Efficacy and safety of ferric carboxymaltose versus ferrous sulfate for iron deficiency anemia during pregnancy: subgroup analysis of Korean women.

BACKGROUND: We performed a post-hoc subgroup analysis in Korean women who participated in the Phase III FER-ASAP (FERric carboxymaltose-Assessment of SAfety and efficacy in Pregnancy) study to compare the efficacy and safety of ferric carboxymaltose (FCM) with oral ferrous sulfate (FS). METHODS: Pregnant Korean women (gestational weeks 16-33) with iron-deficiency anemia (IDA) were randomized 1:1 to FCM (n = 46; 1000-1500 mg iron) or FS (n = 44; 200 mg iron/day) group for 12 weeks. The primary objective was to compare the mean hemoglobin (Hb) increase at week 3; secondary objectives included change in iron parameters, quality of life (QoL), and safety. RESULTS: Baseline characteristics of the Korean subgroup were consistent with those of non-Korean FER-ASAP population except for lower body-mass index and higher maternal age. Hb level increases were comparable between the two treatment groups in Korean women at week 3 (FCM 1.23 ± 0.89 g/dL vs FS 1.14 ± 1.72 g/dL). Iron parameters improved over time as secondary endpoints were significantly in favor of FCM. In terms of QoL, FCM treatment significantly improved the mental and physical components as well as vitality prior to delivery. Both treatments were well tolerated. CONCLUSIONS: FCM provided significantly greater improvements in iron parameters and QoL compared to FS in the Korean subgroup. FCM may be a preferable alternative to currently available treatments for IDA during pregnancy.

Uterine artery pseudoaneurysm manifesting as delayed postpartum hemorrhage after precipitous delivery: three case reports.

Precipitous delivery may lead to serious maternal and neonatal complications. Uterine artery pseudoaneurysm (UAP) is one of the causes of delayed postpartum hemorrhage. Here we describe 3 cases of UAP manifesting as delayed postpartum hemorrhage after precipitous delivery. The duration of the second stage of labor in cases 1, 2, and 3 was 15, 15, and 60 min, respectively. Excessive vaginal bleeding occurred 10, 9, and 31 days after delivery, respectively. Ultrasonogram and pelvic angiography revealed the UAP in each case and uterine artery embolization was performed. UAP may be a complication of precipitous delivery.

The South Korean Twin Registry: an update.

The South Korean Twin Registry (SKTR) is an ongoing nation-wide volunteer registry of South Korean twins and their families, which was established in the year 2001 to understand genetic and environmental etiologies of psychological and physical traits among South Koreans. Recently, the SKTR sampling has been extended in two important ways. First, we began to recruit twins from lower socio-economic families to study interaction effects of gene by environmental context. Second, as a parallel study of the SKTR, the Nigerian Twin and Sibling Registry was developed to understand the origin of the population group differences/similarities in psychological traits between South Koreans and Nigerians. This article summarizes the main findings (based on the SKTR sample to date), recruitment procedures, zygosity assessment, measures, and future plans for the SKTR.

A recent rise in twin birth rates and demographic changes in mothers of twins in South Korea: 2003-2007.

Using the South Korean national live birth data for the years 2003 to 2007, monozygotic (MZ) and dizygotic (DZ) twin birth rates were estimated and analyzed by maternal age, and parents of twins and those of singletons were compared in their level of education. During this period, while the MZ twin birth rate showed no change, the DZ twin birth rate increased up to 9.4 pairs per thousand births. This rate is close to five times as high as the natural DZ twinning rate in the South Korean population. The highest twinning rate occurred among mothers aged 30 to 34 years, followed by mothers aged 25 to 29. These results represented the first evidence for the downward trend in ages of mothers of twins. In each year between 2003 and 2006, percentages of parents who completed college or higher level of education were higher in the twin than in the singleton group, suggesting that the parental socioeconomic level became higher in twins than in singletons. We speculated that these demographic changes occurred because assisted reproductive technology was more easily available among parents of high socioeconomic status. In their sampling strategies, twin researchers should consider our findings of recent changes in demographic characteristics of parents of twins as well as increased DZ twin birth rates.

Successful pregnancy and delivery of a patient with congenital adrenal hyperplasia.

