Small bowel obstruction is an unusual complication of pregnancy, but it is associated with high fetal and maternal mortality. Diagnosis is often delayed due to confusion over symptoms by both the patient and physicians, because symptoms such as colicky abdominal pain, vomiting and constipation are all common at various stages of pregnancy. If is small bowel obstruction of gravid patient suspected, prompt abdominal radiological evaluation and surgical intervention to reduce both maternal and fetal mortality are warranted. We report a recently report a recently experienced case of small bowel obstruction with brief review of literatures.
Abdominal Pain ; Constipation ; Fetal Mortality ; Humans ; Maternal Mortality ; Pregnancy ; Vomiting

Uterine prolapse with pregnancy is rare condition. The overall incidence is 1/10000- 15000 deliveries. The complications from uterine prolapse range from minor cervical ulceration and infection to fetal death or uterine rupture. The fetal mortality was as high as 22% mainly due to prematurity, respiratory infection. The management of this condition is focused on preventing late occurrence of prolapse during pregnancy and continued reduction. We present a case of uterine prolapse in pregnancy with a brief review of the literature.
Fetal Death ; Fetal Mortality ; Incidence ; Pregnancy* ; Prolapse ; Ulcer ; Uterine Prolapse* ; Uterine Rupture

The monitoring of fetal heart rate (FHR) status is an important method to check well-being of the baby during labor. Since the electronic FHR monitoring was introduced 40 years ago, it has been expected to be an innovative screening test to detect fetuses who are becoming hypoxic and who may benefit from cesarean delivery or operative vaginal delivery. However, several randomized controlled trials have failed to prove that electronic FHR monitoring had any benefit of reducing the perinatal mortality and morbidity. Also it is now clear that the FHR monitoring had high intra- and interobserver disagreements and increased the rate of cesarean delivery. Despite such limitations, the FHR monitoring is still one of the most important obstetric procedures in clinical practice, and the cardiotocogram is the most-used equipment. To supplement cardiotocogram, new methods of computerized FHR analysis and electrocardiogram have been developed, and several clinical researches have been currently performed. Computerized equipment makes us to analyze beat-to-beat variability and short term heart rate patterns. Furthermore, researches about multiparameters of FHR variability will be ongoing.
Cardiotocography ; Electrocardiography ; Female ; Fetal Heart* ; Fetus ; Heart Rate ; Heart Rate, Fetal* ; Mass Screening ; Perinatal Mortality ; Pregnancy

Spontaneous umbilical cord hematoma is a rare cause of fetal distress and intrauterine fetal death. The perinatal mortality rate approaches 50%. Various causes of the cord hematoma have been suggested as congenital abnormalities, short cord, trauma, cord around neck, torsion, syphilis, or postmature pregnancy. We have experienced one case of the fetal distress from umbilical cord hematoma, which is presented with a brief review of the literatures.
Congenital Abnormalities ; Fetal Death ; Fetal Distress* ; Hematoma* ; Neck ; Perinatal Mortality ; Pregnancy ; Syphilis ; Umbilical Cord*

OBJECTIVES: This study is aimed to quantify the complex dynamics of beat-to-beat fetal heart rate(FHR) fluctuations by using approximate entropy(ApEn) which is a recently developed mathematical formula quantifying regularity and also to determine the differences between normal fetuses and growth retarded fetuses. BACKGROUND: Recently, some measures of heart rate variability and nonlinear "complexity" of heart rate dynamics have been used as indicators fetal well-being. Approximate entropy is a new mathematical approach and formula to quantify regularity in data. It has been shown to provide new information in fetal heart rate analysis. Because growth retarded fetus accounts for a significant increase in perinatal morbidity and mortality, than normal fetus, we postulated that there existed important differences between normal fetuses and growth retarded fetuses. METHODS: We analyzed FHR tracings for 40 minutes, and approximately 5,000 points in normal fetuses(n=315) and growth retarded fetuses(n=76). The overall "complexity" of each FHR time series was quantified by its approximate entropy, measure of regularity derived from nonlinear dynamics, "chaos theory". RESULTS: Mean baseline FHR increased in growth retarded fetuses than normal fetuses. And the FHR ApEn significantly decreased in growth retarded fetuses(ApEn=0.623) compared to that of the normal fetuses(ApEn=0.868) throughout all gestational ages(p < 0.001). CONCLUSIONS: The ApEn of FHR decreased in growth retarded fetuses throughout all gestational ages. These findings indicated that decreased ApEn values of FHR are associated with sickness and the greater perinatal morbidity risks. Therefore ApEn quantifies subtle changes in FHR regularity and promises for new information in FHR analysis.
Entropy* ; Female ; Fetal Heart* ; Fetus* ; Gestational Age ; Heart Rate ; Heart Rate, Fetal* ; Mortality ; Nonlinear Dynamics ; Pregnancy

