Pregnancy Outcomes and Obstetrical Complications of Twin Pregnancies with Endometriosis:A Single-Center Cohort Study

Purpose@#There are many studies regarding the increased relationship between pregnancy outcomes of singleton with endometriosis. However, there was limited evidence of twin pregnancies with endometriosis. This study aimed to compare the pregnancy outcomes and complications in twin pregnancies with or without endometriosis in a single institution. @*Materials and Methods@#From January 2011 to July 2022, a retrospective analysis of twin pregnancies was conducted. The endometriosis group included patient with histological or visual confirmation before pregnancy or during cesarean section. Pregnancy outcomes and complications were compared between the two groups. @*Results@#Out of 1714 patients examined, 127 (7.4%) were included in the endometriosis group. Maternal body mass index (BMI) was lower in the endometriosis group (p<0.001). There were no significant differences in maternal age, mode of conception, chorionicity, and pregnancy outcomes, such as gestational age at delivery (p=0.835) and the preterm birth rate (p=0.579). The endometriosis group had a significantly higher rate of obstetrical complication: small for gestational age (SGA) <10% (p=0.029). However, after adjustment for BMI, the endometriosis group showed no statistical significance in obstetrical complications, including SGA (adjusted odds ratio, 1.568; 95% confidence interval, 0.984–2.499; p=0.059). @*Conclusion@#Twin pregnancies with endometriosis were not related to adverse effects on pregnancy outcomes and obstetrical complications. To confirm these outcomes, further large prospective studies are required.

The effectiveness of a single preoperative dose of misoprostol during laparoscopic myomectomy / 대한산부인과내시경학회지

OBJECTIVE: To evaluate the effectiveness of single preoperative dose of misoprostol to reduce intraoperative hemorrhage during laparoscopic myomectomy. METHODS: We reviewed retrospectively the medical records of 148 patients who underwent laparoscopic myomectomy in Gangnam CHA Medical Center between January 2007 and December 2009 by single surgeon. Among them, 46 patients used preoperative transrectal misoprostol. One hundred two patients underwent laparoscopic myomectomy in conventional method without any preoperative agents. RESULTS: The two groups were similar in baseline characteristics. There was no significant difference in mean blood loss (misoprostol group: 203.3+/-181.8 mL vs. no agent group: 207.7+/-144.5 mL), operation time (misoprostol group: 113.3+/-28.2 min vs. no agent group: 113.4+/-31.5 min), and hemoglobin change (misoprostol group: 2.0+/-1.0 g/dL vs. no agent group: 1.9+/-1.0 g/dL). Two patients needed transfusion in misoprostol group whereas none in control group, but there was no statistical significance. CONCLUSION: A single preoperative dose of transrectal misoprostol cannot reduce bleeding during laparoscopic myomectomy.

The rate and etiologies of second trimester fetal loss in twin pregnancies / 대한산부인과학회지

OBJECTIVE: To evaluate and compare the rate and etiologies of second trimester pregnancy loss in monochorionic (MC) or dichorionic (DC) twins, and natural or assisted reproductive technology (ART) twins. METHODS: Between January 1997 and December 2008, there were 146 cases of second trimester twin pregnancy losses (between 12 and 24 weeks gestation) from 2,467 twin pregnancies. They were divided into four groups according to chorionicity and fertilization. Chorionicity was established by ultrasound at early gestation and confirmed by histologic examination after delivery. From a total of 2,467 twin deliveries, 392 MC, 2058 DC, and 17 unknown chorionicity were observed. Fertilization methods were classified as 736 natural, 1,590 ART, and 141 unknown conceptions. The pregnancy loss rate and possible mechanisms were compared in each group. RESULTS: During the study period, there were 43 MC, 86 DC, and 17 unknown chorionicities and 45 natural, 78 ART, and 23 unknown fertilizations. Total twin pregnancy loss rate was 5.9% (146/2,467), with 11.0% (43/392) and 4.2% (86/2,058) for MC twin group and DC twin group, respectively. Likewise, it was 6.1% (45/736) and 4.9% (78/1,590) for natural twin group and ART twin group. The most common cause was intrauterine fetal death (IUFD) in 22 (51.2%) in MC twin group and preterm premature rupture of membranes (PPROM) in 40 (46.5%) in DC twin group, followed by preterm labor (PTL) in 37 (43%). In natural pregnancy, IUFD was the most common etiology in 20 (44.5%) and for ART twin group, it was PTL in 35 (44.9%). CONCLUSION: Twin pregnancy loss rate was higher in MC twin group compared with DC twin group in the second trimester. MC twin group had a higher incidence of IUFD as a cause of second trimester pregnancy loss. The etiologies in DC twin group were PPROM and PTL. It is suggested that antenatal care in twin pregnancy should be explored for preventing fetal loss and promoting neonatal well-being.

