Mi-Hye Park

A Model for Prediction of Spontaneous Preterm Birth in Asymptomatic Women

BACKGROUND Preterm birth is a complex health problem with social, environmental, behavioral, and genetic determinants of an individuals risk and remains a major challenge in obstetrics. Recent research has caused improvements in predicting preterm birth; however, there is still controversy about the prediction of preterm birth in asymptomatic women. The purpose of this study was to determine if Bayesian filtering can be used in a clinical setting to predict spontaneous preterm birth in asymptomatic women. METHODS A model of predicting spontaneous preterm birth using PopBayes based on a Bayesian filtering algorithm was developed using a previously collected dataset, then applied to a prospectively collected cohort of asymptomatic women who delivered singleton live newborns at or after 24 weeks of gestation. Cases complicated with major congenital malformations were excluded. RESULTS The proportion of patients with spontaneous preterm birth was 18.4% (96 of 522) at <37 weeks gestation, 5.4% (28 of 522) at <34 weeks gestation, and 2.7% (14 of 522) at <32 weeks gestation. The match rates with the combination of demographic, clinical, and genetic factors using a Bayesian filtering method (PopBayes) were higher than the match rates using demographic and clinical factors only, including maternal age, maternal body mass index (BMI), prior preterm birth, education, occupation, income, and active and passive smoking. The match rates in preterm delivery before 32 weeks of gestation were higher than the match rates in preterm delivery before 37 and 34 weeks of gestation (94.3% vs. 84.7% and 82.0%, respectively). The negative predictive values for demographic, clinical, and genetic factors in predicting preterm delivery using PopBayes were consistently >90%. CONCLUSIONS We suggest that Bayesian filtering (PopBayes) is a customizable and useful tool in establishing a model for the prediction of preterm birth.

Isolated congenital hereditary cataract in a dizygotic twin: prenatal ultrasonographic diagnosis.

Cataract, defined as opacity of the lens in one or both eyes, is a major cause of blindness throughout the world, and not uncommon, particularly in the elderly population. However, congenital cataracts are rare and occur with a frequency of 30 cases in 100,000 births. About one-third of the cases fall into the group inherited without systemic abnormality. Importantly, congenital cataracts produce deprivation amblyopia, refractive amblyopia, and retinal detachment, leading to lifelong visual impairment. Successful management is dependent on early diagnosis and referral for surgery when indicated. Here we present a case of hereditary bilateral cataracts in a dizygotic twin detected on prenatal ultrasound examinations and postnatally confirmed as congenital cataracts associated with posterior lenticonus.

A Case of Successful Selective Abortion Using Radio-frequency Ablation in Twin Pregnancy Suffering from Severe Twin to Twin Transfusion Syndrome

Twin to twin transfusion syndrome (TTTS) is one of the major complication of monochorionic twin pregnancy which is mainly understood by placental vascular anastomosis. Perinatal mortality and morbidity is high as 80-100% if untreated and even higher if the disease is developed at early stage. Variety of methods of isolating or intercepting placental vascular anastomosis are introduced, but they are only available in centers where all the required equipments are prepared. We report here a case of TTTS complicated with severe polyhydroamnios during the second trimester. The blood supply to donor twin was interrupted successfully at 19+2 weeks of gestation by minimally invasive radio-frequency cord ablation, under ultrasound guidance. The normal recipient twin was delivered successfully at 35 weeks of gestation and had no eventful neonatal course.

P42.03: Prenatal diagnosis of a congenital cervical teratoma: EXIT procedure(ex utero intrapartum treatment)

Purpose: In up to 20–30% of myelomeningocele (MMC) cases corrected in utero, fetal skin closure cannot be accomplished due to the size of the defect (myeloschisis). Our aim was to develop a new technique to correct myeloschisis. Method: A skin defect at lumbar fetal region (4 × 3cm) was created at 100 days’ gestation in 7 ovine fetuses, and was correct applying a new endoscopic ‘‘gasless’’ technique (Pedreira et al., 2008). The skin edges were approximated under tension (but not closed) using a continuous running suture and an interposed bovine tendon derived dermal matrix (Integra USA) (3 × 2 cm). This was placed above a biosynthetic cellulose material (Nexfill Brazil) to be used as duramater substitute. At term, fetuses where harvested and the wound was analysed both macro and microscopically. Results: A total of 7 fetuses were operated, in the first two cases we needed to change to an open surgery approach and the other 5 where successfully closed endoscopically. All fetuses survived to the end of the procedure. One maternal death (infection related) occurred the day after the procedure. Two pre-term deliveries occurred days 3 and 4 after the procedure. At birth matrix adherence to the wound edges was observed in all cases. Pathological analysis performed at 3, 4, 15, 21, 25 and 35 days after surgery showed the expected normal fibroblast migration into the dermal matrix and its integration with the adjacent fetal dermis. Conclusions: Dermal matrix can be used as an alternative in cases where primary skin closure in spina bifida cannot be accomplished.

Associated anomalies and perinatal outcome in fetuses with prenatally diagnosed single umbilical artery

Objective:  To evaluate pattern of associated structural anomalies, abnormal karyotypes and perinatal outcomes of fetuses with prenatally diagnosed single umbilical artery and to evaluate the relation of absent side of a single umbilical artery in association with anomalies and abnormal karyotypes.