Hee Young Cho

Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients

Purpose The aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation. Methods We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL. Results Sixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis. The overall success rate was 75% (48/64) for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05). The drainage amount over 1 hour was 500 mL (20–1200 mL) in the balloon failure group and 60 mL (5–500 mL) in the balloon success group (p<0.01). Conclusion Intrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance.

Development of a Screening Tool for Predicting Adverse Outcomes of Gestational Diabetes Mellitus: A Retrospective Cohort Study.

AbstractGestational diabetes mellitus (GDM) is a common disease in pregnancy causing maternal and fetal complications. To prevent these adverse outcomes, optimal screening and diagnostic criteria must be adequate, timely, and efficient. This study suggests a novel approach that is practical, efficient, and patient- and clinician-friendly in predicting adverse outcomes of GDM. The authors conducted a retrospective cohort study via medical record review of patients admitted between March 2001 and April 2013 at the Severance Hospital, Seoul, South Korea. Patients diagnosed by a conventional 2-step method were evaluated according to the presence of adverse outcomes (neonatal hypoglycemia, hyperbilirubinemia, and hyperinsulinemia; admission to the neonatal intensive care unit; large for gestational age; gestational insulin therapy; and gestational hypertension). Of 802 women who had an abnormal 50-g, 1-hour glucose challenge test, 306 were diagnosed with GDM and 496 did not have GDM (false-positive group). In the GDM group, 218 women (71.2%) had adverse outcomes. In contrast, 240 women (48.4%) in the false-positive group had adverse outcomes. Women with adverse outcomes had a significantly higher body mass index (BMI) at entry (P = 0.03) and fasting blood glucose (FBG) (P = 0.03). Our logistic regression model derived from 2 variables, BMI at entry and FBG, predicted GDM adverse outcome with an area under the curve of 0.642, accuracy of 61.3%, sensitivity of 57.2%, and specificity of 66.9% compared with the conventional 2-step method with an area under the curve of 0.610, accuracy of 59.1%, sensitivity of 47.6%, and specificity of 74.4%. Our model performed better in predicting GDM adverse outcomes than the conventional 2-step method using only BMI at entry and FBG. Moreover, our model represents a practical, inexpensive, efficient, reproducible, easy, and patient- and clinician-friendly approach.

Impact of adolescent pregnancy on hypertension in postmenopausal women.

Objective: Several studies have reported the detrimental effects on maternal health due to pregnancy during adolescence, but no studies have reported the influence of adolescent pregnancy on blood pressure in womens later life. Method: We investigated whether there was an association between adolescent pregnancy and the risk of hypertension in Korean postmenopausal women. This study used the data of 2538 postmenopausal women from the Korean National Health and Nutrition Examination Survey in 2010–2011. Multivariate logistic regression analyses were used to evaluate the independent association between adolescent pregnancy and hypertension by adjusting for potential confounding factors. Results: Postmenopausal women with a history of adolescent pregnancy had a higher prevalence of hypertension than those without a history of adolescent pregnancy. After fully adjusting for potential confounding factors such as age, lifestyle, sociodemographic factors, known hypertension risk factors, and reproductive factors, a history of adolescent pregnancy was significantly associated with hypertension (odds ratio, 1.702; 95% confidence interval, 1.125–2.574). Conclusion: This study showed that a history of adolescent pregnancy is significantly and independently associated with a higher risk of hypertension in postmenopausal women.

Feasibility of three-dimensional reconstruction and automated measurement of fetal long bones using 5D Long Bone