Comparison of Maternal Fatty Acid Intake and Fatty Acid Composition of Serum Phospholipids Between Singleton and Twin Pregnancies / 대한지역사회영양학회지

Essential fatty acids are important essential nutrients during pregnancy. The objective of this study was to compare fatty acid composition of serum phospholipids and essential fatty acid intakes between Korean pregnant women with a single baby and Korean pregnant women with twins. A total of 116 pregnant women who had maintained their health without any symptoms of pregnancy complications participated in the study. The subjects consisted of 57 women of singleton pregnancy and 58 women of twin pregnancy at the 1st, 2nd, or 3rd trimester of pregnancy. A 24-hour dietary recall was administered to each subject to obtain dietary information. The mean ages of the singleton pregnancy group and the twin pregnancy group were 31.44 years and 32.27 years, respectively, and the mean height values were 161.86 cm and 160.64 cm, respectively. The mean daily energy intakes in the singleton pregnancy group were 1639.95 kcal, 1904.71 kcal, and 1882.82 kcal for the 1st, 2nd, and 3rd trimester group, respectively. The mean daily energy intakes in the twin pregnancy group were 1745.99 kcal, 2203.46 kcal, and 2092.26 kcal for the 1st, 2nd, and 3rd trimester group, respectively. There were no significant differences in the mean fatty acid intakes by the type of pregnancy (i.e., singleton vs. twins and the stage of pregnancy (i.e., 1st vs. 2nd vs. 3rd trimester). However, the mean total fatty acid intake of those at the 1st trimester among the singleton pregnancy group tended to be higher than that of those at the 1st trimester among the twin pregnancy group. Such a trend seemed to be retro-versed. That is, the mean total fatty acid intakes of the twin pregnancy group were higher compared to the singleton pregnancy group for the 2nd and 3rd trimester group. The LA and total n6 concentrations of serum phospholipids of the singleton pregnancy group were significantly higher as the gestational age increased (p < 0.05). The alpha-LNA(p < 0.05), EPA (p < 0.05), and total n3 (p < 0.001) concentrations of serum phospholipids of the twin pregnancy group were significantly lower as the gestational age increased. The alpha-LNAconcentrations of serum phospholipids in the singleton pregnancy group at the 3rd trimester were significantly higher than that in the twin pregnancy group at the same trimester (p < 0.05). The serum phospholipids levels of AA and DHA of the twin pregnancy group were generally higher compared to those of the singleton pregnancy group. Particularly the differences reached at the level of statistical significance for those at the 1st trimester (p < 0.01). It is concluded that the study findings imply that fatty acid metabolism may meaningfully differ by the type and stage of pregnancy. Future research needs to be conducted to more elucidate grounding etiology and possible roles of dietary fatty acid intake levels in relation to the study findings.

Comparison of Maternal Fatty Acid Intake and Fatty Acid Composition of Serum Phospholipids Between Singleton and Twin Pregnancies / 대한지역사회영양학회지

