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We investigated (1) pregnancy and neonatal outcomes in women with and without disabilities, (2) time trends in deliveries, and (3) risks of pregnancy and neonatal complications among women with various disability types and severity. This was a nationwide population-based study merging the database of the Korea National Health Insurance claims, National Health Screening Program for Infants and Children, and Disability Registration System to compare perinatal outcomes in women with and without disabilities. Pregnancy and neonatal outcomes were analyzed during 2007 and 2015, as were time trends of deliveries. Multivariate logistic regression was used to evaluate risk of perinatal outcomes among women with various disability types and severities. Women with disabilities showed higher rates of cesarean section (aOR, 1.73; 95% CI, 1.69–1.77), hypertensive disorders (aOR, 1.74; 95% CI, 1.63–1.86), placenta abruption (aOR, 1.27; 95% CI, 1.12–1.45), placenta previa (aOR, 1.14; 95% CI, 1.05–1.24), stillbirths (aOR, 1.30; 95% CI, 1.17–1.45), preterm births (aOR, 1.67; 95% CI, 1.57–1.78), and LBW (aOR, 1.87; 95% CI, 1.78–1.97) than those without disabilities. From 2007 to 2015, although delivery rate in women with disabilities decreased steeply compared with that in women without disabilities, the rate of cesarean section increased in women with disabilities. Women with intellectual disability and those with vision impairment had the highest number of perinatal complications among women with various types of disabilities. Women with disability had more adverse pregnancy and neonatal outcomes than those without disabilities. Specific disability types & severities are more vulnerable to specific perinatal complications.

Purpose Adverse pregnancy outcomes (APOs) are associated with an increased risk of chronic diseases, including cardiovascular disease (CVD) and metabolic syndrome (MS), in the future. We designed a large-scale cohort study to evaluate the influence of APOs (preeclampsia, gestational diabetes mellitus [GDM], stillbirth, macrosomia, and low birth weight) on the incidence of chronic diseases, body measurements, and serum biochemistry in the future and investigate whether combinations of APOs had additive effects on chronic diseases.Methods We used health examinee data from the Korean Genome and Epidemiology Study (KoGES-HEXA) and extracted data of parous women (n = 30,174; mean age, 53.02 years) for the analysis. A logistic regression model was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals.Results The prevalence rate of APOs was 17.4% (5,264 women). Univariate analysis revealed that women with APOs were more frequently diagnosed with chronic diseases and had a family history of chronic diseases compared with women without APOs. In logistic regression analysis, composite APOs were associated with an increased risk of hypertension, diabetes mellitus, hyperlipidemia, angina pectoris, stroke, and MS (aOR: 1.093, 1.379, 1.269, 1.351, 1.414, and 1.104, respectively), after adjustment for family history and social behaviors. Preeclampsia and GDM were associated with an increased risk of some chronic diseases; however, the combination of preeclampsia and GDM did not have an additive effect on the risk.Conclusion APOs moderately influenced the future development of maternal CVD and metabolic derangements, independent of family history and social behaviors.

ObjectiveTo evaluate the clinical significance of soft markers for aneuploidy screening in Korean women.MethodsWe retrospectively reviewed the medical records of 5,428 singleton pregnant women who underwent sonography during the second trimester at seven institutions in South Korea. We evaluated the prevalence of the following soft markers: intracardiac echogenic focus, choroid plexus cysts, pyelectasis, echogenic bowel, and mild ventriculomegaly. We developed best-fitted regression equations for the fetal femur and humerus length using our data and defined a short femur and humerus as both long bones below the fifth centile. The results of genetic testing and postnatal outcomes were investigated in patients who had been diagnosed with aforementioned soft markers.ResultsThe median maternal age of our study population was 33 years, and the median gestational age at the time of ultrasonographic examination was 21 weeks. We detected soft markers in 10.0% (n=540) of fetuses: 9.3% (n=504) were isolated cases and 0.7% (n=36) of cases had two or more markers. We identified only two aneuploides (trisomy 18, 46,XX,t[8;10][q22.1;p13]), of which one was clinically significant. We presented the neonatal outcomes of the fetuses with the respective soft markers. Preterm delivery, low birth weight, and small-for-gestational-age (SGA) were significantly more common in women with a shortened fetal femur (P

