Cesarean scar pregnancy is one of the rarest forms of etopic pregnancy. We reported here the case of a 30 year old woman who had a previous preterm delivery with a dead newborn, one live birth with cesarean section and twice MVA after cesarean section. She was presented an with 8-week gestational pregnancy. Diagnosis of cesarean scar pregnancy was made by abdominal and intravaginal ultrasound. We used oocyte retrieval needle to aspirate the gestational sac under ultrasound guidance. The patient was given 4 shots of methotrexate with a dosage of 50mg every other day. Beta HCG level was monitored every 3 days during hospitalization and weekly afterward. It was found that the beta HCG levels normalized after 6 weeks and the woman\u2019s condition was stable. This case showed that the combination of ultrasound-guided gestational sac aspiration and methotrexate injection was successful in management of cesarean scar pregnancy.
Cesarean scar pregnancy ; Gestational reduction

OBJECTIVE: To compare the pregnancy outcomes of transvaginal multifetal pregnancy reduction (MFPR) according to the gestational period when the procedure was performed METHODS: From January l995 to February 1998, total 27 patients with multiple pregnancy were included in this study. The patients were grouped to early MFPR group (<8 weeks, n=16) and delayed MFPR group (>8 weeks, n=ll) according to the gestational age that MFPRs were performed. All MFPRs were performed by transvaginal sonography-guided fetal aspiration or mechanical trauma. The complete pregnancy loss rate before 24 weeks of gestation, spontaneous loss of embryo, procedure-related complication, gestational age at delivery, and pregnancy complication were compared between the two groups. Statistical analysis of data was performed using Students t-test and Fishers exact test as appropriate. Statistical significance was defined as p<0.05. RESULTS: There was no significant difference in the complete pregnancy loss rate between the early MFPR group (6.3%) and the delayed MFPR group (27.3%). The incidence of partial spontaneous loss of embryo in the two groups were not differed significantly (6.3% vs. 18.2%). The procedure-related complication of the delayed MFPR group (36.4%) seemed to be higher than that of the early MFPR group (6.3%), however there was no statistical difference (p=0, 07). Especially, all 3 patients in whom the MFPR was performed after 10 weeks suffered from the procedure-related complication. The mean gestational age at delivery of the two groups were not differed significantly (36.3+2.8 weeks vs. 37.0+1.3 weeks). There was also no significant difference in the mean birth weights of the two groups (2378.8+563.7 gm vs. 2427.1+436.2 gm). CONCLUSION: Although there was no statistically significant difference, the early transvaginal MFPR might be a safe and useful method without significant adverse complications compared to the delayed MFPR.
Birth Weight ; Embryonic Structures ; Female ; Gestational Age ; Humans ; Incidence ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Pregnancy Reduction, Multifetal* ; Pregnancy, Multiple

OBJECTIVE: To identify the factors affecting the complete fetal loss following multifetal pregnancy reduction (MFPR). DESiGN: Retrospective clinical study. METHODS: A total of 256 consecutive treatments of MFPR in iVF-ET cycles performed between 1992 through 2000 in Samsung Cheil hospital were analyzed. MFPR was done around 8 weeks of gestation by transvaginal ultrasono-guided aspiration in multiple pregnancies and reduced to singleton or twins. Stepwise logistic regression was performed to identify the factors affecting the final outcome of pregnancy after MFPR. Dependent variable was complete fetal loss and the independent variables were maternal age, paternal age, initial number of gestational sac (iGSNO), initial number of fetal heart beat, the number of remaining live fetus after MFPR, and chorionicity. RESULTS: The total survival rate was 87.9%, and total fetal loss rate after MFPR was 12.1%. Total fetal loss occurred within four weeks from MFPR procedure was 1.95%. Total loss occurred after four weeks of procedure and before 24 gestational weeks was 8.2%. Seventy nine percent (202/256) of pregnancies delivered after 34 weeks of gestation. The survival rate of pregnancies reduced to singleton was significantly higher than that of pregnancies reduced to twins (93.5% vs. 86.7%, p<0.05). The mean (+/-SEM) gestational age at delivery was 36.2+/-1.0 and 34.1+/-0.5 weeks for pregnancies reduced to singletons and twins, respectively (p=0.065). Logistic regression analysis revealed that the maternal age, the number of initial gestational sac (iGSNO), and the number of remaining live fetus after MFPR significantly affected the rate of total fetal loss (Z = 0.174'age + 0.596'iGSNO + 1.324'remaining fetuses-12.07), (p<0.05). CONCLUSiONS: MFPR seems to be a relatively safe and efficient method to improve the obstetric outcome in high order multiple pregnancy. Because the maternal age, the number of initial gestational sac and the remaining live fetuses after MFPR affect the total fetal loss rate, restriction of the number of transferred embryos according to the age and MFPR to singleton fetus could be considered for the better obstetric outcome in iVF pregnancy.
Chorion ; Embryonic Structures ; Female ; Fetal Heart ; Fetus ; Gestational Age ; Gestational Sac ; Humans ; Logistic Models ; Maternal Age ; Paternal Age ; Pregnancy ; Pregnancy Reduction, Multifetal* ; Pregnancy, Multiple ; Retrospective Studies ; Survival Rate

