OBJECTIVES: The purposes of this study were to determine the usefulness of transvaginal ultrasonographic assessment of the uterine cervix and to compare the diagnostic performance of ultrasonographic and digital examination of the cervix in predicting a successful induction of labor. STUDY DESIGN: One hundred-one singleton term pregnancies without ruptured membranes admitted for the labor induction were included in this study. Digital examination and transvaginal ultrasonography of the uterine cervix were performed at the time of admission. Cervical parameters evaluated included cervical length, presence of funneling, funnel length, and funnel width. Labor induction was underwent by prostaglandin E2 (PGE2) vaginal suppository and/or pitocin intravenous infusion. Outcome variable was a successful labor induction within 48 hours after beginning of the induction. RESULTS: The prevalence of induction failure was 10.9% (11/101). Receiver-operator characteristic (ROC) curve and multiple logistic regression analysis indicated a significant relationship between the successful induction of labor and cervical length <3.1 cm. The diagnositic indices of endocervical length was superior to those of Bishop's cervical score in predicting a successful induction of labor. In patients with cervical length <3.1 cm, the labor was induced successfully with fewer tablets of PGE2, less use of pitocin infusion, and shorter induction-delivery interval. CONCLUSION: Transvaginal ultrasonographical examination of the uterine cervix is more accurate than digital examination of the cervix in the prediction of a successful induction of labor in term gestation.
Cervix Uteri* ; Dinoprostone ; Female ; Humans ; Infusions, Intravenous ; Logistic Models ; Membranes ; Oxytocin ; Pregnancy* ; Prevalence ; Suppositories ; Tablets ; Ultrasonography

Primary lymphoma of uterine cervix is rare disease, which usually occurs in postmenopausal periods. The usual symptoms are vaginal bleeding, postcoital bleeding. The most common pathologic feature is a diffuse cell type, B-cell line. Pap smear is not helpful in diagnosis because it is stromal origin. Biopsy confirms the diagnosis. Treatment consists of radiation therapy and/or chemotherapy. The prognosis of the disease is dependent upon Ann arbor stage and International index score rather than FIGO stage. We experienced one case of primary lymphoma of cervix and report it with a brief review of literature.
B-Lymphocytes ; Biopsy ; Cervix Uteri* ; Diagnosis ; Drug Therapy ; Female ; Hemorrhage ; Lymphoma* ; Postmenopause ; Prognosis ; Rare Diseases ; Uterine Hemorrhage

OBJECTIVE: Macrosomia is associated with increased birth injury and neonatal morbidity as well as a higher rate of cesarean delivery. Our purpose was to determine whether induction of labor after sonographic diagnosis of fetal macrosomia could improve maternal and neonatal outcome. STUDY DESIGN: The hospital records of 180 patients who delivered of an inFant with birth weight over 4000 gm were reviewed. The subjects were divided into three groups based on obstetric management as follows.. expectant management after sonographic diagnosis of fetal macrosomia(group I), induction of labor(group lI), unexpected patients who were underestimated of fetal weight(estimated fetal weight<90th percentile) (groupIII), Patients who underwent elective cesarean delivery and complicated with diabetes were excluded. Outcome variables for comparison in three groups were mode of delivery, 5 minute Apgar score below 7, presence of cephalohematoma, clavicular fracture, brachial plexus injury, and intraventricular hemorrhage. RESULTS: One hundred eighty patients who eligible for the study, of whom 32 patients were included to group I, 57 patients to group lI, and 91 patients to group Ill, respectively. The cesarean rate within elective induction group was 49%, which was significant higher than the 16% rate in expectant management group and 19% in unexpected group(p<0.05). The observed rates of cephalohematoma, clavicular fracture and 5 min Apgar score below 7 were not significantly different in three groups. CONCLUSIONS: There was an significant increased cesarean delivery rate without improvement in neonatal outcomes or reduction in birth injury among pregnancies in which labor was electively induced after sonographic diagnosis of fetal macrosomia. Elective induction of labor should be discharged in cases with fetal macrosomia.
Apgar Score ; Birth Injuries ; Birth Weight ; Brachial Plexus ; Diagnosis* ; Female ; Fetal Macrosomia* ; Hemorrhage ; Hospital Records ; Humans ; Infant ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Ultrasonography*

OBJECTIVE: This study had two main objectives: to compare current suicide rates in OECD countries among 10–19-year-olds and to identify patterns of suicide rates based on age, gender and time. Furthermore we investigated the main dimensions that contributed to the variation in child and adolescent suicide rates across countries. METHODS: We combined the WHO mortality data and the population data released by OECD to calculate the suicide rates in 29 OECD countries. A self-organizing map (SOM), k-means clustering analysis, and multi-dimensional scaling were used to classify countries based on similarities in suicide rate structure and to identify the important dimensions accounting for differences among groups. RESULTS: We identified significant differences in suicide rates depending on age, sex, country, and time period. Late adolescence and male gender were universal risk factors for suicide, and we observed a general trend of declining suicide rates in OECD countries. The SOM analysis yielded eight types of countries. Most countries showed gender gaps in suicide rates of similar magnitudes; however, there were outliers in which the gender gap was particularly large or small. CONCLUSION: Significant variation exists with respect to suicide rates and their associated gender gaps in OECD countries.
Adolescent ; Child ; Humans ; Male ; Mortality ; Organisation for Economic Co-Operation and Development* ; Risk Factors ; Suicide*

