Summary of clinically diagnosed amniotic fluid embolism cases in Korea and disagreement with 4 criteria proposed for research purpose

Objective@#This study aimed 1) to investigate the clinical characteristics of amniotic fluid embolism (AFE) cases clinically diagnosed by maternal fetal medicine (MFM) specialists in Korea, 2) to check the disagreement with 4 recently proposed criteria by the Society for Maternal-Fetal Medicine (SMFM) for research purpose, and 3) to compare maternal outcomes between cases satisfying all 4 criteria and cases with at least 1 missing criterion. @*Methods@#This study included 12 patients clinically diagnosed with AFE from 7 referral hospitals in Korea. We collected information, including maternal age, symptoms of AFE, the amount of transfusion, and maternal mortality. @*Results@#The median maternal age was 33 years (range, 28–40 years). Regarding symptoms, cardiovascular arrest, hypotension, respiratory compromise, clinical coagulopathy, and neurologic signs were observed in 41.7%, 83.3%, 83.3%, 100%, and 66.7% of the cases, respectively. Among the 12 cases, 5 women died and 2 suffered severe neurologic disability, showing an intact survival rate of 41.7%. Disagreement with all 4 criteria proposed by the SMFM was found in 66.7% of the cases, due to the lack of criteria for disseminated intravascular coagulation or strict onset time (<30 minutes after delivery). There was no difference in maternal mortality and the amount of transfusion between cases satisfying all 4 criteria and cases with at least 1 missing criterion. @*Conclusion@#Two-thirds of clinically confirmed AFE cases did not satisfy all 4 criteria proposed by the SMFM, despite similar rates of maternal mortality with cases satisfying all 4 criteria. Our study suggests that there may be some discrepancy between the clinical diagnosis of AFE and the recent diagnostic criteria proposed by the SMFM for research purpose.

Summary of clinically diagnosed amniotic fluid embolism cases in Korea and disagreement with 4 criteria proposed for research purpose

Objective@#This study aimed 1) to investigate the clinical characteristics of amniotic fluid embolism (AFE) cases clinically diagnosed by maternal fetal medicine (MFM) specialists in Korea, 2) to check the disagreement with 4 recently proposed criteria by the Society for Maternal-Fetal Medicine (SMFM) for research purpose, and 3) to compare maternal outcomes between cases satisfying all 4 criteria and cases with at least 1 missing criterion. @*Methods@#This study included 12 patients clinically diagnosed with AFE from 7 referral hospitals in Korea. We collected information, including maternal age, symptoms of AFE, the amount of transfusion, and maternal mortality. @*Results@#The median maternal age was 33 years (range, 28–40 years). Regarding symptoms, cardiovascular arrest, hypotension, respiratory compromise, clinical coagulopathy, and neurologic signs were observed in 41.7%, 83.3%, 83.3%, 100%, and 66.7% of the cases, respectively. Among the 12 cases, 5 women died and 2 suffered severe neurologic disability, showing an intact survival rate of 41.7%. Disagreement with all 4 criteria proposed by the SMFM was found in 66.7% of the cases, due to the lack of criteria for disseminated intravascular coagulation or strict onset time (<30 minutes after delivery). There was no difference in maternal mortality and the amount of transfusion between cases satisfying all 4 criteria and cases with at least 1 missing criterion. @*Conclusion@#Two-thirds of clinically confirmed AFE cases did not satisfy all 4 criteria proposed by the SMFM, despite similar rates of maternal mortality with cases satisfying all 4 criteria. Our study suggests that there may be some discrepancy between the clinical diagnosis of AFE and the recent diagnostic criteria proposed by the SMFM for research purpose.

