1.Analysis of the Causes and Trends of Maternal Mortality in Korea: 2009-2014.
Korean Journal of Perinatology 2016;27(2):110-117
PURPOSE: This study was conducted to analyze recent trends and causes of maternal mortality in Korea between 2009 and 2014. METHODS: We investigated trends and causes of maternal death using the data from Complementary Investigations on the Infant, Maternal, and Perinatal Mortality carried out by Statistics Korea between 2009 and 2014. Maternal age, administrative district, causes of death and gestational age at the time of death were collected from data. Statistics including maternal mortality ratio (MMR) and maternal mortality rate were calculated. We also analyzed MMR according to the age, and administrative districts. The causes of maternal death were sorted and classified using International Classification of Diseases and World Health Organization recommendations. RESULTS: The average MMR during 6 years was 13.16 and maternal mortality rate was 0.45. MMR was highest in 2011 (17.2) and lowest in 2012 (9.9). The average MMR of the administrative districts varied greatly from 7.51 (Gwangju) to 26.84 (Jeju). The average MMR during the study period was lowest in maternal age of 20-24 (6.9), and highest in 45-49 (143.7). On average, direct and indirect maternal deaths accounted for 66.2% and 29.9% of total maternal death, respectively. The three most common causes of maternal deaths were obstetrical embolism (24.4%), postpartum hemorrhage (18.3%), and hypertensive disease of pregnancy (5.5%) in decreasing order of frequency. CONCLUSION: Although MMR is decreasing during the study period, it fluctuates widely according to maternal age, districts, and constant effort for improvements is necessary. To reduce maternal deaths, solution to control preventable causes of maternal deaths, careful management of pregnancies with advanced maternal age, and policy to solve the discrepancy in the medical services among diverse regions in the country are needed.
Cause of Death
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Embolism
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Gestational Age
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Humans
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Infant
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International Classification of Diseases
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Korea*
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Maternal Age
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Maternal Death
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Maternal Mortality*
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Perinatal Mortality
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Postpartum Hemorrhage
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Pregnancy
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World Health Organization
2.Standardization of measurement of cervical elastography, its reproducibility, and analysis of baseline clinical factors affecting elastographic parameters
Hyun Joo SEOL ; Ji Hee SUNG ; Won Joon SEONG ; Hyun Mi KIM ; Hyun Soo PARK ; Hayan KWON ; Han Sung HWANG ; Yun Ji JUNG ; Ja Young KWON ; Soo young OH
Obstetrics & Gynecology Science 2020;63(1):42-54
3.Randomized, Double-Blind, Placebo-Controlled Trial on the Efficacy of Hyaluronidase in Preventing Perineal Trauma in Nulliparous Women
Hayan KWON ; Hyun Soo PARK ; Jae Yoon SHIM ; Kyo Won LEE ; Suk Joo CHOI ; Gyu Yeon CHOI
Yonsei Medical Journal 2020;61(1):79-84
Edema
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Episiotomy
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Female
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Humans
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Hyaluronoglucosaminidase
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Incidence
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Lacerations
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Parity
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Wounds and Injuries
4.Effect of Cervical Cerclage on the Risk of Recurrent Preterm Birth after a Twin Spontaneous Preterm Birth
Shinyoung KIM ; Hyun Soo PARK ; Hayan KWON ; Hyun Joo SEOL ; Jin Gon BAE ; Ki Hoon AHN ; Sunghun NA ; Se Jin LEE ; Mi Young LEE ; Seung Mi LEE ; Dong Wook KWAK ; Jung Yoon PARK ; In Yang PARK ; Hye Sung WON ; Moon Young KIM ; Hyun Sun KO ; Han Sung HWANG ;
Journal of Korean Medical Science 2020;35(11):66-
BACKGROUND: This study aimed to evaluate the effect of cervical cerclage on the recurrence risk for preterm birth in singleton pregnant women after a twin spontaneous preterm birth (sPTB).METHODS: This multicenter retrospective cohort study included women who had a singleton pregnancy from January 2009 to December 2018 at 10 referral hospitals and a twin sPTB before the current pregnancy. We compared the cervical lengths during pregnancy and pregnancy outcomes, according to the placement of prophylactic or emergency cerclage. We evaluated the independent risk factors for sPTB (< 37 weeks of gestation) in a subsequent singleton pregnancy.RESULTS: For the index singleton pregnancy, preterm birth occurred in seven (11.1%) of 63 women. There was no significant difference in the cervical lengths during pregnancy in women with and without cerclage. In a multivariate logistic regression analysis, the placement of emergency cerclage was an independent risk factor for subsequent singleton preterm birth (odds ratio [OR], 93.188; 95% confidence interval [CI], 1.633–5,316.628; P = 0.027); however, the placement of prophylactic cerclage (OR, 19.264; 95% CI, 0.915–405.786; P = 0.057) was not a factor. None of the women who received prophylactic cerclage delivered before 35 weeks' gestation in the index singleton pregnancy.CONCLUSION: Cerclage did not lower the risk of preterm birth in a subsequent singleton pregnancy after a twin sPTB. However, emergency cerclage was an independent risk factor for preterm birth and there was no preterm birth before 35 weeks' gestation in the prophylactic cerclage group. Therefore, close monitoring of the cervical length and prophylactic cerclage might be considered in women who have experienced a twin sPTB at extreme gestation.
