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*

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*

No abstract available.
Arteriovenous Malformations* ; Uterus*

No abstract available.
Arteriovenous Malformations* ; Uterus*

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.
Drug Therapy* ; Uterine Cervical Neoplasms*

We report a case of premature constriction of the fetal ductus arteriosus following maternal ingestion of a cyclooxygenase-2 (COX-2) inhibitor at 37 weeks' gestation. Fetal sonography at 38+2 weeks' gestation revealed tricuspid regurgitation, absent transpulmonary valve flow, right heart enlargement, and pericardial effusion. An immediate delivery resulted in a good postnatal outcome with dramatic improvement in the clinical and echocardiographic findings. Maternal exposure to Non-steroidal anti-inflammatory drugs (NSAIDs), especially late in gestation, can cause premature constriction of the ductus arteriosus, heart failure, and fetal death. Therefore, the use of NSAIDs late in gestation should be considered in limited cases with close fetal heart monitoring.
Anti-Inflammatory Agents, Non-Steroidal ; Cardiomegaly ; Constriction ; Cyclooxygenase 2 ; Ductus Arteriosus ; Eating ; Female ; Fetal Death ; Fetal Heart ; Heart ; Heart Failure ; Maternal Exposure ; Pericardial Effusion ; Pregnancy ; Sulfonamides ; Tricuspid Valve Insufficiency

OBJECTIVE: It is well known that X-ray induces follicular atresia, but the exact mechanism of atresia is not still unveiled completely. In addition, the role of macrophage related with clean-up the dead granulosa cells and other functions within the ovarian follicle is emphasized recently. The aim of this study is to assess the radiation-induced morphological changes of ovarian follicles and follicular macrophages. METHODS: 8 Gy X-ray irradiated on the 3-week old rats (Sprague-Dawley strain), sacrificed at 6, 12, and 24 hours after irradiation, and performed morphological studies with light and transmission electron microscopy, TUNEL, and macrophage immunohistochemistry. RESULTS: Follicular atresia increased significantly (p<0.01) at 6 hours after X-irradiation, and it was decreased significantly (p<0.01) at 12 and 24 hours after irradiation. X-ray induced chromatin condensation in the nucleus and nuclear fragmentation of granulosa cells, which were the typical features of apoptosis. Apoptotic granulosa cells were phagocytosed by the neighboring normal granulosa cells and the macrophages. During atresia of follicles, radioresistant granulosa cells were found in some follicles, which showed similar features morphologically with the granulosa cells of normal follicles. Macrophages were found both within the antrum and at the follicular granulosa layer. CONCLUSION: X-radiation induced follicular atresia by means of granulosa cell apoptosis, and radioresistant granulosa cells which have similar features morphologically with the granulosa cells of normal follicles were observed in some follicles. And the macrophages which phagocytose the apoptotic granulosa cells were located within the follicular antrum and at the follicular granulosa layer.
Animals ; Apoptosis ; Chromatin ; Female ; Follicular Atresia* ; Granulosa Cells ; Immunohistochemistry ; In Situ Nick-End Labeling ; Macrophages* ; Microscopy, Electron, Transmission ; Ovarian Follicle ; Radiation, Ionizing ; Rats

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