Clinical characteristics of induction of labor in nulliparas / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to assess clinical characteristics of induction of labor group in nulliparous women at term with a single fetus in cephalic presentation. METHODS: we reviewed retrospectively the medical records of 73 nulliparous women delivered between August 2004 and July 2006. The patients were classified as induction of labor group and spontaneous onset of labor group to compare of obstetrical data. Student t-test, Chi-square, and Fisher's exact test were performed. RESULTS: Induction of labor group than spontaneous onset of labor group had higher < or =4 of Bishop score cervical status and time from admission to delivery was longer (p<0.05). The rate of cesarean delivery and meconium stained amniotic fluid were higher in induction of labor group (p<0.05). In case of Bishop score is higher than 4, normal vaginal delivery is higher than cesarean delivery (p=0.100). CONCLUSION: Induction of labor in nulliparous women is associated with low Bishop score and an increased risk of cesarean delivery. Success of vaginal delivery is tightly associated with favorable cervical status.

A case of retroperitoneal huge smooth muscle tumor misleading to ovarian cancer / 부인종양

Smooth muscle tumors are very common tumors in the uterus and related adjacent structures but occur rarely in the retroperitoneum. Traditionally, most retroperitoneal smooth muscle tumor are believed to be malignant. But well-differentiated smooth muscle tumors with lack of atypia, necrosis, and significant mitotic activity appear to have a benign behaviors. Laparotomy revealed a huge solid tumor in the retroperitoneal space, about 50 cm in diameter, and histologically diagnosed as a smooth muscle tumor of uncertain malignant potential (STUMP). We report a case of primary retroperitoneal smooth muscle tumor with a brief review of literatures.

A Case of Cloacal Anomaly with Multiple Associated Anomalies / 대한산부인과학회잡지

Cloacal anomaly is an extremely rare congenital malformation results from a failure in the development of the urorectal fold that separates the rectum from uterovaginal tract. It is characterized by the presence of a single duct where the gastrointestinal, genital and urinary tracts join. It presents with highly variable forms, which make it difficult to be diagnosed antenatally. We report a case of cloacal anomaly confirmed with autopsy, which was initially detected by the presence of a huge cystic fetal abdominal mass by ultrasound at a 22 weeks of gestation.

The Benefits and Risks of Multiple Courses of Antenatal Corticosteroid Therapy in Patients with Preterm Premature Rupture of Membranes / 대한산부인과학회잡지

OBJECTIVE: This study was performed to determine the benefits and risks of multiple courses of corticosteroids in patients with preterm premature rupture of membranes (PPROM). METHODS: We retrospectively evaluated the pregnancy and neonatal outcomes for women of singleton pregnancy with PPROM admitted at 24-32 weeks of gestation. Patients were categorized into 3 groups according to antenatal corticosteroids exposure: (1) non-user group, (2) single-course group, (3) multiple-course group. Chi-square test, analysis of variances, Kruskal-Wallis test, and multiple logistic regression analysis were used for statistical analyses. RESULTS: A total of 170 patients were included, with 50 in non-use group, 76 in single-course group, and 44 in multiple-course group. Univariate analyses showed that clinical chorioamnionitis occurred in the highest incidence in multiple-course group (x2=6.20, p<0.05) and the decreased incidence of RDS in multiple-course group (x2=10.0, p<0.01). Multiple logistic regression analyses demonstrated that no significant association was found after adjustment of confounding variables (odds ratio=0.28, p=0.063) whereas multiple courses of corticosteroids were independently associated with clinical chorioamnionitis (odds ratio=13.15, p=0.025). CONCLUSION: Multiple courses of antenatal corticosteroids therapy did not reduce the incidence of RDS in neonates and were associated with increased risk of clinical chorioamnionitis in patients with PPROM.

A Case of Delayed Delivery of Second Twin / 대한산부인과학회잡지

With the introduction of assisted reproductive technologies, the incidence of multifetal pregnancies has significantly increased. In vaginal delivery for multifetal pregnancy, the delivery of the second fetus usually follows the first in few minutes. However in rare circumstances, the delivery is delayed for days due to disappearance of uterine contraction after delivery of the first fetus. Successful prolongation of the interdelivery time may improve the neonatal outcomes of the remaining fetus (es), particularly in the cases of extremely premature gestation. We present a case of a delayed delivery of second twin with an interval of 48 days.

A Clinical Study of Pregnancy and Delivery in Women Aged 40 Years and Older / 대한산부인과학회잡지

OBJECTIVE: To access the pregnancy tendency and delivery in women aged 40 years and older. METHODS: From January 1999 to June 2001, 7882 deliveries were in Gacheon Medical School. Among them we compared 95 cases of pregnant women aged 40 years and older with 94 cases of those aged under 40 years as a control group. RESULTS: The parity was higher in women aged older than 40 years compared to control group. Number of prenatal special studies was higher in women aged older than 40 years (n=82) compared to control group (n=14). In modes of delivery and indications for c/sec, there were no difference in two groups. There were no difference in prenatal complications between two groups. But, number of cases related to placenta previa, myoma and anemia were increased in women aged older than 40 years. In postpartum complications, uterine atony and hysterectomy, postpartum bleeding and placenta accreta were higher in women aged older than 40 years compared to control group. CONCLUSION: For pregnant women aged 40 years and older, a careful approach and appropriate management will be necessary for good pregnant outcome.

