Fetal Loss Rate after Mid-trimester Amniocentesis

PURPOSE: The aim of this study was to asses the fetal loss rate after mid-trimester amniocentesis. MATERIALS AND METHODS: This was a retrospective cohort study including singleton pregnant women who underwent mid-trimester amniocentesis at Cheil General Hospital from January 2008 through December 2010. The procedure-related fetal loss was defined as miscarriage within 2 weeks after amniocentesis. We evaluated the fetal loss rate within 2 weeks after amniocentesis and fetal loss rate before 24 gestational weeks. RESULTS: During the study period, a total of 4,356 singleton pregnant women underwent mid-trimester amniocentesis. A total of Five hundred ninety six women were excluded owing to follow up loss and termination of pregnancy due to abnormal karyotype or major anomaly. At our institute, the fetal loss rate within 2 weeks was 0.1% and before 24 gestational weeks was 0.3% after amniocentesis. CONCLUSION: The fetal loss rate after mid-trimester amniocentesis in our study is lower than previously reported rate. We suggest that amniocentesis is a safe procedure.

Analysis of Parental Decisions Based on Sex Chromosome Abnormalities Detected Prenatally: A Ten-year update (2001-2010)

PURPOSE: The aim of this study was to analyze parental decisions regarding pregnancies in which the fetus had sex chromosome abnormalities (SCA) over a ten-year period. MATERIALS AND METHODS: We collected and reviewed records from our hospital for 2001-2010 and a genetic specialist provided-genetic counseling. RESULTS: We diagnosed 130 cases (0.71%) with SCA out of 18,376 prenatal cases from 2001 to 2010. We reviewed the records and the results of all pregnancies. We also included cases (n=84) of apparently normal anatomic fetuses to analyze the factors influencing parental decisions. We excluded 34 cases with an obvious anomaly or a presumably bad outcome and 12 cases that were not followed up. Forty-three couples (51.2%) continued their pregnancies while forty-one (48.8%) terminated them. Of 38 mosaicism cases, 21 (55.3%) were continued. Among the 20 pregnancies assisted by reproductive techniques, 15 (75%) were continued (P=0.02). More pregnancies were continued when genetic counseling was provided (61.9%) compared to cases in which it was not provided (19%) (P=0.01). CONCLUSION: Genetic counseling is important in providing appropriate information to parents. Establishing guidelines and protocols will help both obstetricians and parents to make informed decisions.

A Prenatal Case of Paracentric Inversion of Chromosome 18, inv(18)(q21.1q22)

Paracentric inversion of chromosome 18 is a rare cytogenetic abnormality. The vast majority of paracentric inversions are harmless and the offspring of paracentric inversion carriers have only slightly elevated risks for unbalanced karyotypes. However, various clinical phenotypes are seen due to breakpoint variation or recombination. We report a prenatally detected case of familial paracentric inversion of chromosome 18, inv(18)(q21.1q22), with normal clinical features.

A Prenatal Case of Paracentric Inversion of Chromosome 18, inv(18)(q21.1q22)

Paracentric inversion of chromosome 18 is a rare cytogenetic abnormality. The vast majority of paracentric inversions are harmless and the offspring of paracentric inversion carriers have only slightly elevated risks for unbalanced karyotypes. However, various clinical phenotypes are seen due to breakpoint variation or recombination. We report a prenatally detected case of familial paracentric inversion of chromosome 18, inv(18)(q21.1q22), with normal clinical features.

Maternal Plasma Hepatocyte Growth Factor Concentrations in Women Who Subsequently Developed Preeclampsia

PURPOSE: The aim of this nested case-control study was to investigate the association between hepatocyte growth factor (HGF) concentrations in maternal plasma and the risk of developing preeclampsia. MATERIALS AND METHODS: Plasma HGF concentration were measured in 52 women who subsequently developed preeclampsia and 104 normal pregnant women at the time of genetic amniocentesis (15-20 weeks) by enzyme-linked immunosorbent assay. RESULTS: Maternal plasma HGF concentrations were significantly higher in women with subsequent preeclampsia (median: 737.8 ng/mL vs. 670.4 ng/mL, P=0.003) than in normal controls. However, HGF concentrations were not significantly different between subgroups by preeclamptic complications. After adjusting for potential confounding factors, women with HGF concentrations > or =702.5 ng/mL had a 3.2-fold increased risk (95% CI 2.7-5.4, P<0.001) of subsequent development of preeclampsia compared with women with HGF concentrations <702.5 ng/mL. CONCLUSION: Elevated maternal plasma HGF concentrations in the early second-trimester are associated with an increased risk of developing preeclampsia.

