No abstract available.
Nuchal Cord* ; Ultrasonography*

Hyperextended neck of the fetal head is among the various fetal attitudes detected by prenatal sonography. Various etiologies may lead to hyperextension of the fetal head, including fetal anomalies such as structural abnormalities, conjoined twins and fetal neck masses, nuchal cord and uterine factors such as leiomyoma and uterine malformations. The importance of the precise prenatal diagnosis of this condition relates not only to the delivery mode, but also to the detection of associated conditions, as noted above. We report a case of a fetus whose persistent hyperextended neck was detected by midtrimester sonography, and who later demonstrated ventriculomegaly and lung immaturity in the 3rd trimester.
Female ; Fetus* ; Head ; Humans ; Leiomyoma ; Lung ; Neck* ; Nuchal Cord ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third* ; Prenatal Diagnosis ; Twins, Conjoined

PURPOSE:To investigate the significance of umbilical artery acidosis and compare perinatal outcomes according to the types of acidosis for a tertiary hospital population delivered at term. METHODS:We reviewed maternal and neonatal medical records of all term liveborn infants with an umbilical artery pH<7.25 who were delivered at our university-based center for three years. Two hundred seventy two study population were grouped into respiratory (N=137), metabolic (N=103), and mixed (N=32) acidosis. Pregnancy complications and perinatal outcomes were analyzed using student T test and chi square test. RESULTS:The mean umbilical artery pH values of respiratory, metabolic, and mixed acidosis were 7.20+/-.05, 7.16+/-.90, and 7.07+/-.10, respectively. Neonates with pathologic fetal acidemia were more frequent in mixed acidosis and less frequent in respiratory acidosis (P<0.001). However, there were no significant differences in 1min and 5min Apgar scores. The cases with multiple nuchal cords were significantly common in mixed acidosis (P=0.021) and oligohydroamnios was higher in the metabolic acidosis (P=0.037). While the high base deficit (> or =20 mEq/L) and high pCO2 (> or =20 mmHg) were significantly associated with low pH value, the perinatal outcomes were not significantly different according to the level of base deficit or pCO2. CONCLUSION:The mixed acidemia was more associated with pathologic fetal acidemia than pure respiratory or metabolic acidosis. The ability to predict not only metabolic but also respiratory component of fetal acidemia may help in safe management of delivery leading to reduce the fetal acidemia.
Acidosis ; Acidosis, Respiratory ; Humans ; Hydrogen-Ion Concentration ; Infant ; Infant, Newborn ; Medical Records ; Nuchal Cord ; Pregnancy Complications ; Tertiary Care Centers ; Umbilical Arteries

BACKGROUNDS: At present, there is no consensus on the induction methods in term pregnancy with borderline oligohydramnios. This study aimed to compare the effectiveness and pregnancy outcomes of labor induction with dinoprostone or single-balloon catheter (SBC) in term nulliparous women with borderline oligohydramnios. METHODS: We conducted a retrospective cohort study from January 2016 to November 2018. During the study period, a total of 244 cases were enrolled. Of these, 103 cases were selected for induction using dinoprostone and 141 cases were selected for induction with SBC. The pregnancy outcomes between the two groups were compared. Primary outcomes were successful vaginal delivery rates. Secondary outcomes were maternal and neonatal adverse events. Multivariate logistic regression was used to assess the risk factors for vaginal delivery failure in the two groups. RESULTS: The successful vaginal delivery rates were similar between the dinoprostone group and the SBC group (64.1% [66/103] vs. 59.6%, [84/141] P = 0.475), even after adjustment for potential confounding factors (adjusted odds ratio [aOR]: 1.07, 95% confidence interval [CI]: 0.57-2.00, P = 0.835). The incidence of intra-amniotic infection was lower in the dinoprostone group than in the SBC group (1.9% [2/103] vs. 7.8%, [11/141] P < 0.001), but the presence of non-reassuring fetal heart rate was higher in the dinoprostone group than in the SBC group (12.6% [13/103] vs. 0.7%, [1/141] P < 0.001). Multivariate logistic regression showed that nuchal cord was a risk factor for vaginal delivery failure after induction with dinoprostone (aOR: 6.71, 95% CI: 1.96-22.95). There were three factors related to vaginal delivery failure after induction with SBC, namely gestational age (aOR: 1.51, 95% CI: 1.07-2.14), body mass index (BMI) >30 kg/m2 (aOR: 2.98, 95% CI: 1.10-8.02), and fetal weight >3500 g (aOR: 2.49, 95% CI: 1.12-5.50). CONCLUSIONS Term nulliparous women with borderline oligohydramnios have similar successful vaginal delivery rates after induction with dinoprostone or SBC, with their advantages and disadvantages. In women with nuchal cord, the risk of vaginal delivery failure is increased if dinoprostone is used in the induction of labor. BMI >30 kg/m2, large gestational age, and estimated fetal weight >3500 g are risk factors for vaginal delivery failure after induction with SBC.
Administration, Intravaginal ; Catheters ; Dinoprostone/therapeutic use* ; Female ; Fetal Weight ; Humans ; Infant, Newborn ; Labor, Induced/methods* ; Nuchal Cord ; Oligohydramnios ; Oxytocics ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies

