The incidence of multifetal pregnancies has significantly increased because of progress of assisted reproductive technologies. Preterm delivery is the most common and significant obstetrical problem in multifetal pregnancies. When the first twin of mutifetal pregnancy is prematurely delivered at previable gestational age, the success of delayed interval delivery of the second twin can improve the neonatal outcome for the remaining fetus. The optimal management of delayed interval delivery is not defined. Tocolysis, prophylactic antibiotics, and cervical cerclage are generally used. I present a case of delayed interval delivery in twin pregnancy with an interval of 89 days. The first twin was delivered at 21.3 weeks of gestation and delayed delivery of the second twin was succeeded by conservative treatment without cervical cerclage. This case is the longest interval case in Korea.
Anti-Bacterial Agents ; Cerclage, Cervical ; Fetus ; Gestational Age ; Humans ; Incidence ; Korea ; Pregnancy ; Pregnancy, Twin ; Reproductive Techniques, Assisted ; Tocolysis

Fetal cardiac tumors are a rare condition and are histologically benign. Cardiac rabdomyoma is the most common cardiac tumor and may be associated with tuberous sclerosis. Clinical follow-up including monitoring of fetal well-being is warranted as long as the fetus remains asymptomatic and there is no evidence for hydrops fetalis. If obstruction to blood flow and/or early fetal compromise is noted, then the decision of whether to deliver early must be made. We report a case of fetal cardiac tumor diagnosed by antenatal ultrasonography and diagnosed as tuberous sclerosis with brain MRI scanning after birth.
Brain ; Fetus ; Follow-Up Studies ; Heart Neoplasms ; Hydrops Fetalis ; Magnetic Resonance Imaging ; Parturition ; Rhabdomyoma ; Tuberous Sclerosis

Uterine leiomyomas cause some complications in pregnancy. Most common complication is red degeneration causing acute pelvic pain. Torsion of a uterine leiomyoma is rare but more frequent during pregnancy. It represents emergency surgery to improve symptoms and prevent complications such as consumptive coagulopathy. We have experienced a case of torsion of subserosal leiomyoma during 1st trimester of pregnancy managed using laparotomy and successfully delivered vaginally at fullterm period. So, we report the case with brief review of literatures.
Emergencies ; Laparotomy ; Leiomyoma ; Pelvic Pain ; Pregnancy

Hydatidiform mole with a coexisting fetus is rare, but this condition has recently shown an increased incidence because of assisted reproduction technology. In most of the reported cases, termination at diagnosis was preferred due to poor fetal survival and maternal risk factors such as vaginal bleeding, preeclampsia, hyperthyroidism, potential of malignant change. However, considering the value of pregnancy by assisted reproduction technology, whether to continue or to terminate this condition is a dilemma. Based on currently available information, it seems that it is reasonable to allow the pregnancy to continue in the absence of maternal complications. We report on a case of the complete hydatidiform mole with two coexisting fetuses with a brief reviews of the literature.
Female ; Fetus ; Hydatidiform Mole ; Hyperthyroidism ; Incidence ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Twin ; Reproduction ; Risk Factors ; Uterine Hemorrhage

PURPOSE: Early-onset preeclampsia is thought to be associated with fetal mortality and maternal complications. We compared maternal clinical characteristics, complications, and perinatal outcome between early- and late-onset preeclampsia. METHODS: We analysed retrospectively 212 pregnant women with preeclampsia between 2004 and 2008 at a tertiary university hospital. We divided preeclamptic women as early-onset (n=58), with an onset before 32 weeks gestation, and late-onset (n=154), with an onset after 32 weeks gestation. We compared maternal characteristics, maternal complications, and neonatal outcomes between the two groups. RESULTS: There were no significant differences in maternal age, parity, BMI, previous history of preeclampsia, hypertension, and DM between early- and late-onset preeclampsia. Among the maternal complications, maternal blood pressure was higher in early-onset preeclampsia without any statistical significance, but the amount of 24 hours urine protein was significantly higher in early-onset preeclampsia than late-onset (P=0.003). There were significantly higher rate of visual disturbance, elevated liver enzyme, pulmonary edema and severe disease in early-onset preeclampsia (all P<0.05). Comparing neonatal outcome, there were higher rate of fetal death in uterus (FDIU) (P=0.0001), low Apgar score (P<0.0001), and perinatal death (P<0.0001) in early-onset preeclampsia. Fetal birth weight and onset of preeclampsia were significant covariate factors for perinatal mortality. CONCLUSION: Early-onset preeclampsia was related to poor perinatal and materanl outcomes, but there was no difference in maternal characteristics. Further studies are necessary for prediction, pathogenesis, and therapy of early-onset preeclampsia.
Apgar Score ; Birth Weight ; Blood Pressure ; Female ; Fetal Death ; Fetal Mortality ; Humans ; Hypertension ; Liver ; Maternal Age ; Parity ; Perinatal Mortality ; Pre-Eclampsia ; Pregnancy ; Pregnant Women ; Pulmonary Edema ; Retrospective Studies ; Uterus