Background/Aims There have been numerous efforts to reduce mother-to-child transmission (MTCT) of hepatitis B virus (HBV) with antiviral agents during pregnancy. However, there are limited data regarding the outcomes of pregnant women after delivery. This study was performed to evaluate the efficacy of antiviral agents in preventing MTCT of HBV and maternal long-term outcomes. Methods The HBV-infected pregnant women treated with antiviral agents to prevent MTCT were retrospectively reviewed. Forty-one pregnant women who received telbivudine or tenofovir during late pregnancy (28-34 week) were analyzed. Hepatitis B virus surface antibody (HBsAb) positivity was tested in 43 infants after 7 months of birth. Eleven mothers were followed >1 year after delivery. Results The mean HBV DNA titer before antiviral therapy was 8.67 (6.60–9.49) log copies/mL, and the median age at delivery was 32 years (range, 22–40). Eleven patients were treated with tenofovir and 30 with telbivudine. The median duration was 57 days (range, 23–100), and the median HBV DNA titer at birth was 5.06 log copies/mL (range, 2.06–6.50). Antiviral treatments were associated with significant HBV DNA reduction (P12 months, and an antiviral agent was administered. Conclusions Antiviral treatment during late pregnancy effectively reduced MTCT. Long-term follow-up should be required in such cases. In addition, given that maternal biochemical flare occurred in 18% of mothers, re-administration of antiviral agents might be required.

Objective This study aimed to evaluate whether state and trait anxiety among pregnant women were associated with fetoplacental Doppler findings, abnormal placental pathology, and placental angiogenic factors. Materials and methods A total of 102 pregnant women at 32–35 gestational weeks were recruited and examined prospectively. State and trait anxiety were measured using the State-Trait Anxiety Inventory. Using Doppler ultrasound, pulsatility index (PI) of the umbilical artery (UA), middle cerebral artery (MCA), and uterine artery (UtA) and cerebroplacental ratio (CPR) were determined. Doppler parameters were converted into multiples of the median (MoM). Abnormal placental pathology was classified into 2 groups: vascular underperfusion (VU) and histological chorioamnionitis (HCA). Immunohistochemical analysis was performed to examine placental cells staining positive for placental growth factor (PLGF) and hypoxia-inducible factor-1-α (HIF-1α), which are markers for angiogenesis and hypoxic status, respectively. Results Women with high state anxiety scores had low MCA-PI MoM and CPR MoM, while those with high trait anxiety scores had low MCA-PI MoM. VU was associated with a higher incidence of high trait anxiety scores, and HCA was associated with a higher incidence of high state and trait anxiety scores. Regression analysis showed a relationship between maternal state anxiety on MCA-PI MoM and HCA after controlling for covariates. Maternal trait anxiety exhibited relationships with VU and HCA after adjustment. Conclusion Our results demonstrated that maternal anxiety is associated with altered fetal cerebral blood flow and abnormal placental pathology but is not associated with uteroplacental insufficiency and placental angiogenic factors.

Study Objective The aim of this study was to compare survival outcomes of open radical hysterectomy and minimally invasive radical hysterectomy in early stage cervical cancer. Design A retrospective analysis. Setting Routine OR setting was done. Patients or Participants 148 patients with stage IB1-IIA2 cervical cancer who underwent primary surgery. Interventions Minimally invasive radical hysterectomy or open radical hysterectomy. Measurements and Main Results Tumor characteristics, recurrence rate, disease-free survival (DFS), and overall survival (OS) were compared according to surgical approach. In total, 110 and 38 patients were assigned to open surgery and MIS groups. After a medical follow-up of 42.1 months, the groups showed similar survival outcomes (recurrence rate, DFS, and OS). However, in patients with tumor size >2 cm, recurrence rate was significantly higher in MIS group (22.5% vs 0%; p=0.008). And MIS group had significantly poorer DFS than open surgery group (p=0.017), although OS was similar between the two groups (p=0.252). Conclusion In patients with tumor size >2 cm, MIS was associated with higher recurrence rates and poorer DFS than open surgery. However, in patients with tumor size ≤2 cm, MIS did not seem to compromise oncologic outcomes.