Impact of Maternal Nutrition Management During Pregnancy on Perinatal Outcome, in One of the Pilot area of Gyeonggi-do Province

PURPOSE: Proper management of nutrition or health care for pregnant women is known to have better perinatal outcomes for maternal and neonatal health. In this study, we investigated the effect of regular medical and nutritional counseling provided to pregnant women for improved-results for mother and neonates. METHODS: Thirty-five pregnant women participated in the study and received information on nutrition management via telephone or e-mail every four weeks until childbirth. The nutrition management program comprised proper diet, low-salt diet, low-sugar diet, breast-feeding preparation, and provision of a healthy menu according to their pregnancy trimesters. We categorized them by their degree of participation into a “low participation group” that formed the control group, and a “high participation group” as the study group. RESULTS: No significant differences were found in maternal age, and body mass index between the two groups at the time of enrollment in the study. Post-natal exclusive breast feeding rate was significantly higher in the high participation group (62%) than in the low participation group (32%) (p<0.05). In the neonatal results, gestational age at birth and neonatal birth weight were significantly higher in the high participation group than in the low participation group (p<0.05). Neonatal complication rate, neonatal admission rate to intensive care unit, rate of low birth weight, Apgar score at 1 and 5 minutes, as well as the rate of transient tachypnea were higher in the low participation group, but lacked any statistically significant difference. CONCLUSION: Collaborative nutrition management with obstetricians and nutritionists is helpful in achieving better perinatal outcomes.

Serosal Cavities Contain Two Populations of Innate-like integrin α4highCD4+ T Cells, Integrin α4β1+α6β1+α4β7− and α4β1+α6β1−α4β7+ Cells

We previously reported peritoneal innate-like integrin α4 (CD49d)highCD4+ T cells that provided help for B-1a cells. Here we analyzed the expression of various integrin chains on the peritoneal and pleural integrin α4highCD4+ T cells and investigated the functional heterogeneity of the subpopulations based on the integrin expression. Pleural cavity contained a lower ratio of integrin α4highCD4+ T cells to integrin α4lowCD4+ T cells than peritoneal cavity, but the pleural integrin α4highCD4+ T cells have the same characteristics of the peritoneal integrin α4highCD4+ T cells. Most of integrin α4highCD4+ T cells were integrin β1highβ7−, but a minor population of integrin α4highCD4+ T cells was integrin β1+β7+. Interestingly, the integrin α4highβ1highβ7− CD4+ T cells expressed high levels of integrin α4β1 and α6β1, whereas integrin α4highβ1+β7+ CD4+ T cells expressed high levels of integrin α4β1 and α4β7, suggesting an alternative expression of integrin α6β1 or α4β7 in combination with α4β1 in respective major and minor populations of integrin α4highCD4+ T cells. The minor population, integrin α4highβ1+β7+ CD4+ T cells, were different from the integrin α4highβ1highβ7− CD4+ T cells in that they secreted a smaller amount of Th1 cytokines upon stimulation and expressed lower levels of Th1-related chemokine receptors CCR5 and CXCR3 than the integrin α4highβ1 highβ7− CD4+ T cells. In summary, the innate-like integrin α4highCD4+ T cells could be divided into 2 populations, integrin α4β1+α6β1+α4β7− and α4β1+α6β1−α4β7+ cells. The functional significance of serosal integrin α4β7+ CD4+ T cells needed to be investigated especially in view of mucosal immunity.