OBJECTIVES: To evaluate the safety and efficacy of selective fetal reduction (SFR) and compare the outcome of twin pregnancy after SFR in multiple pregnancy induced by assisted reproductive technology (ART) with that of natural twin pregnancy. METHODS: From September 1995 to March 2002 in Ajou University Hospital, SFR was performed in 79 patients whose gestational sacs were more than 3. Of these 79 patients, 47 patents resulted in twin pregnancy after SFR. SFR was performed using transvaginal intracardiac KCl injection at gestational age of 6~9 weeks. Control group was composed of 264 patients with natural twin pregnancy, who delivered after intrauterine pregnancy at 24 weeks, from June 1994 through December 2002. We compared Obstetric and perinatal outcomes between SFR group and natural twin group. RESULTS: Among 47 patients with twin pregnancy after SFR, 2 spontaneous abortion were occurred at intrauterine pregnancy at 8 and 19 weeks. Obstetrical and perinatal outcomes were available in 43 patients. Single intrauterine fetal death was occurred in 1 of 43 (2.3%) patients in SFR group. incidence of preterm labor, premature rupture of membrane, preeclampsia and placenta previa were similar, but gestational diabetes mellitus (GDM) was occurred more frequently in SFR group (3 (7.0%) vs 4 (1.5%), p=0.02). Mean gestational age, mean birth weight, incidence of discordancy, use of intubation and ventilation, incidence of fetal anomaly, low (<7) Apgar score and intrauterine growth restriction were similar in both groups. CONCLUSION: Twin pregnancy after SFR has the increased incidence for GDM but other obstetric and perinatal outcome was similar compared with natural twin pregnancy. So SFR is a safe and effective procedure, so we suggest SFR is needed in multifetal pregnancy more than triplet.
Abortion, Spontaneous ; Apgar Score ; Birth Weight ; Diabetes, Gestational ; Female ; Fetal Death ; Gestational Age ; Gestational Sac ; Humans ; Incidence ; Intubation ; Membranes ; Obstetric Labor, Premature ; Placenta Previa ; Pre-Eclampsia ; Pregnancy ; Pregnancy Reduction, Multifetal* ; Pregnancy, Multiple ; Pregnancy, Twin* ; Reproductive Techniques, Assisted ; Rupture ; Triplets ; Ventilation

OBJECTIVE: To investigate the perinatal outcome and complications of reduced twin pregnancies from triplet by multifetal pregnancy reduction (MFPR) in patients who underwent in vitro fertilization and embryo transfer. MATERIALS AND METHODS: From January 1995 to December 1999, a total of 71 twin pregnancies were included in this study. The patients were grouped into the MFPR group (n = 19) and the non-MFPR group (n = 59). The pregnancies in the MFPR group were reduced to twin from triplet by the MFPR. MFPR was performed by transvaginal sonography-guided fetal aspiration or mechanical trauma. The obstetric and perinatal outcomes were compared between the two groups. Statistical analysis was performed using Student's t-test, Fisher's exact test, and kappa2 test as appropriate. Statistical significance was defined as p < 0.05. RESULTS: There were no significant differences in mean gestational age and distribution of gestational age between the two groups. However, the fetal loss rate before 24 weeks of gestation was significantly higher in the MFPR group than the non-MFPR group. We did not find any significant differences in mean birth weight and weight discordancy between the two groups. There were no differences in obstetric and perinatal outcomes between the MFPR and non MFPR groups as well. CONCLUSIONS: These data suggest that pregnancy outcome of reduced twin pregnancies from triplet by MFPR in patients underwent IVF-ET might be comparable to that of non-reduced twin pregnancies.
Birth Weight ; Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization in Vitro* ; Gestational Age ; Humans ; Pregnancy ; Pregnancy Outcome ; Pregnancy Reduction, Multifetal* ; Pregnancy, Twin* ; Triplets*

OBJECTIVETo evaluate the antioxidant activity of astragalus and its therapeutic effect on gestational diabetes.

