Predictive value for adverse pregnancy outcome of quad serum markers in antiphospholipid antibody syndrome

( Sir-yeon Hong ),( Jungsoo Chae ),( Mi Rang Seo ),( Yoo Min Kim ),( Suk-joo Choi ),( Soo-young Oh ),( Cheong-rae Roh ),( Jong-hwa Kim ) 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-

Objective: We investigated the validity of quad serum markers for the prediction of the adverse pregnancy outcome(APO) in women with antiphospholipid antibody syndrome(APAS). Methods: We included 62 women with APAS who delivered in our institution between 2005 and 2017. APO was defined as fetal death in utero(FDIU), small for gestation age(SGA), preeclampsia or preterm delivery(<34weeks). First, we compared clinical characteristics between patients with or without APO. Second, we compared APO according to abnormal level of quad serum markers, which was defined as above 2.0MoM for -fetoprotein(AFP), human chorionic gonadotropin(hCG), inhibin A and below 0.5MoM for unconjugated estriol(uE3). Lastly, receiver operating characteristic(ROC) curve analysis was performed to determine the cutoff of quad serum markers for prediction of each and composite APO. Results: 1) APAS mothers with composite APO showed higher median AFP(1.331 vs. 0.990MoM, p=0.020) and inhibin A(1.568 vs. 0.814MoM, p<0.001) compared to those without APO and was also associated with higher rates of positive risk of Down syndrome(18.8% vs. 0%, p=0.07) and neural tube defect(29.0% vs. 5.3%, p=0.067). 2) Elevated AFP level was associated with higher rates of FDIU(36.4% vs. 5.4%, p=0.019), and SGA(90.9% vs. 51.4%, p=0.032). Elevated inhibin A level was associated with higher rates of FDIU(50.0% vs. 2.9%, p=0.001), SGA(100.0% vs. 55.9%, p=0.009), and preterm delivery(60.0% vs. 15.2%, p=0.053). hCG and uE3 levels were not associated with any of APO and composite APO. 3) ROC curve for prediction of FDIU revealed area under the curve of 0.816 for AFP and 0.930 for inhibin A. With the cut-off value of above 1.28 MoM of AFP, the sensitivity, specificity, positive and negative predictive value for prediction of FDIU was 100%, 63.2%, 28.6% and 100%, respectively. And those of inhibin A above 1.84 MoM were 100%, 86.8%. 54.5% and 100%. Conclusion: Elevated AFP and inhibin A levels in women with APAS have high predictive value for APO, especially FDIU.

Timing of elective cesarean delivery on maternal request and perinatal outcome in non-complicated singleton pregnancies

( Yeon-jin Yang ),( Sir-yeon Hong ),( Yejin Kim ),( Yun-sun Choi ),( Ilyeo Jang ),( Minji Kim ),( Ji-hee Sung ),( Suk-joo Choi ),( Soo-young Oh ),( Cheong-rae Roh ) 대한산부인과학회 2022 대한산부인과학회 학술대회 Vol.108 No.-

Objective: To assess the pregnancy and neonatal outcomes according to scheduled timing of cesarean delivery on maternal request (CDMR). Methods: This was a retrospective cohort study of 344 women with singleton pregnancy who underwent CDMR in a single institution between 2010 and 2021. Pregnant women who received cesarean delivery, preterm delivery, multiple pregnancy, and complicated pregnancy were excluded. Subjects were categorized into 4 groups according to the scheduled gestational age at delivery: 37-week (n=18), 38-week (n=148), 39-week (n=149), ≥40-week (n=29) groups. Pregnancy outcome and neonatal outcome were reviewed. Results: The rate of emergency CDMR was higher in the 38-week (8.1%) and 39-week (10.7%) group compared to the 37-week (0%) and 40-week (3.4%) group, but the difference was not statistically significant. Birth weight significantly increased with advancing gestational age, and the rate of large-for-gestational age (LGA) increased with advancing gestational age (0%, 10.8%, 16.1%, 31.0% in the 37-week, 38-week, 39-week, ≥40-week group, respectively, P=0.02), with highest rate in the ≥40-week group. Other outcome including postpartum hemorrhage, cesarean section wound complications, and neonatal outcomes were comparable among 4 groups, but meconium staining increased with advancing gestational age. Conclusion: According to our study results, timing of scheduled CDMR was not associated with adverse pregnancy or neonatal outcome in non-complicated singleton pregnancies. However, the sample size of our study was too small, especially those in the 37-week and ≥40-week group, and further study with an adequate sample size are needed.

