Jeong Ha Wie

Mesenchymal hamartoma of the chest wall: prenatal sonographic manifestations.

Mesenchymal hamartoma of the chest wall is a rare, benign lesion that arises from one or more ribs, almost exclusively found in infants. Some cases that developed in the fetal period have been reported, but accurate diagnosis was usually possible only after birth, except in a few cases in which fetal magnetic resonance imaging or computed tomography were performed. We present a case of a congenital mesenchymal hamartoma of the chest wall. Although the diagnosis was not confirmed until birth, the prenatal sonographic examination showed strongly suggestive findings. We review the published reports on this condition, and suggest the prenatal sonographic features. Prenatal sonography is valuable in the differential diagnosis of chest mass.

Is it appropriate for Korean women to adopt the 2009 Institute of Medicine recommendations for gestational weight gain

Background The 2009 Institute of Medicine (IOM) guidelines for gestational weight gain (GWG) are intended for use among women in the United States. Little data are available on whether the 2009 IOM recommendations can be applied to Asian women. This study aimed to evaluate whether the recommendations are related to adverse pregnancy outcomes in Korean pregnant women. Methods and findings A retrospective cohort study was conducted for all singleton-pregnant women at a university hospital in Korea. After classifying the enrolled women into four Korean pre-pregnancy body mass index (BMI) categories, the risk of adverse pregnancy outcomes were analyzed for women who gained inadequate or excessive GWG based on 2009 IOM recommendations. Of 7,843 pregnancies, 64.0% of women had normal pre-pregnancy BMI and 42.7% achieved optimal GWG. Across all BMI categories, adverse pregnancies outcomes such as small for gestational age (SGA), large for gestational age (LGA), preterm birth, preeclampsia, and cesarean due to dystocia were significantly associated with GWG (all P ≤ 0.001).Women with normal BMI who gained inadequate weight were more likely to develop SGA and preterm birth and less likely to develop LGA (adjusted odds ratio (aOR) 2.21, 1.33, and 0.54, respectively). Whereas, women with normal BMI who gained excessive weight were more likely to develop LGA, preterm birth, preeclampsia, and cesarean section due to dystocia (aOR 2.10, 1.33, 1.37, and 1.37, respectively) and less likely to develop SGA (aOR 0.60). Conclusions It is tolerable for Korean women to follow recommended GWG from the 2009 IOM guidelines to decrease adverse pregnancy outcomes. This will be helpful for antenatal care on GWG not only for Korean pregnant women, but also other Asian women who have lower BMI criteria than Caucasian women.

Sonographic Parameters for Prediction of Miscarriage Role of 3-Dimensional Volume Measurement

To evaluate the value of volume measurement using 3‐dimensional sonography for prediction of miscarriage.

Effects of Oncostatin M on Invasion of Primary Trophoblasts under Normoxia and Hypoxia Conditions

Purpose To investigate the effect of oncostatin M (OSM) on protein expression levels and enzymatic activities of matrix metalloprotainase (MMP)-2 and MMP-9 in primary trophoblasts and the invasiveness thereof under normoxia and hypoxia conditions. Materials and Methods Protein expression levels and enzymatic activities of MMP-2 and MMP-9 in primary trophoblasts under normoxia and hypoxia conditions were examined by Western blot and zymography, respectively. Effects of exogenous OSM on the in vitro invasion activity of trophoblasts according to oxygen concentration were also determined. Signal transducer and activator of transcription 3 (STAT3) siRNA was used to determine whether STAT3 activation in primary trophoblasts was involved in the effect of OSM. Results OSM enhanced protein expression levels and enzymatic activities of MMP-2 and MMP-9 in term trophoblasts under hypoxia condition, compared to normoxia control (p<0.05). OSM-induced MMP-2 and MMP-9 enzymatic activities were significantly suppressed by STAT3 siRNA silencing under normoxia and hypoxia conditions (p<0.05). Hypoxia alone or OSM alone did not significantly increase the invasiveness of term trophoblasts. However, the invasion activity of term trophoblasts was significantly increased by OSM under hypoxia, compared to that without OSM treatment under normoxia. Conclusion OSM might be involved in the invasiveness of extravillous trophoblasts under hypoxia conditions via increasing MMP-2 and MMP-9 enzymatic activities through STAT3 signaling. Increased MMP-9 activity by OSM seems to be more important in primary trophoblasts.

