Background: Retained products of conception can be troublesome complications following miscarriages. Ultrasound has a significant impact in their diagnosis and with the advent of color doppler sonography can improve the assessment. Objective: The goal of this study was to evaluate the use of grayscale combined with color Doppler ultrasound findings and correlate with histopathology in predicting retained products of conception in a maternity hospital. Methods: This was a cross sectional prospective study of 109 patients who underwent transvaginal grayscale ultrasound with color Doppler to evaluate the presence of retained products of conception. Resistance index(RI) is measured in Pulsed doppler to assess the impedance of blood flow. The standard criterion was the histopathologic reports obtained during completion curettage. Results: Histopathologic results validated the presence of immature placental tissues in 93 (85%) patients and decidua in 16 (15%). Endometrial mass was greater with positive histopath results (p<0.05). Endometrial mass had a sensitivity of 83.9% in detecting retained products of conception. Thickened endometrium was detected in 71.4 % of women with positive histopath results, but only in 28.6% with negative histopath results. Color flow was confirmed in 85% with positive histopathology results. Conclusion The combination of an endometrial mass with vascular pattern had the highest positive predictive value in determining retained products of conception.
Abortion, Spontaneous ; Decidua ; Ultrasonography, Doppler, Color

PURPOSE: The aim of this study was to evaluate whether the presence of an intrauterine hematoma (IUH) on an early pregnancy ultrasound scan showing a live fetus was related to adverse perinatal outcomes. METHODS: We performed a retrospective cohort study to evaluate pregnant women who underwent an ultrasound examination in early pregnancy, between 6 weeks 0 days and 10 weeks 6 days. We compared the perinatal outcomes between women with and without firsttrimester IUH using the Mann-Whitney and Fisher exact tests. Furthermore, we performed a stepwise regression analysis to identify possible predictors of miscarriage among maternal characteristics, ultrasound parameters, and IUH. RESULTS: During the study period, data from 783 pregnancies were included, and the incidence of IUH was 4.5% (35 of 783). We observed a higher proportion of miscarriage following the scan (28.6% vs. 10%, P=0.003) and a larger yolk sac diameter during the scan (4.8 mm vs. 3.8 mm, P < 0.001) in the pregnant women with first-trimester IUH. There was no significant difference regard the prevalence of low birth weight (LBW; P=0.091), very LBW (P=0.370), or extremely LBW (P=0.600) between cases with IUH and without IUH, the cesarean section rate (68% vs. 81%, P=0.130), preterm delivery (16% vs. 16%, P>0.999), or the incidence of first-trimester vaginal bleeding (31% vs. 20%, P=0.130). Moreover, heart rate (HR) was the only variable that predicted miscarriage with statistical significance (P=0.017). CONCLUSION: Women with first-trimester IUH had a higher risk of miscarriage after the ultrasound scan. HR was the only variable that predicted miscarriage with statistical significance.
Abortion, Spontaneous ; Cesarean Section ; Cohort Studies ; Female ; Fetus ; Heart Rate ; Hematoma* ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Pregnancy ; Pregnancy Complications ; Pregnancy Trimester, First ; Pregnant Women ; Prevalence ; Retrospective Studies ; Ultrasonography ; Uterine Hemorrhage ; Yolk Sac

