Kyung-Lan Jung

Prenatal diagnosis of congenital heart disease: Trends in pregnancy termination rate, and perinatal and 1-year infant mortalities in Korea between 1994 and 2005

Aim:  To determine the pregnancy termination rate, and perinatal and 1‐year infant mortality rates following prenatally‐detected congenital heart disease (CHD) and trends over an 11‐year period.

Cervicovaginal matrix metalloproteinase-9 and cervical ripening in human term parturition

OBJECTIVE To investigate the changes of matrix metalloproteinase-9 (MMP-9) in cervicovaginal fluid during pregnancy and its association with parturition. STUDY DESIGN A prospective study was conducted on nulliparous women between 16 and 42 weeks with normal singleton pregnancies in the following categories: (1) preterm control (n=39); (2) term labor induction without labor or rupture of membranes (n=68); (3) term spontaneous labor with intact membranes (n=42); (4) term premature rupture of membranes (n=24). The MMP-9 concentration in the cervicovaginal fluid was measured by immunoassay. RESULTS (1) Cervicovaginal MMP-9 did not change significantly with advancing gestation until 37 weeks, and significantly increased after 37 weeks. (2) Cervicovaginal MMP-9 levels were similar in women with no labor, spontaneous labor, and premature rupture of membranes at term. (3) For the induced labor group, a high Bishop score (>or=4) was significantly correlated with cervicovaginal MMP-9. However, an elevated cervicovaginal MMP-9 did not predict achieving active phase of labor or vaginal delivery after labor induction. CONCLUSION Cervicovaginal MMP-9 correlated with cervical ripening before labor at term. However, cervicovaginal MMP-9 did not change with spontaneous labor or rupture of membranes at term and did not predict success of labor induction.

P39.07: Trends in pregnancy termination rate, perinatal mortality and 1‐year mortality rate of prenatally diagnosed fetal congenital heart disease in Korea: an 11‐year review, 1995–2005

Methods: Consecutive patients with significant fetal cardiac abnormalities from January 2000 to April 2007 were reviewed. The imaging continuum was followed with two and three-dimensional ultrasound. Patients were co-managed by a local team including perinatologist, pediatric cardiologist, and neonatologist. Pre-delivery telemedicine consultation with distant cardiac surgical services also was utilized. Neonatal hospice and palliative care was offered when appropriate. Specific delivery management was correlated with imaging and ultimate neonatal outcome. Results: There were 84 pregnancies with significant cardiac abnormalities in 4090 imaging consultations (1 in 49 or 2.1% of patients seen). The categories were structural (nonchromosomal) 44%, arrhythmia 26%, effusion 10%, and structural (chromosomal) 5%. No maternal transport was required, (and survival was 100%) with arrhythmia, isolated effusions, isolated septal defects and rhabdomyoma patients. Four patients with progressive cardiac failure and chromosomal associated lesions chose to deliver locally, with one survivor (trisomy 21, endocardial defect) and three neonatal losses (45 XO, trisomy 21, trisomy 18). Of the 20 patients having maternal transport to the cardiac surgical center, only 10 with complex conotruncal defects or ventricular hypoplasia actually had subsequent surgery. Conclusions: With collaboration, the majority of patients with fetal cardiac diagnosis can be managed near home, without detriment to neonatal prognosis. In our series, only patients with structural, nonchromosomal lesions improved outcome with delivery in distant surgical centers. The ethical process of offering hospice and palliative care if delivered in rural communities is reviewed.