Neural tube defects are a heterogenous group of malformations resulting from failure of neural tube closure during early embryogenesis. Anencephaly is the commonest form of neural tube defect and results from failure of closure of the anterior portion of the neural tube. Anencephaly is characterized by absence of the cranium along with cerebral hemispheres that are rudimentary or absent and risk of recurrence after affected child is 2-3%. Periconceptual folic acid intake may decrease the incidence and recurrence of anencephaly.

Most often, anencephaly is discovered by conventional two-dimensional ultrasonography at the time of attempted biparietal diameter determination for fetal age in the second trimester. Two-dimensional transvaginal ultrasonography has a limitation in a motion of the transducer shaft due to narrow space of the vagina. It is sometimes impossible to obtain information of the whole brain and to miss the fetal CNS(central nervous system) anomalies. Recent advanced three-dimensional ultrasonography has remarkably improved not only surface rendering but also multiplanar analysis of internal structure.

Recently, we encountered one case of recurrent anencephaly that had occurred in a same pregnant woman and three-dimensional transvaginal ultrasonography enabled us to diagnose anencephaly at 11³ weeks of gestation. We report this case with brief review of the literatures.

A case report is presented on a patient with Wernicke's encephalopathy secondary to hyperemesis gravidarum. The 30-year-old woman was admitted with a severe dehydrated state, ataxia, dizziness at 17 weeks. Neurologic examination demonstrated nystagmus, gait ataxia, paresthesia. The MR imaging revealed the high signal intensity in both hypothalamus, thalamus, midbrain. The neulolgic signs and MRI findings pointed to diagnosis of Wernicke's encephalopathy. The patient was complicated with hyperthyroidism. The patient was treated with parenteral thiamine and prophylthyiouracil. The pregnancy was terminated by spontaneous abortion at gestationl 18 weeks. A review of the literature published during the last 30 years revealed an additional 25 cases.

Citations

Citations to this article as recorded by  

• Wernicke’s encephalopathy in hyperemesis gravidarum: A systematic review
  Erik Oudman, Jan W. Wijnia, Misha Oey, Mirjam van Dam, Rebecca C. Painter, Albert Postma
  European Journal of Obstetrics & Gynecology and Reproductive Biology.2019; 236: 84.     CrossRef

This study has been composed of 5 cases of cordocentesis between 21 and 34 weeks of gestational age from February 1997 to January 1998 at the Ehwa Medical Center. Indications for cordocentesis were as follows : 1) rapid karyotyping 2) evaluation of hematologic status 3) intrauterine infection 4) evaluation of fetal acid-base status. The most common indication for cordocentesis was rapid karyotyping of fetal chromosome. All cases of this study were successful. In conclusion, cordocentesis is a safe and very useful procedure for evaluating fetal status.

Down syndrome is the most common autosomal abnormality disease which has multiple congenital anomalies, occurring in 1 of every 800 liveborn infants. Neonates who are affected with this disease comprise majority of the mentally retarded children. To prevent the birth of this congenital anomaly, prenatal diagnosis of Doen syndrome is important. We experienced a case of Down syndrome, diagnosed by fluorescence in situ hybridization(FISH) in pregnancy for 15 weeks 6 days. We report here eith a brief review of the literatures.

Thanatophoric dwarfism is a short limb dwarf condition which usually results in death shortly after birth. It has been confused with achondroplastic and another congenital short limb dwarf condition. We now report a case of thanatophoric dwarfism in a 29-year-old woman, based on prenatal sonographic, radiological and autopsy findings with a review of literatures.

Leiomonas of the vulva are extremely uncommon tumors. Recently we experienced a case of vulva leiomyoma thus it is presented with a brief review of the case and its literature.

This study was undertaken to evaluate the value of the Papanicolaou smear(Pap smesar) for the screening and detection of the cervical cancer(ca).

274 patients who had cervicovaginal Pap smear and biopsy of the cervix were analysed at the Department of Obstetrics and Gynecology. Ewha Womans University Hospital from the Jan. 1988 to Dec. 1991.

The results were as follows;

1) The highest frequency was noted in the age group of the thirties(34.3%) followed by the age group of forties(30.3%) and the frequency of the age group of the fifties was 20.4%.

2) Six patients with Pap smear Class I showed ca in situ in 4 patients and invasive ca in 2 patients by histopathological study.