Maternal Plasma Hepatocyte Growth Factor Concentrations in Women Who Subsequently Developed Preeclampsia

PURPOSE: The aim of this nested case-control study was to investigate the association between hepatocyte growth factor (HGF) concentrations in maternal plasma and the risk of developing preeclampsia. MATERIALS AND METHODS: Plasma HGF concentration were measured in 52 women who subsequently developed preeclampsia and 104 normal pregnant women at the time of genetic amniocentesis (15-20 weeks) by enzyme-linked immunosorbent assay. RESULTS: Maternal plasma HGF concentrations were significantly higher in women with subsequent preeclampsia (median: 737.8 ng/mL vs. 670.4 ng/mL, P=0.003) than in normal controls. However, HGF concentrations were not significantly different between subgroups by preeclamptic complications. After adjusting for potential confounding factors, women with HGF concentrations > or =702.5 ng/mL had a 3.2-fold increased risk (95% CI 2.7-5.4, P<0.001) of subsequent development of preeclampsia compared with women with HGF concentrations <702.5 ng/mL. CONCLUSION: Elevated maternal plasma HGF concentrations in the early second-trimester are associated with an increased risk of developing preeclampsia.

Analysis of Drug Counseling for Breastfeeding Mothers at the Korean Mothersafe Professional Counseling Center; 5 Years Experience / 대한주산의학회잡지

PURPOSE: There is a dearth of information on maternal drug exposure during lactation. The Korean Mothersafe Professional Counseling Center launched helpline to provide information and clinical consultation service on drug safety during lactation as well as in pregnancy. Here, we reviewed our 5 years' experience of counseling with drug exposed breastfeeding mothers. METHODS: The questionnaires were given to drug exposed breastfeeding mothers from January 2005 to April 2010 who contacted our helpline and follow-up survey data was collected by phone call. The questionnaires included lists of symptoms that exposed mothers experienced and that was observed in their infants, as well as demographic questions and questions about lactation. RESULTS: A total of 278 mothers completed the survey and lactational exposure was estimated. Majority of them reported that their infants and themselves never experienced serious side effects of drugs during lactation. Only 3 (1.1%) babies reported side effects and 20 (7.2%) mothers reported decreased production of breast milk. Two hundred thirty two (83.5%) mothers continued breastfeeding after counseling. Lactation was stopped temporarily in 20 (7.2%) mothers and permanently in 26 (9.3%) mothers. CONCLUSION: Most of the drugs exposed during lactation did not cause serious side effects to infants and mothers. As many drugs have inadequate data to assure safety, the clinician is left with a dilemma as to where the balance of risks and benefits lie with respect to the mother and her baby. The author expect that analyses of these counseling will contribute to provide practical answers to clinicians as well as exposed mothers and to establish correct breastfeeding practice.

Effective Method for Extraction of Cell-Free DNA from Maternal Plasma for Non-Invasive First-Trimester Fetal Gender Determination: A Preliminary Study

PURPOSE: To find the most effective method for extraction of cell-free DNA (cf-DNA) from maternal plasma, we compared a blood DNA extraction system (blood kit) and a viral DNA extraction system (viral kit) for non-invasive first-trimester fetal gender determination. MATERIALS AND METHODS: A prospective cohort study was conducted with maternal plasma collected from 44 women in the first-trimester of pregnancy. The cf-DNA was extracted from maternal plasma using a blood kit and a viral kit. Quantitative fluorescent-polymerase chain reaction (QF-PCR) was used to detect the SRY gene and AMEL gene. The diagnostic accuracy of the QF-PCR results was determined based on comparison with the final delivery records. RESULTS: A total of 44 women were tested, but the final delivery record was only obtained in 36 cases which included 16 male-bearing and 20 female-bearing pregnancies. For the blood kit and viral kit, the diagnostic accuracies for fetal gender determination were 63.9% (23/36) and 97.2% (35/36), respectively. CONCLUSION: In non-invasive first-trimester fetal gender determination by QF-PCR, using a viral kit for extraction of cf-DNA may result in a higher diagnostic accuracy.

