The coronavirus disease 2019 infection in pregnancy and adverse pregnancy outcomes: a systematic review and meta-analysis

Yeonseong Jeong,Min-A Kim 대한산부인과학회 2023 Obstetrics & Gynecology Science Vol.66 No.6

Prediction of the severity of neonatal respiratory complication in early preterm birth complicated gestational diabetes using the placenta/birthweight ratio: a retrospective cohort study

( Yeonseong Jeong ),( Yun Ji Jung ),( Joon Ho Lee ),( Ja-young Kwon ),( Young Han Kim ),( Ha Yan Kwon ) 대한산부인과학회 2021 대한산부인과학회 학술대회 Vol.107 No.-

The risk for future cerebrovascular disease in pregnant women with Moyamoya disease : a nationwide population-based study in South Korea

( Yeonseong Jeong ),( Yun Ji Jung ),( Eunjin Noh ),( Geum Joon Cho ),( Min-jeong Oh ),( Young-han Kim ) 대한산부인과학회 2020 대한산부인과학회 학술대회 Vol.106 No.-

Objective: Physiologic changes during pregnancy affect the development of postpartum cerebrovascular disease (CVD) in women with Moyamoya disease (MMD). Due to the rare prevalence of MMD and large regional variations, large-scale studies on the risk of CVD after delivery have not been conducted. The aim of this study was to determine whether women with MMD have an increased risk of CVD after delivery. Methods: Study data were collected from the Korean National Health Insurance Claims Database of the Health Insurance Review and Assessment Service for 2007-2016. Patient who had delivery in Korea between 2007 and 2014 were enrolled. We used multivariable Cox proportional hazard regression to estimate adjusted hazard ratio for CVD in women with MMD. Results: Among 3,611,216 Korean women who had delivery, 382 had Moyamoya disease. When compared to women without MMD, women with MMD had a higher prevalence of pregestational diabetes and chronic hypertension. Also, women with MMD had a significantly higher incidence of cesarean section, pregnancy induced hypertension, and gestational diabetes mellitus (p<0.0001, <0.0001, 0.02, respectively). Among women with MMD, a total of 246(64.4%) women developed CVD within the follow-up postpartum period, and 87.8% occurred within 2 year of postpartum. Women with MMD were associated with an increased risk of CVD in later (adjusted HR 108.24; 95% CI, 95.37-122.86) after adjusting for maternal age, parity, pregnancy induced hypertension, gestational diabetes mellitus, pregestational diabetes, chronic hypertension. Conclusion: Our study showed that the incidence of CVD after delivery was higher in women with MMD. Therefore, we have to have more cautions of women with MMD and provide long-term postpartum surveillance.

Preliminary report of biometry of pubovisceral muscle and levator hiatus by three-dimensional (3D) ultrasound

( Yeonseong Jeong ),( Yunjin Bang ),( Eun-hee Yoo ) 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-

Objective: To assess the reliabiltity and validity of three-dimensional (3D) ultrasound technique for measurement of pubovisceral muscle and levator hiatus area and explore ethnic differences between these measurements and those in nulliparous Taiwanese /Caucasian women. Methods: We acquired 3D sonographic transperineal measurements from twenty-one nulliparous asymptomatic women. The sonographic measurements were obtained by two observers and assessed inter-observer reproducibility. We measured the maximal levator thickness and hiatal dimensions under resting, Valsalva and contraction status. Reliability was studied by the intraclass correlation coefficient. The sonographic data were compared with those in Taiwanese /Caucasian women. Results: There were good inter-observer agreements of measurement of pelvic floor muscle and hiatal area. The age and body mass index(BMI) of this study ranged 26 to 41 years(mean 30.9) and 18 to 22 Kg/㎡(mean 19.7), respectively. This study population was older and thinner than the previous study of Yang et al. (mean age: 26.7 years, mean BMI: 20.1 Kg/㎡) and Dietz et al. (mean age: 20.5 years, mean BMI: 23.5 Kg/㎡). The thickness of pelvic floor muscle measured by pubovisceral muscle (range: 0.63-1.54, mean: 0.96cm) was thicker than Taiwanese (mean 0.84cm) and Caucasian (mean 0.73cm). The measurements of hiatal area by minimal anteroposterior, lateral hiatal diameter and minimum hiatal area (mean: 4.1cm, 3.4cm, 9.8 ㎠) were smaller than Taiwanese (mean: 4.3cm, 3.9cm, 11.69 ㎠) and Caucasian women (mean: 4.5cm, 3.8cm, 11.3 ㎠). Conclusion: Even though good reliability of inter-observer agreements, the comparative study of pelvic floor muscle thickness and hiatal diameter was inconclusive due to skewed demographics of study population. Further studies tailoring to demographics of study population in a large number are needed.