PURPOSE: This study was aimed to evaluate the incidence and karyotypes according to chromosome in 13 cases with inversion detected by cytogenetic analysis. METHODS: The incidence of inversion was calculated and karyotypes of inversion were classified according to each chromosome in cases with inversion detected from 390 individuals who had undergone cytogenetic analysis in Hanyang University Hospital from January 2005 to February 2009. RESULTS: The overall incidence of inversions was 3.3% (13/390). All of 13 cases were heterozygotes for inversions. Among these 13 inversions, 12 cases (92.3%) were having pericentric inversions showing karyotypes of 46,XX,inv(9)(p11q13) in 7 cases, 46,XX,inv(9)(p11q12) in 2 cases, and one cases of 46,X, inv(Y)(p11.3q11.23), t(8;9)(q24.3;q34.1), 46,X, del(Y)(q12), inv(Y)(p10q11. 23) and 46,XY, inv(8)(p21q24.1) respectively. Last one case (7.7%) was having paracentric inversion showing a karyotype of 46,XX,inv(9)(q22.1q34.3). Classification according to each chromosome in 13 cases with inversion was that 10 of 13 cases (76.9%) were located in chromosome 9 (9 cases of pericentric inversions and a case of paracentric inversions), 2 of 13 cases (15.4%) in chromosome Y and 1 of 13 cases (7.7%) in chromosome 8. CONCLUSION: Although patients are phenotypically normal, they might be inversion carriers. In high risk patients, inversions are more frequent than normal population. Various types of inversion could be in different chromosomes. Classification of types of inversion are needed for further genetic counseling according to the types.
Chromosomes, Human, Pair 9 ; Cytogenetic Analysis ; Cytogenetics ; Genetic Counseling ; Heterozygote ; Humans ; Incidence ; Karyotype

PURPOSE: With the increasing use of antenatal sonography, fetal hydronephrosis has been reported more frequently. But, despite extensive clinical and scientific research much controversy still exists about the assessment and management of hydronephrosis. We performed a retrospective study to determine the frequency of associated malformations and chromosomal defects in prenatally diagnosed hydronephrosis. METHODS: The records of 297 neonates who were diagnosed with hydronephrosis through antenatal ultrasonographic screening, were retrospectively analyzed. They were confirmed at 3 days to 1 month after birth with postnatal ultrasonography in Busan Paik Hospital, between January 2000 and December 2008. We karyotyped 297 neonates after ultrasonographic examination revealed hydronephrosis and malformations. RESULTS: Chromosomal abnormalities were detected in 31 (11%) cases of 297 cases and more common in female than male. The commonest chromosomal abnormality was trisomy 21, followed by Turner syndrome, deletion of autosome, unbalanced translocation. 127 cases in 109 infants had associated malformations such as urogenital and cardiovascular and gastrointestinal anomalies. The associated malformations were more common in moderate to severe hydronephrosis than mild and the number of additional abnormalities increased with the chromosomal defects. CONCLUSION: Particular attention should be paid for the cases in congenital hydronephrosis with any associated malformation such as urogenital and cardiac malformation, to investigate chromosomal abnormalities. This will enable clinicians to establish appropriate management and postnatal care.
Chromosome Aberrations ; Down Syndrome ; Female ; Humans ; Hydronephrosis ; Infant ; Infant, Newborn ; Male ; Mass Screening ; Parturition ; Postnatal Care ; Retrospective Studies ; Turner Syndrome