72% of the patients with Pap smear Class II had chronic inflammation and the rest of the patients had mild dysplasia(1 case), severe dysplasia(1 case), ca in situ(l case), and invasive ca(7 cases) by histopathological study.

73.2% of the patients with Pap smear Class III had the findings of dysplasia and the rest of the patients had those of chronic inflammation(9 cases). ca in situ(13 cases). microinvasive ca(3 cases), and invasive ca(5 cases).

70.0% of the patients with Pap smear Class IV had the findings of ca in situ. microinvasive ca, and invasive ca and the patients with severe dysplasia, ca in situ. microinvasive ca, and invasive ca consisted 90.0% of the patients with Pap smear Class IV.

90.0% of the patients with Pap smear Class V had ca in situ. microinvasive ca, and invasive ca in biopsy.

3) The sensitivity and positive predictive value for the Pap smear screening was 93.2%, and 94.0% respectively.

These data show that the Pap smear is essential for the screening and early detection of cervical cancer and we should reduce the failure occurring during the serial process such as sampling, fixation, staining, and interpretation.

90 patients with abnormal uterine bleeding who were admitted to the Department of Obstertrics and Gynecology. Ewha Womans University Hospital during the period of 6 years from January 1985 to December 1990 wer analysed.

The patients with abnormal uterine bleeding secondary to pregnancy and pelvic mass were excluded in this study.

This study was planned to evaluate the clinical aspects and the histopathology of the endometrium.

The results were as follows:

1) 44.4% of the patients were included in the 40 to 49 years, and the patients of 30 to 39 years and of 50 to 59 years were 16.7% respectively. Mean age of the patients was 40.9 years.

2) The most common gravidity of the patients was 7 or more in number(32.2%), but 20.0% or the patients had never pregnancy and mean gravidity was 4.6 in number.

Para 3 to 4 in number(31.1%) was the most common parity of the patients, but 22.2% of the patients had never delivery, and mean parity was 2.7 in number. 98.9% of the patients had 1 to 2 times of abortion's history, but 20.0% of the patients had never abortion, and mean number of abortion was 1.9.

3) Mean age of onset menarche was 14.9 years and the majority of the patients were included in the 13 to 16 years.

Mean age of onset menopause was 50.1 years and the patients were included in the 49 to 54 years.

4) The most common bleeding pattern was intermenstrual bleeding(33.3%), and the next pattern was menorrhagia(30.0%).

Others were bleeding with amenorrhea, menorrhagia, vaginal spotting, and postmenopausal bleeding, 5 of 8 patients with postmenopausal bleeding were confirmed to endometrial adenocarcinoma. Other symptoms were lower abdominal pain, lumbago, and dizziness.

5) The most common histological finding of endometrium was proliferative phase(33.8%), and the next finding was endometrial hyperplasia(20.3%), and the third finding was secretory phase(14.9%).

Other findings were atrophic endometrium, adenocarcinoma, menstrual phase and irregular shedding of endometrium.

6) Coexisting diseases in patients with abnormal uterine bleeding were myoma uteri(10.0%), adenomyosis(10.0%) and hypertension(10.0%).

Others were ovarian cyst, primary infertility. endometrial polyp, cervical polyp. and diabetes.

7) 30.0% of the patients with abnormal uterine bleeding had 1 to 4 times of previous bleeding episode and curettage was performed in the majority of the patients.

8) 35.5% of the patients had initial hemoglobin level below 10g% at admission and mean hemoglobin level of these patients was 7.99g%.

The majority of these patients had blood transfusion, and mean volume of blood transfusion was 2.88 pints.

9) 16.7% of the patients with abnormal uterine bleeding had conservative treatment and 28.9% of the patients had curettage.

Total abdominal hysterectomy with or without salpingoophorectomy, and adjuvant radiation therapy were performed in the other patients.

This study was undertaken to determine whether any chenges occur in the serum levels of immunoglobulin M(IgM) of mother and cord in term pregnancy.

IgM levels were measured in paired maternal and cord serum samples from 6 pregnancies with intrauterine growth retardation(IUGR) and 42 with normal growth(adequate-for-gestational age(AGA) pregnacies) delivered at term gestation during the period from January. 1989 to June. 1989 at the Ewha Womans University Hospital.

The results obtained were as follows ;

1) Serum IgM levels of mother who delivered IUGR infants were found significantly higher than those who delivered AGA infants.

