Uterine inversion is a condition in which the uterus turns inside out with the fundus prolapsing to or through the cervix. Uterine inversion is classified into puerperal or nonpuerperal. Non-puerperal uterine inversion is a rare entity with no accurate estimate regarding its incidence available to date. A case of 25 year-old primipara with a one year history of abnormal uterine bleeding is presented. Her only pregnancy was 5 years prior to admission. She delivered a term baby girl of unrecalled birth weight vaginally, with no reported intrapartal or postpartum complications. Internal examination revealed a palpable mass within the middle third of the vagina measuring 4.0cm x 4.0cm x 4.0cm, doughy, with a smooth, spongy surface, seemingly prolapsed out of a smooth dilated cervix. The uterine corpus was not appreciated on bimanual examination. The patient was diagnosed to have uterine inversion and underwent conservative surgical reduction of the uterus initially with a vaginal approach using the Kustner technique which was later converted to an abdominal repair via the Haultain procedure. Non puerperal uterine inversion can be diagnosed and successfully managed in a lowresource environment, but may require the utilization of elements from several standard techniques before reduction is accomplished.

Human ; Female ; Adult ; Uterine Inversion ; Birth Weight ; Vagina ; Term Birth ; Parity ; Postpartum Period ; Uterine Hemorrhage

PURPOSE: To compare the secular trends of gestational length distribution in singleton and twin birth by analyzing the birth certificated data of Statistics Korea. METHODS: The birth certificated data of Statistics Korea was used for this analysis (1997~99: 1,850,236 births, 2011~13: 1,325,301 births). The data of triplet birth cases, extra-marital birth, non-hospital birth cases, teenage birth, and gestational length information missing cases were excluded. Odds ratio and 95% confidence intervals were calculated from multinomial logistic regression analyses to describe the secular trend (1997~99 and 2011~13) of early preterm birth rate (≤33 weeks), late preterm birth rate (34~36 weeks), term birth rate (37~41 weeks), and post-term birth rate (≥42 weeks) adjusted for maternal age (20, 25, 30, 35, 40), birth order (1st=1, 2nd=2, ≧3rd=3), infantile gender (male=1, female=0), maternal occupation (none=1, yes=0), and education (≤middle=1, high=2, college/university=3). RESULTS: From phase I (1997~99) to phase II (2011~13), the gestational length distribution in singleton and twin births shifted the left and toward shorter gestational distribution, and mean gestational length decreased from 39.4 weeks to 38.7 weeks in singleton birth, and decreased from 36.9 weeks to 35.7 weeks in twin birth, During the period, the term birth rate of singleton birth was unchanged at 95 percent, but the term birth rate of twin birth was decreased from 65.7 percent to 46.1 percent. The odds ratio of early preterm birth, late preterm birth, term birth rate, and post-term birth rate in singleton birth for phase II were, respectively, 1.138 (95% confidence interval: 1.106~1.171), 1.556 (1.532~1.581), 1.094 (1.081~1.107), and 0.113 (0.109~0.118), compared with rate of each gestational length for phase I. The odds ratio of each gestational length in twin birth of phase II, comparing phase I, were 1.495 (1.405~1.590) for early preterm birth, 2.110 (2.029~2.194) for late preterm birth, 0.444 (0.428~0.461) for full term birth, and 0.055 (0.026-0.117) for post-term birth. CONCLUSION: The risk of early preterm birth, late preterm birth between phase I & II increased higher in twin birth than that of singleton birth. The rise in early and late preterm birth, and decrease in mean gestational length in singleton and twin birth during the period. There was a need to more research in this area to understand the contributing factors to gestational length.
Birth Order ; Birth Rate ; Education ; Humans ; Korea ; Logistic Models ; Maternal Age ; Occupations ; Odds Ratio ; Parturition* ; Premature Birth ; Term Birth ; Triplets ; Twins*

