• Clinical and Experimental Reproductive Medicine
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• 제23권1호
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• pp.11-24
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• 1996

The number of multifetal pregnancies has increased dramatically as a result of the widespread clinical use of ovulation induction and assisted reproductive technology(ART) in infertile patients. In multifetal pregnancies, the adverse outcome is directly proportional to the number of fetuses within the uterus, primarily because of an increased predisposition to premature delivery. It is extremely difficult to counsel patients about the expected outcome of pregnancies involving three or more fetuses. To increase the chances of delivering infants mature enough to survive without being irreversibly damaged by the sequelae of marked prematurity, selective fetal reduction(SFR) to the smaller number of fetuses should be considered in multifetal pregnancies. From January, 1991 to December, 1992, transabdominal SFR in multifetal pregnancies was performed in 22 patients including 13 triplet, 7 quadruplet, 1 quintuplet and 1 heptuplet pregnancies. Transabdominal SFR using intracardiac KCI injection and aspiration of amniotic fluid was carried out in 8-13 weeks of gestation. After procedure, 20 patients were remained as twin pregnancies, and 2 patients as triplet pregnancies. There have been 11 sets of twin delivery including 2 stillbirths, 2 sets of triplet delivery including 1 stillbirth, and 1 singleton delivery. Six cases were delivered after 37 weeks of gestation, 4 cases in 33 - 37 weeks, and 1 case in 30 weeks. Unfortunately, 3 stillbirths occurred in 20-24 weeks of gestation, and 4 cases were aborted. As 7 losses of pregnanancy including 1 case of septic abortion occurred, the delayed fetal loss rate was 38.9%(7/18) in transabdominal SFR. All babies born after 30 weeks of gestation were healthy, and no fetal anomaly directly related to the procedure was encountered. From July, 1993 to February, 1995, transvaginal SFR was performed in 20 patients including 15 triplet, 4 quadruplet and 1 quintuplet pregnancies. Transvaginal SFR using the same method as transabdominal SFR was carried out in 8-11 weeks of gestation. After procedure, 19 patients were remained as twin pregnancies, and 1 patient as singleton pregnancy. There have been 13 sets of twin delivery including 2 stillbirths, and 1 singleton delivery. Six cases were delivered after 37 weeks of gestation, 5 cases in 36-37 weeks, and 1 case in 30 weeks. Unfortunately, 2 still-births occurred in 20 weeks and 21 weeks of gestation, respectively, and 2 cases were aborted. As 4 losses of pregnancy including 1 case of septic abortion occurred, the delayed fetal loss rate was 25.0%(4/16) in transvaginal SFR. No fetal anomaly directly related to the procedure was encountered. It is suggested that transvaginal SFR could be performed more easily and earlier with the lower fetal loss rate as compared with transabdominal SFR. In conclusion, SFR is a rather safe and ethically justified procedure that may improve the outcome of multifetal pregnancies.

• 여성건강간호학회지
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• 제5권2호
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• pp.191-203
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• 1999

A clinical study was made on 365 low birth weight infant and 406 normal birth weight infant who had been born at Kangnam St. mary's Hospital during past 3 years from Jan. 1, 1995 to Dec. 31, 1997. the data of this study were gathered through reviewing of medical records. 1. Comparison of general characteristic with of obstetric characteristic 1) Old maternal age, previous abortion and previous LBWI delivery in the group of low birth weight infant(LBWI) mother were more prevalent than those in the group of normal birth weight infant(NBWI)mother 2) Cesarean section, abnormal presentation and multiple pregnancy in the group of LBWI mother were prevalent than those in the group of NBWI mother. 3) regular antenartal care and visiting rate of tertiary hospital in the group of LBWI mother were more prevalent than those in the group of NBWI mother. 2. Frequency of low birth weight infant 1) Anmual average frequency of LBWI was 6.5% and monthly frequency was the highest in January and december. 2) The frequency of LBWI was the highest in 37-40wks of gestational age and was the highest in 2251-2500 gm of birth weight. 3) The frequency of congenital anomaly in the group of LBWI was more prevalent than that of NBWI. 3. Mortality rate of LBWI The mortality rate of LBWI was 9.2%. The highest mortality rate was noted before 27wks of gestational age, less than 1000gm of birth weight and within 12hrs of delivery. 4. The most common complication of pregnant women was pre-term labor, the most complication relating to placenta was premature rupture of membrane(PROM) and the most fetal complication was fetal distress in delivered LBWI. 5. Significant relating factors of low birth weight infant delivery were associated with maternal age, previous delivery, previous low birth weight delivery, pre-eclampsia, anemia, oligohydramnios, PROM, placenta previa, abruptio placenta, fetal sex, fetal distress and congenital anomaly.