OP09.03: Serial cervical length as a predictor of histologic chorioamnionitis in late preterm birth: Short oral presentation abstracts

4. Multivariate analysis revealed change of the cervical length between mid-trimester and early third trimester were independently associated with an increased risk for histologic chorioamnionitis in late preterm birth. (adjusted odds ratio(OR) 2.799(95% confidence interval(CI) 1.352-5.796), p=0.006) Conclusion In late preterm birth, greater change of cervical length between mid-trimester and early third trimester is independently associated with an increased risk of histologic chorioamnionitis.

Multiple birth rates of Korea and fetal/neonatal/infant mortality in multiple gestation

Objective This study was conducted to analyze recent trends of multiple birth rates (MBR) and fetal/neonatal/infant mortalities according to the number of gestations in Korea. Methods Data from 2009 to 2015 of live births, infant deaths and stillbirths were obtained from the Korean Vital Statistics. Neonatal mortality rate (NMR), infant mortality rate (IMR), and fetal mortality rate (FMR) in singleton, twin and triplet pregnancies were analyzed according to gestational period (GP; ≤ 23, 24–27, 28–31, and 32–36 weeks). Results From 2009 to 2015, twin and triplet birth rates increased 34.5% and 154.3%, respectively. In twin births, NMR and FMR have been decreased significantly (from 10.92 to 8.62, p = 0.034 and from 41.00 to 30.55, p< 0.001, respectively), but IMR did not show significant decrease. There was no significant change of NMR, IMR, and FMR, in triplet births. Overall, in singleton, twin, and triplet births, NMR was 1.26 ± 0.09, 10.6 ± 1.12, and 34.32 ± 11.72, respectively, and IMR was 2.38 ± 0.26, 14.52 ± 1.38, and 41.13 ± 12.2, respectively. FMRs were 12 ± 1.73, 35.99 ± 3.55, and 88.85 ± 16.55, respectively, in singleton, twin, and triplet pregnancies. In spite of decreasing trends in overall mortalities, the odds ratios of NMRs and IMRs in 2015 were approximately 9-fold and 6-fold higher, respectively, in twin births, and approximately 37-fold and 20-fold higher, respectively, in triplet births, than those in singleton births. There were no significant differences in odds ratios of NMRs and IMRs at GP 32–36 among single, twin, and triplet births, although the odds ratios of FMR at GP 32–36 in triplet gestation was significantly higher than those in singleton and twin gestation. Conclusion Neonatal/infant mortality in multiple births is still significantly high, which is mainly related with preterm birth. Close fetal monitoring is needed to prevent fetal death in triplet pregnancies, after 32 gestational weeks.

Fetal Doppler to predict cesarean delivery for non-reassuring fetal status in the severe small-for-gestational-age fetuses of late preterm and term

Objective To evaluate the significance of fetal Doppler parameters in predicting adverse neonatal outcomes and the risk of cesarean delivery due to non-reassuring fetal status, in severe small for gestational age (SGA) fetuses of late preterm and term gestation. Methods Fetal brain and umbilical artery (UmA) Doppler parameters of cerebroplacental ratio (CPR) and UmA pulsatility index (PI) were evaluated in a cohort of 184 SGA fetuses between 34 and 41 weeks gestational age, who were less than the 5th percentile. The risks of neonatal morbidities and cesarean delivery due to non-reassuring fetal status were analyzed. Results Univariate analysis revealed that abnormal CPR was significantly associated with cesarean delivery due to non-reassuring fetal status (P=0.018), but not with neonatal morbidities. However, abnormal CPR did not increase the risk of cesarean delivery due to non-reassuring fetal status in multivariate logistic regression analysis. Abnormal CPR with abnormal PI of UmA was associated with low Apgar score at 1 minute (P=0.048), mechanical ventilation (P=0.013) and cesarean delivery due to non-reassuring fetal status (P<0.001), in univariate analysis. It increased risk of cesarean delivery for non-reassuring fetal status (adjusted odds ratio, 7.0; 95% confidence interval, 1.2–41.3; P=0.033), but did not increase risk of low Apgar score or mechanical ventilation in multivariate logistic regression analysis. Conclusion Abnormal CPR with abnormal PI of UmA increases the risk of cesarean delivery for non-reassuring fetal status, in severe SGA fetuses of late preterm and term. Monitoring of CPR and PI of UmA can help guide management including maternal hospitalization and fetal monitoring.