Exposure of PM2.5 and metabolic dysfunction during pregnancy via personalized measurement of PM2.5 in South Korea: A multi-center prospective cohort, APPO (air pollution on pregnancy outcome) study

( Yeonseong Jeong ),( Young-han Kim ),( Sunwha Park ),( Young Min Hur ),( Eunjin Kwon ),( Young Ju Kim ),( Kyung A Lee ),( Soo Jung Kim ),( Mi Hye Park ),( Geum Joon Cho ),( Min-jeong Oh ),( Sejin Lee 대한산부인과학회 2022 대한산부인과학회 학술대회 Vol.108 No.-

Objective: Ambient particulate matter (PM) is well known as a trigger factor of metabolic dysfunction. The aim of this study is to evaluate the association of particulate matter with metabolic dysfunction in pregnancy. Methods: This is a prospective, multicenter, and observational cohort study from January 2021 to June 2022. For individual measurement of particulate matter, an Airguard device was installed inside the participants' houses. Time-activity log was recorded in order to predict the personal exposure to PM2.5. The participants were divided into groups as the concentration of PM2.5 calculated by the time-weighted average model. Differences in continuous and categorical variables were analyzed through independent two-sample t-test, ANOVA, and Chi-square test (Fisher's exact test), respectively. We used logistic and linear regression models to explore odds ratio (OR) and 95 % confidence intervals (CI) for the associations between exposure to PM2.5 and metabolic dysfunction. Statistical analysis was conducted using SAS version 9.4 (SAS Institute, Cary, NC, USA). Results: Of recruited 333 singleton pregnant women, significant associations were observed between PM2.5 during pregnancy and elevated blood pressure (BP) in the 3rd trimester, elevated triglycerides, and GDM (p=0.0437, 0.0446, and 0.0338, respectively). We conducted subgroup analysis in PM2.5-stratified subgroups and presented an increasing trend of GDM as PM2.5 levels rose (p=0.0339). Triglycerides were especially high in the Exthigh-PM2.5 (≥ 25/m3) group (p=0.0171). After adjusting for confounders, we found that maternal exposure to PM2.5 increased the risk of elevated BP in late pregnancy (aOR 2.228, 95% CI 1.115-4.449, p=0.0232) and GDM (aOR 2.263, 95% CI 1.106-5.039). Conclusion: Exposure to PM2.5 may have a worsening effect on metabolic dysfunction in pregnancy. Further research will be conducted to establish the mechanisms of ambient particulate matter on metabolic dysfunction during pregnancy.

Risk of maternal and neonatal morbidities around term deliveries by intrapartum Cesarean Delivery

( Yeonseong Jeong ),( Jisun Yun ),( Ji Hyun Lee ),( Eui Hyeok Kim ) 대한산부인과학회 2020 대한산부인과학회 학술대회 Vol.106 No.-