• ETRI Journal
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• 제46권3호
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• pp.526-537
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• 2024

Monitoring fetal growth in utero is crucial to anomaly diagnosis. However, current computer-vision models struggle to accurately assess the key metrics (i.e., head circumference and occipitofrontal and biparietal diameters) from ultrasound images, largely owing to a lack of training data. Mitigation usually entails image augmentation (e.g., flipping, rotating, scaling, and translating). Nevertheless, the accuracy of our task remains insufficient. Hence, we offer a U-Net fetal head measurement tool that leverages a hybrid Dice and binary cross-entropy loss to compute the similarity between actual and predicted segmented regions. Ellipse-fitted two-dimensional ultrasound images acquired from the HC18 dataset are input, and their lower feature layers are reused for efficiency. During regression, a novel region of interest pooling layer extracts elliptical feature maps, and during segmentation, feature pyramids fuse field-layer data with a new scale attention method to reduce noise. Performance is measured by Dice similarity, mean pixel accuracy, and mean intersection-over-union, giving 97.90%, 99.18%, and 97.81% scores, respectively, which match or outperform the best U-Net models.

• 대한구순구개열학회지
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• 제11권2호
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• pp.49-58
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• 2008

The development of fetal surgery has led to promising options for many congenital malformations, such as congenital diaphragmatic hernia (CDH), obstructive uropathy, twin-to-twin transfusion syndrome (TTTS), and sacrococcygeal teratoma. However, preterm labor (PTL) and premature rupture of membranes continue to be uniquitous risks for both mother and fetus. To reduce maternal morbidity and the risk of prematurity, minimal access techniques were developed and are increasingly employed recently. Lift-threatening diseases as well as severely disabling but not life-threatening conditions are potentially amenable to treatment. Recently, improvement of video-endoscopic technology has boosted the development of operative techniques for feto-endoscopic surgery, which has been demonstrated to be less invasive than the open approach. Fetal surgery for repair of cleft lip and palate, a congenital anomaly which is not life threatening, is inappropriate until such time that the benefits are shown to outweigh the risks of both the procedure itself and preterm delivery. Further animal studies will be needed before intrauterine surgery for humans should be considered. For the better understanding of recent techniques and complications associated with fetal intervention of congenital facial defect patients, we reviewed recent related articles about the current knowledge and new perspectives of experimental fetal fetal surgery in the cleft lip and palate defects.

• Clinical and Experimental Pediatrics
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• 제48권7호
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• pp.685-690
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• 2005

Recently, twinning rate increases in Korea since the early 1990s by delayed marriage and prevailing of assisted reproductive technology. But twin and higher-order multiples are at increased risk for perinatal and neonatal mortality over 5 fold despite of dramatic improvement of perinatal and neonatal care. Because twins are born more prematurely and have lower birth weights than singleton. In addition, twins are at increased risk for cerebral palsy mainly in monochorionic twins due to co-twin fetal death, twin to twin transfusion and congenital anomaly. So, this article reviews the factors contributing to the mortality and morbidity of the twins and the efforts to decrease the neonatal mortality of twins.

• Toxicological Research
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• 제26권3호
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• pp.209-216
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• 2010