Reduced Number of Endothelial Progenitor Colony-Forming Units in Patients with Preeclampsia

PURPOSE: Endothelial progenitor cells (EPCs), which mediates neovascularization of uterine endometrium may be involved in the neovascularization in the utero-placental circulation. Low numbers of endothelial progenitor colony-forming unit (CFU) in culture are predictive biomarker of vascular disease. The aim of the present study was to evaluate whether the number of CFU in preeclampsia differed from that in normal pregnancy. MATERIALS AND METHODS: Women with singleton normal (n=26) or preeclamptic (n=20) pregnancies were studied during the third trimester. The number of EPCs was quantified by CFU methodology. Plasma levels of angiogenic factors, vascular endothelial growth factor (VEGF), soluble fms-like tyrosine kinase-1 (sFlt-1), and placental growth factor (PlGF) were determined by enzyme-linked immunoassay. RESULTS: CFU numbers were significantly decreased in the preeclamptic patients compared with the controls (median, 3; range 1-12 vs. 31; 3-81 CFU/well, P<0.001). A majority of the cells comprising individual colonies were positive for endothelial characteristics (Ulex europaeus lectin staining and acetylated low-density lipoprotein uptake). Plasma levels of the sFlt-1 were highly elevated (P<0.001) in patient with preeclampsia compared to controls, whereas PlGF were highly reduced (P=0.004), but these factors did not associate with CFU numbers. CONCLUSION: Our results suggest that reduced numbers of CFU obtained from maternal peripheral blood may contribute to the development of preeclampsia.

Pregnancy Outcomes after Peri-conceptional Medication Exposure; 10 Years Experience: Study for Application of Reproductive Toxicity Information / 대한주산의학회잡지

PURPOSE: In Korea, pregnancy termination is frequently reported among women who took medications for an acute or chronic disease during pregnancy, for fear of teratogenic risk. We have previously shown that a service providing evidence-based information is helpful for women who week counseling to make a rational decision regarding their pregnancies. This study aimed to evaluate whether termination of pregnancy based on such perceptions, is justified using the 'DRug Exposure and risk Assessment in Moms' (DREAM) registry. METHODS: The study included 5,032 consenting pregnant women from the clinic and call center at the Korean Motherisk Program, from November 1999 to October 2008. The DREAM registry recorded the pregnancy outcomes (preterm birth, low birth weight, intrauterine fetal death, and congenital anomaly) of 3,328 women. RESULTS: Among women exposed to medications, time of exposure ranged from 3.5-4.6 weeks of gestation. There were 1,308 different drugs prescribed to these women. The drug most frequently prescribed was acetaminophen followed by chlorpheniramine maleate, and pseudoephedrine. There were 4.7% (n=156/3,328) women who underwent a voluntary abortion for fear of birth defects. We compared frequency of birth defects between exposed women and unexposed pregnant women in our institution during gestation. The frequency of major congenital malformations was 2.5% (n=74/2,977) in exposed group and 2.9% (n=75/2,573) in unexposed group (P=0.32). There was no statistically significant difference between exposed and control group in the rate of preterm births, intrauterine fetal death and low-birth weight babies. CONCLUSION: We did not observe increased risk of congenital malformations and adverse pregnancy outcomes in a population of pregnant women exposed to a variety of medications. Therefore these medications are not considered teratogen.