Background: This study investigated the roles of progesterone and leptin in placenta invasion, which is closely related to pregnancy prognosis. We examined the effects of leptin and progesterone on the invasion of BeWo cells, a human trophoblastic cell line, and the effect of concurrent treatment. Methods: Cells were treated with leptin (0, 5, 50, or 500 ng/mL) or progesterone (0, 2, 20, or 200 µM) and cultured in an invasion assay. Cells treated with 500 ng/mL leptin were also treated with progesterone (0, 2, 20, or 200 µM) in the invasion assay for 48 h. The number of cells that invaded the lower surface was counted in five randomly chosen fields using a light microscope with a 200× objective. The mRNA expression levels of MMP-9, TIMP1, TIMP2, and E-cadherin were detected by semi-quantitative PCR. Results: Invasion of BeWo cells was promoted by leptin and influenced by both leptin concentration and treatment duration. Invasion was most effective at 500 ng/mL leptin and 48 h culture. Leptin-induced invasiveness was suppressed by progesterone in a dose-dependent manner. Leptin significantly decreased the expression levels of TIMP1 and E-cadherin, whereas progesterone significantly decreased expression of MMP-9 and significantly increased levels of TIMP1, TIMP2, and E-cadherin. Conclusions: Leptin promotes invasion of BeWo cells, and progesterone suppresses leptin-induced invasion by regulating the expressions of MMP-9, TIMP1, TIMP2, and E-cadherin. The balance between leptin and progesterone may play an important role in human placenta formation during early pregnancy.

Cervical incompetence is characterized by painless dilatation of the incompetent cervix and results in miscarriages and preterm delivery during second trimester. We report a 25-year-old patient, gravid 2, para 1, at 11 weeks' gestation with the diagnosis of cervical incompetence, in whom transvaginal cerclage was not technically possible and laparoscopic cervical cerclage was performed successfully. There were no operative or immediate postoperative complications. A healthy infant was delivered at 35 weeks by cesarean section. Laparoscopic cervical cerclage during pregnancy can be safe and effective treatment for well-selected patients with cervical incompetence and eliminates the need for open laparotomy.

An amniocele is a herniation of the amniotic sac through a uterine defect. Uterine rupture during pregnancy may develop as a result of a pre-existing injury, uterine anomaly, or unscarred uterus. A 30-year-old patient, with a history of 2 vaginal deliveries, presented an amniocele complicated by left fundal perforation and was evaluated with 3-dimensional ultrasound at 23 weeks. Because of worsening lower abdominal pain and vaginal bleeding, she underwent exploratory laparotomy. Herein, we report a uterine rupture with amniocele.

Background: The purpose of this research is to discover whether measurement of cervical length and cervical volume at term is helpful in predicting the onset of labor in VBAC candidates.Methods: Transvaginal sonographic evaluations of the cervixes of pregnant women who desired to undergo VBAC were performed between 36 - 40 weeks gestation. Clinical information such as labor onset time, gestational age at delivery and delivery mode was gathered from medical records.Results: A total of 514 pregnant women participated in this study. Cervical length was significantly longer in the group that delivered 7 days or more after measurement than in the group that delivered within 7 days of measurement (43±0.77 cm vs. 2.99±0.72 cm, p< 0.001). Cervical volume was significantly larger in the group that delivered at and after 7 days than in the group that delivered within 7 days (29.21±11.62 cm3 vs. 34.07±13.41 cm3, p=0.014). The cervical length ROC curve was significantly more predictive than the cervical volume ROC curve (AUC: 0.711 vs 0.594, p= 0.001). There were no significant differences between the combined cervical length/volume ROC curve and the cervical length ROC curve alone (p= 0.565). The AUC of the cervical length ROC curve to predict postterm pregnancy was 0.729.Conclusion: Measuring cervical length is helpful in predicting the onset of spontaneous labor within 7 days and posterm delivery in VBAC candidates.