Congenital adrenal hyperplasia (CAH) during pregnancy is a rare condition. Only a few cases have been reported in the literature. CAH patients has lower pregnancy rate compared to normal women. A 27-year-old nulliparous woman, a diagnosed case of 21-hydroxylase deficient simple virilising form of classic CAH visited. She got pregnant spontaneously without any trial of assisted reproductive technology. At the age of 12, she underwent clitoral resection and vaginoplasty. She took dexamethasone or prednisolone after operation. She delivered healthy singleton female baby by cesarean section. Four years later, she delivered healthy singleton female baby by repeat cesarean section. Two female babies have shown normal external genitalia. Here, we report a case of successful pregnancy and delivery in a patient with CAH.

Incidentally detected ganglioneuroma during pregnancy: A case report.

Retroperitoneal ganglioneuroma is a rare benign tumor, which is included in the neuroblastomas group. It can occur anywhere along the peripheral autonomic ganglion sites, and the tumor is often incidentally detected in asymptomatic patients or may produce symptoms related to the slow growing tumor. Surgical excision is the treatment of choice and the prognosis is good. We report a case of retroperitoneal ganglioneuroma, which was incidentally detected in the first trimester of pregnancy in a 29-year-old woman. Surgical resection of the ganglioneuroma was done at the time of cesarean section at full term without complications.

Comparison of oxidative stress markers in umbilical cord blood after vaginal and cesarean delivery.

OBJECTIVE: The purpose of our study was to investigate the effect of the mode of delivery on the oxidant and antioxidant system in umbilical cord blood. METHODS: We performed gas analysis of umbilical venous blood and umbilical arterial blood immediately after delivery in 38 women; eighteen women had a vaginal delivery while 20 women delivered via cesarean section at over 37 weeks gestation. We examined lipid peroxide concentration by thiobarbituric acid reaction, protein carbonyl content by 2,4-dinitrophenylhydrazine reaction, and total antioxidant capacity by oxygen radical absorbance capacity assay. RESULTS: Lipid peroxide levels in umbilical venous blood were significantly higher in patients delivering by planned cesarean section (1.81 ± 0.06 nmol/mg protein) than those with vaginal delivery (1.24 ± 0.05 nmol/mg protein) (P < 0.05). Antioxidant capacity in umbilical venous blood was significantly higher in patients delivering by planned cesarean section (119.70 ± 0.13 µM/µL) than those with a vaginal delivery (118.70 ± 0.29 µM/µL) (P < 0.05). There was no significant difference in the carbonyl content of umbilical venous blood or in the lipid peroxide, carbonyl content, and total antioxidant capacity of umbilical arterial blood. CONCLUSION: Lipid peroxidation levels and antioxidant capacity in umbilical venous blood were higher in patients delivering by planned cesarean section than those with a vaginal delivery. Therefore, we propose that both the mother and neonate are exposed to higher oxidative stress during cesarean section delivery.

Analysis of high-risk infant births and their mortality: ten years' data from chonnam national university hospital.

Prematurity and low birth weight are major factors associated with neonatal morbidity and mortality, and their incidence is not decreasing despite an annual decrease in the total number of live births in Korea. The objective of this study was to establish a strategy to reduce neonatal mortality by analyzing the clinical characteristics of high-risk infant births along with their mortality and causes of death. We retrospectively surveyed the medical records of infants born at Chonnam National University Hospital and of patients admitted to the neonatal intensive care unit (NICU) for 10 years from October 1999 to December 2008. Premature and low birth weight infants were almost half of the live births, and their NICU admission rate increased with increases in the numbers of outborns and multiples. Also, their mortality decreased dramatically over the past 10 years. About 60% of deaths occurred within 1 week of life, and the causes of death were mostly related to prematurity. Perinatal asphyxia was the major cause of death in infants less than 1 week old, whereas sepsis was the major cause after 4 weeks of age. The major cause of death was sepsis in premature or low birth weight infants and perinatal asphyxia in term or normal weight infants. The major cause of death was sepsis in inborns and perinatal asphyxia in outborns. Our results suggest that medical personnel training for immediate postnatal care including neonatal resuscitation, infection control, and a systematic team approach to regionalization are all needed to reduce the mortality rate.

Triplet pregnancy with partial hydatidiform mole coexisting with two fetuses: a case report.