The Proteomic Analysis of Human Placenta with Pre-eclampsia and Normal Pregnancy

Preeclampsia is one of the most important and complexed disorders for women's health. Searching for novel proteins as biomarkers to reveal pathogenesis, proteomic approaches using 2DE has become a valuable tool to understanding of preeclampsia. To analyze the proteomic profiling of preclamptic placenta compared to that of normal pregnancy for better understanding of pathogenesis in preeclampsia, placentas from each group were handled by use of proteomics approach using 2DE combined with MALDI-TOF-MS. The 20 spots of showing differences were analysed and identified. Among differentially expressed protein spots Hsp 27 and Hsp 70 were selected for validation using Western blot analysis. In preeclamptic placenta 9 differentially expressed proteins were down-regulated with Hsp 70, serum albumin crystal structure chain A, lamin B2, cytokeratin 18, actin cytoplasmic, alpha fibrinogen precursor, septin 2, dihydrolipoamide branched chain transacylase E2 and firbrinogen beta chain. The 11 up-regulated proteins were fibrinogen gamma, cardiac muscle alpha actin proprotein, cytokeratin 8, calumenin, fibrinogen fragment D, F-actin capping protein alpha-1 subunit, Hsp 27, Hsp 40, annexin A4, enoyl-CoA delta isomerase and programmed cell death protein 6. The western blot analysis for validation also showed significant up-regulation of Hsp 27 and down-regulation of Hsp 70 in the placental tissues with preeclmaptic pregnancies. This proteomic profiling of placenta using 2DE in preeclampsia successfully identifies various proteins involved in apoptosis, mitochondrial dysfunction, as well as three Hsps with altered expression, which might play a important role for the understanding of pathogenesis in preeclampsia.

Outcome of pelvic arterial embolization for postpartum hemorrhage: A retrospective review of 117 cases

OBJECTIVE: The aim of this study was to evaluate indications, efficacy, and complications associated with pelvic arterial embolization (PAE) for postpartum hemorrhage (PPH). METHODS: We retrospectively reviewed the medical records of 117 consecutive patients who underwent PAE for PPH between January 2006 and June 2013. RESULTS: In our single-center study, 117 women underwent PAE to control PPH refractory to conservative management including uterine massage, use of uterotonic agents, surgical repair of genital tract lacerations, and removal of retained placental tissues. Among 117 patients, 69 had a vaginal delivery and 48 had a Cesarean section. The major indication for embolization was uterine atony (54.7%). Other causes were low genital tract lacerations (21.4%) and abnormal placentation (14.5%). The procedure showed a clinical success rate of 88.0% with 14 cases of PAE failure; there were 4 hemostatic hysterectomies and 10 re-embolizations. On univariate analysis, PAE failure was associated with overt disseminated intravascular coagulation (P=0.009), transfusion of more than 10 red blood cell units (RBCUs, P=0.002) and embolization of both uterine and ovarian arteries (P=0.003). Multivariate analysis showed that PAE failure was only associated with transfusions of more than 10 RBCUs (odds ratio, 8.011; 95% confidence interval, 1.531-41.912; P=0.014) and embolization of both uterine and ovarian arteries (odds ratio, 20.472; 95% confidence interval, 2.715-154.365; P=0.003), which were not predictive factors, but rather, were the results of longer time for PAE. Three patients showed uterine necrosis and underwent hysterectomy. CONCLUSION: PAE showed high success rates, mostly without procedure-related complications. Thus, it is a safe and effective adjunct or alternative to hemostatic hysterectomy, when primary management fails to control PPH.

Clinical application of non-invasive prenatal testing using cell free fetal DNA

Non-invasive prenatal testing using next generation sequencing technology with cell free fetal DNA from the blood of pregnant women has been rapidly adopted as a screening test for the detection of disorders involving chromosomal aneuploidy, especially Down syndrome. However as part of a prenatal recommendation in high-risk group, this laboratory assessment should be accompanied by informed counseling at both pre-test and post-test stages. In low-risk group and multifetal pregnancies, only conventional maternal serum screening tests in the first trimester and/or second trimester in addition to measurement of nuchal translucency should be recommended, until this potential tool has been incorporated into current screening strategic modalities on the basis ofsufficient published data.