Most uterine fibroids significantly decrease in size spontaneously after delivery

( Joon-young Hong ),( Sir-yeon Hong ),( Yun-sun Choi ),( Yejin Kim ),( Ji-hee Sung ),( Suk-joo Choi ),( Soo-young Oh ),( Cheong-rae Roh ) 대한산부인과학회 2022 대한산부인과학회 학술대회 Vol.108 No.-

Objective: Uterine fibroid is most common benign tumor in childbearing age women and is increasing with age. As the maternal age of childbearing is getting higher in Korea, pregnancies with uterine fibroid are more common. Because of superfluous concern about the effect of fibroid on pregnancy, myomectomy beyond recommended guideline is sometimes performed and it can increase the risk of fatal complications during pregnancy like uterine rupture. The aim of this study was to reveal how much the size of uterine fibroid has decreased spontaneously in postpartum period. Methods: This study included woman who had fibroids during pregnancy and underwent transvaginal sonography within two months after delivery in our institution (study period: Jan 2010 - May 2020). The maximal diameter from uterine fibroids during all trimesters and in postpartum period was collected and compared by paired t-test. The changes were also assessed by the ratio of diameter of uterine fibroid during postpartum period divided by the diameter during pregnancy as a denominator. Results: A total 199 patient was included in this study. Median maternal age was 35 years old [range, 28-45]. Maximal diameter of uterine fibroid during pregnancy and after delivery was 6.6 cm [range, 1.4-17.3 cm], and 4.1 cm [range, 1.0-14.8 cm], respectively. Uterine fibroids significantly decrease in size after delivery, compared to during pregnancy (p<0.001). The median ratio of fibroid in postpartum period was 0.70 [range, 0.03-1.60]. In one-third of patients, the maximal diameter of fibroid was reduced by more than 40%. We also analyzed the difference of decreasing ratio between single and multiple uterine fibroids, but there was no significant difference. Conclusion: Most uterine fibroid significantly decrease in size after delivery, compared to the period of during pregnancy. Our results will help to reduce unnecessary worries for the pregnant women with fibroids and provide useful information to doctors for their counseling.

Elective labor induction versus spontaneous labor or rupture of membranes in low-risk women after 39 weeks of gestation

( Minji Kim ),( Sir Yeon Hong ),( Yejin Kim ),( Yun Sun Choi ),( Ilyeo Jang ),( Ji Hee Sung ),( Suk Joo Choi ),( Soo Young Oh ),( Cheong Rae Roh ) 대한산부인과학회 2022 대한산부인과학회 학술대회 Vol.108 No.-

Objective: We compared the maternal and neonatal outcomes between elective labor induction versus spontaneous labor or rupture of membranes in women with non-complicated singleton pregnancies who tried labor after 39 weeks of gestation. Methods: This was a retrospective cohort study of 342 women with singleton pregnancy who tried labor after 39 weeks of gestation in a single institution between 2018 and 2021. Pregnant women who delivered before 39 weeks of gestation, who delivered by elective cesarean section, or with multiple gestation or complicated pregnancy were excluded. Subjects were categorized into two groups: pregnant women who underwent elective labor induction (induction group) and pregnant women who had spontaneous labor or rupture of membranes (spontaneous group). Pregnancy outcomes and neonatal outcomes were reviewed. Subgroup analyses were done in nulliparous and multiparous women. Results: Maternal characteristics were similar in the two groups. Cesarean section rate was significantly higher in the induction group than the spontaneous group (27.0% vs. 14.6%, P=0.005). However, the indications for cesarean delivery were significantly different between the two groups: induction failure (35.4% vs. 0%), failure to progress (64.6% vs. 79.2%), and fetal distress (0% vs. 20.8%) in the induction group and spontaneous group (P<0.001), respectively. Postoperative complications were comparable between the two groups, but postoperative hemoglobin drop more than 10% was significantly more common in the induction group. Neonatal outcomes were similar between the two groups. In nulliparous women, cesarean section rate was significantly higher in the induction group (37.0% vs. 20.2%, P=0.004). Conclusion: Elective labor induction in non-complicated singleton women at 39 weeks of gestation was associated with a higher cesarean section rate than spontaneous labor or rupture of membranes. And this was mostly due to a higher rate of cesarean delivery for induction failure in nulliparous women.