METHODSEighty-four pregnant women with gestational diabetes were divided into insulin and insulin plus astragalus groups after regular dietary control and insulin treatment to maintain stable blood glucose level. The 43 patients in insulin group received insulin injection, whereas the 41 patients in the other group received treatment with both insulin and astragalus. The SOD activity, MDA level, blood lipids and renal function were determined in both groups after the treatments.

RESULTSThe patients with both insulin and astragalus treatments showed significantly increased serum SOD activity and decreased MDA level, renal function and blood lipids in comparison with those with exclusive insulin treatment.

CONCLUSIONAstragalus can effectively control blood glucose, reduce the free radicals, and promote the antioxidative activity, and may play a role in the prevention and treatment of gestational diabetes.

Antioxidants ; metabolism ; Astragalus Plant ; Diabetes, Gestational ; drug therapy ; metabolism ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Malondialdehyde ; metabolism ; Oxidation-Reduction ; Phytotherapy ; Pregnancy ; Superoxide Dismutase ; metabolism ; Treatment Outcome

Twin reverse arterial perfusion sequence occurs in approximately one percent of monochorionic twins. This condition is always fatal for the recipient twin and carries a high mortality rate for the pump twin. Various treatment options are described, but management is continually evolving with the publication of new data. We report an acardiac acephalic monochorionic twin who was diagnosed at 31 weeks gestation. Serial ultrasonographical examinations of the normal pump twin showed intrauterine growth restriction but with no evidence of heart failure. A healthy pump twin was delivered by caesarean section at 34 weeks.
Abnormalities, Multiple ; diagnostic imaging ; Cesarean Section ; Female ; Fetofetal Transfusion ; diagnostic imaging ; Follow-Up Studies ; Gestational Age ; Heart Defects, Congenital ; diagnostic imaging ; Humans ; Infant, Newborn ; Pregnancy ; Pregnancy Outcome ; Pregnancy Reduction, Multifetal ; methods ; Pregnancy, Multiple ; Twins, Monozygotic ; Ultrasonography, Prenatal

Multifetal pregnancy reduction(MFPR) appears to be an efficacious method for impro-ving the perinatal outcome of high order multifetal pregnancies(three or more fetuses). But it is controversial that larger initial fetal number before MFPR affects pregnancy outcomes adversely. The purpose of this study is to determine the affects of the initial fetal numbers on pregnancy outcomes and to compare the obstetrical outcomes according to the initial fe-tal numbers. Eighty four patients who conceived triplet or more by assisted reproductive technology(ART) in our infertility clinics and underwent MFPR to twins between January 1993 and December 1995. Sixteen patients were lost follow-up. Among the remaining 68 patients, four pateints were excluded from this study because of the pregnancy loss before 20 weeks gestation. The patients(n=64) were divided into three groups by the initial fetal number before reduction. 33 patients with triplet gestations(group 1), 18 patients with qua-druplets gestations(group 2), and 13 patients with quintuplet or more gestations(group 3) were retrospectively enrolled. Gestational age at delivery and birthweights were compared according to the initial fetal numbers. The mean maternal age was similar in each three groups. The results were as follows : 1) Although there was a trend of decreasing gestati-onal weeks at delivery and decreased birthweight in each groups(mean+/-SEM : 36.9+/-0.3, 34.7+/-1.3, 32.7+/-1.9 and 2,600+/-58, 2,161+/-215, 1,855+/-249 respectively), there were no stati-stical difference between group 1 and group 2, but there were significantly lower in group 3, compared with group1(p < 0.05). 2) The incidence of birth before 36 weeks gestation in each group 1, group 2, and group 3 were 12.1%, 38.9%, and 53.8% respectively(p < 0.05). 3) The incidence of low birthweight( < 2,500gm) in each group 1, group 2, and group 3 were 30.3%, 55.6%, and 69.2% respectively(p < 0.05). In conclusion, although MFPR reduced the high order multifetal pregnancy into twin pregnancy, the duration of gestation and the birth weight of newborn were still had a tendency of shortening and low respectively in high order multifetal pregnancy. Therefore strict control of the number of dominant follicles during superovulation and the number of transfered embryo in in vitro fertilization(IVF) is required for improving the pregnancy outcomes in ART.
Birth Weight ; Embryonic Structures ; Female ; Fertilization in Vitro ; Follow-Up Studies ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infertility ; Maternal Age ; Parturition ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Twin ; Quintuplets ; Reproductive Techniques, Assisted ; Retrospective Studies ; Superovulation ; Triplets