Renal agenesis is a disorder characterized by the congenital absence of one or both kidneys due to complete failure of the kidney to form. The syndrome of renal agenesis is severe oligohydramnios, amnion nodosum, flattened face, low-set and floppy ears, and bilateral pulmonary hypoplasia. Bilateral renal agenesis occurs in 0.1 to 0.3 per 1000 births and unilateral involvement occurs in 1 in 500 to 1 in 1300 live births.1,2 Bilateral renal agenesis is an invariably lethal condition, and is associated in more than half of the affected individuals with malformations of the genitourinary tract, cardiovascular system, vertebral bodies or imperforated anus.2 Accurate diagnosis in the mid-trimester permits the parents to allow elective termination. However, the nearly absent amniotic fluid makes an accurate assessment of fetal kidney difficult. We present a case of unilateral renal agenesis with contralateral renal hypoplasia, diagnosed by ultrasonography after amnioinfusion at 21 weeks gestation.
Amnion ; Amniotic Fluid ; Cardiovascular System ; Diagnosis ; Ear ; Female ; Humans ; Kidney ; Oligohydramnios ; Parents ; Parturition ; Pregnancy ; Prenatal Diagnosis ; Ultrasonography

OBJECTIVE: Pregnancy-associated aplastic anemia remains a rare occurrence. The aim of this study was to examine the maternal and fetal outcomes of pregnancy-associated aplastic anemia treated with supportive care. METHODS: From January 1995 to December 2004, a total of 14 women newly diagnosed with pregnancy-associated aplastic anemia were recruited for the study. RESULTS: Eleven (78%) of the 14 women were diagnosed with pregnancy-associated aplastic anemia during the second or third trimester. There were eight severe cases; three of which were diagnosed at the initial presentation. All 14 women had conservative management with transfusions but not specific immunological or hormonal therapies during pregnancy. Blood transfusions were performed prenatally in seven mothers and perinatally in 13. Of the 12 patients eligible for follow-up, one achieved complete remission and another eight showed partial remission after delivery. During the follow up period, there was no case of maternal-fetal death in our series. The pregnancies were continued uneventfully in most cases. CONCLUSIONS: This study demonstrated favorable maternal and neonatal outcomes with transfusion support alone for pregnancy-associated aplastic anemia. Therefore, pregnancy continuation with meticulous blood support should be considered, rather than therapeutic termination, for women with pregnancy-associated aplastic anemia.
Anemia, Aplastic* ; Blood Transfusion ; Female ; Follow-Up Studies ; Humans ; Mothers ; Pregnancy ; Pregnancy Trimester, Third ; Prognosis

OBJECTIVE: To evaluate the outcome of pregnancy in kidney transplanted women, and correlate this with the time of transplantation to conception. MATERIAL AND METHODS: We analyzed the outcome of 31 pregnancies from 21 allograft recipients at Kangnam St. Mary's Hospital, Catholic Medical Center from January 1990 through December 2000. For each reported pregnancy we reviewed obstetrical, medical and pediatric records. For children follow-up and for those whose obstetric procedures were taken in other hospitals, we did a questionarie and telephone interviews. RESULTS: Of the 31 pregnancies followed by us, there were 23 live-born offspring delivered by 21 mothers and 8 stillborn/abortuses, including five artificial abortuses. The mean gestational age at delivery was 36.18+/-0.6 weeks and the mean birth weight of the offspring was 2,525+/-137gm. Only 43.4% was delivered after 37weeks of gestation. Preterm delivery rate (delivered before 37weeks of gestation) was 56.5%. Common obstetric complications were intrauterine growth restriction (39.1%) preterm labor (35%), premature rupture of membrane (30%), preeclampsia (30%), and maternal complications were deterioration of renal function (5%) and rejection of allograft (18%) after delivery. Mean interval from transplantation to pregnancy was 4.7 years. Twelve pregnancies occurred within the first 2 years of transplantation, while 19 pregnancies occurred after that period. No difference was noted in neonatal body weight between 2 groups (p=0.824). There was no difference in mean interval from transplantation to pregnancy in the delivery group (5.21+/-0.9 years) vs. the abortion group (4.57+/-1.1 years) (p=0.207). All women continued with her medication during pregnancy, based on cyclosporine and/or azathioprine and steroids. No congenital anomaly was noted in the newborn. When follow up lately, one boy with neurofibromatosis and a girl with recurrent hematuria were noted. CONCLUSION: Although pregnancy in renal allograft patient is hazardous, good outcome can be expected if function of the allograft is good before conception.
Allografts ; Azathioprine ; Birth Weight ; Body Weight ; Child ; Cyclosporine ; Female ; Fertilization ; Follow-Up Studies ; Gestational Age ; Hematuria ; Humans ; Infant, Newborn ; Interviews as Topic ; Kidney ; Kidney Transplantation* ; Male ; Membranes ; Mothers ; Neurofibromatoses ; Obstetric Labor, Premature ; Pre-Eclampsia ; Pregnancy ; Rupture ; Steroids

