Purpose: To compare umbilical arterial gas parameters in the second twin of twin pregnancies according to the mode of delivery Methods: We retrospectively analyzed the medical records of twin deliveries after 34 weeks of gestation for 3 years.Excluding the cases which underwent emergency cesarean delivery during trial of labor, a total of 79 twin gestations had umbilical arterial blood gas values available and were and divided into cesarean delivery group (N=40) and vaginal delivery group (N=39).The mean differences of umbilical arterial blood parameters and the Apgar score between the first and second twin in each pregnancy were compared according the mode of delivery.Results: The differences of umbilical arterial gas parameters between twin siblings showed no significant difference according to the mode of delivery.With regard to the 1 minute and 5 minute Apgar scores, the differences between twin siblings are significantly increased in vaginal delivery group compared to cesarean delivery group (p=0.048, and p=0.038, respectively).In comparing the 28 cases delivered vaginally with an inter-twin delivery interval < 10 minutes and 40 cases delivered by cesarean section, no significant differences were observed in the umbilical arterial gas parameters and Apgar scores. Conclusion:The inter-twin umbilical arterial blood gas parameters according to the mode of delivery showed no difference.For twin deliveries, it is relatively safe to plan for a vaginal delivery, but an effort should be made to reduce the inter-twin delivery interval time.
모체 태아 의학이 발전함에 따라 고위험 임신관리의 중요성이 점점 증가하고 있으나 임신 중 발생한 태아 감염은 현재까지 그 진단과 치료에 있어 아직도 많은 논란이 있다. 임신 중 발생한 태아감염은 주산기 신생아 이환 및 사망의 중요한 원인이며 또한 출생 후 발달에 영향을 미칠 수 있으므로 태아의 선천성 감염을 일으킬 수 있는 고위험군 임신부와 태아를 선별하며 이에 대한 예방을 시행하거나 적절한 치료를 하는 과정이 반드시 필요하다. 저자들은 태아에게 영향을 미칠 수 있는 여러 바이러스 감염증의 최근 경향을 분석해 보고자하며 아직까지 많은 논란의 여지가 있는 선천성 풍진의 감염에 대하여 보다 구체적 정보를 제공하고자 한다. 여러 가지 이유로 인하여 선천성 바이러스 감염에 대한 신중한 진단, 치료, 상담이 이루어지지 못한 경우 임신부와 가족은 태아 이상이나 손실에 대하여 과도한 불안과 걱정을 갖게 되며 이로 인해 자발적으로 임신종결을 시행하는 경우가 있는 데, 이를 예방하기 위해서는 모체 및 태아에 대하여 검사의 적응증, 검사의 적절한 시기, 정확한 검사의 선택 및 결과의 해석을 통하여 정확한 진단을 시행하고 이에 따라 대처하는 것이 바람직한 것으로 사료된다.
The World Health Organization (WHO) international body mass index (BMI) cut-off points defining pre-pregnancy BMI categories in the Institute of Medicine (IOM) guidelines are not directly applicable to Asians. We aimed to define the optimal gestational weight gain (GWG) for the Korean population based on Asia-specific BMI categories.Data from 2702 live singleton deliveries in three tertiary centers between 2010 and 2011 were analyzed retrospectively. A multivariable logistic regression analysis was conducted to determine the lowest aggregated risk of composite perinatal outcomes based on Asia-specific BMI categories. The perinatal outcomes included gestational hypertensive disorder, emergency cesarean section, and fetal size for gestational age. In each BMI category, the GWG value corresponding to the lowest aggregated risk was defined as the optimal GWG.Among the study population, 440 (16.3%) were underweight (BMI < 18.5), 1459 (54.0%) were normal weight (18.5 ≤ BMI < 23), 392 (14.5%) were overweight (23 ≤ BMI < 25) and 411 (15.2%) were obese (BMI ≥ 25). The optimal GWG by Asia-specific BMI category was 20.8 kg (range, 16.7 to 24.7) for underweight, 16.6 kg (11.5 to 21.5) for normal weight, 13.1 kg (8.0 to 17.7) for overweight, and 14.4 kg (7.5 to 21.9) for obese.Considerably higher and wider optimal GWG ranges than recommended by IOM are found in our study in order to avoid adverse perinatal outcomes. Revised IOM recommendations for GWG could be considered for Korean women according to Asian BMI categories. Further prospective studies are needed in order to determine the optimal GWG for the Korean population.