Essential fatty acids are important essential nutrients during pregnancy. The objective of this study was to compare fatty acid composition of serum phospholipids and essential fatty acid intakes between Korean pregnant women with a single baby and Korean pregnant women with twins. A total of 116 pregnant women who had maintained their health without any symptoms of pregnancy complications participated in the study. The subjects consisted of 57 women of singleton pregnancy and 58 women of twin pregnancy at the 1st, 2nd, or 3rd trimester of pregnancy. A 24-hour dietary recall was administered to each subject to obtain dietary information. The mean ages of the singleton pregnancy group and the twin pregnancy group were 31.44 years and 32.27 years, respectively, and the mean height values were 161.86 cm and 160.64 cm, respectively. The mean daily energy intakes in the singleton pregnancy group were 1639.95 kcal, 1904.71 kcal, and 1882.82 kcal for the 1st, 2nd, and 3rd trimester group, respectively. The mean daily energy intakes in the twin pregnancy group were 1745.99 kcal, 2203.46 kcal, and 2092.26 kcal for the 1st, 2nd, and 3rd trimester group, respectively. There were no significant differences in the mean fatty acid intakes by the type of pregnancy (i.e., singleton vs. twins and the stage of pregnancy (i.e., 1st vs. 2nd vs. 3rd trimester). However, the mean total fatty acid intake of those at the 1st trimester among the singleton pregnancy group tended to be higher than that of those at the 1st trimester among the twin pregnancy group. Such a trend seemed to be retro-versed. That is, the mean total fatty acid intakes of the twin pregnancy group were higher compared to the singleton pregnancy group for the 2nd and 3rd trimester group. The LA and total n6 concentrations of serum phospholipids of the singleton pregnancy group were significantly higher as the gestational age increased (p < 0.05). The alpha-LNA(p < 0.05), EPA (p < 0.05), and total n3 (p < 0.001) concentrations of serum phospholipids of the twin pregnancy group were significantly lower as the gestational age increased. The alpha-LNAconcentrations of serum phospholipids in the singleton pregnancy group at the 3rd trimester were significantly higher than that in the twin pregnancy group at the same trimester (p < 0.05). The serum phospholipids levels of AA and DHA of the twin pregnancy group were generally higher compared to those of the singleton pregnancy group. Particularly the differences reached at the level of statistical significance for those at the 1st trimester (p < 0.01). It is concluded that the study findings imply that fatty acid metabolism may meaningfully differ by the type and stage of pregnancy. Future research needs to be conducted to more elucidate grounding etiology and possible roles of dietary fatty acid intake levels in relation to the study findings.

Comparison of surgical outcomes after laparoscopy-assisted vaginal hysterectomy and total laparoscopic hysterectomy / 대한산부인과학회지

OBJECTIVE: To compare the surgical outcomes between laparoscopy-assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH). METHODS: The data were collected retrospectively from hospital records. Between September 2006 and August 2007, Patients undergone with LAVH (93 cases) and TLH (142 cases) with pathologic reports of leiomyoma or adenomyosis were enrolled. The characteristics and surgical results were compared according to the operation type. The correlations among the variables were analyzed with multiple linear regression. RESULTS: Between two groups, the characteristics of patients were similar such as age, body mass index, surgical history, and pathologic findings. In the univariate analysis, the differences of operation duration and blood loss between LAVH (129.0+/-34.5 min, 385.5+/-296.1 mL) and TLH (123.6+/-40.8 min, 294.7+/-285.4 mL) were significant (P0.050). In multivariate analysis, blood loss was correlated with operation duration and specimen weight (P=0.000) but not with operation type (P=0.213). CONCLUSIONS: LAVH tends to be selected in larger uteri and results in more blood loss and longer operation duration. Operation type (LAVH or TLH) does not affect blood loss which is related with operation duration and uterine weight.

Posterior Reversible Encephalopathy Syndrome after Cesarean Section under Spinal Anesthesia: A case report / 대한마취과학회지

A posterior reversible encephalopathy syndrome (PRES) is characterized as headache, altered mental function, seizure, and visual disturbances resulted from vasogenic edema in the brain. A 29-year-old normotensive parturient developed a postural headache two days after the cesarean section under spinal anesthesia. The headache was initially misdiagnosed as a postdural puncture headache (PDPH). The patient experienced generalized seizures four days after delivery. Her blood pressure increased to 170/100 mmHg with mild proteinuria. She developed homonymous hemianopsia two days after the seizures. MRI revealed high signal intensity areas in the posterior temporal, frontal, occipital and parietal white matter. Presuming a diagnosis of PRES, the patient was treated with magnesium sulfate, sodium valproate, and carbohydrate solutions. She was discharged without headache or neurologic deficit on postoperative day 13. When patients present a headache with focal neurological deficits or visual disturbances, the anesthesiologist must consider the possibility of PRES and aggressively treat based on the clinical presentation.

