Han Soo Kim

Diagnosis in the first trimester of placenta accreta with previous Cesarean section

The prenatal diagnosis of adherent placenta is clinically very important, as this condition can seriously affect perinatal mortality and morbidity. The outcome is generally worse in cases with a history of Cesarean section. Here we report a case of placenta increta associated with previous Cesarean delivery, diagnosed by sonography during the first trimester, enabling earlier counseling of the parents and planning of appropriate treatment. Copyright

P46.07: Perinatal outcome according to umbilical artery blood flow velocity waveform of term pregnancies with small for gestational age pregnancies

outcome were significantly increased in infants with abnormal S/D ratio (P < 0.001). When logistic regression analysis was performed after adjusting for gestational age, the odds ratio for poor perinatal outcome was 3.7 in the group showing abnormal S/D ratio (95% confidence interval 1.42–9.54, P = 0.007). Conclusion: Umbilical artery Doppler velocimetry is shown as a significantly efficient method in predicting perinatal outcome in preterm neonates with small-for-gestational age, and it may be useful in managing preterm patients with small-for-gestational age fetuses.

P46.05: Umbilical artery Doppler study as a predictive marker of perinatal outcome in preterm pregnancies with small for gestational age

Objectives: Fetal kidney produces amniotic fluid and it is crucial for the fetal and development maturation. To evaluate fetal renal function by analyzing the hemodynamics of fetal renal artery and the renal volume, we have measured them in normal fetuses after 20 weeks of gestation using the color Doppler and 3D sonography. Methods: After obtaining informed consent from 66 pregnant women with healthy fetuses, the following investigations were performed every 4 weeks after 20 weeks of gestation.: (1) Hemodynamic analysis: maximum systolic velocity (Vmax), mean velocity (Vmean), minimal velocity (Vmin), arterial cross sectional area (Area), resistance index (RI) and pulsatility index (PI) of the fetal renal artery (2) Fetal renal volume. Results: All hemodynamic indexes except RI and PI increased significantly with the course of pregnancy. Vmax, Vmean and area of the renal artery increased significantly from 21.80 ± 0.40 cm/s, 9.56 ± 0.17 cm/s and 6.78 ± 0.25 mm2 at 20–24 weeks to 41.59 ± 0.46, 20.15 ± 0.22 and 10.12 ± 0.19 at 37–40 weeks, respectively (P < 0.05). Renal Volume of the fetal kidney also increased significantly between the 20–24 weeks and the 37–40 weeks (1.375 ± 1.41 mm2 vs. 11.21 ± 1.63 mm2, P < 0.003). Conclusions: We have clarified the changes of fetal renal hemodynamic indexes and the fetal renal volume during the normal course of pregnancy. These indices might be used for the evaluation of fetal renal function in the near future.

Percutaneous Mitral Balloon Valvotomy in Patients with Restenosis after Surgical Commissurotomy: A Comparative Study

We performed percutaneous mitral balloon valvuloplasty (PMV) in 367 patients to compare the effectiveness of PMV between patients with mitral restenosis after surgical commissurotomy (group 1) and patients with unoperated mitral stenosis (group 2). Twenty-two had undergone closed or open mitral commissurotomy 11.2 years before. There were no significant differences in clinical profiles between the two groups. The mitral valve area was increased from 1.0 +/- 0.8 to 1.8 +/- 0.6 cm2 in group 1 and 0.9 +/- 0.3 to 2.0 +/- 0.7 cm2 in group 2 (p > 0.05). The mitral gradient was decreased from 14 +/- 5.9 to 6 +/- 2.6 mmHg in group 1 and 18 +/- 7.0 to 7 +/- 5.3 mmHg in group 2 (p > 0.05). The increment of mitral regurgitation and significant left to right shunt after PMV were not significantly different (10% versus 14.7%, 5% versus 10.4% respectively). Optimal results were attained in 75% of the patients in group 1 and in 84.3% of the patients in group 2 (p > 0.05). These results suggest PMV in mitral restenosis after surgical commissurotomy may be safe in selected patients and may be equally effective as in unoperated mitral stenosis.