Objective: To investigate the maternal and neonatal morbidities associated with intrapartum cesarean deliveries (CD) performed around term compared morbidities associated with elective CD without labor around term. Methods: We conducted a retrospective observational study of singleton pregnancies that were at 38 or more weeks of gestation from 2009 to 2019. CD due to placenta previa, fetal death, or multifetal pregnancies were excluded in this study. Maternal and neonatal morbidities of intrapartum CD were compared with that of the elective CD without labor. Results: A total of 308 women who have undergone CD were recruited. Of these, 92 were delivered by intrapartum CD, 216 by elective CD. In intrapartum CD, maternal age was younger and gestational age at birth and fetal birthweight were higher. Maternal length of stay and readmission rate after discharge were higher in intrapartum CD (6.7±0.9 vs. 6.3 ± 0.9 days, 6.5% vs. 0%, all p< 0.001). The rate of outpatient visits > 2 within 50 days after discharge was higher in intrapartum CD (Relative risk[RR] 2.1, 95% confidence interval[CI] 1.19-3.96). Decrement of hemoglobin after delivery and transfusion rate were increased in intrapartum CD (2.4 ±1.3 vs. 1.6 ± 1.1 mg/dl, p<0.001, 7.6% vs. 2.8%, p=0.05). Regarding neonatal morbidities, the NICU admission rate was higher in intrapartum CD (RR 4.56, 95% CI 2.32-8.94). Intubation rate and severe neonatal morbidities such as respiratory distress syndrome and transient tachypnea of newborn were increased in intrapartum CD (5.4% vs. 0.9%, p<0.015, 0.5% vs. 4.3%, p=0.014). APGAR score <7 at 5 minutes and meconium-stained amnionic fluid were also higher in intrapartum CD. Conclusion: Compared with elective CD without labor, postpartum hemorrhage, maternal length of stay, readmission rate, and the number of outpatient visits after discharge were all increased in intrapartum CD. Moreover, neonates delivered by intrapartum CD have increased risks of overall morbidities despite higher gestational age and fetal birthweight.

Electronic Fetal Monitoring: Past, Present and Future

( Yun Ji Jung ),( Yeonseong Jeong ),( Young-han Kim ) 대한주산의학회 2021 Perinatology Vol.32 No.4

Electronic fetal monitoring was introduced in 1957 and has been used clinically to assess fetal well-being and uterine contractions throughout pregnancy. The electronic fetal monitoring can detect fetal distress early during labor and has significantly contributed to reduce fetal morbidity and mortality. Currently, electric fetal monitoring has been accepted worldwide, at every delivery unit and outpatient clinic in most medical centers. Although electronic fetal monitoring using Doppler ultrasound and tocodynamometry has many advantages such as non-invasiveness and simplicity, the accuracy of measurement varies according to maternal movement and band-holding devices give discomfort to women during the examination. Recently, devices for intrauterine pressure measurement are seldom used because of the risks of uterine rupture, infection, and placental abruption in spite of its high accuracy. Nowadays, wireless fetal monitoring has been developed and commercially available to compensate these limitations. Electrohysterography and fetal electrocardiogram consist of the wireless fetal monitoring device. The device is handy and helpful in the management of high-risk pregnancy by enabling fetal monitoring outside the hospital, even at home. It is expected that the birth environment may become safer through the development of a monitoring system based on artificial intelligence by improving the predictability of complicated high-risk pregnancies. This review summarizes the past and present of electronic fetal monitoring and suggests future directions of fetal monitoring.

Asymptomatic Uterine Incarceration at Near-Term Pregnancy with a Successful Delivery Outcome: A Case Report and Review of Literature

( Yejin Kwon ),( Hanna Moon ),( Yeonseong Jeong ),( Young-han Kim ) 대한주산의학회 2022 Perinatology Vol.33 No.2

An incarcerated gravid uterus is a rare obstetrical complication that requires close monitoring to ensure fetal and maternal well-being and to plan a successful delivery. Most patients present with vague anatomic pressure-related symptoms, such as pelvic discomfort and urinary symptoms, in the early 2nd trimester. Initial presentation in the 3rd trimester is scarce, and asymptomatic cases are even rarer. In this case report, we present an asymptomatic patient who was referred at 30 weeks of gestation with an initial impression of placenta previa totalis. She was not a candidate for uterine reduction; therefore, after a close follow-up period, she underwent planned cesarean section at 36 weeks of gestation. Because of its rare frequency and related obstetrical complications, early clinical suspicion and diagnosis are critical for management until delivery and establishing a successful delivery strategy.