The Value of Transvaginal Ultrasonographic Measurement of Cervical Length for Prediction of Preterm Delivery in Patients with Preterm Labor / 대한산부인과학회잡지

OBJECTIVE: The aim of this study is to evaluate the value of vaginal ultrasonographic cervical length in prediction of preterm delivery in patients with preterm labor. METHODS: One-hundred twenty-nine women in preterm labor at 24-34 weeks of gestation were studied retrospectively. Transvaginal ultrasonography for measurement of cervical length was performed at the time of admission. Receiver-operating characteristic (ROC) curve analysis, partial correlation coefficient, and multiple logistic regression analysis were used for statistical analysis. RESULTS: The mean gestational age at admission was 30.2 +/- 2.5 weeks and the mean gestational age at delivery was 35.7 +/- 3.9 weeks. The median admission-to-delivery interval was 864 hours (24-2616). ROC curve analysis showed a significant relationship between cervical length and preterm delivery (area under the curve=0.82, por=2.5 cm was significantly shorter than that in patients with cervical length >2.5 cm. CONCLUSION: Transvaginal ultrasonographic measurement of cervical length is a useful predictor of preterm delivery in patients with preterm labor and intact membranes.

The Peripartum Prognosis of Amnioinfusion in Oligohydramnios without Preterm Premature Rupture of Membrane / 대한주산의학회잡지

OBJECTIVE: The aim of this study was to evaluate the peripartum efficiency of amnioinfusion in oligohydramnios without preterm premature rupture of membrane. METHODS: 73 singleton pregnant women with oligohydramnios were enrolled in this study. Women with preterm premature rupture of membrane were excluded. 21 women were treated with transabdominal amnioinfusion 31 times and 52 women were closely observed without amnioinfusion. Mean amniotic fluid index, mean gestational age, mean maternal age and the parity at the time of diagnosis was not statistically different in both groups. RESULTS: Mean amounts of infused artificial amniotic fluid was 536ml (200-700), the mean time consumed was 61(+/-39.2)min. After infusion, mean amniotic fluid index was increased significantly from 4.2(+/-1.6) to 10.0(+/-2.9). But we found no statistically significant differences in pregnancy outcomes. The outcomes are as follows 1)Mean gestational age at birth was 36.3(+/-3.5) weeks in amnioinfusion group and 37.2(+/-2.9) weeks in control group. 2) Mean birth weight was 2.54(+/-0.9)kg versus 2.51(+/-0.8)kg. 3) The proportions of poor Apgar score at 1 minute and 5 minute were not significantly different. 4) Cesarean section rate was 0.79 versus 0.65. 5.There were two still births in both groups. CONCLUSION: Transabdominal amnioinfusion in oligohydramnios has little effects in improving longterm pregnancy outcomes.

Allele distribution of FMR1 gene in Korean women / 대한산부인과학회잡지

OBJECTIVE: Fragile X syndrome is the most common form of familial mental retardation, attributable to (CGG)n expansion in the FMR1 gene. This study was undertaken to ascertain the distribution of FMR1 CGG repeat in the general Korean women and to identify ethnic difference in FMR1 CGG repeat number. Material and METHOD: Between January 1999 and December 1999, we evaluated 1,000 low risk women who visited Gachon Medical School Hospital. DNA samples were extracted from the venous bloods by routine methods, and G-C specific Polymerase Chain Reaction (PCR)s were performed to evaluate FMR1 CGG repeat number. RESULTS: Mean FMR1 CGG repeat number was 26.9 (6-50), single PCR bands were detected in 776 cases (77.7%). There were two more bands in 22.3% of the cases. Most of the cases are located between 21 and 35 repeats, especially 21-25 repeats. The pattern of distribution of CGG repeat is dispersed. In 13 cases, we could not obtain the PCR results. CONCLUSION: Low risk of transmission rate of the FRX in Korea can be expected.

Cytogenetic Aberration Analysis of Midtrimester Amniotic Fluid / 대한산부인과학회잡지

OBJECTIVE: To analyze cytogenetic results of prenatal genetic amniocentesis. METHODS: From January 1997 to December 2000, We analyzed 1,390 cases of midtrimester amniocentesis which were done at Gil medical center of Gachon medical school according to its indications and maternal age. RESULTS: Chromosomal aberrations were found in 88 cases (6.3%). Of all our chromosomal aberrations, 29 cases (2.1%) of normal variants and 59 cases (4.2%) of abnormal karyotypes were found. 37 cases of autosomal numerical abnormal karyotypes and 7 cases of sex chromosomal abnormal karyotypes were diagnosed. In abnormal karyotype group, the incidence was high after 40 years of maternal age and in abnormal ultrasound findings, but no such correlations were found in normal variant group. CONCLUSION: In analysis of midtrimester amniocentesis, it would be better to analyze separately abnormal karyotype group and normal variant group.