Pregnancy Outcomes after Conservative Treatment of Cervical Intraepithelial Lesions: Cold Knife Conization and Loop Electrosurgical Procedure / 대한주산의학회잡지

OBJECTIVE: In this study, we evaluated whether different methods of conization of the cervix were associated with an increased risk of adverse pregnancy outcomes in subsequent pregnancy. METHODS: A retrospective case-control study was conducted. The study group included women who had undergone cold knife conization (n=170) or a loop electrosurgical excision procedure (LEEP) (n=86) and then had subsequent singleton pregnancies. The control group (n=497) included women with no history of cervical surgery. The outcomes were spontaneous preterm delivery and various neonatal outcomes such as low birth weight (LBW) and perinatal mortality. RESULTS: Cold knife conization was associated with a significantly increased risk of preterm delivery less than 34 weeks (relative risk 4.9, 95% confidence interval 1.6-15.1), preterm delivery less than 28 weeks (7.6, 15-39.6), LBW (2.6, 1.2-5.8), and perinatal mortality (11.9, 1.3-107.6). LEEP was not associated with a increased risk of adverse pregnancy outcomes. CONCLUSION: Cold knife cone biopsy, but not LEEP of the cervix, is associated with an increased risk of preterm delivery less than 34 weeks of gestation and adverse neonatal outcomes. Clinicians counsel women appropriately before conservative treatment of cervical intraepithelial lesions.

Fetal Anomaly and Pregnancy Outcomes after Exposure to Ibuprofen in First Trimester of Pregnancy / 대한주산의학회잡지

PURPOSE: Ibuprofen is a non steroidal anti-inflammatory drug used for treating fever and pain including headache, arthralgia, and back pain. There is scarce information on the safety of ibuprofen associated with fetal anomaly when used early in pregnancy. Epidemiology studies have suggested that use of NSAIDs, including ibuprofen, during pregnancy may increase the risk of cardiac defects and gastroschisis. The aim of the study was to evaluate fetal outcomes among pregnant women who were unintentionally exposed to ibuprofen in early pregnancy. METHODS: Total 381 pregnant women who were unintentionally exposed to ibuprofen during early pregnancy were prospectively followed up. In addition, 643 age and gravity matched pregnant women not exposed to any potential teratogenic agent during pregnancy were recruited as controls. Patients were followed-up until delivery or loss to follow-up. Newborns were examined in order to identify any major congenital malformation. RESULTS: Mean age of exposed women was 31.2+/-3.4 years, with a mean number of previous pregnancies of 2.3+/-1.2 and mean gestational weeks at exposure of 4.4+/-2.2. All gestations were confirmed by ultrasonography. Of exposed women, 17 (5.6%) had spontaneous abortions, 16 were on- going pregnancies, 1 had an intra-uterine fetal death, 21 artificial abortion and 55 cases were lost to follow-up. Therefore, 271 pregnancies unintentionally exposed to ibuprofen were evaluated, each delivering a singleton baby. Three babies had congenital anomalies: one had unilateral hydronephrosis, another baby was born with a unilateral inguinal hernia. The last baby was born with unilateral kidney dysplasia with megaureter. In the control group, 6 babies were born with major malformations [1.11% vs. 1.31% (P=0.552, OR: 0.841, 95% CI: 0.2 to 3.4)]. CONCLUSION: These preliminary results suggest that the ibuprofen may not be a major human teratogen.

