptic women showed significantly (P=0.02) enhanced SOD activity in erythrocyte (2.323+/-0.574 U/mg protein) as compared with normotensive pregnancy (1.859+/-0.528 U/mg protein). CONCLUSION: The finding in this study do not show that oxidative stress might be a pathogenetically relevant process causally contributing to the disease. Oxidative process seem to be counteracted by the enhanced activation of antioxidant enzyme.

A Case of Poland Syndrome Diagnosed by Prenatal Ultrasonography / 대한산부인과학회지

Poland syndrome is a rare congenital disorder. It is characterized by unilateral chest wall hypoplasia, ipsilateral arm and hand abnormalities, and a variety of associated anomalies. It is suggested that the deformity has a sporadic and nongenetic nature. The main pathogenetic mechanism is the interruption of embryological blood supply to the subclavian artery with hypoplasia at the end of the 6th week of gestation. Most frequently involved muscle is the sternocostal portion of the pectoralis major muscle, with hypoplasia of breast and nipple, rib anomalies and unilateral brachysyndactyly. We experienced an unusual case of Poland syndrome which was detected by prenatally ultrasonographic evaluation at 36 gestational weeks. So, we report this case with a brief review of the literature.

A Case of Fetal Cardiac Tumor Diagnosed by Ultrasonography / 대한산부인과학회지

Primary tumors of the heart are uncommon in fetus and neonate, and most tumors are histologically benign. They remain clinically unimportant and regress with age, but they may cause mechanical obstruction and induce even life-threatening symptoms. Hemodynamic disturbance are correlated with the size and location of the tumors. Murmurs, arrhythmia, cyanosis, respiratory distress, and heart failure are main presenting signs of cardiac tumors in perinatal periods. The most common histological form of cardiac tumors in perinatal periods is rhabdomyoma. Rhabdomyomas are associated with tuberous sclerosis in 50% of cases. The widespread use of echocardiography and other new imaging techniques has contributed significantly to eariler diagnosis, treatment, and thus improving survival. We have experienced a case of fetal cardiac tumor which were detected by prenatal ultrasonographic evaluation in 21 weeks and 4 days of gestation. After termination, autopsy was performed and rhabdomyoma was diagnosed, but not accompanied tuberous sclerosis.

A Case of Post-Cesarean Endomyometritis Associated with Myometrial Gas Formation / 대한산부인과학회지

Postpartum endomyometritis is an important cause of maternal morbidity, especially after cesarean delivery. The management of postpartum endomyometritis is primarily medical with surgical intervention only occasionally required. But the gas forming abscess rarely happens, making the medical treatment difficult and needing emergency hysterectomy. We present a case of post-cesarean delivery endomyometritis complicated by intrauterine gas formation penetrating myometrium, which could not be managed by medical treatment, so finally needed emergency hysterectomy.

Relationship between the Maternal-Fetal Complications and the Severity of HELLP Syndrome, Classified based on Maternal Platelet Count Nadir / 대한산부인과학회잡지

OBJECTIVE: To determine the incidence of HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome and assess the relationship between the maternal-fetal complications and the severity of HELLP syndrome, classified based on platelet count nadir. METHODS: We reviewed the maternal and neonatal charts of ten pregnancies complicated by HELLP syndrome, managed at Dankook University Hospital between January, 1995 and December, 2002. Women were divided into 2 groups as class I HELLP which had a maternal platelet nadir 50,000 and 100,000/mm3. We compared the maternal and fetal complications between class I and class II HELLP syndrome. But we did not analyze statistically due to small number of patients. RESULTS: There were four cases of class I HELLP and six cases of class II HELLP syndrome. The incidence of HELLP syndrome was 0.10% (10/10,238) in total deliveries and was 2.26% (10/443) in women with severe pre-eclampsia or eclampsia. The mean level of platelet counts nadir was 41,500/mm3 in class I and 64,000/mm3 in class II HELLP. The mean platelet recovery days (more than 100,000/mm3) were 6.0 and 4.2 days in each class. The mean values of the maximal aspartate aminotransferase (AST/SGOT), alanine aminotransferase (ALT/SGPT) and uric acid might show no differences, but there might be difference in lactate dehydrogenase (LDH) levels which were 5854 and 1388 IU/L in each class. All patients with class I HELLP syndrome showed maternal complications, but only one patient with class II HELLP showed maternal complications. There might be no differences in the mean gestational ages and birth weights. The neonatal complications were similar in each class. CONCLUSION: Our data suggest that patients with class I HELLP syndrome may be at increased risk for serious maternal complications, but the neonatal complications may be associated with gestational ages.

Tsutsugamushi Disease in a Pregnant Woman / 대한산부인과학회잡지

Tsutsugamushi disease (scrub typhus) is a rickettsian febrile disease which is seldom found in pregnancy. A 28-year-old woman was infected with scrub typhus at the 22th week of gestation which was diagnosed on the basis of clinical features. A serology for Tsutsugamushi was negative at that time. Therapy with tetracycline (doxycycline) or chloramphenicol is currently recommended for the treatment. However these drugs which are class D drugs according to the USA FDA, and Fetal Risk Summary, should not be used to treat pregnant women. Recently azithromycin, a new macrolide antibiotic, has been proven to be more effective than doxycycline. Moreover, there is no evidence that azithromycin causes harm to the developing fetus or to children. Here we describe a pregnant patient with Tsutsugamushi disease who was treated successfully with azithromycin without complications.