We report a case of transient abnormal myelopoiesis in a Down syndrome fetus diagnosed at 28(+3) weeks of gestation that rapidly progressed to intrauterine death 10 days later. Fetal hepatosplenomegaly with cerebral ventriculomegaly, although not specific, may be a suggestive finding of Down syndrome with transient abnormal myelopoiesis. Prompt fetal blood sampling for liver function test and chromosomal analysis are mandatory for early detection and management.
Adult ; Down Syndrome/*ultrasonography ; Female ; Fetal Blood/cytology ; Fetal Death ; Fetal Diseases/*diagnosis ; Hepatomegaly/ultrasonography ; Humans ; Leukocytosis/diagnosis ; *Myelopoiesis ; Pregnancy ; *Prenatal Diagnosis ; Splenomegaly/ultrasonography ; Thrombocytopenia/diagnosis

OBJECTIVE: The aim of this study is to predict spontaneous labor onset delivery within 7 days in low risk pregnant women at 38 weeks' of gestation by ultrasonographic examination of cervical changes. MATERIAL AND METHODS: This prospective study included 110 singleton low risk pregnancies between 37(+0) and 37(+6) weeks of gestation. Fifteen cases were lost during follow-up and finally 95 pregnant women (58 nulliparous, 37 multiparous) were analysed. The study period was from Oct/2005 to May/2007. Four cervical changes (length, gland thickness, funneling and canal formation) were evaluated. Main outcome was remaining day to delivery after the examination. Remaining days to actual delivery with spontaneous labor onset were recorded and the pregnancies were divided into two groups according to remaining days (within 7 days, over 7 days) to compare predicting power of delivery within 7 days. ROC curves were drawn to find out cut-off values of cervical length and gland thickness. Sensitivity, specificity, positive predictive value and negative predictive value were extracted from four cervical changes. RESULTS: Mean cervical length of pregnant women at 38 weeks' of gestation was 25.8 (+/-10.0) mm and mean cervical gland thickness was 4.3 (+/-1.2) mm. Funnelings of uterine cervix were detected in 13 cases (13.7%), canal formations in 6 cases (6.3%). All four cervical changes were statistically valuable to predict delivery within 7 days and the cervical length showed highest sensitivity. When the cervical length was measured under 20 mm, the possibility of delivery within 7 days was 78.6% (p<0.001). The cervical gland thickness less than 4 mm could predict the delivery within 7 days with sensitivity of 57.1% (p<0.01). Sensitivities of funneling and canal formation for delivery within 7 days were 54.5%, 36.4% each. CONCLUSION: Ultrasonographic examination of the cervical changes in low risk singleton pregnancy at 38 weeks' of gestation are valuable for predicting spontaneous labor onset delivery within 7 days. Among four cervical changes, cervical length is most sensitive ultrasonographic marker.
Cervix Uteri ; Female ; Follow-Up Studies ; Humans ; Labor Onset ; Parturition* ; Pregnancy* ; Pregnant Women ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity

OBJECTIVE: The aim of this study was to evaluate the role of lower uterine segment thickness in predicting an actual delivery date and to determine the factors affecting the depth of lower uterine segment. METHODS: Sixty patients with singleton gestation were weekly measured for their lower uterine segment (LUS), cervical length, cervical gland thickness and AFI by ultrasonography from 36 weeks. The regression analysis was carried to find out the relevance between LUS and the remaining days to birth and Pearson correlation analysis was performed for relevance between LUS and other factors such as maternal age, parity, cervical length, cervical gland thickness, and AFI. RESULTS: LUS became thin as cervical length decreasing. However, the relevance between LUS and other factors such as age, parity, cervical gland thickness, and AFI was not found. While individual LUS thickness is decreasing as delivery date becomes closer, LUS thickness as a group is found not to be related with the delivery date. CONCLUSION: In term pregnancy, LUS thickness decreases with cervical change but it cannot predict the delivery date.
Female ; Humans ; Maternal Age ; Parity ; Parturition ; Pregnancy* ; Ultrasonography

No abstract available.
Down Syndrome*

Hyperreactio luteinalis is a rare disease characterized by marked cystic enlargement of the ovary due to multiple benign theca lutein cyst. The cause of this disease is not well known but is believed to be induced by high serum levels of human chorionic gonadotropins (hCG). It occurs usually in gestational trophoblastic disease, multiple pregnancies, and rarely in normal pregnancy. In nature, hyperreactio luteinalis is a benign condition. Therefore, the appropriate management is conservative, but surgical intervention is definitely indicated to remove infarcted tissue, control hemorrhage, or decrease androgen production in virilized patients. Here we report a case of hyperreactio luteinalis which was diagnosed at 11 weeks gestation. Lower abdominal pain was developed and progressed. Emergent right wedge oophorectomy and left salpingoophorectomy was performed due to probable torsion of left ovarian cyst and the pregnancy maintained. Theca lutein cysts were confirmed on pathologic examination.
Abdominal Pain ; Chorionic Gonadotropin ; Female ; Gestational Trophoblastic Disease ; Hemorrhage ; Humans ; Lutein ; Ovarian Cysts ; Ovariectomy ; Ovary ; Pregnancy* ; Pregnancy, Multiple ; Rare Diseases