2) There were no significant differences in the maternal serum IgM levels of the four groups(38 weeks' gestation. 39 weeks' gestation. 40 weeks' gestation. and 41 or more weeks' gestation).

3) There was no significant difference in the serum IgM levels between mother delivered male infant and female infant.

4) There was no significance between the maternal serum IgM levels and the birth weight of baby, although the maternal serum IgM levels had decreased tendency gradually as the birth weights of the baby were increased.

5) Cord serum IgM levels of IUGR infant were not significantly different from those of AGA infant.

6) The cord serum IgM levels were not related to the maternal werum IgM levels in term pregnancy.

This study was planned to evaluate the effect the effect of treatment, morbidity and prognosis of 91 cases with invasive cervical carcinoma who were admitted and treated at the Department of Obstetrics and Gynecology, Ewha Womans University Hospital during the period of 4 years from January 1986 to December 1989.

The results were as follows :

1) The two-thirds of the cases were found to be in the group of age between 40 and 59, and mean age of the cases was 50.7 year.

2) The majority of the cases(84.6%) were concentrated on the gravida of 5 or more, and also parity with 5 or more were noticed over one-third of cases(36.1%).

3) The most common clinical symptom was vaginal spotting and vaginal bleeding(29.7% respectively), and others were postcoital spotting(13.2%), foul odored leukorrhea(14.3%), lower abdominal pain(14.3%), leukorrhea(11.0%), and back pain(11.0%).

4) Distribution of clinical stage in cases with invasive cervical carcinoma was 24.2% in stage I, 50.5% in stage II, 16.5% in stage III and 8.8% in stage IV.

5) The results of Pap smear were found to be abnormal in the majority of cases(84.6%, III : 27.5%, IV : 17.6%, V : 39.5%), but 15.4% of cases were normal(I:5.5%, II:9.9%).

Histological subtypes of the invasive cervical carcinoma were large cell nonkeratinizing type(62.6%), large cell keratinizing type(17.6%), and small cell type(9.9%).

Serum CEA levels were measured in 31.9% of cases, and normal level less than 2.5 ng/ml were found to be about one-third of the cases, but the rest had high levels than normal level.

6) Radical hysterectomy with pelvic lymphadenectomy was performed in cases of stage Ia, and IIa(25 cases : 27.5%), radiation in 66 cases(72.5%), adjuvant chemotherapy in 11 cases(12.1%).

7) Accuracy of preoperative stage in operation cases was 56.0%, and 87.5% in stage Ia, 28.6% in stage Ib, and 50.0% in stage IIb.

8) Complications due to cervical carcinoma itself were hydronephrosis, pulmonary congestion, rectovaginal fistula and vesicovaginal fistula. Recurrence rate was 20.0% in operation cases, and 22.2% in radiation cases.

9) The two-year survival rate in confirmed cases(79 cases) by follow up was 100% in stage Ia, 85.7% in stage Ib, 70% in stage IIa by operation, and 100% in stage Ia, 83.3% in stage Ib, 77.8% in stage IIa, 72.2% in stage IIb, 66.7% in stage III, 0% in stage IV by radiation.

This study was planned to evaluate the clinical status of 33 patients with malignant ovarian tumors, who were admitted, operated, and confirmed histopathologically at the Department of Obstetrics and Gynecology, Ewha Womans University Hospital during the period of 5 years from January 1984 to December 1988.

The results were as follows :

1) The incidence of malignant ovarian tumors was 13.1% of all ovarian tumors.

2) The most common clinical symptom was palpable abdominal mass(54.5%), and the rest were abdominal discomfort(42.4%), abdominal distention(30.3%), and vaginal bleeding(24.2%) in that order.

The patients with malignant ovarian tumor were comprised of stage I(51.5%), stage II(15.2%), stage III(21.2%) and stage IV(12.1%).

3) According to histopathological classification, patients with epithelial tumor were 81.8%, and epithelial tumors were divided into the serous type(34.3%) and mucinous type(30.3%), undifferentiated type(12.1%), and endomentrioid type(6.1%), Other tumors were germ cell tumor(endodermal sinus tumor, malignant teratoma), granulosa cell tumor(endodermal sinus tumor, malignant teratoma), granulosa cell tumor, and Krukenberg tumor.