Limb bud (LB) and central nerve system (CNS) cells were prepared from 12.5 day old pregnant female Crj:CD (SD) rats and treated with olaquindox and vitamin A. Cytotoxicity and inhibition on differentiation were measured in each cell. Three doses of olaquindox (4, 21 and 100 mgkg), and 0.2 and 75 mg/kg of vitamin A were administered to pregnant rat for 11 days from $6^{th}$ to $16^{th}$ of pregnancy. $IC_{50}$ values of olaquindox for proliferation and differentiation in CNS cell were 22.74 and $28.32\;{\mu}g/ml$ and 79.34 and $23.29\;{\mu}g/ml$ in LB cell and those values of vitamin A were 8.13 and $5.94\;{\mu}g/ml$ in CNS cell and 0.81 and $0.05\;{\mu}g/ml$ in LB cell, respectively. Mean body weights of pregnant rats were decreased at high dose of olaquindox (110 mg/kg) but relative ovary weight, number of corpus lutea, and number of implantation were not changed. Resorption and dead fetus were increased at high dose of olaquindox, and relative ovary weight, the number of corpus lutea and implantation, and sex ratio of male to female were not significantly changed in all dose of olaquindox. Mean fetal and placenta weights were significantly (p < 0.01) decreased in rats of high group. Seven fetuses out of 103 showed external anomaly like bent tail, and 10 out of 114 fetuses showed visceral anomalies at high group. The ossification of sternebrae and metacarpals were significantly (p < 0.01) increased by low and middle dose of olaquindox but it was significantly (p < 0.01) prohibited by high dose of olaquindox. In rats treated with vitamin A, the resorption and dead fetus were increased by high dose. Mean fetal weights were significantly (p < 0.01) increased by low dose but significantly (p < 0.01) decreased by high dose. Thirty four fetuses out of 52 showed external anomaly; bent tail (1), cranioarchschisis (14), exencephaly (14), dome shaped head (22), anophthalmia (15), brcahynathia (10) and others (19). Forty five fetuses out of 52 showed soft tissue anomaly; cleft palate (42/52) and anophthalmia (22/52) by high dose of vitamin A. Sixty one fetuses out of 61 (85.2%) showed skull anomaly; defect of frontal, partial and occipital bone (21/61), defect of palatine bone (52/61) and others (50/61). In summary, we support that vitamin A is strong teratogen based on our micromass and in vivo data, and olaquindox has a weak teratogenic potential in LB cell but not in CNS cell. We provide the in vivo evidence that a high dose of olaquindox could have weak embryotoxic potential in rats.

• Journal of Genetic Medicine
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• 제9권1호
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• pp.22-24
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• 2012

Purpose: The aim of this study was to asses the fetal loss rate after mid-trimester amniocentesis. Materials and Methods: This was a retrospective cohort study including singleton pregnant women who underwent mid-trimester amniocentesis at Cheil General Hospital from January 2008 through December 2010. The procedure-related fetal loss was defined as miscarriage within 2 weeks after amniocentesis. We evaluated the fetal loss rate within 2 weeks after amniocentesis and fetal loss rate before 24 gestational weeks. Results: During the study period, a total of 4,356 singleton pregnant women underwent mid-trimester amniocentesis. A total of Five hundred ninety six women were excluded owing to follow up loss and termination of pregnancy due to abnormal karyotype or major anomaly. At our institute, the fetal loss rate within 2 weeks was 0.1% and before 24 gestational weeks was 0.3% after amniocentesis. Conclusion: The fetal loss rate after mid-trimester amniocentesis in our study is lower than previously reported rate. We suggest that amniocentesis is a safe procedure.

• Clinical and Experimental Reproductive Medicine
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• 제13권2호
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• pp.137-144
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• 1986

A reveiw of 85 patients with uterine anomalies was made in respect to the incidence, chief complaints, the reason of infertility, fetal wastage rate, pregnancy complications, fetal presentations and obstetric outcome after metroplasty from 1980 to 1985. The results were summarized as follows: 1. Incidence of uterine anomaly was 0.18% among all outpatients (85/48,240). 2. Of the 85 patients, there were 36 with bicornuate deformities (42.3%), 21 septate (24.7%), 18 uterus didelphys (21.2%), 8 arcuate (9.4%) and 2 patients with unicornuate anomalies (2.4%). 3. Uterine anomalies were diagnosed by hysterosalpingogram (54.1%), pelvic examination (14.2%) and other operative procedures. 4. Chief complaints were primary infertility (41.2%), secondary infertility (15.3%), repeated pregnancy loss (12.9%), antenatal care (11.8%) and menstural disturbance (10.6%), etc. 5. Twenty-nine patients with uterine anomalies had primary infertility. The cause of infertility was proved nonuterine in 26 cases and remained unknown in 3 cases. 6. The obstetric outcome of 104 pregnancies was spontaneous abortion in 51.0%, premature delivery in 11.50/0 and fetal loss in 57.7%. 7. Complications of 41 present pregnancies were threatened abortion (22%), premature rupture of membrane (12%) and premature labor (10%), etc. The frequency of abnormal presentation was 35.3% and 64.7% of deliveries was made by Cesarian section. 8. Metroplasty was performed in 13 patients who didn't have a baby because of repeated miscarriage and unknown cause of infertility. Subsequently 8 patients had 9 successful pregnancies: 6 patients had 7 healthy babies and 2 patients are now in pregnancy without any complications.

