태아 심장종양의 산전 진단과 산후 결과

Objective: The objective of this study was to evaluate the ultrasonographic appearance of suspected fetal cardiac tumor and their evolution until delivery and in the postnatal period, and to document the associated problems including tuberous sclerosis. Methods: We retrospectively reviewed the medical records of all cases born in Yonsei University Health System, Seoul, Korea, between September 1996 and August 2006, and diagnosed as fetal cardiac tumor prenatally. Results: 10 cases were found in all medical records. The mean age of the mothers on delivery was 30.2±2.4 and the mean gestational age on diagnosis was 30.6±5.4 weeks. The cardiac tumors were single in five cases and multiple in the other five cases. The size ranged from 7 to 34mm. Most of the tumors were located in right ventricle (RV, n=9), left ventricle (LV, n=6), but they also located in interventricular septum (IVS, n=4), right atrium (RA, n=1). In one case, fetal arrhythmia was found, which was normalized in two days after birth, and in another case, mild intracardiac flow obstruction was noted. The duration of postnatal follow-up ranged from 2 months to 36 months (mean, 18.9±13.1 months). In most cases the tumor masses decreased after birth (n=6), but had no change in utero (n=5). Three of them were diagnosed as tuberous sclerosis after birth, and none of them needed surgical intervention. Conclusion: Fetal cardiac tumors and their effect on the fetal cardiac function could be well evaluated by two-dimensional and Doppler echocardiography. The fetal cardiac tumors may have little effect on the fetal well being both prenatally and postnatally from the cardiovascular standpoint in most affected fetuses, but are important in the early diagnosis of tuberous sclerosis and in suggesting careful follow-up and management.ope

Recent advances in management of fetal growth restriction

Small-for-gestational-age (SGA) is associated with poor perinatal outcomes. The term SGA is descriptive and means that the fetal size and weight at birth are less than expected (in general, 10th percentile using standard curves for gestational age) regardless of the cause. It was estimated that about 50~70% of fetuses born weighing less than the 10th percentile for gestational age are constitutionally small, with fetal growth appropriate for parental size and ethnicity; these are usually associated with normal placental function and have a normal outcome. Fetal growth restriction (FGR) describes a decrease in the fetal growth rate that prevents an infant from obtaining the complete genetic growth potential. It is common with placental dysfunction occurring in about 3% of pregnancies despite advances in obstetric care. In human pregnancies, placental insufficiency is the leading cause of FGR and is usually due to poor utero-placental blood flow and placental infarcts. The reduction of placental supply of nutrients to the fetus has been associated with several adaptive changes taking place in both the placenta and fetus. Adaptive changes can be followed by pathology leading to fetal death, and therefore staging of the disease is fundamental to timing delivery. Thus, it is responsible for the obstetricians to distinguish SGA from intrauterine growth restriction, correct the causes if possible, and if not, accurately stage the disease progress so as to deliver at the most suitable time. In this review, the management of fetal growth restrictions is summarized based on the diagnosis, etiologic factors, antenatal surveillance, and their possible therapeutic approachesope