Objective. This study was to compare pregnancy outcomes between cerclage and expectant management in wemen with a dilated cervix. Design. Retrospective multicenter cohort study. Setting. Five hospitals of Catholic University Medical Center Network in Korea. Population. A total of 173 women between 14 0/7 and 29 6/7 weeks' gestation with cervical dilation of 1 cm or greater by digital examination. Methods. Pregnancy outcomes were compared according to cerclage or expectant management, with the use of propensity-score matching. Main Outcome Measures. Primary outcome was time from presentation until delivery (weeks). Secondary outcomes were gestational age at delivery, neonatal survival, morbidity, preterm birth, and so on. Results. Of 173 women, 116 received a cerclage (cerclage group), and 57 were managed expectantly without cerclage (expectant group). Cervical dilation at presentation, and the use of amniocentesis performed to exclude subclinical chorioamnionitis differed between two groups. In the overall matched cohort, there was significant difference in the time from presentation until delivery (cerclage vs. expectant group, 10.6±6.2 vs. 2.9±3.2 weeks, p

Aims: To understand the intracellular reducing power metabolism, growth and intracellular NAD(P)H concentrations of a phosphoglucose isomerase (pgi)-disrupted Escherichia coli (KS002) were investigated with the expressions of redox enzymes. Methods and Results: The isogenic pgi-mutation enabled E. coli to harbour two times both the intracellular NADPH and NADH at half the growth rate. The wild-type expressing NAD-dependent malic enzyme (maeA) was incapable of sufficient growth (

Background: We would like to find out that whether the patient's parity, previous delivery mode and previous labor could influence cervical parameters. Cervical length, volume and width were measured using two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound on normal pregnant women. Method: This study was conducted between January 2009 and December 2010 in singleton pregnant women who were admitted for routine antenatal care at hospitals in affiliation with the Catholic University, Seoul, Korea. The study group was classified by parity (nullipara and multipara) and previous delivery mode (cesarean section group and vaginal delivery group). The previous cesarean section group was divided by elective group who did not undergo labor and labor group who underwent labor. Cervical parameters such as cervical length, volume and width were measured using 2D and 3D ultrasound examinations in the first and second trimesters and the results were analyzed between those groups mentioned above. Results: One hundred and twenty-one pregnant women in their 1st trimester and 233 pregnant women in their 2nd trimester (a total of 354) were enrolled in this study. Cervical parameters were not statistically significant from parity, nor previous delivery mode and previous labor in 1st trimester. Cervical volumes were not statistically significant from nullipara and elective cesarean section groups (35.96±9.81 vs. 34.73±9.75 cm3), but the nullipara groups were significantly lowered in the vaginal group (35.96±9.81 vs. 43.10±11.87 cm3) in 2nd trimester. For the nullipara group, cervical widths were not statistically significant in the elective cesarean section group but these were significantly lower than labor and previous vaginal group in the 2nd trimester. Conclusion: The cervical volume and width have an influence on parity, previous delivery mode and labor in the 2nd trimester.