Comparison of Helmet Therapy and Counter Positioning for Deformational Plagiocephaly

OBJECTIVE: To compare effectiveness on correcting cranial and ear asymmetry between helmet therapy and counter positioning for deformational plagiocephaly (DP). METHODS: Retrospective data of children diagnosed with DP who visited our clinic from November 2010 to October 2012 were reviewed. Subjects or =10 mm of diagonal difference were included for analysis. For DP treatment, information on both helmet therapy and counter positioning was given and either of the two was chosen by each family. Head circumference, cranial asymmetry measurements including diagonal difference, cranial vault asymmetry index, radial symmetry index, and ear shift were obtained by 3-dimensional head-surface laser scan at the time of initiation and termination of therapy. RESULTS: Twenty-seven subjects were included: 21 had helmet therapy and 6 underwent counter positioning. There was no significant difference of baseline characteristics, head circumferences and cranial asymmetry measurements at the initiation of therapy. The mean duration of therapy was 4.30+/-1.27 months in the helmet therapy group and 4.08+/-0.95 months in the counter positioning group (p=0.770). While cranial asymmetry measurements improved in both groups, significantly more improvement was observed with helmet therapy. There was no significant difference of the head circumference growth between the two groups at the end of therapy. CONCLUSION: Helmet therapy resulted in more favorable outcomes in correcting cranial and ear asymmetry than counter positioning on moderate to severe DP without compromising head growth.

Umbilical Artery Doppler Study as a Predictive Marker of Perinatal Outcome in Preterm Small for Gestational Age Infants

PURPOSE: To evaluate the merit of umbilical artery Doppler study as a predictive marker of perinatal outcome in preterm small for gestational age (SGA) infants. MATERIALS AND METHODS: A total of 218 patients at 27 - 36 weeks of gestational age (GA) who received antenatal umbilical artery Doppler velocimetry and delivered singleton infants with SGA. The ratio of peak-systolic to end-diastolic blood flow velocities (S/D) in the umbilical artery was measured in each patient. The patients were divided into 3 groups: the normal group with S/D ratios of less than 95th percentile (n = 134), elevated S/D ratio group of 95th or more percentile (n = 41), and those with absent/reversed end diastolic flow (n = 43). Maternal characteristics and neonatal outcomes of these groups were comparatively analyzed. RESULTS: The gestational age (GA) at the time of diagnosis of SGA, the mean GA at delivery, and the mean birth weight showed statistically significant difference among three groups (p < 0.001). Also, poor perinatal outcome was significantly increased in infants with abnormal S/D ratio (13.4% vs. 31.7% vs. 67.4%, p < 0.001). Multivariate logistic regression analysis revealed umbilical artery Doppler study as a significant independent factor for prediction of poor perinatal outcome (odds ratio: 3.7, 95% confidence interval 1.4 - 9.5, p = 0.007). CONCLUSION: Antenatal umbilical artery Doppler velocimetry is shown as a significantly efficient marker in predicting perinatal outcome in preterm SGA infants.

The efficacy of umbilical artery blood flow velocity waveform to predict the perinatal outcome of term pregnancies with small for gestational age / 대한산부인과학회지

OBJECTIVE: To investigate whether umbilical artery Doppler blood flow velocity waveform is effective in predicting perinatal outcome of term pregnancies with small for gestational age (SGA). METHODS: A total of 381 patients at 37~41 weeks of gestational age (GA) who received antenatal umbilical artery Doppler blood flow test and delivered singleton SGA infants. The ratio of peak-systolic to end-diastolic (S/D) blood flow velocities in the umbilical artery was measured in each patient. The patients were divided into a normal group (n=307) with a S/D ratio equal to or less than 3.0, and an abnormal group with a S/D ratio of greater than 3.0 (n=74). These groups were comparatively analysed with respect to maternal characteristics and neonatal outcomes. Results: There were no significant differences between the two groups in mean maternal age, gestational age at the time of delivery, and cesarean section rate due to fetal distress. There was significantly increased incidence of hypertensive disorders in pregnancy in the abnormal S/D ratio group. And the abnormal S/D ratio group showed lower neonatal birthweight, higher incidence of admission to neonatal intensive care unit (NICU), and longer stay in neonatal intensive care unit. According to linear regression, in pregnancies complicated by SGA, abnormal S/D ratio was still a risk factor for low birthweight even after controlling for the incidence of hypertension. Conclusion: In term pregnancies accompanied by SGA, abnormal umbilical artery S/D ratio is an independent predictor of neonatal birth weight, incidence of admission to NICU, and NICU stay.

