Yoon-Ha Kim

Fetal weight prediction by thigh volume measurement with three-dimensional ultrasonography.

Objective To evaluate the usefulness and accuracy of a simple method of predicting fetal weight by measuring fetal thigh volume with three-dimensional ultrasonography. Methods In 84 pregnant women, fetuses without structural or chromosomal anomalies were studied prospectively and cross-sectionally. Biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL) were measured by two-dimensional ultrasound. Fetal thigh volume was measured by three-dimensional ultrasound, using three cross-sectional images of femur, from proximal, middle, and distal parts of femur diaphysis. Infants were delivered within 48 hours after ultrasound examinations. Results Modified thigh volume measurements using three cross-sectional images of femur by three-dimensional ultrasound were correlated strongly with birth weight (R2 = 0.921, P < .001). Using linear and polynomial regression, we calculated a new best-fit formula: Birth weight (g) = 165.32 + 28.78 × modified thigh volume (mL). The mean and standard deviation of the residual were 121.8 and 110.4, respectively, in three-dimensional formulas, which were significantly smaller than those of two-dimensional formulas. Conclusion Thigh volume measurement using three cross-sectional images of femur by three-dimensional ultrasound was simple, and there was better accuracy with this method than with two-dimensional ultrasound methods for predicting fetal weight during the third trimester of pregnancy.

Delayed interval delivery in multiple gestations

Abstract Two multiple pregnancies with delayed delivery after expulsion of dead fetus are presented. Case 1: A woman with a twin pregnancy and one intrauterine fetal death at 20 weeks’ gestation delivered a dead fetus at 27 weeks’ gestation. She delivered a healthy male infant weighing 2430 g at 33 weeks’ gestation (42 d after the delivery of the first twin). Case 2: A woman with quadruplets pregnancy (2 live fetuses, one empty sac, and one fetocide at 7 weeks’ gestation) got a intrauterine fetal death at 21 weeks’ gestation at one fetus among 2 live fetuses and delivered a dead fetus at 24 weeks’ gestation. She delivered a healthy female infant weighing 2110 g at 33 weeks’ gestation (58 d after the delivery of a dead fetus). On the basis of our experience and the review of literature, delayed delivery with careful observation of fetal and maternal condition is recommended for improved survival and decreased morbidity among latter-born siblings.

Hydrogen peroxide-producing Lactobacilli in the vaginal flora of pregnant women with preterm labor with intact membranes.

Objectives: To investigate the role of vaginal infection in preterm delivery, we studied characteristics of vaginal discharge related to hydrogen peroxide‐producing Lactobacilli. Methods: Vaginal specimens were obtained from 66 women with normal pregnancy and 30 women with preterm labor with intact membranes. pH, leukocyte counts on wet smear, and scores by Nugent criteria on Gram stain were measured. Lactobacilli were tested for their production of hydrogen peroxide. Results: Leukocyte levels in wet smears and Nugent scores of Gram‐stained smear of women with preterm labor with intact membranes were significantly higher than those of normal pregnant women (P < 0.01, P < 0.05). Hydrogen peroxide‐producing Lactobacilli levels in the vaginal flora of women with preterm labor with intact membranes were significantly lower (P < 0.01). Conclusion: Distribution of hydrogen peroxide‐producing Lactobacilli in vaginal flora as defense factors for infection may have an important role in the pathophysiology of preterm labor.

Low Neonatal Risk of Thrombocytopenia in Pregnancy Associated with Immune Thrombocytopenic Purpura

Objective: To estimate the risk of neonatal thrombocytopenia in infants born to mothers with immune thrombocytopenic purpura (ITP). Methods: During the years 1993–1997, there were 6,082 deliveries. There were 32 infants born to 31 mothers with ITP. Cordocentesis was performed between 34 and 41 weeks of gestation in 16 mothers with ITP. The cord blood platelet count was checked in all cases at delivery. Results: In mothers with ITP, 5 neonates (15.6%) had mild thrombocytopenia and 7 neonates (21.9%) moderate thrombocytopenia. Severe thrombocytopenia was not observed in any neonate born to mothers with ITP. Conclusions: The means of delivery in pregnant women with ITP can be determined solely on the basis of obstetric indications because the incidence of severe fetal and neonatal thrombocytopenia is very rare, neonatal intracranial hemorrhage is unlikely to be related to the mode of delivery and percutaneous umbilical blood sampling is technically difficult with a risk of fetal death.

Prenatal Diagnosis of Severe Tricuspid Insufficiency in Ebstein's Anomaly with Pulmonary Atresia and Intact Ventricular Septum: A Case Report

Pulmonary atresia with intact ventricular septum is an uncommon congenital cardiac anomaly which very often present varying degrees of downward displacement and dysplasia of the tricuspid valve.

Serum hCG level and rising world health organization score at second-line chemotherapy (pulse dactinomycin): poor prognostic factors for methotrexate-failed low-risk gestational trophoblastic neoplasia.