PURPOSE: Accidental out-of-hospital deliveries are generally associated with high rates of perinatal morbidity and mortality. To determine the status of accidental out-of-hospital deliveries transferred by emergency medical services (EMS), we analyzed the records of EMS runsheets in two South Korean provinces, Gyeonggi and Gangwon. METHODS: The EMS runsheets of patients who were more than 20 weeks pregnant and had delivery-related symptoms between January 2012 and December 2013 in Gyeonggi and Gangwon province were reviewed retrospectively. We analyzed the characteristics of accidental out-of-hospital deliveries by comparing these with those non out-of-hospital deliveries. RESULTS: There were 1,426 urgent dispatches during the study period. In 137 (9.6%) out-of-hospital deliveries, which took place prior to arriving at the hospital, and 48 of these were attended by EMS providers. The accidental out-of-hospital deliveries were more frequent during night time and more common among multiparous and younger age women; however, these observation was without any significance with respect to premature birth. The rate of the accidental out-of-hospital deliveries was not significantly different between rural and urban areas. Twenty cases of complication, including 10 arrests of neonates and EMS providers managed them by the following intervention: reduction of nuchal cord, umbilical cord clamping and cut, warming-up of and stimulating the neonates warms, using oropharyngeal suction, O₂ supplication, and neonatal cardiopulmonary resuscitation. CONCLUSION: As the rate of accidental out-of-hospital deliveries in patients who were transferred by EMS is higher than the rate of out-of-hospital deliveries in general, EMS providers should be fully trained. Moreover, there is the need for more completive records and continuous education.
Cardiopulmonary Resuscitation ; Constriction ; Education ; Emergencies* ; Emergency Medical Services* ; Female ; Gangwon-do ; Gyeonggi-do ; Humans ; Infant, Newborn ; Mortality ; Nuchal Cord ; Obstetric Labor Complications ; Pregnancy ; Premature Birth ; Retrospective Studies ; Suction ; Umbilical Cord

OBJECTIVE: The purpose of this study was to evaluate the incidence, causes and maternal complications in cases of fetal death in utero (FDIU). METHODS: This is a clinical study of 224 cases of FDIU among 10,582 deliveries at 00 University Hospital during January 1990 to December 2004. All the clinical informations were obtained by reviewing medical records retrospectively. RESULTS: The average incidence of FDIU was 2.1%. The mean age of mothers with FDIU was 28.5 years old. The mean gestational age was 30.4 weeks and mean weight of dead fetus was 1442 gm. The causes of FDIU were placenta abuptio (14.3%), severe preeclampsia (13.4%), congenital anomalies (9.4%), severe intrauterine growth restriction (IUGR, 9.4%), nuchal cord (6.7%), chrioamnionitis (5.8%). However the causes of FDIU were largely unknown (18.8%). The modes of delivery were induced labor (65.2%), laparotomy (26.8%), spontaneous labor (8.0%). The most common indication of laparotomy was placenta abuptio (36.7%). There were 66 cases (29.5%) with maternal complications and common complications were hemorrhage (11.2%), fever (8.5%), DIC (5.8%). The incidence of hypofibrinogenemia (<150 mg/dL) was 14.3%. CONCLUSION: The most common suspected causes of FDIU were placenta abruptio, severe preeclampsia and the causes could not be determined in 42 cases (18.8%). The proper prenatal care should be taken of fetuses on the basis of risk factors of antepartum and intrapartum so that unnecessary intrauterine fetal death might be able to be prevented.
Dacarbazine ; Female ; Fetal Death* ; Fetus ; Fever ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Labor, Induced ; Laparotomy ; Medical Records ; Mothers ; Nuchal Cord ; Placenta ; Pre-Eclampsia ; Pregnancy ; Prenatal Care ; Retrospective Studies ; Risk Factors