Haeng-Soo Kim

Sonographic findings of placental lacunae and the prediction of adherent placenta in women with placenta previa totalis and prior Cesarean section

To investigate the value of transvaginal sonographic findings of intraplacental lacunae for predicting adherent placenta and clinical outcome in patients with placenta previa totalis and a history of Cesarean section.

Clinical characteristics of struma ovarii.

OBJECTIVE To evaluate the clinical characteristics of struma ovarii. METHODS Twenty-five cases of struma ovarii were reviewed retrospectively from June 1994 to April 2007. The presenting clinical, radiologic, and pathologic features of the patients were reviewed. RESULTS The mean age of the patients in this study was 45.3 years. The majority was of premenopausal status. Sixteen patients had clinical symptoms such as low abdominal pain, palpable abdominal mass and vaginal bleeding. Although one patient had an abnormal thyroid function test, the laboratory findings normalized after operative treatment. CA-125 levels were elevated in 6 cases. Diagnosis by preoperative imaging studies were 8 dermoid cysts, while only 3 cases were diagnosed as struma ovarii. There were 4 cases of malignant struma ovarii, and no patients with recurrent disease. CONCLUSION Struma ovarii is a rare tumor. The presented clinical, laboratory and radiological findings of patients are very diverse. The diagnosis was confirmed by pathologic findings. The treatment of benign struma ovarii is surgical resection only. The cases of malignant struma ovarii may need adjuvant treatment, but recurrence is uncommon.

Clinical outcomes of pregnancy with one elevated glucose tolerance test value.

Objective: To evaluate clinical outcomes of pregnancies with one elevated glucose tolerance test. Methods: We performed a 50 g glucose challenge test (GCT) in 5019 pregnant women at 24–28 weeks of gestation. In 1170 women with plasma glucose levels over 130 mg/dl, a 100 g oral glucose tolerance test (OGTT) was performed at 28–32 weeks of gestation. During follow‐up, 282 patients were lost and in the 888 cases that were followed‐up, 189 were excluded because of GDM. Therefore 699 study patients were divided into four groups: No Elevated group (NE, N=577) with all four normal 100 g OGTT values, and Groups 1 (N=16), 2 (N=35), and 3 (N=71) with one elevated 100 g OGTT value after 1, 2 and 3 h, respectively. Results: Poor maternal outcomes (NE group, Group 1, Group 2, Group 3: 17.5%, 37.6%, 22.9%, 25.3%) with pre‐eclampsia, cesarean delivery for cephalopelvic disproportion, failure to progress, or fetal distress, was highest in Group 1 (odds ratio 2.94; 95% confidence interval 1.02–8.42). Poor perinatal outcomes (15.8%, 43.1%, 14.3%, 21.1%) with any one of the following; fetal distress, Apgar score of <7 at 5 min, hypoglycemia, respiratory distress syndrome, small for gestational age and perinatal death, was also highest in Group 1 (odds ratio 4.24; 95% confidence interval 1.02–17.52). Conclusion: Pregnancies with one elevated glucose tolerance test value after 1 h exhibited increased adverse maternal and perinatal outcomes compared with the group with all normal OGTT values or the groups with an elevated glucose tolerance test value after 2 or 3 h.

OC014: Clinical significance of sonographic findings in placenta previa with prior Cesarean section

Objective: To evaluate the efficacy of intraplacental lacunae by transvaginal sonography in diagnosing the placenta accreta and increta and the prediction of clinical outcome. Methods: Forty-seven patients delivered in our hospital with history of cesarean section, diagnosis of placenta previa totalis by transvaginal sonography, and postpartum placental pathology were included in the study. Intraplacental lacunae were classified into 4 different grades from 0 to 3 by the degree (HJ Finberg, 1992). Placental pathology was done to all the patients delivered, and in case of hysterectomy, pathologic examination of removed uterus was also performed.Then they were compared with antepartum sonographic findings. Results: The lacunae was found in 8 cases with grade 1, 11 cases with grade 2, 5 cases with grade 3, and they were not showed in 23 cases. Sensitivity, specificity, positive predictive value, and negative predictive value of diagnosing placenta accreta above grade 1 lacunae were 79.2%, 87.0%, 86.4%, and 80%, respectively. When the pathologic diagnosis of placenta and removed uterus were placenta increta or percreta, all sonographic findings were above grade 2 lacunae. Sensitivity, specificity, positive predictive value, and negative predictive value of diagnosing placenta increta with lacunae above grade 2 were 93.8%, 100%, 100%, and 96.9%. Hysterectomy was performed to 17 cases, among them, 1 case showed grade 1 lacuna, 11 cases showed grade 2 lacunae, and 5 cases showed grade 3 lacunae. Without lacunae, no hysterectomy was done. Comparing the absence of lacunae or grade 1 lacunae, the relative risks of cesarean hysterectomy was 17 folds in the above grade 2 lacunae. Conclusions: Lacunar findings of transvaginal ultrasonography in patients with placenta previa totalis and history of cesarean section are very usefulness for diagnosis of placenta accreta and increta. These might be used as a valuable clinical prognostic marker.