OBJECTIVE: This study was conducted to determine the effectiveness and safety of medical treatment with sublingual misoprostol (MS) in the 1st trimester miscarriage under the approval by Health Insurance Review and Assessment Service (HIRA) for off-label usage by the single medical center in Korea. METHODS: A retrospective cohort study was performed in one institution between April 2013 and June 2016. Ninety-one patients diagnosed with miscarriage before 14 weeks of gestation and wanted to try medical treatment were included. A detailed ultrasound scan was performed to confirm the diagnosis. Patients took 600 microgram (mcg) of MS sublingually at initial dose, and repeated the same dose 4–6 hours apart. Successful medical abortion was defined as spontaneous expulsion of gestational products (including gestational sac, embryo, fetus, and placenta). If gestational products were not expelled, surgical evacuation was performed at least 24 hours later from the initial dose. Information about side effects was obtained by medical records. RESULTS: About two-thirds of patients had a successful outcome. The median interval time from pill to expulsion was 18 hours in the successful medical treatment group. There was no serious systemic side effect or massive vaginal bleeding. Presence or absence of vaginal spotting before diagnosis of miscarriage, uterine leiomyomas, subchorionic hematoma, or distorted shape of gestational sac on ultrasound scan were not statistically different between the two groups. CONCLUSION: Medical treatment with sublingual MS can be a proper option for the 1st trimester miscarriage, especially for the patient who want to avoid surgical procedure. We can reduce the unnecessary sedation or surgical intervention in the patients with the 1st trimester miscarriage.
Abortion, Incomplete ; Abortion, Missed ; Abortion, Spontaneous* ; Administration, Sublingual ; Cohort Studies ; Diagnosis ; Embryonic Structures ; Female ; Fetus ; Gestational Sac ; Hematoma ; Humans ; Insurance, Health ; Korea* ; Leiomyoma ; Medical Records ; Metrorrhagia ; Misoprostol* ; Off-Label Use* ; Pregnancy ; Retrospective Studies ; Ultrasonography ; Uterine Hemorrhage

OBJECTIVETo explore the value of multiplex ligation-dependent probe amplification (MLPA) for the detection of chromosome abnormalities in miscarriage tissues, and to correlate the result with ultrasound findings.

METHODSA total of 421 cases of spontaneous abortions and fetal deaths were detected with the MLPA method.

RESULTSAmong the 421 samples, 232 (55.11%) had an abnormal MLPA result. For the 286 cases derived from < 13 weeks pregnancy, 206 (72.03%) were abnormal. For the 49 cases from 14-19 weeks pregnancy, 14 (28.57%) were abnormal. For the 86 cases derived after 20 weeks pregnancy, 12 (13.95%) were abnormal. Among the 117 cases with abnormal ultrasound findings, 33 cases (28.21%) had an abnormal MLPA result, 28 out of the 33 cases were numerical chromosome abnormality, 4 cases were chromosome microdeletion and/or micro duplication, 1 case had both numerical abnormality and microduplication. For those with abnormal ultrasound findings for the neck region, fetal edematous syndrome, multiple malformations and digestive system, the detection rates for MLPA were 71.4%, 58.8%, 37.8%, and 9.1%, respectively. For those with abnormal finding of cardiac system, nervous system, face, skeletal system and urinary system, none was found with positive results of MLPA.

CONCLUSIONNumerical chromosomal abnormalities account for the majority of cases with spontaneous abortion. With the increase of gestational age, the occurrence of chromosomal abnormalities gradually declines. Combined ultrasound and MLPA assay can improve the detection rate and accuracy for chromosomal abormalities.

Abortion, Spontaneous ; diagnostic imaging ; genetics ; Chromosome Deletion ; Chromosome Disorders ; diagnostic imaging ; genetics ; Chromosome Duplication ; DNA ; analysis ; Female ; Fetal Diseases ; diagnostic imaging ; genetics ; Gestational Age ; Humans ; Multiplex Polymerase Chain Reaction ; methods ; Pregnancy ; Reproducibility of Results ; Sensitivity and Specificity ; Telomere ; genetics ; Ultrasonography, Prenatal ; methods