OBJECTIVE:The purpose of this study was to investigate the role of sonographic findings and tumor markers in predicting malignancy of adnexal masses in pregnancy. METHODS:From January 1995 to September 2005, 190 cases of adnexal masses were operated during pregnancy. We reviewed their sonographic findings and medical records retrospectively. Sonographic features and tumor markers were correlated with malignant pathology. Pregnancy and neonatal outcomes were also studied after treatment of adnexal mass during pregnancy. RESULTS:From 190 cases, there were 10 cases (5.3%) of malignant tumor or tumors of borderline malignancy. In the 180 cases of benign adnexal mass, the most common type was mature cystic teratoma (36.7%). Preoperative sonographic findings were available in 110 cases. The median size was 6.3 cm for benign masses and 7.7 cm for malignant masses (p=0.05). Mixed echogenecity, septa and mural nodule were more frequently found in malignant masses (p=0.003, 0.029, 0.013, respectively). Tumor markers were available in 47 cases. In the 1st trimester, the level of serum CA-125 of the patients with benign masses were not different from those with malignant masses. However, in the 2nd and 3rd trimester, the difference was statistically significant (p=0.031). Forty- six patients underwent antepartum surgery and the overall pregnancy outcome was similar between the laparoscopic group and the laparotomy group. CONCLUSION:Mixed echogenecity, septa and mural nodule showed significant correlation with malignant adnexal mass in pregnancy.
Female ; Humans ; Laparotomy ; Medical Records ; Pathology* ; Pregnancy Outcome ; Pregnancy* ; Retrospective Studies ; Teratoma ; Biomarkers, Tumor ; Ultrasonography*

OBJECTIVE: To investigate the maternal and neonatal outcomes in pregnancies complicated with idiopathic thrombocypenic purpura (ITP) and to identify antenatal factors to predict the neonatal thrombocytopenia. METHODS: We analyzed retrospectively maternal and neonatal outcomes of the32 pregnant women with ITP who were delivered over a 12-year period. RESULTS: The prevalence incidence of ITP in pregnancy was 0.87 per 1,000 live births in this study population. The diagnosis of ITP was made more before pregnancy than with afterduring during pregnancy (63% vs 37%). Maternal platelet transfusion was done in 62.5 % of pregnancies with ITP. Sixty nine percent of pregnancies with ITP received medical therapies; steroid only in 8 cases (25%), steroid + IVIG (intravenous immunoglobulin) in 6 cases (18.7%), IVIG only in 2 cases (6.2%), and steroid + IVIG + anti-Rh (anti-D) in 1 case (3.1%). Overall response rate (Plt > 50 x 10(9)/L) to medical treatment was 77%. Neonatal thrombocytopenia (Plt < 50 x 10(9)/Ll) was observed seen in 4 cases (14.2%) immunoglobulin. There was no correlation between the maternal and the neonatal platelet count. Moreover medical treatment during pregnancy did not make any difference in neonatal platelet count. There was one case of neonatal ICH (germinal matrix hemorrhage). CONCLUSION: Although neonatal thrombocytopenia occurred in 140% of pregnancies with ITP, no antenatal factor could predict neonatal thrombocytopenia.
Diagnosis ; Female ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Incidence ; Live Birth ; Platelet Count ; Platelet Transfusion ; Pregnancy* ; Pregnant Women ; Prevalence ; Purpura ; Purpura, Thrombocytopenic, Idiopathic* ; Retrospective Studies ; Thrombocytopenia, Neonatal Alloimmune

OBJECTIVE: The purpose of this study is to survey the clinical practice pattern of postterm pregnancy in Korea. METHODS: A questionnaire was mailed to 1114 physicians who are registered in Korean Society of Obstetrics and Gynecology (KSOG) and work in primary and secondary hospital as well as tertiary care center. The questions included information about the practice pattern implicating definition of postterm pregnancy, the time and the method of routine fetal surveillance and induction of labor as well as demographic information such as age, sex, location, professional part and the number of delivery. We got 23.2% (258/1114) of surveys returned and analyzed the data. RESULTS: Seventy-four percent (73.6%) of the respondents define 42 weeks gestation or greater to be postterm. However, 84.5% consider induction of labor at 41 weeks of gestation. Sixty-eight percent (68.3%) of the respondents start postterm pregnancy fetal testing at 40 weeks and 59.3% of them perform testing every week. For fetal surveillance testing, 85.7% of the respondents use NST and 39.5% of them use modified BPP. As for induction of labor, 65% of practitioners use oxytocin and 45% of them use prostaglandins (misoprostol and dinoprostone) when inducing both nulliparous and multiparous women with unfavorable cervix. CONCLUSION: Most of the respondents (84.5%) routinely induce low-risk singleton pregnancy at 41 weeks gestation, whereas the majority of them (73.6%) define postterm pregnancy beyond 42 weeks gestation.
Cervix Uteri ; Surveys and Questionnaires ; Female ; Gynecology ; Humans ; Korea* ; Obstetrics ; Oxytocin ; Physician's Practice Patterns* ; Postal Service ; Pregnancy* ; Prostaglandins ; Surveys and Questionnaire ; Tertiary Care Centers