Rapid prenatal diagnosis of Down syndrome and Edward syndrome by fluorescence In situ hybridization:Clinical experience with 309 cases

PURPOSE: The purpose of this study was to evaluate the clinical utility of rapid detection of Down syndrome and Edward syndrome by Interphase Fluorescence in Situ Hybridization (FISH) analysis METHODS: A retrospective study in 309 cases of amniotic fluid samples, analysed by interphase FISH with DNA probes specific to chromosome 18 and 21, was performed. All FISH results were compared with conventional cytogenetic karyotypings. RESULTS: The results were considered as informative and they were obtained within 48 hrs. A case of Down syndrome and a case of Edward syndrome were diagnosed by FISH and confirmed by subsequent cytogenetic analysis. In 12 cases with normal FISH results, the cytogenetic analysis showed a case of partial trisomy 22, three cases of sex chromosomal aneuploidy, two cases of mosaicism, two cases of microdeletion, and four cases of structural rearrangement. CONCLUSION: FISH is a rapid and effective diagnostic method, which can be used as an adjunctive test to cytogenetic analysis, for prenatal identification of chromosome aneuploidies. For the more genome- wide screening with variety of probes, the technique of FISH is both expensive and labor-intensive.

Prenatal Diagnosis and Clinical Outcome of Fetal Ovarian Cysts / 대한주산의학회잡지

PURPOSE:The purpose of this study is to evaluate the ultrasonographic finding and clinical course of fetal ovarian cysts. METHODS:A retrospective study of 11 cases of fetal ovarian cysts, evaluated by prenatal and postnatal ultrasonographic studies was conducted. We analyzed the demographic factors, the ultrasonographic findings, the change of ultrasonographic parameters, the mode of delivery, the management of ovarian cysts and pathologic finding. RESULTS:In all cases, fetal ovarian cysts were unilateral simple cysts at the time of diagnosis. The mean sizes of the ovarian cysts were 29.7 mm on prenatal and 19.8 mm on postnatal studies. In four of the 11 cases, the ultrasonographic patterns of cysts changed from simple to complicated cysts on serial monitorng, and one of them required postnatal surgery. Ten of 11 cases were spontaneously resolved during perinatal follow-up ultrasound. CONCLUSION:We recommend continuous ultrasonographic assessment of antenatally diagnosed ovarian cysts, which is helpful to predict the outcome of cysts and decide on the management.

Relationship between Initial Anesthetic methods and Perioperative Courses in Emergency Cesarean Hysterectomy / 대한산부인과학회지

OBJECTIVE: The Purpose of this study was to compare the perioperative variables in patients administered inhalation or regional anesthesia for the initial cesarean section following emergency hysterectomy under general anesthesia. METHODS: Emergency cesarean hysterectomies performed between January 1993 and December 2004 was analyzed retrospectively. There were 65 emergency cesarean hysterectomies during the period. General anesthesia for both delivery and following hysterectomy was employed 24 cases (General group) and regional anesthesia for the initial cesarean section following general anesthesia for emergency hysterectomy was employed 41 cases (Regional group). RESULTS: Most common indication of cesarean hysterectomy was placenta accreta in the both groups. Incidence of uterine atony without pathology was higher in the regional group than in the general group (34.1% vs. 4.2%). There was no difference in the intraoperative managements, estimated blood loss, and transfusions between the two groups. Total perioperative complications were found in 20 out of 65 cases (28.2%), and the incidence of disseminated intravascular coagulopathy (DIC) was higher in the regional group than in the general group (24.4% vs. 4.2%). CONCLUSION: The anesthetic method did not affect the intraoperative managements although the incidence of uterine atony without pathology was higher, and perioperative DIC was more in the regional group than in the general group.