OBJECTIVE: To investigate whether natural killer (NK) cell and autoimmune antibody acts synergistically, by the action of autoantibodies to increase NK cell number and cytotoxicity, to decrease uterine blood flow during early pregnancy in pregnant women with a history of recurrent spontaneous abortion (RSA). METHODS: Seventy-five pregnant women (between 5 and 7 weeks gestation) with a history of unexplained RSA were included in the study group. Forty-one pregnant women without a history of RSA were included as controls. All women with a history of RSA were tested for autoantibodies and number of peripheral blood natural killer (pbNK) cell by flow cytometry. Study populations were stratified into four groups by existence of autoantibody and degree of increase of pbNK cells. The uterine radial artery resistance index (RI) was measured by color-pulsed Doppler transvaginal ultrasound. RESULTS: The mean RI of the autoimmune antibody-positive (AA+) group (0.63+/-0.09) was significantly higher than that of the normal control group (0.53+/-0.10, P=0.001). The mean RI of the AA+/only-NK elevated (eNK) group (0.63+/-0.09) was significantly higher than those of the only-AA+ group (0.55+/-0.07, P=0.019) and the only-eNK group (0.57+/-0.07, P=0.021). CONCLUSION: Concurrent elevation in NK cells and autoimmunity results in decreased uterine blood flow during early pregnancy. However, the majority of cases of RSA remain unexplained and larger scale studies are needed to confirm our conclusion and to develop diagnostic and therapeutic plans for women with a history of RSA.
Abortion, Spontaneous ; Autoantibodies ; Autoimmunity* ; Female ; Flow Cytometry ; Humans ; Killer Cells, Natural* ; Pregnancy* ; Pregnant Women ; Radial Artery ; Ultrasonography

OBJECTIVE: To evaluate the relationship between increased nuchal translucency (NT) and abnormal pregnancy outcomes. METHODS: From January 1999 to December 2001, The 298 fetuses of increased nuchal translucency (>or=2.5 mm) in period of 10-14 weeks gestation were reviewed retrospectively. Amniocentesis and high resolution ultrasonography during second trimester were done for all cases. We analyzed septation within NT, karyotypes, structural anomalies, and adverse pregnancy outcomes such as spontaneous abortion, intrauterine fetal death and preterm delivery. RESULTS: The mean age of the patients was 30.5 +/- 3.5 years. The mean gestational age and CRL were 12.5 +/- 0.95 weeks and 6.5 +/- 1.15 mm. We observed 18 (6%) cases of abnormal karyotypes. 7/46 (15.2%) fetuses with internal septation had abnormal karyotype and 11/252 (4.4%) fetuses without internal septation had abnormal karyotype (p=0.013). Among the 280 fetuses with normal karyotype, 8 (2.8%) fetuses had structural anomalies and 18 (6.4%) fetuses had adverse pregnancy outcomes. The chromosomal abnormality and structural anomaly were significantly increased in the group of nuchal translucency thickness above 3.5 mm (p=0.001). CONCLUSION: Increased nuchal translucency is related with chromosomal abnormality and abnormal pregnancy outcomes.
Abnormal Karyotype ; Abortion, Spontaneous ; Amniocentesis ; Chromosome Aberrations ; Female ; Fetal Death ; Fetus ; Gestational Age ; Humans ; Karyotype ; Nuchal Translucency Measurement* ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second ; Retrospective Studies ; Ultrasonography

Ovarian torsion is the fifth most common condition in gynecologic surgical emergencies, with an incidence of 2.7% occuring mainly in women of reproductive age. It is an uncommon but well recognized complication of ovarian stimulation, especially when ovarian hyperstimulation syndrome occurs. Patients with ovarian torsion normally present with an acute abdomen, necessitating an exploratory laparotomy, with removal of the organ when necrosis is evident. Ultrasound may suggest the diagnosis of adnexal torsion. If the ovarian tumor is a luteal cyst, it is also standard to administer progesterone after surgical treatment, although how efficient this treatment is in preventing miscarriage is questionable. A documented case of adnexal torsion associated with in vitro fertilization is hyperstimulated enlarged corpus luteal cyst. Emergency left salpingo-oophorectomy was done and have concluded a successful pregnancy after exogenous progesterone support. We report a case of enlarged corpus luteal cyst torsion in early pregnancy with a brief review of literatures.
Abdomen, Acute ; Abortion, Spontaneous ; Diagnosis ; Emergencies ; Female ; Fertilization in Vitro* ; Humans ; Incidence ; Laparotomy ; Necrosis ; Ovarian Hyperstimulation Syndrome ; Ovulation Induction ; Pregnancy* ; Progesterone ; Ultrasonography