• Clinical and Experimental Reproductive Medicine
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• 제30권1호
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• pp.85-93
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• 2003

Objective : To evaluate the safety and efficacy of selective fetal reduction (SFR) and compare the outcome of twin pregnancy after SFR in multiple pregnancy induced by assisted reproductive technology (ART) with that of natural twin pregnancy. Methods : From September 1995 to March 2002 in Ajou University Hospital, SFR was performed in 79 patients whose gestational sacs were more than 3. Of these 79 patients, 47 patents resulted in twin pregnancy after SFR. SFR was performed using transvaginal intracardiac KCl injection at gestational age of $6{\sim}9$ weeks. Control group was composed of 264 patients with natural twin pregnancy, who delivered after intrauterine pregnancy at 24 weeks, from June 1994 through December 2002. We compared Obstetric and perinatal outcomes between SFR group and natural twin group. Results: Among 47 patients with twin pregnancy after SFR, 2 spontaneous abortion were occurred at intrauterine pregnancy at 8 and 19 weeks. Obstetrical and perinatal outcomes were available in 43 patients. Single intrauterine fetal death was occurred in 1 of 43 (2.3%) patients in SFR group. Incidence of preterm labor, premature rupture of membrane, preeclampsia and placenta previa were similar, but gestational diabetes mellitus (GDM) was occurred more frequently in SFR group (3 (7.0%) vs 4 (1.5%), p=0.02). Mean gestational age, mean birth weight, incidence of discordancy, use of intubation and ventilation, incidence of fetal anomaly, low (<7) Apgar score and intrauterine growth restriction were similar in both groups. Conclusion: Twin pregnancy after SFR has the increased incidence for GDM but other obstetric and perinatal outcome was similar compared with natural twin pregnancy. So SFR is a safe and effective procedure, so we suggest SFR is needed in multifetal pregnancy more than triplet.

• Clinical and Experimental Pediatrics
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• 제49권10호
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• pp.1073-1078
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• 2006

목 적 : 본 연구는 태아 심기형의 산전 진단이 보호자의 임신유지 결정에 어떠한 영향을 미치는지에 대한 분석을 시행하고자 하였다. 방 법 : 서울대학교 어린이병원에서 1988년 7월부터 2003년 6월까지 시행한 태아 심 초음파 검사 중 태아 심혈관 질환이 발견되었던 370 검사를 우선 선정 후, 기질적 심질환이 없는 부정맥과 다태 임신을 제외한 299 임신을 본 조사의 대상으로 하였다. 299례에 대하여 의무기록 및 전화 설문을 통한 후향적 분석을 시행하여 분만 지속 여부 및 분만 방법에 대하여 조사하였고, 임신 지속 여부에 관한 보호자의 결정에 영향을 미치는 요인들을 분석하였다. 결 과 : 본 연구에 포함된 대상의 진단시 평균 재태 주령은 $28{\pm}6.0$주였으며, 산모의 평균 연령은 $30{\pm}3.9$세였다. 임신 중단군과 지속군으로 구분하여 각 요인이 임신 지속 여부에 미치는 영향에 대해 조사한 결과, 진단시 재태 주령이 어릴수록(P=0.000), 심기형의 정도가 심할수록(P=0.002), 그리고 산모의 연령이 어릴수록(P=0.014) 임신 종결을 더 많이 선택한 것으로 나타났다. 반면, 태아 상태의 정도, 동반 기형의 정도, IVF 시행여부, 자녀의 수는 임신 지속 여부와 무관한 것으로 나타났다(Table 5). 결 론 : 본 연구에 의하면 진단시 재태 주령이 어릴수록, 산모의 연령이 적을 수록, 그리고 태아 심기형의 정도가 심할수록 임신을 중단하는 비율이 높다는 결론을 얻었다. 현실적으로는 태아 심초음파가 시행되는 재태 주령이 평균 29주로 너무 늦은 감이 있으며, 기형에 대한 극도의 편견으로 인하여 완치가 가능한 질환 마저 인공 임신 중절을 시행하는 비윤리적인 상황이 벌어지고 있는 상황이다.