OBJECTIVE: To evaluate the importance of assessment of fetal cardiac output (CO) for the prediction of complications of pregnancy. METHODS: We evaluated 65 fetuses and all of them had a fetal cardiac scan at 20 to 24 weeks of pregnancy. To measure CO, diameters (d) of the left right ventricle outflow tract were measured just above the valves. Each left CO (LCO) and right CO (RCO) was derived using the following equation: CO = velocity time integral ×π× d²/4 × heart rate. Pregnancy complications included gestational hypertensive disorders, fetal growth restriction (FGR) and preterm birth (PTB) caused from preterm labor or preterm premature rupture of membrane (PPROM). RESULTS: There were 23 cases with one more pregnancy complication (FGR, 9; gestational hypertensive disorders, 8; PTB caused from PTB or PPROM, 12). The LCO was lower in complication group than in normal group (88±53 vs. 117±48 mL/min, P=0.028). The RCO to the LCO ratio (RCO/LCO) was higher in complication group (2.43±1.69 vs. 1.48±0.81, P=0.001). Regression analysis demonstrated that RCO/LCO was a significant predictor of pregnancy complication; Odds ratio was 7.76 (95% CI, 1.15 to 52.21; P=0.029). The area under the receiver-operating characteristic curve for prediction of pregnancy complications from LCO was 0.71. The diagnostic cut-off value of LCO was 80 mL/min. The area under the receiver-operating characteristic curve from RCO/LCO was 0.68 and cut-off value was 1.41. CONCLUSION: This study demonstrated that pregnancy complications can be suspected based on fetal CO assessments at a GA of 20 to 24 weeks.
Cardiac Output* ; Echocardiography ; Female ; Fetal Development ; Fetal Growth Retardation ; Fetus ; Heart Rate ; Heart Ventricles ; Membranes ; Obstetric Labor, Premature ; Odds Ratio ; Pre-Eclampsia ; Pregnancy Complications* ; Pregnancy* ; Premature Birth ; Rupture ; Ultrasonography*

OBJECTIVE: To access the pregnancy tendency and delivery in women aged 40 years and older. METHODS: From January 1999 to June 2001, 7882 deliveries were in Gacheon Medical School. Among them we compared 95 cases of pregnant women aged 40 years and older with 94 cases of those aged under 40 years as a control group. RESULTS: The parity was higher in women aged older than 40 years compared to control group. Number of prenatal special studies was higher in women aged older than 40 years (n=82) compared to control group (n=14). In modes of delivery and indications for c/sec, there were no difference in two groups. There were no difference in prenatal complications between two groups. But, number of cases related to placenta previa, myoma and anemia were increased in women aged older than 40 years. In postpartum complications, uterine atony and hysterectomy, postpartum bleeding and placenta accreta were higher in women aged older than 40 years compared to control group. CONCLUSION: For pregnant women aged 40 years and older, a careful approach and appropriate management will be necessary for good pregnant outcome.
Anemia ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Myoma ; Parity ; Placenta Accreta ; Placenta Previa ; Postpartum Period ; Pregnancy* ; Pregnant Women ; Schools, Medical ; Uterine Inertia

Acute atherosis is unique vascular changes of the placenta associated with poor placentation. It is characterized by subendothelial lipid-filled foam cells, fibrinoid necrosis of the arterial wall, perivascular lymphocytic infiltration, and it is histologically similar to early-stage atherosclerosis. Acute atherosis is rare in normal pregnancies, but is frequently observed in non- transformed spiral arteries in abnormal pregnancies, such as preeclampsia, small for gestational age (SGA), fetal death, spontaneous preterm labor and preterm premature rupture of membranes. In preeclampsia, spiral arteries fail to develop physiologic transformation and retain thick walls and a narrow lumen. Failure of physiologic transformation of spiral arteries is believed to be the main cause of uteroplacental ischemia, which can lead to the production of anti-angiogenic factors and induce endothelial dysfunction and eventually predispose the pregnancy to preeclampsia. Acute atherosis is more frequently observed in the spiral arteries of the decidua of the placenta (parietalis or basalis) than in the decidual or myometrial segments of the placental bed. The presence and deeper location of acute atherosis is associated with poorer pregnancy outcomes, more severe disease, earlier onset of preeclampsia, and a greater frequency of SGA neonates in patients with preeclampsia. Moreover, the idea that the presence of acute atherosis in the placenta may increase the risk of future cardiovascular disease in women with a history of preeclampsia is of growing concern. Therefore, placental examination is crucial for retrospective investigation of pregnancy complications and outcomes, and accurate placental pathology based on universal diagnostic criteria in patients with abnormal pregnancies is essential for clinicopathologic correlation.
Arteries* ; Atherosclerosis ; Cardiovascular Diseases ; Cholesterol ; Decidua ; Female ; Fetal Death ; Foam Cells ; Gestational Age ; Humans ; Infant, Newborn ; Ischemia ; Membranes ; Necrosis ; Obstetric Labor, Premature ; Pathology ; Placenta ; Placentation ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Retrospective Studies ; Rupture