Background: We would like to find out that whether the patient's parity, previous delivery mode and previous labor could influence cervical parameters. Cervical length, volume and width were measured using two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound on normal pregnant women.Method: This study was conducted between January 2009 and December 2010 in singleton pregnant women who were admitted for routine antenatal care at hospitals in affiliation with the Catholic University, Seoul, Korea. The study group was classified by parity (nullipara and multipara) and previous delivery mode (cesarean section group and vaginal delivery group). The previous cesarean section group was divided by elective group who did not undergo labor and labor group who underwent labor. Cervical parameters such as cervical length, volume and width were measured using 2D and 3D ultrasound examinations in the first and second trimesters and the results were analyzed between those groups mentioned above.Results: One hundred and twenty-one pregnant women in their 1st trimester and 233 pregnant women in their 2nd trimester (a total of 354) were enrolled in this study. Cervical parameters were not statistically significant from parity, nor previous delivery mode and previous labor in 1st trimester. Cervical volumes were not statistically significant from nullipara and elective cesarean section groups (35.96±9.81 vs. 34.73±9.75 cm3), but the nullipara groups were significantly lowered in the vaginal group (35.96±9.81 vs. 43.10±11.87 cm3) in 2nd trimester. For the nullipara group, cervical widths were not statistically significant in the elective cesarean section group but these were significantly lower than labor and previous vaginal group in the 2nd trimester.Conclusion: The cervical volume and width have an influence on parity, previous delivery mode and labor in the 2nd trimester.

Purpose: To compare umbilical arterial gas parameters in the second twin of twin pregnancies according to the mode of delivery Methods: We retrospectively analyzed the medical records of twin deliveries after 34 weeks of gestation for 3 years. Excluding the cases which underwent emergency cesarean delivery during trial of labor, a total of 79 twin gestations had umbilical arterial blood gas values available and were and divided into cesarean delivery group (N=40) and vaginal delivery group (N=39). The mean differences of umbilical arterial blood parameters and the Apgar score between the first and second twin in each pregnancy were compared according the mode of delivery. Results: The differences of umbilical arterial gas parameters between twin siblings showed no significant difference according to the mode of delivery. With regard to the 1 minute and 5 minute Apgar scores, the differences between twin siblings are significantly increased in vaginal delivery group compared to cesarean delivery group (p=0.048, and p=0.038, respectively). In comparing the 28 cases delivered vaginally with an inter-twin delivery interval < 10 minutes and 40 cases delivered by cesarean section, no significant differences were observed in the umbilical arterial gas parameters and Apgar scores. Conclusion: The inter-twin umbilical arterial blood gas parameters according to the mode of delivery showed no difference. For twin deliveries, it is relatively safe to plan for a vaginal delivery, but an effort should be made to reduce the inter-twin delivery interval time.

Ureteral involvement by endometriosis is a rare and often silent disease but capable of producing significant morbidity and leading to hydronephrosis and to renal failure. Surgery is the treatment of choice to remove endometriotic lesions and relieve ureteral obstruction if the kidney is still functional or a nephrectomy is performed if there is a complete loss of renal function. We report a case of acute renal failure induced ureteral endometriosis managed with laparoscopic unilateral nephrectomy and endometrioma cystectomy. Differential diagnosis is important to confirm diagnosis for patients with ureteral obstruction presenting nonspecific symptoms.

PURPOSE To evaluate whether serial change in cervical length (CL) over time can be a predictor for emergency cesarean section (CS) in patients with placenta previa. METHODS This was a retrospective cohort study of patients with placenta previa between January 2010 and November 2014. All women were offered serial measurement of CL by transvaginal ultrasound at 19 to 23 weeks (CL1), 24 to 28 weeks (CL2), 29 to 31 weeks (CL3), and 32 to 34 weeks (CL4). We compared clinical characteristics, serial change in CL, and outcomes between the emergency CS group (case group) and elective CS group (control group). The predictive value of change in CL for emergency CS was evaluated. RESULTS A total of 93 women were evaluated; 31 had emergency CS due to massive vaginal bleeding. CL tended to decrease with advancing gestational age in each group. Until 29-31 weeks, CL showed no significant differences between the two groups, but after that, CL in the emergency CS group decreased abruptly, even though CL in the elective CS group continued to gradually decrease. On multivariate analysis to determine risk factors, only admissions for bleeding (odds ratio, 34.710; 95% CI, 5.239-229.973) and change in CL (odds ratio, 3.522; 95% CI, 1.210-10.253) were significantly associated with emergency CS. Analysis of the receiver operating characteristic curve showed that change in CL could be the predictor of emergency CS (area under the curve 0.734, p < 0.001), with optimal cutoff for predicting emergency cesarean delivery of 6.0 mm. CONCLUSIONS Previous admission for vaginal bleeding and change in CL are independent predictors of emergency CS in placenta previa. Women with change in CL more than 6 mm between the second and third trimester are at high risk of emergency CS in placenta previa. Single measurements of short CL at the second or third trimester do not seem to predict emergency CS.