Purpose:The purpose of this retrospective cohort study was to elucidate whether the location of placenta below uterine incision in cesarean section is important in the development of maternal complications in placenta previa patients.Methods: The study was conducted on 409 patients 414 parturition at 3 hospitals in affiliation with the Catholic Medical Center, Seoul, Korea from May 1999 to December 2009.The subjects were divided to two groups: the group whose placenta was located in the anterior portion of the uterus (anterior group) and the group whose placenta was located in the posterior portion of the uterus (posterior group).And then they are compared to each other.Logistic regression was used to control for confounding factors.Results: In the anterior group, regardless of confounding factors, the incidence of excessive blood loss (OR 2.97; 95% CI: 1.64-5.37),massive transfusion (OR 3.31; 95% CI: 1.33-8.26),placental accreta (OR 2.60, 95% CI: 1.40-4.83),and hysterectomy (OR 3.47, 95% CI: 1.39-8.68)was higher.Conclusion: Sonographic determination of the placental position where its location beneath the uterine incision is very important to predict maternal outcomes in placenta previa patients, and such cases, close attention should be paid for massive hemorrhage.
One of the most interesting congenital malformations is a conjoined twin. Conjoined twins are a rare occurrence in obstetric practice. More commonly known as Siamese twins, this phenomenon is shrouded in mystery and considered a curiosity by general public. Current technology is providing a basis for earlier diagnosis and a better prognosis. Frequently, the twins are born dead, but there are a few cases in which the twins survive. We present a case of thoraco-omphalophagus with omphalocele in 35 years old woman at 25weeks 5 days gestation by 3-D ultrasonography and MRI.
목적 : 최근 여러 원인에 의하여 자궁 외 임신의 발생 빈도가 증가하고있다. 이중 특히 난소임신의 경우 아직 명확한 수술 전 진단 기준이 정립되지 못한 상황이다. 임상적 고찰을 통하여 향후 난소임신이 의심되는 경우 진단에 도움을 얻기 위하여 연구를 시작하였다. 연구 방법 : 1991년 1월부터 2002년 12월까지 강남성모병원 산부인과에 입원하여 수술을 시행받았으며 조직 검사상 난소 임신으로 진단된 23명을 연구의 대상으로 하였다. 이들에 대하여 진단시
The aim of this study was to examine the current perinatal outcomes among infants born late-preterm and early-term compared to those born full-term and evaluate the optimal gestational age for delivery.We performed a retrospective cohort study for births occurred at Seoul St. Mary's Hospital over the past 7 years. Statistical comparison was performed using χ2 test and multivariable logistic regression models.A total of 7580 women met the study criteria. Compared to 39 weeks, delivery at late-preterm and early-term had higher risk of composite morbidity, including respiratory morbidities, intracranial hemorrhage (ICH), and admission to neonatal intensive care unit (NICU) (34 weeks adjusted odds ratio [aOR]: 132.54; 95% confidence interval (CI): 74.00-240.10; 37 weeks aOR: 2.14; 95%CI: 1.65-2.77). The risks of sepsis and necrotizing enterocolitis in deliveries before 36 weeks and the risk of feeding difficulty in deliveries before 37 weeks were significantly higher than those of 39 weeks. Neonatal morbidity at deliveries was not significantly different between 38 and 39 weeks.Neonatal morbidities at late-preterm births are significant and surveillance for them seems increasing. Obstetricians should recognize the risk of respiratory morbidity, ICH, and NICU admission for deliveries before 38 weeks' gestation.
The concurrence of lymphoma with pregnancy has been rare but is most commonly associated with an aggressive histology and disseminated disease. Thus, extensive staging is required, and either local radiotherapy or systemic chemotherapy is indicated as soon as possible. We have experienced a case of diffuse, large B-cell lymphoma, stage diagnosed at 31 weeks of gestational age. During pregnancy period, CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy was performed and complete remission of disease was attained. The infant was successfully delivered at 34 weeks in gestation without any gross anomaly or combined disease. We report a case of diffuse large B-cell lymphoma successfully treated with combination chemotherapy during pregnancy and a brief review of the literatures.
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