OBJECTIVE: This study examined the effect of a maximal cervical dilatation prior to their primary cesarean birth on the time length of labor in women attempting vaginal birth after cesarean section (VBAC). METHODS: From January 2000 to Jun 2005, a total of 526 patients with VBAC were entered into the study. Patients were classified into 4 groups according to the maximal cervical dilatation on the prior cesarean birth: Group 1 (0~3 cm), Group 2 (4~7 cm), Group 3 (8~9 cm), and Group 4 (10 cm). RESULTS: An analysis of the duration of labor showed that the time length of active phase was significantly shorter in each of Group 3 (147.3+/-103.9 minutes) and 4 (155.2+/-104.2 minutes) than in Group 1 (192.9+/-126.0 minutes) or 2 (195.1+/-148.2 minutes) (p<0.05), although there was no difference with regard to the second stage between each group. These results were also sustained even among the selected 248 patients without prior use of oxytocin, vacuum delivery, or epidural anesthesia that could affect the duration of labor. CONCLUSION: The time length of active phase on VBAC is significantly shorter in women with a prior maximal cervical dilatation of > or =8 cm than those without. Study results indicate that prior cervical dilatation may affect the labor time of subsequent VBAC. The proper understanding of the association between prior cervical dilatation and labor time on a subsequent VBAC may be useful for better management or further intervention in the setting of VABC.
Anesthesia, Epidural ; Female ; Humans ; Labor Stage, First* ; Oxytocin ; Parturition ; Pregnancy ; Vacuum ; Vaginal Birth after Cesarean*

Lymphangiomas are congenital malformations of lymphatic vessels that have the potential to infiltrate surrounding structures. In 95% of cases, they are located in the neck (cystic hygroma), head and axilla. But they can occur in a variety of anatomical locations, such as the abdominal cavity, extremities and urinary bladder. Pathologically they can be classified into three group: lymphangioma simplex; carvenous lymphangioma; and cystic lymphangiomas or hygromas. Mixed lesions may coexist in different areas of the same lymphangioma. Although these lesions are benign, they have a propensity for rapid growth and invasion into the underlying muscles and connective tissues. A extensive mass can compress adjacent vital organs, which determines the severity of the lesion. Accurate prenatal diagnosis and anatomical evaluation are important as they permit planned delivery and prompt postnatal resuscitation, and allow the option of terminating the pregnancy if a poor outcome is predicted. Prenatal MRI can confirm ultrasonographic findings, provide detailed fetal anatomical evaluation, and demonstrate the extent and character of lymphangiomas. We present a case of a huge retroperitoneal cystic lymphangioma diagnosed prenatally using ultrasound and MRI at 26 weeks gestation.
Abdominal Cavity ; Axilla ; Connective Tissue ; Extremities ; Head ; Lymphangioma ; Lymphangioma, Cystic* ; Lymphatic Vessels ; Magnetic Resonance Imaging ; Muscles ; Neck ; Pregnancy ; Prenatal Diagnosis ; Resuscitation ; Ultrasonography ; Urinary Bladder

To evaluate the cephalometric and dental characteristics of obstructive sleep apnea (OSA) patients, 23 OSA patients and 15 control, non-OSA, patients who visited the Sleep Disorder Clinic Center, Keimyung University were investigated. Patients who suffered from apnea-hypopnea episodes over 10 times per hour were diagnosed as having OSA after polysomnograph testing. Impressions were taken with alginate. Cephalometric radiographs were taken at maximum intercuspation. The dental cast measurements, including transpalatal width, intercanine width, intermolar width and palatal depth did not differ between the control and OAS groups and did not have a positive correlation with the apnea-hypopnea index (AHI). Upper airway width was statistically narrower than the control group. Upper airway width had a low negative correlation with AHI, but, lower airway width had a low positive correlation, and, the higher the AHI score, the longer the mandibular border to hyoid distance.
Humans ; Sleep Apnea, Obstructive*