BACKGROUND: Clinical manifestations and complications of measles are more severe in adults than children. But, there has been few clinical and epidemiologic data about adult measles in Korea. OBJECTIVE: We investigated clinical features, laboratory findings, disease courses and complications and discussed the reason why measles incidence has been increasing recently in young adults to find out the solutions to prevent measles. METHOD: From April 1999 to February 2001, we examined prodromal symptoms, skin rash, complications, routine CBC, and blood chemistry of 42 adults who were admitted in KangBuk SamSung Hospital for measles and performed qualitative serum measles specific IgM and IgG antibody test using ELISA method. RESULTS: Age distribution of most adult measle patients was between 15 and 25 years old(78.6%). Fever was found in all patients and cough, coryza, headache, myalgia, conjunctivitis, sore throat, nausea, diarrhea, and vomit were found in decreasing order of frequency. Skin rashes were started from the face and spread to trunk, arms and then legs in 37 patients out of 42. Five patients had skin rash in the face and trunk at the same time, and one had hemorrhagic rash. Koplik's spots were found in 26 patients (62%). Among them, 2 had Koplik's spots before the rash and 24 had Koplik's spots with the rash simultaneously or thereafter. Koplik's spots were disappeared as skin rash disappeared. Exfoliative dermatitis was found following the skin rash in one patient. Among 26 patients who performed qualitiative serum measles specific IgM and IgG antibody test using ELISA, the seropositivity of measles specific IgM was 70%, of measles specific IgG was 27%, and of both measles specific IgM and IgG was 12%. Complications were like this; hepatitis in 23, cervical lympadenitis in 20, laryngitis and bronchitis in 7, otitis media in 4, pneumonia on chest X-ray in 3, hepatosplenomegaly on upper abdomen ultrasonography in 5. Two patients were in pregnancy of 12 and 16 weeks, and the former had spontaneous abortion. Pnemonia and otitis media were recovered within average 5 days after administrating antibiotics and antipyretics.
Abdomen ; Abortion, Spontaneous ; Adult* ; Age Distribution ; Anti-Bacterial Agents ; Antipyretics ; Arm ; Bronchitis ; Chemistry ; Child ; Conjunctivitis ; Cough ; Dermatitis, Exfoliative ; Diarrhea ; Enzyme-Linked Immunosorbent Assay ; Epidemiologic Studies* ; Exanthema ; Female ; Fever ; Headache ; Hepatitis ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Incidence ; Korea ; Laryngitis ; Leg ; Measles* ; Myalgia ; Nausea ; Otitis Media ; Pharyngitis ; Pneumonia ; Pregnancy ; Prodromal Symptoms ; Thorax ; Ultrasonography ; Young Adult

