OBJECTIVE: To evaluate perinatal outcomes in high risk pregnancy fifty-four women who were delivered of small for gestational age infants were studied antenatally by serially umbilical artery doppler velocimetry in our unit. Five study subjects with loss of end diastolic velocities were excepted. METHODS: Forty-nine study subjects were separated with normal (group I, 12 subjects) and abnormal (group II, 37 subjects) systolic/diastolic (A/B) ratio of umbilical artery. Perinatal outcomes were compared with normal and abnormal group. Fisher's exact test and student t test were used for statistical analysis RESULTS: The group with an abnormal A/B ratio had a signifiamtly higher incidence cesarean section for fetal distress, admission into the neonatal intensive care unit, perinatal death, and adverse perinatal outcome. these data suggest that small for gestational age fetus with normal ratio is at significantly lower risk than are those with abnonnal ratio. CONCLUSION: An abnormal Doppler umbilical artery A/B ratio is a strong predictor of adverse perinatal outcome in small-for-gestational-age-fetuses.
Cesarean Section ; Female ; Fetal Distress ; Fetus* ; Gestational Age* ; Humans ; Incidence ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Pregnancy ; Pregnancy, High-Risk ; Rheology* ; Umbilical Arteries*

No abstract available.
Drug Therapy* ; Uterine Cervical Neoplasms*

No abstract available.
Leiomyoma*

OBJECTIVE: To investigate the clinical impact of absent or reversed end-diastolic (ARED) umbilical artery flow detected before the 34th week of pregnancy in high-risk pregnancies. METHODS: Fifty-eight singleton pregnant women with high-risk factors were included in this retrospective study. Based on the umbilical artery Doppler finding, pregnant women were divided into 3 groups: group 1 (12 subjects) with normal Doppler systolic/diastolic (S/D) ratios; group 2 (30 subjects) with significant abnormal umbilical artery S/D ratios, and group 3 (16 subjects) with ARED flow in the umbilical artery between the 25+0 and 33+6 gestational weeks. Incidence of intrauterine growth retardation (IUGR) and pregnancy-induced hypertension, detection week, diagnosis-to-delivery interval, birth weight and gestational ages at delivery, Apgar scores, emergency cesarean section, neonatal intensive care unit (NICU) admission, admission-to-discharge interval, perinatal mortality (PNM) and morbidity, and neonatal morbidity were registered. Perinatal outcomes were assessed. The data was analyzed using the Mann-Whitney U-test and X-square test. A significant difference was considered present if p was<0.05. RESULTS: The PNM in group 3 in the study was 25% (4/16). Sixteen had ARED flow. Our study shows that fetuses with ARED flow tend to be more severely growth-retarded. Our results also show ARED flow to be associated with poor perinatal outcome. There was a higher incidence of cesarean section for fetal distress, neonatal intensive care unit admission, and lower Apgar scores. Birth weight and gestational age at delivery were lower. The diagnosis-to-delivery interval was shorter. The admission-to-discharge interval was longer. CONCLUSION: An early ARED finding before the 34th week in the umbilical artery is a very serious sign of likely fetal compromise. The perinatal mortality and morbidity rate were high, and there was evidence of acute or chronic hypoxia in most fetuses. It is an indication that extremely careful surveillance should be followed but not necessarily an indication for an emergency delivery.
Anoxia ; Birth Weight ; Cesarean Section ; Emergencies ; Female ; Fetal Distress ; Fetal Growth Retardation ; Fetus ; Gestational Age ; Humans ; Hypertension, Pregnancy-Induced ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Perinatal Mortality ; Pregnancy* ; Pregnancy, High-Risk ; Pregnant Women ; Retrospective Studies ; Umbilical Arteries*

No abstract available.
Arteriovenous Malformations* ; Uterus*

No abstract available.
Arteriovenous Malformations* ; Uterus*

OBJECTIVES: To determine the change in cervical length after cerclage and whether a transvaginal ultrasonographic measurement about change in cervical lengthening after cerclage is predictive of term delivery METHODS: Twenty-nine single pregnant women were suspected as cervical incompetence by using a serial transvaginal ultrasonography. When a shortening of the cervix was substantial before 25 weeks' gestation, a therapeuric McDonald cerclage was applied. The 29 pregnant women had a transvaginal ultrasonographic measurement of the cervix within 48-72 hours before and after cerclage. At each examination, the first measurement was discarded, and the mean of the subsequent three measurements was calculated. Statistical analysis was performed by use of SAS with the significance set at the 5% level. RESULTS: In the 29 single pregnancies examined, the mean cervical length (distance between internal os and external os) before cerclage was 30.0+/-4.5 mm. A cerclage was applied at the mean gestational age of 16.76+/-3.02 weeks. After the cerclage the mean cervical length increased significantly (r=0.895, p=0.0001) to 34.1+/-4.5 mm. There was a significant relation between the gestational age at delivery and the length of postoperative upper cervix (endocervical canal length above suture) (r=0.378, p=0.043). But there was no significant relation between the gestational age at delivery and the following measurements; preoperative cervical length (r=0.348, p=0.064), postoperative cervical length (r=0.279, p=0.143), cervical lengthening (postoperative cervical length - preoperative cervical length) (r=-0.156, p=0.420), length of postoperative lower cervix (endocervical canal length below suture) (r=-0.003, p=0.999). CONCLUSION: Therapeutic McDonald cerclage results in a longer cervical length as measured by transvaginal ultrasonography. The increase in cervical length after cerclage is not a predictive term delivery. But the Length in upper cervix after cerclage correlated with gestational weeks at delivery.
Cervix Uteri ; Female ; Gestational Age ; Humans ; Pregnancy ; Pregnant Women ; Ultrasonography*