OBJECTIVE: To evaluate the efficacy and safety of prostaglandin (PG) E₂ for preterm labor induction and to investigate the predictive factors for the success of vaginal delivery. METHODS: A retrospective cohort study was performed in women (n=155) at 24+0 to 36+6 weeks of gestation who underwent induction of labor using a PGE₂ vaginal pessary (10 mg, Propess) from January 2009 to December 2015. Success rates of vaginal delivery according to gestational age at induction and incidence of intrapartum complications such as tachysystole and nonreassuring fetal heart rate were investigated. Multivariable logistic regression analysis was performed to evaluate the predictive factors for success of labor induction. RESULTS: The vaginal delivery rate was 57% (n=89) and the rate of cesarean delivery after induction was 43% (n=66). According to gestational age, labor induction was successful in 16.7%, 50.0%, and 62.8% of patients at 24 to 31, 32 to 33, and 34 to 36 weeks, showing a stepwise increase (P=0.006). There were 18 cases (11%) of fetal distress, 9 cases (5.8%) of tachysystole, and 6 cases (3.8%) of massive postpartum bleeding (>1,000 mL). After adjusting for confounding factors, multiparity (odds ratio [OR], 8.47; 95% confidence interval [CI], 3.10 to 23.14), younger maternal age (OR, 0.84; 95% CI, 0.75 to 0.94), advanced gestational age at induction (OR, 1.06; 95% CI, 1.02 to 1.09), rupture of membranes (OR, 11.83; 95% CI, 3.55 to 39.40), and the Bishop score change after removal of PGE₂ (OR, 2.19; 95% CI, 1.0 to 4.8) were significant predictors of successful preterm vaginal delivery. CONCLUSION: An understanding of the principal predictive factors of successful preterm labor induction, as well as the safety of PGE₂, will provide useful information when clinicians consult with preterm pregnant women requiring premature delivery.
Cohort Studies ; Dinoprostone ; Female ; Fetal Distress ; Gestational Age ; Heart Rate, Fetal ; Hemorrhage ; Humans ; Incidence ; Labor, Induced ; Logistic Models ; Maternal Age ; Membranes ; Obstetric Labor, Premature ; Parity ; Pessaries ; Postpartum Period ; Pregnancy ; Pregnant Women ; Premature Birth ; Retrospective Studies ; Rupture

OBJECTIVE: Our purpose was to determine whether abnormal triple marker in the second trimester may be associated with adverse pregnancy outcomes. METHODS: Between November 1996 and April 1998, we evaluated 1,158 pregnant women undergoing second trimester triple marker screening tests who delivered at our hospital. The pregnancy outcomes of 48 women with false positive screens were compared with 1,158 screen negative controls. The pregnancy outcomes were obtained from hospital delivery records. RESULTS: Women with abnormal triple marker showed increased risks for low birth weight(p<0.01). But there was no significant differences between study and control groups with respect to preterm labor, pregnancy induced hypertension, oligohydroamnios, premature rupture of membrane, placenta previa, abruptio placenta, fetal death in utero. CONCLUSION: Abnormal triple marker in the second trimester was associated with low birth weight.
Female ; Fetal Death ; Humans ; Hypertension, Pregnancy-Induced ; Infant, Low Birth Weight ; Infant, Newborn ; Mass Screening* ; Membranes ; Obstetric Labor, Premature ; Parturition ; Placenta ; Placenta Previa ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second ; Pregnancy, High-Risk* ; Pregnant Women ; Rupture