Choledochal cyst is a cystic or fusiform dilatation of the extra- or intrahepatic bile duct that has rarely been reported in prenatal cases. Here we report a fetus with choledochal cyst diagnosed prenatally by three-dimensional (3-D) ultrasonography at 22 weeks of gestation. We demonstrated an image of choledochal cyst by using a new ultrasound technique, a 3-D multislice view. After close intrauterine followup, surgery was successfully performed and postoperative course was uneventful.
Anastomosis, Roux-en-Y ; Cholangiography/methods ; Choledochal Cyst/*diagnosis/*ultrasonography ; Female ; Fetal Diseases/*diagnosis/*ultrasonography ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Infant ; Male ; Pregnancy ; Pregnancy Trimester, Second ; Prenatal Diagnosis ; Treatment Outcome ; Ultrasonography, Prenatal/*methods

OBJECTIVE: The objective of this study is to determine whether the club foot of the affected fetus is related to the location, size, and rupture state of the spinal neural tube defect lesion. METHODS: Ultrasound and medical records of 21 fetuses with spinal neural tube defect were reviewed. At the time of diagnosis 7 fetuses had clubfoot and 14 fetuses didn't have. All the fetuses with spinal neural tube defect were divided into two groups, one with clubfoot fetuses, and the others without clubfoot. RESULTS: The mean lesion size of the clubfoot group was significantly larger than normal foot group (4.1+/-1.22 cm vs 2.1+/-1.59 cm). And the level of lesion is significantly higher in club foot group. But the rate of sac rupture is lower in club foot group. CONCLUSION: The fetuses with clubfoot detected at the time of diagnosis had larger size and higher level of lesion.
Clubfoot ; Diagnosis ; Fetus* ; Foot* ; Medical Records ; Neural Tube Defects* ; Neural Tube* ; Rupture ; Ultrasonography ; Ultrasonography, Prenatal*

Background/Aims: Endoscopic submucosal dissection (ESD) is the first-line treatment for superficial gastrointestinal neoplasms with negligible lymph node metastasis. It has evolved through improvements in expertise and equipment, increased understanding of indications and short- and long-term outcomes, and better management of complications. This study aimed to assess and characterize the most influential publications in ESD research. Materials and Methods: We searched the top 50 most cited articles using Web of Science Core Collection (WoSCC) and Google Scholar (GS) from the inception of these services to January 2019. The top 50 Altmetric Attention Score (AAS) articles based on online media mentions were also searched. Each article was evaluated for the number of citations, title, journal, and publication year. Results: The number of citations for the top 50 WoSCC articles on ESD ranged from 37 to 199; Endoscopy published the most articles (20%). Among the top 50 GS articles, Gastrointestinal Endoscopy published the most ESD articles (34%) and the most shared AAS articles (42.6%). PubMed Central article citations in WoSCC or GS showed significant correlation with those from each metric, unlike AAS. The words with the highest relevance scores were “submucosal tunnel dissection,” “guideline,” “novel submucosal gel,” “adhesive material,” “cell sheet,” “esophageal ulcer,” “hemospray,” and “endoscopic closure,” while the following words were influential: “meta-analysis,” “esophageal stricture,” “perforation,” “bleeding,” “fibrin glue,” “artificial ulcer,” “porcine model” and “esophageal squamous cell neoplasia,” excluding “ESD.” Conclusions This study presents a detailed list of influential articles, journals, and topic words.

Background/Aims: Endoscopic submucosal dissection (ESD) is the first-line treatment for superficial gastrointestinal neoplasms with negligible lymph node metastasis. It has evolved through improvements in expertise and equipment, increased understanding of indications and short- and long-term outcomes, and better management of complications. This study aimed to assess and characterize the most influential publications in ESD research. Materials and Methods: We searched the top 50 most cited articles using Web of Science Core Collection (WoSCC) and Google Scholar (GS) from the inception of these services to January 2019. The top 50 Altmetric Attention Score (AAS) articles based on online media mentions were also searched. Each article was evaluated for the number of citations, title, journal, and publication year. Results: The number of citations for the top 50 WoSCC articles on ESD ranged from 37 to 199; Endoscopy published the most articles (20%). Among the top 50 GS articles, Gastrointestinal Endoscopy published the most ESD articles (34%) and the most shared AAS articles (42.6%). PubMed Central article citations in WoSCC or GS showed significant correlation with those from each metric, unlike AAS. The words with the highest relevance scores were “submucosal tunnel dissection,” “guideline,” “novel submucosal gel,” “adhesive material,” “cell sheet,” “esophageal ulcer,” “hemospray,” and “endoscopic closure,” while the following words were influential: “meta-analysis,” “esophageal stricture,” “perforation,” “bleeding,” “fibrin glue,” “artificial ulcer,” “porcine model” and “esophageal squamous cell neoplasia,” excluding “ESD.” Conclusions This study presents a detailed list of influential articles, journals, and topic words.

Traditionally postpartum hemorrhage is a bleeding more than 500 ml that occurs immediately after the placenta is delivered. It remains one of the most common causes of maternal mortality. Morbid adhesion of the placenta is emerging as a major cause of massive postpartum hemorrhage unresponsive to medical therapy. We experienced three cases of major postpartum hemorrhage over 5,000 ml, developed from anterior placenta previa totalis with adhesion of placenta. The hemorrhage had been controlled successfully by compressing abdominal aorta intermittently with the operator's hand during Cesarean hysterectomy. In immediate life- threatening postpartum hemorrhage this simple and safe technique can be used in slowing the bleeding while stabilizing the patient and preparing for definitive treatment.
Aorta, Abdominal ; Hand ; Hemorrhage ; Humans ; Hysterectomy ; Maternal Mortality ; Placenta ; Placenta Previa ; Postpartum Hemorrhage* ; Postpartum Period*