PURPOSE: Premature narrowing of the foramen ovale is rare but serious clinical entity. Prenatal narrowing or obstruction of the foramen ovale shows symptoms such as right heart failure, fetal hydrops, triscupid regurgitation, left heart obstructive disease, and supraventricular tachycardia. This study aimed to assess the prenatal diagnosis and postnatal clinical course of restrictive foramen ovale in utero in otherwise normal heart. METHODS: The subjects were five patients diagnosed with restrictive foramen ovale in utero from January 2001 to June 2005 at Chungnam National University Hospital. The diagnostic criteria was defined when the maximum diameter in a 4-chamber view is less than 2.5 mm and there is a continuous doppler velocity at the foramen ovale of more than 0.6m/s. RESULTS: At the time of diagnosis of restrictive foramen ovale, gestation age was 34~37 wks, and chief complaints were fetal arrhythmia(2 cases), pericardial effusion, Ebstein anomaly and subaortic stenosis. Two cases which were diagnosed fetal hydrops and supraventricular tachycardia delivered by emergent cesarian section. Five cases were found to have right heart dilatation on echocardiogram after birth, but right heart dilatation became normalized at day 7 after birth and the clinical courses were not eventful. CONCLUSION: Identifying an obstructed foramen ovale in the fetus warrants the further search for additional cardiac and extracardiac anomalies, which may alter the prognosis. Delivery should be induced if possible in cases of foramen ovale obstruction with signs of cardiac decompensation.
Chungcheongnam-do ; Constriction, Pathologic ; Diagnosis ; Dilatation ; Ebstein Anomaly ; Fetal Heart ; Fetus ; Foramen Ovale* ; Heart Failure ; Heart* ; Humans ; Hydrops Fetalis ; Parturition ; Pericardial Effusion ; Pregnancy ; Prenatal Diagnosis* ; Prognosis ; Tachycardia, Supraventricular ; Ultrasonography, Prenatal

OBJECTIVE: Recent epidemiologic studies indicate that use of nonsteroidal anti-inflammatory drugs that inhibit cyclooxygenase (COX) activity reduce the risk of colorectal cancer. COX-2 expression has been identified in cancers of many organs. There are also many reports that identify COX-2 expression and its possible role in tumorigenesis in cervical cancers. This study was performed to determine wether COX-2 is expressed in cervical cancer and to evaluate the value of COX-2 as a predictor of treatment results. PATIENTS AND METHODS: The study included 34 cases of stage IB to IVA cervical cancer and 22 cases of normal cervical specimens obtained through biopsy or surgery at the Chungnam National University Hospital. A COX-2 immunohistochemical stain was performed on these specimens. RESULTS: There was a statistically significant difference of COX-2 positivity between the cervical cancer group and a control group (p=0.01, Fisher's exact test), between the well controlled group and the treatment failure group (p=0.00, Fisher's exact test) and among stages (p=0.01, linear-by-linear association). The COX-2 positive group had a mean overall survival time of 55 months compared with 80 months for COX-2 negative group (p=0.00, log-rank test). The Locally advanced cervical cancer group (stage IIB-IV A) had a mean overall survival time of 46 months compared with 84 months for early stage disease group (stage IB, II A) (p=0.00, log-rank test). A Cox regression model showed that COX-2 positivity and clinical stages retained independent roles in predicting treatment results and prognosis. CONCLUSION: Evaluation of COX-2 expression in cervical cancer patients is valuable for predicting the treatment results and prognosis.
Biopsy ; Carcinogenesis ; Chungcheongnam-do ; Colorectal Neoplasms ; Cyclooxygenase 2* ; Humans ; Prognosis ; Prostaglandin-Endoperoxide Synthases ; Treatment Failure ; Uterine Cervical Neoplasms

OBJECTIVE: The present study was conducted to evaluate the tissue inhibitor of matrix-metalloproteinase (TIMP-2), which leads to tumor proliferation, invasion and metastasis and which can be used as a prognostic factor for cervical carcinoma, and to correlate TIMP-2 with recurrence in cervical carcinoma. METHODS: Thirty-three cases of cervical carcinoma and ten control cervices were analysed for expression of TIMP-2 by immunohistochemical staining. Results were analysed for possible correlation with prognostic factors. RESULTS: Lymph node metastasis, lymphovascular invasion, and recurrence groups showed a lower expression tendency of TIMP-2 in tumor cells (0.67 vs 0.88, 0.77 vs 0.93, 0.78 vs 0.91) (p>0.05). However, there was no statistical significance in the correlation of TIMP-2 expression with tumor variables. On the other hand, in stromal cells, deep invasion (>or=5 mm), squamous cell carcinoma groups showed a higher expression tendency of TIMP-2 (0.80 vs 0.67, 0.74 vs 0.40) (p>0.05) but, there was no statistical significance. However, recurrence group showed a significantly lower expression of TIMP-2 in stromal cells (0.33 vs 0.83) (p<0.05). CONCLUSION: In spite of no statistically significant correlation in tumor cells, recurrence group showed a significantly lower expression of TIMP-2 in stromal cells. Therefor there was an inverse correlation between expression of TIMP-2 in stromal cell and recurrence. These results indicate that expression of TIMP-2 in stromal cells is closely correlated with the recurrence of cervical carcinoma.
Carcinoma, Squamous Cell ; Hand ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence ; Stromal Cells ; Tissue Inhibitor of Metalloproteinase-2 ; Uterine Cervical Neoplasms