OBJECTIVE: This exploratory study was undertaken to analyze the anxiety of parents of prenatally diagnosed fetal congenital disease and satisfaction after the multidisciplinary counseling. METHODS: The study included 32 prospective parents of antenatally diagnosed congenital disease fetus who received multidisciplinary counseling at The Catholic Congenital Disease Center (CCDC) for the period from May, 2009 through March, 2010. The Korean version of the Spielberger State-Trait Anxiety Inventory (STAI) was utilized to assess parental anxiety. Categories of satisfaction survey were classified into accessibility, professionalism, empathy, recoverability, satisfaction, and expectation after counseling. RESULTS: The mean time and number of medical professionals for each counseling were 58.0+/-36.9 min and 3.5+/-1.1 persons. Most common congenital diseases were cardiovascular (36.1%) and urogenital diseases (25.0%). STAI scores were significantly decreased after than before counseling (43.5+/-5.9 vs 36.9+/-6.0, P=0.0007). STAI scores after counseling showed significant decrease in prospective mothers who were nulliparous (P=0.0005), less than 35 years old (P=0.0014), had religion (P=0.0014) and counseled more than 40 minutes (P=0.0027). The mean rate of positive satisfactory response about multidisciplinary counseling was 85.6% in satisfaction survey. CONCLUSION: This study provides evidence of the positive impact on the prospective parental anxiety of a multidisciplinary counseling in prenatal management of fetal congenital diseases.
Anxiety ; Counseling ; Empathy ; Fetus ; Humans ; Mothers ; Parents ; Prospective Studies

OBJECTIVE: This study was to evaluate the safety of cesarean delivery through transplacental incision in anterior placenta previa and its effect on mother and neonate. METHODS: We examined 74 cases of placenta previa retrospectively who underwent cesarean section from May 2006 to December 2009, in Chungbuk National University Hospital. They were divided into two groups according to the placental incision. Transplacental incision was made in all cases of anterior placenta previa. We compared postoperative maternal hemoglobin change, neonatal hemoglobin and hematocrit, intra and/or postoperative transfusion volume, neonatal intensive care unit (NICU) admission days between the two groups. RESULTS: There were no differences in maternal characteristics, hemoglobin changes, transfusion volume between the two groups. Nor the neonatal hemoglobin and hematocrit level, Apgar score and admission days were different. There was no neonatal acidosis below pH 7.20. CONCLUSION: The cesarean delivery through transplacental incision in anterior placenta previa seems to be safe because it did not increase maternal and fetal blood loss nor NICU admission days.
Acidosis ; Apgar Score ; Cesarean Section ; Female ; Fetal Blood ; Hematocrit ; Hemoglobins ; Humans ; Hydrogen-Ion Concentration ; Infant, Newborn ; Intensive Care, Neonatal ; Mothers ; Placenta ; Placenta Previa ; Pregnancy ; Retrospective Studies

OBJECTIVE: The aim of this study was to investigate the effect of gestational weight gain on pregnancy outcome in twin pregnancies according to prepregnancy body mass index (BMI), on the basis of 2009 Institute of Medicine (IOM) recommendations. METHODS: One hundred ninety-eight twin pregnancy women and their 396 neonates who delivered in Yonsei University Health System from January 1st, 2005 to April 30th, 2010. Maternal height, maternal weight in prepregnancy and gestational weight gain were retrospectively reviewed. Women were grouped into four categories of BMI: underweight (<18.5 kg/m2), normal weight (18.5~24.9 kg/m2), overweight (25~29.9 kg/m2) and obese (> or =30 kg/m2). Gestational weight gain was categorized as "Less" if it was below the IOM's recommended range for the woman's prepregnancy BMI, "Within" if it was within the range, and "More" if it was above the range. RESULTS: Underweight with "Less" or "Within" maternal weight gain groups were associated with significantly increased odds for small for gestational age ("Less", odds ratio [OR] 6.5, confidence interval [CI] 1.75~24.14; "Within", OR 3.55, CI 1.37~9.14) and "More" weight gain with overweight or obesity groups were associated with significantly increased odds for large for gestational age (overweight, OR 6.25, CI 1.14~34.32; obesity, OR 8.33, CI 1.14~47.93). Overweight or obese women and excessive gestational weight gain were associated with significantly increased odds of pregnancy induced hypertension (overweight: OR 7.04, CI 1.04~47.78, obesity: OR 10.56, CI 1.32~84.14) and gestational diabetes mellitus (overweight: OR 13.2, CI 1.78~97.74, obesity: OR 19.8, CI 2.29~171.02). CONCLUSION: Overweight or obese women with excessive gestational weight gain were associated with significantly increased risk of adverse pregnancy outcome in twin pregnancies. Therefore, physician should pay attention not only to prepregnancy BMI but also to maternal weight gain. A large prospective study is necessary to confirm the relationships between gestational weight gain and pregnancy outcome in twin pregnancies.
Body Mass Index ; Diabetes, Gestational ; Female ; Gestational Age ; Humans ; Hypertension, Pregnancy-Induced ; Infant, Newborn ; Institute of Medicine (U.S.) ; Obesity ; Odds Ratio ; Overweight ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Twin ; Retrospective Studies ; Thinness ; Weight Gain