Currently, the rate of cesarean sections being performed in Korea is approximately 40%, with Korea ranking 4th among the Organization for Economic Co-operation and Development countries with respect to cesarean deliveries. Breech presentation at term is an important indication for cesarean section among other factors, including medicolegal concerns and pregnancies in women of advanced maternal age. Term breech presentation is associated with a higher fetal mortality rate than that associated with a cephalic presentation. Therefore, in Korea, most of these women deliver by cesarean section to avoid the complications of vaginal breech delivery. However, cesarean section is itself associated with considerable obstetric morbidity and sometimes, mortality. External cephalic version (ECV) is a useful method to reduce the cesarean section rate in women with breech presentation and therefore to reduce the incidence of breech presentation at delivery. Studies have shown that routine use of ECV reduces the cesarean section rate by approximately two-thirds in term pregnancies with breech presentation. ECV is accepted as a safe, efficacious, and cost-effective method and is recommended by both the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynecologists in all pregnancies with term breech presentation, if not contraindicated. In Korea, although most clinicians are aware of the option of ECV, their relative lack of experience in performing the procedure and fear of complications render them hesitant to perform ECV. This review is aimed at guiding obstetricians by describing the efficacy, safety concerns, and technical aspects of this procedure.
Breech Presentation ; Cardiotocography ; Cesarean Section ; Female ; Fetal Mortality ; Humans ; Incidence ; Korea ; Maternal Age ; Methods ; Mortality ; Pregnancy ; Version, Fetal

Monoamniotic twin pregnancies are relatively rare, occuring in 1 percentage. But perinatal mortality is 50-60 percentage. The high mortality rate has been attributed to preterm delivery, cord entanglement, twin-to-twin transfusion syndrome, intrauterine growth retardation and congenital anomalies. However, the desirable management plan of the monoamniotic twin pregnancies is still not established and there are controversies regarding the proper antepartum care of monoamniotic twins and the optimal timing and mode of delivery. We have experienced one case of monoamniotic twin without cord entanglement and both fetuses survival by cesarean section at 36+3 weeks, is reported with a brief review of the literatures.
Cesarean Section ; Female ; Fetal Growth Retardation ; Fetofetal Transfusion ; Fetus* ; Humans ; Mortality ; Perinatal Mortality ; Pregnancy ; Pregnancy, Twin*

PURPOSE: The purpose of this study was to construct a fetal animal model of congenital diaphragmatic hernia in a lamb under domestic environments. METHODS: Left-sided diaphragmatic hernias were created in seven fetal lambs at about 85 days' gestation (experimental group). Three other fetal lambs did not receive any surgical procedure and served as control group. Four of these lambs (3 in the experimental group and 1 in the control group) were delivered after a sufficient intrauterine period. The morphological changes of lung development were compared between the two groups. RESULTS: Creation of diaphragmatic hernia resulted in marked hypoplasia in fetal lung development. In this experiment, the maternal mortality was 33.3%, and the fetal mortality was 60% which are relatively high as compared with previous reports. CONCLUSION: From this data, the authors concluded that experimental fetal diaphragmatic hernia can be established although the technique for the measurement of gestational age, anesthesia and postoperative care should be improved to overcome domestic inexperience in using the lamb as an experimental animal.
Anesthesia ; Animals ; Fetal Mortality ; Gestational Age ; Hernia, Diaphragmatic* ; Lung ; Maternal Mortality ; Models, Animal ; Postoperative Care ; Pregnancy