Osteoporosis is a disease characterized by exaggerated loss of bone mass, with as much as 50 to 85% of the variation in bone mineral density (BMD) commonly accepted as being genetically determined. Although intensive studies have attempted to elucidate the genetic effects of polymorphisms on BMD and/or osteoporosis in several genes, the genes involved are still largely unknown. The possible associations of genetic variants in five-candidate genes (IL10, CCR3, MCP1, MCP2 and GC) with spinal BMD were investigated in Korean postmenopausal women (n = 370). Fourteen SNPs in five candidate genes were genotyped, and the haplotypes of each gene constructed. The associations of adjusted spinal BMD by age, year since menopause (YSM) and body mass index (BMI), with genetic polymorphisms, were analyzed using multiple regression models. Genetic association analysis of Korean postmenopausal women revealed that IL10 -592A > C and/or IL10 ht2 were associated with decreased bone mass, whereas no significant associations were observed with all polymorphisms in other genes. The levels of spinal BMD in individuals bearing the IL10 -592CC genotype were lower (0.78 +/- 0.16) than those in others (0.85 +/- 0.17) (P = 0.02), and the BMD of IL10 ht2 bearing individuals were also lower (0.82 +/- 0.15) than those in others (0.85 +/- 0.17) (P = 0.04). Our results suggest that variants of IL10 might play a role in the decreased BMD, although additional study might need to be followed-up in a more powerful cohort.

Background: The purpose of this research is to discover whether measurement of cervical length and cervical volume at term is helpful in predicting the onset of labor in VBAC candidates. Methods: Transvaginal sonographic evaluations of the cervixes of pregnant women who desired to undergo VBAC were performed between 36 - 40 weeks gestation. Clinical information such as labor onset time, gestational age at delivery and delivery mode was gathered from medical records. Results: A total of 514 pregnant women participated in this study. Cervical length was significantly longer in the group that delivered 7 days or more after measurement than in the group that delivered within 7 days of measurement (43±0.77 cm vs. 2.99±0.72 cm, p< 0.001). Cervical volume was significantly larger in the group that delivered at and after 7 days than in the group that delivered within 7 days (29.21±11.62 cm3 vs. 34.07±13.41 cm3, p=0.014). The cervical length ROC curve was significantly more predictive than the cervical volume ROC curve (AUC: 0.711 vs 0.594, p= 0.001). There were no significant differences between the combined cervical length/volume ROC curve and the cervical length ROC curve alone (p= 0.565). The AUC of the cervical length ROC curve to predict postterm pregnancy was 0.729. Conclusion: Measuring cervical length is helpful in predicting the onset of spontaneous labor within 7 days and posterm delivery in VBAC candidates.

A first-trimester ultrasound scan has become an essential part of antenatal care. The Korean Society of Ultrasound in Obstetrics and Gynecology held a first-trimester ultrasound forum on April 5, 2014. The forum aimed to present an updated review of the literature on the topic of first-trimester ultrasound in specific lectures and to host a panel discussion on several important issues regarding first-trimester scans. The forum provided evidence- and consensus-based best practice patterns for obstetricians in Korea. Here, we report the review and checklists presented from the forum.