PURPOSE: Ibuprofen is a non steroidal anti-inflammatory drug used for treating fever and pain including headache, arthralgia, and back pain. There is scarce information on the safety of ibuprofen associated with fetal anomaly when used early in pregnancy. Epidemiology studies have suggested that use of NSAIDs, including ibuprofen, during pregnancy may increase the risk of cardiac defects and gastroschisis. The aim of the study was to evaluate fetal outcomes among pregnant women who were unintentionally exposed to ibuprofen in early pregnancy. METHODS: Total 381 pregnant women who were unintentionally exposed to ibuprofen during early pregnancy were prospectively followed up. In addition, 643 age and gravity matched pregnant women not exposed to any potential teratogenic agent during pregnancy were recruited as controls. Patients were followed-up until delivery or loss to follow-up. Newborns were examined in order to identify any major congenital malformation. RESULTS: Mean age of exposed women was 31.2+/-3.4 years, with a mean number of previous pregnancies of 2.3+/-1.2 and mean gestational weeks at exposure of 4.4+/-2.2. All gestations were confirmed by ultrasonography. Of exposed women, 17 (5.6%) had spontaneous abortions, 16 were on- going pregnancies, 1 had an intra-uterine fetal death, 21 artificial abortion and 55 cases were lost to follow-up. Therefore, 271 pregnancies unintentionally exposed to ibuprofen were evaluated, each delivering a singleton baby. Three babies had congenital anomalies: one had unilateral hydronephrosis, another baby was born with a unilateral inguinal hernia. The last baby was born with unilateral kidney dysplasia with megaureter. In the control group, 6 babies were born with major malformations [1.11% vs. 1.31% (P=0.552, OR: 0.841, 95% CI: 0.2 to 3.4)]. CONCLUSION: These preliminary results suggest that the ibuprofen may not be a major human teratogen.
Abortion, Spontaneous ; Anti-Inflammatory Agents, Non-Steroidal ; Arthralgia ; Back Pain ; Female ; Fetal Death ; Fever ; Follow-Up Studies ; Gastroschisis ; Gravitation ; Headache ; Hernia, Inguinal ; Humans ; Hydronephrosis ; Ibuprofen ; Infant, Newborn ; Kidney ; Lost to Follow-Up ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, First ; Pregnant Women ; Prospective Studies

PURPOSE: This study was undertaken to investigate the spectrum and the prognosis of neonate with cardiovascular malformation delivered from diabetic mothers. METHODS: From January 2004 to December 2008, 70 neonates born to diabetic mothers who were delivered at Dongsan Medical Center, Keimyung University, and received echocardiographic study between 3rd and 14th days of life to identify the presence of cardiac anomaly were included. Cases combined with chromosomal anomaly were excluded. And follow up results (rate of cardiac operation and mortality) were assessed. RESULTS: Among 67 neonates, 22 cases (32.8%) had combined cardiovascular malformation. They were interventricular septal hypertrophy (10 cases), atrial septal defect (7 cases), significant patent ductus arteriosus (5 cases), ventricular septal defect (2 cases) and tetralogy of Fallot (1 case). Among them, 20 neonates (29.9%) were preterm babies, and 21 neonates (31.3%) were large babies. On follow up echocardiograpic examination between 2 and 12 months of life, all but 2 infants (received cardiac operation due to VSD or Tetralogy of Fallot) was improved spontaneously. And combined extracardiac anomalies were tracheoesophageal fistula (2 cases), imperforated anus (1 case) and corpus callosum agenesis (1 case). Only one preterm baby was dead due to necrotizing enterocolitis, but did not have cardiac disease. CONCLUSION: Pre-existing maternal diabetes was associated with the development of neonatal cardiac anomalies, but the prognosis was good in this study.
Agenesis of Corpus Callosum ; Anal Canal ; Ductus Arteriosus, Patent ; Echocardiography ; Enterocolitis, Necrotizing ; Follow-Up Studies ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Hypertrophy ; Infant ; Infant, Newborn ; Mothers ; Prognosis ; Tetralogy of Fallot ; Tracheoesophageal Fistula

PURPOSE: To determine the means, medians and reference intervals for TSH (thyroid-stimulating hormone) and fT4 (free thyroxine) for each month of gestation and for three trimesters in Korean pregnant women. METHODS: Serum samples were collected from 265 pregnant women with singleton gestation. Levels of TSH, fT4 were measured by immunoassay. After exclusion of subjects with positive antimicrosomal autoantibodies, the means, medians and reference intervals based on 2.5th and 97.5th percentiles for TSH, fT4 were determined. RESULTS: The study population consisted of 94 women in first trimester, 49 women in second trimester, and 122 women in third trimester. The trimester-specific reference intervals were: TSH (1st trimester: 0.03~2.72, 2nd: 0.27~2.29, and 3rd: 0.03~2.88 mIU/L), fT4 (1st trimester 4.50~19.75, 2nd: 4.70~12.98 and 3rd: 5.07~11.84 pg/mL). fT4 levels were significantly lower in the second and third trimesters. TSH levels were lower in the first trimester than second and third trimester, with gradual elevation in the second and third trimester. CONCLUSION: Levels of TSH, fT4 during pregnancy differ from those in non-pregnant women. Gestational age specific reference intervals will play a cental role in screening and diagnosis of thyroid disorders. Further studies for normal reference ranges during pregnancy are needed to create reference intervals in Korean pregnant women.
Autoantibodies ; Female ; Gestational Age ; Humans ; Immunoassay ; Mass Screening ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Pregnant Women ; Reference Values ; Thyroid Function Tests ; Thyroid Gland ; Thyrotropin