Early Cervical Ectopic Pregnancy: A Case Report and Review of the Literature

For women in the early stages of pregnancy, the intrauterine gestational sac cannot yet be seen. Both adnexal regions, the posterior cul-de-sac and the cervical canal should therefore be imaged to avoid missing the very rare cases of early cervical pregnancy. Color Doppler ultrasound can locate the exact site of implantation and confidently confirm the diagnosis of cervical pregnancy. Early diagnosis is important for early intervention and reduces the associated major complications

Risk Factors for Spontaneous Preterm Delivery Before 34 Weeks of Gestation Among Taiwanese Women

SUMMARYObjectiveTo identify the risk factors for spontaneous preterm delivery before 34 weeks of gestation among Taiwanese women.Materials and MethodsThis retrospective cohort study involved 36,453 Taiwanese women who delivered between July 1990 and December 2003. Pregnancies complicated by multiple gestation, fetal anomalies, and iatrogenic preterm births due to maternal or fetal indications were excluded.ResultsFive hundred and five spontaneous preterm deliveries (1.4%) were identified. Risk factors for early preterm delivery included a prior preterm delivery (odds ratio [OR], 16.5; 95% confidence interval [CI], 11.1–24.6), placental abruption (OR, 13.4; 95% CI, 9.4–19.2), history of fetal demise (OR, 11.8; 95% CI, 7.7–18.0), chorioamnionitis (OR, 10.5; 95% CI, 7.4–14.9), oligohydramnios (OR, 10.1; 95% CI, 6.7–15.3), history of abruption (OR, 7.9; 95% CI, 2.4–26.0), unmarried (OR, 6.2; 95% CI, 2.9–13.2), conception by reproductive technology (OR, 2.7; 95% CI, 1.4–5.5), maternal age less than 20 years (OR, 3.5; 95% CI, 1.8–6.7), maternal age greater than 34 years (OR, 1.6; 95% CI, 1.2–2.1), three or more abortions (OR, 1.6; 95% CI, 1.9–2.3), and premature rupture of membranes (OR, 1.6; 95% CI, 1.3–2.0).ConclusionSome of the risk factors for early preterm delivery among Taiwanese women were the same as those of other ethnic groups, whereas some of the other risk factors were different

Perinatal outcome in normal pregnant women with incidental thrombocytopenia at delivery

AbstractObjectiveTo investigate the perinatal outcomes of women who suffered from thrombocytopenia at delivery but did not have other diseases during pregnancy.Materials and MethodsWe considered all singleton deliveries after 24 weeks of gestation at Chang Gung Memorial Hospital, Taipei, Taiwan between 2001 and 2010. Women were excluded from this study if they suffered from any of the following conditions: chronic hypertension, hepatitis, acute fatty liver, liver cirrhosis, nephropathy, overt diabetes mellitus, connective tissue disease, systemic lupus erythematosus, or immune thrombocytopenia. Pregnancies complicated by gestational hypertension, preeclampsia, or fetal anomalies during gestation were also excluded. A total of 18,384 deliveries were included for analysis. Women were divided into three groups according to platelet count at admission.ResultsA total of 787 pregnancies (4.3%) were complicated by thrombocytopenia. Thrombocytopenic women had a significantly higher rate of cesarean delivery compared to women who did not have this condition. No other differences were observed among these three groups regarding the rates of adverse pregnancy outcomes.ConclusionsThe results indicate that women who suffered from incidental thrombocytopenia at delivery but did not have other diseases during pregnancy were not at increased risk for adverse pregnancy outcomes

First- and Second-trimester Down Syndrome Screening: Current Strategies and Clinical Guidelines

SummaryDown syndrome (DS) is the most common human disease caused by a structural chromosome defect. The original screening test for DS was maternal age or a history of a previously affected infant. Maternal serum screening has been incorporated into routine prenatal checkup in Taiwan since 1994. We used free β-human chorionic gonadotropin and α-fetoprotein (double test) as the serum markers, and this was carried out between the 15 to 20th week of gestation. The overall detection rate was 56% and was compatible with studies of Caucasian populations. The impact of double tests in Taiwan has shown itself by a dramatic lowering of the rate of DS live birth from 0.63 before screening to 0.16 per 1,000 live births at present. However, because of its relatively low detection rate and poor cost-effectiveness, the double test is not justified as a routine screening tool currently. First-trimester combined test is now becoming more widely available and provides increased sensitivity when detecting DS; it has a detection rate of approximately 85% with a false-positive rate of 5%. Nuchal translucency measurement requires ongoing quality control and sufficient certificated obstetricians; therefore, first-trimester ultrasound is limited only in designated centers. The quadruple test, having comparable detection rate, should be considered for incorporation into second-trimester screening in Taiwan in the near future. Other screening approaches and combinations have also been utilized in the Western countries. In this review, we outline the various options with respect to DS screening and hope that this will provide practical information for physicians offering such screenings. [Taiwan J Obstet Cynecol 2008;47(2):157-1 62