BACKGROUND: Clinical manifestations and complications of measles are more severe in adults than children. But, there has been few clinical and epidemiologic data about adult measles in Korea. OBJECTIVE: We investigated clinical features, laboratory findings, disease courses and complications and discussed the reason why measles incidence has been increasing recently in young adults to find out the solutions to prevent measles. METHOD: From April 1999 to February 2001, we examined prodromal symptoms, skin rash, complications, routine CBC, and blood chemistry of 42 adults who were admitted in KangBuk SamSung Hospital for measles and performed qualitative serum measles specific IgM and IgG antibody test using ELISA method. RESULTS: Age distribution of most adult measle patients was between 15 and 25 years old(78.6%). Fever was found in all patients and cough, coryza, headache, myalgia, conjunctivitis, sore throat, nausea, diarrhea, and vomit were found in decreasing order of frequency. Skin rashes were started from the face and spread to trunk, arms and then legs in 37 patients out of 42. Five patients had skin rash in the face and trunk at the same time, and one had hemorrhagic rash. Koplik's spots were found in 26 patients (62%). Among them, 2 had Koplik's spots before the rash and 24 had Koplik's spots with the rash simultaneously or thereafter. Koplik's spots were disappeared as skin rash disappeared. Exfoliative dermatitis was found following the skin rash in one patient. Among 26 patients who performed qualitiative serum measles specific IgM and IgG antibody test using ELISA, the seropositivity of measles specific IgM was 70%, of measles specific IgG was 27%, and of both measles specific IgM and IgG was 12%. Complications were like this; hepatitis in 23, cervical lympadenitis in 20, laryngitis and bronchitis in 7, otitis media in 4, pneumonia on chest X-ray in 3, hepatosplenomegaly on upper abdomen ultrasonography in 5. Two patients were in pregnancy of 12 and 16 weeks, and the former had spontaneous abortion. Pnemonia and otitis media were recovered within average 5 days after administrating antibiotics and antipyretics.
Abdomen ; Abortion, Spontaneous ; Adult* ; Age Distribution ; Anti-Bacterial Agents ; Antipyretics ; Arm ; Bronchitis ; Chemistry ; Child ; Conjunctivitis ; Cough ; Dermatitis, Exfoliative ; Diarrhea ; Enzyme-Linked Immunosorbent Assay ; Epidemiologic Studies* ; Exanthema ; Female ; Fever ; Headache ; Hepatitis ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Incidence ; Korea ; Laryngitis ; Leg ; Measles* ; Myalgia ; Nausea ; Otitis Media ; Pharyngitis ; Pneumonia ; Pregnancy ; Prodromal Symptoms ; Thorax ; Ultrasonography ; Young Adult

OBJECTIVE: To evaluate the clinicopathologic features and clinical outcomes of adnexal tumors in pregnancy. METHODS: After review of charts of 51 patients managed at Kyungpook National University Hospital from January 1996 to June 2002, data including clinical findings, treatments and outcomes were analyzed. RESULTS: The mean age of pregnant women with adnexal tumors was 28.5 years old and the adnexal tumors were more common in nulliparous pregnant women (74.5%) than parous those. There were asymptomatic or no signs in 40 cases (78.4%), lower abdominal pain in 9 cases (17.6%), vaginal bleeding in 1 case (2.0%) and palpable mass by patient herself in 1 case (2.0%). The surgical treatments were performed at first trimester in 9 cases (19.1%), second trimester in 31 cases (66.0%) and third trimester in 7 cases (14.9%). Postoperative histopathologic diagnoses of adnexal tumors were 22 cases (43.1%) of benign cystic teratoma, 7 cases (13.8%) of functional cyst, 6 cases (11.8%) of serous cystadenoma, 4 cases (7.8%) of mucinous cystadenoma, 4 cases (7.8%) of endometrioma, 3 cases (5.9%) of parovarian cyst and 4 cases (7.8%) of malignancy including 2 cases of mucinous cystadenocarcinoma and 2 cases of mucinous tumor, borderline. The complication resulting from adnexal tumors was torsion of 6 cases (11.8%). The outcome of pregnancy was available in 30 cases, term delivery in 25 cases (83.3%), preterm delivery in 3 cases (10%) and spontaneous abortion in 2 cases (6.7%). CONCLUSION: Although the incidence of adnexal tumors with pregnancy is variable according to the reports, the detection rate is more and more increasing due to a widespread application of ultrasound. Thus, obstetricians must always consider adnexal tumors combined with pregnancy and try to minimize the complications of surgery during pregnancy to prevent adverse fetal outcome and maternal morbidity.
Abdominal Pain ; Abortion, Spontaneous ; Cystadenocarcinoma, Mucinous ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Diagnosis ; Endometriosis ; Female ; Gyeongsangbuk-do ; Humans ; Incidence ; Mucins ; Parovarian Cyst ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Pregnancy* ; Pregnant Women ; Teratoma ; Ultrasonography ; Uterine Hemorrhage