The efficacy of umbilical artery blood flow velocity waveform to predict the perinatal outcome of term pregnancies with small for gestational age / 대한산부인과학회지

OBJECTIVE: To investigate whether umbilical artery Doppler blood flow velocity waveform is effective in predicting perinatal outcome of term pregnancies with small for gestational age (SGA). METHODS: A total of 381 patients at 37~41 weeks of gestational age (GA) who received antenatal umbilical artery Doppler blood flow test and delivered singleton SGA infants. The ratio of peak-systolic to end-diastolic (S/D) blood flow velocities in the umbilical artery was measured in each patient. The patients were divided into a normal group (n=307) with a S/D ratio equal to or less than 3.0, and an abnormal group with a S/D ratio of greater than 3.0 (n=74). These groups were comparatively analysed with respect to maternal characteristics and neonatal outcomes. Results: There were no significant differences between the two groups in mean maternal age, gestational age at the time of delivery, and cesarean section rate due to fetal distress. There was significantly increased incidence of hypertensive disorders in pregnancy in the abnormal S/D ratio group. And the abnormal S/D ratio group showed lower neonatal birthweight, higher incidence of admission to neonatal intensive care unit (NICU), and longer stay in neonatal intensive care unit. According to linear regression, in pregnancies complicated by SGA, abnormal S/D ratio was still a risk factor for low birthweight even after controlling for the incidence of hypertension. Conclusion: In term pregnancies accompanied by SGA, abnormal umbilical artery S/D ratio is an independent predictor of neonatal birth weight, incidence of admission to NICU, and NICU stay.

The normal range of amniotic fluid alpha-fetoprotein in singleton midtrimester pregnancy of Korean women / 대한산부인과학회지

OBJECTIVE: To determine normal range of amniotic fluid alpha-fetoprotein (AFAFP) in midtrimester singleton Korean pregnant women whose pregnancy and neonatal outcomes were uneventful. METHODS: AFAFP levels were measured in midtrimester pregnancy during amniocentesis from May 1995 to September 2006 at tertiary referral center. Normal ranges were obtained from 954 singleton pregnancies in which pregnancy and neonatal outcomes were normal. RESULTS: Median values of AFAFP in midtrimester pregnancy were 15,800 ng/mL, 13,903.9 ng/mL, 11,408.7 ng/mL, 9,690.1 ng/mL, 6,923.4 ng/mL, 6,330.0 ng/mL, 5,295.3 ng/mL, 4,421.2 ng/mL, 3,162.5 ng/mL at 16 week, 17 week, 18 week, 19 week, 20 week, 21 week, 22 week, 23 week, and 24 week. CONCLUSION: The normal range of AFAFP level in each gestational week in Korean women could be a good reference for prenatal diagnosis of various disorders.

The Types of Impairments in Burn Patients

OBJECTIVE: The aim of this study was to investigate the types of impairments in burn patients. METHOD: The retrospective data of 143 patients with burn injury was collected who were admitted to the burn rehabilitation department in Hangang Sacred Heart Hospital from Jan 2000 to Jul 2004. We have collected the informations on impairment of burn injury. RESULTS: Limitation of joint motion (78.6%) was the most common disability, followed by hypertrophic scar (53%), peripheral neuropathy (32.9%), and amputation (20.3%) in burn injured patients in rehabilitation management. The common sites of joint limitation were finger joint (38.1%), shoulder (35.7%), elbow (30.8%) and knee (28.0%) joint. Neuropathy by the order of frequency were median (29.7%), ulnar (22.6%) and peroneal (20.2%) nerve lesion. The most common site of amputation was transradial amputation (8.4%). CONCLUSION: Above analytic data will provide the useful information about disability of burn patients to know where we should focus on to reduce complication rate or to restore body functional level in burn patient rehabilitation.