안구근육동맥과 그 변이

이혜연(Hye Yeon Lee),정인혁(In Hyuk Chung),서원석(Won Seok Sir),고기석(Ki Suk Koh),고형준(Hyung Joon Koh),홍영재(Young Jae Hong) 대한안과학회 1992 대한안과학회지 Vol.33 No.12

안구곧은근육에 분포하는 동맥의 미세해부 2 . 곧은근육동맥의 분포

홍영재(Young Jae Hong),이혜연(Hye Yeon Lee),정인혁(In Hyuk Chung),서원석(Won Seok Sir) 대한안과학회 1992 대한안과학회지 Vol.33 No.12

안구곧은근육에 분포하는 동맥의 미세해부 1 . 곧은근육동맥의 이는곳

홍영재(Young Jae Hong),이혜연(Hye Yeon Lee),정인혁(In Hyuk Chung),서원석(Won Seok Sir) 대한안과학회 1992 대한안과학회지 Vol.33 No.12

Down Syndrome, Obstetricians Should Know

( Ji-hee Sung ),( Soo Hyun Kim ),( Sir-yeon Hong ),( Chi-son Chang ),( Yejin Kim ),( Jungeun Jeon ),( Hyea Park ),( Soo-young Oh ) 대한주산의학회 2021 Perinatology Vol.32 No.1

Down syndrome is the most common trisomy abnormality, and generally occurs in about 1 in 700 surviving children. According to a Korean study, the prevalence of Down syndrome was about 5.03 out of 10,000 surviving children born from 2007 to 2016 and about 200-277 newborns with Down syndrome were born every year. In the past, the average survival age of Down syndrome was low, but recently it has been extended to 60 years and the quality of life is improving. Recently, there have been many improvements in the education of children with Down syndrome, and various studies have been conducted at the preclinical and clinical stages about cognitive impairment, which was thought to be impossible to treat previously. In Korea, obstetricians mainly play the role of providing medical information in the process of screening and confirming Down syndrome. Therefore, medical staff need to be familiar with the latest knowledge on medical conditions, treatment and prognosis, and quality of life of Down syndrome. Through this review, we provide information on prenatal diagnosis and counseling for Down syndrome and medical problems that may occur in Down syndrome. We also review the latest research on improving cognitive function of Down syndrome. In addition, we summarize literature in Korean about Down syndrome from a social point of view and introduce websites and social media related to Down syndrome, as well as an economic support system in Korea. By providing comprehensive and contemporary information, we ultimately hope to help families with Down syndrome.

Which placental pathologic findings affect perinatal and infant long-term outcomes of preterm-delivered intrauterine growth restriction baby?

( Young Eun Chung ),( Soo-young Oh ),( Jung-sun Kim ),( Cheong-rae Roh ),( Suk-joo Choi ),( Ji-hee Sung ),( Yun-sun Choi ),( Yejin Kim ),( Sir-yeon Hong ) 대한산부인과학회 2022 대한산부인과학회 학술대회 Vol.108 No.-

Objective: To characterize perinatal and infant long-term outcomes in preterm-delivered intrauterine growth restriction according to the specific placenta pathologic findings. Methods: This study includes singleton pregnancies with fetal growth restriction (FGR) delivered between 22+0 and 36+6 weeks from 2011 to 2018 in our institution. Placenta pathology was assessed according to findings of maternal vascular malperfusion and fetal vascular malperfusion by Amsterdam criteria. We retrospectively examined perinatal outcomes including gestational age at delivery (GAD), severe preeclampsia, neonatal mortality and infant long-term outcomes including postnatal growth and delayed neurodevelopment. Results: There were 383 consecutive preterm FGR during the study period. After exclusion of unavailable placenta pathology(n=4) and major anomaly(n=25), 354 pregnancies finally included. Earlier gestational age at delivery was significantly associated with most findings of maternal vascular malperfusion including villous infarct, increased syncytial knot, acute atherosis of basal plate arteries and/or decidual arterioles (p<0.001 for all). Severe preeclampsia was also related to findings of fetal vascular malperfusion as well as maternal vascular malperfusion. Neonatal mortality was associated with hyalinized avascular villi (odds ratio (OR)=5.118, 95% confidence interval (CI): 1.727-15.166). Conclusion: This study reveals that specific placenta findings of maternal vascular malperfusion and fetal vascular malperfusion are related to perinatal and infant long-term outcomes in preterm FGR, emphasizing the importance of systematic and detailed placental pathology examination.