Objective To evaluate the feasibility of five-dimensional Long Bone (5D LB), a new technique that automatically archives, reconstructs images, and measures lengths of fetal long bones, to assess whether the direction of volume sweep influences fetal long bone measurements in three-dimensional (3D) ultrasound and 5D LB, and to compare measurements of fetal long bone lengths obtained with 5D LB and those obtained with conventional two-dimensional (2D) and manual 3D techniques. Methods This prospective study included 39 singleton pregnancies at 26+0 to 32+0 weeks of gestation. Multiple pregnancies, fetuses with multiple congenital anomalies, and mothers with underlying medical diseases were excluded. Fetal long bones of the lower extremities-the femur, tibia, and fibula were measured by 2D and 3D ultrasound, and 5D LB, by an expert and non-expert examiner. First, we analyzed the 3D ultrasound and 5D LB data according to 2 different sweeping angles. We analyzed intra- and inter-observer variability and agreement between ultrasound techniques. Paired t-test, interclass correlation coefficient, and Bland-Altman plot and Passing-Bablok regression were used for statistical analysis. Results There was no statistical difference between long bone measurements analyzed according to 2 different volume-sweeping angles by 3D ultrasound and 5D LB. Intra- and inter-observer variability were not significantly different among all 3 ultrasound techniques. Comparing 2D ultrasound and 5D LB, the interclass correlation coefficient for femur, tibia, and fibula was 0.91, 0.92, and 0.89, respectively. Conclusion 5D LB is reproducible and comparable with conventional 2D and 3D ultrasound techniques for fetal long bone measurement.

The association between maternal hyperglycemia and perinatal outcomes in gestational diabetes mellitus patients: A retrospective cohort study.

AbstractPregnancies complicated by gestational diabetes mellitus (GDM) are associated with increased risks of adverse maternal and fetal outcomes. The risks of adverse pregnancy outcomes differ depending on the glucose values among GDM patients. For accurate and effective prenatal counseling, it is necessary to understand the relationship between different maternal hyperglycemia values and the severity of adverse outcomes. With this objective, this study reexamines the relationship between maternal hyperglycemia versus maternal and perinatal outcomes in GDM patients. For this study, maternal hyperglycemia was diagnosed using the 2-step diagnostic approach.Medical records of 3434 pregnant women, who received the 50-g glucose challenge test (GCT) between March 2001 and April 2013, were reviewed. As a result, 307 patients were diagnosed with GDM, and they were divided into 2 groups according to their fasting glucose levels. A total of 171 patients had normal fasting glucose level (<95 mg/dL), and 136 patients had abnormal fasting glucose level (≥95 mg/dL). The 50-g GCT results were subdivided by 20-unit increments (140–159, n = 123; 160–179, n = 84; 180–199, n = 50; and ≥200, n = 50), and the maternal and perinatal outcomes were compared against the normal 50-g GCT group (n = 307).Maternal fasting blood glucose (FBG) level showed clear association with adverse perinatal outcomes. The odds ratio (OR) of macrosomia was 6.72 (95% CI: 2.59–17.49, P < 0.001) between the 2 groups. The ORs of large for gestational age (LGA) and neonatal hypoglycemia were 3.75 (95% CI: 1.97–7.12, P < 0.001) and 1.65 (95% CI: 0.79–3.43, P  =  0.183), respectively. Also, the results of the 50-g GCT for each category showed strong association with increased risks of adverse perinatal outcomes compared to the normal 50-g GCT group. The OR of macrosomia (up to 20.31-fold), LGA (up to 6.15-fold), and neonatal hypoglycemia (up to 84.00-fold) increased with increasing 50-g GCT result.

Safety of Exposure From Extremely Low Frequency Magnetic Fields During Prenatal Ultrasound Examinations in Clinicians and Pregnant Women

Abstract Investigations into the safety of ultrasonography in pregnancy have focused on the potential harm of ultrasound itself. However, no data have been published regarding the electromagnetic fields that ultrasound devices might produce. This study is the first to measure extremely low-frequency magnetic field (ELF-MF) exposure of clinicians and pregnant women during prenatal ultrasound examinations in the examination room from 2 different ultrasound devices and compare them with ELF-MFs during patient consultation in the consulting room. The ELF-MF intensities that clinicians and pregnant women were exposed to were measured every 10 seconds for 40 prenatal ultrasound examinations using Philips iU22 or Accuvix V20 Prestige machines and 20 patient consultations in a consulting room using portable ELF-MF measurement devices. The mean ELF-MF exposure of both clinicians and pregnant women was 0.18 ± 0.06 mG during prenatal ultrasound examination. During patient consultation, the mean ELF-MF exposures of clinicians and pregnant women were 0.10 ± 0.01 and 0.11 ± 0.01 mG, respectively. Mean ELF-MF exposures during prenatal ultrasound examination were significantly higher than those during patient consultations (P < 0.001 by Mann–Whitney U test). Our results provide basic reference data on the ELF-MF exposure of both clinicians and pregnant women during prenatal ultrasound monitoring from 2 different ultrasound devices and patient consultation, all of which were below 2 mG, the most stringent level considered safe in many studies, thus relieving any anxiety of clinicians and pregnant women regarding potential risks of ELF-MFs.

