Sun-Hee Chun

Endoscopic treatment of interstitial pregnancy

Interstitial pregnancy is a rare disease accounting for 2 to 4% of all ectopic pregnancies (1). It usually ruptures later than other tubal pregnancies. It may be associated with catastrophic hemorrhage, thus carrying a risk higher of morbidity and mortality than other forms of tubal pregnancy. Conventional treatment of interstitial pregnancy has been cornual resection by laparotomy, or local or systemic injection of methotrexate (2). Recently, endoscopic treatment has been attempted with the aid of introductory serial serum human chorionic gonadotropin measurement and high resolution transvaginal ultrasonography (3,4). We report four patients with interstitial pregnancy who undertook pelviscopic cornuostomy and repair of the uterus wall.

Concentration of cord serum adiponectin in normal and gestational diabetic pregnancies

목적: 이번 연구의 목적은 정상임신군과 임신성 당뇨임신군의 비교를 통해 자궁내 환경의 차이가 제대혈내 adiponectin 농도에 어떠한 영향을 주는지 알아보고자 하는 것이다. 연구방법: 2004년 1월부터 2009년 6월까지 이화여자대학교 목동병원 산부인과에서 35주 이후에 분만한 정상 산모군 204명과 임신성 당뇨로 진단받은 산모 204명을 대상으로 하여 연구를 시행하였다. 임신성 당뇨로 진단받은 204명의 산모 중에서 118명은 식이조절만으로 혈당을 조절하였고, 나머지 86명은 임신 기간 동안 인슐린을 투여 받았다. 분만 시 제대정맥혈액을 채취하여 원심분리 후, 효소면역측정법 (enzyme-linked immunosorbent assay)을 사용하여 제대혈액내 adiponectin의 농도를 측정하였다. 결과: 제대혈내 adiponectin 농도는 정상임신군에 비해 임신성 당뇨로 진단받은 임신군에서 더 높은 수치를 나타내었다(P = 0.02). 정상임신군과 임신성 당뇨임신군 모두에서 제대혈내 adiponectin 농도는 남아에 비해 여아가 높은 수치를 보였다(P = 0.04, P = 0.03). 정상임신군에서 임신 주수와 제대혈내 adiponectin 농도는 유의한 양의 상관관계를 보였다(r = 0.2374, P = 0.0129). 출생 시 주수와 성별을 보정한 경우, 정상 임신군에서 출생 시 체중과 제대혈내 adiponectin 농도는 유의한 연관성이 없었다(P > 0.05). 임신성 당뇨를 진단받았던 임신군에서, 식이 조절만으로 혈당을 관리한 군과 인슐린 치료를 받은 군의 제대혈내 adiponectin 농도는 통계적으로 유의한 차이가 없었다(P > 0.05). 결론: 제대혈내 adiponectin 농도가 정상임신 및 임신성 당뇨임신군 사이에서 차이를 보이고, 성별 간 두형태성을 나타내는 것은 이들의 자궁내 환경이 다르기 때문이라고 생각된다. 임신성 당뇨임신군 및 여아에서 높은 제대혈내 adiponectin 농도를 보이는 것은, 이들의 증가된 지방 축적도를 반영한 결과라 할 수 있을 것이다.

P18.02: Prenatal ultrasonographic diagnosis of congenital hereditary cataracts in a dizygotic twin

Results: Chromosomal abnormalities were found in 78 cases. In the first group the flow was abnormal in 53 cases, the overall detection rate, specificity, positive predictive value, negative predictive value and likelihood ratio for aneuploidy were 67.9%, 99.0%, 67.9%, 99% and 66.7 respectively. On basis in the ductus venosus blood flow during atrial contraction as positive marker only A-wave was negative (43 cases) the sensitivity, specificity, the positive and negative predictive values and likelihood ratio were 55.1%, 99.1%, 67.2%, 98.6%, 64.4 respectively. Conclusions: Abnormal ductus venosus blood flow is an useful marker of chromosomal anomalies in the first trimester ultrasound screening. We could improve the predictive for the detection of aneuploidies by considering absent flow during atrial contraction as a positive marker (abnormal).

P32.08: Single cervical length measurement at 36 to 38 weeks as a predictor of spontaneous onset of labor by 41 weeks

Objectives: The aim of this study was to investigate the relationship between single cervical length measurement at 36 to 38 weeks and prediction of spontaneous onset of labor by 41 weeks. Methods: We performed transvaginal ultrasound to measure single cervical length in women with singleton gestation in cephalic presentation at 36 to 38 weeks. We used a receiver operating characteristic curve (ROC) to assess the relationship between cervical length and prediction of spontaneous onset of labor by 41 weeks by SPSS 6.0. Results: For the 176 women included in the analysis, the mean cervical length (±SD) was 27.8 ± 0.96 mm. Significant probability of spontaneous labor within 41 weeks was increased when cervical length is < 20 mm. A single cervical length measurement below 30.5 mm between 36 and 38 weeks of gestation predicted spontaneous onset labor before 41 weeks gestation with a sensitivity of 61%, specificity of 84%, positive predictive value of 96% and negative predictive value of 26%. Conclusions: Single cervical length measurement at 36–38 weeks is an independent predictor of spontaneous onset of labor by 41 weeks, but with low sensitivity and negative predictive value. This information can be utilized when counseling patients regarding the management of term pregnancies.

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.