Uterine myoma: Treatment modalities and patient preference / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to describe the clinical features of myoma, treatment options, patient preference and to identify the clinical features which affect the management of myoma. METHODS: We retrospectively analyzed medical records of 577 patients who were diagnosed as uterine myoma on ultrasound exam between January 2006 and December 2006. Patients' characteristics, treatment methods and questionnaires for patient preference were evaluated. RESULTS: The mean age was 42.3 years and 90.8% of the patients were premenopausal status. Common symptoms were pain (58.6%), bleeding (51.3%) and compression symptom (30.2%). In our study, 183 of 577 patients (31.7%) planned to have regular follow-up without treatment. Non-hormonal medical treatment was used in 27.1% and hormonal treatment was used in 41.9% of the patients. One hundred eighty-two patients underwent surgical treatment, including myomectomy (57.1%), subtotal hysterectomy (19.8%) and total hysterectomy (23.1%). Among the patients who underwent surgery, 50.6% of patients (88/174) had surgery due to compression symptom, 42.6% (126/296) due to bleeding, and 34.6% (117/338) due to pain. According to the 100 patients who answered the questionnaires, 78 patients preferred medical therapy initially, but 22 patients chose surgical treatment. When the patient was asked to choose between myomectomy and hysterectomy, 94 patients wanted myomectomy, but only 6 patients chose hysterectomy. CONCLUSIONS: Many patients diagnosed as myoma prefer medical treatment initially. Medical treatment for myoma may be considered as the first line treatment for pain and bleeding symptoms before proceeding to surgical treatment.

Three different approach to hysterectomy for benign uterine pathology / 대한산부인과학회지

OBJECTIVE: To evaluate the rates and clinical outcomes between abdominal hysterectomy (AH), laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH). METHODS: Medical records of 236 patients who underwent hysterectomy (by one surgeon) for benign uterine pathology between march 2004 and april 2006 were reviewed. Primary outcome measure was the rate of each method of hysterectomy. Secondary outcome measures included perioperative and postoperative outcomes between groups. RESULTS: The mean age, weight, height, body mass index, and parity in three groups showed no difference. In two hundred and twenty two cases of hysterectomies, the rate of AH was 13.5%, LH 34.2%, and VH 52.3%. Perioperative outcomes of AH, LH and VH were as follows : operative time (83.2+/-27.1 min, 94.2+/-25.2 min, and 50.8+/-15.5 min, respectively), change in hemoglobin (2.3+/-1.5 g/dL, 2.0+/-0.9 g/dL, and 1.3+/-1.1 g/dL, respectively), duration of urinary catheterization (2.0+/-0.2 days, 1.0+/-0.0 days, and 1.0+/-0.4 days, respectively), postoperative hospitalization (5.7+/-1.2 days, 4.7+/-0.9 days, and 4.3+/-1.0 days, respectively), uterine weight (733+/-665 g, 340+/-213 g, and 300+/-156 g, respectively). Uterine weight in the AH group was significantly heavier than in the LH and VH. The benefits of LH versus AH were shorter duration of urinary catheterization and postoperative hospitalization (p<0.05). The benefits of VH versus AH were shorter operative time, a smaller drop in hemoglobin, shorter duration of urinary catheterization and postoperative hospitalization (p<0.05). The benefits of VH versus LH were shorter operative time, a smaller drop in hemoglobin, and postoperative hospitalization (p<0.05). There were no differences in complications of AH, LH and VH (13.3%, 10.5%, and 9.5%, respectively p=0.825). CONCLUSIONS: Eighty six point five percent of hysterectomy can be done vaginal or laparoscopic approach. When there is a concerted effort to increase laparoscopic or vaginal hysterectomy, abdominal hysterectomy can decrease without increasing complication rate.

The association between polymorphisms of beta-adrenoceptors and preeclampsia

PURPOSE: The beta-adrenoceptors are pharmacologically classified into beta1-, beta2- and beta3-adrenoceptor. The gene of each subtype has polymorphisms related to their function (beta1-adrenoceptor: Ser49Gly, beta2- adrenoceptor: Gln27Glu, beta3-adrenoceptor: Trp64Arg). The objectives of this study were to analyse the allelic and genotypic distribution of the representative polymorphism of beta-adrenoceptors in preeclampsia and to investigate whether combined genotype of beta-adrenoceptors may be associated with preeclampsia. METHODS: Blood samples were collected from a Korean population (159 preeclamptic pregnancies and 168 normotensive pregnancies). The beta1-, beta2- and beta3-adrenoceptor genotypes was determined using polymerase chain reaction-restriction fragment length polymorphism. RESULTS: There were no differences in allelic and genotypic distribution of beta1- and beta2-adrenoceptor polymorphisms between the two groups. However, the Arg allele of beta3-adrenoceptor polymorphism were more frequent in preecalmpsia than in controls (P<0.05, OR=1.57, 95% CI=1.01-2.46). Moreover, prevalence of genotype carrying heterozygote of beta3-adrenoceptor polymorphism was increased in preeclampsia compared with controls (P<0.05, OR 1.76, 95% CI 1.06-2.92). When combination of the three polymorphisms were evaluated, pregnancies with the particular combined genotype that is consisted of heterozygote of beta1-, beta3-adrenoceptor and wild homozygote of beta2-adrenoceptor (Ser/Gly, Gln/Gln, Trp/Arg), showed a significant increase in the risk of preeclampsia (P<0.05, OR=3.01, 95% CI 1.12-8.08). CONCLUSION: A particular combined genotype (Ser/Gly, Gln/Gln, Trp/Arg) of - adrenoceptors was associated with the risk of preeclampsia.