Midtrimester triple test in IVF/ICSI twin pregnancies / 대한산부인과학회지

OBJECTIVE: To compare the midtrimester triple marker levels for down syndrome screening between natural and IVF twin pregnancies and to evaluate the difference triple marker in IVF twin pregnancies according to the fertilization method and number of transferred embryos. METHODS: The study population consisted of conventional IVF twin (n=106), ICSI twin (n=142), and natural (n=436) twin pregnancies as controls between 2001 and 2004. All pregnancies in this study were known to have normal outcome. Maternal serum samples were collected between 14-18 gestational weeks. Levels of AFP, total hCG, and uE3 were measured and were expressed as multiples of the median (MoM) based on reference medians established at Cheil Hospital. RESULTS: The mean maternal age (31.6+/-2.8 vs. 31.6+/-3.0 vs. 32.1+/-2.1: conventional IVF group vs. ICSI group vs. control, respectively) and gestational weeks (16.0+/-0.5 vs. 16.0+/-0.7 vs. 16.1+/-0.2) for triple test were similar. There was no difference in levels of all serum markers between conventional IVF and ICSI group. The median AFP MoM for conventional IVF and ICSI group were significantly higher than that of the control group (2.40 vs. 2.22 vs. 1.98; p0.05). Also, the median hCG MoM was not different from that of the control group (2.04 vs. 2.06 vs. 2.02; p>0.05). There was no correlation in triple marker levels according to the number of transferred embryos in conventional IVF and ICSI groups. CONCLUSION: Midtrimester triple marker levels of IVF twin pregnancy for down syndrome screening are similar with those of natural twin pregnancy regardless of fertilization method and number of transferred embryos.

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.

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.

Maternal Serum and Amniotic Fluid Inhibin A Levels in Women who Subsequently Develop Severe Preeclampsia

The purpose of this study was to evaluate whether maternal serum (MS) and amniotic fluid (AF) inhibin A levels are elevated in patients who subsequently develop severe preecalmpsia, and to investigate the correlation between MS and AF inhibin A levels in the second trimester. The study included 40 patients who subsequently developed severe preecalmpsia and 80 normal pregnant women. Inhibin A levels in MS and AF were measured with enzyme-linked immunosorbent assay (ELISA). The MS and AF inhibin A levels in patients who developed severe preeclampsia were significantly higher than those in the control group (both for p<0.001). There was a positive correlation between MS and AF inhibin A levels in patients who developed severe preeclampsia (r=0.397, p=0.011), but not in the control group (r=0.185, p=0.126). The best cutoff values of MS and AF inhibin A levels for the prediction of severe preeclampsia were 427 pg/mL and 599 pg/mL, respectively; the estimated ORs that were associated with these cut-off values were 9.95 (95% CI 3.8-25.9, p<0.001) and 6.0 (95% CI 2.3-15.8, p<0.001). An elevated level of inhibin A in MS and AF at the time of second trimester amniocentesis may be a risk factor for the subsequent development of severe preeclampsia.

Threshold of Nuchal Translucency for the Detection of Chromosomal Aberration: Comparison of Different Cut-offs

This study evaluated the sensitivities and false positive rates of the screening test using ultrasonographic measurement of thickness of nuchal translucency (NT) with different cut-offs for chromosomal aberration in a Korean population. We included 2,570 singleton pregnancies undergoing ultrasound between 11 weeks and 14 weeks of gestation in this study. We analyzed the sensitivities of NT alone for screening chromosomal aberration using three cut-offs -2.5 mm, 3.0 mm, and 95th percentile for each crown rump length (CRL). There were 31 chromosomal aberrations (1.2%) including 12 cases of trisomy 21. The numbers of chromosomal aberrations that were detected by NT with different cut-offs of 2.5 mm, 3.0 mm and the 95th percentile CRL were 22, 18 and 23, respectively. At a threshold of 2.5 mm, the sensitivity and the false positive rate for total chromosomal aberrations were 67.7% and 6.3%, respectively. At 3.0 mm, those were 54.8% and 3.5%, respectively. At the 95th percentile CRL, those were 70.9% and 5.8%, respectively. The use of CRL-dependent cut-offs for nuchal translucency improves the detection of chromosomal aberrations when compared to fixed cut-offs in a Korean population.

