G. S. R. Lee

Elective vs. conservative management of ovarian tumors in pregnancy

Objectives: To determine optimal management of the ovarian tumors in pregnancy. Methods: This study included 89 cases of the ovarian tumor in pregnancy that required surgery at Holy Family hospital of the Catholic University from January, 1990 to December, 2001. Among 89 cases, 36 and 53 were emergency and elective surgery, respectively. Students t‐test and the χ2‐test were used for statistical analysis and a P‐value of <0.05 was considered statistically significant. Results: The most common size of torsion of ovarian tumors during pregnancy was 6–10 cm and the incidence was the most frequent during the first trimester of pregnancy. The incidence of preterm delivery (<37 weeks) was higher in emergency surgery, but there was no difference in the gestational age at delivery, also no difference in the birth weight or the method of delivery. Conclusions: Although surgery for ovarian tumors in pregnancy is delayed until the onset of symptoms, adverse pregnancy outcome is not worsened when compared with that after elective surgery. We propose that conservative management would be used in optimal management of pregnant women with ovarian tumors.

Korean-Specific Parameter Models for Calculating the Risk of Down Syndrome in the Second Trimester of Pregnancy

The purpose of the current study was to propose a Korean-specific parameter set for calculating the risk of Down syndrome in the second trimester of pregnancy and to determine the screening performances of triple and quadruple tests in Korean women. Using the data on triple or quadruple screening from three hospitals in Korea during 7 yr, we re-converted the concentrations of four serum markers to multiple of median values according to gestational age and maternal weight. After re-calculating the risk of Down syndrome in each pregnancy by multiplying maternal age-specific risk by the likelihood ratio values for the serum markers, screening performances and optimal cut-off values of triple and quadruple tests were analyzed. Among 16,077 pregnancies, 23 cases had Down syndrome (1.4/1,000 deliveries). Compared to the previous program, the tests with new parameters had improved screening performance. The triple and quadruple tests had detection rates of 65.2% and 72.7%, respectively, at a false-positive rate of 5%. The optimal cut-off value for the quadruple and triple tests was 1:250. We have presented a Korean-specific parameter set for Down syndrome screening. The proposed screening test using this parameter set may improve the performance of Down syndrome screening for Korean women.

P29.03: A case of unicornuate uterus with noncommunicating rudimentary horn with ipsilateral renal agenesis

Rudimentary uterus with ipsilateral renal agenesis is a very rare mullerian duct malformation. The unicornuate uterus is a rare type of the anomalous uteri, which is caused by failure of development of one of the mullerian ducts. The most common clinical presentation is pelvic pain and dysmenorrhea shortly after menarche, in associated with the finding of a vaginal or pelvic mass. An appropriate and prompt diagnosis and treatment will prevent unnecessary procedures and offer relief of symptoms. We presented a rare case of a unicornuate uterus with a noncommunicating horn, and ipsilateral renal agenesis with a brief review of concerned literatures.

P49.12: Clinical efficacy of XI VOCAL in cervical volume measurement for the prediction of preterm delivery in Korea

Objectives: To determine if low cervical volume predicts risk of spontaneous preterm birth in preterm contraction pregnancy. Study design: A prospective study that measured cervical volume by transvaginal XI VOCAL was performed among 100 patients with a singleton pregnancy hospitalized with signs of premature labor between 24 and 36 weeks’ gestation. Result: The rate of preterm birth was 32.2%. The sensitivity, specificity of transvaginal XI VOCAL were, respectively, 72.2%, 65.3% for delivery before 37 weeks’ gestation. When cervical volume was ≤ 17 CC, the gestational age at delivery was significantly lower than when it exceeded 17 CC (P < 0.05). Conclusion: Transvaginal XI VOCAL in cervical volum measurement provides an objective method for evaluating the risk of preterm delivery. Its predictive values are impressive and allow better discrimination between women at high risk of preterm delivery and those in false preterm labor.

P37.02: The validity of 3D/4D ultrasound technique for evaluation of enlarged cisterna magna compared to fetal magnetic resonance imaging and 2D ultrasonogrphy

Acephalus acardiac fetus is a rare condition due to twin reverse arterial perfusion syndrome (TRAP-sequence), affecting 1/35000 pregnancies and about 1% of monochorionic twins. In this condition the donor fetus (pump fetus) provides circulation for itself and the recipient twin, developing progressive heart failure. The acardiac twin is grossly abnormal, with severe reduction anomalies of the upper part of the body. We report a case of an acephalus acardiac fetus presenting at the third trimester scan as a small complex cystic mass. A 34-year-old woman, gravida 1, with a singleton pregnancy, was referred to our unit at 31 weeks and 6 days of gestation for a detailed scan, because of a neck/thorax fetal mass. The scan revealed an IUGR fetus (abdominal circumference at 10th centile) with no evidence of structural anomalies. The umbilical and uterine artery Doppler flow were normal (umbilical artery PI 0.97, 50th centile; RI right uterine artery 0.53; RI left uterine artery 0.45). An intramniotic complex mass, measuring 9 cm × 5 cm, was visualized, independent from fetal structures and from the uterus wall. A little and thin ‘cord-like’ structure connecting the cyst to the placenta was seen. Color and pulsed Doppler showed an umbilical artery flow. The diagnosis of acephalus acardiac twin was therefore suggested. The patient underwent weekly ultrasound examinations. At 35 weeks’ gestation a Cesarean section was performed, because of donor progressive growth restriction, giving birth to a female healthy baby, weighing 2400 g, Apgar 9. Post-mortem examination of the small cystic mass confirmed prenatal diagnosis. Our report demonstrates that TRAP-sequence could present as an intramniotic small complex mass and, regardless of the dimension, affect pump twin growth.