Introduction: The aim of this study was to determine the factors associated with failure in patients receiving pulse dactinomycin as second-line chemotherapy for low-risk gestational trophoblastic neoplasia (GTN) according to the revised International Federation of Obstetrics and Gynecology 2000 scoring system at a single institution. Methods: Between January 1997 and June 2007, 37 patients with methotrexate-failed low-risk GTN were treated with pulse dactinomycin (1.25 mg/m2 intravenously every 2 weeks). All patients had low-risk GTN based on the revised International Federation of Obstetrics and Gynecology 2000 scoring system at the time of second-line chemotherapy. A logistic regression model was used to analyze the relationship between covariates and treatment failure. Results: There were 28 (75.7%) patients who achieved primary remission with pulse dactinomycin. All 9 treatment failures achieved complete remission after receiving subsequent chemotherapy; 1 patient also underwent hysterectomy. Patients successfully treated with pulse dactinomycin required a median of 4.0 cycles (range, 2-7) to achieve a complete response. The risk of failure with pulse dactinomycin was higher for serum hCG levels 103 or higher when initiating pulse dactinomycin (odds ratio, 8.91; 95% confidence interval, 1.08-73.53) and a rising World Health Organization score of 2 or higher after first-line chemotherapy (odds ratio, 12.59; 95% confidence interval, 1.60-99.25). With respect to the previous methotrexate regimen and cause of failed methotrexate chemotherapy, there were no differences between those who were successfully treated and those who failed pulse dactinomycin. Conclusions: Serum hCG level and a rising World Health Organization score at the time of initiating pulse dactinomycin are important prognostic factors in patients with methotrexate-failed low-risk GTN receiving pulse actinomycin as second-line chemotherapy.

Maternal cardiac arrest after intravenous methylergonovine administration during Cesarean section: A case report

Methylergonovine is commonly used for the prevention and treatment of postpartum hemorrhage, which promotes contractions of uterine and vascular smooth muscles. However, this drug precipitates serious cardiac complications such as ischemic heart disease, acute myocardial infarction and cardiac arrest in some patients as a consequence of coronary artery spasm. Cardiac complication of methylergonovine is often overlooked by an obstetrician because the frequency of this is very low during postpartum. We report a case of maternal cardiac arrest induced by intravenous methylergonovine which was recovered by prompt cardiac resuscitation and adequate medical treatment during Cesarean section of triplet pregnancy.

P1028 A study on inhibition of cell growth and apoptosis in human cervical cancer cell line (CaSki) by paclitaxel, cisplatin, arsenic trioxide, and tetraarsenic oxide

Objectives: To compare inhibition of cell growth and apoptosis in human cervical cancer cell lines (CaSki) by paclitaxel, cisplatin, arsenic trioxide and tetraarsenic oxide. Materials and Methods: Inhibition of cell growth was determined by theWater-soluble tetrazolium salts (WSTs)-1 assay. For apoptosis analysis in CaSki cell line treated with single or combination of two agents, CaSki cell line treated with each agent was stained with annexin-V/PI and flow cytometry was performed. Especially, tetraarsenic oxide was more effective in inhibition of CaSki cell growth compared to arsenic trioxide. Results: Progression of apoptosis in CaSki cell line treated with paclitaxel, cisplatin, arsenic trioxide, and tetraarsenic oxide was time dependent. Inhibition of cell growth in CaSki cell line by paclitaxel, cisplatin, arsenic trioxide, and tetraarsenic oxide was dose and time dependent. Group treated with combination of cisplatin and tetraarsenic oxide showed more progressive apoptosis compared to other combination group. Conclusion: Tetraarsenic oxide has more potent anti-tumor effects than other agents on CaSki cell line. It is considered to further study about antitumor effect of tetraarsenic oxide through clinical study.

P1039 Comparison between L and E gene amplification analytical methods for human papillomavirus typing

March 2008. Eligible patients received 0.5mg/m of intravenous (IV) belotecan on days 1 to 5, every 3 weeks (B) or 50mg/m of IV cisplatin on day 1 plus 0.3mg/m of IV belotecan on days 1 to 5, every 3 weeks (BP). Results: Of the 53 treated patients, 34 received BP and 19 received B. Thirty-four patients had platinum-sensitive disease and 19 had platinum-resistant disease. The overall response of the 53 patients was 37.7% (20/53). According to regimen, the response rate in the BP group was 47.1% (16/34) and that of the B group was 21.1% (4/19). BP had better response (66.7%, 14/21) than B (15.4%, 2/13) for platinum-sensitive disease (P = 0.004), but it was not superior in terms of progression-free survival (BP, 6 month; B, 7 months). Grade 3 or 4 toxicity was less common in B than in BP. Conclusions: Both BP and B seems to be effective and safe regimens for patients with platinum-sensitive or platinum-resistant recurrent ovarian cancer. These results warrant further prospective randomized trials.

Predictive factors for vaginal birth after cesarean delivery

The dictum ‘once a cesarean always a cesarean’ dominated obstetric practice for nearly 70 years in the United States. The concept began to change approximately 30 years ago and reports have documented the relative safety of a trial of labor. The purpose of this study was to determine predictive factors associated with a successful trial of labor in women attempting a vaginal delivery after a cesarean delivery. The study was carried out from 1 January 1998 through 31 December 2001 at the Chonnam National University Hospital in Gwangju Korea. All pregnant women who satisfied the inclusion criterion of attempting a vaginal delivery after a cesarean delivery were invited to participate. They were counseled and their informed consent was obtained. A retrospective review of their charts and operative records was then performed and data for potential predictors were abstracted. These predictors were prior successful vaginal birth after cesarean delivery reasons for prior cesarean delivery and gestational age and birth weight at prior cesarean delivery. At the time of admission for labor we added data such as maternal age height body mass index and Bishop score gravity gestational age estimated fetal body weight and labor management techniques adopted such as induction or augmentation of labor. (excerpt)