We aimed to determine the maternal characteristics (demographics, an obstetric history, and prior cervical excisional procedure) associated with a short mid-trimester cervical length (CL, defined as a CL of ≤ 25 mm) and whether having a short cervix explains the association between these maternal characteristics and spontaneous preterm delivery (SPTD, defined as a delivery before 34 weeks). This is a single-center retrospective cohort study of 3,296 consecutive women with a singleton pregnancy who underwent routine CL measurement between 20 and 24 weeks. Data were collected on maternal age, weight, height, parity, obstetric history (nulliparity; a history of at least 1 SPTD; and at least 1 term birth and no preterm birth [low-risk history group]), and prior cervical excisional procedure. In the multivariate regression analysis, an obstetric history, prior cervical excisional procedure, and gestational age at measurement were the variables significantly associated with short CL. In contrast, maternal weight, height, age, and parity were not significantly associated with short CL. By using the likelihood of SPTD as an outcome variable, logistic regression indicated that short CL and obstetric history, but not prior cervical excisional procedure, were significantly associated with SPTD after adjustment for potential confounders. A history of SPTD and prior cervical excisional procedure were associated with an increased risk of a short mid-trimester CL. A history of SPTD, but not prior cervical excisional procedure, is associated with an increased risk of SPTD, independent of a short CL.
Cervix Uteri ; Cohort Studies ; Female ; Gestational Age ; Humans ; Logistic Models ; Maternal Age ; Parity ; Pregnancy ; Premature Birth ; Retrospective Studies ; Term Birth

BACKGROUND: Although preterm delivery is the most common cause of infant morbidity and mortality, an obvious cause cannot be found in most cases. Preterm delivery is known to be the most important risk factor for preterm birth in a subsequent pregnancy. We aimed to evaluate the recurrence rate of premature births for subsequent pregnancies in women with a history of a preterm birth. METHODS: Study data were collected from the Korea National Health Insurance (KNHI) claims database and data from a national health-screening program for infants and children. We enrolled women who had their first delivery between January 1, 2007 and December 31, 2007 and a subsequent delivery before 2014. RESULTS: Preterm delivery had a significant higher risk of preterm birth in a subsequent singleton pregnancy. The risk of preterm birth at second pregnancy was 2.2% in women whose first delivery at ≥ 37 weeks and 18.6% in women whose first delivery at 37 weeks (relative risks [RR], 8.64; 95% confidence interval [CI], 7.94–9.40). In the analysis of the third pregnancy, we compared women with an initial term birth followed by preterm birth and women with an initial preterm birth followed by a subsequent term birth. A history of a just preceding preterm birth at 37 weeks was the most relevant factor for recurrence of preterm delivery in a subsequent pregnancy (26.6%, RR, 4.01; 95% CI, 2.45–6.58). CONCLUSION: We found that the prognosis of a third pregnancy was more closely related to the outcome of the second pregnancy to that of the first pregnancy.
Child ; Female ; Humans ; Infant ; Korea* ; Mortality ; National Health Programs ; Pregnancy* ; Premature Birth* ; Prognosis ; Recurrence ; Risk Factors ; Term Birth

The ultrasonic estimation of fetal weight at delivery is of important prognostic significance in obstetrical practice. The convertional regression formulas used for estimating fetal weight have the disadvantage of less reliability. In this study, we used the back propagation neural network (BP) to estimate Fetal Weight. Some input variables were adopted in constructing the BP model: biparietal diameter (BPD), cerebellum transverse diameter (TCD), abdominal circumference (AC), liver length (LL), femur length (FL), fetal thigh soft tissue thickness (FSTT), and gestational age (GA). The fetal weights of 109 singleton fetuses were estimated. In the training group and validation group, coincidence rates were 89.77% and 76.19% respectively. The results show that the estimation based on neural network is more accurate than that by regression method. GA, its unit is not week but day in our formulas, is very valuable in combination with other ultrasonic parameters on estimation.
Anthropometry ; methods ; Birth Weight ; Female ; Fetal Weight ; Gestational Age ; Humans ; Infant, Newborn ; Neural Networks (Computer) ; Pregnancy ; Regression Analysis ; Term Birth