Human transforming growth factor-beta1 (TGFB1) is a family of polypeptides that regulate cell growth, cell differentiation, and cell function as a multifunctional regulator of cellular activity. TGFB1 is produced by osteoblasts and stored in substantial amounts in the bone matrix, which is an important regulator of both skeletal development and homeostasis of bone metabolism. In the present study, we identified four new polymorphisms in TGFB1 and examined whether these polymorphisms are risk factors for osteoporosis. We have sequenced all exons including in the promoter region up to -1,800bp to identify additional genetic polymorphisms in TGFB1. Four novel polymorphisms were newly identified: one in 5' region (g.14129555_14129557dupAGG), one in promoter region (g.14128838C>T), and two in intron (g.14106505G>A and g.14106215G>A). Two known SNPs (g.14128554C>T and g.14127139T>C) were also confirmed. The frequencies of each SNP were 0.479 (g.14129555_14129557dupAGG), 0.007 (g.14128838C>T), 0.478 (g.14128554C>T), 0.476 (g.14127139T>C), 0.016 (g.14106505G>A), and 0.004 (g.14106215G>A) in the Korean population (n=1,885), respectively. Haplotypes and their frequencies were estimated by EM algorithm, and linkage disequilibrium coefficients (mid R:/D'/: and r2) between polymorphism pairs were calculated. We analyzed genetic associations of TGFB1 polymorphisms and haplotypes with spinal bone mineral density (BMD) value of 433 postmenopausal Korean women. By statistical analysis, we could not find any associations with spinal BMD. The information from this study of the critical TGFB1 would be useful for genetic studies of other diseases.

We read with great interest the leading article by Tremosini and coworkers in Gut (2012 doi:10.1136/gutjnl-2011-301951) on the prospective validation of an immunohistochemical panel (glypican 3, heat shock protein 70 and glutamine synthetase) in liver biopsies for diagnosis of very early hepatocellular carcinoma (HCC).1 In this …

Objective This study aimed to survey the current clinical practice of first-trimester ultrasonography among members of the Korean Society of Ultrasound in Obstetrics and Gynecology (KSUOG) and to provide basic data for making practical recommendations about first-trimester ultrasonography scan in Korea. Methods This survey was conducted using a self-administered anonymous questionnaire. The first-trimester in this survey was divided into two parts: early and late first-trimester. The survey was focused on safety issue, nuchal translucency (NT) cutoff, the anatomic structures they check, and the need for practical recommendations or educational courses during the first-trimester. Results During the study period, 194 KSUOG members participated into this survey. The survey on early first-trimester scan reveal that 173 (89.2%) of respondents had used pulsed-wave Doppler or color Doppler imaging to monitor fetal heart beat. For the late first-trimester scan, 145 (74.7%) of respondents was found to check for fetal anatomical assessments during their NT screening performance; however, the clinical practice patterns were considerably varied among participants. More than half of the respondents used the criterion of NT ≥3.0 mm to define increased NT. Approximately 80% of respondents stated that the screening ultrasonography of fetal structures in the first-trimester was necessary. Furthermore, 187 (96.4%) of respondents were in favor of a recommendation for first-trimester ultrasonography in Korea. Conclusion This is the first survey of the current clinical practice of first-trimester ultrasonography in Korea. Our survey findings highlight the need for the practical recommendation or educational course for first-trimester ultrasonography.

Methods This study was conducted on 175 women who underwent CT between March of 2006 and May of 2008. For making an objective assessment, one specialist in obsterics and gynecology measured the obstetrical conjugate, the true conjugate and the diagonal conjugate on the sagittal plane and the transverse diameter, the intertuberous diameter and the interspinous diameter on the coronal plane. The patients who underwent total hysterectomy or those who had a disease of the uterus were excluded from the current analysis.