P15.02: A clinical study of cornual pregnancy; comparative study according to the timing of diagnosis

Over the 15 patients with suspected placenta accreta, 7 had corporeal and 8 inferior segment Cesarean section. Over the 7 inferior segment Cesarean sections, 5 extractions were trans-placental. 9 of the 15 cases of placenta accreta successfully benefited conservative management, and 6 hysterectomies had to be realized because of immediate or secondary severe bleeding. Conclusion: Whilst only cases of patients at high risk for placenta accreta are reported in this study, ultrasound global sensibility is only 80% (lacunae seem to be the best sign), and global specificity is only 50%. MRI does not improve prenatal diagnosis in our study. Accuracy improvement of ultrasound and MRI detection of placenta accreta is a condition for confidence prenatal diagnosis based optimal per-partum management.

P11.06: Clinical characteristics and perinatal outcome with isolated oligohydramnios in low‐risk term pregnancies

Objective: This study involving 752 women at 18–24 weeks of pregnancy, to determine the distribution of cervical length. Methods: We studied 752 pregnants with 18th to 24th weeks the inclusion criteria were sonographic confirmation of gestational age in 12th weeks and the absence of any risk factors for preterm birth. Cervical length was measured in a straight line if the cervix did not show any curvature; in the presence of cervical curvature, the measurement was broken down into two or more segments. Results: A statistical divergence exist between fragmented and linear measuring procedures. An average difference of 1.67 mm (±2.67 mm) for 95% [1.48; 1.86]. Up to 21st week maintains a presence of cervical curvature (58.9%), becoming straight after this period of time (54.2%). The cervical length was constant (no have statistical difference) between 752 women at 18–24 weeks of pregnancy. Conclusions: Fragmented and linear measuring procedures for cervical length, are different. In routine ultrasound, the cervical measurement, is most recommended after 21st week (straight after this period of time in 54.2%).

P15.16: The risk factors of emergency cesarean hysterectomy for placenta previa

목적: 이 연구의 목적은 전치 태반 산모에서 응급 제왕 자궁절제술의 임상적 위험요소와 전치 태반의 제 3삼분기 경질 초음파로 응급 제왕 자궁절제술을 예측할 수 있는 지를 알기 위해 조사하였다. 조사 대상 및 방법: 1995년 1월부터 2005년 3월까지 전치 태반으로 제왕 절개술을 시행한 산모의 의무 기록을 후향적으로 비교 분석하여 자궁 절제술을 받은 군과 받지 않은 군으로 나누어 조사하였다. 결과: 연구 기간 중 31명의 전치 태반 산모가 있었으며 3명이 응급 제왕 자궁 절제술을 시행 받았다 (10.83%). 산모의 연령 (31.53±4.41 vs 34.06±4.12, p<0.05), 분만력 (0.81±0.70 vs 1.29±0.63, p<0.05), 기 제왕절개 횟수 (0.36±0.56 vs 0.91±0.75, p<0.05), 전치 태반의 과거력과 유착 태반인 경우에 두 군간의 유의한 차이가 있었으나 재태 연령, 산전 질 출혈, 유산 횟수, 응급 제왕절개술 등은 유의한 차이를 보이지 않았다. 제 3삼분기 경질 초음파 기록에서 자궁 경부로부터의 거리 (1.18±3.66 vs 2.67±2.94, p<0.05)와 하부 태반 변연부 두께 (1.91±1.55 vs 2.96±1.33, p<0.05)는 유의한 차이를 보였으나, 라쿠나 (lacuna)는 유의한 차이를 보이지 않았다. 결론: 전치태반의 경우 응급 제왕 자궁절제술을 시행하게 되는 위험요인은 산모의 유착태반과 태반 부착 부위가 자궁 경부로부터의 양의 방향으로 먼 거리, 태반 변연부의 두꺼운 두께 등이 관련된다. 다른 임상적 위험 요인은 산모 연령, 분만력, 제왕절개 횟수, 전치 태반의 과거력 등이 관련된다.

P09.31: Intrauterine vesicoamniotic shunt of posterior urethral valve at early second trimester

Neonatal morbidities including acute respiratory distress, chronic lung disease, requirement for ventilatory assistance, patent ductus arteriosus, hypotension, and oliguric renal failure had a lower incidence in the laser group. On brain imaging, ischaemic brain injury was seen in 12% of the pre-laser group and none in the laser group of infants (p = 0.01). Conclusions: These findings indicate that perinatal outcomes are improved with less neonatal morbidity for pregnancies with severe TTTS following introduction of a laser program. It is suggested that laser ablation of communicating placental vessels may be the preferred treatment, consistent with the recent results from a randomised controlled trial.

P11.05: Lissencephaly diagnosed by ultrasound and magnetic resonance imaging

Lissencephaly is a rare disorder that is characterized by the disorganized and unlayered cortex. The cause of this disorder is related to chromosomal abnormalities and infection. The pathogenesis of lissencephaly is faulty migration of neuroblast. Lissencephaly is associated with Dandy-Walker syndrome and Miller-Dieker syndrome. A woman at 35 weeks of gestation was transferred to our hospital due to structural abnormality of fetal brain. Fetal brain showed ventricular dilation and decreased sulci in cerebral cortex on prenatal ultrasound examination and we diagnosed this case as lissencephaly. The baby was spontaneously delivered at 37 weeks 3 days of gestation and lissencephaly was confirmed by postnatal magnetic resonance imaging.