Ultrasonographic Findings as Prognostic Factor in Fetal Ovarian Cysts / 대한산부인과학회지

OBJECTIVE: To investigate whether there was any correlation between sonographic parameters and perinatal course of fetal ovarian cysts. METHODS: This was a retrospective analysis of cases from July, 1994 through February, 2003. The pre- and postnatal data of 10 fetuses who prenatally diagnosed to have an ovarian cyst, delivered and followed up in our obstetric center were analyzed. Maternal age, gestational age of diagnosis, ovarian cyst location, size, combined anomaly, mode of delivery, changes of ultrasonographic parameters, management of ovarian cysts and pathologic findings were reviewed. RESULTS: A total of 10 fetal ovarian cysts were all purely cystic, with well defined margins. Three of 10 cases (30%) showed antenatal sonographic patterns of complicated cysts (2 septa, 1 intraluminal echo) which spontaneously resolved during serial sonographic monitoring. In 2 cases the sonographic findings became complicated postnatally and were operated on revealing dermoid cyst with torsion. Five uncomplicated cysts of 10 cases were spontaneously resolved during perinatal follow-up. In eight cases of ovarian cysts larger than 4 cm, there was only one case which required postnatal surgery. CONCLUSION: There was no single ultrasonographic parameter (internal echoes, septum, character, size) to predict perinatal course of ovarian cysts including spontaneous resolution, torsion and need of operation.

Relationship between nRBC counts and fetal hypoxia, perinatal outcome in severe preeclampsia / 대한산부인과학회잡지

OBJECTIVE: To determine the usefulness of neonatal nucleated red blood cell counts (nRBC) as an independent predictor of fetal hypoxia and perinatal outcome in severe preeclampsia. METHODS: One hundred thirty eight patients with severe preeclampsia were studied. Umbilical artery Dopppler velocimetry was performed in all patients, and were divided into two groups, the control group with present umbilical artery end diastolic velocity, and the case group with absent or reversed velocity. The patients were also separately grouped as another control (n=58), acute (n=19), and chronic hypoxia (n=55) according to abnormal Doppler findings, presence of oligohydramnios, intrauterine growth restriction (IUGR), and pattern of fetal heart rate tracings during labor. At delivery, the umbilical cord blood was collected and the levels of nRBC per 100 WBC were measured from the samples along with blood gas analysis. The results were compared between the control and acute groups, and chronic hypoxic fetus. Correlation with perinatal outcomes was also evaluated. Student's t-test, ANOVA, and regression analysis were performed for statistical analysis. RESULTS: Those with absent or reversed end diastolic velocity did not have significantly greater nRBC counts, but had lower platelet counts (p=0.02), lower pO2 (p=0.005), and higher pCO2 saturation levels (p=0.01). There were no significant differences with regard to nRBC counts among the control, acute, and chronic hypoxia groups. Elevated nRBC counts were significantly associated with neonatal intensive care unit stay of more than 28 days (p=0.013), respiratory distress syndrome (p=0.003), disseminated intravascular coagulopathy, or sepsis (p=0.041). CONCLUSION: nRBC counts did not show significant difference according to umbilical artery Doppler velocity. Also we could not find any difference between the control, acute, and chronic hypoxic group, suggesting that nRBC counts does not correlate with both hypoxic status, or duration of hypoxia. Correlation with elevated nRBC counts and neonatal intensive care unit stay of more than 28 days, respiratory distress syndrome, disseminated intravascular coagulopathy, and sepsis was observed. However, the overlapping results and the wide range of nRBC counts according to the complications limits its role as a predictor of poor perinatal outcome.