OBJECTIVE: The purpose of this study is to compare the pregnancy outcomes of gestational diabetes mellitus (GDM) class A1 to those of GDM A2. METHODS: We performed a retrospective analysis of 99 women who were diagnosed as GDM during prenatal care and managed until delivery from March 1996 to September 2007. Subjects were grouped into GDM class A1 and class A2. The obstetric and neonatal outcomes were compared between the two groups. RESULTS: There were 57 cases of GDM class A1 and 42 cases of GDM class A2. Hemoglobin A1c level of GDM A2 group was significantly higher than GDM A1 group. We could not find any significant difference in obstetric (body mass index, hypertensive disorder, preterm delivery, preterm labor, preterm premature rupture of membrane) and neonatal outcomes (gestational age at delivery, macrosomia, shoulder dystocia, respiratory distress syndrome, transient tachypnea of neonate, sepsis, Apgar score, congenital anomaly) between the two groups other than increased frequency of cesarean delivery and admission to neonatal intensive care unit in GDM A2 group. CONCLUSION: After proper management, overall pregnancy outcomes of women with GDM class A2 are comparable to those with GDM class A1.
Apgar Score ; Diabetes, Gestational ; Dystocia ; Female ; Hemoglobins ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Outcome ; Prenatal Care ; Retrospective Studies ; Rupture ; Sepsis ; Shoulder ; Tachypnea

The International Federation of Gynecology and Obstetrics (FIGO) has reported annually for the development and changes of gynecologic cancer classification and staging since 1958. FIGO staging systems in gynecologic malignancies has been reflected on prognostic factors in predicting patients' outcomes and organized patients into several groups. The aim of the FIGO staging system is to afford a classification of gynecologic cancer and to share treatment methods with others. The FIGO staging systems have been updated several times every 3 years according to the latest data, which is responsive and adaptive to scientific development including imaging and treatment modalities. In 2008, the FIGO staging system for carcinoma of the cervix, endometrium, vulva, and uterine sarcomas was revised. After applying the revised staging system in clinical setting, it is need to consider and review problems. As a result, we must make up for the weak points in staging systems continuously.
Cervix Uteri ; Endometrium ; Female ; Gynecology ; Humans ; Obstetrics ; Sarcoma ; Vulva

Pelvic actinomycosis is well-known to be associated with the longstanding use of intrauterine devices, sometimes related with a pregnancy history and an obstetric and/or gynecologic surgery. It can extend to the retroperitoneum and may also be associated with ureteral obstruction. In this case, pelvic actinomycosis in the form of bilateral tubo-ovarian abscess extending to the retroperitoneum resulting in bilateral hydronephrosis occurred in a nulligravida woman who had only few prior sexual intercourses. Apparently, pelvic actinomycosis can occur without any specific history. Moreover, such could possibly give rise to hydronephrosis by direct extension to the retroperitoneum.
Abscess ; Actinomycosis ; Female ; Gynecologic Surgical Procedures ; Humans ; Hydronephrosis ; Intrauterine Devices ; Reproductive History ; Ureteral Obstruction