The Delta Neutrophil Index as a predictive marker of histological chorioamnionitis in patients with preterm premature rupture of membranes: A retrospective study

Background Histological chorioamnionitis (HCA) is related to perinatal morbidity. However, there is no definite diagnostic method for detecting chorioamnionitis before delivery. Methods We evaluated whether the delta neutrophil index (DNI) was an effective early marker of HCA in patients with preterm premature rupture of membranes (PPROM). We retrospectively evaluated 149 women diagnosed with PPROM (gestational age, 20+0 to 36+6 weeks) at Severance Hospital from January 2013 to December 2014. The women were categorized into the following two groups: (a) PPROM without HCA and (b) PPROM with HCA. The maternal white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP) level, and DNI were measured at admission. The DNI has been reported to reflect the fraction of circulating immature granulocytes associated with infection. Results Of the 149 patients, 87 were included in the PPROM without HCA group and 62 were included in the PPROM with HCA group. The interval between admission and delivery was significantly shorter in the PPROM with HCA group than in the PPROM without HCA group. There was no significant difference in the maternal WBC count. The serum CRP level, NLR, and DNI were significantly lower in the PPROM without HCA group than in the PPROM with HCA group, while the lymphocyte count was significantly lower in the PPROM with HCA group than in the PPROM without HCA group. A predictive equation was generated by combining the DNI, lymphocyte count, and CRP level, and the sensitivity and specificity for predicting a placental inflammatory response were 69.1% and 70.5%, respectively. Conclusions The DNI could be a predictive marker for HCA in patients with PPROM. Our predictive equation involving the DNI, lymphocyte count, and CRP level may be helpful for predicting the placental inflammatory response in patients with PPROM.

Increased delta neutrophil index in women with severe preeclampsia

The pathophysiology of preeclampsia (PE) is believed to be associated with a systemic inflammatory response, but few inflammatory markers are currently available to predict PE. Therefore, the aim of this study was to compare the serum delta neutrophil index (DNI) between normal and preeclamptic women.

Image Settings Affecting Nuchal Translucency Measurement Using Volume NT™ Software

Purpose To evaluate the effects of the deviation from the mid-sagittal plane, fetal image size, tissue harmonic imaging (THI), and speckle reduction filter (SRF) on the measurement of the nuchal translucency (NT) thickness using Volume NT™ software. Materials and Methods In 79 pregnant women, NT was measured using Volume NT™. Firstly, the three-dimensional volumes were categorized based on the angle of deviation in 10° intervals from the mid-sagittal plane. Secondly, the operator downsized the fetal image to less than 50% of the screen (Method A) and by magnifying the image (Method B). Next, the image was magnified until the fetal head and thorax occupied 75% of the screen, and the NT was measured (Method C). Lastly, NT values were acquired with THI and SRF functions on, with each function alternately on, and with both functions off. Results The mean differences in NT measurements were -0.09 mm (p<0.01) between two-dimensional (2D) and a deviation of 31-40° and -0.10 mm (p<0.01) between 2D and 41-50°. The intraclass correlation coefficients (ICC) for 2D-NT and NT according to image size were 0.858, 0.923, and 0.928 for methods A, B, and C, respectively. The ICC for 2D-NT and NT with respect to the THI and SRF were 0.786, 0.761, 0.740, and 0.731 with both functions on, THI only, SRF only, and with both functions off, respectively. Conclusion NT measurements made using Volume NT™ are affected by angle deviation from the mid-sagittal plane and fetal image size. Additionally, the highest correlation with 2D-NT was achieved when THI and SRF functions were used.