Hydatidiform mole with a coexistent fetus is rare, but this condition has recently shown an increased incidence because of assisted reproduction technology. Herein, we report on a case of triplet pregnancy with a partial hydatidiform mole coexisting with two fetuses. It was diagnosed by p57(kip2) immunohistochemical staining which is helpful in determining histologically equivocal cases. After termination of pregnancy, the patient was diagnosed with persistent gestational trophoblastic disease. Six courses of methotrexate chemotherapy were performed. Her beta-human chorionic gonadotrophin titers then fell to a normal level.

A case of fetal congenital mesoblastic nephroma with oligohydramnios.

Although congenital renal tumors are rare, congenital mesoblastic nephroma (CMN) is the most common renal tumor in early infancy. It is non-metastatic, well differentiated, amenable to surgical removal, and carries a good prognosis. Polyhydramnios has been detected in most of the published cases of CMN. However, we experienced a rare case of fetal CMN associated with oligohydramnios. A 28-yr old woman at 34 weeks of gestation was referred to our hospital for oligohydramnios and a fetal abdominal mass. An ultrasonography revealed a huge, well-encapsulated mass arising from the right kidney. An emergency cesarean section was performed due to fetal distress. After birth, despite intensive neonatal care, the baby died because of renal failure, disseminated intravascular coagulopathy, pulmonary edema, together with other problems.

A case of septic shock and disseminated intravascular coagulation complicated by acute myocardial infarction following amniocentesis.

Maternal septic shock and disseminated intravascular coagulation (DIC) following amniocentesis is a relatively rare condition, and its incidence is only 0.03 approximately 0.19%. Acute myocardial infarction (AMI) associated with DIC is also rare. We report here on a 40-year-old female patient who had septic shock and DIC that was complicated by AMI following amniocentesis. The possible mechanism of AMI in this patient may have been coronary artery thrombosis associated with DIC.

Chronic hypoxia alters vasoconstrictive responses of femoral artery in the fetal sheep.

The purpose of this study was to determine if mild hypoxia alters the responsiveness to vasoactive agents in the renal and the femoral arteries in the fetal sheep. Ten pregnant sheep were operated under halothane anesthesia at 116 to 124 days' gestation. A maternal tracheal catheter was placed for infusing compressed air (control group, n=5) or nitrogen (hypoxia group, n=5) starting on post operative day 6 and maintained for 5 days. Femoral and renal arteries were harvested from the fetus to study the constriction response to phenylephrine (PE 10(-9) to 10(-5)mol/L). To determine the involvement of nitric oxide as a modulator of vessel constriction, N-nitro-L-arginine methyl ester (L-NAME) was used at a concentration of 10 -4 mol/L in parallel chambers. In the hypoxia group, maternal PaO2 significantly decreased from a base-line of 110.4+/-1.4 to 80.5+/-1.6 (mmHg, p<0.01), fetal PaO2 significantly decreased from a baseline of 20.9+/-0.3 to 15.5+/-0.1 (mmHg, p<0.01). Hypoxia was associated with a significant increase in PE maximal response in the absence (184.5+/-6.6 vs. 146.2+/-4.3) and presence (166.9+/-6.3 vs. 145.0+/-4.5) of L-NAME, and a decrease in EC50 in the absence (6.0+/-1.1 vs. 27.0+/-4.1) of L-NAME of femoral arteries. However, there were no significant differences in PE maximal response and EC50 in the absence and presence of L-NAME of renal arteries. We concluded that mild chronic hypoxia seems to increase the fetal femoral artery response to PE, but not in the fetal renal artery. This observation is consistent with a redistribution of cardiac output away from the carcass.

Fetal axillary cystic hygroma detected by prenatal ultrasonography: a case report.

Fetal cystic hygroma is a rare developmental congenital anomaly of the lymphatic system, characterized by the formation of a multilocular, variable sized cystic mass. Most of cystic hygromas are found in the neck and other rare locations include axilla, mediastinum, and limbs. There are many papers about cystic hygroma colli, but there are only a few papers about fetal axillary cystic hygroma and no domestic papers. We present a case of fetal axillary cystic hygroma diagnosed antenatally followed by full-term delivery in a 30-yr-old woman. Operation was performed on the 8th day after birth and the mass was excised and confirmed as cystic hygroma.