Antioxidant vitamins intakes and plasma levels of retinol, beta-carotene and alpah-tocopherol in pregnant women / 대한산부인과학회지

OBJECTIVE: It is now accepted that intakes and serum levels of antioxidant vitamins are associated with the degree of oxidative stress and prevalence of some negative pregnancy outcomes. The purpose of this study was to assess the nutritional status of antioxidant vitamins. METHODS: The study included 82 pregnant women in Department of Obstetrics and Gynecology in Samsung Cheil Hospital and Women's Healthcare Center between December 2000 and May 2001. The study group was divided according to gestational age: group I (8-17 weeks, 26 women), group II (18-27 weeks, 27 women), group III (28-36 weeks 29 women). Data on dietary intake was collected with the 24 hours recall method. Plasma concentrations of retinol, beta-carotene and alpah-tocopherol were measured by high performance liquid chromatography (HPLC). In addition, the relationship between intakes of antioxidant vitamins and plasma concentrations of retinol, beta-carotene, alpah-tocopherol were analyzed. RESULTS: Mean daily intake of energy was 1,958.5 kcal (85.5% of recommended dietary allowance, RDA). Mean daily intake of vitamin A, retinol, beta-carotene and vitamin E was 90.5 microgram RE (retinol equivalent) (117.9% of RDA), 195.2 microgram, 4,052.8 microgram and 15.0 mg (140% of RDA) respectively. Plasma levels of retinol, beta-carotene and alpah-tocopherol was 1.48 micro mol/l, 0.27 micro mol/l and 19.99 micro mol/l respectively. Maternal plasma levels of beta-carotene in group III were significantly higher than those in group I or II (p<.05). No significant relationship between plasma antioxidant vitamin intakes and plasma antioxidant vitamin levels was observed with exception of that between plasma alpah-tocopherol concentration and dietary intakes of vitamin E (p<.05) in group I. CONCLUSION: It is suggested that the nutritional status of antioxidant vitamins of some Korean pregnant women may evaluated as acceptable in general.

Clinical Effectiveness of Urinary Human Chorionic Gonadotropin Related Protein (hCGRP) Quantification for Diagnosis of Ectopic Pregnancy

We detected pregnancy related new molecule, human chorionic gonadotropin related protein (hCGRP) in the urine of a pregnant women by using a monoclonal antibody against the human chorionic gonadotropin (hCG). This study examined the effectiveness of urinary hCGRP quantification in diagnosing ectopic pregnancy. This study included 40 normal pregnant women and 25 patients with ectopic pregnancy. Patients' serum and urinary intact whole hCG (i-hCG) and hCGRP concentrations were measured using sandwich ELISA and the ratio of hCGRP to i-hCG was calculated. Statistical analysis was performed using statistical package for social sciences (SPSS) 10.0. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the cut-off value to discriminate ectopic pregnancies from normal intrauterine pregnancies. Urinary hCGRP and hCGRP/i-hCG ratio in ectopic pregnancy group (14 +/- 6.6 ng/mL, 4.6 +/- 1.9%, respectively) were significantly lower than those of normal pregnancy group (149 +/- 10.2 ng/mL, 29.7 +/- 1.9%, respectively; p<0.001). Based on ROC curve analysis, a cut-off point of urinary hCGRP/i-hCG ratio <16.2% discriminated between ectopic pregnancy and normal pregnancy with a sensitivity, specificity, positive predictive value and negative predictive value of 92.0%, 90.0%, 32.6%, and 99.5%, respectively. Urinary hCGRP/i-hCG ratio measurement may be effective in diagnosing ectopic pregnancy.

Expression of Transforming Growth Factor -beta1, -beta2 in Human Endometrium of The Uterine Adenocarcinoma / 대한부인종양콜포스코피학회잡지

OBJECTIVE: To determine the differences of expression of Transforming Growth Factor (TGF)-beta1 and TGF-beta2 in the human proliferative, secretory, menopausal endometrium, and in hyperplasia and adenocarcinoma of the endometrium. MATERIALS AND METHODS: Fifty patients were divided into 5 groups. Twenty samples were collected from patients with endometrial hyperplasia (n=l0) and adenocarcinoma(n=10) after hysterectomy. Thirty samples were collected from the normal menstrual cycle and the menopausal women as a control group. The histological types of endometrium were proliferative(n=10), secretory(n=10), menopausal(n=10). Immunohistochemical staining was performed through the use of monoclonal antibodies against anti-human TGF-beta1/ beta2 polycolonal IgG rabbit antibody. Expression of TGF-beta1 and TGF-beta2 were judged positive when the staining revealed color development in 5% or more. Specimens were rated absent, trace, weak, moderate and intense. Then, they were scored 4 in case of intense positive for TGF-beta1 and TGF-beta2, and '0' in case of absent for TGF-beta1 and TGF-beta2 . RESULTS: Mean scores of TGF-beta1 in glandular cell were proliferative(1.0), secretory (2.3), menopausal endometrium(1.0), endometrial hyperplasia(0) and adenocarcinoma(0). Expression of TGF-beta2 in glandular cell were proliferative(3.8), secretory(3.3), menopausal endometrium(2.8), endometrial hyperplasia(0.3) and adenocarcinoma(0.3). No specific different expression of TGF-beta1 and TGF-beta2 was found between stromal, vascular and myometrium. However, there was similar expression of TGF-beta1 and TGF-beta2 in endometrial hyperplasia and adenocarcinoma gmup. CONCLUSIONS: TGF-beta1 and TGF-beta2 may have important roles to suppress the development of the precancerous or cancerous lesions in endometrial glandular cells.