Incidence of congenital defects coexisting with fetal urinary tract anomaly

Objective: Due to advances in diagnosing fetal anomalies by ultrasound, prognosis of babies with anomalies, especially in urinary tract, has improved. However, multiple anomalies with poor prognosis are still noted. We analyze congenital defects which coexist with fetal urinary tract anomalies. Methods: We identified all pregnancies complicated by fetal urinary tract anomalies which were followed and delivered from 1998 August to 2008 July at Yonsei University Health System. Fetal urinary tract defects were subdivided to hydronephrosis, multicystic dysplastic kidney, polycystic kidney disease, renal agenesis, renal duplication and horse-shoe kidney. A retrospective study was performed regarding both medical records and ultrasound findings. Results: 236 (1.8%) in total 12,431 cases were identified with urinary tract defects and 25 (12.3%) cases had coexisting other anomalies. Hydronephrosis was found in 156 (68.2%) cases. Multicystic dysplastic kidney was found in 37 (15.6%) cases, renal duplication in 11 (4.7%), renal agenesis in 9 (3.8%), polycystic disease in 6 (2.5%) and horse-shoe kidney in 2 (1.0%). In 25 cases with coexisting anomalies, the most common type was congenital heart defect which was found in 9 (27.6%) cases. They were composed of 8 (24.5%) atrial septal defect and 1 (3.1%) ventricular septal defect combined with pulmonary atresia. Other coexisting anomalies were cerebral or gastrointestinal tract associated anomalies, Mullerian duct anomalies and polydactyly. Six in 9 (66.7%) fetuses with one kidney had other anomalies. Conclusion: Urinary tract anomalies in fetus seem to be associated with a variety of other malformation, especially cardiac anomalies. Detailed ultrasound or echocardiography should be carefully performed because of frequent coexisting fetal congenital anomalies. Furthermore, comprehensive prenatal counseling and postnatal evaluation and management will be needed.ope

Sudden Fetal Death Resulting from Intrauterine Hemorrhage Due to Umbilical Cord Ulceration Associated with Congenital Intestinal Atresia: A Case Report

Congenital intestinal atresia is usually detected on prenatal ultrasound in the late second to third trimester, depicted as proximal bowel dilatation accompanied by polyhydramnios. Since the initial report in 1991 pertaining to the association between umbilical cord ulceration (UCU) and congenital intestinal obstruction, many studies have followed to investigate fetal cord hemorrhage and fetal death associated with congenital intestinal atresia. Nonetheless, UCU has not received much attention from many obstetricians. In light of this, we report a case of intrauterine hemorrhage from an umbilical cord ulcer in a fetus with jejunal atresia that resulted in intrauterine death.ope

First Trimester Placental Volume and Second Trimester Uterine Artery Doppler Velocimetry in the Prediction of Perinatal Outcomes

Objective: To determine to what extent the placental quotient (PQ: placental volume/crown-rump length) is able to detect adverse perinatal outcomes and to compare the value of first trimester placental volume and second trimester uterine artery Doppler velocimetry for predicting adverse perinatal outcomes. Methods: This was a prospective study comprising of 263 women with singleton pregnancies attending our hospital for nuchal translucency screening at 10-13 weeks of gestation. Three dimensional ultrasound was used to obtain images for measurement of placenta volume at 10-13 weeks of gestation. In addition, Doppler assessment of both uterine arteries was carried out for measurement of the pulsatility index (PI) in the second trimester and the mean PI of the two vessels was calculated. The variables of adverse perinatal outcomes were preeclampsia, preterm delivery, small for gestational age (SGA), 5-minute APGAR score, and admission to the neonatal intensive care unit. Results: Of the initial 263 pregnancies originally participating, 219 women who delivered at our institution were included in the final analysis. Pregnancy complications occurred in 27 (12.3%) of the 219 pregnancies. Comparison between crownrump length and placental volume proved a significant correlation (r=0.474, p<0.001). There were no correlation between PQ and uterine artery Doppler velocimetry PI. PQ was significantly lower in SGA group and neonatal intensive care unit admission group (p=0.049, p=0.019, respectively). Uterine artery Doppler velocimetry PI was significantly higher in SGA group (p=0.024). PQ in the first trimester and uterine artery Doppler velocimetry in the second trimester had similar sensitivities for predicting SGA. Conclusions: PQ in the first trimester and uterine artery Doppler velocimetry PI in the second trimester have significant difference in SGA group compared to appropriate for gestational age, and have similar sensitivities for predicting SGA. While both methods seem to be insufficient for screening, the PQ method has the potential advantage of being performed in the first trimesterope