We report a case of Cushing syndrome secondary to adrenal adenoma presenting with hypertension and oligohydramnios during pregnancy. The tumor was confirmed by magnetic resonance imaging at 28 week 3 day weeks of pregnancy and was removed surgically at 29 week 1 day weeks of gestation. After surgery, hypertension subsided and amniotic fluid volume returned to normal range. The gravid woman subsequently delivered a healthy infant at term.
Adenoma ; Adrenalectomy ; Adrenocortical Adenoma* ; Amniotic Fluid ; Cushing Syndrome* ; Female ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Oligohydramnios ; Pregnancy* ; Reference Values

PURPOSE: To compare the accuracy of fetal magnetic resonance imaging (MRI) and prenatal ultrasonography (USG) with postnatal diagnosis for the diagnosis of fetal anomalies. METHODS: Retrospective analysis of 41 fetuses who underwent fetal MRI with prenatal USG from 2005 to 2008 was performed. In 28 cases of the total population, the final neonatal diagnosis was also analyzed for the consistency of pre- and postnatal diagnoses for each diagnostic tool. Postnatal diagnosis was confirmed by physical examination, radiographic studies (USG, MRI and/or computed tomography), surgery, and/or autopsy. RESULTS: Mean gestational age at the fetal MRI performed was 26.1+/-4.7 weeks. The most common indication of the fetal MRI was central nervous system (CNS) anomalies (n=12), followed by thoracic anomalies (n=5), abdominal anomalies (n=2), genitourinary anomalies (n=3), head and neck anomalies (n=4), and others (n=2). When compared with postnatal diagnosis, the accuracy of prental MRI was superior to prenatal USG (89% vs. 71%). The cases with additional accurate diagnosis with using fetal MRI were 4 CNS, 1 genitourinary, and 1 craniofacial anomaly. Of notes, there was a case of enlarged cisterna magna in which prenatal MRI missed the diagnosis. In 2 cases (7.1%), both imaging studies made an incorrect prenatal diagnoses. CONCLUSION: Fetal MRI could confirm the USG diagnosis in most cases and provided more accurate diagnosis in some cases of CNS and thoracic, genitourinary system abnormalities. MRI is expected to be a good adjunctive for USG to improve prenatal diagnosis of fetal anomalies.
Central Nervous System ; Cisterna Magna ; Fetus ; Gestational Age ; Head ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Neck ; Physical Examination ; Prenatal Diagnosis ; Retrospective Studies ; Ultrasonography, Prenatal ; Urogenital System

OBJECTIVE: To investigate the neonatal outcome according to the gestational age at delivery and to determine the optimal timing for delivery in uncomplicated monochorionic and dichorionic twin pregnancies. METHODS: This is a retrospective cohort study of women with uncomplicated twin pregnancies delivered at or beyond 35 weeks of gestation from 1995 to 2013. The primary outcome was neonatal composite morbidity, which was defined as when either one or both twins have one or more of the followings: fetal death after 35 weeks gestation, admission to neonatal intensive care unit, mechanical ventilator requirement, respiratory distress syndrome and neonatal death. To determine the optimal gestational age for delivery according to chorionicity, we compared the neonatal composite morbidity rate between women who delivered and women who remained undelivered at each gestational week in both monochorionic and dichorionic twin pregnancies. RESULTS: A total of 697 twin pregnancies were included (171 monochorionic and 526 dichorionic twins). The neonatal composite morbidity rate significantly decreased with advancing gestational age at delivery and its nadir was observed at 38 and > or =39 weeks of gestation in monochorionic and dichorionic twins, respectively. However, the composite morbidity rate did not differ between women who delivered and women who remained undelivered > or =36 and > or =37 weeks in monochorionic and dichorionic twins, respectively. CONCLUSION: Our data suggest that the optimal gestational age for delivery was at > or =36 and > or =37 weeks in uncomplicated monochorionic and dichorionic twin pregnancies, respectively.
Chorion* ; Cohort Studies ; Female ; Fetal Death ; Gestational Age* ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Pregnancy ; Pregnancy, Twin* ; Retrospective Studies ; Twins* ; Ventilators, Mechanical