Impact of vaginal hysterectomy on total vaginal length / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the impact of vaginal hysterectomy on total vaginal length (TVL). METHODS: Retrospective analysis of 155 medical records of patients underwent vaginal hysterectomy by one surgeon with benign uterine pathology in the absence of prolapse between January 2004 and February 2007. After hysterectomy, uterosacral vaginal vault resuspension (anchoring to vaginal vault about 1.0~1.5 cm proximal at the ligament) was performed for prevention of vault prolapse. Patients' characteristics and TVL before and after surgery were evaluated. RESULTS: Preoperative mean TVL was 7.32+/-0.84cm. At two months after the surgery, mean TVL was 7.42+/-0.77 cm. The change of vaginal length was statistical significance (P=0.045). Eighty-one patients were reevaluated at five to twelve months after surgery, mean TVL was longer than the preoperative results (7.3+/-0.82 cm vs 7.48+/-0.78 cm, P=0.011). We evaluated 30 patients who were followed at least 12 months after the surgery, the length was longer than the preoperative results, also (7.17+/-0.81 cm vs 7.46+/-0.66 cm, P=0.006). CONCLUSION: Although that appears to be statistically significant elongation of the total vaginal length after vaginal hysterectomy, the impact is unlikely to be clinically significant.

Perinatal Outcome in Twin Pregnancies Complicated by Gestational Diabetes Mellitus: A Comparative Study

The purpose of this study is to compare perinatal outcomes of twin pregnancies complicated by gestational diabetes (GDM) with those unaffected by GDM. A total of 1,154 twin pregnancies who delivered at Cheil General Hospital, between January 1998 and December 2002 were recruited to participate in a retrospective analysis. Out of these twin pregnancies, 37 women were had GDM. Four pregnancies exposed to GDM were excluded due to the loss of medical records; therefore 33 twin pregnancies exposed to GDM were enrolled. We matched the GDM pregnancies with pregnancies unaffected by GDM in a 1:2 ratio; therefore there were 33 GDM/66 without GDM who delivered during the study period. Our findings show that there were no significant differences including birth weight, Apgar score, respiratory distress syndrome, meconium aspiration pneumonia, transient tachypnea of new born, hyperbilirubinemia, hypoglycemia, hypocalcemia and congenital anomalies. Therefore, well controlled GDM may not increase perinatal complications in twin pregnancies. Careful pregnancy management and fetal surveillance in twin pregnancies is important to decrease perinatal complications and maintain a sound pregnancy and healthy offspring.

Hysterectomy; Is it essential for the correction of uterine prolapse? / 대한산부인과학회지