4) Operative methods for malignant ovarian tumor were total abdominal hysterectomy with bilateral salpingo-oophorectomy(24.3%), total abdominal hysterectomy, bilateral salpingo-oophorectomy with omentectomy(21.2%), and total abdominal hysterectomy, bilateral salpingo-oophorectomy with lymphnode biopsy(9.1%).

Postoperative chemotherapy for patients were done in 75.7% of patients, and 30.3% of patients with melphalan, 39.4% with combination therapy of cisplatinum-based regimen(aclacinon plus cyclophosphamide, cyclophosphamide, adriamycin, bleomycin).

5) 14 patients(42.4%) were alive in the follow-up period from less than 1 year to 5years and 11 patients were in stage I, 2 patients in stage II, and 1 patient in stage III.

12 patients(36.4%) were dead; 2 patients with stage I endodermal sinus tumor were dead within 6 months since the diagnosis was confirmed, 6 patients with stage III and 4 patients with stage IV were dead within 6-18 months.

Laparoscopy is simple, and safe procedure to evaluate clinical diagnosis under direct vision, to avoid unnecessary operation and used to assess the pelvic abnormalities and infertility. One hundreds and eighteen cases who underwent diagnostic laparosocopy from January, 1980 to December, 1986 were analyzed clinically. The results of the study are as follows; 1) Clinical indications for diagnostic laparoscopy were suspicious ectopic pregnancy(44.9%), infertility(23.8%), obscure pelvic mass(11.9%), amenorrhea(10.2%) and pelvic pain(4.2%). 2) The acurracy of clinical diagnosis confirmed by laparoscopy was 72.0%. 3) Abnormal laparoscopic findings were demonstrated in 82.2% of 28 infertility cases which included 2.5%(7cases) of unilateral tubal obstruction, 14.3%(4 cases) of unilateral hydrosalpinx, 17.8%(5 cases) of polycystic ovaries and other abnormal finding cases. Agreement between hysterosalpingography and laparoscopic finding were observed in 54% of the cases. 4) In 75.5% of clinically suspicious ectopic pregnancy cases, ectopic pregnancy was confirmed by laparoscopy, and other cases were found to be ruptured corpus luteum(11.3%), normal pelvic organ(5.6%), regurgitation of menstrual blood(3.8%), torsion of ovarian cyst(1.9%) and pyosalpinx(1.9%). 13.2% of the suspicious ectopic pregnancy cases could avoid unnecessary operation with the use of laparoscope. 5) Identical ciagnoses on clinical impression and laparoscopy were found in 63.6% of ovarian cyst cases, 100% of myoma uteri, pelvic abscess, and endometriosis cases, respectively, 50% of pelvic inflammatory disease cases, and 33.3% o uterine perforation cases. One case of ectopic pregnancy was found during the laparoscopic sterilization. 6) Laparoscopic evaluation of 8 cases of primary amenorrhea showed 50% (4 cases) of no ovaries or streak ovaries, 25%(2 cases) of Mullerian dysgenesis, 12.5%(1 case) of male hermaphroditism, and 12.5%(1case) of ovarian tumor. Polycystic ovaries were found in 50%(2 cases) of 4 secondary amenorrhea cases and other cases showed absence of one ovary and normal pelvic organ.

Seventy one pregnant women who were admitted and delivered at Ewha Womans University Hospital were diagnosed as syphilis by VDRL(Venereal Disease Research Laboratory) rest and TPHA(Treponema pallidum, hemagglutination assay). These seventy one pregnant women with syphilis and their new born babies were analyzed. The results of this study are as follows: 1) The prevalence rate of syphilis in pregnant women was about 0.75%)71 seropositive women among 9410 women during a period of 4 year from Jan. 1983 to Dec. 1986). 2) In obstetric history, rate of spontaneous abortion was 14.1%, stillbirth; 8.5%, neonatal death; 4.2%, and congenital anomaly; 4.2%. 3) Obstetric complications of fetal side were prematurity(12.7%), small for date baby(12.7%), intrauterine fetal death(8.5%), and neonatal death(2.8%). Maternal obstetric complications were preeclampsia(12.7%), spontaneous premature rupture of membrane(12.7%), anemia in pregnancy(11.3%), hepatitis(5.6%), abruptio placentae(2.8%), and diabetes mellitus(1.4%). 4) 39.4% of pregnant women with syphilis were detected by syphilitic test at admission for delivery, and 8.5% were detected by visiting hospital because of absence of fetal movement. 23.9% of pregnant women with syphilis were detected by syphilitic test during the antenatal care, and 28.2% were detected already before this pregnancy. 39.4% of pregnant women with syphilis failed to check the syphilitic test during the antepartum period in spite of taking antenatal care. 5) VDRL titers of the syphilitic mother were 1 : 1(23.1%), 1 : 2(36.9%), and 1 : 32 or more (7.7%). VDRL titers of the fetus were negative(30.8%), weakly reactive(7.7%), and 1 : 1(35.4%). 6) Mother's VDRL titers in cases of intrauterine fetal death were 1 : 2-1 : 64. In neonatal death, VDRL titers of the neonate were 1:64-1:320, and mother's titers were 1:32-1:320.

