Moon-Kyung Kim

Predictive factors for adverse pregnancy outcomes after renal transplantation.

Several predictive factors associated with adverse pregnancy outcomes in female renal recipients have been suggested. Our study aimed to determine the most important factor for prediction of adverse pregnancy outcomes in female renal recipients. We studied 41 pregnancies in 29 female renal recipients retrospectively. We reviewed pregnancy outcomes and possible predictive factors including pre‐pregnancy serum creatinine (SCr), pre‐pregnancy glomerular filtration rate (GFR), pre‐pregnancy hypertension, pre‐pregnancy proteinuria, transplantation‐pregnancy interval and type of immunosuppressants. We defined an adverse pregnancy‐related outcomes index (APOI) that included the following conditions: (i) preeclampsia; (ii) fetal growth restriction (FGR); (iii) prematurity before 34 wk of gestation; (iv) fetal loss (v) graft dysfunction during pregnancy or within three months from delivery. The cutoff of pre‐pregnancy serum creatinine and GFR was determined by receiver operating characteristics curves for the prediction of each adverse outcome and APOI. Only pre‐pregnancy serum creatinine was associated with adverse pregnancy outcome, and 1 mg/dL was determined to be a useful cutoff for the prediction of each adverse outcomes. Pre‐pregnancy SCr ≥ 1 mg/dL was associated with 7.7 times increased risk of preeclampsia and 6.9 times increased risk of APOI. Pre‐pregnancy serum creatinine is the most powerful predictive factor for adverse pregnancy outcomes, and <1 mg/dL may be used as a screen for successful pregnancy outcome.

Metastatic skin lesions on lower extremities in a patient with recurrent serous papillary ovarian carcinoma: a case report and literature review.

Clinical observation of skin metastasis in ovarian cancer cases is relatively uncommon. And distant metastatic skin lesions including the extremities are much rarer still as most metastatic skin lesions are located in the skin in the abdominal wall adjacent to where the primary ovarian tumors exist. We report the case of a 60-year-old woman who presented skin lesions on both lower extremities as a consequence of the metastasis of serous papillary adenocarcinoma of the ovary. She presented with erythematous and painful cutaneous nodules on both upper legs and in the inguinal area 42 months after initial diagnosis of ovarian cancer. Skin biopsy revealed metastasis of adenocarcinoma in the dermis. She was treated with surgical excision and systemic chemotherapy. Literature review has suggested that a combined modality approach including surgical excision and chemotherapy may be useful in the management of skin metastases due to ovarian cancer.

Outcome of isolated fetal renal pyelectasis diagnosed during midtrimester screening ultrasound and cut-off value to predict a persistent or progressive pyelectasis in utero.

Abstract Aim: To define a better cut-off value of the renal pelvis anteroposterior diameter (RPAPD) to predict persistent or progressive pyelectasis during pregnancy. Methods: We retrospectively reviewed 8873 women whose fetal RPAPD was measured. Midtrimester pyelectasis was defined as a RPAPD of ≥4 mm. Persistent/progressive pyelectasis was defined as a RPAPD of ≥10 mm before delivery. A RPAPD cut-off value to predict a persistent/progressive pyelectasis was determined by receiver operating characteristic curve analysis. Results: Among 249 isolated cases of pyelectasis, persistent/progressive pyelectasis was found in 6.9% before delivery. The midtrimester RPAPD cut-off value that best predicted persistent/progressive pyelectasis before delivery was ≥6 mm with sensitivity, specificity, positive and negative predictive values of 64.3%, 88.7%, 30.0%, and 97.1%, respectively. Conclusions: Although most cases of midtrimester fetal pyelectasis regress to normal during pregnancy, those with a RPAPD of ≥6 mm in the midtrimester are at higher risk for persistent or progressive pyelectasis.

OP26.07: Outcome of fetal renal pyelectasis diagnosed during a routine second trimester screening ultrasound and a cut‐off value for its progression in utero

Methods: This was a prospective, cross sectional study. The study enrolled pregnant women, in the 2nd and 3rd trimester, undergoing a routine fetal ultrasound. The parenchymal measurements were done in transverse and sagital cross sections, using predefined criteria. Results: The final analysis included 128 women. The various measurements preformed (anterior and posterior parenchyma), in each of the cross sections (Sagital and transverse) did not show and difference between male and female fetuses. In the sagital section, there were no differences between the right and left kidney. The nomogram established demonstrates that there is a linear constant growth of the fetal parenchyma during pregnancy. Conclusions: This is a novel study, describing the normal growth of the renal parenchyma in healthy, non anomalous fetuses. This is the basis for future studies that will determine the correlation between parenchymal thickness and post natal kidney function, in fetuses with urinary tract anomalies.

P06.19: Is twin pregnancy more vulnerable to cervical incompetence?

Case report of monochorionic, diamniotic triplets with cord entanglement identified at 16 weeks’ gestation. The pregnancy was managed as for a monoamniotic twin pregnancy at this institution – steroids at 24, 26 and 28 weeks; weekly ultrasound monitoring; planned elective delivery at 32 weeks’ gestation. Ultrasounds continued to identify cord entanglement with no evidence of compromise until 30 weeks when periods of absent end diastolic flow and bradycardia to 105 bpm occurred. Caesarean section was performed and three baby girls were delivered in good condition. Examination at delivery confirmed monochorionic, diamniotic placenta with cord entanglement of the monoamniotic pair.