OBJECTIVES: The purpose of this study was to evaluate the efficacy and safety of magnesium sulfate and ritodrine hydrochloride in the management of preterm labor. METHODS: This study was undertaken to assess the clinical efficacy & safety of magnesium sulfate and ritodrine hydrochloride on 120 patients admitted with preterm labor from Jul. 1, 1996 to Dec. 31, 1998. RESULTS: 1. The incidence of preterm labor was showed 6.0~7.7% of total number of delivery. 2. The risk factors of the preterm labor were premature rupture of membrane, severe preeclampsia, previous preterm delivery, twin pregnancy, placenta previa, fetal anomaly, incompetent cervix, placental abruption, and uterine myoma in order, but 28.6% of preterm labor had no apparent risk factors. 3. The days gained in uterus was not statistically different between the magnesium sulfate group and the ritodrine group (p<0.05) but longer in the two groups than the control group. And the delivery time was also not statistically different between the magnesium sulfate group and the ritodrine group (p<0.01) but significantly increased in the two groups than the control group. 4. The rate of complete and incomplete success was similar as 12.5% and 35% (total success rate 47.5%) in the magnesium sulfate group, 7.5% and 45% (total success rate 52.5%) in the ritodrine group but only 2.5% and 27.5% (total success rate 30%) was showed in the control group. 5. The side effects were much more in the ritodrine group than the magnesium sulfate group. The patients requiring second-line therapy were similar in the both groups but the main cause was uncontrolled uterine contraction in the magnesium sulfate group, and intolerable side effects in the ritodrine group. 6. The pulse rate was not statistically different in magnesium sulfate group but markedly increased in ritodrine group (p<0.05). After managements of preterm labor, the serum potassium and ionized calcium level was significantly decreased in the two groups (p<0.05, p<0.01). CONCLUSION: There was not significantly different efficacy and safety of magnesium sulfate and ritodrine hydrochloride in the management of preterm labor.
Abruptio Placentae ; Calcium ; Female ; Heart Rate ; Humans ; Incidence ; Leiomyoma ; Magnesium Sulfate* ; Magnesium* ; Membranes ; Obstetric Labor, Premature* ; Placenta Previa ; Potassium ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Twin ; Risk Factors ; Ritodrine* ; Rupture ; Uterine Cervical Incompetence ; Uterine Contraction ; Uterus

OBJECTIVES: To evaluate the safety and efficacy of selective fetal reduction (SFR) and compare the outcome of twin pregnancy after SFR in multiple pregnancy induced by assisted reproductive technology (ART) with that of natural twin pregnancy. METHODS: From September 1995 to March 2002 in Ajou University Hospital, SFR was performed in 79 patients whose gestational sacs were more than 3. Of these 79 patients, 47 patents resulted in twin pregnancy after SFR. SFR was performed using transvaginal intracardiac KCl injection at gestational age of 6~9 weeks. Control group was composed of 264 patients with natural twin pregnancy, who delivered after intrauterine pregnancy at 24 weeks, from June 1994 through December 2002. We compared Obstetric and perinatal outcomes between SFR group and natural twin group. RESULTS: Among 47 patients with twin pregnancy after SFR, 2 spontaneous abortion were occurred at intrauterine pregnancy at 8 and 19 weeks. Obstetrical and perinatal outcomes were available in 43 patients. Single intrauterine fetal death was occurred in 1 of 43 (2.3%) patients in SFR group. incidence of preterm labor, premature rupture of membrane, preeclampsia and placenta previa were similar, but gestational diabetes mellitus (GDM) was occurred more frequently in SFR group (3 (7.0%) vs 4 (1.5%), p=0.02). Mean gestational age, mean birth weight, incidence of discordancy, use of intubation and ventilation, incidence of fetal anomaly, low (<7) Apgar score and intrauterine growth restriction were similar in both groups. CONCLUSION: Twin pregnancy after SFR has the increased incidence for GDM but other obstetric and perinatal outcome was similar compared with natural twin pregnancy. So SFR is a safe and effective procedure, so we suggest SFR is needed in multifetal pregnancy more than triplet.
Abortion, Spontaneous ; Apgar Score ; Birth Weight ; Diabetes, Gestational ; Female ; Fetal Death ; Gestational Age ; Gestational Sac ; Humans ; Incidence ; Intubation ; Membranes ; Obstetric Labor, Premature ; Placenta Previa ; Pre-Eclampsia ; Pregnancy ; Pregnancy Reduction, Multifetal* ; Pregnancy, Multiple ; Pregnancy, Twin* ; Reproductive Techniques, Assisted ; Rupture ; Triplets ; Ventilation

OBJECTIVE: Uterine compression sutures such as modified B-Lynch suture or multiple square-shaped sutures of uterine body are simple methods for control of postpartum hemorrhage refractory to medical treatment. We evaluated the treatment outcome and morbidity of uterine compression sutures and analyzed clinical findings of patients undergone uterine compression sutures and postpartum hysterectomy. METHODS: From January 2005 through December 2008, we retrospectively reviewed the medical records of patients undergone uterine compression sutures or postpartum hysterectomy. We analyzed success rates of preserving uterus of uterine compression sutures according to operative indications and mode of delivery and compared maternal characteristics, operative findings, morbidities and mortality with those of postpartum hysterectomy. RESULTS: The frequency of uterine compression sutures for control of massive postpartum hemorrhage was 0.24% (73/30,677). The success rates of preserving uterus were 85.1% in uterine atony, 80.9% in placenta previa, and 40.0% in placenta accreta (P=0.051). The rates of preserving uterus of uterine compression sutures after vaginal delivery and cesarean section were 50.0% and 82.6%, respectively (P=0.164). The frequencies of postoperative morbidities such as disseminated intravascular coagulation, pulmonary edema, ileus were not different between immediate hysterectomy and hysterectomy after uterine compression sutures. There was no maternal mortality. CONCLUSION: Uterine compression suture was successful method for control of postpartum hemorrhage resulting from uterine atony and placenta previa. We suggest the use of uterine compression sutures as the first-line operation for control of postpartum hemorrhage.
Cesarean Section ; Disseminated Intravascular Coagulation ; Female ; Humans ; Hysterectomy ; Ileus ; Maternal Mortality ; Medical Records ; Placenta Accreta ; Placenta Previa ; Postpartum Hemorrhage ; Postpartum Period ; Pregnancy ; Pulmonary Edema ; Retrospective Studies ; Sutures ; Treatment Outcome ; Uterine Inertia ; Uterus