Optimal Timing of Delivery Based on the Risk of Stillbirth and Infant Death Associated with Each Additional Week of Expectant Management in Multiple Pregnancies: a National Cohort Study of Koreans

Background The purpose of this study was to compare the fetal/infant mortality risk associated with each additional week of expectant management to that associated with immediate delivery in women with multiple gestations. Methods This was a retrospective national cohort study of 94,170 multiple deliveries, 92,619 (98.4%) twin and 1,352 (1.44%) triplet pregnancies, between 32 0/7 and 42 6/7 weeks of gestation recorded in the Korean vital statistics database. We investigated the risks of stillbirth and infant death after birth in Korea according to the week of gestation in twin and triplet pregnancies. Results The risk of stillbirth significantly increased between 34 and 35 weeks of gestation and between 37 and 38 weeks of gestation in twin pregnancies and between 34 and 37 weeks of gestation in triplet pregnancies. The risk of infant death following delivery gradually decreased as pregnancies approached full term. Week-by-week differences were statistically significant between 33 and 34 weeks, with decreasing risks of infant death at advancing gestational ages in twin pregnancies. At 37 weeks of gestation, the relative risk of mortality was significantly higher with expectant management compared with immediate delivery (relative risk, 3.00; 95% confidence interval, 1.41–6.38). Conclusion In twin pregnancies, delivery at 37 weeks of gestation can minimize the risks of stillbirth and infant death in uncomplicated cases, although individual maternal and fetal characteristics must be considered when determining the optimal timing of delivery. In multiple pregnancies, close fetal surveillance is needed after 34 weeks of gestation.

EP18.14: Influence of previous vaginal delivery on cervical length

Objectives: As research on the management of polyps in pregnancy is limited, there are no accepted treatment protocols. The purpose of this study was to clarify whether the presence of uterine polyps and polypectomy in pregnancy are associated with the risk of preterm birth. Methods: Pregnant patients with uterine polyps who delivered at our institution from January 2005 to January 2016 were reviewed retrospectively. Maternal clinical courses and outcomes were evaluated and analysed according to polypectomy and type of polyp. Results: 35 patients met the inclusion criteria. The incidence of delivery before 37 gestational weeks was 34.3%; this was significantly higher than the rate in the general population. Groups 1 (with polypectomy) and 2 (without polypectomy) did not show any clinically significant differences, including gestational days at delivery, laboratory findings, root of polyp and neonatal outcomes. Conclusions: Patients with uterine polyps have a high risk of preterm birth. The results of our study showed no differences in preterm birth incidence between those with and without polypectomy, therefore polypectomy in pregnancy seems not risky.

P01.03: Ultrasound assessment of cervical length and volume: comparison of transabdominal and transvaginal approach

A. Shrim5, R. Beloosesky6, M. Steinberg6,5, K. Nizar3, Y. Ginsberg1, Z. Weiner2, D.M. Schwake4 1Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; 2Rambam Medical Centre, Haifa, Israel; 3Obstetrics and Gynecology, Rambam Medical Centre, Acre, Israel; 4Obstetrics and Gynecology Ultrasound Unit, Rambam Medical Centre, Haifa, Israel; 5Technion Israel, Neve Yarak, Israel; 6Obstetrics and Gynecology, Rambam Medical Centre, Haifa, Israel