The purpose of this study was to determine if differences could be found in hematologic and blood chemical assays of women with preeclampsia compared with normal pregnant controls. Seventy patients with severe preeclampsia, seventy with preeclampsia, and ninety normal pregnant women for control were taken part in this study at the Department of Obstetrics and Gynecology, Ewha Womans University Hospital from January, 1984 to March, 1986. The levels of hemoglobin, hematocrit, total bilirubin, alkaline phosphatase, serum glutamic oxaloacetic transaminase(SGOT), serum glutamic pyruvic transaminase(SGPT), total protein, albumin, blood urea nitrogen(BUN), creatinine, and uric acid in both of mild preeclampsia and severe preeclampsia group were measured and compared with those of normal pregnancy group. The results of this study were summarized as follows:1) The mean levels of hemoglobin, hematocrit, and platelets in both of mild preeclampsia and severe preeclampsia group were not significantly different from those of normal pregnancy group. 2) The mean total bilirubin levels in both of mild preeclampsia and severe preeclampsia group were not significantly different from that of normal pregnancy group. The mean level of alkaline phosphatase of mild preeclampsia group was significantly lower than of normal pregnancy group, but that of severe preeclampsia group was not significantly lower than that of normal pregnancy group. The mean SGOT level of mild preeclampsia group was not significantly higher than that of normal pregnancy group, but that of severe preeclampsia group was significantly higher than that of normal pregnancy group. The mean SGPT levels in both of mild preeclampsia and severe preeclampsia group were significantly increased than of normal pregnancy group. 3) The mean total protein levels in both of mild preeclampsia and severe preeclampsia group were significantly lower than that of normal pregnacy group. The mean serum albumin levels in both of mild preeclampsia and severe preeclampsia group were also significantly lower than of normal pregnancy group. The mean total protein and serum albumin level of sever preeclampsia group were significantly lower than those of mild preeclampsia group. 4) The mean BUN and serum creatinine level in both of mild preeclampsia and severe preeclampsia group were significantly higher than those of normal pregnancy group. The mean serum uric acid level of severe preeclampsia group was significantly increased than that of mild preeclampsia group.

It is estimated that fully 20% of all women over 35 years of age harbor uterine myoma. This clinicopathological study on the uterine myoma was based upon 138 cases which were operated and diagnosed in the Dept. of Obstetrics and Gynecology, Ewha Womans University Hospital from the beginning of 1972 to the end of 1979. Summaries of the results were as follows: 1. Myoma was 6.1% of the total major gynecological operations. 2. The most frequent age group was 40-49 years(60.1%). There was the most common in case with parity 3 and the mean age of menarche was 16.0 years. 3. Majority of cases were corporeal myoma, 90.6%, whereas cervical myomas were 7.2%. The types of tumor consist of 47.1% of intramural myoma, 22.5% of subserous myoma and 14.5% of submucous myoma. 4. Pain and pressure symptoms were the most common chief complaints(69.5%), whereas abnormal uterine bleeding in 52.2% and palpable mass in 31.9% in orders. 5. Infertility was observed in 21% of all cases(primary infertility; 6.5% and secondary infertility 14.5%). Hemoglobin less than 10.0gm% was seen in 21.1%. 6. Total abdominal hysterectomy was performed in the majority cases(90.6%). There was no mortality due to operation. 7. The most commonly associated condition in myoma was adenomyosis(19.5%) and the most fequent secondary change was hyaline degeneration.(6.5%) 8. Postoperative morbidity was found in 12.3% of all cases and wound infection(4.3%) was the most common morbidity.