OBJECTIVE: The aim of this study was to compare the efficacy of sacrospinous colpopexy without hysterectomy and with hysterectomy for symptomatic uterine prolapse. METHODS: A retrospective chart review was performed in the women who underwent sacrospinous ligament suspension between March 1998 and March 2002. A hundred fifty five women with a symptomatic uterine prolapse were treated with either sacrospinous colpopexy without hysterectomy and/or anterior-posterior repair (83 cases=Group A) or sacrospinous colpopexy with hysterectomy and/or anterior-posterior repair (72 cases=Group B). RESULTS: The mean duration of surgery, hemoglobin change, catheter days and inpatient days were shorter in group A compared with group B. (Group A 102.5+/-33.4 min, 2.4+/-0.7 mg/dL, 5.2+/-1.4 days, 7.6+/-2.2 days vs. Group B 135.3+/-33.9 min, 2.9+/-0.8 mg/dL, 6.1+/-2.1 days, 9.4+/-3.7 days, p<0.05 respectively) Recurrent pelvic organ prolapse developed in 14.5% in group A and 12.5% in group B. Six patients (7.2%) in group A and 5 patients (6.9%) in group B required repeat operation for recurrent pelvic organ prolapse. CONCLUSIONS: Sacrospinous colpopexy without hysterectomy and with hysterectomy are equally effective surgical operation for uterine prolapse. This study shows that hysterectomy is not essential for the correction of uterine prolapse.

Fetal Loss Rate after Midtrimester Amniocentesis in Twin Pregnancies / 대한산부인과학회지

OBJECTIVE: To assess the fetal loss rate among dichorionic twin gestations undergoing genetic amniocentesis compared with singletons undergoing the procedure and untested twins. METHODS: From January 2002 through December 2004, total 132 pregnant women with dichorionic twin gestation with mid-trimester amniocentesis at Hospital were included in this study. In control group, 595 women with untested dichorionic twins during the same period and 402 women with singleton pregnancies with amniocentesis performed by the same physician at the same date of study group were selected. Excluded were fetuses with known structural anomalies, cases in which amniocentesis was done in only one fetus, and cases of which pregnancies were terminated due to fetal chromosomal abnormalities. Fetal loss was defined as the loss of both fetuses and subdivided into two categories: within 4 weeks after amniocentesis and before 28 gestational weeks. RESULTS: Up to 4 weeks after the procedure, one case (0.75%) in the tested twin group, two cases in post-procedure singleton group (0.49%, P=.729), and eight cases in the untested twin control group (1.34%, P=.581) were aborted spontaneously. Up to 28 gestational weeks, four fetal losses occurred in post-amniocentesis twins (3.03%), sixteen cases in untested twins (2.69%, P=.83), and two cases in the singleton pregnancies with amniocentesis (0.49%, P=.017). CONCLUSION: The risk of fetal loss in twin underwent mid-trimester amniocentesis appears to be higher than that of tested singletons in this study. However, there was no significant difference in the fetal loss rates between amniocentesis twin group and untested twin group.

The Influence of Monochorionicity on the Perinatal Outcomes in Spontaneously Conceived Twins / 대한산부인과학회잡지

OBJECTIVE: The Purpose of this study was to evaluate monochorionicity as a risk factor for adverse perinatal outcomes in spontaneously conceived twins. METHODS: Using an established database, the study included pregnant women with spontaneously conceived twin gestations between January 1998 and December 2002. From a total of 1145 twin deliveries, 371 spontaneous twin pregnancies were observed in Department of Obstetrics and Gynecology in Samsung Cheil Hospital and Women's Healthcare Center. Chorionicity was established by histologic examination and divided into two groups, monochorionic (diamnionic and monoamnionic) twins (MC) and dichorionic diamnionic twins (DC). The obstetric and neonatal outcomes were compared between the two groups. RESULTS: There were 176 MC and 195 DC twin deliveries following natural fertilization. The incidence of intrauterine growth restriction was significantly higher (16.4% vs. 5.4%, P<.001) in MC twins. However, there were no statistically significant differences in the frequency of antepartum or intrapartum complications such as preterm delivery, preeclampsia, placenta previa and gestational diabetes mellitus between the two groups. In addition, there were no statistically significant difference in the frequency of neonatal complications, congenital anomalies, Apgar scores, perinatal mortality, morbidity and duration of neonatal intensive care unit admission. CONCLUSION: When compared with DC twin group, MC twin group is more likely to have a higher incidence of intrauterine growth restriction in natural fertilization. However, monochorionicity is not a risk factor for adverse obstetric outcomes, perinatal mortality and morbidity in spontaneously conceived twins in our study.