The Significance of Plasma Homocysteine Level in Pregnant Women with Severe Preeclampsia / 대한산부인과학회잡지

OBJECTIVE: The elevated plasma homocysteine concentrations is a independent risk factor of atherosclerosis. We investigated the level of plasma homocysteine is associated with severe preeclampsia. METHODS: 28 pregnant women with severe preeclampsia (study group) and 26 normotensive, healthy pregnant women (control group), matched by maternal age, gestational age, pre-pregnant body mass index and parity were enrolled into this study. Blood samples were collected within 24 hours before delivery and just 24 hours after delivery. The level of plasma homocysteine was measured by fluorescent polarization immunoassay. Statistical analysis was performed using Student t test. RESULTS: Plasma homocysteine levels in the women with severe preeclampsia were significantly elevated than those of control group in antepartum and postpartum 24 hours [7.17 2.71 vs 5.37 1.49 g/mL (mean SD); p<0.05 in antepartum, 6.38 2.03 vs 4.48 +/- 0.40 g/mL (mean SD); p<0.05 in postpartum]. CONCLUSION: In the present study the increase of plasma homocysteine in pregnant women with severe preeclampsia is related the pathogenesis of preeclampsia as like in atherosclerosis and may be used as a marker of preeclampsia by further research.

Perinatal Prognosis in Cystic Hygroma According to the Presence of Septation / 대한산부인과학회잡지

OBJECTIVE: We evaluated the association between perinatal prognosis and the presence of septation in cystic hygroma deteted by antenatal ultrasonography. METHODS: During a 5-year period, 65 cases of cystic hygroma were diagnosed by antenatal ultrasonography. 31 cases were included in this study. Fetal karyotyping, hydrops, and associated anomalies were compared between septated and non-septated groups. Statistical analysis was performed using Fisher exact test. RESULTS: There were 24 cases of septated cystic hygromas, and 7 cases of nonseptated cystic hygromas. Sixty-three percent of the septated cystic hygromas had accompanying hydrops and other anomalies (15/24), versus 28% (2/7) in the nonseptated group (p=0.022). Other anomalies such as cleft lip and palate, omphalocele, and club foot were more frequently seen in the septated group. Nine of 14 cases of septated cystic hygroma that underwent karyotying showed aneuploidy (64%), compared with 0% (0 of 6 cases) aneuploidy rate in the nonseptated cystic hygroma group (p=0.014). CONCLUSION: Abnormal fetal karyotyping, hydrops, and other anomalies are more likely to be associated in fetuses with septated cystic hygroma. So, the presence of septation may be the useful prognostic indicator of cystic hygroma.

A Case of Pregnancy-Associated Breast Cancer / 대한산부인과학회잡지

The breast cancer is the second most common malignancy in pregnancy after cervical cancer. Pregnancy- associated breast caner tends to show unfavorable prognosis, because it is diagnosed at more advanced stage due to delay of diagnosis and treatment. For appropriate management, collaboration with physicians and obstetricians should make precise decisions considering gestational weeks and cancer stage at the time of diagnosis in a point of view from mother and fetus. A case of successful gestation and delivery after chemotherapy in a woman with inflammatory breast cancer diagnosed in the second trimester is presented with review of literature.

Antepartal Evaluation and Management of Fetal Growth Restriction / 대한주산의학회잡지

No abstract available.

Delivery in a Patient with Paroxysmal Nocturnal Hemoglobinuria Successfully Managed with Low Molecular Weight Heparin Therapy / 대한산부인과학회잡지

Paroxysmal nocturnal hemoglobinura is a very rare acquired clonal hematopoietic cell disorder leading to chronic intravascular hemolysis caused by abnormal complement activation. Pregnancy in a patient with paroxysmal nocturnal hemoglobinuria is often complicated with thrombosis resulting serious materno-fetal morbidity and mortality. A case of successful maintenance of the pregnancy, delivery and postpartum in a woman at gestational age of 37 weeks and 2 days with paroxysmal nocturnal hemoglobinuria managed with prophylactic transfusions and anticoagulation therapy by low molecular weight heparin is presented with a review of literature.