Acardiac twin is a rare anomaly that occurs 1% in monochorionic twins and 1 in 35,000 pregnancies overall. Acardiac twin, also known as twin-reversed arterial perfusion (TRAP) sequence, involves a "pump" or donor twin perfusing a recipient or "acardiac" twin through vascular (usually arterial-arterial and venous-venous) anastomoses. Perinatal mortality rate for the pump twin has been reported to be 50~75%, mainly as a result of polyhydramnios, preterm labor, and congestive heart failure. Therefore, occlusion of the circulation to the acardiac twin has been recommended to improve perinatal outcome of the pump twin. Radiofrequency ablation of the acardiac twin effectively protects the pump twin from high-output cardiac failure and death. We report our experience in the treatment of patients with TRAP sequence using radio frequency ablation to stop perfusion to the acardiac twin.
Female ; Fetus ; Heart Failure ; Humans ; Obstetric Labor, Premature ; Perfusion ; Perinatal Mortality ; Polyhydramnios ; Pregnancy ; Pregnancy, Twin ; Tissue Donors ; Umbilical Cord

A 24-year-old woman, gravida 1, para 0, was referred to our hospital at 14 weeks of gestation due to suspected twin pregnancy with hydatidiform mole and coexisting fetuses. The present pregnancy was achieved following in vitro fertilization and embryo transfer (IVF-ET). Ultrasound examinations at 14 weeks 3 days of gestation revealed a live fetus appropriate for assigned gestational age with a normal-looking placenta and a dead fetus with an additional echogenic mass resembling molar placenta. The patient was planned to take amniocentesis for chromosomal analysis. However, regular uterine contraction was developed and spontaneous expulsion was occurred at 14 weeks 4 days of gestation. Chromosomal analysis of twin pregnancy using normal and molar placental tissues revealed normal karyotype with 46,XY, 46,XX, respectively. Follow-up showed no progression to persistent gestational trophoblastic disease. We present a twin pregnancy with diploid partial hydatidiform mole and coexisting fetuses that occurred following IVF-ET, which was aborted spontaneously.
Amniocentesis ; Diploidy ; Embryo Transfer ; Embryonic Structures ; Female ; Fertilization in Vitro ; Fetus ; Follow-Up Studies ; Gestational Age ; Gestational Trophoblastic Disease ; Humans ; Hydatidiform Mole ; Karyotype ; Molar ; Placenta ; Pregnancy ; Pregnancy, Twin ; Uterine Contraction ; Young Adult

Thromobotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS), characterized by microangiopathic hemolytic anemia, thrombocytopenia, fever, central nervous system abnormalities, and renal dysfunction, is severe multisystem disorder. TTP-HUS occurs predominantly in the reproductive aged-women, associated with poor prognosis. Although the morbidity and mortality have been significantly decreased by using plasma exchange therapy, refractory TTP-HUS remains a tremendous problem. It is crucial to differentiate other microangiopathic hemolytic anemia disease with a confusing presentation and to perform the immediate plasmapheresis. We have experienced three cases, which were initially diagnosed as HELLP syndrome or immune thrombocytopenic purpura. Despite of aggressive plasmapheresis, two women died. We present these cases with a review of the literature on pregnancy-associated thrombotic microangiopathy, including ADAMTS-13 activity assay as a new diagnostic test.
Anemia, Hemolytic ; Central Nervous System ; Diagnostic Tests, Routine ; Female ; Fever ; HELLP Syndrome ; Humans ; Plasma Exchange ; Plasmapheresis ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Prognosis ; Purpura, Thrombocytopenic, Idiopathic ; Purpura, Thrombotic Thrombocytopenic ; Thrombocytopenia ; Thrombotic Microangiopathies

Acute fatty liver of pregnancy are relatively rare but extremely dangerous, because they may quickly develop into a fulminant disease and become a serious life-threatening disorder for mother and fetus in the third trimester. Therefore, early diagnosis, prompt delivery and intensive supportive care the cornerstones in the management of acute fatty liver of pregnancy. Clinical findings in acute fatty liver of pregnancy vary because it may occur with varying degrees of clinical severity and in conjunction with other third trimester symptoms, making early diagnosis difficult. However, careful history and physical examination, in conjunction with compatible laboratory and imaging results, are often sufficient to make the diagnosis, and liver biopsy is rarely indicated. We have experienced a case of acute fatty liver of pregnancy presenting as early hepatic encephalopathy, renal failure which developed during the third trimester. We diagnosed acute fatty liver of pregnancy based on clinical presentation and laboratory abnormalities. Despite of prompt delivery and adequate supportive care management, this severe complication of pregnancy has had an adverse outcome for mother.
Biopsy ; Early Diagnosis ; Fatty Liver ; Female ; Fetus ; Hepatic Encephalopathy ; Humans ; Liver ; Mothers ; Physical Examination ; Pregnancy ; Pregnancy Complications ; Pregnancy Trimester, Third ; Renal Insufficiency