OBJECTIVE: Perinatal mortality rates were higher in postdate than in term pregnancies. Previous study showed the risk to be greater in postterm newborns weighing less than 2500 grams at birth. This study is designed to examine the effect of gestational age and fetal growth restriction (FGR) on the perinatal mortalities of the postterm pregnancies. METHODS: Maternal and perinatal database of Yonsei University Medical Center from 1961 to 1990 was reviewed. After excluding pregnancies with known medical or obstetrical complications, we compared perinatal mortality rates of 39,631 singleton pregnancies delivered between 37 weeks and 44 weeks of gestational age according to the birthweight percentile. Birth weight percentile were grouped as FGR1 (<5 percentile), FGR2 (5-10 percentile), and adequate for gestational age (AGA) (>10 percentile). Mortalities were compared using Chi-square statistics. RESULTS: Mean birth weight increased up to 42 weeks of gestation. Perinatal mortalities increased after 42 weeks of gestation. FGR1 group showed higher perinatal mortality rate compared with AGA group at 41 weeks of gestation (135/8, p<0.01). At 42 weeks of gestation, both FGR1 and FGR2 showed increased perinatal mortality rates (130/10 p<0.01, 56/10 p<0.01). Among AGA group, mortality increase was not obvious up to 42 weeks of gestation. CONCLUSION: Fetal growth restriction was a major cause of increased perinatal mortalities in postterm pregnancies.
Academic Medical Centers ; Birth Weight ; Fetal Development* ; Gestational Age ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Mortality ; Parturition ; Perinatal Mortality* ; Pregnancy*

PURPOSE: Intrauterine growth retardatation(IUGR) is very important because of high mortality and morbidity in the neonatal period. We studied the intrauterine growth retardation pattern in neonates with congenital heart disease(CHD). METHODS: One hundred seventeen cases with CHD(acyanotic, 73 cases; cyanotic, 44 cases) who had no other congenital malformation or maternal diseases that might affect fetal growth were enrolled in this study along with 120 control cases without CHD. We analyzed birth weight, crown-heel length and neonatal ponderal index. RESULTS:The proportion of IUGR infants was 17 out of 237 cases(7.2%). Compared to a normal control group(5/120, 4.2%), the CHD group had more IUGR(12/117, 10.3%)(P=0.006). Low birth weight(LBW) was higher in the CHD group(26/117, 22.2% vs 15/120, 12.5%; P=0.048). Among the CHD group, acyanotic CHD had often more than cyanotic CHD(21/73, 28.8% vs 5/44, 11.4%; P= 0.028). The proportion of IUGR among the LBW was 12 out of 41 cases(16.3%) in total. But, there were no significant difference in the proportion of IUGR among the LBW(10/26, 38.5% vs 2/15, 13.3 %; P=0.089), the proportion of IUGR among the prematurity(3/25, 12.0% vs 2/25, 8.0%; P=0.637) and abnormal neonatal ponderal index(5/12, vs 3/5; P=0.490). The proportion of short crown-heel length was high in the CHD group(7/117, 6.0% vs 1/120, 0.8%; P=0.028). CONCLUSION: Neonates with CHD had greater incidence of LBW, short crown-heel length and IUGR compared to normal neonates. Moreover, symmetrical IUGR was more common in IUGR neonates with CHD. Therefore, intrauterine development might be more influenced by intrinsic fetal factors than hemodynamic alteration of the circulation in CHD with IUGR.
Birth Weight ; Fetal Development ; Fetal Growth Retardation ; Heart ; Heart Defects, Congenital* ; Hemodynamics ; Humans ; Incidence ; Infant ; Infant, Newborn* ; Mortality ; Parturition