PURPOSE: Since 1997, private postnatal care facilities (San-hu-jo-ri-won in Korean) have emerged to take the role of the family. As a result, neonates are now exposed to many people and are very vulnerable to infection. However, there has been no study on the influence of postnatal care facilities on neonatal infection. The aim of this study was to determine the risk factors of neonatal infection in full-term babies in Korea. MATERIALS and METHODS: We followed up 556 pregnant women and their babies for 4 weeks after their births at 2 hospitals in Seoul and Daejeon from October 2004 to September 2005. Among 512 full-term babies, 58 had infectious diseases. To determine the risk factors for infection, 53 infected neonates at 4-28 days of life and 413 healthy neonates were compared. RESULTS: The incidence of neonatal infection at 4 to 28 days after birth was 10.5%. After adjusting the related factors, the number of siblings (OR = 2.05, 95% CI = 1.13-3.71 for 1 or more) and postnatal care facilities or home aides (OR = 1.91, 95% CI = 1.07-3.45) were significant risk factors. Formula or mixed feeding (OR = 1.66, 95% CI = 0.91-3.04) increased the risk of neonatal infection but it was not statistically significant. CONCLUSION: When the newborns had siblings, stayed at postnatal care facilities, or were cared for by home aides, the risk of neonatal infections significantly increased. Further research on the feeding effect on neonatal infection and evaluation of prevention efforts are needed.
Communicable Diseases/*epidemiology ; Female ; Humans ; Infant, Newborn ; Korea/epidemiology ; Mothers ; Risk Factors ; *Term Birth

PURPOSE: This study was performed to explore the weight variations in high-risk term newborns hospitalized during the early postnatal period. METHODS: A retrospective explorative study was performed with 64 term newborns who were hospitalized in the NICU after birth. Data on daily weight, birth information, and clinical features such as phototherapy, placements, nutritional status were reviewed through medical records for 14 days of life. General Linear Model, GLM was applied to analyze the weight variation by clinical features of these high-risk term newborns for 14 days of life. RESULTS: Newborns at 40 weeks of gestation showed little weight loss during the few days after birth then steadily gained weight to 7.6% at the 14th day. Infants born at 37-39 gestation showed little weight gain for 14 days though the weight loss itself was not apparent. As well, return to birthweight was not observed in newborns with phototherapy, infants placed on a warmer or infants having gastrointestinal dysfunction for 14 days of life. CONCLUSION: Even for term newborns, physiologic weight loss may not be warranted even if newborn is born at less than 40 week of gestation, or with high-risk conditions that warrant admission to NICU.
Birth Weight ; Humans ; Infant ; Infant, Newborn* ; Intensive Care Units, Neonatal ; Linear Models ; Medical Records ; Nutritional Status ; Parturition ; Phototherapy ; Pregnancy ; Retrospective Studies ; Term Birth ; Weight Gain ; Weight Loss

OBJECTIVE: To compare the distribution and expression of hsp60 and hsp27 in placental trophoblast between preterm and term placenta and to observe hsp immune response in relation to the pathogenesis of preterm birth. METHODS: 22 cases of preterm trophoblast, between 24 weeks and 36 weeks gestation, which were developed spontaneous onset or less than 24 hours after rupture of membrane were obtained. And aged-matched, 22 cases of normal term trophoblast, as control were also obtained after informed consent from each patient. The protein extraction form trophoblast was stained by immunohistochemical methods and was measured by the assay of Western blots. And the density of band using Image-writer were taken and statistical assay were performed as significance <0.05. RESULTS: The expressions of hsp60 and hsp27 in trophoblast of preterm and term placenta were identified by immunohistochemical staining method. The hsp60 had significantly higher expression in trophoblast of preterm birth than in that of term birth (P<0.001) and the hsp27 also had significantly higher expression in trophoblast of preterm birth than in that of term birth (P<0.02) CONCLUSION: The higher expression of hsp60 and hsp27 in trophoblast of preterm birth might be suggested the development of immune response to occur preterm labor Further study are necessary to determine the exact actions of hsp60 and27 in trophoblast and to understand the immune mechanism of preterm birth.
Blotting, Western ; Chaperonin 60 ; Female ; Heat-Shock Proteins ; Hot Temperature ; Humans ; Informed Consent ; Membranes ; Obstetric Labor, Premature ; Placenta ; Pregnancy ; Premature Birth ; Rupture ; Term Birth ; Trophoblasts