5.Addition of Cervical Elastography May Increase Preterm Delivery Prediction Performance in Pregnant Women with Short Cervix: a Prospective Study
Hyun Soo PARK ; Hayan KWON ; Dong Wook KWAK ; Moon Young KIM ; Hyun Joo SEOL ; Joon Seok HONG ; Jae Yoon SHIM ; Sae Kyung CHOI ; Han Sung HWANG ; Min Jeong OH ; Geum Joon CHO ; Kunwoo KIM ; Soo young OH ;
Journal of Korean Medical Science 2019;34(9):e68-
BACKGROUND: We investigated whether there is a difference in elastographic parameters between pregnancies with and without spontaneous preterm delivery (sPTD) in women with a short cervix (≤ 25 mm), and examined the ability of elastographic parameters to predict sPTD in those women. METHODS: E-CervixTM (WS80A; Samsung Medison, Seoul, Korea) elastography was used to examine the cervical strain. Elastographic parameters were compared between pregnancies with and without sPTD. Diagnostic performance of elastographic parameters to predict sPTD ≤ 37 weeks, both alone and in combination with other parameters, was compared with that of cervical length (CL) using area under receiver operating characteristic curve (AUC) analysis. RESULTS: A total of 130 women were included. Median gestational age (GA) at examination was 24.4 weeks (interquartile range, 21.4–28.9), and the prevalence of sPTD was 20.0% (26/130). Both the elastographic parameters and CL did not show statistical difference between those with and without sPTD. However, when only patients with CL ≥ 1.5 cm (n = 110) were included in the analysis, there was a significant difference between two groups in elasticity contrast index (ECI) within 0.5/1.0/1.5 cm from the cervical canal (P < 0.05) which is one of elastographic parameters generated by E-Cervix. When AUC analysis was performed in women with CL ≥ 1.5 cm, the combination of parameters (CL + pre-pregnancy body mass index + GA at exam + ECI within 0.5/1.0/1.5 cm) showed a significantly higher AUC than CL alone (P < 0.05). CONCLUSION: An addition of cervical elastography may improve the ability to predict sPTD in women with a short CL between 1.5 and 2.5 cm.
Area Under Curve
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Body Mass Index
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Cervix Uteri
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Elasticity
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Elasticity Imaging Techniques
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Female
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Gestational Age
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Humans
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Pregnancy
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Pregnant Women
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Prevalence
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Prospective Studies
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ROC Curve
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Seoul
;
Ultrasonography
6.Effect of Cervical Cerclage on the Risk of Recurrent Preterm Birth after a Twin Spontaneous Preterm Birth
Shinyoung KIM ; Hyun Soo PARK ; Hayan KWON ; Hyun Joo SEOL ; Jin Gon BAE ; Ki Hoon AHN ; Sunghun NA ; Se Jin LEE ; Mi Young LEE ; Seung Mi LEE ; Dong Wook KWAK ; Jung Yoon PARK ; In Yang PARK ; Hye Sung WON ; Moon Young KIM ; Hyun Sun KO ; Han Sung HWANG ;
Journal of Korean Medical Science 2020;35(11):e66-
BACKGROUND:
This study aimed to evaluate the effect of cervical cerclage on the recurrence risk for preterm birth in singleton pregnant women after a twin spontaneous preterm birth (sPTB).
METHODS:
This multicenter retrospective cohort study included women who had a singleton pregnancy from January 2009 to December 2018 at 10 referral hospitals and a twin sPTB before the current pregnancy. We compared the cervical lengths during pregnancy and pregnancy outcomes, according to the placement of prophylactic or emergency cerclage. We evaluated the independent risk factors for sPTB (< 37 weeks of gestation) in a subsequent singleton pregnancy.
RESULTS:
For the index singleton pregnancy, preterm birth occurred in seven (11.1%) of 63 women. There was no significant difference in the cervical lengths during pregnancy in women with and without cerclage. In a multivariate logistic regression analysis, the placement of emergency cerclage was an independent risk factor for subsequent singleton preterm birth (odds ratio [OR], 93.188; 95% confidence interval [CI], 1.633–5,316.628; P = 0.027); however, the placement of prophylactic cerclage (OR, 19.264; 95% CI, 0.915–405.786; P = 0.057) was not a factor. None of the women who received prophylactic cerclage delivered before 35 weeks' gestation in the index singleton pregnancy.
CONCLUSION
Cerclage did not lower the risk of preterm birth in a subsequent singleton pregnancy after a twin sPTB. However, emergency cerclage was an independent risk factor for preterm birth and there was no preterm birth before 35 weeks' gestation in the prophylactic cerclage group. Therefore, close monitoring of the cervical length and prophylactic cerclage might be considered in women who have experienced a twin sPTB at extreme gestation.