Clinical outcomes of frozen embryo transfer cycles after freeze-all policy to prevent ovarian hyperstimulation syndrome

( Jae Jun Shin ),( Yeonseong Jeong ),( Eunjee Nho ),( Byung Chul Jee ) 대한산부인과학회 2018 Obstetrics & Gynecology Science Vol.61 No.4

Objective To compare the clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR) in frozen embryo transfers (FETs) following either freeze-all policy to prevent ovarian hyperstimulation syndrome (OHSS; freeze-all group) or excess embryo cryopreservation after fresh embryo transfer (surplus group). Methods The freeze-all group comprised 44 FET cycles performed in 25 women between 2010 and 2016. The surplus group comprised 53 FET cycles performed in 47 women during the same period. The cumulative CPR and OPR according to duration of cryopreservation (interval between cryopreservation and FET) was estimated using Kaplan-Meier plots. Cox regression analysis was used for identifying factor to affect to cryopreservation duration in cycles with pregnancy. Results In day 2-4 transfer cycles, the crude CPR (40% vs. 18.2%) and OPR (20% vs. 4.5%) were similar between the 2 groups. In day 5 transfer, the crude CPR (33.3% vs. 38.7%) and OPR (33.3% vs. 29%) were also similar between the 2 groups. The cumulative CPR (100% vs. 47.5%) and OPR (100% vs. 33.3%) in day 2-4 transfer as well as the cumulative CPR (46.7% vs. 100%) and OPR (46.7% and 74.8%) in day 5 transfer were also similar between the 2 groups. The median duration of cryopreservation was significantly shorter in the freeze-all group than in the surplus group (19.8 vs. 36.9 weeks, P=0.04). Previous history of delivery was the only factor associated with a shorter cryopreservation duration in cycles with pregnancy (hazard ratio, 0.18; 95% confidence interval, 0.05-0.65; P=0.01). Conclusion Freezing embryos to prevent OHSS and transferring the frozen embryos later may guarantee an acceptable reproductive outcome.

A Case of Cornual pregnancy at 10 gestational age, after laparoscopic myomectomy

( Kyung Lim Lee ),( Yeonseong Jeong ),( Jong Wook Seo ),( In Ok Lee ),( Eui Hyeok Kim ),( Jae Eun Chung ),( Jisun Yun ) 대한산부인과학회 2020 대한산부인과학회 학술대회 Vol.106 No.-

To report the case of cornual pregnancy at 10 gestational age Case: A 41-year-old woman, was transferred to the emergency department at amenorrhea 10 weeks 5 days after diagnosis of cornual pregnancy at the primary hospital. The patient was nullipara, and has histories of 1 induced abortion and 2 missed abortions. She was previous laparoscopic myomectomy status, which performed 1 year ago. After last menstruation period, she was diagnosed with blight ovum at amenorrhea 8 weeks 4 days, and dilatation and curettage of uterus was performed at primary hospital. Serum hCG arrival was 84573.8 mIU/mL. Trans-abdominal ultrasonography showed mass protruding from left corn of the uterine cavity, containing a gestation sac (mean sac diameter 39.0mm, 10+0 weeks size) and an embryo of cranio-caudal length of 38.2mm(10+5 weeks size). There was no sign or finding of any intraperitoneal hemorrhage. Entering the abdominal cavity, 5x5cm² sized conceptual mass surrounded thin fragile myometrium was noted on left uterine cornus, include left fallopian tube. Open wedge resection of left cornual pregnancy, left salpingectomy was performed. The resected mass was 4.0x3.5cm² size. an embryo with 45mm size was confirmed inside the mass. Conclusion: We present a case of an un-ruptured cornual pregnancy at 10 gestational age with a brief review of literatures.