Maternal Serum CA 125 Levels in Intrauterine Pregnancy and Abortion in the First Trimester / 대한주산의학회잡지

OBJECTIVE: The study was carried out to assess whether a sudden rise in the serum CA 125 level might predict spontaneous abortion in the first trimester. In the process, we assessed the clinical value of maternal CA 125 in patients with missed abortion and evaluate the prognostic significance of CA 125 in early normal pregnancies, threatened abortions. The purpose of this study was to prospectively compare serum CA 125 levels among women who abort in the first trimester, who experience threateneda bortion and who go through normal pregnancy. METHODS: Between March 2001 and September 2001, a total of 133 patients were observed in the Department of Obstetrics and Gynecology at CHA Hospital. Fifty-eight with missed abortions, forty-five with threatened abortions and thirty normal pregnancies (no history of endometriosis or ovarian mass) were evaluated during gestational age 6 to 12 weeks and maternal serum samples were collected. All patients were sonographically assessed and CA 125 values were compared. RESULTS: There was no statistically significant difference in the CA 125 levels between the spontaneous aborted patients and the patients without abortion: missed abortion, 72.9 +/- 102.0IU/ml (range 7.3-487.6); threatened abortion, 46.6 +/- 37.9IU/ml (range 13.9-206.1); normal pregnancy, 63.4 +/- 61.2IU/ml (range 13.8-62.8). CONCLUSION: Our study shows that serum CA 125 levels are not predictive of spontaneous abortion in the first trimester and failed to discriminate among missed abortions, threatened abortions, and normal pregnancies.

Twin Gestations with a Single Anomalous Fetus / 대한산부인과학회잡지

OBJECTIVE: To evaluate of the perinatal outcome of twin gestations complicated by a single anomalous fetus. METHODS: The study included all patients with twin gestations diagnosed with a major fetal anomaly in one fetus in the second trimester during 1997-2000. Twins with anomalies in both fetuses and minor anomalies were excluded. From a total of 717 twin deliveries, there were 24 twin pregnancies with single anomalous fetus observed in Department of Obstetrics and Gynecology, CHA Hospital. Outcomes assessed included gestational age at diagnosis and delivery, antenatal complications, type of anomalies and perinatal mortality rate. RESULTS: The incidence of single anomalous fetus with twin pregnancies was 3.3% in the study population. There were 24 twin pregnancies with one anomalous fetus, and their median gestational age at delivery was 35+3 weeks (range 27-39). The incidence of preterm delivery was 54.2% (13/24) and growth restriction and respiratory distress syndrome of the normal sibling were 12.5% (8/24) and 8.3% (2/24), respectively. Eight cases (33.3%) of preterm deliveries, 3 cases (12.5%) of severe preeclampsia were noted and 2 cases (8.3%) of the pregnancies were complicated with both conditions. Regarding the type of anomalies, chromosomal anomalies and central nervous system (CNS) anomalies were the most common with 5 cases (20.8%) each. Perinatal outcomes of the normal twin and the anomalous twin were compared. There were 2 cases (8.3%) of neonatal death in the normal twin compared with 9 cases (37.5%) of intrauterine death, 9 cases (37.5%) of neonatal death in the abnormal twin. CONCLUSION: Our study shows that the presence of a major anomaly in one fetus in a twin gestation significantly increased the risk of preterm delivery and risk of intrauterine fetal death and neonatal death rate in anomalous fetus. This information may provide useful information for counseling patients about their options when faced in dilemma.