PURPOSE: The unique nutrient requirements of premature infants necessitate knowledge of the composition of human milk produced by mothers of such infants. We investigated longitudinal changes in iron concentration of preterm human milk and compared to those observed in human milk of mothers of 1-week old term infants to determine optimal iron supplementation guidelines when preterm infants are nourished exclusively by breast feeding. METHODS: Human milk samples were collected at 1, 2, 4, 6, 8 and 12 weeks postpartum from 103 mothers who delivered infants of gestational age <34 weeks or weighing <1,800 g. Term human milk samples were collected at 1 week postpartum from 24 mothers. RESULTS: There were no significant differences in the iron concentrations of preterm human milk obtained at 2 to 8 weeks postpartum (36.3+/-23.1 to 45.8+/-26.0 microg/dL), but these concentrations were higher than those noted at 1 week in preterm (23.1+/-14.6 microg/dL) and term (25.2+/-7.55 microg/dL) infants. The iron concentration in preterm human milk obtained at corrected term age (42.2+/-19.4 microg/dL) was significantly higher than that of mature term human milk (25.2+/-7.55 microg/dL). CONCLUSION: The concentration of iron in preterm human milk was consistently low during the first 3 months of lactation. Supplementation with iron of at least 2 mg/kg/day should be considered for preterm infants who are exclusively breastfed and who have low body iron stores, to meet the minimum enteral iron requirements recommended by AAP-CON (2004).
Breast ; Female ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Iron ; Lactation ; Longitudinal Studies ; Milk, Human ; Mothers ; Postpartum Period ; Premature Birth ; Term Birth

OBJECTIVE: To determine the clinical characteristics and videofluoroscopic swallowing study (VFSS) findings in infants with suspected dysphagia and compare the clinical characteristics and VFSS findings between full-term and preterm infants. METHODS: A total of 107 infants (67 full-term and 40 preterm) with suspected dysphagia who were referred for VFSS at a tertiary university hospital were enrolled in this retrospective study. Clinical characteristics and VFSS findings were reviewed by a physiatrist and an experienced speech-language pathologist. The association between the reasons of referral for VFSS and VFSS findings were analyzed. RESULTS: Mean gestational age was 35.1+/-5.3 weeks, and mean birth weight was 2,381+/-1,026 g. The most common reason for VFSS referral was 'poor sucking' in full-term infants and 'desaturation' in preterm infants. The most common associated medical condition was 'congenital heart disease' in full-term infants and 'bronchopulmonary dysplasia' in preterm infants. Aspiration was observed in 42 infants (39.3%) and coughing was the only clinical predictor of aspiration in VFSS. However, 34 of 42 infants (81.0%) who showed aspiration exhibited silent aspiration during VFSS. There were no significant differences in the VFSS findings between the full-term and preterm infants except for 'decreased sustained sucking.' CONCLUSION: There are some differences in the clinical manifestations and VFSS findings between full-term and preterm infants with suspected dysphagia. The present findings provide a better understanding of these differences and can help clarify the different pathophysiologic mechanisms of dysphagia in infants.
Birth Weight ; Cough ; Deglutition ; Deglutition Disorders ; Fluoroscopy ; Gestational Age ; Heart ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Referral and Consultation ; Retrospective Studies ; Term Birth