Results: Among 1,112 twin pregnancies, there were 15 (1.3%) monoamnionic twins, including 2 conjoined twin pregnancies. Twelve (80%), 9 (60%), 5 (33.3%), and 4 pregnancies (26.7%) delivered after 20, 30, 32, and 34 weeks, respectively. Among 12 pregnancies that continued after 20 weeks of gestation, three cases showed one-fetal death and one, both-fetal death. The perinatal mortality rate (from 20 weeks of gestation to 28 days after birth) was 37.5%. The incidence of lethal anomalies and congenital heart anomalies was 20% and 23.3%, respectively. The mean gestational age at delivery was 31.4±4.53 weeks; 16 of 18 neonates (84.2%) were admitted to the neonatal intensive care unit (NICU). Three neonates expired on the first day after birth. The mean duration of the NICU stays for 13 live neonates was 32.0±29.3 days (range, 3 to 114 days). The main causes of perinatal deaths were preterm birth, congenital anomalies, pregnancy loss before 20 weeks, and intrauterine fetal demise that might have resulted form cord entanglement. Conclusion: Perinatal mortality in monoamniotic twins was still very high and the survival rate after 32 weeks of gestation is approximately one-third. Further studies are needed to improve the perinatal mortality.

Metastatic Cancer of Unknown Primary Site (CUP) accounts for approximately 3-5% of all malignant neoplasms. CUP represents a heterogeneous group of metastatic tumors for which no primary site can be detected following a thorough medical history, careful clinical examination, and extensive diagnostic work-up. Several authors have reported poor prognosis of this malignancy, because there is no consensus on diagnostic guidelines and optimal therapy. Historically, chemotherapy has been the cornerstone of treatment for patients with CUP. We experienced a case of inguinal lymph node squamous cell carcinoma of unknown origin, accompanied with carcinoma in situ of the cervix. We report this case with a brief review of the literatures.

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic tumor (GTT) that has different behavior in disease process. The hysterectomy is general for PSTT, but hysterectomy is undesirable for patients who wish to remain fertile. We planned to preserve fertility of a young patient by first administering EMA/CO (Etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine) chemotherapy and then performing an open uterine surgery to remove residual tumor. The patient who attempted primary chemotherapy for PSTT must be undergone a hysterectomy because this conservative regimen showed sign of chemoresistance. We report a case of chemoresistant PSTT with trial to preserve fertility with a brief review of literatures.

Congenital diaphragmatic hernia (CDH) is often associated with major anomalies and chromosomal abnormalities. Chromosomal abnormalities are usually detected in 9.5% to 34% of fetuses with CDH prenatally diagnosed and the defect has also been reported in association with multiple syndromes such as Pallister-Killian syndrome, Fryns syndrome, Di George syndrome and Apert syndrome. Among the chromosomal abnormalities associated with CDH, trisomy 21, 18, and 13 are most common. Association with complex chromosomal aberrations such as mosaicism has also been reported. However, CDH presented in a fetus with Y-autosome translocation is extremely rare. Herein, we reported a case of fetus with 46,XY/46,X,-Y, +der(Y)t(Y;1)(q12;q12) mosaicism who presented with CDH diagnosed by ultrasonography at 19 weeks' gestation.

Objective To investigate which ultrasound findings or serum biomarkers, including insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 1 and 3 (IGFBP-1 and IGFBP-3, respectively), in the first and early second trimesters are the best predictors for preterm delivery. Materials and Methods This was a case–control study conducted between March 2011 and March 2013 with women presenting for routine antenatal care at 11–18 weeks. We collected serum samples from pregnant women and stored them at −80°C. All patients underwent cervical length (CL) measurement at 18–21 weeks. We retrieved frozen samples for analysis from women with subsequent preterm and term delivery. Prediction models were developed using multivariate stepwise logistic regression. Receiver-operating characteristics curves were used to determine the most useful cutoff point. Results Of the 72 women recruited, 24 women underwent spontaneous preterm delivery, and 48 women with term delivery were randomly selected as the control group, in a 1:2 ratio. The maternal serum concentration of IGFBP-3 and CL were significantly associated with preterm birth. Conclusion Among the various known ultrasound findings and serum biomarkers in the early midtrimester, only CL and IGFBP-3 are independent predictors for preterm delivery in asymptomatic women.