Cesarean hysterectomy is associated with high risks of severe blood loss, postoperative complication, and maternal morbidity. This study was undertaken to identify the risk factors of cesarean hysterectomy and to reduce the postoperative complications and maternal morbidity. There were 6,362 deliveries between January 1992 and December 1996 at department of obstetrics and gynecology, Inchon Christian Hospital. 1'he results of this study were as follows, 15 cases of cesarean hysterectomy were performed during this period. Cesarean hysterectomy was performed in 10 cases (0.32 %) among 3178 cesarean deliveries and in 5 cases (0.16 %) among 3184 vaginal deliveries. The incidence of cesarean hysterectomy was 0.24 % (15/6,362). The age of patients ranged from 24 to 38 years old. The maternal mortality and morbidity were 0 % (0/15) and 86.7% (13/15), respectively. Indications for cesarean hysterectomy were uterine atony (53.3 %), uterine myoma with pregnancy (20.0 %), placenta accreta and/or increta(20.0 %), and placenta previa (6.7 %) in orders. The associated risk factors of cesarean hysterectomy were prior cesarean delivery (46.7 %) and placenta previa (6.7 %). The postoperative complications were anemia (60.0%), febrile morbidity (13.3 %), paralytic ileus (6.7 %), and wound disruption (6.7 %). We concluded that risk factors of cesarean hysterectomy were cesarean delivery, prior cesarean delivery, uterine myoma with pregnancy, placenta accreta and/or increta, and placenta previa and that sufficient fresh blood and careful prenatal care were needed in risk group of postpartum bleeding.
Adult ; Anemia ; Gynecology ; Hemorrhage ; Humans ; Hysterectomy* ; Incheon ; Incidence ; Intestinal Pseudo-Obstruction ; Leiomyoma ; Maternal Mortality ; Obstetrics ; Placenta Accreta ; Placenta Previa ; Postoperative Complications ; Postoperative Hemorrhage ; Postpartum Period ; Pregnancy ; Prenatal Care ; Risk Factors ; Uterine Inertia ; Wounds and Injuries

The intrauterine fetal death(IUFD) is the death of the fetus prior to complete expulsion or extraction from its mother when the fetus is over 20 weeks gestation or weights more than 500 gm. This is a clinical study of 262 cases of IUFD and 262 control cases among 18542 deli-veries at Chung Goo Sung Sim Hospital during 10 years from 1987 to 1996. The results obtain-ed were as follows: 1. The incidence of IUFD was 1.41%. 2. The risk of IUFD was high in women older. 3. The risk of IUFD was high in women with parity of three or more, there was a previous history of IUFD in 11.2% of the IUFD cases and in 6.3% of the control cases, but there was no difference between the two groups of women in history of spontaneous abortion. 4. The sex ratio of male versus female was 1.24:1 in the IUFD cases, 1.11:1 in the control cases. 5. The low birth weight and preterm infants were much more frequent in the IUFD cases. 6. The mode of delivery IUFD was induced labor(77.5%), laparotomy(12.2%), spontaneo- us delivery(10.3%). The indications for laparotomy were placental abruption, placenta previa, transverse lie, previous cesarean section status, cephalopelvic disproportion and uterine rupture. 7. The most common cause of IUFD was unexplained causes(45.1%). 8. There were 67 cases(25.6%) of maternal complication, and the most common complica- tion was fever(35.8%). 9. In the incidence of abnormal coagulation test, the low platelet count(<100,000/mm3) was 8.0%, the prolonged prothrombin time(>14 seconds) was 7.2%, the prolonged partial thr- omboplastin time was 1.0%, the hypofibrinogenemia(<150mg/dl) was 7.2% and the elevated fibrinogen degradation products(>40 ug/ml) was 8.4%. 10. The risk of IUFD was lowered as the number of antenatal care was increased.
Abortion, Spontaneous ; Abruptio Placentae ; Blood Platelets ; Cephalopelvic Disproportion ; Cesarean Section ; Female ; Fetal Death* ; Fetus ; Fibrinogen ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Laparotomy ; Male ; Mothers ; Parity ; Placenta Previa ; Pregnancy ; Prothrombin ; Sex Ratio ; Uterine Rupture ; Weights and Measures