후성 유전학적 마커를 이용하여 측정한 모체 혈액 내 세포 유리 DNA의 농도와 임신성 고혈압 질환의 연관성 분석

Department of Medicine/박사연구목적: 후성 유전학적 마커를 이용하여 측정한 모체 혈액 내 세포 유리 DNA의 농도와 임신성 고혈압 질환의 연관성에 대해 알아보고자 한다. 연구방법: 세포 유리 DNA의 마커로 HYP2 유전자를 선정하였고, 임신성 고혈압 질환의 마커로서의 적합성 검증을 위해 정상 산모 3명과 임신성 고혈압 산모의 3명의 혈액과 태반 조직에서 비술피트 직접 서열 결정 (bisulfite direct sequencing)을 시행하였다. 임신 6주부터 41주 사이의 188명의 정상 임신부의 혈장과 92명의 임신성 고혈압 질환 산모 [전자간증 (preeclampsia) 63명, 임신성 고혈압 (gestational hypertension) 29명]의 혈장에서 실시간 중합효소 연쇄반응 (Real time qPCR)을 통해 HYP2의 정량 분석을 수행하였다. 또한 마커로서의 타당성을 확인하기 위해 추가로 정상 산모 54명의 혈액에서 glyceraldehyde-3-phosphate dehydrogenase 유전자의 정량 분석하였다. 정상 산모와 임신성 고혈압 산모에서 HYP2 농도의 차이를 분기별로 나누어 분석하였고, 이를 발병 시기 및 출생 체중에 따라 재분석하였다. 결과: HYP2 유전자는 정상 대조군과 임신성 고혈압 질환 산모의 혈장과 태반 모두에서 완전히 메틸화 되어있었다. 또한 정상 대조군의 HYP2 농도는 임신 주수와 유의한 양의 상관관계를 보였고 (p<0.001), glyceraldehyde-3- phosphate dehydrogenase 농도와 정비례 하였다 (p<0.001). 정상 대조군에 비해 전자간증 산모의 임신 제 3삼분기 혈액내의 HYP2 유전자의 농도는 유의하게 증가되어 있었으나, 임신 제 1삼분기 및 2삼분기의 HYP2 농도 차이는 통계적인 유의성을 보이지 않았다. 하지만, 임신성 고혈압 질환 산모를 태아 출생 체중에 따라 저체중아와 그렇지 않은 군으로 나누어 분석하였을 때, 저체중아를 동반한 전자간증 산모의 혈액 내 HYP2의 농도는 정상 대조군에 비해 임신 제 3삼분기 뿐만 아니라 1삼분기, 2삼분기 모두에서 통계적으로 의미 있게 증가하였다. 반면, 임신성 고혈압 (Gestational hypertension) 산모의 경우에는, 이러한 차이를 보이지 않았다. 결론: 본 연구를 통해 산모의 제1삼분기 혈액 내의 세포 유리 DNA는 자궁내 성장 지연을 동반한 전자간증을 조기에 예측하는데 사용될 수 있음을 제시하였다.open박

Co-infection with vaginal Ureaplasma urealyticum and Mycoplasma hominis increases adverse pregnancy outcomes in patients with preterm labor or preterm premature rupture of membranes

OBJECTIVE: The purpose of this study was to determine the prevalence of Ureaplasma urealyticum (UU) and Mycoplasma hominis (MH) in patients with preterm labor or preterm premature rupture of membranes (PPROM) and to determine the effect of these organisms on pregnancy outcomes based on the density of colonization. METHODS: The study group consisted of 184 women with preterm labor or PPROM. Vaginal cultures for UU and MH were performed for all patients at admission, and the placentas were histologically evaluated after delivery. RESULTS: The prevalence of positive vaginal fluid cultures for genital mycoplasma was 62.5% (112/179). This group included 99 patients carrying only UU and 13 carrying both organisms. No patients were found to carry only MH. Compared to patients only positive for UU, patients with both organisms showed significantly decreased gestational age at birth and birth weight, and significant increases in the incidences of preterm birth, NICU admissions and histologic chorioamnionitis. CONCLUSION: Vaginal MH tends to be detected with UU, and patients carrying both organisms simultaneously had more severe adverse pregnancy outcomes compared to patients in preterm labor or PPROM who were only positive for UU.ope